MMWR News Synopsis

Nonadherence to Any Prescribed Medication Due to Costs Among Adults with HIV Infection — United States, 2016–2017

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Reducing barriers to the Ryan White AIDS Drug Assistance Program and Medicaid coverage – in addition to reducing medication costs for people with private insurance – might help decrease nonadherence to medication due to cost concerns and improve health outcomes for people living with HIV. An estimated 7% of U.S. adults with HIV skipped doses of medicine, took less medicine, and/or delayed filling a prescription for medicine due to cost. In this analysis, CDC estimated the portion of U.S. adults with HIV during May 2016 – June 2017 who did not adhere to medication due to cost. The portion of U.S. adults with HIV who did not adhere to medicine due to prescription drug costs (7%) was similar to that in the U.S. adult population overall (8%). Adults with HIV who did not adhere because of cost concerns were more likely to have visited an emergency room, to have been hospitalized, and to not be virally suppressed. Because of its strong relationship with viral load, nonadherence to HIV treatment leads to increased morbidity, mortality, and risk of HIV transmission.

Hospitalizations for Inflammatory Bowel Disease Among Medicare Fee-for-Service Beneficiaries — United States, 1999–2017

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This is the first study to document trends in inflammatory bowel disease (IBD)-associated hospitalization during the past two decades among older U.S. adults in United States, by race/ethnicity. In contrast to decreased hospitalization rates for IBD observed among whites, no significant temporal changes in hospitalization rates among blacks were observed.. As the U.S. population ages, the prevalence of Crohn’s disease and ulcerative colitis, collectively known as inflammatory bowel disease (IBD), is expected to increase. Older adults hospitalized with IBD experience more negative outcomes than their younger counterparts. In 2017, out of 100,000 Medicare beneficiaries, there were 15.5 hospitalizations for Crohn’s disease and 16.2 for ulcerative colitis. From 1999 to 2017, the hospitalization rate for IBD decreased among non-Hispanic white beneficiaries but not among non-Hispanic black beneficiaries. Disease management for older adults with IBD should focus on increasing preventive care and preventing emergency surgeries that might result in further complications. 

Patient Characteristics and Product Use Behaviors Among Persons with E-cigarette, or Vaping, Product Use–Associated Lung Injury — Indiana, June ̶ October 2019

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This investigation of Indiana patients with e-cigarette, or vaping, product use-associated lung injury (EVALI) revealed that nearly one-third (31%) reported only using products that did not contain THC. This might be due to underreporting of THC-containing product use by Indiana patients or might indicate that multiple product types can cause EVALI. From August 8–October 28, 2019, the Indiana State Department of Health was notified of 97 patients who met the confirmed or probable case definitions for EVALI and were hospitalized, including three who died. Among 54 patients for whom medical record abstractions were completed, the average age was 26 years and 70% were male. Among the 29 patients who were interviewed, 69% reported using tetrahydrocannabinol (THC)-containing products, which was lower than the percentage of patients reporting use of THC-containing products in Utah (92%); Illinois and Wisconsin (80%); and nationally (80%). These findings should be investigated further to determine whether Indiana patients might have underreported use of THC-containing products for fear of legal repercussions or perceived stigma, or if use of multiple product types might cause EVALI.

Update: Demographic, Product, and Substance-Use Characteristics of Hospitalized Patients in a Nationwide Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injuries — United States, December 2019

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• Hospital Water Contamination Associated with a Pseudo-Outbreak of Mycobacterium porcinum — Wisconsin, 2016–2018

After a pseudo-outbreak of Mycobacterium porcinum at a Wisconsin hospital, an investigation by the Wisconsin Division of Public Health, the Wisconsin State Laboratory of Hygiene, and CDC discovered contamination in two hospital ice machines and one water machine. This investigation highlights the importance of addressing maintenance of ice machine and water dispensers in hospital water management programs to assure safe water use as part of patient care. This investigation found that contaminated ice and water machines might have been the cause of a pseudo-outbreak at a Wisconsin Hospital from 2016-2018. Mycobacterium porcinum, (M. porcinum) a rapidly growing mycobacterium associated with respiratory tract, bloodstream, surgical site, and soft tissue infections, was found in multiple patients admitted to intensive care units. Because M. porcinum, in particular, has been recovered from tap water, the investigation included testing water samples from the ice and water machines and handwashing sinks in the intensive care units. Visible debris was seen on internal machine parts and the dispenser spouts. New machines and new parts were installed along with a revision of the cleaning protocols. No further M. porcinum patient isolates have been found since the changes were made.

• Percentage of Adults Aged ≥18 Years Who Took Medication to Help Fall or Stay Asleep Four or More Times in the Past Week, by Sex and Age Group — National Health Interview Survey, United States, 2017–2018

• Use of Anthrax Vaccine in the United States Recommendations of the Advisory Committee on Immunization Practices, 2019

Today’s report summarizes safety and estimated efficacy data and updates 2009 recommendations from the CDC Advisory Committee on Immunization Practices (ACIP) regarding use of anthrax vaccine in the United States. The report also includes several changes from previous guidance that might be used to guide bioterrorism preparedness planning efforts. These updated recommendations increase the capacity and ease of use of the vaccine in an event where large scale vaccination might be needed. Today’s report summarizes vaccine safety and estimated efficacy data, and updates CDC Advisory Committee on Immunization Practices (ACIP) recommendations regarding use of anthrax vaccine in the United States. Changes from previous guidance include: 1) extending the booster dose interval for pre-exposure vaccination from 1 to 3 years for people who are not at high risk for exposure to anthrax; 2) recommending intramuscular vaccine administration during an emergency response if the subcutaneous route poses significant challenges; 3) recommendations on dose-sparing vaccine regimens; and 4) clarification on how long antimicrobial therapy is needed when used with vaccine for post-exposure prophylaxis. These updated recommendations can be used to guide preparedness planning for a widespread release of B. anthracis spores, and increase capacity and ease of use of the vaccine in an event where large scale vaccination is needed.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CDC works 24/7 protecting America’s health, safety and security. Whether diseases start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.