| prevention-news@cdcnpin.org 2004-10-07, 2:18 am |
| CDC HIV/STD/TB Prevention News Update
Wednesday, October 06, 2004
The CDC National Center for HIV, STD and TB Prevention provides the follo=
wing information as a public service only. Providing synopses of key scie=
ntific articles and lay media reports on HIV/AIDS, other sexually transmi=
tted diseases and tuberculosis does not constitute CDC endorsement. The f=
ollowing summaries were prepared without conducting any additional resear=
ch or investigation into the facts and statements made in the articles be=
ing summarized, and therefore readers are expressly cautioned against rel=
ying on the validity or invalidity of any statements made in these summar=
ies. This daily update also includes information from CDC and other gover=
nment agencies, such as background on Morbidity and Mortality Weekly Repo=
rt (MMWR) articles, fact sheets and announcements. Reproduction of this t=
ext is encouraged; however, copies may not be sold, and the CDC HIV/STD/T=
B Prevention News Update should be cited as the source of the=20
information. Contact the sources of the articles abstracted below for ful=
l texts of the articles.
HEADLINES
NATIONAL NEWS
UNITED STATES: =93Flu Vaccine Shortage and Rationing Loom=94
NEW JERSEY: =93Committee Approves Needle Exchange, Treatment Funding=94
INTERNATIONAL NEWS
CANADA: =93Region Helps Women in Sex Trade=94
MEDICAL NEWS
UNITED STATES: =93Spatial Analysis and Mapping of Sexually Transmitted Di=
seases to Optimize Intervention and Prevention Strategies=94
UNITED STATES: =93Doctors' Group Urges Early Ob-Gyn Visit for Teens=94
LOCAL AND COMMUNITY NEWS
CALIFORNIA: =93'Not a Simple Answer' for Desert's Syphilis Problem=94
CALIFORNIA: =93Sexual Diseases Alert via the Net; New Health Department P=
rogram for Gays=94
NEWS BRIEFS
CALIFORNIA: =93News Briefs from California's Central Coast=94
GERMANY: =93Strong Rise in Syphilis Cases Reported in Germany=94
THAILAND: =93Thailand to Supply Drugs to 300,000 AIDS Patients in 2 Years=
=94
REPUBLIC OF KOREA: =93Sexual Diseases Spreading=94
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NATIONAL NEWS=09
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UNITED STATES:
=93Flu Vaccine Shortage and Rationing Loom=94
Baltimore Sun (10.06.04)::Erika Niedowski; Dennis O'Brien
On Tuesday, US public health officials announced a plan to ration fl=
u vaccine after learning that Chiron Corp. will not provide any of the 46=
million to 48 million doses it had been expected to ship. =93This is ver=
y disappointing news that creates a serious challenge to our vaccine supp=
ly for the upcoming flu season,=94 US Secretary of Health and Human Servi=
ces Tommy Thompson said in an afternoon conference call with reporters.=20
The sudden news of the shortage prompted an immediate shift to volun=
tary rationing. Health officials said the approximately 56 million doses =
available from other manufacturers should go to: infants six to 23 months=
old; persons 65 or older; individuals with chronic medical conditions, i=
ncluding AIDS; pregnant women; nursing home residents; children on aspiri=
n therapy; health-care workers who deal with high-risk patients; and thos=
e who live with or care for babies younger than six months.=20
In August, California-based Chiron Corp., which produces the Fluviri=
n vaccine at a plant in England, announced it was delaying shipment to th=
e United States after several batches were found to be contaminated. Chir=
on had expected to have the problem solved in time for this year's flu se=
ason and had been working with CDC officials, who were confident there wo=
uld be an adequate supply. But the Britain's Medicines and Healthcare Pro=
ducts Regulatory Agency announced it was pulling the factory's production=
license for three months =97 a decision Howard Pien, Chiron's president =
and CEO, called =93disappointing=94 and =93unexpected.=94=20
A team of Food and Drug Administration officials is heading to Brita=
in to investigate. Because none of the contaminated lots was distributed,=
there is no need for a recall.=20
HHS had anticipated a total of about 100 million doses of flu vaccin=
e this year. Aventis is expected to provide 54 million. MedImmune Inc. is=
ready to ship 1 million to 2 million doses of FluMist nasal spray, which=
can be used by person ages five to 49. Federal officials have asked Aven=
tis to produce more doses, but that is not likely to happen. =93At this l=
ate stage in the development process, it's extremely unlikely that they w=
ould be able to make more,=94 said Dr. Anthony Fauci, director of the Nat=
ional Institute of Allergy and Infectious Diseases.=20
CDC Director Dr. Julie Gerberding advised, =93Take a deep breath; th=
is is not an emergency. We'll work through this, as we have with other sh=
ortages in the past.=94
NEW JERSEY:
=93Committee Approves Needle Exchange, Treatment Funding=94
Associated Press (10.04.04)
Legislation that would permit New Jersey municipalities to operate n=
eedle-exchange programs was approved by the Assembly Appropriations Commi=
ttee Monday, and $10 million was added to the measure for drug treatment =
programs. Democrats said the funding for drug treatment was added because=
of the need for inpatient and residential substance abuse programs in th=
e state. The legislation, which recently received approval from the Healt=
h and Human Services Committee, is expected to be voted on by the full As=
sembly on Thursday.
New Jersey is one of just two states that do not have a needle-excha=
nge program or allow for the nonprescription sale of needles and syringes=
.. The measure has provoked contentious debate: Supporters argue that need=
le exchanges curb the spread of diseases like HIV and hepatitis, while op=
ponents claim the exchanges promote drug use.=20
=93Needle exchange programs have been proven to be an effective dete=
rrent to the spread of HIV and other infectious diseases,=94 said Assembl=
y Majority Leader Joseph Roberts (D-Camden), who co-sponsored the measure=
.. =93New Jersey is alarmingly behind the curve of the vast majority of ot=
her states that have looked at the data and embraced needle-exchange stra=
tegies.=94
Legislation that would allow for small quantities of syringes to be =
sold over-the-counter at pharmacies is also expected to come up for a vot=
e on Thursday.
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INTERNATIONAL NEWS=09
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CANADA:=20
=93Region Helps Women in Sex Trade=94
The Record (Kitchener-Waterloo, Ontario) (10.06.04)::Carol Goodwin
At a meeting Tuesday, the regional community services committee co-c=
hair said that the population of drug using female sex workers in the Wat=
erloo Region, especially Cambridge, is increasing and will require help. =
Despite an 18-month initiative that provides support and health referrals=
to sex workers, more funding is necessary, said Anne Tinkler, who is als=
o executive director of Cambridge Shelter Group.
Tinkler said the prostitution problem is growing in Cambridge becaus=
e the city has become a significant center for crack-cocaine use.=20
The ultimate goal of getting sex workers off the street is the final=
stage of an often-difficult process, Tinkler said during CSG's overview =
of the initiative =93Between a Rock and a Hard Place.=94 Besides treatmen=
t and rehabilitation, Tinkler advocated outreach efforts including condom=
and needle distribution, and a safe space with access to nutritious snac=
ks, information, showers and laundry facilities.
Since April 2003, the project's coordinator has gained enough trust =
to make contact with 55 street-level sex workers and another 83 at-risk w=
omen. Most of the women are =93receptive and see this as a valuable progr=
am,=94 said Heidy Choi, project coordinator. The project has made 150 ser=
vice referrals and distributed 6,000 condoms and 1,480 clean needles. How=
ever, the program lacks funding, she said.
Since the project was launched, there has been a noticeable drop in =
prostitution-related complaints called in to the Waterloo regional police=
, said Constable Jen Davis. =20
Tinkler asked the region for $20,000 (US$15,900) to fund the project=
, which the committee approved. In addition, the committee agreed to cons=
ider funding the initiative in the 2005 budget process. =20
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MEDICAL NEWS=09
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UNITED STATES:=20
=93Spatial Analysis and Mapping of Sexually Transmitted Diseases to Optim=
ize Intervention and Prevention Strategies=94
Sexually Transmitted Infections (08.04) Vol. 80; No. 4: P. 294-299::D.C.G=
.. Law; M.L. Serre; G. Christakos; P.A. Leone; W.C. Miller
In the current study, researchers used STD surveillance of four repo=
rtable STDs (chlamydia, gonorrhea, primary and secondary syphilis and HIV=
) to perform spatial analysis and mapping for Wake County, N.C., in order=
to optimize an intervention.=20
The Wake County 2000 STD rates were mathematically represented as a =
spatial random field. =93We analysed spatial variability by calculating a=
nd modelling covariance functions of random field theory,=94 which are us=
eful in assessing spatial patterns for disease at the local level and at =
a distance, the study authors wrote. They then combined STD rates and app=
ropriate covariance models to predict STD rates and related prediction er=
rors for a grid encompassing Wake County. Final disease estimates were in=
terpolated and mapped to generate a continuous surface of infection.
Lower STD incidences produced both larger spatial variability and sm=
aller neighborhoods of influence than for higher incidence STDs. Each STD=
clustered in its spatial distribution, with one key core area of infecti=
on. The core areas for all four STDs overlapped.
With the finding of spatial heterogeneity within STDs, researchers s=
uggested STD-specific prevention strategies should not be uniformly targe=
ted countywide, but instead to core areas. For overlapping core areas, re=
searchers suggested that intervention approaches could be =93combined to =
target multiple STDs effectively. Geostatistical techniques are objective=
, population level approaches to spatial analysis and mapping that can be=
used to visualize disease patterns and identify emerging outbreaks,=94 t=
hey concluded.=20
UNITED STATES:
=93Doctors' Group Urges Early Ob-Gyn Visit for Teens=94
Pittsburgh Post-Gazette (10.05.04)::Michelle K. Massie
The American college of Obstetricians and Gynecologists (ACOG) has r=
ecommended that teenage girls first visit an ob-gyn between ages 13 and 1=
5 =97 ideally, before the initiation of sexual activity. The initial visi=
t, however, would not necessarily include a gynecological or pelvic exami=
nation or a Pap test.
=93We're setting the stage to encourage patients to seek medical and=
gynecological care,=94 said Dr. Joseph Sanfilippo, professor of obstetri=
cs, gynecology and reproductive sciences at the university of Pittsburgh =
School of Medicine and Magee-Women's Hospital. =93We want adolescents to =
visit a gynecologist without fear of a pelvic exam as a prerequisite to g=
et pills and other contraceptives. It's a chat between a doctor and a pat=
ient to encourage girls to remain abstinent, but if they choose to engage=
in activity, then it will also encourage them to seek proper contracepti=
on and the use of condoms.=94
These initial visits should not be confused with a female's first Pa=
p test. Previously, guidelines recommended an initial Pap screening short=
ly after first intercourse or by age 18, whichever occurs first. ACOG's n=
ew recommendations call for a baseline Pap to be conducted approximately =
three years after first intercourse or by age 21, whichever occurs first.=
The new guidelines should not be interpreted as recommending that women =
delay their first ob-gyn visit until age 21, Sanfilippo said, adding that=
annual visits are strongly encouraged.=20
STD screening may be part of that initial visit, Sanfilippo said, bu=
t thanks to recent advancements, screenings can be performed without pelv=
ic exams. Improved methods such as vaginal swabs let patients administer =
tests themselves, or submit urine samples for testing.=20
Some health professionals are using a =93teen toolkit=94 that Sanfil=
ippo helped create to make their practices more adolescent friendly: It o=
ffers suggestions for attracting young patients and teaches doctors how t=
o talk to them. Additional materials address teens and parents regarding =
what to expect during a first pelvic exam, the stages of puberty, blood-p=
ressure readings and body-mass index calculations.
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LOCAL AND COMMUNITY NEWS=09
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CALIFORNIA:
=93'Not a Simple Answer' for Desert's Syphilis Problem=94
Desert Sun (10.03.04)::Brian Joseph
Despite a year of education and testing efforts, syphilis remains a =
serious public health problem in the Coachella Valley. As of the end of A=
ugust, 73 syphilis cases were reported in Riverside County, compared to 7=
8 during the same period for 2003. In both years, the majority of cases w=
ere recorded in the Coachella Valley. =93We've considered it being at epi=
demic levels since 2002,=94 said Barbara Cole, director of disease contro=
l in Riverside County and the lead official on the valley's syphilis outb=
reak.=20
While health officials say syphilis is being spread locally almost e=
xclusively by gay men, many of whom are also HIV-positive, Cole said the =
disease is a county-wide public health issue, not just a =93gay problem.=94=
=93I wouldn't want the heterosexual community to feel like they're not a=
t risk, because this is going to spread to other communities,=94 said Rob=
in Johnson, assistant director of social services for the Desert AIDS Pro=
ject, the lead agency on the outbreak.=20
Riverside County reported just 25 syphilis cases in 2001. By 2002, 9=
4 cases were logged, with the vast majority of them located in the Palm S=
prings area. As a result, the county health department launched a communi=
ty-tailored campaign and stepped-up testing. In 2003, the number of cases=
in Riverside County rose to 105.=20
In April, the county formed the Syphilis Elimination Task Force to r=
efine its safe-sex education campaign. =93If people see the same [message=
] over and over again, it loses=94 impact, said Cole. DAP has added syphi=
lis and other STD curricula to its community HIV/AIDS programs, said John=
son. The task force is also looking into partnering with other groups, su=
ch as local drug rehabilitation centers, on syphilis education. Experts a=
gree that local health departments and DAP are doing virtually everything=
that can be done to stop the spread of syphilis in Coachella Valley: pub=
lic education and testing.=20
CALIFORNIA:=20
=93Sexual Diseases Alert via the Net; New Health Department Program for G=
ays=94
San Francisco Chronicle (10.06.04)::Suzanne Herel
Debuting today, InSPOT (Internet Notification Service for Partners o=
r Tricks) was designed to allow STD-infected gay men to take the initiati=
ve in notifying sex partners. However, the service is open to everyone. I=
nSPOT, which is run by the local Internet Sexuality Information Services,=
is a response to a recent increase in STDs among gay men, said Dr. Jeffr=
ey Klausner, STD prevention director for San Francisco's Department of Pu=
blic Health, which funded the service.
InSPOT especially makes sense for gay men who meet casual partners o=
n the Internet and where the only personal identification known is a scre=
en name or e-mail address, said Klausner. Over half the local syphilis ca=
ses stemmed from meetings arranged online, he said. =93STDs are an unfort=
unate consequence of sexual behavior the same way other infections may be=
the result of hiking, kayaking or contact sports,=94 said Klausner. =93I=
f someone gets an STD, he should not be stigmatized.=94
=93It took a lot of time to come up with language that didn't seem a=
ccusatory,=94 said Tom Kennedy, a gay participant of the community adviso=
ry board that assisted in developing the cards. One of six pithy cards ca=
n be sent to up to six e-mail addresses at a time, and can be signed or a=
nonymous. A drop-down window includes eight STDs but not HIV, due to fear=
s over potential misuse by spammers.
=93The bottom line was they wanted fun,=94 said ISIS Executive Direc=
tor Deb Levine. =93They wanted something that also speaks to the gay cult=
ure and gay lifestyle =97 something you would find in a store in the Cast=
ro, not in a Hallmark store in the mall.=94 The InSPOT Web site does not =
collect any personal information from users, said Levine.
Klausner said the site will cost less than $20,000 annually to maint=
ain, and another $20,000 for marketing that includes billboard advertisem=
ents at Castro and Market streets. The site, www.inspot.org, carries a re=
quest that visitors respect the service and use it responsibly.=20
=20
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NEWS BRIEFS =09
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CALIFORNIA:
=93News Briefs from California's Central Coast=94
Associated Press (10.05.04)
A TB-infected Mixtec Indian jailed in April after twice escaping fro=
m court-ordered quarantine has been cured and will be deported to Mexico =
later this week. On Monday, Superior Court Judge Brian Hall told the pati=
ent that his six-month TB treatment at the County Jail was finished. =93Y=
ou are now safe to proceed with your work and your everyday activities. G=
ood luck to you,=94 Hall said. According to health officials, the patient=
caused one of the worst local TB outbreaks in recent years, infecting 56=
people. After release from jail, illegal immigrants are routinely deport=
ed by the US Border Patrol.=20
GERMANY:
=93Strong Rise in Syphilis Cases Reported in Germany=94
Agence France Presse (10.04.04)
Germany saw a 20 percent increase in the number of syphilis cases re=
ported last year, the Berlin-based Robert Koch Institute said Monday. In =
2003, 2,932 people were diagnosed with syphilis, up from 2,275 cases in 2=
002, RKI said in a report. Most of the syphilis cases were reported in ma=
jor cities, particularly in the northern cities of Berlin and Hamburg. Th=
ree out of four people who contracted syphilis were men who had sex with =
men, while the number of women diagnosed with the disease dropped by 10 p=
ercent over the year. The report said the rise is probably related to an =
increase in the number of sexual partners people reported, and it express=
ed concern an accompanying rise in HIV could result.=20
THAILAND:
=93Thailand to Supply Drugs to 300,000 AIDS Patients in 2 Years=94
Xinhua News Agency (10.03.04)
A Government Pharmaceutical Organization official has announced that=
Thailand will be able to offer locally made generic AIDS drugs to 300,00=
0 HIV-positive patients within two years. After a new state drug factory =
opens in 2006, Thailand's production capacity will be expanded to cover t=
he target number of patients, Isreat Gosriwatna, international sales mana=
ger for GPO, said. The state-owned enterprise can now produce GPO-VIR, a =
generic triple-combination therapy, for 50,000 HIV-positive Thais. As pro=
duction increases, the government plans to provide the drugs in neighbori=
ng countries such as Cambodia and Myanmar.=20
REPUBLIC OF KOREA:
=93Sexual Diseases Spreading=94
Korea Times (10.05.04)
Sexually transmitted infections are increasingly spreading among you=
ng Koreans, the Welfare and Health Ministry said Monday. A report by the =
ministry found that 14,963 people under age 19 had an STI in 2003, up 17.=
3 percent from 12,752 in 2002. The report said males accounted for 54.5 p=
ercent of the STIs. Committee member Yu Phil-u said the rapidly increasin=
g rates are due to a lack of proper sex education for students. STIs amon=
g people over age 60 also increased by 10.7 percent, from 13,063 in 2002 =
to 14,467 last year.=20
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