Wisconsin trends in pneumonia and influenza mortality, 1980-2003.

INTRODUCTION: Mortality due to pneumonia and influenza continues to be a serious public health threat, especially among those aged > or = 65. Continued monitoring of these high-risk populations is necessary for evaluating the impact of public health prevention activities, determining vaccine distribution policies, and ensuring that existing guidelines reflect the populations at risk. OBJECTIVES: We characterized pneumonia and influenza mortality in Wisconsin from 1980 to 2003, including trend analysis, identification of high risk populations, and assessment of Wisconsin's progress toward state and national goals for vaccination. METHODS: We examined mortality trends for pneumonia and influenza as underlying causes of death among all Wisconsin residents who died in the state from 1980 to 2003. RESULTS: The pneumonia and influenza (P&I) mortality rate increased from 27/100,000 to 38/100,000 during 1980 through 1988, and then decreased to 26/100,000 through 2003. The decline in the mortality rate after 1988 was temporally associated with improving pneumococcal and influenza vaccination among those > or = 65. By 2003, all age groups except those aged > or = 85 had lower P&I mortality than in 1980. CONCLUSIONS: In Wisconsin, the increase in pneumonia and influenza mortality demonstrated during the 1980s was reversed. However, there was relatively little change in mortality among those aged 65-84 and rates among those > or = 85 years have increased. Novel improvements in public health interventions are needed to improve the focus on the elderly, including efforts to increase vaccination, prevent pneumococcal disease, and explore other evidence-based strategies to reduce pneumonia and influenza mortality.

Prenatal HIV testing in Wisconsin: results of a survey among women who gave birth in 2003.

Since 1995 the United States Public Health Service has recommended voluntary prenatal human immunodeficiency virus (HIV) testing for all pregnant women in the United States. To better understand how well this goal is being met in Wisconsin, the Wisconsin Division of Public Health facilitated a review of hospital medical records for a random sample of women who gave birth in Wisconsin in 2003. Of the 968 maternal medical records reviewed, 68% (95% CI: 65%-71%) showed evidence that the mother had a completed HIV antibody test during pregnancy. Rates of prenatal HIV testing were higher in Milwaukee County. After controlling for residence, prenatal HIV testing rates were higher among Hispanic mothers compared to white mothers; African American and white mothers had similar testing rates. These data suggest that the goal of voluntary HIV testing for all pregnant women is not currently being met in Wisconsin.

Reductions in transmission risk behaviors in HIV-positive clients receiving prevention case management services: findings from a community demonstration project.

Prevention case management (PCM) for HIV-infected persons is an HIV risk reduction intervention designed to assist clients who are aware of their HIV infection and who continue to engage in risk transmission behaviors. PCM combines individual risk reduction counseling with case management to address the psychosocial factors affecting HIV transmission. More than 350 HIV-positive clients participated in PCM in Wisconsin between 2000 and 2003, and 109 completed both baseline and follow-up risk assessments. The percentage of clients reporting risk transmission behaviors, specifically unprotected vaginal intercourse, insertive anal intercourse, or needle sharing with partners of negative or unknown HIV status, declined from 41.3% at baseline to 29.4% at follow-up (p = 0.04). Furthermore, clients showed progression (p < or =.05) through stages of change using Prochaska and DiClemente's transtheoretical model on seven domains related to HIV transmission risk, including personalizing risk of HIV transmission and sexual risk behavior.