Morbidity and Mortality Weekly Report Supplement / Vol. 60 October 7, 2011 Public Health Then and Now: Celebrating 50 Years of MMWR at CDC January 15, 1993 / Vol. 42 / No. 1 CENTERS FOR DISEASE CONTROL AND PREVENTION 1 Hepatitis E Amon g U.S. T ravelers, 1989–1992 4 Surveillance of Deaths Attributed to a Nor’easter — December 1992 5 Respiratory Syncytial Virus Outbreak Activity — United States, 1992 7 Condom Use and Sexual Identity Am ong Men W ho Have Sex With Men — Dallas, 1991 14 Surveillance of the Health Status of Bhutanese Refugees — Nepal, 1992 17 Notice to Readers Morbidity and Mortality Weekly Report Weekly January 11, 2002 / Vol. 51 / No. 1 Epidemiologic Notes and Reports Rapid Assessment of Injuries Among Survivors of the Terrorist Attack Hepatitis E Among U.S. Travelers, 1989–1992 on the World Trade Center — New York City, September 2001 HepatitisOutbreaks E of— hepatitisContinued E (i.e., enterically transmitted non-A, non-B hepatitis) have occurred in some parts of the world and have generally been related to contaminated water supplies. Until recently, when research-based serologic tests ( 1,2 ) were devel- On September 11, 2001, a jet aircraft crashed into the north health-care services by survivors, the New York City Depart- oped to test for antibody to hepatitis E virus (anti-HEV), no serologic test was available tower of the World Trade Center (WTC) in lower Manhat- ment of Health (NYCDOH) conducted a field investigation to identify HEV infection, and diagnosis depended on a history of exposure in an ap- propriate epidemiologic setting and the exclusion of other causes of viral hepatitis. tan. Minutes later, a second aircraft crashed into the south to review emergency department (ED) and inpatient medical During 1989–1992, acute HEV infection was documented among six persons in the tower. The impact, fires, and subsequent collapse of the build- records at the four hospitals closest to the crash site and a fifth United States who had returned from international travel. This report summarizes Morbidity and Mortality Weekly Report CDC’s serologic document ation of acute HEV infection—presumed to have been ac- ings resulted in the deaths of thousands of persons. The pre- hospital that served as a burn referral center. This report sum- quired during international travel—in four of these persons. cise number and causes of deaths could not be assessed inWeekly the marizes/ Vol. 60findings / No. of 26 that assessment, which indicated that the July 8, 2011 Patient 1 immediate aftermath of the attack; however, data were avail- arrival of injured persons to this sample of hospitals began On February 23, 1991, a woman from Denver traveled to Rosarito Beach, Mexico, able on the frequency and type of injuries among survivors within minutes of the attack and peaked 2 to 3 hours later. for 1 day ( 3 ). On March 17, she developed headache and nausea, and on March 23, became jaundiced. A serum specimen obtained on March 23 demonstrated a serum (Figure 1). In previous disasters, such information assisted in Among 790 injured survivors treated wit3500hin 48 hours, 50 aspartate aminotransferase (AST) level of 2100 U/L (normal: 0–35 U/L), an alkaline characterizing type and severity of injuries and the health-care approximately 50%Drug received Overdosecare within 7 hours Deaths of the attack, — Florida, 2003–2009 phosphatase level of 516 U/L (normal: 110–295 U/L), and a total bi lirubin level of services needed by survivors (1 ). To assess injuries and use of most for inhalation or ocular injuries; 18% were hospitalized. 7.5 mg/dL (normal: 0–1 mg/dL). Physical examination was normal except for jaundice. A (2009 H1N1) Tests for serolog ic markers for hep atitis A, B, and C were negative, and an ultra- In the UComprehensivenited States in 20surveillance07, unint eofntion disaster-relatedal poisoni3000ngs health were effects A (H3)included only drug-caused deaths, referred to in this report as sonogram of the liver was normal. Serum samples obtained on April 18 and May 31 January 15, 1999 / Vol. 48 / No. 1 the secondis leadingan integral cause part of of injury effective death disaster (after planning motor-vehicle and response. A (Subtypingdrug overdose not performed) deaths. 40 FIGURE 1. A survivor of the World Trade Center attack. Most were positive for anti-HEV by uorescent antibody (FA) blocking assay (titers of 1:512 B and 1:128, respectively) and by a Western blot assay. survivors treated at sampled hospitals had inhalation canrashes)d (1); appWitrohinximat 6 houelyrs 93% of t heof alWTCl uninte attacntionk, aal NYCDOH poisoning rapid Using U.S. Census resident population estimates, annual 2500 The patient had no underlying medical problems and denied excessive alcohol con- 1 All-Terrain Vehicle-Related Deaths — ocular injuries. % positive West Virginia, 1985–1997 deaths wereassessment caused byteam drug began poisoning, collecting also demographic known as and drug clinical drug overdose deat h rates per 100,000 population were sump tion, injecting-drug use (IDU), blood transfusions, or contact with anyone known 4 False-Positive Laboratory Tests for data on all persons who sought emergency care from 8 a.m. to have hepatitis during the 6 months before onset of her illness. Al though the source Cryptosporidium Involving an overdose (2). From 1990 to 2001 in Florida, the nonsuicidal calculated for all drugs, prescription drugs, illicit drugs Enzyme-Linked Immunosorbent Assay 30 of infection for this patient was not clearly established, she reported drinking margari- — United States, November September 11 to 8 a.m. September 13 at the five Manhattan positive % 1997–March 1998 poisoning death rate increased 325% (3). To characteri2000ze recent (including specically heroin and cocaine), opioid analgesics tas with crushed ice at two restaurants and eating salsa and chips while in Mexico; she 8 Self-Reported Prevalence of Diabetes hospitals. Information about each person included sex, age, denied drinking water or eating other uncooked food. The patient recovered fully. Among Hispanics — United States, trends in drug overdose death rates in Florida, CDC analyzed (including specically methadone, hydrocodone, oxycodone, 1994–1997 mode of arrival at the hospital, date and time of registration Although her three traveling companions also consumed margaritas with ice, they 12 Recommended Childhood Immunization data from the Florida Medical Examiners Commission. is and morphine), benzodiazepines (including specically did not become ill, and serum samples from all three were negative for anti-HEV. Schedule — United States, 1999 or initial assessment, type and anatomic locati1500on of injury or positive specimens report summarizes the results of that analysis, whichf found alprazolam), and ethanol. To test for the20 statistical signicance o illness, whether the injury or illness was attributable. to the U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES / Public Health Service that, from 2003 to 2009, the number of annual deaths in of changes in death rates from 2003 to 2009, z-tests were attack, and whether the person was admittedNo for additional which medical examiner testing showed lethal concentrations1000 conducted in categories with annual counts >100, and All-Terrain Vehicle-Related Deaths — West Virginia, 1985–1997 treatment or was discharged from the ED. Among the 1,688 of one or more drugs increased 61.0%, from 1,804 to 2,905, examination of overlapping condence intervals from gamma 10 ATV-RelatFrom 1985ed thr Deatoughhs —1997, Cont theinue U.S.d Consumer Product Safety Commission (CPSC) and the death rate increased 47.5%, from 10.6 to 15.7 per distributions was used with counts <100. identied 113 deaths associated with all-terrain vehicles (ATVs)* in West Virginia. This 500 report summarizes data from the CPSC ATV-related death database and on-site and/or 100,000 populationINSIDE . During 2003–2009, death rates increased During 2003–2009, a total of 16,550 drug overdose deaths follow-up telephone investigations; ndings indicate that approximately two thirds of for all substances5 except cocaine and heroin. e death rate were recorded by Florida medical examiners. e annual deaths were caused by injury to the head or neck. Consistent use of helmets by riders Nutritional Assessment of Children After Severe can substantially reduce ATV-related deaths. for prescription drugsWinter increased Weather —84.2%, Mongolia, from June 7.3 2001to 13.40 per number of deaths increased 61.0%, from0 1,804 to 2,905, and 40 42 44 46 48 50 52 2 4 6 CPSC compiles information on ATV-related deaths from its main injury and death 7 Outbreak of Salmonella serotype Kottbus Infec- 100,000 population. e greatest increase was observed in the the deat2010h rate increased 47.5%,201 fr1 om 10.6 to 15.7 per 100,000 database les; data sources for these les include medical examiner and coroner re- death rate from oxycodonetions Associ (264.6%),ated with Eatinfollowedg Alfa bylfa Spalprazolamrouts population. In 2009, approximately eight drug overdose ports, death certicates, newspaper clippings, referrals, and consumer reports of ATV Surveillance week and year crashes ( 1 ). An ATV-related death was dened as a death caused by injury of a driver (233.8%) and9 methNotadoneices to Re(79ader.2%)s . By 2009, the number deaths occurred each day. During 2003–2009, 85.9% of drug or passenger of an ATV that was operated for nonoccupational purposes. To meet the of deaths involving prescription drugs was four times the overdose deaths were unintentional, 11.1% were suicides, 2.6% case denition, the cause of death had to be attributed to the ATV incident rather than AP (Associated Press) photo/Amy Sancetta to a preceding event (e.g., myocardial infarction while riding an ATV). number involving illicit drugs. ese ndings indicate the were of undetermined intent, and 0.4% were homicides or Of the 113 ATV-related deaths in West Virginia during 1985–1997, 100 (88%) need to strengthen interventions aimed at reducing overdose pending.