Disease Control Bulletin: October 2003

Contents

disease control bulletin

Flu Vaccination Recommendations

“Each flu season is unique, but it is estimated that approximately 10 percent to 20 percent of U.S. residents get the flu, and an average of 114,000 persons are hospitalized for flu-related complications. About 36,000 Americans die on average per year from the complications of flu.” (http://www.cdc.gov/ncidod/diseases/flu/facts.htm#14)

Recommendations for Influenza Vaccine in Vermont

The optimal time to receive influenza vaccine is October and November, but it can be given in December or later. The vaccine manufacturers have indicated a sufficient supply of vaccine for the 2003-2004 season; prioritization of high-risk groups in October is not necessary. Yearly vaccination is recommended for people at risk for complications or death from influenza infection, including:

People who might be a source of infection for individuals at high risk for complication from influenza should be vaccinated. These people are:

Anyone who wants to lower their chances of getting the flu (the shot can be administered to children as young as 6 months) can get a flu shot. People who provide essential community services (such as police, firemen, etc.) should consider getting a flu shot to minimize disruption of essential activities during flu outbreaks. Students or others in institutional settings (those who reside in dormitories) should be encouraged to get a flu shot. Healthy children 6–23 months of age should be vaccinated when feasible (see below).

Contraindications to influenza vaccination are:

Influenza Vaccination in Vermont

Because young, otherwise healthy children are at increased risk for influenza-related hospitalization influenza vaccine will be provided for all children aged 6 months to 18 years, through their primary care provider regardless of Vaccines for Children or insurance status. Children without a primary care provider can be vaccinated free of charge through their Vermont Department of Health district office (by appointment). The Vermont Immunization Program will supply multidose vials of Aventis Fluzone vaccine. Single dose prefilled, preservative-free syringes (Fluzone and Fluviron ) and intranasal influenza vaccine (FluMist ) can be purchased directly from the manufacturer if desired. FluMist is approved only for healthy people between the ages of 5 and 49. Inactivated vaccine is preferred over live, intranasal influenza vaccine for physicians, nurses, family members, or anyone else who comes in close contact with anyone with a weakened immune system.

There will be several adult public vaccination clinic settings (e.g., supermarkets, churches, senior meal sites). There is a “flu clinic locator” page on the Vermont Department of Health’s website www.healthyvermonters.info.

Influenza in Long-term Care Facilities

Standing Order Programs

Influenza and pneumococcal vaccines are underused for people in the U.S. aged ≥ 65 years, even among patients in nursing homes (68% for influenza and 38% for pneumococ-cal vaccine) (MMWR 1/31/03, p.68). People in long-term care facilities often have medical conditions that place them at increased risk for complications of influenza. Several studies have shown that the use of standing orders for the administration of influenza and pneumococcal vaccine increases vaccination rates, specifically in long-term care facilities and hospitals. The ACIP recommends the use of standing orders programs, and in October 2002, the Centers for Medicare and Medicaid removed the physician signature requirement for influenza and pneumococcal vaccinations from the conditions of Participation for Medicare and Medicaid participating facilities, including long-term care facilities.

Importance of Staff Vaccination

Vaccination of staff is an important preventive measure in long-term care facilities. Staff who are clinically or subclinically infected can transmit influenza virus to residents many who are at high risk for complications from influenza. Decreasing transmission of influenza from caregivers to people at high risk might reduce influenza-related deaths among people at high risk. Even vaccinated elderly people can be susceptible to influenza as the degree of protection afforded by the vaccine decreases with age of the patient (often 30–40%, although flu vaccine is 50–60% effective in preventing hospitalization or pneumonia and 80% effective in preventing death.

Vaccination in Vermont Long-term Care Facilities

In a survey distributed by the Department of Health in November and December 2002, long-term care facilities were asked about resident and staff vaccination status for influenza and pneumococcal vaccination. On average, 89 percent of residents received influenza vaccine (range 58–100%), and 58% of residents had received pneumococcal vaccine (range 0–100%). The percentage of employees of long-term care facilities who received influenza vaccine ranged from 24–92 percent (mean=49%). Thirty-three (83%) and 31 (78%) of 40 facilities have standing orders in place for administering influenza and pneumococcal vaccines, respectively. While these numbers are similar to those seen at the national level, improvement in staff vaccination rates should be emphasized.

Influenza Summary for 2002-2003

During the 2002-2003 CDC influenza season (Septem-ber 29, 2002 through May 17, 2003), the Vermont Department of Health Laboratory tested approximately 170 respiratory specimens for influenza. Fletcher Allen Health Care Laboratory reported 8 positive influenza cultures. Of a total 55 isolates identified, 34 (62%) were influenza A viruses and 21 (38%) were influenza B viruses. Of the 50 influenza viruses subtyped, 30 (influenza A) were H1N1 (New Caledonia/ so/99), and 20 (influenza B) were B/HongKong/33/01. The flu vaccine for 2002-2003 was a good match for most of the influenza strains circulating in the United States during this season. The 2002-2003 season was considered mild by the CDC.

Confirmed influenza cases ranged in age from 2 years to 67 years. Vermont’s first positive viral culture was collected from an 18-year-old on January 9, 2003 in the Newport District. The last positive cultures of the season were collected during the first week of April. Influenza activity peaked in Vermont in the last 2 weeks of February, when Vermont reported widespread activity to CDC.

Twelve of fourteen Vermont counties (all counties except Grand Isle and Essex) had cases of confirmed influenza. Positive rapid flu tests without culture confirmation were reported from a number of practices. During February, schools reported high absenteeism rates (up to 30% of students absent) due to influenza-like illness. There was one culture-confirmed case of influenza in a nursing home resident, but no reports of outbreaks of influenza-like illness in long term care facilities.

During the regular flu season, ten sentinel medical providers (in Townshend, Springfield, St. Albans, Bennington, Newport, Burlington, Enosburg Falls, Williston, Rutland, and Island Pond) reported influenza-like illness activity to CDC weekly. Three sentinel influenza surveillance sites continued reporting through the summer, with one report of an individual who had influenza-like illness in the first week of June.

Influenza Surveillance 2003-2004

There are eleven sentinel surveillance sites in Vermont for the upcoming influenza season, located in Burlington, White River Junction, Middlebury, Springfield, St. Albans, New-port, Island Pond, Plainfield, Townshend, and St. Johnsbury.These sites report weekly the total number of patients seen and the number with influenza-like illness (fever ≥ 100 F plus cough and/or sore throat) by age group, and collect specimens for flu culture early in the season from some of their patients with influenza-like illness. The objectives of influenza surveillance are to determine when, where, and which influenza viruses are circulating; to determine the intensity and impact of influenza activity; and to detect the emergence of novel influenza viruses and unusual or severe outbreaks of influenza. Data from sentinel providers are critical for monitoring the impact of influenza and can be used to guide prevention and control activities, vaccine strain selection, and patient care.

References:

CDC. Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2003;52(No. RR-8). http://www.cdc.gov/mmwr/preview/ mmwrhtml/rr5208a1.htm

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Chronic Obstructive Pulmonary Disease, COPD

Chronic Obstructive Pulmonary Disease, or COPD, refers primarily to two lung diseases: emphysema and chronic bronchitis. COPD is a progressive, largely irreversible disease that causes decreased airflow to the lungs resulting in difficulty breathing and chronic cough. While both emphysema and chronic bronchitis impair lung function, emphysema causes the destruction of the aveoli, the air sacs within the lungs, and chronic bronchitis causes airway inflammation and the chronic overproduction of mucus. Emphysema and chronic bronchitis are often difficult to distinguish as they frequently occur together, cause similar symptoms, and require similar treatments.

COPD is the fourth leading cause of death* in Vermont, as well as the United States (U.S.), and is expected to be the third leading cause in the U.S. by the year 2020. In response to the increasing morbidity and mortality related to COPD, the Vermont Department of Health has included a Healthy Vermonters 2010 goal directly addressing COPD. The goal is to reduce the COPD mortality rate to 60 deaths per 100,000 Vermont adults over age 45 by 2010. In addition, the World Health Organization and the National Heart, Lung, and Blood Institute joined forces to create The Global Initiative for Chronic Obstructive Lung Disease (GOLD) in 1997. This organization’s objective is to raise awareness, provide guidance, and make recommendations regarding the diagnosis, treatment and management of COPD (www.goldcopd.com). Table 1 outlines the stages of COPD severity and recommended treatments.

Risk Factors

Over 80 percent of COPD cases can be attributed to cigarette smoking. Occupational risk factors for COPD include toxic chemicals, industrial smoke, dust, and other air particles. There is a dose/time dependency to the development of COPD: longer exposure to risk factors increases the risk of developing COPD. While less understood, other factors, including asthma and allergies, poor nutrition, low birth weight, periodontal disease, outdoor air pollution, frequent childhood respiratory infections, and genetics have been shown to increase the risk of COPD.

Epidemiology of COPD

Prevalence: In 2000, an estimated 10 million U.S. adults were diagnosed with COPD. Other estimates, however, suggest COPD is under-diagnosed and the number suffering from COPD is closer to 24 million. In Vermont, questions were added to the Behavioral Risk Factor Surveillance System questionnaire to assess the prevalence of COPD beginning in 2002. Based on that single year’s survey, an estimated 4.4 percent, or approximately 17,500, Vermont adults ages 25 and older reported “having ever been told by a doctor or other health professional they have COPD”.

Age: COPD is primarily a disease of older people; as much as 10 percent of the U.S. population over age 64 suffers from COPD. In 2002, an estimated 8.6 percent of Vermonters over age 64 reported having ever been told by a doctor or other health professionals that they have COPD compared to 3.4 percent of Vermont adults ages 25 to 64 years.

Table 1: GOLD Guidelines for Classifying the Severity and Treatment of COPD
Classification of Severity Characteristics Treatment
0: At risk

Normal Spirometry

Chronic symptoms (cough, sputum)

Avoid risk factors

Smoking cessation

I: Mild

FEV1/FVC < 70%

FEV1 >= 80% of predicted

With or Without Symptoms (cough, sputum)

Avoid risk factors

Short-acting bronchodilator PRN

II. Moderate

FEV1/FVC < 70%

Stage IIA: FEV1 50%-80% of predicted

Stage IIB: FEV1 30%-50% of predicted

With or Without Symptoms (cough, sputum, dyspnea)

Avoid risk factors (Stages IIA and IIB)

Regular therapy with >= 1 bronchodilators (Stages IIA and IIB)

Inhaled corticosteroids if significant symptoms and lung function response (Stages IIA and IIB) or if repeated exacerbations (Stage IIB)

Rehabilitation (Stages IIA and IIB)

III. Severe

FEV /FVC < 70%

FEV1 <30% of predicted or

FEV1<50% of predicted plus respiratory failure or clinical signs of cor pulmonale

Avoid risk factors

Regular therapy with >= 1 bronchodilators

Inhaled corticosteroids if significant symotoms and lung function response or if repeated exacerbations

Rehabilitation

Treatment of complications

Long-term O2 therapy for hypoxic respiratory failure

Evaluate for surgical treatment

Source: COPD Mortality: That was Then - This is Now! CME program for clinicians who treat COPD. April 30, 2003. www.chestnet.org/downloads/copd.pdf.

Gender: Both men and women are affected by COPD. However, over the past two decades, the impact of COPD has dramatically increased in women. In U.S. adults over age 45, the mortality rate* from COPD increased much faster from 1980 to 2000 among women (155%) than among men (12%). In 2000, for the first time, there were more deaths due to COPD among U.S. women than among U.S. men. A similar trend is seen in Vermont, where among adults over age 45, the mortality rate from COPD among women increased 215 percent compared with 31 percent among men, from 1980 to 2000. In 2000, age-adjusted COPD hospitalization rates were similar among adults over age 24 of both sexes (42.4 per 10,000 men vs. 40.2 per 10,000 women), while those for emergency department visits were higher among women (94.4 per 10,000 vs. 80.7 per 10,000). The increase in COPD morbidity and mortality among women is largely due to increases in smoking prevalence among women since the 1940s.

Race: COPD is the only lung disease to affect White Non-Hispanics disproportionately more than other races. In the U.S. in 2000, the estimated self-reported prevalence of COPD among White Non-Hispanics over age 24 was 63.6 per 1,000 vs. 50.4 per 1,000 among African-Americans. Similarly, the age-adjusted mortality rate* for White Non-Hispanics over age 45 was 130.6 per 100,000 vs. 86.4 per 100,000 for Afri-can-Americans. For other minority groups figures are less reliable, but the National Institutes of Health estimates that White Non-Hispanics have higher rates of COPD than the Hispanic and Asian/Pacific Islander populations. The higher rate of COPD experienced by White Non-Hispanics may be partially explained by a higher occurrence of smoking among this population (51.0%) as compared to African-Americans (37.3%).

Mortality:* In 2001, there were 123,974 deaths due to COPD in the United States, of which 305 were Vermont residents. In 2000, among adults over age 45, the age adjusted mortality rate was 125.0 per 100,000 for U.S. residents and 142.1 per 100,000 for Vermont residents. In general, COPD mortality rates in both the U.S. and Vermont increased over the past decade (see chart 1).

chart 1. for more info, contact the dept of health

Chart 1. Deaths due to Chronic Obstructive Pulmonary Disease

Hospitalization: COPD is also a leading cause of illness, hospitalization and disability in the U.S. and Vermont. Nearly 1,000 adult Vermont residents were hospitalized with COPD in 2001 (rate of 24.3 per 10,000 adults over age 24). In 2000, the most recent data year available for comparison, the age-adjusted rate of hospitalization related to COPD was 40.8 per 10,000 U.S. residents over age 24. Data on emergency department, outpatient hospital and primary care physician (PCP) visits are not available for Vermont. In the U.S., however, there were an estimated 1.5 million emergency room visits and 8 million outpatient hospital and PCP visits in 2000. The estimated direct and indirect COPD related medical costs in the U.S. in 1998 were $26 billion dollars.

Future of COPD in Vermont

The Vermont Department of Health is taking steps to reduce the impact of COPD in our state. Results from the Behavioral Risk Factor Surveillance System provide estimates of COPD prevalence and through analysis help guide interventions, such as tobacco cessation efforts, and address risk factors for COPD. The COPD Healthy Vermonters 2010 goal is to reduce the mortality rate due to COPD to 60 deaths per 100,000 Vermont adults over age 45 by 2010. With a current rate of 142.1 per 100,000 it is clear much work lies ahead in order to achieve this goal. Enhanced surveillance efforts, increased awareness, and implementation of necessary strategies (i.e. smoking cessation initiatives) will help to reduce the burden of COPD among all Vermonters.

Footnote

* Chronic lower respiratory disease, as a ranked leading cause of death includes asthma in addition to emphysema and chronic bronchitis. As a result, mortality statistics presented in this report include deaths resulting from asthma in the numerator.

References available upon request.

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STDs in Vermont–2002

In 2002, the incidence of reportable sexually transmitted diseases diagnosed in Vermont remained low compared with national incidence rates. However, reports of Chlamydia trachomatis infections increased significantly, as they did nationally. Possible explanations for rising chlamydia rates focus on increased use of more accurate diagnostic tests and increased screening, although greater occurrence of disease cannot be discounted completely.

The state laboratory’s use of the Aptima Combo 2 Assay test, although not introduced until May, impacted Vermont’s case rate for both chlamydia and gonorrhea in 2002. The Aptima test uses nucleic acid amplification technology (NAAT). It is highly sensitive (limiting the number of infections that the test fails to detect, i.e., false negatives) and highly specific (limiting the number of uninfected patients labeled as positive, i.e., false positives) in identifying both bacteria. Studies estimate NAAT tests are able to identify ten to forty percent more infections. Urine specimens, as well as endocervical and urethral swabs, can be tested, making specimen collection more convenient and less invasive. Asymptomatic partners of diagnosed cases, who previously would have received prophylactic treatment without testing, are now more willing and more likely to be screened.

The positivity rate for Chlamydia trachomatis from urethral and endocervical swabs increased from 2.73 percent to 3.4 percent on the 1100 specimens tested at the state laboratory in 2001 and 2002. The laboratory also tested 1000 urine specimens during 2002 that yielded 93 (9.3%) positives. Combined, the change in laboratory technology resulted in a 59.6 percent increase in the number of positive results reported by the state laboratory between 2001 and 2002.

Chlamydia

Chlamydia trachomatis infection is the most commonly reported STD in Vermont. In 2002, 954 cases of chlamydia (161 per 100,000 population) were reported. Although significantly less than the national rate of 278.3 cases per 100,000 population, this represents a 49.5 percent increase compared to 2001. Since 1998, chlamydia reports in Vermont have increased 131.0 percent.

Adolescents and young adults are most at risk for acquiring chlamydia infection. The chlamydia rate is highest in the 20–24 year old age group (1084 cases per 100,000) while the next highest rate is in the 15–19 year old age group (817 per 100,000). The rate of chlamydia infection among women (240 per 100,000) is more than three times the rate among men (70 per 100,000); however, this difference is decreasing due to more frequent screening of men. Thirty-one (3.4%) reported cases identified themselves as other than white. Geographically, 349 cases (36.6%) resided in Chittenden County. Chlamydial pelvic inflammatory disease (PID) accounted for 2.5 percent (19) of all reported infections in females with cases reported in women between ages 16 and 30. Eighty-four percent of reported PID occurred in women under 22 years of age.

Gonorrhea

During 2002, the Vermont Department of Health received reports of 98 cases of gonorrhea, resulting in a case rate of 16.58 cases per 100,000 population. This represents a 29 percent increase when compared with the 2001 and a 188 percent increase over calendar year 1998, but is still far below the overall national case rate of 128.5 cases per 100,000 population. Although fluctuations are not unusual with such small numbers of cases, the incidence rate of 16.58 cases per 100,000 represents the highest incidence rate within the past ten years. During this time the state rate has remained between 4.4 and 12.2 cases per 100,000 population.

Adolescents and young adults are at greatest risk for gonorrhea. Most cases (33.6%) occurred in the 20–24 year old age group with a case rate of 94 cases per 100,000 population followed closely by the 15–19 year old age group that accounted for 30.8 percent of all reported cases with a case rate of 65 cases per 100,000. Over the past five years, these two age groups have consistently accounted for 60 percent of all cases. Females accounted for 57 percent of all cases during the year and individuals from communities of color represented 19 percent of all reported cases. In 2002, 52 percent of reported cases identified their county of residence as Chittenden County while Rutland, Washington and Windham counties each accounted for approximately 10 percent of the state’s cases. Four cases of gonoccocal PID occurred during the year, and thirty-six cases (37%) were co-infected with Chlamydia trachomatis.

Syphilis

Two cases of infectious syphilis were reported in 2002, Both cases identified out-of-state contacts as their source of infection. This 0.3 cases per 100,000 population rate is lower than the overall reported rate in the United States of 2.2 cases per 100,000 population. No cases of endemic transmission were identified although one contact residing within the state received prophylaxis. Syphilis, which was considered essentially eradicated in Vermont prior to 1998, continues to enter Vermont sporadically through the mobility of our population. Sustained domestic transmission of primary and secondary syphilis has been eliminated.

The current CDC 2002 Sexually Transmitted Disease Treatment Guidelines are available at http://www.cdc.gov/ std/treatment/rr5106.pdf or from the STD program. The STD program also provides medications for the treatment of gonorrhea, syphilis and chlamydia free of charge to all health care providers willing to submit a medication accountability form identifying each patient to whom each drug is dispensed. Bi-cillin, doxycycline, ciprofloxacin, and azithromycin, as well as the STD Treatment Guidelines, are available by telephoning 1-800-244-7639 or 863-7245. Information regarding laboratory services is available at 802-863-7335.

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Vermont Quarterly HIV/AIDS Report - 6/30/2003

Vermont Data through 06/30/03
U.S. Data through 12/31/01

Persons Living with HIV 1,2 Persons Living with AIDS Persons Living with HIV/AIDS Cumulative AIDS Cases
Vermont3 Vermont3 US6 Vermont3 Vermont3 US9
Exposure Category No. % No. % % No. % No. % %
Gender
Male 140 78 195 85 79 82 388 88% 82%
Female 39 22 35 15 21 18 53 12 18
Total 179 100 230 100 100 100 441 100 100
Age
<13 ≤34

<1%

≤3 <1% N/A7   <1% 5 1% 1%
13–19 5 3 <3 1 2 5 1 1
20–29 53 30 27 12 20 57 13 16
30–39 66 37 108 47 42 205 46 44
40–49 47 26 68 30 28 131 30 27
50+ 7 5 23 10 7 38 9 11
Total 179 100 230 100 100 441 100 100
Race/Ethnicity
Hispanic- All Races 4 2 11 5 NA8 4 20 4 NA8
Not Hispanic -American Indian/Alaskan Native ≤3 <1 ≤3 <1 <1 ≤3 <1
Asian ≤3 <1 ≤3 <1 <1 ≤3 <1
Black or African American 16 9 24 10 10 37 8
Native Hawaiian/Pacific Islander ≤3 <1 ≤3 <1 <1 ≤3 <1
White 157 88 194 84 86 382 87
Legacy Asian/Pacific Islander ≤3 <1 ≤3 <1 <1 ≤3 <1
Multi-race ≤3 <1 ≤3 <1 <1 ≤3 <1
Total 1795 100 230 100 100 441 100
Mode of Exposure: Adult
Men who have sex with men (MSM) 102 57 121 53 45   55 257 59 46
Injecting drug use (IDU) 22 12 40 18 27 15 75 17 25
MSM/IDU 7 4 14 6 5 5 25 6 6
Heterosexual 21 12 27 12 20 12 37 9 11
Hemophilia/Coagulation disorder ≤3 2 6 3 2%10 2 11 3 1
Receipt of blood transfusion or tissue ≤3 1 5 2 1 9 2 1
Other/risk not reported or identified 22 12 14 6 9 20 5 10
Total 178 100 227 100 100 100 434 100 100
Mode of Exposure: Pediatric (<13 yrs)
Mother with/at risk for HIV infection ≤3 <1 ≤3 33 N/A11   25 4 57 91
Receipt of blood transfusion or tissue ≤3 <1 ≤3 33 25 ≤3 14 4
Hemophilia/Coagulation disorder ≤3 <1 ≤3 33 25 ≤3 14 3
Other/risk not reported or identified ≤3 100 ≤3 <1 25 ≤3 14 2
Total ≤3 100 ≤3 100 100 7 100 100

Notes:

  1. Includes only persons reported with HIV infection who have not developed AIDS.
  2. A total of 185 cases of HIV infection have been reported to the Vermont Department of Health. Of these, 178 are believed to be living.
  3. Vermont data include only those people who were residents of Vermont at the time of initial diagnosis.
  4. The HIV/AIDS Surveillance Program does not typically release data with values≤3.
  5. Race/Ethnicity is unknown for one individual living with HIV.
  6. Source of US Data: CDC. HIV/AIDS Surveillance Supplemental Report, 2001.7 (No.1), 2001 and CDC, HIV/AIDS Surveillance Report, 2001.13(no.2), 2001.
  7. National data are available for different age categories and are not directly comparable.
  8. National data are currently available for different race and ethnicity categories and are not directly comparable. This is due to a recent reporting change implemented by CDC; future reports that include 2003 data will have a comparable format.
  9. Source of US Data: CDC. HIV/AIDS Surveillance Report, 2001.12(No. 2), 2001.
  10. These exposure categories are all included in the category "Other" in the national data.
  11. National pediatric data among persons living with Aids, categorized by mode of exposure, are not currently available.

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Vermont Selected Reportable Diseases - September 28, 2003

reportable diseases 9/28/03. for more info contact the dept of health

chart 2. reportable diseases sept 28, 2003. for more infor contact the dept of health

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New State Epidemiologist

The Vermont Department of Health has appointed Cortland Lohff, MD, MPH as State Epidemiologist. Dr. Lohff comes to Vermont after serving as the Assistant State Epide-miologist and Chief, Center for Acute Disease Epidemiology at the Iowa Department of Public Health.

Dr. Lohff has an MD from the University of Wisconsin Medical School in Madison and an MPH from the University of Michigan School of Public Health in Ann Arbor. He completed a residency in general preventive medicine /public health through a joint program with the New York State Department of Health and the University at Albany School of Public Health. Dr. Lohff has board certification from the American Board of Preventive Medicine – Public Health and General Preventive Medicine.

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Breastfeeding in Vermont

Research demonstrates that breastfeeding provides general health advantages to both mother and baby and significantly decreases risks for many acute and chronic diseases.

The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of life and continued breastfeeding for at least one year. In the “Blueprint for Action on Breastfeeding,” the Surgeon General states that

“breastfeeding is one of the most important contributors to infant health … In addition, breastfeeding improves maternal health and contributes economic benefits to the family, health care system, and workplace.”

Breastfeeding rates in Vermont

The national Healthy People 2010 objectives call for 75 percent of women to be breastfeeding in the early postpar-tum period, 50 percent breastfeeding at six months, and 25 percent at one year. Breastfeeding rates in Vermont’s WIC population are higher than the national average, and have improved dramatically in the past few years. However, we are still short of the goals for both initiation and duration.

The CDC’s Pediatric Nutrition Surveillance System for 2002 shows that almost 65 percent of Vermont WIC motheres initiated breastfeeding, up from 44 percent in 1993. Fifty-one percent were still breastfeeding at six weeks postpartum, up from 35 percent in 1993 and 22 percent were still breastfeeding at one year.

WIC Helping to Overcoming the Barriers

Despite the many benefits, numerous barriers prevent women from breastfeeding. WIC is helping women overcome these barriers. As more WIC mothers choose breastfeeding, department staff and community partners’ focus needs to shift to providing early and frequent support to help women continue breastfeeding. It appears that once women make it to six months they are likely to continue to breastfeed their infants until their first birthday.

Building Breastfeeding Friendly Communities

“Using Loving Support to Build a Breastfeeding-Friendly Community” is a national collaborative to improve breastfeeding rates. The project addresses barriers to breastfeeding at six month, where rates decline steeply, while working to improve the breastfeeding messages and coordination of community services. Achieving the national goal means working with employers, community lactation partners, and mothers to both promote and support breastfeeding.

Report Disease: Vermont Toll-Free 1-800-640-4374 or 1-802-863-7240

Vermont Department of Health
Division of Health Surveillance P.O. Box 70 Burlington, VT 05402-0070
Agency of Human Services
Paul E. Jarris, MD, MPH
Commissioner

THIS BULLETIN IS PRODUCED BY THE DISEASE CONTROL BULLETIN EDITORIAL STAFF.

Curt Lohff, MD, MPH
State Epidemiologist
Managing Editor

Report Disease: Vermont Toll-Free 1-800-640-4374 or 1-802-863-7240

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