MMWR News Synopsis for March 30, 2017

Screening for Excessive Alcohol Use and Brief Counseling of Adults — 17 States and the District of Columbia, 2014

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Although not routinely done, alcohol screening and brief counseling is recommended for all adults during routine medical visits with their primary healthcare provider as an effective way to reduce excessive alcohol use. Most adult binge drinkers who were asked about their alcohol use during a checkup reported that they did not receive advice about the harms nor were they advised to drink less by their health professional. Binge drinking is five or more drinks on an occasion for men and four or more for women. It may be that the health professionals did not know their patients were binge drinkers because although 3 in 4 adults reported being asked about their alcohol use, only 1 in 3 were asked in a way to identify binge drinking, a type of excessive alcohol use. Routine alcohol screening and brief counseling, as recommended, would include developing a plan to reduce drinking among people who drink excessively, like binge drinkers.

Methadone Prescribing and Overdose and the Association with Medicaid Preferred Drug List Policies — United States 2007–2014

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While methadone is frequently involved in drug overdoses, there is evidence that effective state-based policies that encourage safe prescribing are associated with fewer methadone overdoses. A recent CDC study found that in 2014, methadone accounted for approximately 1 percent of all opioid prescriptions, but methadone-related deaths accounted for about 23 percent of all prescription opioid-related mortality. Drug overdose deaths involving methadone have declined 39 percent since 2007. Despite this decline, methadone continues to account for a large proportion of prescription opioid-related deaths. Opioid prescribing is higher among Medicaid enrollees, signaling an opportunity for intervention. There was a higher rate of methadone overdoses in a state with a Medicaid payment policy in which methadone was a “preferred drug” for pain and with routine reimbursement for the drug than in a state without such a policy. This suggests that Medicaid enrollees might benefit from policies that require review and justification for use of methadone for pain.

Sodium Intake Among Persons Aged ≥2 years — United States, 2013–2014

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Knowing which common foods are the biggest contributors to sodium in your diet is an important step in reducing sodium intake. Reducing sodium intake can reduce blood pressure, a risk factor for cardiovascular disease. This report, based on the most recent NHANES data from 2013-2014, found that 70 percent of sodium intake comes from just 25 foods, most of which are purchased at stores or restaurants. A variety of commonly consumed foods contribute to U.S. sodium intake, emphasizing the importance of sodium reduction across the food supply.

Zika Virus Transmission — Region of the Americas, May 15, 2015–December 15, 2016

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The Zika virus epidemic in the Americas is ongoing despite a decrease in intensity. Due to the possible recurrence of large outbreaks and occurrence of Zika virus-associated complications, countries and territories in the Americas and other regions where competent vectors are present need to maintain surveillance for Zika virus disease and its complications, strengthen capacity for laboratory diagnosis of Zika virus, and continue to implement prevention and control measures. Analysis of surveillance data on Zika virus disease and Guillain-Barré syndrome (GBS) as reported to the Pan American Health Organization shows that Zika virus transmission spread rapidly from Northeast Brazil to a total of 48 countries and territories in the Americas between May 2015 to December 2016, with cases peaking in February 2016 and then declining and remaining at lower levels in all sub-regions. The future of Zika outbreaks is uncertain; nevertheless, recurrent outbreaks caused by other Aedes-transmitted arboviruses, including dengue and chikungunya, suggest that Zika virus outbreaks might also continue to occur. Response efforts, including surveillance for Zika virus disease and its complications, vector control, diagnosis, research, and other prevention activities, need to be maintained or intensified.

Yellow Fever Outbreak — Kongo Central Province, Democratic Republic of the Congo, August 2016

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Border areas with high population mobility and intense trade activities can foster outbreaks such as yellow fever. Public health and border officials should coordinate health surveillance and cross-border trade activities at land border crossings to prevent and control future yellow fever outbreaks. In April 2016, the Democratic Republic of the Congo’s (DRC’s) Ministry of Health declared a yellow fever outbreak. About 90 percent of suspected yellow fever cases and deaths were reported in Kongo Central Province, bordering with Angola, where a large yellow fever outbreak has been ongoing since December 2015. Results from active yellow fever surveillance indicated that among 393 specimens tested, 37 were laboratory confirmed; 35 of these cases were imported from Angola. Two-thirds of confirmed cases occurred in people who crossed the DRC-Angola border at one market city (Lufu), where 40,000 travelers cross the border each week on market day. Coordinating enhanced laboratory and case-based surveillance with border health screening and trade activities is crucial in this area.

Evaluation of Automated Molecular Testing Rollout for Tuberculosis Diagnosis using Routinely Collected Surveillance Data — Uganda, 2012–2015

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WHO recommends use of Xpert MTB/RIF – a test that provides two-hour detection of tuberculosis infection and rifampin-resistance mutations and which can be used in different settings – as the initial diagnostic test for people with HIV, children, and those at risk of drug-resistant TB. A study of the impact of Xpert MTB/RIF in Uganda suggests more comprehensive evaluation should be conducted. Uganda introduced Xpert MTB/RIF in 2012. This study assessed the impact of Xpert MTB/RIF on TB care and control from 2012-2015 using quarterly reports from 10 districts and patient records from six health facilities in Kampala. The analysis found no statistically significant difference in new TB cases reported since Xpert MTB/RIF was introduced, although some districts saw a significant increase in the number of confirmed TB cases. Overall, there were also no differences in treatment outcomes when comparing before-and-after Xpert MTB/RIF availability in the Kampala facilities. The large number of TB cases already diagnosed in Uganda prior to Xpert MTB/RIF’s availability combined with the early stage of the test’s national rollout and the possibility that clinicians defer diagnosis in patients with a negative test may partly explain the lack of the test’s impact. The study recommends that once Xpert MTB/RIF is fully established in Uganda, researchers should re-evaluate its impact and assess clinician estimation of test sensitivity.

Notes from the Field:

• Adverse Events Following a Mass Yellow Fever Immunization Campaign — Kongo Central Province, Democratic Republic of the Congo, September 2016

Quick Stats:

• Percentage of U.S. Women Aged 21–65 Years Who Never Had a Papanicolaou Test (Pap Test), by Place of Birth and Length of Residence in the United States — National Health Interview Survey, 2013 and 2015

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