News in brief - April 14, 2003

Smallpox vaccine deferrals - Government seeks billions from tobacco companies - TB rates hit all-time low, but pockets of infection remain - Childbirth morbidity more frequent than expected

Smallpox vaccine deferrals

The Centers for Disease Control and Prevention recommended in late March that individuals diagnosed with heart disease not be given the smallpox vaccine until officials determine whether there is a connection between the vaccine and reports of heart problems -- including three deaths.

There have been at least seven cases of cardiac adverse events reported among the 25,600 health care workers who have received the vaccine since the program began in January, according to the CDC. Additional cases were reported among military vaccinees.

It's not clear whether this number is greater than would be expected normally in this population, said CDC scientists during a March 25 briefing.

Until an investigation is completed, the CDC is recommending that individuals with cardiomyopathy, previous heart attack, history of angina or other evidence of coronary artery disease be temporarily deferred from receiving a smallpox vaccination.

Agency officials said they would be providing states with simple questions about heart problems to use in their screening procedures.

However, the overall program of smallpox vaccinations will continue, said CDC Director Julie Gerberding, MD, MPH. "Certainly we are at a time in the history of our country where the potential for terrorism has probably never been higher," she said. "And we recognize that we must continue to be prepared to deal with a threat of smallpox in our nation."

Government seeks billions from tobacco companies

The federal government is demanding that the major tobacco companies turn over $289 billion in profits derived from about 50 years of allegedly deceptive marketing practices. The U.S. Dept. of Justice charged Philip Morris USA, R.J. Reynolds, Lorillard Tobacco, Brown and Williamson and the Liggett Group with manipulating nicotine levels, lying to customers about the dangers of smoking and directing multibillion-dollar advertising campaigns at children.

The allegations were developed from the government's reading of more than 38 million pages of documents forfeited by cigarette makers since the 1998 tobacco settlement in which $206 billion was awarded to the states.

The American Cancer Society noted that the nation pays about $158 billion each year for health care costs due to smoking-related illness.

TB rates hit all-time low, but pockets of infection remain

The Centers for Disease Control and Prevention recorded 15,078 cases of tuberculosis in the United States last year, a 6% decrease from 2001 and an all-time low from 1953 when reporting for the disease began, according to a report last month in Morbidity and Mortality Weekly Report. Public health officials are, however, very concerned about rates in some communities that remain stubbornly high. African-Americans have a TB rate eight times higher than whites, and twice that of Latinos. Meanwhile, half of all new cases occur among people who are foreign-born.

Reducing these gaps is key to eliminating the disease, according to the CDC.

Tuberculosis activists worldwide are also calling for increased funding to eradicate the disease and the development of new medications that may be quicker and easier on the body than those currently in use. According to the World Health Organization, TB rates worldwide are increasing an average of 0.4% per year, although at much higher rates in sub-Saharan Africa and former Soviet Union countries.

Childbirth morbidity more frequent than expected

Illness during childbirth labor and delivery is common and preventable, according to a study published in the American Journal of Public Health this month.

Researchers at the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention analyzed the National Hospital Discharge Survey data concerning women giving birth between 1993 and 1997.

Nearly a third of women -- 31% -- had a preexisting medical condition, most commonly hypertension, or experienced an obstetric complication such as cervical lacerations or preeclampsia. Another 12% had a cesarean delivery. Just over half who gave birth -- 57% -- experienced a delivery without morbidity.

"The results show that the magnitude of the problem is greater than generally appreciated," wrote the researchers.

Traditionally, death is the measure of maternal health, but researchers wrote that measuring factors that cause ill health would further improve the life of mothers.