: This publication contains summary tables of the official statistics for the reported occurrence of nationally notifiable diseases in the United States for 1997. These statistics are collected and compiled from reports to the National Notifiable Diseases Surveillance System (NNDSS), which is operated by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE). Because the dates of onset or diagnosis for notifiable diseases are not always reported, these surveillance data are presented by the week they were reported to CDC by public health officials in state and territorial health departments. These data are finalized and published in the MMWR Summary of Notifiable Diseases, United States for use by state and local health departments; schools of medicine and public health; communications media; local, state, and federal agencies; and other agencies or persons interested in following the trends of reportable diseases in the United States. The annual publication of the Summary also documents which diseases are considered national priorities for notification and the annual number of cases of such diseases.

Summary of Notifiable Diseases, United States.

Current trends in US population growth, age distribution, and disease dynamics foretell rises in the prevalence of chronic diseases and other chronic conditions. These trends include the rapidly growing population of older adults, the increasing life expectancy associated with advances in public health and clinical medicine, the persistently high prevalence of some risk factors, and the emerging high prevalence of multiple chronic conditions. Although preventing and mitigating the effect of chronic conditions requires sufficient measurement capacities, such measurement has been constrained by lack of consistency in definitions and diagnostic classification schemes and by heterogeneity in data systems and methods of data collection. We outline a conceptual model for improving understanding of and standardizing approaches to defining, identifying, and using information about chronic conditions in the United States. We illustrate this model’s operation by applying a standard classification scheme for chronic conditions to 5 national-level data systems.

/pdf/defining-and-measuring-chronic-conditions-imperatives-for-4q6bac3kb4.pdf

Defining and Measuring Chronic Conditions: Imperatives for Research, Policy, Program, and Practice

PROBLEM/CONDITION Lyme disease is a multisystem disease that occurs in North America, Europe, and Asia. In the United States, the etiologic agent is Borrelia burgdorferi sensu stricto, a spirochete transmitted to humans by infected Ixodes scapularis and I. pacificus ticks. The majority of patients with Lyme disease develop a characteristic rash, erythema migrans (EM), accompanied by symptoms of fever, malaise, fatigue, headache, myalgia, or arthralgia. Other manifestations of infection can include arthritis, carditis, and neurologic deficits. Lyme disease can be treated successfully with standard antibiotic regimens. REPORTING PERIOD 1992--2006. DESCRIPTION OF SYSTEM U.S. health departments report cases of Lyme disease voluntarily to CDC as part of the National Notifiable Disease Surveillance System. Variables collected include patient age, sex, race, county and state of residence, date of illness onset, and reported signs and symptoms. RESULTS During 1992--2006, a total of 248,074 cases of Lyme disease were reported to CDC by health departments in the 50 states, the District of Columbia, and U.S. territories; the annual count increased 101%, from 9,908 cases in 1992 to 19,931 cases in 2006. During this 15-year period, 93% of cases were reported from 10 states (Connecticut, Delaware, Massachusetts, Maryland, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island, and Wisconsin). Incidence was highest among children aged 5--14 years, and 53% of all reported cases occurred among males. More than 65% of patients with EM had illness onset in June and July, compared with 37% of patients with arthritis. INTERPRETATION Lyme disease is the most commonly reported vectorborne illness in the United States. The geographic distribution of cases is highly focused, with the majority of reported cases occurring in the northeastern and north-central states. During 1992--2006, the number of reported cases more than doubled. A disproportionate increasing trend was observed in children and in young males compared with other demographic groups. PUBLIC HEALTH ACTION The results presented in this report underscore the continued emergence of Lyme disease and the need for tick avoidance and early treatment interventions. Public health practitioners can use the data presented in this report to target prevention campaigns to populations with increasing incidence (i.e., children and young males).

/pdf/surveillance-for-lyme-disease-united-states-1992-2006-fg31gcq6ac.pdf

Surveillance for Lyme disease--United States, 1992-2006.

ContextThe risk of vaccine-preventable diseases among children who have philosophical
and religious exemptions from immunization has been understudied.ObjectivesTo evaluate whether personal exemption from immunization is associated
with risk of measles and pertussis at individual and community levels.Design, Setting, and ParticipantsPopulation-based, retrospective cohort study using data collected on
standardized forms regarding all reported measles and pertussis cases among
children aged 3 to 18 years in Colorado during 1987-1998.Main Outcome MeasuresRelative risk of measles and pertussis among exemptors and vaccinated
children; association between incidence rates among vaccinated children and
frequency of exemptors in Colorado counties; association between school outbreaks
and frequency of exemptors in schools; and risk associated with exposure to
an exemptor in measles outbreaks.ResultsExemptors were 22.2 times (95% confidence interval [CI], 15.9-31.1)
more likely to acquire measles and 5.9 times (95% CI, 4.2-8.2) more likely
to acquire pertussis than vaccinated children. After adjusting for confounders,
the frequency of exemptors in a county was associated with the incidence rate
of measles (relative risk [RR], 1.6; 95% CI, 1.0-2.4) and pertussis (RR, 1.9;
95% CI, 1.7-2.1) in vaccinated children. Schools with pertussis outbreaks
had more exemptors (mean, 4.3% of students) than schools without outbreaks
(1.5% of students; P = .001). At least 11% of vaccinated
children in measles outbreaks acquired infection through contact with an exemptor.ConclusionsThe risk of measles and pertussis is elevated in personal exemptors.
Public health personnel should recognize the potential effect of exemptors
in outbreaks in their communities, and parents should be made aware of the
risks involved in not vaccinating their children.

https://jamanetwork.com/journals/jama/articlepdf/193407/joc01122.pdf

Individual and Community Risks of Measles and Pertussis Associated With Personal Exemptions to Immunization

Objective. —To determine disease incidence and changes in the epidemiology of invasive group A streptococcal infections in a community in Arizona. Design and Setting. —We retrospectively surveyed microbiology records from all 10 hospitals in Pima County, Arizona, to identify patients who had Streptococcus pyogenes isolated from blood, sterile body fluid, or tissue biopsy specimens between April 1985 and March 1990. Demographic and clinical information was abstracted from the medical records of these patients. Patients. —A total of 128 patients with a median age of 53.5 years (range, 6 months to 96 years). Outcome Measures. —Racial/ethnic differences in disease incidence; mortality and changes in the clinical spectrum of disease over the study period. Results. —The annual age-adjusted incidence was 4.3 per 100 000 but was 46.0 per 100000 among Native Americans. Advanced age, age less than 5 years, hypotension, and multi-organ system involvement were significantly associated with increased mortality. From 1985 to 1990, the proportion of infections with hypotension, rash, desquamation, renal impairment, and gastrointestinal involvement increased significantly (χ 2 for trend P ≤.02 for each feature). A toxic shock—like syndrome occurred in 8% of infections since 1988, compared with none of the infections between 1985 and 1987 ( P =.04). Patients with the syndrome were younger than patients with other invasive infections (median age 15 vs 54 years, P =.02), and were less likely to have underlying medical conditions ( P =.008). Conclusions. —Significant changes occurred in the spectrum of invasive group A streptococcal infections in Pima County, Arizona, between 1985 and 1990. Native Americans were at increased risk of acquiring these infections. Patients with the streptococcal toxic shock—like syndrome had epidemiologic features that distinguished them from patients with other invasive infections, including younger age and less underlying illness. ( JAMA . 1993;269:384-389)

The Changing Epidemiology of Invasive Group A Streptococcal Infections and the Emergence of Streptococcal Toxic Shock-like Syndrome: A Retrospective Population-Based Study

Injuries are not among the case definitions. Available: http://www.cdc.gov/mmwr/preview/mmwrhtml/00025629.htm Language: en

Case definitions for public health surveillance.

/pdf/erratum-to-case-definitions-for-public-health-surveillance-4g7q4kie1q.pdf

R. L. Vogt

Papers

Case definitions for public health surveillance.

Erratum to Case definitions for public health surveillance