direct medical services in support of venereal disease control efforts. Question: What have we learned from the VD National Hotline? Answer: We have learned that there is a definite need for a confidential, highly visible, readily available and acceptable source for advice, information and referral which can be tailored to people seeking venereal disease services. This is supported by the fact that approximately 120,000 people seek venereal disease information and referral through the national hotline annually; 70,000 of whom are referred to medical care facilities. The majority of these calls request information on gonorrhea and herpes and are from teenagers and young adults; 76 percent of all callers are 29 years of age or younger and 27 percent are less than 19 years old. Question: Has the VD Hotline been a successful component to the overall program: Answer: A major goal of the venereal disease control effort is to bring exposed and infected people to treatment as rapidly as possible. This prevents further spread of the disease and if treatment occurs early in the infection, it can prevent the development of serious complications. The VD Hotline contributes significantly to this process. This is particularly true for young people who often are reluctant to turn to parents, teachers, or even their friends when it comes to a problem like venereal disease. The confidential nature of the VD Hotline makes it an especially helpful tool. ENVIRONMENTAL HEALTH Question: Do you expect the focus of CDC to change in the next 10 years from infectious disease control to environmental disease control? Answer: This matter is currently under review by Secretary Schweiker. Once the new Administration's policy has been established, it will be provided to the Subcommittee. Question: As CDC broadens the scope of its responsibility in environmental health problems, the use of toxicological testing facilities and equipment will expand. Are current resources sufficient to respond to requests for toxicological assistance in emergencies? Answer: The budget amount for this program is currently under discussion within the Reagan Administration. After the revised budget is forwarded to the Congress, we will provide an appropriate answer to this question. EPIDEMIC SERVICES Question: How many epidemics were reported in 1980? Answer: Actually, 710 epidemics were reported in 1980; however, we have accurate information from only 2/3 of the States so that we would estimate that approximately 1,050 epidemics would have been reported had all State reported epidemics to CDC. Many more epidemics occur than are reported, but are not reported for a variety of reasons such as local sensitivities, existence of the epidemic unknown to health authorities, the epidemic is investigated and solved locally, etc. Question: What were they? Answer: The breakdown of the epidemics is as follows: Question: What services did CDC provide for them? Answer: CDC provided all of the requested and required services including epidemiologists, veterinarians, laboratorians and laboratory support, statisticians, sanitary engineers, nurses, public health advisors, and demographers. Question: How many people were affected in each epidemic? Answer: Our data concerned the number of people affected is not exact, but we would estimate from 1 to 800 people were affected. This is less than the entire number who would be involved in the epidemic. Question: How are you able to measure the efficiency of personnel assigned to epidemic services? Answer: By close supervision of field investigations either directly from Atlanta and/or through discussions with field personnel who supervise the activities of EIS officers. Field investigators discuss their ongoing activities with Atlanta-based personnel regularly throughout the investigation which allows constant supervision of the investigative activities. Upon completing the investigation, reports are prepared and reviewed by the supervisor before being prepared in final form for distribution. Also, the investigation may be reviewed at a meeting or seminar attended by peers and supervisors. Efficiency can also be monitored by knowing if the epidemic was solved, that is, was the source/reservoir identified; was the method of transmission categorized; were host factors related to the occurrence of the epidemic identified? With identification of these factors, was the epidemic brought under control and preventive measures instituted. Ongoing surveillance for the disease will answer these questions. Question: In 1979, several townships in the Philadelphia area found that their water supplies were contaminated with a degreasing solvent called trichloroethylene (TCE). What assistance did CDC give to the local health authorities in testing for potential health hazards? Answer: CDC provided medical epidemiologists to assist in a survey of exposed people for TCE levels in urine and to assess liver cancer incidence in the area. Question: What are the results of your study? Answer: Seven of one hundred and seventeen residents whose urine was tested had detectable TCD metabolite levels, indicating recent TCE exposure. The level of cancer incidence was not found to be increased over expected levels. IMMUNIZATION/MEASLES Question: Last year, your budget justification reported an all-out effort to eliminate measles from the United States by October 1982. What progress has been made toward eliminating measles by that date? How many cases of measles were reported in the United States during calendar year 1980, as compared with 1979? Answer: Provisional data indicate that reported measles cases occurred at a record low level in 1980. The 13,430 reported cases in 1980 represent a 76.6 percent decrease from 1977, a 50 percent decrease from 1978, and a 1.2 percent decrease from 1979. However, reported measles was 40 percent lower during the last half of 1980 (1840) compared to the last half of 1979 (3023). These record-low numbers persisted through the first 6 weeks of 1981. A cumulative total of 210 cases for the first 6 weeks of 1980, a decrease of 68.4 percent. During 1980, more than 75 percent of the nation's 3,144 counties were free of reported measles for the entire year. Of special interest is the low number of reported measles cases during the last 6 months of 1980. The seasonal low occurred during the summer months, as in past years, but persisted throughout the early fall and winter months of 1980. In fact, fewer than 50 cases were reported in 16 of the last 20 weeks. A total of 18 weeks in 1980 had fewer than 50 cases, whereas only 5 such low weeks were ever recorded in all the years before 1980. Question: Last year you also indicated you were testing your system for getting accurate reports on measles cases, as recommended by GAO. What progress has been made to test the accuracy of your statistics on measles cases? Answer: Every case of suspected measles which is reported is being epidemiologically investigated. These investigations seek to determine the source of infection, associated cases, and spread of infection. If reported efficiency is low, we would expect to frequently find unreported cases. This is not the case unreported cases are not frequently encountered during investigations. We presently estimate that at least 80 percent of cases of measles which occur are reported. - CHRONIC CONDITIONS Question: The Carter budget requests $4 million to initiate an Emergency Response Fund. How would these funds be used? Answer: The budget amount for this program is currently under discussion within the Reagan Administration. After the revised budget is forwarded to the Congress, we will provide an appropriate answer to this question. Question: What essential activities were not addressed expeditiously because funds were not available in the past year? Answer: The budget amount for this program is currently under discussion within the Reagan Administration. After the revised budget is forwarded to the Congress, we will provide an appropriate answer to this question. Question: How was the $4 million figure arrived at? Answer: This matter is currently under review by Secretary Schweiker. Once the new Administration's policy has been established, it will be provided to the Subcommittee. PREVENTABLE DISEASES If Question: Periodically, the Department provides this Subcommittee with a list of preventable diseases and prominent risk factors. Have you revised this list in the last two years? not, please do so for the record. What reductions in mortality rates have occurred in certain diseases, and how has CDC contributed to the reductions? Answer: The list previously supplied to the Subcommittee by the Office of the Assistant Secretary for Health remains a valid display of the leading causes of death and their most important risk factors (see attached). The adjusted death rates for all causes of death have declined an average of 2.1 percent annually during the period 1968-1977, but only 1.1 percent between 1977-1978. Death rates for major causes such as heart disease and stroke, diabetes, cirrhosis and suicide decreased in 1978, but cancer (especially lung cancer), accidents, and homicides all increased. Cardiovascular disease has been decreasing for a decade. age-adjusted death rates delined by one-fourth between 1968 and Some suggested explantations include: 1978. o decreasing smoking o improved management of hypertension o decreased dietary intake of saturated fats The o more widespread physical activity o improved medical emergency services o more widespread use and increased efficiency of coronary Unfortunately, no definitive evidence exists to determine how much of the decline might be attributable to each of these possible explanations. LEAD-BASED PAINT POISONING PREVENTION Question: How successful has this program been in reducing the incidence of lead poisoning? Answer: Through the provision of routine screening services high risk children are detected early, generally before symptoms develop. Through medical services and environmental epidemiology to identify and remove the lead source the risk of neurologic damage from lead ingestion is reduced. In each quarter 25 percent of the average 24,000 children reported under care for lead toxicity get better. Very few children are being found with extremely high levels of lead and death from the disease is now a rarity as a result of this comprehensive approach which is generally not available in non-project communities. Question: To what extent have Federal funds been responsible for the early detection and treatment of lead poisoning? Answer: Grant funds have been used to establish comprehensive programs in 105 areas since 1972. This focus of expertise and service capability has resulted in other local child health service providers incorporating lead screening services into their standard medical practice. This has occurred as a result of the lead poisoning prevention grants coordinating and insuring that necessary services are available to complete the epidemiologic and environmental intervention required to reduce the risk of lead poisoning for the children. Question: What percent of the children being screened under the Lead-Based Paint Program are referred by the Early and Periodic Screening, Diagnosis and Treatment Program, the Child Health Assessment Program of the Health Services Administration, and the Women, Infants, and Children Program of the USDA? Answer: In fiscal year 1980, 65 percent of the children screened in the program areas were tested by the other federally supported child health programs, private physicians, hospitals and State and local health programs within the program area. The lead poisoning prevention projects initiate and coordinate these activities and insure the required followup and environmental intervention. Question: How are the other children chosen to be screened? Answer: Outreach activities of the projects concentrate their screening in high risk areas associated with older housing and |