In 2010, an estimated 18.8 million persons in the United States had diagnosed diabetes mellitus and another 7.0 million had undiagnosed diabetes. Since 1990, the prevalence of diagnosed diabetes in the United States has risen sharply among all age groups, both sexes, and all racial/ethnic groups for which data are available. To learn whether the increase has been greater in some regions of the United States than in others, data on self-reported diabetes in adults collected during 1995-2010 by the Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. The analysis showed that the age-adjusted prevalence of diagnosed diabetes increased during the interval in every state, the District of Columbia (DC), and Puerto Rico. In 1995, age-adjusted prevalence was ≥6% in only three states, DC, and Puerto Rico, but by 2010 it was ≥6% in every state, DC, and Puerto Rico, and ≥10.0% in six states and Puerto Rico. Strategies to prevent diabetes and its preventable risk factors are needed, especially for those at highest risk for diabetes, to slow the rise in diabetes prevalence across the United States. Continued surveillance of diabetes prevalence and incidence, its risk factors, and prevention efforts is important to measure progress of prevention efforts.

Beverages marketed as energy drinks have become a popular form of caffeine consumption targeted at young males, with some brands containing the caffeine equivalent of 1-3 cups of coffee or cans of soda. Energy drinks also include other ingredients intended to boost physical energy or mental alertness, such as herbal substances, amino acids, sugars, and sugar derivatives; however, caffeine is the main active ingredient. Approximately 6% of adolescent and young adult males in U.S. civilian and military populations consume energy drinks daily. These products generally are unregulated and can have negative side effects (e.g., caffeine intoxication, overdose, withdrawal, and poor interactions with alcohol). Paradoxically, excess consumption also can increase sleep problems and daytime sleepiness, which can impair performance. To determine the extent of energy drink use and the association with sleep problems and sleepiness during combat operations, Walter Reed Army Institute of Research analyzed data collected by Joint Mental Health Advisory Team 7 (J-MHAT 7) to Operation Enduring Freedom in Afghanistan in 2010. The analysis showed that 44.8% of deployed service members consumed at least one energy drink daily, with 13.9% drinking three or more a day. No differences by age or rank were found. Service members drinking three or more energy drinks a day were significantly more likely to report sleeping ≤4 hours a night on average than those consuming two drinks or fewer. Those who drank three or more drinks a day also were more likely to report sleep disruption related to stress and illness and were more likely to fall asleep during briefings or on guard duty. Service members should be educated regarding the potential adverse effects of excessive energy drink consumption on sleep and mission performance and should be encouraged to moderate their energy drink consumption in combat environments.

Dracunculiasis (Guinea worm disease) is caused by Dracunculus medinensis, a parasitic worm. Approximately 1 year after initial infection from contaminated drinking water, the worm emerges through the skin of the infected person, usually on the lower limb. Pain and secondary bacterial wound infection can cause temporary or permanent disability that disrupts work and schooling for the entire family. In 1986, the World Health Assembly (WHA) called for dracunculiasis elimination and the Guinea Worm Eradication Program, supported by The Carter Center, World Health Organization (WHO), United Nations Children's Fund (UNICEF), CDC, and other partners, was coalesced to assist ministries of health of endemic countries in meeting this goal. At that time, an estimated 3.5 million cases occurred annually in 20 countries in Africa and Asia. This report updates published and previously unpublished surveillance data reported by ministries of health and describes progress toward global dracunculiasis eradication. In 2011, a total of 1,058 cases were reported. As of 2012, dracunculiasis remained endemic in only four countries. Through June 2012, worldwide reductions in reported cases continued, compared with the first 6 months of 2011. Failures in surveillance and containment, lack of clean drinking water, and insecurity in Mali and parts of South Sudan continue to challenge dracunculiasis eradication efforts.

On July 8, 2012, a U.S. resident was admitted to a hospital in Dubai, United Arab Emirates, for evaluation of right arm spasticity, anxiety, and malaise. By the next day, the patient had become comatose following a period of agitation. On July 31, he died. Investigators from CDC, state, and local health departments determined that the patient acquired rabies from contact in March with a bat in California. Person-to-person transmission of rabies has been documented in cases of organ and tissue transplantation and is theoretically possible if infectious saliva or tears are introduced into fresh open wounds or onto mucous membranes. Once symptoms begin, rabies is almost always fatal. While he was potentially infectious, during June 11-July 31, the patient traveled on eight international flights through six countries. To date, 59 persons have been identified as contacts, and 23 persons have been administered postexposure prophylaxis (PEP); no secondary cases have been identified. Bites or scratches from bats or other animals suspected of having rabies should be regarded seriously; victims should promptly seek consultation with public health practitioners and medical-care providers. This report highlights the need for collaboration to 1) identify persons who potentially had contact with infectious materials from a person infected with rabies, 2) conduct a risk assessment, and 3) provide prophylaxis to all those with a reasonable risk for contact with infectious materials (e.g., tears, saliva, or neural tissue from a person with rabies contacting open wounds or mucous membranes of an uninfected person).

An estimated 25,000 infants are born to hepatitis B surface antigen (HBsAg)-positive women annually in the United States. With no intervention, 40%-90% of these infants will acquire hepatitis B virus (HBV) infection. Approximately 90% of infected infants develop chronic HBV infection, with a 15%-25% risk for premature death from cirrhosis or cancer of the liver. To prevent perinatal HBV transmission, the Advisory Committee on Immunization Practices (ACIP) recommends that infants born to HBsAg-positive women receive postexposure prophylaxis with hepatitis B vaccine (HepB) and hepatitis B immune globulin (HBIG) within 12 hours of birth, and complete the 3-dose HepB series. To determine infant outcomes after postexposure prophylaxis, ACIP recommends postvaccination serologic testing (PVST) at age 9-18 months. To evaluate the implementation of these recommendations, CDC assessed outcomes at age 24 months (through 2011) among infants born to HBsAg-positive women enrolled during 2008-2009 in Enhanced Perinatal Hepatitis B Case Management Projects (EPHBP). Of 4,214 EPHBP-managed infants who completed ≥3 HepB doses, 63.7% had reported PVST results, 13.3% had reported PVST results but infant age was unknown, and 23.0% had no reported PVST results. Of 2,683 infants with PVST results by age 24 months, 93.3% were protected, 1.2% were infected, 3.2% remained susceptible, and 2.3% had indeterminate results. ACIP-recommended postexposure prophylaxis was highly effective among infants who completed vaccination and received PVST. PVST is critical for guiding medical management of infants born to HBsAg-positive women, identifying infants with HBV infection and in need of further care, and monitoring progress toward the elimination of perinatal HBV transmission.

Worldwide, 130-170 million persons are living with chronic hepatitis C virus (HCV) infection, which, if left untreated, can result in cirrhosis and liver cancer. Egypt has the largest burden of HCV infection in the world, with a 10% prevalence of chronic HCV infection among persons aged 15-59 years. HCV transmission in Egypt is associated primarily with inadequate infection control during medical and dental care procedures. In response, the Egyptian Ministry of Health and Population (MOHP) in 2001 implemented a program to reduce health-care-associated HCV transmission and in 2008 launched a program to provide care and treatment. This report describes the progress of these programs, identifies deficiencies, and recommends enhancements, including the establishment of a comprehensive national viral hepatitis control program. Infection control programs implemented in 2001 at MOHP facilities resulted in improvements in infection control practices and a decrease in the annual incidence of HCV infection among dialysis patients from 28% to 6%. Through June 2012, a total of 23 hepatitis treatment facilities had been established in Egypt, providing care and treatment to nearly 190,000 persons with chronic HCV infection. Despite these programs, Egypt continues to face an ongoing hepatitis C epidemic. A comprehensive plan is needed to prevent and control hepatitis C in Egypt. This plan should address increasing community awareness and education, preventing of HCV infection in health-care settings, ensuring a safe blood supply, establishing surveillance and monitoring to track the effectiveness of control programs, and providing care and treatment.

On February 6, 2012, the Kentucky Department for Public Health was notified by a local health department of multiple cases of vomiting and diarrhea among participants in a statewide, 7th grade boys' basketball tournament that was held February 3-5. State and local health officials partnered with CDC in an investigation to determine the extent of the outbreak, confirm the cause, and assess potential modes of transmission.

In 2010, the 4,502 motorcyclists (operators and passengers) killed in motorcycle crashes made up 14% of all road traffic deaths, yet motorcycles accounted for <1% of all vehicle miles traveled. Helmet use consistently has been shown to reduce motorcycle crash-related injuries and deaths, and the most effective strategy to increase helmet use is enactment of universal helmet laws. Universal helmet laws require all motorcyclists to wear helmets whenever they ride. To examine the association between states' motorcycle helmet laws and helmet use or nonuse among fatally injured motorcyclists, CDC analyzed 2008-2010 National Highway Traffic Safety Administration (NHTSA) data from the Fatality Analysis Reporting System (FARS), a census of fatal traffic crashes in the United States. Additionally, economic cost data from NHTSA were obtained to compare the costs saved as a result of helmet use, by type of state motorcycle helmet law. The findings indicated that, on average, 12% of fatally injured motorcyclists were not wearing helmets in states with universal helmet laws, compared with 64% in partial helmet law states (laws that only required specific groups, usually young riders, to wear helmets) and 79% in states without a helmet law. Additionally, in 2010, economic costs saved from helmet use by society in states with a universal helmet law were, on average, $725 per registered motorcycle, nearly four times greater than in states without such a law ($198).

Measles is a highly communicable, acute viral illness with potential for severe complications, including death. Although endemic measles was eliminated in the United States in 2000 as a result of widespread vaccination, sporadic measles outbreaks still occur, largely associated with international travel from measles-endemic countries and pockets of unvaccinated persons. On August 26, 2011, the Los Angeles County Department of Public Health (LACDPH) was notified of suspected measles in a refugee from Burma who had arrived in Los Angeles, California, on August 24, after a flight from Kuala Lumpur, Malaysia. Passengers on the flight included 31 other refugees who then traveled to seven other states, widening the measles investigation and response activities. In California alone, 50 staff members from LACDPH and the California Department of Public Health (CDPH) interviewed and reinterviewed 298 contacts. Measles was diagnosed in three contacts of the index patient (patient A). The three contacts with measles were two passengers on the same flight as patient A and a customs worker; no secondary cases were identified. Delayed diagnosis of measles in patient A and delayed notification of health officials precluded use of measles-mumps-rubella (MMR) vaccine as an outbreak intervention. This outbreak emphasizes the importance of maintaining a high level of vaccination coverage and continued high vigilance for measles in the United States, particularly among incoming international travelers; clinicians should immediately isolate persons with suspected measles and promptly report them to health authorities.