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Summary of Notifiable Infectious Diseases and Conditions — United States, 2014



Deborah A. Adams; Kimberly R. Thomas, MPH; Ruth Ann Jajosky, DMD; Loretta Foster, MPH; Pearl Sharp; Diana H. Onweh; Alan W. Schley; Willie J. Anderson; for the Nationally Notifiable Infectious Conditions Group Division of Health Informatics and Surveillance, Office of Public Health Scientific Services, CDC

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Preface

The Summary of Notifiable Infectious Diseases and Conditions—United States, 2014 (hereafter referred to as the summary) contains the official statistics, in tabular and graphic form, for the reported occurrence of nationally notifiable infectious diseases and conditions in the United States for 2014. Unless otherwise noted, data are final totals for 2014 reported as of June 30, 2015. These statistics are collected and compiled from reports sent by U.S. state and territory, New York City, and District of Columbia health departments to the National Notifiable Diseases Surveillance System (NNDSS), which is operated by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE). This 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 2014 for selected infectious diseases and conditions and additional information to aid in the interpretation of surveillance and infectious diseases- and conditions-trend data. Part 1 contains tables showing incident (new) cases and incidence rates for the nationally notifiable infectious diseases and conditions reported during 2014; these tables do not include rows for conditions with zero cases reported in 2014 (Tables 1,2,3,4,5, and 6).* The tables provide the number of cases reported to CDC for 2014 and the distribution of cases by MMWR month, geographic location, and demographic characteristics (e.g., age, sex, race, and ethnicity). Part 1 also includes a table with the reported incidence of notifiable diseases during 2004–2014 and a table enumerating deaths associated with specified notifiable infectious diseases and conditions reported to CDC’s National Center for Health Statistics (NCHS) during 2008–2014 (Tables 7 and 8). Part 2 contains graphs and maps that depict summary data for selected notifiable infectious diseases and conditions described in tabular form in Part 1. Historical notifiable disease data, annotated as Part 3 in previous releases of this summary, will no longer be included in this report. Historical notifiable disease data during 1944–2013 are available online in previous years’ summaries (http://www.cdc.gov/mmwr/mmwr_nd). The Selected Reading section presents general and disease-specific references for notifiable infectious diseases and conditions. These references provide additional information on surveillance and epidemiologic concerns, diagnostic concerns, and infectious disease-control activities. 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 e-mailed to NNDSSweb@cdc.gov with the following subject line: “Annual Summary”.

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Background

The infectious diseases and conditions designated by CSTE and CDC as nationally notifiable during 2014 are listed in this section. A notifiable infectious disease or condition is one for which regular, frequent, and timely information regarding individual cases is considered necessary for the prevention and control of the disease or condition. A brief history of the reporting of nationally notifiable infectious diseases and conditions in the United States is available at https://wwwn.cdc.gov/nndss/history.aspx. In 1961, CDC assumed responsibility for the collection of data on nationally notifiable diseases and deaths in 122 U.S. cities. Data are collected through NNDSS, which is neither a single surveillance system nor a method of reporting. Rather, it is a “system of systems”, which is coordinated by CDC at the national level across disease-specific programs to optimize data compilation, analysis, and dissemination of notifiable disease data. Monitoring surveillance data enables public health authorities to detect sudden changes in disease or condition occurrence and distribution, identify changes in agents and host factors, and detect changes in health-care practices. National level surveillance data are compiled from case notification reports of nationally notifiable infectious diseases and conditions submitted from the state, territory, and selected local health departments to CDC.

Cases are first identified through reports of infectious diseases and conditions from the local level to the state or territory. Legislation, regulation, or other rules in those jurisdictions require health-care providers, hospitals, laboratories, and others to provide information on reportable conditions to public health authorities or their agents. Case 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 control outbreaks; eliminate environmental hazards; and close premises where disease transmission is believed to be ongoing.

Although infectious disease and condition reporting is mandated at the state, territory, and local levels by legislation or regulation, state and territory notification to CDC is voluntary. All U.S. state health departments, five territorial health departments, and two local health departments (New York City and District of Columbia) voluntarily notify CDC about nationally notifiable infectious diseases and conditions which are reportable in their jurisdictions; the data in these case notifications that CDC receives are collected by staff working on reportable disease and condition surveillance systems in local, state, and territorial health departments. Case notification of nationally notifiable infectious diseases and conditions helps public health authorities monitor the effect of these diseases and conditions, measure the disease and condition 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.

The list of nationally notifiable infectious diseases and conditions is revised periodically (Box 1). An infectious disease or condition might be added to the list as a new pathogen emerges, or a disease or condition might be removed as its incidence declines. Public health officials at state and territorial health departments collaborate with CDC staff in determining which infectious diseases and conditions should be considered nationally notifiable. CSTE, with input from CDC, makes recommendations annually for additions and deletions to the list. The list of infectious diseases and conditions considered reportable in each jurisdiction varies over time and across jurisdictions. Current and historic national public health surveillance case definitions used for classifying and enumerating cases consistently at the national level across reporting jurisdictions are available at https://wwwn.cdc.gov/nndss/conditions.

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Data Sources

Provisional data on the reported occurrence of nationally notifiable infectious diseases and conditions are published weekly in MMWR. After each reporting year, staff in state and territory 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 this summary, which represents the official and archival counts of cases for each year. The data in these reports are approved by the appropriate chief epidemiologist from each submitting state or territory before being published in this summary. Data published in MMWR Surveillance Summaries or other surveillance reports produced by CDC programs might differ from data reported in this summary because of differences in the timing of reports, the source of the data, or surveillance methodology.

Data in this 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 (reporting jurisdictions). Data were reported for MMWR weeks 1–53, which correspond to the period for the week ending January 4, 2014 through the week ending January 3, 2015. More information regarding notifiable infectious diseases and conditions, including national surveillance case definitions, is available at https://wwwn.cdc.gov/nndss/conditions. Policies for reporting notifiable infectious disease and condition cases can vary by disease, condition, or reporting jurisdiction. The case-status categories used to determine which cases reported to NNDSS are published in the tables are listed by infectious disease or condition in the publication criteria column of the 2014 NNDSS event code list (Box 2).

For a report of a nationally notifiable disease or condition to be published in MMWR (formerly described as “print criteria” and currently described as “publication criteria”), the reporting state or territory must have designated the infectious disease or condition reportable in their state or territory for the year corresponding to the year of report to CDC. After this criterion is met, the infectious disease- or condition-specific criteria listed in the Exhibit are applied. Where the Exhibit indicates that all reports will be published, this means that cases designated with unknown or suspect case confirmation status will be included in the counts along with probable and confirmed cases. Data for new nationally notifiable infectious diseases or conditions are not usually available from reporting jurisdictions until January of the year following the approval of the CSTE position statement. In addition, CDC must have Office of Management and Budget Paperwork Reduction Act approval to request data from reporting jurisdictions (1). As a result, there is usually a delay between the time CSTE recommends a condition be made nationally notifiable and the time CDC can aggregate the data submitted by reporting jurisdictions.

Final data for certain infectious diseases and conditions are derived from the surveillance records of the CDC program. Requests for further information regarding these data should be directed to the appropriate program. The CDC organization responsible for finalizing the data used for the final MMWR tables for each condition is listed in the Exhibit.

Population estimates were obtained from the NCHS postcensal estimates of the resident population of the United States during July 1, 2013–July 1, 2014, 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 ethnicity (not Hispanic or Latino, Hispanic or Latino), and sex (Vintage 2014), prepared under a collaborative arrangement with the U.S. Census Bureau. Population estimates for states as of June 25, 2015 are available at http://www.cdc.gov/nchs/nvss/bridged_race/data_documentation.htm#vintage2014. Population estimates for territories are from the 2014 U.S. Census Bureau International Data Base, available at http://www.census.gov/population/international/data/idb/informationGateway.php. The choice of population denominators for incidence reported in MMWR is based on the availability of census population data at the time of preparation for publication and the desire for consistent use of the same population data to compute incidence reported by different CDC programs.

Incidence in this summary was calculated as the number of reported cases for each infectious 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. For Territories, incidence in this summary was calculated as the number of reported cases for each infectious disease or condition divided by either the territorial resident population for the specified demographic population or the total territorial resident population, multiplied by 100,000. When a nationally notifiable infectious disease or condition is associated with a specific age restriction, the same age restriction was 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 are 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.

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Interpreting Data

The completeness of information on notifiable infectious diseases and conditions was highly variable and related to the disease or condition being reported (29). Incidence data in this summary are presented by the MMWR week and year (https://wwwn.cdc.gov/nndss/document/MMWR_Week_overview.pdf) assigned by the state or territorial health department, with some exceptions, including human immunodeficiency virus (HIV) (presented by date of diagnosis), tuberculosis (presented by date CDC surveillance staff verified that the case met the criteria in the national surveillance case definition), domestic arboviral diseases (presented by date of illness onset), and varicella deaths (presented by date of death). Data were reported by the jurisdiction of the person’s “usual residence” at the time of disease or condition onset (https://wwwn.cdc.gov/nndss/document/11-SI-04.pdf). For certain nationally notifiable infectious diseases and conditions, surveillance data are reported independently to various CDC programs. For this reason, surveillance data reported by other CDC programs might vary from data reported in this summary because of differences in 1) the date used to aggregate data (e.g., date of report or date of disease or condition 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 jurisdiction should submit the case notification to CDC). In addition, the “date of disease occurrence” of conditions might vary. For infectious diseases, the meaning of the “date of disease occurrence” varies across jurisdictions and by disease and might be a date of symptom or disease onset, diagnosis, laboratory result, reporting of a case to a jurisdiction, or notification of a case to CDC.

Data reported in this summary are useful for analyzing infectious disease or condition trends and determining relative infectious disease or condition numbers. However, reporting practices affect how these data should be interpreted. Infectious disease and condition reporting is likely incomplete, and completeness might vary depending on the infectious disease or condition and reporting state. The degree of completeness of data reporting also might be influenced by the diagnostic facilities available, control measures in effect, public awareness of a specific infectious disease or condition, and the resources and priorities of state and local officials responsible for public health surveillance and for controlling infectious diseases and conditions. Finally, factors such as changes in methods for public health surveillance, introduction of new diagnostic tests, or discovery of new infectious disease or condition entities can cause changes in reporting that are independent of the actual incidence of infectious disease or condition.

Public health surveillance data are published for selected racial/ethnic populations because these characteristics can be risk markers for certain notifiable infectious diseases or conditions. 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. Different racial/ethnic populations might have different patterns of access to health care, potentially resulting in data that are not representative of actual infectious disease or condition incidence among specific population groups. In addition, not all race and ethnicity data are collected or reported uniformly for all infectious diseases and conditions; for example, the recommended standard for classifying a person’s race or ethnicity is based on self-reporting. However, this procedure might not always be followed.

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 this summary might be underestimated.

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Transitions in NNDSS Data Collection

Data collection in NNDSS has undergone various transitions over time. Before 1990, data were reported to CDC as cumulative counts rather than as individual case reports. In 1990, using the National Electronic Telecommunications System for Surveillance (or NETSS), states began electronically capturing and reporting individual cases to CDC without personal identifiers. In 2001, CDC launched the National Electronic Disease Surveillance System (NEDSS) 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, territorial, and national levels. Reporting jurisdictions now use integrated surveillance information systems based on NEDSS architectural standards to submit NNDSS data to CDC. Additional information concerning NEDSS is available at https://wwwn.cdc.gov/nndss/nedss.aspx.

In 2013, CDC began to conceptualize improvements to strengthen and modernize the technical infrastructure supporting NNDSS. In 2014, CDC and selected states began work on the NNDSS Modernization Initiative (NMI), a multiyear commitment to enhance NNDSS surveillance capabilities. An important benefit for public health decision making will be the ability to acquire higher quality data that are more comprehensive and timely. Through NMI, CDC and its state partners will increase the robustness of the NNDSS technological infrastructure so that it is based on interoperable, standardized data and data exchange mechanisms. Additional information is available at http://www.cdc.gov/nmi.

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Method for Identifying which Nationally Notifiable Infectious Diseases and Conditions are Reportable

States and jurisdictions are sovereign entities. Reportable conditions are determined by the laws and regulations of each state, territory, or local jurisdiction. Some infectious diseases and conditions deemed nationally notifiable by CSTE might not be designated as reportable in certain states or jurisdictions. Only data from reporting states, territories, and jurisdictions that designated the infectious disease or condition as reportable are included in the summary tables. This ensures the data displayed in this summary are from population-based surveillance efforts and are generally comparable across states, territories, and other jurisdictions. When a CSTE- and CDC-recommended nationally notifiable disease or condition is not reportable by state, territory, or other jurisdiction officials, an “N” indicator for “not reportable” is inserted in the table for the specified reporting state, territory, or jurisdiction and applicable year. Each year, the NNDSS Data Processing Team solicits information from each NNDSS reporting state, territory, and jurisdiction (all 50 U.S. states, the District of Columbia, New York City, and five U.S. territories) about whether reporting is mandated by law or regulation for each nationally notifiable condition.

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International Health Regulations

At its annual meeting in June 2007, CSTE approved a position statement that supports implementation of International Health Regulations (IHR) in the United States (10). CSTE approval followed the adoption of revised IHR in May 2005 by the World Health Assembly (11) 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 events that might constitute a Public Health Emergency of International Concern (PHEIC). A PHEIC is an extraordinary event that constitutes a public health risk to other countries through international spread of disease and potentially requires a coordinated international response. All WHO member countries are required to notify WHO of a potential PHEIC. WHO makes the final determination about the existence of a PHEIC.

Health care providers in the United States are required to report diseases, conditions, and outbreaks determined to be reportable by local, state, or territorial law or regulation. In addition, all health care providers should work with their local, state, or territorial health agencies to identify and report events occurring in their location that might constitute a PHEIC. U.S. state and territorial departments of health report information about a potential PHEIC to the most relevant federal agency responsible for monitoring such an event. In the case of human infectious disease, the U.S. state or territorial departments of health notifies CDC through existing formal and informal reporting mechanisms (10). CDC further analyzes the event by use of the decision algorithm in Annex 2 of the IHR and notifies the U.S. Department of Health and Human Services (HHS) Secretary’s Operations Center (SOC), as appropriate. The HHS SOC is responsible for reporting a potential PHEIC to WHO.

In the United States, HHS has the lead role in carrying out IHR, in cooperation with multiple federal departments and agencies. When a potential PHEIC is identified, the United States has 48 hours to assess the risk of the reported event. If authorities determine that a potential PHEIC exists, the United States, as with all WHO member countries, has 24 hours to report the event to WHO. The HHS SOC is responsible for reporting a potential PHEIC to WHO.

An IHR decision algorithm (Annex 2 of the IHR) was developed to help countries determine whether an event should be reported. If any two of the following four questions are answered in the affirmative, then 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 for international travel or trade restrictions?

The revised IHR reflects a conceptual shift from the use of 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 is an event that falls within those criteria (further defined in a decision algorithm in Annex 2 of the revised IHR); however, any one of the following four conditions always constitutes 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.

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 that fit the decision algorithm also must be reported to WHO.

Additional information about IHR is available at http://www.who.int/ihr/publications/9789241580496/en, http://www.cdc.gov/globalhealth/ihregulations.htm, and http://www.cdc.gov/globalhealth/healthprotection/ghs/ihr/index.html. CSTE also approved a position statement that added initial detections of novel influenza A virus infections to the list of nationally notifiable infectious diseases, beginning in January 2007, to in part support the implementation of the revised IHR in the United States to identify human influenza caused by a new subtype (12).

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Acknowledgments

We acknowledge all the local, state, and territorial health departments in the United States for collecting the data included in this report from a range of case ascertainment sources (e.g., health-care providers, hospitals, laboratories) and for reporting these data to CDC.

References

  1. U.S. Department of Health and Human Services. Information Collection and Paperwork Reduction Act (PRA) overview. Washington, DC: U.S. Department of Health and Human Services; 2015. https://www.usability.gov/how-to-and-tools/guidance/pra-overview.html
  2. Doyle TJ, Glynn MK, Groseclose SL. Completeness of notifiable infectious disease reporting in the United States: an analytical literature review. Am J Epidemiol 2002;155:866–74. http://dx.doi.org/10.1093/ aje/155.9.866
  3. CDC. Assessing completeness of perinatal hepatitis B virus infection reporting through comparison of immunization program and surveillance data—United States. MMWR Morb Mortal Wkly Rep 2011;60:410–3. 
  4. CDC. Evaluation of acute hepatitis C infection surveillance— United States, 2008. MMWR Morb Mortal Wkly Rep 2010;59:1407–10. 
  5. Hwang J, McClintock S, Kachur SP, Slutsker L, Arguin P. Comparison of national malaria surveillance system with the national notifiable diseases surveillance system in the United States. J Public Health Manag Pract 2009;15:345–51. 
  6. Painter JE, Hlavsa MC, Collier SA, Xiao L,Yoder JS. Cryptosporidiosis surveillance—United States, 2011–2012. MMWR Surveill Summ 2015;64(No. SS-3). 
  7. Painter JE, Gargano JW, Collier SA, Yoder JS. Giardiasis surveillance— United States, 2011–2012. MMWR Suppl 2015;64(No SS-3):15–25. 
  8. Wilson NO, Hall RL, Montgomery SP, Jones JL. Trichinellosis surveillance—United States, 2008–2012. MMWR Surveill Summ 2015;64(No. SS-1):1–8. 
  9. CDC. Babesiosis surveillance—18 States, 2011. MMWR Morb Mortal Wkly Rep 2012;61:505–9. 
  10. Council of State and Territorial Epidemiologists. Events that may constitute a public health emergency of international concern. Position statement 07-ID-06. http://c.ymcdn.com/sites/www.cste.org/resource/ resmgr/PS/07-ID-06.pdf
  11. World Health Organization. International Health Regulations, Second ed. Geneva, Switzerland: World Health Organization; 2005. http://apps.who.int/iris/bitstream/10665/43883/1/9789241580410_ eng.pdf
  12. 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. http://c.ymcdn.com/ sites/www.cste.org/resource/resmgr/PS/07-ID-01.pdf

* No cases of anthrax; dengue hemorrhagic fever (and dengue shock syndrome), eastern equine encephalitis, nonneuroinvasive disease; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated Coronavirus disease (SARS-CoV); smallpox; vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis, neuroinvasive and nonneuroinvasive disease; and yellow fever were reported in the United States during 2014.

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Return to your place in the textBOX 1. Infectious Diseases and Conditions Designated by CSTE and CDC as Nationally Notifiable During 2014*

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 (includes wound and unspecified)

Brucellosis

Chancroid

Chlamydia trachomatis infection

Cholera (Vibrio cholerae O1 or O139)

Coccidioidomycosis

Cryptosporidiosis

Cyclosporiasis

Dengue virus infections

   Dengue fever

   Dengue hemorrhagic fever

   Dengue shock syndrome

Diphtheria

Ehrlichiosis/Anaplasmosis

   Anaplasma phagocytophilum infection

   Ehrlichia chaffeensis infection

   Ehrlichia ewingii infection

   Undetermined human ehrlichiosis/anaplasmosis

Giardiasis

Gonorrhea

Haemophilus influenzae, invasive disease

Hansen’s disease (Leprosy)

Hantavirus pulmonary syndrome

Hemolytic uremic syndrome, postdiarrheal

Hepatitis, viral

   Hepatitis A, acute

   Hepatitis B, acute

   Hepatitis B, chronic

   Hepatitis B, perinatal infection

   Hepatitis C, acute

   Hepatitis C, past or present

Human Immunodeficiency Virus (HIV) diagnoses§

Influenza-associated pediatric mortality

Invasive pneumococcal disease (Streptococcus pneumoniae, invasive disease)

Legionellosis (Legionnaire’s Disease or Pontiac fever)

Leptospirosis

Listeriosis

Lyme disease

Malaria

Measles

Meningococcal disease (Neisseria meningitidis)

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 disease (SARS-CoV)

Shiga toxin-producing Escherichia coli (STEC)

Shigellosis

Smallpox

Spotted fever rickettsiosis

Streptococcal toxic shock syndrome

Syphilis†,¶

Syphilis, congenital

Tetanus

Toxic shock syndrome (other than streptococcal)

Trichinellosis

Tuberculosis

Tularemia

Typhoid fever (caused by Salmonella enterica serotype Typhi)

Vancomycin-intermediate Staphylococcus aureus (VISA) infection

Vancomycin-resistant Staphylococcus aureus (VRSA) infection

Varicella (morbidity)

Varicella (mortality)

Vibriosis (any species of the family Vibrionaceae, other than toxigenic Vibrio cholerae O1 or O139)

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 2013 (or 2012, in the case of leptospirosis) by the Council of State and Territorial Epidemiologists (CSTE) for national surveillance, which were implemented in January 2014. In 2012, CSTE recommended that Leptospirosis be made nationally notifiable, but because of delays in Office of Management and Budget Paperwork Reduction Act approval, it was not added to the list of nationally notifiable conditions until 2014. National surveillance case definitions for these infectious diseases and conditions are available at http://wwwn.cdc.gov/nndss/conditions.

The year 2014 reflects a modified surveillance case definition for this disease per approved 2013 CSTE position statements.

§ AIDS (Acquired Immunodeficiency Syndrome) has been reclassified as HIV stage III.

Includes the following categories: primary, secondary, latent (including early latent and late latent) and late syphilis with clinical manifestations (including late benign syphilis and cardiovascular syphilis).

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Return to your place in the textBOX 2. EXHIBIT: Publication criteria and CDC organization responsible for finalizing the data with reporting jurisdictions for notifiable conditions reported to the National Notifiable Diseases Surveillance System, 2014
Code Notifiable condition Publication criteria*,,§ CDC Organization responsible for finalizing the data
11090 Anaplasma phagocytophilum Confirmed and probable OPHSS
10350 Anthrax Confirmed and probable OPHSS
12010 Babesiosis Confirmed and probable OPHSS
10530 Botulism, foodborne Confirmed OPHSS
10540 Botulism, infant Confirmed OPHSS
10550 Botulism, other (includes wound) Confirmed OPHSS
10548 Botulism, other (unspecified) Confirmed OPHSS
10549 Botulism, wound Confirmed OPHSS
10020 Brucellosis Confirmed and probable OPHSS
10054 California serogroup virus disease, neuroinvasive Confirmed and probable NCEZID; DVBD
10061 California serogroup virus disease, nonneuroinvasive Confirmed and probable NCEZID; DVBD
10273 Chancroid All reports NCHHSTP; DSTDP
10274 Chlamydia trachomatis infection All reports NCHHSTP; DSTDP
10470 Cholera (toxigenic Vibrio cholerae O1 or O139) Confirmed OPHSS
11900 Coccidioidomycosis Confirmed OPHSS
11580 Cryptosporidiosis Confirmed and probable OPHSS
11575 Cyclosporiasis Confirmed and probable OPHSS
10680 Dengue fever (DF) Confirmed and probable NCEZID; DVBD
10685 Dengue hemorrhagic fever (DHF) (and Dengue shock syndrome (DSS) Confirmed and probable NCEZID; DVBD
10040 Diphtheria Confirmed, probable, and unknown OPHSS
10053 Eastern equine encephalitis virus disease, neuroinvasive Confirmed and probable NCEZID; DVBD
10062 Eastern equine encephalitis virus disease, nonneuroinvasive Confirmed and probable NCEZID; DVBD
11088 Ehrlichia chaffeensis Confirmed and probable OPHSS
11089 Ehrlichia ewingii Confirmed and probable OPHSS
11091 Ehrlichiosis/Anaplasmosis, undetermined Confirmed and probable OPHSS
11570 Giardiasis Confirmed and probable OPHSS
10280 Gonorrhea All reports NCHHSTP; DSTDP
10590 Haemophilus influenzae, invasive disease Confirmed, probable, and unknown OPHSS
10380 Hansen’s disease (leprosy) Confirmed OPHSS
11590 Hantavirus pulmonary syndrome (HPS) Confirmed NCEZID; DHCPP
11550 Hemolytic uremic syndrome, postdiarrheal (HUS) Confirmed and probable OPHSS
10110 Hepatitis A, acute Confirmed NCHHSTP; DVH
10100 Hepatitis B, acute Confirmed NCHHSTP; DVH
10105 Hepatitis B, chronic Confirmed and probable NCHHSTP; DVH
10104 Hepatitis B perinatal infection Confirmed NCHHSTP; DVH
10101 Hepatitis C, acute Confirmed NCHHSTP; DVH
10106 Hepatitis C, past or present Confirmed and probable NCHHSTP; DVH
  HIV diagnoses Confirmed NCHHSTP; DHAP
11061 Influenza-associated pediatric mortality Confirmed NCIRD; ID
11723 Invasive Pneumococcal Disease (IPD)/Streptococcus pneumoniae,
invasive disease (all ages)
Confirmed OPHSS
10490 Legionellosis Confirmed OPHSS
10390 Leptospirosis Confirmed and probable OPHSS
10640 Listeriosis Confirmed OPHSS
11080 Lyme disease Confirmed and probable OPHSS
10130 Malaria Confirmed OPHSS
10140 Measles (rubeola), total Confirmed and unknown OPHSS
10150 Meningococcal disease (Neisseria meningitidis) Confirmed and probable OPHSS
10180 Mumps Confirmed, probable, and unknown OPHSS
11062 Novel influenza A virus infections, initial detections of Confirmed NCIRD; ID
10190 Pertussis (Whooping Cough) Confirmed, probable, and unknown OPHSS
10440 Plague All reports OPHSS
10410 Poliomyelitis, paralytic Confirmed OPHSS
10405 Poliovirus infection, nonparalytic Confirmed OPHSS
10057 Powassan virus disease, neuroinvasive Confirmed and probable NCEZID; DVBD
10063 Powassan virus disease, nonneuroinvasive Confirmed and probable NCEZID; DVBD
10450 Psittacosis (Ornithosis) Confirmed and probable OPHSS
10257 Q fever, acute Confirmed and probable OPHSS
10258 Q fever, chronic Confirmed and probable OPHSS
10340 Rabies, animal Confirmed NCEZID; DHCPP
10460 Rabies, human Confirmed NCEZID; DHCPP
10200 Rubella Confirmed and unknown OPHSS
10370 Rubella, congenital syndrome (CRS) Confirmed, probable, and unknown OPHSS
11000 Salmonellosis Confirmed and probable OPHSS
10575 Severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease Confirmed and probable OPHSS
11563 Shiga toxin-producing Escherichia coli (STEC) Confirmed and probable OPHSS
11010 Shigellosis Confirmed and probable OPHSS
11800 Smallpox Confirmed and probable OPHSS
10250 Spotted fever rickettsiosis Confirmed, probable, and unknown OPHSS
10051 St. Louis encephalitis virus disease, neuroinvasive Confirmed and probable NCEZID; DVBD
10064 St. Louis encephalitis virus disease, nonneuroinvasive Confirmed and probable NCEZID; DVBD
11700 Streptococcal toxic shock syndrome (STSS) Confirmed and probable OPHSS
10316 Syphilis, congenital All reports NCHHSTP; DSTDP
10313 Syphilis, early latent All reports NCHHSTP; DSTDP
10314 Syphilis, late latent All reports NCHHSTP; DSTDP
10319 Syphilis, late with clinical manifestations (including late benign syphilis and cardiovascular syphilis) All reports NCHHSTP; DSTDP
10311 Syphilis, primary All reports NCHHSTP; DSTDP
10312 Syphilis, secondary All reports NCHHSTP; DSTDP
10310 Syphilis, total primary and secondary All reports NCHHSTP; DSTDP
10210 Tetanus All reports OPHSS
10520 Toxic shock syndrome (staphylococcal) (TSS) Confirmed and probable OPHSS
10270 Trichinellosis Confirmed and probable OPHSS
10220 Tuberculosis Confirmed NCHHSTP; DTE
10230 Tularemia Confirmed and probable OPHSS
10240 Typhoid fever (caused by Salmonella typhi) Confirmed and probable OPHSS
11663 Vancomycin-intermediate Staphylococcus aureus (VISA) Confirmed OPHSS
11665 Vancomycin-resistant Staphylococcus aureus (VRSA) Confirmed OPHSS
10030 Varicella morbidity (Chickenpox) Confirmed and probable OPHSS
  Varicella mortality Confirmed and probable NCIRD; DVD
11545 Vibriosis (any species of the family Vibrionaceae, other than toxigenic
Vibrio cholerae O1 or O139)
Confirmed and probable OPHSS
11647 Viral hemorrhagic fevers (VHF) Confirmed OPHSS
10056 West Nile virus disease, neuroinvasive Confirmed and probable NCEZID; DVBD
10049 West Nile virus disease, nonneuroinvasive Confirmed and probable NCEZID; DVBD
10052 Western equine encephalitis virus disease, neuroinvasive Confirmed and probable NCEZID; DVBD
10065 Western equine encephalitis virus disease, nonneuroinvasive Confirmed and probable NCEZID; DVBD
10660 Yellow fever Confirmed and probable NCEZID; DVBD

Abbreviations: OPHSS = Office of Public Health Scientific Services; NCEZID = National Center for Emerging and Zoonotic Infectious Diseases; DVBD = Division of Vector-Borne Diseases; NCHHSTP = National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; DSTDP = Division of STD Prevention; DHCPP = Division of High Consequence Pathogens and Pathology; DVH = Division of Viral Hepatitis; DHAP = Division of HIV/AIDS Prevention; NCIRD = National Center for Infectious and Respiratory Diseases; ID = Influenza Division; DTE = Division of Tuberculosis Elimination; DVD = Division of Viral Diseases.

* 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 publication criteria.

† Publication criteria for the National Notifiable Diseases Surveillance System (NNDSS): for a case report of a nationally notifiable disease to be published in 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 publication, this means that cases designated with unknown or suspect case confirmation status will be published just as probable and confirmed cases will be published. Because Council of State and Territorial (CSTE) position statements customarily are not finalized until July of each year, 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.

§ Based on case classification status.

Publication criteria determined by reporting jurisdictions. In 2014 Varicella deaths were reported from four jurisdictions with the following publication criteria; Texas (probable), Florida (confirmed), Virginia (confirmed), and Georgia (confirmed).

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Nationally Notifiable Infectious Conditions Group

Paul M. Arguin, MD; Aileen Artus, MPH; Kaitlin Benedict, MPH; David D. Blaney, MD; Jesse Blanton, MPH; Anna Bowen, MD; William A. Bower, MD; Elizabeth C. Briere, MD; Kevin Chatham-Stephens, MD; Tom Chiller, MD; Mary Choi, MD; Nakia Clemmons, MPH; Shannon Cooney, MPH; Karen A. Cullen, PhD; F. Scott Dahlgren, MSPH; Annabelle de St Maurice, MD; Naomi Drexler, MPH; Elizabeth Ervin, MPH; Amanda E. Faulkner, MPH; Marc Fischer, MD; Kathleen E. Fullerton, MPH; Julia Warner Gargano, PhD; Laurel E. Garrison, MPH; Hannah Gould, PhD; Elizabeth B. Gray, MPH; Marta Guerra, DVM; Rebecca Hall, MPH; Kristen Nichols Heitman, MPH; Katherine A. Hendricks, MD; Barbara L. Herwaldt, MD; Michele C. Hlavsa, MPH; Scott Holmberg, MD; Jacqueline Hurd, MPH; Martha Iwamoto, MD; Kelly A. Jackson, MPH; Ruth Jiles, PhD; Anna Satcher Johnson, MPH; Jeffrey Jones, MD; Michael Judd, MPH; Grishma A. Kharod, MPH; Sarah Kidd, MD; Robert Kirkcaldy, MD; Barbara Knust, DVM; Kiersten J. Kugeler, PhD; Ben Kupronis, MPH; Amanda N. Lankford; Jennifer Lehman; Nicole Lindsey, MPH; Adriana Lopez, MHS; Kimberly E. Mace, PhD; Jessica R. MacNeil, MPH; Barbara Mahon, MD; Lilia P. Manangan, MPH; Stacey W. Martin, MSc; Robert F. Massung, PhD; Orion McCotter, MPH; Paul S. Mead, MD; Rajal K. Mody, MD; Susan Montgomery, DVM; Anna Newton, MPH; Christopher D. Paddock, MD; Emily Pieracci, DVM; Robert H. Pratt; Rodney Presley, PhD; Lawrence Purpura, MD; Susan Redd; Pierre Rollin, MD; Ilana J. Schafer, DVM; Sean V. Shadomy, DVM; Tyler M. Sharp, PhD; Tami H. Skoff, MS; Erin Staples, MD; Tara Stine, PhD; Tejpratap S.P. Tiwari, MD; Elizabeth Torrone, PhD; Rita M. Traxler, MHS; Gregory Wallace, MD; Ryan Wallace, DVM; Hillard Weinstock, MD; Emily Weston, MPH, CDC.

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Highlights for 2014

Anthrax

The U.S. Food and Drug Administration (FDA) has approved two antitoxin treatments for inhalation anthrax: anthrax immune globulin intravenous (human) (i.e., Anthrasil) (1) and raxibacumab (2). These therapeutics are held in the Strategic National Stockpile, and requests for use must be made to CDC. Antitoxins, in combination with antimicrobials and supportive therapies, are recommended for treatment of systemic anthrax. In addition, anthrax vaccine adsorbed (i.e., BioThrax) is FDA-approved as a 3-dose postexposure prophylaxis (PEP) series, along with antimicrobials, to prevent anthrax in adults exposed to Bacillus anthracis (3). PEP and treatment recommendations exist for multiple populations, including children, pregnant and postpartum women, and adults for conventional and mass casualty settings (47).

  1. Food and Drug Administration. FDA approves treatment for inhalation anthrax. 2015. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm439752.htm
  2. Food and Drug Administration. FDA approves raxibacumab to treat inhalational anthrax. 2012. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm332341.htm
  3. Food and Drug Administration. FDA approves vaccine for use after known or suspected anthrax exposure. 2015. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm474027.htm
  4. Bradley JS, Peacock G, Krug SE, et al. Pediatric anthrax clinical management. Pediatrics 2014;133:e1411–36. CrossRef PubMed
  5. Hendricks KA, Wright ME, Shadomy SV, et al. Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis 2014;20: .http://wwwnc.cdc.gov/eid/article/20/2/13-0687_intro CrossRef PubMed
  6. Meaney-Delman D, Zotti ME, Creanga AA, et al. Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women. Emerg Infect Dis 2014;20: .http://wwwnc.cdc.gov/eid/content/20/2/pdfs/v20-n2.pdf CrossRef PubMed
  7. Bower WA, Hendricks K, Pillai S, Guarnizo J, Meaney-Delman D. Clinical framework and medical countermeasure use during an anthrax mass-casualty incident. MMWR Recomm Rep 2015;64(No. RR-4 ). PubMed

Domestic Arboviral Disease, Neuroinvasive and Nonneuroinvasive

In 2014, a total of 2,205 West Nile virus (WNV) disease cases were reported, including 1,347 cases of neuroinvasive disease (e.g., meningitis, encephalitis, and acute flaccid paralysis) and 97 deaths (1). WNV disease cases were reported from 42 states and the District of Columbia. Three states reported two thirds (66%) of the WNV neuroinvasive disease cases: California (561 cases), Texas (253), and Arizona (80). The incidence of neuroinvasive disease was similar to the median incidence during 2002–2013 (median = 0.40; range = 0.13–1.02). However, California reported a record 561 neuroinvasive disease cases, 83% more than the next highest year (2005). In California, 70% of all neuroinvasive disease cases were reported from two counties (Los Angeles and Orange). These findings underscore the focal nature of WNV outbreaks.

After WNV, the next most commonly reported cause of neuroinvasive arboviral disease was La Crosse virus, followed by Jamestown Canyon virus, St. Louis encephalitis virus, Powassan virus, and Eastern equine encephalitis virus. Jamestown Canyon virus disease cases continue to be reported from new locations (e.g., Tennessee) following the implementation of routine Jamestown Canyon virus antibody testing at CDC in 2013 (2). Although rare, Eastern equine encephalitis virus disease remained the most severe arboviral disease, with two deaths among eight patients.

  1. Lindsey NP, Lehman JA, Staples JE, Fischer M. West Nile virus and other nationally notifiable arboviral diseases—United States, 2014. MMWR Morb Mortal Wkly Rep 2015;64:929–34. CrossRef PubMed
  2. Pastula DM, Hoang Johnson DK, White JL, Dupuis AP , Fischer M, Staples JE. Jamestown Canyon virus disease in the United States—2000–2013. Am J Trop Med Hyg 2015;93:384–9. CrossRef PubMed

Babesiosis

Babesiosis is caused by protozoan parasites of the genus Babesia, which 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 also can be transmitted via blood transfusion or congenitally (1).

In 2014, a total of 1,744* cases of babesiosis were reported to CDC. Babesiosis cases were reported by 22 of the 31 states in which babesiosis was a reportable condition; 94% (1,636) of the reported cases occurred in residents of seven states (Connecticut, Massachusetts, Minnesota, New Jersey, New York, Rhode Island, and Wisconsin). The median age of patients was 63 years (range: <1–96 years); 65% (1,131) were male, and sex was unknown for <1% (six). Among the 1,340 patients for whom data were available, 84% (1,124) had symptom onset dates during June–August.

  1. Herwaldt BL, Linden JV, Bosserman E, Young C, Olkowska D, Wilson M. Transfusion-associated babesiosis in the United States: a description of cases. Ann Intern Med 2011;155:509–19. CrossRef PubMed

* This number differs slightly from the denominator of 1,760 presented in table 2, which includes 22 erroneous reports not retracted before the deadline for finalizing the data. In addition, six cases that were reported after the deadline are included at the request of the pertinent health departments.

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Botulism

Botulism is a severe paralytic illness caused by toxins produced by Clostridium botulinum. Exposure to the toxin can occur by ingestion (foodborne botulism), in situ production from C. botulinum colonization of either 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). In 2014, a total of 161 cases of botulism were reported, including 127 cases in infants, 15 foodborne cases, and 19 cases classified as other, including wound botulism. During 2014, four outbreaks (events with two or more cases) of foodborne botulism were reported. One outbreak was associated with stinkheads (fermented whitefish heads, a traditional Alaska Native food) (three cases), one with seal oil (three cases), one with home-canned tomato sauce (two cases), and one with pasta and jarred pesto (two cases). The jarred pesto was produced in a home kitchen, sold commercially, and then mixed with the pasta by one of the cases; the only leftovers available for testing were the pesto and pasta mixed together.

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 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. CrossRef PubMed

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Brucellosis

During 2014, a total of 92 human brucellosis cases were reported in the United States; 58 were among men. Cases were distributed throughout the United States, with the South Atlantic and Pacific regions having the highest number of reported cases (19 and 25, respectively). Persons who consume raw (unpasteurized) dairy products might be at increased risk for exposure to Brucella spp., which can cause brucellosis (1). Feral swine hunters also are considered an at-risk population (2).

  1. CDC. Risks from unpasteurized dairy products. http://www.cdc.gov/brucellosis/exposure/unpasteurized-dairy-products.html
  2. CDC. Hunters risks. http://www.cdc.gov/brucellosis/exposure/hunters.html

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Chlamydia

Chlamydia trachomatis is the most commonly reported nationally notifiable infectious disease in the United States; 1,441,789 cases were reported to CDC in 2014. Following a slight decline during 2012–2013, the national rate of reported chlamydial infection increased 2.8% during 2013–2014,* from 443.5 to 456.1 per 100,000 population (1). Rates were highest among females aged 15–19 years (2,941.0 cases per 100,000 females) and 20–24 years (3,651.1). The rate among women aged 15–19 years increased steadily during 2000–2011, but decreased 4.4% during 2011–2012, 7.9% during 2012–2013, and 4.2% during 2013–2014. As in previous years, rates of reported chlamydia were highest among non-Hispanic blacks. The rate of reported chlamydia among black females aged 15–19 years was 4.9 times the rate among white females in the same age group. Most chlamydial infections are asymptomatic, and rates of reported cases are affected by the diagnostic test used and the proportion of the population screened. Consequently, increases in case rates might reflect expanded screening coverage, use of more sensitive diagnostic tests, and increases in incidence of infection. Likewise, decreases in rates of reported chlamydial infections might suggest decreases in incidence of infection or decreases in screening coverage.

  1. CDC. Sexually transmitted disease surveillance 2014. Atlanta, GA: US Department of Health and Human Services, CDC; 2015.

* Rates for 2014 were calculated using the 2013 population estimates and differ from 2014 rates presented in the figures and table 7 (calculated using 2014 population estimates).

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Cholera

Cholera continues to be rare in the United States and is most often acquired during travel in countries where toxigenic Vibrio cholerae O1 or O139 is circulating (13). Of the five cholera infections in 2014, all were travel-associated (two with travel to Cuba, two to India, and one to Ghana). Although cholera is endemic in many African countries, the patient who traveled to Ghana is the first since 2011 to be associated with travel to an African country (4).

  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 twentieth century. J Infect Dis 2001;184:799–802. CrossRef PubMed
  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. CrossRef PubMed
  3. Loharikar A, Newton AE, Stroika S, et al. Cholera in the United States, 2001–2011: a reflection of patterns of global epidemiology and travel. Epidemiol Infect 2015;143:695–703. CrossRef PubMed
  4. Mintz ED, Guerrant RL. A lion in our village—the unconscionable tragedy of cholera in Africa. N Engl J Med 2009;360:1060–3. CrossRef PubMed

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Coccidioidomycosis

Coccidioidomycosis (i.e., Valley fever) is a fungal infection caused by inhalation of Coccidioides spp. spores that are present in the arid soil of the southwestern United States, California, and parts of Central and South America. Coccidioides also was recently identified in soil in south-central Washington in association with cases of human disease (1). After a substantial increase during 1998–2011 (2), the number of cases has decreased each year since then, including a 13% decrease in the number of cases from 2013 to 2014 (9,438 and 8,232, respectively). Historically, Arizona and California have had the highest number of reported coccidioidomycosis cases. Arizona, which reported the most cases (5,624) of any state in 2014, experienced a 4% decrease in the number of cases compared with 2013 (5,861 cases). California reported the second-highest number of cases (2,243) of any state in 2014 and experienced a 31% decrease compared with 2013 (3,272 cases).

Reasons for the overall decrease in reported cases might, in part, be related to changes in the environment or changes in the at-risk population. Physicians should continue to maintain a high suspicion for acute coccidioidomycosis in patients who live in or have traveled to areas in which the disease is endemic and should be aware of the possibility for coccidioidomycosis outside of its previously recognized geographic range.

  1. Litvintseva AP, Marsden-Haug N, Hurst S, et al. Valley fever: finding new places for an old disease: Coccidioides immitis found in Washington State soil associated with recent human infection. Clin Infect Dis 2015;60:e1–3 CrossRef PubMed
  2. CDC. Increase in reported coccidioidomycosis—United States, 1998–2011. MMWR Morb Mortal Wkly Rep 2013;62:217–21. PubMed

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Cryptosporidiosis

Approximately 95% of human cryptosporidiosis is caused by the numerous Cryptosporidium parvum and Cryptosporidium hominis subtypes. Although cryptosporidiosis affects persons of all age groups, cases are most frequently reported in children aged 1–4 years (1). A substantial increase in transmission of Cryptosporidium occurs during summer, coinciding with increased use of recreational water, a well-established risk factor for cryptosporidiosis. Cryptosporidium has emerged as the leading cause of nationally notified recreational water–associated outbreaks and waterborne disease outbreaks overall (2). Transmission through recreational water is facilitated by the substantial number (up to 108–109) of immediately infectious Cryptosporidium oocysts that can be shed in a single bowel movement (3), the extended time (days to weeks) that oocysts can be shed (4), the low (≤10 oocysts) infectious dose (5), and the extreme tolerance of Cryptosporidium oocysts to chlorine (6). In 2014, the increased reporting observed after 2004 continued. In addition, the proportion of probable cases has increased to 36% of all reported cases, primarily because of changes in the 2011 and 2012 national case definitions.

Conventional diagnostics (e.g., microscopy and immunoassays) cannot discriminate among the Cryptosporidium species and their subtypes. CDC has launched CryptoNet, a molecular-based surveillance system that will integrate traditional and molecular data to help elucidate Cryptosporidium transmission pathways and thus the epidemiology of cryptosporidiosis in the United States. CryptoNet has successfully differentiated clusters of illness caused by different Cryptosporidium species and detected outbreaks caused by rare subtypes. Additional information about CryptoNet is available at http://www.cdc.gov/parasites/crypto/cryptonet.html.

To reduce the burden of cryptosporidiosis associated with recreational water, enhanced prevention measures are needed. In the United States, public health codes for public aquatic facilities are written, enacted, implemented, and enforced by state or local officials; no federal agency regulates the design, construction, operation, and maintenance of these venues. To provide support to state and local jurisdictions, CDC led the development and revision of the Model Aquatic Health Code (MAHC) (http://www.cdc.gov/mahc/editions/current.html). This guidance document integrates the latest science and best practices with specific code language and explanatory materials covering the design, construction, operation, and maintenance of public swimming pools, hot tubs/spas, and other aquatic venues. MAHC is updated every 2 years through an all-stakeholder–driven process via the Council for the Model Aquatic Health Code (www.cmahc.org/index.php) to ensure its continued relevance and to respond to the latest scientific data and aquatics sector innovations.

  1. Painter JE, Hlavsa MC, Collier SA, Xiao L, Yoder JS. Cryptosporidiosis surveillance—United States, 2011–2012. MMWR Suppl 2015;64(No. SS-3 ). PubMed
  2. Hlavsa MC, Roberts VA, Kahler AM, et al. Outbreaks of illness associated with recreational water—United States, 2011–2012. MMWR Morb Mortal Wkly Rep 2015;64:668–72. PubMed
  3. Goodgame RW, Genta RM, White AC, Chappell CL. Intensity of infection in AIDS-associated cryptosporidiosis. J Infect Dis 1993;167:704–9. CrossRef PubMed
  4. 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. CrossRef PubMed
  5. 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. PubMed
  6. Murphy JL, Arrowood MJ, Lu X, Hlavsa MC, Beach MJ, Hill VR. Effect of cyanuric acid on the inactivation of Cryptosporidium parvum under hyperchlorination conditions. Environ Sci Technol 2015;49:7348–55. CrossRef PubMed

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Cyclosporiasis

Of the 398 cyclosporiasis cases reported in 2014, a total of 275 (69%) were domestically acquired (i.e., they occurred in persons with no known history of travel outside the United States and Canada during the 14-day incubation period), 77 (19%) were associated with international travel, and 46 (12%) occurred in persons for whom the travel status was unknown or missing. Of the domestically acquired cases, 244 (89%) occurred in persons with onset of illness during May–August. Clusters of cases were identified in Michigan (June onset dates), Texas (June–July onsets), and South Carolina (July onsets) (1). In Michigan, a cluster of 14 cases identified among attendees of a conference included residents of Michigan and six other states. In Texas, 26 cluster-associated cases occurred among patrons of five different local Mexican-style restaurants. In South Carolina, one temporospatial cluster of 13 cases was investigated, although the exact location(s) of exposure was not identified. A vehicle of infection (i.e., fresh cilantro imported from Mexico) was implicated only for the 26 cluster-associated cases in Texas, marking the second consecutive year in which fresh cilantro from Mexico was implicated as the vehicle of infection for at least some of the reported cyclosporiasis cases in Texas. The vehicle(s) of infection was not identified for the remaining 218 (89% of 244) domestically acquired cases with onsets during May–August 2014. No molecular subtyping methods are available that could facilitate linking cases of cyclosporiasis to each other and to particular vehicles and sources of infection.

  1. CDC. U.S. foodborne outbreaks of cyclosporiasis—2000–2014. Atlanta, GA: US Department of Health and Human Services, CDC; 2014.

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Dengue

Dengue is an acute febrile illness characterized by myalgia, headache, leukopenia, and minor bleeding manifestations (1). Patients with severe dengue experience plasma leakage resulting in fluid accumulation, hemorrhage, and/or major organ impairment (e.g., liver failure, myocarditis, and impaired consciousness). Dengue is endemic throughout much of the tropics and subtropics, where an estimated 50–100 million cases and 9,200 deaths occur annually (2). With proper clinical management, the case-fatality rate of hospitalized dengue patients can be <0.5% (3). Efforts to improve outcomes among persons with dengue include an online clinical education course developed by CDC (http://www.cdc.gov/dengue/training/cme.html).

In 2014, a total 680 laboratory-positive, travel-associated dengue cases were reported from 44 of the 50 states, two of the five territories, and the District of Columbia. Most (65%) persons with travel-associated dengue had a history of travel to the Caribbean or Americas, where chikungunya had recently emerged. Because dengue and chikungunya often have a similar clinical presentation, the increase in reported dengue cases compared to previous years, when dengue was not epidemic in the region, might be attributable to increased diagnostic testing to differentiate between these diseases among patients with acute febrile illness. The states with the most travel-associated dengue cases reported were California (130), Arizona (97), and Florida and New Jersey (84 each). Concomitant with a dengue epidemic in northern Mexico, an outbreak of travel-associated dengue occurred in Arizona, and all reported case-patients had recently traveled to Mexico; enhanced surveillance revealed no locally acquired cases (4). Florida reported seven locally acquired dengue cases. In the dengue-endemic Caribbean territories of Puerto Rico and the U.S. Virgin Island, reports of laboratory-positive dengue cases were substantially lower than in previous years (525 and 19 cases, respectively). No cases of dengue hemorrhagic fever were reported in 2014 in travelers or residents of U.S. territories.

  1. World Health Organization. Dengue: guidelines for diagnosis, treatment, prevention and control. Geneva, Switzerland: World Health Organization; 2009.
  2. Stanaway JD, Shepard DS, Undurrage EA, et al. The global burden of dengue: an analysis from the Global Burden of Disease Study 2013. Lancet Infect Dis 2016;16:712–23.
  3. Lam PK, Tam DT, Diet TV, et al. Clinical characteristics of Dengue shock syndrome in Vietnamese children: a 10-year prospective study in a single hospital. Clin Infect Dis 2013;57:1577–86. CrossRef PubMed
  4. Jones JM, Lopez B, Adams L, et al. Binational dengue outbreak along the United States–Mexico border—Yuma County, Arizona, and Sonora, Mexico, 2014. MMWR Morb Mortal Wkly Rep 2016;65:495–9. CrossRef PubMed

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Diphtheria

During 2014, a nonfatal case of diphtheria caused by nontoxigenic Corynebacterium diphtheriae was reported to CDC. The case occurred in a 17-year-old white female resident of Ohio. The patient was fully vaccinated. No other family member or close contact was ill.

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Giardiasis

Giardiasis is the most common enteric parasitic infection in the United States, infecting an estimated 1.2 million persons annually (1). Symptomatology is variable, but giardiasis is normally characterized by diarrhea, abdominal cramps, bloating, weight loss, and malabsorption; extraintestinal symptoms are possible (2). Infected persons can shed Giardia for several weeks, and recent studies indicate a potential for chronic sequelae from giardiasis (3). Giardia is endemic worldwide, including in the United States, and is the most commonly diagnosed pathogen among travelers returning to the United States from other countries (4). Giardia is commonly detected in internationally adopted children screened in the United States; often, these children do not have gastrointestinal symptoms (5). In 2014, the reported incidence of giardiasis appeared to decrease compared with 2013, which could reflect changes in reporting practices or changes in the actual occurrence of giardiasis.

Giardia is transmitted through the fecal-oral route with the ingestion of environmentally stable Giardia cysts. Most information on giardiasis transmission is from outbreak investigations; 242 giardiasis outbreaks reported to CDC for 1971–2011 resulted from waterborne (74.8%), foodborne (15.7%), person-to-person (2.5%) and animal contact (1.2%) transmission (6). On the basis of outbreak trends, investigators identified groundwater and distribution system vulnerabilities in drinking water systems, inadequate pool disinfection, fruit and vegetable contamination, and poor food handler hygiene as possible targets for giardiasis prevention measures. However, the majority of reported giardiasis cases are not linked to known outbreaks. Among reported cases, <2% are documented as outbreak-associated (7). An ecological study of sporadic giardiasis in the United States indicated that high county-level reliance on private wells was associated with higher giardiasis rates (8). Prospective epidemiologic studies and continued outbreak and case surveillance are needed to understand transmission pathways and to identify effective public health prevention measures.

Population studies of Giardia seroprevalence would contribute substantially to understanding the prevalence of giardiasis in the United States (9). Enhanced genotyping methods would increase knowledge of the molecular epidemiology of Giardia, including elucidating species-specific subassemblages (10). Application of these tools to epidemiologic studies and surveillance has the potential to 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. Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in the United States—major pathogens. Emerg Infect Dis 2011;17:7–15. CrossRef PubMed
  2. 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. CrossRef PubMed
  3. Hanevik K, Wensaas KA, Rortveit G, Eide GE, Mørch K, Langeland N. Irritable bowel syndrome and chronic fatigue 6 years after giardia infection: a controlled prospective cohort study. Clin Infect Dis 2014;59:1394–400. . CrossRef PubMed
  4. Harvey K, Esposito DH, Han P, et al. Surveillance for travel-related disease—GeoSentinel Surveillance System, United States, 1997–2011. MMWR Surveill Summ 2013;62(No. SS-9 ). PubMed
  5. Staat MA, Rice M, Donauer S, et al. Intestinal parasite screening in internationally adopted children: importance of multiple stool specimens. Pediatrics 2011;128:e613–22. PubMed
  6. Adam EA, Yoder JS, Gould H, Hlavsa MC. Giardiasis outbreaks in the United States, 1971–2011. Epidemiol Infect 2016. http://www.ncbi.nlm.nih.gov/pubmed/26750152
  7. Schnell K, Collier S, Derado G, Yoder J, Gargano JW. Giardiasis in the United States—an epidemiologic and geospatial analysis of county-level drinking water and sanitation data, 1993–2010. J Water Health 2016;14:267–79. PubMed
  8. Yoder JS, Gargano JW, Wallace RM, Beach MJ Giardiasis surveillance—United States, 2009–2010. MMWR Surveill Summ 2012;61(No. SS-5 ). PubMed
  9. Priest JW, Moss DM, Visvesvara GS, Jones CC, Li A, Isaac-Renton JL. Multiplex assay detection of immunoglobulin G antibodies that recognize Giardia intestinalis and Cryptosporidium parvum antigens. Clin Vaccine Immunol 2010;17:1695–707. CrossRef PubMed
  10. Feng Y, Xiao L. Zoonotic potential and molecular epidemiology of Giardia species and giardiasis. Clin Microbiol Rev 2011;24:110–40. CrossRef PubMed

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Gonorrhea

Following a historically low rate in 2009 (98.1 cases per 100,000 population), the national rate of reported gonorrhea cases increased 12.8% to 110.7 in 2014* (1). The rate among men steadily increased during this period, including a 10.5% increase during 2013–2014; the rate among women decreased 0.4% during 2013–2014. The increase among men, coinciding with the decrease among women, suggests increased transmission and/or or increased case detection, including expanded extragenital gonorrhea screening, among gay, bisexual, and other men who have sex with men. As in previous years, the highest rates of gonorrhea were among persons aged 15–24 years, among non-Hispanic blacks, and in the South. In 2014, the gonorrhea rate among non-Hispanic blacks was 10.6 times the rate among non-Hispanic whites. Although the highest rate overall was in the South, including a 3.1% increase during 2013–2014, the rate of reported gonorrhea cases increased by 22.2% in the West during the same time.

Treatment for gonorrhea has been complicated by the repeated acquisition of antimicrobial resistance by Neisseria gonorrhoeae. The emergence of fluoroquinolone resistance during 2000–2007 and subsequent declining cefixime susceptibility (2006–2011) resulted in changes in the CDC treatment guidelines in 2007, 2010, and 2012. The only CDC-recommended treatment regimen for gonorrhea is dual therapy with intramuscular ceftriaxone and oral azithromycin (2). In CDC's sentinel surveillance system (Gonococcal Isolate Surveillance Project), the percentage of isolates with reduced cefixime susceptibility decreased from 1.4% in 2011 to 0.4% in 2013, and then increased to 0.8% in 2014. During this time, the percentage of isolates with elevated ceftriaxone minimum inhibitory concentrations (MICs) ranged from 0.05% (2013) to 0.4% (2011). During 2013–2014, the percentage with elevated azithromycin MICs increased from 0.6% to 2.5% (1).

  1. CDC. Sexually transmitted disease surveillance 2014. Atlanta, GA: US Department of Health and Human Services, CDC; 2015.
  2. CDC. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;64(No. RR-3).

* Rates for 2014 were calculated using the 2013 population estimates and differ from 2014 rates presented in the figures and table 7 (calculated using 2014 population estimates).

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Hansen’s Disease (Leprosy)

Hansen’s Disease (HD) (i.e., leprosy) is a chronic infectious disease caused by the obligate intracellular bacterium Mycobacterium leprae. Growing optimally at 27o–30o C (80.6o–86.0o F), HD primarily affects the skin and superficial peripheral nerves, most notably the posterior tibial and lateral popliteal nerves of the lower leg and foot, the ulnar, median, and radial nerves of the forearm and hand, and the facial nerve (1). HD is highly responsive to treatment but requires a prolonged multidrug therapy of 1–2 years of dapsone, rifampin, and clofazamine to result in cure (2). However, untreated disease can result in sensory and motor neuropathy, with eventual permanent disability of the eyes, hands, and feet (3).

An average of 89 HD cases have been reported to CDC per year since 2000, with a low of 66 in 2006 and a high of 105 in 2004; not all states list HD as a reportable disease, which might account for the higher numbers reported annually by the National Hansen’s Disease Programs (4). By race, white and Asian/Pacific Islanders accounted for the majority of new reported cases (36 [54%] of 67 cases and 24 [36%] of 67 cases, respectively). Similar to 2013, the majority of new cases in 2014 were reported from Texas (19 [22%] of 88), Hawaii (14 [16%] of 88), and New York City and Florida (10 [11%] of 88 each). In addition to the 88 cases reported in the United States, 13 cases were reported from Guam and two from Puerto Rico.

  1. Eichelmann K, González González SE, Salas-Alanis JC, Ocampo-Candiani J. Leprosy. An update: definition, pathogenesis, classification, diagnosis, and treatment. Actas Dermosifiliogr 2013;104:554–63. CrossRef PubMed
  2. Worobec SM. Current approaches and future directions in the treatment of leprosy. Res Rep Trop Med 2012;3:79–91. CrossRef
  3. Walker SL, Lockwood DNJ. Leprosy. Clin Dermatol 2007;25:165–72. CrossRef PubMed
  4. Hansen’s Disease Data & Statistics. Washington, DC: US Department of Health and Human Services; 2015. http://www.hrsa.gov/hansensdisease/dataandstatistics.html

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Hantavirus Pulmonary Syndrome

Hantavirus pulmonary syndrome (HPS), a severe and sometimes fatal pulmonary disease resembling acute respiratory distress syndrome, is caused by hantavirus infection. Hantaviruses are transmitted by inhalation or direct contact with virus-containing particles or through direct contact with rodents who harbor the virus, such as the deer mouse (Peromyscus maniculatus). Most HPS cases occur in the western United States (1,2). In 2014, a total of 34* cases of HPS occurred in 13 states, of which 33 (97%) occurred in western states. Median age of patients was 38 years (range: 5–84). The 2014 case fatality rate was 38%, similar to previous reports.

Although HPS is a rare disease in the United States, it is associated with severe illness and high rates of death. Persons should avoid contact with deer mice or their droppings and use personal protective equipment when cleaning rodent infested environments.

  1. MacNeil A, Ksiazek TG, Rollin PE. Hantavirus pulmonary syndrome, United States, 1993–2009. Emerg Infect Dis 2011;17:1195–201. CrossRef PubMed
  2. Knust B, Rollin PE. Twenty-year summary of surveillance for human hantavirus infections, United States. Emerg Infect Dis 2013;19:1934–7. CrossRef PubMed

* Although 32 cases were reported in table 1, two cases were subsequently added.

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Hemolytic Uremic Syndrome, Postdiarrheal

Hemolytic uremic syndrome (HUS) is characterized by the triad of hemolytic anemia, thrombocytopenia, and renal insufficiency. The most common etiology of postdiarrheal HUS in the United States is infection with Shiga toxin-producing Escherichia coli (STEC), principally STEC O157:H7 (1,2). Children aged <5 years progress to HUS more often than all other persons infected with STEC O157:H7 (15.3% vs. 6.3%) (3). In 2014, as in previous years of surveillance, the age group with the most reported cases was children aged 1‒4 years (117 of 250 cases).

  1. Banatvala N, Griffin PM, Greene KD, et al. The United States National Prospective Hemolytic Uremic Syndrome Study: microbiologic, serologic, clinical, and epidemiologic findings. J Infect Dis 2001;183:1063–70. CrossRef PubMed
  2. Mody RK, Luna-Gierke RE, Jones TF, et al. Infections in pediatric postdiarrheal hemolytic uremic syndrome: factors associated with identifying shiga toxin-producing Escherichia coli. Arch Pediatr Adolesc Med 2012;166:902–9. CrossRef PubMed
  3. Gould LH, Demma L, Jones TF, et al. Hemolytic uremic syndrome and death in persons with Escherichia coli O157:H7 infection, foodborne diseases active surveillance network sites, 2000–2006. Clin Infect Dis 2009;49:1480–5. CrossRef PubMed

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Human Immunodeficiency Virus Infections

CDC requires states to report Human Immunodeficiency Virus Infections (HIV) case data through the enhanced HIV/AIDS Reporting System (eHARS), which is a browser-based system deployed at 54 state/local and territorial public health departments in the United States. HIV surveillance data are not reported through NNDSS. De-identified data are transmitted monthly from health departments through the secure access management system (SAMS) directly to CDC’s Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, and are incorporated into the National HIV Surveillance System database.

As of April 2008, all 50 states, the District of Columbia, and six U.S. dependent areas required confidential name-based reporting for HIV infection, in addition to reporting persons whose disease has been classified as stage 3 (acquired immunodeficiency syndrome [AIDS]). In 2008, CDC published a revised surveillance case definition for HIV infection that includes AIDS and incorporates the HIV infection classification (1). Laboratory-confirmed evidence of HIV infection is required to meet the surveillance case definition for HIV infection, including stage 3 (AIDS).

In 2014, the HIV surveillance case definition was revised to adapt to changes in diagnostic criteria used by laboratories and clinicians (2). The laboratory criteria for defining a confirmed case of HIV infection were changed to accommodate multitest algorithms that do not include previously required tests (e.g., Western blot). New to the case definition is the inclusion of criteria for differentiating HIV-1 and HIV-2 infections and for recognizing early HIV infection (stage 0), during which viral loads might be high enough and CD4 T-lymphocyte counts low enough to be confused with stage 3 (AIDS). In addition, the revised definition consolidates the staging systems for adults/adolescents and children, simplifies surveillance criteria for opportunistic illnesses indicative of stage 3, and incorporates revisions of clinical criteria (i.e., medical record documentation) for reporting diagnoses without laboratory evidence. Because retroactive implementation of some features (e.g., the new staging system) of the 2014 case definition would be impractical, for this report, cases diagnosed before 2014 were classified according to the 2008 HIV case definition and cases diagnosed in 2014 were classified according to the 2014 HIV case definition.

A total of 35,606 cases of HIV infection were diagnosed in the United States during 2014 and reported to CDC as of December 2014. Blacks had the highest rate of diagnoses of HIV infection of all racial/ethnic groups (40.1 per 100,000 population) and accounted for 44.5% of diagnoses in 2014. Although HIV affects persons in all age groups, cases were most frequently diagnosed in adults aged 25–39 years. Areas with the highest rates (≥15.0) of diagnoses during 2014 were the District of Columbia, Florida, Louisiana, Mississippi, New York, South Carolina, and the U.S. Virgin Islands.

  1. Schneider E, Whitmore S, Glynn KM, Dominguez K, Mitsch A, McKenna MT. Revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years—United States, 2008. MMWR Recomm Rep 2008;57(No. RR-10 ). PubMed
  2. CDC. Revised surveillance case definition for HIV infection—United States, 2014. MMWR Recomm Rep 2014;63(No. RR-3 ). PubMed

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Influenza-Associated Pediatric Mortality

In 2004, the Council of State and Territorial Epidemiologists added influenza-associated pediatric mortality to the list of conditions reportable to the National Notifiable Diseases Surveillance System (1). A pediatric influenza-associated death is defined for surveillance purposes as a death resulting from a clinically compatible illness that was confirmed to be influenza by an appropriate laboratory or rapid diagnostic test in a person aged <18 years. From December 29, 2013 to January 3, 2015*, a total of 141 influenza-associated pediatric deaths were reported to CDC from 34 states and New York City.

Of the 141 influenza-associated pediatric deaths reported to CDC during 2014, four deaths occurred during the 2008–09 influenza season, six deaths during the 2009–10 influenza season, two deaths during the 2011–12 influenza season, 103 during the 2013–14 influenza season, and 26 during the 2014–15 influenza season. An influenza season spans the time period between MMWR week 40 of a calendar year to MMWR week 39 of the following year. A total of 117 (83%) cases were associated with influenza A viruses, 20 (14%) with influenza B viruses, three (2.1%) with an influenza virus for which the type was not determined, and one (0.7%) death was associated with influenza A virus and influenza B virus co-infection. Of 117 influenza A viruses, subtype was determined for 70 (60%); 52 were influenza A (H1N1)pdm09 viruses and 18 were influenza A (H3N2) viruses.

Among the 141 deaths reported in 2014, a total of 18 (13%) occurred among children aged <6 months, 46 (33%) among those aged 6–59 months, 43 (31%) among those aged 5–11 years, and 34 (24%) among those aged 12–17 years; the median age at the time of death was 6.1 years (range: 3 days–17 years). The median age in 2014 is similar to previous influenza seasons during nonpandemic periods, but is lower than the median age of deaths observed during the 2009 pandemic.

Information on the location of death was available for 131 (93%) of the 141 children: 81 (62%) children died after being admitted to the hospital (73 were admitted to the intensive care unit), 30 (23%) died in the emergency department, and 20 (15%) died outside the hospital. Information on pre-existing medical conditions was reported for 136 (96%) children: 73 (54%) children had one or more underlying medical condition known to confer increased risk for complications from influenza (2). The most common group of underlying conditions was neurologic disorders (e.g., moderate to severe developmental delay, seizure disorders, cerebral palsy, mitochondrial disorders, neuromuscular disorders, and neurologic conditions), which was reported for 48 (35.3%) of 136 children. Eleven (8.1%) of 136 children had cardiac disease or congenital heart disease, 19 (14%) had chromosomal abnormalities and/or genetic syndromes, and 33 (24%) had a chronic pulmonary condition (e.g., asthma, cystic fibrosis, or other chronic pulmonary disease).

Among the 141 deaths in children, 69 children had specimens collected for bacterial culture from normally sterile sites. Of these, 24 (35%) had positive cultures, and two (8.3%) of the 24 were positive for more than one pathogen. Staphylococcus aureus was detected in five (21%) of 24 positive cultures; three were methicillin-resistant, and for two specimens methicillin-sensitivity testing was not done. Three cultures (13%) were positive for Streptococcus pneumoniae, six (25%) were positive for Group A Streptococcus, three (13%) were positive for Pseudomonas aeruginosa, and two (8.3%) were positive for Escherichia coli. Other bacterial pathogens identified included one each with Haemophilus influenzae, Klebsiella pneumoniae, and Streptococcus species.

Of 93 children aged ≥6 months at the time of illness onset for whom seasonal vaccination status was known, 20 (22%) had been vaccinated against influenza as recommended by the Advisory Committee on Immunization Practices (2,3). Twenty-three children were aged <6 months at the time of illness onset and ineligible for vaccination.

The number of influenza-associated pediatric deaths reported during 2014 was higher than that in nine of the previous 10 seasons, excluding the 2009 influenza A (H1N1)pdm09 pandemic. Influenza seasons typically span portions of two calendar years and can vary widely in terms of severity and timing of peak activity, thus affecting the number of deaths reported in a calendar year. The 2014–15 influenza season was moderately severe and peaked in late December 2014 (4). Continued surveillance for influenza-associated mortality is important to monitor the effects of seasonal and novel influenza, factors contributing to severe influenza-associated disease, and the influence of interventions among children.

  1. Council of State and Territorial Epidemiologists. Influenza-associated pediatric mortality. Position statement 04-ID-04. http://c.ymcdn.com/sites/www.cste.org/resource/resmgr/PS/04-ID-04-FINAL.pdf
  2. Grohskopf LA, Olsen SJ, Sokolow LZ, et al. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2014–2015. MMWR Morb Mortal Wkly Rep 2014;63:691–7. PubMed
  3. Advisory Committee on Immunization Practices. Prevention and control of influenza with vaccines: interim recommendations of the Advisory Committee on Immunization Practices (ACIP), 2013. MMWR Morb Mortal Wkly Rep 2013;62:356. PubMed
  4. Appiah GD, Blanton L, D’Mello T, et al. Influenza activity - United States, 2014-15 season and composition of the 2015–16 influenza vaccine. MMWR Morb Mortal Wkly Rep 2015;64:583–90. PubMed

* For 2014, only influenza-associated pediatric deaths that were reported during MMWR week 1 through MMWR week 53 (December 29, 2013–January 3, 2015) are included in this summary.

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Leptospirosis

Leptospirosis is a zoonotic disease caused by bacteria of the genus Leptospira. Infection in humans occurs through direct or indirect contact with the urine of infected host animals including rodents (1,2), livestock (3), dogs (4), and many wildlife species. Initial signs and symptoms might mimic certain other febrile illnesses, making recognition difficult (5). Some cases of leptospirosis progress to severe, potentially fatal, disease with signs of multiorgan involvement that can include aseptic meningitis, jaundice, renal failure, pulmonary involvement, and hemorrhage (1,2).

Exposure risks for leptospirosis include recreational water activities (2,6), such as wading, swimming, rafting and kayaking, especially after heavy rainfall; contact with floodwaters; occupational exposures related to farming (6) and contact with host animals, such as occurs with slaughterhouse workers and veterinarians (2,7); and living in areas with rodent infestation (8). Cases of leptospirosis in the United States also have been linked to adventure racing and multisport events (9,10) and with travel to countries where leptospirosis is endemic.

The emergence of new risk groups; the lack of dynamic data on incidence, distribution, and risk factors; and the likely underestimation of disease incidence led to the reinstatement of leptospirosis to the list of nationally notifiable diseases by the Council of State and Territorial Epidemiologists in 2013. CDC officially began receiving case notifications through the National Notifiable Diseases Surveillance System (NNDSS) in January 2014. Leptospirosis is reportable in 46 jurisdictions, states, and territories.

In 2014, a total of 107 cases of leptospirosis were reported to NNDSS from 11 states and one territory. Sixty-nine (64%) cases were from Puerto Rico and 23 (21%) were from Hawaii. In the 50 states and the District of Columbia, of 38 total cases, 30 (79%) were male, a trend identified in previous reports (6). Of 35 cases with reported age, 31 (89%) were aged 15–64 years. After 19 years without standardized reporting of leptospirosis cases, increasing the awareness of leptospirosis among health care providers and improving the detection and reporting of leptospirosis cases is essential for improving understanding of the disease’s epidemiology in the United States.

  1. Bharti AR, Nally JE, Ricaldi JN, et al. Leptospirosis: a zoonotic disease of global importance. Lancet Infect Dis 2003;3:757–71. CrossRef PubMed
  2. Levett PN. Leptospirosis. Clin Microbiol Rev 2001;14:296–326. CrossRef PubMed
  3. Talpada MD, Garvey N, Sprowls R, Eugster AK, Vinetz JM. Prevalence of leptospiral infection in Texas cattle: implications for transmission to humans. Vector Borne Zoonotic Dis 2003;3:141–7. CrossRef PubMed
  4. Ward MP, Glickman LT, Guptill LE. Prevalence of and risk factors for leptospirosis among dogs in the United States and Canada: 677 cases (1970–1998). J Am Vet Med Assoc 2002;220:53–8. CrossRef PubMed
  5. Lo Y-C, Kintziger KW, Carson HJ, et al. Severe leptospirosis similar to pandemic (H1N1) 2009, Florida and Missouri, USA. Emerg Infect Dis 2011;17:1145–6. CrossRef PubMed
  6. Katz AR, Buchholz AE, Hinson K, Park SY, Effler PV. Leptospirosis in Hawaii, USA, 1999–2008. Emerg Infect Dis 2011;17:221–6. CrossRef PubMed
  7. Guerra MA. Leptospirosis. J Am Vet Med Assoc 2009;234:472–8,30.
  8. Vinetz JM, Glass GE, Flexner CE, Mueller P, Kaslow DC. Sporadic urban leptospirosis. Ann Intern Med 1996;125:794–8. CrossRef PubMed
  9. Stern EJ, Galloway R, Shadomy SV, et al. Outbreak of leptospirosis among Adventure Race participants in Florida, 2005. Clin Infect Dis 2010;50:843–9. CrossRef PubMed
  10. Sejvar J, Bancroft E, Winthrop K, et al. Leptospirosis in “Eco-Challenge” athletes, Malaysian Borneo, 2000. Emerg Infect Dis 2003;9:702–7. CrossRef PubMed

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Listeriosis

Listeria monocytogenes infection (listeriosis) is rare but can cause severe invasive disease (e.g., bacteremia and meningitis). Listeriosis is predominately acquired through contaminated food and occurs most frequently among older adults, persons with certain immunocompromising conditions, and pregnant women and their newborns. Pregnancy-associated listeriosis is usually a relatively mild illness for women, but can result in fetal loss or severe neonatal disease.

Listeriosis has been nationally notifiable since 2000. In 2014, the incidence of listeriosis reported to the National Notifiable Diseases Surveillance System (NNDSS) was 0.24 infections per 100,000 population. Progress toward the 2020 national target of 0.2 infections (1) is measured through the Foodborne Diseases Active Surveillance Network (FoodNet), which conducts active, population-based surveillance for listeriosis in 10 U.S. states. FoodNet reported a preliminary annual incidence of Listeria monocytogenes in 2014 of 0.24 infections, the same rate reported to NNDSS (2).

The Listeria Initiative is an enhanced surveillance system designed to aid 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 that these PFGE subtyping results be submitted to PulseNet, the National Molecular Subtyping Network for Foodborne Disease Surveillance (4); clinical isolates also should be promptly sent to CDC for further characterization. In addition, communicable disease programs are asked to interview all patients with listeriosis promptly using the standard Listeria Initiative questionnaire, which is available in English and Spanish (http://www.cdc.gov/listeria/surveillance.html).

Beginning in September 2013, whole genome sequencing has been performed on all clinical isolates as part of a project conducted by CDC, state and local health departments, the Food and Drug Administration, the U.S. Department of Agriculture’s Food Safety and Inspection Service, the National Institutes of Health, and international partners (5). All isolate sequences are deposited in publicly available databases at the National Center for Biotechnology Information of the National Institutes of Health. The Listeria Initiative has aided in the timely identification and removal of contaminated food during several listeriosis investigations, including a multistate outbreak of 35 illnesses that was linked to commercially produced, prepackaged caramel apples in 2014 (6).

  1. US Department of Health and Human Services. Healthy People 2020 objectives. https://www.healthypeople.gov/2020/topics-objectives/topic/food-safety/objectives?topicId=14
  2. Crim SM, Griffin PM, Tauxe R, et al. Preliminary incidence and trends of infection with pathogens transmitted commonly through food—Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2006–2014. MMWR Morb Mortal Wkly Rep 2015;64:495–9. PubMed
  3. CDC. National Enteric Disease Surveillance: The Listeria Initiative. Atlanta, Georgia: US Department of Health and Human Services, CDC, 2014. http://www.cdc.gov/listeria/pdf/ListeriaInitiativeOverview_508.pdf
  4. CDC. PulseNet. http://www.cdc.gov/pulsenet
  5. CDC. AMD projects: Learning from Listeria . http://www.cdc.gov/amd/project-summaries/listeria.html
  6. CDC. Multistate outbreak of listeriosis linked commercially produced, prepackaged caramel apples made from Bidart Bros. apples (final update). http://www.cdc.gov/listeria/outbreaks/caramel-apples-12-14/index.html

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Lyme Disease

In 2014, the number of confirmed Lyme disease cases reported to CDC decreased compared with the number reported in 2013, but was higher compared to the number reported during 2010–2012. On the basis of reports to the National Notifiable Diseases Surveillance System (NNDSS), the geographic distribution of high incidence areas has expanded over time (1), with 381 counties reporting an incidence of ≥10 confirmed cases per 100,000 persons in 2014, compared with 324 counties in 2008. In addition, during 2013–2014, CDC and state and county health departments investigated several sudden cardiac deaths associated with Lyme carditis through case series, death certificate analysis, and review of NNDSS surveillance data (2,3). This rare but very serious complication of Lyme disease underscores the importance of reducing exposure to ticks and tick habitat.

  1. Kugeler KJ, Farley GM, Forrester JD, Mead PS. Geographic distribution and expansion of human Lyme disease, United States. Emerg Infect Dis 2015;21:1455–7. CrossRef PubMed
  2. CDC. Three sudden cardiac deaths associated with Lyme carditis—United States, November 2012–July 2013. MMWR Morb Mortal Wkly Rep 2013;62:993–6. PubMed
  3. Forrester JD, Meiman J, Mullins J, et al. Notes from the field: update on Lyme carditis, groups at high risk, and frequency of associated sudden cardiac death—United States. MMWR Morb Mortal Wkly Rep 2014;63:982–3. PubMed

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Measles

Measles was declared eliminated from the United States in 2000. Since then, elimination has been maintained through high population immunity along with adequate disease surveillance and public health response capacity (1,2). Nonetheless, because measles remains endemic in much of the world, importations continue to result in sporadic cases and outbreaks in the United States, which can be costly to control (3). As in the other years since elimination, most measles cases (99%) were import-associated (4).

A measles outbreak is defined as a chain of transmission involving three or more cases. A total of 23 outbreaks occurred in 2014, accounting for 81% of the total cases. There were 63 international importations, the most since 2011, and 43% of importations originated from the Philippines. The largest outbreak accounted for 57% of the cases. In each of these outbreaks, transmission occurred after a U.S. resident traveler introduced measles into communities with pockets of persons unvaccinated because of philosophical or religious beliefs. This allowed for spread to occur, mainly in households and community gatherings, before public health interventions could be implemented (CDC, unpublished data, 2014).

The largest outbreak occurred in Ohio, which started when unvaccinated travelers visited the Philippines where a large outbreak of measles was occurring. The travelers returned to Ohio and spread the disease to other unvaccinated persons (89% unvaccinated, 10% unknown, and 1% with 1 dose). This outbreak was the largest outbreak in the United States since 1992.

  1. Hutchins SS, Bellini WJ, Coronado V, Jiles R, Wooten K, Deladisma A. Population immunity to measles in the United States, 1999. J Infect Dis 2004;189(Suppl 1 ):S91–7. CrossRef PubMed
  2. Papania MJ, Wallace GS, Rota PA, et al. Elimination of endemic measles, rubella, and congenital rubella syndrome from the Western hemisphere: the US experience. JAMA Pediatr 2014;168:148–55. CrossRef PubMed
  3. Parker AA, Staggs W, Dayan GH, et al. Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States. N Engl J Med 2006;355:447–55. CrossRef PubMed
  4. Council of State and Territorial Epidemiologists. Revision of measles, rubella, and congenital syndrome case classification as part of elimination goals in the United States. Position statement 2006-ID-16.

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Meningococcal Disease

Neisseria meningitidis is an important cause of bacterial meningitis and sepsis in the United States. In 2014, rates of meningococcal disease continued to be at historic lows in the United States (0.18 cases per 100,000 population). CDC’s Advisory Committee on Immunization Practices (ACIP) recommends routine use of quadrivalent (serogroup A, C, W, and Y) meningococcal conjugate vaccine in adolescents and others at increased risk for disease (13). In 2014, coverage with at least 1 dose of meningococcal conjugate vaccine was 79.3% among adolescents aged 13–17 years in the United States; however, by state, coverage ranged from 46.0%–95.2%, including the District of Columbia (4). Coverage with ≥2 doses of meningococcal conjugate vaccine among adolescents aged 17 years was 28.5% (4).

Two serogroup B meningococcal vaccines were licensed for use in the United States in 2014 and 2015. Both vaccines are approved for use in persons aged 10–25 years. In 2015, ACIP recommended routine use of serogroup B meningococcal vaccine in certain groups at increased risk for disease (5). A serogroup B meningococcal vaccine series also can be administered to adolescents and young adults aged 16–23 years to provide short-term protection against most strains of serogroup B meningococcal disease. The preferred age for serogroup B meningococcal vaccination is 16–18 years (6).

  1. Cohn AC, MacNeil JR, Clark TA, et al. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2013;62(No.RR-2 ). PubMed
  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. CrossRef PubMed
  3. MacNeil JR, Rubin L, McNamara L, Briere EC, Clark TA, Cohn AC. Use of MenACWY-CRM vaccine in children aged 2 through 23 months at increased risk for meningococcal disease: recommendations of the Advisory Committee on Immunization Practices, 2013. MMWR Morb Mortal Wkly Rep 2014;63:527–30. PubMed
  4. Reagan-Steiner S, Yankey D, Jeyarajah J, et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years—United States, 2014. MMWR Morb Mortal Wkly Rep 2015;64:784–92. CrossRef PubMed
  5. Folaranmi T, Rubin L, Martin SW, Patel M, MacNeil JR. Use of serogroup B meningococcal (MenB) vaccines in persons aged ≥10 years at increased risk for serogroup B meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2015. MMWR Morb Mortal Wkly Rep 2015;64:608–12. PubMed
  6. MacNeil JR, Rubin L, Folaranmi T, Ortega-Sanchez IR, Patel M, Martin SW. Use of serogroup B meningococcal (MenB) vaccines in adolescents and young adults: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2015. MMWR Morb Mortal Wkly Rep 2015;64:1171–6. CrossRef PubMed

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Mumps

In 2014, a total of 1,223 cases of mumps were reported in the United States with an overall incidence rate of 0.38 cases per 100,000 persons. Most (N = 883 [72%]) mumps cases reported in the United States during 2014 were from three states (Ohio, Illinois, and Wisconsin) and New York City, all of which experienced university-based outbreaks. University-based outbreaks are known to occur despite high 2-dose vaccine coverage (1). Reported median vaccine-effectiveness for mumps vaccine is 78% for 1-dose and 88% for 2-doses (2). Close and prolonged contact likely facilitates mumps transmission.

  1. Dayan GH, Quinlisk MP, Parker AA, et al. Recent resurgence of mumps in the United States. N Engl J Med 2008;358:1580–9. CrossRef PubMed
  2. McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2013;62(No. RR-4 ). PubMed

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Novel Influenza A Viruses

In 2007, the Council of State and Territorial Epidemiologists added human infection with a novel influenza A virus to the list of conditions reportable to the National Notifiable Diseases Surveillance System (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.

Influenza viruses that normally circulate in swine are called swine influenza viruses when isolated from swine, but are called variant viruses when isolated from humans. During 2005–2014, all reported novel influenza A human infections in the United States involved variant viruses rather than avian-origin influenza viruses. Although most persons identified with variant influenza virus infection report contact with swine preceding their illness, suggesting swine-to-human spread, limited human-to-human transmission of these viruses has occurred (2). Because the implications of ongoing transmission of these viruses between humans are potentially severe, prompt and thorough investigation of human infections with novel influenza viruses is critical so that risk for infection can be more fully understood and appropriate public health measures can be taken (3).

In 2014, three human infections with novel influenza A viruses were reported from two states (Ohio [two] and Wisconsin [one]) (4,5). All three cases involved infection with an influenza A (H3N2) variant virus (H3N2v). The median age of patients was seven years (range: 2–10 years), and all three were female. Reported symptoms associated with infection were fever (100%), cough (100%), fatigue (100%), shortness of breath (67%), muscle aches (67%), vomiting or diarrhea (67%), and conjunctivitis (33%); all three cases reported influenza-like illness (e.g. fever (≥100°F [37.8°C] with cough and/or sore throat). None had an underlying medical condition known to confer increased risk for complications from influenza (6). All three patients sought health care for their illness and one was hospitalized; all three fully recovered. All three reported direct contact with (e.g., touching or handling) or proximity to (e.g., walking through an area or coming within 6 feet of) swine in the week preceding illness onset. No likely human-to-human transmission of novel influenza A viruses was identified.

Transmission of variant influenza A viruses to humans usually occurs among persons with direct, unprotected contact with swine or environments where swine are or have been 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 year-round and conducts extensive epidemiologic investigations on each case. 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 investigation of human infections with novel influenza A viruses are critical so that risk for infection can be more fully understood and appropriate public health measures taken.

  1. Council of State and Territorial Epidemiologists. Public health reporting and national notification for novel influenza A virus infection. Position statement 13-ID-14. http://c.ymcdn.com/sites/www.cste.org/resource/resmgr/PS/13-ID-14.pdf
  2. Jhung MA, Epperson S, Biggerstaff M, et al. Outbreak of variant influenza A(H3N2) virus in the United States. Clin Infect Dis 2013;57:1703–12. CrossRef PubMed
  3. Richards S, Glazier M, Masterson K, et al. Update: Influenza A (H3N2)v transmission and guidelines—five states, 2011. MMWR Morb Mortal Wkly Rep 2012;60:1741–4. PubMed
  4. Blanton L, Brammer L, Smith S, et al. Update: influenza activity—United States and worldwide, May 18–September 20, 2014. MMWR Morb Mortal Wkly Rep 2014;63:861–4. PubMed
  5. Rolfes M, Blanton L, Brammer L, et al. Update: influenza activity—United States, September 28– December 6, 2014. MMWR Morb Mortal Wkly Rep 2014;63:1189–94. PubMed
  6. Grohskopf LA, Olsen SJ, Sokolow LZ, et al. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2014–2015. MMWR Morb Mortal Wkly Rep 2014;63:691–7. PubMed

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Pertussis

Reported pertussis cases in the United States increased 15% from 2013 (incidence: 9.0 per 100,000 population) to 2014 (10.4). Despite the national increase in reporting, a majority of states reported fewer cases in 2014 than in 2013 (32). However, in 2014, California reported the largest number of cases observed (8,723) since its 2010 pertussis epidemic (7,195) (1). Six additional states reported a ≥50% increase in cases (Connecticut, Delaware, Idaho, Maine, Nebraska, and South Dakota). Although the age distribution of reported cases is similar to that reported for 2013, peak incidence has shifted from children aged 10 years in 2013 to those aged 15 years in 2014, likely the effect of waning immunity among aging cohorts of adolescents vaccinated exclusively with acellular pertussis vaccines (24). A total of 13 deaths occurred among all age groups; eight of the deaths occurred among infants aged <1 year, who account for most pertussis-related deaths reported in the United States. Maternal Tdap vaccination during the third trimester of pregnancy remains the primary recommendation for prevention of pertussis in infants (5).

  1. Winter K, Glaser C, Watt J, Harriman K. Pertussis epidemic—California, 2014. MMWR Morb Mortal Wkly Rep 2014;63:1129–32. PubMed
  2. Misegades LK, Winter K, Harriman K, et al. Association of childhood pertussis with receipt of 5 doses of pertussis vaccine by time since last vaccine dose, California, 2010. JAMA 2012;308:2126–32. CrossRef PubMed
  3. Tartof SY, Lewis M, Kenyon C, et al. Waning immunity to pertussis following 5 doses of DTaP. Pediatrics 2013;131:e1047–52. CrossRef PubMed
  4. Acosta AM, DeBolt C, Tasslimi A, et al. Tdap vaccine effectiveness in adolescents during the 2012 Washington State pertussis epidemic. Pediatrics 2015;135:981–9. CrossRef PubMed
  5. CDC. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) in pregnant women—Advisory Committee on Immunization Practices (ACIP), 2012. MMWR Morb Mortal Wkly Rep 2013;62:131–5. PubMed

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Plague

Plague is a highly virulent fleaborne zoonosis caused by Yersinia pestis. A median of eight cases are reported each year in the United States (1). Most human plague infections result from an infectious flea bite; however, domestic animals can become infected and transmit plague to humans. Bubonic and septicemic plague are common clinical forms of plague and are not transmissible to others. In contrast, persons with pneumonic plague can transmit infection to others via infective respiratory droplets (2).

During 2014, an outbreak of pneumonic plague occurred in Colorado involving four patients. All four had exposure to a dog with confirmed pneumonic plague; however, person-to-person transmission between two of these patients could not be excluded (3). This is the first documented transmission from a domestic dog to humans in the United States. Furthermore, this event represents the largest outbreak and the first instance of possible human-to-human transmission in the United States since 1924 (1,2).

  1. Kugeler KJ, Staples JE, Hinckley AF, Gage KL, Mead PS. Epidemiology of human plague in the United States, 1900–2012. Emerg Infect Dis 2015;21:16–22. CrossRef PubMed
  2. Kool JL. Risk of person-to-person transmission of pneumonic plague. Clin Infect Dis 2005;40:1166–72. CrossRef PubMed
  3. Runfola JK, House J, Miller L, et al. Outbreak of human pneumonic plague with dog-to-human and possible human-to-human transmission—Colorado, June–July 2014. MMWR Morb Mortal Wkly Rep 2015;64:429–34. PubMed

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Q-Fever

Q fever is a zoonosis caused by the obligate intracellular bacterium Coxiella burnetii. The primary route of exposure is inhalation of aerosolized birth products from livestock (e.g., cows, goats, or sheep). In addition, other routes of exposure, such as ingestion, tick bite, and sexual transmission, are possible. In 2014, a cluster of five suspect Q fever cases in New York was associated with a history of travel to Germany for live cell therapy (injections of cells from the organs or fetuses of nonhuman animals) (1). A case from Canada was also associated with the New York cluster. Health care providers should be aware of medical tourism for this live cell therapy and the associated risks.

  1. Robyn MP, Newman AP, Amato M, et al. Q Fever outbreak among travelers to Germany linked to live cell therapy—United States and Canada, 2014. MMWR Morb Mortal Wkly Rep 2015;64:1071–3. CrossRef PubMed

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Rabies

During 2014, one case of human rabies was reported in the United States. The case was reported from Missouri. The patient presented with neck pain that radiated down the left arm that progressed to left arm numbness and tingling, bilateral upper body tremors, anxiousness, and hallucinations. Because of the unexplained rapidly progressive encephalitis and self-reported hydrophobia, rabies was suspected. CDC antemortem testing confirmed a rabies virus variant associated with the tri-colored bat Perimyotis subflavus. Following diagnosis, life support was withdrawn and the patient died.

During 2014, the number of animals submitted to state and local laboratories for rabies diagnosis (104,313) increased 7.8% compared with 2013. A total of 5,988 animals were confirmed positive. Increases in the number of animals reported rabid were observed for the following species: sheep/goats (10.0%), skunks (9.8%), cats (9.2%), and bats (9.0%). The number of reported rabid dogs (50.8%), foxes (10.6%), cattle (8.9%), raccoons (4.2%) and horses/mules (3.3%) also decreased compared with 2013.

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Salmonellosis

In 2014, the incidence of salmonellosis in the United States was 16.3 laboratory-confirmed infections per 100,000 population, approximately one and a half times the 2020 national health objectives target of 11.4 (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 towards Healthy People 2020 objectives. In 2014, FoodNet reported a preliminary annual incidence of Salmonella of 15.5, slightly lower than the rate reported to the National Notifiable Diseases Surveillance System (2). During 2014, as in previous years of surveillance, children aged <5 years had the highest reported incidence rates of salmonellosis. Salmonellosis is reported most frequently in late summer and early fall; in 2014, this seasonality was evident, with most reports during July–October.

Accounting for underdiagnosis, Salmonella causes an estimated 1.2 million illnesses annually in the United States; of these, an estimated 1 million 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. The largest multistate outbreak of Salmonella infections in 2014 (serotypes Infantis, Newport, and Hadar) was traced to live poultry in backyard flocks; other notable outbreaks in 2014 were linked to cucumbers (serotype Newport), bean sprouts (serotype Enteritidis), nut butter (serotype Braenderup), clinical and college and university teaching microbiology laboratories (serotype Typhimurium), organic sprouted chia powder (serotypes Newport, Hartford, and Oranienburg), frozen feeder rodents (serotype Typhimurium), pet bearded dragons (serotypes Cotham and Kisarawe), mechanically separated chicken (serotype Heidelberg), and raw cashew cheese (serotype Stanley) (4).

  1. US Department of Health and Human Services. Healthy People 2020 objectives. https://www.healthypeople.gov/2020/topics-objectives/topic/food-safety/objectives?topicId=14
  2. CDC. Foodborne Diseases Active Surveillance Network. http://www.cdc.gov/foodnet/data/trends/tables/2013/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. CrossRef PubMed
  4. CDC. Reports of selected Salmonella  outbreak investigations, 2014. http://www.cdc.gov/salmonella/outbreaks.html

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Shiga Toxin-Producing Escherichia coli

In 2014, the incidence of laboratory-confirmed Shiga toxin-producing Escherichia coli (STEC) infections in the United States was 2.0 cases per 100,000 population. FoodNet, an active, population-based surveillance system for enteric diseases, reported STEC incidence of 2.4 in 2014 (1). As in all previous years of surveillance, the age group with the highest incidence of reported STEC infections was children aged 1–4 years (9.0). In 2014, multistate outbreaks of STEC infection linked to foods included raw clover sprouts (STEC O121) and ground beef (STEC O157:H7) (2).

Public health actions to monitor, prevent, and control STEC infections are based on serogroup characterization. Development of postdiarrheal hemolytic uremic syndrome (HUS), a severe complication of STEC infection, is most strongly associated with STEC O157. Non-O157 STEC, a diverse group that varies in virulence, comprises over 50 other serogroups. 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 (3). STEC can produce Shiga toxins (Stx): Stx1, Stx2, or both. In general, strains that produce certain types of Stx2 are the most virulent (4). Accounting for underdiagnosis, an estimated 96,000 illnesses are caused by STEC O157 and 168,000 illnesses by non-O157 STEC each year (5,6).

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 (or the genes that encode them). Detection of Shiga toxin alone is inadequate for clinical management and public health investigation; characterizing STEC isolates by serogroup and by pulsed-field gel electrophoresis pattern is important to detect, investigate, and control outbreaks.

  1. Crim SM, Griffin PM, Tauxe R, et al. . Preliminary incidence and trends of infection with pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2006–2014. MMWR Morb Mortal Wkly Rep 2015;64:495–9. PubMed
  2. CDC. Reports of selected E. coli  outbreak investigations. http://www.cdc.gov/ecoli/outbreaks.html
  3. Gould LH, Mody RK, Ong KL, et al. Increased recognition of non-O157 Shiga toxin-producing Escherichia coli infections in the United States during 2000–2010: epidemiologic features and comparison with E. coli O157 infections. Foodborne Pathog Dis 2013;10:453–60. CrossRef PubMed
  4. Mody RK, Griffin PM. Fecal shedding of Shiga toxin-producing Escherichia coli: what should be done to prevent secondary cases? Clin Infect Dis 2013;56:1141–4. CrossRef PubMed
  5. Heiman KE, Mody RK, Johnson SD, Griffin PM, Gould LH. Escherichia coli O157 Outbreaks in the United States, 2003–2012. Emerg Infect Dis 2015;21:1293–301. CrossRef PubMed
  6. Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in the United States—major pathogens. Emerg Infect Dis 2011;17:7–15. CrossRef PubMed

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Shigellosis

In 2014, the incidence of reported shigellosis in the United States was 6.5 infections per 100,000 population. This is comparable to the incidence of laboratory-confirmed shigellosis reported by FoodNet, an active, population-based surveillance system for enteric diseases, in 2014 (5.8), and is in line with fairly stable incidence rates observed in FoodNet during the previous decade (1,2). In 2014, as in previous years, the highest number of reported cases of shigellosis occurred among children aged <10 years. S. sonnei infections account for approximately 75% of shigellosis in the United States (3). Shigellosis does not demonstrate marked seasonality, likely reflecting the importance of person-to-person transmission.

Accounting for underdiagnoses, Shigella causes an estimated 500,000 illnesses annually in the United States; of these, an estimated 130,000 are transmitted by food consumed in the United States (3). Shigella is often transmitted person-to-person, including through sexual contact between men who have sex with men (MSM), and can also be transmitted by contaminated food or by contaminated water used for drinking or recreational purposes (4). Some cases of shigellosis are acquired during international travel (5,6) and have caused multidrug-resistant outbreaks in the United States (7). Childcare-associated outbreaks are common and are often difficult to control (8).

MSM and persons infected with human immunodeficiency virus appear to be at the greatest risk for infection with Shigella with decreased susceptibility to azithromycin (9,10). In 2014, the majority of isolates known to be resistant to azithromycin harbored mphA or ermB, macrolide resistance genes that are typically plasmid-encoded. For adults with suspected shigellosis, clinicians should obtain sexual histories, collect stool specimens, test for antimicrobial susceptibility, and counsel patients about prevention.

  1. Crim SM, Griffin PM, Tauxe R, et al. Preliminary incidence and trends of infection with pathogens transmitted commonly through food—Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2006–2014. MMWR Morb Mortal Wkly Rep 2015;64:495–9. PubMed
  2. CDC. Foodborne Diseases Active Surveillance Network—FoodNet 2013 surveillance report. https://www.cdc.gov/foodnet/pdfs/508-compliant-2013-foodnet-annual-report.pdf
  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. CrossRef PubMed
  4. 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. CrossRef PubMed
  5. Baker KS, Dallman TJ, Ashton PM, et al. Intercontinental dissemination of azithromycin-resistant shigellosis through sexual transmission: a cross-sectional study. Lancet Infect Dis 2015;15:913–21. CrossRef PubMed
  6. Gray MD, Lampel KA, Strockbine NA, Fernandez RE, Melton-Celsa AR, Maurelli AT. Clinical isolates of Shiga toxin 1a-producing Shigella flexneri with an epidemiological link to recent travel to Hispañiola. Emerg Infect Dis 2014;20:1669–77. CrossRef PubMed
  7. Bowen A, Hurd J, Hoover C, et al. Importation and domestic transmission of Shigella sonnei resistant to ciprofloxacin—United States, May 2014–February 2015. MMWR Morb Mortal Wkly Rep 2015;64:318–20. PubMed
  8. Arvelo W, Hinkle CJ, Nguyen TA, et al. Transmission risk factors and treatment of pediatric shigellosis during a large daycare center-associated outbreak of multidrug resistant Shigella sonnei: implications for the management of shigellosis outbreaks among children. Pediatr Infect Dis J 2009;28:976–80. CrossRef PubMed
  9. Bowen A, Grass J, Bicknese A, et al. Elevted risk for antimicrobial drug-resistant Shigella infection among men who have sex with men, United States 2011–2015. Emerg Infect Dis 2016;9. E-pub ahead of print.
  10. Bowen A, Eikmeier D, Talley P, et al. Outbreaks of Shigella sonnei infection with decreased susceptibility to azithromycin among men who have sex with men—Chicago and Metropolitan Minneapolis-St. Paul, 2014. MMWR Morb Mortal Wkly Rep 2015;64:597–8. PubMed

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Syphilis, Congenital

From 2008 to 2012, the rate of reported congenital syphilis decreased from 10.5 to 8.4 reported cases per 100,000 live births (1). However, in 2013, the rate of reported congenital syphilis increased to 9.1. In 2014*, the rate increased to 11.6, a 27.5% increase relative to 2013. Historically, increases in congenital syphilis parallel increases in primary and secondary (P&S) syphilis among women. During 2013–2014, the reported P&S syphilis rate among women increased 22.7%.

During 2013–2014, the congenital syphilis rate increased in every region of the United States, but as in previous years, the highest rates in 2014 were reported from the South (15.5). Similarly, during 2013–2014, the congenital syphilis rate increased among most race/ethnicity groups including whites, blacks, Hispanics, and Asians/Pacific Islanders, but race and ethnic disparities persisted in 2014. The rate of congenital syphilis among non-Hispanic blacks (38.2) was 10.3 times the rate among non-Hispanic whites (3.7), and the rate among Hispanics (12.1) was 3.3 times the rate among non-Hispanic whites.

  1. CDC. Sexually transmitted disease surveillance 2014. Atlanta, GA: US Department of Health and Human Services, CDC; 2015.

* Rates for 2013 and 2014 were calculated using the 2012 live birth estimates and differ from the 2013 and 2014 rates presented in the figures and table 7 (calculated using 2013 and 2014 live birth estimates, respectively).

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Syphilis, Primary and Secondary

In 2000 and 2001, the national rate of reported primary and secondary (P&S) syphilis cases reached the lowest rate (2.1 cases per 100,000 population) since reporting began in 1941. However, since 2000–2001, the P&S syphilis rate has increased almost every year. In 2014*, the rate was 6.3 in the United States, the highest rate reported since 1994 (1). Since 2000, increases in the P&S syphilis rate have primarily been attributable to increased cases among men, specifically among gay, bisexual, and other men who have sex with men (collectively referred to as MSM). In 2014, men accounted for the majority (90.7%) of all cases of P&S syphilis. Among male cases with known sex of sex partner(s), 82.9% occurred among MSM. However, during 2013–2014, the P&S syphilis rate increased 22.7% among women (from 0.9 to 1.1) and 14.4% among men (from 10.2 to 11.7). Increases in the overall, male, and female P&S syphilis rates were observed in every region of the country.

  1. CDC. Sexually transmitted disease surveillance 2014. Atlanta, GA: US Department of Health and Human Services, CDC; 2015.

* Rates for 2014 were calculated using the 2013 population estimates and differ from 2014 rates presented in the figures and table 7 (calculated using 2014 population estimates).

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Trichinellosis

In 2014, a total of 11 confirmed and two probable trichinellosis cases were reported. Of these, a known or suspected source of Trichinella infection was documented for nine (69%) and included bear (six), free-range pork (one), pork from an unspecified source (one), and hamburger (one). No likely source of infection could be identified for four cases.

An outbreak of two confirmed (one each from Texas and Utah) and two probable cases (one each from Colorado and Washington) was reported among a group of six persons who hunted and consumed meat from a black bear in Alaska. The meat was consumed “somewhat rare” after being cooked on skewers over an open fire. The Washington State Public Health Laboratory detected Trichinella larvae in a sample of leftover bear meat via microscopy. The best way to prevent Trichinella infection is to thoroughly cook all meats to the USDA-recommended temperatures (as verified with a food thermometer) before consumption (1).

  1. CDC. Trichinellosis. Atlanta, GA: US Department of Health and Human Services, CDC; 2013. http://www.cdc.gov/parasites/trichinellosis/prevent.html .

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Tuberculosis

Tuberculosis (TB) is one of the world’s deadliest airborne diseases. It is the leading cause of death worldwide of persons living with human immunodeficiency virus (HIV), causing one fourth of all HIV-related deaths. In 2014, an estimated 9.6 million persons worldwide developed TB, and 1.5 million died from the disease (1). One third of the world’s population has latent TB infection (LTBI), which can later develop into active disease (2). Many persons arrive in the United States annually from countries with high burdens of TB, including immigrants, refugees, students, or travelers.

In the United States, new cases of TB disease have been reported annually since 1953 to the National Tuberculosis Surveillance System (NTSS) in CDC’s Division of Tuberculosis Elimination (DTBE) (3). CDC receives data from 60 reporting jurisdictions (all 50 U.S. states, the District of Columbia, New York City, and eight U.S.-affiliated islands) through a standardized data collection form, the Report of Verified Case of Tuberculosis (RVCT). In 2009, the RVCT was revised and NTSS transitioned into a web-based reporting system.

The number and rate of TB cases have declined each year since 1993, representing steady progress toward the goal of TB elimination in the United States (<1 case per 1,000,000 population). However, in 2014, the number (9,421) of new TB cases and rate of 3.0 per 100,000 population marked the smallest annual decline of incidence and TB case rate (-2.2%) in more than a decade (4).

Among all TB cases in the United States, racial/ethnic minorities, especially foreign-born persons, are disproportionately affected. In 2014, the proportion of persons with TB who were foreign-born increased to 66% (6,215 of 9,421) of total cases (4). Non-Hispanic Asians had the largest number of TB cases and the highest incidence rate in 2014. Compared with non-Hispanic whites, the TB rate among non-Hispanic Asians in 2014 was approximately 30 times higher (17.8 versus 0.6).*

TB drug resistance continues to be a major concern. During 1996–2014, the percentage of primary multidrug-resistant (MDR) TB cases, (i.e., patients with no previous history of TB disease and resistant to at least isoniazid [INH] and rifampin [RIF]) has fluctuated between 1.3 and 0.9%. The percentage of U.S.-born patients with primary MDR TB has remained below 1%. However, of the total number of reported primary MDR TB cases, the proportion occurring in foreign-born persons increased from 25% in 1993 to 85% in 2014. In addition, 15 extensively drug-resistant TB cases (i.e., patients with resistance to INH and RIF, plus resistance to any fluoroquinolone and at least one of three injectable second-line anti-TB drugs [i.e., amikacin, kanamycin, or capreomycin]) have been reported since 2009; of these, 11 were among foreign-born persons (4).

To achieve TB elimination, intensified efforts are needed to address the persistent disparities that exist between U.S.-born and foreign-born persons and between whites and minorities in the United States. Improved awareness, testing, and treatment of LTBI and TB disease in minorities and foreign-born populations are essential to these efforts. DTBE is developing an initiative to enhance testing, monitoring, and treatment of LTBI to prevent progression to TB disease and accelerate the decline of TB.

  1. World Health Organization. Global tuberculosis report 2015, 20th edition. http://www.who.int/tb/publications/global_report/en
  2. World Health Organization. 10 facts about tuberculosis. http://www.who.int/features/factfiles/tuberculosis/en
  3. CDC. Quality assurance for tuberculosis surveillance data: A guide and toolkit, Atlanta, GA: US Department of Health and Human Services, CDC; 2013.
  4. CDC. Reported tuberculosis in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services, CDC, October 2015. http://www.cdc.gov/tb/statistics/reports/2014/default.htm

* Race/ethnicity is presented differently than in tables 5 and 6. Persons of Hispanic ethnicity might be of any race.

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Typhoid Fever

Typhoid fever is rare in the United States. Since 2009, an annual average of <400 cases has been reported. In 2014, a total of 349 cases were reported. Approximately 75% of U.S. cases are associated with international travel (1), and the risk for infection is highest for travelers visiting friends and relatives in countries where typhoid fever is endemic. These persons might stay for extended periods and are less likely than other travelers to seek pretravel vaccination and to observe strict safe water and food practices, possibly because of misperception of disease risk (2). The risk is also higher for travelers who visit areas where the disease is highly endemic, such as the Indian subcontinent, even for a short time (3). In 2011, CDC removed pretravel typhoid vaccination recommendations for 26 low-risk destinations; pretravel vaccination guidelines are available at http://wwwnc.cdc.gov/travel (4).

  1. Lynch MF, Blanton EM, Bulens S, et al. Typhoid fever in the United States, 1999–2006. JAMA 2009;302:859–65. CrossRef PubMed
  2. Angell SY, Cetron MS. Health disparities among travelers visiting friends and relatives abroad. Ann Intern Med 2005;142:67–72. CrossRef PubMed
  3. Steinberg EB, Bishop R, Haber P, et al. Typhoid fever in travelers: who should be targeted for prevention? Clin Infect Dis 2004;39:186–91. CrossRef PubMed
  4. Johnson KJ, Gallagher NM, Mintz ED, Newton AE, Brunette GW, Kozarsky PE. From the CDC: new country-specific recommendations for pre-travel typhoid vaccination. J Travel Med 2011;18:430–3. CrossRef PubMed

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Varicella

As the 2-dose varicella vaccination program continues to mature and with the discontinuation of active surveillance for varicella, national surveillance is increasingly important for monitoring impact of the program. More states are reporting varicella cases to CDC through the National Notifiable Diseases Surveillance System; reporting of varicella cases to CDC from states and the District of Columbia increased from 29 in 2006 (when the second dose of varicella vaccine was recommended for children [1]) to 40 as of 2014. Although the number of states reporting has increased, varicella incidence has declined 84.3% from an average of 25.4 per 100,000 population during 2005–2006 to 4.0 in 2014.

To monitor impact of the varicella vaccination program, data from key variables such as age, vaccination status, disease severity (e.g., number of lesions), outcome of the case (e.g., hospitalized), and whether the case is associated with an outbreak, are used. In 2014, a total of 10,089 (99%) of 10,172 cases reported to CDC from 40 states had data on at least one of the key variables important for monitoring the varicella vaccination program; completeness was 95% (9,622) for age, 60% (6,077) for vaccination status, 43% (4,344) for disease severity, 8% (802) for whether the case resulted in hospitalization, and 84% (8,493) for whether the case was associated with an outbreak. Of the cases with data reported for each of the key variables, 52% (4,975) was for persons aged 1–9 years, 22% (2,165) for those aged 10–19 years, and 18% (1,726) for those aged >20 years; 55% (3,330) was for persons who had received at least 1 dose of varicella vaccine. Of those with information on number of doses, 56% (1,330 of 2,358) had received 2 doses, 48% (2,081) had mild disease presentation (<50 lesions), 3% (25) resulted in hospitalization, and 11% (919) were associated with outbreaks. Laboratory testing for varicella was performed for 25% (1,159 of 4,696) of reported cases, of which 79% (912 of 1,159) were laboratory confirmed.

Much of the varicella data should be interpreted with caution because of the large proportion of missing data. States continue improving varicella surveillance practices (2) and are working to increase completeness of reporting for the variables important for monitoring the varicella vaccination program. As varicella incidence continues to decline, national surveillance data will provide the information needed to monitor progress and changing varicella epidemiology.

  1. Marin M, Güris D, Chaves SS, Schmid S, Seward JF. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2007;56(No. RR-4 ). PubMed
  2. Lopez AS, Lichtenstein M, Schmid SD, Bialek S. Assessment of varicella surveillance and outbreak control practices—United States, 2012. MMWR Morb Mortal Wkly Rep 2014;63:785–8. PubMed

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Vibriosis

The incidence of vibriosis, defined as infection caused by a species from the family Vibrionaceae other than toxigenic Vibrio cholerae O1 or O139, has increased during 2007–2014 (1). In 2012, an outbreak of V. parahaemolyticus infections was associated with consumption of shellfish harvested from Oyster Bay Harbor, New York (2). Now endemic on the Atlantic Coast, this same strain continued to cause illness in 2013 and 2014 (3).

  1. Newton A, Kendall M, Vugia DJ, Henao OL, Mahon BE. Increasing rates of vibriosis in the United States, 1996–2010: review of surveillance data from 2 systems. Clin Infect Dis 2012;54(Suppl 5 ):S391–5. CrossRef PubMed
  2. Martinez-Urtaza J, Baker-Austin C, Jones JL, Newton AE, Gonzalez-Aviles GD, DePaola A. Spread of Pacific Northwest Vibrio parahaemolyticus strain. N Engl J Med 2013;369:1573–4. CrossRef PubMed
  3. Newton AE, Garrett N, Stroika SG, Halpin JL, Turnsek M, Mody RK. Increase in Vibrio parahaemolyticus infections associated with consumption of Atlantic Coast shellfish—2013. MMWR Morb Mortal Wkly Rep 2014;63:335–6. PubMed

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Viral Hemorrhagic Fever

Viral Hemorrhagic Fever (VHF) is a group of acute febrile illnesses that are caused by approximately 30 viruses (1). Many are of substantial public health concern, particularly in Africa and South America, with the possibility of importation to the United States. Nationally notifiable VHFs are those with documented person to person transmission: Crimean-Congo hemorrhagic fever, Ebola virus disease (EVD), Lassa fever, Lujo, Marburg, and several New World Arenaviruses (Junin, Machupo, Guanarito, Sabia).

The 2014–16 West African EVD epidemic is the largest in history, with approximately 28,000 cases and 11,000 deaths (2). Such large numbers of cases presented new challenges in effectively diagnosing patients with EVD, caring for affected patients, and containing the epidemic. In 2014, a total of 10 persons with EVD received medical care in the United States. Six were medically evacuated to the United States after having EVD diagnosed in West Africa (36); four had the disease diagnosed in the United States. The four EVD cases diagnosed in the United States consisted of traveler from Liberia with two subsequent nosocomial infections (711) and a medical aid worker who returned from Guinea (12). These were the first EVD cases to receive care in the United States. Previously, a patient with Marburg virus disease was cared for in Colorado in 2007 (13).

In response to the concern about importation of EVD to the United States, national and state level surveillance systems were enhanced in 2014 (1418). In October 2014, all airline passengers who had traveled to Liberia, Sierra Leone, and Guinea within the previous 21 days were diverted to five airports for admittance to the United States using enhanced screening methods (19). At risk travelers and health care workers were required to complete a 21-day active monitoring period (17,18). In addition, CDC responded to inquiries from state and local health officials and health care providers and facilitated testing of persons under investigation (20,21).

One imported case of Lassa fever was reported in April 2014. This is only the seventh known imported case to the United States (22). Lassa fever is endemic in West Africa, with an estimated 100,000 to 300,000 cases and 5,000 deaths annually.

  1. Rollin PE, Nichol ST, Zaki S, Ksiazek TG. Arenaviruses and filoviruses. In: Murray PR, Baron EJ, Landry ML, Jorgensen JH, Pfaller MA, eds. Manual of clinical microbiology, 11th edition. Washington, DC: ASM Press; 2015:1669–86.
  2. World Health Organization. Ebola Situation Report, November 2015. http://apps.who.int/ebola/current-situation/ebola-situation-report-4-november-2015
  3. Lyon GM, Mehta AK, Varkey JB, et al. Clinical care of two patients with Ebola virus disease in the United States. N Engl J Med 2014;371:2402–9. CrossRef PubMed
  4. Stephens DS, Ribner BS, Gartland BD, et al. Ebola virus disease: Experience and decision making for the first patients outside of Africa. PLoS Med 2015;12:e1001857. CrossRef PubMed
  5. Sueblinvong V, Johnson DW, Weinstein GL, et al. Critical care for multiple organ failure secondary to Ebola virus disease in the United States. Crit Care Med 2015;43:2066–75. CrossRef PubMed
  6. Goodnough A. (2014, October 10). After years of empty beds, a medical team in Omaha puts its skills into practice. The New York Times, p. A14.
  7. Chevalier MS, Chung W, Smith J, et al. Ebola virus disease cluster in the United States—Dallas County, Texas, 2014. MMWR Morb Mortal Wkly Rep 2014;63:1087–8. PubMed
  8. McCarty CL, Basler C, Karwowski M, et al. . Response to importation of a case of Ebola virus disease—Ohio, October 2014. MMWR Morb Mortal Wkly Rep 2014;63:1089–91. PubMed
  9. Regan JJ, Jungerman R, Montiel SH, et al. Public health response to commercial airline travel of a person with Ebola virus infection—United States, 2014. MMWR Morb Mortal Wkly Rep 2015;64:63–6. PubMed
  10. Chung WM, Smith JC, Weil LM, et al. Active tracing and monitoring of contacts associated with the first cluster of Ebola in the United States. Ann Intern Med 2015;163:164–73. . CrossRef PubMed
  11. Liddell AM, Davey RT , Mehta AK, et al. Characteristics and clinical management of a cluster of 3 patients with Ebola virus disease, including the first domestically acquired cases in the United States. Ann Intern Med 2015;163:81–90. CrossRef PubMed
  12. Yacisin K, Balter S, Fine A, et al. . Ebola virus disease in a humanitarian aid worker—New York City, October 2014. MMWR Morb Mortal Wkly Rep 2015;64:321–3. PubMed
  13. CDC. Imported case of Marburg hemorrhagic fever—Colorado, 2008. MMWR Morb Mortal Wkly Rep 2009;58:1377–81. PubMed
  14. Koonin LM, Jamieson DJ, Jernigan JA, et al. Systems for rapidly detecting and treating persons with ebola virus disease—United States. MMWR Morb Mortal Wkly Rep 2015;64:222–5. PubMed
  15. Sunshine G, Pepin D, Cetron M, Penn M. State and territorial Ebola screening, monitoring, and movement policy statements—United States, August 31, 2015. MMWR Morb Mortal Wkly Rep 2015;64:1145–6. CrossRef PubMed
  16. Benowitz I, Ackelsberg J, Balter SE, et al. . Surveillance and preparedness for Ebola virus disease—New York City, 2014. MMWR Morb Mortal Wkly Rep 2014;63:934–6. PubMed
  17. Parham M, Edison L, Soetebier K, et al. Ebola active monitoring system for travelers returning from West Africa—Georgia, 2014–2015. MMWR Morb Mortal Wkly Rep 2015;64:347–50. PubMed
  18. Stehling-Ariza T, Fisher E, Vagi S, et al. Monitoring of persons with risk for exposure to Ebola virus disease—United States, November 3, 2014–March 8, 2015. MMWR Morb Mortal Wkly Rep 2015;64:685–9. PubMed
  19. Brown CM, Aranas AE, Benenson GA, et al. Airport exit and entry screening for Ebola—August–November 10, 2014. MMWR Morb Mortal Wkly Rep 2014;63:1163–7. PubMed
  20. Karwowski M, Meites E, Fullerton K, et al. Clinical inquiries regarding Ebola virus disease received by CDC—United States, July 9-November 15, 2014. MMWR Morb Mortal Wkly 2015;63:1175–9.
  21. Goodman AB, Meites E, Anstey EH, et al. Clinical inquiries received by CDC regarding suspected Ebola Virus Disease in children—United States, July 9, 2014–January 4, 2015. MMWR Morb Mortal Wkly Rep 2015;64:1006–10. CrossRef PubMed
  22. Amorosa V, MacNeil A, McConnell R, et al. Imported Lassa fever, Pennsylvania, USA, 2010. Emerg Infect Dis 2010;16:1598–600. CrossRef PubMed

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Part 1

Summary of Notifiable Diseases in the United States, 2014

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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, 2014 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.

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Return to your place in the textTABLE 1. Number of reported cases of notifiable diseases,* by month, excluding U.S. territories — United States, 2014
Disease Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. Not stated Total
Arboviral diseases§
  California serogroup viruses 
    neuroinvasive 1 2 1 19 29 28 5 85
    nonneuroinvasive 2 4 4 1 11
  Eastern equine encephalitis virus
    neuroinvasive 1 3 4 8
  Powassan virus
    neuroinvasive 2 2 1 2 7
    nonneuroinvasive 1 1
  St. Louis encephalitis virus
    neuroinvasive 1 2 3 6
    nonneuroinvasive 1 1 2 4
  West Nile virus 
    neuroinvasive 1 1 2 28 182 547 480 88 15 3 1,347
    nonneuroinvasive 1 4 24 129 390 257 46 4 3 858
Babesiosis, total 8 8 15 11 45 221 526 535 158 72 72 89 1,760
  confirmed 6 6 7 4 34 184 476 462 120 51 52 70 1,472
  probable 2 2 8 7 11 37 50 73 38 21 20 19 288
Botulism, total 11 10 11 16 8 19 10 19 9 20 12 16 161
  foodborne 1 1 2 6 1 4 15
  infant 9 9 8 13 6 15 7 11 8 19 11 11 127
  other (wound and unspecified) 2 3 3 2 3 1 2 1 1 1 19
Brucellosis 2 5 4 8 15 7 5 16 11 4 5 10 92
Chancroid 1 1 1 1 2 6
Chlamydia trachomatis infection 97,157 109,226 142,149 110,169 132,858 111,251 107,315 144,706 114,508 114,227 132,164 126,059 1,441,789
Cholera 1 1 2 1 5
Coccidioidomycosis** 761 847 890 676 956 671 483 619 542 483 600 704 8,232
Cryptosporidiosis, total 334 417 502 434 529 534 793 1,637 1,250 953 666 633 8,682
  confirmed 224 253 292 264 311 314 490 1,138 838 612 406 423 5,565
  probable 110 164 210 170 218 220 303 499 412 341 260 210 3,117
Cyclosporiasis 5 2 3 13 36 135 152 22 15 7 8 398
Dengue fever§ 46 27 23 23 40 54 76 85 56 66 137 47 680
Diphtheria 1 1
Ehrlichiosis/Anaplasmosis 
  Anaplasma phagocytophilum 13 18 20 53 351 662 611 339 138 163 302 130 2,800
  Ehrlichia chaffeensis 5 8 6 21 149 313 310 311 131 65 101 55 1,475
  Ehrlichia ewingii 1 1 1 5 8 1 17
  undetermined 3 1 4 5 21 47 38 34 20 8 9 6 196
Giardiasis 835 954 1,204 989 1,221 1,012 1,197 1,973 1,464 1,238 1,296 1,171 14,554
Gonorrhea   24,079 25,407 31,899 25,395 31,273 27,111 27,073 35,376 28,522 27,492 33,167 33,268 350,062
Haemophilus influenzae, invasive disease 
  all ages, serotypes 328 285 356 280 323 255 253 271 204 235 299 452 3,541
    age <5 yrs 
      serotype b 1 2 6 2 4 1 1 4 1 4 5 9 40
     nontypeable 16 18 20 8 8 7 9 3 5 6 9 19 128
     non-b serotype 6 2 7 1 2 5 1 3 3 3 4 1 38
     unknown serotype 27 23 34 28 28 21 11 16 18 19 19 22 266
Hansen's disease 1 10 7 7 5 8 9 9 6 5 5 16 88
Hantavirus pulmonary syndrome 2 1 2 3 5 4 6 1 1 2 3 2 32
Hemolytic uremic syndrome postdiarrheal 4 12 11 12 18 27 31 41 32 21 20 21 250
Hepatitis, virus 
  A acute 62 96 107 83 142 86 87 151 117 86 99 123 1,239
  B acute 205 206 282 222 280 199 188 264 217 189 258 281 2,791
  B chronic 937 941 1,517 1,068 1,330 1,069 958 1,135 835 764 988 858 12,400
  B infection perinatal 3 5 4 6 4 4 3 2 4 1 5 6 47
  C acute 121 171 244 171 238 143 166 214 158 117 226 235 2,204
  C past or present 9,256 11,158 15,679 12,670 15,395 13,707 12,401 15,532 12,269 13,030 15,758 16,008 162,863
Human immunodeficiency virus (HIV) diagnoses †† 3,602 3,209 3,528 3,552 3,506 3,470 3,512 3,247 3,100 2,812 1,664 401 3 35,606
Influenza-associated pediatric mortality§§ 31 24 21 9 6 3 5 13 2 2 4 21 141
Invasive pneumococcal disease 
  all ages 1,722 1,575 1,955 1,481 1,585 832 626 588 706 802 1,200 2,284 15,356
    age <5 yrs 77 89 140 111 100 61 44 46 58 85 104 150 1,065
Legionellosis 205 185 277 261 390 495 607 717 561 470 484 514 5,166
Leptospirosis 2 2 3 2 3 1 3 3 5 3 7 4 38
Listeriosis 39 21 42 45 56 63 81 104 89 69 80 80 769
Lyme disease, total 653 608 856 979 2,201 5,210 7,700 6,502 2,868 2,071 2,124 1,689 33,461
  confirmed 438 434 604 682 1,523 4,100 6,227 5,088 2,124 1,454 1,482 1,203 25,359
  probable 215 174 252 297 678 1,110 1,473 1,414 744 617 642 486 8,102
Malaria 110 86 91 84 170 177 191 246 154 112 121 111 1,653
Measles, total 15 46 49 27 196 210 31 15 4 10 7 57 667
  indigenous 6 32 44 16 189 207 29 15 1 7 4 54 604
  imported 9 14 5 11 7 3 2 3 3 3 3 63
Meningococcal disease 
  all serogroups 53 44 55 36 39 30 14 28 27 32 29 46 433
  serogroup ACWY 18 7 19 12 8 9 7 7 6 6 9 15 123
  serogroup B 9 6 13 7 11 1 4 7 9 6 16 89
  other serogroup 3 4 2 3 2 3 1 2 3 2 25
  unknown serogroup 23 27 21 14 20 18 7 14 13 15 11 13 196
Mumps 26 52 168 335 242 99 48 48 22 29 47 107 1,223
Novel influenza A virus infection 2 1 3
Pertussis 1,984 1,925 2,375 2,236 3,755 3,238 3,073 3,358 2,142 2,038 3,199 3,648 32,971
Plague 1 5 1 1 1 1 10
Psittacosis 1 1 2 3 1 8
Q fever, total 11 9 19 18 19 13 11 24 12 10 7 15 168
  acute 9 8 13 14 15 12 10 16 11 5 5 14 132
  chronic 2 1 6 4 4 1 1 8 1 5 2 1 36
Rabies 
  animal¶¶ 267 292 394 573 515 449 511 756 675 567 292 277 420 5,988
  human 1 1
Rubella 2 1 1 1 1 6
Rubella, congenital syndrome 1 1
Salmonellosis 1,981 2,122 2,691 2,652 4,264 4,538 5,538 7,954 5,837 5,085 4,936 3,857 51,455
Shiga toxin-producing E. coli (STEC) 195 193 354 369 541 624 839 948 604 455 543 514 6,179
Shigellosis 939 825 1,179 1,163 1,980 1,838 2,032 2,132 1,875 2,077 2,319 2,386 20,745
Spotted fever rickettsiosis, total 39 30 77 105 426 745 612 633 339 235 301 215 3,757
  confirmed 1 1 2 1 12 23 26 17 8 8 12 4 115
  probable 38 28 75 104 414 722 583 612 331 227 289 211 3,634
Streptococcal toxic shock syndrome 29 26 36 26 23 24 18 13 10 6 17 31 259
Syphilis, total, all stages¶,**,*** 4,143 4,464 6,056 4,795 6,090 5,153 4,935 6,269 5,086 5,223 5,604 5,632 63,450
  primary and secondary¶,** 1,349 1,377 1,805 1,449 1,902 1,635 1,558 2,040 1,622 1,640 1,773 1,849 19,999
  congenital¶,** 39 36 37 26 36 36 32 48 48 43 38 39 458
Tetanus 2 2 1 2 3 3 4 3 2 3 25
Toxic shock syndrome (other than streptococcal) 7 2 6 3 6 1 10 3 6 1 8 6 59
Trichinellosis 1 3 1 3 1 2 2 13
Tuberculosis††† 503 535 726 879 786 796 775 879 779 777 714 1,272 9,421
Tularemia 1 1 6 19 31 41 25 16 19 10 11 180
Typhoid fever 23 28 36 25 36 31 34 46 40 19 9 22 349
Vancomycin-intermediate Staphylococcus aureus (VISA) 13 18 20 20 17 16 16 20 28 12 17 15 212
Varicella (Chickenpox)                            
  morbidity 603 676 972 869 1,270 843 580 726 913 877 1,008 835 10,172
  mortality§§§ 1 1 1 1 4
Vibriosis 20 19 36 30 68 106 162 343 197 130 77 73 1,261
Viral hemorrhagic fevers 1 4 5
Yellow fever§

* No cases of anthrax; dengue hemorrhagic fever (and dengue shock syndrome), eastern equine encephalitis, nonneuroinvasive disease; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated Coronavirus disease (SARS-CoV); smallpox;vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis, neuroinvasive and nonneuroinvasive disease; or yellow fever were reported in the United States during 2014.

Month is defined using MMWR week http://wwwn.cdc.gov/nndss/document/MMWR_Week_overview.pdf. MMWR week calendars can be found at http://wwwn.cdc.gov/nndss/script/downloads.aspx.

§ Totals reported to the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (ArboNET Surveillance), as of July 1, 2015.

Totals reported to the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), as of June 10, 2015.

** Reportable in <25 states.

†† Total number of HIV diagnoses reported to the Division of HIV/AIDS Prevention, NCHHSTP through December 31, 2014.

§§ Totals reported to the Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD), as of June 30, 2015.

¶¶ Totals reported to the National Center for Emerging and Zoonotic Infectious Diseases, Division of High-Consequence Pathogens and Pathology, as of October 30, 2015.

*** 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 10, 2015.

††† Totals reported to the Division of Tuberculosis Elimination, NCHHSTP, as of July 15, 2015.

§§§ Totals reported to the Division of Viral Diseases, NCIRD, as of June 30, 2015.

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Return to your place in the textTABLE 2a. Number of reported cases of notifiable diseases,* by region and reporting area — United States and U.S. territories, 2014  
Area Total resident population
(in thousands)
Arboviruses
California serogroup§ Eastern equine encephalitis Powassan St. Louis encephalitis West Nile
Neuroinvasive Nonneuroinvasive Neuroinvasive Neuroinvasive Nonneuroinvasive Neuroinvasive Nonneuroinvasive Neuroinvasive Nonneuroinvasive
United States 318,856 85 11 8 7 1 6 4 1,347 858
New England 14,681 2 4 4 8 4
Connecticut 3,597 3 3
Maine 1,330 1
Massachusetts 6,745 2 4 5 1
New Hampshire 1,327 3
Rhode Island 1,055
Vermont 627  
Mid. Atlantic 41,471 2 1 1 36 11
New Jersey 8,938 1 6 2
New York (upstate) 11,255 2 1 7 4
New York City 8,491 12 3
Pennsylvania 12,787 11 2
E.N. Central 46,740 37 6 1 2 59 13
Illinois 12,881 1 36 8
Indiana 6,597 2 9 1
Michigan 9,910 1 1
Ohio 11,594 30 1 10 1
Wisconsin 5,758 5 4 2 3 3
W.N. Central 21,006 6 2 104 221
Iowa 3,107 5 10
Kansas 2,904 18 36
Minnesota 5,457 6 2 6 15
Missouri 6,064 10 3
Nebraska 1,882 41 101
North Dakota 739 12 11
South Dakota 853 12 45
S. Atlantic 62,513 28 2 2 38 11
Delaware 936
District of Columbia 659 1 2
Florida 19,893 1 2 12 5
Georgia 10,097 1 1 11 2
Maryland 5,976 6
North Carolina 9,944 23
South Carolina 4,832 3
Virginia 8,326 2 5 2
West Virginia 1,850 1 1
E.S. Central 18,805 12 1 1 3 38 24
Alabama 4,849 1 1 2
Kentucky 4,413 1
Mississippi 2,994 1 2 26 17
Tennessee 6,549 12 12 4
W.S. Central 38,451 1 3 332 201
Arkansas 2,966 9 2
Louisiana 4,650 61 64
Oklahoma 3,878 9 9
Texas 26,957 1 3 253 126
Mountain 23,197 1 157 126
Arizona 6,731 1 80 27
Colorado 5,356 46 72
Idaho 1,634 6 13
Montana 1,024 2 3
Nevada 2,839 3
New Mexico 2,086 19 5
Utah 2,943 1 1
Wyoming 584 5
Pacific 51,992 575 247
Alaska 737
California 38,803 561 240
Hawaii 1,420 1
Oregon 3,970 7 1
Washington 7,062 7 5
Territories
American Samoa 55
C.N.M.I. 51
Guam 161
Puerto Rico 3,621
U.S. Virgin Islands 104

* No cases of anthrax; dengue hemorrhagic fever; eastern equine encephalitis, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV); smallpox; Vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; and yellow fever were reported in the United States during 2014.

Totals reported to the Division of Vector-Borne Diseases (DVBD), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) (ArboNET Surveillance), as of July 1, 2015.

§ California serogroup viral diseases for 2014 include LaCrosse virus, Jamestown Canyon virus and California serogroup viruses not specified.

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Return to your place in the textTABLE 2b. Number of reported cases of notifiable diseases,* by region and reporting area — United States and U.S. territories, 2014  
Area Babesiosis Botulism Brucellosis
Total Confirmed Probable Total Foodborne Infant Other
United States 1,760 1,472 288 161 15 127 19 92
New England 1,007 902 105 1 1 3
Connecticut 212 173 39
Maine 42 34 8
Massachusetts 537 510 27 3
New Hampshire 41 36 5
Rhode Island 172 148 24
Vermont 3 1 2 1 1
Mid. Atlantic 640 498 142 26 2 24 2
New Jersey 169 133 36 10 10 1
New York (upstate) 421 319 102 5 2 3
New York City 50 46 4 2 2 1
Pennsylvania N N N 9 9
E.N. Central 47 31 16 8 4 4 12
Illinois 1 1 1 1 4
Indiana 1 1
Michigan 2 1 1 1 1 2
Ohio 1 1 5 2 3 1
Wisconsin 43 29 14 5
W.N. Central 50 32 18 4 4 4
Iowa N N N N
Kansas N N N 2
Minnesota 49 31 18 1 1 1
Missouri N N N 3 3
Nebraska 1
North Dakota
South Dakota 1 1
S. Atlantic 6 3 3 18 17 1 19
Delaware 1 1 4 4
District of Columbia N N N 1 1 2
Florida N N N 3
Georgia N N N 2 2 7
Maryland 2 2 10 9 1
North Carolina N N N 2
South Carolina 3 2 1 1
Virginia N N N 1 1 1
West Virginia 3
E.S. Central 1 1 2 2 2
Alabama 1 1
Kentucky N N N 1 1 1
Mississippi N N N
Tennessee 1 1 1
W.S. Central 1 1 11 8 3 16
Arkansas N N N 3 1 2
Louisiana
Oklahoma N N N 1
Texas 1 1 8 7 1 15
Mountain 17 1 15 1 9
Arizona N N N 2 1 1 6
Colorado N N N 6 1 5 3
Idaho N N N
Montana 1 1
Nevada N N N 1 1
New Mexico N N N 1 1
Utah 6 6
Wyoming
Pacific 8 5 3 74 8 52 14 25
Alaska N N N 7 7
California 3 2 1 63 49 14 20
Hawaii N N N 1
Oregon 1 1 1 1 1
Washington 4 3 1 3 3 3
Territories
American Samoa U U U
C.N.M.I.
Guam
Puerto Rico N N N
U.S. Virgin Islands N N N

* No cases of anthrax; dengue hemorrhagic fever; eastern equine encephalitis, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV); smallpox; Vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; and yellow fever were reported in the United States during 2014.

Includes cases reported as wound and unspecified botulism.

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Return to your place in the textTABLE 2c. Number of reported cases of notifiable diseases,* by region and reporting area — United States and U.S. territories, 2014
Area Chancroid Chlamydia trachomatis infection Cholera Coccidioidomycosis§ Cryptosporidiosis Cyclosporiasis
Total Confirmed Probable
United States 6 1,441,789 5 8,232 8,682 5,565 3,117 398
New England 1 48,355 1 5 318 282 36 26
Connecticut 13,382 N 45 45 8
Maine 3,530 N 51 34 17 N
Massachusetts 1 21,271 1 139 139 18
New Hampshire 3,586 3 40 23 17
Rhode Island 4,349 2 16 16
Vermont 2,237 N 27 25 2
Mid. Atlantic 179,254 785 609 176 53
New Jersey 29,904 N 77 77 16
New York (upstate) 38,845 N 237 230 7 14
New York City 59,969 N 102 102 23
Pennsylvania 50,536 N 369 200 169 N
E.N. Central 217,323 55 1,451 1,044 407 26
Illinois 66,536 N 158 79 79 14
Indiana 28,519 N 185 96 89 2
Michigan 44,256 33 239 215 24 8
Ohio 54,858 16 324 109 215 1
Wisconsin 23,154 6 545 545 1
W.N. Central 85,924 1 118 1,248 666 582 10
Iowa 11,804 N 264 61 203
Kansas 11,116 N 67 22 45 1
Minnesota 19,907 1 90 338 244 94 5
Missouri 27,981 19 167 81 86 1
Nebraska 7,499 4 111 87 24 3
North Dakota 3,451 5 148 143 5 N
South Dakota 4,166 N 153 28 125
S. Atlantic 289,330 2 11 2,627 1,488 1,139 70
Delaware 4,473 8 6 2
District of Columbia 5,293 1 5 5
Florida 84,194 2 N 1,905 1,031 874 33
Georgia 51,945 N 240 240 6
Maryland 27,424 10 79 47 32 4
North Carolina 47,147 N 166 85 81 4
South Carolina 28,087 N 63 41 22 18
Virginia 36,048 N 152 32 120 4
West Virginia 4,719 N 9 1 8 1
E.S. Central 97,072 411 282 129 1
Alabama 29,010 N 147 67 80 N
Kentucky 17,664 N 80 50 30 N
Mississippi 19,605 N 66 66 N
Tennessee 30,793 N 118 99 19 1
W.S. Central 1 196,441 3 804 436 368 201
Arkansas 15,605 56 55 1 1
Louisiana 28,955 3 244 107 137
Oklahoma 20,662 N 88 23 65 N
Texas 1 131,219 N 416 251 165 200
Mountain 97,489 1 5,792 487 361 126 6
Arizona 32,397 5,624 46 33 13 2
Colorado 21,863 1 N 75 52 23 1
Idaho 5,442 N 100 87 13 N
Montana 4,193 10 66 57 9 2
Nevada 11,841 70 16 10 6 N
New Mexico 11,558 40 86 80 6
Utah 8,223 46 70 16 54 1
Wyoming 1,972 2 28 26 2
Pacific 4 230,601 2,248 551 397 154 5
Alaska 5,789 N 4 3 1
California 4 176,308 2,243 357 346 11 2
Hawaii 6,419 N 3 3
Oregon 15,508 5 112 10 102 1
Washington 26,577 N 75 35 40 2
Territories
American Samoa N N N N N
C.N.M.I.
Guam 839
Puerto Rico 4,899 N
U.S. Virgin Islands 791

*No cases of anthrax; dengue hemorrhagic fever; eastern equine encephalitis, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV); smallpox; Vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; and yellow fever were reported in the United States during 2014.

Totals reported to the Division of STD Prevention, NCHHSTP, as of June 10, 2015.

§Notifiable in <25 states.

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Return to your place in the textTABLE 2d. Number of reported cases of notifiable diseases,* by region and reporting area — United States and U.S. territories, 2014
Area Dengue Virus Infection Diphtheria Anaplasma phagocytophilum Ehrlichiosis/Anaplasmosis
Dengue Fever Ehrlichia chaffeensis Ehrlichia ewingii Undetermined
United States 680 1 2,800 1,475 17 196
New England 35 1,182 60 10
Connecticut 3 75
Maine 1 191 8 6
Massachusetts 17 621 20 1
New Hampshire 5 131 7 2
Rhode Island 5 97 24
Vermont 4 67 1 1
Mid. Atlantic 160 547 177 26
New Jersey 84 69 54 10
New York (upstate) 28 421 109 11
New York City 42 32 9
Pennsylvania 6 25 5 5
E.N. Central 34 1 507 62 96
Illinois 7 18 47
Indiana 5 49
Michigan 5 4 3
Ohio 9 1 1 4 1
Wisconsin 8 484 8 46
W.N. Central 10 483 386 12 39
Iowa 4 N N N N
Kansas 1 4 46 2 3
Minnesota 3 448 5 1 17
Missouri 2 24 328 9 19
Nebraska 1 6
North Dakota 6 1
South Dakota
S. Atlantic 126 41 299 3 10
Delaware 1 2 22
District of Columbia 2 1
Florida 84 7 29
Georgia 4 1 14 1
Maryland 8 2 38 1
North Carolina 8 12 73
South Carolina 2 8
Virginia 16 15 112 2 8
West Virginia 1 2 3
E.S. Central 8 11 163 1 12
Alabama 3 7 10 2
Kentucky 1 62
Mississippi 2 1 4
Tennessee 2 3 87 1 10
W.S. Central 41 24 328 1
Arkansas 4 15 236 1
Louisiana 3 2 3
Oklahoma 4 77
Texas 34 3 12
Mountain 113 1
Arizona 97 1
Colorado 10 N N N N
Idaho 1 N N N N
Montana 2
Nevada 3
New Mexico N N N N
Utah
Wyoming
Pacific 153 5 2
Alaska 4 N N N N
California 130 5 2
Hawaii 10 N N N
Oregon N
Washington 9
Territories            
American Samoa N N N N
C.N.M.I.
Guam N N N N
Puerto Rico 525 N N N N
U.S. Virgin Islands 19

* No cases of anthrax; dengue hemorrhagic fever; eastern equine encephalitis, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV); smallpox; Vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; and yellow fever were reported in the United States during 2014.

Total number of reported laboratory-positive dengue cases including all confirmed cases [by antidengue 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 July 1, 2015.

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Return to your place in the textTABLE 2e. Number of reported cases of notifiable diseases,* by region and reporting area — United States and U.S. territories, 2014
Area Giardiasis Gonorrhea Haemophilus influenzae, invasive disease Hansen's disease
(leprosy)
All ages,
serotypes
Age <5 Years
Serotype b Nontypeable Non-b serotype Unknown serotype
United States 14,554 350,062 3,541 40 128 38 266 88
New England 1,361 7,287 240 2 8 2 10 3
Connecticut 219 2,333 60 9
Maine 154 237 21 1 2 N
Massachusetts 709 3,817 104 1 4 1 3
New Hampshire 97 226 24 1 1
Rhode Island 45 590 16 1 1
Vermont 137 84 15 N
Mid. Atlantic 2,931 40,104 598 9 15 2 31 10
New Jersey 384 6,636 149 14
New York (upstate) 951 6,616 148 3 5 1 N
New York City 874 14,142 120 12 10
Pennsylvania 722 12,710 181 6 10 2 4
E.N. Central 1,562 53,262 589 7 33 13 18 4
Illinois N 15,970 164 4 5 5
Indiana 167 7,289 102 2 5 1 3
Michigan 506 9,688 106 4 5 5 1
Ohio 385 16,237 128 15 2 4 2
Wisconsin 504 4,078 89 1 4 6 1
W.N. Central 1,501 18,714 304 2 1 1 41 2
Iowa 205 1,641 4 1
Kansas 104 2,568 43 1 1 8
Minnesota 662 4,073 127 18
Missouri 228 7,387 97 8 2
Nebraska 131 1,459 25 6
North Dakota 39 694 8 1 1 N
South Dakota 132 892
S. Atlantic 2,663 75,743 854 4 14 10 62 13
Delaware 24 1,279 16 4
District of Columbia 78 1,883 10 1 1
Florida 1,165 20,944 259 32 10
Georgia 656 13,770 138 1 5 8 4 1
Maryland 268 6,108 85 1 1 2 1
North Carolina N 14,415 146 16
South Carolina 150 8,253 63 1 1
Virginia 256 8,250 89 7 1 1 1
West Virginia 66 841 48 1 2 N
E.S. Central 182 24,854 239 18 5 17 5
Alabama 182 7,677 65 7 3 3
Kentucky N 4,353 37 1 1 6 1
Mississippi N 5,625 36 5 4
Tennessee N 7,199 101 10 1 3
W.S. Central 393 55,000 204 7 9 8 27
Arkansas 113 4,539 50 4 7
Louisiana 280 9,002 46 6 1
Oklahoma N 6,137 96 1 5 2 N
Texas N 35,322 12 6 N N N 19
Mountain 1,111 18,788 330 5 25 2 26 4
Arizona 119 7,750 101 8 12
Colorado 332 3,170 66 4 2 2 1
Idaho 154 443 18
Montana 89 434 14 1 1
Nevada 65 3,188 17 2 1 1
New Mexico 101 2,246 49 2 4 6
Utah 225 1,441 59 2 7 3 2
Wyoming 26 116 6 1
Pacific 2,850 56,310 183 4 5 3 53 20
Alaska 89 1,341 25 4 3
California 1,852 45,408 42 35 6
Hawaii 43 1,020 23 6 14
Oregon 351 2,320 84 1 7 N
Washington 515 6,221 9 4 3 2 N
Territories
American Samoa
C.N.M.I.
Guam 1 99 13
Puerto Rico 31 454 3 1 2
U.S. Virgin Islands 84 N N N N N

* No cases of anthrax; dengue hemorrhagic fever; eastern equine encephalitis, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV); smallpox; Vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; and yellow fever were reported in the United States during 2014.

Totals reported to the Division of STD Prevention, NCHHSTP, as of June 10, 2015.

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Return to your place in the textTABLE 2f. Number of reported cases of notifiable diseases,* by region and reporting area — United States and U.S. territories, 2014
Area Hantavirus pulmonary syndrome Hemolytic uremic syndrome postdiarrheal Hepatitis A, acute Hepatitis B, acute Hepatitis B, chronic Hepatitis B perinatal infection Hepatitis C, acute Hepatitis C, past or present
United States 32 250 1,239 2,791 12,400 47 2,204 162,863
New England 11 88 59 411 1 272 11,227
Connecticut N 4 23 9 72 9 3,263
Maine 1 8 12 44 31 1,423
Massachusetts 6 43 30 233 1 228 5,639
New Hampshire 5 4 28 N N
Rhode Island 8 U U U U
Vermont 1 4 34 4 902
Mid. Atlantic 7 191 240 3,669 11 308 33,947
New Jersey 3 59 77 487 113 7,765
New York (upstate) 3 38 38 496 1 113 8,448
New York City 1 46 57 1,759 6 13 7,339
Pennsylvania 48 68 927 4 69 10,395
E.N. Central 33 186 416 1,662 5 381 32,104
Illinois 4 82 58 972 27 8,777
Indiana 7 20 126 U 122 U
Michigan 6 45 50 475 2 78 7,572
Ohio 9 32 171 214 2 105 15,755
Wisconsin 7 7 11 1 1 49
W.N. Central 4 34 79 78 1,013 2 76 12,033
Iowa 2 6 12 9 66 U
Kansas 10 7 11 116 28 1,560
Minnesota 10 19 16 197 40 1,899
Missouri 6 20 31 431 2 6 6,278
Nebraska 1 9 8 110 2 926
North Dakota 2 9 83 848
South Dakota 1 3 3 10 522
S. Atlantic 31 225 848 2,874 4 423 49,338
Delaware 1 8 88 U U
District of Columbia U U U U U U
Florida 7 90 313 1,137 1 93 22,253
Georgia 7 24 103 N 57 4,237
Maryland 6 27 40 498 42 7,041
North Carolina 4 38 100 447 2 111 N
South Carolina 1 6 37 145 4 3,586
Virginia 6 27 61 341 1 54 5,590
West Virginia 12 186 218 62 6,631
E.S. Central 21 49 561 625 2 334
Alabama N 1 15 117 N 35 N
Kentucky 4 19 164 N 176 N
Mississippi N 2 3 48 N N U
Tennessee 14 12 232 625 2 123 N
W.S. Central 6 37 148 294 211 5 127 2,657
Arkansas 8 2 28 N 13 N
Louisiana 2 5 87 125 1 22 2,116
Oklahoma 1 21 17 57 86 1 45 541
Texas 5 6 124 122 N 3 47 N
Mountain 19 30 86 100 449 112 10,299
Arizona 5 29 31 98 U U
Colorado 4 6 23 29 144 33 3,644
Idaho 10 7 6 51 6 932
Montana 1 5 5 26 13 1,413
Nevada 1 5 21 N 6 N
New Mexico 6 8 2 50 16 2,316
Utah 2 8 8 11 34 38 1,492
Wyoming 1 1 U 46 U 502
Pacific 3 46 187 195 1,486 17 171 11,258
Alaska 1 3 U N
California 1 38 142 110 1,114 14 73 1,317
Hawaii 2 5 6 182 N 1 11
Oregon 1 6 13 32 97 15 5,002
Washington 1 26 44 93 3 82 4,928
Territories
American Samoa N N N
C.N.M.I.
Guam N 5 9 47 5 63
Puerto Rico N 8 19 5 N 558
U.S. Virgin Islands N

* No cases of anthrax; dengue hemorrhagic fever; eastern equine encephalitis, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV); smallpox; Vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; and yellow fever were reported in the United States during 2014.

Reported cases of chronic hepatitis B and hepatitis C past or present might not reflect unique case reports and might include both confirmed and probable case reports.

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Return to your place in the textTABLE 2g. Number of reported cases of notifiable diseases,* by region and reporting area — United States and U.S. territories, 2014
Area HIV diagnoses Influenza- associated pediatric mortality Invasive pneumococcal disease§ Legionellosis Leptospirosis Listeriosis
All ages Age <5 years
United States 35,606 141 15,356 1,065 5,166 38 769
New England 887 3 1,136 51 270 1 57
Connecticut 248 241 9 60 N 15
Maine 40 1 137 6 19 8
Massachusetts 474 2 531 27 144 1 21
New Hampshire 29 98 4 12 N 2
Rhode Island 82 73 4 28 10
Vermont 14 56 1 7 1
Mid. Atlantic 5,315 16 2,009 116 1,173 1 136
New Jersey 1,029 6 519 34 199 17
New York (upstate) 910 1 842 48 422 36
New York City 2,282 6 648 34 228 1 37
Pennsylvania 1,094 3 N N 324 46
E.N. Central 3,449 10 2,600 128 1,108 4 100
Illinois 1,171 3 N 249 30
Indiana 431 624 32 129 1 8
Michigan 703 2 614 34 229 1 20
Ohio 932 2 936 45 406 2 30
Wisconsin 212 3 426 17 95 12
W.N. Central 1,053 10 954 83 254 1 46
Iowa 98 1 N N 33 7
Kansas 112 3 136 N 19 N 6
Minnesota 245 5 487 41 59 17
Missouri 468 N 23 106 1 11
Nebraska 81 1 153 14 23 4
North Dakota 24 88 5 4 N 1
South Dakota 25 90 N 10 N
S. Atlantic 10,895 26 2,944 241 959 153
Delaware 105 41 1 20 1
District of Columbia 242 71 2 13 1
Florida 5,257 6 792 89 280 49
Georgia 1,401 1 925 62 93 15
Maryland 778 1 428 34 144 13
North Carolina 1,378 8 N N 187 30
South Carolina 741 2 421 23 45 10
Virginia 912 6 19 19 129 25
West Virginia 81 2 247 11 48 9
E.S. Central 1,944 9 1,430 101 352 1 34
Alabama 517 213 17 63 1 9
Kentucky 235 1 189 12 95 N 3
Mississippi 463 1 261 23 33 N 6
Tennessee 729 7 767 49 161 N 16
W.S. Central 5,649 34 2,205 208 394 34
Arkansas 283 2 290 26 38 N 4
Louisiana 1,400 6 353 27 64 9
Oklahoma 276 2 N 26 36 2
Texas 3,690 24 1,562 129 256 N 19
Mountain 1,651 10 1,902 116 208 2 50
Arizona 705 3 724 38 59 1 14
Colorado 361 1 471 21 65 N 10
Idaho 12 N 7 17 3
Montana 15 40 2 4 1
Nevada 388 3 139 6 25 4
New Mexico 124 1 299 14 8 9
Utah 37 2 204 25 28 1 9
Wyoming 9 25 3 2
Pacific 4,763 23 176 21 448 28 159
Alaska 41 87 10 2
California 3,988 22 N N 351 5 114
Hawaii 82 89 11 7 23 5
Oregon 215 1 N N 33 16
Washington 437 N N 55 24
Territories
American Samoa N N N
C.N.M.I.
Guam
Puerto Rico 489 13 69
U.S. Virgin Islands 16

* No cases of anthrax; dengue hemorrhagic fever; eastern equine encephalitis, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV); smallpox; Vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; and yellow fever were reported in the United States during 2014.

Totals reported to the Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD), as of June 30, 2015.

§ Streptococcus pneumoniae, invasive disease.  Since January 1, 2010, “Invasive pneumococcal disease (IPD)” has been nationally notifiable and separate notifications for “Drug resistant S. pneumoniae” and “IPD in children <5 years of age” have been discontinued.

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Return to your place in the textTABLE 2h. Number of reported cases of notifiable diseases,* by region and reporting area — United States and U.S. territories, 2014
AreaLyme diseaseMalariaMeasles
TotalConfirmedProbableTotalIndigenousImported
United States33,46125,3598,1021,65366760463
New England11,2928,1683,1241201367
Connecticut2,3601,71964115541
Maine1,4011,1692327
Massachusetts5,3043,6461,65861826
New Hampshire72462210211
Rhode Island90457033422
Vermont5994421574
Mid. Atlantic14,50911,9122,59742738308
New Jersey3,2862,58969779312
New York (upstate)2,8872,28560259523
New York City84956828120427252
Pennsylvania7,4876,4701,01785321
E.N. Central1,9501,5114391413923848
Illinois23323355211
Indiana110100102011
Michigan127933417532
Ohio1199425383823793
Wisconsin1,36199137011211
W.N. Central1,6631,03562811552484
Iowa1941108417
Kansas20128914131
Minnesota1,41689652051211
Missouri10731527252
Nebraska761911
North Dakota142129
South Dakota22588
S. Atlantic3,6782,5571,121421312
Delaware417341762
District of Columbia4035518
Florida155857052
Georgia4482
Maryland1,373957416146
North Carolina170271433611
South Carolina3720176
Virginia1,34697637077211
West Virginia136112242
E.S. Central127487946532
Alabama6428361411
Kentucky44113311
Mississippi221
Tennessee1771020431
W.S. Central4220221431073
Arkansas7
Louisiana2220
Oklahoma10
Texas4020201061073
Mountain59382179862
Arizona211472533
Colorado3011
Idaho9813
Montana7522
Nevada64211
New Mexico311
Utah13585321
Wyoming321
Pacific141707116114611927
Alaska8534
California73541995927517
HawaiiNNN415105
Oregon4534217651
Washington15874133294
Territories
American SamoaNNN
C.N.M.I.
Guam22
Puerto RicoNNN122
U.S. Virgin IslandsNNN

*No cases of anthrax; dengue hemorrhagic fever; eastern equine encephalitis, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV); smallpox; Vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis virus disease, neuroinvasive and non-neuroinvasive; and yellow fever were reported in the United States during 2014.

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Return to your place in the textTABLE 2i. Number of reported cases of notifiable diseases,* by region and reporting area — United States and U.S. territories, 2014
Area Meningococcal disease Mumps Novel influenza A virus infections Pertussis
All Serogroups Serogroups ACWY Serogroup B Other serogroup Unknown serogroup
United States 433 123 89 25 196 1,223 3 32,971
New England 18 11 4 2 1 10 1,199
Connecticut 3 3 3 100
Maine 2 1 1 557
Massachusetts 12 6 4 1 1 5 308
New Hampshire 2 84
Rhode Island 1 1 108
Vermont 42
Mid. Atlantic 51 7 11 3 30 193 2,223
New Jersey 9 9 39 387
New York (upstate) 8 2 5 1 12 901
New York City 18 18 123 122
Pennsylvania 16 5 6 2 3 19 813
E.N. Central 50 19 21 3 7 805 3 5,658
Illinois 12 7 4 1 142 764
Indiana 4 4 25 492
Michigan 12 4 5 3 20 1,424
Ohio 12 7 2 3 552 2 1,463
Wisconsin 10 1 6 2 1 66 1 1,515
W.N. Central 22 3 3 16 41 2,689
Iowa 2 1 1 10 222
Kansas 1 1 2 431
Minnesota 7 7 22 950
Missouri 8 8 6 558
Nebraska 366
North Dakota 2 1 1 1 52
South Dakota 2 1 1 110
S. Atlantic 102 17 22 5 58 47 3,002
Delaware 1 1 205
District of Columbia 1 1 16 22
Florida 50 50 1 719
Georgia 14 7 2 1 4 2 408
Maryland 7 2 4 1 3 203
North Carolina 13 6 5 2 2 752
South Carolina 5 3 1 1 2 170
Virginia 10 2 6 1 1 20 505
West Virginia 1 1 1 18
E.S. Central 19 9 3 7 8 983
Alabama 7 4 1 2 2 285
Kentucky 3 3 2 300
Mississippi 1 1 68
Tennessee 8 5 2 1 4 330
W.S. Central 40 15 8 6 11 21 3,094
Arkansas 1 1 1 286
Louisiana 7 7 1 90
Oklahoma 10 3 4 3 4 142
Texas 22 11 4 3 4 15 2,576
Mountain 33 17 6 4 6 49 4,176
Arizona 9 4 4 1 12 517
Colorado 9 5 1 2 1 4 1,282
Idaho 5 2 1 1 1 26 367
Montana 4 4 1 494
Nevada 3 3 2 144
New Mexico 2 2 2 370
Utah 1 1 2 940
Wyoming 62
Pacific 98 25 11 2 60 49 9,947
Alaska 3 3 1 169
California 57 57 37 8,723
Hawaii 2 1 1 1 38
Oregon 19 11 5 3 1 416
Washington 17 10 6 1 9 601
Territories
American Samoa
C.N.M.I.
Guam
Puerto Rico 17
U.S. Virgin Islands

* No cases of anthrax; dengue hemorrhagic fever; eastern equine encephalitis, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV); smallpox; Vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; and yellow fever were reported in the United States during 2014.

Totals reported to the Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD), as of June 30, 2015.

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Return to your place in the textTABLE 2j. Number of reported cases of notifiable diseases,* by region and reporting area — United States and U.S. territories, 2014
Area Plague Psittacosis Q fever Rabies Rubella
Total Acute Chronic Animal Human
United States 10 8 168 132 36 5,988 1 6
New England 1 1 479
Connecticut N 183
Maine 43
Massachusetts 1 1 148
New Hampshire N N N 23
Rhode Island 27
Vermont N 55
Mid. Atlantic 1 18 13 5 1,136 1
New Jersey 1 4 3 1 349
New York (upstate) 6 6 372
New York City 2 2 12
Pennsylvania 6 4 2 403 1
E.N. Central 18 8 10 150 1
Illinois 4 2 2 40 1
Indiana 2 2 12
Michigan 2 1 1 43
Ohio 4 4 28
Wisconsin 6 3 3 27
W.N. Central 5 15 14 1 204 1 1
Iowa N N N 15
Kansas 2 2 70
Minnesota 3 3 33
Missouri 1 1 26 1
Nebraska 5 2 2 21 1
North Dakota 2 2 18
South Dakota 5 4 1 21
S. Atlantic 1 11 10 1 1,833
Delaware 9
District of Columbia N 40
Florida 1 1 1 95
Georgia 272
Maryland 344
North Carolina 3 3 355
South Carolina 140
Virginia 4 3 1 528
West Virginia 3 3 50
E.S. Central 4 4 137
Alabama 2 2 86
Kentucky 10
Mississippi 1
Tennessee 2 2 40
W.S. Central 22 14 8 1,396
Arkansas 5 5 N 152
Louisiana 1 1 5
Oklahoma 4 2 2 106
Texas N 12 6 6 1,133
Mountain 10 34 24 10 422 1
Arizona 9 6 3 157
Colorado 8 6 4 2 131
Idaho 4 4 12
Montana 4 2 2 16
Nevada 14
New Mexico 2 2 2 12
Utah 9 6 3 22 1
Wyoming 58
Pacific 1 45 45 231 2
Alaska 3
California 35 35 200 2
Hawaii U
Oregon 9 9 13
Washington 1 1 1 15
Territories
American Samoa N N N N U U
C.N.M.I.
Guam N N N
Puerto Rico N 45
U.S. Virgin Islands

* No cases of anthrax; dengue hemorrhagic fever; eastern equine encephalitis, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV); smallpox; Vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; and yellow fever were reported in the United States during 2014.

Totals reported to the National Center for Emerging and Zoonotic Infectious Diseases, Division of High-consequence Pathogens and Pathology, as of December 14, 2015.

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Return to your place in the textTABLE 2k. Number of reported cases of notifiable diseases,* by region and reporting area — United States and U.S. territories, 2014
Area Rubella, Congenital syndrome Salmonellosis Shiga toxin-producing Escherichia coli (STEC) Shigellosis Spotted Fever Rickettsiosis§ Streptococcal toxic shock syndrome
Total Confirmed Probable
United States 1 51,455 6,179 20,745 3,757 115 3,634 259
New England 2,231 223 335 19 1 18 46
Connecticut 457 60 67 6 6 19
Maine 127 33 29 3 3 18
Massachusetts 1,223 95 187 8 8 6
New Hampshire 191 16 14 2 1 1
Rhode Island 140 4 34 1
Vermont 93 15 4 2
Mid. Atlantic 4,968 577 1,224 86 2 84 50
New Jersey 1,170 124 297 58 58 37
New York (upstate) 1,320 200 281 20 1 19 13
New York City 1,008 70 443 1 1
Pennsylvania 1,470 183 203 7 1 6
E.N. Central 1 5,672 871 3,475 148 2 146 78
Illinois 1 1,778 195 840 89 1 88 52
Indiana 725 117 1,362 36 36 12
Michigan 1,053 133 310 4
Ohio 1,199 204 606 12 12 9
Wisconsin 917 222 357 11 1 10 1
W.N. Central 3,038 1,013 2,615 411 8 403 11
Iowa 527 224 208 10 10
Kansas 428 90 55 110 110 2
Minnesota 727 332 95 7 7 8
Missouri 839 180 1,395 265 2 263 1
Nebraska 259 107 220 13 3 10
North Dakota 88 39 21 3 2 1
South Dakota 170 41 621 3 1 2
S. Atlantic 14,163 514 4,768 1,002 56 946 35
Delaware 157 14 74 24 24
District of Columbia 64 5 118
Florida 6,019 117 2,396 29 2 27 N
Georgia 2,242 97 1,021 37 37
Maryland 894 74 260 6 2 4 4
North Carolina 2,057 51 510 496 10 486 20
South Carolina 1,399 15 162 32 1 31 1
Virginia 1,151 121 214 373 4 369 10
West Virginia 180 20 13 5 5
E.S. Central 3,738 323 1,893 881 25 850 4
Alabama 1,165 41 516 220 8 206
Kentucky 585 97 344 53 53 4
Mississippi 990 31 199 50 4 46 N
Tennessee 998 154 834 558 13 545
W.S. Central 7,821 843 3,791 1,155 3 1,152 2
Arkansas 668 89 770 824 824
Louisiana 1,210 18 139 18 18 2
Oklahoma 798 124 139 219 3 216 N
Texas 5,145 612 2,743 94 94 N
Mountain 2,933 627 749 37 10 25 33
Arizona 1,046 98 376 16 6 10 4
Colorado 616 168 80 5 1 4 2
Idaho 174 116 12 1 1 1
Montana 146 39 44 4 1 3
Nevada 173 36 36 1 1 12
New Mexico 333 47 64 2 1 1
Utah 370 91 41 8 1 5 13
Wyoming 75 32 96 1
Pacific 6,891 1,188 1,895 18 8 10
Alaska 68 4 N N N N
California 5,358 691 1,655 11 5 6 N
Hawaii 323 25 29 N N N
Oregon 401 185 50 5 2 3 N
Washington 741 287 157 2 1 1 N
Territories
American Samoa N N N N
C.N.M.I.
Guam 13 4 N N N
Puerto Rico N 832 5 26 N N N N
U.S. Virgin Islands N N N

* No cases of anthrax; dengue hemorrhagic fever; eastern equine encephalitis, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV); smallpox; Vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; and yellow fever were reported in the United States during 2014.

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

§ Total case count includes eight unknown case status reports.

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Return to your place in the textTABLE 2l. Number of reported cases of notifiable diseases*, by region and reporting area — United States and U.S. territories, 2014
Area Syphilis†,§ Tetanus Toxic shock syndrome Trichinellosis
All Stages Primary and Secondary Congenital
United States 63,450 19,999 458 25 59 13
New England 1,256 515 3 2
Connecticut 169 86 N
Maine 23 16
Massachusetts 813 301 3
New Hampshire 79 36
Rhode Island 160 71 1
Vermont 12 5 1
Mid. Atlantic 9,825 2,556 27 2 7
New Jersey 1,172 297 2
New York (upstate) 1,341 401 3 4
New York City 5,788 1,326 19
Pennsylvania 1,524 532 5 2 1
E.N. Central 5,880 2,106 65 3 17 2
Illinois 2,796 863 27 2
Indiana 475 168 8 1 1
Michigan 1,095 421 15 4
Ohio 1,229 568 15 1 9 1
Wisconsin 285 86 1 2
W.N. Central 2,083 857 6 2 6
Iowa 239 72 1 1
Kansas 200 60
Minnesota 631 257 2 5
Missouri 771 352 1
Nebraska 96 50 1
North Dakota 51 13
South Dakota 95 53 3
S. Atlantic 14,857 4,886 93 3 9 1
Delaware 110 47 1
District of Columbia 281 116
Florida 6,102 1,740 47 2 N
Georgia 3,384 1,234 17 4 N
Maryland 1,475 449 16 1 N
North Carolina 1,998 733 6 2
South Carolina 750 250 5 1
Virginia 702 289 2 N 1
West Virginia 55 28 1
E.S. Central 2,541 745 9 1 6
Alabama 475 161 3
Kentucky 447 158 3 1
Mississippi 642 189 1 1 N
Tennessee 977 237 2 5
W.S. Central 10,780 2,483 132 6 2 2
Arkansas 389 121 6 2 N
Louisiana 2,173 575 46 1
Oklahoma 414 151 6 1 N
Texas 7,804 1,636 74 4 N 2
Mountain 3,201 1,317 20 7 2
Arizona 1,459 577 13 2
Colorado 355 186 4 1
Idaho 46 12
Montana 9 8
Nevada 894 357 6
New Mexico 283 126 1
Utah 149 47 1 1
Wyoming 6 4
Pacific 13,027 4,534 103 8 3 6
Alaska 45 15 1 N 2
California 11,440 3,835 99 4 3 2
Hawaii 106 68 N
Oregon 582 272 2 N
Washington 854 344 2 3 N 2
Territories
American Samoa N N
C.N.M.I.
Guam 13 7
Puerto Rico 960 484 N N
U.S. Virgin Islands 6 2

* No cases of anthrax; dengue hemorrhagic fever; eastern equine encephalitis, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV); smallpox; Vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; and yellow fever were reported in the United States during 2014.

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 10, 2015

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Return to your place in the textTABLE 2m. Number of reported cases of notifiable diseases,* by region and reporting area — United States and U.S. territories, 2014
Area Tuberculosis Tularemia Typhoid fever Vancomycin-intermediate Staphylococcus aureus (VISA)
United States 9,421 180 349 212
New England 307 4 19 2
Connecticut 60 1
Maine 14 1
Massachusetts 199 3 15
New Hampshire 11 1 N
Rhode Island 21 2 1
Vermont 2 1
Mid. Atlantic 1,304 4 85 62
New Jersey 308 1 21 7
New York (upstate) 202 3 10 31
New York City 585 39 20
Pennsylvania 209 15 4
E.N. Central 736 12 38 17
Illinois 320 7 15 3
Indiana 108 2 5
Michigan 105 2 9 3
Ohio 156 1 7 9
Wisconsin 47 2 2
W.N. Central 381 63 15 106
Iowa 54 1 1 N
Kansas 40 27 1
Minnesota 147 6
Missouri 79 20 5 104
Nebraska 38 6
North Dakota 15 4 2
South Dakota 8 5 2
S. Atlantic 1,667 2 56 16
Delaware 22 4
District of Columbia 32
Florida 595 1 13 4
Georgia 335 10 3
Maryland 198 16 1
North Carolina 195 4 4
South Carolina 79 1
Virginia 198 9 3
West Virginia 13 1
E.S. Central 438 3 4 3
Alabama 133 2 2
Kentucky 80 1
Mississippi 74
Tennessee 151 2 2 1
W.S. Central 1,542 60 23 5
Arkansas 93 42 1
Louisiana 121 1
Oklahoma 59 17 2
Texas 1,269 20 5
Mountain 431 24 21 1
Arizona 193 4
Colorado 64 16 6 N
Idaho 11 N
Montana 6 1 3
Nevada 74 3
New Mexico 50 5 1 N
Utah 31 1 4 1
Wyoming 2 1
Pacific 2,615 8 88
Alaska 62 N
California 2,145 66 N
Hawaii 136 4
Oregon 77 4 3 N
Washington 195 4 15 N
Territories
American Samoa 1 N
C.N.M.I. 23
Guam 56
Puerto Rico 44 1
U.S. Virgin Islands

* No cases of anthrax; dengue hemorrhagic fever; eastern equine encephalitis, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV); smallpox; Vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; and yellow fever were reported in the United States during 2014.

Totals reported to the Division of Tuberculosis Elimination, NCHHSTP, as of July 1, 2015.

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Return to your place in the textTABLE 2n. Number of reported cases of notifiable diseases,* by region and reporting area — United States and U.S. territories, 2014
Area Varicella Vibriosis Viral hemorrhagic fever§
Morbidity Mortality
United States 10,172 4 1,261 5
New England 1,147 86
Connecticut 186 15
Maine 207 9
Massachusetts 470 N 51
New Hampshire 112 5
Rhode Island 54 6
Vermont 118
Mid. Atlantic 1,151 70 1
New Jersey 317 34
New York (upstate) N N N
New York City 17 1
Pennsylvania 834 19
E.N. Central 2,498 63
Illinois 596 24
Indiana 220 6
Michigan 728 7
Ohio 535 N 12
Wisconsin 419 14
W.N. Central 855 38 1
Iowa N N N
Kansas 294 2
Minnesota 297 25 1
Missouri 201 8
Nebraska 19 2
North Dakota 21 1
South Dakota 23 N
S. Atlantic 1,282 3 326
Delaware 15 5
District of Columbia 1
Florida 570 1 166
Georgia 64 1 18
Maryland N 42
North Carolina N N 14
South Carolina 151 18
Virginia 324 1 59
West Virginia 158 N 3
E.S. Central 111 55
Alabama 107 20
Kentucky N N 9
Mississippi 4 N 11
Tennessee N 15
W.S. Central 1,943 1 130 3
Arkansas 254 N N
Louisiana 42 50
Oklahoma N N 2
Texas 1,647 1 78 3
Mountain 1,059 57
Arizona 300 36
Colorado 386 N 13
Idaho N N N
Montana 72 2
Nevada N N 2
New Mexico 75 N 1
Utah 215 2
Wyoming 11 N 1
Pacific 126 436
Alaska 31 5
California 43 272
Hawaii 52 38
Oregon N N 29
Washington N 92
Territories
American Samoa N N N
C.N.M.I.
Guam 33 N
Puerto Rico 231
U.S. Virgin Islands

* No cases of anthrax; dengue hemorrhagic fever; eastern equine encephalitis, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated coronavirus disease (SARS-CoV); smallpox; Vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; and yellow fever were reported in the United States during 2014.

Totals reported to the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD), as of June 30, 2015.

§ In addition to the four cases of Ebola Virus Disease diagnosed in the United States in 2014, six patients were medically evacuated to the United States for care after being diagnosed with Ebola Virus Disease in West Africa. In total, 11 VHF cases were reported for 2014, 10 confirmed infections with Ebola virus and one confirmed infection with Lassa virus.

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Return to your place in the textTABLE 3. Number of reported cases of notifiable diseases* and rates per 100,000 population, by age group, excluding U.S. territories— United States, 2014
Disease <1 yr 1–4 yrs 5–14 yrs 15–24 yrs 25–39 yrs 40—64 yrs ≥65 yrs Age not stated
No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate No. Rate No. Total
Arboviral diseases
  California serogroup viruses  
  neuroinvasive 2 (0.05) 12 (0.08) 59 (0.14) 2 (0.00) 2 (0.00) 3 (0.00) 5 (0.01) 85
  nonneuroinvasive (0.00) (0.00) 4 (0.01) 2 (0.00) 2 (0.00) 1 (0.00) 2 (0.00) 11
Eastern equine encephalitis virus
  neuroinvasive (0.00) (0.00) (0.00) (0.00) 1 (0.00) 4 (0.00) 3 (0.01) 8
  Powassan virus
  neuroinvasive (0.00) (0.00) (0.00) 1 (0.00) (0.00) 2 (0.00) 4 (0.01) 7
  nonneuroinvasive (0.00) (0.00) (0.00) (0.00) (0.00) (0.00) 1 (0.00) 1
  St. Louis encephalitis virus
  neuroinvasive ( 0.00) (0.00) (0.00) (0.00) 2 (0.00) 4 (0.00) (0.00) 6
  nonneuroinvasive ( 0.00) (0.00) (0.00) (0.00) (0.00) 2 (0.00) 2 (0.00) 4
  West Nile virus
  neuroinvasive 2 (0.05) (0.00) 26 (0.06) 54 (0.12) 150 (0.24) 633 (0.61) 481 (1.04) 1 1,347
  nonneuroinvasive (0.00) 3 (0.02) 13 (0.03) 53 (0.12) 137 (0.22) 432 (0.41) 220 (0.48) 858
Babesiosis, total 1 (0.04) 10 (0.09) 33 (0.12) 48 (0.17) 144 (0.34) 700 (1.03) 816 (2.80) 8 1,760
  confirmed 1 (0.04) 8 (0.08) 23 (0.08) 30 (0.10) 114 (0.27) 575 (0.84) 715 (2.46) 6 1,472
  probable (0.00) 2 (0.02) 10 (0.04) 18 (0.06) 30 (0.07) 125 (0.18) 101 (0.35) 2 288
Botulism, total 127 (3.22) 1 (0.01) 1 (0.00) 4 (0.01) 6 (0.01) 18 (0.02) 4 (0.01) 161
  foodborne 1 (0.03) (0.00) 1 (0.00) 3 (0.01) 1 (0.00) 6 (0.01) 3 (0.01) 15
  infant 126 (3.19) 1 (0.01) (0.00) (0.00) (0.00) (0.00) (0.00) 127
  other (wound and unspecified) (0.00) (0.00) (0.00) 1 (0.00) 5 (0.01) 12 (0.01) 1 (0.00) 19
Brucellosis (0.00) 3 (0.02) 2 (0.00) 13 (0.03) 18 (0.03) 32 (0.03) 22 (0.05) 2 92
Chancroid§ (0.00) (0.00) (0.00) 3 (0.01) 2 (0.00) 1 (0.00) (0.00) 6
Chlamydia trachomatis, infection§ (0.00) (0.00) (0.00) 948,102 (2155.77) 419,569 (61.38) 58,726 (56.40) 1,449 (3.13) 1,753 1,441,789**
Cholera (0.00) 1 (0.01) (0.00) (0.00) 1 (0.00) 3 (0.00) (0.00) 5
Coccidioidomycosis 4 (0.26) 27 (0.43) 256 (1.58) 720 (4.14) 1,532 (6.13) 3,434 (8.47) 2,232 (12.54) 27 8,232
Cryptosporidiosis, total 158 (4.00) 1,313 (8.24) 1,201 (2.92) 1,262 (2.87) 1,975 (3.11) 1,873 (1.80) 883 (1.91) 17 8,682
  confirmed 90 (2.28) 923 (5.79) 817 (1.98) 862 (1.96) 1,272 (2.01) 1,133 (1.09) 457 (0.99) 11 5,565
  probable 68 (1.72) 390 (2.45) 384 (0.93) 400 (0.91) 703 (1.11) 740 (0.71) 426 (0.92) 6 3,117
Cyclosporiasis (0.00) 2 (0.01) 1 (0.00) 21 (0.05) 74 (0.13) 214 (0.23) 85 (0.20) 1 398
Dengue fever 1 (0.03) 1 (0.01) 28 (0.07) 86 (0.20) 167 (0.26) 312 (0.30) 83 (0.18) 2 680
Diphtheria (0.00) (0.00) (0.00) 1 (0.00) (0.00) (0.00) (0.00) 1
Ehrlichiosis/Anaplasmosis  
  Anaplasma phagocytophilum (0.00) 10 (0.07) 99 (0.25) 127 (0.30) 245 (0.40) 1,241 (1.25) 1,072 (2.42) 6 2,800
  Ehrlichia chaffeensis 1 (0.03) 9 (0.06) 36 (0.09) 85 (0.20) 151 (0.25) 657 (0.66) 526 (1.19) 10 1,475
  Ehrlichia ewingii (0.00) (0.00) (0.00) (0.00) 4 (0.01) 7 (0.01) 6 (0.01) 17
  undetermined (0.00) 1 (0.01) 8 (0.02) 17 (0.04) 25 (0.04) 75 (0.08) 69 (0.16) 1 196
Giardiasis 103 (3.37) 1,720 (13.95) 1,960 (6.15) 1,823 (5.29) 2,891 (5.81) 4,493 (5.44) 1,489 (4.00) 75 14,554
Gonorrhea§ (0.00) (0.00) (0.00) 184,668 (419.89) 128,783 (203.01) 32,558 (31.27) 911 (1.97) 485 350,062
Haemophilus influenzae, invasive disease
  all ages, serotypes 277 (7.02) 195 (1.22) 97 (0.24) 80 (0.18) 211 (0.33) 876 (0.84) 1,800 (3.89) 5 3,541
    age <5 yrs  
      serotype b 25 (0.63) 15 (0.09) (0.00) (0.00) (0.00) (0.00) (0.00) 40
      nontypeable 86 (2.42) 42 (0.25) (0.00) (0.00) (0.00) (0.00) (0.00) 128
      non-b serotype 20 (1.52) 18 (0.10) (0.00) (0.00) (0.00) (0.00) (0.00) 38
      unknown serotype 146 (4.10) 120 (0.83) (0.00) (0.00) (0.00) (0.00) (0.00) 266
Hansen's disease (0.00) (0.00) 3 (0.01) 7 (0.02) 22 (0.04) 22 (0.02) 19 (0.05) 15 88
Hantavirus pulmonary syndrome (0.00) (0.00) 2 (0.01) 2 (0.00) 12 (0.02) 13 (0.01) 3 (0.01) 32
Hemolytic uremic syndrome postdiarrheal 6 (0.15) 117 (0.73) 87 (0.21) 12 (0.03) 2 (0.00) 16 (0.02) 8 (0.02) 2 250
Hepatitis,virus
  A acute 2 (0.05) 13 (0.08) 68 (0.17) 181 (0.41) 344 (0.54) 407 (0.39) 217 (0.47) 7 1,239
  B acute (0.00) 1 (0.01) 1 (0.00) 102 (0.23) 1,080 (1.72) 1,436 (1.39) 157 (0.347) 14 2,791
  B chronic 13 (0.41) 28 (0.22) 79 (0.24) 821 (2.30) 4,316 (8.39) 5,705 (6.67) 1,064 (2.75) 374 12,400
  B infection perinatal 24 (0.62) 23 (0.15) (0.00) (0.00) (0.00) (0.00) (0.00) 47
  C acute 11 (0.30) 3 (0.02) 1 (0.00) 502 (1.21) 1,139 (1.90) 482 (0.49) 38 (0.09) 28 2,204
  C  past or present 232 (7.68) 138 (1.13) 142 (0.45) 14,420 (42.41) 42,430 (86.33) 87,854 (107.79) 13,470 (36.85) 4,177 162,863
Human immunodeficiency virus (HIV) diagnoses†† 34 (0.90) 24 (0.20) 95 (0.20) 7,723 (17.60) 14,927 (23.50) 12,059 (11.60) 744 (1.60) 35,606
Influenza-associated pediatric mortality§§ 33 (0.84) 31 (0.19) 61 (0.15) 16 (0.13) (0.00) (0.00) (0.00) 141
Invasive pneumococcal disease
  all ages 363 (13.42) 660 (6.05) 372 (1.32) 262 (0.87) 1,161 (2.69) 6,407 (8.95) 6,103 (19.06) 28 15,356
    age <5 yrs 378 (12.78) 687 (5.75) (0.00) (0.00) (0.00) (0.00) (0.00) 1,065
Legionellosis 1 (0.03) (0.00) 2 (0.00) 37 (0.08) 335 (0.53) 2,374 (2.28) 2,185 (4.73) 232 5,166
Leptospirosis (0.00) (0.00) 2 (0.01) 11 (0.03) 9 (0.02) 11 (0.01) 2 (0.01) 3 38
Listeriosis 48 (1.22) 2 (0.01) 5 (0.01) 19 (0.04) 67 (0.11) 187 (0.18) 438 (0.95) 3 769
Lyme disease, total 36 (0.92) 1,263 (7.97) 5,649 (13.77) 3,337 (7.62) 4,092 (6.48) 11,968 (11.54) 6,310 (13.71) 806 33,461
  confirmed 26 ( 0.66) 1,100 (6.94) 4,502 (10.97) 2,384 (5.44) 3,019 (4.78) 9,115 (8.79) 4,543 (9.87) 670 25,359
  probable 10 (0.25) 163 (1.03) 1,147 (2.80) 953 (2.18) 1,073 (1.70) 2,853 (2.75) 1,767 (3.84) 136 8,102
Malaria 6 (0.15) 49 (0.31) 128 (0.31) 255 (0.58) 512 (0.81) 584 (0.56) 115 (0.25) 4 1,653
Measles, total 49 (1.24) 102 (0.64) 150 (0.36) 156 (0.35) 134 (0.21) 75 (0.07) 1 (0.00) 667
  indigenous 41 (1.04) 90 (0.57) 146 (0.35) 142 (0.32) 120 (0.19) 64 (0.06) 1 (0.00) 604
  imported 8 (0.20) 12 (0.08) 4 (0.01) 14 (0.03) 14 (0.02) 11 (0.01) (0.00) 63
Meningococcal disease  
  all serogroups 42 (1.06) 40 (0.25) 18 (0.04) 63 (0.14) 68 (0.11) 119 (0.11) 83 (0.18) 433
  serogroups ACWY 6 (0.15) 11 (0.07) 4 (0.01) 6 (0.01) 21 (0.03) 40 (0.04) 35 (0.08) 123
  serogroup B 16 (0.41) 12 (0.08) 5 (0.01) 24 (0.05) 10 (0.02) 16 (0.02) 6 (0.01) 89
  other serogroup 6 (0.15) (0.00) 1 (0.00) 7 (0.02) 2 (0.00) 7 (0.01) 2 (0.00) 25
  unknown serogroup 14 (0.35) 17 (0.11) 8 (0.02) 26 (0.06) 35 (0.06) 56 (0.05) 40 (0.09) 196
Mumps 6 (0.15) 62 (0.39) 118 (0.29) 481 (1.09) 242 (0.38) 269 (0.26) 44 (0.10) 1 1,223
Novel influenza A virus infection (0.00) (0.00) 2 (0.00) (0.00) (0.00) (0.00) (0.00) 1 3
Pertussis 4,155 (105.23) 4,418 (27.74) 12,945 (31.43) 6,027 (13.70) 1,820 (2.87) 2,734 (2.63) 750 (1.62) 122 32,971
Plague (0.00) (0.00) (0.00) 1 (0.00) 4 (0.01) 5 (0.00) (0.00) 10
Psittacosis (0.00) (0.00) (0.00) 1 (0.00) 1 (0.00) 4 (0.00) 2 (0.00) 8
Q fever, total (0.00) (0.00) 1 (0.00) 7 (0.02) 22 (0.04) 92 (0.09) 42 (0.09) 4 168
  acute (0.00) (0.00) 1 (0.00) 7 (0.02) 21 (0.03) 73 (0.07) 27 (0.06) 3 132
  chronic (0.00) (0.00) (0.00) (0.00) 1 (0.00) 19 (0.02) 15 (0.03) 1 36
Rabies, human (0.00) (0.00) (0.00) (0.00) (0.00) 1 (0.00) (0.00) 1
Rubella (0.00) (0.00) (0.00) 3 (0.01) 2 (0.00) 1 (0.00) (0.00) 6
Rubella, congenital syndrome (0.00) 1 (0.01) (0.00) (0.00) (0.00) (0.00) (0.00) 1
Salmonellosis 5,135 (130.05) 7,357 (46.19) 6,173 (14.99) 5,136 (11.68) 7,093 (11.18) 12,337 (11.85) 7,929 (17.15) 295 51,455
Shiga toxin-producing E. coli (STEC) 205 (5.19) 1,433 (9.00) 1,208 (2.93) 1,041 (2.37) 855 (1.35) 830 (0.80) 569 (1.23) 38 6,179
Shigellosis 309 (7.83) 5,600 (35.16) 6,303 (15.30) 1,566 (3.56) 3,203 (5.05) 2,866 (2.75) 779 (1.68) 119 20,745
Spotted fever rickettsiosis, total 5 (0.13) 38 (0.23) 175 (0.43) 293 (0.66) 650 (1.03) 1,745 (1.68) 838 (.82) 13 3,757
  confirmed 1 (0.03) 5 (0.03) 6 (0.01) 10 (0.02) 18 (0.03) 46 (0.04) 29 (0.06) 115
  probable 4 (0.10) 33 (0.20) 169 (0.41) 282 (0.64) 630 (1.00) 1,695 (1.63) 808 (1.76) 13 3,634
Streptococcal toxic shock syndrome 1 (0.04) 5 (0.05) 10 (0.04) 16 (0.05) 40 (0.10) 117 (0.16) 70 (0.22) 259
Syphilis, total, all stages§,¶¶ (0.00) (0.00) (0.00) 13,653 (31.04) 27,286 (43.01) 20,572 (19.76) 1,404 (3.04) 18 63,450
  primary and secondary§ (0.00) (0.00) (0.00) 5,160 (11.73) 9,024 (14.22) 5,621 (5.40) 176 (0.38) 6 19,999
  congenital§ (0.00) (0.00) (0.00) (0.00) (0.00) (0.00) (0.00) 458
Tetanus (0.00) 1 (0.01) 3 (0.01) 1 (0.00) 5 (0.01) 5 (0.00) 5 (0.01) 5 25
Toxic shock syndrome (other than streptococcal) (0.00) 2 (0.02) 18 (0.06) 22 (0.07) 3 (0.01) 10 (0.01) (0.00) 4 59
Trichinellosis (0.00) (0.00) 1 (0.00) (0.00) 5 (0.01) 5 (0.01) 2 (0.00) 13
Tuberculosis*** 45 (1.14) 217 (1.36) 198 (0.48) 961 (2.19) 2,150 (3.39) 3,634 (3.49) 2,216 (4.79) 9,421
Tularemia 2 (0.05) 6 (0.04) 30 (0.07) 16 (0.04) 12 (0.02) 68 (0.07) 44 (0.10) 2 180
Typhoid fever 3 (0.08) 31 (0.19) 80 (0.19) 57 (0.13) 102 (0.16) 56 (0.05) 18 (0.04) 2 349
Vancomycin-intermediate Staphylococcus aureus (VISA) 1 (0.03) 1 (0.01) (0.00) 11 (0.03) 20 (0.04) 110 (0.13) 65 (0.17) 4 212
Vibriosis 1 (0.03) 9 (0.06) 108 (0.28) 93 (0.23) 239 (0.40) 550 (0.56) 254 (0.59) 7 1,261
Viral hemorrhagic fevers (0.00) (0.00) (0.00) (0.00) 3 (0.01) 1 (0.00) (0.00) 1 5
Yellow fever (0.00) (0.00) (0.00) (0.00) (0.00) (0.00) (0.00)

* No cases of anthrax; dengue hemorrhagic fever (and dengue shock syndrome), eastern equine encephalitis, nonneuroinvasive disease; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated Coronavirus disease (SARS-CoV); smallpox;  vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis, neuroinvasive and nonneuroinvasive disease; or yellow fever were  reported in the United States during 2014.

Totals reported to the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (ArboNET Surveillance), as of July 1, 2015.

§ Cases among persons aged <15 years are not shown because some might not be caused by sexual transmission; totals reported to the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), as of June 10, 2015.

Reportable in <25 states.

** The row totals do not sum to total column. Data are suppressed for those aged <15 years. The total reflects the total count across all age groups.

††Total number of HIV diagnoses reported to the Division of HIV/AIDS Prevention, NCHHSTP through December 31, 2014.

§§Totals reported to the Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD) as of June 30, 2015.

¶¶ 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 10, 2015.

*** Totals reported to the Division of Tuberculosis Elimination, NCHHSTP, as of July 15, 2015.

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Return to your place in the textTABLE 4. Number of reported cases of notifiable diseases* and rates per 100,000 population, by sex, excluding U.S. territories — United States, 2014
Disease Male Female Sex not stated
No. Rate No. Rate No. Total
Arboviral diseases
  California serogroup viruses
    neuroinvasive 42 (0.03) 43 (0.03) 85
    nonneuroinvasive 6 (0.00) 5 (0.00) 11
  Eastern equine encephalitis virus
    neuroinvasive 4 (0.00) 4 (0.00) 8
  Powassan virus 
    neuroinvasive 5 (0.00) 2 (0.00) 7
    nonneuroinvasive 1 (0.00) (0.00) 1
  St. Louis encephalitis virus
    neuroinvasive 3 (0.00) 3 (0.00) 6
    nonneuroinvasive 1 (0.00) 3 (0.00) 4
  West Nile virus
    neuroinvasive 881 (0.57) 466 (0.29) 1,347
    nonneuroinvasive 522 (0.33) 336 (0.21) 858
Babesiosis, total 1,138 (1.11) 616 (0.58) 6 1,760
  confirmed 969 (0.94) 498 (0.47) 5 1,472
  probable 169 (0.16) 118 (0.11) 1 288
Botulism, total 93 (0.06) 68 (0.04) 161
  foodborne 7 (0.00) 8 (0.00) 15
  infant 71 (3.52) 56 (2.90) 127
  other (wound and unspecified) 15 (0.01) 4 (0.00) 19
Brucellosis 58 (0.04) 34 (0.02) 92
Chancroid§ 4 (0.00) 2 (0.00) 6
Chlamydia trachomatis, infection§ 433,325 (276.11) 1,006,441 (621.56) 2,023 1,441,789
Cholera 4 (0.00) 1 (0.00) 5
Coccidioidomycosis 4,283 (6.96) 3,940 (6.24) 9 8,232
Cryptosporidiosis, total 4,289 (2.73) 4,361 (2.69) 32 8,682
  confirmed 2,775 (1.77) 2,763 (1.71) 27 5,565
  probable 1,514 (0.96) 1,598 (0.99) 5 3,117
Cyclosporiasis 179 (0.12) 218 (0.15) 1 398
Dengue fever 324 (0.21) 356 (0.22) 680
Diphtheria (0.00) 1 (0.00) 1
Ehrlichiosis/Anaplasmosis
  Anaplasma phagocytophilum 1,714 (1.14) 1,079 (0.70) 7 2,800
  Ehrlichia chaffeensis 874 (0.58) 596 (0.39) 5 1,475
  Ehrlichia ewingii 11 (0.01) 6 (0.00) 17
  undetermined 113 (0.08) 83 (0.05) 196
Giardiasis 8,652 (7.00) 5,712 (4.48) 190 14,554
Gonorrhea§ 186,943 (119.12) 162,608 (100.42) 511 350,062
Haemophilus influenzae, invasive disease 
  all ages, serotypes 1,651 (1.05) 1,868 (1.15) 22 3,541
    age <5 yrs 
      serotype b 19 (0.19) 21 (0.22) 40
      nontypeable 74 (0.73) 53 (0.55) 1 128
      non-b serotype 24 (0.24) 13 (0.13) 1 38
      unknown serotype 157 (1.55) 104 (1.07) 5 266
Hansen's disease 48 (0.03) 25 (0.02) 15 88
Hantavirus pulmonary syndrome 25 (0.02) 7 (0.00) 32
Hemolytic uremic syndrome postdiarrheal 99 (0.06) 151 (0.09) 250
Hepatitis, virus
  A acute 645 (0.41) 591 (0.37) 3 1,239
  B acute 1,872 (1.20) 1,057 (0.66) 24 2,953
  B chronic 6,782 (5.30) 5,473 (4.14) 145 12,400
  B infection perinatal 25 (0.02) 22 (0.01) 47
  C acute 1,173 (0.79) 1,029 (0.67) 2 2,204
  C past or present 98,372 (80.68) 63,550 (50.46) 941 162,863
Human immunodeficiency virus (HIV) diagnoses** 28,806 (18.40) 6,800 (4.20) 35,606
Influenza-associated pediatric mortality†† 69 (0.18) 72 (0.20) 141
Invasive pneumococcal disease 
  all ages 7,967 (7.41) 7,321 (6.58) 68 15,356
    age <5 yrs 567 (7.44) 443 (6.08) 55 1,065
Legionellosis 3,050 (1.94) 2,112 (1.30) 4 5,166
Leptospirosis 30 (0.02) 8 (0.01) 38
Listeriosis 368 (0.23) 399 (0.25) 2 769
Lyme disease, total 19,180 (12.28) 13,841 (8.59) 440 33,461
  confirmed 14,526 (9.30) 10,485 (6.50) 348 25,359
  probable 4,654 (2.98) 3,356 (2.08) 92 8,102
Malaria 1,048 (0.67) 598 (0.37) 7 1,653
Measles, total 357 (0.23) 310 (0.19) 667
  indigenous 319 (0.20) 285 (0.18) 604
  imported 38 (0.02) 25 (0.02) 63
Meningococcal disease
  all serogroups 223 (0.14) 210 (0.13) 433
  serogroups ACWY 61 (0.04) 62 (0.04) 123
  serogroup B 50 (0.03) 39 (0.02) 89
  other serogroup 12 (0.01) 13 (0.01) 25
  unknown serogroup 100 (0.06) 96 (0.06) 196
Mumps 598 (0.38) 624 (0.39) 1 1,223
Novel influenza A virus infection (0.00) 3 (0.00) 3
Pertussis 15,378 (9.80) 17,406 (10.75) 187 32,971
Plague 4 (0.00) 6 (0.00) 10
Psittacosis 3 (0.00) 5 (0.00) 8
Q fever, total 117 (0.08) 51 (0.03) 168
  acute 92 (0.06) 40 (0.03) 132
  chronic 25 (0.02) 11 (0.01) 36
Rabies, human 1 (0.00)   (0.00) 1
Rubella 3 (0.00) 3 (0.00) 6
Rubella, congenital syndrome (0.00) 1 (0.00) 1
Salmonellosis 23,965 (15.27) 27,086 (16.73) 404 51,455
Shiga toxin-producing E. coli (STEC) 2,810 (1.79) 3,348 (2.07) 21 6,179
Shigellosis 10,051 (6.40) 10,368 (6.40) 326 20,745
Spotted fever rickettsiosis, total 2,610 (1.66) 1,140 (0.70) 7 3,757
  confirmed 90 (0.06) 24 (0.01) 1 115
  probable 2,515 (1.60) 1,113 (0.68) 6 3,634
Streptococcal toxic shock syndrome 139 (0.13) 120 (0.11) 259
Syphilis, total, all stages§,** 51,774 (32.99) 11,180 (6.90) 496 63,450
Syphilis, total, all stages§,§§ 18,146 (11.56) 1,840 (1.14) 13 19,999
  primary and secondary§ 23 (1.14) 19 (0.98) 416 458
  congenital§ 9 (0.01) 16 (0.01) 25
Toxic shock syndrome (other than streptococcal) 19 (0.02) 40 (0.03) 59
Trichinellosis 9 (0.01) 4 (0.00) 13
Tuberculosis¶¶ 5,840 (3.72) 3,578 (2.21) 3 9,421
Tularemia 113 (0.07) 67 (0.04) 180
Typhoid fever 183 (0.12) 165 (0.10) 1 349
Vancomycin-intermediate Staphylococcus aureus (VISA) 111 (0.09) 101 (0.08) 212
Vibriosis 862 (0.59) 393 (0.26) 6 1,261
Viral hemorrhagic fevers 3 (0.00) 2 (0.00) 5
Yellow fever (0.00) (0.00)

* No cases of anthrax; dengue hemorrhagic fever (and dengue shock syndrome), eastern equine encephalitis, nonneuroinvasive disease; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated Coronavirus disease (SARS-CoV); smallpox;  vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis, neuroinvasive and nonneuroinvasive disease; or yellow fever  were  reported in the United States during 2014.

Totals reported to the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (ArboNET Surveillance), as of July 15, 2015.

§ Totals reported to the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), as of June 10, 2015.

Reportable in <25 states.

** Total number of HIV diagnoses reported to the Division of HIV/AIDS Prevention, NCHHSTP through December 31, 2014.

†† Totals reported to the Division of Influenza, National Center for Immunization and Respiratory Diseases, as of June 30, 2015.

§§ 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 10, 2015.

¶¶ Totals reported to the Division of Tuberculosis Elimination, NCHHSTP, as of June 15, 2015.

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Return to your place in the textTABLE 5. Number of reported cases of notifiable diseases* and rates per 100,000, by race, excluding U.S. territories — United States, 2014
Disease American Indian or Alaska Native Asian or Pacific Islander Black White Other Race Race not stated Total
No. Rate No. Rate No. Rate No. Rate No. No.
Arboviral diseases
  California serogroup viruses
  neuroinvasive 5 (0.11) 1 0.01) 4 (0.01) 68 (0.03) 0 7 85
  West Nile virus
  neuroinvasive 7 (0.15) 17 (0.09) 78 (0.18) 806 (0.32) 114 325 1,347
  nonneuroinvasive 5 (0.11) 10 (0.05) 21 (0.05) 571 (0.23) 39 212 858
Babesiosis, total 6 (0.20) 51 (0.35) 31 (0.12) 1,021 (0.62) 30 621 1,760
  confirmed 5 (0.17) 48 (0.32) 28 (0.10) 841 (0.51) 28 522 1,472
  probable 1 (0.03) 3 (0.02) 3 (0.01) 180 (0.11) 2 99 288
Botulism, total 5 (0.11) 9 (0.05) 5 (0.01) 108 (0.04) 2 32 161
  Infant 1 (1.28) 8 (3.23) 3 (0.44) 91 (3.09) 1 23 127
Brucellosis (0.00) 2 (0.01) 4 (0.01) 54 (0.02) 13 19 92
Chlamydia trachomatis, infection§ 18,205 (402.86) 21,794 (112.35) 436,045 (984.09) 477,720 (190.61) 62,704 425,321 1,441,789
Coccidioidomycosis 127 (5.68) 139 (1.48) 229 (1.69) 2,024 (2.03) 260 5,453 8,232
Cryptosporidiosis, total 80 (1.77) 96 (0.49) 826 (1.86) 5,919 (2.36) 309 1,452 8,682
  confirmed 48 (1.06) 59 (0.30) 530 (1.20) 3,676 (1.47) 203 1,049 5,565
  probable 32 (0.71) 37 (0.19) 296 (0.67) 2,243 (0.89) 106 403 3,117
Cyclosporiasis 1 (0.03) 7 (0.04) 16 (0.04) 292 (0.13) 5 77 398
Dengue fever 3 (0.07) 67 (0.34) 36 (0.06) 345 (0.14) 35 203 680
Ehrlichiosis/Anaplasmosis
  Anaplasma phagocytophilum 30 (0.75) 17 (0.09) 21 (0.05) 1,928 (0.81) 47 757 2,800
  Ehrlichia chaffeensis 12 (0.30) 12 (0.07) 40 (0.09) 971 (0.41) 21 419 1,475
  undetermined 3 (0.07) 1 (0.01) 2 (0.00) 136 (0.06) 18 36 196
Giardiasis 79 (2.26) 670 (4.01) 1,161 (3.46) 6,718 (3.40) 652 5,274 14,554
Gonorrhea§ 4,404 (97.46) 3,761 (19.39) 157,302 (355.01) 99,200 (39.58) 12,939 72,456 350,062
Haemophilus influenzae, invasive disease
  all ages, serotypes 42 (0.93) 68 (0.35) 414 (0.93) 2,295 ( 0.92) 91 631 3,541
    age <5 yrs 
      serotype b 2 (0.52) 1 (0.08) (0.00) 30 (0.20) 7 40
      nontypeable 6 (1.55) 2 (0.16) 27 (0.80) 67 (0.45) 8 18 128
      non-b serotype (0.00) 1 (0.08) 10 (0.29) 18 (0.12) 2 7 38
      unknown serotype 10 (2.59) 12 (0.96) 58 (1.71) 116 (0.78) 15 55 266
Hansen's disease 1 (0.03) 24 (0.13) 3 (0.01) 36 (0.02) 3 21 88
Hantavirus pulmonary syndrome 7 (0.16) 1 (0.01) (0.00) 20 (0.01) 4 32
Hemolytic uremic syndrome postdiarrheal 2 (0.04) 9 (0.05) 3 (0.01) 189 (0.08) 8 39 250
Hepatitis,  virus 
  A acute 4 (0.09) 137 (0.71) 85 (0.19) 710 (0.28) 57 246 1,239
  B acute 23 (0.51) 55 (0.28) 345 (0.79) 1,817 (0.73) 61 490 2,791
  B chronic 24 (0.60) 2,780 (16.36) 1,555 (4.55) 1,801 (0.88) 492 5,748 12,400
  B infection perinatal (0.00) 21 (0.11) 6 (0.01) 8 (0.00) 1 11 47
  C acute 29 (0.74) 11 (0.06) 78 (0.19) 1,655 (0.70) 62 369 2,204
  C past or present 1,331 (38.26) 1,189 (7.13) 12,128 (35.10) 55,561 (28.76) 5,970 86,684 162,863
Human immunodeficiency virus (HIV) diagnoses** 205 (8.70) 813 (4.80) 15,843 (40.10) 10,116 (5.10) 8,629 35,606
Influenza-associated pediatric mortality†† 2 (0.17) 6 (0.14) 20 (0.17) 95 (0.19) 1 17 141
Invasive pneumococcal disease 
  all ages 216 (7.99) 185 (1.75) 2,294 (6.75) 9,054 (5.28) 382 3,225 15,356
    age <5 yrs 19 (7.02) 42 (5.42) 224 (7.92) 466 (4.22) 42 272 1,065
Legionellosis 21 (0.46) 69 (0.36) 901 (2.03) 3,155 (1.26) 122 898 5,166
Leptospirosis (0.00) 2 (0.01) 1 (0.00) 9 (0.00) 4 22 38
Listeriosis 8 (0.18) 70 (0.36) 66 (0.15) 498 (0.20) 25 102 769
Lyme disease, total 102 (2.26) 376 (2.04) 349 (0.79) 19,745 (7.89) 987 11,902 33,461
  confirmed 74 (1.64) 259 (1.40) 255 (0.58) 14,791 (5.91) 804 9,176 25,359
  probable 28 (0.62) 117 (0.63) 94 (0.21) 4,954 (1.98) 183 2,726 8,102
Malaria 3 (0.07) 103 (0.53) 823 (1.86) 261 (0.10) 56 407 1,653
Measles, total 4 (0.09) 86 (0.44) 2 (0.00) 509 (0.20) 4 62 667
  indigenous 4 (0.09) 58 (0.30) 1 (0.00) 484 (0.19) 3 54 604
  imported (0.00) 28 (0.14) 1 (0.00) 25 (0.01) 1 8 63
Meningococcal disease
  all serogroups 7 (0.15) 9 (0.05) 53 (0.12) 296 (0.12) 10 58 433
  serogroups ACWY 5 (0.11) (0.00) 13 (0.03) 86 (0.03) 3 16 123
  serogroup B 1 (0.02) 1 (0.01) 12 (0.03) 64 (0.03) 1 10 89
  other serogroup (0.00) 2 (0.01) 5 (0.01) 15 (0.01) 3 25
  unknown serogroup 1 (0.02) 6 (0.03) 23 (0.05) 131 (0.05) 6 29 196
Mumps 4 (0.09) 39 (0.20) 104 (0.23) 781 (0.31) 24 271 1,223
Pertussis 211 (4.67) 560 (2.89) 1,460 (3.30) 23,466 (9.36) 1,074 6,200 32,971
Q fever, total 3 (0.07) 7 (0.04) 8 (0.02) 112 (0.05) 9 29 168
  acute 3 (0.07) 6 (0.03) 7 (0.02) 92 (0.04) 6 18 132
  chronic (0.00) 1 (0.01) 1 (0.00) 20 (0.01) 3 11 36
Salmonellosis 401 (8.87) 1,829 (9.43) 4,522 (10.21) 32,194 (12.85) 2,099 10,410 51,455
Shiga toxin-producing E. coli (STEC) 56 (1.24) 145 (0.75) 244 (0.55) 4,256 (1.70) 210 1,268 6,179
Shigellosis 684 (15.14) 280 (1.44) 5,511 (12.44) 10,049 (4.01) 885 3,336 20,745
Spotted fever rickettsiosis, total 53 (1.21) 22 (0.11) 95 (0.21) 2,597 (1.04) 35 955 3,757
  confirmed 1 (0.02) 1 (0.01) 4 (0.01) 77 (0.03) 1 31 115
  probable 52 (1.18) 21 (0.11) 90 (0.20) 2,515 (1.01) 34 922 3,634
Streptococcal toxic shock syndrome 1 (0.04) 5 (0.05) 36 (0.11) 162 (0.10) 14 41 259
Syphilis, total, all stages§,§§ 436 (9.65) 1,576 (8.12) 24,281 (54.80) 28,144 (11.23) 4,122 4,891 63,450
  primary and secondary§ 187 (4.14) 483 (2.49) 7,381 (16.66) 9,682 (3.86) 1,083 1,183 19,999
  congenital§ 5 (6.42) 18 (7.27) 227 (33.45) 175 (5.94) 17 16 458
Tetanus (0.00) 1 (0.01) (0.00) 17 (0.01) 7 25
Toxic shock syndrome (other than streptococcal) (0.00) 3 (0.02) 5 (0.02) 45 (0.02) 6 59
Tuberculosis¶¶ 131 (2.90) 3,006 (15.50) 2,078 (4.69) 3,864 (1.54) 254 88 9,421
Tularemia 9 (0.20) (0.00) 1 (0.00) 143 (0.06) 1 26 180
Typhoid fever 2 (0.04) 200 (1.03) 18 (0.04) 50 (0.02) 31 48 349
Vancomycin-intermediate Staphylococcus aureus (VISA) 1 (0.03) 1 (0.01) 51 (0.13) 121 (0.06) 38 212
Vibriosis 6 (0.14) 51 (0.27) 55 (0.13) 860 (0.37) 30 259 1,261
Yellow fever§ (0.00) (0.00) (0.00) (0.00)

*Conditions for which <25 cases were reported for the year are not included in the table. No cases of anthrax; dengue hemorrhagic fever (and dengue shock syndrome), eastern equine encephalitis, nonneuroinvasive disease; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated Coronavirus disease (SARS-CoV); smallpox;  vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis, neuroinvasive and nonneuroinvasive disease; or yellow fever  were  reported in the United States during 2014.

Totals reported to the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (ArboNET Surveillance), as of June 1, 2014.

§ Totals reported to the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), as of June 10, 2015.

Reportable in <25 states.

** Total number of HIV diagnoses reported to the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) through December 31, 2014.

†† Totals reported to the Division of Influenza, National Center for Immunization and Respiratory Diseases, as of June 30, 2015.

§§ 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 10, 2015.

¶¶ Totals reported to the Division of Tuberculosis Elimination, NCHHSTP, as of July 15, 2015.

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Return to your place in the textTABLE 6. Number of reported cases of notifiable diseases* and rates per 100,000 population, by ethnicity, excluding U.S. territories — United States, 2014
Disease Hispanic Non-Hispanic Ethnicity not stated
No. Rate No. Rate No. Total
Arboviral diseases
  California serogroup viruses
  neuroinvasive 2 (0.00) 69 (0.03) 14 85
  West Nile virus 
  neuroinvasive 251 (0.45) 713 (0.27) 383 1,347
  nonneuroinvasive 75 (0.14) 520 (0.20) 263 858
Babesiosis, total 76 (0.18) 842 (0.51) 842 1,760
  confirmed 68 (0.17) 692 (0.41) 712 1,472
  probable 8 (0.02) 150 (0.09) 130 288
Botulism, total 38 (0.07) 86 (0.03) 37 161
  infant 31 (3.06) 69 (2.35) 27 127
Brucellosis 49 (0.09) 31 (0.01) 12 92
Chlamydia trachomatis, infection§,** 201,171 (363.21) 711,693 (270.12) 528,925 1,441,789
Coccidioidomycosis 936 (1.69) 1,737 (0.66) 5,559 8,232
Cryptosporidiosis, total 631 (1.14) 5,789 (2.20) 2,262 8,682
  confirmed 434 (0.78) 3,617 (1.37) 1,514 5,565
  probable 197 (0.36) 2,172 (0.82) 748 3,117
Cyclosporiasis 60 (0.11) 252 (0.10) 86 398
Dengue fever 272 (0.49) 248 (0.09) 160 680
Ehrlichiosis/Anaplasmosis 
  Anaplasma phagocytophilum 31 (0.06) 1,705 (0.68) 1,064 2,800
  Ehrlichia chaffeensis 21 (0.04) 1,044 (0.41) 410 1,475
  undetermined 2 (0.00) 150 (0.06) 44 196
Giardiasis 1,151 (2.81) 7,347 (3.49) 6,056 14,554
Gonorrhea§ 38,672 (69.82) 210,362 (79.84) 101,028 350,062
Haemophilus influenzae, invasive disease 
  all ages, serotypes 216 (0.39) 2,148 (0.82) 1,177 3,541
    age <5 yrs 
      serotype b 5 (0.10) 23 (0.16) 12 40
      nontypeable 24 (0.47) 66 (0.45) 38 128
      non-b serotype 5 (0.10) 27 (0.18) 6 38
      unknown serotype 43 (0.84) 139 (0.94) 84 266
Hansen's disease 12 (0.02) 48 (0.02) 28 88
Hantavirus pulmonary syndrome 4 (0.01) 21 (0.01) 7 32
Hemolytic uremic syndrome postdiarrheal 25 (0.05) 178 (0.07) 47 250
Hepatitis, virus
  A acute 211 (0.38) 730 (0.28) 298 1,239
  B acute 158 (0.29) 1,883 (0.72) 750 2,791
  B chronic 319 (0.76) 4,605 (2.11) 7,476 12,400
  B infection perinatal 2 (0.00) 34 (0.01) 11 47
  C acute 127 (0.24) 1,421 (0.57) 656 2,204
  C past or present 5,086 (12.79) 44,360 (21.32) 113,417 162,863
Human immunodeficiency virus (HIV) diagnoses** 7,927 (14.30) 27,679 (10.50) 35,606
Influenza-associated pediatric mortality†† 44 (0.25) 84 (0.15) 13 141
Invasive pneumococcal disease
  all ages 1,005 (2.94) 8,503 (4.61) 5,848 15,356
    age <5 yrs 153 (4.50) 572 (4.97) 340 1,065
Legionellosis 280 (0.51) 3,577 (1.36) 1,309 5,166
Leptospirosis 1 (0.00) 16 (0.01) 21 38
Listeriosis 117 (0.21) 498 (0.19) 154 769
Lyme disease, total 650 (1.18) 13,839 (5.28) 18,972 33,461
  confirmed 469 (0.85) 10,244 (3.91) 14,646 25,359
  probable 181 (0.33) 3,595 (1.37) 4,326 8,102
Malaria 33 (0.06) 1,264 (0.48) 356 1,653
Measles, total 38 (0.07) 534 (0.20) 95 667
  indigenous 38 (0.07) 479 (0.18) 87 604
  imported 0 (0.00) 55 (0.02) 8 63
Meningococcal disease 
  all serogroups 69 (0.12) 278 (0.11) 86 433
  serogroups ACWY 21 (0.04) 76 (0.03) 26 123
  serogroup B 2 (0.00) 58 (0.02) 29 89
  other serogroup 1 (0.00) 19 (0.01) 5 25
  unknown serogroup 45 (0.08) 125 (0.05) 26 196
Mumps 66 (0.12) 859 (0.33) 298 1,223
Pertussis 6,799 (12.28) 19,531 (7.41) 6,641 32,971
Q fever, total 22 (0.04) 111 (0.04) 35 168
  acute 20 (0.04) 90 (0.03) 22 132
  chronic 2 (0.00) 21 (0.01) 13 36
Salmonellosis 7,181 (12.97) 29,707 (11.28) 14,567 51,455
Shiga toxin-producing E. coli (STEC) 776 (1.40) 3,903 (1.48) 1,500 6,179
Shigellosis 4,091 (7.39) 11,989 (4.55) 4,665 20,745
Spotted fever rickettsiosis, total 124 (0.22) 2,494 (0.94) 1,139 3,757
  confirmed 6 (0.01) 73 (0.03) 36 115
  probable 118 (0.21) 2,415 (0.91) 1,101 3,634
Streptococcal toxic shock syndrome 26 (0.11) 150 (0.08) 83 259
Syphilis, total, all stages§,§§ 15,348 (27.71) 43,029 (16.33) 5,073 63,450
  primary and secondary§ 4,036 (7.29) 14,700 (5.58) 1,263 19,999
  congenital§ 110 (10.86) 322 (10.97) 26 458
Tetanus 4 (0.01) 12 (0.00) 9 25
Toxic shock syndrome (other than streptococcal) 3 (0.01) 41 (0.02) 15 59
Tuberculosis¶¶ 2,758 (4.98) 6,653 (2.53) 10 9,421
Tularemia 7 (0.01) 148 (0.06) 25 180
Typhoid fever 28 (0.05) 271 (0.10) 50 349
Vancomycin-intermediate Staphylococcus aureus (VISA) 13 (0.04) 145 (0.07) 54 212
Vibriosis 142 (0.27) 802 (0.33) 317 1,261
Yellow fever (0.00) (0.00)

*Conditions for which <25 cases were reported for the year are not included in the table. No cases of anthrax; dengue hemorrhagic fever (and dengue shock syndrome), eastern equine encephalitis, nonneuroinvasive disease; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated Coronavirus disease (SARS-CoV); smallpox;  vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis, neuroinvasive and nonneuroinvasive disease; or yellow fever  were  reported in the United States during 2014.

Totals reported to the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (ArboNET Surveillance), as of July 1, 2015.

§ Totals reported to the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), as of June 10, 2015.

Reportable in <25 states.

** Total number of HIV diagnoses reported to the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) through December 31, 2014.

†† Totals reported to the Division of Influenza, National Center for Immunization and Respiratory Diseases, as of June 30, 2015.

§§ 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 10, 2015.

¶¶ Totals reported to the Division of Tuberculosis Elimination, NCHHSTP, as of July 15, 2015.

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Return to your place in the textTABLE 7. Rate of notifiable diseases,* excluding U.S. territories, by year — United States, 2004–2014
Disease 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014*
AIDS 15.28 14 12.87 12.53 13
Anthrax 0 0 0 0 0 0 0 0 0
Arboviral diseases§
California serogroup virus disease
  neuroinvasive 0.02 0.02 0.02 0.02 0.02 0.02 0.04 0.02 0.03 0.03
  nonneuroinvasive 0 0 0 0 0 0 0.01 0 0.01 0
Eastern equine encephalitis virus disease
  neuroinvasive 0 0 0 0 0 0 0 0 0 0
  nonneuroinvasive 0 0 0 0 0
Powassan virus disease
  neuroinvasive 0 0 0 0 0 0 0 0 0 0
  nonneuroinvasive 0 0 0 0 0 0 0 0
St. Louis encephalitis virus disease
  neuroinvasive 0 0 0 0 0 0 0 0 0 0
  nonneuroinvasive 0 0 0 0 0 0 0 0 0 0
West Nile virus disease
   neuroinvasive 0.45 0.5 0.41 0.23 0.13 0.2 0.16 0.92 0.4 0.42
   nonneuroinvasive 0.58 0.94 0.8 0.22 0.11 0.13 0.07 0.9 0.38 0.27
Western equine encephalitis virus disease
   neuroinvasive
   nonneuroinvasive
Babesiosis, total** 
  confirmed 0.22 0.77 0.71
  probable 0.06 0.16 0.14
Botulism, total 0.02 0.01 0.02 0.05 0.05 0.04 0.04 0.01 0.05 0.05 0.05
  foodborne 0.01 0.01 0.01 0.01 0.01 0 0 0.01 0.01 0 0
  infant 2.12 2.09 2.35 2.05 2.56 1.92 1.88 2.34 3.1 3.45 3.22
  other (wound and unspecified) 0.01 0 0.01
Brucellosis 0.04 0.04 0.04 0.04 0.03 0.04 0.04 0.03 0.04 0.03 0.03
Chancroid†† 0 0.01 0.01 0.01 0.01 0.01 0.01 0 0 0 0
Chlamydia trachomatis infections†† 319.61 332.51 347.8 370.2 401.34 409.19 426.01 457.14 456.69 446.65 452.17
Cholera 0 0 0 0 0 0 0 0.01 0.01 0 0
Coccidioidomycosis§§ 4.14 6.24 6.79 14.39 7.76 13.24 § 16.49 12.97 7.82 6.6
Cryptosporidiosis, total 1.23 1.93 2.05 3.73 3.02 2.52 2.91 3 2.56 2.89 2.72
  confirmed 2.43 2.73 1.98 1.68 1.82 1.75
  probable 0.09 0.19 1.01 0.87 1.06 0.98
Cyclosporiasis 0.14 0.24 0.06 0.04 0.05 0.05 0.07 0.05 0.04 0.28 0.14
Dengue virus infection§
  Dengue fever 0.22 0.08 0.17 0.27 0.21
  Dengue hemorrhagic fever 0 0 0 0 0
Diphtheria 0
Ehrlichiosis
  human granulocytic (HGE) 0.2 0.28 0.23 0.31
  human monocytic (HME) 0.12 0.18 0.2 0.3
  human (other and unspecified)¶¶ 0.04 0.08 0.12
Ehrlichiosis/Anaplasmosis
  Ehrlichia chaffeensis 0.35 0.34 0.26 0.29 0.38 0.51 0.48
  Ehrlichia ewingii 0 0 0 0 0.01 0.01 0.01
  Anaplasma phagocytophilum 0.43 0.42 0.61 0.88 0.81 0.93 0.92
  undetermined 0.06 0.06 0.04 0.05 0.06 0.07 0.06
Encephalitis/meningitis, arboviral***
  California serogroup virus 0
  Eastern equine virus 0
  Powassan virus 0
  St. Louis virus 0
  West Nile virus 0.43
  Western equine virus
Enterohemorrhagic Escherichia coli
  O157:H7 0.87 0.89
  non-O157 0.13 0.19
  not serogrouped 0.13 0.16
Giardiasis 8.35 7.82 7.28 7.66 7.41 7.37 7.64 6.42 5.87 5.8 5.79
Gonorrhea†† 113.52 115.64 120.9 118.9 111.64 99.05 100.76 104.14 107.46 106.09 109.79
Haemophilus influenzae, invasive disease
  all ages, serotypes 0.72 0.78 0.82 0.85 0.96 0.99 1.03 1.15 1.1 1.21 1.11
    age <5 yrs
      serotype b 0.03 0.04 0.14 0.11 0.14 0.18 0.11 0.06 0.15 0.16 0.2
      non-b serotype* 0.04 0.67 0.86 0.97 1.18 1.17 0.94 0.57 1.02 1.11 0.5
      unknown serotype 0.97 1.08 0.88 0.88 0.79 0.79 1.05 0.89 1.04 0.93 1.03
      nontypeable 0.64
Hansen's disease (Leprosy) 0.04 0.03 0.03 0.04 0.03 0.04 0.04 0.03 0.03 0.03 0.03
Hantavirus pulmonary syndrome 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01
Hemolytic uremic syndrome postdiarrheal 0.07 0.08 0.11 0.1 0.12 0.09 0.09 0.1 0.09 0.11 0.08
Hepatitis, viral, acute
  A acute 1.95 1.53 1.21 1 0.86 0.65 0.54 0.45 0.5 0.57 0.39
  B acute 2.14 1.78 1.62 1.51 1.34 1.12 1.1 0.94 0.93 0.97 0.88
  B chronic 4.76
  B perinatal infection 0.01 0.02 0.01
  C acute 0.31 0.23 0.26 0.28 0.29 0.27 0.29 0.42 0.59 0.71 0.73
  C past and present 65.7
Human immunodeficiency virus (HIV) diagnoses 12.13 11.64 11.32 11.26 11.06 11.2
Influenza-associated  pediatric mortality†††   § 0.02 0.07 0.1 0.12 0.48 0.08 0.17 0.07 0.22 0.19
Invasive pneumococcal disease, all ages¶¶¶¶ 7.72 8.3 7.02
  age <5 years 8.35 7.8 7.14
Legionellosis 0.71 0.78 0.96 0.91 1.05 1.16 1.09 1.36 1.19 1.58 1.62
Leptospirosis 0.01
Listeriosis 0.32 0.31 0.3 0.27 0.25 0.28 0.27 0.28 0.23 0.23 0.24
Lyme disease, total§§§ 11.67 12.71 9.86 10.78 9.96 11.62 10.54
    confirmed 6.84 7.94 6.75 9.21 9.59 9.85 7.38 7.92 7.1 8.71 7.99
    probable 2.08 2.8 2.49 2.84 2.84 2.91 2.55
Malaria 0.51 0.51 0.5 0.47 0.42 0.48 0.58 0.56 0.48 0.51 0.52
Measles, total 0.01 0.02 0.02 0.01 0.05 0.02 0.02 0.06 0.02 0.06 0.21
  indigenous 0.01 0.04 0.19
  imported 0.01 0.02 0.02
Meningococcal disease, invasive¶¶¶
  all serogroups 0.47 0.42 0.4 0.36 0.39 0.32 0.27 0.25 0.18 0.18 0.14
    serogroup ACWY 0.1 0.11 0.11 0.11 0.1 0.09 0.08 0.05 0.05 0.04
    serogroup B 0.05 0.07 0.06 0.06 0.06 0.04 0.05 0.04 0.03 0.03
    other serogroup 0.01 0.01 0.01 0.01 0.01 0 0.01 0.01 0.01 0.01
    serogroup unknown 0.26 0.22 0.18 0.2 0.16 0.13 0.1 0.08 0.09 0.06
Mumps 0.09 0.11 2.22 0.27 0.15 0.65 0.85 0.13 0.07 0.19 0.38
Novel influenza A virus infections § § § 0 0 14.37 0 0 0.1 0.1 0
Pertussis 8.88 8.72 5.27 3.49 4.4 5.54 8.97 6.06 15.49 9.12 10.34
Plague 0 0 0.01 0 0 0 0 0 0 0 0
Poliomyelitis, paralytic 0 0 0 0
Poliovirus infection, nonparalytic
Psittacosis 0 0.01 0.01 0 0 0 0 0 0 0 0
Q Fever, total**** 0.03 0.05 0.06 0.06 0.04 0.04 0.04 0.04 0.04 0.05 0.05
  acute 0.04 0.03 0.04 0.04 0.04 0.04 0.04
  chronic 0 0.01 0.01 0.01 0.01 0.01 0.01
Rabies
  animal 0 0 0 0 0 0 0 0 1.48 1.41 1.98
  human 0 0 0 0 0 0 0 0 0 0 0
Rubella 0 0 0 0 0.01 0 0 0 0 0 0
Rubella, congenital syndrome 0 0 0 0 0 0 0 0
Salmonellosis 14.47 15.43 15.45 16.03 16.92 16.18 17.73 16.79 17.27 16.13 16.14
SARS-CoV††††
Shiga toxin-producing E. coli (STEC) 1.71 1.62 1.76 1.53 1.78 1.96 2.08 2.13 1.94
Shigellosis 4.99 5.51 5.23 6.6 7.5 5.24 4.82 4.32 4.9 4.06 6.51
Spotted Fever Rickettsiosis, total§§§§ 0.85 0.6 0.65 0.91 1.44 1.08 1.18
  confirmed 0.6 0.66 0.8 0.77 0.06 0.05 0.05 0.08 0.06 0.06 0.04
  probable 0.78 0.55 0.59 0.83 1.38 1.02 1.14
Smallpox
Streptococcal disease, invasive, group A 1.82 2 2.24 1.89 2.3 2.13 § § § § §
Streptococcal, toxic shock syndrome 0.06 0.07 0.06 0.06 0.07 0.08 0.07 0.09 0.1 0.11 0.12
Streptococcus pneumoniae invasive disease (IPD)¶¶¶¶
  all ages 8.83 8.52
    age < 5 yrs 14.15 7.64
Streptococcus pneumoniae invasive disease¶¶¶¶
  drug resistant, all ages 1.49 1.42 2.19 1.49 1.6 1.75
    age <5 yrs 3.73 3.51 4.54
  nondrug resistant, age <5 yrs 8.22 8.21 11.93 13.59 13.36 12.93
Syphilis††
  all stages 11.94 11.33 12.46 13.67 15.34 14.74 14.93 14.9 16.02 17.99 19.9
  congenital 9.12 8.24 9.07 10.46 10.12 9.9 8.85 8.68 8.12 8.83 11.6
  primary and secondary 2.71 2.97 3.29 3.83 4.48 4.6 4.49 4.52 5.03 5.54 6.27
Tetanus 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.01
Toxic shock syndrome 0.04 0.04 0.05 0.04 0.03 0.03 0.04 0.03 0.03 0.03 0.03
Trichinellosis 0 0.01 0.01 0 0.01 0 0 0.01 0.01 0.01 0
Tuberculosis***** 5.09 4.8 4.65 4.44 4.28 3.8 3.64 3.41 3.19 3.05 2.95
Tularemia 0.05 0.05 0.03 0.05 0.04 0.03 0.04 0.05 0.05 0.06 0.06
Typhoid fever 0.11 0.11 0.12 0.14 0.15 0.13 0.15 0.13 0.11 0.11 0.11
Vancomycin-intermediate Staphylococcus aureus 0 0 0.02 0.03 0.03 0.04 0.04 0.06 0.1 0.08
Vancomycin-resistant Staphylococcus aureus 0 0 0 0 0 0 0
Varicella (chickenpox morbidity) 18.41 19.64 28.65 18.68 13.56 8.71 6.46 5.79 5.33 4.62 3.94
Varicella (chickenpox mortality) 0 0 0
Vibriosis 0.25 0.24 0.3 0.3 0.29 0.39 0.43 0.42
Viral hemorrhagic fevers 0 0 0 0 0
Yellow fever§,†††††

* Per 100,000 population. No cases of anthrax; dengue hemorrhagic fever (and dengue shock syndrome), eastern equine encephalitis, nonneuroinvasive disease; poliomyelitis, paralytic; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated Coronavirus disease (SARS-CoV); smallpox; vancomycin-resistant Staphylococcus aureus (VRSA); western equine encephalitis, neuroinvasive and nonneuroinvasive disease; or yellow fever were reported in the United States during 2014.

In 2008 CDC published a revised HIV case definition. This combined separate surveillance case definitions for HIV infection and AIDS into a single case definition for HIV infection that includes AIDS (and incorporates the HIV infection classification system). The revised HIV case definition provides a more complete presentation of the HIV epidemic on a population level. Please see the Centers for Disease Control and Prevention revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years—United States, 2008. MMWR Recomm Rep 2008;57(No. RR-10). These case counts can be found under “HIV Diagnoses” in this table. The total number of HIV Diagnoses includes all cases reported to the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), through December 31, 2012. AIDS: Acquired Immunodeficiency Syndrome. HIV: Human Immunodeficiency Virus.

§Totals reported to the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (ArboNET Surveillance), as of July 1, 2015.

Not nationally notifiable.

** Revision of National Surveillance Case Definition distinguishing between confirmed and probable cases for annual report only (weekly reports contain total cases).

†† Total reported to the Division of STD Prevention, NCHHSTP, as of June 10, 2015.

§§ Reportable in <25 states.

¶¶ As of 2008, these categories were replaced with codes for Anaplasma phagocytophilum. Refer to Ehrlichiosis/Anaplasmosis.

*** In 2005, the arboviral disease surveillance case definitions and categories were revised. The nationally notifiable arboviral encephalitis and meningitis conditions continued to be nationally notifiable in 2005 and 2006, but under the category of arboviral neuroinvasive disease.

†††Totals reported to the Division of Influenza, National Center for Immunization and Respiratory Diseases, as of December 28, 2014.

§§§ The National surveillance case definition was revised in 2008; probable cases not previously reported.

¶¶¶ To help public health specialists monitor the impact of the new meningococcal conjugate vaccine (Menactra®, licensed in the United States in January 2005), the data display for meningococcal disease was modified to differentiate the fraction of the disease that is vaccine preventable (serogroups A,C,Y, W-135) from the nonpreventable fraction of disease (serogroup B and others).

****In 2008, Q fever acute and chronic reporting categories were recognized as a result of revision to the Q fever case definition. Before that time, case counts were not differentiated relative to acute and chronic Q fever cases.

†††† Severe acute respiratory syndrome-associated coronavirus disease.

§§§§ Revision of the National Surveillance Case Definition distinguishing between confirmed and probable cases; total case count includes eight case reports with unknown case status in 2014.

¶¶¶¶ Streptococcus pneumoniae invasive disease drug resistant (all ages) (11720) and nondrug resistant age <5 years (11717) became Streptococcus pneumoniae invasive disease (IPD) (11723) from 2010 through 2011 and finally simply invasive pneumococcal disease (IPD) (11723) starting in 2012.

***** Totals reported to the Division of Tuberculosis Elimination, NCHHSTP, as of July 15, 2015.

††††† The last indigenous case of yellow fever was reported in 1911; all other case reports since 1911 have been imported.

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Return to your place in the textTABLE 8. Number of deaths from selected nationally notifiable infectious diseases — United States, 2008–2014*
Cause of death ICD-10 Cause of death code No. of Deaths  
2008 2009 2010 2011 2012 2013 2014
Anthrax A22 0 0 0 0 0 0 0
Babesiosis B60.0 7 6 4 5 4 6 7
Botulism, foodborne A05.1 4 3 0 0 1 1 2
Brucellosis A23.0–A23.9 0 1 0 1 0 1 0
Cholera (toxigenic Vibrio cholerae O1 or O139) A00 0 1 0 0 0 1 0
Coccidioidomycosis B38 72 87 92 88 70 56 68
Cryptosporidiosis A07.2 3 2 4 4 2 0 1
Cyclosporiasis A07.8 0 0 0 0 0 0 0
Dengue Fever A90 0 1 2 0 1 3 2
Dengue Hemorrhagic Fever A91 0 0 1 0 1 0 0
Diphtheria A36.0–A36.3, A36.9 0 0 0 0 0 0 0
Ehrlichiosis/Anaplasmosis (Anaplasma phagocytophilum, Ehrlichia chaffeensis, Ehrlichia ewingii, Undetermined human Ehrlichiosis/Anaplasmosis) A77.8, A79 6 7 5 5 13 9 13
Giardiasis A07.1 1 0 1 1 0 0 1
Haemophilus influenzae infection A41.3, A49.2, G00.0, J14, J20.1 61 57 47 68 70 65 69
Hansen's disease (leprosy) A30 2 1 4 1 0 0 0
Hantavirus Pulmonary Syndrome (HPS) B33.4 9 0 2 8 4 4 5
Hemolytic uremic syndrome, postdiarrheal D59.3 32 25 20 25 23 22 38
Hepatitis A, viral (acute) B15 37 26 29 25 23 24 26
Hepatitis B, viral (acute, chronic, perinatal) B16, B17.0, B18.0, B18.1 671 597 588 614 581 573 535
Hepatitis C, viral (acute, chronic) B17.1, B18.2 6,834 6,981 6,844 7,048 7,292 7,366 7,349
Human immunodeficiency virus (HIV) infection B20–B24 10,285 9,406 8,369 7,683 7,216 6,955 6,721
Invasive pneumococcal disease, all ages A40.3, G00.1 203 228 191 181 156 199 152
Legionellosis A48.1, A48.2 92 104 104 111 124 131 132
Leptospirosis A27.0, A27.8, A27.9 2 2 0 0 1 2 0
Listeriosis A32, P37.2 30 29 28 52 47 32 36
Lyme disease A69.2, L90.4 10 12 10 6 11 5 15
Measles B05 0 2 2 0 2 0 0
Meningococcal disease A39.0 31 28 14 26 11 9 10
Mumps B26 2 2 1 0 0 1 0
Pertussis A37.0 6 1 5 1 4 2 7
Plague A20 0 1 0 0 0 0 0
Poliomyelitis, paralytic A80 0 0 0 0 0 0 0
Psittacosis A70 0 0 0 0 0 0 0
Q Fever A78 0 1 0 2 0 2 3
Rabies, human A82 2 4 1 4 1 0 1
Rubella B06 0 1 1 1 0 0 0
Rubella, congenital syndrome P35.0 5 4 8 5 8 6 4
Salmonellosis A02 42 26 28 44 44 40 45
Shiga toxin-producing E. coli (STEC) A04.3 0 1 0 0 1 0 0
Shigellosis A03 3 4 2 3 2 5 3
Spotted Fever Rickettsiosis A77.0–A77.3, A77.9 4 8 8 6 4 7 8
Smallpox B03 0 0 0 0 0 0 0
Tetanus A33, A34, A35 3 6 3 6 4 3 1
Trichinellosis B75 1 0 0 0 0 0 0
Tuberculosis A16–A19 585 529 569 539 510 555 493
Tularemia A21 1 3 0 0 0 2 1
Typhoid fever A01.0 2 0 0 0 0 0 0
Varicella (chickenpox mortality) B01 18 22 15 14 16 8 4
Vibriosis A05.3§ 1 0 0 0 0 0 0
Viral hemorrhagic fevers
Crimean-Congo hemorrhagic fever A98.0 0 0 0 0 0 0 0
Ebola virus A98.4 0 0 0 0 0 0 1
Lassa virus A96.2 0 0 0 0 0 0 0
Lujo virus A98.8 0 0 0 0 0 0 0
Marburg virus A98.3 0 0 0 0 0 0 0
New World Arenavirus-Guanarito virus A96.8 0 0 0 0 0 0 0
New World Arenavirus-Junin virus A96.0 0 0 0 0 0 0 0
New World Arenavirus-Machupo virus A96.1 0 0 0 0 0 0 0
New World Arenavirus-Sabia virus A96.8 0 0 0 0 0 0 0
Yellow fever A95.0, A95.1, A95.9 0 0 0 0 0 0 0

Source: CDC. CDC WONDER Detailed Mortality files (http://wonder.cdc.gov/) provided by the National Center for Health Statistics, National Vital Statistics System, 1999-2014. Underlying causes of death are classified according to ICD-10. Data are limited by the accuracy of the information regarding the underlying cause of death indicated on death certificates and reported to the National Vital Statistics System.

* List of Nationally Notifiable Conditions in 2014.

World Health Organization. International Statistical Classification of Disease and Related Health Problems. Tenth Revision, 1992.

§ The mortality code listed (A05.3) specifies cause of death as foodborne Vibrio parahaemolyticus intoxication and might not accurately reflect mortality from other vibrio species.

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PART 2

Graphs and Maps for Selected Notifiable Diseases in the United States, 2014

Abbreviations and Symbols Used in Graphs and Maps

U Data not available.

N Not reportable (i.e., report of disease not required in that jurisdiction).

DC District of Columbia

NYC New York City

AS American Samoa

CNMI Commonwealth of Northern Mariana Islands

GU Guam

PR Puerto Rico

VI U.S. Virgin Islands

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ANTHRAX. Number* of reported cases, by year United States, 1959-2014

* One epizootic-associated cutaneous case was reported in 2001 from Texas.

In 2014, anthrax epizootics were reported in North Dakota, South Dakota, and Texas. Epizootics involved domestic and wildlife bovine, caprine, and cervid species. No human anthrax cases were reported in 2014 from zoonotic or other causes.

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ARBOVIRAL DISEASES. Number* of reported cases of neuroinvasive disease, by year — United States, 2005-2014

 

* Data from the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (ArboNET Surveillance). Only reported cases of neuroinvasive diseases are shown.

During 2005–2014, an average of 69 La Crosse virus neuroinvasive disease cases were reported each year. La Crosse virus was the most common cause of neuroinvasive arboviral disease among children. During that same time period, Jamestown Canyon virus caused an average of two neuroinvasive disease cases per year. Starting in 2013, following the implementation of routine antibody testing for Jamestown Canyon virus disease, reported cases increased.

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ARBOVIRAL DISEASES, WEST NILE VIRUS. Incidence* of reported cases of neuroinvasive disease, by age group — United States, 2014

* Per 100,000 population. Data from the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (ArboNET Surveillance).

In 2014, West Nile virus neuroinvasive disease incidence increased with increasing age, ranging from 0.03 per 100,000 among persons aged <10 years to 1.15 among those aged ≥70 years.

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ARBOVIRAL DISEASES, WEST NILE VIRUS. Incidence* of reported cases of neuroinvasive disease — United States and U.S. territories, 2014

* Per 100,000 population. Data from the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (ArboNET Surveillance).

In 2014, the states with the highest reported incidence of West Nile virus (WNV) neuroinvasive disease were Nebraska (2.2 per 100,000), North Dakota (1.6), California (1.4), South Dakota (1.4), Louisiana (1.3), and Arizona (1.2). Three states reported two thirds of WNV neuroinvasive disease cases: California (561 cases), Texas (253), and Arizona (80).

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ARBOVIRAL DISEASES, WEST NILE VIRUS. Incidence* of reported cases of neuroinvasive disease, by year — United States, 2005-2014

* Per 100,000 population. Data from the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (ArboNET Surveillance).

Nationally, West Nile virus neuroinvasive disease incidence in 2014 was similar to the median incidence during 2005–2013.

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BABESIOSIS. Number of reported cases, by county — United States, 2014

Abbreviation: N = not reportable.

Babesiosis, a tickborne parasitic disease, became a nationally notifiable condition in 2011. In 2014, babesiosis was reportable in 31 states. Twenty-two of the 31 states reported at least one case; however, 1,636 (94%) of the 1,744 reported cases occurred in residents of seven of the states in which tickborne transmission of Babesia microti has been well documented (Connecticut, Massachusetts, Minnesota New Jersey, New York, Rhode Island, and Wisconsin).

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BOTULISM, FOODBORNE. Number of reported cases, by year — United States, 1994-2014

 

The number of foodborne botulism cases, caused by ingestion of preformed toxin, increased slightly from 2013 but remains below the average of the preceding 20 years. Pruno, which caused the 2011 and 2012 outbreaks in Utah and Arizona, respectively, is an illicit alcoholic beverage brewed by prison inmates.

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BOTULISM, INFANT. Number of reported cases, by year — United States, 1994-2014

Infant botulism remains the most common transmission category of botulism in the United States and accounted for most botulism cases in 2014. Reported cases have increased since 2010, but declined slightly from 2013 to 2014.

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BOTULISM, OTHER. Number* of reported cases, by year — United States, 2004-2014

* Includes wound and unspecified.

Annual number of cases of wound botulism and of botulism in “unspecified” transmission categories have remained generally stable since 2007.

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BRUCELLOSIS. Number of reported cases — United States and U.S. territories, 2014

The number of states reporting more than four cases of human brucellosis decreased from 2013 to 2014.

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BRUCELLOSIS. Number of reported cases, by year — United States, 1984-2014

The number of annual reported cases of brucellosis has continued to decrease since 2012.

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CHLAMYDIA. Incidence* of reported cases among women aged 15-24 years — United States and U.S. territories, 2014

* Per 100,000 population.

Among women aged 15–24 years, the population targeted for chlamydia screening, the overall rate of reported cases of chlamydia was 3,305.2 per 100,000 females. Rates varied by state, with the highest reported rates in the South.

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CHOLERA. Number of reported cases — United States and U.S. territories, 2014

In 2014, five travel-associated cases of cholera were reported from four states.

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COCCIDIOIDOMYCOSIS. Number of reported cases — United States and U.S. territories, 2014

Abbreviation: N = not reportable.

In the United States, coccidioidomycosis is endemic in Southwestern states. However, the fungus that causes coccidioidomycosis also was recently found in south-central Washington. Cases reported from states outside the endemic area usually occur among travelers returning from areas in which the disease is endemic.

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CRYPTOSPORIDIOSIS. Incidence* of reported cases, by year — United States, 2003-2014

* Per 100,000 population.

The incidence of reported cryptosporidiosis after 2007 remains elevated (>2.5 cases per 100,000 population) relative to the baseline observed before 2005 (<1.5). Whether this increase reflects a change in the true incidence of cryptosporidiosis or changing diagnosis, testing, or reporting patterns is unclear.

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CRYPTOSPORIDIOSIS. Incidence* of reported cases — United States and U.S. territories, 2014

Abbreviation: N = not reportable.

* Per 100,000 population.

Cryptosporidiosis is widespread geographically in the United States. Although incidence appears to be consistently higher in certain states, differences in reported incidence among states might reflect differences in risk factors; the number of cases associated with outbreaks; or the capacity to detect, investigate, and report cases. Incidence categories have been modified to reflect the recent increase in incidence.

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CYCLOSPORIASIS. Number of reported cases — United States and U.S. territories, 2014

Abbreviation: N = not reportable.

In 2014, a total of 398 cases (356 confirmed and 42 probable) were reported from 30 states and New York City. Of these, 275 (69%) were domestically acquired (i.e., they occurred in persons with no known history of travel outside the United States and Canada during the 14-day incubation period), at least 244 (89%) of which occurred in persons with onset of illness during May–August. A vehicle of infection (fresh cilantro from Mexico) was identified for 26 cluster-associated cases in Texas.

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DENGUE VIRUS INFECTION. Number* of reported cases, by age group — United States, 2014

* Data from the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (ArboNET Surveillance). Three age unknown cases of Dengue Fever. No cases of dengue hemorrhagic fever were reported in 2014 in travelers or residents of U.S territories.

All age groups were affected by dengue.

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DENGUE FEVER AND DENGUE HEMORRHAGIC FEVER. Number* of reported cases, by location of residence — United States and U.S. territories, 2014

* Number of Dengue Fever cases/Dengue Hemorrhagic Fever cases. Data from the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases (ArboNET Surveillance). The District of Columbia reports 2/0 cases, New York City 42/0, and the U.S. Virgin Islands 19/0.

California, New Jersey, and Arizona reported the most dengue cases. No cases of dengue hemorrhagic fever were reported in 2014 in travelers or residents of U.S. states or territories.

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DIPHTHERIA. Number of reported cases, by year — United States, 1984-2014

Reported diphtheria is rare in the United States; no more than one case per year has been reported since 2003.

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EHRLICHIOSIS AND ANAPLASMOSIS, ANAPLASMA PHAGOCYTOPHILUM. Number of reported cases, by county — United States, 2014

Cases are reported primarily from the Upper Midwest and coastal New England, reflecting both the range of the primary tick vector species, Ixodes scapularis, which is also known to transmit Lyme disease and babesiosis, and the range of preferred animal hosts for tick feeding.

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EHRLICHIOSIS AND ANAPLASMOSIS, EHRLICHIA CHAFFEENSIS. Number of reported cases, by county — United States, 2014

Ehrlichia chaffeensis is the most common type of ehrlichiosis infection in the United States. This tickborne pathogen is transmitted by Amblyomma americanum, the lone star tick, whose geographic range extends from the Southeast into parts of the Northeast and Midwest. The majority of cases of E. chaffeensis ehrlichiosis are reported from the Midwest, South, and Northeast regions.

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EHRLICHIOSIS AND ANAPLASMOSIS, EHRLICHIA EWINGII. Number of reported cases, by county — United States, 2014

Ehrlichia ewingii is the least common cause of ehrlichiosis. Ehrlichia ewingii is carried by Amblyomma americanum, which is the same vector that transmits E. chaffeensis, and whose geographic range extends from the Southeast into parts of the Northeast and Midwest. No serologic tests are used to distinguish between the two species, and differentiation can only be made by molecular genotyping.

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EHRLICHIOSIS AND ANAPLASMOSIS, UNDERTERMINED. Number of reported cases, by county — United States, 2014

Cases of ehrlichiosis and anaplasmosis caused by an undetermined species are reported across the United States but are more likely to be reported in the Midwest region and the Middle Atlantic division. This classification of “undetermined” is most often used in areas where no clear geographic boundary separates the individual tick vectors. In the Upper Midwest, some cases are likely caused by Ehrlichia muris-like agent, a recognized cause of ehrlichiosis in the United States. Because ehrlichiosis and anaplasmosis elicit some cross reactivity in antibody detection, this category can also be used when single, inappropriate diagnostic tests are performed that do not provide differentiation of etiology.

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GIARDIASIS. Incidence* of reported cases, by year — United States, 2003-2014

* Per 100,000 population.

The incidence of giardiasis decreased in 2014, continuing a general decrease that began in 2011 following several years of stable reporting. Factors contributing to this decrease might include a decrease in disease transmission, changes in case definition, or changes in surveillance priorities in some states.

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GONNORHEA. Incidence* of reported cases — United States and U.S. territories, 2014

* Per 100,000 population.

In 2014, rates of reported gonorrhea cases per 100,000 population ranged by state from 13.4 in Vermont to 193.6 in Louisiana; the gonorrhea rate in the District of Columbia was 285.8.

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GONORRHEA. Incidence* of reported cases, by sex — United States, 1994-2014

* Per 100,000 population.

Since 2013, the rate of reported cases of gonorrhea among men was higher than the rate among women. During 2010–2014, the rate among men increased from 94.1 to 119.1 (26.5%), and the rate among women decreased from 106.5 to 100.4 (5.7%). During 2013–2014, the rate among men increased from 109.5 to 119.1 (8.8%), and the rate among women decreased from 102.4 to 100.4 (1.9%).

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GONNORHEA. Incidence* of reported cases among women aged 15-24 years — United States and U.S. territories, 2014

* Per 100,000 population.

In 2014, rates per 100,000 population of reported gonorrhea cases continued to be highest among adolescents and young adults. For women, the highest rates were observed among those aged 20–24 years (531.0) and 15–19 years (431.7).

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HAEMOPHILUS INFLUENZAE, INVASIVE DISEASE. Incidence* of reported cases, by serotype among persons aged <5 years — United States, 2001-2014

* Per 100,000 population.

Rates of all invasive Haemophilus influenzae disease remain low; the majority of invasive disease in children aged <5 years is caused by nontypeable Haemophilus influenzae. Haemophilus influenza Type B incidence remains below the Healthy People 2020 goal of 0.27 per 100,000 population among those aged <5 years.

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HAEMOPHILUS INFLUENZAE, INVASIVE DISEASE. Incidence* of reported cases, by serotype among persons aged ≥5 years — United States, 2001–2014

* Per 100,000 population.

Rates of all invasive Haemophilus influenzae disease remain low; the majority of invasive disease in persons aged ≥5 years is caused by nontypeable Haemophilus influenzae.

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HANSEN’S DISEASE (LEPROSY). Number of reported cases, by year — United States, 1994–2014

An annual average of 89 Hansen’s Disease cases have been reported since 2000, with a low of 66 in 2006 and a high of 105 in 2004.

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HEMOLYTIC UREMIC SYNDROME, POSTDIARRHEAL. Number of reported cases — United States and U.S. territories, 2014

Abbreviation: N = not reportable.

In 2014, a total of 41 of 56 jurisdictions (states, districts, and territories) reported cases, and three jurisdictions did not report their data. Most cases of postdiarrheal hemolytic uremic syndrome are caused by Shiga toxin-producing Escherichia coli.

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HEPATITIS, ACUTE A. Incidence* of reported cases, by county — United States, 2014

* Per 100,000 population.

Although effective vaccines to prevent Hepatitis A infections have been available in the United States since 1995, in 2014, at least one case occurred in each state. A total of 1,239 cases were reported, and nine counties in seven states reported incidence rates of >10 cases per 100,000 population.

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HEPATITIS B, PERINATAL INFECTION. Number of reported cases — United States and U.S. territories, 2014

Abbreviations: N = not reportable; U = data not available.

In 2014, a total of 16 states reported 47 cases of perinatal hepatitis B. Because of the asymptomatic nature of hepatitis B (HBV) in young children, lack of timely testing among exposed infants, and incomplete reporting of infants with hepatitis B, the reported number of cases of perinatal hepatitis B is considered low and probably represents only a fraction of all infants infected with HBV at birth.

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HEPATITIS, ACUTE C. Number of reported cases, by year — United States, 2000–2014

After declining during 2000–2005, then remaining stable at approximately 800–1000 reported cases per year until 2010, reported acute hepatitis C cases doubled during 2011–2014. The rate of increase has slowed, and the number of cases were reported in 2014 (2,204) and 2013 (2,154) remained stable.

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HUMAN IMMUNODEFICIENCY VIRUS DIAGNOSES. Percentage of diagnosed cases, by race/ethnicity — United States, 2014

Among persons with HIV infection diagnosed in 2014, the greatest percentage was among blacks/African Americans, followed by whites, Hispanics/Latinos, Asians/Pacific Islanders, persons of multiple races, and American Indians/Alaska Natives.

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HUMAN IMMUNODEFICIENCY VIRUS DIAGNOSES. Diagnosis incidence* — United States and U.S. territories, 2014

* Per 100,000 population.

The highest rates (i.e., ≥15 diagnoses per 100,000 population) of HIV diagnoses were in certain states in the Southeast and Northeast as well as the District of Columbia and the U.S. Virgin Islands.

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INFLUENZA-ASSOCIATED PEDIATRIC MORTALITY. Incidence* of reported cases — United States and U.S. territories, 2014

* Per 100,000 population.

In 2014, New York City and 34 states reported 141 influenza-associated pediatric deaths for an overall incidence rate of 0.19 deaths per 100,000 children aged <18 years.

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LEGIONELLOSIS. Incidence* of reported cases, by year — United States, 1999–2014

* Per 100,000 population.

From 2013 to 2014, the incidence of legionellosis increased, continuing a general increase that began in 2003. Decreases since 2003 did not result in a lower incidence beyond the immediate past year. Factors potentially contributing to this increase include increased diagnostic testing or an increase in disease transmission.

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LEPTOSPIROSIS. Number of reported cases, by year — United States and U.S. territories, 1947–2014

In 2014, of 107 leptospirosis cases reported, 38 were from U.S. states and 69 were from Puerto Rico, demonstrating a substantial increase in cases reported in Puerto Rico compared to all previous years that leptospirosis was notifiable (1947–1994). Although leptospirosis was first notifiable starting in 1947, territories did not begin reporting cases until 1959. Territory data for 1970 and 1978 are not available.

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LISTERIOSIS. Incidence* of reported cases — United States and U.S. territories, 2014

* Per 100,000 population.

In 2014, a total of 47 states, the District of Columbia, and New York City reported 769 cases of Listeriosis for an overall incidence rate of 0.24 infections per 100,000, which is unchanged from 2013.

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LYME DISEASE. Incidence* of reported confirmed cases, by county — United States, 2014

* Per 100,000 population.

Although it is one of the most common nationally notifiable diseases, Lyme disease does not occur nationwide. Approximately 95% of confirmed Lyme disease cases are reported from states in the Northeast, mid-Atlantic, and upper Midwest. Many cases reported from other states are associated with travel to areas where Lyme disease is common. A rash that can be confused with and might be reported as Lyme disease sometimes occurs following bites of the lone star tick (Amblyomma americanum). These ticks, which do not transmit the Lyme disease bacterium, are common human biting ticks in the southeastern United States.

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MALARIA. Number of reported cases — United States and U.S. territories, 2014

In 2014, cases of malaria were reported from almost every state, and nearly all cases reported in the United States were imported. Cases in eight jurisdictions (California, Georgia, Maryland, New Jersey, New York City, Pennsylvania, Texas, and Virginia) accounted for 53% of the reported cases because of large immigrant populations and international travelers.

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MEASLES. Incidence* of reported cases by year — United States, 1979–2014