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        Summary of Notifiable Diseases, United States, 1998

        The following CDC staff members contributed to this report:

        Samuel L. Groseclose, D.V.M., M.P.H.
        Carol M. Knowles
        Patsy A. Hall
        Deborah A. Adams
        Willie J. Anderson
        Kathryn Snavely
        Robert F. Fagan
        Gerald F. Jones
        Carol A. Worsham
        Paul Gangarosa, M.P.H.
        M. Kathleen Glynn, D.V.M., M.P.V.M.
        Man-Huei Chang, M.P.H.
        Timothy Doyle, M.P.H.
        Ruth Ann Jajosky, D.M.D., M.P.H.
        Division of Public Health Surveillance and Informatics
        Epidemiology Program Office

        in collaboration with

        J. Javier Aponte
        TRW, Inc.

        David A. Nitschke
        Sara Zywicki, M.P.H
        EDS, Corp.

         

        Preface

        The MMWR Summary of Notifiable Diseases, United States, 1998 contains summary tables of the official statistics for the reported occurrence of nationally notifiable diseases in the United States for 1998. These statistics are collected and compiled from reports to the National Notifiable Diseases Surveillance System (NNDSS), which is operated by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE).

        Because the dates of onset or diagnosis for notifiable diseases are not always reported, these surveillance data are presented by the week they were reported to CDC by public health officials in state and territorial health departments. These data are finalized and published each year in the MMWR Summary of Notifiable Diseases, United States for use by state and local health departments; schools of medicine and public health; communications media; local, state, and federal agencies; and other agencies or persons interested in following the trends of reportable diseases in the United States. This publication also documents which diseases are considered national priorities for notification and the annual number of cases of such diseases.

        The Highlights section presents information on selected nationally notifiable and non-notifiable diseases to provide a context in which to interpret surveillance and disease-trend data and to provide further information on the epidemiology and prevention of selected diseases.

        Part 1 contains tables that present morbidity for each of the diseases considered nationally notifiable during 1998.* The tables provide the number of cases of notifiable diseases reported to CDC for 1998, as well as the distribution of cases by month and geographic location and by patient's age, sex, race, and Hispanic ethnicity. The data are final totals as of August 13, 1999, unless otherwise noted. Nationally notifiable diseases that are reportable in fewer than 40 states also do not appear in these tables. In all tables, leprosy is listed as Hansen disease, and tickborne typhus fever is listed as Rocky Mountain spotted fever (RMSF).

        Part 2 contains graphs and maps. These graphs and maps depict summary data for many of the notifiable diseases described in tabular form in Part 1.

        Part 3 contains tables that list the number of cases of notifiable diseases reported to CDC since 1967. This section also includes a table enumerating deaths associated with specified notifiable diseases reported to the National Center for Health Statistics (NCHS), CDC, during 1988-1997.

        The Bibliography section presents general and disease-specific references pertaining to the notifiable infectious diseases. These references provide additional information on surveillance and epidemiologic issues, diagnostic issues, or disease control activities.

        -------------------

        * Because no cases of anthrax, western equine encephalitis, or yellow fever were reported in the United States during 1998, these diseases do not appear in the tables in Part 1.

         

        Background

        As of January 1, 1998, a total of 52 infectious diseases were designated as notifiable at the national level. A notifiable disease is one for which regular, frequent, and timely information regarding individual cases is considered necessary for the prevention and control of the disease. This section briefly summarizes the history of the reporting of nationally notifiable diseases in the United States.

        In 1878, Congress authorized the U.S. Marine Hospital Service (i.e., the forerunner of the Public Health Service [PHS]) to collect morbidity reports regarding cholera, smallpox, plague, and yellow fever from U.S. consuls overseas. The intention was to use this information to institute quarantine measures to prevent the introduction and spread of these diseases into the United States. In 1879, a specific Congressional appropriation was made for the collection and publication of reports of these notifiable diseases. Congress expanded the authority for weekly reporting and publication of these reports in 1893 to include data from states and municipal authorities. To increase the uniformity of the data, Congress enacted a law in 1902 directing the Surgeon General to provide forms for the collection and compilation of data and for the publication of reports at the national level. In 1912, state and territorial health authorities -- in conjunction with PHS -- recommended immediate telegraphic reporting of five infectious diseases and the monthly reporting, by letter, of 10 additional diseases. The first annual summary of The Notifiable Diseases in 1912 included reports of 10 diseases from 19 states, the District of Columbia, and Hawaii. By 1928, all states, the District of Columbia, Hawaii, and Puerto Rico were participating in national reporting of 29 specified diseases. At their annual meeting in 1950, state and territorial health officers authorized the Council of State and Territorial Epidemiologists (CSTE) to determine which diseases should be reported to PHS. In 1961, CDC assumed responsibility for the collection and publication of data concerning nationally notifiable diseases.

        The list of nationally notifiable diseases is revised periodically. For example, a disease might be added to the list as a new pathogen emerges, or a disease might be deleted as its incidence declines. Public health officials at state health departments and CDC continue to collaborate in determining which diseases should be nationally notifiable. CSTE, with input from CDC, makes recommendations annually for additions and deletions. However, state reporting of nationally notifiable diseases to CDC is voluntary. Reporting currently is mandated (i.e., by legislation or regulation) only at the state and local level. Thus, the list of diseases considered notifiable varies slightly by state. All states generally report the internationally quarantinable diseases (i.e., cholera, plague, and yellow fever) in compliance with the World Health Organization's International Health Regulations.

        The list of 52 infectious diseases designated as notifiable at the national level during 1998 is as follows:

        The 52 Infectious Diseases Designated as Notifiable at the National Level During 1998

        Acquired immunodeficiency syndrome (AIDS)
        Anthrax
        Botulism
        Brucellosis
        Chancroid
        Chlamydia trachomatis, genital infection
        Cholera
        Coccidioidomycosis*
        Congenital rubella syndrome
        Cryptosporidiosis
        Diphtheria
        Encephalitis, California serogroup viral
        Encephalitis, eastern equine
        Encephalitis, St. Louis
        Encephalitis, western equine
        Escherichia coli O157:H7
        Gonorrhea
        Haemophilus influenzae, invasive disease
        Hansen disease (leprosy)
        Hantavirus pulmonary syndrome
        Hemolytic uremic syndrome, postdiarrheal
        Hepatitis A
        Hepatitis B
        Hepatitis C; non-A, non-B
        HIV infection, pediatric
        Legionellosis
        Lyme disease
        Malaria
        Measles (rubeola)
        Meningococcal disease
        Mumps
        Pertussis (whooping cough)
        Plague
        Poliomyelitis, paralytic
        Psittacosis
        Rabies, animal
        Rabies, human
        Rocky Mountain spotted fever
        Rubella (German measles)
        Salmonellosis
        Shigellosis
        Streptococcal disease, invasive, group A
        Streptococcus pneumoniae, drug-resistant*
        Streptococcal toxic-shock syndrome
        Syphilis
        Syphilis, congenital
        Tetanus
        Toxic-shock syndrome
        Trichinosis
        Tuberculosis
        Typhoid fever
        Yellow fever

        -------------------

        * Not currently published in MMWR weekly tables.

        Note: Although varicella (chickenpox) is not a nationally notifiable disease, the Council of State and Territorial Epidemiologists recommends reporting cases of this disease to CDC.

         

        Data Sources

        Provisional data concerning the reported occurrence of notifiable diseases are published weekly in MMWR. After each reporting year, staff in state health departments finalize reports of cases for that year with local or county health departments and reconcile the data with reports previously sent to CDC throughout the year. These data are compiled in final form in the MMWR Summary of Notifiable Diseases, United States.

        Notifiable disease reports are the authoritative and archival counts of cases. They must be approved by the appropriate epidemiologist from each submitting state or territory before being published in the MMWR Summary of Notifiable Diseases, United States. Although useful for detailed epidemiologic analyses, data published in MMWR Surveillance Summaries or other surveillance reports produced by CDC programs might not agree exactly with data reported in the annual summary because of differences in the timing of reports, the source of the data, and the case definitions.

        Data in the MMWR Summary of Notifiable Diseases, United States were derived primarily from reports transmitted to the Division of Public Health Surveillance and Informatics, Epidemiology Program Office, CDC, from health departments in the 50 states, five territories, New York City, and the District of Columbia through the National Electronic Telecommunications System for Surveillance (NETSS). More information regarding NETSS and notifiable diseases, including case definitions for these conditions, is available on the Internet at http://www.cy118119.com/epo/phs.htm. Policies for reporting notifiable disease cases can vary by disease or reporting jurisdiction, depending on case status classification (i.e., confirmed, probable, or suspect).

        Final data for selected diseases (presented in Parts 1, 2, and 3) are from the surveillance records of the CDC programs listed below. Requests for further information regarding these data should be directed to the appropriate program.

        National Center for Health Statistics (NCHS)

        Office of Vital and Health Statistics Systems (deaths from selected notifiable diseases).

        National Center for Infectious Diseases (NCID)

        Division of Bacterial and Mycotic Diseases (toxic-shock syndrome; Streptococcal disease, invasive, group A; Streptococcal toxic-shock syndrome; and laboratory data regarding botulism, Escherichia coli O157:H7, salmonellosis, and shigellosis).

        Division of Vector-Borne Infectious Diseases (laboratory data regarding arboviral encephalitis).

        Division of Viral and Rickettsial Diseases (animal rabies; Hantavirus pulmonary syndrome).

        National Center for HIV, STD, and TB Prevention (NCHSTP)

        Division of HIV/AIDS Prevention -- Surveillance and Epidemiology (acquired immunodeficiency syndrome [AIDS]).

        Division of Sexually Transmitted Diseases Prevention (chancroid, chlamydia, gonorrhea, and syphilis).

        Division of Tuberculosis Elimination (tuberculosis).

        National Immunization Program (NIP)

        Epidemiology and Surveillance Division (poliomyelitis).

        Disease totals for the United States, unless otherwise stated, do not include data for American Samoa, Guam, Puerto Rico, the Virgin Islands, or the Commonwealth of the Northern Mariana Islands (CNMI). Disease totals from American Samoa, CNMI, and the Virgin Islands were unavailable for 1998.

        Population estimates for the states are from the July 1, 1998, estimates from the Bureau of the Census* (Internet release number ST-98-1. December 31, 1998). Population numbers for territories are 1997 estimates from the Bureau of the Census (Press release numbers CB98-54 and CB98-80). Population numbers used to calculate rates for age and sex are from July 1, 1998, estimates from the Bureau of Census (Internet release. June 15, 1999). More information regarding census estimates is available at http://www.census.gov. Rates in the MMWR Summary of Notifiable Diseases, United States are presented as incidence rates per 100,000 population, based on data for the U.S. total-resident population. However, population data from states in which diseases were not notifiable or disease data were not available were excluded from rate calculations.

        Interpreting Data

        The data reported in the MMWR Summary of Notifiable Diseases, United States are useful for analyzing disease trends and determining relative disease burdens. However, these data must be interpreted in light of reporting practices. Some diseases that cause severe clinical illness (e.g., plague and rabies) are most likely reported accurately, if they were diagnosed by a clinician. However, persons who have diseases that are clinically mild and infrequently associated with serious consequences (e.g., salmonellosis) might not seek medical care from a health-care provider. Even if these less severe diseases are diagnosed, they are less likely to be reported.

        The degree of completeness of data reporting also is influenced by the diagnostic facilities available; the control measures in effect; the public awareness of a specific disease; and the interests, resources, and the priorities of state and local officials responsible for disease control and public health surveillance. Finally, factors such as changes in the case definitions for public health surveillance, the introduction of new diagnostic tests, or the discovery of new disease entities can cause changes in disease reporting that are independent of the true incidence of disease.

        Public health surveillance data are published for selected racial and ethnic population groups because these variables can be risk markers for certain notifiable diseases. Risk markers can identify potential risk factors for investigation in future studies. Race/ethnicity data also can be used to target populations for prevention efforts. However, caution must be used when drawing conclusions from reported race/ethnicity data. Certain races and ethnicities have differential patterns of access to health care, interest in seeking health care, and detection of disease, potentially resulting in data that are not representative of disease incidence in these populations.

        In addition, not all race/ethnicity data are collected uniformly for all diseases. For example, in NCHSTP, the Division of HIV/AIDS Prevention -- Surveillance and Epidemiology and the Division of Sexually Transmitted Diseases Prevention collect race/ethnicity data using a single variable. A person's race/ethnicity is reported as American Indian/Alaskan Native, Asian/Pacific Islander, black non-Hispanic, white non-Hispanic, or Hispanic. Additionally, although the recommended standard for classifying a person's race or ethnicity is based on self-reporting, this procedure might not always be followed.

        -------------------

        * Population Distribution Branch, Population Division of the Bureau of Census, which is under the Economics and Statistics Administration, U.S. Department of Commerce.

         

        Highlights for 1998

        The Highlights section presents information on the public health importance of selected nationally notifiable and non-notifiable diseases, including a) domestic and international disease outbreaks, b) active surveillance findings, c) changes in data reporting practices, d) the impact of prevention programs, e) the emergence of antimicrobial resistance, and f) changes in immunization policies. This information is intended to provide a context in which to interpret surveillance and disease-trend data and to provide further information on the epidemiology and prevention of selected diseases.

        Highlights for Selected Nationally Notifiable Diseases

        Chancroid

        In 1998, a total of 189 cases of chancroid were reported to CDC, for a rate of 0.07 cases/100,000 population. The number of cases reported in 1998 reflects a 23% decline from 1997 and a continuing decline since 1987. However, chancroid is difficult to culture and could be substantially underdiagnosed. Several studies that have used DNA amplification tests (which are not commercially available) have identified this infection in cities where it was previously undetected.

        Chlamydia trachomatis, Genital Infection

        In 1998, a total of 604,420 cases of genital chlamydial infection were reported to CDC, for a rate of 236.57 cases/100,000 population. This is the highest rate of chlamydial infection reported to CDC since cases were first voluntarily reported to the National Center for HIV, STD, and TB Prevention's Division of STD Prevention in the mid-1980s. It is also the highest rate since chlamydia became a nationally notifiable disease in 1995. This increase reflects the continued expansion of chlamydia screening programs and the increased use of more sensitive diagnostic tests for this condition. During the same period, data on chlamydia prevalence obtained by monitoring seropositivity rates of persons screened in different clinic settings have consistently documented declining levels of infection in many parts of the United States (Sexually transmitted disease surveillance 1998. US Department of Health and Human Services, CDC, September 1999).

        Cryptosporidiosis

        National reporting for cryptosporidiosis began in 1995. During 1995-1998, a total of 11,612 cases were reported from 47 states, with an annual median of 2,900 cases per year (range: 2,566-3,793). Because the diagnosis of cryptosporidiosis is often not considered, and because laboratories do not routinely test stool specimens for cryptosporidiosis infection, this disease continues to be underdiagnosed and under-reported.

        Diphtheria

        One probable case of diphtheria was reported from Oregon in 1998. The case-patient had acute membranous pharyngitis. An oropharyngeal specimen was weakly positive for diphtheria toxin by polymerase chain reaction, but bacterial culture of the specimen was negative.

        Outside the United States, more than 2,700 cases of diphtheria were reported in an epidemic in the Newly Independent States of the former Soviet Union (Dittmann S, Wharton M, Vitek C, et al. Successful control of epidemic diphtheria in the Newly Independent States of the Former Soviet Union: lessons learned in fighting public health emergencies. J Infect Dis 2000 [in press]). This epidemic has resulted in approximately 155,000 cases and 5,000 deaths since 1990. No importations into the United States were reported in 1998.

        Gonorrhea

        In 1998, a total of 355,642 cases of gonorrhea were reported to CDC, for a rate of 132.88/100,000 population. This was an 8.9% increase from the 1997 rate and the first increase since 1985. The 1998 increase was reported in all demographic groups defined by age, sex, and race/ethnicity, and it occurred in all major geographic regions except the Northeast. Possible reasons for this trend include expansion of screening programs (motivated by the availability of simultaneous testing for genital chlamydial infections), increased use of new diagnostic tests with improved sensitivity, improvements in surveillance systems, and true increases in morbidity.

        Haemophilus influenzae, Invasive Disease

        In 1998, a total of 255 cases of Haemophilus influenzae (Hi) invasive disease among children aged less than 5 years were reported (data were provided by the National Immunization Program and were based on date of onset, not MMWR week). Before a vaccine was introduced in 1987, approximately 20,000 cases of H. influenzae type b (Hib) invasive disease occurred among children annually (JAMA 1993;269:221-6). The sharp decline in the number of Hib cases is attributed to the widespread use of the Hib vaccine among preschool-aged children. Of the 255 cases reported in 1998, a total of 197 (74%) Hi isolates were serotyped, and 61 (31%) of these were type b. Among the 61 cases of Hib invasive disease reported in children aged less than 5 years, 25 (41%) were among children aged less than 6 months, which is too young to have completed a three-dose primary Hib vaccination. However, 22 (61%) of the 36 children who were old enough (i.e., aged greater than or equal to 6 months) to have completed a three-dose primary series were incompletely vaccinated or their vaccination status was unknown. These cases might have been prevented with age-appropriate vaccination.

        Hantavirus Pulmonary Syndrome

        In 1998, a total of 30 cases of hantavirus pulmonary syndrome (HPS) reported from 12 states were confirmed by CDC. Nine (30%) cases were fatal. HPS is caused by several hantaviruses in the western hemisphere and has also been reported in Canada, Argentina, Paraguay, Brazil, Uruguay, Chile, and Bolivia. Most HPS in the United States is caused by Sin Nombre virus. Other hantaviruses associated with human disease in the United States include Bayou, Black Creek Canal, New York, and Monongahela. Most hantaviruses have specific rodent reservoirs of the family Muridae. The virus is shed in rodent urine, feces, and saliva, then transmitted via inhalation.

        Hemolytic Uremic Syndrome, Postdiarrheal

        Postdiarrheal hemolytic uremic syndrome (HUS) is a life-threatening illness characterized by hemolytic anemia, thrombocytopenia, and renal injury. In the United States, most cases are caused by infection with Escherichia coli O157:H7 or other Shiga toxin-producing E. coli. In 1998, the third year of national reporting, 17 states reported 90 cases of postdiarrheal HUS to CDC. By comparison, 20 states reported 93 cases in 1997, and 18 states reported 104 cases in 1996. The median age of patients was 5 years (range: less than 1-87 years), and 53% of patients were female. Illness was seasonal, with 59% of cases occurring during June through September.

        Hepatitis A

        In 1999, the Advisory Committee on Immunization Practices (ACIP) issued revised recommendations for the use of hepatitis A vaccine (HepA). Routine childhood HepA vaccination is recommended in states or counties/communities where the average annual hepatitis A virus (HAV) rate during 1987-1997 was approximately 20 cases 100,000 population (i.e., approximately twice the national average). In addition, routine childhood HepA vaccination can be considered in states or counties/communities where the average rate during 1987-1997 was at least 10 cases/100,000 population.

        Of the 23,229 cases of HAV reported in 1998, approximately 60% originated from the 17 states affected by the ACIP recommendations. Eleven of these states had average rates of approximately 20 cases/100,000 persons during 1987-1997, and six states had average rates of approximately 10/100,000 during this period. However, these 17 states account for only 34% of the U.S. population.

        Hepatitis B

        The number of reported acute hepatitis B cases has decreased by more than 50% during the past decade, from 21,102 cases in 1990 to 10,258 cases in 1998. This downward trend is expected to continue as a national strategy for eliminating hepatitis B virus (HBV) transmission is implemented. Components of this strategy include a) screening pregnant women for hepatitis B surface antigen (HBsAg) and providing postexposure immunoprophylaxis to infants of infected women; b) routinely vaccinating infants; c) providing catch-up vaccinations for children aged less than 19 years (particularly those aged 11-12 years); and d) targeting vaccinations to children, adolescents, and adults at increased risk for infection. Draft Healthy People 2010 objectives emphasize the elimination of HBV transmission and include reducing the number of perinatal HBV infections to less than 400 and reducing the number of acute hepatitis B cases in persons aged 2-18 years to less than 10. Proposed age-specific target rates per 100,000 population for persons aged greater than 18 years are as follows: 3.2 cases/100,000 for persons aged 19-24 years, 11.1/100,000 for persons aged 25-39 years, and 1.0/100,000 for persons aged greater than or equal to 40 years.

        Hepatitis C

        Hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States (MMWR 1998;47[RR-19]). Based on data from CDC's sentinel counties viral hepatitis surveillance system, approximately 242,000 new HCV infections occurred each year during the 1980s. Since 1989, the annual number of new infections identified in the sentenial counties has declined by 80%. For reasons that are unclear, this dramatic decline correlates with a decrease in cases among injecting-drug users (MMWR 1998;47[RR-19]). But in 1996, data from the Third National Health and Nutrition Examination Survey (1988-1994) indicated that approximately 4 million Americans (1.8%) have been infected with HCV. Most are chronically infected, although the majority might be unaware of their infection because they are not clinically ill. Chronically infected persons can transmit the virus to others and are at risk for chronic liver disease, including cirrhosis and liver cancer.

        CDC guidelines for prevention and control of HCV infection and HCV-related chronic disease were published in October 1998 (MMWR 1998;47[RR-19]). The U.S. Food and Drug Administration also issued guidance in 1998 requiring the notification of persons who received blood or blood products before July 1992 from donors subsequently found to be infected with HCV. In May 1999, a national campaign was initiated to educate the public about hepatitis C and the need for persons at increased risk to be tested. These recommendations and activities are expected to increase the number of HCV-infected persons identified and reported to state and local health departments.

        HIV Infection, Pediatric

        In 1998, reports based on acquired immunodeficiency syndrome (AIDS) surveillance data indicated continued, substantial declines in perinatally acquired AIDS, reflecting declining perinatal human immunodeficiency virus (HIV) transmission. HIV surveillance data indicated that the increasing use of zidovudine was temporally associated with this decline (MMWR 1997;46:1086-92 and CDC. HIV/AIDS surveillance report. Atlanta, GA: US Department of Health and Human Services, 1998:36. [Vol. 10, no. 2]). These data demonstrate success in nationwide efforts to implement Public Health Service (PHS) guidelines for routine, voluntary prenatal HIV testing (MMWR 1995;44[No. RR-7] and MMWR 1998;47:688-91 and MMWR 1999;48:401-4) and the use of zidovudine to reduce perinatal HIV transmission (MMWR 1994;43[No. RR-11] and MMWR 1998;47[No. RR-2]).

        States that conduct surveillance of perinatally exposed and infected children aged less than 13 years can evaluate the impact of the guidelines and document resources needed to care for perinatally exposed infants. In 1998, a total of 32 states conducted surveillance of HIV infection among children, reporting 309 HIV-infected children whose infection had not progressed to AIDS and 143 children who had AIDS. These states also received 2,433 new reports of perinatally exposed children who required follow up with health-care providers to determine their HIV infection status.

        Lyme Disease

        In 1998, a total of 16,801 cases of Lyme disease were reported, the highest number ever reported. This increase could be caused by an increase in human contact with infected ticks and enhanced reporting of cases. Lyme disease occurs primarily in the northeastern and northcentral United States. The following nine states had incidence rates higher than the annual national average of 6.39 cases/100,000 population and accounted for 93.0% of reported cases: Connecticut (105.0/100,000), Rhode Island (79.6), New York (25.5), New Jersey (24.0), Pennsylvania (22.9), Maryland (13.1), Massachusetts (11.5), Wisconsin (12.8), and Delaware (10.7).

        In December 1998, a new Lyme disease vaccine was approved by the U.S. Food and Drug Administration. The Advisory Committee on Immunization Practices issued recommendations for use of this vaccine in June 1999 (MMWR 1999;48 [No. RR-7]). These recommendations emphasize that the decision to vaccinate should be based on both geographic risk and individual exposure to tick-infested habitats. Because the Lyme disease vaccine is not 100% effective and does not protect against transmission of other tickborne diseases, vaccinated persons should continue to practice personal protective measures against ticks and seek early diagnosis and treatment of suspected tickborne infections.

        Pertussis

        On July 29, 1998, the fourth diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) was licensed for use in children aged 6 weeks-6 years. This vaccine is called Certiva,TM and it is manufactured by North American Vaccine, Inc. Other DTaP vaccines licensed since 1996 include Tripedia?(Connaught Laboratories, Inc.), ACEL-IMUNE?(Lederle Laboratories Division of American Cyanamid Company), and Infanrix?(SmithKline Beecham Pharmaceuticals). The Advisory Committee on Immunization Practices recommends DTaP vaccines for all five doses in the childhood vaccination schedule.

        Since 1980, the number of reported cases of pertussis has increased in the United States. The reasons for this rise are unknown, but could include increased awareness of pertussis among health-care providers, increased use of more sensitive diagnostic tests, and better reporting of cases to health departments. In 1998, a total of 24% of 7,405 reported cases occurred among children aged less than 7 months, who were too young to have received the recommended three doses of pertussis vaccine. Thirteen percent of cases were among preschool-aged children (i.e., those aged 1-4 years). Since 1995, the coverage rate with at least three doses of pertussis vaccine has been 95% among U.S. children aged 19-35 months. Twenty-six percent of cases were reported among children aged 10-19 years. Because vaccine-induced immunity wanes approximately 5-10 years after pertussis vaccination, adolescents can become susceptible to disease. Since 1990, the incidence among preschool-aged children has not changed, but the incidence among adolescents has increased in some states (Clin Inf Dis 1999;28:1230-7).

        Plague

        In 1998, nine cases of plague among humans were reported in the United States (six cases in New Mexico, one in Arizona, one in California, and one in Colorado). None were fatal. Of the 360 cases that occurred during 1970-1998, approximately 80% were reported from the southwestern states of New Mexico, Arizona, and Colorado. Nine percent occurred in California, and limited numbers of cases were reported from nine other western states. Yersinia pestis was recently designated as a potential agent of biological terrorism (see page xvi). In recognition of this potential threat, CDC is collaborating with other public health and federal agencies to develop guidelines for responding to bioterrorism events involving Y. pestis. Also in 1998, CDC was informed that Greer Laboratories, Inc., was ceasing production of the only plague vaccine commercially available in the United States. This vaccine has a limited shelf life, and no remaining stockpiles exist.

        Poliomyelitis, Paralytic

        As of January 1999, the Advisory Committee on Immunization Practices recommends only inactivated polio vaccine (IPV) for the first two doses of the polio vaccination series. Distribution of IPV as a proportion of overall polio vaccine use has increased from 6% in 1996 to 29% in 1997 to 34% in 1998. All six cases of vaccine-associated polio reported in the United States since January 1997 (including the single case reported in 1998) were associated with receipt of trivalent oral polio vaccine (OPV) for the first or second dose in an all-OPV schedule. An all-IPV schedule is recommended for routine childhood vaccination beginning January 1, 2000.

        St. Louis Encephalitis

        A summertime epidemic of St. Louis encephalitis in southern Louisiana accounted for 18 of the 24 cases reported nationally. No cases were fatal. Culex pipiens quinquefasciatus was presumed to be the primary mosquito vector. The last major epidemic of St. Louis encephalitis in the United States (223 cases and 11 deaths) occurred in Florida in 1990. This disease occurs in portions of both the eastern and western United States.

        Streptococcal Disease, Invasive, Group A

        Nationally, approximately 10,200 cases of invasive group A streptococcal disease and 1,300 deaths occurred in 1998, according to reports from the Active Bacterial Core Surveillance (ABCS) project under CDC's Emerging Infectious Diseases Program, which operates in seven states (California, Connecticut, Georgia, Maryland, Minnesota, New York, and Oregon). The incidence of this disease during 1998 was 3.8 cases/100,000 population. Rates were highest among children aged less than 1 year (7.5 cases/100,000) and adults aged greater than or equal to 65 years (10.0/100,000). Streptococcal toxic shock syndrome and necrotizing fasciitis each accounted for approximately 5.1% of invasive cases. The overall case-fatality rate among patients with invasive group A streptococcal disease was 12.2%.

        Streptococcus pneumoniae, Drug-Resistant

        During 1998, the Active Bacterial Core Surveillance (ABCS) project of CDC's Emerging Infectious Diseases Program collected information on invasive pneumococcal disease, including drug-resistant Streptococcus pneumoniae, in eight states -- California, Connecticut, Georgia, Maryland, Minnesota, New York, Oregon, and Tennessee. Of 3,335 S. pneumoniae isolates collected during 1998, a total of 10.2% exhibited intermediate penicillin resistance (minimum inhibitory concentration [MIC] 0.1-1 ug/mL), and 13.6% were resistant (MIC greater than or equal to 2 ug/mL). For cefotaxime, 7.7% of all isolates had intermediate resistance (MIC 1 ug/mL), and 6.1% were resistant (MIC greater than or equal to 2 ug/mL). The proportion of isolates resistant to erythromycin was 14.7% (MIC greater than or equal to 2 ug/mL). The overall proportions of isolates that were not susceptible to these three drugs were not substantially different compared with 1997 data. However, the proportions that were resistant varied widely among surveillance sites in 1998, and an increase in the prevalence of resistant strains, compared with earlier years, was reported from some states (data available at http://www.cy118119.com/ncidod/dbmd/abcs/survreports.htm).

        Syphilis, Congenital

        In 1998, a total of 801 cases of congenital syphilis were reported to CDC, for a rate of 20.6/100,000 live births. Like primary and secondary syphilis, the rate of congenital syphilis has declined sharply in recent years, from a peak of 107.3 cases/100,000 live births in 1991. Congenital syphilis persists in the United States because of the substantial number of women who do not receive syphilis serologic testing during pregnancy or who receive this testing too late in their pregnancy. This lack of screening is often related to a lack of prenatal care or late prenatal care (Am J Public Health 1999;89:557-60).

        Syphilis, Primary and Secondary

        In 1998, a total of 6,993 primary and secondary syphilis cases were reported to CDC. During 1990-1998, the primary and secondary syphilis rate declined 86%, from 20.3 cases/100,000 population to 2.6/100,000 -- the lowest level since reporting began in 1941. Although syphilis has declined in all regions of the United States and in all racial/ethnic groups, rates remain disproportionately high in the South and among non-Hispanic blacks, and focal outbreaks continue to occur.

        Tetanus

        The first case of neonatal tetanus reported in the United States since 1995 was reported from Montana in 1998. The case occurred in an infant born to a mother who was not immunized because of her philosophic beliefs and who used a nonsterile bentonite clay recommended by a lay midwife for the care of the baby's umbilical cord. The infant recovered after a 3-week hospitalization, including 12 days of mechanical ventilation. Of the 41 cases of tetanus that occurred in 1998, a total of 16 (39%) were among persons aged greater than or equal to 60 years, and 16 (39%) were among persons aged 20-59 years.

         

        Highlights for Selected Non-Notifiable Diseases

        Cyclosporiasis

        In recent years, multiple foodborne outbreaks of cyclosporiasis linked to various types of fresh produce (i.e., mesclun lettuce, basil, and Guatemalan raspberries) have occurred in the United States. In Spring 1998, Canada allowed importation of fresh Guatemalan raspberries, which resulted in a cyclosporiasis outbreak. The United States did not allow importation and thus, did not have an outbreak associated with raspberries (MMWR 1998;47:806-9).

        Dengue

        In 1998, a total of 90 confirmed or probable cases of dengue were imported into the United States and diagnosed in CDC's Dengue Branch. One case in a man aged 65 years was fatal. The number of cases reported in 1998 is higher than the 56 confirmed or probable cases reported in 1997. No indigenous cases were reported in the United States.

        Also in 1998, the preliminary number of dengue and dengue hemorrhagic fever (DHF) cases reported by Pan American Health Organization member countries (741,794, of which 535,388 were reported by Brazil) was more than twice the total for 1997 (364,945). In addition, cases of dengue-3 were reported from islands in the Caribbean for the first time after a 20-year absence. Hurricanes Georges (September 1998) and Mitch (October-November 1998) did not cause acute changes in dengue incidence in the affected areas, except for brief interruptions in disease surveillance systems.

        HIV Infection in Adults

        In June 1997, reporting of human immunodeficiency virus (HIV) infection among adults (i.e., persons aged greater than or equal to 13 years) was added to the list of nationally notifiable diseases at the annual Council of State and Territorial Epidemiologists (CSTE) meeting. The revised surveillance case definition and associated recommendations become effective January 1, 2000 (MMWR 1999;48[RR-13]). As of December 31, 1998, a total of 29 states and the Virgin Islands had implemented confidential reporting of HIV among adolescents and adults as an extension of current surveillance for acquired immunodeficiency syndrome (AIDS).

        During 1998, reports based on AIDS data continued to highlight substantial declines in AIDS incidence and deaths. As a result of improvements in treatment and care of persons infected with HIV, surveillance of AIDS alone no longer accurately reflects the magnitude of the epidemic or trends in HIV transmission. Data concerning persons in whom HIV infection is diagnosed before AIDS is diagnosed are needed to determine populations that could benefit from prevention and treatment services. In its June 1997 statement, CSTE recommended that all states and territories implement confidential HIV infection reporting based on methods that provide accurate and representative data for all persons diagnosed confidentially.

        Streptococcal Disease, Invasive, Group B

        Efforts to prevent neonatal group B streptococcal (GBS) infections, a leading cause of bacterial disease and death among newborns in the United States, were supported by a 1996 release of consensus guidelines for the prevention of perinatal GBS disease. Adoption of a prevention policy at one hospital correlated with declines in neonatal GBS incidence (Am J Obstet Gynecol 1998:179:1568-71). In addition, surveillance areas with a high proportion of hospitals with GBS-prevention policies have a lower incidence of neonatal GBS disease (MMWR 1998;47:665-70). A recent multistate evaluation demonstrated that the proportion of hospitals with prevention policies increased from 39% in 1994 to 58% in 1997. Active surveillance during 1993-1995 in four U.S. areas (i.e., Maryland and select counties in California, Georgia, and Tennessee) demonstrated an overall 24% decline in newborn GBS disease, from 1.7 cases/1,000 live-born infants in 1993 to 1.3/1,000 in 1995. Surveillance data from these same sites in 1998 revealed a further decline of 54%, to 0.6 cases/1,000 live-born infants (MMWR 1997;46:473-7).

        Tularemia

        The reported incidence of tularemia in the United States continues to be low. Sporadic cases are primarily associated with handling infected animals or exposure to infected arthropods. Because of concerns that Francisella tularensis could be a potential bioterrrorist agent, tularemia will be reinstated as a nationally notifiable disease, effective January 2000 (see page xvi).

        Vancomycin-Resistant Enterococci

        Data regarding the magnitude and impact of vancomycin-resistant enterococci (VRE) in the United States are collected by CDC's National Nosocomial Infections Surveillance (NNIS) system, which includes more than 280 U.S. hospitals. During 1989-1998, the percentage of VRE isolated from patients with nosocomial infections in hospital intensive care units increased from 0.4% to 22.6%. The percentage of VRE isolated from patients with nosocomial infections in nonintensive care units increased from 0.3% to 21.2%. Although the differences between VRE rates by health-care setting have diminished, the overall rates of resistance for many nosocomial pathogens continue to rise and are highest among patients in intensive care units. Additional data are available at http://www.cy118119.com/ncidod/hip/SURVEILL/NNIS.HTM.




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        TABLE: Percentage of nosocomial enterococci reported as resistant to vancomycin, by health-care setting and year*

        Year

        Intensive care unit (ICU)

        Non-ICU

        1989

        0.4

        0.3

        1990

        1.5

        0.8

        1991

        5.3

        2.9

        1992

        7.1

        2.9

        1993

        11.6

        4.8

        1994

        13.6

        9.0

        1995

        12.8

        12.0

        1996

        16.6

        11.6

        1997

        23.2

        15.4

        1998

        22.6

        21.2

        * N>2000 isolates for each year.
        † P<0.0001, chi-square for linear trend.

        Source: National Nosocomial Infections Surveillance (NNIS) system, Hospital Infections Program, National Center for Infectious Diseases, CDC

        Varicella

        Although varicella (chickenpox) deaths did not become nationally notifiable until January 1, 1999, some states began reporting varicella deaths to CDC during the second half of 1998. These data highlighted that both children and adults are continuing to die from a disease that is now vaccine-preventable. During 1998, national coverage for varicella vaccine among children aged 19-35 months was 43%. Efforts to increase vaccination of susceptible children, adolescents, and adults should include educating health-care providers that deaths and severe morbidity from varicella are preventable.

        Surveillance for Potential Bioterrorism Agents

        CDC established the Bioterrorism Preparedness and Response Program in January 1999 to improve the public health capability to detect and respond to biological and chemical terrorism. Members of this program are working with the FBI and other federal agencies to develop an organized and tiered response to suspect and confirmed biological events. The program focuses on state-level preparedness for early clinical and laboratory detection, which is essential to ensure a prompt response to a bioterrorist attack (e.g., providing prophylactic medicines or vaccines). Initial activities target critical agents that a) are associated with high case-fatality, b) can be disseminated to a large population, c) can cause social disruption because of public perception, and d) require special preparedness needs. These critical agents and their associated diseases include variola major (smallpox), Bacillus anthracis (anthrax), Yersinia pestis (plague), Francisella tularensis (tularemia), Clostridium botulinum (botulism), and the viral hemorrhagic fevers (e.g., arenaviruses and filoviruses).

        Several other agents have been identified but require less broad-based preparedness efforts, including ones that cause foodborne and waterborne diseases. A critical element for preparedness is defining the natural epidemiology of diseases that can be caused by critical agents, including anthrax and plague, which are nationally notifiable diseases. The last case of naturally occurring anthrax in the United States was reported in 1992. In 1998, a total of 9 cases of plague among humans were reported in the United States.

        Part 1: Summaries of Notifiable Diseases in the United States, 1998

        EXPLANATION OF SYMBOLS USED IN TABLES, GRAPHS, AND MAPS

        Data not availableNA
        Report of disease is not required in that jurisdiction (not notifiable)NN
        No reported cases--



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        NOTIFIABLE DISEASES -- Summary of reported cases, by month, United States, 1998

        Disease

        Total

        Jan.

        Feb.

        Mar.

        Apr.

        May

        June

        July

        Aug.

        Sept.

        Oct.

        Nov.

        Dec

        AIDS*

        46,521

        3,144

        4,236

        4,723

        4,023

        3,924

        3,924

        3,522

        4,112

        3,992

        3,475

        3,673

        3,773

        Botulism, total

        116

        5

        5

        4

        9

        13

        10

        9

        14

        11

        13

        4

        19

        Brucellosis

        79

        1

        1

        --

        4

        7

        6

        8

        8

        6

        7

        2

        29

        Chancroid

        189

        53

        58

        37

        41

        Chlamydia†?/sup>

        604,420

        136,428

        146,994

        152,886

        168,112

        Cholera

        17

        1

        --

        --

        --

        1

        2

        1

        1

        2

        3

        2

        4

        Cryptosporidiosis

        3,793

        124

        170

        246

        152

        182

        173

        262

        1,158

        424

        365

        218

        319

        Diphtheria

        1

        --

        --

        --

        --

        1

        --

        --

        --

        --

        --

        --

        --

        Encephalitis, California serogroup viral

        97

        --

        --

        --

        --

        --

        --

        8

        38

        22

        15

        3

        11

          Eastern equine

        4

        --

        --

        --

        --

        --

        --

        1

        --

        1

        --

        1

        1

          St. Louis

        24

        --

        --

        --

        --

        --

        --

        --

        2

        1

        17

        1

        3

        Escherichia coli O157:H7

        3,161

        62

        59

        66

        67

        183

        291

        421

        577

        421

        355

        235

        424

        Gonorrhea

        355,642

        80,036

        82,229

        96,129

        97,248

        Haemophilus influenzae, invasive disease

        1,194

        89

        93

        104

        98

        110

        92

        82

        93

        57

        84

        71

        221

        Hansen disease (leprosy)

        108

        5

        12

        7

        17

        4

        12

        8

        10

        4

        9

        12

        8

        Hepatitis A

        23,229

        1,232

        1,474

        1,676

        2,259

        2,327

        2,001

        1,489

        2,280

        1,766

        2,044

        1,659

        3,022

        Hepatitis B

        10,258

        547

        621

        699

        832

        974

        902

        805

        995

        747

        865

        669

        1,602

        Hepatitis C; non-A, non-B

        3,518

        155

        232

        279

        362

        304

        293

        182

        317

        239

        355

        318

        482

        Legionellosis

        1,355

        67

        108

        95

        73

        92

        85

        140

        185

        97

        143

        96

        174

        Lyme disease

        16,801

        200

        249

        440

        380

        572

        1,306

        2,824

        3,458

        2,504

        1,855

        888

        2,125

        Malaria

        1,611

        96

        77

        81

        96

        102

        111

        130

        202

        178

        167

        100

        271

        Measles (rubeola)

        100

        1

        2

        6

        9

        11

        10

        5

        6

        19

        10

        10

        11

        Meningococcal disease

        2,725

        256

        288

        251

        259

        242

        236

        144

        192

        140

        199

        179

        339

        Mumps

        666

        20

        37

        47

        200

        54

        39

        33

        46

        46

        38

        37

        69

        Pertussis (whooping cough)

        7,405

        263

        313

        410

        330

        513

        521

        526

        854

        774

        905

        749

        1,247

        Plague

        9

        --

        --

        --

        --

        --

        3

        2

        2

        --

        1

        --

        1

        Poliomyelitis, paralytic

        1

        --

        --

        --

        --

        --

        --

        --

        --

        1

        --

        --

        --

        Psittacosis

        47

        6

        1

        2

        3

        3

        6

        5

        --

        3

        5

        11

        2

        Rabies, animal

        7,259

        443

        452

        646

        631

        710

        633

        564

        854

        683

        654

        447

        542

        Rabies, human

        1

        --

        --

        --

        --

        --

        --

        --

        --

        --

        --

        --

        1

        Rocky Mountain spotted fever

        365

        2

        5

        6

        9

        22

        45

        50

        69

        53

        33

        18

        53

        Rubella (German measles)

        364

        12

        23

        70

        63

        69

        47

        26

        19

        4

        12

        4

        15

        Rubella, congenital syndrome

        7

        --

        1

        --

        1

        --

        1

        --

        1

        --

        --

        --

        3

        Salmonellosis

        43,694

        1,840

        1,743

        1,861

        2,179

        3,213

        3,485

        4,323

        6,034

        4,985

        5,592

        3,276

        5,163

        Shigellosis

        23,626

        1,064

        1,155

        1,146

        1,416

        1,712

        1,752

        1,640

        2,656

        2,365

        2,935

        2,170

        3,615

        Syphilis, total (all stages)

        37,977

        9,473

        9,879

        9,244

        9,381

          Primary and secondary

        6,993

        1,685

        1,693

        1,845

        1,770

          Congenital (age <1 yr)

        801

        231

        186

        215

        169

        Tetanus

        41

        1

        1

        1

        4

        4

        1

        6

        6

        3

        5

        1

        8

        Toxic-shock syndrome

        138

        9

        9

        12

        15

        11

        14

        8

        12

        5

        14

        13

        16

        Trichinosis

        19

        --

        1

        --

        2

        2

        1

        --

        3

        --

        1

        --

        9

        Tuberculosis?/sup>

        18,361

        685

        1,035

        1,328

        1,293

        1,413

        1,707

        1,737

        1,492

        1,441

        1,740

        1,514

        2,976

        Typhoid fever

        375

        24

        25

        24

        35

        24

        25

        28

        45

        53

        36

        18

        38

        Varicella (chickenpox)**

        82,455

        8,849

        10,830

        11,129

        11,199

        12,119

        5,342

        2,254

        690

        1,539

        2,721

        4,169

        11,614

        * Total number of acquired immunodeficiency syndrome (AIDS) cases reported to the Division of HIV/AIDS Prevention — Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention (NCHSTP), as of December 31, 1998.
        † Cases were updated through the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of July 19, 1999.
        ?Chlamydia refers to genital infections caused by C. trachomatis.
        ?Cases were updated through the Division of Tuberculosis Elimination, NCHSTP, as of June 3, 1999.
        ** Not nationally notifiable.




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        NOTIFIABLE DISEASES -- Reported cases, by geographic division and area--United States, 1998

         

        Botulism

         

        Area

        Total resident population (in thousands)

        AIDS*

        Foodborne

        Infant

        Brucellosis

        Chancroid†

        United States

        270,296

        46,521?/b>

        22

        65

        79

        189

        New England

        13,429

        1,811

        --

        --

        --

        2

        Maine

        1,244

        31

        --

        --

        --

        --

        N.H.

        1,185

        42

        --

        --

        --

        --

        Vt.

        591

        20

        --

        --

        --

        --

        Mass.

        6,147

        924

        --

        --

        --

        --

        R.I.

        988

        128

        --

        --

        --

        --

        Conn.

        3,274

        666

        --

        --

        --

        2

        Mid. Atlantic

        38,291

        12,588

        2

        15

        2

        82

        Upstate N.Y.

        10,850

        1,581

        --

        3

        1

        --

        N.Y. City

        7,325

        7,133

        --

        1

        1

        82

        N.J.

        8,115

        2,134

        2

        9

        --

        --

        Pa.

        12,001

        1,740

        --

        2

        --

        --

        E.N. Central

        44,194

        3,390

        --

        8

        9

        6

        Ohio

        11,209

        685

        --

        4

        1

        3

        Ind.

        5,899

        484

        --

        --

        --

        1

        Ill.

        12,045

        1,304

        --

        3

        5

        --

        Mich.

        9,817

        714

        --

        --

        3

        --

        Wis.

        5,224

        203

        --

        1

        --

        2

        W.N. Central

        18,694

        927

        --

        --

        5

        1

        Minn.

        4,725

        190

        --

        --

        1

        --

        Iowa

        2,862

        75

        --

        NN

        1

        --

        Mo.

        5,439

        443

        --

        --

        3

        --

        N. Dak.

        638

        6

        --

        --

        NN

        NN

        S. Dak.

        738

        15

        --

        --

        --

        --

        Nebr.

        1,663

        72

        --

        --

        --

        --

        Kans.

        2,629

        126

        --

        --

        --

        1

        S. Atlantic

        48,944

        12,194

        1

        3

        9

        40

        Del.

        744

        174

        --

        --

        1

        --

        Md.

        5,135

        1,639

        --

        1

        1

        --

        D.C.

        523

        989

        --

        --

        --

        --

        Va.

        6,791

        998

        1

        --

        1

        7

        W. Va.

        1,811

        86

        --

        --

        --

        --

        N.C.

        7,546

        788

        --

        2

        1

        9

        S.C.

        3,836

        777

        --

        --

        NN

        19

        Ga.

        7,642

        1,295

        --

        --

        2

        2

        Fla.

        14,916

        5,448

        --

        --

        3

        3

        E.S. Central

        16,471

        1,874

        --

        4

        5

        4

        Ky.

        3,936

        280

        --

        3

        1

        --

        Tenn.

        5,431

        695

        --

        1

        2

        --

        Ala.

        4,352

        484

        --

        --

        1

        1

        Miss.

        2,752

        415

        --

        --

        1

        3

        W.S. Central

        30,014

        5,406

        --

        5

        29

        42

        Ark.

        2,538

        203

        --

        --

        2

        7

        La.

        4,369

        951

        --

        --

        1

        1

        Okla.

        3,347

        285

        --

        --

        --

        --

        Tex.

        19,760

        3,967

        --

        5

        26

        34

        Mountain

        16,814

        1,632

        1

        7

        3

        3

        Mont.

        880

        29

        1

        --

        --

        --

        Idaho

        1,229

        32

        --

        1

        1

        --

        Wyo.

        481

        6

        --

        --

        --

        1

        Colo.

        3,971

        314

        --

        2

        1

        --

        N. Mex.

        1,737

        209

        --

        --

        --

        --

        Ariz.

        4,669

        645

        --

        --

        1

        2

        Utah

        2,100

        139

        --

        1

        --

        --

        Nev.

        1,747

        258

        --

        3

        --

        --

        Pacific

        43,445

        6,489

        18

        23

        17

        9

        Wash.

        5,689

        441

        6

        --

        3

        1

        Oreg.

        3,282

        204

        --

        4

        --

        --

        Calif.

        32,667

        5,654

        4

        19

        12

        8

        Alaska

        614

        29

        8

        --

        2

        --

        Hawaii

        1,193

        161

        --

        --

        --

        --

                     

        Guam

        145

        2

        --

        --

        --

        --

        P.R.

        3,860

        1,711

        --

        --

        --

        2

        V.I.

        114

        35

        NN

        NN

        NN

        --

        American Samoa

        60

        --

        NA

        NA

        NA

        NA

        C.N.M.I.

        63

        --

        NA

        NA

        NA

        NA

        * Total number of acquired immunodeficiency syndrome (AIDS) cases reported to the Division of HIV/AIDS Prevention -- Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention (NCHSTP), through December 31, 1998.
        † Totals reported to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of July 19, 1999.
        ?Total includes 210 cases among persons with unknown state of residence.


        NOTIFIABLE DISEASES -- Reported cases, by geographic division and area, United States, 1998 -- Continued

         

        Encephalitis

        Area

        Chlamydia*

        Cholera

        Cryptosporidiosis

        Diphtheria

        California serogroup viral

        Eastern equine

        United States

        604,420

        17

        3,793

        1

        97

        4

        New England

        20,093

        1

        152

        --

        --

        1

        Maine

        1,073

        --

        33

        --

        --

        --

        N.H.

        960

        --

        18

        --

        --

        --

        Vt.

        413

        --

        26

        --

        --

        --

        Mass.

        8,363

        --

        68

        --

        --

        --

        R.I.

        2,307

        --

        7

        --

        --

        1

        Conn.

        6,977

        1

        NA

        --

        --

        --

        Mid. Atlantic

        62,533

        1

        580

        --

        --

        --

        Upstate N.Y.

        NN

        --

        343

        --

        --

        --

        N.Y. City

        26,218

        1

        208

        --

        --

        --

        N.J.

        11,686

        --

        29

        --

        --

        --

        Pa.

        24,629

        --

        NN

        --

        --

        --

        E.N. Central

        100,984

        --

        737

        --

        24

        1

        Ohio

        27,786

        --

        75

        --

        11

        --

        Ind.

        10,801

        --

        63

        --

        1

        1

        Ill.

        26,363

        --

        84

        --

        4

        --

        Mich.

        22,156

        --

        39

        --

        --

        --

        Wis.

        13,878

        --

        476

        --

        8

        --

        W.N. Central

        35,920

        --

        374

        --

        6

        --

        Minn.

        6,970

        --

        173

        --

        4

        --

        Iowa

        5,174

        --

        66

        --

        2

        --

        Mo.

        12,670

        --

        29

        --

        --

        --

        N. Dak.

        1,036

        --

        34

        --

        --

        --

        S. Dak.

        1,572

        --

        25

        --

        --

        --

        Nebr.

        2,911

        --

        36

        --

        --

        --

        Kans.

        5,587

        --

        11

        --

        --

        --

        S. Atlantic

        122,963

        --

        430

        --

        53

        1

        Del.

        2,608

        --

        3

        --

        --

        --

        Md.

        13,097

        --

        21

        --

        --

        --

        D.C.

        NN

        --

        25

        --

        --

        --

        Va.

        13,561

        --

        22

        --

        3

        1

        W. Va.

        2,791

        --

        3

        --

        46

        --

        N.C.

        22,197

        --

        NN

        --

        4

        --

        S.C.

        18,510

        --

        --

        --

        --

        --

        Ga.

        25,250

        --

        152

        --

        --

        --

        Fla.

        24,949

        --

        204

        --

        --

        --

        E.S. Central

        40,837

        --

        27

        --

        14

        --

        Ky.

        6,441

        --

        10

        --

        4

        --

        Tenn.

        13,717

        --

        11

        --

        10

        --

        Ala.

        10,065

        --

        NN

        --

        --

        --

        Miss.

        10,614

        --

        6

        --

        --

        --

        W.S. Central

        89,140

        3

        932

        --

        --

        1

        Ark.

        4,123

        --

        6

        --

        --

        --

        La.

        15,188

        3

        20

        --

        --

        1

        Okla.

        9,393

        --

        NN

        --

        --

        --

        Tex.

        60,436

        --

        906

        --

        --

        --

        Mountain

        34,096

        2

        124

        --

        --

        --

        Mont.

        1,412

        --

        10

        --

        --

        --

        Idaho

        2,035

        --

        17

        --

        --

        --

        Wyo.

        725

        --

        2

        --

        --

        --

        Colo.

        9,113

        1

        19

        --

        --

        --

        N. Mex.

        3,793

        --

        48

        --

        --

        --

        Ariz.

        11,489

        --

        19

        --

        --

        --

        Utah

        2,209

        --

        NN

        --

        --

        --

        Nev.

        3,320

        1

        9

        --

        --

        --

        Pacific

        97,854

        10

        437

        1

        --

        --

        Wash.

        10,998

        --

        NN

        --

        NN

        NN

        Oreg.

        5,855

        --

        70

        1

        NN

        NN

        Calif.

        76,490

        9

        363

        --

        --

        --

        Alaska

        1,907

        1

        1

        --

        NN

        NN

        Hawaii

        2,604

        --

        3

        --

        NN

        NN

                     

        Guam

        410

        2

        --

        --

        --

        --

        P.R.

        1,685

        --

        NN

        --

        --

        --

        V.I.

        10

        NA

        NA

        NA

        NA

        NA

        American Samoa

        NA

        NA

        NA

        NA

        NA

        NA

        C.N.M.I.

        NA

        NA

        NA

        NA

        NA

        NA

        * Chlamydia refers to genital infections caused by C. trachomatis. Totals reported to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of July 19, 1999.


        NOTIFIABLE DISEASES -- Reported cases, by geographic division and area, United States, 1998 -- Continued

         

        Encephalitis

        Escherichia coli O157:H7

         

        Area

        St. Louis

        NETSS*

        PHLIS†

        Gonorrhea?/b>

        Haemophilus influenzae, invasive disease

        United States

        24

        3,161

        2,172

        355,642

        1,194

        New England

        --

        340

        286

        6,061

        108

        Maine

        --

        37

        --

        67

        5

        N.H.

        --

        48

        47

        91

        10

        Vt.

        --

        21

        18

        38

        9

        Mass.

        --

        153

        164

        2,258

        42

        R.I.

        --

        14

        1

        430

        9

        Conn.

        NN

        67

        56

        3,177

        33

        Mid. Atlantic

        --

        312

        87

        38,639

        196

        Upstate N.Y.

        --

        231

        --

        6,965

        81

        N.Y. City

        --

        14

        13

        12,097

        50

        N.J.

        --

        67

        53

        7,858

        53

        Pa.

        --

        NN

        21

        11,719

        12

        E.N. Central

        --

        464

        374

        69,027

        186

        Ohio

        --

        128

        77

        18,275

        48

        Ind.

        --

        106

        54

        6,307

        51

        Ill.

        --

        113

        81

        21,735

        67

        Mich.

        --

        117

        74

        16,359

        13

        Wis.

        --

        NN

        88

        6,351

        7

        W.N. Central

        --

        499

        408

        17,914

        104

        Minn.

        --

        209

        215

        2,708

        77

        Iowa

        --

        93

        60

        1,616

        5

        Mo.

        --

        55

        64

        9,463

        12

        N. Dak.

        --

        12

        15

        80

        1

        S. Dak.

        --

        37

        40

        221

        1

        Nebr.

        --

        57

        --

        1,204

        2

        Kans.

        --

        36

        14

        2,622

        6

        S. Atlantic

        2

        404

        179

        98,054

        224

        Del.

        --

        --

        2

        1,556

        1

        Md.

        --

        43

        15

        11,254

        57

        D.C.

        --

        1

        NA

        4,508

        --

        Va.

        --

        NN

        55

        9,265

        19

        W. Va.

        --

        14

        10

        920

        7

        N.C.

        --

        186

        47

        19,230

        24

        S.C.

        --

        15

        12

        11,575

        3

        Ga.

        --

        84

        --

        20,666

        69

        Fla.

        2

        61

        38

        19,080

        44

        E.S. Central

        --

        120

        67

        39,079

        64

        Ky.

        --

        36

        --

        3,813

        7

        Tenn.

        --

        54

        41

        11,840

        38

        Ala.

        --

        24

        20

        12,737

        16

        Miss.

        --

        6

        6

        10,689

        3

        W.S. Central

        22

        137

        108

        54,528

        68

        Ark.

        --

        12

        10

        3,953

        --

        La.

        18

        14

        7

        12,499

        29

        Okla.

        --

        26

        9

        5,243

        36

        Tex.

        4

        85

        82

        32,833

        3

        Mountain

        --

        367

        249

        9,157

        127

        Mont.

        --

        17

        5

        55

        --

        Idaho

        --

        43

        25

        182

        2

        Wyo.

        --

        53

        55

        36

        1

        Colo.

        --

        90

        69

        2,033

        21

        N. Mex.

        --

        19

        20

        957

        8

        Ariz.

        --

        46

        29

        4,213

        69

        Utah

        --

        75

        22

        236

        7

        Nev.

        --

        24

        24

        1,445

        19

        Pacific

        --

        518

        414

        23,183

        117

        Wash.

        --

        143

        131

        1,948

        11

        Oreg.

        NN

        107

        102

        880

        42

        Calif.

        --

        261

        165

        19,518

        50

        Alaska

        NN

        7

        --

        331

        4

        Hawaii

        NN

        --

        16

        506

        10

                   

        Guam

        --

        NN

        NA

        72

        --

        P.R.

        --

        5

        NA

        400

        2

        V.I.

        NA

        NA

        NA

        39

        NA

        American Samoa

        NA

        NN

        NA

        NA

        NA

        C.N.M.I.

        NA

        NN

        NA

        NA

        NA

        * National Electronic Telecommunications System for Surveillance.
        † Public Health Laboratory Information System. Totals reported to the National Center for Infectious Diseases as of August 26, 1999.
        ?Totals reported to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of July 19, 1999.


        NOTIFIABLE DISEASES -- Reported cases, by geographic division and area, United States, 1998 -- Continued

           

        Hepatitis

           

        Area

        Hansen disease (leprosy)

        A

        B

        C; non-A, non-B

        Legionellosis

        Lyme disease

        United States

        108

        23,229

        10,258

        3,518

        1,355

        16,801

        New England

        1

        299

        230

        61

        98

        5,056

        Maine

        NN

        20

        5

        --

        1

        78

        N.H.

        --

        19

        21

        --

        7

        45

        Vt.

        NN

        17

        10

        6

        7

        11

        Mass.

        --

        126

        81

        51

        34

        699

        R.I.

        1

        18

        75

        4

        26

        789

        Conn.

        --

        99

        38

        --

        23

        3,434

        Mid. Atlantic

        7

        1,726

        1,249

        246

        332

        9,311

        Upstate N.Y.

        3

        376

        262

        124

        113

        4,409

        N.Y. City

        4

        591

        423

        --

        37

        231

        N.J.

        --

        343

        205

        NA

        18

        1,911

        Pa.

        NN

        416

        359

        122

        164

        2,760

        E.N. Central

        --

        3,715

        1,414

        673

        420

        774

        Ohio

        --

        398

        77

        8

        133

        47

        Ind.

        --

        174

        117

        6

        83

        39

        Ill.

        --

        821

        230

        41

        54

        14

        Mich.

        --

        2,135

        476

        470

        82

        17

        Wis.

        NN

        187

        514

        148

        68

        657

        W.N. Central

        4

        1,362

        438

        52

        80

        317

        Minn.

        --

        145

        71

        20

        12

        261

        Iowa

        1

        400

        55

        8

        11

        27

        Mo.

        --

        637

        252

        15

        18

        12

        N. Dak.

        NN

        4

        4

        --

        --

        --

        S. Dak.

        1

        40

        4

        --

        7

        --

        Nebr.

        2

        27

        24

        5

        21

        4

        Kans.

        --

        109

        28

        4

        11

        13

        S. Atlantic

        6

        2,395

        1,323

        197

        170

        977

        Del.

        --

        6

        4

        --

        13

        77

        Md.

        --

        416

        143

        23

        38

        659

        D.C.

        --

        66

        19

        --

        9

        8

        Va.

        --

        226

        109

        13

        27

        73

        W. Va.

        NN

        9

        14

        9

        NN

        13

        N.C.

        2

        128

        243

        26

        14

        63

        S.C.

        --

        54

        65

        20

        12

        8

        Ga.

        NN

        879

        209

        9

        8

        5

        Fla.

        4

        611

        517

        97

        49

        71

        E.S. Central

        1

        416

        512

        284

        66

        115

        Ky.

        --

        32

        49

        23

        27

        27

        Tenn.

        1

        234

        294

        173

        23

        47

        Ala.

        --

        81

        75

        5

        9

        24

        Miss.

        --

        69

        94

        83

        7

        17

        W.S. Central

        28

        4,461

        2,466

        655

        42

        68

        Ark.

        --

        82

        115

        30

        2

        8

        La.

        --

        174

        219

        137

        6

        15

        Okla.

        NN

        667

        172

        25

        17

        13

        Tex.

        28

        3,538

        1,960

        463

        17

        32

        Mountain

        --

        3,134

        813

        387

        78

        19

        Mont.

        --

        96

        8

        8

        2

        --

        Idaho

        --

        235

        49

        87

        3

        7

        Wyo.

        --

        37

        11

        102

        1

        1

        Colo.

        --

        345

        102

        32

        20

        --

        N. Mex.

        --

        155

        311

        97

        2

        4

        Ariz.

        --

        1,843

        185

        19

        21

        1

        Utah

        --

        196

        66

        22

        21

        --

        Nev.

        --

        227

        81

        20

        8

        6

        Pacific

        61

        5,721

        1,813

        963

        69

        164

        Wash.

        --

        1,037

        136

        29

        15

        7

        Oreg.

        4

        435

        201

        21

        NN

        21

        Calif.

        38

        4,178

        1,445

        859

        52

        135

        Alaska

        --

        17

        13

        --

        1

        1

        Hawaii

        19

        54

        18

        54

        1

        NN

                     

        Guam

        3

        1

        2

        1

        2

        1

        P.R.

        --

        94

        276

        --

        --

        NN

        V.I.

        NA

        NA

        NA

        NA

        NA

        NA

        American Samoa

        NA

        NA

        NA

        NA

        NA

        NA

        C.N.M.I.

        NA

        NA

        NA

        NA

        NA

        NA


        NOTIFIABLE DISEASES -- Reported cases, by geographic division and area, United States, 1998 -- Continued

         

        Measles

         

        Area

        Malaria

        Indigenous

        Imported*

        Meningococcal disease

        Mumps

        Pertussis

        United States

        1,611

        74

        26

        2,725

        666

        7,405

        New England

        98

        1

        2

        123

        10

        1,114

        Maine

        5

        --

        --

        8

        --

        5

        N.H.

        6

        --

        --

        13

        --

        149

        Vt.

        2

        --

        1

        5

        --

        80

        Mass.

        27

        1

        1

        59

        6

        805

        R.I.

        15

        --

        --

        8

        1

        21

        Conn.

        43

        --

        --

        30

        3

        54

        Mid. Atlantic

        426

        11

        5

        295

        207

        695

        Upstate N.Y.

        93

        3

        1

        84

        14

        352

        N.Y. City

        240

        --

        --

        35

        167

        54

        N.J.

        58

        7

        1

        60

        6

        29

        Pa.

        35

        1

        3

        116

        20

        260

        E.N. Central

        147

        12

        4

        399

        82

        919

        Ohio

        15

        --

        1

        143

        29

        299

        Ind.

        11

        2

        1

        74

        7

        185

        Ill.

        59

        1

        --

        104

        10

        173

        Mich.

        50

        9

        1

        44

        33

        71

        Wis.

        12

        --

        1

        34

        3

        191

        W.N. Central

        110

        --

        --

        231

        34

        756

        Minn.

        71

        --

        --

        37

        13

        439

        Iowa

        8

        --

        --

        46

        11

        78

        Mo.

        15

        --

        --

        80

        4

        59

        N. Dak.

        3

        --

        --

        5

        2

        46

        S. Dak.

        1

        --

        --

        9

        --

        8

        Nebr.

        2

        --

        --

        17

        --

        21

        Kans.

        10

        --

        --

        37

        4

        105

        S. Atlantic

        349

        4

        5

        482

        57

        380

        Del.

        3

        --

        1

        2

        --

        5

        Md.

        89

        --

        1

        35

        --

        66

        D.C.

        19

        --

        --

        4

        --

        1

        Va.

        61

        --

        2

        49

        13

        56

        W. Va.

        2

        --

        --

        19

        --

        7

        N.C.

        30

        1

        --

        59

        12

        112

        S.C.

        6

        --

        --

        57

        8

        29

        Ga.

        43

        1

        1

        102

        2

        38

        Fla.

        96

        2

        --

        155

        22

        66

        E.S. Central

        35

        --

        2

        205

        19

        168

        Ky.

        7

        --

        --

        38

        1

        95

        Tenn.

        17

        --

        1

        75

        2

        40

        Ala.

        6

        --

        1

        55

        9

        27

        Miss.

        5

        --

        --

        37

        7

        6

        W.S. Central

        101

        --

        --

        338

        67

        427

        Ark.

        2

        --

        --

        31

        13

        93

        La.

        17

        --

        --

        69

        8

        13

        Okla.

        4

        --

        --

        44

        4

        33

        Tex.

        78

        --

        --

        194

        42

        288

        Mountain

        68

        9

        2

        157

        40

        1,324

        Mont.

        1

        --

        --

        5

        --

        17

        Idaho

        8

        --

        --

        14

        7

        263

        Wyo.

        --

        --

        --

        8

        1

        8

        Colo.

        18

        --

        --

        31

        7

        357

        N. Mex.

        12

        --

        --

        26

        NN

        100

        Ariz.

        15

        9

        2

        48

        6

        241

        Utah

        2

        --

        --

        15

        5

        297

        Nev.

        12

        --

        --

        10

        14

        41

        Pacific

        277

        37

        6

        495

        150

        1,622

        Wash.

        30

        --

        1

        77

        11

        407

        Oreg.

        17

        --

        --

        91

        NN

        89

        Calif.

        217

        5

        4

        319

        110

        1,085

        Alaska

        4

        32

        1

        3

        3

        15

        Hawaii

        9

        --

        --

        5

        26

        26

                     

        Guam

        2

        --

        --

        2

        5

        1

        P.R.

        1

        --

        --

        11

        7

        10

        V.I.

        NA

        NA

        NA

        NA

        NA

        NA

        American Samoa

        NA

        NA

        NA

        NA

        NA

        NA

        C.N.M.I.

        NA

        NA

        NA

        NA

        NA

        NA

        * Imported cases include only those resulting from importation from other countries.


        NOTIFIABLE DISEASES -- Reported cases, by geographic division and area, United States, 1998 -- Continued

         

        Rabies

         

        Area

        Plague

        Poliomyelitis, paralytic

        Psittacosis

        Animal

        Human

        RMSF*

        United States

        9

        1

        47

        7,259

        1

        365

        New England

        --

        --

        1

        1,452

        --

        2

        Maine

        --

        --

        --

        241

        --

        --

        N.H.

        --

        --

        1

        83

        --

        --

        Vt.

        --

        --

        --

        72

        --

        --

        Mass.

        --

        --

        --

        498

        --

        --

        R.I.

        --

        --

        --

        103

        --

        --

        Conn.

        --

        --

        NN

        455

        --

        2

        Mid. Atlantic

        --

        --

        18

        1,609

        --

        38

        Upstate N.Y.

        --

        --

        5

        1,095

        --

        11

        N.Y. City

        --

        --

        --

        NA

        --

        2

        N.J.

        --

        --

        --

        224

        --

        12

        Pa.

        --

        --

        13

        290

        --

        13

        E.N. Central

        --

        1

        6

        127

        --

        22

        Ohio

        --

        --

        --

        59

        --

        12

        Ind.

        --

        1

        2

        12

        --

        6

        Ill.

        --

        --

        1

        NN

        --

        1

        Mich.

        --

        --

        3

        37

        --

        3

        Wis.

        NN

        NN

        --

        19

        --

        --

        W.N. Central

        --

        --

        2

        741

        --

        16

        Minn.

        --

        --

        2

        119

        --

        1

        Iowa

        --

        --

        --

        153

        --

        2

        Mo.

        --

        --

        --

        42

        --

        5

        N. Dak.

        --

        --

        --

        155

        --

        2

        S. Dak.

        --

        --

        --

        166

        --

        --

        Nebr.

        --

        --

        --

        7

        --

        3

        Kans.

        --

        --

        --

        99

        --

        3

        S. Atlantic

        --

        --

        4

        2,350

        1

        148

        Del.

        --

        --

        --

        49

        --

        --

        Md.

        --

        --

        --

        439

        --

        18

        D.C.

        --

        --

        --

        10

        --

        --

        Va.

        --

        --

        1

        549

        1

        14

        W. Va.

        --

        --

        --

        77

        --

        4

        N.C.

        --

        --

        --

        555

        --

        71

        S.C.

        --

        --

        --

        147

        --

        34

        Ga.

        --

        --

        --

        309

        --

        4

        Fla.

        --

        --

        3

        215

        --

        3

        E.S. Central

        --

        --

        --

        278

        --

        58

        Ky.

        --

        --

        --

        32

        NN

        6

        Tenn.

        --

        --

        --

        142

        --

        27

        Ala.

        NN

        --

        --

        102

        --

        11

        Miss.

        --

        --

        --

        2

        --

        14

        W.S. Central

        --

        --

        --

        35

        --

        72

        Ark.

        --

        --

        --

        35

        --

        23

        La.

        --

        --

        --

        --

        --

        5

        Okla.

        --

        --

        NN

        NN

        --

        41

        Tex.

        --

        --

        NN

        --

        --

        3

        Mountain

        8

        --

        7

        251

        --

        8

        Mont.

        --

        --

        --

        56

        --

        1

        Idaho

        --

        --

        4

        NN

        --

        1

        Wyo.

        --

        --

        1

        66

        --

        --

        Colo.

        1

        --

        2

        42

        --

        2

        N. Mex.

        6

        --

        --

        6

        --

        2

        Ariz.

        1

        --

        --

        48

        --

        --

        Utah

        --

        --

        --

        27

        --

        1

        Nev.

        --

        --

        --

        6

        --

        1

        Pacific

        1

        --

        9

        416

        --

        1

        Wash.

        --

        --

        3

        --

        --

        --

        Oreg.

        --

        --

        --

        7

        --

        --

        Calif.

        1

        --

        6

        384

        --

        1

        Alaska

        --

        --

        --

        25

        --

        NN

        Hawaii

        --

        --

        --

        --

        --

        NN

                     

        Guam

        --

        --

        --

        --

        --

        --

        P.R.

        --

        --

        --

        52

        --

        NN

        V.I.

        NA

        NA

        NA

        NA

        NA

        NA

        American Samoa

        NA

        NA

        NA

        NA

        NA

        NA

        C.N.M.I.

        NA

        NA

        NA

        NA

        NA

        NA

        * Rocky Mountain spotted fever.


        NOTIFIABLE DISEASES -- Reported cases, by geographic division and area, United States, 1998 -- Continued

         

        Rubella

         

        Syphilis*

        Area

        Congenital syndrome

        Rubella

        Salmonellosis

        Shigellosis

        Congenital (age <1 yr)

        Primary & secondary

        United States

        7

        364

        43,694

        23,626

        801

        6,993

        New England

        --

        38

        2,508

        413

        2

        80

        Maine

        --

        --

        165

        14

        --

        1

        N.H.

        --

        --

        187

        18

        --

        2

        Vt.

        NN

        --

        144

        7

        --

        4

        Mass.

        --

        8

        1,312

        266

        2

        46

        R.I.

        --

        1

        159

        37

        --

        1

        Conn.

        --

        29

        541

        71

        --

        26

        Mid. Atlantic

        3

        150

        6,767

        2,412

        163

        324

        Upstate N.Y.

        --

        114

        1,680

        678

        13

        38

        N. Y. City

        3

        20

        1,895

        710

        43

        81

        N.J.

        --

        14

        1,476

        662

        86

        107

        Pa.

        --

        2

        1,716

        362

        21

        98

        E.N. Central

        --

        2

        6,279

        3,037

        97

        1,044

        Ohio

        --

        --

        1,491

        566

        4

        134

        Ind.

        --

        --

        685

        180

        --

        215

        Ill.

        --

        1

        1,921

        1,573

        71

        424

        Mich.

        --

        1

        1,169

        279

        16

        211

        Wis.

        NN

        --

        1,013

        439

        6

        60

        W.N. Central

        --

        41

        2,361

        1,119

        15

        146

        Minn.

        --

        --

        601

        331

        --

        9

        Iowa

        --

        --

        375

        69

        --

        5

        Mo.

        --

        2

        632

        221

        15

        109

        N. Dak.

        --

        --

        68

        11

        --

        --

        S. Dak.

        --

        --

        132

        33

        --

        1

        Nebr.

        --

        --

        190

        372

        --

        8

        Kans.

        --

        39

        363

        82

        --

        14

        S. Atlantic

        1

        22

        9,326

        4,727

        184

        2,523

        Del.

        --

        --

        79

        46

        --

        21

        Md.

        --

        1

        931

        202

        44

        648

        D.C.

        --

        --

        84

        37

        8

        81

        Va.

        --

        1

        1,135

        200

        4

        149

        W. Va.

        --

        --

        181

        11

        --

        3

        N.C.

        --

        16

        1,309

        372

        24

        723

        S.C.

        1

        --

        667

        198

        19

        271

        Ga.

        --

        --

        1,839

        1,138

        14

        333

        Fla.

        --

        4

        3,101

        2,523

        71

        294

        E.S. Central

        --

        2

        2,363

        1,734

        38

        1,208

        Ky.

        --

        --

        364

        158

        5

        106

        Tenn.

        --

        2

        624

        1,062

        9

        567

        Ala.

        --

        --

        695

        459

        9

        274

        Miss.

        --

        NN

        680

        55

        15

        261

        W.S. Central

        3

        90

        5,381

        5,295

        155

        1,079

        Ark.

        --

        --

        616

        211

        30

        108

        La.

        --

        1

        863

        384

        8

        430

        Okla.

        --

        --

        501

        712

        15

        98

        Tex.

        3

        89

        3,401

        3,988

        102

        443

        Mountain

        --

        6

        2,601

        1,323

        27

        231

        Mont.

        --

        --

        79

        8

        --

        --

        Idaho

        --

        --

        122

        20

        --

        2

        Wyo.

        --

        --

        70

        4

        --

        1

        Colo.

        --

        --

        539

        229

        1

        10

        N. Mex.

        --

        1

        306

        306

        --

        14

        Ariz.

        --

        2

        885

        643

        25

        185

        Utah

        --

        2

        355

        48

        1

        4

        Nev.

        --

        1

        245

        65

        --

        15

        Pacific

        --

        13

        6,108

        3,566

        120

        358

        Wash.

        --

        8

        703

        277

        1

        44

        Oreg.

        --

        --

        329

        194

        --

        6

        Calif.

        --

        3

        4,724

        3,033

        119

        303

        Alaska

        NN

        --

        57

        11

        --

        1

        Hawaii

        --

        2

        295

        51

        --

        4

                     

        Guam

        --

        --

        46

        39

        --

        --

        P.R.

        --

        14

        901

        69

        27

        177

        V.I.

        NA

        NA

        NA

        NA

        --

        7

        American Samoa

        NA

        NA

        NA

        NA

        NA

        NA

        C.N.M.I.

        NA

        NA

        NA

        NA

        NA

        NA

        * Totals reported to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of July 19, 1999.


        NOTIFIABLE DISEASES -- Reported cases, by geographic division and area, United States, 1998 -- Continued

         

        Syphilis*

         

        Area

        All stages

        Tetanus

        Toxic-shock syndrome

        Trichinosis

        Tuberculosis†

        Typhoid fever

        United States

        37,977

        41

        138

        19

        18,361

        375

        New England

        824

        --

        2

        1

        505

        24

        Maine

        4

        --

        --

        --

        13

        --

        N.H.

        14

        --

        --

        --

        14

        1

        Vt.

        6

        --

        2

        1

        5

        --

        Mass.

        568

        --

        --

        --

        282

        15

        R.I.

        55

        --

        --

        --

        63

        --

        Conn.

        177

        --

        NN

        --

        128

        8

        Mid. Atlantic

        6,881

        1

        17

        --

        3,088

        90

        Upstate N.Y.

        495

        --

        10

        --

        442

        17

        N.Y. City

        4,650

        --

        --

        --

        1,558

        52

        N.J.

        826

        --

        --

        --

        640

        16

        Pa.

        910

        1

        7

        --

        448

        5

        E.N. Central

        3,905

        12

        30

        9

        1,762

        56

        Ohio

        474

        3

        1

        7

        230

        9

        Ind.

        509

        1

        6

        --

        188

        2

        Ill.

        2,028

        5

        7

        2

        850

        38

        Mich.

        686

        2

        14

        --

        385

        6

        Wis.

        208

        1

        2

        --

        109

        1

        W.N. Central

        645

        2

        23

        --

        520

        7

        Minn.

        74

        --

        5

        --

        161

        3

        Iowa

        48

        1

        4

        --

        55

        --

        Mo.

        375

        --

        6

        --

        184

        4

        N. Dak.

        --

        --

        1

        --

        10

        --

        S. Dak.

        2

        1

        --

        --

        23

        --

        Nebr.

        33

        --

        3

        --

        31

        --

        Kans.

        113

        --

        4

        --

        56

        --

        S. Atlantic

        10,946

        9

        16

        --

        3,565

        49

        Del.

        114

        --

        4

        --

        36

        3

        Md.

        2,156

        1

        NN

        --

        324

        11

        D.C.

        579

        --

        --

        --

        107

        --

        Va.

        707

        1

        --

        --

        339

        7

        W. Va.

        11

        3

        --

        --

        42

        1

        N.C.

        2,133

        1

        2

        --

        498

        1

        S.C.

        871

        --

        4

        --

        286

        --

        Ga.

        1,836

        --

        3

        --

        631

        10

        Fla.

        2,539

        3

        3

        --

        1,302

        16

        E.S. Central

        4,383

        1

        7

        4

        1,224

        10

        Ky.

        339

        --

        1

        NN

        179

        2

        Tenn.

        1,750

        1

        5

        3

        439

        2

        Ala.

        1,133

        --

        1

        --

        381

        4

        Miss.

        1,161

        --

        NN

        1

        225

        2

        W.S. Central

        6,475

        6

        6

        --

        2,569

        31

        Ark.

        506

        --

        2

        NN

        171

        --

        La.

        1,651

        2

        NN

        --

        380

        1

        Okla.

        363

        --

        4

        NN

        198

        1

        Tex.

        3,955

        4

        NN

        --

        1,820

        29

        Mountain

        1,099

        2

        10

        2

        619

        12

        Mont.

        --

        1

        --

        2

        20

        --

        Idaho

        15

        --

        1

        NN

        14

        1

        Wyo.

        2

        --

        --

        --

        4

        --

        Colo.

        118

        --

        4

        --

        79

        1

        N. Mex.

        76

        --

        --

        --

        68

        2

        Ariz.

        697

        1

        1

        --

        254

        5

        Utah

        55

        --

        2

        --

        52

        --

        Nev.

        136

        --

        2

        --

        128

        3

        Pacific

        2,819

        8

        27

        3

        4,509

        96

        Wash.

        141

        --

        6

        --

        265

        8

        Oreg.

        32

        --

        NN

        --

        156

        1

        Calif.

        2,618

        8

        21

        3

        3,852

        83

        Alaska

        13

        --

        NN

        --

        55

        --

        Hawaii

        15

        --

        NN

        --

        181

        4

                     

        Guam

        3

        --

        --

        --

        89

        --

        P.R.

        1,460

        1

        NN

        --

        201

        2

        V.I.

        35

        NA

        NA

        NA

        NA

        NA

        American Samoa

        NA

        NA

        NA

        NA

        NA

        NA

        C.N.M.I.

        NA

        NA

        NA

        NA

        NA

        NA

        * Totals reported to the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of July 19, 1999.
        † Totals reported to the Division of Tuberculosis Elimination, NCHSTP, as of June 3, 1999.




        Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

        NOTIFIABLE DISEASES -- Summary of reported cases, by age group, United States, 1998

         

        <1

        1-4

        5-14

        15-24

        25-39

        40-64

        >=65

         

        Disease

        Total

        No.

        (Rate)

        No.

        (Rate)

        No.

        (Rate)

        No.

        (Rate)

        No.

        (Rate)

        No.

        (Rate)

        No.

        (Rate)

        Age not stated

        AIDS*

        46,521

        93

        ( 2.46)

        133

        ( 0.88)

        199

        ( 0.51)

        1,667

        ( 4.48)

        24,689

        ( 40.21)

        19,008

        (24.01)

        732

        ( 2.13)

          --

        Botulism, total

        116

        66

        ( 1.76)

        3

        ( 0.02)

        --

        ( --)

        3

        ( 0.01)

        14

        ( 0.02)

        25

        ( 0.03)

        5

        ( 0.01)

        --

        Brucellosis

        79

        --

        ( --)

        10

        ( 0.07)

        10

        ( 0.03)

        9

        ( 0.02)

        18

        ( 0.03)

        23

        ( 0.03)

        9

        ( 0.03)

          --

        Chlamydia†?/sup>

        604,023

        NA

        ( NA)

        NA

        ( NA)

        NA

        ( NA)

        441,225

        (1,259.62)

        124,556

        (209.45)

        11,397

        (15.59)

        1,226

        ( 3.78)

           9,629

        Cholera

        17

        --

        ( --)

        --

        ( --)

        --

        ( --)

        --

        ( 0.00)

        8

        ( 0.01)

        6

        ( 0.01)

        3

        ( 0.01)

          --

        Cryptosporidiosis

        3,793

        93

        ( 2.81)

        674

        ( 5.07)

        629

        ( 1.84)

        328

        ( 1.01)

        1,056

        ( 1.97)

        741

        ( 1.08)

        209

        ( 0.70)

          63

        Diphtheria

        1

        --

        ( --)

        --

        ( --)

        --

        ( --)

        1

        ( 0.00)

        --

        ( --)

        --

        ( --)

        --

        ( --)

          --

        Encephalitis, California serogroup viral

        97

        4

        ( 0.11)

        23

        ( 0.16)

        65

        ( 0.17)

        1

        ( 0.00)

        1

        ( 0.00)

        1

        ( 0.00)

        1

        ( 0.00)

          1

          Eastern equine

        4

        --

        ( --)

        --

        ( --)

        --

        ( --)

        --

        ( --)

        1

        ( 0.00)

        1

        ( 0.00)

        2

        ( 0.01)

          --

          St. Louis

        24

        1

        ( 0.03)

        --

        ( --)

        --

        ( --)

        2

        ( 0.01)

        6

        ( 0.01)

        10

        ( 0.01)

        5

        ( 0.02)

          --

        Escherichia coli O157:H7

        3,161

        70

        ( 2.01)

        639

        ( 4.57)

        655

        ( 1.83)

        392

        ( 1.15)

        341

        ( 0.61)

        583

        ( 0.81)

        366

        ( 1.18)

        115

        Gonorrhea?/sup>

        355,627

        NA

        ( NA)

        NA

        ( NA)

        NA

        ( NA)

        209,036

        ( 571.45)

        109,680

        (176.24)

        24,257

        (31.58)

        1,199

        ( 3.52)

        4,252

        Haemophilus influenzae, invasive disease

        1,194

        157

        ( 4.16)

        96

        ( 0.63)

        63

        ( 0.16)

        55

        ( 0.15)

        107

        ( 0.17)

        256

        ( 0.32)

        452

        ( 1.31)

          8

        Hansen disease (leprosy)

        108

        2

        ( 0.06)

        --

        ( --)

        2

        ( 0.01)

        11

        ( 0.03)

        32

        ( 0.06)

        27

        ( 0.04)

        14

        ( 0.05)

          20

        Hepatitis A

        23,229

        122

        ( 3.23)

        1,154

        ( 7.60)

        4,739

        (12.10)

        3,718

        ( 9.99)

        7,589

        ( 12.36)

        4,560

        ( 5.76)

        1,056

        ( 3.07)

          291

        Hepatitis B

        10,258

        67

        ( 1.77)

        54

        ( 0.36)

        161

        ( 0.41)

        1,757

        ( 4.72)

        4,357

        ( 7.10)

        3,117

        ( 3.94)

        525

        ( 1.53)

          220

        Hepatitis C; non-A, non-B

        3,518

        21

        ( 0.56)

        7

        ( 0.05)

        16

        ( 0.04)

        166

        ( 0.45)

        1,101

        ( 1.79)

        1,619

        ( 2.05)

        145

        ( 0.42)

          443

        Legionellosis

        1,355

        4

        ( 0.11)

        2

        ( 0.01)

        4

        ( 0.01)

        17

        ( 0.05)

        136

        ( 0.23)

        609

        ( 0.79)

        569

        ( 1.69)

          14

        Lyme disease

        16,801

        70

        ( 1.86)

        923

        ( 6.10)

        3,193

        ( 8.19)

        1,396

        ( 3.77)

        2,875

        ( 4.70)

        5,857

        ( 7.43)

        2,332

        ( 6.81)

          155

        Malaria

        1,611

        10

        ( 0.26)

        70

        ( 0.46)

        180

        ( 0.46)

        299

        ( 0.80)

        507

        ( 0.83)

        438

        ( 0.55)

        65

        ( 0.19)

            42

        Measles (rubeola)

        100

        15

        ( 0.40)

        15

        ( 0.10)

        12

        ( 0.03)

        29

        ( 0.08)

        24

        ( 0.04)

        5

        ( 0.01)

        --

        ( --)

           --

        Meningococcal disease

        2,725

        433

        ( 11.47)

        417

        ( 2.75)

        354

        ( 0.90)

        471

        ( 1.27)

        249

        ( 0.41)

        386

        ( 0.49)

        390

        ( 1.13)

         25

        Mumps

        666

        7

        ( 0.19)

        120

        ( 0.80)

        289

        ( 0.75)

        88

        ( 0.24)

        99

        ( 0.16)

        54

        ( 0.07)

        --

        ( --)

          9

        Pertussis (whooping cough)

        7,405

        2,134

        ( 56.51)

        953

        ( 6.27)

        2,016

        ( 5.15)

        890

        ( 2.39)

        634

        ( 1.03)

        675

        ( 0.85)

        56

        ( 0.16)

          47

        Plague

        9

        --

        ( --)

        --

        ( --)

        1

        ( 0.00)

        --

        ( --)

        2

        ( 0.00)

        6

        ( 0.01)

        --

        ( --)

          --

        Poliomyelitis, paralytic

        1

        1

        ( 0.03)

        --

        ( --)

        --

        ( --)

        --

        ( --)

        --

        ( --)

        --

        ( --)

        --

        ( --)

        --

        Psittacosis

        47

        2

        ( 0.06)

        2

        ( 0.01)

        2

        ( 0.01)

        3

        ( 0.01)

        11

        ( 0.02)

        19

        ( 0.03)

        7

        ( 0.02)

          1

        Rabies, human

        1

        --

        ( --)

        --

        ( --)

        --

        ( --)

        --

        ( --)

        1

        ( 0.00)

        --

        ( --)

        --

        ( --)

        --

        Rocky Mountain spotted fever

        365

        2

        ( 0.05)

        25

        ( 0.17)

        58

        ( 0.15)

        34

        ( 0.09)

        86

        ( 0.14)

        118

        ( 0.15)

        39

        ( 0.11)

        3

        Rubella (German measles)

        364

        16

        ( 0.42)

        12

        ( 0.08)

        19

        ( 0.05)

        147

        ( 0.40)

        122

        ( 0.20)

        47

        ( 0.06)

        --

        ( --)

          1

        Salmonellosis

        43,694

        5,517

        (146.09)

        6,975

        (45.92)

        5,348

        (13.66)

        3,622

        ( 9.73)

        5,944

        ( 9.68)

        6,475

        ( 8.18)

        3,954

        (11.49)

          5,859

        Shigellosis

        23,626

        513

        ( 13.58)

        6,399

        (42.13)

        6,134

        (15.66)

        1,653

        ( 4.44)

        3,209

        ( 5.23)

        1,818

        ( 2.30)

        436

        ( 1.27)

        3,464

        Syphilis?/sup>

                                       

          Primary and secondary

        6,995

        NA

        ( NA)

        NA

        ( NA)

        NA

        ( NA)

        1,626

        ( 4.45)

        3,368

        ( 5.41)

        1,833

        ( 2.39)

        103

        ( 0.30)

          18

        Tetanus

        41

        1

        ( 0.03)

        --

        ( --)

        2

        ( 0.01)

        6

        ( 0.02)

        8

        ( 0.01)

        10

        ( 0.01)

        14

        ( 0.04)

        --

        Toxic-shock syndrome

        138

        2

        ( 0.06)

        3

        ( 0.02)

        20

        ( 0.06)

        23

        ( 0.07)

        42

        ( 0.08)

        40

        ( 0.06)

        7

        ( 0.02)

          1

        Trichinosis

        19

        --

        ( --)

        1

        ( 0.01)

        --

        ( --)

        2

        ( 0.01)

        7

        ( 0.01)

        7

        ( 0.01)

        1

        ( 0.00)

          1

        Tuberculosis?/sup>

        18,361

        108

        ( 2.86)

        533

        ( 3.51)

        441

        ( 1.13)

        1,548

        ( 4.16)

        4,585

        ( 7.47)

        6,753

        ( 8.53)

        4,393

        (12.77)

        --

        Typhoid fever

        375

        8

        ( 0.21)

        47

        ( 0.31)

        63

        ( 0.16)

        86

        ( 0.23)

        105

        ( 0.17)

        51

        ( 0.06)

        12

        ( 0.03)

           3

        * Total number of acquired immunodeficiency syndrome (AIDS) cases reported to the Division of HIV/AIDS Prevention -- Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention (NCHSTP), as of December 31, 1998.
        † Chlamydia refers to genital infections caused by C. trachomatis.
        ?Age-related data are collected on aggregate forms different from those used for the number of reported cases. Therefore, the total cases reported on this table can differ slightly from other tables. Cases among persons aged <15 years are not shown because some of these might not be caused by sexual transmission; these cases are, however, included in the totals. Cases and rates were updated through the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of July 19, 1999. Age-related data for 1998 are unavailable for chancroid.
        ?Cases were updated through the Division of Tuberculosis Elimination, NCHSTP, as of June 3, 1999.

        Note: Incidence rates per 100,000 population. Rates <0.01 after rounding are listed as 0.00.




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        NOTIFIABLE DISEASES -- Summary of reported cases, by sex, United States, 1998

         

        Male

        Female

         

        Disease

        Total

        No.

        (Rate)

        No.

        (Rate)

        Sex not stated

        AIDS*

        46,521

        35,776

        ( 27.09)

        10,742

        ( 7.77)

        3

        Botulism, total

        116

        62

        ( 0.05)

        52

        ( 0.04)

        2

        Brucellosis

        79

        39

        ( 0.03)

        39

        ( 0.03)

        1

        Chancroid

        189

        112

        ( 0.09)

        76

        ( 0.06)

        1

        Chlamydia†?/sup>

        604,420

        NA

        ( NA)

        498,406

        (382.24)

        --

        Cholera

        17

        10

        ( 0.01)

        6

        ( 0.00)

        1

        Cryptosporidiosis

        3,793

        1,907

        ( 1.66)

        1,822

        ( 1.52)

        64

        Diphtheria

        1

        NA

        ( NA)

        1

        ( 0.00)

        --

        Encephalitis, California serogroup viral

        97

        61

        ( 0.05)

        35

        ( 0.03)

        1

          Eastern equine

        4

        2

        ( 0.00)

        2

        ( 0.00)

        --

          St. Louis

        24

        13

        ( 0.01)

        11

        ( 0.01)

        --

        Escherichia coli O157:H7

        3,161

        1,405

        ( 1.17)

        1,563

        ( 1.24)

        193

        Gonorrhea

        355,642

        175,233

        (133.75)

        179,651

        (131.50)

        758

        Haemophilus influenzae, invasive disease

        1,194

        517

        ( 0.39)

        578

        ( 0.42)

        99

        Hansen disease (leprosy)

        108

        53

        ( 0.05)

        35

        ( 0.03)

        20

        Hepatitis A

        23,229

        12,656

        ( 9.58)

        8,358

        ( 6.05)

        2,215

        Hepatitis B

        10,258

        5,929

        ( 4.49)

        3,887

        ( 2.81)

        442

        Hepatitis C; non-A, non-B

        3,518

        2,171

        ( 1.64)

        1,272

        ( 0.92)

        75

        Legionellosis

        1,355

        806

        ( 0.62)

        509

        ( 0.38)

        40

        Lyme disease

        16,801

        8,820

        ( 6.71)

        7,948

        ( 5.77)

        33

        Malaria

        1,611

        996

        ( 0.75)

        553

        ( 0.40)

        62

        Measles (rubeola)

        100

        45

        ( 0.03)

        43

        ( 0.03)

        12

        Meningococcal disease

        2,725

        1,329

        ( 1.01)

        1,318

        ( 0.95)

        78

        Mumps

        666

        370

        ( 0.29)

        267

        ( 0.20)

        29

        Pertussis (whooping cough)

        7,405

        3,285

        ( 2.49)

        3,816

        ( 2.76)

        304

        Plague

        9

        3

        ( 0.00)

        5

        ( 0.00)

        1

        Poliomyelitis, paralytic

        1

        1

        ( 0.00)

        --

        ( -- )

        --

        Psittacosis

        47

        12

        ( 0.01)

        34

        ( 0.03)

        1

        Rabies, human

        1

        1

        ( 0.00)

        --

        ( -- )

        --

        Rocky Mountain spotted fever

        365

        222

        ( 0.17)

        141

        ( 0.10)

        2

        Rubella (German measles)

        364

        238

        ( 0.18)

        123

        ( 0.09)

        3

        Salmonellosis

        43,694

        17,942

        ( 13.59)

        19,035

        ( 13.77)

        6,717

        Shigellosis

        23,626

        8,786

        ( 6.65)

        10,667

        ( 7.72)

        4,173

        Syphilis, primary and secondary

        6,993

        3,902

        ( 2.98)

        3,089

        ( 2.26)

        2

        Tetanus

        41

        22

        ( 0.02)

        18

        ( .01)

        1

        Toxic-shock syndrome

        138

        30

        ( 0.03)

        103

        ( 0.09)

        5

        Trichinosis

        19

        10

        ( 0.01)

        9

        ( 0.01)

        --

        Tuberculosis?/sup>

        18,361

        11,413

        ( 8.64)

        6,935

        ( 5.02)

        13

        Typhoid fever

        375

        196

        ( 0.15)

        161

        ( 0.12)

        18

        * Total number of acquired immunodeficiency syndrome (AIDS) cases reported to the Division of HIV/AIDS Prevention -- Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention (NCHSTP), as of December 31, 1998.
        † Cases and rates were updated through the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of July 19, 1999.
        ?Chlamydia refers to genital infections caused by C. trachomatis. The rates for men are not presented because reporting for men is more limited than for women.
        ?Cases were updated through the Division of Tuberculosis Elimination, NCHSTP, as of June 3, 1999.

        Note: Incidence rates per 100,000 population. Rates <0.01 after rounding are listed as 0.00.




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        NOTIFIABLE DISEASES -- Summary of reported cases, by race, United States, 1998

         

        American Indian or Alaskan Native

        Asian or Pacific Islander

        Black

        White

        Other

        Race not stated

        Disease

        Total

        No.

        (%)

        No.

        (%)

        No.

        (%)

        No.

        (%)

        No.

        (%)

        No.

        (%)

        AIDS*

        46,521

        148

        (<1)

        388

        ( 1)

        21,728

        ( 47)

        16,115

        ( 35)

        --

        (--)

        8,142

        (18)

        Botulism, total

        116

        8

        ( 7)

        3

        ( 3)

        7

        ( 6)

        58

        ( 50)

        1

        ( 1)

        39

        (34)

        Brucellosis

        79

        1

        ( 1)

        --

        (--)

        --

        ( --)

        49

        ( 62)

        --

        (--)

        29

        (37)

        ChlamydiaФ

        604,023

        8,466

        ( 1)

        7,483

        ( 1)

        203,013

        ( 34)

        124,323

        ( 21)

        --

        (--)

        260,738

        (43)

        Cholera

        17

        --

        (--)

        4

        (24)

        --

        ( 7)

        10

        ( 59)

        --

        (--)

        3

        (18)

        Cryptosporidiosis

        3,793

        312

        ( 8)

        58

        ( 2)

        278

        ( 7)

        1,967

        ( 52)

        9

        (<1)

        1,169

        (31)

        Diphtheria

        1

        --

        (--)

        --

        (--)

        --

        ( --)

        1

        (100)

        --

        (--)

        --

        (--)

        Encephalitis, California serogroup viral

        97

        1

        ( 1)

        --

        (--)

        1

        ( 1)

        87

        ( 90)

        --

        (--)

        8

        ( 8)

          Eastern equine

        4

        --

        (--)

        --

        (--)

        --

        ( --)

        4

        (100)

        --

        (--)

        --

        (--)

          St. Louis

        24

        --

        (--)

        --

        (--)

        6

        ( 25)

        18

        ( 75)

        --

        (--)

        --

        (--)

        Escherichia coli O157:H7

        3,161

        6

        (<1)

        28

        ( 1)

        93

        ( 3)

        1,999

        ( 63)

        5

        (<1)

        1,030

        (33)

        Gonorrhea?/sup>

        355,627

        1,790

        ( 1)

        1,481

        (<1)

        217,360

        ( 61)

        40,220

        ( 11)

        --

        (--)

        94,776

        (27)

        Haemophilus influenzae, invasive disease

        1,194

        22

        ( 2)

        19

        ( 2)

        159

        ( 13)

        711

        ( 60)

        2

        (<1)

        281

        (24)

        Hansen disease (leprosy)

        108

        1

        ( 1)

        31

        (29)

        6

        ( 6)

        28

        ( 26)

        --

        (--)

        42

        (39)

        Hepatitis A

        23,229

        236

        ( 1)

        349

        ( 2)

        2,689

        ( 12)

        12,229

        ( 53)

        48

        (<1)

        7,678

        (33)

        Hepatitis B

        10,258

        80

        ( 1)

        683

        ( 7)

        1,855

        ( 18)

        3,958

        ( 39)

        25

        (<1)

        3,657

        (36)

        Hepatitis C; non-A, non-B

        3,518

        46

        ( 1)

        33

        ( 1)

        468

        ( 13)

        1,921

        ( 55)

        7

        (<1)

        1,043

        (30)

        Legionellosis

        1,355

        3

        (<1)

        8

        ( 1)

        135

        ( 10)

        913

        ( 67)

        --

        (--)

        296

        (22)

        Lyme disease

        16,801

        44

        (<1)

        102

        ( 1)

        205

        ( 1)

        12,833

        ( 76)

        41

        (<1)

        3,576

        (21)

        Malaria

        1,611

        4

        (<1)

        160

        (10)

        613

        ( 38)

        404

        ( 25)

        14

        ( 1)

        416

        (26)

        Measles (rubeola)

        100

        1

        ( 1)

        5

        ( 5)

        7

        ( 7)

        47

        ( 47)

        --

        (--)

        40

        (40)

        Meningococcal disease

        2,725

        30

        ( 1)

        34

        ( 1)

        405

        ( 15)

        1,716

        ( 63)

        4

        (<1)

        536

        (20)

        Mumps

        666

        3

        (<1)

        53

        ( 8)

        35

        ( 5)

        412

        ( 62)

        2

        (<1)

        161

        (24)

        Pertussis (whooping cough)

        7,405

        89

        ( 1)

        130

        ( 2)

        438

        ( 6)

        5,270

        ( 71)

        10

        (<1)

        1,468

        (20)

        Plague

        9

        3

        (33)

        --

        (--)

        --

        ( --)

        6

        ( 67)

        --

        (--)

        --

        (--)

        Poliomyelitis, paralytic

        1

        --

        (--)

        --

        (--)

        --

        ( --)

        1

        (100)

        --

        (--)

        --

        (--)

        Psittacosis

        47

        1

        ( 2)

        --

        (--)

        4

        ( 9)

        31

        ( 66)

        --

        (--)

        11

        (23)

        Rabies, human

        1

        --

        (--)

        --

        (--)

        1

        (100)

        --

        ( --)

        --

        (--)

        --

        (--)

        Rocky Mountain spotted fever

        365

        5

        ( 1)

        3

        ( 1)

        18

        ( 5)

        280

        ( 77)

        --

        (--)

        59

        (16)

        Rubella (German measles)

        364

        4

        ( 1)

        3

        ( 1)

        3

        ( 1)

        238

        ( 65)

        26

        ( 7)

        90

        (25)

        Rubella, congenital syndrome

        7

        --

        (--)

        --

        (--)

        1

        ( 14)

        3

        ( 43)

        --

        (--)

        3

        (43)

        Salmonellosis

        43,694

        338

        ( 1)

        554

        ( 1)

        3,247

        ( 7)

        19,658

        ( 45)

        25

        (<1)

        19,872

        (45)

        Shigellosis

        23,626

        411

        ( 2)

        147

        ( 1)

        3,483

        ( 15)

        9,430

        ( 40)

        15

        (<1)

        10,140

        (43)

        Syphilis, primary and secondary?/sup>

        6,995

        55

        ( 1)

        36

        ( 1)

        5,398

        ( 77)

        912

        ( 13)

        --

        (--)

        594

        ( 8)

        Tetanus

        41

        1

        ( 2)

        1

        ( 2)

        6

        ( 15)

        29

        ( 71)

        --

        (--)

        4

        (10)

        Toxic-shock syndrome

        138

        --

        (--)

        3

        ( 2)

        11

        ( 8)

        106

        ( 77)

        --

        (--)

        18

        (13)

        Trichinosis

        19

        1

        ( 5)

        1

        ( 5)

        1

        ( 5)

        12

        ( 63)

        --

        (--)

        4

        (21)

        Tuberculosis**

        18,361

        264

        ( 1)

        3,668

        (20)

        5,980

        ( 33)

        8,408

        ( 46)

        --

        (--)

        41

        (<1)

        Typhoid fever

        375

        1

        (<1)

        105

        (28)

        19

        ( 5)

        65

        ( 17)

        13

        ( 3)

        172

        (46)

        * Total number of acquired immunodeficiency syndrome (AIDS) cases reported to the Division of HIV/AIDS Prevention -- Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention (NCHSTP), as of December 31, 1998.
        †Includes the following cases originally reported as Hispanic: 7,931 for AIDS; 70,240 for chlamydia; 16,269 for gonorrhea; and 441 for syphilis, primary and secondary.
        ?Chlamydia refers to genital infections caused by C. trachomatis.
        ?In addition to data collected through the National Electronic Telecommunications System for Surveillance (NETSS), some data concerning race are collected on aggregate forms different from those used for numbers of reported cases. Thus, the total number of cases reported on this table can differ slightly from other tables. Cases were updated through the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of July 19, 1999. Data regarding race for 1998 are unavailable for chancroid.
        ** Cases were updated through the Division of Tuberculosis Elimination, NCHSTP as of June 3, 1999.




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        NOTIFIABLE DISEASES -- Summary of reported cases, by ethnicity, United States, 1998

         

        Hispanic

        Non-Hispanic

        Ethnicity not stated

        Disease

        Total

        No.

        (%)

        No.

        (%)

        No.

        (%)

        AIDS*

        46,521

        7,931

        (17)

        37,843

        ( 81)

        747

        ( 2)

        Botulism, total

        116

        24

        (21)

        59

        ( 51)

        33

        ( 28)

        Brucellosis

        79

        47

        (59)

        14

        ( 18)

        18

        ( 23)

        ChlamydiaФ

        604,023

        70,240

        (12)

        327,336

        ( 54)

        206,447

        ( 34)

        Cholera

        17

        1

        ( 6)

        13

        ( 76)

        3

        ( 18)

        Cryptosporidiosis

        3,793

        237

        ( 6)

        1,600

        ( 42)

        1,956

        ( 52)

        Diphtheria

        1

        --

        (--)

        --

        ( --)

        1

        (100)

        Encephalitis, California serogroup viral

        97

        2

        ( 2)

        33

        ( 34)

        62

        ( 64)

          Eastern equine

        4

        --

        (--)

        2

        ( 50)

        2

        ( 50)

          St. Louis

        24

        --

        (--)

        13

        ( 54)

        11

        ( 46)

        Escherichia coli O157:H7

        3,161

        86

        ( 3)

        1,698

        ( 54)

        1,377

        ( 44)

        Gonorrhea?/sup>

        355,627

        16,269

        ( 5)

        257,580

        ( 72)

        81,778

        ( 23)

        Haemophilus influenzae, invasive disease

        1,194

        78

        ( 7)

        611

        ( 51)

        505

        ( 42)

        Hansen disease (leprosy)

        108

        32

        (30)

        52

        ( 48)

        24

        ( 22)

        Hepatitis A

        23,229

        4,137

        (18)

        9,884

        ( 43)

        9,208

        ( 40)

        Hepatitis B

        10,258

        850

        ( 8)

        4,786

        ( 47)

        4,622

        ( 45)

        Hepatitis C; non-A, non-B

        3,518

        392

        (11)

        1,741

        ( 49)

        1,385

        ( 39)

        Legionellosis

        1,355

        26

        ( 2)

        773

        ( 57)

        556

        ( 41)

        Lyme disease

        16,801

        172

        ( 1)

        7,780

        ( 46)

        8,849

        ( 53)

        Malaria

        1,611

        167

        (10)

        873

        ( 54)

        571

        ( 35)

        Measles (rubeola)

        100

        10

        (10)

        44

        ( 44)

        46

        ( 46)

        Meningococcal disease

        2,725

        263

        (10)

        1,530

        ( 56)

        932

        ( 34)

        Mumps

        666

        115

        (17)

        221

        ( 33)

        330

        ( 50)

        Pertussis (whooping cough)

        7,405

        813

        (11)

        4,866

        ( 66)

        1,726

        ( 23)

        Plague

        9

        1

        (11)

        8

        ( 89)

        --

        ( --)

        Poliomyelitis, paralytic

        1

        --

        (--)

        1

        (100)

        --

        ( --)

        Psittacosis

        47

        5

        (11)

        26

        ( 55)

        16

        ( 34)

        Rabies, human

        1

        --

        (--)

        --

        ( --)

        1

        (100)

        Rocky Mountain spotted fever

        365

        7

        ( 2)

        241

        ( 66)

        117

        ( 32)

        Rubella, congenital syndrome

        7

        4

        (57)

        --

        ( --)

        3

        ( 43)

        Rubella (German measles)

        364

        289

        (79)

        54

        ( 15)

        21

        ( 6)

        Salmonellosis

        43,694

        2,523

        ( 6)

        15,393

        ( 35)

        25,778

        ( 59)

        Shigellosis

        23,626

        3,406

        (14)

        7,999

        ( 34)

        12,221

        ( 52)

        Syphilis, primary and secondary?/sup>

        6,995

        441

        ( 6)

        6,310

        ( 90)

        244

        ( 3)

        Tetanus

        41

        10

        (24)

        21

        ( 51)

        10

        ( 24)

        Toxic-shock syndrome

        138

        4

        ( 3)

        93

        ( 67)

        41

        ( 30)

        Trichinosis

        19

        --

        (--)

        6

        ( 32)

        13

        ( 68)

        Tuberculosis**

        18,361

        4,099

        (22)

        14,212

        ( 77)

        50

        ( <1)

        Typhoid fever

        375

        64

        (17)

        144

        ( 38)

        167

        ( 45)

        * Total number of acquired immunodeficiency syndrome (AIDS) cases reported to the Division of HIV/AIDS Prevention -- Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention (NCHSTP), as of December 31, 1998.
        † Ethnicity is not stated and includes cases originally reported as American Indian/Alaskan Native or Asian/Pacific Islander.
        ?Chlamydia refers to genital infections caused by C. trachomatis.
        ?In addition to data collected through the National Electronic Telecommunications System for Surveillance (NETSS), some data concerning ethnicity are collected on aggregate forms different from those used for numbers of reported cases. Thus, the total number of cases reported on this table can differ slightly from other tables. Cases were updated through the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of July 19, 1999. Data regarding ethnicity for 1998 are unavailable for chancroid.
        ** Cases were updated through the Division of Tuberculosis Elimination, NCHSTP, as of June 3, 1999.

        Part 2: Graphs and Maps for Selected Notifiable Diseases in the United States

        EXPLANATION OF SYMBOLS USED IN TABLES, GRAPHS, AND MAPS

        Data not availableNA
        Report of disease is not required in that jurisdiction (not notifiable)NN
























































        Part 3: Historical Summary Tables

        EXPLANATION OF SYMBOLS USED IN TABLES, GRAPHS, AND MAPS

        No reported cases--



        Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

        TABLE 1. NOTIFIABLE DISEASES -- Summary of reported cases per 100, 000 population, United States, 1988- 1998

        Disease

        1988

        1989

        1990

        1991

        1992

        1993

        1994

        1995

        1996

        1997

        1998

        AIDS*

        12.61

        13.58

        16.72

        17.32

        17.83

        40.20

        30.07

        27.20

        25.21

        21.85

        17.21

        Amebiasis

        1.20

        1.34

        1.38

        1.23

        1.21

        1.21

        1.20

        Anthrax

        0.00

        --

        --

        --

        0.00

        --

        --

        --

        --

        --

        --

        Aseptic meningitis

        2.94

        4.14

        4.77

        6.26

        5.18

        5.39

        3.71

        Botulism, total (wound and unspecified)

        0.03

        0.04

        0.04

        0.05

        0.04

        0.04

        0.06

        0.04

        0.05

        0.05

        0.04

          Foodborne

        0.01

        0.01

        0.01

        0.01

        0.00

        0.01

        0.02

        0.01

        0.01

        0.02

        0.01

        Brucellosis

        0.04

        0.04

        0.03

        0.04

        0.04

        0.05

        0.05

        0.04

        0.05

        0.04

        0.03

        Chancroid

        2.04

        1.90

        1.70

        1.40

        0.80

        0.54

        0.30

        0.20

        0.15

        0.09

        0.07

        Chlamydia?/sup>

        ?/sup>

        182.60

        188.10

        196.80

        236.57

        Cholera

        0.00

        --

        0.00

        0.01

        0.04

        0.00

        0.02

        0.01

        0.01

        0.01

        0.01

        Cryptosporidiosis

        ?/sup>

        1.12

        1.61

        Diphtheria

        0.00

        0.00

        0.00

        0.00

        0.00

        --

        0.00

        --

        0.01

        0.01

        0.00

        Encephalitis, primary

        0.36

        0.40

        0.54

        0.40

        0.30

        0.36

        0.28

          Postinfectious

        0.05

        0.04

        0.04

        0.03

        0.05

        0.07

        0.06

          Encephalitis, California serogroup viral

        ?/sup>

        **

        0.04

          Eastern equine

        ?/sup>

        **

        0.00

          St. Louis

        ?/sup>

        **

        0.01

          Western equine

        ?/sup>

        **

        0.00

        Escherichia coli O157:H7

        ?/sup>

        0.82

        1.01

        1.18

        1.04

        1.28

        Gonorrhea

        298.74

        297.36

        276.60

        249.48

        201.60

        172.40

        168.40

        149.50

        122.80

        121.40

        132.88

        Granuloma inguinale

        0.00

        0.00

        0.00

        0.01

        0.00

        0.00

        0.00

        Haemophilus influenzae, invasive disease

        **

        1.10

        0.55

        0.55

        0.45

        0.45

        0.45

        0.44

        0.44

        Hansen disease (leprosy)

        0.07

        0.07

        0.08

        0.06

        0.07

        0.07

        0.05

        0.06

        0.05

        0.05

        0.05

        Hepatitis A

        11.60

        14.43

        12.64

        9.67

        9.06

        9.40

        10.29

        12.13

        11.70

        11.22

        8.59

        Hepatitis B

        9.43

        9.43

        8.48

        7.14

        6.32

        5.18

        4.81

        4.19

        4.01

        3.90

        3.80

        Hepatitis C; non-A, non-B††

        1.07

        1.02

        1.03

        1.42

        2.36

        1.86

        1.78

        1.78

        1.41

        1.43

        1.30

        Hepatitis, unspecified

        1.00

        0.93

        0.67

        0.50

        0.35

        0.24

        0.17

        Legionellosis

        0.44

        0.48

        0.55

        0.53

        0.53

        0.50

        0.63

        0.48

        0.47

        0.44

        0.51

        Leptospirosis

        0.02

        0.04

        0.03

        0.02

        0.02

        0.02

        0.02

        Lyme disease

        **

        3.80

        3.93

        3.20

        5.01

        4.49

        6.21

        4.79

        6.39

        Lymphogranuloma venereum

        0.07

        0.08

        0.10

        0.19

        0.10

        0.10

        0.10

         

           

        Malaria

        0.45

        0.51

        0.52

        0.51

        0.43

        0.55

        0.47

        0.55

        0.68

        0.75

        0.60

        Measles (rubeola)

        1.38

        7.33

        11.17

        3.82

        0.88

        0.12

        0.37

        0.12

        0.20

        0.06

        0.04

        Meningococcal disease

        1.21

        1.10

        0.99

        0.84

        0.84

        1.02

        1.11

        1.25

        1.30

        1.24

        1.01

        Mumps

        2.05

        2.34

        2.17

        1.72

        1.03

        0.66

        0.60

        0.35

        0.29

        0.27

        0.25

        Murine typhus fever

        0.02

        0.02

        0.02

        0.02

        0.02

        0.01

         

        Pertussis (whooping cough)

        1.40

        1.67

        1.84

        1.08

        1.60

        2.55

        1.77

        1.97

        2.94

        2.46

        2.74

        Plague

        0.01

        0.00

        0.00

        0.00

        0.01

        0.00

        0.01

        0.00

        0.01

        0.01

        0.00

        Poliomyelitis, paralytic

        0.00

        0.00

        0.00

        0.00

        0.00

        0.00

        0.00

        0.00

        0.01

        0.01

        0.00

        Psittacosis

        0.05

        0.05

        0.05

        0.04

        0.04

        0.02

        0.02

        0.03

        0.02

        0.02

        0.02

        Rabies, human

        0.00

        0.00

        0.00

        0.00

        0.00

        0.00

        0.00

        0.00

        0.01

        0.01

        0.00

        Rheumatic fever, acute

        0.14

        0.13

        0.09

        0.12

        0.06

        0.08

        0.09

        Rocky Mountain spotted fever

        0.25

        0.25

        0.26

        0.25

        0.20

        0.18

        0.18

        0.23

        0.32

        0.16

        0.14

        Rubella (German measles)

        0.09

        0.16

        0.45

        0.56

        0.06

        0.07

        0.09

        0.05

        0.10

        0.07

        0.13

        Salmonellosis, excluding typhoid fever

        19.91

        19.26

        19.54

        19.10

        16.04

        16.15

        16.64

        17.66

        17.15

        15.66

        16.17

        Shigellosis

        12.46

        10.07

        10.89

        9.34

        9.38

        12.48

        11.44

        12.32

        9.80

        8.64

        8.74

        Syphilis, primary and secondary

        16.43

        18.07

        20.10

        17.26

        13.70

        10.40

        8.10

        6.30

        4.29

        3.19

        2.61

          Total, all stages

        42.37

        44.94

        53.80

        51.69

        45.30

        39.70

        32.00

        26.20

        19.97

        17.39

        14.19

        Tetanus

        0.02

        0.02

        0.03

        0.02

        0.02

        0.02

        0.02

        0.02

        0.02

        0.02

        0.02

        Toxic-shock syndrome

        0.16

        0.16

        0.13

        0.11

        0.10

        0.08

        0.10

        0.07

        0.06

        0.06

        0.06

        Trichinosis

        0.02

        0.01

        0.05

        0.02

        0.02

        0.01

        0.01

        0.01

        0.01

        0.01

        0.01

        Tuberculosis

        9.13

        9.46

        10.33

        10.42

        10.46

        9.82

        9.36

        8.70

        8.04

        7.42

        6.79

        Tularemia

        0.08

        0.06

        0.06

        0.08

        0.06

        0.05

        0.04

        Typhoid fever

        0.18

        0.19

        0.22

        0.20

        0.16

        0.17

        0.17

        0.14

        0.15

        0.14

        0.14

        Varicella (chickenpox)Ё

        122.43

        121.77

        120.06

        135.82

        176.54

        118.54

        135.76

        118.11

        44.13

        93.55

        70.28

        Yellow fever

        --

        --

        --

        --

        --

        --

        --

        --

        0.01

        --

        --

        * Acquired immunodeficiency syndrome (AIDS).
        † No longer nationally notifiable.
        ?Chlamydia refers to genital infections caused by C. trachomatis.
        ?Not previously nationally notifiable.
        ** Nationally notifiable; data not presented because of limited number of states reporting.
        †† Anti-HCV (hepatitis C virus) antibody test became available May 1990.
        Ё Not nationally notifiable.

        Note: Incidence rates per 100,000 population. Rates <0.01 after rounding are listed as 0.00. Data in the MMWR Summary of Notifiable Diseases, United States might not match data in other CDC surveillance reports because of differences in the timing of reports, the source of the data, and the use of different case definitions.




        Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

        TABLE 2. NOTIFIABLE DISEASES -- Summary of reported cases, United States, 1991-1998

        Disease

        1991

        1992

        1993

        1994

        1995

        1996

        1997

        1998

        AIDS

        43,672

        45,472

        103,691

        78,279

        71,547

        66,885

        58,492

        46,521*

        Amebiasis

        2,989

        2,942

        2,970

        2,983

        Anthrax

        --

        1

        --

        --

        --

        --

        --

        --

        Aseptic meningitis

        14,526

        12,223

        12,848

        8,932

        Botulism, total (wound and unspecified)

        114

        91

        97

        143

        97

        119

        132

        116

          Foodborne

        27

        21

        27

        50

        24

        25

        31

        22

          Infant

        81

        66

        65

        85

        54

        80

        79

        65

        Brucellosis

        104

        105

        120

        119

        98

        112

        98

        79

        Chancroid

        3,476

        1,886

        1,399

        773

        606

        386

        243

        189?/sup>

        Chlamydia?/sup>

        **

        477,638

        498,884

        526,671

        604,420?/sup>

        Cholera

        26

        103

        18

        39

        23

        4

        6

        17

        Cryptosporidiosis

        **

        2,566

        3,793

        Diphtheria

        5

        4

        --

        2

        --

        2

        4

        1

        Encephalitis, primary

        1,021

        774

        919

        717

          Postinfectious

        82

        129

        170

        143

          Encephalitis, California serogroup viral

        **

        ††

        97

          Eastern equine

        **

        ††

        4

          St. Louis

        **

        ††

        24

          Western equine

        **

        ††

        --

        Escherichia coli O157:H7

        **

        1,420

        2,139

        2,741

        2,555

        3,161

        Gonorrhea

        620,478

        501,409

        439,673

        418,068

        392,848

        325,883

        324,907

        355,642?/sup>

        Granuloma inguinale

        29

        6

        19

        3

        Haemophilus influenzae, invasive disease

        2,764

        1,412

        1,419

        1,174

        1,180

        1,170

        1,162

        1,194

        Hansen disease (leprosy)

        154

        172

        187

        136

        144

        112

        122

        108

        Hepatitis A

        24,378

        23,112

        24,238

        26,796

        31,582

        31,032

        30,021

        23,229

        Hepatitis B

        18,003

        16,126

        13,361

        12,517

        10,805

        10,637

        10,416

        10,258

        Hepatitis C; non-A, non-BЁ

        3,582

        6,010

        4,786

        4,470

        4,576

        3,716

        3,816

        3,518

        Hepatitis, unspecified

        1,260

        884

        627

        444

        Legionellosis

        1,317

        1,339

        1,280

        1,615

        1,241

        1,198

        1,163

        1,355

        Leptospirosis

        58

        54

        51

        38

        Lyme disease

        9,465

        9,895

        8,257

        13,043

        11,700

        16,455

        12,801

        16,801

        Lymphogranuloma venereum

        471

        302

        285

        235

        Malaria

        1,278

        1,087

        1,411

        1,229

        1,419

        1,800

        2,001

        1,611

        Measles (rubeola)

        9,643

        2,237

        312

        963

        309

        508

        138

        100

        Meningococcal disease

        2,130

        2,134

        2,637

        2,886

        3,243

        3,437

        3,308

        2,725

        Mumps

        4,264

        2,572

        1,692

        1,537

        906

        751

        683

        666

        Murine typhus fever

        43

        28

        25

        Pertussis (whooping cough)

        2,719

        4,083

        6,586

        4,617

        5,137

        7,796

        6,564

        7,405

        Plague

        11

        13

        10

        17

        9

        5

        4

        9

        Poliomyelitis, paralytic

        10

        6

        4

        8

        7

        5

        5

        1

        Psittacosis

        94

        92

        60

        38

        64

        42

        33

        47

        Rabies, animal

        6,910

        8,589

        9,377

        8,147

        7,811

        6,982

        8,105

        7,259

        Rabies, human

        3

        1

        3

        6

        5

        3

        2

        1

        Rheumatic fever, acute

        127

        75

        112

        112

        Rocky Mountain spotted fever

        628

        502

        456

        465

        590

        831

        409

        365

        Rubella (German measles)

        1,401

        160

        192

        227

        128

        238

        181

        364

        Rubella, congenital syndrome

        47

        11

        5

        7

        6

        4

        5

        7

        Salmonellosis, excluding typhoid fever

        48,154

        40,912

        41,641

        43,323

        45,970

        45,471

        41,901

        43,694

        Shigellosis

        23,548

        23,931

        32,198

        29,769

        32,080

        25,978

        23,117

        23,626

        Syphilis, primary and secondary

        42,935

        33,973

        26,498

        20,627

        16,500

        11,387

        8,550

        6,993?/sup>

          Total, all stages

        128,569

        112,581

        101,259

        81,696

        68,953

        52,976

        46,540

        37,977?/sup>

        Tetanus

        57

        45

        48

        51

        41

        36

        50

        41

        Toxic-shock syndrome

        280

        244

        212

        192

        191

        145

        157

        138

        Trichinosis

        62

        41

        16

        32

        29

        11

        13

        19

        Tuberculosis

        26,283

        26,673

        25,313

        24,361

        22,860

        21,337

        19,851

        18,361***

        Tularemia

        193

        159

        132

        96

        Typhoid fever

        501

        414

        440

        441

        369

        396

        365

        375

        Varicella (chickenpox)†††

        147,076

        158,364

        134,722

        151,219

        120,624

        83,511

        98,727

        82,455

        Yellow fever

        Ё?/sup>

        1

        --

        --

        * Total number of acquired immunodeficiency syndrome (AIDS) cases reported to the Division of HIV/AIDS Prevention -- Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention (NCHSTP), through December 31, 1998.
        † No longer nationally notifiable.
        ?Cases were updated through the Division of Sexually Transmitted Diseases Prevention, NCHSTP, as of July 19, 1999.
        ?Chlamydia refers to genital infections caused by C. trachomatis.
        ** Not previously nationally notifiable.
        †† Nationally notifiable; data not presented because of limited number of states reporting.
        Ё Anti-HCV (hepatitis C virus) antibody test was available as of May 1990.
        抖 Numbers might not reflect changes because of retrospective case evaluations or late reports (see MMWR 1986; 35: 180-2).
        *** Cases were updated through the Division of Tuberculosis Elimination, NCHSTP, as of June 3, 1999.
        ††† Varicella was taken off the nationally notifiable disease list in 1991. Many states continue to report these cases to CDC.
        Ё?Last indigenous case of yellow fever was reported in 1911; before 1996, the last imported case was reported in 1924.

        Note: Data in the MMWR Summary of Notifiable Diseases, United States might not match data in other CDC surveillance reports because of differences in the timing of reports, the source of the data, and the use of different case definitions.




        Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

        TABLE 3. NOTIFIABLE DISEASES -- Summary of reported cases, United States, 1983-1990

        Disease

        1983

        1984

        1985

        1986

        1987

        1988

        1989

        1990

        AIDS*

        4,445

        8,249

        12,932

        21,070

        31,001

        33,722

        41,595

        Amebiasis

        6,658

        5,252

        4,433

        3,532

        3,123

        2,860

        3,217

        3,328

        Anthrax

        --

        1

        --

        --

        1

        2

        --

        --

        Aseptic meningitis

        12,696

        8,326

        10,619

        11,374

        11,487

        7,234

        10,274

        11,852

        Botulism, total (wound and unspecified)

        133

        123

        122

        109

        82

        84

        89

        92

          Foodborne

        ?/sup>

        49

        23

        17

        28

        23

        23

          Infant

        ?/sup>

        70

        79

        59

        50

        60

        65

        Brucellosis

        200

        131

        153

        106

        129

        96

        95

        82

        Chancroid

        847

        665

        2,067

        3,756

        4,998

        5,001

        4,692

        4,212

        Cholera

        1

        1

        4

        23

        6

        8

        --

        6

        Diphtheria

        5

        1

        3

        --

        3

        2

        3

        4

        Encephalitis, primary?/sup>

        1,761

        1,257

        1,376

        1,302

        1,418

        882

        981

        1,341

          Postinfectious?/sup>

        34

        108

        161

        124

        121

        121

        88

        105

        Gonorrhea

        900,435

        878,556

        911,419

        900,868

        780,905

        719,536

        733,151

        690,169

        Granuloma inguinale

        24

        30

        44

        61

        22

        11

        7

        97

        Hansen disease (leprosy)

        259

        290

        361

        270

        238

        184

        163

        198

        Hepatitis A

        21,532

        22,040

        23,210

        23,430

        25,280

        28,507

        35,821

        31,441

        Hepatitis B

        24,318

        26,115

        26,611

        26,107

        25,916

        23,177

        23,419

        21,102

        Hepatitis C; non-A, non-B

        3,470

        3,871

        4,184

        3,634

        2,999

        2,619

        2,529

        2,553

        Hepatitis, unspecified

        7,149

        5,531

        5,517

        3,940

        3,102

        2,470

        2,306

        1,671

        Legionellosis

        852

        750

        830

        980

        1,038

        1,085

        1,190

        1,370

        Leptospirosis

        61

        40

        57

        41

        43

        54

        93

        77

        Lymphogranuloma venereum

        335

        170

        226

        396

        303

        185

        189

        277

        Malaria

        813

        1,007

        1,049

        1,123

        944

        1,099

        1,277

        1,292

        Measles (rubeola)

        1,497

        2,587

        2,822

        6,282

        3,655

        3,396

        18,193

        27,786

        Meningococcal disease

        2,736

        2,746

        2,479

        2,594

        2,930

        2,964

        2,727

        2,451

        Mumps

        3,355

        3,021

        2,982

        7,790

        12,848

        4,866

        5,712

        5,292

        Murine typhus fever

        62

        53

        37

        67

        49

        54

        41

        50

        Pertussis (whooping cough)

        2,463

        2,276

        3,589

        4,195

        2,823

        3,450

        4,157

        4,570

        Plague

        40

        31

        17

        10

        12

        15

        4

        2

        Poliomyelitis, total

        13

        9

        **

          Paralytic

        13

        9

        8

        10

        9

        9

        11

        6

        Psittacosis

        142

        172

        119

        224

        98

        114

        116

        113

        Rabies, animal

        5,878

        5,567

        5,565

        5,504

        4,658

        4,651

        4,724

        4,826

        Rabies, human

        2

        3

        1

        --

        1

        --

        1

        1

        Rheumatic fever, acute

        88

        117

        90

        147

        141

        158

        144

        108

        Rocky Mountain spotted fever

        1,126

        838

        714

        760

        604

        609

        623

        651

        Rubella (German measles)

        970

        752

        630

        551

        306

        225

        396

        1,125

        Rubella, congenital syndrome

        22

        5

        --

        14

        5

        6

        3

        11

        Salmonellosis, excluding typhoid fever

        44,250

        40,861

        65,347

        49,984

        50,916

        48,948

        47,812

        48,603

        Shigellosis

        19,719

        17,371

        17,057

        17,138

        23,860

        30,617

        25,010

        27,077

        Syphilis, primary and secondary

        32,698

        28,607

        27,131

        27,883

        35,147

        40,117

        44,540

        50,223

          Total, all stages

        74,637

        69,888

        67,563

        68,215

        86,545

        103,437

        110,797

        134,255

        Tetanus

        91

        74

        83

        64

        48

        53

        53

        64

        Toxic-shock syndrome

        502

        482

        384

        412

        372

        390

        400

        322

        Trichinosis

        45

        68

        61

        39

        40

        45

        30

        129

        Tuberculosis

        23,846

        22,255

        22,201

        22,768

        22,517

        22,436

        23,495

        25,701

        Tularemia

        310

        291

        177

        170

        214

        201

        152

        152

        Typhoid fever

        507

        390

        402

        362

        400

        436

        460

        552

        Varicella (chickenpox)

        177,462

        221,983

        178,162

        183,243

        213,196

        192,857

        185,441

        173,099

        Yellow fever

        ††

        * Acquired immunodeficiency syndrome (AIDS).
        † Not previously nationally notifiable.
        ?Not reported as distinct categories during this period.
        ?Beginning in 1984, data were recorded by date of report to state health departments. Before 1984, data were recorded by onset date.
        ** Categories other than paralytic are no longer reported.
        †† Last indigenous case of yellow fever was reported in 1911; before 1996, the last imported case was reported in 1924.

        Note: Data in the MMWR Summary of Notifiable Disease, United States might not match data in other CDC Surveillance reports because of differences in timing of reports, the source of the data, and the use of different case definitions.




        Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

        TABLE 4. NOTIFIABLE DISEASES -- Summary of reported cases, United States, 1975-1982

        Disease

        1975

        1976

        1977

        1978

        1979

        1980

        1981

        1982

        Amebiasis

        2,775

        2,906

        3,044

        3,937

        4,107

        5,271

        6,632

        7,304

        Anthrax

        2

        2

        --

        6

        --

        1

        --

        --

        Aseptic meningitis

        4,475

        3,510

        4,789

        6,573

        8,754

        8,028

        9,547

        9,680

        Botulism, total (wound and unspecified)

        20

        55

        129

        105

        45

        89

        103

        97

        Brucellosis

        310

        296

        232

        179

        215

        183

        185

        173

        Chancroid

        700

        628

        455

        521

        840

        788

        850

        1,392

        Cholera

        --

        --

        3

        12

        1

        9

        19

        --

        Diphtheria*

        307

        128

        84

        76

        59

        3

        5

        2

        Encephalitis, primary

        4,064

        1,651

        1,414

        1,351

        1,504

        1,362

        1,492

        1,464

          Postinfectious

        237

        175

        119

        78

        84

        40

        43

        36

        Gonorrhea

        999,937

        1,001,994

        1,002,219

        1,013,436

        1,004,058

        1,004,029

        990,864

        960,633

        Granuloma inguinale

        60

        71

        75

        72

        76

        51

        66

        17

        Hansen disease (leprosy)

        162

        145

        151

        168

        185

        223

        256

        250

        Hepatitis A

        35,855

        33,288

        31,153

        29,500

        30,407

        29,087

        25,802

        23,403

        Hepatitis B

        13,121

        14,973

        16,831

        15,016

        15,452

        19,015

        21,152

        22,177

        Hepatitis, unspecified

        7,158

        7,488

        8,639

        8,776

        10,534

        11,894

        10,975

        8,564

        Legionellosis

        235

        359

        761

        593

        475

        408

        654

        Leptospirosis

        93

        73

        71

        110

        94

        85

        82

        100

        Lymphogranuloma venereum

        353

        365

        348

        284

        250

        199

        263

        235

        Malaria

        373

        471

        547

        731

        894

        2,062

        1,388

        1,056

        Measles (rubeola)

        24,374

        41,126

        57,345

        26,871

        13,597

        13,506

        3,124

        1,714

        Meningococcal disease

        1,478

        1,605

        1,828

        2,505

        2,724

        2,840

        3,525

        3,056

        Mumps

        59,647

        38,492

        21,436

        16,817

        14,225

        8,576

        4,941

        5,270

        Murine typhus fever

        41

        69

        75

        46

        69

        81

        61

        58

        Pertussis (whooping cough)

        1,738

        1,010

        2,177

        2,063

        1,623

        1,730

        1,248

        1,895

        Plague

        20

        16

        18

        12

        13

        18

        13

        19

        Poliomyelitis, total

        13

        10

        19

        8

        22

        9

        10

        12

          Paralytic?/sup>

        13

        10

        19

        8

        22

        9

        10

        12

        Psittacosis

        49

        78

        94

        140

        137

        124

        136

        152

        Rabies, animal

        2,627

        3,073

        3,130

        3,254

        5,119

        6,421

        7,118

        6,212

        Rabies, human

        2

        2

        2

        4

        4

        --

        2

        --

        Rheumatic fever, acute

        2,854

        1,865

        1,738

        851

        629

        432

        264

        137

        Rocky Mountain spotted fever

        844

        937

        1,153

        1,063

        1,070

        1,163

        1,192

        976

        Rubella (German measles)

        16,652

        12,491

        20,395

        18,269

        11,795

        3,904

        2,077

        2,325

        Rubella, congenital syndrome

        30

        30

        23

        30

        62

        50

        19

        7

        Salmonellosis, excluding typhoid fever

        22,612

        22,937

        27,850

        29,410

        33,138

        33,715

        39,990

        40,936

        Shigellosis

        16,584

        13,140

        16,052

        19,511

        20,135

        19,041

        19,859

        18,129

        Syphilis, primary and secondary

        25,561

        23,731

        20,399

        21,656

        24,874

        27,204

        31,266

        33,613

          Total, all stages

        80,356

        71,761

        64,621

        64,875

        67,049

        68,832

        72,799

        75,579

        Tetanus

        102

        75

        87

        86

        81

        95

        72

        88

        Trichinosis

        252

        115

        143

        67

        157

        131

        206

        115

        Tuberculosis?/sup>

        33,989

        32,105

        30,145

        28,521

        27,669

        27,749

        27,373

        25,520

        Tularemia

        129

        157

        165

        141

        196

        234

        288

        275

        Typhoid fever

        375

        419

        398

        505

        528

        510

        584

        425

        Varicella (chickenpox)

        154,248

        183,990

        188,396

        154,089

        199,081

        190,894

        200,766

        167,423

        Yellow fever

        **

        * Cutaneous diphtheria is no longer nationally notifiable after 1979.
        † Not previously nationally notifiable.
        ?No cases with paralytic poliomyelitis caused by wild-virus have been reported in the United States since 1979.
        ?Case data after 1974 are not comparable with earlier years because of changes in reporting criteria that became effective in 1975.
        ** Last indigenous case of yellow fever was reported in 1911; before 1996, the last imported case was reported in 1924.

        Note: Data in the MMWR Summary of Notifiable Diseases, United States might not match data in other CDC surveillance reports because of differences in the timing of reports, the source of the data, and the use of different case definitions.




        Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

        TABLE 5. NOTIFIABLE DISEASES -- Summary of reported cases, United States, 1967-1974

        Disease

        1967

        1968

        1969

        1970

        1971

        1972

        1973

        1974

        Amebiasis

        3,157

        3,005

        2,915

        2,888

        2,752

        2,199

        2,235

        2,743

        Anthrax

        2

        3

        4

        2

        5

        2

        2

        2

        Aseptic meningitis

        3,082

        4,494

        3,672

        6,480

        5,176

        4,634

        4,846

        3,197

        Botulism

        5

        7

        16

        12

        25

        22

        34

        28

        Brucellosis

        265

        218

        235

        213

        183

        196

        202

        240

        Chancroid

        784

        845

        1,104

        1,416

        1,320

        1,414

        1,165

        945

        Cholera

        --

        --

        --

        --

        1

        --

        1

        --

        Diphtheria

        219

        260

        241

        435

        215

        152

        228

        272

        Encephalitis, primary

        1,478

        1,781

        1,613

        1,580

        1,524

        1,059

        1,613

        1,164

          Postinfectious

        1,060

        502

        304

        370

        439

        243

        354

        218

        Gonorrhea

        404,836

        464,543

        534,872

        600,072

        670,268

        767,215

        842,621

        906,121

        Granuloma inguinale

        154

        156

        154

        124

        89

        81

        62

        47

        Hansen disease (leprosy)

        81

        123

        98

        129

        131

        130

        146

        118

        Hepatitis A (infectious)

        38,909

        45,893

        48,416

        56,797

        59,606

        54,074

        50,749

        40,358

        Hepatitis B (serum)

        2,458

        4,829

        5,909

        8,310

        9,556

        9,402

        8,451

        10,631

        Leptospirosis

        67

        69

        89

        47

        62

        41

        57

        8,351

        Lymphogranuloma venereum

        371

        485

        520

        612

        692

        756

        408

        394

        Malaria

        2,022

        2,317

        3,102

        3,051

        2,375

        742

        237

        293

        Measles (rubeola)

        62,705

        22,231

        25,826

        47,351

        75,290

        32,275

        26,690

        22,094

        Meningococcal disease

        2,161

        2,623

        2,951

        2,505

        2,262

        1,323

        1,378

        1,346

        Mumps

        *

        152,209

        90,918

        104,953

        124,939

        74,215

        69,612

        59,128

        Murine typhus fever

        52

        36

        36

        27

        23

        18

        32

        26

        Pertussis (whooping cough)

        9,718

        4,810

        3,285

        4,249

        3,036

        3,287

        1,759

        2,402

        Plague

        3

        3

        5

        13

        2

        1

        2

        8

        Poliomyelitis, total

        41

        53

        20

        33

        21

        31

        8

        7

          Paralytic

        40

        53

        18

        31

        17

        29

        7

        7

        Psittacosis

        41

        43

        57

        35

        32

        52

        33

        164

        Rabies, animal

        4,481

        3,591

        3,490

        3,224

        4,310

        4,369

        3,640

        3,151

        Rabies, human

        2

        1

        1

        3

        2

        2

        1

        --

        Rheumatic fever, acute

        3,985

        3,470

        3,229

        3,227

        2,793

        2,614

        2,560

        2,431

        Rocky Mountain spotted fever

        305

        298

        498

        380

        432

        523

        668

        754

        Rubella (German measles)

        46,888

        49,371

        57,686

        56,552

        45,086

        25,507

        27,804

        11,917

        Rubella, congenital syndrome

        10

        14

        31

        77

        68

        42

        35

        45

        Salmonellosis, excluding typhoid fever

        18,120

        16,514

        18,419

        22,096

        21,928

        22,151

        23,818

        21,980

        Shigellosis

        13,474

        12,180

        11,946

        13,845

        16,143

        20,207

        22,642

        22,600

        Streptococcal sore throat and scarlet fever

        453,351

        435,013

        450,008

        433,405

        Syphilis, primary and secondary

        21,053

        19,019

        19,130

        21,982

        23,783

        24,429

        24,825

        25,385

          Total, all stages

        102,581

        96,271

        92,162

        91,382

        95,997

        91,149

        87,469

        83,771

        Tetanus

        263

        178

        192

        148

        116

        128

        101

        101

        Trichinosis

        66

        77

        215

        109

        103

        89

        102

        120

        Tuberculosis

        45,647

        42,623

        39,120

        37,137

        35,217

        32,882

        30,998

        30,122

        Tularemia

        184

        186

        149

        172

        187

        152

        171

        144

        Typhoid fever

        396

        395

        364

        346

        407

        398

        680

        437

        Varicella (chickenpox)

        *

        164,114

        182,927

        141,495

        Yellow fever

        ?/sup>

        * Not previously nationally notifiable.
        † No longer nationally notifiable.
        ?Last indigenous case of yellow fever was reported in 1911; before 1996, the last imported case was reported in 1924.

        Note: Data in the MMWR Summary of Notifiable Diseases, United States might not match data in other CDC surveillance reports because of differences in the timing of reports, the source of the data, and the use of different case definitions.




        Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

        TABLE 6. NOTIFIABLE DISEASES -- Deaths from selected diseases, United States, 1988-1997

        Cause of Death

        ICD-9*

        1988

        1989

        1990

        1991

        1992

        1993

        1994

        1995

        1996

        1997

        AIDS

        *042-*044

        16,602

        22,082

        25,188

        29,555

        33,566

        37,267

        42,114

        43,115

        31,130

        16,516

        Anthrax

        022

        --

        --

        --

        --

        --

        --

        --

        --

        --

        --

        Botulism, foodborne

        005.1

        1

        2

        4

        2

        1

        --

        --

        2

        1

        2

        Brucellosis

        023

        2

        --

        --

        --

        --

        1

        --

        1

        --

        1

        Chancroid

        099.0

        --

        --

        --

        1

        --

        --

        --

        --

        --

        --

        Cholera

        001

        --

        --

        2

        2

        2

        --

        1

        --

        2

        --

        Diphtheria

        032

        --

        --

        1

        --

        1

        --

        --

        1

        --

        --

        Encephalitis, California serogroup viral

        062.5

        --

        --

        --

        --

        --

        --

        --

        --

        1

        1

          Eastern equine

        062.2

        --

        1

        1

        1

        1

        1

        --

        1

        1

        2

          St. Louis

        062.3

        --

        --

        13

        9

        2

        1

        3

        6

        --

        1

          Western equine

        062.1

        --

        --

        --

        --

        --

        --

        --

        --

        --

        --

        Gonococcal infections

        098

        3

        4

        3

        3

        4

        5

        3

        3

        4

        3

        Haemophilus influenzae, invasive disease

        041.5

        25

        16

        16

        17

        16

        7

        5

        12

        7

        7

        Hansen disease (leprosy)

        030

        --

        4

        3

        --

        2

        1

        3

        2

        --

        2

        Hepatitis, viral, infectious (Hep A)

        070.0,070.1

        70

        88

        76

        71

        82

        95

        97

        142

        121

        127

        Hepatitis, viral, serum (Hep B)

        070.2,070.3

        621

        711

        816

        912

        903

        1,041

        1,120

        1,027

        1,082

        1,030

        Hepatitis, viral, other and unspecified

        070.4-070.9

        599

        717

        686

        857

        1,016

        1,353

        1,844

        2,231

        2,577

        2,900

        Malaria

        084

        7

        11

        3

        4

        8

        12

        3

        8

        4

        7

        Measles (rubeola)

        055

        3

        32

        64

        27

        4

        --

        --

        2

        1

        2

        Meningococcal disease

        036

        278

        273

        215

        198

        201

        260

        276

        273

        290

        309

        Mumps

        072

        2

        3

        1

        1

        --

        --

        --

        --

        1

        --

        Pertussis (whooping cough)

        033

        4

        12

        12

        --

        5

        7

        8

        6

        4

        6

        Plague

        020

        --

        --

        --

        --

        1

        2

        2

        1

        2

        --

        Poliomyelitis, total

        045.0-045.9

        1

        --

        --

        1

        --

        --

        --

        1

        --

        --

        Psittacosis

        073

        1

        1

        2

        --

        4

        1

        --

        --

        1

        --

        Rabies, human

        071

        --

        1

        1

        3

        1

        1

        3

        3

        3

        4

        Rubella (German measles)

        056

        1

        4

        8

        1

        1

        --

        --

        1

        --

        --

        Salmonellosis, incl. paratyphoid fever

        002.1-002.9,003

        66

        99

        80

        53

        47

        52

        49

        66

        58

        51

        Shigellosis

        004

        8

        16

        10

        10

        8

        5

        13

        8

        5

        5

        Spotted fevers

        082.0

        20

        10

        20

        13

        13

        5

        9

        8

        6

        12

        Syphilis

        090-097

        85

        105

        106

        93

        91

        80

        79

        65

        73

        62

        Tetanus

        037

        17

        9

        11

        11

        9

        11

        9

        5

        1

        4

        Trichinosis

        124

        --

        1

        --

        --

        --

        --

        --

        --

        --

        --

        Tuberculosis (all forms)

        010-018

        1,921

        1,970

        1,810

        1,713

        1,705

        1,631

        1,478

        1,336

        1,202

        1,166

        Typhoid fever

        002.0

        --

        --

        1

        1

        --

        --

        1

        --

        1

        --

        Varicella (chickenpox)?/sup>

        052

        83

        89

        120

        81

        100

        100

        124

        115

        81

        99

        Yellow fever

        060

        --

        --

        --

        --

        --

        --

        --

        --

        1

        --

        * International Classification of Diseases, Ninth Revision, 1975. Numbers in this column are ICD-9 categories.
        † Acquired immunodeficiency syndrome (AIDS). In 1987, the National Center for Health Statistics introduced categories *042-*044 for classifying and coding human immunodeficiency virus (HIV) infection. The asterisks are not footnote symbols, but indicate that these codes are not part of ICD-9.
        ?Varicella was taken off the nationally notifiable disease list in 1991. Many states continue to report these cases to CDC.

        Note: Data in the MMWR Summary of Notifiable Diseases, United States might not match data in other CDC surveillance reports because of differences in the timing of reports, the source of the data, and the use of different case definitions.

        Source: National Center for Health Statistics System, 1988-1997. Deaths are classified according to the ICD-9.

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        Haemophilus influenzae, Invasive Disease

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        Mumps

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        Plague

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        Poliomyelitis, Paralytic

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        Psittacosis

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        Rabies, Animal and Human

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        Rocky Mountain Spotted Fever

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        Rubella

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        CDC. Rubella outbreak -- Westchester County, New York, 1997-98. MMWR 1999;48:560-3.

        CDC. Rubella and congenital rubella syndrome -- United States, 1994-1997. MMWR 1997;46:350-4.

        CDC. Rubella and congenital rubella syndrome -- United States, January 1, 1991-May 7, 1994. MMWR 1994;43:391,397-401.

        CDC. Rubella among crew members of commercial cruise ships -- Florida, 1997. MMWR 1998;46:1247-50.

        Salmonellosis

        Van Beneden CA, Keene WE, Strang RA, et al. Multinational outbreak of Salmonella enterica serotype Newport infections due to contaminated alfalfa sprouts. JAMA 1999;281:158-62.

        Mahon BE, Slutsker L, Hutwagner L, et al. Consequences in Georgia of a nationwide outbreak of Salmonella infections: what you don't know might hurt you. Am J Public Health 1999;89:31-5.

        Glynn MK, Bopp C, Dewitt WK, Dabney P, Mokhtar M, Angulo FJ. Emergence of multidrug-resistant Salmonella enterica serotype Typhimurium DT104 infections in the United States. N Engl J Med 1998;338:1333-8.

        CDC. Multistate outbreak of Salmonella serotype Agona infections linked to toasted oats cereal -- United States, April-May, 1998. MMWR 1998;47:462-4.

        Shigellosis

        Sobel J, Cameron DN, Ismail J, et al. A prolonged outbreak of Shigella sonnei infections in traditionally observant Jewish communities in North America caused by a molecularly distinct bacterial subtype. J Infect Dis 1998;177:1405-8.

        Mohle-Boetani JC, Stapleton M, Finger R, et al. Communitywide shigellosis: control of an outbreak and risk factors in child day-care centers. Am J Public Health 1995;85:812-6.

        Ries AA, Wells JG, Olivola D, et al. Epidemic Shigella dysenteriae type 1 in Burundi: panresistance and implications for prevention. J Infect Dis 1994;169:1035-41.

        Lee LA, Shapiro CN, Hargrett-Bean N, Tauxe RV. Hyperendemic shigellosis in the United States: a review of surveillance data for 1967-1988. J Infect Dis 1991;164:894-900.

        Streptococcal Disease, Invasive, Group A

        CDC. Noscomial group A streptococcal infections associated with asymptomatic health-care workers -- Maryland and California, 1997. MMWR 1999;48:163-6.

        The Working Group on Prevention of Invasive Group A Streptococcal Infections. Prevention of invasive group A streptococcal disease among household contacts of case-patients: is prophylaxis warranted? JAMA 1998;279:1206-10.

        Davies HD, McGeer A, Schwartz B, et al. A prospective, population-based study of invasive group A streptococcal infections, including toxic shock syndrome and the risk of secondary infections. N Engl J Med 1996;335:547-54.

        Working Group on Severe Streptococcal Infections. Defining the group A streptococcal toxic shock syndrome: rationale and consensus definition. JAMA 1993;269:390-1.

        Streptococcal Disease, Invasive, Group B

        Schuchat A. Group B streptococcus [Review]. Lancet 1999;353:51-6.

        CDC. Adoption of hospital policies for prevention of perinatal group B streptococcal disease -- United States, 1997. MMWR 1998;47:665-70.

        Factor SH, Levine OS, Nassar A, et al. Impact of a risk-based prevention policy on neonatal group B streptococcal disease. Am J Obstet Gynecol 1998;179:1568-71.

        CDC. Decreasing incidence of perinatal group B streptococcal disease -- United States, 1993-1995. MMWR 1997;46:473-7.

        Streptococcus pneumoniae, Drug-Resistant

        Dowell SF, Butler JC, Giebink GS, et al. Acute otitis media: management and surveillance in an era of pneumococcal resistance -- a report from the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group [published erratum appears in Pediatr Infect Dis J 1999;18(4):341]. Pediatr Infect Dis J 1999;18:1-9.

        Dowell SF. Principles of judicious use of antimicrobial agents for pediatric upper respiratory tract infections. Pediatrics 1998;101(suppl):S163-S184.

        CDC. Defining the public health impact of drug-resistant Streptococcus pneumoniae: report of a working group. MMWR 1996;45(No. RR-1).

        Butler JC, Hofmann J, Cetron MS, et al. The continued emergence of drug-resistant Streptococcus pneumoniae in the United States: an update from the Centers for Disease Control and Prevention's Pneumococcal Sentinel Surveillance System. J Infect Dis 1996;174:986-93.

        Syphilis, Congenital

        Southwick KL, Guidry HM, Weldon MM, Mertz KJ, Berman SM, Levine WC. An epidemic of congenital syphilis in Jefferson County, Texas, 1994-1995: inadequate prenatal syphilis testing after an outbreak in adults. Am J Public Health 1999;89:557-60.

        Coles BF, Hipp SS, Silberstein GS, Chen JH. Congenital syphilis surveillance in upstate New York, 1989-1992: implications for prevention and clinical management. J Infect Dis 1995;171:732-5.

        CDC. Congenital syphilis -- United States, 1998. MMWR 1999;48;757-61.

        CDC. Guidelines for the prevention and control of congenital syphilis. MMWR 1988;37(No. S-1).

        Syphilis, Primary and Secondary

        Williams LA, Klausner JD, Whittington WL, Handsfield HH, Celum C, Holmes KK. Elimination and reintroduction of primary and secondary syphilis. Am J Public Health 1999;89:1093-7.

        CDC. Primary and secondary syphilis -- United States, 1998. MMWR 1999;48:873-8.

        St. Louis ME, Wasserheit JN. Elimination of syphilis in the United States. Science 1998;281:353-4.

        Nakashima AK, Rolfs RT, Flock ML, Kilmarx P, Greenspan JR. Epidemiology of syphilis in the United States, 1941-1993. Sex Transm Dis 1996;23:16-23.

        Tetanus

        Bardenheier B, Prevots R, Khetsuriani N, Wharton M. Tetanus surveillance-United States, 1995-1997. In: CDC surveillance summaries, July 3, 1998. MMWR 1998;47(No. SS-2):1-13.

        CDC. Neonatal tetanus -- Montana, 1998. MMWR 1998;47:928-30.

        CDC. Tetanus among injecting-drug users -- California, 1997. MMWR 1998;47:149-51.

        Gergen PJ, McQuillan GM, Kiely M, Ezzati-Rice TM, Sutter RW, Virella G. A population-based serologic survey of immunity to tetanus in the United States. N Engl J Med 1995;332:761-6.

        Toxic-Shock Syndrome

        Hajjeh RA, Reingold R, Weil A, Shutt K, Schuchat A, Perkins BA. Toxic shock syndrome in the United States: surveillance update, 1979-1996. Emerg Infect Dis 1999;5. Available on the Internet at http://www.cy118119.com/ncidod/eid/vol5no6/hajjeh.htm.

        Schuchat A, Broome CV. Toxic shock syndrome and tampons. Epidemiol Rev 1991;13:99-112.

        CDC. Reduced incidence of menstrual toxic shock syndrome -- United States, 1980-1990. MMWR 1990;39:421-3.

        Gaventa S, Reingold AL, Hightower AW, et al. Active surveillance for toxic shock syndrome in the United States, 1986. Reviews of Infectious Disease 1989;11(suppl):S28-S34.

        Trichinellosis (Trichinosis)

        Moorhead A, Grunenwald PE, Dietz VJ, Schantz PM. Trichinellosis in the United States, 1991-1996: declining but not gone. Am J Trop Med Hyg 1999;60:66-9.

        CDC. Outbreak of trichinellosis associated with eating cougar jerky -- Idaho, 1995. MMWR 1996;45:205-6.

        McAuley JB, Michelson MK, Schantz PM. Trichinosis surveillance, United States, 1987-1990. In: CDC surveillance summaries, December 1991. MMWR 1991;40(No. SS-3):35-42.

        Tuberculosis

        CDC. Recommendations for counting reported tuberculosis cases. In: Reported tuberculosis in the United States, 1996. Atlanta, GA: US Department of Health and Human Services, Public Health Service, CDC, 1997:61-8.

        American Thoracic Society, CDC. Treatment of tuberculosis and tuberculosis infection in adults and children. Am J Respir Crit Care Med 1994;149:1359-74.

        Typhoid Fever

        Mermin J, Villar R, Carpenter J, et al. A massive epidemic of multidrug-resistant typhoid fever in Tajikistan associated with consumption of municipal water. J Infect Dis 1999;179:1416-22.

        Mermin JH, Townes JM, Gerber M, Dolan N, Mintz ED, Tauxe RV. Typhoid fever in the United States, 1985-1994: changing risks of international travel and increasing antimicrobial resistance. Arch Intern Med 1998;158:633-8.

        CDC. Typhoid immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1994;43(No. RR-14).

        Woodruff BA, Pavia AT, Blake PA. A new look at typhoid vaccination: information for the practicing physician. JAMA 1991;265:756-9.

        Varicella

        CDC. Evaluation of varicella reporting to the National Notifiable Disease Surveillance System -- United States, 1972-1997. MMWR 1999;48:55-8.

        CDC. Prevention of varicella. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999:48(No. RR-6).

        CDC. Varicella-related deaths among children -- United States, 1997. MMWR 1998;47:365-8.

        CDC. Prevention of varicella. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1996;45(No. RR-11).

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