Persistence of Zika Virus in Body Fluids — Preliminary Report Interview with:
Gabriela Paz-Bailey MD PhD

Senior Epidemiologist
Centers for Disease Control and Prevention What is the background for this study?

Response: Zika virus is recognized as a cause of microcephaly and other severe birth defects when a woman is infected during pregnancy. Additionally, it has been associated with potentially fatal complications, such as Guillain-Barré syndrome. It is not well understood how often Zika virus particles can be detected in semen and other body fluids and for how long they remain detectable. Existing evidence is based on case reports and cross-sectional observations, primarily from returning travelers. A more comprehensive description of the dynamics of the early stages of Zika virus infection, observed within infected people over time, is needed to inform diagnostic testing as well as prevention recommendations and interventions.
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Hepatitis C Screening of Baby-Boomers Still Underutilized Interview with:
Cheryl Isenhour, DVM, MPH

Epidemiologist |Prevention Branch
Division of Viral Hepatitis | NCHHSTP
Centers for Disease Control and Prevention What is the background for this study?

Response: It is estimated that there are over 3 million people in the United States living with Hepatitis C virus (HCV) infection. Risk factors for infection include, but are not limited to, injection drug use, history of incarceration, HIV coinfection, and blood transfusion prior to July 1992. Several direct acting antiviral medications have recently been approved to treat, and in the majority of cases, cure HCV.

The first step in identifying infected persons so that they may be cured of this infection is a blood test for antibodies to HCV.
The greatest burden of HCV is among persons born from 1945 through 1965; the baby boomer birth cohort. Therefore, in 2012, the Centers for Disease Control and Prevention (CDC) published updated HCV antibody testing recommendations to include one-time testing of persons in the birth cohort. The United States Preventive Services Task Force (USPSTF) published similar recommendations the following year. Additionally, in recent years there has been an increase in HCV infections related to injection drug use among younger people.

We used commercial insurance claims data to describe trends in HCV antibody testing over a 10-year period (2005 – 2014), both to assess the impact of the CDC and USPSTF testing recommendations, and to better understanding how trends varied by gender, age group, and geography.

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Almost 40% of Assisted Reproductive Infants Are Multiple Births Interview with:
Saswati Sunderam, PhD

Division of Reproductive Health
National Center for Chronic Disease Prevention and Health Promotion
CDC. What is the background for this study?

Response: Assisted Reproductive Technology Surveillance – United States, 2014, the surveillance summary published this week in CDC’s Morbidity and Mortality Weekly Report (MMWR), presents state-specific data on assisted reproductive technology (ART) use and outcomes.

The report compares ART infant outcome data with outcomes for all infants born in the U.S. in 2014, and provides data on the contributions of  Assisted Reproductive Technology to total infants born, multiple birth infants, low birth weight infants, and preterm infants for each U.S. state, the District of Columbia, and Puerto Rico.

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African American Women Remain Disproportionately Affected By HIV Interview with:
Donna Hubbard McCree, PhD MPH, RPh
Association Director for Health Equity/Division of HIV/AIDS Prevention
Centers for Disease Control and Prevention What is the background for this study? What are the main findings?

Response: HIV diagnosis rates among women declined 40% between 2005 and 2014 with the largest decline, 42%, occurring in black women. However, in 2015 black women represented 61% of HIV diagnoses among women. Our goal in this analysis was to determine whether the decline resulted in a decrease in the disparities among African American, Hispanic and white women between 2010 and 2014. There is currently not a standard method for measuring HIV-related disparity.

However, for this analysis we used three different measures – the absolute rate difference (the difference between the group with the lowest rate and the group with the highest rate); 2) the diagnosis disparity ratio (the ratio of the difference between the group rate and the overall population rate to the overall rate); and 3) the Index of Disparity (the average of the differences between rates for specific groups and the total rate divided by the total rate, expressed as a percentage). The absolute rate difference between black women and white women decreased annually, from 36.9 in 2010 to 28.3 in 2014. The diagnosis disparity ratio for black women compared to the total population decreased from 1.7 in 2010 to 1.2 in 2014. The Index of Disparity increased during 2010–2011, and then decreased each year during 2012–2014. Although disparities still exist, these findings indicate improvement.

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Do Financial Conflicts Influence CDC Guidelines For Prescription Opioids? Interview with:
Dora Lin, MHS
Sr. Research Assistant
Johns Hopkins Bloomberg School of Public Health
Center for Drug Safety and Effectiveness
Baltimore, MD 21205 What is the background for this study? What are the main findings?

Response: In response to the opioid epidemic and growing number of overdose deaths each year, the CDC released draft guidelines to improve the safe use of opioids in primary care. The draft guidelines were open to public comment, and many organizations, ranging from professional societies to consumer advocates to local governmental organizations, submitted comments regarding the guidelines. We examined the levels of support or non-support for the draft guidelines among the 158 organizations who submitted comments.   We also examined each organization’s relationship to opioid manufacturers. Most organizations supported the guidelines, regardless of whether or not they had a financial relationship to a drug company. However, organizations receiving funding from opioid manufacturers were significantly more likely to be opposed to the guidelines than those who did not receive such funding.

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Lyme Disease Ticks Common in Eastern US National Parks Interview with:
Tammi L. Johnson PhD, Microbiologist

Division of Vector-Borne Diseases
CDC What is the background for this study?

Response: Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of infected blacklegged ticks, also called deer ticks. Lyme disease is the most commonly reported vectorborne illness in the United States, with approximately 300,000 humans becoming infected each year.

While Lyme disease infections are highly concentrated in the northeast and upper Midwest, the number of counties in which the blacklegged tick has become “established” has more than doubled in the past two decades. Established populations of these ticks are found in 35 states.

Knowing that Lyme disease is increasing both in numbers of infections and in geographic range in the United States, we did this study to determine if people are at risk of encountering infected ticks while recreating in eastern national parks. This is the first large-scale survey in multiple national parks, and though suspected, it had not been confirmed that ticks in many of these parks were infected.

So the purpose of the study was to survey national park units across six Northeastern and Mid-Atlantic States and the District of Columbia, ranging from Maine in the north to Virginia in the south and characterize the risk of human exposure to ticks-borne bacteria.

Researchers from the Centers for Disease Control and Prevention and the National Park Service evaluated frequently used trails in Acadia National Park, Catoctin Mountain Park, Fire Island National Seashore, Gettysburg National Military Park, Manassas National Battlefield Park, Monocacy National Battlefield, Prince William Forest Park, Rock Creek Park, and Shenandoah National Park.

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Fewer African Americans, More Whites Injecting Drugs Interview with:

Cyprian Wejnert, Ph.D. National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention CDC

Dr. Cyprian Wejnert

Cyprian Wejnert, Ph.D.
National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
CDC What is the background for this study? What are the main findings?

Response: Our country is dealing with a devastating epidemic of opioid misuse and overdose that affects individuals, families and communities. We have long known that sharing needles and syringes is an incredibly efficient route for HIV, hepatitis and other infections to spread.

Yet, about 10% of annual HIV diagnoses in the United States occur among people who inject drugs, and there are clusters of hepatitis C infections across the country. These infections can be prevented when people who inject drugs use sterile needles, syringes and other injection equipment. One of the main findings of this study is that use of syringe services programs (SSPs) has increased substantially during the past decade, but most people who inject drugs still don’t always use sterile needles.

The analysis finds that more than half (54%) of people who inject drugs in 22 cities with a high number of HIV cases reported in 2015 they used an SSP in the past year, compared to only about one-third (36%) in 2005. Although syringe services program use has increased, findings indicate that too few people who inject drugs use only sterile needles. One in three (33%) reported in 2015 that they had shared a needle within the past year – about the same percentage that reported sharing a decade ago (36% in 2005).

The report also highlights some successes in HIV prevention among African Americans and Latinos who inject drugs, as well as concerning trends in whites who inject drugs. From our study of 22 urban areas, it appears that fewer African Americans are injecting drugs. However, it also appears there has been an increase in white Americans injecting drugs.

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17 States Have More White Deaths Than Births Interview with:

Rogelio Saenz PhD Dean, College of Public Policy University of Texas at San Antonio Senior Fellow

Dr. Rogelio Saenz

Rogelio Saenz PhD
Dean, College of Public Policy
University of Texas at San Antonio
Senior Fellow What is the background for this study? What are the main findings?

Response: My colleague, Kenneth M. Johnson, and I conducted research based on mortality and birth data from the Center for Disease Control. These data allow us to assess natural decrease, i.e., greater number of deaths compared to births. We find that 17 states had more white deaths than white births in 2014, the most historically, compared to only four in 2004. We find that the 17 states with white natural decrease tend to have relatively high percentages of their populations being elderly (65 and older), low proportions of women being in childbearing ages (15-44), and relatively low fertility rates.

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Americans Continue To Have Better Lipid Profiles Interview with:
Asher Rosinger, PHD, MPH
Epidemic Intelligence Service Officer, Centers for Disease Control and Prevention
Division of Health and Examination Nutrition Examination Surveys, Analysis Branch
National Center for Health Statistic What is the background for this study?

Response: Total cholesterol, triglycerides, and low-density lipoprotein (LDL) levels are linked to coronary heart disease and cardiovascular events. Between 1999 and 2010, total cholesterol, triglycerides, and LDL levels declined among U.S. adults. We used new data from the 2011-2014 nationally representative National Health and Nutrition Examination Survey (NHANES) to determine if earlier trends continued.

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Despite Recent Modest Declines, Childhood Obesity Prevalence Remains High Interview with:
Liping Pan, MD MPH

Centers for Disease Control and Prevention
Atlanta, GA What is the background for this study? What are the main findings?

Response: This CDC report is the first to use the WIC Participant Characteristic (WIC PC) data from the USDA to monitor trends in obesity among young children aged 2 to 4 years in the WIC program.

The main findings of the study are:

• 34 of 56 (61%) WIC state agencies reported modest decreases in obesity among young children from 2010 to 2014.
• From 2000 to 2010, the prevalence of obesity among 2-4 year olds increased from 14.0% to 15.9%, then dropped to 14.5% from 2010 to 2014.
• Obesity prevalence varied by state, ranging from 8.2 percent in Utah to 20.0 percent in Virginia.
• From 2010 to 2014, obesity prevalence decreased among all major racial/ethnic groups, including non-Hispanic whites, non-Hispanic blacks, Hispanics, American Indians/Alaska Natives, and Asians/Pacific Islanders.
• From 2000 to 2014, obesity prevalence decreased significantly among Asian/Pacific Islanders, from 13.9 percent to 11.1 percent.

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Smoking Deaths Disproportionately Affect Poor and Black Americans Interview with:
Jane Henley MSPH

Division of Cancer Prevention and Control What is the background for this study? 

Response: The Surgeon General concluded that cigarette smoking causes at least 12 types of cancer: oral cavity and pharynx, esophagus, stomach, colon and rectum, liver, pancreas, larynx, lung, bronchus and trachea, bladder, kidney and renal pelvis, cervix, and acute myeloid leukemia. Other tobacco products — cigars, chewing tobacco and snuff — and secondhand smoke are also linked to some of these cancers. What are the main findings?

Response: We examined rates and trends of new cases and deaths from these cancers using U.S. registry and mortality data from 2004 to 2013. We broke the data down by characteristics that might display disparities — sex, age, race, ethnicity, state, county-level poverty and education, rural/urban continuum, and cancer site.

We found that about 660,000 people were diagnosed with and 343,000 people died each year from these cancers. Rates were higher among men, black men and women, and people in counties with low education or high poverty. Rates ranged by state from a low of 130 cases in Utah (126 in Puerto Rico) to a high of 248 cases in Kentucky. Incidence decreased 1.3 percent per year and mortality decreased faster, at about 1.6 percent per year; decreases were observed across most groups, but not at the same rate. Disparities persist among certain groups with higher rates or slower declines in rates.

We also looked at changes in cancer death rates from 1970 to 2014 and estimated that 1.3 million tobacco-related cancer deaths were averted since 1990, in part because of comprehensive cancer and tobacco control efforts to reduce tobacco use and other cancer risk factors, early detection of cancer, and improvements in cancer treatment. What should readers take away from your report?

Response: Further reducing tobacco use can save thousands more people from getting and dying from cancer. Based on current estimates, about 36.5 million people smoke, and about half will die from a smoking related disease, unless programs are implemented to help them quit smoking. Comprehensive cancer and tobacco control programs actions can be done at the state and local level, such as:

• Promoting healthy, tobacco-free environments
• Increasing access to early detection and care for tobacco-related cancers
• Helping cancer survivors who use tobacco quit
• Better assisting communities disproportionately impacted by cancer

And of course, increasing the price of tobacco products and ongoing media campaigns, like Tips from Former Smokers, have a huge impact. What recommendations do you have for future research as a result of this study?

Response: Ongoing surveillance efforts are needed to monitor changes in the number of new cases and deaths from tobacco-related cancers and whether there are differences among communities or groups of people. This work will provide insight into the impact of comprehensive cancer and tobacco control efforts and how to target these efforts in the areas where they’re needed most. Is there anything else you would like to add?

Response: You can find more information at Thank you for your contribution to the community.


Henley SJ, Thomas CC, Sharapova SR, et al. Vital Signs: Disparities in Tobacco-Related Cancer Incidence and Mortality — United States, 2004–2013. MMWR Morb Mortal Wkly Rep 2016;65:1212–1218. DOI:

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Children Eating Too Much Salt At Every Meal Interview with:

Zerleen S. Quader, MPH CDC

Zerleen S. Quader

Zerleen S. Quader, MPH
CDC What is the background for this study? What are the main findings?

Response: Sodium reduction is considered a key public health strategy to reduce cardiovascular disease nationwide, and this study is the latest in ongoing CDC efforts to monitor U.S. sodium intake.

Eating habits and taste for salt are established early in life by what children eat. Eating too much sodium can set them up for high blood pressure now and health problems later. Previous evidence suggests that one in nine children already has blood pressure above the normal range, and strong evidence has shown that reducing sodium intake reduces blood pressure – and lowering blood pressure lowers the risk of cardiovascular disease among adults. With voluntary efforts already underway by some manufacturers to lower the sodium and added sugar content in some of their products, these findings help provide a baseline to monitor changes in the food industry, as well as sodium intake among U.S. youth.

We examined data from the 2011-2012 National Health and Nutrition Examination Survey (NHANES) to determine sodium intake by major food category, place and eating occasion. We found that average sodium intake among participants was 3,256 mg, and that doesn’t include salt added at the table. On the day of assessment, nearly 90 percent exceeded the upper level of sodium recommended for a healthy diet.

• There were some variations based on age and gender. For example:
o Average intake was highest among high school-aged children
o Girls had significantly lower daily intake than boys (for example, 2,919 mg versus 3,584 mg)
• In addition, we found that ten types of food make up nearly half of youth sodium intake nationwide, including pizza, bread, lunch meats and snack foods.

We also analyzed where the foods were obtained and found that approximately 58 percent of sodium comes from store foods, 16 percent from fast food and pizza restaurants and 10 percent from school cafeteria foods. And when we looked at occasion, we discovered that 39 percent of sodium intake was consumed at dinner, 31 percent at lunch, 16 percent from snacks and 14 percent from breakfast.
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