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Summary of Notifiable Diseases --- United States, 2007

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

Prepared by

Patsy A. Hall-Baker, Coordinator, Summary of Notifiable Diseases1

Enrique Nieves, Jr., MS1

Ruth Ann Jajosky, DMD1

Deborah A. Adams1

Pearl Sharp1

Willie J. Anderson1

J. Javier Aponte1

Gerald F. Jones1

Aaron E. Aranas, MPH, MBA1

Araceli Rey, MPH1

Bernetta Lane, MBA1

Michael S. Wodajo2

1Division of Integrated Surveillance Systems and Services, National Center for Public Health Informatics, Coordinating Center for Health Information and Service, CDC

2McKing Consulting Corporation

Preface

The Summary of Notifiable Diseases --- United States, 2007 contains the official statistics, in tabular and graphic form, for the reported occurrence of nationally notifiable infectious diseases in the United States for 2007. Unless otherwise noted, the data are final totals for 2007 reported as of June 30, 2008. These statistics are collected and compiled from reports sent by state health departments and territories to the National Notifiable Diseases Surveillance System (NNDSS), which is operated by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE). The Summary is available at http://www.cdc.gov/mmwr/summary.html. This site also includes publications from previous years.

The Highlights section presents noteworthy epidemiologic and prevention information for 2007 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 the nationally notifiable infectious diseases during 2007.* The tables provide the number of cases reported to CDC for 2007 and the distribution of cases by month, geographic location, and the patient's demographic characteristics (age, sex, race, and ethnicity). Part 2 contains graphs and maps that depict summary data for certain notifiable infectious 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 1976. This section also includes a table enumerating deaths associated with specified notifiable diseases reported to CDC's National Center for Health Statistics (NCHS) during 2002--2005. The Selected Reading section presents general and disease-specific references for notifiable infectious diseases. These references provide additional information on surveillance and epidemiologic concerns, diagnostic concerns, and disease-control activities.

Comments and suggestions from readers are welcome. To increase the usefulness of future editions, comments about the current report and descriptions of how information is or could be used are invited. Comments should be sent to Public Health Surveillance Team --- NNDSS, Division of Integrated Surveillance Systems and Services, National Center for Public Health Informatics at soib@cdc.gov.

Background

The infectious diseases designated as notifiable at the national level during 2007 are listed in this section. 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. A brief history of the reporting of nationally notifiable infectious diseases in the United States is available at http://www.cdc.gov/ncphi/disss/nndss/nndsshis.htm. In 1961, CDC assumed responsibility for the collection and publication of data on nationally notifiable diseases. NNDSS is neither a single surveillance system nor a method of reporting. Certain NNDSS data are reported to CDC through separate surveillance information systems and through different reporting mechanisms; however, these data are aggregated and compiled for publication purposes.

Notifiable disease reporting at the local level protects the public's health by ensuring the proper identification and follow-up of cases. Public health workers ensure that persons who are already ill receive appropriate treatment; trace contacts who need vaccines, treatment, quarantine, or education; investigate and halt outbreaks; eliminate environmental hazards; and close premises where spread has occurred. Surveillance of notifiable conditions helps public health authorities to monitor the impact of notifiable conditions, measure disease trends, assess the effectiveness of control and prevention measures, identify populations or geographic areas at high risk, allocate resources appropriately, formulate prevention strategies, and develop public health policies. Monitoring surveillance data enables public health authorities to detect sudden changes in disease occurrence and distribution, identify changes in agents and host factors, and detect changes in health-care practices.

The list of nationally notifiable infectious diseases is revised periodically. 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 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. Reporting completeness of notifiable diseases is highly variable and related to the condition or disease being reported (1). The list of diseases considered notifiable varies by state and year. Current and historic national public health surveillance case definitions used for classifying and enumerating cases consistently across reporting jurisdictions are available at http://www.cdc.gov/ncphi/disss/nndss/nndsshis.htm.

Infectious Diseases Designated as Notifiable at the National Level During 2007*

Acquired immunodeficiency syndrome (AIDS)

Anthrax

Domestic arboviral diseases

California serogroup virus disease

Eastern equine encephalitis virus disease

Powassan virus disease

St. Louis encephalitis virus disease

West Nile virus disease

Western equine encephalitis virus disease

Botulism

foodborne

infant

other (wound and unspecified)

Brucellosis

Chancroid

Chlamydia trachomatis, genital infection

Cholera

Coccidioidomycosis

Cryptosporidiosis

Cyclosporiasis

Diphtheria

Ehrlichiosis

human granulocytic

human monocytic

human, other or unspecified agent

Giardiasis

Gonorrhea

Haemophilus influenzae, invasive disease

Hansen disease (leprosy)

Hantavirus pulmonary syndrome

Hemolytic uremic syndrome, postdiarrheal

Hepatitis A, acute

Hepatitis B, acute

Hepatitis B, chronic

Hepatitis B virus, perinatal infection

Hepatitis C, acute

Hepatitis C virus infection (past or present)

Human immunodeficiency virus (HIV) infection

adult (age ≥13 yrs)

pediatric (age <13 yrs)

Influenza-associated pediatric mortality

Legionellosis

Listeriosis

Lyme disease

Malaria

Measles§

Meningococcal disease

Mumps

Novel influenza A virus infections

Pertussis

Plague

Poliomyelitis, paralytic

Poliovirus infection, nonparalytic

Psittacosis

Q fever

Rabies

animal

human

Rocky Mountain spotted fever

Rubella§

Rubella, congenital syndrome§

Salmonellosis

Severe acute respiratory syndrome--associated coronavirus

(SARS-CoV) disease

Shiga toxin-producing Escherichia coli (STEC)

Shigellosis

Smallpox

Streptococcal disease, invasive, group A

Streptococcal toxic-shock syndrome

Streptococcus pneumoniae, invasive disease**

drug resistant, all ages

age <5 years, nondrug resistant

Syphilis

Syphilis, congenital

Tetanus

Toxic-shock syndrome (other than streptococcal)

Trichinellosis

Tuberculosis

Tularemia

Typhoid fever

Vancomycin-intermediate Staphylococcus aureus

  infection (VISA)

Vancomycin-resistant Staphylococcus aureus

infection (VRSA)

Varicella infection (morbidity)

Varicella (mortality)

Vibriosis (non-cholera Vibrio infections)

Yellow fever

Data Sources

Provisional data concerning the reported occurrence of nationally notifiable infectious diseases are published weekly in 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 are approved by the appropriate chief epidemiologist from each submitting state or territory before being published in the Summary. Data published in MMWR Surveillance Summaries or other surveillance reports produced by CDC programs might not agree exactly with data reported in the annual Summary because of differences in the timing of reports, the source of the data, or surveillance methodology.

Data in the Summary were derived primarily from reports transmitted to CDC from health departments in the 50 states, five territories, New York City, and the District of Columbia. Data were reported for MMWR weeks 1--52, which correspond to the period for the week ending January 6, 2007, through the week ending December 29, 2007. More information regarding infectious notifiable diseases, including case definitions, is available at http://www.cdc.gov/ncphi/disss/nndss/nndsshis.htm. Policies for reporting notifiable disease cases can vary by disease or reporting jurisdiction. The case-status categories used to determine which cases reported to NNDSS are published, by disease or condition, and are listed in the print criteria column of the 2007 NNDSS event code list (available at http://www.cdc.gov/ncphi/disss/nndss/phs/files/NNDSS_event_code_list_January_2008.pdf).

Final data for certain 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.

Coordinating Center for Health Information and Service National Center for Health Statistics (NCHS)

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

Coordinating Center for Infectious Diseases

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP).

Division of HIV/AIDS Prevention (AIDS and HIV infection)

Division of STD Prevention (chancroid; Chlamydia trachomatis, genital infection; gonorrhea; and syphilis)

Division of Tuberculosis Elimination (tuberculosis)

National Center for Immunization and Respiratory Diseases

Influenza Division (influenza-associated pediatric mortality).

Division of Viral Diseases, (poliomyelitis, varicella [morbidity and deaths], and SARS-CoV).

National Center for Zoonotic, Vector-Borne, and Enteric Diseases

Division of Vector-Borne Infectious Diseases (arboviral diseases).

Division of Viral and Rickettsial Diseases (animal rabies).

Population estimates for the states are from the NCHS bridged-race estimates of the July 1, 2000--July 1, 2006 U.S. resident population from the vintage 2006 postcensal series by year, county, age, sex, race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau. This data set was released on August 16, 2007, and is available at http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm. Populations for territories are 2006 estimates from the U.S. Census Bureau International Data Base, available at http://www.census.gov/ipc/www/idb/summaries.html. The choice of population denominators for incidence 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 reported by different CDC programs. Incidence in the Summary is calculated as the number of reported cases for each disease or condition divided by either the U.S. resident population for the specified demographic population or the total U.S. residential population, multiplied by 100,000. When a nationally notifiable disease is associated with a specific age restriction, the same age restriction is applied to the population in the denominator of the incidence calculation. In addition, population data from states in which the disease or condition was not notifiable or was not available were excluded from incidence calculations. Unless otherwise stated, disease totals for the United States do not include data for American Samoa, Guam, Puerto Rico, the Commonwealth of the Northern Mariana Islands, or the U.S. Virgin Islands.

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, except for the domestic arboviral diseases, which are presented by date of diagnosis. Data are reported by the state in which the patient resided at the time of diagnosis. For certain nationally notifiable infectious diseases, surveillance data are reported independently to different CDC programs. For this reason, surveillance data reported by other CDC programs might vary from data reported in the Summary because of differences in 1) the date used to aggregate data (e.g., date of report or date of disease occurrence), 2) the timing of reports, 3) the source of the data, 4) surveillance case definitions, and 5) policies regarding case jurisdiction (i.e., which state should report the case to CDC).

The data reported in the Summary are useful for analyzing disease trends and determining relative disease burdens. However, reporting practices affect how these data should be interpreted. Disease reporting is likely incomplete, and completeness might vary depending on the disease and reporting state. The degree of completeness of data reporting might be influenced by the diagnostic facilities available; control measures in effect; public awareness of a specific disease; and the 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/ethnic populations because these variables can be risk markers for certain notifiable diseases. Race and ethnicity data also can be used to highlight populations for focused prevention efforts. However, caution must be used when drawing conclusions from reported race and ethnicity data. Different racial/ethnic populations might have different patterns of access to health care, potentially resulting in data that are not representative of actual disease incidence among specific racial/ethnic populations. Surveillance data reported to NNDSS are in either individual case-specific form or summary form (i.e., aggregated data for a group of cases). Summary data often lack demographic information (e.g., race); therefore, the demographic-specific rates presented in the Summary might be underestimated.

In addition, not all race and ethnicity data are collected uniformly for all diseases. For example, certain disease programs collect data on race and ethnicity using one or two variables, based on the 1977 standards for collecting such data issued by the Office of Management and the Budget (OMB). However, beginning in 2003, certain CDC programs, such as the tuberculosis program, implemented OMB's 1997 revised standards for collecting such data; these programs collect data on multiple races per person using multiple race variables. In addition, although the recommended standard for classifying a person's race or ethnicity is based on self-reporting, this procedure might not always be followed.

Transition in NNDSS Data Collection and Reporting

Before 1990, data were reported to CDC as cumulative counts rather than individual case reports. In 1990, states began electronically capturing and reporting individual case reports (without personal identifiers) to CDC using the National Electronic Telecommunication System for Surveillance (NETSS). In 2001, CDC launched the National Electronic Disease Surveillance System (NEDSS), now a component of the Public Health Information Network, to promote the use of data and information system standards that advance the development of efficient, integrated, and interoperable surveillance information systems at the local, state, and federal levels. One of the objectives of NEDSS is to improve the accuracy, completeness, and timeliness of disease reporting at the local, state, and national level. CDC has developed the NEDSS Base System (NBS), a public health surveillance information system that can be used by states that do not have their own NEDSS-compatible based systems. A major feature of NBS is the ability to capture data already in electronic form (e.g., electronic laboratory results, which are needed for case confirmation) rather than enter these data manually as in NETSS. In 2007, 16 states used NBS to transmit nationally notifiable infectious diseases to CDC. Additional NBS information concerning NEDSS is available at http://www.cdc.gov/NEDSS.

Change in Methodology for Identifying Which Nationally Notifiable Infectious Diseases Were Not Reportable in National Notifiable Diseases Surveillance System (NNDSS) Reporting Jurisdictions in 2007

In 2007, the (NNDSS) program changed the methodology used to gather information regarding which nationally notifiable infectious diseases were reportable in U.S. states and territories. The NNDSS program provided technical assistance to the Council of State and Territorial Epidemiologists (CSTE) in implementing the CSTE State Reportable Conditions Assessment (SRCA). This assessment solicited information from each NNDSS reporting jurisdiction (all 50 U.S. states, the District of Columbia, New York City, and five U.S. territories) regarding which public health conditions were reportable by clinicians, laboratories, hospitals, or 'other" public health reporters, as mandated by law or regulation. A total of 255 conditions, including infectious conditions and noninfectious conditions (e.g., injuries, cancer, and work-related conditions) were included in the assessment. Information concerning all nationally notifiable diseases was also captured by the assessment.

The 2007 assessment was the first collaborative project of such technical magnitude ever conducted by CSTE and CDC in which CDC and CSTE had previously gathered public health reporting requirements independently. The SRCA collected information regarding whether each reportable condition was explicitly reportable (i.e., listed as a specific disease or as a category of diseases on reportable disease lists) or whether it was implicitly reportable (i.e., included in a general category of the reportable disease list, such as "rare diseases of public health importance"), or not reportable. Only explicitly reportable conditions were considered reportable for the purpose of national public health surveillance, and thus NNDSS. Moreover, to determine whether a condition included in the SRCA was considered reportable across all public-health--reporter categories and for a specific NNID in a reporting jurisdiction, CDC developed and applied a condition algorithm and a results algorithm to run on the data collected in the 2007 SRCA. Analyzed results of the 2007 SRCA were used to determine whether a NNID was not reportable in a reporting jurisdiction in 2007 and thus noted with an "N" indicator (for "not notifiable") in the front tables of this report.

Unanalyzed results from the 2007 SRCA (and a subsequent 2008 SRCA) are available, using CSTE's web-query tool, at http://www.cste.org/dnn/programsandacttivities/publichealthinformatics/statereportableconditionsqueryresults/tabid/261/default.aspx.

Revised International Health Regulations

In May 2005, the World Health Assembly adopted revised International Health regulations (IHR) (2) that went into effect in the United States on July 18, 2007. This international legal instrument governs the role of the World Health Organization (WHO) and its member countries, including the United States, in identifying, responding to and sharing information about Public Health Emergencies of International Concern (PHEIC). A PHEIC is an extraordinary event that 1) constitutes a public health risk to other countries through international spread of disease, and 2) potentially requires a coordinated international response.

The IHR are designed to prevent and protect against the international spread of diseases while minimizing the effect on world travel and trade. Countries that have adopted these rules have a much broader responsibility to detect, respond to, and report public health emergencies that potentially require a coordinated international response in addition to taking preventive measures. The IHR will help countries work together to identify, respond to, and share information about PEHIC.

The revised IHR represent a conceptual shift from a predefined disease list to a framework of reporting and responding to events on the basis of an assessment of public health criteria, including seriousness, unexpectedness, and international travel and trade implications. PHEIC are events that fall within those criteria (further defined in a decision algorithm in Annex 2 of the revised IHR). Four conditions always constitute a PHEIC and do not require the use of the IHR decision instrument in Annex 2: Severe Acute Respiratory Syndrome (SARS), smallpox, poliomyelitis caused by wild-type poliovirus, and human influenza caused by a new subtype. Any other event requires the use of the decision algorithm in Annex 2 of the IHR to determine if it is a potential PHEIC. Examples of events that require the use of the decision instrument include, but are not limited to, cholera, pneumonic plague, yellow fever, West Nile fever, viral hemorrhagic fevers, and meningococcal disease. Other biologic, chemical, or radiologic events might fit the decision algorithm and also must be reportable to WHO. All WHO member states are required to notify WHO of a potential PHEIC. WHO makes the final determination about the existence of a PHEIC.

Health-care providers in the United States are required to report diseases, conditions, or outbreaks as determined by local, state, or territorial law and regulation, and as outlined in each state's list of reportable conditions. All health-care providers should work with their local, state, and territorial health agencies to identify and report events that might constitute a potential PHEIC occurring in their location. U.S. State and Territorial Departments of Health have agreed to report information about a potential PHEIC to the most relevant federal agency responsible for the event. In the case of human disease, the U.S. State or Territorial Departments of Health will notify CDC rapidly through existing formal and informal reporting mechanisms (3). CDC will further analyze the event based on the decision algorithm in Annex 2 of the IHR and notify the U.S. Department of Health and Human Services (DHHS) Secretary's Operations Center (SOC), as appropriate.

DHHS has the lead role in carrying out the IHR, in cooperation with multiple federal departments and agencies. The HHS SOC is the central body for the United States responsible for reporting potential events to the WHO. The United States has 48 hours to assess the risk of the reported event. If authorities determine that a potential PHEIC exists, the WHO member country has 24 hours to report the event to the WHO.

An IHR decision algorithm in Annex 2 has been developed to help countries determine whether an event should be reported. If any two of the following four questions can be answered in the affirmative, then a determination should be made that a potential PHEIC exists and WHO should be notified:

  • Is the public health impact of the event serious?
  • Is the event unusual or unexpected?
  • Is there a significant risk of international spread?
  • Is there a significant risk of international travel or trade restrictions?

Additional information concerning IHR is available at http://www.who.int/csr/ihr/en, http://www.globalhealth.gov/ihr/index.html, http://www.cdc.gov/cogh/ihregulations.htm, and http://www.cste.org/PS/2007ps/2007psfinal/ID/07-ID-06.pdf.

At its annual meeting in June 2007, the Council of State and Territorial Epidemiologists (CSTE) approved a position statement to support the implementation of the IHR in the United States (3). CSTE also approved a position statement in support of the 2005 IHR adding initial detections of novel influenza A virus infections to the list of nationally notifiable diseases reportable to NNDSS, beginning in January 2007 (4).

  1. Doyle TJ, Glynn MK, Groseclose LS. Completeness of notifiable infectious disease reporting in the United States: an analytical literature review. Am J Epidemiol 2002;155:866--74.
  2. World Health Organization. Third report of Committee A. Annex 2. Geneva, Switzerland: World Health Organization; 2005. Available at http://www.who.int/gb/ebwha/pdf_files/WHA58/A58_55-en.pdf.
  3. Council of State and Territorial Epidemiologists. Events that may constitute a public health emergency of international concern. Position statement 07-ID-06. Available at http://www.cste.org/PS/2007ps/2007psfinal/ID/07-ID-06.pdf.
  4. Council of State and Territorial Epidemiologists. National reporting for initial detections of novel influenza A viruses. Position statement 07-ID01. Available at: http://www.cste.org/PS/2007ps/2007psfinal/ID/07-ID-06.pdf.

* No cases of diphtheria; neuroinvasive or nonneuroinvasive western equine encephalitis virus disease; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute respiratory syndrome--associated coronavirus syndrome, (SARS-CoV); smallpox; and yellow fever were reported in 2007; these conditions do not appear in the tables in Part 1. For certain other nationally notifiable diseases, incidence data were reported to CDC but are not included in the tables or graphs of this Summary. Data on chronic hepatitis B and hepatitis C virus infection (past or present) are undergoing quality review. Data on human immunodeficiency virus (HIV) infections are not included because HIV reporting has been implemented on different dates and using different methods than for AIDS case reporting.

* Position Statements the Council of State and Territorial Epidemiologists (CSTE) approved in 2006 for national surveillance were implemented beginning in January 2007.

Revised national surveillance case definition.

§ Updated case classifications.

Added to national notifiable disease list, 2007.

** New reporting guidelines.

Highlights for 2007

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

AIDS

Since 1981, confidential name-based AIDS surveillance has been the cornerstone of national, state, and local efforts to monitor the scope and impact of the HIV epidemic. The data have multiple uses, including the development of policy to help prevent and control AIDS. However, because of the introduction of therapies that effectively slow the progression of human immunodeficiency virus (HIV) infection, AIDS data no longer adequately represent the populations affected by the epidemic. By helping public health practitioners understand the epidemic at an earlier stage, combined HIV and AIDS data better represent the overall impact of HIV. As of April 2008, all 50 states, the District of Columbia, and five U.S. territories had implemented confidential name-based HIV reporting. These areas have integrated name-based HIV surveillance into their AIDS surveillance systems; names or other personal indentifying information are not reported to CDC.

At the end of 2007, an estimated 455,636 persons in the United States were living with AIDS (1). During 2003--2007, the estimated number of new AIDS cases decreased 7.5%, from 38,893 cases in 2003 to 35,962 in 2007. More than 1 million persons in the United States were estimated to have received an AIDS diagnosis from the beginning of the epidemic through the end of 2007.

  1. CDC. HIV/AIDS surveillance report, 2007. Atlanta, GA: US Department of Health and Human Services, CDC, Vol. 19; 2009. Available at http://www.cdc.gov/hiv/topics/surveillance/resources/reports.

Anthrax

In August 2007, two related cases of cutaneous anthrax, one confirmed and one probable, occurred in Connecticut. Exposure was determined to be the result of making traditional West African drums using untreated, Bacillus anthracis--contaminated goat hides that were imported from Guinea in the first case and cross-contamination of the residence by the drum maker in the second case. Both patients recovered with treatment (1). This event, and previous, unrelated cases of anthrax associated with contaminated animal skin drums (2,3), demonstrate the health risks that can be posed by drums made with hides imported from countries where anthrax is common. Persons who make, play or handle these drums, or who are exposed to environments cross-contaminated by the making of these drums, are potentially at risk.

Naturally occurring anthrax epizootics continue to be reported annually among U.S. wildlife and livestock populations, with epizootics reported by six states in 2007, including California, North and South Dakota, Minnesota, Montana, and Texas.

  1. CDC. Cutaneous anthrax associated with drum making using goat hides from West Africa--Connecticut, 2007. MMWR 2008;57:628--31.
  2. CDC. Inhalation anthrax associated with dried animal hides---Pennsylvania and New York City, 2006. MMWR 2006;55:280--2.
  3. National Health Service Borders. Report on the management of an anthrax incident in the Scottish borders, July 2006 to May 2007. Melrose, UK: National Health Service Borders; 2007. Available at http://www.nhsborders.org.uk/uploads/18645/anthrax_report_131207.pdf.

Arboviral, Neuroninvasive and Nonneuroinvasive

(West Nile virus)

During 2007, West Nile virus (WNV) activity was detected in 47 states and expanded into 19 counties that had not reported WNV activity previously. Human WNV disease cases were reported in 44 states (1). Nationally, the reported incidence of West Nile neuroinvasive disease (WNND) was 0.4 cases per 100,000 population, which is similar to that reported in 2004 (0.4), 2005 (0.4), and 2006 (0.5). The relative stability in the number of reported WNND cases during the past 4 years likely represents endemic WNV transmission in the continental United States. The highest incidence of WNND continued to occur in western and central states. In 2007, human WNV infection was identified for the first time in Puerto Rico among three asymptomatic blood donors.

  1. CDC. West Nile virus activity---United States, 2007. MMWR 2008;57;720--3.

Brucellosis

Since 2003, incidence of brucellosis in the United States has increased yearly. During 2006--2007, the number of cases increased 12.1%. The overall characteristics of persons with brucellosis remain stable. For patients for whom ethnicity was identified, 63.5% were Hispanic. The majority of cases were reported in the Southwest. In the U.S. animal population, brucellosis eradication efforts continue. In 2007, the U.S. Department of Agriculture declared Idaho a brucellosis Class Free state. Texas remained a Class A state but reported no new infected cattle herds (1). In total, 49 states and three territories were classified as Brucellosis Class Free states at the end of 2007 (1).

Risk factors associated with brucellosis include the consumption of unpasteurized milk or soft cheeses. The risk for brucellosis from dairy produced in the United States is low. Unpasteurized dairy from countries with endemic brucellosis remains a source of brucellosis for immigrants and travelers. Hunters are at an elevated risk, as Brucella abortus remains enzootic in elk and bison in the greater Yellowstone National Park area, and Brucella suis is enzootic in feral swine in the Southeast. In addition, exposure to Brucella spp. can occur accidentally in diagnostic and research laboratories because of a high potential for aerosol transmission (2). For the same reason, biosafety level 3 practices, containment, and equipment are recommended for laboratory manipulation of isolates (3). In the event of an exposure, postexposure prophylaxis can effectively prevent seroconversion and subsequent illness (4). CDC provides recommendations for laboratory exposures and can assist with the serological monitoring of exposed laboratory workers.

  1. Donch DA, Gertonson AA, Rhyan JH, Gilsdorf MJ. Status report---fiscal year 2007 cooperative state-federal Brucellosis Eradication Program. Washington, DC: US Department of Agriculture; 2008. Available at: http://www.aphis.usda.gov/animal_health/animal_diseases/brucellosis/downloads/yearly_rpt.pdf.
  2. CDC. Bioterrorism agents/diseases, by category. Atlanta, GA: US Department of Health and Human Services, CDC; 2006. Available at: http://www.bt.cdc.gov/agent/agentlist-category.asp#adef.
  3. CDC, National Institutes of Health. Biosafety in microbiological and biomedical laboratories (BMBL). 4th ed. Washington, DC: US Department of Health and Human Services, CDC, National Institutes of Health; 1999. Available at: http://www.cdc.gov/OD/OHS/biosfty/bmbl4/bmbl4toc.htm.
  4. CDC. Laboratory-Acquired Brucellosis---Indiana and Minnesota, 2006. MMWR 2008;57:39--42.

Cholera

Cases of cholera continue to be rare in the United States. The number of cases reported in 2007 was higher than the average number of cases per year reported during 2002--2006 (5.8) (1). Foreign travel continues to be the primary source of illness for cholera in the United States. Cholera remains a global threat to health, particularly in areas with poor access to improved water and sanitation, such as sub-Saharan Africa (2). All patients with domestic exposure in 2007 had consumed seafood. Other serogroups of cholera-toxin--producing Vibrio cholerae (e.g., O141 and O75) also have caused severe diarrhea in patients with a history of consumption of seafood from the Gulf Coast (3).

  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 twentieth century. J Infect Dis 2001;184:799--802.
  2. Gaffga NH, Tauxe RV, Mintz ED. Cholera: a new homeland in Africa. Am J Trop Med Hyg 2007;77:705--13.
  3. Tobin-D'Angelo M, Smith AR, Bulens SN, et al. Severe diarrhea caused by cholera toxin--producing Vibrio cholerae serogroup O75 infections acquired in the southeastern United States. Clin Infect Dis 2008;47:1035--40.

Coccidioidomycosis

During 2007, the number of reported coccidioidomycosis cases in the United States decreased slightly, primarily because of a decrease in the number of reports received from the disease-endemic states of Arizona and, to a lesser extent, California. Coccidioidomycosis is a common cause of community-acquired pneumonia in disease-endemic areas, despite infrequent testing.

In 2007, the Council of State and Territorial Epidemiologists adopted modifications to the previous surveillance case definitions (1). The revised case definition allows for a positive serologic test for IgG (any of several clinically accepted methods) without a confirmation of a rising IgG titer to be sufficient for case confirmation. As a result, case counts are expected to rise during 2008.

  1. Council of State and Territorial Epidemiologists. Revision of the surveillance case definition for Coccidioidomycosis. Position statement 07-ID-13. Atlanta, GA: Council of State and Territorial Epidemiologists; 2007. Available at http://www.cste.org/position%20statements/searchbyyear2007final.asp.

Cryptosporidiosis

In 2007, the number of cryptosporidiosis cases reported increased dramatically. This follows an increase in the number of cases in 2005 and 2006. The reasons for this continued increase are unclear but might reflect changes in jurisdictional reporting patterns, increased testing for Cryptosporidium, or a real increase in infection and disease caused by Cryptosporidium. Cryptosporidiosis is widespread geographically in the United States (1), and during 2004--2007, incidence increased in every state.

As in previous years, cryptosporidiosis case reports were influenced by outbreaks, particularly those associated with treated recreational water. Although cryptosporidiosis affects persons in all age groups, the number of reported cases was highest among children aged 1--9 years. A tenfold increase in transmission of cryptosporidiosis occurred during summer through early fall, coinciding with increased use of recreational water by younger children, which is a known risk factor for cryptosporidiosis. Cryptosporidium oocysts can be detected routinely in treated recreational water (2). Contamination of, and the subsequent transmission through, recreational water is facilitated by the substantial number of Cryptosporidium oocysts that can be shed by a single person; the extended periods of time that oocysts can be shed (3); the low infectious dose (4); the resistance of Cryptosporidium oocysts to chlorine (5); and the prevalence of improper pool maintenance (i.e., insufficient disinfection, filtration, and recirculation of water), particularly of children's wading pools (6).

  1. CDC. Cryptosporidiosis surveillance---United States, 2003--2005. In: Surveillance Summaries, September 7, 2007. MMWR 2007;56(No. SS-7):1--10.
  2. Shields JM, Gleim ER, Beach MJ. Prevalence of Cryptosporidium spp. and Giardia intestinalis in swimming pools, Atlanta, Georgia. Emerg Inf Dis 2008;14:948--50.
  3. Chappell CL, Okhuysen PC, Sterling CR, DuPont HL. Cryptosporidium parvum: intensity of infection and oocyst excretion patterns in healthy volunteers. J Infect Dis 1996;173:232--6.
  4. DuPont HL, Chappell CL, Sterling CR, Okhuysen PC, Rose JB, Jakubowski W. The infectivity of Cryptosporidium parvum in healthy volunteers. N Engl J Med 1995;332:855--9.
  5. Korich DG, Mead JR, Madore MS, Sinclair NA, Sterling CR. Effects of ozone, chlorine dioxide, chlorine, and monochloramine on Cryptosporidium parvum occyst viability. Appl Environ Microbiol 1990;56:1423--8.
  6. CDC. Surveillance data from swimming pool inspections---selected states and counties, United States, May--September 2002. MMWR 2003;52:513--6.

Ehrlichiosis and Anaplasmosis

Human monocytic ehrlichiosis (also called HME or ehrlichiosis, caused by Ehrlichia chaffeensis) and human granulocytic ehrlichiosis (also called HGE or anaplasmosis, caused by Anaplasma phagocytophilum) have been reported since 1999. Cases reported for 2007 represent a 44% increase in HME and a 29% increase in HGE over those reported for 2006, and an overall 159% and 130% increase since 2003, respectively. Increases in the numbers of reported cases might be the result of several factors, including possible increases in vector tick populations, or increases in human/tick contact as a result of human encroachment into tick habitat through recreational activities and housing construction. In addition, artifactual increases in reported cases might relate to changes in surveillance techniques or perception/awareness of disease, as might occur through changes in case definitions (which occurred in 2000 and 2004), and the constant evolution of laboratory tests most commonly available for diagnosis.

Expected geographic areas of occurrence for ehrlichiosis and anaplasmosis are based on known distributions of primary tick vectors responsible for infection. HME (ehrlichiosis) cases are expected to be reported primarily in the lower Midwest and the Southeast, reflecting the range of the primary tick vector species (Amblyomma americanum). HGE (anaplasmosis) cases are expected to be reported primarily from the upper Midwest and coastal New England, reflecting both the range of the primary tick vector species (Ixodes scapularis) and preferred animal hosts for tick feeding. However, human antibody responses to both of these infections often exhibit strong immunologic cross-reactivity using available serologic laboratory tests. In certain areas in which the range of expected tick vectors is known to overlap (e.g., in the central eastern United States) and for which one species is not differentiated by serologic testing, cases might be reported most appropriately as "Ehrlichiosis, unspecified." However, the large number of cases of "Human Monocytic Ehrlichiosis" and "Ehrlichiosis, unspecified" reported from the northeastern and upper midwestern United States more likely reflects situations in which physicians, confused as to causative agent, ordered single, incorrect tests resulting in incomplete diagnostic testing and interpretation (e.g., physicians ordering only HME tests in a region where HGE would be expected to predominate). Ehrlichia ewingii cases reflected in the "Ehrlichiosis, unspecified" category are impossible to ascertain, because only molecular diagnostic tests can be used to diagnose ehrlichiosis resulting from this infection; however, numbers are expected to be low.

Since the 2007 reporting year, the case definitions for these diseases have been modified by a resolution adopted by the Council of State and Territorial Epidemiologists to include a separate designation for E. ewingii for better assessment and counting of cases; the new category names and the new case definitions became effective January 1, 2008 (1) and will be first reflected in the 2008 Notifiable Disease Summary epidemiology of gonorrhea.

  1. Council of State and Territorial Epidemiologists. Revision of the surveillance case definitions for Ehrlichiosis. Position statement 07-ID-03. Atlanta, GA: Council of State and Territorial Epidemiologists; 2007. Available at http://www.cste.org/position%20statements/searchbyyear2007final.asp.

Hansen Disease (Leprosy)

The number of cases of Hansen disease (HD) reported in the United States peaked at 361 in 1985 and decreased from 1988 until 2006. In 2007, the number of cases reported to CDC increased by 49% from the number reported in 2006; this increase might be attributable to CDC attempts made to improve reporting. Cases were reported from 25 states and two U.S. territories; 69% of cases were reported from Texas, Hawaii, Florida, California, New York City, and Guam. HD is not highly transmissible; cases appear to be related predominantly to immigration from areas in which the disease is endemic. More information on access to clinical care is available at http://www.hrsa.gov/hansens.

Hemolytic Uremic Syndrome, Postdiarrheal

Hemolytic uremic syndrome (HUS) is characterized by the triad of hemolytic anemia, thrombocytopenia, and renal insufficiency. The most common etiology of HUS in the United States is infection with Shiga toxin--producing Escherichia coli, principally E. coli O157:H7 (1). Approximately 8% of persons infected with E. coli O157:H7 progress to HUS (2). During 2007, as usual, the majority of reported cases occurred among children aged 1--4 years.

  1. Banatvala N, Griffin PM, Greene KD, et al. The United States prospective hemolytic uremic syndrome study: microbiologic, serologic, clinical, and epidemiologic findings. J Infect Dis 2001;183:1063--70.
  2. Slutsker L, Ries AA, Maloney K, et al. A nationwide case-control study of Escherichia coli O157:H7 infection in the United States. J Infect Dis 1998;177:962--6.

Viral Hepatitis, Acute

Implementation of the 1999 recommendations for routine childhood hepatitis A vaccination in the United States has reduced rates of infection; universal vaccination of children against hepatitis B also has reduced disease incidence substantially among younger age groups (1). Higher rates of hepatitis B virus (HBV) infections continue among adults, particularly men aged 25 -- 44 years, reflecting the need to vaccinate adults at risk for HBV infection (e.g., injection-drug users [IDUs] and men who have sex with men). Although screening of blood after 1992 for hepatitis C antibodies has been important, the decline in hepatitis C incidence that has occurred in the past decade is attributable primarily to a decrease in incidence among IDUs (2). The reasons for this decrease are unknown but likely reflect changes in behavior and practices among this population.

In 2006, the expansion of recommendations for routine hepatitis A vaccination to include all children in the United States aged 12-- 23 months is expected to reduce hepatitis A rates further. Ongoing hepatitis B vaccination programs ultimately will eliminate domestic HBV transmission, and increased vaccination of adults with risk factors will accelerate progress toward elimination. Prevention of hepatitis C relies on identifying and counseling uninfected persons at risk for hepatitis C (e.g., IDUs) regarding ways to protect themselves from infection and on identifying and preventing transmission of HCV in health-care settings (3).

  1. CDC. Surveillance for acute viral hepatitis---United States, 2006. In: Surveillance Summaries, March 21, 2008. MMWR 2008;57(No. SS-2).
  2. Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med 2006; 144:705--14.
  3. Thompson NA, Perz JF, Moorman AC, Holmberg SD. Nonhospital health-care associated hepatitis B and C transmission---United States, 1998--2008. Ann Intern Med. 2009;150:33--9.

HIV Infection, Adult

Since 2004, a total of 39 areas (34 states and five dependent areas) have had laws or regulations requiring confidential name-based reporting for human immunodeficiency virus (HIV) infection, in addition to reporting of persons with AIDS. In 2002, CDC initiated a system to monitor HIV incidence; in 2003 this system was expanded. On the basis of extrapolations for the 22 states with HIV incidence surveillance, the estimated number of new HIV infections for the United States in 2006 was 56,3000 (1).

At the end of 2007, an estimated total of 261,741 adults and adolescents in the 39 areas were living with HIV infection (not AIDS) (2). The estimated prevalence rate of HIV infection (not AIDS) in this group was 154.2 per 100,000 population. In these areas, 2007 was the first year in which mature HIV surveillance data (i.e., data available since at least 2003) could be used to allow for stabilization of data collection and for adjustment of the data for reporting delays. Data from additional areas will be included in analyses when ≥4 years of HIV case reports have accrued.

  1. Hall HI, Song R, Rhodes, P, et al. Estimation of HIV incidence in the United States. JAMA 2008;300:520--9.
  2. CDC. HIV/AIDS surveillance report, 2007. Atlanta, GA: US Department of Health and Human Services, CDC; 2009. Available at http://www.cdc.gov/hiv/topics/surveillance/resources/reports.

HIV Infection, Pediatric

At the end of 2007, in the 39 areas (34 states and five dependent areas) that have had confidential name-based human immunodeficiency virus (HIV) surveillance since at least 2003 for children aged <13 years with confirmed HIV infection, an estimated 2,195 children were living with HIV infection (not AIDS) (1). Estimated prevalence of HIV infection (not AIDS) in this group was 6.0 per 100,000 population.

  1. CDC. HIV/AIDS surveillance report, 2007. Atlanta, GA: US Department of Health and Human Services, CDC, Vol. 19; 2009. Available at http://www.cdc.gov/hiv/topics/surveillance/resources/reports.

Influenza-Associated Pediatric Mortality

An early and severe influenza season during 2003--2004 was associated with deaths in children in several states, prompting CDC to request that all state, territorial, and local health departments report laboratory-confirmed influenza-associated pediatric deaths in children aged <18 years (1,2). During the 2003--04 influenza season, 153 pediatric influenza-associated deaths were reported to CDC by 40 state health departments (3). In June 2004, the Council of State and Territorial Epidemiologists added influenza-associated pediatric mortality to the list of conditions reportable to the National Notifiable Diseases Surveillance System (4). Cumulative year-to-date incidence is published each week in MMWR Table I for low-incidence nationally notifiable diseases.

The number of influenza associated pediatric deaths reported to CDC increased during 2007 compared with 2006 (77 and 43, respectively). The median age at death was 7.4 years (range: 9 days---17.8 years) and was higher than in 2006 (median age: 4 years). In 2007, a total of 13 children (17%) were aged <6 months; 10 (13%) were aged 6--23 months; 10 (13%) were aged 24--59 months; and 44 (57%) were aged >5 years. In 2007, of the 76 children for whom location at the time of death was reported, 42 (55%) died after being admitted to the hospital, whereas 34 (45%) died in the emergency room or outside the hospital. The percentage of children who died in the emergency room or outside the hospital was similar to that reported during 2006 (47%). Information on underlying or chronic medical conditions was reported for 72 children: 31 (43%) children had one or more underlying or chronic conditions, and 41 (57%) were previously healthy. The more common chronic conditions reported included moderate to severe developmental delay (n = 11), seizure disorder (n = nine), asthma (n = seven), cardiac disease (n = six), and a history of febrile seizures (n = four). Invasive bacterial coinfection was reported in 28 (36%) children. This represents an increase compared with 2006, when seven (16%) of 43 children had bacterial coinfections. Staphylococcus aureus was the most frequently reported bacterial pathogen in 2007 and was found in 19 (68%) of the 28 children with coinfections. Of the 19 Staphylococcus isolates, 13 were methicillin-resistant, four were methicillin-sensitive, and for two, sensitivity testing was not performed. Other bacterial pathogens identified included Group A Streptococcus (n = four), Group B Streptococcus (n = one), Klebseilla pneumoniae (n = one), Haemophilus influenzae (n = one), Acinebactor (n = one), Enterobacter cloacae (n = one), Haemophilus influenzae (n = one), and Nocardia (n = one). Two children had two bacterial pathogens identified. Data on influenza vaccination status were reported for 71 children: six children (8%) received at least 1 dose of influenza vaccine before the onset of illness during 2007, and only four (6%) were fully vaccinated. The current recommendations of CDC's Advisory Committee on Immunization Practices (ACIP) (5) include annual vaccination of all children aged 6 months--18 years. Annual vaccination of all children aged 5--18 years should begin in September or as soon as vaccine is available for the 2008--09 influenza season, if feasible, but annual vaccination of all children aged 5--18 years should begin no later than during the 2009--10 influenza season. Administration of 2 doses of influenza vaccine is necessary for previously unvaccinated children aged 6 months--<9 years. Continued surveillance of severe influenza-related mortality is important to monitor the effect of influenza and the possible effects of interventions in children.

  1. CDC. Update: influenza-associated deaths reported among children aged <18 years---United States, 2003--04 influenza season. MMWR 2004;52:1254--5.
  2. CDC. Update: influenza-associated deaths reported among children aged <18 years---United States, 2003--04 influenza season. MMWR 2004;52:1286-8.
  3. Bhat N, Wright JG, Broder KR, et al. Influenza-associated deaths among children in the United States, 2003-2004. N Engl J Med 2005;352:2559--67.
  4. CDC. Mid-year addition of influenza-associated pediatric mortality to the list of nationally notifiable diseases, 2004. MMWR 2004;53:951--2.
  5. CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2007;57(No. RR-7).

Legionellosis

Total legionellosis case reports and incidence for the past 5 years have been consistently higher than earlier years. During 2007, a slight decline occurred in the number of reported legionellosis cases compared with 2006. Compared with 2006, the Mid-Atlantic region had the greatest decline in reported cases in 2007 (14%), whereas the West South Central region, specifically Texas, had the greatest increase in reported cases (63%).

Though approximately 40% of reported cases occur in persons aged ≥ 65 years, pediatric cases (aged ≤ 18 years) were reported and accounted for approximately 1% of cases. Although legionellosis is less common in the pediatric population than among adults, many cases are likely undiagnosed. As in previous years, the majority of reported cases were sporadic; of those with known outbreak status, less than 1% were reported to be associated with an outbreak.

Listeriosis

Listeriosis is a rare but severe infection caused by Listeria monocytogenes; it has been a nationally notifiable disease since 2000. Listeriosis is primarily foodborne and occurs most frequently among persons who are older, pregnant, or immunocompromised. During 2007, the majority of cases occurred among persons aged ≥65 years.

Molecular subtyping of L. monocytogenes isolates and sharing of that information through PulseNet has enhanced the ability of public health officials to detect and investigate outbreaks. Recent outbreaks have been linked to ready-to-eat deli meat (1) and unpasteurized cheese (2). During 2007, the incidence of listeriosis in FoodNet active surveillance sites was 0.27 cases per 100,000 population, representing a decrease of 42% compared with 1996--1998; however, the incidence remained higher than at its lowest point in 2002 (3).

All clinical isolates should be submitted to state public health laboratories for pulsed-field gel electrophoresis (PFGE) pattern determination, and all persons with listeriosis should be interviewed by a public health official or health-care provider using a standard Listeria case form, available at http://www.cdc.gov/nationalsurveillance/PDFs/ListeriaCaseReportFormOMB0920-0004.pdf. Rapid analysis of surveillance data will allow identification of possible food sources of outbreaks.

  1. Gottlieb SL, Newbern EC, Griffin PM, et al. Multistate outbreak of listeriosis linked to turkey deli meat and subsequent changes in US regulatory policy. Clin Infect Dis 2006;42:29--36.
  2. MacDonald PDM, Whitwam RE, Boggs JD et al. Outbreak of listeriosis among Mexican immigrants caused by illicitly produced Mexican-style cheese. Clin Infect Dis 2005;40:677--82.
  3. CDC. Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food -- 10 states, 2007. MMWR 2008;57:366--70.

Lyme Disease

Lyme disease is caused in North America by Borrelia burgdorferi sensu stricto, a spirochete transmitted by infected Ixodes ticks. Manifestations of infection include erythema migrans, arthritis, carditis, and neurologic deficits. During 2006--2007, the number of reported cases increased 38%, reaching 15% higher than the previous maximum reported in 2002. Much of this increase can be attributed to enhanced surveillance although evidence of true emergence exists in certain areas. The risk for Lyme disease can be reduced by avoiding tick-infested areas, using insect repellent containing N, N-diethyl-m-toluamide (DEET), and checking daily for attached ticks. The abundance of ticks around the home can be reduced through landscape modification and the use of area-wide acaricides (1,2).

  1. Stafford KC III. Tick management handbook: an integrated guide for homeowners, pest control operators, and public health officials for the prevention of tick-associated disease. New Haven, CT: Connecticut Agricultural Experiment Station; 2004. Available at http://www.cdc.gov/ncidod/dvbid/lyme/resources/handbook.pdf.
  2. Hayes EB, Piesman J. How can we prevent Lyme disease? N Eng J Med 2003;348:2424--30.

Measles

As in recent years, 95% of confirmed measles cases in 2007 were import-associated. Of these, 29 cases were internationally imported and 12 resulted from exposure to persons with imported infections (1). The sources for the remaining two cases were classified as unknown because no link to importation was detected. More than half of all cases for 2007 occurred among adults aged >20 years; four persons were aged >50 years. Thirty-five percent of all cases occurred in U.S. residents who acquired infection while outside the United States, 80% of whom had either never been vaccinated with measles-containing vaccine or had unknown vaccination histories. Four outbreaks occurred during 2007 (range: 3--7 cases), all from imported sources. One outbreak associated with an international sporting event resulted in transmission to seven patients in three states, including one airline passenger and an airport worker (2). Although the elimination of endemic measles in the United States has been achieved, and population immunity remains high (3), outbreaks can occur when measles is introduced into susceptible groups, often at substantial cost to control (4). Measles can be prevented by adhering to recommendations for vaccination, including guidelines for travelers (5,6).

  1. Council of State and Territorial Epidemiologists. Revision of measles, rubella, and congenital rubella syndrome case classifications as part of elimination goals in the United States. Position statement 2006-ID-16. Atlanta, GA: Council of State and Territorial Epidemiologists; 2006. Available at http://www.cste.org/position%20statements/searchbyyear2006.asp.
  2. CDC. Multistate measles outbreak associated with an international youth sporting event---Pennsylvania, Michigan, and Texas, August--September 2007. MMWR 2008;57:169--73.
  3. Hutchins SS, Bellini W, Coronado V, et al. Population immunity to measles in the United States. J Infect Dis 2004;189(Suppl 1):S91--97.
  4. Parker AA, Staggs W, Dayan G, et al. Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States. N Engl J Med 2006;355:447--55.
  5. CDC. Preventable measles among U.S. residents, 2001--2004. MMWR 2005;54:817--20.
  6. CDC. Measles, mumps, and rubella---vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee On Immunization Practices (ACIP). MMWR 1998;47(No. RR-8).

Meningococcal Disease, Invasive

Neisseria meningitidis is a leading cause of bacterial meningitis and sepsis in the United States. Rates of meningococcal disease are highest among infants, with a second peak at age 18 years (1). Rates of meningococcal disease are the lowest they have been in the United States, but meningococcal disease continues to cause substantial morbidity and mortality in all ages.

A tetravalent (A,C,Y,W-135) meningococcal conjugate vaccine ([MCV4] Menactra(r) (Sanofi Pasteur, Swiftwater, Pennsylvania) is licensed for persons aged 2--55 years. In 2007, CDC's Advisory Committee on Immunization Practices revised recommendations for routine use of MCV4 to include children aged 11--12 years at the preadolescent vaccination visit and adolescents aged 13--18 years at the earliest opportunity (2). MCV4 also is recommended for college freshmen living in dormitories and other populations aged 2--55 years at increased risk for meningococcal disease (1). Further reductions in meningococcal disease could be achieved with the development of an effective serogroup B vaccine.

  1. CDC. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2005;54(No. RR-7).
  2. CDC. Notice to readers: revised recommendations of the Advisory Committee on Immunization Practices to vaccinate all persons aged 11--18 years with meningococcal conjugate vaccine. MMWR 2007;56:794--5.
  3. CDC. Use of quadrivalent meningococcal conjugate vaccine (MCV4) in children aged 2--10 years at increased risk for invasive meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. MMWR 2007;56:1265.

Mumps

Since mumps vaccine licensure in 1967, the number of cases of mumps in the United States declined steadily until 2006, when the largest mumps outbreak in >20 years occurred, with >6,000 cases reported (1--4). In response to the 2006 outbreak, CDC's Advisory Committee on Immunization Practices (ACIP) updated criteria for mumps immunity and mumps vaccination recommendations (5). Acceptable presumptive evidence of immunity to mumps includes one of the following: 1) documentation of adequate vaccination, 2) laboratory evidence of immunity, 3) birth before 1957, or 4) documentation of physician-diagnosed mumps. Documentation of adequate vaccination now requires 2 doses of a live mumps virus vaccine for school-aged children (grades K--12) and adults at high risk (i.e., persons who work in health-care facilities, international travelers, and students at post--high school educational institutions). Health-care workers born before 1957 without other evidence of immunity should now consider 1 dose of live mumps vaccine. During an outbreak, a second dose of live mumps vaccine should be considered for children aged 1--4 years and adults at low risk if affected by the outbreak; health-care workers born before 1957 without other evidence of immunity should strongly consider 2 doses of live mumps vaccine. In 2007, the Council of State and Territorial Epidemiologists revised the mumps case definition for surveillance to be implemented January 1, 2008 (6).

  1. CDC. Mumps epidemic---Iowa, 2006. MMWR 2006;55:366--8.
  2. CDC. Update: multistate outbreak of mumps---United States, January 1--May 2, 2006. MMWR 2006;55:559--63.
  3. CDC. Update: mumps activity---United States, January 1--October 7, 2006. MMWR 2006;55:1152--3.
  4. Dayan G, Quinlisk P, et al. Recent resurgence of mumps in the United States. New Engl J Med 2008;358:1580--9.
  5. CDC. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP) for the control and elimination of mumps. MMWR 2006;55:629--30.
  6. Council of State and Territorial Epidemiologists. Atlanta, GA: Council of State and Territorial Epidemiologists; 2007. Revision of the surveillance case definition for mumps 07-ID-02. Available at http://www.cste.org/PS/2007ps/2007psfinal/ID/07-ID-02.pdf.

Novel Influenza A Virus

In 2007, the Council of State and Territorial Epidemiologists adopted a position statement to include human infection with influenza A viruses that are different from currently circulating human influenza A(H1) and A(H3) as a reportable condition (1). Novel subtypes include, but are not limited to, completely different hemagglutinin glycoproteins such as H2, H5, H7, and H9, or influenza H1 and H3 subtypes originating from a nonhuman species or from genetic reassortment between animal and human viruses (2).

In 2007, human cases of novel influenza A infection were reported from three states (Ohio, Illinois, and Michigan). Ill patients were infected with swine influenza A viruses: (swine H1N1 and H1N2). Both the swine H1N1 and H1N2 viruses were triple reassortants containing genes from swine, avian, and human viruses; both have been detected in recent years during outbreaks of respiratory illness in swine herds. Transmission of swine influenza viruses to humans usually occurs among persons in direct contact with ill pigs or persons who have been in places where pigs might have been present (e.g. agricultural fairs, farms, or petting zoos). Infected persons had either direct exposure to sick pigs or indirect exposure to a setting in which sick pigs were present. These cases, as with the other sporadic cases identified in recent years, have not resulted in sustained human-to-human transmission or community outbreaks.

  1. Council of State and Territorial Epidemiologists. National reporting of novel influenza A virus infections. Atlanta, GA: Council of State and Territorial Epidemiologists; 2007. Available at http://www.cste.org/ps/2007pdfs/novelfluanndssjan10final23.pdf.
  2. CDC. Novel influenza virus A case definition 2007. Atlanta, GA: US Department of Health and Human Services, CDC; 2007. Available at http://www.cdc.gov/ncphi/disss/nndss/casedef/novel_influenzaA.htm.

Pertussis

In 2007, the incidence of reported cases of pertussis (3.62 cases per 100,000 population) continued to decline after peaking during 2004--2005 at 8.9 cases per 100,000 population. Infants aged <6 months, who are too young to be fully vaccinated, had the highest reported rate of pertussis (69.9 cases per 100,000 population), but adolescents aged 10--19 years and adults aged >20 years contributed the greatest number of reported cases. Adolescents and adults might be a source of transmission of pertussis to young infants, who are at higher risk for severe disease and death and are recommended to be vaccinated with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) (1,2). Although coverage with Tdap in adolescents aged 13--17 years increased during 2006--2007, from 10.8% to 30.4%, whether increased Tdap coverage has had an effect on disease rates is unknown (3).

  1. CDC. Preventing tetanus, diphtheria, and pertussis among adolescents; use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2006;55(No. RR-3).
  2. CDC. Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP) and Recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for use of Tdap among health-care personnel. MMWR 2006;55(No. RR-17).
  3. CDC. National vaccination coverage among adolescents aged 13--17 years---United States, 2007. MMWR 2008;57:1100--3.

Poliomyelitis, Paralytic and Poliovirus Infections, Nonparalytic

Since January 2007, in addition to paralytic poliomyelitis, nonparalytic poliovirus infections have been included in the list of nationally notifiable diseases reported through the National Notifiable Diseases Surveillance System (1,2). This addition resulted from the identification in 2005 of a type 1 vaccine-derived poliovirus (VDPV) infection among unvaccinated Minnesota children from a closed religious community who were not paralyzed (3). VDPV and wild polioviruses are still circulating worldwide and can be imported into the United States via U.S. or foreign-national travelers to these areas (4). Oral polio virus vaccine remains in widespread use globally and can be excreted in healthy and immunocompromised vaccinated persons. In 2005, a case of contact-acquired vaccine-associated paralytic poliomyelitis (VAPP) acquired overseas, occurred in an unvaccinated U.S. young adult (5). Public health officials should remain alert that paralytic poliomyelitis or poliovirus infections might occur in high-risk (i.e., unvaccinated or undervaccinated) populations and should report any detected poliovirus infections attributed to either wild or vaccine-derived polioviruses and any paralytic poliomyelitis cases.

  1. Council of State and Territorial Epidemiologists. Inclusion of poliovirus infection reporting in the National Notifiable Diseases Surveillance System. Position statement 2006-ID-15. Atlanta, GA: Council of State and Territorial Epidemiologists; 2006. Available at: http://www.cste.org/position%20statements/searchbyyear2006.asp.
  2. CDC. Poliovirus infections in four unvaccinated children---Minnesota, August--October 2005. MMWR 2005;54:1053--5.
  3. CDC. U.S.-incurred costs of wild poliovirus infections in a camp with U.S.-bound refugees---Kenya, 2006. MMWR 2008;57:232--5.
  4. CDC. Imported vaccine-associated paralytic poliomyelitis---United States, 2005. MMWR 2006;55:97--9.

Psittacosis

Human infection with Chlamydophila psittaci (psittacosis) is a potentially severe respiratory illness that occurs through exposure to infected birds. In 2007, the incidence of reported psittacosis cases continued to be low, decreasing slightly compared with 2006. The majority of cases occurred among women aged 25--49 years. Additional information regarding psittacosis, including case reporting tools, is available at http://www.nasphv.org/documentsCompendiaPsittacosis.html.

Q Fever

Q fever (caused by Coxiella burnetii) has been reported since 1999. Cases of Q fever reported for 2007 were similar to those reported for 2006, with a decrease of 9%. Despite this year's slight decrease, the overall number of cases reported in 2007 has increased 115% percent since 2003. In 2007, cases were distributed across the United States, in keeping with the consideration that Q fever is considered enzootic in ruminants (sheep, goats, and cattle) throughout the country. Although relatively few human cases are reported annually, the disease is believed to be substantially underreported because of its nonspecific presentation and the subsequent failure to suspect infection and request appropriate diagnostic tests. The 2007 reporting strategy does not differentiate acute Q fever infection from the more serious, life-threatening chronic form of infection, typically associated with endocarditis. The case definition for Q fever has been modified by a resolution adopted by the Council of State and Territorial Epidemiologists to include separate designations for acute and chronic forms of infection; the new category names and new case definitions became effective January 1, 2008 (1,2) and will be reflected in the 2008 Notifiable Disease Summary.

  1. Council of State and Territorial Epidemiologists. Revision of the surveillance case definitions for Q fever. Position statement 07-ID-04. Atlanta, GA: Council of State and Territorial Epidemiologists; 2007. Available at http://www.cste.org/position%20statements/searchbyyear2007final.asp.
  2. Council of State and Territorial Epidemiologists. Revision of the surveillance case definitions for Q fever. Position statement 08-ID-06. Atlanta, GA: Council of State and Territorial Epidemiologists; 2008. Available at http://www.cste.org/position%20statements/searchbyyear2008final.asp.

Rabies

One case of human rabies was reported during 2007 in a male aged 46 years from Minnesota. Epidemiologic investigation of this case implicated exposure to a bat as the most likely source of infection. As in previous years, the majority of animal rabies cases were reported in wild animal species. In the United States, five animal species are recognized as reservoir species for various rabies virus variants over defined geographic regions: raccoons (eastern United States.), bats (various species, all U. S. states except Hawaii), skunks (north central United States, south central United States, and California), foxes (Alaska, Arizona, and Texas), and mongoose (Puerto Rico) (1).

Reported cases of rabies in domestic animals remain low, in part as a result of high vaccination rates and the elimination of dog-to-dog rabies transmission, which has not been reported in 3 years. One case of canine rabies imported in a dog from India was reported during 2007 (2). This case represents the continued challenge to the United States to remain canine-rabies--free. As in the past decade, cats were the most commonly reported domestic animal with rabies during 2007.

Vaccination programs to control rabies in wild carnivores are ongoing through the distribution of baits containing an oral rabies vaccine in the eastern United States and Texas. Oral rabies vaccination programs in Texas are being maintained as a barrier to prevent the reintroduction of canine rabies from Mexico and to eliminate rabies in gray foxes in west Texas. Oral rabies vaccination programs also are being conducted in the eastern United States in an attempt to stop the westward spread of the raccoon rabies virus variant. In addition to oral rabies vaccination programs and routine public health activities (e.g., companion animal vaccination), public health education should target health-care providers and the public regarding rabies exposure prevention and postexposure prophylaxis recommendations.

  1. Blanton JD, Palmer D, Christian K, Rupprecht CE. Rabies surveillance in the United States during 2007. J Am Vet Med Assoc 2008;233:884--97.
  2. Castrodale L, Walker V, Baldwin J, et al. Rabies in a puppy imported from India to the USA, March 2007. Zoonoses and Public Health 2008;55:427--30.

Rocky Mountain Spotted Fever

After several years in which case numbers were observed to have risen more than twofold, the 2007 reporting year for Rocky Mountain spotted fever (RMSF) caused by Rickettsia rickettsii appeared similar to 2006, decreasing only 3%. Cases in 2007 were distributed across the United States, reflecting the endemic status of RMSF and the widespread ranges of the primary tick vectors responsible for transmission (primarily Dermacentor variabilis and Dermacentor andersonii). RMSF cases associated with transmission by Rhipicephalus sanguineus, first reported in 2004, continued to be associated with cases reported from Arizona during 2007. (1). The overall 103% increase in the number of reported RMSF cases in the United States during the past 5 years might result from several factors, including possible increases in vector tick populations or increases in human/tick contact as a result of human encroachment into tick habitat through recreational activities and housing construction. In addition, artifactual increases in reported cases might reflect changes in surveillance techniques or perception/awareness of disease, as might occur through changes in case definitions (which occurred in 2004), increased recognition and reporting of illness that might be associated with genetically distinct rickettsial species incorrectly diagnosed as RMSF, and the constant evolution of laboratory tests most commonly available for diagnosis. The case definition for RMSF has been modified by a resolution adopted by the Council of State and Territorial Epidemiologists to include more specific information on interpretation of diagnostic laboratory criteria; the new case definitions became effective January 1, 2008 (2) and will be first reflected in the 2008 Summary of Notifiable Diseases.

  1. L Demma, Traeger M, Nicholson W, et al. Rocky Mountain spotted fever from an unexpected tick vector in Arizona. New Engl J Med 2005;353:587--94.
  2. Council of State and Territorial Epidemiologists. Revision of the surveillance case definitions for Rocky Mountain spotted fever. Position statement 07-ID-05. Atlanta, GA: Council of State and Territorial Epidemiologists; 2007. Available at http://www.cste.org/position%20statements/searchbyyear2007final.asp.

Salmonellosis

During 2007, as in previous years, proportionately the majority of cases of salmonellosis occurred among persons aged <5 years. Since 1993, the most frequently reported isolates have been Salmonella enterica serotype Typhimurium and S. enterica serotype Enteritidis (1). The epidemiology of Salmonella has been changing during the past decade. Salmonella serotype Typhimurium has decreased in incidence, whereas the incidence of serotypes Newport, Mississippi, and Javiana have increased. Specific control programs might have led to the reduction of serotype Enteritidis infections, which have been associated with the consumption of internally contaminated eggs. Rates of antibiotic resistance among several serotypes have been increasing; a substantial proportion of serotypes Typhimurium and Newport isolates are resistant to multiple drugs (2). The epidemiology of Salmonella infections is based on serotype characterization, and in 2005, the Council of State and Territorial Epidemiologists adopted a position statement for serotype-specific reporting of laboratory-confirmed salmonellosis cases (3).

  1. CDC. Salmonella Surveillance summary, 2006. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC; 2008. Available at http://www.cdc.gov/nationalsurveillance/salmonella_surveillance.html.
  2. CDC. National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS): 2004 human isolates final report. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC; 2007.
  3. Council of State and Territorial Epidemiologists. Position statement 05-ID-09. Serotype specific national reporting for salmonellosis. Atlanta, GA: Council of State and Territorial Epidemiologists; 2005. Available at http://www.cste.org/PS/2005pdf/final2005/05-ID-09final.pdf.

Shiga Toxin-Producing Escherichia coli (STEC)

Escherichia coli O157:H7 has been nationally notifiable since 1994 (1). National surveillance for all Shiga toxin-producing E. coli (STEC), under the name enterohemorrhagic E. coli (EHEC), began in 2001. In 2006, the nationally notifiable diseases case definition designation was changed from EHEC to STEC, and serotype-specific reporting was implemented (2). Diagnosis solely on the basis of detection of Shiga toxin does not protect public health sufficiently; characterizing STEC isolates by serotype and pulsed-field gel electrophoresis (PFGE) patterns is important to detect, investigate, and control outbreaks. Screening of stool specimens by clinical diagnostic laboratories for Shiga toxin by enzyme immunoassay with simultaneous bacterial culture using sorbitol-MacConkey agar (SMAC) is important for public health surveillance for STEC infections (3). All STEC isolates and enrichment broths from Shiga toxin-positive specimens that do not yield STEC O157 should be forwarded to state or local public health laboratories for further testing.

Healthy cattle, which harbor the organism as part of the bowel flora, are the main animal reservoir of STEC. The majority of reported outbreaks are caused by contaminated food or water. The substantial decline in STEC cases reported during 2002--2003 coincided with industry and regulatory control activities and with a decrease in the contamination of ground beef (4). However, during 2005--2007, incidence of human STEC infections increased. Reasons for the increases are not known.

  1. Mead PS, Griffin PM. Escherichia coli O157:H7. Lancet 1998;352:1207--12.
  2. Council of State and Territorial Epidemiologists. Revision of the Enterohemorrhagic Escherichia coli (EHEC) condition name to Shiga toxin-producing Escherichia coli (STEC) and adoption of serotype specific national reporting for STEC. Position statement 05-ID-07. Atlanta, GA: Council of State and Territorial Epidemiologists; 2005. Available at http://www.cste.org/position%20statements/searchbyyear2005.asp.
  3. CDC. Importance of culture confirmation of Shiga toxin-producing Escherichia coli infection as illustrated by outbreaks of gastroenteritis---New York and North Carolina, 2005. MMWR 2006;55:1042--4.
  4. Naugle AL, Holt KG, Levine P, Eckel R. 2005 Food Safety and Inspection Service regulatory testing program for Escherichia coli O157:H7 in raw ground beef. J Food Prot 2005;68:462--8.

Shigellosis

During 1978--2003, the number of shigellosis cases reported to CDC consistently exceeded 17,000. The approximately 14,000 cases of shigellosis reported to CDC in 2004 represented an all-time low. This number increased to approximately 16,000 in 2005, decreased slightly in 2006, and increased to almost 20,000 in 2007. Shigella sonnei infections continue to account for >75% of shigellosis in the United States (1). The majority of cases occur among young children, and large daycare-associated outbreaks are common and difficult to control (2). Certain cases are acquired during international travel (3,4). In addition to spread from one person to another, Shigellae can be transmitted through contaminated foods, sexual contact, and water used for drinking or recreational purposes (1). Resistance to ampicillin and trimethoprim-sulfamethoxazole among S. sonnei strains in the United States remains common (5).

  1. Gupta A, Polyak CS, Bishop RD, Sobel J, Mintz ED. Laboratory-confirmed shigellosis in the United States, 1989--2002: epidemiologic trends and patterns. Clin Infect Dis 2004;38:1372--7.
  2. CDC. Outbreaks of multidrug-resistant Shigella sonnei gastroenteritis associated with day care centers---Kansas, Kentucky, and Missouri, 2005. MMWR 2006;55:1068-71.
  3. Ram PK, Crump JA, Gupta SK, Miller MA, Mintz, ED. Review article: part II. Analysis of data gaps pertaining to Shigella infections in low and medium human development index countries, 1984--2005. Epidemiol Infect 2008;136:577-603.
  4. Gupta SK, Strockbine N, Omondi M, Hise K, Fair MA, Mintz ED. Short report: emergence of shiga toxin 1 genes within Shigella dysenteriae Type 4 isolates from travelers returning from the island of Hispañola. Am J Trop Med Hyg 2007;76:1163--5.
  5. CDC. National Antimicrobial Resistance Monitoring System (NARMS): enteric bacteria. Atlanta, GA: US Department of Health and Human Services, CDC; 2005. Available at http://www.cdc.gov/narms.

Streptococcus pneumoniae

Cases of invasive pneumococcal disease among children aged <5 years (IPD <5) and invasive drug-resistant Streptococcus pneumoniae (DRSP) among all ages are reportable to the National Notifiable Diseases Surveillance System (NNDSS) (1). The Council of State and Territorial Epidemiologists recommends reporting to track the impact of pneumococcal vaccination and other prevention programs.

In 2007, several reporting areas did not require reporting of IPD <5 and/or DRSP. Among the 52 reporting areas, two states did not require reporting of IPD <5, three areas did not require reporting of DRSP, and seven areas did not require reporting of either type of case. Among those with a reporting requirement, two (5%) of 43 areas reported no cases of IPD <5, and 11 (26%) of 42 areas reported no cases of DRSP.

Currently, data reported to the national level do not enable accurate assessment of pneumococcal disease burden or evaluation of immunization program impact. A new, 13-valent pneumococcal conjugate vaccine is expected to be licensed in 2009, and tracking cases of invasive pneumococcal disease will be important to monitor the effects of the vaccine on target populations (2). State-based surveillance systems and reporting should be enhanced now to provide baseline data and enable assessment of the impact of the new pneumococcal vaccine. A method for PCR-based serotyping is now available for use by state public health laboratories (3). Adopting this method provides an opportunity for state health departments to specifically track changes in serotypes targeted by the conjugate vaccines and would enhance their surveillance systems for vaccine-preventable IPD.

  1. CDC. Nationally notifiable infectious diseases, United States 2007, revised. Atlanta, GA: US Department of Health and Human Services, CDC; 2008. Available from: http://www.cdc.gov/ncphi/disss/nndss/phs/infdis2007r.htm.
  2. Wyeth. Wyeth receives FDA fast track designation for its 13-valent pneumococcal conjugate vaccine for infants and toddlers [Press release]. Collegeville, PA: Wyeth Pharmaceuticals; 2008. Available at http://www.wyeth.com/news?nav=display&navTo=/wyeth_html/home/news/pressreleases/2008/1212065664001.html.
  3. CDC. PCR deduction of pneumococcal serotypes. Atlanta, GA: US Department of Health and Human Services, CDC; 2008. Available at http://www.cdc.gov/ncidod/biotech/strep/pcr.htm.

Syphilis, Primary and Secondary

In 2007, primary and secondary (P&S) syphilis cases reported to CDC increased for the seventh consecutive year (1). During 2006--2007, the number of P&S syphilis cases reported to CDC increased 17.5%. P&S syphilis increased in all race/ethnicities except Asian/Pacific Islanders, but particularly among non-Hispanic blacks and Hispanics. Overall, increases in rates during 2001--2007 were observed primarily among men. In 2007, nearly two thirds (65%) of all P&S syphilis cases in 44 states and Washington D. C. (for which demographic information was available) occurred among men who have sex with men (MSM); 41% of MSM with P&S syphilis were white non-Hispanic, 33% were black non-Hispanic, and 19% were Hispanic. After decreasing during 1990--2004, the rate of P&S syphilis in women increased from 0.8 cases per 100,000 population in 2004 to 1.1 cases per 100,000 population in 2007. These increases occurred primarily in the South.

  1. CDC. Sexually transmitted disease surveillance, 2007. Atlanta, GA: US Department of Health and Human Services, CDC; 2008. Available at http://www.cdc.gov/std/stats/toc2007.htm.

Syphilis, Congenital

During 2006--2007, after 14 years of decline, the rate of congenital syphilis increased 15.4% (1). This increase might relate to the increase in P&S syphilis among women that has occurred in recent years. In 2007, a total of 29 states and the District of Columbia had rates of congenital syphilis that exceeded the HP 2010 target of one case per 100,000 live births. The South accounted for 52% of these cases. The rate of congenital syphilis among non-Hispanic backs was 14 times higher than the rate among non-Hispanic whites, and the rate of congenital syphilis among Hispanics was almost seven times higher than the rate among non-Hispanic whites.

  1. CDC. Sexually transmitted disease surveillance, 2007. Atlanta, GA: US Department of Health and Human Services, CDC; 2008. Available at http://www.cdc.gov/std/stats.

Typhoid Fever

Despite recommendations that travelers to countries in which typhoid fever is endemic should be vaccinated with either of two effective vaccines available in the United States, approximately three fourths of all cases occur among persons who reported international travel during the preceding month and had not been vaccinated. Persons visiting friends and relatives in South Asia appear to be at particular risk, even during short visits (1). Recent illnesses have been attributed to ciprofloxacin-resistant isolates (CDC, unpublished data, 2007). Salmonella Typhi strains with decreased susceptibility to ciprofloxacin are increasingly frequent in that region and might require treatment with alternative antimicrobial agents (2,3). Although the number of S. Typhi infections is decreasing, the number of illnesses attributed to Salmonella Paratyphi A, which causes an illness indistinguishable from that caused by S. Typhi, is increasing. In a cross-sectional laboratory-based surveillance study conducted by CDC, 80% of patients with paratyphoid fever acquired their infections in South Asia, and 75% were infected with nalidixic acid-resistant strains, indicating decreased susceptibility to ciprofloxacin. A vaccine for paratyphoid fever is urgently needed (4).

  1. Steinberg EB, Bishop RB, Dempsey AF, et al. Typhoid fever in travelers: who should be targeted for prevention? Clin Infect Dis 2004;39:186--91.
  2. Crump JA, Ram PK, Gupta SK, Miller MA, Mintz ED. Review article: part I. analysis of data gaps pertaining to Salmonella enterica serotype Typhi infections in low and medium human development index countries, 1984--2005. Epidemiol Infect 2008;136:436-48.
  3. Crump JA, Barrett TJ, Nelson JT, Angulo FJ. Reevaluating fluoroquinolones breakpoints for Salmonella enterica serotype Typhi and for non-Typhi Salmonellae. Clin Infect Dis 2003;37:75--81.
  4. Gupta SK, Medalla F, Omondi MW, et al. Laboratory-based surveillance of paratyphoid fever in the United States: travel and antimicrobial resistance. Clin Infect Dis 2007;46:1656-63.

Varicella (Chickenpox) Deaths

The Council of State and Territorial Epidemiologists recommended that deaths related to varicella be reportable to CDC starting in 1999 (1) as a first step towards national varicella surveillance. Although the number of varicella-related deaths has declined substantially since vaccine licensure from an annual average of 100--150 deaths (2), varicella-related deaths still occur. Of the six varicella-related deaths that were reported in 2007, five occurred in adults aged 23--78 years. More deaths were reported in 2007 than in 2006 (no deaths) or 2005 (three deaths) (3). However, because of incompleteness in reporting, the annual number of deaths is likely to be underestimated.

Of the six deaths in 2007, one occurred in the context of an outbreak in a group mental health home. A male aged 35 years with unknown varicella vaccination and unknown disease history had severe sepsis after varicella infection and died 1 week after rash onset. Closed settings such as group homes are at risk for outbreaks of varicella-zoster virus (VZV) because such settings facilitate VZV transmission. This death highlights the importance of ensuring that both residents and employees of residential homes have evidence of immunity to VZV (4).

One death occurred in a previously healthy girl aged 13 months who, although eligible for varicella vaccination, had not yet received the vaccine. After contracting varicella from her father, she had severe VZV infection with septic shock and died from multiple organ failure.

The remaining four deaths occurred in adults with underlying medical conditions. One of these deaths occurred in an unvaccinated adult with no prior disease history. The varicella vaccination and disease history was unknown for the other three deaths.

  1. Council of State and Territorial Epidemiologists. Position statement 1998-ID-10: inclusion of varicella-related deaths in the National Public Health Surveillance System (NPHSS). Atlanta, GA: Council of State and Territorial Epidemiologists; 1998. Available at http://www.cste.org/ps/1998/1998-id-10.htm.
  2. Nguyen HQ, Jumaan AO, Seward JF. Decline in mortality due to varicella after implementation of varicella vaccination in the United States. N Engl J Med 2005;352:450--8.
  3. CDC. Summary of notifiable diseases---United States, 2006. MMWR 2008;55(53).
  4. CDC. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2007;56(No. RR-4).

Vibriosis

Cholera, which is caused by infection with toxigenic Vibrio cholerae O1 and O139, has been nationally notifiable for many years. Infections attributable to other Vibrio species (vibriosis), especially V. parahaemolyticus and V. vulnificus, are a substantial public health burden. Infections are either foodborne or associated with wounds exposed to waters containing Vibrio species. In January 2007, vibriosis became a nationally notifiable disease reportable to the National Notifiable Diseases Surveillance System (NNDSS) (1). In addition to reporting through NNDSS, CDC requests that states collect information on the standard surveillance form for cholera and other Vibrio illness surveillance (available at http://www.cdc.gov/nationalsurveillance/cholera_vibrio_surveillance.html).

  1. Council of State and Territorial Epidemiologists. National reporting for non-cholera Vibrio infections (vibriosis). Position statement 06-ID-05. Atlanta, GA: Council of State and Territorial Epidemiologists; 2006. Available at http://www.cste.org/position%20statements/searchbyyear2006.asp.

PART 1

Summaries of Notifiable Diseases in the United States, 2007

Abbreviations and Symbols Used in Tables

U Data not available.

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

--- No reported cases.

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

Data in the MMWR Summary of Notifiable Diseases --- United States, 2007 might not match data in other CDC surveillance reports because of differences in the timing of reports, the source of the data, and the use of different case definitions.

TABLE 1. Reported cases of notifiable diseases,* by month --- United States, 2007

Disease

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Total

AIDS

2,179

2,323

3,577

2,947

2,616

4,112

2,358

3,125

3,464

2,679

1,782

6,341

37,503

Anthrax

---

---

---

---

---

---

---

---

1

---

---

---

1

Botulism

foodborne

---

---

2

1

3

1

4

12

---

1

1

7

32

infant

5

8

8

7

9

11

7

6

8

4

5

7

85

other (wound & unspecified)

---

2

1

---

3

3

2

5

3

2

2

4

27

Brucellosis

9

8

13

8

15

12

6

15

11

8

8

18

131

Chancroid§

---

1

1

3

2

1

2

2

2

2

2

5

23

Chlamydia§¶

69,148

81,289

110,160

85,292

91,968

99,883

83,002

86,902

109,130

88,688

81,391

121,521

1,108,374

Cholera

---

---

---

---

---

---

1

---

3

3

---

---

7

Coccidioidomycosis

644

547

733

556

552

862

503

582

591

597

651

1,303

8,121

Cryptosporidiosis

254

204

305

237

285

441

703

2,096

3,964

1,379

668

634

11,170

Cyclosporiasis

9

6

3

6

6

24

14

10

8

5

1

1

93

Domestic arboviral diseases**

California serogroup virus disease

neuroinvasive

---

---

---

---

1

5

7

18

12

6

1

---

50

nonneuroinvasive

---

---

---

---

---

1

1

1

---

1

1

---

5

Eastern equine encephalitis virus disease

neuroinvasive

---

---

---

---

---

---

1

2

---

---

---

---

3

nonneuroinvasive

---

---

---

---

---

---

---

---

---

1

---

---

1

Powassan virus disease, neuroinvasive

---

---

---

---

1

2

1

1

---

---

2

---

7

St. Louis encephalitis virus disease

neuoinvasive

---

---

---

---

1

---

1

1

3

1

1

---

8

nonneuroinvasive

---

---

---

---

---

---

---

1

---

---

---

---

1

West Nile virus disease

neuroinvasive

---

---

4

1

3

36

175

555

356

85

7

5

1,227

nonneuroinvasive

1

---

---

1

11

73

539

1,168

509

84

15

2

2,403

Ehrlichiosis

human granulocytic

6

3

3

4

36

92

135

72

95

78

52

258

834

human monocytic

6

4

14

11

51

130

138

120

85

64

37

168

828

human (other and unspecified)

2

1

4

12

35

86

66

28

39

24

18

22

337

Giardiasis

1,016

1,138

1,428

1,143

1,067

1,406

1,438

1,944

2,617

1,920

1,626

2,674

19,417

Gonorrhea§

23,795

25,854

34,829

26,752

28,384

32,427

27,070

28,758

35,921

28,179

26,125

37,897

355,991

Haemophilus influenzae, invasive disease

all ages, serotypes

218

211

254

250

180

227

179

166

168

143

164

381

2,541

age <5 years

serotype b

3

1

2

1

---

2

1

2

2

4

---

4

22

nonserotype b

14

15

19

22

13

20

16

12

14

9

13

32

199

unknown serotype

18

15

25

12

18

15

16

15

9

9

10

18

180

Hansen disease (Leprosy)

5

8

13

10

7

12

5

5

11

10

7

8

101

Hantavirus pulmonary syndrome

2

---

1

3

2

5

6

2

3

5

2

1

32

Hemolytic uremic syndrome, postdiarrheal

9

10

8

16

9

34

29

42

31

30

22

52

292

Hepatitis, viral, acute

A

161

204

266

225

212

281

248

244

368

206

174

390

2,979

B

268

328

445

323

343

418

322

326

433

364

337

612

4,519

C

40

68

80

55

55

70

66

51

75

62

70

153

845

Influenza-associated pediatric mortality††

8

14

17

12

13

2

3

2

2

---

3

1

77

Legionellosis

118

117

145

103

122

277

260

325

425

244

234

346

2,716

Listeriosis

62

29

49

47

42

70

74

84

119

86

50

96

808

Lyme disease

559

516

786

736

1,383

4,901

6,000

3,787

2,972

1,822

1,550

2,432

27,444

Malaria

79

62

83

82

85

144

119

142

155

115

99

243

1,408

Measles, total

---

2

1

4

9

5

2

2

7

2

1

8

43

Meningococcal disease

all serogroups

92

93

134

107

91

104

73

60

74

72

60

117

1,077

serogroup A, C, Y, & W-135

23

30

48

33

25

30

15

16

26

26

13

40

325

serogroup B

14

13

12

16

12

17

16

12

11

9

13

22

167

other serogroup

---

4

6

4

---

3

2

1

3

4

5

3

35

serogroup unknown

55

46

68

54

54

54

40

31

34

33

29

52

550

Mumps

61

78

136

85

67

57

40

42

49

39

51

95

800

Novel influenza A virus infections

---

---

---

---

---

---

---

2

2

---

---

---

4

Pertussis

653

743

853

697

690

890

899

929

911

810

720

1,659

10,454

Plague

---

---

---

1

1

2

---

---

2

---

1

---

7

Psittacosis

1

2

1

---

---

---

---

1

1

2

2

2

12

Q fever

9

9

16

14

18

23

15

15

14

8

14

16

171

See footnotes on next page.


TABLE 1. (Continued) Reported cases of notifiable diseases,* by month --- United States, 2007

Disease

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Total

Rabies

animal

402

311

520

502

534

599

476

608

699

496

334

381

5,862

human

---

---

---

---

---

---

---

---

---

---

---

1

1

Rocky Mountain spotted fever

24

30

62

96

150

337

307

314

327

140

100

334

2,221

Rubella

4

---

3

1

---

1

3

---

---

---

---

---

12

Salmonellosis

2,621

2,189

2,798

2,468

3,128

4,562

4,733

5,040

6,299

5,093

3,578

5,486

47,995

Shiga toxin-producing E. coli (STEC)

200

125

212

260

256

444

655

693

739

534

326

403

4,847

Shigellosis

861

750

1,099

1,172

1,407

1,917

1,697

1,604

2,090

2,180

1,848

3,133

19,758

Streptococcal disease, invasive, group A

343

460

800

577

517

547

372

258

304

216

293

607

5,294

Streptococcal toxic-shock syndrome

7

4

19

7

14

10

9

5

4

9

6

38

132

Streptococcus pneumoniae, invasive disease, drug-resistant

all ages

327

328

432

306

219

223

145

102

191

153

261

642

3,329

age <5 yrs

40

61

72

55

37

35

23

17

37

36

55

95

563

Streptococcus pneumoniae, invasive disease, nondrug-resistant <5

127

172

228

153

156

177

94

72

91

149

197

416

2,032

Syphilis§

all stages§§

2,417

2,786

3,847

3,182

3,300

3,874

3,100

3,299

4,189

3,346

2,941

4,639

40,920

congenital (age <1 yr)

37

22

44

39

32

40

32

35

34

29

45

41

430

primary and secondary

665

729

1,010

840

849

1,091

813

961

1,216

1,007

888

1,397

11,466

Tetanus

---

1

2

---

2

3

1

3

4

4

3

5

28

Toxic-shock syndrome

5

4

6

7

9

11

8

6

12

9

2

13

92

Trichinellosis

---

1

---

---

---

2

1

---

---

1

---

---

5

Tuberculosis¶¶

620

784

984

974

1,148

1,166

1,107

1,143

1,153

1,111

1,126

1,983

13,299

Tularemia

---

---

1

4

8

33

36

17

11

4

4

19

137

Typhoid fever

28

28

30

34

29

29

32

35

79

30

24

56

434

Vancomycin-intermediate Staphylococcus aureus

---

---

3

1

1

4

---

1

11

7

4

5

37

Vancomycin-resistant Staphylococcus aureus

---

---

---

---

---

---

---

---

---

1

---

1

2

Varicella (morbidity)

3,346

3,982

5,720

4,514

4,746

3,142

965

876

2,139

2,824

2,848

5,044

40,146

Varicella (mortality)***

1

---

---

1

---

---

1

---

---

1

2

---

6

Vibriosis

26

10

17

25

37

49

57

80

82

88

41

37

549

* No cases of diphtheria; neuroinvasive or non-neuroinvasive western equine encephalitis virus disease; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute respiratory syndrome-associated coronavirus syndrome (SARS-CoV); smallpox; and yellow fever were reported in 2007. Data on chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review. Data on human immunodeficiency virus (HIV) infections are not included because HIV infection reporting has been implemented on different dates and using different methods than for AIDS case reporting.

Total number of AIDS cases reported to the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) through December 31, 2007.

§ Totals reported to the Division of STD Prevention, NCHHSTP, as of May 9, 2008.

Chlamydia refers to genital infections caused by Chlamydia trachomatis.

** Totals reported to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED) (ArboNET Surveillance), as of June 1, 2008.

†† Totals reported to the Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD), as of December 31, 2007.

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

¶¶ Totals reported to the Division of TB Elimination, NCHHSTP, as of May 16, 2008.

*** Death counts provided by the Division of Viral Diseases, NCIRD, as of March 31, 2008.


TABLE 2. Reported cases of notifiable diseases,* by geographic division and area --- United States, 2007

Area

Total resident population
(in thousands)

AIDS

Anthrax

Botulism

Brucellosis

Foodborne

Infant

Other§

United States

299,398

37,503

1

32

85

27

131

New England

14,271

1,309

1

---

1

---

---

Connecticut

3,505

528

1

---

1

---

---

Maine

1,322

46

---

---

---

---

---

Massachusetts

6,437

612

---

---

---

---

---

New Hampshire

1,315

51

---

---

---

---

---

Rhode Island

1,068

66

---

---

---

---

---

Vermont

624

6

---

---

---

---

---

Mid. Atlantic

40,472

7,724

---

2

22

3

4

New Jersey

8,725

1,164

---

1

9

---

2

New York (Upstate)

11,092

1,548

---

---

2

1

---

New York City

8,214

3,262

---

---

---

2

1

Pennsylvania

12,441

1,750

---

1

11

---

1

E.N. Central

46,275

3,207

---

7

2

---

12

Illinois

12,832

1,348

---

---

1

---

6

Indiana

6,313

329

---

3

---

---

---

Michigan

10,096

628

---

---

---

---

5

Ohio

11,478

703

---

3

1

---

---

Wisconsin

5,556

199

---

1

---

---

1

W.N. Central

19,942

1,050

---

---

1

---

12

Iowa

2,982

76

---

---

1

---

---

Kansas

2,764

132

---

---

---

---

---

Minnesota

5,167

197

---

---

---

---

7

Missouri

5,843

542

---

---

---

---

2

Nebraska

1,768

80

---

---

---

---

2

North Dakota

636

8

---

---

---

---

1

South Dakota

782

15

---

---

---

---

---

S. Atlantic

57,142

10,750

---

1

8

2

25

Delaware

853

171

---

---

2

---

---

District of Columbia

581

871

---

---

---

---

---

Florida

18,090

3,961

---

---

1

---

10

Georgia

9,364

1,877

---

---

---

---

4

Maryland

5,616

1,394

---

---

2

---

2

North Carolina

8,856

1.024

---

---

1

2

6

South Carolina

4,321

742

---

---

1

---

3

Virginia

7,643

634

---

1

---

---

---

West Virginia

1,818

76

---

---

1

---

---

E.S. Central

17,755

1,693

---

1

2

---

4

Alabama

4,599

391

---

---

---

---

1

Kentucky

4,206

292

---

---

1

---

---

Mississippi

2,911

352

---

---

---

---

---

Tennessee

6,039

658

---

1

1

---

3

W.S. Central

34,186

4,303

---

3

6

---

27

Arkansas

2,811

196

---

---

2

---

1

Louisiana

4,288

879

---

---

---

---

---

Oklahoma

3,579

264

---

---

---

---

1

Texas

23,508

2,964

---

3

4

---

25

Mountain

20,845

1,517

---

5

7

---

10

Arizona

6,166

585

---

---

1

---

4

Colorado

4,753

355

---

4

2

---

2

Idaho

1,466

23

---

---

---

---

1

Montana

945

25

---

---

---

---

---

Nevada

2,495

335

---

---

---

N

2

New Mexico

1,955

113

---

1

2

---

1

Utah

2,550

68

---

---

2

---

---

Wyoming

515

13

---

---

---

---

---

Pacific

48,510

5,728

---

13

36

22

37

Alaska

670

32

---

10

---

---

---

California

36,458

4,952

---

1

35

20

33

Hawaii

1,285

78

---

---

---

---

1

Oregon

3,701

239

---

1

---

---

2

Washington

6,396

427

---

1

1

2

1

American Samoa

63

---

---

---

---

---

---

C.N.M.I.

82

---

---

---

---

---

---

Guam

171

---

---

---

---

---

---

Puerto Rico

3,928

847

---

---

---

---

N

U.S. Virgin Islands

109

34

---

---

---

---

---

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

* No cases of diphtheria; neuroinvasive or non-neuroinvasive western equine encephalitis virus disease; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute respiratory syndrome-associated coronavirus syndrome (SARS-COV); smallpox; and yellow fever were reported in 2007. Data on chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review. Data on human immunodeficiency virus (HIV) infections are not included because HIV infection reporting has been implemented on different dates and using different methods than for AIDS case reporting.

Total number of acquired immunodeficiency syndrome (AIDS) cases reported to the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), through December 31, 2007.

§ Includes cases reported as wound and unspecified botulism.

Includes 222 cases of AIDS in persons with unknown state or area of residence that were reported in 2007.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2007

Area

Chancroid**

Chlamydia††

Cholera

Coccidioidomycosis

Cryptosporidiosis

Cyclosporiasis

United States

23

1,108,374

7

8,121

11,170

93

New England

1

36,429

---

2

335

3

Connecticut

---

11,454

---

N

42

3

Maine

---

2,541

---

N

56

---

Massachusetts

1

16,145

---

N

132

---

New Hampshire

---

2,055

---

2

47

---

Rhode Island

---

3,177

---

---

11

---

Vermont

---

1,057

---

N

47

N

Mid. Atlantic

5

144,722

1

---

1,365

30

New Jersey

---

21,536

---

N

67

9

New York (Upstate)

4

29,975

---

N

254

9

New York City

1

50,742

1

N

105

12

Pennsylvania

---

42,469

---

N

939

N

E.N. Central

2

180,524

2

36

1,921

7

Illinois

---

55,470

---

N

201

3

Indiana

---

20,712

---

N

149

2

Michigan

---

37,353

1

24

211

1

Ohio

---

47,434

1

12

570

---

Wisconsin

2

19,555

---

N

790

1

W.N. Central

---

63,085

---

86

1,659

1

Iowa

---

8,643

---

N

610

---

Kansas

---

8,180

N

N

144

1

Minnesota

---

13,413

---

77

302

---

Missouri

---

23,308

---

9

182

---

Nebraska

---

5,132

---

N

174

N

North Dakota

---

1,789

---

N

78

N

South Dakota

---

2,620

---

N

169

---

S. Atlantic

5

217,935

---

5

1,287

44

Delaware

---

3,479

---

---

20

---

District of Columbia

---

6,029

---

2

3

2

Florida

3

57,575

---

N

667

31

Georgia

---

42,913

---

N

239

3

Maryland

---

23,150

---

3

36

1

North Carolina

2

30,611

---

N

132

4

South Carolina

---

26,431

---

N

88

1

Virginia

---

24,579

---

N

90

2

West Virginia

---

3,168

---

N

12

---

E.S. Central

---

82,503

1

---

616

2

Alabama

---

25,153

---

N

125

N

Kentucky

---

8,798

1

N

249

N

Mississippi

---

21,686

---

N

102

N

Tennessee

---

26,866

---

N

140

2

W.S. Central

9

127,631

1

3

487

2

Arkansas

---

9,954

---

N

63

---

Louisiana

4

19,362

---

3

64

---

Oklahoma

---

12,529

---

N

127

---

Texas

5

85,786

1

N

233

2

Mountain

---

74,414

1

4,998

2,922

3

Arizona

---

24,866

1

4,832

53

---

Colorado

---

17,186

---

N

211

1

Idaho

---

3,722

---

N

464

N

Montana

---

2,748

---

N

75

N

Nevada

---

9,514

---

72

37

N

New Mexico

---

9,460

---

23

125

2

Utah

---

5,721

---

68

1,901

---

Wyoming

---

1,197

---

3

56

---

Pacific

1

181,131

1

2,991

578

1

Alaska

---

4,911

---

N

4

---

California

1

141,928

1

2,991

303

N

Hawaii

---

5,659

---

N

6

N

Oregon

---

9,849

---

N

126

---

Washington

---

18,784

---

N

139

1

American Samoa

---

---

---

N

N

N

C.N.M.I.

---

---

---

---

---

---

Guam

---

822

---

---

---

---

Puerto Rico

---

7,909

---

N

N

N

U.S. Virgin Islands

---

348

---

---

---

---

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

** Totals reported to the Division of STD Prevention, NCHHSTP, as of May 9, 2008.

†† Totals reported to the Division of STD Prevention, NCHHSTP, as of May 9, 2008. Chlamydia refers to genital infections caused by Chlamydia trachomatis.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2007

Domestic arboviral diseases§§

California serogroup virus disease

Eastern equine
encephalitis

Powassan virus disease

St. Louis encephalitis

West Nile virus disease

Area

Neuro-
invasive

Nonneuro-
invasive

Neuro-
invasive

Nonneuro-
invasive

Neuro-
invasive

Nonneuro-
invasive

Neuro-
invasive

Nonneuro-
invasive

Neuro-
invasive

Nonneuro-
invasive

United States

50

5

3

1

7

---

8

1

1,227

2,403

New England

---

---

2

1

---

---

---

---

5

6

Connecticut

---

---

---

---

---

---

---

---

2

2

Maine

---

---

---

---

---

---

---

---

---

---

Massachusetts

---

---

---

---

---

---

---

---

3

3

New Hampshire

---

---

2

1

---

---

---

---

---

---

Rhode Island

---

---

---

---

---

---

---

---

---

1

Vermont

---

---

---

---

---

---

---

---

---

---

Mid. Atlantic

2

---

---

---

6

---

---

---

22

11

New Jersey

---

---

---

---

---

---

---

---

1

---

New York (Upstate)

2

---

---

---

6

---

---

---

3

1

New York City

---

---

---

---

---

---

---

---

13

5

Pennsylvania

---

---

---

---

---

---

---

---

5

5

E.N. Central

12

2

---

---

1

---

---

---

113

65

Illinois

1

---

---

---

---

---

---

---

63

38

Indiana

---

---

---

---

---

---

---

---

14

10

Michigan

---

---

---

---

---

---

---

---

16

1

Ohio

9

---

---

---

---

---

---

---

13

10

Wisconsin

2

2

---

---

1

---

---

---

7

6

W.N. Central

2

---

---

---

---

---

---

1

249

739

Iowa

1

---

---

---

---

---

---

---

12

18

Kansas

---

---

---

---

---

---

---

---

14

26

Minnesota

1

---

---

---

---

---

---

---

44

57

Missouri

---

---

---

---

---

---

---

1

61

16

Nebraska

---

---

---

---

---

---

---

---

21

142

North Dakota

---

---

---

---

---

---

---

---

49

320

South Dakota

---

---

---

---

---

---

---

---

48

160

S. Atlantic

21

2

---

---

---

---

---

---

43

39

Delaware

---

---

---

---

---

---

---

---

1

---

District of Columbia

---

---

---

---

---

---

---

---

---

---

Florida

---

---

---

---

---

---

---

---

3

---

Georgia

1

1

---

---

---

---

---

---

23

27

Maryland

---

---

---

---

---

---

---

---

6

4

North Carolina

9

1

---

---

---

---

---

---

4

4

South Carolina

---

---

---

---

---

---

---

---

3

2

Virginia

---

---

---

---

---

---

---

---

3

2

West Virginia

11

---

---

---

---

---

---

---

---

---

E.S. Central

13

1

1

---

---

---

2

---

76

99

Alabama

---

---

1

---

---

---

---

---

17

7

Kentucky

---

---

---

---

---

---

---

---

4

---

Mississippi

---

---

---

---

---

---

2

---

50

86

Tennessee

13

1

---

---

---

---

---

---

5

6

W.S. Central

---

---

---

---

---

---

5

---

269

158

Arkansas

---

---

---

---

---

---

2

---

13

7

Louisiana

---

---

---

---

---

---

3

---

27

13

Oklahoma

---

---

---

---

---

---

---

---

59

48

Texas

---

---

---

---

---

---

---

---

170

90

Mountain

---

---

---

---

---

---

1

---

289

1,041

Arizona

---

---

---

---

---

---

---

---

50

47

Colorado

---

---

---

---

---

---

---

---

99

477

Idaho

---

---

---

---

---

---

---

---

11

121

Montana

---

---

---

---

---

---

---

---

37

165

Nevada

---

---

---

---

---

---

1

---

2

10

New Mexico

---

---

---

---

---

---

---

---

39

21

Utah

---

---

---

---

---

---

---

---

28

42

Wyoming

---

---

---

---

---

---

---

---

23

158

Pacific

---

---

---

---

---

---

---

---

161

245

Alaska

---

---

---

---

---

---

---

---

---

---

California

---

---

---

---

---

---

---

---

154

226

Hawaii

---

---

---

---

---

---

---

---

---

---

Oregon

---

---

---

---

---

---

---

---

7

19

Washington

---

---

---

---

---

---

---

---

---

---

American Samoa

---

---

---

---

---

---

---

---

---

---

C.N.M.I.

---

---

---

---

---

---

---

---

---

---

Guam

---

---

---

---

---

---

---

---

---

---

Puerto Rico

---

---

---

---

---

---

---

---

---

---

U.S. Virgin Islands

---

---

---

---

---

---

---

---

---

---

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

§§ Totals reported to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED) (ArboNET Surveillance),
as of June 1, 2008.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2007

Area

Ehrlichiosis

Giardiasis

Gonorrhea¶¶

Human
granulocytic

Human
monocytic

Human
(other and unspecified)

United States

834

828

337

19,417

355,991

New England

116

29

1

1,461

5,744

Connecticut

31

---

---

370

2,327

Maine

9

3

---

197

118

Massachusetts

64

15

1

605

2,695

New Hampshire

---

---

---

33

138

Rhode Island

11

11

---

85

402

Vermont

1

---

---

171

64

Mid. Atlantic

271

155

4

3,283

36,479

New Jersey

38

69

1

403

6,076

New York (Upstate)

205

67

---

1,275

7,389

New York City

27

17

---

847

10,308

Pennsylvania

1

2

3

758

12,706

E.N. Central

75

42

236

2,867

72,903

Illinois

6

37

7

866

20,813

Indiana

---

---

1

N

8,790

Michigan

---

---

---

620

15,482

Ohio

2

1

---

826

21,066

Wisconsin

67

4

228

555

6,752

W.N. Central

328

246

16

2,237

19,356

Iowa

N

N

N

301

1,928

Kansas

---

1

---

184

2,282

Minnesota

322

42

---

913

3,459

Missouri

5

201

16

515

9,876

Nebraska

1

2

N

160

1,434

North Dakota

N

N

N

60

116

South Dakota

---

---

---

104

261

S. Atlantic

22

145

26

3,088

85,787

Delaware

1

13

---

41

1,293

District of Columbia

N

N

N

74

2,373

Florida

3

18

---

1,268

23,327

Georgia

1

13

---

681

17,835

Maryland

7

21

11

269

6,768

North Carolina

4

53

3

N

16,666

South Carolina

---

3

2

121

10,326

Virginia

6

23

10

582

6,269

West Virginia

---

1

---

52

930

E.S. Central

10

37

10

576

32,212

Alabama

3

10

2

273

10,885

Kentucky

---

4

---

N

3,449

Mississippi

N

N

N

N

8,314

Tennessee

7

23

8

303

9,564

W.S. Central

9

170

41

469

52,205

Arkansas

3

70

9

158

4,168

Louisiana

---

---

---

139

11,137

Oklahoma

6

100

---

172

4,827

Texas

---

---

32

N

32,073

Mountain

---

---

---

1,887

13,884

Arizona

---

---

---

192

5,062

Colorado

N

N

N

580

3,376

Idaho

N

N

N

223

269

Montana

N

N

N

112

122

Nevada

N

N

N

146

2,357

New Mexico

N

N

N

119

1,796

Utah

---

---

---

466

821

Wyoming

---

---

---

49

81

Pacific

3

4

3

3,549

37,421

Alaska

N

N

N

79

579

California

2

4

3

2,336

31,294

Hawaii

N

N

N

77

659

Oregon

1

---

---

462

1,236

Washington

N

N

N

595

3,653

American Samoa

N

N

N

---

---

C.N.M.I.

---

---

---

---

---

Guam

N

N

N

2

141

Puerto Rico

N

N

N

371

323

U.S. Virgin Islands

---

---

---

---

69

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

¶¶ Totals reported to the Division of STD Prevention, NCHHSTP, as of May 9, 2008.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2007

Haemophilus influenzae, invasive disease

Hansen
disease
(leprosy)

Hantavirus
pulmonary
syndrome

Hemolytic
uremic
syndrome,
postdiarrheal

All ages,
serotypes

Age <5 years

Area

Serotype b

Nonserotype b

Unknown serotype

United States

2,541

22

199

180

101

32

292

New England

188

2

13

3

5

---

18

Connecticut

54

---

5

---

2

N

11

Maine

13

---

1

---

N

---

1

Massachusetts

89

2

6

1

2

---

2

New Hampshire

18

---

---

2

1

---

1

Rhode Island

10

---

---

---

---

---

---

Vermont

4

---

1

---

N

---

3

Mid. Atlantic

491

---

10

40

10

2

18

New Jersey

70

---

---

8

3

---

3

New York (Upstate)

153

---

8

4

N

---

13

New York City

103

---

---

13

7

---

2

Pennsylvania

165

---

2

15

---

2

N

E.N. Central

401

3

23

30

5

---

47

Illinois

124

---

---

12

1

---

5

Indiana

78

1

4

1

1

---

16

Michigan

31

1

5

6

2

---

6

Ohio

108

---

6

9

1

---

14

Wisconsin

60

1

8

2

---

---

6

W.N. Central

161

2

14

8

3

2

44

Iowa

1

---

---

---

---

---

10

Kansas

11

---

---

2

---

---

---

Minnesota

82

1

11

---

1

---

18

Missouri

42

---

---

5

2

---

9

Nebraska

19

1

3

---

---

1

4

North Dakota

6

---

---

1

N

---

2

South Dakota

---

---

---

---

---

1

1

S. Atlantic

620

1

53

40

12

---

34

Delaware

8

---

---

2

---

---

---

District of Columbia

3

---

---

---

---

---

---

Florida

168

---

18

8

10

---

6

Georgia

127

---

14

11

N

---

14

Maryland

88

---

11

---

---

---

---

North Carolina

59

---

7

1

---

---

12

South Carolina

57

1

2

6

1

---

1

Virginia

80

---

---

11

1

---

1

West Virginia

30

---

1

1

N

---

---

E.S. Central

140

---

2

17

4

---

29

Alabama

29

---

---

2

1

N

7

Kentucky

10

---

---

2

---

---

N

Mississippi

10

---

---

3

2

N

---

Tennessee

91

---

2

10

1

---

22

W.S. Central

131

3

11

4

28

5

22

Arkansas

12

---

2

1

5

---

1

Louisiana

14

---

1

3

---

2

1

Oklahoma

91

---

8

---

---

---

9

Texas

14

3

---

---

23

3

11

Mountain

261

6

47

18

5

18

24

Arizona

91

3

16

5

---

6

8

Colorado

58

1

9

---

1

6

4

Idaho

8

---

3

---

---

1

4

Montana

2

---

---

---

---

2

---

Nevada

12

---

2

3

3

---

N

New Mexico

43

1

6

8

1

3

---

Utah

41

1

11

1

---

---

8

Wyoming

6

---

---

1

---

---

---

Pacific

148

5

26

20

29

5

56

Alaska

15

---

---

4

1

N

N

California

48

2

24

3

13

3

44

Hawaii

12

---

---

1

15

---

---

Oregon

67

---

---

11

N

---

10

Washington

6

3

2

1

---

2

2

American Samoa

---

---

---

---

---

N

N

C.N.M.I.

---

---

---

---

---

---

---

Guam

1

---

---

---

7

N

---

Puerto Rico

2

---

---

1

---

N

N

U.S. Virgin Islands

N

---

---

---

---

---

---

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


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2007

Influenza-
associated
pediatric
mortality***

Legionellosis

Listeriosis

Lyme disease

Malaria

Hepatitis, viral, acute

Area

A

B

C

United States

2,979

4,519

845

77

2,716

808

27,444

1,408

New England

131

125

48

1

165

51

7,786

94

Connecticut

26

38

20

1

44

13

3,058

30

Maine

5

19

1

---

9

5

529

8

Massachusetts

66

42

10

---

50

25

2,988

34

New Hampshire

12

5

N

---

8

4

896

9

Rhode Island

14

16

8

---

45

3

177

8

Vermont

8

5

9

---

9

1

138

5

Mid. Atlantic

455

561

174

10

842

167

11,293

403

New Jersey

124

162

95

---

116

33

3,134

72

New York (Upstate)

79

89

45

5

234

34

3,748

78

New York City

156

122

---

5

184

39

417

209

Pennsylvania

96

188

34

---

308

61

3,994

44

E.N. Central

343

457

140

6

608

120

2,102

139

Illinois

118

129

16

2

111

34

149

63

Indiana

28

64

14

1

71

18

55

11

Michigan

97

120

89

---

172

23

51

20

Ohio

68

124

20

2

215

33

33

28

Wisconsin

32

20

1

1

39

12

1,814

17

W.N. Central

201

121

32

9

118

32

1,398

57

Iowa

48

26

---

---

11

8

123

3

Kansas

11

9

---

1

10

4

8

4

Minnesota

93

25

28

6

30

6

1,238

29

Missouri

22

39

3

---

46

6

10

8

Nebraska

19

13

1

1

15

6

9

7

North Dakota

2

2

---

---

2

---

12

5

South Dakota

6

7

---

1

4

2

---

1

S. Atlantic

485

1,039

92

12

464

148

4,575

273

Delaware

9

15

---

---

12

3

715

4

District of Columbia

U

U

U

---

17

3

116

3

Florida

152

337

16

2

153

34

30

56

Georgia

67

155

18

5

43

31

11

39

Maryland

73

113

15

---

89

15

2,576

76

North Carolina

66

128

17

1

51

33

53

22

South Carolina

18

65

---

---

17

10

31

7

Virginia

89

144

8

4

61

16

959

65

West Virginia

11

82

18

---

21

3

84

1

E.S. Central

109

385

89

3

102

29

51

39

Alabama

24

128

10

1

12

8

13

7

Kentucky

20

76

29

---

50

2

6

9

Mississippi

8

37

13

---

---

3

1

2

Tennessee

57

144

37

2

40

16

50

21

W.S. Central

319

1,065

120

18

153

76

98

156

Arkansas

14

72

---

---

17

4

8

2

Louisiana

28

100

4

3

6

6

2

14

Oklahoma

13

152

49

1

9

2

1

10

Texas

264

741

67

14

121

64

87

130

Mountain

231

214

44

8

112

41

45

65

Arizona

152

81

---

2

40

12

2

12

Colorado

26

35

20

1

21

11

---

23

Idaho

8

15

4

---

6

1

9

6

Montana

9

1

1

---

3

1

4

3

Nevada

12

49

9

1

9

8

15

3

New Mexico

12

13

5

2

10

4

5

5

Utah

9

15

5

2

20

3

7

13

Wyoming

3

5

---

---

3

1

4

---

Pacific

705

552

106

10

152

144

103

182

Alaska

5

9

---

2

---

2

10

2

California

603

402

72

5

112

102

75

130

Hawaii

7

17

---

---

2

7

N

2

Oregon

31

59

16

---

14

8

26

18

Washington

59

65

18

3

24

25

12

30

American Samoa

---

14

1

---

N

N

N

---

C.N.M.I.

---

---

---

---

---

---

---

---

Guam

---

3

1

---

---

N

---

1

Puerto Rico

64

93

---

---

4

1

N

3

U.S. Virgin Islands

---

---

---

---

---

---

N

---

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

*** Totals reported to the Division of Influenza, National Center for Immunization and Respiratory Diseases (NCIRD), as of December 31, 2007.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2007

Measles

Meningococcal disease

Area

Indigenous

Imported†††

All
serogroups

Serogroup
A, C, Y, & W-135

Serogroup
B

Other
serogroup

Serogroup
unknown

United States

14

29

1,077

325

167

35

550

New England

---

1

45

24

11

3

7

Connecticut

---

---

6

4

---

2

---

Maine

---

---

8

4

3

1

---

Massachusetts

---

1

20

13

4

---

3

New Hampshire

---

---

3

1

1

---

1

Rhode Island

---

---

3

1

2

---

---

Vermont

---

---

5

1

1

---

3

Mid. Atlantic

---

11

128

32

8

1

87

New Jersey

---

1

18

---

---

---

18

New York (Upstate)

---

2

38

24

7

1

6

New York City

---

5

22

---

---

---

22

Pennsylvania

---

3

50

8

1

---

41

E.N. Central

3

1

167

53

32

3

79

Illinois

---

1

61

---

---

---

61

Indiana

---

---

31

18

13

---

---

Michigan

3

---

28

13

5

3

7

Ohio

---

---

35

19

6

---

10

Wisconsin

---

---

12

3

8

---

1

W.N. Central

---

1

73

35

14

5

19

Iowa

---

---

15

9

4

---

2

Kansas

---

---

5

---

---

---

5

Minnesota

---

1

26

20

5

1

---

Missouri

---

---

17

1

3

4

9

Nebraska

---

---

5

3

1

---

1

North Dakota

---

---

2

---

---

---

2

South Dakota

---

---

3

2

1

---

---

S. Atlantic

5

3

177

85

43

13

36

Delaware

---

---

1

---

---

---

1

District of Columbia

---

---

---

---

---

---

---

Florida

4

1

67

32

18

7

10

Georgia

---

---

24

13

5

---

6

Maryland

---

---

21

14

5

2

---

North Carolina

1

2

22

11

6

1

4

South Carolina

---

---

16

7

3

1

5

Virginia

---

---

23

7

5

2

9

West Virginia

---

---

3

1

1

---

1

E.S. Central

---

---

54

3

3

---

48

Alabama

---

---

9

2

1

---

6

Kentucky

---

---

13

---

---

---

13

Mississippi

---

---

12

---

---

---

12

Tennessee

---

---

20

1

2

---

17

W.S. Central

5

2

115

46

29

7

33

Arkansas

---

---

9

5

1

---

3

Louisiana

---

---

29

3

3

---

23

Oklahoma

---

---

22

7

10

5

---

Texas

5

2

55

31

15

2

7

Mountain

---

1

69

33

13

3

20

Arizona

---

---

13

2

1

1

9

Colorado

---

---

22

14

7

1

---

Idaho

---

---

8

1

---

---

7

Montana

---

---

3

1

---

---

2

Nevada

---

---

6

3

2

---

1

New Mexico

---

1

3

3

---

---

---

Utah

---

---

12

9

2

1

---

Wyoming

---

---

2

---

1

---

1

Pacific

1

9

249

14

14

---

221

Alaska

---

---

3

---

---

---

3

California

1

3

177

---

---

---

177

Hawaii

---

2

10

---

2

---

8

Oregon

---

1

31

---

---

---

31

Washington

---

3

28

14

12

---

2

American Samoa

---

---

---

---

---

---

---

C.N.M.I.

---

---

---

---

---

---

---

Guam

---

---

---

---

---

---

---

Puerto Rico

---

---

8

---

---

---

8

U.S. Virgin Islands

---

---

---

---

---

---

---

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

††† Imported cases include only those directly imported from other countries.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2007

Novel
influenza A
virus infections

Rocky
Mountain
spotted
fever

Rabies

Area

Mumps

Pertussis

Plague

Psittacosis

Q Fever

Animal

Human

United States

800

4

10,454

7

12

171

5,862

1

2,221

New England

43

---

1,552

---

---

8

522

---

10

Connecticut

2

---

89

---

N

---

219

---

---

Maine

24

---

83

---

---

7

86

---

N

Massachusetts

14

---

1,178

---

---

1

N

---

9

New Hampshire

2

---

80

---

---

N

53

---

1

Rhode Island

1

---

59

---

---

---

N

---

---

Vermont

---

---

63

---

---

N

164

---

---

Mid. Atlantic

68

---

1,314

---

2

5

997

---

85

New Jersey

2

---

229

---

1

4

---

---

32

New York (Upstate)

26

---

549

---

1

---

514

---

7

New York City

17

---

150

---

---

---

44

---

28

Pennsylvania

23

---

386

---

---

1

439

---

18

E.N. Central

272

4

1,495

---

4

24

301

---

60

Illinois

170

1

199

---

---

14

---

---

39

Indiana

3

---

68

---

---

---

13

---

6

Michigan

28

1

292

---

2

4

202

---

4

Ohio

20

2

609

---

---

2

86

---

10

Wisconsin

51

---

327

---

2

4

N

---

1

W.N. Central

112

---

909

---

---

26

276

1

369

Iowa

27

---

150

---

---

N

31

---

17

Kansas

28

---

104

---

---

4

110

---

12

Minnesota

28

---

393

---

---

5

40

1

6

Missouri

12

---

118

---

---

12

38

---

315

Nebraska

8

---

70

---

---

4

---

---

14

North Dakota

3

---

14

---

---

---

30

---

---

South Dakota

6

---

60

---

---

1

27

---

5

S. Atlantic

102

---

978

---

---

19

2,184

---

1,020

Delaware

1

---

11

---

---

---

---

---

17

District of Columbia

1

---

9

---

---

---

---

---

3

Florida

21

---

211

---

---

2

128

---

19

Georgia

---

---

37

---

---

3

300

---

60

Maryland

19

---

118

---

---

4

431

---

63

North Carolina

28

---

330

---

---

4

472

---

665

South Carolina

2

---

102

---

---

1

46

---

64

Virginia

27

---

128

---

---

4

730

---

123

West Virginia

3

---

32

---

---

1

77

---

6

E.S. Central

20

---

463

---

2

10

156

---

276

Alabama

14

---

91

N

1

---

---

---

96

Kentucky

---

---

33

---

---

3

21

---

5

Mississippi

2

---

255

---

---

---

3

---

20

Tennessee

4

---

84

---

1

7

132

---

155

W.S. Central

34

---

1,303

---

---

16

1,086

---

361

Arkansas

4

---

173

---

---

1

33

---

122

Louisiana

1

---

21

---

---

4

6

---

4

Oklahoma

8

---

58

---

---

N

78

---

186

Texas

21

---

1,051

---

N

11

969

---

49

Mountain

49

---

1,137

7

2

41

97

---

37

Arizona

10

---

210

2

---

2

N

---

10

Colorado

17

---

307

---

2

19

---

---

3

Idaho

7

---

45

---

---

---

12

---

4

Montana

1

---

53

---

---

---

21

---

1

Nevada

12

---

37

---

---

8

13

---

---

New Mexico

---

---

74

5

---

12

15

---

6

Utah

1

---

387

---

---

---

16

---

---

Wyoming

1

---

24

---

---

---

20

---

13

Pacific

100

---

1,303

---

2

22

243

---

3

Alaska

2

---

89

---

---

---

45

---

N

California

42

---

590

---

1

20

186

---

1

Hawaii

2

---

19

---

---

---

---

---

N

Oregon

1

---

123

---

1

1

12

---

2

Washington

53

---

482

---

---

1

---

---

N

American Samoa

1

---

---

---

N

N

N

N

N

C.N.M.I.

---

---

---

---

---

---

---

---

---

Guam

6

---

---

---

N

N

---

---

N

Puerto Rico

6

---

---

---

N

N

48

---

N

U.S. Virgin Islands

---

---

---

---

---

---

N

---

N

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


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2007

Area

Rubella

Salmonellosis

Shiga
toxin-producing
E. Coli (STEC)§§§

Shigellosis

Streptococcal
disease, invasive,
group A

Streptococcal
toxic-shock
syndrome

United States

12

47,995

4,847

19,758

5,294

132

New England

1

2,239

315

250

409

38

Connecticut

---

431

71

44

132

36

Maine

---

138

41

14

28

N

Massachusetts

1

1,305

145

155

190

---

New Hampshire

---

171

35

7

27

---

Rhode Island

---

111

8

25

14

---

Vermont

---

83

15

5

18

2

Mid. Atlantic

5

5,946

531

939

946

4

New Jersey

4

1,226

118

184

173

1

New York (Upstate)

---

1,476

208

185

295

---

New York City

1

1,296

50

283

226

---

Pennsylvania

---

1,948

155

287

252

3

E.N. Central

4

5,923

746

3,186

987

56

Illinois

1

1,966

131

781

293

33

Indiana

---

675

105

296

128

10

Michigan

3

966

128

83

201

2

Ohio

---

1,322

155

1,257

239

11

Wisconsin

---

994

227

769

126

---

W.N. Central

---

2,877

780

1,819

351

5

Iowa

---

477

175

109

---

---

Kansas

---

405

52

26

32

---

Minnesota

---

701

232

237

173

3

Missouri

---

764

152

1,276

85

1

Nebraska

---

275

93

28

25

1

North Dakota

---

81

29

21

24

---

South Dakota

---

174

47

122

12

---

S. Atlantic

1

12,650

710

4,772

1,264

14

Delaware

---

140

16

11

10

1

District of Columbia

---

64

---

18

17

---

Florida

---

5,022

164

2,288

309

N

Georgia

---

2,031

94

1,641

259

---

Maryland

1

903

85

117

212

---

North Carolina

---

1,844

153

105

167

7

South Carolina

---

1,166

14

220

101

---

Virginia

---

1,249

165

200

162

1

West Virginia

---

231

19

172

27

5

E.S. Central

---

3,482

319

3,037

213

4

Alabama

---

980

67

741

N

N

Kentucky

---

574

123

504

41

4

Mississippi

---

1,048

8

1,420

N

N

Tennessee

---

880

121

372

172

---

W.S. Central

---

6,065

300

3,117

401

---

Arkansas

---

847

45

105

19

---

Louisiana

---

978

12

493

16

---

Oklahoma

---

706

33

161

85

N

Texas

---

3,534

210

2,358

281

N

Mountain

---

2,752

589

983

574

10

Arizona

---

1,001

106

557

208

---

Colorado

---

563

154

123

145

1

Idaho

---

155

133

14

18

---

Montana

---

121

---

27

N

N

Nevada

---

263

31

79

2

4

New Mexico

---

290

42

108

107

1

Utah

---

286

100

42

89

4

Wyoming

---

73

23

33

5

---

Pacific

1

6,061

557

1,655

149

1

Alaska

---

87

5

8

25

1

California

1

4,571

293

1,331

---

---

Hawaii

---

313

39

71

124

---

Oregon

---

330

79

86

N

N

Washington

---

760

141

159

N

N

American Samoa

---

---

---

5

4

N

C.N.M.I.

---

---

---

---

---

---

Guam

---

20

---

19

14

---

Puerto Rico

1

949

1

24

N

N

U.S. Virgin Islands

---

---

---

---

---

---

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

§§§ Includes E-coli O157:H7; shiga toxin-positive, serogroup non-O157; and shiga toxin-positive, not serogrouped.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2007

Streptococcus
pneumoniae
,
invasive disease,
drug-resistant

Streptococcus pneumoniae, invasive disease, nondrug-resistant

age <5 yrs

Syphilis¶¶¶

Toxic-shock
syndrome

Area

All
ages

Age
<5 yrs

All stages****

Congenital
(age <1 yr)

Primary and
secondary

Tetanus

Trichinellosis

United States

3,329

563

2,032

40,920

430

11,466

28

92

5

New England

156

21

141

707

2

279

1

1

---

Connecticut

99

11

24

148

2

39

---

N

---

Maine

13

3

4

21

---

9

---

N

---

Massachusetts

2

2

89

399

---

155

---

---

---

New Hampshire

---

---

13

52

---

30

1

1

---

Rhode Island

24

3

9

76

---

36

---

---

---

Vermont

18

2

2

11

---

10

---

---

---

Mid. Atlantic

168

31

350

6,769

35

1,558

3

18

4

New Jersey

---

---

75

926

11

227

---

5

1

New York (Upstate)

58

12

123

798

8

155

2

5

2

New York City

---

---

152

4,201

8

913

1

---

1

Pennsylvania

110

19

N

844

8

263

---

8

---

E.N. Central

847

139

334

2,628

29

901

2

23

---

Illinois

225

49

84

1,220

10

464

2

9

---

Indiana

203

36

37

217

3

54

---

2

---

Michigan

3

2

84

472

14

123

---

8

---

Ohio

416

52

69

549

1

194

---

2

---

Wisconsin

---

---

60

170

1

66

---

2

---

W.N. Central

360

53

116

876

2

359

5

17

---

Iowa

---

---

---

65

1

21

---

---

---

Kansas

90

10

3

97

---

28

1

---

---

Minnesota

186

35

66

186

---

59

1

9

---

Missouri

65

3

27

484

1

239

3

3

---

Nebraska

2

---

18

30

---

4

---

5

---

North Dakota

---

---

1

2

---

1

---

---

---

South Dakota

17

5

1

12

---

7

---

---

---

S. Atlantic

1,349

249

349

10,088

63

2,784

9

9

---

Delaware

11

2

---

63

---

18

---

---

---

District of Columbia

21

1

3

416

1

178

1

---

---

Florida

726

134

71

3,918

20

913

5

N

---

Georgia

510

103

85

2,254

9

680

2

1

N

Maryland

1

---

72

1,170

23

345

1

N

---

North Carolina

N

---

N

1,093

7

323

---

7

---

South Carolina

---

---

58

411

1

91

---

---

---

Virginia

N

---

52

736

1

230

---

1

---

West Virginia

80

9

8

27

1

6

---

---

---

E.S. Central

282

38

119

3,078

13

936

2

9

---

Alabama

N

---

N

1,006

9

380

1

3

---

Kentucky

28

3

N

153

---

56

---

6

N

Mississippi

61

---

13

707

---

133

---

N

---

Tennessee

193

35

106

1,212

4

367

1

---

---

W.S. Central

96

14

350

7,900

150

1,880

---

1

---

Arkansas

6

2

19

371

12

122

---

---

N

Louisiana

90

12

39

1,807

36

533

---

1

---

Oklahoma

N

---

65

216

3

65

---

N

---

Texas

---

---

227

5,506

99

1,160

---

N

---

Mountain

68

15

259

2,051

45

543

2

12

---

Arizona

---

---

128

1,245

30

296

---

5

---

Colorado

---

---

52

157

2

57

---

4

---

Idaho

N

---

2

14

---

1

---

1

---

Montana

---

---

1

8

---

8

1

N

---

Nevada

N

---

N

396

7

111

---

---

---

New Mexico

---

---

44

180

6

46

1

---

---

Utah

51

12

32

45

---

20

---

2

---

Wyoming

17

3

---

6

---

4

---

---

---

Pacific

3

3

14

6,823

91

2,226

4

2

1

Alaska

N

---

N

16

---

7

---

N

---

California

N

---

N

6,323

87

2,038

4

2

1

Hawaii

3

3

14

58

---

9

---

N

---

Oregon

N

---

N

59

2

18

---

N

---

Washington

N

---

N

367

2

154

---

N

---

American Samoa

N

N

N

---

---

---

---

N

N

C.N.M.I.

---

---

---

---

---

---

---

---

---

Guam

---

---

---

37

2

8

---

---

---

Puerto Rico

---

---

N

1,267

8

169

3

N

N

U.S. Virgin Islands

---

---

N

5

---

---

---

---

---

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

¶¶¶ Totals reported to the Division of STD Prevention, NCHHSTP, as of May 9, 2008.

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


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2007

Area

Tuberculosis††††

Tularemia

Typhoid
fever

Vancomycin-intermediate Staphylococcus aureus

Vancomycin-resistant
Staphylococcus aureus

Varicella

Vibriosis

(morbidity)

(mortality)§§§§

United States

13,299

137

434

37

2

40,146

6

549

New England

410

8

26

2

---

2,551

2

38

Connecticut

108

---

8

1

---

1,440

2

16

Maine

19

---

---

N

---

357

---

---

Massachusetts

224

7

15

1

---

---

N

20

New Hampshire

11

1

1

N

---

374

---

1

Rhode Island

45

---

2

---

---

---

---

---

Vermont

3

---

---

---

---

380

---

1

Mid. Atlantic

1,918

2

131

17

---

4,680

1

20

New Jersey

467

1

35

N

N

N

N

17

New York (Upstate)

261

---

16

2

---

N

N

N

New York City

914

1

70

13

---

N

1

3

Pennsylvania

276

---

10

2

---

4,680

---

N

E.N. Central

1,197

2

47

4

2

11,309

---

9

Illinois

521

1

24

---

---

1,091

N

N

Indiana

128

1

2

N

---

444

---

3

Michigan

226

---

7

---

2

4,187

---

N

Ohio

252

---

11

4

---

4,536

---

6

Wisconsin

70

---

3

N

N

1,051

N

N

W.N. Central

504

57

13

3

---

1,733

---

---

Iowa

43

---

1

---

---

N

N

N

Kansas

59

4

1

N

N

586

N

N

Minnesota

238

1

8

---

---

---

---

---

Missouri

119

35

3

3

---

923

---

N

Nebraska

25

10

---

---

---

N

N

N

North Dakota

7

---

---

---

---

140

N

N

South Dakota

13

7

---

---

---

84

---

N

S. Atlantic

2,708

5

83

5

---

5,296

---

216

Delaware

19

---

2

---

---

49

N

7

District of Columbia

60

---

1

N

N

32

---

3

Florida

989

---

15

1

---

1,321

---

97

Georgia

474

---

17

1

---

N

N

23

Maryland

270

1

17

N

N

N

---

25

North Carolina

345

1

8

---

---

N

N

20

South Carolina

218

---

1

2

---

1,103

---

8

Virginia

309

3

21

1

---

1,582

---

33

West Virginia

24

---

1

---

---

1,209

---

N

E.S. Central

666

3

4

---

---

701

---

23

Alabama

175

---

3

N

N

699

N

10

Kentucky

120

1

---

N

N

N

N

---

Mississippi

137

---

---

N

N

2

N

9

Tennessee

234

2

1

---

---

N

---

4

W.S. Central

1,983

34

25

4

---

10,992

---

62

Arkansas

106

15

---

---

---

808

---

N

Louisiana

218

---

---

---

---

123

N

---

Oklahoma

149

18

3

1

---

N

N

2

Texas

1,510

1

22

3

---

10,061

N

60

Mountain

629

20

17

2

---

2,798

---

17

Arizona

304

3

7

1

---

---

---

11

Colorado

111

3

6

N

---

1,089

N

6

Idaho

9

---

---

N

N

N

N

N

Montana

11

---

---

N

N

424

---

N

Nevada

102

---

---

---

---

N

N

N

New Mexico

51

1

1

N

N

422

N

---

Utah

39

9

3

1

---

828

---

---

Wyoming

2

4

---

---

---

35

---

---

Pacific

3,284

6

88

---

---

86

3

164

Alaska

51

1

---

N

N

43

N

2

California

2,726

1

71

N

N

---

2

104

Hawaii

122

---

6

N

N

43

N

25

Oregon

94