Issue Number 109            September 3, 1999


  1. CDC issues public health dispatch on recent rabies exposures in Iowa
  2. CDC publishes report on epidemiology of measles in the United States in 1998
  3. CDC releases public health dispatch on polio in Afghanistan
  4. Hepatitis C is the focus of national PSAs and pilot for CDC transit ad campaign


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September 3, 1999

The Centers for Disease Control and Prevention (CDC) released "Public Health Dispatch: Multiple Human Exposures to a Rabid Bear Cub at a Petting Zoo and Barnwarming -- Iowa, 1999" in the September 3, 1999, issue of the MMWR.

The dispatch reads: "On August 27, 1999, a black bear cub, approximately 5-6 months old, died after several hours of acute central nervous system symptoms; preliminary test results available on August 28 indicated the bear had rabies. The bear was part of the Swenson's Wild Midwest Exotic Petting Zoo in Clermont, Iowa (northeastern Iowa). At the petting zoo, visitors fed,  wrestled, and may have been nipped by the bear. The bear also was taken to an August 14 barnwarming at the Tharp barn in Holy Cross, Iowa (eastern Iowa), where it reportedly nipped people. An estimated 400 people from 10 states (Arizona, California, Florida, Illinois, Iowa, Minnesota, New Mexico, New York, Ohio, and Wisconsin) and Australia had contact with the bear cub at either the petting zoo or the barnwarming during the 28 days before its death, during which the bear may have transmitted rabies virus.

"On the basis of telephone calls to petting zoo visitors who signed the guest register and provided contact information, approximately 150 of the 400 persons were exposed to the bear's saliva and need to obtain vaccine and rabies immune globulin. Public health authorities are attempting to contact petting zoo visitors by telephone and the Internet. However, because not all petting zoo visitors signed the register or provided sufficient information to enable health authorities to locate them, state and local health departments are encouraged to ensure local media coverage to alert persons who had contact with the bear after July 30 to the need for exposure assessment. Persons who attended the barnwarming also need to be assessed for prophylaxis. "Information is available from the emergency telephone number of the Iowa Department of Public Health: (515) 323-4360."

For more information, you can also contact the immunization branch of your state health department. For a list of state health department phone numbers, click here:

To obtain the text version of this MMWR article, click here:

For information on how to obtain a free electronic subscription to the MMWR, see the instructions that follow article three below.

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September 3, 1999

The Centers for Disease Control and Prevention (CDC) published a report entitled, "Epidemiology of Measles -- United States, 1998" in the September 3, 1999, issue of the MMWR.

According to this MMWR article, data from 1998 suggest "...measles is no longer an indigenous disease in the United States."

The article states, "During 1998, a provisional total of 100 confirmed measles cases was reported to CDC by state and local health departments, representing a record low number of cases and 28% fewer than the 138 cases reported in 1997." In the analysis of epidemiological data, "Most cases reported in 1998 were associated with importation, including the short chains of indigenous transmission of measles that occurred following international importation of measles."

The "Editorial Note" of this MMWR article reads in part: "Cases not associated with importation were insufficient to represent a continuous indigenous chain of measles transmission and probably were misclassifications (not measles), associated with undetected imported measles cases, or linked to known imported cases through chains of transmission not detected by the surveillance system. Misclassifications resulting from false-positive laboratory  tests are an expected result of intensive investigation for a rare disease using a laboratory test that is not 100% specific.

"Some cases may spread from undetected imported cases of measles. Detecting imported cases is difficult. International visitors with measles may leave the country before the rash appears or before they seek medical care. Even when the imported case is detected, it is difficult to detect every case in the chain of transmission, as was seen in the outbreak in Alaska. This highlights the need to obtain viral specimens from every chain of transmission to supplement epidemiologic information.

"The largest outbreak in 1998 occurred in a high school without a second dose measles vaccine requirement. As of the 1998-99 school year, 55% of U.S. students were required by their states to have two doses of measles  vaccine (CDC, unpublished data, 1998). Vaccination of all students with two doses of measles vaccine by 2001, as recommended by the American Academy of Pediatrics and CDC's Advisory Committee on Immunization Practices, will reduce future school outbreaks. Completion of this strategy should further decrease the risk for indigenous transmission of measles following importation of the measles virus.

"The United States appears to have eliminated measles as an indigenous disease. High measles vaccination coverage and strong surveillance remain critical to preventing international imported measles cases from causing a resurgence of measles in the United States."

To read the text version of the entire MMWR article, please click here:

For information on how to obtain a free electronic subscription to the MMWR, see the instructions that follow article three below.

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September 3, 1999

The Centers for Disease Control and Prevention (CDC) published "Public Health Dispatch: Outbreak of Poliomyelitis -- Kunduz, Afghanistan, 1999" in the September 3, 1999, issue of the MMWR.

The report begins: "Since May 10, 1999, 26 cases of acute flaccid paralysis (AFP), including five cases with isolation of wild poliovirus type 1 and one with type 3, have been reported from Kunduz province in northern Afghanistan... Although the exact causes for the outbreak are not known, the discontinuation of polio vaccination activities in mid-1997 in northern Afghanistan because of ongoing civil conflict may have facilitated the outbreak."

To read the text version of this entire public health dispatch, please click here:

To obtain a free electronic subscription to the MMWR (delivered weekly), go to the MMWR website and sign up. When you sign up, you will automatically begin to receive all new ACIP statements which are published as MMWR's "Recommendations and Reports." To go to the MMWR website, click here:

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September 3, 1999

In a "Dear Colleague" letter released on August 10, 1999, Harold S. Margolis, MD, chief of the Hepatitis Branch, Centers for Disease Control and Prevention (CDC), announced a new transit ad campaign to target "individuals who received blood transfusions before July 1992 to ask their doctor about being tested for hepatitis C (HCV) infection."

The letter reads in part: "Beginning as early as September 1, 1999, you may see print or hear radio public service announcements (PSAs) sponsored by CDC advising individuals who received blood transfusions before July 1992 to ask their doctor about being tested for HCV infection. These advertisements are part of our efforts to carry out general notification (lookback) of prior transfusions recipients to complement the blood industries' targeted notification efforts. The messages common to this material are "Hepatitis C: You May Be at Risk if You Had a Blood Transfusion Before July 1992. Ask your doctor if you should be tested." The PSAs will be in both English and Spanish. In addition, a preliminary campaign will occur in Chicago, IL, and Washington, DC, with large print advertisements (English only) of these messages from September 1, 1999, through October 1999 on the inside of public trains and buses."

For more information and/or to speak with a live operator regarding HCV, call CDC's toll-free hepatitis information line at (888) 443-7232 (press option #2).

For more information and/or to view the transit ads, visit CDC's Hepatitis website at

Public health departments and other health professionals who have been contacted by individuals in response to this campaign and need more information, should contact CDC's Hepatitis Branch directly at (404) 639-2709.

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IZ Express is supported in part by Grant No. 1NH23IP922654 from CDC’s National Center for Immunization and Respiratory Diseases. Its contents are solely the responsibility of and do not necessarily represent the official views of CDC.

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Editorial Information

  • Editor-in-Chief
    Kelly L. Moore, MD, MPH
  • Managing Editor
    John D. Grabenstein, RPh, PhD
  • Associate Editor
    Sharon G. Humiston, MD, MPH
  • Writer/Publication Coordinator
    Taryn Chapman, MS
    Courtnay Londo, MA
  • Style and Copy Editor
    Marian Deegan, JD
  • Web Edition Managers
    Arkady Shakhnovich
    Jermaine Royes
  • Contributing Writer
    Laurel H. Wood, MPA
  • Technical Reviewer
    Kayla Ohlde

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