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Notice to Readers: Changes to MMWR Table I and Presentation of National Notifiable Diseases Surveillance System Data --- January 2008

This issue of MMWR incorporates changes to Table I (Provisional cases of infrequently reported notifiable diseases, United States), including revisions to two condition categories designated as nationally notifiable by CDC and the Council of State and Territorial Epidemiologists (CSTE). In addition, a CSTE-CDC initiative is implementing a methodologic change in the way CSTE and CDC solicit and document reporting requirements for nationally notifiable infectious diseases (NNIDs). By March 2008, information about 2007 NNID reporting requirements resulting from this initiative is expected to be included in MMWR Table II (Provisional cases of selected notifiable diseases, United States) and other MMWR tables displaying National Notifiable Diseases Surveillance System (NNDSS) data.

Changes to Table I

As of January 5, 2008, two condition categories have been revised in the list of NNIDs: ehrlichiosis and Q fever. Previously, the ehrlichiosis category included the following three subcategories: 1) human granulocytic; 2) human monocytic; and 3) human, other or unspecified. Because of taxonomic changes in the pathogens, the ehrlichiosis category has been renamed "Ehrlichiosis/Anaplasmosis" and will now include the following four subcategories: Ehrlichia chaffeensis, Ehrlichia ewingii, Anaplasma phagocytophilum, and ehrlichiosis/anaplasmosis, undetermined. In addition, beginning in 2008, Q fever incidence data will be displayed by separating the acute and chronic forms of the disease. Because each state will have to update its surveillance information system to reflect these new categories, reporting for these new categories is expected to be delayed for at least 1 month. The surveillance case definitions adopted for these conditions are listed within their respective CSTE position statements (1,2) and are posted on the case definitions section of the NNDSS website (3).

Methodologic Change in Identifying "N" Indicators

The CSTE-CDC 2007 State Reportable Conditions Assessment project (2007 SRCA) is collecting information from each reporting jurisdiction (i.e., 50 U.S. states, the District of Columbia, New York City, and five U.S. territories) to determine which NNIDs were reportable in 2007. The 2007 SRCA gathers information regarding whether the condition is explicitly reportable (i.e., listed as a specific disease or as a category of diseases on reportable disease lists) or whether it is implicitly reportable (i.e., included in a general category in the reportable disease list, such as "rare diseases of public health importance"). Only conditions that are explicitly reportable will be considered reportable under the new 2007 SRCA methodology.

The results of the 2007 SRCA will be used to indicate whether a specified NNID is not notifiable for the specified period and reporting jurisdiction. This information will be noted with an "N" indicator (for "not notifiable") in MMWR Table II (Provisional cases of selected notifiable diseases, United States) and other MMWR tables displaying NNDSS data by reporting jurisdiction, such as the MMWR Summary of Notifiable Diseases, United States. This notation will allow readers to distinguish whether 1) no cases were reported even though the condition is reportable or 2) no cases were reported because the condition is not reportable.

The results of the 2007 SRCA are not expected to be available to apply to the MMWR tables until the first quarter of calendar year 2008 (possibly by March 2008). Data for the "N" indicator for 2007 that were previously captured using another methodology will be used to populate MMWR Table II until the 2007 SRCA results are available.

The 2008 SRCA is expected to be conducted in July 2008. The MMWR tables displaying 2008 data will not be updated with the 2008 "N" indicators until the results of the 2008 SRCA are extracted, which is expected to occur by September or October 2008. The 2007 "N" indicators will be applied to the 2008 data until the 2008 SRCA information is available.


  1. Council of State and Territorial Epidemiologists. Position statement 07-ID-03. Revision of national surveillance case definition for ehrlichiosis (ehrlichiosis/anaplasmosis). Available at
  2. Council of State and Territorial Epidemiologists. Position statement 07-ID-04. Revision of the surveillance case definition for Q fever. Available at
  3. CDC. Case definitions for nationally notifiable infectious diseases. Available at

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Date last reviewed: 1/10/2008


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