Haemophilus influenzae - Continued

Therefore, chemoprophylaxis of household or day-care contacts of children with Haemophilus b disease should be directed at vaccinated as well as unvaccinated contacts. Because of the length of time necessary to generate an immunologic response to the vaccines, vaccination does not play a major role in the management of patients with Haemophilus b disease or their contacts. Vaccine may be given to previously unvaccinated children of appropriate age to provide protection against future exposure.

9. Conjugate vaccine and DTP may be given simultaneously at different sites. Data are lacking on concomitant administration of conjugate vaccine and measlesmumps-rubella (MMR) or oral polio (OPV) vaccines. However, if the recipient is unlikely to return for further vaccination, simultaneous administration of all vaccines appropriate to the recipient's age and previous vaccination status is recommended (including DTP, OPV, MMR, and conjugate vaccine).

References

1. Peltola H, Käyhty H, Virtanen M, Mäkelä PH. Prevention of Hemophilus influenzae type b bacteremic infections with the capsular polysaccharide vaccine. N Engl J Med 1984;310: 1561-6.

2. Cochi SL, Broome CV, Hightower AW. Immunization of U.S. children with Hemophilus influenzae type b polysaccharide vaccine: a cost-effectiveness model of strategy assessment. JAMA 1985;253:521-9.

3. Immunization Practices Advisory Committee. Polysaccharide vaccine for prevention of Haemophilus influenzae type b disease. MMWR 1985;34:201-5.

4. Eskola J, Peltola H, Takala AK, et al. Efficacy of Haemophilus influenzae type b polysaccharide-diphtheria toxoid conjugate vaccine in infancy. N Engl J Med 1987;317:

717-22.

5. Lepow ML, Samuelson JS, Gordon LK. Safety and immunogenicity of Haemophilus influenzae type b-polysaccharide diphtheria toxoid conjugate vaccine in infants 9 to 15 months of age. J Pediatr 1985;106:185-9.

6. Käyhty H, Eskola J, Peltola H, Stout MG, Samuelson JS, Gordon LK. Immunogenicity in infants of a vaccine composed of Haemophilus influenzae type b capsular polysaccharide mixed with DPT or conjugated to diphtheria toxoid. J Infect Dis 1987;155:100-6.

7. Berkowitz CD, Ward JI, Meier K, et al. Safety and immunogenicity of Haemophilus influenzae type b polysaccharide and polysaccharide diphtheria toxoid conjugate vaccines in children 15 to 24 months of age. J Pediatr 1987;110:509-14.

8. Berkowitz CD, Ward JI, Hendley JO, et al. Persistence of antibody (AB) to Haemophilus influenzae type b (Hib) and response to PRP and PRP-D booster immunization in children initially immunized with either vaccine at 15 to 24 months [Abstract no. 889]. Pediatr Res 1987;21:321A.

9. Eskola J, Käyhty H, Peltola H, et al. Antibody levels achieved in infants by course of Haemophilus influenzae type b polysaccharide/diphtheria toxoid conjugate vaccine. Lancet 1985;1:1184-6.

10. Lepow ML, Barkin RM, Berkowitz CD, et al. Safety and immunogenicity of Haemophilus influenzae type b polysaccharide-diphtheria toxoid conjugate vaccine (PRP-D) in infants. J Infect Dis 1987;156:591-6.

11. Lepow ML, Randolph M, Cimma R, et al. Persistence of antibody and response to booster dose of Haemophilus influenzae type b polysaccharide diphtheria toxoid conjugate vaccine in infants immunized at 9 to 15 months of age. J Pediatr 1986;108:882-6.

12. Granoff DM, Boies EG, Munson RS. Immunogenicity of Haemophilus influenzae type b polysaccharide-diphtheria toxoid conjugate vaccine in adults. J Pediatr 1984;105:22-7.

13. Frank AL, Labotka RJ, Frisone LR, et al. H. influenza b immunization of children with sickle cell diseases [Abstract no. 906]. Pediatr Res 1987;21:324A.

14. Cates KL. Serum opsonic activity for Haemophilus influenzae type b in infants immunized with polysaccharide-protein conjugate vaccines. J Infect Dis 1985;152:1076-7.

15. Immunization Practices Advisory Committee. Update: prevention of Haemophilus influenzae type b disease. MMWR 1986;35:170-4,179-80.

Rapid diagnosis may be particularly useful in preventing nosocomial outbreaks of influenza A since patients exposed to the virus can be given amantadine, an antiviral drug effective against influenza type A. Rapid diagnostic capabilities may also help hospitals encourage their staffs to use antiviral prophylaxis or to be vaccinated, as recommended by the Immunization Practices Advisory Committee (ACIP) (1). Rapid diagnosis, coupled with prompt reporting to public health officials, will also help detect possible epidemics. However, confirmation by a second laboratory is important during nonepidemic periods because it will help avoid reports of false-positive results, which could set control measures into motion unnecessarily.

The cases reported here were identified by laboratory testing. Ideally, suspect isolates should be saved, and a sample should be forwarded to the appropriate state health department for confirmation. Isolates confirmed by state health departments are then forwarded to the WHO Collaborating Center for Influenza at CDC for detailed antigenic analysis, including strain identification. Early in the influenza season, these antigenic analyses need to be performed on as many isolates as possible because the findings are used to identify vaccine strains for the coming year. Reference

1. Immunization Practices Advisory Committee. Prevention and control of influenza. MMWR 1987;36:373-80,385-7.

Since 1984, 26 states* have been gathering data on health practices and behaviors from adults (≥18 years of age) as part of the Behavioral Risk Factor Surveillance System (BRFSS) (1). These data are collected monthly by telephone interview and include information on height and body weight. State-specific estimates of the prevalence of overweight for 1986 have been derived from analysis of this information.

=

The definition of overweight used for this study was based on the Body Mass Index (BMI Weight [kg] Height [m]2), which is derived from height and weight data from the Second National Health and Nutrition Examination Survey (NHANES-II) carried out by the National Center for Health Statistics (NCHS) between 1976 and 1980. The BMI was used because it has a high correlation with body weight and virtually no correlation with height (3). For the BRFSS study, overweight for men was defined as a BMI ≥27.8, and overweight for women, as a BMI ≥27.3. These values represent the sex-specific 85th percentile of BMI for U.S. adults 20 to 29 years of age. The highest prevalence of overweight for a total population (24%) was observed in West Virginia; the lowest (14%) was observed in both Utah and Hawaii (Table 1). For men, the highest prevalence of overweight (24%) was reported from North Dakota; and the lowest (14%) was reported from Hawaii. For women, the highest prevalence (26%) was observed in West Virginia and the District of Columbia; and the lowest (12%), in Arizona and Utah. No clear trend in prevalence of overweight was observed among those states that had participated in the BRFSS for the full period 1984-1986. Reported by: The 1986 State Behavioral Risk Factor Surveillance System Coordinators. Div of Nutrition, Center for Health Promotion and Education, CDC.

*Includes the District of Columbia.

*Previous BRFSS estimates of the prevalence of overweight were derived from the Metropolitan Life Insurance Company's "Desirable Weight Tables" (120% of desirable weight) (2).

The Morbidity and Mortality Weekly Report is prepared by the Centers for Disease Control, Atlanta, Georgia, and available on a paid subscription basis from the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402, (202) 783-3238.

The data in this report are provisional, based on weekly reports to CDC by state health departments. The reporting week concludes at close of business on Friday; compiled data on a national basis are officially released to the public on the succeeding Friday. The editor welcomes accounts of interesting cases, outbreaks, environmental hazards, or other public health problems of current interest to health officials. Such reports and any other matters pertaining to editorial or other textual considerations should be addressed to: Editor, Morbidity and Mortality Weekly Report, Centers for Disease Control, Atlanta, Georgia 30333.

The estimates of overweight from the BRFSS are generally lower than those obtained in other surveys. During 1986, the median prevalence for overweight among the participating states was 20% for men and 19% for women. National data on the prevalence of overweight, based on actual measurement rather than on self-reported data from telephone interviews, are available from the 1976-1980 NHANES-II. When the NCHS reference was used, 24.2% of adult men and 27.1% of adult women were overweight (3). Self-reported data from face-to-face interviews in the 1985 Health Interview Survey indicated that 23.5% of adult men and 24.2% of adult women were overweight (7). The BRFSS and the NHANES-Il results may differ because the BRFSS does not include all states, or the discrepancy may indicate greater underreporting of body weight over the telephone than in face-to-face interviews (8).

The 1990 objective regarding the prevalence of overweight was recently revised to state: "By 1990, the prevalence of overweight (BMI of 27.8 or higher for men and 27.3 for women) among the U.S. adult population should be reduced, without impairment of nutritional status, to approximately 18% of men and 21% of women" (6). Because this objective is based on the prevalence of overweight derived from actual measurements, data from the upcoming NHANES-III will be required to assess progress. State health departments participating in the BRFSS can set similar objectives and can monitor their progress through telephone surveys. However, when interpreting their results, states must bear in mind the potential effects of telephone survey methodology on estimates of prevalence.

The second 1990 objective related to overweight states, "By 1990, 50% of the overweight population should have adopted weight loss regimens combining an appropriate balance of diet and physical activity" (6). This objective is supported by several studies that have found diet and exercise together to be more effective for weight loss than diet alone (9). Forty percent of overweight persons who reported trying to lose weight in the 1986 BRFSS were following this objective. References

1. Centers for Disease Control. Behavioral risk factor surveillance-selected states, 1986. MMWR 1987;36:252-4.

2. The Society of Actuaries. Build and blood pressure study 1959. Vol I and II. Chicago: The Society of Actuaries, 1959.

3. Najjar MF, Rowland M. Anthropometric reference data and prevalence of overweight - United States, 1976-80. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, 1987. DHHS publication no. (PHS)87-1688. (Vital and health statistics; series 11, no. 238).

4. Forman MR, Trowbridge FL, Gentry EM, Marks JS, Hogelin GC. Overweight adults in the United States: the behavioral risk factor surveys. Am J Clin Nutr 1986;44:410-6.

5. Van Itallie TB. Health implications of overweight and obesity in the United States. Ann Intern Med 1985;103(suppl 6, pt 2):983-8.

6. Public Health Service. The 1990 health objectives for the nation: a midcourse review. Washington, DC: US Department of Health and Human Services, Public Health Service, 1986. 7. Stephenson MG, Levy AS, Sass NL, McGarvey WE. 1985 NHIS findings: nutrition knowledge and baseline data for the weight-loss objectives. Public Health Rep 1987;102:61-7.

8. Millar WJ. Distribution of body weight and height: comparison of estimates based on self-reported and observed measures. J Epidemiol Community Health 1986;40:319-23.

9. Björntorp P. Interrelation of physical activity and nutrition on obesity. In: White PL, Mondeika T, eds. Diet and exercise: synergism in health maintenance. Chicago: American Medical Association, 1982:91-8.

The Morbidity and Mortality Weekly Report is prepared by the Centers for Disease Control, Atlanta, Georgia, and available on a paid subscription basis from the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402, (202) 783-3238.

The data in this report are provisional, based on weekly reports to CDC by state health departments. The reporting week concludes at close of business on Friday; compiled data on a national basis are officially released to the public on the succeeding Friday. The editor welcomes accounts of interesting cases, outbreaks, environmental hazards, or other public health problems of current interest to health officials. Such reports and any other matters pertaining to editorial or other textual considerations should be addressed to: Editor, Morbidity and Mortality Weekly Report, Centers for Disease Control, Atlanta, Georgia 30333.