Académique Documents
Professionnel Documents
Culture Documents
interviewed, and 13 reported eating some portion of the kitchenprepared suspect meal. Among these 13, nine had illness that met
the case definition (attack rate = 69%). None of the staff members
who did not eat the suspect dinner were ill (relative risk = infinity,
95% confidence interval = 3.7infinity).
Interviews of the kitchen staff members revealed that the
chicken served at the suspect meal was delivered frozen to the
kitchen on May 4, and was cooked on May 5, the day before
serving. Contrary to hospital guidelines, the chicken was placed
in 6-inch deep pans after cooking and covered with aluminum
foil, which slowed cooling, and the first temperature check was
not until 16 hours later. During the 24 hours between cooking
and serving, the chicken also was removed from cooling three
times for preparation steps before being served as cold chicken
sandwiches or chicken salad. Inspection of the hospital kitchen
by OPH sanitarians found no critical violations of Louisiana
sanitary code.
The state public health laboratory detected C. perfringens
enterotoxin by reversed passive latex agglutination (RPLA)
in 20 of 23 stool specimens from ill residents and staff
members. CDCs Enteric Diseases Laboratory Branch detected
C. perfringens enterotoxin by RPLA and polymerase chain
reaction (PCR) assays for species-specific C. perfringens and
CPE genes in 15 of 20 stool specimens available for testing.
CDCs laboratory also isolated enterotoxin-producing
C. perfringens and detected the CPE gene in all four of the
samples of chicken served at the suspect meal. The stool
Decedents
Patient 1. The first decedent was an ambulatory black
woman aged 43 years with a history of bipolar-type schizoaffective disorder, seizures, and controlled hypothyroidism, but
no known history of constipation. Her medications were citalopram, valproic acid, ziprasidone, quetiapine,* levothyroxine,
and lithium. The morning after eating the suspect evening meal
she experienced fecal incontinence, loose stools, clammy skin,
and atypical behavior and was referred to a nearby medical center emergency department. In the emergency department, the
patient was noted to have a progressive abdominal distention.
Five hours after her arrival at the emergency department, the
patient developed bradycardia, became apneic, and died. Her
stool tested positive for C. perfringens enterotoxin by RPLA.
* Drugs with constipation listed as a common side effect are italicized in the text
and include benztropine, clozapine, fluphenazine, hydrochlorothiazide, loperamide,
and quetiapine.
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 2012;61:[inclusive page numbers].
606
Staff members
Residents
14
No. of cases
12
10
8
6
Dinner served
4
2
0
3:00 6:00 9:00 12:00 3:00 6:00 9:00 12:00 3:00 6:00
p.m. p.m. p.m. a.m. a.m. a.m. a.m. p.m. p.m. p.m.
May 6, 2010
May 7, 2010
607
608
Acknowledgments
Shirley Burton, MPH, Michele Pogue, Randy Ducote, David
Holcombe, MD, Louisiana Dept of Health and Hospitals; Kathy
Nugent, Louisiana State Univ Health Sciences Center. Wun-Ju
Shieh, Infectious Disease Pathology Br; Sue Reynolds, EIS Field
Assignments Br, CDC.
References
1. Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in
the United Statesmajor pathogens. Emerg Infect Dis 2011;17:715.
2. Brynestad S, Granum PE. Clostridium perfringens and foodborne
infections. Int J Food Microbiol 2002;74:195202.
3. Bos J, Smithee L, McClane B, et al. Fatal necrotizing colitis following a
foodborne outbreak of enterotoxigenic Clostridium perfringens type A
infection. Clin Infect Dis 2005;40:e7883.
4. Pollock AM, Whitty PM. Outbreak of Clostridium perfringens food
poisoning. J Hosp Infect 1991;17:17986.
5. Sarker MR, Carman RJ, McClane BA. Inactivation of the gene (cpe)
encoding Clostridium perfringens enterotoxin eliminates the ability of two
cpe-positive C. perfringens type A human gastrointestinal disease isolates
to affect rabbit ileal loops. Mol Microbiol 1999;33:94658.
Surveillance milestone
1972
1981
1991
1995
1996
1997
1998
1998
2002
2006
609
610
No. of states
FIGURE 2. Incidence of varicella* in states meeting the criteria for adequate and consistent
reporting, by age group United States, 20002010
varicella_message_mapping_guide_v2_01.pdf.
611
612
613
614
No/Dont know
2 doses*
Yes
Did the child receive a
total of 2 or more doses of
seasonal influenza vaccine
since July 1, 2010?
No/Dont know
2 doses*
Yes
1 dose
TABLE. Influenza vaccine information, by age group United States, 201213 influenza season*
Vaccine
Trade name
Manufacturer
TIV
Fluzone
Sanofi Pasteur
TIV
TIV
Agriflu
Fluvirin
Novartis Vaccines
Novartis Vaccines
TIV
TIV
Fluarix
FluLaval
TIV
Afluria
GlaxoSmithKline
ID Biomedical Corporation
of Quebec (distributed by
GlaxoSmithKline)
CSL Biotherapies
(distributed by Merck)
TIV
high- dose
TIV
intradermal
LAIV
Fluzone
High-Dose
Fluzone
Intradermal
FluMist***
Sanofi Pasteur
Sanofi Pasteur
MedImmune
Presentation
Mercury content
(g Hg per 0.5 Ovalbumin content
mL dose)
(g per 0.5mL dose)
0.0
0.0
0.0
25.0
0
1
25.0
0
<25.0
<0.4
1
1
0.05
0.3
0.0
24.5
0.0
1
1
0.1 mL prefilled
microinjection system
0.2 mL prefilled
intranasal sprayer
Age group
No. of
doses
Route
635 mos
36 mos
36 mos
6 mos
18 yrs
4 yrs
1 or 2
1 or 2
1 or 2
1 or 2
1
1 or 2
IM**
IM**
IM**
IM**
IM**
IM**
3 yrs
18 yrs
1 or 2
1
IM**
IM**
9 yrs
IM**
65 yrs
IM**
1864 yrs
ID
249 yrs
1 or 2
IN
Abbreviations: TIV = trivalent inactivated vaccine; LAIV = live-attenuated influenza vaccine; IM = intramuscular; ID = intradermal; IN = intranasal.
* Vaccination providers should consult Food and Drug Administrationapproved prescribing information for 201213 influenza vaccines for the most updated
information, including indications, contraindications, and precautions.
Data on maximum ovalbumin content is supplied in package inserts of certain vaccines. Persons with a history of mild allergy to egg (specifically, those who
experience only hives) should receive TIV with additional precautions (Figure 2).
Information is not included in package insert but is available upon request from the manufacturer, Sanofi Pasteur, by contacting 1-800-822-2463 or mis.emails@
sanofipasteur.com.
Figure 1 describes two approaches for determining the number of doses needed for children aged 6 months through 8 years.
** For adults and older children, the recommended site of vaccination is the deltoid muscle. The preferred site for infants and young children is the anterolateral
aspect of the thigh.
Age indication per package insert is 5 years; however, the Advisory Committee on Immunization Practices recommends that Afluria not be used in children aged
6 months through 8 years because of increased risk for febrile reactions noted in this age group with CSLs 2010 Southern Hemisphere TIV. If no other age-appropriate,
licensed inactivated seasonal influenza vaccine is available for a child aged 5 through 8 years who has a medical condition that increases the childs risk for influenza
complications, Afluria can be used; however, vaccination providers should discuss with the parents or caregivers the benefits and risks of influenza vaccination
with Afluria before administering this vaccine. Afluria may be used in persons aged 9 years.
A 0.5-mL dose contains 60 g of each vaccine antigen (180 g total).
A 0.1-mL dose contains 9 g of each vaccine antigen (27 g total).
*** A new quadrivalent formulation of FluMist was approved by the Food and Drug Administration in February 2012. It is anticipated that this formulation will replace
the currently available seasonal trivalent LAIV formulation for the 201314 season. FluMist is shipped refrigerated and stored in the refrigerator at 35F46F (2C8C)
after arrival in the vaccination clinic. The dose is 0.2 mL divided equally between each nostril. Health-care providers should consult the medical record, when available,
to identify children aged 2 through 4 years with asthma or recurrent wheezing that might indicate asthma. In addition, to identify children who might be at greater
risk for asthma and possibly at increased risk for wheezing after receiving LAIV, parents or caregivers of children aged 2 through 4 years should be asked, In the
past 12 months, has a health-care provider ever told you that your child had wheezing or asthma? Children whose parents or caregivers answer yes to this question
and children who have asthma or who had a wheezing episode noted in the medical record within the past 12 months should not receive FluMist.
Insufficient data available for use of LAIV in egg-allergic persons.
Flumist is indicated for healthy, nonpregnant persons aged 2 through 49 years. Persons who care for severely immunosuppressed persons who require a protective
environment should not receive FluMist given the theoretical risk for transmission of the live-attenuated vaccine virus.
High-Dose is indicated for persons aged 65 years and contains 60 g of hemagglutinin per vaccine virus strain (180 g
total) in a 0.5 mL dose. Within specified age indications,
ACIP expresses no preference for any given TIV formulation
over another.
The intranasally administered live-attenuated influenza
vaccine (LAIV), FluMist (MedImmune), is indicated for
healthy, nonpregnant persons aged 2 through 49 years. No
preference is indicated for LAIV versus TIV in this age group
615
616
Yes
Administer vaccine
per usual protocol.
No
After eating eggs or eggcontaining foods, does the
person experience ONLY hives?
Yes
Administer TIV.
Observe for reaction
for at least 30 minutes
after vaccination.
No
Does the person experience
other symptoms such as
Cardiovascular changes
(e.g., hypotension) ?
Yes
Respiratory distress
(e.g., wheezing)?
Gastrointestinal
(e.g., nausea/vomiting)?
Reaction requiring epinephrine?
Reaction requiring
emergency medical attention?
617
618
The H3N2v viruses identified since July 12, 2012, are similar
to the 13 H3N2v viruses identified during July 2011April 2012
(1); all sequenced viruses had the M gene from the influenza A
(H1N1)pdm09 virus. As of August 9, all H3N2v patients for
whom contact information was available reported contact
with swine or attended an agricultural fair where swine were
619
TABLE 2. Number of 10-fold virus dilutions (maximum = five) detected by seven FDA-cleared RIDTs, by H3N2v strain designation CDC,
United States, 2012
RIDT
Subtype
H3N2v
H3N2v
H3N2v
H3N2v
H3N2v
H3N2v
H3N2v
Strain designation
A/Kansas/13/2009
A/Pennsylvania/14/2010
A/Minnesota/11/2010
A/Indiana/08/2011
A/Indiana/10/2011
A/West Virginia/06/2011
A/Iowa/07/2011
TCID50/mL
BinaxNOW
Directigen
FluAlert
QuickVue
Sofia
Veritor
Xpect
104.5
104.5
104.5
106.0
104.0
106.0
104.5
1
2
U
1
U
2
2
4
4
3
3
3
3
4
U
U
U
U
U
U
1
U
2
U
U
U
2
1
2
2
3
2
2
4
3
4
4
3
3
4
4
4
4
3
2
2
2
2
3
Abbreviations: FDA = Food and Drug Administration; TCID50/mL = infectious titer of stock virus; RIDT = rapid influenza diagnostic test; U = undetected at any
concentration tested.
620
References
1. Lindstrom S, Garten R, Balish A, et al. Human infections with novel
reassortant influenza A(H3N2)v viruses, United States, 2011. Emerg
Infect Dis 2012;18:8347.
2. CDC. Update: influenza A (H3N2)v transmission and guidelinesfive
states, 2011. MMWR 2012;60:17414.
3. CDC. Notes from the field: outbreak of influenza A (H3N2) virus
among persons and swine at a county fairIndiana, July 2012. MMWR
2012;61:561.
4. CDC. Antibodies cross-reactive to influenza A (H3N2) variant virus
and impact of 201011 seasonal influenza vaccine on cross-reactive
antibodiesUnited States. MMWR 2012;61:23741.
5. CDC. Antiviral agents for the treatment and chemoprophylaxis of
influenza: recommendations of the Advisory Committee on
Immunization Practices (ACIP). MMWR 2011;60(No. RR-1).
6. Hurt AC, Alexander R, Hibbert J, Deed N, Barr IG. Performance of six
influenza rapid tests in detecting human influenza in clinical specimens.
J Clin Virol 2007;39:1325.
7. Faix DJ, Sherman SS, Waterman SH. Rapid-test sensitivity for novel
swine-origin influenza A (H1N1) virus in humans. N Engl J Med
2009;361:7289.
8. Ginocchio CC, Zhang F, Manji R, et al. Evaluation of multiple test
methods for the detection of the novel 2009 influenza A (H1N1) during
the New York City outbreak. J Clin Virol 2009;45:1915.
9. Uyeki TM, Prasad R, Vukotich C, et al. Low sensitivity of rapid
diagnostic test for influenza. Clin Infect Dis 2009;48:e8992.
10. CDC. Guidance for clinicians on the use of rapid influenza diagnostic
tests. Atlanta, GA: US Department of Health and Human Services,
CDC; 2011. Available at http://www.cdc.gov/flu/professionals/
diagnosis/clinician_guidance_ridt.htm. Accessed August 9, 2012.
621
622
References
1. Bonthius DJ. Lymphocytic choriomeningitis virus: a prenatal and
postnatal threat. Adv Pediatr 2009;56:7586.
2. MacNeil A, Strher U, Farnon E, et al. Solid organ transplantassociated
lymphocytic choriomeningitis, United States, 2011. Emerg Infect Dis
2012;18:125662.
3. Childs JE, Glass GE, Korch GW, Ksiazek TG, Leduc JW. Lymphocytic
choriomeningitis virus infection and house mouse (Mus musculus)
distribution in urban Baltimore. Am J Trop Med Hyg 1992:47;2734.
Announcement
Updated Online NCHHSTP Atlas
CDCs National Center for HIV/AIDS, Viral Hepatitis,
STD, and TB Prevention (NCHHSTP) recently launched an
update to the NCHHSTP Atlas, an interactive, online mapping tool and platform for accessing data collected by the center. With this update, the atlas allows users to observe disease
trends and patterns of not only human immunodeficiency virus
infection, acquired immunodeficiency syndrome, and some
sexually transmitted infections (i.e., chlamydia, gonorrhea,
and primary and secondary syphilis), but also of acute viral
hepatitis A, B, and C, and tuberculosis. The atlas also allows
users to create detailed reports, maps, and other graphics of
these surveillance data.
The interactive atlas is a valuable tool to help public health professionals, researchers, community leaders, health-care providers,
and others view overlapping disease trends, set research priorities,
and plan prevention and care services. The NCHHSTP Atlas is
available at http://www.cdc.gov/nchhstp/atlas.
623
Notices to Readers
Scanned 19521982 Issues of MMWR Available
Online
624
TABLE 2. Reported cases of notifiable diseases,* by geographic division and area United States, 2011
Arboviral diseases
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
California serogroup
virus
Eastern equine
encephalitis
virus
Powassan virus
Total resident
population
(in thousands)
Anthrax
Neuroinvasive
309,049
14,474
3,527
1,313
6,631
1,324
1,057
622
40,943
8,733
11,146
8,431
12,633
46,521
12,944
6,445
9,931
11,532
5,669
20,451
3,023
2,841
5,290
6,012
1,811
654
820
59,659
891
611
18,678
9,908
5,737
9,459
4,597
7,952
1,826
18,367
4,730
4,339
2,960
6,338
36,376
2,910
4,529
3,724
25,213
22,380
6,677
5,095
1,560
980
2,655
2,034
2,831
548
49,878
709
37,267
1,300
3,856
6,746
120
51
1
2
1
44
3
1
52
1
2
26
1
22
15
1
1
1
12
1
1
17
12
6
6
1
4
4
1
1
1
12
1
2
2
9
2
2
1
1
3
3
486
15
8
1
1
35
2
19
9
5
73
22
7
32
10
2
31
5
4
1
6
14
1
67
1
10
20
14
10
2
8
2
56
5
4
31
16
28
1
6
1
20
71
49
2
1
1
12
4
1
1
110
110
226
2
1
22
5
14
2
1
28
12
2
2
11
1
29
4
1
4
15
3
2
27
5
4
8
9
24
1
21
2
11
7
35
20
5
2
2
2
48
48
55
54
159
3,722
106
Nonneuroinvasive
Neuroinvasive
Neuroinvasive
Nonneuroinvasive
Neuroinvasive
Nonneuroinvasive
Neuroinvasive
Nonneuroinvasive
N: Not reportable U: Unavailable : No reported cases C.N.M.I.: Commonwealth of Northern Mariana Islands.
* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute
respiratory syndrome-associated coronavirus disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive;
yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, chronic hepatitis B and hepatitis C virus infection
(past or present) are not included because they are undergoing data quality review. Data on human immunodeficiency virus (HIV) infections are not included because HIV infection
reporting has been implemented on different dates and using different methods than for acquired immunodeficiency syndrome (AIDS) case reporting.
Totals reported to the Division of Vector-Borne Infectious Diseases (DVBD), National Center for Emerging and Zoonotic Infectious Diseases (NCZVED) (ArboNET Surveillance), as of April 17, 2012.
625
TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2011
Botulism
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
Chlamydia
trachomatis
infection
Total
Foodborne
Infant
Other
Brucellosis
Chancroid
1,128
378
74
9
208
13
73
1
584
166
361
57
N
80
N
80
74
N
73
N
1
N
5
1
4
N
2
1
N
N
N
153
29
11
2
4
12
3
1
1
9
2
1
2
2
2
2
3
6
1
5
26
5
4
2
1
2
12
71
6
58
2
5
24
1
1
10
2
8
6
1
97
27
11
1
3
12
1
8
2
2
2
2
2
3
4
4
15
3
3
2
1
2
4
34
30
1
3
32
1
1
29
27
79
1
7
1
3
3
10
8
1
1
1
1
13
6
5
1
4
1
1
2
15
3
1
11
10
3
2
3
18
15
1
1
1
8
2
1
1
1
1,412,791
48,146
13,649
3,094
22,764
3,010
4,146
1,483
181,856
26,209
37,494
65,269
52,884
219,580
64,939
27,801
49,568
52,653
24,619
78,726
10,705
10,598
16,902
27,887
6,780
2,445
3,409
293,101
4,508
6,585
76,033
54,403
27,212
54,819
28,932
36,314
4,295
98,576
29,626
16,629
21,216
31,105
187,144
16,052
31,614
14,596
124,882
90,226
29,251
21,811
4,699
3,406
10,507
11,374
7,086
2,092
215,436
5,739
166,773
6,001
13,643
23,280
N
N
1,071
5,634
820
Babesiosis
N: Not reportable U: Unavailable : No reported cases C.N.M.I.: Commonwealth of Northern Mariana Islands.
* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute
respiratory syndrome-associated coronavirus disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive;
yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, chronic hepatitis B and hepatitis C virus infection
(past or present) are not included because they are undergoing data quality review. Data on human immunodeficiency virus (HIV) infections are not included because HIV infection
reporting has been implemented on different dates and using different methods than for acquired immunodeficiency syndrome (AIDS) case reporting.
Includes cases reported as wound and unspecified botulism.
Totals reported to the Division of STD Prevention, NCHHSTP, as of June 7, 2012.
626
TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2011
Dengue virus infection
Cryptosporidiosis
Area
United States
New England
Connecticut
Maine
Massachusetts
New Hampshire
Rhode Island
Vermont
Cholera
Coccidioidomycosis
Total
Confirmed
Probable
Cyclosporiasis
Dengue fever
Dengue
hemorrhagic fever
Pacific
Alaska
California
Hawaii
Oregon
Washington
40
4
14
1
2
10
1
2
1
13
11
1
1
1
2
1
1
22,634
2
N
N
1
1
N
6
N
N
N
6
56
N
N
36
20
130
N
N
104
18
8
N
N
5
N
N
5
N
N
N
N
N
N
N
N
3
N
3
N
N
16,712
16,467
N
N
5
104
75
58
3
5,720
N
5,697
N
13
10
9,250
418
71
51
168
68
12
48
904
56
234
86
528
2,676
213
261
358
1,106
738
1,563
364
42
309
495
175
32
146
1,239
7
N
437
307
70
115
132
140
31
457
138
177
50
92
712
32
87
89
504
641
46
147
111
77
17
134
63
46
640
12
332
1
207
88
6,130
358
71
19
168
40
12
48
824
55
226
86
457
1,476
31
79
325
303
738
714
61
42
309
156
124
1
21
791
7
203
307
66
69
66
54
19
301
16
160
50
75
579
32
87
2
458
552
42
126
79
77
3
134
62
29
535
12
332
1
179
11
3,120
60
32
28
80
1
8
71
1,200
182
182
33
803
849
303
339
51
31
125
448
234
4
46
66
86
12
156
122
17
17
133
87
46
89
4
21
32
14
1
17
105
28
77
151
12
10
N
2
N
38
8
11
19
N
7
3
1
1
1
N
69
1
N
58
6
1
1
2
N
N
N
2
15
14
1
N
N
N
1
4
N
251
4
1
3
69
8
45
16
21
6
2
6
2
5
13
5
1
6
92
2
66
6
6
4
1
7
11
4
4
3
10
7
6
2
1
2
1
25
5
11
2
2
Territories
American Samoa
C.N.M.I.
Guam
Puerto Rico
U.S. Virgin Islands
1,507
34
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
N: Not reportable U: Unavailable : No reported cases C.N.M.I.: Commonwealth of Northern Mariana Islands.
* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute
respiratory syndrome-associated coronavirus disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive;
yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, chronic hepatitis B and hepatitis C virus infection
(past or present) are not included because they are undergoing data quality review. Data on human immunodeficiency virus (HIV) infections are not included because HIV infection
reporting has been implemented on different dates and using different methods than for acquired immunodeficiency syndrome (AIDS) case reporting.
Total number of reported laboratory-positive dengue cases including all confirmed cases [by anti-dengue virus (DENV) molecular diagnostic methods or seroconversion of anti-DENV IgM]
and all probable cases (by a single, positive anti-DENV IgM). Totals reported to the Division of Vector-Borne Diseases (DVBD), National Center for Emerging and Zoonotic Infectious Diseases
(NCEZID) (ArboNET Surveillance), as of April 17, 2012.
627
TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2011
Ehrlichiosis/Anaplasmosis
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
Anaplasma
phagocytophilum
Ehrlichia chaffeensis
Ehrlichia ewingii
Undetermined
Giardiasis
Gonorrhea
2,575
461
152
26
172
31
72
8
482
126
314
36
6
710
11
9
690
808
N
6
770
25
1
3
3
72
1
N
11
11
7
21
21
15
4
1
10
20
8
1
9
2
1
N
N
N
1
6
N
N
6
850
4
1
2
108
60
41
4
3
42
25
4
6
7
178
N
18
7
151
1
1
272
15
N
15
23
33
83
2
100
1
78
5
16
3
54
167
53
110
4
N
N
N
1
N
13
6
N
1
5
6
2
N
1
2
N
N
N
148
2
1
1
25
7
11
7
58
18
5
1
34
25
N
1
10
13
1
16
1
1
9
2
14
14
1
5
4
N
N
N
N
1
2
N
2
N
16,747
1,594
233
171
758
130
79
223
3,293
437
1,144
917
795
2,657
407
324
550
799
577
1,769
271
139
672
344
179
54
110
2,756
34
56
1,255
651
291
N
117
290
62
171
171
N
N
N
349
123
226
N
1,326
133
445
178
86
79
108
256
41
2,832
101
1,728
38
436
529
321,849
5,612
2,449
272
2,353
130
360
48
41,824
7,348
6,240
14,466
13,770
58,022
17,037
6,569
12,901
16,726
4,789
16,420
1,920
2,209
2,284
7,802
1,352
251
602
79,089
827
2,569
19,689
16,428
6,458
17,454
8,350
6,518
796
27,134
9,132
4,521
5,814
7,667
49,001
4,687
9,169
4,215
30,930
11,336
4,564
2,363
162
85
2,000
1,839
277
46
33,411
984
27,516
685
1,489
2,737
N
N
N
N
N
N
N
N
84
96
341
139
N: Not reportable U: Unavailable : No reported cases C.N.M.I.: Commonwealth of Northern Mariana Islands.
* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute
respiratory syndrome-associated coronavirus disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive;
yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, chronic hepatitis B and hepatitis C virus infection
(past or present) are not included because they are undergoing data quality review. Data on human immunodeficiency virus (HIV) infections are not included because HIV infection
reporting has been implemented on different dates and using different methods than for acquired immunodeficiency syndrome (AIDS) case reporting.
Totals reported to the Division of STD Prevention, NCHHSTP, as of June 7, 2012.
628
TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2011
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
All ages,
serotypes
Nonserotype b
Unknown serotype
Hansen disease
(leprosy)
Hantavirus
pulmonary
syndrome
Hemolytic uremic
syndrome,
postdiarrheal
3,539
252
65
26
121
17
16
7
771
123
195
187
266
645
188
117
72
173
95
224
3
23
71
80
30
16
1
783
6
1
232
140
95
85
79
108
37
225
57
41
19
108
163
35
53
73
2
294
95
67
21
3
17
47
42
2
182
26
44
32
72
8
14
3
1
1
1
3
1
145
9
1
7
1
13
5
30
6
9
15
25
10
7
2
5
1
14
5
1
1
7
9
5
4
N
31
13
5
2
2
9
10
3
7
226
6
4
1
45
9
1
15
20
28
8
14
6
23
13
4
3
46
23
10
1
8
3
1
7
3
13
13
N
16
2
3
10
42
11
27
4
82
3
N
2
1
N
4
N
4
14
11
1
N
1
19
2
1
N
16
2
34
14
20
N
N
23
2
1
16
3
3
1
2
2
5
4
N
2
2
290
12
2
2
5
2
1
21
4
13
4
N
36
7
9
5
15
49
13
4
12
20
24
N
4
7
2
5
3
3
25
9
N
1
15
41
12
7
22
25
5
6
3
1
2
2
5
1
57
N
42
1
14
N
N
N: Not reportable U: Unavailable : No reported cases C.N.M.I.: Commonwealth of Northern Mariana Islands.
* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute
respiratory syndrome-associated coronavirus disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive;
yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, chronic hepatitis B and hepatitis C virus infection
(past or present) are not included because they are undergoing data quality review. Data on human immunodeficiency virus (HIV) infections are not included because HIV infection
reporting has been implemented on different dates and using different methods than for acquired immunodeficiency syndrome (AIDS) case reporting.
629
TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2011
Hepatitis, viral, acute
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
HIV
diagnoses
1,398
77
18
6
39
8
6
252
79
47
66
60
214
73
24
70
39
8
59
8
4
27
13
5
2
222
2
87
27
26
31
11
30
8
48
8
10
7
23
157
3
5
11
138
129
77
21
6
3
5
7
8
2
240
4
186
8
11
31
2,903
97
19
8
67
3
U
291
73
54
80
84
353
85
70
91
90
17
124
15
15
20
60
12
2
775
13
213
142
62
109
39
84
113
519
119
151
57
192
423
57
62
100
204
88
14
23
2
29
10
10
233
3
157
6
32
35
1,229
88
47
12
23
N
U
6
140
53
44
8
35
143
6
84
32
6
15
35
8
17
8
2
284
U
64
53
35
60
1
25
46
248
23
142
U
83
97
7
53
37
85
U
28
12
9
10
14
10
2
109
48
20
41
35,266
1,003
305
46
523
40
88
1
5,628
812
1,301
2,246
1,269
3,641
1,351
434
610
987
259
1,085
116
126
283
481
46
12
21
10,925
99
495
4,890
1,431
851
1,439
771
857
92
2,191
592
233
552
814
4,967
199
1,281
262
3,225
1,410
494
362
16
17
320
111
76
14
4,416
25
3,679
50
213
449
118
4
1
1
1
1
15
4
2
3
6
19
7
2
6
1
3
9
3
1
1
4
22
2
4
10
5
1
2
16
1
4
11
12
4
3
3
1
1
19
16
1
1
1
4,202
406
81
18
240
26
29
12
1,353
235
400
216
502
864
151
71
187
386
69
122
11
14
29
55
8
3
2
640
24
N
185
55
143
83
25
93
32
180
29
53
14
84
165
14
25
15
111
147
46
41
9
1
16
12
18
4
325
261
5
22
37
870
61
18
4
32
4
3
158
33
48
30
47
116
34
11
29
29
13
62
5
14
6
21
9
6
1
111
N
38
9
19
21
6
15
3
22
9
4
4
5
79
6
7
15
51
98
8
51
5
3
5
15
5
6
163
123
12
9
19
43
21
120
28
5
70
N
1
436
22
9
1
Influenza-associated
pediatric mortality
Legionellosis
Listeriosis
N: Not reportable U: Unavailable : No reported cases C.N.M.I.: Commonwealth of Northern Mariana Islands.
* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute
respiratory syndrome-associated coronavirus disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive;
yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, chronic hepatitis B and hepatitis C virus infection
(past or present) are not included because they are undergoing data quality review. Data on human immunodeficiency virus (HIV) infections are not included because HIV infection
reporting has been implemented on different dates and using different methods than for acquired immunodeficiency syndrome (AIDS) case reporting.
Data on HIV diagnoses include persons with a diagnosis of HIV infection regardless of stage of disease (i.e., AIDS status) at diagnosis. Total number of HIV diagnoses case counts was reported
to the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) through December 31, 2011.
Totals reported to the Division of Influenza, National Center for Immunization and Respiratory Diseases (NCIRD), as of December 31, 2011.
630
Please note: An erratum has been published for this issue. To view the erratum, please click here.
Morbidity and Mortality Weekly Report
TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2011
Lyme disease
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
Measles
Total
Indigenous
Imported
Total
Confirmed
Probable
Malaria
33,097
8,602
3,039
1,006
2,476
1,299
159
623
14,114
4,262
3,759
731
5,362
4,094
194
94
104
53
3,649
2,291
100
17
2,124
8
11
27
4
3,637
873
N
115
32
1,351
88
37
1,023
118
69
24
3
5
37
78
2
2
74
52
15
4
11
5
6
9
2
160
11
92
N
38
19
24,364
6,080
2,004
801
1,801
887
111
476
11,255
3,398
2,678
440
4,739
2,808
194
81
89
36
2,408
1,304
72
11
1,185
5
7
22
2
2,720
767
78
32
938
18
24
756
107
20
9
3
3
5
31
1
2
28
32
8
3
9
3
2
6
1
114
9
79
N
9
17
8,733
2,522
1,035
205
675
412
48
147
2,859
864
1,081
291
623
1,286
13
15
17
1,241
987
28
6
939
3
4
5
2
917
106
37
413
70
13
267
11
49
15
2
32
47
46
20
7
1
2
2
4
3
1
46
2
13
N
29
2
1,724
109
20
6
68
3
6
6
438
97
53
227
61
174
66
14
34
41
19
109
22
10
46
21
8
2
478
7
18
99
91
128
49
7
78
1
41
9
10
1
21
121
7
2
10
102
67
21
24
2
2
8
5
5
187
5
129
7
22
24
222
28
1
24
1
1
1
49
4
7
25
13
21
3
14
2
2
34
1
6
26
20
1
N
8
2
2
3
6
6
22
2
1
4
15
38
31
3
4
142
18
17
1
35
3
4
16
12
15
1
13
1
30
6
23
7
1
1
5
5
15
1
14
16
12
2
2
80
10
1
7
1
1
14
1
3
9
1
6
2
1
1
2
4
1
13
2
2
2
1
1
7
2
1
3
1
22
19
1
2
N
N
N: Not reportable U: Unavailable : No reported cases C.N.M.I.: Commonwealth of Northern Mariana Islands.
* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute
respiratory syndrome-associated coronavirus disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive;
yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, chronic hepatitis B and hepatitis C virus infection
(past or present) are not included because they are undergoing data quality review. Data on human immunodeficiency virus (HIV) infections are not included because HIV infection
reporting has been implemented on different dates and using different methods than for acquired immunodeficiency syndrome (AIDS) case reporting.
Imported cases include only those directly related to importation from other countries.
631
TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2011
Meningococcal disease
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
All serogroups
Serogroup A, C, Y,
and W-135
759
29
3
5
14
1
1
5
92
13
23
31
25
115
35
25
12
24
19
63
14
5
15
15
11
3
135
1
1
51
14
15
15
9
18
11
31
11
8
3
9
70
12
16
12
30
55
16
9
7
4
5
3
11
169
2
110
4
31
22
257
18
2
3
8
1
4
20
18
2
59
19
12
4
13
11
15
6
42
10
10
10
5
3
4
13
4
3
1
5
25
5
7
13
32
7
5
6
3
2
9
33
1
22
10
Serogroup other
Serogroup
unknown
Mumps
159
7
2
3
1
1
5
1
44
12
12
6
7
7
15
6
23
1
4
4
4
8
2
10
5
1
1
3
20
5
4
11
17
5
4
1
4
1
18
6
12
20
2
6
1
1
1
2
1
3
1
2
1
1
2
1
1
323
2
1
66
13
31
22
6
3
1
2
30
1
5
15
6
3
66
1
1
51
1
7
4
6
2
3
1
24
2
16
6
6
4
1
1
117
2
110
2
3
404
12
2
4
5
1
55
13
10
29
3
110
78
3
9
16
4
35
8
4
2
11
6
4
46
2
11
5
2
9
3
13
1
6
2
3
1
76
4
4
68
11
7
2
1
53
1
43
3
4
2
14
2
3
3
1
4
3
3
4
Serogroup B
Novel influenza A
virus infections
N: Not reportable U: Unavailable : No reported cases C.N.M.I.: Commonwealth of Northern Mariana Islands.
* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute
respiratory syndrome-associated coronavirus disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive;
yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, chronic hepatitis B and hepatitis C virus infection
(past or present) are not included because they are undergoing data quality review. Data on human immunodeficiency virus (HIV) infections are not included because HIV infection
reporting has been implemented on different dates and using different methods than for acquired immunodeficiency syndrome (AIDS) case reporting.
632
TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2011
Q fever
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
Pertussis
Plague
18,719
870
68
205
271
170
62
94
2,305
312
928
323
742
4,526
1,509
367
691
767
1,192
1,636
232
145
658
438
56
70
37
1,506
29
9
312
179
123
198
156
399
101
481
143
179
49
110
1,140
80
31
68
961
2,574
867
416
192
134
34
273
645
13
3,681
27
2,319
59
314
962
7
8
Psittacosis
Total
Acute
1
1
134
2
14
6
5
1
2
20
4
1
10
1
4
5
1
1
2
1
18
3
2
2
5
2
3
1
2
1
1
27
5
3
19
21
2
3
15
1
25
16
1
8
110
1
N
11
6
2
1
2
16
4
1
8
1
2
3
N
1
15
N
3
2
2
5
1
1
1
24
5
3
16
18
1
2
14
1
22
16
Rabies
Chronic
Animal
Human
24
1
N
3
2
2
N
1
1
1
2
2
1
1
3
3
1
1
1
2
4,357
344
195
66
25
27
31
835
370
13
452
195
51
28
65
51
N
197
25
31
56
29
33
23
1,147
120
305
N
618
104
162
83
16
63
1,144
60
6
60
1,018
75
N
6
N
17
19
7
26
258
14
216
17
11
6
2
2
1
1
47
N: Not reportable U: Unavailable : No reported cases C.N.M.I.: Commonwealth of Northern Mariana Islands.
* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute
respiratory syndrome-associated coronavirus disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive;
yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, chronic hepatitis B and hepatitis C virus infection
(past or present) are not included because they are undergoing data quality review. Data on human immunodeficiency virus (HIV) infections are not included because HIV infection
reporting has been implemented on different dates and using different methods than for acquired immunodeficiency syndrome (AIDS) case reporting.
633
TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2011
Area
Rubella
Salmonellosis
Total
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
4
1
51,887
2,106
466
134
1,049
178
194
85
5,649
1,222
1,423
1,132
1,872
5,119
1,694
634
854
1,187
750
3,001
448
463
717
900
252
59
162
15,305
175
92
5,923
2,645
1,010
2,519
1,567
1,208
166
4,364
1,266
606
1,438
1,054
8,333
848
1,440
827
5,218
2,599
886
522
143
120
175
341
338
74
5,411
54
4,072
332
364
589
6,047
212
57
28
80
22
8
17
663
143
221
90
209
1,023
241
132
152
183
315
1,021
189
108
285
282
103
13
41
624
16
6
103
122
71
155
18
123
10
296
74
75
37
110
655
61
20
88
486
706
126
169
117
37
42
43
142
30
847
N
504
9
136
198
13,352
271
41
32
179
4
9
6
1,430
481
378
448
123
925
262
88
190
314
71
381
18
72
87
182
14
2
6
3,921
6
35
2,635
670
94
225
142
107
7
1,025
322
252
241
210
3,397
96
487
275
2,539
880
434
89
17
124
36
123
55
2
1,122
5
908
48
57
104
2,802
10
1
4
3
2
179
136
12
12
19
120
51
33
4
21
11
301
7
11
270
10
2
1
751
20
4
12
88
29
327
36
231
4
370
79
4
24
263
955
558
10
335
52
103
77
3
2
1
2
8
10
13
N
8
N
1
4
Confirmed
234
2
4
2
2
3
2
21
13
5
2
1
128
1
3
88
3
16
12
5
15
5
3
1
6
21
10
8
3
32
31
2
N
Probable
2,562
8
1
4
1
2
175
134
10
12
19
106
51
24
4
18
9
280
7
11
257
5
623
20
3
9
26
311
24
226
4
355
74
1
23
257
934
548
10
327
49
71
46
3
2
1
2
7
10
10
6
N
1
3
Territories
American Samoa
C.N.M.I.
Guam
Puerto Rico
U.S. Virgin Islands
19
468
6
16
6
N
N
N
N: Not reportable U: Unavailable : No reported cases C.N.M.I.: Commonwealth of Northern Mariana Islands.
* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute
respiratory syndrome-associated coronavirus disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive;
yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, chronic hepatitis B and hepatitis C virus infection
(past or present) are not included because they are undergoing data quality review. Data on human immunodeficiency virus (HIV) infections are not included because HIV infection
reporting has been implemented on different dates and using different methods than for acquired immunodeficiency syndrome (AIDS) case reporting.
Includes Escherichia coli O157:H7; shiga toxin-positive, serogroup non-O157; and shiga toxin positive, not serogrouped.
Total case count includes six unknown case status reports.
634
TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2011
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
Streptococcal
toxic-shock
syndrome
Streptococcus pneumoniae,
invasive disease
All ages
Syphilis
All stages
Congenital
(age <2 yr)
Primary and
secondary
Tetanus
Toxic-shock
syndrome
168
25
N
12
6
7
54
23
25
6
37
13
6
18
30
1
N
15
2
7
5
5
N
5
N
N
N
17
N
1
16
N
N
17,138
807
354
136
38
110
97
72
2,598
680
1,183
735
N
3,283
N
819
694
1,278
492
835
N
N
580
N
121
91
43
4,009
52
55
1,324
1,173
587
N
452
N
366
1,408
42
226
148
992
2,090
228
259
N
1,603
1,963
767
494
N
20
124
329
206
23
145
138
N
7
N
N
1,459
54
14
4
19
5
5
7
138
43
56
39
N
262
76
40
36
83
27
112
N
N
47
35
12
4
14
376
6
138
94
51
N
29
33
25
121
10
23
14
74
229
14
25
37
153
155
55
38
5
N
6
24
27
12
10
N
2
N
N
46,042
1,110
189
24
770
33
84
10
6,882
971
881
3,905
1,125
4,812
2,426
468
762
954
202
982
70
76
367
414
36
5
14
10,619
124
552
4,142
1,895
1,278
1,254
639
726
9
2,866
758
335
748
1,025
8,946
464
2,043
270
6,169
2,036
906
367
42
9
430
212
64
6
7,789
11
6,782
32
252
712
360
23
5
13
5
37
18
6
13
72
1
32
10
24
5
26
10
2
6
8
142
15
18
2
107
17
14
42
40
13,970
416
65
12
266
18
46
9
1,688
232
194
889
373
1,845
881
173
286
440
65
330
20
24
139
136
10
1
3,448
27
165
1,257
678
452
431
221
213
4
826
228
129
191
278
1,882
182
447
84
1,169
648
274
133
13
7
136
71
14
2,887
5
2,443
14
97
328
36
1
1
8
1
4
1
2
4
1
1
2
3
2
3
2
6
1
3
2
4
2
1
3
78
3
N
2
1
13
1
4
8
16
5
2
5
4
10
1
1
3
2
3
14
N
10
N
1
3
N
2
N
2
1
1
N
N
6
2
2
N
1
11
N
11
N
N
N
26
671
7
5
254
N: Not reportable U: Unavailable : No reported cases C.N.M.I.: Commonwealth of Northern Mariana Islands.
* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute
respiratory syndrome-associated coronavirus disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive;
yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, chronic hepatitis B and hepatitis C virus infection
(past or present) are not included because they are undergoing data quality review. Data on human immunodeficiency virus (HIV) infections are not included because HIV infection
reporting has been implemented on different dates and using different methods than for acquired immunodeficiency syndrome (AIDS) case reporting.
The previous categories of invasive pneumococcal disease among children less than 5 years and invasive, drug-resistant Streptococcus pneumoniae were eliminated. All cases of invasive
S. pneumoniae disease, regardless of age or drug resistance are reported under a single disease code.
Includes the following categories: primary, secondary, latent (including early latent, late latent, and latent syphilis of unknown duration), neurosyphilis, late (including late syphilis with
clinical manifestations other than neurosyphilis), and congenital syphilis.
Totals reported to the Division of STD Prevention, NCHHSTP, as of June 7, 2012.
635
TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2011
Area
Trichinellosis
Tuberculosis
Tularemia
Typhoid fever
Vancomycin-intermediate
Staphylococcus aureus
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
15
1
2
1
1
2
1
3
N
1
2
1
1
10,528
334
83
9
196
11
27
8
1,501
331
221
689
260
844
359
100
170
145
70
356
40
36
137
98
23
7
15
2,029
21
56
754
347
233
244
140
221
13
479
161
71
91
156
1,671
85
167
94
1,325
527
255
70
12
8
95
49
34
4
2,787
67
2,323
123
74
200
166
8
4
3
1
8
5
1
1
1
49
3
11
21
4
2
8
7
1
3
52
37
15
18
3
2
3
1
7
1
1
16
5
5
390
29
5
24
93
39
15
26
13
45
28
4
6
3
4
15
4
4
3
1
3
52
8
9
17
8
1
9
31
2
1
2
26
13
3
5
4
1
112
96
1
6
9
82
6
1
5
N
35
4
23
4
4
14
3
N
5
5
1
3
N
N
2
1
11
N
3
2
1
3
2
N
1
6
3
2
N
N
N
N
1
N
N
N
N
Territories
American Samoa
C.N.M.I.
Guam
Puerto Rico
U.S. Virgin Islands
N
1
3
27
78
50
N: Not reportable U: Unavailable : No reported cases C.N.M.I.: Commonwealth of Northern Mariana Islands.
* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic; rubella, congenital syndrome; severe acute
respiratory syndrome-associated coronavirus disease; smallpox; vancomycin-resistant Staphylococcus aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive;
yellow fever; and viral hemorrhagic fevers were reported in the United States during 2011. Data on hepatitis B virus, perinatal infection, chronic hepatitis B and hepatitis C virus infection
(past or present) are not included because they are undergoing data quality review. Data on human immunodeficiency virus (HIV) infections are not included because HIV infection
reporting has been implemented on different dates and using different methods than for acquired immunodeficiency syndrome (AIDS) case reporting.
Totals reported to the Division of Tuberculosis Elimination, NCHHSTP, as of June 25, 2012.
636
TABLE 2. (Continued) Reported cases of notifiable diseases,* by geographic division and area United States, 2011
Varicella
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
Morbidity
Mortality
Vibriosis
14,513
1,360
304
226
513
158
42
117
1,567
466
N
1,101
3,679
881
293
1,036
1,047
422
819
N
418
1
248
20
65
67
1,905
11
12
861
33
N
N
13
549
426
294
279
N
15
N
3,005
347
100
N
2,558
1,737
660
447
N
163
N
65
389
13
147
64
39
44
N
N
N
N
N
N
N
1
2
1
N
N
N
1
N
1
N
N
1
832
32
25
4
1
2
63
28
N
26
9
40
16
2
9
7
6
14
N
N
9
3
2
N
286
6
1
155
33
35
15
11
30
N
35
8
2
13
12
135
N
54
2
79
42
26
6
N
N
6
2
1
1
185
100
33
7
45
102
444
1
1
N
N: Not reportable U: Unavailable : No reported cases C.N.M.I.: Commonwealth of Northern Mariana Islands.
* No cases of diphtheria; eastern equine encephalitis virus disease, nonneuroinvasive; poliomyelitis, paralytic; poliovirus infection, nonparalytic;
rubella, congenital syndrome; severe acute respiratory syndrome-associated coronavirus disease; smallpox; vancomycin-resistant Staphylococcus
aureus; western equine encephalitis virus disease, neuroinvasive and nonneuroinvasive; yellow fever; and viral hemorrhagic fevers were reported
in the United States during 2011. Data on hepatitis B virus, perinatal infection, chronic hepatitis B and hepatitis C virus infection (past or present)
are not included because they are undergoing data quality review. Data on human immunodeficiency virus (HIV) infections are not included because
HIV infection reporting has been implemented on different dates and using different methods than for acquired immunodeficiency syndrome (AIDS)
case reporting.
Totals reported to the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD), as of June 30, 2012.
637
QuickStats
FROM THE NATIONAL CENTER FOR HEALTH STATISTICS
Percentage
40
2011
2009
30
20
10
0
Looked up health Used online chat
information on
groups to
the Internet
learn about
health topics
Filled a
prescription
Scheduled
appointment
with health-care
provider
Communicated
with health-care
provider by
e-mail
* Based on responses to the following question in 2009: Have you ever used computers for any of the following?
...Looked up health information on the Internet ...Refilled a prescription on the Internet ...Scheduled an
appointment with a health-care provider using the Internet ...Communicated with a health-care provider over
e-mail and Have you ever used online chat groups to learn about health topics. Each question was followed
by an additional question asking if the respondent had performed the particular activity in the past 12 months.
In a supplement to the 2011 NHIS, the questions were slightly reworded to combine the measure and period
(DURING THE PAST 12 MONTHS, have you ever used computers for any of the following ...Look up health
information on the Internet ...Fill a prescription ...Schedule an appointment with a health-care provider
...Communicate with a health-care provider by e-mail ...Use online chat groups to learn about health topics.).
Estimates are based on household interviews of a sample of the 2009 and 2011 civilian, noninstitutionalized U.S.
adult populations. Denominators for each percentage exclude adults who refused to answer or did not know.
95% confidence interval.
From 2009 to 2011, increases were noted in the proportion of adults aged 18 years who used the Internet to fill a prescription
(5.9% to 7.1%), schedule an appointment with a health-care provider (2.6% to 4.5%), and communicate with a health-care
provider by e-mail (4.6% to 5.5%). The use of online chat groups to learn about health topics also increased (3.3% to 3.7%). The
percentage of adults who looked up health information on the Internet did not change significantly from 2009 (45.5%) to 2011
(46.5%), but in both years, looking up health information on the Internet was seven to 14 times as likely to occur as each of the
other four activities.
Source: National Health Interview Survey, 2009 and 2011 Sample Adult access to health care and utilization supplemental components.
Reported by: Robin A. Cohen, PhD, rcohen@cdc.gov, 301-458-4152; Patricia F. Adams.
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