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Centers for Disease Control and Prevention - Morbidity and Mortality Weekly Report - Summary of Notifiable Diseases - United States, 2003

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Morbidity and Mortality Weekly Report Weekly Published April 22, 2005, for 2003 / Vol. 52 / No. 54 depar depar depar depar department of health and human ser tment of health and human ser tment of health and human ser tment of health and human ser tment of health and human services vices vices vices vices Centers for Disease Control and Prevention Centers for Disease Control and Prevention Centers for Disease Control and Prevention Centers for Disease Control and Prevention Centers for Disease Control and Prevention Summary of Notifiable Diseases United States, 2003 Please note: An erratum has been published for this issue. To view the erratum, please click here.

MMWR CONTENTS Preface................................................................................ 2 Background......................................................................... 2 Data Sources....................................................................... 4 Interpreting Data................................................................. 4 Highlights............................................................................ 5 PART 1. Summaries of Notifiable Diseases in the United States, 2003........................................................ 15 TABLE 1. Reported cases of notifiable diseases, by month United States, 2003................................. 16 TABLE 2. Reported cases of notifiable diseases, by geographic division and area United States, 2003... 18 TABLE 3. Reported cases and incidence of notifiable diseases, by age group United States, 2003.............. 27 TABLE 4. Reported cases and incidence of notifiable diseases, by sex United States, 2003........................ 29 TABLE 5. Reported cases and incidence of notifiable diseases, by race United States, 2003...................... 31 TABLE 6. Reported cases and incidence of notifiable diseases, by ethnicity United States, 2003................ 33 PART 2. Graphs and Maps for Selected Notifiable Diseases in the United States, 2003.............................................. 35 PART 3. Historical Summaries of Notifiable Diseases in the United States, 1972-2003.................................... 69 TABLE 7. Reported incidence of notifiable diseases United States, 1993-2003........................................... 70 TABLE 8. Reported cases of notifiable diseases United States, 1996-2003........................................... 72 TABLE 9. Reported cases of notifiable diseases United States, 1988-1995........................................... 74 TABLE 10. Reported cases of notifiable diseases United States, 1980-1987........................................... 76 TABLE 11. Reported cases of notifiable diseases United States, 1972-1979........................................... 77 TABLE 12. Deaths from selected notifiable diseases United States, 1996-2001........................................... 78 Selected Reading............................................................... 79 SUGGESTED CITATION Centers for Disease Control and Prevention. Summary of notifiable diseasesUnited States, 2003. Published April 22, 2005, for MMWR 2003;52(No. 54):[inclusive page numbers].

The MMWR series of publications is published by the Coordinating Center for Health Information and Service,*

Centers for Disease Control and Prevention (CDC), U.S.

Department of Health and Human Services, Atlanta, GA 30333.

Centers for Disease Control and Prevention Julie L. Gerberding, MD, MPH Director Dixie E. Snider, MD, MPH Chief of Science Tanja Popovic, MD, PhD (Acting) Associate Director for Science Coordinating Center for Health Information and Service*

Blake Caldwell, MD, MPH, and Edward J. Sondik, PhD (Acting) Directors National Center for Health Marketing*

Steven L. Solomon, MD (Acting) Director Division of Scientific Communications*

Maria S. Parker (Acting) Director Mary Lou Lindegren, MD (Acting) Editor, MMWR Series Suzanne M. Hewitt, MPA Managing Editor, MMWR Series C. Kay Smith-Akin, MEd Lead Technical Writer/Editor Jeffrey D. Sokolow, MA Project Editor Lynda G. Cupell Visual Information Specialist Kim L. Bright, MBA Quang M. Doan, MBA Erica R. Shaver Information Technology Specialists

• Proposed.

Vol. 52 / No. 54 MMWR 1

Summary of Notifiable Diseases United States, 2003 Prepared by Richard S. Hopkins, MD Ruth Ann Jajosky, DMD 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, DrPH Man-huei Chang, MPH Division of Public Health Surveillance and Informatics Epidemiology Program Office

2 MMWR April 22, 2005 Preface The Summary of Notifiable Diseases United States, 2003 contains the official statistics, in tabular and graphic form, for the reported occurrence of nationally notifiable diseases in the United States for 2003. Unless otherwise noted, the data are final totals for 2003 reported as of June 30, 2004. These sta-tistics are collected and compiled from reports sent by state health departments to the National Notifiable Diseases Surveillance System (NNDSS), which is operated by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE). The Summary is available at http://

www.cdc.gov/mmwr/summary.html. This site also includes publications from past years.

The Highlights section presents noteworthy epidemio-logic and prevention information for 2003 for selected dis-eases and additional information to aid in the interpretation of surveillance and disease-trend data. Part 1 contains tables showing incidence data for the nationally notifiable dis-eases during 2003.* The tables provide the number of cases reported to CDC for 2003, as well as the distribution of cases by month, geographic location, and the patients demographic characteristics (age, sex, race, and ethnicity).

Nationally notifiable diseases that are reportable in <40 states do not appear in these tables. Part 2 contains graphs and maps that depict summary data for certain notifiable diseases described in tabular form in Part 1. Part 3 contains tables that list the number of cases of notifiable diseases reported to CDC since 1970. This section also includes a table enumerating deaths associated with specified notifiable diseases reported to CDCs National Center for Health Sta-tistics (NCHS), during 1996-2001. The Selected Read-ing section presents general and disease-specific references for notifiable infectious diseases. These references provide additional information on surveillance and epidemiologic concerns, diagnostic concerns, and disease control activities.

Background

The infectious diseases designated as notifiable at the national level during 2003 are listed on page 3. A notifi-able disease is one for which regular, frequent, and timely information regarding individual cases is considered neces-sary for the prevention and control of the disease. This sec-tion briefly summarizes the history of the reporting of nationally notifiable diseases in the United States.

In 1878, Congress authorized the U.S. Marine Hospital Service (the forerunner of the Public Health Service [PHS])

to collect morbidity reports regarding cholera, smallpox, plague, and yellow fever from U.S. overseas consuls. The intention was to use this information to institute quaran-tine measures to prevent the introduction and spread of these diseases into the United States. In 1879, a specific Congressional appropriation was made for the collection and publication of reports of these notifiable diseases. Con-gress expanded the authority for weekly reporting and pub-lication of these reports in 1893 to include data from states and municipal authorities. To increase the uniformity of the data, Congress enacted a law in 1902 directing the Sur-geon General to provide forms for the collection and com-pilation of data and for the publication of reports at the national level. In 1912, in conjunction with PHS, state and territorial health authorities recommended immediate tele-graphic reporting of five infectious diseases and the monthly reporting, by letter, of 10 additional diseases. The first an-nual summary of The Notifiable Diseases in 1912 included reports of 10 diseases from 19 states, the District of Co-lumbia, and Hawaii. By 1928, all states, the District of Columbia, Hawaii, and Puerto Rico were participating in national reporting of 29 specified diseases. At their annual meeting in 1950, state and territorial health officers autho-rized CSTE to determine which diseases should be reported to PHS. In 1961, CDC assumed responsibility for collecting and publishing data concerning nationally notifi-able diseases.

The list of nationally notifiable diseases is revised peri-odically. For example, a disease might be added to the list as a new pathogen emerges, or a disease might be deleted as its incidence declines. Public health officials at state health departments and CDC continue to collaborate in deter-mining which diseases should be nationally notifiable.

CSTE, with input from CDC, makes recommendations

• Because no cases of anthrax, Powassan encephalitis/meningitis, western equine encephalitis, paralytic poliomyelitis, or yellow fever were reported in the United States during 2003, these diseases do not appear in the tables in Part I. For certain other nationally notifiable diseases, incidence data were reported to CDC but are not included in the tables or graphs of this Summary. Data on chronic hepatitis B and hepatitis C virus infection (past or present) are undergoing data-quality review. Data on ehrlichiosis attributable to other or unspecified agents are being withheld from publication pending the outcome of discussions about the reclassification of certain Ehrlichia species, which will probably affect how data are reported in this category. Data on human immunodeficiency virus (HIV) infections are not included because HIV infection (not acquired immunodeficiency syndrome [AIDS]) reporting has been implemented on different dates and by using different methods than for AIDS case reporting; however, these data are summarized in the Highlights section.

In 1999, mortality data began to be coded according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision.

Comparability ratios provided by NCHS were used to bridge the mortality data for 1996-1998 (deaths coded by using the International Classification of Diseases, Ninth Revision) and 1999-2001.

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annually for additions and deletions. Although disease reporting is mandated by legislation or regulation at the state and local levels, state reporting to CDC is voluntary.

Thus, the list of diseases considered notifiable varies slightly

§ Formerly referred to as trichinosis.

Infectious Diseases Designated as Notifiable at the National Level During 2003 Acquired immunodeficiency syndrome (AIDS)

Anthrax Botulism Brucellosis Chancroid Chlamydia trachomatis, genital infection Cholera Coccidioidomycosis Cryptosporidiosis Cyclosporiasis Diphtheria Ehrlichiosis Human granulocytic Human monocytic Human, other or unspecified agent Encephalitis/meningitis, arboviral California serogroup Eastern equine Powassan St. Louis Western equine West Nile Enterohemorrhagic Escherichia coli (EHEC)

EHEC O157:H7 EHEC serogroup non-O157 EHEC, not serogrouped Giardiasis Gonorrhea Haemophilus influenzae, invasive disease Hansen disease (leprosy)

Hantavirus pulmonary syndrome Hemolytic uremic syndrome, postdiarrheal Hepatitis A, acute Hepatitis B, acute Hepatitis B, chronic Hepatitis B, perinatal infection Hepatitis C, acute Hepatitis C, infection (past or present)

Human immunodeficiency virus (HIV) infection Adult (age >13 yrs)

Pediatric (age <13 yrs)

Legionellosis Listeriosis Lyme disease Malaria Measles Meningococcal disease Mumps Pertussis Plague Poliomyelitis, paralytic Psittacosis Q fever Rabies Animal Human Rocky Mountain spotted fever Rubella Rubella, congenital syndrome Salmonellosis Severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease Shigellosis Streptococcal disease, invasive, group A Streptococcal toxic-shock syndrome Streptococcus pneumoniae, invasive disease Drug-resistant, all ages Age <5 yrs Syphilis Syphilis, congenital Tetanus Toxic-shock syndrome Trichinellosis§ Tuberculosis Tularemia Typhoid fever Varicella Varicella deaths Yellow fever by state. All states report the internationally quarantinable diseases (i.e., cholera, plague, and yellow fever) in compli-ance with the World Health Organizations International Health Regulations.

4 MMWR April 22, 2005 Data Sources Provisional data concerning the reported occurrence of notifiable diseases are published weekly in the MMWR. After each reporting year, staff in state health departments finalize reports of cases for that year with local or county health departments and reconcile the data with reports previously sent to CDC throughout the year. These data are compiled in final form in the Summary.

Notifiable disease reports are the authoritative and archival counts of cases. They must be approved by the appropriate epidemiologist from each submitting state or territory before being published in the Summary. Data published in MMWR Surveillance Summaries or other surveillance reports produced by CDC programs might not agree exactly with data reported in the annual Summary because of differences in the timing of reports, the source of the data, or surveillance methodology.

Data in the Summary were derived primarily from reports transmitted to the Division of Public Health Surveillance and Informatics, Epidemiology Program Office, CDC, from health departments in the 50 states, five territories, New York City, and the District of Columbia. More information regarding notifiable diseases, including case definitions for these condi-tions, is available at http://www.cdc.gov/epo/dphsi/phs.htm.

Policies for reporting notifiable disease cases can vary by disease or reporting jurisdiction.

Final data for certain diseases are derived from the surveil-lance records of the following CDC programs. Requests for further information regarding these data should be directed to the appropriate program.

National Center for Health Statistics (NCHS)

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

National Center for Infectious Diseases (NCID)

Division of Bacterial and Mycotic Diseases (toxic-shock syndrome; streptococcal disease, invasive, group A; strepto-coccal toxic-shock syndrome.

Division of Vector-Borne Infectious Diseases (ArboNET surveillance data regarding arboviral encephalitis/meningitis).

Division of Viral and Rickettsial Diseases (animal rabies, hantavirus pulmonary syndrome, and severe acute respiratory syndrome [SARS]).

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

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

and human immunodeficiency virus [HIV] infection).

Division of STD Prevention (chancroid, chlamydia, gonor-rhea, and syphilis).

Division of TB Elimination (tuberculosis).

National Immunization Program (NIP)

Epidemiology and Surveillance Division (poliomyelitis).

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

Population estimates for the states are derived from CDCs National Center for Health Statistics (NCHS) census popula-tions with bridged race categories, vintage 2003 postcensal series by year, county, age, sex, race, and Hispanic origin for July 1, 2000-July 1, 2003 (http://www.cdc.gov/nchs/about/

major/dvs/popbridge/popbridge.htm). For sexually transmit-ted diseases, population estimates are derived from the vintage 2002 postcensal series by year, county, age, sex, race, and His-panic origin for July 1, 2000-July 1, 2002. The choice of population denominators for incidence rates reported in the MMWR is based on 1) the availability of census population data at the time of preparation for publication and 2) the desire for consistent use of the same population data to com-pute incidence rates reported by various CDC programs.

Incidence rate in the Summary is calculated as the number of reported cases for each disease or condition divided by either the U.S. resident population for the specified demo-graphic population or the total U.S. residential population, multiplied by 100,000. When a nationally notifiable dis-ease is associated with a specific age restriction, the same age restriction is applied to the population in the denomi-nator of the incidence calculation. In addition, population data from states in which the disease or condition was not notifiable or was not available were excluded from incidence calculations.

Interpreting Data Incidence data in the Summary are presented by the date of report to CDC as determined by the MMWR week and year assigned by the state or territorial health department. In addi-tion, data in the Summary are reported by the state in which the patient resided at the time of diagnosis. For many of the nationally notifiable infectious diseases, surveillance data are independently reported to various CDC programs. Thus, sur-veillance data reported by other CDC programs might vary from data reported in the Summary because of differences in

1) the date used to aggregate data (e.g., date of report or date of disease occurrence), 2) the timing of reports, 3) the source of the data, 4) surveillance case definitions, and 5) policies regarding case jurisdiction (i.e., which state should report the case to CDC).

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The data reported in the Summary are useful for analyz-ing disease trends and determining relative disease burdens.

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

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

Different racial/ethnic populations might have different pat-terns of access to health care, potentially resulting in data that are not representative of actual disease incidence among specific racial/ethnic populations. Surveillance data reported to NNDSS are in either individual case-specific form or summary form (i.e., aggregated data for a group of cases).

Summary data often lack demographic information (e.g.,

race); therefore, the demographic-specific incidence rates presented in the Summary might be underestimated.

In addition, not all race and ethnicity data are collected uni-formly for all diseases. For example, certain disease programs collect data on race and ethnicity by using one or two vari-ables, based on the 1977 standards for collecting such data issued by the Office of Management and the Budget (OMB).

However, beginning in 2003, certain CDC programs, includ-ing the tuberculosis program, implemented OMBs 1997 revised standards for collecting such data; these programs col-lect data on multiple races per person by using multiple race variables. Additionally, although the recommended standard for classifying a persons race or ethnicity is based on self-reporting, this procedure might not always be followed.

Highlights for 2003 Below are summary highlights for certain national notifiable diseases. Highlights are intended to assist in the interpretation of major occurrences that affect disease incidence or surveillance trends (e.g., outbreaks, vaccine licensure, or policy changes).

AIDS Since 1981, confidential name-based AIDS surveillance has been the cornerstone of national, state, and local efforts to monitor the scope and impact of the HIV epidemic. The data have many uses, including developing policy to help prevent and control AIDS. However, because of the intro-duction of therapies that effectively slow the progression of the infection, AIDS data no longer adequately represent the populations affected by the epidemic. By providing a window into the epidemic at an earlier stage, HIV data, combined with AIDS data, better represent the overall impact. As of the end of 2003, a total of 40 areas (35 states, Puerto Rico and four U.S. territories) had implemented confidential name-based HIV reporting. These 40 areas have integrated name-based HIV surveillance into their AIDS surveillance systems, whereas other jurisdictions have used other methods for reporting cases of HIV infection. Under no configuration are names or other personal identifying information collected at the national level.

During 1998-1999, declines in AIDS rates began to level.

The number of reported cases in 2003 was essentially the same as the number in 1999. This trend follows a period of sharp declines in reported cases after 1996, when highly effective antiretroviral therapies were introduced. At the end of 2003, an estimated 405,926 persons were living with AIDS. After a dramatic decrease in the number of deaths among persons with AIDS during the late 1990s, the rate of decrease flattened through 2003. The number of deaths among persons with AIDS decreased 65% during 1995-1999. During 1999-2003, the number of deaths reported annually decreased 3%.

Brucellosis By 2003, the National Brucellosis Eradication Program had nearly eliminated Brucella abortus infection from U.S.

cattle herds. The risk of contracting brucellosis through occupational exposure to livestock in the United States or consumption of domestically produced dairy products therefore is minimal. Consumption of unpasteurized dairy

6 MMWR April 22, 2005 products from outside the United States continues to pose a risk of infection with B. abortus or B. melitensis. The ma-jority of U.S. cases of brucellosis occur among returned trav-elers or recent immigrants from areas in which Brucella species are endemic. Hunters exposed to infected wildlife might also be at increased risk for infection. Laboratory personnel working with Brucella species should follow rec-ommended biosafety precautions. Brucella species are con-sidered category-B biologic threat agents.

Chlamydia trachomatis, Genital Infection During 2003, a total of 877,478 cases of genital chlamy-dial infection were reported. Rates were the highest since voluntary case reporting began in the mid-1980s and the highest since genital chlamydial infection became a nation-ally notifiable disease in 1995 (1). This increase is attribut-able in part to continued expansion of chlamydia screening programs and increased use of more sensitive diagnostic tests for this condition. During 1999-2003, the reported chlamydial infection rate among men increased 58% com-pared with a 27% increase among women. However, the rate reported among women was more than three times the rate reported among men, reflecting the larger number of women screened and tested for this disease.

1. CDC. Sexually transmitted disease surveillance, 2003. Atlanta, GA: US Department of Health and Human Services, CDC; 2004.

Cholera During 1995-2003, a total of 68 laboratory-confirmed cases of cholera, all caused by Vibrio cholerae O1, were re-ported to CDC. Of these infections, 44 (65%) were ac-quired outside the United States, and six (9%) were acquired through consumption of contaminated seafood harvested in Gulf Coast waters. One patient died (1). Only two labo-ratory-confirmed cases of cholera were reported to CDC in 2003. Both were caused by Vibrio cholerae O1 and were acquired outside the United States. Both isolates were resis-tant to furazolidone. Production and sale of the only li-censed cholera vaccine in the United States ceased in 2001.

Worldwide, fewer (111,575) cases of cholera were reported to the World Health Organization from fewer (45) countries in 2003 than in any year since 1993 (2).

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

2. World Health Organization. Cholera, 2003. Wkly Epidemiol Rec 2004;31:281-88.

Coccidioidomycosis In recent years, Arizona and California have experienced substantial increases in the incidence of coccidioidomycosis.

This increase is likely related to demographic and climatic changes. Physicians should maintain a high suspicion for acute coccidioidomycosis, especially among patients with a flu-like illness who live in or have visited areas in which disease is endemic.

Diptheria One fatal, confirmed case of diphtheria was reported to CDC in 2003 (1). The patient was a Pennsylvania man aged 63 years who had spent 1 week in Haiti and had a sore throat 1 day before returning to Pennsylvania. He reported never having been vaccinated against diphtheria. On day 4 of illness, the patient was hospitalized with stridor and a swollen neck and was intubated. Despite administration of antibiotics, the patients condition worsened, and on day 8 of illness, an extensive membrane was noted when tracheo-stomy was performed. Diphtheria antitoxin was adminis-tered; polymerase chain reaction testing of a membrane sample was positive for Corynebacterium diphtheriae toxin genes at CDC. After 17 days of illness, cardiac complica-tions ensued, and the patient died. No additional cases or carriers were detected among the patients traveling com-panions or among household or hospital contacts.

1. CDC. Fatal respiratory diphtheria in a U.S. traveler to Haiti2003.

MMWR 2003;52:1285-6.

Enterohemorrhagic Escherichia coli Escherichia coli O157:H7 has been nationally notifiable since 1994 (1). In 2000, the Council for State and Territo-rial Epidemiologists passed a resolution in which all Shiga toxin-producing E. coli were made nationally notifiable under the name Enterohemorrhagic E. coli (EHEC); na-tional surveillance for EHEC began in 2001. Surveillance categories for EHEC include 1) EHEC O157:H7; 2)

EHEC, serogroup non-O157; and 3) EHEC, not serogrouped. Reported infections with the most well-known pathogen in this group, E. coli O157:H7, increased annu-ally during 1994-1999, to a peak of 4,744 cases. This in-crease in the number of cases was attributable in part to the increasing ability of laboratories to identify this pathogen.

During 1996-2002, incidence of diagnosed infections with E.coli O157:H7 reported by active surveillance through FoodNet did not change substantially, although it decreased in 2003 (2).

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During 2003, a total of 3,079 cases of E. coli were reported from 50 states, the District of Columbia, and Puerto Rico. Of these, 2,671 (87%) were classified as EHEC O157:H7; 252 (8%) as EHEC, serogroup non-O157; and 156 (5%) as EHEC, not serogrouped. The majority (54%)

of cases were reported during August-November.

Healthy cattle, which harbor the organism as part of the bowel flora, are the main animal reservoir for E. coli O157:H7 and other Shiga-toxin producing E. coli. The majority of reported outbreaks are caused by contaminated food or water.

Reported cases of E. coli O157:H7 infection have decreased since 2000, following implementation of U.S. Department of Agriculture measures to reduce contamination of meat through improved processing. Direct transmission from animals and their environments to humans in settings such as petting zoos and other animal exhibits remains a grow-ing public health concern (3,4).

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

1207-12.

2. CDC. Preliminary FoodNet Data on the incidence of infection with pathogens transmitted commonly through foodselected sites, United States, 2003. MMWR 2004;53:338-43.

3. CDC. Outbreak of Escherichia coli O157:H7 infections among children associated with farm visitsPennsylvania and Washington, 2000.

MMWR 2001;50:293-7.

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

Gonorrhea During 2003, a total of 335,104 cases of gonorrhea were reported (1). Gonorrhea rates were slightly lower than rates during 1999-2002. In 2003, for the first time, the reported gonorrhea rate among women (118.8 per 100,000) was greater than that reported for men (113.0 per 100,000).

Rates among non-Hispanic black women aged 15-19 years (2,947.8 per 100,000) and non-Hispanic black men aged 20-24 years (2,649.8 per 100,000) remain higher than those for any other racial/ethnic population or age group. Decreased susceptibility to fluoroquinolone antibiotics has also been reported from certain regions (2). In 2003, the prevalence of fluoroquinolone-resistant Neisseria gonorrhoeae infections continued to increase, particularly among men who have sex with men (MSM). Fluoroquinolones are no longer advised for treatment of gonorrhea in Hawaii or California or for infections among MSM (3).

1. CDC. Sexually transmitted disease surveillance 2003. Atlanta, GA: US Department of Health and Human Services, CDC, 2004.

2. CDC. Increases in fluoroquinolone-resistant Neisseria gonorrhoeae among men who have sex with menUnited States, 2003, and revised recom-mendations for gonorrhea treatment, 2004. MMWR 2004;53:335-8.

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

Haemophilus influenzae In 2003, a total of 376 cases of invasive Haemophilus influenzae disease among children aged <5 years were reported; 32 (9%) were reported as H. influenzae type b (Hib), 117 (31%) were reported as other serotypes or nontypeable iso-lates, and 227 (60%) were reported with serotype informa-tion unknown or missing. The continued low number of invasive Hib infections among children (from an estimated 20,000 cases annually in the prevaccine era) is a result of the successful delivery of highly effective conjugate Hib vac-cines to children, beginning at age 2 months (1,2). Be-cause discrepancies in serotyping results have occurred among laboratories, CDC requests that state health depart-ments obtain and send all invasive H. influenzae isolates from children aged <5 years to CDC for serotype confirmation (3,4).

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

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.

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

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

Hemolytic Uremic Syndrome, Postdiarrheal Hemolytic uremic syndrome (HUS) is a syndrome defined by the triad of hemolytic anemia, thrombocytopenia, and renal insufficiency. The patients reported in national notifi-able diseases surveillance include only those with antecedent diarrheal illness. The most common etiology of HUS in the United States is infection with a Shiga toxin-producing Escherichia coli, principally E. coli O157:H7. However, per-sons infected with E. coli O157:H7 rarely progress to HUS (1,2). During 2003, a total of 178 cases of HUS were reported from 32 states; of these, 118 (66%) occurred among children aged <10 years.

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

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

8 MMWR April 22, 2005 Hepatitis A Hepatitis A vaccine is recommended for persons at increased risk of hepatitis A (e.g., international travelers, men who have sex with men [MSM], injection-drug users [IDUs],

and noninjection-drug users) (1) and also for children in states and counties that have historically had consistently elevated rates of hepatitis A (2). Since routine childhood vaccination was recommended in 1996, the overall hepati-tis A rate has declined steadily, and in 2003, it was the lowest (2.7 per 100,000) yet recorded, with 7,653 cases reported. The decline in rates has been greater among chil-dren and in states where routine childhood vaccination is recommended, suggesting an effect of childhood vaccination.

The dramatic declines in disease rates in the age groups and areas in the United States that have historically accounted for the majority of reported cases have resulted in a shift in the epidemiology of this disease. Hepatitis A rates, which historically were much higher in the western states, are now similar in all regions of the United States, and an increasing proportion of cases occur among adults, particularly those in populations at high risk (e.g., MSM).

Despite declining overall rates, outbreaks continue to occur.

In 2003, several foodborne outbreaks were reported, includ-ing one in Pennsylvania that accounted for more than 500 cases; the produce implicated in each outbreak was believed to have been contaminated during harvest (3).

1. CDC. Prevention of hepatitis A through active or passive immunization.

MMWR 1996;45(No. RR-15).

2. CDC. Prevention of hepatitis A through active or passive immunization:

recommendations of the Advisory Committee on Immunization Prac-tices. MMWR 1999;48(No. RR-12).

3. CDC. Hepatitis A outbreak associated with green onions at a restaurant Monaca, Pennsylvania, 2003. MMWR 2003;52;47:1155-7.

Hepatitis B In 2003, a total of 7,526 acute hepatitis B cases were reported, representing a 64% decrease since 1990, when 21,102 cases were reported. The steady decline in hepatitis B rates coincides with the implementation of a national strategy to eliminate hepatitis B virus (HBV) (1). The pri-mary elements of this strategy are screening all pregnant women for HBV infection with the provision of postexposure prophylaxis to infants born to infected women, routine vac-cination of all infants and children aged <19 years; and vaccination of others at increased risk for hepatitis B (e.g.,

health-care workers, men who have sex with men [MSM],

injection-drug users [IDUs], and household and sex con-tacts of persons with chronic HBV infection).

In 2003, the rate among children aged <12 years, the cohort born since routine infant vaccination was implemented, was 0.02 per 100,000 population, representing a decline of >98% com-pared with the equivalent age group in 1990. Rates among ado-lescents aged 12-19 years have declined 90% since 1990 although the rate of decline among this age group, in contrast to that in the younger age group, has slowed in recent years.

Rates among adults declined 63% during 1990-1999 but have since remained stable. Among adults, a high pro-portion of cases occur among persons in identified high-risk populations (i.e., IDUs, MSM, and persons with multiple sex partners) indicating a need to strengthen ef-forts to reach these populations with vaccine.

1. CDC. Hepatitis B virus: a comprehensive strategy for eliminating trans-mission in the United States through universal childhood vaccination.

MMWR 1991;40(No. RR-13).

Hepatitis C Monitoring acute hepatitis C rates nationally has been chal-lenging because 1) available serologic tests cannot distinguish acute infection from past or chronic infection, and 2) not all health departments have the resources to determine if a posi-tive laboratory report for hepatitis C virus (HCV) infection represents acute infection. Consequently, the most reliable es-timates of acute hepatitis C incidence have historically come from sentinel surveillance. Incidence of hepatitis C has declined >80% since the late 1980s, primarily because of a decrease in the number of cases among injection-drug users, the reasons for which are unknown. The majority of hepatitis C cases continue to occur among persons aged >25 years, with injection-drug use being the most common risk factor for infection.

In recent years, analysis of data on acute, symptomatic hepa-titis C collected through the National Notifiable Diseases Sur-veillance System has yielded results similar to those from sentinel surveillance, indicating that the quality of national surveillance data for acute hepatitis C has improved.

Direct reporting of anti-HCV-positive test results by labora-tories has increased the completeness of reporting of HCV-infected persons to health departments. The reporting of other available laboratory or clinical data would improve surveil-lance for hepatitis C by providing information to identify patients with acute disease. Improving the accuracy of hepati-tis C surveillance data continues to be important because monitoring hepatitis C incidence trends provides information needed to evaluate the effectiveness of prevention efforts and identify additional opportunities for prevention.

Vol. 52 / No. 54 MMWR 9

HIV Infection, Adult By December 2003, all 50 states and the District of Co-lumbia had implemented HIV surveillance systems, includ-ing both name-based and nonname-based systems. Since 1999, a total of 33 areas (32 states and the U.S. Virgin Islands) have had laws or regulations requiring name-based confidential reporting for adults/adolescents with confirmed HIV infection, in addition to reporting of persons with AIDS. In 2002, CDC initiated a system to monitor HIV incidence; in 2003, CDC expanded this system and also initiated a national HIV behavioral surveillance system. CDC will assess the implementation and effectiveness of preven-tion activities through multiple monitoring systems, includ-ing use of new performance indicators for state and local health departments and community-based organizations (1).

At the end of 2003, a total of 172,952 adults and adoles-cents in the 33 areas were living with HIV infection (not AIDS).

The prevalence rate of HIV infection (not AIDS) in this group was 128 per 100,000 population (2). In these areas, 2003 was the first complete year of name-based surveillance; data from additional areas will be included in analyses when >1 year of case reports has accrued.

1. CDC. Advancing HIV prevention: new strategies for a changing epidemicUnited States, 2003. MMWR 2003;52:329-32.

2. CDC. HIV/AIDS surveillance report, 2003. Atlanta, GA: US Depart-ment of Health and Human Services, CDC. Vol. 15. Available at http://

www.cdc.gov/hiv/stats/2003surveillancereport.pdf.

HIV Infection, Pediatric In the 33 areas (32 states and the U.S. Virgin Islands) that have had laws or regulations since 1999 requiring con-fidential name-based reporting for children (aged <13 years) with confirmed HIV infection, an estimated 1,687 chil-dren were living with HIV infection (not AIDS) at the end of 2003. The prevalence rate of HIV infection (not AIDS) in this group was 5.6 per 100,000 population (1).

1. CDC. HIV/AIDS surveillance report, 2003. Atlanta, GA: US Depart-ment of Health and Human Services, CDC, Vol. 15. Available at http://

www.cdc.gov/hiv/stats/2003surveillancereport.pdf.

Listeriosis Listeriosis is a severe but relatively uncommon infection caused by Listeria monocytogenes; it was made a nationally notifiable disease in 2000. Listeriosis is primarily foodborne and occurs most frequently among persons who are older, preg-nant, or immunocompromised. During 2003, a total of 696 cases of listeriosis were reported from 46 states and the Dis-trict of Columbia; the majority (57%) of cases occurred among persons aged >60 years. Incidence was highest (1.52 per 100,000 population) among infants aged <1 year, probably reflecting perinatal transmission from mothers who were infected during pregnancy by ingesting contaminated food.

Molecular subtyping of L. monocytogenes isolates and shar-ing of that information through PulseNet has enhanced the ability of public health officials to detect and investigate outbreaks of listeriosis. Recent outbreaks have been linked to ready-to-eat meat (1) and unpasteurized cheese (2). In 2003, incidence of listeriosis as reported to FoodNet active surveillance was 0.33 per 100,000 population (3). In Janu-ary 2001, the Food and Drug Administration (FDA), CDC, and the U.S. Department of Agriculture (USDA) released a national Listeria Action Plan to help guide control efforts by industry, regulators, and public health officials (4). In November 2003, FDA and CDC updated their compo-nents of the Action Plan (5). Also in 2003, USDA issued new regulations aimed at further reducing L. monocytogenes contamination of ready-to-eat meat and poultry products (6).

1. CDC. Outbreak of listeriosisnortheastern United States, 2002.

MMWR 2002;51:950-1.

2. CDC. Outbreak of listeriosis associated with homemade Mexican-style cheeseNorth Carolina, October 2000-January 2001. MMWR 2002;50;560-2.

3. CDC. Preliminary FoodNet data on the incidence of infection with patho-gens transmitted commonly through foodselected sites, United States, 2003. MMWR 2004;53:338-43.

4. Food and Drug Administration, CDC, and US Department of Agricul-ture. Reducing the risk of Listeria monocytogenes: joint response to the President. Available at http://www.foodsafety.gov/~dms/lmriplan.html.

5. Food and Drug Administration. Reducing the risk of Listeria monocytogenes:

FDA/CDC 2003 update of the Listeria Action Plan. Available at http://

www.cfsan.fda.gov/~dms/lmr2plan.html.

6. US Department of Agriculture, Food Safety and Inspection Service.

Control of Listeria monocytogenes in ready-to-eat meat and poultry prod-ucts; Final Rule. Federal Register 2003;68:34208-54.

Lyme Disease A total of 21,273 cases of Lyme disease were reported in 2003, approximately 10% fewer cases than were reported in 2002. As in previous years, >90% of cases were reported from the northeastern and north-central United States. The num-ber of Lyme disease cases reported for Pennsylvania in 2003 included 4,722 confirmed cases and 1,008 suspected cases.

In contrast, the number of suspected Lyme disease cases reported annually for Pennsylvania during 2000-2002 ranged from two to 11 cases. The increase in the number of suspected cases is attributable to changes in reporting practices.

The only Lyme disease vaccine licensed in the United States (LYMErix) was removed from the market in February 2002, reportedly because of poor sales. Nevertheless, new prevention tools and techniques are becoming available.

10 MMWR April 22, 2005 Recent studies indicate that peridomestic tick exposure can be reduced substantially through simple landscaping changes, and bait boxes that deliver rodent-targeted acari-cide are now available through certain pest control opera-tors. Other products under development include devices for reducing ticks on deer and naturally occurring fungi that kill ticks on vegetation.

Measles A total of 56 confirmed measles cases, two of them fatal, were reported during 2003 by 15 states. Of the 56 cases, 24 were internationally imported, and 19 resulted from exposure to persons with imported infections. In two other cases, virologic evidence indicated an imported source. The sources for the remaining 11 cases were classified as unknown because no link to importation was detected. Three out-breaks occurred in 2003 (size range: 3-12 cases) (1,2). The 12-case outbreak was in Hawaii and included persons aged 3 months-21 years; this outbreak began simultaneously with a measles outbreak in the Republic of the Marshall Islands, which resulted in 826 cases and three deaths (3).

1. CDC. Epidemiology of measlesUnited States, 2001-2003. MMWR 2004:53:713-5.

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

3. CDC. Measles epidemicMajuro Atoll, Republic of the Marshall Islands, July 13-September 13, 2003. MMWR 2003;52:888-9.

Pertussis During 2003, a total of 11,647 cases of pertussis were reported (incidence: 4.0 per 100,000 population), the highest number of reported cases since 1964. Of the cases for which age was reported, 1,982 (17%) occurred among infants aged

<6 months, who were too young to have received the first 3 of the 5 doses of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine recommended by age 6 years. This age group had the highest reported incidence (103.1 per 100,000 population). Among the other pertussis cases, 235 occurred among children aged 6-11 months (12.2 per 100,000); 1,138 among children aged 1-4 years (7.5 per 100,000); 852 among children aged 5-9 years (4.4 per 100,000); 4,540 among persons aged 10-19 years (11.1 per 100,000); and 2,854 among persons aged >20 years (1.4 per 100,000).

Pertussis continues to cause morbidity in the United States despite high coverage levels for childhood pertussis vaccine.

The incidence of reported pertussis has increased from 2.5 per 100,000 population in 1993 to 4.0 per 100,000 in 2003.

How much of this increase is caused by increased recogni-tion and better reporting of cases is unclear (1,2). Although infants have the highest morbidity associated with pertus-sis (during the 1990s, approximately 18,500 cases were reported among infants, of whom 67% were hospitalized

[3]), adolescents now account for the majority of reported cases. Adolescents and adults can become susceptible to disease when vaccine-induced immunity wanes, approxi-mately 5-10 years after pertussis vaccination (2).

The actual number of pertussis cases (especially among adolescents and adults) continues to be substantially underreported because the pertussis cough illness resembles other conditions, infected persons might not seek medical care, and availability of reliable diagnostic tests is limited.

Culture for Bordetella pertussis is highly specific but has low sensitivity. Polymerase chain reaction is not standardized, and its use has led to overdiagnosis of pertussis during cer-tain outbreaks (4). New strategies are needed to reduce the burden of pertussis disease in the United States; pertussis vaccines for adolescents and adults are under review by the Food and Drug Administration.

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

2. Guris D, Strebel PM, Bardenheier B et al. Changing epidemiology of pertussis in the United States: increased reported incidence among adolescents and adults, 1990-1996. Clin Infect Dis 1999;28:1230-7.

3. Tanaka M, Vitek CR, Pascual B et al. Trends in pertussis among infants in the United States, 1980-1999. JAMA 2003;290:2968-75.

4. Lievano FA, Reynolds MA, Waring AL, et al. Issues associated with and recommendations for using PCR to detect outbreaks of pertussis. J Clin Microbiol 2002;40:2801-5.

Salmonellosis During 2003, a total of 43,657 cases of salmonellosis were reported, of which 17,608 (40%) occurred among children aged <15 years. As in previous years, the majority (67%) of reported cases occurred during July-October.

Salmonella isolates are reported by serotype through the Public Health Laboratory Information System. Two sero-types, S. enterica serotype Typhimurium and S. enterica serotype Enteritidis, have ranked as the two most frequent reported isolates since 1993 (1). A substantial proportion of S. enterica serotype Typhimurium and S. enterica sero-type Newport isolates are resistant to multiple drugs; national surveillance of S. enterica serotype Typhimurium strains conducted in 2002 indicated that 40% were resis-tant to one or more drugs and that 34% had a five-drug resistance pattern characteristic of a single phage type, DT104 (2). During 1998-2002, the proportion of mul-tiple drug-resistant strains of S. enterica serotype Newport

Vol. 52 / No. 54 MMWR 11 increased dramatically; 22% had a five-drug resistance pattern in 2002 compared with 1% in 1998 (2,3).

1. CDC. PHLIS surveillance data. Salmonella annual summaries. Atlanta, GA: US Department of Health and Human Services, CDC;2002. Avail-able at http://www.cdc.gov/ncidod/dbmd/phlisdata/salmonella.htm.

2. CDC. Human isolates final report, 2002. The National Antimicrobial Resistance Monitoring System: enteric bacteria. Atlanta, GA: US Department of Health and Human Services, CDC; 2002. Available at http://www.cdc.gov/narms.

3. Gupta A., Fontana J, Crowe C, et al. Emergence of multi-drug resistant Salmonella enterica serotype Newport infections resistant to expanded-spectrum cephalosporins in the United States. J Infect Dis 2003;188:1707-16.

SARS-CoV On March 12, 2003, the World Health Organization (WHO) issued a global alert for severe acute respiratory syn-drome (SARS), a potentially fatal new infectious disease that can spread rapidly from person to person and via international air travel. WHO and its partners, including CDC, initiated a rapid, intensive, and coordinated investigative and control effort that led within 2 weeks to the identification of the etio-logic agent, SARS-associated coronavirus (SARS-CoV), and to a series of effective containment efforts. By July 2003, when SARS-CoV transmission was brought to an end, >8,000 cases and 780 deaths had been reported to WHO (1). Of the 161 total cases reported from the United States, 134 were classi-fied as suspected; 19 were classified as probable; and eight were laboratory confirmed (2). As of July 1, 2003, SARS-CoV disease was added to the list of nationally notifiable diseases.

1. World Health Organization. Summary table of SARS cases by country, 1 November, 2002-7 August, 2003. Available at http://www.who.int/

csr/sars/country/2003_08_15/en.

2. CDC. Severe Acute Respiratory Syndrome (SARS): report of cases in the United States, 2003. Atlanta GA: US Department of Health and Human Services; 2003. Available at http://www.cdc.gov/od/oc/media/presskits/

sars/cases.htm.

Shigellosis Shigella sonnei infections continue to account for >75% of shigellosis cases in the United States (1). Prolonged, multistate outbreaks of S. sonnei infections that are transmitted in child care centers in which maintaining good hygienic conditions requires special attention account for much of the problem (2). During June 2001-March 2003, one such outbreak in six eastern states accounted for >3,000 laboratory-confirmed infections (3). S. sonnei can also be transmitted through con-taminated foods and through water used for drinking or recreational purposes (1). A new serotype of Shigella boydii has been reported in the United States and Canada (4).

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

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

3. CDC. Day-care related outbreaks of rhamnose-negative Shigella sonnei six states, June 2001-March 2003. MMWR 2004;53:60-3.

4. Kalluri P, Cummings K, Abbott S, et al. Epidemiological features of a newly described serotype of Shigella boydii. Epidemiol Infect 2004;132;579-83.

Streptococcal Disease, Invasive, Group A In 2003, approximately 1,190 invasive group A strepto-coccus (GAS) infections were reported by nine sites partici-pating in the Active Bacterial Core Surveillance (ABCs) project of CDCs Emerging Infections Program (1). Passive reporting likely underestimates the number of invasive GAS infections in the United States. CDC estimates that approximately 11,000 cases of invasive GAS disease and 1,700 deaths occurred nationally during 2003. The inci-dence of invasive GAS infections in the United States has been relatively stable during the past 5 years (range: 3.1-3.8 per 100,000).

1. CDC. Active Bacterial Core Surveillance report. Emerging Infections Program Network, Group A Streptococus, 2003preliminary. Atlanta, GA: US Department of Health and Human Services, CDC; 2003. Available at http://www.cdc.gov/ncidod/dbmd/abcs/survreports/gas03prelim.pdf.

Streptococcus pneumoniae, Invasive Disease, Drug-Resistant In 2003, the Active Bacterial Core Surveillance (ABCs) project of CDCs Emerging Infections Program (1) collected information on invasive pneumococcal disease, including drug-resistant Streptococcus pneumoniae, in nine states (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New York, Oregon, and Tennessee). For the third straight year, the proportion of pneumococcal isolates that were drug resistant declined. Of the 3,075 S. pneumoniae isolates collected in 2003, 10.0% exhibited intermediate resistance to penicillin (mini-mum inhibitory concentration [MIC] 0.1-1.0 µg/mL), and 9.9% were fully resistant (MIC >2 µg/mL) (2). For cefotaxime, 2.3% of all isolates had intermediate resistance, and 0.8% were fully resistant in 2003. For erythromycin, 17.4% were resis-tant. Approximately one in eight (12.3%) isolates had reduced susceptibility to at least three classes of drugs commonly used to treat pneumococcal infections, a decline from a peak of one in five (18.3%) isolates in 2000.

12 MMWR April 22, 2005 In February 2000, the Food and Drug Administration licensed a pneumococcal conjugate vaccine for use in infants and young children. In October 2000, the Advisory Commit-tee on Immunization Practices issued recommendations for vaccination of children aged <5 years (3). Vaccine use has reduced rates of invasive pneumococcal disease markedly among children, the vaccines target age group, and among unvaccinated older persons and has also reduced racial disparities in disease risk (4).

1. Schuchat A, Hilger T, Zell E, et al. Active Bacterial Core Surveillance of the Emerging Infections Program Network. Emerg Infect Dis 2001;7:1-8.

Available at http://www.cdc.gov/ncidod/eid/vol7no1/schuchat.htm.

2. NCCLS. Performance standards for antimicrobial susceptibility testing:

13th informational supplement [No. M100-S13]. Wayne, PA: NCCLS; 2003.

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

4. Flannery B, Schrag S, Bennett NM, et al. Impact of childhood vaccina-tion on racial disparities in invasive Streptococcus pneumoniae infections in the United States, 1998-2002. JAMA 2004;291:2197-203.

Syphilis, Congenital During 2003, a total of 413 cases of congenital syphilis were reported (10.3 per 100,000 live births), compared with 412 in 2002. As with primary and secondary syphilis, the rate of congenital syphilis has declined sharply in recent years, from a peak of 107.3 per 100,000 in 1991 (1). The continuing decrease in the rate of congenital syphilis likely reflects the substantial reduction in the rate of primary and secondary syphilis among women. Congenital syphilis persists in the United States because a substantial number of women do not receive syphilis serologic testing until late in their preg-nancies or not at all. This lack of screening is often related to absent or late prenatal care (2).

1. CDC. Sexually transmitted disease surveillance 2003. Atlanta, GA: US Department of Health and Human Services, CDC; 2004.

2. CDC. Congenital syphilisUnited States, 2002. MMWR 2004;53:716-9.

Syphilis, Primary and Secondary During 2003, a total of 7,177 primary and secondary syphilis cases were reported, compared with 6,862 cases in 2002. During 1990-2000, the primary and secondary syphilis rate declined 90%, from 20.34 per 100,000 popu-lation to 2.12 per 100,000. The 2000 rate was the lowest since reporting began in 1941. The 2003 rate (2.5 per 100,000) marks the third consecutive year of increases in the overall rate. The 2003 rate was 19% higher than the reported rate in 2000 and reflects a 62% increase among men from 2000 and a 53% decrease among women (1).

This disparity between men and women, observed across all racial and ethnic populations, along with reported out-breaks of syphilis in large urban areas among men who have sex with men (MSM), indicates that increases in syphilis are continuing to occur among MSM. Rates remain dis-proportionately high in the South and among non-Hispanic blacks, but these rates are continuing to decline (1,2).

1. CDC. Sexually transmitted disease surveillance, 2003. Atlanta, GA: US Department of Health and Human Services, CDC; 2004.

2. CDC. Primary and secondary syphilisUnited States, 2002. MMWR 2003;52:1117-20.

Tetanus In 2003, a total of 20 cases of tetanus were reported from 13 states and the District of Columbia. Four (20%) cases occurred among persons aged <25 years; none occurred among persons aged <18 years or neonates. Ten (50%) cases occurred among persons aged 25-59 years, and six (30%)

cases occurred among persons aged >60 years. Although the annual number of reported cases continues to decrease, the percentage of cases among persons aged 25-59 years has increased during the last decade; previously, the major-ity of cases occurred among persons aged >60 years (1,2).

Two (10%) cases were fatal.

1. Pascual FB, McGinley EL, Zanardi LR, Cortese MM, Murphy TV. Teta-nus surveillanceUnited States, 1998-2000. In: Surveillance Summa-ries, June 20, 2003. MMWR 2003;52(No. SS-3):1-8.

2. Bardenheier B, Prevots DR, Khetsuriani N, Wharton M. Tetanus surveil-lanceUnited States, 1995-1997. In: CDC Surveillance Summaries, July 3, 1998. MMWR 1998;47(No. SS-2):1-13.

Tuberculosis During 2003, a total of 14,874 tuberculosis (TB) cases (rate: 5.1 cases per 100,000 population) were reported to CDC from the 50 states and the District of Columbia, rep-resenting a 1.3% decrease in cases and a 1.9% decrease in the rate from 2002. This decline is the smallest since 1992, when TB incidence peaked after a 7-year resurgence (1). In addition, the rate remains higher than the national interim objective of 3.5 cases per 100,000 population that was set for 2000 (2).

Disparities in TB rates persist among racial/ethnic minority populations. In descending order, the highest rates per 100,000 population were reported among Asians (29.3 [3,425 cases]),

Native Hawaiian or Other Pacific Islanders (21.8 [85 cases]),

non-Hispanic blacks (11.6 [4,145 cases]), Hispanics (10.6

[4,115 cases]), American Indian or Alaska Natives (6.1 [176 cases]), and non-Hispanic whites (1.4 [2,790 cases]). In 2003, for the first time, Hispanics (28%) equaled blacks (28%) as

Vol. 52 / No. 54 MMWR 13 the racial/ethnic population with the largest percentage of cases prevalent (1).

In 2003, foreign-born persons accounted for 53% (7,902 cases) of the national case total, and 25 states reported at least 50% of their cases among foreign-born persons (1). The foreign-born prevalence represents an increase from 1993, when foreign-born persons accounted for 29% (7,354) of the national case total, and five states reported >50% of their cases among foreign-born persons (1). The TB rate among foreign-born persons has declined since 1993 (from 33.6 per 100,000 population in 1993 to 23.6 per 100,000 in 2003), but the decline among U.S.-born persons has been greater (from 7.4 in 1993 to 2.7 in 2003). In 2003, the case rate was 8.7 times greater among foreign-born per-sons than among U.S.-born persons; since 1993, this rate ratio has been increasing steadily.

CDC is collaborating with public health partners to imple-ment TB control initiatives for recent international arrivals and residents along the border between the United States and Mexico and to strengthen TB programs in countries with a high incidence of TB disease (2). CDC has recently updated its comprehensive national action plan to reflect the realignment of its priorities with the 2000 Institute of Medi-cine report (3) and to ensure that priority prevention activities are undertaken with optimal collaboration and coordination among national and international public health partners (4).

1. CDC. Reported tuberculosis in the United States, 2003. Atlanta, GA:

US Department of Health and Human Services, CDC; 2004. Available at http://www.cdc.gov/nchstp/tb/surv/surv2003/default.htm.

2. CDC. Trends in tuberculosis morbidityUnited States, 1998-2003.

MMWR 2004;53:209-14.

3. Institute of Medicine. Ending neglect: the elimination of tuberculosis in the United States. Washington, DC: National Academy Press; 2000.

4. CDC. CDCs response to ending neglect: the elimination of tuberculosis in the United States. Atlanta, GA: US Department of Health and Human Services, CDC; 2002.

Tularemia A total of 129 cases of tularemia were reported in 2003, compared with an annual average of 120 cases for the preced-ing 3 years. Noteworthy were cases involving a child who apparently acquired tularemia from exposure to pet hamsters, an outbreak among commercially distributed prairie dogs, an unusual case of intra-abdominal tularemia in a patient with stomach cancer (1), and a cluster of pneumonic tularemia cases among lawn-care workers who mowed over a dead rabbit.

1. Han XY, HoLX, Safdar A. Francisella tularensis peritonitis in stomach cancer patient. Emerg Infect Dis 2004;10:2238-40.

Typhoid Fever In 2003, a total of 356 cases of typhoid fever were reported in the United States. Despite recommendations that travelers to countries in which typhoid fever is endemic should be immunized with either of two effective vaccines available in the United States, approximately 74% of these cases occurred among persons who reported international travel during the preceding 6 weeks. Persons visiting friends and relatives in south Asia appear to be at particular risk, even during short visits (1). Salmonella Typhi strains with decreased susceptibility to ciprofloxacin are increasingly common in that region and should be treated with alterna-tive antimicrobial agents (2). S. Typhi outbreaks in the United States are generally limited in size but can cause substantial morbidity; they are most often foodborne and warrant thorough investigation (3). A sexually transmitted outbreak of typhoid fever has been recognized and reported (4).

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

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

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

3. Olsen SJ, Bleasdale SC, Magnano AR, et al. Outbreaks of typhoid fever in the United States, 1960-1999. Epidemiol Infect 2003;130:13-21.

4. Reller M, Olsen S, Kressel A, et al. Sexual transmission of typhoid fever:

a multi-state outbreak among men who have sex with men. Clin Infect Dis 2003;37:141-4.

Varicella Cases and Deaths In 2003, in all four states (Illinois, Michigan, Texas, and West Virginia) that have maintained consistent and adequate reporting levels¶ since 1990, the number of varicella cases was the lowest ever reported. Compared with 2002, cases declined 15.6%; compared with the prevaccine period 1993-1995, cases declined 81%. This decrease is associ-ated with rapidly increasing vaccination coverage; during 2002-2003, vaccination coverage among children aged 19-35 months increased from 81% to 85%.

The Council of State and Territorial Epidemiologists (CSTE) recommends that all states establish statewide in-dividual varicella case reporting by 2005 (1). The objec-tives of varicella surveillance at state and national levels are to 1) monitor the epidemiology of varicella by age and place and over time, 2) monitor the impact of widespread and increasing immunization on the epidemiology of varicella, and 3) allow prompt implementation of disease control measures.

¶ Number of reported cases constituted >5% of the states annual birth cohort.

14 MMWR April 22, 2005 In 1999, CSTE recommended that states report varicella deaths to CDC to monitor the impact of routine varicella vaccination on varicella-related mortality (2). In 2003, two states (Arkansas and Maryland) each reported one varicella death; ages of persons at time of death were 12 and 18 years. Reporting of varicella deaths is incomplete, which limits the usefulness of mortality data in assessing the im-pact of the varicella vaccination program. CDC encourages states to report varicella deaths, so the risk factors for vari-cella-related mortality can be identified, and the percent-age of deaths that would have been directly preventable by following current recommendations for vaccination can be determined.

1. Council of State and Territorial Epidemiologists. CSTE position state-ment 2002-ID-06: varicella surveillance. Atlanta, GA: Council of State and Territorial Epidemiologists; 2002. Available at http://www.cste.org/

position%20statements/02-ID-06.pdf.

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). Atlanta, GA: Council of State and Territorial Epidemiologists; 1998. Available at http://

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

West Nile Virus During 2003, for the fifth consecutive year, epidemic and epizootic West Nile virus (WNV) activity occurred in the United States, including a substantial epidemic of neuroinvasive WNV disease in the Great Plains states, wide-spread perennial reemergence in areas of previous activity, and continued geographic expansion into western states.

In 2003, a total of 9,862 human WNV illness cases were reported by 45 states and the District of Columbia (DC). Six states (Colorado, Nebraska, North Dakota, South Dakota, Texas, and Wyoming) accounted for 77% of all reported human cases. Of 9,862 total cases, 2,866 (29%) were neuroinvasive, 6,830 (69%) were uncomplicated fever, and 166 (2%) were clinically unspecified. Of 2,866 neuroinvasive cases reported from 42 states and DC, 232 (8 %) were fatal. The 2003 WNV epidemic in the United States was comparable in size to, but focused further west than, the 2002 epidemic, which was centered in states along the Mississippi River Valley (1). Illness onset dates were April 14-December 5; the epidemic peak occurred during the week ending August 16. In 2003, a total of 818 pre-sumptively WNV-viremic blood donors were identified through nationwide blood screening, and investigations were initiated to track birth outcomes among approximately 70 women with WNV illness acquired during pregnancy (2,3).

Increased surveillance for human WNV illness cases might have resulted in improved surveillance for other domestic arboviruses of public health importance.

In 2003, WNV activity was reported from 2,358 coun-ties in 46 states and D.C., including first-ever activity in Arizona, Nevada, and Utah, and first evidence of ecologic WNV transmission in California. In addition, 12,066 WNV-infected dead birds were reported from 43 states and D.C.; 5,145 WNV-infected horses and 106 other WNV-infected animals were reported from 43 states; and WNV seroconversions were reported in 1,956 sentinel bird flocks from 21 states. Culex mosquitoes accounted for 94% of 8,384 reported WNV-positive pools. Cx. tarsalis was the most commonly reported WNV-infected mosquito species and was considered a major epizootic and epidemic vector in western states.

In 2003, a total of 14 cases of neuroinvasive illness caused by eastern equine encephalitis virus were reported from eight states (Alabama, Florida, Georgia, Louisiana, New Jersey, North Carolina, South Carolina, and Virginia), equaling the maxi-mum number reported to CDC in any year during 1964-2003. In addition, a large eastern equine encephalitis epizootic among equines (713 cases) and including dogs (two cases) and other veterinary species (18 cases) was reported in 19 states.

During 1964-2003, a median of four (mean: five; range: 0-14) human cases were reported annually in the United States.

1. OLeary DR, Marfin AA, Montgomery SP, et al. The epidemic of West Nile virus in the United States, 2002. Vector Borne Zoonotic Dis 2004;4:61-9.

2. CDC. West Nile virus screening of blood donations and transfusion-associated transmissionUnited States, 2003. MMWR 2004;53:281-4.

3. CDC. Interim guidelines for the evaluation of infants born to mothers with West Nile virus infection during pregnancy. MMWR 2004;53:154-7.

Vol. 52 / No. 54 MMWR 15 PART 1 Summaries of Notifiable Diseases in the United States, 2003 Abbreviations and Symbols Used in Tables U

Data not available.

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

No reported cases.

Notes:

Rates <0.01 after rounding are listed as 0.

Data in the MMWR Summary of Notifiable Diseases United States, 2003 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.

16 MMWR April 22, 2005 TABLE 1. Reported cases of notifiable diseases,* by month United States, 2003 Disease Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total AIDS 2,265 3,057 4,180 2,883 3,916 3,765 3,443 3,713 3,829 4,479 3,436 5,266 44,232 Botulism Foodborne 1

3 1

1 1

1

1 2

1 8

20 Infant 6

8 6

4 6

1 7

7 6

5 12 8

76 Other (includes wound and unspecified)

1 4

1 2

2 6

5 5

1 6

33 Brucellosis 4

7 4

10 12 5

10 13 8

9 10 12 104 Chancroid§ 1

12 1

3 9

3 7

1 7

6 2

2 54 Chlamydia§¶ 54,988 67,590 85,499 68,695 83,561 67,315 61,388 83,633 67,459 70,657 84,924 81,769 877,478 Cholera

1

1 2

Coccidioidomycosis**

224 270 412 232 231 124 427 449 382 337 718 1,064 4,870 Cryptosporidiosis 126 120 204 146 199 188 276 563 634 397 352 301 3,506 Cyclosporiasis 4

3 3

4 5

11 15 12 1

3 5

9 75 Diphtheria

1

1 Ehrlichiosis Human granulocytic 1

2 6

6 19 35 50 86 35 33 31 58 362 Human monocytic 6

3 3

16 25 51 46 44 27 33 67 321 Encephalitis/meningitis, arboviral California serogroup

1

4 32 42 20 9

108 Eastern equine

1

7 4

1

1 14 St. Louis

1 1

6 24 7

1 1

41 West Nile

1 20 413 1,473 828 103 25 3

2,866 Enterohemorrhagic Escherichia coli (EHEC)

EHEC O157:H7 75 66 87 95 151 208 292 471 355 347 298 226 2,671 EHEC non-O157 8

11 20 13 21 11 25 54 14 27 25 23 252 EHEC not serogrouped 6

5 6

12 18 6

16 28 20 18 8

13 156 Giardiasis 1,045 1,159 1,498 1,179 1,538 1,268 1,466 2,526 2,055 1,908 2,066 2,001 19,709 Gonorrhea§ 22,468 26,193 30,600 23,984 30,889 25,401 24,559 33,339 27,283 27,211 32,362 30,815 335,104 Haemophilus influenzae, invasive, all ages/serotypes 119 142 187 159 215 151 159 164 126 124 147 320 2,013 Age <5 yrs, serotype b 4

2

2 3

3 2

3 2

3 1

7 32 Age <5 yrs, nonserotype b 5

10 16 11 15 11 6

10 6

5 5

17 117 Age <5 yrs, unknown serotype 13 19 24 21 28 11 14 13 12 13 20 39 227 Hansen disease (leprosy) 6 2

16 4

6 5

11 8

9 1

7 20 95 Hantavirus pulmonary syndrome 2

2

1 6

3

3 1

3 5

26 Hemolytic uremic syndrome postdiarrheal 5

9 13 4

14 13 21 19 21 22 18 19 178 Hepatitis A, acute 405 504 624 505 590 505 485 637 753 709 1,233 703 7,653 Hepatitis B, acute 405 513 689 508 688 568 593 707 533 612 697 1,013 7,526 Hepatitis C, acute 66 75 123 70 97 76 84 79 82 78 119 153 1,102 Legionellosis 95 82 85 69 113 223 282 382 260 191 217 233 2,232 Listeriosis 34 41 40 36 54 59 67 106 58 73 45 83 696

Vol. 52 / No. 54 MMWR 17 TABLE 1. (Continued) Reported cases of notifiable diseases,* by month United States, 2003 Disease Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total Lyme disease 479 605 741 573 1,175 2,136 4,094 4,032 2,195 1,411 1,550 2,282 21,273 Malaria 68 88 95 74 71 96 135 188 161 126 124 176 1,402 Measles 1

3 3

11 7

6 6

11 3

1 4

56 Meningococcal disease 124 165 247 152 166 140 95 101 71 110 134 251 1,756 Mumps 14 15 32 13 23 19 12 20 18 11 24 30 231 Pertussis 436 448 701 530 695 660 685 1,108 964 1,102 1,729 2,589 11,647 Plague

1

1 Psittacosis 1

1 1

2

1 3

2 1

12 Q fever 4

4 1

12 10 11 4

7 1

2 4

11 71 Rabies Animal 347 386 719 753 709 577 541 751 616 494 503 450 6,846 Human

1 1

2 Rocky Mountain spotted fever 19 13 30 31 49 96 87 167 162 92 124 221 1,091 Rubella

2

1 1

1 1

1

7 Congenital syndrome

1

1 Salmonellosis 1,782 1,950 2,446 2,178 3,278 3,736 5,061 6,345 4,883 4,252 4,008 3,738 43,657 SARS-CoV

6 1

1

8 Shigellosis 1,502 1,406 1,881 1,397 2,813 2,231 1,927 2,386 2,015 1,790 2,118 2,115 23,581 Streptococcal disease, invasive, group A 356 645 853 650 660 458 357 339 221 222 441 670 5,872 Streptococcal toxic-shock syndrome 14 16 27 19 19 17 5

6 6

6 6

20 161 Streptococcus pneumoniae, invasive Drug-resistant 158 223 288 219 208 132 117 106 88 118 158 541 2,356 Age <5 yrs**

61 79 78 68 72 71 41 33 34 54 94 160 845 Syphilis, total, all stages§ 2,261 2,622 3,737 2,831 3,355 2,612 2,585 3,159 2,455 2,550 3,030 3,073 34,270 Congenital (age <1 yr)§ 42 38 42 28 32 37 37 34 30 25 33 35 413 Primary and secondary§ 496 526 714 574 641 570 525 647 535 550 684 715 7,177 Tetanus 1

2 1

1 8

2 1

1 3

20 Toxic-shock syndrome 5

10 14 15 16 10 5

10 11 7

11 19 133 Trichinellosis

1

3 2

6 Tuberculosis§§ 593 912 1,021 1,284 1,214 1,296 1,216 1,197 1,202 1,385 1,057 2,497 14,874 Tularemia 2

1 1

5 15 15 13 13 9

5 50 129 Typhoid fever 14 26 38 23 24 25 34 51 51 22 24 24 356 Varicella 1,471 1,370 1,642 1,587 2,430 1,129 797 535 914 1,619 2,250 5,204 20,948 Varicella deaths¶¶

1 1

2

• No cases of anthrax, Powassan encephalitis, western equine encephalitis, paralytic poliomyelitis, or yellow fever were reported in 2003.

Total number of acquired immunodeficiency syndrome (AIDS) cases reported to the Division of HIV/AIDS Prevention Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention (NCHSTP), through December 31, 2003.

§ Totals reported to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of May 1, 2004.

¶ Chlamydia refers to genital infections caused by Chlamydia trachomatis

• • Notifiable in <40 states.

Severe acute respiratory syndrome-associated coronavirus; data reported to the Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, notifiable as of July 1, 2003.

§§ Totals reported to the Division of Tuberculosis Elimination, NCHSTP, as of April 1, 2004.

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

18 MMWR April 22, 2005 TABLE 2. Reported cases of notifiable diseases,* by geographic division and area United States, 2003 Total resident population Botulism Area (in thousands)

AIDS Foodborne Infant Other§ Brucellosis Chancroid¶ UNITED STATES 287,974 44,232**

20 76 33 104 54 NEW ENGLAND 14,134 1,697 1

1 3

Maine 1,295 52 N.H.

1,274 37 1

Vt.

616 16 Mass.

6,422 757 3

R.I.

1,068 102 Conn.

3,459 733 1

MID. ATLANTIC 40,038 10,142 1

23 1

9 11 Upstate N.Y.

11,385 1,589 2

1 1

N.Y. City 7,749 5,133 1

1 3

9 N.J.

8,575 1,514 3

1 Pa.

12,329 1,906 1

17 4

1 E.N. CENTRAL 45,635 3,875 3

9 Ohio 11,409 775 2

1 Ind.

6,157 506 1

Ill.

12,586 1,734 Mich.

10,043 676 5

Wis.

5,440 184 3

W.N. CENTRAL 19,464 844 1

4 Minn.

5,025 179 2

Iowa 2,936 75 Mo.

5,670 404 N. Dak.

634 2

S. Dak.

760 13 1

1 Nebr.

1,728 60 1

Kans.

2,712 111 S. ATLANTIC 53,564 12,191 5

13 29 Del.

806 216 3

Md.

5,451 1,572 1

1 D.C.

569 961 Va.

7,288 786 2

W. Va.

1,805 95 N.C.

8,306 1,102 1

2 S.C.

4,104 778 24 Ga.

8,544 1,907 1

Fla.

16,692 4,774 10 2

E.S. CENTRAL 17,225 2,035 1

4 1

Ky.

4,090 220 1

Tenn.

5,790 835 1

Ala.

4,479 471 1

Miss.

2,867 509 3

W.S. CENTRAL 32,409 4,864 1

3 34 3

Ark.

2,706 189 1

La.

4,476 1,048 1

Okla.

3,490 214 Tex.

21,737 3,413 1

3 32 3

MOUNTAIN 19,033 1,501 2

9 1

8 5

Mont.

910 7

Idaho 1,343 25 Wyo.

499 8

1 1

Colo.

4,501 368 1

2 1

1 N. Mex.

1,852 111 3

Ariz.

5,441 628 1

2 Utah 2,319 75 1

5 2

2 Nev.

2,167 279 2

PACIFIC 46,472 6,863 16 33 27 23 2

Wash.

6,067 527 11 1

Oreg.

3,520 242 3

1 2

Calif.

35,002 5,967 2

29 26 19 Alaska 641 17 3

1 Hawaii 1,241 110 1

2 Guam 161 7

7 P.R.

3,859 1,065 V.I.

108 34 Amer. Samoa 57 1

C.N.M.I.

74 2

1 N: Not notifiable. U: Unavailable. -: No reported cases. P.R.: Puerto Rico V.I.: U.S. Virgin Islands C.N.M.I.: Commonwealth of Northern Mariana Islands

• No cases of anthrax were reported in 2003.

Total number of acquired immunodeficiency syndrome (AIDS) cases reported to the Division of HIV/AIDS Prevention Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention (NCHSTP), through December 31, 2003.

§ Includes cases reported as wound and unspecified botulism.

¶ Totals reported to the Division of STD Prevention, NCHSTP, as of May 1, 2004.

• • Total includes 220 cases among persons with unknown state of residence.

Vol. 52 / No. 54 MMWR 19 TABLE 2. (Continued) Reported cases of notifiable diseases, by geographic division and area United States, 2003 Area Chlamydia*

Cholera Coccidioidomycosis Cryptosporidiosis Cyclosporiasis Diphtheria UNITED STATES 877,478 2

4,870 3,506 75 1

NEW ENGLAND 28,400 1

193 10 Maine 2,030 N

20 N.H.

1,616 26 Vt.

1,060 32 N

Mass.

11,301 78 6

R.I.

3,000 1

17 Conn.

9,393 N

20 4

MID. ATLANTIC 110,682 452 27 1

Upstate N.Y.

21,853 N

140 3

N.Y. City 35,369 126 9

N.J.

16,169 19 9

Pa.

37,291 N

167 6

1 E.N. CENTRAL 158,405 7

1,039 2

Ohio 42,522 173 Ind.

17,075 N

126 Ill.

48,294 102 Mich.

32,572 7

152 2

Wis.

17,942 486 W.N. CENTRAL 52,026 4

600 Minn.

10,714 N

155 Iowa 6,491 N

122 Mo.

18,570 1

52 N. Dak.

1,655 N

15 N

S. Dak.

2,608 49 Nebr.

4,739 3

33 Kans.

7,249 N

174 S. ATLANTIC 163,936 5

430 35 Del.

3,035 N

5 1

Md.

16,831 5

29 D.C.

3,168 14 8

Va.

19,439 54 2

W. Va.

2,585 N

4 N.C.

26,187 N

57 2

S.C.

14,623 16 Ga.

35,686 122 8

Fla.

42,382 N

129 14 E.S. CENTRAL 54,763 1

136 Ky.

7,981 N

27 N

Tenn.

20,380 N

43 Ala.

14,209 56 Miss.

12,193 1

10 W.S. CENTRAL 109,039 10 131 1

Ark.

7,856 22 La.

20,970 5

Okla.

11,013 N

24 Tex.

69,200 10 80 1

MOUNTAIN 48,934 1

2,751 139 Mont.

2,547 N

18 Idaho 2,366 N

27 Wyo.

960 1

5 Colo.

13,039 N

38 N. Mex.

7,480 10 17 Ariz.

12,819 1

2,695 6

N Utah 3,893 9

20 Nev.

5,830 36 8

PACIFIC 151,293 1

2,091 386 Wash.

16,797 62 Oreg.

7,688 36 Calif.

117,428 2,091 287 Alaska 3,900 1

Hawaii 5,480 1

Guam 598 P.R.

2,722 N

N N

V.I.

410 Amer. Samoa C.N.M.I.

218 N: Not notifiable. U: Unavailable. -: No reported cases. P.R.: Puerto Rico V.I.: U.S. Virgin Islands C.N.M.I.: Commonwealth of Northern Mariana Islands

• Totals reported to the Division of STD Prevention, NCHSTP, as of May 1, 2004. Chlamydia refers to genital infections caused by Chlamydia trachomatis.

20 MMWR April 22, 2005 TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2003 Ehrlichiosis Encephalitis/meningitis, arboviral Human Human California Eastern Area granulocytic monocytic serogroup equine St. Louis West Nile UNITED STATES 362 321 108 14 41 2,866 NEW ENGLAND 151 37 31 Maine 4

N.H.

1 1

2 Vt.

Mass.

54 15 12 R.I.

63 21 5

Conn.

29 12 MID. ATLANTIC 80 18 2

2 223 Upstate N.Y.

62 11 N.Y. City 8

4 1

57 N.J.

10 3

2 21 Pa.

N N

1 145 E.N. CENTRAL 16 19 37 4

150 Ohio 2

6 17 84 Ind.

1 6

15 Ill.

2 6

11 30 Mich.

1 4

14 Wis.

11 9

7 W.N. CENTRAL 88 34 3

1 696 Minn.

77 2

3 48 Iowa 1

81 Mo.

9 31 39 N. Dak.

N N

94 S. Dak.

1 151 Nebr.

194 Kans.

1 1

89 S. ATLANTIC 23 119 42 9

191 Del.

9 3

12 Md.

5 51 49 D.C.

N N

3 Va.

9 2

1 19 W. Va.

23 1

N.C.

2 28 17 1

16 S.C.

2 2

3 Ga.

20 2

27 Fla.

5 8

3 61 E.S. CENTRAL 1

39 23 2

2 91 Ky.

4 3

11 Tenn.

33 19 21 Ala.

1 2

2 25 Miss.

1 2

34 W.S. CENTRAL 3

54 3

1 26 611 Ark.

19 23 La.

N N

3 1

9 101 Okla.

2 33 56 Tex.

1 2

17 431 MOUNTAIN 1

6 871 Mont.

75 Idaho Wyo.

92 Colo.

N N

621 N. Mex.

1 74 Ariz.

5 7

Utah Nev.

1 2

PACIFIC 2

Wash.

Oreg.

Calif.

2 Alaska Hawaii Guam P.R.

V.I.

Amer. Samoa C.N.M.I.

N: Not notifiable. U: Unavailable. -: No reported cases. P.R.: Puerto Rico V.I.: U.S. Virgin Islands C.N.M.I.: Commonwealth of Northern Mariana Islands

• No cases of Powassan or western equine encephalitis or meningitis were reported in 2003.

Totals reported to the Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases (ArboNET Surveillance).

Vol. 52 / No. 54 MMWR 21 TABLE 2. (Continued) Reported cases of notifiable diseases, by geographic division and area United States, 2003 Enterohemorrhagic Escherichia coli (EHEC)

Haemophilus influenzae, invasive disease Shiga toxin positive Age <5 years Non-Not All ages, Serotype Nonserotype Unknown Area O157:H7 O157 serogrouped Giardiasis Gonorrhea*

serotypes b

b serotype UNITED STATES 2,671 252 156 19,709 335,104 2,013 32 117 227 NEW ENGLAND 163 47 13 1,700 7,443 176 2

7 6

Maine 11 4

186 233 6

1 N.H.

21 3

44 125 20 1

2 Vt.

18 122 97 11 1

Mass.

72 10 13 854 2,901 80 1

5 3

R.I.

4 126 973 15 1

Conn.

37 30 368 3,114 44 MID. ATLANTIC 256 25 36 4,030 41,976 409 3

4 50 Upstate N.Y.

105 13 20 1,284 8,484 155 3

4 10 N.Y. City 7

N 1,200 13,682 70 13 N.J.

31 2

520 7,944 70 11 Pa.

113 10 16 1,026 11,866 114 16 E.N. CENTRAL 580 35 20 3,254 70,663 323 3

6 61 Ohio 132 16 20 903 22,537 78 1

14 Ind.

91 N

6,681 59 11 Ill.

122 2

940 21,817 109 24 Mich.

94 2

781 13,965 26 3

5 1

Wis.

141 15 630 5,663 51 11 W.N. CENTRAL 451 56 22 2,161 18,147 125 2

8 14 Minn.

132 22 1

851 3,202 57 2

8 2

Iowa 104 277 1,554 Mo.

85 20 1

515 8,792 42 11 N. Dak.

14 4

8 50 103 8

S. Dak.

29 4

89 226 1

Nebr.

51 6

145 1,623 2

Kans.

36 12 234 2,647 15 1

S. ATLANTIC 168 51 48 2,883 81,875 453 2

20 33 Del.

11 N

N 57 1,128 Md.

18 3

1 118 8,032 109 1

9 1

D.C.

1 61 2,508 2

Va.

50 15 423 9,066 68 9

W. Va.

7 1

64 847 17 N.C.

38 N

15,116 41 3

2 S.C.

6 175 8,518 13 5

Ga.

27 8

853 17,686 81 9

Fla.

48 24 9

1,132 18,974 122 1

8 7

E.S. CENTRAL 86 2

6 416 27,728 100 1

4 13 Ky.

29 2

6 N

3,578 12 3

2 Tenn.

36 200 8,519 61 1

8 Ala.

17 216 9,303 25 1

3 Miss.

4 6,328 2

W.S. CENTRAL 102 4

4 314 45,248 85 3

13 5

Ark.

13 154 4,251 6

1 La.

3 N

15 11,850 22 2

4 Okla.

30 145 4,552 52 10 Tex.

56 4

4 N

24,595 5

3 1

MOUNTAIN 327 27 7

1,641 10,472 191 9

27 21 Mont.

17 115 122 Idaho 85 16 206 68 7

3 Wyo.

5 1

23 46 2

Colo.

67 4

7 467 2,854 40 7

N. Mex.

13 5

55 1,169 24 1

6 2

Ariz.

41 N

N 256 3,580 93 8

11 5

Utah 75 380 412 15 6

4 Nev.

24 1

139 2,221 10 4

PACIFIC 538 5

3,310 31,552 151 7

28 24 Wash.

128 1

435 2,753 14 3

7 3

Oreg.

102 4

411 1,000 42 4

Calif.

294 N

2,281 25,963 60 4

21 10 Alaska 5

89 573 21 7

Hawaii 9

94 1,263 14 Guam 2

68 P.R.

3 364 277 2

2 V.I.

87 Amer. Samoa 2

C.N.M.I.

31 N: Not notifiable. U: Unavailable. -: No reported cases. P.R.: Puerto Rico V.I.: U.S. Virgin Islands C.N.M.I.: Commonwealth of Northern Mariana Islands

• Totals reported to the Division of STD Prevention, NCHSTP, as of May 1, 2004.

22 MMWR April 22, 2005 TABLE 2. (Continued) Reported cases of notifiable diseases, by geographic division and area United States, 2003 Hemolytic Hansen Hantavirus uremic disease pulmonary

syndrome, Hepatitis, acute viral Area (leprosy) syndrome postdiarrheal A

B C

Legionellosis Listeriosis UNITED STATES 95 26 178 7,653 7,526 1,102 2,232 696 NEW ENGLAND 4

11 370 367 17 122 57 Maine N

21 7

3 2

7 N.H.

19 24 N

9 4

Vt.

1 6

4 13 6

1 Mass.

4 8

217 213 57 19 R.I.

17 21 1

20 4

Conn.

N 2

90 98 28 22 MID. ATLANTIC 12 23 1,821 780 143 632 139 Upstate N.Y.

1 18 146 110 26 176 44 N.Y. City 8

450 193 71 24 N.J.

3 3

208 183 94 24 Pa.

2 1,017 294 117 291 47 E.N. CENTRAL 3

17 681 634 127 459 92 Ohio 2

5 171 160 9

226 27 Ind.

1 73 70 12 34 10 Ill.

3 186 130 22 50 24 Mich.

1 4

206 223 79 131 21 Wis.

4 45 51 5

18 10 W.N. CENTRAL 2

5 27 195 377 285 75 20 Minn.

1 9

52 55 23 5

6 Iowa 1

2 40 18 1

12 1

Mo.

8 60 248 258 37 6

N. Dak.

N 1

2 2

1 S. Dak.

1 1

4 2

Nebr.

1 1

6 14 32 3

7 4

Kans.

2 27 18 11 3

S. ATLANTIC 10 13 1,781 2,090 165 553 150 Del.

9 14 31 N

Md.

1 N

178 132 9

134 27 D.C.

43 13 19 2

Va.

1 141 227 15 109 18 W. Va.

N 1

38 43 20 26 7

N.C.

3 126 163 13 42 18 S.C.

56 201 26 11 9

Ga.

N 2

791 666 13 34 31 Fla.

9 6

399 631 69 147 38 E.S. CENTRAL 1

14 282 531 100 108 33 Ky.

N 36 94 26 46 9

Tenn.

1 14 206 229 25 37 9

Ala.

24 96 6

20 13 Miss.

16 112 43 5

2 W.S. CENTRAL 24 5

8 729 1,249 161 84 50 Ark.

3 38 91 3

2 1

La.

2 N

50 117 102 1

5 Okla.

4 28 76 6

10 3

Tex.

19 5

4 613 965 50 71 41 MOUNTAIN 3

12 15 486 595 53 90 34 Mont.

8 16 4

4 2

Idaho 2

1 18 8

1 7

2 Wyo.

1 2

31 2

Colo.

4 8

63 82 14 12 9

N. Mex.

1 25 36 5

3 Ariz.

1 N

280 283 7

21 12 Utah 1

3 5

39 52 27 2

Nev.

1 1

1 51 87 27 12 4

PACIFIC 36 4

50 1,308 903 51 109 121 Wash.

N 2

76 90 14 13 Oreg.

N 7

62 121 16 17 5

Calif.

21 2

42 1,147 657 31 77 98 Alaska 10 8

Hawaii 15 1

13 27 4

1 5

Guam 11 2

10 5

1 P.R.

1 N

N 102 144 V.I.

Amer. Samoa 1

5 C.N.M.I.

1 N: Not notifiable. U: Unavailable. -: No reported cases. P.R.: Puerto Rico V.I.: U.S. Virgin Islands C.N.M.I.: Commonwealth of Northern Mariana Islands

Vol. 52 / No. 54 MMWR 23 TABLE 2. (Continued) Reported cases of notifiable diseases, by geographic division and area United States, 2003 Lyme Measles Meningococcal Area disease Malaria Indigenous Imported*

disease Mumps Pertussis Plague UNITED STATES 21,273 1,402 32 24 1,756 231 11,647 1

NEW ENGLAND 4,079 74 1

86 4

2,083 Maine 175 5

6 91 N.H.

190 7

1 12 2

119 Vt.

43 2

4 71 Mass.

1,532 32 45 1

1,670 R.I.

736 7

4 55 Conn.

1,403 21 15 1

77 MID. ATLANTIC 14,016 368 14 4

210 30 1,757 Upstate N.Y.

5,179 63 2

55 3

1,067 N.Y. City 220 194 3

2 43 12 150 N.J.

2,887 61 1

1 31 6

188 Pa.

5,730 50 8

1 81 9

352 E.N. CENTRAL 914 109 3

3 262 28 1,590 Ohio 66 23 1

1 60 7

328 Ind.

25 4

48 3

104 Ill.

71 46 1

73 8

321 Mich.

12 25 2

50 8

140 Wis.

740 11 1

31 2

697 W.N. CENTRAL 609 57 131 11 657 Minn.

474 28 29 1

207 Iowa 58 6

28 2

166 Mo.

70 7

49 5

208 N. Dak.

1 1

7 S. Dak.

1 3

1 7

Nebr.

2 8

16 Kans.

4 12 15 3

46 S. ATLANTIC 1,370 351 3

287 28 855 Del.

212 2

9 2

9 Md.

691 80 1

28 5

94 D.C.

14 17 6

4 Va.

195 59 28 1

219 W. Va.

31 4

7 3

28 N.C.

156 25 1

37 2

144 S.C.

18 5

29 5

208 Ga.

10 67 1

37 3

36 Fla.

43 92 106 7

113 E.S. CENTRAL 66 32 97 10 170 Ky.

17 11 23 53 Tenn.

20 7

30 5

83 Ala.

8 7

21 4

19 Miss.

21 7

23 1

15 W.S. CENTRAL 92 139 193 22 879 Ark.

4 21 1

92 La.

7 5

43 1

11 Okla.

5 24 2

106 Tex.

85 125 105 18 670 MOUNTAIN 15 54 1

103 15 1,040 1

Mont.

6 5

Idaho 3

1 9

1 82 Wyo.

2 2

2 1

130 Colo.

23 27 1

372 N. Mex.

1 3

12 1

78 1

Ariz.

4 17 1

34 1

211 Utah 2

6 5

5 127 Nev.

3 2

8 5

35 PACIFIC 112 218 14 13 387 83 2,616 Wash.

7 34 61 11 844 Oreg.

16 11 3

63 N

438 Calif.

86 166 5

242 58 1,255 Alaska 3

1 7

1 67 Hawaii N

6 14 5

14 13 12 Guam 1

5 3

1 P.R.

N 2

12 2

5 V.I.

Amer. Samoa 1

1 C.N.M.I.

N: Not notifiable. U: Unavailable. -: No reported cases. P.R.: Puerto Rico V.I.: U.S. Virgin Islands C.N.M.I.: Commonwealth of Northern Mariana Islands

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

Includes 4,722 confirmed and 1,008 suspected cases.

24 MMWR April 22, 2005 TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2003 Rubella Rabies Congenital SARS-Area Psittacosis Q Fever Animal Human RMSF Rubella syndrome Salmonellosis CoV§ UNITED STATES 12 71 6,846 2

1,091 7

1 43,657 8

NEW ENGLAND 1

6 616 10 1

2,127 Maine 2

73 N

141 N.H.

1 29 152 Vt.

39 73 Mass.

4 216 9

1 1,223 R.I.

71 1

137 Conn.

N 188 401 MID. ATLANTIC 2

2 929 41 3

1 4,995 2

Upstate N.Y.

432 1,282 N.Y. City 2

6 13 1

1 1,301 N.J.

62 16 2

857 1

Pa.

2 N

429 12 1,555 1

E.N. CENTRAL 12 175 22 5,614 Ohio 8

53 10 1,326 Ind.

2 32 1

587 Ill.

24 5

1,955 Mich.

1 52 6

798 Wis.

1 14 948 W.N. CENTRAL 7

646 65 2,525 Minn.

1 48 2

574 Iowa 105 2

415 Mo.

3 43 51 882 N. Dak.

1 57 46 S. Dak.

132 5

131 Nebr.

1 98 4

183 Kans.

1 163 1

294 S. ATLANTIC 6

12 2,657 1

610 11,382 2

Del.

N 64 1

105 Md.

351 106 856 D.C.

2 1

55 Va.

1 542 1

34 1,187 1

W. Va.

N 82 6

152 N.C.

2 773 331 1,435 1

S.C.

2 1

255 49 866 Ga.

1 402 65 2,057 Fla.

3 6

188 17 4,669 E.S. CENTRAL 15 210 131 2,979 Ky.

9 39 3

404 Tenn.

6 103 74 781 Ala.

64 21 792 Miss.

4 33 1,002 W.S. CENTRAL 4

1,200 201 6,079 Ark.

69 48 838 La.

5 1

879 Okla.

N 204 138 494 Tex.

N 4

922 14 3,868 MOUNTAIN 1

3 181 10 1

2,379 2

Mont.

23 1

112 Idaho 1

1 15 2

181 Wyo.

6 2

77 Colo.

38 3

1 503 N. Mex.

5 1

304 1

Ariz.

75 789 Utah 14 1

234 1

Nev.

2 5

179 PACIFIC 2

10 232 1

1 2

5,577 2

Wash.

N 699 Oreg.

1 1

7 1

425 Calif.

1 9

216 1

1 4,127 2

Alaska 9

96 Hawaii 1

230 Guam 1

44 P.R.

N 71 1

N 798 V.I.

Amer. Samoa C.N.M.I.

21 N: Not notifiable. U: Unavailable. -: No reported cases. P.R.: Puerto Rico V.I.: U.S. Virgin Islands C.N.M.I.: Commonwealth of Northern Mariana Islands

• No cases of paralytic poliomyelitis were reported in 2003.

Rocky Mountain spotted fever.

§ Totals reported to the Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases. Data are displayed from all states or territories reporting cases, whether or not that state or territory added SARS to its notifiable disease list.

Vol. 52 / No. 54 MMWR 25 TABLE 2. (Continued) Reported cases of notifiable diseases, by geographic division and area United States, 2003 Streptococcal

disease, Streptococcal Streptococcus pneumoniae, Syphilis*

invasive, toxic-shock invasive Congenital Primary and Area Shigellosis group A syndrome Drug-resistant Age <5 yrs All stages (age <1 yr) secondary UNITED STATES 23,581 5,872 161 2,356 845 34,270 413 7,177 NEW ENGLAND 353 488 7

123 17 1,000 1

224 Maine 7

29 21 8

N.H.

10 34 N

37 19 Vt.

8 19 3

9 5

1 1

Mass.

236 210 2

N N

644 133 R.I.

22 35 2

25 12 90 33 Conn.

70 161 U

89 U

207 1

30 MID. ATLANTIC 2,399 953 8

152 92 6,155 65 913 Upstate N.Y.

645 362 88 88 535 12 53 N.Y. City 416 146 U

U 3,825 30 531 N.J.

360 174 1

4 1,089 21 170 Pa.

978 271 7

64 N

706 2

159 E.N. CENTRAL 1,882 1,305 106 475 331 3,203 75 886 Ohio 301 287 24 285 98 481 3

197 Ind.

201 136 14 190 38 375 15 50 Ill.

1,006 349 68 134 1,376 19 374 Mich.

235 357 N

N N

860 38 249 Wis.

139 176 N

61 111 16 W.N. CENTRAL 796 363 11 188 91 559 6

159 Minn.

103 181 9

167 74 195 47 Iowa 94 N

N N

46 12 Mo.

356 81 2

16 3

207 4

61 N. Dak.

10 18 4

9 2

2 S. Dak.

17 25 1

5 2

Nebr.

92 27 5

27 1

10 Kans.

124 31 N

N 77 1

25 S. ATLANTIC 6,973 987 11 1,149 85 8,744 76 1,940 Del.

164 8

N N

47 7

Md.

579 233 N

27 974 8

312 D.C.

76 11 1

9 330 1

48 Va.

453 111 3

N N

552 1

82 W. Va.

4 39 4

113 12 11 2

N.C.

1,061 111 4

N U

848 18 152 S.C.

620 50 153 N

548 11 94 Ga.

1,169 195 N

249 64 2,152 11 585 Fla.

2,847 229 N

606 N

3,282 26 658 E.S. CENTRAL 1,058 222 7

168 2,037 8

322 Ky.

136 52 6

31 N

160 1

33 Tenn.

405 170 1

137 N

876 2

135 Ala.

342 N

566 3

114 Miss.

175 435 2

40 W.S. CENTRAL 6,047 315 85 155 6,221 81 952 Ark.

113 7

24 8

296 2

51 La.

447 2

61 30 1,576 1

183 Okla.

1,078 99 N

N 77 353 1

64 Tex.

4,409 207 N

40 3,996 77 654 MOUNTAIN 1,354 598 11 12 74 1,725, 42 337 Mont.

2 1

Idaho 36 19 2

N N

45 4

15 Wyo.

8 2

1 10 4

Colo.

333 147 4

55 144 3

39 N. Mex.

286 127 12 205 6

71 Ariz.

572 259 N

N 1,106 29 186 Utah 51 41 3

2 7

72 14 Nev.

66 2

1 149 12 PACIFIC 2,719 641 4

4,626 59 1,444 Wash.

188 74 N

239 82 Oreg.

211 N

N N

118 48 Calif.

2,261 428 N

N 4,202 59 1,299 Alaska 11 N

8 1

Hawaii 48 139 4

59 14 Guam 41 2

1 1

P.R.

33 N

N N

N 1,391 15 204 V.I.

1 1

Amer. Samoa 6

1 1

C.N.M.I.

128 8

8 N: Not notifiable. U: Unavailable. -: No reported cases. P.R.: Puerto Rico V.I.: U.S. Virgin Islands C.N.M.I.: Commonwealth of Northern Mariana Islands

• Totals reported to the Division of STD Prevention, NCHSTP, as of May 1, 2004.

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

26 MMWR April 22, 2005 TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2003 Toxic-shock Typhoid Varicella Varicella Area Tetanus syndrome Trichinellosis Tuberculosis Tularemia fever (chickenpox) deaths§ UNITED STATES 20 133 6

14,874 129 356 20,948 2

NEW ENGLAND 1

8 1

467 6

29 5,522 Maine 1

25 1,012 N.H.

2 1

15 4

Vt.

1 1

9 930 Mass.

3 261 6

15 1,993 R.I.

1 46 2

5 Conn.

N 111 8

1,582 MID. ATLANTIC 1

16 1

2,311 1

80 43 Upstate N.Y.

1 6

1 340 1

12 N.Y. City 1

1,140 37 N.J.

495 21 Pa.

9 336 10 43 E.N. CENTRAL 3

39 1,314 2

33 6,484 Ohio 2

12 229 2

1,302 Ind.

1 2

143 4

Ill.

9 633 1

17 Mich.

13 243 10 4,171 Wis.

3 66 1

1,011 W.N. CENTRAL 1

29 514 46 7

103 Minn.

10 214 1

3 N

Iowa 5

40 N

2 N

Mo.

4 131 32 1

1 N. Dak.

1 6

102 S. Dak.

1 20 5

Nebr.

1 7

28 5

1 N

Kans.

1 75 3

S. ATLANTIC 5

10 2,933 9

59 2,433 1

Del.

33 3

29 Md.

1 N

268 1

11 1

1 D.C.

1 1

79 55 Va.

3 332 4

16 682 W. Va.

21 1,330 N.C.

2 374 1

9 N

S.C.

254 336 Ga.

4 N

526 8

N Fla.

3 N

1,046 15 N

E.S. CENTRAL 3

2 2

809 7

8 Ky.

N 138 2

1 N

Tenn.

1 1

2 285 3

3 Ala.

1 1

258 1

4 Miss.

1 128 1

W.S. CENTRAL 1

2,144 43 31 5,481 1

Ark.

127 32 1

La.

260 16 Okla.

163 9

1 N

Tex.

1 N

1,594 2

30 5,465 MOUNTAIN 19 625 10 8

882 Mont.

7 Idaho 13 1

Wyo.

4 3

113 Colo.

5 111 3

4 N

N. Mex.

1 49 1

1 7

Ariz.

9 295 1

2 N

Utah 2

39 2

762 Nev.

2 107 PACIFIC 5

10 2

3,757 5

101 Wash.

250 3

4 N

Oreg.

106 4

N Calif.

5 10 2

3,227 2

91 N

Alaska 57 Hawaii 117 2

Guam 61 153 P.R.

N 115 626 V.I.

Amer. Samoa 1

21 C.N.M.I.

45 N: Not notifiable. U: Unavailable. -: No reported cases. P.R.: Puerto Rico V.I.: U.S. Virgin Islands C.N.M.I.: Commonwealth of Northern Mariana Islands

• No cases of yellow fever were reported in 2003.

Totals reported to the Division of TB Elimination, NCHSTP, as of April 1, 2004.

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

Vol. 52 / No. 54 MMWR 27 TABLE 3. Reported cases and incidence* of notifiable diseases, by age group United States, 2003

<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 (1.14) 39 (0.25) 174 (0.42) 2,019 (4.97) 19,966 (32.28) 21,209 (23.65) 779 (2.19)

44,232 Botulism, foodborne 3

(0.07) 1 (0.01)

(0) 2 (0) 3 (0) 9 (0.01) 1 (0) 1 20 Infant 72 (1.78)

(0)

(0)

(0)

(0)

(0)

(0) 4 76 Other (includes wound and unspecified) 1 (0.02)

(0) 1 (0)

(0) 4 (0.01) 25 (0.03) 1 (0) 1 33 Brucellosis 1

(0.02) 2 (0.01) 16 (0.04) 10 (0.02) 26 (0.04) 36 (0.04) 10 (0.03) 3 104 Chlamydia¶**

(0)

(0)

(0) 630,385 (1,553.06) 201,630 (326.03) 21,985 (24.51) 677 (1.90) 6,246 877,478 Cholera

(0)

(0) 1 (0)

(0) 1 (0)

(0)

(0)

2 Coccidioidomycosis 20 (1.39) 36 (0.65) 238 (1.64) 511 (3.65) 1,152 (5.43) 1,895 (6.60) 979 (9.21) 39 4,870 Cryptosporidiosis 75 (1.86) 684 (4.39) 593 (1.45) 385 (0.95) 750 (1.21) 720 (0.80) 213 (0.60) 86 3,506 Cyclosporiasis

(0)

(0) 5 (0.01) 4 (0.01) 18 (0.03) 34 (0.04) 12 (0.04) 2 75 Diphtheria

(0)

(0)

(0)

(0)

(0) 1 (0)

(0)

1 Ehrlichiosis Human granulocytic

(0) 1 (0.01) 15 (0.04) 26 (0.07) 58 (0.10) 169 (0.20) 92 (0.28) 1 362 Human monocytic 1

(0.03) 5 (0.03) 13 (0.03) 17 (0.05) 47 (0.08) 151 (0.18) 87 (0.27)

321 Encephalitis/meningitis, arboviral California serogroup

(0) 16 (0.10) 79 (0.19) 3 (0.01) 2 (0) 5 (0.01) 3 (0.01)

108 Eastern equine 1

(0.02) 3 (0.02) 3 (0.01)

(0)

(0) 3 (0) 4 (0.01)

14 St. Louis

(0)

(0)

(0) 1 (0) 4 (0.01) 24 (0.03) 12 (0.03)

41 West Nile 5

(0.12) 12 (0.08) 64 (0.16) 175 (0.43) 411 (0.66) 1,121 (1.25) 987 (2.77) 91 2,866 Enterohemorrhagic Escherichia coli (EHEC)

EHEC O157:H7 61 (1.51) 556 (3.57) 562 (1.37) 419 (1.03) 279 (0.45) 458 (0.51) 314 (0.88) 22 2,671 EHEC non-O157 18 (0.46) 53 (0.35) 46 (0.11) 37 (0.09) 21 (0.03) 43 (0.05) 30 (0.09) 4 252 EHEC not serogrouped 10 (0.31) 31 (0.25) 20 (0.06) 21 (0.06) 27 (0.05) 27 (0.04) 19 (0.06) 1 156 Giardiasis 322 (9.40) 3,415 (25.88) 2,637 (7.52) 1,375 (3.96) 3,858 (7.28) 4,542 (5.86) 981 (3.15) 2,579 19,709 Gonorrhea**

(0)

(0)

(0) 195,987 (482.85) 103,741 (167.75) 26,873 (29.96) 702 (1.97) 2,200 335,104 Haemophilus influenzae, invasive All ages/serotypes

(0)

(0) 97 (0.24) 94 (0.23) 114 (0.18) 476 (0.53) 802 (2.25) 430 2,013 Age <5 yrs, serotype b 19 (0.47) 13 (0.08)

(0)

(0)

(0)

(0)

(0)

32 Age <5 yrs, nonserotype b 59 (1.46) 58 (0.37)

(0)

(0)

(0)

(0)

(0)

117 Age <5 yrs, unknown serotype 134 (3.32) 93 (0.60)

(0)

(0)

(0)

(0)

(0)

227 Hansen disease (leprosy)

(0)

(0) 1 (0) 10 (0.03) 30 (0.05) 26 (0.03) 12 (0.04) 16 95 Hantavirus pulmonary syndrome

(0)

(0)

(0) 1 (0) 9 (0.01) 11 (0.01) 3 (0.01) 2 26 Hemolytic uremic syndrome postdiarrheal 6

(0.16) 83 (0.56) 47 (0.12) 9 (0.02) 5 (0.01) 18 (0.02) 10 (0.03)

178 Hepatitis A, acute 28 (0.69) 203 (1.30) 935 (2.28) 1,124 (2.77) 1,868 (3.02) 2,382 (2.66) 993 (2.79) 120 7,653 Hepatitis B, acute 8

(0.20) 5 (0.03) 22 (0.05) 886 (2.18) 3,075 (4.97) 2,942 (3.28) 344 (0.97) 244 7,526 Hepatitis C, acute 6

(0.15) 2 (0.01) 3 (0.01) 159 (0.39) 352 (0.57) 529 (0.59) 37 (0.10) 14 1,102 Legionellosis 2

(0.05)

(0) 5 (0.01) 29 (0.07) 191 (0.31) 1,187 (1.32) 796 (2.24) 22 2,232 Listeriosis 61 (1.52) 7 (0.05) 3 (0.01) 24 (0.06) 58 (0.09) 181 (0.20) 350 (0.99) 12 696 Lyme disease 62 (1.54) 1,048 (6.76) 4,035 (9.87) 1,987 (4.92) 3,057 (4.96) 8,096 (9.07) 2,670 (7.53) 318 21,273

28 MMWR April 22, 2005 TABLE 3. (Continued) Reported cases and incidence* of notifiable diseases, by age group United States, 2003

<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 Malaria 1

(0.02) 50 (0.32) 142 (0.35) 238 (0.59) 426 (0.69) 468 (0.52) 51 (0.14) 26 1,402 Measles 11 (0.27) 8 (0.05) 5 (0.01) 15 (0.04) 9 (0.01) 7 (0.01) 1 (0)

56 Meningococcal disease 206 (5.11) 240 (1.54) 210 (0.51) 354 (0.87) 176 (0.28) 303 (0.34) 246 (0.69) 21 1,756 Mumps 2

(0.05) 30 (0.19) 70 (0.17) 17 (0.04) 44 (0.07) 58 (0.07) 6 (0.02) 4 231 Pertussis 2,217 (54.96) 1,138 (7.31) 3,481 (8.48) 2,272 (5.60) 1,030 (1.67) 1,328 (1.48) 135 (0.38) 46 11,647 Plague

(0)

(0)

(0)

(0)

(0)

(0) 1 (0)

1 Psittacosis

(0)

(0)

(0)

(0) 2 (0) 9 (0.01) 1 (0)

12 Q fever

(0)

(0)

(0) 6 (0.02) 10 (0.02) 36 (0.04) 19 (0.06)

71 Rabies, human

(0)

(0)

(0)

(0) 1 (0)

(0) 1 (0)

2 Rocky Mountain spotted fever 2

(0.05) 37 (0.24) 84 (0.21) 106 (0.27) 242 (0.40) 462 (0.53) 153 (0.44) 5 1,091 Rubella

(0)

(0) 2 (0) 3 (0.01) 2 (0)

(0)

(0)

7 Salmonellosis 4,356 (107.99) 7,656 (49.15) 5,596 (13.64) 3,591 (8.85) 5,688 (9.20) 7,825 (8.72) 3,958 (11.12) 4,987 43,657 SARS-CoV§§

(0)

(0)

(0) 1 (0) 3 (0) 4 (0)

(0)

8 Shigellosis 418 (10.36) 6,665 (42.79) 7,259 (17.69) 1,517 (3.74) 2,833 (4.58) 1,818 (2.03) 362 (1.02) 2,709 23,581 Streptococcal disease, invasive, group A 138 (3.49) 273 (1.79) 424 (1.06) 252 (0.64) 760 (1.26) 1,880 (2.15) 1,798 (5.18) 347 5,872 Streptococcal toxic-shock syndrome 1

(0.03) 4 (0.03) 6 (0.02) 7 (0.02) 23 (0.04) 64 (0.09) 56 (0.19)

161 Streptococcus pneumoniae, invasive disease Drug-resistant 93 (5.97) 288 (4.77) 103 (0.64) 57 (0.35) 179 (0.74) 732 (1.98) 789 (5.04) 115 2,356 Age <5 yrs 284 (14.53) 561 (7.41)

(0)

(0)

(0)

(0)

(0)

845 Syphilis, primary and secondary**

(0)

(0)

(0) 1,182 (2.91) 3,585 (5.80) 2,351 (2.62) 42 (0.12) 1 7,177 Tetanus

(0)

(0)

(0) 4 (0.01) 4 (0.01) 6 (0.01) 6 (0.02)

20 Toxic-shock syndrome 3

(0.09) 2 (0.02) 26 (0.08) 34 (0.10) 26 (0.05) 31 (0.04) 11 (0.04)

133 Trichinellosis

(0)

(0) 2 (0.01)

(0) 1 (0) 3 (0)

(0)

6 Tuberculosis¶¶ 101 (2.50) 454 (2.91) 367 (0.90) 1,573 (3.88) 3,710 (6.00) 5,666 (6.32) 2,694 (7.57) 309 14,874 Tularemia

(0) 13 (0.08) 31 (0.08) 4 (0.01) 21 (0.03) 36 (0.04) 22 (0.06) 2 129 Typhoid fever 4

(0.10) 42 (0.27) 66 (0.16) 57 (0.14) 99 (0.16) 74 (0.08) 9 (0.03) 5 356

• Per 100,000 population.

No cases of anthrax, Powassan encephalitis or meningitis, western equine encephalitis or meningitis, paralytic poliomyelitis, or yellow fever were reported in 2003.

§ Total number of acquired immunodeficiency syndrome (AIDS) cases reported to the Division of HIV/AIDS Prevention Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention (NCHSTP), through December 31, 2003.

¶ Chlamydia refers to genital infections caused by Chlamydia 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 STD Prevention, NCHSTP, as of May 1, 2004.

Notifiable in <40 states.

§§ Severe acute respiratory syndrome-associated coronavirus; age data provided by the Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases.

¶¶ Totals reported to the Division of TB Elimination, NCHSTP, as of April 1, 2004.

Vol. 52 / No. 54 MMWR 29 TABLE 4. Reported cases and incidence* of notifiable diseases, by sex United States, 2003 Male Female Sex not stated Disease No.

(Rate)

No.

(Rate)

No.

Total AIDS§ 32,851 (23.19) 11,380 (7.76) 1 44,232 Botulism Foodborne 10 (0.01) 10 (0.01)

20 Infant 36 (1.74) 40 (2.03)

76 Other (includes wound and unspecified) 24 (0.02) 8 (0.01) 1 33 Brucellosis 52 (0.04) 50 (0.03) 2 104 Chancroid¶ 25 (0.02) 29 (0.02)

54 Chlamydia¶**

190,244 (134.30) 685,017 (466.93) 2,217 877,478 Cholera 1

(0) 1 (0)

2 Coccidioidomycosis 2,867 (6.02) 1,973 (4.07) 30 4,870 Cryptosporidiosis 1,920 (1.36) 1,512 (1.03) 74 3,506 Cyclosporiasis 37 (0.03) 37 (0.03) 1 75 Diphtheria 1

(0)

(0)

1 Ehrlichiosis Human granulocytic 218 (0.17) 142 (0.11) 2 362 Human monocytic 186 (0.14) 133 (0.10) 2 321 Encephalitis/meningitis, arboviral California serogroup 61 (0.04) 47 (0.03)

108 Eastern equine 8

(0.01) 6 (0)

14 St. Louis 24 (0.02) 17 (0.01)

41 West Nile 1,679 (1.19) 1,180 (0.80) 7 2,866 Enterohemorrhagic Escherichia coli (EHEC)

EHEC O157:H7 1,175 (0.83) 1,483 (1.01) 13 2,671 EHEC non-O157 110 (0.08) 135 (0.09) 7 252 EHEC not serogrouped 81 (0.71) 75 (0.64)

156 Giardiasis 9,472 (7.78) 7,728 (6.12) 2,509 19,709 Gonorrhea¶ 160,106 (113.02) 174,230 (118.76) 768 335,104 Haemophilus influenzae, invasive, all ages/ serotypes 920 (0.65) 1,080 (0.74) 13 2,013 Age <5 yrs, serotype b 19 (0.19) 13 (0.14)

32 Age <5 yrs, nonserotype b 76 (0.76) 40 (0.42) 1 117 Age <5 yrs, unknown serotype 118 (1.18) 106 (1.11) 3 227 Hansen disease (leprosy) 59 (0.05) 20 (0.01) 16 95 Hantavirus pulmonary syndrome 17 (0.01) 7 (0) 2 26 Hemolytic uremic syndrome, postdiarrheal 76 (0.06) 102 (0.07)

178 Hepatitis A, acute 4,024 (2.84) 3,589 (2.45) 40 7,653 Hepatitis B, acute 4,548 (3.21) 2,923 (1.99) 55 7,526 Hepatitis C, acute 648 (0.46) 452 (0.31) 2 1,102 Legionellosis 1,473 (1.04) 743 (0.51) 16 2,232

30 MMWR April 22, 2005 TABLE 4. (Continued) Reported cases and incidence* of notifiable diseases, by sex United States, 2003 Male Female Sex not stated Disease No.

(Rate)

No.

(Rate)

No.

Total Listeriosis 344 (0.24) 350 (0.24) 2 696 Lyme disease 11,294 (8.01) 9,800 (6.71) 179 21,273 Malaria 901 (0.64) 487 (0.33) 14 1,402 Measles 30 (0.02) 26 (0.02)

56 Meningococcal disease 856 (0.60) 889 (0.61) 11 1,756 Mumps 129 (0.09) 100 (0.07) 2 231 Pertussis 5,367 (3.79) 6,223 (4.24) 57 11,647 Plague

(0) 1 (0)

1 Psittacosis 5

(0) 7 (0.01)

12 Q fever 55 (0.04) 16 (0.01)

71 Rabies, human 2

(0)

(0)

2 Rocky Mountain spotted fever 649 (0.47) 437 (0.31) 5 1,091 Rubella 2

(0) 5 (0)

7 Salmonellosis 19,013 (13.42) 20,073 (13.68) 4,571 43,657 SARS-CoV§§ 4

(0) 4 (0)

8 Shigellosis 9,859 (6.96) 11,169 (7.61) 2,553 23,581 Streptococcal disease, invasive, group A 2,895 (2.09) 2,688 (1.87) 289 5,872 Streptococcal toxic-shock syndrome 70 (0.06) 89 (0.07) 2 161 Streptococcus pneumoniae, invasive disease Drug-resistant 1,204 (1.49) 1,152 (1.36)

2,356 Age <5 yrs 462 (9.49) 374 (8.03) 9 845 Syphilis, primary and secondary¶ 5,956 (4.20) 1,217 (0.83) 4 7,177 Tetanus 8

(0.01) 11 (0.01) 1 20 Toxic-shock syndrome 26 (0.02) 107 (0.09)

133 Trichinellosis 3

(0) 3 (0)

6 Tuberculosis¶¶ 9,114 (6.44) 5,754 (3.93) 6 14,874 Tularemia 94 (0.07) 35 (0.02)

129 Typhoid fever 175 (0.12) 180 (0.12) 1 356

• Per 100,000 population.

No cases of anthrax, Powassan encephalitis or meningitis, western equine encephalitis or meningitis, paralytic poliomyelitis, or yellow fever were reported in 2003.

§ Total number of acquired immunodeficiency syndrome (AIDS) cases reported to the Division of HIV/AIDS Prevention Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention (NCHSTP), through December 31, 2003.

¶ Totals reported to the Division of STD Prevention, NCHSTP, as of May 1, 2004.

• • Chlamydia refers to genital infections caused by Chlamydia trachomatis.

Notifiable in <40 states.

§§ Severe acute respiratory syndrome-associated coronavirus; data on sex provided by the Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases.

¶¶ Totals reported to the Division of TB Elimination, NCHSTP, as of April 1, 2004.

Vol. 52 / No. 54 MMWR 31 TABLE 5. Reported cases and incidence* of notifiable diseases, by race United States, 2003 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§ 230 (7.48) 564 (4.41) 21,287 (56.39) 13,777 (5.87) 0 8,374 44,232¶ Botulism Infant

()

5 (2.68) 3 (0.44) 46 (1.47) 2 20 76 Other (includes wound and unspecified) 0 (0) 0 (0) 2 (0.01) 16 (0.01) 0 15 33 Brucellosis 2

(0.07) 1 (0.01) 2 (0.01) 46 (0.02) 3 50 104 Chlamydia**

12,067 (392.28) 12,848 (100.39) 296,564 (785.65) 268,366 (114.32) 17,390 270,243 877,478¶ Coccidioidomycosis§§ 29 (2.11) 103 (1.69) 219 (2.08) 1,188 (1.52) 26 3,305 4,870 Cryptosporidiosis 21 (0.68) 36 (0.28) 269 (0.71) 2,141 (0.91) 46 993 3,506 Cyclosporiasis 0

(0) 2 (0.02) 3 (0.01) 45 (0.02) 1 24 75 Ehrlichiosis Human granulocytic 3

(0.10) 0 (0) 5 (0.01) 198 (0.09) 2 154 362 Human monocytic 2

(0.07) 0 (0) 11 (0.03) 266 (0.12) 0 42 321 Encephalitis/meningitis, arboviral California serogroup 0

(0) 0 (0) 0 (0) 84 (0.04) 0 24 108 St. Louis 0

(0) 0 (0) 0 (0) 32 (0.01) 2 7

41 West Nile 56 (1.82) 5 (0.04) 0 (0) 1,856 (0.79) 13 936 2,866 Enterohemorrhagic Escherichia coli (EHEC)

EHEC O157:H7 16 (0.52) 46 (0.36) 50 (0.13) 1,811 (0.77) 66 682 2,671 EHEC non-O157 2

(0.07) 0 (0) 6 (0.02) 156 (0.07) 7 81 252 EHEC not serogrouped

()

1 (0.01) 4 (0.01) 106 (0.56) 6 39 156 Giardiasis 69 (2.49) 459 (3.88) 957 (2.95) 8,378 (4.17) 384 9,462 19,709 Gonorrhea 1,971 (64.07) 2,218 (17.33) 183,274 (485.52) 62,032 (26.43) 4,572 81,037 335,104¶ Haemophilus influenzae, invasive, all ages/serotypes 44 (1.43) 29 (0.23) 252 (0.67) 1,193 (0.51) 24 471 2,013 Age <5 yrs, serotype b 2

(0.83)

()

1 (0.03) 22 (0.14) 0 7

32 Age <5 yrs, nonserotype b 12 (4.98) 5 (0.56) 19 (0.59) 52 (0.34) 0 29 117 Age <5, unknown serotype 10 (4.15) 1 (0.11) 30 (0.93) 108 (0.71) 0 78 227 Hansen disease (leprosy) 0 (0) 18 (0.15) 3 (0.01) 27 (0.01) 3 44 95 Hantavirus pulmonary syndrome 0

(0) 0 (0) 0 (0) 19 (0.01) 0 7

26 Hemolytic uremic syndrome postdiarrheal 0

(0) 2 (0.02) 2 (0.01) 133 (0.06) 3 38 178 Hepatitis A, acute 33 (1.07) 235 (1.84) 545 (1.44) 3,551 (1.51) 90 3,199 7,653 Hepatitis B, acute 61 (1.98) 197 (1.54) 1,235 (3.27) 2,724 (1.16) 115 3,194 7,526 Hepatitis C, acute 9

(0.29) 11 (0.09) 111 (0.29) 626 (0.27) 6 339 1,102 Legionellosis 5

(0.16) 14 (0.11) 316 (0.84) 1,399 (0.60) 30 468 2,232

32 MMWR April 22, 2005 TABLE 5. (Continued) Reported cases and incidence* of notifiable diseases, by race United States, 2003 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 Listeriosis 0

(0) 26 (0.20) 70 (0.19) 419 (0.18) 17 164 696 Lyme disease 37 (1.20) 81 (0.68) 181 (0.48) 10,636 (4.54) 74 10,264 21,273 Malaria 6

(0.20) 92 (0.72) 606 (1.61) 324 (0.14) 34 340 1,402 Measles 0

(0) 23 (0.18) 1 (0) 20 (0.01) 2 10 56 Meningococcal disease 8

(0.26) 35 (0.27) 237 (0.63) 1,067 (0.45) 20 389 1,756 Mumps 2

(0.07) 21 (0.17) 10 (0.03) 119 (0.05) 5 74 231 Pertussis 97 (3.15) 124 (0.97) 572 (1.52) 8,658 (3.69) 101 2,095 11,647 Q fever 0

(0) 0 (0) 3 (0.01) 45 (0.02) 0 23 71 Rocky Mountain spotted fever 41 (1.39) 1 (0.01) 80 (0.21) 827 (0.36) 2 140 1,091 Salmonellosis 284 (9.23) 613 (4.79) 4,142 (10.97) 21,086 (8.98) 796 16,736 43,657 Shigellosis 352 (11.44) 151 (1.18) 4,945 (13.10) 9,902 (4.22) 352 7,879 23,581 Streptococcal disease, invasive, group A 83 (2.76) 145 (1.15) 749 (1.99) 3,151 (1.38) 105 1,639 5,872 Streptococcal toxic-shock syndrome 0

(0) 2 (0.02) 14 (0.05) 132 (0.07) 2 11 161 Streptococcus pneumoniae, invasive disease Drug-resistant 3

(0.22) 16 (0.31) 472 (2.01) 1,484 (10.95) 49 332 2,356 Age <5 yrs§§ 7

(5.89) 14 (4.06) 146 (9.13) 454 (6.08) 0 224 845 Syphilis, primary and secondary 67 (2.18) 128 (1.00) 2,693 (7.13) 3,690 (1.57) 251 348 7,177¶ Toxic-shock syndrome 0

(0) 2 (0.02) 8 (0.03) 104 (0.05) 2 17 133 Tuberculosis¶¶ 189 (6.14) 3,575 (28.00) 4,261 (11.29) 6,755 (2.88) 0 94 14,874 Tularemia 5

(0.16) 0 (0) 3 (0.01) 76 (0.03) 2 43 129 Typhoid fever 0

(0) 100 (0.78) 26 (0.07) 54 (0.02) 21 155 356

• Per 100,000 population.

No cases of anthrax, Powassan encephalitis or meningitis, western equine encephalitis or meningitis, paralytic poliomyelitis, or yellow fever were reported in 2003. Disease conditions 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 Prevention Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention (NCHSTP), through December 31, 2003.

¶ Includes the following cases originally reported as Hispanic: 8,154 for AIDS; 122,559 for chlamydia; 21,297 for gonorrhea; and 1,097 for syphilis, primary and secondary.

• • Chlamydia refers to genital infections caused by Chlamydia trachomatis.

In addition to data collected through the National Electronic Telecommunications System for Surveillance (NETSS), certain data on ethnicity are collected on aggregate forms different from those used for reported cases. Thus, the total number of cases reported here can differ slightly from totals reported in other surveillance summaries. Totals reported to the Division of STD Prevention, NCHSTP, as of May 1, 2004.

§§ Notifiable in <40 states.

¶¶ Totals reported to the Division of TB Elimination, NCHSTP, as of April 1, 2004.

Vol. 52 / No. 54 MMWR 33 TABLE 6. Reported cases and incidence* of notifiable diseases, by ethnicity United States, 2003 Ethnicity Hispanic Non-Hispanic not Disease No.

(Rate)

No.

(Rate) stated Total AIDS§ 8,154 (21.04) 35,064 (14.05) 1,014 44,232 Botulism Infant 15 (1.80) 38 (1.19) 23 76 Other (includes wound and unspecified) 14 (0.04) 16 (0.01) 3 33 Brucellosis 62 (0.16) 17 (0.01) 25 104 Chlamydia¶**

122,559 (316.19) 448,456 (179.66) 306,463 877,478 Coccidioidomycosis 747 (3.22) 1,238 (1.70) 2,885 4,870 Cryptosporidiosis 235 (0.61) 1,834 (0.73) 1,437 3,506 Cyclosporiasis 10 (0.03) 33 (0.01) 32 75 Ehrlichiosis Human granulocytic 3

(0.01) 147 (0.06) 212 362 Human monocytic 4

(0.01) 232 (0.10) 85 321 Encephalitis/meningitis, arboviral California serogroup 1

(0) 34 (0.01) 73 108 St. Louis 5

(0.01) 20 (0.01) 16 41 West Nile 248 (0.64) 1,366 (0.55) 1,252 2,866 Enterohemorrhagic Escherichia coli (EHEC)

EHEC O157:H7 112 (0.29) 1,563 (0.63) 996 2,671 EHEC non-O157 13 (0.03) 113 (0.05) 126 252 EHEC not serogrouped 2

(0.01) 82 (0.40) 72 156 Giardiasis 1,173 (3.82) 7,422 (3.42) 11,114 19,709 Gonorrhea**

21,297 (54.94) 203,594 (81.57) 110,213 335,104 Haemophilus influenzae, invasive, all ages/serotypes 122 (0.31) 1,003 (0.40) 888 2,013 Age <5 yrs, serotype b 11 (0.29) 18 (0.12) 3 32 Age <5 yrs, nonserotype b 18 (0.48) 66 (0.42) 33 117 Age <5, unknown serotype 28 (0.75) 83 (0.53) 116 227 Hansen disease (leprosy) 34 (0.09) 26 (0.01) 35 95 Hantavirus pulmonary syndrome 3

(0.01) 15 (0.01) 8 26 Hemolytic uremic syndrome, postdiarrheal 21 (0.06) 113 (0.05) 44 178 Hepatitis A, acute 1,083 (2.79) 3,036 (1.22) 3,534 7,653 Hepatitis B, acute 424 (1.09) 3,154 (1.26) 3,948 7,526 Hepatitis C, acute 63 (0.16) 506 (0.20) 533 1,102 Legionellosis 72 (0.19) 1,139 (0.46) 1,021 2,232 Listeriosis 87 (0.22) 344 (0.14) 265 696

34 MMWR April 22, 2005 TABLE 6. (Continued) Reported cases and incidence* of notifiable diseases, by ethnicity United States, 2003 Ethnicity Hispanic Non-Hispanic not Disease No.

(Rate)

No.

(Rate) stated Total Lyme disease 257 (0.66) 6,529 (2.63) 14,487 21,273 Malaria 94 (0.24) 787 (0.32) 521 1,402 Measles 1

(0) 39 (0.02) 16 56 Meningococcal disease 193 (0.50) 952 (0.38) 611 1,756 Mumps 52 (0.14) 104 (0.04) 75 231 Pertussis 1,294 (3.34) 8,033 (3.22) 2,320 11,647 Q fever 8

(0.02) 42 (0.02) 21 71 Rocky Mountain spotted fever 17 (0.04) 750 (0.31) 324 1,091 Salmonellosis 3,300 (8.51) 17,603 (7.05) 22,754 43,657 Shigellosis 3,774 (9.74) 10,029 (4.02) 9,778 23,581 Streptococcal disease, invasive, group A 419 (1.09) 2,568 (1.05) 2,885 5,872 Streptococcal toxic-shock syndrome 5

(0.01) 98 (0.05) 58 161 Streptococcus pneumoniae, invasive Drug-resistant 121 (0.93) 1,032 (6.76) 1,203 2,356 Age <5 yrs 79 (4.69) 351 (4.48) 415 845 Syphilis, primary and secondary**

1,097 (2.83) 5,417 (2.17) 663 7,177 Toxic-shock syndrome 7

(0.03) 79 (0.04) 47 133 Tuberculosis§§ 4,115 (10.62) 10,675 (4.28) 84 14,874 Tularemia 3

(0.01) 58 (0.02) 68 129 Typhoid fever 62 (0.16) 155 (0.06) 139 356

• Per 100,000 population.

No cases of anthrax, Powassan encephalitis or meningitis, western equine encephalitis or meningitis, paralytic poliomyelitis, or yellow fever were reported in 2003. 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, 2003.

¶ Chlamydia refers to genital infections caused by Chlamydia trachomatis.

• • In addition to data collected through the National Electronic Telecommunications System for Surveillance (NETSS), certain data on ethnicity are collected on aggregate forms different from those used for reported cases. Thus, the total number of cases reported here can differ slightly from totals reported in other surveillance summaries. Totals reported to the Division of STD Prevention, NCHSTP, as of May 1, 2004 Notifiable in <40 states.

§§ Totals reported to the Division of TB Elimination, NCHSTP, as of April 1, 2004.

Vol. 52 / No. 54 MMWR 35 PART 2 Graphs and Maps for Selected Notifiable Diseases in the United States, 2003 Abbreviations and Symbols Used in Graphs and Maps U

Data not available.

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

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

36 MMWR April 22, 2005 ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS). Number of reported cases,*

by year United States and U.S. territories, 1983-2003

• Total number of AIDS cases includes all cases reported to CDC as of December 31, 2003. Total includes cases among residents in U.S. territories and 220 cases among persons with unknown state of residence.

During 1994-2000, the number of AIDS cases reported to CDC decreased 47.4%, predominantly attributable to effective antiretroviral therapies. During 2000-2003, the number of reported AIDS cases increased 8.5%. This increase might be attributable to increased AIDS case ascertainment in areas with recent HIV reporting implementation.

140,000 120,000 100,000 80,000 60,000 40,000 20,000 0

1983 1988 1993 1998 2003 Year Number Expansion of surveillance case definition ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS). Incidence* United States and U.S. territories, 2003

• Per 100,000 population.

Includes 220 cases with unknown state of residence.

The highest AIDS rates were observed in the northeastern part of the country. High incidence

(>15 cases per 100,000 residents) also was observed in the Southeast, the U.S. Virgin Islands, and Puerto Rico.

DC AS GU PR VI 0-4.9 5.0-9.9 10.0-14.9

>15.0

Vol. 52 / No. 54 MMWR 37 ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS). Number of reported pediatric*

cases United States and U.S. territories, 2003

• Children and adolescents aged <13 years.

During 2003, a total of 157 new cases were reported in the United States and U.S. territories.

DC AS GU PR VI 0

1-2 3-10

>11 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

1 0

0 0

1 3

0 7

1 1

14 20 1

1 1

1 4

3 5

6 6

1 3

2 1

1 1

2 4

2 1

1 10 50 ANTHRAX. Number of reported cases, by year United States, 1953-2003

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

70 60 50 40 30 20 10 0

1953 1958 1963 1968 1973 1978 1983 1988 1993 1998 2003 Year Number Biologic terrorism-related cases*

38 MMWR April 22, 2005 BOTULISM, INFANT. Number of reported cases, by year United States, 1983-2003 Infant botulism is the most common type of botulism in the United States. Cases are sporadic, and risk factors remain substantially unknown.

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

1983 1988 1993 1998 2003 BOTULISM, FOODBORNE. Number of reported cases, by year United States, 1983-2003 Home-canned foods and Alaska Native foods consisting of fermented foods of aquatic origin remain the principal sources of foodborne botulism in the United States.

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

1983 1988 1993 1998 2003 Outbreak caused by sauteed onions, Illinois Outbreak caused by fermented fish/seafood products, Arkansas Outbreak caused by baked potatoes, Texas Outbreak caused by chili sauce, Texas

Vol. 52 / No. 54 MMWR 39 BOTULISM, OTHER (includes wound and unspecified). Number of reported cases, by year United States, 1993-2003 Wound botulism, which continues to constitute a substantial proportion of adult botulism cases, occurs almost exclusively among injection-drug users in the western United States and appears to be associated with injection of a particular type of heroin known as Black Tar Heroin.

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

1993 1998 2003 BRUCELLOSIS. Number of reported cases, by year United States, 1973-2003 The majority of cases of brucellosis in the United States occur among returned travelers or immigrants from areas in which brucellosis is endemic.

Year Number 350 300 250 200 150 100 50 0

1973 1978 1983 1988 1993 1998 2003

40 MMWR April 22, 2005 CHOLERA. Number of reported cases United States and U.S. territories, 2003 The majority of 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.

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

1 CHLAMYDIA. Incidence* among women United States, 2003

• Per 100,000 population.

Chlamydia refers to genital infections caused by Chlamydia trachomatis. In 2003, the chlamydia rate among women was 466.9 cases per 100,000 population. Rates for men are not given because reporting for men is limited.

DC NYC

<300.0 300.1-400.0 400.01-500.0

>500.0

Vol. 52 / No. 54 MMWR 41 COCCIDIOIDOMYCOSIS. Number of reported cases United States* and U.S.

territories, 2003

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

During 2002-2003, the number of coccidioidomycosis cases in California increased from 1,727 to 2,091, whereas the number of cases in Arizona declined from 3,133 to 2,695. Physicians should maintain a high suspicion for acute coccidioidomycosis, especially for patients with a flu-like illness who live in or have visited areas in which disease is endemic.

DC NYC AS CNMI GU PR VI No reported cases Reported cases N

N 0

0 0

1 N

0 0

0 0

0 0

N 0

0 0

N N

N N

N 0

N N

0 N

0 0

0 0

0 0

N 0

N 0

N N

0 N

N N

N N

0 0

7 10 10 3

1 9

2,695 2,091 36 5

CRYPTOSPORIDIOSIS. Incidence* United States and U.S. territories, 2003

• Per 100,000 population.

Surveillance data from 2003 indicate that infection with Cryptosporidium species is geographically widespread in the United States. The diagnosis or transmission of cryptosporidiosis might be higher in northern states, particularly in the Midwest; however, state-by-state differences should be interpreted with caution because different state surveillance systems have varying capabilities to detect cases.

Reported illness onset dates exhibited a seasonal increase from early summer through early fall.

DC NYC AS CNMI GU PR VI 0

0 0

N 0

0-0.27 0.28-0.63 0.64-1.59

>1.60

42 MMWR April 22, 2005 DIPHTHERIA. Number of reported cases, by year United States, 1973-2003 In 2003, one laboratory-confirmed, fatal case of diphtheria was reported in an unvaccinated adult resident of Pennsylvania who had traveled to Haiti, where diphtheria is endemic. The Advisory Committee on Immunization Practices recommends a 5-dose primary series of DTP/DTaP (diphtheria, tetanus, and pertussis) vaccine by age 6 years, a combined formulation of tetanus and diphtheria (Td) vaccine at age 11-12 years, and a booster dose (Td) at 10-year intervals thereafter.

Outbreak of (mostly) cutaneous diphtheria, Seattle, Washington Cutaneous diphtheria no longer nationally notifiable 450 400 350 300 250 200 150 100 50 0

1973 1978 1983 1988 1993 1998 2003 Year Number Number Year 6

5 4

3 2

1 0

1988 1993 1998 2003 DIPHTERIA. Number of reported cases, by year United States, 1988-2003 EHRLICHIOSIS, HUMAN GRANULOCYTIC. Number of reported cases United States and U.S. territories, 2003 Human ehrlichiosis is an emerging tickborne disease that became nationally notifiable in 1999 (in certain 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.

DC NYC 8

AS CNMI GU PR VI 1

2 1

9 1

77 11 2

1 2

1 5

2 2

62 4

1 54 63 29 10 9

5 No reported cases Reported cases N

N N

N

Vol. 52 / No. 54 MMWR 43 EHRLICHIOSIS, HUMAN MONOCYTIC. Number of reported cases United States and U.S. territories, 2003 Human ehrlichiosis is an emerging tickborne disease that became nationally notifiable in 1999 (in certain states, ehrlichiosis is not a notifiable disease). Identification and reporting of human ehrlichioses are incomplete, and numbers of cases reported here are not definitive for the overall distribution or the regional prevalence of disease.

DC NYC 4

AS CNMI GU PR VI 2

No reported cases Reported cases N

1 33 N

N N

1 2

1 31 19 6

6 6

4 33 2

20 8

28 9

11 51 3

3 21 15 1

N ENCEPHALITIS/MENINGITIS, ARBOVIRAL, CALIFORNIA SEROGROUP. Number of reported cases, by month of onset United States, 1994-2003 California (CAL) serogroup viruses (mainly La Crosse virus in the eastern United States, where the eastern treehole mosquito, Ochleotatus triseriatus, is the primary vector) are a cause of endemic meningoencephalitis, especially in children. In 2003, a total of 108 cases were reported from 11 states (Illinois, Kentucky, Louisiana, Minnesota, Mississippi, North Carolina, Ohio, Tennessee, Virginia, West Virginia, and Wisconsin). During 1964-2003, a median of 68 (average: 80; range: 29-167) cases were reported per year in the United States.

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Year and month Number 50 45 40 35 30 25 20 15 10 5

0

44 MMWR April 22, 2005 ENCEPHALITIS/MENINGITIS, ARBOVIRAL, EASTERN EQUINE. Number of reported cases, by month of onset United States, 1994-2003 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 2003, a total of 14 cases were reported from eight states (Alabama, Florida, Georgia, Louisiana, New Jersey, North Carolina, South Carolina, and Virginia), equaling the greatest number reported to CDC in any year during 1964-2003. During 1964-2003, a median of four (average: five; range, 0-14) cases were reported per year in the United States.

Year and month Number 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 10 9

8 7

6 5

4 3

2 1

0 ENCEPHALITIS/MENINGITIS, ARBOVIRAL, ST. LOUIS. Number of reported cases, by month of onset United States, 1994-2003 Before the emergence of West Nile virus (WNV) in the United States, St. Louis encephalitis (SLE) virus was the primary cause of epidemic viral encephalitis in the United States. In 2003, a total of 41 SLE cases were reported from nine states (Arizona, Louisiana, Michigan, Mississippi, New Mexico, New York, Pennsylvania, South Dakota, and Texas). During 1964-2003, a median of 27 (average:

116; range: 2-1,967) cases were reported per year in the United States.

Year and month Number 60 45 30 15 0

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Vol. 52 / No. 54 MMWR 45 ENCEPHALITIS/MENINGITIS, ARBOVIRAL, WEST NILE. Number of reported cases, by county United States, 2003 In 2003, a total of 2,866 West Nile virus (WNV) neuroinvasive cases were reported from 42 states and the District of Columbia (DC) compared with 2,942 cases from 36 states and DC in 2002. Since WNV was first discovered during an encephalitis outbreak in New York City in 1999, a median of 64 (average: 1,170; range: 19-2,942) neuroinvasive cases were reported per year in the United States.

ENCEPHALITIS/MENINGITIS, ARBOVIRAL, WESTERN EQUINE. Number of reported cases, by month of onset United States, 1994-2003 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 2003. During 1964-2003, a median of two (average: 16; range: 0-172) cases were reported per year in the United States.

Year and month Number 2

1 0

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

46 MMWR April 22, 2005 ESCHERICHIA COLI, ENTEROHEMORRHAGIC O157:H7. Number of reported cases United States and U.S. territories, 2003 E. coli O157:H7 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, certain laboratories still lack the capacity to isolate and identify E. coli serotypes other than O157:H7.

DC NYC AS CNMI GU PR VI 0-17 18-45 46-104

>105 GIARDIASIS. Incidence* United States and U.S. territories, 2003

• Per 100,000 population.

Surveillance data from 2003 indicate that infection with Giardia intestinalis is geographically widespread in the United States. The diagnosis or transmission of giardiasis might be higher in the northern states; however, state-by-state differences should be interpreted with caution because different state surveillance systems have varying capabilities to detect cases. Reported illness onset dates exhibited a seasonal increase from early summer through early fall.

DC NYC AS CNMI GU PR VI 0-3.71 3.72-8.11 8.12-11.31

>11.32 N

N N

N

Vol. 52 / No. 54 MMWR 47 GONORRHEA. Incidence* United States, 2003

• Per 100,000 population.

In 2003, the overall U.S. gonorrhea rate was 116.3 per 100,000 population. The Healthy People 2010 national objective is <19 cases per 100,000 population. Eight states (Idaho, Maine, Montana, New Hampshire, North Dakota, Utah, Vermont and Wyoming) reported rates below the national objective.

DC NYC

<100.0 100.1-200.0

>200.0 GONORRHEA. Incidence,* by sex United States, 1988-2003

• Per 100,000 population.

The overall incidence of gonorrhea in the United States has declined since 1975. In 2003, incidence was slightly higher among women than among men.

Men Women Year Incidence 500 400 300 200 100 0

1988 1993 1998 2003

48 MMWR April 22, 2005 GONORRHEA. Incidence,* by race/ethnicity United States, 1988-2003

• Per 100,000 population.

Gonorrhea incidence among blacks decreased considerably in the 1990s but continues to be the highest among all race/ethnic groups. In 2003, gonorrhea incidence among non-Hispanic blacks was approximately 20 times greater than that for non-Hispanic whites.

Black, non-Hispanic American Indian/Alaska Native Hispanic White, non-Hispanic Asian/Pacific Islander Incidence Year 2,200 2,000 1,800 1,600 1,400 1,200 1,000 800 600 400 200 0

1988 1993 1998 2003 HAEMOPHILUS INFLUENZAE, INVASIVE DISEASE. Incidence,* by age group United States, 1991-2003

• Per 100,000 population.

Before the introduction of conjugate Haemophilus influenzae serotype b (Hib) vaccines in 1987, incidence of invasive Hib disease among children aged <5 years was estimated to be 100 per 100,000 population. In 2003, incidence of invasive H. influenzae disease (all serotypes) was 1.9 per 100,000 in this age group (376 reported cases; 32 [9%] reported as Hib, 117 [31%] as other serotypes or nontypeable isolates, and 227 [60%] with serotype information unknown or missing).

Year Incidence Age <5 yrs Age 5 yrs 8

7 6

5 4

3 2

1 0

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Vol. 52 / No. 54 MMWR 49 HANTAVIRUS PULMONARY SYNDROME. Number of reported cases, by survival status*, and year United States, 1995-2003

• Data from National Center for Infectious Diseases.

Hantavirus pulmonary syndrome incidence varies with ecologic conditions that affect rodent reservoir species. Human infection is associated with high mortality, even with appropriate medical care.

Lived Died Number 60 55 50 45 40 35 30 25 20 15 10 5

0 1995 1996 1997 1998 1999 2000 2001 2002 2003 Year HANSEN DISEASE (LEPROSY). Number of reported cases, by year United States, 1973-2003 Increased influx of refugees from Cambodia, Laos, and Vietnam, 1978-1988 Year Number 400 360 320 280 240 200 160 120 80 40 0

1973 1978 1983 1988 1993 1998 2003

50 MMWR April 22, 2005 HEMOLYTIC UREMIC SYNDROME, POSTDIARRHEAL. Number of reported cases United States and U.S. territories, 2003 In the United States, the majority of cases of postdiarrheal hemolytic uremic syndrome are caused by infection with Escherichia coli O157:H7. Approximately 50% of cases occur among children aged

<5 years.

No reported cases Reported cases DC NYC AS CNMI GU PR VI 3

1 8

1 2

3 N

1 1

7 42 1

1 5

1 8

4 4

1 6

1 9

4 2

8 1

6 2

14 4

1 1

4 3

1 5

2 18 3

N N

HEPATITIS, VIRAL. Incidence,* by year United States, 1973-2003

• Per 100,000 population.

Hepatitis A vaccine was first licensed in 1995.

§Hepatitis B vaccine was first licensed in June 1982.

¶An anti-HCV antibody test first became available in May 1990.

Hepatitis A incidence continues to decline and in 2003 was the lowest ever recorded. However, cyclic increases in hepatitis A have been observed approximately every 10 years, and incidence could increase again. Hepatitis B incidence, which declined >65% during 1990-2000, has remained unchanged for the past 4 years, reflecting ongoing transmission in adult populations at high risk. The trend in reported hepatitis C/non-A, non-B (renamed hepatitis C, acute, in 2003) cases after 1990 is misleading because reported cases have included those based only on a positive laboratory test for anti-HCV, and the majority of these cases represent chronic hepatitis C virus (HCV) infection.

Hepatitis A, acute Hepatitis B, acute Hepatitiis C

¶

§ Incidence Year 35 30 25 20 15 10 5

0 1973 1978 1983 1988 1993 1998 2003

Vol. 52 / No. 54 MMWR 51 HEPATITIS A. Incidence* United States and U.S. territories, 2003

• Per 100,000 population.

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.

DC NYC AS CNMI GU PR VI

<2.5 2.5-4.9 5.0-9.9

• Per 100,000 population.

The increased incidence of legionellosis in 2003 was influenced largely by increases in the incidence of sporadic, community-acquired Legionnaire disease in certain mid-and south Atlantic states. During this same period and in these same states, no changes occurred in diagnostic methods, diagnostic test volume, or surveillance methods. These states did experience record levels of rainfall that correlated with the increased incidence of Legionnaire disease; however, the precise nature of this association is unknown.

LEGIONELLOSIS. Incidence,* by year United States, 1988-2003 Incidence Year 1988 1993 1998 2003 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0

52 MMWR April 22, 2005 LYME DISEASE. Number of reported cases, by county United States, 2003

• The total number of cases from these counties represented 90% of all cases reported in 2003.

A rash that might be misdiagnosed as Lyme disease can occur following bites of the Lone Star tick (Amblyomma americanum). These ticks, which do not transmit the Lyme disease bacterium, are common human-biting ticks in the southern and southeastern United States.

LISTERIOSIS. Incidence* United States and U.S. territories, 2003

• Per 100,000 population.

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

N DC NYC AS CNMI GU PR VI 0

0 0

0 0

0 0

0 0

0-0.04 0.05-0.18 0.19-0.28

>0.29

Vol. 52 / No. 54 MMWR 53 MALARIA. Incidence,* by year United States, 1973-2003

• Per 100,000 population.

Since 1997, the number of malaria cases has decreased. This decline might reflect decreased international travel and immigration after the September 11, 2001, attacks on New york City and the District of Columbia.

Incidence Year 2.0 1.5 1.0 0.5 0

1973 1978 1983 1988 1993 1998 2003 Immigration malaria-endemic countries in Southeast Asia from MEASLES. Incidence, by year United States, 1968-2003

• Per 100,000 population.

In 2003, a total of 56 cases were reported, two of them fatal; measles incidence remains at less than one case per 1,000,000 population for the seventh consecutive year. Of 56 confirmed cases reported in 2003, a total of 24 were identified as international importations, and 19 others were epidemiologically linked to an imported case. The continued low reported incidence of measles disease and the high percentage of import-associated cases support the conclusion that measles is not endemic in the United States.

Year 1968 1973 1978 1983 1988 1993 1998 2003 Incidence 100 90 80 70 60 50 40 30 20 10 0

Incidence Year MEASLES. Incidence,* by year United States, 1988-2003 30 25 20 15 10 5

0 1988 1993 1998 2003

• Per 100,000 population.

54 MMWR April 22, 2005 MENINGOCOCCAL DISEASE. Incidence,* by year United States, 1973-2003

• Per 100,000 population.

Incidence Year 2.0 1.5 1.0 0.5 0

1973 1978 1983 1988 1993 1998 2003 MUMPS. Incidence,* by year United States, 1978-2003

• Per 100,000 population.

A mumps vaccine was first licensed in December 1967. Because of the recommendation of 2 doses of measles-mumps-rubella vaccine and the continued high coverage rate in the United States, mumps incidence continues to be low, with 231 cases reported for 2003, thus meeting the Healthy People 2010 objective of <500 cases per year.

Year Incidence 20 18 16 14 12 10 8

6 4

2 0

1978 1983 1988 1993 1998 2003

Vol. 52 / No. 54 MMWR 55 PERTUSSIS. Incidence,* by year United States, 1973-2003

• Per 100,000 population.

Pertussis epidemics occur every 3-5 years. In 2003, a total of 11, 647 cases were reported, the highest number reported since 1964.

Year Incidence 6.0 5.5 5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0

1973 1978 1983 1988 1993 1998 2003 PERTUSSIS. Number of reported cases,* by age group United States, 2003

• Of 11,647 cases, age was reported unknown for 46 (0.4%) cases.

In 2003, a total of 1,982 (17%) reported cases occurred among infants aged <6 months (who were too young to receive 3 diptheria and tetanus toxoids and acellular pertussis doses), and 7,394 (63%)

cases occurred among persons aged >10 years (no pertussis vaccine is currently licensed for persons aged >7 years).

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

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

>60

56 MMWR April 22, 2005 POLIOMYELITIS, PARALYTIC. Number of reported cases, by year United States, 1973-2003 An inactivated poliomyelitis vaccine (IPV) was first licensed in 1955. An oral vaccine was licensed in 1961. No cases of vaccine-associated paralytic poliomyelitis have been reported since the IPV schedule was implemented in 2000.

Year Number 40 35 30 25 20 15 10 5

0 1973 1978 1983 1988 1993 1998 2003 PLAGUE. Number of reported cases among humans, by year United States, 1973-2003 In 2003, a single case of plague was reported, bringing the 3-year total for 2001-2003 to five cases.

This is the lowest sustained rate of naturally occurring plague in the United States in 40 years. The low number of cases was expected because of prolonged drought conditions in the Southwest during the past 5 years. Increased precipitation in the Southwest in 2004 might result in increased human cases in 2005.

Year Number Prairie dog and rock squirrel epizootics 45 40 35 30 25 20 15 10 5

0 1973 1978 1983 1988 1993 1998 2003

Vol. 52 / No. 54 MMWR 57 Q FEVER. Number of reported cases United States and U.S. territories, 2003 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.

9 2

1 1

1 4

N 1

1 1

1 1

1 1

3 3

2 8

N 4

2 N

2 2

6 1

1 2

6 9

N DC NYC AS CNMI GU PR VI No reported cases Reported cases PSITTACOSIS. Number of reported cases, by year United States, 1973-2003 Year Number 250 225 200 175 150 125 100 75 50 25 0

1973 1978 1983 1988 1993 1998 2003

58 MMWR April 22, 2005 RABIES, ANIMAL. Number of reported cases among wild and domestic animals,*

by year - United States and Puerto Rico, 1973-2003

• Data from 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.

Total Domestic Wild Number Year 10,000 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0

1973 1978 1983 1988 1993 1998 2003 ROCKY MOUNTAIN SPOTTED FEVER. Incidence,* by year United States, 1973-2003

• Per 100,000 population.

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 might be involved.

Incidence Year 1973 1978 1983 1988 1993 1998 2003 0.6 0.5 0.4 0.3 0.2 0.1 0

Vol. 52 / No. 54 MMWR 59 RUBELLA. Incidence,* by year United States, 1973-2003

• Per 100,000 population.

A rubella vaccine was first licensed in 1969. In 2003, only seven confirmed cases of rubella were reported by six states, which is the lowest number of rubella cases ever reported. None were identified as importations. The majority of reported cases continue to occur among persons aged >20 years.

Of the cases in persons with known ethnicity, >50% occurred among Hispanics. Of ill persons for whom the country of birth was known and disease occurred in 2003, half were foreign born.

Year Incidence 20 18 16 14 12 10 8

6 4

2 0

1973 1978 1983 1988 1993 1998 2003 Year Incidence RUBELLA. Incidence,* by year United States, 1988-2003 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0

1988 1993 1998 2003

• Per 100,000 population.

SALMONELLOSIS. Incidence,* by year United States, 1973-2003

• Per 100,000 population.

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 the majority of cases are S. enterica serotype Typhimurium, S. enterica serotype Enteritidis, and S. enterica serotype Newport.

Year Incidence Outbreak in Illinois caused by contaminated pasteurized milk 30 25 20 15 10 5

0 1973 1978 1983 1988 1993 1998 2003

60 MMWR April 22, 2005 Passive reporting likely underestimates the numbers of invasive group A Streptococcus (GAS) infections in the United States. In 2003, approximately 1,190 invasive GAS infections were reported by nine sites participating in CDCs Active Bacterial Core Surveillance (ABCs). On the basis of ABCs data, CDC estimates that approximately 11,000 cases and 1,700 deaths attributable to invasive GAS disease occurred in the United States in 2003.

STREPTOCOCCAL DISEASE, INVASIVE, GROUP A. Number of reported cases United States and U.S. territories, 2003 DC NYC AS CNMI GU PR VI 0-5 6-18 19-67

>68 0

N N

0 0

0 0

0 N

0 SHIGELLOSIS. Incidence,* by year United States, 1973-2003

• Per 100,000 population.

Although incidence of shigellosis declined during 1993-2003, prolonged and extensive outbreaks of Shigella sonnei infections continue to occur in child care settings. These child care-associated infections are responsible for a substantial proportion of the shigellosis cases reported in the United States. Resistance to first-line antimicrobial agents, including trimethoprim-sulfamethoxazole, continues to increase among S. sonnei cases in the United States.

Year Incidence 15 10 5

0 1973 1978 1983 1988 1993 1998 2003

Vol. 52 / No. 54 MMWR 61 STREPTOCOCCUS PNEUMONIAE, INVASIVE, DRUG-RESISTANT. Number of reported cases United States and U.S. territories, 2003 A conjugate pneumococcal vaccine was licensed for young children in early 2000. Data from CDCs Active Bacterial Core Surveillance/Emerging Infections Program Network indicate that rates of invasive disease caused by drug-resistant pneumococci have declined since the vaccine was licensed.

DC NYC AS CNMI GU PR VI 0

1-100 101-400

>401 0

0 N

0 N

N 0

N N

N 0

0 0

N N

N N

0 0

0 N

N 0

0 N

N 0

U 0

0 0

N 0

SYPHILIS, CONGENITAL. Incidence* among infants aged <1 year United States, 1973-2003

• Per 100,000 live births.

Incidence of congenital syphilis has declined steadily since 1991.

Year Incidence Change in surveillance case definition 120 110 100 90 80 70 60 50 40 30 20 10 0

1973 1978 1983 1988 1993 1998 2003

62 MMWR April 22, 2005 SYPHILIS, PRIMARY AND SECONDARY. Incidence* United States, 2003

• Per 100,000 population.

In 2003, the overall U.S. rate of primary and secondary syphilis was 2.5 cases per 100,000 population, which is above the Healthy People 2010 objective of 0.2 cases per 100,000 population per year. Five states reported rates at or below the national objective. Seven states reported fewer than three cases.

DC NYC

<0.2 0.3-4.0

>4.0 SYPHILIS, PRIMARY AND SECONDARY: Incidence,* by sex United States, 1988-2003

• Per 100,000 population.

During 2002-2003, incidence of primary and secondary syphilis in the United States increased slightly, from 2.4 to 2.5 cases per 100,000 population. Among women, incidence continued to decline, from 1.1 cases per 100,000 women in 2001 to 0.8 cases per 100,000 in 2003, the lowest rate for women since reporting began in 1941. Among men, rates increased from 3.7 cases per 100,000 in 2002 to 4.2 cases per 100,000 in 2003, after a low rate of 2.6 cases per 100,000 in 2000.

Men Women Year Incidence 25 20 15 10 5

0 1988 1993 1998 2003

Vol. 52 / No. 54 MMWR 63 TETANUS. Number of reported cases, by year United States, 1973-2003 In 2003, a total of 20 cases of tetanus were reported, two (10%) of them fatal. Nineteen (95%) cases occurred among persons who had not completed a 3-dose primary tetanus toxoid vaccination series or for whom vaccination history was uncertain. No neonatal cases or cases among persons aged

<18 years occurred.

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

1973 1978 1983 1988 1993 1998 2003 SYPHILIS, PRIMARY AND SECONDARY. Incidence,* by race/ethnicity United States, 1988-2003

• Per 100,000 population.

During 2002-2003, incidence of primary and secondary syphilis declined among non-Hispanic blacks, from 9.5 to 7.2 cases per 100,000 population. Increases occurred among all other race/ethnic populations: incidence for non-Hispanic whites increased from 1.2 to 1.5 per 100,000 population, incidence among Hispanics increased from 2.5 to 2.8 per 100,000 population, incidence among Asian/Pacific Islanders increased from 0.8 to 1.0 per 100,000 population, and incidence among American Indians/Alaska Natives increased from 2.1 to 2.2 per 100,000 population. During 1992-2003, overall incidence among non-Hispanic blacks decreased from 64 times that for non-Hispanic whites to five times that for non-Hispanic whites.

Year Incidence 160 140 120 100 80 60 40 20 0

1988 1993 1998 2003 Black, non-Hispanic American Indian/Alaska Native Hispanic White, non-Hispanic Asian/Pacific Islander

64 MMWR April 22, 2005 TOXIC-SHOCK SYNDROME. Number of reported cases, by quarter United States, 1988-2003 Year and quarter Number 140 130 120 110 100 90 80 70 60 50 40 30 20 10 0

1988 1989 1990 2003 2002 2001 1991 2000 1992 1999 1993 1998 1994 1997 1996 1995 TRICHINELLOSIS. Number of reported cases, by year United States, 1973-2003 In 2003, six cases of trichinellosis (trichinosis) were reported by four states (California, New Hampshire, New York, and Tennessee); this was the eighth consecutive year in which <25 cases were reported.

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

1973 1978 1983 1988 1993 1998 2003

Vol. 52 / No. 54 MMWR 65 TUBERCULOSIS. Incidence* United States and U.S. territories, 2003

• Per 100,000 population.

In 2003, a total of 25 states and Puerto Rico had tuberculosis rates <3.5 cases per 100,000 population, which is the interim (i.e., year 2000) incidence target for the elimination of tuberculosis by 2010.

During 2002-2003, the number of states that reported tuberculosis incidence below the national average (5.1 cases per 100,000) increased from 37 to 39.

0-3.5 3.6-5.1 5.2-9.9

>10.0 DC NYC AS CNMI GU PR VI U

U TUBERCULOSIS. Incidence,* by year United States, 1983-2003

• Per 100,000 population.

During 2002-2003, the number of cases of tuberculosis reported to CDC decreased 1.3%, and incidence decreased 1.9%. Although the number and incidence of tuberculosis cases are the lowest since national surveillance began in 1953, the decline for each was the smallest since 1988.

Year Incidence 14 13 12 11 10 9

8 7

6 5

4 3

2 1

0 1983 1988 1993 1998 2003

66 MMWR April 22, 2005 TUBERCULOSIS. Number of reported cases among U.S.-born and foreign-born persons,* by year United States, 1993-2003

• For 69 cases, origin of patients was unknown.

CDC is collaborating with public health partners to implement tuberculosis (TB) control initiatives for recent international arrivals and residents along the border between the United States and Mexico and to strengthen TB programs in countries with a high incidence of disease.

Year Number U.S. born Foreign-born 20,000 16,000 12,000 8,000 4,000 0

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 TULAREMIA. Number of reported cases United States and U.S. territories, 2003 No reported cases Reported cases DC NYC AS CNMI GU PR VI 1

6 3

1 3

2 2

1 1

2 9

2 3

3 5

5 3

1 1

N 32 32 1

1 3

1 2

4 1

1 In 2003, a total of 129 cases of tularemia were reported. Areas with high rates of infection included Arkansas, Missouri, and Marthas Vineyard, Massachusetts. In 2000, tularemia was reinstituted as a nationally notifiable disease.

Vol. 52 / No. 54 MMWR 67 TYPHOID FEVER. Number of reported cases, by year United States, 1973-2003 In 2003, approximately 71% of reported cases of typhoid fever were acquired by travelers to countries where the disease is endemic. Increasing antimicrobial resistance has complicated the treatment of typhoid fever.

Year Number 800 700 600 500 400 300 200 100 0

1973 1978 1983 1988 1993 1998 2003 VARICELLA. Number of reported cases Michigan, Rhode Island, Texas, and West Virginia,* 1994-2003

• These four states maintained consistent and adequate surveillance by reporting cases constituting

>5% of their birth cohort during 1990-1995 (Source: CDC, National Immunization Program).

The number of varicella cases in these four states during 2003 is the lowest ever reported, constituting a 15.6% decline compared with cases reported in 2002 and an 81.0% decline compared with cases reported in the 3 years before vaccine was licensed in 1995.

Vaccine licensed Year Number 80,000 60,000 40,000 20,000 0

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

68 MMWR April 22, 2005

Vol. 52 / No. 54 MMWR 69 PART 3 Historical Summaries of Notifiable Diseases in the United States, 1972-2003 Abbreviations and Symbols Used in Tables NA Data not available.

No reported cases.

Notes:

Rates <0.01 after rounding are listed as 0.

Data in the MMWR Summary of Notifiable Diseases United States, 2003 might not match data in other CDC surveillance reports because of differences in the timing of reports, the source of the data, and case definitions.

70 MMWR April 22, 2005 TABLE 7. Reported incidence* of notifiable diseases United States, 1993-2003 Disease 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 AIDS 40.20 30.07 27.20 25.21 21.85 7.21 16.66 14.95 14.88 15.29 15.36 Amebiasis 1.21 1.20

§

§

§

§

§

§

§

§

§ Anthrax

0 0.01 0

0 Aseptic meningitis 5.39 3.71

§

§

§

§

§

§

§

§

§ Botulism, total (includes wound and unspecified) 0.04 0.06 0.04 0.05 0.05 0.04 0.06 0.05 0.06 0.03 0.01 Foodborne 0.01 0.02 0.01 0.01 0.02 0.01 0.01 0.01 0.01 0

0.01 Brucellosis 0.05 0.05 0.04 0.05 0.04 0.03 0.03 0.03 0.05 0.04 0.04 Chancroid 0.54 0.30 0.20 0.15 0.09 0.07 0.06 0.03 0.01 0.02 0.02 Chlamydia¶ 182.60 188.10 196.80 236.57 254.10 257.76 278.32 296.55 304.71 Cholera 0

0.02 0.01 0.01 0.01 0.01 0

0 0

0 0

Coccidioidomycosis 0.46 0.64 0.65 0.99 3.58 4.69 6.71 3.03 2.57 Cryptosporidiosis 1.13 1.07 1.12 1.61 0.92 1.17 1.34 1.07 1.22 Cyclosporiasis 0.07 0.03 0.07 0.06 0.03 Diphtheria 0

0 0

0.01 0.01 0

0 0

0 0

0 Ehrlichiosis Human granulocytic 0.16 0.14 0.15 0.10 0.18 0.13 Human monocytic 0.03 0.06 0.09 0.05 0.08 0.11 Encephalitis, primary 0.36 0.28

§

§

§

§

§

§

§

§

§ Postinfectious 0.07 0.06

§

§

§

§

§

§

§

§

§ Encephalitis/meningitis, arboviral California serogroup 0

0.04 0.04 0.04 0.03 0.04 0.05 0.06 0.06 Eastern equine 0

0 0

0 0

0 0

0 0

Powassan 0

0 St. Louis 0

0 0.01 0.01 0

0 0.03 0.01 0.01 West Nile 1.01 1.00 Western equine 0

0 0

0 0

0 0

0 0

Enterohemorrhagic Escherichia coli (EHEC)

EHEC O157:H7 0.06 1.01 1.18 1.04 1.28 1.77 1.74 1.22 1.36 0.93 EHEC non-O157 0.19 0.08 0.09 EHEC not serogrouped 0.06 0.02 0.05 Giardiasis 8.06 6.84 Gonorrhea 172.40 168.40 149.50 122.80 121.40 132.88 133.20 131.65 128.53 125.03 116.37 Granuloma inguinale 0

0

§

§

§

§

§

§

§

§

§ Haemophilus influenzae, invasive, all ages/serotypes 0.55 0.45 0.45 0.45 0.44 0.44 0.48 0.51 0.57 0.62 0.70 Age <5 yrs, serotype b 0.18 0.16 Age <5 yrs, nonserotype b 0.75 0.59 Age <5 yrs, unknown serotype 0.80 1.15 Hansen disease (leprosy) 0.07 0.05 0.06 0.05 0.05 0.05 0.04 0.04 0.03 0.04 0.03 Hantavirus pulmonary syndrome NA NA NA NA NA 0.02 0

0.01 0.01 Hemolytic uremic syndrome postdiarrheal NA NA NA NA NA 0.10 0.08 0.08 0.06 Hepatitis A, acute 9.40 10.29 12.13 11.70 11.22 8.59 6.25 4.91 3.77 3.13 2.66 Hepatitis B, acute 5.18 4.81 4.19 4.01 3.90 3.80 2.82 2.95 2.79 2.84 2.61 Hepatitis C, acute§§ 1.86 1.78 1.78 1.41 1.43 1.30 1.14 1.17 1.41 0.65 0.38 Hepatitis, unspecified 0.24 0.17

§

§

§

§

§

§

§

§

§ Legionellosis 0.50 0.63 0.48 0.47 0.44 0.51 0.41 0.42 0.42 0.47 0.78

Vol. 52 / No. 54 MMWR 71 TABLE 7. (Continued) Reported incidence* of notifiable diseases United States, 1993-2003 Disease 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Leptospirosis 0.02 0.02

§

§

§

§

§

§

§

§

§ Listeriosis 0.31 0.29 0.22 0.24 0.24 Lyme disease 3.20 5.01 4.49 6.21 4.79 6.39 5.99 6.53 6.05 8.44 7.39 Lymphogranuloma venereum 0.10 0.10

§

§

§

§

§

§

§

§

§ Malaria 0.55 0.47 0.55 0.68 0.75 0.60 0.61 0.57 0.55 0.51 0.49 Measles 0.12 0.37 0.12 0.20 0.06 0.04 0.04 0.03 0.04 0.02 0.02 Meningococcal disease 1.02 1.11 1.25 1.30 1.24 1.01 0.92 0.83 0.83 0.64 0.61 Mumps 0.66 0.60 0.35 0.29 0.27 0.25 0.14 0.13 0.10 0.10 0.08 Murine typhus fever 0.01 0.01

§

§

§

§

§

§

§

§

§ Pertussis 2.55 1.77 1.97 2.94 2.46 2.74 2.67 2.88 2.69 3.47 4.04 Plague 0

0.01 0

0.01 0.01 0

0 0

0 0

0 Poliomyelitis, paralytic 0

0 0

0.03 0.02 0.01 0

0 0

0 0

Psittacosis 0.02 0.02 0.03 0.02 0.02 0.02 0.01 0.01 0.01 0.01 0

Q Fever 0

0.01 0.01 0.02 0.02 Rabies, human 0

0 0

0.01 0.01 0

0 0

0 0

0 Rheumatic fever, acute 0.08 0.09

§

§

§

§

§

§

§

§

§ Rocky Mountain spotted fever 0.18 0.18 0.23 0.32 0.16 0.14 0.21 0.18 0.25 0.39 0.38 Rubella 0.07 0.09 0.05 0.10 0.07 0.13 0.21 0.06 0.01 0.01 0

Rubella, congenital syndrome 0

0 0

0 0

0 0

0 0

0 0

Salmonellosis 16.15 16.64 17.66 17.15 15.66 16.17 14.89 14.51 14.39 15.73 15.16 SARS-CoV¶¶ 0

Shigellosis 12.48 11.44 12.32 9.80 8.64 8.74 6.43 8.41 7.19 8.37 8.19 Streptococcal disease, invasive, Group A 0.23 0.55 0.75 0.83 0.87 1.45 1.60 1.69 2.04 Streptococcal toxic-shock syndrome 0

0 0.01 0.02 0.02 0.04 0.04 0.05 0.06 Streptococcus pneumoniae, invasive Drug-resistant 0.12 0.57 0.67 1.44 2.39 2.77 2.11 1.14 0.99 Age <5 yrs 1.03 3.62 8.86 Syphilis, total, all stages 39.70 32.00 26.20 19.97 17.39 14.19 13.07 11.58 11.45 11.68 11.90 Primary and secondary 10.40 8.10 6.30 4.29 3.19 2.61 2.50 2.19 2.17 2.44 2.50 Tetanus 0.02 0.02 0.02 0.02 0.02 0.02 0.01 0.01 0.01 0.01 0.01 Toxic-shock syndrome 0.08 0.10 0.07 0.06 0.06 0.06 0.05 0.06 0.05 0.05 0.05 Trichinellosis 0.01 0.01 0.01 0.01 0.01 0.01 0

0.01 0.01 0.01 0

Tuberculosis 9.82 9.36 8.70 8.04 7.42 6.79 6.43 6.01 5.68 5.36 5.17 Tularemia 0.05 0.04

§

§

§

§

§ 0.06 0.05 0.03 0.04 Typhoid fever 0.17 0.17 0.14 0.15 0.14 0.14 0.13 0.14 0.13 0.11 0.12 Varicella***

118.54 135.76 118.11 44.13 93.55 70.28 44.56 26.18 19.51 10.27 7.27 Yellow fever

0

0

0 0

Note: Rates <0.01 after rounding are listed as 0. 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.

• Per 100,000 population.

Acquired immunodeficiency syndrome (AIDS).

§ No longer nationally notifiable.

¶ Chlamydia refers to genital infections caused by Chlamydia trachomatis.

• • Not nationally notifiable.

Data not available.

§§ Before 2003, hepatitis C, acute, was termed hepatitis C/non-A, non-B; anti-HCV antibody test became available May 1990.

¶¶ Severe acute respiratory syndrome-associated coronavirus disease.

• • • Varicella was not a notifiable disease before 2003.

72 MMWR April 22, 2005 TABLE 8. Reported cases of notifiable diseases United States, 1996-2003 Disease 1996 1997 1998 1999 2000 2001 2002 2003 AIDS*

66,885 58,492 46,521 45,104 40,758 41,868 42,745 44,232 Anthrax

1 23 2

Botulism, total (includes wound and unspecified) 119 132 116 154 138 155 118 129 Foodborne 25 31 22 23 23 39 28 20 Infant 80 79 65 92 93 97 69 76 Brucellosis 112 98 79 82 87 136 125 104 Chancroid 386 243 189 143 78 38 67 54§ Chlamydia¶ 498,884 526,671 604,420 656,721 702,093 783,242 834,555 877,478§ Cholera 4

6 17 6

5 3

2 2

Coccidioidomycosis 1,697 1,749 2,274 2,826 2,867 3,922 4,968 4,870 Cryptosporidiosis 2,827 2,566 3,793 2,361 3,128 3,785 3,016 3,506 Cyclosporiasis 56 60 147 156 75 Diphtheria 2

4 1

1 1

2 1

1 Ehrlichiosis Human granulocytic 203 351 261 511 362 Human monocytic 99 200 142 216 321 Encephalitis/meningitis, arboviral California serogroup 123 129 97 70 114 128 164 108 Eastern equine 5

14 4

5 3

9 10 14 Powassan 1

St. Louis 2

13 24 4

2 79 28 41 West Nile 2,840 2,866 Western equine

1

Enterohemorrhagic Escherichia coli (EHEC)

EHEC O157:H7 2,741 2,555 3,161 4,513 4,528 3,287 3,840 2,671 EHEC non-O157 171 194 252 EHEC not serogrouped 20 60 156 Giardiasis 21,206 19,709 Gonorrhea 325,883 324,907 355,642 360,076 358,995 361,705 351,852 335,104§ Haemophilus influenzae, invasive, all ages/serotpyes 1,170 1,162 1,194 1,309 1,398 1,597 1,743 2,013 Age <5 yrs, serotype b 34 32 Age <5 yrs, nonserotype b 144 117 Age <5 yrs, unknown serotype 153 227 Hansen disease (leprosy) 112 122 108 108 91 79 96 95 Hantavirus pulmonary syndrome NA NA NA 33 41 8

19 26 Hemolytic uremic syndrome, postdiarrheal 97 91 119 181 249 202 216 178 Hepatitis A, acute 31,032 30,021 23,229 17,047 13,397 10,609 8,795 7,653 Hepatitis B, acute 10,637 10,416 10,258 7,694 8,036 7,843 7,996 7,526 Hepatitis C, acute§§ 3,716 3,816 3,518 3,111 3,197 3,976 1,835 1,102 Legionellosis 1,198 1,163 1,355 1,108 1,127 1,168 1,321 2,232 Listeriosis 823 755 613 665 696 Lyme disease 16,455 12,801 16,801 16,273 17,730 17,029 23,763 21,273 Malaria 1,800 2,001 1,611 1,666 1,560 1,544 1,430 1,402 Measles 508 138 100 100 86 116 44 56 Meningococcal disease 3,437 3,308 2,725 2,501 2,256 2,333 1,814 1,756 Mumps 751 683 666 387 338 266 270 231 Pertussis 7,796 6,564 7,405 7,288 7,867 7,580 9,771 11,647

Vol. 52 / No. 54 MMWR 73 TABLE 8. (Continued) Reported cases of notifiable diseases United States, 1996-2003 Disease 1996 1997 1998 1999 2000 2001 2002 2003 Plague 5

4 9

9 6

2 2

1 Poliomyelitis, paralytic¶¶ 7

6 3

2

Psittacosis 42 33 47 16 17 25 18 12 Q Fever 21 26 61 71 Rabies Animal 6,982 8,105 7,259 6,730 6,934 7,150 7,609 6,846 Human 3

2 1

4 1

3 2

Rocky Mountain spotted fever 831 409 365 579 495 695 1,104 1,091 Rubella 238 181 364 267 176 23 18 7

Rubella, congenital syndrome 4

5 7

9 9

3 1

1 Salmonellosis 45,471 41,901 43,694 40,596 39,574 40,495 44,264 43,657 SARS-CoV***

8 Shigellosis 25,978 23,117 23,626 17,521 22,922 20,221 23,541 23,581 Streptococcal disease, invasive, Group A 1,445 1,973 2,260 2,667 3,144 3,750 4,720 5,872 Streptococcal toxic-shock syndrome 19 33 58 65 83 77 118 161 Streptococcus pneumoniae, invasive Drug-resistant 1,514 1,799 2,823 4,625 4,533 2,896 2,546 2,356 Age <5 yrs 498 513 845 Syphilis, total, all stages 52,976 46,540 37,977 35,628 31,575 32,221 32,871 34,270§ Primary and secondary 11,387 8,550 6,993 6,657 5,979 6,103 6,862 7,177§ Tetanus 36 50 41 40 35 37 25 20 Toxic-shock syndrome 145 157 138 113 135 127 109 133 Trichinellosis 11 13 19 12 16 22 14 6

Tuberculosis 21,337 19,851 18,361 17,531 16,377 15,989 15,075 14,874§§§ Tularemia

¶¶¶

¶¶¶

¶¶¶

¶¶¶ 142 129 90 129 Typhoid fever 396 365 375 346 377 368 321 356 Varicella****

83,511 98,727 82,455 46,016 27,382 22,536 22,841 20,948 Varicella deaths 9

2 Yellow fever 1

1

1

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.

Acquired immunodeficiency syndrome.

The total number of acquired immunodeficiency syndrome (AIDS) cases includes all cases reported to the Division of HIV/AIDS Prevention-Surveil-lance, and Epidemiology, National Center for HIV, STD, and TB Prevention (NCHSTP), through December 31, 2003.

§ Cases were updated through the Division of STD Prevention, NCHSTP, as of May 1, 2004.

¶ Chlamydia refers to genital infections caused by Chlamydia trachomatis.

Not previously nationally notifiable.

Data provided by the Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases (NCID) (ArboNET Surveillance).

§§ Before 2003, hepatitis C, acute, was termed hepatitis C/non-A, non-B; anti-HCV antibody test became available May 1990.

¶¶ Numbers might not reflect changes based on retrospective case evaluations or late reports (see CDC. Current trends poliomyelitisUnited States, 1975-1984. MMWR 1986;35:180-2).

Severe acute respiratory syndrome-associated coronavirus disease.

Includes all confirmed and probable cases (according to the revised 2003 SARS surveillance case definition) reported to the Division of Viral and Rickettsial Diseases, NCID. SARS-CoV became nationally notifiable as of July 2003.

§§§ Cases were updated through the Division of TB Elimination, NCHSTP, as of April 1, 2004.

¶¶¶ At that time not a nationally notifiable disease.

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

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

74 MMWR April 22, 2005 TABLE 9. Reported cases of notifiable diseases* United States, 1988-1995 Disease 1988 1989 1990 1991 1992 1993 1994 1995 AIDS 31,001 33,722 41,595 43,672 45,472 103,691 78,279 71,547 Amebiasis 2,860 3,217 3,328 2,989 2,942 2,970 2,983

§ Anthrax 2

1

Aseptic meningitis 7,234 10,274 11,852 14,526 12,223 12,848 8,932

§ Botulism, total (includes wound and unspecified) 84 89 92 114 91 97 143 97 Foodborne 28 23 23 27 21 27 50 24 Infant 50 60 65 81 66 65 85 54 Brucellosis 96 95 82 104 105 120 119 98 Chancroid 5,001 4,692 4,212 3,476 1,886 1,399 773 606¶ Chlamydia**

477,638¶ Cholera 8

6 26 103 18 39 23 Coccidioidomycosis

1,212 Cryptosporidiosis

2,970 Diphtheria 2

3 4

5 4

2

Encephalitis Primary§§ 882 981 1,341 1,021 774 919 717

§ Postinfectious 121 88 105 82 129 170 143

§ Encephalitis/meningitis, arboviral California serogroup

11 Eastern equine

1 St. Louis

Western equine

Escherichia coli O157:H7

1,420 2,139 Gonorrhea 719,536 733,151 690,169 620,478 501,409 439,673 418,068 392,848¶ Granuloma inguinale 11 7

97 29 6

19 3

§ Haemophilus influenzae, invasive

1,412 1,419 1,174 1,180 Hansen disease (leprosy) 184 163 198 154 172 187 136 144 Hantavirus pulmonary syndrome

Hemolytic uremic syndrome, postdiarrheal

72 Hepatitis A, acute 28,507 35,821 31,441 24,378 23,112 24,238 26,796 31,582 Hepatitis B, acute 23,177 23,419 21,102 18,003 16,126 13,361 12,517 10,805 Hepatitis C/nonA, non-B¶¶ 2,619 2,529 2,553 3,582 6,010 4,786 4,470 4,576 Hepatitis, unspecified 2,470 2,306 1,671 1,260 884 627 444

§ Legionellosis 1,085 1,190 1,370 1,317 1,339 1,280 1,615 1,241 Leptospirosis 54 93 77 58 54 51 38

§ Lyme disease

9,895 8,257 13,043 11,700 Lymphogranuloma venereum 185 189 277 471 302 285 235

§ Malaria 1,099 1,277 1,292 1,278 1,087 1,411 1,229 1,419 Measles 3,396 18,193 27,786 9,643 2,237 312 963 309

Vol. 52 / No. 54 MMWR 75 TABLE 9. (Continued) Reported cases of notifiable diseases* United States, 1988-1995 Disease 1988 1989 1990 1991 1992 1993 1994 1995 Meningococcal disease 2,964 2,727 2,451 2,130 2,134 2,637 2,886 3,243 Mumps 4,866 5,712 5,292 4,264 2,572 1,692 1,537 906 Murine typhus fever 54 41 50 43 28 25

§

§ Pertussis 3,450 4,157 4,570 2,719 4,083 6,586 4,617 5,137 Plague 15 4

2 11 13 10 17 9

Poliomyelitis, paralytic 9

11 6

10 6

4 8

7 Psittacosis 114 116 113 94 92 60 38 64

Rabies, Animal 4,651 4,724 4,826 6,910 8,589 9,377 8,147 7,811 Human

1 1

3 1

3 6

5 Rheumatic fever, acute 158 144 108 127 75 112 112

§ Rocky Mountain spotted fever 609 623 651 628 502 456 465 590 Rubella 225 396 1,125 1,401 160 192 227 128 Congenital syndrome 6

3 11 47 11 5

7 6

Salmonellosis, excluding typhoid fever 48,948 47,812 48,603 48,154 40,912 41,641 43,323 45,970 Shigellosis 30,617 25,010 27,077 23,548 23,931 32,198 29,769 32,080 Streptococcal disease, invasive, Group A

613 Streptococcus pneumoniae, invasive, drug-resistant

309 Streptococcal toxic-shock syndrome

10 Syphilis, total, all stages 103,437 110,797 134,255 128,569 112,581 101,259 81,696 68,953¶ Primary and secondary 40,117 44,540 50,223 42,935 33,973 26,498 20,627 16,500¶ Tetanus 53 53 64 57 45 48 51 41 Toxic-shock syndrome 390 400 322 280 244 212 192 191 Trichinellosis 45 30 129 62 41 16 32 29 Tuberculosis 22,436 23,495 25,701 26,283 26,673 25,313 24,361 22,860***

Tularemia 201 152 152 193 159 132 96

§ Typhoid fever 436 460 552 501 414 440 441 369 Varicella 192,857 185,441 173,099 147,076 158,364 134,722 151,219 120,624 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.

• No cases of yellow fever were reported during 1988-1995.

Acquired immunodeficiency syndrome (AIDS).

§ No longer nationally notifiable.

¶ Cases were updated through the Division of STD Prevention, NCHSTP, as of March 1, 1996.

• • Chlamydia refers to genital infections caused by Chlamydia trachomatis.

Not previously nationally notifiable.

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

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

• • • Cases were updated through the Division of TB Elimination, NCHSTP, as of May 29, 1996.

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

76 MMWR April 22, 2005 TABLE 10. Reported cases of notifiable diseases* United States, 1980-1987 Disease 1980 1981 1982 1983 1984 1985 1986 1987 AIDS

§

§

§

§ 4,445 8,249 12,932 21,070 Amebiasis 5,271 6,632 7,304 6,658 5,252 4,433 3,532 3,123 Anthrax 1

1

1 Aseptic meningitis 8,028 9,547 9,680 12,696 8,326 10,619 11,374 11,487 Botulism, total (includes wound and unspecified) 89 103 97 133 123 122 109 82 Foodborne

§

§

§

§

§ 49 23 17 Infant

§

§

§

§

§ 70 79 59 Brucellosis 183 185 173 200 131 153 106 129 Chancroid 788 850 1,392 847 666 2,067 3,756 4,998 Cholera 9

19

1 1

4 23 6

Diphtheria¶ 3

5 2

5 1

3

3 Encephalitis Primary 1,362 1,492 1,464 1,761 1,257 1,376 1,302 1,418 Postinfectious**

40 43 36 34 108 161 124 121 Gonorrhea 1,004,029 990,864 960,633 900,435 878,556 911,419 900,868 780,905 Granuloma inguinale 51 66 17 24 30 44 61 22 Hansen disease (leprosy) 223 256 250 259 290 361 270 238 Hepatitis A, acute 29,087 25,802 23,403 21,532 22,040 23,210 23,430 25,280 Hepatitis B, acute 19,015 21,152 22,177 24,318 26,115 26,611 26,107 25,916 Hepatitis C/non-A, non-B

§

§

§

§ 3,871 4,184 3,634 2,999 Hepatitis, unspecified 11,894 10,975 8,564 7,149 5,531 5,517 3,940 3,102 Legionellosis 475 408 654 852 750 830 980 1,038 Leptospirosis 85 82 100 61 40 57 41 43 Lymphogranuloma venereum 199 263 235 335 170 226 396 303 Malaria 2,062 1,388 1,056 813 1,007 1,049 1,123 944 Measles 13,506 3,124 1,714 1,497 2,587 2,822 6,282 3,655 Meningococcal disease 2,840 3,525 3,056 2,736 2,746 2,479 2,594 2,930 Mumps 8,576 4,941 5,270 3,355 3,021 2,982 7,790 12,848 Murine typhus fever 81 61 58 62 53 37 67 49 Pertussis 1,730 1,248 1,895 2,463 2,276 3,589 4,195 2,823 Plague 18 13 19 40 31 17 10 12 Poliomyelitis, total 9

10 12 13 9

8 10

§§ Paralytic¶¶ 9

10 12 13 9

8 10 9

Psittacosis 124 136 152 142 172 119 224 98 Rabies Animal 6,421 7,118 6,212 5,878 5,567 5,565 5,504 4,658 Human

2

2 3

1

1 Rheumatic fever, acute 432 264 137 88 117 90 147 141 Rocky Mountain spotted fever 1,163 1,192 976 1,126 838 714 760 604 Rubella 3,904 2,077 2,325 970 752 630 551 306 Congenital syndrome 50 19 7

22 5

14 5

Salmonellosis 33,715 39,990 40,936 44,250 40,861 65,347 49,984 50,916 Shigellosis 19,041 19,859 18,129 19,719 17,371 17,057 17,138 23,860 Syphilis, total, all stages 68,832 72,799 75,579 74,637 69,888 67,563 68,215 86,545 Primary and secondary 27,204 31,266 33,613 32,698 28,607 27,131 27,883 35,147 Tetanus 95 72 88 91 74 83 64 48 Toxic-shock syndrome

§

§

§

§ 482 384 412 372 Trichinellosis 131 206 115 45 68 61 39 40 Tuberculosis 27,749 27,373 25,520 23,846 22,255 22,201 22,768 22,517 Tularemia 234 288 275 310 291 177 170 214 Typhoid fever 510 584 425 507 390 402 362 400 Varicella 190,894 200,766 167,423 177,462 221,983 178,162 183,243 213,196 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.

• No cases of yellow fever were reported during 1980-1987.

Acquired immunodeficiency syndrome (AIDS).

§ Not previously nationally notifiable.

¶ Cutaneous diphtheria ceased being notifiable nationally after 1979.

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

Anti-HCV antibody test became available May 1990.

§§No longer nationally notifiable.

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

Vol. 52 / No. 54 MMWR 77 TABLE 11. Reported cases of notifiable diseases* United States, 1972-1979 Disease 1972 1973 1974 1975 1976 1977 1978 1979 Amebiasis 2,199 2,235 2,743 2,775 2,906 3,044 3,937 4,107 Anthrax 2

2 2

2 2

6

Aseptic meningitis 4,634 4,846 3,197 4,475 3,510 4,789 6,573 8,754 Botulism, total (includes wound and unspecified) 22 34 28 20 55 129 105 45 Brucellosis 196 202 240 310 296 232 179 215 Chancroid 1,414 1,165 945 700 628 455 521 840 Cholera

1

3 12 1

Diphtheria 152 228 272 307 128 84 76 59 Encephalitis Primary 1,059 1,613 1,164 4,064 1,651 1,414 1,351 1,504 Postinfectious 243 354 218 237 175 119 78 84 Gonorrhea 767,215 842,621 906,121 999,937 1,001,994 1,002,219 1,013,436 1,004,058 Granuloma inguinale 81 62 47 60 71 75 72 76 Hansen disease (leprosy) 130 146 118 162 145 151 168 185 Hepatitis A, acute 54,074 50,749 40,358 35,855 33,288 31,153 29,500 30,407 Hepatitis B, acute 9,402 8,451 10,631 13,121 14,973 16,831 15,016 15,452 Hepatitis, unspecified

7,488 8,639 8,776 10,534 Legionellosis

235 359 761 593 Leptospirosis 41 57 8,351 93 73 71 110 94 Lymphogranuloma venereum 756 408 394 353 365 348 284 250 Malaria 742 237 293 373 471 547 731 894 Measles 32,275 26,690 22,094 24,374 41,126 57,345 26,871 13,597 Meningococcal disease 1,323 1,378 1,346 1,478 1,605 1,828 2,505 2,724 Mumps 74,215 69,612 59,128 59,647 38,492 21,436 16,817 14,225 Murine typhus fever 18 32 26 41 69 75 46 69 Pertussis 3,287 1,759 2,402 1,738 1,010 2,177 2,063 1,623 Plague 1

2 8

20 16 18 12 13 Poliomyelitis, total 31 8

7 13 10 19 8

22 Paralytic 29 7

7 13 10 19 8

22 Psittacosis 52 33 164 49 78 94 140 137 Rabies Animal 4,369 3,640 3,151 2,627 3,073 3,130 3,254 5,119 Human 2

1

2 2

1 4

4 Rheumatic fever, acute 2,614 2,560 2,431 2,854 1,865 1,738 851 629 Rocky Mountain spotted fever 523 668 754 844 937 1,153 1,063 1,070 Rubella 25,507 27,804 11,917 16,652 12,491 20,395 18,269 11,795 Congenital syndrome 42 35 45 30 30 23 30 62 Salmonellosis 22,151 23,818 21,980 22,612 22,937 27,850 29,410 33,138 Shigellosis 20,207 22,642 22,600 16,584 13,140 16,052 19,511 20,135 Syphilis, total, all stages 91,149 87,469 83,771 80,356 71,761 64,621 64,875 67,049 Primary and secondary 24,429 24,825 25,385 25,561 23,731 20,399 21,656 24,874 Tetanus 128 101 101 102 75 87 86 81 Trichinellosis 89 102 120 252 115 143 67 157 Tuberculosis§ 32,882 30,998 30,122 33,989 32,105 30,145 28,521 27,669 Tularemia 152 171 144 129 157 165 141 196 Typhoid fever 398 680 437 375 419 398 505 528 Varicella 164,114 182,927 141,495 154,248 183,990 188,396 154,089 199,081 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.

• No cases of yellow fever were reported during 1972-1979.

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.

78 MMWR April 22, 2005 TABLE 12. Deaths from selected notifiable diseases United States, 1996-2001 1996 1997 1998 1999 2000 2001 Cause-of-Estimated No. of deaths No. of deaths No. of deaths No. of No. of No. of death codes comparability according to according to according to deaths 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 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 14,175 Anthrax A22 022

§§

Botulism, foodborne A05.1 005.1

§§

1

2

4 4

3 Brucellosis A23 023

§§

1

1

1

Chancroid A57 099.0

§§

Chlamydia¶¶ A56 099.5

§§

Cholera A00 001

§§

2

1 1

1

Coccidioidomycosis B38 114

§§

102

87 81 82 67 58 Cryptosporidiosis A07.2 136.8

§§

7

4 5

1

Cyclosporiasis A07.8 136.8

§§

Diphtheria A36 032

§§

1 1

Ehrlichiosis (human granulocytic and human monocytic)

A79.8 083.8

§§ 1

2 Encephalitis/meningitis, arboviral California serogroup A83.5 062.5

§§

1

1

1

Eastern equine A83.2 062.2

§§

1

2

1

1 St. Louis A83.3 062.3

§§

1

2 1

2 Western equine A83.1 062.1

§§

1

1

Enterohemorrhagic Escherichia coli O157:H7 A04.0-A04.4 005.8

§§

1

1

1 7

5 6

Gonococcal infections A54 098

§§

4

3

4 9

12 7

Haemophilus influenzae A49.2 041.5

§§

7

7

11 6

6 11 Hansen disease (leprosy)

A30 030

§§

2

2 2

Hantavirus pulmonary syndrome J12.8 79.89

§§ 2

4

Hemolytic uremic syndrome, postdiarrheal D59.3 35 35 35 Hepatitis A, acute B15 070.0-070.1 0.9328 113 121 118 127 106 114 134 106 83 Hepatitis B, acute B16, B18.0, B18.1 070.2-070.3 0.6879 744 1,082 709 1,030 724 1,052 832 886 769 Hepatitis C/non-A, non-B 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 4,609 Legionellosis A48.1 482.82

§§ 78 84 70 Listeriosis A32 027.0

§§ 42 45 33 Lyme disease A69.2,L90.4 088.81

§§

7 5

2 Malaria B50-B54 084

§§

4

7

6 7

3 9

Measles B05 055

§§

1

2

2 1

1 Meningococcal disease A39 036 0.9861 286 290 305 309 231 234 227 211 199 Mumps B26 072

§§

1

1 1

2

Pertussis A37 033

§§

4

6

5 7

12 17 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

Rocky Mountain spotted fever A77.0 082.0

§§

6

12

3 5

4 6

Rubella B06 056

§§

2 Congenital syndrome P35.0 771.0

§§

4

4

4 8

4 4

Salmonellosis A02 003 0.8929 52 58 46 51 33 37 38 28 40 Shigellosis A03 004

§§

5

5

5 6

9 2

Streptococcal disease, invasive, group A A40.0, A49.1, B95.0 041.0

§§

67

87

87 145 132 91 Syphilis, total, all stages A50-A53 090-097 0.7887 58 73 49 62 35 45 33 41 36 Tetanus A35 037

§§

1

4

7 7

5 5

Toxic-shock syndrome A48.3 041.1

§§

207

216

235 55 74 75 Trichinellosis B75 124

§§

Tuberculosis A16-A19 010-018 0.8821 1,060 1,202 1,029 1,166 981 1,112 930 776 764 Tularemia A21 021

§§

1

1 1

3

Typhoid fever A01.0 002.0

§§

1

1 Varicella B01 052 0.7848 64 81 78 99 64 81 48 44 26 Yellow fever A95 060

§§

1

1

Source: CDC. CDC WONDER Compressed Mortality files (http://wonder.cdc.gov/mortSQL.html) provided by the National Center for Health Statistics. National Vital Statistics System, 1996-2000. Deaths are classified according to the ICD-9 (1996-1998) and ICD-10 (1999-2001). Data for 2002 and 2003 currently are not available. Data are limited by the accuracy of information regarding the underlying cause of death indicated on death certificates and reported to the National Vital Statistics System.

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

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

§ Unpublished estimates; see also Anderson RN, Minino AM, Hoyert DL, et al. Comparability of cause of death between ICD-9 and ICD-10: preliminary estimates. US Depart-ment of Health and Human Services, CDC, National Center for Health Statistics. 2001; DHHS publication no. (PHS) 2001-1120. (Natl Vital Stat Rep;49,2).

¶ 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.

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

• • • Not previously nationally notifiable.

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

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

Vol. 52 / No. 54 MMWR 79 Selected Reading General Bayer R, Fairchild AL. Public health: surveillance and privacy.

Science 2000;290:1898-9.

CDC. Case definitions for infectious conditions under public health surveillance. MMWR 1997;46(No. RR-10). Addi-tional information available at http://www.cdc.gov/epo/

dphsi/casedef/index.htm.

CDC. Demographic differences in notifiable infectious dis-ease morbidityUnited States, 1992-1994. MMWR 1997;46:637-41.

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Lyme Disease Stafford KC III. Tick management handbook: a integrated guide for homeowners, pest control operators, and public health officials for the prevention of tick-associated disease.

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Plague CDC. Imported plagueNew York City, 2002. MMWR 2003;53:725-8.

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Q Fever McQuiston JH, Childs JE. Q fever in humans and animals in the United States [Review]. Vector Borne and Zoonotic Dis 2002;179-191.

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CDC. Human rabies preventionUnited States, 1999: rec-ommendations of the Advisory Committee on Immuniza-tion Practices (ACIP). MMWR 1999;48(No. RR-1).

Krebs J.W., J.T. Wheeling, J.E. Childs. 2003. Rabies surveil-lance in the United States during 2002. J. Am Vet Med Assoc 223:1736-8.

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Rocky Mountain Spotted Fever Cases of Rocky Mountain spotted fever in family clusters three states, 2003. MMWR 2004:53:407-10.

Treadwell TA, Holman RC, Clarke MA et al. Rocky Moun-tain spotted fever in the United States, 1993-1996. Am J Trop Med Hyg 2000;63:21-6.

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Shigellosis Gupta A, Polyak CS, Bishop RD, Sobel J, Mintz ED. Labora-tory-confirmed shigellosis in the United States, 1989-2002:

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84 MMWR April 22, 2005 Streptococcal Disease, Invasive, Group A The Prevention of Invasive Group A Streptococcal Infections Workshop Participants. Prevention of invasive group A strep-tococcal disease among household contacts of case patients and among postpartum and postsurgical patients: recom-mendations from the Centers for Disease Control and Prevention. Clin Infect Dis 2002;35:950-9.

CDC. Active Bacterial Core Surveillance report. Emerging Infections Program Network. Group A streptococcus, 2003preliminary. Atlanta, GA: Available at http://

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Streptococcus pneumoniae, Invasive, Drug-Resistant CDC. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Com-mittee on Immunization Practices. MMWR 2000;49 (No. RR-9):1-38.

Flannery B, Schrag S, Bennett NM, et al. Impact of child-hood vaccination on racial disparities in invasive Streptococ-cus pneumonias infections in the United States, 1998-2002.

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Whitney CG, Farley MM, Hadler J, et al. Decline in invasive pneumococcal disease following the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 2003; 348:1737-46.

Syphilis, Congenital CDC. Congenital syphilisUnited States, 2002. MMWR 2004;53:716-9.

Syphilis, Primary and Secondary CDC. The national plan to eliminate syphilis from the United States. Atlanta, GA: US Department of Health and Human Services, CDC; 1999.

CDC. Trends in primary and secondary syphilis and HIV infections in men who have sex with menSan Francisco and Los Angeles, California, 1998-2002. MMWR 2004;53:575-8.

CDC. Primary and secondary syphilisUnited States, 2002.

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CDC. Sexually transmitted disease surveillance supplement 2002: syphilis surveillance report. Atlanta, GA: US Depart-ment of Health and Human Services, CDC; 2004.

Tetanus Pascual FB, McGinley EL, Zanardi LR, Cortese MM, Murphy TV. Tetanus surveillanceUnited States, 1998-2000. In:

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CDC. TetanusPuerto Rico, 2002. MMWR 2002;51:613-5.

Fair E, Murphy T, Golaz A, Wharton M. Philosophic objec-tion to vaccination as a risk for tetanus among children <15 years of age. Pediatrics 2002;109:E2.

McQuillan GM, Kruszon-Moran D, Deforest A, Chu SY, Wharton M. Serologic immunity to diphtheria and tetanus in the United States. Ann Intern Med 2002;136:660-6.

Trichinellosis CDC. Trichinellosis associated with bear meatNew York and Tennessee, 2003. MMWR 2004;53:606-10.

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CDC. Outbreak of trichinellosis associated with eating cougar jerkyIdaho, 1995. MMWR 1996;45:205-6.

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Vol. 52 / No. 54 MMWR 85 Tularemia CDC. Outbreak of tularemia among commercially distrib-uted prairie dogs, 2002. MMWR 2002;51:688,699.

CDC. TularemiaUnited States, 1990-2000. MMWR 2002;51:182-4.

Dennis DT, Inglesby TV, Henderson DA, et al. Tularemia as a biological weapon: medical and public health manage-ment. JAMA 2001;285:2763-73.

Feldman KA, Enscore RE, Lathrop SL, et al. Outbreak of primary pneumonic tularemia on Marthas Vineyard. N Engl J Med 2001:345:1219-26.

Typhoid Fever Steinberg EB, Bishop RB, Dempsey AF, et al. Typhoid fever in travelers: who should be targeted for prevention? Clin Infect Dis 2004;39:186-91.

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CDC. Outbreak of varicella among vaccinated children Michigan, 2003. MMWR 2004;53:389-92.

CDC. Prevention of varicella: updated recommendations of the Advisory Committee on Immunization Practices (ACIP).

MMWR 1999;48(No. RR-6).

CDC. Prevention of varicella: recommendations of the Advi-sory Committee on Immunization Practices (ACIP).

MMWR 1996;45(No. RR-11):1-25.

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