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Summary of Notifiable Diseases — United States, 2011

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


Deborah A. Adams, Coordinator, Summary of Notifiable Diseases

Kathleen M. Gallagher, DSc

Ruth Ann Jajosky, DMD

Jeffrey Kriseman, PhD

Pearl Sharp

Willie J. Anderson

Aaron E. Aranas, MPH

Michelle Mayes

Michael S. Wodajo

Diana H. Onweh

John P. Abellera, MPH

Division of Notifiable Diseases and Healthcare Information, Office of Surveillance, Epidemiology, and Laboratory Services, CDC


Preface

The Summary of Notifiable Diseases — United States, 2011 contains the official statistics, in tabular and graphic form, for the reported occurrence of nationally notifiable infectious diseases in the United States for 2011. Unless otherwise noted, the data are final totals for 2011 reported as of June 30, 2012. 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/mmwr_nd/index.html. This site also includes Summary publications from previous years.

The Highlights section presents noteworthy epidemiologic and prevention information for 2011 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 2011.* The tables provide the number of cases reported to CDC for 2011 and the distribution of cases by month, geographic location, and patients' demographic characteristics (e.g., 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 1980. This section also includes a table enumerating deaths associated with specified notifiable diseases reported to CDC's National Center for Health Statistics (NCHS) during 2003–2009. 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 at NNDSSweb@cdc.gov.

* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute respiratory syndrome–associated coronavirus disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and non-neuroinvasive; yellow fever; and viral hemorrhagic fevers were reported in 2011. Data on hepatitis B virus, perinatal infection, and chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review.

Background

The infectious diseases designated as notifiable at the national level during 2011 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://wwwn.cdc.gov/nndss/script/history.aspx. 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://wwwn.cdc.gov/nndss/script/casedefDefault.aspx.

Infectious Diseases Designated as Notifiable at the National Level During 2011*

Anthrax

Arboviral diseases, neuroinvasive and nonneuroinvasive

California serogroup viruses

Eastern equine encephalitis virus

Powassan virus

St. Louis encephalitis virus

West Nile virus

Western equine encephalitis virus

Babesiosis

Botulism

foodborne

infant

other (wound and unspecified)

Brucellosis

Chancroid

Chlamydia trachomatis infection

Cholera

Coccidioidomycosis

Cryptosporidiosis

Cyclosporiasis

Dengue virus infections

Dengue Fever

Dengue Hemorrhagic Fever

Dengue Shock Syndrome

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

Hepatitis A, acute

Hepatitis B, acute

Hepatitis B virus, perinatal infection

Hepatitis B, chronic

Hepatitis C, acute

Hepatitis C, past or present

Human Immunodeficiency Virus (HIV) infection 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

Rubella

Rubella, congenital syndrome

Salmonellosis

Severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease

Shiga toxin-producing Escherichia coli (STEC)

Shigellosis

Smallpox

Spotted fever rickettsiosis

Streptococcal toxic-shock syndrome

Streptococcus Pneumoniae, invasive disease

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

Viral Hemorrhagic Fever

Crimean-Congo Hemorrhagic fever virus

Ebola virus

Lassa virus

Lujo virus

Marburg virus

New World Arenaviruses (Guanarito, Machupo, Junin, and Sabia viruses)

Yellow fever

* This list reflects position statements approved in 2010 by the Council of State and Territorial Epidemiologists (CSTE) for national surveillance, which were implemented in January 2011. The following changes were made to the 2011 list of nationally notifiable infectious diseases to create the 2011 list: 1) babesiosis and coccidioidomycosis were added to the list, and 2) Lujo virus was included in the category of viral hemorrhagic fever.

2011 reflects a modified surveillance case definition for this condition, per approved 2010 CSTE position statements.

§ AIDS has been reclassified as HIV stage III.

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 differ from 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 8, 2011, through the week ending December 31, 2011. More information regarding infectious notifiable diseases, including case definitions, is available at http://wwwn.cdc.gov/nndss/default.aspx. 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 2011 NNDSS event code list (Exhibit).

The print criteria for NNDSS is as follows: for a case report of a nationally notifiable disease to print in the MMWR, the reporting state or territory must have designated the disease reportable in their state or territory for the year corresponding to the year of report to CDC. After the criterion is met, the disease-specific criteria listed in the Exhibit are applied. When the above-listed table 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. Because CSTE position statements are not customarily finalized until July of each year, the NNDSS data for the newly added conditions are not usually available from all reporting jurisdictions until January of the year following the approval of the CSTE position statement.

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
National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
Division of HIV/AIDS Prevention (AIDS and HIV infection), Division of Viral Hepatitis, 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, initial detections of novel influenza A virus infections)
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)

NCHS postcensal estimates of the resident population of the United States for July 1, 2010–July 1, 2011, by year, county, single-year of age (range: 0 to ≥85 years), bridged-race, (white, black or African American, American Indian or Alaska Native, Asian or Pacific Islander), Hispanic origin (not Hispanic or Latino, Hispanic or Latino), and sex (Vintage 2010), prepared under a collaborative arrangement with the U.S. Census Bureau. Available at http://www.cdc.gov/nchs/nvss/bridged_race/data_documentation.htm#vintage2010 as of May 31, 2012.

Population estimates for territories are 2010 estimates from the U.S. Census Bureau. 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 reportable 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 jurisdiction of the person's "usual residence" at the time of disease onset (http://wwwn.cdc.gov/nndss/document/03-ID-10_residency_rules.pdf). 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 numbers. 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 actual 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 caused by the transition from NETSS to the National Electronic Disease Surveillance System (NEDSS), which 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 as 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 currently adopted by 18 states and the District of Columbia. A total of 28 states and New York City have a state- or vendor-developed NEDSS-compatible system.The remaining nine jurisdictions, four states and five territories, are either in the process of adopting or changing their NEDSS-compatible system or use a non-NEDSS-compatible system at the time of this publication. 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 2011, a total of 18 states and the District of Columbia used NBS to transmit nationally notifiable infectious diseases to CDC, a total of 32 states and New York City used a NEDSS-compatible based system, and the remaining state and territorial jurisdictions continued to use a non-NEDSS–compatible system. Additional information concerning NEDSS is available at http://wwwn.cdc.gov/nndss/script/nedss.aspx.

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 asking reporting jurisdictions to update previously analyzed results of the 2010 CSTE State Reportable Conditions Assessment (SRCA) individually, because the 2011 SRCA results were not available at the time this report was prepared. The 2010 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 >6 months in 2010 by clinicians, laboratories, hospitals, or "other" public health reporters, as mandated by law or regulation. To assist in the implementation of SRCA, staff from the NNDSS program provided technical assistance to CSTE for the 2010 SRCA.

In 2007, SRCA was established and 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 2010 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 in at least one public health reporter category for a specific nationally notifiable infectious disease (NNID) in a reporting jurisdiction, CDC developed and applied an algorithm to analyze the data collected in SRCA. Analyzed results of the 2010 SRCA were used to determine whether a NNID was not reportable in a reporting jurisdiction in 2010 and thus noted with an "N" indicator (for "not reportable") in the front tables of this report. Unanalyzed results from the 2007, 2008, 2009, and 2010 SRCA are available using CSTE's web query tool at http://www.cste.org/group/SRCAQueryRes. Additional background information has been published previously (2).

Revised International Health Regulations

In May 2005, the World Health Assembly adopted revised International Health regulations (IHR) (3) 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. All WHO member states are required to notify WHO of a potential PHEIC. WHO makes the final determination about the existence of a PHEIC.

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 PHEIC.

The revised IHR reflects 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. A PHEIC ia an event that falls 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 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.

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 (4). 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.cdc.gov/globalhealth/ihregulations.htm, and http://c.ymcdn.com/sites/www.cste.org/resource/resmgr/PS/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 (4). 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 (5).

  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. Jajosky R, Rey A, Park M, et al. Findings from the Council of State and Territorial Epidemiologists' 2008 assessment of state reportable and nationally notifiable conditions in the United States and considerations for the future. Public Health Manag Pract 2011;17:255–64.
  3. World Health Organization. Third report of Committee A. Annex 2. Geneva, Switzerland: World Health Organization; 2005. Available at http://whqlibdoc.who.int/publications/2008/9789241580410_eng.pdf.
  4. 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://c.ymcdn.com/sites/www.cste.org/resource/resmgr/PS/07-ID-06.pdf.
  5. Council of State and Territorial Epidemiologists. Council of State and Territorial Epidemiologists position statement; 2007. National reporting for initial detections of novel influenza A viruses. Available at http://c.ymcdn.com/sites/www.cste.org/resource/resmgr/PS/07-ID-01.pdf.

EXHIBIT. Print criteria for conditions reported to the National Notifiable Diseases Surveillance System, 2011

Code

Notifiable Condition

Print Criteria*,†

11090

Anaplasma phagocytophilum

Confirmed and probable; unknown from California (CA)

10350

Anthrax

Confirmed and probable; unknown reported from CA

12010

Babesiosis

Confirmed and probable; unknown reported from CA

10530

Botulism, foodborne

Confirmed; unknown from CA

10540

Botulism, infant

Confirmed; unknown from CA

10550

Botulism, other (includes wound)

Confirmed; unknown from CA

10548

Botulism, other (unspecified)

Confirmed; unknown from CA

10549

Botulism, wound

Confirmed; unknown from CA

10020

Brucellosis

Confirmed and probable; unknown from CA

10054

California serogroup viruses, neuroinvasive disease

Data for publication received from ArboNET

10061

California serogroup viruses, nonneuroinvasive disease

Data for publication received from ArboNET

10273

Chancroid

All reports printed

10274

Chlamydia trachomatis infection

All reports printed

10470

Cholera (toxigenic Vibrio cholerae O1 or O139)

Confirmed; unknown from CA verified as confirmed

11900

Coccidioidomycosis

Confirmed and unknown from CA

11580

Cryptosporidiosis

Confirmed and probable; unknown from CA

11575

Cyclosporiasis

Confirmed and probable; unknown from CA

10680

Dengue fever (DF)

Data for publication received from ArboNET

10685

Dengue hemorrhagic fever (DHF)

Data for publication received from ArboNET

10040

Diphtheria

Confirmed, probable, and unknown case status printed

10053

Eastern equine encephalitis virus, neuroinvasive disease

Data for publication received from ArboNET

10062

Eastern equine encephalitis virus, nonneuroinvasive disease

Data for publication received from ArboNET

11088

Ehrlichia chaffeensis

Confirmed and probable; unknown from CA

11089

Ehrlichia ewingii

Confirmed and probable; unknown from CA

11091

Ehrlichiosis/Anaplasmosis, undetermined

Confirmed and probable; unknown from CA

11570

Giardiasis

Confirmed and probable; unknown from CA

10280

Gonorrhea

All reports printed

10590

Haemophilus influenzae, invasive disease

Cases with confirmed, probable, and unknown case status printed

10380

Hansen disease (Leprosy)

Confirmed; unknown from CA

11590

Hantavirus pulmonary syndrome

Confirmed and unknown from CA

11550

Hemolytic uremic syndrome postdiarrheal

Confirmed, probable, and unknown from CA

10110

Hepatitis A, acute

Confirmed; unknown from CA

10100

Hepatitis B, acute

Confirmed; unknown from CA

10101

Hepatitis C, acute

Confirmed; unknown from CA

11061

Influenza-associated pediatric mortality

Cases with confirmed case status printed

10490

Legionellosis

Confirmed; unknown from CA

10640

Listeriosis

Confirmed; unknown from CA

11080

Lyme disease

Confirmed and probable; unknown from CA

10130

Malaria

Confirmed; unknown from CA

10140

Measles (rubeola), total

Cases with confirmed and unknown case status printed

10150

Meningococcal disease (Neisseria meningitidis)

Confirmed and probable; unknown from CA

10180

Mumps

Cases with confirmed, probable, and unknown case status printed

10317

Neurosyphilis

All reports printed


EXHIBIT. (Continued) Print criteria for conditions reported to the National Notifiable Diseases Surveillance System, 2011

Code

Notifiable Condition

Print Criteria*,†

11062

Novel influenza A virus infections, initial detections of

Cases with confirmed status and cases reported from CA with unknown status, verified to be confirmed, printed

10190

Pertussis

Cases with confirmed, probable, and unknown case status printed

10440

Plague

All reports printed

10410

Poliomyelitis, paralytic

Confirmed; unknown from CA that are verified as confirmed

10405

Poliovirus infection, nonparalytic

Confirmed; unknown from CA that are verified as confirmed

10057

Powassan virus, neuroinvasive disease

Data for publication received from ArboNET

10063

Powassan virus, nonneuroinvasive disease

Data for publication received from ArboNET

10450

Psittacosis (Ornithosis)

Confirmed and probable; unknown from CA

10257

Q fever, acute

Confirmed and probable; unknown from CA

10258

Q fever, chronic

Confirmed and probable; unknown from CA

10340

Rabies, animal

Confirmed and unknown from CA

10460

Rabies, human

Confirmed; unknown from CA verified as confirmed

10200

Rubella

Cases with confirmed and unknown case status printed

10370

Rubella, congenital syndrome

CSTE VPD print criteria used

Cases with confirmed, probable, and unknown case status printed

11000

Salmonellosis

Confirmed and probable; unknown from CA

10575

Severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease

Confirmed and probable

11563

Shiga toxin-producing Escherichia coli (STEC)

All reports printed

11010

Shigellosis

Confirmed and probable; unknown from CA

11800

Smallpox

Cases with confirmed and probable case status printed

10250

Spotted Fever Rickettsiosis

Confirmed, probable, and unknown

10051

St. Louis encephalitis virus, neuroinvasive disease

Data for publication received from ArboNET

10064

St. Louis encephalitis virus, nonneuroinvasive disease

Data for publication received from ArboNET

11700

Streptococcal toxic-shock syndrome

Confirmed and probable; unknown from CA

11723

Streptococcus pneumoniae, invasive disease (IPD) (all ages)

Confirmed; unknown from CA

10316

Syphilis, congenital

All reports printed

10313

Syphilis, early latent

All reports printed

10314

Syphilis, late latent

All reports printed

10318

Syphilis, late with clinical manifestations other than neurosyphilis

All reports printed

10311

Syphilis, primary

All reports printed

10312

Syphilis, secondary

All reports printed

10310

Syphilis, total primary and secondary

All reports printed

10315

Syphilis, unknown latent

All reports printed

10210

Tetanus

All reports printed

10520

Toxic-shock syndrome (staphylococcal)

Confirmed and probable; unknown from CA

10270

Trichinellosis

Confirmed; unknown from CA

10220

Tuberculosis

Print criteria determined by the CDC Tuberculosis program

10230

Tularemia

Confirmed and probable; unknown from CA

10240

Typhoid fever (caused by Salmonella typhi)

Confirmed and probable; unknown from CA

11663

Vancomycin-intermediate Staphylococcus aureus (VISA)

Confirmed; unknown from CA verified as confirmed

11665

Vancomycin-resistant Staphylococcus aureus (VRSA)

Confirmed; unknown from CA verified as confirmed

10030

Varicella (Chickenpox)

Cases with confirmed, probable, and unknown case status from CA printed


EXHIBIT. (Continued) Print criteria for conditions reported to the National Notifiable Diseases Surveillance System, 2011

Code

Notifiable Condition

Print Criteria*,†

11545

Vibriosis (non-cholera Vibrio species infections)

Confirmed, probable, and unknown from CA

11647

Viral hemorrhagic fever

Confirmed; footnote to denote the specific virus reported to CDC

10056

West Nile virus, neuroinvasive disease

Data for publication received from ArboNET

10049

West Nile virus, nonneuroinvasive disease

Data for publication received from ArboNET

10052

Western equine encephalitis virus, neuroinvasive disease

Data for publication received from ArboNET

10065

Western equine encephalitis virus, nonneuroinvasive disease

Data for publication received from ArboNET

10660

Yellow fever

Data for publication received from ArboNET

Abbreviations: ArboNET = Software for Arboviral Surveillance and Case Management; CDC = Centers for Disease Control and Prevention; CSTE = Council of State and Territorial Epidemiologists; VPD = Vaccine Preventable Disease.

* 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. In both situations, cases are verified to meet the case classification (e.g., confirmed, probable, and suspected) specified in the print criteria.

Print criteria for the National Notifiable Diseases Surveillance System (NNDSS): for a case report of a nationally notifiable disease to print in the MMWR, the reporting state or territory must have designated the disease reportable in their state or territory for the year corresponding to the year of report to CDC. After this criterion is met, the disease-specific criteria listed in the Exhibit are applied. When the above-listed table 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. Because CSTE position statements customarily are not finalized until July of each year, the NNDSS data for the newly added conditions usually are not available from all reporting jurisdictions until January of the year following the approval of the CSTE position statement.


Highlights for 2011

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 2011, public health authorities in Minnesota reported a confirmed case of naturally occurring inhalation anthrax was reported by Minnesota, in a Florida resident who became ill while vacationing in Minnesota and four other northern midwestern states. The patient was hospitalized and was discharged home after appropriate treatment (1). The incident resulted in a joint investigation involving law enforcement officials, state public and animal health agencies, the National Animal Health Laboratory Network, Laboratory Response Network, CDC, and other federal agencies. The investigation revealed that during the 3 weeks of travel before disease onset the patient collected rocks and handled antlers and other animal items, and had been exposed to dust clouds while driving through areas inhabited by herds of animals. No Bacillus anthracis was detected through testing of associated animal products or environmental samples, and public health officials were unable to identify the source of the exposure. Enhanced surveillance was performed in states where the person had traveled, and no other humans or animals infected with the case strain were identified; this case is considered an isolated naturally occurring case. The incidence of anthrax in the United States and U.S. territories remains low, with two or fewer naturally occurring cases reported per year for the past 30 years.

  1. Minnesota Department of Health. Health officials investigate case of inhalational anthrax from suspected natural environmental exposure. Available at http://www.health.state.mn.us/news/pressrel/2011/anthrax080911.html.

Domestic Arboviral, Neuroinvasive and Nonneuroinvasive

During 2011, West Nile virus (WNV) disease cases were reported from 43 states and the District of Columbia. The reported incidence of neuroinvasive disease was 0.16 cases per 100,000 population. Despite the decline in neuroinvasive disease incidence compared with previous years, the overall morbidity caused by WNV continues to be substantial. Based on previous studies, for every reported case of neuroinvasive disease, approximately 140–350 human WNV infections occur, with approximately 80% of infected persons remaining asymptomatic and 20% developing nonneuroinvasive disease (1–3). Using the 486 reported neuroinvasive disease cases, an estimated 13,600–34,000 cases of nonneuroinvasive disease might have occurred in 2011. However, only 226 nonneuroinvasive disease cases were diagnosed and reported; 1%–2% of the cases estimated to have occurred. Evidence of WNV human disease was detected in all geographic regions of the United States. The states with the highest incidence of neuroinvasive disease were the District of Columbia (1.62 per 100,000 population), Mississippi (1.04), Nebraska (0.76), and Arizona (0.76). Among the neuroinvasive disease cases, 250 (51%) cases were reported from five states: California (110 cases), Arizona (49), Michigan (32), Mississippi (31), and New York (28). California reported 23% of all WNV neuroinvasive disease cases in 2011 (4).

Among the other domestic arboviral diseases in the United States, La Crosse virus remained the most common cause of neuroinvasive disease in children. Eastern equine encephalitis virus disease, although rare, remained the most severe arboviral disease, resulting in three deaths among four patients. More Powassan virus disease cases were reported in 2011 than in any previous year, and included the first case ever reported from Pennsylvania. Wisconsin reported its first Eastern equine encephalitis disease case since 1984.

  1. Mostashari F, Bunning ML, Kitsutani PT, et al. Epidemic West Nile encephalitis, New York, 1999: results of a household-based seroepidemiological survey. Lancet 2001;358:261–4.
  2. Busch MP, Wright DJ, Custer B, et al. West Nile virus infections projected from blood donor screening data, United States, 2003. Emerg Infect Dis 2006;12:395–402.
  3. Carson PJ, Borchardt SM, Custer B, et al. Neuroinvasive disease and West Nile virus infection, North Dakota, USA, 1999–2008. Emerg Infect Dis 2012;18:684–6.
  4. CDC. West Nile virus disease and other arboviral diseases—United States, 2011. MMWR 2012;61:510–4.

Babesiosis

Babesiosis, a tickborne parasitic disease, became a nationally notifiable condition in 2011. Babesiosis is caused by protozoan parasites of the genus Babesia that infect red blood cells. Babesia infection can range from asymptomatic to life threatening. Clinical manifestations can include fever, chills, other nonspecific influenza-like symptoms, and hemolytic anemia. Babesia parasites usually are tickborne, but they also are transmissible via blood transfusion or congenitally (1). In recent years, reports of tickborne and transfusion-associated cases have increased in number and geographic distribution (1).

In 2011, public health authorities in seven states (Connecticut, Massachusetts, Minnesota, New Jersey, New York, Rhode Island, and Wisconsin) reported the majority (97%) of babesiosis cases, with 1,092 of 1,128 cases. The median age of patients was 62 years (range: age <1–98 years); 62% (n = 700) were male, 34% (n = 386) were female, and the sex was unknown for 4% (n = 42) of patients. Among the patients for whom data were available, 82% (717 of 879) had symptom onset dates during June–August (2).

  1. Herwaldt BL, Linden JV, Bosserman E, et al. Transfusion-associated babesiosis in the United States: a description of cases. Ann Intern Med 2011;155:509–19.
  2. CDC. Babesiosis surveillance—18 states, 2011. MMWR 2012;61:505–9.

Botulism

Botulism is a severe paralytic illness caused by toxins produced by Clostridium botulinum. Exposure to the toxin can occur by ingestion (foodborne botulism), by in situ production from C. botulinum colonization of a wound (wound botulism) or the gastrointestinal tract (infant botulism and adult intestinal colonization botulism), or overdose of botulinum toxin used for cosmetic or therapeutic purposes (1). Infant botulism continues to be the most frequently observed transmission category. During 2011, eight persons located in a prison acquired foodborne botulism after consuming pruno, an illicitly brewed alcoholic beverage.

All states maintain 24-hour telephone services for reporting of botulism and other public health emergencies. Health-care providers should report suspected botulism cases immediately to their state health departments. CDC maintains intensive surveillance for cases of botulism in the United States and provides consultation to clinicians and antitoxin for suspected cases. State health departments can reach the CDC botulism duty officer on call 24 hours a day, 7 days a week, via the CDC Emergency Operations Center (telephone: 770-488-7100).

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

Brucellosis

Brucellosis is an infectious disease that can be acquired by persons who come into contact with infected animals or animal products contaminated with the bacteria. The number of brucellosis cases reported in 2011 decreased by 31%, from 115 cases in 2010 to 79 cases in 2011. The five states (California, Florida, Georgia, Illinois, and Texas) reported 45 cases, accounting for approximately 57% of all cases. No cases were reported from any U.S. territories.

In 2011, the U.S. Department of Health and Human Services approved a revised brucellosis case report form. Health departments and providers are strongly encouraged to use the approved form to report brucellosis cases to CDC's Bacterial Special Pathogens Branch. This mechanism will ensure collection of standardized data needed to assess risk factors and trends associated with brucellosis better so that targeted preventive strategies can be implemented. A fillable PDF version of the form is available at http://www.cdc.gov/nczved/divisions/dfbmd/diseases/brucellosis/case-report-form.pdf. The form also can be requested via e-mail (bspb@cdc.gov) or by telephone (404-639-1711). Patient identifiers such as full name, address, phone number, hospital name, and chart number should not be included in forms sent to CDC. Instructions for completion and submission of the form are included in pages 1 and 2 of the form.

Chlamydia

In 2011, approximately 1.4 million cases of Chlamydia trachomatis infections were reported, the largest number of cases ever reported to CDC for any condition (1). This case count corresponds to a rate of 457.6 cases per 100,000 population, an increase of 8% compared with the rate in 2010. Rates of reported chlamydial infections among women have been increasing annually since the late 1980s, when public programs for screening and treatment of women were established to avert pelvic inflammatory disease and related complications. The continued increase in chlamydia case reports in 2011 likely represents a continued increase in screening for this usually asymptomatic infection, expanded use of more sensitive tests, and more complete national reporting; however, it also might reflect an increase in morbidity.

  1. CDC. Sexually transmitted disease surveillance 2011. Atlanta, GA: US Department of Health and Human Services; 2012.

Cholera

Cholera continues to be rare in the United States and is acquired most often during travel in countries where toxigenic Vibrio cholerae O1 or O139 is circulating (1). Since epidemic cholera emerged in Haiti in October 2010, cases have continued to be reported in the United States among travelers who have arrived recently from Hispaniola. Of the 42 cholera infections reported in the United States in 2011, a total of 39 were travel associated; 22 patients had arrived recently from Haiti, 11 from the Dominican Republic, and six from other cholera-affected countries. Until the cholera epidemic in Hispaniola wanes, associated cases are expected to continue to occur in the United States (2). Cholera remains a global threat to health, particularly in areas with poor access to improved water and sanitation, such as Haiti and sub-Saharan Africa (3,4).

  1. Steinberg EB, Greene KD, Bopp CA, et al. Cholera in the United States, 1995–2000: trends at the end of the Twentieth Century. J Infect Dis 2001;184:799–802.
  2. Newton AE, Heiman KE, Schmitz A, et al. Cholera in United States associated with epidemic in Hispaniola. Emerg Infect Dis 2011;17:2166–8.
  3. Tappero J, Tauxe RV. Lessons learned during public health response to cholera epidemic in Haiti and the Dominican Republic. Emerg Infect Dis 2011;17:2087–93.
  4. Mintz ED, Guerrant RL. A lion in our village—the unconscionable tragedy of cholera in Africa. New Engl J Med 2009;360:1061–3.

Coccidioidomycosis

Coccidioidomycosis is a fungal infection caused by inhalation of airborne Coccidioides spp. spores that are present in the arid soil of the southwestern United States, California, and parts of Central and South America. The incidence of coccidioidomycosis increased in 2011, for the second consecutive year in California, Arizona, and other states. Coccidioidomycosis was not a nationally notifiable condition during 2010, although many states reported cases. In 2011, coccidioidomycosis incidence increased among all age groups, although rates remain highest among persons aged ≥60 years. Since 2009, the majority of cases have occurred among women in Arizona, whereas the majority of cases have occurred among men elsewhere in the United States. The 16,467 cases reported from Arizona and 5,697 cases from California during 2011 represent a 61% and 129% increase, respectively, compared with 2009. Coccidioidomycosis is currently the second most commonly reported condition in Arizona, and the fourth in California.

The morbidity of this disease in Arizona is considerable (1). Enhanced surveillance conducted during 2007–2008 demonstrated a self-reported median duration of illness of 42 days among persons who had recovered at the time of the interview and 157 days among those who had not; a total of 200 (41%) patients were hospitalized for coccidioidomycosis; a total of 67 (74%) employed persons and 37 (59%) students were unable to attend work or school (1).

Whether the recent increase is related to changes in surveillance methodology is not known. In 2009, one of the major commercial laboratories in Arizona changed its 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 (2). The majority of laboratories in endemic areas perform testing using an enzyme immunoassay, the specificity of which is controversial (3).

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 areas in which the disease is endemic.

  1. Tsang CA, Anderson SM, Imholte SB, et al. Enhanced surveillance of coccidioidomycosis, Arizona, USA, 2007–2008. Emerg Infect Dis 2010;11:1738–44.
  2. 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://c.ymcdn.com/sites/www.cste.org/resource/resmgr/PS/07-ID-13.pdf.
  3. Kuberski T, Herrig J, Pappagianis D. False-positive IgM serology in coccidioidomycosis. J Clin Microbiol 2010;48:2047–9.

Cryptosporidiosis

Cryptosporidiosis is a nationally notifiable gastrointestinal illness caused by chlorine-tolerant protozoa of the genus Cryptosporidium. Cryptosporidium is transmitted by the fecal-oral route with the ingestion of Cryptosporidium oocysts through the consumption of fecally contaminated food or water or through direct person-to-person or animal-to-person contact.

Although cryptosporidiosis affects persons in all age groups, cases are reported most frequently in children (1). A substantial increase in transmission of Cryptosporidium in children occurs during summer through early fall, coinciding with increased use of recreational water, which is a known risk factor for cryptosporidiosis. Cryptosporidium has emerged as the leading cause of reported recreational water-associated outbreaks (2). 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 (3), the low infectious dose (4), and the extreme tolerance of Cryptosporidium oocysts to chlorine (5).

To reduce the number of cryptosporidiosis cases associated with recreational water, enhanced public health prevention measures are needed. In the United States, pool codes are reviewed and approved by state or local public health officials; no federal agency regulates the design, construction, and operation of treated recreational water venues. This lack of uniform national standards has been identified as a barrier to the prevention and control of outbreaks associated with treated recreational water. To provide support to state and local health departments, CDC is sponsoring development of the Model Aquatic Health Code (MAHC) (http://www.cdc.gov/mahc). MAHC is a collaborative effort between local, state, and federal public health agencies and the aquatics sector to develop a data-driven, knowledge-based resource for state and local jurisdictions reviewing and updating their existing pool codes to optimally prevent and control recreational water-associated illness, including cryptosporidiosis.

  1. CDC. Cryptosporidiosis surveillance—United States, 2009–2010. MMWR 2012;61(No. SS-5):1–12.
  2. CDC. Surveillance for waterborne disease outbreaks and other health events associated with recreational water—United States, 2007–2008. MMWR 2011;60(No. SS-12):1–32.
  3. Chappell CL, Okhuysen PC, Sterling CR, DuPont HL. Cryptosporidium parvum: intensity of infection and oocyst excretion patterns in healthy volunteers. J Infect Dis 1996;173:232–6.
  4. Chappell CL, Okhuysen PC, Langer-Curry R, et al. Cryptosporidium hominis: experimental challenge of healthy adults. Am J Trop Med Hyg 2006;75:851–7.
  5. Shields JM, Hill VR, Arrowood MJ, Beach MJ. Inactivation of Cryptosporidium parvum under chlorinated recreational water conditions. J Water Health 2008;6:513–20.

Dengue

With more than one third of the world's population living in areas at risk for transmission, dengue infection is a leading cause of illness and death in the tropics and subtropics. As many as 100 million persons are infected yearly. Dengue is caused by any one of four related viruses transmitted by mosquitoes.

Dengue in the United States occurs among persons living in subtropical and tropical areas where the disease is endemic, among U.S. travelers returning from endemic areas worldwide, and occasionally among persons living in U.S. areas that are not endemic for dengue but that are experiencing an outbreak. In 2011, a total of 1,541 dengue cases were reported to the national arbovirus surveillance network (ArboNET) from the Commonwealth of Puerto Rico and 254 cases were reported from 31 U.S. states. This represents a decrease in reported cases from Puerto Rico, and the U.S. states in 2010 (1). The overall decrease in 2011 in reported dengue cases both from U.S. areas that are and are not endemic for dengue was considered to be because of the cyclical nature of this disease worldwide and the decrease in global dengue cases (2–5).

Dengue is endemic in Puerto Rico, the U.S. Virgin Islands, and the U.S.-affiliated Pacific Islands (USAPI); (i.e., the U.S.-territories of Guam and American Samoa, the Commonwealth of the Northern Mariana Islands, the Republic of Palau, the Republic of the Marshall Islands [RMI], and the Federated States of Micronesia [FSM]). Although dengue is a notifiable disease in most U.S. territories and USAPIs, only Puerto Rico reports dengue cases to ArboNET (6). Puerto Rico did not experience an outbreak year in 2011; however, dengue outbreaks occurred in RMI and FSM. During September–December 2011, a total of 1,408 suspected cases were reported to the RMI Ministry of Health, and 1,017 suspected cases were reported from Yap state to the FSM Department of Health Services. Dengue virus (DENV)-2 and DENV-4 transmission was confirmed during the Yap and RMI outbreaks, respectively. Both outbreaks continued for several months into 2012.

Travel-associated dengue is the leading source of dengue in the U.S. areas that are not endemic for the disease, with 243 cases reported in 2011. Travel-associated dengue cases from residents of the U.S. areas that are not endemic resulted from travel to the following 42 foreign countries or U.S. territories: Puerto Rico (31), Bahamas (27), India (27), Bangladesh (16), Philippines (16), Haiti (14), Dominican Republic (10), Brazil (eight), Cuba (seven), Trinidad (seven), Costa Rica (five), and <5 cases from the Antilles, Aruba, Bermuda, Bolivia, Colombia, Curacao, Ecuador, El Salvador, Ghana, Granada, Guatemala, Guyana, Indonesia, Jamaica, Kenya, Laos, Malaysia, Mexico, Nicaragua, Pakistan, Panama, Peru, Singapore, Sri Lanka, Saint Lucia, Sudan, Thailand, Turks and Caicos, U.S. Virgin Islands, Venezuela, and Vietnam.

Although dengue is not endemic in the 50 U.S. states, an outbreak and locally acquired dengue cases were reported in Hawaii and Florida, respectively, in 2011. During February–March 2011, the Hawaii Department of Health (HI-DOH) detected laboratory-confirmed cases of dengue in five residents of Pearl City on the island of O'ahu. The first case was laboratory-confirmed in an O'ahu resident who travelled to Wisconsin in late February. After being notified by the Wisconsin Department of Health, the HI-DOH conducted case finding activities, which included a serosurvey in the index case household and neighborhood. After exhibiting dengue-like symptoms in late February, two laboratory-confirmed cases were found among the index patient's family members, and one laboratory-confirmed case was found in the neighboring household. None of these persons had travelled outside of the United States in the 2 weeks before illness onset and the virus DENV-1 was identified in two of these patients. The investigation also revealed that the likely source of virus transmission was an unrelated Pearl City resident who developed an acute febrile illness soon after returning in early February from a trip to the Philippines. In 2011, the Florida Department of Health reported cases occurring in seven persons with locally acquired dengue who had no reported travel outside of the United States in the 2 weeks before illness onset. The patients resided in Hillsborough (one patient), Martin (one), Miami-Dade (three), and Palm Beach (two) counties.

  1. CDC. Summary of notifiable diseases—United States, 2010. MMWR 2012;59(No. SS-3):1–111.
  2. World Health Organization (WHO)—Western Pacific Region Office (WPRO). WPRO Dengue situation update; 2012. Available at http://www.wpro.who.int/emerging_diseases/12_Jan2012DengueBiWeekly.pdf.
  3. World Health Organization—Pan American Health Organization. Number of reported cases of dengue and severe dengue in the Americas by country: Figures for 2010; 2010. Available at http://new.paho.org/hq/dmdocuments/2010/dengue_cases_2010_december_10_2%20.pdf.
  4. World Health Organization—Pan American Health Organizatin. Number of reported cases of dengue and dengue severe in the Americas by country: Figures for 2011; 2011. Available at http://new.paho.org/hq/dmdocuments/2011/dengue_cases_2011_January_21_EW_3.pdf.
  5. Dash AP. From the editor's desk. Dengue Bulletin 2011;35:i–i.
  6. Council of State and Territorial Epidemiologists. State reportable conditions query results, 2012. Available at http://www.cste.org/group/SRCAQueryRes.

Ehrlichiosis and Anaplasmosis

Ehrlichiosis and anaplasmosis are rickettsial tickborne diseases. The number of reported cases of anaplasmosis increased by approximately 50%, from 1,761 cases in 2010 to 2,575 cases in 2011, the largest reported incidence since anaplasmosis became notifiable in 1998. The number of reported cases of ehrlichiosis increased by 15%, from 740 cases in 2010 to 850 cases in 2011. A case of Ehrlichia ewingii was reported for the first time from Georgia, Maryland, and Virginia. Reports of undetermined ehrlichiosis or anaplasmosis increased by approximately 40% from 104 cases in 2010 to 148 cases in 2011. The overall increase in reported incidence of all four categories of ehrlichiosis and anaplasmosis from 2010 to 2011 might indicate an increase in tick populations, expansion of tick vector range, and an increase in the use of diagnostic assays.

Giardiasis

Giardia is transmitted through the fecal-oral route with the ingestion of Giardia cysts through the consumption of fecally contaminated water or through person-to-person (or, to a lesser extent, animal-to-person) transmission. The disease normally is characterized by diarrhea, abdominal cramps, bloating, weight losss, and malabsorption.

Although giardiasis is the most common enteric parasitic infection in the United States and no declines in incidence have occurred in recent years, knowledge of its epidemiology remains incomplete. Giardiasis symptomatology is variable; infected persons can shed Giardia for several weeks, and recent studies indicate a potential for chronic sequelae from giardiasis (1,2). New epidemiologic studies are needed to identify effective public health prevention measures.

Most data on giardiasis transmission come from outbreak investigations; however, the overwhelming majority of reported giardiasis cases are not linked to known outbreaks. During 2009–2010, <1% of reported giardiasis cases were associated with outbreaks (3). The relative contributions of person-to-person, animal-to-person, foodborne, and waterborne transmission to sporadic human giardiasis in the United States are not well understood.

Until recently, no reliable serologic assays for Giardia have been available, and no population studies of Giardia seroprevalence have been conducted. With recent laboratory advances (4), such studies might now be feasible and would contribute substantially to understanding the prevalence of giardiasis in the United States. Enhanced genotyping methods would increase knowledge of the molecular epidemiology of Giardia, including elucidating species-specific subassemblages (5). These tools, combined with traditional epidemiology and surveillance, would improve understanding of giardiasis risk factors, enable researchers to identify outbreaks by linking cases currently classified as sporadic infections, and provide risk factor information needed to inform prevention strategies.

  1. Cantey PT, Roy S, Lee B, et al. Study of nonoutbreak giardiasis: novel findings and implications for research. Am J Med 2011;124:1175.e1–8.
  2. Wensaas KA, Langeland N, Hanevik K, et al. Irritable bowel syndrome and chronic fatigue 3 years after acute giardiasis: historic cohort study. Gut 2012;61:214–9.
  3. CDC. Giardiasis surveillance—United States, 2009–2010. MMWR 2012;61 (No. SS-5):13–23.
  4. Priest JW, Moss DM, Visvesvara GS, et al. Multiplex assay detection of immunoglobulin G antibodies that recognize Giardia intestinalis and Cryptosporidium parvum antigens. Clin Vaccine Immunol 2010;17:1695–707.
  5. Feng Y, Xiao L. Zoonotic potential and molecular epidemiology of Giardia species and giardiasis. Clin Microbiol Rev 2011;24:110–40.

Gonorrhea

After a 79% decline in the rate of reported gonorrhea during 1975–2009, and after reaching the lowest gonorrhea rate recorded in 2009, the national gonorrhea rate increased in 2011 for the second consecutive year. During 2009–2011, the national rate of gonorrheal infection increased by 6% to 104 cases per 100,000 population. In 2011, the rate increased among men and women, among all racial/ethnic groups, and in all four regions of the United States (West, Midwest, Northeast, and South). As in previous years, the highest rates were observed among persons aged 15–24 years, among blacks, and in the South. In 2011, the gonorrhea rate among blacks was 17 times higher than the rate among whites (427 cases in blacks per 100,000 population compared with 25 cases in whites per 100,000 population) (1).

Treatment for gonorrhea is complicated by antimicrobial resistance. Most recently, declining susceptibility to cefixime resulted in a change in the CDC treatment guidelines; dual therapy with ceftriaxone and either azithromycin or doxycycline is now the only CDC-recommended treatment regimen for gonorrhea (2). In 2011, no isolates with decreased susceptibility to ceftriaxone were identified in CDC's sentinel surveillance system, the Gonococcal Isolate Surveillance Project (GISP); the percentage of isolates with elevated cefixime minimum inhibitory concentrations remain unchanged. Three isolates with decreased susceptibility to cefixime were identified within GISP from three different regions of the United States in 2011 (1).

  1. CDC. Sexually transmitted disease surveillance 2011. Atlanta, GA: US Department of Health and Human Services; 2012.
  2. CDC. Update to CDC's sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections. MMWR 2012;61:590–4.

Hansen Disease (Leprosy)

The number of reported cases decreased by 16%, from 98 cases in 2010 to 82 cases in 2011. The geographic distribution of cases reported in 2011 was the same as that reported in 2010, with Florida, Texas, California, and Hawaii reporting 61 cases and accounting for the majority (approximately 75%) of 82 reported cases. No cases were reported from any U.S. territories.

Hantavirus Pulmonary Syndrome

Hantavirus Pulmonary Syndrome (HPS) is a severe, sometimes fatal, respiratory disease in humans caused by infection with a hantavirus. Anyone who comes into contact with rodents that carry hantavirus is at risk for HPS. Rodent infestation in and around the home remains the primary risk for hantavirus exposure.

In 2011, HPS was confirmed in a rural Maine resident. This was the first person to have developed HPS from exposure to mice in Maine. Also in 2011, a fatal case of HPS occurred in a Long Island, New York, resident. This was the second case of HPS in a New York resident since 1995, and the fourth case in a person potentially exposed to rodents in the state. Although 517 (>95%) of 538 HPS cases have occurred west of the Mississippi river (1), the deer mouse (Peromyscus maniculatus, reservoir for Sin Nombre virus) and the white-footed mouse (Peromyscus leucopus, reservoir for the New York virus) are distributed widely throughout North America, and the potential for hantavirus infection is present wherever persons come into contact with an infected rodent (2).

  1. Knust B, MacNeil A, Rollin PE. Hantavirus pulmonary syndrome clinical findings: evaluating a surveillance case definition. Vector Borne Zoonotic Dis 2012;12:393–9.
  2. Mills JN, Amman BR, Glass GE. Ecology of hantaviruses and their hosts in North America. Vector Borne Zoonotic Dis 2009;10:563–74.

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 data are published each week in MMWR Table 1 for low-incidence nationally notifiable diseases. MMWR counts of deaths are by date of report in a calendar year and not by date of occurrence. A total of 118 influenza-associated pediatric deaths reported to CDC during 2011. Although all deaths occurred during the 2010–2011 influenza season, 10 of these deaths occurred in 2010, and were reported several months later in 2011. A total of 108 deaths occurred in 2011. This compares with a mean of 68 deaths (range: 43–90) per year that have been reported for seasonal influenza during 2005–2010. A total of 358 deaths were reported from April 15, 2009 to September 30, 2010, coinciding with the 2009 pandemic virus influenza A (H1N1)(pH1N1).

Of the 118 influenza-associated pediatric deaths reported to CDC during 2011, a total of 117 occurred between November 2010 and April 2011, and one occurred during August 2011. Seventy-three (62%) deaths were associated with influenza A viruses and 45 (38%) with influenza B viruses. Among the 73 influenza A virus-associated deaths, a subtype was determined for 54 (74%); 31 were influenza A (H1N1) (pH1N1) and 23 were A (H3N2) viruses.

In 2011, the median age at the time of death was 5.7 years (range: 25 days–17.9 years). This is similar to that observed (4–7.5 years) before the 2009 A (H1N1) pandemic for the years 2005–2008 and January–April 2009 but lower than that seen when pH1N1 viruses circulated widely during May–December 2009 (9.3 years) and 2010 (8.2 years). Sixteen children (14%) were aged <6 months; 18 (15%) were aged 6–23 months; 21 (18%) were aged 24–59 months; 17 (14%) were aged 5–8 years; 17 (14%) were aged 9–12 years; and the remaining 29 (25%) were aged 13–17 years. The overall influenza-associated death rate for children aged <18 years for 2011 was 0.16 per 100,000 population. The rates by age group were 0.63 per 100,000 population for children aged <1 year, 0.19 for children ≥1 year and <5 years, and 0.12 for children ≥5 and <18 years.

Information on the location of death was available for 117 of 118 children. Seventy-three children (62%) died after being admitted to the hospital (63 were admitted to an intensive care unit); 21 (18%) died in the emergency room; and 23 (20%) died outside the hospital. Information on underlying or chronic medical condition was reported for 116 (98%) children: 59 (51%) children had one or more underlying or chronic medical conditions, placing them at increased risk for influenza-associated complications (1). The most common group of underlying conditions were neurologic (e.g., moderate to severe developmental delay, seizure disorder, mitochondrial disorder, cerebral palsy, a neuromuscular disorder, or other neurological condition). These neurologic conditions were reported for 34 of 116 children for whom previous health status was known and 18 of 116 children were reported to have had a chronic pulmonary condition (e.g., asthma, cystic fibrosis, or other chronic pulmonary disease). Of 60 children who had specimens collected for bacterial culture from normally sterile sites, 23 (38%) had positive cultures. Staphylococcus aureus was detected in seven of 23 (30%) of the positive cultures; five were methicillin-resistant and two were methicillin-sensitive. Five cultures (16%) were positive for Streptococcus pneumoniae and four (20%) were positive for Group A Streptococcus. Other streptococcus species, Pseudomonas aeruginosa and Enterobacter cloacae, were identified less frequently. Of the 72 fatal cases among children aged ≥6 months for whom seasonal vaccination status was known, 19 (26%) were vaccinated against influenza as recommended by the Advisory Committee on Immunization Practices (ACIP) for 2011(2). Continued surveillance of influenza-associated mortality is important to monitor both the effects of seasonal and novel influenza and the impact of interventions in children.

  1. CDC. Post-censal estimates of the resident population of the United States for July 1, 2010–July 1, 2011, by year, county, single year of age (0, 1, 12...85 years and over), bridged race, Hispanic origin, sex. Atlanta, GA: CDC, National Center for Health Statistics, 2011. Available at http://www.cdc.gov/nchs/nvss/bridged_race/data_documentation.htm#vintage2011.
  2. CDC. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP) 2011. MMWR 2011;60:1128–32.

Listeriosis

Listeria monocytogenes infection (listeriosis) is rare but causes severe invasive disease (e.g., bacteremia, meningitis, and fetal death). Listeriosis has been nationally notifiable since 2000. Listeriosis is acquired predominately through contaminated food and occurs most frequently among pregnant women and their newborns, older adults, and persons with certain immunocompromising conditions. Pregnancy-associated listeriosis is usually a mild illness but can be associated with fetal death and severe neonatal disease.

In 2011, the incidence of reported listeriosis in the United States was 0.28 infections per 100,000 population. Progress toward the Healthy People 2020 (objective no. FS-1.3) of 0.20 infections per 100,000 population (1) is measured through the Foodborne Diseases Active Surveillance Network (FoodNet), which conducts active surveillance for listeriosis in 10 U.S. states. FoodNet reported a preliminary annual incidence of Listeria monocytogenes in 2011 of 0.24 infections per 100,000 population, similar to the rate reported to NNDSS (2).

The Listeria Initiative is an enhanced surveillance system designed to aid public health authorities in the rapid investigation of listeriosis outbreaks by combining molecular subtyping results with epidemiologic data collected by state and local health departments (3). As part of the Listeria Initiative, CDC recommends that all clinical isolates of L. monocytogenes be forwarded routinely to a public health laboratory for pulsed-field gel electrophoresis (PFGE) subtyping, and submission of these PFGE patterns to PulseNet, the National Molecular Subtyping Network for Foodborne Disease Surveillance (4). In addition, communicable disease programs are asked to interview all listeriosis patients promptly using the standard Listeria Initiative case form, available at in English and Spanish at http://www.cdc.gov/listeria/surveillance.html.

The Listeria Initiative has allowed for timely identification and removal of contaminated food during outbreaks, including a large outbreak in 2011 linked to whole cantaloupes from a single farm (5) that resulted in 147 illnesses, 143 hospitalizations, 33 deaths, and one miscarriage (6). A second outbreak of listeriosis in 2011 was linked to ackawi and chive cheeses made from pasteurized milk; these cheeses were produced by a single manufacturer. In addition, illnesses associated with consumption of blue cheese made from unpasteurized milk were investigated (7).

  1. US Department of Health and Human Services. Healthy People 2020 objectives. Available at http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=14.
  2. CDC. Foodborne diseases active surveillance network. Available at http://www.cdc.gov/foodnet/data/trends/tables/table2a-b.html#table-2b.
  3. CDC. The listeria initiative surveillance overview. Available at http://www.cdc.gov/listeria/pdf/ListeriaInitiativeOverview_508.pdf.
  4. CDC. PulseNet. Available at http://www.cdc.gov/pulsenet.
  5. CDC. Multistate outbreak of listeriosis associated with Jensen Farms cantaloupe—United States, August–September, 2011. MMWR 2011;60:1357–8.
  6. CDC. Multi-state outbreak of listeriosis linked to whole cantaloupe in Jenson Farms, Colorado. Available at http://www.cdc.gov/listeria/outbreaks/cantaloupes-jensen-farms/082712/index.html.
  7. CDC. National listeria surveillance annual summary, 2011. Atlanta, Georgia. US Department of Health and Human Services, CDC, 2013.

Lyme disease

National surveillance for Lyme disease was implemented in the United States in 1991 using a case definition based on clinical and laboratory findings. CSTE revised the case definition, effective 2008, to standardize laboratory criteria for confirmation and allow reporting of "probable" cases.

The number of confirmed and probable Lyme disease cases reported to CDC increased by 2,939 (9.7%) in 2011 over 2010. Nevertheless, the total number of reported cases remained substantially lower than in either 2008 or 2009. Unlike 2010, when reported cases decreased in nearly all Northeastern and mid-Atlantic states, no consistent regional trend was apparent in 2011.

Measles

The elimination of endemic measles has been achieved in the United States (1); however, measles continues to be imported, resulting in substantial morbidity and expenditure of local, state, and federal public health resources (2,3). Although measles incidence in the United States remains low, the number of cases reported during 2011 was the highest since 1996.

A total of 191 cases accounted for the majority (87%) of persons with measles, which were unvaccinated or had unknown vaccination status; an estimated 68 (36%) were known to claim vaccine exemption based on personal, religious, or philosophical beliefs (PBEs). A total of 196 cases accounted for the majority (89%) of cases in 2011, which were import-associated. The World Health Organization, European Region, where approximately 30,000 cases occurred in 2011, accounted for the majority of imported cases (41%) among U.S. residents who acquired measles while traveling. Imported genotypes were identified in all 16 outbreaks, with 12 (75%) of the outbreaks being caused by D4 genotype virus, known to be circulating in Europe.

Seven outbreaks occurred after unvaccinated U.S. residents acquired infection abroad with onset of symptoms after returning to the United States. These outbreaks (range: 3–21 cases) accounted for 58 cases. A total of 38 (65%) persons claimed PBEs, seven (12%) were infants aged <12 months; for one child aged 12 months, measles vaccination had been delayed intentionally by parents until the child was older.

Cases in U.S. residents who were unvaccinated or who had unknown vaccine status, who had no medical contraindication to vaccination, and who were either born after 1957 or were aged ≥12 months (without prior documentation of presumptive evidence of immunity to measles), or were aged 6–11 months, with recent history of international travel, are considered vaccine-preventable. During 2011, a total of 48 of 57 imported cases occurred among unvaccinated U.S. residents who were vaccine-eligible: nine traveler cases occurred in infants aged 6–11 months; nine in infants aged 12–15 months; five in children aged 16 months–4 years; seven in persons aged 5–19 years; and 18 in persons aged 20–53 years. Among persons aged 20–53 years (median: 28 years), 44% held PBEs.

To prevent measles among U.S. residents, health-care providers should follow ACIP vaccination recommendations (4), ensuring that travelers are vaccinated, particularly infants aged 6–11 months, and that 2 doses are administered for those aged ≥12 months. In addition, parents should be educated about the risk for measles associated with international travel. Information on vaccination recommendations for travelers is available from CDC at http://www.cdc.gov/travel.

  1. Katz SL, Hinman AR. Summary and conclusions: measles elimination meeting, 16–17 March 2000. J Infect Dis 2004;189(Suppl 1):S43–7.
  2. CDC. Epidemiology of measles—United States, 2001–2003. MMWR 2004;53:713–6.
  3. Dayan GH, Ortega-Sanchez IR, LeBaron CW. The cost of containing one case of measles: the economic impact on the public health infrastructure, Iowa, 2004. Pediatrics 2005;116:1–4.
  4. CDC. Measles, mumps, and rubella—vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1998;47(No. RR-8):38–9.

Meningoccocal Disease, Invasive

Neisseria meningitidis is a major cause of bacterial meningitis and sepsis in the United States. The highest incidence of meningococcal disease occurred among infants aged <1 year with a second peak occurring in adolescents and young adults (1,2). Among infants, disease incidence peaks within the first 6 months of life and the majority of cases in this age group are caused by serogroup B (2). Rates of meningococcal disease are at historic lows in the United States, but meningococcal disease continues to cause substantial morbidity and mortality in persons of all ages.

The Advisory Committee on Immunization Practices recommends routine use of quadrivalent (A, C, Y, W-135) meningococcal conjugate vaccine in adolescents and others at increased risk for disease (1). In October 2010, a booster dose was recommended for adolescents at age 16 years (3). In 2011, coverage with 1 dose of meningococcal conjugate vaccine was approximately 70% among 23,564 adolescents aged 13–17 years in the United States (4).

  1. CDC. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2005;54(No. RR-7).
  2. Cohn AC, MacNeil JR, Harrison LH, et al. Changes in Neisseria meningitidis disease epidemiology in the United States, 1998–2007: implications for prevention of meningococcal disease. Clin Infect Dis 2010:50:184–91.
  3. CDC. Updated recommendations for use of meningococcal conjugate vaccines—Advisory Committee on Immunization Practices (ACIP), 2010. MMWR 2011;60:72–6.
  4. CDC. National and state vaccination coverage among adolescents aged 13–17 years—United States, 2011. MMWR 2012:61:671–7.

Novel Influenza A

In 2007, CSTE added human infection with a novel influenza A virus to the list of conditions reportable to NNDSS (1). Novel influenza A virus infections are human infections with influenza A viruses that are different from currently circulating human seasonal influenza viruses. These viruses include those that are subtyped as nonhuman in origin and those that cannot be subtyped with standard methods and reagents used for currently circulating influenza viruses.

During 2005–2011, all cases of human infection with novel influenza A viruses involved swine-origin viruses (now called variant influenza viruses when detected in humans [2]), rather than avian-origin influenza viruses. Although most persons identified with variant influenza infection report contact with swine preceding their illness, limited human-to-human transmission of these viruses has occurred. Because the implications of sustained, ongoing transmission of these viruses between humans are potentially severe, prompt and thorough investigation of sporadic human infections with nonhuman influenza viruses is needed to reduce the risk for sustained transmission (2). In 2011, cases of variant influenza virus infection likely from human-to-human transmission were identified, but efficient, sustained transmission did not occur.

In 2011, a total of 14 cases of human infection with novel influenza A viruses were reported from seven states (Indiana [two], Iowa [three], Maine [two], Minnesota [one], Pennsylvania [three], West Virginia [two], and Wisconsin [one]) (3,4). One case (Wisconsin) was associated with an influenza A (H1N1) variant virus (H1N1v), one case (Minnesota) was associated with an influenza A (H1N2) variant virus (H1N2v), and the other 12 cases were associated with influenza A (H3N2) variant viruses (H3N2v). The H1N1v and H1N2v viruses were similar to viruses detected in cases previously reported (5). All 12 H3N2v viruses were similar to viruses previously identified in swine (6); however, these viruses had acquired the matrix (M) gene from the influenza A (H1N1)pdm09 virus, which has been hypothesized to contribute to increased transmissibility in animal models (7,8).

One case occurred in July (Indiana), three cases in August (Pennsylvania), four cases in October (Maine [two], Minnesota [one] and Indiana [one]), and six cases in November (Iowa [three], West Virginia [two], and Wisconsin [one]). Twelve out of 14 patients reported influenza-like illness (e.g., fever with cough and/or sore throat) and two patients (both with H3N2v virus infection) reported fever only. Three of the 14 patients (all with H3N2v virus infection) were hospitalized for influenza; all 14 fully recovered from their illness. Six patients with H3N2v virus infection and the two patients with H1N1v and H1N2v virus infection reported either direct contact (touching or handling) or indirect contact (walking through an area or coming within 6 feet) with swine in the week preceding illness onset. The remaining six patients with H3N2v infection had no known exposure to swine before illness onset, indicating likely human-to-human spread. Five cases occurred in two distinct clusters. In one cluster, illness onset occurred in three patients who were exposed to one another over a 4-day period; in the second cluster, illness onset was reported for two cases within a 10-day period. The patients in the second cluster attended a daycare center where multiple attendees had influenza-like illness during this 10-day period. The sixth patient without exposure to swine had a caretaker who was not ill, but reported contact with swine.

Transmission of variant influenza A viruses to humans usually occurs among persons in direct contact with pigs or in those who have visited places where pigs were present (e.g., agricultural fairs, farms, and petting zoos). CDC conducts surveillance for human infections with novel influenza A viruses in conjunction with state and local public health laboratories. Any specimen with results suggestive of the presence of a novel influenza A virus or that cannot be subtyped using standard methods and reagents at a public health laboratory is immediately submitted to CDC for further testing. Surveillance for human infections with novel influenza A viruses is essential, and early identification and intensive investigation of these cases are critical to evaluate the extent of outbreaks, and the potential for human-to-human transmission.

  1. Council of State and Territorial Epidemiologists. List of Nationally Notifiable Conditions. 2011. Available at http://www.c.ymcdn.com/sites/www.cste.org/resource/resmgr.
  2. CDC. Update: Influenza A (H3N2)v transmission and guidelines—five states, 2011. MMWR 2012;60:1741–4.
  3. CDC. Update: influenza activity—United States, 2010–11 season, and composition of the 2011–12 influenza vaccine. MMWR 2011;60:705–12.
  4. CDC. Update: influenza activity—United States, 2011–12 season, and composition of the 2012–13 influenza vaccine. MMWR 2011;60:705–12.
  5. Shinde V, Bridges CB, Uyeki TM, et al. Triple-reassortant swine influenza A (H1) in humans in the United States, 2005–2009. N Engl J Med 2009;360:2616–25.
  6. Vincent AL, Ma W, Lager KM, Janke BH, Richt JA. Swine influenza viruses: a North American perspective. Adv Virus Res 2008;72:127–54.
  7. Chou YY, Albrecht RA, Pica N, et al. The M segment of the 2009 new pandemic H1N1 influenza virus is critical for its high transmission efficiency in the guinea pig model. J Virol 2011;85:11235–41.
  8. Lakdawala SS, Lamirande EW, Suguitan AL, Jr., et al. Eurasian-origin gene segments contribute to the transmissibility, aerosol release, and morphology of the 2009 pandemic H1N1 influenza virus. PLoS Pathogens 2011;7:e1002443.

Pertussis

After the 2010 peak in reported pertussis (incidence: 8.9 per 100,000 population), reports of disease declined in 2011 (6.1 per 100,000 population). Consistent with previous years, age-specific rates are highest among infants aged <1 year (70.9 per 100,000 population). Similar to trends observed in 2009 and 2010, children aged 7–10 years continue to contribute the second highest rates of disease nationally (20.0 per 100,000 population). Rates of disease among adolescents remained lower than those observed before the introduction of three vaccines: tetanus, diptheria, and acellular pertussis (Tdap) in 2005 (24.5 per 100,000 population in 2004; 10.3 per 100,000 in 2011), and Tdap coverage continues to improve among adolescents aged 13–17 years (68.7% in 2010 to 78.2% in 2011) (13). Increasing Tdap coverage among adults continues to be a priority, and ACIP expanded Tdap recommendations to include vaccination of pregnant women in June of 2011 (4).

  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. Vaccination coverage among adolescents aged 13–17 years—United States, 2010. MMWR 2011;60:1117–23.
  3. CDC. Vaccination coverage among adolescents aged 13–17 years—United States, 2011. MMWR 2012;61:671–7.
  4. CDC. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) in pregnant women and persons who have or anticipate having close contact with an infant aged <12 months—Advisory Committee on Immunization Practices (ACIP), 2011. MMWR 2011;60:1424–6.

Q fever

Q fever is a worldwide disease with acute and chronic stages caused by the bacteria Coxiella burnetii. Cattle, sheep, and goats are the primary reservoirs for Q fever, although a variety of species can be infected. In 2008, the case definition for Q fever was further specified into acute and chronic cases.

Two outbreaks of Q fever were of particular note in 2011. A cluster of five persons had serologic or clinical evidence of infection with Coxiella burnetii, the causative agent of Q fever, in Michigan. Upon investigation, exposure was linked to habitual consumption of raw cow's milk from the same dairy farm (1). This was the first report of transmission by ingestion of raw milk products in the state of Michigan. The second outbreak was one of the largest ever reported in the United States. Twenty cases of Q fever were identified in Montana and Washington between January and July 2011 (2). These cases were linked epidemiologically to exposure to goats that originated from a single farm in eastern Washington state.

  1. Signs KA, Stobierski MG, Gandhi TN. Q fever cluster among raw milk drinkers, Michigan, 2011. Clin Infect Dis 2012;55:1387–9.
  2. CDC. Notes from the field: Q fever outbreak associated with goat farms—Washington and Montana, 2011. MMWR 2011;60:1393.

Rabies

During 2011, six cases of human rabies were reported in the United States, the most reported in a single year since 2004. Three cases reported from Massachusetts, New Jersey, and New York were associated with canine rabies virus variants acquired outside the United States (1,2). Two domestically acquired cases from Massachusetts and South Carolina were associated with bat rabies virus variants. The remaining case reported from California occurred in a person who survived; however, no rabies virus was isolated, and a definitive source of infection was not determined (3).

The recent decline in animals submitted for rabies diagnosis continued during 2011. A total of 99,905 suspected rabid animals were tested in 2011, compared with 104,647 in 2010, a decline of 4.5%. Despite this decline, substantial increases in reported rabid animals were observed among some reservoir species, most notably skunks (4).

  1. CDC. Imported human rabies—New Jersey, 2011. MMWR 2012;60;1734–6.
  2. CDC. Imported human rabies in a U.S. Army soldier—New York, 2011. MMWR 2012;61:302–5.
  3. CDC. Recovery of a patient from clinical rabies—California, 2011. MMWR 2012;61:61–5.
  4. Blanton JD, Dyer J, McBrayer J, Rupprecht CE. Rabies surveillance in the United States during 2011. J Am Vet Med Assoc 2012;241:712–22.

Salmonellosis

During 2011, as in previous years, the age group with the highest incidence of salmonellosis was children aged <5 years. Salmonellosis is reported most frequently in late summer and early fall; in 2011, this seasonality was again evident, with most reports during July–October. Salmonella infections have not declined over the past 10 years. In 2011, the incidence in the United States (16.8 infections per 100,000 population) was nearly one and a half times the 2020 national health objective target of 11.4 infections per 100,000 population (1). Data from the Foodborne Diseases Active Surveillance Network (FoodNet), which conducts active surveillance for salmonellosis in 10 U.S. states, are used to measure progress toward Healthy People 2020 objectives. FoodNet reported a preliminary annual incidence of Salmonella in 2011 of 16.5 infections per 100,000 population, similar to the rate reported to the National Notifiable Diseases Surveillance System (2).

Salmonella causes an estimated 1.2 million illnesses annually in the United States, approximately 1 million of which are transmitted by food consumed in the United States (3). Salmonella can contaminate a wide range of foods, and different serotypes tend to have different animal reservoirs and food sources, making control challenging. During 2011, multistate outbreaks of Salmonella infection were linked to fresh produce: cantaloupe (serotype Panama), alfalfa and spicy sprouts (serotype Enteritidis), and whole, fresh, imported papayas (serotype Agona); meat and poultry: ground beef (serotype Typhimurium), turkey burgers (serotype Hadar), ground turkey (serotype Heidelberg), kosher broiled chicken livers (serotype Heidelberg); other foods: Turkish pine nuts (serotype Enteritidis); and contact with animals: African dwarf frogs (serotype Typhimurium), frozen rodents used as reptile feed (serotype I, 4,[5],12:i:-), and chicks and ducklings (serotypes Altona and Johannesburg) (4).

  1. US Department of Health and Human Services. Healthy People 2020 objectives. Available at http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=14.
  2. CDC. Foodborne diseases active surveillance network. Available at http://www.cdc.gov/foodnet/data/trends/tables/table2a-b.html#table-2b.
  3. Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in the United States—major pathogens. Emerg Infect Dis 2011;17:7–15.
  4. CDC. Reports of selected Salmonella outbreak investigations. Available at http://www.cdc.gov/salmonella/outbreaks.html.

Shigellosis

In 2011, the incidence of reported shigellosis in the United States was 4.3 infections per 100,000 population. Accounting for underdiagnosis, Shigella causes an estimated 494,000 illnesses annually in the United States, approximately 131,000 of which are transmitted by food consumed in the United States (1). Shigella infections have not declined over the past 10 years. During 1999–2009, a total of 97,864 out of 116,191 (84%) of Shigella infection with a known species were caused by S. sonnei (2). During 2011, as in previous years, the age group with the highest incidence of shigellosis was children aged <10 years. S. sonnei infections generally account for approximately 75% of shigellosis in the United States (2). Shigellosis does not demonstrate marked seasonality, likely reflecting the importance of person-to-person transmission.

Shigella often is spread directly from one person to another, including through sexual contact between MSM, and also can be transmitted by contaminated food or by contaminated water used for drinking or recreational purposes (3). Some cases of shigellosis also are acquired during international travel (4,5). Daycare-associated outbreaks are common and are often difficult to control (6). During 2011, outbreaks of S. sonnei infection were reported within traditionally observant Jewish communities in several northeastern and midwestern states. Outbreaks in such communities have occurred before (7). Resistance to ampicillin and trimethoprim-sulfamethoxazole among S. sonnei strains in the United States remains common, and resistance to quinolones, including ciprofloxacin, is emerging and cause for concern (8).

  1. Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in the United States—major pathogens. Emerg Infect Dis 2011;17:7–15.
  2. CDC. National Shigella surveillance annual summary, 2009. Atlanta, GA: US Department of Health and Human Services, CDC; 2012. Available at http://www.cdc.gov/ncezid/dfwed/PDFs/shigella-annual-summary-2009-508c.pdf.
  3. Gupta A, Polyak CS, Bishop RD, Sobel J, Mintz ED. Laboratory confirmed shigellosis in the United States, 1989–2002: epidemiologic trends and patterns. Clin Infect Dis 2004;38:1372–7.
  4. Ram PK, Crump JA, Gupta SK, Miller MA, Mintz ED. Review article: part II. Analysis of data gaps pertaining to Shigella infections in low and medium human development index countries, 1984–2005. Epidemiol Infect 2008;136:577–603.
  5. Gupta SK, Strockbine N, Omondi M, et al. Short report: emergence of Shiga toxin 1 genes within Shigella dysenteriae Type 4 isolates from travelers returning from the island of Hispaniola. Am J Trop Med Hyg 2007;76:1163–5.
  6. Arvelo W, Hinkle J, Nguyen TA, et al. Transmission risk factors and treatment of pediatric shigellosis during a large daycare center-associated outbreak of multidrug resistant Shigella sonnei. Pediatr Infect Dis J 2009;11:976–80.
  7. Garrett V, Bornschlegel K, Lange D, et al. A recurring outbreak of Shigella sonnei among traditionally observant Jewish children in New York City: the risks of daycare and household transmission. Epidemiol Infect 2006;134:1231–6.
  8. CDC. National Antimicrobial Resistance Monitoring System (NARMS) for enteric bacteria: human isolates final report, 2010. Atlanta, GA: US Department of Health and Human Services, CDC; 2012. Available at http://www.cdc.gov/narms.

Spotted Fever Rickettsiosis

Spotted fever rickettsioses are a group of tickborne infections caused by some members of the genus Rickettsia. More cases of spotted fever rickettsiosis were reported in 2011 than in any year since 1920, when spotted fever rickettsiosis became a reportable condition. Similarly, 18 states reported more cases in 2011 than any year in the last decade. Although the increase in reported cases might be influenced by testing and reporting practices, high tick vector activity and increased human exposure to infected ticks in 2011 might have resulted in an increased incidence of spotted fever rickettsiosis.

Shiga Toxin-Producing Escherichia coli (STEC)

During 2011, as in previous years, the age group with the highest incidence of Shiga toxin-producing Escherichia coli (STEC) infections was children aged <5 years. STEC infection is reported most frequently in late summer and early fall. In 2011, this seasonality was evident, with the highest number of reports in July, August, September, and October. During 2011, several multistate outbreaks of STEC O157 infection were linked to foods (e.g., romaine lettuce, Lebanon bologna, and hazelnuts). In addition, six cases of STEC O104:H4 were linked to travel to Germany during a large outbreak associated with sprouts (1).

Accounting for underdiagnosis, an estimated 96,000 illnesses are caused by STEC O157, and 168,000 illnesses are caused by non-O157 STEC each year (2). Escherichia coli O157:H7 infection has been nationally notifiable since 1994 (3). STEC infection caused by any serotype was made nationally notifiable in 2001, originally using the nomenclature "enterohemorrhagic E. coli (EHEC)" and changing to STEC in 2006 (4).

Public health actions to monitor, prevent, and control STEC infections are made on the basis of serogroup characterization. Development of postdiarrheal hemolytic uremic syndrome, a severe complication of STEC infection, is most strongly associated with STEC O157. Non-O157 STEC, a diverse group that varies in virulence, comprises 50 other serogroups. In the United States, STEC O157 is the most commonly reported serogroup of STEC causing human infection (5); however, increased use of assays for the detection of Shiga toxins in clinical laboratories in recent years has led to increased reporting of non-O157 STEC infection (6). Stool specimens from patients with community-acquired diarrhea submitted to clinical laboratories should be tested routinely both by culture for STEC O157 and by an assay that detects Shiga toxins (7). Detection of Shiga toxin alone is inadequate for outbreak detection; characterizing STEC isolates by serogroup and by pulsed-field gel electrophoresis pattern is important to detect, investigate, and control outbreaks.

  1. CDC. Reports of selected E. coli outbreak investigations. Available at http://www.cdc.gov/ecoli/outbreaks.html.
  2. Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in the United States—major pathogens. Emerg Infect Dis 2011;17:7–15.
  3. Mead PS, Griffin PM. Escherichia coli O157:H7. Lancet 1998;352:1207–12.
  4. Council of State and Territorial Epidemiologists. Revision of the Enterohemorrhagic Escherichia coli (EHEC) condition name to Shiga toxin-producing Escherichia coli (STEC) and adoption of serotype specific national reporting for STEC. Position statement 05-ID-07. Atlanta, GA: Council of State and Territorial Epidemiologists; 2005. Available at http://c.ymcdn.com/sites/www.cste.org/resource/resmgr/PS-05-ID-07.
  5. CDC. National shiga toxin-producing Escherichia coli (STEC) surveillance annual summary, 2009. Atlanta, GA: US Department of Health and Human Services, CDC, 2012. Available at http://www.cdc.gov/ncezid/dfwed/PDFs/national-stec-surv-summ-2009-508c.pdf.
  6. Hoefer D, Hurd S, Medis C, et al. Laboratory practices for the identification of Shiga toxin-producing Escherichia coli in the United States, FoodNet Sites, 2007. Foodborne Pathog Dis 2011;8:555–60.
  7. CDC. Recommendations for diagnosis of Shiga toxin-producing Escherichia coli infections by clinical laboratories, 2009. MMWR 2009;58:1–14.

Primary and Secondary Syphilis

During 2011, overall rates of primary and secondary syphilis remained unchanged compared with 2010. Rates among women continued to decrease (33% compared with 2008), but increased among men for the eleventh consecutive year. Rates were highest among men aged approximately 20–24 years and 25–29 years for the fourth consecutive year. Notably, cases among MSM increased each year during 2007–2011 in 33 states and in areas reporting sex of partner data for approximately 70% of cases of primary and secondary syphilis each year during this period. During 2007–2011, rates among black men aged 20–24 years increased from 54.9 to 96.2 cases per 100,000 population (75%); the magnitude of this increase (41.3 cases per 100,000 population) was the greatest reported regardless of age, sex, or race/ethnicity (1). Analyses showing recent trends of increasing primary and secondary syphilis among black MSM are consistent with these data (2).

  1. CDC. Sexually transmitted disease surveillance 2011. Atlanta, GA: US Department of Health and Human Services; 2012.
  2. Su JR, Beltrami JF, Zaidi AA, Weinstock HS. Primary and secondary syphilis among black and Hispanic men who have sex with men: case report data from 27 states. Ann Intern Med 2011;155:145–51.

Typhoid Fever

Typhoid fever is rare in the United States. During 1999–2006, 1,439 out of 1,902 patients reported foreign travel within 30 days of illness, which accounted for approximately 79% of cases associated with international travel (1). The risk for infection is highest for travelers visiting friends and relatives in countries where typhoid fever is endemic, perhaps because they are less likely than other travelers to seek pretravel vaccination and to observe strict safe water and food practices. The risk also is higher for travelers who visit areas where disease is most highly endemic, such as the Indian subcontinent, even for a short time (2). CDC recently removed pretravel typhoid vaccination recommendations for 26 low-risk destinations; pretravel vaccination guidelines can be found at http://www.cdc.gov/travel (3).

During 1960–1999, a total of 60 outbreaks of typhoid fever were reported in the United States (4). The first domestically acquired outbreak of typhoid fever in more than a decade occurred in 2010. Twelve cases were identified, and illness was linked to consumption of imported frozen mamey fruit (5). Mamey from the same producer in Guatemala also was implicated in the last domestic typhoid fever outbreak, which occurred in 1999 (5). No outbreaks were reported in 2011.

  1. Lynch MF, Blanton EM, Bulens S, et al. Typhoid fever in the United States, 1999–2006. JAMA 2009;302:898–9
  2. Steinberg EB, Bishop RB, Dempsey AF, et al. Typhoid fever in travelers: who should be targeted for prevention? Clin Infect Dis 2004;39:186–91.
  3. Johnson KJ, Gallagher NM, Mintz ED, et al. From the CDC: New country-specific recommendations for pre-travel typhoid vaccination. J Travel Med 2011;18:430–3.
  4. Olsen SJ, Bleasdale SC, Magnano AR, et al. Outbreaks of typhoid fever in the United States, 1960–1999. Epidemiol Infect 2003;130:13–21.
  5. Loharikar A, Newton A, Rowley P, et al. Typhoid fever outbreak associated with frozen mamey pulp imported from Guatemala to the western United States, 2010. Clin Infect Dis 2012;55:61–6.

Varicella

As varicella incidence has declined with implementation of the varicella vaccination program (1,2), more states are able to conduct varicella surveillance. Thus, varicella surveillance data reported to CDC through the National Notifiable Diseases Surveillance System (NNDSS) are now adequate for monitoring trends in varicella incidence (3).

The number of states reporting varicella data to CDC through NNDSS continued to increase, from 38 in 2010 to 39 in 2011. Varicella incidence continues to decline during the 2-dose varicella vaccination era; varicella incidence in the 31 states meeting criteria for adequate and consistent reporting (3) decreased 73.6% from 31.4 per 100,000 in 2006 to 8.3 per 100,000 in 2011. Among children aged 5–9 years, which includes children targeted for the second dose of varicella vaccine, age-specific incidence decreased 85.7%, from 261 per 100,000 in 2006 to 37.2 per 100,000 in 2011.

CDC encourages all states to move toward case-based varicella surveillance to allow for effective monitoring of the impact of the 2-dose varicella vaccination program. States are encouraged to collect standard demographic, clinical, and epidemiologic data, in addition to the previously requested information on disease severity (e.g., number of lesions and hospitalizations), vaccination status (e.g., whether the person received varicella-containing vaccine and the number of doses), and ages of persons to help with the continued monitoring of the impact of the 2-dose varicella vaccination recommendation.

  1. CDC. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2007;56 (No. RR-4).
  2. 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.
  3. CDC. Evolution of varicella surveillance—selected states, 2000–2010. MMWR 2012;61:609–12.

Vibriosis

Vibriosis became a nationally notifiable condition in 2007 (1). Three states (California, Florida, and Texas) report the largest numbers of cases. Vibrio parahaemolyticus, V. vulnificus, and V. alginolyticus account for the largest proportion of reported infections. The incidence of vibriosis, both overall and for each of the three most commonly reported species has increased over the past 15 years (2). In 2011, an outbreak of toxigenic (i.e., producing cholera toxin) V. cholerae O75 infection was associated with consumption of raw oysters harvested from Apalachicola Bay.

  1. Council of State and Territorial Epidemiologists. National reporting for non-cholera Vibrio infections (vibriosis). Position statement 06-ID-05. Atlanta, GA: Council of State and Territorial Epidemiologists; 2006.
  2. Newton A, Kendall M, Vugia DJ, et al. Increasing rates of vibriosis in the United States, 1996–2010: review of surveillance data from 2 systems. Clin Infect Dis 2012;545:S391–5.

PART 1 Summaries of Notifiable Diseases in the United States, 2011


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, 2011 might differ from data in other CDC surveillance reports because of differences in the timing of reports, the source of the data, the use of different case definitions, and print criteria.


TABLE 1. Reported cases of notifiable diseases,* by month — United States, 2011

Name

Jan.

Feb.

Mar.

Apr.

May

June

July

Aug.

Sept.

Oct.

Nov.

Dec.

Month not stated

Total

Anthrax

1

1

Arboviral diseases

California serogroup viruses

neuroinvasive

1

4

44

36

28

7

120

nonneuroinvasive

1

1

5

3

3

4

17

Eastern equine encephalitis virus

3

1

4

Powassan virus

neuroinvasive

2

3

4

1

1

1

12

nonneuroinvasive

2

2

4

St. Louis encephalitis virus

neuroinvasive

1

1

1

1

4

nonneuroinvasive

1

1

2

West Nile virus

neuroinvasive

1

2

2

60

181

198

39

1

2

486

nonneuroinvasive

1

1

1

33

88

92

9

1

226

Babesiosis

6

4

2

13

31

111

376

273

92

114

58

48

1,128

Botulism, total

6

11

6

10

16

10

12

8

9

42

10

13

153

foodborne

2

3

3

2

3

8

3

24

infant

4

7

6

6

12

7

12

6

6

13

8

10

97

other (wound and unspecified)

2

2

1

1

3

21

2

32

Brucellosis

3

4

6

10

10

2

11

6

6

9

5

7

79

Chancroid

1

2

1

1

1

1

1

8

Chlamydia trachomatis infection

99,231

103,791

113,539

136,188

110,352

102,752

131,492

113,061

110,013

146,374

104,355

141,643

1,412,791

Cholera

12

3

3

1

1

2

4

3

5

3

3

40

Coccidioidomycosis

1,899

1,679

1,477

2,154

1,720

1,553

2,257

1,835

1,615

2,307

1,914

2,224

22,634

Cryptosporidiosis, total

371

404

440

613

584

734

1,270

1,458

1,306

945

547

578

9,250

confirmed

300

290

313

420

377

459

820

980

834

617

342

378

6,130

probable

71

114

127

193

207

275

450

478

472

328

205

200

3,120

Cyclosporiasis

4

12

9

9

19

17

26

27

7

11

3

7

151

Dengue fever

19

18

11

9

5

5

44

48

31

30

19

12

251

Dengue hemorrhagic fever

1

1

1

3

Ehrlichiosis/Anaplasmosis

14

20

19

42

218

630

712

270

162

166

151

171

2,575

Ehrlichia chaffeensis

7

7

5

25

55

111

283

119

75

49

32

82

850

Ehrlichia ewingii

2

2

2

6

1

13

Undetermined

2

8

16

30

36

14

14

13

6

9

148

Giardiasis

1,000

1,091

1,115

1,331

1,057

1,177

1,701

1,734

1,771

2,011

1,154

1,605

16,747

Gonorrhea

23,459

23,117

23,719

29,724

24,189

23,374

30,177

26,095

26,272

34,117

24,310

33,296

321,849

Haemophilus influenzae, invasive disease, all ages, serotypes

297

258

289

340

321

329

292

204

180

291

259

479

3,539

age<5 yrs

serotype b

1

2

2

1

1

1

1

1

1

3

14

nonserotype b

10

15

25

14

17

10

7

7

5

12

11

12

145

unknown serotype

18

18

24

21

23

18

15

16

16

18

12

27

226

Hansen disease (leprosy)

5

6

15

12

3

9

7

3

7

2

13

82

Hantavirus pulmonary syndrome

3

2

4

2

3

7

1

1

23

Hemolytic uremic syndrome post-diarrheal

7

5

6

16

15

22

44

43

27

46

31

28

290

Hepatitis, virus, acute

A

97

94

86

113

110

106

133

130

135

125

91

178

1,398

B

193

218

213

246

184

263

265

232

269

252

221

347

2,903

C

77

68

101

123

90

97

112

103

105

106

87

160

1,229

HIV diagnoses§

3,623

3,298

3,880

3,392

3,531

3,502

3,102

3,277

2,822

2,662

1,757

415

5

35,266

Influenza-associated pediatric mortality

15

36

33

12

6

6

2

2

4

2

118

Legionellosis

144

164

153

163

180

279

514

483

662

720

348

392

4,202

Listeriosis

40

29

34

37

49

44

74

106

155

144

62

96

870

Lyme disease, total

664

691

804

1,207

1,847

5,170

9,249

4,498

2,781

2,627

1,677

1,882

33,097

confirmed

457

458

548

817

1,286

3,969

7,289

3,347

2,013

1,844

1,112

1,224

24,364

probable

207

233

256

390

561

1,201

1,960

1,151

768

783

565

658

8,733

Malaria

108

96

74

106

120

155

220

218

190

171

107

159

1,724

Measles, total

8

15

21

33

51

37

19

11

12

10

2

1

220

indigenous

3

6

10

22

34

31

17

2

4

8

2

1

140

imported

5

9

11

11

17

6

2

9

8

2

80

Meningococcal disease., invasive, all serogroups

65

77

85

93

64

58

47

39

40

54

51

86

759

serogroup A,C,Y, and W-135

21

21

39

30

21

27

19

10

15

15

12

27

257

serogroup B

9

18

19

21

14

10

2

7

9

18

13

19

159

serogroup other

3

2

2

1

2

1

4

5

20

serogroup unknown

35

38

24

40

27

21

25

20

16

20

22

35

323


TABLE 1. (Continued) Reported cases of notifiable diseases,* by month — United States, 2011

Name

Jan.

Feb.

Mar.

Apr.

May

June

July

Aug.

Sept.

Oct.

Nov.

Dec.

Month not stated

Total

Mumps

22

44

26

28

23

14

20

25

34

81

32

55

404

Novel influenza A virus infection

1

1

2

2

4

4

14

Pertussis

1,438

1,412

1,219

1,325

970

975

1,507

1,333

1,393

1,919

1,947

3,281

18,719

Plague

1

1

1

3

Psittacosis

1

1

2

Q fever, total

6

4

10

6

20

10

11

12

10

11

34

134

acute

4

2

8

6

18

10

8

10

8

9

27

110

chronic

2

2

2

2

3

2

2

2

7

24

Rabies

animal

170

304

268

448

411

404

461

440

424

424

296

307

4,357

human

1

1

1

3

6

Rubella

2

1

1

4

Salmonellosis

1,947

1,807

2,029

3,401

3,572

4,415

7,195

6,777

6,143

6,223

3,905

4,473

51,887

Shiga toxin-producing E. coli (STEC)

171

166

238

394

363

567

943

898

625

732

426

524

6,047

Shigellosis

671

600

609

923

917

1,298

1,406

1,213

1,179

1,530

1,314

1,692

13,352

Spotted fever rickettsiosis, total

23

24

29

64

135

191

542

482

305

324

181

502

2,802

confirmed

8

6

14

14

23

59

39

20

21

14

16

234

probable

15

24

22

49

121

168

480

443

285

302

167

486

2,562

Streptococcal toxic-shock syndrome

15

19

24

19

14

9

13

6

3

9

10

27

168

Streptococcus pneumoniae, invasive disease

all ages

1,786

1,870

1,952

2,153

1,445

1,014

755

556

668

1,222

1,308

2,409

17,138

age <5 yrs

118

125

177

198

113

78

70

49

72

124

133

202

1,459

Syphilis, total, all stages**,††

3,128

3,507

3,690

4,550

3,654

3,663

4,363

3,642

3,502

4,538

3,067

4,738

46,042

congenital (age <1 yr)**

35

47

27

27

28

26

36

32

28

19

28

27

360

primary and secondary**

905

1,043

1,099

1,369

1,032

1,074

1,306

1,119

1,114

1,423

970

1,516

13,970

Tetanus

1

2

4

5

1

5

3

5

2

4

4

36

Toxic-shock syndrome (other than streptococcal)

6

6

6

5

5

7

3

9

5

8

5

13

78

Trichinellosis

1

2

1

5

1

1

1

3

15

Tuberculosis§§

510

631

890

860

849

992

786

904

886

956

807

1,457

10,528

Tularemia

1

6

26

27

30

18

16

18

13

11

166

Typhoid fever

23

37

30

41

35

39

24

35

45

30

18

33

390

Vancomycin-intermediate Staphylococcus aureus (VISA)

4

4

4

9

5

5

10

7

9

9

6

10

82

Varicella (Chickenpox)

morbidity

1,121

1,089

1,382

1,677

1,406

952

744

629

1,002

1,679

1,230

1,602

14,513

mortality¶¶

2

1

1

1

5

Vibriosis

11

14

20

55

53

65

144

146

117

97

47

63

832

* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease; smallpox; vancomycin resistant staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on Hepatitis B virus, perinatal infection, and chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review.

Totals reported to the Division of Vector-Borne Diseases (DVBD), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) (ArboNET Surveillance), as of June 1, 2012.

§ Total number of HIV diagnoses case counts was reported to the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) through December 31, 2011.

Totals reported to the Division of Influenza, National Center for Immunization and Respiratory Diseases (NCIRD), as of December 31, 2011.

** Totals reported to the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), as of June 7, 2012.

†† 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 STD Prevention, NCHHSTP, as of June 7, 2012.

§§ Totals reported to the Division of Tuberculosis Elimination, NCHHSTP, as of June 25, 2012.

¶¶ Totals reported to the Division of Viral Diseases, NCIRD, as of June 30, 2012.


TABLE 2. Reported cases of notifiable diseases,* by geographic division and area — United States, 2011

Area

Total resident population (in thousands)

Anthrax

Arboviral diseases

California serogroup viruses

Eastern equine encephalitis virus

Powassan virus

St. Louis encephalitis virus

West Nile virus

Neuro- invasive

Nonneuro- invasive

Neuro- invasive

Neuro- invasive

Nonneuro- invasive

Neuro- invasive

Nonneuro- invasive

Neuro- invasive

Nonneuro- invasive

United States

309,049

1

120

17

4

12

4

4

2

486

226

New England

14,474

1

15

2

Connecticut

3,527

8

1

Maine

1,313

Massachusetts

6,631

1

5

1

New Hampshire

1,324

Rhode Island

1,057

1

Vermont

622

1

Mid. Atlantic

40,943

1

1

35

22

New Jersey

8,733

2

5

New York (Upstate)

11,146

1

19

14

New York City

8,431

9

2

Pennsylvania

12,633

1

5

1

E.N. Central

46,521

51

12

1

2

2

73

28

Illinois

12,944

1

22

12

Indiana

6,445

2

7

2

Michigan

9,931

1

32

2

Ohio

11,532

44

6

10

11

Wisconsin

5,669

3

6

1

2

2

2

1

W.N. Central

20,451

1

1

9

2

1

31

29

Iowa

3,023

5

4

Kansas

2,841

4

Minnesota

5,290

1

9

2

1

1

Missouri

6,012

1

1

6

4

Nebraska

1,811

14

15

North Dakota

654

1

3

South Dakota

820

2

S. Atlantic

59,659

1

52

5

1

67

27

Delaware

891

1

District of Columbia

611

10

5

Florida

18,678

1

1

20

4

Georgia

9,908

2

14

8

Maryland

5,737

1

10

9

North Carolina

9,459

26

2

South Carolina

4,597

1

Virginia

7,952

1

8

1

West Virginia

1,826

22

4

2

E.S. Central

18,367

15

1

56

24

Alabama

4,730

1

1

5

Kentucky

4,339

1

4

1

Mississippi

2,960

1

31

21

Tennessee

6,338

12

16

2

W.S. Central

36,376

3

28

11

Arkansas

2,910

3

1

Louisiana

4,529

6

4

Oklahoma

3,724

1

Texas

25,213

20

7

Mountain

22,380

1

71

35

Arizona

6,677

1

49

20

Colorado

5,095

2

5

Idaho

1,560

1

2

Montana

980

1

Nevada

2,655

12

4

New Mexico

2,034

4

Utah

2,831

1

2

Wyoming

548

1

2

Pacific

49,878

110

48

Alaska

709

California

37,267

110

48

Hawaii

1,300

Oregon

3,856

Washington

6,746

Territories

American Samoa

55

C.N.M.I.

54

Guam

159

Puerto Rico

3,722

U.S. Virgin Islands

106

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

* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, and chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review.

Totals reported to the Division of Vector-Borne Diseases (DVBD), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) (ArboNET Surveillance), as of April 17, 2012.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area — United States, 2011

Area

Babesiosis

Botulism

Brucellosis

Chancroid§

Chlamydia trachomatis infection§

Total

Foodborne

Infant

Other

United States

1,128

153

24

97

32

79

8

1,412,791

New England

378

1

2

48,146

Connecticut

74

13,649

Maine

9

3,094

Massachusetts

208

1

2

22,764

New Hampshire

13

3,010

Rhode Island

73

4,146

Vermont

1

1,483

Mid. Atlantic

584

29

2

27

7

181,856

New Jersey

166

11

11

1

26,209

New York (Upstate)

361

2

1

1

37,494

New York City

57

4

1

3

3

65,269

Pennsylvania

N

12

12

3

52,884

E.N. Central

80

3

2

1

10

1

219,580

Illinois

N

8

64,939

Indiana

1

1

27,801

Michigan

1

1

49,568

Ohio

N

2

1

1

1

52,653

Wisconsin

80

24,619

W.N. Central

74

2

1

1

1

78,726

Iowa

N

1

10,705

Kansas

N

1

1

10,598

Minnesota

73

1

1

16,902

Missouri

N

27,887

Nebraska

6,780

North Dakota

1

2,445

South Dakota

N

3,409

S. Atlantic

5

9

1

8

13

2

293,101

Delaware

1

2

2

4,508

District of Columbia

N

6,585

Florida

N

6

76,033

Georgia

1

1

5

54,403

Maryland

4

2

2

1

27,212

North Carolina

N

2

2

54,819

South Carolina

N

1

2

28,932

Virginia

N

2

2

36,314

West Virginia

N

4,295

E.S. Central

2

7

7

4

98,576

Alabama

1

1

29,626

Kentucky

N

2

2

16,629

Mississippi

N

2

2

1

21,216

Tennessee

1

3

3

2

31,105

W.S. Central

6

1

4

1

15

1

187,144

Arkansas

N

3

16,052

Louisiana

N

31,614

Oklahoma

N

1

1

1

14,596

Texas

N

5

4

1

11

1

124,882

Mountain

26

10

15

1

10

1

90,226

Arizona

N

5

2

3

3

1

29,251

Colorado

N

4

3

1

21,811

Idaho

N

2

2

2

4,699

Montana

3,406

Nevada

N

1

1

10,507

New Mexico

N

2

2

2

11,374

Utah

N

12

8

4

3

7,086

Wyoming

2,092

Pacific

5

71

8

34

29

18

1

215,436

Alaska

N

6

6

5,739

California

4

58

1

30

27

15

1

166,773

Hawaii

N

1

6,001

Oregon

1

2

1

1

1

13,643

Washington

5

3

2

1

23,280

Territories

American Samoa

C.N.M.I.

Guam

1,071

Puerto Rico

N

N

5,634

U.S. Virgin Islands

N

820

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

* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, and chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review.

Includes cases reported as wound and unspecified botulism.

§ Totals reported to the Division of STD Prevention, NCHHSTP, as of June 7, 2012.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area — United States, 2011

Area

Cholera

Coccidioidomycosis

Cryptosporidiosis

Cyclosporiasis

Dengue virus infection

Total

Confirmed

Probable

Dengue fever

Dengue hemorrhagic fever

United States

40

22,634

9,250

6,130

3,120

151

251

3

New England

4

2

418

358

60

12

4

Connecticut

N

71

71

10

1

Maine

N

51

19

32

N

Massachusetts

4

168

168

2

New Hampshire

1

68

40

28

Rhode Island

1

12

12

Vermont

N

48

48

N

3

Mid. Atlantic

14

6

904

824

80

38

69

New Jersey

1

N

56

55

1

8

New York (Upstate)

2

N

234

226

8

11

8

New York City

10

N

86

86

19

45

Pennsylvania

1

6

528

457

71

N

16

E.N. Central

2

56

2,676

1,476

1,200

7

21

2

Illinois

1

N

213

31

182

6

2

Indiana

N

261

79

182

2

Michigan

1

36

358

325

33

7

6

Ohio

20

1,106

303

803

2

Wisconsin

738

738

5

W.N. Central

1

130

1,563

714

849

3

13

Iowa

N

364

61

303

1

5

Kansas

1

N

42

42

1

Minnesota

104

309

309

6

Missouri

18

495

156

339

1

Nebraska

8

175

124

51

1

North Dakota

N

32

1

31

N

1

South Dakota

N

146

21

125

S. Atlantic

13

5

1,239

791

448

69

92

1

Delaware

7

7

1

2

District of Columbia

N

N

Florida

11

N

437

203

234

58

66

Georgia

1

N

307

307

6

6

Maryland

5

70

66

4

1

6

North Carolina

N

115

69

46

1

4

South Carolina

N

132

66

66

1

Virginia

1

N

140

54

86

2

7

1

West Virginia

N

31

19

12

E.S. Central

2

457

301

156

2

11

Alabama

N

138

16

122

N

4

Kentucky

2

N

177

160

17

N

4

Mississippi

N

50

50

N

Tennessee

N

92

75

17

2

3

W.S. Central

1

3

712

579

133

15

10

Arkansas

N

32

32

Louisiana

3

87

87

1

3

Oklahoma

N

89

2

87

Texas

1

N

504

458

46

14

7

Mountain

1

16,712

641

552

89

1

6

Arizona

16,467

46

42

4

2

Colorado

N

147

126

21

Idaho

N

111

79

32

N

Montana

5

77

77

N

Nevada

104

17

3

14

N

1

New Mexico

1

75

134

134

1

2

Utah

58

63

62

1

1

Wyoming

3

46

29

17

Pacific

2

5,720

640

535

105

4

25

Alaska

1

N

12

12

N

California

1

5,697

332

332

5

Hawaii

N

1

1

11

Oregon

13

207

179

28

Washington

10

88

11

77

4

9

Territories

American Samoa

N

N

N

C.N.M.I.

Guam

Puerto Rico

1

N

N

N

1,507

34

U.S. Virgin Islands

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

* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, and chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review.

Total number of reported laboratory-positive dengue cases including all confirmed cases (by anti-dengue virus [DENV] molecular diagnostic methods or seroconversion of anti-DENV IgM) and all probable cases (by a single, positive anti-DENV IgM). Totals reported to the Division of Vector-Borne Diseases (DVBD), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) (ArboNET Surveillance), as of April 17, 2012.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area — United States, 2011

Area

Ehrlichiosis/Anaplasmosis

Giardiasis

Gonorrhea

Anaplasma phagocytophilum

Ehrlichia chaffeensis

Ehrlichia ewingii

Undetermined

United States

2,575

850

13

148

16,747

321,849

New England

461

4

2

1,594

5,612

Connecticut

152

233

2,449

Maine

26

1

171

272

Massachusetts

172

758

2,353

New Hampshire

31

1

1

130

130

Rhode Island

72

2

1

79

360

Vermont

8

223

48

Mid. Atlantic

482

108

25

3,293

41,824

New Jersey

126

60

7

437

7,348

New York (Upstate)

314

41

11

1,144

6,240

New York City

36

4

917

14,466

Pennsylvania

6

3

7

795

13,770

E.N. Central

710

42

58

2,657

58,022

Illinois

11

25

407

17,037

Indiana

18

324

6,569

Michigan

4

5

550

12,901

Ohio

9

6

1

799

16,726

Wisconsin

690

7

34

577

4,789

W.N. Central

808

178

6

25

1,769

16,420

Iowa

N

N

N

N

271

1,920

Kansas

6

18

1

139

2,209

Minnesota

770

7

1

10

672

2,284

Missouri

25

151

5

13

344

7,802

Nebraska

1

1

1

179

1,352

North Dakota

3

54

251

South Dakota

3

1

110

602

S. Atlantic

72

272

6

16

2,756

79,089

Delaware

1

15

2

34

827

District of Columbia

N

N

N

N

56

2,569

Florida

11

15

1,255

19,689

Georgia

11

23

1

3

651

16,428

Maryland

7

33

2

291

6,458

North Carolina

21

83

1

N

17,454

South Carolina

2

1

117

8,350

Virginia

21

100

1

9

290

6,518

West Virginia

1

2

62

796

E.S. Central

15

78

1

14

171

27,134

Alabama

4

5

171

9,132

Kentucky

16

N

4,521

Mississippi

1

3

N

5,814

Tennessee

10

54

1

14

N

7,667

W.S. Central

20

167

1

349

49,001

Arkansas

8

53

123

4,687

Louisiana

1

1

226

9,169

Oklahoma

9

110

4,215

Texas

2

4

N

30,930

Mountain

1

5

1,326

11,336

Arizona

4

133

4,564

Colorado

N

N

N

N

445

2,363

Idaho

N

N

N

N

178

162

Montana

N

N

N

N

86

85

Nevada

79

2,000

New Mexico

N

N

N

N

108

1,839

Utah

1

256

277

Wyoming

1

41

46

Pacific

6

1

2

2,832

33,411

Alaska

N

N

N

N

101

984

California

2

1,728

27,516

Hawaii

N

N

N

N

38

685

Oregon

6

436

1,489

Washington

1

529

2,737

Territories

American Samoa

N

N

N

N

C.N.M.I.

Guam

N

N

N

N

96

Puerto Rico

N

N

N

N

84

341

U.S. Virgin Islands

139

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

* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, and chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review.

Totals reported to the Division of STD Prevention, NCHHSTP, as of June 7, 2012.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area — United States, 2011

Area

Haemophilus influenza, invasive disease

Hansen disease (leprosy)

Hantavirus pulmonary syndrome

Hemolytic uremic syndrome, postdiarrheal

All ages, serotypes

Age <5 years

Serotype b

Nonserotype b

Unknown serotype

United States

3,539

14

145

226

82

23

290

New England

252

9

6

3

12

Connecticut

65

4

N

2

Maine

26

1

N

2

Massachusetts

121

7

2

5

New Hampshire

17

1

1

Rhode Island

16

1

2

Vermont

7

1

N

1

Mid. Atlantic

771

13

45

4

1

21

New Jersey

123

9

4

New York (Upstate)

195

8

1

N

1

13

New York City

187

15

4

4

Pennsylvania

266

5

20

N

E.N. Central

645

3

30

28

3

36

Illinois

188

6

8

7

Indiana

117

1

9

1

Michigan

72

14

9

Ohio

173

2

15

2

5

Wisconsin

95

6

15

W.N. Central

224

2

4

23

2

2

49

Iowa

3

1

13

Kansas

23

3

4

Minnesota

71

1

3

12

Missouri

80

13

2

20

Nebraska

30

1

1

4

North Dakota

16

3

N

South Dakota

1

1

S. Atlantic

783

2

25

46

14

24

Delaware

6

District of Columbia

1

N

N

Florida

232

23

11

4

Georgia

140

10

10

7

Maryland

95

1

7

1

2

2

North Carolina

85

8

5

South Carolina

79

2

3

3

Virginia

108

1

5

1

3

West Virginia

37

1

1

N

E.S. Central

225

3

14

7

1

25

Alabama

57

1

5

N

9

Kentucky

41

1

4

N

Mississippi

19

1

1

1

N

1

Tennessee

108

1

7

3

15

W.S. Central

163

9

13

19

41

Arkansas

35

5

2

12

Louisiana

53

13

1

Oklahoma

73

4

N

7

Texas

2

N

N

16

22

Mountain

294

3

31

16

2

16

25

Arizona

95

1

13

2

3

5

Colorado

67

5

3

6

Idaho

21

2

1

1

3

Montana

3

2

1

Nevada

17

3

1

2

2

New Mexico

47

2

10

5

2

Utah

42

2

9

1

5

Wyoming

2

1

Pacific

182

1

10

42

34

4

57

Alaska

26

11

N

N

California

44

27

14

42

Hawaii

32

4

20

1

Oregon

72

3

N

2

14

Washington

8

1

7

N

2

Territories

American Samoa

N

N

C.N.M.I.

Guam

N

Puerto Rico

N

U.S. Virgin Islands

N

N

N

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

* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, and chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area — United States, 2011

Area

Hepatitis, viral, acute

HIV diagnoses

Influenza-associated pediatric mortality§

Legionellosis

Listeriosis

A

B

C

United States

1,398

2,903

1,229

35,266

118

4,202

870

New England

77

97

88

1,003

4

406

61

Connecticut

18

19

47

305

1

81

18

Maine

6

8

12

46

1

18

4

Massachusetts

39

67

23

523

1

240

32

New Hampshire

3

N

40

26

4

Rhode Island

8

U

U

88

29

3

Vermont

6

6

1

1

12

Mid. Atlantic

252

291

140

5,628

15

1,353

158

New Jersey

79

73

53

812

4

235

33

New York (Upstate)

47

54

44

1,301

2

400

48

New York City

66

80

8

2,246

3

216

30

Pennsylvania

60

84

35

1,269

6

502

47

E.N. Central

214

353

143

3,641

19

864

116

Illinois

73

85

6

1,351

7

151

34

Indiana

24

70

84

434

2

71

11

Michigan

70

91

32

610

6

187

29

Ohio

39

90

6

987

1

386

29

Wisconsin

8

17

15

259

3

69

13

W.N. Central

59

124

35

1,085

9

122

62

Iowa

8

15

116

11

5

Kansas

4

15

8

126

14

14

Minnesota

27

20

17

283

3

29

6

Missouri

13

60

8

481

1

55

21

Nebraska

5

12

2

46

8

9

North Dakota

12

1

3

6

South Dakota

2

2

21

4

2

1

S. Atlantic

222

775

284

10,925

22

640

111

Delaware

2

13

U

99

24

District of Columbia

495

N

N

Florida

87

213

64

4,890

2

185

38

Georgia

27

142

53

1,431

4

55

9

Maryland

26

62

35

851

143

19

North Carolina

31

109

60

1,439

10

83

21

South Carolina

11

39

1

771

25

6

Virginia

30

84

25

857

5

93

15

West Virginia

8

113

46

92

1

32

3

E.S. Central

48

519

248

2,191

2

180

22

Alabama

8

119

23

592

29

9

Kentucky

10

151

142

233

2

53

4

Mississippi

7

57

U

552

14

4

Tennessee

23

192

83

814

84

5

W.S. Central

157

423

97

4,967

16

165

79

Arkansas

3

57

199

14

6

Louisiana

5

62

7

1,281

1

25

7

Oklahoma

11

100

53

262

4

15

15

Texas

138

204

37

3,225

11

111

51

Mountain

129

88

85

1,410

12

147

98

Arizona

77

14

U

494

4

46

8

Colorado

21

23

28

362

3

41

51

Idaho

6

2

12

16

9

5

Montana

3

9

17

1

3

Nevada

5

29

10

320

3

16

5

New Mexico

7

10

14

111

1

12

15

Utah

8

10

10

76

1

18

5

Wyoming

2

2

14

4

6

Pacific

240

233

109

4,416

19

325

163

Alaska

4

3

25

California

186

157

48

3,679

16

261

123

Hawaii

8

6

50

1

5

12

Oregon

11

32

20

213

1

22

9

Washington

31

35

41

449

1

37

19

Territories

American Samoa

N

N

C.N.M.I.

Guam

43

120

70

1

Puerto Rico

21

28

N

436

9

U.S. Virgin Islands

5

22

1

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

* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, and chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review.

Total number of HIV cases reported to the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) through December 31, 2011.

§ Totals reported to the Division of Influenza, National Center for Immunization and Respiratory Diseases (NCIRD), as of December 31, 2011.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area — United States, 2011

Area

Lyme disease

Malaria

Measles

Total

Confirmed

Probable

Total

Indigenous

Imported

United States

33,097

24,364

8,733

1,724

220

140

80

New England

8,602

6,080

2,522

109

28

18

10

Connecticut

3,039

2,004

1,035

20

1

1

Maine

1,006

801

205

6

Massachusetts

2,476

1,801

675

68

24

17

7

New Hampshire

1,299

887

412

3

1

1

Rhode Island

159

111

48

6

1

1

Vermont

623

476

147

6

1

1

Mid. Atlantic

14,114

11,255

2,859

438

49

35

14

New Jersey

4,262

3,398

864

97

4

3

1

New York (Upstate)

3,759

2,678

1,081

53

7

4

3

New York City

731

440

291

227

25

16

9

Pennsylvania

5,362

4,739

623

61

13

12

1

E.N. Central

4,094

2,808

1,286

174

21

15

6

Illinois

194

194

66

3

1

2

Indiana

94

81

13

14

14

13

1

Michigan

104

89

15

34

2

1

1

Ohio

53

36

17

41

Wisconsin

3,649

2,408

1,241

19

2

2

W.N. Central

2,291

1,304

987

109

34

30

4

Iowa

100

72

28

22

1

1

Kansas

17

11

6

10

6

6

Minnesota

2,124

1,185

939

46

26

23

3

Missouri

8

5

3

21

Nebraska

11

7

4

8

North Dakota

27

22

5

1

1

South Dakota

4

2

2

2

S. Atlantic

3,637

2,720

917

478

20

7

13

Delaware

873

767

106

7

1

1

District of Columbia

N

18

N

Florida

115

78

37

99

8

3

5

Georgia

32

32

91

Maryland

1,351

938

413

128

2

2

North Carolina

88

18

70

49

2

2

South Carolina

37

24

13

7

Virginia

1,023

756

267

78

7

3

4

West Virginia

118

107

11

1

E.S. Central

69

20

49

41

4

1

3

Alabama

24

9

15

9

Kentucky

3

3

10

1

1

Mississippi

5

3

2

1

Tennessee

37

5

32

21

3

1

2

W.S. Central

78

31

47

121

6

5

1

Arkansas

7

Louisiana

2

1

1

2

Oklahoma

2

2

10

Texas

74

28

46

102

6

5

1

Mountain

52

32

20

67

20

13

7

Arizona

15

8

7

21

2

2

Colorado

24

Idaho

4

3

1

2

Montana

11

9

2

2

Nevada

5

3

2

8

1

1

New Mexico

6

2

4

5

4

1

3

Utah

9

6

3

5

13

12

1

Wyoming

2

1

1

Pacific

160

114

46

187

38

16

22

Alaska

11

9

2

5

California

92

79

13

129

31

12

19

Hawaii

N

N

N

7

Oregon

38

9

29

22

3

2

1

Washington

19

17

2

24

4

2

2

Territories

American Samoa

N

1

C.N.M.I.

Guam

Puerto Rico

N

1

U.S. Virgin Islands

N

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

* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, and chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review.

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, 2011

Area

Meningococcal disease

Mumps

Novel influenza A virus infections

All serogroups

Serogroup A, C, Y, and W-135

Serogroup B

Serogroup other

Serogroup unknown

United States

759

257

159

20

323

404

14

New England

29

18

7

2

2

12

2

Connecticut

3

2

1

Maine

5

3

2

2

2

Massachusetts

14

8

3

2

1

4

New Hampshire

1

1

Rhode Island

1

1

5

Vermont

5

4

1

1

Mid. Atlantic

92

20

5

1

66

55

3

New Jersey

13

13

13

New York (Upstate)

23

18

4

1

10

New York City

31

31

29

Pennsylvania

25

2

1

22

3

3

E.N. Central

115

59

44

6

6

110

3

Illinois

35

19

12

1

3

78

Indiana

25

12

12

1

3

2

Michigan

12

4

6

1

1

9

Ohio

24

13

7

2

2

16

Wisconsin

19

11

7

1

4

1

W.N. Central

63

15

15

3

30

35

4

Iowa

14

6

6

1

1

8

3

Kansas

5

5

4

Minnesota

15

6

8

1

2

1

Missouri

15

15

11

Nebraska

11

3

1

1

6

6

North Dakota

4

South Dakota

3

3

S. Atlantic

135

42

23

4

66

46

2

Delaware

1

1

District of Columbia

1

1

2

Florida

51

51

11

Georgia

14

10

1

2

1

5

Maryland

15

10

4

1

2

North Carolina

15

10

4

1

9

South Carolina

9

5

4

3

Virginia

18

3

8

7

13

West Virginia

11

4

2

1

4

1

2

E.S. Central

31

13

10

2

6

6

Alabama

11

4

5

2

2

Kentucky

8

3

1

1

3

Mississippi

3

1

1

1

3

Tennessee

9

5

3

1

1

W.S. Central

70

25

20

1

24

76

Arkansas

12

5

5

2

4

Louisiana

16

16

Oklahoma

12

7

4

1

4

Texas

30

13

11

6

68

Mountain

55

32

17

6

11

Arizona

16

7

5

4

Colorado

9

5

4

7

Idaho

7

6

1

2

Montana

4

4

Nevada

5

3

1

1

New Mexico

3

2

1

1

Utah

11

9

2

Wyoming

1

Pacific

169

33

18

1

117

53

Alaska

2

2

1

California

110

110

43

Hawaii

4

1

1

2

3

Oregon

31

22

6

3

4

Washington

22

10

12

2

Territories

American Samoa

C.N.M.I.

Guam

3

Puerto Rico

4

U.S. Virgin Islands

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

* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, and chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area — United States, 2011

Area

Pertussis

Plague

Psittacosis

Q fever

Rabies

Total

Acute

Chronic

Animal

Human

United States

18,719

3

2

134

110

24

4,357

6

New England

870

2

1

1

344

2

Connecticut

68

N

195

Maine

205

2

1

1

66

Massachusetts

271

2

New Hampshire

170

N

N

25

Rhode Island

62

27

Vermont

94

N

N

31

Mid. Atlantic

2,305

1

14

11

3

835

2

New Jersey

312

6

6

1

New York (Upstate)

928

5

2

3

370

1

New York City

323

1

1

13

Pennsylvania

742

1

2

2

452

E.N. Central

4,526

1

20

16

4

195

Illinois

1,509

4

4

51

Indiana

367

1

1

28

Michigan

691

1

10

8

2

65

Ohio

767

1

1

51

Wisconsin

1,192

4

2

2

N

W.N. Central

1,636

5

3

2

197

Iowa

232

N

N

25

Kansas

145

31

Minnesota

658

1

1

56

Missouri

438

1

1

29

Nebraska

56

2

1

1

33

North Dakota

70

23

South Dakota

37

1

1

S. Atlantic

1,506

18

15

3

1,147

1

Delaware

29

District of Columbia

9

N

N

Florida

312

3

3

120

Georgia

179

2

2

Maryland

123

2

2

305

North Carolina

198

5

5

South Carolina

156

2

1

1

N

1

Virginia

399

3

1

2

618

West Virginia

101

1

1

104

E.S. Central

481

2

2

162

Alabama

143

1

1

83

Kentucky

179

1

1

16

Mississippi

49

Tennessee

110

63

W.S. Central

1,140

27

24

3

1,144

Arkansas

80

5

5

60

Louisiana

31

6

Oklahoma

68

3

3

60

Texas

961

N

19

16

3

1,018

Mountain

2,574

2

21

18

3

75

Arizona

867

2

1

1

N

Colorado

416

3

2

1

Idaho

192

6

Montana

134

15

14

1

N

Nevada

34

17

New Mexico

273

2

19

Utah

645

7

Wyoming

13

1

1

26

Pacific

3,681

1

25

22

3

258

1

Alaska

27

14

California

2,319

16

16

216

1

Hawaii

59

Oregon

314

1

1

1

17

Washington

962

8

6

2

11

Territories

American Samoa

N

N

N

N

N

C.N.M.I.

Guam

7

N

Puerto Rico

8

N

47

U.S. Virgin Islands

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

* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, and chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area — United States, 2011

Area

Rubella

Salmonellosis

Shiga toxin-producing E. coli (STEC)

Shigellosis

Spotted fever rickettsiosis§

Total

Confirmed

Probable

United States

4

51,887

6,047

13,352

2,802

234

2,562

New England

1

2,106

212

271

10

2

8

Connecticut

466

57

41

Maine

134

28

32

1

1

Massachusetts

1

1,049

80

179

4

4

New Hampshire

178

22

4

3

2

1

Rhode Island

194

8

9

2

2

Vermont

85

17

6

Mid. Atlantic

5,649

663

1,430

179

4

175

New Jersey

1,222

143

481

136

2

134

New York (Upstate)

1,423

221

378

12

2

10

New York City

1,132

90

448

12

12

Pennsylvania

1,872

209

123

19

19

E.N. Central

5,119

1,023

925

120

8

106

Illinois

1,694

241

262

51

51

Indiana

634

132

88

33

3

24

Michigan

854

152

190

4

4

Ohio

1,187

183

314

21

3

18

Wisconsin

750

315

71

11

2

9

W.N. Central

3,001

1,021

381

301

21

280

Iowa

448

189

18

7

7

Kansas

463

108

72

Minnesota

717

285

87

11

11

Missouri

900

282

182

270

13

257

Nebraska

252

103

14

10

5

5

North Dakota

59

13

2

2

2

South Dakota

162

41

6

1

1

S. Atlantic

1

15,305

624

3,921

751

128

623

Delaware

175

16

6

20

20

District of Columbia

92

6

35

4

1

3

Florida

5,923

103

2,635

12

3

9

Georgia

2,645

122

670

88

88

Maryland

1,010

71

94

29

3

26

North Carolina

1

2,519

155

225

327

16

311

South Carolina

1,567

18

142

36

12

24

Virginia

1,208

123

107

231

5

226

West Virginia

166

10

7

4

4

E.S. Central

4,364

296

1,025

370

15

355

Alabama

1,266

74

322

79

5

74

Kentucky

606

75

252

4

3

1

Mississippi

1,438

37

241

24

1

23

Tennessee

1,054

110

210

263

6

257

W.S. Central

8,333

655

3,397

955

21

934

Arkansas

848

61

96

558

10

548

Louisiana

1,440

20

487

10

10

Oklahoma

827

88

275

335

8

327

Texas

5,218

486

2,539

52

3

49

Mountain

2,599

706

880

103

32

71

Arizona

886

126

434

77

31

46

Colorado

522

169

89

3

3

Idaho

143

117

17

2

2

Montana

120

37

124

1

1

Nevada

175

42

36

2

2

New Mexico

341

43

123

Utah

338

142

55

8

1

7

Wyoming

74

30

2

10

10

Pacific

2

5,411

847

1,122

13

3

10

Alaska

54

N

5

N

California

4,072

504

908

8

2

6

Hawaii

332

9

48

N

N

N

Oregon

364

136

57

1

1

Washington

2

589

198

104

4

1

3

Territories

American Samoa

1

N

C.N.M.I.

Guam

2

19

16

N

Puerto Rico

468

6

N

U.S. Virgin Islands

6

N

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

* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, and chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review.

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

§ Total case count includes six unknown case status reports.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area — United States, 2011

Area

Streptococcal toxic-shock syndrome

Streptococcus pneumoniae, invasive disease

Syphilis§

Tetanus

Toxic-shock syndrome

All ages

Age <5 years

All stages

Congenital (age <2 yr)

Primary and secondary

United States

168

17,138

1,459

46,042

360

13,970

36

78

New England

25

807

54

1,110

416

1

3

Connecticut

N

354

14

189

65

N

Maine

12

136

4

24

12

Massachusetts

6

38

19

770

266

2

New Hampshire

110

5

33

18

1

Rhode Island

97

5

84

46

1

Vermont

7

72

7

10

9

Mid. Atlantic

54

2,598

138

6,882

23

1,688

1

13

New Jersey

23

680

43

971

5

232

1

New York (Upstate)

25

1,183

56

881

13

194

4

New York City

735

39

3,905

889

Pennsylvania

6

N

N

1,125

5

373

1

8

E.N. Central

37

3,283

262

4,812

37

1,845

8

16

Illinois

N

76

2,426

18

881

1

5

Indiana

13

819

40

468

173

2

Michigan

6

694

36

762

6

286

4

5

Ohio

18

1,278

83

954

13

440

1

Wisconsin

492

27

202

65

2

4

W.N. Central

835

112

982

1

330

4

10

Iowa

N

N

70

20

1

Kansas

N

N

76

24

1

1

Minnesota

580

47

367

139

1

3

Missouri

N

35

414

1

136

2

2

Nebraska

121

12

36

10

3

North Dakota

91

4

5

1

South Dakota

43

14

14

S. Atlantic

30

4,009

376

10,619

72

3,448

6

14

Delaware

1

52

124

27

District of Columbia

55

6

552

1

165

Florida

N

1,324

138

4,142

32

1,257

3

N

Georgia

1,173

94

1,895

10

678

2

10

Maryland

N

587

51

1,278

24

452

N

North Carolina

15

N

N

1,254

5

431

1

South Carolina

2

452

29

639

221

1

3

Virginia

7

N

33

726

213

N

West Virginia

5

366

25

9

4

E.S. Central

5

1,408

121

2,866

26

826

3

4

Alabama

N

42

10

758

10

228

2

Kentucky

5

226

23

335

2

129

2

Mississippi

N

148

14

748

6

191

1

N

Tennessee

992

74

1,025

8

278

2

W.S. Central

2,090

229

8,946

142

1,882

6

1

Arkansas

228

14

464

15

182

1

1

Louisiana

259

25

2,043

18

447

3

Oklahoma

N

N

37

270

2

84

N

Texas

N

1,603

153

6,169

107

1,169

2

N

Mountain

17

1,963

155

2,036

17

648

4

6

Arizona

767

55

906

14

274

2

2

Colorado

494

38

367

133

2

Idaho

N

5

42

13

1

Montana

N

20

N

9

7

N

Nevada

1

124

6

430

3

136

1

New Mexico

329

24

212

71

Utah

16

206

27

64

14

1

Wyoming

23

6

1

Pacific

145

12

7,789

42

2,887

3

11

Alaska

138

10

11

5

N

California

N

N

N

6,782

40

2,443

3

11

Hawaii

7

2

32

14

N

Oregon

N

N

N

252

97

N

Washington

N

N

N

712

2

328

N

Territories

American Samoa

N

N

N

C.N.M.I.

Guam

26

5

Puerto Rico

N

671

2

254

1

N

U.S. Virgin Islands

7

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

* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, and chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review.

The previous categories of invasive pneumococcal disease among children aged <5 years and invasive, drug-resistant Streptococcus pneumoniae were eliminated. All cases of invasive S. pneumoniae disease, regardless of age or drug resistance are reported under a single disease code.

§ 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 STD Prevention, NCHHSTP, as of June 7, 2012.


TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area — United States, 2011

Area

Trichinellosis

Tuberculosis

Tularemia

Typhoid fever

Vancomycin-intermediate Staphylococcus aureus

United States

15

10,528

166

390

82

New England

1

334

8

29

6

Connecticut

83

5

1

Maine

1

9

Massachusetts

196

8

24

5

New Hampshire

11

N

Rhode Island

27

Vermont

8

Mid. Atlantic

2

1,501

4

93

35

New Jersey

1

331

3

39

4

New York (Upstate)

1

221

15

23

New York City

689

26

4

Pennsylvania

260

1

13

4

E.N. Central

2

844

8

45

14

Illinois

359

5

28

3

Indiana

1

100

1

4

N

Michigan

170

6

5

Ohio

1

145

1

3

5

Wisconsin

70

1

4

1

W.N. Central

2

356

49

15

3

Iowa

40

3

4

N

Kansas

36

11

4

N

Minnesota

2

137

3

2

Missouri

98

21

1

1

Nebraska

23

4

3