Morbidity and Mortality Weekly Report

www.cdc.gov/mmwr

Weekly

October 12, 2007 / Vol. 56 / No. 40

World Arthritis Day October 12, 2007

October 12, 2007, is World Arthritis Day, which is intended to highlight the everyday challenges at home and in the workplace for persons with arthritis or rheumatism and to encourage solutions to these challenges. For example, the pain, fatigue, and activity limitations that often accompany arthritis can prevent some persons from working, resulting in disability. Various accommodations, such as flexible work schedules and assistive devices, can counter the effects of arthritis and help keep persons with arthritis working. Accommodating persons with disabilities, including those attributed to arthritis, is a goal of the U.S. Department of Labors Office of Disability Employment Policy. Each October, it sponsors National Disability Employment Awareness Month, which is intended to increase public awareness of the contributions and skills of U.S. workers with disabilities and to eliminate employment barriers. The Americans with Disabilities Act (ADA) prohibits discrimination against persons with disabilities under certain circumstances, including some employment situations. However, the ADA is underused and often misunderstood by persons with arthritis (1). Anticipating employment disability caused by arthritis and addressing employment barriers through increased education, awareness, and other interventions can help reduce arthritis disability in the U.S. workforce. Additional information about World Arthritis Day is available at http://www.worldarthritisday.org.
Reference 1. Allaire SH, Evans SR, LaValley MP, Merrigan DM. Use of the Americans with Disabilities Act by persons with rheumatic diseases and factors associated with use. Arthritis Rheum 2001;45:17482.

State-Specific Prevalence of Arthritis-Attributable Work Limitation United States, 2003

One of the Healthy People 2010 objectives calls for a reduction in the proportion of adults with doctor-diagnosed arthritis who are limited in their ability to work for pay because of arthritis (objective 2-5b) (1). Persons who are limited in their work by arthritis are considered to have arthritis-attributable work limitation (AAWL). In the United States, AAWL affects one in 20 working-age adults (aged 1864 years) and one in three working-age adults with self-reported, doctor-diagnosed arthritis (2). To estimate state-specific prevalence of AAWL and the percentage employed among working-age U.S. adults with AAWL, CDC analyzed data from the 2003 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report describes the results of that analysis, which indicated that the statespecific prevalence of AAWL among all working-age adults ranged from 3.4% (Hawaii) to 15.0% (Kentucky) (median among states: 6.7%) in 2003. Among those with self-reported, doctor-diagnosed arthritis, the prevalence of AAWL ranged from 25.1% (Nevada) to 51.3% (Kentucky) (median among states: 33.0%). In every state, persons with work limitations attributed to arthritis reported being employed less frequently than working-age adults in the state overall and persons with arthritis but not work
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1050 Deaths from Intravenous Colchicine Resulting from a Compounding Pharmacy Error Oregon and Washington, 2007 1052 HIV/AIDS Among Hispanics United States, 2001 2005 1057 Notices to Readers 1058 QuickStats

depar tment of health and human ser vices department services

Centers for Disease Control and Prevention

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The MMWR series of publications is published by the Coordinating Center for Health Information and Service, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333.
Suggested Citation: Centers for Disease Control and Prevention. [Article title]. MMWR 2007;56:[inclusive page numbers].

Centers for Disease Control and Prevention Julie L. Gerberding, MD, MPH Director Tanja Popovic, MD, PhD Chief Science Officer James W. Stephens, PhD Associate Director for Science Steven L. Solomon, MD Director, Coordinating Center for Health Information and Service Jay M. Bernhardt, PhD, MPH Director, National Center for Health Marketing Katherine L. Daniel, PhD Deputy Director, National Center for Health Marketing Editorial and Production Staff Frederic E. Shaw, MD, JD Editor, MMWR Series Suzanne M. Hewitt, MPA Managing Editor, MMWR Series Douglas W. Weatherwax Lead Technical Writer-Editor Catherine H. Bricker, MS Jude C. Rutledge Writers-Editors Beverly J. Holland Lead Visual Information Specialist Lynda G. Cupell Malbea A. LaPete Visual Information Specialists Quang M. Doan, MBA Erica R. Shaver Information Technology Specialists Editorial Board William L. Roper, MD, MPH, Chapel Hill, NC, Chairman Virginia A. Caine, MD, Indianapolis, IN David W. Fleming, MD, Seattle, WA William E. Halperin, MD, DrPH, MPH, Newark, NJ Margaret A. Hamburg, MD, Washington, DC King K. Holmes, MD, PhD, Seattle, WA Deborah Holtzman, PhD, Atlanta, GA John K. Iglehart, Bethesda, MD Dennis G. Maki, MD, Madison, WI Sue Mallonee, MPH, Oklahoma City, OK Stanley A. Plotkin, MD, Doylestown, PA Patricia Quinlisk, MD, MPH, Des Moines, IA Patrick L. Remington, MD, MPH, Madison, WI Barbara K. Rimer, DrPH, Chapel Hill, NC John V. Rullan, MD, MPH, San Juan, PR Anne Schuchat, MD, Atlanta, GA Dixie E. Snider, MD, MPH, Atlanta, GA John W. Ward, MD, Atlanta, GA

limitations. Greater use of interventions is needed to help persons with arthritis become and stay employed. The BRFSS survey is a state-based, random-digitdialed telephone survey of the noninstitutionalized, U.S. civilian population aged >18 years conducted annually in all 50 states, the District of Columbia (DC), Guam, Puerto Rico, and the U.S. Virgin Islands. The 2003 BRFSS survey was the only state-specific survey to assess AAWL among persons with doctor-diagnosed arthritis. Doctor-diagnosed arthritis was defined as a yes response to the question, Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia? AAWL was defined as a yes response to the following: In this next question, we are referring to work for pay. Do arthritis or joint symptoms now affect whether you work, the type of work you do, or the amount of work you do? Participants were asked to choose one of the following to determine their employment status: employed for wages, self-employed, out of work for more than 1 year, out of work for less than 1 year, homemaker, student, retired, or unable to work. Respondents were considered employed if they reported being employed for wages or self-employed. Respondents with missing values for doctor-diagnosed arthritis were excluded from the analysis. State-specific prevalence of AAWL was estimated using the population of working-age adults in the state as the denominator. The state population of working-age adults with arthritis was used as the denominator to calculate the proportion of AAWL in this group. The percentage employed* was estimated for three groups in the workingage population: 1) overall, 2) among those reporting doctordiagnosed arthritis, and 3) among those reporting arthritis and AAWL. Ranges and medians are reported for the 50 states and DC. Weighted point estimates and 95% confidence intervals were derived, accounting for the complex survey design. The Council of American Survey Organizations (CASRO) response rates among the 54 states and territories for the 2003 BRFSS survey ranged from 34.4% (New Jersey) to 80.5% (Puerto Rico) (median: 53.2%), and cooperation rates ranged from 60.1% (California) to 91.9% (Puerto Rico) (median: 74.8%).

* The measure percentage employed is distinct from employment rate as defined by the Bureau of Labor Statistics (definition available at http://www.bls.gov/bls/ glossary.htm), which calculates employment and unemployment among those who have made specific efforts to find employment. No data on efforts to find employment are available through the BRFSS survey. Additional information available at http://www.cdc.gov/brfss/technical_infodata/ pdf/2003summarydataqualityreport.pdf.

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In 2003, the state-specific prevalence of AAWL among working-age adults ranged from 3.4% (Hawaii) to 15.0% (Kentucky) (median among states: 6.7%) (Table). In the territories, prevalence of AAWL was 4.5%, 4.7%, and 5.7% for Puerto Rico, the U.S. Virgin Islands, and Guam, respectively. AAWL was higher in all states and territories among adults aged 4564 years compared with those aged 1844 years, with the median for the older group (11.7%; range: 5.5% [Hawaii] to 23.5% [Kentucky]) nearly three times that of the younger group (3.9%; range: 2.1% [Hawaii] to 9.6% [Kentucky]). The prevalence of AAWL among adults with doctor-diagnosed arthritis ranged from 25.1% (Nevada) to 51.3% (Kentucky) (median among states: 33.0%). Age adjustment resulted in nearly identical estimates. Among all 50 states and DC, the median percentage employed was 73.2% (range: 60.6% [West Virginia] to 82.0% [South Dakota]) for the overall working-age population (Figure) but was consistently lower for those with doctor-diagnosed arthritis (median among states: 64.3%; range: 47.6% [Kentucky] to 77.1% [South Dakota]) and lower still among those with AAWL (median among states: 48.7%; range: 32.9% [Kentucky] to 67.7% [South Dakota]). This pattern also was observed among all the territories except Puerto Rico. Age adjustment resulted in similar estimates.
Reported by: KA Theis, MPH, JM Hootman, PhD, CG Helmick, MD, L Murphy, PhD, J Bolen, PhD, G Langmaid, Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion; GC Jones, PhD, Div of Human Development and Disability, National Center on Birth Defects and Developmental Disability, CDC.

Editorial Note: This report provides the first state-specific prevalence estimates of AAWL among working-age adults. The findings indicate that, in 2003, AAWL varied by state. A recent study demonstrated that, in 2003, the economic costs of low employment among those with arthritis were substantial, with estimated state-specific earnings losses attributed to arthritis and other rheumatic conditions ranging from approximately $79 million (DC) to $4,273 million (California) (3). Both the number of persons affected by arthritis and the prevalence of arthritis are projected to increase (4). Assuming that the 2003 proportion of AAWL among adults with arthritis remains stable, the number of persons experiencing AAWL and its associated consequences will increase. The findings in this report are subject to at least five limitations. First, doctor-diagnosed arthritis was selfreported (i.e., not confirmed by a health-care provider); however, this measure has been validated for surveillance purposes (5). Second, the AAWL question encompassed

three work factors (i.e., whether persons are able to work, the type of work they do, and the amount of work they do); the analysis could not examine the independent associations of AAWL and each work factor. Third, worklimiting factors other than AAWL might have contributed to the lower percentage employed among working-age adults with AAWL; however, at least some of the consistently lower employment prevalence among those with AAWL likely is the result of arthritis. Fourth, BRFSS excludes certain populations, including those in the military, residing in institutions, and without landline telephones. Finally, BRFSS has a low median response rate; however, BRFSS weighting procedures partially correct for nonresponse. The effect of low response rates is uncertain. Arthritis is common, affecting nearly 46 million adults nationally, and is associated with numerous functional and activity limitations (4). Physical impairments, such as pain and activity limitations, might underlie AAWL by interfering with the ability of a person to perform work-related tasks and therefore constitute substantial disability. These state-level data on disability attributed to AAWL are critical for program planning and policy development at the local level. Several interventions have the potential to decrease the impact of arthritis on work. First, CDC funds 36 state health departments to expand the reach of evidence-based programs and interventions for persons with arthritis. Although the content of these programs is not work-specific, they have been demonstrated to be effective in reducing physical and functional limitations, decreasing pain, and delaying disability attributed to arthritis (6), which might contribute to AAWL. Also, because these programs are designed for community-based implementation, they are feasible for worksite health-promotion programs. Second, federal/state partnership programs to increase employment among persons with disabilities exist in every state, including vocational rehabilitation. A recent randomized controlled trial demonstrated that vocational rehabilitation delivered to employed persons at risk for job loss because of arthritis can decrease or delay job loss (7). The U.S. Social Security Administrations Ticket to Work Program, a nationwide employment program aimed at providing services for persons with various impairments, is another option for eligible persons.** Finally, reasonable worksite
Including the Arthritis Foundation Exercise Program, Arthritis Foundation Aquatics Program, Arthritis Foundation Self-Help Course, the Chronic Disease Self-Management Program, and EnhanceFitness. Additional information available at http://www.cdc.gov/arthritis/intervention/index.htm. Additional information available at http://www.jan.wvu.edu/sbses/vocrehab.htm. ** Additional information available at http://www.yourtickettowork.com/index.

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TABLE. State- and territory-specific estimated prevalence of arthritis-attributable work limitation (AAWL)* among working-age adults (aged 1864 years), overall and by age group, and proportion of working-age adults with self-reported, doctor-diagnosed arthritis who reported AAWL Behavioral Risk Factor Surveillance System (BRFSS), United States, 2003
AAWL among adults aged 1844 yrs Weighted no. (in 1,000s) (%) (95% CI) 80 8 66 59 429 58 35 10 247 163 10 18 115 108 31 27 147 90 19 62 92 154 76 56 122 10 21 24 15 82 22 292 133 7 170 60 43 198 14 70 12 138 372 41 9 161 90 53 76 8 33 1 (4.8) (3.56.0) (3.2) (2.24.3) (1.94.4) (3.2) (5.9) (4.67.2) (3.1) (2.34.0) (3.2) (2.34.0) (2.8) (2.13.6) (3.3) (2.34.3) ** (4.1) (2.85.5) (4.6) (3.55.7) (2.1) (1.42.8) (3.5) (2.74.4) (2.3) (1.53.5) (4.7) (3.85.5) (2.9) (2.13.7) (2.7) (2.03.4) (9.6) (8.111.2) (5.3) (4.26.4) (4.2) (3.05.4) (3.0) (2.13.9) (3.8) (2.94.6) (4.1) (2.95.3) (3.9) (2.95.0) (5.0) (3.96.2) (5.8) (4.27.3) (3.2) (2.24.2) (3.2) (2.44.0) (2.8) (1.73.9) (3.2) (2.44.0) (2.6) (2.13.1) (3.2) (2.54.0) (4.0) (3.15.0) (4.0) (3.34.8) (3.0) (2.03.9) (4.1) (2.85.3) (4.6) (3.85.4) (3.3) (2.34.2) (4.5) (3.45.6) (3.5) (2.54.6) (4.4) (3.55.4) (4.3) (3.35.3) (6.3) (4.58.0) (4.3) (3.45.1) (4.2) (2.95.5) (3.8) (2.84.9) (5.7) (4.46.9) (3.9) (3.44.4) (8.2) (6.59.9) (3.7) (2.74.7) (4.2) (3.15.3) 4.0 ** (2.2) (1.43.0) (2.9) (1.54.3) AAWL among adults aged 4564 yrs Weighted no. (in 1,000s) (%) (95% CI) 210 19 154 107 758 102 64 19 12 443 289 17 40 297 212 60 59 226 137 41 159 145 388 141 136 219 24 42 51 31 180 51 574 338 17 359 132 103 323 28 163 21 271 525 38 18 188 179 90 123 13 4 72 2 (19.8) (12.1) (13.0) (17.0) (10.0) (9.3) (7.7) (10.1) (9.9) (11.3) (15.1) (5.5) (13.1) (10.2) (14.8) (8.9) (9.7) (23.5) (13.7) (12.1) (11.4) (9.8) (15.8) (11.9) (21.6) (16.7) (10.4) (10.8) (9.7) (9.5) (8.9) (11.8) (12.9) (17.3) (11.8) (13.0) (16.1) (11.7) (10.3) (11.4) (16.7) (12.5) (18.0) (11.2) (9.1) (11.0) (10.6) (11.9) (19.1) (9.6) (10.2) 11.7 (13.7) (8.4) (7.9) (17.322.3) (9.215.0) (10.315.6) (15.019.1) (8.211.8) (7.810.9) (6.49.1) (8.212.0) (7.012.9) (9.213.4) (13.516.7) (4.16.9) (11.215.0) (8.012.9) (13.116.5) (7.410.3) (8.111.3) (21.325.6) (11.915.4) (9.914.3) (9.413.4) (8.411.3) (13.618.1) (10.013.8) (19.323.8) (14.119.3) (8.512.3) (9.212.4) (7.112.2) (8.111.0) (7.89.9) (10.113.4) (11.114.7) (15.219.3) (9.813.8) (10.915.1) (14.617.7) (9.913.5) (8.512.1) (9.513.4) (14.918.5) (10.814.2) (15.420.6) (9.712.8) (7.111.1) (9.412.7) (9.112.1) (11.012.9) (16.821.5) (7.811.4) (8.511.8) (8.618.8) (6.710.1) (5.510.2) AAWL among working-age adults overall Weighted no. (in 1,000s) (%) (95% CI) 290 27 221 165 1,187 160 99 29 15 691 452 27 58 412 320 91 86 374 227 60 221 238 543 217 192 341 35 63 75 46 262 73 866 472 24 529 192 146 521 43 232 33 409 897 79 27 349 270 142 199 21 5 105 3 (10.6) (6.6) (6.7) (10.2) (5.6) (5.5) (4.8) (5.9) (4.2) (7.0) (8.3) (3.4) (7.1) (5.3) (8.5) (5.2) (5.3) (15.0) (8.4) (7.5) (6.4) (6.1) (8.7) (7.0) (11.1) (10.0) (6.2) (6.1) (5.4) (5.8) (5.0) (6.6) (7.4) (9.0) (6.3) (7.6) (9.0) (6.7) (6.9) (6.5) (9.1) (7.4) (11.0) (6.7) (5.7) (6.9) (7.6) (7.0) (12.8) (6.0) (6.6) 6.7 (5.7) (4.5) (4.7) (9.311.9) (5.37.9) (5.48.0) (9.111.3) (4.76.4) (4.76.3) (4.15.5) (4.96.8) (3.05.4) (5.88.1) (7.49.2) (2.74.1) (6.28.1) (4.36.5) (7.79.4) (4.56.0) (4.66.1) (13.716.2) (7.49.4) (6.38.7) (5.47.4) (5.36.8) (7.69.9) (6.08.0) (9.912.2) (8.611.4) (5.27.3) (5.36.9) (4.26.6) (5.06.5) (4.55.5) (5.87.4) (6.58.3) (8.09.9) (5.37.3) (6.58.7) (8.29.8) (5.77.6) (5.97.9) (5.57.5) (8.210.1) (6.58.3) (9.512.5) (5.97.5) (4.66.8) (5.97.8) (6.68.5) (6.57.5) (11.414.2) (5.06.9) (5.77.6) (3.87.5) (3.75.3) (3.56.0) AAWL among working-age adults with arthritis % (95% CI) 38.1 30.7 34.8 40.0 35.7 28.0 25.7 29.1 25.5 36.3 39.0 26.5 35.8 27.9 34.7 28.2 27.5 51.3 38.8 33.1 29.6 31.8 33.3 34.6 44.7 41.8 31.9 30.8 25.1 27.7 26.9 33.0 35.5 39.1 30.8 31.7 41.9 32.3 28.6 30.2 37.2 35.0 40.5 34.8 32.4 32.6 33.7 33.2 41.7 28.7 29.1 33.0 40.2 25.5 34.2 34.341.9 25.436.1 29.240.4 36.543.6 31.440.1 24.531.6 22.429.1 25.033.2 19.131.9 31.341.3 35.742.3 21.731.4 32.039.6 23.133.2 31.837.7 24.631.7 24.131.0 48.054.6 35.242.3 28.537.6 25.833.5 28.535.1 29.537.0 30.538.8 41.148.3 37.246.3 27.436.3 27.434.3 20.030.2 24.530.9 24.529.3 29.536.4 32.039.0 35.842.4 26.635.0 27.835.7 39.044.8 28.436.1 25.032.2 26.334.1 34.140.3 31.438.6 36.044.9 31.438.2 27.637.3 28.936.3 30.137.4 31.335.1 37.945.4 24.832.6 25.632.6 29.650.8 21.329.6 27.041.4

State/Territory Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State median Guam Puerto Rico U.S. Virgin Islands

* Defined as a yes response to the following: In this next question, we are referring to work for pay. Do arthritis or joint symptoms now affect whether you work, the type of work you do, or the amount of work you do? Defined as a yes response to the question, Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia? Confidence interval. Data might be unreliable; relative standard error (RSE) = 2030. ** Not reported; RSE >30. Illinois BRFSS uses a split-sample design; estimates are derived using a special weighting procedure.

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FIGURE. State- and territory-specific estimated percentage employed* among working-age adults (aged 1864 years) overall, among those with self-reported doctor-diagnosed arthritis (DRDX), and among those with arthritis-attributable work limitation (AAWL) Behavioral Risk Factor Surveillance System, United States, 2003
90

80

70

Percentage employed

60

50

40

30

20

Overall DRDX AAWL

10

H I N H D E M E C T W Y R I AK VA M A M D N V IL M T C O M O N J D C U T O H ID O K IN G A N Y N M N C W A FL AR

M I LA M S AL

State/Territory

* Respondents were considered employed if they reported being employed for wages or self-employed. Defined as a yes response to the question, Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia? Defined as a yes response to the following: In this next question, we are referring to work for pay. Do arthritis or joint symptoms now affect whether you work, the type of work you do, or the amount of work you do?

accommodations can help keep persons with arthritis and AAWL employed and independent. The Job Accommodation Network, a service of the U.S. Department of Labors Office of Disability Employment Policy, offers examples of such accommodations for workers with arthritis (e.g., ergonomic work stations and accessible parking) (8). An increasing proportion of U.S. adults are remaining in the workforce after age 64 years (9). At the same time, the number of persons affected by arthritis and its consequences, including activity limitations, are projected to increase with the aging of the U.S. population (4), suggesting a corresponding increase in AAWL and effects on employment. State-based estimates of arthritis impact, such as AAWL, help define the consequences of arthritis, raise awareness, and provide state programs and policy-makers with data for planning. Anticipating and accommodating employment barriers caused by arthritis can prevent disability and maintain a healthy workforce.
Acknowledgment

The findings in this report for the state of Illinois were provided by B. Steiner, state BRFSS coordinator, Center for Health Statistics, Illinois Dept of Public Health.

References 1. US Department of Health and Human Services. Healthy people 2010 (conference ed, in 2 vols). Washington, DC: US Department of Health and Human Services; 2000. Available at http://www.health.gov/ healthypeople. 2. Theis KA, Murphy L, Hootman JM, Helmick CG, Yelin EH. Prevalence and correlates of arthritis-attributable work limitation in the U.S. population among persons ages 1864, 2002 NHIS data. Arthritis Care Res 2007;57:35563. 3. CDC. National and state medical expenditures and lost earnings attributable to arthritis and other rheumatic conditionsUnited States, 2003. MMWR 2007;56:47. 4. Hootman JM, Helmick CG. Projections of U.S. prevalence of arthritis and associated activity limitations. Arthritis Rheum 2006;54:2269. 5. Sacks JJ, Harrold LR, Helmick CG, Gurwitz JH, Emani S, Yood RA. Validation of a surveillance case definition for arthritis. J Rheumatol 2005;32:3407. 6. Brady TJ, Kruger J, Helmick CG, Callahan LF, Boutaugh ML. Intervention programs for arthritis and other rheumatic diseases. Health Educ Behav 2003;30:4463. 7. Allaire SH, Li W, LaValley MP. Reduction in job loss in persons with rheumatic diseases receiving vocational rehabilitation: a randomized controlled trial. Arthritis Rheum 2003;48:32128. 8. Job Accommodation Network. Job accommodations for people with arthritis. Available at http://www.jan.wvu.edu/media/employmentartfact.doc. 9. Federal Interagency Forum on Aging-Related Statistics. Older Americans update 2006: key indicators of well-being. Washington, DC: US Government Printing Office; 2006:1819,64.

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Deaths from Intravenous Colchicine Resulting from a Compounding Pharmacy Error Oregon and Washington, 2007
Colchicine for injection has been available in the United States since the 1950s. Although not approved by the Food and Drug Administration (FDA), intravenous (IV) cholchicine has been an accepted treatment for acute gout symptoms. Several additional IV uses have been studied, including treatment of familial Mediterranean fever, pericarditis, primary biliary cirrhosis, amyloidosis, and Behets syndrome ( 13 ). More recently, outpatient use of IV administration for chronic back pain has been advocated by alternative medicine providers but is not an accepted practice. Colchicine has well-known toxicities that limit its safe therapeutic use. IV doses that exceed the standard single-use therapeutic dose of 24 mg per episode of gout have resulted in life-threatening toxicity (2 ). In March 2007, two persons from Washington and Oregon died after receiving IV colchicine for back pain from an alternative medicine clinic in Oregon. This report describes the investigation, which determined that a measuring error by a Texas compounding pharmacy resulted in a fatal colchicine concentration that was eight times greater than the recognized standard level. A subsequent review of medical records revealed that a third death from colchicine toxicity in a patient treated at the Oregon clinic also occurred in March and likely was associated with the same compounding error. These deaths highlight the potential risk from use of IV colchicine for back pain and the possibly fatal consequences of measuring errors in compounding pharmacy products.

Initial laboratory test results revealed only slightly increased hepatic enzyme levels. The woman was admitted to the intensive care unit (ICU) for observation. The next day, her condition deteriorated, with onset of acute renal insufficiency, an elevated creatinine level (2.6 mg/dL), acidosis (pH = 7.07), leukocytosis (25,100/L), abnormal liver function (aspartate aminotransferase [AST] = 1,933 units/L, alanine transaminase [ALT] = 2,295 units/L), rhabdomyolysis (creatine kinase = 740 units/L), and myocardial toxicity (peak troponin I = 53.6 ng/mL). The woman experienced severe abdominal pain and refractory hypotension; she died from cardiac arrest later the same day. Postmortem colchicine plasma level was 44 ng/mL; the therapeutic colchicine plasma level is <5 ng/mL (4).

Patient B, Oregon
On March 30, 2006, a woman aged 56 years with a history of fibromyalgia and neck pain arrived at an ED with nausea, vomiting, profuse diarrhea, and chest pain. She had been receiving weekly IV colchicine for back pain from naturopathic and allopathic physicians at the same Oregon clinic as patient A. During the 2 preceding months, she had received a series of six weekly colchicine infusions, in doses intended to be 2 mg each, for an intended cumulative dose of 12 mg. Before arrival at the ED, she had just received the last dose at the clinic and had begun experiencing symptoms within an hour of infusion; a clinic staff member instructed her to go to the ED. Initial laboratory test results for blood urea nitrogen (BUN), creatinine, electrolytes, complete blood count, and troponin were within normal ranges, although her white blood cell (WBC) count was elevated (14,100/L). The woman was admitted to the hospital for rehydration and continued observation. The leukocytosis increased to a peak count of 18,400/L, with 40% band forms and evidence of myelocytes, metamyelocytes, and echinocytes on a peripheral smear. During the next 72 hours, she experienced leukopenia and thrombocytopenia (nadir WBC count = 1,400/L, platelet count = 74,000/ L), renal insufficiency (BUN = 38 mg/dL, creatinine = 2.4 mg/dL), rhabdomyolysis (creatine kinase = 1,485 units/L), lactic acidosis (venous lactate = 6.9 mmol/L), abnormal liver function (AST = 626 units/L, ALT = 290 units/L), and myocardial toxicity (peak troponin I of >50 ng/mL). A cardiac echocardiogram performed on the second hospital day indicated mild wall motion abnormalities with a normal ejection fraction. Her serum colchicine level 3 days after the last infusion was 11 ng/mL.

Patient A, Washington
On March 19, 2007, a woman aged 77 years arrived at an emergency department (ED) with sudden onset of nausea, vomiting, numbness, and mild hypotension. She had been receiving treatment for back pain with what was intended to be 2-mg IV doses (4 mL of 0.5 mg/mL labeled concentration) of colchicine administered every other day in a 6-day period (i.e., 3 total doses). She had received part of her treatment at an alternative medicine clinic in Portland, Oregon, and then took IV colchicine to her home in Washington, where she received the third dose shortly before she became ill and sought treatment at the ED. She had obtained the colchicine from a relative who was an employee in the clinic where she received her initial treatment.

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On the third hospital day, the woman was intubated because of worsening hypoxia and evidence of developing acute respiratory distress syndrome (ARDS) on chest radiograph. Her hemodynamic status deteriorated, and she became hypotensive, requiring dopamine and norepinephrine infusions to maintain a systolic blood pressure of 100 mmHg. During the day, she became increasingly anuric and hypoxic with worsening ARDS and was unable to maintain normal oxygen saturation levels, with a fraction of inspired oxygen (FiO2) of 100%. On the evening of the third hospital day, her oxygen saturation levels continued to decrease; she experienced bradycardia and cardiac arrest and died. Her postmortem colchicine blood level was 32 ng/mL.

Investigation and Control Measures

Investigation into the causes of death of the two patients and a suspected third patient indicated that they each received IV colchicine infusions obtained from the same alternative medicine clinic in Oregon. The clinic had purchased the drug from a Texas compounding pharmacy. The Washington case occurred when an employee in the clinic gave colchicine from the implicated lot to her relative (patient A) to take home. The patient had received previous infusions from different lots and had not become ill, but the infusion from the new lot resulted in sudden onset of symptoms on March 19. The unusual circumstances of the womans death were discussed on March 26 at a weekly Oregon-Washington poison center teleconference, alerting toxicologists and poison centers in three states. On March 30, the Oregon patient (patient B) was treated at the same alternative medicine clinic as patient A. On April 2, when staff members at the Oregon Poison Center were consulted about patient B, they notified the county public health department of the two cases. The Oregon Board of Naturopathic Examiners was notified and voluntarily posted a warning on its website the same day. Investigators from the Oregon office of the state medical examiner learned that the deaths both occurred after the patients had received colchicine supplied by the Oregon clinic. The medical examiners office confiscated from the clinic approximately 70 remaining vials of the colchicine, which were from several lots. Toxicology tests of colchicine vials from the same lot used to treat the patients indicated a concentration of 4 mg/mL. However, the vial labels indicated a concentration of 0.5 mg/mL; therefore, each intended infusion of a 2-mg dose of colchicine was actually 16 mg. The clinic supplied its medical records, including records of a third patient who was treated the same day as

patient B and who also died. The clinic closed voluntarily in April 2007 and subsequently ceased operations. The third suspected case occurred in a man aged 55 years who received a colchicine infusion on March 30 (the same day as patient B). He experienced severe vomiting, diarrhea, and chest pain within 1 hour of infusion and sought treatment at an ED. Because he had a history of coronary heart disease and recently had received a cardiac stent, his initial evaluation included a coronary catheterization, which was normal. He died within 24 hours of receipt of his last colchicine infusion; his death was attributed initially to cardiac causes. Media coverage of the deaths associated with the Oregon clinic prompted a nurse who had treated this man to call the poison center and report possible colchicine toxicity. After the investigation, the medical examiner reissued the mans death certificate, listing colchicine toxicity as cause of death. Although an autopsy was performed, no body fluids were available to confirm colchicine toxicity. After the drug concentration in the colchicine vials used was determined to be eight times the labeled concentration, investigators attributed the deaths to an error at the Texas compounding pharmacy. On April 30, in coordination with FDA, the Texas State Board of Pharmacy issued a recall of all colchicine that had been sold or produced by the compounding pharmacy within the last year and shipped throughout the United Sates. No other cases have since been linked to this product.
Reported by: NJ McKeown, DO, BZ Horowitz, MD, F Garlich, MD, Oregon Poison Center; CR Young, MD, Oregon Medical Examiner. WO Robertson, MD, Washington Poison Center.

Editorial Note: FDA policy allows an ingredient from an FDA-approved drug to be compounded to fill a prescription from a licensed practitioner for use by a specifically named patient. Compounding pharmacies are either registered or licensed by state pharmacy boards. Compounded drugs are not evaluated for safety and efficacy and, unlike pharmaceutical manufacturers, traditional compounding pharmacies are not inspected by FDA to ensure that they have the capacity to consistently produce high-quality drugs. However, certain compounding pharmacies that engage in large-scale manufacturing are subject to regulations that FDA imposes on pharmaceutical manufacturers. Although FDA has approved drugs that contain a combination of colchicine and probenecid for oral use, no FDAapproved colchicine products for IV use exist. The Texas State Board of Pharmacy and the Texas attorney general are investigating the deaths described in this report; the Oregon attorney general has issued an injunction against the Texas pharmacy from doing business in Oregon.

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Colchicine, a naturally occurring alkaloid derivative of the autumn crocus Colchicum autumnale and the glory lily Gloriosa superba, has been used to treat gout for centuries. The drug has a narrow therapeutic range; in toxic levels, colchicine can disproportionately affect rapidly dividing cells and have substantial effects on multiple organ systems. In 2005, the American Association of Poison Control Centers Toxic Exposure Surveillance System reported 312 exposures and four deaths related to colchicine (5), annual totals that had remained stable during the preceding 15 years (6). A review of FDA Adverse Event Reporting System data from 1983 to 2000 indicated that IV administration of colchicine in amounts that exceeded the maximum recognized dose resulted in 20 deaths from colchicine toxicity, 17 of these during treatment for gout (2). In 2001, an incident involving an error of 10 times the standard therapeutic dose occurred in Pennsylvania and resulted in an FDA recall from an Arizona compounding pharmacy (7). The recognized maximum cumulative IV dose is 4 mg for a single course of therapy, with a 7-day colchicine-free interval after each full IV course (8). However, deaths have been reported with cumulative doses as low as 5.5 mg (2). Older adults, patients with preexisting renal and hepatic failure, and patients with concomitant use of nonsteroidal antiinflammatory drugs or oral colchicine might have a higher risk for toxicity and death (2). Use of colchicine for treatment of low back pain and intervertebral disc herniation was described initially in the 1970s. A single case series in 1979 suggested some effectiveness with low doses of oral and IV colchicine in reducing pain (9); subsequent prospective double-blind studies showed no improvement over placebo with oral use (10) and only short-lived improvement with IV therapy (3). Nevertheless, numerous Internet sources continue to recommend use of IV colchicine for back pain, referencing these early studies as evidence of the drugs effectiveness. The cases described in this report highlight the risk for serious health consequences from use of IV colchicine for back pain. Although no FDA-approved indication for use of IV colchicine exists, multiple clinics continue to offer such therapy for various musculoskeletal disorders. These deaths underscore the potentially fatal ramifications of errors by compounding pharmacies, which generally are not subject to the same oversight and manufacturing practices as pharmaceutical manufacturers. The public health response to these drug-related deaths and the sharing of public health information among several states, which included poison control centers, medical examiners offices, and county health departments, likely prevented additional deaths.

References 1. Simons RJ, Kingma DW. Fatal colchicine toxicity. Am J Med 1989;86:3567. 2. Bonnel RA, Villalba ML, Karwoski CB, Beitz J. Deaths associated with inappropriate intravenous colchicine administration. J Emerg Med 2002;22:3857. 3. Simmons JW, Harris WP, Koulisis CW, Kimmich SJ. Intravenous colchicine for low back pain: a double-blind study. Spine 1990;15: 7167. 4. ARUP Laboratories, National Reference Laboratory. Available at http:// www.aruplab.com/index.jsp. 5. Lai MW, Klein-Schwartz W, Rodgers GC, et al. 2005 annual report of the American Association of Poison Control Centers national poisoning and exposure database. Clin Toxicol (Phila) 2006;44: 803932. 6. Mullins ME, Carrico EA, Horowitz BZ. Fatal cardiovascular collapse following acute colchicine ingestion. J Toxicol Clin Toxicol 2000;38: 514. 7. Sussman JS, Brozena SC, Skop N, Korecka M, Shaw LM. Accidental intravenous colchicine poisoning. Ther Drug Monit 2004;26:68892. 8. Drugdex System. Greenwood Village, Colorado: Thomson Micromedex. 9. Rask MR. Colchicine use in the damaged disk syndrome (DDS). Report of 50 patients. Clin Orthop Relat Res 1979;143:18390. 10. Schnebel BE, Simmons JW. The use of oral colchicine for low-back pain. A double-blind study. Spine 1988;13:3547.

HIV/AIDS Among Hispanics United States, 20012005

In the United States, Hispanics are affected disproportionately by human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). Although Hispanics accounted for 14.4% of the U.S. population in 2005 (1), they accounted for 18.9% of persons who received an AIDS diagnosis (2). The rate of HIV diagnosis among Hispanics also remains disproportionately high; in 2005, the annual rate of HIV diagnosis for Hispanics was three times that for non-Hispanic whites. To better characterize HIV infection and AIDS among Hispanics in the United States, CDC analyzed selected characteristics of Hispanics in whom HIV infection was diagnosed during 20012005 and those living with AIDS in 2005. The results indicated that the mode of HIV infection for Hispanics varied by place of birth, suggesting that all HIVprevention measures might not be equally effective among Hispanics and that HIV educational activities should address cultural and behavioral differences among Hispanic subgroups. This analysis includes cases of HIV/AIDS diagnosed among Hispanic adults and adolescents aged >13 years during 20012005 in 33 states and cases of Hispanics living with HIV or AIDS in 50 states and the District of Columbia in 2005. Included are HIV cases reported to

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CDC from the 33 states* that have conducted name-based HIV reporting since at least 2001. Confidential name-based HIV and AIDS reporting has achieved high levels of accuracy and reliability (CDC, unpublished data, 2005). HIV/AIDS cases include those with 1) a diagnosis of HIV infection that have not progressed to AIDS, 2) a diagnosis of HIV infection followed by a diagnosis of AIDS, 3) and concurrent diagnoses of AIDS and HIV infection (i.e., in the same month). Cases were classified according to the following transmission categories: 1) male-to-male sexual contact (i.e., among men who have sex with men [MSM]); 2) injectiondrug use (IDU); 3) MSM with IDU; 4) high-risk heterosexual contact (i.e., with a person of the opposite sex known to be HIV infected or at high risk for HIV/AIDS [e.g., MSM or injection-drug user]); and 5) other modes of infection (e.g., receipt of transfusion of blood, blood components, or tissue transplant) and unknown risk factors. Cases reported with unknown risk factors were reclassified into transmission categories (e.g., MSM, IDU, MSM and IDU, high-risk heterosexual contact, and other) in accordance with methods described previously ( 3 ). Potential duplicate cases were identified based on unique identifiers and selected demographic characteristics and were eliminated on both state and national levels. For 2005, annual HIV/AIDS diagnosis rates per 100,000 population were calculated for Hispanics, non-Hispanic whites, and non-Hispanic blacks. Data were adjusted for reporting delays (3). The number of Hispanics living with HIV or AIDS at the end of 2005 was calculated based on reported cases adjusted for delays in reporting and deaths; this calculation does not account for undiagnosed cases. During 20012005, a total of 184,167 adults and adolescents had HIV/AIDS diagnosed in the 33 states and reported to CDC. Of these, 33,398 (18%) were Hispanics; 93,017 (51%) were non-Hispanic blacks; 54,029 (29%) were non-Hispanic whites; 1% were Asian/Pacific Islanders; and <1% were American Indian/Alaska Natives.
* Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. Reporting delays (i.e., time between diagnosis and report) can differ by geographic location, age, sex, transmission category, and race/ethnicity. Adjustments for reporting time were calculated for HIV and AIDS cases using a maximum likelihood statistical procedure that accounts for differences in reporting time for the preceding characteristics while assuming the reporting delay has remained constant over time. Adjustments also were made based on the redistribution of cases across transmission categories by sex, race/ethnicity, and geographic region for cases diagnosed 310 years earlier and initially classified as reported with unknown risk factors but later reclassified.

The mode of HIV infection for 61% of Hispanic males was male-to-male sexual contact, 17% of infections occurred through high-risk heterosexual contact, and 17% occurred through IDU. Among Hispanic females with HIV/AIDS diagnoses, 76% were exposed through high-risk heterosexual contact, and 23% were exposed through IDU (Table 1). In 2005, the overall annual rate of HIV/AIDS diagnosis among Hispanic males was 56.2 per 100,000 population and among Hispanic females was 15.8 per 100,000 population. For Hispanic males, the highest rate of HIV diagnosis (86.3 per 100,000) occurred among those aged 3039 years; for Hispanic females, the highest rate (25.0 per 100,000) occurred among those aged 4049 years. The overall rates for non-Hispanic white and non-Hispanic black males in 2005 were 18.2 and 124.8, respectively, and the rates for non-Hispanic white and non-Hispanic black females were 3.0 and 60.2, respectively. The mode of HIV infection among Hispanics varied by place of birth (Table 2). Infection through male-to-male sexual contact was more common among Hispanics born in South America (65%), Cuba (62%), and Mexico (54%) than among Hispanics born in the United States (46%). A greater proportion of Hispanics born in the Dominican Republic (47%) and Central America (45%) were infected through high-risk heterosexual contact, compared with Hispanics born in the United States (28%). Hispanics born in Puerto Rico had a greater proportion of HIV infections attributed to IDU (33%) than those born in the United States (22%). In 2005, in the 33 states, the rate of living with HIV infection among Hispanics was estimated at 173.0 per 100,000 population (Table 3). Estimated HIV prevalence among Hispanics ranged from 34.3 per 100,000 population in Wyoming to 443.0 in New York. In the 50 states and DC, the rate of living with AIDS among Hispanics was estimated at 244.2 per 100,000 population. Estimated AIDS prevalence ranged from 28.7 per 100,000 population in Montana to 1,165.8 per 100,000 population in DC.
Reported by: L Espinoza, DDS, KL Dominguez, MD, RA Romaguera, DMD, X Hu, LA Valleroy, PhD, HI Hall, PhD, Div of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, CDC.

Editorial Note: These results confirm a previous report of disproportionate rates of HIV diagnosis among Hispanics, who have the second highest rate among all racial/ethnic groups in the United States (4). During 20012004, HIVdiagnosis rates among Hispanics declined by 4.7% and 13.0% among Hispanic males and females, respectively (4).

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These decreases among Hispanics might have resulted from decreased incidence of HIV infection (e.g., in response to prevention measures) or a decrease in HIV testing among Hispanics. However, this report indicates that Hispanics are not a homogenous group, and risk factors differ for Hispanic subpopulations. Nearly half of U.S. Hispanics in whom HIV infection was diagnosed were not born in the United States. Hispanics born in Mexico and elsewhere often migrate to the United States to work as laborers and in service occupations. Migration might contribute to an increase in HIV risk behaviors, perhaps because change in residence can be followed by homelessness, loneliness, isolation, separation from usual sex partners, and financial instability. These factors can be associated with new sex partners, illegal drug use, and inadequate access to health information and healthcare services (5). During 20012005, the primary mode of HIV infection among Hispanic males was male-to-male sexual contact. A recent study of HIV risk behaviors among MSM reported that Hispanic and non-Hispanic black MSM were more likely than non-Hispanic white MSM to report inconsistent condom use during anal sex (6 ). However, male-to-male sexual contact is not the most common transmission category for Hispanics for certain places of birth. High-risk heterosexual contact was more common among Hispanics born in Central America and the Dominican Republic than Hispanics born in South America, Cuba, Mexico, Puerto Rico, and the United States. In addition, HIV knowledge and perceptions of risk differ among U.S. Hispanic subgroups. Immigrants born in Cuba, Mexico, and Puerto Rico who were injection-drug users reported less AIDS knowledge than U.S.-born injection-drug users ( 7 ). The finding that a greater proportion of Puerto Ricoborn Hispanics residing in the 33 states are infected through IDU is consistent with previous reports (8) and might be the result of both greater prevalence of IDU and increased levels of high-risk behaviors related to IDU (e.g., frequency of injecting and sharing syringes) compared with other Hispanics (9). U.S. Hispanic subgroups of varied national origin or ancestry differ in IDU-related behaviors. Puerto Rico-born injection-drug users are more likely to share syringes, cotton, or rinse water and to inject more frequently than Puerto Ricans born in the United States (10). The findings in this report are subject to at least four limitations. First, although AIDS is a reportable condition in all 50 states, name-based HIV data were available from only 33 states. These states represented an estimated 63% of all AIDS cases and 56% of AIDS cases among Hispanics

in the United States during 20012005. The exclusion (2) of data from some states with high AIDS prevalence and a large Hispanic population (e.g., California) results in an underrepresentation of cases among Hispanics. Second, the assumptions by which the approximately 32% of cases that had no known risk factors were redistributed among transmission categories might no longer be valid; these assumptions are being reevaluated. Third, misclassification of Hispanics as members of other races/ethnicities or inability to include undocumented migrant workers might have resulted in underestimations of the number of Hispanics overall and in Hispanic subgroups. Finally, birthplace information was missing for approximately 24% of Hispanics in this analysis. Depending on the distribution of birthplaces for persons with missing information, transmission-category prevalences for certain subgroups might have been larger or smaller. The disproportionate rate of HIV infection among Hispanics might reflect the failure of HIV-prevention programs to reach Hispanics at high risk for acquiring or transmitting HIV infection. More specifically, the difference in HIV transmission categories among Hispanics by place of birth might represent differences in acculturation, linguistic ability, socioeconomic status, and stigma associated with homosexuality or male-to-male sex. CDC recently established an internal committee to develop a National Plan of Action to reduce the number of new HIV infections among Hispanics and to increase access to culturally appropriate prevention, care, and treatment services. The plan is aimed at enhancing research, policy, and community involvement to increase capacity to deliver appropriate HIV-prevention services to Hispanics. CDC will expand its partnerships with other federal agencies, state and local health departments, academic institutions, and community-based organizations to identify specific steps to implement the National Plan of Action. Because the Hispanic population in the United States is expected to nearly triple between 2000 and 2050, additional attention to the impact of HIV on this population is warranted.
References 1. US Census Bureau. Annual estimates of the population by sex, race and Hispanic or Latino origin for the United States: April 1, 2000 to July 1, 2006. Available at http://www.census.gov/popest/national/asrh/ NC-EST2006-srh.html. 2. CDC. Cases of HIV infection and AIDS in the United States and dependent areas, 2005. HIV/AIDS surveillance report, Vol. 17, revised edition. Atlanta, GA: US Department of Health and Human Services, CDC; 2007:12,47. Available at http://www.cdc.gov/hiv/ topics/surveillance/resources/reports/2005report.
Information

available at http://www.census.gov/ipc/www/usinterimproj/ natprojtab01a.pdf.

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TABLE 1. Estimated* number and percentage of HIV/AIDS diagnoses among Hispanic adults and adolescents aged >13 years, by selected characteristics 33 states, 20012005
Males No. Total Age group (yrs) 1319 2029 3039 4049 5059 >60 Transmission category Male-to-male sexual contact Injection-drug use Male-to-male sexual contact and injection-drug use High-risk heterosexual contact Other** Area of residence Rural Suburban Urban Unknown

Females (%) No. 7,571 (2) (23) (38) (24) (9) (3) (61) (17) (4) (17) (1) (4) (8) (86) (2) 269 1,745 2,438 1,983 841 295 1,737 5,728 106 304 523 6,620 124 (3) (23) (32) (26) (11) (4) (23) (76) (1) (4) (7) (87) (2) (%) No. 33,398 790 7,829 12,234 8,314 3,056 1,175 15,742 6,209 1,184 10,028 235 1,477 2,483 28,776 662

Total (%)

25,827 520 6,084 9,797 6,332 2,215 879 15,742 4,472 1,184 4,301 129 1,173 1,961 22,156 538

(2) (23) (37) (25) (9) (3) (47) (18) (3) (30) (1) (4) (7) (86) (2)

* All estimates have been adjusted for reporting delays and the reclassification of cases with unknown risk factors for HIV infection. Data were reported by 33 U.S. states with confidential, name-based reporting: Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. Because column totals were calculated independently of the values for the subpopulations, the values in each column might not sum to the column total. Heterosexual contact with a sex partner known to have HIV infection or to be at high risk for HIV infection. ** Includes receipt of transfusion of blood, blood components, or tissue and unknown risk factor. Rural: Nonmetropolitan area. Suburban: 50,000500,000 population. Urban: >500,000 population.

TABLE 2. Estimated* number and percentage of HIV/AIDS diagnoses among Hispanic adults and adolescents aged >13 years, by transmission category and place of birth 33 states, 20012005
Male-to-male sexual contact and injection- High-risk heterosexual contact drug use Male Female No. (%) No. (%) No. (%) 553 39 45 50 15 153 89 13 227 1,184 (4) (2) (2) (4) (2) (4) (4) (3) (3) (4) 1,409 338 225 185 106 656 243 77 1,060 4,300 (10) (21) (11) (16) (17) (16) (12) (17) (13) (13) 2,385 383 286 111 185 577 421 78 1,302 5,728 (18) (24) (14) (9) (30) (14) (21) (18) (16) (17)

Place of birth

Male-to-male sexual contact No. (%) (46) (41) (65) (62) (30) (54) (29) (40) (47) (47)

Injection-drug use Male Female No. (%) No. (%) 2,001 139 107 76 80 362 502 62 1,142 4,472 (15) (8) (5) (6) (13) (9) (25) (14) (14) (13) 922 43 40 18 40 64 161 28 421 1,737 (7) (3) (2) (2) (7) (2) (8) (6) (5) (5)

Other No. (%) 75 23 10 3 6 43 15 3 57 235

Total** No.

United States 6,189 Central America 657 South America 1,330 Cuba 732 Dominican Republic 181 Mexico 2,163 Puerto Rico 602 177 Other Unknown 3,710 Total** 15,742

(1) 13,535 (1) 1,622 (1) 2,043 (<1) 1,174 (1) 613 (1) 4,018 (1) 2,033 (1) 439 (1) 7,920 (1) 33,398

* All estimates have been adjusted for reporting delays and the reclassification of cases with unknown risk factors for HIV infection. Data were reported by 33 U.S. states with confidential, name-based reporting: Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. Heterosexual contact with a sex partner known to have HIV infection or to be at high risk for HIV infection. Includes receipt of transfusion of blood, blood components, or tissue and unknown risk factor. ** Because row and column totals were calculated independently of the values for the subpopulations, the values in each row and column might not sum to the row or column total. Places of birth other than those specified.

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TABLE 3. Estimated rates* of Hispanic adults and adolescents aged >13 years living with HIV infection (not AIDS) or AIDS, by area of residence United States, 2005
Area of residence Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Total**

Living with HIV infection (not AIDS) No. Rate Rank 76 16 1,295 49 834 6,184 39 207 39 132 202 201 219 66 178 66 533 3,095 361 10,781 408 3 319 116 142 6 135 5,267 137 496 15 224 9 31,851 99.0 67.1 106.5 52.2 125.2 222.0 41.9 100.4 49.5 79.6 193.9 70.7 163.5 162.8 152.9 75.0 130.0 301.2 55.1 443.0 103.2 38.8 163.2 68.0 135.0 52.3 100.8 88.7 71.8 145.4 117.0 124.3 34.3 173.0 19 26 15 29 12 3 31 18 30 21 4 24 5 7 8 22 11 2 27 1 16 32 6 25 10 28 17 20 23 9 14 13 33

No. 73 31 1,192 50 17,270 766 2,147 101 438 7,992 597 100 33 2,410 238 71 146 103 204 24 397 2,040 247 205 44 176 5 104 529 56 3,649 526 22,552 360 3 342 117 258 2,134 275 140 4 159 8,068 184 9 474 528 9 226 12 77,817

Living with AIDS Rate 94.4 129.6 98.1 52.8 184.5 115.0 740.6 274.5 1,165.8 286.9 126.7 140.4 35.9 179.7 115.2 89.4 88.0 166.7 195.9 236.4 164.4 536.2 87.1 153.0 107.7 151.0 28.7 118.7 129.0 259.1 355.1 80.2 926.6 91.2 38.7 174.7 68.6 100.4 570.2 324.0 133.4 35.0 118.9 135.9 96.5 155.5 138.7 134.0 67.6 125.4 46.2 244.2

Rank 38 26 36 46 13 33 3 9 1 8 28 21 49 14 32 40 41 16 12 11 17 5 42 19 34 20 51 31 27 10 6 43 2 39 48 15 44 35 4 7 25 50 30 23 37 18 22 24 45 29 47

* Rates are per 100,000 population. All estimates have been adjusted for reporting delays. Includes only persons living with HIV (not AIDS) in 33 states with confidential name-based reporting: Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Idaho, Indiana, Iowa, Kansas, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. Includes only persons living with AIDS. Cases were from the 50 U.S. states and the District of Columbia. Areas ranked by highest rate. ** Because column totals were calculated independently of the values for the subpopulations, the values in each column might not sum to the column total. Data exclude Puerto Rico, where census information about race and age categories was lacking.

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3. Green T. Using surveillance data to monitor trends in the AIDS epidemic. Statist Med 1998;17:14354. 4. CDC. Racial/ethnic disparities in diagnoses of HIV/AIDS33 states, 20012004. MMWR 2006;55:1215. 5. Organista KC, Balls Organista P, Garcia de Alba JE, Castillo Moran MA, Ureta Carrillo LE. Survey of condom-related beliefs, behaviors, and perceived social norms in Mexican migrant laborers. J Community Health 1997;22:18598. 6. Rhodes SD, Yee LJ, Hergenrather KC. A community-based rapid assessment of HIV behavioural risk disparities within a large sample of gay men in southeastern USA: a comparison of African American, Latino and white men. AIDS Care 2006;18:101824. 7. Freeman RC, Williams ML, Saunders LA. Drug use, AIDS knowledge, and HIV risk behaviors of Cuban-, Mexican-, and Puerto-Ricanborn drug injectors who are recent entrants into the United States. Subst Use Misuse 1999;34:176593. 8. Diaz T, Buehler JW, Castro KG, Ward JW. AIDS trends among Hispanics in the United States. Am J Public Health 1993;83:5049. 9. Deren S, Oliver-Velez D, Finlinson A, et al. Integrating qualitative and quantitative methods: comparing HIV-related risk behaviors among Puerto Rican drug users in Puerto Rico and New York. Subst Use Misuse 2003;38:124. 10. Finlinson HA, Oliver-Velez D, Deren S, et al. A longitudinal study of syringe acquisition by Puerto Rican injection drug users in New York and Puerto Rico: implications for syringe exchange and distribution programs. Substance Use Misuse 2006;41:131336.

potential exposure is anticipated before the second dose of Twinrix (or monovalent hepatitis B vaccine) is due, according to the standard 3-dose schedule (i.e., 1 month after the first dose). Additional information is available from the manufacturers package insert ( 4) and GlaxoSmithKline Vaccines, telephone 800-366-8900.
References 1. CDC. FDA approval for a combined hepatitis A and B vaccine. MMWR 2001;50:8067. 2. Joines RW, Blatter M, Abraham B, et al. A prospective, randomized, comparative US trial of a combination hepatitis A and B vaccine (Twinrix) with corresponding monovalent vaccines (Havrix and Engerix-B) in adults. Vaccine 2001;19:47109. 3. Nothdurft HD, Dietrich M, Zuckerman JN, et al. A new accelerated vaccination schedule for rapid protection against hepatitis A and B. Vaccine 2002;20:115762. 4. GlaxoSmithKline. Revised package insert. Twinrix (hepatitis A inactivated & hepatitis B [recombinant] vaccine). Available at http:// www.fda.gov/cber/label/hahbgsk032807lb.pdf.

Notice to Readers

Notice to Readers

National Latino AIDS Awareness Day October 15, 2007

October 15 marks the fifth National Latino AIDS Awareness Day (NLAAD). Initiated in 2003 by the Latino Commission on AIDS and the Hispanic Federation in partnership with faith and community organizations, NLAAD raises awareness of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the Hispanic/Latino population living in the United States and abroad. In 2005, Hispanics accounted for approximately 14.4% of the U.S. population but 18.9% of persons who received an AIDS diagnosis in the United States. Because the U.S. Hispanic population is expected to triple from 2000 to 2050, HIV/AIDS prevention needs will require greater attention. Modes of HIV infection among Hispanics have been determined to vary by place of birth (1). Taking into account these and other varying risk behaviors among subgroups of Hispanics is an important consideration in developing prevention programs. Information regarding NLAAD is available at http:// nlaad.org. Information regarding CDC activities and resources supporting NLAAD is available at http:// www.cdc.gov/hiv/nlaad.htm.
Reference 1. CDC. HIV/AIDS among HispanicsUnited States, 20012005. MMWR 2007;56:10527.

FDA Approval of an Alternate Dosing Schedule for a Combined Hepatitis A and B Vaccine (Twinrix)
In April 2007, GlaxoSmithKline Vaccine Division (GlaxoSmithKline Biologicals, King of Prussia, Pennsylvania) received approval from the Food and Drug Administration (FDA) for an alternate schedule for Twinrix, a combined hepatitis A and hepatitis B vaccine. Twinrix was first licensed by FDA in 2001 on a 3-dose schedule (0, 1, and 6 months) for vaccination of persons aged >18 years ( 1). Using the newly licensed, alternate 4-dose schedule, Twinrix doses can be administered at 0, 7, and 2130 days, followed by a dose at 12 months. In immunogenicity studies among adults aged >18 years, the first 3 doses of the alternate schedule provided equivalent protection to the first 2 doses in the standard 3-dose Twinrix series (2). The first 3 doses of the alternate schedule also have proven effective in providing protection equivalent to a single dose of monovalent hepatitis A vaccine and to 2 doses of monovalent hepatitis B vaccine, administered using the licensed schedules for the monvalent vaccines (3). Thus, the alternate 4-dose schedule can be useful if vaccination with Twinrix has been initiated and travel or other

1058

MMWR

October 12, 2007

QuickStats
from the national center for health statistics

Estimated Percentage of Adults with Daily Activity Limitations, by Age Group and Type of Limitation National Health Interview Survey, United States, 2006*
20 1844 yrs 16 4564 yrs 6574 yrs

Percentage

>75 yrs 12

0 Limitation in activities of daily living Limitation in instrumental activities of daily living

Type of limitation
* Estimates are based on household interviews of a sample of the civilian, noninstitutionalized U.S. population. Persons with unknown limitation status were excluded from the denominators. 95% confidence interval. Based on response to the question, Because of a physical, mental, or emotional problem, does [person] need the help of other persons with personal care needs, such as eating, bathing, dressing, or getting around inside the home? Based on response to the question, Because of a physical, mental, or emotional problem, does [person] need the help of other persons in handling routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?

In 2006, adults aged >75 years were nearly three times as likely as those aged 6574 years to require the help of another person in performing activities of daily living (e.g., eating, dressing, or bathing) and instrumental activities of daily living (e.g., household chores or shopping). SOURCE: Adams PF, Lucas JW, Barnes PM. Summary health statistics for the U.S. population: National Health Interview Survey, 2006. Vital Health Stat 2007;10(236). Available at http://www.cdc.gov/nchs/data/ series/sr_10/sr10_236.pdf.

Vol. 56 / No. 40

MMWR

1059

TABLE I. Provisional cases of infrequently reported notifiable diseases (<1,000 cases reported during the preceding year) United States, week ending October 6, 2007 (40th Week)*
Disease Anthrax Botulism: foodborne infant other (wound & unspecified) Brucellosis Chancroid Cholera Cyclosporiasis Diphtheria Domestic arboviral diseases,: California serogroup eastern equine Powassan St. Louis western equine Ehrlichiosis: human granulocytic human monocytic human (other & unspecified) Haemophilus influenzae,** invasive disease (age <5 yrs): serotype b nonserotype b unknown serotype Hansen disease Hantavirus pulmonary syndrome Hemolytic uremic syndrome, postdiarrheal Hepatitis C viral, acute HIV infection, pediatric (age <13 yrs) Influenza-associated pediatric mortality, Listeriosis Measles Meningococcal disease, invasive***: A, C, Y, & W-135 serogroup B other serogroup unknown serogroup Mumps Novel influenza A virus infections Plague Poliomyelitis, paralytic Poliovirus infection, nonparalytic Psittacosis Q fever Rabies, human Rubella Rubella, congenital syndrome SARS-CoV, Smallpox Streptococcal toxic-shock syndrome Syphilis, congenital (age <1 yr) Tetanus Toxic-shock syndrome (staphylococcal) Trichinellosis Tularemia Typhoid fever Vancomycin-intermediate Staphylococcus aureus Vancomycin-resistant Staphylococcus aureus Vibriosis (noncholera Vibrio species infections) Yellow fever Current week 1 1 1 24 16 Cum 2007 15 61 20 93 22 1 83 22 3 1 2 371 474 123 5-year weekly average 0 2 1 2 0 0 1 5 0 1 9 11 2 Total cases reported for previous years 2006 1 20 97 48 121 33 9 136 67 8 1 10 646 578 231 2005 19 85 31 120 17 8 543 80 21 1 13 786 506 112 2004 16 87 30 114 30 5 171 112 6 1 12 537 338 59 2003 20 76 33 104 54 2 75 1 108 14 41 362 321 44 2002 2 28 69 21 125 67 2 156 1 164 10 1 28 511 216 23 MN (24) MN (7), MO (1), NC (1), GA (1), FL (1), AR (5) States reporting cases during current week (No.)

AK (1) CA (1)

NC (1)

6 14 3 1 1 1 4 3 3 11

11 91 161 41 19 159 503 73 478 30 206 102 19 454 595 3 4 6 132 11 77 313 13 61 5 97 241 16 245

0 2 3 1 0 5 20 3 0 20 0 3 2 0 10 14 0 0 0 2 0 0 1 8 1 2 0 3 9 0 0 2

29 175 179 66 40 288 802 52 43 875 55 318 193 32 651 6,584 N 17 N 21 169 3 11 1 125 380 41 101 15 95 353 6 1 N

9 135 217 87 26 221 652 380 45 896 66 297 156 27 765 314 N 8 1 N 16 136 2 11 1 129 329 27 90 16 154 324 2 3 N

19 135 177 105 24 200 713 436 753 37 258 N 3 N 12 70 7 10 132 353 34 95 5 134 322 1 N

32 117 227 95 26 178 1,102 504 N 696 56 231 N 1 N 12 71 2 7 1 8 161 413 20 133 6 129 356 N N N

34 144 153 96 19 216 1,835 420 N 665 44 270 N 2 N 18 61 3 18 1 N 118 412 25 109 14 90 321 N N N 1

OH (3), MN (2), CA (1) RI (1), OH (1), MD (1), NC (1), OK (8), TX (1), CA (1)

RI (1), TX (1), CA (1)

FL (1) IN (1) NE (1) MN (1), NE (1), SC (1), FL (1) OH (1), MI (1), AZ (1)

OH (1), MN (1), FL (1)

FL (4), WA (1), CA (6)

: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. * Incidence data for reporting year 2007 are provisional, whereas data for 2002, 2003, 2004, 2005, and 2006 are finalized. Calculated by summing the incidence counts for the current week, the 2 weeks preceding the current week, and the 2 weeks following the current week, for a total of 5 preceding years. Additional information is available at http://www.cdc.gov/epo/dphsi/phs/files/5yearweeklyaverage.pdf. Not notifiable in all states. Data from states where the condition is not notifiable are excluded from this table, except in 2007 for the domestic arboviral diseases and influenzaassociated pediatric mortality, and in 2003 for SARS-CoV. Reporting exceptions are available at http://www.cdc.gov/epo/dphsi/phs/infdis.htm. Includes both neuroinvasive and nonneuroinvasive. Updated weekly from reports to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, VectorBorne, and Enteric Diseases (ArboNET Surveillance). Data for West Nile virus are available in Table II. ** Data for H. influenzae (all ages, all serotypes) are available in Table II. Updated monthly from reports to the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Implementation of HIV reporting influences the number of cases reported. Updates of pediatric HIV data have been temporarily suspended until upgrading of the national HIV/AIDS surveillance data management system is completed. Data for HIV/AIDS, when available, are displayed in Table IV, which appears quarterly. Updated weekly from reports to the Influenza Division, National Center for Immunization and Respiratory Diseases. A total of 71 cases were reported for the 200607 flu season. No measles cases were reported for the current week. *** Data for meningococcal disease (all serogroups) are available in Table II. No rubella cases were reported for the current week. Updated weekly from reports to the Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases.

1060

MMWR

October 12, 2007

TABLE II. Provisional cases of selected notifiable diseases, United States, weeks ending October 6, 2007, and October 7, 2006 (40th Week)*
Chlamydia Previous 52 weeks Cum Med Max 2007 20,393 720 229 50 305 39 66 19 2,694 405 514 925 764 3,121 943 397 715 704 371 1,169 166 151 230 447 95 27 49 4,026 66 103 1,104 624 399 593 488 490 57 1,442 358 143 355 505 2,305 168 362 266 1,490 1,290 485 245 53 47 181 150 104 23 3,370 87 2,678 101 157 319 0 4 120 3 25,327 1,357 829 74 600 70 108 45 4,284 537 2,758 1,682 1,760 6,216 1,367 646 1,080 3,643 443 1,429 252 294 314 565 183 61 84 6,760 140 166 1,767 3,822 696 1,905 3,030 685 92 2,044 558 691 959 720 2,971 288 855 467 1,956 2,026 993 369 253 82 293 394 209 38 4,362 157 3,627 133 394 621 32 207 544 7 780,684 26,378 7,762 1,979 12,030 1,612 2,335 660 107,317 15,808 19,859 37,414 34,236 126,788 36,424 15,936 27,155 32,882 14,391 44,246 6,488 6,176 7,696 17,745 3,122 1,044 1,975 154,785 2,620 4,303 44,582 19,038 15,474 22,648 24,896 19,000 2,224 54,549 12,235 6,235 14,945 21,134 92,661 6,797 14,854 10,196 60,814 45,957 16,101 7,509 2,399 1,488 7,279 6,124 4,140 917 128,003 3,360 102,995 4,032 6,575 11,041 U U 340 5,684 U Coccidioidomycosis Previous 52 weeks Cum Med Max 2007 130 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 82 79 0 0 0 1 0 1 0 47 0 47 0 0 0 0 0 0 0 658 1 0 0 0 1 0 0 0 0 0 0 0 3 0 0 3 2 0 54 0 0 54 1 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 293 293 0 0 0 5 2 5 1 311 0 311 0 0 0 0 0 0 0 5,179 2 N 2 N N N N N 24 16 8 N 6 N N 6 N N N 3 N N 3 N N N N N N N 1 N 1 N N 3,125 3,015 N N N 48 17 42 3 2,018 N 2,018 N N N U U N U Cryptosporidiosis Previous 52 weeks Cum Med Max 2007 82 4 0 1 1 1 0 1 10 0 3 1 4 18 2 1 3 5 6 12 2 1 3 2 1 0 2 20 0 0 11 4 0 1 1 1 0 3 1 1 0 1 5 0 1 1 2 6 0 1 0 1 0 1 0 0 1 0 0 0 1 0 0 0 0 0 931 36 36 6 4 5 3 3 109 2 21 10 103 107 10 12 10 61 48 120 60 15 34 13 21 11 15 67 4 2 35 17 2 9 11 4 5 60 12 39 10 17 41 8 5 11 29 571 6 25 71 18 3 7 498 8 18 2 0 4 14 0 0 0 0 0 7,695 208 36 41 50 44 6 31 956 9 181 47 719 1,267 110 76 135 449 497 1,127 489 90 168 115 119 14 132 869 16 3 477 165 24 72 57 45 10 447 71 213 74 89 243 25 39 89 90 2,465 37 136 314 54 16 72 1,795 41 113 3 6 104 U U N U

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 American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands

Current week 11,779 566 28 57 424 38 19 2,036 223 1,622 191 1,768 831 366 361 77 133 417 1 370 46 3,272 46 1,318 4 446 72 922 461 3 712 78 150 100 384 1,450 256 94 184 916 294 80 159 44 11 1,264 87 747 10 305 115 U U U

Cum 2006 782,339 24,932 7,136 1,727 11,229 1,492 2,426 922 95,807 15,536 18,499 31,332 30,440 132,084 41,444 15,296 27,310 32,075 15,959 47,580 6,380 6,136 9,913 17,651 4,079 1,394 2,027 148,991 2,714 2,225 37,799 27,271 16,302 25,925 16,010 18,494 2,251 58,592 18,136 6,427 14,481 19,548 88,745 6,299 13,950 9,183 59,313 52,367 16,625 12,598 2,234 1,962 6,454 7,556 3,803 1,135 133,241 3,374 104,636 4,438 7,187 13,606 U U 692 3,854 U

Current week 54 N N N N N N N N N N N N N N N N N N N N N N N N 45 43 N N N 2 9 N 9 N N N U U N U

Cum 2006 6,274 N N N N N N 36 32 4 N 1 N N 1 N N N 3 N N 3 N N N N N N N 1 N 1 N N 4,330 4,216 N N N 49 17 46 2 1,903 N 1,903 N N N U U N U

Current week 262 1 1 37 3 1 26 7 32 5 17 5 5 56 30 21 1 4 6 6 12 4 8 117 2 10 37 1 3 64 1 1 U U N U

Cum 2006 4,351 325 38 36 162 38 11 40 519 41 126 120 232 1,115 176 69 116 284 470 697 156 68 150 162 82 8 71 849 12 12 357 215 15 79 112 39 8 142 52 34 22 34 317 18 69 32 198 317 23 61 29 107 8 36 15 38 70 4 4 62 U U N U

C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Incidence data for reporting year 2007 are provisional. Data for HIV/AIDS, AIDS, and TB, when available, are displayed in Table IV, which appears quarterly. Chlamydia refers to genital infections caused by Chlamydia trachomatis. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).

Vol. 56 / No. 40

MMWR

1061

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 6, 2007, and October 7, 2006 (40th Week)*
Giardiasis Previous 52 weeks Cum Med Max 2007 302 24 5 4 9 0 0 3 57 5 24 15 13 46 12 0 12 15 7 20 5 3 0 7 2 0 1 57 1 0 24 10 4 0 2 9 0 10 4 0 0 5 7 2 1 3 0 29 2 8 3 2 2 2 6 1 60 1 43 1 8 6 0 0 5 0 1,513 50 18 10 20 3 9 12 127 11 108 24 29 77 22 0 20 37 19 553 20 11 514 22 8 16 6 106 3 7 47 33 17 0 8 19 21 23 16 0 0 16 55 13 9 42 0 63 9 24 12 8 8 6 27 4 558 9 93 4 15 449 0 0 15 0 12,008 961 271 153 356 20 36 125 2,054 142 827 599 486 1,729 444 N 434 614 237 863 220 119 12 336 96 16 64 2,136 30 34 983 454 187 74 338 36 387 175 N N 212 274 91 74 109 N 1,155 95 368 131 83 88 77 283 30 2,449 57 1,651 51 327 363 U U 165 U Gonorrhea Previous 52 weeks Med Max 6,652 113 47 2 51 3 8 1 716 117 112 204 240 1,222 350 165 290 318 127 371 39 44 59 198 25 2 6 1,615 27 47 471 294 119 282 202 122 18 559 154 54 140 192 982 78 222 101 575 251 105 54 3 1 46 30 17 2 719 10 611 11 22 60 0 1 6 1 259 204 8 96 8 18 5 1,537 159 1,035 360 586 2,578 498 306 747 1,557 181 512 60 86 86 266 57 7 11 3,209 43 72 717 2,068 227 675 1,361 222 36 752 242 268 310 261 1,177 120 384 235 731 454 220 93 20 8 87 58 34 5 875 27 734 22 46 142 2 38 23 3

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 American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands

Current week 230 8 2 6 2 2 24 N 4 19 1 13 1 7 4 1 49 27 16 3 3 N N 8 4 4 N 56 5 12 3 3 2 31 70 4 39 12 15 U U U

Cum 2006 13,618 1,134 237 134 505 21 92 145 2,690 386 917 755 632 2,183 551 N 553 623 456 1,484 236 158 475 431 96 14 74 2,065 34 52 821 500 183 80 372 23 342 163 N N 179 256 92 67 97 N 1,317 127 439 146 81 95 64 335 30 2,147 82 1,706 44 315 U U 189 U

Current week 3,959 74 3 2 68 1 385 100 249 36 716 285 170 149 27 85 130 127 3 1,447 22 497 2 104 331 338 152 1 231 25 45 43 118 605 108 53 64 380 69 23 35 11 302 13 180 5 63 41 U U U

Cum 2007 4,209 1,579 98 2,057 119 311 45 28,066 4,614 5,125 7,926 10,401 51,040 13,532 6,846 11,055 14,568 5,039 14,114 1,413 1,767 2,033 7,751 885 65 200 59,780 1,009 1,768 18,289 7,742 4,735 10,411 10,500 4,642 684 21,145 5,483 2,468 5,637 7,557 38,536 3,000 8,609 3,923 23,004 9,209 3,423 1,842 178 50 1,781 1,255 618 62 27,780 378 24,029 478 806 2,089 U U 63 261 U

Cum 2006 4,204 1,684 97 1,835 150 383 55 25,480 4,136 4,787 7,866 8,691 54,398 15,572 6,792 11,294 15,398 5,342 14,949 1,430 1,729 2,511 7,828 1,059 103 289 66,834 1,132 1,347 18,631 13,580 5,528 13,330 7,392 5,185 709 23,936 8,424 2,301 5,695 7,516 39,067 3,290 8,374 3,455 23,948 11,803 4,236 2,871 132 157 2,249 1,402 654 102 32,046 471 26,452 761 1,114 3,248 U U 87 240 U

Haemophilus influenzae, invasive All ages, all serotypes Previous Current 52 weeks Cum Cum week Med Max 2007 2006
15 2 2 3 3 7 3 2 1 1 3 2 1 U U U 45 3 0 0 2 0 0 0 10 1 3 2 3 6 1 1 0 2 0 3 0 0 1 1 0 0 0 11 0 0 3 2 1 0 1 1 0 2 0 0 0 1 2 0 0 1 0 4 1 1 0 0 0 1 0 0 2 0 0 0 1 0 0 0 0 0 184 19 7 2 6 2 10 1 27 5 15 6 10 15 6 7 5 5 2 24 1 2 17 5 2 2 0 34 3 2 8 7 6 9 4 22 6 9 3 1 1 6 34 2 2 29 3 11 6 4 1 1 2 4 3 1 16 2 10 2 6 5 0 0 1 0 1,699 131 40 9 58 15 7 2 355 50 103 76 126 204 47 45 21 82 9 106 1 9 47 34 13 2 453 6 3 126 92 65 46 38 53 24 96 20 2 7 67 81 8 6 61 6 182 57 45 5 2 9 32 29 3 91 10 21 9 49 2 U U 2 U 1,752 139 39 16 62 10 4 8 350 61 108 65 116 298 89 65 22 65 57 116 1 16 57 31 7 4 429 1 4 132 88 62 46 29 51 16 89 18 5 12 54 73 8 18 40 7 171 72 43 4 11 24 14 3 87 10 25 14 38 U U 1 3 U

8,941 253,879 272,717

C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. * Incidence data for reporting year 2007 are provisional. Data for H. influenzae (age <5 yrs for serotype b, nonserotype b, and unknown serotype) are available in Table I. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).

Max: Maximum.

1062

MMWR

October 12, 2007

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 6, 2007, and October 7, 2006 (40th Week)*
Hepatitis (viral, acute), by type A Previous 52 weeks Cum Cum Current Med Max 2007 2006 week 53 2 0 0 1 0 0 0 8 2 1 2 1 6 2 0 1 1 0 2 1 0 0 0 0 0 0 10 0 0 3 1 1 0 0 1 0 2 0 0 0 1 5 0 1 0 4 5 3 0 0 0 0 0 0 0 12 0 10 0 1 0 0 0 1 0 201 6 3 1 4 3 2 1 16 5 11 6 5 13 6 7 8 4 3 18 4 1 17 2 2 3 1 21 1 5 11 4 5 11 4 5 2 5 3 2 4 5 43 2 3 8 39 15 11 3 1 2 2 2 1 1 92 1 40 2 2 52 0 0 10 0 2,091 84 16 3 34 12 11 8 303 72 54 113 64 218 78 22 58 53 7 129 34 3 56 20 11 5 401 7 14 122 59 59 48 15 69 8 82 15 17 8 42 178 10 24 11 133 183 127 20 4 9 9 7 5 2 513 3 445 4 23 38 U U 45 U 2,713 152 34 8 73 21 9 7 307 91 67 98 51 280 87 20 93 45 35 105 8 24 9 39 16 9 418 11 6 163 44 54 66 20 49 5 102 11 30 7 54 279 43 25 6 205 216 126 34 9 9 11 12 13 2 854 1 810 10 33 U U 48 U 37 2 2 18 2 1 2 11 2 2 2 7 1 5 1 8 4 4 U U U B Previous 52 weeks Med Max 77 2 0 0 0 0 0 0 9 1 2 2 3 9 2 0 2 2 0 2 0 0 0 1 0 0 0 19 0 0 7 2 2 0 1 3 0 6 2 1 0 3 18 1 1 1 14 3 0 0 0 0 1 0 0 0 10 0 7 0 1 0 0 0 1 0 405 5 5 2 1 1 3 1 21 8 13 6 8 23 6 21 8 7 3 15 3 2 13 5 3 1 1 56 3 2 14 6 6 16 5 8 23 17 10 7 8 8 169 7 4 24 135 7 3 2 1 3 3 2 4 1 106 3 31 1 5 74 0 0 9 0 Legionellosis Previous 52 weeks Cum Med Max 2007 43 2 0 0 0 0 0 0 12 1 4 2 4 9 1 1 2 3 0 1 0 0 0 1 0 0 0 7 0 0 2 0 1 1 0 1 0 2 0 1 0 1 2 0 0 0 1 2 0 0 0 0 0 0 0 0 2 0 1 0 0 0 0 0 0 0 106 12 9 1 3 2 6 2 52 9 30 8 21 26 6 6 10 17 3 9 1 1 6 3 1 1 1 25 2 4 10 2 6 4 2 4 4 7 1 6 1 4 16 3 1 6 13 5 3 2 1 1 2 2 2 1 11 1 11 1 1 3 0 0 2 0 1,629 91 30 4 14 7 29 7 501 64 155 71 211 374 56 35 111 164 8 72 8 2 17 33 8 4 280 6 1 119 18 50 35 13 30 8 70 7 35 28 75 6 3 5 61 75 26 14 5 3 7 8 9 3 91 66 1 7 17 U U 3 U

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 American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands

Current week 20 3 2 1 1 1 10 3 2 4 1 2 1 1 1 1 3 2 1 U U U

Cum 2007 2,924 54 23 8 4 5 13 1 327 62 68 69 128 323 86 41 82 102 12 100 16 7 17 47 9 4 748 15 1 263 87 88 107 47 102 38 260 92 55 17 96 605 49 62 41 453 126 40 21 11 29 10 14 1 381 4 284 4 48 41 U U 44 U

Cum 2006 3,352 93 38 19 18 8 8 2 410 131 48 96 135 393 113 41 112 98 29 112 19 10 14 52 12 5 938 37 5 322 164 125 123 70 46 46 251 72 58 9 112 663 59 49 44 511 110 30 10 30 20 20 382 5 309 7 61 U U 46 U

Current week 14 1 1 6 1 1 4 3 3 2 2 2 1 1 U U U

Cum 2006 2,013 145 38 8 61 12 20 6 712 96 230 144 242 454 98 36 114 170 36 59 10 7 11 18 8 5 339 8 16 127 26 74 29 3 46 10 77 9 27 3 38 56 4 10 1 41 101 32 23 11 5 7 5 18 70 70 U U 1 U

C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. * Incidence data for reporting year 2007 are provisional. Data for acute hepatitis C, viral are available in Table I. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).

Med: Median.

Max: Maximum.

Vol. 56 / No. 40

MMWR

1063

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 6, 2007, and October 7, 2006 (40th Week)*
Lyme disease Previous 52 weeks Cum Med Max 2007 255 39 11 3 0 6 0 1 137 27 50 1 41 7 1 0 1 0 5 5 1 0 1 0 0 0 0 50 11 0 1 0 24 0 0 11 0 1 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 2 0 2 0 0 0 0 0 0 0 1,114 286 214 53 20 78 93 13 578 129 426 19 280 92 10 7 6 3 82 195 11 2 188 6 1 7 0 168 34 7 11 1 109 8 2 60 14 5 3 2 0 4 5 1 1 0 5 4 1 1 2 2 2 1 2 1 16 1 9 0 1 8 0 0 0 0 14,588 2,750 1,496 304 21 670 151 108 7,579 1,606 2,566 116 3,291 801 86 40 50 15 610 340 91 9 208 25 5 2 2,881 582 13 73 1 1,477 40 21 617 57 43 10 4 29 45 1 2 42 34 2 2 7 4 7 4 5 3 115 4 107 N 3 1 U U N U Malaria Previous 52 weeks Med Max 21 1 0 0 0 0 0 0 5 0 1 3 1 2 1 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 1 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 0 105 5 3 2 3 4 1 2 12 3 5 7 3 8 6 2 2 2 2 12 1 1 12 1 1 1 1 13 1 2 7 5 5 4 1 4 1 3 1 1 1 2 29 0 2 3 25 6 3 2 2 1 1 1 3 0 45 1 7 1 3 43 0 0 1 0 Meningococcal disease, invasive All serogroups Previous Current 52 weeks Cum Cum week Med Max 2007 2006 7 1 1 3 1 2 3 2 1 U U U 19 1 0 0 0 0 0 0 2 0 1 0 1 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 0 1 0 0 0 0 0 0 0 0 4 0 3 0 0 0 0 0 0 0 87 3 1 3 2 1 1 1 8 2 3 4 5 9 3 4 3 3 3 5 3 1 3 3 1 3 1 11 1 1 7 5 2 6 2 2 2 4 2 2 4 2 15 2 4 4 11 4 2 2 1 1 1 1 2 1 48 1 10 2 3 43 0 0 1 0 781 32 6 5 17 1 3 104 11 27 25 41 103 26 21 19 28 9 49 11 1 15 13 4 2 3 139 1 53 21 20 15 14 13 2 39 7 9 9 14 80 9 25 15 31 47 8 17 3 1 4 2 10 2 188 1 135 7 27 18 6 887 37 9 4 19 3 2 135 17 31 51 36 137 36 20 24 38 19 51 13 4 11 13 6 1 3 155 4 1 60 14 13 24 18 16 5 32 5 7 4 16 83 10 33 8 32 59 14 19 3 4 5 4 6 4 198 3 152 8 35 6

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 American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands

Current week 59 36 25 6 3 2 7 1 6 14 6 6 1 1 2 2 N U U N U

Cum 2006 15,855 3,714 1,524 180 1,350 571 1 88 8,155 2,169 2,944 263 2,779 1,614 105 20 47 40 1,402 505 91 4 396 4 9 1 1,723 413 41 19 7 978 24 17 215 9 29 7 7 3 12 18 18 24 8 5 3 3 4 1 73 3 64 N 6 U U N U

Current week 7 1 1 3 2 1 2 2 1 1 U U U

Cum 2007 801 32 1 6 16 7 2 190 50 111 29 85 36 9 13 18 9 28 3 2 11 5 6 1 195 4 3 47 29 48 18 5 39 2 28 5 7 2 14 70 14 5 51 44 7 16 2 3 2 3 11 129 2 90 2 13 22 U U 3 U

Cum 2006 1,113 45 10 4 22 8 1 286 75 35 137 39 134 66 11 17 27 13 32 1 6 14 6 3 1 1 281 5 3 48 79 66 24 9 45 2 22 8 3 6 5 86 4 6 7 69 60 19 13 1 2 3 5 17 167 23 127 8 9 U U 1 U

C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Incidence data for reporting year 2007 are provisional. Data for meningococcal disease, invasive caused by serogroups A, C, Y, & W-135; serogroup B; other serogroup; and unknown serogroup are available in Table I. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).

1064

MMWR

October 12, 2007

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 6, 2007, and October 7, 2006 (40th Week)*
Pertussis Previous 52 weeks Cum Med Max 2007 171 26 2 2 20 1 0 0 25 3 13 2 7 32 3 0 7 15 3 13 4 3 0 2 1 0 1 18 0 0 4 1 2 1 2 2 0 5 1 0 1 2 20 2 0 0 16 23 4 6 1 0 0 2 7 0 12 0 2 0 1 2 0 0 0 0 1,479 77 5 14 46 9 31 9 155 16 146 6 20 80 23 45 39 54 24 151 16 13 119 9 4 18 6 163 2 2 18 5 8 112 9 17 19 28 18 1 26 7 226 17 1 36 174 61 13 17 5 7 5 8 47 5 547 8 167 2 11 377 0 2 1 0 6,321 822 44 63 613 48 27 27 884 113 460 90 221 1,161 108 47 232 575 199 495 113 106 111 63 48 4 50 741 10 2 186 24 83 250 62 97 27 299 63 5 162 69 692 119 14 6 553 810 162 218 34 32 11 54 280 19 417 41 109 16 80 171 U U U Rabies, animal Previous 52 weeks Cum Med Max 2007 94 12 4 2 0 1 0 2 13 0 1 12 3 1 0 1 0 0 5 0 2 0 0 0 0 0 40 0 0 0 4 7 9 1 13 0 4 0 0 0 3 2 0 0 0 0 3 2 0 0 0 0 0 0 0 4 0 3 0 0 0 0 0 1 0 148 22 10 7 0 4 3 13 44 0 5 44 48 15 1 27 11 0 13 3 7 5 4 0 6 2 71 0 0 29 34 18 19 11 31 8 11 8 3 1 9 32 5 1 22 27 14 12 0 0 3 1 2 2 4 10 6 8 0 3 0 0 0 5 0 3,804 465 184 67 41 33 140 605 33 572 347 107 10 163 67 223 30 93 27 39 16 18 1,616 100 200 267 396 46 556 51 133 18 1 114 70 25 45 178 125 14 2 8 13 16 167 36 122 N 9 U U 37 U Rocky Mountain spotted fever Previous Current 52 weeks Cum week Med Max 2007 35 1 1 5 5 22 1 18 1 2 7 7 N N N U U N N U 28 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 4 0 0 0 3 0 0 0 13 0 0 0 0 1 4 1 2 0 5 1 0 0 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 211 10 0 0 1 0 9 0 6 2 1 3 3 4 3 2 1 2 0 31 4 1 1 25 2 0 1 110 2 1 4 5 7 96 7 10 3 16 8 2 2 10 168 53 1 108 7 4 1 2 1 1 0 1 0 2 3 0 3 0 1 0 0 0 0 0 1,596 48 6 3 19 20 40 23 5 3 9 332 13 1 1 303 10 4 781 10 1 17 30 49 509 56 104 5 205 61 5 9 130 153 80 2 45 26 29 7 3 4 1 4 10 8 N 6 N 2 N U U N N U

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 American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands

Current week 95 6 1 5 20 1 1 18 12 12 33 5 2 23 2 1 2 1 1 19 1 2 16 3 1 2 U U U

Cum 2006 10,831 1,302 86 94 820 166 45 91 1,431 243 635 77 476 1,682 422 181 446 459 174 1,012 242 227 160 259 79 25 20 858 3 6 172 74 117 155 141 155 35 272 56 56 32 128 648 71 23 18 536 2,095 433 633 77 102 61 95 630 64 1,531 78 1,278 84 91 U U 57 1 U

Current week 50 19 9 2 1 4 3 6 1 1 4 7 1 5 1 13 13 1 1 1 1 3 1 2 N U U U

Cum 2006 4,420 357 160 89 34 25 49 428 28 400 140 44 11 40 45 268 54 66 35 62 16 35 1,853 176 219 337 414 142 479 86 205 69 23 4 109 776 26 5 52 693 190 125 24 14 5 8 9 5 203 15 166 N 22 U U 66 U

Cum 2006 1,718 11 10 1 76 36 21 19 55 24 6 2 22 1 182 5 1 3 151 22 925 19 1 10 48 69 662 32 81 3 319 77 3 4 235 105 46 4 28 27 43 11 4 13 2 7 6 2 N N 2 N U U N N U

C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. * Incidence data for reporting year 2007 are provisional. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).

Med: Median.

Max: Maximum.

Vol. 56 / No. 40

MMWR

1065

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 6, 2007, and October 7, 2006 (40th Week)*
Salmonellosis Previous 52 weeks Cum Med Max 2007 843 29 0 3 19 3 1 1 100 11 29 24 32 104 30 15 17 26 16 49 8 7 13 15 4 0 3 222 2 0 85 33 15 29 18 20 2 54 14 9 12 17 85 14 16 8 43 44 13 10 3 1 4 5 4 1 103 1 85 5 7 9 0 0 13 0 2,338 357 342 14 49 10 20 5 176 29 112 50 69 208 142 54 34 65 50 101 19 20 44 26 12 23 11 421 10 4 176 70 36 110 51 39 31 134 78 22 101 34 595 46 48 103 470 90 44 22 7 6 10 13 14 4 890 5 260 16 15 625 0 0 66 0 31,204 1,484 342 100 775 130 75 62 3,831 288 1,106 1,067 1,370 4,305 1,281 559 695 1,062 708 2,094 357 289 521 570 196 34 127 8,483 117 16 3,342 1,478 673 1,174 777 761 145 2,242 624 435 580 603 3,020 568 573 465 1,414 1,760 538 429 102 73 142 200 219 57 3,985 64 2,966 201 246 508 U U 446 U Shiga toxin-producing E. coli (STEC) Previous Current 52 weeks Cum Cum week Med Max 2007 2006 79 1 1 9 4 4 1 17 7 8 2 15 1 6 4 1 3 8 8 14 1 8 5 15 N 6 9 U U N U 79 3 0 1 1 0 0 0 8 1 3 0 3 9 1 1 1 3 3 11 2 0 4 2 1 0 0 15 0 0 2 1 2 2 0 3 0 4 0 1 0 2 4 1 0 0 2 8 1 1 1 0 0 1 1 0 6 0 2 0 1 0 0 0 0 0 336 82 77 4 10 3 2 1 63 20 15 4 47 28 6 9 6 11 8 45 38 4 17 12 6 12 5 37 3 1 8 7 5 24 2 8 5 26 19 8 2 10 73 7 2 17 68 31 8 9 16 0 5 3 9 1 164 0 13 4 11 162 0 0 0 0 3,151 212 77 33 74 14 6 8 300 22 149 27 102 429 37 65 66 134 127 575 136 39 189 109 66 1 35 533 13 1 112 74 73 115 15 115 15 239 55 86 4 94 139 27 3 16 93 368 68 64 110 18 32 76 356 N 169 17 67 103 U U N U 3,158 247 75 35 87 24 8 18 377 96 133 40 108 564 94 72 73 150 175 550 110 21 167 140 68 4 40 481 7 2 71 68 97 90 11 128 7 241 24 78 8 131 159 33 13 18 95 434 81 92 77 25 39 103 17 105 N N 12 93 U U N U Shigellosis Previous 52 weeks Cum Med Max 2007 335 3 0 0 2 0 0 0 11 2 3 5 1 32 10 2 1 8 4 37 2 0 5 18 0 0 1 88 0 0 46 34 2 0 2 3 0 26 11 3 5 3 39 2 8 3 24 19 9 2 0 1 1 2 1 0 26 0 21 0 1 1 0 0 0 0 1,287 34 31 5 8 2 3 1 47 9 42 10 21 125 32 11 7 104 13 156 14 7 24 72 7 127 30 174 2 5 76 94 9 14 8 11 6 91 67 32 76 14 655 10 22 63 580 66 37 9 2 13 9 7 4 19 256 2 84 2 6 170 0 0 4 0 11,708 149 31 14 91 5 5 3 534 89 109 200 136 1,664 356 83 52 987 186 1,486 69 20 185 1,081 19 5 107 3,534 9 4 1,845 1,284 85 71 106 123 7 1,439 453 356 486 144 1,318 70 349 97 802 661 371 88 8 19 38 81 27 29 923 7 752 21 60 83 U U 18 U

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 American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands

Current week 595 16 1 14 1 7 7 47 11 6 27 3 42 2 12 17 9 2 261 131 58 22 36 12 2 17 16 1 59 30 29 50 14 13 3 4 16 96 3 65 28 U U U

Cum 2006 33,495 1,895 503 103 982 179 73 55 4,254 913 985 1,018 1,338 4,498 1,262 722 808 978 728 2,085 371 292 535 589 158 21 119 8,561 129 50 3,449 1,432 604 1,231 806 769 91 2,179 580 363 634 602 3,862 697 823 383 1,959 2,076 676 507 141 109 178 205 223 37 4,085 64 3,500 184 335 2 U U 433 U

Current week 249 2 2 35 1 1 33 23 7 15 1 69 39 23 4 3 39 33 6 40 1 1 38 20 10 5 5 21 21 U U U

Cum 2006 10,111 239 67 4 147 4 11 6 750 269 190 219 72 1,076 499 118 129 130 200 1,329 90 120 124 567 112 56 260 2,289 8 14 1,064 836 96 125 75 67 4 536 163 174 77 122 1,439 79 187 99 1,074 1,024 515 175 14 14 99 144 53 10 1,429 7 1,275 39 108 U U 33 U

C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. * Incidence data for reporting year 2007 are provisional. Includes E. coli O157:H7; Shiga toxin-positive, serogroup non-O157; and Shiga toxin-positive, not serogrouped. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).

Max: Maximum.

1066

MMWR

October 12, 2007

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 6, 2007, and October 7, 2006 (40th Week)*
Streptococcal disease, invasive, group A Previous Current 52 weeks Cum Cum week Med Max 2007 2006 38 2 1 1 1 1 8 6 2 14 7 3 3 1 1 N 1 N 2 2 8 4 1 N 2 1 2 2 N N N U U U 96 6 0 0 3 0 0 0 17 3 5 4 5 17 4 2 4 4 0 5 0 0 0 2 0 0 0 22 0 0 6 5 4 1 1 2 0 4 0 1 0 3 6 0 0 1 3 9 3 3 0 0 0 1 2 0 3 0 0 2 0 0 0 0 0 0 261 28 23 3 12 4 12 2 41 10 27 13 11 32 13 17 10 14 6 32 0 3 29 6 3 2 2 52 1 3 16 13 10 22 7 11 3 13 0 3 0 13 90 2 4 23 64 21 11 9 2 0 1 5 7 1 9 3 0 9 0 0 0 0 0 0 3,929 310 96 22 141 31 4 16 732 107 242 172 211 672 179 109 164 192 28 274 28 137 67 23 12 7 1,004 9 8 248 195 174 141 82 124 23 170 N 33 N 137 252 17 16 60 159 402 132 127 15 N 2 48 73 5 113 32 N 81 N N U U U 4,263 281 76 15 140 33 5 12 768 124 247 138 259 819 250 98 171 206 94 289 47 136 61 25 10 10 960 10 13 233 199 179 138 54 109 25 170 N 39 N 131 323 23 16 81 203 562 291 98 8 N 108 54 3 91 N N 91 N N U U U

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 American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands

Streptococcus pneumoniae, invasive disease, nondrug resistant Age <5 years Previous Current 52 weeks Cum Cum week Med Max 2007 2006
12 N 2 2 2 1 1 N 3 2 1 3 1 2 N 2 2 N N N U U N N U 31 2 0 0 2 0 0 0 5 1 2 1 0 5 1 0 1 1 0 2 0 0 1 0 0 0 0 4 0 0 1 0 1 0 0 0 0 1 0 0 0 1 4 0 0 1 1 3 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 108 11 6 1 6 2 2 1 27 4 15 25 0 14 6 10 4 7 2 8 0 1 6 2 2 2 0 14 0 1 5 5 6 0 4 4 4 6 0 0 2 6 43 2 4 13 27 9 7 4 1 0 1 4 2 0 4 2 0 2 0 0 0 0 0 0 1,154 77 2 58 7 8 2 186 25 78 83 N 180 47 16 59 49 9 86 1 58 16 10 1 221 53 44 49 37 31 7 73 N 3 70 170 10 27 40 93 135 73 36 2 N 1 19 4 26 24 N 2 N N U U N N U 998 88 26 51 7 4 138 51 69 18 N 264 66 46 62 51 39 81 11 49 11 7 3 62 1 51 10 16 N 16 170 18 19 38 95 159 89 41 1 N 2 26 20 N 20 N N U U N N U

C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Incidence data for reporting year 2007 are provisional. Includes cases of invasive pneumococcal disease, in children aged <5 years, caused by S. pneumoniae, which is susceptible or for which susceptibility testing is not available (NNDSS event code 11717). Contains data reported through the National Electronic Disease Surveillance System (NEDSS).

Vol. 56 / No. 40

MMWR

1067

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 6, 2007, and October 7, 2006 (40th Week)*
Streptococcus pneumoniae, invasive disease, drug resistant All ages Age <5 years Previous Previous 52 weeks Cum Cum Current 52 weeks Cum Med Max 2007 2006 week Med Max 2007
49 1 0 0 0 0 0 0 2 0 1 0 2 10 0 2 0 5 0 2 0 0 0 1 0 0 0 21 0 0 11 7 0 0 0 0 1 3 0 0 0 2 2 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 256 12 5 2 0 0 4 2 9 0 5 0 6 40 4 31 1 38 0 124 0 11 123 5 1 0 3 59 1 2 29 17 1 0 0 0 17 9 0 2 2 8 11 1 4 9 0 5 0 0 0 0 3 0 5 2 0 0 0 0 0 0 0 0 0 0 1,753 36 9 14 13 98 34 64 422 15 110 2 295 N 116 63 45 2 6 800 7 5 458 280 1 N 49 122 N 19 103 114 1 52 61 45 N 18 15 12 N N N U U N N U 1,883 100 75 6 9 10 111 36 75 394 21 103 15 255 N 84 51 32 1 897 21 481 300 N 95 153 N 29 20 104 66 10 56 78 N 16 32 30 N N N U U N N U 5 2 1 1 3 1 2 U U U 9 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 1 0 0 0 0 0 0 0 0 0 4 0 0 2 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 35 3 0 2 0 0 1 1 5 0 4 0 2 7 1 5 1 5 0 15 0 2 15 1 0 0 1 15 1 0 8 10 0 0 0 0 1 3 0 1 0 3 3 0 2 2 0 3 0 0 0 0 2 0 3 1 1 0 0 1 0 0 1 0 0 0 324 6 1 3 2 21 7 14 57 2 18 1 36 9 5 4 169 2 98 61 8 27 2 25 17 7 10 16 5 9 2 2 2 U U U Syphilis, primary and secondary Previous Current 52 weeks Cum Cum week Med Max 2007 2006 136 6 6 25 5 20 14 4 2 3 4 1 6 6 37 21 4 5 4 3 14 3 2 5 4 27 2 7 18 4 4 3 3 U U U 201 5 0 0 3 0 0 0 28 4 3 16 5 15 7 1 2 4 1 6 0 0 1 4 0 0 0 48 0 3 16 7 6 5 2 4 0 17 6 1 2 6 35 1 8 1 21 7 3 1 0 0 2 1 0 0 38 0 36 0 0 2 0 0 3 0 310 13 10 2 8 3 5 1 44 8 14 34 10 27 13 6 9 10 4 13 3 3 5 11 2 0 3 180 3 12 38 153 15 23 11 17 1 30 16 7 9 15 55 10 29 4 39 19 12 5 1 1 6 7 2 1 57 1 54 2 6 12 0 1 10 0 7,843 193 25 8 123 22 14 1 1,176 154 105 729 188 613 278 41 93 155 46 268 11 16 50 182 2 7 1,839 12 133 682 267 241 247 81 171 5 661 267 46 83 265 1,391 94 354 42 901 268 104 30 1 1 87 36 6 3 1,434 5 1,307 7 13 102 U U 3 117 U 7,263 157 34 8 95 10 8 2 868 131 117 411 209 684 333 69 86 141 55 220 15 18 38 131 5 1 12 1,623 16 96 564 287 237 228 53 134 8 548 252 56 48 192 1,163 60 207 55 841 396 149 58 3 1 112 59 14 1,604 9 1,424 15 14 142 U U 109 U

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 American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands

Current week 23 1 1 5 3 2 N 16 4 12 N N 1 N 1 N N N U U N N U

Cum 2006 303 3 1 2 15 7 8 62 6 16 2 38 12 10 2 142 2 91 49 28 6 22 6 2 4 35 2 23 10 U U U

C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Incidence data for reporting year 2007 are provisional. Includes cases of invasive pneumococcal disease caused by drug-resistant S. pneumoniae (DRSP) (NNDSS event code 11720). Contains data reported through the National Electronic Disease Surveillance System (NEDSS).

1068

MMWR

October 12, 2007

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 6, 2007, and October 7, 2006 (40th Week)*
Varicella (chickenpox) Previous 52 weeks Cum Med Max 2007 796 17 0 0 0 7 0 9 111 0 0 0 111 229 2 0 97 106 19 32 0 8 0 15 0 0 1 100 1 0 20 0 0 0 21 28 24 5 5 0 0 0 167 13 2 0 150 56 0 22 0 5 0 5 15 0 0 0 0 0 0 0 2,813 124 76 7 1 17 0 66 195 0 0 0 195 568 11 0 258 449 80 136 0 52 0 78 0 60 15 239 6 8 76 0 0 0 72 190 50 571 571 0 2 0 1,640 105 11 0 1,534 131 0 62 0 40 1 37 73 11 9 9 0 0 0 0 26,982 541 2 246 293 3,275 N N 3,275 7,582 111 3,063 3,611 797 1,287 N 439 702 N 84 62 3,902 36 14 962 N N 801 1,201 888 383 380 N 3 N 7,990 552 99 7,339 1,992 813 N 304 1 302 554 18 30 30 N N West Nile virus disease Neuroinvasive Nonneuroinvasive Previous Previous 52 weeks Cum Cum Current 52 weeks Cum Med Max 2007 2006 week Med Max 2007 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 0 115 2 2 0 1 0 0 0 3 0 0 3 1 13 10 2 5 3 1 37 4 3 11 9 3 11 8 11 1 0 1 8 2 1 2 1 0 11 2 1 7 1 22 4 2 11 15 33 10 17 2 10 1 7 8 4 16 0 16 0 1 0 877 5 3 2 11 9 2 64 38 6 12 6 2 205 7 10 39 48 9 48 44 31 1 3 20 3 2 2 58 12 3 39 4 138 9 1 45 83 226 28 88 7 33 2 33 20 15 139 135 4 1,447 9 7 2 26 2 8 8 8 242 126 27 42 36 11 221 22 17 31 50 44 20 37 16 3 2 10 1 114 8 5 85 16 364 24 89 26 225 371 47 66 138 12 34 3 56 15 84 77 7 1 1 1 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 275 2 1 0 2 0 1 0 1 0 0 1 1 7 6 3 0 1 1 103 3 6 11 1 13 45 32 5 0 1 0 4 1 0 1 1 0 12 1 0 11 1 12 1 1 7 5 138 14 64 16 30 3 6 7 34 21 0 19 0 4 0 1,926 4 1 2 1 4 1 3 33 22 4 4 3 612 12 19 54 8 72 295 152 25 18 4 2 1 74 3 69 2 56 4 1 32 19 913 34 418 97 152 9 18 24 161 205 187 18

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

Current week 386 12 2 10 N N 101 23 78 12 N 12 N 76 29 N N 29 18 N N 147 1 146 38 33 N 5 N N

Cum 2006 34,499 3,378 1,237 185 1,141 292 523 3,755 N N 3,755 11,071 111 3,357 6,796 807 1,363 N 259 1,006 N 44 54 3,449 60 30 N N N 888 1,304 1,167 27 26 N 1 N 9,338 656 191 8,491 2,118 1,146 N N 9 317 611 35 N N N N

Current week 1 1 1

Cum 2006 2,707 3 2 1 12 3 4 4 1 172 87 53 12 10 10 478 15 13 34 10 214 117 75 13 1 6 1 5 94 1 87 6 226 5 84 20 117 1,450 56 277 850 22 89 4 102 50 259 194 62 3

American Samoa U 0 0 U U U 0 0 U U U 0 0 U U C.N.M.I. U U U U U U U U U Guam 6 30 146 183 0 0 0 0 Puerto Rico 11 30 467 456 0 0 0 0 U.S. Virgin Islands U 0 0 U U U 0 0 U U U 0 0 U U C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. * Incidence data for reporting year 2007 are provisional. Updated weekly from reports to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases (ArboNET Surveillance). Data for California serogroup, eastern equine, Powassan, St. Louis, and western equine diseases are available in Table I. Not notifiable in all states. Data from states where the condition is not notifiable are excluded from this table, except in 2007 for the domestic arboviral diseases and influenza associated pediatric mortality, and in 2003 for SARS-CoV. Reporting exceptions are available at http://www.cdc.gov/epo/dphsi/phs/infdis.htm. Contains data reported through the National Electronic Disease Surveillance System (NEDSS).

Vol. 56 / No. 40

MMWR

1069

TABLE III. Deaths in 122 U.S. cities,* week ending October 6, 2007 (40th Week)
All causes, by age (years) Reporting Area 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 494 132 27 16 25 58 26 4 14 19 52 5 41 29 46 2,031 U 27 72 20 9 45 U 979 21 10 475 30 31 119 27 27 70 37 17 15 1,872 72 31 259 77 187 203 136 163 31 72 14 65 187 41 76 39 43 36 87 53 539 52 22 23 89 32 76 72 70 34 69 >65 344 77 21 14 15 40 16 4 9 15 44 5 33 23 28 1,394 U 21 48 6 7 36 U 689 10 8 276 24 27 95 20 22 52 27 15 11 1,198 49 22 154 37 126 126 100 81 26 53 4 43 110 23 51 30 28 28 58 49 341 36 18 13 61 23 44 45 36 19 46 45-64 101 35 5 2 8 11 6 4 3 4 6 5 12 442 U 4 15 11 1 8 U 214 7 1 123 5 3 15 5 5 13 8 1 3 432 17 8 67 21 43 49 30 37 5 16 5 12 43 11 16 5 12 7 24 4 131 14 4 8 18 3 16 20 21 12 15 25-44 28 8 1 2 3 3 1 1 3 1 5 119 U 2 6 1 1 1 U 53 4 1 36 1 3 2 4 2 1 1 145 2 30 8 9 17 5 29 2 3 5 19 5 6 2 1 1 1 33 1 2 4 1 5 5 8 3 4 1-24 9 6 1 1 1 31 U 1 U 14 14 2 59 3 4 4 8 6 1 11 1 2 3 8 1 1 2 2 2 13 1 2 2 3 1 3 1 <1 12 6 3 1 2 44 U 2 2 U 9 25 1 4 1 38 1 1 4 7 1 5 5 2 7 1 2 2 20 3 3 8 1 2 3 P&I Total 37 11 1 1 1 6 4 2 6 4 1 99 U 6 2 U 44 1 1 9 3 2 9 4 5 8 1 3 1 105 3 2 21 4 14 9 3 7 2 5 5 9 3 2 2 3 1 4 6 35 2 1 5 2 5 6 4 3 7 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 causes, by age (years) All Ages 1,058 129 156 97 88 109 57 47 64 51 150 100 10 748 127 65 81 34 113 117 48 163 1,357 112 U 75 207 37 110 355 53 U 229 45 134 1,066 107 30 85 79 278 33 174 31 126 123 1,273 17 70 U 76 50 U 23 116 188 153 89 156 34 126 65 110 >65 642 69 95 70 41 64 36 18 44 34 99 64 8 474 78 44 58 20 64 78 32 100 840 65 U 50 113 26 75 209 31 U 145 30 96 660 67 22 50 41 176 24 95 25 80 80 885 11 48 U 59 30 U 13 78 117 105 71 118 21 83 52 79 45-64 240 29 43 12 13 26 12 12 15 10 42 24 2 187 35 15 21 9 31 26 13 37 361 38 U 19 59 4 25 94 17 U 63 11 31 261 24 6 27 22 68 5 50 6 23 30 255 4 14 U 12 13 U 7 26 51 25 10 27 7 29 12 18 2,410 25-44 109 18 12 5 26 13 6 11 4 3 6 5 50 9 5 2 9 6 1 18 102 7 U 4 19 5 6 30 4 U 18 3 6 81 10 2 6 7 22 2 16 9 7 86 1 8 U 4 5 U 3 9 13 14 4 2 4 9 1 9 753 1-24 39 6 4 4 6 5 1 4 1 2 2 4 20 4 1 5 5 1 4 25 1 U 1 3 1 2 13 U 2 1 1 36 2 1 5 8 2 4 9 5 26 1 U 1 U 5 3 3 6 1 2 4 258 <1 28 7 2 6 2 1 2 2 2 1 3 17 1 1 1 3 4 2 1 4 29 1 U 1 13 1 2 9 1 U 1 25 4 1 4 4 6 5 1 20 U 1 1 U 3 2 5 1 3 1 3 233 P&I Total 61 5 9 8 9 3 3 3 3 5 8 1 4 41 8 5 5 2 8 5 2 6 79 6 U 6 16 2 7 13 1 U 14 5 9 73 4 2 7 7 22 4 9 3 9 6 85 1 3 U 10 3 U 1 9 10 17 7 9 4 5 1 5 615

10,438** 6,778

U: Unavailable. :No reported cases. * Mortality data in this table are voluntarily reported from 122 cities in the United States, most of which have populations of >100,000. A death is reported by the place of its occurrence and by the week that the death certificate was filed. Fetal deaths are not included. Pneumonia and influenza. Because of changes in reporting methods in this Pennsylvania city, these numbers are partial counts for the current week. Complete counts will be available in 4 to 6 weeks. Because of Hurricane Katrina, weekly reporting of deaths has been temporarily disrupted. ** Total includes unknown ages.

1070
TABLE IV. Provisional cases of selected notifiable disease,* United States, quarter ending September 29, 2007 (39th Week)
Tuberculosis Previous 4 quarters Min Max 2,368 3,921 16 11 3 0 0 0 0 392 80 43 218 45 233 121 0 35 52 15 101 7 12 46 26 0 0 2 440 0 0 185 35 45 61 0 37 4 113 35 17 22 32 240 21 0 33 176 66 23 0 0 0 0 0 5 0 506 9 400 22 0 62 0 0 0 0 49 28 6 0 8 14 5 598 136 124 269 98 380 177 33 93 65 23 149 14 20 67 36 12 9 6 815 6 15 315 117 75 144 63 138 6 207 51 37 36 95 443 33 0 43 381 226 138 28 0 12 33 14 14 1 1,062 24 925 37 26 70 3 11 48 0

MMWR

October 12, 2007

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 American Samoa C.N.M.I. Guam Puerto Rico U.S. Virgin Islands

Current quarter 2,863 38 26 6 1 5 547 124 73 269 81 292 137 74 65 16 125 9 20 53 29 12 2 499 6 1 192 64 75 82 12 61 6 152 35 37 26 54 443 33 40 370 98 74 5 10 9 669 15 557 27 70 U 17

Cum 2007 7,604 103 65 13 4 19 2 1,428 317 165 751 195 774 387 7 147 179 54 354 25 52 166 83 18 10 1,459 10 12 592 216 180 222 28 184 15 428 126 79 81 142 1,053 77 122 854 248 158 22 16 24 28 1,757 34 1,430 96 197 U 23

Cum 2006 9,382 212 66 11 104 9 18 4 1,516 372 192 713 239 844 392 92 128 181 51 353 26 75 157 70 16 9 1,940 28 52 723 415 123 230 159 194 16 465 145 59 77 184 1,396 81 111 1,204 410 176 96 68 43 25 2 2,246 46 1,854 93 55 198 U U 43 64

C.N.M.I.: Commonwealth of Northern Mariana Islands. U: Unavailable. : No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Min: Minimum. Max: Maximum. * AIDS and HIV/AIDS data are not updated for this quarter because of upgrading of the national HIV/AIDS surveillance data management system.

Vol. 56 / No. 40

MMWR
FIGURE I. Selected notifiable disease reports, United States, comparison of provisional 4-week totals October 6, 2007, with historical data
DISEASE Giardiasis Hepatitis A, acute Hepatitis B, acute Hepatitis C, acute Legionellosis Measles Meningococcal disease Mumps Pertussis 0.25 0.5 1 Ratio (Log scale)*
Beyond historical limits

1071

DECREASE

INCREASE

CASES CURRENT 4 WEEKS 1,092 138 153 34 127 2 36 14 286

* Ratio of current 4-week total to mean of 15 4-week totals (from previous, comparable, and subsequent 4-week periods for the past 5 years). The point where the hatched area begins is based on the mean and two standard deviations of these 4-week totals.

Notifiable Disease Data Team and 122 Cities Mortality Data Team Patsy A. Hall Deborah A. Adams Rosaline Dhara Willie J. Anderson Carol Worsham Lenee Blanton Pearl C. Sharp

1072

MMWR

October 12, 2007

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U.S. Government Printing Office: 2007-623-038/41053 Region IV ISSN: 0149-2195