Morbidity and Mortality Weekly Report
Encyclopedia
The Morbidity and Mortality Weekly Report is a weekly epidemiological
digest for the United States
published by the Centers for Disease Control and Prevention
(CDC). It is the main vehicle for publishing public health information and recommendations that have been received by the CDC from state health departments, with each issue covering reports that have been received in the week through Friday, and published on the following Friday. Material published in the report is in the public domain
and may be reprinted without permission. , the journal's editor-in-chief is Ronald Moolenaar.
As noted in the sequel, some single reports have evoked media interest also outside health and medical contexts. However, many reports are parts of series, providing consistent long-terms statistics, and also indicating trend changes. Such a standing report section is the "Notifiable Diseases and Mortality Tables", which reports deaths by disease and state, and city for city, for 122 large cities. As another example, there are more than a hundred items about West Nile virus
infections, since the 1999 outbreak of the disease in the US. In the years 2001-2005, there were weekly updates of the WNV situation, during the warm seasons.
in the medical literature (June 5, 1981). Los Angeles
-based general practitioner Joel Weisman
and immunologist Michael S. Gottlieb
of the UCLA Medical Center had encountered a series of gay male patients with symptoms that appeared to be immune system disorders including significant loss of weight and swollen lymph node
s, accompanied by fever and rashes, in addition to two patients with chronic diarrhea, depressed white blood cell counts and fungal infection
s. Gottlieb diagnosed these and a number of his other patients as having pneumocystis pneumonia
. A report they jointly wrote and published in the June 5, 1981, issue of Morbidity and Mortality Weekly Report, described their patients as "5 young men, all active homosexuals, [who] were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California" of which "[t]wo of the patients died" by the time of the original report. This notice has been recognized as the first published report marking the official start of the AIDS pandemic
and as "the first report on AIDS in the medical literature".
, while others were conducted by professor Marc Edwards
, while trying to find the causes of an increased rate of pinhole leaks in copper water pipes. He found some rather high values in a few households, sometimes exceeding 1250 PPM. From 2002 on the matter started to be noted by news media.
Lead
is well known to have toxic effects, especially for embryos and small children. Even in small doses, lead poisoning may lead to e.g. permanent intelligence deficiencies and concentration difficulties.
The report concludes that the high amounts of lead in the drinking water may have led to a slight rise of the blood levels; however, it claimed that "no children were identified with BLL
s >10µg/dL, even in homes with the highest water lead levels". It notes that 10 µg/dL was "CDC's BLL of concern for children" since 1991. The report also claimed that the average levels were sinking with time. On the other hand, the report found some cases of children with BLLs > 5 µg/dL; and also stated that actually "no safe BLL has been identified". Therefore, the report recommends that efforts should be made to eliminate lead in children's blood entirely, and in particular, that the authorities should take measures to ensure that the amount of lead in drinking water always should be less than 15 PPM.
The report does not in itself provide any recommendations to the ordinary Washington DC inhabitants, but it notes that the District of Columbia Department of Health has "recommended that young children and pregnant and breast-feeding women refrain from drinking unfiltered tap water".
Marc Edwards initiated a study, which included investigating health aspects. At first, he was sponsored by EPA; but when they interrupted their support, he financed it out of his own pocket. He claimed that this study, employing raw data also available to the CDC study, had found clear evidence of a correlation between rather high amounts of lead in the water on the one hand, and rather high amounts of lead in the blood of children on the other. Specifically, there were cases known to him, of children with BBL clearly exceeding 10µg/dL; but these cases were absent from the material presented in the MMWR report. Marc Edwards and pediatrician Dana Best of Children's National Medical Center in Washington, actually found a marked increase in high-level results from 2001 to 2004, among small children.
The results of Marc Edwards et al. came from analysis of the same raw data as those underlying the 2004 CDC report. In 2007, Edwards wrote to the CDC's associate director of science, James Stephens
, questioning the report's conclusions and methodology, and the competence of its principal author. In 2008, Stephens answered him: "We have examined CDC's role in the study and have found no evidence of misconduct."
According to Salon
, there was an evident dip in critical year 2003 (when the lead in the drinking water peaked), in the data present in the CDC files, there were test results for children in 2002, only children in 2003, and children in 2004, At the time, Mary Jean Brown had questioned the dip, and had gotten the answer that it was due to a private laboratory not having reported the low values they had found. She had accepted the answer. Salon also claimed that the CDC had found a link between lead pipes and high childhood blood lead levels in the district in 2007, but had not publicized the study.
In 2009, the United States House of Representatives
' Science and Technology Committee opened a congressional investigation into the 2004 CDC report. Investigators found that although the CDC and city health department reported dangerous lead levels in 193 children in 2003, the actual number was 486 according to records taken directly from the testing laboratories. In 2010, in their final report, the committee concluded that the CDC knowingly used flawed data in drafting the report, leading to "scientifically indefensible" claims in the 2004 paper. It also cited the CDC for failing to publicize later research showing that the harm was more serious than the 2004 report suggested.
Epidemiology
Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...
digest for the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
published by the Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...
(CDC). It is the main vehicle for publishing public health information and recommendations that have been received by the CDC from state health departments, with each issue covering reports that have been received in the week through Friday, and published on the following Friday. Material published in the report is in the public domain
Public domain
Works are in the public domain if the intellectual property rights have expired, if the intellectual property rights are forfeited, or if they are not covered by intellectual property rights at all...
and may be reprinted without permission. , the journal's editor-in-chief is Ronald Moolenaar.
As noted in the sequel, some single reports have evoked media interest also outside health and medical contexts. However, many reports are parts of series, providing consistent long-terms statistics, and also indicating trend changes. Such a standing report section is the "Notifiable Diseases and Mortality Tables", which reports deaths by disease and state, and city for city, for 122 large cities. As another example, there are more than a hundred items about West Nile virus
West Nile virus
West Nile virus is a virus of the family Flaviviridae. Part of the Japanese encephalitis antigenic complex of viruses, it is found in both tropical and temperate regions. It mainly infects birds, but is known to infect humans, horses, dogs, cats, bats, chipmunks, skunks, squirrels, domestic...
infections, since the 1999 outbreak of the disease in the US. In the years 2001-2005, there were weekly updates of the WNV situation, during the warm seasons.
Notable articles
- The spread of Hepatitis AHepatitis AHepatitis A is an acute infectious disease of the liver caused by the hepatitis A virus , an RNA virus, usually spread the fecal-oral route; transmitted person-to-person by ingestion of contaminated food or water or through direct contact with an infectious person...
among attendees of jam bandJam band-Ambiguity:By the late 1990s use of the term jam band also became ambiguous. An editorial at jamband.com suggested that any band of which a primary band such as Phish has done a cover of be included as jam band. The example was including New York post-punk band Talking Heads after Phish performed...
concert tours (September 2003). - Low concerns for risks of elevated blood levels of lead in Washington, DC (April 2004). The article was notable and later criticized for not emphasizing the risks, and now is available together with two amending "notices to the readers" by CDC from 2010.
- Several dozen deaths in teens participating in what is called the "choking game" (February 2008)
- A report about the elevated death rate among fisherman in the Pacific NorthwestPacific NorthwestThe Pacific Northwest is a region in northwestern North America, bounded by the Pacific Ocean to the west and, loosely, by the Rocky Mountains on the east. Definitions of the region vary and there is no commonly agreed upon boundary, even among Pacific Northwesterners. A common concept of the...
(April 2008) - Improvements in public health after the implementation of municipal smoking banSmoking banSmoking bans are public policies, including criminal laws and occupational safety and health regulations, which prohibit tobacco smoking in workplaces and/or other public spaces...
s (January 2009) - The initial reports of a novel swine flu virus which led to the 2009 swine flu pandemic (April 24, 2009)
First report of AIDS
Five cases of Pneumocystis carinii pneumonia (PCP) were reported in what turned out to be the first reporting of AIDSAIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
in the medical literature (June 5, 1981). Los Angeles
Los Ángeles
Los Ángeles is the capital of the province of Biobío, in the commune of the same name, in Region VIII , in the center-south of Chile. It is located between the Laja and Biobío rivers. The population is 123,445 inhabitants...
-based general practitioner Joel Weisman
Joel Weisman
Joel D. Weisman was one of the first to identify a pattern of illnesses that was ultimately diagnosed as AIDS during his work as a general practitioner in the United States...
and immunologist Michael S. Gottlieb
Michael S. Gottlieb
Michael Stuart Gottlieb is an American physician and immunologist known predominantly for his research in the identification of acquired immune deficiency syndrome and for clinical and philanthropic work associated with AIDS treatment....
of the UCLA Medical Center had encountered a series of gay male patients with symptoms that appeared to be immune system disorders including significant loss of weight and swollen lymph node
Lymph node
A lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
s, accompanied by fever and rashes, in addition to two patients with chronic diarrhea, depressed white blood cell counts and fungal infection
Mycosis
A mycosis is a fungal infection of animals, including humans. Mycoses are common, and a variety of environmental and physiological conditions can contribute to the development of fungal diseases...
s. Gottlieb diagnosed these and a number of his other patients as having pneumocystis pneumonia
Pneumocystis pneumonia
Pneumocystis pneumonia or pneumocystosis is a form of pneumonia, caused by the yeast-like fungus Pneumocystis jirovecii...
. A report they jointly wrote and published in the June 5, 1981, issue of Morbidity and Mortality Weekly Report, described their patients as "5 young men, all active homosexuals, [who] were treated for biopsy-confirmed Pneumocystis carinii pneumonia at 3 different hospitals in Los Angeles, California" of which "[t]wo of the patients died" by the time of the original report. This notice has been recognized as the first published report marking the official start of the AIDS pandemic
AIDS pandemic
The acquired immune deficiency syndrome pandemic is a widespread disease caused by the human immunodeficiency virus .Since AIDS was first recognized in 1981, it has led to the deaths of more than 25 million people, making it one of the most destructive diseases in recorded history.Despite recent...
and as "the first report on AIDS in the medical literature".
Drinking water lead report controversy
Background
Between 2001 and 2003, various tests showed that the lead content in drinking water in Washington DC more often than not was higher than 15 PPM (parts per million), which was the "action level" fixed by U.S. Environmental Protection Agency (EPA). Some of the tests were prompted by EPA's Lead and Copper RuleLead and copper rule
The "Lead and Copper Rule", or LCR, is a United States federal regulation which limits the concentration of lead and copper allowed in public drinking water at the consumer's tap, as well limiting the permissible amount of pipe corrosion occurring due to the water itself. The U.S...
, while others were conducted by professor Marc Edwards
Marc Edwards
Marc Alexander Edwards is a former professional American football player who last played in the NFL in 2005 for the Chicago Bears....
, while trying to find the causes of an increased rate of pinhole leaks in copper water pipes. He found some rather high values in a few households, sometimes exceeding 1250 PPM. From 2002 on the matter started to be noted by news media.
Lead
Lead
Lead is a main-group element in the carbon group with the symbol Pb and atomic number 82. Lead is a soft, malleable poor metal. It is also counted as one of the heavy metals. Metallic lead has a bluish-white color after being freshly cut, but it soon tarnishes to a dull grayish color when exposed...
is well known to have toxic effects, especially for embryos and small children. Even in small doses, lead poisoning may lead to e.g. permanent intelligence deficiencies and concentration difficulties.
The report
On March 30, 2004, an "MMWR dispatch", Blood Lead Levels in Residents of Homes with Elevated Lead in Tap Water --- District of Columbia, 2004 was made available on the MMWR web site. It was then published by CDC as "MMWR Weekly, April 2, 2004 / 53(12);268-270". Its principal author was Mary Jean Brown, who was the head of the lead poisoning branch of CDC. The report "summarizes the results of the preliminary investigations, which indicated that the elevated water lead levels might have contributed to a small increase in blood lead levels (BLLs)". The report describes the background, and the various kinds of blood tests it employed, and explicitly states: "All blood tests were used in this analysis." There is no mention at all of any test results not being available, not even in the caveat section, where other potential sources of error are discussed.The report concludes that the high amounts of lead in the drinking water may have led to a slight rise of the blood levels; however, it claimed that "no children were identified with BLL
Blood lead level
Blood lead level , is a measure of lead in the body. It is measured in micrograms of lead per deciliter of blood ; 10 µg/dL is equivalent to 0.48 micromoles per liter ....
s >10µg/dL, even in homes with the highest water lead levels". It notes that 10 µg/dL was "CDC's BLL of concern for children" since 1991. The report also claimed that the average levels were sinking with time. On the other hand, the report found some cases of children with BLLs > 5 µg/dL; and also stated that actually "no safe BLL has been identified". Therefore, the report recommends that efforts should be made to eliminate lead in children's blood entirely, and in particular, that the authorities should take measures to ensure that the amount of lead in drinking water always should be less than 15 PPM.
The report does not in itself provide any recommendations to the ordinary Washington DC inhabitants, but it notes that the District of Columbia Department of Health has "recommended that young children and pregnant and breast-feeding women refrain from drinking unfiltered tap water".
Criticism of the report
The report later was strongly criticized, by Marc Edwards, some news media, and ulrtimately by the United States House Committee on Science, Space and Technology.Marc Edwards initiated a study, which included investigating health aspects. At first, he was sponsored by EPA; but when they interrupted their support, he financed it out of his own pocket. He claimed that this study, employing raw data also available to the CDC study, had found clear evidence of a correlation between rather high amounts of lead in the water on the one hand, and rather high amounts of lead in the blood of children on the other. Specifically, there were cases known to him, of children with BBL clearly exceeding 10µg/dL; but these cases were absent from the material presented in the MMWR report. Marc Edwards and pediatrician Dana Best of Children's National Medical Center in Washington, actually found a marked increase in high-level results from 2001 to 2004, among small children.
The results of Marc Edwards et al. came from analysis of the same raw data as those underlying the 2004 CDC report. In 2007, Edwards wrote to the CDC's associate director of science, James Stephens
James Stephens
James Stephens may refer to:*James Stephens , 17th century MP for Gloucester*James Stephen , English lawyer associated with the abolition of slavery* James B...
, questioning the report's conclusions and methodology, and the competence of its principal author. In 2008, Stephens answered him: "We have examined CDC's role in the study and have found no evidence of misconduct."
According to Salon
Salon.com
Salon.com, part of Salon Media Group , often just called Salon, is an online liberal magazine, with content updated each weekday. Salon was founded by David Talbot and launched on November 20, 1995. It was the internet's first online-only commercial publication. The magazine focuses on U.S...
, there was an evident dip in critical year 2003 (when the lead in the drinking water peaked), in the data present in the CDC files, there were test results for children in 2002, only children in 2003, and children in 2004, At the time, Mary Jean Brown had questioned the dip, and had gotten the answer that it was due to a private laboratory not having reported the low values they had found. She had accepted the answer. Salon also claimed that the CDC had found a link between lead pipes and high childhood blood lead levels in the district in 2007, but had not publicized the study.
In 2009, the United States House of Representatives
United States House of Representatives
The United States House of Representatives is one of the two Houses of the United States Congress, the bicameral legislature which also includes the Senate.The composition and powers of the House are established in Article One of the Constitution...
' Science and Technology Committee opened a congressional investigation into the 2004 CDC report. Investigators found that although the CDC and city health department reported dangerous lead levels in 193 children in 2003, the actual number was 486 according to records taken directly from the testing laboratories. In 2010, in their final report, the committee concluded that the CDC knowingly used flawed data in drafting the report, leading to "scientifically indefensible" claims in the 2004 paper. It also cited the CDC for failing to publicize later research showing that the harm was more serious than the 2004 report suggested.