depar depar depar depar department of health and human ser tment of health and human ser tment of health and human ser tment of health and human ser tment of health and human services vices vices vices vices

Malaria Control in War Areas was formed in 1942 to ensure that the areas around military bases in the southern United States remained malaria-free. Initial facilities were modest, a few rooms on the sixth floor of the Volunteer Building on Peachtree Street in Atlanta. Hardly anyone could have foreseen the future of this small organization. But Joseph W. Mountin, who was charged with setting it up, was not just anyone. An architect of modern public health, Mountin quickly realized that malaria control operations serving the needs of the states (response to state calls for help, laboratory and epidemiologic investigations, training) could become the foundation for improving the health of the nation. Indeed, in 1946 the Public Health Service established the Communicable Disease Center to work not only on malaria but on typhus and other infectious diseases. The following year, a token payment of $10 was made for a 15-acre area on Clifton Road to house the operations. In the next 60 years, minor changes were made to the name (Center for Disease Control, Centers for Disease Control, Centers for Disease Control and Prevention), but the initials, CDC, remained the same. The campus on Clifton Road grew to include 2 biosafety level 4 laboratories and other state-of-the-art facilities; operations were established in Morgantown, Cincinnati, Fort Collins, and overseas; and the work expanded to include all infectious diseases, as well as occupational health, toxic chemicals, injury, chronic diseases, health statistics, and birth defects. A magnet for gifted scientists and other professionals looking to serve in public health, CDC has attracted an exceptional cadre of talent over the years. Mountin was succeeded by leaders who pushed the agency to new levels of achievement, constantly probing new challenges and seeking new public health solutions. The thousands who work in laboratories and offices or trot the globe on epidemiologic investigations; the physicians, veterinarians, microbiologists, statisticians, economists, social scientists, other scholars, and support personnel; the many volunteers who serve on institutional review and other boards and committees; and CDC's many partners in academia, industry, clinical practice, and state and local governments all share unequivocal dedication to public health. In this climate of idealism and dedication, the achievements have been many and span all areas. CDC scientists, typically working with like-minded colleagues, identified and characterized several infectious agents and emerging infectious diseases; invented devices, tools, and stains for diagnoses and systems for surveillance; demonstrated the value of combining laboratory practices and epidemiology; and through vision and leadership, worked closely with state and local health departments to increase their effectiveness as public health organizations. Some in its midst made such major contributions that microorganisms were named after them (Lee Ajello, Ajellomyces spp.; Dannie Hollis, Vibrio hollisiae; Don Brenner, Neisseria brenneri; Robert Weaver, Neisseria weaveri; Joseph McDade, Legionella micdadei). CDC led the US campaign to immunize all children against vaccine-preventable infectious diseases; efforts to link states in search of foodborne disease outbreak causes by using molecular approaches to trace the causative organisms (PulseNet); efforts to translate science to practice, protecting women and children from such emerging infection-related conditions as toxic shock syndrome and aspirin-associated Reye syndrome. Achievements in international health have been major benchmarks. CDC contributions range from support for and leadership of the global effort to eradicate smallpox to the establishment of Projet SIDA in Africa to initiate scientific research on the HIV/AIDS epidemic. Science has changed in the past 60 years. Laboratory techniques used to detect, identify, and characterize microorganisms have moved from Petri dish and viral culture to real-time polymerase chain reaction and genome sequencing. During the 1976 Christmas holidays, a CDC laboratory scientist, using simple microbiologic methods, injected guinea pigs with material from persons who died of Legionnaires' disease. When some guinea pigs died, he injected their spleen into chicken eggs. He saw what was later confirmed to be the cause of this disease by looking under the light microscope (Figure 1). Thirty years later, others at CDC are able to identify all of almost 200,000 nucleotides that compose the genome of the smallpox virus. But science moves on. Recently, CDC scientists and colleagues have been able to recreate and reconstruct the 1918 influenza virus that caused the death of 40 to 50 million people (Figure 2). Information technology advances have enabled modeling to predict illness and death under specific circumstances, facilitate advance planning, and improve preparations for natural and human-made disasters. Figure 1 On January 14, 1977, the director of the Center for Disease Control's laboratory division, Charles C. Shepard, and microbiologist Joseph E. McDade isolated the agent that caused an outbreak of respiratory disease among members of the American Legion in ... Figure 2 Terrence Tumpey recreated the 1918 influenza A (H1N1) virus to identify characteristics that made it such a deadly pathogen. (Photo by James Gathany, courtesy of Public Health Image Library, Centers for Disease Control and Prevention) Infectious diseases have changed in the past 60 years. All but hailed as being under control, they have found new virulence, emerging and reemerging globally without end. The new landscape of disease has required changes in management and control. The spectrum of science expertise has broadened, from entomologists and parasitologists (at Malaria Control in War Areas and the 1950s) to epidemiologists, microbiologists, and immunologists (predominating in the 1960s to 1980s). Over the past 2 decades, the CDC community has become increasingly multidisciplinary, embracing molecular biologists, geneticists, bioinformatics specialists, statisticians/mathematicians, behavioral and social scientists, modelers, economists, and other scholars. What have not changed are the unique links between epidemiology and multiple other disciplines and between science and practice that keep CDC on the speed dial of every state and local public health official, every World Health Organization representative, and every minister of health worldwide. What has not changed is CDC's passion for science and public health. CDC scientists are proud to have served with so many colleagues and partners around the world on some of the greatest challenges to public health over the past 60 years. Nothing tells us we can rest on our collective laurels, impressive though they may be. Indeed, the most important lesson we have learned is that working together in research, applied public health, and preventive action is paramount because the emerging infectious disease and microbiologic challenges of the next 60 years may be even tougher than those we have already faced.

During the 2003-04 influenza season, influenza A (H1), A (H3N2), and B viruses co-circulated worldwide, and influenza A (H3N2) viruses predominated. Several Asian countries reported widespread outbreaks of avian influenza A (H5N1) among poultry. In Vietnam and Thailand, these outbreaks were associated with severe illnesses and deaths among humans. In the United States, the 2003-04 influenza season began earlier than most seasons, peaked in December, was moderately severe in terms of its impact on mortality, and was associated predominantly with influenza A (H3N2) viruses. This report 1) summarizes information collected by World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories, state and local health departments, health-care providers, vital statistics registries, and CDC and 2) describes influenza activity in the United States and worldwide during the 2003-04 influenza season and the composition of the 2004-05 influenza vaccine.

Arthritis is the leading cause of disability in the United States, and its prevalence is expected to increase as the U.S. population ages. State-specific estimates of the prevalence of this condition are key to planning health services and programs to prevent arthritis-related disability and to track progress toward meeting national health objectives for 2010 (objectives 2.1-2.8). In 2002, new questions about arthritis were released as an optional module of the Behavioral Risk Factor Surveillance System (BRFSS), and 30 states elected to use the module. This report summarizes results from the 2002 BRFSS on prevalence of doctor-diagnosed arthritis and possible arthritis. The findings indicate that the estimated prevalence of doctor-diagnosed arthritis among adults in the 30 states ranged from 17.8% to 35.8%, and the prevalence of possible arthritis ranged from 10.3% to 21.3%. Increased intervention efforts, including early diagnosis and appropriate clinical and self-management (e.g., physical activity, education, and maintaining appropriate weight), are needed to reduce the impact of arthritis.

School Health Profiles* is conducted biennially to assess characteristics of school health programs. State and local departments of education and health select either all public secondary schools within their jurisdictions or a systematic, equal-probability sample of public secondary schools to participate in School Health Profiles. At each school, the principal and lead health education teacher are sent questionnaires to be self-administered and returned to the state or local agency conducting the survey. Only principals (or their designees) were asked questions regarding competitive foods available for purchase by students in their schools. Participation in School Health Profiles is confidential and voluntary. Followup telephone calls and written reminders were used to encourage participation. Data from each survey were weighted to reflect the likelihood of principals being selected and to

depar depar depar depar department of health and human ser tment of health and human ser tment of health and human ser tment of health and human ser tment of health and human services vices vices vices vices

232 Tuberculosis Outbreak on an American Indian Reservation — Montana, 2000–2001 234 Progress Toward Elimination of Haemophilus influenzae Type b Invasive Disease Among Infants and Children — United States, 1998–2000 237 Notices to Readers March 24, 2002, will mark the 20th annual World TB Day, which recognizes the collaborative efforts of all countries involved in working to eliminate tuberculosis (TB). TB is the second leading infectious cause of death among adults worldwide: approximately 2 million persons die each year from TB, and an estimated 2 billion persons—one third of the world’s population— are infected with the bacteria that cause TB. After years of steady decline in the United States, the number of reported TB cases increased by 20% during 1985–1992. This resurgence was associated with deterioration of the infrastructure for TB services, the human immunodeficiency virus epidemic, immigration of persons from countries in which TB is endemic, TB transmission in institutional settings (e.g., hospitals and prisons), and development of multidrug-resistant TB. However, since 1992, a renewed emphasis on TB control and prevention has resulted in substantial declines in the disease. In 2001, the provisional number of TB cases decreased for the ninth straight year to an all-time low of 15,991 cases, a 2% decrease over the 16,377 cases reported in 2000. Achieving the goal of eliminating TB in the United States will require both the ability to increase resources rapidly for local TB control efforts when outbreaks occur and greatly increased efforts to combat the devastating impact of the global TB epidemic. This issue of MMWR highlights two of CDC’s efforts to eliminate TB—both domestically and internationally. Additional information on World TB Day and CDC’s TB elimination activities is available at http://www.cdc.gov/nchstp/tb. World TB Day — March 24, 2002 Progress Toward Tuberculosis Control — India, 2001

This report updates the 2000 recommendations by the Advisory Committee on Immunization Practices (ACIP) on the use of influenza vaccine and antiviral agents (MMWR 2000;49[No. RR-3]:1-38). The 2001 recommendations include new or updated information regarding a) the cost-effectiveness of influenza vaccination; b) the influenza vaccine supply; c) neuraminidase-inhibitor antiviral drugs; d) the 2001-2002 trivalent vaccine virus strains, which are A/Moscow/10/99 (H3N2)-like, A/New Caledonia/20/99 (H1N1)-like, and B/Sichuan/379/99-like strains; and e) extension of the optimal time period for vaccination through November. A link to this report and other information regarding influenza can be accessed at the website for the Influenza Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, CDC at .

The Centers for Disease Control and Prevention (CDC) is an agency of the U.S. Public Health Service (PHS) within the Department of Health and Human Services. On July 1, 1996, CDC formally celebrated its 50th anniversary. CDC was organized as the Communicable Disease Center in Atlanta, Georgia, on July 1, 1946, by Dr. Joseph W. Mountin. Its predecessor organization, Malaria Control in War Areas, had successfully kept the southeastern states malaria-free during World War II and, for approximately 1 year, free from murine typhus. Since 1946, the CDC mission has expanded to include the prevention and control of all diseases and injuries domestically and internationally. Currently, CDC employs nearly 6,000 persons with assignees in all states and in dozens of countries throughout the world. With a budget of more than $2 billion, CDC supports research and public health programs in a broad array of disciplines, such as breast and cervical cancer prevention, emerging infections, and injury control.

This report provides recommendations for use of the newly licensed hepatitis A vaccines (HAVRIX, manufactured by SmithKline Beecham Biologicals, and VAQTA, manufactured by Merck & Company, Inc.) in persons > or = 2 years of age and updates previous recommendations for use of immune globulin (IG) for protection against hepatitis A (superseding MMWR 1990;39[No. RR-2]:1-5). For preexposure protection, hepatitis A vaccine can now be used instead of IG in many circumstances; for postexposure prophylaxis, the recommendations for IG use are unchanged.

depar depar depar depar department of health and human ser tment of health and human ser tment of health and human ser tment of health and human ser tment of health and human services vices vices vices vices NOTE: A Continuing Education Activity has been approved for this report and will be included in the print and electronic format