# Morbidity and Mortality Weekly Report

Weekly May 27, 2005 / Vol. 54 / No. 20



# depar tment of health and human ser vices
Centers for Disease Control and Prevention INSIDE 

### 509 Cigarette Smoking Among Adults — United States, 2003 512 QuickStats 513 Blood Lead Levels — United States, 1999–2002 

# World No Tobacco Day — May 31, 2005
Tobacco use causes approximately 5 million deaths worldwide each year ( 1 ). Since 1987, the World Health Organization (WHO) has sponsored World No TobaccoDay to encourage countries to implement comprehensive programs to reduce tobacco use. The focus this year is on the role of health professionals in tobacco control.Studies indicate that smokers are more likely to quit smoking permanently if they receive physician assistance, behavioral counseling, and pharmacologic treatment (2).

In accordance with a code of practice proposed in 2004 (3), WHO is encouraging health-care professionals toprovide patients with information about the health consequences of smoking, help their smoking patients quit, and act as role models who promote tobacco-free lifestyles.CDC, WHO, and the Canadian Public Health Association have developed and pilot-tested the Global Health Professionals Survey, which assesses health-care– professional tobacco use, attitudes about tobacco, andtraining to counsel patients in tobacco-cessation techniques ( 4). Additional information on WHO tobaccocontrol programs is available at http://www.who.int/ tobacco.

References 1. World Health Organization. An international treaty for tobacco

control. Geneva, Switzerland: World Health Organization; 2003. Available at http://www.who.int/features/2003/08. 2. Fiore MC, Bailey WC, Cohen SJ, et al. Treating tobacco use and

dependence: clinical practice guideline. Rockville, MD: US Department of Health and Human Services, Public Health Service; 2000. AHQR publication no. 00-0032. 3. World Health Organization. Code of practice on tobacco control

for health professional organizations. Geneva, Switzerland: World Health Organization; 2004. Available at http://www.who.int/ tobacco/codeofpractice.4. CDC. Tobacco use and cessation counseling—Global Health Professionals Survey Pilot Study, 2005. MMWR 2005;54:505–9. 

# Tobacco Use and Cessation Counseling — Global Health Professionals Survey Pilot Study, 10 Countries, 2005
Tobacco use is projected to cause nearly 450 million deaths worldwide during the next 50 years ( 1 ). Health professionals can have a critical role in reducing tobacco use; even brief andsimple advice from health professionals can substantially increase smoking cessation rates (2–4 ). Therefore, one of the strategies to reduce the number of smoking-related deaths is to encourage the involvement of health professionals in tobacco-use prevention and cessation counseling. Studies havecollected information from health-profession students in various countries about their tobacco use and training as cessation counselors (5–8); however, no study has collected this information cross-nationally by using a consistent survey methodology. The World Health Organization (WHO), CDC, and the Canadian Public Health Association (CPHA) developed the Global Health Professionals Survey (GHPS) to collect data on tobacco use and cessation counseling among health-profession students in all WHO member states. This report summarizes findings from the GHPS Pilot Study, whichconsisted of 16 surveys conducted in 10 countries among thirdyear students in four health-profession disciplines (dentistry, medicine, nursing, and pharmacy) during the first quarter of 2005. The findings indicated that current cigarette smoking among these students was higher than 20% in seven of the10 countries surveyed. Nevertheless, 87%–99% of the students surveyed believed they should have a role in counseling patients to quit smoking; only 5%–37% of these third-year

### 506 MMWR May 27, 2005

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## students had actually received formal training in how to conduct such counseling. Schools for health professionals, public health organizations, and education officials should worktogether to design and implement training in smokingcessation counseling for all health-profession students.

GHPS is part of the Global Tobacco Surveillance System(GTSS), which collects data through three surveys: the Global Youth Tobacco Survey (GYTS), the Global School Personnel Survey (GSPS), and GHPS. GHPS is a school-based survey of third-year students pursuing advanced degrees in dentistry, medicine, nursing, or pharmacy. GHPS uses a corequestionnaire on demographics, prevalence of cigarette smoking and other tobacco use, knowledge and attitudes abouttobacco use, exposure to secondhand smoke, desire for smoking cessation, and training received regarding patient counseling on smoking-cessation techniques. GHPS has a standardized methodology for selecting participating schools and classes and uniform data processing procedures. The GHPS Pilot Study surveyed third-year students from Albania (dental [57], medical [138], nursing [356], and pharmacy [56]), Argentina (Buenos Aires) (medical [348]), Bangladesh (dental [205]), Croatia (medical [404]), Egypt (medical [1,770]), Federation of Bosnia and Herzegovina (nursing [874]), India (dental [1,499]), the Philippines (pharmacy [1,045]), the Republic of Serbia (Belgrade) (dental [160], medical [218], and pharmacy [118]), and Uganda (medical [162] and nursing [444]).

Depending on the number of schools and third-year students in participating countries and disciplines and the resources available, the 16 GHPS studies included a census of students and schools or a sample of schools and a sample of students. Albania, Argentina (Buenos Aires), Bangladesh, Croatia, Egypt, the Republic of Serbia (Belgrade), and Uganda conducted a census of schools and third-year students. TheFederation of Bosnia and Herzegovina, India, and the Philippines drew a two-stage sample of schools and classes of thirdyear students in selected schools. For each of the 16 surveys,the school response rate was 100%, and the third-year student response rate ranged from 65.6% (Republic of Serbia [Belgrade] [pharmacy students]) to 100% (Albania [pharmacy students]). GHPS was conducted in schools during regular class sessions. GHPS follows an anonymous, self-administeredformat for data collection, and the questionnaires were translated into local languages as needed. Current cigarette smokers were defined as those who reported that they currently smoke daily or occasionally. Differences in rates for these indicators were considered statistically significant at the p<0.05 level.

Current cigarette smoking among third-year healthprofession students was most prevalent in Albania, Argentina

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## (Buenos Aires), Bangladesh, Croatia, Federation of Bosnia and Herzegovina, the Philippines, and the Republic of Serbia (Belgrade), with rates ranging from 18.1% (Republic of Serbia [Belgrade] medical students) to 47.1% (Albania pharmacy students) (Table 1); the lowest current smoking prevalences were reported among Ugandan nursing (0.5%) and medical (2.8%) students, Egyptian medical students (7.9%), andIndian dental students (9.6%). Male students were significantly more likely than female students to currently smoke cigarettes in Albania, Bangladesh, Egypt, India, Philippines, Republic of Serbia (Belgrade) (medical students only), and Uganda. Only among Serbian dental students were females significantly more likely than males to currently smoke cigarettes.

The majority of third-year students (range: 86.6%–99.8%) in all four health disciplines and in all 10 countries believed health professionals should advise patients about smokingcessation (Table 2). However, the percentage of third-year students who had received formal training in tobacco cessation counseling ranged from 5.2% among medical students in Argentina (Buenos Aires) to 36.6% among pharmacy students in the Philippines. Formal training can include classroom lectures, special seminars, clinical practicum, and other problem-based learning opportunities, but training of health professionals varies among countries and across disciplines within countries.

Data on receipt of formal cessation-counseling training among third-year students of different disciplines within the same country were available for Albania, the Republic of Serbia (Belgrade), and Uganda. In Albania, nursing students (22.6%) were significantly more likely than medical students (10.3%) or pharmacy students (7.7%) to have received such training but not significantly more likely than dental students (14.2%). In the Republic of Serbia (Belgrade), medical (32.6%) and dental (20.7%) students were significantly more likely thanpharmacy students (9.5%) to have received cessation training. In Uganda, nursing students (35.1%) were more than twice as likely as medical students (15.9%) to have received training. More than 90% of third-year students (range: 90.3%– 99.0%) in every survey except medical students in Croatia

**TABLE 1. Preval** **ence of current cigarette smoking* among third-year health-profession students, by sex, country, and discipline**

**— Global Health Professionals Survey Pilot Study, 10 countries, 2005** 

**Total Male Female Country/Discipline No.**  **† % (95% CI**  **§ ) No. % (95% CI) No. % (95% CI)** 

**Albania**

Dental **41 30.1 (23.2–38.1)** 12 38.0 (24.9–53.1) 29 27.1 (19.4–36.6) Medical **114 43.3 (40.7–45.9)** 28 65.1 (59.8–69.9) 85 35.7 (32.8–38.7) Nursing **271 41.5 (37.9–45.1)** 63 57.5 (49.8–64.8) 208 36.4 (32.5–40.5) Pharmacy **40 47.1 (42.8–51.4)** 12 65.8 (58.0–72.9) 28 38.9 (34.1–44.0) **Argentina**

**(Buenos Aires)**

Medical **296 35.5 (33.6–37.4)** 118 33.4 (30.4–36.4) 177 36.5 (34.1–39.1) **Bangladesh**

Dental **192 22.2 (18.2–26.8)** 84 46.7 (39.0–54.7) 108 3.3 (1.6–6.7)
**Federation of Bosnia and Herzegovina** 

Nursing **791 33.0 (28.8–37.6)** 212 27.3 (21.1–34.5) 576 34.8 (29.8–40.2)
**Croatia**

Medical **377 36.6 (34.1–39.2)** 120 35.9 (31.5–40.4) 256 37.1 (34.1–40.3) **Egypt**

Medical **1,749 7.9 (5.7–10.7)** 993 12.9 (9.9–16.5) 756 1.2 (0.5–3.0)
**India**

Dental **1,266 9.6 (6.7–13.6)** 719 14.9 (10.7–20.4) 541 2.4 (0.8–6.9) **Philippines**

Pharmacy **595 22.1 (16.8–28.5)** 119 37.8 (26.5–50.5) 469 18.1 (12.8–24.9) **Republic of Serbia (Belgrade)** 

Dental **152 42.5 (39.1–45.9)** 42 30.2 (24.6–36.4) 110 47.2 (43.2–51.2) Medical **187 18.1 (15.9–20.7)** 54 23.8 (19.3–29.1) 133 15.9 (13.3–18.8) Pharmacy **113 20.4 (16.2–25.2)** 24 16.7 (9.5–27.7) 89 21.3 (16.6–26.9) **Uganda**

Medical **151 2.8 (1.8–4.2)** 101 4.1 (2.7–6.3) 49 0 Nursing **378 0.5 (0.3–0.9)** 60 3.3 (1.9–5.6) 316 0
* Current smokers were defined as those who reported that they currently smoke daily or occasionally. † The reported number is the unweighted number of cases in the denominator. The male and female numbers might not add to the tot al number because of

nonresponse on the question that determines sex. § Confidence interval.

### 508 MMWR May 27, 2005



## (71.7%) thought health-profession students should receive cessation counseling training as part of their normal curriculum. Reported by: V Costa de Silva, PhD, Tobacco Free Initiative, World Health Organization, Geneva, Switzerland. J Chauvin, Canadian Public Health Assoc, Ottawa, Canada. NR Jones, PhD, W Warren, PhD, S Asma, DDS, T Pechacek, PhD, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.


## Editorial Note: Health professionals who continue to smoke cigarettes send an inconsistent message to patients whom theycounsel to quit smoking. Findings from the 2005 GHPS Pilot Study indicate that the current cigarette-smoking rate among third-year health-profession students is higher than 20% in seven of the 10 countries surveyed. The public healthcommunity should target cigarette smoking among healthprofession students because this behavior endangers their own health and reduces their ability to deliver effective antitobacco counseling to their patients. The findings in this report also indicate that most third-year health-profession students in thecountries surveyed did not receive formal training in smokingcessation counseling, even though more than 90% of the same students want such training to be included in their formalcurricula. All health-profession schools, public health organizations, and education officials should discourage tobacco use among health professionals and work together to design and implement programs that train all health professionals in effective cessation-counseling techniques.

The WHO Framework Convention for Tobacco Control(WHO-FCTC), adopted by the 56th World Health Assembly in May 2003, is the first international public health treaty on tobacco control (9 ). In addition to providing a blueprint for a global response to the pandemic of tobacco-induced death and disease, WHO-FCTC calls for countries to use standard methods and procedures for surveillance. GHPS provides **TABLE 2. Third-year health-profession students’ attitudes toward and training in smoking-cessation counseling, by country and discipline — Global Health Professionals Survey Pilot Study, 10 countries, 2005** 

**Believe health Believe health**  **professionals Received professionals should give advice formal should be**  **or information about training in trained in smoking cessation cessation cessation**  **to patients counseling techniques** **Discipline/Country No.* % (95% CI** **† ) No. % (95% CI) No. % (95% CI)** 

**Albania**

Dental 51 95.6 (91.2–97.9) 53 14.2 (9.7–20.2) 53 97.9 (94.2–99.3) Medical 135 95.0 (93.8–95.9) 133 10.3 (9.0–11.9) 135 97.1 (96.2–97.8) Nursing 331 89.4 (87.2–91.4) 338 22.6 (16.8–24.3) 336 96.7 (95.3–97.7) Pharmacy 52 86.6 (83.9–89.0) 52 7.7 (5.9–10.0) 52 98.1 (96.8–98.9) **Argentina**

**(Buenos Aires)**

Medical 304 98.8 (98.3–99.1) 305 5.2 (4.4–6.1) 305 91.3 (90.1–92.3) **Bangladesh**

Dental 204 98.1 (96.1–99.1) 204 24.9 (20.7–29.5) 202 97.5 (95.4–98.7)
**Croatia**

Medical 393 97.7 (96.8–98.4) 392 14.5 (12.8–16.4) 395 71.7 (69.3–73.9) **Egypt**

Medical 1,767 91.1 (89.6–92.4) 1,770 20.9 (18.4–23.6) 1,766 92.5 (90.4–94.2)
**Federation of Bosnia and Herzegovina** 

Nursing NA § 851 28.6 (23.7–34.0) 851 90.3 (87.8–92.3)
**India**

Dental 1,335 99.8 (99.8–99.9) 1,332 10.5 (5.8–18.1) 1,339 99.0 (97.9–99.6) **Philippines**

Pharmacy 632 99.3 (98.3–99.7) 629 36.6 (30.6–43.1) 631 93.9 (91.7–95.5) **Republic of Serbia (Belgrade)** 

Dental NA 156 20.7 (18.1–23.6) 157 91.5 (89.5–93.2) Medical NA 190 32.6 (29.8–35.6) 189 95.9 (94.5–97.0) Pharmacy NA 116 9.5 (6.7–13.2) 116 93.1 (89.7–95.9) **Uganda**

Medical 153 98.8 (97.7–99.3) 154 15.9 (13.5–18.6) 154 97.3 (95.9–98.2) Nursing 394 98.4 (97.8–98.9) 391 35.1 (33.2–37.0) 388 97.1 (96.3–97.7)
* The reported number is the unweighted number of cases in the denominator. † Confidence interval. § Question not asked.

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## countries with a way to measure tobacco use among their thirdyear health-profession students, the desire for cessation among students who smoke, the extent to which students are beingtrained to provide tobacco-cessation counseling, and the willingness of students to use such training to reduce tobacco useamong their patients. The GHPS Pilot Study proved successful in terms of school and student participation, fieldwork procedures, data collection, cost, and reliability of data. Inlight of these successes, GHPS will be expanded during academic year 2005–06 to include approximately 40 additional countries. The goal of WHO, CDC, and CPHA is to gather data from all four disciplines in as many of the 192 WHO member states by the end of academic year 2008.

The findings in this report are subject to at least four limitations. First, because GHPS respondents are third-year healthprofession students who have not had substantial interaction with patients, survey results should not be extrapolated toaccount for practicing health professionals in any of the countries. Second, the GHPS did not survey students in all healthprofessions whose members could provide patients with cessation counseling (e.g., chiropractors, traditional healers, psychologists, and counselors). Third, because adult smoking rates across countries are not collected by using a standardized and consistent methodology, comparison of the prevalence in this report with the prevalence in the general adult populations isnot possible. Finally, a reliability study of the GHPS core questionnaire items has not been undertaken but is required before full expansion of the survey.

The theme of WHO’s World No Tobacco Day (WNTD) 2005 is the role of health professionals in tobacco control. Organizations of health professionals are aware of members’potential role and responsibility in tobacco control, and several have already initiated specific activities. For example, the Doctors’ Manifesto for Tobacco Control was launched in 2002 with the support of medical associations worldwide ( 10 ). In addition, several individual associations have adopted their own codes regarding tobacco control, such as the provision in the Pharmacists against Tobacco code of practice that bans smoking in pharmacies.* Countries in each of the six WHO regions will sponsor events for WNTD 2005, including thedissemination of GHPS findings. A list of the events is available at http://www.who.int/tobacco/communications/events/ wntd/2005.

Acknowledgments



### This report is based, in part, on contributions by F Musoke, Makerere Univ, Kampala, Uganda. NA Labib, Cairo Univ, Cairo, Egypt. H Vrazic, European Medical Students’ Assoc, Zagreb, Croatia. R Shuperka, Institute of Public Health; A Lena, For aTobacco Free Albania, Tirana, Albania. A Ramic-Catak, Federal Public Health Institute, Sarajevo, Federation of Bosnia andHerzegovina. D Stojiljkovic, Ministry of Health, Belgrade, Republic of Serbia. R Pitarque, Municipality of Olavaria, Buenos Aires, Argentina. Z Ali, Bangladesh Institute of Development Studies, Dhaka, Bangladesh. M Shah, Government Dental College and Hospital, Ahmedabad, India. M Miguel-Baquilod, Ministry ofHealth, Manila, Philippines. N Schneider, European Medical Students’ Assoc, Heidelberg, Germany. H Richter-Airijoki, C AuderaLopez, T Musa, J-P Baptiste, T Butua, F El-Awa, H Nikogosian, K Schotte, A Peruga, K Rahman, B Fishburn, J Santos Tobacco Free Initiative, World Health Organization, Geneva, Switzerland.

References

1. Peto R, Lopez AD. Future worldwide health effects of current smoking patterns. In: Koop CD, Pearson C, Schwarz MR, eds. Critical issues in global health. New York, NY: Jossey-Bass; 2001. 2. US Department of Health and Human Services. Reducing tobacco

use: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2000. 3. Fiore MC, Bailey WC, Cohen SJ, et al. Treating tobacco use and

dependence. Clinical practice guideline. Rockville, MD: US Department of Health and Human Services; 2000. 4. Lancaster T, Stead L, Silagy C, et al. Effectiveness of interventions to

help people stop smoking: findings from the Cochrane Library. BMJ 2000;321:355–8. 5. Gupta PC, Ray CS. Smokeless tobacco and health in India and South

Asia. Respirology 2003;8:419–31. 6. Naskar NN, Bhattacharya SK. A study on drug abuse among the

undergraduate medical students in Calcutta. J Indian Med Assoc 1999;97:20–1. 7. Mammas IN, Bertsias GK, Linardakis M, Tzanakis NE, Labadarios

DN, Kafatos AG. Cigarette smoking, alcohol consumption, and serum lipid profile among medical students in Greece. Eur J Public Health 2003;13:278–82.8. Vakeflliu Y, Argjiri D, Poposhi I, Agron S, Melani AS. Tobacco smoking habits, beliefs, and attitudes among medical students in Tirana, Albania. Prev Med 2002;34:370–3. 9. World Health Organization. WHO framework convention on tobacco

control. Geneva, Switzerland: World Health Organization; 2003. Available at http://www.who.int/tobacco/framework. 10. Tobacco under the microscope: the doctors’ manifesto for globaltobacco control. Edinburgh, United Kingdom: British Medical Association Tobacco Control Resource Centre; 2002. Available at http:// www.doctorsmanifesto.org.



# Cigarette Smoking Among Adults — United States, 2003
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, CDC analyzed self-reported data from the 2003 National Health Interview Survey (NHIS). The results of that analysis indicated that, in 2003, approximately 21.6% of U.S. adults were current smokers. Although this prevalence is lower than * Additional information is available at http://www.fip.org/pharmacistsagainsttobacco.

### 510 MMWR May 27, 2005



## the 22.5% prevalence among U.S. adults in 2002 and significantly lower than the 22.8% prevalence in 2001, the rate of decline is not sufficient to meet the national health objective for 2010 (2 ). Comprehensive, sustained interventions that reduce the rate of smoking initiation and increase the rate ofcessation are needed to further the decline in cigarette smoking among adults (3).

Questions on smoking in the 2003 NHIS were included in the adult core questionnaire, which was administered by in-person interview to a nationally representative sample of 30,852 persons aged >18 years in the civilian, noninstitutionalized U.S. population; survey response rate for adults was 74.2%. Respondents were asked, “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?” Ever smokers were defined as those who reported smoking >100 cigarettes during their lifetimes. Current smokers were defined as those who reported smoking >100 cigarettes during their lifetimes and currently smoking every day or some days. Former smokers were defined as ever smokers who no longer smoked. Poverty-level status was calculated on the basis of U.S. Census Bureau 2002 poverty thresholds. Data were adjusted for nonrespondents and weighted to provide national estimates of cigarette smoking prevalence; 95% confidence intervals (CIs) were calculated to account for the multistage probability sample design.

In 2003, an estimated 21.6% (45.4 million) of U.S. adults were current smokers; of these, 81.0% (36.8 million) smoked every day, and 19.0% (8.6 million) smoked some days. Among those who currently smoked every day, 41.1% (15.1 million) reported they had stopped smoking for at least 1 day during the preceding 12 months because they were trying to quit. Among the estimated 43.4% (91.5 million) of persons who had ever smoked, 50.3% (45.9 million) were former smokers.

Prevalence of current cigarette smoking varied substantially across populations and subpopulations (Table). More men (24.1%) than women (19.2%) reported current smoking. Among racial/ethnic populations, Asians (11.7%) and Hispanics (16.4%) had the lowest prevalence, and American Indians/Alaska Natives had the highest prevalence (39.7%). By education level, smoking prevalence was highest among adults who had earned a General Educational Development diploma (44.4%) and lowest among those with graduate degrees (7.5%). Among age groups, persons aged >65 years had the lowest prevalence of cigarette smoking (9.1%), and persons aged 25–44 years had the highest prevalence (25.6%). Current smoking prevalence was higher among adults living below the poverty level (30.5%) than among those at or above the poverty level (21.7%). Persons in certain subpopulations had cigarette smoking prevalence rates below the 2010 health objective target of 12%. These subpopulations included women with undergraduate (11.0%) or graduate degrees (6.7%), men with graduate degrees (8.1%), Hispanic women (10.3%), Asian women (6.5%), and men and women aged >65 years (10.1% and 8.3%, respectively) (Table).

During 1983–2003, a sustained decline in cigarette smoking occurred in all age groups except persons aged 18–24 years (Figure). In this group, prevalence increased during 1993– 2002, before declining significantly from 28.5% in 2002 to 23.9% in 2003, the lowest reported prevalence for persons aged 18–24 years since 1991 ( 4 ). Reported by: A Trosclair, MS, R Caraballo, PhD, A Malarcher, MD, C Husten, MD, T Pechacek, PhD, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.


## Editorial Note: The findings in this report indicate that cigarette smoking continues to decline among adults in the United States. In 2003, for the first time since NHIS began collecting smoking data in 1965, the prevalence of cigarette smokingamong women declined below 20%, to 19.2%. For the second consecutive year, more than half of U.S. adults who ever smoked reported they were no longer smokers. In addition, cigarette smoking among persons aged 18–24 years declinedto the lowest level since 1991. The increase in smoking prevalence among young adults during 1991–2002 was similar to an increase in smoking among youths in 8th, 10th, and 12th grades during the early 1990s (5 )

. Factors associated with the increase in smoking among adolescents (e.g., increased tobaccoindustry marketing to youths) might have had a similar influence on smoking prevalence among young adults ( 6 ). A cohort effect might also have contributed to the increase in smoking prevalence among young adults, as youths with high rates of smoking during the early 1990s entered the young adult age group during 1992–2002 (5–7 ). Although tobacco use usually begins during adolescence, initiation also can occur during young adulthood ( 6,7 )

. Preventing smoking initiation and tobacco use among youths and young adults is critical to reducing tobacco use in the United States. Young adults, who constitute the youngest legal market for the tobacco industry in the United States, and adolescents continue to be the target of intensive tobaccoindustry marketing efforts, including sponsorship of agespecific promotions and other marketing strategies that appeal to persons in these age groups ( 7,8)

.

Efforts to reduce cigarette smoking prevalence among all adults include increasing the retail price of tobacco products and implementing complete smoking bans in all worksites, campuses, sports arenas, concert venues, bars, restaurants, and

### Vol. 54 / No. 20 MMWR 511

**TABLE. Percentage of persons aged** **>18 years who were current smokers,* by sex and selected characteristics — National Health** **Interview Survey, United States, 2003**

**Men Women Total (n = 13,427) (n = 17,425) (N = 30,852)**  **Characteristic % (95% CI †** **) % (95% CI) % (95% CI)**
**Race/Ethnicity §** 

White, non-Hispanic 24.3 ( +1.0) 21.2 ( +0.9) **22.7 ( +0.7)**  Black, non-Hispanic 25.5 ( +2.5) 18.3 ( +1.8) **21.5 ( +1.6)**  Hispanic 22.1 ( +2.0) 10.3 ( +1.1) **16.4 ( +1.2)**  American Indian/Alaska Native ¶ 42.0 ( +15.9) 37.3 ( +14.7) **39.7 ( +11.9)**  Asian** 17.5 ( +4.5) 6.5 ( +2.2) **11.7 ( +2.5)** 
**Education ††** 

0–12 (no diploma) 32.4 ( +2.1) 21.2 ( +1.9) **26.6 ( +1.4)**  <8 yrs 23.4 ( +2.9) 11.8 ( +2.0) **17.6 ( +1.8)**  9–11 yrs 40.6 ( +3.4) 28.5 ( +3.0) **34.0 ( +2.3)**  12 yrs (no diploma) 35.2 ( +7.7) 23.7 ( +5.8) **29.3 ( +4.6)**  GED (diploma) §§ 43.4 ( +5.9) 45.6 ( +5.8) **44.4 ( +4.1)**  12 yrs (diploma) 29.2 ( +2.0) 22.1 ( +1.5) **25.4 ( +1.2)**  Associate degree 21.9 ( +2.9) 18.2 ( +2.1) **19.8 ( +1.7)**  Some college (no degree) 23.7 ( +1.8) 20.4 ( +1.3) **21.9 ( +1.1)**  Undergraduate degree 13.6 ( +1.8) 11.0 ( +1.5) **12.3 ( +1.1)**  Graduate degree 8.1 ( +1.6) 6.7 ( +1.5) **7.5 ( +1.1)**  **Age group (yrs** )

18–24 26.3 ( +2.6) 21.5 ( +2.3) **23.9 ( +1.8)**  25–44 28.4 ( +1.4) 22.8 ( +1.2) **25.6 ( +1.0)**  45–64 23.9 ( +1.5) 20.2 ( +1.4) **22.0 ( +1.0)** 

>65 10.1 ( +1.4) 8.3 ( +1.1) **9.1 ( +0.9)**  **Poverty level** ¶¶

At or above 24.2 ( +1.0) 19.1 ( +0.9) **21.7 ( +0.7)**  Below 33.0 ( +3.1) 28.8 ( +2.5) **30.5 ( +2.1)**  Unknown 21.2 ( +1.6) 16.0 ( +1.3) **18.4 ( +1.0)**  **Total 24.1 ( +0.8) 19.2 (**  **+0.7) 21.6 ( +0.6)** 

* Persons who reported smoking at least 100 cigarettes during their lifetimes and who reported at the time of interview smoking every day or some days.

Excludes 402 respondents whose smoking status was unknown. † Confidence interval. § Excludes 310 respondents of unknown or multiple racial/ethnic categories or whose race/ethnicity was unknown. ¶ Wide variances among estimates reflect small sample sizes. ** Does not include Native Hawaiians or other Pacific Islanders. †† Among persons aged >25 years; excludes 409 persons with unknown years of education. §§ General Educational Development. ¶¶ Calculated on the basis of U.S. Census Bureau 2002 poverty thresholds.



## nightclubs. Strategies for reducing cigarette smoking prevalence among young adults include 1) providing effective smoking-cessation interventions and quitlines tailored to youths and young adults in school, work, and community settings; 2) conducting countermarketing campaigns designed to help young persons reject messages promoting cigarette use, reduce access by minors to tobacco products, and increase access to school programs for preventing tobacco use; and 3) monitoring smoking trends among youths and young adults ( 6–10 ). Ongoing surveillance of smoking patternsamong young adults and evaluation of tobacco-control programs can identify those interventions that are most effective for this age group.

The findings in this report are subject to at least four limitations. First, the wording of questions about cigarette smoking and NHIS data collection procedures have changed since 1993. Before 1993, current smokers were defined as those **FIGURE. Percentage of current cigarette smoking among persons aged**  **>18 years, by age group and year — National Health Interview Survey, United States, 1983–2003** 

0 10 20 30 40 50

1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003



### Year 18–24 yrs 25–44 yrs 45–64 yrs >65 yrs Percentage

### 512 MMWR May 27, 2005



## prevalence among adults and decrease the public health burden of tobacco-related diseases (3,6–10 ). In addition, tailored interventions for populations and subpopulations at high risk are needed to reduce disparities in cigarette smoking by age, race/ethnicity, and education level.

References

1. US Department of Health and Human Services. Healthy people 2010:

understanding and improving health. 2nd ed. Washington, DC: US Department of Health and Human Services; 2000. Available at http://www.healthypeople.gov. 2. CDC. Cigarette smoking among adults—United States, 2002. MMWR

2004;53:427–31.3. Task Force on Community Preventive Services. The guide to community preventive services: tobacco use prevention and control. Am J Prev Med 2001;20(2 Suppl 1):1–87. 4. CDC. Cigarette smoking among adults—United States, 1991. MMWR

1993;42:230–3.5. Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. Monitoring the future: national survey results on drug use, 1975–2003. Volume I: secondary school students. Bethesda, MD: National Institutesof Health, National Institute on Drug Abuse; 2004. DHHS publication no. (NIH) 04-5507.


# QuickStats

from the national center for health statistics 

## Percentage of Adults Aged 18–24 Years Who Have Never Smoked **Cigarettes*, by Sex and Race/Ethnicity — United States, 2002–2003**

* Have not smoked 100 or more cigarettes during their lifetimes.



### During 2002–2003, young women were more likely than young men to report having never smoked cigarettes. Among those aged 18–24 years, Hispanic and non-Hispanic black adults were more likely than non-Hispanic white adults to have never smoked.

**Source:** National Health Interview Surveys, 2002 and 2003. Available at http://www.cdc.gov/nchs/nhis.htm. 60.6 76.8 79.8

63.5 69.7

0 10 20 30 40 50 60 70 80 90 100

Men Women Hispanic White,

nonHispanic Percentage

Black,

nonHispanic 

### Sex and race/ethnicity 

## who had smoked at least 100 cigarettes and currently smoked. Starting in 1993, current smokers were defined as those who had smoked at least 100 cigarettes and currently smoked either every day or some days. Therefore, any comparison of data collected before 1993 with data collected since 1993 should be interpreted with caution. Second, many young adults view themselves as “social smokers” and might not identify themselves as smokers even on “some days” when completing the NHIS questionnaire, leading to underestimates of current smoking. Third, the NHIS questionnaire is administered onlyin English and Spanish, which might lead to imprecise estimates of smoking prevalence among other racial/ethnic populations who are unable to respond to the survey. Finally, because NHIS sample sizes for some subpopulations are minimal (e.g., Asians and American Indians/Alaska Natives), estimates derived from 1 year of data are less precise for these groups.

Effective interventions for tobacco-use prevention and cessation should be implemented in the United States among persons of all ages to accelerate the decline in smoking

### Vol. 54 / No. 20 MMWR 513

6. Lantz PM. Smoking on the rise among young adults: implications for

research and policy. Tob Control 2003;12(Suppl 1);i60–i70. 7. Backinger CL, Fagan P, Matthews E, Grana R. Adolescent and young

adult tobacco prevention and cessation: current status and future directions. Tob Control 2003;12(Suppl 4):iv46–iv53.8. Ling PM, Glantz SA. Why and how the tobacco industry sells cigarettes to young adults: evidence from industry documents. Am J Public Health 2002;92:908–16. 9. Orleans CT, Arkin EB, Backinger CL, et al. Youth tobacco cessation

collaborative and national blueprint for action. Am J Health Behavior 2003;27(Suppl 2):S103–S119. 10. Chaloupka FJ, Cummings KM, Morley CP, Horan JK. Tax, price, andcigarette smoking: evidence from the tobacco documents and implications for tobacco company marketing strategies. Tob Control 2002;11(Suppl 1):i62–i72.



# Blood Lead Levels — United States, 1999–2002
Adverse health effects caused by lead exposure includeintellectual and behavioral deficits in children and hypertension and kidney disease in adults ( 1 ). Exposure to lead is animportant public health problem, particularly for young children (2). Eliminating blood lead levels (BLLs) >10 μg/dL in children is one of the national health objectives for 2010 (objective no. 8-11) (3,4 ). Findings of National Health and Nutrition Examination Surveys (NHANES) from the period 1976–1980 to 1991–1994 reveal a steep decline (from 77.8% to 4.4%) in the percentage of children aged 1–5 years with
BLLs >10 μg/dL (5,6). However, BLLs remain higher for certain populations, especially children in minority populations, children from low-income families, and children who live in older homes (5 ). This report updates estimates of BLLs in theU.S. population with the latest NHANES data, collected during 1999–2002. The findings indicated that BLLs continued to decrease in all age groups and racial/ethnic populations. During 1999–2002, the overall prevalence of elevated BLLs for the U.S. population aged >1 year was 0.7%. BLLs in nonHispanic black children remained higher than in nonHispanic white or Mexican-American children, although the proportion of BLLs >10 μg/dL in this population decreased (72%) since 1991–1994. Approximately 310,000 children aged 1–5 years remained at risk for exposure to harmful leadlevels. Public health agencies should continue efforts to eliminate or control sources of lead, screen persons at highest risk for exposure, and provide timely medical and environmental interventions for those identified with elevated BLLs.

NHANES is an ongoing series of cross-sectional surveys on health and nutrition designed to be nationally representative of the noninstitutionalized, U.S. civilian population by usinga complex, multistage probability design. All NHANES surveys included a household interview followed by a detailed physical examination in a mobile examination center (MEC),at which time venous blood samples were obtained from persons aged >1 year. BLLs were measured by graphite furnaceatomic absorption spectrophotometry in the inorganic toxicology laboratory at CDC.

Detailed analyses compared BLLs of 16,825 persons from the NHANES survey conducted during 1999–2002 with BLLsof 13,472 persons from the NHANES survey conducted during 1991–1994. Results were analyzed by age group, race/ ethnicity (i.e., non-Hispanic white, non-Hispanic black, andMexican American), and low-income status (with the threshold determined by multiplying the U.S. Census Bureau poverty level threshold for the year of the interview by 1.3). Elevated BLLs were defined as BLLs >10 μg/dL for all ages. Geometric mean (GM) BLLs and 95% confidence intervals were calculated. All analyses used MEC sample weights to account for the unequal probability of selection, oversampling, and survey nonresponse.

For 1999–2002, the overall prevalence of elevated BLLs for the U.S. population was 0.7% (Table 1), a decrease of 68% from 2.2% in the 1991–1994 survey. The largest decrease (72%) in elevated BLLs, from 11.2% to 3.1%, was among non-Hispanic black children aged 1–5 years, consistent with a previous decline from 1988–1991 to 1991–1994 (Figure).

During the 1999–2002 survey period, children aged 1–5 years had the highest prevalence of elevated BLLs (1.6%), indicating that approximately 310,000 children in that age group remained at risk for exposure to harmful lead levels. Youths aged 6–19 years had the lowest prevalence of elevatedBLLs (0.2%), although this estimate was not statistically reliable. Overall, by race/ethnicity, non-Hispanic blacks and Mexican Americans had higher percentages of elevated BLLs (1.4% and 1.5%, respectively) than non-Hispanic whites (0.5%) (Table 1). Among subpopulations, non-Hispanic blacks aged 1–5 years and aged >60 years had the highest prevalence of elevated BLLs (3.1% and 3.4%, respectively).Although the prevalence of elevated BLLs among nonHispanic black children was higher compared with children in the other two racial/ethnic populations, statistical power was not sufficient to examine these differences because of the small proportions and variability around the estimates.

GM BLLs declined significantly (p<0.05) from the 1991– 1994 survey period in all populations and subpopulations (Table 2). Overall, the GM BLL declined from 2.3 μg/dL in 1991–1994 to 1.6 μg/dL in 1999–2002. The highest GM BLLs in 1999–2002 were among children aged 1–5 years (1.9 μg/dL) and adults aged >60 years (2.2 μg/dL), and the lowest were among youths aged 6–19 years (1.1 μg/dL). Males had significantly higher GM BLLs than females, except among children aged 1–5 years, which is consistent with the 1991–

### 514 MMWR May 27, 2005



## 1994 survey. By racial/ethnic group, among children aged 1–5 years, the GM BLL was significantly higher for non-Hispanic blacks (2.8 μ g/dL), compared with Mexican Americans (1.9 μg/dL) and non-Hispanic whites (1.8 μg/dL). Among children aged 1–5 years from families with low income, the GM BLL also declined significantly, from 3.7 μg/dL in the 1991–1994 survey to 2.5 μg/dL in 1999–2002. Reported by: JG Schwemberger, MS, JE Mosby, MPH, MJ Doa, PhD, US Environmental Protection Agency. DE Jacobs, PhD, PJ Ashley, PhD, US Dept of Housing and Urban Development. DJ Brody, MPH, National Center for Health Statistics; MJ Brown, ScD, RL Jones, PhD, D Homa, PhD, National Center for Environmental Health, CDC.


## Editorial Note: The findings in this report indicate that BLLs continue to decline in the United States, as measured by NHANES, the only survey providing national data on lead **TABLE 1. Percentage of persons with elevated blood lead levels*, by selected characteristics — National Health and Nutrition** **Examination Surveys (NHANES), United States, 1991–1994 and 1999–2002**

**NHANES 1991–1994 No. in % (95% confidence interval)**  **Sex/Age (yrs) sample All racial/ethnic groups White, non-Hispanic Black, non-Hispanic Mexican American**

**Both sexes** >1 13,472 2.2 (1.6–2.8) 1.5 (0.9–2.2) †§ 5.3 (3.8–6.9) §¶ 2.9 (2.0–4.0) †¶ 1–5 2,392 4.4 (2.7–6.5) 2.3 (0.8–4.5) †† 11.2 (5.9–18.0) 4.0 (1.8–6.9) 6–19 2,960 1.3 (0.7–2.1) 0.6 (0.1–1.8) †† 3.2 (2.3–4.3) 2.3 (0.7–4.7) †† 20–59 5,596 1.7 (1.1–2.5) 1.1 (0.5–2.1) †† 4.1 (2.7–5.7) 2.9 (1.9–4.0) >60 2,524 3.6 (2.8–4.5) 3.0 (2.2–3.9) † 10.5 (7.2–14.3) §¶ 3.8 (1.8–6.6) †

**Male** >1 6,204 3.5 (2.5–4.6) 2.3 (1.3–3.7) † 8.4 (6.2–10.8) §¶ 4.0 (2.6–5.7) † 1–5 1,211 5.5 (3.1–8.4) 2.4 (0.7–5.3) †† 13.8 (8.5–20.0) 4.7 (2.0–8.4) †† 6–19 1,443 1.5 (0.8–2.5) 0.4 (0.0–1.7) †† 4.5 (3.3–5.9) 2.4 (0.6–5.3) †† 20–59 2,365 3.1 (1.9–4.6) 2.1 (0.8–4.0) †† 7.0 (4.4–10.3) 4.3 (2.5–6.5) >60 1,185 6.5 (4.6–8.8) 5.2 (3.2–7.6) † 20.5 (13.2–28.9) §¶ 7.5 (3.4–13.0) †

**Female** >1 7,268 0.9 (0.6–1.3) 0.7 (0.3–1.1) †† 2.6 (1.4–4.1) 1.7 (0.9–2.9) 1–5 1,181 3.3 (2.0– 4.9) 2.1 (0.6–4.3) †† 8.7 (3.0–16.8) †† 3.3 (1.2–6.4) †† 6–19 1,517 1.1 (0.2–2.6) †† 0.9 (0.0–3.3) †† 1.9 (0.7–3.7) †† 2.2 (0.6–4.8) †† 20–59 3,231 0.4 (0.2–0.6) 0.2 (0.0–0.5) †† 1.6 (0.7–2.8) †† 1.3 (0.5–2.3) †† >60 1,339 1.5 (0.7–2.6) 1.4 (0.5–2.7) †† 3.5 (1.3–6.7) †† 0.9 (0.1–2.3) ††



### TABLE 1. ( **Continued** **) Percentage of persons with elevated blood lead levels*, by selected characteristics — National Health and** **Nutrition Examination Surveys (NHANES), United States, 1991–1994 and 1999–2002**

**NHANES 1999–2002 No. in % (95% confidence interval)**  **Sex/Age (yrs) sample All racial/ethnic groups White, non-Hispanic Black, non-Hispanic Mexican American**

**Both sexes** >1 16,825 0.7 (0.5–0.9)** 0.5 (0.4–0.7) †§ ** 1.4 (0.9–1.9) ¶ ** 1.5 (1.0–2.1) ¶ ** 1–5 1,160 1.6 (1.1–2.2)** 1.3 (0.6–2.5) †† 3.1 (1.7–4.9)** 2.0 (0.5–4.4) †† 6–19 6,283 0.2 (0.0–0.4) †† 0.2 (0.0–0.6) †† 0.3 (0.1–0.6) †† 0.3 (0.1–0.6) †† 20–59 5,876 0.7 (0.5–1.0)** 0.6 (0.4–0.9) § 1.3 (0.6–2.1)** 2.0 (1.2–2.9) ¶ >60 3,056 0.8 (0.4–1.2)** 0.4 (0.1–0.7) †† 3.4 (1.9–5.3)** 1.8 (0.9–3.1)
**Male** >1 8,202 1.1 (0.8–1.4)** 0.8 (0.6–1.1) †§ ** 2.2 (1.3–3.3) ¶ ** 2.1 (1.3–3.1) ¶ ** 1–5 846 1.7 (0.8–2.9)** 1.4 (0.3–3.3) †† 2.5 (1.0–4.6) †† 3.2 (0.7–7.2) †† 6–19 3,158 0.2 (0.0–0.4) †† 0.2 (0.0–0.6) †† 0.3 (0.1–0.5)** 0.1 (0.0–0.3) †† 20–59 2,689 1.2 (0.8–1.7)** 1.0 (0.5–1.5) § 2.3 (1.0–4.0) †† 3.0 (1.8–4.5) ¶ >60 1,509 1.5 (0.8–2.4)** 0.7 (0.2–1.5) †† 7.5 (4.4–11.3) § ** 2.2 (1.0–3.7) †**
**Female** >1 8,623 0.3 (0.2–0.5)** 0.3 (0.1–0.5) †† 0.7 (0.4–1.0)** 0.8 (0.4–1.3) 1–5 764 1.4 (0.7–2.4)** 1.3 (0.2–3.5) †† 3.7 (1.6–6.6) †† 0.7 (0.0–2.3) †† 6–19 3,125 0.2 (0.0–0.5) †† 0.2 (0.0–0.8) †† 0.3 (0.0–1.0) †† 0.5 (0.1–1.1) †† 20–59 3,187 0.3 (0.1–0.6) †† 0.3 (0.0–0.7) †† 0.5 (0.1–1.2) †† 0.8 (0.3–1.7) †† >60 1,547 0.2 (0.0–0.4) †† 0.1 (0.0–0.3) †† 0.8 (0.1–2.3) †† 1.6 (0.6–3.1) ††

* >10 μg/dL. † Significantly different from non-Hispanic blacks at p<0.05, with Bonferroni adjustment. § Significantly different from Mexican Americans at p<0.05, with Bonferroni adjustment. ¶ Significantly different from non-Hispanic whites at p<0.05, with Bonferroni adjustment. ** Significantly different between NHANES 1999–2002 and NHANES 1991–1994 at p<0.05. †† Does not meet standard of statistical reliability and precision (i.e., relative standard error is >30%), and significant testin g was not performed.

### Vol. 54 / No. 20 MMWR 515



## exposure. The GM BLL for the U.S. population aged >1 year decreased by 30% from 1991–1994 to 1999–2002, and the prevalence of elevated BLLs decreased by 68% overall and by 64% for children aged 1–5 years. Differences in proportions of elevated BLLs among children by race/ethnicity also werereduced, likely because of the substantial decline among nonHispanic black children. However, the GM BLL for nonHispanic black children remains higher than that forMexican-American and non-Hispanic white children, indicating that differences in risk for exposure still persist. Exposure risk remains of particular concern in light of reported adverse health effects at BLLs <10μg/dL ( 7 ). The decline in BLLs in the United States has resulted from coordinated, intensive efforts at the national, state, and local levels beginning with efforts to remove lead from gasoline, food cans, and residential paint products ( 4 ). Beginning in 2003, CDC and the U.S. Department of Housing and Urban Development (HUD) required funded programs to develop formal plans to eliminate lead poisoning in their jurisdictions. Key components of these plans include coordination of activities by state, local, and nongovernmental organizations, linking BLL surveillance and Medicaid claims data to identify gaps in screening of populations at high risk, and eliminating lead paint hazards in housing, particularly in homes with more than one child with an elevated BLL.

The findings in this report are subject to at least three limitations. First, although NHANES is a nationally representative survey, the current design does not allow for estimates insmaller geographic areas or for identifying risk in certain subpopulations such as recent immigrants. Second, NHANES does not identify specific sources of lead exposure. Finally, the low prevalence of elevated BLLs does not allow stratification by more than one factor that might be related to exposure, such as race/ethnicity or age of residence.

A critical factor in reducing BLLs in children has been the decline in the number of U.S. homes with lead-based paint, from an estimated 64 million in 1990 to 38 million in 2000 ( 8). This decline might be associated, in part, with federal appropriations to HUD of $700 million during fiscal years1992–2002 for residential lead control in low-income, privately owned housing (9 ), and to investments in housingrehabilitation made by other government agencies and the private sector. Lead-control enforcement action by HUD, the U.S. Environmental Protection Agency, and the Departmentof Justice has resulted in approximately 200 on-site inspections and 30 settlements involving approximately 160,000 housing units nationwide ( 10 ). State and local governmentshave provided substantial additional funding for leadpoisoning–prevention activities and enforcement of local ordinances. However, an estimated 24 million housing units still contain substantial lead paint hazards, with 1.2 million of these units occupied by low-income families with young children ( 8). Findings in this report demonstrate progress toward achieving the national health objective for 2010 to eliminate elevated BLLs in children. Continued vigilance to identify remaining lead hazards and children at risk for lead exposure is necessary to meet this goal.

References

1. Agency for Toxic Substances and Disease Registry. Toxicological profile for lead. Atlanta, GA: US Department Health and Human Services, Agency for Toxic Substances and Disease Registry; 1999. 2. National Academy of Sciences, Board on Environmental Studies and

Toxicology, Commission on Life Sciences. Measuring lead exposure in infants, children, and other sensitive populations. Washington, DC: National Academy Press; 1993. 3. US Department of Health and Human Services. Healthy people 2010

(conference ed, in 2 vols). Washington, DC: US Department of Health and Human Services; 2000. Available at http://www.health.gov/ healthypeople. 4. President’s Task Force on Environmental Health Risks and Safety Risks

to Children, US Department of Housing and Urban Development. Eliminating childhood lead poisoning: a federal strategy targeting lead paint hazards, 2000. Washington, DC: US Department of Housing and Urban Development; 2000. Available at http://www.hud.gov/ offices/lead/reports/fedstrategy2000.pdf. **FIGURE. Percentage of children aged 1–5 years with blood lead levels**  **>10 μ**  **g/dL, by race/ethnicity and survey period — National Health and Nutrition Examination Surveys, United**  **States, 1988–1991, 1991–1994, and 1999–2002**



### 1988–1991 1991–1994 1999–2002 

## Black, non-Hispanic

Mexican American
W on-Hispanic hite, n

0 5 10 15 20 25



## Survey period Percentage 

# *

* 95% confidence interval.

### 516 MMWR May 27, 2005

**TABLE 2. ( Continued**  **) Geometric (GMs) means of blood lead levels (measured as μ**  **g/dL), by race/ethnicity, sex, and age group — National Health and Nutrition Examination Surveys (NHANES), United States, 1991–1994 and 1999–2002** 

**NHANES 1999–2002*** **No. in GM (95% confidence interval) Sex/Age (yrs) sample All racial/ethnic groups White, non-Hispanic Black, non-Hispanic Mexican American** 

**Both sexes** >1 16,825 1.6 (1.5–1.6) 1.5 (1.5–1.6) † 1.8 (1.7–1.9) ¶ 1.6 (1.6–1.7) 1–5 1,610 1.9 (1.8–2.1) 1.8 (1.6–2.0) † 2.8 (2.5–3.1) §¶ 1.9 (1.8–2.0) † 6–19 6,283 1.1 (1.1–1.2) 1.1 (1.0–1.1) †§ 1.5 (1.4–1.6) §¶ 1.3 (1.2–1.4) †¶ 20–59 5,876 1.5 (1.5–1.6) 1.5 (1.4–1.5) †§ 1.7 (1.6–1.8) ¶ 1.8 (1.6–1.9) ¶ >60 3,056 2.2 (2.1–2.3) 2.2 (2.1–2.3) † 2.7 (2.5–2.8) §¶ 2.1 (1.9–2.3) †

**Male** >1 8,202 1.9 (1.8–2.0) 1.9 (1.8–1.9) †§ 2.1 (2.0–2.3) ¶ 2.0 (1.9–2.2) ¶ 1–5 846 1.9 (1.8–2.1) 1.8 (1.6–2.0) † 2.8 (2.5–3.1) §¶ 2.0 (1.8–2.1) † 6–19 3,158 1.3 (1.3–1.4) 1.2 (1.1–1.3) †§ 1.7 (1.5–1.8) ¶ 1.5 (1.4–1.6) ¶ 20–59 2,689 2.0 (1.9–2.0) 1.9 (1.8–2.0) § 2.1 (2.0–2.3) 2.3 (2.2–2.5) ¶ >60 1,509 2.7 (2.6–2.8) 2.6 (2.5–2.7) † 3.4 (3.1–3.6) §¶ 2.6 (2.3–2.8) †

**Female** >1 8,623 1.3 (1.3–1.3) 1.3 (1.2–1.3) † 1.5 (1.4–1.6) §¶ 1.3 (1.2–1.4) † 1–5 764 1.9 (1.8–2.1) 1.8 (1.5–2.1) † 2.8 (2.5–3.2) §¶ 1.8 (1.7–2.0) † 6–19 3,125 1.0 (0.9–1.0) 0.9 (0.8–1.0) †§ 1.3 (1.2–1.5) §¶ 1.1 (1.0–1.2) †¶ 20–59 3,187 1.2 (1.2–1.2) 1.2 (1.1–1.2) † 1.4 (1.3–1.5) ¶ 1.3 (1.2–1.4) >60 1,547 1.9 (1.8–2.0) 1.9 (1.8–2.0) † 2.3 (2.1–2.4) §¶ 1.8 (1.6–2.0) †
* Differences in GMs between NHANES 1999–2002 and NHANES 1991–1994 are all significant at p<0.05. † Significantly different from non-Hispanic blacks at p<0.05, with Bonferroni adjustment. § Significantly different from Mexican Americans at p<0.05, with Bonferroni adjustment. ¶ Significantly different from non-Hispanic whites at p<0.05, with Bonferroni adjustment. 

### TABLE 2. Geometric means (GMs) of blood lead levels (measured as **μ g/dL), by race/ethnicity, sex, and age group — National Health**  **and Nutrition Examination Surveys (NHANES), United States, 1991–1994 and 1999–2002**

**NHANES 1991–1994*** **No. in GM (95% confidence interval) Sex/Age (yrs) sample All racial/ethnic groups White, non-Hispanic Black, non-Hispanic Mexican American** 

**Both sexes** >1 13,472 2.3 (2.1–2.4) 2.2 (2.0–2.3) †§ 2.8 (2.5–3.0) ¶ 2.4 (2.3–2.6) ¶ 1–5 2,392 2.7 (2.5–3.0) 2.3 (2.1–2.6) †§ 4.3 (3.6–5.0) §¶ 3.1 (2.7–3.5) †¶ 6–19 2,960 1.7 (1.5–1.8) 1.5 (1.4–1.7) †§ 2.3 (2.1–2.6) ¶ 2.0 (1.8–2.1) ¶ 20–59 5,596 2.2 (2.1–2.3) 2.1 (2.0–2.2) †§ 2.6 (2.4–2.8) ¶ 2.5 (2.4–2.6) ¶ >60 2,524 3.4 (3.2–3.5) 3.3 (3.2–3.4) † 4.3 (3.7–4.9) §¶ 3.1 (2.7–3.6) †

**Male** >1 6,204 2.8 (2.6–2.9) 2.6 (2.5–2.8) †§ 3.6 (3.3–4.0) §¶ 3.1 (2.9–3.3) †¶ 1–5 1,211 2.8 (2.5–3.1) 2.3 (2.1–2.6) †§ 4.7 (3.9–5.5) §¶ 3.3 (2.9–3.6) †¶ 6–19 1,443 1.9 (1.7–2.1) 1.7 (1.5–1.9) †§ 2.7 (2.4–3.1) ¶ 2.3 (2.0–2.5) ¶ 20–59 2,365 2.9 (2.7–3.1) 2.7 (2.5–3.0) †§ 3.6 (3.2–3.9) ¶ 3.4 (3.2–3.6) ¶ >60 1,185 4.2 (4.0–4.4) 4.0 (3.8–4.2) † 6.3 (5.4–7.1) §¶ 4.1 (3.5–4.8) †

**Female** >1 7,268 1.9 (1.8–2.0) 1.8 (1.7–1.9) † 2.2 (2.0–2.4) §¶ 1.9 (1.8–2.1) † 1–5 1,181 2.7 (2.4–2.9) 2.3 (2.0–2.6) † 4.0 (3.2–4.8) ¶ 2.9 (2.4–3.4) 6–19 1,517 1.5 (1.3–1.7) 1.4 (1.2–1.6) † 2.0 (1.7–2.2) ¶ 1.7 (1.5–1.9) 20–59 3,231 1.7 (1.6–1.8) 1.6 (1.5–1.7) †§ 1.9 (1.8–2.1) ¶ 1.8 (1.7–1.9) ¶ >60 1,339 2.9 (2.7–3.0) 2.8 (2.7–3.0) 3.3 (2.8–3.8) 2.5 (2.1–2.9)



### 5. CDC. Update: blood lead levels—United States, 1991–1994. MMWR

1997;46:141–6.6. Meyer P, Pivert T, Dignam T, Homa D, Schoonover J, Brody D. Surveillance for elevated blood lead levels among children—United States, 1997–2001. In: Surveillance Summaries, September 12, 2003. MMWR 2003;52(No. SS-10). 7. Canfield RL, Henderson CR, Cory-Slechta DA, Cos C, Jusko TA,

Lanphear BP. Intellectual impairment in children with blood lead concentrations below 10 microg per deciliter. N Engl J Med 2003;348:1517–26. 8. Jacobs DE, Clickner RP, Zhou JY, et al. The prevalence of lead-based

paint hazards in US housing. Environ Health Perspect 2002;110:599–06. 9. US Department of Housing and Urban Development. Lead-Based Paint Hazard Control Grant Program. Washington, DC: US Department of Housing and Urban Development; updated 2005. Available at http:// www.hud.gov/offices/lead/lhc/index.cfm. 10. US Department of Housing and Urban Development. Complianceassistance and enforcement: Federal Residential Lead-Based Paint Hazard Reduction Act (Lead-Based Paint Disclosure Rule). Washington, DC: US Department of Housing and Urban Development; updated 2004. Available at http://www.hud.gov/offices/lead/compliance/ index.cfm. ¶

### Vol. 54 / No. 20 MMWR 517

* No rubella cases were reported for the current 4-week period yielding a ratio for week 20 of zero (0). † Ratio of current 4-week total to mean of 15 4-week totals (from previous, comparable, and subsequent 4-week periods for the pas t 5 years). The point where the hatched area

begins is based on the mean and two standard deviations of these 4-week totals.

—: No reported cases. * Incidence data for reporting years 2004 and 2005 are provisional and cumulative (year-to-date). † Not notifiable in all states. § Updated weekly from reports to the Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases (ArboN et Surveillance). ¶ Updated monthly from reports to the Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention. Last upda te April 24, 2005. ** Updated weekly from reports to the Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases. †† Of 15 cases reported, nine were indigenous and six were imported from another country. §§ Of 14 cases reported, five were indigenous and nine were imported from another country. ¶¶ Formerly Trichinosis. **TABLE I. Summary of provisional cases of selected notifiable diseases, United States, cumulative, week ending May 21, 2005 (20t h Week)** * **Cum. Cum. Cum. Cum. Disease 2005 2004 Disease 2005 2004**  

### FIGURE I. Selected notifiable disease reports, United States, comparison of provisional 4-week totals May 21, 2005, with histor **ical data** 

Anthrax — — Hemolytic uremic syndrome, postdiarrheal † 43 27 Botulism: HIV infection, pediatric †¶ 116 117 foodborne 5 4 Influenza-associated pediatric mortality † ** 34 — infant 21 25 Measles 15 †† 14 §§ other (wound & unspecified) 9 3 Mumps 96 82 Brucellosis 30 38 Plague — — Chancroid 10 16 Poliomyelitis, paralytic — — Cholera 1 4 Psittacosis † 7 4 Cyclosporiasis † 307 86 Q fever† 22 20 Diphtheria — — Rabies, human 1 — Domestic arboviral diseases Rubella 4 7 (neuroinvasive & non-neuroinvasive): — — Rubella, congenital syndrome 1 — California serogroup † § — 4 SARS † ** — — eastern equine † § — — Smallpox †

— — Powassan † §

— — Staphylococcus aureus : St. Louis † § — — Vancomycin-intermediate (VISA) †

— — western equine † § — — Vancomycin-resistant (VRSA) †

— — Ehrlichiosis: — — Streptococcal toxic-shock syndrome † 64 77 human granulocytic (HGE) † 30 36 Tetanus 5 4 human monocytic (HME) † 31 23 Toxic-shock syndrome 42 37 human, other and unspecified † 10 5 Trichinellosis ¶¶ 7 — Hansen disease † 14 43 Tularemia † 13 15 Hantavirus pulmonary syndrome † 5 4 Yellow fever — — DISEASE DECREASE INCREASE CASES CURRENT 4 WEEKS



### Ratio (Log scale) †

Beyond historical limits 4 2 1 0.5 0.25 0.125 131

222

15

49

3

51

11

598

0 Hepatitis A, acute

Hepatitis B, acute

Hepatitis C, acute

Legionellosis

Measles

Mumps

Pertussis

Rubella Meningococcal disease

0.0625 0.03125 

### *

### 518 MMWR May 27, 2005

**TABLE II. Provisional cases of selected notifiable diseases, United States, weeks ending May 21, 2005, and May 22, 2004 (20th Week)** * **AIDS Chlamydia †**  **Coccidioidomycosis Cryptosporidiosis**

**Cum. Cum. Cum. Cum. Cum. Cum. Cum. Cum. Reporting area 2005**  **§ 2004 2005 2004 2005 2004 2005 2004**  UNITED STATES 13,232 12,150 327,461 352,369 1,610 1,809 671 921
NEW ENGLAND 532 370 10,722 11,658 — — 35 55 Maine 4 5 824 754 N N 3 9 N.H. 7 19 705 661 — — 5 14 Vt. ¶ 3 10 384 444 — — 9 6 Mass. 275 119 5,507 5,221 — — 12 19 R.I. 47 44 1,299 1,340 — — 1 1 Conn. 196 173 2,003 3,238 N N 5 6
MID. ATLANTIC 2,558 2,414 38,792 43,745 — — 100 153 Upstate N.Y. 253 186 8,167 8,453 N N 26 28 N.Y. City 1,476 1,134 11,959 13,511 — — 23 48 N.J. 413 524 4,341 7,007 N N 7 12 Pa. 416 570 14,325 14,774 N N 44 65
E.N. CENTRAL 1,204 1,276 52,221 63,389 3 5 125 237 Ohio 185 231 13,987 16,055 N N 45 53 Ind. 165 164 7,644 7,013 N N 11 30 Ill. 661 606 14,836 18,072 — — 2 40 Mich. 138 207 8,802 15,261 3 5 20 47 Wis. 55 68 6,952 6,988 N N 47 67
W.N. CENTRAL 318 300 18,972 21,473 3 4 100 95 Minn. 88 66 3,030 4,399 3 N 28 39 Iowa 41 19 2,627 2,635 N N 17 14 Mo. 132 125 7,756 7,921 — 3 39 18 N. Dak. 5 12 412 761 N N — — S. Dak. 9 5 1,076 966 — — 7 10 Nebr. ¶ 5 20 1,498 2,004 — 1 1 3 Kans. 38 53 2,573 2,787 N N 8 11
S. ATLANTIC 4,263 4,145 63,599 66,362 — — 153 168 Del. 70 55 1,298 1,141 N N — — Md. 513 475 6,784 7,335 — — 8 9 D.C. 276 149 1,459 1,407 — — 2 3 Va. ¶ 223 209 7,944 8,705 — — 12 22 W. Va. 22 29 886 1,093 N N 4 2 N.C. 350 237 13,171 10,639 N N 21 31 S.C. ¶ 215 267 7,900 6,838 — — 7 7 Ga. 741 690 7,754 12,947 — — 45 49 Fla. 1,853 2,034 16,403 16,257 N N 54 45
E.S. CENTRAL 770 555 22,762 21,694 — 3 19 39 Ky. 91 68 4,269 2,121 N N 7 9 Tenn. ¶ 313 208 8,471 8,773 N N 3 12 Ala. ¶ 213 167 2,996 5,355 — — 8 10 Miss. 153 112 7,026 5,445 — 3 1 8
W.S. CENTRAL 1,513 1,707 42,542 44,547 — 2 18 42 Ark. 71 88 3,413 3,125 — 1 1 7 La. 278 337 6,982 10,043 — 1 3 — Okla. 112 68 4,116 4,155 N N 7 8 Tex. ¶ 1,052 1,214 28,031 27,224 N N 7 27
MOUNTAIN 537 485 20,534 19,806 1,079 1,121 39 36 Mont. 3 — 798 877 N N 4 3 Idaho ¶ 5 3 731 1,190 N N 2 4 Wyo. — 5 427 425 — — 2 2 Colo. 107 97 5,071 5,096 N N 16 19 N. Mex. 56 51 1,478 3,244 2 9 2 1 Ariz. 227 197 8,018 5,550 1,045 1,085 4 5 Utah 25 29 1,645 1,270 2 6 4 1 Nev. ¶ 114 103 2,366 2,154 30 21 5 1
PACIFIC 1,537 898 57,317 59,695 525 674 82 96 Wash. 144 165 7,454 6,608 N N 5 — Oreg. ¶ 90 90 3,399 3,004 — — 15 11 Calif. 1,250 592 43,262 46,298 525 674 62 84 Alaska 9 10 1,473 1,531 — — — — Hawaii 44 41 1,729 2,254 — — — 1

Guam 1 — — 438 — — — — P.R. 335 208 1,631 1,144 N N N N V.I. 7 4 32 150 — — — — Amer. Samoa U U U U U U U U C.N.M.I. 2 U — U — U — U
N: Not notifiable. U: Unavailable. —: No reported cases. C.N.M.I.: Commonwealth of Northern Mariana Islands. * Incidence data for reporting years 2004 and 2005 are provisional and cumulative (year-to-date).

† Chlamydia refers to genital infections caused by C. trachomatis

. § Updated monthly from reports to the Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention. Last update April 24, 2005.

¶ Contains data reported through National Electronic Disease Surveillance System (NEDSS).

### Vol. 54 / No. 20 MMWR 519

**TABLE II. ( Continued**  **) Provisional cases of selected notifiable diseases, United States, weeks ending May 21, 2005, and May 22, 2004**  **(20th Week)***

**Escherichia coli , Enterohemorrhagic (EHEC)**  **Shiga toxin positive, Shiga toxin positive, O157:H7 serogroup non-O157 not serogrouped Giardiasis Gonorrhea** 
**Cum. Cum. Cum. Cum. Cum. Cum. Cum. Cum. Cum. Cum. Reporting area 2005 2004 2005 2004 2005 2004 2005 2004 2005 2004** 
UNITED STATES 386 412 55 71 61 46 5,513 5,994 109,189 121,669
NEW ENGLAND 28 20 15 18 6 5 453 527 1,949 2,722 Maine 2 — 2 — — — 44 52 52 102 N.H. 2 4 1 2 — — 21 16 59 52 Vt. 1 — — — — — 59 39 15 35 Mass. 10 11 5 6 6 5 185 268 1,057 1,202 R.I. 1 2 — — — — 30 37 192 358 Conn. 12 3 7 10 — — 114 115 574 973
MID. ATLANTIC 47 36 3 9 5 10 1,028 1,341 11,027 13,947 Upstate N.Y. 18 10 3 2 2 3 332 379 2,384 2,792 N.Y. City 1 7 — — — — 292 434 2,897 4,374 N.J. 11 7 — 3 — 4 135 175 1,607 2,579 Pa. 17 12 — 4 3 3 269 353 4,139 4,202
E.N. CENTRAL 79 85 7 13 3 4 777 913 20,633 25,726 Ohio 34 18 1 2 2 4 226 270 6,565 8,200 Ind. 8 12 — — — — N N 2,972 2,390 Ill. 9 22 1 — — — 130 304 5,988 7,554 Mich. 14 14 — 2 1 — 239 200 3,199 5,872 Wis. 14 19 5 9 — — 182 139 1,909 1,710
W.N. CENTRAL 53 62 12 11 9 9 713 653 6,006 6,308 Minn. 6 23 3 6 2 2 356 206 865 1,114 Iowa 10 11 — — — — 74 94 579 475 Mo. 20 7 6 4 2 2 151 200 3,189 3,198 N. Dak. 1 2 — — — 3 1 11 19 57 S. Dak. 2 2 — — — — 33 19 140 103 Nebr. 5 8 3 1 2 — 38 54 349 414 Kans. 9 9 — — 3 2 60 69 865 947
S. ATLANTIC 61 41 8 11 30 7 925 928 26,930 29,392 Del. — — N N N N 8 20 313 364 Md. 6 5 2 2 — 2 57 34 2,525 3,059 D.C. — 1 — — — — 18 29 790 947 Va. 2 1 3 6 6 — 195 137 2,865 3,503 W. Va. — 1 — — — — 11 12 258 317 N.C. — — — — 16 4 N N 6,263 5,796 S.C. 1 4 — — — — 30 32 3,380 3,301 Ga. 7 11 1 1 — — 316 286 3,391 5,472 Fla. 45 18 2 2 8 1 290 378 7,145 6,633
E.S. CENTRAL 22 23 — 2 5 6 141 130 8,370 9,444 Ky. 4 7 — 1 4 4 N N 1,344 897 Tenn. 11 3 — — 1 2 74 62 3,008 3,106 Ala. 7 6 — — — — 67 68 1,910 3,041 Miss. — 7 — 1 — — — — 2,108 2,400
W.S. CENTRAL 8 40 1 2 2 5 83 102 16,651 16,578 Ark. 1 5 — — — — 30 45 1,723 1,497 La. 1 1 1 — 2 — 10 15 3,858 4,557 Okla. 3 4 — — — — 43 42 1,733 1,786 Tex. 3 30 — 2 — 5 N N 9,337 8,738
MOUNTAIN 42 45 9 4 1 — 404 439 4,251 4,353 Mont. 3 3 — — — — 11 15 44 30 Idaho 3 12 5 1 — — 31 64 31 34 Wyo. — — 1 — — — 7 5 25 22 Colo. 11 9 1 1 — — 139 149 1,076 1,220 N. Mex. — 5 2 1 — — 14 25 260 394 Ariz. 10 6 N N N N 59 71 1,690 1,566 Utah 7 6 — — — — 115 87 259 174 Nev. 8 4 — 1 1 — 28 23 866 913
PACIFIC 46 60 — 1 — — 989 961 13,372 13,199 Wash. 9 17 — — — — 61 91 1,295 982 Oreg. 4 8 — 1 — — 84 148 618 369 Calif. 27 31 — — — — 793 664 10,954 11,049 Alaska 3 1 — — — — 28 26 188 262 Hawaii 3 3 — — — — 23 32 317 537

Guam N N — — — — — — — 70 P.R. — — — — — — 10 22 153 101 V.I. — — — — — — — — 2 53 Amer. Samoa U U U U U U U U U U C.N.M.I. — U — U — U — U — U
N: Not notifiable. U: Unavailable. —: No reported cases. C.N.M.I.: Commonwealth of Northern Mariana Islands. * Incidence data for reporting years 2004 and 2005 are provisional and cumulative (year-to-date).

### 520 MMWR May 27, 2005

**TABLE II. ( Continued**  **) Provisional cases of selected notifiable diseases, United States, weeks ending May 21, 2005, and May 22, 2004**  **(20th Week)***

**Haemophilus influenzae , invasive**  **All ages Age <5 years All serotypes Serotype b Non-serotype b Unknown serotype** 
**Cum. Cum. Cum. Cum. Cum. Cum. Cum. Cum. Reporting area 2005 2004 2005 2004 2005 2004 2005 2004** 
UNITED STATES 906 892 2 6 49 46 87 94

NEW ENGLAND 65 86 — 1 5 6 4 1 Maine 3 7 — — — — 1 — N.H. 3 12 — — — 2 — — Vt. 6 5 — — — — 2 1 Mass. 24 43 — 1 — 2 1 — R.I. 6 2 — — 2 — — — Conn. 23 17 — — 3 2 — —

MID. ATLANTIC 178 185 — 1 — 3 21 24 Upstate N.Y. 48 63 — 1 — 3 5 3 N.Y. City 27 38 — — — — 6 8 N.J. 37 34 — — — — 5 2 Pa. 66 50 — — — — 5 11

E.N. CENTRAL 122 160 — — 1 7 6 24 Ohio 61 57 — — — 2 5 10 Ind. 35 22 — — 1 4 1 1 Ill. 9 47 — — — — — 10 Mich. 10 9 — — — 1 — 3 Wis. 7 25 — — — — — —

W.N. CENTRAL 45 43 — 1 2 2 6 5 Minn. 18 14 — — 2 2 — — Iowa — 1 — 1 — — — — Mo. 20 18 — — — — 4 4 N. Dak. 1 3 — — — — 1 — S. Dak. — — — — — — — — Nebr. 3 2 — — — — 1 — Kans. 3 5 — — — — — 1

S. ATLANTIC 235 205 — — 13 10 14 16 Del. — — — — — — — — Md. 34 38 — — 4 2 — — D.C. — 1 — — — — — 1 Va. 18 17 — — — — — 1 W. Va. 14 10 — — 1 3 2 — N.C. 37 24 — — 5 3 — — S.C. 10 5 — — — — 1 — Ga. 60 59 — — — — 6 14 Fla. 62 51 — — 3 2 5 —

E.S. CENTRAL 46 29 — — 1 — 10 6 Ky. 4 — — — 1 — 1 — Tenn. 32 20 — — — — 6 4 Ala. 10 9 — — — — 3 2 Miss. — — — — — — — —

W.S. CENTRAL 55 37 1 1 4 4 6 1 Ark. — 1 — — — — — — La. 26 9 1 — 2 — 6 1 Okla. 29 26 — — 2 4 — — Tex. — 1 — 1 — — — —

MOUNTAIN 121 105 — 2 14 10 17 12 Mont. — — — — — — — — Idaho 3 4 — — — — 1 2 Wyo. 1 — — — — — — — Colo. 26 25 — — — — 3 3 N. Mex. 13 23 — — 4 3 1 4 Ariz. 55 43 — — 8 6 4 1 Utah 10 8 — 2 — 1 6 1 Nev. 13 2 — — 2 — 2 1

PACIFIC 39 42 1 — 9 4 3 5 Wash. — 1 — — — — — 1 Oreg. 17 22 — — — — 3 2 Calif. 16 12 1 — 9 4 — 1 Alaska 1 3 — — — — — 1 Hawaii 5 4 — — — — — —

Guam — — — — — — — — P.R. — — — — — — — — V.I. — — — — — — — — Amer. Samoa U U U U U U U U C.N.M.I. — U — U — U — U N: Not notifiable. U: Unavailable. —: No reported cases. C.N.M.I.: Commonwealth of Northern Mariana Islands. * Incidence data for reporting years 2004 and 2005 are provisional and cumulative (year-to-date).

### Vol. 54 / No. 20 MMWR 521

**TABLE II. ( Continued**  **) Provisional cases of selected notifiable diseases, United States, weeks ending May 21, 2005, and May 22, 2004**  **(20th Week)*** **Hepatitis (viral, acute), by type**
**ABC**
**Cum. Cum. Cum. Cum. Cum. Cum. Reporting area 2005 2004 2005 2004 2005 2004**  UNITED STATES 1,412 2,329 2,112 2,175 235 281

NEW ENGLAND 189 319 114 141 6 4 Maine — 7 4 1 — — N.H. 20 8 5 20 — — Vt. 1 5 1 2 6 1 Mass. 143 265 89 66 — 3 R.I. 5 6 — 1 — — Conn. 20 28 15 51 — —

MID. ATLANTIC 222 279 481 298 41 46 Upstate N.Y. 34 33 44 33 9 2 N.Y. City 106 105 39 65 — — N.J. 38 60 317 77 — — Pa. 44 81 81 123 32 44

E.N. CENTRAL 141 180 146 193 45 28 Ohio 24 22 57 57 2 2 Ind. 20 18 10 9 7 2 Ill. 27 58 14 — — 6 Mich. 56 62 65 106 36 18 Wis. 14 20 — 21 — —

W.N. CENTRAL 48 56 105 136 14 1 Minn. 3 10 8 12 — 1 Iowa 9 17 9 7 — — Mo. 27 9 63 96 13 — N. Dak. — 1 — 1 1 — S. Dak. — 2 — — — — Nebr. 2 10 13 11 — — Kans. 7 7 12 9 — —

S. ATLANTIC 209 388 616 686 51 70 Del. — 4 26 17 — 2 Md. 20 57 76 60 12 1 D.C. 2 3 — 12 — 1 Va. 28 27 74 72 6 7 W. Va. 2 1 14 2 5 8 N.C. 29 25 57 57 7 6 S.C. 8 20 41 47 1 6 Ga. 41 157 113 212 3 7 Fla. 79 94 215 207 17 32

E.S. CENTRAL 85 65 125 187 27 27 Ky. 4 9 29 21 1 13 Tenn. 60 45 56 87 7 6 Ala. 9 6 23 29 7 1 Miss. 12 5 17 50 12 7

W.S. CENTRAL 87 443 101 102 25 65 Ark. 2 46 17 50 — — La. 28 11 20 23 6 3 Okla. 3 16 7 23 — 2 Tex. 54 370 57 6 19 60

MOUNTAIN 144 169 202 159 9 17 Mont. 6 3 2 — — 2 Idaho 12 10 5 6 — 1 Wyo. — — — 3 — — Colo. 15 14 12 21 — 4 N. Mex. 7 6 5 9 — 5 Ariz. 86 117 146 78 — 2 Utah 12 17 20 17 6 1 Nev. 6 2 12 25 3 2

PACIFIC 287 430 222 273 17 23 Wash. 16 26 17 22 3 6 Oreg. 17 33 39 40 8 7 Calif. 242 359 161 200 6 10 Alaska 3 2 4 8—— Hawaii 9 10 1 3 — —

Guam — 1 — 4 — — P.R. 2 11 3 21 — — V.I. — — — — — — Amer. Samoa U U U U U U C.N.M.I. — U — U — U
N: Not notifiable. U: Unavailable. —: No reported cases. C.N.M.I.: Commonwealth of Northern Mariana Islands. * Incidence data for reporting years 2004 and 2005 are provisional and cumulative (year-to-date).

### 522 MMWR May 27, 2005

**TABLE II. ( Continued**  **) Provisional cases of selected notifiable diseases, United States, weeks ending May 21, 2005, and May 22, 2004**  **(20th Week)*** **Legionellosis Listeriosis Lyme disease Malaria**
**Cum. Cum. Cum. Cum. Cum. Cum. Cum. Cum. Reporting area 2005 2004 2005 2004 2005 2004 2005 2004**  UNITED STATES 388 462 168 192 1,910 3,043 348 450

NEW ENGLAND 19 9 6 11 108 401 15 31 Maine 1 — — 2 2 20 — 2 N.H. 3 — 1 1 18 14 3 — Vt. — — — — 2 11 — 1 Mass. 11 4 2 3 69 234 10 19 R.I. 1 1 1 1 3 32 2 2 Conn. 3 4 2 4 14 90 — 7
MID. ATLANTIC 109 84 31 44 1,315 2,100 94 111 Upstate N.Y. 30 18 8 12 217 758 19 13 N.Y. City 12 10 7 6 — 68 40 55 N.J. 22 13 7 15 597 476 24 23 Pa. 45 43 9 11 501 798 11 20

E.N. CENTRAL 83 93 19 27 33 129 19 31 Ohio 42 39 7 9 21 15 3 8 Ind. 5 9 1 5 2 1 — 4 Ill. 9 15 — 5 — 19 5 9 Mich. 23 25 6 6 2 — 8 6 Wis. 4 5 5 2 8 94 3 4

W.N. CENTRAL 11 10 11 3 68 38 16 24 Minn. 1 — 2 1 54 12 6 9 Iowa — 3 4 1 8 10 2 1 Mo. 8 4 2 1 5 13 7 5 N. Dak. 1 1 2 — — — — 2 S. Dak. — 1 — — — — — 1 Nebr. — — — — — 3 — 1 Kans. 1 1 1 — 1 — 1 5

S. ATLANTIC 83 99 40 26 328 307 84 113 Del. 1 2 N N 77 44 — 2 Md. 19 14 5 5 171 189 26 26 D.C. 1 3 — — 3 2 2 5 Va. 5 7 1 3 28 11 8 10 W. Va. 4 2 — 1 3 2 1 — N.C. 9 8 9 4 18 34 13 5 S.C. 2 2 1 — 7 3 3 6 Ga. 6 14 8 6 — 6 14 20 Fla. 36 47 16 7 21 16 17 39

E.S. CENTRAL 10 20 9 9 11 12 11 13 Ky. 2 4 1 2 — 5 2 1 Tenn. 3 9 4 5 11 5 6 3 Ala. 5 6 3 1 — 2 3 7 Miss. — 1 1 1 — — — 2

W.S. CENTRAL 11 98 5 32 15 26 22 57 Ark. 1 — — 1 2 — 1 2 La. 4 5 3 1 3 1 — 3 Okla. 1 2 — — — — 2 1 Tex. 5 91 2 30 10 25 19 51

MOUNTAIN 37 25 1 3 2 5 15 15 Mont. 2 — — — — — — — Idaho 1 1 — 1 — 2 — 1 Wyo. 2 4 — — — 2 1 — Colo. 7 4 1 1 — — 8 6 N. Mex. 1 — — — — — — 1 Ariz. 12 5 — — — 1 2 2 Utah 5 8 — — 2 — 4 3 Nev. 7 3 — 1 — — — 2

PACIFIC 25 24 46 37 30 25 72 55 Wash. — 4 2 5 — 2 3 1 Oreg. N N 3 4 2 13 1 8 Calif. 25 20 41 28 27 10 62 44 Alaska — — — — 1 — 2 — Hawaii — — — — N N 4 2

Guam — — — — — — — — P.R. — 1 — — N N — — V.I. — — — — — — — — Amer. Samoa U U U U U U U U C.N.M.I. — U — U — U — U N: Not notifiable. U: Unavailable. —: No reported cases. C.N.M.I.: Commonwealth of Northern Mariana Islands. * Incidence data for reporting years 2004 and 2005 are provisional and cumulative (year-to-date).

### Vol. 54 / No. 20 MMWR 523

**TABLE II. ( Continued**  **) Provisional cases of selected notifiable diseases, United States, weeks ending May 21, 2005, and May 22, 2004**  **(20th Week)*** **Meningococcal disease Serogroup**  **All serogroups A, C, Y, and W-135 Serogroup B Other serogroup Serogroup unknown**
**Cum. Cum. Cum. Cum. Cum. Cum. Cum. Cum. Cum. Cum. Reporting area 2005 2004 2005 2004 2005 2004 2005 2004 2005 2004** 

UNITED STATES 518 617 42 39 26 24 1 — 449 554

NEW ENGLAND 36 29 1 4 — 2 — — 35 23 Maine 1 8 — — — 1 — — 1 7 N.H. 3 3 — — — — — — 3 3 Vt. 3 1 — — — — — — 3 1 Mass. 18 17 — 4 — 1 — — 18 12 R.I. 2 — — — — — — — 2 — Conn. 9 — 1 — — — — — 8 —

MID. ATLANTIC 74 86 21 23 4 5 — — 49 58 Upstate N.Y. 19 25 2 4 3 3 — — 14 18 N.Y. City 10 15 — — — — — — 10 15 N.J. 20 17 — — — — — — 20 17 Pa. 25 29 19 19 1 2 — — 5 8

E.N. CENTRAL 51 57 13 8 4 4 — — 34 45 Ohio 23 34 — 3 4 4 — — 19 27 Ind. 8 8 — — — — — — 8 8 Ill. 2 1 — — — — — — 2 1 Mich. 13 5 13 5 — — — — — — Wis. 5 9 — — — — — — 5 9

W.N. CENTRAL 31 37 2 — 1 3 — — 28 34 Minn. 6 9 1 — — — — — 5 9 Iowa 9 8 — — 1 2 — — 8 6 Mo. 9 11 1 — — 1 — — 8 10 N. Dak. — 1 — — — — — — — 1 S. Dak. 1 1 — — — — — — 1 1 Nebr. 2 3 — — — — — — 2 3 Kans. 4 4 — — — — — — 4 4

S. ATLANTIC 92 121 2 2 4 2 — — 86 117 Del. — 1 — — — — — — — 1 Md. 8 6 1 — 2 — — — 5 6 D.C. — 5 — 2 — — — — — 3 Va. 11 7 — — — — — — 11 7 W. Va. 4 4 — — — — — — 4 4 N.C. 11 18 1 — 2 2 — — 8 16 S.C. 11 12 — — — — — — 11 12 Ga. 8 7 — — — — — — 8 7 Fla. 39 61 — — — — — — 39 61

E.S. CENTRAL 27 29 — — 2 — — — 25 29 Ky. 8 3 — — 2 — — — 6 3 Tenn. 13 10 — — — — — — 13 10 Ala. 2 6 — — — — — — 2 6 Miss. 4 10 — — — — — — 4 10

W.S. CENTRAL 41 56 1 1 3 1 — — 37 54 Ark. 8 10 — — — — — — 8 10 La. 19 20 — 1 2 — — — 17 19 Okla. 6 3 1 — 1 1 — — 4 2 Tex. 8 23 — — — — — — 8 23

MOUNTAIN 41 30 1 — 3 3 1 — 36 27 Mont. — 1 — — — — — — — 1 Idaho 1 4 — — — — — — 1 4 Wyo. — 3 — — — — — — — 3 Colo. 10 9 1 — — — 1 — 8 9 N. Mex. 1 4 — — — 2 — — 1 2 Ariz. 21 5 — — 2 — — — 19 5 Utah 5 2 — — 1 — — — 4 2 Nev. 3 2 — — — 1 — — 3 1

PACIFIC 125 172 1 1 5 4 — — 119 167 Wash. 20 15 1 1 4 4 — — 15 10 Oreg. 23 35 — — — — — — 23 35 Calif. 75 115 — — — — — — 75 115 Alaska 1 2 — — — — — — 1 2 Hawaii 6 5 — — 1 — — — 5 5

Guam — — — — — — — — — — P.R. 3 5 — — — — — — 3 5 V.I. — — — — — — — — — — Amer. Samoa — — — — — — — — — — C.N.M.I. — — — — — — — — — — N: Not notifiable. U: Unavailable. —: No reported cases. C.N.M.I.: Commonwealth of Northern Mariana Islands. * Incidence data for reporting years 2004 and 2005 are provisional and cumulative (year-to-date).

### 524 MMWR May 27, 2005

**TABLE II. ( Continued**  **) Provisional cases of selected notifiable diseases, United States, weeks ending May 21, 2005, and May 22, 2004**  **(20th Week)*** **Rocky Mountain Pertussis Rabies, animal spotted fever Salmonellosis Shigellosis** 
**Cum. Cum. Cum. Cum. Cum. Cum. Cum. Cum. Cum. Cum. Reporting area 2005 2004 2005 2004 2005 2004 2005 2004 2005 2004** 
UNITED STATES 5,935 3,772 1,887 2,614 219 212 8,927 10,479 3,520 4,978

NEW ENGLAND 304 572 287 183 1 5 539 481 68 86 Maine 12 3 19 19 N N 26 29 2 1 N.H. 13 21 4 6 — — 39 30 4 3 Vt. 46 38 22 6 — — 33 18 4 2 Mass. 211 484 174 79 — 5 289 266 38 55 R.I. 8 9 6 10 1 — 19 31 2 4 Conn. 14 17 62 63 — — 133 107 18 21
MID. ATLANTIC 583 862 204 271 15 25 1,142 1,333 395 464 Upstate N.Y. 199 620 152 130 — 1 292 310 98 194 N.Y. City 28 63 9 5 1 8 292 388 163 139 N.J. 98 58 N N 5 6 190 234 105 83 Pa. 258 121 43 136 9 10 368 401 29 48
E.N. CENTRAL 1,436 804 38 14 4 10 950 1,420 228 324 Ohio 627 163 21 5 3 4 291 336 23 66 Ind. 132 22 3 2 — 1 112 151 33 53 Ill. 83 152 8 4 — 4 108 431 24 131 Mich. 98 39 6 2 1 1 231 255 96 33 Wis. 496 428 — 1 — — 208 247 52 41

W.N. CENTRAL 805 213 127 213 24 10 647 664 262 135 Minn. 140 41 28 17 — — 163 163 23 17 Iowa 277 32 26 21 — — 101 132 38 29 Mo. 165 112 19 6 22 9 195 181 157 49 N. Dak. 48 6 6 23 — — 11 13 2 1 S. Dak. 1 8 12 43 — — 45 23 8 6 Nebr. 72 4 — 58 1 1 48 49 20 7 Kans. 102 10 36 45 1 — 84 103 14 26
S. ATLANTIC 450 197 631 959 130 115 2,500 2,132 617 1,127 Del. 12 — — 9 1 2 13 19 4 3 Md. 73 44 109 112 10 5 196 185 27 44 D.C. 3 5 — — — — 14 15 6 21 Va. 74 48 224 176 4 — 255 238 33 34 W. Va. 22 3 13 28 1 — 33 46 — — N.C. 27 33 189 250 87 78 410 247 63 129 S.C. 161 30 5 58 6 10 161 136 35 205 Ga. 15 9 86 121 13 17 407 366 175 253 Fla. 63 25 5 205 8 3 1,011 880 274 438

E.S. CENTRAL 161 47 50 54 14 26 469 574 493 221 Ky. 49 7 6 11 — — 90 98 43 31 Tenn. 65 26 15 17 11 15 173 174 302 87 Ala. 34 7 29 21 3 5 147 168 115 78 Miss. 13 7 — 5 — 6 59 134 33 25

W.S. CENTRAL 149 139 438 812 8 1 6 591 1,481 665 1,816 Ark. 74 12 13 23 2 — 122 102 20 18 La. 13 7 — — 1 3 175 174 41 123 Okla. — 13 41 54 5 13 90 93 281 166 Tex. 62 107 384 735 — — 204 1,112 323 1,509
MOUNTAIN 1,447 405 70 43 19 2 605 706 212 272 Mont. 307 11 — 5 1 — 32 51 2 3 Idaho 46 17 — — — 1 30 55 — 5 Wyo. 13 3 9 — 1 — 12 20 — 1 Colo. 595 215 3 4 1 1 155 162 34 48 N. Mex. 52 59 — — — — 48 73 28 50 Ariz. 261 71 58 34 13 — 201 229 107 132 Utah 155 28 — — 3 — 72 76 16 15 Nev. 18 1 — — — — 55 40 25 18
PACIFIC 600 533 42 65 4 3 1,484 1,688 580 533 Wash. 135 160 — — — — 106 118 22 28 Oreg. 245 181 — — — 2 97 139 23 26 Calif. 160 175 41 54 4 1 1,162 1,280 519 459 Alaska 15 9 1 11 — — 17 28 5 4 Hawaii 45 8 — — — — 102 123 11 16

Guam — — — — — — — 15 — 16 P.R. — 1 28 18 N N 29 75 — 1 V.I. — — — — — — — — — — Amer. Samoa U U U U U U U U U U C.N.M.I. — U — U — U — U — U N: Not notifiable. U: Unavailable. —: No reported cases. C.N.M.I.: Commonwealth of Northern Mariana Islands. * Incidence data for reporting years 2004 and 2005 are provisional and cumulative (year-to-date).

### Vol. 54 / No. 20 MMWR 525

N: Not notifiable. U: Unavailable. —: No reported cases. C.N.M.I.: Commonwealth of Northern Mariana Islands. * Incidence data for reporting years 2004 and 2005 are provisional and cumulative (year-to-date). **TABLE II. ( Continued**  **) Provisional cases of selected notifiable diseases, United States, weeks ending May 21, 2005, and May 22, 2004**  **(20th Week)*** **Streptococcus pneumoniae , invasive disease**  **Streptococcal disease, Drug resistant,**  **Syphilis**

**invasive, group A all ages**  **Age <5 years Primary & secondary Congenital** 

**Cum. Cum. Cum. Cum. Cum. Cum. Cum. Cum. Cum. Cum. Reporting area 2005 2004 2005 2004 2005 2004 2005 2004 2005 2004** 
UNITED STATES 1,951 2,323 1,135 1,181 352 392 2,558 2,863 97 150

NEW ENGLAND 70 165 11 57 32 57 73 68 — — Maine 2 3 N N — 1 1 — — — N.H. 5 11 — — 2 N 5 1 — — Vt. 7 5 5 5 3 1 — — — — Mass. 50 77 — 9 27 36 56 43 — — R.I. 6 16 6 7 — 3 2 6 — — Conn. — 53 U 36 U 16 9 18 — —

MID. ATLANTIC 433 381 121 87 58 53 330 385 15 21 Upstate N.Y. 155 114 46 39 36 34 27 31 11 1 N.Y. City 63 65 U U U U 215 225 3 9 N.J. 85 82 N N 11 4 44 74 1 10 Pa. 130 120 75 48 11 15 44 55 — 1

E.N. CENTRAL 391 518 286 264 94 93 216 342 15 22 Ohio 99 130 186 196 44 45 76 97 2 1 Ind. 42 48 98 68 22 18 28 21 1 1 Ill. 82 155 2 — 24 — 72 130 3 2 Mich. 160 147 — N — N 32 78 7 18 Wis. 8 38 N N 4 30 8 16 2 —

W.N. CENTRAL 137 163 28 10 43 32 68 77 — 2 Minn. 52 72 — — 24 18 12 12 — 1 Iowa N N N N — N 1 4 — — Mo. 43 40 26 9 4 8 46 44 — 1 N. Dak. 2 6 — — 1 — — — — — S. Dak. 9 8 2 1 — — — — — — Nebr. 9 11 — — 4 4 2 5 — — Kans. 22 26 N N 10 2 7 12 — —

S. ATLANTIC 398 434 488 576 43 26 674 706 20 24 Del. — 2 1 3 — N 6 2 — — Md. 110 66 — — 29 18 119 134 7 3 D.C. 5 4 13 5 2 4 46 20 — 1 Va. 27 37 N N — N 35 25 3 1 W. Va. 7 13 49 65 12 4 2 3 — — N.C. 63 56 N N U U 89 57 3 1 S.C. 11 43 — 58 — N 26 52 — 7 Ga. 75 114 155 147 — N 74 129 — 1 Fla. 100 99 270 298 — N 277 284 7 10

E.S. CENTRAL 79 114 87 73 3 9 139 145 11 7 Ky. 19 35 14 18 N N 12 22 — — Tenn. 60 79 73 53 — N 60 54 8 1 Ala. — — — — — N 56 54 3 4 Miss. — — — 2 3 9 11 15 — 2

W.S. CENTRAL 84 266 75 36 51 97 468 427 20 30 Ark. 7 5 8 5 10 5 22 13 — 3 La. 5 1 67 31 16 19 92 93 2 2 Okla. 61 32 N N 16 23 16 12 1 2 Tex. 11 228 N N 9 50 338 309 17 23

MOUNTAIN 319 246 39 17 28 25 136 147 12 11 Mont. — — — — — — 5 — — — Idaho 1 4 N N — N 9 10 — 2 Wyo. 2 5 16 4 — — — 1 — — Colo. 124 48 N N 27 25 15 27 — — N. Mex. 23 52 — 5 — — 18 39 1 2 Ariz. 127 116 N N — N 56 61 11 7 Utah 41 21 22 6 1 — 4 2 — — Nev. 1 — 1 2 — — 29 7 — —

PACIFIC 40 36 — 61 — — 454 566 4 33 Wash. N N N N N N 56 31 — — Oreg. N N N N — N 12 14 — — Calif. — — N N N N 380 518 4 33 Alaska — — — — — N 4 — — — Hawaii 40 36 — 61 — — 2 3 — —

Guam — — — — — — — — — — P.R. N N N N — N 55 50 6 3 V.I. — — — — — — — 4 — — Amer. Samoa U U U U U U U U U U C.N.M.I. — U — U — U — U — U

### 526 MMWR May 27, 2005

**TABLE II. ( Continued**  **) Provisional cases of selected notifiable diseases, United States, weeks ending May 21, 2005, and May 22, 2004**  **(20th Week)***

**Varicella West Nile virus disease †**  **Tuberculosis Typhoid fever (chickenpox) Neuroinvasive Non-neuroinvasive §** 
**Cum. Cum. Cum. Cum. Cum. Cum. Cum. Cum. Cum. Reporting area 2005 2004 2005 2004 2005 2004 2005 2004 2005**  UNITED STATES 3,343 4,618 68 96 9,332 10,689 — 14 —
NEW ENGLAND 102 140 6 10 355 1,232 — — — Maine 7 8 — — 101 43 — — — N.H. 4 6 — — 52 — — — — Vt. — — — — 24 315 — — — Mass. 68 78 5 9 178 15 — — — R.I. 6 15 — 1 — — — — — Conn. 17 33 1 — — 859 — — —
MID. ATLANTIC 741 695 18 27 2,157 29 — 1 — Upstate N.Y. 85 81 3 2 — — — — — N.Y. City 384 353 3 9 — — — — — N.J. 165 148 5 11 — — — — — Pa. 107 113 7 5 2,157 29 — 1 —
E.N. CENTRAL 486 394 3 11 3,114 3,342 — — — Ohio 93 64 — 2 733 862 — — — Ind. 48 50 — — 119 N — — — Ill. 242 183 1 5 17 1 — — — Mich. 71 70 1 3 2,024 2,127 — — — Wis. 32 27 1 1 221 352 — — —

W.N. CENTRAL 172 150 1 2 72 120 — 1 — Minn. 69 60 1 1 — — — — — Iowa 17 15 — — N N — — — Mo. 43 41 — 1 3 2 — — — N. Dak. 2 3 — — 10 68 — — — S. Dak. 5 4 — — 59 50 — 1 — Nebr. 15 6 — — — — — — — Kans. 21 21 — — — — — — N
S. ATLANTIC 714 911 9 8 878 1,222 — 1 — Del. 2 9 — — 6 4 — — — Md. 81 81 1 2 — — — — — D.C. 27 4 — — 15 17 — — — Va. 94 72 2 2 141 316 — — — W. Va. 8 10 — — 539 628 — — N N.C. 72 85 1 2 — N — — — S.C. 80 72 — — 177 257 — — — Ga. 58 265 2 — — — — — — Fla. 292 313 3 2 — — — 1 —

E.S. CENTRAL 192 170 1 4 — — — — — Ky. 40 29 1 2 N N — — — Tenn. 92 48 — 2 — — — — — Ala. 60 60 — — — — — — — Miss. — 33 — — — — — — —
W.S. CENTRAL 276 817 3 9 1,348 3,382 — 1 — Ark. 36 52 — — — — — — — La. — — — — 96 42 — — — Okla. 52 55 — — — — — — — Tex. 188 710 3 9 1,252 3,340 — 1 —
MOUNTAIN 81 192 3 3 1,408 1,362 — 10 — Mont. — — — — — — — — — Idaho — — — — — — — — — Wyo. — 1 — — 42 17 — — — Colo. 16 51 — 1 994 1,041 — 1 — N. Mex. 4 14 — — 78 35 — — — Ariz. 56 80 1 1 — — — 9 — Utah 5 15 1 1 294 269 — — — Nev. — 31 1 — — — — — —
PACIFIC 579 1,149 24 22 — — — — — Wash. 76 78 1 1 N N — — — Oreg. 38 36 2 — — — — — — Calif. 405 981 17 15 — — — — — Alaska 13 12 — — — — — — — Hawaii 47 42 4 6 — — — — —

Guam — 14 — — — 95 — — — P.R. — 21 — — 76 134 — — — V.I. — — — — — — — — — Amer. Samoa U U U U U U U U — C.N.M.I. — U — U — U — U —
N: Not notifiable. U: Unavailable. —: No reported cases. C.N.M.I.: Commonwealth of Northern Mariana Islands. * Incidence data for reporting years 2004 and 2005 are provisional and cumulative (year-to-date). † Updated weekly from reports to the Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases (ArboN et Surveillance).

**§** Not previously notifiable.

### Vol. 54 / No. 20 MMWR 527

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. Compl ete counts will be available in 4 to 6 weeks.

¶ Total includes unknown ages. NEW ENGLAND 558 391 117 34 11 5 61 Boston, Mass. 137 90 37 6 4 — 11 Bridgeport, Conn. 54 40 9 4 1 — 7 Cambridge, Mass. 14 9 3 2 — — 3 Fall River, Mass. 17 13 3 1 — — — Hartford, Conn. 61 45 11 2 3 — 7 Lowell, Mass. 19 16 2 1 — — — Lynn, Mass. 9 5 3 1 — — 1 New Bedford, Mass. 21 16 2 3 — — 7 New Haven, Conn. 42 27 10 4 — 1 6 Providence, R.I. 60 48 9 2 1 — 5 Somerville, Mass. 6 5 1 — — — — Springfield, Mass. 31 14 8 5 2 2 5 Waterbury, Conn. 27 19 6 2 — — — Worcester, Mass. 60 44 13 1 — 2 9
MID. ATLANTIC 2,107 1,520 413 115 33 25 112 Albany, N.Y. 46 29 11 2 2 2 1 Allentown, Pa. 27 23 1 1 — 2 1 Buffalo, N.Y. 78 51 21 4 — 2 4 Camden, N.J. 2 1 — 1 — — 2 Elizabeth, N.J. 13 7 2 4 — — 1 Erie, Pa. 39 31 7 1 — — 1 Jersey City, N.J. 36 23 8 2 1 2 — New York City, N.Y. 1,036 752 206 55 17 6 53 Newark, N.J. 42 22 9 7 1 3 4 Paterson, N.J. U U U U U U U Philadelphia, Pa. 380 262 81 22 9 5 20 Pittsburgh, Pa. § 31 25 5 1 — — 1 Reading, Pa. 18 11 4 3 — — — Rochester, N.Y. 139 114 21 4 — — 16 Schenectady, N.Y. 18 13 5 — — — 1 Scranton, Pa. 29 24 2 3 — — 1 Syracuse, N.Y. 107 84 17 3 1 2 5 Trenton, N.J. 26 19 4 — 2 1 — Utica, N.Y. 21 14 6 1 — — — Yonkers, N.Y. 19 15 3 1 — — 1
E.N. CENTRAL 2,054 1,370 455 126 56 45 120 Akron, Ohio 39 27 7 3 1 1 7 Canton, Ohio 30 28 2 — — — 3 Chicago, Ill. 318 187 83 32 6 8 18 Cincinnati, Ohio 99 58 30 5 4 2 4 Cleveland, Ohio 203 138 46 13 3 3 6 Columbus, Ohio 218 152 48 12 2 4 14 Dayton, Ohio 117 82 29 5 1 — 10 Detroit, Mich. 174 91 52 16 11 4 7 Evansville, Ind. 36 30 3 3 — — 1 Fort Wayne, Ind. 77 50 19 2 5 1 8 Gary, Ind. 17 8 6 3 — — — Grand Rapids, Mich. 62 40 11 2 5 4 3 Indianapolis, Ind. 210 136 40 15 8 11 13 Lansing, Mich. 55 35 16 1 2 1 2 Milwaukee, Wis. 104 81 16 4 — 3 10 Peoria, Ill. 39 30 4 4 1 — 2 Rockford, Ill. 54 43 10 1 — — 1 South Bend, Ind. 54 39 10 1 2 2 — Toledo, Ohio 91 67 16 3 4 1 5 Youngstown, Ohio 57 48 7 1 1 — 6

W.N. CENTRAL 601 395 137 37 15 15 37 Des Moines, Iowa 53 42 10 1 — — 5 Duluth, Minn. 28 23 5 — — — 5 Kansas City, Kans. 40 25 8 5 — 2 1 Kansas City, Mo. 91 62 20 6 2 1 4 Lincoln, Nebr. 32 17 11 3 1 — — Minneapolis, Minn. 56 36 12 3 2 3 3 Omaha, Nebr. 76 47 25 1 — 3 8 St. Louis, Mo. 99 51 26 8 7 5 4 St. Paul, Minn. 50 37 6 5 2 — 5 Wichita, Kans. 76 55 14 5 1 1 2 S. ATLANTIC 1,209 787 270 94 26 31 69 Atlanta, Ga. 137 84 38 12 3 — 4 Baltimore, Md. 150 84 46 13 5 2 15 Charlotte, N.C. 109 78 14 10 3 4 6 Jacksonville, Fla. 157 99 35 15 4 3 5 Miami, Fla. 134 102 18 11 2 1 8 Norfolk, Va. 61 37 13 2 1 8 6 Richmond, Va. 50 33 12 2 2 1 5 Savannah, Ga. 60 45 8 4 — 3 4 St. Petersburg, Fla. 56 38 7 6 2 3 3 Tampa, Fla. 179 123 40 10 2 4 12 Washington, D.C. 102 55 36 7 2 2 1 Wilmington, Del. 14 9 3 2 — — —

E.S. CENTRAL 936 606 213 64 29 23 70 Birmingham, Ala. 193 117 49 13 11 2 12 Chattanooga, Tenn. 73 49 13 7 2 2 7 Knoxville, Tenn. 100 73 21 4 2 — 1 Lexington, Ky. 99 58 21 12 3 5 9 Memphis, Tenn. 183 123 38 12 5 5 19 Mobile, Ala. 72 48 18 1 2 3 4 Montgomery, Ala. 59 44 12 1 — 2 6 Nashville, Tenn. 157 94 41 14 4 4 12
W.S. CENTRAL 2,461 1,565 589 170 65 72 123 Austin, Tex. 85 59 17 7 — 2 4 Baton Rouge, La. 82 52 12 5 3 10 — Corpus Christi, Tex. 70 50 12 5 2 1 8 Dallas, Tex. 166 91 52 9 7 7 17 El Paso, Tex. 93 65 22 4 — 2 4 Ft. Worth, Tex. 113 74 27 5 4 3 1 Houston, Tex. 347 206 99 23 5 14 17 Little Rock, Ark. 87 48 29 3 3 4 — New Orleans, La. 965 632 213 78 26 16 59 San Antonio, Tex. 238 150 59 17 7 5 12 Shreveport, La. 76 42 22 3 6 3 1 Tulsa, Okla. 139 96 25 11 2 5 —
MOUNTAIN 1,138 737 255 81 38 27 72 Albuquerque, N.M. 155 102 33 16 3 1 8 Boise, Idaho 37 21 8 — 5 3 2 Colo. Springs, Colo. 56 38 12 4 2 — — Denver, Colo. 104 60 27 10 3 4 5 Las Vegas, Nev. 243 156 53 21 9 4 20 Ogden, Utah 25 18 5 — 2 — 2 Phoenix, Ariz. 198 111 52 22 4 9 12 Pueblo, Colo. 36 27 8 1 — — 3 Salt Lake City, Utah 101 75 21 3 — 2 10 Tucson, Ariz. 183 129 36 4 10 4 10
PACIFIC 1,668 1,187 326 90 33 32 169 Berkeley, Calif. 11 6 2 1 — 2 — Fresno, Calif. 108 77 22 6 3 — 11 Glendale, Calif. 25 19 6 — — — 4 Honolulu, Hawaii 84 67 11 3 1 2 11 Long Beach, Calif. 70 46 16 6 2 — 11 Los Angeles, Calif. 339 240 67 20 6 6 35 Pasadena, Calif. 12 9 3 — — — 2 Portland, Oreg. 135 92 28 9 3 3 7 Sacramento, Calif. 178 126 38 7 4 3 21 San Diego, Calif. 164 113 30 14 3 4 15 San Francisco, Calif. 59 37 15 5 1 1 10 San Jose, Calif. 181 141 31 4 2 3 18 Santa Cruz, Calif. 28 18 5 2 1 2 3 Seattle, Wash. 110 74 26 5 4 1 8 Spokane, Wash. 50 38 7 1 2 2 6 Tacoma, Wash. 114 84 19 7 1 3 7
TOTAL 12,732 ¶ 8,558 2,775 811 306 275 833 **TABLE III. Deaths in 122 U.S. cities,* week ending May 21, 2005 (20th Week)** **All causes, by age (years) All causes, by age (years)**

**All P&I †**  **All P&I †**  **Reporting Area Ages >65 45–64 25–44 1–24 <1 Total Reporting Area Ages**  **>65 45–64 25–44 1–24 <1 Total**

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### ✩ U.S. Government Printing Office: 2005-733-116/00092 Region IV ISSN: 0149-2195 **528 May 27, 2005**