Synopsis for May 11, 2001

MMWR articles are embargoed until 4 p.m. E.S.T. Thursdays.

1. Outbreak of Legionnaires' Disease Among Automotive Plant Workers — Ohio, 2001
2. Update: Outbreak of Acute Respiratory Febrile Illness Among College Students — Acapulco, Mexico, March 2001
3. Pregnancy-Related Deaths Among Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native Women — United States, 1991–1997

MMWR Reports & Recommendations
May 11, 2001/Vol. 50/No. RR-6

CDC Report Regarding Selected Public Health Topics Affecting Woman's Health

Topics addressed in this report include:

Are Women with Recent Live Births Aware of the Benefits of Folic Acid?
Each year, approximately 4,000 pregnancies result in spina bifida or anencephaly, serious and often fatal conditions for the newborn. The B vitamin folic acid can reduce the incidence of these conditions by 50%--70%. To examine folic acid awareness among women who had recently delivered a live-born infant, CDC analyzed Pregnancy Risk Assessment Monitoring System (PRAMS) data for 1995--1998. The question used to measure awareness was, "Have you ever heard or read that taking the vitamin folic acid can help prevent some birth defects?" During the study period, overall folic acid awareness increased 15%, from 64% in 1996 to 73% in 1998, although changes varied by state. Despite this increase, differences in folic acid awareness were observed among different groups of women.

Contact:
Katherine Lyon Daniel, Ph.D.
CDC, National Center for Birth Defects and Developmental Disabilities
(770) 488–7182

Successful Implementation of Perinatal HIV Prevention Guidelines: A Multistate Surveillance Evaluation
In 1994, zidovudine (ZDV) was demonstrated to substantially reduce perinatal transmission of the human immunodeficiency virus (HIV). Guidelines regarding the use of ZDV to reduce transmission and regarding counseling and voluntary testing of pregnant women were issued in 1994 and 1995, respectively. Surveillance methods were used to evaluate the implementation of these guidelines and to understand reasons for continued perinatal transmission of HIV.

Contact:
Office of Communications
CDC, National Center for HIV, STD and TB Prevention
(404) 639–8895

A Method for Classification of HIV Exposure Category for Women Without HIV Risk Information
An increasing number of cases of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) among women is reported to state and territorial health departments without exposure risk information (i.e., no documented exposure to HIV through any of the recognized routes of HIV transmission). Because surveillance data are used to plan prevention and other services for HIV-infected persons, developing methods to accurately estimate exposure risk for HIV and AIDS cases initially reported without risk information and assisting states to analyze and interpret trends in the HIV epidemic by exposure risk category is important.

Contact:
Office of Communications
CDC, National Center for HIV, STD and TB Prevention
(404) 639–8895

MMWR Fact Sheet: Pregnancy-Related Mortality
May 11, 2001
Contact: Katie Baer
CDC, National Center for Chronic Disease Prevention
& Health Promotion
(770) 488–5131

• Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women suffer a significantly higher risk of pregnancy-related mortality than non-Hispanic white women, while black women continue to have the highest risk of all of these racial and ethnic groups.
  
  
• There were 3193 pregnancy-related deaths between 1991 and 1997 in the United States. This results in an overall pregnancy-related mortality ratio (PRMR) of 11.5 per 100,000 live births.
  
  
• Hispanic women had a PRMR of 10.3 for the study period, while Asian/Pacific Islanders and American Indian/Alaska Natives had higher PRMRs, 11.3 and 12.2 respectively. In comparison, non-Hispanic whites had a PRMR of 7.3 and blacks had a PRMR of 29.6.
  
  
• The risk of a pregnancy-related death was lowest for women under the age of 30, rising after the age of 35, for all of the racial and ethnic groups where there was a large enough number to analyze.
  
  
• Place of birth, within the United States or elsewhere, was also related to the PRMR for some racial and ethnic groups. Hispanic women born outside of the United States had nearly a 50% higher PRMR than Hispanic women born within the United States.
  
  
• Women of Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native origin represented 16% of the reproductive-age population in 1997, but accounted for nearly a quarter of all of the live births in the United States. The Census Bureau projects by 2025, women of these racial and ethnic groups will make up a quarter of the women in the United States.
  
  
• A pregnancy-related death is defined as a death that occurred to women during their pregnancy or within one year after the end of the pregnancy, resulting from pregnancy complications or effects.
  

Synopsis for May 11, 2001

Outbreak of Legionnaires' Disease Among Automotive Plant Workers — Ohio, 2001

Healthcare providers should perform appropriate diagnostic tests for patients with pneumonia, who also work in settings where Legionnaires' disease transmission has been known to occur.

Four cases of Legionnaires' Disease (LD) occurred among workers at the same automotive plant in a three-day period in March, 2001. All of the cases were confirmed to be LD by Legionella urine antigen test. A case-control study was conducted to determine risk factors for exposure to Legionella among plant workers. Among 855 workers who were contacted, 484 (57%) participated in the study. Eleven of those participants met the criteria for illness. Epidemiologic studies identified a single area of the plant as the most likely source of exposure, and appropriate measures for decontamination were undertaken. Legionella can be found in many water environments, including industrial settings. LD outbreaks have been previously reported in industrial settings.

Update: Outbreak of Acute Respiratory Febrile Illness Among College Students — Acapulco, Mexico, March 2001

As of May 1, 2001, cases have been reported from 44 colleges in 22 states and the District of Columbia.

To determine where the infection may have been acquired, a study was conducted among students who stayed at three different hotels in Acapulco during the first 2 weeks of March. Analysis from the study indicate that having stayed at the Calinda Beach Hotel was significantly associated with illness. No obvious sources at the hotel or its vicinity (e.g., construction sites and bird and bat roosts) were identified, and CDC and the Mexico Ministry of Health are continuing to investigate and obtain reports of illnesses in travelers who visited the Calinda Beach Hotel during April. Histoplasmosis is caused by a fungus present in the soil. Symptoms include a high fever lasting for > 3 days, headaches, dry cough, and chest pain. The disease is not transmitted from person to person.

Pregnancy-Related Deaths Among Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native Women — United States, 1991–1997

Race and ethnicity may be indicators of a range of risk factors for pregnancy-related mortality.

It has been widely reported that racial and ethnic minority groups are at higher risk of pregnancy-related mortality, however, rates specific to ethnic minority groups such as Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women have rarely been reported. This report finds that these groups have a significantly higher risk of pregnancy related death compared to non-Hispanic white women. Further, being an immigrant may be a more important risk factor than being a member of racial/ethnic minority. During 1991-1997, there were 3193 pregnancy-related deaths. The pregnancy-related mortality ration was 12.2 for American Indians/Alaska Natives, 11.3 for Asians/Pacific Islanders, and 10.3 for Hispanics. By 2025, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women are expected to represent approximately 25 percent of the females of reproductive age in the United States.

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