MMWR

Morbidity and Mortality Weekly Report

Racial Disparities in Total Knee Replacements Among Medicare Enrollees – United States, 2000-2006

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This study suggests that racial disparities in total knee replacements are unchanged. Blacks with disabling knee osteoarthritis continue to lag in use of an important intervention for reducing pain and disability. This disparity may be reduced by disseminating culturally sensitive information about total knee replacements (TKR) in a variety of public settings, encouraging health care providers to initiate discussions about knee pain symptoms and loss of physical function with all older adult patients, and equipping health care providers with resources that enable them to have discussions that are thorough and tailored to the needs and concerns of their patients. A substantial increase in TKR occurred from 2000 to 2006, with a large disparity in knee replacements seen among black and white Medicare enrollees 65 years and older. Overall, total knee replacements increased by 58 percent between 2000 and 2006, with rates increasing 61 percent among whites and 56 percent among blacks. However, the rate for total knee replacement among blacks was 39 percent lower than for whites in 2006. The rate of total knee replacements varied widely in states among blacks and whites with the lowest differences occurring in D.C., Massachusetts and Delaware and the widest gaps occurring in Illinois and Pennsylvania. Despite the increase total knee replacement, historically whites have been more likely to undergo this procedure than blacks

Clostridium perfringens Food Poisoning Among Inmates in a County Jail – Wisconsin, August 2008

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To prevent foodborne illness in institutional settings prepared foods should not include reused meats or other food items that are cooked or served with meats from previous meals unless stringent food hygiene, preparation, and storage procedures are followed. On August 8, 2008 a Wisconsin county jail nurse informed local health department staff reported over 100 inmates reported experiencing nausea, vomiting and diarrhea over night. This report summarizes findings of the ensuing foodborne outbreak investigation conducted by the Wisconsin Division of Public Health and local health department staff. The illnesses were caused by eating casserole served during the evening meal on August 7, and made in part with foods from previous meals that contained macaroni, ground beef, and ground turkey (RR = 25.1). Clostridium perfringens was isolated from a leftover sample of casserole; enterotoxin was detected in stool samples obtained on August 8 from 6 ill inmates. An environmental investigation determined the casserole was made with food items that were prepared and stored improperly.

Progress Toward Measles Elimination – Europe, 2005-2008

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Despite substantial progress made toward measles elimination in the European region by 2010, achieving the elimination goal could get delayed because of the recent resurgence of measles in part of Western Europe and the presence of large susceptible adult populations in parts of Eastern Europe which creates the risk for measles outbreaks. The European Region of the World Health Organization has the goal of measles elimination by 2010. During 2007-2008, overall measles incidence in the region declined to its lowest to date (less than 10 cases per 1 million population) and coverage among children with 1 dose of measles vaccine reached a high of 94 percent. However, because of unfounded concerns about vaccine safety, measles vaccine uptake has declined in some countries, leading to recent resurgence of measles in parts of Western Europe. In addition, some Eastern European countries still have large susceptible populations among adults and are at risk of measles outbreaks. These challenges need to be urgently addressed to sustain the gains and achieve measles elimination in the European region on time.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES