Chapter 11

If we want more evidence-based practice, we need more practice-based evidence.*


Chapter 11
Communicable Disease Control


Table of Contents


REFERENCES - since publication of 8th edition





Infectious and communicable disease control provided the model for public health. Unfortunately, even the communicable diseases today do not respond so easily to single interventions such as immunization or water purification. The modes of transmission and the multiplicity of factors influencing host and antimicrobial resistance make the viral diseases and the remaining bacterial diseases of our time less responsive to the environmental controls possible against some of the scourges of the past. New models of disease control are contrasted in this chapter with classical models. Our overall objective in this chapter is to develop an understanding of the principles of communicable disease control.


Basic concepts of infection, contamination and related processes of disease transmission are presented first. The epidemiology and classification of infectious diseases follows. The saga of smallpox eradication is a tale of victory, but with tuberculosis and some sexually transmitted diseases we seem to be losing ground. The concepts of host resistance and the agent-host-environment triad suggest specific strategies for control of communicable diseases. 


Drinking While on Medication May Speed Up HIV's Advance.  June 12, 2003

Counseling Reduces Risky Behavior in HIV-Positive People.   April 29, 2003

WHO Announces Coronavirus as Cause of Severe Acute Respiratory Syndrome.  Apr. 17, 2003.   

Lethal Virus Overtaxes Hospitals in Toronto. 

Mystery Illness Moves a Hospital to Quick Action. (The New York Times, March 23, 2003) - Severe Acute Respiratory Syndrome (SARS) is thought to be a new illness, which is found mostly in China and Hong Kong.  However, the new scourge has possibly made its way to the United States.  This possibility requires that hospital take necessary precautions when a suspected case is presented in order to prevent spread of the currently unknown infectious agent.

Crude Test Offers Hope for Tracking Mystery Virus.  (The New York Times, March 22, 2003) - The World Health Organization has announced the development of a crude test to detect cases of Severe Acute Respiratory Syndrome (SARS).

Psychotherapy for HIV-Related Pain May Have Limited Appeal. Feb. 4, 2003

Pain, Poor Coping Skills Diminish Quality of Life for HIV Patients.  Jan. 24, 2003

Inspections Sharply Reduce Diarrhea Outbreaks on Cruise Ships.  Dec. 12, 2002

Perception of Punishment Undermines HIV Treatment Adherence.  Nov. 1, 2002

Alcohol Use, Thrill-Seeking Prove Bad Mix for HIV-Positive Men.  Aug. 16, 2002

Symptoms of Depressed HIV Patients not Just Psychological.  July 1, 2002

Greater Prevention Efforts Could be Cure for Rising Cost of HIV Treatment.  June 28, 2002

Panel Urges Switch to Polio Shots. ATLANTA (AP, June 17, 1999) – A federal panel recommended Thursday that the oral polio vaccine that was first given to baby boomers on a sugar cube be abandoned in favor of the injected version to reduce the risk of contracting the paralyzing disease from the serum itself. The oral vaccine, developed by Dr. Albert Sabin, has been used for nearly four decades and played a major role in the elimination of polio. But because it is made with a live virus, it causes about eight people in the United States each year to become infected with polio. In contrast, the injectable vaccine developed by the medical pioneer Dr. Jonas Salk in the 1950s relies on a killed virus. Salk had long insisted his injectable vaccine was safer. However, other scientists said it was not as effective at providing lifelong immunity. [See below under  "Other References" or go to the full report in MMWR at:]

Weakened AIDS Virus Still Damaging.
(AP, June 3, 1999) - Several people in Australia who caught a weakened form of HIV in the early 1980s are showing AIDS-like damage to their immune systems, a development with disappointing implications in the search for a vaccine. Between 1980 and 1984, 13 people in Australia received blood donated by an HIV-infected man, and eight of them caught the virus. When none got sick, researchers analyzed the virus and found that it was missing a working copy of a gene called nef, which boosts HIV reproduction. Over the years, three of the infected people died of other causes, and none has gotten AIDS. Some researchers had hoped that a vaccine modeled on the weak virus could be an effective AIDS vaccine, protecting people for life without making them sick. For New England Journal of Medicine abstract, see:

Meningitis Vaccine Study Released.
CHICAGO (AP, May 26, 1999) – Researchers have found that college students living on campus are about three times more likely to contract meningitis infections than classmates who live off campus. The analysis released Tuesday in The Journal of the American Medical Association was performed by researchers at Johns Hopkins University School of Public Health. The findings prompted the American College Health Association to renew its 1997 recommendation that all college students consider getting vaccinated against meningococcal disease, which can cause meningitis or an overwhelming and often fatal blood infection called meningococcemia. Meningococcal disease afflicts 125 to 175 college students annually and kills 15 to 20 of them, according to public health estimates.

Flu Season Was Deadlier Than Usual.
ATLANTA (AP, May 14, 1999) – The U.S. flu season was apparently deadlier than usual this year, the government reported Thursday. The flu season runs from October through mid-May. The Centers for Disease Control and Prevention does not know yet how many people died this season from the flu. However, in an average flu season, there are about 20,000 deaths, and about 30,000 when the Type A-H3N2 virus hits – as it did this year, the CDC said. The deadliest flu season in the past decade was 1989-90, when about 44,000 people died. This year, the flu season got off to a slow start, with few cases until mid-January. By February, the flu was widespread in 40 states. The outbreaks had tapered off by mid-April. The strain most prevalent was Type A Sydney.

India Cites Tuberculosis Threat.
NEW DELHI, India (AP, Mar. 17, 1999) - With nearly half of its 980 million people infected with tuberculosis, India has obtained a $144 million loan from the World Bank to fight the disease. Using the loan, the government hopes to reach 271 million people using the directly observe treatment strategy (DOTS), G.R. Khatri, a deputy director general in the health ministry, said at a news conference Wednesday. Globally, tuberculosis is the biggest killer of young people and adults. A half million people die of it every year in India. The death rate has come down to five per 500,000 patients from 53 per 500,000 since India adopted the DOTS strategy 15 years ago, Khat ri said. At present, 13.9 million people are covered by DOTS.

Legionnaire's Disease Hits Netherlands
. AMSTERDAM, Netherlands (AP, Mar. 16, 1999) - An outbreak of lethal Legionnaires' disease at a Dutch flower show killed another victim Tuesday, raising the death toll to 10, Dutch media reported. A government spokeswoman could not immediately confirm the reports of the latest death. The bacterial infection was traced to a flower show in Bovenkarpsel, 40 miles north of Amsterdam. On Monday, the government confirmed only that five deaths were due to Legionnaires' disease, although four others who had visited the show since have died. Just over 40 people were believed to have been infected with the pneumonia-like illness. Legionnaire's disease was named after an outbreak at a 1976 convention of the American Legion in Pennsylvania. The bacteria that are believed to cause the illness are found in soil and grow in air-conditioning ducts, storage tanks and rivers.

Blacks Getting AIDS At Record Rates
. WASHINGTON (AP, Feb. 26, 1999) - Black Americans are becoming infected with AIDS at record rates, receiving poorer care than whites and dying faster. Now, almost two decades into the AIDS epidemic, about 1,000 health care providers and activists gathered for the first medical conference on AIDS among black Americans - a frantic hunt for ways to fight the exploding racial divide. AIDS in the United States is evolving from a disease that once mostly affected white homosexuals into one largely of poor blacks, often infected from dirty drug needles or heterosexual encounters.

New Test Developed For Blood Supply.
WASHINGTON (AP, Mar. 5, 1999) – The nation's blood supply is set to undergo a revolution in safety testing: Blood banks next week begin phasing in sophisticated genetic fingerprinting tests in an attempt to wipe out the few dangerous viral infections that occasionally slip into transfusions. "This is the biggest thing that's happened in blood banking since the HIV test," said James MacPherson of America's Blood Centers, which collects about half of the nation's donated blood. Blood already is safe. But the new genetic technology, which should encompass all blood transfusions by September, promises to make it even safer.

Sudan Meningitis Epidemic Spreads.
NAIROBI, Kenya (AP, Mar. 4, 1999) – A meningitis epidemic spreading through Sudan has reached alarming levels in six states, killing at least 233 people, the International Federation of Red Cross and Crescent Societies reported Thursday. The aid agencies said 1,762 cases have been reported and warned that unless vaccination campaigns are accelerated, the disease will spread further. Vaccination campaigns are under way, but a vaccine shortage has prevented comprehensive coverage in the worst-affected states and people have begun to panic, it said. Streams of frightened people are now besieging aid offices, asking for vaccinations.

Kenya: Campaign Against Typhoid.
(The Nation, Feb. 25, 1999). At a workshop in Nairobi, the Kenya Medical Association (KMA) announced the launch of a national public awareness campaign against typhoid. One out of three Kenyans who gets infected with the disease eventually dies, a consultant microbiologist said. The World Health organization (WHO) estimates that 16 million people worldwide are afflicted by typhoid annually, resulting in about 600,000 deaths ( Typhoid is difficult to diagnose, a problem made worse in Kenya by quacks running laboratory clinics. The first line of action recommended by WHO is to avoid faecal contamination of water sources. The meeting urged Rhone Poulenc to lower the price of their typhoid vaccine to make it affordable to a majority of Kenyans.

Mandatory Hepatitis Shots Urged.
ATLANTA (AP, Feb. 18, 1999) - A U.S. federal health group wants 11 Western states with a high incidence of hepatitis A to require that children be vaccinated. Children are one of the highest risk groups for hepatitis A, the Atlanta-based Centers for Disease Control and Prevention's advisory committee on immunization said Wednesday. The committee recommended that states with at least 20 cases out of every 100,000 people - twice the national average for hepatitis. A cases between 1987 and 1997 - implement routine vaccinations. Those states currently are Arizona, Alaska, California, Idaho, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Utah and Washington.

Health Promoting Hospitals
The International WHO Network of Health Promoting Hospitals was set up in 1991 to support hospitals as the central institution of the health care sector to become a more health promoting setting. Health Promoting Hospitals focus on promoting health for patients, staff and the population in the community and they are trying to move towards a "healthy organization" (in a metaphorical sense). In the last years the experiences of several projects and activities brought about considerable expertise and knowledge. Recently the Ludwig Boltzmann-Institute for the Sociology of Health and Medicine as        Co-ordinating Centre of the network set up a homepage:

Mozambique: Cholera Outbreak.
(Arkia News Network, Feb. 5, 1999)- Cultural and religious beliefs are hampering the control of the cholera epidemic in Mozambique. Go to: Isolation of cholera patients is not adhered to because relatives want to support them and end up getting infected as well. In northern Mozambique people don't use latrines, increasing the risk of the disease. In reaction to a series of violent incidents in Nampula, police detained 99 people accused of participating in a campaign of agitation against health workers involved in combating the cholera outbreak. The agitation was attributed partly to rumors deliberately spread by opposition political parties. Minister of Health, Aurelio Zilhao, said that cholera could be ended or reduced only with the improvement of the water supply systems and hygienic measures, especially in the rural areas.

Uganda: Kampala Cholera Campaign.
(International Federation of Red Cross and Red Crescent Societies, Press Release, 4 February 1999)- The Red Cross is seeking UGS 50 million (EUR 32,200) for a cholera campaign in Uganda to avoid a repetition of last year's outbreak when 100-150 cases a day were registered in Kampala. As part of the National Cholera Task Force, the Red Cross has deployed 50 volunteers to provide community health education, chlorinate water sources, locate cholera cases and transport them to hospital. It also plans to improve environmental sanitation. Poor sanitation and drainage systems appear to be prime causes of the spread of cholera in Kampala. Poor domestic hygiene, inadequate latrine facilities and open defecation in and along city water courses are also contributing factors.
Uganda Red Cross Society, fax: +256-41-258184, mailto                                                                         

Fiji: Health Threat in Wake of Floods. (Australian Broadcasting Corporation, 2 February 1999) Health authorities fear an outbreak of disease in Western Fiji as a result of drinking water pollution by overflowing sewage from pit latrines, dead cattle and poor drainage. Record floods were recorded in the wake of Tropical Cyclone Dani which hit the Pacific islands of Fiji and Vanuatu on 19 January 1999. Fijian authorities have mounted an intensive campaign in flood-affected areas and have used chemicals to destroy mosquito breeding sites. ReliefWeb,

Vaccine Spells Hope for Humans Against Fatal Ebola Virus

Vaccine Spells Hope for Humans Against Fatal Ebola Virus (The Daily Telegraph January 19, 1998) Scientists have successfully immunized animals against the fatal Ebola virus. The researchers have developed a new method called genetic immunization.

CDC Starts New Efforts to Curb Surging Epidemic of Sexual Diseases. (Associated Press March 24,1998) An estimated 10-12 million new cases of sexually transmitted diseases are reported in the US each year.

Health Education: the Gateway to Malaria Prevention. (Times of Zambia March 24, 1998) Health education is essential in combating malaria. WHO and UNESCO has initiated a malaria-safe behaviors program for schools and parents. This disease is preventable and curable.


For related news stories, please click here


Flu Prevention -  offers information on some of the medical options you have for preventing and treating the flu.


Home Hygiene: Tips, Resources and Best Practices for the Prevention of the Spread of Illness 

This guide provides home-cleaning tips that will help keep your home germ-free. 


5 Ways to Protect Your Child in Flu Season 

Written by a physician, this article offers some helpful ways to help prevent your children from getting sick, as well as how to teach them to protect themselves using healthy hygiene practices. 


Healthy House, Healthier Body 

This article identifies some larger-scale home health hazards to take care of that may be threatening your health. 


Waterborne Illness and Swimming Pool Water

Bacteria has a habit of hiding out in our swimming pools. This article informs on what germs to look out for, and how to kill them.


Senior Flu Prevention and Taking Care of the Elderly

Individuals who are 65 and older are especially susceptible to the flu virus. This resource offers insight on keeping your loved ones healthy. 

Resources to Help Prevent the Spread of the Flu Virus

Infectious Disease Weblink         

Comprehensive listing of infectious disease resources available on the Internet from government, university, medical, and microbiology sites.

UNAIDS' "Best Practice Collection"

UNAIDS' "Best Practice Collection" is a collection of documents and materials regarding HIV/AIDS programming information and advocacy. Access to press releases, fact sheets and the Report on the Global HIV/AIDS Epidemic issued in Dec. 1997.

American Foundation for the 

Prevention of Venereal Disease

799 Broadway Suite 638 New York, NY 10003


Seeks to educate the public on the prevention of STDs. Distributes booklet, STD Prevention for Everyone, to individuals, health professionals, and health agencies.

Hepatitis B Coalition

1573 Selby Avenue, Suite 229 St. Paul, MN 55104


Promotes hepatitis B testing and vaccination for high-risk groups including sexually active adolescents; HBsAg screening for all pregnant women; and education and treatment for hepatitis B carriers.

National Institute of Allergy and Infectious Diseases (NIAID)

Office of Communications

9000 Rockville Pike Building 31, Room 7A-50

Bethesda, MD 20892


Conducts and supports research on the prevention, diagnosis, and treatment of infectious, immunologic, and allergic diseases, including research on the immune system and its disorders, including AIDS.

Infectious Diseases Society of America Yale University School of Medicine333 Cedar Street New Heaven, CT 06510-8056


Hold annual meetings of its membership to advance knowledge of infectious diseases.

Canada Disease Surveillance Reports

Canada Disease surveillance reports now online (31 December 1998) Health Canada introduces an online disease surveillance service that not only gives you access to multi-year data on cancer, cardiovascular  diseases and other notifiable diseases from AIDS to yellow fever, but also allows you to customize the data to fit your specific needs

Get Your Free "Healthy Images" Clip Art

Health Canada's Childhood and Youth Web site is offering a new collection of images that portray positive, healthy lifestyles by incorporating safe usage of equipment, clothing, and physical environments. The images may be used free of charge, without prior permission from Health Canada, to promote healthy lifestyles and for non-commercial purposes only. 

American Foundation for AIDS
Research on AIDS (AMFAR)
40 West 57th Street
New York, NY 10019
Phone: (212) 719-0033

Funds biomedical and psychosocial research on AIDS and raises money for research and education projects. Publishes directories

Centers for Disease Control and Prevention
Office of Information
Atlanta, GA 30333
Phone: (404) 329-3286

Answers inquiries from consumers & professionals in areas such as preventive medicine, immunization, disease control, & health education. Distributes publications, including Morbidity & Mortality Weekly Report.

Clearinghouse on Health Indexes
National Center for Health Statistics
Division of Epidemiology and Health Promotion
3700 East-West Highway, Room 2-27
Hyattsville, MD 20782
Phone: (301) 436-7035

Provides informational assistance in the development of health measures for health researchers, administrators, and planners.

Forney Miller Film Associates
West Glen Films
565 Fifth Avenue, New York, NY 10017
Phone: (212) 986-5330

"A Gift, An Obligation," color film, 16mm., 20 min. Comprehensive treatment of the development of vaccinations. Presents a historical overview of serious diseases.

Hand Washing: Compliance Control Center
8012 Fernham Lane
Forestville, MD 20747
Phone: (800) 810-4000
Fax: (301) 736-1907

Hand washing is one of the most effective strategies to prevent the spread of disease. This Center provides a wealth of information on the incidence of disease transmission and importance of hand washing in a wide range of situations.

Massachusetts Medical Society
C.S.P.O. Box 9120
Waltham, MA 02254-9120

Prints and distributes Morbidity and Mortality Weekly Report and Centers for Disease Control Summaries.

AIDS Educational Global Information System
Sisters of St. Elizabeth of Hungary
P. O. Box 184
San Juan Capistrano, CA 92693-0184
Phone: (714) 248-5843

Provides national and international information about HIV/AIDS.

Canadian AIDS Society
400-100 Sparks Street, Ottawa, ON K1P 5B7
Phone: (613) 230-3580
Fax: (613) 563-4998

The Canadian AIDS Society (CAS) is a national coalition of over 100 community-based AIDS organizations across Canada.

Immunization Coordinators in the U.S.


Health Information for International Travel


Eldis Project Based at the Institute of Development Studies University of Sussex, Brighton BN1 9RE


Adult Immunization Schedule  

(800) 232-2522


All Kids Count  

(404) 371-0466  Fax: (404) 371-1087


American Academy of Pediatrics 

(800) 433-9016


National Headquarters 

(847) 228-5005  Fax: (847) 228-5097 email:


Every Child by Two

(202) 651-7226  Fax: (202) 651-7001   email:


Immunization Action Coalition

(612) 647-9009  Fax: (612) 647-9131 email:


National Child Care Information Center (800) 616-2242
email: Anne Goldstein, Director, at 

National Institute on Aging

National Institute on Aging Information Center (800) 222-2225 email:

Basic Facts About HIV/AIDS  

AIDS Prevention Links  

CDC's Hospital Infections Program, National Center for Infectious Diseases,  




Journal References

Abraham, C., Clift, S., & Grabowski, P. Cognitive Predictors Of Adherence To Malaria Prophylaxis Regimens On Return From A Malarious Region: A Prospective Study. SOCIAL SCIENCE & MEDICINE 48 (11): 1641-1654.
    ABSTRACT: Cases of 'imported malaria' into countries where malaria is not endemic are increasing. Evidence suggests that non-use of malaria prophylaxis and lack of adherence are contributing to this increase. Non-adherence may be especially likely because chemoprophylaxis regimens require travelers to continue to take medication for 4 weeks after their return from a malarious region. We investigated the extent to which cognition measures specified by the theory of planned behavior and the health belief model could distinguish between those who reported greater or lesser adherence after their return. Results suggested that malaria prophylaxis adherence could be improved. 22.5% of mefloquine users and 31% of chloroquine and proguanil users reported adherence for 3 weeks or less. A model based on the theory of planned behavior explained approximately 50% of the variance in reported adherence among mefloquine users and 40% among chloroquine and proguanil users. Implications: Targeting key cognitions could enhance adherence on return from malarious regions. Enhancing perceived control over adherence may be important as well as emphasizing susceptibility to malaria infection. Reassuring mefloquine users concerning potential side effects of the drug may also encourage adherence on return.

Aral, S.O., Hughes, J.P., Stoner, B., Whittington, W., Handsfield, H.H., Anderson, R.M., & Holmes, K.K. (1999). Sexual Mixing Patterns In The Spread Of Gonococcal And Chlamydial Infections. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (6): 825-833.
    The Journal’s Home Page is at:
    ABSTRACT: Objectives. This study sought to define, among sexually transmitted disease (STD) clinic attendees, (1) patterns of sex partner selection, (2) relative risks for gonococcal or chlamydial infection associated with each mixing pattern, and (3) selected links and potential and actual bridge populations. Results. Partnerships discordant in terms of race/ethnicity, age, education, and number of partners were associated with significant risk for gonorrhea and chlamydial infection. In low-prevalence subpopulations, within-subpopulation mixing was associated with chlamydial infection, and direct links with high-prevalence subpopulations were associated with gonorrhea. Conclusions. Mixing patterns influence the risk of specific infections, and they should be included in risk assessments for individuals and in the design of screening, health education, and partner notification strategies for populations.

Engel, J. P. (1998).  Long-term Suppression of Genital Herpes. JAMA - JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 280 (10): 928.
    The Journal's Home Page is:

Gunn, R. A., Rolfs, R. T., Greenspan, J. R., et al.   (1998).  Role of Community-Based Organizations in Control of Sexually Transmitted Diseases.  JAMA - JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 280 (5): 419.
    The Journal's Home Page is:
    ABSTRACT: In response to a letter to the editor by officials from the State of New York Department of Health, experts from the Centers for  Disease Control and Prevention agree that community-based organizations (CBOs) are important in the prevention and control of sexually transmitted diseases. These groups "have led the way in providing STD and HIV outreach services to disadvantaged  populations that health department programs have traditionally had difficulty reaching," the authors explain. They note the need to establish integrated STD and HIV prevention efforts on the patient level into more communities, adding that it is essential to assess "the feasibility and impact of integrating  STD screening and treatment into HIV prevention services."  Integrating STD and HIV efforts at the assessment and policy  development levels is also beneficial. The researchers assert that for seamless STD and HIV prevention services, clinicians, managed care organizations, CBOs, and STD programs must work  together and establish policies.

Gounder, C. (1998). The Progress Of The Polio Eradication Initiative: What Prospects For Eradicating Measles? HEALTH POLICY AND PLANNING 13(3):212-233. 
    This issue of the Journal is:

Hinman, A. (1999). Eradication of Vaccine-Preventable Diseases. ANNUAL REVIEW OF PUBLIC HEALTH 20: 211-230.
    ABSTRACT/Full-Text: Abstract.

Hutin, Y. J. F., Bell, B. P., Marshall, K. L. E., Schaben, C. P., Dart, M., Quinlisk, M. P., & Shapiro, C. N. (1999). Identifying Target Groups For A Potential Vaccination Program During A Hepatitis A Communitywide Outbreak. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (6): 918-921.
    The Journal’s Home Page is:
    ABSTRACT: Objectives. This study sought to identify groups for targeted vaccination during a community-wide hepatitis A outbreak in 1996. Methods. Residents of the Sioux City, Iowa, metropolitan area reported with hepatitis A between September 1995 and August 1996 were sampled and compared with population-based controls. Results. In comparison with SI controls, the 40 case patients were more likely to inject methamphetamine, to attend emergency rooms more often than other health care facilities, and to have a family member who used the Special Supplemental Nutrition Program for Women, Infants, and Children. Conclusions. Groups at increased risk of hepatitis A can be identified and accessed for vaccination during communitywide outbreaks.

Kamb, M. L., Fishbein, M., Douglas Jr.,  J. M., et al.  (1998).  Efficacy of Risk-Reduction Counseling to Prevent Human Immunodeficiency Virus and Sexually Transmitted Diseases. JAMA - JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 280 (13): 1161.
    The Journal's Home Page is:

    ABSTRACT: Researchers for the Project RESPECT Study Group report the efficacy of counseling in the prevention of HIV and other sexually transmitted diseases. The researchers compared the effects of two counseling programs at five public STD clinics in the United States between July 1993 and September 1996. Over 5,700 heterosexual, HIV-negative subjects were involved, receiving either enhanced counseling and four interactive theory-based sessions, brief counseling and two interactive risk-reduction sessions, or two brief didactic messages. The researchers found that self-reported consistent condom use increased in both the enhanced and brief counseling groups at three- and six-month follow-up intervals as compared to subjects receiving only the didactic messages. Subjects receiving either enhanced or brief counseling had a 30 percent lower rate of STDs through six-months of follow-up. After one year of follow-up, the subjects in both counseling arms had a 20 percent lower rate of STDs as compared to the subjects in the didactic message arms.  The researchers note that the STD reduction was seen in both men and women and occurred consistently at all five STD clinics studied. The authors conclude that counseling, both brief and enhanced, can reduce the risk of STD infection, with brief, interactive counseling providing benefit even in busy public clinics.

St James, P.S., Shapiro, E., & Waisbren, S.E. (1999). The Resource Mothers Program For Maternal Phenylketonuria. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (5): 762-764.
    The Journal's Home Page:
    ABSTRACT: Objectives. The purpose of this study was to measure the effectiveness of resource mothers in reducing adverse consequences of maternal phenylketonuria. Methods. Nineteen pregnancies in the resource mothers group were compared with 64 pregnancies in phenylketonuric women without resource mothers. Weeks to metabolic control and offspring outcome were measured. Results. Mean number of weeks to metabolic control was 8.5 (SE = 2.2) in the resource mothers group, as compared with 16.1 (SE = 1.7) in the comparison group. Infants of women in the resource mothers group had larger birth head circumferences and higher developmental quotients. Conclusions. The resource mothers program described here improves metabolic control in pregnant women with phenylketonuria.

Thomas, M. P. (1998).  Hepatitis A Vaccination.  THE NEW ENGLAND JOURNAL OF MEDICINE 339 (10): 705. 
For full-text, go to:


Books and Reviews

Kalichman, Seth C. (2005). Positive Prevention: Reducing HIV Transmission among People Living with HIV/AIDS. New York: Springer. 

Zacher M.W. (1999).  Epidemiological Surveillance: International Cooperation To Monitor Infectious Diseases. In I. Kaul, M. Stern, & I. Grunberg, Eds. Global Public Goods. Oxford: Oxford University Press, pp. 268-285.
    This chapter reviews the needs and requirements for effective cooperation among countries to ensure the global spread of communicable diseases.


Other References

Malaria Surveillance --- United States, 2001.

Other References

Malaria Surveillance --- United States, 2001. Morbidity and Mortality Weekly Report, 52(SS-5), July 18, 2003.

HIV Diagnoses Among Injection-Drug Users in States with HIV Surveillance --- 25 State, 1994-2000.  Morbidity and Mortality Weekly Report, 52(27), July 10, 2003.

Update:  Multistate Outbreak of Monkeypox --- Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003.  Morbidity and Mortality Weekly Report, 52(27), July 10, 2003.

West Nile Virus Activity --- United States, July 3-9, 2003.  Morbidity and Mortality Weekly Report, 52(27), July 10, 2003.

Incorporating HIV Prevention into the Medical Care of Persons Living with HIV.

Weekly Update:  West Nile Virus Activity---United States, July 10--16, 2003. 

Update:  Severe Acute Respiratory Syndrome---Worldwide and United States, 2003.  

Rapid Increase in HIV Rates--Orel Oblast, Russian Federation, 1999--2001.  Morbidity and Mortality Weekly Report, 52(28), July 18, 2003.

Severe Acute Respiratory Syndrome --- Singapore, 2003.  Morbidity and Mortality Weekly Report, 52(18), May 9, 2003.

Update: Severe Acute Respiratory Syndrome --- United States, 2003.  Morbidity and Mortality Weekly Report, 52(18), May 9, 2003.

Update: Adverse Events Following Civilian Smallpox Vaccination --- United States, 2003.  Morbidity and Mortality Weekly Report, 52(18), May 9, 2003.

Advancing HIV Prevention: New Strategies for a Changing Epidemic --- United States, 2003.  

Update: Severe Acute Respiratory Syndrome --- United States, 2003.   Morbidity and Mortality Weekly Report, 52(15), Apr 17, 2003.  

Pneumoconiosis Prevalence Among Working Coal Miners Examined in Federal Chest Radiograph Surveillance Programs --- United States, 1996--2002.   Morbidity and Mortality Weekly Report, 52(15), Apr 17, 2003.  

Update: Adverse Events Following Civilian Smallpox Vaccination --- United States, 2003.  Morbidity and Mortality Weekly Report, 52(15), Apr 17, 2003.

Smallpox Vaccine Adverse Events Among Civilians ---United States, March 4--10, 2003.

Outbreak of Group A Streptococcal Pneumonia Among Marine Corps Recruits --- California, November 1--December 20, 2002Morbidity and Mortality Weekly Reports 52 (6), February 14, 2003.

Increase in Coccidioidomycosis --- Arizona, 1998--2001.  Morbidity and Mortality Weekly Report 52 (6), February 14, 2003.

Measles Control --- South-East Asia Region, 1990--1997. Morbidity and Mortality Weekly Report 48 (25), July 2, 1999.
    In 1989, the World Health Assembly resolved to reduce measles morbidity and mortality by 90% and 95%, respectively, by 1995, compared with the number of cases during the prevaccine era. In 1990, the World Summit for Children adopted a goal to vaccinate 90% of children against measles by 2000. Although these goals have not been met, progress has been achieved toward global measles control, including in the South-East Asia Region (SEAR) member countries* of the World Health Organization (WHO). By the end of 1997, estimated worldwide measles morbidity and death were reduced by 74% and 85%, respectively, and by 70% and 88%, respectively, in SEAR. In February 1999, representatives of the United Nations Children's Fund (UNICEF), WHO, and CDC met and recommended a regional plan of action for measles control. This report summarizes the progress in measles control in SEAR during 1990-1997 and summarizes the plans for future activities in the region.

Vaccine-Preventable Diseases: Improving Vaccination Coverage in Children, Adolescents, and Adults. Morbidity and Mortality Weekly Report 48 (No. RR-8), June 18, 1999.

Outbreak of Poliomyelitis --- Angola, 1999. Morbidity and Mortality Weekly Report 48(16), April 30, 1999. (file size 324,530 bytes).

Influenza Activity -- United States, 1998-1999 season.  Morbidity and Mortality Weekly Report 48 (9), March 12, 1999.

Progress Toward Poliomyelitis Eradication --- Pakistan, 1994--1998. Morbidity and Mortality Weekly Reports 48 (6), February 19, 1999.

Preventing Emerging Infectious Diseases: A Strategy for the 21st Century.  This is CDC's strategic plan for reducing the health consequences of emerging and reemerging diseases.  Electronically available from CDC, Georgia.  You can request a copy of the plan by: 1) sending an email to; 2) sending a fax to 404-639-4194; or 3) mailing a request to CDC, NCID, Office of Health Communication, 1600 Clifton Road NE, Mailstop C-14, Atlanta, GA 30333.  Supplementary materials are available from the internet  at  

Adverse Effects Associated with 17D-Derived Yellow Fever Vaccination---United States, 2001-2002.  Morbidity and Mortality Weekly Reports 51(44), November 8, 2002, pp. 989-993.  In June 2001, seven cases of yellow fever vaccine-associated viscerotropic disease (YEL-AVD) (previously called multiple organ system failure) in recipients of 17D-derived yellow fever vaccine (YEL) were reported to the Advisory Committee on Immunization Practices (ACIP).  ACIP reviewed the cases, recommended enhanced surveillance for adverse events, and updated the ACIP statement on YEL.  This report summarizes the preliminary surveillance findings, including two new suspected cases of YEL-AVD and four suspected cases of YEL-associated neurotropic disease (YEL-AND) (previously called postvaccinal encephalitis).  Although YEL remains essential for travelers to area in which yellow fever (YF) is endemic, these findings underscore the need for continued enhanced surveillance and timely clinical assessment of YEL-associated disease.


1. Condoms and prevention. Condoms can be effective in the prevention of sexually transmitted diseases, if the are used. What predisposing, enabling, and reinforcing factors contribute to the behavior of condom use?

2. Surveillance and control systems. It is expected that public health departments will improve methods for monitoring and controlling the spread of newly recognized diseases, infections introduced from other nations, and unexpected epidemics. Recommend ways in which modern technology might be used towards this end.

3. Immunizations. Visit a passport office where immunization regulations are issued for travelers to foreign countries. Describe one of these diseases and the possible consequences of not being properly immunized against it.

4. Ethics and communicable diseases. Contact or visit a community clinic where sexually transmitted diseases are diagnosed and treated. What policies have been implemented to protect confidentiality and to notify others (parents, sexual partners, employers)? How is patient education conducted for prevention of infection reoccurrence?

5. Incidence and prevalence. Contact a local health officer in regard to communicable diseases that have occurred in the community during recent years. Using HIV/AIDs, tuberculosis, syphilis (as examples) plot the incidence and prevalence of these diseases over the last 30 years. Plot the differences between incidence and prevalence in the trend lines. Note the different trend line for these diseases. To what can these differences be attributed?

6. Milestones in disease eradication are presented as a boxed issues in this chapter. What role do you think private funding agencies should play in disease eradication? With new antibiotic resistant bacteria making their debut, what role should public health officials take in preventing the development of these new strains? 

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