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Summary of Notifiable Diseases --- United States, 2009

Prepared by

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

Samuel L. Groseclose, DVM, MPH, Acting Division Director1

Ruth Ann Jajosky, DMD1

Deborah A. Adams1

Pearl Sharp1

Willie J. Anderson1

John P. Abellera, MPH1

Aaron E. Aranas, MPH, MBA1

Michelle Mayes1

Michael S. Wodajo1

Diana H. Onweh1

Meeyoung Park2

Jennifer Ward 1

1Division of Notifiable Diseases and Healthcare Information (proposed), the Office of Surveillance, Epidemiology, and and Laboratory Services, CDC

2McKing Consulting Corporation


Preface

The Summary of Notifiable Diseases--- United States, 2009 contains the official statistics, in tabular and graphic form, for the reported occurrence of nationally notifiable infectious diseases in the United States for 2009. Unless otherwise noted, the data are final totals for 2009 reported as of June 30, 2010. 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 Summary publications from previous years.

The Highlights section presents noteworthy epidemiologic and prevention information for 2009 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 reported during 2009.* The tables provide the number of cases reported to CDC for 2009 and the distribution of cases by month, geographic location, and the patients' 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 1978. 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--2007. 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 regarding 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 Diseases and Healthcare Information (proposed), Public Health Surveillance Program Office at soib@cdc.gov.

Background

The infectious diseases designated as notifiable at the national level during 2009 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 effect 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 2009*

Anthrax

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 (HIV) diagnosis§

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 (VISA) infection

Vancomycin-resistant Staphylococcus aureus (VRSA) infection

Varicella (morbidity)

Varicella (mortality)

Vibriosis

Yellow fever

Data Sources

Provisional data concerning the reported occurrence of nationally notifiable infectious diseases are published weekly in MMWR. After each reporting year, staff in state health departments finalize reports of cases for that year with local or county health departments and reconcile the data with reports previously sent to CDC throughout the year. These data are compiled in final form in the Summary.

Notifiable disease reports are the authoritative and archival counts of cases. They are approved by the appropriate chief epidemiologist from each submitting state or territory before being published in the Summary. Data published in MMWR Surveillance Summaries or other surveillance reports produced by CDC programs might not agree exactly with data reported in the annual Summary because of differences in the timing of reports, the source of the data, or surveillance methodology.

Data in the Summary were derived primarily from reports transmitted to CDC from health departments in the 50 states, five territories, New York City, and the District of Columbia. Data were reported for MMWR weeks 1--52, which correspond to the period for the week ending January 10, 2009, through the week ending January 2, 2010. 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 2009 NNDSS event code list (Exhibit).

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

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
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 mortality], and SARS-CoV)

National Center for Emerging and Zoonotic Infectious Diseases
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, 2008 U.S. resident population from the vintage 2008 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 September 2, 2009, and is available at http://www.cdc.gov/nchs/nvss/bridged_race.htm.

Populations for territories are 2008 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).

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 programs. 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 information systems to implement 1997 OMB standards. In 2005 the Sexually Transmitted Diseases*Management Information System also was updated to implement the 1997 OMB standards. However other diseases reported to the NNDSS using 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; thus, some data are currently reported to CDC using NETSS 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, using NETSS, states began electronically capturing and reporting individual case reports to CDC without personal identifiers. 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 levels. 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 are in the final stage of adopting their NEDSS-compatible system. 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 2009, 16 states used NBS to transmit nationally notifiable infectious diseases to CDC, 27 states used a NEDSS-compatible based system, and the remaining states and territorial jurisdictions continued to use 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 NNDSS reporting jurisdictions was determined by analyzing results of the 2009 CSTE State Reportable Conditions Assessment (SRCA). This assessment solicited information from each NNDSS reporting jurisdiction (all 50 U.S. states, the District of Columbia, New York City, and five U.S. territories) regarding which public health conditions were reportable for more than 6 months in 2009 by clinicians, laboratories, hospitals, or "other" public health reporters, as mandated by law or regulation. To assist in the implementation of SRCA, the NNDSS program provided technical assistance to the CSTE for the 2009 SRCA.

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 2009 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 NNDSS. Moreover, to determine whether a condition included in 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 SRCA. Analyzed results of the 2009 SRCA were used to determine whether a NNID was not reportable in a reporting jurisdiction in 2009 and thus noted with an "N" indicator (for "not reportable") in the front tables of this report.

Unanalyzed results from the 2007, 2008, and 2009 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 is 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 DHHS 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/globalhealth/ihregulations.htm, and http://www.cste.org/PS/2007ps/2007psfinal/ID/07-ID-06.pdf. At its annual meeting in June 2007, CSTE approved a position statement to support the implementation of 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. Available at http://www.cste.org/PS/2007ps/2007psfinal/ID/07-ID-01.pdf.

* No cases of diphtheria; poliovirus infection, nonparalytic; Powassan virus disease, non-neuroinvasive; severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV); smallpox; western equine encephalitis virus disease, neuroinvasive and non-neuroinvasive; and yellow fever were reported in 2009. 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.

* Position Statements the Council of State and Territorial Epidemiologists approved in 2008 for national surveillance were implemented beginning in January 2009. No new conditions were added to the notifiable disease list in 2009.

In a 2009 position statement the Council of State & Territorial Epidemiologists approved the modified national TB surveillance case definition.

§ AIDS has been reclassified as HIV stage III.

EXHIBIT. Print criteria for conditions reported to the National Notifiable Diseases Surveillance System, January 2009

Event*

Print Criteria†,§

Anaplasma phagocytophilum

Confirmed and probable; unknown from California (CA)

Anthrax

Confirmed; unknown reported from CA

Botulism, foodborne

Confirmed and probable; unknown from CA

Botulism, infant

Confirmed; unknown from CA

Botulism, other (includes wound)

Confirmed; unknown from CA

Botulism, other unspecified

Confirmed; unknown from CA

Botulism, wound

Confirmed; unknown from CA

Brucellosis

Confirmed and probable; unknown from CA

California serogroup virus, neuroinvasive disease

Cases with confirmed and probable case status are printed, per request of CCID/NCZVED. Only cases reported with a disease onset date are published. Data are published according to the week and year of disease onset.

California serogroup virus, non-neuroinvasive disease

Cases with confirmed and probable case status are printed, per request of CCID/NCZVED. Only cases reported with a disease onset date are published. Data are published according to the week and year of disease onset.

Chancroid

All reports are printed.

Chlamydia trachomatis genital infection

All reports are printed.

Cholera (toxigenic Vibrio cholerae O1 or O139)

Confirmed; unknown from CA

Coccidioidomycosis

Confirmed; unknown from CA

Cryptosporidiosis

Confirmed; unknown from CA

Cyclosporiasis

Confirmed; unknown from CA

Diphtheria

CSTE VPD print criteria are used. Cases with confirmed, probable, and unknown case status are printed.

Eastern equine encephalitis virus, neuroinvasive disease

Cases with confirmed and probable case status are printed, per request of CCID/NCZVED. Only cases reported with a disease onset date are published. Data are aggregated and published according to the week and year of disease onset.

Eastern equine encephalitis virus, non-neuroinvasive disease

Cases with confirmed and probable case status are printed, per request of CCID/NCZVED. Only cases reported with a disease onset date are published. Data are aggregated and published according to the week and year of disease onset.

Ehrlichia chaffeensis

Confirmed and probable; unknown from CA

Ehrlichia ewingii

Confirmed and probable; unknown from CA

Ehrlichiosis/Anaplasmosis, undetermined

Confirmed and probable; unknown from CA

Giardiasis

Confirmed and probable; unknown from CA

Gonorrhea

All reports are printed.

Haemophilus influenzae, invasive disease

CSTE VPD print criteria are used. Cases with confirmed, probable, and unknown case status are printed.

Hansen disease (Leprosy)

Confirmed; unknown from CA

Hantavirus pulmonary syndrome

Confirmed and unknown

Hemolytic uremic syndrome, postdiarrheal

Confirmed, probable, and unknown

Hepatitis A, acute

Confirmed; unknown from CA

Hepatitis B, acute

Confirmed; unknown from CA

Hepatitis C, acute

Confirmed; unknown from CA

HIV diagnoses

Print criteria are determined by NCCHSTP/DHAP.

Influenza-associated mortality

Confirmed

Legionellosis

Confirmed; unknown from CA

Listeriosis

Confirmed; unknown from CA

Lyme disease

Confirmed and probable; unknown from CA

Malaria

Confirmed; unknown from CA

Measles (rubeola), total

CSTE VPD print criteria are used. Cases with confirmed and unknown case status are printed.

Meningococcal disease (Neisseria meningitidis)

Confirmed and probable; unknown from CA


EXHIBIT. (Continued) Print criteria for conditions reported to the National Notifiable Diseases Surveillance System, January 2009

Event*

Print Criteria†,§

Mumps

CSTE VPD print criteria are used. Cases with confirmed, probable, and unknown case status are printed.

Neurosyphilis

All reports are printed.

Novel influenza A virus infections

Cases with confirmed case status are printed.

Pertussis

CSTE VPD print criteria are used. Cases with confirmed, probable, and unknown case status are printed.

Plague

All reports are printed.

Poliomyelitis, paralytic

Confirmed; unknown from CA that are verified as confirmed

Poliovirus infection, nonparalytic

Confirmed; unknown from CA that are verified as confirmed

Powassan virus, neuroinvasive disease

Cases with confirmed and probable case status are printed, per request of CCID/NCZVED. Only cases reported with a disease onset date are published. Data are published according to the week and year of disease onset.

Powassan virus, non-neuroinvasive disease

Cases with confirmed and probable case status are printed, per request of CCID/NCZVED. Only cases reported with a disease onset date are published. Data are published according to the week and year of disease onset.

Psittacosis (Ornithosis)

Confirmed and probable; unknown from CA

Q fever, acute

Confirmed and probable; unknown from CA

Q fever, chronic

Confirmed and probable; unknown from CA

Rabies, animal

Confirmed and unknown

Rabies, human

Confirmed; unknown from CA

Rocky Mountain spotted fever

Confirmed, probable, unknown

Rubella

CSTE VPD print criteria are used. Cases with confirmed and unknown case status are printed.

Rubella, congenital syndrome

CSTE VPD print criteria are used. Cases with confirmed, probable, and unknown case status are printed.

Salmonellosis

Confirmed and probable; unknown from CA

Severe Acute Respiratory Syndrome (SARS)-associated Coronavirus disease (SARS-CoV)

Confirmed

Shiga toxin-producing Escherichia coli (STEC)

All reports printed except unknown from NJ.

Shigellosis

Confirmed and probable; unknown from CA

Smallpox

Confirmed

St. Louis encephalitis virus, neuroinvasive disease

Cases with confirmed and probable case status are printed, per request of CCID/NCZVED. Only cases reported with a disease onset date are published. Data are published according to the week and year of disease onset.

St. Louis encephalitis virus, non-neuroinvasive disease

Cases with confirmed and probable case status are printed, per request of CCID/NCZVED. Only cases reported with a disease onset date are published. Data are published according to the week and year of disease onset.

Streptococcal disease, invasive, Group A

Confirmed; unknown from CA

Streptococcal toxic-shock syndrome

Confirmed and probable; unknown from CA

Streptococcus pneumoniae invasive, drug-resistant (DRSP)

Confirmed, probable and unknown

Streptococcus pneumoniae, invasive disease

Confirmed; unknown from CA

Syphilis, congenital

All reports are printed.

Syphilis, early latent

All reports are printed.

Syphilis, late latent

All reports are printed.

Syphilis, late with clinical manifestations other than neurosyphilis

All reports are printed.

Syphilis, primary

All reports are printed.

Syphilis, secondary

All reports are printed.

Syphilis, total primary and secondary

All reports are printed.

Syphilis, unknown latent

All reports are printed.

Tetanus

CSTE VPD criteria are used. Cases with confirmed and unknown case status are printed.

Toxic-shock syndrome (staphylococcal)

Confirmed and probable; unknown from CA


EXHIBIT. (Continued) Print criteria for conditions reported to the National Notifiable Diseases Surveillance System, January 2009

Event*

Print Criteria†,§

Trichinellosis

Confirmed; unknown from CA

Tuberculosis

Print criteria are determined by the CDC Tuberculosis program.

Tularemia

All reports are printed.

Typhoid fever (caused by Salmonella typhi)

Confirmed and probable; unknown from CA

Vancomycin-intermediate Staphylococcus aureus (VISA)

Confirmed; unknown from CA

Vancomycin-resistant Staphylococcus aureus (VRSA)

Confirmed; unknown from CA

Varicella (Chickenpox)

VPD print criteria are used. Cases with confirmed, probable, and unknown case status are printed.

Vibriosis (non-cholera Vibrio species infections)

Confirmed, probable, and unknown from CA

West Nile virus, neuroinvasive disease

Cases with confirmed and probable case status are printed, per request of CCID/NCZVED. Only cases reported with a disease onset date are published. Data are published according to the week and year of disease onset.

West Nile virus, non-neuroinvasive disease

Cases with confirmed and probable case status are printed, per request of CCID/NCZVED. Only cases reported with a disease onset date are published. Data are published according to the week and year of disease onset.

Western equine encephalitis virus, neuroinvasive disease

Cases with confirmed and probable case status are printed, per request of CCID/NCZVED. Only cases reported with a disease onset date are published. Data are published according to the week and year of disease onset.

Western equine encephalitis virus, non-neuroinvasive disease

Cases with confirmed and probable case status are printed, per request of CCID/NCZVED. Only cases reported with a disease onset date are published. Data are published according to the week and year of disease onset.

Yellow fever

Confirmed and probable; unknown from CA

* Designated by CSTE as nationally notifiable and should be reported to CDC on a regular basis.

An unknown case classification status is used when a reporting jurisdiction sends aggregate counts of cases or when the surveillance information system of a reporting jurisdiction does not capture case classification data. However, in both situations, cases are verified to meet the case classification (e.g., confirmed, probable, suspected) specified in the print criteria.

§ Print criteria for the National Notifiable Diseases Surveillance System: For a case report of a nationally notifiable disease to print in the Morbidity and Mortality Weekly Report (MMWR), reporting states or territories must have designated the disease reportable in their state or territory for the year corresponding to the data year of report to CDC. After this criterion is met, the disease-specific criteria listed in the exhibit are applied. When the above list indicates that "all reports" will be earmarked for printing, this means that cases designated with "unknown" or "suspect" case confirmation status will print just as "probable" and "confirmed" cases will print. Print criteria for Vaccine Preventable Diseases (VPD) reflect the case-confirmation status print criteria described by the Council of State and Territorial Epidemiologists (CSTE) 1999 Position Statement #ID-08 entitled Vaccine Preventable Diseases Surveillance Data, and subsequent CSTE position statements.

Abbreviations:

CCID Coordinating Center for Infectious Disease

CDC Centers for Disease Control and Prevention

CSTE Council of State and Territorial Epidemiologists

MMWR Morbidity and Mortality Weekly Report

NCIRD National Center for Immunization and Respiratory Diseases, CDC

NCPDCID National Center for Preparedness, Detection, and Control of Infectious Disease

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

NEDSS National Electronic Disease Surveillance System

NETSS National Electronic Telecommunications System for Surveillance

NNDL National Notifiable Disease List (infectious diseases reportable to CDC)

NNDSS National Notifiable Diseases Surveillance System

STD*MIS Sexually Transmitted Diseases Management Information System--software for STD surveillance and case management

TIMS Tuberculosis Information Management System--software for TB surveillance and case management

VPD Vaccine Preventable Diseases


Highlights for 2009

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).


Anthrax

In 2009, one confirmed case of gastrointestinal anthrax occurred in New Hampshire. The exposure was determined to be the result of participation in a drumming event where animal-hide drums were played. Although several drums were played at the event, two were found to be contaminated with the same Bacillus anthracis strain as infected the patient. The patient recovered with treatment; the case is the first related to animal-hide drum exposures that involved the gastrointestinal form of the disease (1). This event and previous unrelated cases of anthrax associated with contaminated animal-hide drums reported in 2006, 2007, and 2008 in the United States and the United Kingdom (2-5) reflect the low but potential risk for anthrax among persons who 1) make or use drums made of untreated animal hides from countries where anthrax is common in animals, and among persons who 2) are exposed to environments that are cross-contaminated by these activities.

Naturally occurring anthrax epizootics occur annually among U.S. wildlife and livestock populations; in 2009 such events were reported among wildlife and livestock in Texas, North and South Dakota, and Nevada.

  1. CDC. Gastrointestinal anthrax after an animal-hide drumming event---New Hampshire and Massachusetts, 2009. MMWR 2010;59:872--7.
  2. CDC. Cutaneous anthrax associated with drum making using goat hides from West Africa---Connecticut, 2007. MMWR 2008;57:628--31.
  3. CDC. Inhalation anthrax associated with dried animal hides---Pennsylvania and New York City, 2006. MMWR 2006;55:280--2.
  4. National Health Service Borders. Report on the management of an anthrax incident in the Scottish borders, July 2006 to May 2007. Melrose, UK: National Health Service Borders; 2007. Available at http://www.nhsborders.org.uk/uploads/18645/anthrax_report_131207.pdf.
  5. Anaraki S, Addiman S, Nixon G, et al. Investigations and control measures following a case of inhalation anthrax in East London in a drum maker and drummer, October 2008. Euro Surveill 2008;13:19076.

Brucellosis

The number of reported brucellosis cases in the United States increased 46.3% in 2009 from the previous year; however, the 2009 case total remains consistent with reports from 2004 through 2007. The reason for the decline in 2008 is unknown. Overall, in 2009, the demographic characteristics of persons with brucellosis remained stable. For patients for whom ethnicity was identified, 61.5% were Hispanic. A majority of cases (55.6%) were reported from California, Florida, Georgia, Michigan, and Texas.

Substantial progress has been made to eradicate brucellosis from the U.S. domestic livestock population through the Cooperative State-Federal Brucellosis Eradication Program (1).By the end of July 2009, all 50 States, Puerto Rico, and the Virgin Islands were officially classified as Class Free for bovine brucellosis (Brucella abortus) (2). All States except Texas are classified as Stage III (Free) for swine brucellosis; Texas remains classified at Stage II. 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 where brucellosis is endemic remain a source of the illness 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 accidentally in diagnostic and research laboratories because of their high potential for aerosol transmission (3). For the same reason, biosafety level 3 practices, containment, and equipment are recommended for laboratory manipulation of isolates (4). In the event of an exposure, post-exposure prophylaxis can effectively prevent illness (5). CDC provides recommendations for laboratory exposures and assistance with serologic monitoring of exposed laboratory workers at telephone 404-639-1711.

  1. USDA APHIS. 2003. Brucellosis eradication: Uniform methods and rules, Effective October 1, 2003. APHIS 91-45-013. Available at http://www.aphis.usda.gov/animal_health/animal_diseases/brucellosis/downloads/umr_bovine_bruc.pdf.
  2. Donch DA, Gertonson AA, Rhyan JH, Gilsdorf MJ. Status report---fiscal year 2009 cooperative state-federal Brucellosis Eradication Program. Washington, DC: US Department of Agriculture; 2010.
  3. 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.
  4. 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/biosafety/publications/bmbl5/index.htm.
  5. CDC. Laboratory-acquired brucellosis---Indiana and Minnesota, 2006. MMWR 2008;57:39--42.

Coccidioidomycosis

The incidence of coccidioiodomycosis increased in 2009, although this increase might be partially artifactual. In 2009, one of the major commercial laboratories in Arizona changed reporting practices to conform to the CSTE laboratory case definition, which was revised in 2007 to include cases with a single positive enzyme immunoassay result (1). As a result, the increase in 2009 case counts in Arizona might be attributed, at least in part, to an artifactual increase.

Approximately 60% of coccidioidomycosis cases in the United States occur in Arizona. The public health burden of this disease on Arizona is considerable, as described in a recent report, which explained the use of enhanced surveillance (2). Among this representative group of coccidioidomycosis case-patients, self-reported median duration of illness was 42 days, and 41% of case-patients were hospitalized for coccidioidomycosis; 74% of those employed and 59% of students were unable to attend school or work.

Physicians, particularly in areas where the disease is endemic, should continue to maintain a high suspicion for acute coccidioidomycosis, especially among patients with an influenza-like illness or pneumonia who live in or have visited disease-endemic areas.

  1. Council of State and Territorial Epidemiologists. Revision of the surveillance case definition for Coccidioidomycosis. Position statement 07-ID-13. Atlanta, GA: Council of State and Territorial Epidemiologists; 2007. Available at http://www.cste.org/position%20statements/searchbyyear2007final.asp.
  2. Tsang CA, Anderson SM, Imholte SB, Erhart LM, Chen S, Park BJ. Enhanced surveillance of coccidioidomycosis, Arizona, USA, 2007--2008. Emerg Infect Dis 2010;11:1738--44.

Cryptosporidiosis

In 2009, cryptosporidiosis incidence decreased for the second consecutive year. The decreases in incidence in 2008 and 2009 follow a >3-fold rise during 2005--2007. Whether the changes in cryptosporidiosis reporting reflect a true change in cryptosporidiosis incidence or reflect changing diagnosis, testing, and reporting patterns is unclear.

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, cases were most frequently reported in children aged 1--9 years. An almost tenfold increase in transmission of Cryptosporidium in these young children occurred during summer through early fall, coinciding with increased use of recreational water, which is a known risk factor for cryptosporidiosis. Good hygiene practices are essential to prevention, especially in high-risk settings. Persons should also avoid food and water that might be contaminated. 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); and the chlorine tolerance of Cryptosporidium oocysts (4). 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 (5).

  1. Shields JM, Gleim ER, Beach MJ. Prevalence of Cryptosporidium spp. and Giardia intestinalis in swimming pools, Atlanta, Georgia. Emerg Inf Dis 2008;14:948--50.
  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. Xiao L. Molecular epidemiology of cryptosporidiosis: an update. Exp Parasitol 2010;124:80--89

Ehrlichiosis and Anaplasmosis

Four categories of ehrlichiosis and anaplasmosis were reportable during 2009: 1) Ehrlichia chaffeensis, 2) Ehrlichia ewingii, 3) Anaplasma phagocytophilum, and 4) Human ehrlichiosis/anaplasmosis - undetermined.

During 2009, infections caused by E. chaffeensis were reported primarily from the lower Midwest and the Southeast, reflecting the historically known 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. Missouri, Ohio, and South Carolina reported seven 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 number of "Human ehrlichiosis/anaplasmosis - undetermined" cases reported from some northern states (1) 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 is expected to predominate).

During 2009, cases attributed to E. chaffeensis remained similar to numbers reported the previous year, whereas those attributed to A. phagocytophilum cases increased by 15% (1,009 to 1,161). The numbers of reported ehrlichiosis and anaplasmosis cases have increased more than twofold during the last decade. Increases in the numbers of reported cases might be the result of several factors, including ecological changes influencing vector tick populations and 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 (2) also might have altered how cases were classified.

  1. CDC. Anaplasmosis and ehrlichiosis--- Maine, 2008. MMWR 2009: 58(37):1033--6.
  2. 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.

Gonorrhea

In 2009, the rate of gonorrhea was the lowest ever reported. During 2006--2009, decreases in gonorrhea rates were reported in all racial/ethnic groups and in all age groups. Although the gonorrhea rate among women has remained slightly higher than that among men, rates have decreased in both groups. Despite overall rate decreases, the rate for blacks in 2009 was 20.5 times higher than that for whites whereas the rates among American Indians/Alaska Natives and Hispanics were 4.2 and 2.2 times higher, respectively, than rates in whites (1).

  1. CDC. Sexually transmitted disease surveillance, 2009. Atlanta, GA: U.S. Department of Health and Human Services.

Hansen Disease (Leprosy)

The number of cases of Hansen's disease (HD) reported in the United States peaked in 1985 and decreased until 2006. Since 2006 the annual number of reported cases has fluctuated between 73 and 109. Cases were reported from 20 states and one territory; 64.4% of cases were reported from California, Hawaii, and Texas. 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 www.hrsa.gov/hansens.

Hantavirus Pulmonary Syndrome

Less than 7% of hantavirus pulmonary syndrome (HPS) cases in the United States have been in pediatric populations. Each year, 20--40 cases of HPS occur in the United States; cases in persons aged <17 years make up fewer than 7% of those cases, and cases in children aged <10 years are exceptionally rare. However, in 2009, six pediatric cases of HPS were identified (one case resulted in a fatality), including four cases in persons aged <10 years (1).

  1. CDC. Hantavirus pulmonary syndrome in five pediatric patients---four states, 2009. MMWR 2009;58:1409--12.

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.

The majority of pediatric deaths that occurred during the 2008--09 and 2009--10 influenza seasons, including those associated with the 2009 pandemic influenza A (H1N1) virus (2009 H1N1), were reported in 2009. The 2009 H1N1 virus was first detected in the United States in mid-April 2009 and became the predominant circulating influenza virus worldwide. From April 15 through the end of 2009, 96% of all subtyped influenza A viruses from the United States were 2009 H1N1. For this report, pediatric deaths associated with seasonal influenza viruses are analyzed separately from those associated with 2009 H1N1 infection. Influenza A viruses that were not subtyped are classified as seasonal influenza A viruses for deaths that occurred during January 1 -- April 14, 2009 and as 2009 H1N1 for deaths that occurred during April 15 -- December 31, 2009. Of the 358 influenza-associated pediatric deaths reported to CDC during 2009, a total of 290 (81%) were associated with the 2009 H1N1 virus and 68 (19%) were associated with seasonal influenza viruses. Of the 37 seasonal influenza A viruses, 11 (30%) were subtyped; 9 were seasonal A(H1N1) viruses and 2 were influenza A (H3N2) viruses. Twenty-six (70%) were influenza A viruses that were not subtyped and the remaining 31 were influenza B viruses.

The median age at the time of death in 2009 was higher for children presumed infected with 2009 H1N1 virus (9.3 years) than for those infected with seasonal influenza viruses (7.5 years). Both groups had a higher median age than was observed in the previous 3 years when the median age at death ranged from 4 years in 2006 to 7.4 years in 2007. The distributions of race, ethnicity, and sex were similar for children infected with the seasonal influenza viruses and children infected with the 2009 H1N1 virus. The proportion of children infected with seasonal influenza virus admitted to the hospital before death (73%) was similar to that among those infected with 2009 H1N1 virus (69%) but higher than that seen in the previous 3 years (range: 51%-- 62%). Children who died following infection with 2009 H1N1 virus were more likely to have at least one chronic condition placing them at increased risk for influenza-associated complications (67%) compared with children with seasonal influenza infection in 2009 (42%). During the previous 3 years, the percent of children with at least one chronic medical condition has ranged from 43% to 57%. Among children who had specimens collected for bacterial culture from sterile sites, no substantial difference was present in the proportion with bacterial coinfection for children with 2009 H1N1 (57%) and seasonal influenza infection (58%). For children with a bacterial coinfection, Staphylococcus aureus was identified in 12 of 18 (67%) children with seasonal influenza and 17 of 44 (39%) children with 2009 H1N1 infection. Of the S. aureus isolates identified among all deaths, 18 were methicillin-resistant, nine were methicillin-sensitive, and two did not have sensitivity testing performed. Coinfection with Streptococcus pneumoniae occurred in 2 of 18 (11%) children with seasonal influenza and 12 of 44 (27%) children with 2009 H1N1 infection.

Of 45 children aged ≥6 months who died with the seasonal influenza virus and for whom seasonal vaccination status was known, only seven (16%) were vaccinated against influenza as recommended by the Advisory Committee on Immunization Practices (ACIP) for 2009 (1). Of the 158 children aged ≥6 months who died with the 2009 A (H1N1) virus and for whom the vaccination status was known, 27 (17%) were vaccinated against seasonal influenza but only one (0.8%) received 2009 A(H1N1) vaccine according to ACIP recommendations.

Children who died with 2009 H1N1 were older and more likely to have an underlying condition that placed them at high risk for influenza complications than children who died with seasonal influenza. The proportion of children with bacterial co-infection was similar among those with seasonal influenza and 2009 H1N1. Continued surveillance of influenza-related mortality is important to monitor both the effects of seasonal and novel influenza and the effect of interventions in children.

  1. CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2009: July 31, 2009 / 58(RR08);1-52.

Lyme disease

Lyme disease is caused in North America by Borrelia burgdorferi sensu stricto, a spirochete transmitted by certain species of Ixodes ticks. Manifestations of infection include erythema migrans, arthritis, carditis, and neurologic deficits. Effective January 2008, the national surveillance case definition was revised to include reporting of probable cases and to update laboratory criteria to reflect current testing practices. Between 2008 and 2009 there was a 3.6% increase in confirmed cases and 35.6% increase in probable cases. Much of the increase can be attributed to variability in surveillance practices, although evidence of true emergence exists in certain areas. Because of the burden on endemic states posed by Lyme disease surveillance, some states have modified surveillance protocols to better manage limited resources. States using modified methods, including case estimation, might report decreased case counts.

Measles

Measles was declared eliminated from the United States in 2000. Since then, elimination has been maintained through high population immunity (1). Nonetheless, because measles remains endemic in much of the world; importations continue to result in sporadic cases and outbreaks in the United States, which can be costly to control (2). In recent years, the majority of measles cases in 2009 (80%) were import associated (3). Measles was classified as internationally imported in 21 cases, 14 of which were in U.S. residents exposed while traveling abroad, and 7 of which were among international visitors. Source countries for imported measles cases in 2009 included: United Kingdom (8 ), India (6 ), China (2 ), Philippines (2 ), Vietnam (1 ), Italy (1 ), and Cape Verde (1 ).

Thirty-three states reported no measles cases in 2009; 11 states and the District of Columbia reported fewer than 3 cases, and 6 states reported a total of 8 outbreaks (defined as 3 or more epidemiologically linked cases). Outbreaks ranged from 3 to 15 cases (median: 4). Seven outbreaks (87%) had viral and/or epidemiologic evidence of imported source. Six outbreaks (75%) included case-patients who reported personal belief exemptions. Of the 45 unvaccinated U.S. residents with measles in 2009, 20 (44%) held personal or religious beliefs opposing vaccination, and 10 (22%) were among children aged 15 months to 5 years whose parents had chosen to delay their MMR vaccination.

  1. Hutchins SS, Bellini W, Coronado V, et al. Population immunity to measles in the United States. J Infect Dis 2004:189(Suppl 1):S91--97.1.
  2. 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.
  3. Council of State and Territorial Epidemiologists. Revision of measles, rubella, and congenital syndrome case classification as part of elimination goals in the United States. Position statement 2006-ID-16. Available at http://www.cste.org/position%20statements/searchbyyear2006.asap.

Mumps

The majority (90%) of mumps cases reported in the United States during 2009 were associated with a large outbreak focused in the Northeastern states (primarily New York and New Jersey) that began in New York in June 2009 (1). A total of 1,776 cases occurred through December 31, 2009. The outbreak primarily affected adolescent boys in the Orthodox Jewish communities. Fewer than 3% of the cases associated with this outbreak occurred among persons outside this community. Most cases (77%) were among males and 36% were among adolescents aged 13 to 17 years. Among the patients for whom vaccination status was reported, 88% had received at least 1 dose of mumps-containing vaccine, and 76% had received 2 doses. This was the largest mumps outbreak to occur in the United States since 2006 (2).

  1. CDC. Mumps outbreak---New York, New Jersey, Quebec, 2009. MMWR 2009;58:1270--4.
  2. Dayan G, Quinlisk P, et al. Recent resurgence of mumps in the United States. New Engl J Med 2008;358:1580--9.

Novel Influenza A

In 2007, the Council of State and Territorial Epidemiologists added novel influenza A virus infection to the list of conditions reportable to the National Notifiable Diseases Surveillance System. Novel influenza A virus infections are human infections with influenza A viruses that are different from currently circulating human influenza A (H1) and A (H3) viruses. These viruses include those that are subtyped as non-human in origin and those that cannot be subtyped with standard methods and reagents.

After recognition of the first cases of infection with 2009 pandemic influenza A (H1N1) virus in April 2009, CDC and state health departments initiated enhanced surveillance to identify additional cases of 2009 pandemic influenza A (H1N1) virus infection. From April 15 to July 24, 2009, state and territorial health departments were asked to submit a daily line list of individual confirmed and probable cases of 2009 pandemic influenza A (H1N1) virus infections to the Influenza Division at CDC. A total of 43,771 cases were reported from all 50 states, Washington DC, and four territories during that 14-week period.

In addition, four cases of human infection with novel influenza A viruses, unrelated to the 2009 pandemic influenza A (H1N1) virus strain, were reported from three states (two from Iowa, one from Kansas, and one from Minnesota). These four cases represented sporadic cases of human infection; two patients were infected with swine influenza A (H1N1) viruses, and the remaining two were infected with swine influenza A (H3N2) viruses. Transmission of swine influenza A viruses to humans usually occurs among persons in direct contact with pigs or in those who have visited places where pigs have been present (e.g. agricultural fairs, farms, and petting zoos). Three of the four patients had direct contact with pigs. No definite exposure to swine was identified in one case. These cases did not result in sustained human-to-human transmission or community outbreaks.

Surveillance for human infections with all novel influenza A viruses remains essential even with the sustained community transmission of the 2009 pandemic influenza A (H1N1) virus. The early identification and investigation of these cases is critical to evaluate the extent of outbreaks and possible human-to-human transmission.

Pertussis

Although the incidence of reported pertussis declined in the United States following the 2004 peak (8.9 per 100,000), overall incidence is increasing again (5.54 in 2009, 4.18 in 2008, and 3.53 in 2007). Infants aged <6 months, who are at greatest risk for severe disease and death, continued to have the highest reported rate of pertussis (126.9 per 100,000). However, adolescents (aged 10--19 years) and adults (aged >20 years) accounted for approximately half of reported cases in 2009, and the contribution of cases in persons aged 7-10 years has been increasing in recent years (13% in 2007, 23.5% of cases in 2008, 23% of cases in 2009). In 2005, a combined tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) was recommended for use among adolescents and adults (1,2). Tdap coverage continues to increase among persons aged 13--17 years (10.8% in 2006 to 55.6% in 2009) (3,4), and early data suggests a decline in reported pertussis incidence among adolescents following the introduction of Tdap (5). Continued monitoring of disease trends through national surveillance will be important to assess the direct effect 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, 2009. MMWR 2010;59:1018--1023. Available at http://cdc.confex.com/cdc/nic2009/webprogram/Paper18157.html.

Poliomyelitis, Paralytic and Poliovirus Infections

Vaccine-Associated Paralytic Poliomyelitis (VAPP) is a rare adverse event that can occur following vaccination with live-attenuated oral poliovirus vaccine (OPV) (1). Inactivated poliovirus vaccine (IPV) does not cause VAPP. To reduce the risk of VAPP, the United States changed from an all OPV schedule to a sequential IPV/OPV schedule in 1997, and then to an all IPV schedule in 2000(2). Before the use of OPV was discontinued in 2000, approximately 8 cases of VAPP occurred in the United States each year (3). Since 2000, only two cases of VAPP have been reported in the United States, one in 2005 in a traveler to countries using OPV and a second, described below, who had common-variable immunodeficiency (CVID) (4).

In 2009, the Minnesota Department of Health reported VAPP in a U.S.-born resident with longstanding CVID. The case-patient, aged 44 years, had abrupt onset of limb and respiratory paralysis beginning in December 2008 and died in March 2009. A stool culture for enterovirus obtained in March 2009 tested positive for an enterovirus, which was later identified as type 2 vaccine-derived poliovirus. The number of genetic mutations in this virus suggested that it had been acquired by the case-patient in the mid 1990s, around the time that a household member was vaccinated with OPV (5).

  1. CDC. Poliomyelitis prevention in the United States: introduction of a sequential vaccination schedule of inactivated poliovirus vaccine followed by oral poliovirus vaccine; recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997;46(RR-3).
  2. CDC. Poliomyelitis prevention in the United States: updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2000;49(RR-5).
  3. Alexander LN, Seward JF, Santibanez TA, et al. Vaccine policy changes and epidemiology of poliomyelitis United States. JAMA 2004;292:1696--1701.
  4. CDC. Imported vaccine-associated paralytic poliomyelitis United States, 2005. MMWR 2006:55:97--9.
  5. DeVries, A, Harper, J, Murray, A. Neuroinvasive immunodeficiency-associated vaccine-derived polio Minnesota, 2008. Abstract #652 presented at the 47th Annual Meeting of IDSA, Philadelphia, PA, October 29-November 1, 2009.

Q Fever

During 2009, both acute and chronic Q fever infections were notifiable. Among the 113 cases reported in 2009, 93 were acute infection, and 20 were chronic Q fever. 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 2009, the number of cases of Q fever reported remained similar to those reported during the previous year. Although relatively few human cases are reported annually, Q fever is believed to be substantially underreported because of its nonspecific presentation and the subsequent failure of clinicians to suspect infection and request appropriate diagnostic tests.

Rabies

During 2009, four cases of human rabies were reported in the United States: an abortive infection in Texas, an imported case from India in Virginia, and two indigenous cases attributed to bat rabies virus variants in Indiana and Michigan. The Texas abortive rabies case marks the first documented human rabies case in which clinical and serologic findings were indicative of rabies and no alternate etiology for the illness was determined despite an extensive investigation. The patient experienced a shorter clinical course, less severe neurologic abnormalities, less stimulation of the immune system, and recovered without extensive medical intervention (1).

During June 2009, evidence on the number of doses of rabies vaccine required for postexposure prophylaxis (PEP) was presented to the Advisory Committee on Immunization Practices, and a change in the PEP guidelines was approved.

The new guidelines recommended that immunocompetent persons not previously vaccinated against rabies should receive human rabies immune globulin (20 IU/kg; day 0) and 4 doses of rabies vaccine (1mL IM; days 0, 3, 7, and 14). Persons who are immunocompromised should continue to receive the 5-dose PEP protocol with serologic testing to confirm adequate response to the vaccine (2).

During 2009, the majority (92%) of 6,694 rabid animals reported in the United States were wildlife. Overall, a 2% decrease was reported compared with 2008. Cats remain the most commonly reported rabid domestic animal (59% of rabid domestic animals). Reports of rabid domestic animals remain low in part because of increased vaccination rates and the continued elimination of dog-to-dog rabies transmission. Canine rabies remains a serious concern in many developing countries and public health education should target travelers and health-care providers with messages regarding rabies prevention measures and the potential risk of rabies exposure in countries where the disease is endemic in domestic animals (3).

  1. CDC. Presumptive abortive human rabies---Texas, 2009. MMWR. 2010; 59: 185--190.
  2. CDC. Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the Advisory Committee on Immunization Practices. MMWR 2010; 59(No.R:R-2)
  3. Blanton JD, Palmer D, Rupprecht CE. Rabies surveillance in the United States during 2009. J Am Vet Med Assoc. 2010; 237: (in press).

Rocky Mountain Spotted Fever

During 2009, RMSF cases decreased 29% from those reported in 2008. Cases reported in 2009 were distributed across the United States, reflecting the endemic status of Rocky Mountain spotted fever (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 (1), continued to be reported from Arizona during 2009.

Although RMSF case reports increased more than 400% from 2000 through 2008 (495 to 2,563), case reporting in 2009 represented a decline of nearly 750 cases. This decrease might be the result of several factors, including ecological changes influencing vector tick populations and disease transmission, changes in diagnostic approaches that alter detection rates, or changes in surveillance and reporting. Because serologic tests commonly used to diagnose RMSF exhibit cross-reactivity between spotted fever rickettsial pathogens, some cases reported as RMSF during 2009 might actually have been caused by other spotted fever rickettsial infections.

  1. L Demma, Traeger M, Nicholson W, et al. Rocky Mountain spotted fever from an unexpected tick vector in Arizona. New Engl J Med 2005;353:587--94.

Rubella, Congenital Rubella Syndrome

Rubella virus infection usually results in mild disease, but if contracted during pregnancy can result in vertical transmission to the fetus, leading to a constellation of congenital birth defects known as congenital rubella syndrome (CRS). Although rubella is no longer endemic in the United States, it remains common in many parts of the world. The U.S. strategy for ensuring maintenance of rubella and CRS elimination includes (1) maintaining high vaccination rates among children; (2) ensuring vaccination among all women of childbearing age; (3) continuing surveillance of both rubella and CRS; and (4) responding rapidly to any outbreaks of rubella (1).

The CRS case definition requires the presence of compatible congenital anomalies and laboratory evidence of rubella infection in the first year of infancy. Birth defects most often associated with CRS include cataracts, heart defects, and deafness. For a CRS case to be classified as an international importation, the mother must have acquired rubella virus infection outside the United States, or, in the absence of documented rubella virus infection, the mother must have been out of the United States for a period covering 21 days before and 24 weeks after conception. Laboratory confirmation of CRS in infants requires either rubella virus isolation, rubella virus detection by real-time polymerase chain reaction (RT-PCR), detection of serum rubella IgM, or serum IgG levels that persist longer than expected from passive transfer of maternal IgG (i.e., rubella titer that does not drop at the expected rate of a twofold dilution per month) (1).

Two CRS cases were reported in the United States in 2009. Both infants were born during 2008 and officially reported to CDC after investigations of the cases were completed in 2009. The first case was in an infant born to a U.S. resident with a travel history to India and China during time of conception and early in her first trimester of pregnancy. The infant, with a syndrome clinically compatible with CRS, tested positive at birth for infection with rubella genotype 2B virus. The source of infection for the second CRS case reported in 2009 is unknown. This infant was born to a U.S. resident who reported no international travel during her pregnancy. The case was diagnosed by PCR testing at a commercial laboratory; however, specimens were not available for confirmation and genotyping at CDC. Neither an epidemiologic nor virologic link to an importation could be established (CDC, unpublished data).

  1. Reef SE, Cochi SL. The evidence for the elimination of rubella and congenital rubella syndrome in the United States: a public health achievement. Clin Infect Dis 2006;43 (Suppl 3):S123−5.

Syphilis, Primary and Secondary

In 2009, rates of primary and secondary syphilis increased for the eighth consecutive year, reaching the highest rate reported since 1995. Although increases have occurred mostly among men, in 2009 62% of cases from 44 states and the District of Columbia occurred in men who have sex with men. Increases also were observed among women during 2004--2008, mostly in the south. The overall rate in women declined slightly in 2009. In 2009, the primary and secondary syphilis rate among blacks was 9 times the rate among whites. During 2005--2009, syphilis rates increased 167% among black men aged 15-19 years and 212% among black men aged 20--24 years, the greatest increase observed in any age, sex, or racial/ethnic group. Among black women aged 15--24 years, rates more than doubled during 2005--2009 (1).

  1. CDC. Sexually transmitted disease surveillance, 2009. Atlanta, GA: U.S. Department of Health and Human Services.

Trichinellosis

Of the 13 trichinellosis cases reported in 2009, five were associated with a shared meal that included a dish prepared with Trichinella-infected raw bear meat. One case-patient reported travelling to Southeast Asia and consuming raw pig's blood before the onset of illness. The implicated meat sources of five cases were pork (2), wild boar (2), and bear (1). Two cases of another disease were mistakenly reported as trichinellosis.

At least one outbreak associated with raw bear meat has been reported during 8 of the past 10 years (1-3). These results highlight the continued need for public health prevention messages aimed at persons who eat wild game meat, particularly bear, and for prevention messages targeted to cultural groups whose food choices might put them at a higher risk for Trichinella infection.

Proper cooking of meat dishes will prevent trichinellosis. Meat products, including sausages, ground meat, and other cuts of meat, should be cooked to internal temperatures of at least 160oF (4). Some species of Trichinella are resistant to freezing, so freezing might not be an effective prevention method.

  1. CDC. Summary of Notifiable Diseases --- United States, 2008. MMWR 2010;57(No. 54).
  2. 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).
  3. Roy SL, Lopez AS, Schantz PM. Trichinellosis surveillance---United States, 1997--2001. In: Surveillance Summaries, July 25, 2003. MMWR 2003;52(No. SS-6). Available at http://www.fsis.usda.gov/factsheets/meat_preparation_fact_sheets/index.asp.

Varicella

In 1981, varicella was removed from the National Notifiable Diseases list. Because of high disease burden and lack of established national surveillance for varicella when the one-dose varicella vaccination program was implemented in 1995, active surveillance sites were created to monitor the effect of the varicella vaccination program. Data from the active surveillance sites have indicated a greater than 90% decline in cases during 1995--2005 (1).

In 2002, the Council of State and Territorial Epidemiologists recommended that states move to case-based reporting for varicella by 2005. In 2003, varicella was added back to the national notifiable diseases list. As of 2009, 36 states were conducting case-based reporting for varicella. National data on varicella incidence reported through the National Notifiable Diseases Surveillance Sytem (NNDSS) are consistent with data reported through the active surveillance sites and document a decline in cases even as the number of states reporting has increased. During 2006--2009, the number of varicella cases reported through NNDSS decreased by 58% whereas the number of states and territories reporting increased from 31 to 36.

As varicella incidence has decreased, monitoring of cases has become more feasible nationwide and thus, NNDSS will be able to replace the active surveillance sites as the primary national source of surveillance data for varicella. Further declines in varicella disease burden are expected with implementation in 2006 of the universal recommendation for two doses of varicella vaccine for children (2). Therefore, all states should be advised of the importance of conducting varicella case-based reporting.

  1. Guris D, Jumaan AO, Mascola L, et al. Changing varicella epidemiology in active surveillance sites---United States, 1995--2005. J Infect Dis 2008;197 Suppl 2:S71--5.
  2. CDC. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2007;56(RR-4). Available at: http://www.cdc.gov/mmwr/PDF/rr/rr5604.pdf.

PART 1

Summaries of Notifiable Diseases in the United States, 2009


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, 2009 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, 2009

Disease

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sept

Oct

Nov

Dec

Month not stated

Total

Anthrax

---

---

---

---

---

---

---

---

---

---

---

1

---

1

Arboviral diseases

California serogroup virus

neuroinvasive

---

---

---

---

1

3

12

21

6

3

---

---

---

46

nonneuroinvasive

---

2

---

---

---

---

1

3

2

---

1

---

---

9

Eastern equine encephalitis virus

neuroinvasive

---

---

---

---

---

---

2

---

1

---

---

---

---

3

nonneuroinvasive

---

---

---

---

---

---

---

---

1

---

---

---

---

1

Powassan virus, neuroinvasive

1

---

---

1

---

2

---

1

---

---

1

---

---

6

St. Louis encephalitis virus

neuroinvasive

---

---

---

1

---

3

4

1

1

1

---

---

---

11

nonneuroinvasive

---

---

---

---

---

---

---

---

---

---

---

1

---

1

West Nile virus

neuroinvasive

---

---

---

---

3

11

59

182

111

18

---

1

1

386

nonneuroinvasive

---

---

---

1

4

8

57

174

74

16

---

---

---

334

Botulism, total

5

13

10

13

7

7

7

9

8

7

14

18

---

118

foodborne

1

3

---

1

2

---

1

1

---

---

---

1

---

10

infant

2

8

8

8

5

6

5

5

7

6

10

13

---

83

other (wound and unspecified)

2

2

2

4

---

1

1

3

1

1

4

4

---

25

Brucellosis

1

4

9

12

12

10

7

13

11

8

7

21

---

115

Chancroid§

---

2

6

4

---

2

---

1

---

1

4

8

---

28

Chlamydia trachomatis genital infection§

93,356

100,303

98,845

98,846

114,944

98,941

94,182

125,258

94,924

120,816

85,399

118,366

---

1,244,180

Cholera

1

---

---

1

---

1

4

---

1

1

---

1

---

10

Coccidioidomycosis

654

496

628

527

726

1,448

1,204

1,571

1,174

1,476

1,304

1,718

---

12,926

Cryptosporidiosis, total

328

311

353

442

602

551

791

1,320

982

883

484

607

---

7,654

confirmed

325

306

349

429

594

541

759

1,245

942

849

468

586

---

7,393

probable

3

5

4

13

8

10

32

75

40

34

16

21

---

261

Cyclosporiasis

31

9

1

5

9

23

18

20

9

3

8

5

---

141

Ehrlichiosis/Anaplasmosis

Ehrlichia chaffeensis

7

6

8

20

65

136

181

144

83

66

24

204

---

944

Ehrlichia ewingii

---

---

---

---

---

---

3

3

1

---

---

---

---

7

Anaplasma phagocytophilum

---

2

7

14

102

160

177

127

52

101

44

375

---

1,161

Undetermined

1

1

5

2

17

22

23

23

9

6

4

42

---

155

Giardiasis

1,078

1,215

1,256

1,328

1,468

1,273

1,754

2,294

1,970

2,117

1,505

2,141

---

19,399

Gonorrhea§

23,914

23,822

23,003

23,218

27,248

24,251

23,411

31,147

24,368

29,252

20,053

27,487

---

301,174

Haemophilus influenzae, invasive disease, all ages, serotypes

238

247

259

244

309

259

227

223

166

189

190

471

---

3,022

age <5 yrs

serotype b

3

3

9

2

2

2

3

2

4

4

---

4

---

38

nonserotype b

21

29

26

20

26

19

24

11

14

8

17

30

---

245

unknown serotype

15

14

15

7

22

12

7

10

5

11

11

37

---

166

Hansen disease (Leprosy)

5

12

9

6

8

12

7

12

3

11

14

4

---

103

Hantavirus pulmonary syndrome

---

---

2

---

4

2

3

1

2

1

---

5

---

20

Hemolytic uremic syndrome, post-diarrheal

6

6

15

12

24

24

22

25

23

28

17

40

---

242

Hepatitis, viral, acute

A

135

165

139

161

174

143

187

205

179

176

123

200

---

1,987

B

260

271

283

259

297

246

252

312

261

292

197

475

---

3,405

C

54

50

61

63

61

76

61

67

53

72

60

104

---

782

HIV diagnoses

3,746

3,810

4,136

3,996

3,354

3,764

3,543

3,191

2,969

2,583

1,493

279

6

36,870

Influenza-associated pediatric mortality**

3

18

22

13

11

17

13

14

17

80

108

42

---

358

Legionellosis

135

118

132

115

192

352

439

583

426

445

264

321

---

3,522

Listeriosis

67

40

41

41

61

47

93

113

93

90

58

107

---

851

Lyme disease, total

686

756

914

1,118

2,407

5,826

8,818

7,038

2,980

2,637

1,591

3,697

---

38,468

confirmed

488

555

650

744

1,772

4,917

7,421

5,579

2,194

1,985

1,104

2,550

---

29,959

probable

198

201

264

374

635

909

1,397

1,459

786

652

487

1,147

---

8,509

Malaria

89

80

72

77

124

101

147

228

126

131

87

189

---

1,451

Measles, total

2

2

7

11

16

12

9

5

1

3

---

3

---

71

indigenous

---

1

3

8

11

11

8

4

1

3

---

1

---

51

imported

2

1

4

3

5

1

1

1

---

---

---

2

---

20

Meningococcal disease, all serogroups

59

102

118

87

103

59

66

59

49

76

81

121

---

980

serogroup A,C,Y, and W-135

15

34

34

32

30

16

18

14

12

21

32

43

---

301

serogroup B

9

18

28

11

21

12

12

8

7

13

11

24

---

174

other serogroup

1

4

2

2

4

1

3

2

2

2

---

---

---

23

serogroup unknown

34

46

54

42

48

30

33

35

28

40

38

54

---

482

Mumps

27

24

37

40

42

24

32

45

75

137

282

1,226

---

1,991

Pertussis

956

856

912

1,177

1,425

1,342

1,627

1,981

1,333

1,316

1,021

2,912

---

16,858

Plague

---

---

---

---

2

2

2

1

1

---

---

---

---

8

Poliomyelitis, paralytic

---

---

---

---

---

---

---

---

---

---

---

1

---

1


TABLE 1. (Continued) Reported cases of notifiable diseases,* by month --- United States, 2009

Disease

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sept

Oct

Nov

Dec

Month not stated

Total

Psittacosis

---

1

3

---

1

---

1

1

1

---

---

1

---

9

Q Fever, total

6

5

9

10

14

8

10

8

9

12

4

18

---

113

acute

5

3

7

10

13

6

9

8

6

11

3

12

---

93

chronic

1

2

2

---

1

2

1

---

3

1

1

6

---

20

Rabies, animal

210

416

406

501

634

442

416

644

546

526

285

317

---

5,343

human

---

---

---

---

---

1

---

---

---

1

1

1

---

4

Rocky Mountain spotted fever, total

39

34

34

72

190

259

278

233

122

70

26

458

---

1,815

confirmed

2

1

5

6

17

33

23

29

7

15

3

10

---

151

probable

37

33

29

65

173

226

254

204

115

55

23

448

---

1,662

Rubella

---

---

---

1

1

---

1

---

---

---

---

---

---

3

Rubella, congenital syndrome

---

1

---

---

---

1

---

---

---

---

---

---

---

2

Salmonellosis

2,798

2,194

2,356

2,658

3,855

4,068

4,976

7,030

5,301

5,567

3,624

4,765

---

49,192

Shiga toxin-producing E. coli (STEC)

253

201

168

258

429

426

506

705

475

505

303

414

---

4,643

Shigellosis

1,219

1,161

1,132

1,036

1,808

1,366

1,392

1,723

1,105

1,224

968

1,797

---

15,931

Streptococcal disease, invasive, group A

462

565

658

647

588

422

328

337

201

263

258

550

---

5,279

Streptococcal, toxic-shock syndrome

8

21

24

20

17

7

6

10

8

8

6

26

---

161

Streptococcus pneumoniae, invasive disease

drug resistant

all ages

291

394

360

326

308

160

117

104

138

241

218

713

---

3,370

age <5 yrs

36

69

63

55

57

31

19

24

28

53

53

95

---

583

non-drug resistant, age <5 yrs

143

204

183

208

192

118

81

86

104

178

171

320

---

1,988

Syphilis, total, all stages §,††

3,263

3,590

3,672

3,569

4,315

3,499

3,351

4,503

3,546

4,254

2,988

4,278

---

44,828

congenital (age <1 yr)§

45

39

42

33

34

23

38

40

35

32

25

41

---

427

primary and secondary§

1,070

1,032

1,099

1,080

1,323

1,029

1,101

1,556

1,123

1,271

985

1,328

---

13,997

Tetanus

1

2

2

---

---

1

---

---

3

4

1

4

---

18

Toxic-shock syndrome

5

7

5

10

6

7

9

5

5

6

4

5

---

74

Trichinellosis

2

4

1

2

1

---

1

1

1

---

---

---

---

13

Tuberculosis§§

531

710

850

942

947

1,114

1,001

949

931

988

891

1,691

---

11,545

Tularemia

2

1

3

3

4

14

14

17

9

12

5

9

---

93

Typhoid fever

33

35

32

23

33

28

17

62

53

30

16

35

---

397

Vancomycin-intermediate Staphylococcus aureus (VISA)

5

4

3

11

12

9

7

6

6

5

4

6

---

78

Vancomycin-resistant Staphylococcus aureus (VRSA)

---

---

---

---

---

---

---

---

---

---

---

1

---

1

Varicella (Chickenpox)

morbidity

1,961

2,304

2,275

2,277

3,062

1,255

787

777

1,205

1,730

1,240

1,607

---

20,480

mortality¶¶

---

---

---

1

---

---

---

---

---

---

1

---

---

2

Vibriosis

42

11

27

20

51

61

81

171

114

101

55

55

---

789

* No cases of diphtheria; poliovirus infection, nonparalytic; Powassan virus disease, non-neuroinvasive; severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV); smallpox; western equine encephalitis virus disease, neuroinvasive and non-neuroinvasive; and yellow fever were reported in 2009. 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.

Totals reported to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases (ArboNET Surveillance), as of May 28, 2010.

§ Totals reported to the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), as of May 7, 2010.

Total number of HIV cases reported to the Division of HIV/AIDS Prevention, NCHHSTP through December 31, 2009.

** Totals reported to the Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD), as of December 31, 2009.

†† 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 14, 2010.

¶¶ Totals reported to the Division of Viral Diseases, NCIRD, as of June 30, 2010.


TABLE 2. Reported cases of notifiable diseases,* by geographic division and area --- United States, 2009

Area

Total resident population (in thousands)

Anthrax

United States

304,057

1

New England

14,303

1

Connecticut

3,501

---

Maine

1,316

---

Massachusetts

6,498

---

New Hampshire

1,316

1

Rhode Island

1,051

---

Vermont

621

---

Mid. Atlantic

40,622

---

New Jersey

8,683

---

New York (Upstate)

11,127

---

New York City

8,364

---

Pennsylvania

12,448

---

E.N. Central

46,396

---

Illinois

12,902

---

Indiana

6,377

---

Michigan

10,003

---

Ohio

11,486

---

Wisconsin

5,628

---

W.N. Central

20,165

---

Iowa

3,003

---

Kansas

2,802

---

Minnesota

5,220

---

Missouri

5,912

---

Nebraska

1,783

---

North Dakota

641

---

South Dakota

804

---

S. Atlantic

58,398

---

Delaware

873

---

District of Columbia

592

---

Florida

18,328

---

Georgia

9,686

---

Maryland

5,634

---

North Carolina

9,222

---

South Carolina

4,480

---

Virginia

7,769

---

West Virginia

1,814

---

E.S. Central

18,085

---

Alabama

4,662

---

Kentucky

4,269

---

Mississippi

2,939

---

Tennessee

6,215

---

W.S. Central

35,235

---

Arkansas

2,855

---

Louisiana

4,411

---

Oklahoma

3,642

---

Texas

24,327

---

Mountain

21,783

---

Arizona

6,500

---

Colorado

4,939

---

Idaho

1,524

---

Montana

967

---

Nevada

2,600

---

New Mexico

1,984

---

Utah

2,736

---

Wyoming

533

---

Pacific

49,070

---

Alaska

686

---

California

36,757

---

Hawaii

1,288

---

Oregon

3,790

---

Washington

6,549

---

Territories

American Samoa

65

---

C.N.M.I.

55

---

Guam

176

---

Puerto Rico

3,955

---

U.S. Virgin Islands

110

---

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

* No cases of diphtheria; poliovirus infection, nonparalytic; Powassan virus disease, non-neuroinvasive; severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV); smallpox; western equine encephalitis virus disease, neuroinvasive and non-neuroinvasive; and yellow fever were reported in 2009. 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.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2009

Area

Arboviral diseases

California serogroup virus

Eastern equine encephalitis virus

Powassan virus

St. Louis encephalitis virus

West Nile virus

Neuro-
invasive

Nonneuro-invasive

Neuro-
invasive

Nonneuro-invasive

Neuro-
invasive

Neuro-
invasive

Nonneuro- invasive

Neuro-
invasive

Nonneuro-
invasive

United States

46

9

3

1

6

11

1

386

334

New England

---

---

---

1

---

---

---

---

---

Connecticut

---

---

---

---

---

---

---

---

---

Maine

---

---

---

---

---

---

---

---

---

Massachusetts

---

---

---

---

---

---

---

---

---

New Hampshire

---

---

---

1

---

---

---

---

---

Rhode Island

---

---

---

---

---

---

---

---

---

Vermont

---

---

---

---

---

---

---

---

---

Mid. Atlantic

---

3

1

---

3

---

---

9

1

New Jersey

---

---

---

---

---

---

---

3

---

New York (Upstate)

---

3

1

---

3

---

---

3

1

New York City

---

---

---

---

---

---

---

3

---

Pennsylvania

---

---

---

---

---

---

---

---

---

E.N. Central

7

1

---

---

---

1

---

9

4

Illinois

---

1

---

---

---

---

---

5

---

Indiana

1

---

---

---

---

1

---

2

2

Michigan

---

---

---

---

---

---

---

1

---

Ohio

5

---

---

---

---

---

---

---

2

Wisconsin

1

---

---

---

---

---

---

1

---

W.N. Central

1

---

---

---

2

---

---

26

75

Iowa

---

---

---

---

---

---

---

---

5

Kansas

---

---

---

---

---

---

---

4

9

Minnesota

---

---

---

---

2

---

---

1

3

Missouri

1

---

---

---

---

---

---

4

1

Nebraska

---

---

---

---

---

---

---

11

41

North Dakota

---

---

---

---

---

---

---

---

1

South Dakota

---

---

---

---

---

---

---

6

15

S. Atlantic

28

5

1

---

1

---

---

16

2

Delaware

---

---

---

---

---

---

---

---

---

District of Columbia

---

---

---

---

---

---

---

2

---

Florida

---

---

---

---

---

---

---

2

1

Georgia

2

---

---

---

---

---

---

4

---

Maryland

---

---

---

---

---

---

---

---

1

North Carolina

16

---

1

---

---

---

---

---

---

South Carolina

---

---

---

---

---

---

---

3

---

Virginia

---

1

---

---

1

---

---

5

---

West Virginia

10

4

---

---

---

---

---

---

---

E.S. Central

9

---

---

---

---

2

---

38

27

Alabama

1

---

---

---

---

---

---

---

---

Kentucky

---

---

---

---

---

---

---

3

---

Mississippi

---

---

---

---

---

2

---

31

22

Tennessee

8

---

---

---

---

---

---

4

5

W.S. Central

---

---

1

---

---

7

1

117

35

Arkansas

---

---

---

---

---

4

---

6

---

Louisiana

---

---

1

---

---

---

---

10

11

Oklahoma

---

---

---

---

---

---

---

8

2

Texas

---

---

---

---

---

3

1

93

22

Mountain

1

---

---

---

---

---

---

77

123

Arizona

---

---

---

---

---

---

---

12

8

Colorado

---

---

---

---

---

---

---

36

67

Idaho

---

---

---

---

---

---

---

9

29

Montana

1

---

---

---

---

---

---

2

3

Nevada

---

---

---

---

---

---

---

7

5

New Mexico

---

---

---

---

---

---

---

6

2

Utah

---

---

---

---

---

---

---

1

1

Wyoming

---

---

---

---

---

---

---

4

8

Pacific

---

---

---

---

---

1

---

94

67

Alaska

---

---

---

---

---

---

---

---

---

California

---

---

---

---

---

---

---

67

45

Hawaii

---

---

---

---

---

---

---

---

---

Oregon

---

---

---

---

---

---

---

1

10

Washington

---

---

---

---

---

1

---

26

12

Territories

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 Infectious Diseases, National Center for Emerging and Zoonotic Infectious Diseases (ArboNET Surveillance), as of May 28, 2010.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2009

Area

Botulism

Total

Foodborne

Infant

Other§

Brucellosis

Chancroid

Chlamydia

United States

118

10

83

25

115

28

1,244,180

New England

---

---

---

---

1

3

40,776

Connecticut

---

---

---

---

---

---

12,127

Maine

---

---

---

---

---

---

2,431

Massachusetts

---

---

---

---

1

3

19,315

New Hampshire

---

---

---

---

---

---

2,102

Rhode Island

---

---

---

---

---

---

3,615

Vermont

---

---

---

---

---

---

1,186

Mid. Atlantic

22

---

22

---

4

---

159,111

New Jersey

11

---

11

---

1

---

23,974

New York (Upstate)

1

---

1

---

1

---

33,722

New York City

1

---

1

---

---

---

58,347

Pennsylvania

9

---

9

---

2

---

43,068

E.N. Central

7

1

5

1

23

7

197,133

Illinois

---

---

---

---

4

---

60,542

Indiana

---

---

---

---

4

1

21,732

Michigan

1

---

---

1

10

---

45,714

Ohio

5

1

4

---

4

---

48,239

Wisconsin

1

---

1

---

1

6

20,906

W.N. Central

4

1

3

---

5

---

70,396

Iowa

---

---

---

---

2

---

9,406

Kansas

1

---

1

---

---

---

10,510

Minnesota

---

---

---

---

---

---

14,197

Missouri

2

---

2

---

1

---

25,868

Nebraska

1

1

---

---

1

---

5,443

North Dakota

---

---

---

---

1

---

1,957

South Dakota

---

---

---

---

---

---

3,015

S. Atlantic

10

---

10

---

30

9

249,979

Delaware

2

---

2

---

---

---

4,718

District of Columbia

---

---

---

---

1

---

6,549

Florida

1

---

1

---

9

1

72,931

Georgia

---

---

---

---

10

---

39,828

Maryland

3

---

3

---

---

---

23,747

North Carolina

---

---

---

---

1

6

41,045

South Carolina

---

---

---

---

4

1

26,654

Virginia

4

---

4

---

5

1

30,903

West Virginia

---

---

---

---

---

---

3,604

E.S. Central

2

---

2

---

3

---

92,522

Alabama

1

---

1

---

3

---

25,929

Kentucky

---

---

---

---

---

---

13,293

Mississippi

---

---

---

---

---

---

23,589

Tennessee

1

---

1

---

---

---

29,711

W.S. Central

8

---

8

---

15

8

162,915

Arkansas

3

---

3

---

---

---

14,354

Louisiana

1

---

1

---

1

---

27,628

Oklahoma

---

---

---

---

2

---

15,023

Texas

4

---

4

---

12

8

105,910

Mountain

7

1

6

---

5

---

80,476

Arizona

3

---

3

---

3

---

26,002

Colorado

1

---

1

---

---

---

19,998

Idaho

---

---

---

---

---

---

3,842

Montana

---

---

---

---

---

---

2,988

Nevada

1

---

1

N

---

---

10,045

New Mexico

1

1

---

---

2

---

9,493

Utah

1

---

1

---

---

---

6,145

Wyoming

---

---

---

---

---

---

1,963

Pacific

58

7

27

24

29

1

190,872

Alaska

1

---

1

---

---

---

5,166

California

43

3

20

20

24

1

146,796

Hawaii

4

---

4

---

1

---

6,026

Oregon

---

---

---

---

3

---

11,497

Washington

10

4

2

4

1

---

21,387

Territories

American Samoa

---

---

---

---

---

---

---

C.N.M.I.

---

---

---

---

---

---

---

Guam

---

---

---

---

1

---

620

Puerto Rico

---

---

---

---

---

---

7,302

U.S. Virgin Islands

---

---

---

---

---

---

488

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

§ Includes cases reported as wound and unspecified botulism.

Totals reported to the Division of STD Prevention, NCHHSTP, as of May 7, 2010.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2009

Area

Cholera

Coccidioidomycosis

Cryptosporidiosis**

Cyclosporiasis

Total

Confirmed

Probable

United States

10

12,926

7,654

7,393

261

141

New England

1

1

470

458

12

26

Connecticut

---

N

38

38

---

18

Maine

---

N

67

55

12

N

Massachusetts

1

N

181

181

---

7

New Hampshire

---

1

83

83

---

1

Rhode Island

---

---

22

22

---

---

Vermont

---

N

79

79

---

N

Mid. Atlantic

3

---

821

820

1

39

New Jersey

---

N

53

53

---

8

New York (Upstate)

---

N

222

222

---

12

New York City

2

N

80

80

---

19

Pennsylvania

1

N

466

465

1

N

E.N. Central

1

38

1,727

1,716

11

9

Illinois

---

N

154

154

---

5

Indiana

1

N

288

284

4

1

Michigan

---

22

285

282

3

2

Ohio

---

16

388

384

4

---

Wisconsin

---

N

612

612

---

1

W.N. Central

---

11

1,162

1,124

38

2

Iowa

---

N

232

211

21

1

Kansas

---

N

104

104

---

---

Minnesota

---

---

347

347

---

1

Missouri

---

11

193

183

10

---

Nebraska

---

N

117

116

1

N

North Dakota

---

N

31

31

---

N

South Dakota

---

N

138

132

6

---

S. Atlantic

---

5

1,226

1,138

88

52

Delaware

---

1

12

12

---

---

District of Columbia

---

---

8

8

---

2

Florida

---

N

497

456

41

38

Georgia

---

N

336

336

---

6

Maryland

---

4

43

43

---

2

North Carolina

---

N

159

116

43

2

South Carolina

---

N

62

61

1

1

Virginia

---

N

86

86

---

1

West Virginia

---

N

23

20

3

---

E.S. Central

1

---

235

231

4

2

Alabama

---

N

68

68

---

N

Kentucky

---

N

67

67

---

N

Mississippi

---

N

19

19

---

N

Tennessee

1

N

81

77

4

2

W.S. Central

2

2

677

596

81

11

Arkansas

---

N

60

60

---

---

Louisiana

---

2

56

56

---

1

Oklahoma

---

N

142

128

14

---

Texas

2

N

419

352

67

10

Mountain

---

10,381

567

560

7

---

Arizona

---

10,233

34

34

---

---

Colorado

---

N

138

137

1

---

Idaho

---

N

98

97

1

N

Montana

---

N

57

57

---

N

Nevada

---

61

25

25

---

N

New Mexico

---

47

149

146

3

---

Utah

---

39

39

39

---

---

Wyoming

---

1

27

25

2

---

Pacific

2

2,488

769

750

19

---

Alaska

---

N

8

8

---

---

California

2

2,488

459

459

---

---

Hawaii

---

N

1

1

---

---

Oregon

---

N

199

185

14

---

Washington

---

N

102

97

5

---

Territories

American Samoa

---

N

N

---

---

N

C.N.M.I.

---

---

---

---

---

---

Guam

---

---

---

---

---

---

Puerto Rico

---

N

N

---

---

N

U.S. Virgin Islands

---

---

---

---

---

---

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

** Revision of National Surveillance Case Definition and data display to distinguish between confirmed and probable cases.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2009

Area

Ehrlichiosis/Anaplasmosis

Giardiasis

Gonorrhea

Ehrlichia
chaffeensis

Ehrlichia
ewingii

Anaplasma phagocytophilum

Undetermined

United States

944

7

1,161

155

19,399

301,174

New England

23

---

189

2

1,757

5,162

Connecticut

---

---

22

---

290

2,558

Maine

1

---

15

---

223

143

Massachusetts

9

---

99

---

751

1,976

New Hampshire

4

---

18

2

197

113

Rhode Island

8

---

35

---

75

322

Vermont

1

---

N

---

221

50

Mid. Atlantic

196

---

322

27

3,520

31,904

New Jersey

102

---

70

---

430

4,762

New York (Upstate)

70

---

241

8

1,419

6,111

New York City

10

---

9

1

832

10,893

Pennsylvania

14

---

2

18

839

10,138

E.N. Central

84

1

283

55

2,917

62,690

Illinois

33

---

6

3

613

19,962

Indiana

---

---

---

21

312

6,835

Michigan

6

---

---

---

672

14,704

Ohio

12

1

1

---

806

15,988

Wisconsin

33

---

276

31

514

5,201

W.N. Central

160

5

323

51

1,971

14,825

Iowa

N

N

N

N

291

1,658

Kansas

6

---

1

---

161

2,505

Minnesota

8

---

317

38

674

2,303

Missouri

144

5

5

13

524

6,488

Nebraska

2

N

---

---

177

1,376

North Dakota

N

N

N

N

32

151

South Dakota

---

---

---

---

112

344

S. Atlantic

208

1

14

1

3,774

74,944

Delaware

22

---

2

---

29

971

District of Columbia

N

N

N

N

73

2,561

Florida

11

---

3

---

1,981

20,878

Georgia

18

---

1

---

747

13,687

Maryland

33

---

1

---

277

6,395

North Carolina

53

---

3

---

N

13,870

South Carolina

2

1

---

---

106

8,318

Virginia

68

---

4

---

503

7,789

West Virginia

1

---

---

1

58

475

E.S. Central

99

---

3

16

434

26,492

Alabama

8

---

2

N

204

7,498

Kentucky

12

---

---

N

N

3,827

Mississippi

6

---

---

---

N

7,241

Tennessee

73

---

1

16

230

7,926

W.S. Central

171

---

25

1

529

47,424

Arkansas

38

---

6

---

155

4,460

Louisiana

---

---

---

---

203

8,996

Oklahoma

129

---

17

---

171

4,673

Texas

4

---

2

1

N

29,295

Mountain

---

---

---

1

1,645

9,486

Arizona

---

---

---

1

198

3,250

Colorado

N

N

N

N

499

2,823

Idaho

N

N

N

N

208

110

Montana

N

N

N

N

133

80

Nevada

N

---

N

N

109

1,726

New Mexico

N

N

N

N

113

1,082

Utah

---

---

---

---

312

341

Wyoming

---

---

---

---

73

74

Pacific

3

---

2

1

2,852

28,247

Alaska

N

N

N

N

111

990

California

3

---

2

1

1,832

23,228

Hawaii

N

N

N

N

21

631

Oregon

---

---

---

---

421

1,113

Washington

N

N

N

N

467

2,285

Territories

American Samoa

N

N

N

N

---

---

C.N.M.I.

---

---

---

---

---

---

Guam

N

N

N

N

3

59

Puerto Rico

N

N

N

N

156

230

U.S. Virgin Islands

---

---

---

---

---

115

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, 2009

Area

Haemophilus influenzae, invasive disease

Hansen disease (leprosy)

Hantavirus pulmonary syndrome

Hemolytic uremic syndrome, postdiarrheal

All ages,
serotypes

Age <5 yrs

Serotype b

Nonserotype b

Unknown serotype

United States

3,022

38

245

166

103

20

242

New England

216

3

10

3

9

---

17

Connecticut

64

---

3

---

1

N

10

Maine

21

2

2

1

N

---

2

Massachusetts

100

---

3

---

6

---

2

New Hampshire

14

---

---

---

---

---

1

Rhode Island

12

---

---

---

2

---

1

Vermont

5

1

2

2

N

---

1

Mid. Atlantic

601

13

22

34

5

---

20

New Jersey

132

---

---

11

1

---

3

New York (Upstate)

172

3

9

4

N

---

11

New York City

78

---

---

15

3

---

6

Pennsylvania

219

10

13

4

1

---

N

E.N. Central

468

3

31

27

4

---

31

Illinois

182

---

---

20

1

---

1

Indiana

84

2

7

1

---

---

---

Michigan

24

1

6

---

1

---

7

Ohio

101

---

18

2

2

---

14

Wisconsin

77

---

---

4

---

---

9

W.N. Central

192

1

10

16

---

2

42

Iowa

1

1

---

---

---

---

9

Kansas

14

---

---

---

---

---

2

Minnesota

79

---

10

2

---

1

17

Missouri

63

---

---

9

---

---

7

Nebraska

25

---

---

3

---

---

4

North Dakota

10

---

---

2

N

1

---

South Dakota

---

---

---

---

---

---

3

S. Atlantic

795

2

68

24

7

---

24

Delaware

5

---

---

1

---

---

---

District of Columbia

6

---

---

---

---

---

---

Florida

222

1

24

4

7

---

5

Georgia

162

1

18

5

---

---

5

Maryland

94

---

7

---

---

---

4

North Carolina

105

---

---

12

---

---

4

South Carolina

79

---

8

1

---

---

2

Virginia

88

---

8

1

---

---

2

West Virginia

34

---

3

---

N

---

2

E.S. Central

183

1

10

12

3

---

23

Alabama

43

---

1

---

---

N

6

Kentucky

21

---

---

6

---

---

N

Mississippi

8

---

---

2

2

---

---

Tennessee

111

1

9

4

1

---

17

W.S. Central

148

5

13

7

28

1

32

Arkansas

24

---

3

1

4

1

7

Louisiana

24

---

---

5

---

---

2

Oklahoma

93

2

10

1

N

---

17

Texas

7

3

---

---

24

---

6

Mountain

260

8

47

16

4

9

25

Arizona

84

1

17

1

---

1

2

Colorado

74

2

9

---

2

2

9

Idaho

5

---

---

2

---

---

3

Montana

2

1

---

---

---

---

2

Nevada

19

2

2

4

1

---

N

New Mexico

36

---

4

9

---

5

3

Utah

37

2

14

---

1

1

6

Wyoming

3

---

1

---

---

---

---

Pacific

159

2

34

27

43

8

28

Alaska

21

---

---

5

---

N

N

California

41

---

28

8

19

3

24

Hawaii

32

1

1

4

24

---

---

Oregon

56

---

---

7

N

2

4

Washington

9

1

5

3

N

3

---

Territories

American Samoa

---

---

---

---

---

N

N

C.N.M.I.

---

---

---

---

---

---

---

Guam

---

---

---

---

6

N

---

Puerto Rico

4

---

---

3

---

---

N

U.S. Virgin Islands

---

---

---

---

---

---

---

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, 2009

Area

Hepatitis, viral, acute

HIV†† diagnoses

Influenza-associated pediatric mortality§§

Legionellosis

Listeriosis

Lyme disease

Malaria

Total

Confirmed

Probable

A

B

C

United States

1,987

3,405

782

36,870

358

3,522

851

38,468

29,959

8,509

1,451

New England

108

54

66

805

10

203

77

12,440

9,030

3,410

62

Connecticut

18

16

53

308

1

55

26

4,156

2,751

1,405

7

Maine

1

15

2

48

---

10

4

970

791

179

2

Massachusetts

71

17

10

307

5

95

35

5,256

4,019

1,237

40

New Hampshire

7

6

N

38

1

15

2

1,415

996

419

4

Rhode Island

9

U

U

100

3

21

6

235

150

85

5

Vermont

2

---

1

4

---

7

4

408

323

85

4

Mid. Atlantic

275

328

99

6,339

34

1,196

205

16,346

13,682

2,664

413

New Jersey

71

93

7

908

6

218

45

4,973

4,598

375

103

New York (Upstate)

48

57

48

1,411

15

368

74

4,600

3,493

1,107

53

New York City

88

72

5

2,551

8

227

38

1,051

641

410

204

Pennsylvania

68

106

39

1,469

5

383

48

5,722

4,950

772

53

E.N. Central

284

436

92

3,564

40

723

119

2,969

2,281

688

173

Illinois

126

118

6

1,202

8

135

38

136

136

---

70

Indiana

17

74

22

425

5

62

9

83

61

22

25

Michigan

72

132

35

731

6

169

26

103

81

22

31

Ohio

36

88

26

914

15

282

30

58

51

7

37

Wisconsin

33

24

3

292

6

75

16

2,589

1,952

637

10

W.N. Central

126

154

33

1,230

20

135

25

1,693

1,176

517

84

Iowa

38

37

11

123

3

24

4

108

77

31

10

Kansas

12

6

1

136

2

7

1

18

18

---

8

Minnesota

29

38

15

358

9

28

3

1,543

1,063

480

43

Missouri

21

47

---

504

4

59

14

3

3

---

13

Nebraska

21

22

3

77

---

13

---

5

4

1

8

North Dakota

2

---

2

12

---

2

2

15

10

5

1

South Dakota

3

4

1

20

2

2

1

1

1

---

1

S. Atlantic

429

913

174

11,953

54

605

142

4,466

3,507

959

367

Delaware

4

34

U

144

2

19

7

984

984

---

5

District of Columbia

1

10

1

556

---

24

1

61

53

8

17

Florida

171

299

53

5,401

12

193

25

110

77

33

93

Georgia

54

144

31

1,606

8

60

30

40

40

---

68

Maryland

47

72

23

1,057

5

157

14

2,024

1,466

558

80

North Carolina

41

104

24

1,521

10

62

27

96

21

75

32

South Carolina

63

56

1

727

6

13

12

42

25

17

7

Virginia

42

110

10

869

8

67

16

908

698

210

61

West Virginia

6

84

31

72

3

10

10

201

143

58

4

E.S. Central

46

348

107

2,334

25

142

40

41

14

27

35

Alabama

12

89

10

594

2

20

14

3

3

---

9

Kentucky

12

90

64

289

5

52

7

1

1

---

13

Mississippi

9

33

U

549

4

4

5

---

---

---

4

Tennessee

13

136

33

902

14

66

14

37

10

27

9

W.S. Central

209

680

74

4,594

71

151

59

278

90

188

102

Arkansas

12

65

2

133

4

8

8

---

---

---

5

Louisiana

6

73

9

1,223

7

18

16

---

---

---

8

Oklahoma

7

122

27

123

10

10

8

2

2

---

2

Texas

184

420

36

3,115

50

115

27

276

88

188

87

Mountain

163

132

53

1,553

56

151

31

57

28

29

48

Arizona

68

42

U

540

24

49

8

7

3

4

10

Colorado

52

27

28

348

14

31

9

1

---

1

26

Idaho

5

11

7

32

1

8

3

16

4

12

3

Montana

6

1

1

27

1

8

---

3

3

---

5

Nevada

15

34

5

333

2

14

3

13

10

3

---

New Mexico

8

8

6

148

9

9

3

5

1

4

---

Utah

7

5

6

107

5

28

2

9

6

3

4

Wyoming

2

4

---

18

---

4

3

3

1

2

---

Pacific

347

360

84

4,498

48

216

153

178

151

27

167

Alaska

2

4

U

18

1

1

---

7

7

---

2

California

273

258

43

3,776

36

167

106

117

117

---

126

Hawaii

11

6

U

34

1

1

4

N

N

N

1

Oregon

19

44

19

203

4

18

19

38

12

26

12

Washington

42

48

22

467

6

29

24

16

15

1

26

Territories

American Samoa

---

---

---

---

---

---

---

N

N

N

---

C.N.M.I.

---

---

---

1

---

---

---

---

---

---

---

Guam

7

57

49

3

1

---

---

---

---

---

---

Puerto Rico

21

34

---

474

---

3

2

N

N

N

5

U.S. Virgin Islands

---

---

---

18

---

---

---

---

---

---

---

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

†† Total number of HIV diagnoses reported to the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) through December 31, 2009.

§§ Totals reported to the Division of Influenza, National Center for Immunization and Respiratory Diseases (NCIRD), as of December 31, 2009.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2009

Area

Measles

Meningococcal disease

All serogroups

Serogroup A, C,
Y, and W-135

Serogroup
B

Other
serogroup

Unknown serogroup

Mumps

Total

Indigenous

Imported¶¶

United States

71

51

20

980

301

174

23

482

1,991

New England

2

1

1

35

19

6

4

6

27

Connecticut

---

---

---

7

4

1

---

2

1

Maine

---

---

---

4

2

---

2

---

6

Massachusetts

2

1

1

16

9

5

---

2

15

New Hampshire

---

---

---

3

1

---

---

2

---

Rhode Island

---

---

---

4

3

---

1

---

3

Vermont

---

---

---

1

---

---

1

---

2

Mid. Atlantic

34

29

5

110

25

32

---

53

1,668

New Jersey

2

2

---

19

---

---

---

19

200

New York (Upstate)

---

---

---

27

12

9

---

6

647

New York City

18

15

3

17

---

---

---

17

806

Pennsylvania

14

12

2

47

13

23

---

11

15

E.N. Central

1

1

---

169

54

43

2

70

75

Illinois

---

---

---

47

---

---

---

47

47

Indiana

---

---

---

34

17

15

2

---

2

Michigan

---

---

---

21

11

5

---

5

11

Ohio

1

1

---

43

14

13

---

16

6

Wisconsin

---

---

---

24

12

10

---

2

9

W.N. Central

8

8

---

90

19

11

2

58

53

Iowa

1

1

---

15

9

4

2

---

15

Kansas

---

---

---

14

---

---

---

14

7

Minnesota

1

1

---

16

7

6

---

3

7

Missouri

6

6

---

27

---

---

---

27

15

Nebraska

---

---

---

11

1

1

---

9

7

North Dakota

---

---

---

2

2

---

---

---

---

South Dakota

---

---

---

5

---

---

---

5

2

S. Atlantic

14

6

8

165

76

38

5

46

45

Delaware

---

---

---

2

---

---

---

2

1

District of Columbia

2

---

2

---

---

---

---

---

2

Florida

5

---

5

52

33

12

---

7

18

Georgia

1

1

---

31

19

6

2

4

---

Maryland

4

3

1

12

6

6

---

---

8

North Carolina

---

---

---

31

7

1

2

21

4

South Carolina

---

---

---

11

4

7

---

---

2

Virginia

1

1

---

18

4

2

---

12

9

West Virginia

1

1

---

8

3

4

1

---

1

E.S. Central

1

---

1

37

9

4

1

23

13

Alabama

---

---

---

12

4

4

1

3

6

Kentucky

---

---

---

6

---

---

---

6

1

Mississippi

---

---

---

4

1

---

---

3

1

Tennessee

1

---

1

15

4

---

---

11

5

W.S. Central

1

---

1

96

41

19

2

34

48

Arkansas

---

---

---

9

6

1

---

2

4

Louisiana

---

---

---

18

---

---

---

18

1

Oklahoma

---

---

---

16

6

7

2

1

3

Texas

1

---

1

53

29

11

---

13

40

Mountain

---

---

---

68

47

8

6

7

27

Arizona

---

---

---

15

9

1

4

1

10

Colorado

---

---

---

24

19

4

1

---

6

Idaho

---

---

---

7

4

---

---

3

3

Montana

---

---

---

5

4

1

---

---

---

Nevada

---

---

---

6

5

---

---

1

3

New Mexico

---

---

---

3

3

---

---

---

1

Utah

---

---

---

3

2

1

---

---

4

Wyoming

---

---

---

5

1

1

1

2

---

Pacific

10

6

4

210

11

13

1

185

35

Alaska

---

---

---

6

---

---

---

6

6

California

9

6

3

131

---

---

---

131

16

Hawaii

---

---

---

5

1

---

1

3

5

Oregon

---

---

---

43

---

---

---

43

2

Washington

1

---

1

25

10

13

---

2

6

Territories

American Samoa

---

---

---

---

---

---

---

---

---

C.N.M.I.

---

---

---

---

---

---

---

---

---

Guam

---

---

---

---

---

---

---

---

---

Puerto Rico

---

---

---

1

---

---

---

1

6

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, 2009

Novel influenza A virus infections***, †††

Poliomyelitis, paralytic

Q Fever

Rabies

Area

Pertussis

Plague

Psittacosis

Total

Acute

Chronic

Animal

Human

United States

43,696

16,858

8

1

9

113

93

20

5,343

4

New England

3,726

626

---

---

---

1

1

---

354

---

Connecticut

1,713

56

---

---

N

---

---

---

153

---

Maine

145

80

---

---

---

---

---

---

56

---

Massachusetts

1,370

358

---

---

---

1

1

---

---

---

New Hampshire

247

76

---

---

---

N

N

N

34

---

Rhode Island

192

45

---

---

---

---

---

---

45

---

Vermont

59

11

---

---

---

N

N

N

66

---

Mid. Atlantic

6,112

1,222

---

---

5

15

12

3

852

---

New Jersey

1,414

244

---

---

2

2

1

1

287

---

New York (Upstate)

1,424

265

---

---

---

2

---

2

436

---

New York City

1,314

98

---

---

---

1

1

---

29

---

Pennsylvania

1,960

615

---

---

3

10

10

---

100

---

E.N. Central

10,620

3,206

1

---

---

9

9

---

220

2

Illinois

3,404

648

1

---

---

---

---

---

82

---

Indiana

291

392

---

---

---

1

1

---

25

1

Michigan

515

900

---

---

---

1

1

---

66

1

Ohio

188

1,096

---

---

---

---

---

---

47

---

Wisconsin

6,222

170

---

---

---

7

7

---

N

---

W.N. Central

1,539

2,840

---

1

---

20

16

4

391

---

Iowa

167

235

---

---

---

N

N

N

35

---

Kansas

205

240

---

---

---

2

2

---

76

---

Minnesota

670

1,121

---

1

---

2

2

---

69

---

Missouri

76

1,015

---

---

---

3

3

---

65

---

Nebraska

313

141

---

---

---

4

2

2

77

---

North Dakota

63

30

---

---

---

---

---

---

16

---

South Dakota

45

58

---

---

---

9

7

2

53

---

S. Atlantic

5,626

1,632

---

---

1

7

6

1

2,103

1

Delaware

381

13

---

---

---

1

1

---

---

---

District of Columbia

45

7

---

---

---

1

1

---

---

---

Florida

2,915

497

---

---

---

1

1

---

161

---

Georgia

222

223

---

---

---

1

1

---

405

---

Maryland

766

148

---

---

---

---

---

---

384

---

North Carolina

483

220

---

---

---

1

1

---

468

---

South Carolina

244

262

---

---

1

---

---

---

---

---

Virginia

327

222

---

---

---

1

1

---

566

1

West Virginia

243

40

---

---

---

1

---

1

119

---

E.S. Central

1,155

803

---

---

---

3

1

2

138

---

Alabama

477

305

N

---

---

1

1

---

---

---

Kentucky

143

226

---

---

---

2

---

2

46

---

Mississippi

252

75

---

---

---

---

---

---

4

---

Tennessee

283

197

---

---

---

---

---

---

88

---

W.S. Central

5,703

3,993

---

---

---

17

10

7

925

1

Arkansas

131

369

---

---

---

2

2

---

47

---

Louisiana

232

149

---

---

---

---

---

---

---

---

Oklahoma

189

117

---

---

---

2

---

2

48

---

Texas

5,151

3,358

---

---

N

13

8

5

830

1

Mountain

3,176

1,019

7

---

---

18

15

3

108

---

Arizona

947

277

---

---

---

4

4

---

N

---

Colorado

171

231

---

---

---

9

7

2

---

---

Idaho

166

99

---

---

---

---

---

---

8

---

Montana

94

61

---

---

---

---

---

---

25

---

Nevada

467

24

---

---

---

1

1

---

6

---

New Mexico

232

85

6

---

---

4

3

1

26

---

Utah

988

220

1

---

---

---

---

---

13

---

Wyoming

111

22

---

---

---

---

---

---

30

---

Pacific

6,039

1,517

---

---

3

23

23

---

252

---

Alaska

272

59

---

---

---

1

1

---

15

---

California

3,161

869

---

---

3

20

20

---

226

---

Hawaii

1,424

46

---

---

---

1

1

---

---

---

Oregon

524

252

---

---

---

---

---

---

11

---

Washington

658

291

---

---

---

1

1

---

---

---

Territories

American Samoa

8

---

---

---

N

N

---

N

N

N

C.N.M.I.

---

---

---

---

---

---

---

---

---

---

Guam

1

2

---

---

---

N

---

N

---

---

Puerto Rico

20

1

---

---

N

---

---

---

41

---

U.S. Virgin Islands

49

---

---

---

---

---

---

---

---

---

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). After recognition of the first cases of infection with 2009 pandemic influenza A (H1N1) virus in April 2009, the Centers for Disease Control and Prevention (CDC) and state health departments initiated enhanced surveillance to identify additional cases. From April 15 to July 24, 2009, state and territorial health departments were requested to submit a daily line list of individual confirmed cases of 2009 pandemic influenza A (H1N1) virus infections directly to the Influenza Division at CDC. As of July 24, 2009, a total of 43,771 cases were reported from all 50 states, Washington DC, and four territories. This table reflects cases reported by this method.

††† In addition, three cases of human infection with novel influenza A viruses, different from the 2009 pandemic influenza A (H1N1) strain, were identified by state health departments and reported to CDC during 2009. These three cases, identified in Iowa [2] and Kansas, were isolated cases of human infections and one virus was identified as a swine influenza A (H1N1) virus, and the remaining two cases were swine-lineage influenza A (H3N2) viruses." This total case count includes both confirmed and probable case reports.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2009

Area

Rocky Mountain spotted fever§§§

Rubella

Rubella, congenital syndrome

Salmonellosis

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

Shigellosis

Total

Confirmed

Probable

United States

1,815

151

1,662

3

2

49,192

4,643

15,931

New England

14

2

12

1

---

2,174

292

346

Connecticut

---

---

---

---

---

430

67

43

Maine

5

---

5

---

---

121

19

5

Massachusetts

7

1

6

1

---

1,155

106

245

New Hampshire

1

---

1

---

---

261

37

21

Rhode Island

---

---

---

---

---

144

38

27

Vermont

1

1

---

---

---

63

25

5

Mid. Atlantic

110

13

97

---

1

5,514

435

2,800

New Jersey

63

2

61

---

1

1,132

106

587

New York (Upstate)

16

1

15

---

---

1,370

158

241

New York City

8

1

7

---

---

1,253

57

447

Pennsylvania

23

9

14

---

---

1,759

114

1,525

E.N. Central

90

9

81

---

---

5,169

717

2,514

Illinois

49

1

48

---

---

1,484

166

620

Indiana

13

3

10

---

---

629

96

80

Michigan

5

4

1

---

---

960

140

219

Ohio

18

---

18

---

---

1,407

133

1,096

Wisconsin

5

1

4

---

---

689

182

499

W.N. Central

276

20

256

1

---

2,679

751

1,439

Iowa

5

1

4

---

---

408

163

53

Kansas

1

1

---

---

---

398

54

214

Minnesota

5

3

2

1

---

575

219

79

Missouri

253

7

246

---

---

656

143

1,046

Nebraska

12

8

4

---

---

341

86

34

North Dakota

---

---

---

---

---

103

15

9

South Dakota

---

---

---

---

---

198

71

4

S. Atlantic

451

68

383

---

---

14,478

691

2,365

Delaware

19

---

19

---

---

142

13

151

District of Columbia

1

---

1

---

---

100

3

28

Florida

10

2

8

---

---

6,741

177

461

Georgia

52

52

---

---

---

2,362

71

661

Maryland

40

3

37

---

---

803

91

370

North Carolina

255

7

248

---

---

1,810

112

359

South Carolina

19

3

16

---

---

1,195

33

126

Virginia

53

1

52

---

---

1,095

156

198

West Virginia

2

---

2

---

---

230

35

11

E.S. Central

268

9

257

---

---

3,077

215

813

Alabama

68

3

65

---

---

932

47

156

Kentucky

1

1

---

---

---

453

73

226

Mississippi

9

---

9

---

---

899

6

52

Tennessee

190

5

183

---

---

793

89

379

W.S. Central

564

12

552

---

---

6,411

378

3,188

Arkansas

184

1

183

---

---

615

44

318

Louisiana

2

---

2

---

---

1,180

23

177

Oklahoma

342

9

333

---

---

652

64

398

Texas

36

2

34

---

---

3,964

247

2,295

Mountain

41

17

24

---

---

3,028

561

1,138

Arizona

23

11

12

---

---

1,086

68

806

Colorado

1

1

---

---

---

619

168

102

Idaho

1

---

1

---

---

174

92

8

Montana

10

4

6

---

---

110

35

11

Nevada

1

---

1

---

---

252

35

79

New Mexico

1

---

1

---

---

369

38

104

Utah

1

---

1

---

---

321

110

24

Wyoming

3

1

2

---

---

97

15

4

Pacific

1

1

---

1

1

6,662

603

1,328

Alaska

N

---

---

---

N

68

1

4

California

1

1

---

1

1

5,003

301

1,066

Hawaii

N

---

---

---

---

338

11

49

Oregon

---

---

---

---

---

433

84

56

Washington

---

---

---

---

---

820

206

153

Territories

American Samoa

N

---

---

---

---

---

---

3

C.N.M.I.

---

---

---

---

---

---

---

---

Guam

N

---

---

---

---

11

---

13

Puerto Rico

N

---

---

1

N

596

---

15

U.S. Virgin Islands

---

---

---

---

---

---

---

---

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

§§§ Total case count includes 2 unknown case status reports.

¶¶¶ Includes E. coli O157; Shiga toxin-positive, non-O157 STEC; and Shiga toxin positive, not serogrouped.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2009

Area

Streptococcal
disease, invasive,
group A

Streptococcal
toxic-shock
syndrome

Streptococcus pneumoniae, invasive disease

Syphilis

All
stages****

Congenital
(age <1 yr)

Primary and
secondary

Drug-resistant

Nondrug-resistant

All ages

Age <5 yrs

Age <5 yrs

United States

5,279

161

3,370

583

1,988

44,828

427

13,997

New England

316

29

158

22

96

769

3

341

Connecticut

89

22

100

18

20

179

2

65

Maine

21

N

23

2

7

15

---

4

Massachusetts

135

2

4

2

50

473

---

238

New Hampshire

38

2

---

---

11

37

---

14

Rhode Island

14

1

18

---

4

64

1

20

Vermont

19

2

13

---

4

1

---

---

Mid. Atlantic

1,026

32

207

42

306

6,540

26

1,735

New Jersey

163

3

---

---

70

890

7

212

New York (Upstate)

337

24

97

18

139

702

5

128

New York City

193

---

16

9

97

3,921

10

1,054

Pennsylvania

333

5

94

15

N

1,027

4

341

E.N. Central

942

57

690

101

324

3,834

28

1,542

Illinois

282

23

N

N

74

1,915

16

750

Indiana

167

23

251

33

49

324

1

158

Michigan

158

---

27

4

79

635

4

230

Ohio

209

11

412

64

78

794

7

360

Wisconsin

126

---

---

---

44

166

---

44

W.N. Central

414

9

366

79

115

1,010

11

308

Iowa

---

---

---

---

---

65

---

23

Kansas

39

---

52

18

N

151

3

32

Minnesota

189

7

227

53

45

217

1

71

Missouri

93

2

74

6

39

514

6

173

Nebraska

46

---

2

---

17

45

---

5

North Dakota

18

---

7

---

5

8

1

4

South Dakota

29

N

4

2

9

10

---

---

S. Atlantic

1,132

18

1,419

245

371

10,909

79

3,507

Delaware

11

---

18

3

---

87

1

27

District of Columbia

14

---

27

3

4

431

---

163

Florida

279

N

779

143

66

3,863

21

1,041

Georgia

238

---

460

87

98

2,717

14

953

Maryland

188

1

4

---

87

993

31

314

North Carolina

107

4

N

N

N

1,524

10

579

South Carolina

81

---

---

---

53

507

---

123

Virginia

173

1

N

N

47

755

2

299

West Virginia

41

12

131

9

16

32

---

8

E.S. Central

204

1

278

40

113

3,439

36

1,149

Alabama

N

N

N

N

N

1,138

13

417

Kentucky

40

1

78

8

N

239

2

92

Mississippi

N

N

55

12

16

745

8

237

Tennessee

164

---

145

20

97

1,317

13

403

W.S. Central

530

---

131

27

354

9,785

149

2,757

Arkansas

22

---

60

13

29

552

10

275

Louisiana

27

---

71

14

19

1,964

11

741

Oklahoma

155

N

N

N

61

296

2

97

Texas

326

N

N

N

245

6,973

126

1,644

Mountain

512

15

118

25

281

1,965

32

529

Arizona

161

---

---

---

128

1,084

28

231

Colorado

127

---

---

---

53

269

---

105

Idaho

10

---

N

N

9

31

1

3

Montana

N

N

---

---

N

5

---

4

Nevada

6

2

43

7

---

306

3

91

New Mexico

122

1

---

---

38

208

---

61

Utah

85

12

63

16

52

55

---

31

Wyoming

1

---

12

2

1

7

---

3

Pacific

203

---

3

2

28

6,577

63

2,129

Alaska

38

---

---

---

20

4

---

---

California

N

N

N

N

N

6,031

61

1,900

Hawaii

165

---

3

2

8

88

1

33

Oregon

N

N

N

N

N

132

---

57

Washington

N

N

N

N

N

322

1

139

Territories

American Samoa

---

N

---

---

---

---

---

---

C.N.M.I.

---

---

---

---

---

---

---

---

Guam

---

---

---

---

---

12

---

2

Puerto Rico

N

N

---

---

N

724

5

227

U.S. Virgin Islands

---

---

---

---

---

2

---

---

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, 2009

Area

Tetanus

Toxic-shock syndrome

Trichinellosis

Tuberculosis††††

Tularemia

Typhoid fever

United States

18

74

13

11,545

93

397

New England

---

1

---

394

6

17

Connecticut

---

N

---

95

1

5

Maine

---

N

---

9

---

---

Massachusetts

---

---

---

243

4

10

New Hampshire

---

---

---

16

---

1

Rhode Island

---

1

---

24

---

1

Vermont

---

---

---

7

1

---

Mid. Atlantic

2

12

1

1,647

4

110

New Jersey

---

3

---

405

2

35

New York (Upstate)

---

2

---

246

---

10

New York City

---

3

1

760

1

53

Pennsylvania

2

4

---

236

1

12

E.N. Central

4

11

1

928

5

47

Illinois

---

1

---

418

3

15

Indiana

2

1

---

119

1

1

Michigan

---

6

1

144

---

11

Ohio

2

2

---

180

1

12

Wisconsin

---

1

---

67

---

8

W.N. Central

3

11

---

402

29

14

Iowa

---

2

---

42

1

---

Kansas

---

1

---

64

4

---

Minnesota

---

1

---

161

1

5

Missouri

2

4

---

80

13

7

Nebraska

1

3

---

32

5

---

North Dakota

---

---

---

5

---

---

South Dakota

---

---

---

18

5

2

S. Atlantic

---

6

---

2,221

3

67

Delaware

---

---

---

19

---

2

District of Columbia

---

---

---

41

---

2

Florida

---

N

---

821

1

19

Georgia

---

6

N

415

---

11

Maryland

---

N

---

218

1

16

North Carolina

---

---

---

251

1

5

South Carolina

---

---

---

164

---

---

Virginia

---

---

---

273

---

12

West Virginia

---

---

---

19

---

---

E.S. Central

1

6

---

569

5

4

Alabama

1

---

---

168

---

---

Kentucky

---

1

N

77

1

---

Mississippi

---

N

---

122

---

1

Tennessee

---

5

---

202

4

3

W.S. Central

1

3

---

1,879

24

25

Arkansas

---

3

N

82

17

---

Louisiana

---

---

---

194

---

---

Oklahoma

---

N

---

102

7

2

Texas

1

N

---

1,501

---

23

Mountain

2

3

2

536

8

12

Arizona

---

1

---

232

---

2

Colorado

---

1

2

85

3

6

Idaho

---

---

---

18

---

1

Montana

---

N

---

8

2

---

Nevada

1

1

---

106

---

3

New Mexico

---

---

---

48

1

---

Utah

1

---

---

37

---

---

Wyoming

---

---

---

2

2

---

Pacific

5

21

9

2,969

9

101

Alaska

---

N

1

37

2

1

California

5

21

8

2,470

1

90

Hawaii

---

N

---

117

---

5

Oregon

---

N

---

89

1

1

Washington

---

N

---

256

5

4

Territories

American Samoa

---

N

N

4

---

1

C.N.M.I.

---

---

---

32

---

---

Guam

---

---

---

102

---

---

Puerto Rico

2

N

N

63

---

---

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 Tuberculosis Elimination, NCHHSTP, as of May 14, 2010.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area --- United States, 2009

Area

Vancomycin-intermediate
Staphylococcus aureus

Vancomycin-resistant
Staphylococcus aureus

Varicella

Vibriosis

Morbidity

Mortality§§§§

United States

78

1

20,480

2

789

New England

8

---

1,096

---

41

Connecticut

2

---

486

---

27

Maine

---

---

235

---

4

Massachusetts

6

---

4

---

---

New Hampshire

N

---

202

---

6

Rhode Island

---

---

57

---

2

Vermont

---

---

112

---

2

Mid. Atlantic

30

---

2,052

---

52

New Jersey

1

---

470

---

32

New York (Upstate)

11

---

N

N

N

New York City

16

---

---

---

20

Pennsylvania

2

---

1,582

---

N

E.N. Central

12

1

6,415

1

30

Illinois

---

---

1,582

---

13

Indiana

N

---

457

1

3

Michigan

4

1

1,888

---

2

Ohio

5

---

1,911

N

6

Wisconsin

3

---

577

---

6

W.N. Central

11

---

1,272

---

9

Iowa

---

---

N

N