Publication of the Bureau of Epidemiology & Disease Control Services

March/April 2002, Vol. 16, No. 2

Top Infectious Disease Issues: Year 2001 in Review
By Victorio Vaz, D.V.M., Ph.D.

Looking back, 2001 was
characterized by major events
that impacted the public and
those involved in protecting the
public’s health and safety nationwide and elsewhere. It is very
unlikely that public health will
return to business as usual.
Below are some issues that the
country has experienced with
some emphasis on how these
relate to us in Arizona and other
issues specific to the State.
Bioterrorism. Historically,
anthrax in humans has been a
disease of those with close contact to animals or animal products contaminated with
B. anthracis spores. Thus, the
diagnosis of the first case of pulmonary anthrax in the U.S. since
1976 on October 4, 2001, was
first considered a naturally

occurring isolated case of inhalation anthrax. However, a second
case in a co-worker in Florida,
raised the specter of bioterrorism. Other cases were subsequently reported in New York
City, New Jersey, Washington
and Connecticut. These cases
represent the first known victims
of a successful release of B.
anthracis as a biological weapon
in the U.S.
The events strained scarce
public health surveillance and
laboratory resources, and intensified the concerns about the
capacity of the country’s public
health system to respond to a
larger bioterrorist attack. Its full
impact in terms of costs, public
mental health, disruption of
other critical services, and
continued on page 2

Figure 1
Rates of Selected Diseases by Year - Arizona, 1990-2001*

Number of Cases per 100,000 Population

50

COCCI
HEPATITIS A
PERTUSSIS
TUBERCULOSIS

40
30
20
10
0

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

Year

Arizona Disease Facts
1. Hepatitis A - Rates have been traditionally high in the
state with peak rates in 1990, 1994 and 1997 (34, 43
and 42/100,000). Rates have declined significantly
for the past four years to less than 8/100,000 (Fig 1).
2. Coccidioidomycosis – Rates have climbed from
approximately 4/100,000 in 1990 to 43/100,000 in
2001; is this a true increase or better
awareness/reporting (Fig 1)?
3. Tuberculosis – Despite dramatic and consistent
reductions in TB rates nationwide from 10.5/100,000
in 1992 to 5.8/100,000 in 2000, the trend in Arizona
does not parallel the decline. The rates in the state
have fluctuated from 6.7 to 5.1 during the same period (5.4, 5.3, 5.1 and 5.4, respectively for the past
four years) (Fig 1).
4. Pertussis – Despite the effectiveness of vaccination,
pertussis continues to occur in the United States.
Pertussis was a major cause of morbidity and mortality among infants and children prior to the introduction of the vaccine in the mid-1940s. Since the
early 1980s, incidence has increased cyclically
every 3-4 years. In Arizona, recent peak rates were
reported in 1992, 1995, 1998, 2000 and 2001. The
highest rates for the past 12 years was in 2001 with
7.2/100,000, including three infant deaths (Fig 1).
5. Chlamydia – This disease continues to reflect the
highest rate among reportable infectious diseases.
The rate for 2001 was approximately 270/100,000.
Rates have fluctuated from 260 (1992) to 314
(1991).
6. Animal Rabies – A record 129 animals tested positive for rabies in 2001. Fortunately, due to animal
control measures, vaccination programs and risk
assessment for post-exposure prophylaxis, the last
human case of rabies in Arizona occurred in 1981.
7. Aedes aegypti – Mosquito surveillance efforts have
revealed the presence of the mosquito not only in
southern Arizona but also as far north as Maricopa
or Yavapai Counties; however, no cases of locally
acquired dengue have been reported.

Visit the ADHS Web site at www.hs.state.az.us
World
TB Day
Page 2

March/April 2002

New Test Highlights
Newborn Screening
Changes
Page 3

Progress In
Controlling Chronic
Disease Risk Factors
Page 4

Summary Chart
of Reportable
Diseases
Page 5

Childhood
Immunization
Schedule
Page 6
Prevention Bulletin

1

continued from page 1

widespread use of antibiotics for prophylaxis will not be known for some
time.
More than 900 environmental
samples were tested for anthrax at the
Arizona State Health Laboratory. All
tests were negative. The country experienced more anthrax cases during these
two months than during the entire last
century.
Public health officials discovered
that anthrax transmission, albeit rare,
can also occur through postal processing of sealed envelopes containing
weaponized spores. Fortunately, many
additional cases probably were averted
through prophylaxis and, more importantly, the 40% mortality rate ended up
being much lower than expected due
to better treatment options.
No Causal Association between
MMR vaccine and Autism. The possibility of a link between the measles
vaccine and autism was published in
an article in the Lancet in 1998 based
on intestinal abnormalities in 12 children with autism. Reports from parents
of 8 of the study children also associated onset of behavioral symptoms of
autism with receipt of MMR vaccine.
The authors theorized that the measles
vaccine could have led to malabsorp-

tion of vitamin B12, which is important
for the central nervous system development, and could be a contributing factor for the development of autism.
However, several studies addressing
this issue since 1998 have failed to
establish a causal association. In 2001,
the IOM Safety Review committee, also
found no causal relationship at the
population level between MMR vaccine and autistic-spectrum disorders.
We all agree that decisions to vaccinate
or not should be made through objective assessment of the benefits and
risks; however, no evidence exists to
outweigh or diminish the overwhelming benefits of the vaccine. Thanks to
vaccination, measles is rare in the U.S.
No Link between Hepatitis B
Vaccine and Multiple Sclerosis. Reports
of development of multiple sclerosis
(MS) after receipt of hepatitis B vaccine
have raised concerns about the possibility of this vaccine causing or exacerbating MS in healthy persons. However,
two studies published in the NEJM in
2001 did not show an association
between receipt of vaccine and development of MS and did not find an
increase in the short term risk of relapse
after vaccination.
Poliomyelitis outbreak. The 21
laboratory-confirmed cases of polio-

myelitis in the Dominican Republic &
Haiti from July 2000 through
September 2001 represent the first outbreak of the disease in the Americas
since 1991 when the last case of wild
poliovirus was identified. Evidence
seems to indicate that type 1 poliovirus
from oral polio vaccine (OPV) may
have reacquired some of the virulence
and transmissibility characteristics of
the wild poliovirus when transmitted
among unimmunized persons. In the
U.S., the last case of polio by a wild
virus occurred in 1979. Major reductions in incidence were first achieved
through improved sanitation, followed
by the introduction of inactivated polio
vaccine (IPV) in 1955 and OPV in
1961 (20,000+ cases in the early
1950’s, 2,525 in 1960 and 61 in 1965).
Due to about 140 vaccine-associated
paralytic polio cases caused by live
OPV from 1980 to 1999, the Advisory
Committee on Immunizations Practices
recommended that IPV be used exclusively in the U.S.
For more information on top infectious diseases of 2001, visit The
Infectious Disease News Web site at
http://infectiousdiseasenews.com
Victorio Vaz is acting State Epidemiologist and Office
Chief of Infectious Diseases for ADHS. He can be
reached at 602.230.5820 or vvaz@hs.state.az.us.

World TB Day 2002

2

Prevention Bulletin

U.S. The case rate for the U.S.-born
was 3.5 cases per 100,000, compared
to 25.8 among the foreign-born, more
than seven times higher. In Arizona,
the proportion of TB cases among the
foreign-born exceeded half (58%) for
the first time in 2000. Most TB in
immigrants occurs within five years of
arrival in the U.S., and more than a
quarter of cases are reported within the
first year.
Rates of multi-drug resistant (MDR)
TB have also decreased in the U.S. in
recent years, but show less improvement among the foreign-born. The proportion of MDR TB cases in the U.S.
decreased from 3% in 1993 to 1% in
2000. However, the proportion of those
cases occurring among the foreign
born increased from 31% (150 of 486)
in 1993 to 72% (101 of 141) in 2000.
Physicians should maintain a high clin-

ical suspicion for TB among foreignborn patients from high-incidence
countries who present with compatible
symptoms, especially if other risk factors (e.g., HIV, homelessness, or history
of incarceration in jail or prison) are
present.
Dr. Cheryl McRill is the chief medical officer for the
Department and the State TB Control Officer. She can
be reached at cmcrill@hs.state.az.us or 602.230.5808.

Figure 1
200

Number of TB Cases in US-born vs.
Foreign-born Persons
Arizona, 1995-2000

150
No. of Cases

On March 24, 1882, Robert Koch
announced his discovery of the organism responsible for what was then the
leading cause of death in Western
Europe, tuberculosis (TB). The date is
now commemorated as World TB Day,
a time to reflect on the current state
of humankind’s struggle with this
ancient disease.
For the year 2000, 16,377 cases of
TB were reported in the U.S., the lowest number ever which is reflective of
the 6-7% annual decline since the
recent peak in 1992. However, this
decline has occurred almost entirely
among the U.S.-born population while
the number of cases in the foreignborn population has changed very little, thus accounting for a greater proportion of total cases each year (Fig 1).
In 2000, 46% of all U.S. TB cases
occurred among those not born in the

By Cheryl McRill, M.D.

100

50

0

1995

1996

1997

US-born

1998

1999

2000

Foreign-born

March/April 2002

New Test Highlights
Newborn Screening Changes
Effective February 2002, several
changes took place in the Arizona
Newborn Screening Program.
Congenital Adrenal Hyperplasia (CAH)
was added to the newborn screening
panel; two specimens are needed from
each baby for the newborn screening
test; physicians need to verify that a
baby of one year or less has had a newborn screening test; and the screening
fee has increased from $15 to $20 per
screen.
Currently, the Arizona Newborn
Screening Program
screens babies for
seven disorders. CAH
will be the eighth disorder tested. All babies
born in Arizona are
required to have a
newborn screening test
to identify those babies
with one or more of
the disorders. Finding these babies and
giving them early treatment can prevent
serious problems, such as mental retardation or even death.
CAH is a genetic disorder affecting
the adrenal glands’ ability to produce
enough cortisol, and possibly aldosterone, to meet the body’s needs; however, androgen production may
increase. A baby born with this disorder
may have a crisis within five to ten days
after birth. This crisis can include dehydration, cardiac arrest and death. CAH
is treated with a cortisol replacement
and, as appropriate, electrolyte and
water balance medications.
CAH disorder is detected through
screening of samples for elevated levels
of 17-hydroxyprogesterone (17-OHP).
High levels of 17-OHP and androgens
are seen due to the blockage of the
pathway converting steroids to corticosteroids resulting from 21-hydroxylase
deficiency.
The Department’s State Health
Laboratory will be testing the newborn
samples by a method known as Time
Resolved Fluorescence (TRF) to detect
elevated levels of 17-OHP. Samples in
the top 3 percent of the test runs or any
sample yielding results of 50 ng/ml or
greater will be retested. Normal values
March/April 2002

are based upon the birth weight of the
baby. Samples yielding abnormal results
will be referred to the Newborn
Screening Program for follow up and
treatment.
CAH exists in three forms; salt
wasting, simple virilizing, and non-classical. If left untreated, the salt wasting
form can result in life-threatening adrenal crisis within the first weeks of life.
The classical disease incidence of
CAH in the general population is one in
15,000 births while the non-classical
form has been estimated to occur in
one percent of the
population. If the
incidence rate in
Arizona is similar
to the national statistics, it is anticipated that there
will be six cases
per year of the classical forms of CAH
detected by the State Lab.
Two newborn screening specimens,
rather than one specimen, will be
required for the newborn screening test.
The second specimen can verify the
results of the first specimen. In addition,
many babies have the first screen prior
to 24 hours of life, just prior to discharge
from the hospital.
Early collection of the first screen
presents some problems. Some metabolic conditions may not be detected if the
blood for the newborn screen is taken
soon after birth. This may lead to a false
negative on the first screen. The second
screen can also detect delayed onset of
a condition, as well as those conditions
in which accumulation of a specific
metabolic product occurs over time.
About 8% of State Lab confirmed positive cases were normal on the first
screen, but abnormal on the second.
To ensure that every newborn has
been adequately screened, physicians
will verify that a baby of one year or less
entering the practice has had a valid
newborn screening.
If you have any questions regarding
these changes please call the Newborn
Screening Program at 602.364.1409 or
800.548.8381.

Vaccine Shortages
Affect Arizona
Arizona, as well as other states, has
been affected by shortages of several
recommended vaccines in both the
public and private sectors. Reasons for
the various vaccine shortages vary. In
early 2001, the shortage of tetanusdiphtheria (Td) vaccine began when
Wyeth Lederle stopped producing
diphtheria-tetanus containing vaccines. The shortage should not affect
children less than 7 years of age. All
providers were asked to defer the adolescent Td booster dose and the routine adult booster doses. Td continues
to be prioritized for those requiring
tetanus vaccination for wound management. Supply of Td is anticipated to
normalize sometime this Fall.
DTaP vaccine is also in short supply as a result of Wyeth Lederle’s withdrawal from the marketplace. It has
been recommended that all vaccine
providers defer the 4th dose of DTaP
that is usually given at 12 to 18
months of age until the DTaP vaccine
supply becomes adequate. Currently,
providers should continue to administer the DTaP dose given between 4-6
years of age for entry into kindergarten. Supply of DTaP is anticipated
to reach sufficient quantities sometime
this Fall.
The 7-valent pneumococcal conjugate vaccine (PCV7) is also in short
supply due to a greater demand for
the vaccine than the manufacturer
anticipated. It has been recommended
that the existing vaccine be prioritized
to infants less than 1 year of age and
to the highest risk children 2 through 5
year of age. Supply of PCV7 is anticipated to normalize sometime this
summer.
Varicella vaccine and some of the
other Merck vaccines were delayed.
This delay has caused spot shortages
of some of these vaccines. Merck indicated that shortages are due to interruptions in their manufacturing operations. It is recommended that Varicella
vaccine be prioritized to children 1
through 5 years of age. There is no
recommendation, at this time, to defer
or delay administration of any Merck
vaccines.
Prevention Bulletin

3

Progress in Controlling Chronic Disease Risk Factors: Nutrition
By Sharon Sass, R.D., Judy Nowak, M.P.H., Jennifer Koslo, M.S., R.D.

Editor’s Note: In the Nov./Dec. 2001 issue of
Prevention Bulletin, Dr. Tim Flood presented a
perspective of the major causes of death of
Arizonans. As a follow-up, Prevention Bulletin will
present a series of articles this year examining the
status of various behavioral risk factors and how
these factors may affect the rates of chronic diseases in Arizona. The second of six articles in the
series appears below.

The combination of poor diet and
physical inactivity together was first
identified as the second leading cause
of preventable death in 1993, accounting for nearly as many deaths as tobacco each year.1 With accelerating rates
of obesity and diabetes, it is likely that
poor diet and physical inactivity may
soon exceed tobacco as the nation’s
leading preventable cause of death.
Physical inactivity as a risk factor for
chronic disease will be considered in a
future article of this series.
In Arizona, the three leading causes
of death are diseases influenced by
one’s diet: heart disease, cancer, and
cerebrovascular disease. The 15 leading causes of death in our state include
the additional diet-related diseases of
diabetes (8th), liver disease (10th),
renal disease (11th) and hypertension
(15th). In 2000, these diseases caused
24,545 or nearly two-thirds (61%) of
all the deaths in Arizona.2 To decrease
the burden of diet-related diseases in
Arizona, significant changes in food
consumption will be needed. The Year
2000 Behavioral Risk Factor Survey
found that only 37.9% of Arizona
adults ate the recommended five or
more servings of vegetables and fruits
each day.3 In 1995, a random digit dial
telephone survey of 3,600 adults in
Arizona showed:
• 58% consumed >30% of calories
from fat;
• 60% consumed >10% of calories
from saturated fat;
• 97% consumed inadequate fiber;
• 51% consumed inadequate folate;
• 30% consumed >3,000 mg
sodium.4
4

Prevention Bulletin

In Arizona, similar to national
trends, the number of overweight
adults (BMI >25 kg/m2) has increased
in recent years from 44.7% in 1994 to
54.2% in 2000.3 Last year, Surgeon
General David Satcher issued a call to
action, identifying overweight and
obesity a significant public health
problem in America. The Surgeon
General identified that for most people, overweight and obesity are due to
excess calorie intake and/or inadequate physical activity.
Overweight and obesity are associated with increased risk for heart disease; type 2 diabetes; endometrial,
colon, postmenopausal breast, and
other cancers; stroke; hypertension;
sleep apnea; gallbladder disease;
osteoarthritis; depression; and psychological difficulties due to social stigmatization.5 For a copy of the call to
action on overweight and obesity and
patient fact sheets, visit http://www.surgeongeneral.gov/topics/obesity/calltoaction.
In Healthy Arizona 2010: Collaborating for a Healthier Future, nutrition
was selected as one of the 12 focus
areas.6 Five nutrition and two maternal/infant health objectives address
critical areas that represent the most
significant nutrition-related concerns in
Arizona. The nutrition-related objectives include:
• Healthy Weight
• Fruit and vegetable intake
(especially dark green or deep
yellow vegetables)
• Dietary Calcium
• Folate
• Breastfeeding
• Iron Deficiency Anemia
• Food Security.
National recommendations from
Healthy People 2010, the Surgeon
General’s Call to Action and other
health experts are consistent in identifying the food consumption patterns
outlined in the Dietary Guidelines for
Americans as the cornerstone of prevention and treatment efforts needed
to promote health and prevent disease

Table 1

Nutrition and
Your Health:
Dietary Guidelines
for Americans
Aim for Fitness
• Aim for a healthy weight
• Be physically active each day
Build a Healthy Base
• Let the Pyramid guide your food
choices
• Choose a variety of grains daily,
especially whole grains
• Choose a variety of fruits and
vegetables daily
• Prepare and keep food safe to eat
Choose Sensibly
• Choose a diet that is low in saturated fat and cholesterol and
moderate in total fat
• Choose beverages and foods to
moderate your intake of sugars
• Choose and prepare foods with
less salt
• If you drink alcoholic beverages,
do so in moderation
in the United States.7 These guidelines
are listed in Table 1. The United States
Department of Agriculture (USDA)
indicates that only three percent of
Americans meet four of the five
recommendations for the intake of
grains, fruits, vegetables, dairy products and meats.8
For more information on dietary
recommendations, visit the USDA’s
Center for Nutrition Policy and
Promotion website at
www.usda.gov/cnpp. This website
includes information on the Dietary
Guidelines, the Food Guide Pyramid
and an interactive “Healthy Eating
Index” assessment tool.
continued on page 8

March/April 2002

SUMMARY OF SELECTED REPORTABLE DISEASES
(January - December, 2001)1
Jan - Dec
2001

Jan - Dec
2000

5 Year Median
Jan - Dec

10 (4)
1
1
382 (160)
0 (0)

5 (3)
0
5
102 (52)
1 (0)

6 (3)
5
5
71 (43)
2 (1)

655
31
10
743
491

619
56
20
795
568

537
*
19
844
638

411
163
1186
9
6391

466
212
1121
21
6331

1760
202
*
25
5565

787
199
56
21

813
214
42
33

*
183
*
44

14357
3923
180 (32)

12610
4136
189 (26)

11431
4136
185 (21)

11 (3)
876

17 (3)
1089

16 (2)
*

1
0
128

4
1
101

3
1
52

2305
289
281
260
197 (169)
27

1917
261
386
357
275 (212)
24

1464
262
346
496
319 (285)
30

VACCINE PREVENTABLE DISEASES:
Haemophilus influenzae, serotype b invasive disease (<5 years of age)
Measles
Mumps
Pertussis (<12 years of age)
Rubella (Congenital Rubella Syndrome)
FOODBORNE DISEASES:
Campylobacteriosis
E.coli O157:H7
Listeriosis
Salmonellosis
Shigellosis
VIRAL HEPATITIDES:
Hepatitis A
Hepatitis B
Hepatitis B: non-acute2
Hepatitis C
Hepatitis C: non-acute3
INVASIVE DISEASES:
Streptococcus pneumoniae
Streptococcus Group A
Streptococcus Group B in infants <30 days of age
Meningococcal Infection
SEXUALLY TRANSMITTED DISEASES:
Chlamydia
Gonorrhea
P/S Syphilis (Congenital Syphilis)
DRUG-RESISTANT BACTERIA:
TB isolates resistant to at least INH (resistant to at least INH & Rifampin)
Vancomycin resistant Enterococci isolates
VECTOR-BORNE & ZOONOTIC DISEASES:
Hantavirus Pulmonary Syndrome
Plague
Animals with Rabies
ALSO OF INTEREST IN ARIZONA:
Coccidioidomycosis
Tuberculosis
HIV
AIDS
Lead Poisoning (<16 years of age)
Pesticide Poisoning4

1 Data are provisional and reflect case reports during this period except HIV, AIDS, and Lead Poisoning which are by date of diagnosis.
2 The non-acute hepatitis B case count includes individuals with a positive HBsAg or HbeAg test alone and may include some acutely infected individuals. These counts reflect the year reported or tested and not the date infected. Case counts are not available before 1997.
3 The non-acute hepatitis C case count includes individuals with a positive screening test alone and may include falsely positive individuals. Known risk factors such as intravenous drug use
increases the likelihood of these screening tests to be true positives. These counts reflect the year reported or tested and not the date infected. Case counts are not available before 1997.
4 Not all reports will be confirmed as meeting the case definition for pesticide poisoning upon further investigation.
* Vancomycin Resistant Enterococci, E.coli O157:H7, Streptococcus pneumoniae, and Group B Streptococcal disease not reportable until 4/97.

March/April 2002

Prevention Bulletin

5

Pertussis Endemic in Maricopa County
By Sarah Santana

Pertussis is endemic in Maricopa
County, with intervals from two to six
years between epidemic years (Fig.1)
The most recent epidemic years in
Maricopa County have been 1988-89,
1992, 1998, and now 2000-2001. Of
note in 2001 are three pertussis related
infant deaths, two in Maricopa County
and a third in Pinal County.
According to the Centers for
Disease Control and Prevention, during the period 1990-1996, 17% of
reported cases less than 6 months of
age experienced pneumonia, and 72%
of infant cases required hospitalization.
With a case fatality rate of one in 500
cases, 72% of deaths occurred among
those less than 6 months of age. Cases

among adolescents and adults contribute 60% of the total (Fig. 2).
The periodic resurgence of the disease is attributable to several factors:
• the cyclic nature of the disease;
• both natural and vaccine immunity
wane with age, and no vaccine is
licensed for use among those 7
years of age or older;
• an increase in the proportion of
adolescent and adult pertussis cases
who serve as an important reservoir
in the transmission of disease to
non-immune children.
Physicians and the public are
reminded that pertussis occurs in adolescents and adults, and that they
should suspect pertussis in any person

having an unexplained cough for a
period of more than two weeks.
Providers should report a suspected
case of pertussis immediately to the
county health department. County
health department investigators will
interrupt transmission of pertussis by
ensuring antibiotic prophylaxis of close
contacts. The State Laboratory offers
free culturing of suspected pertussis
cases through your county health
department.
Sarah Santana is the Director of the Division of
Epidemiology and Statistics for Maricopa County
Department of Public Health. She can be
reached at sarahsantana@mail.maricopa.gov
or 602.506.6952.

Figure 1 Figure 2

Cases and Rates of Reported Pertussis
in Maricopa County, 1995 - 2001*

350

Cases

300

Rate/100,000

Percentage of Pertussis Cases by Age Group
Maricopa County, 2001

14
12
10

250
8

200
6

150
4

100
2

Cases per 100,000

Reported Cases

400

15-19 yrs
9%

20+ yrs
35%

10-14 yrs
16%

50
0

0

1995

1996

1997

1998 1999
Year of Report

2000

2001

*2001 are provisional data Source: Maricopa County Department of Public Health

5-9 yrs
5%

0-4 yrs
35%

Noteworthy. . .
Perchlorate contamination of
Colorado River water
The Colorado River below Lake
Mead is contaminated with low
levels of the perchlorate ion (ClO4 )originating from rocket fuel contamination in the Las Vegas Wash, near
Henderson, Nevada. Perchlorate
levels in the Colorado River water
range from non-detectable to 8
micrograms per liter.
Cleanup efforts are currently
underway at the source, but complete removal will take several years.
The thyroid appears to be the most
March/April 2002

sensitive organ in the body to perchlorate since perchlorate can interfere with iodine uptake. Studies in
human clinical drug trials have
shown that daily doses of several milligrams of perchlorate are required to
alter thyroid iodine uptake. However,
the Federal EPA is conducting new
toxicology studies to better understand the health effects, if any, from
consuming water contaminated with
low concentrations of perchlorate.
The EPA published a draft toxicological review and risk characterization for perchlorate in drinking water
in January 2002. The draft document

is currently out for public comment.
The report recommends a drinking
water clean-up level of 1 microgram
per liter. The new draft recommended
level incorporates the latest information from various studies and
includes a wide safety margin.
More information is available at:
http://www.epa.gov/safewater/ccl/perchlor/perchlo.html.
Prevention Bulletin will provide
updates on this important issue as
more information becomes available.
continued on page 8

Prevention Bulletin

7

Noteworthy. . .

continued from page 1

To improve nutrition new approaches to
dietary change are needed. Some of these
include: improving nutrition information
and education, increasing access to medical nutrition therapy, increasing the availability of healthy foods in a variety of settings, focusing on prevention of chronic
disease beginning in childhood, maintaining a sound science base for dietary recommendations and effective interventions,
strengthening state and community data
systems for nutrition indicators and building
community-based efforts by public and
private sector partners to improve dietary
habits in Arizona.
References
1.
2.
3.
4.

5.

6.

7.

8.

McGinnis JM, Foege, WH. Actual causes of death in the United States. JAMA
1993;270:2207-2212.
ADHS. Arizona Health Status and Vital Statistics 2000. ADHS, 2001.
ADHS. Behavioral Risk Factor Survey 2000. ADHS, 2001.
University of Arizona Prevention Center and Arizona Department of Health
Services. Dietary Profile of the State of Arizona 1995: Nutrient Intake and Fruit and
Vegetable Consumption. Tucson: University of Arizona, 1995.
United States Department of Health and Human Services, Public Health Service,
Office of the Surgeon General. The Surgeon General’s Call to Action To Prevent
and Decrease Obesity 2001. Bethesda: USHHS, 2001.
Arizona Department of Health Services. Healthy Arizona 2010: Collaborating for
a Healthier Future. ADHS, 2001. The ADHS website contains the nutrition-related objectives: http://www.hs.state.az.us/phs/healthyaz2010 .
United States Department of Agriculture. Nutrition and Your Health: Dietary
Guidelines for Americans, 5th edition. Washington, D.C: USDA/USHHS, (Home
and Garden Bulletin 232), 2000.
United States Department of Agriculture. USDA Continuing Survey of Food
Intakes by Individuals, 1994-96. Washington, D.C.: USDA, 1998.

Wellness Symposium Highlights
Public Health Month
National Public Health Week is
April 1-7, 2002. However, in an
effort to increase awareness of public health, Gov. Hull has issued a
proclamation to extend the state’s
celebration to the entire month of
April. Throughout the month, county
health departments will sponsor
activities across Arizona including
smoking cessation classes, screenings, immunization clinics, safety
demonstrations and teen health fairs.
To highlight the month, the 7th
Annual Wellness Symposium will be
held in Phoenix on April 18th and
19th at the Arizona Biltmore. For
more information, contact Jana
Granillo at 602.364.0155.

Study shows clarithromycin is
effective treatment for pertussis
Drs. Lebel and Mehra conducted
a prospective, randomized, single

blind trial comparing the 14 day
course of erythomycin to a 7 day
course of clarithromycin among 153
patients aged one month to 16 years
in Montreal, Canada. Clarithromycin
was equally effective in Bordetella
pertussis eradication rates and clinical cure rates. There were significantly fewer drug-related adverse
events and significantly better compliance. Also there was a significant
incidence of otitis media in the erythomycin treatment group versus
clarithromycin, 6 vs. 0.

Corrections
There was an error in the Public
Health Services Phone Directory in
the Jan./Feb. issue of Prevention
Bulletin. The correct number for
Health Registries is 602.542.7308.
The fax number for the State Health
Laboratory also was incorrect. The
correct fax number is 602.542.0760.
We apologize for any confusion
these errors may have caused.

❍ Change of Address/Name
❍ Delete my name from your mailing list
❍ I received more than one copy
Please include your mailing label with all requests
for changes. Fax changes to 602.230.5959

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Arizona Department of Health Services
Public Information Office
3815 North Black Canyon Hwy.
Phoenix, AZ 85015
602.230.5901 • Fax 602.230.5959
Jane Dee Hull, Governor
Catherine R. Eden, Ph.D., Director ADHS
Lee A. Bland, Chief, Bureau of Epidemiology
and Disease Control Services
Editorial Board
Victorio Vaz, D.V.M., Ph.D., Acting State Epidemiologist
Tim Flood, M.D.
Kathy Fredrickson, M.P.H.
Will Humble, M.P.H.
Ken Komatsu, M.P.H.
Cheryl McRill, M.D.
Wesley Press, M.S.
Sam Van Leeuwen
Emma N. Viera, M.P.H.
Managing Editor: Courtney Casillas
e-mail: ccasill@hs.state.az.us
Contributors: Jennifer Koslo, Cheryl McRill, Judy Nowak, Sarah
Santana, Sharon Sass, Bill Slanta, RuthAnn Smejkal, Victorio Vaz
This publication is supported by the Preventive Health and Health Services Block
Grant from the Centers for Disease Control and Prevention (CDC). Its contents do
not necessarily represent the views of the CDC.
If you need this publication in alternative format, please contact the ADHS Public
Information Office at 602.230.5901 or 1.800.367.8939 (State TDD/TTY Relay).

8

Prevention Bulletin

March/April 2002