MMWR – Morbidity and Mortality Weekly Report

MMWR News Synopsis for November 21, 2013

1. Outbreaks of Human Metapneumovirus in Long-Term Care Facilities — West Virginia and Idaho, 2011–2012

Human metapneumovirus can cause severe lower respiratory disease in persons of all ages, especially among young children, older adults, and immunocompromised persons.. First identified in 2001, human metapneumovirus (hMPV) has been associated with upper and lower acute respiratory infections in persons of all ages. hMPV can cause symptomatic reinfection throughout life, especially among young children, older adults and immunocompromised persons. The hMPV outbreaks presented in this MMWR occurred in skilled nursing facilities (SNFs) and caused severe respiratory disease in more than 75 percent of patients, with an overall fatality rate of 11 percent in a population with a high prevalence of multiple illnesses or advanced age. Clinicians should consider hMPV infection in the differential diagnosis, particularly when clusters of severe unexplained respiratory infections are detected such as for patients with respiratory tract infection in SNFs.

2. Fixed Drug Eruption Associated with Sulfonamides Sold in Latino Grocery Stores — Greater Washington, DC, Area, 2012

Patients, particularly Latino children, whose medical conditions resemble an adverse drug reaction, especially several severe skin disorders, may have been exposed to trimethoprim-sulfamethoxazole (TMP-SMX), sulfonamide containing antibiotic, .that were sold over-the-counter in Latino groceries. Two children in the greater Washington, DC, area were treated for an unusual skin disorder that is typically caused by an adverse reaction to a prescription medication. The families reported that the children had taken only over-the-counter cough and cold remedies obtained at Latino grocery stores. The medical team obtained bottles of the medication and learned that they were manufactured in El Salvador and that they carried TMP-SMX. In the United States, TMP-SMX requires a prescription to be dispensed. Labels on the Salvadoran products indicated that two were intended for use solely in El Salvador and not all required a prescription. The medical team went to 19 Latino grocery stores in the DC area and found that seven carried Salvadoran TMP-SMX products for over-the-counter sales.

3. Childhood Lead Poisoning Associated with the Use of Kajal, an Eye Cosmetic from Afghanistan — Albuquerque, New Mexico, 2013

Health-care providers, who provide health services to refugee and immigrant children, should be aware of the unique lead exposure risk factors among this population., Specifically, health-care providers should be aware those who are relocating from countries with a documented history of increased lead exposure risks associated with cultural practices or unregulated industrial processes. Expanding lead screening to all infants and children, and pregnant women, might avoid unintentionally excluding cases. This report brings attention to pediatric lead exposure risks from lead contaminated imported products among refugee children in the United States. Current CDC recommendations advise that all refugee children aged 6 months to 16 years be screened for lead within 90-days of their arrival into the United States, which excludes the screening of infants less than 6 months of age. Expanding the recommendation to include screening of all infants and pregnant women could prevent unintentionally missed cases. Clinicians and other health-care workers providing services to refugees and immigrants from Africa, Asia, and the Middle East should be aware of potential sources of lead in these populations and ask about the use of traditional eye cosmetics, especially with women receiving prenatal care or during early childhood screening programs.

4. Health-Care Provider Screening for Tobacco Smoking and Advice to Quit — 17 Countries, 2008–2011

Health-care providers should consistently and routinely screen for tobacco use among all patients and for those who use tobacco, offer advice and assistance in quitting. Effective community-based strategies that increase cessation among tobacco users are encouraged globally, especially in settings where access to health-care providers is limited. Countries can also create supportive environments that encourage and increase cessation by increasing the price of tobacco products, implementing smoke-free policies, mass media campaigns, and quitlines, and promoting health systems changes to increase clinical interventions. This report indicates a wide variation across 17 countries in the percentage of smokers (aged >15 years) who visited a health-care provider. Report of health-care providers screening for tobacco smoking was highest in Romania (82.1 percent), Uruguay (76.6 percent), and Egypt (74.1 percent). Report of health-care providers asking and advising smokers to quit in the past year was highest in Romania (67.3 percent), Egypt (67.0 percent) and Brazil (57.1 percent). Among smokers in five of the seventeen countries, men were significantly more likely than women to report that a health-care provider asked about smoking and advised them to quit, with adjusted odds ratios ranging from 1.6 to 8.5. In fourteen of the seventeen countries, older (45-64 years of age) versus younger smokers (<24 years of age) were significantly more likely to report that a health-care provider asked and advised them to quit, with adjusted odds ratios ranging from 1.8 to 6.7.

5. Progress Toward Poliomyelitis Eradication — Afghanistan, January 2012–August 2013

Afghanistan, one of three remaining countries endemic for wild poliovirus (WPV) transmission, has reached the lowest number of cases since 2004. The Southern Region, previously the major wild poliovirus reservoir in Afghanistan, has not had a confirmed WPV type 1 (WPV1) case since November 2012 (one full year). Afghanistan has made progress toward polio eradication during 2012-2013 by implementing strategies to improve routine immunization services, increase the effectiveness of immunization campaigns, and gain access to children living in conflict-affected areas of the Southern Region. Polio cases in the Southern Region caused by circulating vaccine-derived poliovirus type 2, however, are a reminder that these strategies need to be sustained and enhanced in the Southern Region. They also need to be implemented in other areas in Afghanistan, especially in the Eastern Region bordering Pakistan. Compared with 80 WPV cases in 2011, there were only 37 cases in 2012 and nine cases during January-September 2013. More than three years have passed since the last case of WPV type 3 infection was reported in Afghanistan in April 2010. In 2013 to date, all nine cases were in the Eastern Region and caused by WPV1 that originated in the bordering tribal areas of Pakistan.

6. Progress Toward Poliomyelitis Eradication — Afghanistan, January 2012–August 2013

During 2012-2013, Pakistan has made progress toward polio eradication by implementing strategies to improve management and accountability and improve the quality and effectiveness of immunization campaigns. Bans on vaccination in conflict-affected tribal areas and attacks against polio workers in several areas have adversely affected immunization campaigns. Intense transmission of WPV1 and circulating vaccine-derived poliovirus type 2, especially in the Federally Administered Tribal Areas (FATA), with transmission within and outside Pakistan, demonstrates the ongoing threat to achievement of polio eradication in Pakistan and globally. Pakistan, one of three remaining countries endemic for wild poliovirus (WPV) transmission, has made improvements in polio program performance and decreased the extent of WPV transmission during 2012-2013. Compared with 198 WPV cases in 2011, there were only 58 cases in 2012 and 52 cases during January-September 2013. Quetta, Balochistan, one of the historical reservoir areas, has not reported a WPV type 1 (WPV1) case during 2013. The last polio case caused by WPV type 3 infection was reported in April 2012 (>1 year). During 2013, however, intense transmission of WPV1 and rapid spread of circulating vaccine-derived poliovirus type 2 has occurred in tribal areas bordering Afghanistan.