operations in infested areas. Local climatic conditions, degree of infestations, latitude, and customs of the people are variable which directly affect the time required to arrive at the initial zero index. Verification of eradication requires an additional 2 years in view of the ability of the mosquito to survive in egg stage for more than a year. Since the goal of the program is the total eradication of the Aedes aegypti mosquito, the factors encountered since its inception have required ongoing activities to be intensified and supplemented beyond the original plan. This has been necessary so that eradication can be achieved before the mosquito builds up resistance to insecticides. As a result, the program has been unable to expand its activities geographically as rapidly as scheduled. Though the operational experience has required a revised estimate of cost and duration of the program, some significant results have been achieved. Operations indicate the validity of the procedures and confirm the feasibility of eradication. Further, results in selected areas have demonstrated that containers which permit propagation of the mosquito can be eliminated from private and public premises through support from individual citizens, community organizations, and local and State governmental agencies. Procedures for this aspect of the total program are being developed and will be implemented as a standard facet of the operations. The PHS costs for the eradication program are estimated as follows: The net increase of $499,000 includes $699,000 for annualization of new program in 1966 and annualization of pay raises offset by $200,000 in nonrecurring program costs. AFTERNOON SESSION FRIDAY, FEBRUARY 11, 1966. CONTROL OF TUBERCULOSIS WITNESSES DR. ALFONSO H. HOLGUIN, CHIEF, TUBERCULOSIS BRANCH, COMMUNICABLE DISEASE CENTER DR. AARON W. CHRISTENSEN, DEPUTY CHIEF, BUREAU OF STATE SERVICES HARRY PEDIGO, PROGRAM MANAGEMENT OFFICER, TUBERCULOSIS BRANCH, COMMUNICABLE DISEASE CENTER LELAND W. SMITH, FINANCIAL MANAGEMENT OFFICER, COMMUNICABLE DISEASE CENTER JOHN W. HAMBLETON, FINANCIAL MANAGEMENT OFFICER FOR DR. WILLIAM H. STEWART, SURGEON GENERAL JAMES B. CARDWELL, DEPARTMENT DEPUTY COMPTROLLER 1 Includes capital outlay as follows: 1965, $99,000; 1966, $41,000; 1967, $104,000. 2 Selected resources as of June 30, are as follows: Unpaid undelivered orders, 1964, $41,000; 1965, $596,000; 1966, $596,000; 1967, $596,000. Mr. DENTON. The committee will come to order. BUDGET REQUEST We will take up the control of tuberculosis. The adjusted appropriation for 1966 is $15,661,000. The request for 1967 is $20,605,000, an increase of $4,944,000 and 15 positions. How does this request conform to the recommendations of the Surgeon General's task force report? Dr. HOLGUIN. This is a little less than the Surgeon General's task force recommendation for the second year. Mr. DENTON. How much? Dr. HOLGUIN. This is $1,326,000. Mr. DENTON. Just what did you ask for? Dr. HOLGUIN. We asked for a total appropriation of $21,976,000. TREND IN INCIDENCE AND DEATH RATE OF TUBERCULOSIS Mr. DENTON. What is the current trend in the incidence of tuberculosis and the death rate? Dr. HOLGUIN. The current trend for tuberculosis is down slightly from what it was last year. We had 50,874 cases of tuberculosis this last year; 1964, that is. The death rate also is declining slightly. EXPANSION OF CHILD CENTER PROGRAM ACTIVITY Mr. DENTON. Most of the increase, $4,250,000, is for project grants. Is this just stepping up what is being done now or is this for a new type of activity? Dr. HOLGUIN. This will include some increases for what is presently going on in the program but this is also to expand and intensify the child center program activity that is recommended by the Surgeon General's task force. INCREASED RESEARCH FOR MORE SPECIFIC TUBERCULIN TESTS Mr. DENTON. You have small increases for research and training. Would you comment on your activities in these areas and tell us why you need these increases? Dr. HOLGUIN. Our increase in research, most specifically, is to allow us to have more specific tuberculin tests. We have found there is difficulty in differentiating between those individuals that are truly infected with the tubercular bacillus and those which have a similar type of infection called an atypical microbacterial infection. We feel we do have a tuberculin at the present time which is more sensitive and will differentiate between these two types of infection. BCG Mr. DENTON. On page 232 you say, "From BCG animal trials thus far, it appears that development of tuberculosis is postponed rather than prevented." This is a rather new finding, is it not? Dr. HOLGUIN. Yes, sir. This is a relatively new finding. It appears as if actually disease in the guinea pig that had been vaccinated with BCG is actually prolonged before disease occurs. It is a prolongation of the incubation period rather than abortion of the disease itself. Mr. DENTON. How sure are you of the validity of this finding? Dr. HOLGUIN. We are reasonably certain at this time and we feel that our research efforts in this area will hold up. Mr. DENTON. The British and the Japanese have gone much further than we have on experimenting with BCG, have they not? Dr. HOLGUIN. The British and Japanese have been using BCG, yes, sir. Mr. DENTON. What has been the result? Have they been successful with it or not? Dr. HOLGUIN. When BCG is used there is a reduction of disease in those that were not previously infected, of about 80 percent. If I may go on just a little bit further, our problem here in the United States. is one in which three-fourths of the disease is occurring in those individuals who have already been infected and in this group BCG does not seem to have an effect. Mr. DENTON. That is what they told us 4 or 5 years ago. We made an appropriation to study BCG. They came back with the same finding that you have now, did they not? Dr. HOLGUIN. That is correct. 61-209-66-pt. 3-20 ferent diseases demonstrate the demand for these services. Success in field evaluation of the measles vaccine and of the jet-injector guns reflects the usefulness of field evaluations. The epidemic of salmonellosis, affecting 15,000 to 20,000 inhabitants of Riverside, Calif., furnishes dramatic evidence of the need for increased intensive efforts toward control of epidemics. Extensive investigation by several epidemic intelligence officers from the Center revealed that this epidemic was water borne, and raised a question about the adequacy of standard methods of testing water for safety. The rubella epidemic in 1965 resulted in an estimated 3,000 to 4,000 birth defects in the children of mothers infected during the first trimester of pregnancy. National surveillance will be intensified after rubella becomes a reportable disease and may provide keys to preventing such birth defects. Surveillance has revealed that meningococcal infections are more extensive in the civilian population than originally thought. As a result a unit to investigate meningococcal infections has been established. In addition a nationwide shigella surveillance program has been approved by the State and territorial health officers. Intensified efforts toward control of these and other diseases, and the increasing demand for epidemiological services has taxed existing resources, and reflects the extreme shortage of trained epidemiologists. The growing demand for services of the Epidemic Intelligence Service (EIS) program on foreign missions by the Agency for International Development, the Peace Corps and other agencies lacking sufficient numbers of epidemiologically trained staff has further emphasized the need for more trained epidemiologists to meet these needs in addition to our increasing domestic responsibilities. The Communicable Disease Center is well equipped to help meet the shortage of epidemiologists and at the same time, to meet the increased demand for epidemiological services. The well established EIS program and the unique national facilities and services of the Center provide excellent training and topnotch tutelage while carrying out the basic mission of the Center. The net increase of $372,500 and 10 positions includes $228,000 and 9 positions to provide increased epidemic services including large-scale epidemic investigations requiring extensive travel and increased laboratory diagnostic support and $30,000 and 1 position for electronic data processing, offset by $3,000 in nonrecurring equipment costs, and $117,500 for annualization of new program in 1966, annualization of pay raises and the increase in the pro rata share of the Bureau of State Services management fund. National laboratory improvement and reference services: 1966 estimate__. 1967 estimate____ Increase or decrease__. $3,640, 100 4, 177, 900 +537,80 The objective of the national laboratory improvement program is to aid and stimulate continued improvement in the Nation's health by providing services to the State public health laboratories. These services include the standardization of diagnostic test procedures; evaluation of accuracy of test results within and between diagnostic laboratories; laboratory consultation and review: reference diagnostic activities; and laboratory training. The enthusiastic acceptance of the program by the State public health laboratory directors testifies to its worth and effectiveness. Although the objective of this program is unchanged, the problems and requirements are far exceeding original estimates. The need for vast improvement and standardization in clinical chemistry has been demonstrated through pilot programs conducted under the current program at the insistence of State and public health laboratories. Evaluation of the accuracy and reproducibility of glucose determinations performed by hospital and public health laboratories revealed that of the 25 to 30 million blood or urine tests for sugar performed annually, some 10 to 12 million of the test results are incorrect. Only 27 of 56 participating laboratories reported acceptable results on glucose standards. An association between hospital admission hemoglobin levels and blood transfusion rates has been documented. As hemoglobin results are inaccurately reported low, unnecessary transfusions are given, subjecting the patient to the needless risk of a transfusion reaction and infection with serum hepatitis. Only 40 |