July 30, 1999

MMWR articles are embargoed until 4 p.m. Eastern time on Thursday.

1. Achievements in Public Health, 1900 - 1999: Control of Infectious Diseases
2. Meningococcal Disease — New England, 1993-1998
3. Progress Toward Poliomyelitis Eradication During Armed Conflict— Somalia and Southern Sudan, January 1998- June 1999

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Achievements in Public Health, 1900 - 1999: Control of Infectious Diseases
Despite impressive progress toward controlling infectious diseases, preventing epidemics requires constant vigilance and public health efforts.

1. Abortion Surveillance —United States 1996

Lisa M. Koonin, M.N., M.P.H.
CDC, National Center for Chronic Disease Prevention & Health Promotion
(770) 488–5188

In 1996, the number of legal induced abortions remained at about the same level as in 1995; however, the national abortion rate and abortion ratios continue to be at an all-time low.
In 1996, 1,221,585 legal, induced abortions were reported to CDC, representing a slight increase (0.9%) from the number reported in 1995. As in 1995, the 1996 national abortion rate of 20 per 1,000 women of reproductive age (aged 15-44 years) continues to be the lowest rate recorded since 1975. The national abortion ratio (number of legal abortions per 1000 live births) increased slightly from 311 in 1995 to 314 in 1996 and is at the lowest recorded level since 1976. CDC receives data on legal induced abortions from the 50 states, New York City and the District of Columbia. Women who obtained legal abortions in 1996, as in previous years, were predominantly white, and unmarried. As in 1995, most women obtaining a legal induced abortion in 1996 were 20 years and older; about one-fifth of women who obtained abortions were aged 19 years or younger.

Achievements in Public Health, 1900-1999: Control of Infectious Diseases

July 30, 1999
Contact: Division of Media Relations
(404) 639-3286

• Deaths from infectious diseases declined markedly in the United States during the 20th century, contributing to a sharp drop in infant and child mortality and a >30-year average increase in life expectancy. In 1900, 30% of children died before their fifth birthdays; in 1997, only 1% died.
• In 1900, the three leading causes of death were pneumonia, tuberculosis (TB), and diarrhea and enteritis, which (together with diphtheria) were responsible for one third of all deaths. Of these deaths, 40% were deaths of children aged <5 years. Today, heart disease and cancers account for almost three quarters of deaths, with 5% attributable to pneumonia, flu, and HIV infection.
• One of the most devastating epidemics in human history occurred during the 20th century. The the 1918 flu pandemic killed 20 million people, including 500,000 persons in the United States, in less than 1 year.
• Chlorination and other treatments of drinking water began in the early 1900s and became widespread 20th century public health practices, decreasing the incidence of cholera, typhoid, and other waterborne diseases.
• In 1900, TB killed 200 out of every 100,000 Americans, most of them residents of urban areas. In 1940 (before the introduction of antibiotic therapy) TB remained a leading killer, but the death rate had decreased to 60 per 100,000 persons
• Malaria, which had been endemic throughout the U.S. Sunbelt (southeastern and south-central states), was reduced to negligible levels by the late 1940s through regional mosquito control programs.
• The last major rat-associated outbreak of plague in the United States occurred in 1924-1925 in Los Angeles. This outbreak included the last identified instance of human-to-human transmission of plague (through inhalation of infectious respiratory droplets from coughing patients) in this country.
• By 1900, 40 states had established public health departments, and the first county health departments were established in 1908. Between the 1930s and 1950s, state and local health departments made substantial progress in disease prevention activities including sewage disposal, water treatment, food safety, and public education on hygienic practices (e.g., food handling and handwashing).
• Over the past 50 years, strategic vaccination campaigns have virtually eliminated diseases that used to be common in the United States -- including diphtheria, tetanus, pertussis, poliomyelitis, smallpox, measles, mumps, rubella, and Haemophilus influenzae type b meningitis.
• A federally coordinated vaccination program was established through the passage of the Vaccination Assistance Act of 1962. A landmark piece of legislation, this Act has been continuously renewed and now supports the purchase and administration of a full range of childhood vaccines.
• Smallpox was eradicated in 1980, after an 11-year campaign (1967-1977) involving 33 nations, approximately one decade after it had been eliminated from the United States and the rest of the Western Hemisphere. Polio and dracunculiasis may be eradicated by 2000.
• Antibiotics have been in civilian use for 57 years and have saved the lives and health of hundreds of thousands of persons with infections such as streptococcal and staphylococcal infections, gonorrhea, and syphilis.
• New diseases that have emerged during the 20th century include hepatitis C, Lyme disease, human ehrlichiosis, hantavirus pulmonary syndrome, AIDS, Ebola and Marburg hemorrhagic fevers, new variant Creutzfeldt-Jakob disease, and Nipah virus disease.
• Recent examples of microbial evolution include the emergence of a virulent strain of avian influenza in Hong Kong; the multidrug-resistant W strain of TB in the United States; and Staphylococcus aureus with reduced susceptibility to vancomycin in the United States and Japan.
• Between 1980 and 1994 there was an overall increase in infectious disease mortality in the United States, due in part to the emergence of AIDS and the re-emergence of TB (including multi-drug resistant TB).
• Current research suggests that infectious agents may cause or intensify certain chronic diseases, including some types of diabetes, cancers, and heart conditions.