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Measles-Continued

In early April, to control the spread of measles, particularly among the young preschoolers involved in the current outbreak, the New York City Department of Health increased vaccination clinic hours from 3 to 24 hours of clinic time and recommended measles vaccination for children aged 6 months through 11 months in the outbreak area. Subsequent reimmunization with measles-mumps-rubella vaccine at 15 months of age was recommended for all children vaccinated before the first birthday. The New York City Department of Health also recommended that Harlem children 12 months old or older be vaccinated with combined measlesmumps-rubella vaccine (2). This early immunization policy was discontinued on June 20 after active surveillance revealed no new cases for 4 weeks (two incubation periods of measles).

Reported by City Health Information, Vol. 3 (August 1-8, 1984), New York City Dept of Health; Div of Field Svcs, Epidemiology Program Office, CDC.

References

1. Rutherford GW, Desilva JM, et al. The epidemiology of measles in New York City, 1983: the role of imported cases. 19th Annual Immunization Conference, Boston, Massachusetts, May 22, 1984. 2. ACIP. Measles prevention. MMWR 1982;31:217-24, 229-31.

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Lung Cancer among Women - Tennessee

Lung cancer has, or will shortly, become the leading site-specific cause of cancer deaths among women in California, Florida, Louisiana, Mississippi, Oregon, Texas, and Washington, (1). It is now the leading cause of cancer deaths among women in Kentucky (2), where the age-adjusted rate doubled from 1971 to 1981. In Tennessee, analysis of cancer deaths among women by primary site revealed that, from 1968 through 1982, the lung cancer death rate increased 152.6%, from 9.7 deaths per 100,000 females in 1968 to

Lung Cancer - Continued

24.5/100,000 in 1982.

By contrast, rates for digestive system cancer have remained relatively stable, ranging from 35.4/100,000 in 1973 to 40.8/100,000 in 1979. The 1982 rate was only 1.5% greater than the 1968 rate; this statistic includes all digestive cancers, whereas lung cancer rates are site-specific. Breast cancer mortality rates rose from 21.9/100,000 in 1968 to 27.7/100,000 in 1982, a 26.5% increase. Breast cancer death rates have fluctuated around a mean of 25.3/100,000, compared to the nearly linear rise in the lung cancer death rate for women. Genital cancer rates in Tennessee women have declined 29.2%, from 26.4/100,000 in 1968 to 18.7/100,000 in 1982.

The rising trend for deaths from lung cancer among Tennessee women parallels the U.S. trends (3). However, while U.S. rates increased 127.0% from 1968 to 1980, the last year for which final statistics are available, Tennessee rates rose 140.2% during that period (Figure 3). Breast cancer mortality rates for the United States and Tennessee rose similarly for the same time period, showing 8.5% and 8.7% increases, respectively.

Higher respiratory cancer death rates for every age group are seen in 1982 than in 1968 or 1975 (Figure 4). Death rates in 1982 for women aged 45-54 years and 55-64 years were 182.0% and 168.8% higher, respectively, than comparable 1968 rates.

Death rates for respiratory cancer among men in Tennessee rose from 53.5/100,000 in 1968 to 90.2/100,000 in 1982, a 68.6% increase. The health profession and public should focus attention, time, and effort on reducing smoking to control this new epidemic (4). Reported by J Harris, MD, Northern Telecom, Nashville, Center for Health Statistics, Tennessee Dept of Health and Environment.

Editorial Note: Epidemics of chronic diseases do not receive the same public attention as epidemics of acute diseases, because they usually occur after a long latent period and over a longer period of time. The steady increase of lung cancer among women in the United States is an example of this phenomenon. While the prevalence of smoking has fallen substantially among men, it has not among women. Several states have reported that lung cancer has overtaken breast cancer as the leading cause of cancer mortality among women. It is anticipated that this will soon be true for the nation as a whole.

FIGURE 3. Respiratory cancer death rates for female residents
States, 1968-1982

30

Tennessee and United

DEATHS PER 100,000 FEMALE POPULATION

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Lung Cancer - Continued

Approximately 85% of all lung cancer cases are attributed to cigarette smoking (5). The lung cancer epidemic is especially tragic because it is preventable.

References

1. Starzyk P. Lung cancer deaths: equality by 2000? [Letter]. N Engl J Med 1983;308:1289-90.

2. Division of Epidemiology, Kentucky Department of Health Services. The rising epidemic of lung cancer among Kentucky women. Kentucky epidemiologic notes and reports 1983;1811:1-2.

3. National Center for Health Statistics. Advance report of final mortality statistics, 1980. Monthly vital statistics report 1983:32(Suppl).

4. Stolley, PD. Lung cancer in women-five years later, situation worse. N Engl J Med 1983;309:428-9. 5. Office on Smoking and Health. The health consequences of smoking, cancer: a report of the Surgeon General. Rockville, Maryland: Public Health Service, Department of Health and Human Services, 1982. FIGURE 4. Respiratory cancer death rates among female residents, by age at death Tennessee, 1968, 1975, and 1982

100

DEATHS PER 100,000 FEMALE POPULATION

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✩U.S. Government Printing Office: 1984-746-149/10019 Region IV

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MMWR

MORBIDITY AND MORTALITY WEEKLY REPORT

Current Trends

October 26, 1984 / Vol. 33 / No. 42

589 Update: Acquired Immunodeficiency

Syndrome (AIDS) in Persons with Hemophilia 592 Organophosphate Insecticide Poisoning Among Siblings - Mississippi

599 Cryptosporidiosis among Children Attending Day-Care Centers - Georgia, Pennsylvania, Michigan, California, New Mexico

601 Outbreak of Tick-Borne Tularemia South

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Dakota

603 Availability of MMWR-Related Publications

The University

of MICHIEST
Public Health
Library
Update: Acquired Immunodeficiency Syndrome (AIDS)

in Persons with Hemophilia

Reports of hemophilia-associated acquired immunodeficiency syndrome (AIDS) in the United States were first published in July 1982 (1). Since then, the number of U.S. patients with underlying coagulation disorders who develop AIDS has increased each year. In 1981, one U.S. case was reported; in 1982, eight; in 1983, 14; and, as of October 15, 29 cases have been reported in 1984, for a total of 52 cases (Figure 1). Two of these 52 patients had hemophilia B; one, a factor V deficiency; and one, factor VIII deficiency due to her postpartum acquisition of a factor VIII inhibitor. The remaining 48 cases occurred among hemophilia A patients. Three patients are known to have had risk factors for AIDS other than hemophilia. These 52 persons resided in 22 states. Only 10 states have reported more than one case, and no state has reported more than eight cases.

With the exception of one 31-year-old factor V-deficient individual with Kaposi's sarcoma (and without risk factors for AIDS other than his hemophilia), each patient had at least one opportunistic infection suggestive of an underlying cellular immune deficiency. Pneumocystis carinii pneumonia has been the most common opportunistic infection, occurring in 44 (85%) of the 52 patients. Other opportunistic infections have included toxoplasmic encephalitis (two cases), disseminated Mycobacterium avium intracellulare (one), disseminated cytomegalovirus infection (two), disseminated candidiasis (one), and cryptococcal meningitis (one). Thirty hemophilia patients with AIDS have died; only three of the survivors were diagnosed more than 1 year ago.

CDC has investigated the blood product usage of the majority of these cases. In nine cases, factor VIII concentrates have been the only blood product reportedly used in the 5 years before diagnosis of AIDS. These nine persons had no risk factors for AIDS other than hemophilia. The factor V-deficient patient with Kaposi's sarcoma had not used factor VIII concentrate products but had used large volumes of plasma and factor IX concentrates.

The sera of 22 (42%) of the 52 hemophilia-associated AIDS patients have been tested for antibody to antigens of the AIDS virus using Western blot analysis (2). Eighteen (82%) of these specimens contained antibody to one or more antigens (2,3). In cooperation with numerous hemophilia treatment centers and physicians, CDC has studied over 200 recipients of factor VIII and 36 recipients of factor IX concentrates containing materials from U.S. donors. Rates of AIDS virus antibody prevalence were 74% for factor VIII recipients and 39% for factor IX recipients (3,4). Only prospective evaluation will determine what risk of AIDS exists for seropositive individuals. A recently published study evaluated the thermostability of

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES / PUBLIC HEALTH SERVICE

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AIDS-Continued

murine retroviruses inocculated into factor concentrates, using a cell transformation assay (5). After 48 hours at 68 C (154.4 F), viral titers dropped from 108 to two infectious particles/ml. In studies done at CDC, in cooperation with Cutter Laboratories, AIDS virus was added to factor VIII concentrate (virus titer 105) and the factor was lyophilized and heated to 68 C (154.4 F). The residual virus titer was determined by an infectivity assay (6). Virus was undetectable after 24 hours of heat treatment, the shortest time period examined.

Reported by P Levine, MD, Medical Director, National Hemophilia Foundation, New York City; Div of Host Factors, Center for Infectious Diseases, CDC.

Editorial Note: The possibility of blood or blood products being vehicles for AIDS transmission to hemophilia patients has been supported by the finding of risk of acquisition of AIDS for intravenous drug abusers (7) and, subsequently, by reports of transfusion-associated AIDS cases (8). The mainstays of therapy for the hemorrhagic phenomena of hemophilia are cryoprecipitate, fresh frozen plasma, and plasma factor preparations; these have been associated with the transmission of several known viral agents, including cytomegalovirus, hepatitis B virus, and the virus(es) of non-A, non-B hepatitis (9). While many U.S. hemophiliaassociated AIDS patients have received blood products other than factor concentrates in the 5 years preceding their AIDS diagnosis, the occurrence of nine cases with no known risk factor or exposure other than the use of factor VIII preparations implicates these products as potential vehicles of AIDS transmission.

FIGURE 1. Hemophilia-associated acquired immunodeficiency syndrome (AIDS), by quarter United States, 1981-October 15, 1984

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