Outcomes from the Centers for Disease Control and Prevention 2018 Breastfeeding Report Card: Public Policy Implications.

OBJECTIVES: To compare the impact of Baby-Friendly designation vs rates of in-hospital breastfeeding initiation on breastfeeding outcomes at 3, 6, and 12 months postdischarge. STUDY DESIGN: Breastfeeding outcome data from the 2018 Centers for Disease Control (CDC) Breastfeeding Report Card were used as a basis for determining outcomes from the corresponding 2015 birth cohort. Linear regression models were used to determine the strength of association of breastfeeding initiation and Baby-Friendly hospital penetrance and attainment of postdischarge breastfeeding rates. All hospital births from all 50 states, 3 territories, and the District of Columbia were included in the study. RESULTS: Statewide breastfeeding initiation rates were positively associated with targeted breastfeeding outcomes. Similar associations were not found for Baby-Friendly hospital designation penetrance. CONCLUSIONS: To attain the Healthy People 2020 breastfeeding objectives, future public policy initiatives should consider the interaction of population demographics, individual hospital programs, and public health strategies used to support breastfeeding in states reporting high breastfeeding initiation rates.

Comparing the Use of Centers for Disease Control and Prevention and World Health Organization Growth Charts in Children with Cystic Fibrosis through 2 Years of Age.

OBJECTIVE: To examine differences between use of World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) growth reference in children with cystic fibrosis (CF) up to 2 years of age. STUDY DESIGN: Growth from 1-24 months in 2587 children, born 2003-2006 and recorded in the US CF Foundation Registry, was evaluated using WHO and CDC references. RESULTS: In both boys and girls with CF aged 1-24 months, use of WHO charts resulted in ∼8 percentile lower length-for-age and ∼13% higher short stature rate (length-for-age <5th percentile). WHO weight-for-age was ∼9 percentile lower prior to age 6 months, crossed at 6-7 months, and remained ∼14 percentile higher at 8-24 months. WHO weight-for-length (WFL) percentile (WFLp) was similar before 12 months but ∼10 percentile higher at 12-24 months compared with CDC. When using WHO charts, 9% of children had underweight (WFLp <50th) classified differently and this rate varied with age: 4% in the first year, 7% at 12, 13% at 15, and 16% at 18 months, respectively. Weight status assessed by WHO body mass index (BMI) charts was different from WHO WFL charts. At 24 months when switching back to CDC, 26% of children with normal WFLp on WHO charts appeared underweight on CDC charts. A 70th percentile of WHO BMI percentile was equivalent to the 50th percentile CDC BMI percentile. CONCLUSIONS: Growth status in children with CF differed when using WHO and CDC references, particularly during the second year of life. These differences need to be considered for all uses of growth assessment in CF.

The control of rotavirus gastroenteritis in the United States.

Since 2006, two new vaccines have been licensed to prevent rotavirus, the cause of 20% to 50% of severe acute gastroenteritis in young children worldwide. These vaccines have been implemented in national immunization programs in about 30 high- and middle-income countries, including the United States, and vaccine use has led to substantial decreases in diarrhea-related health care visits. In addition to reductions in diarrhea burden in vaccinated children, decreases have been observed in older, unvaccinated age groups in many settings, suggesting indirect benefits (i.e., herd immunity) from vaccination. Although the efficacy of these oral rotavirus vaccines is expectedly lower in developing countries in Asia and Africa, the public health benefits of vaccination in these settings, where more than 90% of the estimated 453,000 annual deaths from rotavirus occur, are likely to be substantial. Efforts continue to develop alternative rotavirus vaccines that could have a better efficacy and safety profile and may be less expensive.

Avaliação do estado nutricional das crianças menores de cinco anos em uma Creche no Município de Florianópolis segundo a curva de referência da OMS 2006 e comparação do diagnóstico nutricional com a curva de referência do CDC 2000 / Valuation of nutricional status of children under five years old at a daycare center according to OMS 2006 growth reference and comparison of the nutricional diagnostic with the CDC 2000 growth reference

Objetivo: Avaliar o estado nutricional das crianças menores de cinco anos cuidadas em uma creche segundoa curva de referência da Organização Mundial de Saúde (OMS) 2006 e comparar o diagnóstico nutricionalcom a curva de referência do Centers for Disease Control and Prevention (CDC) 2000. Metodologia: Estudo observacional, transversal com crianças menores de cinco anos, matriculadas em uma creche no município de Florianópolis-SC, no mês de Agosto de 2007. A amostra foi composta por 63 crianças obedecendo critérios de inclusão e exclusão. O estado nutricional foi analisado mediante indicadores antropométricos: peso e estatura para idade e peso para estatura utilizando-se o escore z. Resultados: Observou-se ausência de desnutrição aguda e de baixa estatura. O sobrepeso foi encontrado em 7,9% das crianças, o risco de baixa estatura em 19%.36,8% das crianças eutróficas pelo CDC encontravamse com risco de sobrepeso pela OMS (p=0,00) e 40% das com risco de sobrepeso pelo CDC já eram consideradas com sobrepeso pela atual curva (p=0,00); 33,3% das crianças com estatura adequada pelo CDC possuíam risco de baixa estatura pela OMS (p=0,00). Conclusão: Foi encontrado alta prevalência de sobrepeso e risco de baixa estatura. A curva da OMS comparada à curva do CDC superestima o diagnóstico derisco de sobrepeso e sobrepeso assim como o risco de baixa estatura.

Objectives: To evaluate the nutritional status of children under five years old at a daycare center according to the World Health Organization (WHO) 2006 growth reference and compare the nutritional diagnostic whith the Centers for Disease Control ad Prevention(CDC) 2000 growth reference.Methodology: A transversal descriptive study was carried out with children under five years old enrolled ata daycare center at the municipality of Florianópolis-SC in August of 2007. The sample was composed by 63 children according to inclusion and exclusion criteria. The nutritional status was analyzed by antropometric indicators:weight and heigth for age and weigth for heigth using the z score system. Results: The wasting and stunting were not observed in this study. Overweight was found in 7,9% of children and the risc of stunting in 19%. 36,5% of childrenconsidered eutrofic according to the CDC were at risc of overweigth according to the actual reference (p=0,00);33,3% of children with adequate heigth according to CDC were at risc of stunting according to OMS (p=0,00).Conclusion: High prevalence of overweight and risc of stunting were found. The OMS reference comparedwith the CDC increased the diagnostic of risc of overweigth, overweigth as well as the risc of stunting.

Rabies surveillance in the United States during 2005.

During 2005, 49 states and Puerto Rico reported 6,417 cases of rabies in nonhuman animals and 1 case in a human being to the CDC, representing a 6.2% decrease from the 6,836 cases in nonhuman animals and 8 cases in human beings reported in 2004. Approximately 92% of the cases were in wildlife, and 8% were in domestic animals. Relative contributions by the major animal groups were as follows: 2,534 raccoons (39.5%), 1,478 skunks (23%), 1,408 bats (21.9%), 376 foxes (5.9%), 269 cats (4.2%), 93 cattle (1.5%), and 76 dogs (1.2%). Compared with numbers of reported cases in 2004, cases in 2005 decreased among all groups, except bats, horses, and other wild animals. Decreases in numbers of rabid raccoons during 2005 were reported by 10 of the 20 eastern states in which raccoon rabies was enzootic and decreased overall by 1.2%, compared with 2004. On a national level, the number of rabies cases in skunks during 2005 decreased 20.4% from the number reported in 2004. Once again, Texas reported the greatest number (n = 392) of rabid skunks and the greatest overall state total of rabies cases (741). Texas reported no cases of rabies associated with the dog/coyote rabies virus variant and only 8 cases associated with the Texas gray fox rabies virus variant (compared with 22 cases in 2004). The total number of cases of rabies reported nationally in foxes decreased 3.3%, compared with those reported in 2004. The 1,408 cases of rabies reported in bats represented a 3.5% increase over numbers reported in 2005. Cases of rabies in cats, dogs, cattle, and sheep and goats decreased 4.3%, 19.2%, 19.1%, and 10%, respectively, whereas cases reported in horses and mules increased 9.3%. In Puerto Rico, reported cases of rabies in mongooses increased 29.8%, and rabies in domestic animals decreased 37.5%. One case of human rabies was reported from Mississippi during 2005. This case was submitted by the state to the CDC's unexplained deaths project and diagnosed as rabies retrospectively.

Rabies surveillance in the United States during 2004.

During 2004, 49 states and Puerto Rico reported 6,836 cases of rabies in nonhuman animals and 8 cases in human beings to the CDC, representing a 4.6% decrease from the 7,170 cases in nonhuman animals and 3 cases in human beings reported in 2003. Approximately 92% of the cases were in wildlife, and 8% were in domestic animals (compared with 91% and 9%, respectively, in 2003). Relative contributions by the major animal groups were as follows: 2,564 raccoons (37.5%), 1,856 skunks (27.1%), 1,361 bats (19.9%), 389 foxes (5.7%), 281 cats (4.1%), 115 cattle (1.7%), and 94 dogs (1.4%). Compared with the numbers of reported cases in 2003, cases in 2004 decreased among all groups, except bats, cattle, human beings, and "other domestics" (1 llama). Decreases in numbers of rabid raccoons during 2004 were reported by 12 of the 20 eastern states in which raccoon rabies was enzootic. In the East, Massachusetts reported the first cases of raccoon rabies detected beyond the Cape Cod oral rabies vaccine barrier. Along the western edge of the raccoon rabies epizootic (Ohio in the north and Tennessee in the south), cases of rabies were reported from unexpected new foci beyond oral rabies vaccine zones. On a national level, the number of rabies cases in skunks during 2004 decreased by 12.1% from the number reported in 2003. Once again, Texas reported the greatest number (n = 534) of rabid skunks and the greatest overall state total of rabies cases (913). Texas reported only 1 case of rabies in a dog that was infected with the dog/coyote rabies virus variant and only 22 cases associated with theTexas gray fox rabies virus variant (compared with 61 cases in 2003). The total number of cases of rabies reported nationally in foxes and raccoons declined 14.7% and 2.7%, respectively, during 2004. The 1,361 cases of rabies reported in bats during 2004 represented a 12.3% increase over the previous year's total of 1,212 cases for this group of mammals. Cases of rabies reported in cats, dogs, horses and mules, and sheep and goats decreased 12.5%, 19.7%, 31.8%, and 16.7%, respectively, whereas cases reported in cattle increased 174%. In Puerto Rico, reported cases of rabies in mongooses decreased 4.1% and rabies in dogs (9 cases) remained unchanged from those reported in 2003. Among the 8 cases of rabies in human beings, 1 person from Oklahoma and 3 from Texas died following receipt of infected organs and tissues from an Arkansas donor. In California, a person originally from El Salvador and, in Florida, a person originally from Haiti both died of canine rabies infections acquired outside the United States. In Wisconsin, a teenager contracted rabies from a bat bite and became the first known person to survive rabies despite not having received rabies vaccine prior to symptom onset.

Rabies surveillance in the United States during 2001.

During 2001, 49 states and Puerto Rico reported 7,437 cases of rabies in nonhuman animals and 1 case in a human being to the Centers for Disease Control and Prevention, an increase of < 1% from 7,364 cases in nonhuman animals and 5 human cases reported in 2000. More than 93% (6,939 cases) were in wild animals, whereas 6.7% (497 cases) were in domestic species (compared with 93.0% in wild animals and 6.9% in domestic species in 2000). The number of cases reported in 2001 increased among bats, cats, skunks, rodents/lagomorphs, and swine and decreased among dogs, cattle, foxes, horses/mules, raccoons, and sheep/goats. The relative contributions of the major groups of animals were as follows: raccoons (37.2%; 2,767 cases), skunks (30.7%; 2,282), bats (17.2%; 1,281), foxes (5.9%; 437), cats (3.6%; 270), dogs (1.2%; 89), and cattle (1.1%; 82). Nine of the 19 states where the raccoon-associated variant of the rabies virus has been enzootic reported decreases in the numbers of rabid raccoons during 2001. Among states with extensive wildlife rabies control programs, Ohio reported (other than rabies in bats) 1 case of rabies in a raccoon that was associated with the epizootic of rabies in raccoons and 1 case in a bovid that was infected with a bat variant of the rabies virus, compared with no cases reported in any terrestrial animals during 2000. Texas reported 1 case associated with the dog/coyote variant of the rabies virus (compared with no cases in 2000) and 20 cases associated with the gray fox variant of the virus (a decrease of 50% from reported cases in 2000). Reports of rabid skunks in Massachusetts and Rhode Island, states with enzootic raccoon rabies, exceeded reports of rabid raccoons for the fifth consecutive year. A similar situation may soon exist in the state of Maine (32 rabid skunks and 34 rabid raccoons during 2001). Nationally, the number of rabies cases in skunks during 2001 increased by 2.7% over those reported in 2000. Texas reported the greatest number of rabid skunks ever documented during a single year by any state, as well as the greatest numerical increase in rabid skunks (778 cases in 2001, compared with 550 in 2000; an increase of 228 cases, or 41.5%) and the largest overall state total of rabies cases (1,043) during 2001. Arizona reported the greatest percentage increase in rabid skunks (247.1%), representing an increase from 17 rabid skunks in 2000 to 59 in 2001. Nineteen of these cases were infected with a bat variant of the rabies virus, documenting a spillover event followed by unprecedented detection of temporal enzootic transmission of a bat variant in a terrestrial species. The number of cases of rabies reported in bats during 2001 (1,281 cases) increased 3.3% and surpassed the previous year's record (1,240 cases) as the largest number of reported cases ever recorded for this group of mammals. Cases of rabies reported in dogs (89) and cattle (82) decreased by 21.9 and 1.2%, respectively; these are the lowest numbers reported for rabid cattle and dogs since the dawn of national rabies record keeping (ca 1938). Cases in cats (270) increased by 8.4% over those reported in 2000, whereas rabies among sheep and goats declined 70%, from 10 cases in 2000 to 3 cases (goats only) in 2001. Rabies among horses and mules declined 1.9% (52 cases in 2000 to 51 cases in 2001). Reported cases of rabies in mongooses in Puerto Rico increased 18.6%, compared with the previous year (70 cases in 2001 from 59 cases in 2000), whereas cases of rabies in dogs declined 15.3% (15 to 13). One case of rabies in a human being reported by California during 2001 was the result of infection with a canine variant of the rabies virus acquired outside the United States.

Aspartame: scientific evaluation in the postmarketing period.

Prior to marketing, the safety of the high-intensity sweetener aspartame for its intended uses as a sweetener and flavor enhancer was demonstrated by the results of over 100 scientific studies in animals and humans. In the postmarketing period, the safety of aspartame was further evaluated through extensive monitoring of intake, postmarketing surveillance of anecdotal reports of alleged health effects, and additional research to evaluate these anecdotal reports and other scientific issues. The results of the extensive intake evaluation in the United States, which was done over an 8-year period, and the results of studies done in other countries demonstrated intakes which were well below the acceptable daily intakes set by the FDA and regulatory bodies in other countries, as well as the Joint FAO/WHO Expert Committee on Food Additives. Evaluation of the anecdotal reports of adverse health effects, the first such system for a food additive, revealed that the reported effects were generally mild and also common in the general population and that there was no consistent or unique pattern of symptoms that could be causally linked to consumption of aspartame. Finally, the results of the extensive scientific research done to evaluate these allegations did not show a causal relationship between aspartame and adverse effects. Thus, the weight of scientific evidence confirms that, even in amounts many times what people typically consume, aspartame is safe for its intended uses as a sweetener and flavor enhancer.

Rabies surveillance in the United States during 2000.

During 2000, 49 states, the District of Columbia, and Puerto Rico reported 7,364 cases of rabies in nonhuman animals and 5 cases in human beings to the Centers for Disease Control and Prevention, an increase of 4.3% from 7,067 cases in nonhuman animals reported in 1999. Ninety-three percent (6,855 cases) were in wild animals, whereas 6.9% (509 cases) were in domestic species (compared wth 91.5% in wild animals and 8.5% in domestic species in 1999). Compared with cases reported in 1999, the number of cases reported in 2000 increased among bats, dogs, foxes, skunks, and sheep/goats and decreased among cats, cattle, horses/mules, raccoons, and swine. The relative contributions of the major groups of animals were as follows: raccoons (37.7%; 2,778 cases), skunks (30.2%; 2,223), bats (16.8%; 1,240), foxes (6.2%; 453), cats (3.4%; 249), dogs (1.6%; 114), and cattle (1.1%; 83). Ten of the 19 states where the raccoon-associated variant of the rabies virus has been enzootic reported increases in the numbers of cases of rabies during 2000. Among those states that have engaged in extensive wildlife rabies control programs, no cases of rabies associated with the epizootic of rabies in raccoons (or in any other terrestrial species) were reported in Ohio, compared with 6 cases reported in 1999. No rabies cases associated with the dog/coyote variant (compared with 10 cases in 1999, including 5 in dogs) were reported in Texas, and cases associated with the gray fox variant of the virus decreased (58 cases in 2000, including 38 among foxes). Reports of rabid skunks exceeded those of rabid raccoons in Massachusetts and Rhode Island, states with enzootic raccoon rabies, for the fourth consecutive year. Nationally, the number of rabies cases in skunks increased by 7.1% from that reported in 1999. The greatest numerical increase in rabid skunks (550 cases in 2000, compared with 192 in 1999) was reported in Texas. The number of cases of rabies reported in bats (1,240) during 2000 increased 25.4% over the number reported during 1999 (989) and represented the greatest contribution (16.8% of the total number of rabid animals) ever recorded for this group of mammals. Cases of rabies reported in cattle (83) and cats (249) decreased by 38.5% and 10.4%, respectively, whereas cases in dogs (114) increased by 2.7% over those reported in 1999. Reported cases of rabies among horses and mules declined 20% from 65 cases in 1999 to 52 cases in 2000. Four indigenously acquired cases of rabies reported in human beings were caused by variants of the rabies virus associated with bats. One case of human rabies acquired outside the United States that resulted from a dog bite was caused by the canine variant of the rabies virus.