Morbidity and Mortality Weekly Report
www.cdc.gov/mmwr
Weekly
October 12, 2007 / Vol. 56 / No. 40
World Arthritis Day —
October 12, 2007
October 12, 2007, is World Arthritis Day, which is
intended to highlight the everyday challenges at home
and in the workplace for persons with arthritis or rheumatism and to encourage solutions to these challenges.
For example, the pain, fatigue, and activity limitations
that often accompany arthritis can prevent some persons from working, resulting in disability. Various
accommodations, such as flexible work schedules and
assistive devices, can counter the effects of arthritis and
help keep persons with arthritis working.
Accommodating persons with disabilities, including
those attributed to arthritis, is a goal of the U.S.
Department of Labor’s Office of Disability Employment
Policy. Each October, it sponsors National Disability
Employment Awareness Month, which is intended to
increase public awareness of the contributions and skills
of U.S. workers with disabilities and to eliminate
employment barriers. The Americans with Disabilities
Act (ADA) prohibits discrimination against persons with
disabilities under certain circumstances, including some
employment situations. However, the ADA is underused
and often misunderstood by persons with arthritis (1).
Anticipating employment disability caused by arthritis
and addressing employment barriers through increased
education, awareness, and other interventions can help
reduce arthritis disability in the U.S. workforce. Additional information about World Arthritis Day is available at http://www.worldarthritisday.org.
Reference
1. Allaire SH, Evans SR, LaValley MP, Merrigan DM. Use of the
Americans with Disabilities Act by persons with rheumatic diseases and factors associated with use. Arthritis Rheum
2001;45:174–82.
State-Specific Prevalence
of Arthritis-Attributable Work
Limitation — United States, 2003
One of the Healthy People 2010 objectives calls for a
reduction in the proportion of adults with doctor-diagnosed
arthritis who are limited in their ability to work for pay
because of arthritis (objective 2-5b) (1). Persons who are
limited in their work by arthritis are considered to have
arthritis-attributable work limitation (AAWL). In the
United States, AAWL affects one in 20 working-age adults
(aged 18–64 years) and one in three working-age adults
with self-reported, doctor-diagnosed arthritis (2). To estimate state-specific prevalence of AAWL and the percentage
employed among working-age U.S. adults with AAWL, CDC
analyzed data from the 2003 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report describes the
results of that analysis, which indicated that the statespecific prevalence of AAWL among all working-age adults
ranged from 3.4% (Hawaii) to 15.0% (Kentucky)
(median among states: 6.7%) in 2003. Among those with
self-reported, doctor-diagnosed arthritis, the prevalence of
AAWL ranged from 25.1% (Nevada) to 51.3% (Kentucky)
(median among states: 33.0%). In every state, persons with
work limitations attributed to arthritis reported being
employed less frequently than working-age adults in the
state overall and persons with arthritis but not work
INSIDE
1050 Deaths from Intravenous Colchicine Resulting from a
Compounding Pharmacy Error — Oregon and
Washington, 2007
1052 HIV/AIDS Among Hispanics — United States, 2001–
2005
1057 Notices to Readers
1058 QuickStats
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Centers for Disease Control and Prevention
1046
MMWR
The MMWR series of publications is published by the Coordinating
Center for Health Information and Service, 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 2007;56:[inclusive page numbers].
Centers for Disease Control and Prevention
Julie L. Gerberding, MD, MPH
Director
Tanja Popovic, MD, PhD
Chief Science Officer
James W. Stephens, PhD
Associate Director for Science
Steven L. Solomon, MD
Director, Coordinating Center for Health Information and Service
Jay M. Bernhardt, PhD, MPH
Director, National Center for Health Marketing
Katherine L. Daniel, PhD
Deputy Director, National Center for Health Marketing
Editorial and Production Staff
Frederic E. Shaw, MD, JD
Editor, MMWR Series
Suzanne M. Hewitt, MPA
Managing Editor, MMWR Series
Douglas W. Weatherwax
Lead Technical Writer-Editor
Catherine H. Bricker, MS
Jude C. Rutledge
Writers-Editors
Beverly J. Holland
Lead Visual Information Specialist
Lynda G. Cupell
Malbea A. LaPete
Visual Information Specialists
Quang M. Doan, MBA
Erica R. Shaver
Information Technology Specialists
Editorial Board
William L. Roper, MD, MPH, Chapel Hill, NC, Chairman
Virginia A. Caine, MD, Indianapolis, IN
David W. Fleming, MD, Seattle, WA
William E. Halperin, MD, DrPH, MPH, Newark, NJ
Margaret A. Hamburg, MD, Washington, DC
King K. Holmes, MD, PhD, Seattle, WA
Deborah Holtzman, PhD, Atlanta, GA
John K. Iglehart, Bethesda, MD
Dennis G. Maki, MD, Madison, WI
Sue Mallonee, MPH, Oklahoma City, OK
Stanley A. Plotkin, MD, Doylestown, PA
Patricia Quinlisk, MD, MPH, Des Moines, IA
Patrick L. Remington, MD, MPH, Madison, WI
Barbara K. Rimer, DrPH, Chapel Hill, NC
John V. Rullan, MD, MPH, San Juan, PR
Anne Schuchat, MD, Atlanta, GA
Dixie E. Snider, MD, MPH, Atlanta, GA
John W. Ward, MD, Atlanta, GA
October 12, 2007
limitations. Greater use of interventions is needed to help
persons with arthritis become and stay employed.
The BRFSS survey is a state-based, random-digit–dialed
telephone survey of the noninstitutionalized, U.S. civilian
population aged >18 years conducted annually in all 50
states, the District of Columbia (DC), Guam, Puerto Rico,
and the U.S. Virgin Islands. The 2003 BRFSS survey was
the only state-specific survey to assess AAWL among persons with doctor-diagnosed arthritis. Doctor-diagnosed
arthritis was defined as a “yes” response to the question,
“Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid
arthritis, gout, lupus, or fibromyalgia?” AAWL was defined
as a “yes” response to the following: “In this next question,
we are referring to work for pay. Do arthritis or joint symptoms now affect whether you work, the type of work you
do, or the amount of work you do?” Participants were asked
to choose one of the following to determine their employment status: employed for wages, self-employed, out of
work for more than 1 year, out of work for less than 1 year,
homemaker, student, retired, or unable to work. Respondents were considered employed if they reported being
employed for wages or self-employed. Respondents with
missing values for doctor-diagnosed arthritis were excluded
from the analysis.
State-specific prevalence of AAWL was estimated using
the population of working-age adults in the state as the
denominator. The state population of working-age adults
with arthritis was used as the denominator to calculate the
proportion of AAWL in this group. The percentage
employed* was estimated for three groups in the workingage population: 1) overall, 2) among those reporting doctordiagnosed arthritis, and 3) among those reporting arthritis
and AAWL. Ranges and medians are reported for the 50
states and DC. Weighted point estimates and 95% confidence intervals were derived, accounting for the complex
survey design. The Council of American Survey Organizations (CASRO) response rates among the 54 states and territories for the 2003 BRFSS survey ranged from 34.4%
(New Jersey) to 80.5% (Puerto Rico) (median: 53.2%),
and cooperation rates ranged from 60.1% (California) to
91.9% (Puerto Rico) (median: 74.8%).†
* The measure “percentage employed” is distinct from “employment rate” as defined
by the Bureau of Labor Statistics (definition available at http://www.bls.gov/bls/
glossary.htm), which calculates employment and unemployment among those
who “have made specific efforts to find employment.” No data on efforts to find
employment are available through the BRFSS survey.
† Additional information available at http://www.cdc.gov/brfss/technical_infodata/
pdf/2003summarydataqualityreport.pdf.
Vol. 56 / No. 40
MMWR
In 2003, the state-specific prevalence of AAWL among
working-age adults ranged from 3.4% (Hawaii) to 15.0%
(Kentucky) (median among states: 6.7%) (Table). In the
territories, prevalence of AAWL was 4.5%, 4.7%, and 5.7%
for Puerto Rico, the U.S. Virgin Islands, and Guam,
respectively. AAWL was higher in all states and territories
among adults aged 45–64 years compared with those aged
18–44 years, with the median for the older group (11.7%;
range: 5.5% [Hawaii] to 23.5% [Kentucky]) nearly three
times that of the younger group (3.9%; range: 2.1%
[Hawaii] to 9.6% [Kentucky]). The prevalence of AAWL
among adults with doctor-diagnosed arthritis ranged from
25.1% (Nevada) to 51.3% (Kentucky) (median among
states: 33.0%). Age adjustment resulted in nearly identical
estimates.
Among all 50 states and DC, the median percentage
employed was 73.2% (range: 60.6% [West Virginia] to
82.0% [South Dakota]) for the overall working-age population (Figure) but was consistently lower for those with
doctor-diagnosed arthritis (median among states: 64.3%;
range: 47.6% [Kentucky] to 77.1% [South Dakota]) and
lower still among those with AAWL (median among states:
48.7%; range: 32.9% [Kentucky] to 67.7% [South
Dakota]). This pattern also was observed among all the territories except Puerto Rico. Age adjustment resulted in similar estimates.
Reported by: KA Theis, MPH, JM Hootman, PhD, CG Helmick, MD,
L Murphy, PhD, J Bolen, PhD, G Langmaid, Div of Adult and Community
Health, National Center for Chronic Disease Prevention and Health
Promotion; GC Jones, PhD, Div of Human Development and Disability,
National Center on Birth Defects and Developmental Disability, CDC.
Editorial Note: This report provides the first state-specific
prevalence estimates of AAWL among working-age adults.
The findings indicate that, in 2003, AAWL varied by state.
A recent study demonstrated that, in 2003, the economic
costs of low employment among those with arthritis were
substantial, with estimated state-specific earnings losses
attributed to arthritis and other rheumatic conditions ranging from approximately $79 million (DC) to $4,273 million (California) (3). Both the number of persons affected
by arthritis and the prevalence of arthritis are projected to
increase (4). Assuming that the 2003 proportion of AAWL
among adults with arthritis remains stable, the number of
persons experiencing AAWL and its associated consequences
will increase.
The findings in this report are subject to at least five
limitations. First, doctor-diagnosed arthritis was selfreported (i.e., not confirmed by a health-care provider);
however, this measure has been validated for surveillance
purposes (5). Second, the AAWL question encompassed
1047
three work factors (i.e., whether persons are able to work,
the type of work they do, and the amount of work they
do); the analysis could not examine the independent associations of AAWL and each work factor. Third, worklimiting factors other than AAWL might have contributed
to the lower percentage employed among working-age
adults with AAWL; however, at least some of the consistently lower employment prevalence among those with
AAWL likely is the result of arthritis. Fourth, BRFSS
excludes certain populations, including those in the military, residing in institutions, and without landline telephones. Finally, BRFSS has a low median response rate;
however, BRFSS weighting procedures partially correct for
nonresponse. The effect of low response rates is uncertain.
Arthritis is common, affecting nearly 46 million adults
nationally, and is associated with numerous functional and
activity limitations (4). Physical impairments, such as pain
and activity limitations, might underlie AAWL by interfering with the ability of a person to perform work-related
tasks and therefore constitute substantial disability. These
state-level data on disability attributed to AAWL are critical for program planning and policy development at the
local level.
Several interventions have the potential to decrease the
impact of arthritis on work. First, CDC funds 36 state
health departments to expand the reach of evidence-based
programs and interventions § for persons with arthritis.
Although the content of these programs is not work-specific,
they have been demonstrated to be effective in reducing
physical and functional limitations, decreasing pain, and
delaying disability attributed to arthritis (6), which might
contribute to AAWL. Also, because these programs are
designed for community-based implementation, they are
feasible for worksite health-promotion programs. Second,
federal/state partnership programs to increase employment
among persons with disabilities exist in every state, including vocational rehabilitation.¶ A recent randomized controlled trial demonstrated that vocational rehabilitation
delivered to employed persons at risk for job loss because
of arthritis can decrease or delay job loss (7). The U.S.
Social Security Administration’s Ticket to Work Program, a
nationwide employment program aimed at providing services for persons with various impairments, is another
option for eligible persons.** Finally, reasonable worksite
§
Including the Arthritis Foundation Exercise Program, Arthritis Foundation
Aquatics Program, Arthritis Foundation Self-Help Course, the Chronic Disease
Self-Management Program, and EnhanceFitness®. Additional information
available at http://www.cdc.gov/arthritis/intervention/index.htm.
¶ Additional information available at http://www.jan.wvu.edu/sbses/vocrehab.htm.
** Additional information available at http://www.yourtickettowork.com/index.
1048
MMWR
October 12, 2007
TABLE. State- and territory-specific estimated prevalence of arthritis-attributable work limitation (AAWL)* among working-age adults
(aged 18–64 years), overall and by age group, and proportion of working-age adults with self-reported, doctor-diagnosed arthritis† who
reported AAWL — Behavioral Risk Factor Surveillance System (BRFSS), United States, 2003
State/Territory
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois††
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State median
Guam
Puerto Rico
U.S. Virgin Islands
AAWL among adults
aged 18–44 yrs
Weighted no.
(in 1,000s) (%)
(95% CI§)
80
8
66
59
429
58
35
10
—
247
163
10
18
115
108
31
27
147
90
19
62
92
154
76
56
122
10
21
24
15
82
22
292
133
7
170
60
43
198
14
70
12
138
372
41
9
161
90
53
76
8
—
—
33
1
(4.8)
(3.5–6.0)
(3.2)
(2.2–4.3)
¶
(1.9–4.4)
(3.2)
(5.9)
(4.6–7.2)
(3.1)
(2.3–4.0)
(3.2)
(2.3–4.0)
(2.8)
(2.1–3.6)
(3.3)
(2.3–4.3)
—**
—
(4.1)
(2.8–5.5)
(4.6)
(3.5–5.7)
(2.1)
(1.4–2.8)
(3.5)
(2.7–4.4)
(2.3)
(1.5–3.5)
(4.7)
(3.8–5.5)
(2.9)
(2.1–3.7)
(2.7)
(2.0–3.4)
(9.6) (8.1–11.2)
(5.3)
(4.2–6.4)
(4.2)
(3.0–5.4)
(3.0)
(2.1–3.9)
(3.8)
(2.9–4.6)
(4.1)
(2.9–5.3)
(3.9)
(2.9–5.0)
(5.0)
(3.9–6.2)
(5.8)
(4.2–7.3)
(3.2)
(2.2–4.2)
(3.2)
(2.4–4.0)
(2.8)¶ (1.7–3.9)
(3.2)
(2.4–4.0)
(2.6)
(2.1–3.1)
(3.2)
(2.5–4.0)
(4.0)
(3.1–5.0)
(4.0)
(3.3–4.8)
(3.0)
(2.0–3.9)
(4.1)
(2.8–5.3)
(4.6)
(3.8–5.4)
(3.3)
(2.3–4.2)
(4.5)
(3.4–5.6)
(3.5)
(2.5–4.6)
(4.4)
(3.5–5.4)
(4.3)
(3.3–5.3)
(6.3)
(4.5–8.0)
(4.3)
(3.4–5.1)
(4.2)
(2.9–5.5)
(3.8)
(2.8–4.9)
(5.7)
(4.4–6.9)
(3.9)
(3.4–4.4)
(8.2)
(6.5–9.9)
(3.7)
(2.7–4.7)
(4.2)
(3.1–5.3)
4.0
—
—**
—
(2.2)
(1.4–3.0)
¶
(2.9)
(1.5–4.3)
AAWL among adults
aged 45–64 yrs
Weighted no.
(in 1,000s) (%)
(95% CI)
210
19
154
107
758
102
64
19
12
443
289
17
40
297
212
60
59
226
137
41
159
145
388
141
136
219
24
42
51
31
180
51
574
338
17
359
132
103
323
28
163
21
271
525
38
18
188
179
90
123
13
—
4
72
2
(19.8)
(12.1)
(13.0)
(17.0)
(10.0)
(9.3)
(7.7)
(10.1)
(9.9)
(11.3)
(15.1)
(5.5)
(13.1)
(10.2)
(14.8)
(8.9)
(9.7)
(23.5)
(13.7)
(12.1)
(11.4)
(9.8)
(15.8)
(11.9)
(21.6)
(16.7)
(10.4)
(10.8)
(9.7)
(9.5)
(8.9)
(11.8)
(12.9)
(17.3)
(11.8)
(13.0)
(16.1)
(11.7)
(10.3)
(11.4)
(16.7)
(12.5)
(18.0)
(11.2)
(9.1)
(11.0)
(10.6)
(11.9)
(19.1)
(9.6)
(10.2)
11.7
(13.7)
(8.4)
(7.9)
(17.3–22.3)
(9.2–15.0)
(10.3–15.6)
(15.0–19.1)
(8.2–11.8)
(7.8–10.9)
(6.4–9.1)
(8.2–12.0)
(7.0–12.9)
(9.2–13.4)
(13.5–16.7)
(4.1–6.9)
(11.2–15.0)
(8.0–12.9)
(13.1–16.5)
(7.4–10.3)
(8.1–11.3)
(21.3–25.6)
(11.9–15.4)
(9.9–14.3)
(9.4–13.4)
(8.4–11.3)
(13.6–18.1)
(10.0–13.8)
(19.3–23.8)
(14.1–19.3)
(8.5–12.3)
(9.2–12.4)
(7.1–12.2)
(8.1–11.0)
(7.8–9.9)
(10.1–13.4)
(11.1–14.7)
(15.2–19.3)
(9.8–13.8)
(10.9–15.1)
(14.6–17.7)
(9.9–13.5)
(8.5–12.1)
(9.5–13.4)
(14.9–18.5)
(10.8–14.2)
(15.4–20.6)
(9.7–12.8)
(7.1–11.1)
(9.4–12.7)
(9.1–12.1)
(11.0–12.9)
(16.8–21.5)
(7.8–11.4)
(8.5–11.8)
—
(8.6–18.8)
(6.7–10.1)
(5.5–10.2)
AAWL among working-age
adults overall
Weighted no.
(in 1,000s)
(%)
(95% CI)
290
27
221
165
1,187
160
99
29
15
691
452
27
58
412
320
91
86
374
227
60
221
238
543
217
192
341
35
63
75
46
262
73
866
472
24
529
192
146
521
43
232
33
409
897
79
27
349
270
142
199
21
—
5
105
3
(10.6)
(6.6)
(6.7)
(10.2)
(5.6)
(5.5)
(4.8)
(5.9)
(4.2)
(7.0)
(8.3)
(3.4)
(7.1)
(5.3)
(8.5)
(5.2)
(5.3)
(15.0)
(8.4)
(7.5)
(6.4)
(6.1)
(8.7)
(7.0)
(11.1)
(10.0)
(6.2)
(6.1)
(5.4)
(5.8)
(5.0)
(6.6)
(7.4)
(9.0)
(6.3)
(7.6)
(9.0)
(6.7)
(6.9)
(6.5)
(9.1)
(7.4)
(11.0)
(6.7)
(5.7)
(6.9)
(7.6)
(7.0)
(12.8)
(6.0)
(6.6)
6.7
(5.7)
(4.5)
(4.7)
(9.3–11.9)
(5.3–7.9)
(5.4–8.0)
(9.1–11.3)
(4.7–6.4)
(4.7–6.3)
(4.1–5.5)
(4.9–6.8)
(3.0–5.4)
(5.8–8.1)
(7.4–9.2)
(2.7–4.1)
(6.2–8.1)
(4.3–6.5)
(7.7–9.4)
(4.5–6.0)
(4.6–6.1)
(13.7–16.2)
(7.4–9.4)
(6.3–8.7)
(5.4–7.4)
(5.3–6.8)
(7.6–9.9)
(6.0–8.0)
(9.9–12.2)
(8.6–11.4)
(5.2–7.3)
(5.3–6.9)
(4.2–6.6)
(5.0–6.5)
(4.5–5.5)
(5.8–7.4)
(6.5–8.3)
(8.0–9.9)
(5.3–7.3)
(6.5–8.7)
(8.2–9.8)
(5.7–7.6)
(5.9–7.9)
(5.5–7.5)
(8.2–10.1)
(6.5–8.3)
(9.5–12.5)
(5.9–7.5)
(4.6–6.8)
(5.9–7.8)
(6.6–8.5)
(6.5–7.5)
(11.4–14.2)
(5.0–6.9)
(5.7–7.6)
—
(3.8–7.5)
(3.7–5.3)
(3.5–6.0)
AAWL among
working-age adults
with arthritis
%
(95% CI)
38.1
30.7
34.8
40.0
35.7
28.0
25.7
29.1
25.5
36.3
39.0
26.5
35.8
27.9
34.7
28.2
27.5
51.3
38.8
33.1
29.6
31.8
33.3
34.6
44.7
41.8
31.9
30.8
25.1
27.7
26.9
33.0
35.5
39.1
30.8
31.7
41.9
32.3
28.6
30.2
37.2
35.0
40.5
34.8
32.4
32.6
33.7
33.2
41.7
28.7
29.1
33.0
40.2
25.5
34.2
34.3–41.9
25.4–36.1
29.2–40.4
36.5–43.6
31.4–40.1
24.5–31.6
22.4–29.1
25.0–33.2
19.1–31.9
31.3–41.3
35.7–42.3
21.7–31.4
32.0–39.6
23.1–33.2
31.8–37.7
24.6–31.7
24.1–31.0
48.0–54.6
35.2–42.3
28.5–37.6
25.8–33.5
28.5–35.1
29.5–37.0
30.5–38.8
41.1–48.3
37.2–46.3
27.4–36.3
27.4–34.3
20.0–30.2
24.5–30.9
24.5–29.3
29.5–36.4
32.0–39.0
35.8–42.4
26.6–35.0
27.8–35.7
39.0–44.8
28.4–36.1
25.0–32.2
26.3–34.1
34.1–40.3
31.4–38.6
36.0–44.9
31.4–38.2
27.6–37.3
28.9–36.3
30.1–37.4
31.3–35.1
37.9–45.4
24.8–32.6
25.6–32.6
—
29.6–50.8
21.3–29.6
27.0–41.4
* Defined as a “yes” response to the following: “In this next question, we are referring to work for pay. Do arthritis or joint symptoms now affect whether you work, the type of work
you do, or the amount of work you do?”
† Defined as a “yes” response to the question, “Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout,
lupus, or fibromyalgia?”
§ Confidence interval.
¶ Data might be unreliable; relative standard error (RSE) = 20–30.
** Not reported; RSE >30.
†† Illinois BRFSS uses a split-sample design; estimates are derived using a special weighting procedure.
Vol. 56 / No. 40
MMWR
1049
FIGURE. State- and territory-specific estimated percentage employed* among working-age adults (aged 18–64 years) overall,
among those with self-reported doctor-diagnosed arthritis (DRDX),† and among those with arthritis-attributable work limitation
(AAWL)§ — Behavioral Risk Factor Surveillance System, United States, 2003
90
80
Percentage employed
70
60
50
40
Overall
DRDX
AAWL
30
20
10
U
S
G VI
ua
m
PR
KY
W
V
M
I
LA
M
S
AL
TX
C
A
AZ
PA
TN
O
R
SC
H
I
N
H
D
E
M
E
C
T
W
Y
R
I
AK
VA
M
A
M
D
N
V
IL
M
T
C
O
M
O
N
J
D
C
U
T
O
H
ID
O
K
IN
G
A
N
Y
N
M
N
C
W
A
FL
AR
SD
W
I
N
E
M
N
N
D
IA
KS
VT
0
State/Territory
* Respondents were considered employed if they reported being employed for wages or self-employed.
†
Defined as a “yes” response to the question, “Have you ever been told by a doctor or other health professional that you have some form of arthritis,
rheumatoid arthritis, gout, lupus, or fibromyalgia?”
§
Defined as a “yes” response to the following: “In this next question, we are referring to work for pay. Do arthritis or joint symptoms now affect whether
you work, the type of work you do, or the amount of work you do?”
accommodations can help keep persons with arthritis and
AAWL employed and independent. The Job Accommodation Network, a service of the U.S. Department of Labor’s
Office of Disability Employment Policy, offers examples of
such accommodations for workers with arthritis (e.g.,
ergonomic work stations and accessible parking) (8).
An increasing proportion of U.S. adults are remaining in
the workforce after age 64 years (9). At the same time, the
number of persons affected by arthritis and its consequences,
including activity limitations, are projected to increase with
the aging of the U.S. population (4), suggesting a corresponding increase in AAWL and effects on employment.
State-based estimates of arthritis impact, such as AAWL,
help define the consequences of arthritis, raise awareness,
and provide state programs and policy-makers with data
for planning. Anticipating and accommodating employment barriers caused by arthritis can prevent disability and
maintain a healthy workforce.
Acknowledgment
The findings in this report for the state of Illinois were provided by
B. Steiner, state BRFSS coordinator, Center for Health Statistics,
Illinois Dept of Public Health.
References
1. US Department of Health and Human Services. Healthy people 2010
(conference ed, in 2 vols). Washington, DC: US Department of Health
and Human Services; 2000. Available at http://www.health.gov/
healthypeople.
2. Theis KA, Murphy L, Hootman JM, Helmick CG, Yelin EH. Prevalence and correlates of arthritis-attributable work limitation in the U.S.
population among persons ages 18–64, 2002 NHIS data. Arthritis Care
Res 2007;57:355–63.
3. CDC. National and state medical expenditures and lost earnings attributable to arthritis and other rheumatic conditions—United States, 2003.
MMWR 2007;56:4–7.
4. Hootman JM, Helmick CG. Projections of U.S. prevalence of arthritis
and associated activity limitations. Arthritis Rheum 2006;54:226–9.
5. Sacks JJ, Harrold LR, Helmick CG, Gurwitz JH, Emani S, Yood RA.
Validation of a surveillance case definition for arthritis. J Rheumatol
2005;32:340–7.
6. Brady TJ, Kruger J, Helmick CG, Callahan LF, Boutaugh ML. Intervention programs for arthritis and other rheumatic diseases. Health Educ
Behav 2003;30:44–63.
7. Allaire SH, Li W, LaValley MP. Reduction in job loss in persons with
rheumatic diseases receiving vocational rehabilitation: a randomized
controlled trial. Arthritis Rheum 2003;48:3212–8.
8. Job Accommodation Network. Job accommodations for people with
arthritis. Available at http://www.jan.wvu.edu/media/employmentartfact.doc.
9. Federal Interagency Forum on Aging-Related Statistics. Older Americans update 2006: key indicators of well-being. Washington, DC: US
Government Printing Office; 2006:18–19,64.
1050
MMWR
Deaths from Intravenous Colchicine
Resulting from a Compounding
Pharmacy Error — Oregon and
Washington, 2007
Colchicine for injection has been available in the United
States since the 1950s. Although not approved by the Food
and Drug Administration (FDA), intravenous (IV)
cholchicine has been an accepted treatment for acute gout
symptoms. Several additional IV uses have been studied,
including treatment of familial Mediterranean fever, pericarditis, primary biliary cirrhosis, amyloidosis, and Behçet’s
syndrome (1–3). More recently, outpatient use of IV
administration for chronic back pain has been advocated
by alternative medicine providers but is not an accepted
practice. Colchicine has well-known toxicities that limit
its safe therapeutic use. IV doses that exceed the standard
single-use therapeutic dose of 2–4 mg per episode of gout
have resulted in life-threatening toxicity (2). In March
2007, two persons from Washington and Oregon died
after receiving IV colchicine for back pain from an alternative medicine clinic in Oregon. This report describes the
investigation, which determined that a measuring error by
a Texas compounding pharmacy resulted in a fatal colchicine concentration that was eight times greater than the
recognized standard level. A subsequent review of medical
records revealed that a third death from colchicine toxicity
in a patient treated at the Oregon clinic also occurred in
March and likely was associated with the same compounding error. These deaths highlight the potential risk from
use of IV colchicine for back pain and the possibly fatal
consequences of measuring errors in compounding
pharmacy products.
Patient A, Washington
On March 19, 2007, a woman aged 77 years arrived at
an emergency department (ED) with sudden onset of nausea, vomiting, numbness, and mild hypotension. She had
been receiving treatment for back pain with what was
intended to be 2-mg IV doses (4 mL of 0.5 mg/mL labeled
concentration) of colchicine administered every other day
in a 6-day period (i.e., 3 total doses). She had received part
of her treatment at an alternative medicine clinic in Portland, Oregon, and then took IV colchicine to her home in
Washington, where she received the third dose shortly
before she became ill and sought treatment at the ED. She
had obtained the colchicine from a relative who was an
employee in the clinic where she received her initial
treatment.
October 12, 2007
Initial laboratory test results revealed only slightly
increased hepatic enzyme levels. The woman was admitted
to the intensive care unit (ICU) for observation. The next
day, her condition deteriorated, with onset of acute renal
insufficiency, an elevated creatinine level (2.6 mg/dL), acidosis (pH = 7.07), leukocytosis (25,100/µL), abnormal liver
function (aspartate aminotransferase [AST] = 1,933 units/L,
alanine transaminase [ALT] = 2,295 units/L),
rhabdomyolysis (creatine kinase = 740 units/L), and
myocardial toxicity (peak troponin I = 53.6 ng/mL).
The woman experienced severe abdominal pain and
refractory hypotension; she died from cardiac arrest later
the same day. Postmortem colchicine plasma level was
44 ng/mL; the therapeutic colchicine plasma level is
<5 ng/mL (4).
Patient B, Oregon
On March 30, 2006, a woman aged 56 years with a history of fibromyalgia and neck pain arrived at an ED with
nausea, vomiting, profuse diarrhea, and chest pain. She had
been receiving weekly IV colchicine for back pain from
naturopathic and allopathic physicians at the same Oregon
clinic as patient A. During the 2 preceding months, she
had received a series of six weekly colchicine infusions, in
doses intended to be 2 mg each, for an intended cumulative dose of 12 mg. Before arrival at the ED, she had just
received the last dose at the clinic and had begun experiencing symptoms within an hour of infusion; a clinic staff
member instructed her to go to the ED. Initial laboratory
test results for blood urea nitrogen (BUN), creatinine, electrolytes, complete blood count, and troponin were within
normal ranges, although her white blood cell (WBC) count
was elevated (14,100/µL). The woman was admitted to the
hospital for rehydration and continued observation. The
leukocytosis increased to a peak count of 18,400/µL, with
40% band forms and evidence of myelocytes,
metamyelocytes, and echinocytes on a peripheral smear.
During the next 72 hours, she experienced leukopenia and
thrombocytopenia (nadir WBC count = 1,400/µL, platelet count = 74,000/µL), renal insufficiency (BUN =
38 mg/dL, creatinine = 2.4 mg/dL), rhabdomyolysis
(creatine kinase = 1,485 units/L), lactic acidosis (venous
lactate = 6.9 mmol/L), abnormal liver function (AST = 626
units/L, ALT = 290 units/L), and myocardial toxicity (peak
troponin I of >50 ng/mL). A cardiac echocardiogram performed on the second hospital day indicated mild wall
motion abnormalities with a normal ejection fraction. Her
serum colchicine level 3 days after the last infusion was
11 ng/mL.
Vol. 56 / No. 40
MMWR
On the third hospital day, the woman was intubated
because of worsening hypoxia and evidence of developing
acute respiratory distress syndrome (ARDS) on chest
radiograph. Her hemodynamic status deteriorated, and she
became hypotensive, requiring dopamine and norepinephrine infusions to maintain a systolic blood pressure of 100
mmHg. During the day, she became increasingly anuric
and hypoxic with worsening ARDS and was unable to
maintain normal oxygen saturation levels, with a fraction
of inspired oxygen (FiO2) of 100%. On the evening of the
third hospital day, her oxygen saturation levels continued
to decrease; she experienced bradycardia and cardiac arrest
and died. Her postmortem colchicine blood level was
32 ng/mL.
Investigation and Control Measures
Investigation into the causes of death of the two patients
and a suspected third patient indicated that they each
received IV colchicine infusions obtained from the same
alternative medicine clinic in Oregon. The clinic had purchased the drug from a Texas compounding pharmacy.
The Washington case occurred when an employee in the
clinic gave colchicine from the implicated lot to her relative (patient A) to take home. The patient had received
previous infusions from different lots and had not become
ill, but the infusion from the new lot resulted in sudden
onset of symptoms on March 19. The unusual circumstances of the woman’s death were discussed on March 26
at a weekly Oregon-Washington poison center teleconference, alerting toxicologists and poison centers in three states.
On March 30, the Oregon patient (patient B) was treated
at the same alternative medicine clinic as patient A. On
April 2, when staff members at the Oregon Poison Center
were consulted about patient B, they notified the county
public health department of the two cases. The Oregon
Board of Naturopathic Examiners was notified and voluntarily posted a warning on its website the same day.
Investigators from the Oregon office of the state medical
examiner learned that the deaths both occurred after the
patients had received colchicine supplied by the Oregon
clinic. The medical examiner’s office confiscated from the
clinic approximately 70 remaining vials of the colchicine,
which were from several lots. Toxicology tests of colchicine
vials from the same lot used to treat the patients indicated
a concentration of 4 mg/mL. However, the vial labels indicated a concentration of 0.5 mg/mL; therefore, each
intended infusion of a 2-mg dose of colchicine was actually
16 mg. The clinic supplied its medical records, including
records of a third patient who was treated the same day as
1051
patient B and who also died. The clinic closed voluntarily
in April 2007 and subsequently ceased operations.
The third suspected case occurred in a man aged 55 years
who received a colchicine infusion on March 30 (the same
day as patient B). He experienced severe vomiting, diarrhea, and chest pain within 1 hour of infusion and sought
treatment at an ED. Because he had a history of coronary
heart disease and recently had received a cardiac stent, his
initial evaluation included a coronary catheterization, which
was normal. He died within 24 hours of receipt of his last
colchicine infusion; his death was attributed initially to
cardiac causes. Media coverage of the deaths associated with
the Oregon clinic prompted a nurse who had treated this
man to call the poison center and report possible colchicine toxicity. After the investigation, the medical examiner
reissued the man’s death certificate, listing colchicine toxicity as cause of death. Although an autopsy was performed,
no body fluids were available to confirm colchicine toxicity.
After the drug concentration in the colchicine vials used
was determined to be eight times the labeled concentration, investigators attributed the deaths to an error at the
Texas compounding pharmacy. On April 30, in coordination with FDA, the Texas State Board of Pharmacy issued a
recall of all colchicine that had been sold or produced by
the compounding pharmacy within the last year and
shipped throughout the United Sates. No other cases have
since been linked to this product.
Reported by: NJ McKeown, DO, BZ Horowitz, MD, F Garlich, MD,
Oregon Poison Center; CR Young, MD, Oregon Medical Examiner.
WO Robertson, MD, Washington Poison Center.
Editorial Note: FDA policy allows an ingredient from an
FDA-approved drug to be compounded to fill a prescription from a licensed practitioner for use by a specifically
named patient. Compounding pharmacies are either registered or licensed by state pharmacy boards. Compounded
drugs are not evaluated for safety and efficacy and, unlike
pharmaceutical manufacturers, traditional compounding
pharmacies are not inspected by FDA to ensure that they
have the capacity to consistently produce high-quality
drugs. However, certain compounding pharmacies that
engage in large-scale manufacturing are subject to regulations that FDA imposes on pharmaceutical manufacturers.
Although FDA has approved drugs that contain a combination of colchicine and probenecid for oral use, no FDAapproved colchicine products for IV use exist. The Texas
State Board of Pharmacy and the Texas attorney general are
investigating the deaths described in this report; the
Oregon attorney general has issued an injunction against
the Texas pharmacy from doing business in Oregon.
1052
MMWR
Colchicine, a naturally occurring alkaloid derivative of
the autumn crocus Colchicum autumnale and the glory lily
Gloriosa superba, has been used to treat gout for centuries.
The drug has a narrow therapeutic range; in toxic levels,
colchicine can disproportionately affect rapidly dividing cells
and have substantial effects on multiple organ systems. In
2005, the American Association of Poison Control Centers
Toxic Exposure Surveillance System reported 312 exposures
and four deaths related to colchicine (5), annual totals that
had remained stable during the preceding 15 years (6). A
review of FDA Adverse Event Reporting System data from
1983 to 2000 indicated that IV administration of colchicine in amounts that exceeded the maximum recognized
dose resulted in 20 deaths from colchicine toxicity, 17 of
these during treatment for gout (2). In 2001, an incident
involving an error of 10 times the standard therapeutic dose
occurred in Pennsylvania and resulted in an FDA recall from
an Arizona compounding pharmacy (7).
The recognized maximum cumulative IV dose is 4 mg
for a single course of therapy, with a 7-day colchicine-free
interval after each full IV course (8). However, deaths have
been reported with cumulative doses as low as 5.5 mg (2).
Older adults, patients with preexisting renal and hepatic
failure, and patients with concomitant use of nonsteroidal
antiinflammatory drugs or oral colchicine might have a
higher risk for toxicity and death (2).
Use of colchicine for treatment of low back pain and
intervertebral disc herniation was described initially in the
1970s. A single case series in 1979 suggested some effectiveness with low doses of oral and IV colchicine in reducing pain (9); subsequent prospective double-blind studies
showed no improvement over placebo with oral use (10)
and only short-lived improvement with IV therapy (3).
Nevertheless, numerous Internet sources continue to recommend use of IV colchicine for back pain, referencing
these early studies as evidence of the drug’s effectiveness.
The cases described in this report highlight the risk for
serious health consequences from use of IV colchicine for
back pain. Although no FDA-approved indication for use
of IV colchicine exists, multiple clinics continue to offer
such therapy for various musculoskeletal disorders. These
deaths underscore the potentially fatal ramifications of
errors by compounding pharmacies, which generally are
not subject to the same oversight and manufacturing practices as pharmaceutical manufacturers. The public health
response to these drug-related deaths and the sharing of
public health information among several states, which
included poison control centers, medical examiners’ offices,
and county health departments, likely prevented additional
deaths.
October 12, 2007
References
1. Simons RJ, Kingma DW. Fatal colchicine toxicity. Am J Med
1989;86:356–7.
2. Bonnel RA, Villalba ML, Karwoski CB, Beitz J. Deaths associated
with inappropriate intravenous colchicine administration. J Emerg
Med 2002;22:385–7.
3. Simmons JW, Harris WP, Koulisis CW, Kimmich SJ. Intravenous
colchicine for low back pain: a double-blind study. Spine 1990;15:
716–7.
4. ARUP Laboratories, National Reference Laboratory. Available at http://
www.aruplab.com/index.jsp.
5. Lai MW, Klein-Schwartz W, Rodgers GC, et al. 2005 annual report of
the American Association of Poison Control Centers’ national
poisoning and exposure database. Clin Toxicol (Phila) 2006;44:
803–932.
6. Mullins ME, Carrico EA, Horowitz BZ. Fatal cardiovascular collapse
following acute colchicine ingestion. J Toxicol Clin Toxicol 2000;38:
51–4.
7. Sussman JS, Brozena SC, Skop N, Korecka M, Shaw LM. Accidental
intravenous colchicine poisoning. Ther Drug Monit 2004;26:688–92.
8. Drugdex ® System. Greenwood Village, Colorado: Thomson
Micromedex.
9. Rask MR. Colchicine use in the damaged disk syndrome (DDS).
Report of 50 patients. Clin Orthop Relat Res 1979;143:183–90.
10. Schnebel BE, Simmons JW. The use of oral colchicine for low-back
pain. A double-blind study. Spine 1988;13:354–7.
HIV/AIDS Among Hispanics —
United States, 2001–2005
In the United States, Hispanics are affected disproportionately by human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS).
Although Hispanics accounted for 14.4% of the U.S. population in 2005 (1), they accounted for 18.9% of persons
who received an AIDS diagnosis (2). The rate of HIV diagnosis among Hispanics also remains disproportionately high;
in 2005, the annual rate of HIV diagnosis for Hispanics
was three times that for non-Hispanic whites. To better
characterize HIV infection and AIDS among Hispanics in
the United States, CDC analyzed selected characteristics
of Hispanics in whom HIV infection was diagnosed during
2001–2005 and those living with AIDS in 2005. The
results indicated that the mode of HIV infection for Hispanics varied by place of birth, suggesting that all HIVprevention measures might not be equally effective among
Hispanics and that HIV educational activities should
address cultural and behavioral differences among Hispanic
subgroups.
This analysis includes cases of HIV/AIDS diagnosed
among Hispanic adults and adolescents aged >13 years
during 2001–2005 in 33 states and cases of Hispanics living with HIV or AIDS in 50 states and the District of
Columbia in 2005. Included are HIV cases reported to
Vol. 56 / No. 40
MMWR
CDC from the 33 states* that have conducted name-based
HIV reporting since at least 2001. Confidential name-based
HIV and AIDS reporting has achieved high levels of
accuracy and reliability (CDC, unpublished data, 2005).
HIV/AIDS cases include those with 1) a diagnosis of HIV
infection that have not progressed to AIDS, 2) a diagnosis
of HIV infection followed by a diagnosis of AIDS, 3) and
concurrent diagnoses of AIDS and HIV infection (i.e., in
the same month).
Cases were classified according to the following transmission categories: 1) male-to-male sexual contact (i.e.,
among men who have sex with men [MSM]); 2) injectiondrug use (IDU); 3) MSM with IDU; 4) high-risk heterosexual contact (i.e., with a person of the opposite sex known
to be HIV infected or at high risk for HIV/AIDS [e.g.,
MSM or injection-drug user]); and 5) other modes of
infection (e.g., receipt of transfusion of blood, blood components, or tissue transplant) and unknown risk factors.
Cases reported with unknown risk factors were reclassified
into transmission categories (e.g., MSM, IDU, MSM and
IDU, high-risk heterosexual contact, and other) in accordance with methods described previously (3). Potential
duplicate cases were identified based on unique identifiers
and selected demographic characteristics and were eliminated on both state and national levels.
For 2005, annual HIV/AIDS diagnosis rates per 100,000
population were calculated for Hispanics, non-Hispanic
whites, and non-Hispanic blacks. Data were adjusted for
reporting delays† (3). The number of Hispanics living with
HIV or AIDS at the end of 2005 was calculated based on
reported cases adjusted for delays in reporting and deaths;
this calculation does not account for undiagnosed cases.
During 2001–2005, a total of 184,167 adults and adolescents had HIV/AIDS diagnosed in the 33 states and
reported to CDC. Of these, 33,398 (18%) were Hispanics; 93,017 (51%) were non-Hispanic blacks; 54,029
(29%) were non-Hispanic whites; 1% were Asian/Pacific
Islanders; and <1% were American Indian/Alaska Natives.
* Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana, Iowa,
Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska,
Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota,
Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah,
Virginia, West Virginia, Wisconsin, and Wyoming.
† Reporting delays (i.e., time between diagnosis and report) can differ by geographic
location, age, sex, transmission category, and race/ethnicity. Adjustments for
reporting time were calculated for HIV and AIDS cases using a maximum
likelihood statistical procedure that accounts for differences in reporting time for
the preceding characteristics while assuming the reporting delay has remained
constant over time. Adjustments also were made based on the redistribution of
cases across transmission categories by sex, race/ethnicity, and geographic region
for cases diagnosed 3–10 years earlier and initially classified as reported with
unknown risk factors but later reclassified.
1053
The mode of HIV infection for 61% of Hispanic males was
male-to-male sexual contact, 17% of infections occurred
through high-risk heterosexual contact, and 17% occurred
through IDU. Among Hispanic females with HIV/AIDS
diagnoses, 76% were exposed through high-risk heterosexual contact, and 23% were exposed through IDU
(Table 1).
In 2005, the overall annual rate of HIV/AIDS diagnosis
among Hispanic males was 56.2 per 100,000 population
and among Hispanic females was 15.8 per 100,000 population. For Hispanic males, the highest rate of HIV diagnosis (86.3 per 100,000) occurred among those aged 30–39
years; for Hispanic females, the highest rate (25.0 per
100,000) occurred among those aged 40–49 years. The
overall rates for non-Hispanic white and non-Hispanic black
males in 2005 were 18.2 and 124.8, respectively, and the
rates for non-Hispanic white and non-Hispanic black
females were 3.0 and 60.2, respectively.
The mode of HIV infection among Hispanics varied by
place of birth (Table 2). Infection through male-to-male
sexual contact was more common among Hispanics born
in South America (65%), Cuba (62%), and Mexico (54%)
than among Hispanics born in the United States (46%). A
greater proportion of Hispanics born in the Dominican
Republic (47%) and Central America (45%) were infected
through high-risk heterosexual contact, compared with
Hispanics born in the United States (28%). Hispanics born
in Puerto Rico had a greater proportion of HIV infections
attributed to IDU (33%) than those born in the United
States (22%).
In 2005, in the 33 states, the rate of living with HIV
infection among Hispanics was estimated at 173.0 per
100,000 population (Table 3). Estimated HIV prevalence
among Hispanics ranged from 34.3 per 100,000 population in Wyoming to 443.0 in New York. In the 50 states
and DC, the rate of living with AIDS among Hispanics
was estimated at 244.2 per 100,000 population. Estimated
AIDS prevalence ranged from 28.7 per 100,000 population in Montana to 1,165.8 per 100,000 population in
DC.
Reported by: L Espinoza, DDS, KL Dominguez, MD, RA Romaguera,
DMD, X Hu, LA Valleroy, PhD, HI Hall, PhD, Div of HIV/AIDS
Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and
TB Prevention, CDC.
Editorial Note: These results confirm a previous report of
disproportionate rates of HIV diagnosis among Hispanics,
who have the second highest rate among all racial/ethnic
groups in the United States (4). During 2001–2004, HIVdiagnosis rates among Hispanics declined by 4.7% and
13.0% among Hispanic males and females, respectively (4).
1054
MMWR
These decreases among Hispanics might have resulted from
decreased incidence of HIV infection (e.g., in response to
prevention measures) or a decrease in HIV testing among
Hispanics. However, this report indicates that Hispanics
are not a homogenous group, and risk factors differ for
Hispanic subpopulations.
Nearly half of U.S. Hispanics in whom HIV infection
was diagnosed were not born in the United States. Hispanics born in Mexico and elsewhere often migrate to the United
States to work as laborers and in service occupations.
Migration might contribute to an increase in HIV risk
behaviors, perhaps because change in residence can be followed by homelessness, loneliness, isolation, separation from
usual sex partners, and financial instability. These factors
can be associated with new sex partners, illegal drug use,
and inadequate access to health information and healthcare services (5).
During 2001–2005, the primary mode of HIV infection among Hispanic males was male-to-male sexual contact. A recent study of HIV risk behaviors among MSM
reported that Hispanic and non-Hispanic black MSM were
more likely than non-Hispanic white MSM to report
inconsistent condom use during anal sex (6). However,
male-to-male sexual contact is not the most common transmission category for Hispanics for certain places of birth.
High-risk heterosexual contact was more common among
Hispanics born in Central America and the Dominican
Republic than Hispanics born in South America, Cuba,
Mexico, Puerto Rico, and the United States. In addition,
HIV knowledge and perceptions of risk differ among U.S.
Hispanic subgroups. Immigrants born in Cuba, Mexico,
and Puerto Rico who were injection-drug users reported
less AIDS knowledge than U.S.-born injection-drug users
(7).
The finding that a greater proportion of Puerto Ricoborn Hispanics residing in the 33 states are infected through
IDU is consistent with previous reports (8) and might be
the result of both greater prevalence of IDU and increased
levels of high-risk behaviors related to IDU (e.g., frequency
of injecting and sharing syringes) compared with other
Hispanics (9). U.S. Hispanic subgroups of varied national
origin or ancestry differ in IDU-related behaviors. Puerto
Rico-born injection-drug users are more likely to share
syringes, cotton, or rinse water and to inject more frequently
than Puerto Ricans born in the United States (10).
The findings in this report are subject to at least four
limitations. First, although AIDS is a reportable condition
in all 50 states, name-based HIV data were available from
only 33 states. These states represented an estimated 63%
of all AIDS cases and 56% of AIDS cases among Hispanics
October 12, 2007
in the United States during 2001–2005. The exclusion (2)
of data from some states with high AIDS prevalence and a
large Hispanic population (e.g., California) results in an
underrepresentation of cases among Hispanics. Second, the
assumptions by which the approximately 32% of cases that
had no known risk factors were redistributed among transmission categories might no longer be valid; these assumptions are being reevaluated. Third, misclassification of
Hispanics as members of other races/ethnicities or inability to include undocumented migrant workers might have
resulted in underestimations of the number of Hispanics
overall and in Hispanic subgroups. Finally, birthplace
information was missing for approximately 24% of Hispanics in this analysis. Depending on the distribution of
birthplaces for persons with missing information, transmission-category prevalences for certain subgroups might have
been larger or smaller.
The disproportionate rate of HIV infection among
Hispanics might reflect the failure of HIV-prevention programs to reach Hispanics at high risk for acquiring or transmitting HIV infection. More specifically, the difference in
HIV transmission categories among Hispanics by place of
birth might represent differences in acculturation, linguistic ability, socioeconomic status, and stigma associated with
homosexuality or male-to-male sex. CDC recently established an internal committee to develop a National Plan of
Action to reduce the number of new HIV infections among
Hispanics and to increase access to culturally appropriate
prevention, care, and treatment services. The plan is aimed
at enhancing research, policy, and community involvement
to increase capacity to deliver appropriate HIV-prevention
services to Hispanics. CDC will expand its partnerships
with other federal agencies, state and local health departments, academic institutions, and community-based organizations to identify specific steps to implement the
National Plan of Action. Because the Hispanic population
in the United States is expected to nearly triple between
2000 and 2050, § additional attention to the impact of
HIV on this population is warranted.
References
1. US Census Bureau. Annual estimates of the population by sex, race
and Hispanic or Latino origin for the United States: April 1, 2000 to
July 1, 2006. Available at http://www.census.gov/popest/national/asrh/
NC-EST2006-srh.html.
2. CDC. Cases of HIV infection and AIDS in the United States and
dependent areas, 2005. HIV/AIDS surveillance report, Vol. 17,
revised edition. Atlanta, GA: US Department of Health and Human
Services, CDC; 2007:12,47. Available at http://www.cdc.gov/hiv/
topics/surveillance/resources/reports/2005report.
§ Information
available at http://www.census.gov/ipc/www/usinterimproj/
natprojtab01a.pdf.
Vol. 56 / No. 40
MMWR
1055
TABLE 1. Estimated* number and percentage of HIV/AIDS diagnoses among Hispanic adults and adolescents aged >13 years, by
selected characteristics — 33 states,† 2001–2005
Males
No.
Total§
Age group (yrs)
13–19
20–29
30–39
40–49
50–59
>60
Transmission category
Male-to-male sexual contact
Injection-drug use
Male-to-male sexual contact
and injection-drug use
High-risk heterosexual contact¶
Other**
Area of residence††
Rural
Suburban
Urban
Unknown
Total§
Females
(%)
No.
25,827
(%)
No.
7,571
(%)
33,398
520
6,084
9,797
6,332
2,215
879
(2)
(23)
(38)
(24)
(9)
(3)
269
1,745
2,438
1,983
841
295
(3)
(23)
(32)
(26)
(11)
(4)
790
7,829
12,234
8,314
3,056
1,175
(2)
(23)
(37)
(25)
(9)
(3)
15,742
4,472
1,184
(61)
(17)
(4)
—
1,737
—
—
(23)
—
15,742
6,209
1,184
(47)
(18)
(3)
4,301
129
(17)
(1)
5,728
106
(76)
(1)
10,028
235
(30)
(1)
1,173
1,961
22,156
538
(4)
(8)
(86)
(2)
304
523
6,620
124
(4)
(7)
(87)
(2)
1,477
2,483
28,776
662
(4)
(7)
(86)
(2)
* All estimates have been adjusted for reporting delays and the reclassification of cases with unknown risk factors for HIV infection.
Data were reported by 33 U.S. states with confidential, name-based reporting: Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana,
Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North
Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.
§ Because column totals were calculated independently of the values for the subpopulations, the values in each column might not sum to the column total.
¶ Heterosexual contact with a sex partner known to have HIV infection or to be at high risk for HIV infection.
** Includes receipt of transfusion of blood, blood components, or tissue and unknown risk factor.
†† Rural: Nonmetropolitan area. Suburban: 50,000–500,000 population. Urban: >500,000 population.
†
TABLE 2. Estimated* number and percentage of HIV/AIDS diagnoses among Hispanic adults and adolescents aged >13 years, by
transmission category and place of birth — 33 states,† 2001–2005
Place of birth
Male-to-male
sexual contact
No.
(%)
United States
6,189
Central America
657
South America
1,330
Cuba
732
Dominican Republic 181
Mexico
2,163
Puerto Rico
602
177
Other††
Unknown
3,710
Total**
15,742
(46)
(41)
(65)
(62)
(30)
(54)
(29)
(40)
(47)
(47)
Injection-drug use
Male
Female
No.
(%)
No.
(%)
2,001
139
107
76
80
362
502
62
1,142
4,472
(15)
(8)
(5)
(6)
(13)
(9)
(25)
(14)
(14)
(13)
922
43
40
18
40
64
161
28
421
1,737
(7)
(3)
(2)
(2)
(7)
(2)
(8)
(6)
(5)
(5)
Male-to-male
sexual
contact and
injection- High-risk heterosexual contact§
drug use
Male
Female
No.
(%)
No.
(%)
No.
(%)
553
39
45
50
15
153
89
13
227
1,184
(4)
(2)
(2)
(4)
(2)
(4)
(4)
(3)
(3)
(4)
1,409
338
225
185
106
656
243
77
1,060
4,300
(10)
(21)
(11)
(16)
(17)
(16)
(12)
(17)
(13)
(13)
2,385
383
286
111
185
577
421
78
1,302
5,728
(18)
(24)
(14)
(9)
(30)
(14)
(21)
(18)
(16)
(17)
Other¶
No.
(%)
75
23
10
3
6
43
15
3
57
235
Total**
No.
(1) 13,535
(1) 1,622
(1) 2,043
(<1) 1,174
(1)
613
(1) 4,018
(1) 2,033
(1)
439
(1) 7,920
(1) 33,398
* All estimates have been adjusted for reporting delays and the reclassification of cases with unknown risk factors for HIV infection.
Data were reported by 33 U.S. states with confidential, name-based reporting: Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana,
Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North
Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.
§ Heterosexual contact with a sex partner known to have HIV infection or to be at high risk for HIV infection.
¶ Includes receipt of transfusion of blood, blood components, or tissue and unknown risk factor.
** Because row and column totals were calculated independently of the values for the subpopulations, the values in each row and column might not sum
to the row or column total.
†† Places of birth other than those specified.
†
1056
MMWR
October 12, 2007
TABLE 3. Estimated rates* of Hispanic adults and adolescents aged >13 years living with HIV infection (not AIDS) or AIDS, by area of
residence — United States, 2005
Area of residence
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Total**
Living with HIV infection (not AIDS)†
No.
Rate
Rank¶
76
16
1,295
49
—
834
—
—
—
6,184
—
—
39
—
207
39
132
—
202
—
—
—
201
219
66
178
—
66
533
—
3,095
361
10,781
408
3
319
116
—
—
—
142
6
135
5,267
137
—
496
—
15
224
9
31,851
99.0
67.1
106.5
52.2
—
125.2
—
—
—
222.0
—
—
41.9
—
100.4
49.5
79.6
—
193.9
—
—
—
70.7
163.5
162.8
152.9
—
75.0
130.0
—
301.2
55.1
443.0
103.2
38.8
163.2
68.0
—
—
—
135.0
52.3
100.8
88.7
71.8
—
145.4
—
117.0
124.3
34.3
173.0
19
26
15
29
—
12
—
—
—
3
—
—
31
—
18
30
21
—
4
—
—
—
24
5
7
8
22
11
—
2
27
1
16
32
6
25
—
—
—
10
28
17
20
23
—
9
—
14
13
33
No.
73
31
1,192
50
17,270
766
2,147
101
438
7,992
597
100
33
2,410
238
71
146
103
204
24
397
2,040
247
205
44
176
5
104
529
56
3,649
526
22,552
360
3
342
117
258
2,134
275
140
4
159
8,068
184
9
474
528
9
226
12
77,817
Living with AIDS§
Rate
94.4
129.6
98.1
52.8
184.5
115.0
740.6
274.5
1,165.8
286.9
126.7
140.4
35.9
179.7
115.2
89.4
88.0
166.7
195.9
236.4
164.4
536.2
87.1
153.0
107.7
151.0
28.7
118.7
129.0
259.1
355.1
80.2
926.6
91.2
38.7
174.7
68.6
100.4
570.2
324.0
133.4
35.0
118.9
135.9
96.5
155.5
138.7
134.0
67.6
125.4
46.2
244.2
Rank¶
38
26
36
46
13
33
3
9
1
8
28
21
49
14
32
40
41
16
12
11
17
5
42
19
34
20
51
31
27
10
6
43
2
39
48
15
44
35
4
7
25
50
30
23
37
18
22
24
45
29
47
* Rates are per 100,000 population. All estimates have been adjusted for reporting delays.
Includes only persons living with HIV (not AIDS) in 33 states with confidential name-based reporting: Alabama, Alaska, Arizona, Arkansas, Colorado,
Florida, Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York,
North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and
Wyoming.
§ Includes only persons living with AIDS. Cases were from the 50 U.S. states and the District of Columbia.
¶ Areas ranked by highest rate.
** Because column totals were calculated independently of the values for the subpopulations, the values in each column might not sum to the column total.
Data exclude Puerto Rico, where census information about race and age categories was lacking.
†
Vol. 56 / No. 40
MMWR
3. Green T. Using surveillance data to monitor trends in the AIDS
epidemic. Statist Med 1998;17:143–54.
4. CDC. Racial/ethnic disparities in diagnoses of HIV/AIDS—33 states,
2001–2004. MMWR 2006;55:121–5.
5. Organista KC, Balls Organista P, Garcia de Alba JE, Castillo Moran
MA, Ureta Carrillo LE. Survey of condom-related beliefs, behaviors,
and perceived social norms in Mexican migrant laborers. J Community
Health 1997;22:185–98.
6. Rhodes SD, Yee LJ, Hergenrather KC. A community-based rapid
assessment of HIV behavioural risk disparities within a large sample of
gay men in southeastern USA: a comparison of African American,
Latino and white men. AIDS Care 2006;18:1018–24.
7. Freeman RC, Williams ML, Saunders LA. Drug use, AIDS knowledge, and HIV risk behaviors of Cuban-, Mexican-, and Puerto-Ricanborn drug injectors who are recent entrants into the United States.
Subst Use Misuse 1999;34:1765–93.
8. Diaz T, Buehler JW, Castro KG, Ward JW. AIDS trends among
Hispanics in the United States. Am J Public Health 1993;83:504–9.
9. Deren S, Oliver-Velez D, Finlinson A, et al. Integrating qualitative
and quantitative methods: comparing HIV-related risk behaviors
among Puerto Rican drug users in Puerto Rico and New York. Subst
Use Misuse 2003;38:1–24.
10. Finlinson HA, Oliver-Velez D, Deren S, et al. A longitudinal study of
syringe acquisition by Puerto Rican injection drug users in New York
and Puerto Rico: implications for syringe exchange and distribution
programs. Substance Use Misuse 2006;41:1313–36.
Notice to Readers
FDA Approval of an Alternate Dosing
Schedule for a Combined Hepatitis A
and B Vaccine (Twinrix®)
In April 2007, GlaxoSmithKline Vaccine Division
(GlaxoSmithKline Biologicals, King of Prussia, Pennsylvania)
received approval from the Food and Drug Administration
(FDA) for an alternate schedule for Twinrix®, a combined
hepatitis A and hepatitis B vaccine. Twinrix was first
licensed by FDA in 2001 on a 3-dose schedule (0, 1, and 6
months) for vaccination of persons aged >18 years (1).
Using the newly licensed, alternate 4-dose schedule, Twinrix
doses can be administered at 0, 7, and 21–30 days,
followed by a dose at 12 months.
In immunogenicity studies among adults aged >18 years,
the first 3 doses of the alternate schedule provided equivalent protection to the first 2 doses in the standard 3-dose
Twinrix series (2). The first 3 doses of the alternate schedule also have proven effective in providing protection equivalent to a single dose of monovalent hepatitis A vaccine and
to 2 doses of monovalent hepatitis B vaccine, administered
using the licensed schedules for the monvalent vaccines (3).
Thus, the alternate 4-dose schedule can be useful if vaccination with Twinrix has been initiated and travel or other
1057
potential exposure is anticipated before the second dose of
Twinrix (or monovalent hepatitis B vaccine) is due, according to the standard 3-dose schedule (i.e., 1 month after
the first dose). Additional information is available from the
manufacturer’s package insert (4) and GlaxoSmithKline
Vaccines, telephone 800-366-8900.
References
1. CDC. FDA approval for a combined hepatitis A and B vaccine. MMWR
2001;50:806–7.
2. Joines RW, Blatter M, Abraham B, et al. A prospective, randomized,
comparative US trial of a combination hepatitis A and B vaccine
(Twinrix®) with corresponding monovalent vaccines (Havrix® and
Engerix-B®) in adults. Vaccine 2001;19:4710–9.
3. Nothdurft HD, Dietrich M, Zuckerman JN, et al. A new accelerated
vaccination schedule for rapid protection against hepatitis A and B.
Vaccine 2002;20:1157–62.
4. GlaxoSmithKline. Revised package insert. Twinrix® (hepatitis A inactivated & hepatitis B [recombinant] vaccine). Available at http://
www.fda.gov/cber/label/hahbgsk032807lb.pdf.
Notice to Readers
National Latino AIDS Awareness Day —
October 15, 2007
October 15 marks the fifth National Latino AIDS Awareness Day (NLAAD). Initiated in 2003 by the Latino Commission on AIDS and the Hispanic Federation in
partnership with faith and community organizations,
NLAAD raises awareness of human immunodeficiency
virus/acquired immunodeficiency syndrome (HIV/AIDS)
in the Hispanic/Latino population living in the United
States and abroad.
In 2005, Hispanics accounted for approximately 14.4%
of the U.S. population but 18.9% of persons who received
an AIDS diagnosis in the United States. Because the U.S.
Hispanic population is expected to triple from 2000 to
2050, HIV/AIDS prevention needs will require greater
attention. Modes of HIV infection among Hispanics have
been determined to vary by place of birth (1). Taking into
account these and other varying risk behaviors among subgroups of Hispanics is an important consideration in
developing prevention programs.
Information regarding NLAAD is available at http://
nlaad.org. Information regarding CDC activities and
resources supporting NLAAD is available at http://
www.cdc.gov/hiv/nlaad.htm.
Reference
1. CDC. HIV/AIDS among Hispanics—United States, 2001–2005.
MMWR 2007;56:1052–7.
1058
MMWR
October 12, 2007
QuickStats
from the national center for health statistics
Estimated Percentage of Adults with Daily Activity Limitations, by Age Group
and Type of Limitation — National Health Interview Survey, United States, 2006*
20
18–44 yrs
45–64 yrs
16
Percentage
65–74 yrs
>75 yrs
12
8
4
†
0
Limitation in activities
of daily living §
Limitation in instrumental
activities of daily living¶
Type of limitation
* Estimates are based on household interviews of a sample of the civilian,
noninstitutionalized U.S. population. Persons with unknown limitation status
were excluded from the denominators.
† 95% confidence interval.
§ Based on response to the question, “Because of a physical, mental, or
emotional problem, does [person] need the help of other persons with personal
care needs, such as eating, bathing, dressing, or getting around inside the home?”
¶ Based on response to the question, “Because of a physical, mental, or
emotional problem, does [person] need the help of other persons in handling
routine needs, such as everyday household chores, doing necessary
business, shopping, or getting around for other purposes?”
In 2006, adults aged >75 years were nearly three times as likely as those aged 65–74 years to require the
help of another person in performing activities of daily living (e.g., eating, dressing, or bathing) and instrumental
activities of daily living (e.g., household chores or shopping).
SOURCE: Adams PF, Lucas JW, Barnes PM. Summary health statistics for the U.S. population: National
Health Interview Survey, 2006. Vital Health Stat 2007;10(236). Available at http://www.cdc.gov/nchs/data/
series/sr_10/sr10_236.pdf.
Vol. 56 / No. 40
MMWR
1059
TABLE I. Provisional cases of infrequently reported notifiable diseases (<1,000 cases reported during the preceding year) — United States,
week ending October 6, 2007 (40th Week)*
Current
week
—
Disease
Anthrax
Botulism:
foodborne
infant
other (wound & unspecified)
Brucellosis
Chancroid
Cholera
Cyclosporiasis§
Diphtheria
Domestic arboviral diseases§,¶:
California serogroup
eastern equine
Powassan
St. Louis
western equine
Ehrlichiosis§:
human granulocytic
human monocytic
human (other & unspecified)
Haemophilus influenzae,**
invasive disease (age <5 yrs):
serotype b
nonserotype b
unknown serotype
Hansen disease§
Hantavirus pulmonary syndrome§
Hemolytic uremic syndrome, postdiarrheal§
Hepatitis C viral, acute
HIV infection, pediatric (age <13 yrs)††
Influenza-associated pediatric mortality§,§§
Listeriosis
Measles¶¶
Meningococcal disease, invasive***:
A, C, Y, & W-135
serogroup B
other serogroup
unknown serogroup
Mumps
Novel influenza A virus infections
Plague
Poliomyelitis, paralytic
Poliovirus infection, nonparalytic§
Psittacosis§
Q fever§
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)§
Yellow fever
Cum
2007
—
5-year
weekly
average†
—
Total cases reported for previous years
2006
1
2005
—
2004
—
2003
—
2002
2
1
—
1
—
—
—
1
—
15
61
20
93
22
1
83
—
0
2
1
2
0
0
1
—
20
97
48
121
33
9
136
—
19
85
31
120
17
8
543
—
16
87
30
114
30
5
171
—
20
76
33
104
54
2
75
1
28
69
21
125
67
2
156
1
—
—
—
—
—
22
3
1
2
—
5
0
—
1
—
67
8
1
10
—
80
21
1
13
—
112
6
1
12
—
108
14
—
41
—
164
10
1
28
—
24
16
—
371
474
123
9
11
2
646
578
231
786
506
112
537
338
59
362
321
44
511
216
23
—
—
—
—
—
6
14
—
—
3
—
11
91
161
41
19
159
503
—
73
478
30
0
2
3
1
0
5
20
3
0
20
0
29
175
179
66
40
288
802
52
43
875
55
9
135
217
87
26
221
652
380
45
896
66
19
135
177
105
24
200
713
436
—
753
37
32
117
227
95
26
178
1,102
504
N
696
56
34
144
153
96
19
216
1,835
420
N
665
44
1
1
1
4
3
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
3
—
—
11
—
206
102
19
454
595
3
4
—
—
6
132
—
11
—
—
—
77
313
13
61
5
97
241
16
—
245
—
3
2
0
10
14
—
0
0
—
0
2
0
0
—
—
—
1
8
1
2
0
3
9
0
0
2
—
318
193
32
651
6,584
N
17
—
N
21
169
3
11
1
—
—
125
380
41
101
15
95
353
6
1
N
—
297
156
27
765
314
N
8
1
N
16
136
2
11
1
—
—
129
329
27
90
16
154
324
2
3
N
—
—
—
—
—
258
N
3
—
N
12
70
7
10
—
—
—
132
353
34
95
5
134
322
—
1
N
—
—
—
—
—
231
N
1
—
N
12
71
2
7
1
8
—
161
413
20
133
6
129
356
N
N
N
—
—
—
—
—
270
N
2
—
N
18
61
3
18
1
N
—
118
412
25
109
14
90
321
N
N
N
1
States reporting cases during current week (No.)
AK (1)
CA (1)
NC (1)
MN (24)
MN (7), MO (1), NC (1), GA (1), FL (1), AR (5)
OH (3), MN (2), CA (1)
RI (1), OH (1), MD (1), NC (1), OK (8), TX (1), CA (1)
RI (1), TX (1), CA (1)
FL (1)
IN (1)
NE (1)
MN (1), NE (1), SC (1), FL (1)
OH (1), MI (1), AZ (1)
OH (1), MN (1), FL (1)
FL (4), WA (1), CA (6)
—: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts.
* Incidence data for reporting year 2007 are provisional, whereas data for 2002, 2003, 2004, 2005, and 2006 are finalized.
† 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/epo/dphsi/phs/files/5yearweeklyaverage.pdf.
§ Not notifiable in all states. Data from states where the condition is not notifiable are excluded from this table, except 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/epo/dphsi/phs/infdis.htm.
¶ Includes both neuroinvasive and nonneuroinvasive. Updated weekly from reports to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, VectorBorne, 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. A total of 71 cases were reported for the 2006–07 flu season.
¶¶ No measles cases were reported for the current week.
*** Data for meningococcal disease (all serogroups) are available in Table II.
††† 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.
1060
MMWR
October 12, 2007
TABLE II. Provisional cases of selected notifiable diseases, United States, weeks ending October 6, 2007, and October 7, 2006
(40th Week)*
Reporting area
United States
Current
week
Chlamydia†
Previous
52 weeks
Cum
Med
Max
2007
Cum
2006
Current
week
Coccidioidomycosis
Previous
52 weeks
Cum
Med
Max
2007
Cum
2006
Current
week
Cryptosporidiosis
Previous
52 weeks
Cum
Med
Max
2007
Cum
2006
11,779
20,393
25,327
780,684
782,339
54
130
658
5,179
6,274
262
82
931
7,695
4,351
566
28
57
424
38
—
19
720
229
50
305
39
66
19
1,357
829
74
600
70
108
45
26,378
7,762
1,979
12,030
1,612
2,335
660
24,932
7,136
1,727
11,229
1,492
2,426
922
—
N
—
—
—
—
N
0
0
0
0
0
0
0
1
0
0
0
1
0
0
2
N
—
—
2
—
N
—
N
—
—
—
—
N
1
—
—
—
—
—
1
4
0
1
1
1
0
1
36
36
6
4
5
3
3
208
36
41
50
44
6
31
325
38
36
162
38
11
40
Mid. Atlantic
New Jersey
New York (Upstate)
New York City
Pennsylvania
2,036
223
—
1,622
191
2,694
405
514
925
764
4,284
537
2,758
1,682
1,760
107,317
15,808
19,859
37,414
34,236
95,807
15,536
18,499
31,332
30,440
—
N
N
N
N
0
0
0
0
0
0
0
0
0
0
—
N
N
N
N
—
N
N
N
N
—
—
—
—
—
10
0
3
1
4
109
2
21
10
103
956
9
181
47
719
519
41
126
120
232
E.N. Central
Illinois
Indiana
Michigan
Ohio
Wisconsin
1,768
831
366
361
77
133
3,121
943
397
715
704
371
6,216
1,367
646
1,080
3,643
443
126,788
36,424
15,936
27,155
32,882
14,391
132,084
41,444
15,296
27,310
32,075
15,959
—
—
—
—
—
N
1
0
0
0
0
0
3
0
0
3
2
0
24
—
—
16
8
N
36
—
—
32
4
N
37
—
3
1
26
7
18
2
1
3
5
6
107
10
12
10
61
48
1,267
110
76
135
449
497
1,115
176
69
116
284
470
417
—
—
1
370
—
—
46
1,169
166
151
230
447
95
27
49
1,429
252
294
314
565
183
61
84
44,246
6,488
6,176
7,696
17,745
3,122
1,044
1,975
47,580
6,380
6,136
9,913
17,651
4,079
1,394
2,027
—
N
N
—
—
N
N
N
0
0
0
0
0
0
0
0
54
0
0
54
1
0
0
0
6
N
N
—
6
N
N
N
1
N
N
—
1
N
N
N
32
5
—
17
5
5
—
—
12
2
1
3
2
1
0
2
120
60
15
34
13
21
11
15
1,127
489
90
168
115
119
14
132
697
156
68
150
162
82
8
71
3,272
46
—
1,318
4
446
72
922
461
3
4,026
66
103
1,104
624
399
593
488
490
57
6,760
140
166
1,767
3,822
696
1,905
3,030
685
92
154,785
2,620
4,303
44,582
19,038
15,474
22,648
24,896
19,000
2,224
148,991
2,714
2,225
37,799
27,271
16,302
25,925
16,010
18,494
2,251
—
—
—
N
N
—
—
N
N
N
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
1
0
0
0
0
3
—
—
N
N
3
—
N
N
N
3
—
—
N
N
3
—
N
N
N
56
—
—
30
21
1
4
—
—
—
20
0
0
11
4
0
1
1
1
0
67
4
2
35
17
2
9
11
4
5
869
16
3
477
165
24
72
57
45
10
849
12
12
357
215
15
79
112
39
8
E.S. Central
Alabama§
Kentucky
Mississippi
Tennessee§
712
78
150
100
384
1,442
358
143
355
505
2,044
558
691
959
720
54,549
12,235
6,235
14,945
21,134
58,592
18,136
6,427
14,481
19,548
—
N
N
N
N
0
0
0
0
0
0
0
0
0
0
—
N
N
N
N
—
N
N
N
N
6
—
6
—
—
3
1
1
0
1
60
12
39
10
17
447
71
213
74
89
142
52
34
22
34
W.S. Central
Arkansas§
Louisiana
Oklahoma
Texas§
1,450
256
94
184
916
2,305
168
362
266
1,490
2,971
288
855
467
1,956
92,661
6,797
14,854
10,196
60,814
88,745
6,299
13,950
9,183
59,313
—
N
—
N
N
0
0
0
0
0
1
0
1
0
0
1
N
1
N
N
1
N
1
N
N
12
4
—
8
—
5
0
1
1
2
41
8
5
11
29
243
25
39
89
90
317
18
69
32
198
Mountain
Arizona
Colorado
Idaho§
Montana§
Nevada§
New Mexico§
Utah
Wyoming§
294
80
—
—
—
159
—
44
11
1,290
485
245
53
47
181
150
104
23
2,026
993
369
253
82
293
394
209
38
45,957
16,101
7,509
2,399
1,488
7,279
6,124
4,140
917
52,367
16,625
12,598
2,234
1,962
6,454
7,556
3,803
1,135
45
43
N
N
N
2
—
—
—
82
79
0
0
0
1
0
1
0
293
293
0
0
0
5
2
5
1
3,125
3,015
N
N
N
48
17
42
3
4,330
4,216
N
N
N
49
17
46
2
117
2
10
37
1
3
—
64
—
6
0
1
0
1
0
1
0
0
571
6
25
71
18
3
7
498
8
2,465
37
136
314
54
16
72
1,795
41
317
23
61
29
107
8
36
15
38
1,264
87
747
10
305
115
3,370
87
2,678
101
157
319
4,362
157
3,627
133
394
621
128,003
3,360
102,995
4,032
6,575
11,041
133,241
3,374
104,636
4,438
7,187
13,606
9
N
9
N
N
N
47
0
47
0
0
0
311
0
311
0
0
0
2,018
N
2,018
N
N
N
1,903
N
1,903
N
N
N
1
—
—
—
1
—
1
0
0
0
1
0
18
2
0
4
14
0
113
3
—
6
104
—
70
4
—
4
62
—
U
U
—
—
U
0
—
4
120
3
32
—
207
544
7
U
U
340
5,684
U
U
U
692
3,854
U
U
U
—
N
U
0
—
0
0
0
0
—
0
0
0
U
U
—
N
U
U
U
—
N
U
U
U
—
N
U
0
—
0
0
0
0
—
0
0
0
U
U
—
N
U
U
U
—
N
U
New England
Connecticut
Maine§
Massachusetts
New Hampshire
Rhode Island§
Vermont§
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
Pacific
Alaska
California
Hawaii
Oregon§
Washington
American Samoa
C.N.M.I.
Guam
Puerto Rico
U.S. Virgin Islands
C.N.M.I.: Commonwealth of Northern Mariana Islands.
U: Unavailable. —: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum.
*† Incidence data for reporting year 2007 are provisional. Data for HIV/AIDS, AIDS, and TB, when available, are displayed in Table IV, which appears quarterly.
Chlamydia refers to genital infections caused by Chlamydia trachomatis.
§
Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
Vol. 56 / No. 40
MMWR
1061
TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 6, 2007, and October 7, 2006
(40th Week)*
Reporting area
United States
Current
week
Giardiasis
Previous
52 weeks
Cum
Med
Max
2007
Cum
2006
Current
week
Gonorrhea
Previous
52 weeks
Med
Max
Cum
2007
Cum
2006
8,941 253,879 272,717
Haemophilus influenzae, invasive
All ages, all serotypes†
Previous
Current
52 weeks
Cum
Cum
week
Med
Max
2007
2006
230
302
1,513
12,008
13,618
3,959
6,652
15
45
184
1,699
1,752
New England
Connecticut
Maine§
Massachusetts
New Hampshire
Rhode Island§
Vermont§
8
2
6
—
—
—
—
24
5
4
9
0
0
3
50
18
10
20
3
9
12
961
271
153
356
20
36
125
1,134
237
134
505
21
92
145
74
3
2
68
1
—
—
113
47
2
51
3
8
1
259
204
8
96
8
18
5
4,209
1,579
98
2,057
119
311
45
4,204
1,684
97
1,835
150
383
55
—
—
—
—
—
—
—
3
0
0
2
0
0
0
19
7
2
6
2
10
1
131
40
9
58
15
7
2
139
39
16
62
10
4
8
Mid. Atlantic
New Jersey
New York (Upstate)
New York City
Pennsylvania
2
—
—
2
—
57
5
24
15
13
127
11
108
24
29
2,054
142
827
599
486
2,690
386
917
755
632
385
100
—
249
36
716
117
112
204
240
1,537
159
1,035
360
586
28,066
4,614
5,125
7,926
10,401
25,480
4,136
4,787
7,866
8,691
—
—
—
—
—
10
1
3
2
3
27
5
15
6
10
355
50
103
76
126
350
61
108
65
116
E.N. Central
Illinois
Indiana
Michigan
Ohio
Wisconsin
24
—
N
4
19
1
46
12
0
12
15
7
77
22
0
20
37
19
1,729
444
N
434
614
237
2,183
551
N
553
623
456
716
285
170
149
27
85
1,222
350
165
290
318
127
2,578
498
306
747
1,557
181
51,040
13,532
6,846
11,055
14,568
5,039
54,398
15,572
6,792
11,294
15,398
5,342
2
—
—
—
2
—
6
1
1
0
2
0
15
6
7
5
5
2
204
47
45
21
82
9
298
89
65
22
65
57
W.N. Central
Iowa
Kansas
Minnesota
Missouri
Nebraska§
North Dakota
South Dakota
13
1
—
—
7
4
1
—
20
5
3
0
7
2
0
1
553
20
11
514
22
8
16
6
863
220
119
12
336
96
16
64
1,484
236
158
475
431
96
14
74
130
—
—
—
127
—
—
3
371
39
44
59
198
25
2
6
512
60
86
86
266
57
7
11
14,114
1,413
1,767
2,033
7,751
885
65
200
14,949
1,430
1,729
2,511
7,828
1,059
103
289
3
—
—
3
—
—
—
—
3
0
0
1
1
0
0
0
24
1
2
17
5
2
2
0
106
1
9
47
34
13
2
—
116
1
16
57
31
7
4
—
S. Atlantic
Delaware
District of Columbia
Florida
Georgia
Maryland§
North Carolina
South Carolina§
Virginia§
West Virginia
49
—
—
27
16
3
—
3
—
—
57
1
0
24
10
4
0
2
9
0
106
3
7
47
33
17
0
8
19
21
2,136
30
34
983
454
187
—
74
338
36
2,065
34
52
821
500
183
—
80
372
23
1,447
22
—
497
2
104
331
338
152
1
1,615
27
47
471
294
119
282
202
122
18
3,209
43
72
717
2,068
227
675
1,361
222
36
59,780
1,009
1,768
18,289
7,742
4,735
10,411
10,500
4,642
684
66,834
1,132
1,347
18,631
13,580
5,528
13,330
7,392
5,185
709
7
—
—
3
2
1
1
—
—
—
11
0
0
3
2
1
0
1
1
0
34
3
2
8
7
6
9
4
22
6
453
6
3
126
92
65
46
38
53
24
429
1
4
132
88
62
46
29
51
16
E.S. Central
Alabama§
Kentucky
Mississippi
Tennessee§
—
—
N
N
—
10
4
0
0
5
23
16
0
0
16
387
175
N
N
212
342
163
N
N
179
231
25
45
43
118
559
154
54
140
192
752
242
268
310
261
21,145
5,483
2,468
5,637
7,557
23,936
8,424
2,301
5,695
7,516
—
—
—
—
—
2
0
0
0
1
9
3
1
1
6
96
20
2
7
67
89
18
5
12
54
W.S. Central
Arkansas§
Louisiana
Oklahoma
Texas§
8
4
—
4
N
7
2
1
3
0
55
13
9
42
0
274
91
74
109
N
256
92
67
97
N
605
108
53
64
380
982
78
222
101
575
1,177
120
384
235
731
38,536
3,000
8,609
3,923
23,004
39,067
3,290
8,374
3,455
23,948
—
—
—
—
—
2
0
0
1
0
34
2
2
29
3
81
8
6
61
6
73
8
18
40
7
Mountain
Arizona
Colorado
Idaho§
Montana§
Nevada§
New Mexico§
Utah
Wyoming§
56
5
12
3
3
2
—
31
—
29
2
8
3
2
2
2
6
1
63
9
24
12
8
8
6
27
4
1,155
95
368
131
83
88
77
283
30
1,317
127
439
146
81
95
64
335
30
69
23
—
—
—
35
—
11
—
251
105
54
3
1
46
30
17
2
454
220
93
20
8
87
58
34
5
9,209
3,423
1,842
178
50
1,781
1,255
618
62
11,803
4,236
2,871
132
157
2,249
1,402
654
102
3
—
2
1
—
—
—
—
—
4
1
1
0
0
0
1
0
0
11
6
4
1
1
2
4
3
1
182
57
45
5
2
9
32
29
3
171
72
43
4
—
11
24
14
3
Pacific
Alaska
California
Hawaii
Oregon§
Washington
70
4
39
—
12
15
60
1
43
1
8
6
558
9
93
4
15
449
2,449
57
1,651
51
327
363
2,147
82
1,706
44
315
—
302
13
180
5
63
41
719
10
611
11
22
60
875
27
734
22
46
142
27,780
378
24,029
478
806
2,089
32,046
471
26,452
761
1,114
3,248
—
—
—
—
—
—
2
0
0
0
1
0
16
2
10
2
6
5
91
10
21
9
49
2
87
10
25
14
38
—
American Samoa
C.N.M.I.
Guam
Puerto Rico
U.S. Virgin Islands
U
U
—
—
U
0
—
0
5
0
0
—
0
15
0
U
U
—
165
U
U
U
—
189
U
U
U
—
—
U
0
—
1
6
1
2
—
38
23
3
U
U
63
261
U
U
U
87
240
U
U
U
—
—
U
0
—
0
0
0
0
—
0
1
0
U
U
—
2
U
U
U
1
3
U
C.N.M.I.: Commonwealth of Northern Mariana Islands.
U: Unavailable. —: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median.
*† Incidence data for reporting year 2007 are provisional.
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).
Max: Maximum.
1062
MMWR
October 12, 2007
TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 6, 2007, and October 7, 2006
(40th Week)*
Reporting area
Current
week
Hepatitis (viral, acute), by type†
A
Previous
52 weeks
Cum
Cum
Current
Med
Max
2007
2006
week
B
Previous
52 weeks
Med
Max
Cum
2007
Cum
2006
Current
week
Legionellosis
Previous
52 weeks
Cum
Med
Max
2007
Cum
2006
United States
20
53
201
2,091
2,713
37
77
405
2,924
3,352
14
43
106
1,629
2,013
New England
Connecticut
Maine§
Massachusetts
New Hampshire
Rhode Island§
Vermont§
3
2
—
—
1
—
—
2
0
0
1
0
0
0
6
3
1
4
3
2
1
84
16
3
34
12
11
8
152
34
8
73
21
9
7
—
—
—
—
—
—
—
2
0
0
0
0
0
0
5
5
2
1
1
3
1
54
23
8
4
5
13
1
93
38
19
18
8
8
2
1
1
—
—
—
—
—
2
0
0
0
0
0
0
12
9
1
3
2
6
2
91
30
4
14
7
29
7
145
38
8
61
12
20
6
Mid. Atlantic
New Jersey
New York (Upstate)
New York City
Pennsylvania
—
—
—
—
—
8
2
1
2
1
16
5
11
6
5
303
72
54
113
64
307
91
67
98
51
—
—
—
—
—
9
1
2
2
3
21
8
13
6
8
327
62
68
69
128
410
131
48
96
135
—
—
—
—
—
12
1
4
2
4
52
9
30
8
21
501
64
155
71
211
712
96
230
144
242
E.N. Central
Illinois
Indiana
Michigan
Ohio
Wisconsin
—
—
—
—
—
—
6
2
0
1
1
0
13
6
7
8
4
3
218
78
22
58
53
7
280
87
20
93
45
35
2
—
—
—
2
—
9
2
0
2
2
0
23
6
21
8
7
3
323
86
41
82
102
12
393
113
41
112
98
29
6
—
1
1
4
—
9
1
1
2
3
0
26
6
6
10
17
3
374
56
35
111
164
8
454
98
36
114
170
36
W.N. Central
Iowa
Kansas
Minnesota
Missouri
Nebraska§
North Dakota
South Dakota
1
—
—
—
1
—
—
—
2
1
0
0
0
0
0
0
18
4
1
17
2
2
3
1
129
34
3
56
20
11
—
5
105
8
24
9
39
16
—
9
—
—
—
—
—
—
—
—
2
0
0
0
1
0
0
0
15
3
2
13
5
3
1
1
100
16
7
17
47
9
—
4
112
19
10
14
52
12
—
5
—
—
—
—
—
—
—
—
1
0
0
0
1
0
0
0
9
1
1
6
3
1
1
1
72
8
2
17
33
8
—
4
59
10
7
11
18
8
—
5
S. Atlantic
Delaware
District of Columbia
Florida
Georgia
Maryland§
North Carolina
South Carolina§
Virginia§
West Virginia
10
—
—
3
2
—
4
1
—
—
10
0
0
3
1
1
0
0
1
0
21
1
5
11
4
5
11
4
5
2
401
7
14
122
59
59
48
15
69
8
418
11
6
163
44
54
66
20
49
5
18
—
—
2
1
2
11
2
—
—
19
0
0
7
2
2
0
1
3
0
56
3
2
14
6
6
16
5
8
23
748
15
1
263
87
88
107
47
102
38
938
37
5
322
164
125
123
70
46
46
3
—
—
3
—
—
—
—
—
—
7
0
0
2
0
1
1
0
1
0
25
2
4
10
2
6
4
2
4
4
280
6
1
119
18
50
35
13
30
8
339
8
16
127
26
74
29
3
46
10
E.S. Central
Alabama§
Kentucky
Mississippi
Tennessee§
—
—
—
—
—
2
0
0
0
1
5
3
2
4
5
82
15
17
8
42
102
11
30
7
54
2
—
2
—
—
6
2
1
0
3
17
10
7
8
8
260
92
55
17
96
251
72
58
9
112
—
—
—
—
—
2
0
1
0
1
7
1
6
1
4
70
7
35
—
28
77
9
27
3
38
W.S. Central
Arkansas§
Louisiana
Oklahoma
Texas§
2
1
—
—
1
5
0
1
0
4
43
2
3
8
39
178
10
24
11
133
279
43
25
6
205
7
1
—
5
1
18
1
1
1
14
169
7
4
24
135
605
49
62
41
453
663
59
49
44
511
—
—
—
—
—
2
0
0
0
1
16
3
1
6
13
75
6
3
5
61
56
4
10
1
41
Mountain
Arizona
Colorado
Idaho§
Montana§
Nevada§
New Mexico§
Utah
Wyoming§
1
1
—
—
—
—
—
—
—
5
3
0
0
0
0
0
0
0
15
11
3
1
2
2
2
1
1
183
127
20
4
9
9
7
5
2
216
126
34
9
9
11
12
13
2
—
—
—
—
—
—
—
—
—
3
0
0
0
0
1
0
0
0
7
3
2
1
3
3
2
4
1
126
40
21
11
—
29
10
14
1
110
—
30
10
—
30
20
20
—
2
2
—
—
—
—
—
—
—
2
0
0
0
0
0
0
0
0
5
3
2
1
1
2
2
2
1
75
26
14
5
3
7
8
9
3
101
32
23
11
5
7
5
18
—
Pacific
Alaska
California
Hawaii
Oregon§
Washington
3
—
2
—
1
—
12
0
10
0
1
0
92
1
40
2
2
52
513
3
445
4
23
38
854
1
810
10
33
—
8
—
4
—
—
4
10
0
7
0
1
0
106
3
31
1
5
74
381
4
284
4
48
41
382
5
309
7
61
—
2
—
1
—
1
—
2
0
1
0
0
0
11
1
11
1
1
3
91
—
66
1
7
17
70
—
70
—
—
—
American Samoa
C.N.M.I.
Guam
Puerto Rico
U.S. Virgin Islands
U
U
—
—
U
0
—
0
1
0
0
—
0
10
0
U
U
—
45
U
U
U
—
48
U
U
U
—
—
U
0
—
0
1
0
0
—
0
9
0
U
U
—
44
U
U
U
—
46
U
U
U
—
—
U
0
—
0
0
0
0
—
0
2
0
U
U
—
3
U
U
U
—
1
U
C.N.M.I.: Commonwealth of Northern Mariana Islands.
U: Unavailable. —: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts.
*† Incidence data for reporting year 2007 are provisional.
Data for acute hepatitis C, viral are available in Table I.
§
Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
Med: Median.
Max: Maximum.
Vol. 56 / No. 40
MMWR
1063
TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 6, 2007, and October 7, 2006
(40th Week)*
Reporting area
Current
week
Lyme disease
Previous
52 weeks
Cum
Med
Max
2007
Cum
2006
Current
week
Malaria
Previous
52 weeks
Med
Max
Cum
2007
Cum
2006
Meningococcal disease, invasive†
All serogroups
Previous
Current
52 weeks
Cum
Cum
week
Med
Max
2007
2006
United States
59
255
1,114
14,588
15,855
7
21
105
801
1,113
7
19
87
781
887
New England
Connecticut
Maine§
Massachusetts
New Hampshire
Rhode Island§
Vermont§
36
25
6
—
3
—
2
39
11
3
0
6
0
1
286
214
53
20
78
93
13
2,750
1,496
304
21
670
151
108
3,714
1,524
180
1,350
571
1
88
—
—
—
—
—
—
—
1
0
0
0
0
0
0
5
3
2
3
4
1
2
32
1
6
16
7
—
2
45
10
4
22
8
—
1
—
—
—
—
—
—
—
1
0
0
0
0
0
0
3
1
3
2
1
1
1
32
6
5
17
—
1
3
37
9
4
19
3
—
2
Mid. Atlantic
New Jersey
New York (Upstate)
New York City
Pennsylvania
7
1
—
—
6
137
27
50
1
41
578
129
426
19
280
7,579
1,606
2,566
116
3,291
8,155
2,169
2,944
263
2,779
—
—
—
—
—
5
0
1
3
1
12
3
5
7
3
190
—
50
111
29
286
75
35
137
39
—
—
—
—
—
2
0
1
0
1
8
2
3
4
5
104
11
27
25
41
135
17
31
51
36
E.N. Central
Illinois
Indiana
Michigan
Ohio
Wisconsin
—
—
—
—
—
—
7
1
0
1
0
5
92
10
7
6
3
82
801
86
40
50
15
610
1,614
105
20
47
40
1,402
1
—
1
—
—
—
2
1
0
0
0
0
8
6
2
2
2
2
85
36
9
13
18
9
134
66
11
17
27
13
1
—
1
—
—
—
3
0
0
0
1
0
9
3
4
3
3
3
103
26
21
19
28
9
137
36
20
24
38
19
W.N. Central
Iowa
Kansas
Minnesota
Missouri
Nebraska§
North Dakota
South Dakota
—
—
—
—
—
—
—
—
5
1
0
1
0
0
0
0
195
11
2
188
6
1
7
0
340
91
9
208
25
5
2
—
505
91
4
396
4
9
—
1
—
—
—
—
—
—
—
—
0
0
0
0
0
0
0
0
12
1
1
12
1
1
1
1
28
3
2
11
5
6
—
1
32
1
6
14
6
3
1
1
3
—
—
1
—
2
—
—
1
0
0
0
0
0
0
0
5
3
1
3
3
1
3
1
49
11
1
15
13
4
2
3
51
13
4
11
13
6
1
3
S. Atlantic
Delaware
District of Columbia
Florida
Georgia
Maryland§
North Carolina
South Carolina§
Virginia§
West Virginia
14
—
—
6
—
6
1
—
1
—
50
11
0
1
0
24
0
0
11
0
168
34
7
11
1
109
8
2
60
14
2,881
582
13
73
1
1,477
40
21
617
57
1,723
413
41
19
7
978
24
17
215
9
3
—
—
—
—
2
1
—
—
—
4
0
0
1
0
1
0
0
1
0
13
1
2
7
5
5
4
1
4
1
195
4
3
47
29
48
18
5
39
2
281
5
3
48
79
66
24
9
45
2
3
—
—
2
—
—
—
1
—
—
3
0
0
1
0
0
0
0
0
0
11
1
1
7
5
2
6
2
2
2
139
1
—
53
21
20
15
14
13
2
155
4
1
60
14
13
24
18
16
5
E.S. Central
Alabama§
Kentucky
Mississippi
Tennessee§
—
—
—
—
—
1
0
0
0
0
5
3
2
0
4
43
10
4
—
29
29
7
7
3
12
—
—
—
—
—
0
0
0
0
0
3
1
1
1
2
28
5
7
2
14
22
8
3
6
5
—
—
—
—
—
1
0
0
0
0
4
2
2
4
2
39
7
9
9
14
32
5
7
4
16
W.S. Central
Arkansas§
Louisiana
Oklahoma
Texas§
—
—
—
—
—
1
0
0
0
1
5
1
1
0
5
45
1
2
—
42
18
—
—
—
18
—
—
—
—
—
1
0
0
0
1
29
0
2
3
25
70
—
14
5
51
86
4
6
7
69
—
—
—
—
—
1
0
0
0
0
15
2
4
4
11
80
9
25
15
31
83
10
33
8
32
Mountain
Arizona
Colorado
Idaho§
Montana§
Nevada§
New Mexico§
Utah
Wyoming§
—
—
—
—
—
—
—
—
—
1
0
0
0
0
0
0
0
0
4
1
1
2
2
2
1
2
1
34
2
2
7
4
7
4
5
3
24
8
—
5
—
3
3
4
1
2
—
2
—
—
—
—
—
—
1
0
0
0
0
0
0
0
0
6
3
2
2
1
1
1
3
0
44
7
16
2
3
2
3
11
—
60
19
13
1
2
3
5
17
—
—
—
—
—
—
—
—
—
—
1
0
0
0
0
0
0
0
0
4
2
2
1
1
1
1
2
1
47
8
17
3
1
4
2
10
2
59
14
19
3
4
5
4
6
4
Pacific
Alaska
California
Hawaii
Oregon§
Washington
2
—
2
N
—
—
2
0
2
0
0
0
16
1
9
0
1
8
115
4
107
N
3
1
73
3
64
N
6
—
1
—
1
—
—
—
3
0
2
0
0
0
45
1
7
1
3
43
129
2
90
2
13
22
167
23
127
8
9
—
—
—
—
—
—
—
4
0
3
0
0
0
48
1
10
2
3
43
188
1
135
7
27
18
198
3
152
8
35
—
American Samoa
C.N.M.I.
Guam
Puerto Rico
U.S. Virgin Islands
U
U
—
N
U
0
—
0
0
0
0
—
0
0
0
U
U
—
N
U
U
U
—
N
U
U
U
—
—
U
0
—
0
0
0
0
—
0
1
0
U
U
—
3
U
U
U
—
1
U
U
U
—
—
U
0
—
0
0
0
0
—
0
1
0
—
—
—
6
—
—
—
—
6
—
C.N.M.I.: Commonwealth of Northern Mariana Islands.
U: Unavailable. —: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum.
*† Incidence data for reporting year 2007 are provisional.
Data for meningococcal disease, invasive caused by serogroups A, C, Y, & 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).
1064
MMWR
October 12, 2007
TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 6, 2007, and October 7, 2006
(40th Week)*
Reporting area
Current
week
Pertussis
Previous
52 weeks
Cum
Med
Max
2007
Cum
2006
Current
week
Rabies, animal
Previous
52 weeks
Cum
Med
Max
2007
Cum
2006
Rocky Mountain spotted fever
Previous
Current
52 weeks
Cum
week
Med
Max
2007
Cum
2006
United States
95
171
1,479
6,321
10,831
50
94
148
3,804
4,420
35
28
211
1,596
1,718
New England
Connecticut
Maine†
Massachusetts
New Hampshire
Rhode Island†
Vermont†
6
—
1
—
—
5
—
26
2
2
20
1
0
0
77
5
14
46
9
31
9
822
44
63
613
48
27
27
1,302
86
94
820
166
45
91
19
9
2
—
1
4
3
12
4
2
0
1
0
2
22
10
7
0
4
3
13
465
184
67
—
41
33
140
357
160
89
—
34
25
49
—
—
—
—
—
—
—
0
0
0
0
0
0
0
10
0
0
1
0
9
0
—
—
—
—
—
—
—
11
—
—
10
1
—
—
Mid. Atlantic
New Jersey
New York (Upstate)
New York City
Pennsylvania
—
—
—
—
—
25
3
13
2
7
155
16
146
6
20
884
113
460
90
221
1,431
243
635
77
476
—
—
—
—
—
13
0
—
1
12
44
0
—
5
44
605
—
—
33
572
428
—
—
28
400
—
—
—
—
—
1
0
0
0
0
6
2
1
3
3
48
6
3
19
20
76
36
—
21
19
E.N. Central
Illinois
Indiana
Michigan
Ohio
Wisconsin
20
—
1
1
18
—
32
3
0
7
15
3
80
23
45
39
54
24
1,161
108
47
232
575
199
1,682
422
181
446
459
174
6
1
—
1
4
—
3
1
0
1
0
0
48
15
1
27
11
0
347
107
10
163
67
—
140
44
11
40
45
—
1
—
—
—
1
—
1
0
0
0
0
0
4
3
2
1
2
0
40
23
5
3
9
—
55
24
6
2
22
1
W.N. Central
Iowa
Kansas
Minnesota
Missouri
Nebraska†
North Dakota
South Dakota
12
—
—
—
—
12
—
—
13
4
3
0
2
1
0
1
151
16
13
119
9
4
18
6
495
113
106
111
63
48
4
50
1,012
242
227
160
259
79
25
20
7
1
—
5
—
—
1
—
5
0
2
0
0
0
0
0
13
3
7
5
4
0
6
2
223
30
93
27
39
—
16
18
268
54
66
35
62
—
16
35
5
—
—
—
5
—
—
—
4
0
0
0
3
0
0
0
31
4
1
1
25
2
0
1
332
13
1
1
303
10
—
4
182
5
1
3
151
22
—
—
S. Atlantic
Delaware
District of Columbia
Florida
Georgia
Maryland†
North Carolina
South Carolina†
Virginia†
West Virginia
33
—
—
5
—
2
23
2
1
—
18
0
0
4
1
2
1
2
2
0
163
2
2
18
5
8
112
9
17
19
741
10
2
186
24
83
250
62
97
27
858
3
6
172
74
117
155
141
155
35
13
—
—
—
—
—
13
—
—
—
40
0
0
0
4
7
9
1
13
0
71
0
0
29
34
18
19
11
31
8
1,616
—
—
100
200
267
396
46
556
51
1,853
—
—
176
219
337
414
142
479
86
22
—
—
—
1
—
18
1
2
—
13
0
0
0
0
1
4
1
2
0
110
2
1
4
5
7
96
7
10
3
781
10
1
17
30
49
509
56
104
5
925
19
1
10
48
69
662
32
81
3
E.S. Central
Alabama†
Kentucky
Mississippi
Tennessee†
—
—
—
—
—
5
1
0
1
2
28
18
1
26
7
299
63
5
162
69
272
56
56
32
128
—
—
—
—
—
4
0
0
0
3
11
8
3
1
9
133
—
18
1
114
205
69
23
4
109
—
—
—
—
—
5
1
0
0
2
16
8
2
2
10
205
61
5
9
130
319
77
3
4
235
W.S. Central
Arkansas†
Louisiana
Oklahoma
Texas†
2
—
—
1
1
20
2
0
0
16
226
17
1
36
174
692
119
14
6
553
648
71
23
18
536
1
1
—
—
—
2
0
0
0
0
32
5
1
22
27
70
25
—
45
—
776
26
5
52
693
7
7
—
—
—
1
0
0
0
0
168
53
1
108
7
153
80
2
45
26
105
46
4
28
27
Mountain
Arizona
Colorado
Idaho†
Montana†
Nevada†
New Mexico†
Utah
Wyoming†
19
1
2
—
—
—
—
16
—
23
4
6
1
0
0
2
7
0
61
13
17
5
7
5
8
47
5
810
162
218
34
32
11
54
280
19
2,095
433
633
77
102
61
95
630
64
1
—
—
—
—
—
—
1
—
3
2
0
0
0
0
0
0
0
14
12
0
0
3
1
2
2
4
178
125
—
—
14
2
8
13
16
190
125
—
24
14
5
8
9
5
—
—
—
—
—
—
—
—
—
0
0
0
0
0
0
0
0
0
4
1
2
1
1
0
1
0
2
29
7
3
4
1
—
4
—
10
43
11
4
13
2
—
7
—
6
Pacific
Alaska
California
Hawaii
Oregon†
Washington
3
1
—
—
—
2
12
0
2
0
1
2
547
8
167
2
11
377
417
41
109
16
80
171
1,531
78
1,278
84
91
—
3
1
2
N
—
—
4
0
3
0
0
0
10
6
8
0
3
0
167
36
122
N
9
—
203
15
166
N
22
—
—
N
—
N
—
N
0
0
0
0
0
0
3
0
3
0
1
0
8
N
6
N
2
N
2
N
—
N
2
N
American Samoa
C.N.M.I.
Guam
Puerto Rico
U.S. Virgin Islands
U
U
—
—
U
0
—
0
0
0
0
—
2
1
0
U
U
—
—
U
U
U
57
1
U
U
U
—
—
U
0
—
0
1
0
0
—
0
5
0
U
U
—
37
U
U
U
—
66
U
U
U
N
N
U
0
—
0
0
0
0
—
0
0
0
U
U
N
N
U
U
U
N
N
U
C.N.M.I.: Commonwealth of Northern Mariana Islands.
U: Unavailable. —: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts.
*† Incidence data for reporting year 2007 are provisional.
Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
Med: Median.
Max: Maximum.
Vol. 56 / No. 40
MMWR
1065
TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 6, 2007, and October 7, 2006
(40th Week)*
Reporting area
United States
Current
week
Salmonellosis
Previous
52 weeks
Cum
Med
Max
2007
Cum
2006
Shiga toxin-producing E. coli (STEC)†
Previous
Current
52 weeks
Cum
Cum
week
Med
Max
2007
2006
Current
week
Shigellosis
Previous
52 weeks
Cum
Med
Max
2007
Cum
2006
595
843
2,338
31,204
33,495
79
79
336
3,151
3,158
249
335
1,287
11,708
10,111
New England
Connecticut
Maine§
Massachusetts
New Hampshire
Rhode Island§
Vermont§
16
—
1
—
—
14
1
29
0
3
19
3
1
1
357
342
14
49
10
20
5
1,484
342
100
775
130
75
62
1,895
503
103
982
179
73
55
1
—
1
—
—
—
—
3
0
1
1
0
0
0
82
77
4
10
3
2
1
212
77
33
74
14
6
8
247
75
35
87
24
8
18
—
—
—
—
—
—
—
3
0
0
2
0
0
0
34
31
5
8
2
3
1
149
31
14
91
5
5
3
239
67
4
147
4
11
6
Mid. Atlantic
New Jersey
New York (Upstate)
New York City
Pennsylvania
7
—
—
7
—
100
11
29
24
32
176
29
112
50
69
3,831
288
1,106
1,067
1,370
4,254
913
985
1,018
1,338
—
—
—
—
—
8
1
3
0
3
63
20
15
4
47
300
22
149
27
102
377
96
133
40
108
2
—
—
2
—
11
2
3
5
1
47
9
42
10
21
534
89
109
200
136
750
269
190
219
72
E.N. Central
Illinois
Indiana
Michigan
Ohio
Wisconsin
47
—
11
6
27
3
104
30
15
17
26
16
208
142
54
34
65
50
4,305
1,281
559
695
1,062
708
4,498
1,262
722
808
978
728
9
—
4
—
4
1
9
1
1
1
3
3
28
6
9
6
11
8
429
37
65
66
134
127
564
94
72
73
150
175
35
1
1
—
33
—
32
10
2
1
8
4
125
32
11
7
104
13
1,664
356
83
52
987
186
1,076
499
118
129
130
200
W.N. Central
Iowa
Kansas
Minnesota
Missouri
Nebraska§
North Dakota
South Dakota
42
2
—
12
17
9
2
—
49
8
7
13
15
4
0
3
101
19
20
44
26
12
23
11
2,094
357
289
521
570
196
34
127
2,085
371
292
535
589
158
21
119
17
—
—
7
8
2
—
—
11
2
0
4
2
1
0
0
45
38
4
17
12
6
12
5
575
136
39
189
109
66
1
35
550
110
21
167
140
68
4
40
23
—
—
7
15
1
—
—
37
2
0
5
18
0
0
1
156
14
7
24
72
7
127
30
1,486
69
20
185
1,081
19
5
107
1,329
90
120
124
567
112
56
260
261
—
—
131
58
22
36
12
2
—
222
2
0
85
33
15
29
18
20
2
421
10
4
176
70
36
110
51
39
31
8,483
117
16
3,342
1,478
673
1,174
777
761
145
8,561
129
50
3,449
1,432
604
1,231
806
769
91
15
—
—
1
6
4
1
3
—
—
15
0
0
2
1
2
2
0
3
0
37
3
1
8
7
5
24
2
8
5
533
13
1
112
74
73
115
15
115
15
481
7
2
71
68
97
90
11
128
7
69
—
—
39
23
—
4
3
—
—
88
0
0
46
34
2
0
2
3
0
174
2
5
76
94
9
14
8
11
6
3,534
9
4
1,845
1,284
85
71
106
123
7
2,289
8
14
1,064
836
96
125
75
67
4
E.S. Central
Alabama§
Kentucky
Mississippi
Tennessee§
17
—
16
1
—
54
14
9
12
17
134
78
22
101
34
2,242
624
435
580
603
2,179
580
363
634
602
8
—
8
—
—
4
0
1
0
2
26
19
8
2
10
239
55
86
4
94
241
24
78
8
131
39
—
33
6
—
26
11
3
5
3
91
67
32
76
14
1,439
453
356
486
144
536
163
174
77
122
W.S. Central
Arkansas§
Louisiana
Oklahoma
Texas§
59
30
—
29
—
85
14
16
8
43
595
46
48
103
470
3,020
568
573
465
1,414
3,862
697
823
383
1,959
—
—
—
—
—
4
1
0
0
2
73
7
2
17
68
139
27
3
16
93
159
33
13
18
95
40
1
—
1
38
39
2
8
3
24
655
10
22
63
580
1,318
70
349
97
802
1,439
79
187
99
1,074
Mountain
Arizona
Colorado
Idaho§
Montana§
Nevada§
New Mexico§
Utah
Wyoming§
50
14
13
3
—
4
—
16
—
44
13
10
3
1
4
5
4
1
90
44
22
7
6
10
13
14
4
1,760
538
429
102
73
142
200
219
57
2,076
676
507
141
109
178
205
223
37
14
—
1
8
—
—
—
5
—
8
1
1
1
0
0
1
1
0
31
8
9
16
0
5
3
9
1
368
68
64
110
—
18
32
76
—
434
81
92
77
—
25
39
103
17
20
10
5
—
—
—
—
5
—
19
9
2
0
1
1
2
1
0
66
37
9
2
13
9
7
4
19
661
371
88
8
19
38
81
27
29
1,024
515
175
14
14
99
144
53
10
Pacific
Alaska
California
Hawaii
Oregon§
Washington
96
3
65
—
—
28
103
1
85
5
7
9
890
5
260
16
15
625
3,985
64
2,966
201
246
508
4,085
64
3,500
184
335
2
15
N
6
—
—
9
6
0
2
0
1
0
164
0
13
4
11
162
356
N
169
17
67
103
105
N
N
12
93
—
21
—
21
—
—
—
26
0
21
0
1
1
256
2
84
2
6
170
923
7
752
21
60
83
1,429
7
1,275
39
108
—
American Samoa
C.N.M.I.
Guam
Puerto Rico
U.S. Virgin Islands
U
U
—
—
U
0
—
0
13
0
0
—
0
66
0
U
U
—
446
U
U
U
—
433
U
U
U
N
—
U
0
—
0
0
0
0
—
0
0
0
U
U
N
—
U
U
U
N
—
U
U
U
—
—
U
0
—
0
0
0
0
—
0
4
0
U
U
—
18
U
U
U
—
33
U
S. Atlantic
Delaware
District of Columbia
Florida
Georgia
Maryland§
North Carolina
South Carolina§
Virginia§
West Virginia
C.N.M.I.: Commonwealth of Northern Mariana Islands.
U: Unavailable. —: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median.
*† Incidence data for reporting year 2007 are provisional.
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).
Max: Maximum.
1066
MMWR
October 12, 2007
TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 6, 2007, and October 7, 2006
(40th Week)*
Reporting area
Streptococcal disease, invasive, group A
Previous
Current
52 weeks
Cum
Cum
week
Med
Max
2007
2006
Streptococcus pneumoniae, invasive disease, nondrug resistant†
Age <5 years
Previous
Current
52 weeks
Cum
Cum
week
Med
Max
2007
2006
United States
38
96
261
3,929
4,263
12
31
108
1,154
998
New England
Connecticut
Maine§
Massachusetts
New Hampshire
Rhode Island§
Vermont§
2
—
—
—
—
1
1
6
0
0
3
0
0
0
28
23
3
12
4
12
2
310
96
22
141
31
4
16
281
76
15
140
33
5
12
—
—
—
—
—
—
—
2
0
0
2
0
0
0
11
6
1
6
2
2
1
77
—
2
58
7
8
2
88
26
—
51
7
4
—
Mid. Atlantic
New Jersey
New York (Upstate)
New York City
Pennsylvania
—
—
—
—
—
17
3
5
4
5
41
10
27
13
11
732
107
242
172
211
768
124
247
138
259
—
—
—
—
N
5
1
2
1
0
27
4
15
25
0
186
25
78
83
N
138
51
69
18
N
E.N. Central
Illinois
Indiana
Michigan
Ohio
Wisconsin
1
—
1
—
—
—
17
4
2
4
4
0
32
13
17
10
14
6
672
179
109
164
192
28
819
250
98
171
206
94
—
—
—
—
—
—
5
1
0
1
1
0
14
6
10
4
7
2
180
47
16
59
49
9
264
66
46
62
51
39
W.N. Central
Iowa
Kansas
Minnesota
Missouri
Nebraska§
North Dakota
South Dakota
8
—
—
6
—
2
—
—
5
0
0
0
2
0
0
0
32
0
3
29
6
3
2
2
274
—
28
137
67
23
12
7
289
—
47
136
61
25
10
10
2
—
—
2
—
—
—
—
2
0
0
1
0
0
0
0
8
0
1
6
2
2
2
0
86
—
1
58
16
10
1
—
81
—
11
49
11
7
3
—
S. Atlantic
Delaware
District of Columbia
Florida
Georgia
Maryland§
North Carolina
South Carolina§
Virginia§
West Virginia
14
—
—
7
3
3
1
—
—
—
22
0
0
6
5
4
1
1
2
0
52
1
3
16
13
10
22
7
11
3
1,004
9
8
248
195
174
141
82
124
23
960
10
13
233
199
179
138
54
109
25
2
—
—
1
—
—
—
1
—
—
4
0
0
1
0
1
0
0
0
0
14
0
1
5
5
6
0
4
4
4
221
—
—
53
44
49
—
37
31
7
62
—
1
—
—
51
—
—
—
10
E.S. Central
Alabama§
Kentucky
Mississippi
Tennessee§
1
N
1
N
—
4
0
1
0
3
13
0
3
0
13
170
N
33
N
137
170
N
39
N
131
—
N
—
—
—
1
0
0
0
1
6
0
0
2
6
73
N
—
3
70
16
N
—
16
—
W.S. Central
Arkansas§
Louisiana
Oklahoma
Texas§
2
—
—
—
2
6
0
0
1
3
90
2
4
23
64
252
17
16
60
159
323
23
16
81
203
3
—
—
2
1
4
0
0
1
1
43
2
4
13
27
170
10
27
40
93
170
18
19
38
95
Mountain
Arizona
Colorado
Idaho§
Montana§
Nevada§
New Mexico§
Utah
Wyoming§
8
4
1
—
N
—
2
1
—
9
3
3
0
0
0
1
2
0
21
11
9
2
0
1
5
7
1
402
132
127
15
N
2
48
73
5
562
291
98
8
N
—
108
54
3
3
1
2
—
N
—
—
—
—
3
2
1
0
0
0
0
0
0
9
7
4
1
0
1
4
2
0
135
73
36
2
N
1
19
4
—
159
89
41
1
N
2
26
—
—
Pacific
Alaska
California
Hawaii
Oregon§
Washington
2
2
N
—
N
N
3
0
0
2
0
0
9
3
0
9
0
0
113
32
N
81
N
N
91
N
N
91
N
N
2
2
N
—
N
N
0
0
0
0
0
0
4
2
0
2
0
0
26
24
N
2
N
N
20
—
N
20
N
N
American Samoa
C.N.M.I.
Guam
Puerto Rico
U.S. Virgin Islands
U
U
—
—
U
0
—
0
0
0
0
—
0
0
0
U
U
—
—
U
U
U
—
—
U
U
U
N
N
U
0
—
0
0
0
0
—
0
0
0
U
U
N
N
U
U
U
N
N
U
C.N.M.I.: Commonwealth of Northern Mariana Islands.
U: Unavailable. —: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum.
* Incidence data for reporting year 2007 are provisional.
†
Includes cases of invasive pneumococcal disease, in children aged <5 years, caused by S. pneumoniae, which is susceptible or for which susceptibility testing is not available
(NNDSS event code 11717).
§
Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
Vol. 56 / No. 40
MMWR
1067
TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 6, 2007, and October 7, 2006
(40th Week)*
Reporting area
Current
week
Streptococcus pneumoniae, invasive disease, drug resistant†
All ages
Age <5 years
Previous
Previous
52 weeks
Cum
Cum
Current
52 weeks
Cum
Med
Max
2007
2006
week
Med
Max
2007
Cum
2006
Syphilis, primary and secondary
Previous
Current
52 weeks
Cum
Cum
week
Med
Max
2007
2006
United States
23
49
256
1,753
1,883
5
9
35
324
303
136
201
310
7,843
7,263
New England
Connecticut
Maine§
Massachusetts
New Hampshire
Rhode Island§
Vermont§
1
—
—
—
—
—
1
1
0
0
0
0
0
0
12
5
2
0
0
4
2
36
—
9
—
—
14
13
100
75
6
—
—
9
10
—
—
—
—
—
—
—
0
0
0
0
0
0
0
3
0
2
0
0
1
1
6
—
1
—
—
3
2
3
—
1
—
—
—
2
6
—
—
6
—
—
—
5
0
0
3
0
0
0
13
10
2
8
3
5
1
193
25
8
123
22
14
1
157
34
8
95
10
8
2
Mid. Atlantic
New Jersey
New York (Upstate)
New York City
Pennsylvania
—
—
—
—
—
2
0
1
0
2
9
0
5
0
6
98
—
34
—
64
111
—
36
—
75
—
—
—
—
—
0
0
0
0
0
5
0
4
0
2
21
—
7
—
14
15
—
7
—
8
25
5
—
20
—
28
4
3
16
5
44
8
14
34
10
1,176
154
105
729
188
868
131
117
411
209
E.N. Central
Illinois
Indiana
Michigan
Ohio
Wisconsin
5
—
3
—
2
N
10
0
2
0
5
0
40
4
31
1
38
0
422
15
110
2
295
N
394
21
103
15
255
N
2
—
1
—
1
—
2
0
0
0
1
0
7
1
5
1
5
0
57
2
18
1
36
—
62
6
16
2
38
—
14
4
2
3
4
1
15
7
1
2
4
1
27
13
6
9
10
4
613
278
41
93
155
46
684
333
69
86
141
55
W.N. Central
Iowa
Kansas
Minnesota
Missouri
Nebraska§
North Dakota
South Dakota
—
—
—
—
—
—
—
—
2
0
0
0
1
0
0
0
124
0
11
123
5
1
0
3
116
—
63
—
45
2
—
6
84
—
—
51
32
—
—
1
—
—
—
—
—
—
—
—
0
0
0
0
0
0
0
0
15
0
2
15
1
0
0
1
9
—
5
—
—
—
—
4
12
—
—
10
2
—
—
—
6
—
—
—
6
—
—
—
6
0
0
1
4
0
0
0
13
3
3
5
11
2
0
3
268
11
16
50
182
2
—
7
220
15
18
38
131
5
1
12
S. Atlantic
Delaware
District of Columbia
Florida
Georgia
Maryland§
North Carolina
South Carolina§
Virginia§
West Virginia
16
—
—
4
12
—
—
—
N
—
21
0
0
11
7
0
0
0
0
1
59
1
2
29
17
1
0
0
0
17
800
7
5
458
280
1
—
—
N
49
897
—
21
481
300
—
—
—
N
95
3
—
—
1
2
—
—
—
—
—
4
0
0
2
1
0
0
0
0
0
15
1
0
8
10
0
0
0
0
1
169
2
—
98
61
—
—
—
—
8
142
—
2
91
49
—
—
—
—
—
37
—
—
21
—
4
5
4
3
—
48
0
3
16
7
6
5
2
4
0
180
3
12
38
153
15
23
11
17
1
1,839
12
133
682
267
241
247
81
171
5
1,623
16
96
564
287
237
228
53
134
8
E.S. Central
Alabama§
Kentucky
Mississippi
Tennessee§
—
N
—
—
—
3
0
0
0
2
9
0
2
2
8
122
N
19
—
103
153
N
29
20
104
—
—
—
—
—
0
0
0
0
0
3
0
1
0
3
27
—
2
—
25
28
—
6
—
22
14
3
2
5
4
17
6
1
2
6
30
16
7
9
15
661
267
46
83
265
548
252
56
48
192
W.S. Central
Arkansas§
Louisiana
Oklahoma
Texas§
—
—
—
—
—
2
0
1
0
0
11
1
4
9
0
114
1
52
61
—
66
10
56
—
—
—
—
—
—
—
0
0
0
0
0
3
0
2
2
0
17
—
7
10
—
6
2
4
—
—
27
2
7
—
18
35
1
8
1
21
55
10
29
4
39
1,391
94
354
42
901
1,163
60
207
55
841
Mountain
Arizona
Colorado
Idaho§
Montana§
Nevada§
New Mexico§
Utah
Wyoming§
1
—
—
N
—
1
—
—
—
1
0
0
0
0
0
0
0
0
5
0
0
0
0
3
0
5
2
45
—
—
N
—
18
—
15
12
78
—
—
N
—
16
—
32
30
—
—
—
—
—
—
—
—
—
0
0
0
0
0
0
0
0
0
3
0
0
0
0
2
0
3
1
16
—
—
—
—
5
—
9
2
35
—
—
—
—
2
—
23
10
4
—
—
—
—
4
—
—
—
7
3
1
0
0
2
1
0
0
19
12
5
1
1
6
7
2
1
268
104
30
1
1
87
36
6
3
396
149
58
3
1
112
59
14
—
Pacific
Alaska
California
Hawaii
Oregon§
Washington
—
—
N
—
N
N
0
0
0
0
0
0
0
0
0
0
0
0
—
—
N
—
N
N
—
—
N
—
N
N
—
—
—
—
—
—
0
0
0
0
0
0
1
0
0
1
0
0
2
—
—
2
—
—
—
—
—
—
—
—
3
—
—
—
—
3
38
0
36
0
0
2
57
1
54
2
6
12
1,434
5
1,307
7
13
102
1,604
9
1,424
15
14
142
U
U
N
N
U
0
—
0
0
0
0
—
0
0
0
U
U
N
N
U
U
U
N
N
U
U
U
—
—
U
0
—
0
0
0
1
—
0
0
0
U
U
—
—
U
U
U
—
—
U
U
U
—
—
U
0
—
0
3
0
0
—
1
10
0
U
U
3
117
U
U
U
—
109
U
American Samoa
C.N.M.I.
Guam
Puerto Rico
U.S. Virgin Islands
C.N.M.I.: Commonwealth of Northern Mariana Islands.
U: Unavailable. —: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum.
*† Incidence data for reporting year 2007 are provisional.
Includes cases of invasive pneumococcal disease caused by drug-resistant S. pneumoniae (DRSP) (NNDSS event code 11720).
§
Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
1068
MMWR
October 12, 2007
TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 6, 2007, and October 7, 2006
(40th Week)*
Reporting area
United States
Current
week
Varicella (chickenpox)
Previous
52 weeks
Cum
Med
Max
2007
Cum
2006
Current
week
West Nile virus disease†
Neuroinvasive
Nonneuroinvasive§
Previous
Previous
52 weeks
Cum
Cum
Current
52 weeks
Cum
Med
Max
2007
2006
week
Med
Max
2007
Cum
2006
386
796
2,813
26,982
34,499
1
1
115
877
1,447
1
2
275
1,926
2,707
New England
Connecticut
Maine¶
Massachusetts
New Hampshire
Rhode Island¶
Vermont¶
12
—
—
—
2
—
10
17
0
0
0
7
0
9
124
76
7
1
17
0
66
541
2
—
—
246
—
293
3,378
1,237
185
1,141
292
—
523
—
—
—
—
—
—
—
0
0
0
0
0
0
0
2
2
0
1
0
0
0
5
3
—
2
—
—
—
9
7
—
2
—
—
—
—
—
—
—
—
—
—
0
0
0
0
0
0
0
2
1
0
2
0
1
0
4
1
—
2
—
1
—
3
2
—
1
—
—
—
Mid. Atlantic
New Jersey
New York (Upstate)
New York City
Pennsylvania
—
N
N
—
—
111
0
0
0
111
195
0
0
0
195
3,275
N
N
—
3,275
3,755
N
N
—
3,755
—
—
—
—
—
0
0
0
0
0
3
0
0
3
1
11
—
—
9
2
26
2
8
8
8
—
—
—
—
—
0
0
0
0
0
1
0
0
1
1
4
—
—
1
3
12
3
4
4
1
E.N. Central
Illinois
Indiana
Michigan
Ohio
Wisconsin
101
—
—
23
78
—
229
2
0
97
106
19
568
11
0
258
449
80
7,582
111
—
3,063
3,611
797
11,071
111
—
3,357
6,796
807
—
—
—
—
—
—
0
0
0
0
0
0
13
10
2
5
3
1
64
38
6
12
6
2
242
126
27
42
36
11
—
—
—
—
—
—
0
0
0
0
0
0
7
6
3
0
1
1
33
22
4
—
4
3
172
87
53
12
10
10
W.N. Central
Iowa
Kansas
Minnesota
Missouri
Nebraska¶
North Dakota
South Dakota
12
N
—
—
12
N
—
—
32
0
8
0
15
0
0
1
136
0
52
0
78
0
60
15
1,287
N
439
—
702
N
84
62
1,363
N
259
—
1,006
N
44
54
1
—
—
1
—
—
—
—
0
0
0
0
0
0
0
0
37
4
3
11
9
3
11
8
205
7
10
39
48
9
48
44
221
22
17
31
50
44
20
37
—
—
—
—
—
—
—
—
0
0
0
0
0
0
0
0
103
3
6
11
1
13
45
32
612
12
19
54
8
72
295
152
478
15
13
34
10
214
117
75
S. Atlantic
Delaware
District of Columbia
Florida
Georgia
Maryland¶
North Carolina
South Carolina¶
Virginia¶
West Virginia
76
—
—
29
N
N
—
29
—
18
100
1
0
20
0
0
0
21
28
24
239
6
8
76
0
0
0
72
190
50
3,902
36
14
962
N
N
—
801
1,201
888
3,449
60
30
N
N
N
—
888
1,304
1,167
—
—
—
—
—
—
—
—
—
—
0
0
0
0
0
0
0
0
0
0
11
1
0
1
8
2
1
2
1
0
31
1
—
3
20
3
—
2
2
—
16
—
—
3
2
10
—
—
—
1
—
—
—
—
—
—
—
—
—
—
0
0
0
0
0
0
0
0
0
0
5
0
1
0
4
1
0
1
1
0
25
—
—
—
18
4
—
2
1
—
13
—
1
—
6
1
—
—
5
—
E.S. Central
Alabama¶
Kentucky
Mississippi
Tennessee¶
—
—
N
—
N
5
5
0
0
0
571
571
0
2
0
383
380
N
3
N
27
26
N
1
N
—
—
—
—
—
0
0
0
0
0
11
2
1
7
1
58
12
3
39
4
114
8
5
85
16
—
—
—
—
—
0
0
0
0
0
12
1
0
11
1
74
3
—
69
2
94
—
1
87
6
W.S. Central
Arkansas¶
Louisiana
Oklahoma
Texas¶
147
1
—
—
146
167
13
2
0
150
1,640
105
11
0
1,534
7,990
552
99
—
7,339
9,338
656
191
—
8,491
—
—
—
—
—
0
0
0
0
0
22
4
2
11
15
138
9
1
45
83
364
24
89
26
225
—
—
—
—
—
0
0
0
0
0
12
1
1
7
5
56
4
1
32
19
226
5
84
20
117
Mountain
Arizona
Colorado
Idaho¶
Montana¶
Nevada¶
New Mexico¶
Utah
Wyoming¶
38
—
33
N
—
—
—
5
—
56
0
22
0
5
0
5
15
0
131
0
62
0
40
1
37
73
11
1,992
—
813
N
304
1
302
554
18
2,118
—
1,146
N
N
9
317
611
35
—
—
—
—
—
—
—
—
—
0
0
0
0
0
0
0
0
0
33
10
17
2
10
1
7
8
4
226
28
88
7
33
2
33
20
15
371
47
66
138
12
34
3
56
15
—
—
—
—
—
—
—
—
—
1
0
0
0
0
0
0
0
0
138
14
64
16
30
3
6
7
34
913
34
418
97
152
9
18
24
161
1,450
56
277
850
22
89
4
102
50
Pacific
Alaska
California
Hawaii
Oregon¶
Washington
—
—
—
—
N
N
0
0
0
0
0
0
9
9
0
0
0
0
30
30
—
—
N
N
—
N
N
—
N
N
—
—
—
—
—
—
0
0
0
0
0
0
16
0
16
0
1
0
139
—
135
—
4
—
84
—
77
—
7
—
1
—
1
—
—
—
0
0
0
0
0
0
21
0
19
0
4
0
205
—
187
—
18
—
259
—
194
—
62
3
American Samoa
U
0
0
U
U
U
0
0
U
U
U
0
0
U
U
C.N.M.I.
U
—
—
U
U
U
—
—
U
U
U
—
—
U
U
Guam
—
6
30
146
183
—
0
0
—
—
—
0
0
—
—
Puerto Rico
—
11
30
467
456
—
0
0
—
—
—
0
0
—
—
U.S. Virgin Islands
U
0
0
U
U
U
0
0
U
U
U
0
0
U
U
C.N.M.I.: Commonwealth of Northern Mariana Islands.
U: Unavailable. —: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum.
* Incidence data for reporting year 2007 are provisional.
†
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.
Not notifiable in all states. Data from states where the condition is not notifiable are excluded from this table, except in 2007 for the domestic arboviral diseases and influenza¶ associated pediatric mortality, and in 2003 for SARS-CoV. Reporting exceptions are available at http://www.cdc.gov/epo/dphsi/phs/infdis.htm.
Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
Vol. 56 / No. 40
MMWR
1069
TABLE III. Deaths in 122 U.S. cities,* week ending October 6, 2007 (40th Week)
All causes, by age (years)
Reporting Area
All
Ages
>65
45-64
25-44
1-24
All causes, by age (years)
<1
P&I†
Total
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
494
132
27
16
25
58
26
4
14
19
52
5
41
29
46
344
77
21
14
15
40
16
4
9
15
44
5
33
23
28
101
35
5
2
8
11
6
—
4
3
4
—
6
5
12
28
8
1
—
2
3
3
—
1
1
3
—
—
1
5
9
6
—
—
—
1
1
—
—
—
—
—
—
—
1
12
6
—
—
—
3
—
—
—
—
1
—
2
—
—
37
11
1
1
1
6
4
—
—
2
—
—
6
4
1
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
2,031
U
27
72
20
9
45
U
979
21
10
475
30
31
119
27
27
70
37
17
15
1,394
U
21
48
6
7
36
U
689
10
8
276
24
27
95
20
22
52
27
15
11
442
U
4
15
11
1
8
U
214
7
1
123
5
3
15
5
5
13
8
1
3
119
U
2
6
1
1
1
U
53
4
1
36
—
1
3
2
—
4
2
1
1
31
U
—
1
—
—
—
U
14
—
—
14
—
—
2
—
—
—
—
—
—
44
U
—
2
2
—
—
U
9
—
—
25
1
—
4
—
—
1
—
—
—
99
U
—
6
—
—
2
U
44
1
1
9
3
2
9
4
5
8
1
3
1
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
1,872
72
31
259
77
187
203
136
163
31
72
14
65
187
41
76
39
43
36
87
53
1,198
49
22
154
37
126
126
100
81
26
53
4
43
110
23
51
30
28
28
58
49
432
17
8
67
21
43
49
30
37
5
16
5
12
43
11
16
5
12
7
24
4
145
2
—
30
8
9
17
5
29
—
2
3
5
19
5
6
2
1
1
1
—
59
3
—
4
4
8
6
1
11
—
1
2
3
8
1
1
2
2
—
2
—
38
1
1
4
7
1
5
—
5
—
—
—
2
7
1
2
—
—
—
2
—
105
3
2
21
4
14
9
3
7
2
5
—
5
9
3
2
2
3
1
4
6
539
52
22
23
89
32
76
72
70
34
69
341
36
18
13
61
23
44
45
36
19
46
131
14
4
8
18
3
16
20
21
12
15
33
1
—
2
4
1
5
5
8
3
4
13
1
—
—
2
2
3
1
3
—
1
20
—
—
—
3
3
8
1
2
—
3
35
2
—
1
5
2
5
6
4
3
7
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
Reporting Area
All
Ages
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
1,058
129
156
97
88
109
57
47
64
51
150
100
10
25-44
1-24
642
69
95
70
41
64
36
18
44
34
99
64
8
240
29
43
12
13
26
12
12
15
10
42
24
2
109
18
12
5
26
13
6
11
4
3
6
5
—
39
6
4
4
6
5
1
4
1
2
2
4
—
28
7
2
6
2
1
2
2
—
2
1
3
—
61
5
9
8
9
3
3
3
3
5
8
1
4
748
127
65
81
34
113
117
48
163
474
78
44
58
20
64
78
32
100
187
35
15
21
9
31
26
13
37
50
9
5
—
2
9
6
1
18
20
4
—
1
—
5
5
1
4
17
1
1
1
3
4
2
1
4
41
8
5
5
2
8
5
2
6
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
1,357
112
U
75
207
37
110
355
53
U
229
45
134
840
65
U
50
113
26
75
209
31
U
145
30
96
361
38
U
19
59
4
25
94
17
U
63
11
31
102
7
U
4
19
5
6
30
4
U
18
3
6
25
1
U
1
3
1
2
13
—
U
2
1
1
29
1
U
1
13
1
2
9
1
U
1
—
—
79
6
U
6
16
2
7
13
1
U
14
5
9
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
1,066
107
30
85
79
278
33
174
31
126
123
660
67
22
50
41
176
24
95
25
80
80
261
24
6
27
22
68
5
50
6
23
30
81
10
2
6
7
22
2
16
—
9
7
36
2
—
1
5
8
2
4
—
9
5
25
4
—
1
4
4
—
6
—
5
1
73
4
2
7
7
22
4
9
3
9
6
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
1,273
17
70
U
76
50
U
23
116
188
153
89
156
34
126
65
110
885
11
48
U
59
30
U
13
78
117
105
71
118
21
83
52
79
255
4
14
U
12
13
U
7
26
51
25
10
27
7
29
12
18
86
1
8
U
4
5
U
3
9
13
14
4
2
4
9
1
9
26
1
—
U
—
1
U
—
—
5
3
3
6
1
2
—
4
20
—
—
U
1
1
U
—
3
2
5
1
3
1
3
—
—
85
1
3
U
10
3
U
1
9
10
17
7
9
4
5
1
5
10,438** 6,778
2,410
753
258
233
615
Total
<1
P&I†
Total
45-64
E.S. Central
Birmingham, AL
Chattanooga, TN
Knoxville, TN
Lexington, KY
Memphis, TN
Mobile, AL
Montgomery, AL
Nashville, TN
>65
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.
¶
Because of Hurricane Katrina, weekly reporting of deaths has been temporarily disrupted.
** Total includes unknown ages.
1070
MMWR
TABLE IV. Provisional cases of selected notifiable disease,*
United States, quarter ending September 29, 2007 (39th Week)
Reporting area
United States
New England
Connecticut
Maine
Massachusetts
New Hampshire
Rhode Island
Vermont
Current
quarter
2,863
Tuberculosis
Previous
4 quarters
Min
Max
2,368
3,921
Cum
2007
7,604
Cum
2006
9,382
38
26
6
—
1
5
—
16
11
3
0
0
0
0
49
28
6
0
8
14
5
103
65
13
—
4
19
2
212
66
11
104
9
18
4
Mid. Atlantic
New Jersey
New York (Upstate)
New York City
Pennsylvania
547
124
73
269
81
392
80
43
218
45
598
136
124
269
98
1,428
317
165
751
195
1,516
372
192
713
239
E.N. Central
Illinois
Indiana
Michigan
Ohio
Wisconsin
292
137
—
74
65
16
233
121
0
35
52
15
380
177
33
93
65
23
774
387
7
147
179
54
844
392
92
128
181
51
W.N. Central
Iowa
Kansas
Minnesota
Missouri
Nebraska
North Dakota
South Dakota
125
9
20
53
29
12
—
2
101
7
12
46
26
0
0
2
149
14
20
67
36
12
9
6
354
25
52
166
83
18
—
10
353
26
75
157
70
16
—
9
S. Atlantic
Delaware
District of Columbia
Florida
Georgia
Maryland
North Carolina
South Carolina
Virginia
West Virginia
499
6
1
192
64
75
82
12
61
6
440
0
0
185
35
45
61
0
37
4
815
6
15
315
117
75
144
63
138
6
1,459
10
12
592
216
180
222
28
184
15
1,940
28
52
723
415
123
230
159
194
16
E.S. Central
Alabama
Kentucky
Mississippi
Tennessee
152
35
37
26
54
113
35
17
22
32
207
51
37
36
95
428
126
79
81
142
465
145
59
77
184
W.S. Central
Arkansas
Louisiana
Oklahoma
Texas
443
33
—
40
370
240
21
0
33
176
443
33
0
43
381
1,053
77
—
122
854
1,396
81
—
111
1,204
Mountain
Arizona
Colorado
Idaho
Montana
Nevada
New Mexico
Utah
Wyoming
98
74
5
—
—
—
10
9
—
66
23
0
0
0
0
0
5
0
226
138
28
0
12
33
14
14
1
248
158
22
—
—
16
24
28
—
410
176
96
—
—
68
43
25
2
Pacific
Alaska
California
Hawaii
Oregon
Washington
669
15
557
27
—
70
506
9
400
22
0
62
1,062
24
925
37
26
70
1,757
34
1,430
96
—
197
2,246
46
1,854
93
55
198
U
—
—
17
—
0
—
0
0
0
3
—
11
48
0
U
—
—
23
—
U
U
43
64
—
American Samoa
C.N.M.I.
Guam
Puerto Rico
U.S. Virgin Islands
C.N.M.I.: Commonwealth of Northern Mariana Islands.
U: Unavailable.
—: No reported cases.
N: Not notifiable.
Cum: Cumulative year-to-date counts.
Min: Minimum.
Max: Maximum.
* AIDS and HIV/AIDS data are not updated for this quarter because of upgrading
of the national HIV/AIDS surveillance data management system.
October 12, 2007
Vol. 56 / No. 40
MMWR
1071
FIGURE I. Selected notifiable disease reports, United States, comparison of provisional
4-week totals October 6, 2007, with historical data
DECREASE
DISEASE
CASES CURRENT
4 WEEKS
INCREASE
Giardiasis
1,092
Hepatitis A, acute
138
Hepatitis B, acute
153
Hepatitis C, acute
34
Legionellosis
127
Measles
2
Meningococcal disease
36
Mumps
14
Pertussis
286
0.25
0.5
1
2
4
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.
Notifiable Disease Data Team and 122 Cities Mortality Data Team
Patsy A. Hall
Deborah A. Adams
Rosaline Dhara
Willie J. Anderson
Carol Worsham
Lenee Blanton
Pearl C. Sharp
1072
MMWR
October 12, 2007
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