ML12221A283

Centers for Disease Control and Prevention. Summary of Notifiable Diseases, United States, 2001

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Inside: Continuing Medical Education for U.S. Physicians and Nurses Summary of Notifiable Diseases United States, 2001 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention (CDC)

Atlanta, GA 30333 Published May 2, 2003, for 2001/ Vol. 50 / No. 53 1

Summaries of Notifiable Diseases in the United States, 2001 23 Graphs and Maps for Selected Notifiable Diseases in the United States 89 Historical Summaries of Notifiable Diseases in the United States, 1970-2001 99 Selected Reading Please note: An erratum has been published for this issue. To view the erratum, please click here.

Centers for Disease Control and Prevention.................Julie L. Gerberding, M.D., M.P.H.

Director The material in this report was collected and forwarded to CDC by the 57 reporting areas.

The production of this report as an MMWR serial publication was coordinated in:

Epidemiology Program Office...................................... Stephen B. Thacker, M.D, M.Sc.

Director Division of Public Health Surveillance and Informatics..........................................................Daniel M. Sosin, M.D., M.P.H.

Director Associate Editor, MMWR Surveillance Summaries Office of Scientific and Health Communications....................... John W. Ward, M.D.

Director Editor, MMWR Series Suzanne M. Hewitt, M.P.A.

Managing Editor MMWR C. Kay Smith-Akin, M.Ed.

Lead Technical Writer-Editor

......................................................................................... Lynne McIntyre, M.A.L.S.

Project Editor

.........................................................................................................Lynda G. Cupell

....................................................................................Visual Information Specialist

......................................................................................................... Quang M. Doan Erica R. Shaver Information Technology Specialists The Summary of Notifiable Diseases, United States is published to accompany each volume of the Morbidity and Mortality Weekly Report by the Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, Georgia 30333.

SUGGESTED CITATION Centers for Disease Control and Prevention. Summary of notifiable diseases, United States, 2001. MMWR 2001;50(No. 53):[inclusive page numbers].

Vol. 50 / No. 53 MMWR i

Contents Preface............................................................................................................... iv Background......................................................................................................... v Data Sources..................................................................................................... vii Interpreting Data............................................................................................. viii Highlights............................................................................................................ x Part 1. Summaries of Notifiable Diseases in the United States, 2001............ 1 Table 1. Reported cases by month, 2001....................................................... 2 Table 2. Reported cases by geographic division and area, 2001................. 4 Table 3. Reported cases and incidence rates by age group, 2001............. 14 Table 4. Reported cases and incidence rates by sex, 2001......................... 16 Table 5. Reported cases and incidence rates by race, 2001....................... 18 Table 6. Reported cases and incidence rates by ethnicity, 2001................ 20 Part 2. Graphs and Maps for Selected Notifiable Diseases in the United States...................................................................................... 23 Part 3. Historical Summaries of Notifiable Diseases in the United States, 1970-2001.................................................................. 89 Table 7. Reported incidence rates per 100,000 population, 1991-2001.......................................................... 90 Table 8. Reported cases, 1994-2001............................................................. 92 Table 9. Reported cases, 1986-1993............................................................. 94 Table 10. Reported cases, 1978-1985........................................................... 96 Table 11. Reported cases, 1970-1977........................................................... 97 Table 12. Deaths from selected diseases, 1996-1999................................. 98 Selected Reading.............................................................................................. 99 State and Territorial Epidemiologists and Laboratory Directors........................................................... Inside back cover

ii MMWR May 2, 2003 Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.

All MMWR references are available on the Internet at <http://www.cdc.gov/mmwr>.

Use the search function to find specific articles.

Vol. 50 / No. 53 MMWR iii The following CDC staff members contributed to this report:

Samuel L. Groseclose, D.V.M., M.P.H.

Wayne S. Brathwaite Patsy A. Hall Carol M. Knowles Deborah A. Adams Felicia J. Connor Pearl Sharp Willie J. Anderson Robert F. Fagan J. Javier Aponte Gerald F. Jones David A. Nitschke Jim Vaughan Carol A. Worsham Man-huei Chang, M.P.H.

Timothy Doyle, M.P.H.

Ruth Ann Jajosky, D.M.D., M.P.H.

Division of Public Health Surveillance and Informatics Epidemiology Program Office in collaboration with John D. Hatmaker Affiliated Computer Services

iv MMWR May 2, 2003

• Because no cases of paralytic poliomyelitis, western equine encephalitis, or yellow fever were reported in the United States during 2001, these diseases do not appear in the tables in Part 1.

In 1999, mortality data began to be coded according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. To bridge the mortality data for the period 1996-1998 (deaths coded using the International Classification of Diseases, Ninth Revision), and 1999, we use comparability ratios provided by the National Center for Health Statistics.

Preface The MMWR Summary of Notifiable Diseases, United States, 2001 contains, in tabu-lar and graphic form, the official statistics for the reported occurrence of nationally notifiable diseases in the United States for 2001. These statistics are collected and com-piled from reports sent by state 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 located on the Internet at http://www2.cdc.gov/mmwr/

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

Because the dates of onset or diagnosis for notifiable diseases are not always reported, these surveillance data are presented by the year and week they were reported to CDC by public health officials in state and territorial health departments.

The data are finalized and published each year in the Summary for use by state and local health departments; schools of medicine and public health; communications media; local, state, and federal agencies; and other agencies or persons interested in following the trends of reportable diseases in the United States. This publication also documents which diseases are considered national priorities for notification and the annual number of reported cases of such diseases.

The Highlights section presents information on selected nationally notifiable dis-eases to provide a context in which to interpret surveillance and disease-trend data and to provide further information on the epidemiology and prevention of selected diseases.

Part 1 contains tables showing incidence data for each of the diseases considered nationally notifiable during 2001.* The tables provide the number of cases of notifiable diseases reported to CDC for 2001, as well as the distribution of cases by month and geographic location and by patients age, sex, race, and Hispanic ethnicity. The data are final totals reported as of June 21, 2002, unless otherwise noted. Nationally notifiable diseases that are reportable in <40 states also do not appear in these tables. Ehrlichiosis, human, other or unspecified agent, is not reported in any tables because data are incomplete. In all tables, leprosy is listed as Hansen disease, and tickborne typhus fever is listed as Rocky Mountain spotted fever (RMSF). In addition, syphilis (all stages) includes the following categories: latent; early latent; late latent; latent of unknown duration; neurosyphilis; late, with clinical manifestations other than neurosyphilis; syphilitic stillbirth, and congenital syphilis. Part 2 contains graphs and maps that depict summary data for many of the notifiable 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 1970. This section also includes a table enumerating deaths associated with specified notifiable diseases reported to the National Center for Health Statistics (NCHS),

CDC, during 1996-1999.

The Selected Reading section presents general and disease-specific references for notifiable infectious diseases. These references provide additional information on surveillance and epidemiologic issues, diagnostic issues, or disease control activities.

Vol. 50 / No. 53 MMWR v

Background

The infectious diseases designated as notifiable at the national level during 2001 are listed in the following table. A notifiable disease is one for which regular, frequent, and timely information regarding individual cases is considered necessary for the prevention and control of the disease. This section briefly summarizes the history of the reporting of nationally notifiable diseases in the United States.

In 1878, Congress authorized the U.S. Marine Hospital Service (the forerunner of the Public Health Service [PHS]) to collect morbidity reports regarding cholera, small-pox, plague, and yellow fever from U.S. consuls overseas. The intention was to use this information to institute quarantine measures to prevent the introduction and spread of these diseases into the United States. In 1879, a specific Congressional appropriation was made for the collection and publication of reports of these notifiable diseases.

Congress expanded the authority for weekly reporting and publication of these reports in 1893 to include data from states and municipal authorities. To increase the unifor-mity of the data, Congress enacted a law in 1902 directing the Surgeon General to provide forms for the collection and compilation of data and for the publication of reports at the national level. In 1912, state and territorial health authorities in con-junction with PHS recommended immediate telegraphic reporting of five infectious diseases and the monthly reporting, by letter, of 10 additional diseases. The first annual summary of The Notifiable Diseases in 1912 included reports of 10 diseases from 19 states, the District of Columbia, and Hawaii. By 1928, all states, the District of Columbia, Hawaii, and Puerto Rico were participating in national reporting of 29 speci-fied diseases. At their annual meeting in 1950, state and territorial health officers authorized the Council of State and Territorial Epidemiologists (CSTE) to determine which diseases should be reported to PHS. In 1961, CDC assumed responsibility for the collection and publication of data concerning nationally notifiable diseases.

The list of nationally notifiable diseases is revised periodically. For example, a dis-ease 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 health departments and CDC continue to collaborate in determining which diseases should be nationally notifi-able. CSTE, with input from CDC, makes recommendations annually for additions and deletions. Although disease reporting is mandated by legislation or regulation at the state and local levels, state reporting to CDC is voluntary. Thus, the list of diseases considered notifiable varies slightly by state. All states generally report the internation-ally quarantinable diseases (i.e., cholera, plague, and yellow fever) in compliance with the World Health Organizations International Health Regulations.

vi MMWR May 2, 2003 Acquired immunodeficiency syndrome (AIDS)

Anthrax Botulism Brucellosis Chancroid Chlamydia trachomatis, genital infection Cholera Coccidioidomycosis Cryptosporidiosis Cyclosporiasis Diphtheria Ehrlichiosis, human granulocytic Ehrlichiosis, human monocytic Ehrlichiosis, human, other or unspecified agent Encephalitis, California serogroup viral Encephalitis, eastern equine Encephalitis, St. Louis Encephalitis, western equine Escherichia coli, enterohemorrhagic (EHEC),

O157:H7 EHEC, serogroup non-O157

• Although varicella (chickenpox) is not a nationally notifiable disease, the Council of State and Territorial Epidemiologists recommends reporting cases of this disease to CDC.

Infectious Diseases Designated as Notifiable at the National Level During 2001 EHEC, not serogrouped Gonorrhea Haemophilus influenzae, invasive disease Hansen disease (leprosy)

Hantavirus pulmonary syndrome Hemolytic uremic syndrome, postdiarrheal Hepatitis A, acute Hepatitis B, acute Hepatitis B, perinatal Hepatitis C; non-A, non-B Human immunodeficiency virus (HIV) infection, adult HIV infection, pediatric

(<13 yrs)

Legionellosis Listeriosis Lyme disease Malaria Measles Meningococcal disease Mumps Pertussis Plague Poliomyelitis, paralytic Psittacosis Q fever Rabies, animal Rabies, human Rocky Mountain spotted fever Rubella Rubella, congenital syndrome Salmonellosis Shigellosis Streptococcal disease, invasive, group A Streptococcal toxic-shock syndrome Streptococcus pneumoniae, invasive, drug-resistant Streptococcus pneumoniae, invasive, <5 yrs Syphilis Syphilis, congenital Tetanus Toxic-shock syndrome Trichinosis Tuberculosis Tularemia Typhoid fever Varicella (chickenpox)*

Varicella deaths Yellow fever

Vol. 50 / No. 53 MMWR vii Data Sources Provisional data concerning the reported occurrence of notifiable diseases are pub-lished weekly in the MMWR. After each reporting year, staff in state health depart-ments 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. These data are compiled in final form in the Summary.

Notifiable disease reports are the authoritative and archival counts of cases. They must be approved by the appropriate epidemiologist from each submitting state or territory before being published in the Summary. Although useful for detailed epide-miologic analyses, data published in CDC Surveillance Summaries or other surveil-lance reports produced by CDC programs might not agree exactly with data reported in the annual summary because of differences in the timing of reports, the source of the data, or the case definitions.

Data in the Summary were derived primarily from reports transmitted to the Divi-sion of Public Health Surveillance and Informatics, Epidemiology Program Office, CDC, from health departments in the 50 states, five territories, New York City, and the District of Columbia through the National Electronic Telecommunications System for Surveil-lance (NETSS). More information regarding NETSS and notifiable diseases, including case definitions for these conditions, is available on the Internet at http://www.cdc.gov/

epo/dphsi/phs.htm. Policies for reporting notifiable disease cases can vary by disease or reporting jurisdiction, depending on case status classification (i.e., confirmed, prob-able, or suspected).

Final data for selected diseases (presented in Parts 1, 2, and 3) are from the surveil-lance records of the CDC programs listed below. Requests for further information regarding these data should be directed to the appropriate program.

National Center for Health Statistics (NCHS)

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

National Center for Infectious Diseases (NCID)

Division of Bacterial and Mycotic Diseases (toxic-shock syndrome; streptococcal disease, invasive, group A; streptococcal toxic-shock syndrome; laboratory data regarding botulism, Escherichia coli, enterohemorrhagic O157:H7, salmonellosis, and shigellosis).

Division of Vector-Borne Infectious Diseases (laboratory data regarding arboviral encephalitis).

Division of Viral and Rickettsial Diseases (animal rabies, hantavirus pulmonary syndrome).

National Center for HIV, STD, and TB Prevention (NCHSTP)

Division of HIV/AIDS Prevention Surveillance and Epidemiology (acquired immunodeficiency syndrome [AIDS]).

Division of Sexually Transmitted Diseases Prevention (chancroid, chlamydia, gonorrhea, syphilis).

Division of Tuberculosis Elimination (tuberculosis).

viii MMWR May 2, 2003 National Immunization Program (NIP)

Epidemiology and Surveillance Division (poliomyelitis).

Disease totals for the United States, unless otherwise stated, do not include data for American Samoa, Guam, Puerto Rico, the U.S. Virgin Islands, or the Commonwealth of the Northern Mariana Islands.

Population estimates for the states are from the April 1, 2000, population estimates from the Population Division, U.S. Bureau of the Census. Population numbers for terri-tories are 2000 estimates from the U.S. Bureau of the Census, International Data Base Data Access Display Mode. More information regarding census estimates is available at http://eire.census.gov/popest/data/states/tables/ST-EST2002-01.php and http://

www.census.gov/ipc/www/idbprint.html. The choice of population denominators for incidence rates reported in the MMWR is based on 1) the consistency in the incidence rates reported by various CDC programs, and 2) the availability of census population data at the time of preparation for MMWR publications. Rates in the Summary are presented as incidence rates per 100,000 population, based on data for the U.S. total-resident population. However, population data from states in which diseases were not notifiable or disease data were not available were excluded from rate calculations.

Interpreting Data Incidence data in the Summary are presented by the date of report to CDC as deter-mined by the MMWR week and year assigned by the state or territorial health depart-ment. As a result, annual incidence data in the Summary represent cases with onset during the MMWR year assigned to the case, or during previous years. In addition, data in the Summary are reported by the state in which the patient resides at the time of diagnosis. For many of the nationally notifiable infectious diseases, surveillance data are independently reported to EPO and other CDC programs. Thus, surveillance data reported by other CDC programs may vary from data reported in the Summary because of differences in 1) the date used to aggregate data (e.g., date of report, date of disease occurrence), 2) the timing of reports, 3) the source of the data, 4) surveillance case definitions, and 5) policies regarding case jurisdiction (i.e., which state should report the case to CDC).

The data reported in the Summary are useful for analyzing disease trends and determining relative disease burdens. However, these data must be interpreted in light of reporting practices. Some diseases that cause severe clinical illness (e.g., plague and rabies) are most likely reported accurately if they were diagnosed by a clinician.

However, persons who have diseases that are clinically mild and infrequently associ-ated with serious consequences (e.g., salmonellosis) might not seek medical care from a health-care provider. Even if these less severe diseases are diagnosed, they are less likely to be reported.

The degree of completeness of data reporting also is influenced by the diagnostic facilities available; the control measures in effect; public awareness of a specific disease; and interests, resources, and priorities of state and local officials responsible for disease control and public health surveillance. Finally, factors such as changes in the case definitions for public health surveillance, introduction of new diagnostic tests, or discovery of new disease entities can cause changes in disease reporting that are independent of the true incidence of disease.

Vol. 50 / No. 53 MMWR ix Public health surveillance data are published for selected racial and ethnic popula-tion groups because these variables can be risk markers for certain notifiable diseases.

Race and ethnicity data can also be used to highlight populations for focused preven-tion efforts. However, caution must be used when drawing conclusions from reported race and ethnicity data. Certain racial/ethnic population groups have differential pat-terns of access to health care, potentially resulting in data that are not representative of disease incidence in these populations. Surveillance data reported to NNDSS are either in individual case-specific form or summary form (aggregated data for a group of cases). Summary data often lack demographic information (e.g., race); therefore, the demographic-specific incidence rates presented in the Summary may be underestimated.

In addition, not all race and ethnicity data are collected uniformly for all diseases.

For example, in NCHSTP, the Division of HIV/AIDS Prevention Surveillance and Epidemiology and the Division of Sexually Transmitted Diseases Prevention collect race/ethnicity data using a single variable. A persons race/ethnicity is reported as American Indian/Alaska Native, Asian/Pacific Islander, black non-Hispanic, white non-Hispanic, or Hispanic. Additionally, although the recommended standard for classify-ing a persons race or ethnicity is based on self-reporting, this procedure might not always be followed.

x MMWR May 2, 2003 Highlights for 2001 This section presents information on the public health importance of selected nationally notifiable diseases reported from the states to CDC, including a) domestic and some international disease outbreaks, b) active surveillance findings, c) changes in data reporting practices, d) the impact of prevention programs, e) the emergence of antimicrobial resistance, and f) changes in immunization policies. This information is intended to provide a context in which to interpret surveillance and disease-trend data and to provide further information on the epidemiology and prevention of selected diseases.

AIDS Since the use of highly active antiretroviral therapy (HAART) in the United States became widespread in 1996, the number of persons diagnosed with acquired immuno-deficiency syndrome (AIDS) has declined. The number of deaths among persons with AIDS has also declined substantially; as a result, the number of persons living with AIDS has increased (1). By December 2001, a total of 807,075 adults and 9,074 children had been reported with AIDS.

In 1996, sharp declines in AIDS incidence occurred for the first time; during 1998-1999, declines in AIDS incidence began to level, and essentially no change occurred from 1999 through 2000. Through December 2001, 462,653 adult and 5,257 pediatric AIDS cases resulted in death. Since 1996, the number of deaths among persons with AIDS declined sharply and continued to decline each year through 2000. The number of persons living with AIDS, approximately 362,827, was the highest ever reported; of these persons, 78% were men and 61% were black or Hispanic. Of the 282,250 adult and adolescent men with AIDS, 57% were men who have sex with men, 24% were injecting drug users, 9% were exposed through heterosexual contact, and 8% were both men who have sex with men and injecting drug users. Of the 76,696 adult and adolescent women with AIDS, 59% were exposed through heterosexual contact and 38% through injecting drug use (2).

To provide better data for prevention of human immunodeficiency virus (HIV) infec-tion (the virus that causes AIDS), CDC and CSTE recommend that national surveillance include the monitoring of both HIV infection and AIDS (3,4). CDC supports several supplemental surveillance projects that collect data on barriers to preventing AIDS cases and deaths of persons with AIDS, including access to HIV testing and treatment in accordance with current public health service guidelines.

1. CDC. Update: AIDSUnited States, 2000. MMWR 2002;51;592-5.

2. CDC. HIV/AIDS Surveillance Report, 2002. Atlanta: Centers for Disease Control and Prevention.

Vol. 13, No. 2. Available at http://www.cdc.gov/hiv/stats/hasrlink.htm.

3. CDC. Guidelines for national human immunodeficiency virus case surveillance, including monitoring for human immunodeficiency virus infection and acquired immunodeficiency syndrome. MMWR 1999;48(No. RR-13).

4. Council of State and Territorial Epidemiologists. CSTE position statement ID-4: National HIV surveillanceaddition to the National Public Health Surveillance System. Atlanta: Council of State and Territorial Epidemiologists, 1997.

Vol. 50 / No. 53 MMWR xi Anthrax In September and October 2001, in an unprecedented biological terrorism event, letters containing Bacillus anthracis spores were sent through the U.S. Postal Service to various addresses in several states. Eleven inhalational and 11 cutaneous (four sus-pected and seven confirmed) anthrax cases resulted. Five of the 11 inhalational infec-tions were fatal. These bioterrorism-associated cases occurred among residents of seven states along the East Coast of the United States: Connecticut, one case; Florida, two cases; Maryland, three cases; New Jersey, five cases; New York City, eight cases (includes a case in a New Jersey resident exposed in New York City); Pennsylvania, one case; and Virginia, two cases. In addition to the 22 bioterrorism-associated cases, one naturally occurring case of cutaneous anthrax (associated with direct exposure to live-stock that had died of anthrax) was reported from Texas in the summer of 2001.

B. anthracis remains a Category A bioterrorism threat agent.

Botulism Thirty-nine cases of foodborne botulism were reported in 2001 through NNDSS. An outbreak of foodborne botulism in Texas involving nine culture-confirmed and seven clinically diagnosed cases was caused by commercially produced chili sauce and likely occurred because of time and temperature abuse of the food at a retail salvage store.

The highest annual frequency of infant botulism, 97 cases, was reported in 2001. The number of wound botulism cases reported in 2001 was 19. Botulism surveillance con-ducted by the Foodborne and Diarrheal Diseases Branch, NCID, indicated 33 foodborne cases, 112 cases of infant botulism, and 23 cases of wound botulism. Clostridium botulinum toxin is a Category A bioterrorism threat agent.

Brucellosis In 2001, the control program for brucellosis among cattle in the United States has nearly eliminated Brucella abortus infection from U.S. herds. Therefore, at present, the risk of contracting brucellosis either from occupational exposure to livestock in the United States or from domestically produced food products is minimal. However, a risk remains for infection with both B. abortus and B. melitensis from consumption of unpasteurized goat and cow milk products, in particular those produced outside the United States. Most cases in the United States are now seen in international travelers or recent immigrants. Hunters exposed to infected wildlife and laboratory personnel working with Brucella species also have an elevated risk for infection. B. melitensis and B. suis are considered Category B bioterrorism threat agents.

Chancroid During 2001, a total of 38 cases of chancroid were reported (rate: 0.01 cases/100,000 population), representing a 51% decline from 2000 and a continuing decline since 1987 (1). However, chancroid is difficult to culture and could be substantially underdiagnosed.

Several studies that used DNA amplification tests (which are not commercially avail-able) have identified this infection in cities where it was previously undetected (2).

1. CDC. Sexually transmitted disease surveillance 2001. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 2002.

2. Mertz KJ, Trees D, Levine WC, et al. Etiology of genital ulcers and prevalence of human immunodeficiency virus coinfection in 10 US cities. The Genital Ulcer Disease Surveillance Group. J Infect Dis 1998;178:1795-8.

xii MMWR May 2, 2003 Chlamydia trachomatis, Genital Infection During 2001, a total of 783,242 cases of genital chlamydial infection were reported (rate: 278.32/100,000). This rate was the highest since voluntary case reporting began in the mid-1980s and the highest since genital chlamydial infection became a nation-ally notifiable disease in 1995 (1). This increase could be caused in part by the con-tinued expansion of chlamydia screening programs and increased use of more sensitive diagnostic tests for this condition.

1. CDC. Sexually transmitted disease surveillance 2001. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 2002.

Cholera During 1995-2000, 61 laboratory-confirmed cases of cholera, all caused by Vibrio cholerae O1, were reported to CDC. Thirty-five (57%) patients were hospitalized, and one died. Thirty-seven (61%) infections were acquired outside the United States, whereas six (10%) were acquired through consumption of contaminated seafood har-vested in Gulf Coast waters (1). Only three laboratory-confirmed cases of cholera were reported to CDC in 2001. All were caused by V. cholerae O1 and were acquired outside the United States. All three isolates were resistant to trimethoprim-sulfamethoxazole, sulfisoxazole, streptomycin, and furazolidone. Thus, foreign travel continues to account for most cholera cases in the United States, and antimicrobial resistance is common among V. cholerae O1 strains isolated from ill travelers. Production and sale of the only licensed cholera vaccine in the United States ceased in 2001.

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 millennium. J Infect Dis 2001;184:799-802.

Coccidioidomycosis In recent years, Arizona has experienced a significant increase in the incidence rates of coccidioidomycosis, from 18/100,000 in 1997 to 42/100,000 in 2001. This increase is likely related to demographic and climactic changes. Physicians should maintain a high suspicion for acute coccidioidomycosis, especially for persons with a flu-like illness who live in or have visited endemic-disease areas.

Diphtheria During 2001, two probable diphtheria cases were reported to CDC. Both patients had membranous pharyngitis. The first was a man aged 59 years from Montana. A specimen for culture was not obtained from this patient. The second patient was a woman aged 19 years from Michigan. Although a throat swab culture from this patient did not yield Corynebacterium diphtheriae, a weakly positive Taqman polymerase chain reaction test result was obtained from the membranous tissue. Neither patient had a history of recent travel or had contact with international or local visitors. Both patients survived.

Encephalitis, Arboviral In 2001, epizootic and epidemic West Nile virus (WNV) activity continued in the United States, and geographic limits of reported viral activity extended to western Arkansas and southern Florida (1). WNV-infected birds, mosquitoes, or horses were detected in 27 states and the District of Columbia; 16 of these states had not previously reported WNV activity. In Florida, dead infected birds were collected as late as

Vol. 50 / No. 53 MMWR xiii December 26, suggesting the potential for winter transmission in southern regions.

An unprecedented equine WNV epizootic occurred in Florida and Georgia and resulted in 511 reported equine cases. Culex (Cx. pipiens, Cx. restuans, and Cx. salinarius) mos-quitoes were again the most commonly identified mosquito vectors of WNV. WNV was also detected in several human-feeding mosquito species (Cx. nigripalpus, Ochlerotatus sollicitans, Oc. tainiorhynchus, and Coquillitidia perturbans), raising concerns about increased human risk in areas where these species are common (2,3). A total of 66 human cases of WNV disease were reported from 39 counties in 10 states (64 patients with WNV meningoencephalitis and two persons with uncomplicated WNV fever).

In 2001, 79 human cases of St. Louis encephalitis (SLE) were reported from Arizona (n = 1), Arkansas (n = 2), Louisiana, (n = 71), and Texas (n = 5). Epidemic SLE activity in Louisiana was centered in the city of Monroe (4).

1. CDC. West Nile virus activity, United States2001. MMWR 2002;51:497-501.

2. Sardelis MR, Turrell MJ, Dohm DJ, et al. Vector competence of selected North American Culex and Coquillettidia mosquitoes for West Nile virus. Emerg Infect Dis 2001;7:1018-22.

3. Turrell MJ, OGuinn ML, Dohm JD, et al. Vector competence of North American mosquitoes (Diptera: Culicidae) for West Nile virus. J Med Entomol 2001;38:130-4.

4. Louisiana Office of Public Health. Four types of encephalitis found in Louisiana in 2001. Louisiana Morbidity Report 2001;12(5),2-3. Available at http://oph.dhh.state.la.us/infectiousdisease/docs/

Lmr/sepoct01.pdf Escherichia coli, enterohemorrhagic In 2001, the National Notifiable Diseases Surveillance System expanded surveil-lance of Escherichia coli O157:H7 to include other serogroups of Shiga toxin-producing E. coli under the inclusive name enterohemorrhagic E. coli (EHEC). Surveillance cat-egories for EHEC include 1) EHEC O157:H7; 2) EHEC, serogroup non-O157; and 3) EHEC, not serogrouped.

During 2001, 3,485 cases of EHEC infection were reported from 50 states, Guam and Puerto Rico. These cases included 3,294 due to EHEC O157:H7, 171 due to EHEC, serogroup non-O157, and 20 due to EHEC that were not serogrouped. Approximately 50% of stools are tested for E. coli O157, and few stool specimens are tested in a way that would identify other Shiga toxin-producing E. coli (1). The number of cases reported for EHEC should be interpreted as an underestimate in a maturing surveil-lance system.

Healthy cattle are the main animal reservoir for E. coli O157:H7 and other Shiga toxin-producing E. coli, and they harbor the organism as part of the bowel flora. Most reported outbreaks are caused by contaminated food or water. However, direct trans-mission from animals and their environment to humans in settings such as petting zoos, open farms, and animal exhibits represents a growing public health concern (2).

1. Van Gilder T, Christensen D, Wallace D, et al. Variations in stool handling and culturing practices among clinical microbiology laboratories within the Foodborne Diseases Active Surveillance network (FoodNet): Do we need practice guidelines? [Abstract]. Presented at the 99th General Meeting of the American Society for Microbiology. Chicago, 1999. Available at: http://

www.cdc.gov/foodnet/pub/asm/1999/van_gilder.htm

2. Crump JA, Sulka AC, Langer AJ, et al. An outbreak of Escherichia coli O157:H7 infections among visitors to a dairy farm. N Engl J Med 2002;347:555-60.

xiv MMWR May 2, 2003 Gonorrhea During 2001, a total of 361,705 cases of gonorrhea were reported (rate: 128.53/

100,000). The 2001 rate was similar to rates for 2000 (129.04/100,000), 1999 (132.32/

100,000), and 1998 (131.89/100,000) (1) and has remained stable among men and women. Nevertheless, increases have been observed in some areas among men who have sex with men (2). Decreased susceptibility to the fluoroquinolone antibiotics and azithromycin has been reported from some regions (3). In 2001, the prevalence of fluoroquinolone-resistant Neisseria gonorrhoeae infections increased in California. As a result, fluoroquinolones are no longer advised for treatment of gonorrhea in Hawaii or California or for infections that may have been acquired in those states (4).

1. CDC. Sexually transmitted disease surveillance 2001. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 2002.

2. Fox KK, del Rio C, Holmes KK, et al. Gonorrhea in the HIV era: a reversal in trends among men who have sex with men. Am J Public Health 2001;91:1-5.

3. CDC. Fluoroquinolone-resistance in Neisseria gonorrhoeae, Hawaii, 1999, and decreased susceptibility to azithromycin in N. gonorrhoeae, Missouri, 1999. MMWR 2000;49:833-7.

4. CDC. Sexually transmitted diseases treatment guidelines 2002. MMWR 2002;51(No. RR-6).

Haemophilus influenzae, Invasive Disease Since 1990, when Haemophilus influenzae type b (Hib) conjugate vaccines were licensed for use in infants beginning at age 2 months, Hib has become a rare cause of invasive disease (e.g., meningitis) among children aged <5 years in the United States (1). Surveillance information is used to monitor the effectiveness of immunization pro-grams and vaccines and to assess progress toward disease elimination. To continue to assess progress toward the elimination of Hib invasive disease, accurate laboratory information is essential to correctly identify the serotype of the causative H. influenzae (Hi) isolate (2). Serotyping Hi by slide agglutination can sometimes be inaccurate, especially since it is not performed frequently in most laboratories. Recently, CDC reported discrepancies in Hi slide agglutination serotyping results obtained by state health department laboratories participating in active surveillance and those obtained by CDC. In this study, 28 (70%) of 40 Hi isolates that had been reported as Hib to CDC were actually identified at CDC as nontypeable Hi (2). Because of these discrepancies, CDC requests state health department laboratories to send all Hi invasive disease isolates from children aged <5 years to CDC for testing to reconfirm serotype.

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

2. CDC. Serotyping discrepancies in Haemophilus influenzae type b diseaseUnited States, 1998-1999. MMWR 2002;51:706-7.

Hansen Disease A total of 81 Hansen disease cases were reported to CDC through the NNDSS data-base from 20 states, Puerto Rico and American Samoa in 2001; three states (California, Hawaii and New York) accounted for 74% of the total number of cases reported. In contrast, 110 Hansen disease cases were reported to the National Hansen Disease Program from 27 states and Puerto Rico in 2001; six states (Texas, New York, Louisiana, Washington, Florida and California) accounted for 71% of the total number of cases reported. These data suggest that the annual number of cases in the United States may not be declining and underscore the need for coordination between the multiple sur-veillance systems as well as the need to continue to identify and treat patients with Hansen disease.

Vol. 50 / No. 53 MMWR xv Hantavirus Pulmonary Syndrome During 2001, a total of 11 cases of hantavirus pulmonary syndrome (HPS) were confirmed in eight states through the Hantavirus Pulmonary Syndrome National Sur-veillance System and Registry. Three (27%) cases were fatal. This is the lowest number of annual cases reported since the disease was recognized in 1993. Previously, the average number of cases per year was 34 (range: 22-48). As of December 31, 2001, a total of 313 cases have been confirmed in 31 states, including 32 cases that were retro-spectively identified back to 1959. Hantaviruses are rodent borne, and human infection most commonly occurs through inhalation of virus particles from infectious rodent droppings, urine, or saliva. Preventing exposure to rodent hosts remains the most effective way of preventing morbidity and mortality from HPS because treatment for the disease is largely supportive (1).

1. CDC. Hantavirus pulmonary syndrome-United States: updated recommendations for risk reduction. MMWR 2002;51(No. RR-9):1-12.

Hemolytic Uremic Syndrome, Postdiarrheal During 2001, the sixth year of national reporting, 28 states reported 202 cases of postdiarrheal hemolytic uremic syndrome (HUS). The median age of patients was 5 years (range: <1-79), and 66% were female. Illness was seasonal, with 43% of cases occurring from June through September. Although the number of reported cases in 2001 decreased compared with 2000 (249 cases), it was greater than in 1999 (181 cases);

thus, a trend is not possible to determine. At least five states, the District of Columbia, and two territories did not list HUS as a notifiable disease in 2000, contributing to substantial underreporting.

Postdiarrheal HUS is a life-threatening illness characterized by hemolytic anemia, throm-bocytopenia, and renal injury. In the United States, most cases are caused by infection with Escherichia coli O157:H7; some are caused by other Shiga toxin-producing E. coli (1,2).

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

2. CDC. Escherichia coli O111:H8 outbreak among teenage campersTexas, 1999. MMWR 2000;49:321-4.

Hepatitis A Hepatitis A vaccine is recommended for persons at increased risk of acquiring hepa-titis A (e.g., illegal drug users, men who have sex with men [MSM]) and also for chil-dren in states and counties that have historically had consistently elevated rates of hepatitis A (1). After routine childhood vaccination was recommended, the overall hepa-titis A rate has declined steadily, and in 2001 it was the lowest yet recorded (4.0/100,000).

Because hepatitis A rates tend to vary from year to year and from region to region, continued monitoring of hepatitis A incidence is needed to determine whether this low rate is due to routine immunization or natural variability in infection rates. However, declines in rates have been greater among children and in the states where routine childhood vaccination is recommended, suggesting an impact of childhood vaccina-tion. Despite declining overall rates, some states reported increasing rates in 2000-2001. In several states, these increases were related to outbreaks occurring among high-risk adults, including MSM, and cases among adults in high-risk groups represent an increasing proportion of reported cases nationwide. For example, cases among MSM increased from 4% (1990) to 8% (1995) to12% (2000).

1. CDC. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(No. RR-12).

xvi MMWR May 2, 2003 Hepatitis B During 2001, a total of 7,843 acute hepatitis B cases were reported, representing a

>60% decrease since 1990 (21,102 cases). Surveillance data are being used to monitor the impact of the national strategy for eliminating hepatitis B virus (HBV) infection.

Healthy People 2010 objectives call for a 75%-90% reduction in the national incidence of hepatitis B among adults (baseline: 15-24 cases/100,000), a 99% reduction among children aged 2-18 years (baseline: 945 cases/year), and a 75% reduction in the num-ber of perinatal HBV infections (baseline: 1,682 infections/year) (1). The effect of routine infant and adolescent vaccination can already be seen in the declining rate of disease among persons aged <19 years. In contrast, the continued high incidence among per-sons in other risk groups for which vaccination is recommended, e.g., injection drug users and persons engaging in high-risk sexual behaviors, indicates that programs for reaching these populations need to be developed or strengthened.

1. US Department of Health and Human Services. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health (2 vols.). Washington, DC: US Department of Health and Human Services, 2000.

Hepatitis C; Non-A, Non-B Cases of hepatitis C reported to CDC are considered unreliable because 1) no sero-logic marker for acute infection exists, and 2) most health departments do not have the resources to determine if a positive laboratory report for hepatitis C virus (HCV) infec-tion represents acute infection, chronic infection, repeated testing of a person previ-ously reported, or a false-positive result (1). Historically, the most reliable national esti-mates of acute disease incidence have come from sentinel surveillance. After adjusting for underreporting and asymptomatic infections, the annual number of new infections has decreased >80% since 1989 to 25,000 cases in 2001 (CDC, unpublished data, 2002).

Because surveillance for acute hepatitis C can be used to evaluate the effectiveness of prevention efforts and identify missed opportunities for prevention, efforts are under way to help states establish and improve surveillance.

1. CDC. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998;47(No. RR-19).

HIV Infection, Adult*

Persons with HIV infection are living longer without progressing to AIDS. As a result, AIDS incidence is decreasing and no longer provides the most accurate information on the HIV epidemic. Recommendations for implementing national HIV case surveillance were published in December 1999, and the revised surveillance case definition became effective January 1, 2000 (1).

By December 31, 2001, 37 areas had laws or regulations requiring confidential reporting by name of adults/adolescents with confirmed HIV infection. Nine areas (Washington, DC, Hawaii, Illinois, Kentucky, Maryland, Massachusetts, Puerto Rico, Rhode Island, and Vermont) had implemented a code-based system to conduct case surveillance for HIV infection. Other areas (Delaware, Maine, Montana, Oregon, and Washington) had implemented a name-to-code system to conduct HIV infection sur-veillance: names are collected initially and later are converted to codes. Data on cases of HIV infection from those areas conducting code-based or name-to code systems are not included in this report pending evaluations demonstrating acceptable performance under CDC guidelines and the development of methods to report such data to CDC (2).

• For information on AIDS, see page x..

Vol. 50 / No. 53 MMWR xvii Trend analysis is possible by examining data from the 25 states* that have continu-ally conducted HIV surveillance since 1994. These 25 states represent 24% of all AIDS cases diagnosed in the United States. During 1994-2000, HIV infection was diagnosed in 128,813 persons from the 25 states. The number of persons newly diagnosed each year with HIV infection declined steadily during 1994-1997. From 1997 through 2000, case counts have been stable in all age, race/ethnicity and HIV exposure categories.

The largest declines were observed in the following groups: persons aged 25-44 years, men who have sex with men, and injection-drug users. The majority (55%) of persons with newly diagnosed HIV in these 25 states were black non-Hispanic, and 36% were white non-Hispanic. Because persons with newly diagnosed HIV infections include those who may have had previously unrecognized infections for a long time, these data do not represent incident infections. However, the stability in the number of infec-tions diagnosed each year during the latter part of the 1990s and the small declines in the proportion of persons presenting with AIDS indicate that improvements in the tar-geting of HIV counseling and testing are needed to facilitate earlier diagnoses. Early diagnosis is a critical factor in ensuring that infected persons are linked to effective treatment and prevention services to reduce further transmission and improve quality of life (3).

1. CDC. Guidelines for national human immunodeficiency virus case surveillance, including monitoring for human immunodeficiency virus infection and acquired immunodeficiency syndrome. MMWR, 1999;48(No. RR-13):1-31.

2. CDC. HIV/AIDS Surveillance Report, 2002. Vol. 13, No. 2. Atlanta: Centers for Disease Control and Prevention. Available at http://www.cdc.gov/hiv/stats/hasrlink.htm.

3. CDC. Diagnosis and reporting of HIV and AIDS in states with HIV/AIDS surveillanceUnited States, 1994-2000. MMWR 2002;51;595-8.

HIV Infection, Pediatric As of December 2001, 39 areas conducted name-based surveillance for HIV infec-tion among children aged <13 years. In 2001, 543 children whose infection had not progressed to AIDS and 175 children who had AIDS were reported (1). These states also received reports of perinatally exposed children who required follow-up with health-care providers to determine their HIV infection status.

In 2000, an estimated 6,075-6,422 infants were born to HIV-positive mothers in the United States. Of these infants, an estimated 280-370 were infected with HIV, repre-senting a decline of >80% from the 1991 peak of 1,760 estimated HIV-positive U.S.

births (2). Declines in perinatal HIV infections have been attributed to the use of zidovudine to reduce perinatal HIV transmission (3) and to nationwide efforts to imple-ment routine, voluntary prenatal HIV testing for all pregnant women (4). Continued declines in perinatal HIV infections may be difficult to sustain unless new HIV infections in women of childbearing age are reduced.

1. CDC. HIV/AIDS Surveillance Report, 2002. Vol 13, No. 2. Atlanta: Centers for Disease Control and Prevention. Available at http://www.cdc.gov/hiv/stats/hasr1302.htm.

2. Fleming P, Lindegren ML, Byers R, et al. Estimated number of perinatal HIV infections, United States, 2000 [abstract Tu PeC4773]. Presented at the XIV International AIDS Conference.

Barcelona, Spain. July 2002.

• Alabama, Arizona, Arkansas, Colorado, Idaho, Indiana, Louisiana, Michigan, Minnesota Mississippi, Missouri, Nevada, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.

xviii MMWR May 2, 2003

3. CDC. Public Health Service Task Force recommendations for the use of antiretroviral drugs in pregnant women infected with HIV-1 for maternal health and for reducing perinatal HIV-1 transmission in the United States. MMWR 1998;47(RR-2).

4. CDC. Revised recommendations for HIV screening of pregnant women. MMWR 2001;50 (No.

RR-19):59-86.

Lyme Disease During 2001, 17,029 cases of Lyme disease were reported, most from the northeast-ern and north-central United States. During 1991-2000, the reported incidence of Lyme disease nearly doubled (1). LYMErix, the Lyme disease vaccine produced by GlaxoSmithKline Pharmaceuticals, was removed from the market in February 2002 and is no longer available. CDC promotes community-based Lyme disease prevention using strategies aimed at reducing vector tick densities and preventing human infec-tion and is currently funding such projects in Connecticut, Massachusetts, New Jersey, and New York.

1. CDC. Lyme DiseaseUnited States, 2000. MMWR 2002;51:29-31.

Malaria During 2001, 1,544 malaria cases were reported in the United States. Most cases were imported, with twice as many cases occurring among U.S. residents traveling to malarious areas as occurred among foreign residents immigrating to or visiting the United States (1). Although the number of reported cases was similar to 2000 (1,591)

(2), the annual number of cases has increased during the past 15 years. This increase was likely caused by increases in both international travel (3) and immigration (4), as well as the spread and intensification of antimalarial drug resistance globally (5).

1. Causer LM, Newman RD, Barber AM, et al. Malaria surveillanceUnited States, 2000. In: CDC Surveillance Summaries, July 12, 2002. MMWR 2002;51(No SS-5):9-23.

2. CDC. Summary of notifiable diseases, United States, 2000. MMWR 2002;49:1-102.

3. International Trade Administration, Office of Travel and Tourism Industries. US resident travel to Canada, Mexico, and overseas countries historical visitation outbound, 1989-1999.

Washington, DC: US Department of Commerce, International Trade Administration, Tourism Industries. Available at http://www.tinet.ita.doc.gov/view/f-1999-11-001/index.html.

4. US Census Bureau. Current population reports. Series P23-205. Population profile of the United States:1999. Washington, DC: US Government Printing Office, 2001. Available at http://

www.census.gov/prod/2001pubs/p23-205.pdf.

5. Barat LM, Bloland PB. Drug resistance among malaria and other parasites. Infect Dis Clin North Am 1997;11:969-87.

Measles A total of 116 confirmed measles cases were reported in 2001; cases occurred in 22 states. Fifty-four of the cases were internationally imported, and exposure to these cases resulted in 25 additional cases. Twelve other cases had virologic evidence of importation (i.e., genotypic analysis of measles viruses indicated an imported source).

The remaining 25 cases were classified as unknown source cases because no link to importation was detected. The majority of confirmed measles cases (61 cases) occurred in persons aged >20 years; 29 cases occurred in persons 5-19 years, and 26 occurred in children aged <5 years. Ten outbreaks, ranging in size from 3 to 14 cases, accounted for 49% of cases (n = 57). All 10 outbreaks were linked to international importation; nine had an epidemiologic link to imported cases and one had virologic evidence of importation.

Vol. 50 / No. 53 MMWR xix Meningococcal disease Rates of meningococcal disease have been relatively stable in the United States. A total of 2,333 cases were reported in 2001, of which 1,931 were confirmed, 77 probable, seven suspected, and 318 of unknown case status. Serogroup information was reported for 33% of cases, and serogroup Y accounted for 33% of those reported. Most other cases were caused by serogroup B (32%) or serogroup C (27%). Although rates of men-ingococcal disease are usually highest among children aged <1 year, 55% of cases in 2001 occurred among persons aged >18 years.

Using the technology applied to the development of Haemophilus influenzae type b (Hib) conjugate vaccines, several companies are in the final stages of developing and testing meningococcal conjugate vaccines with various serogroup-specific formulas and in combination with other antigens for licensure in the United States (1). Three serogroup C meningococcal conjugate vaccines were licensed and integrated into rou-tine childhood immunization in the United Kingdom in 2000; early results confirm 85%-95% efficacy in infants, toddlers and teenagers (2) and suggest herd immunity.

1. Rosenstein NE, Perkins BA, Stephens DA, Popovic T, Hughes JM. Meningococcal disease.

N Engl J Med 2000;344:1378-88.

2. Miller E, Borrow R, Kaczmarski E, et al. Update on meningococcal C conjugate vaccination programme in England and Wales: coverage, herd immunity, vaccine efficacy, and validation of serological correlates. Presented at the Thirteenth International Pathogenic Neisseria Conference. Oslo, Norway, September 2002:60.

Mumps Because of the recommendation of two doses of Measles/Mumps/Rubella vaccine and its high coverage rate in the United States, mumps is at record low levels. During the 1990s, mumps cases declined substantially, from 5,292 reported cases in 1990 to 266 reported cases in 2001, meeting the Healthy People 2000 objective of <500 cases per year (1).

1. CDC. Mumps surveillance-United States, 1988-1993. In: CDC Surveillance Summaries, August 11, 1995. MMWR 1995;44(No. SS-3).

Pertussis During 2001, a total of 7,580 cases of pertussis were reported. Of these, 22%

occurred among infants aged <6 months, who were too young to have received the recommended three doses of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine; 3% occurred among children aged 6-11 months; 13% among preschool-aged children (i.e., those aged 1-4 years); 10% among children aged 5-9 years; 30%

among persons aged 10-19 years; and 22% among persons aged >20 years.

Since 1995, the coverage rate with >3 doses of a pertussis-containing vaccine has been >94% among U.S. children aged 19-35 months (1). Since 1980, the number of reported cases of pertussis in infants aged <7 months and in adolescents and adults has increased markedly in some states (2). The reasons for this rise are unknown but could include increased awareness of pertussis among health-care providers, increased use of more sensitive diagnostic tests, better reporting of cases to health departments, and possibly an increase in circulating pertussis. In contrast, the incidence of reported pertussis among children aged 7 months to 9 years has not increased markedly and suggests protection against pertussis. Adolescents and adults can become susceptible to disease because vaccine-induced immunity is believed to wane approximately 5-10 years after pertussis vaccination.

xx MMWR May 2, 2003

1. CDC. National, state, and urban area vaccination coverage levels among children aged 19-35 monthsUnited States, 2001. MMWR 2001;50:637-41.

2. CDC. PertussisUnited States, 1997-2000. MMWR 2002;51:73-6.

Rubella Because of the success of the U.S. rubella vaccination program, rubella is at a record low level, with 23 reported cases in 2001. Rubella now mostly occurs among adults born in countries that do not have routine rubella vaccination programs or that have only recently implemented such programs. In 2000 and 2001, 10 mothers of the 11 children with reported congenital rubella syndrome were foreign-born Hispanics.

Salmonellosis A total of 40,495 salmonellosis cases were reported in 2001, an 11% decrease from 46,831 cases in 1995. Salmonella isolates are reported through the Public Health Labo-ratory Information System by serotype (1). Of >2,000 known Salmonella serotypes, the three most commonly reported in 2001 were S. Typhimurium, S. Enteritidis, and S. Newport; these accounted for 50% of isolates reported. During the 5-year period 1997-2001, the number of S. Newport isolates increased from 5% to 10% of all reported Salmonella isolates.

The increasing number of S. Newport infections in the United States is concurrent with the emergence and rapid dissemination of multidrug-resistant strains of S. New-port with resistance to at least nine antimicrobial drugs. Some strains are also resistant to third-generation cephalosporins such as ceftriaxone, which may be used to treat serious infections. Several outbreaks caused by multidrug-resistant S. Newport have been investigated, including one in which raw or undercooked ground beef was implicated (2).

1. CDC. PHLIS surveillance data. Salmonella annual summaries. Available at http://www.cdc.gov/

ncidod/dbmd/phlisdata/salmonella.htm.

2. CDC. Outbreak of multidrug-resistant Salmonella NewportUnited States, January-April 2002.

MMWR 2002;51:545-8.

Shigellosis Shigella sonnei infections continue to account for approximately 75% of shigellosis in the United States. Prolonged, communitywide outbreaks of S. sonnei infections that are transmitted in child care centers and other settings where maintenance of good hygienic conditions requires special care account for much of the problem (1). In 2001, one such outbreak in Ohio and Kentucky accounted for several hundred laboratory-confirmed infections. S. sonnei can also be transmitted through contaminated foods and through water used for drinking or recreational purposes (2,3). Recent evidence suggests that S. sonnei infections are increasing among men who have sex with men (4).

1. Mohle-Boetani JC, Stapleton M, Finger R, et al. Communitywide shigellosis: control of an outbreak and risk factors in child day-care centers. Am J Public Health 1995;85:812-6.

2. CDC. Outbreaks of Shigella sonnei infection associated with eating fresh parsleyUnited States and Canada, July-August 1998. MMWR 1999;48:285-9.

3. CDC. Shigellosis outbreak associated with an unchlorinated fill-and-drain wading pool, Iowa, 2001. MMWR 2001;50:797-800.

4. CDC. Shigella sonnei outbreak among men who have sex with menSan Francisco, California, 2000-2001. MMWR 2001;50:922-6.

Vol. 50 / No. 53 MMWR xxi Streptococcal Disease, Invasive, Group A (including streptococcal toxic-shock syndrome)

During 2001, 1,147 cases of invasive group A streptococcal (GAS) disease were reported from nine states (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New York, Oregon, and Tennessee) through the Active Bacterial Core Sur-veillance (ABCs) project under CDCs Emerging Infections Program (1). Based on these 1,147 cases, CDC estimates that approximately 9,930 cases of invasive GAS disease (rate: 3.5/100,000) and 1,350 deaths occurred nationally during 2001. Disease incidence was highest among children aged <1 year (5.5/100,000) and adults aged >65 years (9.9/

100,000). Streptococcal toxic-shock syndrome and necrotizing fasciitis accounted for approximately 5.9% and 6.7% of invasive cases, respectively. The overall case-fatality rate among persons with invasive GAS disease was 13.2%.

In 2002, CDC published recommendations for the control of invasive group A strep-tococcal disease among household contacts of persons with invasive GAS infections and for responding to postpartum and postsurgical infections. These recommenda-tions are based on routine surveillance data, studies of the epidemiology of subse-quent invasive GAS infections among household contacts of case-patients and postpartum and postsurgical GAS clusters, and studies of the effectiveness of chemoprophylactic regimens for eradicating carriage (2).

1. CDC. Active Bacterial Core Surveillance (ABCs) report. Emerging Infections Program Network.

Group A streptococcus, 2001. Available at http://www.cdc.gov/ncidod/dbmd/abcs/survreports/

gas01_provis.pdf

2. The Prevention of Invasive Group A Streptococcal Infections Workshop Participants. Prevention of invasive group A streptococcal disease among household contacts of case patients and among postpartum and postsurgical patients: recommendations from the Centers for Disease Control and Prevention. Clin Infect Dis 2002;35:950-9.

Streptococcus pneumoniae, Invasive, Drug-Resistant In 2001, the ABCs project of CDCs Emerging Infections Program(1) collected infor-mation on invasive pneumococcal disease, including drug-resistant Streptococcus pneumoniae, in nine states (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New York, Oregon, and Tennessee). For the first time, the proportion of pneumococcal isolates that were drug resistant was lower in the current year than reported in the previous year. Of the 3,418 S. pneumoniae isolates collected in 2001, 9.7% exhibited intermediate resistance to penicillin (minimum inhibitory concentration

[MIC] 0.1-1 µg/mL), and 15.6% were fully resistant (MIC >2 µg/mL); in 2000, 9.8% were intermediate and 17.1% were fully resistant (2). For cefotaxime, 10.5% of all isolates had intermediate resistance and 5.7% were fully resistant in 2001, compared with 9.8%

of all isolates with intermediate resistance and 7.5% fully resistant in 2000. For erythro-mycin, 19.4% were resistant in 2001 versus 21.3% in 2000. Approximately one in six (16.9%) isolates had reduced susceptibility to at least three classes of drugs commonly used to treat pneumococcal infections, a decline from approximately one fifth (18.9%)

of isolates in 2000.

In February 2000, the Food and Drug Administration licensed a pneumococcal con-jugate vaccine for use in infants and young children. In October 2000, the Advisory Committee on Immunization Practices issued recommendations for use of the vaccine in children aged <5 years (3). Among isolates from children aged <5 years reported to ABCs during 2001, 63.9% of all strains (n = 587) and 75.9% of strains not susceptible to penicillin (n = 199) were serotypes included in this 7-valent vaccine.

xxii MMWR May 2, 2003

1. Schuchat A, Hilger T, Zell E, et al. Active Bacterial Core Surveillance of the Emerging Infections Program Network. Emerg Infect Dis 2001;7:1-8. Available at http://www.cdc.gov/ncidod/eid/

vol7no1/schuchat.htm.

2. National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility testing: M100-S11. Wayne, PA: National Committee for Clinical Laboratory Standards, 2001.

3. CDC. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices. MMWR 2000;49(No. RR-9):1-38.

Streptococcus pneumoniae, Invasive, <5 Years Invasive Streptococcus pneumoniae infection in children aged <5 years was report-able in 28 states and the District of Columbia in 2001. Of these 29 jurisdictions with mandated reporting, only 11 states and the District of Columbia reported cases. The incidence rate in these reporting areas was 13.3/100,000, which is lower than the rate of 39.7 cases/100,000 population estimated from data collected through the Active Bacterial Core Surveillance (CDC, unpublished data).

Syphilis, Congenital During 2001, a total of 441 cases of congenital syphilis were reported (rate: 11.1/

100,000 live births). Like primary and secondary syphilis, the rate of congenital syphilis has declined sharply in recent years, from a peak of 107.3/100,000 in 1991 (1). The continuing decrease in the rate of congenital syphilis likely reflects the substantial reduction in the rate of primary and secondary syphilis among women that has occurred in the last decade. Congenital syphilis persists in the United States because a substantial number of women do not receive syphilis serologic testing until late in their pregnancy or not at all. This lack of screening is often related to absent or late prenatal care (2).

1. CDC. Sexually transmitted disease surveillance 2000. Atlanta, GA: US Department of Health and Human Services, Public Health Service, CDC, 2001.

2. CDC. Congenital syphilisUnited States, 2000. MMWR 2001;50:573-7.

Syphilis, Primary and Secondary During 2001, a total of 6,103 primary and secondary syphilis cases were reported.

From 1990 to 2000, the primary and secondary syphilis rate declined 90%, from 20.34/

100,000 to 2.12/100,000. The overall 2001 rate (2.17/100,000) is a 2% increase from the 2000 rate, which was the lowest since reporting began in 1941 (1) and the first annual increase since 1990. The 2001 primary and secondary syphilis rate reflects a 15.4%

increase among men but a 17.7% decrease among women. This disparity between men and women, observed across all racial and ethnic groups, along with reported outbreaks of syphilis among men who have sex with men (MSM) in large urban areas, suggests that increases in syphilis are occurring among MSM. Rates also remain disproportionately high in the South and among non-Hispanic blacks. (2,3).

1. CDC. Sexually transmitted disease surveillance 2000. Atlanta, GA: US Department of Health and Human Services, Public Health Service, CDC, 2001.

2. CDC. Outbreak of syphilis among men who have sex with menSouthern California, 2000.

MMWR 2001;50:117-20.

3. CDC. Primary and secondary syphilisUnited States, 1999. MMWR 2001;50:113-7.

Vol. 50 / No. 53 MMWR xxiii Tetanus In 2001, 37 cases of tetanus were reported from 15 states. Four (10.8%) cases were among persons aged <25 years, 19 (51.4%) cases were among persons aged 25-59 years, and 14 (37.8%) cases were among persons aged >60 years. The percentage of cases among persons aged 25-59 years has increased during the last decade; previ-ously, most cases were among persons aged >60 years (1). One neonatal case with an atypical presentation of tetanus was reported from California. The mother of the infant was foreign born and had an unknown vaccination status. The infant recovered after 30 days of hospitalization. Six (16.7%) of the non-neonatal cases were fatal.

1. CDC. Tetanus SurveillanceUnited States, 1995-1997. In: CDC surveillance Summaries, July 3, 1998. MMWR 1998;47(No. SS-2):1-13.

Tuberculosis During 2001, a total of 15,989 cases (rate: 5.6/100,000 population) of tuberculosis (TB) were reported to CDC from the 50 states and the District of Columbia, representing a 2% decrease from 2000 and a 40% decrease from 1992, when the number of cases and the case rate most recently peaked in the United States (1). In 1991, 73% of reported cases were among U.S.-born persons (rate: 8.2/100,000), and 27% were among foreign-born persons (33.9/100,000). In comparison in 2001, there was an equal distri-bution (50%) in the number of TB cases among these two groups (case rates: 3.1/100,000 for U.S.-born persons and 26.6/100,000 for foreign-born persons) (1).

Despite the decrease in case rate among foreign-born persons during the past decade, half of the TB cases in the United States in 2001 occurred in this population, and the case rate was eight times greater in this population than among U.S.-born persons. To address the high rate, CDC is collaborating with public health partners to implement TB control initiatives among recent international arrivals and residents along the border between the United States and Mexico and to strengthen TB programs in countries with a high incidence of TB disease (2). CDC has recently updated its compre-hensive national action plan to reflect the alignment of its priorities with the Institute of Medicine report (3) and to ensure that priority prevention activities are undertaken with optimal collaboration and coordination among national and international public health partners (4).

1. CDC. Reported tuberculosis in the United States, 2001. Atlanta, GA: US Department of Health and Human Services, CDC, September 2002. Available at http://www.cdc.gov/tb.

2. CDC. Tuberculosis morbidity among U.S.-born and foreign-born populationsUnited States, 2000. MMWR 2002;51:101-4.

3. Institute of Medicine. Ending neglect: the elimination of tuberculosis in the United States.

Washington, DC: National Academy Press, 2000.

4. CDC. CDCs response to ending neglect: the elimination of tuberculosis in the United States.

Atlanta: US Department of Health and Human Services, CDC, 2002.

Typhoid Fever In 2001, typhoid fever was diagnosed in 368 persons in the United States. Despite the availability of two effective vaccines, NNDSS reports 350-450 cases each year.

Approximately 80% of these cases occur among persons who report international travel during the 6 weeks before illness. Persons visiting friends and relatives in their country

xxiv MMWR May 2, 2003 of origin appear to be at high risk (1). In many areas of the world, Salmonella Typhi strains have acquired resistance to multiple antimicrobial agents, including ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole (1). S. Typhi outbreaks in the United States are generally small in size, but they can cause significant morbidity and are often foodborne, warranting thorough investigation (2).

1. Ackers ML, Puhr ND, Tauxe RV, Mintz ED. Laboratory-based surveillance of Salmonella Serotype Typhi infections in the United States: antimicrobial resistance on the rise. JAMA 2000;283:

2668-73.

2. Olsen SJ, Bleasdale SC, Magnano AR, et al. Outbreaks of typhoid fever in the United States, 1960-1999. Epidemiol Infect 2002: In Press.

ABBREVIATIONS AND SYMBOLS USED IN TABLES Data not available.................................. NA Report of disease is not required in that jurisdiction (not notifiable)...... NN No reported cases...................................

American Samoa....................................AS Commonwealth of Northern Mariana Islands............................................. CNMI Guam...................................................... GU Puerto Rico.............................................. PR U.S. Virgin Islands.................................... VI Note: Rates <0.01 after rounding are listed as 0.00.

PART 1 Summaries of Notifiable Diseases in the United States, 2001

2 MMWR May 2, 2003 TABLE 1. Reported cases of notifiable diseases,* by month United States, 2001 Disease Total Jan.

Feb.

Mar.

Apr.

May June July Aug.

Sept.

Oct.

Nov.

Dec.

AIDS 41,868 2,550 2,949 3,275 2,886 3,482 3,759 3,406 3,217 3,696 3,507 4,369 4,772 Anthrax 23

1

3 11 7

1 Botulism, foodborne 39

4

2 2

2 1

9 13

6 Infant 97 3

5 15 8

10 7

7 7

9 9

6 11 Other (includes wound) 19

2 2

2 1

5 1

2 4

Brucellosis 136 5

4 15 5

12 19 7

17 14 11 7

20 Chancroid§ 38

9

12

7

10 Chlamydia§¶ 783,242

187,864

190,115

197,521

207,742 Cholera 3

1 1

1

Coccidioidomycosis**

3,922 89 242 200 162 63 303 218 258 361 398 336 1,292 Cryptosporidiosis 3,785 116 134 189 146 145 232 289 860 827 302 274 271 Cyclosporiasis**

147 1

15 4

8 5

20 14 29 23 15 7

6 Diphtheria 2

1

1

Ehrlichiosis, human granulocytic 261 1

1 16

4 15 43 46 40 6

14 75 Human monocytic 142 3

1 3

2 6

21 24 16 15 8

7 36 Encephalitis, California serogroup viral 128

1 1

11 19 40 28 12 16 Eastern equine 9

4 2

2

1 St. Louis 79

40 33 3

3 Escherichia coli enterohemorrhagic (EHEC)

O157:H7 3,287 56 89 103 115 170 354 362 487 627 339 240 345 EHEC, serogroup non-O157 171 5

2 8

6 8

10 13 33 20 18 20 28 EHEC, not serogrouped 20 1

2

1

1 2

4 4

2 3

Gonorrhea§ 361,705

86,379

83,831

95,705

95,790 Haemophilus influenzae, invasive disease 1,597 110 125 169 133 121 178 87 96 100 80 108 290 Hansen disease (leprosy) 79 3

5 9

4 6

10 7

2 4

7 5

17 Hantavirus pulmonary syndrome 8

1

2 1

1

1 1

1 Hemolytic uremic syndrome, postdiarrheal 202 6

6 6

8 10 17 20 16 34 25 15 39 Hepatitis A 10,609 653 742 864 652 639 859 769 951 1,301 935 910 1,334 Hepatitis B 7,843 361 476 751 541 558 713 580 632 749 563 614 1,305 Hepatitis C; non-A, non-B 3,976 304 352 403 338 287 410 277 313 359 282 224 427 Legionellosis 1,168 42 61 77 71 56 114 111 94 152 110 99 181 Listeriosis 613 26 40 34 42 49 51 62 63 71 51 56 68 Lyme disease 17,029 174 430 379 284 549 1,965 2,870 2,882 2,165 1,280 935 3,116

Vol. 50 / No. 53 MMWR 3

Malaria 1,544 90 104 96 74 112 137 182 163 210 82 84 210 Measles 116 12 18 25 5

11 8

6 11 7

3 8

2 Meningococcal disease 2,333 225 292 302 249 170 209 118 102 139 130 124 273 Mumps 266 13 13 21 27 23 19 16 32 16 21 19 46 Pertussis 7,580 341 443 563 350 348 461 359 445 637 512 612 2,509 Plague 2

2

Psittacosis 25 1

2 1

3 1

1 1

3 7

5 Q fever**

26

2

2 3

7 1

5 1

1 4

Rabies, animal 7,150 423 431 733 624 548 691 508 676 853 547 475 641 Rabies, human 1

1

Rocky Mountain spotted fever 695 4

6 9

15 32 88 110 83 99 66 40 143 Rubella 23

5 1

2 6

1 1

3 2

2 Rubella, congenital syndrome 3

3 Salmonellosis 40,495 1,566 1,748 2,327 2,406 2,632 4,210 4,251 4,646 5,666 3,639 3,016 4,388 Shigellosis 20,221 891 913 1,216 986 1,206 2,008 1,959 2,405 2,384 1,905 1,608 2,740 Streptococcal disease, invasive, group A 3,750 269 324 466 433 294 366 291 190 236 216 212 453 Streptococcal toxic-shock syndrome 77 8

9 7

9 7

11 1

5 3

3 4

10 Streptococcus pneumoniae, invasive, drug-resistant**

2,896 224 338 396 303 218 212 127 116 128 87 134 613 Streptococcus pneumoniae, invasive, <5 years**

498 64 61 61 59 45 24 15 17 26 45 40 41 Syphilis, total (all stages)§ 32,221

7,152

8,256

8,399

8,414 Congenital (age <1 yr)§ 441

119

113

123

86 Primary and secondary§ 6,103

1,335

1,488

1,609

1,671 Tetanus 37 4

1 1

5 3

8 1

3

2 9

Toxic-shock syndrome 127 5

13 25 6

9 6

11 6

9 7

10 20 Trichinosis 22 2

1 1

1

3 3

1 6

3

1 Tuberculosis 15,989 563 881 1,233 1,200 1,336 1,461 1,228 1,398 1,290 1,384 1,304 2,711 Tularemia 129 1

1 3

6 5

28 22 23 18 10 6

6 Typhoid fever 368 9

22 29 19 38 34 30 39 48 32 21 47 Varicella (chickenpox) 22,536 1,385 1,689 2,472 2,505 1,811 1,475 283 1,345 683 1,623 1,843 5,422

• No cases of western equine encephalitis, paralytic poliomyelitis, or yellow fever were reported in 2001.

Total number of acquired immunodeficiency syndrome (AIDS) cases reported to the Division of HIV/AIDS PreventionSurveillance and Epidemiol-ogy, National Center for HIV, STD, and TB Prevention (NCHSTP), through December 31, 2001.

§ Totals reported quarterly to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of May 3, 2002.

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

• • Notifiable in <40 states.

Totals reported to the Division of Tuberculosis Elimination, NCHSTP, as of March 29, 2002.

TABLE 1. (Continued) Reported cases of notifiable diseases,* by month United States, 2001 Disease Total Jan.

Feb.

Mar.

Apr.

May June July Aug.

Sept.

Oct.

Nov.

Dec.

4 MMWR May 2, 2003 TABLE 2. Reported cases of notifiable diseases, by geographic division and area United States, 2001 Total resident population Botulism Area (in thousands)

AIDS*

Anthrax Foodborne Infant Other Brucellosis Chancroid§ United States 281,418 41,868¶ 23 39 97 19 136 38 New England 13,923 1,565 1

2 Maine 1,275 48

N.H.

1,236 40

Vt.

609 25

Mass.

6,349 765

2 R.I.

1,048 103

Conn.

3,406 584 1

Mid. Atlantic 39,671 11,072 14 1

23

4 7

Upstate N.Y.

11,291 1,492

2

1

N.Y. City 7,685 5,984 7

4

1 3

N.J.

8,414 1,756 6

6

1 4

Pa.

12,281 1,840 1

1 11

1

E.N. Central 45,154 3,023

3

7

Ohio 11,353 581

3

Ind.

6,080 378

Ill.

12,419 1,323

4

Mich.

9,938 548

3

Wis.

5,364 193

W.N. Central 19,236 892

2

7

Minn.

4,919 157

2

2

Iowa 2,926 90

2

Mo.

5,595 445

1

N. Dak.

642 3

S. Dak.

755 25

Nebr.

1,711 74

1

Kans.

2,688 98

1

S. Atlantic 51,768 12,583 7

12

9 20 Del.

784 248

1

1

Md.

5,296 1,860 3

5

D.C.

572 870

Va.

7,079 951 2

4

1

W. Va.

1,808 100

1

N.C.

8,049 942

2 3

S.C.

4,012 729

15 Ga.

8,186 1,745

1

1

Fla.

15,982 5,138 2

4 2

E.S. Central 17,023 1,791

9

3

Ky.

4,042 333

5

1

Tenn.

5,689 602

4

1

Ala.

4,447 438

1

Miss.

2,845 418

W.S. Central 31,445 4,195 1

17 5

52 6

Ark.

2,673 199

1

9

La.

4,469 861

1

2

Okla.

3,451 243

1

Tex.

20,852 2,892 1

15 4

41 6

Mountain 18,172 1,386

1 9

10 1

Mont.

902 15

1

Idaho 1,294 19

Wyo.

494 5

Colo.

4,301 288

2

N. Mex.

1,819 143

1

1

Ariz.

5,131 540

1 2

6

Utah 2,233 124

4

1 1

Nev.

1,998 252

1

Pacific 45,026 5,248

20 34 19 44 2

Wash.

5,894 532

7

Oreg.

3,421 259

2 1

Calif.

33,872 4,315

3 30 18 41 2

Alaska 627 18

10

Hawaii 1,212 124

2

3

GU 158 12

1

PR 3,937 1,242

4 VI 122 35 NA NA NA NA NA

AS 67 1

CNMI 75

3

• Total number of acquired immunodeficiency syndrome (AIDS) cases reported to the Division of HIV/AIDS PreventionSurveillance and Epidemiology, National Center for HIV, STD, and TB Prevention (NCHSTP), through December 31, 2001.

Includes cases reported as wound and unspecified botulism.

§ Totals reported to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of May 3, 2002.

¶ Total includes 113 cases in persons with unknown state of residence.

Vol. 50 / No. 53 MMWR 5

TABLE 2. (Continued ) Reported cases of notifiable diseases, by geographic division and area United States, 2001 Area Chlamydia*

Cholera Coccidioidomycosis Cryptosporidiosis Cyclosporiasis Diphtheria United States 783,242 3

3,922 3,785 147 2

New England 24,391 1

3 152 20

Maine 1,338

NN 19

N.H.

1,383 1

3 17

Vt.

638

NN 34 NN

Mass.

10,402

NN 55 16

R.I.

2,912

NN 10 N

Conn.

7,718

NN 17 4

Mid. Atlantic 91,076 2

374 36

Upstate N.Y.

16,744 1

NN 125 5

N.Y. City 29,649 1

NN 123 20

N.J.

16,312

NN 24 3

Pa.

28,371

NN 102 8

E.N. Central 144,001

8 1,607 5

1 Ohio 37,653

NN 183

Ind.

15,258

NN 90

Ill.

43,716

NN 483 2

Mich.

31,090

8 187 3

1 Wis.

16,284

NN 664

W.N. Central 40,110

5 546 1

Minn.

8,323

NN 197

Iowa 5,699

NN 82 1

Mo.

13,949

NN 55

N. Dak.

1,062

NN 15 NN

S. Dak.

1,821

NN 8

Nebr.

3,206

5 185

Kans.

6,050

NN 4

NN

S. Atlantic 151,297

380 79

Del.

2,793

NN 6

Md.

15,640

NN 40 NN

D.C.

3,286

14 1

Va.

18,337

NN 27 1

W. Va.

2,346

NN 2

N.C.

22,101

NN 31

S.C.

15,329

NN 7

Ga.

33,840

NN 162 29

Fla.

37,625

NN 91 48

E.S. Central 50,758

62

Ky.

8,881

NN 5

NN

Tenn.

15,560

24

Ala.

14,524

NN 18 NN

Miss.

11,793

NN 15

W.S. Central 105,350

130

Ark.

7,280

NN 10 NN

La.

17,840

NN 8

Okla.

10,478

NN 16

Tex.

69,752

NN 96

Mountain 46,455

2,368 243 6

1 Mont.

1,919

NN 37

1 Idaho 2,023

23 NN

Wyo.

839

4 7

Colo.

13,239

NN 44 5

N. Mex.

6,254

14 30 1

Ariz.

14,346

2,301 11 NN

Utah 3,004

11 84

Nev.

4,831

38 7

Pacific 129,804

1,538 291

Wash.

13,631

NN

Oreg.

7,454

NN 58

Calif.

101,944

1,538 229 NN

Alaska 2,744

NN 1

Hawaii 4,031

NN 3

GU 431

PR 2,748

NN

VI 131 NA NA NA NA NA AS NA

NA

CNMI NA 1

NA

• Totals reported to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of May 3, 2002. Chlamydia refers to genital infections caused by C. trachomatis.

6 MMWR May 2, 2003 TABLE 2. (Continued ) Reported cases of notifiable diseases, by geographic division and area United States, 2001 Encephalitis*

Ehrlichiosis California Escherichia coli, enterohemorrhagic (EHEC)

Human Human serogroup Eastern O157:H7 Serogroup Not Area granulocytic monocytic viral equine St. Louis NETSS PHLIS§ non-O157 serogrouped United States 261 142 128 9

79 3,287 2,580 171 20 New England 62 4

1 1

250 233 43 1

Maine 1

29 27 2

N.H.

36 32 3

Vt.

15 10 1

1 Mass.

2 4

1

115 114 10

R.I.

17

17 12 1

Conn.

42

1

38 38 26

Mid. Atlantic 85 27

251 219

3 Upstate N.Y.

73 18

161 145

N.Y. City 6

4

16 11

N.J.

6 5

74 63

Pa.

NN

3 E.N. Central 2

4 31 1

813 529 12 7

Ohio 1

14

224 158 10 7

Ind.

1 5

90 49

Ill.

1 3

5

174 141

Mich.

1

102 88 2

Wis.

7

223 93

W.N. Central 102 34 14

523 493 46 4

Minn.

93 3

12

219 232 36

Iowa

2

79 69

Mo.

8 27

66 97 NN NN N. Dak.

NN NN

27 36 3

4 S. Dak.

44 44 6

Nebr.

60

1

Kans.

1 4

28 15

S. Atlantic

24 56 5

269 203 41

Del.

4 8

1

Md.

NN NN 1

29 1

D.C.

Va.

1 2

52 43 9

W. Va.

44

11 8

N.C.

11 9

59 75

S.C.

24 10

Ga.

4

2

45 29 10

Fla.

8

3

45 29 21

E.S. Central

24 26

144 127 1

3 Ky.

2

65 49 1

3 Tenn.

22 17

49 56

Ala.

1

18 13

Miss.

NN NN 8

12 9

W.S. Central 8

24

2 78 222 120

Ark.

8

2 17

La.

NN NN

1 71 8

27

Okla.

24

36 34

Tex.

1 5

161 59

Mountain

1

1 301 202 22 2

Mont.

NN NN

23

Idaho NN NN

81 46 5

Wyo.

10 2

3

Colo.

NN NN

87 50 8

2 N. Mex.

NN NN

17 14 6

Ariz.

1

1 30 23

Utah

35 45

Nev.

18 22

Pacific 2

514 454 6

Wash.

NN NN

150 136

Oreg.

1

86 76 6

Calif.

1

253 229

Alaska NN NN

4 1

Hawaii

21 12

GU

1

PR

2

VI NA NA NA NA NA NA NA NA NA AS

NA

NA NA CNMI

NA

NA NA

• No cases of western equine encephalitis were reported in 2001.

National Electronic Telecommunications System for Surveillance.

§ Public Health Laboratory Information System. Totals reported to the National Center for Infectious Diseases as of June 12, 2002.

Vol. 50 / No. 53 MMWR 7

TABLE 2. (Continued ) Reported cases of notifiable diseases, by geographic division and area United States, 2001 Haemophilus Hemolytic influenzae, Hansen Hantavirus uremic Hepatitis, acute invasive disease pulmonary

syndrome, C; non-A, Area Gonorrhea*

disease (leprosy) syndrome postdiarrheal A

B non-B United States 361,705 1,597 79 8

202 10,609 7,843 3,976 New England 6,983 121 1

18 736 149 34 Maine 141 2

1 11 7

1 N.H.

176 7

18 16

Vt.

76 5

NN

16 5

7 Mass.

3,214 43 1

13 376 41 26 R.I.

830 10

1 75 33

Conn.

2,546 54

3 240 47

Mid. Atlantic 45,464 248 17

27 1,370 1,426 1,397 Upstate N.Y.

9,685 98 1

16 333 153 36 N.Y. City 12,614 59 15

2 447 660

N.J.

8,921 48 1

5 283 286 1,218 Pa.

14,244 43

4 307 327 143 E.N. Central 75,291 285 3

23 1,214 1,049 161 Ohio 21,163 74 1

12 258 92 9

Ind.

6,972 59

102 75 1

Ill.

24,025 103 1

3 441 218 12 Mich.

17,120 14 1

326 618 139 Wis.

6,011 35

8 87 46

W.N. Central 17,045 89 2

12 395 250 1,170 Minn.

2,701 56 1

9 47 44 33 Iowa 1,418

36 24

Mo.

8,723 20 1

2 88 130 1,119 N. Dak.

56 8

NN

1 3

2

S. Dak.

289

3 1

Nebr.

1,189 3

NN NN 37 35 10 Kans.

2,669 2

181 14 8

S. Atlantic 93,709 394 2

13 2,693 1,666 144 Del.

1,733

16 29 11 Md.

9,427 92

NN NN 296 141 9

D.C.

2,883

80 13

Va.

11,095 34 1

167 213 3

W. Va.

732 16

29 35 26 N.C.

16,583 50 NN NN 2

242 221 22 S.C.

10,805 8

85 72 13 Ga.

18,920 109 NN

6 930 435

Fla.

21,531 85 1

5 848 507 60 E.S. Central 32,674 84 2

10 453 520 198 Ky.

3,588 2

NN 145 64 13 Tenn.

10,145 51 2

10 189 275 70 Ala.

11,182 29

NN

81 88 5

Miss.

7,759 2

NN

38 93 110 W.S. Central 51,665 64 2

1 18 825 1,061 671 Ark.

4,604 3

1 74 107 15 La.

12,253 10 1

87 124 151 Okla.

4,784 48 1

1 5

116 116 6

Tex.

30,024 3

12 548 714 499 Mountain 10,382 175 4

6 27 753 497 58 Mont.

104 1

16 3

1 Idaho 76 2

1 2

NN 57 11 2

Wyo.

77 1

7 3

8 Colo.

3,190 38 NN

11 88 103 11 N. Mex.

1,040 29

2

40 136 12 Ariz.

3,920 82 1

1 NN 409 164 9

Utah 219 10 1

1 13 66 25 3

Nev.

1,756 12 1

3 70 52 12 Pacific 28,492 137 46 1

54 2,170 1,225 143 Wash.

2,991 9

NN 1

184 171 31 Oreg.

1,144 39

11 105 168 15 Calif.

23,296 60 22

43 1,848 854 97 Alaska 457 6

16 10

Hawaii 604 23 24

17 22

GU 48

2

PR 589 2

1 NN NN 258 297 1

VI 34 NA NA NA NA NA NA NA AS NA NA 1

2 NA NA CNMI

NA

NA 38 NA

• Totals reported to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of May 3, 2002.

8 MMWR May 2, 2003 TABLE 2. (Continued ) Reported cases of notifiable diseases, by geographic division and area United States, 2001 Measles Meningococcal Area Legionellosis Listeriosis Lyme disease Malaria Indigenous Imported*

disease United States 1,168 613 17,029 1,544 62 54 2,333 New England 74 57 5,526 107 4

1 113 Maine 8

2 108 5

8 N.H.

12 4

129 2

14 Vt.

5 3

18 1

1

7 Mass.

21 30 1,164 53 2

1 57 R.I.

13 3

510 16

7 Conn.

15 15 3,597 30 1

20 Mid. Atlantic 285 119 8,909 440 7

13 257 Upstate N.Y.

82 36 4,020 76

4 72 N.Y. City 43 26 63 250 3

4 42 N.J.

24 20 2,020 65

1 43 Pa.

136 37 2,806 49 4

4 100 E.N. Central 316 88 720 177

10 361 Ohio 143 17 44 27

3 91 Ind.

23 8

26 19

4 47 Ill.

24 24 32 71

3 88 Mich.

82 25 21 40

83 Wis.

44 14 597 20

52 W.N. Central 55 22 540 77 2

4 174 Minn.

15 4

461 45 2

2 29 Iowa 8

2 36 9

31 Mo.

22 10 37 15

2 58 N. Dak.

1

8 S. Dak.

3

5 Nebr.

5 1

4 2

28 Kans.

1 5

2 6

15 S. Atlantic 223 77 1,039 317 3

2 383 Del.

12 NN 152 2

6 Md.

32 16 608 112 2

1 42 D.C.

8

17 13

Va.

39 15 156 55 1

46 W. Va.

NN 6

16 1

15 N.C.

11 NA 41 19

63 S.C.

15 5

6 9

33 Ga.

12 16

45

1 57 Fla.

94 19 43 61

121 E.S. Central 63 23 72 38 2

146 Ky.

14 7

23 14 2

27 Tenn.

32 9

31 14

64 Ala.

13 7

10 6

35 Miss.

4

8 4

20 W.S.Central 31 34 87 91

1 336 Ark.

1 4

3

25 La.

7

8 6

78 Okla.

7 2

5

32 Tex.

17 31 75 77

1 201 Mountain 57 39 15 68 1

1 103 Mont.

3

4 Idaho 3

1 5

4

1 8

Wyo.

3 2

1 1

5 Colo.

16 10

25

38 N. Mex.

3 7

1 3

11 Ariz.

21 10 3

19 1

21 Utah 7

2 1

4

8 Nev.

4 7

4 9

8 Pacific 64 154 121 229 43 22 460 Wash.

10 14 9

19 13 2

71 Oreg.

NN 12 15 17 3

63 Calif.

48 122 95 179 25 15 310 Alaska 1

2 1

3 Hawaii 5

6 NN 13 2

5 13 GU

1

PR 2

6 1

9 VI NA NA NA NA NA NA NA AS

3 CNMI

• Imported cases include only those resulting from importation from other countries.

Vol. 50 / No. 53 MMWR 9

TABLE 2. (Continued ) Reported cases of notifiable diseases,* by geographic division and area United States, 2001 Rubella Rabies Congenital Area Mumps Pertussis Plague Psittacosis Q fever Animal Human RMSF Rubella syndrome United States 266 7,580 2

25 26 7,150 1

695 23 3

New England 2

736

760

3

Maine

22

82

N.H.

31

21

1

Vt.

113

NN 62

Mass.

2 537

NN 279

2

R.I.

9

NN 72

Conn.

24

244

Mid. Atlantic 35 455

9

1,371

33 9

Upstate N.Y.

4 175

6

781

2 1

N.Y. City 13 59

38

2 6

N.J.

4 23

200

9 1

Pa.

14 198

3 NN 352

20 1

E.N. Central 32 985

1 1

158

16 2

1 Ohio 1

327

NN 52

2

1 Ind.

3 116

1 NN 15

1

Ill.

21 194

24

12 2

Mich.

5 149

1 47

1

Wis.

2 199

20

W.N. Central 17 609

4 6

375

69 3

Minn.

6 308

1 47

1

Iowa 1

139

3 NN 84

2 1

Mo.

4 107

1 1

40

62 1

N. Dak.

11

NN 1

42

1

S. Dak.

5

58

2

Nebr.

1 8

2 4

1

Kans.

5 31

100

1

S. Atlantic 45 493

2 3

2,512

328 5

1 Del.

NN 39

13

Md.

8 53

1 NN 504

39 1

D.C.

1

1

Va.

8 272

NN 502

40

1 W. Va.

6

141

1

N.C.

5 75

571

185

S.C.

7 34

144

31 2

Ga.

9 23

1 402

9

Fla.

8 29

1 1

209

9 2

E.S. Central 9

208

3 204

121

Ky.

3 96

1 30

2

Tenn.

1 70

2 106

85

Ala.

37 NN

64

18

Miss.

5 5

NN 4

16

W.S. Central 16 1,528

1 1,144

113 2

Ark.

858

NN 32

54

La.

2 12

1 9

2

Okla.

43

60

57

Tex.

14 615

NN 1,043

2

Mountain 17 1,561 2

6 254

11

Mont.

1 54

38

1

Idaho 2

171

28

1

Wyo.

2 1

1 28

2

Colo.

3 389

4

2

N. Mex.

2 137 1

15

1

Ariz.

2 690

129

Utah 1

78 1

15

3

Nev.

4 41

1 1

1

Pacific 93 1,005

9 7

372 1

1 2

1 Wash.

2 184

Oreg.

NN 57

4

1

Calif.

48 706

8 7

319 1

1

Alaska 1

16

1

49

NN

Hawaii 42 42

1 1

GU

PR 2

99

3

VI

AS 1

NA

NA NA NA CNMI NA NA

NA

NA NA NA

• No cases of paralytic poliomyelitis were reported in 2001.

Rocky Mountain spotted fever.

10 MMWR May 2, 2003 TABLE 2. (Continued ) Reported cases of notifiable diseases, by geographic division and area United States, 2001 Streptococcal Streptococcus

disease, Streptococcal pneumoniae, Salmonellosis Shigellosis

invasive, toxic-shock

invasive, Area NETSS*

PHLIS NETSS*

PHLIS group A syndrome drug-resistant United States 40,495 31,675 20,221 10,598 3,750 77 2,896 New England 2,344 2,324 312 288 239

150 Maine 168 151 6

3 12

N.H.

166 158 7

4 NN

NN Vt.

82 79 7

6 16

9 Mass.

1,328 1,295 208 190 67

NN R.I.

151 163 24 25 15

20 Conn.

449 478 60 60 129 NN 121 Mid. Atlantic 5,424 5,153 1,508 967 687 10 188 Upstate N.Y.

1,398 1,342 489 131 282 NN 178 N.Y. City 1,313 1,482 410 380 166

NA N.J.

1,174 812 274 227 148

NN Pa.

1,539 1,517 335 229 91 10 10 E.N. Central 4,981 4,227 4,443 1,897 780 47 206 Ohio 1,335 1,240 2,951 1,197 195 17 NN Ind.

549 510 253 66 69 12 206 Ill.

1,383 1,151 630 374 254 18

Mich.

884 839 304 232 211

NN Wis.

830 487 305 28 51

NN W.N. Central 2,380 2,429 2,112 1,332 409 6

160 Minn.

689 728 496 500 200

108 Iowa 335 312 365 291

NN Mo.

648 943 321 215 75 4

11 N. Dak.

73 88 27 41 22

7 S. Dak.

151 131 716 243 17

6 Nebr.

170

111

44

28 Kans.

314 227 76 42 51 2

NN S. Atlantic 9,681 6,587 3,439 1,331 640 5

1,582 Del.

96 125 17 16 4

6 Md.

809 797 163 104 NN NN NN D.C.

81

54

22

11 Va.

1,368 1,138 784 382 85 NN NN W. Va.

183 149 8

10 25 5

52 N.C.

1,386 1,283 356 186 147 NN NN S.C.

915 720 251 124 14

292 Ga.

1,721 1,696 752 465 187

434 Fla.

3,122 679 1,054 44 156

787 E.S. Central 2,775 2,076 1,772 647 123

265 Ky.

406 248 846 336 39

27 Tenn.

706 856 123 127 84

238 Ala.

748 652 211 152 NN

NN Miss.

915 320 592 32 NN NN

W.S. Central 5,052 2,253 3,005 795 322 1

291 Ark.

928 91 570 154 1

24 La.

832 842 255 238 1

NN 267 Okla.

500 434 147 75 49 1

NN Tex.

2,792 886 2,033 328 271

NN Mountain 2,331 2,102 1,063 775 461 8

50 Mont.

81

9

NN

Idaho 146 119 40 15 7

2 NN Wyo.

61 54 8

5 12

11 Colo.

591 601 245 254 161 2

N. Mex.

280 242 122 87 91 2

37 Ariz.

741 658 505 302 187

NN Utah 229 222 63 62 3

2

Nev.

202 206 71 50

2 Pacific 5,527 4,524 2,567 2,566 89

4 Wash.

681 747 236 236

NN Oreg.

281 319 116 113

Calif.

4,159 3,040 2,149 2,149 NN NN NN Alaska 50 45 7

7

NN Hawaii 356 373 59 61 89

4 GU 24

50

1

PR 972

21

NN

NN VI NA NA NA NA NA NA NA AS

18

CNMI 17

8

• National Electronic Telecommunications System for Surveillance.

Public Health Laboratory Information System. Totals reported to the National Center for Infectious Diseases as of April 26, 2002.

Vol. 50 / No. 53 MMWR 11 TABLE 2. (Continued ) Reported cases of notifiable diseases, by geographic division and area United States, 2001 Streptococcus pneumoniae, Syphilis*

invasive Congenital Primary &

Toxic-shock Area

<5 years All stages (age <1 yr) secondary Tetanus syndrome United States 498 32,221 441 6,103 37 127 New England 52 694 4

72

4 Maine 1

16

1

N.H.

NN 20

1

1 Vt.

1 8

3

Mass.

NN 446 2

46

3 R.I.

6 39

9

Conn.

44 165 2

12

NN Mid. Atlantic 123 5,370 69 541 3

21 Upstate N.Y.

123 304 5

22 1

7 N.Y. City NN 3,300 28 282 1

4 N.J.

NN 1,040 32 137

Pa.

726 4

100 1

10 E.N. Central 178 3,645 60 1,091 2

25 Ohio

297 1

81

8 Ind.

107 529 13 151

1 Ill.

71 1,541 40 409 2

4 Mich.

NN 1,147 4

428

10 Wis.

131 2

22

2 W.N. Central 70 457 7

100 2

22 Minn.

58 132

33

9 Iowa NN 44

5

1 Mo.

174 5

26

4 N. Dak.

12 2

S. Dak.

1

1

Nebr.

NN 16

10

6 Kans.

NN 88 2

25 2

2 S. Atlantic 14 9,240 98 2,008 7

17 Del.

NN 79

14

Md.

NN 937 4

266 1

NN D.C.

4 459 2

43

1 Va.

NN 524 2

102

2 W. Va.

10 7

5 1

N.C.

NN 1,422 19 445 2

7 S.C.

NN 913 16 235

3 Ga.

NN 1,985 18 414

4 Fla.

NN 2,914 37 484 3

E.S. Central

3,042 30 661 2

3 Ky.

NN 191 1

48

2 Tenn.

NN 1,478 14 331 1

1 Ala.

NN 720 6

142

Miss.

653 9

140 1

NN W.S. Central 61 4,980 84 760 4

1 Ark.

NN 239 6

49

La.

61 793

173

Okla.

288 5

60 1

1 Tex.

3,660 73 478 3

Mountain

1,471 30 243 2

8 Mont.

Idaho NN 11

1

Wyo.

4

1

Colo.

149 1

23 1

7 N. Mex.

73

19

1 Ariz.

NN 1,147 29 180 1

Utah

25

11

Nev.

62

8

Pacific

3,322 59 627 15 26 Wash.

NN 174

57

NN Oreg.

NN 48

13

Calif.

NN 3,050 59 545 15 26 Alaska

9

NN Hawaii

41

12

GU

30 1

12

PR

1,267 21 244

VI NA 9

1

NA NA AS

CNMI

• Totals reported to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of May 3, 2002.

12 MMWR May 2, 2003 TABLE 2. (Continued ) Reported cases of notifiable diseases,* by geographic division and area United States, 2001 Varicella§ Area Trichinosis Tuberculosis Tularemia Typhoid fever (chickenpox)

United States 22 15,989 129 368 22,536 New England

498 7

20 3,096 Maine

20

1 146 N.H.

20 1

2 NN Vt.

7

149 Mass.

270 6

12 1,093 R.I.

60

9 Conn.

121

5 1,699 Mid. Atlantic 3

2,556 2

113

Upstate N.Y.

415 1

15 NN N.Y.City 2

1,261

49 NN N.J.

1 530 1

38 NN Pa.

350

11 NN E.N. Central 2

1,544 17 34 10,474 Ohio

306 1

5 1,653 Ind.

115 NN 2

NN Ill.

1 707 14 18

Mich.

330 2

5 6,600 Wis.

1 86

4 2,221 W.N. Central 2

561 47 16 18 Minn.

239

7 NN Iowa 2

43 NN

NN Mo.

157 27 9

3 N. Dak.

6 1

15 S. Dak.

13 7

NN Nebr.

40 5

NN Kans.

63 7

NN S. Atlantic

3,088 4

52 2,100 Del.

33 1

1 NN Md.

262 1

10 NN D.C.

74

73 Va.

306 NN 15 540 W. Va.

32

1,421 N.C.

398 1

3 NN S.C.

263

66 Ga.

NN 575 1

12 NN Fla.

1,145

11 NN E.S. Central

884 11 1

Ky.

NN 152 4

NN Tenn.

313 6

1 NN Ala.

265 1

NN Miss.

154

NN W.S. Central

2,293 16 20 5,800 Ark.

NN 162 9

NN La.

294

59 Okla.

194 7

1

Tex.

1,643 NN 19 5,741 Mountain 1

644 17 11 1,048 Mont.

20 2

2 NN Idaho

9

3 Wyo.

1 3

7

NN Colo.

138 2

1 NN N. Mex.

54 1

NN Ariz.

289 1

2 951 Utah

35 4

2 92 Nev.

96

4 2

Pacific 14 3,921 8

101

Wash.

261 5

7 NN Oreg.

123 1

8

Calif.

13 3,332 1

82 NN Alaska 1

54 1

1 NN Hawaii

151

3

GU 22 63

3 60 PR

121

2,187 VI NA NA NA NA NA AS

173 CNMI

58

• No cases of yellow fever were reported in 2001.

Totals reported to the Division of Tuberculosis Elimination, NCHSTP, as of March 29, 2002.

§ Although not nationally notifiable, reporting is recommended by the Council of State and Territorial Epidemiologists.

Vol. 50/ No. 53 MMWR 13

14 MMWR May 2, 2003 TABLE 3. Reported cases and incidence rates of notifiable diseases,* by age group United States, 2001

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

>65 yrs Age not Disease Total No.

(Rate)

No.

(Rate)

No.

(Rate)

No.

(Rate)

No.

(Rate)

No.

(Rate)

No.

(Rate) stated AIDS 41,868 49 (1.29) 59 (0.38) 138 (0.34) 1,721 (4.39) 20,031 (32.00) 19,033 (22.55) 837 (2.39)

Anthrax 23 1

(0.03)

(0.00)

(0.00) 1 (0.00) 8 (0.01) 11 (0.01) 2 (0.01)

Botulism, foodborne 39 5

(0.13) 2 (0.01) 1 (0.00) 2 (0.01) 5 (0.01) 16 (0.02) 8 (0.02)

Infant 97 92 (2.42) 4 (0.03) 1 (0.00)

(0.00)

(0.00)

(0.00)

(0.00)

Other (includes wound) 19

(0.00)

(0.00)

(0.00) 1 (0.00) 5 (0.01) 13 (0.02)

(0.00)

Brucellosis 136

(0.00) 8 (0.05) 20 (0.05) 20 (0.05) 31 (0.05) 30 (0.04) 25 (0.07) 2 Chlamydia§¶ 783,242 NA NA NA NA NA NA 569,254 (1452.78) 172,238 (275.15) 17,486 (20.72) 911 (2.60) 6,410 Cholera 3

(0.00) 1 (0.01)

(0.00)

(0.00)

(0.00) 1 (0.00) 1 (0.00)

Coccidioidomycosis**

3,922 10 (0.27) 18 (0.12) 167 (0.42) 433 (1.14) 964 (1.58) 1,563 (1.90) 712 (2.09) 55 Cryptosporidiosis 3,785 98 (2.58) 696 (4.53) 790 (1.92) 375 (0.96) 900 (1.44) 717 (0.85) 170 (0.49) 39 Cyclosporiasis**

147 1

(0.03) 1 (0.01) 1 (0.00) 23 (0.06) 35 (0.06) 50 (0.06) 33 (0.09) 3 Diphtheria 2

(0.00)

(0.00)

(0.00) 1 (0.00)

(0.00) 1 (0.00)

(0.00)

Ehrlichiosis, Human granulocytic 261 1

(0.03) 3 (0.02) 18 (0.04) 14 (0.04) 35 (0.06) 117 (0.14) 67 (0.19) 6 Human monocytic 142 1

(0.03)

(0.00) 7 (0.02) 8 (0.02) 22 (0.04) 65 (0.08) 35 (0.10) 4 Encephalitis, California serogroup viral 128 6

(0.16) 18 (0.12) 90 (0.22) 4 (0.01) 4 (0.01) 4 (0.00) 2 (0.01)

Eastern equine 9

1 (0.03) 1 (0.01) 2 (0.00)

(0.00)

(0.00) 1 (0.00) 4 (0.01)

St. Louis 79

(0.00)

(0.00) 3 (0.01) 6 (0.02) 11 (0.02) 45 (0.05) 14 (0.04)

Escherichia coli, enterohemorrhagic (EHEC)

O157:H7 3,287 75 (1.97) 647 (4.21) 799 (1.95) 464 (1.18) 364 (0.58) 590 (0.70) 307 (0.88) 41 EHEC, serogroup non-O157 171 9

(0.77) 35 (0.74) 44 (0.34) 25 (0.20) 21 (0.11) 17 (0.06) 19 (0.16) 1 EHEC, not serogrouped 20 1

(0.24) 3 (0.18) 3 (0.06) 1 (0.02) 1 (0.01) 6 (0.06) 4 (0.09) 1 Gonorrhea¶ 361,705 NA NA NA NA NA NA 215,672 (550.41) 109,604 (175.09) 26,122 (30.95) 837 (2.39) 2,667 Haemophilus influenzae, invasive disease 1,597 196 (5.15) 129 (0.84) 69 (0.17) 61 (0.16) 135 (0.22) 361 (0.43) 621 (1.77) 25 Hansen disease (leprosy) 79

(0.00)

(0.00) 1 (0.00) 7 (0.02) 19 (0.03) 17 (0.02) 11 (0.03) 24 Hantavirus pulmonary syndrome 8

(0.00)

(0.00) 2 (0.00) 3 (0.01) 1 (0.00) 1 (0.00)

(0.00) 1 Hemolytic uremic syndrome, postddiarrheal 202 4

(0.11) 84 (0.55) 78 (0.19) 11 (0.03) 3 (0.00) 13 (0.02) 9 (0.03)

Hepatitis A, acute 10,609 35 (0.92) 368 (2.39) 1,531 (3.73) 1,491 (3.81) 3,337 (5.33) 2,850 (3.38) 834 (2.38) 163 Hepatitis B, acute 7,843 17 (0.45) 17 (0.11) 48 (0.12) 1,140 (2.91) 3,241 (5.18) 2,838 (3.36) 365 (1.04) 177 Hepatitis C; non-A, non-B 3,976 8

(0.21) 13 (0.08) 23 (0.06) 205 (0.52) 983 (1.57) 2,379 (2.82) 227 (0.65) 138 Legionellosis 1,168 3

(0.08) 2 (0.01) 8 (0.02) 7 (0.02) 128 (0.20) 590 (0.70) 421 (1.20) 9 Listeriosis 613 64 (1.68) 10 (0.07) 8 (0.02) 24 (0.06) 68 (0.11) 145 (0.17) 289 (0.83) 5 Lyme disease 17,029 42 (1.10) 993 (6.46) 3,496 (8.51) 1,550 (3.96) 2,457 (3.93) 6,054 (7.17) 2,183 (6.24) 254 Malaria 1,544 8

(0.21) 68 (0.44) 164 (0.40) 283 (0.72) 487 (0.78) 455 (0.54) 52 (0.15) 27 Measles 116 16 (0.42) 10 (0.07) 14 (0.03) 30 (0.08) 33 (0.05) 13 (0.02)

(0.00)

Vol. 50/ No. 53 MMWR 15 TABLE 3. (Continued) Reported cases and incidence rates of notifiable diseases,* by age group United States, 2001

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

>65 yrs Age not Disease Total No.

(Rate)

No.

(Rate)

No.

(Rate)

No.

(Rate)

No.

(Rate)

No.

(Rate)

No.

(Rate) stated Meningococcal disease 2,333 265 (6.96) 332 (2.16) 272 (0.66) 523 (1.33) 223 (0.36) 405 (0.48) 304 (0.87) 9 Mumps 266 2

(0.05) 47 (0.31) 83 (0.20) 24 (0.06) 48 (0.08) 49 (0.06) 6 (0.02) 7 Pertussis 7,580 1,886 (49.56) 971 (6.32) 2,077 (5.06) 1,157 (2.95) 654 (1.04) 717 (0.85) 94 (0.27) 24 Plague 2

(0.00)

(0.00) 1 (0.00) 1 (0.00)

(0.00)

(0.00)

(0.00)

Psittacosis 25

(0.00)

(0.00) 2 (0.00) 2 (0.01) 5 (0.01) 10 (0.01) 3 (0.01) 3 Q fever**

26

(0.00)

(0.00)

(0.00) 1 (0.00) 5 (0.01) 18 (0.02) 2 (0.01)

Rabies, human 1

(0.00)

(0.00)

(0.00)

(0.00)

(0.00)

(0.00) 1 (0.00)

Rocky Mountain spotted fever 695

(0.00) 19 (0.12) 82 (0.20) 85 (0.22) 152 (0.24) 246 (0.29) 102 (0.29) 9 Rubella 23 1

(0.03) 1 (0.01) 2 (0.00) 3 (0.01) 11 (0.02) 3 (0.00) 2 (0.01)

Salmonellosis 40,495 4,719 (124.00) 6,576 (42.78) 5,096 (12.41) 3,508 (8.95) 5,368 (8.58) 6,670 (7.90) 3,601 (10.29) 4,957 Shigellosis 20,221 406 (10.67) 6,172 (40.16) 5,318 (12.95) 1,299 (3.32) 2,628 (4.20) 1,562 (1.85) 358 (1.02) 2,478 Streptococcal disease, invasive, group A 3,750 106 (2.79) 189 (1.23) 288 (0.70) 165 (0.42) 553 (0.88) 1,252 (1.48) 1,174 (3.36) 23 Streptococcal toxic-shock syndrome 77

(0.00) 5 (0.03) 7 (0.02) 1 (0.00) 12 (0.02) 29 (0.03) 23 (0.07)

Streptococcus pneumoniae, invasive, drug-resistant**

2,896 208 (5.47) 482 (3.14) 128 (0.31) 78 (0.20) 243 (0.39) 745 (0.88) 951 (2.72) 61 Streptococcus pneumoniae, invasive, <5 yrs 498 125 (16.89) 373 (12.38)

(0.00)

(0.00)

(0.00)

(0.00)

(0.00)

Syphilis primary and secondary¶ 6,103 NA NA NA NA NA NA 1,223 (3.12) 2,986 (4.77) 1,806 (2.14) 64 (0.18)

Tetanus 37 1

(0.03)

(0.00)

(0.00) 3 (0.01) 8 (0.01) 15 (0.02) 10 (0.03)

Toxic-shock syndrome 127

(0.00) 6 (0.04) 22 (0.05) 27 (0.07) 30 (0.05) 37 (0.04) 5 (0.01)

Trichinosis 22

(0.00)

(0.00) 2 (0.00)

(0.00) 7 (0.01) 10 (0.01) 3 (0.01)

Tuberculosis 15,989 97 (2.55) 447 (2.91) 387 (0.94) 1,595 (4.07) 4,129 (6.60) 6,035 (7.15) 3,295 (9.42) 4 Tularemia 129 1

(0.03) 6 (0.04) 24 (0.06) 15 (0.04) 22 (0.04) 42 (0.05) 15 (0.04) 4 Typhoid fever 368 5

(0.13) 48 (0.31) 68 (0.17) 64 (0.16) 105 (0.17) 63 (0.07) 10 (0.03) 5

• No cases of paralytic poliomyelitis, western equine encephalitis, or yellow fever were reported in 2001.

Total number of acquired immunodeficiency syndrome (AIDS) cases reported to the Division of HIV/AIDS PreventionSurveillance and Epidemiology, National Center for HIV, STD, and TB Prevention (NCHSTP), through December 31, 2001.

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

¶ Age-related data are collected on aggregate forms different from those used for the number of reported cases. Thus, total cases reported here will differ slightly from other tables. Cases among persons aged <15 years are not shown because some might not be caused by sexual transmission; these cases are included in the totals. Totals reported to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of May 3, 2002.

• • Notifiable in <40 states.

Totals reported to the Division of Tuberculosis Elimination, NCHSTP, as of March 29, 2002.

16 MMWR May 2, 2003 TABLE 4. Reported cases and incidence rates of notifiable diseases,* by sex United States, 2001 Sex Male Female not Disease Total No.

(Rate)

No.

(Rate) stated AIDS 41,868 31,042 ( 22.49) 10,826 (

7.55)

Anthrax 23 13 (

0.01) 10 (

0.01)

Botulism, foodborne 39 15 (

0.01) 18 (

0.01) 6 Infant 97 54 (

0.04) 43 (

0.03)

Other (includes wound) 19 11 (

0.01) 8 (

0.01)

Brucellosis 136 75 (

0.05) 58 (

0.04) 3 Chancroid§ 38 24 (

0.02) 14 (

0.01)

Chlamydia§¶ 783,242 NA (

NA) 623,926 (435.19) 2,095 Cholera 3

1 (

0.00) 2 (

0.00)

Coccidioidomycosis**

3,922 2,380 (

1.77) 1,534 (

1.10) 8 Cryptosporidiosis 3,785 2,002 (

1.45) 1,743 (

1.22) 40 Cyclosporiasis**

147 69 (

0.05) 76 (

0.05) 2 Diphtheria 2

1 (

0.00) 1 (

0.00)

Ehrlichiosis, human granulocytic**

261 153 (

0.11) 107 (

0.07) 1 Human monocytic**

142 86 (

0.06) 52 (

0.04) 4 Encephalitis, California serogroup viral 128 75 (

0.05) 52 (

0.04) 1 Eastern equine 9

6 (

0.00) 3 (

0.00)

St. Louis 79 39 (

0.03) 38 (

0.03) 2 Escherichia coli, enterohemorrhagic (EHEC) O157:H7 3,287 1,592 (

1.15) 1,666 (

1.16) 29 EHEC, serogroup non-O157 171 83 (

0.19) 88 (

0.19)

EHEC, not serogrouped 20 8 (

0.05) 12 (

0.07)

Gonorrhea§ 361,705 177,213 (128.37) 183,897 (128.27) 595 Haemophilus influenzae, invasive disease 1,597 768 (

0.56) 811 (

0.57) 18 Hansen disease (leprosy) 79 34 (

0.02) 21 (

0.01) 24 Hantavirus pulmonary syndrome 8

5 (

0.00) 2 (

0.00) 1 Hemolytic uremic syndrome, postdiarrheal 202 69 (

0.05) 133 (

0.09)

Hepatitis A, acute 10,609 6,836 (

4.95) 3,709 (

2.59) 64 Hepatitis B, acute 7,843 4,879 (

3.53) 2,903 (

2.02) 61 Hepatitis C; non-A, non-B 3,976 2,403 (

1.74) 1,518 (

1.06) 55 Legionellosis 1,168 715 (

0.52) 452 (

0.32) 1 Listeriosis 613 280 (

0.20) 323 (

0.23) 10 Lyme disease 17,029 9,044 (

6.55) 7,875 (

5.49) 110 Malaria 1,544 1,023 (

0.74) 498 (

0.35) 23 Measles 116 52 (

0.04) 63 (

0.04) 1

Vol. 50/ No. 53 MMWR 17 TABLE 4. (Continued) Reported cases and incidence rates of notifiable diseases,* by sex United States, 2001 Sex Male Female not Disease Total No.

(Rate)

No.

(Rate) stated Meningococcal disease 2,333 1,177 (

0.85) 1,150 (

0.80) 6 Mumps 266 132 (

0.10) 126 (

0.09) 8 Pertussis 7,580 3,499 (

2.53) 4,072 (

2.84) 9 Plague 2

2 (

0.00) 0 (

0.00)

Psittacosis 25 7 (

0.01) 18 (

0.01)

Q fever**

26 23 (

0.02) 3 (

0.00)

Rabies, human 1

1 (

0.00) 0 (

0.00)

Rocky Mountain spotted fever 695 411 (

0.30) 279 (

0.19) 5 Rubella 23 7 (

0.01) 16 (

0.01)

Salmonellosis 40,495 17,503 ( 12.68) 18,280 ( 12.75) 4,712 Shigellosis 20,221 8,454 (

6.12) 9,250 (

6.45) 2,517 Streptococcal disease, invasive, group A**

3,750 1,954 (

1.42) 1,784 (

1.24) 12 Streptococcal toxic-shock syndrome**

77 35 (

0.03) 42 (

0.03)

Streptococcus pneumoniae, invasive, drug-resistant**

2,896 1,466 (

1.06) 1,412 (

0.98) 18 Streptococcus pneumoniae, invasive, <5 yrs**

498 273 (

1.00) 225 (

0.78)

Syphilis, primary and secondary§ 6,103 4,131 (

2.99) 1,967 (

1.37) 5 Tetanus 37 20 (

0.01) 17 (

0.01)

Toxic-shock syndrome 127 41 (

0.03) 86 (

0.06)

Trichinosis 22 17 (

0.01) 5 (

0.00)

Tuberculosis 15,989 9,943 (

7.20) 6,045 (

4.22) 1 Tularemia 129 84 (

0.06) 45 (

0.03)

Typhoid fever 368 203 (

0.15) 158 (

0.11) 7

• No cases of western equine encephalitis, paralytic poliomyelitis, or yellow fever were reported in 2001.

Total number of acquired immunodeficiency syndrome (AIDS) cases reported to the Division of HIV/AIDS PreventionSurveillance and Epidemiology, National Center for HIV, STD, and TB Prevention (NCHSTP),

through December 31, 2001.

§ Totals reported to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of May 3, 2002.

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

• • Notifiable in <40 states.

Totals reported to the Division of Tuberculosis Elimination, NCHSTP, as of March 29, 2002.

18 MMWR May 2, 2003 TABLE 5. Reported cases and incidence rates of notifiable diseases,* by race United States, 2001 American Race Indian or Asian not Alaska Native or Pacific Islander Black White Other stated Disease Total No.

(Rate)

No.

(Rate)

No.

(Rate)

No.

(Rate)

No.

No.

AIDS 41,868 194 (

9.10) 418

( 3.80) 21,007 ( 60.45) 13,230

( 6.67) 0 7,019§ Botulism, foodborne 39 10 (

0.47) 0

( 0.00) 15 (

0.04) 10

( 0.01) 0 4

Infant 97 3 (

0.14) 7

( 0.06) 6 (

0.02) 43

( 0.02) 0 38 Brucellosis 136 1 (

0.05) 0

( 0.00) 0 (

0.00) 78

( 0.04) 0 57 Chlamydia¶ **

783,242 9,705 (454.99) 10,417 (94.80) 258,930 (745.06) 161,671 (81.55) 0 342,519§ Coccidioidomycosis 3,922 16 (

0.76) 55

( 0.50) 81 (

0.24) 659

( 0.34) 19 3,092 Cryptosporidiosis 3,785 18 (

0.84) 30

( 0.27) 301 (

0.87) 2,026

( 1.02) 29 1,381 Cyclosporiasis 147 1 (

0.05) 5

( 0.05) 2 (

0.01) 96

( 0.05) 0 43 Ehrlichiosis, human granulocytic 261 3 (

0.14) 1

( 0.01) 0 (

0.00) 162

( 0.08) 0 95 Human monocytic 142 3 (

0.14) 0

( 0.00) 3 (

0.01) 102

( 0.05) 0 34 Encephalitis, California serogroup viral 128 3 (

0.14) 0

( 0.00) 6 (

0.02) 97

( 0.05) 0 22 St.Louis 79 0 (

0.00) 0

( 0.00) 33 (

0.09) 45

( 0.02) 0 1

Escherichia coli, enterohemorrhagic (EHEC)

O157:H7 3,287 31 (

1.45) 33

( 0.30) 100 (

0.29) 2,128

( 1.07) 11 984 EHEC, serogroup non-O157 171 2 (

0.32) 3

( 0.16) 0 (

0.00) 102

( 0.14) 0 64 Gonorrhea**

361,705 1,817 ( 85.18) 2,210 (20.11) 205,956 (592.63) 43,605 (22.00) 0 108,117§ Haemophilus influenzae, invasive disease 1,597 45 (

2.11) 26

( 0.24) 188 (

0.54) 962

( 0.49) 4 372 Hansen disease (leprosy) 79 1 (

0.05) 18

( 0.16) 6 (

0.02) 10

( 0.01) 2 42 Hemolytic uremic syndrome, postdiarrheal 202 5 (

0.23) 6

( 0.05) 10 (

0.03) 135

( 0.07) 1 45 Hepatitis A, acute 10,609 129 (

6.05) 234

( 2.13) 898 (

2.58) 5,557

( 2.80) 139 3,652 Hepatitis B, acute 7,843 73 (

3.42) 335

( 3.05) 1,460 (

4.20) 3,025

( 1.53) 51 2,899 Hepatitis C; non-A, non-B 3,976 77 (

3.61) 45

( 0.41) 253 (

0.73) 1,111

( 0.56) 3 2,487 Legionellosis 1,168 18 (

0.84) 14

( 0.13) 154 (

0.44) 780

( 0.39) 4 198 Listeriosis 613 8 (

0.38) 30

( 0.27) 55 (

0.16) 352

( 0.18) 2 166 Lyme disease 17,029 663 ( 31.08) 91

( 0.83) 170 (

0.49) 11,450

( 5.78) 47 4,608 Malaria 1,544 7 (

0.33) 82

( 0.75) 673 (

1.94) 331

( 0.17) 27 424 Measles 116 1 (

0.05) 46

( 0.42) 3 (

0.01) 46

( 0.02) 1 19 Meningococcal disease 2,333 21 (

0.98) 40

( 0.36) 333 (

0.95) 1,474

( 0.74) 9 456

Vol. 50/ No. 53 MMWR 19 TABLE 5. (Continued) Reported cases and incidence rates of notifiable diseases,* by race United States, 2001 American Race Indian or Asian not Alaska Native or Pacific Islander Black White Other stated Disease Total No.

(Rate)

No.

(Rate)

No.

(Rate)

No.

(Rate)

No.

No.

Mumps 266 4

( 0.19) 48

( 0.44) 14

( 0.04) 133 (0.07) 4 63 Pertussis 7,580 101

( 4.74) 93

( 0.85) 515

( 1.48) 5,564 (2.81) 18 1,289 Psittacosis 25 0

( 0.00) 0

( 0.00) 4

( 0.01) 12 (0.01) 1 8

Q fever 26 0

( 0.00) 1

( 0.01) 1

( 0.00) 10 (0.01) 0 14 Rocky Mountain spotted fever 695 16

( 0.75) 2

( 0.02) 46

( 0.13) 534 (0.27) 0 97 Salmonellosis 40,495 460 (21.57) 645

( 5.87) 3,257

( 9.37) 19,034 (9.60) 105 16,994 Shigellosis 20,221 649 (30.43) 144

( 1.31) 4,140 (11.91) 7,438 (3.75) 120 7,730 Streptococcal disease, invasive, group A 3,750 112

( 5.25) 57

( 0.52) 493

( 1.42) 2,202 (1.11) 10 876 Streptococcal toxic-shock syndrome 77 0

( 0.00) 0

( 0.00) 15

( 0.04) 49 (0.02) 1 12 Streptococcus pneumoniae, invasive, drug-resistant 2,896 6

( 0.28) 14

( 0.13) 626

( 1.80) 1,753 (0.88) 8 489 Streptococcus pneumoniae, invasive, <5 yrs 498 3

( 1.36) 5

( 0.26) 116

( 1.50) 270 (0.66) 7 97 Syphilis, primary and secondary**

6,103 87

( 4.08) 53

( 0.48) 3,680 (10.59) 1,329 (0.67) 0 954§ Tetanus 37 1

( 0.05) 2

( 0.02) 1

( 0.00) 22 (0.01) 0 11 Toxic-shock syndrome 127 0

( 0.00) 5

( 0.05) 9

( 0.03) 85 (0.04) 0 28 Tuberculosis§§ 15,989 247 (11.58) 3,587 (32.65) 4,891 (14.07) 7,209 (3.64) 0 55 Tularemia 129 8

( 0.38) 2

( 0.02) 2

( 0.01) 80 (0.04) 0 37 Typhoid fever 368 4

( 0.19) 97

( 0.88) 30

( 0.09) 53 (0.03) 18 166

• No cases of paralytic poliomyelitis, western equine encephalitis, or yellow fever were reported in 2001. Diseases with <25 reported cases are not included in this table.

Total number of acquired immunodeficiency syndrome (AIDS) cases reported to the Division of HIV/AIDS PreventionSurveillance and Epidemiology, National Center for HIV, STD, and TB Prevention (NCHSTP), through December 31, 2001.

§ Includes the following cases originally reported as Hispanic: 6,962 for AIDS; 107,470 for chlamydia; 19,780 for gonorrhea; and 724 for syphilis, primary and secondary.

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

• • In addition to data collected through the National Electronic Telecommunications System for Surveillance (NETSS), some ethnicity data are collected on aggregate forms different from those used for reported cases. Thus, the total number of cases reported here can differ slightly from others. Totals reported to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of May 3, 2002.

Notifiable in <40 states.

§§ Totals reported to the Division of Tuberculosis Elimination, NCHSTP, as of March 29, 2002.

20 MMWR May 2, 2003 TABLE 6. Reported cases and incidence rates of notifiable diseases,* by ethnicity United States, 2001 Ethnicity Hispanic Non-Hispanic not Disease Total No.

(Rate)

No.

(Rate) stated AIDS 41,868 6,962 (

9.72) 34,237 ( 13.91) 669 Botulism, foodborne 39 3 (

0.01) 18 (

0.01) 18 Infant 97 13 (

0.04) 40 (

0.02) 44 Brucellosis 136 93 (

0.26) 19 (

0.01) 24 Chlamydia§¶ 783,242 107,470 (304.40) 440,723 (179.07) 235,049 Coccidioidomycosis**

3,922 635 (

4.51) 682 (

1.54) 2,602 Cryptosporidiosis 3,785 185 (

0.52) 1,704 (

0.69) 1,896 Cyclosporiasis**

147 6 (

0.03) 75 (

0.04) 66 Ehrlichiosis, human granulocytic 261 4 (

0.01) 71 (

0.03) 169 Human monocytic 142 1 (

0.00) 90 (

0.04) 51 Encephalitis, California serogroup viral 128 2 (

0.01) 51 (

0.02) 75 St.Louis 79 2 (

0.01) 3 (

0.00) 74 Escherichia coli, enterohemorrhagic (EHEC)

O157:H7 3,287 129 (

0.37) 1,689 (

0.72) 1,469 EHEC, serogroup non-O157 171 0 (

0.00) 0 (

0.00) 171 Gonorrhea¶ 361,705 19,780 ( 56.02) 253,588 (103.04) 88,337 Haemophilus influenzae, invasive disease 1,597 101 (

0.29) 771 (

0.31) 725 Hansen disease (leprosy) 79 22 (

0.07) 27 (

0.01) 30 Hemolytic uremic syndrome, postdiarrheal 202 19 (

0.06) 107 (

0.05) 73 Hepatitis A, acute 10,609 1,816 (

5.14) 4,607 (

1.87) 4,186 Hepatitis B, acute 7,843 657 (

1.86) 3,698 (

1.50) 3,488 Hepatitis C; non-A, non-B 3,940 123 (

0.38) 1,324 (

0.58) 2,464 Legionellosis 1,168 25 (

0.07) 701 (

0.29) 442 Listeriosis 613 49 (

0.14) 312 (

0.13) 252 Lyme disease 17,029 217 (

0.61) 7,518 (

3.05) 9,294 Malaria 1,544 154 (

0.44) 815 (

0.33) 575 Measles 116 9 (

0.03) 88 (

0.04) 19 Meningococcal disease 2,333 233 (

0.66) 1,357 (

0.55) 743 Mumps 266 49 (

0.14) 146 (

0.06) 71 Pertussis 7,580 1,059 (

3.00) 5,075 (

2.06) 1,446

Vol. 50/ No. 53 MMWR 21 TABLE 6. (Continued) Reported cases and incidence rates of notifiable diseases,* by ethnicity United States, 2001 Ethnicity Hispanic Non-Hispanic not Disease Total No.

(Rate)

No.

(Rate) stated Psittacosis 25 2

( 0.01) 16 (0.01) 7 Q fever**

26 0

( 0.00) 11 (0.01) 15 Rocky Mountain spotted fever 695 10

( 0.03) 496 (0.20) 189 Salmonellosis 40,495 2,711

( 7.68) 14,575 (5.92) 23,209 Shigellosis 20,221 2,467

( 6.99) 6,014 (2.44) 11,740 Streptococcal disease, invasive group A 3,750 309

( 1.29) 1,638 (0.78) 1,787 Streptococcal toxic-shock syndrome 77 4

( 0.02) 39 (0.02) 34 Streptococcus pneumoniae, invasive, drug-resistant**

2,896 164

( 1.36) 1,205 (0.96) 1,527 Streptococcus pneumoniae, invasive, <5 yrs**

498 28

( 0.52) 199 (0.39) 271 Syphilis, primary and secondary¶ 6,103 724

( 2.05) 5,149 (2.09) 230 Tetanus 37 11

( 0.03) 20 (0.01) 6 Toxic-shock syndrome 127 6

( 0.02) 73 (0.03) 48 Tuberculosis 15,989 4,001 (11.33) 11,952 (4.86) 36 Tularemia 129 1

( 0.00) 79 (0.04) 49 Typhoid fever 368 48

( 0.14) 147 (0.06) 173

• No cases of paralytic poliomyelitis, western equine encephalitis, or yellow fever were reported in 2001.

Diseases with <25 reported cases are not included in this table.

Total number of acquired immunodeficiency syndrome (AIDS) cases reported to the Division of HIV/AIDS PreventionSurveillance and Epidemiology, National Center for HIV, STD, and TB Prevention (NCHSTP),

through December 31, 2001.

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

¶ In addition to data collected through the National Electronic Telecommunications System for Surveillance (NETSS), some ethnicity data are collected on aggregate forms different from those used for reported cases.

Thus, the total number of cases reported here can differ slightly from others. Totals reported to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of May 3, 2002.

• • Notifiable in <40 states.

Totals reported to the Division of Tuberculosis Elimination, NCHSTP, as of March 29, 2002.

22 MMWR May 2, 2003

Vol. 50 / No. 53 MMWR 23 PART 2 Graphs and Maps for Selected Notifiable Diseases in the United States ABBREVIATIONS AND SYMBOLS USED IN GRAPHS AND MAPS Data not available.................................. NA Report of disease is not required in that jurisdiction (not notifiable).... NN American Samoa.................................... AS Commonwealth of Northern Mariana Islands............................................. CNMI Guam...................................................... GU Puerto Rico.............................................. PR U.S. Virgin Islands................................... VI

24 MMWR May 2, 2003 ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS). Reported cases, by year United States* and U.S. territories, 1981-2001 1981 1986 1991 1996 2001 Reported Cases (Thousands)

Year 140 120 100 80 60 40 20 0

Expansion of surveillance case definition

• Total number of AIDS cases includes all cases reported to CDC as of December 31, 2001. Total includes cases among residents in U.S.

territories and 113 cases among persons with unknown state of residence AIDS incidence increased rapidly throughout the 1980s, peaked in the early 1990s, and then declined. The peak of new diagnoses in 1993 was associated with expansion of the AIDS surveillance case definition. In 1996, sharp declines in AIDS incidence were associated with implementation of highly active antiretroviral therapy in the United States. During 1998-1999, declines in AIDS incidence began to level, and essentially no change occurred during 1999-2001.

Vol. 50 / No. 53 MMWR 25 ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS). Reported cases per 100,000 population United States* and U.S.

territories, 2001 0-4.9 5.0-9.9 10.0-14.9

>15.0 GU PR VI AS DC

• 113 cases with unknown state of residence.

AIDS case reports continue to reflect the concentration of the epidemic in populous states in the northeastern, southeastern, and western United States. By region, from 1996 through 2001, AIDS incidence declined in the West; declined and then leveled in the Northeast, Midwest, and U.S. territories; and declined and then increased in the South.

26 MMWR May 2, 2003 ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS). Reported pediatric cases* United States and U.S. territories, 2001

• Children and adolescents aged <13 years.

Includes one case with unknown state of residence.

The number of reported pediatric AIDS cases reported has declined each year since 1992. During 2001, 175 new cases of AIDS among children were reported. Of these, 150 (86%) were attributed to perinatal exposure.

0 2

0 8

5 0

9 2

0 0

1-2 3-10

>11 DC 2

PR 0

VI 0

GU 0

AS 0

11 37 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 1

1 1

1 1

1 1

1 1

2 2

2 12 0

34 7

6 7

8 3

3 3

0

Vol. 50 / No. 53 MMWR 27 ANTHRAX. Reported cases, by year United States, 1951-2001

• One epizootic-associated cutaneous case was reported in 2001 from Texas.

In 2001, 22 anthrax cases (11 inhalational and 11 cutaneous [four suspected, seven confirmed]) were associated with an unprecedented biological terrorism event.

Five of the 11 inhalational cases were fatal. Cases occurred among residents of seven states. In addition, one naturally occurring case was reported from Texas.

Bacillus anthracis remains a Class A bioterrorism threat agent.

Reported Cases Year 70 60 50 40 30 20 10 0

1951 1956 1961 1966 1971 1976 1981 1986 1991 1996 2001 Bioterrorism-related cases*

28 MMWR May 2, 2003 BOTULISM, FOODBORNE. Reported cases, by year United States, 1981-2001

• Data from annual survey of state epidemiologists and directors of state public health laboratories.

Foodborne botulism is a rare but potentially fatal disease. Every case of botulism must be treated as a public health emergency, and the contaminated food vehicle and all exposed persons must be identified.

Reported Cases Year 130 120 110 100 90 80 70 60 50 40 30 20 10 0

1981 1986 1991 1996 2001 Outbreak caused by sauteed onions, IL Outbreak caused by fermented fish/sea products, AK Outbreak caused by baked potatoes, TX Laboratory-confirmed cases*

National Notifiable Diseases Surveillance System (NNDSS) data Outbreak caused by chili sauce, TX

Vol. 50 / No. 53 MMWR 29 BOTULISM, INFANT. Reported cases, by year United States, 1981-2001

• Data from annual survey of state epidemiologists and directors of state public health laboratories.

Infant botulism is the most common type of botulism in the United States. Cases are sporadic and risk factors remain largely unknown.

Reported Cases Year 130 120 110 100 90 80 70 60 50 40 30 20 10 0

1981 1986 1991 1996 2001 Laboratory-confirmed cases*

National Notifiable Diseases Surveillance System (NNDSS) data

30 MMWR May 2, 2003 BOTULISM, OTHER (includes wound and unspecified). Reported cases, by year United States, 1992-2001

• Data from annual survey of state epidemiologists and directors of state public health laboratories. Data for wound botulism only.

Wound botulism has increased sharply during the past decade. Most cases occur in injection-drug users in the western United States and appear to be associated with injection of a particular type of heroin.

Reported Cases Year 130 120 110 100 90 80 70 60 50 40 30 20 10 0

2001 Laboratory-confirmed cases*

National Notifiable Diseases Surveillance System (NNDSS) data 1992 1993 1994 1995 1996 1997 1998 1999 2000

Vol. 50 / No. 53 MMWR 31 BRUCELLOSIS. Reported cases, by year United States, 1971-2001 In 2001, because of the successful control program for brucellosis among cattle in the United States, the risk for brucellosis among U.S. residents is minimal. Most cases in the United States occur among international travelers or recent immigrants. Hunters exposed to infected wildlife and laboratory personnel working with Brucella species also have an elevated risk for infection. B. melitensis and B. suis are considered Class B bioterrorism threat agents.

Reported Cases Year 350 300 250 200 150 100 50 0

1971 1976 1981 1986 1991 1996 2001

32 MMWR May 2, 2003 CHLAMYDIA. Reported cases among women per 100,000 female population United States, 2001 Chlamydia refers to genital infections caused by Chlamydia trachomatis. In 2001, the chlamydia rate among women was 435.2 cases/100,000 population. Rates for men are not given because reporting for men is limited.

<300 300.1-400 400.1-500

>500 DC NYC

Vol. 50 / No. 53 MMWR 33 CHOLERA. Reported cases United States and U.S. territories, 2001 Most cholera infections in the United States are acquired in developing countries or through consumption of contaminated seafood. Cholera vaccine is not recommended for international travelers and is no longer available in the United States.

No Reported Cases Reported Cases NYC DC PR GU AS CNMI VI NA

34 MMWR May 2, 2003 COCCIDIOIDOMYCOSIS. Reported cases United States and U.S. territories, 2001 In the United States, coccidioidomycosis is endemic in the southwestern region. However, cases have been reported in other states, usually among travelers returning from areas of endemic disease.

No Reported Cases Reported Cases 0

DC NYC NN 0

GU 0

AS 0

CNMI PR NN VI NA 1538 38 0

NN NN NN NN NN 4

11 2301 14 NN NN 5

NN NN NN NN 8

0 3

NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN

Vol. 50 / No. 53 MMWR 35 CRYPTOSPORIDIOSIS. Reported cases per 100,000 population United States and U.S. territories, 2001 Surveillance data from 2001 suggest that infection with Cryptosporidium is geographically widespread. Reported illness onset dates exhibited a seasonal increase from May to September. Case-detection and reporting rates are higher in states that participate in CDCs FoodNet or Emerging Infectious Diseases Program and in states that report outbreaks. States conducting active surveillance included California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New York, Tennessee, and Oregon. Outbreak-associated cases were reported from Hawaii, Illinois, Kentucky, Minnesota, New Hampshire, New York, Wisconsin, and Wyoming.

0-0.38 0.39-1.00 1.01-2.07

>2.08 NYC DC PR 0

VI NA GU 0

AS 0

CNMI 0

36 MMWR May 2, 2003 DIPHTHERIA. Reported cases, by year United States, 1971-2001 In 2001, two probable cases of diphtheria were reported. Both case-patients were inadequately immunized adults. Respiratory diphtheria may manifest as an acute membranous pharyngitis, particularly in persons who are unimmunized or inadequately immunized. The Advisory Committee on Immunization Practices recommends that after completing a 5-dose primary series of DTP and/or DTaP (diphtheria, tetanus, and pertussis) vaccine by age 6 years, a combined formulation of tetanus and diphtheria (Td) should be administered at age 11-18 years, and thereafter, a booster shot (Td) at 10-year intervals.

Reported Cases Year 450 400 350 300 250 200 150 100 50 0

1971 1976 1981 1986 1991 1996 2001 Reported Cases Year 6

5 4

3 2

1 0

1986 1991 1996 2001 DIPHTHERIA. Reported cases, by year United States, 1986-2001 Outbreak of (mostly) cutaneous diphtheria, Seattle, WA Cutaneous diphtheria no longer nationally notifiable

Vol. 50 / No. 53 MMWR 37 EHRLICHIOSIS, HUMAN GRANULOCYTIC. Reported cases United States and U.S. territories, 2001 Human ehrlichiosis is an emerging tickborne disease that became nationally notifiable only in 1999 (in some states ehrlichiosis is not a notifiable disease).

Identification and reporting of human ehrlichioses are incomplete, and numbers of cases reported here are not indicative of the overall distribution or the regional prevalence of disease. Six cases of ehrlichiosis, human, other, or unspecified, also were reported by Kentucky, Ohio, Illinois, and Virginia in 2001.

2 17 42 8

6 NYC DC PR NA VI GU AS CNMI No Reported Cases Reported Cases 6

8 93 NN NN NN NN NN NN NN NN NN 73 1

1 1

1 1

1

38 MMWR May 2, 2003 EHRLICHIOSIS, HUMAN MONOCYTIC. Reported cases United States and U.S. territories, 2001 Human ehrlichiosis is an emerging tickborne disease that became nationally notifiable only in 1999 (in some states ehrlichiosis is not a notifiable disease).

Identification and reporting of human ehrlichioses are incomplete, and numbers of cases reported here are not indicative of the overall distribution or the regional prevalence of disease. Six cases of ehrlichiosis, human, other, or unspecified, also were reported by Kentucky, Ohio, Illinois, and Virginia in 2001.

NYC DC PR VI CNMI AS GU NA No Reported Cases Reported Cases 3

4 2

11 22 18 27 24 8

4 NN NN NN NN NN NN NN NN NN 4

5 1

1 1

3 4

Vol. 50 / No. 53 MMWR 39 ENCEPHALITIS. Reported cases caused by California serogroup viruses, by month of onset United States, 1992-2001 California serogroup viruses (mainly La Crosse virus in the eastern United States, where the eastern treehole mosquito, Aedes triseriatus, is the primary vector) are a cause of endemic encephalitis, especially in children. In 2001, 128 cases were reported from 14 states. During 1964-2001, a median of 66 (mean: 75) cases were reported per year in the United States.

Reported Cases Year (Month) 50 45 40 35 30 25 20 15 10 5

0 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

40 MMWR May 2, 2003 ENCEPHALITIS. Reported cases caused by eastern equine encephalitis virus, by month of onset United States, 1992-2001 Cases of eastern equine encephalitis among humans, often associated with high mortality rates (>20%) and severe neurologic sequelae, occur sporadically in the eastern United States. In 2001, nine cases were reported from Florida (n = 1), Georgia (n = 2), Louisiana, (n = 3), Massachusetts (n = 1), Michigan (n = 1) and Texas (n = 1). During 1964-2001, a median of 4 (mean: 5) cases were reported per year in the United States.

0 1

2 3

4 5

6 Year (Month)

Reported Cases 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Vol. 50 / No. 53 MMWR 41 ENCEPHALITIS. Reported cases caused by St. Louis encephalitis virus, by month of onset United States, 1992-2001 Historically, St. Louis encephalitis virus has been the most important cause of epidemic viral encephalitis in the United States. In 2001, 79 cases were reported from Arizona (n =1), Arkansas (n = 2), Louisiana (n = 71) and Texas (n = 5). During 1964-2001, a median of 26 (mean: 121) cases were reported per year in the United States.

Reported Cases Year (Month) 135 120 105 90 75 60 45 30 15 0

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

42 MMWR May 2, 2003 ENCEPHALITIS. Reported cases caused by western equine encephalitis virus, by month of onset United States, 1992-2001 The most recent epidemic of western equine encephalitis occurred in Colorado in 1987. The reasons for the recent absence of epidemic transmission are poorly understood. No cases were reported nationally in 2001. During 1964-2001, a median of 3 (mean: 17) cases were reported per year in the United States.

Year (Month) 2 1

0 Reported Cases 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Vol. 50 / No. 53 MMWR 43 ESCHERICHIA COLI, ENTEROHEMORRHAGIC O157:H7. Reported cases United States and U.S. territories, 2001 0-17 18-45 46-104

>105 NYC DC PR VI GU AS CNMI NN NA In 2001, the National Notifiable Diseases Surveillance System case definition for enterohemorrhagic E. coli included cases of illness due to all serotypes of enterohemorrhagic E. coli. Only cases due to serotype O157:H7 are included in this graph. Many infections from enterohemorrhagic E. coli, especially non-O157:H7 serotypes, are not recognized or reported, in part because laboratories do not routinely test for them.

44 MMWR May 2, 2003 ESCHERICHIA COLI, ENTEROHEMORRHAGIC O157:H7. Reported isolates,* United States, 2001 NA DC NYC 0-17 18-45 46-104

>105 NA

• Data from the Public Health Laboratory Information System (PHLIS).

In 2001, the National Notifiable Diseases Surveillance System case definition for enterohemorrhagic E. coli included isolates of all serotypes of enterohemorrhagic E. coli. Only isolates confirmed by a state public health laboratory are reported to PHLIS. Isolates of serotype O157:H7 are included in this graph. Many public health laboratories can subtype isolates using pulsed-field gel electrophoresis and compare their findings electronically with other states through PulseNet, a national network of public health laboratories.

Vol. 50 / No. 53 MMWR 45 GONORRHEA. Reported cases per 100,000 population United States, 2001 In 2001, the overall U.S. gonorrhea rate was 128.5 cases/100,000 population. The Healthy People 2010 national objective is <19 cases/100,000 population. Eight states reported rates below the national objective.

<100 100.1-200

>200 NYC DC

46 MMWR May 2, 2003 GONORRHEA. Reported cases per 100,000 population, by sex United States, 1986-2001 Rates of gonorrhea in the United States have been steady since 1998, at about 130 cases/100,000 population (128.5 in 2001, 129.0 in 2000, 132.3 in 1999, and 131.9 in 1998). In 2001, rates among men and women were nearly identical (128.4 cases/100,000 men and 128.2 cases/100,000 women).

Reported Cases/100,000 Population Year 500 400 300 200 100 0

1986 1991 1996 2001 Men Women

Vol. 50 / No. 53 MMWR 47 GONORRHEA. Reported cases per 100,000 population, by race and ethnicity United States, 1986-2001 In 2001, the gonorrhea rate among non-Hispanic blacks was approximately 27 times greater than the rate for non-Hispanic whites.

Year Reported Cases/100,000 Population 2,200 2,000 1,800 1,600 1,400 1,200 1,000 800 600 400 200 0

1986 1991 1996 2001 Black, non-Hispanic American Indian/Alaska Native Hispanic White, non-Hispanic Asian/Pacific Islander

48 MMWR May 2, 2003 HAEMOPHILUS INFLUENZAE, INVASIVE DISEASE. Reported cases per 100,000 population, by age group United States 1991-2001 Before the introduction of conjugate Haemophilus influenzae type b (Hib) vaccines in December 1987, the incidence of Hib invasive disease among children aged

<5 years was estimated to be 100/100,000 population. In 2001, the incidence of H. influenzae invasive disease (all types) was 1.7/100,000 in this age group (325 cases: 27 [8%] reported as due to Hib, 144 [44%] due to other serotypes or nontypeable isolates, and 154 [47%] for which serotype information was unknown or missing). Because accurate serotyping of H. influenzae isolates from children is essential for surveillance, all H. influenzae isolates causing invasive disease in children aged <5 years should be sent to CDC for serotype confirmation.

0 1

2 3

4 5

6 7

8 Year Age <5 years Age 5 years Reported Cases/100,000 Population 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Vol. 50 / No. 53 MMWR 49 HANSEN DISEASE (leprosy). Reported cases, by year United States, 1971-2001 Reported Cases Year 400 360 320 280 240 200 160 120 80 40 0

1971 1976 1981 1986 1991 1996 2001 Increased influx of Indo-Chinese refugees, 1978-1988

50 MMWR May 2, 2003 HANTAVIRUS PULMONARY SYNDROME. Reported cases by survival status,* by year United States, 1994-2001

• Data from the National Center for Infectious Diseases.

Between 2000 and 2001, the number of annual cases of hantavirus pulmonary syndrome declined from 46 to a record low of 11. The case-fatality ratio for the period 1994-2001 is 30%. The figure includes recently confirmed cases with onset in 1999 and 2000.

Lived Died 1994 1995 1996 1997 1998 1999 2000 2001 60 55 50 45 40 35 30 25 20 15 10 5

0 Year Reported Cases

Vol. 50 / No. 53 MMWR 51 HEMOLYTIC UREMIC SYNDROME, POSTDIARRHEAL. Reported cases United States and U.S. territories, 2001 In the United States, most cases of postdiarrheal hemolytic uremic syndrome are caused by infections with Escherichia coli O157:H7 or other E. coli bacteria that produce Shiga toxin.

1 3

5 6

3 1

9 2

3 5

2 1

5 4

1 8

2 No Reported Cases Reported Cases NYC DC AS CNMI GU PR VI NN NA 11 43 13 11 12 10 16 13 NN NN NN NN NN 12

52 MMWR May 2, 2003 HEPATITIS. Reported cases per 100,000 population, by year United States, 1971-2001

• Hepatitis A vaccine was first licensed in 1995.

Hepatitis B vaccine was first licensed in June 1982.

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

In 2001, the hepatitis A rate was the lowest ever recorded. However, cyclic increases in hepatitis A have been observed approximately every 10 years, and thus rates could increase again. The incidence of hepatitis B continues to decline, but because of asymptomatic infections and underreporting, reported cases represent only a fraction of actual infections occurring (approximately 78,000 new infections in 2001). The trend in reported hepatitis C; non-A, non-B after 1990 is misleading because reported cases have included those based only on a positive laboratory test for anti-HCV, and most of these cases represent chronic HCV infection.

Year Reported Cases/100,000 Population 35 30 25 20 15 10 5

0 1971 1976 1981 1986 1991 1996 2001 Hepatitis A, acute*

Hepatitis B, acute

Hepatitis, C/non-A, non-B

§

Vol. 50 / No. 53 MMWR 53 HEPATITIS A. Reported cases per 100,000 population United States and U.S. territories, 2001 Hepatitis A rates have declined in all regions of the United States, including the western states where rates have historically been higher than elsewhere in the country. Because hepatitis A rates vary from year to year with nationwide increases approximately every 10 years, further monitoring is needed to determine whether these rates will remain low.

NYC DC 0-2.4 2.5-4.9 5.0-9.9 10.0-19.9

>20 PR GU AS CNMI VI NA

54 MMWR May 2, 2003 LEGIONELLOSIS. Reported cases per 100,000 population, by year United States, 1986-2001 In 2001, the overall reported rate of legionellosis was 0.42 cases/100,000 population. However, data from population-based studies indicate that the actual rate is more than 10 times this number.

Reported Cases/100,000 Population Year 1986 1991 1996 2001 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0

Vol. 50 / No. 53 MMWR 55 LISTERIOSIS. Reported cases per 100,000 population United States and U.S. territories, 2001 Listeriosis was made a nationally notifiable disease in 2000. Although infection is relatively uncommon, listeriosis is a leading cause of death due to foodborne illness in the United States. Recent outbreaks have been linked to frankfurters, deli meats, and Mexican-style cheeses. Routine subtyping of isolates through PulseNet helps identify multistate outbreaks.

0-0.04 0.05-0.18 0.19-0.28

>0.29 NYC DC AS CNMI GU PR VI NA NN 0

0 0

0 0

0 0

0 0

0 0

NA

56 MMWR May 2, 2003 LYME DISEASE. Reported cases by county United States, 2001

• The total number of cases from these counties represented 90% of all cases reported in 2001.

A total of 17,029 cases of Lyme disease were reported in 2001, 15,998 of these from 10 states with endemic disease (Connecticut, Delaware, Massachusetts, Maryland, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island, Wisconsin). The incidence rate in these states was 23.9/100,000 population. By integrating prevention strategies into community-based programs, CDC and state health departments hope to achieve the Healthy People 2010 goal of reducing the incidence of Lyme disease to 9.7 cases/100,000 population in states with endemic disease.

0 1-14

>15*

Vol. 50 / No. 53 MMWR 57 MALARIA. Reported cases per 100,000 population, by year United States, 1971-2001 In the last 15 years, imported malaria cases have increased, most likely because of increasing international travel and immigration as well as increased antimalarial drug resistance.

Reported Cases/100,000 Population Year 2.0 1.5 1.0 0.5 0

1971 1976 1981 1986 1991 1996 2001 Foreign immigration from malaria-endemic countries in Southeast Asia

58 MMWR May 2, 2003 MEASLES. Reported cases, by year United States, 1966-2001 With a total of 116 measles cases reported in 2001, measles incidence remained at <1 case/1,000,000 population for the fifth consecutive year, and 78% of cases were associated with international importation.

MEASLES. Reported cases, by year United States, 1986-2001 Reported Cases (Thousands)

Year 1966 1971 1976 1981 1986 1991 1996 2001 500 450 400 350 300 250 200 150 100 50 0

Reported Cases (Thousands)

Year 30 25 20 15 10 5

0 1986 1991 1996 2001

Vol. 50 / No. 53 MMWR 59 MENINGOCOCCAL DISEASE. Reported cases per 100,000 population, by year United States, 1971-2001 Rates of meningococcal disease have been relatively stable in the United States. A total of 2,333 cases were reported in 2001, of which 1,931 were confirmed, 77 probable, seven suspected, and 318 of unknown case status. Serogroup information was reported for 33% of cases; serogroup Y accounted for 33% of those reported. Most other cases were caused by serogroup B (32%) or serogroup C (27%). Although rates of meningococcal disease are usually highest among children aged <1 year, 55% of cases in 2001 occurred among persons aged >18 years.

Reported Cases/100,000 Population Year 2.0 1.5 1.0 0.5 0

1971 1976 1981 1986 1991 1996 2001

60 MMWR May 2, 2003 MUMPS. Reported cases per 100,000 population, by year United States, 1976-2001 Because of the recommendation of two doses of measles-mumps-rubella (MMR) vaccine and the continued high coverage rate in the United States, mumps has reached an all-time record low of 266 reported cases for 2001, thus meeting the Healthy People 2001 objective of <500 cases per year.

Note:

Note:

Note:

Note:

Note: A mumps vaccine was first licensed in December 1967.

Reported Cases/100,000 Population Year 40 35 30 25 20 15 10 5

0 1976 1981 1986 1991 1996 2001 Year Reported Cases/

100,000 Population MUMPS. Reported cases/100,000 population, by year United States, 1986-2001 7

6 5

4 3

2 1

0 1986 1991 1996 2001

Vol. 50 / No. 53 MMWR 61 PERTUSSIS. Reported cases per 100,000 population, by year United States, 1971-2001 Pertussis epidemics occur every 3-4 years. During 2000, the highest number of pertussis cases (7,867) since 1967 was reported (incidence: 2.9 cases per 100,000 population).

Reported Cases/100,000 Population 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0

Year 1971 1976 1981 1986 1991 1996 2001

62 MMWR May 2, 2003 PERTUSSIS. Reported cases,* by age group United States, 2001

• Of 7,580 cases, 25 were reported with unknown age.

In 2001, 22% of reported cases were among infants aged <6 months (who were too young to receive 3 doses of DTaP vaccine), and 52% of cases were among persons aged >10 years (no pertussis vaccine was licensed for use in persons aged >7 years).

Reported Cases Age Group (Years) 2,400 2,100 1,800 1,500 1,200 900 600 300 0

<1 1-4 5-9 10-14 15-19 20-29 30-39 40-49 50-59

>60

Vol. 50 / No. 53 MMWR 63 PLAGUE. Reported cases among humans, by year United States, 1971-2001 Only two laboratory-confirmed cases of human plague were identified from the United States in 2001. Utah and New Mexico each reported a single case, both of which were of the primary bubonic form of the disease. Both cases were acquired from natural sources within known enzootic regions, and both patients recovered.

Reported Cases Year 45 40 35 30 25 20 15 10 5

0 1971 1976 1981 1986 1991 1996 2001 Prairie dog and rock squirrel epizootics

64 MMWR May 2, 2003 POLIOMYELITIS, PARALYTIC. Reported cases, by year United States, 1971-2001 As of January 1, 2000, the Advisory Committee on Immunization Practices recommended the exclusive use of inactivated poliovirus vaccine for routine childhood polio vaccination in the United States.

Note: An inactivated poliomyelitis vaccine was first licensed in 1955. An oral vaccine was licensed in 1961.

Reported Cases Year 40 35 30 25 20 15 10 5

0 1971 1976 1981 1986 1991 1996 2001

Vol. 50 / No. 53 MMWR 65 PSITTACOSIS. Reported cases, by year United States, 1971-2001 Throughout the 1990s, the number of reported cases of psittacosis steadily declined. This might reflect both improved diagnostic testing to distinguish Chlamydophila psittaci from C. pneumoniae infections and improved control measures for psittacosis among birds.

Reported Cases Year 250 225 200 175 150 125 100 75 50 25 0

1971 1976 1981 1986 1991 1996 2001

66 MMWR May 2, 2003 Q FEVER. Reported cases United States and U.S. territories, 2001 Q fever became nationally notifiable in 1999. Identification and reporting of Q fever is incomplete, and the number of cases reported do not represent the overall distribution or regional prevalence of disease.

No Reported Cases Reported Cases NYC DC AS CNMI GU PR VI NA NN NN NN NN NN NN NN NN NN NN NN NN NN

Vol. 50 / No. 53 MMWR 67 RABIES. Reported cases among wild and domestic animals, by year* United States and Puerto Rico, 1971-2001

• Data from the National Center for Infectious Diseases.

Periods of resurgence and decline of rabies incidence are primarily the result of cyclic reemergence, mainly among raccoons in the eastern United States. Wildlife populations increase and reach densities sufficient to support epizootic transmission of the disease, resulting in substantial increases in reported cases. As populations are decimated by these epizootics, numbers of reported cases decline until populations again reach levels to support epizootic transmission of the disease.

Reported Cases (Thousands)

Year 10 9

8 7

6 5

4 3

2 1

0 1971 1976 1981 1986 1991 1996 2001 Total Domestic Wild

68 MMWR May 2, 2003 ROCKY MOUNTAIN SPOTTED FEVER. Reported cases per 100,000 population, by year United States, 1971-2001 Changes in the number of reported cases of Rocky Mountain spotted fever might reflect changes in surveillance algorithms for this and other tickborne diseases.

Biological factors (e.g., changes in tick populations resulting from fluctuating environmental conditions) also could be involved.

Reported Cases/100,000 Population Year 0.6 0.5 0.4 0.3 0.2 0.1 0

1971 1976 1981 1986 1991 1996 2001

Vol. 50 / No. 53 MMWR 69 RUBELLA. Reported cases per 100,000 population, by year United States, 1971-2001 In 2001, only 23 cases of rubella were reported, which is the lowest number ever reported and an 87% decrease from the previous year. The majority of reported cases continue to be among persons aged >20 years; however, in contrast to year 2000, most of the cases in 2001 were among non-Hispanics.

Note:

Note:

Note:

Note:

Note: A rubella vaccine was first licensed in 1969.

Reported Cases/100,000 Population Year 35 30 25 20 15 10 5

0 1971 1976 1981 1986 1991 1996 2001 RUBELLA. Reported cases/100,000 population, by year United States, 1986-2001 Reported Cases/

100,000 Population Year 1986 1991 1996 2001 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0

70 MMWR May 2, 2003 SALMONELLOSIS. Reported cases per 100,000 population, by year United States, 1971-2001 Foodborne transmission accounts for approximately 95% of salmonellosis in the United States. In a population-based analysis, the estimated incidence of culture-confirmed salmonellosis declined 15% during 1996-2001.

Year Reported Cases/100,000 Population 30 25 20 15 10 5

0 1971 1976 1981 1986 1991 1996 2001 Outbreak caused by contaminated pasteurized milk, IL

Vol. 50 / No. 53 MMWR 71 SALMONELLA. Reported isolates,* by serotype and year United States, 1976-2001

• Data from Public Health Laboratory Information System (PHLIS).

In 2001, Salmonella serotypes Typhimurium and Enteritidis accounted for 40% of all reported Salmonella isolates from humans. A multidrug-resistant strain of S. Typhimurium now accounts for approximately 47% of the S. Typhimurium infections in the country. During 2001, a new multidrug-resistant strain of S. Newport was identified.

Typhimurium Enteritidis Other Unknown Reported Isolates (Thousands)

Year 30 27 24 21 18 15 12 9

6 3

0 1976 1981 1986 1991 1996 2001 Outbreak caused by contaminated pasteurized milk, IL

72 MMWR May 2, 2003 SHIGELLOSIS. Reported cases per 100,000 population, by year United States, 1971-2001 The incidence of shigellosis has remained relatively stable during the last several years.

Reported Cases/100,000 Population Year 15 10 5

0 1971 1976 1981 1986 1991 1996 2001

Vol. 50 / No. 53 MMWR 73 SHIGELLA. Reported isolates, by species and year* United States, 1976-2001

• Data from the Public Health Laboratory Information System (PHLIS).

Prolonged and extensive outbreaks of Shigella sonnei infections continue to occur in child care settings. The reported incidence of S. flexneri infections continues to decrease. Both serogroups have become increasingly resistant to first-line antimicrobial agents, including trimethoprim-sulfamethoxazole and ampicillin.

Reported Isolates (Thousands)

Year 16 14 12 10 8

6 4

2 0

1976 1981 1986 1991 1996 2001 Shigella sonnei Shigella flexneri Shigella boydii Shigella dysenteriae Unknown

74 MMWR May 2, 2003 STREPTOCOCCAL DISEASE, INVASIVE, GROUP A. Reported cases United States and U.S. territories, 2001 Passive reporting likely underestimates the numbers of invasive group A Streptococcus (GAS) infections in the United States. In 2001, 1,146 invasive GAS infections were reported by nine sites participating in CDCs Active Bacterial Core Surveillance (ABCs), corresponding to an incidence rate of 3.5 cases/100,000 population and a projected 9,950 cases nationwide.

DC NYC AS CNMI GU PR VI NN NA 0-5 6-18 19-67

>68 0

0 0

0 0

0 0

NN NN NN NN NN NN

Vol. 50 / No. 53 MMWR 75 STREPTOCOCCUS PNEUMONIAE, INVASIVE, DRUG-RESISTANT. Reported cases United States and U.S. territories, 2001 The burden of disease due to drug-resistant Streptococcus pneumoniae may be underrepresented because of passive reporting. According to data from CDCs Active Bacterial Core Surveillance (ABCs) for 2001, the rate of invasive pneumococcal disease in the United States was 17 cases/100,000 population; 23.6% of pneumococcal strains causing invasive pneumococcal disease had decreased susceptibility to penicillin. Disease rates were lower in 2001 after the introduction of pneumococcal conjugate vaccine in 2000.

0 NN 0

0 0

0 NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN DC NYC AS CNMI GU PR VI 0

0 0

NA NA NN 0

1-100 101-400

>401

76 MMWR May 2, 2003 SYPHILIS, CONGENITAL. Reported cases per 100,000 live births among infants aged <1 year United States, 1971-2001 The rate of congenital syphilis decreased from 14.0 cases/100,000 live births in 2000 to 11.1 cases/100,000 in 2001.

Year Reported Cases/100,000 Live Births 1971 1976 1981 1986 1991 1996 2001 120 110 100 90 80 70 60 50 40 30 20 10 0

Change in surveillance case definition

Vol. 50 / No. 53 MMWR 77 SYPHILIS, PRIMARY AND SECONDARY. Reported cases per 100,000 population United States, 2001 In 2001, the overall U.S. rate of primary and secondary syphilis was 2.2 cases/100,000 population, which is above the Healthy People 2010 objective of 0.2 cases/

100,000 population per year. Ten states reported rates at or below the national objective, and 11 states reported fewer than six cases.

<0.2 0.3-4

>4 NYC DC

78 MMWR May 2, 2003 SYPHILIS, PRIMARY AND SECONDARY. Reported cases per 100,000 population, by sex United States, 1986-2001 The reported rate of primary and secondary syphilis increased slightly in the United States from 2.1 cases/100,000 population in 2000 to 2.2/100,000 in 2001.

Among women, rates continued to decline, from 1.7 cases/100,000 women in 2000 to 1.4 cases/100,000 women in 2001, the lowest rate for women since reporting began in 1941. Among men, rates increased from 2.6 cases/100,000 men in 2000 to 3.0/100,000 men in 2001, the first increase since 1990.

Reported Cases/100,000 Population Year 25 20 15 10 5

0 1986 1991 1996 2001 Men Women

Vol. 50 / No. 53 MMWR 79 SYPHILIS, PRIMARY AND SECONDARY. Reported cases per 100,000 population, by race and ethnicity United States, 1986-2001 Rates of primary and secondary syphilis continued to decline among non-Hispanic blacks, from 12.2 cases/100,000 in 2000 to 11.0/100,000 in 2001, while rates among all other race/ethnic groups increased (non-Hispanic whites from 0.5/100,000 to 0.7/100,000, Hispanics from 1.6/100,000 to 2.1/100,000, American Indians/

Alaska Natives from 2.4/100,000 to 4.2/100,000, and Asian/Pacific Islanders from 0.3/100,000 to 0.5/100,000). Although the rate for non-Hispanic blacks declined, the rate in 2001 was 16 times the rate for non-Hispanic whites.

Year Reported Cases/100,000 Population 1986 1991 1996 2001 160 140 120 100 80 60 40 20 0

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

80 MMWR May 2, 2003 TETANUS. Reported cases, by year United States, 1971-2001 In 2001, 37 tetanus cases were reported: four (11%) among persons aged <25 years, 19 (51%) among those aged 25-59 years, and 14 (38%) among those >60 years.

In 1997-2001, fewer than 10% of reported cases and no reported deaths occurred among persons known to have received at least 3 doses of tetanus toxoid and whose most recent dose was <10 years before disease onset.

Year Reported Cases 200 180 160 140 120 100 80 60 40 20 0

1971 1976 1981 1986 1991 1996 2001

Vol. 50 / No. 53 MMWR 81 TOXIC-SHOCK SYNDROME (TSS). Reported cases, by quarter United States, 1986-2001

• Includes cases meeting the CDC definition for confirmed and probable cases of staphylococcal TSS.

In 2001, a total of 20 cases of staphylococcal toxic shock syndrome (TSS) were reported to NCID. Of those cases, five (25%) were menstrual TSS.

Reported Cases Year (Quarter) 160 140 120 100 80 60 40 20 0

1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 National Center for Infectious Diseases (NCID) data*

National Notifiable Diseases Surveillance System (NNDSS) data

82 MMWR May 2, 2003 TRICHINOSIS. Reported cases, by year United States, 1971-2001 In 2001, 22 cases of trichinosis were reported from seven states (Alaska, California, Illinois, Iowa, New Jersey, Wisconsin, and Wyoming). The year 2001 was the sixth consecutive year in which <25 cases were reported.

Year Reported Cases 300 270 240 210 180 150 120 90 60 30 0

1971 1976 1981 1986 1991 1996 2001

Vol. 50 / No. 53 MMWR 83 TUBERCULOSIS. Reported cases per 100,000 population United States and U.S. territories, 2001 In 2001, a total of 21 states and Puerto Rico had tuberculosis rates <3.5 cases/100,000, which is the interim (i.e., year 2000) incidence target for the elimination of tuberculosis by the year 2010.

0-3.5 3.6-6.0 6.1-9.9

>10 NA DC NYC AS CNMI GU PR VI

84 MMWR May 2, 2003 TUBERCULOSIS. Reported cases per 100,000 population, by year United States, 1981-2001 In 2001, a total of 15,989 cases of tuberculosis were reported to CDC, representing a 2.4% decrease from 2000.

Year Reported Cases/100,000 Population 1981 1986 1991 1996 2001 14 13 12 11 10 9

8 7

6 5

4 3

2 1

0

Vol. 50 / No. 53 MMWR 85 TUBERCULOSIS. Reported cases among U.S.-born and foreign-born persons,* by year United States, 1989-2001

• In 2001, place of birth was unknown for 279 case-patients.

The number of tuberculosis cases among foreign-born persons in the United States increased from 5,411 (23% of the total number) in 1989 to 7,865 (50% of the total) in 2001.

Reported Cases (Thousands)

Year 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 20 16 12 8

4 0

U.S.-born Foreign-born

86 MMWR May 2, 2003 TULAREMIA. Reported cases United States and U.S. territories, 2001 DC NYC AS CNMI GU PR VI No Reported Cases Reported Cases NN NA 5

1 1

1 1

4 2

7 2

1 7

7 5

7 1

NN NN 2

1 4

6 27 14 9

1 1

1 1

1 1

6 1

NN 1

Vol. 50 / No. 53 MMWR 87 TYPHOID FEVER. Reported cases, by year United States, 1971-2001 The majority of reported cases of typhoid fever are acquired by unvaccinated travelers to countries where the disease is endemic.

Year Reported Cases 800 700 600 500 400 300 200 100 0

1971 1976 1981 1986 1991 1996 2001

88 MMWR May 2, 2003 VARICELLA (Chickenpox). Reported cases from selected U.S. states* (n=4), 1992-2001

• Michigan, Rhode Island, Texas, and West Virginia maintained adequate reporting by reporting cases constituting >5% of their birth cohort during 1990-1995 (National Immunization Program).

The number of varicella cases in four states (Michigan, Rhode Island, Texas, and West Virginia) that reported in 2001 is the lowest ever reported, constituting a 22%

decline compared with cases reported in 2000 and a 76% decline compared with cases reported in the prevaccine years of 1993-1995.

Year Report Cases (Thousands) 80 60 40 20 0

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Vaccine licensed

Vol. 50/ No. 53 MMWR 89 PART 3 Historical Summaries of Notifiable Diseases in the United States, 1970-2001 SYMBOLS USED IN TABLES No reported cases...................................

Data not available.................................. NA Rates <0.01 after rounding are listed as 0.00.

Note: Data in the MMWR Summary of Notifiable Diseases, United States, 2001 might not match data in other CDC surveillance reports because of differences in the timing of reports, the source of the data, and case definitions.

90 MMWR May 2, 2003 TABLE 7. Reported incidence rates of notifiable diseases per 100,000 population United States, 1991-2001 Disease 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 AIDS*

17.32 17.83 40.20 30.07 27.20 25.21 21.85 17.21 16.66 14.95 14.88 Amebiasis 1.23 1.21 1.21 1.20

Anthrax

0.00

0.00 0.01 Aseptic meningitis 6.26 5.18 5.39 3.71

Botulism, total (including wound and unsp.)

0.05 0.04 0.04 0.06 0.04 0.05 0.05 0.04 0.06 0.05 0.06 Foodborne 0.01 0.00 0.01 0.02 0.01 0.01 0.02 0.01 0.01 0.01 0.01 Brucellosis 0.04 0.04 0.05 0.05 0.04 0.05 0.04 0.03 0.03 0.03 0.05 Chancroid 1.40 0.80 0.54 0.30 0.20 0.15 0.09 0.07 0.06 0.03 0.01 Chlamydia§

¶

¶

¶

¶ 182.60 188.10 196.80 236.57 254.10 257.76 278.32 Cholera 0.01 0.04 0.00 0.02 0.01 0.01 0.01 0.01 0.00 0.00 0.00 Coccidioidomycosis

¶

¶

¶

¶ NA NA NA NA NA NA 6.71 Cryptosporidiosis

¶

¶

¶

¶

¶

¶ 1.12 1.61 0.92 1.17 1.34 Cyclosporiasis

¶

¶

¶

¶

¶

¶

¶

¶

¶ 0.03 0.07 Diphtheria 0.00 0.00 0.00 0.00 0.00 0.01 0.01 0.00 0.00 0.00 0.00 Ehrlichiosis, human granulocytic

¶

¶

¶

¶

¶

¶

¶

¶

¶ 0.15 0.10 Human monocytic

¶

¶

¶

¶

¶

¶

¶

¶

¶ 0.09 0.05 Encephalitis, primary 0.40 0.30 0.36 0.28

Postinfectious 0.03 0.05 0.07 0.06

Encephalitis, California serogroup viral

¶

¶

¶

¶

¶

¶

¶ 0.04 0.03 0.04 0.05 Encephalitis, eastern equine

¶

¶

¶

¶

¶

¶

¶ 0.00 0.00 0.00 0.00 Encephalitis, St. Louis

¶

¶

¶

¶

¶

¶

¶ 0.01 0.00 0.00 0.03 Encephalitis, western equine

¶

¶

¶

¶

¶

¶

¶ 0.00 0.00 0.00 0.00 Escherichia coli, enterohemorrhagic (EHEC)

O157:H7

¶

¶

¶

¶ 1.01 1.18 1.04 1.28 1.77 1.74 1.22 EHEC, serogroup non-O157

¶

¶

¶

¶

¶

¶

¶

¶

¶

¶ 0.19 EHEC, not serogrouped

¶

¶

¶

¶

¶

¶

¶

¶

¶

¶ 0.06 Gonorrhea 249.48 201.60 172.40 168.40 149.50 122.80 121.40 132.88 133.20 131.65 128.53 Granuloma inguinale 0.01 0.00 0.00 0.00

Haemophilus influenzae, invasive 1.10 0.55 0.55 0.45 0.45 0.45 0.44 0.44 0.48 0.51 0.57 Hansen disease (leprosy) 0.06 0.07 0.07 0.05 0.06 0.05 0.05 0.05 0.04 0.04 0.03 Hantavirus pulmonary syndrome

¶

¶

¶

¶ NA NA NA NA NA 0.02 0.00 Hemolytic uremic syndrome, postdiarrheal

¶

¶

¶

¶ NA NA NA NA NA 0.10 0.08 Hepatitis A, acute 9.67 9.06 9.40 10.29 12.13 11.70 11.22 8.59 6.25 4.91 3.77 Hepatitis B, acute 7.14 6.32 5.18 4.81 4.19 4.01 3.90 3.80 2.82 2.95 2.79 Hepatitis, C/non-A, non-B**

1.42 2.36 1.86 1.78 1.78 1.41 1.43 1.30 1.14 1.17 1.41 Hepatitis, unspecified 0.50 0.35 0.24 0.17

Legionellosis 0.53 0.53 0.50 0.63 0.48 0.47 0.44 0.51 0.41 0.42 0.42 Leptospirosis 0.02 0.02 0.02 0.02

Listeriosis

¶

¶

¶

¶

¶

¶

¶

¶

¶ 0.29 0.22 Lyme disease 3.80 3..93 3.20 5.01 4.49 6.21 4.79 6.39 5.99 6.53 6.05 Lymphogranuloma venereum 0.19 0.10 0.10 0.10

Malaria 0.51 0.43 0.55 0.47 0.55 0.68 0.75 0.60 0.61 0.57 0.55 Measles 3.82 0.88 0.12 0.37 0.12 0.20 0.06 0.04 0.04 0.03 0.04 Meningococcal disease 0.84 0.84 1.02 1.11 1.25 1.30 1.24 1.01 0.92 0.83 0.83 Mumps 1.72 1.03 0.66 0.60 0.35 0.29 0.27 0.25 0.14 0.13 0.10 Murine typhus fever 0.02 0.02 0.01 0.01

Vol. 50/ No. 53 MMWR 91 TABLE 7. (Continued) Reported incidence rates of notifiable diseases per 100,000 population United States, 1991-2001 Disease 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Pertussis 1.08 1.60 2.55 1.77 1.97 2.94 2.46 2.74 2.67 2.88 2.69 Plague 0.00 0.01 0.00 0.01 0.00 0.01 0.01 0.00 0.00 0.00 0.00 Poliomyelitis, paralytic 0.00 0.00 0.00 0.00 0.00 0.03 0.02 0.01 0.00 0.00 0.00 Psittacosis 0.04 0.04 0.02 0.02 0.03 0.02 0.02 0.02 0.01 0.01 0.01 Q fever

¶

¶

¶

¶

¶

¶

¶

¶

¶ 0.01 0.01 Rabies, human 0.00 0.00 0.00 0.00 0.00 0.01 0.01 0.00 0.00 0.00 0.00 Rheumatic fever, acute 0.12 0.06 0.08 0.09

Rocky Mountain spotted fever 0.25 0.20 0.18 0.18 0.23 0.32 0.16 0.14 0.21 0.18 0.25 Rubella 0.56 0.06 0.07 0.09 0.05 0.10 0.07 0.13 0.10 0.06 0.01 Rubella, congenital syndrome 0.02 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Salmonellosis, excluding typhoid fever 19.10 16.04 16.15 16.64 17.66 17.15 15.66 16.17 14.89 14.51 14.39 Shigellosis 9.34 9.38 12.48 11.44 12.32 9.80 8.64 8.74 6.43 8.41 7.19 Streptococcal disease, invasive, group A

¶

¶

¶

¶

¶

¶

¶

¶

¶ 1.45 1.60 Streptococcal, toxic-shock syndrome

¶

¶

¶

¶

¶

¶

¶

¶

¶ 0.04 0.04 Streptococcus, pneumoniae, invasive, drug-resistant

¶

¶

¶

¶

¶

¶

¶

¶

¶ 2.77 2.11 Streptococcus, pneumoniae, invasive, <5 yrs

¶

¶

¶

¶

¶

¶

¶

¶

¶

¶ 1.03 Syphilis, primary and secondary 17.26 13.70 10.40 8.10 6.30 4.29 3.19 2.61 2.50 2.19 2.17 Total, all stages 51.69 45.30 39.70 32.00 26.20 19.97 17.39 14.19 13.07 11.58 11.45 Tetanus 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.01 0.01 0.01 Toxic-shock syndrome 0.11 0.10 0.08 0.10 0.07 0.06 0.06 0.06 0.05 0.06 0.05 Trichinosis 0.02 0.02 0.01 0.01 0.01 0.01 0.01 0.01 0.00 0.01 0.01 Tuberculosis 10.42 10.46 9.82 9.36 8.70 8.04 7.42 6.79 6.43 6.01 5.68 Tularemia 0.08 0.06 0.05 0.04

0.06 0.05 Typhoid fever 0.20 0.16 0.17 0.17 0.14 0.15 0.14 0.14 0.13 0.14 0.13 Varicella (chickenpox)¶ 135.82 176.54 118.54 135.76 118.11 44.13 93.55 70.28 44.56 26.18 19.51 Yellow fever

0.00

0.00

• Acquired Immunodeficiency syndrome.

No longer nationally notifiable.

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

¶ Not nationally notifiable.

• • Anti-HCV antibody test became available May 1990.

Note: Rates <0.01 after rounding are listed as 0.00. Data in the MMWR Summary of Notifiable Diseases, United States might not match data in other CDC surveillance reports because of differences in the timing of reports, the source of the data, and case definitions.

92 MMWR May 2, 2003 TABLE 8. Reported cases of notifiable diseases United States, 1994-2001 Disease 1994 1995 1996 1997 1998 1999 2000 2001 AIDS 78,279 71,547 66,885 58,492 46,521 45,104 40,758 41,868*

Amebiasis 2,983

Anthrax

1 23 Aseptic meningitis 8,932

Botulism, total (including wound and unsp.)

143 97 119 132 116 154 138 155 Foodborne 50 24 25 31 22 23 23 39 Infant 85 54 80 79 65 92 93 97 Brucellosis 119 98 112 98 79 82 87 136 Chancroid 773 606 386 243 189 143 78 38§ Chlamydia¶ 477,638 498,884 526,671 604,420 656,721 702,093 783,242§ Cholera 39 23 4

6 17 6

5 3

Coccidioidomycosis 1,212 1,696 1,749 2,275 2,827 2,867 3,922 Cryptosporidiosis 2,970 2,827 2,566 3,793 2,361 3,128 3,785 Cyclosporiasis NA NA 94 58 63 60 147 Diphtheria 2

2 4

1 1

1 2

Ehrlichiosis, human granulocytic 216 351 261 human monocytic 116 200 142 Encephalitis, primary 717

Postinfectious 143

Encephalitis, California serogroup viral 11 123 129 97 70 114 128 Eastern equine 1

5 14 4

5 3

9 St. Louis 3

2 13 24 4

2 79 Western equine

1

Escherichia coli, enterohemorrhagic (EHEC) O157:H7 1,420 2,139 2,741 2,555 3,161 4,513 4,528 3,287 EHEC, serogroup non-O157 171 EHEC, not serogrouped 20 Gonorrhea 418,068 392,848 325,883 324,907 355,642 360,076 358,995 361,705§ Granuloma inguinale 3

Haemophilus influenzae, invasive 1,174 1,180 1,170 1,162 1,194 1,309 1,398 1,597 Hansen disease (leprosy) 136 144 112 122 108 108 91 79 Hantavirus pulmonary syndrome NA NA NA NA 31 41 8

Hemolytic uremic syndrome, postdiarrheal 72 97 91 119 180 249 202 Hepatitis A, acute 26,796 31,582 31,032 30,021 23,229 17,047 13,397 10,609 Hepatitis B, acute 12,517 10,805 10,637 10,416 10,258 7,694 8,036 7,843 Hepatitis, C/non-A, non-B 4,470 4,576 3,716 3,816 3,518 3,111 3,197 3,976 Hepatitis, unspecified 444

Legionellosis 1,615 1,241 1,198 1,163 1,355 1,108 1,127 1,168 Leptospirosis 38

Listeriosis 755 613 Lyme disease 13,043 11,700 16,455 12,801 16,801 16,273 17,730 17,029 Lymphogranuloma venereum 235

Vol. 50/ No. 53 MMWR 93 TABLE 8. (Continued) Reported cases of notifiable diseases United States, 1994-2001 Disease 1994 1995 1996 1997 1998 1999 2000 2001 Malaria 1,229 1,419 1,800 2,001 1,611 1,666 1,560 1,544 Measles 963 309 508 138 100 100 86 116 Meningococcal disease 2,886 3,243 3,437 3,308 2,725 2,501 2,256 2,333 Mumps 1,537 906 751 683 666 387 338 266 Pertussis 4,617 5,137 7,796 6,564 7,405 7,288 7,867 7,580 Plague 17 9

5 4

9 9

6 2

Poliomyelitis, paralytic§§ 8

7 7

6 3

2

Psittacosis 38 64 42 33 47 16 17 25 Q fever 21 26 Rabies, animal 8,147 7,811 6,982 8,105 7,259 6,730 6,934 7,150 Rabies, human 6

5 3

2 1

4 1

Rheumatic fever, acute 112

Rocky Mountain spotted fever 465 590 831 409 365 579 495 695 Rubella 227 128 238 181 364 267 176 23 Rubella, congenital syndrome 7

6 4

5 7

9 9

3 Salmonellosis, excluding typhoid fever 43,323 45,970 45,471 41,901 43,694 40,596 39,574 40,495 Shigellosis 29,769 32,080 25,978 23,117 23,626 17,521 22,922 20,221 Streptococcal disease, invasive, group A 613 1,445 1,973 2,260 2,667 3,144 3,750 Streptococcus pneumoniae, invasive, drug-resistant 309 1,514 1,799 2,823 4,625 4,533 2,896 Streptococcus pneumoniae, invasive, <5 years 498 Streptococcal toxic-shock syndrome 10 19 33 58 65 83 77 Syphilis, primary and secondary 20,627 16,500 11,387 8,550 6,993 6,657 5,979 6,103§ Total, all stages 81,696 68,953 52,976 46,540 37,977 35,628 31,575 32,221§ Tetanus 51 41 36 50 41 40 35 37 Toxic-shock syndrome 192 191 145 157 138 113 135 127 Trichinosis 32 29 11 13 19 12 16 22 Tuberculosis 24,361 22,860 21,337 19,851 18,361 17,531 16,377 15,989¶¶ Tularemia 96

142 129 Typhoid fever 441 369 396 365 375 346 377 368 Varicella (chickenpox)***

151,219 120,624 83,511 98,727 82,455 46,016 27,382 22,536 Yellow fever

1

1

• Total number of acquired immunodeficiency syndrome (AIDS) cases includes all cases reported to the Division of HIV/AIDS PreventionSurveillance, and Epidemiology, National Center for HIV, STD, and TB Prevention (NCHSTP) through December 31, 2001.

No longer nationally notifiable.

§ Cases were updated through the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of May 3, 2002.

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

• • Not previously nationally notifiable.

Anti-HCV antibody test available May 1990.

§ § Numbers might not reflect changes based on retrospective case evaluations or late reports (See MMWR 1986;35:180-2).

¶ ¶ Cases were updated through the Division of Tuberculosis Elimination, NCHSTP, as of March 29, 2002.

• • • Varicella was taken off the nationally notifiable disease list in 1991. Many states continue to report these cases to CDC.

The last indigenous case of yellow fever was reported in 1911; the last imported case was reported in 1999.

Note: Rates <0.01 after rounding are listed as 0.00. Data in the MMWR Summary of Notifiable Diseases, United States might not match data in other CDC surveillance reports because of differences in the timing of reports, the source of the data, and case definitions.

94 MMWR May 2, 2003 TABLE 9. Reported cases of notifiable diseases* United States, 1986-1993 Disease 1986 1987 1988 1989 1990 1991 1992 1993 AIDS 12,932 21,070 31,001 33,722 41,595 43,672 45,472 103,691 Amebiasis 3,532 3,123 2,860 3,217 3,328 2,989 2,942 2,970 Anthrax

1 2

1

Aseptic meningitis 11,374 11,487 7,234 10,274 11,852 14,526 12,223 12,848 Botulism, total (including wound and unsp.)

109 82 84 89 92 114 91 97 Foodborne 23 17 28 23 23 27 21 27 Infant 79 59 50 60 65 81 66 65 Brucellosis 106 129 96 95 82 104 105 120 Chancroid 3,756 4,998 5,001 4,692 4,212 3,476 1,886 1,399 Cholera 23 6

8

6 26 103 18 Diphtheria

3 2

3 4

5 4

Encephalitis, primary§ 1,302 1,418 882 981 1,341 1,021 774 919 Postinfectious 124 121 121 88 105 82 129 170 Gonorrhea 900,868 780,905 719,536 733,151 690,169 620,478 501,409 439,673 Granuloma inguinale 61 22 11 7

97 29 6

19 Haemophilus influenzae, invasive disease

¶

¶

¶

¶

¶

¶ 1,412 1,419 Hansen disease (leprosy) 270 238 184 163 198 154 172 187 Hepatitis A, acute 23,430 25,280 28,507 35,821 31,441 24,378 23,112 24,238 Hepatitis B, acute 26,107 25,916 23,177 23,419 21,102 18,003 16,126 13,361 Hepatitis, C/non-A, non-B 3,634 2,999 2,619 2,529 2,553 3,582 6,010 4,786 Hepatitis, unspecified 3,940 3,102 2,470 2,306 1,671 1,260 884 627 Legionellosis 980 1,038 1,085 1,190 1,370 1,317 1,339 1,280 Leptospirosis 41 43 54 93 77 58 54 51 Lyme disease

¶

¶

¶

¶

¶

¶ 9,895 8,257 Lymphogranuloma venereum 396 303 185 189 277 471 302 285 Malaria 1,123 944 1,099 1,277 1,292 1,278 1,087 1,411 Measles 6,282 3,655 3,396 18,193 27,786 9,643 2,237 312 Meningococcal disease 2,594 2,930 2,964 2,727 2,451 2,130 2,134 2,637 Mumps 7,790 12,848 4,866 5,712 5,292 4,264 2,572 1,692 Murine typhus fever 67 49 54 41 50 43 28 25 Pertussis 4,195 2,823 3,450 4,157 4,570 2,719 4,083 6,586

Vol. 50/ No. 53 MMWR 95 TABLE 9. (Continued) Reported cases of notifiable diseases United States, 1986-1993 Disease 1986 1987 1988 1989 1990 1991 1992 1993 Plague 10 12 15 4

2 11 13 10 Poliomyelitis, paralytic 10 9

9 11 6

10 6

4 Psittacosis 224 98 114 116 113 94 92 60 Rabies, animal 5,504 4,658 4,651 4,724 4,826 6,910 8,589 9,377 Rabies, human

1

1 1

3 1

3 Rheumatic fever, acute 147 141 158 144 108 127 75 112 Rocky Mountain spotted fever 760 604 609 623 651 628 502 456 Rubella 551 306 225 396 1,125 1,401 160 192 Rubella, congenital syndrome 14 5

6 3

11 47 11 5

Salmonellosis, excluding typhoid fever 49,984 50,916 48,948 47,812 48,603 48,154 40,912 41,641 Shigellosis 17,138 23,860 30,617 25,010 27,077 23,548 23,931 32,198 Syphilis, primary and secondary 27,883 35,147 40,117 44,540 50,223 42,935 33,973 26,498 Total, all stages 68,215 86,545 103,437 110,797 134,255 128,569 112,581 101,259 Tetanus 64 48 53 53 64 57 45 48 Toxic-shock syndrome 412 372 390 400 322 280 244 212 Trichinosis 39 40 45 30 129 62 41 16 Tuberculosis 22,768 22,517 22,436 23,495 25,701 26,283 26,673 25,313 Tularemia 170 214 201 152 152 193 159 132 Typhoid fever 362 400 436 460 552 501 414 440 Varicella (chickenpox) 183,243 213,196 192,857 185,441 173,099 147,076 158,364 134,722

• No cases of yellow fever were reported during 1986-1993.

Acquired immunodeficiency syndrome.

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

¶ Not previously notifiable nationally.

Note: Rates <0.01 after rounding are listed as 0.00. Data in the MMWR Summary of Notifiable Diseases, United States might not match data in other CDC surveillance reports because of differences in the timing of reports, the source of the data, and case definitions.

96 MMWR May 2, 2003 TABLE 10. Reported cases of notifiable diseases* United States, 1978-1985 Disease 1978 1979 1980 1981 1982 1983 1984 1985 AIDS

§

§

§

§

§

§ 4,445 8,249 Amebiasis 3,937 4,107 5,271 6,632 7,304 6,658 5,252 4,433 Anthrax 6

1

1

Aseptic meningitis 6,573 8,754 8,028 9,547 9,680 12,696 8,326 10,619 Botulism, total (including wound and unsp.)

105 45 89 103 97 133 123 122 Foodborne

§

§

§

§

§

§

§ 49 Infant

§

§

§

§

§

§

§ 70 Brucellosis 179 215 183 185 173 200 131 153 Chancroid 521 840 788 850 1,392 847 666 2,067 Cholera 12 1

9 19

1 1

4 Diphtheria¶ 76 59 3

5 2

5 1

3 Encephalitis, primary 1,351 1,504 1,362 1,492 1,464 1,761 1,257 1,376 Postinfectious**

78 84 40 43 36 34 108 161 Gonorrhea 1,013,436 1,004,058 1,004,029 990,864 960,633 900,435 878,556 911,419 Granuloma inguinale 72 76 51 66 17 24 30 44 Hansen disease (leprosy) 168 185 223 256 250 259 290 361 Hepatitis A, acute 29,500 30,407 29,087 25,802 23,403 21,532 22,040 23,210 Hepatitis B, acute 15,016 15,452 19,015 21,152 22,177 24,318 26,115 26,611 Hepatitis C; non-A, non-B

§

§

§

§

§

§ 3,871 4,184 Hepatitis, unspecified 8,776 10,534 11,894 10,975 8,564 7,149 5,531 5,517 Legionellosis 761 593 475 408 654 852 750 830 Leptospirosis 110 94 85 82 100 61 40 57 Lymphogranuloma venereum 284 250 199 263 235 335 170 226 Malaria 731 894 2,062 1,388 1,056 813 1,007 1,049 Measles 26,871 13,597 13,506 3,124 1,714 1,497 2,587 2,822 Meningococcal disease 2,505 2,724 2,840 3,525 3,056 2,736 2,746 2,479 Mumps 16,817 14,225 8,576 4,941 5,270 3,355 3,021 2,982 Murine typhus fever 46 69 81 61 58 62 53 37 Pertussis 2,063 1,623 1,730 1,248 1,895 2,463 2,276 3,589 Plague 12 13 18 13 19 40 31 17 Poliomyelitis, total 8

22 9

10 12 13 9

8 Paralytic 8

22 9

10 12 13 9

8 Psittacosis 140 137 124 136 152 142 172 119 Rabies, animal 3,254 5,119 6,421 7,118 6,212 5,878 5,567 5,565 Rabies, human 4

4

2

2 3

1 Rheumatic fever, acute 851 629 432 264 137 88 117 90 Rocky Mountain spotted fever 1,063 1,070 1,163 1,192 976 1,126 838 714 Rubella 18,269 11,795 3,904 2,077 2,325 970 752 630 Rubella, congenital syndrome 30 62 50 19 7

22 5

Salmonellosis, excluding typhoid fever 29,410 33,138 33,715 39,990 40,936 44,250 40,861 65,347 Shigellosis 19,511 20,135 19,041 19,859 18,129 19,719 17,371 17,057 Syphilis, primary and secondary 21,656 24,874 27,204 31,266 33,613 32,698 28,607 27,131 Total, all stages 64,875 67,049 68,832 72,799 75,579 74,637 69,888 67,563 Tetanus 86 81 95 72 88 91 74 83 Toxic-shock syndrome

§

§

§

§

§

§ 482 384 Trichinosis 67 157 131 206 115 45 68 61 Tuberculosis 28,521 27,669 27,749 27,373 25,520 23,846 22,255 22,201 Tularemia 141 196 234 288 275 310 291 177 Typhoid fever 505 528 510 584 425 507 390 402 Varicella (chickenpox) 154,089 199,081 190,894 200,766 167,423 177,462 221,983 178,162

• No cases of yellow fever were reported during 1978-1985.

Acquired immunodeficiency syndrome.

§ Not previously notifiable nationally.

¶ Cutaneous diphtheria was no longer 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.

No cases of paralytic poliomyelitis caused by wild virus have been reported in the United States since 1979.

Note: Rates <0.01 after rounding are listed as 0.00. Data in the MMWR Summary of Notifiable Diseases, United States might not match data in other CDC surveillance reports because of differences in the timing of reports, the source of the data, and case definitions.

Vol. 50/ No. 53 MMWR 97 TABLE 11. Reported cases of notifiable diseases* United States, 1970-1977 Disease 1970 1971 1972 1973 1974 1975 1976 1977 Amebiasis 2,888 2,752 2,199 2,235 2,743 2,775 2,906 3,044 Anthrax 2

5 2

2 2

2 2

Aseptic meningitis 6,480 5,176 4,634 4,846 3,197 4,475 3,510 4,789 Botulism, total (includes wound and unspecified) 12 25 22 34 28 20 55 129 Brucellosis 213 183 196 202 240 310 296 232 Chancroid 1,416 1,320 1,414 1,165 945 700 628 455 Cholera

1

3 Diphtheria 435 215 152 228 272 307 128 84 Encephalitis, primary 1,580 1,524 1,059 1,613 1,164 4,064 1,651 1,414 Postinfectious 370 439 243 354 218 237 175 119 Gonorrhea 600,072 670,268 767,215 842,621 906,121 999,937 1,001,994 1,002,219 Granuloma inguinale 124 89 81 62 47 60 71 75 Hansen disease (leprosy) 129 131 130 146 118 162 145 151 Hepatitis A (infectious) 56,797 59,606 54,074 50,749 40,358 35,855 33,288 31,153 Hepatitis B (serum) 8,310 9,556 9,402 8,451 10,631 13,121 14,973 16,831 Hepatitis, unspecified

7,488 8,639 Legionellosis

235 359 Leptospirosis 47 62 41 57 8,351 93 73 71 Lymphogranuloma venereum 612 692 756 408 394 353 365 348 Malaria 3,051 2,375 742 237 293 373 471 547 Measles 47,351 75,290 32,275 26,690 22,094 24,374 41,126 57,345 Meningococcal disease 2,505 2,262 1,323 1,378 1,346 1,478 1,605 1,828 Mumps 104,953 124,939 74,215 69,612 59,128 59,647 38,492 21,436 Murine typhus fever 27 23 18 32 26 41 69 75 Pertussis 4,249 3,036 3,287 1,759 2,402 1,738 1,010 2,177 Plague 13 2

1 2

8 20 16 18 Poliomyelitis, total 33 21 31 8

7 13 10 19 Paralytic 31 17 29 7

7 13 10 19 Psittacosis 35 32 52 33 164 49 78 94 Rabies, animal 3,224 4,310 4,369 3,640 3,151 2,627 3,073 3,130 Rabies, human 3

2 2

1

2 2

1 Rheumatic fever, acute 3,227 2,793 2,614 2,560 2,431 2,854 1,865 1,738 Rocky Mountain spotted fever 380 432 523 668 754 844 937 1,153 Rubella 56,552 45,086 25,507 27,804 11,917 16,652 12,491 20,395 Rubella, congenital syndrome 77 68 42 35 45 30 30 23 Salmonellosis, excluding typhoid fever 22,096 21,928 22,151 23,818 21,980 22,612 22,937 27,850 Shigellosis 13,845 16,143 20,207 22,642 22,600 16,584 13,140 16,052 Streptococcal sore throat and scarlet fever 433,405

§

§

§

§

§

§

§ Syphilis, primary and secondary 21,982 23,783 24,429 24,825 25,385 25,561 23,731 20,399 Total, all stages 91,382 95,997 91,149 87,469 83,771 80,356 71,761 64,621 Tetanus 148 116 128 101 101 102 75 87 Trichinosis 109 103 89 102 120 252 115 143 Tuberculosis¶ 37,137 35,217 32,882 30,998 30,122 33,989 32,105 30,145 Tularemia 172 187 152 171 144 129 157 165 Typhoid fever 346 407 398 680 437 375 419 398 Varicella (chickenpox)

164,114 182,927 141,495 154,248 183,990 188,396

• No cases of yellow fever were reported during 1970-1977.

Not previously nationally notifiable.

§ No longer nationally notifiable.

¶ Case data after 1974 are not comparable with earlier years because of changes in reporting criteria that became effective in 1975.

Note: Rates <0.01 after rounding are listed as 0.00. Data in the MMWR Summary of Notifiable Diseases, United States might not match data in other CDC surveillance reports because of differences in the timing of reports, the source of the data, and case definitions.

98 MMWR May 2, 2003 TABLE 12. Deaths from selected notifiable diseases United States, 1996-1999 1996 1997 1998 1999 Estimated No. of deaths No. of deaths No. of deaths Number Cause of death codes comparability allocated according to allocated according to allocated according to of deaths Cause of death ICD-10*

ICD-9 ratio§ ICD-10¶ ICD-9**

ICD-10 ICD-9 ICD-10 ICD-9 ICD-10 AIDS B20-B24 042-044 1.0824 33,695 31,130 17,877 16,516 14,532 13,426 14,802 Anthrax A22 022

§ §

§ §

§ §

§ §

Botulism A05.1 005.1

§ §

§ § 1

§ § 2

§ §

9 Brucellosis A23 023

§ §

§ §

§ § 1

§ § 1

Chancroid A57 099.0

§ §

§ §

§ §

§ §

Chlamydia trachomatis A56 099.8

§ §

§ §

§ §

§ §

Cholera A00 001

§ §

§ § 2

§ §

§ § 1

Cryptosporidiosis A07.2 136.8

§ §

§ § 7

§ § 4

§ § 5

Cyclosporiasis A07.8 136.8

§ §

§ §

§ §

§ §

Diphtheria A36 032

§ §

§ §

§ §

§ § 1

1 Ehrlichiosis, human granulocytic A79.8 083.8

§ §

§ §

§ §

§ §

1 Ehrlichiosis, human monocytic A79.8 083.8

§ §

§ §

§ §

§ §

Encephalitis, California serogroup viral A83.5 062.5

§ §

§ § 1

§ § 1

§ §

1 Eastern equine A83.2 062.2

§ §

§ § 1

§ § 2

§ § 1

St. Louis A83.3 062.3

§ §

§ §

§ § 1

§ §

2 Western equine A83.1 062.1

§ §

§ §

§ §

§ § 1

Escherichia coli A04.0-A04.4 005.8

§ §

§ §

§ §

§ §

7 Gonorrhea A54 098

§ §

§ § 4

§ § 3

§ § 4

9 Haemophilus influenzae A49.2 041.5

§ §

§ § 7

§ § 7

§ § 11 6

Hansen disease A30 030

§ §

§ §

§ § 2

§ §

2 Hepatitis A B15 070.0, 070.1 0.9328 107 115 115 123 98 105 134 Hepatitis B B16, B18.0, B18.1 070.2, 070.3 0.6879 709 1,031 673 979 680 988 832 Hepatitis C B17.1, B18.2 070.4-070.5 0.7114 1,586 2,230 1,840 2,586 2,289 3,218 3,763 Legionellosis A48.1, A48.2 482.8 0.5273 88 166 110 208 94 178 78 Lyme disease A69.2 104.8

§ §

§ §

§ §

§ §

7 Malaria B50-B54 084

§ §

§ § 4

§ § 7

§ § 6

7 Measles B05 055

§ §

§ § 1

§ § 2

§ §

2 Meningococcal disease A39 036 0.9861 286 290 305 309 231 234 227 Mumps B26 072

§ §

§ § 1

§ §

§ § 1

1 Pertussis A37 033

§ §

§ § 4

§ § 6

§ § 5

7 Plague A20 020

§ §

§ § 2

§ §

§ §

1 Poliomyelitis A80 045

§ §

§ §

§ §

§ §

Psittacosis A70 073

§ §

§ § 1

§ §

§ §

Q fever A78 083.0

§ §

§ § 1

§ §

§ §

Rabies, human A82 071

§ §

§ § 3

§ § 4

§ § 1

Rubella B06 056

§ §

§ §

§ §

§ §

Rubella, congenital syndrome P35.0 771.0

§ §

§ § 4

§ § 4

§ § 48 8

Salmonellosis A02 003 0.8929 52 58 46 51 33 37 38 Shigellosis A03 004

§ §

§ § 5

§ § 5

§ § 5

6 Rocky Mountain spotted fever A77.0 082.0

§ §

§ § 6

§ § 12

§ § 3

5 Syphilis, all stages A50-A53 090-097 0.7887 58 73 49 62 35 45 33 Tetanus A35 037

§ §

§ § 1

§ § 4

§ § 7

7 Trichinosis B75 124

§ §

§ §

§ §

§ §

Tuberculosis A16-A19 010-018 0.8821 1,060 1,202 1,029 1,166 981 1,112 930 Typhoid fever A01.0 002.0

§ §

§ § 1

§ §

§ §

Varicella (chickenpox)¶¶ B01 052 0.7848 64 81 78 99 64 81 48 Yellow fever A95 060

§ §

§ § 1

§ §

§ §

1

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

World Health Organization. International Classification of Diseases, Ninth Revision, 1975.

§ Unpublished estimates; see also Anderson RN, Minino AM, Hoyert DL, et al. Comparability of cause of death between ICD-9 and ICD-10: Preliminary estimates. CDC, National Center for Health Statistics. 2001; DHHS publication no. (PHS) 2001-1120. (National Vital Statistics Report Vol. 49, No. 2).

¶ Number of deaths modified with the comparability ratio for ICD-10 code.

• • Number of deaths based on ICD-9 code; unmodified with the comparability ratio for ICD-10 code.

Acquired immunodeficiency syndrome. In 1987, the National Center for Health Statistics introduced ICD-9 categories 042-044 for classifying and coding human immunodeficiency virus (HIV) infection.

§ § Comparability ratio not calculated because it does not meet standards of reliability or precision.

¶ ¶ Varicella was removed from the nationally notifiable disease list in 1991. Many states continue to report these cases to CDC.

Source: National Center for Health Statistics. National Vital Statistics System, 1996-1999. Deaths are classified according to the ICD-9 (1996-1998) and ICD-10 (1999). Data for 2000 and 2001 currently are not available.

Please note: An erratum has been published for this issue. To view the erratum, please click here.

Vol. 50 / No. 53 MMWR 99 Selected Reading General Bayer R, Fairchild AL. Public health: surveillance and privacy. Science 2000;290:1898-9.

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CDC. Reporting race and ethnicity dataNational Electronic Telecommunications System for Surveillance, 1994-1997. MMWR 1999;48:305-12.

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CDC. Use of race and ethnicity in public health surveillance: summary of the CDC/ATSDR work-shop. MMWR 1993;42(No. RR-10).

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100 MMWR May 2, 2003 Pinner RW, Koo D, Berkelman RL. Surveillance of infectious diseases. In: Lederberg J, Alexander M, Bloom RB, eds. Encyclopedia of microbiology. 2nd ed. San Diego, CA: Academic Press, 2000;4:506-25.

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AIDS CDC. HIV/AIDS Surveillance Report, 2002.Vol. 13, No. 2. Atlanta: Centers for Disease Control and Prevention. Available at http://www.cdc.gov/hiv/stats/hasrlink.htm.

CDC. Diagnosis and reporting of HIV and AIDS in states with integrated HIV and AIDS surveil-lanceUnited States, January 1994-June 1997. MMWR 1998;47:309-14.

Janssen RS, Satten GA, Stramer SL, et al. New testing strategy to detect early HIV-1 infection for use incidence estimates and for clinical and prevention purposes. JAMA 1998;280:42-48.

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Botulism CDC. Botulism in the United States, 1899-1996: handbook for epidemiologists, clinicians, and laboratory workers. Atlanta, GA: US Department of Health and Human Services, Public Health Service, CDC, 1998. Available at http://www.cdc.gov/ncidod/dbmd/diseaseinfo/botulism.pdf.

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Brucellosis Yagupsky P. Detection of brucellae in blood cultures. J Clin Microbiol 1999;37:3437-42.

CDC. Human exposure to Brucella abortus strain RB51Kansas, 1997. MMWR 1998;47:172-5.

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Taylor JP, Perdue JN. The changing epidemiology of human brucellosis in Texas, 1977-1986. Am J Epidemiol 1989;130:160-5.

Chancroid DiCarlo RP, Armentor BS, Martin DH. Chancroid epidemiology in New Orleans men. J Infect Dis 1995;172:446-52.

Mertz KJ, Weiss JB, Webb RM, et al. An investigation of genital ulcers in Jackson, Mississippi, with use of a multiplex polymerase chain reaction assay: high prevalence of chancroid and human immunodeficiency virus infection. J Infect Dis 1998;178:1060-6.

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Chlamydia trachomatis, Genital infection CDC. Chlamydia trachomatis genital infectionsUnited States, 1995. MMWR 1997;46:193-8.

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Vol. 50 / No. 53 MMWR 101 Gaydos CA, Howell MR, Pare B, et al. Chlamydia trachomatis infections in female military recruits.

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Mertz KJ, McQuillan GM, Levine WC, et al. A pilot study of chlamydial infection in a national household survey. Sex Transm Dis 1998;25:225-8.

Cholera Mahon BE, Mintz ED, Greene KD, Wells JG, Tauxe RV. Reported cholera in the United States, 1992-1994: a reflection of global changes in cholera epidemiology. JAMA 1996;276:307-12.

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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 millennium. J Infect Dis 2001;184:799-802.

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Cyclosporiasis Herwaldt BL. Cyclospora cayetanensis: a review, focusing on the outbreaks of cyclosporiasis in the 1990s. Clin Infect Dis 2000;31:1040-57.

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Lopez AS, Dodson DR, Arrowood MJ, et al. Outbreak of cyclosporiasis associated with basil in Missouri in 1999. Clin Infect Dis 2001;32:1010-7.

Diphtheria Bisgard KM, Hardy IR, Popovic T, et al. Respiratory diphtheria in the United States, 1980 through 1995. Am J Public Health 1998;88:787-91.

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CDC. Arboviral infections of the central nervous systemUnited States, 1996-1997. MMWR 1998;47:517-22.

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Campbell GL, Marfin AM, Lanciotti RS, Gubler DJ. West Nile virus. Lancet Infectious Diseases 2002;2:519-29.

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102 MMWR May 2, 2003 Gonorrhea CDC. Fluoroquinolone-resistance in Neisseria gonorrhoeae, Hawaii, 1999, and decreased suscep-tibility to azithromycin in N. gonorrhoeae, Missouri, 1999. MMWR 2000;49:833-7.

CDC. GonorrheaUnited States, 1998. MMWR 2000;49:538-42.

CDC. Sexually transmitted diseases surveillance 2000 supplement: Gonococcal Isolate Surveil-lance Project (GISP) annual report2000. Atlanta, GA: US Department of Health and Human Services, CDC, October 2001.

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

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Hantavirus Pulmonary Syndrome CDC. Hantavirus pulmonary syndromeUnited States: updated recommendations for risk reduc-tion. MMWR 2002;51(No. RR-9):1-12.

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CDC. Escherichia coli O111:H8 outbreak among teenage campersTexas, 1999. MMWR 2000;49:321-4.

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Hepatitis A Armstrong GL, Bell BP. Hepatitis A virus infections in the United States: model-based estimates and implications for childhood immunization. Pediatrics 2002;109:839-45.

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Shapiro CN, Coleman PJ, McQuillan GM, Alter MJ, Margolis HS. Epidemiology of hepatitis A:

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Vol. 50 / No. 53 MMWR 103 Hepatitis B Coleman PJ, McQuillan GM, Moyer LA, Lambert SB, Margolis HS. Incidence of hepatitis B virus infection in the United States, 1976-1994: estimates from the National Health and Nutrition Examination Surveys. J Infect Dis 1998;178:954-9.

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Armstrong GA, Alter MJ, McQuillan GM, Margolis HS. The past incidence of hepatitis C virus infection: implications for the future burden of chronic liver disease in the United States.

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CDC. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998;47(No. RR-19).

HIV Infection, Pediatric CDC. Guidelines for national human immunodeficiency virus case surveillance, including moni-toring for human immunodeficiency virus infection and acquired immunodeficiency syn-drome. MMWR 1999;48(No. RR-13):1-31.

CDC. Successful implementation of perinatal HIV prevention guidelines: a multistate surveillance evaluation. MMWR 2001;50(No. RR-6):17-28.

Lansky A, Jones JL, Frey RL, Lindegren ML. Trends in HIV testing among pregnant women United States, 1994-1997. Am J Public Health 2001;91:1291-3.

Lindegren ML, Steinberg S, Byers RH, Jr. Epidemiology of HIV/AIDS in children. Pediatr Clin North Am 2000; 47(1):1-20.

HIV Infection, Adult CDC. Diagnosis and reporting of HIV and AIDS in states with HIV/AIDS surveillanceUnited States, 1994-2000. MMWR 2002;51:595-8.

CDC. HIV/AIDS Surveillance Report, 2002 13, (No. 2). Atlanta: Centers for Disease Control and and Prevention. Vol. 13, No. 2. In press. Available at http://www.cdc.gov/hiv/stats/hasrlink.htm.

Lee LM, Fleming PL. Trends in human immundeficiency virus diagnoses among women in the United States, 1994-1998. J Am Med Womens Assoc 2001;56:94-99.

Lee LM, Karon JM, Selik R, Neal JJ, Fleming PL. Survival after AIDS diagnosis in adolescents and adults during the treatment era, United States, 1984-1997. JAMA 2001; 285:1308-15.

Legionellosis American Society of Heating, Refrigerating, and Air-Conditioning Engineers. ASHRAE Guideline 12-2000. Minimizing the Risk of Legionellosis Associated With Building Water Systems.

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CDC. Guidelines for prevention of nosocomial pneumonia. MMWR 1997;46(No. RR-1).

CDC. Guidelines for the prevention of opportunistic infections in hematopoietic stem cell transplant recipients. MMWR 2000;49(No. RR-10).

104 MMWR May 2, 2003 Lyme Disease CDC. Lyme diseaseUnited States, 2000. MMWR 2002;51:29-31.

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Malaria Lobel HO, Kozarsky PE. Update on prevention of malaria for travelers. JAMA 1997;278:1767-71.

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Measles CDC. Epidemiology of measlesUnited States, 1998. MMWR 1999;48:749-53.

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Meningococcal Disease CDC. Prevention and control of meningococcal disease, and meningococcal disease and college students: recommendations of the Advisory Committee on Immunization Practices (ACIP).

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Mumps Briss PA, Fehrs LJ, Parker RA, et al. Sustained transmission of mumps in a highly vaccinated population: assessment of primary vaccine failure and waning vaccine-induced immunity.

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CDC. Measles, mumps, and rubellavaccine use and strategies for elimination of measles, ru-bella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices. MMWR 1998;47(No. RR-8).

CDC. Mumps surveillance United States, 1988-1993. MMWR 1995;44(No. SS-3).

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Pertussis Bisgard KM, Christie CDC, Reising SF, et al. Molecular epidemiology of Bordetella pertussis by pulsed-field gel electrophoresis profile: Cincinnati, 1989-1996. J Infect Dis 2001;183:1360-7.

CDC. Guidelines for the control of pertussis outbreaks. Atlanta: Centers for Disease Control and Prevention, 2000. Available at http://www.cdc.gov/nip/publications/pertussis/guide.htm.

CDC. Pertussis deathsUnited States, 2000. MMWR 2002;51:616-8.

CDC. PertussisUnited States, 1997-2000. MMWR 2002;51:73-6.

Vol. 50 / No. 53 MMWR 105 Plague Inglesby TV, Dennis DT, Henderson DA, et al. Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense [Review]. JAMA 2000;283:2281-90.

Dennis DT, Gage KL, Gratz N, Poland JD, Tikhomirov E. Plague manual: epidemiology, distribu-tion, surveillance and control. Geneva, Switzerland: World Health Organization, 1999.

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Poliomyelitis, Paralytic CDC. Poliomyelitis prevention in the United States: updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2000;49(No. RR-5).

Prevots DR, Khetsuriani N, Wharton M. Evidence for a decline in the number of vaccine-associated paralytic poliomyelitis cases in the United States following implementation of a sequential poliovirus vaccination schedule, 1997-1998. Presented at the 36th annual meeting of the Infectious Disease Society of America, November 12-15, 1998.

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Psittacosis CDC. Compendium of measures to control Chyamydia psittaci among humans (psittacosis) and pet birds (avian chlamydiosis), 2000. MMWR 2000;49(No. RR-8):1-17.

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Q Fever Bernard KW, Parham GL, Winkler WG, Helmick CG. Q fever control measures: recommendations for research facilities using sheep. Infect Control 1982;3:461-5.

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Rabies, Animal and Human CDC. Human rabies preventionUnited States, 1999: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(No. RR-1).

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Rocky Mountain Spotted Fever CDC. Consequences of delayed diagnosis of Rocky Mountain spotted fever in childrenWest Virginia, Michigan, Tennessee, and Oklahoma, May-July 2000. MMWR 2000;49:885-8.

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Treadwell TA, Holman RC, Clarke MA, Krebs JW, Paddock CD, Childs JE. Rocky Mountain spotted fever in the United States, 1993-1996. Am J Trop Med Hyg 2000;63:21-6.

106 MMWR May 2, 2003 Rubella and Congenital Rubella Syndrome CDC. Control and prevention of rubella: evaluation and management of suspected outbreaks, rubella in pregnant women, and surveillance for congenital rubella syndrome. MMWR 2001;50(No. RR-12).

Danovaro-Holliday MC, LeBaron CW, Allensworth C, et al. A large rubella outbreak with spread from the workplace to the community. JAMA 2000;284:2733-9.

Reef SE, Frey TK, Theall K, et al. The changing epidemiology of rubella in the 1990s: on the verge of elimination and new challenges for control and prevention. JAMA 2002;287:464-72.

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Salmonella CDC. Outbreak of multidrug-resistant Salmonella NewportUnited States, January-April 2002.

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Shigellosis CDC. Outbreaks of Shigella sonnei infection associated with eating fresh parsleyUnited States and Canada, July-August 1998. MMWR 1999;48:285-9.

CDC. Shigellosis outbreak associated with an unchlorinated fill-and-drain wading poolIowa, 2001. MMWR 2001;50:797-800.

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Streptococcal Disease, Invasive, Group A The Prevention of Invasive Group A Streptococcal Infections Workshop Participants. Prevention of invasive group A streptococcal disease among household contacts of case patients and among postpartum and postsurgical patients: recommendations from the Centers for Disease Control and Prevention. Clin Infect Dis 2002;35:950-9.

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Streptococcus pneumoniae, Drug-Resistant, Invasive Disease CDC. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices. MMWR 2000;49(No. RR-9):1-35.

CDC. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997;46(No. RR-8):1-24.

Robinson KA, Baughman W, Rothrock G, et al. Epidemiology of invasive Streptococcus pneumoniae infections in the United States, 1995-1998: opportunities for prevention in the conjugate vaccine era. JAMA 2001;285:1729-35.

Whitney CG, Farley MM, Hadler J, et al. Increasing prevalence of multidrug-resistant Streptococ-cus pneumoniae in the United States. N Engl J Med 2000;343:1917-24.

Vol. 50 / No. 53 MMWR 107 Syphilis, Congenital CDC. Congenital syphilisUnited States, 2000. MMWR 2001;50:573-7.

CDC. Guidelines for the prevention and control of congenital syphilis. MMWR 1988;37(No. S-1).

Southwick KL, Guidry HM, Weldon MM, Mertz KJ, Berman SM, Levine WC. An epidemic of con-genital syphilis in Jefferson County, Texas, 1994-1995: inadequate prenatal syphilis testing after an outbreak in adults. Am J Public Health 1999;89:557-60.

Syphilis, Primary and Secondary CDC. The national plan to eliminate syphilis from the United States. Atlanta: US Department of Health and Human Services, CDC, October 1999.

CDC. Outbreak of syphilis among men who have sex with menSouthern California, 2000. MMWR 2001;50:117-20.

CDC. Primary and secondary syphilisUnited States, 1999. MMWR 2001;50:113-7.

CDC. Sexually transmitted disease surveillance supplement 2000: syphilis surveillance report.

Atlanta, GA: US Department of Health and Human Services, CDC, December 2001.

Tetanus CDC. TetanusPuerto Rico, 2002. MMWR 2002;51:613-15.

CDC. Notice to readers. Resumption of routine schedule for tetanus and diphtheria toxoids. MMWR 2002;51:529-30.

Fair E, Murphy T, Golaz A, Wharton M. Philosophic objection to vaccination as a risk for tetanus among children <15 years of age. Pediatrics 2002;109:E2.

McQuillan GM, Kruszon-Moran D, Deforest A, Chu SY, Wharton M. Serologic immunity to diphtheria and tetanus in the United States. Ann Intern Med 2002;136:660-6.

Toxic-Shock Syndrome Hajjeh RA, Reingold R, Weil A, Shutt K, Schuchat A, Perkins BA. Toxic shock syndrome in the United States: surveillance update, 1979-1996. Emerg Infec Dis 1999;5:807-10. Available at

<http://www.cdc.gov/ncidod/eid/vol5no6/hajjeh.htm>.

Schuchat A, Broome CV. Toxic shock syndrome and tampons. Epidemiol Rev 1991;13:99-112.

CDC. Reduced incidence of menstrual toxic-shock syndromeUnited States, 1980-1990. MMWR 1990;39:421-3.

Gaventa S, Reingold AL, Hightower AW, et al. Active surveillance for toxic shock syndrome in the United States, 1986. Rev Infect Dis 1989;11(suppl):S28-S34.

Tuberculosis CDC. Reported tuberculosis in the United States, 2001. Atlanta, GA: US Department of Health and Human Services, CDC, September 2002. Available at http://www.cdc.gov/tb.

Saraiya M, Cookson ST, Tribble P, et al. Tuberculosis screening among foreign-born persons applying for permanent US residence. Am J Public Health 2002;92:826-829.

Talbot EA, Moore M, McCray E, Binkin NJ. Tuberculosis among foreign-born persons in the United States, 1993-1998. JAMA 2000;284:2894-900.

Tularemia CDC. TularemiaUnited States, 1990-2000. MMWR 2002;51:181-4.

Dennis DT, Inglesby TV, Henderson DA, et al. Tularemia as a biological weapon: medical and public health management. JAMA 2001;285:2763-73.

Feldman KA, Enscore R, Lathrop S, et al. Outbreak of primary pneumonic tularemia on Marthas Vineyard. N Engl J Med 2001:345:1219-26.

Trichinosis Moorhead A, Grunenwald PE, Dietz VJ, Schantz PM. Trichinellosis in the United States, 1991-1996: declining but not gone. Am J Trop Med Hyg 1999;60:66-9.

CDC. Outbreak of trichinellosis associated with eating cougar jerkyIdaho, 1995. MMWR 1996;45:205-6.

McAuley JB, Michelson MK, Schantz PM. Trichinosis surveillance, United States, 1987-1990. In:

CDC surveillance summaries, December 1991. MMWR 1991;40(No. SS-3):35-42.

108 MMWR May 2, 2003 Typhoid Fever Ackers ML, Puhr ND, Tauxe RV, Mintz ED. Laboratory-based surveillance of Salmonella Serotype Typhi infections in the United States: antimicrobial resistance on the rise. JAMA 2000;283:2668-73.

CDC. Typhoid immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1994;43(No. RR-14).

Mermin JH, Townes JM, Gerber M, Dolan N, Mintz ED, Tauxe RV. Typhoid fever in the United States, 1985-1994: changing risks of international travel and increasing antimicrobial resistance. Arch Intern Med 1998;158:633-8.

Olsen SJ, Bleasdale SC, Magnano AR, et al. Outbreaks of typhoid fever in the United States, 1960-1999. Epidemiol Infect; 2002: In Press.

Varicella CDC. Varicella-related deathsFlorida, 1998. MMWR 1999;48:379-81.

CDC. Evaluation of varicella reporting to the National Notifiable Disease Surveillance System United States, 1972-1997. MMWR 1999;48;55-8.

CDC. Prevention of varicella: updated recommendations of the Advisory Committee on Immuni-zation Practices (ACIP). MMWR 1999:48(No. RR-6).

CDC. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1996:45(No. RR-11):1-25.

State and Territorial Epidemiologists and Laboratory Directors State and Territorial Epidemiologists and Laboratory Directors are acknowledged for their contributions to CDC Surveillance Summaries. The epidemiologists and laboratory directors listed below were in the positions shown as of April 2003.

State/Territory Epidemiologist Laboratory Director Alabama Charles Woernle, MD, MPH William J. Callan, PhD Alaska John P. Middaugh, MD Bernard Jilly, PhD Arizona Bob England, MD, MPH Wes B. Press, MS Arkansas Sharon Williams, DVM, MS Michael G. Foreman California Duc Vugia, MD, MPH Paul Kimsey, PhD Colorado Ned Calonge, MD, MPH Ronald L. Cada, DrPH Connecticut James L. Hadler, MD, MPH Katherine Kelley, DrPH Delaware A. LeRoy Hathcock, PhD Jane Getchall, DrPH District of Columbia John O. Davies-Cole, MD, MPH Maurice Knuckles, PhD (Acting)

Florida Steven Wiersma, MD, MPH Ming S. Chan, PhD Georgia Paul Blake, MD, MPH Elizabeth A. Franko, DrPH Hawaii Paul V. Effler, MD, MPH Vernon K. Miyamoto, PhD Idaho Christine G. Hahn, MD Richard H. Hudson, PhD Illinois Mark Dworkin, MD, MPH David L. Maserang, PhD Indiana Robert Teclaw, DVM, PhD, MPH David E. Nauth Iowa M. Patricia Quinlisk, MD, MPH Mary J. R. Gilchrist, PhD Kansas Gianfranco Pezzino, MD, MPH Theresa Hodges (Acting)

Kentucky Steven J. Englender, MD, MPH Samuel B. Gregorio, DrPH Louisiana Raoult Ratard, MD, MPH Henry B. Bradford, Jr, PhD Maine Kathleen F. Gensheimer, MD, MPH John A. Krueger Maryland David Blythe, MD, MPH J. Mehsen Joseph, PhD Massachusetts Alfred DeMaria, Jr, MD Ralph J. Timperi, MPH Michigan Matthew L. Boulton, MD, MPH Frances Pouch Downes, DrPH Minnesota Harry F. Hull, MD Norman Crouch, PhD Mississippi Mary Currier, MD, MPH Joe O. Graves, PhD Missouri Joseph Malone, MD Eric C. Blank, DrPH Montana Todd A. Damrow, PhD, MPH Mike Spence, MD Nebraska Thomas J. Safranek, MD Steve Hinrichs, MD Nevada Randall L. Todd, DrPH L. Dee Brown, MD, MPH New Hampshire Jesse Greenblatt, MD, MPH Veronica C. Malmberg, MSN New Jersey Eddy A. Bresnitz, MD, MS S. I. Shahied, PhD New Mexico Mack C. Sewell, DrPH, MS David E. Mills, PhD New York City Benjamin A. Mojica, MD, MPH Alex Ramon, MD, MPH New York State Perry F. Smith, MD Lawrence S. Sturman, MD, PhD North Carolina Jeffrey Engel, MD Lou F. Turner, DrPH North Dakota Larry A. Shireley, MPH, MS Bonna R. Cunningham Ohio Forrest W. Smith, MD William Becker, DO Oklahoma J. Michael Crutcher, MD, MPH John Hitz, DrPH Oregon Melvin Kohn, MD, MPH Michael R. Skeels, PhD, MPH Pennsylvania James T. Rankin, Jr, DVM, PhD, MPH Bruce Kleger, DrPH Rhode Island Utpala Bandyopadhyay, MD, MPH Gregory Hayes, DrPH South Carolina James J. Gibson, MD, MPH Harold Dowda, PhD South Dakota Lon Kightlinger, MD Michael Smith Tennessee Allen Craig, MD Michael W. Kimberly, DrPH Texas Dennis Perrotta, PhD, CIC Susan Neill, PhD, MBA Utah Robert Rolfs, MD Charles D. Brokopp, DrPH Vermont Ann R. Fingar, MD, MPH Burton W. Wilcke, Jr, PhD Virginia John Marr, MD, MPH James L. Pearson, DrPH Washington Juliet VanEenwyk, PhD (Acting)

John Kobayashi, MD, MPH West Virginia Loretta E. Haddy, MS, MA Andrea Labik, PhD Wisconsin Jeffrey P. Davis, MD Ronald H. Laessig, PhD Wyoming Karl Musgrave, DVM, MPH Richard Harris, PhD American Samoa Joseph Tufa, DSM, MPH Joseph Tufa, DSM, MPH Federated States of Micronesia Jean-Paul Chaine

Guam Robert L. Haddock, DVM, MPH Aurelto S. Espinola, MD Marshall Islands Tom D. Kijiner

Northern Mariana Islands Jose L. Chong, MD Joseph K.P. Villagomez Palau

Puerto Rico Angeles Rodriguez, MD José Luis Miranda Arroyo, MD Virgin Islands Jose Poblete, MD (Acting)

Norbert Mantor, PhD

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