MMWR - CDC Depression

Morbidity and Mortality Weekly Report
Weekly / Vol. 59 / No. 38 October 1, 2010
National Depression Screening Day October 7, 2010

National Depression Screening Day, sponsored by Screening for Mental Health, will be observed October 7, 2010, during Mental Illness Awareness Week, October 39, which is sponsored by the National Alliance on Mental Illness. In 2004, depression was the third leading cause of disease burden worldwide and a leading cause of disability in high-income countries (1). By 2020, depression is expected to be second only to cardiovascular disease in disease burden (1). Depression can adversely affect the course and outcome of common chronic conditions, such as arthritis, asthma, cardiovascular disease, cancer, diabetes, and obesity (2). Depression also can result in increased work absenteeism, short-term disability, and decreased productivity (3). The U.S. Preventive Services Task Force recommends that health-care providers screen adults for depression when programs are in place to ensure that accurate diagnosis and effective treatment can be provided with careful monitoring and follow-up (4). An online self-assessment of emotional health and additional information regarding National Depression Screening Day are available at http:// www.mentalhealthscreening.org. Additional information regarding Mental Illness Awareness Week is available at http://www.nami.org.
References
1. World Health Organization. The global burden of disease: 2004 update. Geneva, Switzerland: WHO Press; 2008. Available at http://www.who.int/healthinfo/global_burden_disease/GBD_ report_2004update_full.pdf. Accessed September 29, 2010. 2. Chapman DP, Perry GS, Strine TW. The vital link between chronic disease and depressive disorders. Prev Chronic Dis 2005;2:A14. 3. Goetzel RZ, Hawkins K, Ozminkowski RJ, Wang S. The health and productivity cost burden of the top 10 physical and mental health conditions affecting six large U.S. employers in 1999. J Occup Environ Med 2003;45:514. 4. US Preventive Services Task Force. Screening for depression in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2009;151:78492.
Current Depression Among Adults United States, 2006 and 2008

Major depression is a common and treatable mental disorder; a study conducted during 20012002 estimated that 6.6% of the U.S. adult population had experienced a major depressive disorder during the preceding 12 months (1). Depressive disorders are more common among persons with chronic conditions (e.g., obesity, cardiovascular disease, diabetes, asthma [2,3], arthritis, and cancer [3]) and among those with unhealthy behaviors (e.g., smoking, physical inactivity, and binge drinking [2]). To estimate the prevalence of current depression, CDC analyzed Behavioral Risk Factor Surveillance System (BRFSS) survey data from 2006 and 2008. Current depression was defined as meeting BRFSS criteria for either major depression or other depression during the 2 weeks preceding the survey. This report summarizes the results of that analysis, which indicated that, among 235,067 adults (in 45 states, the District of Columbia [DC], Puerto Rico, and the U.S. Virgin Islands), 9.0% met the criteria for current depression, including 3.4% who met the criteria for major depression. By state, age-standardized estimates for current depression ranged from 4.8% in North Dakota to 14.8% in Mississippi. State health departments that include depression measures in their BRFSS surveys can track prevalence, set health goals for prevention and control, and monitor the effectiveness of relevant programs and policies. BRFSS conducts state-based, random-digitdialed telephone surveys of the noninstitutionalized U.S. civilian population aged 18 years, collecting data on health conditions and health risk INSIDE
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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention
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behaviors.* Data from the 29 participating states, DC, Puerto Rico, and the U.S. Virgin Islands from the 2006 survey were included in the analysis along with data from the 16 states that participated in the 2008 survey (the most recent years the optional depression module was included in the BRFSS survey). Nine states (Hawaii, Kansas, Louisiana, Maine, Mississippi, Nebraska, North Dakota, Vermont, and Washington) participated in both years, but only their 2008 data were included. Five states (Kentucky, New Jersey, North Carolina, Pennsylvania, and South Dakota) did not participate in either year. Council of American Survey and Research Organizations (CASRO) response rates ranged from 36.9% (California) to 73.4% (Puerto Rico) in 2006 (mean: 52.7%) and from 40.0% (New York) to 65.5% (Nebraska) in 2008 (mean: 52.0%). Cooperation rates ranged from 56.9% (California) to 89.0% (Puerto Rico) in 2006 and from 63.4% (New York) to 81.9% (Colorado) in 2008.
* Additional information available at http://www.cdc.gov/brfss/ technical_infodata/surveydata.htm.
Current depression was determined based on responses to the Patient Health Questionnaire 8 (PHQ-8) (4), which covers eight of the nine criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) for diagnosis of major depressive disorder (5). The ninth criterion in the DSM-IV assesses suicidal or self-injurious ideation and was omitted from the BRFSS depression module because interviewers would not able to provide adequate intervention by telephone. The PHQ-8 classification other depression includes the DSM-IV category Depressive Disorder, Not Otherwise Specified (sometimes referred to as minor or subthreshold depression); persons with other depression also might meet criteria for the category Dysthymia. The PHQ-8 sensitivity and specificity for major depression have been reported as 88% (4). The PHQ-8 response set was standardized to BRFSS methodology for current depression by asking the number of days over the last 2 weeks that the respondent experienced a particular depressive symptom. Participants were considered to have major depression if, for more than half the days, they met at least five of the eight criteria, including at least
The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333. Suggested citation: Centers for Disease Control and Prevention. [Article title]. MMWR 2010;59:[inclusive page numbers].
Centers for Disease Control and Prevention

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

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

William L. Roper, MD, MPH, Chapel Hill, NC, Chairman Virginia A. Caine, MD, Indianapolis, IN Patricia Quinlisk, MD, MPH, Des Moines, IA Patrick L. Remington, MD, MPH, Madison, WI Jonathan E. Fielding, MD, MPH, MBA, Los Angeles, CA David W. Fleming, MD, Seattle, WA Barbara K. Rimer, DrPH, Chapel Hill, NC John V. Rullan, MD, MPH, San Juan, PR William E. Halperin, MD, DrPH, MPH, Newark, NJ King K. Holmes, MD, PhD, Seattle, WA William Schaffner, MD, Nashville, TN Anne Schuchat, MD, Atlanta, GA Deborah Holtzman, PhD, Atlanta, GA John K. Iglehart, Bethesda, MD Dixie E. Snider, MD, MPH, Atlanta, GA John W. Ward, MD, Atlanta, GA Dennis G. Maki, MD, Madison, WI
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MMWR / October 1, 2010 / Vol. 59 / No. 38
one of the following: 1) little interest or pleasure in doing things or 2) feeling down, depressed, or hopeless. Participants were considered to have other depression if they met two, three, or four of the eight criteria, including at least one of the two specified. Weighted prevalence estimates for major depression and other depression and 95% confidence intervals were calculated using statistical software to account for the complex survey design. Estimates were stratified by type of depression, age, sex, race/ethnicity, education level, and marital, employment, and health insurance coverage plan status. Age-standardized estimates also were calculated by state/territory using the 2000 U.S. standard population. For comparisons of prevalence, statistical significance (p<0.05) was determined using a two-sided z-test. Among the 235,067 adult respondents in the sample for survey years 2006 and 2008, 9.0% met criteria for current depression, including 3.4% who met criteria for major depression (Table 1). The prevalence of major depression increased with age, from 2.8% among persons aged 1824 years to 4.6% among persons aged 4564 years, but declined to 1.6% among those aged 65 years. Women were significantly more likely than men to report major depression (4.0% versus 2.7%), as were persons without health insurance coverage compared with those with coverage (5.9% versus 2.9%), persons previously married (6.6%) or never married (4.1%) compared with those currently married (2.2%), and persons unable to work (22.2%) or unemployed (9.8%) compared with homemakers and students (3.0%), persons employed (2.0%), and retired persons (1.6%) (Table 1). Non-Hispanic blacks (4.0%), Hispanics (4.0%), and non-Hispanic persons of other races (4.3%) were significantly more likely to report major depression than non-Hispanic whites (3.1%). Persons with less than a high school diploma (6.7%) and high school graduates (4.0%) were more likely to report major depression than those with at least some college (2.5%). Patterns of prevalence for other depression generally were similar to those for major depression, with some notable exceptions. Among age groups,
The
What is already known on this topic? Depression is a common and treatable mental disorder, with an estimated 6.6% of the U.S. adult population (often including persons with chronic conditions or unhealthy behaviors) experiencing a major depressive disorder during a 12-month period. What does this report add? In 2006 and 2008, an estimated 9.0% of U.S. adults reported symptoms for current depression (i.e., during the preceding 2 weeks), including 3.4% who reported symptoms for major depression, among 235,067 survey respondents in 45 states, the District of Columbia, and two U.S. territories. By state, estimates for current depression varied widely, ranging from 4.8% in North Dakota to 14.8% in Mississippi. What are the implications for public health? States that monitor the prevalence of current depression and major depression can analyze their data by participant characteristics, identify those populations at greatest risk, and target them for interventions.
other depression was highest (8.1%) among persons aged 1824 years (Table 1). The age-standardized prevalence of major depression, other depression, and any current depression also varied by state and territory. The estimates for major depression ranged from 1.5% in North Dakota to 5.3% in Mississippi and West Virginia (Table 2). Estimates of other depression were highest in Puerto Rico (10.2%), Mississippi (9.5%), and West Virginia (9.0%) and lowest in North Dakota (3.2%), Oregon (3.6%), and Minnesota (3.8%). Estimates for any current depression ranged from 4.8% in North Dakota to 14.8% in Mississippi and was mainly concentrated in the southeastern region of the United States (Figure).
Reported by
O Gonzalez, PhD, JT Berry, PhD, JD, Substance Abuse and Mental Health Svcs Admin. LR McKnight-Eily, PhD, T Strine, PhD, VJ Edwards, PhD, H Lu, MS, JB Croft, PhD, Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.
Editorial Note
remaining six criteria were 1) trouble falling asleep or staying asleep or sleeping too much, 2) feeling tired or having little energy, 3) poor appetite or overeating, 4) feeling bad about yourself or that you were a failure or let yourself or your family down, 5) trouble concentrating on things, such as reading the newspaper or watching television, and 6) moving or speaking so slowly that other people could have noticed . . . or the opposite: being so fidgety or restless that you were moving around a lot more than usual.
Unlike previous epidemiologic studies of depression that have used different methodologies and focused on lifetime or 12-month prevalence of depression (1), the PHQ-8 and BRFSS enabled assessment of current depression (i.e., symptoms occurring during
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TABLE 1. Weighted* percentage of adults meeting criteria for current depression, by type of depression and selected characteristics Behavioral Risk Factor Surveillance System, United States, 2006 and 2008
No. in sample 235,067 9,944 27,086 39,440 97,642 59,246 89,842 145,225 183,563 17,604 18,391 13,528 21,463 68,250 145,020 133,642 65,789 34,850 133,951 8,991 55,172 13,054 23,447 208,323 26,265 Major depression % 3.4 2.8 3.4 3.6 4.6 1.6 2.7 4.0 3.1 4.0 4.0 4.3 6.7 4.0 2.5 2.2 6.6 4.1 (95% CI) (3.23.5) (2.33.4) (3.03.9) (3.24.0) (4.35.0) (1.41.8) (2.53.0) (3.84.2) (2.93.2) (3.64.6) (3.44.6) (3.65.1) (6.07.6) (3.74.3) (2.32.6) (2.02.4) (6.17.0) (3.74.5) Other depression % 5.7 8.1 5.6 5.0 5.4 5.2 5.2 6.1 4.8 8.7 7.5 6.3 10.4 7.2 4.1 4.3 7.9 7.5 (95% CI) (5.45.9) (7.29.2) (5.26.2) (4.75.5) (5.05.8) (4.95.6) (4.95.5) (5.96.4) (4.65.0) (7.99.7) (6.78.3) (5.57.3) (9.511.4) (6.77.6) (3.94.3) (4.14.6) (7.58.4) (6.98.2) Any current depression % 9.0 10.9 9.1 8.6 10.0 6.8 7.9 10.1 (95% CI) (8.79.3) (9.812.1) (8.59.8) (8.19.2) (9.510.5) (6.47.2) (7.58.2) (9.810.4)
Characteristic Total Age group (yrs) 1824 2534 3544 4564 65 Sex Men Women Race/Ethnicity White, non-Hispanic Black, non-Hispanic Hispanic Other** Education Less than high school diploma High school diploma At least some college Marital status Married Previously married Never married Employment status Employed Unemployed Retired Unable to work Homemaker/Student Health insurance coverage Yes No
7.9 (7.68.1) 12.8 (11.813.8) 11.4 (10.512.5) 10.6 (9.511.9) 17.1 (16.018.3) 11.2 (10.611.7) 6.6 (6.36.9) 6.5 (6.36.8) 14.5 (13.915.1) 11.6 (10.912.3) 6.4 (6.16.7) 21.3 (19.623.2) 6.3 (5.96.7) 39.1 (37.340.9) 9.2 (8.410.1) 7.9 (7.78.2) 14.9 (14.015.8)
2.0 (1.82.1) 9.8 (8.711.0) 1.6 (1.41.8) 22.2 (20.723.8) 3.0 (2.63.5) 2.9 5.9 (2.83.1) (5.46.5)
4.5 (4.24.7) 11.6 (10.213.1) 4.7 (4.45.1) 16.9 (15.618.3) 6.2 (5.57.0) 5.0 9.0 (4.85.2) (8.29.8)
* Data were weighted to adjust for differences in probability of selection and nonresponse, as well as noncoverage (e.g., households lacking landlines). Based on responses to Patient Health Questionnaire 8. Data presented were collected by 16 states in 2008 and by 29 different states, the District of Columbia, and two territories in 2006. Five states (Kentucky, New Jersey, North Carolina, Pennsylvania, and South Dakota) did not participate in either year. Nine states (Hawaii, Kansas, Louisiana, Maine, Mississippi, Nebraska, North Dakota, Vermont, and Washington) participated in both years, but only 2008 data were included. Confidence interval. ** Includes non-Hispanic persons of other races or multiple races. Includes divorced, widowed, or separated.
the preceding 2 weeks). However, the distribution of major depression among selected sociodemographic groups in this analysis generally is consistent with previous research indicating that women, younger and middle-aged adults, those who were never married, and persons with less than a high school education were more likely to have met diagnostic criteria for depression during the preceding 12 months (1). Older adults have been found less likely to meet diagnostic criteria, but depression in this population might be underrecognized or underreported (6).
The greater prevalence of depression among women is not fully understood, although potential contributors include different responses to stressful life events, genetic predisposition, and hormonal differences (7). Racial/ethnic differences in depression have not been found consistently; some studies have reported no differences (8), whereas others have found lower rates (1) among racial/ethnic minorities compared with whites. However, this report and other BRFSS-based studies (2) indicate significantly higher rates of current depression among racial/ ethnic minorities. This is consistent with the greater
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TABLE 2. Age-standardized* percentage of adults meeting criteria for current depression, by type of depression and state/territory Behavioral Risk Factor Surveillance System, United States, 2006 and 2008
No. in sample 2,758 1,806 5,314 4,809 5,177 5,093 4,109 3,780 3,485 9,298 6,485 5,901 4,570 4,879 5,746 4,692 3,783 N/A 5,388 3,724 4,261 5,835 5,077 4,119 6,387 4,771 5,262 4,840 3,222 5,230 N/A 5,745 3,444 N/A 4,482 5,797 6,117 4,294 N/A 4,002 7,853 N/A 3,860 5,856 4,621 6,185 4,636 9,382 3,439 4,228 4,495 4,181 2,649 Major depression % 4.1 2.3 3.6 4.9 3.7 2.4 2.0 3.4 2.8 3.2 3.4 3.1 2.9 3.1 3.9 2.1 3.6 2.9 3.5 2.6 2.6 3.8 2.1 5.3 4.1 2.4 2.3 3.7 3.0 3.5 2.2 1.5 3.9 4.7 3.5 3.4 3.6 4.1 3.5 3.4 3.0 2.8 3.1 5.3 2.3 3.1 4.5 1.7 (95% CI) (3.35.1) (1.63.2) (2.65.0) (4.25.8) (3.14.4) (1.83.0) (1.52.6) (2.74.2) (2.03.9) (2.63.9) (2.94.1) (2.53.9) (2.43.5) (2.53.8) (3.34.6) (1.72.7) (2.84.6) N/A (2.43.5) (2.84.4) (2.03.3) (2.03.3) (3.14.6) (1.72.6) (4.66.1) (3.35.1) (2.03.0) (1.63.2) (2.75.0) (2.43.8) N/A (2.94.1) (1.72.8) N/A (1.22.0) (3.24.7) (4.15.4) (2.84.4) N/A (2.74.3) (3.04.2) N/A (3.45.1) (2.84.5) (2.84.2) (2.53.6) (1.94.1) (2.63.7) (4.46.3) (1.92.9) (2.53.7) (3.95.2) (1.22.3) Other depression % 8.9 3.9 6.7 7.0 5.4 4.1 4.5 6.9 5.7 6.6 5.0 6.6 4.7 6.9 5.0 4.0 4.8 7.9 4.4 4.4 4.9 6.4 3.8 9.5 5.6 4.1 6.0 6.1 4.1 5.3 5.6 3.2 4.9 6.6 3.6 5.4 6.0 6.9 5.4 5.4 4.8 4.2 4.6 9.0 4.2 4.5 10.2 7.4 (95% CI) (7.011.2) (2.95.3) (5.28.7) (6.18.1) (4.66.3) (3.35.0) (3.75.5) (5.58.6) (4.76.9) (5.87.6) (4.45.8) (5.77.6) (3.95.6) (5.98.1) (4.45.8) (3.34.9) (3.85.9) N/A (7.09.0) (3.65.3) (3.65.5) (3.96.2) (5.67.3) (3.24.6) (8.410.7) (4.66.7) (3.54.9) (4.67.9) (4.87.5) (3.44.9) N/A (4.56.1) (4.76.8) N/A (2.64.0) (4.15.9) (5.97.5) (2.94.4) N/A (4.46.5) (5.36.9) N/A (5.78.2) (4.66.3) (4.66.3) (4.15.7) (3.45.2) (4.05.3) (7.810.3) (3.45.1) (3.85.4) (9.111.3) (6.18.9) Any current depression % 13.0 6.2 10.3 11.9 9.1 6.4 6.5 10.2 8.4 9.8 8.5 9.7 7.6 10.0 8.9 6.2 8.3 10.8 7.9 7.0 7.5 10.2 5.9 14.8 9.7 6.5 8.3 9.8 7.1 8.7 7.8 4.8 8.8 11.3 7.1 8.8 9.6 11.0 8.9 8.8 7.8 7.0 7.7 14.3 6.5 7.6 14.7 9.1 (95% CI) (11.015.4) (5.07.7) (8.512.5) (10.813.2) (8.110.2) (5.57.5) (5.67.6) (8.712.0) (7.19.9) (8.810.9) (7.69.5) (8.710.9) (6.68.7) (8.811.3) (8.09.9) (5.37.2) (7.19.8) N/A (9.711.9) (6.89.1) (6.08.2) (6.38.9) (9.111.3) (5.16.8) (13.516.2) (8.411.1) (5.77.4) (6.710.3) (8.211.6) (6.18.2) N/A (7.89.8) (6.79.1) N/A (4.05.6) (7.710.0) (10.312.4) (6.18.2) N/A (7.610.1) (8.710.6) N/A (9.612.5) (7.810.2) (7.89.9) (6.98.8) (5.88.5) (6.98.5) (12.815.9) (5.67.6) (6.78.6) (13.515.9) (7.710.6)
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 Puerto Rico U.S. Virgin Islands
Abbreviation: N/A = data not available. * Age standardized to the 2000 U.S. standard population. Based on responses to Patient Health Questionnaire 8. Data presented were collected by 16 states in 2008 and by 29 different states, the District of Columbia, and two territories in 2006. Five states (Kentucky, New Jersey, North Carolina, Pennsylvania, and South Dakota) did not participate in either year. Nine states (Hawaii, Kansas, Louisiana, Maine, Mississippi, Nebraska, North Dakota, Vermont, and Washington) participated in both years, but only 2008 data were included. Confidence interval.
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FIGURE. Age-standardized* percentage of adults meeting criteria for current depression, by state/territory Behavioral Risk Factor Surveillance System, United States, 2006 and 2008
DC PR USVI
10.4%14.8% 9.2%10.3% 8.4%9.1% 7.1%8.3% 4.8%7.0% No data
* Age standardized to the 2000 U.S. standard population. Based on responses to Patient Health Questionnaire 8. Data presented were collected by 16 states in 2008 and by 29 different states, the District of Columbia, and two territories in 2006. Five states (Kentucky, New Jersey, North Carolina, Pennsylvania, and South Dakota) did not participate in either year. Nine states (Hawaii, Kansas, Louisiana, Maine, Mississippi, Nebraska, North Dakota, Vermont, and Washington) participated in both years, but only 2008 data were included.
risk factors for mental illness that these populations often experience (e.g., social and economic inequality, exposure to racism and discrimination, increased prevalence of some chronic diseases, and less access to care and treatment for mental health and health conditions [8]). Targeted efforts are needed to address racial/ethnic disparities in recognition and treatment of depression (8). In this study, persons without health insurance coverage were more likely to have current depression. Although seeking care for depression might have grown more common, for many, lack of health insurance coverage (or limited mental health coverage) remains a major barrier to care (9). State and territorial variations in depression prevalence might result from differences in socioeconomic status, prevalence of comorbid mental and physical disorders (particularly chronic conditions), and access to health-care and treatment (e.g., availability of mental health service providers) (2,10). In this
study, a greater prevalence of depression was found in southeastern states, where a greater prevalence of chronic conditions associated with depression also has been observed (e.g., obesity and stroke). Depression can lead to chronic diseases, and chronic diseases can exacerbate depressive conditions (3). The variations among states in depression prevalence should be examined further to target prevention and intervention efforts and to allocate mental health treatment resources of the federal government. In addition, the Task Force on Community Preventive Services recommends collaborative care, an approach that facilitates the collaboration of primary-care providers, mental health specialists, and case managers for the management of depressive disorders, on the basis of strong evidence of effectiveness in improving depression outcomes. The findings in this report are subject to at least three limitations. First, the increase in the number households with cellular telephones only and the increase in telephone number portability continue to decrease BRFSS response rates, reducing the precision of state estimates and potentially introducing bias; however, in 2009 all states incorporated surveys for cellular telephone households along with landline surveys, which should increase response rates to the survey. Second, institutionalized and homeless persons are not included in BRFSS surveys; their inclusion might have increased depression estimates. Finally, because not all states participated, estimates might not be generalizable to the entire U.S. adult population. PHQ-8 was added as a component of an optional module in the BRFSS survey in 2006 through an intra-agency agreement with the Substance Abuse and Mental Health Services Agency to determine state-based estimates of depression in adults. These data also allow for examination of comorbid chronic diseases and associated health-risk behaviors among adults with depressive disorders and should be used to help guide state-level chronic disease and mental health programs. The prevalence of depressive disorders should be monitored by state public health departments through surveillance, and at-risk populations should be targeted for intervention.
Information
available at http://www.thecommunityguide.org/ mentalhealth/collab-care.html.
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References
1. Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 2003;289: 3095105. 2. Strine TW, Mokdad AH, Balluz LS, et al. Depression and anxiety in the United States: findings from the 2006 Behavioral Risk Factor Surveillance System. Psychiatr Serv 2008;59:138390. 3. Chapman DP, Perry GS, Strine TW. The vital link between chronic disease and depressive disorders. Prev Chronic Dis 2005;2:A14. 4. Kroenke K, Strine TW, Spitzer RL, Williams JB, Berry JT, Mokdad AH. The PHQ-8 as a measure of current depression in the general population. J Affect Disord 2009; 114:16373. 5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Association; 1994. 6. Byers AL, Yaffe K, Covinsky KE, Friedman MB, Bruce ML. High occurrence of mood and anxiety disorders among older adults: the National Comorbidity Survey Replication. Arch Gen Psychiatry 2010;67:48996.
7. National Institute of Mental Health. Women and depression: discovering hope. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health; 2009. Available at http://www. nimh.nih.gov/health/publications/women-and-depressiondiscovering-hope/index.shtml. Accessed September 27, 2010. 8. US Department of Health and Human Services, Office of the Surgeon General, Substance Abuse and Mental Health Services Administration. Mental health: culture, race, and ethnicity: a supplement to mental health: a report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Office of the Surgeon General, Substance Abuse and Mental Health Services Administration; 2001. Available at http://www.surgeongeneral.gov/library/ mentalhealth/cre. Accessed September 27, 2010. 9. Mojtabai R. Unmet need for treatment of major depression in the United States. Psychiatr Serv 2009;60:297305. 10. Lewis G, Booth M. Regional differences in mental health in Great Britain. J Epidemiol Community Health 1992;46:60811.
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Human Rabies Virginia, 2009

On October 28, 2009, CDC notified the Virginia Department of Health (VDH) of suspected rabies in a Virginia man aged 42 years. Earlier that day, an infectious disease physician in Virginia had contacted CDC requesting confirmatory diagnostic testing and reported initiating treatment with the Milwaukee protocol (1) after consultation with staff at the Medical College of Wisconsin. This report summarizes the patients exposure history, clinical course, and treatment, and describes efforts to identify close contacts requiring postexposure prophylaxis (PEP). According to family members, the patient had reported an encounter with a dog while in India approximately 3 months before symptom onset. On October 29, infection with a rabies virus was confirmed by direct fluorescent antibody testing of a nuchal skin biopsy, and reverse transcriptionpolymerase chain reaction (RT-PCR) typed the virus as a variant associated with dogs in India. The patient died on November 20. Public health authorities conducted rabies exposure assessments of 174 persons associated with the patient, and 32 persons (18%) initiated rabies PEP. This is the seventh case of rabies reported in the United States acquired abroad since 2000. This case highlights the importance of raising public awareness of rabies, particularly the risk for rabies exposures in association with travel to rabies-endemic countries, and the importance of initiating PEP promptly after a potential exposure. 27, the patient contacted his primary-care physician and raised concern about the possibility of rabies. He was referred back to the same ED for evaluation of neurologic disorders, including rabies. On October 27, the patient returned to the ED and, in addition to the previously noted symptoms, exhibited anxiety and erratic behavior and had involuntary dystonic movements of his upper extremities. The patient reported travel to India approximately 3 months before symptom onset but gave no clear history of animal exposure occurring while in India or in the United States. Physical examination showed tachycardia (134 beats per minute) and elevated blood pressure (153/93 mm Hg) but no fever. The patient was noted to have dystonic movements of the upper extremities and neck and loud involuntary vocalizations. Sensation and motor strength were normal. The patient demonstrated aversion to water when offered. A computed tomography (CT) scan of the head showed only left maxillary sinusitis. The patient was admitted to the hospital (hospital A) with a differential diagnosis that included rabies and other neurologic diagnoses of unknown etiology. Empiric antimicrobial and antiviral therapy for meningioencephalitis was initiated. Within 24 hours of admission, the patient was noted to be shouting, gagging on copious salivary secretions, and unable to follow commands. His tachycardia and hypertension worsened and, soon after he was transferred to the intensive-care unit, he developed seizures, sustained a cardiac arrest, and required ventilator support. At this time, the patient developed a low-grade fever (99.4F [37.4C]). Complete blood count showed mild leukocytosis (15.42 109/L [normal: 510 109/L]), mild hyperglycemia (120 mg/ dL [normal: 70105 mg/dL), and a creatine kinase of >16,000 U/mL (normal: 1270 U/mL). Urinalysis showed large blood and hyaline casts. Toxicology and heavy metal screenings were unremarkable. On October 28, the second hospital day, a lumbar puncture showed an elevated cerebrospinal fluid (CSF) glucose of 101 mg/dL (normal: 5080 mg/dL), normal protein of 31 mg/dL (normal: 1545 mg/ dL), and 6 white blood cells/mm3 (normal: 03 cells/ mm3). The treating physician initiated the Milwaukee protocol, including ketamine infusion, but in keeping with this protocol, the patient was not given rabies
Case Report
On October 23, 2009, a male physician aged 42 years in Virginia experienced the onset of chills and hot flashes. The next morning, he began experiencing discomfort in his legs, and that evening he developed spontaneous ejaculation occurring up to once per hour, urinary incontinence, and back pain radiating to the left lower extremity. Two days later, on October 26, he visited an ED for assessment. The patient was awake, oriented, and afebrile during this visit. Magnetic resonance imaging of his lumbar spine revealed degenerative disease at L4L5, and he was discharged with a diagnosis of lumbar back pain, given pain medications, and instructed to follow up with his primary-care physician. That evening he began to gag while drinking and showering. On October
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immune globulin, vaccine, or antivirals (1). Serum, CSF, nuchal skin biopsy, and saliva were collected and submitted to CDC for rabies testing. The next day, October 29, CDC detected rabies virus antigen in the skin biopsy by direct fluorescent antibody testing. Rabies viral RNA amplified by RT-PCR was typed as a variant common to dogs in India. Serial assessments of serum, CSF, and saliva were conducted to monitor for viral clearance. A ventriculostomy drain was placed for continuous monitoring and management of intracranial fluid pressures. With turning and suctioning, the patient experienced asystole. Increasing episodes of asystole resulted in placement of a transvenous pacemaker by hospital day 8. By hospital day 12, the patient developed inappropriate antidiuretic hormone secretion followed by severe central diabetes insipidus treated with desmopressin and continuous vasopressin infusion. By hospital day 15, the patient developed late and marginal antibody response in saliva but never developed neutralizing antibody in CSF, which is necessary for viral clearance and cure. Sedation was tapered over 1 week with clinical evidence of denervation indicated by loss of brain stem reflexes and diminished autonomic dysfunction. The patient died on November 20 (hospital day 25).
What is already known on this topic? If not prevented by administration of postexposure prophylaxis (PEP), the rabies virus causes acute progressive viral encephalitis that is almost always fatal. What is added by this report? In November 2009, a man from Virginia aged 42 years died of rabies acquired while traveling in India; this is the seventh case of rabies reported in the United States acquired abroad since 2000. What are the implications for public health practice? Public health officials and clinicians should advise travelers of the risk for rabies exposure in rabiesendemic countries and should evaluate promptly persons with potential exposure to initiate PEP based on guidelines from the Advisory Committee on Immunization Practices.
Public Health Investigation

VDH and the Fairfax County Health Department (FCHD) were notified of a suspected rabies case on October 28, the patients second hospital day. FCHD began working with hospital As epidemiology and occupational health staff to generate a list of potentially exposed hospital employees. In addition, FCHD initiated interviews with family and friends to clarify the patients exposure history and gather information about persons who had contact with the patient since October 8, the date after which he was considered potentially infectious. According to the patients father, the patient had an unwitnessed encounter with a dog while he was in India. Family members were unaware of other possible exposures to rabies and did not know if the patient sought medical care or rabies PEP. The patient was a psychiatrist and worked primarily at a hospital (hospital B), where he supervised psychiatry residents and did not have direct patient contact. He also worked 1 day a week at two additional health-care facilities (facilities A and B). Hospital B
is located in the District of Columbia, and the two facilities are located in Maryland. On October 29, VDH contacted the Maryland Department of Health and Mental Hygiene (MDHMH) and the District of Columbia Department of Health (DCDOH) to facilitate assessment of coworkers and patients for PEP according to Advisory Committee on Immunization Practices (ACIP) criteria (2). A survey tool was created to assess health-care contacts, and another questionnaire was developed to assess household contacts and coworkers. A total of 32 (18%) of 174 persons evaluated for potential exposure initiated PEP. No adverse reactions to PEP or additional cases of rabies were reported to public health authorities. FCHD interviewed all 70 health-care providers who had administered care to the patient in hospital A, and 17 met the criteria for a nonbite exposure to rabies (because of exposure to the patients saliva). An additional seven assessed persons initiated rabies PEP despite no indication; two had already initiated PEP before the exposure assessment by FCHD. Among the 34 coworkers assessed at hospital B by DCDOH, only one, who identified himself as a close friend of the patient, met the criteria for nonbite exposure and received rabies PEP. MDHMH assessed 37 coworkers and 26 patients associated with facilities A and B. No coworkers or patients at either facility met the criteria for exposure, and none pursued rabies PEP. All six family members and one assessed friend were identified who might have been exposed to saliva from the patient, and all received rabies PEP.
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Reported by
P Troell, MD, B Miller-Zuber, MEd, Fairfax County Health Dept; J Ondrush, MD, Inova Fairfax Hospital; J Murphy, DVM, Virginia Dept of Health. N Fatteh, MD, Kaiser Permanente Mid Atlantic, Rockville; K Feldman, DVM, K Mitchell, MPH, Maryland Dept of Health and Mental Hygiene. R Willoughby, MD, Medical College of Wisconsin. C Glymph, MPH, District of Columbia Dept of Health. J Blanton, MPH, C Rupprecht, VMD, PhD, Div of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC.
Editorial Note
The case described in this report underscores two important aspects of human rabies prevention: 1) the importance of awareness about rabies risks when traveling abroad and 2) the need to seek prompt medical evaluation after an animal exposure (3). Since 2000, seven of the 31 human rabies cases reported in the United States were acquired from exposure abroad; two were acquired in the Philippines (California, 2001 and 2006), and one each were acquired in Ghana (New York, 2000), El Salvador (California, 2004), Haiti (Florida, 2004), Mexico (California, 2008), and India (the 2009 case described in this report) (4). An attempt to treat the patient after the onset of clinical symptoms of rabies using an experimental treatment (the Milwaukee protocol) failed. Prompt administration of rabies PEP after an exposure remains the only documented method for preventing death after an exposure to rabies (2). Although human-to-human rabies transmission in a health-care setting is theoretically possible, no such occurrence has been documented. Rabies exposure risks for health-care personnel who care for rabies patients include exposure of mucous membranes or open wounds to infectious body fluids or tissue (e.g., saliva, tears, or neurologic tissue). Adherence to standard infection control precautions minimizes the risk for health-care personnel. However, additional precautions, such as wearing face shields when performing higher-risk procedures that can produce droplets or aerosols of saliva (i.e., suction of oral secretions), might be warranted (2). Among the health-care personnel assessed for potential contact in recent human rabies cases in the United States, the proportion that received PEP ranged from 2.5% to 30.0% (58). In this report, 34% of health-care personnel received PEP after a potential contact with
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the patient. However, seven health-care personnel received PEP despite PEP not being recommended after risk assessment. Prompt communication with public health authorities and education of personnel who have contact with a rabies patient is critical to permit appropriate risk assessment and reduce unnecessary PEP (2,9). Dogs represent the most frequent risk for bite exposures to travelers and should be avoided. Travelers to rabies-endemic countries should be warned about the risk for acquiring rabies and educated about animal bite prevention and appropriate actions to take if an exposure does occur (i.e., wound washing and medical attention to determine if PEP is necessary). Relative rabies risk and recommendations for travelers by region and country can be found in CDCs Health Information for International Travel 2010 (10).
Acknowledgments The findings in this report are based, in part, on contributions by B Bullock, Fairfax County Health Dept; G Lum, M Hille, District of Columbia Dept of Health; E Jones, Maryland Dept of Health and Mental Hygiene; and F Jackson, MS, L Orciari, MS, S Recuenco, MD, DrPH, P Yager, Div of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC. References
1. Medical College of Wisconsin. Rabies registry. Available at: http://www.mcw.edu/rabies. Accessed September 23, 2010. 2. CDC. Human rabies preventionUnited States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR 2008;57(No. RR-3) 3. Blanton JD, Rupprecht CE. Travel vaccination for rabies. Expert Rev Vaccines 2008;7:61320. 4. Blanton JD, Palmer D, Rupprecht CE. Rabies surveillance in the United States during 2009. J Am Vet Med Assoc 2010;237:64657. 5. CDC. Human rabiesMissouri, 2008. MMWR 2009;58: 12079. 6. CDC. Imported human rabiesCalifornia, 2008. MMWR 2009;58:7136. 7. CDC. Human rabiesMinnesota, 2007. MMWR 2008;57: 4602. 8. CDC. Human rabiesKentucky/Indiana, 2009. MMWR 2010;59:3936. 9. CDC. Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the Advisory Committee on Immunization Practices. MMWR 2010;59(No. RR-2):19. 10. CDC. Health information for international travel 2010. Atlanta, GA: US Department of Health and Human Services, Public Health Service; 2009. Available at http://wwwnc.cdc. gov/travel/content/yellowbook/home-2010.aspx. Accessed September 23, 2010.
Progress Toward Global Eradication of Dracunculiasis, January 2009June 2010

In 1986, the World Health Assembly (WHA) called for the elimination of dracunculiasis (Guinea worm disease), a parasitic infection in humans caused by Dracunculus medinensis (1). At the time, an estimated 3.5 million cases were occurring annually in 20 countries in Africa and Asia, and 120 million persons were at risk for the disease (1,2). Because of slow mobilization in countries with endemic disease, the 1991 WHA goal to eradicate dracunculiasis globally by 1995 was not achieved (3). In 2004, WHA established a new target date of 2009 for global eradication (4); despite considerable progress, that target date also was not met. This report updates both published (57) and previously unpublished data and updates progress toward global eradication of dracunculiasis since January 2009. At the end of December 2009, dracunculiasis remained endemic in four countries (Ethiopia, Ghana, Mali, and Sudan). The number of indigenous cases of dracunculiasis worldwide had decreased 31%, from 4,613 in 2008 to 3,185 in 2009. Of the 766 cases that occurred during JanuaryJune 2010, a total of 745 (97%) were reported from 380 villages in Sudan. Ghana, Ethiopia, and Mali each are close to interrupting transmission, as indicated by the small and declining number of cases. The current target is to complete eradication in all four countries as quickly as possible. Insecurity (e.g., sporadic violence or civil unrest) in areas of Sudan and Mali where dracunculiasis is endemic poses the greatest threat to the success of the global dracunculiasis eradication program. Persons become infected with D. medinensis by drinking water from stagnant sources (e.g., ponds) contaminated by copepods (water fleas) that contain Guinea worm larvae. Currently, no effective drug to treat nor vaccine to prevent dracunculiasis is available, and persons who contract D. medinensis infections do not become immune. After a 1-year incubation period, adult female worms 2847 inches (70120 centimeters) long migrate under the skin to emerge, usually through the skin of the foot or lower leg. On contact with water, these worms eject larvae that can then be ingested by copepods and infect persons who drink the water. The emerging worm can be removed by rolling it up on a stick a few centimeters each day. Complete removal averages approximately 4 weeks or more. Disabilities caused by dracunculiasis are secondary to bacterial infections that frequently develop in the skin, causing pain and swelling (8,9). Dracunculiasis can be prevented by 1) educating persons from whom worms are emerging to avoid bathing affected body parts in sources of drinking water, 2) filtering potentially contaminated drinking water through a cloth filter, 3) treating potentially contaminated surface water with a larvicide such as temephos (Abate), and 4) providing safe drinking water from borehole or hand-dug wells (3). Containment* of transmission, achieved through 1) voluntary isolation of each patient to prevent contamination of drinking water sources, 2) provision of first aid, 3) manual extraction of the worm, and 4) application of occlusive bandages, is a complementary component to the four main interventions. Countries enter the World Health Organization (WHO) precertification stage of eradication approximately 1 year (i.e., one incubation period for D. medinensis) after reporting their last indigenous case. A case of dracunculiasis is defined as occurring in a person exhibiting a skin lesion or lesions with emergence of one or more Guinea worms. Each person is counted only once during a calendar year. An imported case is an infection acquired in a place (another country or village within the same country) other than the community where detected and reported. Seven countries where transmission of dracunculiasis was formerly endemic (Burkina Faso, Chad, Cte dIvoire, Kenya, Nigeria, Niger, and Togo) are in the precertification stage of eradication. In each country affected by dracunculiasis, a national eradication program receives monthly reports of cases from each village that has endemic
* Transmission from a patient with dracunculiasis is contained if all of the following conditions are met: 1) the disease is detected <24 hours after worm emergence; 2) the patient has not entered any water source since the worm emerged; 3) a volunteer has managed the patient properly, by cleaning and bandaging the lesion until the worm has been fully removed manually and by providing health education to discourage the patient from contaminating any water source (if two or more emerging worms are present, transmission is not contained until the last worm is removed); and 4) the containment process, including verification of dracunculiasis, is validated by a supervisor within 7 days of emergence of the worm.
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transmission. Reporting rates are calculated by dividing the number of villages with endemic dracunculiasis that report each month by the total number of villages with endemic disease. All villages where endemic transmission of dracunculiasis is interrupted (i.e., zero cases reported for 12 consecutive months) are kept under active surveillance with searches of households for persons with signs and symptoms suggestive of dracunculiasis. This is done to ensure that detection occurs within 24 hours of worm emergence so that patient management can begin to prevent contamination of water. WHO certifies a country free from dracunculiasis after it maintains adequate nationwide surveillance for 3 consecutive years and demonstrates that no cases of indigenous dracunculiasis occurred during that period. As of October 2009, WHO had certified 187 countries and territories as free from dracunculiasis (5); 17 African countries, including four with endemic transmission, remained to be certified.
Country Reports
Sudan. Since 2003, all indigenous cases of dracunculiasis in Sudan have been reported from Southern Sudan. The Southern Sudan Guinea Worm Eradication Program (GWEP) reported 2,733 cases of dracunculiasis in 2009, of which 2,134 (78%) were contained (Table 1). For JanuaryJune 2010, the Southern Sudan GWEP reported a provisional total of 745 cases (74% contained, versus 72% contained during JanuaryJune 2009), a reduction of 37%, compared with the 1,184 cases reported for the same period in 2009 (Table 2). During 2009, a total of 1,011 villages reported one or more cases; during JanuaryJune 2010, a total of 380 villages reported one or more cases, of which 141 reported indigenous cases. During JanuaryApril 2010, the Southern Sudan Ministry of Water Resources and Irrigation, the United Nations Childrens Fund (UNICEF), and other partners completed borehole wells in 43 villages that had endemic dracunculiasis. During
TABLE 1. Number of reported dracunculiasis cases, by country and local intervention worldwide, 2009
Villages/localities reporting cases in 2009 No. reporting only cases imported into village 427 33 29 6 5 0 500 No. of villages reporting indigenous cases during 2008 2009 1,283 49 92 4 1 2 1,431 Villages/localities and interventions* % with one or more sources of safe drinking water 16 73 23 50 100 100 19
No. of reported cases in 2009 Country Sudan Ghana Mali Ethiopia Niger Nigeria Total Indigenous 2,733 242 186 24 0 0 3,185 Imported 0 0 0 0 5 0 5
% of cases reported that were contained in 2009 78 93 73 79 40 0 79
No. reporting one or more cases 1,011 52 52 9 5 0 1,129
No. reporting only cases indigenous to village 584 19 23 3 0 0 629
% reporting monthly 94 100 100 100 100 100 95
% with cloth filters in all households 98 93 89 100 100 100 98
% using temephos 45 86 63 100 100 100 48
% provided with health education 68 100 100 100 100 100 71
* Interventions include distribution of filters, use of temephos (Abate) larvicide, provision of one or more sources of safe water, and provision of health education. Definitions of imported and indigenous cases as they relate to villages/localities are available at http://www.cartercenter.org/health/guinea_worm/program_definition.html. One of the cases imported into Niger was from Ghana; four were from Mali.
TABLE 2. Number of reported indigenous dracunculiasis* cases, by country worldwide, 2008June 2010
Country Sudan Ghana Mali Ethiopia Niger Nigeria Total 2008 3,618 501 417 39 2 38 4,615 2009 2,733 242 186 24 0 0 3,185 % change -24 -52 -55 -38 -100 -100 -31 JanuaryJune 2009 1,184 228 8 21 0 0 1,441 JanuaryJune 2010 745 8 1 12 0 0 766 % change -37 -96 -88 -43 0 0 -47 % of cases contained during JanuaryJune 2010 74 100 100 92
74
* Excludes five cases imported from another country in 2009. Provisional case counts.
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What is already known on this topic? Annual cases of dracunculiasis (Guinea worm disease) have decreased from 3.5 million to <3,200 since the 1986 World Health Assembly proclaimed eradication as a goal. What is added by this report? The number of dracunculiasis cases continued to decline (by 31% from 2008 to 2009, and by 47% from JanuaryJune 2009 to JanuaryJune 2010), and only four countries remain with endemic transmission of dracunculiasis. What are the implications for public health practice? Although earlier target dates for global dracunculiasis eradication were missed, progress continues; eradication within the next few years is likely if 100% of cases are contained and program disruptions, particularly in Sudan and Mali, are minimized.
JanuaryJune 2010, a total of 14 security incidents (e.g., civil disorder, banditry, or other situations involving violence or threat of violence) disrupted Guinea worm program operations in Southern Sudan, compared with 23 such incidents during JanuaryJune 2009. Ghana. Ghanas GWEP reported 242 cases of dracunculiasis from 33 villages for 2009, of which 19 villages reported indigenous cases and the remaining villages reported cases imported from elsewhere in the country. This is a reduction in indigenous cases of 52%, compared with the 501 cases reported for 2008. Of the 242 cases reported for 2009, 93% were contained (Table 1). Ghana reported zero cases for an entire month for the first time in November 2009. For JanuaryJune 2010, Ghana reported eight cases, all of which were contained, and zero cases were reported for June, compared with 228 cases reported for JanuaryJune 2009, a reduction of 96%. The last known uncontained case in Ghana occurred in July 2009. Mali. Malis GWEP reported 186 indigenous cases in 2009, which was a reduction of 55% from the 417 cases reported in 2008. Of the 186 reported cases for 2009, 135 (73%) were contained. Mali reported only one case (which was contained) during JanuaryJune 2010, compared with eight cases during JanuaryJune 2009, a reduction of 88%. Ethiopia. Reporting of indigenous cases resumed in 2008, after approximately 20 months with no known indigenous cases, and for 2009, Ethiopia
reported 24 indigenous cases, of which 19 (79%) were contained. For JanuaryJune 2010, Ethiopia reported 12 indigenous cases (83% contained) in seven villages, compared with 21 indigenous cases in eight villages (76% contained) during JanuaryJune 2009, a reduction of 43%. Beginning in January 2010, active surveillance was extended to all 71 known inhabited settlements of Gambella Regions Gog District, which is the only remaining focus of endemic disease in Ethiopia. Much of the remaining transmission appears to be from ponds along walking paths between the main population centers and dispersed farming communities. Inhabitants of all villages where cases were reported in 2009 or 2010 have been receiving health education, and cloth filters have been distributed to more than 93% of those households and pipe filters to at least 62% Unsafe water sources have been treated with larvicide at 89 (77%) of 117 targeted sites, including the seven villages reporting cases in 2010 and ponds along walking paths. Four of the seven villages now have at least one source of safe drinking water. Niger and Nigeria. Niger and Nigeria (10) reported zero indigenous cases of dracunculiasis during an entire year for the first time in 2009. Neither country reported cases during JanuaryJune 2010.
Reported by
DR Hopkins, MD, E Ruiz-Tiben, PhD, The Carter Center, Atlanta, Georgia. ML Eberhard, Div of Parasitic Diseases and Malaria, Center for Global Health; SL Roy, Div of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC.
Editorial Note
Fewer than 3,200 cases of dracunculiasis were reported globally during 2009, the lowest annual total ever, and the number of countries in which the disease remained endemic was reduced from six to four in 2008. Of the remaining endemic countries, Mali and Ethiopia appear to be close to interrupting transmission, although Malis peak transmission season (JuneNovember) for 2010 was just beginning and insecurity has been a major concern in
The
peak transmission season varies for each country. The peak transmission season occurs during MarchSeptember in Ethiopia, during MarchOctober in Southern Sudan, during JuneOctober in Mali, and during NovemberApril in Ghana.
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Malis remaining endemic area. Ghana might have interrupted transmission already, but interruption cannot be confirmed until 1 year after the last known case (i.e., mid-2011). The program in Southern Sudan continues to make progress despite several challenges, of which sporadic insecurity is the most important. Obtaining reports about persons purported to have dracunculiasis in areas free of the disease, properly investigating such reports, and promptly notifying local authorities is a challenge for all four countries. In October 2009, WHOs International Commission for the Certification of Dracunculiasis Eradication certified three more formerly-endemic countries (Benin, Mauritania, and Uganda) as being free of dracunculiasis transmission, bringing the total number of countries certified to 187, including nine formerly endemic countries since 1996. WHA has not established a new target date for eradication. A status report on the eradication program is expected to be submitted to WHA in May 2011.
References
1. World Health Assembly. Resolution WHA 39.21. Elimination of dracunculiasis: resolution of the 39th World Health Assembly. Geneva, Switzerland: World Health Organization; 1986. 2. Watts SJ. Dracunculiasis in Africa: its geographic extent, incidence, and at-risk population. Am J Trop Med Hyg 1987;37:11925. 3. Ruiz-Tiben E, Hopkins DR. Dracunculiasis (Guinea worm disease) eradication. Adv Parasitol 2006;61:275309. 4. World Health Assembly. Resolution WHA 57.9. Eradication of dracunculiasis: resolution of the 57th World Health Assembly. Geneva, Switzerland: World Health Organization; 2004. Available at http://www.who.int/gb/ebwha/pdf_files/ wha57/a57_r9-en.pdf. Accessed October 9, 2009. 5. World Health Organization. Dracunculiasis eradication: global surveillance summary, 2009. Wkly Epidemiol Rec 2010;85:16676. 6. World Health Organization. Monthly report on dracunculiasis cases, January 2009February 2010. Wkly Epidemiol Rec 2010;85:1478. 7. CDC. Progress toward global eradication of dracunculiasis, January 2008June 2009. MMWR 2009;58:11235. 8. Imtiaz R, Hopkins DR, Ruiz-Tiben E. Permanent disability from dracunculiasis. Lancet 1990;336:630. 9. Ruiz-Tiben E, Hopkins DR. Dracunculiasis. In: Guerrant RL, Walker DH, Weller PF, eds. Tropical infectious diseases: principles, pathogens, and practice. 2nd ed. New York, NY: Elsevier; 2006:12047. 10. Miri E, Hopkins DR, Ruiz-Tiben E, et al. 2010. Nigerias triumph: dracunculiasis eradicated. Am J Trop Med Hyg 2010;83:21525.
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Announcement
National Sudden Cardiac Arrest Awareness Month October 2010
October is National Sudden Cardiac Arrest Awareness Month, dedicated to educating patients and the public about what sudden cardiac arrest is and how to respond to a cardiac arrest. Sudden cardiac arrest is when the heart suddenly stops beating, resulting in no blood flow to the brain and other vital organs. Approximately 300,000 outof-hospital cardiac arrests occur each year in the United States, with a median reported survival-tohospital-discharge rate of 8% (1). Rapidly implementing the chain of survival model (2) can help increase the chances of survival from sudden cardiac arrest. The steps in the chain include activation of emergency medical services by calling 9-1-1, starting cardiopulmonary resuscitation (CPR), using an automated external defibrillator (AED), and acquiring appropriate care. This year marks the 50th anniversary of CPR; updated CPR guidelines will be released later this year by the American Heart Association (AHA). Additional information about sudden cardiac arrest is available from the National Heart, Lung, and Blood Institute at http://www.nhlbi.nih.gov/ health/dci/Diseases/scda/scda_whatis.html and from AHA at http://www.americanheart.org/presenter. jhtml?identifier=4741. Information about CPR is available from AHA at http://www.americanheart. org/presenter.jhtml?identifier=4479. Additional information about heart disease and stroke is available from CDC at http://www.cdc.gov/dhdsp.
References
1. Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart disease and stroke statistics2010 update. Circulation 2010;121: e46215. 2. Cummins RO, Ornato JP, Thies WH, Pepe PE. Improving survival from sudden cardiac arrest: the chain of survival concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. Circulation 1991;83:183247.
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QuickStats
FROM THE NATIONAL CENTER FOR HEALTH STATISTICS
Annual Rates* of Hospitalization with a Diagnosis of HIV/AIDS Among Persons Aged 45 Years, by Sex National Hospital Discharge Survey, United States, 19972007
16 14 12 10 Men Women
Rate
8 6 4 2 0 1997 1999 2001 2003 2005 2007
Year
Abbreviation: HIV/AIDS = human immunodeficiency virus/acquired immunodeficiency syndrome. * Per 10,000 population. Annual hospitalizations estimated from hospital discharges during 19972007 with any-listed HIV/AIDS diagnoses codes 042 and V08 using the International Classification of Diseases, Ninth Revision, Clinical Modification. Population estimates for 19971999 are based on U.S. Census Bureau civilian population estimates as of July 1, 19971999. Population estimates for 20002007 were calculated using U.S. Census Bureau 2000based postcensal civilian population estimates. From 1997 to 2007, a substantially higher rate of men than women aged 45 years were hospitalized with a diagnosis of HIV/AIDS. Hospitalization rates for men in this age group increased from 7.7 per 10,000 in 1997 to 14.8 in 2007; rates for women in this age group increased from 1.9 per 10,000 in 1997 to 4.9 in 2007. Source: National Hospital Discharge Survey. Annual files, 19972007. Available at http://www.cdc.gov/nchs/nhds.htm.
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Notifiable Diseases and Mortality Tables

TABLE I. Provisional cases of infrequently reported notifiable diseases (<1,000 cases reported during the preceding year) United States, week ending September 25, 2010 (38th week)*
Current week 1 1 2 3 5 1 6 12 1 6 11 1 1 2 8 1 25 Cum 2010 66 6 46 14 92 33 5 138 36 10 4 4 11 130 166 33 15 148 56 569 48 180 83 7 275 2,366 1 1 4 83 65 18 1 6 126 143 5 57 2 74 274 66 1 563 1 5-year weekly average 2 0 2 0 2 0 0 1 3 0 1 0 2 2 2 1 8 1 2 23 1 4 2 0 8 19 0 0 0 0 3 1 0 0 0 1 8 1 2 0 3 12 1 12 Total cases reported for previous years 2009 2008 2007 2006 2005 1 118 10 83 25 115 28 10 141 55 4 6 12 35 236 178 103 20 242 358 851 71 301 174 23 482 1,991 43,774 8 1 9 114 94 20 4 3 2 161 423 18 74 13 93 397 78 1 789 NN 145 17 109 19 80 25 5 139 62 4 2 13 30 244 163 80 18 330 90 759 140 330 188 38 616 454 2 3 8 120 106 14 2 16 157 431 19 71 39 123 449 63 588 NN 1 144 32 85 27 131 23 7 93 55 4 7 9 22 199 180 101 32 292 77 808 43 1 165 20 97 48 121 33 9 137 67 8 1 10 29 175 179 66 40 288 43 884 55 135 19 85 31 120 17 8 543 80 21 1 13 9 135 217 87 26 221 380 45 896 66 297 156 27 765 314 NN 8 1 NN 16 136 2 11 1 129 329 27 90 16 154 324 2 3 NN NN States reporting cases during current week (No.)
Disease Anthrax Botulism, total foodborne infant other (wound and unspecified) Brucellosis Chancroid Cholera Cyclosporiasis Diphtheria Domestic arboviral diseases , : California serogroup virus disease Eastern equine encephalitis virus disease Powassan virus disease St. Louis encephalitis virus disease Western equine encephalitis virus disease Haemophilus influenzae,** invasive disease (age <5 yrs): serotype b nonserotype b unknown serotype Hansen disease Hantavirus pulmonary syndrome Hemolytic uremic syndrome, postdiarrheal HIV infection, pediatric (age <13 yrs) Influenza-associated pediatric mortality , Listeriosis Measles Meningococcal disease, invasive***: A, C, Y, and W-135 serogroup B other serogroup unknown serogroup Mumps Novel influenza A virus infections Plague Poliomyelitis, paralytic Polio virus Infection, nonparalytic Psittacosis Q fever, total , acute chronic Rabies, human Rubella Rubella, congenital syndrome SARS-CoV,**** Smallpox Streptococcal toxic-shock syndrome Syphilis, congenital (age <1 yr) Tetanus Toxic-shock syndrome (staphylococcal) Trichinellosis Tularemia Typhoid fever Vancomycin-intermediate Staphylococcus aureus Vancomycin-resistant Staphylococcus aureus Vibriosis (noncholera Vibrio species infections) Viral hemorrhagic fever Yellow fever See Table I footnotes on next page.
CA (1) IA (1), WA (1) NY (1), MD (1), TX (1)
OH (1), MD (1), FL (2), ID (1) IN (1) NE (2), ID (1), WA (1), CA (2)
OH (2), MO (1), MD (1), NC (1), FL (2), AR (1), WA (4)
325 318 167 193 35 32 550 651 800 6,584 4 NN 7 17 NN 12 21 171 169 1 3 12 11 1 132 125 430 349 28 41 92 101 5 15 137 95 434 353 37 6 2 1 549 NN NN NN
TX (1)
OH (1), KY (1), CA (4) TX (10), AZ (1)
NC (1)
CA (1) OK (1), WA (1) NY (1), PA (2), GA (1), FL (1), CA (3) MO (1) MI (1), MD (2), VA (2), NC (2), FL (2), TN (1), TX (2), WA (4), CA (9)
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TABLE I. (Continued) Provisional cases of infrequently reported notifiable diseases (<1,000 cases reported during the preceding year) United States, week ending September 25, 2010 (38th week)*
: No reported cases. N: Not reportable. NN: Not Nationally Notifiable Cum: Cumulative year-to-date counts. * Incidence data for reporting years 2009 and 2010 are provisional, whereas data for 2005 through 2008 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/ncphi/disss/nndss/phs/files/5yearweeklyaverage.pdf. Not reportable in all states. Data from states where the condition is not reportable are excluded from this table except starting in 2007 for the domestic arboviral diseases, STD data, TB data, and influenza-associated pediatric mortality, and in 2003 for SARS-CoV. Reporting exceptions are available at http://www.cdc.gov/ncphi/disss/nndss/phs/infdis.htm. Includes both neuroinvasive and nonneuroinvasive. Updated weekly from reports to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases (ArboNET Surveillance). Data for West Nile virus are available in Table II. ** Data for H. influenzae (all ages, all serotypes) are available in Table II. Updated monthly from reports to the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Implementation of HIV reporting influences the number of cases reported. Updates of pediatric HIV data have been temporarily suspended until upgrading of the national HIV/AIDS surveillance data management system is completed. Data for HIV/AIDS, when available, are displayed in Table IV, which appears quarterly. Updated weekly from reports to the Influenza Division, National Center for Immunization and Respiratory Diseases. Since April 26, 2009, a total of 286 influenza-associated pediatric deaths associated with 2009 influenza A (H1N1) virus infection have been reported. Since August 30, 2009, a total of 281 influenza-associated pediatric deaths occurring during the 200910 influenza season have been reported. A total of 133 influenza-associated pediatric deaths occurring during the 2008-09 influenza season have been reported. No measles cases were reported for the current week. *** Data for meningococcal disease (all serogroups) are available in Table II. CDC discontinued reporting of individual confirmed and probable cases of 2009 pandemic influenza A (H1N1) virus infections on July 24, 2009. During 2009, three cases of novel influenza A virus infections, unrelated to the 2009 pandemic influenza A (H1N1) virus, were reported to CDC. The one case of novel influenza A virus infection reported to CDC during 2010 was identified as swine influenza A (H3N2) virus and is unrelated to pandemic influenza A (H1N1) virus. Total case count for 2009 was provided by the Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD). In 2009, Q fever acute and chronic reporting categories were recognized as a result of revisions to the Q fever case definition. Prior to that time, case counts were not differentiated with respect to acute and chronic Q fever cases. No rubella cases were reported for the current week. **** Updated weekly from reports to the Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases. Updated weekly from reports to the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. There was one case of viral hemorrhagic fever reported during week 12. The one case report was confirmed as lassa fever. See Table II for dengue hemorrhagic fever.
FIGURE I. Selected notifiable disease reports, United States, comparison of provisional 4-week totals September 25, 2010, with historical data
DISEASE Giardiasis Hepatitis A, acute Hepatitis B, acute Hepatitis C, acute Legionellosis Measles* Meningococcal disease Mumps Pertussis 0.03125 0.0625 0.125 0.25 0.5
DECREASE
INCREASE
CASES CURRENT 4 WEEKS 982 91 139 40 145 0 21 29 918
Ratio (Log scale)
Beyond historical limits

* No measles cases were reported for the current 4-week period yielding a ratio for week 38 of zero (0). 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-Baker Deborah A. Adams Rosaline Dhara Willie J. Anderson Pearl C. Sharp Michael S. Wodajo Lenee Blanton
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TABLE II. Provisional cases of selected notifiable diseases, United States, weeks ending September 25, 2010, and September 26, 2009 (38th week)*
Chlamydia trachomatis infection Reporting area United States New England Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Mid. Atlantic New Jersey New York (Upstate) New York City Pennsylvania E.N. Central Illinois Indiana Michigan Ohio Wisconsin W.N. Central Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota S. Atlantic Delaware District of Columbia Florida Georgia Maryland North Carolina South Carolina Virginia West Virginia E.S. Central Alabama Kentucky Mississippi Tennessee W.S. Central Arkansas Louisiana Oklahoma Texas Mountain Arizona Colorado Idaho Montana Nevada New Mexico Utah Wyoming Pacific Alaska California Hawaii Oregon Washington Territories American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands Current week 13,553 1,253 318 66 696 42 103 28 3,287 489 741 1,368 689 823 28 527 140 128 368 5 28 255 61 19 2,902 83 75 600 699 653 714 78 1,347 445 234 395 273 827 379 448 700 135 151 45 148 221 2,046 1,739 307 195 Previous 52 weeks Med 22,836 741 216 50 397 40 65 23 3,250 489 674 1,194 890 3,526 821 347 898 965 413 1,330 186 186 273 490 94 37 60 4,492 84 97 1,403 355 448 802 517 596 70 1,729 485 290 395 574 2,816 245 0 258 2,203 1,432 437 382 69 57 173 172 116 38 3,471 109 2,739 112 0 391 0 4 93 10 Max 26,119 1,396 736 75 638 115 120 63 4,619 693 2,530 2,143 1,092 4,127 1,274 786 1,420 1,078 500 1,592 293 235 337 606 237 93 82 5,681 220 177 1,674 1,323 1,031 1,562 706 902 137 2,415 673 642 780 731 4,578 394 1,055 1,375 3,201 2,081 713 709 200 76 337 453 175 79 5,350 148 4,406 158 468 497 0 31 265 29 Cum 2010 837,539 28,990 7,172 1,870 14,788 1,720 2,545 895 124,011 19,151 24,876 45,919 34,065 124,865 25,774 13,548 34,996 35,196 15,351 48,883 7,131 6,877 9,892 17,823 3,573 1,375 2,212 165,385 3,209 3,661 54,406 12,198 15,735 30,585 20,034 22,838 2,719 64,812 18,971 11,299 13,988 20,554 104,493 8,335 2,922 11,588 81,648 49,923 13,686 12,845 2,861 2,203 7,026 5,735 4,146 1,421 126,177 4,258 102,251 4,144 1,367 14,157 201 3,934 323 Cum 2009 919,599 29,370 8,505 1,758 13,964 1,581 2,731 831 115,171 17,914 22,501 42,751 32,005 148,896 45,491 17,270 34,431 36,103 15,601 52,604 7,241 8,013 10,685 19,237 3,970 1,256 2,202 186,976 3,477 5,153 54,636 30,172 16,601 30,916 20,296 23,027 2,698 69,457 19,883 9,505 17,767 22,302 120,913 10,813 21,595 10,849 77,656 57,846 19,191 13,578 2,619 2,237 7,682 6,554 4,579 1,406 138,366 3,924 105,904 4,509 7,941 16,088 285 5,582 386 Current week 119 12 8 4 27 1 19 7 22 7 12 3 19 13 4 1 1 3 3 16 2 2 12 8 1 5 1 1 12 12 N N Cryptosporidiosis Previous 52 weeks Med 124 8 0 1 3 1 0 1 15 0 3 1 9 30 3 4 5 7 10 24 4 2 1 4 2 0 2 19 0 0 7 5 1 1 1 2 0 4 1 1 0 1 8 1 1 1 4 10 0 2 2 1 0 2 1 0 12 0 7 0 3 2 0 0 0 0 Max 305 68 62 7 8 5 8 9 37 3 16 5 26 106 15 10 17 24 52 78 21 9 30 29 26 18 7 51 2 1 24 31 3 12 8 8 3 17 10 6 3 5 39 3 5 9 30 28 3 8 6 4 6 8 4 2 28 1 19 0 11 8 0 0 0 0 Cum 2010 5,598 355 62 65 120 44 9 55 605 165 59 381 1,473 143 133 246 357 594 1,035 253 110 98 293 190 19 72 761 6 2 287 228 29 55 66 73 15 204 85 61 12 46 306 25 46 67 168 411 27 103 71 38 29 80 50 13 448 2 260 124 62 N N Cum 2009 5,490 363 38 40 148 66 16 55 617 41 163 67 346 1,315 122 222 212 296 463 824 165 79 226 152 86 7 109 834 8 6 317 275 34 85 44 54 11 167 51 46 15 55 406 41 40 87 238 437 27 115 73 47 17 108 33 17 527 6 305 1 154 61 N N
C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Incidence data for reporting years 2009 and 2010 are provisional. Data for HIV/AIDS, AIDS, and TB, when available, are displayed in Table IV, which appears quarterly. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
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TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending September 25, 2010, and September 26, 2009 (38th week)*
Dengue Virus Infection Dengue Fever Reporting area United States New England Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Mid. Atlantic New Jersey New York (Upstate) New York City Pennsylvania E.N. Central Illinois Indiana Michigan Ohio Wisconsin W.N. Central Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota S. Atlantic Delaware District of Columbia Florida Georgia Maryland North Carolina South Carolina Virginia West Virginia E.S. Central Alabama Kentucky Mississippi Tennessee W.S. Central Arkansas Louisiana Oklahoma Texas Mountain Arizona Colorado Idaho Montana Nevada New Mexico Utah Wyoming Pacific Alaska California Hawaii Oregon Washington Territories American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands Current week Previous 52 weeks Med 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 88 0 Max 25 2 0 2 0 0 0 1 9 0 0 7 2 2 0 2 1 2 1 2 1 1 2 0 0 1 0 16 0 0 14 2 0 1 3 0 1 1 1 0 0 1 1 0 0 1 0 2 1 0 0 1 1 1 0 0 2 0 1 0 0 2 0 0 531 0 Cum 2010 294 4 3 1 74 62 12 25 8 4 10 3 13 1 1 10 1 154 132 8 3 9 2 2 1 1 1 1 10 3 2 4 1 11 4 7 7,165 Cum 2009 NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN Current week Dengue Hemorrhagic Fever Previous 52 weeks Med 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Max 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 Cum 2010 2 1 1 1 1 28 Cum 2009 NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN NN
C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Incidence data for reporting years 2009 and 2010 are provisional. Dengue Fever includes cases that meet criteria for Dengue Fever with hemorrhage, other clinical, and unknown case classifications. DHF includes cases that meet criteria for dengue shock syndrome (DSS), a more severe form of DHF. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
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Ehrlichiosis/Anaplasmosis Ehrlichia chaffeensis Reporting area United States New England Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Mid. Atlantic New Jersey New York (Upstate) New York City Pennsylvania E.N. Central Illinois Indiana Michigan Ohio Wisconsin W.N. Central Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota S. Atlantic Delaware District of Columbia Florida Georgia Maryland North Carolina South Carolina Virginia West Virginia E.S. Central Alabama Kentucky Mississippi Tennessee W.S. Central Arkansas Louisiana Oklahoma Texas Mountain Arizona Colorado Idaho Montana Nevada New Mexico Utah Wyoming Pacific Alaska California Hawaii Oregon Washington Territories American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands Current Previous 52 weeks week Med Max 5 2 2 1 1 2 1 1 11 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 2 0 0 0 1 0 0 0 4 0 0 0 0 0 1 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 181 3 0 1 0 1 2 0 15 6 15 3 5 4 2 0 1 3 3 13 0 1 6 13 1 0 0 19 3 0 2 4 3 13 2 13 0 10 3 2 1 10 141 34 1 105 2 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 Cum 2010 480 3 2 1 39 24 14 1 24 10 2 6 6 111 6 104 1 207 16 8 18 20 82 3 60 75 10 11 3 51 20 2 1 14 3 1 1 Cum 2009 770 39 3 9 3 23 1 148 85 41 9 13 77 32 4 12 29 141 6 1 132 2 219 18 9 17 35 58 9 72 1 113 6 10 6 91 30 4 24 2 3 3 Current week 8 1 1 7 7 Anaplasma phagocytophilum Previous 52 weeks Med 13 1 0 0 0 0 0 0 3 0 3 0 0 2 0 0 0 0 2 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Max 309 17 13 2 4 3 7 0 17 2 17 1 1 29 1 0 0 1 29 261 0 0 261 3 0 0 0 7 1 0 1 1 2 4 0 2 0 2 2 0 1 2 23 6 0 16 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cum 2010 514 57 18 14 11 14 160 1 156 3 222 1 1 220 8 8 49 4 3 1 11 18 12 16 7 1 8 2 2 Cum 2009 712 207 3 12 83 15 94 232 62 163 6 1 246 6 1 239 7 1 3 2 1 14 2 3 1 3 3 2 3 1 2 1 1 2 2 Current week 1 1 1 Undetermined Previous 52 weeks Med 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Max 35 2 2 0 0 1 0 0 2 0 1 0 1 5 2 3 1 0 3 30 0 0 30 3 0 0 0 1 0 0 0 1 1 0 0 1 1 2 0 0 0 2 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 Cum 2010 85 7 5 2 4 4 51 3 27 3 18 12 12 4 1 2 1 6 6 1 1 Cum 2009 148 2 1 1 42 5 1 36 64 3 35 2 24 16 3 13 2 2 22 22
C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Incidence data for reporting years 2009 and 2010 are provisional. Cumulative total E. ewingii cases reported for year 2010 = 10. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
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Giardiasis Reporting area United States New England Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Mid. Atlantic New Jersey New York (Upstate) New York City Pennsylvania E.N. Central Illinois Indiana Michigan Ohio Wisconsin W.N. Central Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota S. Atlantic Delaware District of Columbia Florida Georgia Maryland North Carolina South Carolina Virginia West Virginia E.S. Central Alabama Kentucky Mississippi Tennessee W.S. Central Arkansas Louisiana Oklahoma Texas Mountain Arizona Colorado Idaho Montana Nevada New Mexico Utah Wyoming Pacific Alaska California Hawaii Oregon Washington Territories American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands Current Previous 52 weeks Cum week Med Max 2010 244 8 7 1 44 26 5 13 30 8 19 3 21 1 5 12 2 1 70 54 4 N 12 N N 6 5 1 N 21 11 4 2 1 3 44 29 2 13 345 31 5 4 13 3 1 4 60 6 22 16 14 52 11 5 13 16 8 26 5 4 0 8 4 0 2 75 0 1 39 12 5 0 2 9 1 5 4 0 0 2 8 2 3 2 0 30 3 13 4 2 1 2 4 1 54 2 33 0 9 8 0 0 0 0 666 65 13 12 33 9 7 14 112 13 84 31 37 82 20 14 25 23 17 165 11 10 135 23 9 8 10 143 5 4 87 51 11 0 9 36 5 22 8 0 0 18 18 9 9 7 0 47 6 27 9 11 11 5 11 5 133 5 61 4 15 75 0 1 8 0 12,739 1,098 187 159 463 113 35 141 2,179 193 817 632 537 2,018 379 191 493 611 344 1,072 213 170 136 308 165 19 61 2,785 24 23 1,564 485 198 N 109 355 27 181 128 N N 53 269 89 117 63 N 1,163 110 500 152 78 76 63 154 30 1,974 69 1,254 24 330 297 2 27 Cum 2009 13,636 1,270 226 170 543 152 42 137 2,507 329 931 622 625 2,156 471 213 493 600 379 1,209 234 119 250 387 129 8 82 2,648 18 51 1,401 544 206 N 75 319 34 311 150 N N 161 372 102 152 118 N 1,228 154 359 144 97 90 100 235 49 1,935 85 1,266 16 296 272 3 130 Gonorrhea Current Previous 52 weeks week Med Max 3,255 156 62 3 77 2 12 717 102 148 265 202 248 10 135 57 46 114 6 79 27 2 872 20 44 197 263 205 133 10 364 123 67 110 64 264 129 135 79 16 5 23 35 441 390 51 6 5,372 101 44 3 44 3 5 0 674 102 104 227 219 955 185 89 247 316 93 272 32 39 40 122 22 2 6 1,290 18 38 378 137 131 259 153 164 8 479 141 76 115 145 770 73 0 80 571 169 55 51 2 2 28 19 6 1 580 23 483 14 0 48 0 0 5 2 6,656 196 169 11 81 7 13 17 941 161 422 394 295 1,536 441 217 502 372 155 367 53 83 62 172 50 11 16 1,651 48 65 471 494 237 596 234 271 20 700 217 156 216 196 1,227 139 343 359 962 262 109 94 6 6 94 41 15 4 789 37 693 24 43 66 0 4 14 7 Cum 2010 195,468 3,893 1,706 128 1,700 111 202 46 25,676 3,980 4,088 8,914 8,694 34,050 5,920 3,798 9,761 11,231 3,340 9,901 1,210 1,407 1,395 4,677 847 94 271 48,005 733 1,405 14,684 4,263 4,540 10,284 6,060 5,662 374 17,605 5,516 2,944 3,911 5,234 27,929 2,558 910 3,377 21,084 5,865 1,608 1,832 83 80 1,253 762 222 25 22,544 919 19,147 514 106 1,858 23 200 78 Cum 2009 224,382 3,559 1,677 102 1,411 81 257 31 23,071 3,514 4,202 8,017 7,338 47,675 15,214 5,636 11,190 11,759 3,876 11,049 1,246 1,892 1,733 4,834 996 92 256 55,949 704 2,025 15,889 10,222 4,509 10,611 6,349 5,260 380 20,102 5,679 2,771 5,563 6,089 35,346 3,340 7,038 3,432 21,536 6,865 2,276 2,047 78 56 1,346 790 217 55 20,766 710 17,085 468 799 1,704 16 185 96 Haemophilus influenzae, invasive All ages, all serotypes Current week 33 3 1 2 3 3 3 2 1 16 4 1 3 7 1 3 1 2 3 3 1 1 1 1 Previous 52 weeks Med 59 3 0 0 2 0 0 0 11 2 3 2 4 9 2 1 0 2 2 3 0 0 0 1 0 0 0 14 0 0 3 3 1 2 2 2 0 3 0 0 0 2 2 0 0 1 0 5 2 1 0 0 0 1 0 0 2 0 0 0 1 0 0 0 0 0 Max 171 21 15 2 8 2 1 1 34 7 20 6 9 20 9 6 4 6 5 24 1 2 17 6 2 4 0 27 1 1 9 9 6 9 7 4 5 12 3 2 2 10 20 3 3 15 2 15 10 5 2 1 2 5 4 2 9 2 4 2 5 4 0 0 1 0 Cum 2010 2,128 121 25 10 65 8 7 6 417 67 109 83 158 354 99 67 26 90 72 126 1 12 25 61 17 10 578 5 2 134 136 50 104 66 63 18 129 20 26 10 73 99 13 17 62 7 221 83 65 13 2 6 31 16 5 83 17 12 6 44 4 1 Cum 2009 2,172 147 42 17 69 8 7 4 431 101 104 53 173 338 129 61 18 76 54 124 13 43 44 19 5 598 3 3 182 118 72 71 57 68 24 136 34 19 7 76 95 15 16 60 4 188 61 53 3 1 14 26 27 3 115 13 39 27 33 3 4
C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Incidence data for reporting years 2009 and 2010 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).
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Hepatitis (viral, acute), by type A Current Previous 52 weeks week Med Max 29 3 1 2 6 1 5 3 3 9 6 1 2 3 1 2 3 3 2 2 30 2 0 0 1 0 0 0 4 0 1 1 1 4 1 0 1 0 0 1 0 0 0 0 0 0 0 7 0 0 3 1 1 0 1 1 0 1 0 0 0 0 2 0 0 0 2 3 1 1 0 0 0 0 0 0 5 0 4 0 0 0 0 0 0 0 69 5 3 1 4 1 4 0 10 3 4 4 6 8 3 2 4 5 3 13 3 2 12 2 4 1 0 14 1 1 7 3 4 5 4 6 2 3 1 2 1 2 19 3 2 3 18 8 5 3 2 1 2 1 2 3 16 1 15 2 2 2 0 6 1 0 B Previous 52 weeks Med 60 1 0 0 0 0 0 0 5 1 1 2 1 8 2 1 2 2 1 2 0 0 0 1 0 0 0 16 0 0 6 2 1 1 1 1 0 7 1 2 1 3 10 0 1 1 5 2 0 0 0 0 1 0 0 0 6 0 4 0 1 1 0 1 0 0 Max 204 5 2 2 2 2 0 1 10 5 6 4 5 17 6 5 6 6 8 15 2 2 13 3 2 0 1 40 2 1 12 7 6 15 4 14 14 13 5 8 3 7 109 4 4 19 87 8 2 3 1 1 3 1 1 0 20 1 17 1 4 4 0 6 5 0 C Previous 52 weeks Med 15 1 0 0 0 0 0 0 2 0 1 0 0 2 0 0 1 0 0 0 0 0 0 0 0 0 0 4 0 0 1 0 0 1 0 0 0 3 0 2 0 1 1 0 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 Max 44 4 3 1 1 0 0 0 6 2 4 1 3 8 1 2 6 1 1 11 4 0 9 1 1 1 0 8 0 1 6 2 2 3 0 2 5 7 2 5 0 4 14 1 1 12 3 5 0 2 2 0 1 2 2 0 6 2 4 0 3 6 0 6 0 0
Reporting area United States New England Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Mid. Atlantic New Jersey New York (Upstate) New York City Pennsylvania E.N. Central Illinois Indiana Michigan Ohio Wisconsin W.N. Central Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota S. Atlantic Delaware District of Columbia Florida Georgia Maryland North Carolina South Carolina Virginia West Virginia E.S. Central Alabama Kentucky Mississippi Tennessee W.S. Central Arkansas Louisiana Oklahoma Texas Mountain Arizona Colorado Idaho Montana Nevada New Mexico Utah Wyoming Pacific Alaska California Hawaii Oregon Washington Territories American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands
Cum 2010 1,097 73 23 7 36 1 6 142 11 44 48 39 144 28 15 43 35 23 60 5 10 13 20 12 266 6 1 104 30 21 43 22 37 2 32 5 13 2 12 90 7 83 116 55 25 6 4 12 3 8 3 174 1 141 2 15 15 14 3
Cum 2009 1,488 86 17 1 53 7 6 2 215 57 37 64 57 231 106 15 54 33 23 88 29 7 14 17 18 3 317 3 1 137 36 35 34 44 26 1 33 8 8 8 9 144 7 4 3 130 125 54 41 3 6 9 7 3 2 249 2 196 8 12 31 4 20
Current week 33 U 1 1 3 3 2 1 1 11 3 2 5 1 3 2 1 5 2 3 1 1 7 5 2
Cum 2010 2,218 40 13 11 8 6 U 2 211 52 39 62 58 345 61 44 91 79 70 84 11 5 6 50 11 1 638 19 3 224 107 46 75 41 75 48 250 43 90 24 93 347 32 38 71 206 90 22 20 6 1 33 3 5 213 2 147 1 30 33 33 10
Cum 2009 2,441 43 13 9 17 4 U 258 78 42 51 87 333 87 54 102 72 18 105 28 5 17 35 17 3 678 23 10 215 115 60 89 42 72 52 244 70 57 22 95 428 54 51 75 248 105 37 20 10 25 5 4 4 247 2 177 5 30 33 48 21
Current week 7 N U 1 1 1 1 1 U 1 3 3 U 1 1 U U U
Cum 2010 595 26 17 9 N U 79 7 48 24 96 1 21 60 8 6 15 1 1 6 5 2 133 U 2 47 6 19 35 10 14 107 5 74 U 28 53 5 19 29 37 U 6 8 3 10 10 49 U 21 U 10 18 27
Cum 2009 546 48 37 1 9 N U 1 77 5 36 4 32 69 4 14 25 23 3 14 8 1 2 2 1 123 U 1 32 29 17 17 1 7 19 76 5 45 U 26 43 1 6 12 24 37 U 23 2 1 3 5 3 59 U 31 U 15 13 37
C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Incidence data for reporting years 2009 and 2010 are provisional. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
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Legionellosis Current Previous 52 weeks Cum week Med Max 2010 31 1 1 11 3 8 6 1 5 5 4 1 1 1 2 1 1 5 5 60 3 0 0 1 0 0 0 16 2 5 2 6 11 1 2 3 4 1 2 0 0 0 0 0 0 0 11 0 0 4 1 3 1 0 1 0 2 0 0 0 1 3 0 0 0 2 3 1 1 0 0 0 0 0 0 5 0 3 0 0 0 0 0 0 0 111 11 4 2 7 5 3 2 41 8 19 12 16 35 10 6 19 12 11 19 2 2 16 4 2 1 1 26 3 4 10 4 12 7 2 6 3 10 2 4 3 6 14 2 3 4 10 10 5 5 1 1 2 2 3 2 19 2 19 1 3 4 0 0 1 0 2,146 144 31 9 77 13 5 9 543 52 183 91 217 484 76 79 119 166 44 83 11 7 23 25 8 4 5 389 13 12 136 35 85 40 9 49 10 97 12 22 9 54 95 11 5 11 68 119 39 27 5 4 18 6 15 5 192 2 165 1 10 14 Cum 2009 2,492 160 45 6 80 11 11 7 918 171 271 189 287 533 93 45 118 215 62 87 20 5 8 42 10 1 1 384 13 17 129 38 94 43 7 37 6 102 13 40 4 45 79 7 8 3 61 99 35 15 4 5 11 6 20 3 130 1 99 1 12 17 1 Current week 191 37 1 36 89 1 55 33 1 1 1 1 54 4 1 24 1 24 9 9 N N N Lyme disease Previous 52 weeks Med 416 123 38 12 40 22 0 4 176 44 55 2 74 21 1 1 1 0 18 3 0 0 0 0 0 0 0 59 12 0 2 0 25 1 1 15 0 1 0 0 0 1 3 0 0 0 3 0 0 0 0 0 0 0 0 0 4 0 3 0 1 0 0 0 0 0 Max 2,336 415 194 76 161 61 11 26 677 180 577 31 367 148 12 7 14 5 127 1,395 10 1 1,380 1 2 15 1 163 31 4 11 2 73 9 3 79 33 4 1 1 0 4 44 0 1 2 42 3 1 1 1 1 1 2 1 1 10 1 8 0 3 3 0 0 0 0 Cum 2010 19,642 5,580 1,929 542 1,876 929 45 259 9,405 2,313 2,265 37 4,790 1,487 80 63 89 23 1,232 98 69 5 1 9 13 1 2,772 502 18 74 8 1,140 71 26 844 89 38 2 3 33 73 2 71 19 4 2 5 1 5 2 170 4 116 N 43 7 N N Cum 2009 30,543 10,661 3,675 652 4,628 1,166 201 339 13,252 4,357 3,071 875 4,949 2,633 129 74 86 41 2,303 193 101 17 68 3 3 1 3,448 810 51 59 36 1,702 83 28 580 99 29 2 1 26 155 155 47 4 1 13 3 12 4 8 2 125 5 79 N 31 10 N N Current week 16 1 1 3 2 1 2 1 1 1 1 4 4 2 2 3 3 Malaria Previous 52 weeks Med 25 1 0 0 1 0 0 0 7 0 1 4 1 2 1 0 0 0 0 1 0 0 0 0 0 0 0 6 0 0 2 0 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 3 0 2 0 0 0 0 0 0 0 Max 89 4 1 1 3 1 1 1 17 4 6 14 3 9 7 2 4 5 1 11 2 2 11 3 2 1 2 36 1 3 7 2 19 13 1 5 2 3 1 3 2 2 31 1 1 1 30 3 2 2 1 1 1 1 1 0 19 1 13 1 1 5 0 0 1 0 Cum 2010 1,001 52 1 5 37 2 4 3 271 1 59 171 40 105 33 7 25 32 8 55 9 9 3 17 15 2 262 2 7 97 3 62 35 3 51 2 23 5 6 2 10 62 1 2 5 54 45 20 14 1 2 4 1 3 126 2 86 1 9 28 2 Cum 2009 1,044 47 5 2 29 4 4 3 307 80 38 146 43 141 59 20 22 31 9 45 10 6 13 9 6 1 275 4 12 76 58 58 21 3 41 2 28 8 8 3 9 49 3 5 1 40 43 8 24 2 5 4 109 2 79 1 11 16 4
C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Incidence data for reporting years 2009 and 2010 are provisional. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
1252
Meningococcal disease, invasive All groups Reporting area United States New England Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Mid. Atlantic New Jersey New York (Upstate) New York City Pennsylvania E.N. Central Illinois Indiana Michigan Ohio Wisconsin W.N. Central Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota S. Atlantic Delaware District of Columbia Florida Georgia Maryland North Carolina South Carolina Virginia West Virginia E.S. Central Alabama Kentucky Mississippi Tennessee W.S. Central Arkansas Louisiana Oklahoma Texas Mountain Arizona Colorado Idaho Montana Nevada New Mexico Utah Wyoming Pacific Alaska California Hawaii Oregon Washington Territories American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands Current Previous 52 weeks week Med Max 7 1 1 1 1 1 1 4 4 16 0 0 0 0 0 0 0 1 0 0 0 0 3 0 0 0 1 0 1 0 0 0 0 0 0 0 3 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 3 0 1 0 1 0 0 0 0 0 43 2 2 1 1 1 0 1 4 2 3 2 2 8 4 3 2 2 2 6 3 2 2 3 2 1 2 7 1 0 5 2 1 2 1 2 2 4 2 2 1 2 9 2 4 7 7 6 2 4 2 1 1 1 1 1 16 1 13 1 3 7 0 0 1 0 Cum 2010 545 13 2 3 3 5 45 9 9 12 15 94 17 21 13 24 19 39 8 6 2 16 5 2 106 1 49 9 5 14 9 17 2 28 5 13 3 7 64 5 12 14 33 44 11 13 7 1 8 3 1 112 1 74 1 24 12 Cum 2009 702 26 3 4 12 2 4 1 78 13 17 13 35 126 33 28 18 29 18 54 7 10 10 19 5 1 2 128 2 41 25 8 25 11 11 5 25 7 4 3 11 65 6 13 8 38 50 12 15 6 5 4 3 1 4 150 6 97 5 29 13 Current week 250 1 1 30 20 10 35 9 26 18 12 3 3 16 8 5 3 10 1 7 2 71 7 64 29 2 9 13 4 1 40 40 Med 289 8 1 0 4 0 0 0 22 3 7 0 9 68 11 9 22 20 6 26 6 3 0 8 2 0 1 26 0 0 5 3 2 1 5 4 1 13 4 4 1 4 58 4 1 0 49 22 7 3 2 1 0 2 4 0 34 0 22 0 5 4 0 0 0 0 Pertussis Previous 52 weeks Max 1,756 20 8 5 11 3 8 4 63 8 27 11 39 164 29 26 48 69 15 627 25 9 601 25 13 30 5 77 4 1 28 18 8 32 19 15 8 29 8 13 6 10 753 29 4 41 681 41 14 13 19 12 7 9 10 2 186 6 163 6 16 24 0 2 0 0 Cum 2010 12,642 322 80 33 164 12 22 11 948 76 353 49 470 3,198 505 413 900 1,093 287 1,366 302 115 480 260 146 38 25 1,088 9 4 240 172 84 124 269 138 48 547 149 191 48 159 2,115 119 24 49 1,923 889 279 151 154 51 26 80 138 10 2,169 28 1,587 37 247 270 Cum 2009 11,609 512 39 73 294 63 34 9 882 180 150 63 489 2,441 530 274 630 869 138 1,694 178 193 336 820 115 17 35 1,275 12 4 420 190 107 159 203 156 24 652 253 191 55 153 2,423 280 129 37 1,977 737 179 183 66 37 23 54 173 22 993 36 490 33 213 221 1 Current week 32 1 1 7 7 2 1 1 3 1 2 17 11 5 1 2 1 1 N Rabies, animal Previous 52 weeks Med 71 4 0 1 0 0 0 1 17 0 9 2 5 2 1 0 1 0 0 5 0 1 0 1 1 0 0 22 0 0 0 0 6 0 0 10 1 3 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 3 0 2 0 0 0 0 0 1 0 Max 145 24 22 4 0 5 2 5 41 0 22 12 24 38 22 0 5 12 0 16 2 4 9 6 4 7 2 85 0 0 72 13 13 15 0 26 6 7 4 4 1 4 40 10 0 30 30 8 5 0 2 3 1 3 2 4 12 2 12 0 2 0 0 0 3 0 Cum 2010 2,585 174 59 47 11 14 43 771 396 112 263 256 157 56 43 195 7 52 26 58 43 9 826 72 276 421 57 120 38 16 1 65 61 21 40 61 10 15 4 10 2 20 121 12 99 10 N 33 Cum 2009 4,006 246 101 41 25 35 44 463 350 13 100 205 77 25 61 42 309 27 64 45 55 71 4 43 1,685 161 312 311 382 429 90 116 38 4 74 687 38 21 628 86 7 24 6 21 9 19 209 11 187 11 N 31
C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Incidence data for reporting years 2009 and 2010 are provisional. Data for meningococcal disease, invasive caused by serogroups A, C, Y, and W-135; serogroup B; other serogroup; and unknown serogroup are available in Table I. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
1253
Salmonellosis Current Previous 52 weeks Cum week Med Max 2010 945 2 1 1 64 36 2 26 33 5 28 49 3 8 32 4 2 411 220 58 20 76 26 11 38 19 19 166 37 6 27 96 27 11 8 1 6 1 155 110 9 36 902 29 0 2 21 3 2 1 97 18 24 25 29 82 26 10 15 24 10 45 7 7 1 12 4 0 3 267 3 1 127 40 15 29 20 18 3 51 14 8 14 14 115 10 21 10 73 49 18 10 3 2 4 5 5 1 115 1 84 4 8 14 1 0 5 0 1,662 380 364 7 48 10 17 5 209 50 78 56 80 234 113 53 41 47 43 97 35 19 32 44 13 39 8 565 11 4 277 128 52 144 78 68 16 159 42 29 63 47 547 39 47 46 477 105 42 23 9 7 20 15 18 9 299 5 227 14 48 61 1 2 39 0 34,682 1,679 364 91 945 130 97 52 4,203 738 1,078 1,001 1,386 3,808 1,287 369 686 1,023 443 1,865 396 340 178 627 182 31 111 10,096 125 52 4,230 1,788 768 1,181 1,023 786 143 2,441 570 412 760 699 4,026 542 816 471 2,197 1,981 677 429 120 70 233 204 212 36 4,583 65 3,461 138 400 519 2 4 156 Cum 2009 35,236 1,830 430 107 899 227 112 55 4,198 897 978 967 1,356 4,053 1,148 475 770 1,114 546 2,086 325 319 450 507 289 35 161 9,660 94 75 4,177 1,766 580 1,368 686 756 158 2,287 648 360 695 584 4,046 458 844 473 2,271 2,335 786 494 142 90 201 295 256 71 4,741 55 3,528 257 337 564 9 416 Shiga toxin-producing E. coli (STEC) Previous 52 weeks Current Cum Cum week Med Max 2010 2009 71 5 3 2 1 1 10 7 3 8 7 1 4 4 7 3 4 12 2 5 4 1 24 16 8 80 3 0 0 2 0 0 0 8 1 3 1 2 11 2 1 3 3 3 10 2 1 0 3 1 0 0 13 0 0 4 1 2 1 0 2 0 4 1 1 0 2 5 1 0 0 3 9 1 2 1 0 0 1 1 0 9 0 5 0 2 3 0 0 0 0 201 43 43 2 8 2 26 2 30 4 15 7 13 35 8 8 16 11 13 39 16 6 14 27 6 7 4 30 2 1 13 15 6 7 3 15 5 11 4 6 2 7 68 5 2 27 41 31 5 18 7 5 5 5 7 2 46 1 35 4 11 19 0 0 0 0 3,305 150 43 14 62 17 2 12 382 40 150 57 135 545 85 61 139 116 144 484 132 51 31 191 58 21 507 4 5 177 77 67 45 16 100 16 181 36 45 12 88 204 42 12 18 132 427 49 149 65 31 28 32 60 13 425 2 188 18 71 146 3,421 205 67 14 75 28 1 20 332 81 104 50 97 588 141 73 112 106 156 590 135 49 156 110 74 4 62 502 11 2 124 53 72 86 25 110 19 167 39 57 6 65 222 30 20 23 149 452 49 139 72 27 28 30 95 12 363 1 180 4 60 118 Current week 179 12 8 4 8 1 5 2 16 1 13 2 47 26 6 2 9 4 3 2 1 44 6 1 6 31 16 6 4 6 33 29 4 Shigellosis Previous 52 weeks Med 257 5 0 0 4 0 0 0 34 6 4 6 17 25 8 1 4 6 4 48 1 4 0 42 0 0 0 40 1 0 13 13 3 2 1 3 0 12 3 4 1 4 47 1 4 6 35 15 8 2 0 0 0 2 0 0 20 0 16 0 1 1 1 0 0 0 Max 527 53 47 2 16 2 3 1 53 16 19 13 35 236 228 5 9 23 10 88 5 14 5 75 4 5 2 85 10 4 49 32 8 17 5 15 8 40 10 28 4 11 251 9 13 96 144 32 25 6 3 1 7 9 4 2 64 2 51 3 4 22 1 3 1 0 Cum 2010 9,750 249 47 5 179 8 9 1 1,259 255 173 228 603 1,239 646 31 178 244 140 1,715 41 194 14 1,430 29 7 1,722 37 20 751 521 92 131 55 106 9 498 107 187 34 170 1,735 46 180 215 1,294 549 290 86 20 6 34 84 29 784 1 648 13 39 83 2 1 Cum 2009 11,942 286 43 5 197 16 20 5 2,289 502 171 352 1,264 2,123 493 57 183 949 441 732 47 162 62 429 25 3 4 1,835 91 19 343 482 316 332 95 151 6 632 117 155 38 322 2,238 247 151 218 1,622 901 649 75 7 11 54 88 15 2 906 2 726 31 42 105 3 7 11
C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Incidence data for reporting years 2009 and 2010 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).
1254
Spotted Fever Rickettsiosis (including RMSF) Confirmed Reporting area United States New England Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Mid. Atlantic New Jersey New York (Upstate) New York City Pennsylvania E.N. Central Illinois Indiana Michigan Ohio Wisconsin W.N. Central Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota S. Atlantic Delaware District of Columbia Florida Georgia Maryland North Carolina South Carolina Virginia West Virginia E.S. Central Alabama Kentucky Mississippi Tennessee W.S. Central Arkansas Louisiana Oklahoma Texas Mountain Arizona Colorado Idaho Montana Nevada New Mexico Utah Wyoming Pacific Alaska California Hawaii Oregon Washington Territories American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands Current week 3 2 1 1 1 1 N N N N N Previous 52 weeks Med 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Max 12 0 0 0 0 0 0 0 2 0 1 1 2 1 0 1 1 0 0 4 0 1 1 4 1 0 0 9 1 0 1 6 1 3 1 2 0 3 1 2 0 2 3 1 0 3 1 2 2 0 0 1 0 0 0 0 2 0 2 0 1 0 0 0 0 0 Cum 2010 121 15 2 1 12 2 2 14 2 11 1 62 1 3 41 2 11 1 3 16 4 6 6 4 3 1 2 2 6 N 5 N 1 N N N Cum 2009 123 2 1 1 11 2 1 8 8 1 3 3 1 17 1 1 1 7 7 59 47 3 6 3 7 3 1 3 6 5 1 12 6 1 4 1 1 N 1 N N N N Current week 17 2 2 5 5 6 1 1 2 2 3 3 1 1 N N N N N Med 16 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 2 0 0 0 2 0 0 0 5 0 0 0 0 0 1 0 1 0 3 1 0 0 3 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Probable Previous 52 weeks Max 421 1 0 1 1 1 0 0 4 2 3 4 1 8 5 5 2 2 1 20 1 0 1 19 1 1 0 59 3 1 1 0 4 48 2 10 0 28 8 0 2 20 408 110 1 287 11 2 1 1 1 1 0 1 1 0 1 0 0 0 1 0 0 0 0 0 Cum 2010 1,084 1 1 43 12 21 10 73 22 38 3 9 1 233 4 224 4 1 367 15 8 33 204 10 97 299 55 8 236 59 20 2 21 16 8 2 1 2 1 1 1 1 N N 1 N N N Cum 2009 1,136 9 4 5 86 55 12 6 13 79 47 10 1 17 4 241 4 1 232 4 338 16 5 34 220 15 46 2 235 58 9 168 125 62 2 43 18 23 11 1 6 1 1 1 2 N N N N N
C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Incidence data for reporting years 2009 and 2010 are provisional. Illnesses with similar clinical presentation that result from Spotted fever group rickettsia infections are reported as Spotted fever rickettsioses. Rocky Mountain spotted fever (RMSF) caused by Rickettsia rickettsii, is the most common and well-known spotted fever. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
1255
Streptococcus pneumoniae, invasive disease All ages Reporting area United States New England Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Mid. Atlantic New Jersey New York (Upstate) New York City Pennsylvania E.N. Central Illinois Indiana Michigan Ohio Wisconsin W.N. Central Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota S. Atlantic Delaware District of Columbia Florida Georgia Maryland North Carolina South Carolina Virginia West Virginia E.S. Central Alabama Kentucky Mississippi Tennessee W.S. Central Arkansas Louisiana Oklahoma Texas Mountain Arizona Colorado Idaho Montana Nevada New Mexico Utah Wyoming Pacific Alaska California Hawaii Oregon Washington Territories American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands Current Previous 52 weeks week Med Max 110 3 2 1 6 2 1 3 22 4 18 10 1 3 2 4 28 13 6 6 3 6 2 4 15 3 1 11 19 4 14 1 1 1 190 7 0 2 0 0 0 1 18 1 3 5 6 31 1 7 7 14 5 8 0 1 0 2 1 0 0 43 0 0 20 11 6 0 6 0 1 20 0 2 1 13 18 2 1 0 15 20 8 6 0 0 1 2 2 0 4 1 3 0 0 0 0 0 0 0 494 99 92 6 5 7 35 6 54 8 12 25 22 98 7 23 27 49 22 182 0 7 179 10 7 11 3 144 3 4 89 28 25 0 25 4 21 50 0 16 6 44 91 9 8 5 83 82 51 20 2 2 4 9 9 1 14 9 12 0 0 0 0 0 0 0 Cum 2010 10,456 571 254 91 54 59 54 59 908 81 120 345 362 2,092 70 422 496 862 242 602 74 287 86 97 44 14 2,444 27 21 1,118 412 354 379 43 90 933 146 43 744 1,355 126 65 38 1,126 1,327 614 394 11 14 57 118 110 9 224 86 138 Cum 2009 2,198 40 11 3 15 11 139 57 8 74 497 197 20 280 143 47 35 51 1 7 2 985 16 17 575 286 4 87 208 56 38 114 94 44 50 89 35 45 9 3 3 Current week 16 1 1 4 2 2 2 2 2 2 4 3 1 2 2 1 1 Med 51 1 0 0 1 0 0 0 7 1 3 1 0 8 2 1 2 2 1 2 0 0 0 0 0 0 0 12 0 0 3 4 1 0 1 1 0 2 0 0 0 2 5 0 0 1 3 5 2 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 Age <5 Previous 52 weeks Max 156 24 22 2 4 2 2 1 48 5 19 24 5 18 5 6 6 6 4 12 0 2 10 3 2 1 2 28 2 2 18 12 6 0 4 4 4 8 0 2 2 7 41 3 3 5 34 12 7 4 2 1 1 4 4 1 7 5 2 1 0 0 0 0 0 0 Cum 2010 1,629 77 24 8 37 3 2 3 253 41 86 84 42 262 63 37 60 70 32 108 12 44 30 13 2 7 409 7 151 113 41 40 41 16 92 13 9 70 218 13 19 38 148 182 78 52 5 1 5 14 24 3 28 18 10 Cum 2009 1,701 52 4 36 8 1 3 221 42 96 70 13 282 44 59 51 96 32 137 15 61 39 10 4 8 407 1 3 143 109 62 37 34 18 108 7 20 81 253 34 20 46 153 216 98 31 7 7 24 48 1 25 16 9 Syphilis, primary and secondary Current week 112 3 2 1 33 6 2 19 6 2 2 3 1 2 38 4 3 19 12 10 1 5 4 3 3 5 1 4 15 7 8 3 Previous 52 weeks Med 237 8 1 0 5 0 0 0 33 4 2 18 7 26 11 3 3 8 1 5 0 0 1 3 0 0 0 54 0 2 19 10 6 7 2 4 0 18 5 2 5 5 33 3 0 1 25 8 3 2 0 0 1 1 1 0 39 0 36 0 0 3 0 0 4 0 Max 413 22 10 3 15 1 4 2 45 12 11 31 16 46 23 13 12 16 3 16 2 3 9 9 1 1 1 218 2 8 38 167 11 31 7 22 2 39 12 13 17 17 63 13 21 6 42 20 7 5 1 1 9 4 4 0 60 1 55 3 5 10 0 0 15 0 Cum 2010 8,334 330 69 21 196 14 28 2 1,260 171 102 718 269 957 319 132 155 321 30 225 9 13 85 111 6 1 1,985 4 99 722 371 191 282 103 210 3 653 173 97 160 223 1,084 116 64 55 849 320 93 80 2 1 80 33 31 1,520 1 1,334 27 6 152 170 Cum 2009 10,413 236 44 2 167 13 10 1,327 171 90 814 252 1,147 558 120 175 259 35 241 19 27 56 131 5 3 2,496 24 133 776 598 216 422 94 229 4 857 339 49 157 312 2,117 183 615 72 1,247 406 185 74 3 77 41 23 3 1,586 1,407 26 42 111 168
C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Incidence data for reporting years 2009 and 2010 are provisional. Includes drug resistant and susceptible cases of invasive Streptococcus pneumoniae disease among children <5 years and among all ages. Case definition: Isolation of S. pneumoniae from a normally sterile body site (e.g., blood or cerebrospinal fluid). Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
1256
West Nile virus disease Varicella (chickenpox) Reporting area United States New England Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Mid. Atlantic New Jersey New York (Upstate) New York City Pennsylvania E.N. Central Illinois Indiana Michigan Ohio Wisconsin W.N. Central Iowa Kansas Minnesota Missouri Nebraska North Dakota South Dakota S. Atlantic Delaware District of Columbia Florida Georgia Maryland North Carolina South Carolina Virginia West Virginia E.S. Central Alabama Kentucky Mississippi Tennessee W.S. Central Arkansas Louisiana Oklahoma Texas Mountain Arizona Colorado Idaho Montana Nevada New Mexico Utah Wyoming Pacific Alaska California Hawaii Oregon Washington Territories American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands Current week 175 2 2 21 N 21 39 1 5 6 20 7 7 N 1 6 N 51 30 N N N 8 13 5 5 N N 34 N 34 16 14 N 2 N N N N Previous 52 weeks Med 325 15 6 3 0 2 1 0 33 9 0 0 21 108 26 6 35 28 7 14 0 6 0 6 0 0 0 38 0 0 15 0 0 0 0 11 8 6 6 0 0 0 54 3 1 0 47 21 0 8 0 3 0 2 6 0 1 0 0 0 0 0 0 0 5 0 Max 549 36 20 15 1 8 12 10 62 30 0 0 41 176 49 35 62 56 22 40 0 22 0 23 0 26 7 99 4 4 57 0 0 0 35 34 26 28 27 0 2 0 285 32 5 0 272 37 0 19 0 17 0 8 22 3 5 5 0 2 0 0 0 3 30 0 Cum 2010 10,398 483 224 130 95 22 12 1,174 412 N 762 3,456 899 323 1,030 944 260 570 N 210 303 N 32 25 1,626 21 15 813 N N N 75 367 335 222 215 N 7 N 2,061 122 40 N 1,899 767 314 N 160 N 83 197 13 39 31 8 N N N 12 207 Cum 2009 15,903 806 386 154 3 155 28 80 1,589 326 N 1,263 4,925 1,208 370 1,394 1,492 461 1,038 N 436 504 N 57 41 2,007 11 26 960 N N N 93 558 359 422 418 N 4 N 3,969 410 114 N 3,445 1,060 408 N 126 N 97 429 87 53 34 N N N 19 427 Current week 1 1 1 Neuroinvasive Previous 52 weeks Med 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Max 58 3 2 0 2 0 0 0 17 3 9 7 3 7 6 1 4 1 0 7 1 1 1 1 3 2 2 4 0 0 2 1 3 0 0 1 0 1 1 0 1 0 9 3 3 1 9 11 10 4 0 0 0 3 0 1 6 0 6 0 0 0 0 0 0 0 Cum 2010 321 9 6 3 85 11 37 28 9 31 14 1 15 1 25 1 1 3 4 10 2 4 20 6 4 8 2 3 1 2 41 3 12 26 77 58 10 8 1 30 30 Cum 2009 366 8 3 3 2 9 5 2 1 1 26 4 1 4 11 6 15 2 1 4 3 5 35 3 28 4 112 6 10 7 89 76 12 35 9 2 7 6 1 4 85 58 1 26 Current week Nonneuroinvasive Previous 52 weeks Med 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Max 36 1 1 0 0 0 0 0 6 3 6 4 1 4 2 2 1 1 1 8 1 2 1 1 7 1 3 3 0 0 1 2 1 0 0 0 0 2 1 1 2 1 3 0 1 0 2 10 9 6 2 0 1 2 0 1 4 0 4 0 0 0 0 0 0 0 Cum 2010 226 1 1 33 6 19 5 3 11 4 4 1 1 1 55 2 5 26 6 16 8 1 6 1 7 2 1 3 1 11 6 5 80 43 28 1 2 3 3 20 20 Cum 2009 318 1 1 4 2 2 70 5 8 2 1 39 1 14 2 1 1 26 21 5 33 9 2 22 118 7 65 27 3 5 2 1 8 64 42 10 12
C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Incidence data for reporting years 2009 and 2010 are provisional. Data for HIV/AIDS, AIDS, and TB, when available, are displayed in Table IV, which appears quarterly. Updated weekly from reports to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases (ArboNET Surveillance). Data for California serogroup, eastern equine, Powassan, St. Louis, and western equine diseases are available in Table I. Contains data reported through the National Electronic Disease Surveillance System (NEDSS). Not reportable in all states. Data from states where the condition is not reportable are excluded from this table, except starting in 2007 for the domestic arboviral diseases and influenzaassociated pediatric mortality, and in 2003 for SARS-CoV. Reporting exceptions are available at http://www.cdc.gov/ncphi/disss/nndss/phs/infdis.htm.
1257
TABLE III. Deaths in 122 U.S. cities,* week ending September 25, 2010 (38th week)
All causes, by age (years) Reporting area New England Boston, MA Bridgeport, CT Cambridge, MA Fall River, MA Hartford, CT Lowell, MA Lynn, MA New Bedford, MA New Haven, CT Providence, RI Somerville, MA Springfield, MA Waterbury, CT Worcester, MA Mid. Atlantic Albany, NY Allentown, PA Buffalo, NY Camden, NJ Elizabeth, NJ Erie, PA Jersey City, NJ New York City, NY Newark, NJ Paterson, NJ Philadelphia, PA Pittsburgh, PA Reading, PA Rochester, NY Schenectady, NY Scranton, PA Syracuse, NY Trenton, NJ Utica, NY Yonkers, NY E.N. Central Akron, OH Canton, OH Chicago, IL Cincinnati, OH Cleveland, OH Columbus, OH Dayton, OH Detroit, MI Evansville, IN Fort Wayne, IN Gary, IN Grand Rapids, MI Indianapolis, IN Lansing, MI Milwaukee, WI Peoria, IL Rockford, IL South Bend, IN Toledo, OH Youngstown, OH W.N. Central Des Moines, IA Duluth, MN Kansas City, KS Kansas City, MO Lincoln, NE Minneapolis, MN Omaha, NE St. Louis, MO St. Paul, MN Wichita, KS All Ages 489 150 33 10 12 41 25 11 26 24 46 2 36 18 55 2,005 40 27 70 29 21 40 22 966 34 14 350 40 37 141 19 33 68 28 12 14 1,778 49 42 196 81 241 160 115 160 36 58 11 57 184 41 76 50 55 35 84 47 684 78 25 29 91 38 63 96 128 56 80 65 323 89 24 8 9 30 19 9 20 11 31 2 20 12 39 1,399 31 21 50 13 13 31 17 705 11 9 210 26 28 109 14 22 50 17 12 10 1,230 31 31 125 55 181 103 88 86 28 39 9 43 130 28 51 33 41 31 57 40 435 53 22 20 57 27 38 72 57 37 52 4564 121 46 4 3 8 3 2 6 7 11 13 6 12 422 8 5 11 12 6 7 4 182 16 3 81 14 7 27 3 9 14 9 4 404 11 8 58 16 43 44 17 49 7 15 2 10 44 10 17 14 8 3 22 6 181 21 2 8 21 8 15 21 47 16 22 2544 24 7 2 2 2 3 5 2 1 113 1 1 6 2 1 1 1 51 5 1 31 2 3 2 3 2 82 3 3 10 5 12 7 5 13 3 2 4 2 5 1 3 1 3 35 2 1 1 4 1 5 14 2 5 124 12 4 2 1 1 1 2 1 32 3 1 14 1 11 2 31 1 3 2 3 6 4 4 1 1 1 2 2 1 17 1 5 2 4 4 1 <1 9 4 1 1 1 2 39 2 1 14 2 17 2 1 31 3 3 2 1 8 1 4 1 3 2 1 1 1 16 1 4 1 3 6 1 Total 44 20 4 1 1 3 2 2 5 1 3 2 98 1 5 2 4 3 48 8 2 5 12 1 1 5 1 105 4 2 11 8 14 10 8 5 1 3 5 14 2 5 6 2 1 4 36 3 2 5 2 5 7 5 4 3 P&I Reporting area S. Atlantic Atlanta, GA Baltimore, MD Charlotte, NC Jacksonville, FL Miami, FL Norfolk, VA Richmond, VA Savannah, GA St. Petersburg, FL Tampa, FL Washington, D.C. Wilmington, DE E.S. Central Birmingham, AL Chattanooga, TN Knoxville, TN Lexington, KY Memphis, TN Mobile, AL Montgomery, AL Nashville, TN W.S. Central Austin, TX Baton Rouge, LA Corpus Christi, TX Dallas, TX El Paso, TX Fort Worth, TX Houston, TX Little Rock, AR New Orleans, LA San Antonio, TX Shreveport, LA Tulsa, OK Mountain Albuquerque, NM Boise, ID Colorado Springs, CO Denver, CO Las Vegas, NV Ogden, UT Phoenix, AZ Pueblo, CO Salt Lake City, UT Tucson, AZ Pacific Berkeley, CA Fresno, CA Glendale, CA Honolulu, HI Long Beach, CA Los Angeles, CA Pasadena, CA Portland, OR Sacramento, CA San Diego, CA San Francisco, CA San Jose, CA Santa Cruz, CA Seattle, WA Spokane, WA Tacoma, WA Total All Ages 1,089 116 113 99 143 102 48 69 68 52 206 57 16 847 143 80 106 85 186 65 45 137 1,116 86 71 55 191 101 U 101 86 U 217 95 113 1,041 68 64 56 92 257 23 170 34 119 158 1,699 10 100 25 70 66 284 19 140 212 173 112 196 31 114 58 89 10,748 All causes, by age (years) 65 715 66 75 69 101 72 38 39 50 33 131 33 8 546 92 57 61 54 116 47 29 90 722 59 53 32 95 67 U 62 57 U 150 64 83 695 57 50 39 64 171 18 84 23 80 109 1,129 6 70 20 48 45 176 15 85 148 118 71 140 24 64 40 59 7,194 4564 264 41 24 24 30 18 4 21 16 12 54 15 5 221 36 19 35 24 50 13 12 32 257 18 12 14 58 23 U 28 19 U 42 21 22 226 10 12 8 18 64 4 48 7 24 31 408 3 20 4 16 17 67 3 42 46 39 29 37 5 40 15 25 2,504 2544 124 62 7 6 2 7 9 2 6 1 3 12 4 3 41 7 3 7 2 11 2 2 7 82 5 3 6 26 4 U 4 8 U 17 4 5 64 1 4 6 17 1 17 3 6 9 98 1 6 4 3 21 11 12 10 8 8 2 6 2 4 601 24 2 2 3 2 3 1 1 2 3 5 15 3 1 2 1 2 2 1 3 36 3 3 2 9 6 U 2 1 U 6 3 1 30 1 1 3 1 2 10 1 7 4 39 2 1 1 13 2 5 2 2 6 3 1 1 236 <1 24 6 1 3 3 2 1 2 6 24 5 1 4 7 1 1 5 19 1 1 3 1 U 5 1 U 2 3 2 20 2 3 3 10 2 25 2 1 1 7 1 1 4 2 5 1 207 P&I Total 58 9 10 7 5 4 1 1 4 1 10 5 1 74 13 9 4 6 12 7 10 13 61 2 3 10 6 U 5 4 U 16 7 8 52 7 1 6 16 1 11 6 4 146 7 2 12 4 35 2 5 23 11 10 13 5 6 5 6 674
U: Unavailable. : No reported cases. * Mortality data in this table are voluntarily reported from 122 cities in the United States, most of which have populations of >100,000. A death is reported by the place of its occurrence and by the week that the death certificate was filed. Fetal deaths are not included. Pneumonia and influenza. Because of changes in reporting methods in this Pennsylvania city, these numbers are partial counts for the current week. Complete counts will be available in 4 to 6 weeks. Total includes unknown ages.
1258
The Morbidity and Mortality Weekly Report (MMWR) Series is prepared by the Centers for Disease Control and Prevention (CDC) and is available free of charge in electronic format. To receive an electronic copy each week, visit MMWRs free subscription page at http://www.cdc.gov/mmwr/mmwrsubscribe.html. Paper copy subscriptions are available through the Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20402; telephone 202-512-1800. Data presented by the Notifiable Disease Data Team and 122 Cities Mortality Data Team in the weekly MMWR are provisional, based on weekly reports to CDC by state health departments. Address all inquiries about the MMWR Series, including material to be considered for publication, to Editor, MMWR Series, Mailstop E-90, CDC, 1600 Clifton Rd., N.E., Atlanta, GA 30333 or to mmwrq@cdc.gov. All material in the MMWR Series is in the public domain and may be used and reprinted without permission; citation as to source, however, is appreciated. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services. References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of these sites. URL addresses listed in MMWR were current as of the date of publication.
U.S. Government Printing Office: 2010-623-026/41278 Region IV
ISSN: 0149-2195

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Morbidity and Mortality Weekly Report

Weekly / Vol. 59 / No. 38 October 1, 2010

National Depression Screening Day October 7, 2010

Current Depression Among Adults United States, 2006 and 2008

MMWR Morbidity and Mortality Weekly Report

* Additional information available at http://www.cdc.gov/brfss/ technical_infodata/surveydata.htm.

Centers for Disease Control and Prevention

MMWR Editorial and Production Staff

MMWR Editorial Board

MMWR / October 1, 2010 / Vol. 59 / No. 38

MMWR Morbidity and Mortality Weekly Report

MMWR Morbidity and Mortality Weekly Report

MMWR / October 1, 2010 / Vol. 59 / No. 38

MMWR Morbidity and Mortality Weekly Report

MMWR / October 1, 2010 / Vol. 59 / No. 38

MMWR Morbidity and Mortality Weekly Report

10.4%14.8% 9.2%10.3% 8.4%9.1% 7.1%8.3% 4.8%7.0% No data

available at http://www.thecommunityguide.org/ mentalhealth/collab-care.html.

MMWR / October 1, 2010 / Vol. 59 / No. 38

MMWR Morbidity and Mortality Weekly Report

MMWR / October 1, 2010 / Vol. 59 / No. 38

MMWR Morbidity and Mortality Weekly Report

Human Rabies Virginia, 2009

MMWR / October 1, 2010 / Vol. 59 / No. 38

MMWR Morbidity and Mortality Weekly Report

Public Health Investigation

MMWR / October 1, 2010 / Vol. 59 / No. 38

MMWR Morbidity and Mortality Weekly Report

MMWR Morbidity and Mortality Weekly Report

Progress Toward Global Eradication of Dracunculiasis, January 2009June 2010

MMWR / October 1, 2010 / Vol. 59 / No. 38

MMWR Morbidity and Mortality Weekly Report

% of cases reported that were contained in 2009 78 93 73 79 40 0 79

No. reporting one or more cases 1,011 52 52 9 5 0 1,129

No. reporting only cases indigenous to village 584 19 23 3 0 0 629

% reporting monthly 94 100 100 100 100 100 95

% with cloth filters in all households 98 93 89 100 100 100 98

% using temephos 45 86 63 100 100 100 48

% provided with health education 68 100 100 100 100 100 71

MMWR / October 1, 2010 / Vol. 59 / No. 38

MMWR Morbidity and Mortality Weekly Report

MMWR / October 1, 2010 / Vol. 59 / No. 38

MMWR Morbidity and Mortality Weekly Report

MMWR / October 1, 2010 / Vol. 59 / No. 38

MMWR Morbidity and Mortality Weekly Report

MMWR / October 1, 2010 / Vol. 59 / No. 38

MMWR Morbidity and Mortality Weekly Report

8 6 4 2 0 1997 1999 2001 2003 2005 2007

MMWR / October 1, 2010 / Vol. 59 / No. 38

MMWR Morbidity and Mortality Weekly Report

Notifiable Diseases and Mortality Tables

CA (1) IA (1), WA (1) NY (1), MD (1), TX (1)

OH (1), MD (1), FL (2), ID (1) IN (1) NE (2), ID (1), WA (1), CA (2)

OH (2), MO (1), MD (1), NC (1), FL (2), AR (1), WA (4)

OH (1), KY (1), CA (4) TX (10), AZ (1)

MMWR / October 1, 2010 / Vol. 59 / No. 38

MMWR Morbidity and Mortality Weekly Report

CASES CURRENT 4 WEEKS 982 91 139 40 145 0 21 29 918

Ratio (Log scale)

Beyond historical limits

MMWR / October 1, 2010 / Vol. 59 / No. 38

MMWR Morbidity and Mortality Weekly Report

MMWR / October 1, 2010 / Vol. 59 / No. 38