Environmental public health surveillance: possible estuary-associated syndrome.

Public health surveillance involves the collection, analysis, and dissemination of data for use in public health practice. A surveillance system includes the capacity to collect and analyze data as well as the ability to disseminate the data to public health agencies that can undertake effective prevention and control activities. An emerging issue in environmental public health surveillance involves human exposure to the toxins produced by microorganisms present in oceans and estuaries. One of these organisms is Pfiesteria piscicida Steidinger & Burkholder, a dinoflagellate found in estuaries along the Atlantic and gulf coasts of the United States. There have been reports of both human illness associated with occupational exposures to concentrated laboratory cultures of P. piscicida and massive fill kills associated with the presence of the organism in rivers and estuaries. These reports, and anecdotal reports from people who worked on rivers where the organism has been found, generated concern that environmental exposures to P. piscicida, similar organisms, or perhaps a toxin or toxins produced by the organism(s), could cause adverse human health effects. To begin to evaluate the public health burden associated with P. piscicida, investigators from the National Center for Environmental Health at Centers for Disease Control and Prevention and health agencies from states along the Atlantic coast collaborated to develop a passive surveillance system for collecting, classifying, and tracking public inquiries about the organism. Specifically, the group developed exposure and symptom criteria and developed data collection and reporting capabilities to capture the human health parameters collectively referred to as possible estuary-associated syndrome (PEAS). The surveillance system was implemented in six states (Delaware, Florida, Maryland, North Carolina, South Carolina, Virginia) beginning in June 1998. From 1 June 1998 through 30 June 2001, the six state health agencies participating in the PEAS surveillance system received 3,859 calls: 3,768 callers requested information and 91 callers reported symptoms. Five individuals have been identified as meeting PEAS criteria.

Estimated prevalence of noise-induced hearing threshold shifts among children 6 to 19 years of age: the Third National Health and Nutrition Examination Survey, 1988-1994, United States.

OBJECTIVE: This analysis estimates the first nationally representative prevalence of noise-induced hearing threshold shifts (NITS) among US children. Historically, NITS has not been considered a common cause of childhood hearing problems. Among children, NITS can be a progressive problem with continued exposure to excessive noise, which can lead to high-frequency sound discrimination difficulties (eg, speech consonants and whistles). METHODS: The Third National Health and Nutrition Examination Survey (NHANES III) was conducted from 1988 to 1994. NHANES III is a national population-based cross-sectional survey with a household interview, audiometric testing at 0.5 to 8 kHz, and compliance testing. A total of 5249 children aged 6 to 19 years completed audiometry and compliance testing for both ears in NHANES III. The criteria used to assess NITS included audiometry indicating a noise notch in at least 1 ear. RESULTS: Of US children 6 to 19 years old, 12.5% (approximately 5.2 million) are estimated to have NITS in 1 or both ears. In the majority of the children meeting NITS criteria, only 1 ear and only 1 frequency are affected. In this analysis, all children identified with NITS passed compliance testing, which essentially rules out middle ear disorders such as conductive hearing loss. The prevalence estimate of NITS differed by sociodemographics, including age and sex. CONCLUSIONS: These findings suggest that children are being exposed to excessive amounts of hazardous levels of noise, and children's hearing is vulnerable to these exposures. These data support the need for research on appropriate hearing conservation methods and for NITS screening programs among school-aged children. Public health interventions such as education, training, audiometric testing, exposure assessment, hearing protection, and noise control when feasible are all components of occupational hearing conservation that could be adapted to children's needs with children-specific research.

Differences in notifiable infectious disease morbidity among adult women--United States, 1992-1994.

By 1990, all 50 states were using the Centers for Disease Control and Prevention (CDC) National Electronic Telecommunications System for Surveillance to report individual case data that included demographic information (without personal identifiers) about most notifiable diseases. This analysis of National Notifiable Diseases Surveillance System (NNDSS) data is useful for evaluating the distribution of reported notifiable infectious diseases among adult women by age and race. The number of cases of the 48 nationally notifiable infectious diseases reported among adult women (i.e., women > or = 15 years of age) were compiled for 1992-1994. These data were then analyzed by age and race, and rates per 100,000 adult women were calculated. During 1992-1994, the 10 most commonly reported nationally notifiable diseases among adult women in the United States were, in descending order of frequency, gonorrhea, primary/secondary syphilis, acquired immunodeficiency syndrome (AIDS), salmonellosis, tuberculosis, hepatitis A, hepatitis B, shigellosis, Lyme disease, and hepatitis C/non-A non-B. Gonorrhea was the most commonly reported notifiable infectious disease for women of all ages, except those ages > or = 55 years, and for women of all races, except Asian/Pacific Islanders. Tuberculosis was the most commonly reported infectious disease among women of Asian/Pacific Island descent. Analysis of NNDSS data provides information about the relative reported burden of diseases among women of all ages and different races. This information may be used for targeting research, prevention, and control efforts.

Prevalence of hearing loss among children 6 to 19 years of age: the Third National Health and Nutrition Examination Survey.

CONTEXT: Hearing loss in children influences the development of communication and behavioral skills, but few studies in the United States have used pure-tone audiometry to derive hearing loss prevalence estimates for children. OBJECTIVE: To describe the prevalence of hearing loss among US children by sociodemographic characteristics, reported hearing loss, and audiometric screening factors. DESIGN: National population-based cross-sectional survey with an in-person interview and audiometric testing at 0.5 to 8 kHz. SETTING/PARTICIPANTS: A total of 6166 children aged 6 to 19 years completed audiometry in the mobile examination center of the Third National Health and Nutrition Examination Survey conducted between 1988 and 1994. MAIN OUTCOME MEASURE: Hearing loss, defined as audiometric threshold values of at least 16-dB hearing level based on a low or high pure-tone average. RESULTS: A total of 14.9% of children had low-frequency or high-frequency hearing loss of at least 16-dB hearing level, 7.1% had low-frequency hearing loss of at least 16-dB hearing level, and 12.7% had high-frequency hearing loss of at least 16-dB hearing level. Most hearing loss was unilateral and slight in severity (16- to 25-dB hearing level). Of those with measured hearing loss, 10.8% were reported to have current hearing loss during the interview. CONCLUSIONS: This analysis indicates that 14.9% of US children have low-frequency or high-frequency hearing loss of at least 16-dB hearing level in 1 or both ears. Among children in elementary, middle, and high school, audiometric screening should include low-frequency and high-frequency testing to detect hearing loss.