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incidence, and minority women of the southwest. While this work deals with other factors contributing to cervical disease, there is a strong emphasis on infectious agents. Significant emphasis is placed on looking for HPVs with high cancer producing ability and on studying the interaction between infectious agents, notably HIV and HPV.



Molecular techniques to detect HPV in clinical
This work is focused on the detailed
characterization of the nucleic acids found in HPV in
order to better detect the agent and to better
understand how HPV infection changes the infected
cervical cell and contributes to the development of



Question. As the population age 65 and older continues to grow, the incidence of cardiovascular disease can only increase. What more needs to be done to promote prevention of cardiovascular disease?

Answer. Many research and educational efforts are presently under way at the community, State, and national levels to address the growing concern of cardiovascular disease and its major risk factors: cigarette smoking, high blood cholesterol, high blood pressure, diabetes, and sedentary lifestyle. ·

A growing body of evidence demonstrates that changing certain health behaviors, even in old age, can produce definite benefits to health and to the quality of life. Modifiable lifestyle behaviors such as cigarette smoking, sedentary lifestyle, and consumption of high dietary fats are just a few of the behaviors for which aggressive intervention can make a difference in preventing the onset or in diminishing the progression of cardiovascular diseases.

The Year 2000 Objectives report: Healthy People 2000, National Health Promotion and Disease Prevention Objectives establishes a template for action in various prevention arenas, including cardiovascular disease prevention.

While targeted interventions are increasingly needed for high-risk populations, such as older adults and certain ethnic or socioeconomic groups, there is also a continued need for the broader programs which strive to increase awareness and encourage healthy behaviors via nationwide, state-wide, and community-based campaigns and services. CDC continues to provide technical assistance in these areas. Furthermore, the 1992 President's budget proposed an increase of $15 million for the Preventive Health and Health Services Block Grant for such activities. this increase, $4 million will be used to achieve improved accountability of resources, and improved targeting and evaluation of efforts and national surveillance activities for such chronic diseases.



Question. Scientific studies have suggested that the use of multivitamins prior to and early in pregnancy may help prevent birth defects such as spina bifida. CDC is undertaking a study the China Study on the use of multivitamins. How much is required in FY 1992 for the China Study?

Answer. CDC expects to continue spending $865,000 in 1992, the same level as supported in 1991 for the pilot study for a controlled randomized trial of the effectiveness of multivitamins in preventing spina bifida. If the pilot study shows the study feasible, CDC will consider funding options and priorities in future budget proposals.


Question. Injury is the leading killer of our children, claiming an estimated 22,000 children under the age of 20. more needs to be done to reduce the number of injuries?


Answer. A national campaign of proven-effective interventions has been identified by the CDC Injury Control program to reduce deaths and injuries to children in motor vehicle and bicycle crashes and a multifaceted campaign to limit unsupervised access of children to firearms. The overall approach of the campaign will be to:

Develop and carry out a public information campaign
that is national in scope;


Work with our partners in the public and private sector in implementing and evaluating the interventions;

Determine the most effective way to implement the


Provide information to stimulate appropriate regulatory and legislative changes; and,

Manage and evaluate the campaign.

The 1992 President's budget includes $26.1 million for injury control activities. This is an increase of $2 million, or +8%, over 1991.

Question. As catastrophic emergencies have occurred, such as hurricanes, flooding, earthquakes, or releases of hazardous materials, a strain is put on local and State health departments. What is CDC's role in emergency preparedness and response?

Answer. CDC is working closely with the other PHS Agencies and Regional Offices to ensure that viable response plans are in place and are tested periodically. We have a dedicated staff of

Emergency Response Coordinators who provide preparedness and health response assistance throughout the U.S. CDC operates a 24-hour emergency response system and response teams can be on-site within hours.

In the near future, an Emergency Response Coordinator will be assigned to assist the Central United State Earthquake Consortium and their seven member States in preparing for earthquakes and other natural disasters.

We are actively involved in natural and technologic disaster response preparations throughout the country.

Question. Does CDC have a reserve on which to draw to respond to such emergencies?

Answer. As part of its mission, CDC makes extensive use of its existing personnel and fiscal resources to respond to routine requests for assistance. In the event of a major disaster requiring extraordinary federal resources, a Presidential disaster declaration would be made and CDC activities would be supported through the Stafford Act. In addition, CDC has access to PHS Commissioned Corps Officers who can be mobilized to respond to respond in emergency situations.

Question. In your professional opinion, what should be the amount of a reserve or contingency fund be from which CDC could draw to respond to natural disasters or threats to the public health?

Answer. In our professional opinion, the American public could be better seved if a $10,000,000 Director's contingency fund were established to respond to natural disasters, threats to the public health, and new and emerging diseases and conditions.

Although this is my professional judgement, I did not request these resources this year within the Administration's process to formulate the 1992 budget, and thus, there was never the opportunity to weigh these increases against other competing priorities within CDC or other parts of the President's budget request.


Question. Over the last years, many of the measles cases occurred in children less than 24 months of age whose families were participants in low-income assistance programs such as WIC and AFDC. The FY 92 request includes an increase of $8,700,000 to investigate and evaluate the effectiveness of coordinating assistance programs with documented immunization of young children. How will this program be conducted? ·

Answer. The principal cause for the measles epidemic in 1989 and 1990 was failure to deliver vaccinations to at-risk preschoolaged children at the appropriate age, particularly in inner cities. In 1990, the proportion of cases in preschool-aged children increased to almost half, the highest proportion since the start of national data collection in 1973. Most of these preschool children

were unvaccinated.

Although inner-city, minority, and preschool children are often described as hard-to-reach, many of them are in regular contact with public assistance programs. Recent investigations of several inner-city measles outbreaks indicate that, depending on the site, 40-91 percent of unvaccinated preschool cases were enrolled in one or more public assistance programs. Programs such as WIC or AFDC typically see enrolled families frequently (every 1 to 2 months) and offer additional opportunities to vaccinate high-risk children.

One chief goal of this program is to link/coordinate immunization with other public assistance programs. An Intergovernmental Committee on Immunizations has been formed. Through this group, which includes the various agencies of the Departments of Agriculture, Health and Human Services, and Housing and Urban Development that are involved in vaccine delivery or serving high-risk populations, selective pilot studies will be conducted to investigate and evaluate the effectiveness of a variety of approaches for improving immunization coverage of infants and young children served by low-income assistance programs. Through this committee, we will also ensure that the immunization status of WIC and AFDC clients is assessed and that on-site vaccination or referral for vaccination is established.

Question. CDC has reported that many children do not receive immunizations at the appropriate age because of barriers to immunization services. What are those barriers and what actions do you plan to take to eliminate those barriers?

Answer. While investigating outbreaks of measles, a number of policy and resource barriers to immunization of preschool-aged children have been identified. The policy barriers include: immunization availability by appointment only, requirements for physical examination prior to immunization, need for physician referral in order to be vaccinated, and requirements for enrollment in well-baby clinics in order to be immunized. State and local resource barriers include: insufficient clinic personnel, inadequate clinic hours, and too few clinic locations. These barriers are disincentives to obtaining age-appropriate immunizations and must be addressed in each public health agency where they occur in order to attain immunization levels of 90 percent in preschool-aged children.

CDC is requesting $6.3 million and 26 FTEs to conduct indepth program reviews of State and local immunization activities. Through these reviews, area-specific barriers will be identified and CDC will assist State and local health officials in developing action plans to remove or reduce those barriers. In a limited number of locations, demonstration projects will be conducted to evaluate the effectiveness of those efforts in increasing vaccine coverage.

Question. Haemophilus influenzae type b is the most common cause of meningitis and the major cause of invasive bacterial meningitis in children under 5 years of age. The ability to use Hib vaccines in infants less than 15 months of age creates the potential to prevent 12,000 to 18,000 deaths annually. How much

funding is required to meet 100 percent of the public sector's need?

Answer. Based on a new contract which was awarded March 13, 1991, the $36 million requested in the 1992 President's budget for Hib vaccine will purchase 6,979 million doses of vaccine or approximately 87 percent of the public sector's annual need. Based on this new contract price, and on revised estimates of the number of new births per year, it is estimated that an additional $5.3 million would be required to meet 100 percent of the public sector's need in 1992, following reductions in other programs under the domestic discretionary spending cap. However, CDC does not currently purchase 100 percent of the public sector need of any childhood vaccine.

Question. Although there is an effective vaccine for hepatitis B, the number of cases which occur each year is higher than before the vaccine became available in 1982. What is being done to curb transmission of hepatitis B to children, and specifically, how are we addressing high risk infants?

Answer. The President's budget for 1992 includes $13,766,000 in grant funds, which includes an increase of $1,845,000, to continue and expand the public sector screening and immunization program initiated in 1990 to reduce perinatal transmission of hepatitis B. This funding level will support 95 percent of the public sector's need for the screeing of pregnant women for hepatitis B and the immunization of approximately 17,800 infants born to infected carrier mothers.

Question. What would it take to implement universal immunization of children?

Answer. We believe that it would take 3- to 5- years to fully implement a program for universal immunizations of infants against hepatitis B. If such a program were to begin in 1992, to become fully operational we estimate that an additional $55-$60 million per year in grant funds would be needed by 1996-1997. This estimate includes a projected price reduction of about 30 percent in the cost of vaccine or a savings of about $10 million. These grant funds would be in addition to the current funding support for the perinatal grant program. The first phase of reaching approximately 20 percent of infants in the public sector is estimated to require an additional $15.0 million in grant funds, after reductions were taken for other programs within the domestic discretionary cap. However, the CDC budget proposal for FY 1992 does not request any such additional funds for universal

immunization of children against hepatitis B. Other prevention activities, such as removing immunization barriers, control of congenital syphilis, prevention block grant enhancements, screening breast and cervical cancer and childhood lead poisoning, health surveys, infant mortality surveillance and investigations, are regarded by CDC as higher priorities than universal hepatitis B immunization of children, as the 1992 budget request indicates.

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