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AIDS
Since 1981, confidential name-based AIDS surveillance has been the cornerstone
of national, state, and local efforts to monitor the scope and impact of
the HIV epidemic. The data have many uses, including developing policy to
help prevent and control AIDS. However, because of the introduction of therapies
that effectively slow the progression of the infection, AIDS data no longer
adequately represent the populations affected by the epidemic. By providing
a window into the epidemic at an earlier stage, HIV data, combined with AIDS
data, better represent the overall impact. Since 1998, 30 areas (29 states
and the U.S. Virgin Islands) have had integrated name-based HIV surveillance
into their AIDS surveillance systems while other jurisdictions have used
other methods for reporting cases of HIV infection.
During 1998-1999, declines in AIDS began to level, and essentially no change
occurred during 1999-2002. This trend follows a period of sharp declines in
incident cases after 1996, when highly effective antiretroviral therapies were
introduced. The estimated annual number of deaths among persons with AIDS,
however, declined 14% from 1998 to 2002. At the end of 2002, an estimated 384,906
persons were known to be living with AIDS.
Anthrax
In November 2002, the Advisory Committee on Immunization Practices (ACIP) recommended
preexposure use of anthrax vaccine for groups at risk for repeated exposures,
including 1) laboratory personnel handling environmental specimens and performing
confirmatory testing for Bacillus anthracis in U.S. Laborator y
Response Network for Bioterrorism level B laboratories or above, 2) workers
making
repeated entries into known B. anthracis spore-contaminated areas
after a terrorist attack, and 3) workers in other settings in which repeated
exposure
to aerosolized B. anthracis spores might occur. The ACIP recommendations
are available at http://www.cdc.gov/mmwr/PDF/wk/mm5145.pdf.
Brucellosis
By 2002, the control program for brucellosis among cattle in the United States
had nearly eliminated Brucella abortus infection from U.S. herds. Therefore,
at present, the risk of contracting brucellosis either from occupational
exposure to livestock in the United States or from domestically produced
food items is minimal. However, a risk remains for infection with both B.
abortus and B. melitensis from consumption of unpasteurized goat and cow
milk products, in particular those produced outside the United States. Most
cases in the United States are now seen in international travelers or recent
immigrants. Laboratory personnel working with Brucella species and hunters
exposed to infected wildlife also have an elevated risk for infection. B.
melitensis and B. suis are considered Category B bioterrorism threat agents.
Chancroid
During 2002, a total of 67 cases of chancroid were reported (rate: 0.02/100,000),
an increase from 38 cases in 2001 but an overall decline of 99% of the cases
reported since 1987 (1). Of the 2002 cases, 43 (64%) were reported from one
state. Overall, only 10 states and one outlying area reported ≥1 case
of chancroid in 2002. The causative agent of chancroid is difficult to culture
and therefore the disease 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).
Chlamydia trachomatis, Genital Infection
During 2002, a total of 834,555 cases of genital chlamydial infection were
reported (rate: 296.55/100,000). This rate was the highest since voluntary
case reporting began in the mid1980s 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.
From 1998 to 2002, the reported chlamydial infection rate in men increased
by 55% compared with a 20% increase in women. However, the rate among women
was over three times the rate reported among men, reflecting the larger number
of women screened for this disease.
Cholera
During 1995-2002, a total of 66 laboratory-confirmed cases of cholera, all
caused by Vibrio cholerae O1, were reported to CDC. Forty-two (64%) infections
were acquired outside the United States, whereas six (9%) were acquired through
consumption of contaminated seafood harvested in Gulf Coast waters. One patient
died (1). Only two laboratory-confirmed cases of cholera were reported to
CDC in 2002. Both were caused by V. cholerae O1 and were acquired outside
the United States. Both isolates were resistant to furazolidone. Production
and sale of the only licensed cholera vaccine in the United States ceased
in 2001.
Coccidioidomycosis
In recent years, Arizona and California have experienced significant increases
in the incidence rates of coccidioidomycosis. This increase is likely related
to demographic and climatic changes. Physicians should maintain a high suspicion
for acute coccidioidomycosis, especially among patients with a flu-like illness
who live in or have visited areas with endemic disease.
Diphtheria
During 2002, one probable, nonfatal case of diphtheria was reported to CDC.
The patient was a female resident of California, aged 38 years. Symptoms
and signs included a sore throat and difficulty in swallowing for 7 days,
an extensive pharyngeal membrane, and low-grade fever 99°-101°F.
A throat swab specimen for culture was negative for Corynebacterium diphtheriae,
but it was obtained a day after an antibiotic regimen was started. The patient
had recent, prolonged, frequent face-to-face exposure to visitors from eastern
Europe and Australia. She had received the last booster dose of vaccine in
1987.
Encephalitis, Arboviral
In 2002, an unprecedented epidemic and epizootic of West Nile virus (WNV) occurred
in the United States (1). Epidemic and epizootic activity was most intense
in the central United States. A total of 2,146 human WNV encephalitis and/or
meningitis (i.e., meningoencephalitis) cases were reported through the ArboNet
Arboviral Surveillance System from 36 states, representing the largest arboviral
meningoencephalitis epidemic documented in the Western Hemisphere. In addition,
WNV-infected birds, mosquitoes, or horses were detected in 44 states and
the District of Columbia. Of these 45 jurisdictions, 16 reported their first
ever WNV activity. One human case reported in a Los Angeles County, California,
resident with no known travel history and a report of a WNV-infected horse
in Island County, Washington, indicated the complete transcontinental movement
of WNV within 3 years of its first appearance in the Eastern United States.
An unprecedented equine WNV epizootic occurred in the midwestern states and
resulted in 14,539 reported cases. Three mosquito species, Culex pipiens,
Cx. quinquefasciatus, and Cx. restuans, accounted for the majority of the
6,604 reported WNV-positive mosquito pools. WNV was also detected for the
first time in Cx. tarsalis, an important vector of St. Louis encephalitis
virus, raising concerns about its potential to transmit WNV to humans in
western states where it is common (2).
In 2002, 164 cases of encephalitis caused by California (CAL) serogroup viruses
were reported from 16 states, representing the most reported to CDC in any
year since 1964. WNV human case surveillance may have resulted in improved
surveillance for CAL serogroup virus meningoencephalitis cases. During 1964-2002,
a median of 67 cases (average: 80; range: 29-167) were reported per year in
the United States.
Gonorrhea
During 2002, a total of 351,852 cases of gonorrhea were reported (rate: 125.03/100,000
population). This rate is slightly lower than rates in 2001 (128.53/100,000),
2000 (129.04/ 100,000), 1999 (132.32/100,000), and 1998 (131.89/ 100,000)
(1). In 2002, the reported gonorrhea rate among women (125.3/100,000)
was similar to that among men (124.2/100,000). Rates among non-Hispanic black
women aged 15-19 years (3,307.7/100,000) and non-Hispanic black men aged
20-24 years (3,256.2/100,000) remain higher than in any other racial/ethnic
or age group. Increases have been observed in some areas among men who have
sex with men (2). Decreased susceptibility to the fluoroquinolone
antibiotics has also been reported from some regions (3). In 2002,
the prevalence of fluoroquinolone-resistant Neisseria gonorrhoeae infections
continued to increase in California. Fluoroquinolones are no longer advised
for treatment of gonorrhea
in Hawaii or California or for infections that might have been acquired in
those states (4).
Haemophilus influenzae, Invasive Disease
In 2002, 331 cases of invasive Haemophilus influenzae disease in children aged <5
years were reported; 34 (10%) were reported as H. influenzae type b (Hib),
144 (44%) were reported as other serotypes or nontypeable isolates, and 153
(46%) were reported with serotype information unknown or missing. The continued
remarkably low number of invasive Hib infections in children (down from an
estimated 20,000 cases annually in the prevaccine era) is a result of the successful
delivery of highly effective conjugate Hib vaccines to children, beginning
at age 2 months (1,2). Because discrepancies in serotyping results have occurred
between laboratories, CDC requests that state health departments obtain and
send all invasive H. influenzae isolates from children aged <5 years to
CDC for serotype confirmation (3,4).
Hantavirus Pulmonary Syndrome
The geographic center of hantavirus pulmonary syndrome (HPS) cases during the
2002 season was more northerly than in previous years. This reflects weather
patterns that delivered greater rainfall or milder antecedent winter conditions
resulting in more abundant food supplies and an increase in the host rodent
species in those northerly areas. CDC guidance for prevention of HPS has
been updated and made available in Spanish and English (1).
Hepatitis A
Hepatitis A vaccine is recommended for persons at increased risk of acquiring
hepatitis A (e.g., international travelers, men who have sex with men (MSM),
and injection-and noninjection-drug users) (1) and also for children
in states and counties that have historically had consistently elevated rates
of hepatitis A (2). Since childhood vaccination in high-risk areas
was recommended, the overall hepatitis A rate has declined steadily, and
in 2002, it was the
lowest yet recorded (3.1/100,000). The decline in rates has been greater
among children and in states where routine childhood vaccination is recommended,
suggesting an impact of childhood vaccination. The dramatic declines in disease
rates in these groups and areas that have historically accounted for the
majority of reported cases have resulted in a shift in the epidemiology of
this disease in the United States. Hepatitis A rates, historically much higher
in the western states, are now similar in all regions of the United States,
and an increasing proportion of cases are among adults, particularly those
in high-risk groups such as MSM. Continued monitoring of disease rates is
needed to determine if the current low rates are sustained and attributable
to vaccination and to identify groups and areas where additional vaccination
efforts are needed.
Hepatitis B
During 2002, a total of 7,996 acute hepatitis B cases were reported, representing
a >65% decrease since 1990 (21,102 cases). The steady decline in hepatitis
B rates coincides with the implementation of a national strategy to achieve
the elimination of hepatitis B virus (HBV) infection (1). The primary elements
of this strategy are 1) screening of all pregnant women for HBV infection
with provision of postexposure prophylaxis to infants born to infected women,
2) routine vaccination of all infants and children aged ≤18 years, and
3) vaccination of others at increased risk of acquiring hepatitis B (e.g.,
health-care workers, MSM, injection drug users, and household and sex contacts
of persons with chronic HBV infection).
The rate among children aged ≤18 years, the age group covered by the recommendation
for routine childhood immunization, has declined by approximately 90% since
1990. In comparison, high rates of disease continue among adults, particularly
males aged 25-39 years. This and the high proportion of cases occurring among
persons in identified risk groups (i.e., injection-drug users, MSM and persons
with multiple sex partners) indicate a need to strengthen efforts to reach
these populations with vaccine.
Hepatitis C; Non-A, Non-B
Monitoring acute hepatitis C rates nationally has been challenging because
1) no serologic marker for acute infection exists, and 2) many health departments
do not have the resources to determine if a positive laboratory report for
hepatitis C virus (HCV) infection represents acute infection. Consequently,
the most reliable estimates of acute hepatitis C incidence have historically
come from sentinel surveillance. Incidence of hepatitis C has declined by >80%
since the late 1980s, largely the result of a decrease in cases among injection-drug
users, the reasons for which are unknown. The majority of hepatitis C cases
continue to occur among persons aged >25 years, with injection-drug use
the most common risk factor for infection.
In recent years, analysis of cases of acute, symptomatic hepatitis C reported
through NNDSS has yielded similar results as those from sentinel surveillance,
suggesting that the quality of national surveillance data for acute hepatitis
C has improved. Direct reporting of anti-HCV-positive test results by laboratories
has increased the completeness of reporting of HCV-infected persons to health
departments. Reporting other available laboratory or clinical data would improve
surveillance for hepatitis C by providing information to identify patients
with acute disease. Improving the accuracy of hepatitis C surveillance data
continues to be a priority because monitoring hepatitis C incidence trends
provides information needed to evaluate the effectiveness of prevention efforts
and identify opportunities for prevention.
HIV Infection, Adult
By December 2002, 49 states and the District of Columbia had an HIV surveillance
system in place. Since 1998, 30 areas (29 states and the U.S. Virgin Islands)
have had laws or regulations requiring confidential reporting by name for
adults/ adolescents or children with confirmed HIV infection, in addition
to reporting of persons with AIDS (1). CDC also initiated a pilot system
in 2002 to monitor HIV incidence.
Beginning in 2003, CDC expanded its HIV/AIDS surveillance activities through
the addition of a national HIV behavioral surveillance system. CDC will assess
the implementation and effectiveness of prevention activities through several
monitoring systems, including the use of new performance indicators for state
and local health departments and community-based organizations.
At the end of 2002, 142,713 adults and adolescents in the 30 areas were known
to be living with HIV infection (not AIDS). The prevalence rate of HIV infection
(not AIDS) in this group was 125.7/100,000 population (1).
HIV Infection, Pediatric
Effective January 1, 2000, the surveillance case definition for HIV infection
was revised to reflect advances in laboratory HIV virology tests. The definition
incorporates the reporting criteria for HIV infection and AIDS into a single
case definition for adults and children (1).
In the 30 areas (29 states and the U.S. Virgin Islands) that have had laws
or regulations since 1998 requiring confidential reporting by name for children
with confirmed HIV infection, 1,416 children (aged <13 years) were known
to be living with HIV infection (not AIDS) at the end of 2002. The prevalence
rate of HIV infection (not AIDS) in this group was 5.6/ 100,000 population
(2).
Lyme Disease
A total of 23,763 cases of Lyme disease were reported in 2002, a 39% increase
over 2001 and the highest number reported since national surveillance began
in 1982. As in previous years, the majority of cases were reported from the
northeastern and north-central United States. Factors potentially contributing
to the overall increase in Lyme disease include better reporting, increased
development in wooded areas, and growing deer populations. In addition, ecological
studies suggest that infected ticks are spreading to new areas. The only
Lyme disease vaccine licensed in the United States (LYMErix®) was removed
from the market in February 2002. New products aimed at reducing ticks on
mice and deer are under development.
Malaria
Almost all malaria cases are imported, with more than twice as many cases occurring
among U.S. residents traveling to malarious areas as occur among foreign
residents immigrating to or visiting the United States (1). Over 75% of cases
among
U.S. residents occur in persons who were either not taking malaria chemoprophylaxis
or did not take recommended drugs (1).The annual number of cases has increased
during the past 15 years, likely because of increases in both international
travel
(2) and immigration (3), as well as the spread and intensification of antimalarial
drug resistance globally (4).
Measles
A record low of 44 confirmed measles cases was reported in 2002, with cases
occurring in 17 states. Eighteen cases were internationally imported, and
exposure to these cases resulted in 15 additional cases. Three other cases
had only virologic evidence of importation (i.e., genotypic analysis of measles
viruses indicated an imported source). The remaining eight cases were classified
as unknown source cases because no link to importation was detected. The
majority of cases were either in infants aged <12 months (18 cases) or
persons aged >20 years (19 cases); only three cases occurred among children
aged <5 years, and four cases among those aged 5-19 years. Three outbreaks,
ranging in size from 3 to 13 cases, accounted for 43% of cases (n=19). In
two of these outbreaks, the source cases were imported.
Pertussis
During 2002, 9,771 cases of pertussis were reported (rate: 3.4/100,000), the
highest number of reported cases since 1964. Of these cases, 21% occurred
among infants aged <6 months (108.8/100,000), who were too young to have
received the first 3 of the 5 doses of diphtheria and tetanus toxoids and
acellular pertussis (DTaP) vaccine recommended by age 6; 3% occurred among
children aged 6-11 months (15.4/100,000); 14% among children aged 1-4 years
(8.9/100,000); 10% among children aged 5-9 years (4.8/100,000); 29% among
persons aged 10-19 years (7.0/100,000); and 23% among persons aged ≥20
years (1.2/100,000).
Since 1995, the coverage rate with ≥3 doses of pertussis vaccine has
been >94%
among U.S. children aged 19-35 months (1). Since 1980, the number
of reported cases of pertussis in infants aged <6 months and in adolescents
and adults has increased in some states (2). The reasons for this
increase are unknown but could include increased awareness of pertussis among
health-care providers,
better reporting of cases to health departments (3), and possibly
an increase in circulating Bordetella pertussis. The true number of
pertussis cases in adolescents and adults has likely been underreported because
the pertussis
cough is not pathognomonic for pertussis, persons may not seek medical care
for a cough illness, and (if medical care is sought) diagnostic tests are not
sufficiently sensitive. Adolescents and adults can become susceptible to disease
when vaccine-induced immunity wanes, approximately 5-10 years after pertussis
vaccination. The incidence of reported pertussis among children aged 7 months
to 9 years has been relatively stable, suggesting protection against pertussis
by routine vaccination according to the recommended schedule.
Shigellosis
Shigella sonnei infections continue to account for over 75%
of shigellosis in the United States(1). Prolonged, multistate outbreaks
of S. sonnei infections that are transmitted in day care centers, where
maintenance of good hygienic conditions requires special care, account
for much of the problem (2). From June 2001 through March 2003, one
such outbreak in six eastern states accounted for over 3,000 laboratory-confirmed
infections (3). S. sonnei can also be transmitted through contaminated
foods and through water used for drinking or recreational purposes
(4). Recent evidence suggests that S. sonnei infections may be increasing
among men who have sex with men (1).
Streptococcal Disease, Invasive, Group A
(including streptococcal toxic-shock syndrome)
During 2002, 986 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 986 cases, CDC estimates that approximately 9,100 cases of invasive
GAS disease (rate: 3.2/ 100,000) and 1,350 deaths occurred nationally during
2002. Disease incidence was highest among children aged <1 year (6.9/100,000)
and adults aged >65 years (8.9/100,000). Streptococcal toxic-shock syndrome
and necrotizing fasciitis accounted for approximately 5.9% and 6.1% of invasive
cases, respectively. The overall case-fatality rate among persons with invasive
GAS disease was 14.6%.
In 2002, CDC published recommendations for the control of invasive group A
streptococcal disease among household contacts of persons with invasive GAS
infections and for responding to postpartum and postsurgical infections. These
recommendations are based on routine surveillance data, studies of the epidemiology
of subsequent invasive GAS infections among household contacts of case-patients
and postpartum and postsurgical GAS clusters, and studies of the effectiveness
of chemoprophylactic regimens for eradicating carriage (2-4).
Streptococcus pneumoniae, Invasive,
Drug-Resistant
In 2002, the Active Bacterial Core Surveillance (ABCs) project of CDC's Emerging
Infections Program (1) 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). For the second straight year, the proportion of pneumococcal isolates
that were drug resistant declined. Of the 3,012 S. pneumoniae isolates collected
in 2002, 9.1% exhibited intermediate resistance to penicillin (minimum inhibitory
concentration [MIC] 0.1-1 µg/mL), and 11.5% were fully resistant (MIC >2 µg/mL)
(2). For cefotaxime, 8.4% of all isolates had intermediate resistance and 3.5%
were fully resistant in 2001. For erythromycin, 16.4% were resistant in 2001.
Approximately one in eight (13.2%) isolates had reduced susceptibility to at
least three classes of drugs commonly used to treat pneumococcal infections,
a decline from a peak of one in five (18.3%) isolates in 2000.
In February 2000, the Food and Drug Administration licensed a pneumococcal
conjugate vaccine for use in infants and young children. In October 2000, the
Advisory Committee on Immunization Practices issued recommendations for use
of the vaccine in children aged <5 years (3). Vaccine use has reduced rates
of invasive pneumococcal disease markedly among children, the vaccine's target
age group, but also among unvaccinated older persons (4).
Syphilis, Congenital
During 2002, a total of 412 cases of congenital syphilis were reported (10.20/100,000
live births), down from 492 in 2001. 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). The continuing decrease in the rate
of congenital syphilis likely reflects the substantial reduction in the rate
of primary and secondary syphilis among women that has occurred in the last
decade and continues to occur. 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).
Syphilis, Primary and Secondary
During 2002, a total of 6,862 primary and secondary syphilis cases were reported,
an increase from 6,103 cases in 2001. From 1990 to 2000, the primary and
secondary syphilis rate declined 90%, from 20.34/100,000 to 2.12/100,000.
The 2001 rate (2.2/100,000), the first annual increase in syphilis in over
a decade, was 2.1% higher than the 2000 rate, which was the lowest since
reporting began in 1941. The 2002 rate (2.4/100,000) was 9.1% higher than
the reported rate in 2001. The 2002 primary and secondary syphilis rate reflects
a 27% increase among men from 2001 but a 21% decrease among women (1). This
disparity between men and women, observed across all racial and ethnic groups,
along with reported outbreaks of syphilis among MSM in large urban areas,
suggests that increases in syphilis are occurring among MSM. Rates remain
disproportionately high in the South and among non-Hispanic blacks, but rates
in these two groups are continuing to decline (1,2,3).
Tetanus
In 2002, 25 cases of tetanus were reported from 14 states. Three (12%) cases
were among persons aged <25 years, 12 (48%) cases were among persons aged
25-59 years, and 10 (40%) cases were among persons aged >60 years. Although
the annual number of reported cases continues to decrease, the percentage
of cases among persons aged 25-59 years has increased during the last decade;
previously, most cases were among persons aged >60 years (1).
Three (12%) of the cases were fatal.
Tuberculosis
During 2002, a total of 15,075 cases (rate: 5.3/100,000) of tuberculosis (TB)
were reported to CDC from the 50 states and the District of Columbia, representing
a 5.7% decrease from 2001 and a 43.5% decrease from 1992, when the number
and rate of cases most recently peaked in the United States (1).
Despite a 68.4% decline in case rates from 1992 to 2002 (31.0/100,000 to 9.8/100,000),
U.S.-born non-Hispanic blacks continued to have the highest TB rate of any
U.S.-born racial/ethnic population (2). U.S.-born, non-Hispanic blacks had
the largest number of TB cases among both U.S.-born and foreign-born populations,
representing 46.7% of TB cases among U.S.-born persons and approximately one
fourth of all cases (2).
In 1992, 72.6% of reported cases were among U.S.-born persons (8.2/100,000),
and 27.4% were among foreign-born persons (34.5/100,000). In comparison in
2002, 48.2% of reported cases were among U.S.-born persons (2.8/100,000), and
51.8% of reported cases were among foreign-born persons (23.6/100,000) (2).
Despite the decrease in case rate among foreign-born persons during the past
decade, more than half the TB cases in the United States in 2002 occurred in
this population, and the case rate was eight times greater in this population
than among U.S.-born persons. To address the high rate, CDC is collaborating
with public health partners to implement TB control initiatives among recent
international arrivals and residents along the border between the United States
and Mexico and to strengthen TB programs in countries with a high incidence
of TB disease (2). CDC recently updated its comprehensive national action plan
to reflect the alignment of its priorities with the Institute of Medicine report
(3) and to ensure that priority prevention activities are undertaken with optimal
collaboration and coordination among national and international public health
partners (4).
Typhoid Fever
In 2002, typhoid fever was diagnosed in 321 persons in the United States (NNDSS
data), despite the availability of two effective vaccines. Approximately
80% of these cases occurred among persons who reported international travel
during the preceding 6 weeks. Persons visiting friends and relatives in their
country of origin appear to be at higher 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).
S. Typhi outbreaks in the United States are usually small in size but can cause
significant morbidity and are often foodborne, warranting thorough investigation
(2). Recently a sexually transmitted outbreak of typhoid fever was recognized
and reported (3).
Varicella deaths
In 2002, nine varicella deaths were reported to CDC from eight states (1).
Three of the deaths occurred among children aged 5-11 years, and six occurred
among adults aged 26-74 years. In 1999, the Council of State and Territorial
Epidemiologists recommended that varicella deaths be reported to CDC to
monitor the impact of routine varicella vaccination on vari-cella-related
mortality
(2). However, reporting of varicella deaths is incomplete, limiting the
usefulness of mortality data in assessing the impact of the varicella vaccination
program.
CDC encourages states to report varicella deaths so that risk factors for
varicella-related mortality can be identified and the percentage of deaths
that would have been directly preventable by following current recommendations
for vaccination can be determined.
In 2003, as an adjunct to mortality
surveillance, varicella infection was again designated a nationally notifiable
condition.
The objectives of varicella morbidity surveillance at state and national
levels are to monitor the epidemiology of varicella by age, place, and
over time,
to monitor the impact of widespread and increasing immunization on the
epidemiology of varicella, and to allow prompt implementation of disease
control measures
(3).
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