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MMWR Summary of Notifiable Diseases, United States, 1993The following CDC staff members prepared this report: Denise T. Koo, M.D., M.P.H. Andrew G. Dean, M.D., M.P.H. Ruth W. Slade Carol M. Knowles Deborah A. Adams Wanda K. Fortune Patsy A. Hall Robert F. Fagan Barbara Panter-Connah Harry R. Holden Gerald F. Jones Clarence Lee Maddox Division of Surveillance and Epidemiology Epidemiology Program Office Consultant Willie J. Anderson Office of the Vice President for Health Affairs Emory University Foreword MMWR Summary of Notifiable Diseases, United States, 1993 This publication contains summary tables of the official statistics for the occurrence of nationally notifiable diseases in the United States for calendar year 1993. This information is collected and compiled from reports to the National Notifiable Diseases Surveillance System (NNDSS). Part 1 contains information on morbidity for each of the 49 currently notifiable conditions. In all tables, leprosy is listed as Hansen disease, typhus fever (flea-borne) as murine typhus fever, and typhus fever (tick- borne) as Rocky Mountain spotted fever (RMSF). The tables show the number of cases of notifiable diseases reported to CDC for 1993, as well as the distri- bution of cases by month and geographic location, and by patient's age, race, and ethnicity. Part 2 contains graphs and maps depicting summary data for many of the notifiable conditions described in tabular form in Part I. Part 3 includes tables showing the number of cases of notifiable diseases reported to CDC and to the National Office of Vital Statistics since 1944. It also includes a table on deaths associated with specified notifiable diseases reported to the National Center for Health Statistics, CDC, for the period 1982-1991. Background As of January 1, 1994, 49 infectious diseases were designated as noti- fiable at the national level. A notifiable disease is one for which regular, frequent, and timely information on individual cases is considered necessary for the prevention and control of the disease. This section briefly sum- marizes the history of national notifiable disease reporting in the United States. In 1878, Congress authorized the U.S. Public Health Service (PHS) to collect morbidity reports on cholera, smallpox, plague, and yellow fever from U.S. consuls overseas; this information was to be used for instituting quar- antine 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. The authority for weekly reporting and publication was expanded by Congress 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 Surgeon General to provide forms for the collection and compilation of data and for the publication of reports at the national level. In 1912, state and territorial health authorities -- in conjunction with PHS -- recommended weekly telegraphic reporting of five infectious diseases and monthly report- ing by letter of 10 additional diseases. The first annual summary of The Notifiable Diseases in 1912 included reports of 10 diseases from 19 states, the District of Columbia, and Hawaii. By 1928, all states, the District of Columbia, Hawaii, and Puerto Rico were participating in national reporting of nearly 30 specified conditions. At their meeting in 1950, the State and Territorial Health Officers authorized a conference of state epidemiologists whose purpose was to determine which diseases should be reported to PHS. CDC assumed responsibility for the collection and publication of data on nation- ally notifiable diseases in 1961. Public health officials at state health departments and CDC continue to collaborate in determining which diseases should be nationally notifiable; the Council of State and Territorial Epidemiologists (CSTE) makes recommenda- tions annually for additions and deletions to the national notifiable disease list on the basis of CDC suggestions. However, reporting of nationally noti- fiable diseases to CDC by the states is voluntary. Reporting is currently mandated only at the state level. The list of diseases that are considered notifiable, therefore, varies slightly by state. All states generally report the internationally quarantinable diseases (i.e., cholera, plague, and yellow fever) in compliance with the World Health Organization's International Health Regulations. The list of nationally notifiable diseases is revised periodically. Diseases are added to the list as new pathogens emerge; diseases are deleted as their incidence declines. During 1993, 49 infectious diseases were con- sidered notifiable at the national level and were reported to CDC; 41 were reported on a weekly basis, and eight were reported monthly. CSTE will review the principles of notifiable disease reporting in late fall 1994. Data Sources Provisional data on the reported occurrence of notifiable diseases are published routinely in MMWR; these data are compiled in final form in this summary. Notifiable disease reports published in the annual MMWR Summary of Notifiable Diseases are the authoritative and archival counts of cases. Data from surveillance records for selected diseases, which are useful for de- tailed epidemiologic analyses, are published on a periodic basis. Data ap- pearing in those surveillance reports may not agree exactly with reports published in MMWR due to differences in the timing of reports or the source of the data or due to refinements in case definitions. Data in this summary are primarily derived from electronic reports trans- mitted to the Epidemiology Program Office, CDC, by state and territorial health departments through the National Electronic Telecommunications System for Surveillance (NETSS). Final data for other diseases are from surveillance program records of the CDC programs listed below. Requests for further infor- mation regarding these data should be directed to the appropriate source. National Center for Health Statistics Office of Vital and Health Statistics Systems (deaths from selected notifiable diseases) National Center for Infectious Diseases Division of Bacterial and Mycotic Diseases (cholera and toxic- shock syndrome) Division of HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) Division of Vector-Borne Infectious Diseases (arboviral infec tions of the central nervous system and plague) Division of Viral and Rickettsial Diseases (animal rabies) National Center for Prevention Services Division of Sexually Transmitted Diseases and HIV Prevention (gonorrhea, syphilis, chancroid, granuloma inguinale, and lymphogranuloma venereum) Division of Tuberculosis Elimination (tuberculosis) National Immunization Program 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 Virgin Islands, and the Commonwealth of the Northern Mariana Islands (CNMI). Data on notifiable diseases before 1960 are obtained from publications of the National Office of Vital Statistics. Population estimates for states are based on the July 1, 1993, post- censal estimates made by the U.S. Department of Commerce, Bureau of the Census, Population Division, Population Estimates Branch, Press Release CB93-219. Population estimates for territories are from the 1990 census, U.S. Department of Commerce, Bureau of the Census, Press Releases CB91-142, 242, 243, 263, and 276. Rates in the 1993 Summary of Notifiable Diseases were based on data for the U.S. total resident population. However, population data from states in which diseases were not notifiable or not available were excluded from rate calculations. Interpreting Data Although the data reported in this summary are important for analyzing disease trends and determining relative disease burdens, these data must be interpreted with caution. Some diseases, such as plague and rabies, that cause severe clinical illness and are associated with serious consequences probably are diagnosed and reported accurately. However, diseases that are clinically mild and infrequently associated with serious consequences (e.g., salmonellosis and mumps) are less likely to be reported. Additionally, sub- clinical cases are seldom detected except in the course of special studies. The degree of completeness of reporting also is influenced by the diagnostic facilities available, the control measures in effect, and the interests and priorities of state and local officials responsible for disease control and surveillance. Finally, factors such as the introduction of new diagnostic tests and the discovery of new disease entities may cause changes in disease reporting that are independent of the true incidence of disease. Public health surveillance data are published for selected racial and ethnic population groups because these variables may be risk markers for certain notifiable diseases. Risk markers can identify potential risk factors for investigation in future studies. Data on race and ethnicity also can be useful for identifying groups to target for prevention efforts. Year 2000 Objectives for racial and ethnic groups have been established for several of the notifiable diseases. EXPLANATION OF SYMBOLS USED IN TABLES, GRAPHS, AND MAPS Data not available ............................................. NA No reported cases .............................................. - Report of disease not required by state health department (not notifiable) ............................................. NN 1993 HIGHLIGHTS FOR SELECTED DISEASES This section highlights important developments in the reported occur- rences of certain notifiable and non-notifiable infectious diseases. Those diseases that currently are not nationally notifiable are highlighted under the subheading "Emerging Infections." AIDS In 1993, the number of AIDS cases reported to CDC increased 127% from the number reported in 1992. The large increase in the number of cases was largely due to changes in the 1993 AIDS surveillance case definition. As of January 1, 1993, HIV-infected persons with additional clinical conditions, as well as those with markers of severe immunosuppression, were defined as having AIDS. Botulism In 1993, two restaurant-associated outbreaks of botulism occurred in which unusual vehicles of transmission were implicated. In one of the out- breaks, which occurred in Georgia, the toxin was transmitted by a canned cheese sauce; in the other outbreak in Texas, toxin was transmitted by a dip containing baked potatoes. Cholera Epidemics of cholera caused by a new pathogen, Vibrio cholerae O139, occurred in late 1992 and early 1993 in southern Asia; in the United States, the first recognized case of infection caused by Vibrio cholerae 0139 occurred during 1993 in a California resident who had visited India in January 1993. Diphtheria Outbreaks of diphtheria were reported from the Newly Independent States of the former Soviet Union (especially Russia and Ukraine) and Ecuador. No cases were reported last year among U.S. travelers to these countries. Haemophilus influenzae The rate of Haemophilus influenzae disease as reported through the National Notifiable Diseases Surveillance System (NNDSS) has continued to decline. Rates decreased 95% between 1987 and 1993. Data collected by active surveillance from selected sites indicate that the decline is primarily in Haemophilus influenzae type b (Hib) disease among children <5 years of age. This decline is associated with the use of the newly licensed Hib conjugate vaccines. Hepatitis B The reported incidence of hepatitis B decreased 59% from 1985 through 1993. This decline was caused by decreases in the number of cases reported among homosexual men between 1985 and 1989 (61%) and in the number reported among injecting-drug users from 1989 through 1992 (51%). These decreases are thought to result from an increase in AIDS awareness, which has resulted in behavioral changes (e.g., safer sex and needle-using practices). Hepatitis, Non-A, Non-B The steady increase in the number of cases of non-A, non-B hepatitis reported to NNDSS since 1990 is not thought to be caused by an increase in incidence, but rather caused by the screening of blood for the presence of antibody to the hepatitis C virus (anti-HCV, available beginning in May, 1990). Persons testing positive for anti-HCV, regardless of the presence of illness, have been reported as having non-A, non-B hepatitis. Surveillance at sentinel sites has actually shown a steady decrease in the incidence of non- A, non-B hepatitis, with a decline of >50% from 1988 through 1993. This decline is primarily attributable to a 58% decrease in the number of reported cases among injecting-drug users. Legionnaires' Disease Although only 1,280 cases of Legionnaires' disease were reported through NNDSS in 1993, data from recent prospective pneumonia studies suggest that between 10,000 and 15,000 cases occur each year. Lyme Disease In 1993, the number of cases of Lyme disease reported to CDC nationwide decreased by 15% from 1992. Hunterdon, New Jersey meanwhile experienced an increase in reported cases of Lyme disease from 75 cases in 1992 to 206 cases in 1993; upon investigation, the increase in reported cases was found to be due to both increased reporting by physicians and an increase in disease incidence. Malaria In August 1993, three persons without recent bloodborne exposure and who had not recently traveled were diagnosed with Plasmodium falciparum malaria infection in New York City. The results of the epidemiologic investigation suggest local acquisition through mosquito-borne transmission. Measles The total number of measles cases reported to CDC in 1993 -- 312 -- was the lowest number ever recorded in the United States. This reduction in reported measles cases may reflect cyclical changes in measles incidence as well as increases in measles vaccination coverage among preschool-aged children, increased use of a second dose of measles vaccine among school- and college-aged persons, and increased efforts to control measles throughout the Western Hemisphere. Meningococcal disease Several clusters of group C disease were recognized in 1993, resulting in mass vaccinations with meningococcal vaccine. Because approximately one half of severe meningococcal disease in this country is caused by serogroup B and because the vaccine is only effective for disease caused by serogroups A, C, Y, and W, the clusters illustrate the importance of serogroup determination and reporting for all cases of invasive Neisseria meningitidis. Mumps The total number of mumps cases reported in 1993 -- 1,692 -- was the lowest number ever reported in the United States. Pertussis The 6,503 pertussis cases reported in the United States in 1993 represent the highest annual total since 1967. Of 1,347 cases of pertussis among children 7 months to 4 years of age with known vaccination status, 630 (46.8%) had received fewer than three doses of DTP vaccine -- the minimum number of doses necessary for clinical protection. Rubella The total number of rubella cases reported to the CDC remained low in 1993 (N=192), although the number increased by 19% over the record low number of cases reported in 1992. Sexually Transmitted Diseases Nationally, the rates for gonorrhea and primary and secondary syphilis have declined since 1990, reaching low points in 1993 that were below or approaching the Year 2000 Objectives (1) (greater than or equal to 225 cases gonorrhea and greater than or equal to 10 cases primary and secondary syphilis per 100,000 persons). However, rates for both diseases remained higher than the Year 2000 Objectives for certain population subgroups: adolescents and young adults, minorities (especially blacks), and persons living in the southern United States. Shigella The number of cases of Shigella reported through NNDSS increased 35% from 1992 to 1993, with increases of 27%-405% reported from nine states. This increase was also reported through the national Shigella surveillance system, which receives reports of laboratory isolates of Shigella through the Public Health Laboratory Information System (PHLIS); 91% of Shigella isolates reported through PHLIS in 1993 were Shigella sonnei. Tuberculosis Between 1992 and 1993, the number of reported tuberculosis (TB) cases in the United States decreased from 26,673 to 25,313. This decrease may be associated with the effectiveness of prevention and control measures imple- mented during the period 1989-1993. However, two other factors also may be responsible for the decrease, including a) delayed reporting caused by use of the new TB surveillance reporting form and the change from paper records to a computerized system and b) underreporting because of modification of the AIDS surveillance case definition in January 1993. EMERGING INFECTIONS NOTE: The term "emerging infectious diseases" refers to those "infectious diseases whose incidence in humans has increased within the past two decades or threatens to increase in the near future" (2). These can be new or previously unrecognized infectious diseases, reemerging diseases, or infec- tious diseases that have developed resistance to previously effective anti- microbial drugs. Coccidioidomycosis The outbreak of coccidioidomycosis in California that began in 1991 continued in 1993. From an annual average number of 428 cases reported per year in California during the period 1981-1990, 1,200 cases were reported in 1991, 4,516 in 1992, and4,137 in 1993, 70% of which were reported from Kern County in central California. Key factors that may be associated with the ongoing outbreak include weather conditions that are conducive to the growth and spread of Coccidioides immitis (e.g., protracted drought followed by heavy rains), activities that disturb the soil and facilitate airborne spread of the organism, and an increasing population of persons who are susceptible to the organism because of migration from areas where coccidoidomycosis is not endemic. Cryptosporidiosis In spring 1993, a municipal water supply in Milwaukee, Wisconsin, contaminated with Cryptosporidium caused the largest recognized outbreak of waterborne illness in the history of the United States. More than 400,000 persons became ill, 4,400 of whom required hospitalization. Escherichia coli O157:H7 In 1993, an outbreak of E. coli O157:H7 affected more than 500 people in four western states, resulting in 56 cases of hemolytic uremic syndrome and four deaths. Because of this outbreak, many clinical laboratories began screening stool samples for E. coli O157:H7, which resulted in the identifi- cation of many more cases and outbreaks. In May 1993, the Council of State and Territorial Epidemiologists (CSTE) passed a resolution recommending that E. coli O157:H7 infection be made reportable by all states and territories. Group A Streptococcal Disease During 1993, CDC surveillance for invasive group A streptococcal infec- tions consisted of a passive nationwide surveillance system. This system operated through the collection of isolates from normally sterile sites and the collection of case reports. Although current data on incidence and trends for invasive disease, streptococcal toxic shock syndrome, and necrotizing fasciitis are not available, population-based active surveillance for these infections has begun in several geographic areas and will be expanded in 1994 as part of surveillance for emerging infectious diseases. Hantavirus Pulmonary Syndrome Hantavirus Pulmonary Syndrome (HPS), a newly recognized illness charac- terized by an influenza-like prodrome followed by the acute onset of respira- tory failure, was first identified in the southwestern United States in June 1993 during the investigation of a cluster of unexplained deaths. A new hantavirus (Sin Nombre virus) and a rodent reservoir for the virus (the deer mouse {Peromyscus maniculatus}) were identified. As of August 31, 1994, national surveillance for HPS, initiated by CDC in coordination with CSTE, has identified 91 confirmed cases of HPS (with 48 deaths) in 20 states (case fatality rate: 53%). Drug-Resistant Pneumococcus The increasing incidence of drug-resistant Streptococcus pneumoniae (DRSP) strains in the United States has created an emerging public health challenge. CDC surveillance data from 1992 indicated that the prevalence of pneumococcal strains that are highly resistant to penicillin increased 60- fold (from 0.02% to 1.3%) when compared with the prevalence of isolates collected from 1979 through 1987. CDC, CSTE, and the infectious diseases and microbiology communities are developingrecommendations for the surveillance of DRSP infections. This surveillance data will be used to determine optimal empiric treatment regimens for pneumococcal infections. Vancomycin-Resistant Enterococci (VRE) From 1989 through 1993, the percentage of nosocomial enterococci resis- tant to vancomycin reported from hospitals participating in the National Nosocomial Infections Surveillance System increased from 0.3% to 7.9%. During this period, numerous VRE outbreaks (occurring primarily among immunocom- promised patients) were reported. Because of the public health importance of the emergence of VRE, CDC has published draft Guidelines for Preventing the Spread of Vancomycin Resistance and is conducting studies to assess the effectiveness of these guidelines in preventing disease transmission. References
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New York: Harper and Row, 1989:151;1296-1306. Poliomyelitis CDC. Poliomyelitis -- United States, 1975-1984. MMWR 1986;35(11):180-2. Prevots DR, Suter RW, Strebel PM, Weibel RE, Cochi SL. Completeness of reporting for paralytic poliomyelitis, United States, 1980 through 1991. Archives of Pediatrics and Adolescent Medicine 1994;148:479-85. Strebel PM, Sutter RW, Cochi SL, et al. Epidemiology of poliomyelitis in the United States: one decade after the last reported case of indigenous wild virus-associated disease. Clin Infect Dis 1992;14:568-79. Psittacosis Anonymous. Compendium of chlamydiosis (psitticosis) control, 1994. National Association of State Public Health Veterinarians, Inc. J Am Vet Med Assoc 1993;203:1673-80. Barnes RC. Laboratory diagnosis of human chlamydial infections. Clin Micro- biol Rev 1989;2:119-36. Kuritsky JN, Schmid GP, Potter ME, Anderson DC, Kaufmann AF. Psittacosis: a diagnostic challenge. J Occup Med 1984;26:731-3. Rabies Baer G. Natural history of rabies. 2nd ed. Boca Raton, Florida: CRC press, 1991. CDC. Compendium of animal rabies control, 1994. MMWR 1994;43(No. RR-10). CDC. Rabies prevention -- United States, 1991: recommendations of the Immuni- zation Practices Advisory Committee (ACIP). MMWR 1991;40(No. RR-3). Krebs JW, Strine TW, Childs JE. Rabies surveillance in the United States during 1992. J Am Vet Med Assoc 1993;203:1718-31. Rheumatic Fever Dajani AS. Prevention of rheumatic fever: a statement for health profession- als by the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, the American Heart Association. Pediatr Infect Dis J 1989;8:263-6. Kaplan EL, Johnson DR, Cleary PP. Group A streptococcal serotypes isolated from patients and sibling contacts during the resurgence of rheumatic fever in the United States in the mid-1980's. J Infect Dis 1989;1259: 101-3. Veasy GL, Wiedmeier SE, Orsmond GS, et al. Resurgence of acute rheumatic fever in the intermountain area in the United States. N Engl J Med 1987;316:421-8. Rocky Mountain Spotted Fever (RMSF) Burgdorfer W, Anacker FL, eds. Rickettsiae and Rickettsial Diseases. New York: Academic Press, 1981. McDade JE, Fishbein DB. Rickettsiaceae: the rickettsiae. In: Laboratory diagnosis of infectious diseases: principles and practice. Vol II. Viral, rickettsial, and chlamydial diseases. New York: Springer-Verlag, 1988: 864-89. Rubella CDC. Increase in rubella and congenital rubella syndrome -- United States, 1988-1990. MMWR 1991;40(6):93-9. CDC. Rubella and congenital rubella syndrome -- United States, January 1, 1991-May 7, 1994. MMWR 1994;43(21):391,397-401. CDC. Outbreaks of rubella among the Amish -- United States, 1991. MMWR 1991;40(16):264. CDC. Congenital rubella syndrome among the Amish -- Pennsylvania, 1991-1992. MMWR 1992;41(26):468-9,475-6. CDC. Rubella prevention: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR 1990;39(No. RR-15). Lindegren ML, Fehrs LJ, Hadler SC, Hinman AR. Update: rubella and congenital rubella syndrome, 1980-1990. Epidemiol Rev 1991;13:341-8. Salmonellosis Lee LA, Puhr ND, Maloney EK, Bean NH, Tauxe RV. Increase in antimicrobial- resistant Salmonella infections in the United States, 1989-1990. J Infect Dis 1994;170:128-34. Mishu B, Griffin PM, Tauxe RV, Cameron DN, Hutcheson RH, Schaffner W. Salmo- nella enteritidis gastroenteritis transmitted by intact chicken eggs. Ann Intern Med 1991;115:190-4. St. Louis ME, Morse DL, Potter ME, et al. The emergence of grade A eggs as a major source of Salmonella enteritidis infections: new implications for the control of salmonellosis. JAMA 1988;259:2103-7. Tauxe RV. Salmonella : a postmodern pathogen. Journal of Food Protection 1991;54:563-8. Shigellosis Lee LA, Shapiro CN, Hargrett-Bean N, Tauxe RV. Hyperendemic shigellosis in the United States: a review of surveillance data for 1967-1988. J Infect Dis 1991;164:894-900. Parsonnet J, Greene KD, Gerber AR, et al. Shigella dysenteriae type 1 infec- tions in U.S. travellers to Mexico. Lancet 1989:543-5. Ries AA, Wells JG, Olivola D, et al. Epidemic Shigella dysenteriae type 1 in Burundi: panresistance and implications for prevention. J Infect Dis 1994;169:1035-41. Syphilis Aral SO, Wasserheit JN, Green SB, Judson FN, Sparling FP. The NIAID/NIH working group on integrated behavioral research for prevention and control of STDs. Part III: Issues in evaluating behavioral interventions. Sex Transm Dis 1990;17:208-10. CDC. Primary and secondary syphilis -- United States, 1981-1990. MMWR 1991; 40(19):314-5,321-3. CDC. Regional and temporal trends in the surveillance of syphilis, United States, 1986-1990. MMWR 1991;40(No. SS-3):29-33. CDC. Special focus: surveillance for sexually transmitted diseases. MMWR 1993;42(No. SS-3):13-9. Tetanus CDC. Surveillance of tetanus -- United States, 1989-1990. MMWR 1992;41(No. SS-8):1-9. Sutter RW, Cochi SL, Brink EW, Sirotkin BI. Assessment of vital statistics and surveillance data for monitoring tetanus mortality, United States, 1979-1984. Am J Epidemiol 1990;131:132-42. Toxic Shock Syndrome CDC. Reduced incidence of menstrual toxic shock syndrome -- United States, 1980-1990. MMWR 1990;39(25):421-3. Gaventa S, Reingold AL, Hightower AW, et al. Active surveillance for toxic shock syndrome in the United States, 1986. Rev Infect Dis 1989;(suppl): S28-34. Schuchat A, Broome CV. Toxic shock syndrome and tampons. Epidemiol Rev 1991;13:99-112. Trichinosis Bailey TM, Schantz PM. Trends in the incidence and transmission patterns of human trichinosis in the United States, 1982-1986. Rev Infect Dis 1990; 12:5-11. Campbell WC (ed.). Trichinella and trichinosis. New York: Plenum Press, 1983. CDC. Trichinosis surveillance -- United States, 1987-1990. MMWR 1991;40(No. SS-3):35-42. McAuley JB, Michelson MK, Hightower AW, Engeran S, Wintermeyer LA, Schantz PM. A trichinosis outbreak among Southeast Asian refugees. Am J Epidemiol 1992;135:1404-10. Tuberculosis American Thoracic Society/CDC. Treatment of tuberculosis and tuberculosis infection in adults and children. Am J Respir Crit Care Med 1994;149: 1359-74. CDC. Recommendations for counting reported tuberculosis cases. Atlanta: US Department of Health and Human Services, Public Health Service, 1977. CDC. Expanded tuberculosis surveillance and tuberculosis morbidity -- United States, 1993. MMWR 1994;43(20):361-6. Tularemia Evans ME, Gregory DW, Schaffner W, McGee ZA. Tularemia: a 30 year experience with 88 cases. Medicine 1985;64:251-69. Taylor JP, Istre GR, McChesny TC, Satalowich FT, Parker RE, McFarland LM. Epidemiologic characteristics of human tularemia in the southwest-central states, 1981-1987. Am J Epidemiol 1991;133:1032-8. Typhoid Fever CDC. Typhoid immunization: recommendations of the Immunization Practices Advisory Committee. MMWR 1990;39(No. RR-10). Ryan CA, Hargrett-Bean NT, Blake PA. Salmonella typhi infections in the United States, 1975-1984: increasing role of foreign travel. Rev Infect Dis 1989;II:1-7. Woodruff BA, Pavia AT, Blake PA. A new look at typhoid vaccination: informa- tion for the practicing physician. JAMA 1991;265(6):756-9. Varicella CDC. Varicella outbreak in a women's prison -- Kentucky. MMWR 1989;38(37): 635-6,641-2. Gershon AA, LaRussa P, Hardy I, Steinberg S, Silverstein S. Varicella vac- cine: the American experience. J Infect Dis 1992;166(suppl 1):S63-8. Lieu TA, Cochi SL, Black SB, et al. Cost-effectiveness of a routine varicella vaccination program for U.S. children. JAMA 1994;271:375-81. PART 1: Summaries of Notifiable Diseases in the United States Table_N1 NOTIFIABLE DISEASES -- summary of reported cases, by month, United States, 1993 Table_N2 NOTIFIABLE DISEASES -- reported cases, by geographic division and area, United States, 1993 Table_N3 NOTIFIABLE DISEASES -- summary of reported cases, by age group, United States, 1993 Table_N4 NOTIFIABLE DISEASES -- summary of reported cases, by race, United States, 1993 Table_N5 NOTIFIABLE DISEASES -- summary of reported cases, by ethnici- ty, United States, 1993 PART 2: Graphs and Maps for Selected Notifiable Diseases in the United States Figure_1 ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) -- reported cases and known deaths, by year, United States, 1981-1993 Figure_2 ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) -- annual rates, by selected age group and sex for reported cases, United States, 1993 Figure_3 ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) -- reported pediat- ric cases, United States and Puerto Rico, 1993 Figure_4 ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) -- reported cases, per 100,000 population, United States and Puerto Rico, 1993 Figure_5 ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) -- reported adult/ adolescent cases among men, by exposure category, United States, 1993 Figure_6 ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) -- reported adult/ adolescent cases among women, by exposure category, United States, 1993 Figure_7 ARBOVIRAL INFECTIONS (of the central nervous system) -- cases due to St. Louis encephalitis virus, by month, United States, 1975-1993 Figure_8 ARBOVIRAL INFECTIONS (of the central nervous system) -- cases due to California serogroup viruses, by month, United States, 1975-1993 Figure_9 ARBOVIRAL INFECTIONS (of the central nervous system) -- cases due to Western equine encephalitis virus, by month, United States, 1975-1993 Figure_10 ARBOVIRAL INFECTIONS (of the central nervous system) -- cases due to Eastern equine encephalitis virus, by month, United States, 1975-1993 Figure_11 ASEPTIC MENINGITIS -- by month, United States, 1986-1993 Year Figure_12 AMEBIASIS -- by year, United States, 1955-1993 Figure_13 ASEPTIC MENINGITIS -- reported cases, per 100,000 population, United States and territories, 1993 Figure_14 BOTULISM (infant) -- by year, United States, 1975-1993 Figure_15 BOTULISM (foodborne) -- by year, United States, 1975-1993 Figure_16 BRUCELLOSIS -- by year, United States, 1945-1993 Figure_17 CHOLERA -- reported cases, United States and territories, 1993 Figure_18 DIPHTHERIA -- by year, United States, 1955-1993 Figure_19 ENCEPHALITIS (post-infectious) -- by year, United States, 1984-1993 Figure_20 GONORRHEA -- by sex, United States, 1960-1993 Figure_21 GONORRHEA -- by race and ethnicity, United States, 1981-1993 Figure_22 GONORRHEA -- reported cases, per 100,000 population, United States, 1993 Figure_23 HAEMOPHILUS INFLUENZAE -- reported cases, per 100,000 popula- tion, United States and territories, 1993 Figure_24 HAEMOPHILUS INFLUENZAE -- by age group, United States, 1993 Figure_25 HANSEN DISEASE (leprosy) -- by year, United States, 1955-1993 Figure_26 HEPATITIS -- by year, United States, 1965-1993 Figure_27 HEPATITIS A -- reported cases, per 100,000 population, United States and territories, 1993 Figure_28 HEPATITIS B -- reported cases, per 100,000 population, United States and territories, 1993 Figure_29 LEGIONELLOSIS -- reported cases, per 100,000 population, United States and territories, 1993 Figure_30 LEPTOSPIROSIS -- by year, United States, 1955-1993 Figure_31 LYME DISEASE -- reported cases, per 100,000 population, United States and territories, 1993 Figure_32 MALARIA -- by year, United States, 1930-1993 Figure_33 MEASLES (rubeola) -- by year, United States, 1950-1993 Figure_34 MEASLES (rubeola) -- counties reporting cases, United States, 1993 Figure_35 MENINGOCOCCAL INFECTION -- counties reporting cases, United States, 1993 Figure_36 MENINGOCOCCAL INFECTION -- by year, United States, 1935-1993 Figure_37 MUMPS -- by year, United States, 1968-1993 Figure_38 MURINE TYPHUS FEVER -- by year, United States, 1955-1993 Figure_39 PERTUSSIS (whooping cough) -- by year, United States, 1957- 1993 Figure_40 PERTUSSIS (whooping cough) -- by age group, United States, 1993 Figure_41 PERTUSSIS (whooping cough) -- reported cases, per 100,000 population, United States and territories, 1993 Figure_42 PLAGUE -- among humans, by year, United States, 1955-1993 Figure_43 POLIOMYELITIS (paralytic) -- by year, United States, 1951- 1993 Figure_44 PSITTACOSIS -- by year, United States, 1955-1993 Figure_45 RABIES -- wild and domestic animals, by year, United States and Puerto Rico, 1955-1993 Figure_46 RHEUMATIC FEVER -- reported cases, United States and territo- ries, 1993 Figure_47 ROCKY MOUNTAIN SPOTTED FEVER -- counties reporting cases, United States, 1993 Figure_48 ROCKY MOUNTAIN SPOTTED FEVER -- by year, United States, 1955-1993 Figure_49 RUBELLA (German measles) -- by year, United States, 1966-1993 Figure_50 SALMONELLOSIS (excluding typhoid fever) -- by year, United States, 1955-1993 Figure_51 SHIGELLOSIS -- by year, United States, 1955-1993 Figure_52 SYPHILIS -- by year, United States, 1941-1993 Figure_53 SYPHILIS (primary and secondary) -- reported cases, per 100,000 population, United States, 1993 Figure_54 SYPHILIS (primary and secondary) -- counties with rates above and below the Year 2000 Objective, United States, 1993 Figure_55 SYPHILIS (primary and secondary) -- by race and ethnicity, United States, 1981-1993 Figure_56 SYPHILIS (primary and secondary) -- by sex, United States, 1956-1993 Figure_57 CONGENITAL SYPHILIS -- reported cases in infants <1 year of age and rate of primary and secondary syphilis among women -- United States, 1970-1993 Figure_58 TETANUS -- by year, United States, 1955-1993 Figure_59 TETANUS -- by age group, United States, 1993 Figure_60 TOXIC SHOCK SYNDROME -- by quarter, United States, 1979-1993 Figure_61 TRICHINOSIS -- by year, United States, 1950-1993 Figure_62 TUBERCULOSIS -- rates by state, United States, 1993 Figure_63 TUBERCULOSIS -- percentage of cases, by race and ethnicity, United States, 1993 Figure_64 TUBERCULOSIS - by year, United States, 1975-1993 Figure_65 TUBERCULOSIS -- frequency distribution of cases by age, race, and ethnicity, United States, 1993 Figure_66 TUBERCULOSIS -- cases, among foreign-born persons and persons born in the United Sates, 1993 Figure_67 TULAREMIA -- by year, United States, 1955-1993 Figure_68 TULAREMIA -- counties reporting cases, United States, 1993 Figure_69 TYPHOID FEVER -- by year, United States, 1955-1993 Figure_70 VARICELLA (chickenpox) -- by month, United States, 1986-1993 PART 3: Historical Summary Tables TABLE_1 NOTIFIABLE DISEASES -- summary of reported cases, United States, 1984-1993 TABLE_2 NOTIFIABLE DISEASES -- summary of reported cases, per 100,000 population, United States, 1984-1993 TABLE_3 NOTIFIABLE DISEASES -- summary of reported cases, United States, 1974-1983 TABLE_4 NOTIFIABLE DISEASES -- summary of reported cases, United States, 1964-1973 TABLE_5 NOTIFIABLE DISEASES -- summary of reported cases, United States, 1954-1963 TABLE_6 NOTIFIABLE DISEASES -- summary of reported cases, United States, 1944-1953 TABLE_7 NOTIFIABLE DISEASES -- deaths from specified notifiable diseases, United States, 1982-1991
NOTIFIABLE DISEASES -- summary of reported cases, by month, United States, 1993
===========================================================================================================================================================================================
Disease Total Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. Unk.
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AIDS * 103,691 7,153 7,222 21,244 6,725 10,081 8,254 7,597 8,524 9,176 5,072 5,797 6,846 -
Amebiasis 2,970 144 198 202 211 218 228 284 313 272 310 245 345 -
Anthrax - - - - - - - - - - - - - -
Aseptic meningitis 12,848 519 532 502 478 698 739 1,569 1,891 1,797 1,909 1,005 1,209 -
Botulism, total 97 6 5 4 5 6 6 11 11 8 16 10 9 -
Brucellosis 120 4 6 6 7 8 6 12 8 3 11 7 42 -
Chancroid + 1,399 ..............401.......... ..............469.......... ..............229.......... ..............300.......... -
Cholera 18 5 3 1 3 2 - 2 - 1 1 - - -
Diphtheria - - - - - - - - - - - - - -
Encephalitis, primary infections 919 43 49 45 33 53 45 84 93 158 152 72 92 -
Post-infectious 170 7 20 16 14 17 17 13 15 9 10 14 18 -
Gonorrhea + 439,673 ..........103,178.......... ..........102,890.......... ..........120,498.......... ..........113,107.......... -
Granuloma inguinale + 19 ...............15.......... ................4.......... ................-.......... ................-.......... -
Haemophilus influenzae 1,419 99 104 149 97 141 100 105 68 78 126 155 197 -
Hansen disease (leprosy) 187 11 9 20 17 27 10 8 18 14 30 11 12 -
Hepatitis A 24,238 1,739 1,718 1,985 1,739 2,104 1,678 2,132 1,661 1,838 2,535 1,916 3,193 -
Hepatitis B 13,361 772 918 1,000 1,038 1,311 999 1,191 994 1,003 1,207 1,036 1,892 -
Hepatitis, non-A , non-B & 4,786 272 354 337 293 383 301 347 340 364 496 384 915 -
Hepatitis, unspecified 627 44 47 52 43 77 34 61 40 55 49 39 86 -
Legionellosis 1,280 110 81 88 77 112 86 104 107 104 155 88 168 -
Leptospirosis 51 1 8 1 1 3 2 4 7 5 3 8 8 -
Lyme disease 8,257 175 310 323 234 433 524 1,474 1,156 845 840 738 1,205 -
Lymphogranuloma venereum + 285 ...............69.......... ...............73.......... ...............71 ......... ...............72.......... -
Malaria 1,411 51 69 74 118 77 98 144 154 124 200 110 192 -
Measles (rubeola) 312 17 41 27 11 28 72 28 24 17 26 9 12 -
Meningococcal infections 2,637 155 211 311 251 273 180 204 109 121 202 160 460 -
Mumps 1,692 101 132 169 144 186 191 120 80 97 138 126 208 -
Murine typhus fever 25 - - 1 - 3 - 5 - 4 4 4 4 -
Pertussis (whooping cough) 6,586 214 236 202 239 298 329 777 876 988 1,061 469 897 -
Plague 10 - - 1 - 2 - 1 4 - 2 - - -
Poliomyelitis, paralytic @ 3 - - - - - - 1 1 - - - 1
Psittacosis 60 3 7 4 3 8 6 5 7 4 1 7 5 -
Rabies, animal 9,377 408 512 649 801 994 724 876 930 899 1,001 713 870 -
Rabies, human 3 - - - - - - - 1 - - - 2 -
Rheumatic fever, acute 112 5 16 12 4 10 28 13 7 1 3 4 9 -
Rocky Mountain spotted fever 456 9 3 3 3 16 38 90 95 69 74 24 32 -
Rubella (German measles) 192 10 8 25 15 30 20 30 19 7 5 6 17 -
Rubella, congenital syndrome 5 1 1 - 2 - - 1 - - - - - -
Salmonellosis 41,641 1,909 2,099 2,196 2,188 3,131 3,256 4,819 5,119 4,367 4,980 3,164 4,413 -
Shigellosis 32,198 1,224 1,554 1,507 1,572 2,511 2,799 3,494 3,665 3,060 4,005 2,725 4,082 -
Syphilis, total all stages + 101,259 ...........25,621.......... ...........26,942.......... ...........24,692.......... ...........24,004.......... -
Primary and secondary + 26,498 ............6,952.......... ............6,684.......... ............6,621.......... ............6,241.......... -
Congenital <1 year + 3,211 ..............678.......... ..............834.......... ..............864.......... ..............835.......... -
Tetanus 48 1 1 1 3 5 5 4 7 5 4 3 9 -
Toxic-shock syndrome 212 7 21 26 23 16 15 19 25 23 15 6 16 -
Trichinosis 16 1 3 3 - - 1 - 2 - 2 1 3 -
Tuberculosis 25,313 778 1,322 1,881 2,105 1,979 2,371 2,003 2,009 1,938 2,028 1,769 5,130 -
Tularemia 132 3 5 4 3 13 20 24 21 12 12 2 13 -
Typhoid fever 440 26 24 26 25 40 26 46 38 46 62 30 51 -
Varicella (chickenpox) 134,722 12,815 15,322 18,553 17,373 23,933 13,866 5,129 3,093 2,534 4,038 6,536 11,530
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* AIDS total updated through December 31, 1993. & The number of reported cases of non-A, non-B hepatitis is misleading because in some states, reported cases
+ Cases updated through Feburary 28, 1994. included persons positive for antibody to hepatitis C virus (anti-HCV) identified in routine screening programs but
who did not have acute hepatitis.
@ Subject to change due to retrospective case evaluations or late reports.
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NOTIFIABLE DISEASES -- reported cases, by geographic division and area, United States,
1993 (Page 1)
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Total resident Botulism
population Aseptic -------------------------- Brucel-
Area (in thousands) AIDS Amebiasis Anthrax meningitis Foodborne Infant Other losis
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United States 257,908 103,691 * 2,970 - 12,848 27 65 5 + 120
New England 13,230 5,156 112 - 425 - - - 1
Maine 1,239 149 11 - 41 - - - -
N.H. 1,125 124 5 - 55 - - - -
Vt. 576 74 7 - 45 - - - -
Mass. 6,012 2,703 87 - 177 - - - 1
R.I. 1,000 348 2 - 107 - - - -
Conn. 3,277 1,758 NN - NN - - - -
Mid. Atlantic 38,125 26,115 619 - 1,133 - 8 1 3
N.Y. (excl. NYC) 10,921 3,565 116 - 575 - - - 1
N.Y.C. 7,276 13,902 457 - 257 - 2 1 -
N.J. 7,879 5,434 16 - NN - 3 - 1
Pa. 12,048 3,214 30 - 301 - 3 - 1
E.N. Central 43,017 8,069 208 - 2,234 - 6 1 10
Ohio 11,091 1,585 18 - 720 - 5 1 1
Ind. 5,713 954 25 - 244 - 1 - -
Ill. 11,697 2,959 50 - 562 - - - 6
Mich. 9,478 1,840 48 - 643 - - - 1
Wis. 5,038 731 67 - 65 - - - 2
W.N. Central 18,054 3,181 173 - 817 - - - 3
Minn. 4,517 659 58 - 118 - - - -
Iowa 2,814 202 31 - 159 - - - 2
Mo. 5,234 1,745 54 - 275 - - - -
N. Dak. 635 11 3 - 20 - - - -
S. Dak. 715 29 1 - 22 - - - 1
Nebr. 1,607 179 4 - 21 - - - -
Kans. 2,531 356 22 - 202 - - - -
S. Atlantic 45,738 22,783 198 - 2,645 6 2 - 36
Del. 700 375 2 - 70 - 1 - -
Md. 4,965 2,528 9 - 220 - - - -
D.C. 578 1,585 - - 37 - - - -
Va. 6,491 1,625 34 - 343 - - - -
W. Va. 1,820 106 2 - 56 - - - -
N.C. 6,945 1,368 11 - 273 - - - 27
S.C. 3,643 1,476 NN - 35 - - - -
Ga. 6,917 2,789 90 - 173 5 1 - 5
Fla. 13,679 10,931 50 - 1,438 1 - - 4
E.S. Central 15,717 2,720 7 - 774 2 4 - 1
Ky. 3,789 323 1 - 335 1 1 - -
Tenn. 5,099 1,203 NN - 166 1 - - -
Ala. 4,187 733 1 - 192 - - - 1
Miss. 2,643 461 5 - 81 - 3 - -
W.S. Central 27,983 10,136 102 - 1,500 - 3 - 40
Ark. 2,424 404 4 - 79 - 1 - 3
La. 4,295 1,464 5 - 91 - - - 2
Okla. 3,231 725 7 - 1 - - - 1
Tex. 18,031 7,543 86 - 1,329 - 2 - 34
Mountain 14,776 3,913 177 - 732 3 4 - 6
Mont. 839 32 - - 1 - - - -
Idaho 1,099 77 7 - 11 - 2 - -
Wyo. 470 46 3 - 8 1 - - -
Colo. 3,566 1,324 66 - 240 1 - - 3
N. Mex. 1,616 294 21 - 115 - - - 1
Ariz. 3,936 1,238 70 - 202 - 1 - 2
Utah 1,860 264 4 - 74 1 1 - -
Nev. 1,389 638 6 - 81 - - - -
Pacific 41,269 21,460 1,374 - 2,588 16 38 3 20
Wash. 5,255 1,564 49 - NN 4 5 - -
Oreg. 3,032 778 95 - NN - 2 - -
Calif. 31,211 18,689 1,193 - 2,428 3 29 3 19
Alaska 599 70 6 - 23 9 - - -
Hawaii 1,172 359 31 - 137 - 2 - 1
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Guam 133 2 - - 7 - - - -
P.R. 3,522 3,199 - - 72 - - - -
V.I. 102 57 - - - - - - -
C.N.M.I. 43 - - - 2 - - - -
American Samoa 47 - - - - - - - -
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* Total reported through December 31, 1993. Total includes 158 cases with unknown state of residence.
+ Includes wound and unspecified botulism.
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NOTIFIABLE DISEASES -- reported cases, by geographic division and area, United States,
1993 (Page 2)
---------------------------------------------------------------------------------------------------------------------------------
Encephalitis
----------------------- Hansen
Primary Post- Gonor- Granuloma Haemophilus disease
Area Chancroid Cholera Diphtheria infections infectious rhea inguinale influenzae (leprosy)
---------------------------------------------------------------------------------------------------------------------------------
UNITED STATES 1,399 * 18 - 919 170 439,673 * 19 * 1,419 187
New England 5 2 - 26 8 8,391 - 59 7
Maine - - - 3 - 80 - 4 -
N.H. 3 - - - 2 83 - 6 -
Vt. - - - 6 - 25 - 3 -
Mass. 2 - - 12 4 3,118 - 35 7
R.I. - 1 - 5 2 427 - 2 -
Conn. - 1 - - - 4,658 - 9 -
Mid. Atlantic 618 - - 63 11 54,796 - 135 18
N.Y. (excl. NYC) 5 - - 45 6 10,887 - 43 1
N.Y.C. 613 - - 3 - 19,240 - 34 14
N.J. - - - - - 6,444 - 27 3
Pa. - - - 15 5 18,225 - 31 -
E.N. Central 115 3 - 226 22 80,638 1 221 4
Ohio 21 1 - 72 4 22,286 1 125 1
Ind. 3 - - 20 5 8,656 - 12 -
Ill. 91 2 - 62 3 28,412 - 57 2
Mich. - - - 54 10 18,014 - 18 -
Wis. - - - 18 - 3,270 - 9 1
W.N. Central 3 - - 56 17 22,415 1 180 1
Minn. 1 - - 18 - 2,543 - 21 -
Iowa - - - 7 2 1,915 1 8 -
Mo. 1 - - 11 15 13,148 - 135 -
N. Dak. - - - 5 - 54 - - -
S. Dak. - - - 7 - 270 - 2 -
Nebr. - - - 1 - 714 - 9 1
Kans. 1 - - 7 - 3,771 - 5 -
S. Atlantic 86 2 - 231 78 124,475 13 244 13
Del. 1 - - 3 - 1,586 - - -
Md. - - - 25 - 13,548 - 52 1
D.C. 1 - - - 1 6,162 - 1 -
Va. 3 1 - 44 7 12,022 - 28 -
W. Va. 1 - - 117 - 635 - 10 -
N.C. 13 - - 31 - 24,187 1 23 1
S.C. - - - - - 10,953 - 40 -
Ga. 21 - - 2 - 31,483 12 71 -
Fla. 46 1 - 9 70 23,899 - 19 11
E.S. Central 35 - - 37 7 45,173 - 56 2
Ky. 4 - - 21 6 4,627 - 16 -
Tenn. 8 - - 10 - 14,285 - 12 -
Ala. 23 - - 3 - 15,793 - 18 2
Miss. - - - 3 1 10,468 - 10 -
W.S. CENTRAL 517 2 - 80 2 55,795 1 109 33
Ark. 170 - - 3 - 7,590 - 8 -
La. 310 - - 10 - 13,323 1 4 -
Okla. - - - 8 - 4,759 - 46 2
Tex. 37 2 - 59 2 30,123 - 51 31
Mountain 8 3 - 21 5 11,549 1 125 6
Mont. - - - - 1 81 - 5 -
Idaho - - - - - 171 - 3 1
Wyo. 1 - - - - 85 - 5 -
Colo. - 1 - 14 - 3,803 - 24 -
N. Mex. - - - 4 2 1,014 - 9 -
Ariz. 3 - - - - 4,176 1 31 3
Utah 4 2 - 1 1 350 - 12 1
Nev. - - - 2 1 1,869 - 36 1
PACIFIC 12 6 - 179 20 36,441 2 290 103
Wash. - - - 1 - 3,740 - 19 9
Oreg. - - - - - 1,189 - 11 -
Calif. 12 6 - 167 20 29,970 2 240 75
Alaska - - - 10 - 678 - 6 1
Hawaii - - - 1 - 864 - 14 18
---------------------------------------------------------------------------------------------------------------------------------
Guam - - - - - 83 - - 4
P.R. 25 - - - - 527 1 3 -
V.I. 5 - - - - 84 - - -
C.N.M.I. - - - 1 - - - 24 2
American Samoa - - - - - - - - -
---------------------------------------------------------------------------------------------------------------------------------
* Cases updated through February 28, 1994.
====================================================================================================================================
NOTIFIABLE DISEASES -- reported cases, by geographic division and area, United States,
1993 (Page 3)
-------------------------------------------------------------------------------------------------------------------------------
Hepatitis Lympho-
non-A, Hepatitis Legionel- Lepto- Lyme granuloma
Area Hepatitis A Hepatitis B non-B unsp. losis spirosis disease venereum Malaria
-------------------------------------------------------------------------------------------------------------------------------
United States 24,238 13,361 4,786 * 627 1,280 51 8,257 285 + 1,411
New England 448 356 106 13 66 - 1,815 8 97
Maine 14 11 2 - 6 - 18 - 7
N.H. 18 27 8 - 2 - 15 1 4
Vt. 9 10 6 - 3 - 12 - 3
Mass. 213 214 77 13 32 - 148 7 46
R.I. 77 19 13 - 23 - 272 - 7
Conn. 117 75 - - NN - 1,350 - 30
Mid. Atlantic 1,665 1,574 398 7 253 3 4,689 184 325
N.Y. (excl. NYC) 464 457 259 1 89 2 2,758 12 123
N.Y.C. 722 353 3 - 3 - 60 172 126
N.J. 295 407 98 - 33 1 786 - 51
Pa. 184 357 38 6 128 - 1,085 - 25
E.N. Central 2,727 1,497 595 15 327 5 505 4 93
Ohio 338 192 37 - 154 2 30 4 15
Ind. 646 249 15 1 49 - 32 - 2
Ill. 1,023 344 102 7 26 3 19 - 46
Mich. 213 393 400 7 62 - 23 - 19
Wis. 507 319 41 - 36 - 401 - 11
W.N. Central 2,372 802 79 27 95 8 319 2 45
Minn. 497 96 14 4 3 - 141 - 21
Iowa 60 36 9 4 19 3 8 - 5
Mo. 1,443 585 25 19 33 3 108 1 9
N. Dak. 80 1 3 - 2 - 2 - 1
S. Dak. 18 - - - - - - 1 2
Nebr. 195 19 11 - 30 2 6 - 4
Kans. 79 65 17 - 8 - 54 - 3
S. Atlantic 1,329 2,408 723 95 219 2 639 60 338
Del. 12 18 1 - 4 1 143 - 2
Md. 159 265 42 3 56 - 180 2 48
D.C. 11 43 3 - 15 - 2 8 11
Va. 156 157 54 43 11 - 95 7 41
W. Va. 29 44 43 - 4 - 50 - 2
N.C. 94 315 80 - 27 1 86 16 145
S.C. 18 51 5 1 19 - 9 - 7
Ga. 145 670 451 1 36 - 44 22 20
Fla. 705 845 44 47 47 - 30 5 62
E.S. Central 364 1,748 1,025 4 44 2 40 3 29
Ky. 142 99 16 - 19 - 16 1 5
Tenn. 104 1,152 994 3 17 1 20 1 12
Ala. 58 107 5 1 2 1 4 1 7
Miss. 60 390 10 - 6 - - - 5
W.S. Central 3,190 1,909 645 173 51 6 78 14 65
Ark. 74 90 5 3 6 1 8 - 4
La. 105 269 178 4 10 5 3 12 7
Okla. 213 195 50 9 13 - 19 - 6
Tex. 2,798 1,355 412 157 22 - 48 2 48
Mountain 4,164 686 366 79 81 - 20 1 40
Mont. 77 28 3 - 7 - - - 2
Idaho 298 89 - 3 1 - 2 - 1
Wyo. 17 34 119 - 7 - 9 - -
Colo. 877 81 62 44 9 - - - 25
N. Mex. 400 215 107 3 6 - 2 - 5
Ariz. 1,493 96 13 14 17 - - 1 1
Utah 828 69 42 13 16 - 2 - 2
Nev. 174 74 20 2 18 - 5 - 4
Pacific 7,979 2,381 849 214 144 25 152 9 379
Wash. 926 247 219 11 12 - 9 4 41
Oreg. 532 221 55 2 1 1 8 & 1 14
Calif. 5,677 1,876 560 198 121 - 134 4 314
Alaska 775 15 12 - - - - - 3
Hawaii 69 22 3 3 10 24 1 - 7
-------------------------------------------------------------------------------------------------------------------------------
Guam 3 6 - 11 - - - - 3
P.R. 79 412 90 2 - 11 - 1 -
V.I. 1 6 - - - - - - -
C.N.M.I. - 2 - 1 - 1 - - 2
American Samoa 20 1 - - - - - - -
-------------------------------------------------------------------------------------------------------------------------------
* The number of reported cases of non-A, non-B hepatitis is misleading because in some states, reported cases included persons
positive for antibody to hepatitis C virus (anti-HCV) identified in routine screening programs but who did not have hepatitis.
+ Cases updated through February 28, 1994.
& Voluntarily reportable for this state.
====================================================================================================================================
NOTIFIABLE DISEASES -- reported cases, by geographic division and area, United States,
1993 (Page 4)
-----------------------------------------------------------------------------------------------------------
Measles Meningo- Murine Polio-
--------------------- coccal typhus myelitis,
Area Indigenous Imported infections Mumps fever Pertussis Plague paralytic
-----------------------------------------------------------------------------------------------------------
United States 237 75 * 2,637 1,692 25 6,586 10 3 +
New England 54 9 133 15 - 834 - -
Maine 1 - 15 - - 20 - -
N.H. 2 - 6 3 - 168 - -
Vt. 30 1 7 1 - 122 - -
Mass. 11 7 72 1 - 408 - -
R.I. 1 1 - 2 - 14 - -
Conn. 9 - 33 8 - 102 - -
Mid. Atlantic 22 19 310 135 2 991 - 1
N.Y. (excl. NYC) 4 7 126 46 1 373 - -
N.Y.C. 12 7 37 2 1 116 - 1
N.J. 6 5 50 17 - 85 - -
Pa. - - 97 70 - 417 - -
E.N. Central 20 11 375 259 - 1,627 - -
Ohio 6 3 108 74 - 523 - -
Ind. 1 - 51 8 - 178 - -
Ill. 5 4 104 74 - 434 - -
Mich. 5 1 65 80 - 116 - -
Wis. 3 3 47 23 - 376 - -
W.N. Central 1 2 142 67 - 626 - -
Minn. - - 23 2 - 393 - -
Iowa - - 28 11 - 38 - -
Mo. 1 - 34 46 - 144 - -
N. Dak. - - 3 6 - 5 - -
S. Dak. - - 7 - - 8 - -
Nebr. - - 11 1 - 14 - -
Kans. - 2 36 1 - 24 - -
S. Atlantic 25 8 470 463 1 673 - 1
Del. - - 15 1 - 11 - -
Md. - 4 60 82 - 133 - 1
D.C. - - 6 1 - 14 - -
Va. - 4 52 40 1 75 - -
W. Va. - - 19 23 - 8 - -
N.C. 1 - 67 231 - 199 - -
S.C. - - 31 17 - 73 - -
Ga. - - 94 20 - 56 - -
Fla. 24 - 126 48 - 104 - -
E.S. Central 1 - 154 58 1 297 - -
Ky. - - 25 - - 38 - -
Tenn. - - 45 19 1 183 - -
Ala. 1 - 53 22 - 65 - -
Miss. - - 31 17 - 11 - -
W.S. Central 8 3 264 274 13 239 1 -
Ark. - - 27 10 1 18 - -
La. 1 - 46 20 - 14 - -
Okla. - - 34 13 - 86 - -
Tex. 7 3 157 231 12 121 1 -
Mountain 4 3 211 81 - 464 10 -
Mont. - - 13 - - 11 - -
Idaho - - 21 6 - 101 - -
Wyo. - - 5 5 - 2 - -
Colo. 3 - 41 18 - 187 2 -
N. Mex. - - 8 NN - 43 6 -
Ariz. - 3 86 19 - 70 - -
Utah - - 24 6 - 45 1 -
Nev. 1 - 13 27 - 5 - -
Pacific 102 20 578 340 8 835 - 1
Wash. - - 97 14 - 91 - 1
Oreg. - 4 110 NN - 106 - -
Calif. 89 7 346 285 8 619 - -
Alaska 2 - 15 11 - 5 - -
Hawaii 11 9 10 30 - 14 - -
-----------------------------------------------------------------------------------------------------------
Guam 22 3 1 13 - - - -
P.R. 356 - 14 3 - 11 - -
V.I. - - - 5 - - - -
C.N.M.I. 92 1 - 15 - 1 - -
American Samoa - - - 5 - 2 - -
-----------------------------------------------------------------------------------------------------------
* For measles only, imported includes both out-of-state and international importations.
+ Ten suspected cases of paralytic poliomyelitis were reported in 1993. Three cases have been confirmed as of August 12, 1994,
two of which were vaccine-associated; one was classified as imported. The number of reported cases is subject to change due
to retrospective case evaluations or late reports.
====================================================================================================================================
NOTIFIABLE DISEASES -- reported cases, by geographic division and area, United States,
1993 (Page 5)
----------------------------------------------------------------------------------------------------------------
Rubella
Rabies Rheumatic ------------------
Psitta- --------------- fever, Cong. Salmonel- Shigel-
Area cosis Animal Human acute RMSF * Rubella syndrome losis losis
----------------------------------------------------------------------------------------------------------------
United States 60 9,377 3 112 456 192 5 41,641 32,198
New England 2 1,695 - 2 4 10 - 3,882 605
Maine - - - 1 - 1 - 158 8
N.H. - 148 - NN - - - 220 17
Vt. 1 45 - - - - - 421 8
Mass. 1 720 - - 4 9 - 2,041 285
R.I. - 2 - - - - - 231 42
Conn. - 780 - 1 - - - 811 245
Mid. Atlantic 16 3,585 1 - 28 59 2 7,005 2,218
N.Y. (excl. NYC) 5 2,692 1 NN 7 17 1 2,390 790
N.Y.C. - 53 - NN 1 22 - 1,601 554
N.J. 2 458 - - 10 15 - 1,215 347
Pa. 9 382 - NN 10 5 1 1,799 527
E.N. Central 8 110 - 33 18 8 - 5,810 5,111
Ohio 4 6 - 5 8 1 - 1,214 1,411
Ind. - 12 - - 4 3 - 543 811
Ill. 1 23 - 2 4 1 - 2,232 1,722
Mich. 1 18 - 21 2 2 - 815 829
Wis. 2 51 - 5 - 1 - 1,006 338
W.N. Central 3 351 - 26 34 1 - 1,924 1,509
Minn. - 45 - 7 1 - - 551 240
Iowa 2 79 - 2 7 - - 241 69
Mo. 1 35 - - 20 1 - 529 674
N. Dak. - 57 - NN - - - 60 7
S. Dak. - 49 - 14 3 - - 99 111
Nebr. - 7 - NN 2 - - 145 200
Kans. - 79 - 3 1 - - 299 208
S. Atlantic 8 2,165 - - 215 7 - 8,502 7,049
Del. - 135 - NN - - - 185 178
Md. 2 605 - NN 14 3 - 936 384
D.C. - 18 - NN - - - 102 87
Va. 1 387 - NN 14 - - 1,055 776
W. Va. - 90 - - 6 - - 109 38
N.C. 4 107 - NN 129 - - 1,121 2,305
S.C. 1 165 - NN 11 - - 738 414
Ga. - 471 - NN 37 - - 1,316 474
Fla. - 187 - NN 4 4 - 2,940 2,393
E.S. Central 1 260 - - 63 1 - 1,879 1,849
Ky. - 20 - NN 16 1 - 302 171
Tenn. 1 124 - NN 32 - - 558 938
Ala. - 116 - NN 4 - - 554 375
Miss. - - - - 11 - - 465 365
W.S. Central 2 635 1 - 77 24 - 3,297 5,748
Ark. - 42 - - 17 - - 402 201
La. - 17 - NN 2 1 - 650 482
Okla. 1 65 - NN 51 1 - 321 484
Tex. 1 511 1 NN 7 22 - 1,924 4,581
Mountain 3 178 - 28 16 12 - 2,018 1,921
Mont. - 24 - NN 2 - - 106 56
Idaho 1 8 - NN - 2 - 173 46
Wyo. - 25 - 1 10 - - 59 22
Colo. - 29 - 5 4 3 - 550 611
N. Mex. 1 9 - 3 - - - 326 411
Ariz. - 60 - NN - 2 - 519 693
Utah 1 8 - 19 - 4 - 154 42
Nev. - 15 - NN - 1 - 131 40
Pacific 17 398 1 23 1 70 3 7,324 6,188
Wash. 4 - - - - - - 832 797
Oreg. 4 7 - NN 1 - - 349 169
Calif. 9 363 1 20 - 41 3 5,739 5,093
Alaska - 28 - 3 - 1 - 59 30
Hawaii - - - NN - 28 - 345 99
----------------------------------------------------------------------------------------------------------------
Guam - - - 2 - - - 119 35
P.R. - 43 - - - - - 734 46
V.I. - - - - - - - 5 1
C.N.M.I. - - - 10 - - - 54 73
American Samoa - - - 1 - - - 55 17
----------------------------------------------------------------------------------------------------------------
* Rocky Mountain spotted fever.
====================================================================================================================================
NOTIFIABLE DISEASES -- reported cases, by geographic division and area, United States,
1993 (Page 6)
--------------------------------------------------------------------------------------------------------------------------------
Syphilis
------------------------------- Toxic- Varicella
Primary & Cong. All shock Trich- Tuber- Typhoid (chicken-
Area secondary (<1 yr.) stages Tetanus syndrome inosis culosis Tularemia fever pox)
--------------------------------------------------------------------------------------------------------------------------------
United States 26,498 * 3,211 * 101,259 * 48 212 16 25,313 132 440 134,722
New England 330 17 1,713 2 13 - 649 - 31 12,655
Maine 7 - 19 - 3 - 27 - - 1,733
N.H. 26 - 50 - 3 - 26 - 2 1,635
Vt. 1 - 1 - 1 - 7 - - NN
Mass. 122 6 935 2 5 - 370 - 23 6,619
R.I. 16 1 146 - 1 - 64 - - 2,668
Conn. 158 10 562 - - - 155 - 6 NN
Mid. Atlantic 2,415 1,070 19,306 2 33 4 5,611 2 139 4,773
N.Y. (excl. NYC) 258 94 1,980 - 17 4 718 2 20 NA
N.Y.C. 1,132 654 10,513 - 1 - 3,235 - 95 4,773
N.J. 328 161 2,556 - - - 912 - 18 NN
Pa. 697 161 4,257 2 15 - 746 - 6 NN
E.N. Central 4,070 527 11,789 7 48 2 2,385 5 40 64,380
Ohio 1,180 70 2,889 2 12 - 315 - 7 5,472
Ind. 362 1 1,019 1 1 - 248 1 2 NN
Ill. 1,489 368 4,881 1 11 2 1,242 3 23 26,447
Mich. 543 84 1,952 3 24 - 480 1 7 32,461
Wis. 496 4 1,048 - - - 100 - 1 NA
W.N. Central 1,631 111 3,271 10 15 - 582 39 2 16,814
Minn. 66 9 261 6 3 - 141 - - NN
Iowa 64 1 175 1 7 - 59 - - 5,057
Mo. 1,354 97 2,500 1 2 - 257 17 2 9,609
N. Dak. 1 - 4 - - - 7 - - 37
S. Dak. 2 - 3 - - - 16 17 - 420
Nebr. 14 1 35 - - - 22 2 - 4
Kans. 130 3 293 2 3 - 80 3 - 1,687
S. Atlantic 6,513 586 24,237 8 24 6 4,626 4 63 8,332
Del. 94 3 274 - - - 66 - 1 3
Md. 359 30 1,865 2 1 3 406 - 8 NN
D.C. 291 74 1,652 - - - 161 - - 4
Va. 660 23 1,970 - 7 1 458 - 7 2,917
W. Va. 8 6 195 - - - 75 - - 5,288
N.C. 1,937 54 4,448 - 4 - 594 2 3 NN
S.C. 921 82 2,339 1 - - 401 - - 120
Ga. 1,052 79 4,077 - 2 - 810 - 3 NN
Fla. 1,191 235 7,417 5 10 2 1,655 2 41 NN
E.S. Central 4,117 158 10,494 3 11 - 1,727 4 7 3,981
Ky. 331 9 651 - 3 - 405 1 2 1,429
Tenn. 1,156 52 3,241 2 4 - 556 2 2 2,552
Ala. 869 27 2,333 1 2 - 487 1 3 NN
Miss. 1,761 70 4,269 - 2 - 279 - - NN
W.S. Central 5,969 409 19,079 9 2 - 3,181 58 19 14,292
Ark. 559 8 1,600 1 - - 209 36 2 NN
La. 2,598 144 6,854 - - - 367 -- 1 NN
Okla. 282 11 721 1 2 - 209 17 1 -
Tex. 2,530 246 9,904 7 - - 2,396 5 15 14,291
Mountain 256 27 1,251 1 16 1 592 12 11 7,192
Mont. 1 - 4 - - - 22 5 - 84
Idaho 2 - 15 - 2 - 12 - - NN
Wyo. 4 - 9 - - 1 7 3 - NN
Colo. 90 8 287 1 2 - 102 1 5 NN
N. Mex. 34 - 172 - 1 - 74 - 2 NN
Ariz. 95 16 557 - 2 - 231 - 3 6,811
Utah 10 - 68 - 7 - 46 2 1 297
Nev. 20 3 139 - 2 - 98 1 - NN
Pacific 1,197 306 10,119 6 50 3 5,960 8 128 2,303
Wash. 67 4 360 1 7 - 286 2 8 NN
Oreg. 39 4 179 - - - 154 3 4 NN
Calif. 1,073 298 9,488 5 42 1 5,212 3 113 NN
Alaska 11 - 51 - - - 57 - - NN
Hawaii 7 - 41 - 1 2 251 - 3 2,303
--------------------------------------------------------------------------------------------------------------------------------
Guam - - 5 - - - NA - 4 553
P.R. 470 18 2,482 2 - - 253 - - |
