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Publication of CDC Surveillance Summaries

Since 1983, CDC has published the CDC Surveillance Summaries under separate cover as part of the MMWR series. Each report published in the CDC Surveillance Summaries focuses on public health surveillance; surveillance findings are reported for a broad range of risk factors and health conditions.

Summaries for each of the reports published in the most recent (December 11, 1992) issue of the CDC Surveillance Summaries (1) are provided below. All subscribers to MMWR receive the CDC Surveillance Summaries, as well as the MMWR Recommendations and Reports, as part of their subscriptions. TETANUS SURVEILLANCE -- UNITED STATES, 1989-1990

During the period 1989-1990, 117 cases of tetanus were reported from 34 states, for an average annual incidence of 0.02/100,000 population. Fifty-eight percent of patients were greater than or equal to 60 years of age, while seven (6%) were less than 20 years of age, including one case of neonatal tetanus. Among adults, the risk of tetanus in those greater than 80 years of age was more than 10 times the risk in persons ages 20-29 years. The case-fatality rate increased with age, from 17% in persons 40- 49 years of age to 50% in those greater than or equal to 80 years of age. Only 11% of patients reported receipt of a primary series of tetanus toxoid before disease onset, while 31% lacked a history of tetanus vaccination. Tetanus occurred following an acute injury in 78% of patients. Of patients who sought medical care, only 58% received tetanus toxoid as part of wound prophylaxis. Tetanus remains a severe disease that primarily affects unvaccinated or inadequately vaccinated older adults. Increased efforts are needed to reduce the burden of tetanus among the elderly. Health-care providers should take every opportunity to review the vaccination status of their patients and provide tetanus vaccine when indicated. Authors: Rebecca Prevots, Ph.D., M.P.H., Roland W. Sutter, M.D., M.P.H. & T.M., Peter M. Strebel, M.D., M.P.H., Stephen L. Cochi, M.D., Stephen Hadler, M.D., Division of Immunization, National Center for Prevention Services, CDC. PERTUSSIS SURVEILLANCE -- UNITED STATES, 1989-1991

The licensure of whole-cell pertussis vaccine combined with diphtheria and tetanus toxoids as DTP in the 1940s -- and its widespread use in infants and children -- led to a dramatic decline in the incidence of reported pertussis. In the prevaccine era, the average annual incidence and mortality for reported pertussis were 150 cases and six deaths per 100,000 population, respectively. From 1989 through 1991, pertussis cases were reported by state and local health departments to CDC through two distinct national surveillance systems: the National Notifiable Diseases Surveillance System (NNDSS) and the Supplementary Pertussis Surveillance System (SPSS).

During the period 1989-1991, 11,446 pertussis cases were reported to the NNDSS (4157 in 1989; 4570 in 1990; and 2719 in 1991), for an unadjusted annual incidence of 1.7, 1.8, and 1.1 cases per 100,000 population in 1989, 1990, and 1991, respectively. For the period 1989-1991, case reports were received through the SPSS on 9480 (83%) of the 11,446 patients reported to the NNDSS. Age-specific incidence and age-specific hospitalization rates were highest among children less than 1 year of age and declined with increasing age.

Long-term trends suggest an underlying upward trend in the reported incidence of pertussis in the United States since 1976. The peak in reported pertussis cases in 1990 represents the highest annual incidence of pertussis since 1970. However, the incidence of pertussis declined 41% from 1990 through 1991.

Whether the long-term upward trend in reported pertussis is a true increase in incidence is unclear; the observed increase may be a function of improved surveillance. To better estimate the true incidence of pertussis, the surveillance system needs to use a sensitive and specific case definition, and the information collected needs to be as complete and accurate as possible. Because available diagnostic tests vary in sensitivity and specificity, the following steps should be taken to improve surveillance for pertussis in the United States: a) increase physician knowledge of the clinical presentation of pertussis; b) encourage more widespread use of culture, the current "gold standard" of pertussis laboratory diagnosis; and c) encourage the use of uniform clinical case definitions as recommended by the Council of State and Territorial Epidemiologists and CDC. Authors: Susan F. Davis, M.D., Peter M. Strebel, M.D., M.P.H., Stephen L. Cochi, M.D., Elizabeth R. Zell, M.Stat., Stephen C. Hadler, M.D., Division of Immunization, National Center for Prevention Services, CDC.


  1. CDC. CDC surveillance summaries (December 11). MMWR 1992;41(no. SS-8).

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