MMWR 2010 Report

Please note: An erratum has been published for this issue. To view the erratum, please click here.
Morbidity and Mortality Weekly Report

Weekly / Vol. 59 / No. 46 November 26, 2010
World AIDS Day 2010

World AIDS Day (December 1) draws attention to the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic worldwide. In the United States, approximately 56,000 persons become infected with HIV each year. The National HIV/AIDS Strategy calls for 1) educating all persons in the United States about the continued risk for HIV, 2) implementing intensive, combined HIV-prevention programs in communities with high HIV prevalence, 3) ensuring access to services, and 4) reducing HIV-related health disparities (1). Globally, at the beginning of 2003, approximately 50,000 persons were receiving antiretroviral therapy (ART) in sub-Saharan Africa, where the need for such therapy was greatest (2). Currently, through the U.S. Presidents Emergency Plan for AIDS Relief (PEPFAR) and a partnership among many organizations, approximately 5 million persons receive ART in low-income and middle-income countries (3). Building on these successes, CDC focuses on strengthening systems and capacities of ministries of health to implement sustainable, evidence-based prevention, care, and treatment services. CDC also is working with its partners to ensure cost-effective programming and efficient implementation through increased technical assistance to multiple countries.
References
1. Office of National AIDS Policy. National HIV/AIDS Strategy. Washington, DC: Office of National AIDS Policy; 2010. Available at http://www.whitehouse.gov/administration/eop/onap/nhas. Accessed November 16, 2010. 2. Office of Global AIDS Coordinator. The U.S. Presidents emergency plan for AIDS relief: five-year strategy. Annex: PEPFAR and prevention, care, and treatment. Washington, DC: Office of Global AIDS Coordinator; 2009. Available at http://www.pepfar.gov/strategy. Accessed November 16, 2010. 3. World Health Organization. More than five million people receiving HIV treatment. Geneva, Switzerland: World Health Organization; 2010. Available at http://www.who.int/mediacentre/news/ releases/2010/hiv_treament_20100719. Accessed November 16, 2010.
Mortality Among Patients with Tuberculosis and Associations with HIV Status United States, 19932008
Worldwide, tuberculosis (TB) incidence increased from 125 cases per 100,000 population in 1990 to 142 cases per 100,000 population in 2004, primarily because of the human immunodeficiency virus (HIV) epidemic (1). Persons with HIV are at increased risk for TB disease, and those with TB have a high risk for death. This is documented most clearly in resource-limited settings, where limited access to antiretroviral therapy (ART) and other health-care services contribute to the elevated mortality (1). The impact of HIV on patients with TB is less clear in resource-rich nations such as the United States. To understand the impact of HIV on the risk for death during TB treatment in the United States, data were analyzed for all culture-positive patients with TB from 1993 to 2008, and the proportion that died was determined and stratified by HIV test result. Mortality data were restricted to patients reported before 2007. The proportion of all patients with TB who died during TB treatment decreased from 2,445 of 13,629 (18%) in 1993 to 682 of 7,578 (9%) in 2006. Among patients with TB and HIV, 950 of 2,337 (41%) died during treatment in 1993; this proportion declined to 131 of 663 (20%) in 2006. The proportion of patients with TB and HIV who received their TB diagnosis postmortem dropped from 191 of 2,927 (7%) in 1993 to 32 of 768 (4%) in 2006; 624 of 10,468 (6%) persons with TB and unknown HIV status received their TB INSIDE
1514 HIV Testing and Treatment Among Tuberculosis Patients Kenya, 20062009 1518 Racial Disparities in Smoking-Attributable Mortality and Years of Potential Life Lost Missouri, 20032007 1523 Announcement 1524 QuickStats
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diagnosis postmortem in 1993, and this proportion did not decline. Further reductions in mortality can be achieved by enhanced TB/HIV program collaboration and service integration. Since 1993, all cases of TB diagnosed in the United States have been reported to CDC and entered into the National TB Surveillance System (NTSS), a comprehensive database that contains demographic, clinical, and outcome data. All culture-confirmed cases of TB were reviewed by CDC to determine 1) the proportion of cases diagnosed postmortem and 2) the proportion of cases in persons who were alive at diagnosis and who died during TB treatment; results then were stratified by HIV status (i.e., HIV infected, HIV uninfected, or HIV status unknown). The HIV-unknown category included patients with indeterminate or unknown results as well as patients who were not offered or refused testing. Rates of HIV test reporting during 20072008 were stratified by selected demographic characteristics. Mortality analyses were restricted to patients reported before 2007 (to allow 2 years for treatment outcomes to be reported) and to those whose outcomes were known (excluding patients who moved, were lost to follow-up, were uncooperative with treatment, or whose outcome was missing or listed as other).
Because California reports HIV test results only for patients who receive diagnoses of acquired immunodeficiency syndrome (AIDS), and does not report the HIV status of those who test negative, all data from California were excluded. The proportion of patients with TB who had documented HIV test results increased substantially, from 6,015 of 16,507 (36%) in 1993 to 6,234 of 7,872 (79%) in 2008 (Figure 1). The proportion of patients with TB who had a known outcome and were alive at diagnosis but died during TB treatment decreased from 2,445 of 13,629 (18%) in 1993 to 682 of 7,578 (9%) in 2006 (Figure 2). Among patients with TB and HIV, 950 of 2,337 (41%) died during treatment in 1993; this proportion declined to 299 of 1,393 (21%) in 1997 and later to 131 of 663 (20%) in 2006 (Figure 2). By contrast, the proportion of TB patients without HIV who died during treatment decreased from 213 of 2,705 (8%) in 1993 to 281 of 5,315 (5%) in 2006. For patients with unknown HIV status, 1,282 of 8,587 (15%) died in 1993, with no decrease in proportion observed over the study period (Figure 2). Among patients with HIV who received diagnoses of TB, 191 of 2,927 (7%) received their TB diagnosis postmortem in 1993, which decreased to 32 of 768 (4%) in 2006. Among culture-confirmed cases of TB
The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333. Suggested citation: Centers for Disease Control and Prevention. [Article title]. MMWR 2010;59:[inclusive page numbers].
Centers for Disease Control and Prevention

Thomas R. Frieden, MD, MPH, Director Harold W. Jaffe, MD, MA, Associate Director for Science James W. Stephens, PhD, Office of the Associate Director for Science Stephen B. Thacker, MD, MSc, Deputy Director for Surveillance, Epidemiology, and Laboratory Services Stephanie Zaza, MD, MPH, Director, Epidemiology and Analysis Program Office
MMWR Editorial and Production Staff

Ronald L. Moolenaar, MD, MPH, Editor, MMWR Series John S. Moran, MD, MPH, Deputy Editor, MMWR Series Martha F. Boyd, Lead Visual Information Specialist Malbea A. LaPete, Stephen R. Spriggs, Terraye M. Starr Robert A. Gunn, MD, MPH, Associate Editor, MMWR Series Visual Information Specialists Teresa F. Rutledge, Managing Editor, MMWR Series Quang M. Doan, MBA, Phyllis H. King Douglas W. Weatherwax, Lead Technical Writer-Editor Information Technology Specialists Donald G. Meadows, MA, Jude C. Rutledge, Writer-Editors
MMWR Editorial Board

William L. Roper, MD, MPH, Chapel Hill, NC, Chairman Virginia A. Caine, MD, Indianapolis, IN Patricia Quinlisk, MD, MPH, Des Moines, IA Jonathan E. Fielding, MD, MPH, MBA, Los Angeles, CA Patrick L. Remington, MD, MPH, Madison, WI David W. Fleming, MD, Seattle, WA Barbara K. Rimer, DrPH, Chapel Hill, NC William E. Halperin, MD, DrPH, MPH, Newark, NJ John V. Rullan, MD, MPH, San Juan, PR King K. Holmes, MD, PhD, Seattle, WA William Schaffner, MD, Nashville, TN Deborah Holtzman, PhD, Atlanta, GA Anne Schuchat, MD, Atlanta, GA John K. Iglehart, Bethesda, MD Dixie E. Snider, MD, MPH, Atlanta, GA Dennis G. Maki, MD, Madison, WI John W. Ward, MD, Atlanta, GA
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MMWR / November 26, 2010 / Vol. 59 / No. 46
Please note: An erratum has been published for this issue. To view the erratum, please click here. MMWR Morbidity and Mortality Weekly Report
that occurred in persons who were HIV uninfected, 53 of 3,080 (2%) received their TB diagnosis postmortem in 1993, a proportion that decreased to 31 of 5,762 (1%) in 2006. Of those with unknown HIV status, 624 of 10,468 (6%) received their TB diagnosis postmortem; that proportion did not decline. Among those with known HIV status, 2,932 of 6,015 (49%) patients with TB had HIV infection in 1993 and accounted for 950 of 1,163 (82%) deaths during treatment and 191 of 244 (78%) patients who received a TB diagnosis postmortem. In 2006, 769 of 6,533 (12%) patients with reported status had HIV, but accounted for 131 of 412 (32%) and 32 of 63 (51%) of those who died during treatment and those who received a TB diagnosis postmortem, respectively. HIV testing during 20072008 was lower in certain demographic groups than the overall sample, notably, 102 of 201 (51%) patients aged 4 years, 95 of 144 (66%) patients aged 514 years, 1,824 of 3,253 (56%) patients aged 65 years, and 2,154 of 3,056 (70%) non-Hispanic white patients had HIV test results reported (Table).
Reported by
FIGURE 1. Number of culture-confirmed tuberculosis patients with a recorded HIV test result, by HIV infection status United States,* 19932008
18,000 16,000 14,000
HIV infected HIV uninfected HIV status unknown
No. of cases
12,000 10,000 8,000 6,000 4,000 2,000 0
1993
1995
1997
1999
2001
2003
2005
2007
Year
* Excludes California data because of lack of HIV data on patients with tuberculosis without AIDS.
FIGURE 2. Case-fatality rates among culture-confirmed tuberculosis patients who were alive at diagnosis and whose treatment outcomes were known, by HIV infection status United States,* 19932006
50 45 40 Total HIV infected HIV uninfected HIV status unknown Highly active antiretroviral therapy becomes widely available in the United States (19951996)
Case-fatality rate (%)
35 30 25 20 15 10 5 0
S Shah, MD, Dept of Medicine, Albert Einstein College of Medicine, Bronx, New York. K Cain, MD, S Marks, MPH, MA, Div of TB Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; J Cavanaugh, MD, EIS Officer, CDC.
Editorial Note
This analysis demonstrates a substantial reduction in case-fatality rate among patients with TB in the United States from 1993 to 2006, a decline that occurred almost exclusively in persons with HIV and corresponded to an increase in reported HIV test results and broader availability of highly active ART. In 2008, however, 21% of patients with TB still had unknown HIV status, and this proportion was even higher in certain demographic groups. This is unacceptable given that knowledge of HIV status is essential for appropriate treatment and that current guidelines recommend HIV testing for all patients with TB in the United States (2). A larger proportion of patients with TB were tested for HIV in some countries with a much higher burden of HIV and TB than the United States and far fewer resources, such as Kenya.*
* Additional information available at http://www.nltp.co.ke/reports. html.
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year
* Excludes California data because of lack of HIV data on patients with tuberculosis without AIDS.
In resource-limited settings, studies have demonstrated that without concurrent treatment of HIV, up to 50% of persons with HIV who develop TB will die during the 6- to 8-month course of TB treatment, many of them in the first 2 to 3 months (3,4). When patients with TB and HIV are treated with ART and prophylactic therapy for opportunistic infections as recommended (5), the proportion of patients who die during TB treatment can be reduced to less than 10% (4). Recent research from New York City showed acceptable TB treatment success in patients with TB and HIV only when they received ART and directly observed therapy (6), underscoring the critical
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Please note: An erratum has been published for this issue. To view the erratum, please click here. MMWR Morbidity and Mortality Weekly Report
TABLE. Number/sample and percentage of tuberculosis patients with a recorded HIV test result, by selected demographic characteristics United States, 20072008
Characteristic Sex* Male Female Age group (yrs) 04 514 1524 2544 4564 65 Race/Ethnicity Hispanic American Indian/Alaska Native Asian/Pacific Islander Black, non-Hispanic Native Hawaiian White, non-Hispanic Origin Foreign-born U.S.-born No. 8,246/10,081 4,568/6,019 102/201 95/144 1,771/1,961 4,938/5,543 4,085/4,998 1,824/3,253 3,591/4,254 168/215 2,571/3,533 4,186/4,847 72/95 2,154/3,056 7,077/8,778 5,713/7,275 (%) (82) (76) (51) (66) (90) (89) (82) (56) (84) (78) (73) (86) (76) (70) (81) (79)
What is already known on this topic? Data from resource-limited settings demonstrate a strong association between HIV infection and death among patients with TB; however, the effect of the HIV epidemic on patients with TB has not been wellcharacterized in the United States. What is added by this report? The findings in this report show that mortality among patients with TB and HIV has decreased substantially in the United States since highly active antiretroviral therapy became widely available, and in conjunction with increased HIV testing of patients with TB; however, in 2006, nearly one quarter of patients with TB still had unknown HIV status, and nearly 20% of patients with TB and HIV died. What are the implications for public health practice? Mortality among patients with TB in the United States likely will be reduced by increasing the proportion of patients with TB tested for HIV, improving screening for TB among those known to be HIV infected, initiating early treatment for both diseases, and stepping up efforts to prevent TB. In addition, a better understanding of causes of death would further improve practice.
* Two patients had missing data for sex; both were tested for HIV. Two patients had missing data for age; one was tested for HIV. Forty-four patients were listed as multiple race/ethnicity; 36 (82%) were tested for HIV. Fifty-eight patients had missing data for race/ ethnicity; 38 (66%) were tested for HIV. Forty-nine patients had missing data for origin; 26 (53%) were tested for HIV.
importance of these two treatment modalities. In this analysis, mortality declined steeply among patients with TB and HIV after highly active ART became widely available during 19951996. Data such as ART use, CD4 count, and specific cause of death are not reported to NTSS, and the impact of each of these could not be directly assessed; however, highly active ART use likely was an important factor in reducing mortality and, of course, can only be provided to those whose HIV infection is known. A substantial proportion of culture-confirmed TB diagnoses among persons with either documented HIV infection or unknown HIV status were made postmortem. Research has demonstrated that when patients with TB and HIV die from TB, it is often because diagnosis is delayed (7), and these deaths might have been prevented if TB disease had been diagnosed and treated earlier. Screening persons with HIV for TB at regular intervals in accordance with current recommendations (8) allows for earlier diagnosis and treatment of TB and has been shown to lower mortality (9).
Treatment of latent TB infection and use of ART have been shown to substantially reduce the risk for TB disease in persons with HIV (10). Increasing HIV testing of the general population will help identify those for whom early ART initiation and treatment of latent TB infection might prevent TB before it develops (10). The findings in this report are subject to at least two limitations. First, California accounts for approximately 20% of the patients with TB in the United States, and excluding those data might affect generalizability if those patients differed from other patients with TB in key ways. Second, outcome data were missing for 10% of all patients included in this analysis, and NTSS does not document cause of death for those who died; knowledge of mortality concerning these patients is limited. Much progress has been made in reducing mortality among patients with TB and HIV in the United States since 1993. Further reductions in mortality can be achieved by enhanced TB and HIV program collaboration and service integration, including 1) providing HIV testing to all patients with TB; 2) screening all persons with HIV for TB disease and infection regularly; and 3) providing early and
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appropriate TB and HIV treatment to all patients with TB and HIV. States and local health-care organizations should analyze their own data to determine how to best target interventions aimed at increasing HIV testing. In addition, studying the specific causes of death in patients with TB and HIV would facilitate development of additional measures to decrease the risk for death.
Additional
information available at http://www.who.int/hiv/pub/ tb/tbhiv/en/index.html.
References
1. World Health Organization. Global tuberculosis control 2010. Geneva, Switzerland: World Health Organization; 2010. Available at http://www.who.int/tb/publications/ global_report/2010. Accessed on November 19, 2010. 2. CDC. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR 2006;55(No. RR-14). 3. Mukadi YD, Maher D, Harries A. Tuberculosis case fatality rates in high HIV prevalence populations in sub-Saharan Africa. AIDS 2001;15:14352.
4. Manosuthi W, Chottanapand S, Thongyen S, Chaovavanich A, Sungkanuparph S. Survival rate and risk factors of mortality among HIV/tuberculosis-coinfected patients with and without antiretroviral therapy. J Acquir Immune Defic Syndr 2006;43:426. 5. Sterling TR, Pham PA, Chaisson RE. HIV infection-related tuberculosis: clinical manifestations and treatment. Clin Infect Dis 2010;50(Suppl 3):S22330. 6. King L, Munsiff SS, Ahuja SD. Achieving international targets for tuberculosis treatments success among HIVpositive patients in New York City. Int J Tuberc Lung Dis 2010;14:161320. 7. Cain KP, Anekthananon T, Burapat C. Causes of death in HIV-infected persons who have tuberculosis, Thailand. Emerg Infect Dis 2009;15:25864. 8. CDC. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR 2009;58(No. RR-4). 9. Reid A, Scano F, Getahun H. Towards universal access to HIV prevention, treatment, care, and support: the role of tuberculosis/HIV collaboration. Lancet Infect Dis 2006;6:48395. 10. Akolo C, Adetifa I, Shepperd S, Volmink J. Treatment of latent tuberculosis infection in HIV infected persons. Cochrane Database Syst Rev 2010;Jan 20:CD000171.
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HIV Testing and Treatment Among Tuberculosis Patients Kenya, 20062009

In resource-limited settings, high case-fatality rates are seen among tuberculosis (TB) patients with human immunodeficiency virus (HIV) infection, especially during the early months of TB treatment (1). HIV prevalence among TB patients has been estimated to be as high as 80%90% in some areas of sub-Saharan Africa (2). In 2004, the World Health Organization (WHO) recommended increasing collaboration between HIV and TB programs (3). Since then, many countries, including Kenya, have worked to increase TB/HIV collaborative activities. In 2005, the Kenya Division of Leprosy, Tuberculosis, and Lung Disease (DLTLD) added questions regarding HIV testing and treatment to the existing TB surveillance system.* This report summarizes HIV data collected from Kenyas extended TB surveillance system during 20062009. During this period, HIV testing among TB patients increased from 60% in 2006 to 88% in 2009, and the prevalence of HIV infection among TB patients tested decreased from 52% to 44%. In 2009, 92% of HIV-infected TB patients received cotrimoxazole prophylaxis for the prevention of opportunistic infections (4). Although these data highlight the increase in HIV services provided to TB patients, only 34% of HIV-infected TB patients started antiretroviral therapy (ART) while being treated for TB. Innovative interventions are needed to increase HIV treatment among TB patients in Kenya, especially considering the 2009 WHO guidelines recommending that all HIV-infected TB patients be started on ART as soon as possible, regardless of CD4 count (5). Although these guidelines have not yet been implemented in Kenya, officials are working to identify methods of increasing access to ART for TB patients. In 2004, the Kenya Ministry of Health (which in 2008 became the Ministry of Public Health and Sanitation [MOPHS]) established the TB/HIV Coordinating Committee to help develop policy and guidance for implementation of TB/HIV collaborative activities. The committee recommended using the existing national TB program infrastructure to
* Available at http://www.nltp.co.ke/docs/annual_report_2007.pdf.
expand HIV counseling and testing services to TB patients. In addition, the committee recommended using provider-initiated testing and counseling, an opt-out model in which HIV testing is performed routinely unless the patient declines. Because cotrimoxazole prophylaxis has been shown to reduce opportunistic infections and to decrease morbidity and mortality for HIV-infected TB patients, the committee recommended that TB clinics offer cotrimoxazole prophylaxis to all HIV-infected TB patients (i.e., those with documentation of a positive HIV test result in the facility TB register) (6). Finally, the committee recommended that HIV-infected patients be referred to separate HIV care and treatment clinics for additional HIV care and evaluation for eligibility for ART. DLTLD is responsible for overseeing clinical activities at approximately 2,200 TB diagnostic and treatment facilities and for collecting routine surveillance data. Provincial and district TB/leprosy coordinators manage the network of TB facilities. District coordinators receive quarterly reports regarding all patients with active TB disease who are newly registered (i.e., currently diagnosed with active TB disease and receiving TB treatment) at each TB clinic, compile this information into quarterly aggregate district reports, and then forward the reports to the provincial coordinators, who submit the information to DLTLD. In 2005, DLTLD added key HIV-related information to the local TB facility register and the districtlevel reporting forms: HIV testing status for TB patients, HIV test results, and receipt of cotrimoxazole prophylaxis, which are available directly from TB clinic records, and information about ART during
HIV
testing in Kenya follows an established algorithm that involves parallel or serial testing with two rapid HIV tests. If the two tests have discordant results, a third confirmatory test (rapid test or other confirmatory test) is used as a tie-breaker. Rapid test results are provided to the patient on the same day that the test was conducted. In Kenya, HIV-infected patients are eligible for ART if they have 1) a CD4 count of <200 cells/mm3, 2) a CD4 count of 200350 cells/mm3 and WHO stage III disease, or 3) WHO stage IV disease (regardless of CD4 count).
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TB treatment, which generally is based on patient reports of care received at separate HIV clinics (8). By January 1, 2006, all TB districts in Kenya had added these HIV variables to the routine TB surveillance reporting forms. For this report, data collected through the extended TB surveillance system during 20062009 were analyzed. From 2006 to 2009, the total number of newly registered TB patients reported each year decreased 5%, from 115,234 to 110,015 (Table). The prevalence of HIV testing among TB patients increased from 60% (of 115,234 patients) to 88% (of 110,015 patients), and the prevalence of HIV infection among TB patients tested decreased from 52% (of 69,337 tested) in 2006 to 44% (of 96,280 tested) in 2009. In 2009, HIV prevalence among TB patients varied widely by province, ranging from 5% in North Eastern Province to 70% in Nyanza Province (Figure). Provision of cotrimoxazole prophylaxis to HIVinfected TB patients remained high throughout this period; 87% received cotrimoxazole in 2006, and 92% in 2009. During the same period, the percentage of HIV-infected TB patients receiving ART increased from 26% to 34% (Table).
Reported by
What is already known on this topic? TB is the leading cause of mortality worldwide for persons living with HIV infection, and HIV prevalence among TB patients in sub-Saharan Africa is estimated to be as high as 80%90%. What is added by this report? Data from Kenya indicate increases in HIV testing among TB patients from 60% in 2006 to 88% in 2009; cotrimoxazole prophylaxis for opportunistic infections was provided to 92% of HIV-infected TB patients in 2009, but only 34% received potentially life-saving therapy with antiretroviral drugs during TB treatment. What are the implications for public health practice? Efforts to reach HIV-infected TB patients through national TB programs can be successful, but TB/ HIV collaborative efforts must be strengthened to increase use of antiretroviral therapy among these patients.
J Sitienei, MD, H Kipruto, Kenya Div of Leprosy, Tuberculosis, and Lung Disease, Ministry of Public Health and Sanitation. L Nganga, MD, M Ackers, MD, J Odhiambo, MD, Global AIDS Program (Kenya). K Laserson, ScD, Center for Global Health, Kenya. AK Nakashima, MD, Global AIDS Program (Atlanta); S Modi, MD, EIS Officer, CDC.
Editorial Note
Within 5 years of the addition of HIV activities to the countrys TB program, 88% of TB patients in Kenya were tested for HIV, and 92% of HIV-infected TB patients received cotrimoxazole prophylaxis in
TB clinical settings. Elsewhere in sub-Saharan Africa, success with HIV testing of TB patients varies widely; Malawi tests approximately 80% of TB patients, but estimates of testing are lower in Uganda (60%), Zambia (60%), and South Africa (40%) (CDC, unpublished data, 2010). HIV testing and clinical services in Kenya historically have been provided through the National AIDS and STI Control Programme. However, the findings in this report show that DLTLD has been successful in providing key HIV services within the existing TB program infrastructure. Multiple actions were critical to achieving this success, including establishment of the TB/HIV Coordinating Committee, which assisted with development of national guidelines for HIV testing in 2004 and promoted provider-initiated testing and counseling in multiple health-care settings (7). Provider-initiated testing and counseling has been shown to increase the proportion of patients tested when compared with traditional opt-in models in
TABLE. HIV testing and care and treatment services among newly registered TB patients* Kenya, 20062009
2006 (N = 115,234) HIV testing/Services Tested for HIV HIV infected Receiving CTX prophylaxis Receiving ART No. 69,337 36,136 31,438 9,395 (%) (60%) (52%) (87%) (26%) 2007 (N = 116,723) No. 91,841 43,954 37,800 11,867 (%) (79%) (48%) (86%) (27%) 2008 (N = 110,251) No. 91,463 41,174 37,757 12,426 (%) (83%) (45%) (92%) (30%) 2009 (N = 110,015) No. 96,280 42,210 38,989 14,259 (%) (88%) (44%) (92%) (34%)
Abbreviations: HIV = human immunodeficiency virus; TB = tuberculosis; CTX = cotrimoxazole; ART = antiretroviral therapy. * All patients who are currently diagnosed with active TB disease and are receiving TB treatment.
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FIGURE. Prevalence of HIV infection among newly registered TB patients,* by province Kenya, 2009
Sudan Ethiopia
Eastern Uganda Rift Valley Western Central North Eastern Somalia
Lake Victoria
Nyanza
Tanzania 50%
Nairobi Coast Indian Ocean
41%50% 31%40% 21%30% 20%
Abbreviations: HIV = human immunodeficiency virus; TB = tuberculosis. * All patients who are currently diagnosed with active TB disease and are receiving TB treatment.
which patients must request HIV testing (2). As HIV testing among newly registered TB patients increased, the prevalence of HIV among TB patients decreased, indicating that providers might have targeted early testing efforts to patients at greater risk for HIV (8). Overall, HIV prevalence among newly registered TB patients remains high, particularly in Nyanza Province (70%). In addition to strong commitment to TB/HIV collaborative activities at the national level in Kenya, local leaders have been recruited to form regional TB/HIV coordinating bodies to translate national policy into action. These regional bodies implemented continuing medical education modules to promote provider-initiated testing and counseling and cotrimoxazole prophylaxis for HIV-infected patients as standard interventions in all TB clinical settings. Financial support from international donors including the U.S. Presidents Emergency Plan for AIDS Relief (PEPFAR), WHO, and the Global Fund to Fight
AIDS, Tuberculosis, and Malaria also has been critical to the success of TB/HIV collaborative efforts. This funding has allowed MOPHS to hire additional staff members to support TB/HIV collaborative activities, and to ensure an uninterrupted supply of HIV rapid test kits, cotrimoxazole prophylaxis, ART, and monitoring and evaluation tools. Despite these efforts, provision of ART to persons with HIV during TB treatment remains at only 34%. Data from the region indicate that more than 90% of HIV-infected TB patients in Kenya likely meet the countrys CD4 count criteria for initiating ART (8), underscoring a large unmet need for treatment in this population. The findings in this report are subject to at least two limitations. First, the number of HIV-infected TB patients receiving ART might have been underestimated. Some HIV-infected TB patients might have received ART late in TB treatment or after the end of TB treatment, and this information might not be captured by the extended TB surveillance system. No formal mechanism exists for transmitting information from the HIV clinic that provides ART to the TB clinic that reports these data. Second, this report relies on surveillance data, which often are subject to reporting delays and might not reflect the most recent program performance. Initiation of ART for persons with HIV during TB treatment has been shown to reduce mortality by approximately 50% (9). In 2009, WHO recommended that all HIV-infected TB patients be started on ART regardless of CD4 count (5). Although Kenyas ART-eligibility criteria have not yet been changed, MOPHS has been working to identify methods of increasing access to ART for TB patients. Integration of HIV testing and cotrimoxazole provision into TB clinics in Kenya has resulted in increases in testing and cotrimoxazole prophylaxis. Similar increases might result with ART if offered within the TB clinic and not at another clinical site. One high-volume TB clinic in rural Kenya has integrated provision of ART into the clinic, resulting in a fourfold increase in ART initiation among HIV-infected TB patients (10). Additional strategies are needed to improve access to ART and strengthen linkages between TB clinics and HIV clinics to improve outcomes for HIV-infected TB patients.
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References
1. CDC. Mortality among patients with tuberculosis and associations with HIV statusUnited States, 19932008. MMWR 2010;59:150913. 2. CDC. Provider-initiated HIV testing and counseling of TB patientsLivingstone District, Zambia, September 2004December 2006. MMWR 2008;57:2859. 3. World Health Organization. Interim policy on collaborative TB/HIV activities. Geneva, Switzerland: World Health Organization; 2004. Available at http://whqlibdoc.who. int/hq/2004/who_htm_tb_2004.330_eng.pdf. Accessed November 22, 2010. 4. World Health Organization. Guidelines on co-trimoxazole prophylaxis for HIV-related infections among children, adolescents, and adults: recommendations for a public health approach. Geneva, Switzerland: World Health Organization; 2006. Available at http://www.who.int/entity/hiv/pub/ guidelines/ctxguidelines.pdf. Accessed November 22, 2010. 5. World Health Organization. Rapid advice: antiretroviral therapy for HIV infection in adolescents and adults. Geneva, Switzerland: World Health Organization; 2009. Available at http://www.who.int/entity/hiv/pub/arv/rapid_advice_art. pdf. Accessed November 22, 2010.
6. Chakaya JM, Mansoer JR, Scano F, et al. National scale-up of HIV testing and provision of HIV care to tuberculosis patients in Kenya. Int J Tuberc Lung Dis 2008;12:4249. 7. Republic of Kenya Ministry of Health. National AIDS and STI Control Programme: guidelines for HIV testing in clinical settings. Nairobi, Kenya: Republic of Kenya Ministry of Health; 2004. 8. Teck R, Ascurra O, Gomani P, et al. WHO clinical staging of HIV infection and disease, tuberculosis, and eligibility for antiretroviral treatment: relationship to CD4 lymphocyte counts. Int J Tuberc Lung Dis 2005;9:25862. 9. Abdool Karim SS, Naidoo K, Grobler A, et al. Timing of initiation of antiretroviral drugs during tuberculosis therapy. N Engl J Med 2010;362:697706. 10. Huerga H, Spillan H, Guerrero W, Odongo A, Varaine F. Impact of introducing human immunodeficiency virus testing, treatment, and care in a tuberculosis clinic in rural Kenya. Int J Tuberc Lung Dis 2010;14:6115.
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Racial Disparities in Smoking-Attributable Mortality and Years of Potential Life Lost Missouri, 20032007
An estimated 443,000 deaths in the United States occur each year as a result of cigarette smoking and exposure to secondhand smoke (1). These deaths cost the nation approximately $97 billion in lost productivity and $96 billion in health-care costs (1). During 20002004 in Missouri, smoking caused 9,600 deaths, 132,000 years of potential life lost (YPLL), $2.4 billion in productivity losses, and $2.2 billion in smoking-related health-care expenditures annually (2). To limit the adverse health consequences of tobacco use, states implement comprehensive tobacco control programs that identify disparities among population groups and target those disproportionately affected by tobacco use (3). This report compares the public health burden of smoking among whites and blacks in Missouri by estimating the number of smoking-attributable deaths and YPLL in these population subgroups during 20032007. The findings indicate that the average annual smoking-attributable mortality (SAM) rate in the state was 18% higher for blacks (338 deaths per 100,000) than for whites (286 deaths per 100,000). The relative difference in smoking-attributable mortality rates between blacks and whites was larger for men (28%) than women (11%). For Missouri, these estimates provide an important benchmark for measuring the success of tobacco control programs in decreasing the burden of smoking-related diseases in these populations and reaffirm the need for full implementation of the states comprehensive tobacco control program (3). The adult module of CDCs Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC) system* was used to calculate the SAM and YPLL rates for 19 disease categories. Five-year average annual SAM and YPLL rates were computed from annual
* Available at http://apps.nccd.cdc.gov/sammec. Based on International Classification of Diseases, 10th Revision coding, including the following: malignant neoplasms: lip, oral cavity, pharynx (C00C14), esophagus (C15), stomach (C16), pancreas (C25), larynx (C32), trachea, lung, bronchus (C33C34), cervix uteri (C53), kidney and renal pelvis (C64C65), urinary bladder (C67), and acute myeloid leukemia (C92.0); circulatory diseases: ischemic heart disease (I20I25), other heart disease (I00I09, I26I51), cerebrovascular disease (I00I69), atherosclerosis (I70I71), aortic aneurysm (I71), and other arterial disease (I72I78); respiratory diseases: pneumonia, influenza (J10J18), bronchitis, emphysema (J40J42, J43), and chronic airway obstruction (J44).
reports generated through SAMMEC. These estimates only cover deaths among persons aged 35 years. Deaths attributable to secondhand smoke or from smoking-related fires were not included. Sex-, race-, and age-specific smoking-attributable deaths were calculated by multiplying the total number of deaths in each of the 19 disease categories by the estimate of the smoking-attributable fraction (SAF) of deaths for each demographic group. These deaths were then grouped into three cause-of-death categories (malignant neoplasm, circulatory disease, and respiratory disease). Both races were assumed to have the same relative risk for dying from a particular disease among the 19 disease categories attributable to smoking. Missouri data for 20032007 from the Behavioral Risk Factor Surveillance System (BRFSS) were used to estimate the age-, sex-, and race-specific annual prevalence of current and former smoking in the state. Missouri death records for 20032007 were used to calculate the age-, sex-, race-, and disease-specific number of deaths each year (4). The life expectancy (average remaining years of life) by age group and sex was calculated using the abridged life table,** and absolute and relative disparity indexes were computed for each smokingrelated disease category (Tables 13) comparing SAM rates for blacks to SAM rates for whites. T-tests were used to evaluate the statistical significance (p0.05) of differences in SAM/YPLL rates between blacks and whites for the three major disease categories and major diseases. During 20032007, smoking caused an estimated average of 9,377 deaths (8,400 among whites and 853 among blacks) annually among adults in Missouri
SAFs for each disease were calculated by using the following equation: SAF = [(p1(RR1) 1) + p2(RR2 1)] / [p1(RR1 1) + p2(RR2 1) + 1] where p1 = percentage of current smokers (persons who have smoked 100 cigarettes and now smoke every day or some days), p2 = percentage of former smokers (persons who have smoked 100 cigarettes and do not currently smoke), RR1 = relative risk for current smokers relative to never smokers, and RR2 = relative risk for former smokers relative to never smokers. Available at http://www.cdc.gov/brfss/index.htm. ** Available at http://www.dhss.mo.gov/VitalStatistics. Absolute disparity = (SAM or YPLL) blacks - (SAM or YPLL) whites; relative disparity = {[(SAM or YPLL) blacks - (SAM or YPLL) whites] / (SAM or YPLL) whites} 100. Number of smoking-attributable deaths for groups other than blacks and whites could not be estimated because of small numbers; 99.5% of deaths occurred among blacks and whites.
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TABLE 1. Average annual smoking-attributable deaths among persons aged 35 years, by cause of death,* sex, and race SAMMEC, Missouri, 20032007
Smoking-attributable deaths Among all Missouri residents Cause of death (ICD-10 code) Total Malignant neoplasm Trachea, lung, bronchus (C33C34) Circulatory diseases Ischemic heart disease (I20I25) Respiratory diseases Chronic airway obstruction (J44) Male 5,642 2,561 1,984 1,780 1,138 1,301 1,013 Female 3,735 1,374 1,165 1,147 670 1,214 987 Total 9,377 3,935 3,149 2,927 1,808 2,515 2,000 Male 5,071 2,291 1,784 1,554 1,002 1,227 958 White Female 3,329 1,206 1,031 982 577 1,141 932 Total 8,400 3,497 2,815 2,536 1,579 2,367 1,890 Male 523 253 186 200 119 70 51 Black Female 329 134 110 136 77 58 45 Total 853 387 297 336 197 128 96
Abbreviation: SAMMEC = Smoking-Attributable Mortality, Morbidity, and Economic Costs system. * Based on International Classification of Diseases, 10th Revision coding, including the following: malignant neoplasms: lip, oral cavity, pharynx (C00C14), esophagus (C15), stomach (C16), pancreas (C25), larynx (C32), trachea, lung, bronchus (C33C34), cervix uteri (C53), kidney and renal pelvis (C64C65), urinary bladder (C67), and acute myeloid leukemia (C92.0); circulatory diseases: ischemic heart disease (I20I25), other heart disease (I00I09, I26I51), cerebrovascular disease (I00I69), atherosclerosis (I70I71), aortic aneurysm (I71), and other arterial disease (I72I78); respiratory diseases: pneumonia, influenza (J10J18), bronchitis, emphysema (J40J42, J43), and chronic airway obstruction (J44). The two races, black and white, constitute >96% of the population of Missouri. Number of smoking-attributable deaths for groups other than blacks and whites could not be estimated because of small numbers; 99.5% of deaths occurred among blacks and whites. Based on 5-year annual average for 20032007. Does not include smoking-related fire deaths or secondhand smoke deaths.
TABLE 2. Average annual SAM rates among persons aged 35 years, by cause of death,* sex, and race, and racial disparity indexes SAMMEC, Missouri, 20032007
SAM rates (per 100,000 population) All Missouri residents Cause of death (ICD-10 code) Total (per 100,000 population) Malignant neoplasm Trachea, lung, bronchus (C33C34) Circulatory diseases Ischemic heart disease (I20I25) Respiratory diseases Chronic airway obstruction (J44) Male Female Total 421 186 144 133 83 102 79 196 76 65 57 34 63 51 289 123 99 89 55 78 62 417 183 143 128 81 105 82 White Male Female Total 193 75 64 54 32 65 53 286 121 98 85 53 80 64 536 253 186 200 118 82 60 Black Male Female Total 215 89 73 87 50 40 30 338 153 117 130 76 54 41 Racial disparity index Absolute disparity Male Female Total 119 70 43 72 37 -23 -22 22 14 9 33 18 -25 -23 52 32 20 45 23 -26 -23 Relative disparity (%) Male Female Total (28) (38) (30) (56) (45) (-22) (-27) (11) (19) (15) (61) (56) (-39) (-43) (18) (26) (20) (53) (44) (-32) (-36)
Abbreviations: SAM = smoking-attributable mortality; SAMMEC = Smoking-Attributable Mortality, Morbidity, and Economic Costs system; YPLL = years of potential life lost. * Based on International Classification of Diseases, 10th Revision coding, including the following: malignant neoplasms: lip, oral cavity, pharynx (C00C14), esophagus (C15), stomach (C16), pancreas (C25), larynx (C32), trachea, lung, bronchus (C33C34), cervix uteri (C53), kidney and renal pelvis (C64C65), urinary bladder (C67), and acute myeloid leukemia (C92.0); circulatory diseases: ischemic heart disease (I20I25), other heart disease (I00I09, I26I51), cerebrovascular disease (I00I69), atherosclerosis (I70I71), aortic aneurysm (I71), and other arterial disease (I72I78); respiratory diseases: pneumonia, influenza (J10J18), bronchitis, emphysema (J40J42, J43), and chronic airway obstruction (J44). The two races, black and white, constitute >96% of the population of Missouri. Number of smoking-attributable deaths for groups other than blacks and whites could not be estimated because of small numbers; 99.5% of deaths occurred among blacks and whites. Based on 5-year annual average for 20032007. Does not include smoking-related fire deaths or secondhand smoke deaths. Absolute disparity = (SAM or YPLL) blacks - (SAM or YPLL) whites; relative disparity = {[(SAM or YPLL) blacks - (SAM or YPLL) whites] / (SAM or YPLL) whites} 100. The difference in the SAM/YPLL rates of blacks and whites is statistically significant by t-test (p0.05) for the three categories and major diseases.
(Table 1). An estimated 18.1% of deaths among persons aged 35 years in Missouri were the result of cigarette smoking (total number of deaths for this age group was 51,856). Smoking caused 32.1% of all deaths from cancer, 15.3% of all circulatory deaths, and 46.5% of all respiratory deaths in Missouri during this period (4). In the cancer category, the major cause of death was cancer of the trachea, lung, or bronchus; in the circulatory category, the major cause
was ischemic heart disease; and in the respiratory disease category, the major cause was chronic airway obstruction (Table 1). For both blacks and whites in Missouri, regardless of sex, the leading cause of SAM was cancer, followed by circulatory and respiratory diseases. Although SAM for blacks represented only 9.1% of the total SAM, the SAM rate for blacks in Missouri was 18% higher than for whites (Table 2). This disparity
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TABLE 3. Average annual smoking-attributable YPLL among persons aged 35 years, by cause of death,* sex, and race, and racial disparity indexes SAMMEC, Missouri, 20032007
Smoking-attributable YPLL rates (per 100,000 population) All Missouri residents Cause of death (ICD-10 code) Malignant neoplasm Trachea, lung, bronchus (C33C34) Circulatory diseases Ischemic heart disease (I20I25) Respiratory diseases Chronic airway obstruction (J44) Male Female Total 4,301 1,952 1,563 1,393 896 957 765 2,676 2,054 1,952 1,310 1,113 864 1,366 1,170 925 538 856 704 Total (per 100,000 population) 5,741 3,147 White Male Female Total 5,720 3,136 2,664 2,056 1,887 1,288 1,169 910 1,354 1,169 870 518 912 756 4,292 1,944 1,565 1,336 877 1,013 814 Black Male Female Total 7,165 3,601 3,461 2,534 2,820 1,690 884 640 1,519 1,264 1,527 812 555 428 5,048 2,313 1,782 2,058 1,181 677 506 Racial disparity index Absolute disparity Male Female Total 1,445 796 478 934 402 -285 -270 465 165 95 656 294 -357 -328 756 369 216 723 304 -336 -308 Relative disparity (%) Male Female Total (25) (30) (23) (49) (31) (-24) (-30) (15) (12) (8) (75) (57) (-39) (-43) (18) (19) (14) (54) (35) (-33) (-38)
Abbreviations: SAM = smoking-attributable mortality; SAMMEC = Smoking-Attributable Mortality, Morbidity, and Economic Costs system; YPLL = years of potential life lost. * Based on International Classification of Diseases, 10th Revision coding, including the following: malignant neoplasms: lip, oral cavity, pharynx (C00C14), esophagus (C15), stomach (C16), pancreas (C25), larynx (C32), trachea, lung, bronchus (C33C34), cervix uteri (C53), kidney and renal pelvis (C64C65), urinary bladder (C67), and acute myeloid leukemia (C92.0); circulatory diseases: ischemic heart disease (I20I25), other heart disease (I00I09, I26I51), cerebrovascular disease (I00I69), atherosclerosis (I70I71), aortic aneurysm (I71), and other arterial disease (I72I78); respiratory diseases: pneumonia, influenza (J10J18), bronchitis, emphysema (J40J42, J43), and chronic airway obstruction (J44). The two races, black and white, constitute >96% of the population of Missouri. Number of smoking-attributable deaths for groups other than blacks and whites could not be estimated because of small numbers; 99.5% of deaths occurred among blacks and whites. Based on 5-year annual average for 20032007. Does not include smoking-related fire deaths or secondhand smoke deaths. Absolute disparity = (SAM or YPLL) blacks - (SAM or YPLL) whites; relative disparity = {[(SAM or YPLL) blacks - (SAM or YPLL) whites] / (SAM or YPLL) whites} 100. The difference in the SAM/YPLL rates of blacks and whites is statistically significant by t-test (p0.05) for the three categories and major diseases.
was larger (28%) for black men than for black women (11%). SAM rates for blacks were 26% higher than for whites for malignant neoplasm and 53% higher for circulatory diseases but 32% lower for respiratory diseases. The smoking-attributable YPLL rate for blacks also was 18% higher than for whites and differed most for men. Black men had a YPLL rate 25% higher than white men, and the rate for black women was 15% higher than for white women (Table 3). Similar to the SAM results, the YPLL rates for the three major disease categories showed that the YPLL rates for blacks were higher than for whites for malignant neoplasm and circulatory diseases but lower for respiratory diseases. The YPLL rate resulting from smoking-related cancer deaths for blacks was 19% higher than for whites, but 26% higher for the SAM rate. For circulatory deaths, the YPLL rate for blacks was 54% higher, similar to the disparity in the SAM rate (53%). For respiratory diseases, the YPLL rate for blacks was 33% lower than for whites, and similarly, 32% lower for the SAM rate. For specific diseases, blacks had a 14% higher YPLL rate for lung cancer, 35% higher rate for ischemic heart disease, and 38% lower rate for chronic airway obstruction than whites.
Reported by
N Kayani, PhD, SG Homan, PhD, S Yun, MD, PhD, Missouri Dept of Health and Senior Svcs. A Malarcher, PhD, Office on Smoking and Health, CDC.
Editorial Note
This is the first study to provide data on racial disparities in SAM and YPLL using SAMMEC. These data are valuable for Missouris tobacco control program for documenting and evaluating changes in tobacco-related racial disparities in the state. Additional studies are needed to explain why Missouri blacks are more likely to die from smokingrelated cancers and circulatory diseases than whites, but less likely to die from smoking-related respiratory diseases. Variations in smoking-related mortality exist across states and occur because of differences in population demographics and tobacco use. Differences in other tobacco-userelated behaviors, variations in tobacco control programs and policies, and tobacco industry marketing also exist (5). Racial and ethnic disparities in smoking-related morbidity and mortality also are associated with socioeconomic status, cigarette smoking patterns, and differences in biologic and genetic factors; for example, smoking initiation and
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cessation rates vary by race, as does nicotine metabolism and disease outcomes among cigarette smokers (6). Significant racial disparities in SAM existed in Missouri during 20032007, with an average of 52 per 100,000 more black adults dying each year from cigarette smoking than white adults, reflecting an 18% higher SAM rate among blacks than whites. Smoking-attributable YPLL also were 18% higher among blacks than whites. SAM during 20032007 reflects smoking patterns of the past 40 years. Although the smoking prevalence among blacks and whites in Missouri fluctuated during the past 2 decades, blacks tended to have a higher smoking prevalence than whites. The amount and duration of smoking and brands or types of cigarettes used also could contribute to disparities (7,8). However, data on these types of smoking patterns were not captured in Missouris tobacco use surveillance systems. More research is needed to explore the causes of these disparities. Smoking prevalence declined by 26.3% among white adults and 25.8% among black adults in Missouri during 19952009. In 2009, the smoking prevalence was 27.1% among black adults and was 22.1% among white adults. Among youths, smoking prevalence in Missouri declined during 19952009, to 19.4% in whites and 15.7% in blacks. During the entire period, smoking prevalence among black young adults (aged 1824 years) remained lower than for white young adults, but the prevalence of smoking among persons aged 3544 years of either race was similar. The late initiation of tobacco use among black youths and black young adults suggests that the current racial disparities in smoking-associated morbidity and mortality in Missouri might change in the future; continued surveillance of youth and young adult smoking is needed because of this later initiation of smoking among blacks. Continued implementation of effective population-based tobacco control interventions that discourage initiation and increase cessation among youths and adults also is needed to prevent smoking-related morbidity and mortality in the next several decades (3,8). In 2006, the Missouri Comprehensive Tobacco Use Prevention Program identified disparities in tobacco use, and the state disparities work group created a strategic plan for addressing the identified
What is already known on this topic? Although disparities in smoking prevalence among blacks and whites are well documented, no study has shown differences in health outcomes in terms of smoking-attributable mortality (SAM). What is added by this report? Using 20032007 Missouri data and attributable risk calculations, this study identified significant racial disparities in SAM, with an average of 52 per 100,000 more black adults dying each year from cigarette smoking than white adults, reflecting an 18% larger SAM rate among blacks than whites. What are the implications for public health practice? States should continue to implement populationwide tobacco control interventions (e.g., quitlines, smoke-free policies, and increased excise taxes on tobacco products) that reach all racial groups, and implement targeted strategies for high-risk groups to decrease disparities in tobacco use and related mortality.
disparities. The plan was incorporated into Missouris 20062009 and 20102014 comprehensive tobacco control plans. The Missouri Comprehensive Tobacco Control Program supports the Missouri Tobacco Quitline to help smokers (especially low-income smokers) quit smoking, and hosts a website that can assist public health agencies in developing interventions to reduce the health impact of and disparities in tobacco use.*** The quitline will continue to play a role in reducing racial disparities in smoking and smoking-related morbidity and mortality in Missouri. An analysis of 20052009 Missouri quitline data showed that slightly higher percentages of black smokers than white smokers were calling the quitline; black smokers comprised 12.6% of all smokers, but the quitline received 14.0% of all calls from black smokers. The findings of this report are subject to at least four limitations. First, SAMMEC uses estimates of current years smoking to estimate SAM; however, current prevalence estimates do not adequately reflect smoking patterns in past decades when the smoking prevalence was higher. These estimates also do not account for deaths associated with cigar and pipe smoking, the use of smokeless tobacco, secondhand smoke, smoking-related fires, and deaths among persons aged <35 years. Second, SAM rates for groups
*** Available at http://www.dhss.mo.gov/CHIR.
Available at http://apps.nccd.cdc.gov/youthonline/app/ questionsorlocations.aspx?categoryid=2.
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other than blacks and whites in Missouri could not be estimated accurately because of the small numbers of deaths; however, 99.5% of deaths from the 19 disease categories considered in this report were among blacks and whites. Third, the same relative risks for dying from a particular disease among the 19 disease categories attributable to smoking for current and former smokers were used for blacks and for whites, although relative risk might be different between blacks and whites. Preferences for types and brands of cigarettes as well as smoking intensity and duration differ between white and blacks and might result in differing relative risks. Finally, relative risk was adjusted for the effects of age but not for other potential confounders. However, research suggests that education, alcohol use, and other confounders had negligible additional effects on SAM estimates for lung cancer, chronic obstructive pulmonary disease, ischemic heart disease, and cerebrovascular disease (9). Effective population-wide interventions (e.g., increasing the price of tobacco products through excise tax and implementing smoke-free policies) appear to reach all segments of the population; however, targeted strategies might still be needed for certain high-risk groups (e.g., persons with lower socioeconomic status or educational attainment) to reduce disparities (3,10). Race-specific SAM measures and race-specific trends in youth and adult smoking prevalence can be used to document and assess progress in eliminating tobacco-related disparities within a state.
References
1. CDC. Smoking-attributable mortality, years of potential life lost, and productivity lossesUnited States, 20002004. MMWR 2008;57:12268. 2. Kayani N, Yun S, Zhu BP. The health and economic burden of smoking in Missouri, 20002004. Mo Med 2007; 104:2659. 3. CDC. Best practices for comprehensive tobacco control programs2007. Atlanta, GA: US Department of Health and Human Services, CDC; 2007. Available at http://www.cdc. gov/tobacco/tobacco_control_programs/stateandcommunity/ best_practices. Accessed November 18, 2010. 4. Missouri Department of Health and Senior Services. Missouri information for community assessment: death MICA (2003 2007). Jefferson City, MO: Missouri Department of Health and Senior Services; 2008. Available at http://www.dhss.mo.gov/ DeathMICA/index.html. Accessed November 18, 2010. 5. Farrelly M, Pechacek T, Thomas K, Nelson D. The impact of tobacco control programs on adult smoking. Am J Public Health 2008;98:3049. 6. National Institutes of Health State-of-the-Science Panel. National Institutes of Health State-of-the Science conference statement: tobacco use: prevention, cessation, and control. Ann Intern Med 2006;145:83944. 7. CDC. Tobacco use among U.S. racial/ethnic minority groupsAfrican Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 1998. Available at http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_1998. Accessed November 18, 2010. 8. CDC. The health consequences of smoking: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2004. Available at http://www.cdc. gov/tobacco/data_statistics/sgr/2004/index.htm. Accessed November 18, 2010. 9. Thun MJ, Apicella LF, Henley SJ. Smoking vs other risk factors as the cause of smoking-attributable deaths confounding in the courtroom. JAMA 2000;284:70612. 10. Fiore MC, Jaen CR, Baker TB, et al. Treating tobacco use and dependence; 2008 update. Clinical practice guideline. Rockville, MD: US Department of Health and Human Services, Public Health Service; 2008. Available at http:// www.surgeongeneral.gov/tobacco/treating_tobacco_use08. pdf. Accesssed November 18, 2010.
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Announcement
2009 Chronic Disease Epidemiology Capacity: Findings and Recommendations Available Online
The Council of State and Territorial Epidemiologists (CSTE) has released a new report on state-based chronic disease epidemiology capacity in the United States. The report, Chronic Disease Epidemiology Capacity: Findings and Recommendations, an update from the 2004 report (1), provides findings from the 2009 CSTE national assessment (2) and recommendations for improving capacity. The report notes that 53% of jurisdictions (all 50 states and the District of Columbia) reported at least substantial chronic disease epidemiology capacity in 2009 and more quality-level work is being conducted than in previous years. However, nearly half of the jurisdictions lack substantial capacity, and the percentage of jurisdictions with little or no chronic disease epidemiology capacity increased progressively during 20012009. A major recommendation is that improving capacity in jurisdictions with little or no chronic disease epidemiology capacity should be a priority. The report is available online at http://www. cste.org/2009chroniceca.pdf. Additional information or printed copies are available from CSTE by e-mail (jlemmings@cste.org) or telephone (770-458-3811).
References
1. Council of State and Territorial Epidemiologists. National assessment of epidemiologic capacity in chronic disease: findings and recommendations. Atlanta, GA: Council of State and Territorial Epidemiologists; 2004. Available at http://www. cste.org/dnn/LinkClick.aspx?fileticket=A%2flteXZ47NY%3d &tabid=175&mid=716. Accessed November 15, 2010. 2. CDC. Assessment of epidemiology capacity in state health departmentsUnited States, 2009. MMWR 2009;58:13737.
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QuickStats
FROM THE NATIONAL CENTER FOR HEALTH STATISTICS
Infant Mortality Rates* for Single Births, by Age Group of Mother United States, 2006
18
Rate per 1,000 live births
12
Total
<15
1519
2024
2529
3034
3539
4044
45
Age group (yrs)

* Per 1,000 live births.
In 2006, infant mortality rates were highest for mothers in the youngest and oldest age groups. The infant mortality rate for single births to mothers aged <15 years was 16.7 infant deaths per 1,000 live births, approximately three times the rates for mothers aged 2529 years (5.1), 3034 years (4.5), and 3539 years (5.2), the age groups at lowest risk. The infant mortality rate for single births to mothers aged 45 years was 11.46, approximately twice the rate for mothers in the three age groups at lowest risk.
Sources: National Center for Health Statistics. Linked birth/infant death data set, 2006. Available at http://www.cdc.gov/nchs/linked.htm. Mathews TJ, MacDorman MF. Infant mortality statistics from the 2006 period linked birth/infant death data set. Natl Vital Stat Rep 2010;58(17). Available at http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_17.pdf.
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Notifiable Diseases and Mortality Tables

TABLE I. Provisional cases of infrequently reported notifiable diseases (<1,000 cases reported during the preceding year) United States, week ending November 20, 2010 (46th week)*
Current week 3 3 1 1 1 8 1 4 6 4 8 6 1 2 2 1 5 3 6 Cum 2010 87 6 61 20 111 35 5 163 63 10 5 7 14 132 226 56 17 203 58 683 56 211 95 8 352 2,469 3 2 4 104 80 24 1 6 143 189 7 68 4 99 369 81 1 697 1 5-year weekly average 3 1 2 1 2 1 0 1 0 0 0 0 3 3 2 0 4 2 5 15 0 5 3 0 10 30 0 0 0 2 1 0 0 0 1 7 0 1 0 1 4 1 7 Total cases reported for previous years 2009 2008 2007 2006 2005 1 118 10 83 25 115 28 10 141 55 4 6 12 35 236 178 103 20 242 358 851 71 301 174 23 482 1,991 43,774 8 1 9 114 94 20 4 3 2 161 423 18 74 13 93 397 78 1 789 NN 145 17 109 19 80 25 5 139 62 4 2 13 30 244 163 80 18 330 90 759 140 330 188 38 616 454 2 3 8 120 106 14 2 16 157 431 19 71 39 123 449 63 588 NN 1 144 32 85 27 131 23 7 93 55 4 7 9 22 199 180 101 32 292 77 808 43 1 165 20 97 48 121 33 9 137 67 8 1 10 29 175 179 66 40 288 43 884 55 135 19 85 31 120 17 8 543 80 21 1 13 9 135 217 87 26 221 380 45 896 66 297 156 27 765 314 NN 8 1 NN 16 136 2 11 1 129 329 27 90 16 154 324 2 3 NN NN States reporting cases during current week (No.)
Disease Anthrax Botulism, total foodborne infant other (wound and unspecified) Brucellosis Chancroid Cholera Cyclosporiasis Diphtheria Domestic arboviral diseases , : California serogroup virus disease Eastern equine encephalitis virus disease Powassan virus disease St. Louis encephalitis virus disease Western equine encephalitis virus disease Haemophilus influenzae,** invasive disease (age <5 yrs): serotype b nonserotype b unknown serotype Hansen disease Hantavirus pulmonary syndrome Hemolytic uremic syndrome, postdiarrheal HIV infection, pediatric (age <13 yrs) Influenza-associated pediatric mortality , Listeriosis Measles Meningococcal disease, invasive***: A, C, Y, and W-135 serogroup B other serogroup unknown serogroup Mumps Novel influenza A virus infections Plague Poliomyelitis, paralytic Polio virus Infection, nonparalytic Psittacosis Q fever, total , acute chronic Rabies, human Rubella Rubella, congenital syndrome SARS-CoV,**** Smallpox Streptococcal toxic-shock syndrome Syphilis, congenital (age <1 yr) Tetanus Toxic-shock syndrome (staphylococcal) Trichinellosis Tularemia Typhoid fever Vancomycin-intermediate Staphylococcus aureus Vancomycin-resistant Staphylococcus aureus Vibriosis (noncholera Vibrio species infections) Viral hemorrhagic fever Yellow fever See Table I footnotes on next page.
PA (2), WA (1) CA (1) NY (1) FL (1)
NY (2), PA (1), OH (1), NC (1), GA (1), ID (1), CA (1) AR (1) NY (2), MD (1), OK (1)
PA (1), OH (2), FL (1), CA (2)
325 318 167 193 35 32 550 651 800 6,584 4 NN 7 17 NN 12 21 171 169 1 3 12 11 1 132 125 430 349 28 41 92 101 5 15 137 95 434 353 37 6 2 1 549 NN NN NN
NC (1), TX (3)
ME (1), OH (2), FL (1), CO (1), CA (3) OH (2), MI (1), TX (2), CA (1) WI (1)
NY (1), CA (1)
OH (1)
TX (1), CA (4) NY (1), FL (2) MD (1), FL (4), AZ (1)
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TABLE I. (Continued) Provisional cases of infrequently reported notifiable diseases (<1,000 cases reported during the preceding year) United States, week ending November 20, 2010 (46th week)*
: No reported cases. N: Not reportable. NN: Not Nationally Notifiable Cum: Cumulative year-to-date counts. * Case counts for reporting year 2010 are provisional and subject to change. For further information on interpretation of these data, see http://www.cdc.gov/ncphi/disss/nndss/phs/files/ ProvisionalNationa%20NotifiableDiseasesSurveillanceData20100927.pdf. Calculated by summing the incidence counts for the current week, the 2 weeks preceding the current week, and the 2 weeks following the current week, for a total of 5 preceding years. Additional information is available at http://www.cdc.gov/ncphi/disss/nndss/phs/files/5yearweeklyaverage.pdf. Not reportable in all states. Data from states where the condition is not reportable are excluded from this table except starting in 2007 for the domestic arboviral diseases, STD data, TB data, and influenza-associated pediatric mortality, and in 2003 for SARS-CoV. Reporting exceptions are available at http://www.cdc.gov/ncphi/disss/nndss/phs/infdis.htm. Includes both neuroinvasive and nonneuroinvasive. Updated weekly from reports to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases (ArboNET Surveillance). Data for West Nile virus are available in Table II. ** Data for H. influenzae (all ages, all serotypes) are available in Table II. Updated monthly from reports to the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Implementation of HIV reporting influences the number of cases reported. Updates of pediatric HIV data have been temporarily suspended until upgrading of the national HIV/AIDS surveillance data management system is completed. Data for HIV/AIDS, when available, are displayed in Table IV, which appears quarterly. Updated weekly from reports to the Influenza Division, National Center for Immunization and Respiratory Diseases. Since October 3, 2010, one influenza-associated pediatric death occurred during the 201011 influenza season. Since August 30, 2009, a total of 282 influenza-associated pediatric deaths occurring during the 200910 influenza season have been reported. No measles cases were reported for the current week. *** Data for meningococcal disease (all serogroups) are available in Table II. CDC discontinued reporting of individual confirmed and probable cases of 2009 pandemic influenza A (H1N1) virus infections on July 24, 2009. During 2009, four cases of human infection with novel influenza A viruses, different from the 2009 pandemic influenza A (H1N1) strain, were reported to CDC. The three cases of novel influenza A virus infection reported to CDC during 2010 were identified as swine influenza A (H3N2) virus and are unrelated to the 2009 pandemic influenza A (H1N1) virus. Total case counts for 2009 were provided by the Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD). In 2009, Q fever acute and chronic reporting categories were recognized as a result of revisions to the Q fever case definition. Prior to that time, case counts were not differentiated with respect to acute and chronic Q fever cases. No rubella cases were reported for the current week. **** Updated weekly from reports to the Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases. Updated weekly from reports to the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. There was one case of viral hemorrhagic fever reported during week 12. The one case report was confirmed as lassa fever. See Table II for dengue hemorrhagic fever.
FIGURE I. Selected notifiable disease reports, United States, comparison of provisional 4-week totals November 20, 2010, with historical data
DISEASE Giardiasis Hepatitis A, acute Hepatitis B, acute Hepatitis C, acute Legionellosis Measles Meningococcal disease Mumps Pertussis 0.25 0.5 1 Ratio (Log scale)* Beyond historical limits
* Ratio of current 4-week total to mean of 15 4-week totals (from previous, comparable, and subsequent 4-week periods for the past 5 years). The point where the hatched area begins is based on the mean and two standard deviations of these 4-week totals.
DECREASE
INCREASE
CASES CURRENT 4 WEEKS 797 71 112 33 150 1 30 21 914
Notifiable Disease Data Team and 122 Cities Mortality Data Team Patsy A. Hall-Baker Deborah A. Adams Rosaline Dhara Willie J. Anderson Pearl C. Sharp Michael S. Wodajo Lenee Blanton
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TABLE II. Provisional cases of selected notifiable diseases, United States, weeks ending November 20, 2010, and November 21, 2009 (46th week)*
Chlamydia trachomatis infection Reporting area United States New England Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Mid. Atlantic New Jersey New York (Upstate) New York City Pennsylvania E.N. Central Illinois Indiana Michigan Ohio Wisconsin W.N. Central Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota S. Atlantic Delaware District of Columbia Florida Georgia Maryland North Carolina South Carolina Virginia West Virginia E.S. Central Alabama Kentucky Mississippi Tennessee W.S. Central Arkansas Louisiana Oklahoma Texas Mountain Arizona Colorado Idaho Montana Nevada New Mexico Utah Wyoming Pacific Alaska California Hawaii Oregon Washington Territories American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands Current week 9,338 547 445 40 62 1,661 1,025 636 885 594 154 137 442 46 396 1,901 73 60 576 246 345 601 219 219 591 170 421 603 312 22 219 20 30 2,489 17 1,982 156 334 104 Previous 52 weeks Med 23,719 759 216 50 398 42 64 23 3,347 480 688 1,210 917 3,468 801 364 913 972 424 1,348 191 189 278 504 93 31 61 4,695 84 96 1,460 582 460 765 529 596 72 1,718 491 269 377 574 3,003 267 245 261 2,205 1,440 498 356 69 60 175 152 121 36 3,677 113 2,784 112 209 399 0 6 92 10 Max 26,215 1,396 736 69 698 114 120 51 4,893 691 2,530 2,739 1,092 4,127 1,225 796 1,419 1,085 511 1,565 269 235 331 603 237 89 77 5,681 220 177 1,737 1,229 1,031 1,562 763 902 112 2,415 757 614 780 738 4,578 392 1,077 1,374 3,194 1,904 713 560 200 82 337 453 176 79 5,350 148 4,406 158 468 500 0 31 265 29 Cum 2010 1,056,024 35,306 8,917 1,996 18,115 2,167 3,031 1,080 149,983 21,905 31,023 54,775 42,280 153,494 32,104 16,615 42,863 43,101 18,811 59,810 8,703 8,498 11,424 23,013 4,037 1,436 2,699 211,487 3,893 4,320 66,289 25,784 20,573 35,595 24,027 27,671 3,335 77,151 22,345 12,749 16,742 25,315 138,336 10,851 12,856 13,493 101,136 65,157 21,566 15,087 3,396 2,670 8,247 6,979 5,477 1,735 165,300 5,081 126,887 5,099 9,794 18,439 259 4,888 323 Cum 2009 1,110,577 35,754 10,328 2,165 16,980 1,906 3,302 1,073 140,595 21,789 27,986 52,276 38,544 178,130 54,671 19,872 41,154 43,606 18,827 63,275 8,559 9,583 12,906 23,189 4,767 1,601 2,670 224,882 4,203 6,068 65,791 36,141 20,102 37,058 24,165 28,070 3,284 84,229 23,752 12,149 21,453 26,875 144,441 12,959 24,754 12,771 93,957 71,365 23,122 17,747 3,402 2,699 8,915 8,220 5,500 1,760 167,906 4,643 128,554 5,465 9,952 19,292 327 6,654 460 Current week 57 1 1 5 3 2 10 7 3 4 2 2 14 5 4 4 1 1 1 2 2 2 2 18 17 1 N N Cryptosporidiosis Previous 52 weeks Med 121 7 0 1 3 1 0 1 14 0 3 2 8 30 4 3 5 7 9 21 4 2 0 4 2 0 2 18 0 0 7 5 1 0 1 2 0 4 2 1 0 1 8 0 1 1 5 10 0 2 2 1 0 2 1 0 11 0 7 0 3 1 0 0 0 0 Max 339 74 68 7 8 5 2 5 37 1 16 5 26 122 21 10 18 24 55 83 24 9 16 30 26 18 6 51 2 1 19 31 3 12 8 8 3 19 12 6 3 5 39 3 6 8 30 29 3 8 7 4 6 11 5 2 28 1 19 0 13 8 0 0 0 0 Cum 2010 6,903 418 68 74 148 49 13 66 725 195 86 444 1,865 265 140 298 423 739 1,221 315 123 98 351 219 30 85 912 7 3 338 274 33 73 81 87 16 295 142 79 22 52 400 31 59 78 232 503 33 128 87 46 31 104 58 16 564 4 333 156 71 N N Cum 2009 6,712 423 38 46 166 76 22 75 746 49 195 74 428 1,578 145 261 260 349 563 1,025 192 96 314 175 111 12 125 1,039 9 6 415 317 39 106 56 75 16 211 61 61 17 72 515 51 53 115 296 519 33 131 83 52 25 138 37 20 656 6 393 1 176 80 N N
C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Case counts for reporting year 2010 are provisional and subject to change. For further information on interpretation of these data, see http://www.cdc.gov/ncphi/disss/nndss/phs/files/ ProvisionalNationa%20NotifiableDiseasesSurveillanceData20100927.pdf. Data for HIV/AIDS, AIDS and TB, when available, are displayed in Table IV, which appears quarterly. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
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TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending November 20, 2010, and November 21, 2009 (46th week)*
Dengue Virus Infection Dengue Fever Reporting area United States New England Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Mid. Atlantic New Jersey New York (Upstate) New York City Pennsylvania E.N. Central Illinois Indiana Michigan Ohio Wisconsin W.N. Central Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota S. Atlantic Delaware District of Columbia Florida Georgia Maryland North Carolina South Carolina Virginia West Virginia E.S. Central Alabama Kentucky Mississippi Tennessee W.S. Central Arkansas Louisiana Oklahoma Texas Mountain Arizona Colorado Idaho Montana Nevada New Mexico Utah Wyoming Pacific Alaska California Hawaii Oregon Washington Territories American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands Current week Previous 52 weeks Med 5 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 106 0 Max 30 2 0 2 0 0 0 1 9 0 0 7 2 5 0 2 2 2 2 2 1 1 2 0 0 1 0 17 0 0 14 2 0 1 3 3 1 2 2 1 1 1 1 0 0 1 0 2 1 0 1 1 1 1 0 0 5 0 5 0 0 2 0 0 535 0 Cum 2010 394 6 5 1 78 63 15 40 11 9 15 5 17 2 1 13 1 205 166 11 4 10 12 2 5 2 1 1 1 4 4 16 6 2 3 4 1 23 11 12 9,366 Cum 2009 NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN Current week Dengue Hemorrhagic Fever Previous 52 weeks Med 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Max 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 Cum 2010 4 1 1 2 2 1 1 33 Cum 2009 NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN
C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Case counts for reporting year 2010 are provisional and subject to change. For further information on interpretation of these data, see http://www.cdc.gov/ncphi/disss/nndss/phs/files/ ProvisionalNationa%20NotifiableDiseasesSurveillanceData20100927.pdf. Data for HIV/AIDS, AIDS and TB, when available, are displayed in Table IV, which appears quarterly. Dengue Fever includes cases that meet criteria for Dengue Fever with hemorrhage, other clinical, and unknown case classifications. DHF includes cases that meet criteria for dengue shock syndrome (DSS), a more severe form of DHF. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
1528
Ehrlichiosis/Anaplasmosis Ehrlichia chaffeensis Reporting area United States New England Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Mid. Atlantic New Jersey New York (Upstate) New York City Pennsylvania E.N. Central Illinois Indiana Michigan Ohio Wisconsin W.N. Central Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota S. Atlantic Delaware District of Columbia Florida Georgia Maryland North Carolina South Carolina Virginia West Virginia E.S. Central Alabama Kentucky Mississippi Tennessee W.S. Central Arkansas Louisiana Oklahoma Texas Mountain Arizona Colorado Idaho Montana Nevada New Mexico Utah Wyoming Pacific Alaska California Hawaii Oregon Washington Territories American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands Current Previous 52 weeks week Med Max 8 1 1 3 1 2 4 4 8 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 4 0 0 0 0 0 2 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 181 2 0 1 0 1 1 0 15 2 15 3 1 4 2 0 1 3 1 13 0 1 6 13 1 0 0 19 3 0 2 4 3 13 2 13 1 10 3 2 1 6 141 34 1 105 2 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 Cum 2010 558 5 3 2 48 28 19 1 32 12 2 6 12 117 6 109 2 246 17 8 22 23 100 3 72 1 85 11 16 3 55 24 6 1 14 3 1 1 Cum 2009 887 52 5 9 4 33 1 184 98 51 10 25 83 33 5 13 32 153 6 2 143 2 249 21 11 18 40 61 11 86 1 133 8 12 6 107 30 4 24 2 3 3 Current week 8 5 5 1 1 2 2 Anaplasma phagocytophilum Previous 52 weeks Med 11 1 0 0 0 0 0 0 2 0 2 0 0 3 0 0 0 0 3 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Max 309 8 5 2 2 3 7 0 17 1 17 1 1 39 1 0 0 1 39 261 0 0 261 3 0 0 0 7 1 0 1 1 2 4 1 2 0 2 2 0 1 2 23 6 0 16 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cum 2010 706 79 23 16 16 24 188 1 184 3 347 5 2 340 12 12 57 4 3 2 15 21 1 11 18 7 1 10 5 2 2 1 Cum 2009 860 251 17 14 93 18 109 296 70 217 8 1 269 6 1 262 21 1 15 4 1 17 2 3 1 4 3 4 3 1 2 1 1 2 2 Current week 1 1 1 Undetermined Previous 52 weeks Med 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Max 35 2 2 0 0 1 0 0 2 0 1 0 1 7 2 3 1 0 4 30 0 0 30 3 0 0 0 1 0 0 0 1 1 0 0 1 1 1 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 Cum 2010 95 7 5 2 4 4 61 3 27 4 27 10 10 6 1 2 3 6 6 1 1 Cum 2009 160 2 1 1 44 6 1 37 71 3 36 2 30 16 3 13 2 2 24 24 1 1
C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Case counts for reporting year 2010 are provisional and subject to change. For further information on interpretation of these data, see http://www.cdc.gov/ncphi/disss/nndss/phs/files/ ProvisionalNationa%20NotifiableDiseasesSurveillanceData20100927.pdf. Data for HIV/AIDS, AIDS and TB, when available, are displayed in Table IV, which appears quarterly. Cumulative total E. ewingii cases reported for year 2010 = 10. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
1529
Giardiasis Reporting area United States New England Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Mid. Atlantic New Jersey New York (Upstate) New York City Pennsylvania E.N. Central Illinois Indiana Michigan Ohio Wisconsin W.N. Central Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota S. Atlantic Delaware District of Columbia Florida Georgia Maryland North Carolina South Carolina Virginia West Virginia E.S. Central Alabama Kentucky Mississippi Tennessee W.S. Central Arkansas Louisiana Oklahoma Texas Mountain Arizona Colorado Idaho Montana Nevada New Mexico Utah Wyoming Pacific Alaska California Hawaii Oregon Washington Territories American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands Current Previous 52 weeks Cum week Med Max 2010 206 15 4 10 1 44 32 4 8 19 3 16 7 7 65 50 8 N 1 6 1 1 N N N 13 2 7 3 1 42 25 17 348 32 5 4 13 3 1 4 61 4 22 17 15 54 12 5 13 17 8 25 5 4 0 8 4 0 1 72 0 1 39 10 5 0 2 9 0 6 4 0 0 1 8 2 3 2 0 30 3 13 4 2 1 2 4 1 53 2 33 0 9 8 0 0 1 0 666 54 13 12 24 8 7 10 103 13 84 33 27 81 26 13 25 29 30 165 11 10 135 26 9 7 7 143 5 5 87 51 11 0 9 36 6 15 11 0 0 9 16 7 9 7 0 50 8 27 9 7 11 5 11 5 133 6 61 3 20 75 0 1 8 0 15,828 1,436 236 203 637 129 60 171 2,752 208 1,049 809 686 2,542 515 197 612 772 446 1,278 259 192 136 392 193 28 78 3,301 28 33 1,915 485 240 N 124 437 39 241 184 N N 57 339 121 155 63 N 1,466 144 639 188 93 88 83 195 36 2,473 86 1,536 28 424 399 2 63 Cum 2009 16,909 1,597 263 193 690 186 60 205 3,095 389 1,182 752 772 2,639 560 271 604 732 472 1,508 269 144 343 468 159 24 101 3,321 23 68 1,738 663 255 N 100 425 49 374 180 N N 194 469 140 184 145 N 1,514 189 456 188 124 102 109 285 61 2,392 104 1,545 19 371 353 3 145 Gonorrhea Current Previous 52 weeks week Med Max 2,101 71 64 3 4 361 191 170 285 203 42 40 124 6 118 543 10 23 166 96 126 122 54 54 204 74 130 70 39 4 27 389 5 333 10 41 2 5,519 102 42 3 46 3 5 0 683 106 103 228 248 921 180 98 249 316 93 278 32 39 38 136 20 2 7 1,346 18 35 390 207 133 246 152 153 10 475 145 73 110 147 801 76 71 78 578 173 58 52 2 2 29 19 6 0 606 24 494 14 19 53 0 0 6 1 6,403 196 169 11 81 7 14 17 1,121 161 422 529 365 1,260 380 221 471 375 155 357 53 83 62 175 50 11 19 1,745 48 66 493 421 237 596 232 271 24 698 218 142 216 195 1,284 133 441 359 964 262 109 95 6 6 94 41 15 4 816 37 691 24 43 80 0 4 14 7 Cum 2010 247,293 4,688 1,983 136 2,120 140 262 47 31,774 4,814 5,138 10,524 11,298 42,179 7,625 4,690 11,836 13,829 4,199 12,479 1,480 1,749 1,629 6,208 938 97 378 61,315 877 1,618 17,847 8,674 6,007 11,923 7,112 6,767 490 20,972 6,461 3,333 4,786 6,392 37,556 3,335 3,693 3,962 26,566 7,719 2,549 2,305 100 93 1,441 932 270 29 28,611 1,092 23,506 651 899 2,463 30 273 78 Cum 2009 270,108 4,434 2,142 121 1,735 95 297 44 28,231 4,289 5,210 9,837 8,895 56,851 18,101 6,299 13,371 14,400 4,680 13,333 1,511 2,277 2,087 5,814 1,220 120 304 67,401 860 2,370 18,906 12,349 5,491 12,562 7,575 6,845 443 24,161 6,814 3,514 6,651 7,182 42,232 4,033 8,060 4,046 26,093 8,336 2,800 2,524 96 72 1,525 955 299 65 25,129 876 20,653 574 982 2,044 19 213 112 Haemophilus influenzae, invasive All ages, all serotypes Current week 35 11 5 6 2 2 2 1 1 15 4 5 1 5 1 1 2 2 1 1 1 1 Previous 52 weeks Med 59 3 0 0 2 0 0 0 11 2 3 2 4 10 3 1 0 2 2 3 0 0 0 1 0 0 0 14 0 0 3 3 1 2 2 2 0 3 0 0 0 2 2 0 0 1 0 5 2 1 0 0 0 1 0 0 2 0 0 0 1 0 0 0 0 0 Max 171 21 15 2 8 2 2 1 34 7 20 6 9 20 9 6 4 6 5 24 1 2 17 6 2 4 0 27 1 1 9 9 6 9 7 4 5 12 3 2 2 10 20 3 3 15 2 15 10 5 2 1 2 5 4 2 21 2 18 2 5 4 0 0 1 0 Cum 2010 2,535 161 34 11 86 11 11 8 505 78 138 97 192 428 136 72 28 105 87 144 1 15 25 72 21 10 665 5 4 163 156 59 113 71 72 22 150 22 30 11 87 113 15 22 68 8 257 94 73 17 2 7 37 21 6 112 20 21 8 57 6 1 Cum 2009 2,516 174 48 18 82 12 9 5 509 112 134 62 201 393 147 70 23 87 66 145 13 50 55 21 6 687 3 5 202 135 80 89 67 79 27 147 35 19 8 85 111 18 20 69 4 217 67 62 4 1 18 31 31 3 133 20 40 28 42 3 4
C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Case counts for reporting year 2010 are provisional and subject to change. For further information on interpretation of these data, see http://www.cdc.gov/ncphi/disss/nndss/phs/files/ ProvisionalNationa%20NotifiableDiseasesSurveillanceData20100927.pdf. Data for HIV/AIDS, AIDS and TB, when available, are displayed in Table IV, which appears quarterly. Data for H. influenzae (age <5 yrs for serotype b, nonserotype b, and unknown serotype) are available in Table I. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
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Hepatitis (viral, acute), by type A Current Previous 52 weeks week Med Max 20 2 1 1 6 4 1 1 1 1 2 2 9 9 31 2 0 0 1 0 0 0 4 0 1 1 1 4 1 0 1 0 0 1 0 0 0 0 0 0 0 7 0 0 3 1 0 1 0 1 0 1 0 0 0 0 3 0 0 0 2 3 1 1 0 0 0 0 0 0 5 0 4 0 0 0 0 0 0 0 69 5 3 1 5 1 4 0 10 3 4 5 4 9 3 2 4 5 3 13 3 3 12 2 4 1 1 14 1 1 7 3 3 5 3 6 5 3 1 3 1 2 19 1 2 3 18 8 5 3 2 1 2 1 1 3 16 1 16 2 2 2 0 6 2 0 B Previous 52 weeks Med 62 1 0 0 0 0 0 0 5 1 1 2 1 9 1 1 3 2 1 2 0 0 0 1 0 0 0 16 0 0 6 3 1 1 1 2 0 7 1 2 1 2 9 0 1 2 5 2 0 1 0 0 1 0 0 0 6 0 4 0 1 1 0 1 0 0 Max 204 5 2 2 2 2 0 1 10 5 6 4 5 17 5 5 6 6 8 15 2 2 13 3 2 0 1 40 2 1 11 7 6 16 4 14 14 13 4 8 3 8 109 4 4 19 87 8 2 5 1 1 3 1 1 1 20 1 17 1 3 4 0 6 2 0 C Previous 52 weeks Med 14 1 0 0 0 0 0 0 2 0 1 0 0 2 0 0 1 0 0 0 0 0 0 0 0 0 0 4 0 0 1 0 0 0 0 0 0 3 0 2 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 Max 44 4 4 0 1 0 0 1 6 2 4 1 3 8 1 2 4 1 2 11 1 1 9 1 1 1 0 7 0 1 5 2 2 3 1 2 5 8 1 5 0 4 14 0 1 12 3 5 0 1 2 1 1 2 2 0 6 0 4 0 3 6 0 7 0 0
Reporting area United States New England Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Mid. Atlantic New Jersey New York (Upstate) New York City Pennsylvania E.N. Central Illinois Indiana Michigan Ohio Wisconsin W.N. Central Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota S. Atlantic Delaware District of Columbia Florida Georgia Maryland North Carolina South Carolina Virginia West Virginia E.S. Central Alabama Kentucky Mississippi Tennessee W.S. Central Arkansas Louisiana Oklahoma Texas Mountain Arizona Colorado Idaho Montana Nevada New Mexico Utah Wyoming Pacific Alaska California Hawaii Oregon Washington Territories American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands
Cum 2010 1,363 86 28 7 41 2 8 185 12 54 68 51 193 44 15 64 44 26 69 9 11 15 21 12 1 310 7 1 126 35 21 45 22 46 7 37 6 17 2 12 126 2 10 1 113 132 59 34 6 4 14 4 8 3 225 2 187 3 16 17 18 13
Cum 2009 1,764 100 18 1 64 7 8 2 247 61 43 81 62 265 121 16 64 35 29 111 35 12 19 21 20 1 3 386 3 1 158 47 44 36 56 36 5 37 10 9 8 10 173 11 6 3 153 145 60 47 4 6 13 8 5 2 300 2 238 8 15 37 6 21
Current week 27 U 3 3 11 7 2 1 1 7 3 4 6 5 1
Cum 2010 2,741 47 18 13 8 6 U 2 246 57 48 75 66 403 77 47 109 84 86 108 13 8 8 66 12 1 786 23 3 269 134 68 89 51 88 61 322 61 114 35 112 436 41 42 85 268 121 28 40 6 1 35 5 5 1 272 3 190 2 34 43 40 17
Cum 2009 2,900 49 15 13 17 4 U 301 91 47 63 100 392 109 67 115 80 21 124 31 6 24 41 19 3 797 30 10 258 134 68 98 52 86 61 307 80 80 29 118 511 60 64 90 297 118 39 23 11 1 29 6 5 4 301 3 212 6 40 40 54 31
Current week 11 1 N U 1 3 3 4 U 2 1 1 3 1 U 2 U U U
Cum 2010 716 37 25 10 N U 2 98 14 55 1 28 102 2 21 63 8 8 22 2 12 6 2 155 U 2 52 8 24 39 1 12 17 133 6 90 U 37 65 7 28 30 48 U 12 9 2 4 11 10 56 U 22 U 15 19 35
Cum 2009 665 60 47 2 10 N U 1 91 6 42 5 38 81 4 19 29 26 3 21 10 1 6 2 1 1 151 U 1 44 30 21 21 1 8 25 92 7 55 U 30 53 2 7 12 32 48 U 26 6 1 4 6 5 68 U 37 U 17 14 48
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Legionellosis Current Previous 52 weeks Cum week Med Max 2010 51 7 2 5 9 1 8 8 8 20 6 1 5 2 6 1 1 1 1 1 1 4 4 57 3 1 0 1 0 0 0 15 2 5 2 5 11 1 2 2 4 0 2 0 0 0 0 0 0 0 10 0 0 3 1 2 0 0 1 0 2 0 0 0 1 3 0 0 0 2 3 1 1 0 0 0 0 0 0 5 0 4 0 0 0 0 0 0 0 114 15 6 4 8 5 4 2 38 11 19 10 18 41 15 6 20 15 11 19 2 2 16 4 2 1 2 27 3 4 9 4 6 7 2 6 3 10 2 4 3 6 14 2 3 4 10 10 6 5 1 1 2 2 2 2 19 2 19 1 3 4 0 1 1 0 2,863 211 43 12 103 21 23 9 775 93 257 131 294 640 120 100 161 213 46 115 13 11 35 33 9 6 8 482 15 15 152 48 104 53 10 72 13 119 17 26 9 67 134 14 8 13 99 152 59 32 6 4 19 7 20 5 235 2 197 1 12 23 1 Cum 2009 3,160 185 50 8 88 13 19 7 1,104 205 323 215 361 672 121 60 155 264 72 109 22 7 12 53 12 1 2 535 19 21 167 55 139 58 11 56 9 129 17 47 4 61 116 7 13 6 90 133 42 27 6 7 12 9 26 4 177 1 136 1 16 23 2 Current week 106 9 8 1 57 33 24 1 1 35 2 7 26 1 1 3 3 N N N Lyme disease Previous 52 weeks Med 396 123 36 11 41 22 1 4 168 41 51 2 77 15 1 1 1 0 12 2 0 0 0 0 0 0 0 58 10 0 1 0 25 1 0 17 0 1 0 0 0 1 2 0 0 0 2 0 0 0 0 0 0 0 0 0 4 0 3 0 1 0 0 0 0 0 Max 2,336 474 200 76 206 67 40 27 721 207 577 14 383 260 16 7 13 5 235 1,395 10 1 1,380 1 2 15 1 175 32 4 10 2 100 9 3 79 32 4 1 1 0 4 44 0 1 2 42 3 1 1 2 1 1 2 1 1 11 1 9 0 4 3 0 0 0 0 Cum 2010 24,718 7,215 2,257 649 2,763 1,093 147 306 11,431 2,918 2,676 67 5,770 2,123 115 66 90 22 1,830 113 78 6 1 9 18 1 3,477 565 25 92 11 1,513 80 28 1,045 118 43 2 5 36 94 2 92 23 2 3 7 3 1 5 2 199 6 132 N 48 13 N N Cum 2009 34,479 11,838 4,002 835 5,053 1,338 224 386 15,022 4,810 3,718 995 5,499 2,861 136 81 98 50 2,496 229 106 18 96 3 5 1 4,077 932 61 100 38 1,919 93 37 733 164 35 3 1 31 210 210 53 6 1 15 3 12 5 9 2 154 6 97 N 37 14 N N Current week 11 1 1 7 3 2 2 1 1 2 1 1 Malaria Previous 52 weeks Med 27 2 0 0 1 0 0 0 7 0 1 4 1 2 1 0 0 0 0 1 0 0 0 0 0 0 0 7 0 0 2 0 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 3 0 2 0 0 0 0 0 0 0 Max 89 4 1 1 3 2 1 1 17 4 6 14 3 9 7 2 4 5 1 11 2 2 11 3 2 1 2 42 1 2 7 5 22 13 1 5 2 3 1 3 2 2 31 1 1 1 30 4 2 3 1 1 1 1 1 0 19 1 13 1 3 5 0 0 2 0 Cum 2010 1,314 65 1 5 45 4 7 3 359 1 68 235 55 132 47 8 29 38 10 64 12 10 3 21 15 3 377 2 9 116 41 91 47 4 64 3 29 9 6 2 12 76 2 4 5 65 57 22 20 3 2 6 1 3 155 3 106 1 12 33 4 Cum 2009 1,245 55 5 2 36 4 5 3 370 92 43 185 50 157 65 21 28 34 9 63 10 8 24 12 8 1 322 5 17 83 65 62 29 5 54 2 30 9 9 3 9 63 5 5 1 52 46 9 26 2 5 4 139 2 104 1 11 21 5
1532
Meningococcal disease, invasive All groups Reporting area United States New England Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Mid. Atlantic New Jersey New York (Upstate) New York City Pennsylvania E.N. Central Illinois Indiana Michigan Ohio Wisconsin W.N. Central Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota S. Atlantic Delaware District of Columbia Florida Georgia Maryland North Carolina South Carolina Virginia West Virginia E.S. Central Alabama Kentucky Mississippi Tennessee W.S. Central Arkansas Louisiana Oklahoma Texas Mountain Arizona Colorado Idaho Montana Nevada New Mexico Utah Wyoming Pacific Alaska California Hawaii Oregon Washington Territories American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands Current Previous 52 weeks week Med Max 12 1 1 2 2 2 1 1 3 3 1 1 3 3 15 0 0 0 0 0 0 0 1 0 0 0 0 2 0 0 0 1 0 1 0 0 0 0 0 0 0 2 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 3 0 2 0 1 0 0 0 0 0 43 3 2 1 2 0 0 1 4 2 3 2 2 8 3 3 3 2 2 6 3 2 2 3 2 1 1 7 1 0 5 2 1 2 1 2 2 3 2 2 1 2 9 1 4 7 7 6 2 4 2 1 1 1 1 0 16 1 13 1 2 7 0 0 1 0 Cum 2010 666 17 2 4 6 5 62 16 11 14 21 114 19 23 20 31 21 43 9 6 2 19 5 2 121 2 55 10 8 15 10 19 2 38 6 17 5 10 78 6 12 15 45 52 13 19 7 1 8 3 1 141 1 94 1 29 16 Cum 2009 837 30 4 4 14 3 4 1 95 17 20 16 42 153 41 33 19 39 21 71 11 13 11 22 9 1 4 153 2 49 30 10 29 11 16 6 30 8 5 3 14 82 9 17 12 44 57 12 19 7 5 4 3 2 5 166 6 105 5 37 13 1 Current week 241 4 1 2 1 53 18 35 79 12 66 1 22 20 2 16 7 1 1 1 6 2 2 26 2 24 33 4 29 6 2 4 Med 331 8 1 0 5 0 0 0 26 2 9 0 11 82 14 9 26 27 7 32 9 3 0 8 4 0 0 28 0 0 5 3 3 0 5 5 1 14 4 5 1 4 56 3 1 0 48 24 7 4 3 1 0 2 4 0 40 0 27 0 6 5 0 0 0 0 Pertussis Previous 52 weeks Max 1,756 23 8 5 14 2 9 4 63 8 27 9 42 173 29 26 54 71 20 627 26 9 601 39 13 30 5 78 4 1 28 18 8 32 19 15 13 34 8 14 8 11 753 29 4 41 681 57 16 40 19 12 7 11 13 2 209 6 181 6 16 38 0 2 1 0 Cum 2010 17,250 434 95 43 239 18 26 13 1,396 109 485 78 724 4,350 711 470 1,233 1,527 409 2,007 451 142 698 439 201 50 26 1,359 12 6 287 213 120 124 298 214 85 668 176 231 63 198 2,523 159 32 65 2,267 1,311 367 320 180 75 31 119 209 10 3,202 37 2,438 41 294 392 3 Cum 2009 13,750 582 50 77 331 72 41 11 1,073 221 203 86 563 2,834 578 339 778 983 156 2,008 216 226 421 942 132 29 42 1,489 13 6 477 212 135 186 239 191 30 727 282 210 66 169 2,950 317 143 73 2,417 875 231 204 69 54 24 66 205 22 1,212 50 630 41 240 251 2 1 Current week 28 1 1 7 7 1 1 18 5 13 1 1 N Rabies, animal Previous 52 weeks Med 64 4 0 1 0 0 1 1 18 0 9 2 5 2 1 0 1 0 0 4 0 1 0 1 1 0 0 21 0 0 0 0 6 0 0 10 1 3 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 3 0 2 0 0 0 0 0 1 0 Max 140 15 14 4 0 5 4 5 41 0 19 12 24 27 11 0 5 12 0 16 2 4 9 6 4 7 2 73 0 0 60 13 14 7 0 25 7 7 4 4 1 4 30 7 0 30 14 8 5 0 2 3 2 2 2 4 12 2 12 0 2 0 0 0 3 0 Cum 2010 2,931 210 59 58 13 31 49 893 463 120 310 222 114 64 44 220 7 58 26 65 49 15 986 72 337 506 71 137 49 19 1 68 61 21 40 77 11 16 8 11 10 21 125 12 101 12 N 40 Cum 2009 4,716 313 132 50 31 41 59 522 404 18 100 217 82 25 64 46 361 31 72 60 64 77 4 53 1,964 161 375 363 440 514 111 134 45 4 85 864 38 32 794 102 8 25 6 26 13 24 239 12 216 11 N 39
C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Case counts for reporting year 2010 are provisional and subject to change. For further information on interpretation of these data, see http://www.cdc.gov/ncphi/disss/nndss/phs/files/ ProvisionalNationa%20NotifiableDiseasesSurveillanceData20100927.pdf. Data for HIV/AIDS, AIDS and TB, when available, are displayed in Table IV, which appears quarterly. Data for meningococcal disease, invasive caused by serogroups A, C, Y, and W-135; serogroup B; other serogroup; and unknown serogroup are available in Table I. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
1533
Salmonellosis Current Previous 52 weeks Cum week Med Max 2010 668 5 1 3 1 48 25 7 16 19 4 15 24 15 9 422 164 39 16 183 6 14 27 9 7 11 23 3 12 8 15 2 9 4 85 52 2 31 900 32 0 2 23 3 2 1 94 19 25 25 29 86 28 9 15 24 11 45 9 8 0 13 4 0 3 268 3 1 121 41 15 29 20 18 2 52 18 10 16 14 98 11 19 11 51 48 18 10 3 2 4 5 5 1 124 1 89 4 8 15 0 0 11 0 1,706 448 432 7 54 10 17 5 219 57 78 56 82 239 114 55 48 47 44 98 34 19 32 44 13 39 8 601 11 6 227 132 54 197 94 68 16 177 51 31 67 53 547 43 48 46 477 105 42 24 9 7 22 16 17 5 299 5 227 14 48 61 1 2 39 0 45,573 2,076 432 117 1,164 152 140 71 5,212 977 1,306 1,242 1,687 4,706 1,636 430 844 1,204 592 2,224 479 404 178 752 235 48 128 14,127 164 66 5,686 2,520 941 2,145 1,431 1,016 158 3,593 937 528 1,146 982 5,412 722 1,099 615 2,976 2,490 861 529 148 81 266 288 278 39 5,733 75 4,339 197 459 663 2 7 456 Cum 2009 43,732 2,009 430 114 1,032 242 131 60 4,997 1,035 1,174 1,164 1,624 4,734 1,345 566 891 1,307 625 2,411 370 364 512 597 324 63 181 12,838 129 92 5,822 2,178 725 1,677 1,051 966 198 2,848 855 415 854 724 5,381 569 1,106 571 3,135 2,768 978 570 159 101 233 339 298 90 5,746 63 4,292 302 396 693 11 502 Shiga toxin-producing E. coli (STEC) Previous 52 weeks Current Cum Cum week Med Max 2010 2009 56 1 1 3 3 4 4 2 2 18 4 4 9 1 2 1 1 6 6 4 1 3 16 15 1 84 3 0 0 2 0 0 0 9 1 3 1 3 10 2 1 2 2 3 12 3 1 0 4 1 0 0 13 0 0 4 1 1 1 0 2 0 5 1 1 0 2 5 1 0 0 3 10 1 3 1 1 0 1 1 0 10 0 6 0 2 3 0 0 0 0 208 52 52 3 8 2 26 2 31 6 13 7 13 39 9 9 16 11 17 39 16 6 13 27 6 10 4 30 2 1 13 15 8 10 3 15 4 19 4 6 12 7 68 5 2 27 41 34 9 21 7 5 5 5 7 2 46 1 35 4 9 19 0 0 0 0 4,250 186 52 18 77 20 2 17 459 56 179 67 157 673 115 66 149 133 210 602 162 64 31 226 70 17 32 659 6 5 218 100 91 82 19 120 18 246 46 65 28 107 271 45 17 40 169 573 78 208 94 39 28 35 76 15 581 2 266 18 100 195 4,176 283 67 19 99 35 38 25 392 97 135 55 105 667 157 89 127 121 173 681 150 53 195 128 81 8 66 619 13 2 159 67 87 101 30 131 29 197 44 66 6 81 289 41 23 31 194 534 64 160 88 34 34 34 106 14 514 1 237 11 77 188 Current week 193 1 1 5 1 4 9 9 6 6 85 34 11 3 35 2 4 1 1 2 54 1 7 46 4 3 1 25 23 2 Shigellosis Previous 52 weeks Med 273 4 0 0 4 0 0 0 33 6 4 6 14 26 9 1 5 6 4 48 1 5 0 42 1 0 0 45 1 0 14 13 2 3 1 2 0 13 3 3 1 5 51 1 5 6 38 15 8 2 0 0 1 2 1 0 21 0 16 0 1 2 1 0 0 0 Max 527 62 57 1 16 1 3 1 53 16 19 14 34 238 228 5 9 23 21 88 5 14 3 75 10 5 2 97 8 4 53 39 8 18 5 15 11 40 13 28 4 14 251 9 13 96 144 32 19 6 3 1 6 9 4 0 64 2 51 3 4 20 1 1 1 0 Cum 2010 12,195 290 57 7 202 12 11 1 1,410 288 207 271 644 1,517 741 33 218 284 241 1,895 48 238 14 1,533 55 7 2,326 39 23 1,010 693 119 216 61 129 36 660 168 210 48 234 2,344 65 232 247 1,800 713 396 91 23 6 44 114 39 1,040 1 863 19 55 102 4 1 4 Cum 2009 13,935 318 43 5 221 21 23 5 2,563 556 195 418 1,394 2,322 555 63 209 1,025 470 1,040 49 185 73 696 29 4 4 2,156 134 22 421 593 348 343 112 175 8 743 145 200 44 354 2,609 285 166 256 1,902 1,060 763 90 8 11 66 100 18 4 1,124 2 902 38 49 133 3 13 13
C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Case counts for reporting year 2010 are provisional and subject to change. For further information on interpretation of these data, see http://www.cdc.gov/ncphi/disss/nndss/phs/files/ ProvisionalNationa%20NotifiableDiseasesSurveillanceData20100927.pdf. Data for HIV/AIDS, AIDS and TB, when available, are displayed in Table IV, which appears quarterly. Includes E. coli O157:H7; Shiga toxin-positive, serogroup non-O157; and Shiga toxin-positive, not serogrouped. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
1534
Spotted Fever Rickettsiosis (including RMSF) Confirmed Reporting area United States New England Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Mid. Atlantic New Jersey New York (Upstate) New York City Pennsylvania E.N. Central Illinois Indiana Michigan Ohio Wisconsin W.N. Central Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota S. Atlantic Delaware District of Columbia Florida Georgia Maryland North Carolina South Carolina Virginia West Virginia E.S. Central Alabama Kentucky Mississippi Tennessee W.S. Central Arkansas Louisiana Oklahoma Texas Mountain Arizona Colorado Idaho Montana Nevada New Mexico Utah Wyoming Pacific Alaska California Hawaii Oregon Washington Territories American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands Current week 1 1 1 N N N N N Previous 52 weeks Med 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Max 12 0 0 0 0 0 0 0 2 0 1 1 2 1 1 1 0 0 0 4 0 1 1 4 1 0 0 9 1 1 1 6 1 3 1 2 0 3 1 2 0 2 3 2 0 3 1 1 1 0 0 1 0 0 0 0 2 0 2 0 1 0 0 0 0 0 Cum 2010 150 16 2 1 13 4 2 2 17 2 13 2 78 1 1 4 53 3 11 1 4 19 5 6 8 6 2 3 1 2 2 8 N 7 N 1 N N N Cum 2009 141 2 1 1 12 2 1 9 9 1 3 4 1 18 1 1 1 7 8 65 51 3 7 3 1 9 3 1 5 9 7 2 16 10 1 4 1 1 N 1 N N N N Current week 30 12 1 1 7 3 2 2 16 13 3 N N N N N Med 19 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 4 0 0 0 4 0 0 0 7 0 0 0 0 1 1 0 2 0 5 1 0 0 4 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Probable Previous 52 weeks Max 421 1 0 1 1 1 0 0 4 2 3 4 1 9 5 5 1 2 1 21 1 0 1 20 1 1 0 60 3 1 2 0 4 48 2 12 0 29 8 0 2 20 408 110 1 287 11 2 1 1 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 Cum 2010 1,412 3 2 1 57 17 27 13 91 33 43 1 13 1 301 4 293 3 1 482 19 11 52 251 18 131 370 73 12 285 96 50 2 25 19 12 2 1 5 1 1 1 1 N N N N N Cum 2009 1,212 10 5 5 92 58 14 7 13 81 48 10 1 18 4 250 4 1 241 4 368 17 7 36 241 15 50 2 252 61 9 182 135 68 2 46 19 24 12 1 6 1 1 1 2 N N N N N
C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Case counts for reporting year 2010 are provisional and subject to change. For further information on interpretation of these data, see http://www.cdc.gov/ncphi/disss/nndss/phs/files/ ProvisionalNationa%20NotifiableDiseasesSurveillanceData20100927.pdf. Data for HIV/AIDS, AIDS and TB, when available, are displayed in Table IV, which appears quarterly. Illnesses with similar clinical presentation that result from Spotted fever group rickettsia infections are reported as Spotted fever rickettsioses. Rocky Mountain spotted fever (RMSF) caused by Rickettsia rickettsii, is the most common and well-known spotted fever. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
1535
Streptococcus pneumoniae, invasive disease All ages Reporting area United States New England Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Mid. Atlantic New Jersey New York (Upstate) New York City Pennsylvania E.N. Central Illinois Indiana Michigan Ohio Wisconsin W.N. Central Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota S. Atlantic Delaware District of Columbia Florida Georgia Maryland North Carolina South Carolina Virginia West Virginia E.S. Central Alabama Kentucky Mississippi Tennessee W.S. Central Arkansas Louisiana Oklahoma Texas Mountain Arizona Colorado Idaho Montana Nevada New Mexico Utah Wyoming Pacific Alaska California Hawaii Oregon Washington Territories American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands Current Previous 52 weeks week Med Max 207 4 2 2 7 1 6 39 5 28 6 11 6 5 60 26 12 18 1 3 20 20 40 2 38 24 11 10 1 2 2 1 1 224 9 0 2 1 0 0 1 24 1 3 8 8 47 1 7 11 19 6 8 0 1 0 2 2 0 0 50 0 0 22 10 7 0 6 1 2 21 0 3 1 17 26 3 2 1 22 28 10 9 0 0 1 2 2 0 5 2 3 0 0 0 0 0 0 0 495 99 91 6 5 7 36 6 56 8 12 31 22 98 7 24 27 49 22 182 0 7 179 10 7 11 3 144 3 4 89 28 31 0 25 4 21 50 0 16 6 44 91 9 8 5 83 82 51 20 2 2 4 9 9 1 14 9 12 0 0 0 0 0 0 0 Cum 2010 12,349 650 288 107 58 59 69 69 1,182 91 137 517 437 2,502 88 452 603 1,047 312 655 80 287 103 114 55 16 2,835 34 24 1,276 483 446 419 49 104 1,100 165 48 887 1,601 147 83 42 1,329 1,567 686 488 15 20 71 134 142 11 257 100 157 Cum 2009 2,603 46 16 3 15 12 180 75 15 90 586 220 25 341 163 52 41 59 2 7 2 1,177 18 19 679 364 4 93 238 69 48 121 107 50 57 103 36 56 11 3 3 Current week 20 1 1 1 1 3 2 1 6 1 3 2 1 1 3 2 1 5 2 2 1 Med 45 1 0 0 1 0 0 0 7 1 2 2 1 7 2 1 2 2 0 2 0 0 0 1 0 0 0 9 0 0 3 3 1 0 1 1 0 2 0 0 0 2 5 0 0 1 3 4 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Age <5 Previous 52 weeks Max 156 24 22 1 4 1 3 1 48 5 19 24 5 18 5 6 6 6 4 12 0 2 10 3 2 1 2 28 0 2 18 12 6 0 4 4 4 8 0 2 2 7 41 3 3 5 34 12 7 4 2 1 1 4 3 1 7 5 2 0 0 0 0 0 0 0 Cum 2010 1,906 87 27 9 40 3 3 5 315 48 99 115 53 315 81 39 73 89 33 118 13 44 37 14 2 8 470 7 172 132 48 45 47 19 109 13 10 86 252 16 22 42 172 209 87 61 9 3 5 16 25 3 31 19 12 Cum 2009 2,106 69 8 42 11 4 4 268 55 120 78 15 355 62 71 67 117 38 165 18 78 42 12 5 10 505 3 5 174 146 71 45 42 19 133 8 24 101 314 39 28 52 195 268 109 45 8 7 34 63 2 29 19 10 Syphilis, primary and secondary Current week 53 6 2 4 9 3 6 1 1 2 2 16 1 1 4 4 6 1 1 5 4 1 1 1 12 8 1 3 4 Previous 52 weeks Med 242 9 1 0 5 0 0 0 33 4 2 19 7 26 8 3 4 9 1 6 0 0 2 3 0 0 0 57 0 2 20 13 6 7 2 4 0 17 5 2 4 6 38 3 7 2 25 9 3 3 0 0 1 1 1 0 42 0 35 0 1 4 0 0 3 0 Max 413 22 10 3 15 2 4 2 45 12 11 31 16 47 24 14 12 18 3 19 3 3 9 10 1 0 1 218 1 21 44 167 14 31 7 22 2 39 11 13 17 17 62 13 27 7 35 23 7 8 1 2 9 4 4 0 61 1 54 3 7 11 0 0 15 0 Cum 2010 10,871 408 81 23 245 22 35 2 1,495 203 118 838 336 1,163 378 152 187 408 38 300 16 18 114 142 6 4 2,671 4 145 959 584 276 307 129 262 5 799 212 117 193 277 1,662 159 366 75 1,062 430 124 118 2 3 104 43 36 1,943 1 1,669 28 57 188 200 Cum 2009 12,475 288 51 3 207 13 14 1,581 205 106 958 312 1,387 674 139 213 320 41 278 21 29 64 155 5 4 3,007 27 158 927 724 274 512 111 270 4 1,025 393 62 192 378 2,513 251 692 83 1,487 476 213 87 3 3 86 54 27 3 1,920 1,710 33 48 129 196
C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Case counts for reporting year 2010 are provisional and subject to change. For further information on interpretation of these data, see http://www.cdc.gov/ncphi/disss/nndss/phs/files/ ProvisionalNationa%20NotifiableDiseasesSurveillanceData20100927.pdf. Data for HIV/AIDS, AIDS and TB, when available, are displayed in Table IV, which appears quarterly. Includes drug resistant and susceptible cases of invasive Streptococcus pneumoniae disease among children <5 years and among all ages. Case definition: Isolation of S. pneumoniae from a normally sterile body site (e.g., blood or cerebrospinal fluid). Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
1536
West Nile virus disease Varicella (chickenpox) Reporting area United States New England Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Mid. Atlantic New Jersey New York (Upstate) New York City Pennsylvania E.N. Central Illinois Indiana Michigan Ohio Wisconsin W.N. Central Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota S. Atlantic Delaware District of Columbia Florida Georgia Maryland North Carolina South Carolina Virginia West Virginia E.S. Central Alabama Kentucky Mississippi Tennessee W.S. Central Arkansas Louisiana Oklahoma Texas Mountain Arizona Colorado Idaho Montana Nevada New Mexico Utah Wyoming Pacific Alaska California Hawaii Oregon Washington Territories American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands Current week 173 3 3 16 N 16 65 6 2 23 32 2 15 N 15 N 31 16 N N N 7 8 7 7 N N 28 N 28 8 8 N N N N N Previous 52 weeks Med 282 15 6 3 0 2 1 0 31 8 0 0 22 100 23 6 31 29 7 16 0 4 0 7 0 0 0 34 0 0 15 0 0 0 0 11 8 5 5 0 0 0 46 2 1 0 41 20 0 8 0 3 0 2 5 0 1 0 0 0 0 0 0 0 9 0 Max 549 36 20 15 1 8 12 10 62 30 0 0 39 176 45 35 62 56 22 40 0 22 0 23 0 26 7 100 3 4 57 0 0 0 35 34 26 22 22 0 2 0 285 32 5 0 272 36 0 18 0 17 0 8 17 3 5 5 0 2 0 0 0 2 30 0 Cum 2010 12,586 637 256 195 2 114 32 38 1,414 463 N 951 4,250 1,074 367 1,274 1,217 318 725 N 231 413 N 37 44 1,909 22 17 907 N N N 75 478 410 268 261 N 7 N 2,431 129 40 N 2,262 903 369 N 177 N 91 252 14 49 37 12 N N N 15 501 Cum 2009 18,614 985 449 216 4 185 38 93 1,864 413 N 1,451 5,883 1,456 408 1,725 1,758 536 1,156 N 504 543 N 57 52 2,357 12 30 1,059 N N N 113 678 465 514 509 N 5 N 4,511 458 124 N 3,929 1,251 484 N 153 N 112 502 93 55 38 N N N 28 485 Current week Neuroinvasive Previous 52 weeks Med 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Max 70 3 2 0 2 1 0 0 19 3 9 7 3 14 10 1 6 1 0 7 1 1 1 1 3 2 2 4 0 1 2 1 3 0 1 1 0 1 1 1 1 1 15 3 3 0 15 18 13 5 0 0 0 5 1 1 7 0 7 0 0 0 0 0 0 0 Cum 2010 585 13 6 6 1 125 15 57 32 21 73 41 4 25 3 28 2 3 4 3 10 2 4 32 1 8 4 16 1 2 8 1 2 3 2 97 6 14 77 148 100 26 19 1 2 61 61 Cum 2009 384 9 3 3 3 9 5 2 1 1 26 4 1 4 11 6 16 2 2 4 3 5 36 3 29 4 117 6 10 8 93 77 12 36 9 2 7 6 1 4 94 67 1 26 Current week Nonneuroinvasive Previous 52 weeks Med 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Max 52 1 1 0 1 0 0 0 13 6 7 4 3 6 4 2 1 1 1 11 2 2 3 0 7 2 3 4 0 1 1 3 2 0 0 1 0 3 1 1 2 2 3 1 1 0 2 15 9 11 1 0 1 2 1 1 5 0 5 0 0 1 0 0 0 0 Cum 2010 372 2 1 1 62 15 30 8 9 28 15 6 4 1 2 68 4 10 4 27 7 16 20 1 3 8 7 1 10 2 1 5 2 17 1 6 10 128 59 55 3 2 4 1 4 37 36 1 Cum 2009 334 1 1 4 2 2 75 5 9 3 1 41 1 15 2 1 1 27 22 5 35 11 2 22 123 8 67 29 3 5 2 1 8 67 45 10 12
C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Case counts for reporting year 2010 are provisional and subject to change. For further information on interpretation of these data, see http://www.cdc.gov/ncphi/disss/nndss/phs/files/ ProvisionalNationa%20NotifiableDiseasesSurveillanceData20100927.pdf. Data for HIV/AIDS, AIDS and TB, when available, are displayed in Table IV, which appears quarterly. Updated weekly from reports to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases (ArboNET Surveillance). Data for California serogroup, eastern equine, Powassan, St. Louis, and western equine diseases are available in Table I. Contains data reported through the National Electronic Disease Surveillance System (NEDSS). Not reportable in all states. Data from states where the condition is not reportable are excluded from this table, except starting in 2007 for the domestic arboviral diseases and influenzaassociated pediatric mortality, and in 2003 for SARS-CoV. Reporting exceptions are available at http://www.cdc.gov/ncphi/disss/nndss/phs/infdis.htm.
1537
TABLE III. Deaths in 122 U.S. cities,* week ending November 20, 2010 (46th week)
All causes, by age (years) Reporting area New England Boston, MA Bridgeport, CT Cambridge, MA Fall River, MA Hartford, CT Lowell, MA Lynn, MA New Bedford, MA New Haven, CT Providence, RI Somerville, MA Springfield, MA Waterbury, CT Worcester, MA Mid. Atlantic Albany, NY Allentown, PA Buffalo, NY Camden, NJ Elizabeth, NJ Erie, PA Jersey City, NJ New York City, NY Newark, NJ Paterson, NJ Philadelphia, PA Pittsburgh, PA Reading, PA Rochester, NY Schenectady, NY Scranton, PA Syracuse, NY Trenton, NJ Utica, NY Yonkers, NY E.N. Central Akron, OH Canton, OH Chicago, IL Cincinnati, OH Cleveland, OH Columbus, OH Dayton, OH Detroit, MI Evansville, IN Fort Wayne, IN Gary, IN Grand Rapids, MI Indianapolis, IN Lansing, MI Milwaukee, WI Peoria, IL Rockford, IL South Bend, IN Toledo, OH Youngstown, OH W.N. Central Des Moines, IA Duluth, MN Kansas City, KS Kansas City, MO Lincoln, NE Minneapolis, MN Omaha, NE St. Louis, MO St. Paul, MN Wichita, KS All Ages 577 142 27 22 21 43 19 6 35 42 72 3 49 33 63 1,891 45 28 82 20 19 47 24 1,037 29 15 200 33 36 89 25 28 73 27 15 19 2,111 39 46 222 106 263 237 138 158 45 82 23 63 193 41 95 51 56 65 126 62 657 37 40 U 96 55 71 94 205 59 U 65 394 91 23 15 16 31 16 5 27 30 53 1 26 19 41 1,330 34 21 59 15 9 32 14 737 5 7 126 25 30 67 22 19 62 19 13 14 1,414 29 31 139 54 186 156 99 88 32 55 12 49 127 30 63 36 41 47 88 52 419 20 29 U 65 49 44 64 112 36 U 4564 120 32 4 5 4 7 3 1 6 5 15 2 14 9 13 406 9 4 17 2 8 11 7 223 4 6 57 5 4 18 2 8 9 6 1 5 486 6 11 71 24 59 56 29 56 11 18 4 8 41 7 23 6 8 11 29 8 156 11 8 U 23 5 21 19 58 11 U 2544 32 11 1 4 2 2 4 4 4 104 1 2 5 2 2 4 3 49 15 2 8 3 2 1 1 1 2 1 128 2 4 9 13 9 19 7 8 2 5 7 2 16 2 7 6 1 5 3 1 40 2 1 U 3 1 4 6 16 7 U 124 12 5 1 1 2 1 1 1 31 1 1 1 17 4 4 1 1 1 37 1 3 6 2 1 4 2 3 3 2 2 1 4 3 18 1 1 U 3 1 3 8 1 U <1 19 3 1 3 3 4 1 4 20 1 11 1 5 2 46 1 9 9 4 2 2 2 1 6 2 2 2 3 1 23 3 1 U 2 1 2 10 4 U Total 46 14 3 1 2 4 3 5 3 1 2 8 96 1 6 2 1 3 2 52 2 1 8 1 4 6 1 2 3 1 130 6 1 19 3 13 10 7 7 6 2 4 20 3 6 4 5 4 4 6 45 1 3 U 10 5 6 6 12 2 U P&I Reporting area S. Atlantic Atlanta, GA Baltimore, MD Charlotte, NC Jacksonville, FL Miami, FL Norfolk, VA Richmond, VA Savannah, GA St. Petersburg, FL Tampa, FL Washington, D.C. Wilmington, DE E.S. Central Birmingham, AL Chattanooga, TN Knoxville, TN Lexington, KY Memphis, TN Mobile, AL Montgomery, AL Nashville, TN W.S. Central Austin, TX Baton Rouge, LA Corpus Christi, TX Dallas, TX El Paso, TX Fort Worth, TX Houston, TX Little Rock, AR New Orleans, LA San Antonio, TX Shreveport, LA Tulsa, OK Mountain Albuquerque, NM Boise, ID Colorado Springs, CO Denver, CO Las Vegas, NV Ogden, UT Phoenix, AZ Pueblo, CO Salt Lake City, UT Tucson, AZ Pacific Berkeley, CA Fresno, CA Glendale, CA Honolulu, HI Long Beach, CA Los Angeles, CA Pasadena, CA Portland, OR Sacramento, CA San Diego, CA San Francisco, CA San Jose, CA Santa Cruz, CA Seattle, WA Spokane, WA Tacoma, WA Total All Ages 1,129 135 133 128 158 34 39 59 48 53 205 124 13 864 164 75 107 64 164 86 32 172 1,423 113 U 59 189 101 U 438 48 U 247 54 174 1,091 115 59 58 89 259 33 194 34 140 110 1,604 11 129 33 63 60 242 23 104 225 38 101 205 31 144 70 125 11,347 All causes, by age (years) 65 706 78 74 79 93 23 27 38 37 37 134 80 6 594 103 56 73 38 114 63 25 122 935 82 U 38 118 70 U 272 27 U 178 40 110 718 77 45 42 53 174 24 116 23 92 72 1,123 11 83 30 50 39 159 14 70 155 30 63 154 23 100 51 91 7,633 4564 296 35 42 35 48 9 10 14 8 8 51 31 5 196 44 16 21 22 38 17 6 32 349 26 U 16 50 22 U 115 17 U 44 9 50 261 23 13 12 25 60 6 52 10 33 27 352 32 2 10 16 60 7 23 53 5 31 37 5 31 11 29 2,622 2544 124 87 12 6 9 13 2 1 7 1 8 17 9 2 37 5 2 7 1 9 6 1 6 85 3 U 3 8 8 U 34 2 U 13 4 10 63 9 1 3 5 12 2 14 10 7 83 10 1 2 5 12 1 6 8 1 4 12 2 9 5 5 659 24 6 5 4 2 3 4 18 6 1 3 2 2 4 24 2 U 1 3 1 U 7 1 U 7 2 25 5 2 7 6 1 3 1 27 3 1 8 3 6 1 1 1 1 2 216 <1 14 2 6 1 2 1 2 19 6 3 1 1 8 30 U 1 10 U 10 1 U 5 1 2 20 1 1 4 6 1 4 2 1 19 1 3 1 2 3 1 3 1 3 1 210 P&I Total 69 7 12 7 9 1 1 3 3 4 13 9 60 8 3 7 5 17 2 7 11 90 4 U 8 15 2 U 26 U 25 1 9 66 10 3 3 7 10 1 10 11 11 129 1 5 7 11 5 24 2 10 19 2 8 16 2 5 4 8 731
U: Unavailable. : No reported cases. * Mortality data in this table are voluntarily reported from 122 cities in the United States, most of which have populations of >100,000. A death is reported by the place of its occurrence and by the week that the death certificate was filed. Fetal deaths are not included. Pneumonia and influenza. Because of changes in reporting methods in this Pennsylvania city, these numbers are partial counts for the current week. Complete counts will be available in 4 to 6 weeks. Total includes unknown ages.
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The Morbidity and Mortality Weekly Report (MMWR) Series is prepared by the Centers for Disease Control and Prevention (CDC) and is available free of charge in electronic format. To receive an electronic copy each week, visit MMWRs free subscription page at http://www.cdc.gov/mmwr/mmwrsubscribe.html. Paper copy subscriptions are available through the Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20402; telephone 202-512-1800. Data presented by the Notifiable Disease Data Team and 122 Cities Mortality Data Team in the weekly MMWR are provisional, based on weekly reports to CDC by state health departments. Address all inquiries about the MMWR Series, including material to be considered for publication, to Editor, MMWR Series, Mailstop E-90, CDC, 1600 Clifton Rd., N.E., Atlanta, GA 30333 or to mmwrq@cdc.gov. All material in the MMWR Series is in the public domain and may be used and reprinted without permission; citation as to source, however, is appreciated. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services. References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of these sites. URL addresses listed in MMWR were current as of the date of publication.
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