 |
 |
| DISSS Home | Contact Us |
| ||||||||
|
|
|
|
|
|
| ||
|
|
| ||||||
.gif){kind=spacer} 
|
|
|
|||||||||||||||||||||||||||||||||||||||||||||
|
|
||||||||||||||||||||||||||||||||||||
|
| ||||||||||||||||||||||||||||||||||||
This section presents information on the public health importance of selected nationally notifiable diseases reported from the states to CDC, including a) domestic and some international disease outbreaks, b) active surveillance findings, c) changes in data reporting practices, d) the impact of prevention programs, e) the emergence of antimicrobial resistance, and f) changes in immunization policies. This information is intended to provide a context in which to interpret surveillance and disease-trend data and to provide further information on the epidemiology and prevention of selected diseases.
As of December 31, 2000, a total of 774,467 acquired immunodeficiency syndrome (AIDS) cases were reported; 448,060 cases resulted in death, and 3,542 cases had unknown vital status. Of the total, approximately one third of cases were reported during 1993-1995 and 1996-2000; the remaining third were reported before 1993. The number of persons presumed living with AIDS (322,865) at the end of 2000 was the highest ever reported; of these persons, 79% were men, 61% were black or Hispanic, and 41% were infected through male-to-male sex. Since 1981, approximately 85% of persons diagnosed with AIDS have been aged 20-49 years (1).
From January 1998 through June 2000, AIDS incidence and deaths leveled off, but AIDS prevalence continued to increase. The number of reported cases is affected by epidemic trends and other factors that can affect case reporting (e.g., changes in the AIDS surveillance case definition and widespread introduction of effective treatments).
To provide better data for prevention of human immunodeficiency virus (HIV) infection (the virus that causes AIDS), CDC and CSTE recommend that national surveillance include the monitoring of both HIV infection and AIDS (2,3). CDC supports several supplemental surveillance projects that collect data on barriers to preventing AIDS cases and death of persons with AIDS, including access to HIV testing and treatment in accordance with current public health service guidelines.
1. CDC. HIV and AID—SUnited States, 1981-2000. MMWR 2001;50:430-4.
2. CDC. Guidelines for national human immunodeficiency virus case surveillance, including monitoring for human immunodeficiency virus infection and acquired immunodeficiency syndrome. MMWR 1999;48(No. RR-13):1-11.
3. Council of State and Territorial Epidemiologists. CSTE position statement ID-4: National HIV surveillance—addition to the National Public Health Surveillance System. Atlanta, GA: Council of State and Territorial Epidemiologists, 1997.
During 2000, a total of 78 cases of chancroid were reported (rate: 0.03 cases/100,000 population), representing a 45% decline from 1999 and a continuing decline since 1987 (1). However, chancroid is difficult to culture and could be substantially underdiagnosed. Several studies that used DNA amplification tests (which are not commercially available) have identified this infection in cities where it was previously undetected (2).
1. CDC. Sexually transmitted disease surveillance 2000. Atlanta, GA: US Department of Health and Human Services, Public Health Service, CDC, 2001.
2. Mertz KJ, Trees D, Levine WC, et al. Etiology of genital ulcers and prevalence of human immunodeficiency virus coinfection in 10 US cities. The Genital Ulcer Disease Surveillance Group. J Infect Dis 1998;178:1795-8.
During 2000, a total of 702,093 cases of genital chlamydial infection were reported (rate: 257.5/100,000). This rate was the highest since voluntary case reporting began in the mid-1980s and the highest since genital chlamydial infection became a nationally notifiable disease in 1995 (1). This increase could be caused in part by the continued expansion of chlamydia screening programs and increased use of more sensitive diagnostic tests for this condition. Since the late 1980s, data on chlamydia prevalence obtained by monitoring test positivity rates of persons screened in different clinic settings have generally documented declining levels of infection in many parts of the United States (1).
1. CDC. Sexually transmitted disease surveillance 2000. Atlanta, GA: US Department of Health and Human Services, Public Health Service, CDC, 2001.
During 1995-2000, a total of 61 laboratory-confirmed cases of cholera, all caused by Vibrio cholerae O1, were reported. Thirty-five (57%) patients were hospitalized, and one died. Thirty-seven (61%) infections were acquired outside the United States, whereas six (10%) were acquired through consumption of contaminated seafood harvested in Gulf Coast waters. Among the 37 travel-associated cholera cases, 31% of isolates were resistant to trimethoprim-sulfamethoxazole, sulfisoxazole, streptomycin, and furazolidone. Thus, foreign travel and contaminated seafood continue to account for most cholera cases in the United States, and antimicrobial resistance is increasing among V. cholerae O1 strains isolated from ill travelers (1). Production and sale of the only licensed cholera vaccine in the United States ceased in 2001.
1. Steinberg EB, Greene KD, Bopp CA, Cameron DN, Wells JG, Mintz ED. Cholera in the United States, 1995-2000: trends at the end of the millennium. J Infect Dis 2001;184:799--802.
During 2000, one confirmed case of diphtheria was reported from California in a female patient aged 86 years who had acute membranous pharyngitis. A culture taken from the patient was positive for Corynebacterium diphtheriae, but toxigenicity testing was not conducted. Non-toxigenic C. diphtheriae can cause localized membranous pharyngitis.
During 2000, the second full year of national reporting of the emerging tick-borne zoonosis ehrlichiosis, 200 cases of human monocytic ehrlichiosis (HME) and 351 cases of human granulocytic ehrlichiosis (HGE) were reported through NETSS. By comparison, 99 cases of HME and 203 cases of HGE were reported during 1999 (1) Through December 2000, ehrlichiosis was a notifiable disease in 36 states, compared with 19 states through August 1998 (2).
In 2000, CSTE changed the case definition for human ehrlichiosis. A third reporting category (i.e., ehrlichiosis, other or unspecified agent) was added to clarify reporting criteria and provide a mechanism for classifying and reporting cases caused by unspecified or novel Ehrlichia species, including E. ewingii (3).
In addition to reporting via NETSS, case information on the three categories of ehrlichiosis also should be reported on the revised Tick-Borne Rickettsial Disease Case Report form (CDC 55.1 Rev. 01/2001), which was distributed to state health departments in April 2001 and replaces all previous Rocky Mountain Spotted Fever Case Report forms. Copies of this form are available at <http://www.cdc.gov/ncidod/dvrd/ehrlichia> and <http://www.cdc.gov/ncidod/dvrd/rmsf>.
1. CDC. Summary of notifiable diseases, United States, 1999. MMWR 2001;48(No. 53):5.
2. McQuiston JH, Paddock CD, Holman RC, Childs JE. The human ehrlichioses in the United States. Emerg Infect Dis 1999;5:635-42.
3. Council of State and Territorial Epidemiologists. CSTE position statement ID-3: Changes in the case definition for human ehrlichiosis, and addition of a new ehrlichiosis category as a condition placed under surveillance according to the National Public Health Surveillance System (NPHSS). Atlanta, GA: Council of State and Territorial Epidemiologists, 2000. Available at <http://www.cste.org/ps/2000/2000-id-03.htm>.
During 1999, a summer epidemic of acute meningoencephalitis of unknown etiology in the greater New York City area, with 62 human cases and seven fatalities, signaled the first known introduction of West Nile virus from the Eastern Hemisphere to the Western Hemisphere (1). Urban Culex species were the apparent primary mosquito vectors to humans. Birds were the primary amplifying hosts, and unprecedented morbidity and mortality were observed among some native bird species, especially crows. Previously, the known geographic distribution of West Nile virus included Africa, West Asia, and Europe (2). West Nile virus is related closely to St. Louis encephalitis virus, historically the major cause of epidemic viral encephalitis in the United States.
During early 2000, West Nile virus was detected in dormant mosquitoes collected in the northeastern United States, indicating its successful overwintering and potential reemergence across a larger area of the eastern United States during the following spring and summer (3). During the summer and fall of 2000, a total of 21 cases of West Nile viral disease among humans were reported from the greater New York City area (14 in New York, six in New Jersey, and one in Connecticut); two of these cases were fatal (4).
1. Nash D, Mostashari F, Fine A, et al. The outbreak of West Nile virus infection in the New York City area. N Eng J Med 2001;344:1807-14.
2. Hayes CG. West Nile fever. In: Monath TP, ed. The arboviruses: epidemiology and ecology. Vol. V. Boca Raton, FL: CRC Press, 1989:59-88.
3. CDC. Update: West Nile virus isolated from mosquitoes—New York, 2000. MMWR 2000;49:211.
4. CDC. Human West Nile virus surveillance—Connecticut, New Jersey, and New York, 2000. MMWR 2001;50:265-8.
During 2000, a total of 358,995 cases of gonorrhea were reported (rate: 131.6/100,000). The 2000 rate was similar to rates for 1999 (132.0/100,000) and 1998 (121.4/100,000) (1). Although rates have stabilized, increases have been observed in some areas among men who have sex with men (2). Additionally, decreased susceptibility to the fluoroquinolone antibiotics and azithromycin has been reported from some regions (3).
1. CDC. Sexually transmitted disease surveillance 2000. Atlanta, GA: US Department of Health and Human Services, Public Health Service, CDC, 2001.
2. Fox KK, del Rio C, Holmes KK, et al. Gonorrhea in the HIV era: a reversal in trends among men who have sex with men. Am J Public Health 2001;91:1-5.
3. CDC. Fluoroquinolone-resistance in Neisseria gonorrhoeae, Hawaii, 1999, and decreased susceptibility to azithromycin in N. gonorrhoeae, Missouri, 1999. MMWR 2000;49:833-7.
During 2000, a total of 293 cases of Haemophilus influenzae (Hi) invasive disease among children aged <5 years were reported.** Before a vaccine was introduced in 1987, approximately 20,000 cases of H. influenzae type b (Hib) invasive disease occurred among children annually (1). Because of widespread use of the Hib vaccine among preschool-aged children, the number of Hib cases has declined sharply. Of the 293 cases reported during 2000, a total of 227 (78%) Hi isolates were serotyped, and 55 (24%) of these were type b. Among the 55 cases of Hib invasive disease reported among children aged <5 years, 23 (42%) were among those aged <6 months, who had not completed a two- or three-dose primary Hib vaccination. However, 23 (72%) of the 32 children who were old enough (i.e., aged >6 months) to have completed a three-dose primary series either had unknown vaccination status (six children) or were incompletely or not vaccinated (17 children). Data as of August 2001 are provided to the National Immunization Program Office.
1. Cochi SL, Broome CV, Hightower AW. Immunization of U.S. children with Haemophilus influenzae type b polysaccharide vaccine: a cost-effectiveness model of strategy assessment. JAMA 1985;253:521-9.
During 2000, a total of 41 probable cases of hantavirus pulmonary syndrome (HPS) were reported from 10 states. Of the 34 cases laboratory confirmed by CDC, seven (21%) were fatal. Since 1993, a total of 256 cases from 30 states have been confirmed. An additional 32 cases were identified retrospectively back to 1959. Cases of HPS have now been recognized in countries throughout the Western Hemisphere. Reports of confirmed cases in patients with mild disease that does not meet the clinical criteria for HPS are increasing (1). Treatment is available only for the symptoms of HPS, as a 1993-1994 open-label trial of the antiviral drug ribavirin did not suggest a benefit (2). Although most HPS in the United States is caused by Sin Nombre virus and its variants (i.e., New York and Monongahela), some cases have been associated with other hantaviruses, including Bayou and Black Creek Canal. Virus is shed in rodent urine, feces, and saliva and is primarily transmitted through inhalation. Since the initial recognition of HPS in 1993, researchers continue to investigate the probable relationship between environmental conditions and reports of HPS cases (3,4).
1. Kitsutani PI, Denton RW, Fritz CL, et al. Acute Sin Nombre hantavirus infection without pulmonary syndrome, United States. Emerg Infect Dis 1999;5:701--5. Available at <http://www.cdc.gov/ncidod/eid/vol5no5/kitsutani.htm>.
2. Chapman LE, Mertz GJ, Peters CJ, et al. Intravenous ribavirin for hantavirus pulmonary syndrome: safety and tolerance during 1 year of open-label experience. Antivir Ther 1999;4:211-9.
3. Glass GE, Cheek JE, Patz JA, et al. Using remotely sensed data to identify areas at risk for hantavirus pulmonary syndrome. Emerg Infect Dis 2000;6:238-47. Available at <http://www.cdc.gov/ncidod/eid/vol6no3/glass.htm>.
4. Hjelle B, Glass G. Outbreak of hantavirus infection
in the four corners region of the United States in the wake of the
1997-1998 El Niño-Southern Oscillation. J Infect Dis 2000;181:1569-73.
Abstract available at <http://www.journals.uchicago.edu/JID/journal
/issues/v181n5/991334/brief /991334.abstract.html>.
During 2000, the fifth year of national reporting, 24 states reported 249 cases of postdiarrheal hemolytic uremic syndrome (HUS). The median age of patients was 4 years (range: <1-91), and 56% were female. Illness was seasonal, with 45% of cases occurring from June through September. By comparison, 26 states reported 181 cases in 1999, and 17 states reported 119 cases in 1998. Though the number of areas reporting and the number of cases reported increased in 2000, the increased number of cases is likely a result of improved ascertainment rather than a change in incidence. Eight states and at least one territory did not list HUS as a notifiable disease in 2000, contributing to substantial underreporting.
Postdiarrheal HUS is a life-threatening illness characterized by hemolytic anemia, thrombocytopenia, and renal injury. In the United States, most cases are caused by infection with Escherichia coli O157:H7; some are caused by other Shiga toxin-producing E. coli (1,2).
1. Banatvala N, Griffin PM, Greene KD, et al. The United States prospective hemolytic uremic syndrome study: microbiologic, serologic, clinical, and epidemiologic findings. J Infect Dis 2001;183:1063-70.
2. CDC. Escherichia coli O111:H8 outbreak among teenage campers—Texas, 1999. MMWR 2000;49:321-4.
During 2000, the overall hepatitis A rate (4.9/100,000) reported was the lowest ever recorded. However, because hepatitis A rates tend to vary from year to year and from region to region, determining whether this low rate was caused by routine immunization or natural variability in infection rates is not possible. Monitoring hepatitis A incidence to determine if these low rates are sustained over time is critical to assessing the impact of routine vaccination.
Routine childhood hepatitis A vaccination is recommended in the 11 states where the average annual hepatitis A rate during 1987-1997 was >20 cases/100,000 (i.e., approximately twice the national average) (1). Routine childhood vaccination should be considered in the six states where the average rate during 1987-1997 was approximately 10-20/100,000.
1. CDC. Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(No. RR-12).
During 2000, a total of 8,036 acute hepatitis B cases were reported, representing a >60% decrease since 1990 (21,102 cases). Surveillance data are being used to monitor the impact of the national strategy for eliminating hepatitis B virus (HBV) infection. Healthy People 2010 objectives call for a 75%-90% reduction in the national incidence of hepatitis B among adults (baseline: 15-24 cases/100,000), a 99% reduction among children aged 2-18 years (baseline: 945 cases/year), and a 75% reduction in the number of perinatal HBV infections (baseline: 1,682 infections/year) (1).
Reported hepatitis B cases can be used to monitor the occurrence of disease among adults. However, because most infections among infants and young children are asymptomatic, reported cases underestimate the incidence of disease in these age groups. Thus, data from other sources (e.g., serosurveys) are needed to monitor progress to ward eliminating HBV transmission among younger age groups.
1. US Department of Health and Human Services. Healthy People 2010, vols I and II. 2nd ed. Washington, DC: US Government Printing Office, November 2000.
Cases of hepatitis C reported to CDC are considered unreliable because a) no serologic marker for acute infection exists and b) most health departments do not have the resources to determine if a positive laboratory report for hepatitis C virus (HCV) infection represents acute infection, chronic infection, repeated testing of a person previously reported, or a false-positive result (1). Historically, the most reliable national estimates of acute disease incidence have come from sentinel surveillance. After adjusting for underreporting and asymptomatic infections, the annual number of new infections has decreased >80% since 1989 to 35,000 cases in 1999 (CDC, unpublished data, 2000). Because surveillance for acute hepatitis C can be used to evaluate the effectiveness of prevention efforts and identify missed opportunities for prevention, efforts are underway to help states establish and improve surveillance.
1. CDC. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998;47(No. RR-19).
During 2000, a total of 21,704 cases of HIV infection (in the absence of AIDS diagnosis) in persons aged >13 years were reported. The number of reported cases of HIV infection is affected by epidemic trends as well as other factors (e.g., testing rates among populations at risk or when states initiated HIV case reporting). Before 1991, surveillance for HIV infection was not standardized, and reporting was primarily passive. CDC has since helped states conduct active surveillance for HIV infection using standardized report forms and software.
In December 1999, CDC published a revised HIV case definition (effective January 2000) for adults and children aged >18 months that includes laboratory criteria requiring positive HIV antibody test results or reports of a detectable quantity of HIV nucleic acid or plasma HIV RNA (1). As states have begun implementing laboratory-initiated reporting of viral load tests, they have identified additional HIV and AIDS cases.
HIV infection data should be interpreted with caution because not all infected persons have been tested and not all anonymous tests have been reported (2). Many factors influence testing patterns, including the extent that testing is targeted or routinely offered to specific groups and the availability of and access to medical care and testing services.
To provide better data for HIV prevention, CDC and CSTE recommend that national surveillance include both HIV infection and AIDS (1,3). An integrated national HIV/AIDS surveillance system would provide information regarding persons in whom HIV infection has been newly diagnosed, those with severe HIV disease (i.e., AIDS), and those dying of HIV disease.
1. CDC. Guidelines for national human immunodeficiency virus case surveillance, including monitoring for human immunodeficiency virus infection and acquired immunodeficiency syndrome. MMWR 1999;48(No. RR-13):1-11.
2. CDC. Diagnosis and reporting of HIV and AIDS in states with integrated HIV and AIDS surveillance—United States, January 1994-June 1997. MMWR 1998;47:309-14.
3. Council of State and Territorial Epidemiologists. CSTE position statement ID-4: National HIV surveillance—addition to the National Public Health Surveillance System. Atlanta, GA: Council of State and Territorial Epidemiologists, 1997.
As of December 31, 2000, all states and U.S. territories reported AIDS in children aged <13 years, and 34 states and two territories also conducted surveillance for HIV infection among children. During 2000, a total of 224 children whose HIV infection had not progressed to AIDS and 196 children who had AIDS were reported. Data for 2000 indicated continued declines in perinatally acquired AIDS, reflecting declines in perinatal HIV transmission (1). The increasing use of zidovudine (ZDV) by mothers and newborns was temporally associated with this decline, demonstrating success in nationwide efforts to implement guidelines for routine, voluntary prenatal HIV testing (2) and the use of ZDV to reduce perinatal HIV transmission (3).
Beginning January 1, 2000, the surveillance case definition for HIV infection was revised to reflect advances in laboratory HIV virologic tests and to incorporate the reporting criteria for HIV infection and AIDS into one case definition for adults and children (4). For children aged >18 months, the definition includes laboratory criteria requiring positive HIV antibody test results or reports of a detectable quantity of HIV nucleic acid or plasma HIV RNA (4). For children aged <18 months, the reporting criteria permit diagnosis of HIV infection during the first month of life. Children aged <18 months born to an HIV-infected mother are categorized as having perinatal exposure to HIV infection if they do not meet the criteria for either "HIV infection" or "not infected with HIV" (4,5).
1. CDC. US HIV and AIDS cases reported through June 2000. HIV/AIDS surveillance report 2000;12(No. 1):1-42. Available at <http://www.cdc.gov/hiv/stats/hasr1201.htm>.
2. CDC. US Public Health Service recommendations for human immunodeficiency virus counseling and voluntary testing for pregnant women. MMWR 1995;44(No. RR-7):1-15.
3. CDC. Public Health Service Task Force recommendations for the use of antiretroviral drugs in pregnant women infected with HIV-1 for maternal health and for reducing perinatal HIV-1 transmission in the United States. MMWR 1998;47(No. RR-2).
4. CDC. Guidelines for national human immunodeficiency virus case surveillance, including monitoring for human immunodeficiency virus infection and acquired immunodeficiency syndrome. MMWR 1999;48(No. RR-13):1-11.
5. CDC. Guidelines for the use of antiretroviral agents in pediatric HIV infection. MMWR 1998;47(No. RR-4):1-31.
During 2000, approximately 17,730 cases of Lyme disease were reported, most from the northeastern and north-central United States. CDC promotes community-based Lyme disease prevention using strategies aimed at reducing vector tick densities, preventing human exposure to infected vector ticks, and vaccinating persons aged 15-70 years when appropriate (1). CDC has funded new community-based prevention projects in Connecticut, Massachusetts, New Jersey, and New York.
1. CDC. Recommendations for the use of Lyme disease vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(No. RR-7):1-25.
During 2000, a total of 1,560 malaria cases were reported in the United States. Most cases were imported, with approximately half occurring among U.S. residents traveling to malarious areas and half occurring among foreign residents immigrating to or visiting the United States (1). Although the number of reported cases was similar to 1999 (1,666) (2), the annual number of cases has increased during the past 15 years. This increase was likely caused by increases in both international travel (3) and immigration (4), as well as the spread and intensification of antimalarial drug resistance globally (5).
1. MacArthur JR, Levin AR, Roberts J, et al. Malaria surveillance—United States, 1997. In: CDC Surveillance Summaries, March 30, 2001. MMWR 2001;50(No. SS-1):25-44.
2. CDC. Summary of notifiable diseases, United States, 1999. MMWR 1999;48:1-104.
3. International Trade Administration, Tourism Industries. US resident travel to overseas countries historical visitation outbound, 1988-1998 (one or more nights). Washington, DC: US Department of Commerce, International Trade Administration, Tourism Industries. Available at <http://www.tinet.ita.doc.gov/view/f-1998-11-001/index.html>.
4. US Census Bureau. Current population reports. Series P23-205. Population profile of the United States: 1999. Washington, DC: US Government Printing Office, 2001. Available at <http://www.census.gov/prod/2001pubs/p23-205.pdf>. Requires Adobe Acrobat Reader - available here.
5. Barat LM, Bloland PB. Drug resistance among malaria and other parasites. Infect Dis Clin North Am 1997;11:969-87.
During 2000, a total of 86 confirmed measles cases were reported. Thirty states and the District of Columbia did not report any confirmed cases. Thirty-seven case-patients were aged <5 years, 17 were aged 5-19 years, and 32 were aged >20 years. Ten outbreaks (range: 3-9 cases) were reported. Of the 86 cases reported, 26 were imported from outside the United States, and 19 cases were epidemiologically linked to imported cases. Nine additional cases had virologic evidence of importation (i.e., genotypic analysis of measles viruses indicated no evidence of an endemic strain). The remaining 32 cases were classified as unknown source cases because no link to importation was detected.
Rates of meningococcal disease have been relatively stable in the United States. A total of 2,256 cases were reported in 2000, of which 1,808 were confirmed, 111 probable, seven suspect, and 330 of unknown case status. Serogroup information was reported for 32% of cases, and serogroup Y accounted for 31% of those reported. Most other cases were caused by serogroup C (30%) or serogroup B (28%). Although rates of meningococcal disease are usually highest among children aged <1 year, 55% of cases in 2000 occurred among persons aged >18 years.
Using the technology applied to the development of Haemophilus influenzae type b (Hib) conjugate vaccines, several companies are in the final stages of developing and testing meningococcal conjugate vaccines with various serogroup-specific formulas and in combination with other antigens for licensure in the United States (1). Three serogroup C meningococcal conjugate vaccines were licensed and integrated into routine childhood immunization in the United Kingdom last year; early results confirm >90% efficacy in toddlers and teenagers (2).
1. Rosenstein NE, Perkins BA, Stephens DA, Popovic T, Hughes JM. Meningococcal disease. N Engl J Med 2000;344:1378-88.
2. Ramsey ME, Andrews N, Kaczmarski EB, Miller E. Efficacy of meningococcal serogroup C conjugate vaccine in teenagers and toddlers in England. Lancet 2000;357:195-6.
Because of the recommendation of two doses of MMR and its high coverage rate in the United States, mumps is at record low levels. During the 1990s, mumps cases declined substantially, from 5,292 reported cases in 1990 to 338 reported cases in 2000, meeting the Healthy People 2000 objective of <500 cases per year (1).
1. CDC. Mumps surveillance United States, 1988-1993. In: CDC surveillance summaries, August 11, 1995. MMWR 1995;44(No. SS-3).
During 2000, a total of 7,867 cases of pertussis were reported. Of these cases, 24% occurred among children too young to have received the recommended three doses of a pertussis-containing vaccine (i.e., those aged <7 months); 2% among children aged 7-11 months; 10% among preschool-aged children (aged 1-4 years); 8% among children aged 5-9 years; 36% among persons aged 10-19 years; and 20% among persons aged >20 years.
Since 1995, the coverage rate with >3 doses of a pertussis-containing vaccine has been 95% among U.S. children aged 19-35 months (1). Since 1990, the incidence of pertussis among preschool-aged children has not changed, but the incidence among adolescents has increased in some states (2). Because vaccine-induced immunity wanes approximately 5-10 years after pertussis vaccination, adolescents can become susceptible to disease. Pertussis deaths reported through NNDSS also increased in the 1990s, predominantly among infants too young to receive three doses (CDC, unpublished data, 2000).
Since 1980, the number of reported pertussis cases has increased in the United States (2). The reasons are unknown but could include increased awareness of pertussis among health-care providers, increased use of more sensitive diagnostic tests, better reporting of cases to health departments, and an increase in circulating pertussis.
1. CDC. National, state, and urban area vaccination coverage levels among children aged 19-35 months—United States, 1999. MMWR 2000;49:585-9.
2. Guris D, Strebel PM, Bardenheier B, et al. Changing epidemiology of pertussis in the United States: increasing reported incidence among adolescents and adults, 1990-1996. Clin Infect Dis 1999;28:1230-7.
During 2000, six cases of human plague were reported from six states (Arizona, California, Colorado, New Mexico, Utah, and Wyoming), representing <50% of the average number reported during the past 20 years (i.e., 13.1 cases/year during 1980-1999). None of the six cases were fatal, and all were acquired from naturally occurring sources. The low number of reported cases is possibly linked to hot summer and dry winter conditions during the past 2 years in the southwestern states of Arizona, New Mexico, Colorado, and Utah (1,2). CDC works cooperatively with state and local health departments and other federal agencies to improve human and animal-based plague surveillance programs, including the ability to detect human cases acquired from natural sources or as a result of bioterrorism. In 2000, these efforts included CDC participation in a bioterrorism exercise designed to test the abilities of public health and other agencies to respond to a large pneumonic plague outbreak caused by an aerosol release of Yersinia pestis in a major U.S. city (Denver) (3). The exercise highlighted the need for an improved understanding of concerns related to leadership, decision-making, prioritization and distribution of resources, formulation of appropriate principles for containment, and development of methods for managing the crises that would occur in health-care facilities during such an incident.
1. Parmenter RR, Yadav EP, Parmenter CA, Ettestad P, Gage KL. Incidence of plague associated with increased winter-spring precipitation in New Mexico. Am J Trop Med Hyg 1999;61:814-21.
2. Enscore RE, Biggerstaff BJ, Brown TL, et al. Modeling relationships between climate and the frequency of human plague in the southwestern United States, 1960-1997. Am J Trop Med Hyg 2001 (in press).
3. Inglesby TV, Grossman R, O'Toole T. A plague on your city: observations from TOPOFF. Clin Infect Dis 2000;32:436-45.
In January 2000, the Advisory Committee on Immunization Practices (ACIP) approved an all inactivated polio vaccine (IPV) schedule for routine childhood vaccination to eliminate the risk for vaccine-associated paralytic polio (VAPP) (1). Since implementation of this schedule, no cases of VAPP have been confirmed in the United States. Continued monitoring with additional observation time is required to confirm these preliminary findings because of potential delays in reporting.
Under the previous schedule of all oral poliovirus vaccine (OPV), which ended in 1997, an average eight VAPP cases were reported each year (2). Under the sequential polio vaccine schedule (two doses of IPV followed by two doses of OPV) used during 1997-1999, the number of VAPP cases declined steadily from seven cases in 1997 to two cases each in 1998 and 1999 (3).
1. CDC. Poliomyelitis prevention in the United States: updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2000;49(No. RR-5).
2. Strebel PM, Sutter RW, Cochi SL, et al. Epidemiology of poliomyelitis in the United States one decade after the last reported case of indigenous wild virus-associated disease. Clin Infect Dis 1992;14:568-79.
3. CDC. Poliomyelitis prevention in the United States: introduction of a sequential schedule of inactivated poliovirus vaccine followed by oral poliovirus vaccine. Recommendations of the Advisory Committee on Immunization Practices. MMWR 1997;46(No. RR-3).
Because of the success of the U.S. rubella vaccination program, rubella is at a record low level, with 176 reported cases in 2000. In recent years, surveillance data have indicated that rubella has disproportionately affected adults of Hispanic ethnicity, with an increase in the proportion of cases among Hispanics from 19% in 1991 to 78% in 2000. Rubella now mostly occurs among persons born in countries that do not have routine rubella vaccination programs or that have only recently implemented such programs.
1. Danovaro-Holliday MC, LeBaron CW, Allensworth C, et al. A large rubella outbreak with spread from the workplace to the community. JAMA 2000;284:2733-9.
2. CDC. Control and prevention of rubella: evaluation and management of suspected rubella outbreaks, rubella in pregnant women, and surveillance for congenital rubella. MMWR 2001;50(No. RR-12).
3. Reef SE, Plotkin S, Cordero JF, et al. Preparing for elimination of congenital rubella syndrome (CRS): summary of a workshop on CRS elimination in the United States. Clin Infect Dis 2000;31:85-95.
4. CDC. Rubella among Hispanic adults—Kansas, 1998 and Nebraska, 1999. MMWR 2000;49:225-8.
During 2000, a total of 32,021 Salmonella isolates were reported through the Public Health Laboratory Information System (PHLIS) (rate: 11.7/100,000), which was a 24% decrease from 1990 and a 2% decrease from 1999. Of the 2,449 known Salmonella serotypes, the two most commonly reported in 2000 were Typhimurium and Enteritidis, accounting for 42% of isolates. S. Typhimurium and S. Enteritidis have ranked first and second, respectively, in frequency since 1990, although their rankings reversed during 1994-1996 (1). According to a 1999 national survey, 49% of S. Typhimuriumisolates were resistant to more than one drug, and 28% had a five-drug resistance pattern characteristic of a single phage type, Definitive Type 104 (2). The number of reported S. Enteritidis isolates has decreased since the mid-1990s, possibly because of egg safety regulations and egg industry improvements in the 1990s (3).
1. Olsen SJ, Bishop R, Brenner FW, et al. The changing epidemiology of Salmonella: trends in serotypes isolated from humans in the United States, 1987-1997. J Clin Microbiol 2001;183:753-61.
2. CDC. The National Antimicrobial Resistance Monitoring System: enteric bacteria. Available at <http://www.cdc.gov/ncidod/dbmd/narms>.
3. CDC. Outbreaks of Salmonella serotype Enteritidis infection associated with eating raw or undercooked shell eggsUnited States, 1996-1998. MMWR 2000;49:73-9.
During 2000, a total of 12,732 isolates of shigellosis were reported through PHLIS, with Shigella sonnei infections continuing to account for most cases in the United States. Prolonged, communitywide outbreaks of S. sonnei infections transmitted in child care centers and other settings where maintenance of good hygienic conditions requires special care account for much of the problem (1). S. sonnei also can be transmitted through contaminated foods and water used for drinking or recreational purposes (2,3), and recent evidence has indicated that infections are increasing among men who have sex with men (4).
1. Mohle-Boetani JC, Stapleton M, Finger R, et al. Communitywide shigellosis: control of an outbreak and risk factors in child day-care centers. Am J Public Health 1995;85:812-6.
2. CDC. Outbreaks of Shigella sonnei infection associated with eating fresh parsley—United States and Canada, July-August 1998. MMWR 1999;48:285-9.
3. CDC. Outbreak of gastroenteritis associated with an interactive water fountain at a beachside park—Florida, 1999. MMWR 2000;49:565-8.
4. CDC. Shigella sonnei outbreak among men who have sex with men — San Francisco, California, 2000-2001. MMWR 2001;50:922.
During 2000, a total of 915 cases of invasive group A streptococcal (GAS) disease were reported from nine states (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New York, Oregon, and Tennessee) through the Active Bacterial Core Surveillance (ABCs) project under CDC's Emerging Infections Program (1). Based on these 915 cases, CDC estimates that approximately 8,800 cases of invasive GAS disease (rate: 3.2/100,000) and 1,000 deaths occurred nationally during 2000.
Disease incidence was highest among children aged 1 year (5.8/100,000) and adults aged >65 years (8.5/100,000). Streptococcal toxic-shock syndrome and necrotizing fasciitis accounted for approximately 4.0% and 6.0% of invasive cases, respectively. The overall case-fatality rate among patients with invasive GAS disease was 11.5%. CDC identifies invasive GAS isolates based on sequences of the variable portion of the M-protein gene (i.e., emm typing). Although approximately 50% of the GAS isolates emm-typed for 2000 were one of the five known emm types (i.e., 1, 3, 12, 28, and 82), emm-type distribution shows considerable geographic diversity.
1. CDC. Active Bacterial Core Surveillance (ABCs) report. Emerging Infections Program Network. Group A streptococcus, 2000 (preliminary).
During 2000, CDC collected information on invasive pneumococcal disease, including drug-resistant Streptococcus pneumoniae, in nine states (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New York, Oregon, and Tennessee) (1). Of the 3,607 S. pneumoniae isolates collected, 9.8% exhibited intermediate resistance to penicillin (minimum inhibitory concentration [MIC] of 0.11 µg/mL), and 17.1% were fully resistant (MIC >2 µg/mL) (2). For cefotaxime, 9.8% of all isolates had intermediate resistance and 7.5% were resistant. For erythromycin, 21.3% were resistant. Approximately one-fifth (18.9%) of isolates were not susceptible to the three classes of drugs commonly used to treat pneumococcal infections.
In February 2000, the U.S. Food and Drug Administration (FDA) licensed a pneumococcal conjugate vaccine for use in infants and young children. In October 2000, ACIP issued recommendations for use of the vaccine in children aged <5 years (3). Of isolates from children aged <5 years reported during 2000, a total of 67.6% of all strains (n = 887) and 77.7% of strains not susceptible to penicillin (n = 328) were serotypes included in this 7-valent vaccine.
1. Schuchat A, Hilger T, Zell E, et al. Active Bacterial Core Surveillance of the Emerging Infections Program Network. Emerg Infect Dis 2001;7:1-8.
2. National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility testing: M100-S10 Wayne, PA: National Committee for Clinical Laboratory Standards, 2000.
3. CDC. Prevention of pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices. MMWR 2000;49 (No. RR-9):1-38.
During 2000, a total of 529 cases of congenital syphilis were reported (rate: 12.6/100,000 live births). Like primary and secondary syphilis, the rate of congenital syphilis has declined sharply in recent years, from a peak of 107.3/100,000 in 1991 (1). Congenital syphilis persists in the United States because a substantial number of women do not receive syphilis serologic testing until late in their pregnancy or not at all. This lack of screening is often related to absent or late prenatal care (2).
1. CDC. Sexually transmitted disease surveillance 2000. Atlanta, GA: US Department of Health and Human Services, Public Health Service, CDC, 2001.
2. CDC. Congenital syphilis—United States, 2000. MMWR 2001;50:573-7.
During 2000, a total of 5,979 primary and secondary syphilis cases were reported. During 1990-2000, the primary and secondary syphilis rate declined 89%, from 20.3/100,000 to 2.2/100,000. The 2000 rate was the lowest since reporting began in 1941 (1). Although syphilis has declined in all regions of the United States and in all racial/ethnic groups, rates remain disproportionately high in the South and among non-Hispanic blacks, and focal outbreaks continue to occur (including recent outbreaks among men who have sex with men [2,3]).
1. CDC. Sexually transmitted disease surveillance 2000. Atlanta, GA: US Department of Health and Human Services, Public Health Service, CDC, 2001.
2. CDC. Outbreak of syphilis among men who have sex with men—Southern California, 2000. MMWR 2001;50:117-20.
3. CDC. Primary and secondary syphilis—United States, 1999. MMWR 2001;50:113-7.
During 2000, a total of 35 cases of tetanus were reported from 19 states; no cases of neonatal tetanus were reported. Four (11%) cases were among persons aged <25 years, 19 (54%) among persons aged 2559 years, and 12 (34%) among persons aged >59 years. The percentage of cases among persons aged 25-59 years has increased during the 1990s; previously, most cases were among persons aged >59 years (1). One case occurred in a child aged 12 years who had never been vaccinated against tetanus because of the parents' objection to vaccination. Six (15%) cases were fatal.
1. Bardenheier B, Prevots DR, Khetsuriani N, Wharton M. Tetanus surveillance—United States, 1995-1997. In: CDC surveillance summaries, July 3, 1998. MMWR 1998;47(No. SS2):1-13.
During 2000, a total of 135 cases of toxic-shock syndrome (TSS) were reported. Of these cases, three occurred in men. Three cases were fatal, with two of the deaths menstruation-related. The limited number of reported cases in recent years is likely caused by decreased reporting and not a true decline in incidence of disease (1). Continued surveillance will be important to monitor the reemergence of TSS that could occur among women using barrier contraceptive devices and to define better the risk factors for nonmenstrual TSS.
1. Hajjeh RA, Reingold R, Weil A, Shutt K, Schuchat A, Perkins BA. Toxic shock syndrome in the United States: surveillance update, 1979-1996. Emerg Infec Dis 1999;5:807-10.
During 2000, a total of 16 cases of trichinosis were reported from eight states (Alaska, Florida, Hawaii, Illinois, Maryland, Michigan, Ohio, and Wisconsin). Case-patients included seven men and three women whose ages ranged from 34 to 65 years. Bear meat was the cause of the five cases reported from Alaska, and pork was identified as the source of cases from Illinois (n = 2) and Hawaii (n = 1).
During 2000, a total of 16,377 tuberculosis (TB) cases (rate: 6.0/100,000) were reported (1), representing a 7% decrease from 1999 and a 39% decrease from 1992, when cases peaked during the resurgence of TB in the United States. During 1992-2000, TB cases among U.S.-born persons decreased 55%, whereas cases among foreign-born persons increased 4% (1).
Since 1993, when states began reporting initial drug susceptibility results to CDC, the number of multidrug-resistant TB (MDR TB) cases in persons with no previous history of TB decreased from approximately 400 (2.5%) to approximately 120 (1.1%) (1). These declines could be the result of stronger control efforts after the resurgence of TB and the emergence of MDR TB. The relatively stable number of cases reported among foreign-born persons indicates that most cases could be caused by infection with Mycobacterium tuberculosis in the person's country of origin. CDC has collaborated with state and local health departments to publish recommendations for enhancing TB control efforts among foreign-born persons and is working to expand current efforts based on these recommendations (2,3).
1. CDC. Reported tuberculosis in the United States, 2000. Atlanta, GA: US Department of Health and Human Services, CDC, August 2001. Available at <http://www.cdc.gov/nchstp/tb/>.
2. CDC. Recommendations for prevention and control of tuberculosis among foreign-born persons: report of the working group on tuberculosis among foreign-born persons. MMWR 1998;47(No. RR-16).
3. CDC. Preventing and controlling tuberculosis along the US-Mexico border: work group report. MMWR 2001;50(No. RR-1).
During 2000, a total of 142 cases of tularemia were reported. The incidence of tularemia in the United States has declined substantially, from nearly 0.36/100,000 in 1955 to 0.06/100,000 in 2000 (1). Although tularemia was removed as a nationally notifiable disease in 1994, it was reinstated effective January 1, 2000, primarily because of the potential for use of Francisella tularensis as a bioterrorism agent (2). Guidelines for public health and medical response to the use of F. tularensis as a biological weapon are available (3). During the summer of 2000, lawn mowing or brush-cutting was identified as a risk factor in an outbreak of pneumonic tularemia on Martha's Vineyard, Massachusetts (4).
1. Cross JT, Penn RL. Francisella tularensis (tularemia). In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone, 2000:2393-402.
2. Notice to readers: changes in national notifiable diseases data presentation. MMWR 2000;49:892.
3. Dennis DT, Inglesby TV, Henderson DA, et al. Tularemia as a biological weapon: medical and public health management. JAMA 2001;285:2763-73.
4. Feldman KA, Lathrop SL, Enscore RE, et al. Lawnmower tularemia—Martha's Vineyard, Massachusetts, 2000. In: Program and abstract of the 50th Annual Epidemic Intelligence Service (EIS) Conference. Atlanta, GA: CDC, 2001:29.
During 2000, a total of 377 cases of typhoid fever were reported. Despite the availability of two effective vaccines, 300-400 cases are reported each year. Approximately 80% of these cases occur in persons who report international travel during the 6 weeks before illness. Persons traveling to and from their country of origin can be at high risk (1). In many areas of the world, Salmonella Typhi strains have acquired resistance to multiple antimicrobial agents, including ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole (1).
1. Ackers ML, Puhr ND, Tauxe RV, Mintz ED. Laboratory-based surveillance of Salmonella serotype Typhi infections in the United States: antimicrobial resistance on the rise. JAMA 2000;283:2668-73.
In 1995, varicella vaccine was licensed in the United States, and in 1996, the vaccine became available for use in the public sector (1). Although varicella is not a nationally notifiable disease, since 1990, six states (Massachusetts, Michigan, Missouri, Rhode Island, Texas, and West Virginia) have maintained adequate reporting levels by reporting varicella disease burden constituting >5% of their birth cohort.§§ In these states, a 67% reduction in disease incidence has occurred between the immediate prevaccination years (1993-1995) and the most recent year for which data are available (2000). This decrease is associated with rapidly increasing vaccination coverage; among children aged 19-35 months, vaccination coverage reached 63% during July 1999—June 2000. The marked decline in reported cases from passive reporting to CDC was consistent with data from active varicella surveillance sites (CDC, unpublished data, 2000).
Ongoing surveillance will be important to monitor the impact of the varicella vaccination program. Although deaths from varicella became nationally notifiable beginning January 1, 1999, reporting remains incomplete (2). CDC encourages all states to review death certificates and vital statistics to identify and report deaths from varicella among children, adolescents, and adults.
1. CDC. Notice to readers: licensure of varicella virus vaccine, live. MMWR 1995;44;264.
2. Council of State and Territorial Epidemiologists. CSTE position statement ID-10: Inclusion of varicella-related deaths in the National Public Health Surveillance System. Atlanta, GA: Council of State and Territorial Epidemiologists, 1998.
¶For information on HIV infection, see page xiv.
**National Immunization Program data based on date of onset, not MMWR reporting week.
†† For information on AIDS, see page ix.
§§Data obtained from the National Immunization Program.
 |
|
|
|
|
Privacy Policy | Accessibility CDC Home | Search | Health Topics A-Z This page last updated January 9, 2008 United States
Department of Health and Human Services "Epi Info" is a trademark of the Centers for Disease Control and Prevention (CDC). |
