Morbidity and Mortality Weekly Report (MMWR)

{"issue-date":"2019-01-18","issue-vol":"68","issue-no":"2","title":"Opioid Prescribing Rates in Nonmetropolitan and Metropolitan Counties Among Primary Care Providers Using an Electronic Health Record System - United States, 2014-2017 | MMWR","already_known":"Opioid prescribing rates vary by county urbanization level and are declining overall.","added_by_report":"Analysis of patient opioid prescription data from a national electronic health record vendor during 2014-2017 found that the percentage of patients prescribed an opioid was higher in rural than in urban areas. Significant decreases in opioid prescribing occurred across all urban-rural categories after the March 2016 release of the CDC Guideline for Prescribing Opioids for Chronic Pain.","implications":"As less densely populated areas indicate both progress in decreasing opioid prescribing and need for ongoing reduction, tailoring community health care practices and intervention programs to community characteristics will remain important.","tags":[{"tag":"Opioid Prescribing Rates"},{"tag":" Opioid Prescriptions And Electronic Health Record System"},{"tag":" Opioid And Urbanization"},{"tag":" Opioid Prescription By County"}],"url":"https://www.cdc.gov/mmwr/volumes/68/wr/mm6802a1.htm?s_cid=mm6802a1_w","content-ver":"1","schema-ver":"1","command":"add"}

{"issue-date":"2019-01-18","issue-vol":"68","issue-no":"2","title":"Opioid Prescribing Rates in Nonmetropolitan and Metropolitan Counties Among Primary Care Providers Using an Electronic Health Record System - United States, 2014-2017 | MMWR","already_known":"Opioid prescribing rates vary by county urbanization level and are declining overall.","added_by_report":"Analysis of patient opioid prescription data from a national electronic health record vendor during 2014-2017 found that the percentage of patients prescribed an opioid was higher in rural than in urban areas. Significant decreases in opioid prescribing occurred across all urban-rural categories after the March 2016 release of the CDC Guideline for Prescribing Opioids for Chronic Pain.","implications":"As less densely populated areas indicate both progress in decreasing opioid prescribing and need for ongoing reduction, tailoring community health care practices and intervention programs to community characteristics will remain important.","tags":[{"tag":"Opioid Prescribing Rates"},{"tag":" Opioid Prescriptions And Electronic Health Record System"},{"tag":" Opioid And Urbanization"},{"tag":" Opioid Prescription By County"}],"url":"https://www.cdc.gov/mmwr/volumes/68/wr/mm6802a1.htm?s_cid=mm6802a1_w","content-ver":"1","schema-ver":"1","command":"add"}

{"issue-date":"2019-01-18","issue-vol":"68","issue-no":"2","title":"QuickStats: Percentage of Adults Aged 18-64 Years Who Had an Influenza Vaccination in the Past 12 Months, by Sex and Current Asthma Status - National Health Interview Survey, 2017 | MMWR","already_known":"Summary not available.\nView Full Article for more information.","added_by_report":"Summary not available.\nView Full Article for more information.","implications":"Summary not available.\nView Full Article for more information.","tags":[{"tag":"Influenza Vaccination"},{"tag":" Influenza Vaccination By Sex"},{"tag":" Influenza Vaccination By Asthma Status"},{"tag":" Influenza Vaccination And Adults"}],"url":"https://www.cdc.gov/mmwr/volumes/68/wr/mm6802a7.htm?s_cid=mm6802a7_w","content-ver":"1","schema-ver":"1","command":"add"}

{"issue-date":"2019-01-18","issue-vol":"68","issue-no":"2","title":"Notes from the Field: Tuberculosis Control in the Aftermath of Hurricane Maria - Puerto Rico, 2017 | MMWR","already_known":"Summary not available.\nView Full Article for more information.","added_by_report":"Summary not available.\nView Full Article for more information.","implications":"Summary not available.\nView Full Article for more information.","tags":[{"tag":"Hurricane Maria And Puerto Rico"},{"tag":" Puerto Rico And Tuberculosis Control"},{"tag":" Hurricane Maria And Tuberculosis"}],"url":"https://www.cdc.gov/mmwr/volumes/68/wr/mm6802a6.htm?s_cid=mm6802a6_w ","content-ver":"1","schema-ver":"1","command":"add"}

{"issue-date":"2019-01-18","issue-vol":"68","issue-no":"2","title":"Notes from the Field: Typhoid Fever Outbreak - Harare, Zimbabwe, October 2017-February 2018 | MMWR","already_known":"Summary not available.\nView Full Article for more information.","added_by_report":"Summary not available.\nView Full Article for more information.","implications":"Summary not available.\nView Full Article for more information.","tags":[{"tag":"Typhoid Fever Outbreak"},{"tag":" Typhoid And Zimbabwe"},{"tag":" Harare Typhoid Fever Outbreak"},{"tag":" Typhoid In Mbare"}],"url":"https://www.cdc.gov/mmwr/volumes/68/wr/mm6802a5.htm?s_cid=mm6802a5_w ","content-ver":"1","schema-ver":"1","command":"add"}

{"issue-date":"2019-01-18","issue-vol":"68","issue-no":"2","title":"Notes from the Field: Typhoid Fever Outbreak - Harare, Zimbabwe, October 2017-February 2018 | MMWR","already_known":"Summary not available.\nView Full Article for more information.","added_by_report":"Summary not available.\nView Full Article for more information.","implications":"Summary not available.\nView Full Article for more information.","tags":[{"tag":"Typhoid Fever Outbreak"},{"tag":" Typhoid And Zimbabwe"},{"tag":" Harare Typhoid Fever Outbreak"},{"tag":" Typhoid In Mbare"}],"url":"https://www.cdc.gov/mmwr/volumes/68/wr/mm6802a5.htm?s_cid=mm6802a5_w ","content-ver":"1","schema-ver":"1","command":"add"}

{"issue-date":"2019-01-18","issue-vol":"68","issue-no":"2","title":"Notes from the Field: Fentanyl Drug Submissions - United States, 2010-2017 | MMWR","already_known":"Summary not available.\nView Full Article for more information.","added_by_report":"Summary not available.\nView Full Article for more information.","implications":"Summary not available.\nView Full Article for more information.","tags":[{"tag":"Fentanyl Drug Submissions"},{"tag":" Illicitly Manufactured Fentanyl"},{"tag":" Fentanyl Overdose Deaths"}],"url":"https://www.cdc.gov/mmwr/volumes/68/wr/mm6802a4.htm?s_cid=mm6802a4_w ","content-ver":"1","schema-ver":"1","command":"add"}

{"issue-date":"2019-01-18","issue-vol":"68","issue-no":"2","title":"Notes from the Field: Fentanyl Drug Submissions - United States, 2010-2017 | MMWR","already_known":"Summary not available.\nView Full Article for more information.","added_by_report":"Summary not available.\nView Full Article for more information.","implications":"Summary not available.\nView Full Article for more information.","tags":[{"tag":"Fentanyl Drug Submissions"},{"tag":" Illicitly Manufactured Fentanyl"},{"tag":" Fentanyl Overdose Deaths"}],"url":"https://www.cdc.gov/mmwr/volumes/68/wr/mm6802a4.htm?s_cid=mm6802a4_w ","content-ver":"1","schema-ver":"1","command":"add"}

{"issue-date":"2019-01-18","issue-vol":"68","issue-no":"2","title":"Overdose Deaths Involving Fentanyl and Fentanyl Analogs - New York City, 2000-2017 | MMWR","already_known":"During 1999-2017, the rate of drug overdose deaths nationally approximately tripled; approximately 70,000 overdose deaths occurred nationally in 2017, with nearly 68% involving an opioid.","added_by_report":"Using toxicology data, New York City identified fentanyl in 2% of drug overdose deaths during 2000-2012. By 2017, fentanyl was involved in 57% of all drug overdose deaths in New York City.","implications":"Universal fentanyl testing by local medical examiners and inclusion of drug-specific language on death certificates can aid surveillance and address the role of fentanyl in drug overdoses. Community-level educational outreach is indicated when an increase in fentanyl involvement is detected.","tags":[{"tag":"Overdose Deaths And Fentanyl"},{"tag":" Fentanyl Analogs And Overdose Deaths"},{"tag":" Fentanyl Deaths And New Year City"},{"tag":" Overdose Deaths In New York City"}],"url":"https://www.cdc.gov/mmwr/volumes/68/wr/mm6802a3.htm?s_cid=mm6802a3_w","content-ver":"1","schema-ver":"1","command":"add"}

{"issue-date":"2019-01-18","issue-vol":"68","issue-no":"2","title":"Overdose Deaths Involving Fentanyl and Fentanyl Analogs - New York City, 2000-2017 | MMWR","already_known":"During 1999-2017, the rate of drug overdose deaths nationally approximately tripled; approximately 70,000 overdose deaths occurred nationally in 2017, with nearly 68% involving an opioid.","added_by_report":"Using toxicology data, New York City identified fentanyl in 2% of drug overdose deaths during 2000-2012. By 2017, fentanyl was involved in 57% of all drug overdose deaths in New York City.","implications":"Universal fentanyl testing by local medical examiners and inclusion of drug-specific language on death certificates can aid surveillance and address the role of fentanyl in drug overdoses. Community-level educational outreach is indicated when an increase in fentanyl involvement is detected.","tags":[{"tag":"Overdose Deaths And Fentanyl"},{"tag":" Fentanyl Analogs And Overdose Deaths"},{"tag":" Fentanyl Deaths And New Year City"},{"tag":" Overdose Deaths In New York City"}],"url":"https://www.cdc.gov/mmwr/volumes/68/wr/mm6802a3.htm?s_cid=mm6802a3_w","content-ver":"1","schema-ver":"1","command":"add"}

{"issue-date":"2019-01-18","issue-vol":"68","issue-no":"2","title":"Gastroschisis Trends and Ecologic Link to Opioid Prescription Rates - United States, 2006-2015 | MMWR","already_known":"Gastroschisis prevalence has increased worldwide. A previous U.S. report found that gastroschisis increased during 1995-2012, with the greatest increase among mothers aged

{"issue-date":"2019-01-18","issue-vol":"68","issue-no":"2","title":"Gastroschisis Trends and Ecologic Link to Opioid Prescription Rates - United States, 2006-2015 | MMWR","already_known":"Gastroschisis prevalence has increased worldwide. A previous U.S. report found that gastroschisis increased during 1995-2012, with the greatest increase among mothers aged

Analysis of patient opioid prescription data from a national electronic health record vendor during 2014-2017 found that the percentage of patients prescribed an opioid was higher in rural than in urban areas.

In 2017, adults aged 18-64 years with current asthma were more likely to have had an influenza vaccination in the past 12 months (47.9%) than those without asthma (36.4%).

In 2014 in the United States, an infant with neonatal abstinence syndrome (NAS) was born every 15 minutes.

From 1999 to 2017, the death rate from drug overdose among women aged 30-64 years increased by 260%.

Among women in India aged 30-49 years, less than one-third (29.8%) reported ever having been screened for cervical cancer.

During 2015-2016, 3.5% of adult visits to the emergency department were made by those with chronic kidney disease.

During 2006-2015, 79% of isolates from U.S. typhoid fever patients who traveled to Pakistan were fluoroquinolone nonsusceptible.

In December 2017, the Louisiana Department of Health was notified of seven cases of respiratory syncytial virus infection at a five-unit, 84-bed neonatal intensive care unit that included 66 individual infant rooms.

Effective January 11, 2019, the MMWR Series will no longer offer new continuing education (CE) activities through CDC's Training and Continuing Education Online (TCEO) system.

In 2017, 41.7% of adults aged ≥18 years had ever been tested for human immunodeficiency virus (HIV). Adults living in the Midwest (35.5%) were less likely to have ever been tested for HIV than adults in the Northeast (43.5%), South (43.5%), and West (43.4%).

During September 2017-April 2018, nine cases of wound botulism were reported in San Diego County, California; all patients reported injecting heroin and seven used black tar heroin, including subcutaneous injection in six patients.

In December 2016, a hospital in Los Angeles County reported two infections, later identified as Mycobacterium chimaera, in patients with a recent history (

Among adults receiving human immunodeficiency virus (HIV) care from 2011 to 2015, American Indians/Alaska Natives patients had high poverty levels (51%), depression (27%), HIV stigma (78%), and suboptimal sustained HIV viral suppression (64%).

In 2017, among 70,237 drug overdose deaths, 47,600 (67.8%) involved opioids, with increases across age groups, racial/ethnic groups, county urbanization levels, and in multiple states. From 2013 to 2017, synthetic opioids contributed to increases in drug overdose death rates in several states. From 2016 to 2017, synthetic opioid-involved overdose death rates increased 45.2%.

On June 12, 2018, the Michigan Department of Health and Human Services requested assistance from CDC to investigate risk factors for Salmonella infection linked to live backyard poultry originating at a mail-order hatchery in Michigan.

A U.S. citizen was bitten by a puppy while in India; rabies postexposure prophylaxis was not sought. The traveler developed rabies upon return to the United States and died during hospitalization.

In 2017, among 70,237 drug overdose deaths, 47,600 (67.8%) involved opioids, with increases across age groups, racial/ethnic groups, county urbanization levels, and in multiple states. From 2013 to 2017, synthetic opioids contributed to increases in drug overdose death rates in several states. From 2016 to 2017, synthetic opioid-involved overdose death rates increased 45.2%.

CDC evaluated a pilot HIV-related mortuary surveillance system in Nairobi, Kenya.

The percentage of emergency department visits for pain with an opioid given or prescribed for those aged

Parent-reported data from 2016 indicated that a higher percentage of children in lower-income households had ever received a diagnosis of a mental, behavioral, or developmental disorder and a lower percentage had seen a health care provider in the previous year, compared with children in higher-income households. Most children in lower-income households were in families receiving public assistance benefits.

During 2014-2016, blood collections increased and donor HIV prevalence decreased in seven of 14 countries, but systems to link HIV-positive and donors at high risk to testing and treatment are inadequate.

Importation of a rabid dog into the United States from Egypt, with documentation of rabies vaccination but no medical history, resulted in a six-state investigation and administration of rabies postexposure prophylaxis to multiple persons.

On September 17, 2018, the Texas Department of State Health Services received notification of Enterobacter cloacae and Citrobacter freundii bloodstream infections in three patients who had received injections or infusions of non-FDA-approved umbilical cord blood-derived stem cell products processed by Genetech, Inc., and distributed by Liveyon, LLC, for other than hematopoietic or immunologic reconstitution at an outpatient clinic on September 12.

During 2013-2015, total drug and opioid-involved overdose mortality rates for American Indians and Alaska Natives were 2.7 times higher than those of whites in Washington. Misclassification of American Indians and Alaska Natives race in death certificates underestimated overdose mortality among American Indians and Alaska Natives in Washington by approximately 40%.

Despite recommendations, most U.S.-bound Congolese refugees with splenomegaly did not have documented receipt of primaquine after resettlement. Most patients were clustered within families. Approximately 50% of patients with available medical records had persistent splenomegaly >6 months after arrival; 63% of patients with splenomegaly had a hematologic abnormality.

During 2015-2017, the proportion of students currently using tobacco products who used a product ≥20 of the past 30 days ranged from 14.0% of cigar smokers to 38.7% of smokeless tobacco users among high school students and from 13.1% of e-cigarette users to 24.5% of hookah smokers among middle school students.

Influenza activity in the United States was low during October 2018, and, although it increased slowly during November, activity remains low across most of the country.

In 2017, among adults aged ≥18 years, those with a diagnosis of diabetes were more likely to have had an influenza vaccination in the past 12 months than were those with a diagnosis of prediabetes (62.5% versus 56.1%); those with no diagnosed diabetes were the least likely to have had an influenza vaccination (40.1%).

From 2014 to 2017, the annual rate of false positive diagnosis pf human immunodeficiency virus in Chókwè district, Mozambique decreased from 0.66% to 0.00%, and the cumulative false diagnosis rate was 0.56%, compared with the median rate of 3.1% reported in the systematic review.

During 2016, 11 infants were born to women in Los Angeles County who met the Council of State and Territorial Epidemiologists case definition for confirmed (four infants) or probable (seven) Zika virus infection.

Although secondhand smoke exposure among U.S. nonsmokers declined from 87.5% to 25.2% during 1988-2014, one in four nonsmokers, including 14 million children, were exposed to secondhand smoke during 2013-2014.

In June 2017, PulseNet, the national molecular subtyping network for foodborne disease surveillance, identified 17 Salmonella Agbeni clinical isolates with indistinguishable XbaI enzyme pattern (outbreak strain) by pulsed-field gel electrophoresis.

The percentage of adults aged 20-64 who had a blood cholesterol check by a health professional in the past 12 months increased from 58.0% in 2012 to 65.5% in 2017.

During 1999-2015 and 1999-2016, uterine cancer incidence and mortality rates increased 0.7% and 1.1% per year, respectively, with black women disproportionately affected.

Monitoring procedures for highly pathogenic avian influenza responders were successfully implemented during a 2016 outbreak of highly pathogenic avian influenza A(H7N8) in commercial turkey flocks in Indiana. No human cases of avian influenza were identified.

This report details the first documented outbreak of adenovirus D53 epidemic keratoconjunctivitis in the United States. Seventeen epidemic keratoconjunctivitis cases were identified; after the primary case, all cases occurred in eye care clinic patients or their household contacts. Infection prevention lapses were associated with the outbreak, specifically improper ocular equipment disinfection.

Since September 2015, the World Health Organization has recommended antiretroviral therapy (ART) for all persons with human immunodeficiency virus (HIV) infection, regardless of clinical stage or CD4 count (1).

Compared with other racial/ethnic groups, American Indians/Alaska Natives (AI/AN) have a lower life expectancy, lower quality of life, and are disproportionately affected by many chronic conditions (1,2).