Passive Smoking - Continued

if they were annoyed by exposure to ETS. In addition, working respondents (n = 8,600) were asked about the extent of their exposure to ETS at work and about policies that restrict smoking at their worksites. Finally, respondents were asked whether they would choose smoking or nonsmoking sections in planes, restaurants, and other public places when a choice was available.

Eighty-eight percent of all respondents (93% of never smokers, 89% of former smokers) considered ETS to be generally harmful to health. In addition, 79% of current smokers felt that ETS was generally harmful; of these, 75% reported that ETS was "very harmful" or "somewhat harmful," as opposed to "slightly harmful" or "not harmful." Sixty-nine percent of all respondents (62% of former smokers, 74% of never smokers) considered ETS to be harmful to their own health.* Seventy-one percent of all respondents (43% of current smokers, 74% of former smokers, and 85% of never smokers) were annoyed by the cigarette smoke of others.

Among working respondents, 42% reported restrictions on smoking in their workplaces; 3% reported a total ban on smoking; and 55% reported no restrictions. Sixty-five percent of respondents who reported no restrictions against smoking in their worksites are at least somewhat exposed to ETS. Of these, 14% reported a "very smoky" worksite. Fifty-three percent of respondents who worked in environments with restrictive smoking policies reported exposure to ETS. Of these, 11% reported that their worksite is "very smoky." Even among the 2.5% of respondents reporting a total ban on smoking in the workplace, 21% still reported being at least somewhat exposed to ETS at work.

If given a choice, 61% of all respondents choose nonsmoking seating in airplanes, restaurants, and other public places. Most former smokers (69%) and never smokers (82%) choose nonsmoking sections, as do 14% of current smokers.

Reported by: Office on Smoking and Health, Center for Health Promotion and Education, CDC. Editorial Note: These data indicate that a large percentage of smokers and nonsmokers regard ETS as a health hazard. In addition, a majority of nonsmokers and almost half of current smokers are annoyed by ETS. These results represent substantial changes in beliefs and attitudes since the 1970s. For example, a national opinion survey conducted by the Roper Organization in 1978 for the Tobacco Institute (3) showed that 58% of respondents (40% of smokers, 69% of nonsmokers) considered passive smoking hazardous. The Roper survey also found that 60% of nonsmokers and 5% of smokers were annoyed by being near a person who was smoking.

In 1986, 36% of a random sample of the members of the American Society for Personnel Administration (ASPA)* reported that their worksites had restrictive smoking policies (4). A similar percentage of respondents to the Adult Use of Tobacco Survey reported such policies. In a second survey of ASPA members in 1987, the percentage of members reporting a restrictive smoking policy had increased to 54% (4). Data from the Adult Use of Tobacco Survey suggest that these policies reduce, but do not eliminate, ETS exposure in the workplace. In fact, the 1986 Surgeon General's report concluded that simply separating smokers and nonsmokers within the same airspace is not sufficient to prevent exposure of nonsmokers to ETS (1).

*Current smokers were not asked this question.

*ASPA is a society of personnel executives representing manufacturing and nonmanufacturing firms and nonbusiness organizations such as hospitals, educational institutions, and government agencies.

These data also show that the majority of Americans would choose nonsmoking sections in airplanes, restaurants, and other public places, if given a choice. In 1986, the Committee on Airliner Cabin Air Quality, which was appointed by the National Academy of Sciences, recommended a ban on smoking on all commercial domestic flights for the following reasons: 1) to lessen irritation and discomfort among passengers and crew, 2) to reduce potential health hazards for the cabin crew, 3) to eliminate the possibility of fires caused by cigarettes, and 4) to bring the cabin air quality into line with established standards for other closed environments (5). On April 23, 1988, a new federal law that prohibits smoking on domestic flights of 2 hours or less takes effect. This legislation is part of an ongoing national effort to protect nonsmokers from exposure to ETS. Regulations issued by the General Services Administration (GSA) in December 1986 now prohibit smoking in GSA-controlled facilities except in designated smoking areas (6). The 1990 Health Objectives for the Nation, which were adopted by the Public Health Service, recommend that all 50 states have laws by 1990 that both prohibit smoking in enclosed public places and require separate smoking areas in the workplace and in dining establishments (7). References

1. Office on Smoking and Health. The health consequences of involuntary smoking: a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Centers for Disease Control, 1987:vii; DHHS publication no. (CDC)` 87-8398.

2. Waksberg J. Sampling methods for random digit dialing. J Am Stat Assoc 1978;73:40-6. 3. Roper Organization. A study of public attitudes toward cigarette smoking and the tobacco industry in 1978. New York: Roper Organization, May 1978.

4. Bureau of National Affairs. Where there's smoke: problems and policies concerning smoking in the workplace. A BNA special report, 2nd ed. Rockville, Maryland: Bureau of National Affairs, 1987.

5. National Academy of Sciences, Committee on Airliner Cabin Air Quality, Board on Environmental Studies and Toxicology, Commission on Life Sciences, National Research Council. The airliner cabin environment: air quality and safety. Washington, DC: National Academy Press, 1986.

6. General Services Administration. Smoking regulations. Federal Register 1986;51:44258. (41 CFR Part 101-20).

7. Public Health Service. Promoting health/preventing disease: objectives for the nation. Washington, DC: US Department of Health and Human Services, Public Health Service, 1980.

Update on Influenza Activity - United States and Worldwide,
with Recommendations for Influenza Vaccine Composition
for the 1988-89 Season

Worldwide

Although influenza activity in the United States this season has been primarily associated with type A(H3N2), influenza B has been the predominant virus type reported from other areas of the world.

Between October 1987 and April 1988, localized outbreaks of influenza B occurred in Finland, France, Greece, the United Kingdom, West Germany, and the Union of Soviet Socialist Republics (U.S.S.R.). In Japan, a localized outbreak of influenza B occurred during November of 1987, and sporadically occurring cases were confirmed through February of 1988. Sporadically occurring cases of influenza B were also confirmed from North Korea during March. Influenza B has been the most frequently isolated influenza virus in the western provinces of Canada; during February, it was

Influenza Continued

associated with an outbreak in Calgary, Alberta. Influenza B has also been the predominant virus type in Ontario since October of 1987. In the United States, influenza B has accounted for 9% of isolates reported nationally by World Health Organization (WHO) Collaborating Laboratories; only Hawaii has reported influenza B as the predominant virus type.

Influenza A (H3N2) caused localized outbreaks in Taiwan from September through November of 1987. Singapore reported isolating influenza A(H3N2) viruses from sporadically occurring cases during September and October 1987, and Japan made similar reports from October 1987 through February 1988. In Europe, influenza A(H3N2) was associated with localized outbreaks in East Germany and Romania during March. Localized outbreaks of influenza A (H3N2) in the U.S.S.R. during January and February escalated to widespread activity during March, as an epidemic of influenza B was waning. Sporadically occurring cases of influenza A(H3N2) were confirmed in several European countries, including Finland, France, Hungary, Norway, and the United Kingdom between January and March 1988 and in Egypt during January and February. Sporadic influenza A(H3N2) activity has also been reported in several Canadian provinces, and a few localized outbreaks have been associated with influenza A, but the subtype of these viruses has not been identified.

Sporadically occurring cases of influenza A(H1N1) have been confirmed in the United States since January of this year and have been confirmed recently in Canada. In Europe, influenza A(H1N1) was isolated from sporadically occurring cases in Switzerland during February and March. A localized outbreak of influenza A(H1N1) was reported in a primary school in Italy during March.

United States

Surveillance indicators in the United States suggest that influenza activity is waning. Reports from state and territorial epidemiologists have shown a progressive decline in outbreak activity since the week ending March 12, when 57% of the states were still reporting regional or widespread outbreaks of influenza-like illness. For the week ending April 16, two states reported widespread activity, and five states reported regional activity. For the same week, the percentage of patients visiting reporting sentinel physicians for influenza-like illnesses dropped to a low of 3.4%, from a peak of 8.1% for the week ending February 20. The number of specimens tested and the number of influenza viruses isolated at WHO Collaborating Laboratories have also declined since the end of February, from a peak of over 1,700 specimens tested with approximately 300 influenza viruses isolated, to 448 specimens tested and 43 viruses isolated for the week ending April 16. However, the ratio of pneumonia and influenza deaths to deaths from all causes, which has declined since reaching a peak on the week ending March 5, remains above the epidemic threshold for the ninth week. Antigenic Analysis of Recent Influenza Isolates and Recommendations for Influenza Vaccine Composition for the 1988-89 Season

As previously reported (1), influenza A(H3N2) viruses isolated in the United States and in other parts of the world during the 1987-88 influenza season were found to be antigenically distinct from viruses that circulated from 1985 through the spring of 1987. Although influenza B viruses have been isolated less frequently, it has become clear, as more isolates become available, that antigenic variation has also occurred among these viruses. Analysis of recent influenza B virus isolates indicates that these antigenic variants are different from the previously prevalent strains B/USSR/100/83

and B/Ann Arbor/1/86 (Table 1). Most recent isolates resemble the reference strain B/Victoria/2/87. The additional antigenic variant B/USSR/2/87, which was isolated in Moscow in December 1987, has been identified less frequently than strains that resemble B/Victoria/2/87.

The antibody response induced by the current type B vaccine strain, B/Ann Arbor/1/86, is greater to the homologous virus than to the reference variant B/Victoria/2/87 (Table 2). Vaccinees in all age groups developed neutralizing antibody titers >100 more frequently to B/Ann Arbor/1/86 than to the B/Victoria/2/87 variant (2), and the geometric mean titers were higher to the homologous vaccine component than to the B/Victoria/2/87 variant. During the 1987-88 season, influenza A(H1N1) viruses have continued to resemble the A/Taiwan/1/86 and A/Singapore/6/86 viruses, which were first isolated in Asia in 1986.

Based on antigenic analysis of recent influenza viruses, WHO has recommended updated type A(H3N2) and type B antigens for influenza vaccines for use during the 1988-89 influenza season. WHO recommends the same A(H1N1) component that was used in the 1987-88 vaccine (3). Consistent with these recommendations, the Public Health Service has recommended the following antigens for the trivalent influenza vaccine to be manufactured in the United States for the 1988-89 influenza season: A/Taiwan/1/86(H1N1), A/Sichuan/2/87(H3N2), and B/Victoria/2/87.

Reported by: F Ruben, MD, Univ of Pittsburgh, Pittsburgh, Pennsylvania. K Edwards, MD, P Palmer, Vanderbilt Univ, Nashville, Tennessee. RB Couch, MD, WA Keitel, MD, Baylor Coll of Medicine, Houston, Texas. National Influenza Centers, Microbiology and Immunology Support Svcs, WHO, Geneva. Div of Virology, Office of Biologics, FDA. Participating State and Territorial Epidemiologists and State Laboratory Directors. WHO Collaborating Center for Influenza, Influenza Br, Div of Viral Diseases, Center for Infectious Diseases, CDC.

TABLE 1. Hemagglutination-inhibition reactions* of influenza type B viruses

*Titers are the reciprocal of antiserum dilutions; homologous titers appear in bold type. Fourfold or greater differences in reactions of sera with different antigens are considered significant.

TABLE 2. Neutralizing antibody responses to influenza B viruses induced by the 1987-88 trivalent influenza vaccine*

*Volunteers received trivalent influenza vaccine containing 15μg each of A/Leningrad/360/83

(H3N2), A/Taiwan/1/86(H1N1), and B/Ann Arbor/1/86.

*Geometric mean titer.

1. Centers for Disease Control. Influenza-United States. MMWR 1988;37:207-9.

2. Harmon MW, Rota PA, Walls HH, Kendal AP. Antibody response in humans to influenza virus type B host-cell-derived variants after vaccination with standard (egg-derived) vaccine or natural infection. J Clin Microbiol 1988;26:333-7.

3. World Health Organization. Recommended composition of influenza virus vaccines for use in the 1988-89 season. Wkly Epidem Rec 1988;9:57-60.

✩U.S. Government Printing Office: 1988-530-111/60073 Region IV

UNIVERSITY OF MAHIGAN

UNITED STATES GOVERNMENT PRINTING OFFICE

SUPERINTENDENT OF DOCUMENTS

Washington, D.C. 20402

OFFICIAL BUSINESS

Penalty for Private Use, $300

BULK RATE POSTAGE & FEES PAID

HHS Publication No. (CDC) 88-8017

ΜΙ 48109

Redistribution using indicia is illegal.