Final Project Milestone One: Problem Identification and Statement : (Tobacco use and dependence in New Hampshire)
Weekly November 14, 2008 / Vol. 57 / No. 45
department of health and human services Centers for disease Control and Prevention
Morbidity and Mortality Weekly Report www.cdc.gov/mmwr
INSIDE
1226 Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses — United States, 2000–2004
1229 Deaths from Chronic Obstructive Pulmonary Disease — United States, 2000–2005
1232 Notices to Readers 1234 QuickStats
Great American Smokeout — November 20, 2008
Approximately 43.4 million (or one in five) U.S. adults are current smokers (1), and smoking and exposure to tobacco smoke result in approximately 443,000 premature deaths in the United States annually (2). November 20, 2008, marks the American Cancer Society’s 32nd annual Great American Smokeout, an event that encourages smokers to quit for at least 1 day (in the hope that this might challenge them to stop using tobacco permanently) and that raises awareness of the many effective ways to quit for good.
Smoking cessation has substantial and immediate health benefits, and smokers who use proven interventions (e.g., assistance from a health-care provider, pharmacotherapies approved by the Food and Drug Administration, and behav- ioral counseling) greatly increase their likelihood of quitting permanently (3). Smokers in all 50 states, the District of Columbia, and certain U.S. territories who want help in quitting can telephone 800-QUIT-NOW (800-784-8669) for free telephone counseling or referrals.
Information about the Great American Smokeout is avail- able at http://www.cancer.org/docroot/ped/ped_10_4.asp or by telephone at 800-227-2345. Advice on how to quit smoking is available at http://www.smokefree.gov. References 1. CDC. Cigarette smoking among adults—United States, 2007.
MMWR 2008;57:1221–6. 2. CDC. Smoking-attributable mortality, years of potential life lost,
and productivity losses—United States, 2000–2004. MMWR 2008; 57:1226–8.
3. Fiore MC, Jaen CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update. Clinical practice guideline. Rockville, MD: US Department of Health and Human Services, Public Health Service; 2008. Available at http://www.ncbi.nlm.nih.gov/books/ bv.fcgi?rid=hstat2.chapter.28163.
Cigarette Smoking Among Adults — United States, 2007
One of the national health objectives for 2010 is to reduce the prevalence of cigarette smoking among adults to <12% (objective 27.1a) (1). To assess progress toward this objective, each year CDC analyzes self-reported data from the National Health Interview Survey (NHIS). This report summarizes findings for 2007, which indicated that approximately 19.8% of adults were current smokers in 2007, a decrease of 1.0 per- centage point from 2006 (20.8%) (2). Cigarette smoking has declined during the past 40 years among all sociodemographic subpopulations of adults; however, the declines during the past decade have been smaller than in previous decades. The pro- portion of current everyday smokers who made a quit attempt during the preceding year decreased 7.2 percentage points from 1993 (47.0%) to 2007 (39.8%). During 1993–2007, young adults (aged 18–24 years) consistently had the highest prevalence of quitting for >1 day during the preceding year (59.3% in 1993 and 53.1% in 2007). Prevention of initiation and smoking cessation at all ages is beneficial in reducing mor- bidity and mortality. Clinicians should strongly advise smokers to quit and recommend they use effective cessation treatments (3). Health insurers, health insurance purchasers, and health systems should assist clinicians in making effective treatments available by including counseling and medications for smoking cessation as covered benefits and should support effective com- munity interventions for cessation, including increased excise taxes, mass media campaigns, and smoke-free laws (3,4).
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 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
William Schaffner, MD, Nashville, TN Anne Schuchat, MD, Atlanta, GA
Dixie E. Snider, MD, MPH, Atlanta, GA John W. Ward, MD, Atlanta, GA
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 2008;57:[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 Susan F. Davis, MD
(Acting) Assistant Editor, MMWR Series Teresa F. Rutledge
Managing Editor, MMWR Series Douglas W. Weatherwax
Lead Technical Writer-Editor Donald G. Meadows, MA
Jude C. Rutledge Writers-Editors Martha F. Boyd
Lead Visual Information Specialist Malbea A. LaPete
Stephen R. Spriggs Visual Information Specialists
Kim L. Bright, MBA Quang M. Doan, MBA
Phyllis H. King Information Technology Specialists
1222 MMWR November 14, 2008
* For this report, persons identified as white, black, Asian, and American Indian/ Alaska Native are all non-Hispanic. Persons identified as Hispanic might be of any race.
The 2007 NHIS adult core questionnaire, which contained questions on cigarette smoking and cessation attempts, was administered by in-person interview to a nationally repre- sentative sample of the noninstitutionalized, U.S. civilian population aged >18 years (N = 23,393). One adult per selected household was chosen randomly to participate in the survey. NHIS oversampled for blacks, Hispanics, and Asians aged >65 years, who were selected at twice the probability of other adults in the household.* The total household response rate was 87.1%, and the overall survey response rate for the sample adult component of the survey was 67.8%. Smoking status was classified based on the respondent’s answers to the following questions: “Have you smoked at least 100 cigarettes in your entire life?” and “Do you now smoke cigarettes every day, some days, or not at all?” Current smokers reported they had smoked 100 cigarettes or more during their lifetime and currently smoke every day or some days. Former smokers reported smoking at least 100 cigarettes during their lifetime and currently do not smoke. The prevalence of one or more ces- sation attempts during the preceding year was assessed among current everyday smokers and included those who responded “yes” to the question, “During the past 12 months, have you stopped smoking for more than one day because you were try- ing to quit smoking?” Data were adjusted for nonresponse and weighted to provide national estimates of cigarette smoking prevalence and quit attempts; 95% confidence intervals were calculated using statistical software to account for the multi- stage probability sample design. For all comparisons, statistical significance was determined using a two-sided z test; differences were considered statistically significant at p<0.05.
In 2007, an estimated 19.8% (43.4 million) of U.S. adults were current cigarette smokers; of these, 77.8% (33.8 million) smoked every day, and 22.2% (9.6 million) smoked some days. In 2007, 39.8% (13.4 million) of adult current everyday smok- ers had stopped smoking for >1 day during the preceding 12 months because they were trying to quit. Among the estimated 86.8 million adults who had smoked at least 100 cigarettes in their lifetime (defined as ever smokers), 52.1% (47.3 million) were no longer smoking at the time of the interview.
Smoking prevalence was higher among men (22.3%) than women (17.4%) (p<0.01) (Table). Among the different racial/ ethnic populations, Asians (9.6%) had the lowest smoking prevalence, whereas American Indians/Alaska Natives (36.4%) had significantly higher prevalence than the other racial/ ethnic populations (p<0.05 for all comparisons). Smoking prevalence among whites (21.4%) and blacks (19.8%) was
Vol. 57 / No. 45 MMWR 1223
TABLE. Estimated percentage of adults aged >18 years who were current smokers,* by sex and selected characteristics — National Health Interview Survey, United States, 2006 and 2007
Characteristic
Men Women Total
2006 (n = 10,715) 2007 (n = 10,173) 2006 (n = 13,560) 2007 (n = 12,817) 2006 (N = 24,275) 2007 (N = 22,990)
% (95% CI†)
% (95% CI)
% (95% CI)
% (95% CI)
% (95% CI)
% (95% CI)
Race/Ethnicity§
White, non-Hispanic 24.3 (23.0–25.6)
23.1 (21.6–24.6)
19.7 (18.6–20.8)
19.8 (18.7–20.9)
21.9 (21.0–22.8)
21.4 (20.4–22.4)
Black, non-Hispanic 27.6 24.8 19.2 15.8 23.0 19.8 (24.2–31.0) (22.0–27.6) (17.3–21.1) (13.7–17.9) (21.1–24.9) (18.2–21.4)
Hispanic 20.1 18.0 10.1 8.3 15.2 13.3 (17.8–22.4) (15.5–20.5) (8.5–11.7) (6.7–9.9) (13.7–16.7) (11.7–14.9)
Asian, non-Hispanic¶ 16.8 15.9 4.6 4.0 10.4 9.6 (13.1–20.5) (12.8–19.0) (3.0–6.2) (2.4–5.6) (8.4–12.4) (8.0–11.2)
American Indian/Alaska Native, non-Hispanic**
35.6 36.7 29.0 36.0 32.4 36.4 (18.7–52.5) (18.9–54.5) (15.7–42.3) (20.2–51.8) (19.7–45.1) (22.9–49.9)
Education††
0–12 yrs (no diploma) 30.6 29.5 23.0 20.2 26.7 24.8 (27.9–33.3) (26.9–32.1) (20.7–25.3) (18.0–22.4) (25.0–28.4) (23.1–26.5)
<8 yrs 22.3 20.4 12.3 10.0 17.4 15.4 (18.5–26.1) (17.0–23.8) (9.7–14.9) (7.7–12.3) (15.1–19.7) (13.2–17.6)
9–11 yrs 40.1 36.9 31.4 30.0 35.4 33.3 (35.7–44.5) (32.4–41.4) (27.7–35.1) (26.1–33.9) (32.5–38.3) (30.4–36.2)
12 yrs (no diploma) 27.9 33.1 23.3 14.8 25.6 22.7 (21.5–34.3) (25.2–41.4) (17.5–29.1) (10.3–19.3) (21.2–30.0) (18.1–27.3)
High school diploma 27.6 27.4 20.4 20.4 23.8 23.7 (25.3–29.9) (24.9–29.9) (18.7–22.1) (18.3–22.5) (22.3–25.3) (22.0–25.4)
GED§§ diploma 51.3 49.6 40.2 38.9 46.0 44.0 (43.4–59.2) (42.0–57.2) (33.2–47.2) (31.8–46.0) (40.5–51.5) (39.0–49.0)
Associate degree 25.4 21.2 17.8 18.9 21.2 19.9 (22.1–28.7) (18.1–24.3) (15.2–20.4) (16.4–21.4) (19.1–23.3) (17.8–22.0)
Some college (includes associate degree)
26.1 22.5 20.0 19.5 22.7 20.9 (24.2–28.0) (20.2–24.8) (18.3–21.7) (18.0–21.0) (21.4–24.0) (19.5–22.3)
Undergraduate degree 10.8 13.4 8.4 9.4 9.6 11.4 (9.0–12.6) (10.7–16.1) (7.0–9.8) (8.0–10.8) (8.5–10.7) (9.9–12.9)
Graduate degree 7.3 6.4 5.8 6.0 6.6 6.2 (5.4–9.2) (4.7–8.1) (4.1–7.5) (4.5–7.5) (5.3–7.9) (5.1–7.3)
Age group (yrs) 18–24 28.5 25.4 19.3 19.1 23.9 22.2
(24.7–32.3) (22.1–28.7) (16.7–21.9) (16.2–22.0) (21.7–26.1) (19.9–24.5) 25–44 26.0 26.0 21.0 19.6 23.5 22.8
(24.3–27.7) (24.1–27.9) (19.7–22.3) (18.1–21.1) (22.4–24.6) (21.5–24.1) 45–64 24.5 22.6 19.3 19.5 21.8 21.0
(22.7–26.3) (20.8–24.4) (17.9–20.7) (18.0–21.0) (20.6–23.0) (19.7–22.3) >65 12.6 9.3 8.3 7.6 10.2 8.3
(10.6–14.6) (7.8–10.8) (7.0–9.6) (6.3–8.9) (9.2–11.2) (7.3–9.3) Poverty status¶¶
At or above federal poverty level
22.9 22.8 17.8 17.8 20.4 20.3 (21.6–24.2) (21.4–24.2) (16.8–18.8) (16.6–19.0) (19.6–21.2) (19.3–21.3)
Below federal poverty level
34.0 32.4 28.0 26.3 30.6 28.8 (30.0–38.0) (28.3–36.5) (25.2–30.8) (23.3–29.3) (28.0–33.2) (26.2–31.4)
Unknown 23.3 17.6 14.2 13.4 18.3 15.2 (21.0–25.6) (15.1–20.1) (12.6–15.8) (11.2–15.6) (16.9–19.7) (13.6–16.8)
Total 23.9 (22.8–25.0)
22.3 (21.1–23.5)
18.0 (17.2–18.8)
17.4 (16.5–18.3)
20.8 (20.1–21.5)
19.8 (19.0–20.6)
* Persons who reported smoking at least 100 cigarettes during their lifetimes and who, at the time of interview, reported smoking every day or some days. 2006 estimates exclude 315 respondents whose smoking status was unknown, and 2007 estimates exclude 403 respondents whose smoking status was unknown.
† Confidence interval. § 2006 estimates exclude 266 respondents of unknown race or multiple races, and 2007 estimates exclude 317 respondents of unknown race or multiple races. ¶ Does not include Native Hawaiians or Other Pacific Islanders. ** Wide variances reflect small sample sizes. †† Among persons aged >25 years. 2006 estimates exclude 305 persons whose education level was unknown, and 2007 estimates exclude 1,770 persons whose education level
was unknown. §§ General Educational Development. ¶¶ 2006 estimates are based on family income reported by respondents and 2005 poverty thresholds (published by the U.S. Census Bureau), and 2007 estimates are based on
family income reported by respondents and 2006 poverty thresholds.
1224 MMWR November 14, 2008
† 2007 estimates are based on family income reported by respondents and 2006 poverty thresholds (published by the U.S. Census Bureau).
§ Additional information available at http://www.cdc.gov/tobacco/data_statistics/ tables/adult/table_2.htm.
¶ Available at http://www.oas.samhsa.gov/nsduhlatest.htm and http://riskfactor. cancer.gov/studies/tus-cps, respectively.
significantly higher than among Hispanics (13.3%) (p<0.01 for both comparisons).
Smoking prevalence also varied by education level among adults aged >25 years. Adults who had a General Education Development (GED) diploma (44.0%) and those with 9–11 years of education (33.3%) had the highest prevalence of cur- rent smoking. Those who had an undergraduate or graduate degree had the lowest smoking prevalence (11.4% and 6.2%, respectively). By age group, the prevalence of smoking was lowest among those aged >65 years (8.3%), compared with those aged <65 years (persons aged 18–24 years [22.2%], aged 25–44 years [22.8%], and aged 45–64 years [21.0%]). Smoking among adults whose incomes were below the federal poverty level (28.8%) was significantly higher than those whose incomes were at or above this level (20.3%) (p<0.02).†
The prevalence of cigarette smoking among adults was significantly lower in 2007 (19.8%) than in 2006 (20.8%) (p=0.05). Subgroups with significant decreases in smoking prevalence from 2006 to 2007 included blacks (from 23.0% in 2006 to 19.8% in 2007 [p=0.01]) and adults aged >65 years (from 10.2% in 2006 to 8.3% in 2007 [p=0.01]).
From 1993 (the first year that quit attempt data were col- lected in NHIS with everyday smokers identified separately) to 2007, the prevalence of a quit attempt during the preced- ing 12 months among everyday smokers decreased (p<0.01); these decreases were significant among those aged 25–44 years (p<0.01) and >65 years (p=0.02) (Figure). In each year, the proportion of current everyday smokers who tried to quit dur- ing the preceding 12 months decreased with increasing age, and young adults aged 18–24 years were significantly more likely to have made a quit attempt than older adults (p<0.05 for all comparisons). In 2007, the proportion of current everyday smokers who tried to quit was 53.1% among persons aged 18–24 years, 39.9% among those aged 25–44 years, 38.1% among those aged 45–64 years, and 25.3% among those aged >65 years. Reported by: SL Thorne, MPH, A Malarcher, PhD, E Maurice, MSPH, R Caraballo, PhD, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Editorial Note: After 3 years during which prevalence in current cigarette smoking among adults remained virtually unchanged (20.9% in 2004, 20.9% in 2005, and 20.8% in 2006), the prevalence in 2007 (19.8%) was significantly lower than in 2006 (2). For 5 consecutive years, the prevalence of smoking among women remained below 20% (19.2% in 2003, 18.5% in 2004, 18.2% in 2005, 18.0% in 2006, and 17.4% in 2007); however, variability existed among the subgroups of women. Also, for 6 consecutive years, former
smokers outnumbered current smokers. During the past 40 years, smoking prevalence has declined overall and among each sociodemographic subpopulation.§ However, large disparities in smoking prevalence continue to exist by race/ethnicity and education level. The continuing higher prevalence among several populations, such as American Indians/Alaska Natives (36.4%), persons with GED diplomas (44.0%), and persons reporting family incomes below the federal poverty level (28.8%), emphasizes the need for more effective policy and environmental and individual-level interventions to reach and assist these subpopulations.
The trends in smoking prevalence from NHIS data showing a slow decrease from the 1990s through the early- and mid- 2000s are similar to trends in other national surveys (e.g., the National Household Survey on Drug Use and Health and the Tobacco Control Supplement to the Current Population Survey¶). NHIS data on smoking prevalence is the primary measure used to assess progress in meeting the Healthy People 2010 objective of reducing smoking among adults to <12%, and these data indicate that the objective likely will not be met. Before 2007, several population subgroups had met the Healthy People 2010 smoking prevalence objective of <12% and, in 2007, these same subpopulations continued to meet this goal. Subpopulations who continued to meet this goal in 2007 include Hispanic (8.3%) and Asian (4.0%) women, women with 0–8 years of education (10.0%) or undergraduate (9.4%) or graduate degrees (6.0%), and women aged >65 years (7.6%). Men with graduate degrees (6.4%) and men aged >65 years (9.3%) also met this goal.
The percentage of everyday smokers who attempted to quit for >1 day during the preceding 12 months decreased during 1993–2007. The lack of funding for comprehensive state tobacco-control programs likely has remained a barrier to achieving progress in increasing smokers’ quit attempts. In fiscal year 2005, investments by states in tobacco control varied; the mean per capita expenditure was $2.76, with some states investing approximately $11.00, whereas others invested noth- ing (4). CDC recommends a per capita annual expenditure of $9.23 to $18.03 by state comprehensive tobacco-control programs to implement effective programs (5).
The majority of smokers who attempt to quit do not use recommended cessation methods (3), and most of these untreated smokers relapse within the first 8 days after quitting; an estimated 24%–51% are abstinent at 1 week, 15%–28% are abstinent at 1 month, and 10%–20% are abstinent at 3 months (6). Of untreated adult smokers who try to quit smoking each
Vol. 57 / No. 45 MMWR 1225
FIGURE. Estimated percentage of adult current everyday smokers* who quit for >1 day† during the preceding year, by age group — National Health Interview Survey, United States, 1993–2007
0
20
40
60
80
1993 1994 1995 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
P e rc
e n ta
g e
18–24 yrs
25–44 yrs
45–64 yrs
>65 yrs
Overall
* Persons who reported smoking at least 100 cigarettes during their lifetimes and who, at the time of the interview, reported smoking every day. † Persons who reported that, during the preceding 12 months, they had stopped smoking for >1 day because they were trying to quit smoking.
year, only 4%–7% are likely to be successful (3). Among daily smokers, younger adults (aged 18–24 years) were more likely to try to quit smoking during the preceding year than older adults. This finding is consistent with other national studies (7). Young adults have lower levels of addiction, are less likely to be heavy smokers, and are more likely to have smoke-free homes than older adults; lower levels of dependence and having a smoke-free home are associated with increases in trying to quit during the preceding year (7). Smoking cessation is beneficial at any age; however, quitting at younger ages is associated with greater decreases in premature mortality (8).
The findings in this report are subject to at least three limita- tions. First, estimates of cigarette smoking were based on self- report and were not validated with biochemical tests. However, self-reported smoking status has validity when compared with measured serum cotinine levels and yields similar population prevalence estimates (9). Second, the NHIS questionnaire is administered in English and Spanish only, which might affect estimates for racial/ethnic populations who do not speak English or Spanish primarily. Finally, single-year estimates with large confidence intervals for certain population groups (e.g., American Indians/Alaska Natives) primarily resulted from small sample sizes.
Tobacco use screening with a brief cessation intervention is one of the top three clinical preventive services that have been found to be cost-saving (10). Effective clinical cessation inter- ventions include brief interventions by clinicians; individual, group, or telephone counseling; and the following pharma- cologic therapies: Bupropion SR, Varenicline, and nicotine gum, inhaler, lozenge, nasal spray, or patch (3). Clinicians and health-care delivery systems need to consistently identify and document tobacco use status, treat every tobacco user seen in
the health-care setting, and promote patients’ use of quitlines (available countrywide through the toll-free access number 1-800 QUIT- NOW) (3). These effective clinical approaches should be part of a comprehensive tobacco-control program that includes increasing the real price of tobacco products, implementing smoke-free policies, and increasing health insurance coverage for effective cessation interventions; with wider implementation of these policies and programs, greater progress in reducing smoking prevalence among adults could be attained (4,5). References 1. US Department of Health and Human Services. Tobacco use in
population groups: reduce tobacco use in adults. Cigarette smoking (27- 1a). In: Healthy people 2010 (conference ed, in 2 vols). Washington, DC: US Department of Health and Human Services; 2000. Available at http://www.healthypeople.gov/document/html/volume2/27tobacco. htm#_toc489766222.
2. CDC. Cigarette smoking among adults—United States, 2006. MMWR 2007;56:1157–61.
3. Fiore MC, Jaen CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update. Clinical practice guideline. Rockville, MD: US Department of Health and Human Services, Public Health Service; 2008. Available at http://www.surgeongeneral.gov/tobacco/treating_ tobacco_use08.pdf.
4. Institute of Medicine. Ending the tobacco problem: a blueprint for the nation. Washington, DC: National Academies Press; 2007.
5. CDC. Best practices for comprehensive tobacco control programs—2007. Atlanta, GA, US Department of Health and Human Services, CDC; 2007. Available at http://www.cdc.gov/tobacco/tobacco_control_programs/state andcommunity/best_practices/index.htm.
6. Hughes JR, Keely J, Naud S. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction 2004;99:29–38.
7. Messer K, Trinidad DR, Al-Delaimy WK, Pierce JP. Smoking cessation rates in the United States: a comparison of young adults and older smokers. Am J Public Health 2008;98:317–22.
8. Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ 2004; 328:1519.
1226 MMWR November 14, 2008
* The computations also use other data elements; available at http://apps.nccd. cdc.gov/sammec.
9. Caraballo RS, Giovino GA, Pechacek TF, Mowery PD. Factors associated with discrepancies between self-reports on cigarette smoking and measured serum cotinine levels among person aged 17 years or older: third National Health and Nutrition Examination Survey, 1988–1994. Am J Epidemiol 2001;153:807–14.
10. Maciosek MV, Coffield AB, Edwards NM, et al. Priorities among effective clinical preventive services. Am J Prev Med 2006;31:51–1.
Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses — United States, 2000–2004
Cigarette smoking and exposure to tobacco smoke are asso- ciated with premature death from chronic diseases, economic losses to society, and a substantial burden on the United States health-care system. Smoking is the primary causal factor for at least 30% of all cancer deaths, for nearly 80% of deaths from chronic obstructive pulmonary disease, and for early cardiovascular disease and deaths (1). In 2005, to assess the economic and public health burden from smoking, CDC published results of an analysis of smoking-attributable mortality (SAM), years of potential life lost (YPLL), and productivity losses in the United States from smoking during 1997–2001 (2). The analysis was based on data from CDC’s Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC) system,* which estimates SAM, YPLL, and productivity losses based on data from the National Health Interview Survey and death certificate data from the National Center for Health Statistics. This report presents an update of that analysis for 2000–2004, the most recent years for which source data are available. The updated analysis indicated that, during 2000–2004, cigarette smoking and exposure to tobacco smoke resulted in at least 443,000 premature deaths, approxi- mately 5.1 million YPLL, and $96.8 billion in productivity losses annually in the United States. Comprehensive, national tobacco-control recommendations have been provided to the public health community with the goal of reducing smoking so substantially that it is no longer a significant public health problem in the United States (3,4).
The adult and the maternal and child health SAMMEC software modules were used to estimate SAM, YPLL, and productivity losses attributed to diseases caused by smoking. Sex- and age-specific smoking-attributable deaths were calcu- lated by multiplying the total number of deaths for 19 adult and four infant disease categories (Table) by estimates of the
smoking-attributable fraction (SAF)† of preventable deaths. The attributable fractions provide estimates of the public health burden of each risk factor and the relative importance of risk factors for multifactorial diseases. Because of the effect of interactions between various risk factors, attributable frac- tions for a given disease can total more than 100%. For adults, SAFs were derived using sex-specific relative risk (RR) esti- mates from the American Cancer Society’s Cancer Prevention Study-II (CPS-II) for current and former smokers for each cause of death for the period 1982–1988. For ischemic heart disease and cerebrovascular disease deaths, RR estimates also were stratified by age (35–64 years and >65 years). Sex- and age-specific (35–64 years and >65 years) current and former cigarette smoking prevalence estimates from the National Health Interview Survey also were used to calculate SAFs. For infants, SAFs were calculated by using pediatric RR estimates and maternal smoking prevalence estimates from birth cer- tificates. Smoking-attributable YPLL and productivity losses were estimated by multiplying sex- and age-specific SAM by remaining life expectancy (5) and lifetime earnings data (6). In addition, smoking-attributable residential fire-related deaths (7) and lung cancer and heart disease deaths attributable to exposure to secondhand smoke (8,9) were included in the SAM, but not in YPLL and productivity loss estimates.
During 2000–2004, smoking resulted in an estimated annual average of 269,655 deaths among males and 173,940 deaths among females in the United States (Table). The three leading specific causes of smoking-attributable death were lung cancer (128,922), ischemic heart disease (126,005), and chronic obstructive pulmonary disease (COPD)§ (92,915). Among adults aged >35 years, 160,848 (41.0%) smoking- attributable deaths were caused by cancer, 128,497 (32.7%) by cardiovascular diseases, and 103,338 (26.3%) by respiratory diseases (excluding deaths from secondhand smoking and from residential fires). Smoking during pregnancy resulted in an estimated 776 infant deaths annually during 2000–2004. An estimated 49,400 lung cancer and heart disease deaths annu- ally were attributable to exposure to secondhand smoke. The average annual SAM estimates also included 736 deaths from smoking-attributable residential fires.
During 2000–2004, on average, smoking accounted for an estimated 3.1 million YPLL for males and approximately 2.0 † SAFs for each disease are calculated using the following equation: SAF =
[(p1(RR1 – 1) + p2(RR2 – 1)] / [ p1(RR1 – 1) + p2(RR2 – 1) + 1] where p1 = percentage of current smokers (persons who have smoked >100 cigarettes and now smoke every day or some days), p2 = percentage of former smokers (persons who have smoked >100 cigarettes and do not currently smoke), RR1 = relative risk for current smokers relative to never smokers, and RR2 = relative risk for former smokers relative to never smokers.
§ COPD includes bronchitis/emphysema (International Classification of Diseases, Tenth Revision [ICD-10] codes J40–J42 and J43) and chronic airway obstruction (ICD-10 J44) (1).
Vol. 57 / No. 45 MMWR 1227
TABLE. Annual deaths and estimates* of smoking-attributable mortality (SAM), years of potential life lost (YPLL), and productivity losses, by sex and cause of death — United States, 2000–2004
Male Female
Causes of death (ICD-10 code†) Deaths SAM YPLL
Productivity losses (in
thousands) ($) Deaths SAM YPLL
Productivity losses (in
thousands) ($)
Malignant neoplasm Lip, oral cavity, pharynx (C00–C14) 5,126 3,749 65,336 1,613,319 2,494 1,144 19,047 354,635 Esophagus (C15) 9,707 6,961 108,847 2,464,063 2,926 1,631 25,382 433,273 Stomach (C16) 7,056 1,900 27,602 600,702 5,024 584 8,971 157,891 Pancreas (C25) 14,845 3,147 50,201 1,162,577 15,481 3,536 53,334 884,761 Larynx (C32) 2,984 2,446 38,012 853,914 778 563 9,914 186,317 Trachea/lung/bronchus (C33–C34) 90,025 78,680 1,118,359 23,189,096 66,874 46,842 770,655 13,597,333 Cervix uteri (C53) 0 0 0 0 3,774 447 11,918 307,412 Kidney and renal pelvis (C64–65) 7,469 2,827 43,898 997,062 4,527 216 3,722 70,680 Urinary bladder (C67) 8,508 3,907 44,166 742,898 3,951 1,076 13,245 174,529 Acute myeloid leukemia (C92.0) 3,889 855 12,527 272,429 3,189 337 5,496 99,772
Subtotal 149,609 104,472 1,508,948 31,896,060 109,018 56,376 921,684 16,266,603
Cardiovascular diseases Ischemic heart disease (I20–I25) 248,506 50,884 804,551 19,019,062 238,845 29,121 389,974 6,068,242 Other heart disease (I00–I09, I26–I51) 72,312 12,944 55,621 1,134,588 95,304 8,060 31,745 428,084 Cerebrovascular disease (I60–I69) 61,616 7,896 127,280 3,075,304 97,681 8,026 140,894 2,878,017 Atherosclerosis (I70–I71) 5,000 1,282 11,814 155,198 8,430 611 5,475 40,423 Aortic aneurysm (I71) 8,861 5,628 70,512 1,339,220 5,862 2,791 34,192 445,625 Other circulatory diseases (I72–I79) 4,238 505 6,636 134,357 5,715 749 9,386 133,702
Subtotal 400,533 79,139 1,076,414 24,857,729 451,837 49,358 611,666 9,994,093
Respiratory diseases Pneumonia, influenza (J10–J18) 27,517 6,042 29,828 448,507 35,008 4,381 23,438 273,061 Bronchitis, emphysema (J40–J42, J43) 8,321 7,536 42,842 708,007 7,941 6,391 40,844 532,162 Chronic airways obstruction (J44) 49,774 40,217 421,721 6,306,543 52,328 38,771 462,973 5,545,304
Subtotal 85,612 53,795 494,391 7,463,057 95,277 49,543 527,255 6,350,527
Perinatal conditions Short gestation/low birth weight (P07) 2,557 219 16,315 — 2,030 174 13,898 — Respiratory distress syndrome (P22) 550 18 1,358 — 382 13 1,007 — Other respiratory (newborn) (P23–28) 786 35 2,611 — 556 25 1,983 — Sudden infant death syndrome (R95) 1,357 173 12,878 — 935 119 9,531 —
Subtotal 5,250 445 33,161 — 3,903 331 26,419 —
Residential fire 1,600 416 — — 1,270 320 — —
Secondhand smoke Lung cancer — 2,131 — — — 1,269 — — Ischemic heart disease — 29,256 — — — 16,744 — —
Subtotal — 31,388 — — — 18,012 — —
Total 269,655 3,112,914 64,216,846 173,940 2,087,024 32,611,223 * CDC estimates from 2000–2004 National Health Interview Survey responses and 2000–2004 National Center for Health Statistics death certificate data;
smoking-attributable residential fire-related death estimates from 2002–2005 data; productivity losses in 2004 dollars. † International Classification of Diseases and Health Conditions, 10th Revision; available at http://www.who.int/classifications/apps/icd/icd10online.
million YPLL for females annually, excluding deaths from smoking-attributable residential fires and adult deaths from secondhand smoke. Estimates for average annual smoking- attributable productivity losses were approximately $96.8 billion ($64.2 billion for males and $32.6 billion for females) during this period (Table). Reported by: B Adhikari, PhD, J Kahende, PhD, A Malarcher, PhD, T Pechacek, PhD, V Tong, National Center for Chronic Disease Prevention and Health Promotion, CDC. Editorial Note: During 2000–2004, an estimated 443,000 persons in the United States died prematurely each year as
a result of smoking or exposure to secondhand smoke. This figure is higher than the average annual estimate of approxi- mately 438,000 deaths during 1997–2001 (2). The number of smoking-attributable deaths varies according to trends in smoking prevalence and the number of deaths from diseases caused by smoking. SAM estimates also change when a causal relationship is established between smoking and a disease not previously included in SAMMEC (1). Although smoking prevalence has declined dramatically since its peak in the 1960s, the number of smoking-attributable deaths has remained rela- tively unchanged, primarily because of increases in population
1228 MMWR November 14, 2008
size (particularly among older age groups). Even with declines in the rates of various smoking-related diseases (e.g., coronary heart disease), the absolute number of deaths is increasing as the total population increases. In addition, cohorts of smokers with the highest peak prevalence have now reached the ages with the highest incidence of smoking-attributable diseases.
The relative risk estimates used in the calculation of SAM have remained the same. In general, the magnitude of the relationship between smoking and the diseases it causes has remained stable over time (1). However, CDC is continuing to monitor whether the RRs for smoking are changing over time. Future SAMMEC estimates might contain updated RRs, particularly for females, because their adoption of smoking (and hence their duration of smoking) lagged that of males during the early to mid-1900s. Prevalence of smoking among females peaked in the 1960s and in recent cohorts of smokers more closely follows the trend for male smokers. Smoking- attributable fractions are higher for cancers and COPD than for cardiovascular diseases; however, because the absolute number of deaths is highest for coronary heart disease, it contributes a large number of smoking-attributable deaths.
Preventing smoking and increasing cessation rates need to remain priorities of public health professionals who are work- ing to prevent heart disease and stroke. Dramatic declines in smoking-attributable deaths can be achieved by further reduc- ing smoking prevalence rates. Leading causes of death, such as lung cancer and COPD, could become relatively uncom- mon in future generations if the prevalence of smoking was substantially reduced (1,3).
The findings in this report are subject to at least six limita- tions. First, the estimates understate deaths attributable to tobacco use because estimates of deaths attributable to cigar smoking, pipe smoking, and smokeless tobacco use were excluded. Although the overall prevalence rates of cigar and pipe smoking and use of smokeless tobacco have remained relatively stable, increased public health concerns about these products might warrant including estimates of deaths attribut- able to these tobacco products in the future. Second, RRs were based on deaths during 1982–1988 among birth cohorts who might have had different smoking histories than current or former smokers (e.g., age of initiation and duration of smoking before quitting). Third, this report used a death-certificate– based definition of COPD, including codes for bronchitis/ emphysema and chronic airway obstruction (ICD-10 J44) (1). Therefore, the COPD SAM estimate used for this report might differ from other estimates that use other definitions of COPD (1). Fourth, RRs were adjusted for the effects of age but not for other potential confounders. However, research suggests that education, alcohol, and other confounders had negligible additional effects on SAM estimates for lung cancer, COPD,
ischemic heart disease, and cerebrovascular disease in CPS-II. Fifth, productivity losses understate the total costs of smoking because costs associated with smoking-attributable health-care expenditures, smoking-related disability, employee absentee- ism, and secondhand-smoke–attributable disease morbidity and mortality were not included. Finally, the estimates do not account for the sampling variability in smoking prevalence estimates or RRs.
Cigarette smoking continues to impose substantial health and financial costs on society. During 2001–2004, average annual smoking-attributable health-care expenditures were approximately $96 billion. Accounting for direct health-care expenditures and productivity losses (approximately $97 billion), the total economic burden of smoking is approxi- mately $193 billion per year. By comparison, investments in comprehensive, state-based tobacco prevention and control programs in fiscal year 2007 totaled $595 million, approxi- mately 325-times less than the smoking-attributable costs (10). Comprehensive statewide tobacco-control programs significantly accelerate declines in consumption and smoking prevalence (4). By increasing their investment in such programs to the levels recommended by CDC, states can further hasten the reduction in cigarette use and reduce the health and eco- nomic burden of smoking (3). References 1. CDC. The health consequences of smoking: a report of the Surgeon
General. Atlanta, GA: US Department of Health and Human Services, CDC; 2004. Available at http://www.cdc.gov/tobacco/data_statistics/ sgr/sgr_2004/index.htm.
2. CDC. Annual smoking-attributable mortality, years of potential life lost, and economic costs—United States, 1997–2001. MMWR 2005;54:625–8.
3. Institute of Medicine. Ending the tobacco problem: a blueprint for the nation. Washington, DC: National Academies Press; 2007.
4. CDC. Best practices for comprehensive tobacco control programs— 2007. Atlanta, GA, US Department of Health and Human Services, CDC; 2007. Available at http://www.cdc.gov/tobacco/tobacco_ control_programs/stateandcommunity/best_practices/index.htm.
5. Arias E. United States life tables, 2004. Nat Vital Stat Rep 2006;56:1–39. 6. Haddix AC, Teutsch SM, Corso PS. Prevention effectiveness: a guide
to decision analysis and economic evaluation. 2nd ed. New York, NY: Oxford University Press; 2003.
7. Hall JR Jr. The smoking-material fire problem. Quincy, MA: National Fire Protection Association, Fire Analysis and Research Division; 2007.
8. CDC. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2006.
9. California Environmental Protection Agency. Proposed identification of environmental tobacco smoke as a toxic air contaminant. Sacramento, CA: Environmental Protection Agency, Office of Environmental Health Hazard Assessment; 2005. Available at http://www.oehha.org/ air/environmental_tobacco/2005etsfinal.html.
10. Campaign for Tobacco-Free Kids. A broken promise to our children: the 1998 state tobacco settlement eight years later. Washington, DC: Campaign for Tobacco-Free Kids; 2006. Available at http://www. tobaccofreekids.org/reports/settlements/2007/fullreport.pdf.
Vol. 57 / No. 45 MMWR 1229
Deaths from Chronic Obstructive Pulmonary Disease — United
States, 2000–2005 Chronic obstructive pulmonary disease (COPD) is a het-
erogeneous group of slowly progressive diseases characterized by airflow obstruction that interferes with normal breathing (1). In 2005, approximately one in 20 deaths in the United States had COPD as the underlying cause. Smoking is esti- mated to be responsible for at least 75% of COPD deaths (2). Excess health-care expenditures are estimated at nearly $6,000 annually for every COPD patient in the United States (3). To update national estimates of deaths from COPD for the period 2000–2005 (the most recent years for which data are avail- able), CDC analyzed data from the National Vital Statistics System (NVSS). Results of that analysis indicated that an estimated 126,005 deaths of persons aged >25 years occurred in 2005 with COPD as the underlying cause, an increase of 8% from 116,494 deaths in 2000. Age-standardized COPD mortality rates remained fairly stable during the period overall but decreased among men and increased among women. To decrease the number and rate of COPD deaths, public health programs should continue efforts to reduce all personal expo- sure to 1) tobacco smoke, including passive smoke exposure; 2) occupational dusts and chemicals; and 3) other indoor and outdoor air pollutants linked to COPD (3). Once COPD is diagnosed, chronic disease management programs should work to prevent further deterioration in lung function and reduce COPD mortality (4).
The numbers of deaths for which COPD was the underly- ing cause* and population estimates for calculation of rates were obtained from the CDC Wonder compressed mortality database† of the National Vital Statistics System. International Classification of Diseases, Tenth Revision (ICD-10) codes were used to identify cases of COPD.§ Annual age-, sex-, and race- specific rates (per 100,000 population) of death from COPD during 2000–2005 were computed by dividing the number of COPD deaths by midyear population estimates, using the
2000 U.S. standard population aged >25 years for direct age standardization. Rate calculations were restricted to adults aged >25 years because this group accounted for 99.9% of all COPD deaths.
During 2000–2005, COPD was the underlying cause of death for 718,077 persons overall aged >25 years in the United States. The number of deaths from COPD increased from 116,494 in 2000 to 121,267 in 2003, decreased to 117,134 in 2004, and increased to 126,005 in 2005 (Table 1). Age-standardized death rates per 100,000 population decreased during 2000–2004; the rate in 2005 was similar to that for 2003.
From 2000 to 2005, the annual number of deaths from COPD increased 5% among men (Table 1), and the number of deaths was higher in 2005 than in 2004. The death rate for men declined during 2000–2005 and was lower in 2004 than in 2005 (Figure 1). Among women, the annual number of deaths increased 11% from 2000 to 2005 and was lower in 2005 than in 2004. The death rate for women increased from 2000 to 2003, decreased in 2004, and increased in 2005 (Figure 1). The death rate was higher for men compared with the rate for women in each year, but the number of deaths was greater for women.
For each year during 2000–2005, COPD mortality rates were higher among whites than among blacks or persons of all other races. During this period, the rate for blacks remained stable, except for 2004, when the rate was lower. In 2005, the death rate among white men was 80.2 (95% confidence interval [CI] = 79.5–80.9) compared with 63.8 (CI = 61.8–65.8) among black men, 60.3 (CI = 59.8–60.8) among white women, and 29.9 (CI = 28.9–30.9) among black women.
By state, in 2005, age-standardized death rates from COPD for adults aged >25 years ranged from 27.1 per 100,000 in Hawaii to 93.6 per 100,000 population in Oklahoma. States with COPD death rates in the highest quartile were as follows: Idaho, Indiana, Kansas, Kentucky, Maine, Montana, Nevada, Ohio, Oklahoma, Vermont, West Virginia, and Wyoming (Figure 2). Among adults aged 25–64 years, rates ranged from 6.2 (Massachusetts and New Jersey) to 19.2 (Oklahoma) per 100,000 population for men and from 3.8 (New Jersey) to 16.5 (West Virginia) in women (Table 2). Among adults aged >65 years, rates ranged from 169.0 (Hawaii) to 540.4 (Vermont) per 100,000 population in men and from 94.7 (Hawaii) to 394.9 (Nevada) in women. Reported by: DW Brown, JB Croft, PhD, KJ Greenlund, PhD, WH Giles, MD, Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Editorial Note: From 1980 to 2000, the COPD death rate in the United States among women aged >25 years increased from 20.1 to 56.7 per 100,000 population, while the rate for men aged >25 years increased from 73.0 to 82.6 per 100,000 population (5). The findings in this report indicate that, during
* Underlying cause is defined by the World Health Organization as the disease or injury that initiated the train of morbid events leading directly to death or the circumstances of the accident or violence that produced the fatal injury. The underlying cause is selected from the conditions entered by the physician in the cause-of-death section of the death certificate. When more than one cause or condition is entered by the physician, the underlying cause is determined by the sequence of conditions on the certificate, provisions of the International Classification of Diseases, and associated selection rules and modifications. Additional information is available at http://www.cdc.gov/nchs/data/nvsr/ nvsr49/nvsr49_08.pdf.
† Available at http://wonder.cdc.gov/mortsql.html. § ICD-10 codes used were J40 (bronchitis not specified as acute or chronic), J41
(simple and mucopurulent chronic bronchitis), J42 (unspecified chronic bronchitis), J43 (emphysema), and J44 (other chronic obstructive pulmonary disease)(2). Available at http://www.cdc.gov/nchs/about/major/dvs/icd10des.htm.
1230 MMWR November 14, 2008
State-specific variations in COPD mortality might reflect dif- ferences in smoking histories and/or differences in other expo- sures such as occupational exposure across states. Occupational exposure to dust, fumes, and gases accounts for approximately 15% of COPD cases (8).
The findings in this report are subject to at least two limita- tions. First, data are subject to misclassification of race both in the population census and on death certificates, which might result in overreporting or underreporting of deaths or rates for certain racial groups. Second, data on underlying cause of death might be subject to errors in diagnosis and reporting on the death certificate.
Public health programs that focus on reducing total personal exposure to tobacco smoke, occupational dusts and chemicals, and other indoor and outdoor air pollutants are critically important (4). Although current evidence does not support population screening using office spirometry to detect COPD (9), patients should be identified and treated as early as possible in the course of the disease. Disease prevention is the ultimate goal, but once COPD has been diagnosed, effective manage- ment should be aimed at relieving symptoms; preventing disease progression; improving exercise tolerance, daily activity, and health status; preventing and treating complications and exacerbations; and reducing mortality (4,9). No treatment has been shown to effectively modify the rate of decline in lung function; however, evidence supports the use of bronchodila- tors as the primary pharmacologic therapy to prevent and control symptoms, reduce the frequency and severity of acute exacerbations, and improve quality of life (9). Physicians should be aware of the availability of clinical practice guidelines for the diagnosis and management of COPD and guidelines on smoking cessation among COPD patients.
TABLE 1. Annual number of deaths and rate* of death with chronic obstructive pulmonary disease as the underlying cause among adults aged >25 years, by age group, sex, and race — National Vital Statistics System, United States, 2000–2005
2000 2001 2002 2003 2004 2005
Characteristic No. of deaths Rate
No. of deaths Rate
No. of deaths Rate
No. of deaths Rate
No. of deaths Rate
No. of deaths Rate
Overall† 116,494 65.2 117,697 64.7 119,480 64.4 121,267 64.3 117,134 61.1 126,005 64.3
Age group (yrs) 25–44 500 0.6 554 0.7 586 0.7 573 0.7 554 0.7 558 0.7 45–54 2,618 6.9 2,695 6.9 2,842 7.1 2,883 7.1 2,920 7.0 3,356 7.9 55–64 10,130 41.7 10,545 41.7 10,670 40.1 11,451 41.0 11,183 38.5 12,173 40.1 65–74 30,249 164.5 29,942 163.5 29,040 158.9 29,241 159.5 27,740 150.2 29,296 157.2 >75 72,997 439.7 73,961 435.6 76,342 440.6 77,119 438.6 74,737 419.2 80,622 444.2
Sex†
Men 58,058 83.8 57,908 81.3 58,807 80.4 58,904 78.7 56,940 74.5 60,812 77.3 Women 58,436 54.4 59,789 54.7 60,673 54.6 62,363 55.4 60,194 52.8 65,193 56.0
Race†
White 68,979 68.5 69,823 68.0 71,947 67.8 72,748 67.9 70,517 64.7 75,883 68.1 Black 3,173 42.6 3,269 41.9 3,508 42.7 3,388 41.4 3,242 38.6 3,657 42.4 All other 845 28.4 869 26.8 887 25.0 983 25.5 978 23.5 1,082 24.0
* Per 100,000 population. † Age standardized to the 2000 U.S. standard population, aged >25 years.
FIGURE 1. Age-standardized death rate* from chronic obstructive pulmonary disease among adults aged >25 years, by sex — National Vital Statistics System, United States, 2000–2005
0
30
Year
R at
e
60
90
2000 2001 2002 2003 2004 2005
Men
Women Overall
* Per 100,000 population.
2000–2005, the overall age-standardized mortality rate from COPD in the United States was fairly stable, but the absolute number of COPD deaths increased 8% from 2000 to 2005. During the period, more women than men died from COPD, and death rates from COPD increased among women while rates decreased among men. The difference in mortality rates between men and women might reflect a delay in mortality related to smoking exposure among women relative to men in the United States in the second half of the 20th century (6). In addition, women might be more susceptible to COPD as a result of sex differences in xenobiotic metabolism, hormones that modify detoxifying enzymes, airway inflammation and responsiveness, and particle deposition (7). The changes in death rates observed in 2004 and 2005 for men, women, and overall suggest a need for continued monitoring to assess whether changes are trending in a more favorable or less favorable pattern.
Vol. 57 / No. 45 MMWR 1231
TABLE 2. Number of deaths and rate* of death with chronic obstructive pulmonary disease as the underlying cause, among adults aged >25 years, by state, sex, and age group — National Vital Statistics System, United States, 2005
State
Men Women
No. of deaths
Rate†
No. of deaths
Rate†
25–64 yrs >65 yrs All ages >25 yrs 25–64 yrs >65 yrs
All ages >25 yrs
Alabama 1,212 14.6 442.8 98.3 1,106 10.8 254.6 58.4 Alaska 73 —§ 349.5 73.9 72 — 242.0 54.7 Arizona 1,281 10.9 334.5 74.1 1,442 9.2 290.1 64.1 Arkansas 794 16.4 423.2 95.9 714 13.2 254.4 60.3 California 5,944 8.2 326.7 70.5 6,664 6.9 250.2 54.4 Colorado 961 10.6 445.5 95.6 903 6.0 297.8 63.0 Connecticut 626 6.6 291.7 62.3 795 5.4 230.3 49.3 Delaware 184 — 368.4 77.3 214 7.4 290.0 62.6 District of Columbia 58 — 189.8 41.4 65 — 125.5 26.4 Florida 4,436 11.0 294.3 66.3 4,737 8.7 230.5 52.0 Georgia 1,595 12.7 395.3 87.5 1,667 9.5 261.3 58.7 Hawaii 150 — 169.0 36.6 110 — 94.7 20.3 Idaho 365 10.5 458.5 98.1 326 10.0 304.3 67.5 Illinois 2,209 8.1 321.6 69.4 2,608 7.5 237.4 52.4 Indiana 1,621 13.8 452.8 99.6 1,744 12.5 311.0 70.8 Iowa 844 11.4 415.5 90.3 806 9.4 258.5 58.1 Kansas 772 12.1 459.5 99.6 757 9.2 300.9 66.2 Kentucky 1,239 17.5 508.6 113.4 1,268 16.2 328.6 77.2 Louisiana 949 11.3 398.4 87.0 881 8.5 234.6 52.7 Maine 394 11.2 445.8 96.1 419 8.3 325.1 70.2 Maryland 760 6.6 263.4 56.8 1,063 6.0 238.3 51.4 Massachusetts 1,102 6.2 290.4 61.8 1,427 6.7 224.0 49.2 Michigan 2,017 9.0 352.3 76.1 2,287 8.9 258.4 57.7 Minnesota 923 6.7 322.8 68.5 960 6.4 218.7 47.9 Mississippi 763 16.9 461.6 103.8 653 11.7 245.7 57.4 Missouri 1,508 12.6 422.4 92.7 1,494 10.0 272.5 61.3 Montana 287 11.5 454.4 98.1 282 12.3 320.8 72.6 Nebraska 459 9.0 430.5 91.4 438 6.4 272.8 58.5 Nevada 577 10.7 443.2 95.2 632 10.5 394.9 85.6 New Hampshire 265 10.1 347.2 75.9 346 7.3 318.5 68.1 New Jersey 1,330 6.2 265.7 56.9 1,679 3.8 215.6 45.2 New Mexico 425 8.9 382.9 82.0 399 7.0 261.4 56.8 New York 2,907 6.8 258.3 56.0 3,565 6.0 196.4 43.2 North Carolina 2,033 12.2 430.7 94.0 1,972 9.4 265.8 59.5 North Dakota 144 — 325.0 68.8 116 — 179.7 40.1 Ohio 3,062 12.8 440.7 96.4 3,344 11.0 305.3 68.5 Oklahoma 1,159 19.2 514.9 116.1 1,137 15.9 341.8 79.6 Oregon 822 9.7 356.6 77.5 945 9.8 293.9 65.3 Pennsylvania 2,813 8.5 330.3 71.4 3,122 6.5 227.4 49.6 Rhode Island 219 9.2 316.7 69.3 283 9.6 241.2 54.8 South Carolina 965 13.3 387.0 86.4 914 11.0 235.7 54.9 South Dakota 242 12.9 447.7 97.9 182 — 242.5 52.3 Tennessee 1,510 15.8 427.3 96.2 1,566 14.3 284.3 67.0 Texas 3,816 9.6 362.6 78.6 3,850 8.0 246.4 54.6 Utah 322 8.7 294.1 64.5 237 6.2 161.3 36.5 Vermont 192 — 540.4 111.7 178 — 314.0 68.1 Virginia 1,295 7.1 346.9 73.5 1,475 8.0 243.5 54.1 Washington 1,194 8.7 340.8 73.6 1,397 8.3 282.4 61.9 West Virginia 657 15.8 516.1 113.6 658 16.5 329.6 77.7 Wisconsin 1,191 8.3 358.7 76.8 1,161 5.9 234.1 50.5 Wyoming 145 12.7 477.9 103.6 132 14.0 310.7 72.0
Total 60,812 10.0 355.1 77.3 65,193 8.4 252.0 56.0 * Per 100,000 population. † Age standardized to the 2000 U.S. standard population aged >25 years. § Rate not calculated because of small number of deaths.
1232 MMWR November 14, 2008
COPD represents an important public health challenge that is both preventable and treatable. Globally, the COPD burden is projected to increase in coming decades because of continued exposure to COPD risk factors and aging of the population (10). Further efforts to improve public recognition of COPD as a public health problem and to increase awareness of COPD symptoms are needed. References 1. Rennard SI. COPD: overview of definitions, epidemiology, and factors
influencing its development. Chest 1998;113(Suppl 4):235–41s. 2. CDC. Annual smoking-attributable mortality, years of potential life
lost, and productivity losses—United States, 1997–2001. MMWR 2005;54:625–8.
3. Miller JD, Foster T, Boulanger L, et al. Direct costs of COPD in the U.S.: an analysis of Medical Expenditure Panel Survey (MEPS) data. COPD 2005;2:311–8.
4. Celli BR. Update on the management of COPD. Chest 2008;133: 1451–62.
5. Mannino DM, Homa DM, Akinbami LJ, Ford ES, Redd SC. Chronic obstructive pulmonary disease surveillance—United States, 1971– 2000. Respir Care 2002;47:1184–99.
6. Shopland DR. Tobacco use and its contribution to early cancer mortality with a special emphasis on cigarette smoking. Environ Health Perspect 1995;103(Suppl 8):131–42.
7. Sin DD, Cohen SB, Day A, Coxson H, Pare PD. Understanding the biological differences in susceptibility to chronic obstructive pulmonary disease between men and women. Proc Am Thorac Soc 2007;4:671–4.
8. Balmes J, Becklake M, Blanc P, et al. American Thoracic Society Statement: occupational contribution to the burden of airway disease. Am J Respir Crit Care Med 2003;167:787–97.
9. O’Donnell DE, Aaron S, Bourbeau J, et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease—2007 update. Can Respir J 2007;14(Suppl B):5–32B.
10. Lopez AD, Shibuya K, Rao C, et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J 2006;27: 397–412.
Notice to Readers
World COPD Day — November 19, 2008 Chronic obstructive pulmonary disease (COPD) is a growing
global public health problem. According to new projections, COPD is predicted to become the third leading cause of death worldwide by 2030 (1). In 2005, COPD was the fourth leading cause of death in the United States. To increase global aware- ness of COPD, the Global Initiative for Chronic Obstructive Lung Disease (http://www.goldcopd.com) is sponsoring World COPD Day on November 19, 2008.
The World Health Organization recently published Global Surveillance, Prevention and Control of Chronic Respiratory Diseases: a Comprehensive Approach to raise awareness of the substantial impact of chronic respiratory diseases worldwide and to highlight the risk factors and ways to prevent and treat these diseases. Improving global awareness of COPD will require basic epidemiologic data on COPD risk factors, burden, and surveillance. These data currently are lacking for much of the world’s population, particularly persons in low- and middle-income countries.
Smoking is the most important recognized cause of COPD. Other causes include exposure to occupational hazards, air pollu- tion, alpha 1-antitrypsin deficiency (2), and secondhand smoke. All smokers should stop smoking, and all persons should be protected from exposure to secondhand smoke. Many resources are available to help smokers quit. Additional information is avail- able at http://www.smokefree.gov, http://www.cdc.gov/tobacco/ quit_smoking, or by telephone, 1-800-QUIT-NOW.
COPD is treatable, and early diagnosis is important. Persons at risk for COPD who have cough, sputum production, or shortness of breath should talk with their physicians and be tested for the disease using spirometry, a simple breathing test for assessing lung function (3). Additional information on COPD is available at http://www.nhlbi.nih.gov/health/public/ lung/copd/lmbb-campaign. References 1. World Health Organization. World health statistics 2008. Geneva,
Switzerland: World Health Organization; 2008. Available at http://www. who.int/whosis/whostat/2008/en/index.html.
2. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS, GOLD Scientific Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/ WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 2001;163:1256–76.
3. National Heart, Lung, and Blood Institute. COPD Learn More, Breathe Better Campaign. Available at http://www.nhlbi.nih.gov/health/public/ lung/copd/lmbb-campaign/index.htm.
FIGURE 2. Rate* of death with chronic obstructive pulmonary disease as the underlying cause, among adults aged >25 years, by quartile — National Vital Statistics System, 2005
* Per 100,000 population, age standardized to the 2000 U.S. standard population aged >25 years.
27.1–58.7
>58.7–69.0
>69.0–78.1
>78.1–93.6
Vol. 57 / No. 45 MMWR 1233
Notice to Readers
Twelfth Annual Conference on Vaccine Research
CDC and 11 other national and international agencies and organizations will collaborate with the National Foundation for Infectious Diseases in sponsoring the Twelfth Annual Conference on Vaccine Research, April 27–29, 2009, at the Marriott Waterfront Hotel, Baltimore, Maryland. The confer- ence is the largest scientific forum devoted exclusively to the research and development of all vaccines and related technolo- gies for prevention and treatment of disease through immuniza- tion. The conference brings together the diverse fields of human and veterinary vaccinology to encourage cross-fertilization of ideas and approaches among researchers otherwise focused on specific diseases or methods.
Twenty invited speakers at five symposia will discuss vac- cine safety, immunization programs for global health, synergy between veterinary and human vaccine development, and
tuberculosis and malaria vaccines. Six oral sessions and posters will include presentations selected through peer review from among submitted abstracts.
A travel grant program to subsidize attendees from countries with limited resources has an application deadline of December 7, 2008. Deadline for online submission of general abstracts is January 26, 2009. Abstracts from eligible authors may be designated for consideration for the Maurice R. Hilleman Early-Stage Career Investigator Award, which provides $10,000 for research expenses and a travel stipend and registration for the 2010 conference.
Additional information about the preliminary program, travel grants, abstract submission, registration, hotel accom- modation, and exhibition space is available at http://www.nfid. org/conferences/vaccine09, by e-mail (vaccine@nfid.org), fax (301-907-0878), by telephone (301-656-0003, ext 19), and by mail (NFID, Suite 750, 4733 Bethesda Avenue, Bethesda, MD 20814-5278).
1234 MMWR November 14, 2008
QuickStats from the national center for health statistics
Percentage of Deaths from Leading Causes Among Teens Aged 15–19 Years — National Vital Statistics System, United States, 2005
In 2005, a total of 13,073 deaths occurred among teens aged 15–19 years. The leading cause of death in this age group was unintentional injury, accounting for 48.3% of the deaths. Homicide accounted for 15.1% of the deaths and suicide for 11.8%, followed by cancer (5.3%), heart disease (2.8%), and congenital anomalies (1.8%).
SOURCE: National Vital Statistics System mortality data available at http://www.cdc.gov/ncipc/wisqars. Additional infor- mation available at http://www.cdc.gov/nchs/deaths.htm.
Unintentional injury
Homicide
Suicide
Cancer
Heart disease
Congenital anomalies
All other causes
Vol. 57 / No. 45 MMWR 1235
TABLE 1. Provisional cases of infrequently reported notifiable diseases (<1,000 cases reported during the preceding year) — United States, week ending November 8, 2008 (45th week)*
Disease Current
week Cum 2008
5-year weekly
average†
Total cases reported for previous years
States reporting cases during current week (No.)2007 2006 2005 2004 2003 Anthrax — — — 1 1 — — — Botulism: foodborne — 11 0 32 20 19 16 20 infant — 79 1 85 97 85 87 76 other (wound & unspecified) — 16 0 27 48 31 30 33 Brucellosis 1 78 3 131 121 120 114 104 CA (1) Chancroid — 29 1 23 33 17 30 54 Cholera — 1 0 7 9 8 6 2 Cyclosporiasis§ 1 115 1 93 137 543 160 75 VA (1) Diphtheria — — 0 — — — — 1 Domestic arboviral diseases§,¶: California serogroup — 35 0 55 67 80 112 108 eastern equine — 2 0 4 8 21 6 14 Powassan — 1 0 7 1 1 1 — St. Louis — 8 0 9 10 13 12 41 western equine — — — — — — — — Ehrlichiosis/Anaplasmosis§,**: Ehrlichia chaffeensis 9 732 8 828 578 506 338 321 OH (1), MN (1), MD (1), VA (1), NC (1), KY (1), TN (1),
OK (2) Ehrlichia ewingii — 7 — — — — — — Anaplasma phagocytophilum 7 358 10 834 646 786 537 362 NY (4), MN (2), MD (1) undetermined 1 64 2 337 231 112 59 44 NY (1) Haemophilus influenzae,††
invasive disease (age <5 yrs): serotype b 1 23 0 22 29 9 19 32 NC (1) nonserotype b 1 139 2 199 175 135 135 117 NY (1) unknown serotype 2 162 3 180 179 217 177 227 MO (1), GA (1) Hansen disease§ 1 65 2 101 66 87 105 95 OH (1) Hantavirus pulmonary syndrome§ — 14 1 32 40 26 24 26 Hemolytic uremic syndrome, postdiarrheal§ — 180 4 292 288 221 200 178 Hepatitis C viral, acute 7 694 17 849 766 652 720 1,102 IN (1), MD (1), KY (1), NV (1), CA (3) HIV infection, pediatric (age <13 years)§§ — — 5 — — 380 436 504 Influenza-associated pediatric mortality§,¶¶ 1 90 0 77 43 45 — N WA (1) Listeriosis 7 549 16 808 884 896 753 696 PA (1), OH (1), NC (1), FL (1), AZ (1), WA (1), CA (1) Measles*** 1 132 0 43 55 66 37 56 NY (1) Meningococcal disease, invasive†††: A, C, Y, & W-135 2 235 4 325 318 297 — — OH (1), OK (1) serogroup B 2 130 2 167 193 156 — — OH (1), TX (1) other serogroup — 30 1 35 32 27 — — unknown serogroup 7 522 10 550 651 765 — — NY (1), OH (1), MI (1), MO (1), TN (1), OR (1), CA (1) Mumps 1 349 13 800 6,584 314 258 231 AK (1) Novel influenza A virus infections — — — 4 N N N N Plague — 1 0 7 17 8 3 1 Poliomyelitis, paralytic — — — — — 1 — — Polio virus infection, nonparalytic§ — — — — N N N N Psittacosis§ — 9 0 12 21 16 12 12 Qfever§,§§§ total: 2 103 2 171 169 136 70 71 acute 2 92 — — — — — — NY (2) chronic — 11 — — — — — — Rabies, human — — 0 1 3 2 7 2 Rubella¶¶¶ — 13 — 12 11 11 10 7 Rubella, congenital syndrome — — — — 1 1 — 1 SARS-CoV§,**** — — — — — — — 8 Smallpox§ — — — — — — — — Streptococcal toxic-shock syndrome§ — 111 1 132 125 129 132 161 Syphilis, congenital (age <1 yr) — 187 8 430 349 329 353 413 Tetanus — 9 0 28 41 27 34 20 Toxic-shock syndrome (staphylococcal)§ 3 54 1 92 101 90 95 133 KY (1), TN (1), NV (1) Trichinellosis — 5 0 5 15 16 5 6 Tularemia — 86 1 137 95 154 134 129 Typhoid fever 4 341 5 434 353 324 322 356 MO (1), CA (3) Vancomycin-intermediate Staphylococcus aureus§ — 6 0 37 6 2 — N Vancomycin-resistant Staphylococcus aureus§ — — 0 2 1 3 1 N Vibriosis (noncholera Vibrio species infections)§ 6 385 5 447 N N N N MN (1), MD (1), AL (1), AZ (1), CA (2) Yellow fever — — — — — — — —
See Table 1 footnotes on next page.
1236 MMWR November 14, 2008
TABLE 1. (Continued) Provisional cases of infrequently reported notifiable diseases (<1,000 cases reported during the preceding year) — United States, week ending November 8, 2008 (45th week)* —: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. * Incidence data for reporting year 2008 are provisional, whereas data for 2003, 2004, 2005, 2006, and 2007 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 and 2008 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. ¶ Includes both neuroinvasive and nonneuroinvasive. Updated weekly from reports to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-
Borne, and Enteric Diseases (ArboNET Surveillance). Data for West Nile virus are available in Table II. ** The names of the reporting categories changed in 2008 as a result of revisions to the case definitions. Cases reported prior to 2008 were reported in the categories: Ehrlichiosis,
human monocytic (analogous to E. chaffeensis); Ehrlichiosis, human granulocytic (analogous to Anaplasma phagocytophilum), and Ehrlichiosis, unspecified, or other agent (which included cases unable to be clearly placed in other categories, as well as possible cases of E. ewingii).
†† 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. There are no reports of confirmed influenza-associated pediatric deaths for the current 2008-09 season.
*** The one measles case reported for the current week was indigenous. ††† Data for meningococcal disease (all serogroups) are available in Table II. §§§ In 2008, Q fever acute and chronic reporting categories were recognized as a result of revisions to the Q fever case definition. Prior to that time, case counts were not
differentiated with respect to acute and chronic Q fever cases. ¶¶¶ No rubella cases were reported for the current week. **** Updated weekly from reports to the Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases.
* 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.
FIGURE I. Selected notifiable disease reports, United States, comparison of provisional 4-week totals November 8, 2008, with historical data
Notifiable Disease Data Team and 122 Cities Mortality Data Team Patsy A. Hall Deborah A. Adams Rosaline Dhara Willie J. Anderson Michael S. Wodajo Lenee Blanton Pearl C. Sharp
Ratio (Log scale)*
DISEASE
4210.50.25
Beyond historical limits
DECREASE INCREASE CASES CURRENT
4 WEEKS
927
100
121
33
122
1
25
11
434
Hepatitis A, acute
Hepatitis B, acute
Hepatitis C, acute
Legionellosis
Measles
Mumps
Pertussis
Giardiasis
Meningococcal disease
Vol. 57 / No. 45 MMWR 1237
TABLE II. Provisional cases of selected notifiable diseases, United States, weeks ending November 8, 2008, and November 10, 2007 (45th week)*
Reporting area
Chlamydia† Coccidiodomycosis Cryptosporidiosis
Current week
Previous 52 weeks Cum
2008 Cum 2007
Current week
Previous 52 weeks Cum
2008 Cum 2007
Current week
Previous 52 week Cum
2008 Cum 2007Med Max Med Max Med Max
United States 8,748 21,172 28,892 923,486 950,910 240 121 341 5,635 6,577 57 102 426 6,356 10,272 New England 688 706 1,516 31,808 30,311 — 0 1 1 2 1 5 39 281 306 Connecticut — 221 1,093 9,786 9,064 N 0 0 N N — 0 37 37 42 Maine§ 47 50 72 2,230 2,208 N 0 0 N N — 1 6 41 46 Massachusetts 485 325 660 14,997 13,578 N 0 0 N N — 1 9 91 123 New Hampshire 37 40 64 1,838 1,805 — 0 1 1 2 1 1 4 52 46 Rhode Island§ 88 54 102 2,298 2,738 — 0 0 — — — 0 2 7 10 Vermont§ 31 15 52 659 918 N 0 0 N N — 1 7 53 39
Mid. Atlantic 1,403 2,717 4,921 122,875 124,220 — 0 0 — — 2 13 34 636 1,289 New Jersey — 413 520 15,469 18,671 N 0 0 N N — 1 2 25 63 New York (Upstate) 493 561 2,177 23,469 23,482 N 0 0 N N 1 4 17 239 224 New York City 620 975 3,001 47,787 44,842 N 0 0 N N — 2 6 94 90 Pennsylvania 290 823 1,025 36,150 37,225 N 0 0 N N 1 5 15 278 912
E.N. Central 664 3,487 4,373 150,437 155,331 — 1 3 38 31 11 25 122 1,774 1,737 Illinois 5 1,065 1,711 43,250 46,122 N 0 0 N N — 2 7 101 187 Indiana 246 377 656 17,665 18,352 N 0 0 N N 2 3 41 170 89 Michigan 397 827 1,226 38,215 32,326 — 0 3 29 21 — 5 13 228 178 Ohio 16 846 1,261 36,958 41,309 — 0 1 9 10 9 6 59 644 532 Wisconsin — 334 612 14,349 17,222 N 0 0 N N — 8 46 631 751
W.N. Central 644 1,258 1,700 56,043 54,936 — 0 77 2 7 12 16 71 868 1,495 Iowa — 166 240 7,598 7,615 N 0 0 N N 2 4 30 259 593 Kansas 236 178 529 8,031 7,003 N 0 0 N N — 1 8 72 135 Minnesota — 264 373 11,447 11,776 — 0 77 — — 6 5 15 206 256 Missouri 408 477 566 21,211 20,314 — 0 1 2 7 1 3 13 151 165 Nebraska§ — 92 252 3,914 4,499 N 0 0 N N 3 2 8 105 158 North Dakota — 33 65 1,441 1,495 N 0 0 N N — 0 51 7 23 South Dakota — 54 85 2,401 2,234 N 0 0 N N — 1 9 68 165
S. Atlantic 1,588 3,719 7,609 162,305 186,623 — 0 1 4 5 18 18 46 849 1,133 Delaware 58 69 150 3,218 2,984 — 0 1 1 — — 0 2 10 20 District of Columbia — 131 216 5,804 5,186 — 0 1 — 2 — 0 2 8 3 Florida 1,161 1,359 1,569 60,302 49,962 N 0 0 N N 9 8 35 413 598 Georgia 1 330 1,338 15,557 37,305 N 0 0 N N 5 4 13 197 210 Maryland§ 342 451 699 19,841 19,359 — 0 1 3 3 1 0 4 32 33 North Carolina — 5 4,783 5,901 24,299 N 0 0 N N 1 0 16 61 101 South Carolina§ 26 465 3,047 22,920 23,084 N 0 0 N N — 1 4 42 81 Virginia§ — 612 1,059 26,255 21,662 N 0 0 N N 2 1 4 67 76 West Virginia — 57 96 2,507 2,782 N 0 0 N N — 0 3 19 11
E.S. Central 587 1,565 2,394 70,060 72,281 — 0 0 — — — 3 9 144 580 Alabama§ — 461 589 18,558 22,091 N 0 0 N N — 1 6 60 110 Kentucky — 234 370 10,252 7,245 N 0 0 N N — 0 4 30 244 Mississippi — 364 1,048 16,976 19,004 N 0 0 N N — 0 2 16 98 Tennessee§ 587 528 791 24,274 23,941 N 0 0 N N — 1 6 38 128
W.S. Central 512 2,732 4,426 120,332 108,353 — 0 1 3 2 2 5 130 969 405 Arkansas§ 348 274 455 12,502 8,702 N 0 0 N N 1 0 6 37 56 Louisiana 164 354 774 16,601 17,274 — 0 1 3 2 — 1 5 48 56 Oklahoma — 195 392 7,668 11,108 N 0 0 N N 1 1 16 120 112 Texas§ — 1,900 3,923 83,561 71,269 N 0 0 N N — 2 117 764 181
Mountain 430 1,183 1,811 50,831 64,133 94 87 170 3,731 4,071 1 9 37 476 2,842 Arizona 292 430 650 16,967 21,711 94 86 168 3,658 3,930 — 1 9 83 46 Colorado — 185 488 8,136 14,977 N 0 0 N N — 1 12 102 202 Idaho§ 3 61 314 3,185 3,203 N 0 0 N N 1 1 14 60 440 Montana§ — 58 363 2,414 2,248 N 0 0 N N — 1 6 39 61 Nevada§ 135 181 416 8,177 8,406 — 1 6 41 60 — 0 2 1 36 New Mexico§ — 137 561 5,859 7,880 — 0 3 26 20 — 1 23 143 116 Utah — 118 253 4,803 4,665 — 0 3 4 58 — 0 6 31 1,888 Wyoming§ — 30 58 1,290 1,043 — 0 1 2 3 — 0 4 17 53
Pacific 2,232 3,692 4,676 158,795 154,722 146 31 217 1,856 2,459 10 9 29 359 485 Alaska 96 88 129 3,865 4,241 N 0 0 N N — 0 1 3 3 California 1,869 2,873 4,115 125,324 120,816 146 31 217 1,856 2,459 6 5 14 217 255 Hawaii — 103 152 4,389 4,940 N 0 0 N N — 0 1 2 6 Oregon§ — 188 402 8,392 8,374 N 0 0 N N 2 1 4 49 121 Washington 267 372 634 16,825 16,351 N 0 0 N N 2 2 16 88 100
American Samoa — 0 20 73 95 N 0 0 N N N 0 0 N N C.N.M.I. — — — — — — — — — — — — — — — Guam — 5 24 115 735 — 0 0 — — — 0 0 — — Puerto Rico 76 121 612 6,138 6,460 N 0 0 N N N 0 0 N N U.S. Virgin Islands — 12 23 502 146 — 0 0 — — — 0 0 — —
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 2008 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).
1238 MMWR November 14, 2008
TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending November 8, 2008, and November 10, 2007 (45th week)*
Reporting area
Giardiasis Gonorrhea Haemophilus influenzae, invasive
All ages, all serotypes†
Current week
Previous 52 weeks Cum
2008 Cum 2007
Current week
Previous 52 weeks Cum
2008 Cum 2007
Current week
Previous 52 weeks Cum
2008 Cum 2007Med Max Med Max Med Max
United States 252 309 1,158 14,696 15,947 1,961 5,878 8,913 256,099 306,441 21 48 173 2,180 2,075 New England 5 24 49 1,132 1,308 63 103 227 4,543 4,757 — 3 12 127 159 Connecticut 1 6 11 278 324 — 53 199 2,232 1,836 — 0 9 34 43 Maine§ 3 3 12 158 174 1 2 6 81 109 — 0 1 13 12 Massachusetts — 9 17 343 547 56 38 127 1,841 2,268 — 1 5 57 77 New Hampshire — 2 11 132 31 2 2 6 88 131 — 0 1 9 16 Rhode Island§ — 1 8 76 77 4 6 13 277 359 — 0 1 6 8 Vermont§ 1 2 13 145 155 — 0 5 24 54 — 0 3 8 3
Mid. Atlantic 43 60 131 2,740 2,787 297 625 1,028 27,674 31,639 3 10 31 418 396 New Jersey — 8 14 300 359 — 105 168 3,971 5,260 — 1 7 61 61 New York (Upstate) 23 23 111 1,022 1,013 119 124 545 5,233 5,891 2 3 22 128 113 New York City 4 16 27 692 752 136 175 518 8,877 9,286 — 1 6 73 87 Pennsylvania 16 15 45 726 663 42 220 394 9,593 11,202 1 4 8 156 135
E.N. Central 25 46 78 2,134 2,532 228 1,241 1,647 53,610 63,259 3 8 28 325 320 Illinois — 10 22 469 795 2 370 589 15,034 17,356 — 2 7 101 99 Indiana N 0 0 N N 85 150 284 7,110 7,907 — 1 20 65 53 Michigan 3 11 21 489 543 138 329 657 14,426 13,395 — 0 3 17 26 Ohio 21 16 31 780 713 3 305 531 13,159 18,615 3 2 6 118 91 Wisconsin 1 9 23 396 481 — 98 175 3,881 5,986 — 1 2 24 51
W.N. Central 9 27 621 1,707 1,168 171 320 425 14,230 17,089 3 3 24 169 124 Iowa 2 6 17 282 270 — 28 48 1,289 1,700 — 0 1 2 1 Kansas — 3 11 140 166 71 41 130 1,998 1,999 — 0 3 11 11 Minnesota — 0 575 590 7 — 58 92 2,517 3,027 — 0 21 54 56 Missouri 6 8 22 400 471 100 149 203 6,938 8,757 3 1 6 65 37 Nebraska§ 1 4 10 179 143 — 25 47 1,121 1,274 — 0 2 25 15 North Dakota — 0 36 19 19 — 2 6 87 108 — 0 3 12 4 South Dakota — 1 10 97 92 — 6 15 280 224 — 0 0 — —
S. Atlantic 62 55 87 2,411 2,674 492 1,201 3,072 54,667 71,865 10 11 29 584 523 Delaware — 1 3 34 39 10 20 44 908 1,128 — 0 2 6 8 District of Columbia — 1 5 51 68 — 48 104 2,197 2,060 — 0 1 9 3 Florida 28 22 52 1,106 1,118 383 451 549 20,046 20,323 3 3 10 156 140 Georgia 18 10 27 511 596 — 105 560 5,983 15,357 4 2 9 132 106 Maryland§ 2 5 12 214 242 86 118 206 5,346 5,763 — 2 6 81 76 North Carolina N 0 0 N N — 3 1,949 2,638 12,026 2 1 9 65 51 South Carolina§ 3 2 6 106 105 13 189 832 8,250 8,924 — 1 7 44 44 Virginia§ 11 8 39 338 460 — 173 486 8,708 5,451 1 1 6 73 70 West Virginia — 1 5 51 46 — 14 26 591 833 — 0 3 18 25
E.S. Central 12 9 21 414 496 154 559 945 25,096 28,107 1 3 8 111 119 Alabama§ 2 5 12 231 232 — 181 287 7,345 9,450 — 0 2 17 25 Kentucky N 0 0 N N — 90 153 3,917 2,859 — 0 1 2 8 Mississippi N 0 0 N N — 131 401 6,098 7,254 — 0 2 13 9 Tennessee§ 10 4 13 183 264 154 164 296 7,736 8,544 1 2 6 79 77
W.S. Central 6 7 41 365 385 197 952 1,355 41,058 44,999 — 2 29 94 89 Arkansas§ 1 3 8 123 141 135 86 167 4,062 3,708 — 0 3 8 9 Louisiana — 2 9 106 125 62 159 317 7,156 9,883 — 0 2 7 8 Oklahoma 5 3 35 136 119 — 67 124 2,903 4,304 — 1 21 71 62 Texas§ N 0 0 N N — 636 1,102 26,937 27,104 — 0 3 8 10
Mountain 9 28 60 1,259 1,590 66 206 337 8,788 12,076 1 5 14 241 219 Arizona 1 3 7 117 177 44 63 111 2,442 4,454 1 2 11 100 78 Colorado — 11 27 483 507 — 58 100 2,602 2,933 — 1 4 47 53 Idaho§ 3 4 19 173 161 1 3 13 137 238 — 0 4 12 6 Montana§ — 1 9 74 99 — 2 48 95 61 — 0 1 2 2 Nevada§ 5 1 6 79 124 21 42 130 1,892 2,079 — 0 2 14 10 New Mexico§ — 2 7 76 106 — 24 104 1,094 1,565 — 0 4 31 37 Utah — 5 22 235 376 — 11 36 418 679 — 0 6 32 28 Wyoming§ — 0 3 22 40 — 2 9 108 67 — 0 2 3 5
Pacific 81 54 185 2,534 3,007 293 612 746 26,433 32,650 — 2 7 111 126 Alaska 2 1 10 89 68 9 10 24 441 490 — 0 2 16 14 California 51 35 91 1,643 2,017 257 514 657 21,941 27,251 — 0 3 25 45 Hawaii — 0 5 36 70 — 11 22 479 574 — 0 2 17 11 Oregon§ 5 8 18 399 409 — 23 53 1,045 1,072 — 1 4 50 54 Washington 23 8 87 367 443 27 56 90 2,527 3,263 — 0 3 3 2
American Samoa — 0 0 — — — 0 1 3 3 — 0 0 — — C.N.M.I. — — — — — — — — — — — — — — — Guam — 0 0 — 2 — 1 15 72 114 — 0 1 — — Puerto Rico — 2 10 111 354 8 5 25 245 281 — 0 0 — 2 U.S. Virgin Islands — 0 0 — — — 2 6 93 37 N 0 0 N N
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 2008 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).
Vol. 57 / No. 45 MMWR 1239
TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending November 8, 2008, and November 10, 2007 (45th week)*
Reporting area
Hepatitis (viral, acute), by type†
LegionellosisA B
Current week
Previous 52 weeks Cum
2008 Cum 2007
Current week
Previous 52 weeks Cum
2008 Cum 2007
Current week
Previous 52 weeks Cum
2008 Cum 2007Med Max Med Max Med Max
United States 20 47 171 2,113 2,513 33 68 259 2,939 3,763 22 50 138 2,374 2,276 New England — 2 7 96 121 — 1 7 50 108 — 2 16 117 135 Connecticut — 0 4 26 25 — 0 7 19 35 — 0 5 37 36 Maine§ — 0 2 6 3 — 0 2 10 12 — 0 2 8 6 Massachusetts — 1 5 38 61 — 0 1 9 40 — 0 3 13 38 New Hampshire — 0 2 12 12 — 0 1 6 4 — 0 5 24 8 Rhode Island§ — 0 2 12 12 — 0 2 4 13 — 0 14 30 38 Vermont§ — 0 1 2 8 — 0 1 2 4 — 0 1 5 9
Mid. Atlantic 2 6 12 248 407 4 9 15 364 488 9 15 58 807 732 New Jersey — 1 4 42 116 — 3 7 102 137 — 1 8 62 104 New York (Upstate) — 1 6 57 66 2 1 4 57 80 6 5 19 294 198 New York City — 2 6 91 144 — 2 6 77 107 — 2 12 98 167 Pennsylvania 2 1 6 58 81 2 3 7 128 164 3 6 33 353 263
E.N. Central 4 6 16 279 301 3 7 12 336 399 4 10 38 513 522 Illinois — 1 10 85 107 — 1 5 78 122 — 1 7 66 104 Indiana — 0 4 21 27 2 0 6 40 47 1 1 7 43 51 Michigan 1 2 7 102 81 — 2 6 109 100 — 2 16 140 151 Ohio 3 1 4 45 57 1 2 8 103 110 3 5 18 247 185 Wisconsin — 0 2 26 29 — 0 1 6 20 — 0 3 17 31
W.N. Central 1 5 29 233 152 — 2 9 83 100 1 2 9 108 103 Iowa — 1 7 104 43 — 0 2 13 23 — 0 2 13 11 Kansas — 0 3 12 7 — 0 3 6 8 — 0 1 2 9 Minnesota — 0 23 36 62 — 0 5 10 17 1 0 4 19 23 Missouri 1 1 3 38 19 — 1 4 48 34 — 1 5 53 43 Nebraska§ — 0 5 39 15 — 0 1 5 11 — 0 4 19 13 North Dakota — 0 2 — — — 0 1 1 — — 0 2 — — South Dakota — 0 1 4 6 — 0 0 — 7 — 0 1 2 4
S. Atlantic 4 7 15 340 429 9 16 60 750 876 7 9 28 397 374 Delaware — 0 1 7 7 — 0 3 7 14 — 0 2 11 11 District of Columbia U 0 0 U U U 0 0 U U — 0 1 13 14 Florida 1 3 8 136 134 2 6 12 291 299 3 3 7 129 130 Georgia 1 1 4 43 61 3 3 6 123 134 1 0 4 27 35 Maryland§ 1 1 3 34 69 — 2 4 70 102 1 2 10 104 70 North Carolina — 0 9 57 56 — 0 17 73 120 1 0 7 33 39 South Carolina§ — 0 3 15 15 — 1 6 52 55 — 0 2 11 17 Virginia§ 1 1 5 43 78 4 2 16 88 113 1 1 6 49 46 West Virginia — 0 2 5 9 — 1 30 46 39 — 0 3 20 12
E.S. Central — 1 9 72 94 2 7 13 313 336 — 2 10 97 88 Alabama§ — 0 4 12 18 — 2 6 89 117 — 0 2 13 9 Kentucky — 0 3 27 19 1 2 5 76 67 — 1 4 48 44 Mississippi — 0 2 4 8 — 0 3 36 36 — 0 1 1 — Tennessee§ — 0 6 29 49 1 3 8 112 116 — 1 5 35 35
W.S. Central — 5 55 183 228 9 14 131 544 814 — 1 23 69 113 Arkansas§ — 0 1 5 12 — 0 4 30 66 — 0 2 11 14 Louisiana — 0 1 10 27 — 2 4 70 87 — 0 2 8 4 Oklahoma — 0 3 7 10 4 2 22 96 119 — 0 6 10 5 Texas§ — 4 53 161 179 5 8 107 348 542 — 1 18 40 90
Mountain 3 4 9 168 205 — 4 10 172 185 — 2 4 65 98 Arizona 3 2 8 76 137 — 1 5 59 73 — 0 2 16 36 Colorado — 1 3 35 24 — 0 3 30 33 — 0 2 10 21 Idaho§ — 0 3 18 4 — 0 2 9 12 — 0 1 3 5 Montana§ — 0 1 1 9 — 0 1 2 — — 0 1 4 3 Nevada§ — 0 3 8 11 — 1 3 32 42 — 0 1 8 8 New Mexico§ — 0 3 16 11 — 0 2 9 12 — 0 1 6 9 Utah — 0 2 11 6 — 0 5 27 9 — 0 2 18 13 Wyoming§ — 0 1 3 3 — 0 1 4 4 — 0 0 — 3
Pacific 6 11 51 494 576 6 8 30 327 457 1 4 18 201 111 Alaska — 0 1 3 4 — 0 2 9 7 — 0 1 1 — California 5 9 42 404 496 5 5 19 230 338 1 3 14 160 82 Hawaii — 0 2 16 6 — 0 2 6 14 — 0 1 8 2 Oregon§ — 0 3 25 26 — 1 3 40 51 — 0 2 15 10 Washington 1 1 7 46 44 1 1 9 42 47 — 0 3 17 17
American Samoa — 0 0 — — — 0 0 — 14 N 0 0 N N C.N.M.I. — — — — — — — — — — — — — — — Guam — 0 0 — — — 0 1 — 2 — 0 0 — — Puerto Rico — 0 4 16 56 — 1 5 37 79 — 0 1 1 4 U.S. Virgin Islands — 0 0 — — — 0 0 — — — 0 0 — —
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 2008 are provisional. † Data for acute hepatitis C, viral are available in Table I. § Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
1240 MMWR November 14, 2008
TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending November 8, 2008, and November 10, 2007 (45th week)*
Reporting area
Lyme disease Malaria Meningococcal disease, invasive†
All serotypes
Current week
Previous 52 weeks Cum
2008 Cum 2007
Current week
Previous 52 weeks Cum
2008 Cum 2007
Current week
Previous 52 weeks Cum
2008 Cum 2007Med Max Med Max Med Max
United States 236 376 1,414 22,362 24,396 10 22 136 917 1,125 11 18 53 917 933 New England 37 52 252 3,308 7,436 — 1 35 33 53 — 0 3 21 41 Connecticut — 0 35 — 2,932 — 0 27 11 2 — 0 1 1 6 Maine§ 34 2 75 770 447 — 0 1 — 7 — 0 1 5 7 Massachusetts — 13 114 1,039 2,906 — 0 2 14 31 — 0 3 15 19 New Hampshire — 8 133 1,194 860 — 0 1 4 9 — 0 0 — 3 Rhode Island§ — 0 12 — 163 — 0 8 — — — 0 1 — 3 Vermont§ 3 2 39 305 128 — 0 1 4 4 — 0 1 — 3
Mid. Atlantic 141 168 1,000 12,974 10,025 — 4 14 210 344 1 2 6 105 118 New Jersey — 32 188 2,301 2,919 — 0 2 — 64 — 0 2 10 17 New York (Upstate) 109 53 453 4,408 2,961 — 1 8 28 57 1 0 3 26 34 New York City — 0 7 26 394 — 3 10 148 184 — 0 2 25 20 Pennsylvania 32 55 528 6,239 3,751 — 1 3 34 39 — 1 5 44 47
E.N. Central 1 9 122 1,030 2,042 — 2 7 112 119 4 3 9 153 146 Illinois — 0 9 75 149 — 1 6 48 53 — 1 4 53 55 Indiana — 0 8 35 44 — 0 2 5 9 — 0 4 23 24 Michigan — 1 12 90 51 — 0 2 14 18 1 0 3 27 24 Ohio 1 0 5 42 31 — 0 3 28 22 3 1 4 36 32 Wisconsin — 7 108 788 1,767 — 0 3 17 17 — 0 2 14 11
W.N. Central 7 8 740 1,133 517 1 1 9 59 38 1 2 8 84 61 Iowa — 1 8 82 119 — 0 1 5 3 — 0 3 16 14 Kansas — 0 1 5 8 — 0 2 9 3 — 0 1 4 4 Minnesota 7 2 731 989 372 1 0 8 24 16 — 0 7 22 18 Missouri — 0 4 41 9 — 0 4 13 7 1 0 3 25 15 Nebraska§ — 0 2 12 6 — 0 2 8 7 — 0 1 12 5 North Dakota — 0 9 1 3 — 0 2 — 1 — 0 1 3 2 South Dakota — 0 1 3 — — 0 0 — 1 — 0 1 2 3
S. Atlantic 38 66 177 3,505 4,131 4 4 15 237 233 — 3 10 139 154 Delaware — 12 37 671 654 — 0 1 2 4 — 0 1 2 1 District of Columbia — 3 11 147 115 — 0 2 4 2 — 0 0 — — Florida 6 1 10 96 24 — 1 7 49 50 — 1 3 48 59 Georgia — 0 3 21 10 — 1 5 47 37 — 0 2 16 22 Maryland§ 16 30 136 1,739 2,386 2 1 6 60 62 — 0 4 16 19 North Carolina 3 0 7 39 42 2 0 7 26 20 — 0 4 12 18 South Carolina§ — 0 3 21 28 — 0 1 9 6 — 0 3 19 16 Virginia§ 13 12 68 709 805 — 1 7 40 51 — 0 2 21 17 West Virginia — 0 11 62 67 — 0 0 — 1 — 0 1 5 2
E.S. Central — 1 3 41 50 1 0 2 17 33 1 1 6 47 45 Alabama§ — 0 3 10 13 — 0 1 4 6 — 0 2 8 8 Kentucky — 0 1 3 5 — 0 1 4 8 — 0 2 8 10 Mississippi — 0 1 1 1 — 0 1 1 2 — 0 2 11 10 Tennessee§ — 0 3 27 31 1 0 2 8 17 1 0 3 20 17
W.S. Central 3 2 11 95 70 — 1 64 72 83 2 2 13 96 93 Arkansas§ — 0 0 — 1 — 0 0 — 2 — 0 2 7 9 Louisiana — 0 1 3 2 — 0 1 3 14 — 0 3 21 25 Oklahoma — 0 1 — — — 0 4 2 5 1 0 5 14 16 Texas§ 3 2 10 92 67 — 1 60 67 62 1 1 7 54 43
Mountain — 0 4 40 42 — 1 3 29 61 — 1 4 49 58 Arizona — 0 2 7 2 — 0 2 14 12 — 0 2 10 12 Colorado — 0 2 7 — — 0 1 4 23 — 0 1 12 21 Idaho§ — 0 2 10 9 — 0 1 3 4 — 0 2 4 4 Montana§ — 0 1 4 4 — 0 0 — 3 — 0 1 5 2 Nevada§ — 0 2 4 12 — 0 3 3 3 — 0 1 4 4 New Mexico§ — 0 2 6 5 — 0 1 2 5 — 0 1 7 2 Utah — 0 0 — 7 — 0 1 3 11 — 0 1 5 11 Wyoming§ — 0 1 2 3 — 0 0 — — — 0 1 2 2
Pacific 9 5 10 236 83 4 3 10 148 161 2 4 18 223 217 Alaska — 0 2 5 8 1 0 2 6 2 — 0 2 4 1 California 8 3 10 178 66 3 2 8 110 116 1 3 18 158 159 Hawaii N 0 0 N N — 0 1 3 2 — 0 2 4 8 Oregon§ 1 0 5 43 6 — 0 2 4 16 1 1 3 33 28 Washington — 0 7 10 3 — 0 3 25 25 — 0 5 24 21
American Samoa N 0 0 N N — 0 0 — — — 0 0 — — C.N.M.I. — — — — — — — — — — — — — — — Guam — 0 0 — — — 0 2 3 1 — 0 0 — — Puerto Rico N 0 0 N N — 0 1 1 3 — 0 1 3 7 U.S. Virgin Islands N 0 0 N N — 0 0 — — — 0 0 — —
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 2008 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).
Vol. 57 / No. 45 MMWR 1241
TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending November 8, 2008, and November 10, 2007 (45th week)*
Reporting area
Pertussis Rabies, animal Rocky Mountain spotted fever
Current week
Previous 52 weeks Cum
2008 Cum 2007
Current week
Previous 52 weeks Cum
2008 Cum 2007
Current week
Previous 52 weeks Cum
2008 Cum 2007Med Max Med Max Med Max
United States 150 155 849 7,265 8,442 45 94 147 4,148 5,453 47 33 195 2,028 1,849 New England — 14 49 559 1,320 11 7 20 328 485 — 0 1 2 8 Connecticut — 0 4 34 78 8 3 17 183 205 — 0 0 — — Maine† — 1 5 33 74 1 1 5 50 79 N 0 0 N N Massachusetts — 11 33 420 1,024 N 0 0 N N — 0 1 1 7 New Hampshire — 0 4 31 73 — 1 3 35 49 — 0 1 1 1 Rhode Island† — 0 25 29 22 N 0 0 N N — 0 0 — — Vermont† — 0 6 12 49 2 1 6 60 152 — 0 0 — —
Mid. Atlantic 27 19 43 811 1,111 12 22 50 1,173 905 2 1 5 65 72 New Jersey — 0 9 4 198 — 0 0 — — — 0 2 2 27 New York (Upstate) 8 7 24 382 490 12 9 20 455 474 — 0 2 16 6 New York City — 1 6 46 126 — 0 2 13 42 — 0 2 23 24 Pennsylvania 19 8 23 379 297 — 14 35 705 389 2 0 2 24 15
E.N. Central 29 22 189 1,215 1,387 2 3 28 240 399 1 1 13 126 57 Illinois — 4 18 211 169 — 1 21 103 112 — 1 10 84 37 Indiana — 1 15 87 53 — 0 2 10 12 — 0 3 7 5 Michigan 3 5 14 222 266 2 1 8 70 199 — 0 1 3 4 Ohio 26 8 176 631 588 — 1 7 57 76 1 0 4 31 10 Wisconsin — 1 7 64 311 N 0 0 N N — 0 1 1 1
W.N. Central 43 14 142 759 595 8 3 12 172 243 1 5 36 482 354 Iowa — 1 9 68 135 — 0 5 27 30 — 0 2 6 15 Kansas — 1 10 44 95 — 0 7 — 99 — 0 0 — 12 Minnesota — 2 131 200 157 7 0 10 61 32 — 0 4 — 1 Missouri 19 4 20 274 82 1 0 9 48 38 — 4 35 453 307 Nebraska† 24 2 21 157 62 — 0 0 — — 1 0 4 20 14 North Dakota — 0 5 1 7 — 0 8 24 21 — 0 0 — — South Dakota — 0 3 15 57 — 0 2 12 23 — 0 1 3 5
S. Atlantic 8 15 50 737 843 8 37 101 1,806 1,992 30 12 70 785 867 Delaware — 0 3 15 11 — 0 0 — — — 0 4 26 16 District of Columbia — 0 1 5 9 — 0 0 — — — 0 2 7 3 Florida 4 4 20 248 194 — 0 77 124 128 1 0 3 17 15 Georgia — 1 6 59 33 — 6 42 288 268 — 1 8 67 56 Maryland† 3 2 9 102 105 — 8 17 382 387 — 1 7 60 59 North Carolina — 0 38 79 282 8 9 16 412 442 28 1 55 414 545 South Carolina† 1 2 22 96 69 — 0 0 — 46 — 1 8 49 61 Virginia† — 3 10 127 111 — 12 24 527 646 1 2 15 139 107 West Virginia — 0 2 6 29 — 1 11 73 75 — 0 1 6 5
E.S. Central 3 6 13 270 428 — 2 7 93 144 — 3 22 280 268 Alabama† 1 1 5 42 85 — 0 0 — — — 1 8 83 92 Kentucky — 1 8 79 27 — 0 4 43 18 — 0 1 1 5 Mississippi — 2 7 82 241 — 0 1 2 2 — 0 3 6 20 Tennessee† 2 1 6 67 75 — 0 6 48 124 — 2 18 190 151
W.S. Central 15 24 198 1,238 937 — 1 40 85 974 12 2 153 252 186 Arkansas† — 1 11 48 157 — 1 6 47 28 — 0 14 50 99 Louisiana — 1 7 67 20 — 0 0 — 6 — 0 1 5 4 Oklahoma — 0 26 32 6 — 0 32 36 45 12 0 132 158 47 Texas† 15 20 179 1,091 754 — 0 20 2 895 — 1 8 39 36
Mountain 1 15 37 661 967 — 1 8 71 88 1 0 3 32 34 Arizona — 3 10 172 194 N 0 0 N N 1 0 2 13 9 Colorado — 3 13 131 261 — 0 0 — — — 0 1 1 3 Idaho† 1 0 5 28 37 — 0 1 — 11 — 0 1 1 4 Montana† — 1 11 77 41 — 0 2 8 19 — 0 1 3 1 Nevada† — 0 7 18 37 — 0 4 5 13 — 0 2 2 — New Mexico† — 0 5 31 70 — 0 3 24 11 — 0 1 2 5 Utah — 5 27 188 304 — 0 6 13 16 — 0 0 — — Wyoming† — 0 2 16 23 — 0 3 21 18 — 0 2 10 12
Pacific 24 21 303 1,015 854 4 4 13 180 223 — 0 1 4 3 Alaska 10 2 19 185 86 — 0 4 13 41 N 0 0 N N California — 7 129 299 399 4 3 12 154 171 — 0 1 1 1 Hawaii — 0 2 11 18 — 0 0 — — N 0 0 N N Oregon† 2 3 9 154 111 — 0 4 13 11 — 0 1 3 2 Washington 12 5 169 366 240 — 0 0 — — N 0 0 N N
American Samoa — 0 0 — — N 0 0 N N N 0 0 N N C.N.M.I. — — — — — — — — — — — — — — — Guam — 0 0 — — — 0 0 — — N 0 0 N N Puerto Rico — 0 0 — — — 1 5 56 47 N 0 0 N N U.S. Virgin Islands — 0 0 — — N 0 0 N N N 0 0 N N
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 2008 are provisional. † Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
1242 MMWR November 14, 2008
TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending November 8, 2008, and November 10, 2007 (45th week)*
Reporting area
Salmonellosis Shiga toxin-producing E. coli (STEC)† Shigellosis
Current week
Previous 52 weeks Cum
2008 Cum 2007
Current week
Previous 52 weeks Cum
2008 Cum 2007
Current week
Previous 52 weeks Cum
2008 Cum 2007Med Max Med Max Med Max
United States 645 796 2,110 37,991 40,993 51 84 248 4,368 4,306 350 402 1,227 16,579 15,756 New England — 19 456 1,581 2,112 — 3 46 205 298 — 2 35 149 231 Connecticut — 0 426 426 431 — 0 43 43 71 — 0 34 34 44 Maine§ — 2 8 129 125 — 0 3 21 39 — 0 6 21 14 Massachusetts — 14 52 741 1,227 — 1 11 80 134 — 2 5 78 145 New Hampshire — 2 10 121 155 — 0 3 30 34 — 0 1 3 5 Rhode Island§ — 1 8 92 100 — 0 3 8 7 — 0 1 10 20 Vermont§ — 1 7 72 74 — 0 3 23 13 — 0 1 3 3
Mid. Atlantic 45 87 164 4,372 5,418 1 7 192 554 473 8 37 95 1,868 693 New Jersey — 13 30 488 1,130 — 1 4 25 106 — 8 37 568 155 New York (Upstate) 30 25 73 1,233 1,292 1 3 188 389 185 5 9 35 521 141 New York City 1 21 52 1,134 1,198 — 1 5 50 46 — 11 35 617 239 Pennsylvania 14 27 78 1,517 1,798 — 1 8 90 136 3 3 65 162 158
E.N. Central 34 87 178 4,143 5,358 4 10 58 715 673 59 70 145 3,154 2,507 Illinois — 22 67 963 1,805 — 1 7 70 126 — 16 29 676 614 Indiana 10 9 53 543 609 — 1 14 82 91 6 11 83 555 123 Michigan — 17 38 785 861 — 2 34 190 106 — 2 7 121 76 Ohio 24 25 65 1,151 1,190 3 3 17 180 149 53 24 76 1,427 1,086 Wisconsin — 15 49 701 893 1 3 18 193 201 — 9 39 375 608
W.N. Central 21 48 126 2,439 2,544 8 12 57 731 715 7 17 39 775 1,690 Iowa — 8 15 365 432 — 2 20 190 170 — 3 11 135 90 Kansas — 6 25 384 372 — 0 7 43 50 — 0 5 47 24 Minnesota 7 13 70 648 607 5 3 21 185 210 1 5 25 276 219 Missouri 10 14 51 669 699 1 2 9 131 145 5 4 29 193 1,210 Nebraska§ 4 4 13 207 244 2 1 28 139 86 1 0 3 10 24 North Dakota — 0 35 42 41 — 0 20 3 8 — 0 15 37 3 South Dakota — 2 11 124 149 — 1 4 40 46 — 0 9 77 120
S. Atlantic 288 263 456 10,464 10,569 11 13 50 702 608 55 57 149 2,638 4,021 Delaware — 3 9 136 131 — 0 1 10 14 — 0 1 7 10 District of Columbia — 1 4 46 52 — 0 1 11 — — 0 3 13 17 Florida 143 102 174 4,460 4,171 6 2 18 136 129 8 16 75 717 2,018 Georgia 56 37 85 1,980 1,796 1 1 7 81 88 20 22 48 955 1,405 Maryland§ 10 13 35 660 819 2 2 9 111 76 2 1 5 68 98 North Carolina 55 21 228 1,218 1,370 — 1 12 92 122 13 3 27 199 84 South Carolina§ 11 21 55 946 1,006 — 0 4 37 12 7 9 32 483 167 Virginia§ 13 20 49 876 1,049 2 3 25 195 149 5 4 13 180 162 West Virginia — 3 25 142 175 — 0 3 29 18 — 0 61 16 60
E.S. Central 25 56 135 2,996 3,076 3 5 21 252 296 25 39 170 1,663 2,481 Alabama§ 9 15 47 819 848 — 1 17 56 62 1 8 27 350 645 Kentucky 8 9 18 418 514 3 1 7 91 113 2 5 24 244 441 Mississippi — 13 57 961 967 — 0 2 5 6 — 6 102 287 1,135 Tennessee§ 8 17 54 798 747 — 2 7 100 115 22 16 41 782 260
W.S. Central 69 89 894 4,464 4,486 — 5 25 215 231 124 86 748 3,828 1,920 Arkansas§ 5 12 40 697 750 — 1 3 40 42 4 9 27 497 78 Louisiana — 17 49 865 887 — 0 1 2 10 — 10 25 523 460 Oklahoma 11 17 72 729 565 — 0 19 45 16 4 3 32 154 118 Texas§ 53 35 794 2,173 2,284 — 3 11 128 163 116 58 702 2,654 1,264
Mountain 22 56 109 2,723 2,414 5 9 36 513 544 26 18 52 969 846 Arizona 13 19 45 952 871 1 1 5 63 101 20 9 34 507 481 Colorado — 11 43 607 512 — 3 17 182 149 — 2 9 110 106 Idaho§ 5 3 14 162 126 4 2 15 130 123 — 0 2 13 12 Montana§ — 2 10 100 92 — 0 3 30 — — 0 1 6 23 Nevada§ 3 3 10 156 236 — 0 3 9 28 4 4 13 208 61 New Mexico§ — 6 32 446 258 — 1 6 46 38 2 1 9 90 97 Utah — 5 17 260 256 — 1 6 49 89 — 1 4 30 34 Wyoming§ 1 1 5 40 63 — 0 2 4 16 — 0 1 5 32
Pacific 141 111 399 4,809 5,016 19 8 50 481 468 46 30 83 1,535 1,367 Alaska 3 1 4 48 82 — 0 1 7 4 1 0 1 2 8 California 104 78 286 3,491 3,811 8 5 39 251 237 42 27 74 1,316 1,093 Hawaii 1 5 15 228 259 — 0 5 13 29 — 1 3 39 65 Oregon§ 1 6 20 370 289 — 1 8 61 72 — 2 10 86 71 Washington 32 13 103 672 575 11 2 16 149 126 3 2 13 92 130
American Samoa — 0 1 2 — — 0 0 — — — 0 1 1 5 C.N.M.I. — — — — — — — — — — — — — — — Guam — 0 2 13 15 — 0 0 — — — 0 3 14 16 Puerto Rico 3 10 41 426 819 — 0 1 2 1 — 0 4 16 24 U.S. Virgin Islands — 0 0 — — — 0 0 — — — 0 0 — —
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 2008 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).
Vol. 57 / No. 45 MMWR 1243
TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending November 8, 2008, and November 10, 2007 (45th week)*
Reporting area
Streptococcal diseases, invasive, group A Streptococcus pneumoniae, invasive disease, nondrug resistant†
Age <5 years
Current week
Previous 52 weeks Cum
2008 Cum 2007
Current week
Previous 52 weeks Cum
2008 Cum 2007Med Max Med Max
United States 44 96 259 4,525 4,534 32 35 166 1,353 1,516 New England — 6 31 315 346 1 1 14 60 112 Connecticut — 0 26 95 107 — 0 11 — 13 Maine§ — 0 3 26 24 1 0 1 2 2 Massachusetts — 3 8 138 165 — 0 5 39 76 New Hampshire — 0 2 26 26 — 0 1 11 11 Rhode Island§ — 0 9 18 8 — 0 2 7 8 Vermont§ — 0 2 12 16 — 0 1 1 2
Mid. Atlantic 6 18 43 885 836 2 3 19 158 270 New Jersey — 3 11 133 154 — 1 6 30 52 New York (Upstate) 1 6 17 290 256 2 2 14 87 89 New York City — 4 10 163 200 — 1 8 41 129 Pennsylvania 5 6 16 299 226 N 0 0 N N
E.N. Central 2 19 42 832 856 4 6 23 231 260 Illinois — 5 16 219 258 — 1 6 48 68 Indiana 1 2 11 119 103 — 0 14 34 17 Michigan — 3 10 155 181 1 1 5 62 64 Ohio 1 5 14 237 200 3 1 5 54 55 Wisconsin — 2 10 102 114 — 1 3 33 56
W.N. Central — 5 39 339 297 1 2 16 122 86 Iowa — 0 0 — — — 0 0 — — Kansas — 0 5 34 29 — 0 3 16 1 Minnesota — 0 35 154 144 — 0 13 53 47 Missouri — 2 10 80 75 — 1 2 30 24 Nebraska§ — 1 3 39 23 1 0 3 8 13 North Dakota — 0 5 12 15 — 0 2 8 1 South Dakota — 0 2 20 11 — 0 1 7 —
S. Atlantic 9 22 37 972 1,104 5 7 16 258 273 Delaware — 0 2 7 10 — 0 0 — — District of Columbia — 0 4 26 17 — 0 1 2 2 Florida 6 5 11 232 276 3 1 4 57 58 Georgia — 4 14 211 216 — 1 5 61 65 Maryland§ 1 4 8 161 185 — 1 5 48 57 North Carolina — 3 10 125 149 N 0 0 N N South Carolina§ — 1 5 61 90 2 1 4 45 47 Virginia§ 2 3 12 117 137 — 1 6 38 37 West Virginia — 0 3 32 24 — 0 1 7 7
E.S. Central 4 4 9 154 193 4 2 11 84 85 Alabama§ N 0 0 N N N 0 0 N N Kentucky 1 1 3 36 37 N 0 0 N N Mississippi N 0 0 N N — 0 3 18 5 Tennessee§ 3 3 6 118 156 4 1 9 66 80
W.S. Central 17 9 85 410 272 13 5 66 235 212 Arkansas§ — 0 2 5 17 — 0 2 6 13 Louisiana — 0 2 15 15 — 0 2 10 33 Oklahoma 2 2 19 100 62 — 1 7 58 47 Texas§ 15 6 65 290 178 13 3 58 161 119
Mountain 4 10 22 475 501 2 4 12 191 205 Arizona 2 4 9 182 191 2 2 8 97 99 Colorado — 2 8 126 124 — 1 4 53 40 Idaho§ 2 0 2 15 16 — 0 1 5 2 Montana§ N 0 0 N N — 0 1 4 1 Nevada§ — 0 1 10 2 N 0 0 N N New Mexico§ — 2 8 88 88 — 0 3 16 36 Utah — 1 5 48 75 — 0 3 15 27 Wyoming§ — 0 2 6 5 — 0 1 1 —
Pacific 2 3 10 143 129 — 0 2 14 13 Alaska 2 1 4 37 24 N 0 0 N N California — 0 0 — — N 0 0 N N Hawaii — 2 10 106 105 — 0 2 14 13 Oregon§ N 0 0 N N N 0 0 N N Washington N 0 0 N N N 0 0 N N
American Samoa — 0 12 30 4 N 0 0 N N C.N.M.I. — — — — — — — — — — Guam — 0 0 — 14 — 0 0 — — Puerto Rico N 0 0 N N N 0 0 N N U.S. Virgin Islands — 0 0 — — N 0 0 N N
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 2008 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).
1244 MMWR November 14, 2008
TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending November 8, 2008, and November 10, 2007 (45th week)*
Reporting area
Streptococcus pneumoniae, invasive disease, drug resistant†
Syphilis, primary and secondaryA B
Current week
Previous 52 weeks Cum
2008 Cum 2007
Current week
Previous 52 weeks Cum
2008 Cum 2007
Current week
Previous 52 weeks Cum
2008 Cum 2007Med Max Med Max Med Max
United States 35 57 307 2,377 2,534 7 9 43 359 432 77 233 351 9,987 9,679 New England — 1 49 53 104 — 0 8 9 13 5 5 13 269 235 Connecticut — 0 44 7 55 — 0 7 — 4 — 0 6 28 28 Maine§ — 0 2 17 11 — 0 1 3 2 — 0 2 10 9 Massachusetts — 0 0 — 2 — 0 0 — 2 5 4 11 194 140 New Hampshire — 0 0 — — — 0 0 — — — 0 2 19 26 Rhode Island§ — 0 3 16 19 — 0 1 4 3 — 0 5 13 29 Vermont§ — 0 2 13 17 — 0 1 2 2 — 0 5 5 3
Mid. Atlantic 2 4 13 208 141 — 0 2 19 26 14 32 51 1,455 1,342 New Jersey — 0 0 — — — 0 0 — — — 4 10 162 191 New York (Upstate) 1 1 6 55 47 — 0 2 6 9 2 3 13 118 120 New York City — 1 5 63 — — 0 0 — — 12 21 37 957 794 Pennsylvania 1 2 9 90 94 — 0 2 13 17 — 5 12 218 237
E.N. Central 7 14 64 602 657 2 2 14 86 99 9 19 33 858 757 Illinois — 0 17 71 158 — 0 6 14 33 — 5 19 218 389 Indiana — 2 39 179 150 — 0 11 21 24 2 2 10 118 47 Michigan — 0 3 14 3 — 0 1 2 2 2 3 17 180 97 Ohio 7 8 17 338 346 2 1 4 49 40 5 6 15 291 169 Wisconsin — 0 0 — — — 0 0 — — — 1 4 51 55
W.N. Central 1 3 115 137 171 — 0 9 9 38 1 8 15 335 308 Iowa — 0 0 — — — 0 0 — — — 0 2 14 17 Kansas — 1 5 58 79 — 0 1 4 8 — 0 5 26 19 Minnesota — 0 114 — 25 — 0 9 — 24 — 2 5 86 52 Missouri 1 1 8 74 53 — 0 1 2 2 1 5 10 201 209 Nebraska§ — 0 0 — 2 — 0 0 — — — 0 2 8 4 North Dakota — 0 0 — — — 0 0 — — — 0 1 — — South Dakota — 0 2 5 12 — 0 1 3 4 — 0 0 — 7
S. Atlantic 21 22 53 1,036 1,106 3 4 10 175 199 28 50 215 2,213 2,237 Delaware — 0 1 3 10 — 0 0 — 2 — 0 4 14 15 District of Columbia — 0 3 15 19 — 0 1 1 1 — 2 9 109 163 Florida 14 13 30 605 610 1 3 6 112 107 8 20 36 868 776 Georgia 7 7 22 328 403 2 1 5 52 81 — 10 175 411 420 Maryland§ — 0 2 4 1 — 0 1 1 — 9 6 14 283 287 North Carolina N 0 0 N N N 0 0 N N 11 5 19 237 286 South Carolina§ — 0 0 — — — 0 0 — — — 1 5 71 86 Virginia§ N 0 0 N N N 0 0 N N — 5 17 218 198 West Virginia — 1 9 81 63 — 0 2 9 8 — 0 1 2 6
E.S. Central 4 5 15 240 224 2 1 4 43 32 7 21 36 947 788 Alabama§ N 0 0 N N N 0 0 N N — 8 17 382 324 Kentucky 1 1 6 67 24 1 0 2 12 3 — 1 7 75 52 Mississippi — 0 5 4 46 — 0 1 1 — — 3 15 131 106 Tennessee§ 3 3 13 169 154 1 0 3 30 29 7 8 18 359 306
W.S. Central — 2 7 70 74 — 0 2 12 9 8 38 61 1,723 1,628 Arkansas§ — 0 2 13 6 — 0 1 3 2 5 2 19 151 107 Louisiana — 1 7 57 68 — 0 2 9 7 3 9 22 386 457 Oklahoma N 0 0 N N N 0 0 N N — 1 5 54 56 Texas§ — 0 0 — — — 0 0 — — — 25 48 1,132 1,008
Mountain — 1 7 29 54 — 0 2 4 13 2 9 22 344 444 Arizona — 0 0 — — — 0 0 — — — 4 17 145 243 Colorado — 0 0 — — — 0 0 — — — 2 7 86 45 Idaho§ N 0 0 N N N 0 0 N N 2 0 1 6 1 Montana§ — 0 0 — — — 0 0 — — — 0 3 — 4 Nevada§ N 0 0 N N N 0 0 N N — 1 6 68 96 New Mexico§ — 0 1 2 — — 0 0 — — — 1 4 36 36 Utah — 0 7 25 38 — 0 2 4 11 — 0 2 — 16 Wyoming§ — 0 1 2 16 — 0 1 — 2 — 0 1 3 3
Pacific — 0 1 2 3 — 0 1 2 3 3 43 65 1,843 1,940 Alaska N 0 0 N N N 0 0 N N — 0 1 1 7 California N 0 0 N N N 0 0 N N 2 38 59 1,658 1,789 Hawaii — 0 1 2 3 — 0 1 2 3 — 0 2 14 7 Oregon§ N 0 0 N N N 0 0 N N — 0 3 20 16 Washington N 0 0 N N N 0 0 N N 1 3 9 150 121
American Samoa N 0 0 N N N 0 0 N N — 0 0 — 4 C.N.M.I. — — — — — — — — — — — — — — — Guam — 0 0 — — — 0 0 — — — 0 0 — — Puerto Rico — 0 0 — — — 0 0 — — 3 3 11 141 137 U.S. Virgin Islands — 0 0 — — — 0 0 — — — 0 0 — —
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 2008 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).
Vol. 57 / No. 45 MMWR 1245
TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending November 8, 2008, and November 10, 2007 (45th week)*
West Nile virus disease†
Reporting area
Varicella (chickenpox) Neuroinvasive Nonneuroinvasive§
Current week
Previous 52 weeks Cum
2008 Cum 2007
Current week
Previous 52 weeks Cum
2008 Cum 2007
Current week
Previous 52 weeks Cum
2008 Cum 2007Med Max Med Max Med Max
United States 297 622 1,660 22,759 33,675 — 1 80 585 1,219 — 2 82 661 2,392 New England 9 11 68 443 2,190 — 0 2 6 5 — 0 1 3 6 Connecticut — 0 38 — 1,256 — 0 2 5 2 — 0 1 3 2 Maine¶ — 0 14 — 302 — 0 0 — — — 0 0 — — Massachusetts — 0 1 1 — — 0 0 — 3 — 0 0 — 3 New Hampshire 2 6 18 220 310 — 0 0 — — — 0 0 — — Rhode Island¶ — 0 0 — — — 0 1 1 — — 0 0 — 1 Vermont¶ 7 6 17 222 322 — 0 0 — — — 0 0 — — Mid. Atlantic 57 50 83 1,988 4,234 — 0 8 45 22 — 0 5 19 11 New Jersey N 0 0 N N — 0 1 3 1 — 0 1 4 — New York (Upstate) N 0 0 N N — 0 5 23 3 — 0 2 7 1 New York City N 0 0 N N — 0 2 8 13 — 0 2 6 5 Pennsylvania 57 50 83 1,988 4,234 — 0 2 11 5 — 0 1 2 5 E.N. Central 67 140 336 5,636 9,554 — 0 7 43 111 — 0 5 22 65 Illinois 12 14 63 938 963 — 0 4 11 61 — 0 2 8 38 Indiana — 0 222 — 222 — 0 1 2 14 — 0 1 1 10 Michigan 15 61 154 2,381 3,515 — 0 4 11 16 — 0 2 6 1 Ohio 40 49 128 1,952 3,926 — 0 3 16 13 — 0 2 3 10 Wisconsin — 4 38 365 928 — 0 1 3 7 — 0 1 4 6 W.N. Central 13 22 145 973 1,364 — 0 6 42 249 — 0 23 157 738 Iowa N 0 0 N N — 0 3 5 12 — 0 1 4 17 Kansas — 5 36 316 485 — 0 2 6 14 — 0 4 26 26 Minnesota — 0 0 — — — 0 2 3 44 — 0 6 18 57 Missouri 13 10 51 588 801 — 0 3 11 61 — 0 1 7 16 Nebraska¶ N 0 0 N N — 0 1 4 21 — 0 8 33 142 North Dakota — 0 140 49 — — 0 2 2 49 — 0 12 41 320 South Dakota — 0 5 20 78 — 0 5 11 48 — 0 6 28 160 S. Atlantic 41 92 173 4,065 4,531 — 0 3 13 43 — 0 3 12 39 Delaware — 1 6 46 45 — 0 0 — 1 — 0 1 1 — District of Columbia — 0 3 22 27 — 0 0 — — — 0 0 — — Florida 30 28 87 1,424 1,108 — 0 2 2 3 — 0 0 — — Georgia N 0 0 N N — 0 1 3 23 — 0 1 4 27 Maryland¶ N 0 0 N N — 0 2 7 6 — 0 2 6 4 North Carolina N 0 0 N N — 0 0 — 4 — 0 0 — 4 South Carolina¶ 3 15 66 741 965 — 0 0 — 3 — 0 0 — 2 Virginia¶ 7 24 81 1,229 1,384 — 0 0 — 3 — 0 1 1 2 West Virginia 1 13 66 603 1,002 — 0 1 1 — — 0 0 — — E.S. Central 8 18 101 1,002 502 — 0 9 52 74 — 0 12 81 96 Alabama¶ 8 17 101 989 500 — 0 3 11 17 — 0 3 9 7 Kentucky N 0 0 N N — 0 1 3 4 — 0 0 — — Mississippi — 0 2 13 2 — 0 6 32 48 — 0 10 66 83 Tennessee¶ N 0 0 N N — 0 1 6 5 — 0 2 6 6 W.S. Central 101 174 886 6,923 8,944 — 0 7 55 267 — 0 8 54 155 Arkansas¶ 1 10 38 514 665 — 0 2 8 13 — 0 0 — 7 Louisiana — 1 10 63 108 — 0 2 9 27 — 0 6 27 12 Oklahoma N 0 0 N N — 0 1 2 59 — 0 1 5 47 Texas¶ 100 165 852 6,346 8,171 — 0 6 36 168 — 0 4 22 89 Mountain — 36 105 1,620 2,294 — 0 12 88 287 — 0 23 180 1,037 Arizona — 0 0 — — — 0 10 53 49 — 0 8 44 45 Colorado — 15 43 723 928 — 0 4 13 99 — 0 12 64 477 Idaho¶ N 0 0 N N — 0 1 2 11 — 0 7 30 119 Montana¶ — 6 27 278 349 — 0 0 — 37 — 0 2 5 165 Nevada¶ N 0 0 N N — 0 2 8 1 — 0 3 7 10 New Mexico¶ — 4 22 175 334 — 0 2 6 39 — 0 1 3 21 Utah — 10 55 434 649 — 0 2 6 28 — 0 4 19 42 Wyoming¶ — 0 4 10 34 — 0 0 — 23 — 0 2 8 158 Pacific 1 2 8 109 62 — 0 36 241 161 — 0 20 133 245 Alaska 1 1 5 58 34 — 0 0 — — — 0 0 — — California — 0 0 — — — 0 36 240 154 — 0 19 129 226 Hawaii — 1 6 51 28 — 0 0 — — — 0 0 — — Oregon¶ N 0 0 N N — 0 0 — 7 — 0 1 3 19 Washington N 0 0 N N — 0 1 1 — — 0 1 1 — American Samoa N 0 0 N N — 0 0 — — — 0 0 — — C.N.M.I. — — — — — — — — — — — — — — — Guam — 2 17 62 227 — 0 0 — — — 0 0 — — Puerto Rico — 7 20 371 657 — 0 0 — — — 0 0 — — U.S. Virgin Islands — 0 0 — — — 0 0 — — — 0 0 — —
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 2008 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).
1246 MMWR November 14, 2008
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.
New England 500 348 85 42 15 10 46 Boston, MA 134 70 31 21 8 4 8 Bridgeport, CT 41 33 4 3 1 — 5 Cambridge, MA 14 11 3 — — — 3 Fall River, MA 24 21 1 2 — — 2 Hartford, CT 39 25 8 5 1 — 3 Lowell, MA 21 16 4 — — 1 1 Lynn, MA 14 12 1 — 1 — 1 New Bedford, MA 23 19 3 1 — — 6 New Haven, CT U U U U U U U Providence, RI 55 39 11 1 1 3 4 Somerville, MA 2 1 — 1 — — — Springfield, MA 36 25 6 1 2 2 6 Waterbury, CT 40 31 6 2 1 — 3 Worcester, MA 57 45 7 5 — — 4
Mid. Atlantic 1,716 1,165 384 102 43 20 88 Albany, NY 58 40 15 2 1 — 4 Allentown, PA 26 22 3 — 1 — 2 Buffalo, NY 82 53 17 7 3 2 3 Camden, NJ U U U U U U U Elizabeth, NJ 19 15 2 2 — — 2 Erie, PA 51 41 10 — — — 5 Jersey City, NJ U U U U U U U New York City, NY 967 652 233 51 19 11 43 Newark, NJ 27 13 10 3 1 — 4 Paterson, NJ 19 10 8 — 1 — 2 Philadelphia, PA 136 73 35 19 6 2 1 Pittsburgh, PA§ 45 25 11 5 3 1 3 Reading, PA 36 29 4 2 — 1 3 Rochester, NY 132 96 21 7 5 3 9 Schenectady, NY 19 15 3 1 — — 4 Scranton, PA 20 19 — — 1 — — Syracuse, NY 27 21 5 — 1 — 3 Trenton, NJ 27 20 4 3 — — — Utica, NY 15 14 1 — — — — Yonkers, NY 10 7 2 — 1 — —
E.N. Central 2,026 1,377 464 107 34 44 126 Akron, OH U U U U U U U Canton, OH 31 24 6 1 — — 4 Chicago, IL 336 200 93 28 10 5 23 Cincinnati, OH 88 63 18 2 2 3 5 Cleveland, OH 227 163 53 4 4 3 7 Columbus, OH 235 158 55 11 4 7 7 Dayton, OH 156 112 35 7 — 2 12 Detroit, MI 152 84 48 14 3 3 12 Evansville, IN 39 22 12 5 — — 1 Fort Wayne, IN 69 54 7 5 — 3 8 Gary, IN 7 3 1 1 — 2 — Grand Rapids, MI 60 45 8 1 — 6 6 Indianapolis, IN 181 123 42 9 4 3 14 Lansing, MI 46 32 11 1 — 2 2 Milwaukee, WI 81 53 20 5 1 2 4 Peoria, IL 51 36 12 3 — — 6 Rockford, IL 61 46 8 4 2 1 3 South Bend, IN 54 37 10 4 2 1 3 Toledo, OH 95 70 20 2 2 1 9 Youngstown, OH 57 52 5 — — — —
W.N. Central 595 389 131 37 20 17 28 Des Moines, IA 93 69 15 6 1 2 5 Duluth, MN 23 18 4 — 1 — 2 Kansas City, KS 28 15 7 5 — 1 2 Kansas City, MO 109 72 26 4 4 3 5 Lincoln, NE 23 14 5 2 — 2 1 Minneapolis, MN 54 31 13 7 2 1 2 Omaha, NE 79 53 20 — 3 3 4 St. Louis, MO 72 37 17 9 5 3 3 St. Paul, MN 50 37 9 3 1 — 1 Wichita, KS 64 43 15 1 3 2 3
S. Atlantic 1,170 717 316 77 36 23 59 Atlanta, GA 105 59 31 8 6 1 1 Baltimore, MD 134 71 46 10 2 5 10 Charlotte, NC 109 69 27 8 3 2 15 Jacksonville, FL 166 96 50 8 6 5 8 Miami, FL 100 64 25 8 1 2 6 Norfolk, VA 51 27 12 6 4 2 2 Richmond, VA 56 33 19 — 3 1 1 Savannah, GA 50 32 9 8 1 — 2 St. Petersburg, FL 50 31 13 3 1 2 1 Tampa, FL 224 154 55 10 4 1 5 Washington, D.C. 112 72 26 8 4 2 4 Wilmington, DE 13 9 3 — 1 — 4
E.S. Central 799 514 210 47 17 11 63 Birmingham, AL 151 99 39 4 5 4 10 Chattanooga, TN 72 47 20 3 1 1 6 Knoxville, TN 107 67 31 6 — 3 7 Lexington, KY 51 36 12 3 — — 4 Memphis, TN 164 98 45 15 5 1 19 Mobile, AL 75 54 12 7 1 1 5 Montgomery, AL 42 27 13 1 1 — 5 Nashville, TN 137 86 38 8 4 1 7
W.S. Central 1,388 894 340 92 28 34 76 Austin, TX 83 42 29 7 1 4 7 Baton Rouge, LA U U U U U U U Corpus Christi, TX 60 46 12 2 — — 3 Dallas, TX 188 118 47 12 7 4 10 El Paso, TX 71 52 14 4 — 1 6 Fort Worth, TX 128 87 26 5 2 8 7 Houston, TX 384 238 93 32 11 10 24 Little Rock, AR 76 49 19 7 1 — 1 New Orleans, LA¶ U U U U U U U San Antonio, TX 240 155 64 9 6 6 10 Shreveport, LA 35 23 10 2 — — 2 Tulsa, OK 123 84 26 12 — 1 6
Mountain 995 660 211 69 28 27 57 Albuquerque, NM 109 75 23 5 — 6 7 Boise, ID 52 39 8 1 — 4 3 Colorado Springs, CO 75 52 15 4 2 2 2 Denver, CO 79 51 17 7 4 — 2 Las Vegas, NV 241 174 44 17 3 3 14 Ogden, UT 25 16 6 2 — 1 1 Phoenix, AZ 129 72 35 9 9 4 5 Pueblo, CO 26 15 9 2 — — — Salt Lake City, UT 117 72 22 11 7 5 13 Tucson, AZ 142 94 32 11 3 2 10
Pacific 1,389 959 298 60 40 31 120 Berkeley, CA 6 6 — — — — — Fresno, CA U U U U U U U Glendale, CA 44 40 3 — 1 — 8 Honolulu, HI 69 52 14 3 — — 7 Long Beach, CA 78 45 22 4 5 2 11 Los Angeles, CA 246 149 64 14 12 7 29 Pasadena, CA 24 16 5 1 — 2 3 Portland, OR 96 75 14 5 2 — 3 Sacramento, CA 184 130 35 7 5 7 18 San Diego, CA 135 88 32 6 4 4 13 San Francisco, CA U U U U U U U San Jose, CA 198 140 45 6 5 2 18 Santa Cruz, CA 28 19 6 3 — — — Seattle, WA 110 72 26 7 1 4 6 Spokane, WA 66 49 11 2 2 2 3 Tacoma, WA 105 78 21 2 3 1 1
Total** 10,578 7,023 2,439 633 261 217 663
TABLE III. Deaths in 122 U.S. cities,* week ending November 8, 2008 (45th week)
Reporting area
All causes, by age (years)
P&I† Total Reporting area
All causes, by age (years)
P&I† Total
All Ages ≥65 45–64 25–44 1–24 <1
All Ages ≥65 45–64 25–44 1–24 <1
MMWR
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1248 November 14, 2008
U.S. Government Printing Office: 2009-523-019/41139 Region IV ISSN: 0149-2195
- Great American Smokeout — November 20, 2008
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- Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses — United States, 2000–2004
- Deaths from Chronic Obstructive Pulmonary Disease — United States, 2000–2005
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