CDC Editorial Note: Asthma is a chronic respiratory illness often associated with familial, allergenic, socioeconomic, psychological, and environmental factors. 3 Although recent reports suggest asthma-related mortality has been declining since 1996, a disparity remains between rates for non-Hispanic whites and those for non-Hispanic blacks and other racial/ethnic populations. 4 Non-Hispanic blacks experience higher rates than non-Hispanic whites for ED visits, hospitalizations, and deaths; these trends are not explained entirely by higher asthma prevalence among non-Hispanic blacks. 4 Other racial/ethnic populations experience higher asthma mortality and hospitalization rates than non-Hispanic whites while also reporting lower asthma prevalence and fewer outpatient and ED visits. The asthma-control characteristics described in this report can contribute to increased mortality and higher hospitalization rates.
In 2002, the BRFSS adult lifetime asthma prevalence estimate and the adult current asthma prevalence estimate for the 50 states and DC were higher than in 2001 3 The findings in this report are subject to at least four limitations. First, the median response rate for the survey was 58.3%. However, BRFSS asthma prevalence is similar to estimates from other surveys with higher response rates, such as the National Health Interview Survey. 5 Second, BRFSS does not measure asthma prevalence among institutionalized adults, military personnel, persons aged 18 years, and residents without telephones. Third, the validity of selfreported asthma or asthma-control characteristics in BRFSS is unknown. 6 Actual adherence to prescribed medication or asthma treatment plans in respondents with current asthma is unknown. Finally, the asthma-control questions were asked in 19 of the 54 BRFSS reporting areas and might not accurately reflect the asthma-control characteristics of other reporting areas or accurately represent their racial/ethnic distribution.
States and territories using the BRFSS Adult Asthma History module can direct asthma management within their jurisdictions and address disparities in asthma risk and control characteristics among racial/ethnic populations. Use of comprehensive state-specific asthma surveillance data to identify populations with poorly controlled asthma is instrumental in developing, implementing, and evaluating asthma-control programs and interventions. MMWR. 2004;53:154-157 WEST NILE VIRUS (WNV) IS A SINGLEstranded RNA flavivirus with antigenic similarities to Japanese encephalitis and St. Louis encephalitis viruses. It is transmitted to humans primarily through the bites of infected mosquitoes. Flavivirus infection during pregnancy has been associated rarely with both spontaneous abortion and neonatal illness but has not been known to cause birth defects in humans.  During 2002, a total of 4,156 cases of WNV illness in humans, including 2,946 cases of neuroinvasive disease, were reported to CDC by state health departments. In 2002, a woman who had WNV encephalitis during the 27th week of her pregnancy delivered a full-term infant with chorioretinitis, cystic destruction of cerebral tissue, and FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION laboratory evidence of congenitally acquired WNV infection. 5,6 Although this case demonstrated intrauterine WNV infection in an infant with congenital abnormalities, it did not prove a causal relation between WNV infection and these abnormalities. During 2002, CDC investigated three other instances of maternal WNV infection. In all three cases, the infants were born at full term with normal appearance and negative laboratory tests for WNV infection; cranial imaging studies and ophthalmologic examinations were not performed. During 2003, CDC received reports of approximately 9,100 cases of WNV illness, including approximately 2,600 cases of neuroinvasive disease. - CDC is gathering data on pregnancy outcomes for approximately 70 women with WNV illness during pregnancy (CDC, unpublished data, 2003).

# Interim Guidelines for the Evaluation of Infants Born to Mothers Infected With West Nile Virus During Pregnancy
To develop guidelines for evaluating infants born to mothers who acquire WNV infection during pregnancy, on December 2, 2003, CDC convened a meeting of specialists in the evaluation of congenital infections. This report summarizes the interim guidelines established during that meeting.

# Screening for WNV During Pregnancy
No specific treatment for WNV infection exists, and the consequences of WNV infection during pregnancy have not been well defined. For these reasons, screening of asymptomatic pregnant women for WNV infection is not recommended.

# Diagnosis of WNV Infection During Pregnancy
Pregnant women who have meningitis, encephalitis, acute flaccid paralysis, or unexplained fever in an area of ongoing WNV transmission should have serum (and cerebrospinal fluid , if clinically indicated) tested for antibody to WNV. If serologic or other laboratory tests indicate recent infection with WNV, these infections should be reported to the local or state health department, and the women should be followed to determine the outcomes of their pregnancies.

# Evaluation of the Fetus in Pregnant Women with WNV Infection
If WNV illness is diagnosed during pregnancy, a detailed ultrasound examination of the fetus to evaluate for structural abnormalities should be considered no soonerthan2-4weeksafteronsetofWNV illness in the mother, unless earlier examination is otherwise indicated. Amniotic fluid, chorionic villi, or fetal serum can be tested for evidence of WNV infec-tion. However, the sensitivity, specificity,andpredictivevalueofteststhatmight be used to evaluate fetal WNV infection are not known, and the clinical consequences of fetal infection have not been determined. In case of miscarriage or induced abortion, testing of all products of conception (e.g., the placenta and umbilical cord) for evidence of WNV infection is advised to document the effects of WNV infection on pregnancy outcome.

# FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION

# Evaluation of Infants Born to Mothers Infected With WNV During Pregnancy
When an infant is born to a mother who was known or suspected to have WNV infection during pregnancy, clinical evaluation is recommended (see sidebar 1). Further evaluation should be considered if any clinical abnormality is identified or if laboratory testing indicates that an infant might have congenital WNV infection (see sidebar 2).

# Prevention of WNV Infection During Pregnancy
Pregnant women who live in areas with WNV-infected mosquitoes should ap-ply insect repellent to skin and clothes when exposed to mosquitoes and wear clothing that will help protect against mosquito bites. In addition, whenever possible, pregnant women should avoid being outdoors during peak mosquitofeeding times (i.e., usually dawn and dusk). CDC Editorial Note: Neither the proportion of WNV infections during pregnancy that result in congenital infection nor the spectrum of clinical abnormalities associated with congenital WNV infection is known. However, one case reported in 2002 suggests that intrauterine transmission of WNV in certain instances might affect the newborn adversely. To evaluate the possible effects of WNV infection during pregnancy, CDC is gathering clinical and laboratory data on outcomes of pregnancies of women who were known or suspected to be infected with WNV during pregnancy. Guidance on diagnosis of WNV can be obtained from local or state health departments and from CDC, telephone 970-221-6400. Guidance also is available at  .gov/ncidod/dvbid/westnile/resources /fact_sheet_clinician.htm. Clinicians are encouraged to report cases of WNV infections in pregnant women to their state or local health departments or CDC.