ML12221A286

Centers for Disease Control and Prevention - Morbidity and Mortality Weekly Report - Summary of Notifiable Diseases United States, 2002

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Morbidity and Mortality Weekly Report Weekly Published April 30, 2004 for 2002 / Vol. 51 / No. 53 Summary of Notifiable Diseases United States, 2002 depar tment of health and human ser department vices services Centers for Disease Control and Prevention

MMWR CONTENTS The MMWR series of publications is published by the Preface ................................................................................ 2 Epidemiology Program Office, Centers for Disease Background ......................................................................... 2 Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333. Data Sources ....................................................................... 4 Interpreting Data ................................................................. 4 Highlights ............................................................................ 6 SUGGESTED CITATION Part 1. Summaries of Notifiable Diseases in the Centers for Disease Control and Prevention. United States .................................................................. 15 Summary of notifiable diseasesUnited States, Table 1. Reported cases by month, 2002 ......................... 16 2002. Published April 30, 2004, for MMWR 2002;51(No. 53):[inclusive page numbers]. Table 2. Reported cases by geographic division and area, 2002 ........................................................... 18 Table 3. Reported cases and incidence rates Centers for Disease Control and Prevention (per 100,000 population) by age group, 2002 ............. 27 Julie L. Gerberding, M.D., M.P.H. Table 4. Reported cases and incidence rates Director (per 100,000 population) by sex, 2002 ......................... 29 Dixie E. Snider, Jr., M.D., M.P.H. Table 5. Reported cases and incidence rates (Acting) Deputy Director for Public Health Science (per 100,000 population) by race, 2002 ....................... 31 Tanja Popovic, M.D., Ph.D. Table 6. Reported cases and incidence rates (Acting) Associate Director for Science (per 100,000 population) by ethnicity, 2002 ................. 33 Epidemiology Program Office Part 2. Graphs and Maps for Selected Notifiable Diseases Stephen B. Thacker, M.D., M.Sc. in the United States ........................................................ 35 Director Part 3. Historical Summaries of Notifiable Diseases Office of Scientific and Health Communications in the United States, 1971-2002 .................................... 69 John W. Ward, M.D. Table 7. Reported incidence rates per 100,000 Director population, 1992-2002 ............................................... 70 Editor, MMWR Series Table 8. Reported cases, 1995-2002 ............................... 72 Suzanne M. Hewitt, M.P.A. Table 9. Reported cases, 1987-1994 ............................... 74 Managing Editor, MMWR Series Table 10. Reported cases, 1979-1986 ............................. 75 C. Kay Smith-Akin, M.Ed. Table 11. Reported cases, 1971-1978 ............................. 76 Lead Technical Writer/Editor Table 12. Deaths from selected diseases, 1996-2000 ...... 77 Lynne McIntyre, M.A.L.S. Selected Reading ............................................................... 79 Project Editor Beverly J. Holland Lead Visual Information Specialist Lynda G. Cupell Visual Information Specialist Quang M. Doan Erica R. Shaver Information Technology Specialists

Vol. 51 / No. 53 MMWR 1 Summary of Notifiable Diseases United States, 2002 Prepared by Samuel L. Groseclose, D.V.M.

Wayne S. Brathwaite Patsy A. Hall, Annual Summary Coordinator Deborah A. Adams Felicia J. Connor Pearl Sharp Willie J. Anderson Robert F. Fagan J. Javier Aponte Gerald F. Jones David A. Nitschke Carol A. Worsham Nelson Adekoya, Dr.P.H.

Man-Huei Chang, M.P.H.

Timothy Doyle, M.P.H.

Rosaline Dhara, M.A., M.P.H.

Ruth Ann Jajosky, D.M.D.

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

2 MMWR April 30, 2004 Preface Background The Summary of Notifiable Diseases, United States, 2002 con- The infectious diseases designated as notifiable at the tains the official statistics, in tabular and graphic form, for the national level during 2002 are listed on page 3. A notifiable reported occurrence of nationally notifiable diseases in the disease is one for which regular, frequent, and timely informa-United States for 2002. The data are final totals for 2002 tion regarding individual cases is considered necessary for the reported as of June 30, 2003, unless otherwise noted. These prevention and control of the disease. This section briefly sum-statistics are collected and compiled from reports sent by state marizes the history of the reporting of nationally notifiable health departments to the National Notifiable Diseases Sur- diseases in the United States.

veillance System (NNDSS), which is operated by CDC in col- In 1878, Congress authorized the U.S. Marine Hospital laboration with the Council of State and Territorial Service (the forerunner of the Public Health Service [PHS]) to Epidemiologists (CSTE). collect morbidity reports regarding cholera, smallpox, plague, The Summary is located on the Internet at http:// and yellow fever from U.S. overseas consuls. The intention www.cdc.gov/mmwr/summary.html. This site also includes was to use this information to institute quarantine measures publications from past years. to prevent the introduction and spread of these diseases into The Highlights section presents noteworthy epidemiologic the United States. In 1879, a specific Congressional appro-or prevention information for 2002 for selected diseases and priation was made for the collection and publication of additional information to aid in the interpretation of surveil- reports of these notifiable diseases. Congress expanded the lance and disease-trend data. authority for weekly reporting and publication of these Part 1 contains tables showing incidence data for each of the reports in 1893 to include data from states and municipal nationally notifiable diseases during 2002.* The tables pro- authorities. To increase the uniformity of the data, Congress vide the number of cases reported to CDC for 2002, as well as enacted a law in 1902 directing the Surgeon General to pro-the distribution of cases by month, geographic location, and vide forms for the collection and compilation of data and for by patients age, sex, race, and Hispanic ethnicity. Nationally the publication of reports at the national level. In 1912, state notifiable diseases that are reportable in <40 states do not ap- and territorial health authorities in conjunction with PHS pear in these tables. Part 2 contains graphs and maps that de- recommended immediate telegraphic reporting of five pict summary data for many of the notifiable diseases described infectious diseases and the monthly reporting, by letter, of 10 in tabular form in Part 1. Part 3 contains tables that list the additional diseases. The first annual summary of The Notifi-number of cases of notifiable diseases reported to CDC since able Diseases in 1912 included reports of 10 diseases from 19 1970. This section also includes a table enumerating deaths states, the District of Columbia, and Hawaii. By 1928, all states, associated with specified notifiable diseases reported to the the District of Columbia, Hawaii, and Puerto Rico were par-National Center for Health Statistics (NCHS), CDC, during ticipating in national reporting of 29 specified diseases. At their 1996-2000. annual meeting in 1950, state and territorial health officers The Selected Reading section presents general and disease- authorized the Council of State and Territorial Epidemiologists specific references for notifiable infectious diseases. These (CSTE) to determine which diseases should be reported to PHS.

references provide additional information on surveillance and In 1961, CDC assumed responsibility for the collection and epidemiologic issues, diagnostic issues, or disease control publication of data concerning nationally notifiable diseases.

activities. The list of nationally notifiable diseases is revised periodi-cally. For example, a disease might be added to the list as a new pathogen emerges, or a disease might be deleted as its inci-dence declines. Public health officials at state health depart-ments and CDC continue to collaborate in determining which diseases should be nationally notifiable. CSTE, with input from CDC, makes recommendations annually for additions and

• Because no cases of paralytic poliomyelitis and western equine encephalitis deletions. Although disease reporting is mandated by legisla-were reported in the United States during 2002, these diseases do not appear in the tables in Part 1.

tion or regulation at the state and local levels, state reporting In 1999, mortality data began to be coded according to the International to CDC is voluntary. Thus, the list of diseases considered no-Statistical Classification of Diseases and Related Health Problems, Tenth Revision. tifiable varies slightly by state. All states generally report the To bridge the mortality data for the period 1996-1998 (deaths coded using the International Classification of Diseases, Ninth Revision), and 1999-2000, internationally quarantinable diseases (i.e., cholera, plague, and we use comparability ratios provided by the National Center for Health yellow fever) in compliance with the World Health Statistics. Organizations International Health Regulations.

Vol. 51 / No. 53 MMWR 3 Infectious Diseases Designated as Notifiable at the National Level During 2002 Acquired immunodeficiency syndrome (AIDS) Legionellosis Anthrax Listeriosis Botulism Lyme disease Brucellosis Malaria Chancroid Measles Chlamydia trachomatis, genital infection Meningococcal disease Cholera Mumps Coccidioidomycosis Pertussis Cryptosporidiosis Plague Cyclosporiasis Poliomyelitis, paralytic Diphtheria Psittacosis Ehrlichiosis, Q fever Human granulocytic Rabies, animal Human monocytic Rabies, human Human, other or unspecified agent Rocky Mountain spotted fever Encephalitis/meningitis, arboviral Rubella California serogroup Rubella, congenital syndrome Eastern equine Salmonellosis Powassan Shigellosis St. Louis Streptococcal disease, invasive, group A Western equine Streptococcal toxic-shock syndrome West Nile Streptococcus pneumoniae, drug-resistant, invasive disease Enterohemorrhagic Escherichia coli (EHEC), O157:H7 Streptococcus pneumoniae, invasive, <5 yrs EHEC serogroup non-O157 Syphilis EHEC, not serogrouped Syphilis, congenital Giardiasis Tetanus Gonorrhea Toxic-shock syndrome Haemophilus influenzae, invasive disease Trichinosis Hansen disease Tuberculosis Hantavirus pulmonary syndrome Tularemia Hemolytic uremic syndrome, postdiarrheal Typhoid fever Hepatitis A, acute Varicella*

Hepatitis B, acute Varicella deaths Hepatitis B, perinatal infection Yellow fever Hepatitis C/non-A, non-B, acute Human immunodeficiency virus (HIV) infection Adult (>13 yrs)

Pediatric (<13 yrs)

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

4 MMWR April 30, 2004 Data Sources Division of Tuberculosis Elimination (tuberculosis).

National Immunization Program (NIP)

Provisional data concerning the reported occurrence of Epidemiology and Surveillance Division (poliomyelitis).

notifiable diseases are published weekly in the MMWR. After each reporting year, staff in state health departments finalize Disease totals for the United States, unless otherwise stated, reports of cases for that year with local or county health do not include data for American Samoa, Guam, Puerto Rico, departments and reconcile the data with reports previously the U.S. Virgin Islands, or the Commonwealth of the North-sent to CDC throughout the year. These data are compiled in ern Mariana Islands.

final form in the Summary.

Population estimates for the states are from the U.S. Census Notifiable disease reports are the authoritative and archival Bureau, Population Division, Table ST-EST2002 State counts of cases. They must be approved by the appropriate Population Estimates: April 1, 2000, available at http://

epidemiologist from each submitting state or territory before eire.census.gov/popest/data/states/tables/NST-EST2003-being published in the Summary. Data published in CDC 01.php. Numbers for territories are estimates from the U.S.

Surveillance Summaries or other surveillance reports produced Bureau of the Census, International Data Base, available at by CDC programs might not agree exactly with data reported http://www.census.gov/ipc/www/idbprint.html. The choice of in the annual Summary because of differences in the timing of population denominators for incidence rates reported in the reports, the source of the data, or surveillance methodology.

MMWR is based on 1) the availability of census Data in the Summary were derived primarily from reports population data at the time of preparation for publication, transmitted to the Division of Public Health Surveillance and and 2) the desire for consistent use of the same population Informatics, Epidemiology Program Office, CDC, from health data to compute incidence rates reported by various CDC pro-departments in the 50 states, five territories, New York City, grams. Rates in the Summary are presented as incidence rates and the District of Columbia. More information regarding per 100,000 population, based on data for the U.S. total resi-notifiable diseases, including case definitions for these condi-dent population. However, population data from states in tions, is available on the Internet at http://www.cdc.gov/epo/

which diseases were not notifiable or disease data were not dphsi/phs.htm. Policies for reporting notifiable disease cases available were excluded from rate calculations.

can vary by disease or reporting jurisdiction.

Final data for some diseases are derived from the surveil-lance records of the CDC programs listed below. Requests for Interpreting Data further information regarding these data should be directed to the appropriate program. Incidence data in the Summary are presented by the date of National Center for Health Statistics (NCHS) report to CDC as determined by the MMWR week and year Office of Vital and Health Statistics Systems (deaths from assigned by the state or territorial health department. In addi-selected notifiable diseases). tion, data in the Summary are reported by the state in which National Center for Infectious Diseases (NCID) the patient resides at the time of diagnosis. For many of the Division of Bacterial and Mycotic Diseases (toxic-shock nationally notifiable infectious diseases, surveillance data are syndrome; streptococcal disease, invasive, group A; strepto- independently reported to EPO and other CDC programs.

coccal toxic-shock syndrome; laboratory data regarding botu- Thus, surveillance data reported by other CDC programs may lism, Escherichia coli, enterohemorrhagic O157:H7, vary from data reported in the Summary because of differences salmonellosis, and shigellosis). in 1) the date used to aggregate data (e.g., date of report, date Division of Vector-Borne Infectious Diseases (laboratory data of disease occurrence), 2) the timing of reports, 3) the source regarding arboviral encephalitis). of the data, 4) surveillance case definitions, and 5) policies Division of Viral and Rickettsial Diseases (animal rabies, regarding case jurisdiction (i.e., which state should report the hantavirus pulmonary syndrome). case to CDC).

National Center for HIV, STD, and TB Prevention The data reported in the Summary are useful for analyzing (NCHSTP) disease trends and determining relative disease burdens. How-Division of HIV/AIDS Prevention Surveillance and Epi- ever, these data must be interpreted in light of reporting prac-demiology (acquired immunodeficiency syndrome [AIDS], tices. Disease reporting is likely incomplete, and its human immunodeficiency virus [HIV] infection). completeness may vary depending on the disease. The degree of Division of Sexually Transmitted Diseases Prevention (chan- completeness of data reporting may be influenced by the diag-croid, chlamydia, gonorrhea, syphilis). nostic facilities available; the control measures in effect; public

Vol. 51 / No. 53 MMWR 5 awareness of a specific disease; and interests, resources, and in data that are not representative of true racial/ethnic group-priorities of state and local officials responsible for disease con- specific disease incidence. Surveillance data reported to trol and public health surveillance. Finally, factors such as NNDSS are either in individual case-specific form or sum-changes in methods for public health surveillance, introduc- mary form (aggregated data for a group of cases). Summary tion of new diagnostic tests, or discovery of new disease enti- data often lack demographic information (e.g., race); there-ties can cause changes in disease reporting that are independent fore, the demographic-specific incidence rates presented in the of the true incidence of disease. Summary may be underestimated.

Public health surveillance data are published for selected In addition, not all race and ethnicity data are collected racial and ethnic population groups because these variables uniformly for all diseases. For example, some disease programs can be risk markers for certain notifiable diseases. Race and collect race and ethnicity as one variable; other programs col-ethnicity data can also be used to highlight populations for lect these data as two variables. Additionally, although the rec-focused prevention efforts. However, caution must be used ommended standard for classifying a persons race or ethnicity when drawing conclusions from reported race and ethnicity is based on self-reporting, this procedure might not always be data. Different racial/ethnic population groups may have dif- followed.

ferential patterns of access to health care, potentially resulting

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6 MMWR April 30, 2004 Highlights for 2002 AIDS food items is minimal. However, a risk remains for infection with both B. abortus and B. melitensis from consumption of Since 1981, confidential name-based AIDS surveillance has unpasteurized goat and cow milk products, in particular those been the cornerstone of national, state, and local efforts to produced outside the United States. Most cases in the United monitor the scope and impact of the HIV epidemic. The data States are now seen in international travelers or recent immi-have many uses, including developing policy to help prevent grants. Laboratory personnel working with Brucella species and and control AIDS. However, because of the introduction of hunters exposed to infected wildlife also have an elevated risk therapies that effectively slow the progression of the infection, for infection. B. melitensis and B. suis are considered Category AIDS data no longer adequately represent the populations B bioterrorism threat agents.

affected by the epidemic. By providing a window into the epi-demic at an earlier stage, HIV data, combined with AIDS data, better represent the overall impact. Since 1998, 30 areas (29 Chancroid states and the U.S. Virgin Islands) have had integrated name-based HIV surveillance into their AIDS surveillance systems During 2002, a total of 67 cases of chancroid were reported while other jurisdictions have used other methods for report- (rate: 0.02/100,000), an increase from 38 cases in 2001 but ing cases of HIV infection. an overall decline of 99% of the cases reported since 1987 (1).

During1998-1999, declines in AIDS began to level, and Of the 2002 cases, 43 (64%) were reported from one state.

essentially no change occurred during 1999-2002. This trend Overall, only 10 states and one outlying area reported >1 case follows a period of sharp declines in incident cases after 1996, of chancroid in 2002. The causative agent of chancroid is when highly effective antiretroviral therapies were introduced. difficult to culture and therefore the disease could be substan-The estimated annual number of deaths among persons with tially underdiagnosed. Several studies that used DNA amplifi-AIDS, however, declined 14% from 1998 to 2002. At the end cation tests (which are not commercially available) have of 2002, an estimated 384,906 persons were known to be liv- identified this infection in cities where it was previously ing with AIDS. undetected (2).

1. CDC. Sexually transmitted disease surveillance 2002. Atlanta: US Department of Health and Human Services, CDC, 2003.

2. Mertz KJ, Trees D, Levine WC, et al. Etiology of genital ulcers and preva-Anthrax lence of human immunodeficiency virus coinfection in 10 US cities. The In November 2002, the Advisory Committee on Immuni- Genital Ulcer Disease Surveillance Group. J Infect Dis 1998;178:175-8.

zation Practices (ACIP) recommended preexposure use of anthrax vaccine for groups at risk for repeated exposures, including 1) laboratory personnel handling environmental Chlamydia trachomatis, specimens and performing confirmatory testing for Bacillus Genital Infection anthracis in U.S. Laboratory Response Network for During 2002, a total of 834,555 cases of genital chlamydial Bioterrorism level B laboratories or above, 2) workers making infection were reported (rate: 296.55/100,000). This rate was repeated entries into known B. anthracis spore-contaminated the highest since voluntary case reporting began in the mid-areas after a terrorist attack, and 3) workers in other settings in 1980s and the highest since genital chlamydial infection became which repeated exposure to aerosolized B. anthracis spores might a nationally notifiable disease in 1995 (1). This increase could occur. The ACIP recommendations are available at http:// be caused in part by the continued expansion of chlamydia www.cdc.gov/mmwr/PDF/wk/mm5145.pdf. screening programs and increased use of more sensitive diagnostic tests for this condition. From 1998 to 2002, the reported chlamydial infection rate in men increased by 55%

Brucellosis compared with a 20% increase in women. However, the rate By 2002, the control program for brucellosis among cattle among women was over three times the rate reported among in the United States had nearly eliminated Brucella abortus men, reflecting the larger number of women screened for this infection from U.S. herds. Therefore, at present, the risk of disease.

contracting brucellosis either from occupational exposure to 1. CDC. Sexually transmitted disease surveillance 2002. Atlanta: US livestock in the United States or from domestically produced Department of Health and Human Services, CDC, 2003.

Vol. 51 / No. 53 MMWR 7 Cholera WNV-infected birds, mosquitoes, or horses were detected in 44 states and the District of Columbia. Of these 45 jurisdic-During 1995-2002, a total of 66 laboratory-confirmed cases tions, 16 reported their first ever WNV activity. One of cholera, all caused by Vibrio cholerae O1, were reported to human case reported in a Los Angeles County, California, resi-CDC. Forty-two (64%) infections were acquired outside the dent with no known travel history and a report of a WNV-United States, whereas six (9%) were acquired through con-infected horse in Island County, Washington, indicated the sumption of contaminated seafood harvested in Gulf Coast complete transcontinental movement of WNV within 3 years waters. One patient died (1). Only two laboratory-confirmed of its first appearance in the Eastern United States. An unprec-cases of cholera were reported to CDC in 2002. Both were edented equine WNV epizootic occurred in the midwestern caused by V. cholerae O1 and were acquired outside the United states and resulted in 14,539 reported cases. Three mosquito States. Both isolates were resistant to furazolidone. Produc-species, Culex pipiens, Cx. quinquefasciatus, and Cx. restuans, tion and sale of the only licensed cholera vaccine in the United accounted for the majority of the 6,604 reported WNV-States ceased in 2001.

1. Steinberg EB, Greene KD, Bopp CA, Cameron DN, Wells JG, Mintz positive mosquito pools. WNV was also detected for the first ED. Cholera in the United States, 1995-2000: trends at the end of the time in Cx. tarsalis, an important vector of St. Louis encepha-millennium. J Infect Dis 2001;184:799-802. litis virus, raising concerns about its potential to transmit WNV to humans in western states where it is common (2).

In 2002, 164 cases of encephalitis caused by California (CAL)

Coccidioidomycosis serogroup viruses were reported from 16 states, representing In recent years, Arizona and California have experienced sig- the most reported to CDC in any year since 1964. WNV hu-nificant increases in the incidence rates of coccidioidomyco- man case surveillance may have resulted in improved surveil-sis. This increase is likely related to demographic and climatic lance for CAL serogroup virus meningoencephalitis cases.

changes. Physicians should maintain a high suspicion for acute During 1964-2002, a median of 67 cases (average: 80; range:

coccidioidomycosis, especially among patients with a flu-like 29-167) were reported per year in the United States.

illness who live in or have visited areas with endemic disease. 1. CDC. Provisional surveillance summary of the West Nile virus epidemic United States, January-November 2002. MMWR 2002;51:1129-33.

2. Turrell MJ, OGuinn ML, Dohm JD, et al. Vector competence of Culex tarsalis from Orange County, California, for West Nile virus. Vector-Borne Diphtheria Zoonotic Dis 2002;2:193-6.

During 2002, one probable, nonfatal case of diphtheria was reported to CDC. The patient was a female resident of Cali-fornia, aged 38 years. Symptoms and signs included a sore Gonorrhea throat and difficulty in swallowing for 7 days, an extensive During 2002, a total of 351,852 cases of gonorrhea were pharyngeal membrane, and low-grade fever 99°-101°F. A reported (rate: 125.03/100,000 population). This rate is slightly throat swab specimen for culture was negative for Corynebac- lower than rates in 2001 (128.53/100,000), 2000 (129.04/

terium diphtheriae, but it was obtained a day after an antibi- 100,000), 1999 (132.32/100,000), and 1998 (131.89/

otic regimen was started. The patient had recent, prolonged, 100,000) (1). In 2002, the reported gonorrhea rate among frequent face-to-face exposure to visitors from eastern Europe women (125.3/100,000) was similar to that among men and Australia. She had received the last booster dose of (124.2/100,000). Rates among non-Hispanic black women vaccine in 1987. aged 15-19 years (3,307.7/100,000) and non-Hispanic black men aged 20-24 years (3,256.2/100,000) remain higher than in any other racial/ethnic or age group. Increases have been Encephalitis, Arboviral observed in some areas among men who have sex with men In 2002, an unprecedented epidemic and epizootic of West (2). Decreased susceptibility to the fluoroquinolone antibiot-Nile virus (WNV) occurred in the United States (1). Epidemic ics has also been reported from some regions (3). In 2002, the and epizootic activity was most intense in the central United prevalence of fluoroquinolone-resistant Neisseria gonorrhoeae States. A total of 2,146 human WNV encephalitis and/or infections continued to increase in California.

meningitis (i.e., meningoencephalitis) cases were reported Fluoroquinolones are no longer advised for treatment of gon-through the ArboNet Arboviral Surveillance System from 36 orrhea in Hawaii or California or for infections that might states, representing the largest arboviral meningoencephalitis have been acquired in those states (4).

epidemic documented in the Western Hemisphere. In addition,

8 MMWR April 30, 2004

1. CDC. Sexually transmitted disease surveillance 2002. Atlanta: US Hepatitis A Department of Health and Human Services, CDC, 2003.

2. Fox KK, del Rio C, Holmes KK, et al. Gonorrhea in the HIV era: a Hepatitis A vaccine is recommended for persons at increased reversal in trends among men who have sex with men. Am J Public Health risk of acquiring hepatitis A (e.g., international travelers, men 2001;91:1-5. who have sex with men (MSM), and injection- and

3. CDC. Increases in fluoroquinolone-resistant Neisseria gonorrhoeae noninjection-drug users) (1) and also for children in states Hawaii and California, 2001. MMWR 2002;51:1041-4.

4. CDC. Sexually transmitted diseases treatment guidelines 2002. MMWR and counties that have historically had consistently elevated 2002;51(No. RR-6). rates of hepatitis A (2). Since childhood vaccination in high-risk areas was recommended, the overall hepatitis A rate has declined steadily, and in 2002, it was the lowest yet recorded Haemophilus influenzae, (3.1/100,000). The decline in rates has been greater among Invasive Disease children and in states where routine childhood vaccination is recommended, suggesting an impact of childhood vaccination.

In 2002, 331 cases of invasive Haemophilus influenzae dis-The dramatic declines in disease rates in these groups and ease in children aged <5 years were reported; 34 (10%) were areas that have historically accounted for the majority of reported as H. influenzae type b (Hib), 144 (44%) were re-reported cases have resulted in a shift in the epidemiology of ported as other serotypes or nontypeable isolates, and 153 this disease in the United States. Hepatitis A rates, historically (46%) were reported with serotype information unknown or much higher in the western states, are now similar in all missing. The continued remarkably low number of invasive regions of the United States, and an increasing proportion of Hib infections in children (down from an estimated 20,000 cases are among adults, particularly those in high-risk groups cases annually in the prevaccine era) is a result of the success-such as MSM. Continued monitoring of disease rates is needed ful delivery of highly effective conjugate Hib vaccines to chil-to determine if the current low rates are sustained and attrib-dren, beginning at age 2 months (1,2). Because discrepancies utable to vaccination and to identify groups and areas where in serotyping results have occurred between laboratories, CDC additional vaccination efforts are needed.

requests that state health departments obtain and send all 1. CDC. Prevention of hepatitis A through active or passive immuniza-invasive H. influenzae isolates from children aged <5 years to tion: recommendations of the Advisory Committee on Immunization CDC for serotype confirmation (3,4). Practices. MMWR 1996;45(No. RR-15).

1. CDC. Progress toward elimination of Haemophilus influenzae type b dis- 2. CDC. Prevention of hepatitis A through active or passive immunization:

ease among infants and childrenUnited States, 1998-2000. MMWR recommendations of the Advisory Committee on Immunization Prac-2002;51:234-7. tices. MMWR 1999;48(No. RR-12).

2. Zhou, F, Bisgard KM, Yusuf H, et al. Impact of universal Haemophilus influenzae type b vaccination starting at 2 months of age in the United States: an economic analysis. Pediatrics 2002;110:653-61. Hepatitis B

3. LaClaire LL, Tondella ML, Beall DS, et al. Identification of Haemophilus influenzae serotypes by standard slide agglutination serotyping and PCR- During 2002, a total of 7,996 acute hepatitis B cases were based capsule typing. J Clin Microbiol 2003;41:393-6. reported, representing a >65% decrease since 1990 (21,102

4. CDC. Serotyping discrepancies in Haemophilus influenzae type b disease cases). The steady decline in hepatitis B rates coincides with United States, 1998-1999. MMWR 2002;51:706-7.

the implementation of a national strategy to achieve the elimi-nation of hepatitis B virus (HBV) infection (1). The primary Hantavirus Pulmonary Syndrome elements of this strategy are 1) screening of all pregnant women for HBV infection with provision of postexposure prophy-The geographic center of hantavirus pulmonary syndrome laxis to infants born to infected women, 2) routine vaccina-(HPS) cases during the 2002 season was more northerly than tion of all infants and children aged <18 years, and in previous years. This reflects weather patterns that delivered 3) vaccination of others at increased risk of acquiring hepatitis B greater rainfall or milder antecedent winter conditions result- (e.g., health-care workers, MSM, injection drug users, and ing in more abundant food supplies and an increase in the household and sex contacts of persons with chronic HBV host rodent species in those northerly areas. CDC guidance infection).

for prevention of HPS has been updated and made available The rate among children aged <18 years, the age group cov-in Spanish and English (1). ered by the recommendation for routine childhood immuni-

1. CDC. All about hantaviruses. Atlanta: US Department of Health and zation, has declined by approximately 90% since 1990. In Human Services, CDC, 2003. Available at http://www.cdc.gov/ncidod/

diseases/hanta/hps/index.htm. comparison, high rates of disease continue among adults,

Vol. 51 / No. 53 MMWR 9 particularly males aged 25-39 years. This and the high pro- Beginning in 2003, CDC expanded its HIV/AIDS surveil-portion of cases occurring among persons in identified risk lance activities through the addition of a national HIV behav-groups (i.e., injection-drug users, MSM and persons with ioral surveillance system. CDC will assess the implementation multiple sex partners) indicate a need to strengthen efforts to and effectiveness of prevention activities through several moni-reach these populations with vaccine. toring systems, including the use of new performance indica-

1. CDC. Hepatitis B virus: a comprehensive strategy for eliminating trans- tors for state and local health departments and mission in the United States through universal childhood vaccination: community-based organizations.

recommendations of the Immunization Practices Advisory Committee.

At the end of 2002, 142,713 adults and adolescents in the MMWR 1991;40(No. RR-13).

30 areas were known to be living with HIV infection (not AIDS). The prevalence rate of HIV infection (not AIDS) in Hepatitis C; Non-A, Non-B this group was 125.7/100,000 population (1).

1. CDC. HIV/AIDS Surveillance Report, 2002. Atlanta: US Department Monitoring acute hepatitis C rates nationally has been chal- of Health and Human Services, CDC. Vol. 14. Available at http://

lenging because 1) no serologic marker for acute infection exists, www.cdc.gov/hiv/stats/hasrlink.htm.

and 2) many health departments do not have the resources to determine if a positive laboratory report for hepatitis C virus (HCV) infection represents acute infection. Consequently, the HIV Infection, Pediatric most reliable estimates of acute hepatitis C incidence have his- Effective January 1, 2000, the surveillance case definition torically come from sentinel surveillance. Incidence of hepa- for HIV infection was revised to reflect advances in laboratory titis C has declined by >80% since the late 1980s, largely the HIV virology tests. The definition incorporates the reporting result of a decrease in cases among injection-drug users, the criteria for HIV infection and AIDS into a single case defini-reasons for which are unknown. The majority of hepatitis C tion for adults and children (1).

cases continue to occur among persons aged >25 years, with In the 30 areas (29 states and the U.S. Virgin Islands) that injection-drug use the most common risk factor for infection. have had laws or regulations since 1998 requiring confidential In recent years, analysis of cases of acute, symptomatic hepati- reporting by name for children with confirmed HIV infec-tis C reported through NNDSS has yielded similar results as tion, 1,416 children (aged <13 years) were known to be living those from sentinel surveillance, suggesting that the quality of with HIV infection (not AIDS) at the end of 2002. The preva-national surveillance data for acute hepatitis C has improved. lence rate of HIV infection (not AIDS) in this group was 5.6/

Direct reporting of anti-HCV-positive test results by labora- 100,000 population (2).

tories has increased the completeness of reporting of HCV- 1. CDC. Appendix: Revised surveillance case definition for HIV infection.

infected persons to health departments. Reporting other MMWR 1999;48(No. RR-13):29-31.

available laboratory or clinical data would improve 2. CDC. HIV/AIDS Surveillance Report, 2002. Atlanta: US Department of Health and Human Services, CDC, Vol. 14. Available at http://

surveillance for hepatitis C by providing information to iden-www.cdc.gov/hiv/stats/hasrlink.htm.

tify patients with acute disease. Improving the accuracy of hepa-titis C surveillance data continues to be a priority because monitoring hepatitis C incidence trends provides information Lyme Disease needed to evaluate the effectiveness of prevention efforts and A total of 23,763 cases of Lyme disease were reported in identify opportunities for prevention.

2002, a 39% increase over 2001 and the highest number reported since national surveillance began in 1982. As in pre-HIV Infection, Adult vious years, the majority of cases were reported from the north-eastern and north-central United States. Factors potentially By December 2002, 49 states and the District of Columbia contributing to the overall increase in Lyme disease include had an HIV surveillance system in place. Since 1998, 30 areas better reporting, increased development in wooded areas, and (29 states and the U.S. Virgin Islands) have had laws or regu- growing deer populations. In addition, ecological studies sug-lations requiring confidential reporting by name for adults/ gest that infected ticks are spreading to new areas. The only adolescents or children with confirmed HIV infection, in Lyme disease vaccine licensed in the United States (LYMErix) addition to reporting of persons with AIDS (1). CDC also was removed from the market in February 2002. New initiated a pilot system in 2002 to monitor HIV incidence. products aimed at reducing ticks on mice and deer are under development.

10 MMWR April 30, 2004 Malaria first 3 of the 5 doses of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine recommended by age 6; 3%

Almost all malaria cases are imported, with more than twice occurred among children aged 6-11 months (15.4/100,000);

as many cases occurring among U.S. residents traveling to 14% among children aged 1-4 years (8.9/100,000); 10%

malarious areas as occur among foreign residents immigrating among children aged 5-9 years (4.8/100,000); 29% among to or visiting the United States (1). Over 75% of cases among persons aged 10-19 years (7.0/100,000); and 23% among U.S. residents occur in persons who were either not taking persons aged >20 years (1.2/100,000).

malaria chemoprophylaxis or did not take recommended drugs Since 1995, the coverage rate with >3 doses of pertussis vac-(1).The annual number of cases has increased during the past cine has been >94% among U.S. children aged 19-35 months 15 years, likely because of increases in both international travel (1). Since 1980, the number of reported cases of pertussis in (2) and immigration (3), as well as the spread and intensifica-infants aged <6 months and in adolescents and adults has in-tion of antimalarial drug resistance globally (4).

1. Filler S, Causer LM, Newman RD, et al. Malaria surveillanceUnited creased in some states (2). The reasons for this increase are States, 2001. In: CDC Surveillance Summaries, July 18, 2003. MMWR unknown but could include increased awareness of pertussis 2003;52(No SS-5):1-14. among health-care providers, better reporting of cases to health

2. Office of Travel and Tourism Industries. International travelers to and departments (3), and possibly an increase in circulating from the U.S.international visitors (inbound) and U.S. residents (out- Bordetella pertussis. The true number of pertussis cases in ado-bound), 1992-2002r. Washington, DC: US Department of Commerce, lescents and adults has likely been underreported because the ITA, Office of Travel and Tourism Industries. Available at http://

www.tinet.ita.doc.gov/view/f-2001-05-001/index.html. pertussis cough is not pathognomonic for pertussis, persons

3. US Census Bureau. Current population reports. Series P23-206. Profile may not seek medical care for a cough illness, and (if medical of the foreign-born population in the United States, 2000. Washington, care is sought) diagnostic tests are not sufficiently sensitive.

DC: US Government Printing Office, 2001. Available at http:// Adolescents and adults can become susceptible to disease when www.census.gov/prod/2002pubs/p23-206.pdf. vaccine-induced immunity wanes, approximately 5-10 years 4 Barat LM, Bloland PB. Drug resistance among malaria and other para-sites. Infect Dis Clin North Am 1997;11:969-87.

after pertussis vaccination. The incidence of reported pertus-sis among children aged 7 months to 9 years has been rela-tively stable, suggesting protection against pertussis by Measles routine vaccination according to the recommended schedule.

1. CDC. National, state, and urban area vaccination levels among children A record low of 44 confirmed measles cases was reported in aged 19-35 monthsUnited States, 2002. MMWR 2003;52:728-32.

2002, with cases occurring in 17 states. Eighteen cases were 2. CDC. PertussisUnited States, 1997-2000. MMWR 2002;51:73-6.

internationally imported, and exposure to these cases resulted 3. Cherry JD. The science and fiction of the resurgence of pertussis. Pedi-in 15 additional cases. Three other cases had only virologic atrics 2003;112:405-6.

evidence of importation (i.e., genotypic analysis of measles viruses indicated an imported source). The remaining eight cases were classified as unknown source cases because no link Shigellosis to importation was detected. The majority of cases were either Shigella sonnei infections continue to account for over 75%

in infants aged <12 months (18 cases) or persons aged >20 of shigellosis in the United States(1). Prolonged, multistate years (19 cases); only three cases occurred among children aged outbreaks of S. sonnei infections that are transmitted in day

<5 years, and four cases among those aged 5-19 years. Three care centers, where maintenance of good hygienic conditions outbreaks, ranging in size from 3 to 13 cases, accounted for requires special care, account for much of the problem (2).

43% of cases (n=19). In two of these outbreaks, the source From June 2001 through March 2003, one such outbreak in cases were imported. six eastern states accounted for over 3,000 laboratory-confirmed infections (3). S. sonnei can also be transmitted through con-taminated foods and through water used for drinking or rec-Pertussis reational purposes (4). Recent evidence suggests that S. sonnei During 2002, 9,771 cases of pertussis were reported (rate: infections may be increasing among men who have sex with 3.4/100,000), the highest number of reported cases since 1964. men (1).

1. Gupta A, Polyak CS, Bishop RD, Sobel J, Mintz ED. Laboratory-Of these cases, 21% occurred among infants aged <6 months confirmed shigellosis in the United States, 1989-2002: epidemiologic (108.8/100,000), who were too young to have received the trends and patterns. Clin Infect Dis. 2004; in press.

Vol. 51 / No. 53 MMWR 11

2. Shane A, Crump J, Tucker N, Painter J, Mintz E. Sharing Shigella: risk Streptococcus pneumoniae, factors and costs of a multi-community outbreak of shigellosis. Arch Pediatr Adolesc Med 2003;157:601-3. Invasive, Drug-Resistant

3. Day care-related outbreaks of rhamnose-negative Shigella sonneisix In 2002, the Active Bacterial Core Surveillance (ABCs) states, June 2001-March 2003. MMWR 2004;53:60-3.

4. CDC. Outbreaks of Shigella sonnei infection associated with eating fresh project of CDCs Emerging Infections Program (1) collected parsleyUnited States and Canada, July-August 1998. MMWR information on invasive pneumococcal disease, including drug-1999;48:285-9. resistant Streptococcus pneumoniae, in nine states (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New York, Oregon, and Tennessee). For the second straight year, Streptococcal Disease, Invasive, the proportion of pneumococcal isolates that were drug resis-Group A (including streptococcal tant declined. Of the 3,012 S. pneumoniae isolates collected in toxic-shock syndrome) 2002, 9.1% exhibited intermediate resistance to penicillin (minimum inhibitory concentration [MIC] 0.1-1 µg/mL), and During 2002, 986 cases of invasive group A streptococcal 11.5% were fully resistant (MIC >2 µg/mL) (2). For (GAS) disease were reported from nine states (California, Colo- cefotaxime, 8.4% of all isolates had intermediate resistance rado, Connecticut, Georgia, Maryland, Minnesota, New York, and 3.5% were fully resistant in 2001. For erythromycin, Oregon, and Tennessee) through the Active Bacterial Core 16.4% were resistant in 2001. Approximately one in eight Surveillance (ABCs) project under CDCs Emerging Infections (13.2%) isolates had reduced susceptibility to at least three Program (1). Based on these 986 cases, CDC estimates that classes of drugs commonly used to treat pneumococcal approximately 9,100 cases of invasive GAS disease (rate: 3.2/ infections, a decline from a peak of one in five (18.3%)

100,000) and 1,350 deaths occurred nationally during 2002. isolates in 2000.

Disease incidence was highest among children aged <1 year In February 2000, the Food and Drug Administration (6.9/100,000) and adults aged >65 years (8.9/100,000). Strep- licensed a pneumococcal conjugate vaccine for use in infants tococcal toxic-shock syndrome and necrotizing fasciitis and young children. In October 2000, the Advisory Commit-accounted for approximately 5.9% and 6.1% of invasive cases, tee on Immunization Practices issued recommendations for respectively. The overall case-fatality rate among persons with use of the vaccine in children aged <5 years (3). Vaccine use invasive GAS disease was 14.6%. has reduced rates of invasive pneumococcal disease markedly In 2002, CDC published recommendations for the control among children, the vaccines target age group, but also among of invasive group A streptococcal disease among household unvaccinated older persons (4).

contacts of persons with invasive GAS infections and for 1. Schuchat A, Hilger T, Zell E, et al. Active Bacterial Core Surveillance of responding to postpartum and postsurgical infections. These the Emerging Infections Program Network. Emerg Infect Dis 2001;7:1-8.

recommendations are based on routine surveillance data, stud- Available at http://www.cdc.gov/ncidod/eid/vol7no1/schuchat.htm.

ies of the epidemiology of subsequent invasive GAS infections 2. NCCLS. Performance standards for antimicrobial susceptibility testing:

M100-S12. Wayne, PA: National Committee for Clinical Laboratory among household contacts of case-patients and postpartum Standards, 2002.

and postsurgical GAS clusters, and studies of the effectiveness 3. CDC. Preventing pneumococcal disease among infants and young chil-of chemoprophylactic regimens for eradicating carriage (2-4). dren: recommendations of the Advisory Committee on Immunization

1. CDC. Active Bacterial Core Surveillance (ABCs) report. Emerging Practices. MMWR 2000;49(No. RR-9):1-38.

Infections Program Network. Group A streptococcus, 2001. Available at 4. Whitney CG, Farley MM, Hadler J, et al. Decline in invasive pneumo-http://www.cdc.gov/ncidod/dbmd/abcs/survreports/gas01_provis.pdf coccal disease following the introduction of protein-polysaccharide

2. The Prevention of Invasive Group A Streptococcal Infections Workshop conjugate vaccine. N Engl J Med 2003;348:1737-46.

Participants. Prevention of invasive group A streptococcal disease among household contacts of case patients and among postpartum and postsur-gical patients: recommendations from the Centers for Disease Control and Prevention. Clin Infect Dis 2002;35:950-9.

Syphilis, Congenital

3. Robinson KA, Rothrock G, Phan Q, Sayler B, Stefonek K, Van Beneden During 2002, a total of 412 cases of congenital syphilis were C , Levine OS, for the Active Bacterial Core Surveillance (ABCs)/Emerg- reported (10.20/100,000 live births), down from 492 in 2001.

ing Infections Program Network. Risk of severe group A streptococcal Like primary and secondary syphilis, the rate of congenital disease among patients household contacts. Emerg Infect Dis 2003;9:443-7.

4. Factor SH, Levine OS, Schwartz B, et al. Invasive group A streptococcal syphilis has declined sharply in recent years, from a peak of disease: risk factors for adults. Emerg Infect Dis 2003; 9: 970-7. 107.3/100,000 in 1991 (1). The continuing decrease in the

12 MMWR April 30, 2004 rate of congenital syphilis likely reflects the substantial reduc- 2. Pascual FB, McGinley EL, Zanardi LR, Cortese MM, Murphy TV, Teta-tion in the rate of primary and secondary syphilis among nus surveillanceUnited States, 1998-2000. In: CDC Surveillance Sum-maries, June 20, 2003. MMWR 2003;52(No. SS-3).

women that has occurred in the last decade and continues to occur. Congenital syphilis persists in the United States because a substantial number of women do not receive syphilis sero- Tuberculosis logic testing until late in their pregnancy or not at all. This lack of screening is often related to absent or late prenatal care (2). During 2002, a total of 15,075 cases (rate: 5.3/100,000) of

1. CDC. Sexually transmitted disease surveillance 2002. Atlanta: US tuberculosis (TB) were reported to CDC from the 50 states Department of Health and Human Services, CDC, 2003. and the District of Columbia, representing a 5.7% decrease

2. CDC. Congenital syphilis United States, 2000. MMWR 2001;50:573-7. from 2001 and a 43.5% decrease from 1992, when the num-ber and rate of cases most recently peaked in the United States (1).

Syphilis, Primary and Secondary Despite a 68.4% decline in case rates from 1992 to 2002 During 2002, a total of 6,862 primary and secondary syphilis (31.0/100,000 to 9.8/100,000), U.S.-born non-Hispanic cases were reported, an increase from 6,103 cases in 2001. blacks continued to have the highest TB rate of any U.S.-born From 1990 to 2000, the primary and secondary syphilis rate racial/ethnic population (2). U.S.-born, non-Hispanic blacks declined 90%, from 20.34/100,000 to 2.12/100,000. The had the largest number of TB cases among both U.S.-born 2001 rate (2.2/100,000), the first annual increase in syphilis and foreign-born populations, representing 46.7% of TB cases in over a decade, was 2.1% higher than the 2000 rate, which among U.S.-born persons and approximately one fourth of all was the lowest since reporting began in 1941. The 2002 rate cases (2).

(2.4/100,000) was 9.1% higher than the reported rate in 2001. In 1992, 72.6% of reported cases were among U.S.-born The 2002 primary and secondary syphilis rate reflects a 27% persons (8.2/100,000), and 27.4% were among foreign-born increase among men from 2001 but a 21% decrease among persons (34.5/100,000). In comparison in 2002, 48.2% of women (1). This disparity between men and women, observed reported cases were among U.S.-born persons (2.8/100,000),

across all racial and ethnic groups, along with reported out- and 51.8% of reported cases were among foreign-born per-breaks of syphilis among MSM in large urban areas, suggests sons (23.6/100,000) (2).

that increases in syphilis are occurring among MSM. Rates Despite the decrease in case rate among foreign-born per-remain disproportionately high in the South and among non- sons during the past decade, more than half the TB cases in Hispanic blacks, but rates in these two groups are continuing the United States in 2002 occurred in this population, and the to decline (1,2,3). case rate was eight times greater in this population than among

1. CDC. Sexually transmitted disease surveillance 2002. Atlanta, GA: US U.S.-born persons. To address the high rate, CDC is collabo-Department of Health and Human Services, CDC 2003. rating with public health partners to implement TB control

2. CDC. Primary and secondary syphilis among men who have sex with initiatives among recent international arrivals and residents menNew York City, 2001. MMWR 2002;51:853-6.

3. CDC. Primary and secondary syphilisUnited States, 2000-2001. along the border between the United States and Mexico and MMWR 2002;51:971-3. to strengthen TB programs in countries with a high incidence of TB disease (2). CDC recently updated its comprehensive national action plan to reflect the alignment of its priorities Tetanus with the Institute of Medicine report (3) and to ensure that In 2002, 25 cases of tetanus were reported from 14 states. priority prevention activities are undertaken with optimal col-Three (12%) cases were among persons aged <25 years, 12 laboration and coordination among national and international (48%) cases were among persons aged 25-59 years, and 10 public health partners (4).

(40%) cases were among persons aged >60 years. Although 1. CDC. Reported tuberculosis in the United States, 2002. Atlanta, GA:

US Department of Health and Human Services, CDC, 2003. Available the annual number of reported cases continues to decrease, at http://www.cdc.gov/tb.

the percentage of cases among persons aged 25-59 years has 2. CDC. Trends in tuberculosis morbidityUnited States, 1992-2002.

increased during the last decade; previously, most cases were MMWR 2003;52:217-222.

among persons aged >60 years (1). Three (12%) of the cases 3. Institute of Medicine. Ending neglect: the elimination of tuberculosis in were fatal. the United States. Washington, DC: National Academy Press, 2000.

1. CDC. Tetanus SurveillanceUnited States, 1995-1997. In: CDC 4. CDC. CDCs response to ending neglect: the elimination of tuberculosis Surveillance Summaries, July 3, 1998. MMWR 1998;47(No. SS-2): in the United States. Atlanta: US Department of Health and Human 1-13. Services, CDC, 2002.

Vol. 51 / No. 53 MMWR 13 Typhoid Fever aged 5-11 years, and six occurred among adults aged 26-74 years. In 1999, the Council of State and Territorial Epidemi-In 2002, typhoid fever was diagnosed in 321 persons in the ologists recommended that varicella deaths be reported to CDC United States (NNDSS data), despite the availability of two to monitor the impact of routine varicella vaccination on vari-effective vaccines. Approximately 80% of these cases occurred cella-related mortality (2). However, reporting of varicella among persons who reported international travel during the deaths is incomplete, limiting the usefulness of mortality data preceding 6 weeks. Persons visiting friends and relatives in their in assessing the impact of the varicella vaccination program.

country of origin appear to be at higher risk (1). In many areas CDC encourages states to report varicella deaths so that risk of the world, Salmonella Typhi strains have acquired resistance factors for varicella-related mortality can be identified and the to multiple antimicrobial agents, including ampicillin, percentage of deaths that would have been directly prevent-chloramphenicol, and trimethoprim-sulfamethoxazole (1).

able by following current recommendations for vaccination S. Typhi outbreaks in the United States are usually small in can be determined.

size but can cause significant morbidity and are often In 2003, as an adjunct to mortality surveillance, varicella foodborne, warranting thorough investigation (2). Recently a infection was again designated a nationally notifiable condi-sexually transmitted outbreak of typhoid fever was recognized tion. The objectives of varicella morbidity surveillance at state and reported (3).

1. Ackers ML, Puhr ND, Tauxe RV, Mintz ED. Laboratory based surveil-and national levels are to monitor the epidemiology of vari-lance of Salmonella serotype Typhi infections in the United States: cella by age, place, and over time, to monitor the impact of antimicrobial resistance on the rise. JAMA 2000;283:2668-73. widespread and increasing immunization on the epidemiol-

2. Olsen SJ, Bleasdale SC, Magnano AR, et al. Outbreaks of typhoid fever ogy of varicella, and to allow prompt implementation of in the United States, 1960-1999. Epidemiol Infect 2003;130:13-21. disease control measures (3).

3. Reller M, Olsen S, Kressel A, et al. Sexual transmission of typhoid fever: 1. CDC. Varicella-related deathsUnited States, 2002. MMWR a multi-state outbreak among men who have sex with men. Clin Infect 2003;52:545-7.

Dis 2003;37:141-4. 2. Council of State and Territorial Epidemiologists. CSTE position state-ment 1998-ID-10: inclusion of varicella-related deaths in the National Public Health Surveillance System (NPHSS). Available at http://

Varicella deaths www.cste.org/ps/1998/1998-id-10.htm.

3. Council of State and Territorial Epidemiologists. CSTE position state-In 2002, nine varicella deaths were reported to CDC from ment 2003-ID-06: Varicella surveillance. Available at http://www.cste.org/

eight states (1). Three of the deaths occurred among children position%20statements/02-ID-06.pdf.

14 MMWR April 30, 2004 Vol. 51 / No. 53 MMWR 15 PART 1 Summaries of Notifiable Diseases in the United States, 2002 Abbreviations and Symbols Used in Tables NA Data not available NN Report of disease is not required in that jurisdiction (not notifiable)

No reported cases AS American Samoa CNMI Commonwealth of Northern Mariana Islands GU Guam PR Puerto Rico VI U.S. Virgin Islands Note: Rates <0.01 after rounding are listed as 0.

16 MMWR April 30, 2004 TABLE 1. Reported cases of notifiable diseases,* by month United States, 2002 Disease Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sep. Oct. Nov. Dec. Total AIDS 2,481 2,487 4,273 2,708 3,706 4,288 3,769 3,290 3,580 4,114 3,279 4,770 42,745 Anthrax - - 1 - - - 1 - - - - - 2 Botulism, foodborne 2 2 - 1 1 - 12 2 3 1 2 2 28 Infant 7 3 8 2 8 8 5 6 4 6 5 7 69 Other (includes wound) 2 1 1 1 - 2 1 2 2 3 3 3 21 Brucellosis 6 9 8 15 8 13 7 10 13 10 12 14 125 Chancroid§ - 25 - - 16 - - 13 - - 13 - 67 Chlamydia§¶ - 198,259 - - 205,818 - - 211,442 - - 219,036 - 834,555 Cholera - - - - - - 1 - - - 1 - 2 Coccidioidomycosis** 113 387 480 205 453 594 335 406 395 230 223 1,147 4,968 Cryptosporidiosis 138 168 213 160 162 201 223 541 426 304 245 235 3,016 Cyclosporiasis 5 8 14 2 23 23 31 30 6 4 6 4 156 Diphtheria - - - - - 1 - - - - - - 1 Ehrlichiosis, human granulocytic 2 1 2 4 23 32 76 48 32 44 30 217 511 Human monocytic 2 1 2 1 13 24 36 45 24 27 11 30 216 Encephalitis/meningitis, arboviral, California serogroup 4 1 1 - - 1 10 38 48 37 10 14 164 Eastern equine - - - - - 1 - - 1 3 2 3 10 Powassan - - - - - - - 1 - - - - 1 St. Louis - - 1 - - 2 3 7 3 4 - 8 28 West Nile - 2 - - - 3 136 801 937 507 204 250 2,840 Escherichia coli, enterohemorrhagic (EHEC) O157:H7 95 85 110 157 147 334 413 793 594 388 372 352 3,840 EHEC, serogroup non-O157 4 7 4 7 8 26 21 47 23 18 15 14 194 EHEC, not serogrouped - 2 1 1 1 4 11 10 4 6 10 10 60 Giardiasis 1,135 1,340 1,687 1,423 1,392 1,594 1,438 2,604 2,404 2,033 2,132 2,024 21,206 Gonorrhea§ - 85,773 - - 85,441 - - 91,189 - - 89,449 - 351,852 Haemophilus influenzae, invasive disease 130 160 228 150 128 152 106 127 85 90 171 216 1,743 Age <5 yrs, serotype b 1 2 3 3 4 3 3 6 - 1 2 6 34 Age <5 yrs, non-serotype b 10 18 12 17 14 5 7 11 8 2 24 16 144 Age <5 yrs, unknown serotype 5 22 28 11 14 9 11 9 7 10 15 12 153 Hansen disease 4 6 17 9 7 8 8 5 3 2 10 17 96 Hantavirus pulmonary syndrome - 1 - 3 2 5 1 3 - 1 1 2 19 Hemolytic uremic syndrome, postdiarrheal 7 4 10 13 10 30 24 43 17 11 27 20 216 Hepatitis A, acute 710 852 1,026 771 657 768 587 796 727 656 646 599 8,795 Hepatitis B, acute 381 493 808 516 656 677 597 747 542 574 772 1,233 7,996 Hepatitis C/non-A, non-B 95 128 205 170 162 154 128 224 154 108 142 165 1,835 Legionellosis 58 62 70 46 57 124 121 155 145 165 181 137 1,321 Listeriosis 29 27 39 36 43 49 56 103 74 74 76 59 665

Vol. 51 / No. 53 MMWR 17 TABLE 1. (Continued) Reported cases of notifiable diseases,* by month United States, 2002 Disease Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sep. Oct. Nov. Dec. Total Lyme disease 357 414 632 546 835 2,335 3,358 3,856 2,926 3,083 2,485 2,936 23,763 Malaria 83 88 83 86 97 147 134 220 147 121 97 127 1,430 Measles 2 2 4 4 - 3 5 6 - - 13 5 44 Meningococcal disease 124 197 253 183 150 173 90 140 92 96 148 168 1,814 Mumps 13 23 43 16 26 31 15 22 19 19 17 26 270 Pertussis 292 495 664 561 549 893 708 1,142 715 788 976 1,988 9,771 Plague - - - - - - - - - - 1 1 2 Psittacosis 6 1 2 - 1 1 - 1 - - 3 3 18 Q fever 3 1 5 7 3 4 8 4 8 5 4 9 61 Rabies, animal 406 411 677 676 606 710 602 986 763 608 698 466 7,609 Rabies, human - - - 1 - - - - 1 1 - - 3 Rocky Mountain spotted fever 22 24 28 31 71 158 131 185 124 147 70 113 1,104 Rubella - 2 1 1 2 1 2 1 1 5 - 2 18 Rubella, congenital syndrome - - 1 - - - - - - - - - 1 Salmonellosis 1,885 2,282 2,477 2,358 2,809 4,161 4,305 5,889 4,978 4,870 4,354 3,896 44,264 Shigellosis 984 1,089 1,290 1,124 1,209 1,892 1,730 2,666 2,280 2,717 2,867 3,693 23,541 Streptococcal disease, invasive, group A 331 405 583 589 459 434 297 307 251 246 298 520 4,720 Streptococcal toxic-shock syndrome 10 9 12 17 11 12 4 7 5 4 10 17 118 Streptococcus pneumoniae, invasive, drug-resistant 177 224 424 259 227 192 93 80 101 185 172 412 2,546 Streptococcus pneumoniae, invasive, <5 yrs 29 29 47 54 31 27 51 22 18 51 64 90 513 Syphilis, total (all stages)§ - 7,943 - - 8,278 - - 8,056 - - 8,593 - 32,871 Congenital (age <1 yr)§ - 113 - - 89 - - 116 - - 93 - 412 Primary and secondary§ - 1,507 - - 1,710 - - 1,750 - - 1,895 - 6,862 Tetanus - 1 4 1 3 3 3 1 1 2 2 4 25 Toxic-shock syndrome 10 4 18 7 6 16 6 6 8 5 12 11 109 Trichinosis - 2 1 5 2 - - 3 - - 1 - 14 Tuberculosis 552 886 1,187 1,233 1,354 1,353 1,211 1,326 1,152 1,276 1,173 2,372 15,075 Tularemia 2 1 2 - 6 17 13 12 7 8 4 18 90 Typhoid fever 19 31 32 18 24 28 24 22 38 32 35 18 321 Varicella§§ 1,544 1,896 2,767 1,808 1,846 1,711 272 381 741 1,316 2,646 5,913 22,841 Varicella deaths 2 - 1 1 1 - 1 - 3 - - - 9 Yellow fever - - - - - - - - - - - 1 1

• No cases of western equine encephalitis or paralytic poliomyelitis were reported in 2002.

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, 2002.

§ Totals reported quarterly to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of May 2, 2003.

¶ 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 28, 2003.

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

18 MMWR April 30, 2004 TABLE 2. Reported cases of notifiable diseases, by geographic division and area United States, 2002 Total resident population Botulism Area (in thousands) AIDS* Anthrax Foodborne Infant Other Brucellosis Chancroid§ UNITED STATES 281,418 42,745¶ 2 28 69 21 125 67 NEW ENGLAND 13,923 1,616 - 2 1 - 1 3 Maine 1,275 28 - 2 1 - - -

N.H. 1,236 41 - - - - - -

Vt. 609 12 - - - - - -

Mass. 6,349 810 - - - - 1 3 R.I. 1,048 107 - - - - - -

Conn. 3,406 618 - - - - - -

MID. ATLANTIC 39,671 9,911 - 1 22 - 4 2 Upstate N.Y. 11,291 1,342 - - - - 1 -

N.Y. City 7,685 5,322 - - 4 - 2 2 N.J. 8,414 1,436 - - 3 - - -

Pa. 12,281 1,811 - 1 15 - 1 -

E.N. CENTRAL 45,154 4,355 - - 5 - 18 1 Ohio 11,353 780 - - 2 - 3 -

Ind. 6,080 491 - - 1 - - -

Ill. 12,419 2,108 - - 1 - 7 -

Mich. 9,938 789 - - 1 - 7 -

Wis. 5,364 187 - - - - 1 1 W.N. CENTRAL 19,236 800 1 - - - 2 -

Minn. 4,919 161 - - - - 1 -

Iowa 2,926 94 - - - - - -

Mo. 5,595 391 - - - - 1 -

N. Dak. 642 3 - - - - - -

S. Dak. 755 11 1 - - - - -

Nebr. 1,711 70 - - - - - -

Kans. 2,688 70 - - - - - -

S. ATLANTIC 51,768 12,435 - 1 3 - 12 51 Del. 784 193 - - - - - -

Md. 5,296 1,854 - - - - 1 -

D.C. 572 927 - - - - - -

Va. 7,079 955 - 1 3 - - 1 W. Va. 1,808 83 - - - - - -

N.C. 8,049 1,061 - - - N 2 -

S.C. 4,012 833 - - - - 1 43 Ga. 8,186 1,471 - - - - 2 -

Fla. 15,982 5,058 - - - - 6 7 E.S. CENTRAL 17,023 1,962 - - 3 - 1 -

Ky. 4,042 305 - - - - 1 -

Tenn. 5,689 792 - - 3 - - -

Ala. 4,447 432 - - - - - -

Miss. 2,845 433 - - - - - -

W.S. CENTRAL 31,445 4,751 1 1 1 1 38 7 Ark. 2,673 240 - - - - - -

La. 4,469 1,167 - - - - - 2 Okla. 3,451 204 - - - - 1 -

Tex. 20,852 3,140 1 1 1 1 37 5 MOUNTAIN 18,172 1,518 - - 9 - 14 -

Mont. 902 17 - - - - - -

Idaho 1,294 31 - - - - 2 -

Wyo. 494 12 - - - - 1 -

Colo. 4,301 332 - - 2 - 2 -

N. Mex. 1,819 88 - - 1 - 2 -

Ariz. 5,131 630 - - 3 - 6 -

Utah 2,233 94 - - 3 - 1 -

Nev. 1,998 314 - - - - - -

PACIFIC 45,026 5,303 - 23 25 20 35 3 Wash. 5,894 477 - 6 - - 2 1 Oreg. 3,421 301 - 1 2 - - -

Calif. 33,872 4,364 - 1 22 20 32 2 Alaska 627 33 - 15 - - - -

Hawaii 1,212 128 - - 1 - 1 -

Guam 149 3 - - - - - -

P.R. 3,937 1,139 - - - - - 2 V.I. 118 58 U U U U U U Amer. Somoa 62 1 - - - - - -

C.N.M.I. 67 3 - 5 - - - -

N: Not notifiable. U: Unavailable. -: No reported cases. C.N.M.I.: Commonwealth of Northern Mariana Islands.

• 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, 2002.

Includes cases reported as wound and unspecified botulism.

§ Totals reported to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of May 2, 2003.

¶ Total includes 94 cases in persons with unknown state of residence.

Vol. 51 / No. 53 MMWR 19 TABLE 2. (Continued) Reported cases of notifiable diseases, by geographic division and area United States, 2002 Area Chlamydia* Cholera Coccidioidomycosis Cryptosporidiosis Cyclosporiasis Diphtheria UNITED STATES 834,555 2 4,968 3,016 156 1 NEW ENGLAND 27,870 - - 193 22 -

Maine 1,805 - N 12 - -

N.H. 1,557 - - 31 1 -

Vt. 954 - N 33 N -

Mass. 10,914 - - 77 14 -

R.I. 2,832 - - 21 - -

Conn. 9,808 - N 19 7 -

MID. ATLANTIC 97,078 - - 428 59 -

Upstate N.Y. 18,060 - N 153 13 -

N.Y. City 33,063 - - 147 36 -

N.J. 14,164 - - 17 7 -

Pa. 31,791 - N 111 3 -

E.N. CENTRAL 152,505 - 23 960 6 -

Ohio 38,032 - N 119 - -

Ind. 17,100 - N 70 - -

Ill. 48,101 - 3 121 3 -

Mich. 32,272 - 20 135 3 -

Wis. 17,000 - N 515 - -

W.N. CENTRAL 47,517 - 2 447 - -

Minn. 10,107 - - 206 - -

Iowa 6,195 - N 49 - -

Mo. 16,181 - - 41 - -

N. Dak. 1,256 - N 41 N -

S. Dak. 2,215 - - 42 - -

Nebr. 4,779 - 2 52 - -

Kans. 6,784 - N 16 - -

S. ATLANTIC 158,923 1 4 343 61 -

Del. 2,649 - N 4 - -

Md. 16,891 1 4 19 - -

D.C. 3,305 - - 5 3 -

Va. 18,518 - - 35 1 -

W. Va. 2,464 - N 3 - -

N.C. 24,726 - N 40 - -

S.C. 14,314 - - 8 3 -

Ga. 33,998 - N 123 22 -

Fla. 42,058 - N 106 32 -

E.S. CENTRAL 52,209 - - 128 1 -

Ky. 8,756 - N 10 N -

Tenn. 16,042 - - 61 1 -

Ala. 15,611 - - 47 - -

Miss. 11,800 - N 10 - -

W.S. CENTRAL 106,079 - 14 68 1 -

Ark. 7,312 - - 8 - -

La. 18,442 - N 10 - -

Okla. 10,804 - N 16 - -

Tex. 69,521 - 14 34 1 -

MOUNTAIN 51,816 - 3,198 160 1 -

Mont. 2,475 - - 6 - -

Idaho 2,503 - - 29 1 -

Wyo. 944 - 1 9 - -

Colo. 14,028 - N 57 - -

N. Mex. 7,417 - 9 20 - -

Ariz. 14,973 - 3,133 19 N -

Utah 3,540 - 11 16 - -

Nev. 5,936 - 44 4 - -

PACIFIC 140,558 1 1,727 289 5 1 Wash. 14,934 1 N 46 5 -

Oreg. 7,009 - - 40 - -

Calif. 110,288 - 1,727 200 - 1 Alaska 3,806 - - 1 - -

Hawaii 4,521 - - 2 - -

Guam 550 1 - - - -

P.R. 2,999 - N N N -

V.I. 207 U U U U U Amer. Somoa - - - - - -

C.N.M.I. - - - - - -

N: Not notifiable. U: Unavailable. -: No reported cases.

• Totals reported to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of May 2, 2003. Chlamydia refers to genital infections caused by Chlamydia trachomatis.

20 MMWR April 30, 2004 TABLE 2. (Continued) Reported cases of notifiable diseases, by geographic division and area United States, 2002 Ehrlichiosis Encephalitis/meningitis, arboviral*

Human Human California Eastern Area granulocytic monocytic serogroup equine Powassan St. Louis West Nile UNITED STATES 511 216 164 10 1 28 2,840 NEW ENGLAND 145 9 - - - - 29 Maine 1 - - - - - -

N.H. 1 3 - - - - -

Vt. - - - - - - -

Mass. 29 1 - - - - 18 R.I. 65 5 - - - - 1 Conn. 49 - - - - - 10 MID. ATLANTIC 181 28 - - - - 138 Upstate N.Y. 159 19 - - - - 51 N.Y. City 17 2 - - - - 28 N.J. 5 6 - - - - 23 Pa. - 1 - - - - 36 E.N. CENTRAL 5 4 71 6 1 5 1,629 Ohio - 3 26 - - - 439 Ind. 1 - 4 - - - 19 Ill. - 1 8 - - 2 554 Mich. - - 11 6 1 3 566 Wis. 4 - 22 - - - 51 W.N. CENTRAL 170 55 16 - - - 200 Minn. 149 4 13 - - - 17 Iowa - - 3 - - - -

Mo. 19 50 - - - - 113 N. Dak. N N - - - - 2 S. Dak. - - - - - - 14 Nebr. - - - - - - 35 Kans. 2 1 - - - - 19 S. ATLANTIC 7 52 56 2 - 2 104 Del. 2 3 - - - - -

Md. 3 27 - - - - 21 D.C. - - - - - - -

Va. - 1 2 - - 1 29 W. Va. - - 40 - - - 3 N.C. 1 13 13 - - - -

S.C. - - - 1 - - 1 Ga. - 3 1 - - - 21 Fla. 1 5 - 1 - 1 29 E.S. CENTRAL 1 30 18 2 - - 279 Ky. - 2 2 - - - 42 Tenn. - 26 15 - - - 11 Ala. 1 2 - - - - 34 Miss. - - 1 2 - - 192 W.S. CENTRAL 1 38 3 - - 19 455 Ark. - 18 - - - - 33 La. - - 1 - - - 204 Okla. - 13 - - - - 14 Tex. 1 7 2 - - 19 204 MOUNTAIN - - - - - 2 6 Mont. - - - - - - 1 Idaho - - - - - - 1 Wyo. - - - - - - -

Colo. N N - - - - -

N. Mex. - - - - - - -

Ariz. - - - - - 2 4 Utah - - - - - - -

Nev. - - - - - - -

PACIFIC 1 - - - - - -

Wash. - - - - - - -

Oreg. - - - - - - -

Calif. 1 - - - - - -

Alaska - - - - - - -

Hawaii - - - - - - -

Guam - - - - - - -

P.R. N N - - - - -

V.I. - - - - - - -

Amer. Somoa - - - - - - -

C.N.M.I. - - - - - - -

N: Not notifiable. U: Unavailable. -: No reported cases.

• No cases of western equine encephalitis were reported in 2002.

Vol. 51 / No. 53 MMWR 21 TABLE 2. (Continued) Reported cases of notifiable diseases, by geographic division and area United States, 2002 Escherichia coli, enterohemorrhagic (EHEC) Haemophilus influenzae, invasive disease Shiga toxin positive All ages Age <5 years Non- Not All Serotype Non-serotype Unknown Area O157:H7 O157 serogrouped Giardiasis Gonorrhea* serotypes b b serotype UNITED STATES 3,840 194 60 21,206 351,852 1,743 34 144 153 NEW ENGLAND 265 51 7 1,769 7,743 135 - 12 2 Maine 39 10 - 213 142 2 - - -

N.H. 35 - - 46 120 14 - - -

Vt. 14 1 1 145 98 7 - - -

Mass. 120 21 6 935 3,242 46 - 5 2 R.I. 12 1 - 170 900 16 - - -

Conn. 45 18 - 260 3,241 50 - 7 -

MID. ATLANTIC 426 1 8 4,304 43,029 326 4 17 26 Upstate N.Y. 183 N N 1,347 9,114 134 2 4 9 N.Y. City 19 - - 1,417 12,727 70 - - 10 N.J. 63 - 1 474 7,894 58 - - 7 Pa. 161 1 7 1,066 13,294 64 2 13 -

E.N. CENTRAL 855 31 6 3,597 74,540 319 4 15 44 Ohio 154 11 5 972 22,008 82 - 1 10 Ind. 87 1 - N 7,395 44 2 9 -

Ill. 191 6 - 1,011 24,026 120 - - 21 Mich. 134 3 1 923 14,770 18 2 5 -

Wis. 289 10 - 691 6,341 55 - - 13 W.N. CENTRAL 521 34 12 2,321 18,124 81 1 3 7 Minn. 163 29 - 982 3,049 52 1 3 4 Iowa 121 - - 314 1,480 1 - - -

Mo. 70 - - 512 8,952 13 - - 2 N. Dak. 20 - 4 47 72 7 - - 1 S. Dak. 41 2 - 83 263 1 - - -

Nebr. 74 3 - 191 1,564 2 - - -

Kans. 32 - 8 192 2,744 5 - - -

S. ATLANTIC 488 39 3 3,076 89,450 385 5 17 29 Del. 10 N N 54 1,576 - - - -

Md. 29 - - 118 9,355 98 2 4 1 D.C. 3 - - 47 2,669 - - - -

Va. 70 11 - 386 10,462 41 - - 5 W. Va. 9 - 3 78 974 20 - 1 1 N.C. 244 N N N 15,531 33 - 3 -

S.C. 7 - - 149 9,152 15 - - 2 Ga. 47 8 - 926 18,383 84 - - 13 Fla. 69 20 - 1,318 21,348 94 3 9 7 E.S. CENTRAL 113 - 10 396 30,113 74 1 5 13 Ky. 30 - 10 N 3,772 10 - 1 2 Tenn. 52 - - 191 9,348 38 - 1 7 Ala. 20 - - 205 10,118 16 1 3 1 Miss. 11 N N - 6,875 10 - - 3 W.S. CENTRAL 115 2 9 269 47,620 76 4 12 3 Ark. 12 - - 175 4,584 5 - - -

La. 4 - - 6 11,387 11 - - 3 Okla. 25 - - 85 4,661 53 - 12 -

Tex. 74 2 9 3 26,988 7 4 - -

MOUNTAIN 347 29 5 1,750 11,412 199 7 42 17 Mont. 31 - - 94 123 - - - -

Idaho 45 18 - 137 94 2 - - 1 Wyo. 15 2 - 29 65 2 - - -

Colo. 98 6 5 571 3,511 35 - - 4 N. Mex. 14 3 - 153 1,462 27 - 6 1 Ariz. 39 N N 269 3,795 101 5 30 7 Utah 77 - - 335 374 20 1 4 1 Nev. 28 - - 162 1,988 12 1 2 3 PACIFIC 710 7 - 3,724 29,821 148 8 21 12 Wash. 166 - - 510 2,925 5 2 3 -

Oreg. 206 7 - 447 909 57 - - 3 Calif. 293 - - 2,561 24,606 44 6 17 4 Alaska 8 - - 115 641 2 - - 2 Hawaii 37 - - 91 740 40 - 1 3 Guam - - - 7 49 - - - -

P.R. 1 - N 86 411 2 - - 1 V.I. - - - - 49 - - - -

Amer. Somoa - - - - - - - - -

C.N.M.I. - - - 1 - - - - -

N: Not notifiable. U: Unavailable. -: No reported cases.

• Totals reported to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of May 2, 2003.

22 MMWR April 30, 2004 TABLE 2. (Continued) Reported cases of notifiable diseases, by geographic division and area United States, 2002 Hemolytic Hansen Hantavirus uremic Hepatitis, acute viral disease pulmonary syndrome, C; non-A Area (leprosy) syndrome postdiarrheal A B non-B Legionellosis Listeriosis UNITED STATES 96 19 216 8,795 7,996 1,835 1,321 665 NEW ENGLAND 4 - 31 295 251 22 123 64 Maine - - 3 8 14 - 6 5 N.H. - - 2 12 25 - 7 4 Vt. N - 1 4 7 15 35 3 Mass. - - 16 144 169 6 45 34 R.I. 2 - 1 34 36 1 11 2 Conn. 2 N 8 93 U - 19 16 MID. ATLANTIC 15 - 23 1,121 1,559 119 377 194 Upstate N.Y. - N 18 189 140 56 118 59 N.Y. City 10 - 3 445 733 - 66 39 N.J. 4 - 2 188 344 5 35 37 Pa. 1 - - 299 342 58 158 59 E.N. CENTRAL 1 - 16 1,030 756 118 296 91 Ohio - - 11 301 110 2 123 26 Ind. - - - 51 85 1 22 12 Ill. - - - 262 185 24 28 23 Mich. - - - 220 327 87 85 22 Wis. 1 - 5 196 49 4 38 8 W.N. CENTRAL 1 2 19 299 257 643 71 22 Minn. 1 - 11 53 52 14 18 4 Iowa - - 3 66 20 1 13 3 Mo. - - 2 84 119 612 19 10 N. Dak. N - - 4 8 - 1 1 S. Dak. - - - 3 3 1 4 1 Nebr. - 1 2 19 31 15 16 2 Kans. - 1 1 70 24 - - 1 S. ATLANTIC 4 1 24 2,422 1,811 215 234 90 Del. - - - 15 14 - 10 N Md. - 1 N 300 131 14 56 21 D.C. - - - 81 22 - 6 -

Va. - - 8 163 224 15 35 10 W. Va.. N - - 24 25 4 - 1 N.C. N - 2 209 233 29 13 8 S.C. - - - 65 135 5 10 8 Ga. N - 9 509 484 64 19 14 Fla. 4 - 5 1,056 543 84 85 28 E.S. CENTRAL 2 - 7 273 405 140 50 21 Ky. 2 - N 47 67 5 22 4 Tenn. - - 7 124 145 31 20 12 Ala. - - - 39 101 11 8 4 Miss. - - - 63 92 93 - 1 W.S. CENTRAL 21 3 7 1,070 1,473 405 37 38 Ark. - - - 74 118 12 - -

La. - - 1 89 135 99 4 5 Okla. - - 3 52 110 21 5 9 Tex. 21 3 3 855 1,110 273 28 24 MOUNTAIN 4 10 22 569 635 58 57 34 Mont. - - - 13 10 1 4 -

Idaho 2 1 1 31 7 1 3 2 Wyo. - - 1 3 17 5 2 -

Colo. - 1 14 74 79 6 9 7 N. Mex. - - 1 32 146 3 2 3 Ariz. - 3 N 306 252 7 15 18 Utah 2 4 4 56 53 4 16 3 Nev. - 1 1 54 71 31 6 1 PACIFIC 44 3 67 1,716 849 115 76 111 Wash. - - 1 162 83 27 8 11 Oreg. 1 - 22 65 128 13 5 9 Calif. 32 3 43 1,452 614 74 60 83 Alaska - - - 12 12 - 2 -

Hawaii 11 - 1 25 12 1 1 8 Guam - - - 1 1 - - -

P.R. 1 N N 239 211 - 1 2 V.I. - - - - - - - -

Amer. Samoa - - - 21 12 - - -

C.N.M.I. 1 - - - 37 - - -

N: Not notifiable. U: Unavailable. -: No reported cases.

Vol. 51 / No. 53 MMWR 23 TABLE 2. (Continued) Reported cases of notifiable diseases, by geographic division and area United States, 2002 Lyme Measles Meningococcal Area disease Malaria Indigenous Imported* disease Mumps Pertussis Plague UNITED STATES 23,763 1,430 26 18 1,814 270 9,771 2 NEW ENGLAND 7,807 85 - - 95 8 925 -

Maine 219 6 - - 7 - 21 -

N.H. 261 8 - - 14 5 78 -

Vt. 37 4 - - 4 - 172 -

Mass. 1,807 33 - - 48 2 602 -

R.I. 852 12 - - 6 - 22 -

Conn. 4,631 22 - - 16 1 30 -

MID. ATLANTIC 11,873 375 4 5 222 34 694 -

Upstate N.Y. 5,476 52 - 1 60 5 442 -

N.Y. City 59 230 3 3 37 4 24 -

N.J. 2,349 43 - 1 29 3 34 -

Pa. 3,989 50 1 - 96 22 194 -

E.N. CENTRAL 1,266 163 2 3 265 39 1,097 -

Ohio 82 24 - 1 74 11 441 -

Ind. 21 15 1 1 37 2 183 -

Ill. 47 62 1 - 57 18 231 -

Mich. 26 46 - - 45 7 62 -

Wis. 1,090 16 - 1 52 1 180 -

W.N. CENTRAL 966 73 1 3 154 20 822 -

Minn. 867 31 - 2 36 5 429 -

Iowa 42 4 - - 29 1 157 -

Mo. 41 16 1 1 52 4 147 -

N. Dak. 1 1 - - 4 2 9 -

S. Dak. 2 2 - - 2 - 8 -

Nebr. 6 6 - - 23 2 9 -

Kans. 7 13 - - 8 6 63 -

S. ATLANTIC 1,486 334 2 3 297 28 453 -

Del. 194 5 - - 7 - 4 -

Md. 738 109 - - 9 9 68 -

D.C. 25 22 - - - - 2 -

Va. 259 36 - - 46 5 168 -

W. Va.. 26 3 - - 5 - 35 -

N.C. 137 22 - - 35 2 46 -

S.C. 26 9 - - 34 3 48 -

Ga. 2 52 1 2 32 2 29 -

Fla. 79 76 1 1 129 7 53 -

E.S. CENTRAL 76 22 11 1 98 13 273 -

Ky. 25 8 - - 18 3 103 -

Tenn. 28 4 - - 38 2 124 -

Ala. 11 5 11 1 22 3 37 -

Miss. 12 5 - - 20 5 9 -

W.S. CENTRAL 147 87 - 1 229 18 1,870 -

Ark. 3 3 - - 26 - 488 -

La. 5 4 - - 48 1 7 -

Okla. - 11 - - 25 2 135 -

Tex. 139 69 - 1 130 15 1,240 -

MOUNTAIN 19 57 1 - 95 18 1,717 2 Mont. - 2 - - 3 - 10 -

Idaho 4 - - - 5 1 151 -

Wyo. 2 - - - - - 11 -

Colo. 1 25 - - 26 2 465 -

N. Mex. 1 3 - - 4 1 200 2 Ariz. 4 17 - - 32 1 717 -

Utah 5 6 - - 5 7 115 -

Nev. 2 4 1 - 20 6 48 -

PACIFIC 123 234 5 2 359 92 1,920 -

Wash. 11 26 - 1 76 - 575 -

Oreg. 12 12 - - 46 - 188 -

Calif. 97 185 5 - 224 70 1,120 -

Alaska 3 2 - - 4 - 7 -

Hawaii - 9 - 1 9 22 30 -

Guam - - 9 - 1 - 2 -

P.R.N 1 2 - 7 6 3 3 V.I. - - - - - - - -

Amer. Samoa - - - - 2 4 - -

C.N.M.I. - - - - - - 1 -

N: Not notifiable. U: Unavailable. -: No reported cases.

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

24 MMWR April 30, 2004 TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2002 Rubella Rabies Congenital Area Psittacosis Q Fever Animal Human RMSF Rubella syndrome Salmonellosis UNITED STATES 18 61 7,609 3 1,104 18 1 44,264 NEW ENGLAND - - 837 - 10 - - 2,234 Maine - - 64 - - - - 147 N.H. - - 50 - - - - 142 Vt. - N 89 - - - - 77 Mass. - - 303 - 3 - - 1,222 R.I. - - N - 4 - - 189 Conn. N - 331 - 3 - - 457 MID. ATLANTIC 3 2 1,348 - 59 2 - 5,884 Upstate N.Y. 2 - 701 - - 1 - 1,614 N.Y. City 1 1 21 - 10 - - 1,396 N.J. - - 188 - 16 - - 1,044 Pa. - 1 438 - 33 1 - 1,830 E.N. CENTRAL - 6 163 - 33 3 - 5,568 Ohio - 1 39 - 13 - - 1,425 Ind. - - 31 - 5 - - 599 Ill. - 3 31 - 12 2 - 1,770 Mich. - 1 46 - 3 1 - 875 Wis. - 1 16 - - - - 899 W.N. CENTRAL - 9 485 1 105 - - 2,659 Minn. - 1 47 - 1 - - 591 Iowa - N 79 1 3 - - 507 Mo. - 1 50 - 96 - - 830 N. Dak. N - 59 - - - - 55 S. Dak. - 1 96 - 1 - - 121 Nebr. - 4 - - 4 - - 203 Kans. - 2 154 - - - - 352 S. ATLANTIC 5 7 2,660 - 494 5 - 11,725 Del. - N 55 - 1 - - 103 Md. - 1 396 - 43 - - 938 D.C. - 1 - - 2 - - 82 Va. - - 592 - 43 - - 1,277 W. Va.. - N 172 - 2 - - 173 N.C. - 2 702 - 294 - - 1,655 S.C. 2 - 151 - 75 - - 895 Ga. - 1 411 - 19 - - 1,952 Fla. 3 2 181 - 15 5 - 4,650 E.S. CENTRAL - 14 216 1 134 - 1 3,331 Ky. - 9 28 - 5 - - 415 Tenn. - 3 108 1 85 - 1 886 Ala. - - 76 - 16 - - 864 Miss. - 2 4 - 28 - - 1,166 W.S. CENTRAL - 6 1,295 - 249 3 - 4,718 Ark. - - 131 - 125 - - 1,074 La. - - - - - 1 - 792 Okla. - N 126 - 111 - - 527 Tex. N 6 1,038 - 13 2 - 2,325 MOUNTAIN 1 5 311 - 15 - - 2,558 Mont. - - 19 - 1 - - 91 Idaho - 2 38 - - - - 184 Wyo. - - 18 - 5 - - 107 Colo. - 1 59 - 2 - - 607 N. Mex. - - 10 - 1 - - 338 Ariz. - - 143 - 1 - - 829 Utah 1 - 13 - - - - 185 Nev. - 2 11 - 5 - - 217 PACIFIC 9 12 294 1 5 5 - 5,587 Wash. - - - - - 2 - 656 Oreg. - - 14 - 3 - - 342 Calif. 9 12 253 1 2 3 - 4,235 Alaska - - 27 - - - - 86 Hawaii - - - - - - - 268 Guam - - - - - - - 46 P.R. - - 87 - N - - 616 V.I. - - - - - - - -

Amer. Samoa - - - - - - - 1 C.N.M.I. - - - - - - - 25 N: Not notifiable. U: Unavailable. -: No reported cases.

• No cases of paralytic poliomyelitis were reported in 2002.

Rocky Mountain spotted fever.

Vol. 51 / No. 53 MMWR 25 TABLE 2. (Continued) Reported cases of notifiable diseases, by geographic division and area United States, 2002 Streptococcal Streptococcus Streptococcus disease, Streptococcal pneumoniae, pneumoniae, Syphilis*

invasive, toxic-shock invasive, invasive, Congenital Primary &

Area Shigellosis group A syndrome drug-resistant (<5 years) All stages (age <1 yr) secondary UNITED STATES 23,541 4,720 118 2,546 513 32,871 412 6,862 NEW ENGLAND 353 334 6 136 81 831 1 152 Maine 10 20 - - - 9 - 2 N.H. 15 36 - - - 24 - 8 Vt. 1 10 5 5 2 2 - 2 Mass. 203 112 - N 74 541 1 99 R.I. 20 23 1 27 5 67 - 13 Conn. 104 133 N 104 U 188 - 28 MID. ATLANTIC 1,908 745 5 139 95 5,630 66 752 Upstate N.Y. 405 313 N 106 80 396 3 43 N.Y. City 506 157 - - - 3,483 22 435 N.J. 617 146 1 N N 1,062 36 169 Pa. 380 129 4 33 15 689 5 105 E.N. CENTRAL 2,294 998 80 301 172 3,576 81 1,216 Ohio 661 212 15 107 31 351 3 159 Ind. 138 68 18 192 79 318 7 62 Ill. 1,105 279 47 2 - 1,592 39 479 Mich. 200 312 N N N 1,181 32 486 Wis. 190 127 - - 62 134 - 30 W.N. CENTRAL 1,111 282 6 407 77 508 2 127 Minn. 222 147 - 373 70 148 1 59 Iowa 122 N - N N 54 - 8 Mo. 217 47 3 5 1 204 1 34 N. Dak. 22 5 - 2 4 - - -

S. Dak. 157 14 - 1 - - - -

Nebr. 279 28 2 26 2 25 - 6 Kans. 92 41 1 N N 77 - 20 S. ATLANTIC 8,380 741 4 1,161 49 8,706 82 1,839 Del. 418 3 - N N 62 - 11 Md. 1,233 125 N 2 26 839 15 228 D.C. 68 10 - - 4 431 1 58 Va. 1,061 82 2 - - 528 1 71 W. Va.. 13 22 2 60 9 5 - 2 N.C. 1,074 122 - N N 1,049 13 279 S.C. 148 42 - 201 10 619 14 134 Ga. 1,826 133 N 289 N 1,893 10 439 Fla. 2,539 202 N 609 N 3,280 28 617 E.S. CENTRAL 1,573 119 5 151 - 2,437 17 454 Ky. 210 24 5 19 N 212 3 88 Tenn. 180 95 - 132 - 1,074 2 168 Ala. 836 - - - - 700 6 149 Miss. 347 - - - - 451 6 49 W.S. CENTRAL 3,494 322 - 200 34 5,389 84 847 Ark. 199 12 - 15 - 217 8 34 La. 508 1 - 182 11 775 1 152 Okla. 718 56 N N 11 287 2 72 Tex. 2,069 253 - 3 12 4,110 73 589 MOUNTAIN 1,270 603 12 51 5 1,581 21 333 Mont. 4 - - N - 4 - -

Idaho 22 11 - - - 23 - 8 Wyo. 8 7 1 14 - 1 - -

Colo. 213 125 7 N - 174 2 64 N. Mex. 250 114 - 36 - 110 - 39 Ariz. 685 314 - N N 1,085 19 200 Utah 35 32 3 - 5 71 - 7 Nev. 53 - 1 1 - 113 - 15 PACIFIC 3,158 576 - - - 4,213 58 1,142 Wash. 230 60 - N N 158 2 70 Oreg. 109 - - - - 75 - 28 Calif. 2,742 406 - - - 3,912 56 1,033 Alaska 5 - - - - 9 - -

Hawaii 72 110 - - - 59 - 11 Guam 37 - - 4 - 18 - 6 P.R. 31 N N N N 1,390 20 270 V.I. - - - - - 4 - 1 Amer. Samoa 33 - - - - - - -

C.N.M.I. 18 - - - - - - -

N: Not notifiable. U: Unavailable. -: No reported cases.

• Totals reported to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of May 2, 2003.

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

26 MMWR April 30, 2004 TABLE 2. (Continued) Reported cases of notifiable diseases, by geographic division and area United States, 2002 Toxic-shock Typhoid Varicella Varicella§ Yellow Area Tetanus syndrome Trichinosis Tuberculosis* Tularemia fever (chickenpox) deaths fever UNITED STATES 25 109 14 15,075 90 321 22,841 9 1 NEW ENGLAND 2 5 1 474 5 13 5,714 - -

Maine 1 1 - 23 - - 792 - -

N.H. - - - 19 - - - - -

Vt. - 2 1 8 - - 799 - -

Mass. - 2 - 271 5 7 2,290 - -

R.I. 1 - - 49 - - 12 - -

Conn. - N - 104 - 6 1,821 - -

MID. ATLANTIC 4 20 1 2,317 1 80 - 1 -

Upstate N.Y. 1 7 - 350 - 10 N - -

N.Y. City 1 1 - 1,084 1 42 - - -

N.J. 1 1 - 530 - 19 - - -

Pa. 1 11 1 353 - 9 - 1 -

E.N. CENTRAL 3 24 1 1,458 7 34 8,325 3 -

Ohio 1 4 - 257 1 7 1,748 - -

Ind. - - - 128 1 2 N 1 -

Ill. 1 5 1 680 5 17 - 2 -

Mich. 1 11 - 315 - 4 5,352 - -

Wis. - 4 - 78 - 4 1,225 - -

W.N. CENTRAL 1 21 - 543 23 10 20 1 -

Minn. - 10 - 237 1 4 - - -

Iowa 1 1 - 34 N - N - -

Mo. - 6 - 136 16 2 1 - -

N. Dak. - - - 6 - - 19 - -

S. Dak. - 1 - 13 3 - - - -

Nebr. - 3 - 28 1 4 - - -

Kans. - - - 89 2 - N 1 -

S. ATLANTIC 3 14 1 3,058 6 45 2,489 1 -

Del. - 2 - 25 1 - 56 - -

Md. - N - 306 2 11 - - -

D.C. - 1 - 82 - - 43 - -

Va. - 3 - 315 1 8 605 - -

W. Va.. - - - 30 1 - 1,586 - -

N.C. - 5 1 434 1 2 - - -

S.C. - 2 - 256 - - 199 - -

Ga. - 1 N 524 - 5 N - -

Fla. 3 N - 1,086 - 19 N 1 -

E.S. CENTRAL 2 2 1 821 8 4 - 1 -

Ky. - - N 146 2 4 N - -

Tenn. - 2 1 308 4 - - - -

Ala. 1 - - 233 1 - - - -

Miss. 1 - - 134 1 - - 1 -

W.S. CENTRAL 2 - - 2,106 27 30 6,076 - 1 Ark. - - - 136 14 - - - -

La. - - - 230 - - 29 - -

Okla. - - - 190 10 2 N - -

Tex. 2 N - 1,550 3 28 6,047 - 1 MOUNTAIN - 10 - 569 6 11 217 - -

Mont. - - - 12 - - - - -

Idaho - 1 - 14 - - - - -

Wyo. - - - 3 2 - 68 - -

Colo. - 5 - 104 1 5 N - -

N. Mex. - - - 57 2 2 - - -

Ariz. - - - 263 - - 2 - -

Utah - 3 - 31 1 2 147 - -

Nev. - 1 - 85 - 2 - - -

PACIFIC 8 13 9 3,729 7 94 - 2 -

Wash. - - - 252 3 7 - - -

Oreg. - - - 111 2 2 - - -

Calif. 8 13 2 3,169 1 80 - 1 -

Alaska - - 7 49 1 - - - -

Hawaii - - - 148 - 5 - 1 -

Guam - - - 65 - - 68 - -

P.R. 3 N - 129 - - 1,137 - -

V.I. U U U U U U U U U Amer. Samoa 2 - - - - 3 211 - -

C.N.M.I. - - - 53 - - - - -

N: Not notifiable. U: Unavailable. -: No reported cases.

• Totals reported to the Division of Tuberculosis Elimination, NCHSTP, as of March 28, 2003.

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

§ Death counts provided by the Epidemiology and Surveillance Division, National Immunization Program.

Vol. 51 / No. 53 MMWR 27 TABLE 3. Reported cases and incidence rates (per 100,000 population) of notifiable diseases,* by age group United States, 2002

<1 yr 1-4 yrs 5-14 yrs 15-24 yrs 25-39 yrs 40-64 yrs >65 yrs Age not Disease No. (Rate) No. (Rate) No. (Rate) No. (Rate) No. (Rate) No. (Rate) No. (Rate) stated Total AIDS 46 (1.21) 49 (0.32) 131 (0.32) 1,858 (4.74) 19,812 (31.65) 20,045 (23.75) 804 (2.30) - 42,745 Anthrax - (0) - (0) - (0) - (0) 1 (0) 1 (0) - (0) - 2 Botulism, foodborne 2 (0.05) - (0) 2 (0) 1 (0) 1 (0) 12 (0.01) 10 (0.03) - 28 Infant 69 (1.79) - (0) - (0) - (0) - (0) - (0) - (0) - 69 Other (includes wound) - (0) 1 (0.01) - (0) - (0) 6 (0.01) 13 (0.02) 1 (0) - 21 Brucellosis 2 (0.05) 4 (0.03) 14 (0.03) 15 (0.04) 28 (0.04) 39 (0.05) 21 (0.06) 2 125 Chlamydia§¶ - (0) 2,270 (14.77) 15,341 (37.35) 600,224(1,531.81) 188,556 (301.22) 20,321 (24.08) 805 (2.30) 7,038 834,555 Cholera - (0) - (0) - (0) 1 (0) - (0) 1 (0) - (0) - 2 Coccidioidomycosis** 19 (0.87) 39 (0.44) 241 (1.03) 515 (2.34) 1,126 (3.19) 1,954 (4.23) 1,012 (5.56) 62 4,968 Cryptosporidiosis 79 (2.08) 541 (3.52) 451 (1.10) 337 (0.86) 752 (1.20) 631 (0.75) 165 (0.47) 60 3,016 Cyclosporiasis - (0) 2 (0.01) 4 (0.01) 15 (0.04) 32 (0.05) 75 (0.09) 22 (0.07) 6 156 Diphtheria - (0) - (0) - (0) - (0) 1 (0) - (0) - (0) - 1 Ehrlichiosis, human granulocytic 2 (0.05) 6 (0.04) 30 (0.07) 25 (0.06) 80 (0.13) 235 (0.28) 131 (0.38) 2 511 Human monocytic 1 (0.03) 4 (0.03) 7 (0.02) 9 (0.02) 37 (0.06) 97 (0.12) 59 (0.17) 2 216 Encephalitis/meningitis, arboviral, California serogroup 3 (0.08) 35 (0.23) 100 (0.24) 5 (0.01) 10 (0.02) 11 (0.01) - (0) - 164 Eastern equine 1 (0.03) - (0) 1 (0) 1 (0) 2 (0) 3 (0) 2 (0.01) - 10 Powassan - (0) - (0) - (0) - (0) - (0) 1 (0) - (0) - 1 St. Louis 2 (0.05) - (0) 1 (0) 3 (0.01) 5 (0.01) 11 (0.01) 6 (0.02) - 28 West Nile 10 (0.26) 14 (0.09) 47 (0.11) 135 (0.34) 405 (0.65) 1,065 (1.26) 1,159 (3.31) 5 2,840 Escherichia coli, enterohemorrhagic (EHEC)

O157:H7 93 (2.44) 794 (5.17) 1,024 (2.49) 550 (1.40) 360 (0.58) 638 (0.76) 356 (1.02) 25 3,840 EHEC, serogroup non-O157 15 (0.45) 37 (0.28) 38 (0.11) 28 (0.08) 22 (0.04) 27 (0.04) 23 (0.08) 4 194 EHEC, not serogrouped 2 (0.06) 12 (0.09) 10 (0.03) 8 (0.02) 8 (0.01) 8 (0.01) 11 (0.04) 1 60 Giardiasis 386 (10.85) 3,541 (24.61) 2,823 (7.33) 1,350 (3.69) 4,497 (7.68) 4,802 (6.09) 1,027 (3.13) 2,780 21,206 Gonorrhea¶ - (0) 679 (4.42) 5,567 (13.55) 207,324 (529.11) 108,219 (172.88) 26,812 (31.77) 785 (2.24) 2,466 351,852 Haemophilus influenzae, invasive disease - (0) - (0) 89 (0.22) 65 (0.17) 120 (0.19) 401 (0.48) 714 (2.04) 354 1,743 Age <5 yrs, serogroup b 14 (0.37) 20 (0.13) - (0) - (0) - (0) - (0) - (0) - 34 Age <5 yrs, non-serogroup b 90 (2.36) 54 (0.35) - (0) - (0) - (0) - (0) - (0) - 144 Age <5 yrs, unknown serogroup 89 (2.34) 64 (0.42) - (0) - (0) - (0) - (0) - (0) - 153 Hansen disease - (0) - (0) - (0) 15 (0.04) 24 (0.04) 17 (0.02) 6 (0.02) 34 96 Hantavirus pulmonary syndrome - (0) - (0) 1 (0) 3 (0.01) 7 (0.01) 8 (0.01) - (0) - 19 Hemolytic uremic syndrome, postdiarrheal 6 (0.17) 119 (0.82) 48 (0.12) 13 (0.03) 4 (0.01) 13 (0.02) 11 (0.03) 2 216 Hepatitis A 39 (1.02) 258 (1.68) 1,089 (2.65) 1,268 (3.24) 2,556 (4.08) 2,531 (3.00) 952 (2.72) 102 8,795 Hepatitis B 10 (0.27) 6 (0.04) 27 (0.07) 1,094 (2.82) 3,316 (5.36) 2,939 (3.53) 388 (1.12) 216 7,996 Hepatitis C/non-A, non-B 12 (0.34) 6 (0.04) 12 (0.03) 163 (0.42) 537 (0.86) 995 (1.18) 80 (0.24) 30 1,835 Legionellosis 4 (0.11) - (0) 5 (0.01) 28 (0.07) 128 (0.20) 673 (0.80) 476 (1.36) 7 1,321

28 MMWR April 30, 2004 TABLE 3. (Continued) Reported cases and incidence rates (per 100,000 population) of notifiable diseases,* by age group United States, 2002

<1 yr 1-4 yrs 5-14 yrs 15-24 yrs 25-39 yrs 40-64 yrs >65 yrs Age not Disease No. (Rate) No. (Rate) No. (Rate) No. (Rate) No. (Rate) No. (Rate) No. (Rate) stated Total Listeriosis 69 (1.82) 4 (0.03) 10 (0.02) 18 (0.05) 74 (0.12) 170 (0.20) 314 (0.90) 6 665 Lyme disease 96 (2.52) 1,232 (8.02) 4,617 (11.24) 2,155 (5.50) 3,495 (5.58) 8,764 (10.38) 2,991 (8.55) 413 23,763 Malaria 7 (0.18) 42 (0.27) 148 (0.36) 248 (0.63) 453 (0.72) 458 (0.54) 52 (0.15) 22 1,430 Measles 17 (0.45) 3 (0.02) 4 (0.01) 5 (0.01) 11 (0.02) 3 (0) - (0) 1 44 Meningococcal disease 242 (6.36) 254 (1.65) 226 (0.55) 346 (0.88) 169 (0.27) 317 (0.38) 255 (0.73) 5 1,814 Mumps 4 (0.11) 51 (0.33) 100 (0.24) 25 (0.06) 38 (0.06) 43 (0.05) 7 (0.02) 2 270 Pertussis 2,352 (61.80) 1,348 (8.77) 2,642 (6.43) 1,397 (3.57) 876 (1.40) 1,020 (1.21) 111 (0.32) 25 9,771 Plague - (0) - (0) - (0) - (0) - (0) 2 (0) - (0) - 2 Psittacosis - (0) 3 (0.02) 1 (0) 1 (0) 3 (0.01) 6 (0.01) 4 (0.01) - 18 Q fever - (0) - (0) 1 (0) 3 (0.01) 15 (0.02) 33 (0.04) 9 (0.03) - 61 Rabies, human - (0) - (0) 1 (0) 1 (0) 1 (0) - (0) - (0) - 3 Rocky Mountain spotted fever 4 (0.11) 43 (0.28) 137 (0.33) 100 (0.26) 227 (0.36) 437 (0.52) 148 (0.42) 8 1,104 Rubella - (0) - (0) 2 (0) - (0) 13 (0.02) 3 (0) - (0) - 18 Salmonellosis 5,268 (138.43) 7,607 (49.49) 5,536 (13.48) 3,695 (9.43) 5,716 (9.13) 7,683 (9.10) 3,789 (10.83) 4,970 44,264 Shigellosis 473 (12.43) 6,958 (45.27) 6,489 (15.80) 1,605 (4.10) 2,809 (4.49) 1,731 (2.05) 372 (1.06) 3,104 23,541 Streptococcal disease, invasive, group A 148 (3.93) 237 (1.56) 337 (0.83) 223 (0.58) 619 (1.00) 1,493 (1.79) 1,443 (4.18) 220 4,720 Streptococcal toxic-shock syndrome - (0) 2 (0.02) 13 (0.04) 8 (0.03) 21 (0.04) 46 (0.07) 28 (0.11) - 118 Streptococcus pneumoniae, invasive, drug-resistant 159 (5.27) 326 (2.67) 109 (0.33) 57 (0.18) 205 (0.41) 730 (1.10) 826 (2.99) 134 2,546 Streptococcus pneumoniae, invasive, <5 yrs 186 (6.62) 327 (2.88) - (0) - (0) - (0) - (0) - (0) - 513 Syphilis, primary and secondary¶ - (0) 3 (0.02) 16 (0.04) 1,193 (3.04) 3,359 (5.37) 2,222 (2.63) 67 (0.19) 2 6,862 Tetanus - (0) - (0) - (0) 3 (0.01) 7 (0.01) 8 (0.01) 7 (0.02) - 25 Toxic-shock syndrome 2 (0.06) 2 (0.02) 13 (0.04) 33 (0.10) 25 (0.05) 29 (0.04) 5 (0.02) - 109 Trichinosis - (0) - (0) 1 (0) 2 (0.01) 3 (0.01) 7 (0.01) 1 (0) - 14 Tuberculosis 103 (2.71) 454 (2.95) 389 (0.95) 1,499 (3.83) 3,853 (6.16) 5,624 (6.66) 3,147 (8.99) 6 15,075 Tularemia - (0) 8 (0.05) 15 (0.04) 11 (0.03) 12 (0.02) 30 (0.04) 13 (0.04) 1 90 Typhoid fever 7 (0.18) 44 (0.29) 59 (0.14) 65 (0.17) 86 (0.14) 49 (0.06) 8 (0.02) 3 321 Yellow fever - (0) - (0) - (0) - (0) - (0) 1 (0) - (0) - 1

• No cases of paralytic poliomyelitis or western equine encephalitis were reported in 2002.

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, 2002.

§ 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 2, 2003.

• • Notifiable in <40 states.

Totals reported to the Division of Tuberculosis Elimination, NCHSTP, as of March 28, 2003.

Vol. 51 / No. 53 MMWR 29 TABLE 4. Reported cases and incidence rates (per 100,000 population) of notifiable diseases,

• by sex United States, 2002 Male Female Sex not Disease No. (Rate) No. (Rate) stated Total AIDS 31,712 (22.97) 11,033 (7.70) - 42,745 Anthrax 1 (0) 1 (0) - 2 Botulism, foodborne 15 (0.01) 13 (0.01) - 28 Infant 31 (1.57) 38 (2.02) - 69 Other (includes wound) 17 (0.01) 4 (0) - 21 Brucellosis 62 (0.04) 62 (0.04) 1 125 Chancroid§ 24 (0.02) 42 (0.03) 1 67 Chlamydia§¶ 179,580 (130.08) 652,811 (455.34) 2,164 834,555 Cholera - (0) 2 (0) - 2 Coccidioidomycosis** 2,808 (3.65) 2,085 (2.63) 75 4,968 Cryptosporidiosis 1,658 (1.20) 1,301 (0.91) 57 3,016 Cyclosporiasis 68 (0.05) 82 (0.06) 6 156 Diphtheria - (0) 1 (0) - 1 Ehrlichiosis, human granulocytic 282 (0.21) 226 (0.16) 3 511 Human monocytic 129 (0.10) 86 (0.06) 1 216 Encephalitis/meningitis, arboviral, California serogroup 95 (0.07) 69 (0.05) - 164 Eastern equine 7 (0.01) 3 (0) - 10 Powassan - (0) 1 (0) - 1 St. Louis 16 (0.01) 12 (0.01) - 28 West Nile 1,522 (1.10) 1,306 (0.91) 12 2,840 Escherichia coli, enterohemorrhagic (EHEC), O157:H7 1,815 (1.31) 2,010 (1.40) 15 3,840 EHEC, serogroup non-O157 91 (0.08) 96 (0.08) 7 194 EHEC, not serogrouped 20 (0.02) 40 (0.03) - 60 Giardiasis 10,141 (7.85) 8,329 (6.21) 2,736 21,206 Gonorrhea§ 171,496 (124.22) 179,640 (125.30) 716 351,852 Haemophilus influenzae, invasive disease 780 (0.56) 950 (0.66) 13 1,743 Age <5 yrs, serotype b 17 (0.17) 17 (0.18) - 34 Age <5 yrs, non-serotype b 81 (0.82) 62 (0.66) 1 144 Age <5 yrs, unknown serotype 84 (0.85) 67 (0.71) 2 153 Hansen disease 61 (0.05) 24 (0.02) 11 96 Hantavirus pulmonary syndrome 14 (0.01) 5 (0) - 19 Hemolytic uremic syndrome postdiarrheal 99 (0.08) 116 (0.09) 1 216 Hepatitis A 5,431 (3.93) 3,316 (2.31) 48 8,795 Hepatitis B 4,831 (3.54) 3,095 (2.19) 70 7,996 Hepatitis C/non-A, non-B 1,088 (0.79) 727 (0.51) 20 1,835

30 MMWR April 30, 2004 TABLE 4. (Continued) Reported cases and incidence rates (per 100,000 population) of notifiable diseases,

• by sex United States, 2002 Male Female Sex not Disease No. (Rate) No. (Rate) stated Total Legionellosis 831 (0.60) 489 (0.34) 1 1,321 Listeriosis 322 (0.23) 337 (0.24) 6 665 Lyme disease 12,481 (9.04) 11,040 (7.70) 242 23,763 Malaria 934 (0.68) 478 (0.33) 18 1,430 Measles 20 (0.01) 24 (0.02) - 44 Meningococcal disease 954 (0.69) 857 (0.60) 3 1,814 Mumps 146 (0.11) 121 (0.08) 3 270 Pertussis 4,409 (3.19) 5,330 (3.72) 32 9,771 Plague 1 (0) 1 (0) - 2 Psittacosis 4 (0) 14 (0.01) - 18 Q fever 50 (0.04) 11 (0.01) - 61 Rabies, human 3 (0) - (0) - 3 Rocky Mountain spotted fever 617 (0.45) 481 (0.34) 6 1,104 Rubella 14 (0.01) 4 (0) - 18 Salmonellosis 19,116 (13.85) 20,387 (14.22) 4,761 44,264 Shigellosis 9,634 (6.98) 10,895 (7.60) 3,012 23,541 Streptococcal disease invasive, group A 2,345 (1.72) 2,152 (1.52) 223 4,720 Streptococcal toxic-shock syndrome 53 (0.05) 65 (0.06) - 118 Streptococcus pneumoniae, invasive, drug-resistant, 1,288 (1.18) 1,147 (1.01) 111 2,546 Streptococcus pneumoniae, invasive, <5 yrs 283 (3.91) 224 (3.24) 6 513 Syphilis, primary and secondary§ 5,267 (3.82) 1,594 (1.11) 1 6,862 Tetanus 17 (0.01) 8 (0.01) - 25 Toxic-shock syndrome 30 (0.03) 79 (0.07) - 109 Trichinosis 9 (0.01) 5 (0) - 14 Tuberculosis 9,186 (6.65) 5,884 (4.10) 5 15,075 Tularemia 70 (0.05) 20 (0.01) - 90 Typhoid fever 157 (0.11) 162 (0.11) 2 321 Yellow fever 1 (0) - (0) - 1

• No cases of western equine encephalitis or paralytic poliomyelitis were reported in 2002.

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, 2002.

§ Totals reported to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of May 2, 2003.

¶ 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 28, 2003.

Vol. 51 / No. 53 MMWR 31 TABLE 5. Reported cases and incidence rates (per 100,000 population) of notifiable diseases,* by race United States, 2002 American Asian Race Indian or or Pacific not Alaska Native Islander Black White Other stated Disease No. (Rate) No. (Rate) No. (Rate) No. (Rate) No. No. Total AIDS 197 (9.24) 453 (4.12) 21,748 (62.58) 13,174 (6.65) 0 7,173 42,745§ Botulism, foodborne 15 (0.70) 0 (0) 0 (0) 7 (0) 0 6 28 Infant 0 (3.99) 5 (2.96) 1 (0.16) 42 (1.39) 0 21 69 Brucellosis 0 (0) 2 (0.02) 1 (0) 51 (0.03) 1 70 125 Chlamydia¶** 10,924 (512.13) 11,871 (108.04) 280,075 (805.90) 178,802 (90.19) 0 352,883 834,555§ Coccidioidomycosis 42 (3.24) 87 (1.09) 148 (0.83) 1,154 (1.12) 10 3,527 4,968 Cryptosporidiosis 11 (0.52) 26 (0.24) 267 (0.77) 1,842 (0.93) 17 853 3,016 Cyclosporiasis 0 (0) 2 (0.02) 5 (0.01) 105 (0.06) 1 43 156 Ehrlichiosis, human granulocytic 2 (0.09) 2 (0.02) 2 (0.01) 267 (0.14) 1 237 511 Human monocytic 1 (0.05) 0 (0) 6 (0.02) 146 (0.08) 0 63 216 Encepalitis/meningitis, arboviral, California serogroup 1 (0.05) 0 (0) 5 (0.01) 122 (0.06) 2 34 164 St. Louis 0 (0) 0 (0) 1 (0) 14 (0.01) 0 13 28 West Nile 5 (0.23) 8 (0.07) 366 (1.05) 1,669 (0.84) 3 789 2,840 Escherichia coli, enterohemorrhagic (EHEC), O157:H7 153 (7.17) 63 (0.57) 101 (0.29) 2,412 (1.22) 22 1,089 3,840 EHEC, serogroup non-O157 1 (0.06) 1 (0.01) 5 (0.02) 113 (0.06) 0 74 194 EHEC, not serogrouped 0 (0) 0 (0) 2 (0.01) 32 (0.02) 1 25 60 Giardiasis 76 (3.77) 498 (4.62) 808 (2.51) 9,853 (5.37) 99 9,872 21,206 Gonorrhea** 2,049 (96.06) 2,013 (18.32) 198,221 (570.37) 46,781 (23.60) 0 102,788 351,852§ Haemophilus influenzae, invasive disease 39 (1.83) 25 (0.23) 209 (0.60) 1,020 (0.51) 11 439 1,743 Age <5 yrs, serotype b 2 (0.76) 1 (0.12) 2 (0.06) 24 (0.16) 0 5 34 Age <5 yrs, non-serotype b 14 (5.30) 1 (0.12) 15 (0.48) 69 (0.46) 0 45 144 Age <5 yrs, unknown serogroup 8 (3.03) 2 (0.24) 28 (0.90) 74 (0.49) 2 39 153 Hansen disease 0 (0) 23 (0.21) 3 (0.01) 24 (0.01) 1 45 96 Hemolytic uremic syndrome, postdiarrheal 0 (0) 6 (0.06) 6 (0.02) 153 (0.08) 6 45 216 Hepatitis A 90 (4.22) 252 (2.29) 705 (2.03) 4,544 (2.29) 67 3,137 8,795 Hepatitis B 118 (5.55) 237 (2.16) 1,343 (3.86) 2,932 (1.48) 49 3,317 7,996 Hepatitis C/non-A, non-B 16 (0.79) 9 (0.08) 141 (0.41) 913 (0.46) 4 752 1,835 Legionellosis 5 (0.23) 10 (0.09) 160 (0.46) 860 (0.43) 4 282 1,321 Listeriosis 2 (0.09) 35 (0.32) 60 (0.17) 351 (0.18) 6 211 665 Lyme disease 45 (2.11) 134 (1.22) 229 (0.66) 15,408 (7.77) 44 7,903 23,763

32 MMWR April 30, 2004 TABLE 5. (Continued) Reported cases and incidence rates (per 100,000 population) of notifiable diseases,* by race United States, 2002 American Asian Race Indian or or Pacific not Alaska Native Islander Black White Other stated Disease No. (Rate) No. (Rate) No. (Rate) No. (Rate) No. No. Total Malaria 3 (0.14) 66 (0.60) 634 (1.82) 321 (0.16) 37 369 1,430 Measles 0 (0) 9 (0.08) 2 (0.01) 28 (0.01) 1 4 44 Meningococcal disease 16 (0.75) 28 (0.26) 230 (0.66) 1,107 (0.56) 6 427 1,814 Mumps 3 (0.14) 38 (0.35) 16 (0.05) 139 (0.07) 2 72 270 Pertussis 89 (4.17) 110 (1.00) 538 (1.55) 7,355 (3.71) 42 1,637 9,771 Q fever 0 (0) 1 (0.01) 3 (0.01) 40 (0.02) 0 17 61 Rocky Mountain spotted fever 21 (0.99) 6 (0.05) 73 (0.21) 816 (0.41) 0 188 1,104 Salmonellosis 371 (17.39) 607 (5.53) 3,863 (11.12) 21,557 (10.87) 137 17,729 44,264 Shigellosis 421 (19.74) 159 (1.45) 5,838 (16.80) 7,884 (3.98) 97 9,142 23,541 Streptococcal disease, invasive, group A 79 (3.72) 56 (0.52) 514 (1.48) 2,186 (1.12) 22 1,863 4,720 Streptococcal toxic-shock syndrome 0 (0) 0 (0) 18 (0.08) 94 (0.06) 0 6 118 Streptococcus pneumoniae, invasive, drug-resistant 10 (0.81) 11 (0.12) 428 (1.48) 1,431 (0.72) 5 661 2,546 Streptococcus pneumoniae, invasive, <5 yrs 4 (2.04) 7 (1.03) 63 (2.89) 212 (1.91) 16 211 513 Syphilis, primary and secondary** 49 (2.30) 89 (0.81) 3,268 (9.40) 2,190 (1.10) 0 1,266 6,862§ Tetanus 0 (0) 1 (0.01) 1 (0) 15 (0.01) 0 8 25 Toxic-shock syndrome 0 (0) 1 (0.01) 4 (0.01) 84 (0.05) 0 20 109 Tuberculosis§§ 202 (9.47) 3,371 (30.68) 4,537 (13.05) 6,886 (3.47) 0 79 15,075 Tularemia 6 (0.28) 0 (0) 5 (0.01) 60 (0.03) 0 19 90 Typhoid fever 2 (0.09) 80 (0.73) 29 (0.08) 44 (0.02) 13 153 321

• No cases of paralytic poliomyelitis or western equine encephalitis were reported in 2002. 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, 2002.

§ Includes the following cases originally reported as Hispanic: 7,128 for AIDS; 116,869 for chlamydia; 20,537 for gonorrhea; and 919 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 individual case reports. 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 2, 2003.

Notifiable in <40 states.

§§ Totals reported to the Division of Tuberculosis Elimination, NCHSTP, as of March 28, 2003.

Vol. 51 / No. 53 MMWR 33 TABLE 6. Reported cases and incidence rates (per 100,000 population) of notifiable diseases,* by ethnicity United States, 2002 Ethnicity Hispanic Non-Hispanic not Disease No. (Rate) No. (Rate) stated Total AIDS 7,128 (20.19) 34,922 (14.19) 695 42,745 Botulism, foodborne 2 (0.01) 19 (0.01) 7 28 Infant 13 (1.69) 36 (1.17) 20 69 Brucellosis 91 (0.26) 14 (0.01) 20 125 Chlamydia§¶ 116,869 (331.02) 481,672 (195.71) 236,014 834,555 Coccidioidomycosis** 758 (2.95) 926 (0.71) 3,284 4,968 Cryptosporidiosis 182 (0.52) 1,639 (0.67) 1,195 3,016 Cyclosporiasis 10 (0.03) 89 (0.04) 57 156 Ehrlichiosis, human granulocytic 7 (0.02) 170 (0.07) 334 511 Human monocytic 4 (0.01) 144 (0.06) 68 216 Encephalitis/meningitis, arboviral, California serogroup 3 (0.01) 65 (0.03) 96 164 St. Louis 10 (0.03) 14 (0.01) 4 28 West Nile 82 (0.23) 927 (0.38) 1,831 2,840 Escherichia coli, enterohemorrhagic (EHEC), O157:H7 176 (0.50) 2,264 (0.92) 1,400 3,840 EHEC, serogroup non-O157 9 (0.03) 96 (0.04) 89 194 EHEC, not serogrouped 2 (0.01) 24 (0.01) 34 60 Giardiasis 1,486 (4.29) 8,206 (3.59) 11,514 21,206 Gonorrhea¶ 20,537 (58.17) 249,064 (101.20) 82,251 351,852 Haemophilus influenzae, invasive disease 118 (0.33) 892 (0.36) 733 1,743 Age <5 yrs, serotype b 10 (0.27) 18 (0.12) 6 34 Age <5 yrs, non-serotype b 31 (0.83) 67 (0.43) 46 144 Age <5 yrs, unknown serotype 14 (0.38) 72 (0.47) 67 153 Hansen disease 32 (0.09) 37 (0.02) 27 96 Hemolytic uremic syndrome, postdiarrheal 20 (0.06) 132 (0.06) 64 216 Hepatitis A 1,509 (4.27) 4,308 (1.75) 2,978 8,795 Hepatitis B 581 (1.65) 3,627 (1.49) 3,788 7,996 Hepatitis C/non-A, non-B 109 (0.31) 888 (0.36) 838 1,835 Legionellosis 43 (0.12) 740 (0.30) 538 1,321 Listeriosis 70 (0.20) 339 (0.14) 256 665 Lyme disease 347 (0.98) 11,017 (4.48) 12,399 23,763 Malaria 75 (0.21) 818 (0.33) 537 1,430 Measles 4 (0.01) 18 (0.01) 22 44 Meningococcal disease 227 (0.64) 1,072 (0.44) 515 1,814 Mumps 44 (0.12) 160 (0.07) 66 270 Pertussis 1,518 (4.30) 6,690 (2.72) 1,563 9,771 Q fever 8 (0.02) 36 (0.02) 17 61 Rocky Mountain spotted fever 19 (0.05) 810 (0.33) 275 1,104 Salmonellosis 2,964 (8.40) 19,250 (7.82) 22,050 44,264 Shigellosis 2,945 (8.34) 9,589 (3.90) 11,007 23,541 Streptococcal disease, invasive, group A 393 (1.12) 2,101 (0.86) 2,226 4,720 Streptococcal toxic-shock syndrome 4 (0.01) 72 (0.04) 42 118 Streptococcus pneumoniae, invasive, drug-resistant 121 (0.40) 1,129 (0.59) 1,296 2,546 Streptococcus pneumoniae, invasive, <5 yrs 38 (1.27) 210 (1.88) 265 513 Syphilis, primary and secondary¶ 919 (2.60) 5,596 (2.27) - 6,862 Tetanus 6 (0.02) 13 (0.01) 6 25 Toxic-shock syndrome 3 (0.01) 65 (0.03) 41 109 Tuberculosis 3,976 (11.26) 11,032 (4.48) 67 15,075 Tularemia 2 (0.01) 53 (0.02) 35 90 Typhoid fever 51 (0.14) 147 (0.06) 123 321

• No cases of paralytic poliomyelitis or western equine encephalitis were reported in 2002. 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, 2002.

§ 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 individual case reports. 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 2, 2003.

• • Notifiable in <40 states Totals reported to the Division of Tuberculosis Elimination, NCHSTP, as of March 28, 2003.

34 MMWR April 30, 2004 Vol. 51 / No. 53 MMWR 35 PART 2 Graphs and Maps for Selected Notifiable Diseases in the United States Abbreviations and Symbols Used in Graphs and Maps NA Data not available NN Report of disease is not required in that jurisdiction (not notifiable)

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

36 MMWR April 30, 2004 ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS). Reported cases, by year United States* and U.S. territories, 1982-2002 140,000 120,000 Expansion of 100,000 surveillance case definition 80,000 Number 60,000 40,000 20,000 0

1982 1987 1992 1997 2002 Year

• Total number of AIDS cases includes all cases reported to CDC as of December 31, 2002. Total includes cases among residents in the U.S. territories and 94 cases among persons with unknown state of residence.

The number of reported AIDS cases increased rapidly throughout the 1980s, peaked in the early 1990s, and then declined. Since 1997, the number of new cases has been stable.

ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS). Reported cases per 100,000 population United States* and U.S. territories, 2002 DC AS GU PR VI 0-4.9 5.0-9.9 10.0-14.9 >15.0

• 94 cases with unknown state of residence.

Reported cases of AIDS continue to reflect the concentration of the epidemic in populous states in the northeastern, southeastern, and western United States. In 2002, rates were >15/100,000 population in 16 geographic areas.

Vol. 51 / No. 53 MMWR 37 ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS). Reported pediatric cases*

United States and U.S. territories, 2002 0

0 0 0 1 4 0 0

0 0 2 23 2 0 2 2 1

1 4 8 0 0 3 0 0 5 4 6 11 1 0 3 0 0 3 2 DC 4

0 0 1 0 0 2 0 AS 2 1 1

0 GU 7

4 0 7 PR 0 40 1 VI 0 1-2 3-10 >11

• Children and adolescents aged <13 years.

The number of reported pediatric AIDS cases has declined each year since 1992. During 2002, 158 new cases were reported in the United States and U.S. territories.

ANTHRAX. Reported cases, by year United States, 1952-2002 70 60 50 40 Number 30 Bioterrorism-related cases*

20 10 0

1952 1957 1962 1967 1972 1977 1982 1987 1992 1997 2002 Year

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

Two cases of cutaneous anthrax were reported to CDC in 2002. One case occurred in a laboratorian who had been processing environmental samples for Bacillus anthracis in support of investigations of the bioterrorist attacks in the United States during fall 2001. The other was a naturally occurring case in a veterinarian who was performing a necropsy of a cow.

38 MMWR April 30, 2004 BOTULISM, FOODBORNE. Reported cases, by year United States, 1982-2002 110 100 90 80 Outbreak caused by sauteed onions, IL 70 Outbreak caused by baked potatoes, TX Outbreak caused by fermented Number 60 fish/seafood products, AK Outbreak caused by chili sauce, TX 50 40 30 20 10 0

1982 1987 1992 1997 2002 Year 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.

BOTULISM, INFANT. Reported cases, by year United States, 1982-2002 110 100 90 80 70 Number 60 50 40 30 20 10 0

1982 1987 1992 1997 2002 Year Infant botulism is the most common type of botulism in the United States. Cases are sporadic and risk factors remain largely unknown.

Vol. 51 / No. 53 MMWR 39 BOTULISM, OTHER (includes wound and unspecified). Reported cases, by year United States, 1992-2002 110 100 90 80 70 Number 60 50 40 30 20 10 0

1992 1997 2002 Year Incidence of 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.

BRUCELLOSIS. Reported cases, by year United States, 1972-2002 350 300 250 200 Number 150 100 50 0

1972 1977 1982 1987 1992 1997 2002 Year

40 MMWR April 30, 2004 CHLAMYDIA. Reported cases among women per 100,000 female population United States, 2002 DC NYC

<300 300.1-400 400.1-500 >500 Chlamydia refers to genital infections caused by Chlamydia trachomatis. In 2002, the chlamydia rate among women was 455.37 cases/100,000 population. Rates for men are not given because reporting for men is limited.

CHOLERA. Reported cases United States and U.S. territories, 2002 1

1 DC NYC AS CNMI GU PR U VI No reported cases Reported cases 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.

Vol. 51 / No. 53 MMWR 41 COCCIDIOIDOMYCOSIS. Reported cases United States* and U.S. territories, 2002 N

0 N N 0 0 N 0 0 0 N N 0 1 20 0 N

N N 0 44 2 N N 11 3 N 1,727 N 4 N 0 0 DC N 0 N 0 NYC N

0 3,133 N 9 0 0 0 AS 0 N N

0 CNMI 14 N

0 0 GU 0

N N PR U VI No reported cases Reported cases

• 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.

During the last few 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 patients with a flu-like illness who live or have visited areas with endemic disease.

CRYPTOSPORIDIOSIS. Reported cases per 100,000 population United States and U.S. territories, 2002 DC NYC 0 AS 0 CNMI 0 GU N PR U VI 0-0.27 0.28-0.63 0.64-1.59 >1.60 Surveillance data from 2002 suggest that infection with Cryptosporidium spp. is geographically widespread in the United States. The incidence of cryptosporidiosis may be particularly high in northern midwestern states, although state-by-state differences in cryptosporidiosis surveillance systems can affect the capacity to detect cases, thus making it difficult to interpret this observation. Reported illness onset dates exhibited a seasonal increase from July to October.

42 MMWR April 30, 2004 DIPHTHERIA. Reported cases, by year United States, 1972-2002 450 DIPHTHERIA. Reported cases, by year 400 United States, 1987-2002 6

350 5 Outbreak of (mostly) 4 Number cutaneous diphtheria, 3 300 Seattle, WA 2

Number 250 1 0

1987 1992 1997 2002 200 Year 150 100 Cutaneous diphtheria no 50 longer nationally notifiable 0

1972 1977 1982 1987 1992 1997 2002 Year In 2002, a probable, unconfirmed, diphtheria case was reported in an inadequately immunized adult female with history of recent and close contact with foreign visitors. Respiratory diphtheria can manifest as an acute membranous pharyngitis in persons who are unimmunized or inadequately immunized.

The Advisory Committee on Immunization Practices recommends a 5-dose primary series of DTP/

DTaP (diphtheria and tetanus and pertussis) vaccine by age 6 years, a combined adult formulation of diphtheria and tetanus (Td) vaccine at age 11-18 years, and a booster dose (Td) at 10-year intervals thereafter.

EHRLICHIOSIS, HUMAN GRANULOCYTIC. Reported cases United States and U.S. territories, 2002 N 1 149 1

4 159 29 65 49 5

2 1

3 1 N DC 2 19 17 NYC 1

AS 1

CNMI 1

GU 1

N PR VI No reported cases Reported cases 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. Twenty-three cases of ehrlichiosis classified as other or unspecified were also reported in 2002.

Vol. 51 / No. 53 MMWR 43 EHRLICHIOSIS, HUMAN MONOCYTIC. Reported cases United States and U.S.

territories, 2002 N

4 3

19 1 5

1 6 3 3 1 27 N 1 DC 1 50 2 2 NYC 13 26 13 18 AS 2 3 CNMI 7

GU 5

N PR VI No reported cases Reported cases 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. Twenty-three cases of ehrlichiosis classified as other or unspecified were also reported in 2002.

ENCEPHALITIS/MENINGITIS, CALIFORNIA SEROGROUP VIRAL. Reported cases, by month of onset United States, 1993-2002 50 45 40 35 30 Number 25 20 15 10 5

0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Year (month)

California (CAL) serogroup viruses (mainly La Crosse virus in the eastern United States, where the eastern treehole mosquito, Ochlerotatus triseriatus [formerly Aedes triseriatus], is the primary vector) are a cause of endemic meningoencephalitis, especially in children. During 1964-2002, a median of 67 (average: 80; range: 29-167) cases were reported per year in the United States. In 2002, 167 cases were reported from 16 states, representing the most reported to CDC in any year during 1964-2000. West Nile virus human case surveillance may have resulted in improved surveillance for CAL serogroup virus meningoencephalitis cases.

44 MMWR April 30, 2004 ENCEPHALITIS/MENINGITIS, EASTERN EQUINE. Reported cases, by month of onset United States, 1993-2002 6

5 4

Number 3

2 1

0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Year (month)

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 2002, 9 cases were reported from Florida, Michigan, Mississippi, and South Carolina. During 1964-2002, a median of 4 (average: 6; range: 0-24) cases were reported per year in the United States.

ENCEPHALITIS/MENINGITIS, ST. LOUIS. Reported cases, by month of onset United States, 1993-2002 60 45 Number 30 15 0

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Year (month)

Before the emergence of West Nile virus (WNV) in the United States, St. Louis encephalitis (SLE) virus was the countrys most common cause of epidemic viral encephalitis. In 2002, 28 SLE cases were reported from Arizona, Florida, Illinois, Michigan, and Texas; and SLE virus cocirculated with WNV, especially in Texas. During 1964-2002, a median of 28 (average: 118; range: 2-1,967) cases were reported per year in the United States.

Vol. 51 / No. 53 MMWR 45 ENCEPHALITIS/MENINGITIS, WESTERN EQUINE. Reported cases, by month of onset United States, 1993-2002 2

Number 1

0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Year (month)

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 2002. During 1964-2002, a median of 2 (average: 18; range: 0-172) cases were reported per year in the United States.

ENCEPHALITIS/MENINGITIS, WEST NILE. Reported cases, by county United States, 2002 0

1-50

>50 In 2002, 36 states and the District of Columbia reported 2,146 West Nile virus (WNV), through the Arbonet surveillance system, neuroinvasive cases (i.e., encephalitis or meningitis) compared with a total of 64 cases from 10 states in 2001. Since WNV was first discovered during an encephalitis outbreak in New York City, a median of 61.5 (average: 572; range: 21-2,146) cases were reported per year in the United States.

46 MMWR April 30, 2004 ESCHERICHIA COLI, ENTEROHEMORRHAGIC O157:H7. Reported cases United States and U.S. territories, 2002 DC NYC AS CNMI GU PR VI 0-17 18-45 46-104 >105 E. coli O157:H7, represented in this graph, constitutes the major serotype of the enterohemorrhagic E. coli, although many other E. coli serotypes can produce Shiga toxin and cause hemorrhagic colitis.

E. coli O157:H7 has been a nationally notifiable disease since 1994. In 2001, surveillance was expanded to include all serotypes of enterohemorrhagic E. coli; however, some laboratories still lack the capacity to isolate and identify E. coli serotypes other than O157:H7.

GIARDIASIS. Reported cases per 100,000 population United States and U.S.

territories, 2002 N

DC N

NYC N

AS CNMI GU PR VI 0-3.71 3.72-8.11 8.12-11.31 >11.32 Giardiasis became a nationally notifiable disease in 2002. Reporting was previously voluntary (1992-2001). Surveillance data for 2002 suggest that infection with Giardia intestinalis is geographically widespread. Reported illness onset dates exhibited a seasonal increase from July to October.

Vol. 51 / No. 53 MMWR 47 GONORRHEA. Reported cases per 100,000 population United States, 2002 DC NYC

<100 100.1-200 >200 In 2002, the overall U.S. gonorrhea rate was 125.03/100,000 population. The Healthy People 2010 national objective is <19 cases/100,000 population. Idaho, Maine, Montana, New Hampshire, North Dakota, Utah, Vermont, and Wyoming reported rates below the national objective.

GONORRHEA. Reported cases per 100,000 population, by sex United States, 1987-2002 500 Male Female 400 300 Rate 200 100 0

1987 1992 1997 2002 Year Rates of gonorrhea in the United States have been steady since 1998, at approximately 130 cases/

100,000 population (125.0 in 2002, 128.5 in 2001, 129.0 in 2002, 132.3 in 1999, and 131.9 in 1998).

In 2002, rates among men and women were similar (122.6 cases/100,000 men and 125.3 cases/

100,000 women).

48 MMWR April 30, 2004 GONORRHEA. Reported cases per 100,000 population, by race and ethnicity United States, 1987-2002 2,200 Black, non-Hispanic 2,000 American Indian/Alaska Native Hispanic White, non-Hispanic 1,800 Asian/Pacific Islander 1,600 1,400 1,200 Rate 1,000 800 600 400 200 0

1987 1992 1997 2002 Year Gonorrhea rates among blacks decreased considerably in the 1990s but continue to be the highest among all race/ethnic groups. In 2002, the gonorrhea rate among non-Hispanic blacks was approximately 24 times greater than the rate for non-Hispanic whites.

HAEMOPHILUS INFLUENZAE, INVASIVE DISEASE. Reported cases per 100,000 population, by age group United States, 1991-2002 8

Age <5 yrs 7 Age >5 yrs 6

5 Rate 4 3

2 1

0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Year Before the introduction of conjugate Haemophilus influenzae serotype b (Hib) vaccines in December 1987, the incidence of invasive Hib disease among children aged <5 years was estimated to be 100/

100,000 population. In 2002, the incidence of invasive H. influenzae disease (all serotypes) was 1.8/

100,000 in this age group (331 reported cases: 34 [10%] reported as Hib, 144 [44%] as other serotypes or nontypeable isolates, and 153 [46%] with serotype information unknown or missing).

Vol. 51 / No. 53 MMWR 49 HANSEN DISEASE. Reported cases, by year United States, 1972-2002 400 360 320 280 240 Number 200 160 120 Increased influx of Indo-Chinese 80 refugees, 1978-1988 40 0

1972 1977 1982 1987 1992 1997 2002 Year A total of 96 Hansen disease cases were reported from 17 states, Puerto Rico, and the Commonwealth of Northern Mariana Islands in 2002. Four states (Texas, New York, California and Hawaii) accounted for 77% of the total number of cases reported.

HANTAVIRUS PULMONARY SYNDROME. Reported cases by survival status,* by year United States, 1995-2002 60 55 Lived Died 50 45 40 35 Number 30 25 20 15 10 5

0 1995 1996 1997 1998 1999 2000 2001 2002 Year

• Data from the National Center for Infectious Diseases.

After record lows in 2001, reported cases of hantavirus pulmonary syndrome increased in 2002.

50 MMWR April 30, 2004 HEMOLYTIC UREMIC SYNDROME, POSTDIARRHEAL. Reported cases United States and U.S. territories, 2002 1

3 22 11 1 1 5 18 16 1 1 8

3 2 1 2 11 4

N 43 14 8 1 DC 2 N 3 NYC 2

7 N 3 1

AS 9

CNMI 3

1 GU 1 5 N PR VI No reported cases Reported cases 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. Approximately 59%

of cases occur in children aged <5 years.

HEPATITIS, VIRAL. Reported cases per 100,000 population, by year United States, 1972-2002 35 Hepatitis A, acute*

Hepatitis B, acute 30 Hepatitis, C/non-A, non-B

§ 25 20 Rate 15 10 5

0 1972 1977 1982 1987 1992 1997 2002 Year

• 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.

Hepatitis A incidence continues to decline and in 2002 was the lowest ever recorded. However, cyclic increases in hepatitis A have been observed approximately every 10 years, and thus rates could increase again. Hepatitis B incidence, which declined by >65% between 1990 and 2000, has remained unchanged for the past 3 years, reflecting ongoing transmission in adult high-risk groups. The trend in reported hepatitis C/non-A, non-B cases 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.

Vol. 51 / No. 53 MMWR 51 HEPATITIS A. Reported cases per 100,000 population United States and U.S.

territories, 2002 DC NYC AS CNMI GU PR VI

<2.5 2.5-4.9 5.0-9.9 10.0-19.9 >20 In 1999, routine hepatitis A vaccination was recommended for children living in 11 states with consistently elevated disease rates. Since then, hepatitis A rates have declined in all regions, with the greatest declines occurring in the West, where 10 of these states are located. Hepatitis A rates are now similar in all regions. Several of the states with the highest rates in 2002 reported large outbreaks among adult high-risk groups, including men who have sex with men and injection-drug users.

LEGIONELLOSIS. Reported cases per 100,000 population, by year United States, 1987-2002 1.0 0.9 0.8 0.7 0.6 Rate 0.5 0.4 0.3 0.2 0.1 0

1987 1992 1997 2002 Year

52 MMWR April 30, 2004 LISTERIOSIS. Reported cases per 100,000 population United States and U.S.

territories, 2002 0

0 N

0 DC NYC 0

0 AS 0 CNMI 0 GU PR 0 VI 0-0.04 0.05-0.18 0.19-0.28 >0.29 Listeriosis was made a nationally notifiable disease in 2000. Although the infection is relatively uncommon, listeriosis is a leading cause of death due to foodborne illness in the United States. In 2002, a large outbreak of listeriosis occurred caused by contaminated turkey deli meat. Fifty-four cases were confirmed in nine states, including eight deaths and three fetal deaths. The greatest concentration of cases was in Pennsylvania and New York. Recent outbreaks have been linked to frankfurters, deli meats, and Mexican-style cheeses.

LYME DISEASE. Reported cases by county United States, 2002 0 1-14 >15*

• The total number of cases from these counties represented 90% of all cases reported in 2002.

More Lyme disease cases were reported in 2002 (N = 23,763) than in any previous year. The incidence in 10 endemic-disease states (Connecticut, Delaware, Massachusetts, Maryland Minnesota, New Jersey, New York, Pennsylvania, Rhode Island, and Wisconsin) was 32/100,000 population, over threefold higher than the Healthy People 2010 objective.

Vol. 51 / No. 53 MMWR 53 MALARIA. Reported cases per 100,000 population, by year United States, 1972-2002 2.0 1.5 Foreign immigration from malaria-endemic countries in Southeast Asia Rate 1.0 0.5 0

1972 1977 1982 1987 1992 1997 2002 Year In the past 15 years, a general upward trend has occurred in imported malaria cases, likely caused by increasing international travel and immigration and increased antimalarial drug resistance. The decline since 1997 may reflect a decrease in international travel and immigration.

MEASLES. Reported cases, by year United States, 1967-2002 500,000 MEASLES. Reported cases by year 450,000 United States, 1987-2002 30,000 400,000 25,000 20,000 Number 350,000 15,000 10,000 300,000 Number 5,000 250,000 0 1987 1992 1997 2002 200,000 Year 150,000 100,000 50,000 0

1967 1972 1977 1982 1987 1992 1997 2002 Year In 2002, only 44 cases of measles were reported, which is the lowest number ever reported and a 72% decrease from the previous year. Measles incidence remains at <1 per million population for the sixth consecutive year. Fewer than 600 cases were reported during 1997-2002. Of the 44 cases reported this year, 18 were identified as international importations and 15 others were epidemiologically linked to an imported case.

54 MMWR April 30, 2004 MENINGOCOCCAL DISEASE. Reported cases per 100,000 population, by year United States, 1972-2002 2.0 1.5 Rate 1.0 0.5 0

1972 1977 1982 1987 1992 1997 2002 Year Rates of meningococcal disease have been nearly stable in the United States. A total of 1,814 cases were reported in 2002, of which 1,524 were confirmed, 64 probable, two suspected, and 224 of unknown case status. Although rates of meningococcal disease are highest among children aged <1 year, 54.3 % of cases in 2002 occurred among persons aged >18 years.

MUMPS. Reported cases per 100,000 population, by year United States, 1977-2002 40 MUMPS. Reported cases per 100,000 population, by year United States, 35 1987-2002 7

6 30 5

Rate 4

25 3 2

1 Rate 20 0 1987 1992 1997 2002 Year 15 10 5

0 1977 1982 1987 1992 1992 2002 Year Because of the recommendation of two doses of measles-mumps-rubella (MMR) vaccine and the continued high coverage rate in the United States, mumps incidence continues to be low, with 270 cases reported for 2002, thus meeting the Healthy People 2010 objective of <500 cases per year.

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

Vol. 51 / No. 53 MMWR 55 PERTUSSIS. Reported cases per 100,000 population, by year United States, 1972-2002 4.0 3.5 3.0 2.5 Rate 2.0 1.5 1.0 0.5 0

1972 1977 1982 1987 1992 1997 2002 Year Pertussis epidemics occur every 3-5 years. In 2002, 9,771 cases were reported, the highest number reported since 1964.

PERTUSSIS. Reported cases,* by age group United States, 2002 2,400 2,100 1,800 1,500 Number 1,200 900 600 300 0

<1 1-4 5-9 10-14 15-19 20-29 30-39 40-49 50-59 >60 Age group (yrs)

• Of 9,771 cases, 25 cases were reported with unknown age.

In 2002, 21% of reported cases were in infants aged <6 months (who were too young to receive 3 DTaP doses), and 52% of cases were in persons aged >10 years (no pertussis vaccine is licensed for use in persons aged >7 years).

56 MMWR April 30, 2004 PLAGUE. Reported cases among humans, by year United States, 1972-2002 45 40 Prairie dog and rock squirrel epizootics 35 30 25 Number 20 15 10 5

0 1972 1977 1982 1987 1992 1997 2002 Year Since 1983, nearly 90% of all plague cases have been contracted in the four states of New Mexico (50%), Colorado (17%), Arizona (11%), and California (11%). The limited number of cases in recent years correlate with hot, dry conditions in the Southwest. In 2002, only two cases were reported, both in travelers to New York City who contracted the disease in New Mexico.

POLIOMYELITIS, PARALYTIC, VACCINE ASSOCIATED. Reported cases, by year United States, 1972-2002 40 35 30 25 Number 20 15 10 5

0 1972 1977 1982 1987 1992 1997 2002 Year No cases of vaccine-associated paralytic poliomyelitis have been reported since the all-IPV schedule was implemented in 2000.

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

Vol. 51 / No. 53 MMWR 57 PSITTACOSIS. Reported cases, by year United States, 1972-2002 250 225 200 175 150 Number 125 100 75 50 25 0

1972 1977 1982 1987 1992 1997 2002 Year Q FEVER. Reported cases United States and U.S. territories, 2002 1 N 2

1 1 1

N 1 2 4 1 N 3

1 1 N 12 2 1 1 DC 9

1 NYC 2

3 N

AS 1

2 CNMI 6

GU 2 PR VI No reported cases Reported cases Q fever became nationally notifiable in 1999. Identification and reporting of Q fever are incomplete, and the number of cases reported do not represent the overall distribution or regional prevalence of disease.

58 MMWR April 30, 2004 ANIMAL RABIES. Reported cases among wild and domestic animals, by year*

United States and Puerto Rico, 1972-2002 10,000 Total 9,000 Domestic Wild 8,000 7,000 6,000 Number 5,000 4,000 3,000 2,000 1,000 0

1972 1977 1982 1987 1992 1997 2002 Year

• 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.

ROCKY MOUNTAIN SPOTTED FEVER. Reported cases per 100,000 population, by year United States, 1972-2002 0.6 0.5 0.4 Rate 0.3 0.2 0.1 0

1972 1977 1982 1987 1992 1997 2002 Year Changes in the number of reported cases of Rocky Mountain spotted fever might reflect alterations to 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.

Vol. 51 / No. 53 MMWR 59 RUBELLA. Reported cases per 100,000 population, by year United States, 1972-2002 35 RUBELLA. Reported cases per 100,000 population, by year United States, 30 1987-2002 0.7 0.6 25 0.5 Rate 0.4 0.3 20 0.2 Rate 0.1 0

15 1987 1992 1997 2002 Year 10 5

0 1972 1977 1982 1987 1992 1997 2002 Year In 2002, only 18 cases of rubella were reported by nine states, which is the lowest number of rubella cases ever reported. Eight (44%) cases were identified as importations. The majority of reported cases continue to be among persons aged >20 years; however, in contrast to year 2000, most of the cases in the last 2 years were among non-Hispanics.

Note: A rubella vaccine was first licensed in 1969.

SALMONELLOSIS. Reported cases per 100,000 population, by year United States, 1972-2002 30 Outbreak caused by contaminated pasteurized milk, IL 25 20 Rate 15 10 5

0 1972 1977 1982 1987 1992 1997 2002 Year Foodborne transmission accounts for approximately 95% of salmonellosis in the United States. CDC estimates that approximately 38 cases occur for every one case reported through national surveillance.

The three Salmonella serotypes that cause most cases are S. Typhimurium, S. Enteritidis, and S.

Newport.

60 MMWR April 30, 2004 SHIGELLOSIS. Reported cases per 100,000 population, by year United States, 1972-2002 15 10 Rate 5

0 1972 1977 1982 1987 1992 1997 2002 Year Prolonged and extensive outbreaks of Shigella sonnei infections continue to occur in child care settings and are responsible for a large proportion of shigellosis cases in the Unites States. Resistance to first-line antimicrobial agents, including trimethoprim-sulfamethoxazole, continues to increase among S. sonnei in the United States.

STREPTOCOCCAL DISEASE, INVASIVE, GROUP A. Reported cases United States and U.S. territories, 2002 0

0 N

0 DC NYC 0 AS 0 0 0 CNMI 0 0 GU N PR 0 VI 0-5 6-18 19-67 >68 Passive reporting likely underestimates the numbers of invasive group A Streptococcus (GAS) infections in the United States. In 2002, approximately 980 invasive GAS infections were reported by nine sites participating in CDCs Active Bacterial Core Surveillance (ABCs). The incidence rate of invasive GAS infections in the United States has been nearly stable during the past 5 years (range:

3.1-3.8 cases/100,000 population).

Vol. 51 / No. 53 MMWR 61 STREPTOCOCCUS PNEUMONIAE, INVASIVE, DRUG-RESISTANT. Reported cases United States and U.S. territories, 2002 N

N 0 0

0 0 0 N N

N N N

0 0 N 0 DC N 0 0 NYC N

N N 0 AS 0 0 0 CNMI 0 GU 0

N PR 0 VI 0 1-100 101-400 >401 A conjugate pneumococcal vaccine was licensed for young children in early 2000 and became widely used later that year. Data from CDCs Active Bacterial Core (ABCs) Surveillance/Emerging Infections Program Network indicate that rates of invasive disease caused by drug-resistant pneumococci are declining after the vaccine licensure.

SYPHILIS, CONGENITAL. Reported cases per 100,000 live births among infants aged

<1 year United States, 1972-2002 120 110 100 Change in surveillance 90 case definition 80 70 Rate 60 50 40 30 20 10 0

1972 1977 1982 1987 1992 1997 2002 Year The rate of congenital syphilis continues to decline, from 12.2 cases/100,000 live births in 2001 to 10.2 cases/100,000 in 2002.

62 MMWR April 30, 2004 SYPHILIS, PRIMARY AND SECONDARY. Reported cases per 100,000 population United States, 2002 DC NYC

<0.2 0.3-4 >4 In 2002, the overall U.S. rate of primary and secondary syphilis was 2.4 cases/100,000 population, which is above the Healthy People 2010 objective of 0.2 cases/100,000 population per year. Seven states reported rates at or below the national objective, compared with 10 in 2001. Eight states reported fewer than six cases.

SYPHILIS, PRIMARY AND SECONDARY. Reported cases per 100,000 population, by sex United States, 1987-2002 25 Male Female 20 15 Rate 10 5

0 1987 1992 1997 2002 Year The reported rate of primary and secondary syphilis increased slightly in the United States from 2.2 cases/100,000 in 2001 to 2.4 cases/100,000 in 2002. Among women, rates continued to decline, from 1.4 cases/100,000 women in 2001 to 1.1 cases/100,000, the lowest rate for women since reporting began in 1941. Among men, rates increased from 3.0 cases/100,000 in 2001 to 3.8 cases/100,000 in 2002, after a low rate of 2.6 cases/100,000 in 2000.

Vol. 51 / No. 53 MMWR 63 SYPHILIS, PRIMARY AND SECONDARY. Reported cases per 100,000 population, by race and ethnicity United States, 1987-2002 160 Black, non-Hispanic 140 American Indian/Alaska Native Hispanic White, non-Hispanic 120 Asian/Pacific Islander 100 Rate 80 60 40 20 0

1987 1992 1997 2002 Year Rates of primary and secondary syphilis declined among non-Hispanic blacks, from 11.0 cases/

100,000 in 2001 to 9.8 cases/100,000 in 2002, and among American Indians/Alaska Natives from 4.2 cases/100,000 in 2001 to 2.4 cases/100,000 in 2002. Increases occurred in all other race/ethnic groups (non-Hispanic whites from 0.7/100,000 to 1.2/100,000, Hispanics from 2.1/100,000 to 2.7/

100,000, and Asian/Pacific Islanders from 0.5/100,000 to 0.9/100,000.). The overall rate among non-Hispanic blacks has decreased from 64 times the rate of non-Hispanic whites in 1992 to 8 times the non-Hispanic white rate in 2002.

TETANUS. Reported cases, by year United States, 1972-2002 200 180 160 140 120 Number 100 80 60 40 20 0

1972 1977 1982 1987 1992 1997 2002 Year The majority of tetanus cases reported in 2002, including both fatal cases, occurred in persons who were not appropriately vaccinated against tetanus or who had an unknown vaccination history.

64 MMWR April 30, 2004 TOXIC-SHOCK SYNDROME. Reported cases, by quarter United States, 1987-2002 140 120 100 80 Number 60 40 20 0

1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Year (quarter)

The limited number of reported cases of toxic-shock syndrome (TSS) in recent years is likely caused by decreased reporting and not a true decline in incidence of disease. Continued surveillance will be important to monitor the reemergence of TSS that could occur among women using barrier contraceptive devices.

TRICHINOSIS. Reported cases, by year United States, 1972-2002 300 270 240 210 180 Number 150 120 90 60 30 0

1972 1977 1982 1987 1992 1997 2002 Year In 2002, 14 cases of trichinosis were reported by seven states (Alaska, California, Illinois, North Carolina, Pennsylvania, Tennessee, and Vermont). The year 2002 was the seventh consecutive year in which <25 cases were reported.

Vol. 51 / No. 53 MMWR 65 TUBERCULOSIS. Reported cases per 100,000 population. United States and U.S.

territories, 2002 DC NYC AS CNMI GU PR U VI 0-3.5 3.6-5.2 5.3-9.9 >10 In 2002, a total of 25 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.

TUBERCULOSIS. Reported cases per 100,000 population, by year United States, 1982-2002 14 13 12 11 10 9

8 Rate 7 6

5 4

3 2

1 0

1982 1987 1992 1997 2002 Year In 2002, a total of 15,075 cases of tuberculosis were reported to CDC, representing a 5.7% decrease from 2001.

66 MMWR April 30, 2004 TUBERCULOSIS. Reported cases among U.S.-born and foreign-born persons,* by year United States, 1990-2002 20,000 U.S.-born Foreign-born 16,000 12,000 Number 8,000 4,000 0

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Year

• For 120 cases, origin of patients was unknown.

The number of tuberculosis cases among foreign-born persons in the United States increased from 6,262 (25% of the total number) in 1990 to 7,659 (51% of the total) in 2002.

TULAREMIA. Reported cases United States and U.S. territories, 2002 3

2 1 3 5 2

N 1

1 1 1 5 1 2

1 1 1 1 2 16 DC 2

1 NYC 1

4 10 2 14 AS 1 1 CNMI 3

1 GU PR U VI No reported cases Reported cases In 2002, 90 cases of tularemia were reported. Areas with high rates of infection in recent years include Missouri and neighboring states, and Marthas Vineyard, Massachusetts. Tularemia was reinstated as a nationally notifiable disease in 2000.

Vol. 51 / No. 53 MMWR 67 TYPHOID FEVER. Reported cases, by year United States, 1972-2002 800 700 600 500 Number 400 300 200 100 0

1972 1977 1982 1987 1992 1997 2002 Year Approximately 80% of reported cases of typhoid fever are acquired by unvaccinated travelers to countries where the disease is endemic. Increasing antimicrobial resistance has complicated the treatment of typhoid fever.

VARICELLA. Reported cases from selected U.S. states* (n=4), 1993-2002 80,000 Vaccine licensed 60,000 Number 40,000 20,000 0

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Year

• Michigan, Rhode Island, Texas, and West Virginia maintained consistent and adequate surveillance 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 2002 is the lowest ever reported, constituting a 6.29% decline compared with cases reported in 2001 and a 77.64% decline compared with cases reported in the prevaccine years of 1993-1995.

68 MMWR April 30, 2004 Vol. 51 / No. 53 MMWR 69 PART 3 Historical Summaries of Notifiable Diseases in the United States, 1971-2002 Abbreviations and Symbols Used in Tables NA Data not available

- No reported cases Rates <0.01 after rounding are listed as 0.

Note: Data in the MMWR Summary of Notifiable Diseases, United States, 2002 might not match data in other CDC surveillance reports because of differences in the timing of reports, the source of the data, and case definition.

70 MMWR April 30, 2004 TABLE 7. Reported incidence rates of notifiable diseases per 100,000 population, United States, 1992-2002 Disease 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 AIDS* 17.83 40.20 30.07 27.20 25.21 21.85 17.21 16.66 14.95 14.88 15.29 Amebiasis 1.21 1.21 1.20 Anthrax 0.00 - - - - - - - 0.00 0.01 0.00 Aseptic meningitis 5.18 5.39 3.71 Botulism, total (including wound and unsp.) 0.04 0.04 0.06 0.04 0.05 0.05 0.04 0.06 0.05 0.06 0.03 Foodborne 0.00 0.01 0.02 0.01 0.01 0.02 0.01 0.01 0.01 0.01 0.00 Brucellosis 0.04 0.05 0.05 0.04 0.05 0.04 0.03 0.03 0.03 0.05 0.04 Chancroid 0.80 0.54 0.30 0.20 0.15 0.09 0.07 0.06 0.03 0.01 0.02 Chlamydia§ ¶ ¶ ¶ 182.60 188.10 196.80 236.57 254.10 257.76 278.32 296.55 Cholera 0.04 0.00 0.02 0.01 0.01 0.01 0.01 0.00 0.00 0.00 0.00 Coccidioidomycosis ¶ ¶ ¶ NA NA NA NA NA NA 6.71 3.03 Cryptosporidiosis ¶ ¶ ¶ ¶ ¶ 1.12 1.61 0.92 1.17 1.34 1.07 Cyclosporiasis ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ 0.03 0.07 0.06 Diphtheria 0.00 0.00 0.00 0.00 0.01 0.01 0.00 0.00 0.00 0.00 0.00 Ehrlichiosis, human granulocytic ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ 0.l5 0.10 0.18 Human monocytic ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ 0.09 0.05 0.08 Encephalitis, primary 0.30 0.36 0.28 Postinfectious 0.05 0.07 0.06 Encephalitis/meningitis, arboviral California serogroup ¶ ¶ ¶ ¶ ¶ ¶ 0.04 0.03 0.04 0.05 0.06 Eastern equine ¶ ¶ ¶ ¶ ¶ ¶ 0.00 0.00 0.00 0.00 0.00 Powassan ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ 0.00 St. Louis ¶ ¶ ¶ ¶ ¶ ¶ 0.01 0.00 0.00 0.03 0.01 West Nile ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ 1.01 Western equine ¶ ¶ ¶ ¶ ¶ ¶ 0.00 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 1.36 EHEC, serogroup non-O157 ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ 0.19 0.08 EHEC, not serogrouped ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ 0.06 0.02 Giardiasis ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ 8.06 Gonorrhea 201.60 172.40 168.40 149.50 122.80 121.40 132.88 133.20 131.65 128.53 125.03 Granuloma inguinale 0.00 0.00 0.00 Haemophilus influenzae, invasive disease 0.55 0.55 0.45 0.45 0.45 0.44 0.44 0.48 0.51 0.57 0.62 Age <5 yrs, serotype b ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ 0.18 Age <5 yrs, non-serotype b ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ 0.75 Age <5 yrs, unknown serotype ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ 0.80 Hansen disease 0.07 0.07 0.05 0.06 0.05 0.05 0.05 0.04 0.04 0.03 0.04 Hantavirus pulmonary syndrome ¶ ¶ ¶ NA NA NA NA NA 0.02 0.00 0.01 Hemolytic uremic syndrome postdiarrheal ¶ ¶ ¶ NA NA NA NA NA 0.10 0.08 0.08 Hepatitis A, acute 9.06 9.40 10.29 12.13 11.70 11.22 8.59 6.25 4.91 3.77 3.13 Hepatitis B, acute 6.32 5.18 4.81 4.19 4.01 3.90 3.80 2.82 2.95 2.79 2.84 Hepatitis C/non-A, non-B, acute** 2.36 1.86 1.78 1.78 1.41 1.43 1.30 1.14 1.17 1.41 0.65 Hepatitis, unspecified 0.35 0.24 0.17 Legionellosis 0.53 0.50 0.63 0.48 0.47 0.44 0.51 0.41 0.42 0.42 0.47 Leptospirosis 0.02 0.02 0.02

Vol. 51 / No. 53 MMWR 71 TABLE 7. (Continued) Reported incidence rates of notifiable diseases per 100,000 population, United States, 1992-2002 Disease 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Listeriosis ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ 0.29 0.22 0.24 Lyme disease 3.93 3.20 5.01 4.49 6.21 4.79 6.39 5.99 6.53 6.05 8.44 Lymphogranuloma venereum 0.10 0.10 0.10 Malaria 0.43 0.55 0.47 0.55 0.68 0.75 0.60 0.61 0.57 0.55 0.51 Measles 0.88 0.12 0.37 0.12 0.20 0.06 0.04 0.04 0.03 0.04 0.02 Meningococcal disease 0.84 1.02 1.11 1.25 1.30 1.24 1.01 0.92 0.83 0.83 0.64 Mumps 1.03 0.66 0.60 0.35 0.29 0.27 0.25 0.14 0.13 0.10 0.10 Murine typhus fever 0.02 0.01 0.01 Pertussis 1.60 2.55 1.77 1.97 2.94 2.46 2.74 2.67 2.88 2.69 3.47 Plague 0.01 0.00 0.01 0.00 0.01 0.01 0.00 0.00 0.00 0.00 0.00 Poliomyelitis, paralytic 0.00 0.00 0.00 0.00 0.03 0.02 0.01 0.00 0.00 0.00 0.00 Psittacosis 0.04 0.02 0.02 0.03 0.02 0.02 0.02 0.01 0.01 0.01 0.01 Q Fever ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ 0.01 0.01 0.02 Rabies, human 0.00 0.00 0.00 0.00 0.01 0.01 0.00 0.00 0.00 0.00 0.00 Rheumatic fever, acute 0.06 0.08 0.09 Rocky Mountain spotted fever 0.20 0.18 0.18 0.23 0.32 0.16 0.14 0.21 0.18 0.25 0.39 Rubella 0.06 0.07 0.09 0.05 0.10 0.07 0.13 0.10 0.06 0.01 0.01 Rubella, congenital syndrome 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Salmonellosis 16.04 16.15 16.64 17.66 17.15 15.66 16.17 14.89 14.51 14.39 15.73 Shigellosis 9.38 12.48 11.44 12.32 9.80 8.64 8.74 6.43 8.41 7.19 8.37 Streptococcal disease, invasive, group A ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ 1.45 1.60 1.69 Streptococcal toxic-shock syndrome ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ 0.04 0.04 0.05 Streptococcus pneumoniae, invasive, drug resistant ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ 2.77 2.11 1.14 Streptococcus pneumoniae, invasive

<5 years ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ ¶ 1.03 3.62 Syphilis, primary and secondary 13.70 10.40 8.10 6.30 4.29 3.19 2.61 2.50 2.19 2.17 2.44 Total, all stages 45.30 39.70 32.00 26.20 19.97 17.39 14.19 13.07 11.58 11.45 11.68 Tetanus 0.02 0.02 0.02 0.02 0.02 0.02 0.02 0.01 0.01 0.01 0.01 Toxic-shock syndrome 0.10 0.08 0.10 0.07 0.06 0.06 0.06 0.05 0.06 0.05 0.05 Trichinosis 0.02 0.01 0.01 0.01 0.01 0.01 0.01 0.00 0.01 0.01 0.01 Tuberculosis 10.46 9.82 9.36 8.70 8.04 7.42 6.79 6.43 6.01 5.68 5.36 Tularemia 0.06 0.05 0.04 0.06 0.05 0.03 Typhoid fever 0.16 0.17 0.17 0.14 0.15 0.14 0.14 0.13 0.14 0.13 0.11 Varicella¶ 176.54 118.54 135.76 118.11 44.13 93.55 70.28 44.56 26.18 19.51 10.27 Yellow fever - - - - 0.00 - - 0.00 - - 0.00

• Acquired Immunodeficiency syndrome (AIDS).

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 the use of different case definitions.

72 MMWR April 30, 2004 TABLE 8. Reported cases of notifiable diseases United States, 1995-2002 Disease 1995 1996 1997 1998 1999 2000 2001 2002 AIDS 71,547 66,885 58,492 46,521 45,104 40,758 41,868 42,745*

Anthrax - - - - - 1 23 2 Botulism, total (including wound and unsp.) 97 119 132 116 154 138 155 118 Foodborne 24 25 31 22 23 23 39 28 Infant 54 80 79 65 92 93 97 69 Brucellosis 98 112 98 79 82 87 136 125 Chancroid 606 386 243 189 143 78 38 67 Chlamydia§ 477,638 498,884 526,671 604,420 656,721 702,093 783,242 834,555 Cholera 23 4 6 17 6 5 3 2 Coccidioidomycosis 1,212 1,696 1,749 2,275 2,827 2,867 3,922 4,968 Cryptosporidiosis 2,970 2,827 2,566 3,793 2,361 3,128 3,785 3,016 Cyclosporiasis NA NA 94 58 63 60 147 156 Diphtheria - 2 4 1 1 1 2 1 Ehrlichiosis, human granulocytic ¶ ¶ ¶ ¶ 216 351 261 511 Human monocytic ¶ ¶ ¶ ¶ 116 200 142 216 Encephalitis, California serogroup viral 11 123 129 97 70 114 128 164 Eastern equine 1 5 14 4 5 3 9 10 Powassan ¶ ¶ ¶ ¶ ¶ ¶ ¶ 1 St. Louis 3 2 13 24 4 2 79 28 West Nile ¶ ¶ ¶ ¶ ¶ ¶ ¶ 2,840 Western equine - - - - 1 - - -

Escherichia coli , enterohemorrhagic (EHEC) O157:H7 2,139 2,741 2,555 3,161 4,513 4,528 3,287 3,840 EHEC, serogroup non-O157 ¶ ¶ ¶ ¶ ¶ ¶ 171 194 EHEC, not serogrouped ¶ ¶ ¶ ¶ ¶ ¶ 20 60 Giardiasis ¶ ¶ ¶ ¶ ¶ ¶ ¶ 21,206 Gonorrhea 392,848 325,883 324,907 355,642 360,076 358,995 361,705 351,852 Haemophilus influenzae, invasive disease 1,180 1,170 1,162 1,194 1,309 1,398 1,597 1,743 Age <5 yrs serotype B ¶ ¶ ¶ ¶ ¶ ¶ ¶ 34 Age <5 yrs non-serotype B ¶ ¶ ¶ ¶ ¶ ¶ ¶ 144 Age <5 yrs unknown serotype ¶ ¶ ¶ ¶ ¶ ¶ ¶ 153 Hansen disease 144 112 122 108 108 91 79 96 Hantavirus pulmonary syndrome NA NA NA NA 31 41 8 19 Hemolytic uremic syndrome, postdiarrheal 72 97 91 119 180 249 202 216 Hepatitis A, acute 31,582 31,032 30,021 23,229 17,047 13,397 10,609 8,795 Hepatitis B, acute 10,805 10,637 10,416 10,258 7,694 8,036 7,843 7,996 Hepatitis C/non-A, non-B** 4,576 3,716 3,816 3,518 3,111 3,197 3,976 1,835 Legionellosis 1,241 1,198 1,163 1,355 1,108 1,127 1,168 1,321 Listeriosis ¶ ¶ ¶ ¶ ¶ 755 613 665 Lyme disease 11,700 16,455 12,801 16,801 16,273 17,730 17,029 23,763 Malaria 1,419 1,800 2,001 1,611 1,666 1,560 1,544 1,430 Measles 309 508 138 100 100 86 116 44 Meningococcal disease 3,243 3,437 3,308 2,725 2,501 2,256 2,333 1,814

Vol. 51 / No. 53 MMWR 73 TABLE 8. (Continued) Reported cases of notifiable diseases United States, 1995-2002 Disease 1995 1996 1997 1998 1999 2000 2001 2002 Mumps 906 751 683 666 387 338 266 270 Pertussis 5,137 7,796 6,564 7,405 7,288 7,867 7,580 9,771 Plague 9 5 4 9 9 6 2 2 Poliomyelitis, paralytic 7 7 6 3 2 - - -

Psittacosis 64 42 33 47 16 17 25 18 Q Fever ¶ ¶ ¶ ¶ ¶ 21 26 61 Rabies, animal 7,811 6,982 8,105 7,259 6,730 6,934 7,150 7,609 Rabies, human 5 3 2 1 - 4 1 3 Rocky Mountain spotted fever 590 831 409 365 579 495 695 1,104 Rubella 128 238 181 364 267 176 23 18 Rubella, congenital syndrome 6 4 5 7 9 9 3 1 Salmonellosis 45,970 45,471 41,901 43,694 40,596 39,574 40,495 44,264 Shigellosis 32,080 25,978 23,117 23,626 17,521 22,922 20,221 23,541 Streptococcal disease, invasive, group A 613 1,445 1,973 2,260 2,667 3,144 3,750 4,720 Streptococcus pneumoniae, drug-resistant, invasive 309 1,514 1,799 2,823 4,625 4,533 2,896 2,546 Streptococcus pneumoniae, invasive <5 yrs ¶ ¶ ¶ ¶ ¶ ¶ 498 513 Streptococcal toxic-shock syndrome 10 19 33 58 65 83 77 118 Syphilis, primary and secondary 16,500 11,387 8,550 6.993 6,657 5,979 6,103 6,862 Total, all stages 68,953 52,976 46,540 37,977 35,628 31,575 32,221 32,871 Tetanus 41 36 50 41 40 35 37 25 Toxic-shock syndrome 191 145 157 138 113 135 127 109 Trichinosis 29 11 13 19 12 16 22 14 Tuberculosis 22,860 21,337 19,851 18,361 17,531 16,377 15,989 15,075§§ Tularemia ¶ ¶ ¶ ¶ ¶ 142 129 90 Typhoid fever 369 396 365 375 346 377 368 321 Varicella¶¶ 120,624 83,511 98,727 82,455 46,016 27,382 22,536 22,841 Varicella deaths ** ** ** ** ** ** ** 9 Yellow fever*** - 1 - - 1 - - 1

• The 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, 2002.

Cases were updated through the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of May 2, 2003.

§ 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 28, 2003.

¶¶ 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 1991; all others since then have been imported.

Note: 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 the use of different case definitions.

74 MMWR April 30, 2004 TABLE 9. Reported cases of notifiable diseases* United States, 1987-1994 Disease 1987 1988 1989 1990 1991 1992 1993 1994 AIDS 21,070 31,001 33,722 41,595 43,672 45,472 103,691 78,279 Amebiasis 3,123 2,860 3,217 3,328 2,989 2,942 2,970 2,983 Anthrax 1 2 - - - 1 - -

Aseptic meningitis 11,487 7,234 10,274 11,852 14,526 12,223 12,848 8,932 Botulism, total (including wound and unsp.) 82 84 89 92 114 91 97 143 Foodborne 17 28 23 23 27 21 27 50 Infant 59 50 60 65 81 66 65 85 Brucellosis 129 96 95 82 104 105 120 119 Chancroid 4,998 5,001 4,692 4,212 3,476 1,886 1,399 773 Cholera 6 8 - 6 26 103 18 39 Diphtheria 3 2 3 4 5 4 - 2 Encephalitis, primary§ 1,418 882 981 1,341 1,021 774 919 717 Postinfectious 121 121 88 105 82 129 170 143 Escherichia coli O157:H7 2,139 2,741 2,555 3,161 4,513 4,528 3,287 1,420 Gonorrhea 780,905 719,536 733,151 690,169 620,478 501,409 439,673 418,068 Granuloma inguinale 22 11 7 97 29 6 19 3 Haemophilus influenzae, invasive disease ¶ ¶ ¶ ¶ ¶ 1,412 1,419 1,174 Hansen disease 238 184 163 198 154 172 187 136 Hepatitis A, acute 25,280 28,507 35,821 31,441 24,378 23,112 24,238 26,796 Hepatitis B, acute 25,916 23,177 23,419 21,102 18,003 16,126 13,361 12,517 Hepatitis C/non-A, non-B 2,999 2,619 2,529 2,553 3,582 6,010 4,786 4,470 Hepatitis, unspecified 3,102 2,470 2,306 1,671 1,260 884 627 444 Legionellosis 1,038 1,085 1,190 1,370 1,317 1,339 1,280 1,615 Leptospirosis 43 54 93 77 58 54 51 38 Lyme disease ¶ ¶ ¶ ¶ ¶ 9,895 8,257 13,043 Lymphogranuloma venereum 303 185 189 277 471 302 285 235 Malaria 944 1,099 1,277 1,292 1,278 1,087 1,411 1,229 Measles 3,655 3,396 18,193 27,786 9,643 2,237 312 963 Meningococcal disease 2,930 2,964 2,727 2,451 2,130 2,134 2,637 2,886 Mumps 12,848 4,866 5,712 5,292 4,264 2,572 1,692 1,537 Murine typhus fever 49 54 41 50 43 28 25 **

Pertussis 2,823 3,450 4,157 4,570 2,719 4,083 6,586 4,617 Plague 12 15 4 2 11 13 10 17 Poliomyelitis, paralytic 9 9 11 6 10 6 4 8 Psittacosis 98 114 116 113 94 92 60 38 Rabies, animal 4,658 4,651 4,724 4,826 6,910 8,589 9,377 8,147 Rabies, human 1 - 1 1 3 1 3 6 Rheumatic fever, acute 141 158 144 108 127 75 112 112 Rocky Mountain spotted fever 604 609 623 651 628 502 456 465 Rubella 306 225 396 1,125 1,401 160 192 227 Rubella, congenital syndrome 5 6 3 11 47 11 5 7 Salmonellosis, excluding typhoid fever 50,916 48,948 47,812 48,603 48,154 40,912 41,641 43,323 Shigellosis 23,860 30,617 25,010 27,077 23,548 23,931 32,198 29,769 Syphilis, primary and secondary 35,147 40,117 44,540 50,223 42,935 33,973 26,498 20,627 Total, all stages 86,545 103,437 110,797 134,255 128,569 112,581 101,259 81,696 Tetanus 48 53 53 64 57 45 48 51 Toxic-shock syndrome 372 390 400 322 280 244 212 192 Trichinosis 40 45 30 129 62 41 16 32 Tuberculosis 22,517 22,436 23,495 25,701 26,283 26,673 25,313 24,361 Tularemia 214 201 152 152 193 159 132 96 Typhoid fever 400 436 460 552 501 414 440 441 Varicella 213,196 192,857 185,441 173,099 147,076 158,364 134,722 151,219

• No cases of yellow fever were reported during 1987-1994.

Acquired immunodeficiency syndrome (AIDS).

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

¶ Not previously nationally notifiable.

• • No longer nationally notifiable.

Note: 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 the use of different case definitions.

Vol. 51 / No. 53 MMWR 75 TABLE 10. Reported cases of notifiable diseases* United States, 1979-1986 Disease 1979 1980 1981 1982 1983 1984 1985 1986 AIDS § § § § § 4,445 8,249 12,932 Amebiasis 4,107 5,271 6,632 7,304 6,658 5,252 4,433 3,532 Anthrax - 1 - - - 1 - -

Aseptic meningitis 8,754 8,028 9,547 9,680 12,696 8,326 10,619 11,374 Botulism, total (including wound and unsp.) 45 89 103 97 133 123 122 109 Foodborne § § § § § § 49 23 Infant § § § § § § 70 79 Brucellosis 215 183 185 173 200 131 153 106 Chancroid 840 788 850 1,392 847 666 2,067 3,756 Cholera 1 9 19 - 1 1 4 23 Diphtheria¶ 59 3 5 2 5 1 3 -

Encephalitis, primary** 1,504 1,362 1,492 1,464 1,761 1,257 1,376 1,302 Postinfectious 84 40 43 36 34 108 161 124 Gonorrhea 1,004,058 1,004,029 990,864 960,633 900,435 878,556 911,419 900,868 Granuloma inguinale 76 51 66 17 24 30 44 61 Hansen disease 185 223 256 250 259 290 361 270 Hepatitis A, acute 30,407 29,087 25,802 23,403 21,532 22,040 23,210 23,430 Hepatitis B, acute 15,452 19,015 21,152 22,177 24,318 26,115 26,611 26,107 Hepatitis C/ non-A, non-B § § § § § 3,871 4,184 3,634 Hepatitis, unspecified 10,534 11,894 10,975 8,564 7,149 5,531 5,517 3,940 Legionellosis 593 475 408 654 852 750 830 980 Leptospirosis 94 85 82 100 61 40 57 41 Lymphogranuloma venereum 250 199 263 235 335 170 226 396 Malaria 894 2,062 1,388 1,056 813 1,007 1,049 1,123 Measles (rubeola) 13,597 13,506 3,124 1,714 1,497 2,587 2,822 6,282 Meningococcal disease 2,724 2,840 3,525 3,056 2,736 2,746 2,479 2,594 Mumps 14,225 8,576 4,941 5,270 3,355 3,021 2,982 7,790 Murine typhus fever 69 81 61 58 62 53 37 67 Pertussis 1,623 1,730 1,248 1,895 2,463 2,276 3,589 4,195 Plague 13 18 13 19 40 31 17 10 Poliomyelitis, total 22 9 10 12 13 9 8 10 Paralytic 22 9 10 12 13 9 8 10 Psittacosis 137 124 136 152 142 172 119 224 Rabies, animal 5,119 6,421 7,118 6,212 5,878 5,567 5,565 5,504 Rabies, human 4 - 2 - 2 3 1 -

Rheumatic fever, acute 629 432 264 137 88 117 90 147 Rocky Mountain spotted fever 1,070 1,163 1,192 976 1,126 838 714 760 Rubella 11,795 3,904 2,077 2,325 970 752 630 551 Rubella, congenital syndrome 62 50 19 7 22 5 - 14 Salmonellosis 33,138 33,715 39,990 40,936 44,250 40,861 65,347 49,984 Shigellosis 20,135 19,041 19,859 18,129 19,719 17,371 17,057 17,138 Syphilis, primary and secondary 24,874 27,204 31,266 33,613 32,698 28,607 27,131 27,883 Total, all stages 67,049 68,832 72,799 75,579 74,637 69,888 67,563 68,215 Tetanus 81 95 72 88 91 74 83 64 Toxic-shock syndrome § § § § § 482 384 412 Trichinosis 157 131 206 115 45 68 61 39 Tuberculosis 27,669 27,749 27,373 25,520 23,846 22,255 22,201 22,768 Tularemia 196 234 288 275 310 291 177 170 Typhoid fever 528 510 584 425 507 390 402 362 Varicella 199,081 190,894 200,766 167,423 177,462 221,983 178,162 183,243

• No cases of yellow fever were reported during 1979-1986.

Acquired immunodeficiency syndrome (AIDS).

§ Not previously notifiable nationally

¶ Cutaneous diphtheria ceased being notifiable nationally after 1979.

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

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

§§ No longer nationally notifiable.

Note: 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 the use of different case definitions.

76 MMWR April 30, 2004 TABLE 11. Reported cases of notifiable diseases* United States, 1971-1978 Disease 1971 1972 1973 1974 1975 1976 1977 1978 Amebiasis 2,752 2,199 2,235 2,743 2,775 2,906 3,044 3,937 Anthrax 5 2 2 2 2 2 - 6 Aseptic meningitis 5,176 4,634 4,846 3,197 4,475 3,510 4,789 6,573 Botulism, total (including wound and unsp.) 25 22 34 28 20 55 129 105 Brucellosis 183 196 202 240 310 296 232 179 Chancroid 1,320 1,414 1,165 945 700 628 455 521 Cholera - - 1 - - - 3 12 Diphtheria 215 152 228 272 307 128 84 76 Encephalitis, primary 1,524 1,059 1,613 1,164 4,064 1,651 1,414 1,351 Postinfectious 439 243 354 218 237 175 119 78 Gonorrhea 670,268 767,215 842,621 906,121 999,937 1,001,994 1,002,219 1,013,436 Granuloma inguinale 89 81 62 47 60 71 75 72 Hansen disease 131 130 146 118 162 145 151 168 Hepatitis A (infectious) 59,606 54,074 50,749 40,358 35,855 33,288 31,153 29,500 Hepatitis B (serum) 9,556 9,402 8,451 10,631 13,121 14,973 16,831 15,016 Hepatitis, unspecified 7,488 8,639 8,776 Legionellosis 235 359 761 Leptospirosis 62 41 57 8,351 93 73 71 110 Lymphogranuloma venereum 692 756 408 394 353 365 348 284 Malaria 2,375 742 237 293 373 471 547 731 Measles 75,290 32,275 26,690 22,094 24,374 41,126 57,345 26,871 Meningococcal disease 2,262 1,323 1,378 1,346 1,478 1,605 1,828 2,505 Mumps 124,939 74,215 69,612 59,128 59,647 38,492 21,436 16,817 Murine typhus fever 23 18 32 26 41 69 75 46 Pertussis 3,036 3,287 1,759 2,402 1,738 1,010 2,177 2,063 Plague 2 1 2 8 20 16 18 12 Poliomyelitis, total 21 31 8 7 13 10 19 8 Paralytic 17 29 7 7 13 10 19 8 Psittacosis 32 52 33 164 49 78 94 140 Rabies, animal 4,310 4,369 3,640 3,151 2,627 3,073 3,130 3,254 Rabies, human 2 2 1 - 2 2 1 4 Rheumatic fever, acute 2,793 2,614 2,560 2,431 2,854 1,865 1,738 851 Rocky Mountain spotted fever 432 523 668 754 844 937 1,153 1,063 Rubella 45,086 25,507 27,804 11,917 16,652 12,491 20,395 18,269 Rubella, congenital syndrome 68 42 35 45 30 30 23 30 Salmonellosis 21,928 22,151 23,818 21,980 22,612 22,937 27,850 29,410 Shigellosis 16,143 20,207 22,642 22,600 16,584 13,140 16,052 19,511 Syphilis, primary and secondary 23,783 24,429 24,825 25,385 25,561 23,731 20,399 21,656 Total, all stages 95,997 91,149 87,469 83,771 80,356 71,761 64,621 64,875 Tetanus 116 128 101 101 102 75 87 86 Trichinosis 103 89 102 120 252 115 143 67 Tuberculosis§ 35,217 32,882 30,998 30,122 33,989 32,105 30,145 28,521 Tularemia 187 152 171 144 129 157 165 141 Typhoid fever 407 398 680 437 375 419 398 505 Varicella 164,114 182,927 141,495 154,248 183,990 188,396 154,089

• No cases of yellow fever were reported during 1971-1978.

Not previously nationally notifiable.

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

Note: 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 the use of different case definitions.

Vol. 51 / No. 53 MMWR 77 TABLE 12. Deaths from selected notifiable diseases United States, 1996-2000 1996 1997 1998 1999 2000 Cause of Estimated No. of deaths No. of deaths No. of deaths No. of No. of death codes comparability according to according to according to deaths deaths Cause of death ICD-10* ICD-9 ratio§ ICD-10¶ ICD-9** ICD-10 ICD-9 ICD-10 ICD-9 ICD-10 ICD-10 AIDS B20-B24 042-044 1.0824 33,695 31,130 17,877 16,516 14,532 13,426 14,802 14,478 Anthrax A22 022 §§ §§ - §§ - §§ - - -

Botulism, foodborne A05.1 005.1 §§ §§ 1 §§ 2 §§ - 4 4 Brucellosis A23 023 §§ §§ - §§ 1 §§ 1 - 1 Chancroid A57 099.0 §§ §§ - §§ - §§ - - -

Cholera A00 001 §§ §§ 2 §§ - §§ 1 1 1 Diphtheria A36 032 §§ §§ - §§ - §§ 1 1 -

Encephalitis/meningitis, arboviral California serogroup A83.5 062.5 §§ §§ 1 §§ 1 §§ - 1 -

Eastern equine A83.2 062.2 §§ §§ 1 §§ 2 §§ 1 - -

St. Louis A83.3 062.3 §§ §§ - §§ 1 §§ - 2 1 Western equine A83.1 062.1 §§ §§ - §§ - §§ 1 - 1 Gonorrhea A54 098 §§ §§ 4 §§ 3 §§ 4 9 12 Haemophilus influenzae A49.2 041.5 §§ §§ 7 §§ 7 §§ 11 6 6 Hansen disease A30 030 §§ §§ - §§ 2 §§ - 2 2 Hepatitis A B15 070.0-070.1 0.9328 113 121 118 127 106 114 134 106 Hepatitis B B16,B18.0,B18.1 070.2-070.3 0.6879 744 1,082 709 1,030 724 1,052 832 886 Hepatitis C B17.1, B18.2 070.4-070.5 0.7114 1,692 2,378 1,940 2,727 2,457 3,454 3,763 4,225 Malaria B50-B54 084 §§ §§ 4 §§ 7 §§ 6 7 3 Measles B05 055 §§ §§ 1 §§ 2 §§ - 2 1 Meningococcal disease A39 036 0.9861 286 290 305 309 231 234 227 211 Mumps B26 072 §§ §§ 1 §§ - §§ 1 1 2 Pertussis A37 033 §§ §§ 4 §§ 6 §§ 5 7 12 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 - 3 Rubella B06 056 §§ §§ - §§ - §§ - - -

Rubella, congenital syndrome P35.0 771.0 §§ §§ 4 §§ 4 §§ 4 8 4 Salmonellosis A02 003 0.8929 52 58 46 51 33 37 38 28 Shigellosis A03 004 §§ §§ 5 §§ 5 §§ 5 6 9 Spotted fever (tickborne rickettsioses) A77.0 082.0 §§ §§ 6 §§ 12 §§ 3 5 4 Syphilis, all stages A50-A53 090-097 0.7887 58 73 49 62 35 45 33 41 Tetanus A35 037 §§ §§ 1 §§ 4 §§ 7 7 5 Trichinosis B75 124 §§ §§ - §§ - §§ - - -

Tuberculosis A16-A19 010-018 0.8821 1,060 1,202 1,029 1,166 981 1,112 930 776 Tularemia A21 021 §§ §§ - §§ 1 §§ 1 1 3 Typhoid fever A01.0 002.0 §§ §§ 1 §§ - §§ - - -

Varicella ¶¶ B01 052 0.7848 64 81 78 99 64 81 48 44 Yellow fever A95 060 §§ §§ 1 §§ - §§ - 1 -

• World Health Organization. International Statistical Classification of Diseases 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 immunodefi-ciency 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: CDC. CDC WONDER Compressed mortality files Available at http://wonder.cdc.gov/mortSQL.html. Provided by the National Center for Health Statistics. National Vital Statistics System, 1996-2000. Deaths are classified according to ICD-9 (1996-1998) and ICD-10 (1999-2000). Data for 2001 and 2002 currently are not available.

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