ML12199A449

Summary of Notifiable Disease - United State, 2006

ML12199A449
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Issue date:	03/21/2008
From:	Darrell Adams, Anderson W, Aponte J, Jajosky R, Jones G, Mcnabb S, Nitschke D, Rey A, Sharp P, Wodajo M, Worsham C US Dept of Health & Human Services, Centers for Disease Control
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Weekly March 21, 2008, for 2006 / Vol. 55 / No. 53 department of health and human services department of health and human services department of health and human services department of health and human services department of health and human services Centers for Disease Control and Prevention Centers for Disease Control and Prevention Centers for Disease Control and Prevention Centers for Disease Control and Prevention Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report www.cdc.gov/mmwr Summary of Notifiable Diseases United States, 2006

MMWR March 21, 2008 Centers for Disease Control and Prevention Julie L. Gerberding, MD, MPH Director Tanja Popovic, MD, PhD Chief Science Officer James W. Stephens, PhD Associate Director for Science Steven L. Solomon, MD Director, Coordinating Center for Health Information and Service Jay M. Bernhardt, PhD, MPH Director, National Center for Health Marketing Katherine L. Daniel, PhD Deputy Director, National Center for Health Marketing Editorial and Production Staff Frederic E. Shaw, MD, JD Editor, MMWR Series Suzanne M. Hewitt, MPA Managing Editor, MMWR Series Douglas W. Weatherwax Lead Technical Writer-Editor Catherine H. Bricker, MS Jude C. Rutledge Writers-Editors Beverly J. Holland Lead Visual Information Specialist Lynda G. Cupell Malbea A. LaPete Visual Information Specialists Quang M. Doan, MBA Erica R. Shaver Information Technology Specialists Editorial Board William L. Roper, MD, MPH, Chapel Hill, NC, Chairman Virginia A. Caine, MD, Indianapolis, IN David W. Fleming, MD, Seattle, WA William E. Halperin, MD, DrPH, MPH, Newark, NJ Margaret A. Hamburg, MD, Washington, DC King K. Holmes, MD, PhD, Seattle, WA Deborah Holtzman, PhD, Atlanta, GA John K. Iglehart, Bethesda, MD Dennis G. Maki, MD, Madison, WI Sue Mallonee, MPH, Oklahoma City, OK Stanley A. Plotkin, MD, Doylestown, PA Patricia Quinlisk, MD, MPH, Des Moines, IA Patrick L. Remington, MD, MPH, Madison, WI Barbara K. Rimer, DrPH, Chapel Hill, NC John V. Rullan, MD, MPH, San Juan, PR Anne Schuchat, MD, Atlanta, GA Dixie E. Snider, MD, MPH, Atlanta, GA John W. Ward, MD, Atlanta, GA The MMWR series of publications is published by the Coordinating Center for Health Information and Service, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333.

Suggested Citation: Centers for Disease Control and Prevention.

[Article title]. MMWR 2007;56:[inclusive page numbers].

CONTENTS Preface.................................................................................2 Background..........................................................................2 Revised International Health Regulations..............................3 Infectious Diseases Designated as Notifiable at the National Level During 2006............................................................5 Data Sources........................................................................6 Interpreting Data..................................................................6 Transition in NNDSS Data Collection and Reporting.............7 Highlights.............................................................................8 PART 1. Summaries of Notifiable Diseases in the United States, 2006...................................................................19 TABLE 1. Reported cases of notifiable diseases, by month United States, 2006......................................20 TABLE 2. Reported cases of notifiable diseases, by geographic division and area United States, 2006...22 TABLE 3. Reported cases and incidence of notifiable diseases, by age group United States, 2006............33 TABLE 4. Reported cases and incidence of notifiable diseases, by sex United States, 2006.......................35 TABLE 5. Reported cases and incidence of notifiable diseases, by race United States, 2006......................37 TABLE 6. Reported cases and incidence of notifiable diseases, by ethnicity United States, 2006...............39 PART 2. Graphs and Maps for Selected Notifiable Diseases in the United States, 2006..............................................41 PART 3. Historical Summaries of Notifiable Diseases in the United States, 1975-2006...............................................73 TABLE 7. Reported incidence of notifiable diseases United States, 1996-2006............................................74 TABLE 8. Reported cases of notifiable diseases United States, 1999-2006............................................76 TABLE 9. Reported cases of notifiable diseases United States, 1991-1998............................................78 TABLE 10. Reported cases of notifiable diseases United States, 1983-1990............................................80 TABLE 11. Reported cases of notifiable diseases United States, 1975-1982............................................81 TABLE 12. Deaths from selected nationally notifiable diseases United States, 2002-2003..........................82 Selected Reading...............................................................84

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Summary of Notifiable Diseases United States, 2006 Prepared by Scott J.N. McNabb, PhD Ruth Ann Jajosky, DMD Patsy A. Hall-Baker, Annual Summary Coordinator Deborah A. Adams Pearl Sharp Carol Worsham Willie J. Anderson J. Javier Aponte Gerald F. Jones David A. Nitschke Araceli Rey, MPH Michael S. Wodajo Division of Integrated Surveillance Systems and Services, National Center for Public Health Informatics, Coordinating Center for Health Information and Service, CDC

2 MMWR March 21, 2008 Preface The Summary of Notifiable Diseases United States, 2006 contains the official statistics, in tabular and graphic form, for the reported occurrence of nationally notifiable infec-tious diseases in the United States for 2006. Unless other-wise noted, the data are final totals for 2006 reported as of June 30, 2007. These statistics are collected and compiled from reports sent by state and territorial health departments to the National Notifiable Diseases Surveillance System (NNDSS), which is operated by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE).

The Summary is available at http://www.cdc.gov/mmwr/

summary.html. This site also includes publications from previous years.

The Highlights section presents noteworthy epidemio-logic and prevention information for 2006 for selected dis-eases and additional information to aid in the interpretation of surveillance and disease-trend data. Part 1 contains tables showing incidence data for the nationally notifiable infec-tious diseases during 2006.* The tables provide the num-ber of cases reported to CDC for 2006 as well as the distribution of cases by month, geographic location, and the patients demographic characteristics (age, sex, race, and ethnicity). Part 2 contains graphs and maps that depict summary data for certain notifiable infectious diseases described in tabular form in Part 1. Part 3 contains tables that list the number of cases of notifiable diseases reported to CDC since 1975. This section also includes a table enu-merating deaths associated with specified notifiable diseases reported to CDCs National Center for Health Statistics (NCHS) during 2002-2004. The Selected Reading sec-tion presents general and disease-specific references for notifiable infectious diseases. These references provide additional information on surveillance and epidemiologic concerns, diagnostic concerns, and disease-control activities.

Comments and suggestions from readers are welcome. To increase the usefulness of future editions, comments about the current report and descriptions of how information is or could be used are invited. Comments should be sent to Public Health Surveillance Team NNDSS, Division of Integrated Surveillance Systems and Services, National Center for Public Health Informatics at soib@cdc.gov.

Background

The infectious diseases designated as notifiable at the national level during 2006 are listed on page 5. A notifi-able disease is one for which regular, frequent, and timely information regarding individual cases is considered neces-sary for the prevention and control of the disease. A brief history of the reporting of nationally notifiable infectious diseases in the United States is available at http://

www.cdc.gov/epo/dphsi/nndsshis.htm. In 1961, CDC assumed responsibility for the collection and publication of data on nationally notifiable diseases. NNDSS is neither a single surveillance system nor a method of reporting. Cer-tain NNDSS data are reported to CDC through separate surveillance information systems and through different reporting mechanisms; however, these data are aggregated and compiled for publication purposes.

Notifiable disease reporting at the local level protects the publics health by ensuring the proper identification and follow-up of cases. Public health workers ensure that per-sons who are already ill receive appropriate treatment; trace contacts who need vaccines, treatment, quarantine, or edu-cation; investigate and halt outbreaks; eliminate environ-mental hazards; and close premises where spread has occurred. Surveillance of notifiable conditions helps public health authorities to monitor the impact of notifiable con-ditions, measure disease trends, assess the effectiveness of control and prevention measures, identify populations or geographic areas at high risk, allocate resources appropri-ately, formulate prevention strategies, and develop public health policies. Monitoring surveillance data enables pub-lic health authorities to detect sudden changes in disease occurrence and distribution, detect changes in health-care practices, develop and implement public health programs and interventions, and contribute data to monitor global trends.

The list of nationally notifiable infectious diseases is revised periodically. A disease might be added to the list as a new pathogen emerges, or a disease might be deleted as its incidence declines. Public health officials at state and territorial health departments and CDC collaborate in determining which diseases should be nationally notifiable.

CSTE, with input from CDC, makes recommendations annually for additions and deletions. Although disease reporting is mandated by legislation or regulation at the

• No cases of diphtheria, neuroinvasive or nonneuroinvasive western equine encephalitis virus disease, paralytic poliomyelitis, severe acute respiratory syndrome-associated coronavirus (SARS-CoV), smallpox, yellow fever, or varicella deaths were reported in the United States in 2006; these conditions do not appear in the tables in Part 1. For certain other nationally notifiable diseases, incidence data were reported to CDC but are not included in the tables or graphs of this Summary. Data on chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review. CDC is upgrading its national surveillance data management system for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). During this transition, CDC is not updating AIDS or HIV infection surveillance data. Therefore, no updates are provided for HIV and AIDS data in this Summary.

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state and local levels, state reporting to CDC is voluntary.

Reporting completeness of notifiable diseases is highly vari-able and related to the condition or disease being reported (1). The list of diseases considered notifiable varies by state and year. Current and historic national public health sur-veillance case definitions used for classifying and enumerat-ing cases consistently across reporting jurisdictions are available at http://www.cdc.gov/epo/dphsi/nndsshis.htm.

Revised International Health Regulations In May 2005, the World Health Assembly adopted revised International Health regulations (IHR) (2) that went into effect in the United States on July 18, 2007. This international legal instrument governs the role of the World Health Organization (WHO) and its member countries, including the United States, in identifying, responding to and sharing information about Public Health Emergencies of International Concern (PHEIC). A PHEIC is an extraor-dinary event that 1) constitutes a public health risk to other countries through international spread of disease, and 2) potentially requires a coordinated international response.

The IHR are designed to prevent and protect against the international spread of diseases while minimizing the effect on world travel and trade. Countries that have adopted these rules have a much broader responsibility to detect, respond to, and report public health emergencies that potentially require a coordinated international response in addition to taking preventive measures. The IHR will help countries work together to identify, respond to, and share informa-tion about public health emergencies of international concern.

The revised IHR represent a conceptual shift from a pre-defined disease list to a framework of reporting and respond-ing to events on the basis of an assessment of public health criteria, including seriousness, unexpectedness, and inter-national travel and trade implications. PHEIC are events that fall within those criteria (further defined in a decision algorithm in Annex 2 of the revised IHR). Four conditions always constitute a PHEIC and do not require the use of the IHR decision instrument in Annex 2: Severe Acute Res-piratory Syndrome (SARS), smallpox, poliomyelitis caused by wild-type poliovirus, and human influenza caused by a new subtype. Any other event requires the use of the deci-sion algorithm in Annex 2 of the IHR to determine if it is a potential PHEIC. Examples of events that require the use of the decision instrument include, but are not limited to, cholera, pneumonic plague, yellow fever, West Nile fever, viral hemorrhagic fevers, and meningococcal disease. Other biologic, chemical, or radiologic events might fit the deci-sion algorithm and also must be reportable to WHO. All WHO member states are required to notify WHO of a potential PHEIC. WHO makes the final determination about the existence of a PHEIC.

Health-care providers in the United States are required to report diseases, conditions, or outbreaks as determined by local, state, or territorial law and regulation, and as out-lined in each states list of reportable conditions. All health-care providers should work with their local, state, and territorial health agencies to identify and report events that might constitute a potential PHEIC occurring in their location. U.S. State and Territorial Departments of Health have agreed to report information about a potential PHEIC to the most relevant federal agency responsible for the event.

In the case of human disease, the U.S. State or Territorial Departments of Health will notify CDC rapidly through existing formal and informal reporting mechanisms (3).

CDC will further analyze the event based on the decision algorithm in Annex 2 of the IHR and notify the U.S. De-partment of Health and Human Services (DHHS) Secretarys Operations Center (SOC), as appropriate.

DHHS has the lead role in carrying out the IHR, in cooperation with multiple federal departments and agen-cies. The HHS SOC is the central body for the United States responsible for reporting potential events to the WHO. The United States has 48 hours5.555556e-4 days <br />0.0133 hours <br />7.936508e-5 weeks <br />1.8264e-5 months <br /> to assess the risk of the reported event. If authorities determine that a potential PHEIC exists, the WHO member country has 24 hours2.777778e-4 days <br />0.00667 hours <br />3.968254e-5 weeks <br />9.132e-6 months <br /> to report the event to the WHO.

An IHR decision algorithm in Annex 2 has been devel-oped to help countries determine whether an event should be reported. If any two of the following four questions can be answered in the affirmative, then a determination should be made that a potential PHEIC exists and WHO should be notified:

• Is the public health impact of the event serious?

• Is the event unusual or unexpected?

• Is there a significant risk of international spread?

• Is there a significant risk of international travel or trade restrictions?

Additonal information concerning IHR is available at http://www.who.int/csr/ihr/en, http://www.globalhealth.

gov/ihr/index.html, http://www.cdc.gov/cogh/ihregulations.

htm, and http://www.cste.org/PS/2007ps/2007psfinal/ID/

07-ID-06.pdf.

At its annual meeting in June 2007, the Council of State and Territorial Epidemiologists (CSTE) approved a posi-tion statement to support the implementation of the 2005

4 MMWR March 21, 2008 IHR in the United States (3). CSTE also approved a posi-tion statement in support of the 2005 IHR adding initial detections of novel influenza A virus infections to the list of nationally notifiable diseases reportable to NNDSS, begin-ning in January 2007 (4).

1. Doyle TJ, Glynn MK, Groseclose LS. Completeness of notifiable infec-tious disease reporting in the United States: an analytical literature review.

Am J Epidemiol 2002;155:866-74.

2. World Health Organization. Third report of Committee A. Annex 2.

Geneva, Switzerland: World Health Organization; 2005. Available at http://www.who.int/gb/ebwha/pdf_files/WHA58/A58_55-en.pdf.

3. Council of State and Territorial Epidemiologists. Events that may consti-tute a public health emergency of international concern. Position state-ment 07-ID-06. Available at http://www.cste.org/PS/2007ps/2007psfinal/

ID/07-ID-06.pdf.

4. Council of State and Territorial Epidemiologists. National reporting for initial detections of novel influenza A viruses. Position statement 07-ID-

01. Available at: http://www.cste.org/PS/2007ps/2007psfinal/ID/07-ID-01.pdf.

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Acquired immunodeficiency syndrome (AIDS)

Anthrax Botulism foodborne infant other (wound and unspecified)

Brucellosis Chancroid Chlamydia trachomatis, genital infection Cholera Coccidioidomycosis Cryptosporidiosis Cyclosporiasis Diphtheria Domestic arboviral diseases, neuroinvasive and nonneuroinvasive California serogroup virus disease eastern equine encephalitis virus disease Powassan virus disease St. Louis encephalitis virus disease West Nile virus disease western equine encephalitis virus disease Ehrlichiosis human granulocytic human monocytic human, other or unspecified agent Giardiasis Gonorrhea Haemophilus influenzae, invasive disease Hansen disease (leprosy)

Hantavirus pulmonary syndrome Hemolytic uremic syndrome, postdiarrheal Hepatitis A, acute Hepatitis B, acute Hepatitis B, chronic Hepatitis B virus, perinatal infection Hepatitis C, acute Hepatitis C virus infection (past or present)§ Human immunodeficiency virus (HIV) infection adult (age >13 yrs) pediatric (age <13 yrs)

Influenza-associated pediatric mortality Legionellosis§ Listeriosis Lyme disease Malaria Measles Meningococcal disease, invasive§ Mumps Pertussis Plague Poliomyelitis, paralytic Psittacosis Q fever Rabies animal human Rocky Mountain spotted fever Rubella Rubella, congenital syndrome Salmonellosis Severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease Shiga toxin-producing Escherichia coli (STEC)¶ Shigellosis Smallpox Streptococcal disease, invasive, group A Streptococcal toxic-shock syndrome Streptococcus pneumoniae, invasive disease age <5 years Streptococcus pneumoniae, invasive disease, drug-resistant all ages Syphilis Syphilis, congenital Tetanus Toxic-shock syndrome (other than streptococcal)

Trichinellosis Tuberculosis Tularemia Typhoid fever Vancomycin-intermediate Staphylococcus aureus infection (VISA)

Vancomycin-resistant Staphylococcus aureus infection (VRSA)

Varicella infection (morbidity)

Varicella (mortality)

Yellow fever Infectious Diseases Designated as Notifiable at the National Level During 2006 The 2005 CSTE position statement approving changes to the AIDS case definition for adults and adolescents aged >13 years is pending final review and publication in MMWR.

§In accord with position statements approved by CSTE in 2005, the national surveillance case definitions for hepatitis C virus infection (past or present), legionellosis, and meningococcal disease were revised.

¶Beginning in 2006, STEC replaced the Enterohemorrhagic Escherichia coli infection category that was previously nationally notifiable.

6 MMWR March 21, 2008 Data Sources Provisional data concerning the reported occurrence of nationally notifiable infectious diseases are published weekly in MMWR. After each reporting year, staff in state and ter-ritorial health departments finalize reports of cases for that year with local or county health departments and reconcile the data with reports previously sent to CDC throughout the year. Notifiable disease reports are the authoritative and archival counts of cases. They are approved by the appro-priate chief epidemiologist from each submitting state or territory before being compiled and published in the Summary.

Data in the Summary are derived primarily from reports transmitted to CDC from health departments in the 50 states, five territories (American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, Puerto Rico, and the U.S. Virgin Islands), New York City, and the District of Columbia. Data were reported for MMWR weeks 1-52, which correspond to the period for the week ending January 7, 2006, through the week ending December 30, 2006. More information regarding infectious notifiable dis-eases, including case definitions, is available at http://

www.cdc.gov/epo/dphsi/phs.htm. Policies for reporting no-tifiable disease cases can vary by disease or reporting juris-diction. The case-status categories used to determine which cases reported to NNDSS are published, by disease or con-dition, and are listed in the print criteria column of the 2006 NNDSS event code list (available at http://www.cdc.gov/

epo/dphsi/phs/files/NNDSSeventcodelistJanuary2007.pdf).

Final data for certain diseases are derived from the sur-veillance records of the CDC programs listed below.

Requests for further information regarding these data should be directed to the appropriate program.

Coordinating Center for Health Information and Service National Center for Health Statistics (NCHS)

Office of Vital and Health Statistics Systems (deaths from selected notifiable diseases)

Coordinating Center for Infectious Diseases National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP)

Division of HIV/AIDS Prevention (AIDS and HIV infection)

Division of STD Prevention (chancroid; Chlamydia trachomatis, genital infection; gonorrhea; and syphilis)

Division of Tuberculosis Elimination (tuberculosis)

National Center for Immunization and Respiratory Diseases Influenza Division (influenza-associated pediatric mortality)

Division of Viral Diseases (poliomyelitis, varicella deaths, and SARS-CoV)

National Center for Zoonotic, Vector-Borne, and Enteric Diseases Division of Vector-Borne Infectious Diseases (arboviral diseases)

Division of Viral and Rickettsial Diseases (animal rabies)

Population estimates for the states are from the NCHS bridged-race estimates of the July 1, 2000-July 1, 2005 U.S.

resident population from the vintage 2005 postcensal series by year, county, age, sex, race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau. This data set was released on August 16, 2005, and is available at http://www.cdc.gov/nchs/about/major/dvs/

popbridge/popbridge.htm. Populations for territories are 2005 estimates from the U.S. Census Bureau International Data Base Data Access-Display Mode, available at http://

www.census.gov/ipc/www/idb/summaries.html. The choice of population denominators for incidence reported in MMWR is based on 1) the availability of census population data at the time of preparation for publication and 2) the desire for consistent use of the same population data to com-pute incidence reported by different CDC programs. Inci-dence in the Summary is calculated as the number of reported cases for each disease or condition divided by either the U.S. resident population for the specified demographic population or the total U.S. residential population, multi-plied by 100,000. When a nationally notifiable disease is associated with a specific age restriction, the same age restriction is applied to the population in the denominator of the incidence calculation. In addition, population data from states in which the disease or condition was not noti-fiable or was not available were excluded from incidence calculations. Unless otherwise stated, disease totals for the United States do not include data for American Samoa, Guam, Puerto Rico, the Commonwealth of the Northern Mariana Islands, or the U.S. Virgin Islands.

Interpreting Data Incidence data in the Summary are presented by the date of report to CDC as determined by the MMWR week and year assigned by the state or territorial health department, except for the domestic arboviral diseases, which are pre-sented by date of diagnosis. Data are reported by the state in which the patient resided at the time of diagnosis. For certain nationally notifiable infectious diseases, surveillance data are reported independently to different CDC programs.

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Thus, surveillance data reported by other CDC programs might vary from data reported in the Summary because of differences in 1) the date used to aggregate data (e.g., date of report or date of disease occurrence), 2) the timing of reports, 3) the source of the data, 4) surveillance case defi-nitions, and 5) policies regarding case jurisdiction (i.e.,

which state should report the case to CDC).

Data reported in the Summary are useful for analyzing disease trends and determining relative disease burdens.

However, reporting practices affect how these data should be interpreted. Disease reporting is likely incomplete, and completeness might vary depending on the disease. The degree of completeness of data reporting might be influ-enced by the diagnostic facilities available; control measures in effect; public awareness of a specific disease; and the in-terests, resources, and priorities of state and local officials responsible for disease control and public health surveil-lance. Finally, factors such as changes in methods for public health surveillance, introduction of new diagnostic tests, or discovery of new disease entities can cause changes in dis-ease reporting that are independent of the true incidence of disease.

Public health surveillance data are published for selected racial/ethnic populations because these variables can be risk markers for certain notifiable diseases. Race and ethnicity data also can be used to highlight populations for focused prevention efforts. However, caution must be used when drawing conclusions from reported race and ethnicity data.

Different racial/ethnic populations might have different patterns of access to health care, potentially resulting in data that are not representative of actual disease incidence among specific racial/ethnic populations. Surveillance data reported to NNDSS are in either individual case-specific form or summary form (i.e., aggregated data for a group of cases). Summary data often lack demographic information (e.g., race); therefore, the demographic-specific rates pre-sented in the Summary might be underestimated.

In addition, not all race and ethnicity data are collected uniformly for all diseases. For example, certain disease pro-grams collect data on race and ethnicity using one or two variables, based on the 1977 standards for collecting such data issued by the Office of Management and the Budget (OMB). However, beginning in 2003, certain CDC pro-grams, such as the tuberculosis program, implemented OMBs 1997 revised standards for collecting such data; these programs collect data on multiple races per person using multiple race variables. In addition, although the recom-mended standard for classifying a persons race or ethnicity is based on self-reporting, this procedure might not always be followed.

Transition in NNDSS Data Collection and Reporting Before 1990, data were reported to CDC as cumulative counts rather than individual case reports. In 1990, states began electronically capturing and reporting individual case reports (without personal identifiers) to CDC using the National Electronic Telecommunication System for Surveil-lance (NETSS). In 2001, CDC launched the National Elec-tronic Disease Surveillance System (NEDSS), now a component of the Public Health Information Network (http://www.cdc.gov/phin), to promote the use of data and information system standards that advance the development of efficient, integrated, and interoperable surveillance information systems at the local, state, and federal level.

One of the objectives of NEDSS is to improve the accuracy, completeness, and timeliness of disease reporting at the local, state, and national level (5). CDC has developed the NEDSS Base System (NBS), a public health surveillance informa-tion system that can be used by states that do not wish to develop their own NEDSS-based systems. NBS can cap-ture data that already are in electronic form (e.g., electronic laboratory results, which are needed for case confirmation) rather than requiring that these data be entered manually as in the NETSS application. In 2006, NBS was used by 16 states to transmit nationally notifiable infectious dis-eases to CDC. Additional information concerning NEDSS is available at http://www.cdc.gov/NEDSS.

5. National Electronic Disease Surveillance System Working Group.

National Electronic Disease Surveillance System (NEDSS): a standards-based approach to connect public health and clinical medicine. J Public Health Manag Pract 2001;7:43-50.

8 MMWR March 21, 2008 Highlights for 2006 Below are summary highlights for certain national notifiable diseases. Highlights are intended to assist in the interpreta-tion of major occurrences that affect disease incidence or surveillance trends (e.g., outbreaks, vaccine licensure, or policy changes).

the United States in 1999, a median of 1,229 (mean:1,238; range:19-2,946) WNND cases have been reported annually.

1. CDC. West Nile virus activityUnited States, 2006. MMWR 2007;56;556-9.

Botulism Botulism is a severe paralytic illness caused by the toxins of Clostridium botulinum. Exposure to toxin can occur by ingestion (foodborne botulism) or by in situ production from C. botulinum colonization of a wound (wound botu-lism) or the gastrointestinal tract (infant botulism and adult intestinal colonization of botulism) (1). In addition to the National Notifiable Diseases Surveillance System, CDC maintains intensive surveillance for cases of botulism in the United States. In 2006, cases were attributed to foodborne botulism, wound botulism, and infant botulism.

1. Sobel J. Botulism. Clin Infect Dis 2005;41:1167-73.

Brucellosis In 2006, two cattle herds in one state were reported by the U.S. Department of Agriculture (USDA) to be affected by brucellosis. USDA has designated 48 states and three territories as being free of cattle brucellosis, with one state regaining and another state losing Brucellosis Class Free state status (1). Brucella abortus remains enzootic in elk and bison in the greater Yellowstone National Park area, and Brucella suis is enzootic in feral swine in the southeast. Hunt-ers exposed to these animals might be at increased risk for infection. Human cases can occur among immigrants and travelers returning from countries with endemic brucellosis and are associated with consumption of unpasteurized milk or soft cheeses. Pathogenic Brucella species are considered category B biologic threat agents because of a high poten-tial for aerosol transmission (2). For the same reason, biosafety level 3 practices, containment, and equipment are recommended for laboratory manipulation of isolates (3).

1. Donch DA, Gertonson AA, Rhyan JH, Gilsdorf MJ. Status report fiscal year 2006 cooperative state-federal Brucellosis Eradication Pro-gram. Washington, DC: US Department of Agriculture; 2007. Available at: http://www.aphis.usda.gov/animal_health/animal_diseases/brucello-sis/downloads/yearly_rpt.pdf.

Anthrax In February 2006, the first naturally-occurring case of inhalation anthrax in the United States since 1976 occurred in a New York City resident. His exposure to Bacillus anthracis spores was determined to be the result of making tradi-tional African drums using hard-dried animal hides that were contaminated with spores (1). The patient recovered with treatment (2). A subsequent, unrelated, fatal case of inhalation anthrax occurred in July 2006 in Scotland; exposure was suspected to result from the playing of tradi-tional African drums. In both cases, the animal hides were suspected to originate from west Africa. These events dem-onstrate a previously unrecognized risk for serious illness and death from inhalation anthrax resulting from the making and playing of animal-skin drums.

Naturally occurring anthrax epizootics in animal popula-tions continue to be reported in the United States annu-ally. In 2006, epizootics were reported in four states, affecting livestock in Minnesota, North Dakota, and South Dakota and livestock and wildlife in Texas.

1. CDC. Inhalation anthrax associated with dried animal hides Pennsylvania and New York City, 2006. MMWR 2006;55:280-2.

2. Walsh JJ, Pesik N, Quinn CP, et al. A case of naturally acquired inhala-tion anthrax: clinical care and analyses of anti-protective antigen immunoglobulin G and lethal factor. Clin Infect Dis 2007;44:968-71.

Arboviral, Neuroninvasive and Nonneuroinvasive (West Nile Virus)

During 2006, for the second consecutive year, West Nile virus (WNV) activity was detected in all 48 contiguous states; in one state (Washington), human cases were reported for the first time (1). Cases of WNV disease in humans were reported from 731 counties in 43 states and the Dis-trict of Columbia. Of these cases, 35% were West Nile neuroinvasive disease (WNND), 61% were uncomplicated fever, and 4% were clinically unspecified. Of the cases with WNND, 12% were fatal. The number of WNND cases reported was the highest since 2003; approximately 10%

of these cases were from Idaho, which previously had reported very few cases. Since WNV was first recognized in

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2. CDC. Bioterrorism agents/diseases, by category. Atlanta, GA: US Department of Health and Human Services, CDC; 2006. Available at http://www.bt.cdc.gov/agent/agentlist-category.asp#adef.

3. CDC, National Institutes of Health. Biosafety in microbiological and biomedical laboratories (BMBL). 4th ed. Washington, DC: US Depart-ment of Health and Human Services, CDC, National Institutes of Health; 1999. Available at http://www.cdc.gov/OD/OHS/biosfty/bmbl4/

bmbl4toc.htm.

Cholera Cases of cholera continue to be rare in the United States.

The number of cases reported in 2006 was slightly higher than the average number of cases per year reported during 2001-2005 (4.6) (1). Foreign travel continues to be the primary source of illness for cholera in the United States.

Cholera remains a global threat to health, particularly in areas with poor access to improved water and sanitation, such as sub-Saharan Africa (2). All patients with domestic exposure had consumed seafood (3). Crabs harvested from the U.S. Gulf Coast continue to be a common source of cholera, especially during warmer months, when environ-mental conditions favor the growth and survival of Vibrio species in marine water.

1. Steinberg EB, Greene KD, Bopp CA, Cameron DN, Wells JG, Mintz ED. Cholera in the United States, 1995-2000: trends at the end of the twentieth century. J Infect Dis 2001;184:799-802.

2. Gaffga NH, Tauxe RV, Mintz ED. Cholera: a new homeland in Africa.

Am J Trop Med Hyg 2007;77:705-13.

3. Brunkard JM, et al. Cholera, crabs, and Katrina: Is cholera increasing in southern Louisiana? [Abstract]. Presented at the 45th annual meeting of the Infectious Disease Society of America, San Diego, CA; October 4-7, 2007.

Cryptosporidiosis In 2006, the number of cryptosporidiosis cases contin-ued to increase. This follows a dramatic increase in the num-ber of cases in 2005. The reasons for this increase are unclear but might reflect changes in jurisdictional reporting pat-terns; increased testing for Cryptosporidium following the introduction of nitazoxanide, the first licensed treatment for the disease (1); or a real increase in infection and disease caused by Cryptosporidium. This drug introduction might have affected clinical practice by increasing the likelihood of health-care providers requesting Cryptosporidium testing, leading to an increase in subsequent case reports.

Although cryptosporidiosis is widespread geographically in the United States, a higher incidence is reported by north-ern states (2). However, this observation is difficult to interpret because of differences in cryptosporidiosis surveil-lance systems and reporting among states.

As in previous years, cryptosporidiosis case reports were clearly influenced by cryptosporidiosis outbreaks. Although cryptosporidiosis affects persons in all age groups, the number of reported cases was highest among children aged 1-9 years. A tenfold increase in transmission of cryptosporidiosis occurred during summer through early fall compared with winter, coinciding with increased use of recreational water by younger children, which is a known risk factor for cryptosporidiosis. Transmission through rec-reational water is facilitated by the substantial number of Cryptosporidium oocysts that can be shed by a single per-son; the extended periods of time that oocysts can be shed (3); the low infectious dose (4); the resistance of Cryptosporidium oocysts to chlorine (5); and the prevalence of improper pool maintenance (i.e., insufficient disinfec-tion, filtration, and recirculation of water), particularly of childrens wading pools (6).

1. Fox LM, Saravolatz LD. Nitazoxanide: a new thiazolide antiparasitic agent. Clin Infect Dis 2005;40:1173-80.

2. Yoder JS, Beach MJ. Cryptosporidiosis surveillanceUnited States, 2003-2005. In: Surveillance Summaries, September 7, 2007. MMWR 2007;56(No. SS-7):1-10.

3. Chappell CL, Okhuysen PC, Sterling CR, DuPont HL. Cryptosporidium parvum: intensity of infection and oocyst excretion patterns in healthy volunteers. J Infect Dis 1996;173:232-6.

4. DuPont HL, Chappell CL, Sterling CR, Okhuysen PC, Rose JB, Jakubowski W. The infectivity of Cryptosporidium parvum in healthy vol-unteers. N Engl J Med 1995;332:855-9.

5. Korich DG, Mead JR, Madore MS, Sinclair NA, Sterling CR. Effects of ozone, chlorine dioxide, chlorine, and monochloramine on Cryptosporidium parvum occyst viability. Appl Environ Microbiol 1990;56:1423-8.

6. CDC. Surveillance data from swimming pool inspectionsselected states and counties, United States, May-September 2002. MMWR 2003;52:513-6.

Ehrlichiosis Human monocytic ehrlichiosis and human granulocytic ehrlichiosis (now known as human [granulocytic] anaplas-mosis) are emerging tick-borne diseases that became nationally notifiable in 1999. Because identification and reporting of these diseases remain incomplete, areas shown in the maps on pages 49-50 of this summary might not be definitive predictors for overall distribution or regional preva-lence. Increases in numbers of reported cases of human rick-ettsial infections might result from several factors, including but not limited to increases in vector tick populations, increases in human-tick contact as a result of encroachment into tick habitat through suburban/rural recreational activities and housing construction; changes in case defini-tions, case report forms, and laboratory tests; and increased use of active surveillance methods to supplement previously

10 MMWR March 21, 2008 passive surveillance methods as a result of increased resource availability and perception of high case density in newly surveyed areas.

The pathogen responsible for human granulocytic ehrlichiosis, genus Ehrlichia, has been reclassified and now belongs to the genus Anaplasma. Diseases resulting from infection with Ehrlichia chaffeensis, Anaplasma phagocytophilum (formerly Ehrlichia phagocytophila), and other pathogens (comprising Ehrlichia ewingii and undif-ferentiated species) have been referred to respectively by the acronyms HME, HGE, and Ehrlichiosis (unspeci-fied or other agent). The case definitions for these diseases have been modified by a resolution adopted at the June 2007 meeting of the Council of State and Territorial Epi-demiologists; the new category names and the new case definitions became effective January 1, 2008 (1).

1. Council of State and Territorial Epidemiologists. Revision of the surveillance case definitions for ehrlichiosis. Position statement 07-ID-03. Available at http://www.cste.org/position%20statements/searchbyyear2007final.asp.

Gonorrhea In 2006, rates of gonorrhea in the United States increased for the second consecutive year (1). Increases in gonorrhea rates in eight western states during 2000-2005 have been described previously (2). Increases in quinolone-resistant Neisseria gonorrhoeae in 2006 led to changes in national guidelines that now limit the recommended treatment of gonorrhea to a single class of drugs, the cephalosporins (3).

The combination of increases in gonorrhea morbidity with increases in resistance and decreased treatment options have increased the need for better understanding of the epide-miology of gonorrhea.

1. CDC. Sexually transmitted disease surveillance, 2006. Atlanta, GA: US Department of Health and Human Services, CDC; 2007. Available at http://www.cdc.gov/std/stats/toc2006.htm.

2. CDC. Increases in gonorrheaeight western states, 2000-2005. MMWR 2007;56:222-5.

3. CDC. Update to CDCs sexually transmitted diseases treatment guide-lines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR 2007;56:332-6.

Haemophilus influenzae Before the introduction of effective vaccines, Haemophilus influenzae type b (Hib) was the leading cause of bacterial meningitis and other invasive bacterial disease among chil-dren aged <5 years. Incidence of invasive Hib disease began to decline dramatically in the late 1980s, coincident with licensure of conjugate Hib vaccines; incidence has declined

>99% compared with the prevaccine era (1). During 2006, approximately 8% of all cases of invasive Haemophilus influenzae (Hi) disease reported among children aged <5 years were attributed to Hib, reflecting successful delivery of highly effective conjugate Hib vaccines to children beginning at age 2 months (2). Nevertheless, for approximately 50% of reported cases, serotype information was either unknown or missing, and some of these also might be Hib cases. Accurate laboratory information is essential to correctly identify the serotype of the causative Hi isolate and to assess progress toward elimination of Hib invasive disease (3).

1. Schuchat A, Rosentein Messonnier N. From pandemic suspect to the postvaccine era: the Haemophilus influenzae story. Clin Infect Dis 2007;44:817-9

2. CDC. Progress toward elimination of Haemophilus influenzae type b disease among infants and childrenUnited States, 1998-2000. MMWR 2002;51:234-7.

3. LaClaire LL, Tondella ML, Beall DS, et al. Identification of Haemophilus influenzae serotypes by standard slide agglutination serotyping and PCR-based capsule typing. J Clin Microbiol 2003;41:393-6.

Hansen Disease (Leprosy)

The number of cases of Hansen disease (HD) reported in the United States peaked at 361 in 1985 and has declined since 1988. In 2006, cases were reported from 20 states and two territories. HD is not highly transmissible; cases appear to be related predominantly to immigration. HD outpatient clinics operated under the guidance and direc-tion of the U.S. Department of Health and Human Ser-vices, Health Resources and Services Administration exist in Phoenix, Arizona; Los Angeles, Martinez, and San Diego, California; Miami, Florida; Chicago, Illinois; Baton Rouge, Louisiana; Boston, Massachusetts; New York City, New York; San Juan, Puerto Rico; Austin, Dallas, Harlingen, Houston, and San Antonio, Texas; and Seattle, Washing-ton. Services provided to HD patients include diagnosis, treatment, follow-up of patients and contacts, disability prevention and monitoring, education, and a referral sys-tem for HD health-care services. Approximately 6,500 per-son in the United States are living with HD. Additional information regarding access to clinical care is available at http://www.hrsa.gov/hansens.

Hemolytic Uremic Syndrome, Postdiarrheal Hemolytic uremic syndrome (HUS) is characterized by the triad of hemolytic anemia, thrombocytopenia, and renal insufficiency. The most common etiology of HUS in the United States is infection with Shiga toxin-producing

Vol. 55 / No. 53 MMWR 11 Escherichia coli, principally E. coli O157:H7 (1). Approxi-mately 8% of persons infected with E. coli O157:H7 progress to HUS (2). During 2006, the majority of reported cases occurred among children aged <5 years.

1. Banatvala N, Griffin PM, Greene KD, et al. The United States prospec-tive hemolytic uremic syndrome study: microbiologic, serologic, clinical, and epidemiologic findings. J Infect Dis 2001;183:1063-70.

2. Slutsker L, Ries AA, Maloney K, et al. A nationwide case-control study of Escherichia coli O157:H7 infection in the United States. J Infect Dis 1998;177:962-6.

Influenza-Associated Pediatric Mortality An early and severe influenza season during 2003-2004 was associated with deaths in children in multiple states, prompting CDC to request that all state, territorial, and local health departments report laboratory confirmed influenza-associated pediatric deaths in children aged

<18 years (1,2). During the 2003-04 influenza season, 153 pediatric influenza-associated deaths were reported to CDC by 40 state health departments (3). In June 2004, the Council of State and Territorial Epidemiologists added influenza-associated pediatric mortality to the list of condi-tions reportable to the National Notifiable Diseases Sur-veillance System (NNDSS) (4). Cumulative year-to-date incidence data are published each week in MMWR Table I for low-incidence nationally notifiable diseases.

During 2006, a total of 43 influenza-associated pediatric deaths were reported to CDC. The median age at death was 4 years (range: 28 days-17 years): seven children (16%)

were aged <6 months; 12 (28%) were aged 6-23 months; five (12%) were aged 24-59 months; and 19 (44%) were aged >5 years. In 2006, approximately half of all influenza-associated pediatric deaths occurred in the inpatient set-ting; a slight increase occurred in the number of children who died in the emergency room or outside the hospital compared with 2005 (22 and 17, respectively). Twenty (47%) children had one or more underlying or chronic con-dition, and 21 (53%) were previously healthy. The more common chronic conditions reported included moderate to severe developmental delay (n = 8), neuromuscular dis-orders (n = 5), chronic pulmonary disease (n = 5), seizure disorder (n = 4), and asthma (n = 4). Bacterial coinfections were confirmed in seven children. Pathogens cultured were Staphylococcus aureus, sensitivity not done; Staphylococcus aureus, methicillin-sensitive; Streptococcus viridans; Group A Streptococcus; Pseudomonas aeruginosa, and one infection with an unidentified gram-negative bacteria. Of the six (14%) children who received >1 dose of influenza vaccine before the onset of illness during the 2005-06 season, only three were fully vaccinated. The current recommendations of the Advisory Committee on Immunization Practices high-light the importance of administering 2 doses of influenza vaccine for previously unvaccinated children aged 6 months-

<9years (5). Continued surveillance of severe influenza-related mortality is important to monitor the impact of influenza and the possible effects of interventions in children.

1. Update: influenza-associated deaths reported among children aged <18 yearsUnited States, 2003-04 influenza season. MMWR 2004;52:1254-5.

2. Update: influenza-associated deaths reported among children aged <18 yearsUnited States, 2003-04 influenza season. MMWR 2004;52:

1286-8.

3. Bhat N, Wright JG, Broder KR, et al. Influenza-associated deaths among children in the United States, 2003-2004. N Engl J Med 2005;352:

2559-67.

4. CDC. Mid-year addition of influenza-associated pediatric mortality to the list of nationally notifiable diseases, 2004. MMWR 2004;53:951-2.

5. CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2007;56(No. RR-6).

Legionellosis During 2005-2006, nationwide legionellosis case counts increased for the second year in a row. In 2005, in collabo-ration with CDC, the Council for State and Territorial Epi-demiologists adopted a position statement to improve reporting of travel-associated legionellosis (1); this might have resulted in an increase in case reporting. Nearly all regions of the United States, with the exception of the West North Central area, reported more cases in 2006 than in 2005. Other possible explanations for the increase include an actual increase in disease incidence or increased use of Legionella diagnostic tests.

1. Council of State and Territorial Epidemiologists. Strengthening surveil-lance for travel-associated legionellosis and revised case definitions for legionellosis. Position statement 05-ID-01. Available at http://

www.cste.org/position%20statements/searchbyyear2005.asp.

Listeriosis Listeriosis is a rare but severe infection caused by Listeria monocytogenes that has been a nationally notifiable disease since 2000. Listeriosis is primarily foodborne and occurs most frequently among persons who are older, pregnant, or immunocompromised. During 2005, the majority of reported cases occurred among persons aged >65 years.

Molecular subtyping of L. monocytogenes isolates and shar-ing of that information through PulseNet has enhanced the

12 MMWR March 21, 2008 ability of public health officials to detect and investigate outbreaks. Recent outbreaks have been linked to ready-to-eat deli meat (1) and unpasteurized cheese (2). During 2006, the incidence of listeriosis in FoodNet active surveillance sites was 0.3 cases per 100,000 population, representing a decrease of 34% compared with 1996-1998; however, incidence remained higher than at its lowest point in 2002 (3).

All clinical isolates should be submitted to state public health laboratories for pulsed-field gel electrophoresis (PFGE) pattern determination, and all persons with list-eriosis should be interviewed by a public health official or health-care provider using a standard Listeria case form (avail-able at http://www.cdc.gov/nationalsurveillance/

ListeriaCaseReportFormOMB0920-0004.pdf ). Rapid analysis of surveillance data will allow identification of possible food sources of outbreaks.

1. Gottlieb SL, Newbern EC, Griffin PM et al. Multistate outbreak of listeriosis linked to turkey deli meat and subsequent changes in US regu-latory policy. Clin Infect Dis 2006;42:29-36.

2. MacDonald PDM, Whitwam RE, Boggs JD et al. Outbreak of listeriosis among Mexican immigrants caused by illicitly produced Mexican-style cheese. Clin Infect Dis 2005;40:677-82.

3. CDC. Preliminary FoodNet data on the incidence of infection with patho-gens transmitted commonly through food10 states, 2006. MMWR 2007;56:336-9.

Measles In 2006, the Council of State and Territorial Epidemi-ologists (CSTE) approved a modified case classification for measles, simultaneously with those for rubella and congenital rubella syndrome (1). Because measles is no longer endemic in the United States, its future epidemiology in the U.S.

will reflect its global epidemiology. The modification of the case classification clearly identifies the origin of each case and will help define the impact of imported cases on the epidemiology of measles in the United States.

As in recent years, 95% of confirmed measles cases reported during 2006 were import-associated. Of these, 31 cases were internationally imported, 20 resulted from exposure to persons with imported infections, and in one case, virologic evidence indicated an imported source. The sources for the remaining three cases were classified as unknown because no link to importation was detected.

Nearly half of all cases occurred among adults aged 20-39 years, and 20% occurred in adults aged >40 years. Four outbreaks occurred during 2006 (size range: 3-18 cases),

all from imported sources. Three imported cases occurred in each of two outbreaks, with no secondary transmission.

In another outbreak; one imported case and two secondary cases occurred in an immigrant community. In the fourth outbreak, 18 cases occurred among persons aged 25-46 years, most of whom had unknown vaccination histories.

The primary exposure setting for this outbreak was a large office building and nearby businesses. Five case-patients were foreign born, including the index case-patient, who had arrived in the United States 9 days before onset of symptoms.

Measles can be prevented by adhering to recommenda-tions for vaccination, including guidelines for travelers (2,3).

Although the elimination of endemic measles in the United States has been achieved, and population immunity remains high (4), an outbreak can occur when measles is introduced into a susceptible group, often at significant cost to control (5).

1. Council of State and Territorial Epidemiologists. Revision of measles, rubella, and congenital rubella syndrome case classifications as part of elimination goals in the United States. Position statement 2006-ID-16.

Available at http://www.cste.org/position%20statements/

searchbyyear2006.asp.

2. CDC. Preventable measles among U.S. residents, 2001-2004. MMWR 2005;54:817-20.

3. CDC. Measles, mumps, and rubellavaccine use and strategies for elimi-nation of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee On Immuniza-tion Practices (ACIP). MMWR 1998;47(No. RR-8).

4. Hutchins SS, Bellini W, Coronado V, et al. Population immunity to measles in the United States. J Infect Dis 2004;189(Suppl 1):S91-S97.

5. Parker AA, Staggs W, Dayan G, et al. Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States. N Engl J Med 2006;355:447-55.

Meningococcal Disease, Invasive Neisseria meningitidis is a leading cause of bacterial men-ingitis and sepsis in the United States. Rates of meningo-coccal disease are highest among infants, with a second peak at age 18 years (1). The proportion of cases caused by each serogroup of N. meningitidis varies by age group. Among adolescents aged 11-19 years, 75% of cases are caused by serogroups contained in the tetravalent (A,C,Y,W-135) meningococcal conjugate vaccine ([MCV4] Menactra (Sanofi Pasteur, Swiftwater, Pennsylvania). The majority of cases in infants are caused by serogroup B, for which no vaccine is licensed in the United States.

MCV4 is licensed for persons aged 2-55 years. In 2007, CDCs Advisory Committee on Immunization Practices revised recommendations for routine use of MCV4 to include children aged 11-12 years at the preadolescent vaccination visit and adolescents aged 13-18 years at the earliest opportunity (2). MCV4 also is recommended for college freshmen living in dormitories and other popula-tions aged 2-55 years at increased risk for meningococcal disease (1). Further reductions in meningococcal disease

Vol. 55 / No. 53 MMWR 13 could be achieved with the development of an effective serogroup B vaccine.

1. CDC. Prevention and control of meningococcal disease: recommenda-tions of the Advisory Committee on Immunization Practices (ACIP).

MMWR 2005;54(No. RR-7).

2. CDC. Notice to readers: revised recommendations of the Advisory Com-mittee on Immunization Practices to vaccinate all persons aged 11-18 years with meningococcal conjugate vaccine. MMWR 2007;56:794-5.

3. CDC. Use of quadrivalent meningococcal conjugate vaccine (MCV4) in children aged 2-10 years at increased risk for invasive meningococcal disease: recommendation of the Advisory Committee on Immunization Practices (ACIP). MMWR. In press.

Mumps Since vaccine licensure in 1967, the number of cases of mumps in the United States has declined steadily. Since 2001, an average of 265 mumps cases (range: 231-293 cases) has been reported each year (1). However, in 2006, the largest mumps outbreak in >20 years occurred, with

>5,000 cases reported (1-3). The outbreak began in Iowa in December 2005, peaked in April 2006, and declined to lower levels of reporting during summer 2006 (3). The majority of cases occurred during March-May, 2006 (3).

The outbreak was primarily focal in geographic distribu-tion; 84% of cases were reported by six contiguous midwestern states (Illinois, Iowa, Kansas, Nebraska, South Dakota, and Wisconsin) (3). In contrast to the childhood age range traditionally associated with mumps disease, young adults aged 18-24 years were the age group most highly affected (1-3). In 2006, a total of 63% of reported cases occurred in females; previously, no gender differences in case rates had been reported (3).

In response to the outbreak, the Advisory Committee on Immunization Practices (ACIP) updated criteria for mumps immunity and mumps vaccination recommendations (4).

Acceptable presumptive evidence of immunity to mumps includes one of the following: 1) documentation of adequate vaccination, 2) laboratory evidence of immunity, 3) birth before 1957, or 4) documentation of physician-diagnosed mumps. Documentation of adequate vaccination now requires 2 doses of a live mumps virus vaccine for school-aged children (grades K-12) and adults at high risk (i.e.,

persons who work in health-care facilities, international travelers, and students at post-high school educational in-stitutions). Health-care workers born before 1957 without other evidence of immunity should now consider 1 dose of live mumps vaccine. During an outbreak, a sec-ond dose of live mumps vaccine should be considered for children aged 1-4 years and adults at low risk if affected by the outbreak; health-care workers born before 1957 with-out other evidence of immunity should strongly consider 2 doses of live mumps vaccine.

1. CDC. Mumps epidemicIowa, 2006. MMWR 2006;55:366-8.

2. CDC. Update: multistate outbreak of mumpsUnited States, January 1-May 2, 2006. MMWR 2006;55:559-63.

3. CDC. Update: mumps activityUnited States, January 1-October 7, 2006. MMWR 2006;55:1152-3.

4. CDC. Updated recommendations of the Advisory Committee on Immu-nization Practices (ACIP) for the control and elimination of mumps.

MMWR 2006;55:629-30.

Pertussis In 2006, incidence of reported pertussis decreased to 5.35 cases per 100,000 population after peaking during 2004-2005 at 8.9 per 100,000. Infants aged <6 months, who are too young to be fully vaccinated, had the highest reported rate of pertussis (84.21 per 100,000 population), but ado-lescents aged 10-19 years and adults aged >20 years contributed the greatest number of reported cases. Adoles-cents and adults might be a source of transmission of per-tussis to young infants who are at higher risk for severe disease and death and are recommended to be vaccinated with tetanus toxoid, reduced diphtheria toxoid, and acellu-lar pertussis vaccine (Tdap) (1,2). In 2006, coverage with Tdap in adolescents aged 13-17 years was 10.8%, com-pared with 49.4% coverage with tetanus and diphtheria toxoids vaccine (Td) (3). The decrease in reported pertussis incidence in 2006 is unlikely to be related to use of Tdap and is more likely related to the cyclical nature of disease.

1. CDC. Preventing tetanus, diphtheria, and pertussis among adolescents; use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines: recommendations of the Advisory Committee on Immuniza-tion Practices (ACIP). MMWR 2006;55(No. RR-3).

2. CDC. Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine:recommendations of the Advisory Committee on Immunization Practices (ACIP) and Recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC),

for use of Tdap among health-care personnel. MMWR 2006;55 (No. RR-17).

3. CDC. National vaccination coverage among adolescents aged 13-17 yearsUnited States, 2006. MMWR 2007;56:885-8.

Plague The number of human plague cases reported in 2006 was the greatest number since 1994 and was fourfold higher than the average for the preceding 5 years. Six cases were classified as primary septicemic plague, approximately twice the usual frequency of this disease manifestation. Nearly half of the cases reported in 2006 were from New Mexico (n = 8); two of these cases were fatal. Although factors

14 MMWR March 21, 2008 governing the occurrence of plague are incompletely un-derstood, the disease appears to fluctuate naturally in re-sponse to climactic factors.

Poliomyelitis, Paralytic and Polio Virus Infections In 2006, the Council of State and Territorial Epidemi-ologists (CSTE) recommended revision of the surveillance case definition for paralytic poliomyelitis to include nonparalytic poliovirus infection and the addition of non-paralytic poliovirus infection to the list of nationally notifi-able diseases reported through the National Notifiable Diseases Surveillance System (1). These changes resulted from the identification in 2005 of a type 1 vaccine-derived poliovirus (VDPV) infection among unvaccinated Minne-sota Amish children who were not paralyzed (2). Public health officials should remain alert that paralytic poliomy-elitis or poliovirus infections might occur in high-risk (i.e.,

unvaccinated or undervaccinated) populations and should report any detected poliovirus infections attributed to either wild or vaccine-derived polioviruses and any para-lytic poliomyelitis cases.

1. Council of State and Territorial Epidemiologists. Inclusion of poliovirus infection reporting in the National Notifiable Diseases Surveillance Sys-tem. Position statement 2006-ID-15. Available at: http://www.cste.org/

position%20statements/searchbyyear2006.asp.

2. CDC. Poliovirus infections in four unvaccinated childrenMinnesota, August-October 2005. MMWR 2005;54:1053-5.

Psittacosis Psittacosis is an avian zoonosis with a spectrum of disease that ranges from a mild influenza-like illness to severe pneu-monia with multiorgan involvement. Case reports of psit-tacosis in 2006 increased slightly compared with the previous four years. Further information regarding diagno-sis, treatment, and prevention of psittacosis is available at http://www.avma.org/pubhlth/psittacosis.asp.

Rabies During 2006, the majority (92%) of animal rabies cases were reported in wild animal species. Overall an 8.2%

increase in rabies cases was reported in animals compared with 2005 (1). In the United States five animal species are recognized as reservoir species for various rabies virus vari-ants over defined geographic regions: raccoons (eastern United States), bats (various species, all U.S. states except Hawaii), skunks (North Central United States, South Central United States, and California), foxes (Alaska, Arizona, and Texas), and mongoose (Puerto Rico). During 2006, bats became the second most reported species with rabies.

Reported cases of rabies in domestic animals remain low in part because of high vaccination rates. Dog-to-dog transmission has not been reported in 2 years, making the United States free of the canine rabies virus variant in 2006.

As in the past decade, cats were the most commonly re-ported domestic animal with rabies during 2006.

Vaccination programs to control rabies in wild carnivores were ongoing through the distribution of baits containing an oral rabies vaccine in the Eastern United States and Texas.

Oral rabies vaccination programs in Texas are being main-tained as a barrier to prevent the reintroduction of canine rabies from Mexico. Oral rabies vaccination programs are also being conducted in the Eastern United States to attempt to stop the westward spread of the raccoon rabies virus variant.

Active surveillance conducted by the U. S. Department of Agriculture (USDA) to monitor oral rabies vaccination pro-grams were further enhanced by the deployment of the Direct Rapid Immunohistochemical Test (DRIT) which USDA began implementing in the last half of 2005 after receiving training on its use at CDC. This test is used for screening the large number of samples collected by USDA in the field, reducing the burden on state laboratories and allowing for faster processing of surveillance samples (2).

Three cases of human rabies were identified during 2006:

one in a male aged 16 years from Texas, one in a female aged 10 years from Indiana, and one in a male aged 11 years from California. The cases in Texas and Indiana were attributable to bat-associated rabies virus variants; free-tailed bat and sliver-haired bat respectively. The case in California was associated with a canine variant from the Philippines.

The patient had recently immigrated from the Philippines where an exposure to a dog was noted approximately 2 years before onset of rabies (2).

1. Blanton JD, Hanlon CA, Ruprrecht CE. Rabies surveillance in the United States during 2006. J Am Vet Med Assoc 2007;231:540-56.

2. Lembo T, Niezgoda M, Hamir AN, et al. Evaluation of a direct, rapid immunohistochemical test for rabies diagnosis. Emerg Infect Dis 2006;12:310-3.

Salmonellosis During 2006, as in previous years, the majority of reported cases occurred among persons aged <5 years. Since 1993, the most frequently reported isolates have been Salmonella enterica serotype Typhimurium and S. enterica serotype Enteritidis (1). The epidemiology of Salmonella

Vol. 55 / No. 53 MMWR 15 has been changing over the past decade. Salmonella serotype Typhimurium has decreased in incidence, while incidence of serotypes Newport, Mississippi, and Javiana have increased. Specific control programs might have led to the reduction of serotype Enteritidis infections, which have been associated with the consumption of internally con-taminated eggs. Rates of antibiotic resistance among sev-eral serotypes have been increasing; a substantial proportion of serotypes Typhimurium and Newport isolates are resis-tant to multiple drugs (2).

The epidemiology of Salmonella infections is based on serotype characterization; in 2005, the Council of State and Territorial Epidemiologists adopted a position statement for serotype-specific reporting of laboratory-confirmed salmonellosis cases (3). However, reporting through the National Notifiable Diseases Surveillance System (NNDSS) does not include serotype; serotypes for Salmonella isolates are reported through the Public Health Laboratory Infor-mation System (PHLIS). The National Electronic Disease Surveillance System (NEDSS) or compatible systems even-tually will replace PHLIS; users of NEDSS or compatible systems should report serotype in NEDSS.

1. CDC. Salmonella surveillance summary, 2005. Atlanta, GA: US Depart-ment of Health and Human Services, CDC; 2006. Available at http://

www.cdc.gov/ncidod/dbmd/phlisdata/salmonella.htm.

2. CDC. National Antimicrobial Resistance Monitoring System for enteric bacteria (NARMS): 2004 human isolates, final report. Atlanta, GA: US Department of Health and Human Services, CDC; 2006.

3. Council of State and Territorial Epidemiologists. Serotype specific national reporting for salmonellosis. Position statement 05-ID-09. Available at http://

www.cste.org/position%20statements/searchbyyear2005.asp.

Shiga toxin-producing Escherichia coli (STEC)

Escherichia coli O157:H7 has been nationally notifiable since 1994 (1). National surveillance for all Shiga toxin-producing E.

coli (STEC),

under the name enterohemorrhagic E. coli (EHEC), began in 2001. As of January 1, 2006, the nationally notifiable diseases case defi-nition designation changed from EHEC to STEC, and serotype-specific reporting was implemented (2). Because diagnosis solely on the basis of detection of Shiga toxin does not sufficiently protect the publics health, characterizing STEC isolates by serotype and pulsed-field gel electrophore-sis (PFGE) patterns is critical to detect, investigate, and control outbreaks. Screening of stool specimens by clinical diagnostic laboratories for Shiga toxin by enzyme immu-noassay, subsequent bacterial culture using sorbitol MacConkey agar (SMAC), and forwarding enrichment broths from Shiga toxin-positive specimens that do not yield STEC O157 to state or local public health laboratories are important for public health surveillance of STEC infections (3).

Healthy cattle, which harbor the organism as part of the bowel flora, are the main animal reservoir of STEC. The majority of reported outbreaks are caused by contaminated food or water. The substantial decline in cases reported during 2002-2003 coincided with industry and regula-tory control activities and with a decrease in the contami-nation of ground beef (4). However, during 2005-2006, incidence of human STEC infections increased. Reasons for the increases are not known. Three large multistate out-breaks of E. coli O157 infections during fall 2006 caused by contaminated spinach and lettuce suggest that produce that is consumed raw is an important source of STEC infection (5,6).

1. Mead PS, Griffin PM. Escherichia coli O157:H7. Lancet 1998;352:

1207-12.

2. Council of State and Territorial Epidemiologists. Revision of the Enterohemorrhagic Escherichia coli (EHEC) condition name to Shiga toxin-producing Escherichia coli (STEC) and adoption of serotype specific national reporting for STEC. Position statement 05-ID-07. Available at http://www.cste.org/position%20statements/searchbyyear2005.asp.

3. CDC. Importance of culture confirmation of Shiga toxin-producing Escherichia coli infection as illustrated by outbreaks of gastroenteritis New York and North Carolina, 2005. MMWR 2006;55:1042-4.

4. Naugle AL, Holt KG, Levine P, Eckel R. 2005 Food Safety and Inspec-tion Service regulatory testing program for Escherichia coli O157:H7 in raw ground beef. J Food Prot 2005;68:462-8.

5. CDC. Ongoing multistate outbreak of Escherichia coli serotype O157:H7 associated with consumption of fresh spinachUnited States, September 2006. MMWR 2006;55:1045-6.

6. CDC. Multistate outbreak of E. coli infections linked to Taco Bell. Atlanta, GA: US Department of Health and Human Services, CDC; 2006. Avail-able at http://www.cdc.gov/ecoli/2006/december/index.htm.

Shigellosis During 1978-2003, the number of shigellosis cases reported to CDC consistently exceeded 17,000. The approximately 14,000 cases of shigellosis reported to CDC in 2004 represented an all-time low. This number increased to approximately 16,000 in 2005 and decreased slightly in 2006. Shigella sonnei infections continue to account for

>75% of shigellosis in the United States (1). Certain cases of shigellosis are acquired during international travel (2,3).

In addition to spread from one person to another, shigellae can be transmitted through contaminated foods, sexual con-tact, and water used for drinking or recreational purposes (1). Resistance to ampicillin and trimethoprim-sulfamethoxazole among S. sonnei strains in the United States remains common (4).

16 MMWR March 21, 2008

1. Gupta A, Polyak CS, Bishop RD, Sobel J, Mintz ED. Laboratory-confirmed shigellosis in the United States, 1989-2002: epidemiologic trends and patterns. Clin Infect Dis 2004;38:1372-7.

2. Ram PK, Crump JA, Gupta SK, Miller MA, Mintz, ED. Review article:

part II. Analysis of data gaps pertaining to Shigella infections in low and medium human development index countries, 1984-2005. Epidemiol Infect. In press.

3. Gupta SK, Strockbine N, Omondi M, Hise K, Fair MA, Mintz ED.

Short report: emergence of shiga toxin 1 genes within Shigella dysenteriae Type 4 isolates from travelers returning from the island of Hispanola. Am J Trop Med Hyg 2007;76:1163-5.

4. CDC. National Antimicrobial Resistance Monitoring System (NARMS):

enteric bacteria. Atlanta, GA: US Department of Health and Human Services, CDC; 2007. Available at http://www.cdc.gov/narms.

Streptococcus pneumoniae, invasive disease In 1994, the Council of State and Territorial Epidemi-ologists (CSTE) adopted a position statement making drug-resistant Streptococcus pneumoniae (DRSP) invasive disease a nationally notifiable disease (1). In 2000, in anticipation of the routine introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) (2), CSTE made invasive pneu-mococcal disease (IPD) among children aged <5 years nationally notifiable (3). Consequently, the National Noti-fiable Diseases Surveillance System (NNDSS) had two event codes for reporting IPD that were not mutually exclusive:

DRSP among persons of all ages and IPD among children aged <5 years.

To avoid submissions of duplicate reports, CSTE modi-fied the case classification of DRSP and IPD in 2006.

Under the modified case definition, which became effective in January 2007, cases with isolates causing IPD from chil-dren aged <5 years for whom antibacterial susceptibilities are available and determined to be DRSP should be reported only as DRSP, and cases with isolates causing IPD from children aged <5 years who are susceptible or for which susceptibilities are not available should be reported only as IPD in children aged <5 years (4). Only susceptible IPD episodes among children aged <5 years are reported in this Summary. In 2006, for the first time after several years of increasing case counts, the number of cases of pneumococ-cal disease in both reportable categories declined. The ini-tial increases in reported cases likely represented improvements in surveillance and possibly duplicate report-ing of DRSP and IPD cases during the first few years after the adoption of the 2000 position statement. Other data sources have demonstrated substantial declines in the inci-dence of IPD and DRSP among children and adults after introduction of PCV7 (5,6).

Although PCV7 has been recommended for use in chil-dren since 2000, recommendations for use of the 23-valent pneumococcal polysaccharide vaccine for adults aged

>65 years and for older children and adults with underly-ing illnesses were updated in 1997 (7). Cases of susceptible IPD among persons aged >5 years are not nationally notifiable.

States are encouraged to evaluate their own pneumococ-cal disease surveillance programs (8). CSTE also has recom-mended that technology for pneumococcal serotyping using polymerase chain reaction (PCR) (9) should be shared with state public health laboratories to improve surveillance for vaccine-and nonvaccine-preventable IPD among children aged <5 years (4). PCR is used by the majority of state public health laboratories to detect a variety of infectious diseases; therefore, this technology should allow most, if not all, state health departments to enhance surveillance for vaccine-preventable IPD. With better data, public health officials will be able to assess the burden of vaccine-preventable IPD and to evaluate current PCV7 immuniza-tion programs.

1. Council of State and Territorial Epidemiologists. National surveillance for drug-resistant Streptococcus pneumoniae (DRSP) invasive diseases.

Position statement 1994-NSC-10. Available at http://www.cste.org/ps/

1994/1994-nsc-10.htm.

2. CDC. Preventing pneumococcal disease among infants and young chil-dren: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2000;49(No. RR-9).

3. Council of State and Territorial Epidemiologists. Surveillance for inva-sive pneumococcal disease in children less than five years of age. Position statement 2000-ID-6. Available at http://www.cste.org/ps/2000/2000-id-06.htm.

4. Council of State and Territorial Epidemiologists. Enhancing local, state and territorial-based surveillance for invasive pneumococcal disease in chil-dren less than five years of age. Position statement 06-ID-14. Available at http://www.cste.org/position%20statements/searchbyyear2006.asp.

5. CDC. Direct and indirect effects of routine vaccination of children with 7-valent pneumococcal conjugate vaccine on incidence of invasive pneumo-coccal diseaseUnited States, 1998-2003. MMWR 2005;54:893-7.

6. Kyaw MH, Lynfield R, Schaffner W, et al. Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. N Engl J Med 2006;354:1455-63.

7. CDC. Prevention of pneumococcal disease. MMWR 1997;46(No. RR-8).

8. CDC. Updated guidelines for evaluating public health surveillance sys-tems: recommendations from the guidelines working group. MMWR 2001;50(No. RR-13).

9. CDC. PCR deduction of pneumococcal serotypes. Atlanta, GA: US Department of Health and Human Services, CDC; 2007. Available at http://www.cdc.gov/ncidod/biotech/strep/PRC.htm.

Vol. 55 / No. 53 MMWR 17 Syphilis, Primary and Secondary In 2006, primary and secondary (P&S) syphilis cases reported to CDC increased for the sixth consecutive year (1). During 2005-2006, the number of P&S syphilis cases reported to CDC increased 11.8%. Overall increases in rates during 2001-2006 were observed primarily among men (2). However, after decreasing during 2001-2004, the rate of primary and secondary syphilis among women increased, from 0.8 cases per 100,000 population in 2004 to 1.0 cases per 100,000 population in 2006. During 2005-2006, P&S syphilis increased among persons of all races and ethnicities.

In 2005, CDC requested that all state health departments report the sex of partners of persons with syphilis. In 2006, of all P&S syphilis cases reported from the 30 areas (29 states and Washington, D.C.) for which complete data were available, 64% occurred among men who have sex with men (3).

Although the majority of cases of syphilis in the United States occur among men who have sex with men, recent increases in the number of cases reported among women suggest that heterosexually transmitted syphilis might be an emerging problem. In collaboration with partners throughout the United States, CDC updated the Syphilis Elimination Plan for 2005-2010 and is now working to implement it (4). Collaboration with multiple organiza-tions, public health professionals, the private medical com-munity, and other partners is essential for the successful elimination of syphilis in the United States.

1. CDC. Sexually transmitted disease surveillance, 2006. Atlanta, GA: US Department of Health and Human Services, CDC; 2007. Available at http://www.cdc.gov/std/stats/toc2006.htm.

2. Heffelfinger JD, Swint EB, Berman SM, Weinstock HS. Trends in pri-mary and secondary syphilis among men who have sex with men in the United States. Am J Public Health 2007;97:1076-83.

3. Beltrami JF, Weinstock H.S. Primary and secondary syphilis among men who have sex with men in the United States, 2005 [Abstract O-069].

Program and abstracts of the 17th biennial meeting of the International Society for Sexually Transmitted Diseases Research; July 29-August 1, 2006; Seattle, Washington.

4. CDC. The national plan to eliminate syphilis from the United States.

Atlanta, GA: US Department of Health and Human Services, CDC; 2006.

Tetanus In 2006, incidence of reported tetanus and case fatality continued to be low. No neonatal cases were reported. The majority of cases occurred among persons aged 25-59 years and those aged >60 years. Mortality from tetanus was asso-ciated with diabetes, intravenous drug use, and advanced age, especially in the setting of unknown vaccination status.

Typhoid Fever Despite recommendations that travelers to countries in which typhoid fever is endemic should be vaccinated with either of two effective vaccines available in the United States, approximately three fourths of all cases occur among persons who reported international travel during the pre-ceding month and were not immunized. Persons visiting South Asia appear to be at particular risk, even during short visits (1). Salmonella Typhi strains with decreased suscepti-bility to ciprofloxacin are increasingly frequent in that region and might require treatment with alternative anti-microbial agents (2,3). Although the number of S. Typhi infections is decreasing, the number of illnesses attributed to S. Paratyphi A infection is increasing. In a cross-sectional laboratory-based surveillance study conducted by CDC, 80% of patients with paratyphoid fever acquired their infections in South Asia, and 75% were infected with nali-dixic acid-resistant strains. A vaccine for paratyphoid fever is needed (4).

1. Steinberg EB, Bishop RB, Dempsey AF, et al. Typhoid fever in travelers:

who should be targeted for prevention? Clin Infect Dis 2004;39:186-91.

2. Crump JA, Ram PK, Gupta SK, Miller MA, Mintz ED. Review article:

part I. analysis of data gaps pertaining to Salmonella enterica serotype Typhi infections in low and medium human development index countries, 1984-2005. Epidemiol Infect. In press.

3. Crump JA, Barrett TJ, Nelson JT, Angulo FJ. Reevaluating fluoroquinolones breakpoints for Salmonella enterica serotype Typhi and for non-Typhi Salmonellae. Clin Infect Dis 2003;37:75-81.

4. Gupta SK, Medalla F, Omondi MW, et al. Salmonella Paratyphi A in the United States: travel and quinolone resistance [Abstract]. Presented at the International Conference on Emerging Infectious Diseases, Atlanta, Georgia; March 19-26, 2006.

Varicella (Chickenpox)

Since implementation of the varicella vaccine program in 1995, varicella morbidity and mortality have declined sub-stantially. During 1995-2006, the number of cases declined 85%, the number of hospitalizations declined 85%, and the number of deaths declined 82% (1). In 2006, the Advisory Committee on Immunization Practices (ACIP) updated recommendations for varicella vaccination to include a second dose for children and catch-up vaccina-tion for persons without evidence of immunity (2). With this new recommendation, case-based and outbreak sur-veillance for varicella will become increasingly important.

In 2006, a total of 33 states and the District of Columbia reported varicella data through the National Notifiable Diseases Surveillance System (NNDSS): 23 (70%) sites reported case-based data and 10 (30%) reported aggregate

18 MMWR March 21, 2008 data. An additional 12 states conducted either statewide or sentinel case-based varicella surveillance but did not report these data through NNDSS. Although varicella was not a notifiable disease in Indiana in 2006, a total of 910 cases were reported.

1. Roush SW, Murphy TV, Vaccine Disease Table Working Group. His-torical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States. JAMA 2007;298:2155-63.

2. CDC. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2007;56 (No. RR-4).

Vol. 55 / No. 53 MMWR 19 PART 1 Summaries of Notifiable Diseases in the United States, 2006 Abbreviations and Symbols Used in Tables U

Data not available.

N Not notifiable (i.e., report of disease is not required in that jurisdiction).

No reported cases.

Notes:

Rates <0.01 after rounding are listed as 0.

Data in the MMWR Summary of Notifiable Diseases United States, 2006 might not match data in other CDC surveillance reports because of differences in the timing of reports, the source of the data, and the use of different case definitions.

20 MMWR March 21, 2008 TABLE 1. Reported cases of notifiable diseases,* by month United States, 2006 Disease Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total Anthrax

1

1 Botulism foodborne

1 3

1 4

1 5

5 20 infant 3

8 9

5 4

9 11 8

7 7

5 21 97 other (wound & unspecified) 1 9

2 7

3 3

5 8

1 1

1 7

48 Brucellosis 8

6 6

8 13 10 15 10 15 12 7

11 121 Chancroid 2

2 3

7 1

2 6

1 2

2 3

2 33 Chlamydia§ 67,194 77,005 81,645 101,292 79,030 75,189 94,856 81,694 102,408 87,509 72,947 110,142 1,030,911 Cholera 1

1 4

1 2

9 Coccidioidomycosis 491 683 678 1,035 634 609 813 620 572 417 615 1,750 8,917 Cryptosporidiosis 217 221 217 273 241 264 481 995 1,445 674 446 597 6,071 Cyclosporiasis 13 10 3

4 10 22 26 19 9

5 6

10 137 Domestic arboviral diseases¶ California serogroup neuroinvasive

2 17 23 13 8

1

64 nonneuroinvasive

1 1

1 1

1 5

eastern equine, neuroinvasive

1 3

4

8 Powassan, neuroinvasive

1

1 St. Louis neuroinvasive 1

2

2 1

1

7 nonneuroinvasive

1

1

1

3 West Nile neuroinvasive 1

1 3

2 26 329 758 301 64 7

3 1,495 nonneuroinvasive

1 1

3 31 515 1,628 488 91 13 3

2,774 Ehrlichiosis human granulocytic 2

4 5

10 24 71 128 61 56 35 31 219 646 human monocytic 19 9

10 13 24 45 95 98 52 49 27 137 578 human (other & unspecified)

1

6 18 52 70 25 18 15 6

20 231 Giardiasis 1,002 1,145 1,195 1,379 1,260 1,086 1,789 1,774 2,484 1,677 1,329 2,833 18,953 Gonorrhea 25,182 26,034 26,555 33,788 26,305 26,953 34,207 28,872 37,595 30,107 24,927 37,841 358,366 Haemophilus influenzae, invasive disease all ages, serotypes 197 187 183 240 159 171 243 165 175 161 168 387 2,436 age <5 yrs serotype b 1

2 2

1 2

2 1

1 2

2 1

12 29 nonserotype b 10 15 21 25 4

10 18 10 6

12 11 33 175 unknown serotype 15 14 7

20 11 16 10 18 14 11 14 29 179 Hansen disease (leprosy) 1 5

4 7

5 10 8

5 8

3 4

6 66 Hantavirus pulmonary syndrome 2 3

2 1

3 6

6

3 2

3 9

40 Hemolytic uremic syndrome, postdiarrheal 2

3 5

18 21 17 42 33 75 23 7

42 288 Hepatitis, viral acute A

263 312 282 391 253 230 266 271 383 274 231 423 3,579 B

270 283 345 434 301 385 443 363 426 387 344 732 4,713 C

43 61 53 78 66 69 67 54 51 47 41 136 766 Influenza-associated pediatric mortality**

7 3

4 11 8

3 5

1

1 43

• No cases of diphtheria; neuroinvasive or nonneuroinvasive western equine encephalitis virus disease, paralytic poliomyelitis, severe acute respiratory syndrome-associated coronavirus (SARS-CoV), smallpox, and yellow fever, or varicella deaths were reported in 2006. Data on chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review. CDC is upgrading its national surveillance data management system for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). During this transition, CDC is not updating AIDS or HIV infection surveillance data. Therefore, no updates are provided for HIV and AIDS data in this Summary.

Totals reported to the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), as of June 22, 2007.

§ Chlamydia refers to genital infections caused by Chlamydia trachomatis.

¶ Totals reported to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED) (ArboNET Surveillance), as of June 1, 2007.

• • Totals reported to the Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD), as of June 29, 2007.

Vol. 55 / No. 53 MMWR 21 Legionellosis 106 94 92 140 115 228 417 300 446 350 239 307 2,834 Listeriosis 50 41 42 66 34 44 115 87 124 101 61 119 884 Lyme disease 313 375 439 507 859 2,249 5,388 3,137 2,334 1,234 1,192 1,904 19,931 Malaria 97 100 76 81 116 118 171 159 170 98 105 183 1,474 Measles 1

2 3

2 15 15 2

4 6

2

3 55 Meningococcal disease all serogroups 104 112 136 143 80 89 82 54 74 57 74 189 1,194 serogroup A, C, Y, & W-135 26 27 39 35 25 21 19 9

22 22 25 48 318 serogroup B 7

17 21 21 14 16 17 8

13 4

9 46 193 other serogroup 3

4 3

2 4

3 2

2 2

7 32 serogroup unknown 68 64 73 85 37 52 46 34 37 29 38 88 651 Mumps 24 77 348 2,656 1,673 515 271 149 227 141 164 339 6,584 Pertussis 988 1,088 1,120 1,270 951 927 1,338 1,391 1,402 1,194 1,165 2,798 15,632 Plague

1

3 1

5 4

1 2

17 Psittacosis

2 1

3 1

1 3

2 5

1 2

21 Q fever 11 5

18 12 13 16 26 18 18 9

8 15 169 Rabies animal 345 243 362 479 485 436 607 568 770 483 380 376 5,534 human

1

1 1

3 Rocky Mountain spotted fever 141 70 44 76 136 170 345 360 352 174 128 292 2,288 Rubella 1

1 1

2 2

3

1 11 Rubella, congenital syndrome

1

1 Salmonellosis 2,376 1,999 1,963 2,723 2,815 3,444 5,483 5,081 6,416 4,214 3,387 5,907 45,808 Shiga toxin-producing E. coli (STEC)§§ 173 103 141 208 187 315 563 574 789 386 248 745 4,432 Shigellosis 792 729 651 784 975 1,004 1,296 1,473 1,963 1,726 1,422 2,688 15,503 Streptococcal disease, invasive, group A 449 501 694 653 482 395 419 281 317 272 280 664 5,407 Streptococcal toxic-shock syndrome 9

18 17 25 9

7 7

7 2

9 4

11 125 Streptococcus pneumoniae, invasive disease drug-resistant, all ages 298 336 362 347 236 210 168 112 149 238 207 645 3,308 age <5 yrs 124 164 192 178 145 103 95 74 119 151 182 3346 1,861 Syphilis all stages¶¶ 2,326 2,713 2,857 3,474 2,894 2,673 3,485 3,107 3,622 3,050 2,695 4,039 36,935 congenital (age <1 yr) 35 21 16 26 29 38 33 43 33 28 30 17 349 primary & secondary 615 680 698 882 722 703 937 863 985 801 696 1,174 9,756 Tetanus 1

5 4

2 4

5 3

4 4

1 8

41 Toxic-shock syndrome 4

10 18 8

2 6

6 5

12 7

6 17 101 Trichinellosis 2

1 2

2 3

1 1

3 15 Tuberculosis***

583 905 1,138 1,102 1,220 1,109 1,164 1,307 1,082 1,131 1,102 1,936 13,779 Tularemia 2

1

5 13 6

22 14 15 6

2 9

95 Typhoid fever 22 19 23 29 26 20 36 31 61 29 15 42 353 Vancomycin-intermediate Staphylococcus aureus

1

1 2

1

1 6

Vancomycin-resistant Staphylococcus aureus

1 1

Varicella (chickenpox) 3,422 4,350 5,528 6,733 5,604 3,618 1,596 813 2,126 3,008 3,950 7,697 48,445

§§ Includes E-coli O157:H7; shiga toxin-positive, serogroup non-O157; and shiga toxin-positive, not serogrouped.

¶¶ Includes the following categories: primary, secondary, latent (including early latent, late latent, and latent syphilis of unknown duration), neurosyphilis, late (including late syphilis with clinical manifestations other than neurosyphilis), and congenital syphilis.

• • • Totals reported to the Division of TB Elimination, NCHHSTP, as of May 25, 2007.

TABLE 1. (Continued) Reported cases of notifiable diseases,* by month United States, 2006 Disease Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total

22 MMWR March 21, 2008 TABLE 2. Reported cases of notifiable diseases,* by geographic division and area United States, 2006 Total resident population Botulism Area (in thousands)

Anthrax Foodborne Infant Other Brucellosis United States 296,410 1

20 97 48 121 New England 14,239

1

3 Connecticut 3,510

Maine 1,321

Massachusetts 6,399

1

2 New Hampshire 1,310

Rhode Island 1,076

1 Vermont 623

Mid. Atlantic 40,402 1

16 3

2 New Jersey 8,718

7

1 New York (Upstate) 11,111

1

New York City 8,143 1

3

Pennsylvania 12,430

8

1 E.N. Central 46,156

1 2

14 Illinois 12,763

1

8 Indiana 6,272

1 Michigan 10,121

3 Ohio 11,464

2

2 Wisconsin 5,536

W.N. Central 19,816

1

12 Iowa 2,966

1

2 Kansas 2,745

3 Minnesota 5,133

3 Missouri 5,800

1 Nebraska 1,759

3 North Dakota 637

South Dakota 776

S. Atlantic 56,180

5 6

1 19 Delaware 844

1 District of Columbia 551

Florida 17,790

1

5 Georgia 9,073

3

5 Maryland 5,600

5 1

3 North Carolina 8,683

1

2 South Carolina 4,255

3 Virginia 7,567

West Virginia 1,817

1

E.S. Central 17,615

1

3 Alabama 4,558

1 Kentucky 4,173

1 Mississippi 2,921

Tennessee 5,963

1

1 W.S. Central 33,711

5 1

20 Arkansas 2,779

Louisiana 4,524

Oklahoma 3,548

2 Texas 22,860

5 1

18 Mountain 20,291

2 12

12 Arizona 5,939

5

4 Colorado 4,665

1

4 Idaho 1,429

Montana 936

1

Nevada 2,415

2 1

3 New Mexico 1,928

1

Utah 2,470

3

Wyoming 509

1 Pacific 48,000

12 53 43 36 Alaska 664

6

California 36,132

6 44 42 34 Hawaii 1,275

2 Oregon 3,641

Washington 6,288

9 1

American Samoa 58

C.N.M.I.

80

Guam 169

Puerto Rico 3,912

N

U.S. Virgin Islands 109

N: Not notifiable.

U: Unavailable.

No reported cases.

C.N.M.I.: Commonwealth of Northern Mariana Islands.

• No cases of diphtheria; neuroinvasive or nonneuroinvasive western equine encephalitis virus disease, paralytic poliomyelitis, severe acute respiratory syndrome-associated coronavirus (SARS-CoV), smallpox, and yellow fever, or varicella deaths were reported in 2006. Data on chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review. CDC is upgrading its national surveillance data management system for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). During this transition, CDC is not updating AIDS or HIV infection surveillance data. Therefore, no updates are provided for HIV and AIDS data in this release of the Final 2006 Reports of Nationally Notifiable Infectious Diseases.

Includes cases reported as wound and unspecified botulism.

Vol. 55 / No. 53 MMWR 23 TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2006 Area Chancroid§ Chlamydia¶ Cholera Coccidioidomycosis Cryptosporidiosis Cyclosporiasis United States 33 1,030,911 9

8,917 6,071 137 New England

34,976

379 14 Connecticut

10,946

N 38 11 Maine

2,306

52

Massachusetts

15,394

175 2

New Hampshire N

1,997

47

Rhode Island

3,142

14 1

Vermont N

1,191

N 53

Mid. Atlantic 5

128,401 2

667 40 New Jersey

20,194 1

N 42 8

New York (Upstate) 1 27,488

N 184 2

New York City 4

41,232 1

N 155 23 Pennsylvania

39,487

N 286 7

E.N. Central 1

170,494 1

46 1,350 4

Illinois

53,586 1

204 1

Indiana

19,859

113 1

Michigan 1

36,753

40 144

Ohio

40,106

6 357

Wisconsin

20,190

N 532 2

W.N. Central

62,017

56 892 4

Iowa N

8,390

N 176

Kansas

7,829

N 82

Minnesota

12,935

54 242 4

Missouri

22,982

2 188

Nebraska N

5,428

N 98 N

North Dakota N

1,820

N 20 N

South Dakota

2,633

N 86

S. Atlantic 21 199,732

6 1,222 65 Delaware

3,615

1 15 1

District of Columbia

3,368

17 4

Florida 1

48,955

N 577 31 Georgia

38,972

N 275 19 Maryland

21,859

5 20 2

North Carolina 5

33,615

101 3

South Carolina 14 22,351

N 131 5

Virginia 1

24,087

N 71

West Virginia

2,910

N 15

E.S. Central

76,177

188 4

Alabama

22,915

N 72 N

Kentucky

8,940

N 44 N

Mississippi

19,002

N 24 N

Tennessee

25,320

N 48 4

W.S. Central 6

114,679 4

1 438 2

Arkansas

8,259

N 29

Louisiana 1

17,885 4

1 86

Oklahoma N

12,992

N 50 1

Texas 5

75,543

N 273 1

Mountain

71,139

5,677 416 1

Arizona

24,090

5,535 29

Colorado

16,313

N 77

Idaho

3,345

N 38 N

Montana

2,650

N 141 N

Nevada

8,398

62 14

New Mexico

9,829

22 45 1

Utah

5,092

56 21

Wyoming

1,422

2 51

Pacific

173,296 2

3,131 519 3

Alaska N

4,525

N 4

California

135,827 2

3,131 340 N

Hawaii N

5,548

N 4

N Oregon

9,577

N 76 2

Washington

17,819

N 95 1

American Samoa N

N N

N C.N.M.I.

Guam

832

Puerto Rico N

5,102

N N

N U.S. Virgin Islands

203

N: Not notifiable.

U: Unavailable.

No reported cases.

C.N.M.I.: Commonwealth of Northern Mariana Islands.

§ Totals reported to the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP), as of June 22, 2007.

¶ Totals reported to the Division of STD Prevention, NCHHSTP, as of June 22, 2007. Chlamydia refers to genital infections caused by Chlamydia trachomatis.

24 MMWR March 21, 2008 TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2006 Domestic arboviral diseases**

California serogroup Eastern equine Powassan St. Louis West Nile Neuro-Nonneuro-Neuro-Nonneuro-Neuro-Nonneuro-Neuro-Nonneuro-Neuro-Nonneuro-Area invasive invasive invasive invasive invasive invasive invasive invasive invasive invasive United States 64 5

8

1

7 3

1,495 2,774 New England

5

1

9 3

Connecticut

7 2

Maine

Massachusetts

5

2 1

New Hampshire

1

Rhode Island

Vermont

Mid. Atlantic

26 12 New Jersey

2 3

New York (Upstate)

1

8 4

New York City

8 4

Pennsylvania

8 1

E.N. Central 18 1

1

1

244 175 Illinois

127 88 Indiana 3

27 53 Michigan 2

43 12 Ohio 11

1

36 12 Wisconsin 2

1

1

11 10 W.N. Central 2

1

224 484 Iowa 1

22 15 Kansas

17 13 Minnesota 1

31 34 Missouri

1

51 11 Nebraska

45 219 North Dakota

20 117 South Dakota

38 75 S. Atlantic 35 1

2

18 14 Delaware

District of Columbia

2 Florida 1

3

Georgia

1 1

2 6

Maryland

10 1

North Carolina 17

1

1

South Carolina 1

1

Virginia

5 West Virginia 16

1

E.S. Central 7

1

118 101 Alabama

8

Kentucky

1

5 1

Mississippi 1

89 94 Tennessee 7

16 6

W.S. Central 2

1 1

2 1

375 236 Arkansas

24 5

Louisiana 2

1 1

2

91 89 Oklahoma

27 21 Texas

1 233 121 Mountain

1 2

393 1,487 Arizona

1 1

68 82 Colorado

66 279 Idaho

1 139 857 Montana

12 22 Nevada

34 90 New Mexico

3 5

Utah

56 102 Wyoming

15 50 Pacific

88 262 Alaska

California

81 197 Hawaii

Oregon

7 62 Washington

3 American Samoa

C.N.M.I.

Guam

Puerto Rico

U.S. Virgin Islands

N: Not notifiable.

U: Unavailable.

No reported cases.

C.N.M.I.: Commonwealth of Northern Mariana Islands.

• • Totals reported to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED) (ArboNET Surveillance), as of June 1, 2007. The not notifiable indicator is not applied to data on domestic arboviral diseases.

Vol. 55 / No. 53 MMWR 25 TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2006 Ehrlichiosis Human Human Human (other &

Area granulocytic monocytic unspecified)

Giardiasis Gonorrhea United States 646 578 231 18,953 358,366 New England 90 13 10 1,456 5,936 Connecticut 37

307 2,610 Maine 10 4

192 137 Massachusetts 30 6

1 621 2,429 New Hampshire

1 1

26 180 Rhode Island 13 2

8 117 508 Vermont

193 72 Mid. Atlantic 285 208 1

3,611 34,417 New Jersey 49 67 N

476 5,492 New York (Upstate) 206 125 1

1,375 7,160 New York City 29 16

936 10,299 Pennsylvania 1

824 11,466 E.N. Central 56 37 123 2,806 70,712 Illinois 6

23 3

695 20,186 Indiana

4

N 8,732 Michigan 1

2

715 15,677 Ohio 1

5

809 19,190 Wisconsin 48 3

120 587 6,927 W.N. Central 182 92 25 2,307 19,636 Iowa N

N N

303 1,966 Kansas

198 2,210 Minnesota 177 19

1,001 3,303 Missouri 2

73 24 548 10,204 Nebraska 3

1 122 1,433 North Dakota

38 153 South Dakota

97 367 S. Atlantic 18 118 54 2,858 89,406 Delaware 7

14

43 1,485 District of Columbia

69 1,887 Florida 1

5

1,165 23,976 Georgia 2

14

642 19,669 Maryland 5

25 45 256 7,328 North Carolina 1

54 3

17,312 South Carolina

4 2

112 10,320 Virginia 2

2 4

514 6,476 West Virginia

57 953 E.S. Central 3

35 5

465 31,147 Alabama 2

2

224 10,665 Kentucky

4

N 3,277 Mississippi

N 7,511 Tennessee 1

29 5

241 9,694 W.S. Central 10 75 11 401 50,589 Arkansas 2

32 6

148 4,306 Louisiana

1 1

87 10,883 Oklahoma 8

39

166 4,951 Texas

3 4

N 30,449 Mountain 1

1 1,709 15,576 Arizona

163 5,949 Colorado

554 3,695 Idaho N

N N

190 206 Montana N

N N

103 194 Nevada 1

110 2,791 New Mexico

80 1,733 Utah

471 888 Wyoming

1 38 120 Pacific 1

1 3,340 40,947 Alaska N

N N

113 630 California

1 2,303 33,740 Hawaii N

N N

58 885 Oregon 1

417 1,461 Washington N

N N

449 4,231 American Samoa N

N N

N

C.N.M.I.

Guam N

N N

5 98 Puerto Rico N

N N

276 302 U.S. Virgin Islands

34 N: Not notifiable.

U: Unavailable.

No reported cases.

C.N.M.I.: Commonwealth of Northern Mariana Islands.

Totals reported to the Division of STD Prevention, NCHHSTP, as of June 22, 2007.

26 MMWR March 21, 2008 TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2006 Haemophilus influenzae, invasive disease Hemolytic Age <5 years Hansen Hantavirus uremic All ages, Serotype Nonserotype Unknown disease pulmonary

syndrome, Area serotypes b

b serotype (leprosy) syndrome postdiarrheal United States 2,436 29 175 179 66 40 288 New England 195

15 4

2

16 Connecticut 48

3

N 5

Maine 21

2 1

N

6 Massachusetts 85

7 1

1

4 New Hampshire 16

1 1

Rhode Island 16

2

Vermont 9

1 1

N

1 Mid. Atlantic 499 6

15 44 4

21 New Jersey 90

14 1

7 New York (Upstate) 158 1

3 8

N

8 New York City 90

14 3

6 Pennsylvania 161 5

12 8

N E.N. Central 395

19 39 4

42 Illinois 120

20 3

8 Indiana 81

8

Michigan 32

5 1

5 Ohio 93

6 7

15 Wisconsin 69

11 1

14 W.N. Central 180 3

14 5

2 4

48 Iowa 2

1

1

9 Kansas 20

3

1 Minnesota 98 2

14

19 Missouri 39

1 1

8 Nebraska 10

9 North Dakota 11

1 N

2 1

South Dakota

2 1

S. Atlantic 579 6

35 25 8

27 Delaware 1

District of Columbia 9

2

Florida 167 3

11 5

7

5 Georgia 122 2

18 N

8 Maryland 83

10

N North Carolina 61

5

8 South Carolina 40 1

4

2 Virginia 69

3

1

2 West Virginia 27

2

N

2 E.S. Central 117

6 17

25 Alabama 23

1 4

N 2

Kentucky 5

1

N Mississippi 13

3

Tennessee 76

5 9

23 W.S. Central 122 5

10 11 11 2

18 Arkansas 10

4 2

Louisiana 23

6

Oklahoma 78

10 1

2 Texas 11 5

9 2

16 Mountain 217 4

42 12 4

28 32 Arizona 88 3

19 7

9 1

Colorado 51

8

N 6

8 Idaho 7

5 1

1 2

4 Montana

Nevada 14

2

1 2

3 New Mexico 33 1

4 1

1 8

4 Utah 19

4 2

1

12 Wyoming 5

1

1

Pacific 132 5

19 22 31 6

59 Alaska 12

6 1

N N

California 40 4

18 4

19 3

47 Hawaii 21

2 11

Oregon 54

7 N

11 Washington 5

1 1

3 N

3 1

American Samoa

N N

C.N.M.I.

Guam 1

3 N

Puerto Rico 3

1 2

N N

U.S. Virgin Islands

N: Not notifiable.

U: Unavailable.

No reported cases.

C.N.M.I.: Commonwealth of Northern Mariana Islands.

Vol. 55 / No. 53 MMWR 27 TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2006 Influenza-associated Hepatitis, viral, acute pediatric Lyme Area A

B C

mortality§§ Legionellosis Listeriosis disease Malaria United States 3,579 4,713 766 43 2,834 884 19,931 1,474 New England 182 120 40 3

190 62 4,588 61 Connecticut 44 49 14 1

59 19 1,788 13 Maine 8

26 2

11 6

338 4

Massachusetts 84 19

69 22 1,432 29 New Hampshire 22 11 N

15 7

617 10 Rhode Island 16 11 1

1 28 6

308 4

Vermont 8

4 23 1

8 2

105 1

Mid. Atlantic 400 538 179 8

984 213 10,134 362 New Jersey 111 164 90 1

120 42 2,432 90 New York (Upstate) 102 82 44

345 60 4,155 50 New York City 120 120

5 185 36 305 173 Pennsylvania 67 172 45 2

334 75 3,242 49 E.N. Central 362 509 128 2

612 130 1,700 165 Illinois 109 132 13

128 31 110 83 Indiana 33 80 3

54 21 26 13 Michigan 125 141 104 1

151 18 55 21 Ohio 53 123 7

1 231 44 43 29 Wisconsin 42 33 1

N 48 16 1,466 19 W.N. Central 145 152 38 2

85 36 1,039 73 Iowa 13 21

12 6

97 2

Kansas 27 11

2 10 4

4 8

Minnesota 31 32 11

26 7

914 50 Missouri 44 62 27

22 12 5

6 Nebraska 18 20

9 4

11 4

North Dakota 3

1

1 1

7 2

South Dakota 9

5

5 2

1 1

S. Atlantic 550 1,237 99 4

497 167 2,270 338 Delaware 13 47 3

12 2

482 5

District of Columbia 10 9

2

33 2

62 5

Florida 213 420 18

167 47 34 61 Georgia 56 205 8

1 38 20 8

88 Maryland 60 148 16 N

109 28 1,248 79 North Carolina 104 159 19 1

42 25 31 32 South Carolina 24 97

8 9

20 10 Virginia 64 78 9

2 68 20 357 55 West Virginia 6

74 24

20 14 28 3

E.S. Central 125 332 80 1

112 25 36 25 Alabama 13 95 11 N

10 7

11 9

Kentucky 33 69 36 1

48 3

7 4

Mississippi 9

13 4

5 2

3 6

Tennessee 70 155 29

49 13 15 6

W.S. Central 427 1,079 85 1

94 56 30 129 Arkansas 48 87 1

4 4

4 Louisiana 38 63 9

11 6

1 9

Oklahoma 11 96 19 1

10 5

10 Texas 330 833 56 N

69 41 29 106 Mountain 286 147 52 8

125 37 31 77 Arizona 179 U

2 38 7

10 23 Colorado 44 34 28 2

27 12

24 Idaho 9

15 3

N 11

7 1

Montana 11 5

7 1

1 2

Nevada 11 42 7

11 9

4 4

New Mexico 16 24 4

3 5

6 3

5 Utah 14 26 10

26 2

5 18 Wyoming 2

1

1

1

Pacific 1,102 599 65 14 135 158 103 244 Alaska 2

8

N 1

N 3

23 California 992 427 25 14 96 124 85 157 Hawaii 12 8

6

4 N

8 Oregon 44 82 11 N

18 12 7

13 Washington 52 74 23 N

20 18 8

43 American Samoa

N N

N

C.N.M.I.

Guam 1

4

N

N

3 Puerto Rico 76 83

N 1

N 2

U.S. Virgin Islands

N: Not notifiable.

U: Unavailable.

No reported cases.

C.N.M.I.: Commonwealth of Northern Mariana Islands.

§§ Totals reported to the Division of Influenza, National Center for Immunization and Respiratory Diseases (NCIRD), as of December 31, 2006.

28 MMWR March 21, 2008 TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2006 Meningococcal disease Measles All Serogroup Serogroup Other Serogroup Area Indigenous Imported¶¶ serogroups A, C, Y, & W-135 B

serogroup unknown United States 24 31 1,194 318 193 32 651 New England 17 3

52 26 17 3

6 Connecticut

10 9

1

Maine

9 1

6 2

Massachusetts 17 2

24 14 7

1 2

New Hampshire

1 4

4 Rhode Island

2 2

Vermont

3

3

Mid. Atlantic 6

7 174 48 18 1

107 New Jersey

1 24

24 New York (Upstate) 4 3

40 26 10

4 New York City

3 58

58 Pennsylvania 2

52 22 8

1 21 E.N. Central

2 173 41 31 3

98 Illinois

46

46 Indiana

1 24 7

12

5 Michigan

1 30 14 2

3 11 Ohio

48 20 17

11 Wisconsin

25

25 W.N. Central

3 70 35 19 1

15 Iowa

20 14 4

2 Kansas

1 5

2 1

2 Minnesota

1 16 10 5

1 Missouri

1 15 6

7

2 Nebraska

6

1 1

4 North Dakota

4

4 South Dakota

4 3

1

S. Atlantic 1

5 215 89 52 7

67 Delaware

6

6 District of Columbia

2

2 Florida

4 79 40 10 3

26 Georgia

19 8

9 1

1 Maryland 1

1 16 11 4

1 North Carolina

34 12 8

2 12 South Carolina

26 5

11

10 Virginia

22 5

8

9 West Virginia

11 8

2 1

E.S. Central

50 1

6 2

41 Alabama

7

1

6 Kentucky

11

11 Mississippi

7

7 Tennessee

25 1

5 2

17 W.S. Central

107 27 21 10 49 Arkansas

11 1

2

8 Louisiana

36 13 4

19 Oklahoma

15 2

4 8

1 Texas

45 11 11 2

21 Mountain

1 71 38 10 5

18 Arizona

16 4

4 1

7 Colorado

1 22 16 1

3 2

Idaho

4 1

3 Montana

6 3

1

2 Nevada

7 4

3

New Mexico

6 6

Utah

6 4

1 1

Wyoming

4

4 Pacific

10 282 13 19

250 Alaska

4

4 California

6 184

184 Hawaii

10

10 Oregon

2 41

41 Washington

2 43 13 19

11 American Samoa

2

2 C.N.M.I.

Guam

1

1 Puerto Rico

7

7 U.S. Virgin Islands

N: Not notifiable.

U: Unavailable.

No reported cases.

C.N.M.I.: Commonwealth of Northern Mariana Islands.

¶¶ Imported cases include only those directly related to importation from other countries.

Vol. 55 / No. 53 MMWR 29 TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2006 Rocky Mountain Rabies spotted Area Mumps Pertussis Plague Psittacosis Q Fever Animal Human fever United States 6,584 15,632 17 21 169 5,534 3

2,288 New England 21 1,975

1 5

488

23 Connecticut

126

N 1

208

Maine

174

4 127

N Massachusetts 12 1,238

N

12 New Hampshire 5

226

1 N

50

1 Rhode Island 4

101

30

10 Vermont

110

N 73

Mid. Atlantic 199 2,083

7 7

549

90 New Jersey 12 301

2 1

N

41 New York (Upstate) 51 1,083

3 1

N

New York City 19 112

3 44

23 Pennsylvania 117 587

2 2

505

26 E.N. Central 1,779 2,365

31 164 1

65 Illinois 798 588

17 46

26 Indiana 10 280

1 11 1

6 Michigan 84 632

3 49

6 Ohio 45 644

6 58

26 Wisconsin 842 221

4 N

1 W.N. Central 3,960 1,453

1 22 318

199 Iowa 1,964 345

N 57

5 Kansas 968 310

1 83

1 Minnesota 180 320

2 42

5 Missouri 170 308

11 66

163 Nebraska 368 101

1 6

25 North Dakota 14 43

32

South Dakota 296 26

2 38

S. Atlantic 264 1,311

2 21 2,314

1,203 Delaware

3

22 District of Columbia 1

6

1 Florida 15 228

1 8

176

21 Georgia 6

102

1 267

53 Maryland 48 152

1 4

414

93 North Carolina 43 334

4 521

852 South Carolina 10 199

181

43 Virginia 117 221

4 637

114 West Virginia 24 66

118

4 E.S. Central 61 374

2 13 247

371 Alabama 47 106 N

84

94 Kentucky 1

59

4 28

3 Mississippi 2

37

4

9 Tennessee 11 172

2 9

131

265 W.S. Central 79 1,154 1

15 997 1

288 Arkansas 8

112

2 32

104 Louisiana 3

24

7

5 Oklahoma 10 64

69

139 Texas 58 954 1

N 13 889 1

40 Mountain 120 2,501 14 1

33 213

47 Arizona 40 508

4 140

11 Colorado 51 710 4

1 14

5 Idaho 7

88

1 24

14 Montana

115

15

2 Nevada 5

71 1

7 5

New Mexico 3

147 8

4 10

8 Utah 5

779 1

11

Wyoming 9

83

3 8

7 Pacific 101 2,416 2

7 22 244 1

2 Alaska 3

91

1 N

18

N California 31 1,749 2

3 22 201 1

Hawaii 6

87

N

N Oregon 19 112

3

25

2 Washington 42 377

N American Samoa

N N

N N

N C.N.M.I.

Guam 1

64

N N

N Puerto Rico 16 3

N

78

N U.S. Virgin Islands

N: Not notifiable.

U: Unavailable.

No reported cases.

C.N.M.I.: Commonwealth of Northern Mariana Islands.

30 MMWR March 21, 2008 TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2006 Shiga toxin-Streptococcal

Rubella, producing

disease, Streptococcal congenital E. coli

invasive, toxic-shock Area Rubella syndrome Salmonellosis (STEC)***

Shigellosis group A syndrome United States 11 1

45,808 4,432 15,503 5,407 125 New England 3

2,303 287 280 360 22 Connecticut 1

503 75 67 98 20 Maine

161 50 10 19 N

Massachusetts 2

1,214 105 168 174

New Hampshire

225 29 11 35

Rhode Island

119 9

18 20

Vermont

81 19 6

14 2

Mid. Atlantic 2

5,521 610 922 963 8

New Jersey

1,120 163 291 149

New York (Upstate)

1,423 193 269 322 4

New York City 2

1,277 43 274 167

Pennsylvania

1,701 211 88 325 4

E.N. Central 1

5,695 693 1,485 1,000 52 Illinois

1,603 104 720 307 19 Indiana

898 95 178 127 12 Michigan 1

998 94 152 205 2

Ohio

1,290 196 196 238 19 Wisconsin

906 204 239 123 N

W.N. Central 3

2,725 722 1,944 372 6

Iowa

476 163 137

Kansas 1

368 25 138 53

Minnesota

724 220 259 171 4

Missouri 2

766 167 658 90 1

Nebraska

201 79 128 33 1

North Dakota

55 18 235 15

South Dakota

135 50 389 10

S. Atlantic 1

11,805 668 3,576 1,218 21 Delaware

150 16 11 10 2

District of Columbia

65 4

22 18

Florida 1

4,928 102 1,646 312 N

Georgia

1,835 84 1,379 272

Maryland

780 131 139 212 N

North Carolina

1,696 129 174 164 10 South Carolina

1,091 17 80 69

Virginia

1,089 168 120 132

West Virginia

171 17 5

29 9

E.S. Central

2,987 297 895 209 1

Alabama

910 32 348 N

N Kentucky

463 101 237 44 1

Mississippi

787 11 133 N

N Tennessee

827 153 177 165

W.S. Central

5,712 324 2,654 472

Arkansas

918 52 133 27

Louisiana

1,129 18 261 18

Oklahoma

605 44 195 125 N

Texas

3,060 210 2,065 302

Mountain

2,725 543 1,531 681 13 Arizona

958 105 729 351

Colorado

625 109 238 122 1

Idaho

179 106 15 12

Montana

132

69 N

N Nevada

245 35 143

5 New Mexico

261 46 177 123

Utah

278 122 72 68 7

Wyoming

47 20 88 5

Pacific 1

1 6,335 288 2,216 132 2

Alaska

N 82 N

7 N

N California 1

1 4,939 N

1,873 N

N Hawaii

265 19 45 132 2

Oregon

422 107 121 N

N Washington

627 162 170 N

N American Samoa

2 N

6

N C.N.M.I.

Guam

38 N

18

N Puerto Rico

N 774

43

N U.S. Virgin Islands

N: Not notifiable.

U: Unavailable.

No reported cases.

C.N.M.I.: Commonwealth of Northern Mariana Islands.

• • • Includes E-coli O157:H7; shiga toxin-positive, serogroup non-O157; and shiga toxin-positive, not serogrouped.

Vol. 55 / No. 53 MMWR 31 TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2006 Streptococcus pneumoniae, Streptococcus invasive disease pneumoniae, Syphilis drug-resistant invasive disease Congenital Primary &

Toxic-shock Area all ages age <5 yrs All stages§§§ (age <1 yr) secondary Tetanus syndrome United States 3,308 1,861 36,935 349 9,756 41 101 New England 156 147 710

227

4 Connecticut 106 43 197

64

N Maine 12

22

9

N Massachusetts

84 378

124

1 New Hampshire

12 35

13

2 Rhode Island 20 8

71

14

Vermont 18

7

3

1 Mid. Atlantic 189 227 6,261 30 1,173 4

16 New Jersey

73 799 15 173 1

4 New York (Upstate) 72 117 858 8

158

2 New York City

37 3,719 7

578

Pennsylvania 117 N

885

264 3

10 E.N. Central 651 380 2,768 28 894 9

18 Illinois 33 106 1,473 15 431 1

2 Indiana 198 68 250

93 2

1 Michigan 18 75 384 13 118 3

8 Ohio 402 82 491

184 3

7 Wisconsin N

49 170

68

W.N. Central 320 121 840 5

282 3

20 Iowa

68

19

Kansas 72 14 87 1

27

2 Minnesota 199 74 189 1

47 1

9 Missouri 44 16 430 3

168 1

5 Nebraska 1

12 34

7

4 North Dakota

5 3

1 1

South Dakota 4

29

13

S. Atlantic 1,429 382 8,393 61 2,312 5

15 Delaware

2 74

20

District of Columbia 27 2

314 1

116

Florida 774 72 2,945 21 719 2

N Georgia 504 141 1,933 9

581

7 Maryland 3

72 1,038 19 300 1

N North Carolina

961 6

309 1

8 South Carolina

25 397 2

66 1

N Virginia N

50 701 3

190

West Virginia 121 18 30

11

E.S. Central 222 103 2,654 16 727 1

10 Alabama N

N 931 9

319

2 Kentucky 38 N

188 1

73

4 Mississippi 31 19 520

86

N Tennessee 153 84 1,015 6

249 1

4 W.S. Central 198 260 6,837 101 1,553 6

3 Arkansas 12 24 243 7

77 1

3 Louisiana 77 24 1,387 13 342 3

Oklahoma 109 69 251 2

70 1

N Texas

143 4,956 79 1,064 1

N Mountain 143 214 1,816 42 513 2

11 Arizona

120 926 16 203 1

2 Colorado

55 182 2

69

8 Idaho N

3 12

3

Montana

N 2

1

N Nevada 23 3

388 15 137

1 New Mexico

33 237 7

79

Utah 75

68 2

21 1

Wyoming 45

1

Pacific

27 6,656 66 2,075 11 4

Alaska N

N 25

11

N California N

N 6,043 66 1,835 11 4

Hawaii

27 66

18

N Oregon N

N 99

29

N Washington N

N 423

182

N American Samoa

N

N C.N.M.I.

Guam

N 13

3

Puerto Rico N

N 1,066 13 150 1

N U.S. Virgin Islands

5

1

N: Not notifiable.

U: Unavailable.

No reported cases.

C.N.M.I.: Commonwealth of Northern Mariana Islands.

Totals reported to the Division of STD Prevention, NCHHSTP, as of June 22, 2007.

§§§ Includes primary, secondary, latent (including early latent, late latent, and latent syphilis of unknown duration), neurosyphilis, late (including late syphilis with clinical manifestiations other than neurosyphilis), and congenital syphilis.

32 MMWR March 21, 2008 TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2006 Vancomycin-Vancomycin-intermediate resistant Typhoid Staphylococcus Staphylococcus Varicella Area Trichinellosis Tuberculosis¶¶¶ Tularemia fever aureus aureus (morbidity)

United States 15 13,779 95 353 6

1 48,445 New England

415 11 14 1

4,316 Connecticut

89

4 1

1,727 Maine

16

1

238 Massachusetts

259 11 7

1,142 New Hampshire

17

N

419 Rhode Island

26

2 N

N

Vermont

8

790 Mid. Atlantic 3

2,120 2

100 1

5,202 New Jersey 2

508

15

N New York (Upstate) 1 317 1

11 1

N New York City

954

65

Pennsylvania

341 1

9

5,202 E.N. Central 1

1,229 1

39 1

1 15,321 Illinois

569 1

18

150 Indiana

125

N

N Michigan

221

7 1

1 5,200 Ohio

239

11

8,860 Wisconsin 1

75

3 N

N 1,111 W.N. Central 3

491 36 11 1

2,001 Iowa

40 1

N Kansas

82 7

2 N

N 372 Minnesota 3

217

5

Missouri

104 14 2

1

1,408 Nebraska

25 7

1

N North Dakota

9 2

103 South Dakota

14 5

1

118 S. Atlantic 2

2,846 2

52 2

4,832 Delaware

29

66 District of Columbia

72

1 N

N 51 Florida 1

1,038

16

N Georgia N

504

5 1

N Maryland 1

253

7 N

N N

North Carolina

374 1

3 1

South Carolina

222

1,259 Virginia

332

20 N

1,959 West Virginia

22 1

1,497 E.S. Central

674

6

601 Alabama

196

1 N

N 599 Kentucky N

84

2 N

N N

Mississippi

115

2

2 Tennessee

279

1

N W.S. Central

2,038 10 18

13,183 Arkansas N

102 6

1 N

N 1,214 Louisiana

207 1

201 Oklahoma

144 3

N N

N Texas

1,585

17

11,768 Mountain

659 23 18

2,989 Arizona

315 1

7

Colorado N

124 3

7 N

1,504 Idaho

20 1

N N

N Montana

13 4

N N

N Nevada

101 1

1

10 New Mexico

48 7

1 N

N 370 Utah

34 3

2

1,035 Wyoming

4 3

70 Pacific 6

3,307 10 95

Alaska

70

N N

N California 5

2,779 5

76 N

N N

Hawaii

115

8

N Oregon

81 4

4 N

N N

Washington 1

262 1

7 N

N N

American Samoa N

1 N

N N

C.N.M.I.

35

Guam

53

N

292 Puerto Rico N

112

N

615 U.S. Virgin Islands

N: Not notifiable.

U: Unavailable.

No reported cases.

C.N.M.I.: Commonwealth of Northern Mariana Islands.

¶¶¶ Totals reported to the Division of Tuberculosis Elimination, NCHHSTP, as of May 25, 2007.

Vol. 55 / No. 53 MMWR 33 TABLE 3. Reported cases and incidence* of notifiable diseases, by age group United States, 2006

<1 yr 1-4 yrs 5-14 yrs 15-24 yrs 25-39 yrs 40-64 yrs

>65 yrs Age not Disease No.

Rate No.

Rate No.

Rate No.

Rate No.

Rate No.

Rate No.

Rate stated Total Anthrax

0

0

0

0

0 1

0

0

1 Botulism foodborne 2

0.05

0

0

0 2

0 8

0.01 8

0.02

20 infant 93 2.26

0

0

0

0

0

0 4

97 other (wound & unspecified) 2 0.05

0 1

0

0 10 0.02 32 0.03

0 3

48 Brucellosis

0 6

0.04 8

0.02 12 0.03 34 0.06 45 0.05 16 0.04

121 Chlamydia§¶ 953 23.21 141 0.87 13,822 34.22 726,669 1,727.00 254,706 416.56 28,942 30.24 889 2.42 4,789 1,030,911 Cholera

0

0

0 1

0 2

0 5

0.01 1

0

9 Coccidioidomycosis**

22 1.66 51 0.97 300 2.27 781 5.81 1,976 10.21 3,685 12.52 2,034 18.69 68 8,917 Cryptosporidiosis 121 2.95 1,076 6.64 1,159 2.87 650 1.54 1,335 2.18 1,241 1.30 436 1.19 53 6,071 Cyclosporiasis

0 1

0.01 4

0.01 12 0.04 28 0.06 80 0.10 11 0.04 1

137 Domestic arboviral diseases California serogroup neuroinvasive 2

0.05 11 0.07 33 0.08 6

0.01 2

0 4

0 6

0.02

64 nonneuroinvasive

0

0 1

0 1

0

0 1

0 2

0.01

5 eastern equine, neuroinvasive

0 1

0.01 1

0 1

0

0 4

0 1

0

8 Powassan, neuroinvasive

0

0

0

0

0 1

0

0

1 St. Louis neuroinvasive

0

0

0 3

0.01 1

0 2

0 1

0

7 nonneuroinvasive

0

0

0

0

0 1

0 2

0.01

3 West Nile neuroinvasive 2

0.05 7

0.04 27 0.07 74 0.18 148 0.24 636 0.66 599 1.63 2

1,495 nonneuroinvasive 1

0.02 9

0.06 87 0.22 213 0.51 530 0.87 1,490 1.56 431 1.17 13 2,774 Ehrlichiosis human granulocytic

0 6

0.04 20 0.05 36 0.09 73 0.12 335 0.37 171 0.49 5

646 human monocytic

0 6

0.04 17 0.04 38 0.09 74 0.13 289 0.32 150 0.43 4

578 human (other & unspecified)

0 2

0.01 9

0.02 15 0.04 14 0.02 91 0.10 66 0.19 34 231 Giardiasis 240 6.78 3,512 25.12 3,096 8.81 1,682 4.58 3,709 6.94 5,118 6.05 1,174 3.57 422 18,953 Gonorrhea¶ 187 4.55 133 0.82 4,386 10.86 206,569 490.93 113,291 185.28 31,360 32.77 796 2.16 1,644 358,366 Haemophilus influenzae, invasive disease all ages, serotypes 223 5.43 160 0.99 88 0.22 103 0.24 150 0.25 635 0.66 1,067 2.90 10 2,436 age <5 yrs serotype b 14 0.34 15 0.09

0

0

0

0

0

29 nonserotype b 103 2.51 72 0.44

0

0

0

0

0

175 unknown serotype 106 2.58 73 0.45

0

0

0

0

0

179 Hansen disease (leprosy)

0

0

0 3

0.01 20 0.04 25 0.03 6

0.02 12 66 Hantavirus pulmonary syndrome

0

0 2

0.01 5

0.01 9

0.02 22 0.02 1

0 1

40 Hemolytic uremic syndrome, postdiarrheal 8

0.21 142 0.94 80 0.21 18 0.05 6

0.01 20 0.02 12 0.04 2

288 Hepatitis, viral acute A

9 0.22 137 0.85 560 1.39 561 1.33 812 1.33 1,101 1.15 376 1.02 23 3,579 B

5 0.12 1

0.01 8

0.02 381 0.92 1,922 3.21 2,037 2.17 247 0.69 112 4,713 C

3 0.07

0 1

0 153 0.37 268 0.44 297 0.31 26 0.07 18 766

• Per 100,000 population.

No cases of diphtheria; neuroinvasive or non-neuroinvasive western equine encephalitis virus disease, paralytic poliomyelitis, severe acute respiratory syndrome-associated coronavirus (SARS-CoV), smallpox, and yellow fever, or varicella deaths were reported in 2006. Data on chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review. CDC is upgrading its national surveillance data management system for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). During this transition, CDC is not updating AIDS or HIV infection surveillance data. Therefore, no updates are provided for HIV and AIDS data in this Summary.

§ Chlamydia refers to genital infections caused by Chlamydia trachomatis.

¶ Cases among persons aged <15 years are not shown because some of these cases might not be caused by sexual transmission; these cases are included in the totals. Totals reported to the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), as of June 22, 2007.

• • Notifiable in <40 states.

34 MMWR March 21, 2008 TABLE 3. (Continued) Reported cases and incidence* of notifiable diseases, by age group United States, 2006

<1 yr 1-4 yrs 5-14 yrs 15-24 yrs 25-39 yrs 40-64 yrs

>65 yrs Age not Disease No.

Rate No.

Rate No.

Rate No.

Rate No.

Rate No.

Rate No.

Rate stated Total Influenza-associated pediatric mortality 14 0.42 10 0.08 14 0.04 5

0.01

0

0

0

43 Legionellosis 4

0.10 3

0.02 4

0.01 29 0.07 209 0.34 1,466 1.53 1,111 3.02 8

2,834 Listeriosis 53 1.29 5

0.03 6

0.01 37 0.09 71 0.12 238 0.25 467 1.27 7

884 Lyme disease 48 1.17 1,062 6.59 3,954 9.83 1,947 4.65 2,374 3.90 7,479 7.85 2,566 7.01 501 19,931 Malaria 8

0.19 63 0.39 149 0.37 265 0.63 407 0.67 505 0.53 55 0.15 22 1,474 Measles 3

0.07 13 0.08 1

0 4

0.01 23 0.04 11 0.01

0

55 Meningococcal disease all serogroups 136 3.31 151 0.93 96 0.24 269 0.64 130 0.21 228 0.24 174 0.47 10 1,194 serogroup A, C, Y, & W-135 21 0.51 22 0.14 26 0.06 74 0.18 40 0.07 69 0.07 65 0.18 1

318 serogroup B 56 1.36 33 0.20 15 0.04 36 0.09 14 0.02 22 0.02 12 0.03 5

193 other serogroup 6

0.15 5

0.03 1

0 3

0.01 3

0 8

0.01 6

0.02

32 serogroup unknown 53 1.29 91 0.56 54 0.13 156 0.37 73 0.12 129 0.13 91 0.25 4

651 Mumps 18 0.44 351 2.17 1,097 2.72 2,270 5.39 1,283 2.10 1,329 1.39 198 0.54 38 6,584 Pertussis 2,029 49.41 1,315 8.12 3,730 9.23 2,847 6.77 1,877 3.07 2,907 3.04 424 1.15 503 15,632 Plague

0

0 2

0.01 1

0 3

0 8

0.01 3

0.01

17 Psittacosis

0

0 1

0 1

0 4

0.01 11 0.01 3

0.01 1

21 Q fever

0

0 2

0.01 7

0.02 40 0.07 86 0.09 32 0.09 2

169 Rabies human

0

0 1

0 1

0

0

0

0 1

3 Rocky Mountain spotted fever 3

0.08 45 0.29 234 0.60 271 0.67 505 0.85 934 1.01 282 0.79 14 2,288 Rubella

0

0

0

0 4

0.01 7

0.01

0

11 Rubella, congenital syndrome

0 1

0.01

0

0

0

0

0

1 Salmonellosis 4,816 117.27 8,205 50.66 6,288 15.57 4,431 10.53 6,295 10.30 9,712 10.15 5,008 13.61 1,053 45,808 Shiga toxin-producing E. coli (STEC)§§ 136 3.82 916 6.54 887 2.54 766 2.08 478 0.90 736 0.87 430 1.31 83 4,432 Shigellosis 301 7.33 4,526 27.94 4,935 12.22 1,207 2.87 2,164 3.54 1,712 1.79 415 1.13 243 15,503 Streptococcal disease, invasive, group A 114 3.44 249 1.91 338 1.04 209 0.61 636 1.29 2,018 2.58 1,725 5.64 118 5,407 Streptococcal toxic-shock syndrome

0 4

0.04 3

0.01 4

0.01 15 0.03 56 0.08 42 0.16 1

125 Streptococcus pneumoniae, invasive disease drug-resistant, all ages 162 8.03 305 3.85 112 0.56 65 0.30 264 0.87 1,134 2.29 1,155 5.79 111 3,308 age <5 yrs 610 19.31 1,251 10.05

0

0

0

0

0

1,861 Syphilis primary & secondary¶ 1

0.02 2

0.01 13 0.03 1,946 4.62 4,373 7.15 3,332 3.48 81 0.22 8

9,756 Tetanus

0

0 2

0 6

0.01 6

0.01 11 0.01 12 0.03 4

41 Toxic-shock syndrome 1

0.03 2

0.02 20 0.07 35 0.11 16 0.03 24 0.03 2

0.01 1

101 Trichinellosis

0 1

0.01 2

0.01 1

0 3

0.01 4

0 3

0.01 1

15 Tuberculosis¶¶ 92 2.24 393 2.43 322 0.80 1,540 3.66 3,502 5.73 5,252 5.49 2,676 7.27 2

13,779 Tularemia 1

0.02 4

0.02 18 0.04 14 0.03 18 0.03 32 0.03 8

0.02

95 Typhoid fever 1

0.02 46 0.28 90 0.22 55 0.13 94 0.15 41 0.04 17 0.05 9

353 Vancomycin-intermediate Staphylococcus aureus

0

0

0

0

0 4

0.01 2

0.01

6 Vancomycin-resistant Staphylococcus aureus

0

0

0

0

0 1

0

0

1 Totals reported to the Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD), as of December 31, 2006.

§§ Includes E-coli O157:H7; shiga toxin-positive, serogroup non-O157; and shiga toxin-positive, not serogrouped.

¶¶ Totals reported to the Division of TB Elimination, NCHHSTP, as of May 25, 2007.

Vol. 55 / No. 53 MMWR 35 TABLE 4. Reported cases and incidence* of notifiable diseases, by sex United States, 2006 Male Female Sex not stated Disease No.

Rate No.

Rate No.

Total Anthrax 1

0

0

1 Botulism foodborne 9

0.01 11 0.01

20 infant 42 2.00 55 2.74

97 other (wound & unspecified) 35 0.02 13 0.01

48 Brucellosis 61 0.04 59 0.04 1

121 Chancroid§ 12 0.01 21 0.01

33 Chlamydia§¶ 252,630 173.03 775,788 515.78 2,493 1,030,911 Cholera 4

0 5

0

9 Coccidioidomycosis**

5,530 8.54 3,332 5.01 55 8,917 Cryptosporiasis 3,117 2.13 2,900 1.93 54 6,071 Cyclosporiasis 63 0.05 74 0.06

137 Domestic arboviral diseases California serogroup neuroinvasive 44 0.03 20 0.01

64 nonneuroinvasive 3

0 2

0

5 eastern equine, neuroinvasive 5

0 3

0

8 Powassan, neuroinvasive 1

0 0

0

1 St. Louis neuroinvasive 3

0 4

0

7 nonneuroinvasive 1

0 1

0 1

3 West Nile neuroinvasive 893 0.61 599 0.40 3

1,495 nonneuroinvasive 1,440 0.99 1,329 0.88 5

2,774 Ehrlichiosis human granulocytic 357 0.26 273 0.19 16 646 human monocytic 337 0.24 234 0.16 7

578 human (other & unspecified) 130 0.10 100 0.07 1

231 Giardiasis 10,538 8.23 8,176 6.19 239 18,953 Gonorrhea§ 170,508 116.79 187,033 124.35 825 358,366 Haemophilus influenzae, invasive disease all ages, serotypes 1,072 0.73 1,351 0.90 13 2,436 age <5 yrs serotype b 14 0.13 15 0.15

29 nonserotype b 87 0.84 87 0.88 1

175 unknown serotype 95 0.92 80 0.81 4

179 Hansen disease (leprosy) 36 0.03 18 0.01 12 66 Hantavirus pulmonary syndrome 23 0.02 17 0.01

40 Hemolytic uremic syndrome, postdiarrheal 116 0.09 171 0.12 1

288 Hepatitis, viral, acute A

1,948 1.33 1,610 1.07 21 3,579 B

2,984 2.09 1,684 1.14 45 4,713 C

412 0.28 350 0.23 4

766

• Per 100,000 population.

No cases of diphtheria; neuroinvasive or nonneuroinvasive western equine encephalitis virus disease, paralytic poliomyelitis, severe acute respiratory syndrome-associated coronavirus (SARS-CoV), smallpox, and yellow fever, or varicella deaths were reported in 2006. Data on chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review. CDC is upgrading its national surveillance data management system for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). During this transition, CDC is not updating AIDS or HIV infection surveillance data. Therefore, no updates are provided for HIV and AIDS data in this Summary.

§ Totals reported to the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), as of June 22, 2007.

¶ Chlamydia refers to genital infections caused by Chlamydia trachomatis.

• • Notifiable in <40 states.

36 MMWR March 21, 2008 TABLE 4. (Continued) Reported cases and incidence* of notifiable diseases, by sex United States, 2006 Male Female Sex not stated Disease No.

Rate No.

Rate No.

Total Influenza-associated pediatric mortality 27 0.09 16 0.05

43 Legionellosis 1,846 1.26 979 0.65 9

2,834 Listeriosis 415 0.28 463 0.31 6

884 Lyme disease 10,997 7.57 8,520 5.69 414 19,931 Malaria 977 0.67 475 0.32 22 1,474 Measles 30 0.02 25 0.02

55 Meningococcal disease all serogroups 613 0.42 575 0.38 6

1,194 serogroup A, C, Y, & W-135 159 0.11 158 0.11 1

318 serogroup B 113 0.08 79 0.05 1

193 other serogroup 15 0.01 17 0.01

32 serogroup unknown 326 0.22 321 0.21 4

651 Mumps 2,407 1.65 4,139 2.75 38 6,584 Pertussis 6,603 4.52 8,931 5.94 98 15,632 Plague 8

0.01 9

0.01

17 Psittacosis 8

0.01 13 0.01

21 Q fever 127 0.09 42 0.03

169 Rabies human 2

0 1

0

3 Rocky Mountain spotted fever 1,256 0.89 1,007 0.69 25 2,288 Rubella 6

0 5

0

11 Rubella, congenital syndrome

0 1

0

1 Salmonellosis 21,731 14.88 23,536 15.65 541 45,808 Shiga toxin-producing E. coli (STEC)§§ 2,003 1.57 2,388 1.81 41 4,432 Shigellosis 7,359 5.04 8,018 5.33 126 15,503 Streptococcal disease, invasive, group A 2,786 2.35 2,485 2.03 136 5,407 Streptococcal toxic-shock syndrome 59 0.06 65 0.06 1

125 Streptococcus pneumoniae, invasive disease drug-resistant, all ages 1,598 2.16 1,590 2.07 120 3,308 age <5 yrs 1,050 13.17 801 10.50 10 1,861 Syphilis, primary & secondary§ 8,293 5.68 1,458 0.97 5

9,756 Tetanus 27 0.02 14 0.01

41 Toxic-shock syndrome 19 0.02 81 0.07 1

101 Trichinellosis 8

0.01 7

0.01

15 Tuberculosis¶¶ 8,547 5.85 5,227 3.48 5

13,779 Tularemia 66 0.05 29 0.02

95 Typhoid fever 185 0.13 163 0.11 5

353 Vancomycin-intermediate Staphylococcus aureus 3

0 3

0

6 Vancomycin-resistant Staphylococcus aureus

0 1

0

1 Totals reported to the Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD), as of December 31, 2006.

§§ Includes E-coli O157:H7; shiga toxin-positive, serogroup non-O157; and shiga-toxin positive, not serogrouped.

¶¶ Totals reported to the Division of TB Elimination, NCHHSTP, as of May 25, 2007.

Vol. 55 / No. 53 MMWR 37 TABLE 5. Reported cases and incidence* of notifiable diseases, by race United States, 2006 American Asian Race Indian or or Pacific not Alaska Native Islander Black White Other stated Disease No.

Rate No.

Rate No.

Rate No.

Rate No.

No.

Total Botulism infant

0 6

2.96 5

0.75 47 1.47 3

36 97 other (wound & unspecified) 0 0

0 0

5 0.01 17 0.01 0

26 48 Brucellosis 1

0.03 2

0.01 7

0.02 58 0.02 7

46 121 Chlamydia§¶ 14,493 458.47 13,476 95.98 349,968 895.65 306,763 127.75 33,086 313,125 1,030,911 Coccidioidomycosis**

93 5.93 150 2.00 469 2.99 2,064 1.94 240 5,901 8,917 Cryptosporidiosis 29 0.92 66 0.47 521 1.33 3,679 1.53 169 1,607 6,071 Cyclosporiasis 1

0.04 2

0.02 4

0.01 87 0.04 4

39 137 Domestic arboviral diseases California serogroup neuroinvasive 1

0.03 0

0 4

0.01 54 0.02 0

5 64 West Nile neuroinvasive 17 0.54 9

0.06 104 0.27 1,070 0.45 14 281 1,495 nonneuroinvasive 43 1.36 13 0.09 34 0.09 1,832 0.76 15 837 2,774 Ehrlichiosis human granulocytic 3

0.11 0

0 4

0.01 302 0.13 3

334 646 human monocytic 10 0.35 1

0.01 12 0.03 366 0.16 2

187 578 human (other & unspecified) 3 0.11 0

0 9

0.02 182 0.08 0

37 231 Giardiasis 86 2.91 726 5.55 1,231 3.58 8,059 3.84 720 8,131 18,953 Gonorrhea¶ 2,725 86.20 2,284 16.27 191,586 490.32 71,359 29.72 6,789 83,623 358,366 Haemophilus influenzae, invasive disease all ages, serotypes 37 1.17 30 0.21 300 0.77 1,461 0.61 73 535 2,436 age <5 yrs serotype b 2

0.94 3

0.30 2

0.06 13 0.08 5

4 29 nonserotype b 8

3.76 3

0.30 26 0.79 88 0.56 8

42 175 unknown serotype 9

4.23 3

0.30 25 0.76 79 0.50 9

54 179 Hansen disease (leprosy) 0 0

22 0.17 0

0 15 0.01 5

24 66 Hantavirus pulmonary syndrome 5

0.17 0

0 1

0 29 0.01 0

5 40 Hemolytic uremic syndrome postdiarrheal 2

0.07 1

0.01 18 0.05 196 0.09 7

64 288

• Per 100,000 population. Diseases for which <25 cases were reported are not included in this table.

No cases of diphtheria; neuroinvasive or nonneuroinvasive western equine encephalitis virus disease, paralytic poliomyelitis, severe acute respiratory syndrome-associated coronavirus (SARS-CoV), smallpox, and yellow fever, or varicella deaths were reported in 2006. Data on chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review. CDC is upgrading its national surveillance data management system for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). During this transition, CDC is not updating AIDS or HIV infection surveillance data. Therefore, no updates are provided for HIV and AIDS data in this Summary.

§ Chlamydia refers to genital infections caused by Chlamydia trachomatis.

¶ Cases with unknown race have not been redistributed. For this reason, the total number of cases reported here might differ slightly from totals reported in other surveillance summaries. Totals reported to the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), as of June 22, 2007.

• • Notifiable in <40 states.

Totals reported to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED)

(ArboNET Surveillance), as of June 1, 2007.

38 MMWR March 21, 2008 Hepatitis, viral acute A

14 0.44 192 1.37 236 0.60 1,884 0.78 149 1,104 3,579 B

31 1.09 162 1.17 847 2.18 2,315 0.99 121 1,237 4,713 C

17 0.54 9

0.06 59 0.15 487 0.20 14 180 766 Influenza-associated pediatric mortality§§ 1

0.13 5

0.17 8

0.08 20 0.04 0

9 43 Legionellosis 6

0.19 20 0.14 396 1.01 1,826 0.76 65 521 2,834 Listeriosis 3

0.10 27 0.19 85 0.22 553 0.23 20 196 884 Lyme disease 23 0.73 98 0.74 166 0.43 9,163 3.82 1,614 8,867 19,931 Malaria 2

0.06 111 0.79 661 1.69 291 0.12 60 349 1,474 Measles 0

0 7

0.05 4

0.01 36 0.01 2

6 55 Meningococcal disease all serogroups 8

0.25 32 0.23 163 0.42 700 0.29 21 270 1,194 serogroup A, C, Y, & W-135 3

0.09 3

0.02 52 0.13 201 0.08 10 49 318 serogroup B 1

0.03 4

0.03 19 0.05 129 0.05 4

36 193 other serogroup 2

0.06 1

0.01 3

0.01 19 0.01 0

7 32 serogroup unknown 2

0.06 24 0.17 89 0.23 351 0.15 7

178 651 Mumps 62 1.96 131 0.93 298 0.76 4,869 2.03 100 1,124 6,584 Pertussis 175 5.50 226 1.61 661 1.70 10,830 4.50 393 3,347 15,632 Q fever 1

0.03 2

0.01 8

0.02 97 0.04 1

60 169 Rocky Mountain spotted fever 43 1.47 14 0.11 138 0.36 1,612 0.69 18 463 2,288 Salmonellosis 349 11.04 1,130 8.05 3,848 9.85 24,625 10.25 1,362 14,494 45,808 Shiga toxin-producing E. coli (STEC)¶¶ 26 1.02 53 0.57 159 0.44 2,903 1.37 105 1,186 4,432 Shigellosis 754 23.85 197 1.40 2,442 6.25 6,450 2.69 685 4,975 15,503 Streptococcal disease, invasive, group A 80 3.51 116 1.36 755 2.23 2,904 1.48 158 1,394 5,407 Streptococcal toxic-shock syndrome 0

0 4

0.05 12 0.04 88 0.05 2

19 125 Streptococcus pneumoniae, invasive disease drug-resistant, all ages 16 1.42 17 0.45 691 3.13 1,983 1.60 98 503 3,308 age <5 yrs 33 20.61 57 9.33 393 13.92 856 7.13 74 448 1,861 Syphilis, primary & secondary¶ 81 2.56 168 1.20 4,060 10.39 4,725 1.97 266 456 9,756 Tetanus 0

0 1

0.01 4

0.01 24 0.01 0

12 41 Toxic-shock syndrome 0

0 3

0.03 9

0.03 61 0.03 4

24 101 Tuberculosis***

197 6.23 3,394 24.17 3,864 9.89 6,252 2.60 42 30 13,779 Tularemia 4

0.13 0

0 2

0.01 58 0.02 1

30 95 Typhoid fever 2

0.06 140 1.00 26 0.07 35 0.01 21 129 353

§§ Totals reported to the Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD), as of December 31, 2006.

¶¶ Includes E-coli O157:H7; shiga toxin-positive, serogroup non-O157; and shiga toxin-positive, not serogrouped.

• • • Totals reported to the Division of TB Elimination, NCHHSTP, as of May 25, 2007.

TABLE 5. (Continued) Reported cases and incidence* of notifiable diseases, by race United States, 2006 American Asian Race Indian or or Pacific not Alaska Native Islander Black White Other stated Disease No.

Rate No.

Rate No.

Rate No.

Rate No.

No.

Total

Vol. 55 / No. 53 MMWR 39 TABLE 6. Reported cases and incidence* of notifiable diseases, by ethnicity United States, 2006 Ethnicity Hispanic Non-Hispanic not stated Disease No.

Rate No.

Rate No.

Total Botulism infant 25 2.68 44 1.39 28 97 other (wound & unspecified) 23 0.05 20 0.01 5

48 Brucellosis 60 0.14 30 0.01 31 121 Chlamydia§¶ 147,625 345.83 505,768 199.34 377,518 1,030,911 Coccidioidomycosis**

1,294 6.17 2,009 1.82 5,614 8,917 Cryptosporidiosis 412 0.97 3,237 1.28 2,422 6,071 Cyclosporiasis 10 0.03 82 0.04 45 137 Domestic arboviral diseases California serogroup neuroinvasive 4

0.01 46 0.02 14 64 West Nile neuroinvasive 142 0.33 901 0.36 452 1,495 nonneuroinvasive 151 0.35 1,576 0.62 1,047 2,774 Ehrlichiosis human granulocytic 7

0.02 203 0.08 436 646 human monocytic 13 0.03 302 0.13 263 578 human (other & unspecified) 4 0.01 182 0.08 45 231 Giardiasis 1,584 4.63 7,781 3.44 9,588 18,953 Gonorrhea¶ 25,555 59.87 208,615 82.22 124,196 358,366 Haemophilus influenzae, invasive disease all ages, serotypes 186 0.44 1,298 0.51 952 2,436 age <5 yrs serotype b 5

0.11 15 0.10 9

29 nonserotype b 31 0.68 79 0.50 65 175 unknown serotype 25 0.55 83 0.53 71 179 Hansen disease (leprosy) 16 0.04 29 0.01 21 66 Hantavirus pulmonary syndrome 4

0.01 23 0.01 13 40 Hemolytic uremic syndrome, postdiarrheal 23 0.06 188 0.08 77 288

• Per 100,000 population. Diseases for which <25 cases were reported are not included in this table.

No cases of diphtheria; neuroinvasive or nonneuroinvasive western equine encephalitis virus disease, paralytic poliomyelitis, severe acute respiratory syndrome-associated coronavirus (SARS-CoV), smallpox, and yellow fever, or varicella deaths were reported in 2006. Data on chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review. CDC is upgrading its national surveillance data management system for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). During this transition, CDC is not updating AIDS or HIV infection surveillance data. Therefore, no updates are provided for HIV and AIDS data in this Summary.

§ Chlamydia refers to genital infections caused by Chlamydia trachomatis.

¶ Cases with unknown ethnicity have not been redistributed. For this reason, the total number of cases reported here might differ slightly from totals reported in other surveillance summaries. Totals reported to the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), as of June 22, 2007.

• • Notifiable in <40 states.

Totals reported to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED)

(ArboNET Surveillance), as of June 1, 2007.

40 MMWR March 21, 2008 TABLE 6. (Continued) Reported cases and incidence* of notifiable diseases, by ethnicity United States, 2006 Ethnicity Hispanic Non-Hispanic not stated Disease No.

Rate No.

Rate No.

Total Hepatitis, viral, acute A

1,000 2.34 1,733 0.68 846 3,579 B

477 1.16 2,511 1.01 1,725 4,713 C

47 0.11 409 0.16 310 766 Influenza-associated pediatric mortality§§ 14 0.13 18 0.04 11 43 Legionellosis 120 0.28 1,663 0.66 1,051 2,834 Listeriosis 114 0.27 506 0.20 264 884 Lyme disease 254 0.60 7,118 2.82 12,559 19,931 Malaria 67 0.16 860 0.34 547 1,474 Measles 3

0.01 46 0.02 6

55 Meningococcal disease all serogroups 150 0.35 691 0.27 353 1,194 serogroup A, C, Y, & W-135 34 0.08 186 0.07 98 318 serogroup B 15 0.04 111 0.04 67 193 other serogroup 1

0 20 0.01 11 32 serogroup unknown 100 0.23 374 0.15 177 651 Mumps 336 0.79 4,730 1.86 1,518 6,584 Pertussis 1,629 3.82 10,194 4.02 3,809 15,632 Q fever 15 0.04 88 0.04 66 169 Rocky Mountain spotted fever 83 0.20 1,527 0.62 678 2,288 Salmonellosis 5,673 13.29 21,476 8.46 18,659 45,808 Shiga toxin-producing E. coli (STEC)¶¶ 291 0.97 2,515 1.09 1,626 4,432 Shigellosis 3,925 9.19 6,287 2.48 5,291 15,503 Streptococcal disease, invasive, group A 447 1.55 2,425 1.14 2,535 5,407 Streptococcal toxic-shock syndrome 12 0.05 54 0.03 59 125 Streptococcus pneumoniae, invasive disease drug-resistant, all ages 178 1.55 1,748 1.25 1,382 3,308 age <5 yrs 246 8.23 802 6.36 813 1,861 Syphilis, primary & secondary¶ 1,465 3.43 7,202 2.84 1,089 9,756 Tetanus 8

0.02 21 0.01 12 41 Toxic-shock syndrome 6

0.02 47 0.02 48 101 Tuberculosis***

4,066 9.53 9,702 3.82 11 13,779 Tularemia 6

0.01 45 0.02 44 95 Typhoid fever 40 0.09 214 0.08 99 353

§§ Totals reported to the Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD), as of December 31, 2006.

¶¶ Includes E-coli O157:H7; shiga toxin-positive, serogroup non-O157; and shiga toxin-positive, not serogrouped.

• • • Totals reported to the Division of TB Elimination, NCHHSTP, as of May 25, 2007.

Vol. 55 / No. 53 MMWR 41 PART 2 Graphs and Maps for Selected Notifiable Diseases in the United States, 2006 Abbreviations and Symbols Used in Graphs and Maps U

Data not available.

N Not notifiable (i.e., report of disease not required in that jurisdiction).

AS American Samoa CNMI Commonwealth of Northern Mariana Islands GU Guam PR Puerto Rico VI U.S. Virgin Islands

42 MMWR March 21, 2008 BOTULISM, FOODBORNE. Number of reported cases, by year United States, 1986-2006 Home-canned foods and Alaska Native foods consisting of fermented foods of aquatic origin remain the principal sources of foodborne botulism in the United States. During 2006, a multistate outbreak of foodborne botulism was linked to commercial carrot juice.

BOTULISM, INFANT. Number of reported cases, by year United States, 1986-2006 Infant botulism is the most common type of botulism in the United States. Cases are sporadic, and risk factors remain substantially unknown.

0 10 20 30 40 50 60 70 80 90 100 110 Year 1986 1991 1996 2001 2006 Number Outbreak caused by fermented fish/seafood products, Alaska Outbreak caused by baked potatoes, Texas Outbreak caused by chili sauce, Texas 0

10 20 30 40 50 60 70 80 90 100 110 Year 1986 1991 1996 2001 2006 Number

Vol. 55 / No. 53 MMWR 43 BOTULISM, OTHER (includes wound and unspecified). Number of reported cases, by year United States, 1996-2006 Wound botulism cases occur almost exclusively in the western United States among injection-drug users and are associated with a particular type of heroin known as black tar heroin. The number of reported cases suggests an upward trend, with the highest number of cases reported in 2006.

BRUCELLOSIS. Number of reported cases, by year United States, 1976-2006 The incidence of brucellosis has remained stable in recent years, reflecting an ongoing risk for infection with Brucella melitensis and B. abortus acquired through exposure to unpasteurized milk products in countries with endemic brucellosis in sheep, goats, and cattle and B. suis acquired through contact with feral swine in the United States.

0 10 20 30 40 50 60 70 80 90 100 110 Year 1996 2001 2006 Number 0

50 100 150 200 250 300 350 Year 1981 1991 2001 2006 Number 1976 1996 1986

44 MMWR March 21, 2008 CHLAMYDIA. Incidence* among women United States and U.S. territories, 2006

• Per 100,000 population.

Chlamydia refers to genital infections caused by Chlamydia trachomatis. In 2006, the chlamydia rate among women in the United States and U.S. territories was 511.7 cases per 100,000 population.

BRUCELLOSIS. Number of reported cases United States and U.S. territories, 2006 The incidence of brucellosis has remained stable in recent years, although the distribution of cases regionally has changed. The number of cases in the West South Central region (Arkansas, Louisiana, Oklahoma, and Texas) has been decreasing steadily, whereas the number of cases in the West North Central region (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota) and the South Atlantic region (Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, and West Virginia) appears to be on the rise.

After an increase in the number of cases last year in the Mid Atlantic region (New Jersey, New York upstate, New York City, and Pennsylvania), incidence has returned to a rate much closer to what it was previously.

0

>1 1

4 34 4

1 5

5 2

8 1

2 3

1 3

2 3

3 1

3 3

1 2

2 2

1 1

3 1

18 1

DC NYC AS CNMI GU PR VI 300.01-400.00 400.01-500.00

>500.01 DC NYC GU PR VI

<300.00

Vol. 55 / No. 53 MMWR 45 CHOLERA. Number of reported cases United States and U.S. territories, 2006 In 2006, approximately half of the cholera infections in the United States were acquired in Louisiana, where noncommercial harvesting of shellfish is a common practice. Louisiana was the focus of cholera infections associated with consumption of contaminated shellfish harvested in local waters.

Consumption of contaminated seafood and foreign travel remain the most common sources of infection.

COCCIDIOIDOMYCOSIS. Number of reported cases United States* and U.S.

territories, 2006

• In the United States, coccidioidomycosis is endemic in the southwestern states. However, cases have been reported in other states, typically among travelers returning from areas in which the disease is endemic.

0 2

1 4

1 DC NYC AS CNMI GU PR VI 1

>1 0

N N

5,535 N

3,131 N

N 1

N N

N N

N N

N 1

5 40 54 N

2 N

N 62 N

22 N

N 6

N N

N N

N N

N 56 N

N N

N N

2

>1 DC NYC AS CNMI GU PR VI N

N N

46 MMWR March 21, 2008 CRYPTOSPORIDIOSIS. Incidence,* by year United States, 1995-2006

• Per 100,000 population.

Cryptosporidiosis is widespread geographically in the United States, with increased diagnosis or reporting of cryptosporidiosis in northern states. However, differences in cryptosporidiosis surveillance systems and reporting among states can affect the capability to detect and report cases, making interpretation of this observation difficult. Increased transmission of Cryptosporidium occurs during summer through early fall, coinciding with the summer recreational water season.

CRYPTOSPORIDIOSIS. Incidence* United States and U.S. territories, 2006

• Per 100,000 population.

The marked increase in the incidence of cryptosporidiosis that began in 2005 was sustained in 2006. Whether this increase reflects changes in reporting patterns and diagnostic testing practices or a real change in infection and disease caused by Cryptosporidium is unclear.

0 0.50 1.00 1.50 2.00 2.50 Year 1995 1996 1997 2005 2006 Incidence 2001 2002 2003 2004 2000 1998 1999

<0.50 0.51-1.50 1.51-2.50 2.51-3.50

>3.51 DC NYC AS CNMI GU PR VI N

0 0

0 N

Vol. 55 / No. 53 MMWR 47 DIPHTHERIA. Number of reported cases, by year United States, 1976-2006 For 3 consecutive years since 2004, the national health objective for 2010 of zero cases of respiratory diphtheria has been maintained.

0 150 300 450 Year 1981 1991 2001 2006 Number 1976 1996 1986 50 200 350 100 250 400 Number 0

1 2

3 4

5 6

Year 2001 2006 1996 1991 DIPHTHERIA. Number of reported cases, by year United States, 1991-2006 Cutaneous diphtheria no longer nationally notifiable

48 MMWR March 21, 2008 DOMESTIC ARBOVIRAL DISEASES. Number* of reported cases, by year United States, 1997-2006

• Data from the Division of Vector-Borne Infectious Diseases,National Center for Zoonotic, Vector-Borne, and Enteric Diseases (ArboNET Surveillance). Only reported cases of neuroinvasive disease are shown.

Arboviral diseases are seasonal, occurring during the summer and fall, with incidence peaking in the late summer. The most common arboviruses affecting humans in the United States are West Nile virus (WNV), La Crosse virus (LACV), Eastern equine encephalitis virus (EEEV), and St.

Louis encephalitis virus (SLEV). California serogroup viruses (mainly LACV in the eastern United States) cause encephalitis, especially in children. In 2006, California serogroup virus were reported from 12 states (Florida, Indiana, Iowa, Louisiana, Michigan, Minnesota, North Carolina, Ohio, South Carolina, Tennessee, West Virginia, and Wisconsin). During 1964-2006, a median of 68 (range: 29-167) cases per year were reported in the United States. EEEV disease in humans is associated with high mortality rates (>20%) and severe neurologic sequelae. In 2006, EEEV cases were reported from four states (Georgia, Louisiana, Massachusetts, and North Carolina).

During 1964-2006, a median of five (range: 0-21) cases per year were reported in the United States. Before the introduction of West Nile virus to the United States, SLEV was the nations leading cause of epidemic viral encephalitis. In 2006, SLEV cases were reported from six states (Arizona, Kentucky, Louisiana, Missouri, New Hampshire, and Ohio). During 1964-2006, a median of 26 (range: 2-1,967) cases per year were reported in the United States.

0 20 40 60 80 100 120 140 160 180 200 Year 1997 2001 2006 Number 2002 1998 2003 1999 2004 2000 2005 California serogroup Eastern equine St. Louis

Vol. 55 / No. 53 MMWR 49 DOMESTIC ARBOVIRAL DISEASES, WEST NILE. Number* of reported cases, by county United States, 2006

• Data from the Division of Vector-Borne Infectious Diseases,National Center for Zoonotic, Vector-Borne, and Enteric Diseases (ArboNET Surveillance). Only reported cases of neuroinvasive disease are shown.

In 2006, a total of 41 states reported neuroinvasive West Nile virus (WNV) disease. More than 30% of West Nile neuroinvasive disease cases were reported from three states (Idaho, Illinois, and Texas).

0 1-50

>50 EHRLICHIOSIS, HUMAN GRANULOCYTIC. Number of reported cases, by county United States, 2006 0

1-14

>15 As a result of recent taxonomic changes, human granulocytic enrlichiosis is now known as anaplasmosis (caused by Anaplasma phagocytophilum). Cases of this disease are reported primarily from the upper Midwest and coastal New England, reflecting the range of the primary tick vector species, Ixodes scapularis, and human population density.

50 MMWR March 21, 2008 EHRLICHIOSIS, HUMAN (OTHER & UNSPECIFIED). Number of reported cases, by county United States, 2006 0

1-14

>15 EHRLICHIOSIS, HUMAN MONOCYTIC. Number of reported cases, by county United States, 2006 0

1-14

>15 Cases of ehrlichiosis (caused by Ehrlichia chaffeensis) occur primarily in the lower Midwest and the Southeast, reflecting the range of the primary tick vector species, Amblyomma americanum.

States might report cases of ehrlichiosis caused by Ehrlichia ewingii under this category heading.

More commonly, states report cases to this category for which the causative species (i.e. Anaplasma phagocytophilum or E. chaffeensis) is not clearly differentiated by serologic testing.

Vol. 55 / No. 53 MMWR 51 GONORRHEA. Incidence* United States and U.S. territories, 2006

• Per 100,000 population.

In 2006, the gonorrhea rate in the United States and U.S. territories was 119.4 cases per 100,000 population, an increase of 5.6% from the rate in 2005 (113.1 per 100,000 population). The national health objective for 2010 is <19 cases per 100,000 population. Four states (Idaho, Maine, New Hampshire, and Vermont) and Puerto Rico reported rates below the national objective.

<100.00 100.01-200.00

>200.01 DC NYC GU PR VI GIARDIASIS. Incidence* United States and U.S. territories, 2006

• Per 100,000 population.

Giardiasis is widespread geographically in the United States, with increased diagnosis or reporting of giardiasis in northern states. However, because differences in giardiasis surveillance systems among states can affect the capability to detect cases, whether this finding is of true biologic significance or is only the result of differences in case detection or reporting is difficult to determine.

0-3.71 3.72-8.11 8.12-11.31

>11.32 N

N N

N DC NYC AS CNMI GU PR VI N

52 MMWR March 21, 2008 GONORRHEA. Incidence,* by sex United States, 1991-2006

• Per 100,000 population.

Following a 74% decline in the rate of reported gonorrhea during 1975-1997, overall gonorrhea rates plateaued and then increased for the past 2 years. In 2006, for the sixth year in a row, the gonorrhea rate among women was slightly higher than the rate among men.

0 100 200 300 400 500 Year 1991 1996 2001 2006 Incidence Men Women GONORRHEA. Incidence,* by race/ethnicity United States, 1991-2006

• Per 100,000 population.

Gonorrhea incidence among blacks decreased considerably during the 1990s but continues to be the highest among all racial/ethnic populations. In 2006, incidence among non-Hispanic blacks was approximately 18 times greater than that for non-Hispanic whites.

Black, non-Hispanic American Indian/Alaska Native Hispanic White, non-Hispanic Asian/Pacific Islander 0

200 600 800 1,000 1,200 1,400 1,600 1,800 2,000 2,200 Year 1991 1996 2001 2006 Incidence 400

Vol. 55 / No. 53 MMWR 53 HANSEN DISEASE (LEPROSY). Number of reported cases, by year United States, 1971-2006 The number of cases of Hansen Disease reported per year peaked in 1985 and has gradually declined since 1989.

0 80 160 200 280 320 360 400 Year 1976 1991 2001 2006 Number 1971 1996 1986 240 40 120 1981 Influx of refugees from Cambodia, Laos, and Vietnam, 1978-1988 HAEMOPHILUS INFLUENZAE, INVASIVE DISEASE. Incidence,* by age group United States, 1993-2006

• Per 100,000 population.

0 4

8 Year 1997 1999 2001 2006 Incidence 1996 2000 1998 2

6 2002 2003 2004 2005 1995 1993 1994 3

7 1

5 Age <5 yrs Age 5 yrs

54 MMWR March 21, 2008 HANTAVIRUS PULMONARY SYNDROME. Number of reported cases, by survival status* and year United States, 1997-2006

• Data from National Center for Zoonotic, Vector-Borne, and Enteric Diseases, two unknown cases; survival status of two persons could not be determined at the time of publication.

Hantaviruses occur in wild rodents throughout North America, and cause sporadic cases of severe disease in humans after occupational or peridomestic rodent exposure.

Lived Died 0

5 10 15 20 25 30 35 40 45 50 55 60 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Number Year

Vol. 55 / No. 53 MMWR 55 HEPATITIS A. Incidence,* by county United States, 2006

• Per 100,000 population.

In 1999, routine hepatitis A vaccination was recommended for children living in 11 states with consistently elevated rates of disease. Since then, rates of hepatitis A have declined in all regions, with the greatest decline occurring in western states. Hepatitis A rates are now the lowest ever reported and similar in all regions. As of 2005, hepatitis A vaccine is recommended for children in all states.

0 0.10-9.99 10.00-19.99

>20.00 HEMOLYTIC UREMIC SYNDROME, POSTDIARRHEAL. Number of reported cases United States and U.S. territories, 2006 In the United States, the majority of cases of postdiarrheal hemolytic uremic syndrome (HUS) are caused by infection with Escherichia coli O157:H7. Infection with other serotypes of Shiga toxin-producing E. coli can cause HUS. Half of HUS cases occur among children aged <5 years.

0 2

N 1

47 8

5 5

8 4

8 9

1 N

6 4

5 19 8

9 3

7 4

8 8

1 15 2

11 N

2 1

23 16 12 1

2 1

2 14 DC NYC AS CNMI GU PR VI 6

>1 N

N N

56 MMWR March 21, 2008 HEPATITIS, VIRAL. Incidence,* by year United States, 1976-2006

• Per 100,000 population.

Hepatitis A vaccine was first licensed in 1995.

§Hepatitis B vaccine was first licensed in June 1982.

¶An anti-hepatitis C virus (HCV) antibody test first became available in May 1990.

Hepatitis A incidence continues to decline and in 2006 was the lowest ever recorded. This reduction in incidence is attributable at least in part to routine vaccination of children in states with consistently elevated rates. Hepatitis B incidence has declined 90% since the last nationwide outbreak in 1995.

Routine hepatitis B vaccination of infants has reduced rates >95% in children. Rates also have declined among adults, but a large proportion of cases continue to occur among adults with high-risk behaviors. Incidence of acute hepatitis C has declined 90% since 1992; however, a large burden of disease caused by chronic HCV infection remains.

0 5

10 15 20 Incidence Hepatitis A, viral, acute

Hepatitis B, viral, acute Hepatitis C, viral, acute

§

¶ Year 1981 1991 2001 2006 1976 1996 1986 INFLUENZA-ASSOCIATED PEDIATRIC MORTALITY. Number of reported cases United States and U.S. territories, 2006 Initial reporting for this condition began in week 40 (week ending October 9, 2004) of the 2004-05 influenza season. During 2006, a total of 43 influenza-associated pediatric deaths were reported to CDC by 18 states and New York City, with California reporting 14 deaths.

0

>1 N

N 2

14 2

1 1

N 2

1 N

1 1

3 1

1 1

N 2

1 N

1 2

N N

1 N

N DC NYC AS CNMI GU PR VI 5

Vol. 55 / No. 53 MMWR 57 LISTERIOSIS. Incidence* United States and U.S. territories, 2006

• Per 100,000 population.

Listeriosis has been nationally notifiable since 2000. Although the infection is relatively uncommon, listeriosis is a leading cause of death attributable to foodborne illness in the United States. Recent outbreaks have been linked to deli meats and unpasteurized cheese.

0 0.01-0.18 0.19-0.28 DC NYC AS CNMI GU PR VI

>0.29 N

• Per 100,000 population.

The increase in the incidence of legionellosis continued through 2006. Factors contributing to this increase might include a true increase in disease transmission, greater use of diagnostic testing, and increased reporting.

LEGIONELLOSIS. Incidence,* by year United States, 1991-2006 0

0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 Year 1991 1996 2001 2006 Incidence

58 MMWR March 21, 2008 LYME DISEASE. Number of reported cases, by county United States, 2006 Cases are reported by state of residence rather than state of exposure. A rash that can be confused with the erythema migrans of early Lyme disease sometimes occurs following bites of the lone star tick (Amblyomma americanum). These ticks, which do not transmit the Lyme disease bacterium, are common human-biting ticks in the southern and southeastern United States.

0 1-14

>15 MALARIA. Incidence,* by year United States, 1992-2006

• Per 100,000 population.

The number of reported cases of malaria in the United States has remained relatively stable for the preceding 15 years. Nearly all of these infections occur in persons who traveled recently to a malaria-endemic country.

0 0.6 1.0 Year 1997 1999 2001 2006 Incidence 1996 2000 1998 0.3 0.9 2002 2003 2004 2005 1993 1995 1992 1994 0.5 0.2 0.8 0.4 0.1 0.7

Vol. 55 / No. 53 MMWR 59 MENINGOCOCCAL DISEASE, INVASIVE. Incidence,* by year United States, 1976-2006

• Per 100,000 population.

0 0.5 1.0 1.5 2.0 Year 1981 1991 2001 2006 Incidence 1976 1996 1986 MEASLES. Incidence,* by year United States, 1971-2006

• Per 100,000 population.

Measles vaccine was licensed in 1963. Evidence suggests that measles is no longer endemic in the United States.

0 30 70 100 Year 1976 1991 2001 2006 Incidence 1971 1996 1986 10 40 80 20 60 90 1981 50 Incidence 0.01 0.10 1.00 10.00 Year 2001 2006 1996 1991 MEASLES. Incidence,* by year United States, 1991-2006

• Per 100,000 population.

Y-axis is log scale.

60 MMWR March 21, 2008 MUMPS. Incidence,* by year United States, 1981-2006

• Per 100,000 population. Mumps vaccine was licensed in 1967.

In 2006 the U.S. experienced the largest mumps outbreak in two decades, affecting primarily non-Hispanic white college students aged 18-24 years living in the Midwest. As a result, the Advisory Committee on Immunization Practices (ACIP) updated its vaccination recommendations, and the Council of State and Territorial Epidemiologists (CSTE) updated its case definition.

0 4

7 10 Year 1986 2001 2006 Incidence 1981 1996 1991 2

5 8

3 6

9 Incidence 0.01 0.10 1.00 10.00 Year 2001 2006 1996 MUMPS. Incidence,* by year United States, 1996-2006

1

• Per 100,000 population.

Y-axis is log scale.

PERTUSSIS. Incidence,* by year United States, 1976-2006

• Per 100,000 population.

In 2006, incidence of reported pertussis dropped sharply from the peak in 2004 but remains higher than in the 1990s. Reasons for this decrease are unknown, but several statewide outbreaks of pertussis contributed reported cases in 2004 and 2005, but not in 2006. Use of tetanus and diphtheria toxoids, acellular pertussis vaccine (Tdap) among adolescents and adults is not likely to have contributed to decreased pertussis reports because coverage with Tdap was low in 2006, the year adolescent and adult recommendations were published.

0 2.5 5.0 7.5 10.0 Year 1981 1991 2001 2006 Incidence 1976 1996 1986 2.0 4.5 7.0 9.5 1.5 4.0 6.5 9.0 1.0 3.5 6.0 8.5 0.5 3.0 5.5 8.0

Vol. 55 / No. 53 MMWR 61 Q FEVER. Number of reported cases United States and U.S. territories, 2006 0

N 4

2 22 14 1

8 1

1 17 1

N 1

4 4

4 3

2 11 6

7 N

1 4

1 4

6 2

2 9

13 N

4 4

3 DC NYC AS CNMI GU PR VI 3

>1 N

N PERTUSSIS. Number of reported cases,* by age group United States, 2006

• Of 15,632 cases of pertussis, age was reported as unknown for 503 persons.

Pertussis is an acute, infectious cough illness that remains endemic in the United States despite longstanding routine childhood pertussis vaccination. Immunity to pertussis wanes 5-10 years after completion of childhood vaccination, leaving adolescents and adults susceptible to infection.

Infants, especially those who are undervaccinated, are at increased risk for complicated infections and death from pertussis. Tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine, adsorbed (Tdap) vaccine is recommended for adolescents and adults, both to reduce the burden of disease in those age groups and to reduce transmission to vulnerable infants.

0 300 600 1,200 1,500 1,800 2,100 2,400 2,700 3,000 Age group (yrs) 900 Number

<1 1-4 5-9 10-14 15-29 20-29 30-39 40-49 50-59

>60 Q fever (caused by Coxiella burnetii) occurs through the United States, primarily as a result of human contact with livestock. In 1999, Q fever was made notifiable, effective January 1, 2000.

Although more cases were reported in 2006 than in previous surveillance years, this is likely attributable to a continuing increase in national Q fever surveillance activities.

62 MMWR March 21, 2008 RABIES, ANIMAL. Number of reported cases among wild and domestic animals,*

by year United States and Puerto Rico, 1976-2006

• Data from the National Center for Zoonotic, Vector-Borne, and Enteric Diseases.

In thousands.

Periods of resurgence and decline of rabies incidence result primarily from cyclic reemergence.

The recent increase of >8% in the number of reported cases from 2005 follows 3 years of decline.

Although numeric increases are subject to surveillance bias, the proportion of positive cases among tested animals also increased in 2006. Recent increases in the number of reported cases of rabies in bats have led to this order of mammals becoming the second-most-reported group with rabies after raccoons. Ongoing public health control measures and interventions, such as domestic animal vaccination and the oral vaccination of wildlife species, contributed to the elimination of dog-to-dog rabies transmission in 2006.

0 5

10 1981 1991 2001 2006 Number

1976 1996 1986 3

9 1

8 7

6 4

2 Total Domestic Wild

Vol. 55 / No. 53 MMWR 63 ROCKY MOUNTAIN SPOTTED FEVER. Number of reported cases, by county United States, 2006 0

1-14

>15 Rocky Mountain spotted fever (RMSF) is caused by Rickettsia rickettsii. Since 2000, the number of reported cases of RMSF has increased during all but a single year. RMSF is reported throughout much of the United States, reflecting the ranges of the primary tick vectors responsible for transmission. Local and regional areas of new or increased reporting and higher incidence are evident in multiple states, including Idaho, Nebraska, North Carolina, and Tennessee.

RUBELLA. Incidence,* by year United States, 1976-2006

• Per 100,000 population.

Rubella vaccine was licensed in 1969. Evidence suggests that rubella is no longer endemic in the United States.

0 8

14 Year 1981 1991 2001 2006 Incidence 1976 1996 1986 4

10 16 6

12 20 18 2

Incidence Year 2001 2006 1996 1991 1.000 0.100 0.010 0.001 RUBELLA. Incidence,* by year United States, 1991-2006

• Per 100,000 population.

Y-axis is log scale.

64 MMWR March 21, 2008 SHIGA TOXIN-PRODUCING ESCHERICHIA COLI (STEC). Number of reported cases United States and U.S. territories, 2006 0-17 18-45 46-104 N

N DC NYC AS CNMI GU PR VI N

N

>105 Escherichia coli O157:H7 is the most common serotype of Shiga toxin-producing E. coli (STEC) isolated from ill persons. Other serotypes of E. coli also produce Shiga toxin and can cause diarrhea and hemolytic uremic syndrome. E. coli O157:H7 has been nationally notifiable since 1994. In 2001, all enterohemorrhagic E. coli (EHEC) serotypes were made nationally notifiable. In 2006, the National Notifiable Diseases Surveillance System designation was changed by the Council of State and Territorial Epidemiologists from enterohemorrhagic E. coli (EHEC) to STEC, and reporting of serotypes to CDC was strongly encouraged.

SALMONELLOSIS and SHIGELLOSIS. Number* of reported cases, by year United States, 1976-2006

• In thousands.

Foodborne transmission accounts for the majority of cases of salmonellosis. In the United States, serotypes Typhimurium, Enteritidis, and Newport are the most common serotypes. During 2006, large multistate outbreaks were linked to consumption of tomatoes, fruit salad, pet turtles, and peanut butter.

0 24 80 Year 1981 1991 2001 2006 Number 1976 1996 1986 16 8

56 40 32 72 48 64 Outbreak in Illinois caused by contaminated pasteurized milk Salmonellosis Shigellosis

Vol. 55 / No. 53 MMWR 65 STREPTOCOCCAL DISEASE, INVASIVE, GROUP A. Number of reported cases United States and U.S. territories, 2006 0

1-18 19-67 N

N N

N N

N N

>68 DC NYC AS CNMI GU PR VI Completeness of reporting of invasive group A streptococcal disease to the National Notifiable Diseases Surveillance System (NNDSS) is unknown. In 2006, NNDSS data indicated that incidence of disease was 2.24 cases per 100,000 persons. The NNDSS rate excludes data from seven states in which the disease was not reportable (Alabama, Alaska, California, Mississippi, Montana, Oregon, and Washington). In 2006, the estimated rate of disease from active, laboratory-based surveillance conducted in 10 U.S. sites was 3.8 cases per 100,000 population.

66 MMWR March 21, 2008 SYPHILIS, PRIMARY AND SECONDARY. Incidence* United States, 2006

• Per 100,000 population.

In 2006, the primary and secondary syphilis rate in the United States and U.S. territories was 3.3 cases per 100,000 population, which is greater than the national health objective for 2010 of 0.2 cases per 100,000 population per year. Three states (Montana, North Dakota, and Wyoming) reported rates at or below the national objective.

0.30-3.99

<0.29

>4.00 DC NYC AS CNMI GU PR VI SYPHILIS, CONGENITAL. Incidence* among infants aged <1 year United States, 1976-2006

• Per 100,000 live births.

Following a decline in the incidence of congenital syphilis since 1991, overall congenital syphilis rates increased slightly during 2005-2006, from 8.2 to 8.5 cases per 100,000 live births.

0 60 120 Year 1981 1991 2001 2006 Incidence 1976 1996 1986 50 110 30 40 90 20 80 10 70 Change in surveilance case definition

Vol. 55 / No. 53 MMWR 67 SYPHILIS, PRIMARY AND SECONDARY. Incidence,* by sex United States, 1991-2006

• Per 100,000 population.

During 2005-2006, incidence of primary and secondary syphilis in the United States per 100,000 population increased slightly, from 2.9 to 3.3 cases (women: from 0.9 to 1.0; men: from 5.1 to 5.7).

Men Women 0

5 10 15 20 25 Year 1991 1996 2001 2006 Incidence SYPHILIS, PRIMARY AND SECONDARY. Incidence,* by race/ethnicity United States, 1991-2006

• Per 100,000 population.

During 2005-2006, incidence of primary and secondary syphilis increased among all racial/ethnic populations. Incidence per 100,000 population increased from 9.7 to 11.3 among non-Hispanic blacks, from 3.2 to 3.6 among Hispanics, from 2.4 to 3.3 among American Indians/Alaska Natives, from 1.8 to 1.9 among non-Hispanic whites, and from 1.1 to 1.3 among Asians/Pacific Islanders.

Black, non-Hispanic American Indian/Alaska Native Hispanic White, non-Hispanic Asian/Pacific Islander 0

20 40 60 80 100 120 140 160 Year 1991 1996 2001 2006 Incidence

68 MMWR March 21, 2008 TETANUS. Number of reported cases,* by age group United States, 2006 0

2 4

6 8

10 12 14 16 Age group (yrs)

<1 1-4 5-9 10-14 15-29 20-29 30-39 40-49 50-59

>60 Number TETANUS. Number of reported cases,* by year United States, 1976-2006

• Including neonatal cases.

0 70 120 Year 1981 1991 2001 2006 Number 1976 1996 1986 60 110 20 40 100 10 90 80 30 50

• Of 41 cases, age was unknown for four (10%) persons.

Vol. 55 / No. 53 MMWR 69 TRICHINELLOSIS. Number of reported cases, by year United States, 1976-2006 For the eleventh consecutive year <25 cases of trichinellosis were reported to CDC. Cases were reported by nine states. Ingestion of raw or undercooked bear meat was implicated in three cases.

No food vehicle of infection was identified for the remainder of the cases. Although improved methods of swine husbandry over the past several decades have made pork-associated cases of trichinellosis in the United States extremely rare, consumption of wild game meat continues to be the most commonly identified risk factor for trichinellosis.

0 150 300 Year 1981 1991 2001 2006 Number 1976 1996 1986 120 270 60 90 240 30 210 180 TUBERCULOSIS. Incidence* United States and U.S. territories, 2006

• Per 100,000 population.

The national average for 2006 was 4.6 cases per 100,000 population. Ten states and the District of Columbia had incidence rates above the national average.

3.51-4.60 DC NYC AS CNMI GU PR VI

<3.50 (low incidence)

>4.60 (above national average)

70 MMWR March 21, 2008 TUBERCULOSIS. Number of reported cases among U.S.-born and foreign-born persons,* by year United States, 1996-2006

• For 46 cases, the patients origin was unknown.

The gap in U.S.-born and foreign-born cases continued to widen in 2006. Since 2001, the number of foreign-born cases has exceeded that of U.S.-born cases.

0 8

12 16 20 Year 1996 2001 2006 Number (in thousands) 1997 1998 1999 2000 2005 2002 2003 2004 4

U.S.-born Foreign-born TUBERCULOSIS. Incidence,* by race/ethnicity United States, 1996-2006

• Per 100,000 population.

Incidence of tuberculosis has continued to decline in all racial/ethnic populations since 1996.

Incidence among American Indians/Alaska Natives appears to have trended slightly upward in 2006, but this might be attributable to small case numbers. Asians/Pacific Islanders continue to have the highest incidence rate among all racial/ethnic populations.

0 30 50 Year 1997 1999 2001 2006 Incidence 1996 2000 1998 20 10 40 2002 2003 2004 2005 Black, non-Hispanic American Indian/Alaska Native Hispanic White, non-Hispanic Asian/Pacific Islander

Vol. 55 / No. 53 MMWR 71 TULAREMIA. Number of reported cases United States and U.S. territories, 2006 Five states (Arkansas, Kansas, Massachusetts, Missouri, and Nebraska) accounted for 50% of all cases of tularemia reported to CDC in 2006. To define the geographic distribution of Francisella tularensis subspecies better, CDC requests that isolates be forwarded to the CDC laboratory in Ft. Collins, Colorado.

0 1

6 5

3 1

1 1

7 1

11 14 4

7 1

7 1

1 2

3 4

1 5

3 1

1 3

DC NYC AS CNMI GU PR VI

>1 TYPHOID FEVER. Number of reported cases, by year United States, 1976-2006 Although the number of cases of typhoid fever reported annually appears to have stabilized, an increasing proportion of all cases of enteric fever appear to be caused by Salmonella Paratyphi A.

Increasing antimicrobial resistance has complicated the management of cases of typhoid fever and cases of paratyphoid fever.

0 300 800 Year 1981 1991 2001 2006 Number 1976 1996 1986 200 700 100 600 500 400

72 MMWR March 21, 2008 VARICELLA (CHICKENPOX). Number of reported cases Illinois, Michigan, Texas, and West Virginia,* 1990-2006 Source: CDC. National Center for Immunization and Respiratory Diseases, 1990-2006.

• In four states (Michigan, Illinois, Texas, and West Virginia), the number of cases reported in 2006 was 34% higher than in 2005 and 76% less than the number reported during the prevaccine years 1993-1995. This figure has been modified from previous years to include updated data from Illinois.

0 15 45 75 105 Year 1990 2006 Number (in thousands) 1992 1996 2000 2002 2004 Vaccine licensed 1994 1998 30 60 90

Vol. 55 / No. 53 MMWR 73 PART 3 Historical Summaries of Notifiable Diseases in the United States, 1975-2006 Abbreviations and Symbols Used in Tables NA Data not available.

No reported cases.

Notes:

Rates <0.01 after rounding are listed as 0.

Data in the MMWR Summary of Notifiable Diseases United States, 2006 might not match data in other CDC surveillance reports because of differences in the timing of reports, the source of the data, and the use of different case definitions.

74 MMWR March 21, 2008 TABLE 7. Reported incidence* of notifiable diseases United States, 1996-2006 Disease 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 AIDS 25.21 21.85 7.21 16.66 14.95 14.88 15.29 15.36 15.28 14.00

§ Anthrax

0 0.01 0

0 Botulism, total (includes wound

& unspecified) 0.05 0.05 0.04 0.06 0.05 0.06 0.03 0.01 0.02 0.01 0.02 foodborne 0.01 0.02 0.01 0.01 0.01 0.01 0

0.01 0.01 0.01 0.01 Brucellosis 0.05 0.04 0.03 0.03 0.03 0.05 0.04 0.04 0.04 0.04 0.04 Chancroid 0.15 0.09 0.07 0.06 0.03 0.01 0.02 0.02 0

0.01 0.01 Chlamydia¶ 188.10 196.80 236.57 254.10 257.76 278.32 296.55 304.71 319.61 332.51 347.80 Cholera 0.01 0.01 0.01 0

0 0

0 0

0 0

0 Coccidioidomycosis 0.64 0.65 0.99 3.58 4.69 6.71 3.03 2.57 4.14 6.24 6.79 Cryptosporidiosis 1.07 1.12 1.61 0.92 1.17 1.34 1.07 1.22 1.23 1.93 2.05 Cyclosporiasis 0.07 0.03 0.07 0.06 0.03 0.14 0.24 0.06 Diphtheria 0.01 0.01 0

0 0

0 0

0 0

0 0

Domestic arboviral diseases California sergroup neuroinvasive

0.02 0.02 nonneuroinvasive 0

0 eastern equine neuroinvasive

0.01 0

nonneuroinvasive 0

0 Powassan neuroinvasive

0 0

nonneuroinvasive 0

0 St. Louis neuroinvasive

0 0

nonneuroinvasive 0

0 West Nile neuroinvasive

0.45 0.50 nonneuroinvasive 0.58 0.94 western equine neuroinvasive

0 0

nonneuroinvasive 0

0 Ehrlichiosis human granulocytic (HGE) 0.16 0.14 0.15 0.10 0.18 0.13 0.20 0.28 0.23 human monocytic (HME) 0.03 0.06 0.09 0.05 0.08 0.11 0.12 0.18 0.20 human (other & unspecified)

0.04 0.08 Encephalitis/meningitis, arboviral§§ California serogroup 0.04 0.04 0.04 0.03 0.04 0.05 0.06 0.06 0

§§

§§ eastern equine 0

0 0

0 0

0 0

0 0

§§

§§ Powassan 0

0 0

§§

§§ St. Louis 0

0.01 0.01 0

0 0.03 0.01 0.01 0

§§

§§ West Nile 1.01 1.00 0.43

§§

§§ Western equine 0

0 0

0 0

0 0

0

§§

§§ Enterohemorrhagic Escherichia coli 0157:H7 1.18 1.04 1.28 1.77 1.74 1.22 1.36 0.93 0.87 0.89 non-0157 0.19 0.08 0.09 0.13 0.19 not serogrouped 0.06 0.02 0.05 0.13 0.16 Giardiasis 8.06 6.84 8.35 7.82 7.28 Gonorrhea 122.80 121.40 132.88 133.20 131.65 128.53 125.03 116.37 113.52 115.64 120.90 Haemophilus influenzae, invasive disease all ages, serotypes 0.45 0.44 0.44 0.48 0.51 0.57 0.62 0.70 0.72 0.78 0.82 age<5 yrs serotype b 0.18 0.16 0.03 0.04 0.14 nonserotype b 0.75 0.59 0.04 0.67 0.86 unknown serotype 0.80 1.15 0.97 1.08 0.88 Hansen disease (leprosy) 0.05 0.05 0.05 0.04 0.04 0.03 0.04 0.03 0.04 0.03 0.03

• Per 100,000 population Acquired immunodeficiency syndrome (AIDS).

§ CDC is upgrading its national surveillance data management system for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). During this transition, CDC is not updating AIDS or HIV infection surveillance data. Therefore, no updates are provided for HIV and AIDS data in this Summary.

¶ Chlamydia refers to genital infections caused by C. trachomatis.

• • Not nationally notifiable.

Data for ehrlichiosis attributable to other or unspecified agents were being withheld from publication pending the outcome of discussions about the reclassification of certain Ehrlichia species, which would probably affect how data in this category was reported.

§§ See also Domestic arboviral disease incidence rates in this table for years 2005 and 2006. In 2005 and 2006, the domestic arboviral disease surveillance case definitions and categories were revised. The nationally notifiable arboviral encephalitis and meningitis conditions continued to be nationally notifiable in 2005 and 2006, but under the category of arboviral neuroinvasive disease. In addition, in 2005, nonneuroinvasive domestic arboviral diseases for the six domestic arboviruses listed above were added to the list of nationally notifiable diseases.

Vol. 55 / No. 53 MMWR 75 Hantavirus Pulmonary Syndrome NA NA NA NA 0.02 0

0.01 0.01 0.01 0.01 0.01 Hemolytic uremic syndrome postdiarrheal NA NA NA NA 0.10 0.08 0.08 0.06 0.07 0.08 0.11 Hepatitis, viral, acute A

11.70 11.22 8.59 6.25 4.91 3.77 3.13 2.66 1.95 1.53 1.21 B

4.01 3.90 3.80 2.82 2.95 2.79 2.84 2.61 2.14 1.78 1.62 C

1.41 1.43 1.30 1.14 1.17 1.41 0.65 0.38 0.31 0.23 0.26 Influenza-associated pediatric mortality 0.02 0.07 Legionellosis 0.47 0.44 0.51 0.41 0.42 0.42 0.47 0.78 0.71 0.78 0.96 Listeriosis 0.31 0.29 0.22 0.24 0.24 0.32 0.31 0.30 Lyme disease 6.21 4.79 6.39 5.99 6.53 6.05 8.44 7.39 6.84 7.94 6.75 Malaria 0.68 0.75 0.60 0.61 0.57 0.55 0.51 0.49 0.51 0.51 0.50 Measles 0.20 0.06 0.04 0.04 0.03 0.04 0.02 0.02 0.01 0.02 0.02 Meningococcal disease, invasive all serogroups 1.30 1.24 1.01 0.92 0.83 0.83 0.64 0.61 0.47 0.42 0.40 serogroup A,C,Y, & W-135

¶¶

¶¶

¶¶

¶¶

¶¶

¶¶

¶¶

¶¶

¶¶ 0.10 0.11 serogroup B

¶¶

¶¶

¶¶

¶¶

¶¶

¶¶

¶¶

¶¶

¶¶ 0.05 0.07 other serogroup

¶¶

¶¶

¶¶

¶¶

¶¶

¶¶

¶¶

¶¶

¶¶ 0.01 0.01 serogroup unknown

¶¶

¶¶

¶¶

¶¶

¶¶

¶¶

¶¶

¶¶

¶¶ 0.26 0.22 Mumps 0.29 0.27 0.25 0.14 0.13 0.10 0.10 0.08 0.09 0.11 2.22 Pertussis 2.94 2.46 2.74 2.67 2.88 2.69 3.47 4.04 8.88 8.72 5.27 Plague 0.01 0.01 0

0 0

0 0

0 0

0 0.01 Poliomyelitis, paralytic 0.03 0.02 0.01 0

0 0

0 0

0 0

0 Psittacosis 0.02 0.02 0.02 0.01 0.01 0.01 0.01 0

0 0.01 0.01 Q Fever 0

0.01 0.01 0.02 0.02 0.03 0.05 0.06 Rabies, human 0.01 0.01 0

0 0

0 0

0 0

0 0

Rocky Mountain spotted fever 0.32 0.16 0.14 0.21 0.18 0.25 0.39 0.38 0.60 0.66 0.80 Rubella 0.10 0.07 0.13 0.10 0.06 0.01 0.01 0

0 0

0 Rubella, congenital syndrome 0

0 0

0 0

0 0

0 0

0 0

Salmonellosis 17.15 15.66 16.17 14.89 14.51 14.39 15.73 15.16 14.47 15.43 15.45 (SARS-CoV) ***

0

Shigellosis 9.80 8.64 8.74 6.43 8.41 7.19 8.37 8.19 4.99 5.51 5.23 Shiga toxin E. coli (STEC) 1.71 Smallpox

Streptococcal disease, invasive, group A 0.55 0.75 0.83 0.87 1.45 1.60 1.69 2.04 1.82 2.00 2.24 Streptococcal, toxic shock syndrome 0

0.01 0.02 0.02 0.04 0.04 0.05 0.06 0.06 0.07 0.06 Streptococcus, pneumoniae, invasive disease, age <5 yrs 1.03 3.62 8.86 8.22 8.21 11.93 Streptococcus, pneumoniae, invasive disease, drug-resistant, all ages 0.57 0.67 1.44 2.39 2.77 2.11 1.14 0.99 1.49 1.42 2.19 Syphilis primary & secondary 4.29 3.19 2.61 2.50 2.19 2.17 2.44 2.49 2.71 2.97 3.29 total, all stages 19.97 17.39 14.19 13.07 11.58 11.45 11.68 11.90 11.94 11.33 12.46 Tetanus 0.02 0.02 0.02 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 Toxic-shock syndrome 0.06 0.06 0.06 0.05 0.06 0.05 0.05 0.05 0.04 0.04 0.05 Trichinellosis 0.01 0.01 0.01 0

0.01 0.01 0.01 0

0 0.01 0.01 Tuberculosis 8.04 7.42 6.79 6.43 6.01 5.68 5.36 5.17 5.09 4.80 4.65 Tularemia 0.06 0.05 0.03 0.04 0.05 0.05 0.03 Tyhoid fever 0.15 0.14 0.14 0.13 0.14 0.13 0.11 0.12 0.11 0.11 0.12 Vancomycin-intermediate Staphylococcus aureus

0 0

Vancomycin-resistant Staphylococcus aureus 0

0 0

Varicella (chickenpox) 44.13 93.55 70.28 44.56 26.18 19.51 10.27 7.27 18.41 19.64 28.65 Yellow fever 0

0

0

¶¶ To help public health specialists monitor the impact of the new meningococcal conjugate vaccine (Menactra, licensed in the U.S. in January 2005), the data display for meningococcal disease was modified to differentiate the fraction of the disease that is vaccine preventable (serogroups A, C, Y, W-135) from the non-vaccine-preventable fraction of disease (serogroup B and others).

• • • Severe acute respiratory syndrome-associated coronavirus disease.

Varicella became a nationally notifiable disease in 2003.

TABLE 7. (Continued) Reported incidence* of notifiable diseases United States, 1996-2006 Disease 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

76 MMWR March 21, 2008 TABLE 8. Reported cases of notifiable diseases United States, 1999-2006 Disease 1999 2000 2001 2002 2003 2004 2005 2006 AIDS*

45,104 40,758 41,868 42,745 44,232 44,108 41,120

Anthrax

1 23 2

1 Botulism, total (including wound &

unspecified) 154 138 155 118 129 133 135 48 foodborne 23 23 39 28 20 16 19 20 infant 92 93 97 69 76 87 85 97 Brucellosis 82 87 136 125 104 114 120 121 Chancroid 143 78 38 67 54 30 17 33§ Chlamydia¶ 656,721 702,093 783,242 834,555 877,478 929,462 976,445 1,030,911§ Cholera 6

5 3

2 2

5 8

9 Coccidioidomycosis 2,826 2,867 3,922 4,968 4,870 6,449 6,542 8,917 Cryptosporidiosis 2,361 3,128 3,785 3,016 3,506 3,577 5,659 6,071 Cyclosporiasis 56 60 147 156 75 171 543 137 Diphtheria 1

1 2

1 1

Domestic arboviral diseases**

California serogroup neuroinvasive

73 64 nonneuroinvasive

7 5

eastern equine neuroinvasive

21 8

nonneuroinvasive

Powassan neuroinvasive

1 1

nonneuroinvasive

St. Louis neuroinvasive

7 7

nonneuroinvasive

6 3

western equine neuroinvasive

nonneuroinvasive

West Nile neuroinvasive

1,309 1,495 nonneuroinvasive

1,691 2,774 Ehrlichiosis human granulocytic 203 351 261 511 362 537 786 646 human monocytic 99 200 142 216 321 338 506 578 human (other & unspecified)

§§

§§

§§

§§

§§

§§ 112 231 Encephalitis/Meningitis, arboviral California serogroup 70 114 128 164 108 112

¶¶

¶¶ eastern equine 5

3 9

10 14 6

¶¶

¶¶ Powassan

1

1

¶¶

¶¶ St. Louis 4

2 79 28 41 12

¶¶

¶¶ West Nile

2,840 2,866 1,142

¶¶

¶¶ western equine 1

¶¶

¶¶ Enterohemorrhagic Escherichia coli infection Shiga toxin-positive O157:H7 4,513 4,528 3,287 3,840 2,671 2,544 2,621

non-O157

171 194 252 316 501

not serogrouped

20 60 156 308 407

Giardiasis

21,206 19,709 20,636 19,733 18,953 Gonorrhea 360,076 358,995 361,705 351,852 335,104 330,132 339,593 358,366§ Haemophilus influenzae, invasive disease all ages, serotypes 1,309 1,398 1,597 1,743 2,013 2,085 2,304 2,496 age <5 yrs serotype b

34 32 19 9

29 nonserotype b

144 117 135 135 175 unknown serotype

153 227 177 217 179 Hansen disease (leprosy) 108 91 79 96 95 105 87 66

• Acquired immunodeficiency syndrome.

CDC is upgrading its national surveillance data management system for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). During this transition, CDC is not updating AIDS or HIV infection surveillance data. Therefore, no updates are provided for HIV and AIDS data in this Summary.

§ Cases were updated through the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), as of June 22, 2007.

¶ Chlamydia refers to genital infections caused by Chlamydia trachomatis.

• • Data provided by the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED)

(ArboNET Surveillance), as of June 1, 2007.

Not nationally notifiable.

§§ Data on ehrlichiosis attributable to other or unspecified agents were withheld from publication pending the outcome of discussions about the reclassification of certain Ehrlichia species, which probably could affect how data in this category are reported.

¶¶ See also domestic arboviral disease incidence in this table for year 2005. In 2005 and 2006, the domestic arboviral disease surveillance case definitions and categories were revised. The nationally notifiable arboviral encephalitis and meningitis conditions continued to be nationally notifiable in 2005, but under the category of arboviral neuroinvasive disease. In addition, in 2005, nonneuroinvasive domestic arboviral diseases for the six domestic arboviruses listed above were added to the list of nationally notifiable diseases.

Vol. 55 / No. 53 MMWR 77 Hantavirus pulmonary syndrome 33 41 8

19 26 24 26 40 Hemolytic uremic syndrome, postdiarrheal 181 249 202 216 178 200 221 288 Hepatitis, viral, acute***

A 17,047 13,397 10,609 8,795 7,653 5,683 4,488 3,579 B

7,694 8,036 7,843 7,996 7,526 6,212 5,119 4,713 C

3,111 3,197 3,976 1,835 1,102 720 652 766 Influenza-associated pediatric mortality

45 43 Legionellosis 1,108 1,127 1,168 1,321 2,232 2,093 2,301 2,834 Listeriosis 823 755 613 665 696 753 896 884 Lyme disease 16,273 17,730 17,029 23,763 21,273 19,804 23,305 19,931 Malaria 1,666 1,560 1,544 1,430 1,402 1,458 1,494 1,474 Measles 100 86 116 44 56 37 66 55 Meningococcal disease, invasive all serogroups 2,501 2,256 2,333 1,814 1,756 1,361 1,245 1,194 serogroup A, C, Y, & W-135

297 318 serogroup B

156 193 other serogroup

27 32 serogroup unknown

765 651 Mumps 387 338 266 270 231 258 314 6,584 Pertussis 7,288 7,867 7,580 9,771 11,647 25,827 25,616 15,632 Plague 9

6 2

2 1

3 8

17 Poliomyelitis, paralytic§§§ 2

1

Psittacosis 16 17 25 18 12 12 16 21 Q Fever

21 26 61 71 70 136 169 Rabies animal 6,730 6,934 7,150 7,609 6,846 6,345 5,915 5,534 human

4 1

3 2

7 2

3 Rocky Mountain spotted fever 579 495 695 1,104 1,091 1,713 1,936 2,288 Rubella 267 176 23 18 7

10 11 11 Rubella, congenital syndrome 9

9 3

1 1

1 1

Salmonellosis 40,596 39,574 40,495 44,264 43,657 42,197 45,322 45,808 SARS-CoV¶¶¶

8

Shiga toxin-producing Escherichia coli (STEC)

4,432 Shigellosis 17,521 22,922 20,221 23,541 23,581 14,627 16,168 15,503 Streptococcal disease, invasive, group A 2,667 3,144 3,750 4,720 5,872 4,395 4,715 5,407 Streptococcal toxic-shock syndrome 65 83 77 118 161 132 129 125 Streptococcus pneumoniae, invasive disease, age <5 yrs

498 513 845 1,162 1,495 1,861 Streptococcus pneumoniae, invasive disease, drug-resistant, all ages 4,625 4,533 2,896 2,546 2,356 2,590 2,996 3,308 Syphilis all stages 35,628 31,575 32,221 32,871 34,270 33,401 33,278 36,935****

congenital (age <1 yr) 556 529 441 412 413 353 329 349 primary & secondary 6,657 5,979 6,103 6,862 7,177 7,980 8,724§ 9,756 Tetanus 40 35 37 25 20 34 27 41 Toxic-shock syndrome 113 135 127 109 133 95 90 101 Trichinellosis 12 16 22 14 6

5 16 15 Tuberculosis 17,531 16,377 15,989 15,075 14,874 14,517 14,097 13,779 Tularemia

142 129 90 129 134 154 95 Typhoid fever 346 377 368 321 356 322 324 353 Vancomycin-intermediate Staphylococcus aureus

3 6

Vancomycin-resistant Staphylococcus aureus

1 2

1 Varicella (chickenpox)§§§§ 46,016 27,382 22,536 22,841 20,948 32,931 32,242 48,445 Varicella (deaths)¶¶¶¶

9 2

9 3

Yellow fever*****

1

• • • The anti-hepatitis C virus antibody test became available May 1990. Data on chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review.

To help public health specialists monitor the impact of the new meningococcal conjugate vaccine (Menactra, licensed in the United States in January 2005), the data display for meningococcal disease was modified to differentiate the fraction of the disease that is potentially vaccine preventable (serogroups A, C, Y, W-135) from the nonvaccine-preventable fraction of disease (serogroup B and others).

§§§ Cases of vaccine-associated paralytic poliomyelitis (VAPP) caused by polio vaccine virus. Numbers might not reflect changes based on retrospec-tive case evaluations or late reports (CDC. PoliomyelitisUnited States, 1975-1984. MMWR 1986;35:180-2).

¶¶¶ Severe acute respiratory syndrome (SARS)-associated coronavirus disease. The total number of SARS-CoV cases includes all cases reported to the Division of Viral Diseases, Coordinating Center for Infectious Diseases (CCID).

• • • • Totals reported to the Division of STD Prevention, NCHHSTP, as of June 22, 2006.

Cases were updated through the Division of TB Elimination, NCHHSTP, as of May 25, 2007.

§§§§ Varicella was taken off the nationally notifiable disease list in 1991. Varicella again became nationally notifiable in 2003.

¶¶¶¶ Death counts provided by the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, as of December 31, 2006.

• • • • • The last indigenous case of yellow fever was reported in 1911; all other cases since 1911 have been imported.

TABLE 8. (Continued) Reported cases of notifiable diseases United States, 1999-2006 Disease 1999 2000 2001 2002 2003 2004 2005 2006

78 MMWR March 21, 2008 TABLE 9. Reported cases of notifiable diseases United States, 1991-1998 Disease 1991 1992 1993 1994 1995 1996 1997 1998 AIDS*

43,672 45,472 103,691 78,279 71,547 66,885 58,492 46,521 Amebiasis 2,989 2,942 2,970 2,983

Anthrax

1

Aseptic meningitis 14,526 12,223 12,848 8,932

Botulism, total (including wound & unspecified) 114 91 97 143 97 119 132 116 foodborne 27 21 27 50 24 25 31 22 infant 81 66 65 85 54 80 79 65 Brucellosis 104 105 120 119 98 112 98 79 Chancroid 3,476 1,886 1,399 773 606 386 243 189§ Chlamydia¶

477,638 498,884 526,671 604,420§ Cholera 26 103 18 39 23 4

6 17 Coccidioidomycosis

1,212 1,697 1,749 2,274 Cryptosporidiosis

2,970 2,827 2,566 3,793 Diphtheria 5

4

2

2 4

1 Encephalitis primary 1,021 774 919 717

postinfectious 82 129 170 143

Encephalitis/Meningitis California serogroup viral

11 123 129 97 eastern Equine

1 5

14 4

St. Louis

2 13 24 western Equine

2

Escherichia coli 0157:H7

1,420 2,139 2,741 2,555 3,161 Gonorrhea 620,478 501,409 439,673 418,068 392,848 325,883 324,907 355,642§ Granuloma inguinale 29 6

19 3

Haemophilus influenzae, invasive disease all ages, serotypes

1,412 1,419 1,174 1,180 1,170 1,162 1,194 Hansen disease (leprosy) 154 172 187 136 144 112 122 108 Hantavirus Pulmonary Syndrome

NA NA NA Hemolytic uremic syndrome, postdiarrheal

72 97 91 119 Hepatitis, viral, acute A

24,378 23,112 24,238 26,796 31,582 31,032 30,021 23,229 B

18,003 16,126 13,361 12,517 10,805 10,637 10,416 10,258 C/non-A, non-B**

3,582 6,010 4,786 4,470 4,576 3,716 3,816 3,518 unspecified 1,260 884 627 444

• Acquired immunodeficiency syndrome.

Not nationally notifiable.

§ Cases were updated through the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), as of June 22, 2007.

¶ Chlamydia refers to genital infections caused by Chlamydia trachomatis.

• • The anti-hepatitis C virus antibody test became available in May 1990.

Vol. 55 / No. 53 MMWR 79 Legionellosis 1,317 1,339 1,280 1,615 1,241 1,198 1,163 1,355 Leptospirosis 58 54 51 38

Lyme disease 9,465 9,895 8,257 13,043 11,700 16,455 12,801 16,801 Lymphogranuloma venereum 471 302 285 235

Malaria 1,278 1,087 1,411 1,229 1,419 1,800 2,001 1,611 Measles 9,643 2,237 312 963 309 508 138 100 Meningococcal disease, invasive 2,130 2,134 2,637 2,886 3,243 3,437 3,308 2,725 Mumps 4,264 2,572 1,692 1,537 906 751 683 666 Murine typhus fever 43 28 25

Pertussis 2,719 4,083 6,586 4,617 5,137 7,796 6,564 7,405 Plague 11 13 10 17 9

5 4

9 Poliomyelitis, paralytic 10 6

4 8

7 7

6 3

Psittacosis 94 92 60 38 64 42 33 47 Rabies animal 6,910 8,589 9,377 8,147 7,811 6,982 8,105 7,259 human 3

1 3

6 5

3 2

1 Rheumatic fever, acute 127 75 112 112

Rocky Mountain spotted fever 628 502 456 465 590 831 409 365 Rubella 1,401 160 192 227 128 238 181 364 Rubella, congenital syndrome 47 11 5

7 6

4 5

7 Salmonellosis, excluding typhoid fever 48,154 40,912 41,641 43,323 45,970 45,471 41,901 43,694 Shigellosis 23,548 23,931 32,198 29,769 32,080 25,978 23,117 23,626 Streptococcal disease, invasive, group A

613 1,445 1,973 2,260 Streptococcal toxic-shock syndrome

10 19 33 58 Streptococcus pneumoniae, invasive disease, drug-resistant, all ages

309 1,514 1,799 2,823 Syphilis all stages 128,569 112,581 101,259 81,696 68,953 52,976 46,540 37,977 primary & secondary 42,935 33,973 26,498 20,627 16,500 11,387 8,550 6,993 Tetanus 57 45 48 51 41 36 50 41 Toxicshock syndrome 280 244 212 192 191 145 157 138 Trichinellosis 62 41 16 32 29 11 13 19 Tuberculosis 26,283 26,673 25,313 24,361 22,860 21,337 19,851 18,361 Tularemia 193 159 132 96

Typhoid fever 501 414 440 441 369 396 365 375 Varicella§§ 147,076 158,364 134,722 151,219 120,624 83,511 98,727 82,455 Yellow fever¶¶

1

Cases were updated through the Division of TB Elimination, NCHHSTP, as of June 22, 2007.

§§ Varicella was taken off the nationally notifiable disease list in 1991. Certain states continued to report these cases to CDC. Varicella became nationally notifiable again in 2003.

¶¶ The last indigenous case of yellow fever was reported in 1911; all other cases since 1911 have been imported.

TABLE 9. (Continued) Reported cases of notifiable diseases United States, 1991-1998 Disease 1991 1992 1993 1994 1995 1996 1997 1998

80 MMWR March 21, 2008 TABLE 10. Reported cases of notifiable diseases* United States, 1983-1990 Disease 1983 1984 1985 1986 1987 1988 1989 1990 AIDS

§ 4,445 8,249 12,932 21,070 31,001 33,722 41,595 Amebiasis 6,658 5,252 4,433 3,532 3,123 2,860 3,217 3,328 Anthrax 1

1 2

Aseptic meningitis 12,696 8,326 10,619 11,374 11,487 7,234 10,274 11,852 Botulism, total (including wound & unspecified) 133 123 122 109 82 84 89 92 foodborne

§

§ 49 23 17 28 23 23 infant

§

§ 70 79 59 50 60 65 Brucellosis 200 131 153 106 129 96 95 82 Chancroid 847 666 2,067 3,756 4,998 5,001 4,692 4,212 Cholera 1

1 4

23 6

8

6 Diphtheria¶ 5

1 3

3 2

3 4

Encephalitis primary 1,761 1,257 1,376 1,302 1,418 882 981 1,341 postinfectious**

34 108 161 124 121 121 88 105 Gonorrhea 900,435 878,556 911,419 900,868 780,905 719,536 733,151 690,169 Granuloma inguinale 24 30 44 61 22 11 7

97 Hansen disease (leprosy) 259 290 361 270 238 184 163 198 Hepatitis, viral, acute A

21,532 22,040 23,210 23,430 25,280 28,507 35,821 31,441 B

24,318 26,115 26,611 26,107 25,916 23,177 23,419 21,102 C/non-A, non-B

§ 3,871 4,184 3,634 2,999 2,619 2,529 2,553 unspecified 7,149 5,531 5,517 3,940 3,102 2,470 2,306 1,671 Legionellosis 852 750 830 980 1,038 1,085 1,190 1,370 Leptospirosis 61 40 57 41 43 54 93 77 Lymphogranuloma venereum 335 170 226 396 303 185 189 277 Malaria 813 1,007 1,049 1,123 944 1,099 1,277 1,292 Measles 1,497 2,587 2,822 6,282 3,655 3,396 18,193 27,786 Meningococcal disease, invasive 2,736 2,746 2,479 2,594 2,930 2,964 2,727 2,451 Mumps 3,355 3,021 2,982 7,790 12,848 4,866 5,712 5,292 Murine typhus fever 62 53 37 67 49 54 41 50 Pertussis 2,463 2,276 3,589 4,195 2,823 3,450 4,157 4,570 Plague 40 31 17 10 12 15 4

2 Poliomyelitis, total 13 9

8 10

§§

§§

§§

§§ paralytic§§ 13 9

8 10 9

9 11 6

Psittacosis 142 172 119 224 98 114 116 113 Rabies animal 5,878 5,567 5,565 5,504 4,658 4,651 4,724 4,826 human 2

3 1

1

1 1

Rheumatic fever, acute 88 117 90 147 141 158 144 108 Rocky Mountain spotted fever 1,126 838 714 760 604 609 623 651 Rubella 970 752 630 551 306 225 396 1,125 Rubella, congenital syndrome 22 5

14 5

6 3

11 Salmonellosis 44,250 40,861 65,347 49,984 50,916 48,948 47,812 48,603 Shigellosis 19,719 17,371 17,057 17,138 23,860 30,617 25,010 27,077 Syphilis, primary & secondary 32,698 28,607 27,131 27,883 35,147 40,117 44,540 50,223 total, all stages 74,637 69,888 67,563 68,215 86,545 103,437 110,797 134,255 Tetanus 91 74 83 64 48 53 53 64 Toxic-shock syndrome

§ 482 384 412 372 390 400 322 Trichinosis 45 68 61 39 40 45 30 129 Tuberculosis 23,846 22,255 22,201 22,768 22,517 22,436 23,495 25,701 Tularemia 310 291 177 170 214 201 152 152 Typhoid fever 507 390 402 362 400 436 460 552 Varicella 177,462 221,983 178,162 183,243 213,196 192,857 185,441 173,099

• No cases of yellow fever were reported during 1983-1990 Acquired immunodeficiency syndrome.

§ Not nationally notifiable.

¶ Cutaneous diphtheria ceased being notifiable nationally after 1979.

• • Beginning in 1984, data were recorded by date of record to state health departments. Before 1984, data were recorded by onset date.

The anti-hepatitis C virus antibody test became available in May 1990.

§§ No cases of paralytic poliomyelitis caused by wild virus have been reported in the United States since 1993.

Vol. 55 / No. 53 MMWR 81 TABLE 11. Reported cases of notifiable diseases* United States, 1975-1982 Disease 1975 1976 1977 1978 1979 1980 1981 1982 Amebiasis 2,775 2,906 3,044 3,937 4,107 5,271 6,632 7,304 Anthrax 2

2

6

1

Aseptic meningitis 4,475 3,510 4,789 6,573 8,754 8,028 9,547 9,680 Botulism, total (including wound & unspecified) 20 55 129 105 45 89 103 97 Brucellosis 310 296 232 179 215 183 185 173 Chancroid 700 628 455 521 840 788 850 1,392 Cholera

3 12 1

9 19

Diphtheria 307 128 84 76 59 3

5 2

Encephalitis primary 4,064 1,651 1,414 1,351 1,504 1,362 1,492 1,464 postinfectious 237 175 119 78 84 40 43 36 Gonorrhea 999,937 1,001,994 1,002,219 1,013,436 1,004,058 1,004,029 990,864 960,633 Granuloma inguinale 60 71 75 72 76 51 66 17 Hansen disease (leprosy) 162 145 151 168 185 223 256 250 Hepatitis A (infectious) 35,855 33,288 31,153 29,500 30,407 29,087 25,802 23,403 B (serum) 13,121 14,973 16,831 15,016 15,452 19,015 21,152 22,177 unspecified

7,488 8,639 8,776 10,534 11,894 10,975 8,564 Legionellosis

235 359 761 593 475 408 654 Leptospirosis 93 73 71 110 94 85 82 100 Lymphogranuloma venereum 353 365 348 284 250 199 263 235 Malaria 373 471 547 731 894 2,062 1,388 1,056 Measles 24,374 41,126 57,345 26,871 13,597 13,506 3,124 1,714 Meningococcal disease, invasive 1,478 1,605 1,828 2,505 2,724 2,840 3,525 3,056 Mumps 59,647 38,492 21,436 16,817 14,225 8,576 4,941 5,270 Murine typhus fever 41 69 75 46 69 81 61 58 Pertussis 1,738 1,010 2,177 2,063 1,623 1,730 1,248 1,895 Plague 20 16 18 12 13 18 13 19 Poliomyelitis, total 13 10 19 8

22 9

10 12 paralytic 13 10 19 8

22 9

10 12 Psittacosis 49 78 94 140 137 124 136 152 Rabies animal 2,627 3,073 3,130 3,254 5,119 6,421 7,118 6,212 human 2

2 1

4 4

2

Rheumatic fever, acute 2,854 1,865 1,738 851 629 432 264 137 Rocky Mountain spotted fever 844 937 1,153 1,063 1,070 1,163 1,192 976 Rubella 16,652 12,491 20,395 18,269 11,795 3,904 2,077 2,325 Rubella, congenital syndrome 30 30 23 30 62 50 19 7

Salmonellosis 22,612 22,937 27,850 29,410 33,138 33,715 39,990 40,936 Shigellosis 16,584 13,140 16,052 19,511 20,135 19,041 9,859 18,129 Syphilis primary & secondary 25,561 23,731 20,399 21,656 24,874 27,204 31,266 33,613 total, all stages 80,356 71,761 64,621 64,875 67,049 68,832 72,799 75,579 Tetanus 102 75 87 86 81 95 72 88 Trichinosis 252 115 143 67 157 131 206 115 Tuberculosis§ 33,989 32,105 30,145 28,521 27,669 27,749 27,373 25,520 Tularemia 129 157 165 141 196 234 288 275 Typhoid fever 375 419 398 505 528 510 584 425 Varicella 154,248 183,990 188,396 154,089 199,081 190,894 200,766 167,423

• No cases of yellow fever were reported during 1975-1982.

Not nationally notifiable.

§Case data are not comparable with earlier years because of changes in reporting criteria that became effective in 1975.

82 MMWR March 21, 2008 Table 12. Deaths from selected nationally notifiable infectious diseases United States, 2002-2004 ICD-10*

cause of No. deaths Cause of death death code 2002 2003 2004 AIDS B20-B24 14,095 13,658 13,063 Anthrax A22 0

0 0

Botulism, foodborne A05.1 2

6 0

Brucellosis A23 1

0 0

Chancroid A57 0

0 0

Chlamydia§ A56 0

0 0

Cholera A00 0

0 0

Coccidioidomycosis B38 84 73 100 Cryptosporidiosis A07.2 1

0 1

Cyclosporiasis A07.8 0

0 0

Diphtheria A36 0

1 0

Ehrlichiosis A79.8 0

1 0

Encephalitis, aboviral California serogroup A83.5 0

0 0

eastern equine A83.2 1

1 2

St. Louis A83.3 3

2 2

western equine A83.1 0

0 0

Giardiasis A07.1 1

0 1

Gonoccocal infections A54 7

6 2

Haemophilus influenzae A49.2 7

5 11 Hansen disease (leprosy)

A30 2

2 5

Hantavirus pulmonary syndrome A98.5 0

0 0

Hemolytic uremic syndrome, postdiarrheal D59.3 35 29 27 Hepatitis, viral, acute A

B15 76 54 58 B

B16 659 583 556 C

B17.1 4,321 4,109 4,099 Hepatitis, viral, chronic B

B18.0-B18.1 103 102 87 C

B18.2 518 507 487 Source: CDC. CDC WONDER Compressed Mortality files (http://wonder.cdc.gov/mortSQL.html) provided by the National Center for Health Statistics.

National Vital Statistics System, 1999-2004. Underlying causes of death are classified according to ICD 10. Data for 2005-2006 are not available. Data are limited by the accuracy of the information regarding the underlying cause of death indicated on death certificates and reported to the National Vital Statistics System.

• World Health Organization. International Statistical Classification of Diseases and Related Health Problems. Tenth Revision, 1992.

Acquired immunodeficiency syndrome.

§Chlamydia refers to genital infections caused by Chlamydia trachomatis.

Vol. 55 / No. 53 MMWR 83 Influenza-associated pediatric mortality J10, J11 25 147 51 Legionellosis A48.1 62 98 72 Listeriosis A32 32 33 37 Lyme disease A69.2, L90.4 6

4 6

Malaria B50-B54 12 4

8 Measles B05 0

1 0

Meningococcal disease A39 161 161 138 Mumps B26 1

0 0

Pertussis A37 18 11 16 Plague A20 0

0 1

Poliomyelitis A80 0

0 0

Psittacosis A70 0

0 0

Q fever A78 0

1 1

Rabies, human A82 3

2 3

Rocky Mountain spotted fever A77.0 8

9 5

Rubella B06 0

0 1

Rubella congenital syndrome P35.0 6

4 5

Salmonellosis A02 21 43 30 Shiga toxin-producing Escherichia coli (STEC)

A04.0-A04.4 4

2 4

Shigellosis A03 4

2 0

Smallpox B03 0

0 0

Streptococcal disease, invasive, group A A40.0, A49.1 109 115 121 Streptococcus pneumoniae, invasive disease (age <5 yrs)

A40.3, B95.3, J13 13 15 13 Syphilis, total, all stages A50-A53 41 34 43 Tetanus A35 5

4 4

Toxic-shock syndrome A48.3 78 71 71 Trichinellosis B75 0

0 0

Tuberculosis A16-A19 784 711 657 Tularemia A21 2

2 1

Typhoid fever A01.0 0

0 0

Varicella B01 32 16 19 Yellow fever¶ A95 1

0 0

¶For one fatality, the cause of death was erroneously reported as yellow fever in the National Center for Health Statistics dataset for 2003. Subsequent investigation has determined that this death did not result from infection with wild-type yellow fever virus, and it is therefore not included in this table.

Table 12. (Continued) Deaths from selected nationally notifiable infectious diseases United States, 2002-2004 ICD-10 cause of No. deaths Cause of death death code 2002 2003 2004

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