Influenza vaccine. Past and present

The difficulty experienced last year in delivering influenza vaccine, while disappointing, nevertheless provided a unique opportunity for public and private partners to focus attention on the weaknesses in the national influenza vaccine-manufacturing and delivery system. Every effort is being made to ensure the timely distribution of sufficient vaccine to the public during the 2001-2002 influenza season. It is important for providers to target their highest risk patients with the first available influenza vaccine distribution (expected no later than October 2001). Additionally, DHSS regulations require that eligible hospitalized patients and residents of long-term care facilities receive vaccine as a key strategy to improving vaccination rates. Finally, the DHSS will continue intensive influenza surveillance and outreach efforts throughout the 2001-2002 influenza season.

Widespread West Nile virus activity, eastern United States, 2000

In 1999, the U.S. West Nile (WN) virus epidemic was preceded by widespread reports of avian deaths. In 2000, ArboNET, a cooperative WN virus surveillance system, was implemented to monitor the sentinel epizootic that precedes human infection. This report summarizes 2000 surveillance data, documents widespread virus activity in 2000, and demonstrates the utility of monitoring virus activity in animals to identify human risk for infection.

Clinical findings of West Nile virus infection in hospitalized patients, New York and New Jersey, 2000

Outbreaks of West Nile (WN) virus occurred in the New York metropolitan area in 1999 and 2000. Nineteen patients diagnosed with WN infection were hospitalized in New York and New Jersey in 2000 and were included in this review. Eleven patients had encephalitis or meningoencephalitis, and eight had meningitis alone. Ages of patients ranged from 36 to 87 years (median 63 years). Fever and neurologic and gastrointestinal symptoms predominated. Severe muscle weakness on neurologic examination was found in three patients. Age was associated with disease severity. Hospitalized cases and deaths were lower in 2000 than in 1999, although the case-fatality rate was unchanged. Clinicians in the Northeast should maintain a high level of suspicion during the summer when evaluating older patients with febrile illnesses and neurologic symptoms, especially if associated with gastrointestinal complaints or muscle weakness.

The Dover township childhood cancer investigation

In 1995 the New Jersey Department of Health and Senior Services (DHSS) determined that the incidence of childhood cancer--specifically, brain and central nervous system cancer in children under the age of five--in a New Jersey community was significantly higher than expected. This finding, which confirmed public perceptions, as well as the location within the community of two Superfund sites generated a comprehensive undertaking by state and federal agencies to account for the observation and to determine possible etiologies. Beginning in 1997 the DHSS designed and conducted an epidemiologic study primarily for the purpose of identifying possible disease risk factors that might have led to the increased cancer incidence. In December 1999 the agency released an interim report of its findings. Although the interim report did not identify significant differences in potential exposures between cancer cases and appropriately chosen control groups, the DHSS cautions that the study remains incomplete and no conclusions should be drawn at this time. Other factors, including the source of the drinking water, residential proximity to hazardous sites, parental occupation, and purported exposure to sources of air pollution remain to be analyzed. The final report is due by the end of 2001. New Jersey Medicine associate editors Leah Ziskin, MD, and Alan Lippman, MD, met with James Blumenstock, MA, senior assistant commissioner; Jerald Fagliano, PhD, program manager; and Eddy Bresnitz, MD, assistant commissioner and state epidemiologist at DHSS. The following interview seeks to understand the motivation behind this comprehensive study and the methodologies that are used to evaluate a cancer cluster.