News in brief - March 1, 2004

Fourth pneumococcal vaccine dose suspended temporarily - Life expectancy longer than ever, infant deaths increase - Salt and water - Public health readiness

Fourth pneumococcal vaccine dose suspended temporarily

Physicians should hold off on administering the recommended fourth dose of pneumococcal conjugate vaccine to young children because supplies are tight, according to a February statement by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices. The recommendation was also endorsed by the American Academy of Pediatrics and the American Academy of Family Physicians because of production problems that emerged last year at Wyeth Vaccines, the sole supplier.

The fourth dose should be administered only to high-risk children. All other children should get their final jab when supplies return to normal, although it is unclear when that will be.

"We are taking this action to ensure that every child can be protected against pneumococcal disease despite the limited supply," said Steve Cochi, MD, MPH, acting director of the CDC's National Immunization Program.

Life expectancy longer than ever, infant deaths increase

Americans are living longer than ever before, but infant mortality increased for the first time since 1958, according to Deaths: Preliminary Data for 2002 published last month by the Centers for Disease Control and Prevention's National Center for Health Statistics.

Infant mortality hit seven per 1,000 live births in 2002, an increase from 6.8 in 2001. Life expectancy increased from 77.2 years to 77.4 for the general population and increased for nearly all subgroups.

The increase in infant deaths was blamed primarily on an increase in congenital anomalies; incidents of low birth weight and preterm birth; and maternal complications.

The increase in longevity was accounted for by declines in heart disease, stroke, accidents, homicide and cancer. They were in part balanced out, however, by increases in deaths related to Alzheimer's, influenza, pneumonia, hypertension and blood poisoning.

Salt and water

Most healthy people already drink enough water and other fluids each day by letting their thirst be their guide, says a new Institute of Medicine report on essential nutrients. But the typical Western diet is too high in salt and too low in potassium for optimal health, the report concludes.

An adequate level of water was set at 125 ounces a day for men and 91 ounces per day for women. The IOM report included caffeinated beverages, juices, milk, fruits and vegetables in the beverage count.

Adults should also consume 4.7 grams of potassium per day to blunt the effects of salt and reduce the risk of kidney stones and bone loss, said an IOM panel. More than 95% of American men and 90% of Canadian men ages 31 to 50 and 75% of American women and 50% of Canadian women in this age range regularly consume salt in excess of the upper limit of 5.8 grams recommended by the report.

About 25% of American adults and more than half of those 60 and older have hypertension, which is linked to high salt intake. Studies indicate that reduced consumption of salt coupled with increased potassium intake can help offset the age-related rise in blood pressure.

The report is one of a series to develop reference values for nutrients that can be used in the United States and in Canada.

Public health readiness

Although states have been developing many important aspects of public health preparedness, no state is fully prepared to respond to a major public health threat, says a new General Accounting Office report.

States have improved their disease surveillance systems, laboratory capacity, communication capacity and work force needed to respond to public health threats, but gaps in each area remain, said the report. Regional planning between states is lacking, and many states lack the surge capacity that would be needed during an emergency.

In addition, most states have not finalized their plans for receiving and distributing medical supplies and material for mass vaccinations from the Strategic National Stockpile.

The Dept. of Health and Human Services was also faulted for not yet publishing its influenza pandemic plan although federal officials told the GAO that the plan was under review. Most of the state plans have also not been finalized. The GAO had recommended in 2000 that HHS complete its blueprint.

Without such a plan, the congressional watch dog agency questioned the adequacy of the federal role in the purchase, distribution and administration of vaccines and antiviral drugs during a pandemic.

The report was delivered as testimony on Feb. 12 before the House Committee on Government Reform.