initiative. This planning phase will fund approximately 30 sites to develop community action plans designed to identify and implement effective interventions aimed at improving health disparities in racial and ethnic populations. CDC anticipates disbursing these planning awards by September 30, 1999 in amounts ranging from $250,000 to $350,000. In years 2-5, CDC expects to award 15-20 comprehensive awards between $1.5 and $2 million. These awards will be used to fund the implementation of specific community action plans utilizing the strategies developed in the planning phase of this program. In addition, a portion of the Initiative funding will also provides program evaluation and technical assistance support to the grantees receiving comprehensive awards. CDC projects that data on the health outcomes associated with these efforts will be available 3-5 years (2003-2005) after the initiation of the comprehensive phase of this program. It is hoped that the planning phase of the initiative will result in communities identifying promising interventions and that these same strategies will be replicated in communities that are not funded through the initiative to further eliminate disparities. INCIDENCE OF HIV AND AIDS Mr. Porter:. Please provide the latest data regarding the prevalence and incidence of HIV and AIDS. Dr. Koplan: CDC estimates that between 650,000 and 900,000 people are living with HIV. We hope to be able to better estimate HIV prevalence as additional states initiate HIV reporting. Currently, 31 states have HIV infection reporting. Through June 1998, a total of 665,357 cases of AIDS have been reported to the CDC. The June 1998 Midyear HIV/AIDS Surveillance Report on AIDS incidence data (1996-1997) indicate that between 1996 and 1997, new AIDS cases declined 15%, from 60,785 to 51,982. This decline reflects the combined impact of successful prevention efforts, which have helped slow the epidemic in recent years, and the impact of new therapies in lengthening the healthy lifespan of people with HIV. The decrease in AIDS incidence is smaller among women (8%) than men (16%). Among some of the smallest decreases were among persons infected through heterosexual contact (6% for women and 3% for men). The estimated AIDS incidence among minorities represented 67% of the total estimated AIDS incidence in 1997 which underscores the need for intensified prevention efforts in this community, as well as the need to ensure timely access to HIV counseling and testing and HIV and STD treatment services. Deaths declined -42% from 37,525 in 1996 to 21,909 in 1997, while the number of people living with AIDS continued to increase, 240,873 in 1996 to 271,246 in 1997 (+13%). This trend underscores the importance of HIV prevention efforts. In states with HIV reporting, the number of new HIV cases declined only 2%. proximately 30 sites to develop community ber 30, 1999 in amounts ranging from As progression to AIDS is successfully delayed for an increasing number of infected VACCINE PURCHASE Mr. Porter: Update the tables that appear on page 235 of the last year hearing record relating to vaccines to include this year's information. Dr. Koplan: Vaccine Purchase Appropriation by Funding Source ($ in Millions) FY 93 FY e HIV infection reporting. Through June en reported to the CDC. ance Report on AIDS incidence data 97, new AIDS cases declined 15%, from bined impact of successful prevention recent years, and the impact of new people with HIV. nong women (8%) than men (16%). Total $193.4 $271.9 $563.9 $488.7 $637.9 $527.9 $666.5 $703.8 • President's Budget Request **CDC estimated $80 million but Congress increased the amount requested to $151.9 million based on State requests to Congress to increase the vaccine purchase amount. Vaccine Purchase Expenditures by Funding Source ($ in Millions) FY 1993 FY 1994 FY 1995 FY 1996 FY 1997 FY 1998 VFC ong persons infected through nen). The estimated AIDS incidence 317 nated AIDS incidence in 1997 which *The States' FY 1993 and FY 1994 expenditures were provided in the 1998 hearing record and remain the same in the current hearing record. CDC believes States' vaccine purchase expenditures decreased in 1994 as States prepared for implementation of the VFC program in October 1994. Total vaccine spending from all funding sources does not represent a significant decrease from 1993 to 1994. ADOLESCENT IMMUNIZATION FOR HEPATITIS B Mr. Porter: What percentage of adolescents are immunized against hepatitis B? Dr. Koplan: Adolescents are defined by the American Academy of Pediatrics and the American Medical Association as persons ages 11-21 years. The National Health Interview Survey (NHIS) included questions on hepatitis B vaccination in their survey for adolescents through age 17 yars in 1997. Data from this survey are projected to be available in late August, 1999. Where data are available, hepatitis B vaccination coverage appears to be low (<15%). In those states/localities where a school-based vaccination program has been implemented or there is a middle school vaccination entry requirement, coverage ranges from 60-70 percent. BIOTERRORISM INFORMATICS FELLOWSHIP PROGRAM Mr. Porter: Describe in further detail the proposed bioterrorism informatics fellowship program including its funding level. Dr. Koplan: With the funding provided under the Health Alert Network, CDC will design and deliver distance learning training courses in public health informatics, medical response to biological and chemical terrorism, and laboratory testing and procedures related to potential bioterrorist agents. By delivering training in public health informatics, CDC will strengthen the workforce in fully utilizing data and information for public health decision-making and practice. DIAGNOSTIC TECHNIQUES FOR BIOTERRORISM AGENTS Mr. Porter: Do rapid diagnostic techniques and reagents exist for all potential bioterrorism agents? Dr. Koplan: This is a difficult question to address since any organism can potentially be used in a terrorist event. If the answer is restricted to the main agents (anthrax, plague, tularemia, smallpox, botulinum toxin, brucella), USAMRIID and CDC are developing rapid diagnostic assays. However, these tests have not yet been fully validated. For chemical agents, very few rapid diagnostic tests exist. CDC is working to develop a Rapid Toxic Screen which will consist of rapid methods to measure 150 chemical agents in blood and urine. These include nerve agents (like the sarin gas used in Tokyo in 1995), sulfur mustards, nitrogen mustards, lewisites, hydrogen cyanide, and g from all funding sources does OR HEPATITIS B nunized against hepatitis B? can Academy of Pediatrics and 21 years. The National Health tis B vaccination in their survey In this survey are projected to be le, hepatitis B vaccination calities where a school-based a middle school vaccination entry OWSHIP PROGRAM bioterrorism informatics Health Alert Network, CDC will public health informatics, and laboratory testing and delivering training in public in fully utilizing data and ctice. ERRORISM AGENTS gents exist for all potential since any organism can restricted to the main agents brucella), USAMRIID and CDC tests have not yet been fully tests exist. CDC is working methods to measure 150 7ts (like the sarin gas used s, hydrogen cyanide, and AGENCY FOR TOXIC SUBSTANCES AND DISEASE REGISTRY Mr. Porter: The Agency for Toxic Substances and Disease Registry (ATSDR) initiated activity to address 38 sites in FY 98 and will initiate activity at 56 additional sites in FY 99. How many sites will be initiated in FY 00? Dr. Koplan: At the President's budget level of $64 million, ATSDR will not be able to address any backlogged sites in FY 2000. Instead, approximately 50 more sites will be added to the backlogged sites list. To date, ATSDR has initiated, or will initiate, public health activities at 94 of the 234 backlogged sites identified in FY 1997. Community involvement, exposure assessment, health studies, health education, and health promotion activities have been conducted at these sites to address environmental health issues affecting more than one million people. NATIONAL CHILD AND ENVIRONMENTAL CANCER REGISTRY Mr. Porter: What is the status of a national child and environmental cancer registry? Dr. Koplan: CDC's National Program of Cancer Registries (NPCR) is now providing grants to 45 states, the District of Columbia, and three territories representing 96% of the US population to collect population-based data on all reportable cancers including childhood cancers. By September 1999, CDC will have in place the infrastructure by which timely and high quality cancer data from the NPCR states will be reported to a national central database in a uniform, standard format. The National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program already receives data on childhood cancers from the remaining areas of the US. The Children's Environmental Health and Safety Task Force established by the White House has identified additional needs for information on childhood cancers in the US including: a rapid case identification method to a centralized source for purposes of recruitment of children into clinical treatment trials; coalescence of information from the many databases derived from the pediatric clinical trial studies carried out by the Pediatric Oncology Group and the Childrens' Cancer Group into a single data resource network; a tissue bank of samples of children's cancers; and, a national childhood cancer registry. CDC's representatives to the Cancer Working Group of the Children's information needs for a childhood cancer registry be met by building on and enhancing SEER program. After discussions with the multiple public and private partners that make up the Task Force, the NCI has elected to develop new data systems and infrastructures to establish a separate national childhood cancer registry that will parallel existing data collection systems for childhood cancers. A MEDICAL MONITORING PROGRAM Mr. Porter: In FY 98, ATSDR funded a feasibility study to evaluate the appropriateness of implementing a medical monitoring program for persons exposed to lead and other contaminant releases from the Bunker Hill, Idaho Superfund site. What were the results from this study? Dr. Koplan: In FY 98, ATSDR provided funding to the State of Idaho, through a cooperative agreement, to conduct a feasibility study to determine whether a medical monitoring program was viable for the population living around and working at the Bunker Hill Site. The feasibility study has been designed by ATSDR in conjunction with Idaho Health Department to accomplish the following: Develop and implement a strategy to identify the potential eligible medical Develop procedures to contact and determine the interest of the eligible Develop and implement procedures to ascertain whether the health and medical establishment in the states of Idaho, Montana, and Washington are supportive of and willing to participate in the medical monitoring program; Establish outreach procedures designed to obtain a broad-based participation from local area citizens in the determination of the implementation of the medical monitoring program; Develop an outreach and education program to provide information to those populations identified as potential participants in the medical monitoring program; and Establish a work group of state, local, federal, and private sector health care provider experts to assist in evaluating the availability of referral systems for screening and treatment for those with no or limited health care coverage in the three state area. Results from the feasibility study are anticipated in the summer 1999. Following completion of the study, ATSDR will finalize its decision regarding medical monitoring for the populations affected by Bunker Hill. If the results warrant action, it is |