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MINNESOTA
DEPARTMENT
OF HEALTH
D ISEASE C ONTROL N EWSLETTER
Volume 34, Number 1 (pages 1-8)
January/February 2006
Hmong Resettlement, June 2004-June 2005
Starting in June 2004, Minnesota
experienced the largest volume of
refugee arrivals since state
resettlement efforts began in 1979.
Increased refugee numbers reflect
continuing strong migration from Africa
and a one-time, large group
resettlement of ethnic Hmong from
Wat Tham Krabok, a refugee camp
near Bangkok, Thailand.
Refugees have a unique immigration
status in that they are forced to leave
their homeland because of civil strife,
war, famine, or natural disaster. The
U.S. Department of Homeland Security
defines refugees as foreign-born
persons fleeing their country of origin
because of persecution or a wellfounded fear of persecution due to
race, religion, nationality, political
opinion, or membership in a particular
social group.
This report covers the resettlement
period from June 2004 through June
2005. During this timeframe, 7,859
primary refugees (ones who arrived
directly from overseas) came to
Minnesota; more than half of these, or
3,999 (51%), were Hmong arrivals
from Wat Tham Krabok (Figure 1).
Historical Context of Hmong-U.S.
Relations
An estimated 12 million ethnic Hmong
live throughout Southeast Asia. The
Hmong population is also growing in
the United States.1 From 1963-1975,
the U.S. military recruited Hmong living
in the highlands of Laos as soldiers to
fight Communist expansion of the Ho
Chi Minh Trail. With the fall of Saigon,
Figure 1. Hmong Refugees Arriving in Minnesota, June 2004-June 2005
1,500
1,424
Number of Arrivals
1,200
continued...
Migration Halted *
900
Inside:
819
600
348
308
300
235
191
236
208
61
44
74
51
Mar
Apr
0
0
Jun
Jul
Aug Sept
2004
Oct
Nov
thousands of Hmong fled from Laos
into Thailand, where refugee camps
were established. In recognition of its
wartime alliance with the Hmong, the
United States opened its borders to
Hmong refugees beginning in late
1975. The last U.S. resettlement from
these camps occurred in 1992.2 The
Hmong who chose to remain in
Thailand did so knowing that U.S.
humanitarian aid would no longer be
available to them. A benevolent monk
invited those Hmong remaining in
Thailand to live on the grounds of Wat
Tham Krabok, a Buddhist temple. By
the end of 2003, more than 15,000
Hmong were living there. At that point,
the Thai government approached the
United States about accepting this
population as refugees, and the U. S.
Department of State agreed. In
December 2003, the Minnesota
Department of Health (MDH) Refugee
Health Program (RHP) was notified of
this anticipated resettlement. One third
of the refugees at Wat Tham Krabok
were expected to join families in
Minnesota.
Dec
Jan
Feb
2005
Month of Arrival
*Migration halted January 21, 2005, due to detection of
multidrug-resistant tuberculosis among refugees
May
Jun
Early- and Late-Onset Neontal
Group B Streptococcal Disease;
Neonatal Sepsis Now
Reportable..................................... 4
Proposed Revisions to Newborn
Screening Rules.............................6
New Report Describes Burden of
Asthma in Minnesota.....................6
Subject Index for the Disease
Control Newsletter, 2005...............7
MDH’s Interactive Asthma Action
Plan (IAAP)—An Update...............8
In June 2004, the Wat Tham Krabok
resettlement began. Twenty-two states
have been involved, with California,
Minnesota, and Wisconsin receiving
the majority of the refugees –
approximately 38%, 34%, and 21%,
respectively. These states are also
those with the largest existing Hmong
populations, according to the 2000
U.S. Census.4 Of U.S. cities, St. Paul,
Minnesota, has received the highest
number of Wat Tham Krabok
refugees—approximately 2,387
individuals from June 2004 through
June 2005.3
Background on Refugee Health
Screening
The RHP, which is federally funded,
offers refugees a comprehensive
physical exam within 90 days of their
arrival in the United States. The exam
focuses on the detection and treatment
of infectious disease as well as on the
assessment of preventive health needs
among the new refugees. These
exams are completed by county public
health clinics in the Twin Cities
metropolitan area and in Rochester,
and by private clinics in other parts of
the state. In the Minneapolis-St. Paul
area, the RHP trained and partnered
with more than 18 private clinics to
meet the increased need for health
screening created by the high volume
of arrivals from Wat Tham Krabok. In
St. Paul, five of the recruited clinics are
the private practices of Hmong
physicians, who share linguistic and
cultural similarities with the incoming
refugee population. These partnerships
have been critical in enabling the state
to maintain a high overall screening
rate and to respond effectively to the
special disease outbreak situations
reported below.
Fifty-four percent of the refugees were
children under 15 years of age. Due to
established Hmong communities in St.
Paul and environs, 2,537 (64%) of the
refugees initially resettled in Ramsey
County. Another 1,126 (28%) moved to
Hennepin County (Figure 2).
Almost all of the refugees who
resettled in Minnesota, 3,973 (99%),
were eligible for refugee health
screening and assessment. The
remaining 26 individuals either moved
out of state or died prior to screening.
Among those who were eligible, 3,896
(98%) received a complete or partial
health screening. A complete exam
includes testing for tuberculosis (TB),
hepatitis B, pathogenic intestinal
parasites, sexually transmitted
infections, anemia, and lead level (in
children younger than 6 years). Most
refugees were assessed for and
vaccinated with age-appropriate
immunizations. They were also
assessed for other chronic conditions
and referred for follow-up care.
Health Screening Results
Tuberculosis
Although TB is a major health concern
in Southeast Asia, the infection rate
was lower than expected among the
3,318 Hmong who arrived in Minnesota
Figure 2. Initial County/Area of Resettlement of Hmong Refugess,
Arriving in Minnesota, June 2004-June 2005
2%
2%
4%
N=3,999
28%
64%
Ramsey
2
Hennepin
Anoka
Suburban Metro
Greater MN
between June 21, 2004, and January
21, 2005. Of the 3,201 refugees who
received a tuberculin skin test (TST)
during this period, 413 (13%) had an
induration of 10 mm or more; adults
aged 25 to 44 years had the highest
rate of TB infection (Table 1).
Among this initial cohort of screened
refugees, six TB disease cases (three
children [< 10 years of age] and three
adults) were identified in Minnesota.
Isolates from all six cases were drug
susceptible. However, multidrugresistant (MDR) TB was detected at
Wat Tham Krabok and among
refugees newly arrived to California.5
Because these cases of active disease
were missed in the overseas screening
process, the migration of Hmong
refugees was suspended on January
21 to allow for the implementation of
an enhanced screening protocol at
Wat Tham Krabok. All refugees started
on TB treatment were prohibited from
traveling until full treatment was
completed. The enhanced screening
included a TST for children <10 years
of age and multiple chest x-rays for all
refugees (>6 months of age). In
addition, sputum smears,
mycobacterial cultures, and drug
susceptibility tests were required if
persons presented with suspect TB
disease. Some children who were
contacts of active TB cases were
started on latent tuberculosis infection
(LTBI) treatment.
Minnesota health officials responded to
the suspension of refugee arrivals and
the identification of cases of active
disease among new arrivals by holding
educational forums for resettlement
agencies, the Hmong community, and
healthcare providers serving the
Hmong community.
Migration resumed on March 3, 2005.
Families without any indication of TB
were allowed to travel to the United
States. Subsequently, contacts of TB
cases and people with positive TST
results but without evidence of TB
disease were permitted to resettle as
well.
Between March 3, and June 30, 2005,
a second cohort of 681 Wat Tham
Krabok refugees arrived in Minnesota.
This group had a higher rate of TB
infection than the previous one. Of the
639 persons screened for TB in this
second cohort, 143 (22%) had a
positive TST with >10 mm induration.
DCN 34;1 January/February 2006
One person (> 65 years of age) was
diagnosed with TB disease during this
time frame and started on treatment.
children younger than 14 years, and
was particularly common among
children younger than 5 years.
Hepatitis B
Of the 3,896 Hmong refugees who
received a health assessment in
Minnesota, 3,741 (96%) were tested for
hepatitis B surface antigen, and 402
(11%) were positive. Among the
individuals with acute or chronic
infection, 53% were adults. All refugees
with positive results were referred to
primary care for follow up.
Hepatitis A
Hepatitis A screening becomes part of
the domestic health screening protocol
for refugees only when a known
outbreak of the disease occurs in a
specific camp. In late August 2004, an
acute hepatitis A case (IgM+ and ALT
>100 U/L) in a recently arrived Hmong
refugee was reported. Within 3 weeks
of this first report, MDH was notified of
three additional cases. In collaboration
with the Centers for Disease Control
and Prevention (CDC), an investigation
was conducted at Wat Tham Krabok.
An outbreak of hepatitis A was
recognized in the camp, and an
immunization campaign targeting
children aged 1 to 12 years was quickly
implemented. In Minnesota, recent
arrivals and clinics conducting
screenings were notified; 10 additional
acute cases were subsequently
identified between October 2004 and
December 2004. Of the 14 acute
cases, 11 (79%) were in children aged
5 years and younger. The remaining
three cases were in children aged 9,
10, and 14 years. Two cases of
transmission from new arrivals to host
family members were also reported.
Intestinal Parasites
During the time period covered in this
report, Hmong refugees had the
highest rate of parasitosis compared to
refugees who came from other world
regions; the infection rate among subSaharan Africans, for example, was
12%. Parasites were identified either
by a stool ova and parasite exam or by
antigen testing. Of the 3,642 (93%)
Hmong refugees who were screened,
860 (24%) had at least one type of
intestinal parasite. The most commonly
identified parasite was Giardia
intestinalis; it was found in 715 (83%)
of the cases. Other parasites identified
included Hymenolepis nana (90
cases), Strongyloides stercoralis (37
cases), Entamoeba histolytica (26
cases), Dientamoeba fragilis (15
cases), and hookworm (11 cases).
Multiple parasites were found in 48
(6%) of the refugees (43 had two types
and five had three types of parasites).
Parasitosis was most prevalent among
Immunizations
Due to their precarious living
circumstances, most refugees do not
arrive in the United States with health
records (if such records exist); thus,
the Hmong refugee’s immunization
status was unknown prior to their
domestic health assessment. Under a
unique immunization campaign, the
International Office of Migration (IOM)
and CDC began immunizing Hmong
refugees at Wat Tham Krabok in May
2004. Of the refugees arriving in
Minnesota, 3,985 (~100%) had
received at least one type of
vaccination. Most adults were given
tetanus and varicella vaccinations.
Children (<19 years) were given ageappropriate vaccinations against MMR
(measles, mumps, and rubella),
varicella, polio, tetanus/diphtheria,
hepatitis B, and hepatitis A. During
their health assessments in Minnesota,
3,624 (93%) of all those who were
screened started their age-appropriate
vaccines or continued with the series
that were initiated in the camp. All
vaccinations given at Wat Tham
Krabok were entered into the
Minnesota immunization registry, the
Minnesota Immunization Information
Connection (MIIC).
Lead
Between June 2004 and June 2005,
1,067 Hmong children younger than 6
years received a health assessment.
Of these children, 870 (85%) were
tested for lead, and 24 (3%) were
found to have an elevated blood lead
level greater than 10 ug/dl. These
children were referred for follow-up
care.
Table 1. Tuberculosis, Hepatitis B, and Parastic Infection Rates by Age Distribution Among Hmong Refugees
Arriving in Minnesota, June 2004-June 2005
Tuberculosis
Mar 2005-Jun 2005
Jun 2004-Jan 2005
Hepatitis B
Intestinal Parasites
Age Group
(years)
No.TST+* /Total No.
Screened (%)
No. TST+* /Total No.
Screened (%)
No. HBsAg+†/Total No.
Screened (%)
No. with >1
Type of Parasite/Total
No. Screened (%)
<5
20/703 (3)
13/136 (10)
37/766 (5)
311/795 (39)
5-14
101/1,037 (10)
34/196 (17)
126/1,200 (11)
377/1,154 (33)
15-24
84/609 (15)
44/137 (32)
104/746 (14)
103/716 (14)
25-44
123/505 (24)
36/107 (34)
90/614 (15)
46/588 (8)
45-64
54/231 (23)
10/42 (24)
27/274 (10)
19/260 (7)
65+
21/116 (18)
6/21 (29)
18/141 (13)
4/129 (3)
Total
413/3,201 (13)
402/3,741 (11)
860/3,642 (24)
143/639 (22)
*TST indicates tuberculin skin test
†
HBsAg, hepatitis B surface antigen
DCN 34;1 January/February 2006
3
Conclusion
As of December 2005, approximately
800 Hmong refugees remain with their
families at Wat Tham Krabok,
completing treatment for TB. Once
their treatment is completed, those
individuals and their families will
depart, and resettlement of the refugee
camp will be finished.
During the time period covered in this
report, 3,860 non-Hmong refugees
also resettled in Minnesota, for a total
of 7,859 refugees. More than 2,000 of
the non-Hmong arrivals were from
Somalia. Other large numbers of
refugees arrived from Ethiopia, Liberia,
and Burma.
For more information about the RHP or
the Hmong resettlement call 651-2015414 or visit www.health.state.mn.us/
refugee.
References
1. United Hmong International, Inc.,
and Lao Human Rights Council, Inc.
Hmong population in the world, Year
2000. Available at:
www.laohumrights.org/2000data.html.
Accessed December 2005.
2. Txong PL, Pfeifer ME. Building
bridges: Learning about the Hmong.
Hmong Cultural and Resource Center
online presentation. Available at:
www.learnabouthmong.org/
presentation/hmong101_files/
frame.htm. Accessed December 2005.
3. U.S. Office of Refugee
Resettlement. Cumulative Hmong
Arrivals by Voluntary Agency
(VOLAG). Arlington, VA: Refugee
Processing Center, 2005.
4. Pfeifer, ME. U.S. Census 2000:
Trends in Hmong Population Across
the Regions and Metropolitan Areas of
the United States. Research Report.
St. Paul, Minn: Hmong Resource
Centre of the Hmong Cultural Center;
2001.
5. Centers for Disease Control and
Prevention. Multidrug-resistant
tuberculosis in Hmong refugees
resettling from Thailand into the United
States, 2004-2005. MMWR Morb
Mortal Wkly Rep. 2005;54:741-744.
Early- and Late-Onset Neonatal Group B
Streptococcal Disease; Neonatal Sepsis Now Reportable
On December 2, 2005, the Centers for
Disease Control and Prevention (CDC)
published an article in the MMWR
concerning early- and late-onset
neonatal group B streptococcal
disease (GBS) in the United States.1
As a participant in the Emerging
Infections Program (EIP) Active
Bacterial Core surveillance (ABCs)
system, the Minnesota Department of
Health (MDH) was one of 10 ABCs
sites participating in this study. ABCs
conducts active, population-based
surveillance for invasive group B
Streptococcus, defined as isolation of
GBS from a normally sterile site. ABCs
collects data from standardized casereport forms that capture demographic,
obstetric, and neonatal data from
medical records. Below is a summary
of the results of that study with data
specific to Minnesota included. The
complete article as it appears in the
MMWR can be found at http://
www.cdc.gov/mmwr/preview/
mmwrhtml/mm5447a2.htm?s_c
prevention. The screening-based
approach recommends obtaining
vaginal and rectal cultures at 35-37
weeks gestation. Women with GBSpositive cultures are offered
intrapartum antimicrobial prophylaxis
(IAP) during labor. The risk-based
approach recommends administering
IAP to women who present with GBS
risk factors during labor.
Introduction
GBS disease emerged as the leading
cause of invasive bacterial infections in
newborns in the United States in the
1970s. In the mid-1980s, clinical trials
demonstrated that administering
antimicrobials intrapartum to GBS
carriers protected their newborns from
disease. In 1996, CDC published
consensus guidelines recommending
two methods of perinatal GBS disease
Multistate ABCs data indicated a 65%
decline in the incidence of early-onset
disease (0-6 days of age) from 1993 to
1998, coinciding with increased use of
IAP, followed by a plateau during 19992001. Adoption of the 2002 guidelines
was expected to result in further
reductions in early-onset disease, and
a subsequent decline was observed
during 2003-2004. To assess the
impact of these new guidelines on the
4
A large, population-based cohort study
of deliveries during 1998-1999
demonstrated that routine screening
and IAP for carriers prevented more
cases of early-onset disease than the
risk-based method. In 2002, CDC, the
American College of Obstetricians and
Gynecologists, and the American
Academy of Pediatrics issued revised
guidelines for prevention of perinatal
GBS disease.2 These guidelines
recommend universal screening of
pregnant women for rectovaginal GBS
colonization at 35-37 weeks’ gestation
and administering IAP to carriers.
incidence of neonatal GBS disease,
CDC analyzed data from the ABCs
sites from 1996-2004.
Results
From 2000-2001 (the period
immediately before universal screening
was implemented) to 2004 (the period
after universal screening was
implemented), the incidence of earlyonset GBS disease decreased by 31%
(10% decrease in Minnesota). From
1999-2001, the incidence of earlyonset disease remained stable,
averaging 0.47 (0.39 in Minnesota)
cases per 1,000 live births. Incidence
declined to 0.32 (0.29 in Minnesota) in
2003 and remained stable at 0.34
(0.37 in Minnesota) in 2004. Incidence
of GBS disease in infants aged 7-89
days (late-onset disease) has
remained unchanged. During 19962004, late-onset disease incidence
varied little, averaging 0.35 per 1,000
live births, with annual rates ranging
from 0.29-0.39 cases per 1,000 live
births. In 2003, in most sites except
Minnesota, the rate of late-onset
disease surpassed that of early-onset
disease for the first time, a trend that
continued in 2004.
Continued monitoring is needed to
assess the impact of the 2002
guidelines on early-onset disease and
the long-term effect of widespread
intrapartum use of antimicrobial agents
on neonatal GBS disease.
DCN 34;1 January/February 2006
Information regarding GBS is available
from MDH at www.health.state.mn.us/
divs/idepc/diseases/gbs/index.html
Evaluation of Adherence to the 2002
Revised Guidelines for the
Prevention of Perinatal GBS Disease
Despite great progress in perinatal
disease prevention, vertically-transmitted infections remain a leading cause
of preventable morbidity and mortality
among newborns in the United States.
This winter, MDH will be involved in a
multi-site survey to evaluate prenatal
screening practices for group B
Streptococcus, hepatitis B virus, human
immunodeficiency virus, rubella,
syphilis, Chlamydia trachomatis,
gonococcus, and bacterial vaginosis.
We will examine adherence to recommendations for treatment or prophylaxis against the diseases caused by
these pathogens. Such detailed
knowledge of actual prevention
practices will help to identify barriers to
adherence and detect missed opportunities for prevention, which will in turn
help to formulate strategies for increasing uptake of the guidelines.
All 20, seven-county Minneapolis-St.
Paul metropolitan area hospitals that
delivered an infant during 2003-2004
will be surveyed. Data for the survey
will be collected through chart review
by staff from MDH. Data will be
abstracted exclusively from labor and
delivery records. For the subset of
women who present to the delivery
hospital for premature labor (not
progressing to delivery), additional
data will be collected from the hospital
record.
If you would like further information
regarding this survey, please contact
Craig Morin at
[email protected] or call
(651) 201-5414.
Neonatal Sepsis is Now Reportable
Increase in the use of IAP associated
with GBS prevention strategies has
raised concern that other pathogens
with reduced susceptibility to penicillin
or ampicillin may become more
common causes of disease among
neonates. Recent reports from some
hospital-based studies have shown
increasing rates of early-onset nonGBS sepsis due to antibiotic-resistant
organisms among very-low-birthweight
and pre-term infants, heightening
interest in this area. Although overall
trends have been reassuring, continued surveillance in large populations
and additional information on antimicrobial resistance is needed in order to
assess whether increases in the
incidence of disease or deaths caused
by organisms other than GBS exceeds
the decreases in illness and death
attributable to IAP.
As a result, MDH added neonatal
sepsis to the Minnesota Communicable Disease Reporting Rules in
September 2005
(www.health.state.mn.us/divs/idepc/
newsletters/dcn/2005/mayjune05.pdf).
Reporting of all bacteria, excluding
coagulase-negative Staphylococcus,
isolated from a sterile site in infants
less than 7 days of age is now required. Sites considered sterile include
blood, CSF, joint fluid, etc. Submission
of clinical materials to the MDH Public
Health Laboratory is also required as
part of the disease reporting rule.
Please indicate either “Neonatal
Sepsis” or “Study 789” (project
identification code for this study) when
submitting clinical materials.
Please call the MDH Public Health
Laboratory at (651) 201-4953 if you
have questions about submitting
clinical materials, or call (651) 2015414 if you have questions about
disease reporting.
To download copies of our neonatal
sepsis poster or for more information
on neonatal sepsis surveillance
activities in Minnesota please visit:
www.health.state.mn.us/divs/idepc/
dtopics/neosep/
References
1. Centers for Disease Control and
Prevention. Early-Onset and LateOnset Neonatal Group B Streptococcal Disease – United States, 19962004. MMWR Morb Mortal Wkly Rep
2005;54(47);1205-1208.
2. Centers for Disease Control and
Prevention. Prevention of Perinatal
Group B Streptococcal Disease.
MMWR Morb Mortal Wkly Rep
2002;51(No. RR-11).
DCN 34;1 January/February 2006
5
Proposed Revisions to Newborn Screening Rules
The Minnesota Department of Health
(MDH) is proposing revisions to the
state’s Newborn Screening (NBS)
Rules, Minn. Rules, Chapter 4615.
Newborn screening is the practice of
testing every newborn for certain
harmful or potentially fatal metabolic
disorders that are not otherwise
apparent at birth. Since 1965, the
MDH Newborn Screening Program has
screened all infants born in Minnesota.
This program provides quality, costeffective screening and follow-up in
order to prevent or minimize the longterm effects of disorders that can lead
to death, developmental disability, or
other serious medical conditions in
newborns. Currently, the Program
screens infants for disorders in the
following categories: amino acid
disorders, organic acid disorders, fatty
acid oxidation disorders, endocrinopathies, and hemoglobinopathies. While
the disorders included in the newborn
screening panel are individually rare,
approximately 70 Minnesota babies
are born every year with a condition
detected by newborn blood spot
screening.
All Minnesota newborns are required
to receive newborn screening as per
Minnesota Statute 144.125 unless
their parent or guardian denies such
testing and indicates their intentions
on a form. Blood is collected on a
specimen card available from MDH.
Collection from all infants should be
completed between 24-48 hours of
age by the birthing facility or the
clinician attending the birth.
The newborn screening specimen
cards should be submitted daily to the
MDH Laboratory in St. Paul. A portion
of the specimen is sent to the Mayo
Clinic where tandem mass spectrometry (MS/MS) is performed to detect a
number of metabolic diseases. The
rest of the specimen is retained by
MDH to conduct the remaining tests in
the panel. All results are released
together in a final MDH report. Testing
is typically completed within 2 days
from receipt of specimen. For infants
with a normal newborn screen, results
are mailed to the submitter (birthing
hospital or clinic) who then forwards
them to the practitioner listed on the
newborn screening card as the
physician for follow-up. Infants who
require repeat screening will be
identified and brought to the attention
of the submitting birth hospital or clinic
and/or the practitioner. Repeat
screening is necessary if the original
specimen was collected improperly or
if the infant was less than 24 hours old
at the time of collection. The practitioner may be asked to help obtain the
repeat specimens. When an infant’s
newborn screen is abnormal, MDH will
immediately contact the primary care
physician for follow-up as well as the
relevant medical specialists by phone
and fax to ensure appropriate diagnosis and prompt care of the child.
Program staff will assist in establishing
a connection between the primary care
practitioner and the appropriate
metabolic, endocrine, or hematology
specialists. These specialists can
provide expert guidance for diagnostic
testing and follow-up evaluations.
This rulemaking process will update
the NBS rules to reflect 2003 statutory
changes and new technological
advances, as well as to clarify the
roles of MDH, hospitals, and health
care providers. In general, the department is considering the following
changes: updating references to
include all tests, strengthening roles of
participants, deleting obsolete information, describing how parents will
receive information required by statute,
and describing how the “opt out”
provision in the new statute will be
implemented. All interested persons or
groups may submit comments or
information on these possible changes
in writing. MDH encourages you to
submit your comments by February 13,
2006 to ensure that they are considered for the next draft. For more
information and a copy of the draft
revisions, visit the MDH rulemaking
Web site at http://
www.health.state.mn.us/divs/phl/
newborn/rulechange.html, e-mail
[email protected], or call
(651) 201-5465, 1-800-664-7772
New Report Describes Burden of Asthma in Minnesota
The Minnesota Department of Health
recently released a new report on the
burden of asthma in Minnesota.
Among other things, the report describes asthma prevalence, asthmarelated hospitalizations, quality of life
for people with asthma, and asthma
mortality. Asthma affects an estimated
255,000 adult Minnesotans and more
than 98,000 Minnesota children ages
0-17. Overall, Minnesota’s asthma
rates are lower than national rates;
6
however, disparities affect certain
segments of the population. Most
significantly, there are large disparities
in asthma hospitalization rates
between those who live in the Minneapolis-St. Paul metropolitan area and
the rest of the state.
The Asthma in Minnesota 2005
Epidemiology Report can be found at
http://www.health.state.mn.us/divs/
hpcd/cdee/asthma/documents/
epi2005.pdf.
For more information, call the Minnesota Department of Health Asthma
Program at 651-201-5909 or visit their
Web site at http://
www.health.state.mn.us/asthma for
fact sheets, educational materials,
blank Asthma Action Plans, and local
resources. Information on the Minnesota Asthma Coalition can be found at
http://www.mnasthma.org.
DCN 34;1 January/February 2006
Subject Index for the Disease Control Newsletter, 2005
ANNUAL SUMMARY
Annual Summary of Communicable Diseases
Reported to the Minnesota Department of Health, 2003.....................................................................................July/August
ANTIMICROBIAL RESISTANCE
Antimicrobial Susceptibilities of Selected Pathogens, 2004........................................................................................May/June
CANCER
Minnesota Cervical Cancer Update..............................................................................................................................May/June
DISEASE REPORTING
Revisions to the Communicable Disease Reporting Rules..........................................................................................May/June
Notice of Intent to Adopt Amendments to Rules Governing Communicable Disease Reporting,
Minnesota Rules, Chapter 4605.................................................................................................................January/February
MISCELLANEOUS
Delusional Parasitosis..................................................................................................................................September/October
Disease Control Newsletter-20 Years Ago...................................................................................................................May/June
Emerging Infections Conference..........................................................March/April,May/June,July/August,September/October
Health of Refugees in Minnesota, 2003-2004.................................................................................................January/February
Recent Infectious Disease Publications by MDH Staff................................................................................September/October
Revised Recommendations for Screening and Treating Latent Tuberculosis (TB) Infection in
Children and Adolescents...........................................................................................................................January/February
Subject Index for the Disease Control Newsletter, 2004.................................................................................January/February
NEW BUILDINGS
Health Department Moves to New Quarters in St. Paul............................................................................November/December
We Are Moving at the End of October to St. Paul........................................................................................September/October
SEXUALLY TRANSMITTED DISEASES
HIV Drug Resistance and Subtype Surveillance..........................................................................................September/October
VACCINES/VACCINE-PREVENTABLE DISEASES
Decline in Pneumococcal Disease in Adults Following Introduction of Pediatric Vaccine........................November/December
Meningococcal Vaccine................................................................................................................................September/October
Minnesota Influenza Vaccination Plan, 2005-06........................................................................................November/December
Pertussis and the Healthcare Setting........................................................................................................November/December
Pertussis Vaccines for Adolescents and Adults and Updated Treatment and Prophylaxis
Recommendations................................................................................................................................November/December
Recommended Childhood and Adolesecent Immunization Schedule, Minnesota, 2005................................January/February
Shortage of Pneumococcal Conjugate Vaccine, 7-valent (PCV7) is Resolved...............................................January/February
VECTOR-BORNE DISEASES
Dramatic Increase in Lyme Disease and Other Tick-borne Diseases, 2004................................................................May/June
ZOONOTIC DISEASES
Enteric Disease Associated with Animal Contact, Minnesota, 1999-2004................................................................March/April
DCN 34;1 January/February 2006
7
MDH’s Interactive Asthma Action Plan (IAAP) – An Update
Health care providers who treat
patients with asthma are encouraged
to use a downloadable, interactive tool
developed by the Minnesota Department of Health (MDH) Asthma Program. Available in desktop or online
formats, this tool assists the provider in
determining the correct asthma
severity level and selecting an appropriate treatment plan especially for
their patient. The program pulls the
provided information into a user
friendly IAAP that can be printed in
both English and Spanish. A prescription of selected medications can also
be printed. Formulary information for
seven key Minnesota health plans has
been updated to include the latest
medication listings for each plan. If
you have previously downloaded this
Dianne Mandernach, Commissioner of Health
Division of Infectious Disease Epidemiology, Prevention and Control
Harry F. Hull, M.D...............................................................State Epidemiologist
Richard N. Danila, Ph.D., M.P.H........................Assistant State Epidemiologist
Susan Perry..............................................................................................Editor
Valerie Solovjovs....................................................................Production Editor
software, you should now download the
update by going to https://
www.mnasthma.org/aap. If you have
questions, please contact
[email protected] or 651201-5629. For fact sheets, patient
education materials and other information on asthma, please visit
www.health.state.mn.us/asthma.
CHANGING YOUR ADDRESS?
Mail changes to:
MDH/Disease Control Newsletter
PO Box 64975
St. Paul, MN 55164-0975
or Phone:
651-201-5414 or
Outstate: 1-877-676-5414
or email:
[email protected]
The Disease Control Newsletter is available on the MDH web site
(http://www.health.state.mn.us/divs/idepc/newsletters/dcn/index.html).
If you require this document in another format such as large print, Braille, or cassette tape,
call 651-201-5414 or, in Greater Minnesota, call 1-877-676-5414
Minnesota Deparmtnet of Health
625 Robert Street North
PO Box 64975
St Paul, MN 55164-0975
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