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Summary of Notifiable Diseases --- United States, 2008

Prepared by

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

Enrique Nieves, Jr., MS, Acting Division Director1

Ruth Ann Jajosky, DMD1

Deborah A. Adams1

Pearl Sharp1

Willie J. Anderson1

J. Javier Aponte1

Aaron E. Aranas, MPH, MBA1

Susan B. Katz, MPH1

Michelle Mayes1

Michael S. Wodajo1

Diana H. Onweh1

James Baillie1

Meeyoung Park2

1Division of Notifiable Disease Surveillance (Proposed), the Office of Surveillance, Epidemiology and Laboratory Services (Proposed), CDC

2McKing Consulting Corporation


Preface

The Summary of Notifiable Diseases--- United States, 2008 contains the official statistics, in tabular and graphic form, for the reported occurrence of nationally notifiable infectious diseases in the United States for 2008. Unless otherwise noted, the data are final totals for 2008 reported as of June 30, 2009. 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 2008 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 2008.* The tables provide the number of cases reported to CDC for 2008 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 1977. 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--2006. 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 Data Operations Team---NNDSS, Division of Notifiable Disease Surveillance (Proposed), Public Health Surveillance Program Office (Proposed) at soib@cdc.gov.

* No cases of anthrax; diphtheria; Eastern equine encephalitis virus disease, non-neuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; Powassan virus disease, nonneuroinvasive; rubella, congenital syndrome; severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV); smallpox; vancomycin-resistant Staphylococcus aureus (VRSA) infection; Western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; and yellow fever were reported in 2008. 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.

Background

The infectious diseases designated as notifiable at the national level during 2008 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 2008*

Acquired immunodeficiency syndrome (AIDS)

Anthrax

Domestic arboviral diseases, neuroinvasive and nonneuroinvasive

California serogroup virus

Eastern equine encephalitis virus

Powassan virus

St. Louis encephalitis virus

West Nile virus

Western equine encephalitis virus

Botulism

foodborne

infant

other (wound and unspecified)

Brucellosis

Chancroid

Chlamydia trachomatis infections

Cholera

Coccidioidomycosis

Cryptosporidiosis

Cyclosporiasis

Diphtheria

Ehrlichiosis/Anaplasmosis

Ehrlichia chaffeensis

Ehrlichia ewingii

Anaplasma phagocytophilum

Undetermined

Giardiasis

Gonorrhea

Haemophilus influenzae, invasive disease

Hansen disease (Leprosy)

Hantavirus pulmonary syndrome

Hemolytic uremic syndrome, post-diarrheal

Hepatitis, viral, acute

Hepatitis A, acute

Hepatitis B, acute

Hepatitis B virus, perinatal infection

Hepatitis C, acute

Hepatitis, viral, chronic

Chronic Hepatitis B

Hepatitis C virus infection (past or present)

Human Immunodeficiency Virus 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

acute

chronic

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, drug resistant, all ages, invasive disease

Streptococcus pneumoniae, invasive disease non-drug resistant, in children aged <5 years

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 (morbidity)

Varicella (mortality)

Vibriosis

Yellow fever

* Position Statements the Council of State and Territorial Epidemiologists approved in 2007 for national surveillance were implemented beginning in January 2008. No new conditions were added to the Notifiable disease list in 2008

Revised national surveillance case definition.

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--53, which correspond to the period for the week ending January 5, 2008, through the week ending January 3, 2009. 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 2008 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.

Office of Surveillance, Epidemiology and Laboratory Services (Proposed)
National Center for Health Statistics (NCHS)
Office of Vital and Health Statistics Systems (deaths from selected notifiable diseases).

Office of Infectious Diseases (Proposed)
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 Emerging and Zoonotic Infectious Diseases (Proposed)
Division of Vector-Borne 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, 2007 U.S. resident population from the vintage 2007 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 2007 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 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. resident 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 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 or reported uniformly for all diseases, the standards for race and ethnicity have changed over time, and the transition in implementation to the newest race and ethnicity standard has taken varying amounts of time for different CDC surveillance systems. For example, in 1990, the National Electronic Telecommunications System for Surveillance (NETSS) was established to facilitate data collection and submission of case-specific data to CDC's National Notifiable Diseases Surveillance System, except for selected diseases. In 1990, NETSS implemented the 1977 Office of Management and Budget (OMB) standard for race and ethnicity, in which race and ethnicity were collected in one variable. Other surveillance programs implemented two variables for collection of race and ethnicity data. The 1997 OMB race and ethnicity standard, which requires collection of multiple races per person using multiple race variables, should have been implemented by federal programs beginning January 1, 2003. In 2003, the CDC Tuberculosis and HIV/AIDS programs were able to update their surveillance systems to implement 1997 OMB standards. In 2005 the STD*MIS system was also updated to implement the 1997 OMB standards. In 2003, the CDC's Division of Tuberculosis Elimination was able to update the Tuberculosis Information Management System (TIMS) to implement the 1997 OMB race/ethnicity standards. However, in 2003, other diseases that constitute NETSS were undergoing a major change in the manner in which data were collected and reported to CDC. This change is known as the transition from NETSS to the National Electronic Disease Surveillance System (NEDSS). NEDSS implemented the newer 1997 OMB standard for race and ethnicity. However, the transition from NETSS to NEDSS was slower than originally expected relative to reporting data to CDC using NEDSS and hence some data are currently reported to CDC using NETSS and NEDSS formats, even if the data in the reporting jurisdictions are collected using NEDSS. Until the transition to NEDSS is complete, race and ethnicity data collected or reported to NETSS using different race and ethnicity standards will need to be converted to one standard. The data are now converted to the 1977 OMB standard originally implemented in NETSS.

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 by using NETSS. In 2001, CDC launched 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 adopted by 16 states; 31 states have their own NEDSS-compatible based system, and three in the final stage of adoption. A major feature of all NEDSS compatible solutions, which includes 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 2008, 16 states used NBS to transmit nationally notifiable infectious diseases to CDC, 24 states used a NEDSS-compatible based system, and the remaining states and territorial jurisdictions continued to use the NETSS or other applications. Additional information concerning NEDSS is available at http://www.cdc.gov/phin/activities/applications-services/nedss/index.html.

Methodology for Identifying which Nationally Notifiable Infectious Diseases are Reportable

States and jurisdictions are sovereign entities. Reportable conditions are determined by laws and regulations of each state and jurisdiction. It is possible that some conditions deemed nationally notifiable might not be reportable in certain states or jurisdictions. Determining which nationally notifiable infectious diseases are reportable in National Notifiable Diseases Surveillance System (NNDSS) reporting jurisdictions was determined by analyzing results of the 2008 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 for more than 6 months in 2008 by clinicians, laboratories, hospitals, or "other" public health reporters, as mandated by law or regulation. In 2008, to assist in the implementation of the SRCA, the NNDSS program provided technical assistance to the Council of State and Territorial Epidemiologists (CSTE).

In 2007, SRCA became the first collaborative project of such technical magnitude ever conducted by CSTE and CDC. Previously, CDC and CSTE had gathered public health reporting requirements independently. The 2008 SRCA collected information regarding whether each reportable condition was 1) explicitly reportable (i.e., listed as a specific disease or as a category of diseases on reportable disease lists), 2) 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 3) not reportable. Only explicitly reportable conditions were considered reportable for the purpose of national public health surveillance and thus reflected in the NNDSS. Moreover, to determine whether a condition included in the SRCA was reportable across all public health reporter categories and for a specific nationally notifiable infectious disease (NNID) in a reporting jurisdiction, CDC developed and applied a condition algorithm and a results algorithm to run on the data collected in the SRCA. Analyzed results of the 2008 SRCA were used to determine whether a NNID was not reportable in a reporting jurisdiction in 2008 and thus noted with an "N" indicator (for "not reportable") in the front tables of this report.

Unanalyzed results from the 2007 and 2008 SRCA are available using CSTE's web query tool, at http://www.cste.org/dnn/programsandactivities/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 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 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.

Highlights for 2008

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 human immunodeficiency virus (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 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 surveillance into their AIDS surveillance systems; names or other personal identifying information are not reported to CDC.

Botulism

Botulism is a severe paralytic illness caused by toxins produced by Clostridium botulinum. Exposure to toxin can occur by ingestion (foodborne botulism) or by in situ production from C. botulinum colonization of a wound (wound botulism) or the gastrointestinal tract (infant botulism and adult intestinal colonization botulism) (1). CDC maintains intensive surveillance for cases of botulism in the United States with a 24 hour/7 day a week consultation service. Health-care providers should report suspected botulism cases immediately to their state health departments; all states maintain 24-hour telephone services for reporting of botulism and other public health emergencies. Additional emergency consultation is available from the CDC botulism duty officer via the CDC Emergency Operations Center, telephone 660-488-7100. In 2008, cases were attributed to foodborne botulism, wound botulism, infant botulism, and unknown forms of botulism.

  1. Sobel J. Botulism. Clin Infect Dis 2005;41:1167--73.

Brucellosis

The incidence of brucellosis in the United States increased from 2003 until 2007. The number of reported cases in 2008 decreased 36.0% from the previous year. Overall, the demographic characteristics of persons with brucellosis remained stable. For patients for whom ethnicity was identified, 62.3% were Hispanic. The majority of cases were reported in the Southwest.

In the U.S. animal population, brucellosis eradication efforts continue. In 2008, the U.S. Department of Agriculture declared Texas a brucellosis Class Free state. Montana was reclassified as a Class A state following the report of a second brucellosis-affected herd within 2 years (1). In total, 49 states and three territories were classified as brucellosis Class Free states at the end of 2008 (1). 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.

Risk factors associated with brucellosis include the consumption of unpasteurized milk or soft cheeses. The risk for brucellosis from domestic dairy products is low. Unpasteurized dairy products from countries with endemic brucellosis remains a source of brucellosis for immigrants and travelers. Hunters are at an elevated risk for contracting brucellosis from the carcass or meat of infected animals. In addition, exposure to Brucella spp. can occur in diagnostic and research laboratories because of the 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 illness (4). CDC provides recommendations for laboratory exposures and can assist with the serologic monitoring of laboratory workers who are affected.

  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). 5th ed. Washington, DC: US Department of Health and Human Services, CDC, National Institutes of Health; 2007. Available at http://www.cdc.gov/OD/OHS/biosfty/bmbl5/bmbl_5th_edition.pdf.
  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. Cases reported in 2008 were fewer than the average number of cases per year reported during 2003--2007 (mean: 6.8) (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 (2,3). The single patient with domestic exposure in 2008 ate crab harvested from the U.S. Gulf Coast. Other serogroups of toxin-producing Vibrio cholerae (e.g., O141 and O75) also have caused severe diarrhea in patients who have a history of consumption of seafood from the Gulf Coast (4).

  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. Mintz ED, Guerrant RL. A lion in our village -- the unconscionable tragedy of cholera in Africa. New Engl J Med 2009;360:1061--3.
  4. 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

Coccidioidomycosis is a common cause of community-acquired fungal pneumonia in disease-endemic areas of the southwest United States; however, clinical suspicion and laboratory testing occur infrequently (1). Fungal conidia survive in the soil and are propagated in an airborne manner, particularly when soil is disrupted. In the southwest United States, alkaline soil and climate support coccidioidomycosis growth and propagation. In recent years, strategies to model the effects of climate on disease incidence have begun, which include linking changes in incidence to climatic change, particularly in the region where the disease is endemic (2--4).

Case counts decreased for the first time in a decade during 2007. In 2008, reported coccidioidomycosis cases in the United States decreased again, primarily because of fewer reports received from the disease-endemic states of California and, to a lesser extent, Arizona. Case counts decreased even after the case definition revision implemented by the Council of State and Territorial Epidemiologists in 2007 included less stringent diagnostic criteria.

In 2009, certain laboratories in Arizona, where approximately 60% of coccidioidomycosis cases in the United States occur, modified their reporting criteria to include all cases with a positive enzyme immunoassay without confirmation by immunodiffusion assay. As a result, case counts in Arizona might increase during 2009; however, such an increase can be attributed to a less stringent case definition.

  1. Valdivia L, Nix D, Wright M, et al. Coccidioidomycosis as a common cause of community-acquired pneumonia. Emerg Infect Dis 2006;12:958--62.
  2. Park B, Sigel K, Vaz V, et al. An epidemic of coccidioidomycosis in Arizona associated with climatic changes, 1998--2001. J Infect Dis 2005;191:1981--7.
  3. Comrie AC. Climate factors influencing coccidioidomycosis seasonality and outbreaks. Environ Health Perspect 2005;113:688--92.
  4. Kolivras KN, Comrie AC. Modeling valley fever (coccidioidomycosis) incidence on the basis of climate condition. Int J Biometeorol 2003;47:87--101.

Cryptosporidiosis

The number of cryptosporidiosis cases reported to CDC increased during 2005--2007. Despite a decrease in the number of cases reported in 2008, cryptosporidiosis incidence was approximately threefold greater compared with 2004.

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 occurred more frequently 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 (1). 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 time that oocysts can be shed (2); the low infectious dose (3); the resistance of Cryptosporidium oocysts to chlorine (4); and the prevalence of improper pool maintenance (i.e., insufficient disinfection, filtration, and recirculation of water), particularly of children's wading pools (5). The application of molecular epidemiology (i.e., genotyping and subtyping Cryptosporidium specimens) to clinical and environmental samples has demonstrated potential to expand our knowledge of Cryptosporidium epidemiology (6). In 2008, CDC partnered with state and local health professionals to release Cryptosporidiosis Outbreak and Response Evaluation (CORE) guidelines (http://www.cdc.gov/crypto/resources/core_guidelines.pdf) that health departments, aquatic facilities, and child care programs can implement to reduce the risk of community-wide spread.

  1. Shields JM, Gleim ER, Beach MJ. Prevalence of Cryptosporidium spp. and Giardia intestinalis in swimming pools, Atlanta, Georgia. Emerg Infect Dis 2008;14:948--50.
  2. 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.
  3. 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.
  4. Shields JM, Hill VR, Arrowood MJ, Beach MJ. Inactivation of Cryptosporidium parvum under chlorinated recreational water conditions. J Water Health. 2008;6:513--20.
  5. CDC. Surveillance data from swimming pool inspections---selected states and counties, United States, May--September 2002. MMWR 2003;52:513--6.
  6. Xiao L. Molecular epidemiology of cryptosporidiosis: an update. Exp Parasitol 2009 April 7 [Epub ahead of print].

Domestic Arboviral, Neuroinvasive and Nonneuroinvasive
(West Nile virus disease)

During 2008, West Nile virus (WNV) disease cases were reported from 45 states and the District of Columbia, including 27 counties that had not reported cases previously. Nationally, the reported incidence of West Nile neuroinvasive disease (WNND) was 0.2 cases per 100,000 population, which is lower than that reported in the previous 4 years during 2004--2007 (median: 0.4, range: 0.4-0.5). The highest incidence of WNND continued to occur in western and central states.

In 2008, CDC, the Food and Drug Administration (FDA), and state health departments investigated an increase in false-positive test results obtained with a commercially available WNV test kit (1). The investigation revealed that one particular kit lot was the source of the false-positive results, and that lot was recalled. Among specimens that tested positive using the implicated kit lot that were retested at CDC, 72% were determined to be false-positive results. A higher false-positive percentage was found among patients without evidence of neuroinvasive disease (77%) than patients with evidence of neuroinvasive disease (47%). Commercially available WNV test kits should be used to determine a presumptive diagnosis of WNV neuroinvasive disease. These kits should not be used to test specimens from persons without compatible illness, and any positive result should be confirmed by additional testing at a state health department or CDC. Considering the large proportion of false-positives, CDC recommended that state health departments not classify patients as having WNV disease if the only laboratory evidence was from the recalled kit lot. States have since reevaluated affected cases to arrive at the final WNV disease totals for 2008.

  1. CDC. False-positive results with a commercially available West Nile Virus immunoglobulin M assay---United States, 2008. MMWR 2009;58:458--60.

Ehrlichiosis and Anaplasmosis

Case definitions for these diseases were modified beginning in 2008 (1) to include a separate designation for Ehrlichia ewingii for better assessment and enumeration of these cases. Four categories of ehrlichiosis and anaplasmosis were reportable during 2008: 1) Ehrlichia chaffeensis, 2) Ehrlichia ewingii, 3) Anaplasma phagocytophilum, and 4) Human ehrlichiosis/anaplasmosis - undetermined. Infection caused by E. chaffeensis was reported primarily from the lower Midwest and the Southeast, reflecting the range of the primary tick vector species (Amblyomma americanum). Infection caused by A. phagocytophilum was 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. Four central U.S. states and Delaware reported nine confirmed cases of E. ewingii infection. The category "Human ehrlichiosis/anaplasmosis - undetermined" includes cases for which a specific etiologic agent could not be identified using available serologic tests. The high number of "Human ehrlichiosis/anaplasmosis - undetermined" cases reported from some northern states (2) reflects state-specific classifications based on indistinguishable antigenic cross-reactivity or situations in which physicians, confused regarding the likely causative agent, ordered single or inappropriate tests (e.g., ordering only ehrlichiosis tests in a region where anaplasmosis would be expected to predominate).

During 2008, cases attributed to E. chaffeensis and A. phagocytophilum increased by 16% and 21%, respectively. Reported ehrlichiosis and anaplasmosis cases have increased every year since this group of diseases became notifiable in 1999. Increases in reported cases might be the result of several factors, including ecological changes influencing disease transmission, changes in diagnostic approaches that alter detection rates, or changes in surveillance and reporting. Changes in the case definition that became effective in January 2008 (1) also might have altered how cases were classified.

  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.
  2. CDC. Anaplasmosis and Ehrlichiosis--- Maine, 2008. MMWR 2009; 58:1033--6.

Hansen Disease (Leprosy)

The number of cases of Hansen disease (HD) reported in the United States peaked in 1985 and decreased until 2006. The number of reported cases increased in 2007 and decreased 26.6% in 2008. Cases were reported from 19 states and one territory; 70% of cases were reported from California, Florida, Hawaii, Texas, and New York City. HD is not highly transmissible; cases appear to be related predominantly to immigration from areas in which the disease is endemic. 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 6.3% of all persons infected with E. coli O157:H7, but 15.3% of children aged < 5 years, progress to HUS (2). During 2008, as usual, most 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. Gould L, Demma L, Jones TF, et al. Hemolytic uremic syndrome and death in persons with Escherichia coli O157:H7 infection, Foodborne Diseases Active Surveillance Network Sites, 2000--2006. Clin Infect Dis 2009;49:1480--5.

HIV Infection

As of April 2008, all 50 states, the District of Columbia, and five U.S. dependent areas have laws or regulations requiring confidential name-based reporting for human immunodeficiency virus (HIV) infection, in addition to reporting persons with AIDS. In 2008, CDC published a revised surveillance case definition for HIV infection that includes AIDS and incorporates the HIV infection classification (1). Laboratory-confirmed evidence of HIV infection is now required to meet the surveillance case definition for HIV infection, including stage 3 HIV infection, i.e., 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 56,300 (2).

  1. CDC. Revised surveillance case definitions for HIV infection among adults, adolescents and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years---United States, 2008. MMWR 2008;57(No. RR-10).
  2. Hall HI, Song, R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA 2008;300:520--9.

Influenza-Associated Pediatric Mortality

In June 2004, the Council of State and Territorial Epidemiologists added influenza-associated pediatric mortality (i.e., among persons aged <18 years) to the list of conditions reportable to the National Notifiable Diseases Surveillance System. Cumulative year-to-date incidence is published each week in MMWR Table I for low-incidence nationally notifiable diseases.

A total of 90 cases of influenza-associated pediatric deaths were reported to CDC during 2008. Pediatric deaths reported during 2008 occurred during the 2006--07, 2007--08, and 2008--09 influenza seasons. In 2008, the median age at death was 5.6 years (range: 29 days--17.9 years). A total of 10 children (11%) were aged <6 months; 14 (16%) were aged 6--23 months; 19 (21%) were aged 24--59 months; and 47 (52%) were aged >5 years. Among all pediatric deaths reported in 2008, 56 (62%) children died after being admitted to the hospital, whereas 34 (38%) died in the emergency room or outside the hospital. Information on underlying or chronic medical conditions was reported for 82 children: 47 (57%) children had one or more underlying or chronic medical conditions, placing them at increased risk for influenza-associated complications. Fifty-one of the 90 children had specimens collected for bacterial culture from normally sterile sites and 15 (29%) were positive. Staphylococcus aureus was the most frequently reported bacterial pathogen in 2008 and was found in 13 (87%) of the 15 children with co-infections. Nine of the Staphylococcus isolates were methicillin-resistant and the remaining four were sensitive to methicillin. Of the 65 children aged >6 months for whom the vaccination status was known, nine had been vaccinated against influenza according to the 2008 Advisory Committee on Immunization Practices recommendations (1). Continued surveillance of influenza-related mortality is important to monitor the effects of influenza and the possible effect of interventions in children.

  1. CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2008; 57(No. RR-7):1--60.

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 2008, most cases occurred among persons aged ≥65 years.

Molecular subtyping of L. monocytogenes isolates and sharing 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 2008, the incidence of listeriosis in FoodNet/active surveillance sites was 0.29 cases per 100,000 population, representing a decrease of 36% 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 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/national/surveillance/listeria_surveillance.html. 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, 2008. MMWR 2009;58:333--7.
  4. Outbreak of Listeria monocytogenes Infections associated with pasteurized milk from a local dairy---Massachusetts, 2007. MMWR 2008;57:1097--1100.

Lyme Disease

In January 2008, a CSTE-approved revised national surveillance case definition was implemented. The purpose of the revision was to permit states and territories to report confirmed and probable cases of Lyme disease to the National Notifiable Diseases Surveillance System in accordance with the 2007 CSTE position statement template, update the criteria for laboratory evidence of infection to reflect current testing practices, and provide measures to assess the public health surveillance burden. Because of the modifications to the classification of a confirmed case and criteria for laboratory evidence and addition of probable cases to the total case count, the total and confirmed case counts from 2008 are not directly comparable to total case counts reported in previous years. The revised surveillance case definition can be accessed at http://www.cdc.gov/ncphi/disss/nndss/casedef/lyme_disease_2008.htm.

Measles

As in recent years, the majority (125) of confirmed measles cases in 2008 were import-associated (1). Twenty-five cases were internationally imported, including 13 in U.S. residents who had acquired measles while traveling abroad and 12 in non-U.S. residents who had acquired the disease abroad before traveling to the United States. Importations came from 12 countries, many of which are within the WHO European Region. Other import-associated cases included 29 cases with a direct link to an imported case, 22 imported virus cases (i.e., cases that cannot be linked epidemiologically to an imported case, but for which imported virus has been isolated), and 49 cases with link to virus-only cases. The sources of infection for the remaining 15 cases were classified as unknown because no link to importation was found.

Of the 127 U.S. residents with measles in 2008, 7 were vaccinated, 21 had unknown vaccination histories, and 99 were not vaccinated. Of the 99 cases in unvaccinated U.S. residents: 67% were among persons unvaccinated because of their personal or religious beliefs. Fourteen cases occurred among children unvaccinated because of missed opportunity, delayed vaccination, or unknown reasons. This group included mostly children aged 12--15 months, who had not been vaccinated, or older toddlers whose parents delayed vaccination but did not state any religious or personal objections to vaccination. Seventeen cases occurred in children too young to be vaccinated routinely, although two infants, aged 6 and 9 months, were traveling internationally and thus should have been vaccinated according to vaccination recommendations of the Advisory Committee for Immunization Practices (2). One case occurred in a person who was born before 1957, and therefore was considered to have evidence of immunity because of birth year (2).

Although still low, the number of measles cases reported during 2008 was the highest since 1996. The increase was not the result of a greater number of imported cases, but was the result of greater viral transmission after importation into the United States. The import-linked cases occurred largely among school-aged children who were eligible for vaccination but whose parents chose not to have them vaccinated (3). One study reported an increase in the number of vaccine exemptions among U.S. children who attend school in states that allow philosophical exemptions (4). In 2008, 41% of measles cases occurred among school-aged children and adolescents (aged 5--19 years). Seventeen children, including five aged <15 months, were hospitalized.

Nine outbreaks occurred in seven states, all with viral or epidemiologic evidence of an imported source. These outbreaks accounted for 74% of all cases. In four outbreaks, 50% of cases occurred among persons unvaccinated because of personal beliefs. Two such outbreaks involved home-schooled populations (3). In one 12-case outbreak among children with personal belief exemptions, 70 children exposed to a measles case were placed on voluntary home quarantine because parents declined vaccination or because they were too young to be vaccinated (5). In another outbreak, the majority of infections were acquired in hospitals or emergency rooms. This outbreak lasted over 2 months and 6 generations of spread. This outbreak included a case in an unvaccinated health-care worker who was infected in a hospital (6).

Although the elimination of endemic measles in the United States has been achieved, and population immunity remains high (7), outbreaks can occur when measles is introduced into susceptible groups, often at substantial cost to control (8). Measles can be prevented by adhering to recommendations for vaccinations, including guidelines for travelers (2, 9).

  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. Available at http://www.cste.org/position%20statements/searchbyyear2006.asp.
  2. CDC. Measles, mumps, and rubella---vaccine use and strategies for elimination of measles, rubella, congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1998;47(No. RR-8).
  3. CDC. Measles--- United States, January--July 2008. MMWR 2008;57:893--6.
  4. Omer SB, Pan WKY, Halsey NA, et al. Nonmedical exemptions school immunization requirements: secular trends and association to state policies with pertussis incidence. JAMA 2006;296:1757--63.
  5. CDC. Outbreak of measles---San Diego, California, January--February 2008. MMWR 2008;57:203--6.
  6. Measles---United States, January 1--April 25, 2008. MMWR 2008;57:494--8.
  7. Hutchins SS, Bellini W, Coronado V, et al. Population immunity to measles in the United States. J Infect Dis 2004:189(Suppl 1):S91--7.
  8. 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.
  9. CDC. Preventable measles among U.S. residents, 2001--2004. MMWR 2005:54:817--20.

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 reported cases (1--4). Following the resurgence of mumps in 2006, reported cases declined towards pre-resurgence levels with 800 cases in 2007 and 454 cases in 2008 (5). In response to the 2006 outbreak, the Advisory Committee on Immunization Practices (ACIP) updated criteria for mumps immunity and mumps vaccination recommendations (5). In 2007, the Council of State and Territorial Epidemiologists revised the mumps case definition by extending the case definition to include cases with mumps symptoms other than parotitis, by adding mumps virus nucleic acid detection to the laboratory criteria, and by making several changes to the case classification system (6). The revised case definition has been in effect since January 1, 2008.

In 2008, after a review of scientific evidence, ACIP, the Healthcare Infection Control Practices Advisory Committee, and the American Academy of Pediatrics recommended reducing, from 9 to 5 days, the period of isolation for persons with mumps in both health-care and community settings. All three groups now recommend a 5-day period of isolation after onset of parotitis, both for isolation of persons with mumps in either community or health-care settings and for use of standard precautions and droplet precautions. Among the rationale cited for these recommendations is the substantial reduction in viral secretion 5 days after onset of parotitis and the likelihood that much transmission in community settings occurs from persons with asymptomatic infection and, among persons with symptomatic disease, before the onset of parotitis. Postexposure recommendations remain unchanged. Health-care personnel with no evidence of mumps immunity who are exposed to patients with mumps should be excluded from duty from the 12th day after first exposure through the 26th day after last exposure (7--8).

  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, Parker, A, et al. Recent resurgence of mumps in the United States. N Engl J Med 2008;358:1580--9.
  5. Barskey AE, Glasser, JW, LeBaron CW.  Mumps resurgence in the United States:  A historical perspective on unexpected elements. Vaccine 2009;27:6186--95.
  6. CDC. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP) for the control and elimination of mumps. MMWR 2006;55:629--30.
  7. Council of State and Territorial Epidemiologists. 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.
  8. CDC. Updated recommendations for isolation of persons with mumps. MMWR 2008;57:1103--5.

Pertussis

Although the incidence of reported pertussis has declined in the United States following the 2004 peak (8.9 per 100,000), overall incidence increased slightly during 2007 and 2008 (3.62 and 4.18 cases per 100,000, respectively). Infants aged <6 months, who are at greatest risk for severe disease and death, continued to have the highest reported rate of pertussis (79.41 per 100,000). However, adolescents (aged 10--19 years) and adults (aged >20 years) accounted for nearly half of reported cases in 2008, and the contribution of cases in persons aged 5--9 years appears to be increasing in comparison with previous years (20% of cases in 2008, 13% of cases in 2007, 10% in 2006). Adolescents and adults are critical age groups as they are thought to be a source of transmission of pertussis to young infants who are too young to be completely vaccinated. In 2005, a combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) was recommended for use among adolescents and adults (1,2). Although Tdap coverage among adolescents aged 13--17 years has increased from 10.8% in 2006 to 40.8% in 2008, the direct impact of Tdap is still unknown (3,4). Continued monitoring of disease trends through national surveillance will be important to assess both the direct impact of Tdap among target vaccine age groups and the indirect effects of vaccination on infants.

  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. Vaccination coverage among adolescents aged 13--17 years-- United States, 2006. MMWR 2007;56:885--8.
  4. CDC. Vaccination coverage among adolescents aged 13--17 years---United States, 2008. MMWR 2009;58:997--1001.

Psittacosis

Psittacosis is a respiratory infection caused by the bacterium Chlamydophila psittaci. Once referred to as "parrot fever", psittacosis occurs through exposure to the feces, respiratory secretions, plumage, or tissues of infected birds and can lead to severe respiratory compromise in a minority of cases. In 2008, the incidence of reported cases of psittacosis continued to be low. Because of the recent development of improved molecular diagnostics for the detection of C. psittaci (1), a revised position statement by the Council of State and Territorial Epidemiologists and case definition for psittacosis is anticipated. Additional information about psittacosis and case reporting tools can be found at http://www.nasphv.org/documentsCompendiaPsittacosis.html.

  1. Mitchell SL, Wolff BJ, Thacker WL, et al. Genotyping of Chlamydophila psittaci by real time PCR and high resolution melt analysis. J Clin Microbiol 2008;47:175--81.

Q Fever

The case definition for Q fever was modified beginning in 2008 (1) to include a separate designation for acute and chronic infection and to restrict designation of cases diagnosed by use of indirect immunofluorescent antibody assays to those minimally exhibiting IgG antibody titers ≥1:128. Among cases reported in 2008, 88% were identified as acute infection, whereas 12% were the result of chronic Q fever infection. In 2008, cases remained 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.

During 2008, cases of Q fever reported decreased by 30% from those reported for 2007, the largest decrease since reporting of cases of Q fever was initiated in 2000. This decrease likely reflects the more stringent case classification criteria in effect during 2008 (1) compared with the previous year. Although few human cases are reported annually, Q fever is believed to be substantially underreported because of its nonspecific presentation and the failure of physicians to suspect infection and request appropriate diagnostic tests.

  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.

Rabies

During 2008, two cases of human rabies were reported in the United States: an imported case from Mexico and an indigenous case in a 55-year-old male from Missouri. Epidemiologic investigations of these cases implicated bat rabies virus variants in both cases. The case from Mexico marked the first imported case of rabies reported as a rabies virus variant not associated with dogs in the origin country (1). During 2008, the majority (93%) of 6,841 animal rabies cases in the United States were reported in wild animal species. Overall, a 3% decrease in rabies cases was reported in animals in 2008 compared with 2007. In the United States, five groups of animals are recognized as reservoirs 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) (2). A skunk rabies virus variant associated with spillover and adaptation of a big brown bat rabies virus was reported in Flagstaff, Arizona after nearly 2 years with no cases after wildlife vaccination campaigns were implemented in the area.

Reported cases of rabies in domestic animals remain low (7% of reported rabid animals) in part because of high vaccination rates and the elimination of dog-to-dog transmission, which was last reported in 2004. One case of canine rabies imported in a dog from Iraq was reported during 2008 (3). This case illustrates the continued challenge for the United States to remain canine rabies free. Public health education programs should target travelers and health-care providers regarding rabies prevention measures and the potential risk of rabies exposure in countries where the disease is endemic in domestic animals. In the United States, cats remained the most commonly reported domestic animal with rabies during 2008 (62% of reported rabid domestic animals).

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 the eastern United States are targeted at preventing the westward spread of the raccoon rabies virus variant whereas programs in Texas are being maintained as a barrier to prevent the reintroduction of canine rabies from Mexico and to eliminate gray fox rabies.

  1. Velasco-Villa A, Messenger SL, Orciari LA, et al. New rabies virus variant in a Mexican immigrant. Emerg Infect Dis 2008;14:1906--8.
  2. Blanton JD, Robertson K, Palmer D, Rupprecht CE. Rabies surveillance in the United States during 2008. J Am Vet Med Assoc 2009; 235:676--89.
  3. CDC. Rabies in a dog imported from Iraq---New Jersey, June 2008. MMWR 2008;57:1076--8.

Rocky Mountain Spotted Fever

The case definition for Rocky Mountain Spotted Fever (RMSF) was modified beginning in 2008 (1) to include more detailed classification criteria for serologic assays, including enzyme-linked immunosorbent assays and use of IgM antibody tests. During 2008, RMSF cases increased 15% over those reported in 2007. Cases reported in 2008 were distributed across the United States, reflecting the endemic status of RMSF and the widespread ranges of the primary tick vectors (primarily Dermacentor variabilis and Dermacentor andersoni) responsible for transmission. RMSF cases associated with transmission by Rhipicephalus sanguineus, first reported in 2004 (2), continued to be reported from Arizona during 2008.

The reporting years 2005--2008 reflect a trend toward stabilized numbers of reported RMSF cases. However, RMSF case reports have increased more than 300% during the past decade. This increase might be the result of several factors, including ecological changes influencing disease transmission, changes in diagnostic approaches that alter detection rates, or changes in surveillance and reporting. Changes in the case definition in 2004 and a further revision of the case definition beginning in 2008 (1) also might have altered how cases were classified.

  1. 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.
  2. 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.

Salmonellosis

During 2008, as in previous years, the age group with the highest incidence of salmonellosis was children aged <5 years. Salmonella enterica serotype Typhimurium and S. enterica serotype Enteritidis have been the most frequently isolated serotypes since 1996 (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 antimicrobial 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; therefore, in 2005, the Council of State and Territorial Epidemiologists adopted a position statement for serotype-specific reporting of laboratory-confirmed salmonellosis cases (3). Increasing evidence indicates that infections with certain serotypes of Salmonella are more likely to be invasive and lead to poor outcomes than infections with other serotypes. Such findings have implications for better understanding the public health importance and pathogencity of salmonellosis (4).

  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): 2006 human isolates final report. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC; 2009.
  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.
  4. Jones TF, Ingram LA, Cieslak PR, et al. Salmonellosis outcomes differ substantially by serotype. J Infect Dis 2008;198:109--14.

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 serogroup and, for E. coli O157, also by pulsed-field gel electrophoresis pattern is important to detect, investigate, and control outbreaks. Stool specimens from patients with community-acquired diarrhea should be submitted to clinical laboratories for routine testing, should be cultured for O157 STEC, and tested with an assay that detects Shiga toxins (3). This simultaneous approach has several advantages. First, it enables rapid detection of Shiga toxin-related illness, including that caused by non-O157 STEC, which are not readily identified in culture. Second, it permits rapid identification of O157 STEC, the serogroup most strongly associated with the development of hemolytic uremic syndrome (HUS); quickly identifying O157 STEC infections might facilitate measures to prevent HUS and speed the identification of outbreaks. Third, culturing enables isolation of STEC, which can then be characterized by serogroup and pulsed-field gel electrophoresis pattern to facilitate outbreak detection and investigation. 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. Most reported outbreaks are caused by contaminated food or water. During 2004, a substantial decline in reported O157:H7 STEC cases led to an incidence measured in the Foodborne Diseases Active Surveillance System (FoodNet) that met the Healthy People 2010 goal of <1.0 cases/100,000 population; since then, the incidence has increased (4).

  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. Recommendations for diagnosis of shiga toxin-producing Escherichia coli infections by clinical laboratories, 2009. MMWR 2009;58(RR12):1--14.
  4. CDC. Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food, 10 sites---United States, 2004. MMWR 2005; 54:352--6.

Shigellosis

During 1978--2003, shigellosis cases reported to CDC exceeded 17,000 in nearly every year. 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, increased to approximately 20,000 in 2007, and to approximately 22,000 in 2008. Shigella sonnei infections continue to account for >75% of shigellosis in the United States (1). Most cases occur among young children, and large day care-associated outbreaks are common and difficult to control (2). Some cases of shigellosis are acquired during international travel (3,4). In addition to spreading 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. Arvelo W, Hinkle J, Nguyen TA, et al. Transmission risk factors and treatment of pediatric shigellosis during a large daycare center-associated outbreak of multidrug resistant Shigella sonnei. Pediatr Infect Dis J 2009;11:976--80
  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 Hispanola. Am J Trop Med Hyg 2007;76:1163--5.
  5. CDC. National Antimicrobial Resistance Monitoring System for enteric bacteria (NARMS): Human isolates final report, 2006. Atlanta, GA: US Department of Health and Human Services, CDC; 2009. Available at http://www.cdc.gov/narms.

Syphilis, Primary and Secondary

The rate of primary and secondary (P&S) syphilis in the United States declined 90% during 1990--2000. However, the rate of P&S syphilis has increased each year since 2001, mostly in men, but also in women for the past 4 years. In 2008, a total of 13,500 cases of P&S syphilis were reported to CDC. (1) This is the highest number of reported cases since 1995 and corresponds to a rate of 4.5 cases per 100,000 population, an 18% increase from 2007. Since 2001, the rate of P&S syphilis has increased 114%. On the basis of information from 44 states and Washington, D.C. in 2008, 63% of reported P&S syphilis cases in the United States occurred among men who have sex with men (MSM). Although the majority of U.S. syphilis cases have occurred among MSM, syphilis among heterosexuals is an emerging problem as reflected in a 88% increase in women since 2004 (1).

  1. CDC. Sexually Transmitted Disease Surveillance, 2008. Atlanta, GA: U.S. Department of Health and Human Services; November 2009.

Trichinellosis

In November 2008, an outbreak of trichinellosis occurred in Humboldt County, California, among several families who participated in a cultural ceremony. At least 34 persons attended the event, at which they shared a meal of bear meat that was hunted by one of the family members. Case-patients recalled eating both raw and undercooked bear meat; 30 confirmed cases were reported to CDC.

This is the eighth outbreak and the largest attributed to bear meat reported to CDC in the past 10 years (1,2); it highlights the continued need for public health prevention messages aimed at consumers of wild game meat in general and for targeted prevention messages for certain cultural groups whose customs put them at risk for Trichinella infection in particular.

Proper cooking of meat dishes, especially dishes prepared with some types of game meats, will prevent trichinellosis. Meat products, including sausages or other prepared dishes, should be cooked to internal temperatures of at least 170° F or until juices run clear. Some species of Trichinella are resistant to freezing, so freezing might not be an effective prevention measure (3).

  1. Kennedy ED, Hall RL, Montgomery SP, Pyburn DG, Jones JL. Trichinellosis surveillance---United States, 2002--2007. In: Surveillance Summaries, December 4, 2009. MMWR 2009;58 (No. SS-9).
  2. Roy SL, Lopez AS, Schantz PM. Trichinellosis surveillance---United States, 1997--2001. In: Surveillance Summaries, July 25, 2003. MMWR 2003;52(No. SS-6).
  3. Hill DE, Gamble HR, Zarlenga DS, Coss C, Finnigan J. Trichinella native in a black bear from Plymouth, New Hampshire. Vet Parasitol 2005;132:143--6.

Typhoid Fever

Recommendations indicate that travelers to countries in which typhoid fever is endemic should be vaccinated with either of two effective vaccines available in the United States. Despite these recommendations, approximately 75% of all cases of typhoid fever reported in the United States from 1999 through 2006 occurred among persons who reported international travel during the preceding month and who had not been vaccinated (1). Persons visiting friends and relatives in South Asia appear to be at particular risk, even during short visits (1,2). Certain recent illnesses have been caused by ciprofloxacin-resistant isolates (1). Salmonella serotype Typhi strains with decreased susceptibility to ciprofloxacin are isolated with increasing frequency, and infected persons might require treatment with alternative antimicrobial agents (3). Although the number of S. Typhi infections in the United States has been decreasing slowly, the number of infections attributed to Salmonella serotype Paratyphi A, which causes an illness indistinguishable from that caused by S. Typhi, has been 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 needed (4).

  1. Lynch MF, Blanton EM, Bulens S, et al. Typhoid fever in the United States, 1999--2006. JAMA 2009;302:898--9
  2. 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.
  3. 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.
  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

Varicella-related deaths have declined dramatically since the prevaccine era; during 2003--2005 the national annual average of varicella-related deaths was 16 (1) compared with 100--150 deaths during 1990--1994 (2,3). In 1999, varicella-related deaths became reportable to CDC (4) and an average of five deaths (range: 0--9 deaths) has been reported annually to CDC since then (1). The two varicella-related deaths reported in 2008 highlight important aspects of continued progress towards varicella disease control and prevention.

Both varicella-related deaths occurred in adult females aged 41 and 72 years; both were born outside of the United States, had underlying chronic conditions that were not contraindications for vaccination, and had no history of varicella disease or vaccination. Assessing evidence of immunity to varicella is important in determining who should be vaccinated. One of the criteria for evidence of immunity is birth in the United States before 1980 (5). Both of the reported deaths that occurred in adults in 2008 were in persons born outside of the United States. Both women had been assessed as susceptible to varicella during previous health-care visits. Vaccination was recommended to both women at the time of assessment but one refused it and vaccine was not available for the second woman at a follow-up visit. These deaths highlight the importance of assessing immune status among foreign-born persons and emphasize the need for vaccination if they are determined to be susceptible.

  1. CDC. Summary of Notifiable Diseases---United States, 2007. MMWR 2007;56(No. 53).
  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. Preblud SR. Age-specific risk of varicella complications. Pediatrics 1981;68:14--7.
  4. Council of State and Territorial Epidemiologists. CSTE position statement 1998-ID-10: inclusion of varicella-related deaths in the National Public Health Surveillance System (NPHSS). Available at http://www.cste.org/ps/1998/1998-id-10.htm.
  5. CDC. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2007;56 (No. RR-4).

Vibriosis

Vibriosis became a nationally notifiable disease in January 2007 (1). Cholera, which is caused by infection with toxigenic Vibrio cholerae O1 and O139, has been nationally notifiable for several 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. During 2008, the majority of cases occurred in persons aged 40--64 years. In addition to reporting through the National Notifiable Diseases Surveillance System, 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.

PART 1

Summaries of Notifiable Diseases in the United States, 2008

Abbreviations and Symbols Used in Tables

U Data not available.

N Not reportable (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, 2008 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, 2008

Disease

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Total

AIDS

1,557

1,675

4,757

1,999

1,723

6,378

1,782

1,728

6,332

1,891

1,800

7,580

39,202

Botulism, total

9

6

9

14

13

10

13

15

9

17

18

12

145

foodborne

---

---

---

2

4

1

---

2

---

4

3

1

17

infant

9

6

8

10

8

7

12

12

8

11

10

8

109

other (wound and unspecified)

---

---

1

2

1

2

1

1

1

2

5

3

19

Brucellosis

4

5

2

7

10

7

6

9

8

6

8

8

80

Chancroid§

1

6

4

3

2

1

3

1

---

1

1

2

25

Chlamydia trachomatis infections§

76,143

89,998

113,581

97,620

114,978

92,058

88,902

118,288

94,455

95,523

114,776

114,201

1,210,523

Cholera

---

---

---

---

---

---

1

2

1

---

---

1

5

Coccidioidomycosis

702

443

552

474

665

516

464

533

432

486

997

1,259

7,523

Cryptosporidiosis

269

260

394

385

418

411

657

2,015

1,532

1,166

778

828

9,113

Cyclosporiasis

10

9

6

2

8

23

27

22

6

6

6

14

139

Domestic arboviral diseases

California serogroup virus

neuroinvasive

---

1

---

1

1

6

11

18

14

3

---

---

55

nonneuroinvasive

---

---

---

---

1

1

2

2

1

---

---

---

7

Eastern equine encephalitis virus, neuroinvasive

---

---

---

---

---

1

---

1

1

1

---

---

4

Powassan virus, neuroinvasive

---

---

---

---

---

1

1

---

---

---

---

---

2

St. Louis encephalitis virus

neuroinvasive

---

---

1

---

1

2

3

1

---

---

---

---

8

nonneuroinvasive

---

---

---

---

---

---

1

2

1

1

---

---

5

West Nile virus

neuroinvasive

---

1

1

---

2

10

78

265

236

84

10

2

689

nonneuroinvasive

1

---

1

3

9

22

67

325

181

55

3

---

667

Ehrlichiosis/Anaplasmosis

Ehrlichia chaffeensis

5

8

17

8

62

126

180

185

85

73

71

137

957

Ehrlichia ewingii

---

---

---

---

---

1

3

3

1

1

---

---

9

Anaplasma phagocytophilum

2

3

25

12

59

125

169

154

87

91

133

149

1,009

Undetermined

---

---

1

1

6

6

35

30

9

10

13

21

132

Giardiasis

959

1,148

1,451

1,173

1,518

1,276

1,557

2,405

2,067

1,809

1,821

1,724

18,908

Gonorrhea§

23,231

25,311

31,347

26,579

31,286

25,720

26,435

33,882

26,847

26,345

29,468

30,291

336,742

Haemophilus influenzae, invasive disease

all ages, serotypes

260

267

324

222

284

232

191

198

132

167

240

369

2,886

age<5 yrs

serotype b

2

6

3

1

2

---

1

2

1

2

3

7

30

nonserotype b

29

22

27

18

31

15

15

15

11

13

18

30

244

unknown serotype

12

22

18

13

19

14

15

5

7

6

13

19

163

Hansen disease (Leprosy)

7

10

9

8

4

1

7

8

8

6

5

7

80

Hantavirus pulmonary syndrome

---

2

1

1

4

2

---

2

3

---

1

2

18

Hemolytic uremic syndrome, post-diarrheal

4

8

14

13

23

38

29

38

29

27

28

79

330

Hepatitis, viral, acute

A

186

218

237

222

295

167

233

243

215

183

162

224

2,585

B

245

308

345

296

397

249

321

378

312

299

337

546

4,033

C

45

69

58

57

102

69

88

85

49

66

83

106

877

Influenza-associated pediatric mortality**

---

23

35

8

12

8

1

1

---

1

1

---

90

Legionellosis

142

141

185

117

205

257

439

455

380

309

235

316

3,181

Listeriosis

61

34

48

48

47

53

58

93

70

82

70

95

759

Lyme disease, total

498

646

832

913

2,099

4,788

7,426

5,864

3,079

2,783

2,528

3,742

35,198

confirmed

420

524

672

701

1,717

4,169

6,463

4,958

2,481

2,217

2,004

2,595

28,921

probable

78

122

160

212

382

619

963

906

598

566

524

1,147

6,277

Malaria

68

72

35

71

110

111

137

174

145

107

94

131

1,255

Measles, total

1

5

24

39

21

36

5

2

1

---

1

5

140

indigenous

---

3

21

34

14

34

5

1

1

---

---

2

115

imported

1

2

3

5

7

2

---

1

---

---

1

3

25

Meningococcal disease

all serogroups

70

137

197

100

114

96

81

68

54

65

81

109

1,172

serogroup A,C,Y, & W-135

16

40

62

28

31

26

26

21

13

17

19

31

330

serogroup B

14

25

30

10

15

14

17

11

8

9

16

19

188

other serogroup

4

3

9

1

6

6

1

3

---

1

3

1

38

serogroup unknown

36

69

96

61

62

50

37

33

33

38

43

58

616

Mumps

38

76

63

37

33

22

28

29

23

25

25

55

454

Novel influenza A virus infections

---

---

---

---

---

---

---

---

---

---

1

1

2

Pertussis

557

723

620

576

659

692

877

1,318

1,122

1,046

1,683

3,405

13,278

Plague

1

---

---

---

---

---

---

---

---

1

---

1

3

Psittacosis

1

1

1

---

2

---

---

---

1

---

1

1

8

See footnotes on next page.


TABLE 1. (Continued) Reported cases of notifiable diseases,* by month --- United States, 2008

Disease

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Total

Q Fever, total

4

5

8

7

15

15

8

12

12

8

8

18

120

acute

4

5

7

7

12

14

7

11

11

5

7

16

106

chronic

---

---

1

---

3

1

1

1

1

3

1

2

14

Rabies

animal

320

188

345

322

435

364

368

567

407

328

309

243

4,196

human

---

---

1

---

---

---

---

---

---

---

1

---

2

Rocky Mountain spotted fever, total

16

16

23

48

140

308

456

585

257

194

201

319

2,563

confirmed

3

2

4

6

16

31

28

50

21

11

7

11

190

probable

13

14

19

42

124

277

427

532

235

183

193

308

2,367

Rubella

---

---

2

3

2

1

1

---

3

1

3

---

16

Salmonellosis

2,467

1,955

2,516

2,303

3,758

4,825

5,379

6,908

5,443

4,600

4,655

6,231

51,040

Shiga toxin-producing E. coli (STEC)

188

147

256

233

359

520

668

843

581

551

408

555

5,309

Shigellosis

1,034

985

1,311

1,311

2,093

1,837

1,989

2,394

1,839

1,960

2,634

3,238

22,625

Streptococcal disease, invasive, group A

422

569

817

538

603

453

313

372

253

244

393

697

5,674

Streptococcal, toxic-shock syndrome

10

11

23

17

20

11

7

8

4

5

11

30

157

Streptococcus pneumoniae, invasive disease

drug resistant, all ages

347

330

465

319

308

186

119

129

125

177

347

596

3,448

age <5 yrs

34

43

68

54

53

33

24

27

28

46

57

65

532

non-drug resistant, age <5 yrs

164

177

228

157

203

115

83

94

112

135

218

312

1,998

Syphilis, total, all stages§††

2,813

3,181

4,296

3,544

4,378

3,411

3,417

4,744

3,638

3,780

4,343

4,732

46,277

congenital (age <1 yr)§

36

31

34

32

38

29

42

51

42

42

18

36

431

primary and secondary§

858

931

1,201

973

1,165

970

1,061

1,330

1,092

1,141

1,305

1,473

13,500

Tetanus

---

---

1

1

1

2

1

4

2

5

---

2

19

Toxic-shock syndrome

2

5

10

1

5

5

6

7

3

7

8

12

71

Trichinellosis

---

1

1

---

---

1

2

2

---

---

1

31

39

Tuberculosis§§

605

790

996

1,068

1,134

1,024

1,175

1,090

1,015

1,173

961

1,873

12,904

Tularemia

1

---

1

4

14

25

22

24

9

4

5

14

123

Typhoid fever

22

35

41

39

50

24

31

46

61

39

19

42

449

Vancomycin-intermediate Staphylococcus aureus (VISA)

3

7

6

2

3

3

3

2

12

5

7

10

63

Varicella (chickenpox) morbidity¶¶

2,042

2,867

3,896

3,546

4,345

2,068

919

884

1,732

2,059

2,560

3,468

30,386

Vibriosis

23

10

19

12

25

47

74

119

96

49

58

56

588

* No cases of anthrax; diphtheria; eastern equine encephalitis virus, non-neuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; Powassan virus, non-neuroinvasive; rubella; congenital syndrome; severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV); smallpox; vancomycin-resistant Staphylococcus aureus (VRSA) infection; western equine encephalitis virus, neuroinvasive and non-neuroinvasive; and yellow fever were reported in 2008. 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, 2008.

§ Totals reported to the Division of STD Prevention, NCHHSTP, as of May 8, 2009.

Totals reported to the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, (ArboNET Surveillance), as of May 1, 2009.

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

§§ Totals reported to the Division of TB Elimination, NCHHSTP, as of May 15, 2009.

¶¶ Totals reported to the Division of Viral Diseases, NCIRD, as of June 30, 2009.


TABLE 2. Reported cases of notifiable diseases,* by geographic division and area --- United States, 2008

Total resident population (in thousands)

Botulism

Area

AIDS

Total

Foodborne

Infant

Other§

Brucellosis

United States

301,621

39,202

145

17

109

19

80

New England

14,264

1,188

4

---

4

---

---

Connecticut

3,502

408

2

---

2

---

---

Maine

1,317

30

---

---

---

---

---

Massachusetts

6,450

622

1

---

1

---

---

New Hampshire

1,316

30

---

---

---

---

---

Rhode Island

1,058

88

1

---

1

---

---

Vermont

621

10

---

---

---

---

---

Mid. Atlantic

40,417

7,042

23

---

23

---

7

New Jersey

8,686

1,627

3

---

3

---

2

New York (Upstate)

11,023

1,522

1

---

1

---

1

New York City

8,275

2,649

1

---

1

---

2

Pennsylvania

12,433

1,244

18

---

18

---

2

E.N. Central

46,339

3,310

6

4

2

---

6

Illinois

12,853

1,360

1

---

1

---

1

Indiana

6,345

424

1

1

---

---

1

Michigan

10,072

651

---

---

---

---

1

Ohio

11,467

701

4

3

1

---

---

Wisconsin

5,602

174

---

---

---

---

3

W.N. Central

20,051

913

5

1

4

---

4

Iowa

2,988

71

1

---

1

---

2

Kansas

2,776

122

---

---

---

---

---

Minnesota

5,198

207

1

---

1

---

1

Missouri

5,878

417

2

---

2

---

---

Nebraska

1,775

73

1

1

---

---

1

North Dakota

640

12

---

---

---

---

---

South Dakota

796

11

---

---

---

---

---

S. Atlantic

57,860

13,411

13

1

12

---

14

Delaware

865

166

---

---

---

---

---

District of Columbia

588

767

---

---

---

---

1

Florida

18,251

5,064

1

---

1

---

10

Georgia

9,545

2,153

---

---

---

---

1

Maryland

5,618

2,389

5

---

5

---

---

North Carolina

9,061

1,384

1

---

1

---

1

South Carolina

4,408

723

1

---

1

---

1

Virginia

7,712

698

3

---

3

---

---

West Virginia

1,812

67

2

1

1

---

---

E.S. Central

17,945

1,640

---

---

---

---

1

Alabama

4,628

402

---

---

---

---

---

Kentucky

4,241

293

---

---

---

---

---

Mississippi

2,919

356

---

---

---

---

---

Tennessee

6,157

589

---

---

---

---

1

W.S. Central

34,649

4,001

8

---

8

---

10

Arkansas

2,835

100

---

---

---

---

---

Louisiana

4,293

903

---

---

---

---

1

Oklahoma

3,617

137

---

---

---

---

---

Texas

23,904

2,861

8

---

8

N

9

Mountain

21,361

1,486

19

1

17

1

9

Arizona

6,339

570

4

1

2

1

3

Colorado

4,862

343

3

---

3

---

2

Idaho

1,499

31

1

---

1

---

---

Montana

958

48

3

---

3

---

---

Nevada

2,565

307

---

---

---

N

1

New Mexico

1,970

109

2

---

2

---

1

Utah

2,645

65

5

---

5

---

1

Wyoming

523

13

1

---

1

---

1

Pacific

48,735

5,539

67

10

39

18

29

Alaska

684

27

7

7

---

---

---

California

36,553

4,818

55

3

36

16

23

Hawaii

1,283

97

---

---

---

---

4

Oregon

3,747

207

2

---

2

---

1

Washington

6,468

390

3

---

1

2

1

American Samoa

64

---

---

---

---

---

---

C.N.M.I.

59

1

---

---

---

---

---

Guam

174

7

U

U

U

U

U

Puerto Rico

3,942

704

---

---

---

---

---

U.S. Virgin Islands

110

12

---

---

---

---

---

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

* No cases of anthrax; diphtheria; eastern equine encephalitis virus disease, non-neuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; Powassan virus disease, non-neuroinvasive; rubella, congenital syndrome; severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV); smallpox; vancomycin-resistant Staphylococcus aureus (VRSA) infection; western equine encephalitis virus disease, neuroinvasive and non-neuroinvasive; and yellow fever were reported in 2008. 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, 2008.

§ Includes cases reported as wound and unspecified botulism.

Includes 672 cases of AIDS in persons with unknown state or area of residence that were reported in 2008.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2008

Area

Chancroid**

Chlamydia**

Cholera

Coccidioidomycosis

Cryptosporidiosis

Cyclosporiasis

United States

25

1,210,523

5

7,523

9,113

139

New England

4

39,246

---

1

393

10

Connecticut

---

12,519

---

N

41

4

Maine

---

2,608

---

N

46

N

Massachusetts

4

17,503

---

N

172

5

New Hampshire

---

2,109

---

1

60

1

Rhode Island

---

3,317

---

---

10

---

Vermont

---

1,190

---

N

64

N

Mid. Atlantic

2

152,997

1

---

742

33

New Jersey

---

22,405

1

N

40

9

New York (Upstate)

2

31,881

---

N

269

6

New York City

---

56,478

---

N

107

18

Pennsylvania

---

42,233

---

N

326

N

E.N. Central

1

194,359

1

44

2,163

9

Illinois

---

59,169

1

N

205

4

Indiana

---

22,154

---

N

203

2

Michigan

---

44,923

---

31

280

1

Ohio

1

47,117

---

13

689

1

Wisconsin

---

20,996

---

N

786

1

W.N. Central

---

68,198

---

3

1,002

4

Iowa

---

9,372

---

N

284

---

Kansas

---

9,208

---

N

84

---

Minnesota

---

14,351

---

---

236

3

Missouri

---

24,817

---

3

181

---

Nebraska

---

5,573

---

N

113

N

North Dakota

---

1,921

---

N

16

N

South Dakota

---

2,956

---

N

88

1

S. Atlantic

5

247,480

---

5

1,071

70

Delaware

---

3,868

---

2

12

---

District of Columbia

---

6,924

---

---

15

3

Florida

---

71,017

---

N

486

58

Georgia

---

42,629

---

N

263

2

Maryland

---

24,669

---

3

54

3

North Carolina

4

37,516

---

N

78

1

South Carolina

1

26,323

---

N

57

1

Virginia

---

31,218

---

N

81

2

West Virginia

---

3,316

---

N

25

---

E.S. Central

---

86,214

---

---

174

3

Alabama

---

24,760

---

N

74

N

Kentucky

---

12,163

---

N

36

N

Mississippi

---

21,253

---

N

17

N

Tennessee

---

28,038

---

N

47

3

W.S. Central

8

152,468

2

3

2,545

6

Arkansas

---

14,136

---

N

95

---

Louisiana

---

22,659

1

3

67

---

Oklahoma

---

14,803

---

N

143

---

Texas

8

100,870

1

N

2,240

6

Mountain

2

77,774

---

4,870

580

3

Arizona

---

24,769

---

4,768

89

---

Colorado

2

19,180

---

N

112

1

Idaho

---

4,194

---

N

72

N

Montana

---

3,101

---

N

44

N

Nevada

---

9,670

---

52

17

N

New Mexico

---

9,262

---

35

175

2

Utah

---

6,021

---

12

48

---

Wyoming

---

1,577

---

3

23

---

Pacific

3

191,787

1

2,597

443

1

Alaska

---

4,861

---

N

3

---

California

2

148,798

---

2,597

275

---

Hawaii

---

5,982

---

N

2

---

Oregon

---

10,744

1

N

64

---

Washington

1

21,402

---

N

99

1

American Samoa

---

---

---

N

N

N

C.N.M.I.

---

---

---

---

---

---

Guam

---

687

U

U

U

U

Puerto Rico

---

6,874

---

N

N

N

U.S. Virgin Islands

---

587

---

---

---

---

N: Not reportable. 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 8, 2009.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2008

Domestic arboviral diseases††

California serogroup virus

Eastern equine encephalitis virus

Powassan virus

St. Louis encephalitis virus

West Nile virus

Area

Neuro-
invasive

Nonneuro- invasive

Neuro-
invasive

Neuro-
invasive

Neuro-
invasive

Nonneuro- invasive

Neuro-
invasive

Nonneuro-
invasive

United States

55

7

4

2

8

5

689

667

New England

---

---

1

---

---

---

7

3

Connecticut

---

---

---

---

---

---

5

3

Maine

---

---

---

---

---

---

---

---

Massachusetts

---

---

1

---

---

---

1

---

New Hampshire

---

---

---

---

---

---

---

---

Rhode Island

---

---

---

---

---

---

1

---

Vermont

---

---

---

---

---

---

---

---

Mid. Atlantic

5

1

---

1

---

1

50

20

New Jersey

---

---

---

---

---

---

6

4

New York (Upstate)

5

1

---

1

---

---

24

7

New York City

---

---

---

---

---

---

8

7

Pennsylvania

---

---

---

---

---

1

12

2

E.N. Central

13

2

---

---

---

---

44

20

Illinois

---

---

---

---

---

---

12

8

Indiana

---

---

---

---

---

---

3

1

Michigan

---

---

---

---

---

---

11

6

Ohio

9

---

---

---

---

---

14

1

Wisconsin

4

2

---

---

---

---

4

4

W.N. Central

1

---

---

1

---

1

51

134

Iowa

---

---

---

---

---

---

3

3

Kansas

---

---

---

---

---

---

14

17

Minnesota

1

---

---

1

---

---

2

8

Missouri

---

---

---

---

---

1

12

3

Nebraska

---

---

---

---

---

---

7

40

North Dakota

---

---

---

---

---

---

2

35

South Dakota

---

---

---

---

---

---

11

28

S. Atlantic

27

1

2

---

3

---

20

20

Delaware

---

---

---

---

---

---

---

1

District of Columbia

---

---

---

---

---

---

4

4

Florida

---

1

1

---

---

---

3

---

Georgia

2

---

---

---

---

---

4

4

Maryland

---

---

---

---

---

---

6

8

North Carolina

9

---

1

---

3

---

2

1

South Carolina

---

---

---

---

---

---

---

1

Virginia

2

---

---

---

---

---

---

1

West Virginia

14

---

---

---

---

---

1

---

E.S. Central

8

3

1

---

---

---

48

57

Alabama

---

---

1

---

---

---

11

7

Kentucky

1

---

---

---

---

---

3

---

Mississippi

1

3

---

---

---

---

22

43

Tennessee

6

---

---

---

---

---

12

7

W.S. Central

1

---

---

---

5

2

69

62

Arkansas

---

---

---

---

4

---

7

2

Louisiana

1

---

---

---

1

2

18

31

Oklahoma

---

---

---

---

---

---

4

5

Texas

---

---

---

---

---

---

40

24

Mountain

---

---

---

---

---

---

103

184

Arizona

---

---

---

---

---

---

62

52

Colorado

---

---

---

---

---

---

17

54

Idaho

---

---

---

---

---

---

4

35

Montana

---

---

---

---

---

---

---

5

Nevada

---

---

---

---

---

---

9

7

New Mexico

---

---

---

---

---

---

5

3

Utah

---

---

---

---

---

---

6

20

Wyoming

---

---

---

---

---

---

---

8

Pacific

---

---

---

---

---

1

297

167

Alaska

---

---

---

---

---

---

---

---

California

---

---

---

---

---

---

292

153

Hawaii

---

---

---

---

---

---

---

---

Oregon

---

---

---

---

---

1

3

13

Washington

---

---

---

---

---

---

2

1

American Samoa

---

---

---

---

---

---

---

---

C.N.M.I.

---

---

---

---

---

---

---

---

Guam

---

---

---

---

---

---

---

---

Puerto Rico

---

---

---

---

---

---

---

---

U.S. Virgin Islands

---

---

---

---

---

---

---

---

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

†† Totals reported to the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) (ArboNET Surveillance), as of May 1, 2009.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2008

Area

Ehrlichiosis/Anaplasmosis

Giardiasis

Gonorrhea**

Ehrlichia
chaffeensis

Ehrlichia
ewingii

Anaplasma phagocytophilum

Undetermined

United States

957

9

1,009

132

18,908

336,742

New England

42

---

197

1

1,660

5,470

Connecticut

2

---

45

---

334

2,801

Maine

1

---

17

---

188

96

Massachusetts

21

---

85

---

678

2,129

New Hampshire

7

---

14

---

160

100

Rhode Island

11

---

36

1

90

307

Vermont

---

---

---

---

210

37

Mid. Atlantic

123

1

303

10

3,532

33,477

New Jersey

54

---

45

3

520

5,298

New York (Upstate)

61

---

239

3

1,282

6,615

New York City

5

1

17

---

851

10,493

Pennsylvania

3

---

2

4

879

11,071

E.N. Central

58

---

205

31

2,743

69,397

Illinois

28

---

3

3

705

20,674

Indiana

4

---

---

---

N

8,769

Michigan

3

---

---

---

611

17,064

Ohio

11

---

1

---

904

16,803

Wisconsin

12

---

201

28

523

6,087

W.N. Central

212

6

281

69

2,106

17,003

Iowa

N

N

N

N

326

1,700

Kansas

---

---

---

---

162

2,274

Minnesota

14

1

278

43

769

3,037

Missouri

195

5

1

26

468

8,014

Nebraska

3

N

1

N

209

1,460

North Dakota

N

N

N

N

36

143

South Dakota

---

---

1

---

136

375

S. Atlantic

207

1

15

5

3,119

86,462

Delaware

19

1

4

---

42

1,045

District of Columbia

N

N

N

N

72

2,656

Florida

10

---

2

---

1,391

23,326

Georgia

19

---

1

---

691

16,272

Maryland

61

---

4

1

284

6,666

North Carolina

34

---

2

4

N

15,972

South Carolina

1

---

---

---

136

9,442

Virginia

63

---

2

---

432

10,337

West Virginia

---

---

---

---

71

746

E.S. Central

86

---

---

14

506

30,562

Alabama

9

---

N

N

281

9,740

Kentucky

13

---

---

---

N

4,548

Mississippi

---

---

---

---

N

7,494

Tennessee

64

---

---

14

225

8,780

W.S. Central

229

1

8

---

473

51,353

Arkansas

87

---

N

N

143

4,514

Louisiana

---

1

---

---

150

9,455

Oklahoma

114

---

7

---

180

5,185

Texas

28

---

1

---

N

32,199

Mountain

---

---

---

2

1,661

11,691

Arizona

---

---

---

2

142

3,449

Colorado

N

N

N

N

564

3,757

Idaho

N

N

N

N

211

187

Montana

N

N

N

N

93

122

Nevada

N

N

N

N

121

2,172

New Mexico

N

N

N

N

107

1,403

Utah

---

---

---

---

374

477

Wyoming

---

---

---

---

49

124

Pacific

---

---

---

---

3,108

31,327

Alaska

N

N

N

N

108

578

California

---

---

N

N

2,017

25,787

Hawaii

N

N

N

N

42

610

Oregon

---

---

---

---

455

1,225

Washington

N

N

N

N

486

3,127

American Samoa

N

N

N

N

---

---

C.N.M.I.

---

---

---

---

---

---

Guam

U

U

U

U

U

109

Puerto Rico

N

N

N

N

227

273

U.S. Virgin Islands

N

N

N

N

---

120

N: Not reportable. 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, 2008

Haemophilus influenzae, invasive disease

Hansen disease
(leprosy)

Hantavirus
pulmonary
syndrome

Hemolytic
uremic
syndrome,
postdiarrheal

All ages,
serotypes

Age <5 yrs

Area

Serotype b

Nonserotype b

Unknown serotype

United States

2,886

30

244

163

80

18

330

New England

196

1

10

2

8

---

15

Connecticut

54

---

4

---

3

N

5

Maine

21

---

2

---

N

---

1

Massachusetts

83

1

3

1

5

---

6

New Hampshire

12

---

---

1

---

---

1

Rhode Island

17

---

1

---

---

---

---

Vermont

9

---

---

---

N

---

2

Mid. Atlantic

554

2

16

38

9

---

15

New Jersey

98

---

---

10

1

---

3

New York (Upstate)

171

2

15

2

N

---

7

New York City

90

---

---

9

8

---

5

Pennsylvania

195

---

1

17

---

---

N

E.N. Central

483

8

35

30

3

---

28

Illinois

157

---

---

16

1

---

3

Indiana

93

2

6

5

---

---

1

Michigan

31

2

6

---

---

---

6

Ohio

135

2

11

9

2

---

7

Wisconsin

67

2

12

---

---

---

11

W.N. Central

211

5

5

21

4

2

48

Iowa

2

---

---

---

1

1

16

Kansas

20

---

---

2

---

---

3

Minnesota

71

5

5

2

1

---

11

Missouri

72

---

---

15

1

---

13

Nebraska

30

---

---

2

---

---

1

North Dakota

16

---

---

---

N

1

1

South Dakota

---

---

---

---

1

---

3

S. Atlantic

714

4

77

22

11

---

36

Delaware

8

---

---

2

---

---

---

District of Columbia

8

---

---

---

---

---

---

Florida

191

1

22

2

10

---

5

Georgia

149

---

14

10

N

---

19

Maryland

97

1

12

---

---

---

1

North Carolina

81

1

11

2

---

---

7

South Carolina

62

---

8

3

1

---

2

Virginia

92

1

8

3

---

---

2

West Virginia

26

---

2

---

N

---

---

E.S. Central

151

2

7

11

---

---

25

Alabama

25

1

2

---

---

N

5

Kentucky

10

---

---

1

---

---

N

Mississippi

14

1

1

---

---

---

---

Tennessee

102

---

4

10

---

---

20

W.S. Central

132

2

11

4

3

2

69

Arkansas

15

---

3

1

---

---

5

Louisiana

13

---

1

3

2

2

1

Oklahoma

93

---

7

---

1

---

51

Texas

11

2

---

---

---

---

12

Mountain

297

5

49

16

4

12

32

Arizona

107

3

23

3

---

1

6

Colorado

60

---

6

2

1

6

6

Idaho

12

---

3

3

---

---

4

Montana

5

---

1

2

---

2

---

Nevada

16

---

1

---

---

---

N

New Mexico

50

1

3

6

1

2

6

Utah

43

1

12

---

2

1

10

Wyoming

4

---

---

---

---

---

---

Pacific

148

1

34

19

38

2

62

Alaska

21

---

---

8

---

N

N

California

46

1

32

6

20

---

46

Hawaii

22

---

---

1

18

---

1

Oregon

57

---

---

4

N

---

13

Washington

2

---

2

---

N

2

2

American Samoa

---

---

---

---

1

N

N

C.N.M.I.

---

---

---

---

---

---

---

Guam

U

U

U

U

U

U

U

Puerto Rico

1

---

---

---

---

N

N

U.S. Virgin Islands

N

---

---

---

---

---

---

N: Not reportable. 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, 2008

Influenza-
associated
pediatric
mortality
§§

Legionellosis

Listeriosis

Lyme disease¶¶

Malaria

Hepatitis, viral, acute

Total

Confirmed

Probable

Area

A

B

C

United States

2,585

4,033

877

90

3,181

759

35,198

28,921

6,277

1,255

New England

128

81

37

9

231

63

11,601

9,205

2,396

61

Connecticut

26

30

19

2

47

16

3,896

2,738

1,158

14

Maine

18

15

3

1

11

5

908

780

128

1

Massachusetts

58

21

13

4

91

30

4,582

3,960

622

33

New Hampshire

12

8

N

1

30

6

1,601

1,211

390

5

Rhode Island

12

4

1

---

47

5

210

186

24

3

Vermont

2

3

1

1

5

1

404

330

74

5

Mid. Atlantic

333

448

131

13

1,061

168

15,097

12,773

2,324

337

New Jersey

86

118

61

1

150

34

3,485

3,214

271

65

New York (Upstate)

66

73

43

3

360

48

6,986

5,203

1,783

42

New York City

113

100

---

5

143

30

808

538

270

188

Pennsylvania

68

157

27

4

408

56

3,818

3,818

---

42

E.N. Central

335

536

195

12

667

104

2,321

1,759

562

152

Illinois

112

184

10

6

121

28

108

108

---

77

Indiana

20

67

13

1

60

10

42

42

---

5

Michigan

119

149

129

1

179

20

92

76

16

18

Ohio

51

118

40

1

268

29

45

40

5

31

Wisconsin

33

18

3

3

39

17

2,034

1,493

541

21

W.N. Central

255

107

27

5

145

31

1,438

1,172

266

72

Iowa

109

24

---

2

21

1

109

85

24

12

Kansas

15

9

1

---

2

6

16

16

---

9

Minnesota

49

25

22

3

25

8

1,282

1,046

236

29

Missouri

35

38

2

---

70

11

6

6

---

14

Nebraska

41

9

2

---

21

4

12

8

4

8

North Dakota

2

2

---

---

3

---

10

8

2

---

South Dakota

4

---

---

---

3

1

3

3

---

---

S. Atlantic

393

981

150

13

508

147

4,331

3,732

599

303

Delaware

7

U

U

---

13

2

772

772

---

3

District of Columbia

U

U

U

---

16

---

74

71

3

7

Florida

146

344

32

4

148

50

88

72

16

65

Georgia

57

187

16

4

43

26

35

35

---

57

Maryland

44

85

22

1

143

17

2,218

1,746

472

80

North Carolina

63

81

46

1

37

25

47

16

31

31

South Carolina

19

71

4

---

12

7

29

14

15

9

Virginia

51

130

8

3

66

17

933

886

47

49

West Virginia

6

83

22

---

30

3

135

120

15

2

E.S. Central

81

409

109

7

119

29

46

19

27

27

Alabama

12

109

13

---

18

4

9

6

3

5

Kentucky

30

101

68

1

58

7

5

5

---

6

Mississippi

7

50

---

4

1

4

1

1

---

1

Tennessee

32

149

28

2

42

14

31

7

24

15

W.S. Central

294

852

89

12

117

60

158

109

49

97

Arkansas

10

67

1

1

14

5

---

---

---

1

Louisiana

12

94

9

---

11

11

3

3

---

4

Oklahoma

13

129

20

2

11

7

2

1

1

5

Texas

259

562

59

9

81

37

153

105

48

87

Mountain

219

202

62

9

100

28

65

32

33

36

Arizona

118

80

---

2

26

8

8

2

6

15

Colorado

36

33

14

2

14

8

3

2

1

5

Idaho

17

12

3

---

3

1

9

5

4

3

Montana

1

2

6

---

4

1

17

6

11

---

Nevada

13

43

22

2

13

1

12

9

3

5

New Mexico

18

12

5

1

11

5

8

4

4

3

Utah

13

14

12

2

29

2

5

3

2

5

Wyoming

3

6

---

---

---

2

3

1

2

---

Pacific

547

417

77

10

233

129

141

120

21

170

Alaska

5

10

---

1

3

3

6

6

---

6

California

446

303

29

6

185

88

74

74

---

125

Hawaii

20

7

---

---

8

3

N

---

---

3

Oregon

25

41

23

1

18

6

38

18

20

4

Washington

51

56

25

2

19

29

23

22

1

32

American Samoa

---

---

---

---

N

N

N

---

---

---

C.N.M.I.

---

---

---

---

---

---

---

---

---

---

Guam

U

U

U

---

U

U

U

U

U

U

Puerto Rico

27

50

---

---

---

---

N

---

---

2

U.S. Virgin Islands

---

---

---

---

---

---

N

---

---

---

N: Not reportable. 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, 2008.

¶¶ National Surveillance Case Definition revised in 2008; probable cases not previously reported.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2008

Measles

Meningococcal disease

Area

All
serogroups

Serogroup A, C,
Y, and W-135

Serogroup
B

Other
serogroup

Serogroup
unknown

Total

Indigenous

Imported***

United States

140

115

25

1,172

330

188

38

616

New England

2

1

1

38

15

20

---

3

Connecticut

---

---

---

1

1

---

---

---

Maine

---

---

---

6

3

3

---

---

Massachusetts

2

1

1

24

8

14

---

2

New Hampshire

---

---

---

5

1

3

---

1

Rhode Island

---

---

---

2

2

---

---

---

Vermont

---

---

---

---

---

---

---

---

Mid. Atlantic

32

23

9

128

27

12

---

89

New Jersey

1

---

1

17

---

---

---

17

New York (Upstate)

2

---

2

33

21

11

---

1

New York City

28

22

6

28

---

---

---

28

Pennsylvania

1

1

---

50

6

1

---

43

E.N. Central

42

40

2

211

64

32

3

112

Illinois

32

32

---

88

---

---

---

88

Indiana

---

---

---

27

18

8

---

1

Michigan

4

4

---

35

15

4

1

15

Ohio

---

---

---

40

23

11

1

5

Wisconsin

6

4

2

21

8

9

1

3

W.N. Central

1

1

---

105

39

23

2

41

Iowa

---

---

---

19

12

6

---

1

Kansas

---

---

---

8

1

---

---

7

Minnesota

---

---

---

30

13

13

1

3

Missouri

1

1

---

26

8

---

---

18

Nebraska

---

---

---

13

4

3

1

5

North Dakota

---

---

---

6

---

---

---

6

South Dakota

---

---

---

3

1

1

---

1

S. Atlantic

4

1

3

157

64

43

10

40

Delaware

---

---

---

2

---

---

---

2

District of Columbia

1

1

---

---

---

---

---

---

Florida

1

---

1

51

24

16

2

9

Georgia

1

---

1

18

6

10

---

2

Maryland

---

---

---

19

8

3

3

5

North Carolina

---

---

---

16

6

2

2

6

South Carolina

---

---

---

22

6

10

3

3

Virginia

1

---

1

24

9

2

---

13

West Virginia

---

---

---

5

5

---

---

---

E.S. Central

---

---

---

55

11

7

10

27

Alabama

---

---

---

10

2

2

4

2

Kentucky

---

---

---

10

---

---

---

10

Mississippi

---

---

---

12

7

1

4

---

Tennessee

---

---

---

23

2

4

2

15

W.S. Central

3

2

1

131

58

28

9

36

Arkansas

2

2

---

16

6

2

1

7

Louisiana

1

---

1

26

9

4

1

12

Oklahoma

---

---

---

19

9

4

6

---

Texas

---

---

---

70

34

18

1

17

Mountain

15

14

1

60

36

10

3

11

Arizona

14

13

1

9

6

2

---

1

Colorado

---

---

---

16

12

4

---

---

Idaho

---

---

---

6

1

1

---

4

Montana

---

---

---

4

1

---

---

3

Nevada

---

---

---

7

3

1

1

2

New Mexico

1

1

---

8

7

---

1

---

Utah

---

---

---

8

6

1

1

---

Wyoming

---

---

---

2

---

1

---

1

Pacific

41

33

8

287

16

13

1

257

Alaska

---

---

---

8

---

---

---

8

California

17

13

4

204

---

---

---

204

Hawaii

4

1

3

5

---

2

---

3

Oregon

1

---

1

39

---

---

---

39

Washington

19

19

---

31

16

11

1

3

American Samoa

---

---

---

---

---

---

---

---

C.N.M.I.

---

---

---

---

---

---

---

---

Guam

U

U

U

U

U

U

U

U

Puerto Rico

---

---

---

3

---

---

---

3

U.S. Virgin Islands

---

---

---

---

---

---

---

---

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

*** Imported cases include only those directly related to importation from other countries.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2008

Novel
influenza A
virus infections

Q Fever

Rabies

Area

Mumps

Pertussis

Plague

Psittacosis

Total

Acute

Chronic

Animal

Human

United States

454

2

13,278

3

8

120

106

14

4,196

2

New England

18

---

1,052

1

2

---

---

---

433

---

Connecticut

---

---

55

1

N

---

---

---

202

---

Maine

5

---

49

---

---

---

---

---

64

---

Massachusetts

7

---

800

---

1

---

---

---

---

---

New Hampshire

5

---

49

---

---

---

N

N

58

---

Rhode Island

---

---

87

---

1

---

---

---

34

---

Vermont

1

---

12

---

---

---

N

N

75

---

Mid. Atlantic

71

---

1,311

---

1

17

15

2

944

---

New Jersey

13

---

246

---

1

2

2

---

---

---

New York (Upstate)

19

---

456

---

---

9

7

2

500

---

New York City

18

---

114

---

---

6

6

---

19

---

Pennsylvania

21

---

495

---

---

---

---

---

425

---

E.N. Central

151

---

2,252

---

---

7

6

1

256

---

Illinois

91

---

628

---

---

---

---

---

104

---

Indiana

2

---

270

---

---

1

---

1

10

---

Michigan

22

---

317

---

---

2

2

---

78

---

Ohio

23

---

845

---

---

1

1

---

64

---

Wisconsin

13

---

192

---

---

3

3

---

N

---

W.N. Central

50

1

2,327

---

---

15

15

---

323

1

Iowa

24

---

257

---

---

---

N

N

29

---

Kansas

2

---

106

---

---

2

2

---

68

---

Minnesota

9

---

1,034

---

---

5

5

---

70

---

Missouri

8

---

561

---

---

5

5

---

64

1

Nebraska

4

---

277

---

---

2

2

---

34

---

North Dakota

2

---

25

---

---

---

---

---

34

---

South Dakota

1

1

67

---

---

1

1

---

24

---

S. Atlantic

49

---

1,068

---

3

9

7

2

1,650

---

Delaware

1

---

18

---

---

---

---

---

---

---

District of Columbia

2

---

7

---

---

1

1

---

---

---

Florida

16

---

314

---

2

1

1

---

138

---

Georgia

3

---

115

---

---

2

2

---

386

---

Maryland

11

---

164

---

---

1

1

---

420

---

North Carolina

6

---

94

---

---

2

2

---

N

---

South Carolina

---

---

147

---

1

---

---

---

---

---

Virginia

9

---

198

---

---

2

---

2

620

---

West Virginia

1

---

11

---

---

---

---

---

86

---

E.S. Central

7

---

473

---

---

3

3

---

181

---

Alabama

5

---

69

N

---

2

2

---

---

---

Kentucky

---

---

183

---

---

1

1

---

45

---

Mississippi

---

---

105

---

---

---

---

---

7

---

Tennessee

2

---

116

---

---

---

---

---

129

---

W.S. Central

27

1

2,438

---

---

26

22

4

94

---

Arkansas

5

---

197

---

---

2

2

---

49

---

Louisiana

1

---

95

---

---

---

---

---

---

---

Oklahoma

1

---

100

---

---

---

N

N

43

---

Texas

20

1

2,046

---

N

24

20

4

2

---

Mountain

26

---

885

2

---

19

16

3

108

---

Arizona

5

---

218

1

---

4

3

1

N

---

Colorado

8

---

161

---

---

5

5

---

---

---

Idaho

2

---

40

---

---

1

1

---

11

---

Montana

1

---

84

---

---

1

1

---

13

---

Nevada

6

---

28

---

---

2

2

---

12

---

New Mexico

---

---

94

1

---

3

3

---

30

---

Utah

4

---

242

---

---

3

1

2

14

---

Wyoming

---

---

18

---

---

---

---

---

28

---

Pacific

55

---

1,472

---

2

24

22

2

207

1

Alaska

5

---

277

---

---

---

---

---

15

---

California

31

---

534

---

1

20

18

2

179

1

Hawaii

4

---

20

---

---

3

3

---

---

---

Oregon

1

---

181

---

1

1

1

---

13

---

Washington

14

---

460

---

---

---

---

---

---

---

American Samoa

25

---

---

---

N

---

---

N

N

N

C.N.M.I.

---

---

---

---

---

---

---

---

---

---

Guam

U

U

U

U

U

U

U

U

U

U

Puerto Rico

3

---

---

---

N

---

---

---

59

---

U.S. Virgin Islands

---

---

---

---

---

---

---

---

N

---

N: Not reportable. 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, 2008

Area

Rocky Mountain spotted fever†††

Rubella

Salmonellosis

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

Shigellosis

Streptococcal
disease,
invasive,

Streptococcal
toxic-shock
syndrome

Total

Confirmed

Probable

United States

2,563

190

2,367

16

51,040

5,309

22,625

5,674

157

New England

7

---

7

2

2,244

264

243

397

23

Connecticut

---

---

---

1

491

47

40

118

21

Maine

1

---

1

---

159

26

20

28

N

Massachusetts

2

---

2

1

1,227

117

160

176

1

New Hampshire

1

---

1

---

155

34

6

30

---

Rhode Island

3

---

3

---

115

10

12

29

---

Vermont

---

---

---

---

97

30

5

16

1

Mid. Atlantic

154

5

149

4

5,827

476

2,572

1,097

23

New Jersey

85

3

82

---

1,297

138

925

191

4

New York (Upstate)

43

1

42

---

1,491

187

596

347

18

New York City

11

1

10

1

1,276

58

738

207

---

Pennsylvania

15

---

15

3

1,763

93

313

352

1

E.N. Central

150

9

141

2

5,252

876

4,339

1,018

61

Illinois

110

3

107

---

1,522

135

990

279

36

Indiana

6

6

---

---

652

96

607

150

10

Michigan

3

---

3

---

960

219

257

186

1

Ohio

31

---

31

---

1,366

204

1,923

262

13

Wisconsin

---

---

---

2

752

222

562

141

1

W.N. Central

439

22

417

1

2,878

837

953

401

10

Iowa

8

1

7

---

425

208

214

---

---

Kansas

---

---

---

---

467

52

67

41

---

Minnesota

---

---

---

---

748

191

311

185

6

Missouri

407

12

395

---

764

153

227

96

2

Nebraska

20

7

13

---

243

150

16

44

2

North Dakota

1

1

---

1

79

30

42

12

---

South Dakota

3

1

2

---

152

53

76

23

---

S. Atlantic

961

109

852

3

12,837

844

3,248

1,177

19

Delaware

33

1

32

---

148

15

12

11

2

District of Columbia

6

3

3

---

62

6

21

15

---

Florida

19

1

18

3

5,312

146

801

275

N

Georgia

78

78

---

---

2,302

88

1,103

273

---

Maryland

92

8

84

---

884

128

138

198

N

North Carolina

511

10

501

---

1,570

142

275

136

6

South Carolina

57

7

50

---

1,185

46

554

78

---

Virginia

155

1

154

---

1,165

241

310

150

---

West Virginia

10

---

10

---

209

32

34

41

11

E.S. Central

338

13

321

---

3,533

286

1,959

197

4

Alabama

93

2

91

---

1,013

65

427

N

N

Kentucky

1

1

---

---

485

100

264

46

4

Mississippi

11

---

11

---

1,087

5

296

N

N

Tennessee

233

10

219

---

948

116

972

151

---

W.S. Central

465

17

448

---

8,401

535

6,127

598

---

Arkansas

129

2

127

---

797

59

585

11

---

Louisiana

6

2

4

---

1,115

9

640

19

---

Oklahoma

268

10

258

---

906

135

237

142

N

Texas

62

3

59

---

5,583

332

4,665

426

---

Mountain

46

12

32

---

3,425

635

1,261

606

17

Arizona

17

11

6

---

1,154

69

650

204

---

Colorado

1

---

1

---

718

204

150

150

1

Idaho

1

---

1

---

200

149

14

16

---

Montana

3

---

3

---

130

38

8

N

N

Nevada

3

1

2

---

241

19

228

13

3

New Mexico

4

---

4

---

521

52

161

148

---

Utah

7

---

6

---

377

91

42

66

13

Wyoming

10

---

9

---

84

13

8

9

---

Pacific

3

3

---

4

6,643

556

1,923

183

---

Alaska

N

---

---

1

58

6

1

41

---

California

---

---

---

3

5,034

280

1,665

N

N

Hawaii

N

---

---

---

269

13

46

142

---

Oregon

3

3

---

---

436

68

95

N

N

Washington

---

---

---

---

846

189

116

N

N

American Samoa

N

---

---

1

3

---

1

30

N

C.N.M.I.

---

---

---

---

---

---

---

---

---

Guam

U

U

U

U

U

U

U

U

U

Puerto Rico

N

---

---

---

847

---

31

N

N

U.S. Virgin Islands

N

---

---

---

---

---

---

---

---

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

††† Revision of National Surveillance Case Definition distinguishing between confirmed and probable cases. Total count includes six unknown case status reports.

§§§ 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, 2008

Area

Streptococcus
pneumoniae
,
invasive disease,
drug-resistant

Streptococcus pneumoniae, invasive disease, nondrug-resistant

age <5 yrs

Syphilis**

Tetanus

Toxic-shock
syndrome

Trichinellosis

All
stages
¶¶¶

Congenital
(age <1 yr)

Primary and
secondary

All ages

Age <5 yrs

United States

3,448

532

1,998

46,277

431

13,500

19

71

39

New England

135

19

105

793

2

309

---

3

---

Connecticut

70

7

15

173

2

34

---

N

---

Maine

18

2

3

27

---

10

---

N

---

Massachusetts

---

---

66

479

---

216

---

1

---

New Hampshire

---

---

11

41

---

20

---

2

---

Rhode Island

31

8

10

55

---

18

---

---

---

Vermont

16

2

---

18

---

11

---

---

---

Mid. Atlantic

315

33

277

7,426

35

1,715

4

8

3

New Jersey

---

---

70

1,009

4

226

---

---

1

New York (Upstate)

78

10

116

778

5

146

---

3

1

New York City

127

6

91

4,737

18

1,071

---

---

1

Pennsylvania

110

17

N

902

8

272

4

5

---

E.N. Central

660

85

354

3,412

34

1,320

1

20

1

Illinois

N

N

98

1,565

20

554

---

4

1

Indiana

242

29

44

351

---

140

---

2

---

Michigan

23

2

90

546

10

210

1

10

---

Ohio

395

54

67

763

3

351

---

4

---

Wisconsin

---

---

55

187

1

65

---

---

---

W.N. Central

368

44

124

1,053

2

402

2

10

2

Iowa

---

---

---

75

---

16

---

1

---

Kansas

79

6

N

125

---

30

---

1

---

Minnesota

185

32

51

265

---

116

1

4

1

Missouri

93

3

39

542

2

224

---

2

---

Nebraska

---

---

9

36

---

15

1

1

---

North Dakota

2

---

12

4

---

---

---

---

1

South Dakota

9

3

13

6

---

1

---

1

---

S. Atlantic

1,378

254

375

11,178

68

3,162

2

1

3

Delaware

3

---

---

59

---

16

---

---

---

District of Columbia

N

N

N

370

---

146

---

---

---

Florida

792

161

70

4,585

17

1,044

2

N

1

Georgia

462

79

106

2,833

11

914

---

1

N

Maryland

7

1

62

1,088

23

378

---

N

1

North Carolina

N

N

N

998

10

287

---

---

---

South Carolina

---

---

72

412

2

98

---

---

---

Virginia

N

N

52

789

4

266

---

---

1

West Virginia

114

13

13

44

1

13

---

---

---

E.S. Central

350

61

96

3,424

23

1,139

---

9

---

Alabama

N

N

N

1,187

12

449

---

1

---

Kentucky

80

11

N

218

1

93

---

2

N

Mississippi

44

14

12

736

---

184

---

N

---

Tennessee

226

36

84

1,283

10

413

---

6

---

W.S. Central

108

16

348

9,125

162

2,404

4

1

---

Arkansas

23

5

17

508

9

206

---

1

N

Louisiana

85

11

17

2,024

23

707

1

---

---

Oklahoma

N

N

76

257

3

86

---

N

---

Texas

---

---

238

6,336

127

1,405

3

N

---

Mountain

132

18

270

2,345

43

608

2

9

---

Arizona

---

---

117

1,394

30

317

---

1

---

Colorado

---

---

62

352

---

128

---

4

---

Idaho

N

N

6

26

---

7

1

2

---

Montana

1

---

N

10

---

7

1

N

---

Nevada

55

6

6

325

9

77

---

2

---

New Mexico

---

---

40

189

4

44

---

---

---

Utah

73

12

37

40

---

25

---

---

---

Wyoming

3

---

2

9

---

3

---

---

---

Pacific

2

2

49

7,521

62

2,441

4

10

30

Alaska

---

---

29

9

---

1

---

N

---

California

N

N

N

6,909

62

2,204

4

10

30

Hawaii

2

2

20

68

---

29

---

N

---

Oregon

N

N

N

97

---

26

---

N

---

Washington

N

N

N

438

---

181

---

N

---

American Samoa

N

N

N

---

---

---

---

N

N

C.N.M.I.

---

---

---

---

---

---

---

---

---

Guam

U

U

U

45

---

6

U

U

U

Puerto Rico

---

---

N

797

8

167

3

N

N

U.S. Virgin Islands

---

---

N

1

---

---

---

---

---

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

¶¶¶ 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, 2008

Area

Tuberculosis****

Tularemia

Typhoid
fever

Vancomycin-
intermediate
Staphylococcus
aureus

Varicella

Vibriosis

Morbidity

Mortality††††

United States

12,904

123

449

63

30,386

2

588

New England

429

19

23

9

1,729

---

19

Connecticut

98

---

3

2

857

---

14

Maine

9

---

---

---

269

---

3

Massachusetts

261

19

16

7

---

---

---

New Hampshire

19

---

2

N

280

---

2

Rhode Island

36

---

1

---

---

---

---

Vermont

6

---

1

---

323

---

---

Mid. Atlantic

2,009

3

124

22

2,409

2

22

New Jersey

422

2

31

N

N

N

17

New York (Upstate)

305

---

12

6

N

1

N

New York City

895

1

57

16

---

1

5

Pennsylvania

387

---

24

---

2,409

---

N

E.N. Central

1,056

2

44

11

7,805

---

30

Illinois

469

1

18

2

1,489

---

11

Indiana

118

---

1

N

---

---

5

Michigan

188

---

9

6

3,053

---

N

Ohio

213

---

8

3

2,403

---

9

Wisconsin

68

1

8

---

860

---

5

W.N. Central

476

45

25

4

1,418

---

8

Iowa

49

---

6

---

N

N

N

Kansas

57

2

2

N

481

---

N

Minnesota

211

2

7

3

---

---

8

Missouri

107

21

2

1

774

---

N

Nebraska

33

7

3

---

N

N

N

North Dakota

3

3

3

---

108

---

N

South Dakota

16

10

2

---

55

---

N

S. Atlantic

2,630

5

78

7

4,863

---

205

Delaware

23

---

4

---

47

---

4

District of Columbia

54

---

---

N

24

---

2

Florida

954

---

18

3

1,735

---

94

Georgia

478

---

9

1

N

N

18

Maryland

278

1

17

N

N

---

33

North Carolina

335

3

6

3

N

N

13

South Carolina