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Summary of Notifiable Diseases --- United States, 2002

Prepared by
Samuel L. Groseclose, D.V.M.
Wayne S. Brathwaite
Patsy A. Hall, Annual Summary Coordinator
Deborah A. Adams
Felicia J. Connor
Pearl Sharp
Willie J. Anderson
Robert F. Fagan
J. Javier Aponte
Gerald F. Jones
David A. Nitschke
Carol A. Worsham
Nelson Adekoya, Dr.P.H.
Man-Huei Chang, M.P.H.
Timothy Doyle, M.P.H.
Rosaline Dhara, M.A., M.P.H.
Ruth Ann Jajosky, D.M.D.

Division of Public Health Surveillance and Informatics
Epidemiology Program Office

in collaboration with

John D. Hatmaker
Affiliated Computer Services

Preface

The Summary of Notifiable Diseases, United States, 2002 contains the official statistics, in tabular and graphic form, for the reported occurrence of nationally notifiable diseases in the United States for 2002. The data are final totals for 2002 reported as of June 30, 2003, unless otherwise noted. These statistics 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 located on the Internet at http://www.cdc.gov/mmwr/summary.html. This site also includes publications from past years.

The Highlights section presents noteworthy epidemiologic or prevention information for 2002 for selected diseases and additional information to aid in the interpretation of surveillance and disease-trend data.

Part 1 contains tables showing incidence data for each of the nationally notifiable diseases during 2002.* The tables provide the number of cases reported to CDC for 2002, as well as the distribution of cases by month, geographic location, and by patient's age, sex, race, and Hispanic 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 many of the notifiable diseases described in tabular form in Part 1. Part 3 contains tables that list the number of cases of notifiable diseases reported to CDC since 1970. This section also includes a table enumerating deaths associated with specified notifiable diseases reported to the National Center for Health Statistics (NCHS), CDC, during 1996--2000. The Selected Reading section presents general and disease-specific references for notifiable infectious diseases. These references provide additional information on surveillance and epidemiologic issues, diagnostic issues, or disease control activities.

_______________________

* Because no cases of paralytic poliomyelitis and western equine encephalitis were reported in the United States during 2002, these diseases do not appear in the tables in Part 1.

In 1999, mortality data began to be coded according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. To bridge the mortality data for the period 1996--1998 (deaths coded using the International Classification of Diseases, Ninth Revision), and 1999--2000, we use comparability ratios provided by the National Center for Health Statistics.

Background

The infectious diseases designated as notifiable at the national level during 2002 are listed on page 3. A notifiable disease is one for which regular, frequent, and timely information regarding individual cases is considered necessary for the prevention and control of the disease. This section briefly summarizes the history of the reporting of nationally notifiable diseases in the United States.

In 1878, Congress authorized the U.S. Marine Hospital Service (the forerunner of the Public Health Service [PHS]) to collect morbidity reports regarding cholera, smallpox, plague, and yellow fever from U.S. overseas consuls. The intention was to use this information to institute quarantine measures to prevent the introduction and spread of these diseases into the United States. In 1879, a specific Congressional appropriation was made for the collection and publication of reports of these notifiable diseases. Congress expanded the authority for weekly reporting and publication of these reports in 1893 to include data from states and municipal authorities. To increase the 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 immediate telegraphic reporting of five infectious diseases and the monthly reporting, by letter, of 10 additional diseases. The first annual summary of The Notifiable Diseases in 1912 included reports of 10 diseases from 19 states, the District of Columbia, and Hawaii. By 1928, all states, the District of Columbia, Hawaii, and Puerto Rico were participating in national reporting of 29 specified diseases. At their annual meeting in 1950, state and territorial health officers authorized the Council of State and Territorial Epidemiologists (CSTE) to determine which diseases should be reported to PHS. In 1961, CDC assumed responsibility for the collection and publication of data concerning nationally notifiable diseases.

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

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 CDC 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 conditions, is available on the Internet at http://www.cdc.gov/epo/dphsi/phs.htm. Policies for reporting notifiable disease cases can vary by disease or reporting jurisdiction.

Final data for some diseases are derived from the surveillance records of the CDC programs listed below. Requests for further information regarding these data should be directed to the appropriate program.

National Center for Health Statistics (NCHS)

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

National Center for Infectious Diseases (NCID)

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

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

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

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

Division of HIV/AIDS Prevention --- Surveillance and Epidemiology (acquired immunodeficiency syndrome [AIDS], human immunodeficiency virus [HIV] infection).

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

Division of Tuberculosis 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 Northern Mariana Islands.

Population estimates for the states are from the U.S. Census Bureau, Population Division, Table ST-EST2002-01 - State Population Estimates: April 1, 2000, available at http://eire.census.gov/popest/data/states/tables/NST-EST2003-01.php. Numbers for territories are estimates from the U.S. Bureau of the Census, International Data Base, available at http://www.census.gov/ipc/www/idbprint.html. The choice of population denominators for incidence rates reported in the MMWR is based on 1) the 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 compute incidence rates reported by various CDC programs. Rates in the Summary are presented as incidence rates per 100,000 population, based on data for the U.S. total resident population. However, population data from states in which diseases were not notifiable or disease data were not available were excluded from rate calculations.

Interpreting Data

Incidence data in the Summary are presented by the date of report to CDC as determined by the MMWR week and year assigned by the state or territorial health department. In addition, data in the Summary are reported by the state in which the patient resides at the time of diagnosis. For many of the nationally notifiable infectious diseases, surveillance data are independently reported to EPO and other CDC programs. Thus, surveillance data reported by other CDC programs may vary from data reported in the Summary because of differences in 1) the date used to aggregate data (e.g., date of report, date of disease occurrence), 2) the timing of reports, 3) the source of the data, 4) surveillance case definitions, and 5) policies regarding case jurisdiction (i.e., which state should report the case to CDC).

The data reported in the Summary are useful for analyzing disease trends and determining relative disease burdens. However, these data must be interpreted in light of reporting practices. Disease reporting is likely incomplete, and its completeness may vary depending on the disease. The degree of completeness of data reporting may be influenced by the diagnostic facilities available; the control measures in effect; public awareness of a specific disease; and interests, resources, and priorities of state and local officials responsible for disease control and public health surveillance. Finally, factors such as changes in methods for public health surveillance, introduction of new diagnostic tests, or discovery of new disease entities can cause changes in disease reporting that are independent of the true incidence of disease.

Public health surveillance data are published for selected racial and ethnic population groups because these variables can be risk markers for certain notifiable diseases. Race and ethnicity data can also be used to highlight populations for focused prevention efforts. However, caution must be used when drawing conclusions from reported race and ethnicity data. Different racial/ethnic population groups may have differential patterns of access to health care, potentially resulting in data that are not representative of true racial/ethnic group--specific disease incidence. Surveillance data reported to NNDSS are either in individual case-specific form or summary form (aggregated data for a group of cases). Summary data often lack demographic information (e.g., race); therefore, the demographic-specific incidence rates presented in the Summary may be underestimated.

In addition, not all race and ethnicity data are collected uniformly for all diseases. For example, some disease programs collect race and ethnicity as one variable; other programs collect these data as two variables. Additionally, although the recommended standard for classifying a person's race or ethnicity is based on self-reporting, this procedure might not always be followed.

Highlights for 2002

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 introduction 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. Since 1998, 30 areas (29 states and the U.S. Virgin Islands) have had integrated name-based HIV surveillance into their AIDS surveillance systems while other jurisdictions have used other methods for reporting cases of HIV infection.

During1998--1999, declines in AIDS began to level, and essentially no change occurred during 1999--2002. This trend follows a period of sharp declines in incident cases after 1996, when highly effective antiretroviral therapies were introduced. The estimated annual number of deaths among persons with AIDS, however, declined 14% from 1998 to 2002. At the end of 2002, an estimated 384,906 persons were known to be living with AIDS.

Anthrax

In November 2002, the Advisory Committee on Immunization Practices (ACIP) recommended preexposure use of anthrax vaccine for groups at risk for repeated exposures, including 1) laboratory personnel handling environmental specimens and performing confirmatory testing for Bacillus anthracis in U.S. Laboratory Response Network for Bioterrorism level B laboratories or above, 2) workers making repeated entries into known B. anthracis spore-contaminated areas after a terrorist attack, and 3) workers in other settings in which repeated exposure to aerosolized B. anthracis spores might occur. The ACIP recommendations are available at http://www.cdc.gov/mmwr/PDF/wk/mm5145.pdf.

Brucellosis

By 2002, the control program for brucellosis among cattle in the United States had nearly eliminated Brucella abortus infection from U.S. herds. Therefore, at present, the risk of contracting brucellosis either from occupational exposure to livestock in the United States or from domestically produced food items is minimal. However, a risk remains for infection with both B. abortus and B. melitensis from consumption of unpasteurized goat and cow milk products, in particular those produced outside the United States. Most cases in the United States are now seen in international travelers or recent immigrants. Laboratory personnel working with Brucella species and hunters exposed to infected wildlife also have an elevated risk for infection. B. melitensis and B. suis are considered Category B bioterrorism threat agents.

Chancroid

During 2002, a total of 67 cases of chancroid were reported (rate: 0.02/100,000), an increase from 38 cases in 2001 but an overall decline of 99% of the cases reported since 1987 (1). Of the 2002 cases, 43 (64%) were reported from one state. Overall, only 10 states and one outlying area reported >1 case of chancroid in 2002. The causative agent of chancroid is difficult to culture and therefore the disease could be substantially underdiagnosed. Several studies that used DNA amplification tests (which are not commercially available) have identified this infection in cities where it was previously undetected (2).

  1. CDC. Sexually transmitted disease surveillance 2002. Atlanta: US Department of Health and Human Services, CDC, 2003.
  2. Mertz KJ, Trees D, Levine WC, et al. Etiology of genital ulcers and prevalence of human immunodeficiency virus coinfection in 10 US cities. The Genital Ulcer Disease Surveillance Group. J Infect Dis 1998;178:175--8.

Chlamydia trachomatis, Genital Infection

During 2002, a total of 834,555 cases of genital chlamydial infection were reported (rate: 296.55/100,000). This rate was the highest since voluntary case reporting began in the mid-1980s and the highest since genital chlamydial infection became a nationally notifiable disease in 1995 (1). This increase could be caused in part by the continued expansion of chlamydia screening programs and increased use of more sensitive diagnostic tests for this condition. From 1998 to 2002, the reported chlamydial infection rate in men increased by 55% compared with a 20% increase in women. However, the rate among women was over three times the rate reported among men, reflecting the larger number of women screened for this disease.

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

Cholera

During 1995--2002, a total of 66 laboratory-confirmed cases of cholera, all caused by Vibrio cholerae O1, were reported to CDC. Forty-two (64%) infections were acquired outside the United States, whereas six (9%) were acquired through consumption of contaminated seafood harvested in Gulf Coast waters. One patient died (1). Only two laboratory-confirmed cases of cholera were reported to CDC in 2002. Both were caused by V. cholerae O1 and were acquired outside the United States. Both isolates were resistant to furazolidone. Production and sale of the only licensed cholera vaccine in the United States ceased in 2001.

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

Coccidioidomycosis

In recent years, Arizona and California have experienced significant increases in the incidence rates 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 with endemic disease.

Diphtheria

During 2002, one probable, nonfatal case of diphtheria was reported to CDC. The patient was a female resident of California, aged 38 years. Symptoms and signs included a sore throat and difficulty in swallowing for 7 days, an extensive pharyngeal membrane, and low-grade fever 99°--101°F. A throat swab specimen for culture was negative for Corynebacterium diphtheriae, but it was obtained a day after an antibiotic regimen was started. The patient had recent, prolonged, frequent face-to-face exposure to visitors from eastern Europe and Australia. She had received the last booster dose of vaccine in 1987.

Encephalitis, Arboviral

In 2002, an unprecedented epidemic and epizootic of West Nile virus (WNV) occurred in the United States (1). Epidemic and epizootic activity was most intense in the central United States. A total of 2,146 human WNV encephalitis and/or meningitis (i.e., meningoencephalitis) cases were reported through the ArboNet Arboviral Surveillance System from 36 states, representing the largest arboviral meningoencephalitis epidemic documented in the Western Hemisphere. In addition, WNV-infected birds, mosquitoes, or horses were detected in 44 states and the District of Columbia. Of these 45 jurisdictions, 16 reported their first ever WNV activity. One human case reported in a Los Angeles County, California, resident with no known travel history and a report of a WNV-infected horse in Island County, Washington, indicated the complete transcontinental movement of WNV within 3 years of its first appearance in the Eastern United States. An unprecedented equine WNV epizootic occurred in the midwestern states and resulted in 14,539 reported cases. Three mosquito species, Culex pipiens, Cx. quinquefasciatus, and Cx. restuans, accounted for the majority of the 6,604 reported WNV-positive mosquito pools. WNV was also detected for the first time in Cx. tarsalis, an important vector of St. Louis encephalitis virus, raising concerns about its potential to transmit WNV to humans in western states where it is common (2).

In 2002, 164 cases of encephalitis caused by California (CAL) serogroup viruses were reported from 16 states, representing the most reported to CDC in any year since 1964. WNV human case surveillance may have resulted in improved surveillance for CAL serogroup virus meningoencephalitis cases. During 1964--2002, a median of 67 cases (average: 80; range: 29--167) were reported per year in the United States.

  1. CDC. Provisional surveillance summary of the West Nile virus epidemic---United States, January--November 2002. MMWR 2002;51:1129--33.
  2. Turrell MJ, O'Guinn ML, Dohm JD, et al. Vector competence of Culex tarsalis from Orange County, California, for West Nile virus. Vector-Borne Zoonotic Dis 2002;2:193--6.

Gonorrhea

During 2002, a total of 351,852 cases of gonorrhea were reported (rate: 125.03/100,000 population). This rate is slightly lower than rates in 2001 (128.53/100,000), 2000 (129.04/100,000), 1999 (132.32/100,000), and 1998 (131.89/100,000) (1). In 2002, the reported gonorrhea rate among women (125.3/100,000) was similar to that among men (124.2/100,000). Rates among non-Hispanic black women aged 15--19 years (3,307.7/100,000) and non-Hispanic black men aged 20--24 years (3,256.2/100,000) remain higher than in any other racial/ethnic or age group. Increases have been observed in some areas among men who have sex with men (2). Decreased susceptibility to the fluoroquinolone antibiotics has also been reported from some regions (3). In 2002, the prevalence of fluoroquinolone-resistant Neisseria gonorrhoeae infections continued to increase in California. Fluoroquinolones are no longer advised for treatment of gonorrhea in Hawaii or California or for infections that might have been acquired in those states (4).

  1. CDC. Sexually transmitted disease surveillance 2002. Atlanta: US Department of Health and Human Services, CDC, 2003.
  2. Fox KK, del Rio C, Holmes KK, et al. Gonorrhea in the HIV era: a reversal in trends among men who have sex with men. Am J Public Health 2001;91:1--5.
  3. CDC. Increases in fluoroquinolone-resistant Neisseria gonorrhoeae--- Hawaii and California, 2001. MMWR 2002;51:1041--4.
  4. CDC. Sexually transmitted diseases treatment guidelines 2002. MMWR 2002;51(No. RR-6).

Haemophilus influenzae, Invasive Disease

In 2002, 331 cases of invasive Haemophilus influenzae disease in children aged <5 years were reported; 34 (10%) were reported as H. influenzae type b (Hib), 144 (44%) were reported as other serotypes or nontypeable isolates, and 153 (46%) were reported with serotype information unknown or missing. The continued remarkably low number of invasive Hib infections in children (down from an estimated 20,000 cases annually in the prevaccine era) is a result of the successful delivery of highly effective conjugate Hib vaccines to children, beginning at age 2 months (1,2). Because discrepancies in serotyping results have occurred between laboratories, CDC requests that state health departments 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 children---United 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 Microbiol 2003;41:393--6.
  4. CDC. Serotyping discrepancies in Haemophilus influenzae type b disease---United States, 1998--1999. MMWR 2002;51:706--7.

Hantavirus Pulmonary Syndrome

The geographic center of hantavirus pulmonary syndrome (HPS) cases during the 2002 season was more northerly than in previous years. This reflects weather patterns that delivered greater rainfall or milder antecedent winter conditions resulting in more abundant food supplies and an increase in the host rodent species in those northerly areas. CDC guidance for prevention of HPS has been updated and made available in Spanish and English (1).

  1. CDC. All about hantaviruses. Atlanta: US Department of Health and Human Services, CDC, 2003. Available at http://www.cdc.gov/ncidod/diseases/hanta/hps/index.htm.

Hepatitis A

Hepatitis A vaccine is recommended for persons at increased risk of acquiring hepatitis A (e.g., international travelers, men who have sex with men (MSM), and injection- 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 childhood vaccination in high-risk areas was recommended, the overall hepatitis A rate has declined steadily, and in 2002, it was the lowest yet recorded (3.1/100,000). The decline in rates has been greater among children and in states where routine childhood vaccination is recommended, suggesting an impact of childhood vaccination. The dramatic declines in disease rates in these groups and areas that have historically accounted for the majority of reported cases have resulted in a shift in the epidemiology of this disease in the United States. Hepatitis A rates, historically much higher in the western states, are now similar in all regions of the United States, and an increasing proportion of cases are among adults, particularly those in high-risk groups such as MSM. Continued monitoring of disease rates is needed to determine if the current low rates are sustained and attributable to vaccination and to identify groups and areas where additional vaccination efforts are needed.

  1. CDC. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices. MMWR 1996;45(No. RR-15).
  2. CDC. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices. MMWR 1999;48(No. RR-12).

Hepatitis B

During 2002, a total of 7,996 acute hepatitis B cases were reported, representing a >65% decrease since 1990 (21,102 cases). The steady decline in hepatitis B rates coincides with the implementation of a national strategy to achieve the elimination of hepatitis B virus (HBV) infection (1). The primary elements of this strategy are 1) screening of all pregnant women for HBV infection with provision of postexposure prophylaxis to infants born to infected women, 2) routine vaccination of all infants and children aged <18 years, and 3) vaccination of others at increased risk of acquiring hepatitis B (e.g., health-care workers, MSM, injection drug users, and household and sex contacts of persons with chronic HBV infection).

The rate among children aged <18 years, the age group covered by the recommendation for routine childhood immunization, has declined by approximately 90% since 1990. In comparison, high rates of disease continue among adults, particularly males aged 25--39 years. This and the high proportion of cases occurring among persons in identified risk groups (i.e., injection-drug users, MSM and persons with multiple sex partners) indicate a need to strengthen efforts to reach these populations with vaccine.

  1. CDC. Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination: recommendations of the Immunization Practices Advisory Committee. MMWR 1991;40(No. RR-13).

Hepatitis C; Non-A, Non-B

Monitoring acute hepatitis C rates nationally has been challenging because 1) no serologic marker for acute infection exists, and 2) many health departments do not have the resources to determine if a positive laboratory report for hepatitis C virus (HCV) infection represents acute infection. Consequently, the most reliable estimates of acute hepatitis C incidence have historically come from sentinel surveillance. Incidence of hepatitis C has declined by >80% since the late 1980s, largely the result of a decrease in 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 the most common risk factor for infection.

In recent years, analysis of cases of acute, symptomatic hepatitis C reported through NNDSS has yielded similar results as those from sentinel surveillance, suggesting that the quality of national surveillance data for acute hepatitis C has improved. Direct reporting of anti-HCV--positive test results by laboratories has increased the completeness of reporting of HCV-infected persons to health departments. Reporting other available laboratory or clinical data would improve surveillance for hepatitis C by providing information to identify patients with acute disease. Improving the accuracy of hepatitis C surveillance data continues to be a priority because monitoring hepatitis C incidence trends provides information needed to evaluate the effectiveness of prevention efforts and identify opportunities for prevention.

HIV Infection, Adult

By December 2002, 49 states and the District of Columbia had an HIV surveillance system in place. Since 1998, 30 areas (29 states and the U.S. Virgin Islands) have had laws or regulations requiring confidential reporting by name for adults/adolescents or children with confirmed HIV infection, in addition to reporting of persons with AIDS (1). CDC also initiated a pilot system in 2002 to monitor HIV incidence. Beginning in 2003, CDC expanded its HIV/AIDS surveillance activities through the addition of a national HIV behavioral surveillance system. CDC will assess the implementation and effectiveness of prevention activities through several monitoring systems, including the use of new performance indicators for state and local health departments and community-based organizations.

At the end of 2002, 142,713 adults and adolescents in the 30 areas were known to be living with HIV infection (not AIDS). The prevalence rate of HIV infection (not AIDS) in this group was 125.7/100,000 population (1).

  1. CDC. HIV/AIDS Surveillance Report, 2002. Atlanta: US Department of Health and Human Services, CDC. Vol. 14. Available at http://www.cdc.gov/hiv/stats/hasrlink.htm.

HIV Infection, Pediatric

Effective January 1, 2000, the surveillance case definition for HIV infection was revised to reflect advances in laboratory HIV virology tests. The definition incorporates the reporting criteria for HIV infection and AIDS into a single case definition for adults and children (1).

In the 30 areas (29 states and the U.S. Virgin Islands) that have had laws or regulations since 1998 requiring confidential reporting by name for children with confirmed HIV infection, 1,416 children (aged <13 years) were known to be living with HIV infection (not AIDS) at the end of 2002. The prevalence rate of HIV infection (not AIDS) in this group was 5.6/100,000 population (2).

  1. CDC. Appendix: Revised surveillance case definition for HIV infection. MMWR 1999;48(No. RR-13):29--31.
  2. CDC. HIV/AIDS Surveillance Report, 2002. Atlanta: US Department of Health and Human Services, CDC, Vol. 14. Available at http://www.cdc.gov/hiv/stats/hasrlink.htm.

Lyme Disease

A total of 23,763 cases of Lyme disease were reported in 2002, a 39% increase over 2001 and the highest number reported since national surveillance began in 1982. As in previous years, the majority of cases were reported from the northeastern and north-central United States. Factors potentially contributing to the overall increase in Lyme disease include better reporting, increased development in wooded areas, and growing deer populations. In addition, ecological studies suggest that infected ticks are spreading to new areas. The only Lyme disease vaccine licensed in the United States (LYMErix®) was removed from the market in February 2002. New products aimed at reducing ticks on mice and deer are under development.

Malaria

Almost all malaria cases are imported, with more than twice as many cases occurring among U.S. residents traveling to malarious areas as occur among foreign residents immigrating to or visiting the United States (1). Over 75% of cases among U.S. residents occur in persons who were either not taking malaria chemoprophylaxis or did not take recommended drugs (1).The annual number of cases has increased during the past 15 years, likely because of increases in both international travel (2) and immigration (3), as well as the spread and intensification of antimalarial drug resistance globally (4).

  1. Filler S, Causer LM, Newman RD, et al. Malaria surveillance---United States, 2001. In: CDC Surveillance Summaries, July 18, 2003. MMWR 2003;52(No SS-5):1--14.
  2. Office of Travel and Tourism Industries. International travelers to and from the U.S.---international visitors (inbound) and U.S. residents (outbound), 1992-2002r. Washington, DC: US Department of Commerce, ITA, Office of Travel and Tourism Industries. Available at http://www.tinet.ita.doc.gov/view/f-2001-05-001/index.html.
  3. US Census Bureau. Current population reports. Series P23-206. Profile of the foreign-born population in the United States, 2000. Washington, DC: US Government Printing Office, 2001. Available at http://www.census.gov/prod/2002pubs/p23-206.pdf.
  4. Barat LM, Bloland PB. Drug resistance among malaria and other parasites. Infect Dis Clin North Am 1997;11:969--87.

Measles

A record low of 44 confirmed measles cases was reported in 2002, with cases occurring in 17 states. Eighteen cases were internationally imported, and exposure to these cases resulted in 15 additional cases. Three other cases had only virologic evidence of importation (i.e., genotypic analysis of measles viruses indicated an imported source). The remaining eight cases were classified as unknown source cases because no link to importation was detected. The majority of cases were either in infants aged <12 months (18 cases) or persons aged >20 years (19 cases); only three cases occurred among children aged <5 years, and four cases among those aged 5--19 years. Three outbreaks, ranging in size from 3 to 13 cases, accounted for 43% of cases (n=19). In two of these outbreaks, the source cases were imported.

Pertussis

During 2002, 9,771 cases of pertussis were reported (rate: 3.4/100,000), the highest number of reported cases since 1964. Of these cases, 21% occurred among infants aged <6 months (108.8/100,000), 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; 3% occurred among children aged 6--11 months (15.4/100,000); 14% among children aged 1--4 years (8.9/100,000); 10% among children aged 5--9 years (4.8/100,000); 29% among persons aged 10--19 years (7.0/100,000); and 23% among persons aged >20 years (1.2/100,000).

Since 1995, the coverage rate with >3 doses of pertussis vaccine has been >94% among U.S. children aged 19--35 months (1). Since 1980, the number of reported cases of pertussis in infants aged <6 months and in adolescents and adults has increased in some states (2). The reasons for this increase are unknown but could include increased awareness of pertussis among health-care providers, better reporting of cases to health departments (3), and possibly an increase in circulating Bordetella pertussis. The true number of pertussis cases in adolescents and adults has likely been underreported because the pertussis cough is not pathognomonic for pertussis, persons may not seek medical care for a cough illness, and (if medical care is sought) diagnostic tests are not sufficiently sensitive. Adolescents and adults can become susceptible to disease when vaccine-induced immunity wanes, approximately 5--10 years after pertussis vaccination. The incidence of reported pertussis among children aged 7 months to 9 years has been relatively stable, suggesting protection against pertussis by routine vaccination according to the recommended schedule.

  1. CDC. National, state, and urban area vaccination levels among children aged 19--35 months---United States, 2002. MMWR 2003;52:728--32.
  2. CDC. Pertussis---United States, 1997--2000. MMWR 2002;51:73--6.
  3. Cherry JD. The science and fiction of the "resurgence" of pertussis. Pediatrics 2003;112:405--6.

Shigellosis

Shigella sonnei infections continue to account for over 75% of shigellosis in the United States(1). Prolonged, multistate outbreaks of S. sonnei infections that are transmitted in day care centers, where maintenance of good hygienic conditions requires special care, account for much of the problem (2). From June 2001 through March 2003, one such outbreak in six eastern states accounted for over 3,000 laboratory-confirmed infections (3). S. sonnei can also be transmitted through contaminated foods and through water used for drinking or recreational purposes (4). Recent evidence suggests that S. sonnei infections may be increasing among men who have sex with men (1).

  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; in press.
  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. Day care-related outbreaks of rhamnose-negative Shigella sonnei---six states, June 2001--March 2003. MMWR 2004;53:60--3.
  4. CDC. Outbreaks of Shigella sonnei infection associated with eating fresh parsley---United States and Canada, July--August 1998. MMWR 1999;48:285--9.

Streptococcal Disease, Invasive, Group A (including streptococcal toxic-shock syndrome)

During 2002, 986 cases of invasive group A streptococcal (GAS) disease were reported from nine states (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New York, Oregon, and Tennessee) through the Active Bacterial Core Surveillance (ABCs) project under CDC's Emerging Infections Program (1). Based on these 986 cases, CDC estimates that approximately 9,100 cases of invasive GAS disease (rate: 3.2/100,000) and 1,350 deaths occurred nationally during 2002. Disease incidence was highest among children aged <1 year (6.9/100,000) and adults aged >65 years (8.9/100,000). Streptococcal toxic-shock syndrome and necrotizing fasciitis accounted for approximately 5.9% and 6.1% of invasive cases, respectively. The overall case-fatality rate among persons with invasive GAS disease was 14.6%.

In 2002, CDC published recommendations for the control of invasive group A streptococcal disease among household contacts of persons with invasive GAS infections and for responding to postpartum and postsurgical infections. These recommendations are based on routine surveillance data, studies of the epidemiology of subsequent invasive GAS infections among household contacts of case-patients and postpartum and postsurgical GAS clusters, and studies of the effectiveness of chemoprophylactic regimens for eradicating carriage (2--4).

  1. CDC. Active Bacterial Core Surveillance (ABCs) report. Emerging Infections Program Network. Group A streptococcus, 2001. Available at http://www.cdc.gov/ncidod/dbmd/abcs/survreports/gas01_provis.pdf 
  2. The Prevention of Invasive Group A Streptococcal Infections Workshop Participants. Prevention of invasive group A streptococcal disease among household contacts of case patients and among postpartum and postsurgical patients: recommendations from the Centers for Disease Control and Prevention. Clin Infect Dis 2002;35:950--9.
  3. Robinson KA, Rothrock G, Phan Q, Sayler B, Stefonek K, Van Beneden C , Levine OS, for the Active Bacterial Core Surveillance (ABCs)/Emerging Infections Program Network. Risk of severe group A streptococcal disease among patients' household contacts. Emerg Infect Dis 2003;9:443--7.
  4. Factor SH, Levine OS, Schwartz B, et al. Invasive group A streptococcal disease: risk factors for adults. Emerg Infect Dis 2003; 9: 970--7.

Streptococcus pneumoniae, Invasive, Drug-Resistant

In 2002, the Active Bacterial Core Surveillance (ABCs) project of CDC's 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 second straight year, the proportion of pneumococcal isolates that were drug resistant declined. Of the 3,012 S. pneumoniae isolates collected in 2002, 9.1% exhibited intermediate resistance to penicillin (minimum inhibitory concentration [MIC] 0.1--1 µg/mL), and 11.5% were fully resistant (MIC >2 µg/mL) (2). For cefotaxime, 8.4% of all isolates had intermediate resistance and 3.5% were fully resistant in 2001. For erythromycin, 16.4% were resistant in 2001. Approximately one in eight (13.2%) 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.

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 Committee on Immunization Practices issued recommendations for use of the vaccine in children aged <5 years (3). Vaccine use has reduced rates of invasive pneumococcal disease markedly among children, the vaccine's target age group, but also among unvaccinated older persons (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: M100-S12. Wayne, PA: National Committee for Clinical Laboratory Standards, 2002.
  3. CDC. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices. MMWR 2000;49(No. RR-9):1--38.
  4. 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

During 2002, a total of 412 cases of congenital syphilis were reported (10.20/100,000 live births), down from 492 in 2001. Like primary and secondary syphilis, the rate of congenital syphilis has declined sharply in recent years, from a peak of 107.3/ 100,000 in 1991 (1). The continuing decrease in the rate of congenital syphilis likely reflects the substantial reduction in the rate of primary and secondary syphilis among women that has occurred in the last decade and continues to occur. Congenital syphilis persists in the United States because a substantial number of women do not receive syphilis serologic testing until late in their pregnancy or not at all. This lack of screening is often related to absent or late prenatal care (2).

  1. CDC. Sexually transmitted disease surveillance 2002. Atlanta: US Department of Health and Human Services, CDC, 2003.
  2. CDC. Congenital syphilis --- United States, 2000. MMWR 2001;50:573--7.

Syphilis, Primary and Secondary

During 2002, a total of 6,862 primary and secondary syphilis cases were reported, an increase from 6,103 cases in 2001. From 1990 to 2000, the primary and secondary syphilis rate declined 90%, from 20.34/100,000 to 2.12/100,000. The 2001 rate (2.2/100,000), the first annual increase in syphilis in over a decade, was 2.1% higher than the 2000 rate, which was the lowest since reporting began in 1941. The 2002 rate (2.4/100,000) was 9.1% higher than the reported rate in 2001. The 2002 primary and secondary syphilis rate reflects a 27% increase among men from 2001 but a 21% decrease among women (1). This disparity between men and women, observed across all racial and ethnic groups, along with reported outbreaks of syphilis among MSM in large urban areas, suggests that increases in syphilis are occurring among MSM. Rates remain disproportionately high in the South and among non-Hispanic blacks, but rates in these two groups are continuing to decline (1,2,3).

  1. CDC. Sexually transmitted disease surveillance 2002. Atlanta, GA: US Department of Health and Human Services, CDC 2003.
  2. CDC. Primary and secondary syphilis among men who have sex with men---New York City, 2001. MMWR 2002;51:853--6.
  3. CDC. Primary and secondary syphilis---United States, 2000--2001. MMWR 2002;51:971--3.

Tetanus

In 2002, 25 cases of tetanus were reported from 14 states. Three (12%) cases were among persons aged <25 years, 12 (48%) cases were among persons aged 25--59 years, and 10 (40%) cases were 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, most cases were among persons aged >60 years (1). Three (12%) of the cases were fatal.

  1. CDC. Tetanus Surveillance---United States, 1995--1997. In: CDC Surveillance Summaries, July 3, 1998. MMWR 1998;47(No. SS-2): 1--13.
  2. Pascual FB, McGinley EL, Zanardi LR, Cortese MM, Murphy TV, Tetanus surveillance---United States, 1998--2000. In: CDC Surveillance Summaries, June 20, 2003. MMWR 2003;52(No. SS-3).

Tuberculosis

During 2002, a total of 15,075 cases (rate: 5.3/100,000) of tuberculosis (TB) were reported to CDC from the 50 states and the District of Columbia, representing a 5.7% decrease from 2001 and a 43.5% decrease from 1992, when the number and rate of cases most recently peaked in the United States (1).

Despite a 68.4% decline in case rates from 1992 to 2002 (31.0/100,000 to 9.8/100,000), U.S.-born non-Hispanic blacks continued to have the highest TB rate of any U.S.-born racial/ethnic population (2). U.S.-born, non-Hispanic blacks had the largest number of TB cases among both U.S.-born and foreign-born populations, representing 46.7% of TB cases among U.S.-born persons and approximately one fourth of all cases (2).

In 1992, 72.6% of reported cases were among U.S.-born persons (8.2/100,000), and 27.4% were among foreign-born persons (34.5/100,000). In comparison in 2002, 48.2% of reported cases were among U.S.-born persons (2.8/100,000), and 51.8% of reported cases were among foreign-born persons (23.6/100,000) (2).

Despite the decrease in case rate among foreign-born persons during the past decade, more than half the TB cases in the United States in 2002 occurred in this population, and the case rate was eight times greater in this population than among U.S.-born persons. To address the high rate, CDC is collaborating with public health partners to implement TB control initiatives among recent international arrivals and residents along the border between the United States and Mexico and to strengthen TB programs in countries with a high incidence of TB disease (2). CDC recently updated its comprehensive national action plan to reflect the alignment of its priorities with the Institute of Medicine report (3) and to ensure that priority prevention activities are undertaken with optimal collaboration and coordination among national and international public health partners (4).

  1. CDC. Reported tuberculosis in the United States, 2002. Atlanta, GA: US Department of Health and Human Services, CDC, 2003. Available at http://www.cdc.gov/tb.
  2. CDC. Trends in tuberculosis morbidity---United States, 1992--2002. MMWR 2003;52:217--222.
  3. Institute of Medicine. Ending neglect: the elimination of tuberculosis in the United States. Washington, DC: National Academy Press, 2000.
  4. CDC. CDC's response to ending neglect: the elimination of tuberculosis in the United States. Atlanta: US Department of Health and Human Services, CDC, 2002.

Typhoid Fever

In 2002, typhoid fever was diagnosed in 321 persons in the United States (NNDSS data), despite the availability of two effective vaccines. Approximately 80% of these cases occurred among persons who reported international travel during the preceding 6 weeks. Persons visiting friends and relatives in their country of origin appear to be at higher risk (1). In many areas of the world, Salmonella Typhi strains have acquired resistance to multiple antimicrobial agents, including ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole (1). S. Typhi outbreaks in the United States are usually small in size but can cause significant morbidity and are often foodborne, warranting thorough investigation (2). Recently a sexually transmitted outbreak of typhoid fever was recognized and reported (3).

  1. Ackers ML, Puhr ND, Tauxe RV, Mintz ED. Laboratory based surveillance of Salmonella serotype Typhi infections in the United States: antimicrobial resistance on the rise. JAMA 2000;283:2668--73.
  2. Olsen SJ, Bleasdale SC, Magnano AR, et al. Outbreaks of typhoid fever in the United States, 1960--1999. Epidemiol Infect 2003;130:13--21.
  3. 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 deaths

In 2002, nine varicella deaths were reported to CDC from eight states (1). Three of the deaths occurred among children aged 5--11 years, and six occurred among adults aged 26--74 years. In 1999, the Council of State and Territorial Epidemiologists recommended that varicella deaths be reported to CDC to monitor the impact of routine varicella vaccination on varicella-related mortality (2). However, reporting of varicella deaths is incomplete, limiting the usefulness of mortality data in assessing the impact of the varicella vaccination program. CDC encourages states to report varicella deaths so that risk factors for varicella-related mortality can be identified and the percentage of deaths that would have been directly preventable by following current recommendations for vaccination can be determined.

In 2003, as an adjunct to mortality surveillance, varicella infection was again designated a nationally notifiable condition. The objectives of varicella morbidity surveillance at state and national levels are to monitor the epidemiology of varicella by age, place, and over time, to monitor the impact of widespread and increasing immunization on the epidemiology of varicella, and to allow prompt implementation of disease control measures (3).

  1. CDC. Varicella-related deaths---United States, 2002. MMWR 2003;52:545--7.
  2. Council of State and Territorial Epidemiologists. CSTE position statement 1998-ID-10: inclusion of varicella-related deaths in the National Public Health Surveillance System (NPHSS). Available at http://www.cste.org/ps/1998/1998-id-10.htm.
  3. Council of State and Territorial Epidemiologists. CSTE position statement 2003-ID-06: Varicella surveillance. Available at http://www.cste.org/position%20statements/02-ID-06.pdf.

PART 1

Summaries of Notifiable Diseases in the United States, 2002


Table 1
Table 1 Continued
Table 2
Table 2 Continued
Table 2 Continued
Table 2 Continued
Table 2 Continued
Table 2 Continued
Table 2 Continued
Table 2 Continued
Table 2 Continued
Table 3 Continued
Table 3 Continued




Table 6

PART 2

Graphs and Maps for Selected Notifiable Diseases in the United States

































































PART 3

Historical Summaries of Notifiable Diseases in the United States, 1971--2002



Table 7

Table 7 Continued
Table 8
Table 8 Continued
Table 9
Table 10
Table 11
Table 12

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). Additional information available at http://www.cdc.gov/epo/dphsi/casedef/index.htm.

CDC. Demographic differences in notifiable infectious disease morbidity---United States, 1992--1994. MMWR 1997;46:637--41.

CDC. Framework for program evaluation in public health. MMWR 1999;48(No. RR-11).

CDC. Historical perspectives: notifiable disease surveillance and notifiable disease statistics---United States, June 1946 and June 1996. MMWR 1996;45:530--6.

CDC. Manual of procedures for the reporting of nationally notifiable diseases to CDC. Atlanta, GA: US Department of Health and Human Services, Public Health Service, CDC, 1995.

CDC. Manual for the surveillance of vaccine-preventable diseases. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1999. Available at http://www.cdc.gov/nip/publications/surv-manual/begin.pdf.

CDC. National Electronic Disease Surveillance System (NEDSS): a standards-based approach to connect public health and clinical medicine. J Public Health Management Practice 2001;7:43--50.

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

CDC. Sexually transmitted disease surveillance 1998. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1999.

CDC. Ten leading nationally notifiable infectious diseases---United States, 1995. MMWR 1996;45:883--4.

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

Chang M-H, Glynn MK, Groseclose SL. Endemic, notifiable bioterrorism-related diseases, United States, 1992--1999. Emerg Infect Dis 2003;9:556--64.

Chin JE, ed. Control of communicable diseases manual. 17th ed. Washington, DC: American Public Health Association, 2000.

Doyle TJ, Glynn MK, Groseclose SL. Completeness of notifiable infectious disease reporting in the United States: an analytical literature review. Am J Epidemiol 2002;155:866--74.

Effler P, Ching-Lee M, Bogard A, Ieong M-C, Nekomoto T, Jernigan D. Statewide system of electronic notifiable disease reporting from clinical laboratories: comparing automated reporting with conventional methods. JAMA 1999;282;1845--50.

Freimuth V, Linnan HW, Potter P. Communicating the threat of emerging infections to the public. Emerg Infect Dis 2000;6:337--47.

Koo D, Caldwell B. The role of providers and health plans in infectious disease surveillance. Eff Clin Pract 1999;2:247--52. Available at http://www.acponline.org/journals/ecp/sepoct99/koo.htm.

Koo D, Wetterhall S. History and current status of the National Notifiable Diseases Surveillance System. J Public Health Management Practice 1996;2:4--10.

Lin SS, Kelsey JL. Use of race and ethnicity in epidemiologic research: concepts, methodological issues, and suggestions for research. Epidemiol Rev 2000;22:187--202.

Martin SM, Bean NH. Data management issues for emerging diseases and new tools for managing surveillance and laboratory data. Emerg Infect Dis 1995;1:124--8. Available at http://www.cdc.gov/ncidod/eid/vol1no4/martin2.htm#top.

Niskar AS, Koo D. Differences in notifiable infectious disease morbidity among adult women---United States, 1992--1994. J Womens Health 1998;7:451--8.

Panackal AA, M'ikanatha NM , Tsui FC, et al. Automatic electronic laboratory-based reporting of notifiable infectious diseases at a large health system. Emerg Infect Dis 2002;8:685--91.

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

Pinner RW, Jernigan DB, Sutliff SM. Electronic laboratory-based reporting for public health. Military Medicine 2000;165(suppl 2):20--4.

Roush S, Birkhead G, Koo D, Cobb A, Fleming D. Mandatory reporting of diseases and conditions by health care professionals and laboratories. JAMA 1999;282:164--70. Available at http://jama.ama-assn.org/issues/v282n2/abs/joc90413.html.

Teutsch SM, Churchill RE, eds. Principles and practice of public health surveillance. 2nd ed. New York, NY: Oxford University Press, 2000.

Thacker SB, Choi K, Brachman PS. The surveillance of infectious diseases. JAMA 1983;249:1181--5.

AIDS

CDC. Cases of HIV infection and AIDS in the United States, 2002 HIV/AIDS surveillance report, Vol. 14. Atlanta: U.S. Department of Health and Human Services, CDC, 2003. Available at: http://www.cdc.gov/hiv/stats/hasr1402.htm.

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

Nakashima AK, Fleming PL. HIV/AIDS surveillance in the United States, 1981--2001. J Acquir Immune Defic Syndr 2003;32:68--85.

Brucellosis

CDC. Brucellosis: (Brucella melitensis, abortus, suis, and canis). Atlanta: US Department of Health and Human Services, CDC. Available at http://www.cdc.gov/ncidod/dbmd/diseaseinfo/brucellosis_g.htm.

CDC. Brucellosis case definition. Atlanta: US Department of Health and Human Services, CDC. Available at http://www.bt.cdc.gov/Agent/Brucellosis/CaseDef.asp.

CDC. Human exposure to Brucella abortus strain RB51---Kansas, 1997. MMWR 47:172--5.

Stevens, MG, Olsen SC, Palmer MV, Cheville NF. US Department of Agriculture, Agricultural Research Service National Animal Disease Center, Iowa State University. Brucella abortus strain RB51: a new brucellosis vaccine for cattle. Compendium 1997;19:766--74.

Martin-Mazuelos E, Nogales MC, Florez C, Gomez-Mateos M, Lozano F, Sanchez A. Outbreak of Brucella melitensis among microbiology laboratory workers. J Clin Microbiol 1994;32:2035--6.

Chomel BB, DeBess EE, Mangiamele DM, et al. Changing trends in the epidemiology of human brucellosis in California from 1973 to 1992: a shift toward foodborne transmission. J Infect Dis 1994;170:1216--23.

Chancroid

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

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

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

Chlamydia trachomatis, Genital Infection

CDC. Sexually transmitted disease surveillance 2001 supplement: Chlamydia Prevalence Monitoring Project, 2001. Atlanta: US Department of Health and Human Services, CDC, 2002. Available at http://www.cdc.gov/std/chlamydia2001.

Gaydos CA, Howell MR, Pare B, et al. Chlamydia trachomatis infections in female military recruits. N Engl J Med 1998;339:739--44.

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

Cholera

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.

Mintz ED, Tauxe RV, Levine MM. The global resurgence of cholera. In: Noah ND, O'Mahony M, eds. Communicable disease epidemiology and control. Chichester, England: John Wiley & Sons, 1998:63--104.

Mahon BE, Mintz ED, Greene KD, Wells JG, Tauxe RV. Reported cholera in the United States, 1992--1994: a reflection of global changes in cholera epidemiology. JAMA 1996;276:307--312.

World Health Organization. Guidelines for cholera control. Geneva, Switzerland: World Health Organization, 1993.

Cryptosporidiosis

CDC. DPDx Diagnostic procedures--stool specimens--detection of parasite antigens. Atlanta: US Department of Health and Human Services, CDC. Available at http://www.dpd.cdc.gov/DPDx/HTML/DiagnosticProcedures. htm.

Lee SH, Levy DA, Craun GF, Beach MJ, Calderon RL. Surveillance for waterborne-disease outbreaks---United States, 1999--2000. In: CDC Surveillance summaries, November 22, 2002. MMWR 2002:51(No. SS-8):1--47.

Rose JB, Huffman DE, Gennaccaro A. Risk and control of waterborne cryptosporidiosis. FEMS Microbiol Rev 2002;26:113--23.

CDC. Cryptosporidium and water: a public health handbook. Atlanta: US Department of Health and Human Services, CDC, Working Group on Waterborne Cryptosporidiosis, 1997. Available at http://www.cdc.gov/ncidod/diseases/crypto/crypto.pdf.

Cyclosporiasis

Lopez AS, Bendik JM, Alliance JY, et al. Epidemiology of Cyclospora cayetanensis and other intestinal parasites in a community in Haiti. J Clin Microbiol 2003;41:2047--54.

Ho AY, Lopez AS, Eberhard MG, et al. Outbreak of cyclosporiasis associated with imported raspberries, Philadelphia, Pennsylvania, 2000. Emerg Infect Dis 2002;8:783--8.

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

Encephalitis, Arboviral (California Serogroup Viral, Eastern Equine, St. Louis, West Nile Western Equine)

CDC. Notice to readers: revision of guidelines for surveillance, prevention, and control of West Nile virus infection. MMWR 2003;52:797.

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

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

Nash D, Mostashari F, Fine A, et al. The outbreak of West Nile virus infection in the New York City area. N Engl J Med 2001;344:1807--14.

Escherichia coli, Enterohemorrhagic.

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

Giardiasis

CDC. DPDx diagnostic procedures--stool specimens--detection of parasite antigens. Atlanta: US Department of Health and Human Services, CDC. Available at http://www.dpd.cdc.gov/DPDx/HTML/DiagnosticProcedures. htm.

Lee SH, Levy DA, Craun GF, Beach MJ, Calderon RL. Surveillance for waterborne-disease outbreaks---United States, 1999--2000. In: CDC surveillance summaries, November 22, 2002. MMWR 2002:51(No. SS-8):1--47.

Furness BW, Beach MJ, Roberts JM. Giardiasis surveillance---United States, 1992--1997. In: CDC surveillance summaries, August 11, 2000. MMWR 2000:49(No. SS-7):1--13.

Gonorrhea

CDC. Increases in fluoroquinolone-resistant Neisseria gonorrhoeae---Hawaii and California, 2001. MMWR 2002;51:1041--4.

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

CDC. Sexually transmitted diseases surveillance 2001 supplement: Gonococcal Isolate Surveillance Project (GISP) annual report---2002. Atlanta, GA: US Department of Health and Human Services, CDC, October 2002.

Fox KK, del Rio C, Holmes KK, et al. Gonorrhea in the HIV era: a reversal in trends among men who have sex with men. Am J Public Health 2001;91:959--64.

Haemophilus influenzae, Invasive Disease

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 Microbiol 2003;41:393--6.

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

Fry AM, Lurie P, Gidley M, Schmink S, Lingappa J, Rosenstein NE. Haemophilus influenzae type b (Hib) disease among Amish children in Pennsylvania: reasons for persistent disease. Pediatrics 2001;108:1--6.

CDC. Recommendations for use of Haemophilus b conjugate vaccines and a combined diphtheria, tetanus, pertussis, and Haemophilus b vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1993;42(No. RR-13).

Hepatitis A

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

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

Bell BP, Shapiro CN, Alter MJ, et al. The diverse patterns of hepatitis A epidemiology in the United States---implications for vaccination strategies. J Infect Dis 1998;178:1579--84.

Lemon SM, Shapiro CN. The value of immunization against hepatitis A. Infect Agents Dis 1994;3:38--49.

Shapiro CN, Coleman PJ, McQuillan GM, Alter MJ, Margolis HS. Epidemiology of hepatitis A: seroepidemiology and risk groups in the USA. Vaccine 1992;10(suppl 1):S59--S62.

Hepatitis B

Coleman PJ, McQuillan GM, Moyer LA, Lambert SB, Margolis HS. Incidence of hepatitis B virus infection in the United States, 1976--1994: estimates from the National Health and Nutrition Examination Surveys. J Infect Dis 1998;178:954--9.

CDC. Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR 1991;40(No. RR-13):1--19.

Goldstein ST, Alter MJ, Williams IT, et al. Incidence and risk factors for acute hepatitis B in the United States, 1982--1998: implications for vaccination programs. J Infect Dis 2002;185:713--9.

McQuillan GM, Coleman PJ, Kruszon-Moran D, Moyer LA, Lambert SB, Margolis HS. Prevalence of hepatitis B virus infection in the United States: The National Health and Nutrition Examination Surveys, 1976 through 1994. Am J Public Health 1999;89:14--8.

Margolis HS, Alter MJ, Hadler SC. Hepatitis B: evolving epidemiology and implications for control [Review]. Semin Liver Dis 1991;11:84--92.

Hepatitis C; Non-A, Non-B

Alter MJ, Kruszon-Moran D, Nainan OV, et al. The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. N Engl J Med 1999;341:556--62.

Armstrong GA, Alter MJ, McQuillan GM, Margolis HS. The past incidence of hepatitis C virus infection: implications for the future burden of chronic liver disease in the United States. Hepatology 2000;31:777--82.

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

Legionella

CDC. Guidelines for environmental infection control in health-care facilities: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR 2003;52(No. RR-10).

American Society of Heating, Refrigerating, and Air-Conditioning Engineers. ASHRAE Guideline 12-2000. Minimizing the risk of legionellosis associated with building water systems. Atlanta: American Society of Heating, Refrigerating, and Air-Conditioning Engineers, Inc., 2000:1--17. Available at http://www.baltimoreaircoil.com.

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

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

Lyme Disease

Hayes EB, Piesman J. How can we prevent Lyme disease? N Engl J Med 2003;348:2424--30.

Bacon RM, Biggerstaff BJ, Schriefer ME, et al. Serodiagnosis of Lyme disease by kinetic enzyme-linked immunosorbent assay using recombinant VlsE1 or peptide antigens of Borrelia burgdorferi compared with 2-tiered testing using whole cell lysates. J Infect Dis 2003;187:1187--99.

Guerra M, Walker E, Jone C, et al. Predicting risk of Lyme disease: habitat suitability for Ixodes scapularis in the North Central United States. Emerg Infect Dis 2002;8:289--97.

Poland GA. Prevention of Lyme disease: a review of the evidence. Mayo Clin Proc 2001;76:713--24.

Malaria

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

MacArthur JR, Holtz TH, Jenkins J, et al. Probable locally acquired mosquito-transmitted malaria in Georgia, 1999. Clin Infect Dis 2001;32:E124--8.

Zucker JR. Changing patterns of autochthonous malaria transmission in the United States: a review of recent outbreaks. Emerg Infect Dis 1996;2:37--43. Available at http://www.cdc.gov/ncidod/eid/vol2no1/zuckerei.htm.

Zucker JR, Campbell CC. Malaria: principles of prevention and treatment [review]. Infect Dis Clin North Am 1993;7:547--67.

Pertussis

Vitek CR, Pascual FB, Baughman AL, Murphy TV. Increase in deaths from pertussis among young infants in the United States in the 1990s. Pediatr Infect Dis J 2003;22:628--34.

CDC. Guidelines for the control of pertussis outbreaks. Atlanta: US Department of Health and Human Services, CDC, 2000. Available at http://www.cdc.gov/nip/publications/pertussis/guide.htm 

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

CDC. Pertussis outbreak among adults at an oil refinery---Illinois, August--October 2002. MMWR 2003;52:1-4.

Plague

CDC. Imported plague---New York City, 2002. MMWR 2003;52:725--8.

Enscore RE, Biggerstaff BJ, Brown TL, et al. Modeling relationships between climate and the frequency of human plague cases in the southwestern United States, 1960--1997. Am J Trop Med Hyg 2002;66:186--96.

Inglesby TV, Dennis DT, Henderson DA, et al. Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense [review]. JAMA 2000;283:2281--90.

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

Salmonella

Olsen SJ, Bishop R, Brenner FW, et al. The changing epidemiology of Salmonella: trends in serotypes isolated from humans in the United States, 1987--1997. J Infect Dis 2001;183:753--61.

Mahon BE, Slusker L, Hutwagner L, et al. Consequences in Georgia of a nationwide outbreak of Salmonella infections: what you don't know might hurt you. Am J Public Health 1999;89:31--5.

CDC. Outbreak of multidrug-resistant Salmonella Newport ---United States, January--April 2002. MMWR 2002;51:545--8.

Shigellosis

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.

Gupta A, Polyak CA, Bishop RD, Sobel J, Mintz ED. Laboratory-confirmed shigellosis in the United States, 1989--2002: epidemiologic trends and patterns. Clin Infect Dis 2004:In press.

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

Sobel J, Cameron DN, Ismail J, et al. A prolonged outbreak of Shigella sonnei infections in traditionally observant Jewish communities in North America caused by a molecularly distinct bacterial subtype. J Infect Dis 1998;177:1405--8.

Streptococcus pneumoniae, Drug-Resistant, Invasive Disease

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

Robinson KA, Baughman W, Rothrock G, et al. Epidemiology of invasive Streptococcus pneumoniae infections in the United States, 1995--1998: opportunities for prevention in the conjugate vaccine era. JAMA 2001;285:1729--35.

Whitney CG, Farley MM, Hadler J, et al. Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States. N Engl J Med 2000;343:1917--24.

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 syphilis---United States, 2000. MMWR 2001;50:573--7.

CDC. Guidelines for the prevention and control of congenital syphilis. MMWR 1988;37(No. S-1).

Southwick KL, Guidry HM, Weldon MM, Mertz KJ, Berman SM, Leveine WC. An epidemic of congenital syphilis in Jefferson County, Texas, 1994--1995: inadequate prenatal syphilis testing after an outbreak in adults. Am J Public Health 1999;89:557--60.

Syphilis, Primary and Secondary

CDC. The national plan to eliminate syphilis from the United States. Atlanta: US Department of Health and Human Services, CDC, October 1999.

CDC. Primary and secondary syphilis among men who have sex with men---New York City, 2001. MMWR 2002;51:853--6.

CDC. Primary and secondary syphilis---United States, 2000--2001. MMWR 2002;51:971--3.

CDC. Sexually transmitted disease surveillance supplement 2001: syphilis surveillance report. Atlanta, GA: US Department of Health and Human Services, CDC, February 2003.

Tetanus

Pascual FB, McGinley EL, Zanardi LR, Cortese MM, Murphy TV. Tetanus surveillance---United States, 1998--2000. In: CDC surveillance summaries, June 20, 2003. MMWR 2003;52(No. SS-3):1--8.

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

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

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

Trichinosis

Roy SL, Lopez AS, Schantz PM. Trichinellosis surveillance---United States, 1997--2001. In: CDC surveillance summaries, July 2003. MMWR 2003;52(No.SS-6):1--8.

Moorhead A, Grunenwald PE, Dietz VJ, Schantz PM. Trichinellosis in the United States, 1991--1996: declining but not gone. Am J Trop Med Hyg 1999;60:66--9.

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

McAuley JB, Michelson MK, Schantz PM. Trichinosis surveillance, United States, 1987--1990. In: CDC surveillance summaries, December 1991. MMWR 1991;40 (No. SS-3):35--42.

Tuberculosis

CDC. Reported tuberculosis in the United States, 2002. Atlanta, GA: US Department of Health and Human Services, CDC, September 2003. Available at http://www.cdc.gov/tb.

CDC. Trends in tuberculosis morbidity---United States, 1992--2002. MMWR 2003;52:217--22.

Saraiya M, Cookson ST, Tribble P, et al. Tuberculosis screening among foreign-born persons applying for permanent US residence. Am J Public Health 2002;92:826--9.

Talbot EA, Moore M, McCray E, Binkin NJ. Tuberculosis among foreign-born persons in the United States, 1993--1998. JAMA 2000;284:2894--900.

Tularemia

CDC. Public Health Dispatch: Outbreak of tularemia among commercially distributed prairie dogs, 2002. MMWR 2002;51:688,699.

CDC. Tularemia---United 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 management. JAMA 2001;285:2763--73.

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

Typhoid Fever

Reller ME, Olsen SJ, Kressel AB, 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.

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

Ackers ML, Puhr ND, Tauxe RV, Mintz ED. Laboratory-based surveillance of Salmonella serotype Typhi infections in the United States: antimicrobial resistance on the rise. JAMA 2000;283:2668--73.

CDC. Typhoid immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1994;43(No. RR-14).

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