Morbidity and Mortality Weekly Report

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

department of health and human services

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 Tobacco

Day 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 to

provide 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, and

training 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 and

simple 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 have

collected 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, which

consisted 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 the

10 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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Centers for Disease Control and Prevention

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* Proposed.

students had actually received formal training in how to conduct such counseling. Schools for health professionals, public

health organizations, and education officials should work

together 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 core

questionnaire on demographics, prevalence of cigarette smoking and other tobacco use, knowledge and attitudes about

tobacco 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. The

Federation 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-administered

format 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
Vol. 54 / No. 20 MMWR 507

(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%), and

Indian 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 smoking

cessation (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 than

pharmacy 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. Prevalence 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 total 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 they

counsel 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 health

community 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 the

countries 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 formal

curricula. 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.
Vol. 54 / No. 20 MMWR 509

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 being

trained to provide tobacco-cessation counseling, and the willingness of students to use such training to reduce tobacco use

among their patients. The GHPS Pilot Study proved successful in terms of school and student participation, fieldwork

procedures, data collection, cost, and reliability of data. In

light 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 to

account for practicing health professionals in any of the countries. Second, the GHPS did not survey students in all health

professions 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 is

not 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 the

dissemination 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 a

Tobacco Free Albania, Tirana, Albania. A Ramic-Catak, Federal Public Health Institute, Sarajevo, Federation of Bosnia and

Herzegovina. 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 of

Health, 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 global

tobacco 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 of

cessation 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 smoking

among 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 declined

to 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 tobacco

industry 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 tobacco

industry 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 patterns

among 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 Institutes

of 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

Women Hispanic Men 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 only

in 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, and

cigarette 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 include

intellectual and behavioral deficits in children and hypertension and kidney disease in adults (1). Exposure to lead is an

important 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 the

U.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 lead

levels. 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 using

a 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 furnace

atomic 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 BLLs

of 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, and

Mexican 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 elevated

BLLs (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 μg/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 testing 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 were

reduced, likely because of the substantial decline among nonHispanic black children. However, the GM BLL for nonHispanic black children remains higher than that for

Mexican-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 in

smaller 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 years

1992–2002 for residential lead control in low-income, privately owned housing (9), and to investments in housing

rehabilitation made by other government agencies and the private sector. Lead-control enforcement action by HUD, the

U.S. Environmental Protection Agency, and the Department

of Justice has resulted in approximately 200 on-site inspections and 30 settlements involving approximately 160,000

housing units nationwide (10). State and local governments

have 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 μg/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 μg/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 μg/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. Compliance

assistance 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 past 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 (ArboNet Surveillance). ¶ Updated monthly from reports to the Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention. Last update 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 (20th 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 historical

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

0.125 0.25 0.5 1 2 4

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

0.03125 0.0625

*
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 16 591 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 (ArboNet 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. Complete 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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528 May 27, 2005