Impact of increased legal access to needles and syringes on practices of injecting-drug users and police officers--Connecticut, 1992-1993

To determine whether the simultaneous, partial repeal of needle prescription and drug paraphernalia laws in Connecticut affected purchasing and usage of needles and syringes (syringes) by injecting-drug users (IDUs) and risk of needlestick injuries to police officers, we conducted two serial cross-sectional surveys with IDUs recruited in drug treatment centers, correctional facilities, and health department settings. Reports of needlestick injuries among Hartford police officers were reviewed before and after the new laws. Among IDUs who reported ever sharing a syringe, syringe-sharing decreased after the new laws (52% before vs. 31% after; p = 0.02). Fewer IDUs reported purchasing syringes on the street after the new laws (74% before vs. 28% after; p < 0.0001). More IDUs reported purchasing syringes from a pharmacy after the new laws (19% before vs. 78% after; p < 0.0001). Eight to eleven months after the new laws were enacted, over two thirds (91 of 134) of active IDUs interviewed were aware of both new laws. Needlestick injury rates among Hartford police officers were lower after the new laws (six injuries in 1,007 drug-related arrests for 6-month period before new laws vs. two in 1,032 arrests for 6-month period after new laws). The changes in Connecticut laws were associated with decreases in self-reported syringe-sharing and increases in purchasing by IDUs of sterile syringes from reliable sources, suggesting that the simultaneous repeal of both prescription and paraphernalia laws is an important HIV prevention strategy.

Is the high ischemic heart disease mortality rate in New York State just an urban effect?

To determine whether New York State's high ischemic heart disease mortality rate was due primarily to an urban effect, rates for regions in the State were compared with each other and with national data. New York State mortality rates for the period 1980-87 were highest for New York City (344.5 per 100,000 residents), followed by upstate urban and rural areas (267.1-285.1), and New York City suburbs (272.5). However, the overall 1986 age-adjusted rate for the New York State region with the lowest mortality rate (265.7) exceeded that of 42 States. New York State's number one ischemic heart disease mortality ranking reflects the need for statewide intervention programs, because even regions with relatively low mortality rates are high when they are compared with national rates.

Sustained transmission of mumps in a highly vaccinated population: assessment of primary vaccine failure and waning vaccine-induced immunity

From January to July 1991, an outbreak of mumps occurred in Maury County, Tennessee. At the primarily affected high school, where 98% of students and all but 1 student with mumps had been vaccinated before the outbreak, 68 mumps cases occurred among 1116 students (attack rate, 6.1%). Students vaccinated before 1988 (the first year mumps vaccination was required for school attendance in Tennessee) may have been at greater risk of mumps than those vaccinated later (65[6.1%] of 1001 vs. 2[2.2%] of 89; risk ratio, 2.9; 95% confidence interval, 0.7-11.6). Of 13 persons with confirmed mumps who underwent serologic testing, 3 lacked IgM antibody in well-timed acute- and convalescent-phase serum specimens. Vaccine failure accounted for a sustained mumps outbreak in a highly vaccinated population. Most mumps cases were attributable to primary vaccine failure. It is possible that waning vaccine-induced immunity also played a role.

Rubella among the Amish: resurgent disease in a highly susceptible community

Although the Amish make up less than 0.05% of the United States population, nearly all rubella reported in the United States in 1991 occurred in this population. In early 1991 a large rubella outbreak in a Tennessee Amish community that had experienced no rubella for 17 years afforded an opportunity to describe the epidemiology of rubella in this unique population. Structured interviews were conducted with 54 Amish families. Of 383 persons in the sample 85 (22%) had rubella. Illnesses were mild; 16% of cases lacked fever and 20% of cases reported no symptoms except rash. Children < 17 years of age were 7 times more likely than older individuals to be affected (77 of 214 vs. 8 of 165). All pregnant women in the community were > 20 years of age; none developed rubella. No congenital rubella syndrome was recognized. Although rubella is increasingly a disease of adolescents and young adults, in this outbreak, rubella was again a childhood disease. Illness in this community-based investigation was mild; rubella may be difficult to diagnose and report. Immunity after remote natural infection was durable since the community's last outbreak. Pregnant women probably were protected by the age distribution of immunity; this age distribution may not occur in other Amish populations. If preventable morbidity from rubella and other vaccine preventable diseases is to be avoided in this group, increased attention should be directed to encouraging vaccinations among Amish persons.

Targeted HIV screening at a Los Angeles prenatal/family planning health center

In 1988, the Los Angeles County Health Department conducted a blinded human immunodeficiency virus (HIV) seroprevalence study at a public prenatal (PN) and family planning (FP) center serving mostly Hispanic women in order to determine seroprevalence and to evaluate the center's targeted HIV screening program. Four women (0.13 percent) tested positive (3/1801 PN and 1/1167 FP). Three reported no risk factors; one reported a history of syphilis since 1978. Voluntary HIV testing was selectively offered to women who reported risk factors for HIV infection. Only 14 percent (96/685) of clients offered testing chose to do it: 28 percent (14/50) of clients classified as being at highest risk of infection, and 27 percent (16/59) of women who judged themselves to have some chance of being exposed to HIV. None of the four women who tested positive by blinded testing chose testing. While few women at this center were infected with HIV, higher risk women were not persuaded to be tested through a targeted screening program. Blinded HIV seroprevalence studies provide a tool for both tracking infection in a population and evaluating screening programs.

Trial of anonymous versus confidential human immunodeficiency virus testing

Before December, 1986, all public human immunodeficiency virus (HIV) testing in Oregon was done confidentially (using names). In December, clients were offered the option of either anonymous or confidential services. As judged by questionnaire responses, the availability of anonymity increased overall demand for testing by 50%: 125% for homosexual/bisexual (gay) men, 56% for female prostitutes, 17% for intravenous drug users, and 32% for other clients. The number of gay clients who had tests increased from a mean of 42 per month during the 4 months before anonymity was available to 108 per month during the 4 months after, whereas, at public sites in Colorado or California and private sites in Oregon, the number of gay clients tested did not increase. Twice as many seropositive persons were identified during the 3 1/2 months after anonymity became available (n = 85) as in the 3 1/2 months before (n = 36). Thus, availability of anonymous HIV testing and counselling drew gay men who had not sought services under a confidential testing system.

Prevalence of hepatitis B markers among pregnant Hispanic women in migrant/seasonal work in Oregon

We screened 303 Hispanic pregnant women who were migrant or seasonal agricultural workers in Oregon for the presence of Hepatitis B serological markers. One carrier was identified (0.3 per cent, 95% confidence interval [CI] .02%, 2.1%). Evidence of previous HB infection was present in 5.3 per cent (16/303) of the women (95% CI 3.2%, 8.6%), rates similar to those for the general US population.

Group A beta-hemolytic streptococcal skin infections in a US meat-packing plant

In 1985, the second reported outbreak of group A beta-hemolytic streptococcal (GABHS) skin infections among US meat packers was recognized at an Oregon meat-packing plant. All 69 plant workers were interviewed and examined for the presence of pustular, draining, or inflamed lesions. During a three-month period, 44 episodes of skin infection occurred in 32 workers, all but four of whom worked in boning or killing areas. Acquiring infection was associated with job category (relative risk [RR], 5.7; 95% confidence intervals [CI], 2.9 to 11.3) and having at least two hand lacerations (RR adjusted for occupation, 6.2; 95% CI, 3.0 to 12.5). Group A beta-hemolytic Streptococcus (18), Staphylococcus aureus (12), or both (20) were isolated from 70 lesions cultured. Meat is suspected as a vehicle of transmission because cultures of two meat specimens contained the same GABHS strain as did 24 isolates from patients. Increasing reports of GABHS skin infections in meat packers suggest that this occupational risk may be more common than is realized.