Weekly January 30, 2009 / Vol. 58 / No. 3

department of health and human services

Centers for Disease Control and Prevention

Morbidity and Mortality Weekly Report

www.cdc.gov/mmwr

Assisted Reproductive Technology and Trends in Low Birthweight — 

Massachusetts, 1997–2004

Low birthweight (LBW) (<2,500 g) is an important cause 

of infant morbidity and mortality (1). The rate of LBW has 

been steadily increasing in the United States. In 2005, the most 

recent year for which data are available, LBW represented 8.2% 

of all births, the highest level reported in the past 4 decades (2). 

The use of assisted reproductive technology (ART)* has been 

associated with LBW (3,4). Research in 1999 indicated that, in 

Massachusetts during 1989–1996, the rate of LBW increased, 

paralleling the national trend, and an increasing percentage 

of LBW infants were born to mothers aged >35 years and to 

mothers with more education.† These findings suggested that 

a proportion of LBW births might be attributable to infertility 

treatment; however, at that time, no information was available 

from birth certificate records to examine whether ART was 

associated with the increasing rates of LBW. To investigate the 

role of ART, the Massachusetts Department of Public Health 

(MDPH) and CDC linked birth certificate records to ART 

records for the years 1997–2004 (the most recent data available). This report summarizes the results of that analysis, which 

indicated that, on average, 2% of births during the period 

resulted from ART; however, 7% of LBW births resulted from 

ART. The rate of LBW increased during this period among 

non-ART singletons (from 4.8% to 5.1%), accounting for an 

additional 407 LBW infants, and among ART singletons (from 

6.4% to 8.2%), accounting for an additional 59 LBW infants. 

Although ART contributes disproportionately to LBW, only 

a small percentage of the excess LBW births in Massachusetts 

are explained by ART; therefore, other causes for the increase 

in LBW should be examined. 

The analysis was conducted by merging birth certificate 

records and ART records for 1997–2004. After all births 

in Massachusetts, information for birth certificate records 

is abstracted by hospital staff and sent to the Massachusetts 

Registry of Vital Records and Statistics. All clinics that perform ART report standardized data without personal identifiers for every ART procedure to CDC, as mandated by the 

Federal Fertility Clinic Success Rate and Certification Act.§

For this analysis, investigators linked birth certificate records 

with live-birth ART records in 2-year intervals (5). Birth 

certificate records and ART records were included based on 

mother’s residence in Massachusetts. A deterministic linkage 

was performed using maternal and infant dates of birth and 

plurality. Questions regarding duplicate matches were resolved 

using postal code of residence. A total of 13,025 ART records 

were linked to a birth certificate record, representing 83% of 

*ART includes infertility treatments in which both eggs and sperm are handled 

in a laboratory for the purpose of establishing a pregnancy. Procedures include 

in vitro fertilization, gamete intrafallopian transfer, zygote intrafallopian transfer, 

embryo cryopreservation, and surrogate birth.

† Additional information available at http://www.cdc.gov/mmwr/preview/

mmwrhtml/00056908.htm.

INSIDE

52 Methicillin-Resistant Staphylococcus aureus Among Players 

on a High School Football Team — New York City, 2007

55 Children with Elevated Blood Lead Levels Related to Home 

Renovation, Repair, and Painting Activities — New York 

State, 2006–2007

58 Invasive Haemophilus influenzae Type B Disease in Five 

Young Children — Minnesota, 2008

60 Notice to Readers

62 QuickStats

§ Fertility Clinic Success Rate and Certification Act of 1992 (FCSRCA), Public 

Law 102–493, October 24, 1992. Additional information available at http://

www.popline.org/docs/1270/087273.html and http://wwwn.cdc.gov/dls/art/

fcsrca.aspx.
Editorial Board

William L. Roper, MD, MPH, Chapel Hill, NC, Chairman

Virginia A. Caine, MD, Indianapolis, IN

David W. Fleming, MD, Seattle, WA

William E. Halperin, MD, DrPH, MPH, Newark, NJ

Margaret A. Hamburg, MD, Washington, DC

King K. Holmes, MD, PhD, Seattle, WA

Deborah Holtzman, PhD, Atlanta, GA

John K. Iglehart, Bethesda, MD

Dennis G. Maki, MD, Madison, WI

Sue Mallonee, MPH, Oklahoma City, OK

Patricia Quinlisk, MD, MPH, Des Moines, IA

Patrick L. Remington, MD, MPH, Madison, WI

Barbara K. Rimer, DrPH, Chapel Hill, NC

John V. Rullan, MD, MPH, San Juan, PR

William Schaffner, MD, Nashville, TN

Anne Schuchat, MD, Atlanta, GA

Dixie E. Snider, MD, MPH, Atlanta, GA

John W. Ward, MD, Atlanta, GA

The MMWR series of publications is published by the Coordinating 

Center for Health Information and Service, Centers for Disease 

Control and Prevention (CDC), U.S. Department of Health and 

Human Services, Atlanta, GA 30333.

Suggested Citation: Centers for Disease Control and Prevention. 

[Article title]. MMWR 2009;58:[inclusive page numbers].

Centers for Disease Control and Prevention

Richard E. Besser, MD

(Acting) Director

Tanja Popovic, MD, PhD

Chief Science Officer

James W. Stephens, PhD

Associate Director for Science

Steven L. Solomon, MD

Director, Coordinating Center for Health Information and Service

Jay M. Bernhardt, PhD, MPH

Director, National Center for Health Marketing

Katherine L. Daniel, PhD

Deputy Director, National Center for Health Marketing

Editorial and Production Staff

Frederic E. Shaw, MD, JD

Editor, MMWR Series

Susan F. Davis, MD

(Acting) Assistant Editor, MMWR Series

Robert A. Gunn, MD, MPH

Associate Editor, MMWR Series

Teresa F. Rutledge

Managing Editor, MMWR Series

Douglas W. Weatherwax

 Lead Technical Writer-Editor

Donald G. Meadows, MA

Jude C. Rutledge

Writers-Editors

Martha F. Boyd

Lead Visual Information Specialist

Malbea A. LaPete

Stephen R. Spriggs

Visual Information Specialists

Kim L. Bright, MBA

Quang M. Doan, MBA

Phyllis H. King

Information Technology Specialists

50 MMWR January 30, 2009

eligible ART births. These were defined as Massachusetts ART 

births. ART records not linked to birth certificate records (n 

= 2,684 [17% of eligible ART births]) were excluded. During 

1997–2004, a total of 713 births (0.1% of birth records) 

occurred in which use of ART was recorded on the birth certificate but the births were not linked to a Massachusetts livebirth ART record. These births were excluded because whether 

they reflected mothers who had undergone ART procedures in 

another state or were simply missed by the linkage could not be 

established. All other births were defined as non-ART births.

Gestational age at birth was obtained from the clinical estimate in weeks recorded on the birth certificate record. Births 

were excluded if the gestational age was not deemed realistic or 

not consistent with viability (i.e., <24 weeks [n = 1,329 (0.2%)] 

or >43 weeks [n = 5,229 (0.8%)]). Birthweight was obtained 

from the birth certificate record. Birthweight was missing for 

203 infants (0.03%). Therefore, for the study period, a total 

of 636,349 births (98.8% of all birth certificate records) were 

included in the analysis, 623,434 non-ART (98%) and 12,915 

ART (2%) births. 

LBW percentages were calculated for births overall and by 

ART status and plurality. The population attributable risk percentage (PAR%) for LBW resulting from ART was calculated 

for each 2-year period. The Cochrane-Armitage test for trend 

was used to test for changes over time.

During 1997–2004 in Massachusetts, the percentage 

of births resulting from ART ranged from 1.8% to 2.3% 

(Table 1). During this period, 7.0% of all LBW births were 

attributable to ART (PAR% range: 5.9%–8.1%). From 

1997–1998 to 2003–2004, the percentage of LBW among 

all infants increased from 6.8% to 7.5% (p-value for trend 

<0.0001) (Table 2). The percentage of LBW births increased 

among non-ART births overall (from 6.3% to 7.0%; p-value 

for trend <0.0001) and among non-ART singleton births 

(from 4.8% to 5.1%; p-value for trend <0.0001). Among ART 

singleton births, the percentage of LBW births also increased 

(from 6.4% to 8.2%; p-value for trend = 0.03). After adjusting 

for the change in the distribution of births by plurality from 

1997 to 2004, 407 additional LBW non-ART singleton births 

and 59 additional LBW ART singleton births occurred during 2003–2004 compared with 1997–1998. The percentage 

of LBW births did not increase among twin births or among 

triplet and higher order multiple births.

Reported by: BB Cohen, PhD, Z Zhang, MD, A Nannini, PhD, 

Massachusetts Dept of Public Health. SL Farr, PhD, JE Anderson, PhD, 

DJ Jamieson, MD, M Macaluso, MD, Div of Reproductive Health, 

National Center for Chronic Disease Prevention and Health Promotion; 

NK Tepper, MD, EIS Officer, CDC.

Editorial Note: In 1996, Massachusetts introduced a question on its birth certificate form regarding the use of fertility 
Vol. 58 / No. 3 MMWR 51

assistance; however, this item has only 30% sensitivity for 

ART treatment.¶ Linking birth certificate records with ART 

records provides a more sensitive measure of use of ART 

than birth certificate records alone. Using linked records, the 

analysis in this report determined that, during 1997–2004 in 

Massachusetts, although ART accounted for 2% of all births, 

approximately 7% of LBW births were attributable to ART. 

However, LBW in Massachusetts increased among both ART 

and non-ART singletons, and only a small part of the increase 

in LBW might be explained by ART.

Despite substantial improvements in the United States in 

infant survival and outcomes, a steady increase in the rate of 

LBW has occurred. During 1984–2005, the rate of LBW in 

the United States increased 22%, from 6.7% to 8.2% of all 

births (2). The rate of LBW among all singletons also increased 

7% since 2000, from 6.0% to 6.4% (2). Although the contribution of ART to national rates of LBW is not known, these 

results from one state are important to consider in the context 

of increasing rates of LBW nationwide. 

Certain factors increase the risk for LBW, such as prematurity, congenital abnormalities, maternal hypertension and 

diabetes, maternal smoking and drug use, infections, placental 

abnormalities, socioeconomic factors, and multiple gestations 

(6,7). LBW also has been associated with ART, but a large 

part of the elevated risk for LBW among ART births has been 

attributed to an increased incidence of multiple gestations 

(3). ART also has been associated with LBW among singleton 

births. However, for those births, the etiology is less clear; 

studies have shown potential effects stemming from the treatment itself and from underlying infertility (3). Other factors 

might be contributing to the increase among non-ART births, 

such as an increase in delayed childbearing (7) or iatrogenic 

preterm delivery (8). 

The findings in this report are subject to at least four 

limitations. First, ART births might have been misclassified 

as non-ART births if they were not linked to an ART record. 

However, given the 83% linkage rate of ART records, potential 

underestimation of ART births would not substantially affect 

results. Second, some births might have been misclassified 

as Massachusetts ART births if they were missing residency 

information but involved mothers who underwent ART in 

Massachusetts and delivered in one of three neighboring 

states. Third, the reliability of information from birth records 

is variable. However, birthweight from birth certificate records 

has been shown to have high accuracy when compared with 

medical records (9). Finally, births occurring at <24 weeks’ 

gestation, the conventional limit of infant viability, were not 

included in the analysis. Although these births tend to be LBW, 

they represented only 0.2% of eligible birth records. 

¶ Zhang Z, Schieve L, Macaluso M, Cohen B, Nannini A, Wright V. Evaluation 

of assisted reproductive technology reporting on the Massachusetts birth 

certificates. Presented at the 12th Annual Maternal and Child Health 

Epidemiology Conference, December 6–8, 2006, Atlanta, GA.

TABLE 1. Percentage of all births resulting from assisted reproductive technology (ART) and population attributable risk percentage 

(PAR%) of low birthweight (LBW)* attributable to ART,† by 2-year period — Massachusetts, 1997–2004

Year

1997–1998 1999–2000 2001–2002 2003–2004 Total

Births from ART (%) 1.8 2.3 1.9 2.2 2.0

PAR% LBW attributable to ART 7.1 8.1 5.9 6.9 7.0

* Less than 2,500 g.

† PAR% = [(Incidence LBWTotal - Incidence LBWNon-ART) / Incidence LBWTotal] x 100. For example, during 1997–1998, PAR% = [(6.76 – 6.28) / 6.76] x 100 = 7.10

TABLE 2. Number and percentage of low birthweight (LBW) births,* by 2-year period, plurality, and assisted reproductive technology 

(ART) status — Massachusetts, 1997–2004

Type of birth 

and plurality

Total 

no. of 

births for 

all years

Year

p-value 

for trend†

1997–1998 1999–2000 2001–2002 2003–2004

Total no. 

of births

LBW births Total no. 

of births

LBW births Total no. 

of births

LBW births Total no. 

of births

LBW births

No. (%) No. (%) No. (%) No. (%)

All births 636,349 160,054 10,819 (6.8) 158,554 10,714 (6.8) 160,484 11,497 (7.2) 157,257 11,832 (7.5) <0.0001

Non ART births 623,434 157,142 9,861 (6.3) 154,956 9,630 (6.2) 157,489 10,616 (6.7) 153,847 10,768 (7.0) <0.0001

 Singleton 602,259 152,276 7,343 (4.8) 150,437 7,300 (4.9) 151,514 7,551 (5.0) 148,032 7,615 (5.1) <0.0001

 Twin 20,135 4,610 2,285 (49.6) 4,360 2,189 (50.2) 5,675 2,783 (49.0) 5,490 2,848 (51.9) 0.06

 Triplet and higher 1,040 256 233 (91.0) 159 141 (88.7) 300 282 (94.0) 325 305 (93.9) 0.07

ART births 12,915 2,912 958 (32.9) 3,598 1,084 (30.1) 2,995 881 (29.4) 3,410 1,064 (31.2) 0.17

 Singleton 6,615 1,428 92 (6.4) 1,795 118 (6.6) 1,575 118 (7.5) 1,817 148 (8.2) 0.03

 Twin 5,534 1,211 614 (50.7) 1,613 791 (49.0) 1,268 618 (48.7) 1,442 775 (53.7) 0.10

 Triplet and higher 766 273 252 (92.3) 190 175 (92.1) 152 145 (95.4) 151 141 (93.4) 0.41

* Less than 2,500 g.

† By Cochrane-Armitage test.
52 MMWR January 30, 2009

The excess LBW births in Massachusetts during 1997–2004 

is largely not explained by ART, although ART disproportionately contributed to the overall prevalence of LBW. Future 

LBW research and prevention efforts are needed and should 

include 1) determining the risk factors that contribute to 

increasing rates of LBW among non-ART births, and 2) investigating additional risk factors and etiologies for LBW among 

ART singleton births. Additionally, further reducing rates of 

multiple gestation resulting from ART, as recommended by 

the Society for Assisted Reproductive Technology and the 

American Society for Reproductive Medicine (10), and making 

clinicians more aware of the elevated risk for LBW among ART 

births also might reduce this outcome among ART births.

Acknowledgments

The findings in this report are based, in part, on contributions by 

the Society for Assisted Reproductive Technology.

References

1. Kramer MS, Barros FC, Demissie K, Liu S, Kiely J, Joseph KS. Does 

reducing infant mortality depend on preventing low birthweight? An 

analysis of temporal trends in the Americas. Paediatr Perinat Epidemiol 

2005;19:445–51.

2. Martin JA, Hamilton BE, Sutton PD, et al. Births: final data for 2005. 

Natl Vital Stat Rep 2007;56(6).

3. Schieve LA, Cohen B, Nannini A, et al. A population-based study 

of maternal and perinatal outcomes associated with assisted reproductive technology in Massachusetts. Matern Child Health J 

2007;11:517–25.

4. Schieve LA, Meikle SF, Ferre C, Peterson HB, Jeng G, Wilcox LS. Low 

and very low birth weight in infants conceived with use of assisted 

reproductive technology. N Engl J Med 2002;346:731–7.

5. Sunderam S, Schieve LA, Cohen B, et al. Linking birth and infant 

death records with assisted reproductive technology data: Massachusetts, 

1997–1998. Matern Child Health J 2006;10:115–25.

6. Cunningham FG, Hauth JC, Leveno KJ, Gilstrap L, Bloom SL, 

Wenstrom KD, eds. Williams obstetrics. 22nd ed. New York, NY: 

McGraw-Hill; 2005.

7. Tough SC, Newburn-Cook C, Johnston DW, Svenson LW, Rose S, 

Belik J. Delayed childbearing and its impact on population rate changes 

in lower birth weight, multiple birth, and preterm delivery. Pediatrics 

2002;109:399–403.

8. Yoder BA, Gordon MC, Barth WH Jr. Late-preterm birth: does the 

changing obstetric paradigm alter the epidemiology of respiratory 

complications? Obstet Gynecol 2008;111:814–22.

9. DiGiuseppe DL, Aron DC, Ranbom L, Harper DL, Rosenthal GE. 

Reliability of birth certificate data: a multi-hospital comparison to 

medical records information. Matern Child Health J 2002;6:169–79.

10. Practice Committee of Society for Assisted Reproductive Technology; 

Practice Committee of American Society for Reproductive Medicine. 

Guidelines on number of embryos transferred. Fertil Steril 2008;90(5 

Suppl):S163–4.

Methicillin-Resistant 

Staphylococcus aureus Among 

Players on a High School Football 

Team — New York City, 2007

On September 12, 2007, the New York City Department of 

Health and Mental Hygiene (DOHMH) was notified of three 

players on a Brooklyn high school football team with cultureconfirmed methicillin-resistant Staphylococcus aureus (MRSA) 

skin and soft tissue infections (SSTIs). During August 19–24, 

the team had attended a preseason football training camp, 

where all 59 players on the team lived together in the school 

gymnasium. An investigation by DOHMH revealed four 

culture-confirmed and two suspected cases of MRSA among 

51 players interviewed (11.8% attack rate). Of the six cases, 

three involved abscesses that required incision and drainage. 

The risk for MRSA infection was higher among those who 

shared towels during the training camp than among those who 

did not (relative risk [RR] = 8.2). In addition, the six players 

with MRSA infections had a mean body mass index (BMI) 

that was significantly higher than the mean for those who were 

not infected. Multivariable logistic modeling determined that 

sharing towels during camp (adjusted odds ratio [AOR] = 15.7) 

and higher BMI (AOR = 1.4) were associated independently 

with MRSA infection. Similar outbreaks have been reported 

among football teams in which inadequate hygiene, combined 

with skin injuries and living in close quarters, contributed to 

the spread of MRSA infection. Such outbreaks might be prevented by better educating players and coaches regarding SSTIs 

and by better promoting proper player hygiene, particularly 

during training camps. 

Initial investigation by DOHMH began on September 12. 

Investigators learned that all 59 players had attended a preseason training camp during August 19–24. The players had 

lived together in the school gymnasium, slept on cots in close 

proximity to each other, and showered in the school locker 

room, usually only once at the end of the day. The school had 

supplied antibacterial soap in pump dispensers in the showers; however, several players brought their own soap. Players 

supplied their own towels. Players reported that they usually 

left their towels on their cots or on the floor when not in use. 

The school offered a daily laundry service for uniforms and 

towels during the camp; however, most players did not have 

their towels washed and wore their uniforms two or three times 

between launderings. Players often remained in sweat-soaked 

clothes between the morning and afternoon practices. The 

school did not have whirlpools or hot tubs. 

Investigators hypothesized that sharing facilities and equipment, previous skin injuries, player position, inadequate player 
Vol. 58 / No. 3 MMWR 53

hygiene, and having a higher BMI might be risk factors linked 

to MRSA infections (1–3). To find additional cases, identify 

risk factors for infection, and implement infection control 

measures, DOHMH conducted face-to-face interviews on 

September 14 with 51 of the 59 players, using a close-ended 

questionnaire; the eight remaining players could not be contacted. In addition, a DOHMH physician further examined 

the five players reported by the school nurse as potentially 

infected. 

A confirmed MRSA case was defined as a clinically compatible SSTI with a positive MRSA culture in a team member 

during August 5–September 14, a period ranging from 2 

weeks before to 3 weeks after the end of the training camp. A 

suspected MRSA case was defined as a clinically compatible 

SSTI or systemic infection with no culture confirmation. Date 

of symptom onset was defined as the date an infected player 

reported first noticing an infected wound. 

Among the 51 players interviewed, four confirmed and two 

suspected MRSA cases were identified (11.8% attack rate). 

Molecular typing with pulsed-field gel electrophoresis revealed 

that three of the confirmed cases were USA300, a strain usually 

considered to be a community-associated MRSA. An isolate 

from the fourth player with confirmed MRSA was not available for typing. Symptom onsets ranged from August 24, the 

last day of training camp, to September 6, a total of 13 days 

after the camp (Figure 1). 

In the four confirmed cases, infections initially appeared as 

a blister on the ankle, calf, hip, or instep. One suspected case 

involved impetigo on the upper arm; the other suspected case 

involved impetigo on the arms and eyebrow. Three players 

reported their wounds to the school nurse or a physician only 

after blisters had developed into infections requiring medical 

attention. The six players with confirmed or suspected MRSA 

infections were referred to their personal physicians for treatment. Three of the players had abscesses that required incision and drainage. Three of the players with confirmed cases 

were treated with Bactrim and doxycycline, clindamycin and 

mupirocin, and Bactrim and mupirocin, respectively. One of 

the players with suspected MRSA infection was treated with 

ciprofloxacin. Antibiotics used to treat the remaining two 

players were unknown.

Interviews with the players revealed that 33 (65%) had 

sustained at least one cut, abrasion, or turf burn during the 

preseason camp or regular season. The players reported that, 

unless the skin injuries were severe, they had cleaned, dressed, 

or bandaged them by themselves. No players reported sharing 

towels or soap during the regular season, because players went 

home after practice to shower. However, 10 (20%) had shared 

towels and six (12%) had shared soap during training camp, 

when the players showered on site.

In a retrospective cohort analysis, after combining confirmed 

and suspected MRSA cases, bivariate RRs and their 95% confidence intervals (CIs) were calculated to identify risk factors 

associated with infection. Multivariable logistic regression was 

used to evaluate the independent association of multiple risk factors, including BMI, which was modeled as a continuous variable 

because the small number of cases did not allow for tests based 

on BMI categories (i.e., normal, overweight, and obese). 

Sharing towels during training camp significantly increased 

the risk for MRSA infection (RR = 8.2) (Table). Sharing 

protective pads, sharing soap, showering less than once a day, 

having more than one skin injury, and washing uniforms less 

than once a day were not significant risk factors for infection. Playing at lineman or linebacker and wide receiver or 

FIGURE 1. Number* of culture-confirmed and suspected cases of methicillin-resistant Staphylococcus aureus (MRSA) infection† 

among players on a high school football team, by date of symptom onset — New York City, 2007 

19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14

0

1

2

3

Preseason

training camp

No. of cases

Aug

Day and month

Culture-confirmed

Suspected

Sep

First day

of regular

season

* N = 6.

† A confirmed MRSA case was defined as a clinically compatible skin and soft tissue infection (SSTI) with a positive MRSA culture in a team member during 

August 5–September 14, a period ranging from 2 weeks before to 3 weeks after the end of the training camp. A suspected MRSA case was defined as a 

clinically compatible SSTI or systemic infection with no culture confirmation.
54 MMWR January 30, 2009

cornerback positions (previously shown to be potential risk 

factors in football MRSA outbreaks [2,4]) also were not significant risk factors (Table). 

The six players with MRSA infection had a mean BMI 

of 29.1 (CI = 24.7–33.3), which was significantly higher 

by t-test (t = 2.56; p=0.014) than the mean BMI of 23.8 

(CI = 22.8–25.0) for the 45 players without infection. Using 

CDC’s child and teen BMI-for-age weight status categories,* 

five of the six (83%) players with MRSA infection could be 

classified as overweight or obese, compared with 20 of the 45 

(44%) players without infection (Figure 2). A bivariate analysis 

using logistic regression revealed that higher BMI was associated 

with higher risk for infection (OR = 1.3 per unit increase in 

BMI; CI = 1.1–1.7). A multivariable logistic model confirmed 

that both sharing towels during training camp (AOR = 15.7; 

CI = 1.5–167.4) and BMI (AOR = 1.4; CI = 1.1–1.9) were 

associated independently with MRSA infection.

Reported by: P Kellner, MPH, A Yeung, MPH, HA Cook, MPH, 

J Kornblum, PhD, M Wong, MPH, F Eniola, MPH, D Weiss, MD, 

New York City Dept of Health and Mental Hygiene. HP Nair, PhD, 

EIS Officer, CDC.

Editorial Note: Since 2000, outbreaks of MRSA SSTIs have 

been reported among players on high school, college, and 

professional football teams with attack rates similar to those 

described in this report (1–4). Despite education efforts by 

CDC and state and local health departments, MRSA infections 

continue to be a problem among football players. A 2007 CDC 

survey of high school athletic trainers revealed that 53% had 

treated MRSA infections in football players (1). The results of 

this investigation suggest that sharing of towels among players 

at a preseason training camp was associated with MRSA infection, a risk factor previously linked to football-related MRSA 

outbreaks (1–3). These results are also consistent with three 

previous reports that identified MRSA infections in football 

teams temporally linked to training camps (2–4), which might 

be a setting that increases risk behaviors for infection (4). Living 

in close quarters for an extended period, a potential risk factor 

identified in other settings (5), might have further contributed 

to the outbreak. 

The results also indicated that higher BMI among team 

players was associated with higher risk for MRSA infection, 

independent of sharing towels. These results are consistent 

with those of two other football-related outbreaks (5) and published reports linking higher BMI with a range of infections, 

including skin infections (6). The possibility that higher BMI 

is confounded by player positions (e.g., lineman) involving 

heavier players and more frequent contact is not supported 

by the data, which found no differences by player position. 

Evaluating player position in general is statistically problematic 

because sample sizes vary substantially by position on most 

football rosters. 

The findings in this report are subject to at least two limitations. First, the small number of cases reduced the precision 

of the point estimates, as reflected in the wide CIs. Second, 

because players were not interviewed until 3 weeks after the 

first reported symptom onsets, they might not have been able 

to accurately recall events, leading to misclassification of players by risk factor. 

High school football programs might be able to reduce the 

risk for MRSA outbreaks by improving their procedures and 

facilities to promote optimal player hygiene, particularly during training camps. Improvements might include providing a 

towel service and collecting used towels from players on a daily 

basis. Skin injuries should be monitored closely by coaches *Additional information available at http://www.cdc.gov/nccdphp/dnpa/

healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.htm.

TABLE. Association between exposure to risk factors and culture-confirmed or suspected cases of methicillin-resistant 

Staphylococcus aureus (MRSA) infection* in players on a high school football team — New York City, 2007

Players exposed Players not exposed

Relative 

risk (95% CI† Risk factor Cases Total )

Attack rate 

(%) Cases Total

Attack rate 

(%)

Sharing towels during training camp 4 10 (40) 2 41 (5) 8.2 (1.7–38.6)

Sharing soap during training camp 2 6 (33) 4 45 (9) 3.8 (0.9–16.2)

Sharing protective pads during 

 training camp

0 4 — 6 47 (13) — —

Showering less than once a day during 

 training camp

0 2 — 6 49 (12) — —

Having more than one skin injury during 

 training camp

3 18 (17) 2 26 (8) 2.2 (0.4–11.7)

Washing uniforms less than once a day during

 training camp

5 45 (11) 1 6 (17) 0.7 (0.1–4.8)

Playing at lineman or linebacker 2 17 (12) 4 34 (12) 1.0 (0.2–4.9)

Playing at wide receiver or cornerback 1 23 (4) 5 28 (18) 0.2 (0.03–1.9)

* A confirmed MRSA case was defined as a clinically compatible skin and soft tissue infection (SSTI) with a positive MRSA culture in a team member during August 5–September 14, a period ranging from 2 weeks before to 3 weeks after the end of the training camp. A suspected MRSA case was defined 

as a clinically compatible SSTI or systemic infection with no culture confirmation. 

† Confidence interval.
Vol. 58 / No. 3 MMWR 55

and trainers, rather than by players alone. Living arrangements 

might be modified so that players are not living in close quarters for extended periods. Education on SSTI identification, 

prevention, and intervention might be included as a standard 

component of football training camps.

Acknowledgments

This report is based, in part, on contributions by M Marx, PhD, 

J Nguyen, MPH, M Layton, MD, Bur of Communicable Disease; 

L Thorpe, PhD, K Konty, PhD, Div of Epidemiology; T Matte, MD, 

Div of Environmental Surveillance and Policy, New York City Dept 

of Health and Mental Hygiene. J Magri, MD, Office of Workforce 

and Career Development, CDC.

References 

1. Brinsley-Rainisch K, Goding A, Sinkowitz-Cochran R, Pearson M, 

Hageman J, the National Athletic Trainers’ Association. MRSA infections 

in athletics: perceptions and practices of certified athletic trainers [Poster]. 

Presented at the Society for Healthcare Epidemiology of America 17th 

Annual Meeting, Baltimore MD; April 15, 2007.

2. Begier EM, Frenette K, Barrett NL, et al. A high-morbidity outbreak 

of methicillin-resistant Staphylococcus aureus among players on a college 

football team, facilitated by cosmetic body shaving and turf burns. Clin 

Infect Dis 2004;39:1446–53.

3. Romano R, Lu D, Holtom P, et al. Outbreak of community-acquired 

methicillin-resistant Staphylococcus aureus skin infections among a collegiate football team. J Athl Train 2006;41:141–5.

4. Kazakova SV, Hageman JC, Matava M, et al. A clone of methicillinresistant Staphylococcus aureus among professional football players. N Engl 

J Med 2005;352:468–75.

5. Campbell KM, Vaughn AF, Russell KL, et al. Risk factors for communityassociated methicillin-resistant Staphylococcus aureus infections in an 

outbreak of disease among military trainees in San Diego, California, in 

2002. J Clin Microbiol 2004;42:4050–3.

6. Falagas M, Kompoti M. Obesity and infection. Lancet Infect Dis 

2006;6:438–46.

Children with Elevated Blood 

Lead Levels Related to Home 

Renovation, Repair, and Painting 

Activities — New York State, 

2006–2007

Although blood lead levels (BLLs) >10 μg/dL are associated with adverse behavioral and developmental outcomes, 

and environmental and medical interventions are recommended at >20 μg/dL, no level is considered safe (1,2). A 

1997 analysis conducted by the New York State Department 

of Health (NYSDOH) indicated that home renovation, repair, 

and painting (RRP) activities were important sources of lead 

exposure among children with BLLs >20 μg/dL in New York 

state (excluding New York City) during 1993–1994 (3). 

Subsequently, local health departments in New York state 

began to routinely collect information about RRP activities 

when investigating children’s home environments for lead 

sources. This report updates the 1997 analysis with data from 

environmental investigations conducted during 2006–2007 

in New York state (excluding New York City) for 972 children with BLLs >20 μg/dL. RRP activities were identified 

as the probable source of lead exposure in 139 (14%) of the 

972 children. Resident owners or tenants performed 66% of 

the RRP work, which often included sanding and scraping 

(42%), removal of painted materials or structures (29%), and 

other activities (29%) that can release particles of lead-based 

paint. RRP activities continued to be an important source of 

lead exposure during 2006–2007. Children living in housing 

FIGURE 2. Number of players on a high school football team* 

categorized as overweight/obese or normal, based on body 

mass index (BMI),† by case status regarding methicillin-resistant 

Staphylococcus aureus (MRSA) infection — New York City, 2007

* N = 51.

† Using CDC’s child and teen BMI-for-age weight status categories, persons 

with a BMI equal to or greater than the 85th percentile are categorized 

as overweight or obese. Additional information available at http://www.

cdc.gov/nccdphp/dnpa/healthyweight/assessing/bmi/childrens_bmi/

about_childrens_bmi.htm. § Includes both confirmed and suspected cases of MRSA infection. A confirmed MRSA case was defined as a clinically compatible skin and soft 

tissue infection (SSTI) with a positive MRSA culture in a team member 

during August 5–September 14, a period ranging from 2 weeks before 

to 3 weeks after the end of the training camp. A suspected MRSA case 

was defined as a clinically compatible SSTI or systemic infection with no 

culture confirmation.

16

18

20

22

24

26

28

30

32

34

36

38

§

BMI

Noninfected players

Cases (infected players)

Overweight/Obese Normal

BMI category
56 MMWR January 30, 2009

built before 1978 (when lead-based paint was banned from 

residential use) that are undergoing RRP activities should be 

considered at high risk for elevated BLLs, and appropriate 

precautions should be taken to prevent exposure. 

Since 1993, New York state regulations* have required BLL 

testing for all children at ages 1 and 2 years. In 2007, 83% of 

children were tested at least once before age 3 years, but only 

41% were tested at ages 1 and 2 years (NYSDOH, unpublished 

data, 2008). Regulations also require laboratories to report all 

BLLs to NYSDOH, which then provides results to respective 

local health departments. For all children reported with BLLs 

>20 μg/dL, local health departments are required to conduct 

environmental investigations to determine potential sources 

of exposure and recommend actions to reduce or eliminate 

exposures following CDC guidelines (1,2). Investigations 

include questioning about any activities that might have disturbed lead-based paint, including RRP activities, inspection 

of the home and household items for evidence of cracked or 

peeling paint, and water testing. If available, paint chips are 

tested for lead.

During 2006–2007, local health departments conducted 

environmental investigations for all 972 children reported 

in New York state with BLLs >20 μg/dL. In January 2008, 

NYSDOH abstracted data from local health department 

records to identify investigations in which RRP activities were 

determined to be the most likely source of lead exposure and 

in which no other source of exposure was identified. RRP 

activities were considered the most likely source if an activity 

occurred that might have generated dust or paint chips that 

could have been inhaled or ingested. Lead-based paint that 

was intact and in good condition was not considered a source 

of exposure. For each case, abstracted data included 1) child’s 

age, 2) blood test date, 3) BLL, 4) address and approximate 

age of dwelling, 5) activities that might have disturbed paint, 

and 6) identity of person who performed the RRP work.

The results indicated that, during 2006–2007, the elevated 

BLLs of 139 (14%) of the 972 children with BLLs >20 μg/dL 

were related to RRP activities (Table). Among the 139 children, 

63 (45%) had BLLs of 20–24 μg/dL, 24 (17%) had BLLs of 

25–29 μg/dL, and 52 (38%) had BLLs ≥30 μg/dL. Most of 

the children (71%) were aged 1–2 years, and 25% were aged 

3–5 years. The 139 children resided in 131 homes; eight homes 

had two children per home, and all other homes had only one 

child. All but one of the homes were built before 1978. Of 131 

homes in which environmental investigations were conducted, 

56 (43%) were identified as urban, 36 (28%) as suburban, and 

39 (30%) as rural. 

Reported by: EM Franko, DrPH, JM Palome, New York State Dept 

of Health. MJ Brown, ScD, CM Kennedy, DrPH, Lead Poisoning 

Prevention Br, Div of Environmental Hazards and Health Effects, 

National Center for Environmental Health; LV Moore, PhD, EIS 

Officer, CDC.

Editorial Note: In the United States, median BLLs in children aged <5 years have declined 89% from 1976–1980 to 

2003–2004 (4). This decline is largely a result of the phaseout of leaded gasoline and efforts by federal, state, and local 

agencies to limit lead paint hazards in housing. The latter has 

resulted in a decline in housing units with lead paint hazards 

from 64 million to 38 million during 1990–2000 (4). The 

decline in the prevalence of elevated BLLs over time has been 

most pronounced among children belonging to high-risk 

groups, especially non-Hispanic black children (5). However, 

an estimated 250,000 children remain at risk for exposure to 

TABLE. Number and percentage of children with elevated bloodlead levels (BLL >20 μg/dL) related to home renovation, repair, 

and painting (RRP) activities, by selected characteristics — New 

York (excluding New York City), 1993–1994 and 2006–2007

1993–1994 2006–2007

Characteristic No. (%) No. (%)

No. of children with BLL

 related to RRP activities 320 (6.9)* 139 (14.3)*

BLL (μg/dL)

20–24 117 (36.6) 63 (45.3)

25–29 76 (23.8) 24 (17.3)

30–39 87 (27.2) 30 (21.6)

>40 40 (12.5) 22 (15.8)

Age (yrs)

<1 29 (9.1) 4 (2.9)

1–2 163 (50.9) 98 (70.5)

3–5 88 (27.5) 35 (25.2)

>6 9 (2.8) 2 (1.4)

Unknown 31 (9.7) 0 —

Area of home

Suburban 120 (37.5) 36† (27.5)

Rural 101 (31.6) 39† (29.8)

Urban 60 (18.8) 56† (42.8)

Unknown 39 (12.2) 0† —

Types of RRP activity

Scraping and/or sanding 155 (48.4) 58 (41.7)

Painted component removal 41 (12.8) 40 (28.8)

Chemical stripping 32 (10.0) 0 —

Hand-held heat guns/torches 17 (5.3) 1 (0.7)

Exterior blasting 5 (1.6) 0 —

Multiple activities 47 (14.7) 21 (15.1)

Unknown 23 (7.2) 19 (13.7)

Work performed by

Resident owner/tenant 187 (58.4) 92 (66.2)

Contractor 42 (13.1) 9 (6.5)

Other 73 (22.8) 17 (12.2)

Multiple persons 0 — 3 (2.2)

Unknown 18 (5.6) 18 (13.0)

* Of a total of 4,608 environmental investigations conducted during 1993–

1994 and 972 conducted during 2006–2007. 

† RRP activities occurred at 131 homes and involved 139 children who had 

BLLs >20 μg/dL.

*Title 10 NYCRR Part 67, available at http://www.health.state.ny.us/

environmental/lead/laws_and_regulations/chapter_2_subpart_67.htm. 
Vol. 58 / No. 3 MMWR 57

harmful lead levels in the United States (4). Children living in 

housing undergoing RRP and built before 1978, when leadbased paint was banned from residential use, and particularly 

those built before 1950, when concentrations of lead in paint 

were higher (6), are now at high risk for elevated BLLs. This 

is of particular concern in New York state, where both the 

number (3,309,770) and proportion (43%) of housing units 

built before 1950 are greater than in any other state (7).

The assessment described in this report showed that RRP 

activities were an important source of lead exposure among 

children with BLLs >20 μg/dL during 2006–2007 in New York 

state. Of 972 children investigated for BLLs >20 μg/dL during 

2006–2007, 139 (14%) were traceable to RRP. Among the 131 

homes linked to RRP-related lead exposures, all but one were 

built before 1978. Young children in homes built before 1978 

are known to be a high-risk group for lead exposure (5), and 

these findings indicate RRP activities are an important source 

of lead exposure in this group.

 NYSDOH used methods identical to ones used for this 

analysis to assess the role of RRP in elevated BLLs during 

1993–1994, except that the majority of 2006–2007 records 

were electronic. During 1993–1994, the total number of 

children reported with BLLs >20 μg/dL related to RRP was 

320, and these children made up 7% of all children detected 

with BLLs >20 μg/dL, compared with 139 children and 14% 

of such cases during 2006–2007. Thus, although the absolute 

number of RRP-related cases dropped substantially between 

the two periods, the relative burden of these cases on the state’s 

lead screening and treatment efforts increased. 

The increase in the relative burden of RRP-related cases 

might signal a shift in populations at risk for lead exposure in 

New York state. Additional analyses and follow-up studies are 

needed to better characterize this possible shift. 

The findings in this study are subject to at least two limitations. First, any incomplete reporting of children with BLLs 

>20 μg/dL by laboratories might result in an underestimation 

of the number of children exposed to lead. Second, RRP activities also might be an important lead exposure source among 

children with lower BLLs (<20 μg/dL) who were not included 

in this study. Although not required by regulation, several 

local health departments conducted environmental investigations for children with BLLs <20 μg/dL during 2006–2007. 

Children identified with BLLs <20 μg/dL were similar in 

characteristics to those in this analyses, and RRP activities were 

the most probable source of lead exposure for 71 (40%) of 178 

children (NYSDOH, unpublished data, 2008). 

Contractors performed a small percentage (6.5%) of RRP 

work related to elevated BLLs in New York state during 

2006–2007. Resident owners or tenants performed 66% of this 

work. To help prevent lead contamination when contractors 

perform RRP projects, the U.S. Environmental Protection 

Agency issued regulations in March 2008 that will require all 

renovators in the United States that work on certain types of 

housing or child-occupied facilities to be certified and follow 

specific work practices as of April 2010 (8). To address the 

risk from RRP by owners and do-it-yourselfers, more public 

outreach and education is needed to raise awareness of potential lead-exposure hazards from RRP and to ensure protective 

measures that safely contain dust and paint chips. In New York, 

state and local health departments have implemented education programs on RRP activities and lead-safe work practices 

for contractors and do-it-yourselfers.†

Persons who remove lead-based paint should follow recommendations of the U.S. Department of Housing and 

Urban Development and the U.S. Environmental Protection 

Agency to protect children from lead exposure (9,10). These 

recommendations include 1) relocate occupants during paint 

removal, and exclude children and pregnant women from the 

work area; 2) isolate work areas from other areas of the house; 

3) avoid practices that create lead dust or fumes; 4) perform a 

full cleanup after work is completed; and 5) consider monitoring BLLs in persons who live or work in the dwelling. 

References

1. CDC. Preventing lead poisoning in young children: a statement by the Centers 

for Disease Control and Prevention. Atlanta, GA: CDC; 2005. Available at 

http://www.cdc.gov/nceh/lead/publications/prevleadpoisoning.pdf. 

2. CDC. Managing elevated blood lead levels among young children: 

recommendations from the Advisory Committee on Childhood Lead 

Poisoning Prevention. Atlanta, GA: CDC; 2002. Available at http://

www.cdc.gov/nceh/lead/casemanagement/casemanage_main.htm.

3. CDC. Children with elevated blood lead levels attributed to home 

renovation and remodeling activities—New York, 1993–1994. MMWR 

1997;45:1120–3.

4. US Environmental Protection Agency. America’s children and the environment. Measure B1: lead in the blood of children. Washington, DC: 

US Environmental Protection Agency; 2008. Available at http://www.

epa.gov/envirohealth/children/body_burdens/b1-graph.htm. 

5. Jones R, Homa D, Meyer P, et al. Trends in blood lead levels and 

blood lead testing among U.S. children aged 1 to 5 years: 1998–2004. 

Pediatrics. In press 2009.

6. US Department of Housing and Urban Development. Putting the pieces 

together: controlling lead hazards in the nation’s housing. Lead-Based 

Paint Hazard Reduction and Financing Task Force. Washington, DC: 

US Department of Housing and Urban Development; 1995. 

7. US Census Bureau. Census 2000 summary file 3 (SF 3), table H34 year 

structure built, all states. Washington, DC: US Census Bureau; 2000. 

Available at http://factfinder.census.gov. 

8. US Environmental Protection Agency. 40 CFR part 745. Lead; renovation, 

repair, and painting program; lead hazard information pamphlet; notice 

of availability; final rule. Federal Register 2008;73(78). Available at http://

www.epa.gov/fedrgstr/EPA-TOX/2008/April/Day-22/t8141.pdf. 

† Available at http://www.health.state.ny.us/environmental/lead. 
58 MMWR January 30, 2009

9. US Department of Housing and Urban Development. Guidelines 

for the evaluation and control of lead-based paint hazards in housing. Washington, DC: US Department of Housing and Urban 

Development; 1995. Available at http://www.hud.gov/offices/lead/lbp/

hudguidelines.

10. US Environmental Protection Agency. Reducing lead hazards when 

remodeling your home. Washington, DC: US Environmental Protection 

Agency; 1997.

Invasive Haemophilus influenzae

Type B Disease 

in Five Young Children — 

Minnesota, 2008

On January 23, this report was posted as an MMWR 

Early Release on the MMWR website (http://www.cdc.gov/

mmwr).

In 2008, five children aged <5 years were reported to the 

Minnesota Department of Health (MDH) with invasive 

Haemophilus influenzae type b (Hib) disease; one died. Only 

one of the children had completed the primary Hib immunization series; three had received no doses of Hib-containing 

vaccine (1). The five Hib cases are the largest number among 

children aged <5 years reported from Minnesota since 1992. 

The cases occurred during a Hib vaccine recall and continuing 

nationwide shortage that began in December 2007. The recall 

of certain lots of the two Hib-containing vaccines manufactured by Merck & Co., Inc. (West Point, Pennsylvania) and 

cessation of production of both vaccines left only one manufacturer of Hib vaccine in the United States (Sanofi Pasteur, 

Swiftwater, Pennsylvania) (2,3). In response, CDC recommended that health-care providers defer the routine 12–15 

month booster dose for children not at increased risk for Hib 

disease (2,3). CDC also emphasized that all children should 

complete the primary series with available Hib-containing 

vaccines. However, Minnesota vaccination data indicate that 

primary Hib series coverage was lower during 2008 than coverage with other vaccines administered at the same ages and 

lower than Hib coverage in previous years. Increases in Hib 

cases like the one in Minnesota do not appear to have occurred 

in other states. The increase highlights the need to ensure that 

all children complete the primary Hib immunization series. 

Additional investigation to better elucidate the factors that led 

to these cases is being conducted by MDH and CDC.

Minnesota conducts surveillance for invasive H. influenzae 

disease as part of the Active Bacterial Core surveillance system 

of CDC’s Emerging Infections Program (4). A Hib case is 

defined as isolation of H. influenzae from a normally sterile site 

in a resident of the state. Merck products are both Hib PRPOMP* vaccines, for which a primary series consists of 2 doses 

at 2 and 4 months. Sanofi Pasteur products are Hib PRP-TT†

vaccines, for which a primary series consists of a 3-dose primary 

series at 2, 4, and 6 months. For both Hib vaccine series, a 

routine booster is recommended at age 12–15 months

During 2008 in Minnesota, five children aged 5 months to 3 

years were reported with invasive Hib disease; one died (Table). 

The patients resided in five different counties in Minnesota and 

had no known relationship to each other. Three patients had 

received no vaccinations because of parent or guardian deferral 

or refusal. One child was aged 5 months and had received 2 

doses of Hib PRP-TT vaccine in accordance with the primary 

series schedule. Another child had received 2 doses of Hib 

PRP-OMP vaccine, but no booster dose, per CDC recommendations during the shortage. Subsequent to Hib infection, 

this child was diagnosed with hypogammaglobulinemia. None 

of the five were enrolled in group child care. The five cases in 

2008 were the most reported for 1 year from Minnesota since 

1992, when 10 cases were reported (Figure 1).

Although the recall and cessation of production of Merck 

Hib-containing vaccines in December 2007 resulted in a 

nationwide Hib vaccine shortage, supply of the remaining two 

products manufactured by Sanofi Pasteur is adequate for all 

infants to complete the 3-dose primary vaccine series. However, 

in February 2008 the Minnesota Vaccines for Children program began receiving reports from vaccine providers regarding shortages of vaccine in their offices. In response, MDH 

advised providers to ensure completion of the primary series 

as recommended whenever possible and to track and recall 

infants who had not completed the primary series so that they 

could be vaccinated as soon as doses were available. On January 

13, MDH examined 2008 vaccination coverage data in the 

Minnesota Immunization Information Connection (MIIC), 

Minnesota’s immunization registry. Data were reviewed for 

25,699 children born between November 1, 2007 and March 

31, 2008 (Figure 2). Among children aged 7 months, 3-dose 

primary Hib series coverage was 46.5%, which is lower than 

the age-appropriate coverage for children who had received 

pneumococcal conjugate or diphtheria and tetanus toxoids and 

acellular pertussis (DTaP) vaccination. In contrast, data from 

the 2007 National Immunization Survey, conducted prior to 

the shortage, showed that Hib vaccination coverage among 

children in Minnesota aged 19 months to 35 months was high 

and did not differ from the national average, suggesting that 

coverage has declined as a result of the shortage.

*Capsular polysaccharide polyribosomal phosphate (PRP)–outer membrane 

protein (OMP).

† PRP-tetanus toxoid.
Vol. 58 / No. 3 MMWR 59

Reported by: J Rainbow, MPH, R Danila, PhD, L Bahta, K White, 

MPH, K Ehresmann, MPH, R Lynfield, MD, Minnesota Dept of Health. 

F Coronado, MD, A Cohn, MD, T Clark, MD, N Messonnier, MD, Div 

of Bacterial Diseases, J Santoli, MD, L Rodewald, MD, Immunization 

Svcs Div, National Center for Immunization and Respiratory Diseases; 

M Jackson, PhD, S Lowther, PhD, EIS officers, CDC.

Editorial Note: Before development of Hib conjugate vaccines, Hib was the most common cause of bacterial meningitis 

in children aged <5 years. Since implementation of the Hib 

conjugate vaccine immunization program in the United States 

in the early 1990s, the incidence of Hib disease has declined 

from a peak of 41 cases per 100,000 children aged <5 years in 

1987 to approximately 0.11 cases per 100,000 in 2007 (3,5). 

As with other bacterial diseases in which acquisition of carriage 

is necessary for development of invasive disease, reductions 

in asymptomatic carriage and transmission are substantial 

contributors to the reduction in Hib disease achieved through 

vaccination programs (6–8). This herd immunity provided by 

high vaccination coverage provides additional protection both 

for fully vaccinated and undervaccinated persons (6–8).

Three of the five Hib cases in Minnesota occurred in children 

who had not been vaccinated. One case occurred in a child 

who was too young to complete the primary series, and a fifth 

case occurred in a child with an immunodeficiency. Given the 

prolonged booster dose deferral and reduced primary series 

coverage in the state, the increase in the number of Hib cases 

likely reflects increasing carriage and transmission affecting 

those with suboptimal primary series vaccination coverage, or 

a weakening of herd immunity. None of the children failed 

to receive vaccine because of the vaccine shortage. However, 

MDH is planning evaluations to describe the extent of Hib 

carriage in the affected communities and understand reasons 

why some children are not vaccinated. While the shortage 

continues, completion of the primary series in all children 

is essential to safeguard individual protection as well as to 

strengthen herd immunity.

The current Hib vaccine supply in the United States is sufficient to ensure completion of the primary series for all children, but not yet to resume the booster dose. However, vaccine 

TABLE. Characteristics of five reported cases of invasive Haemophilus influenzae type b (Hib) disease* in persons aged <5 years 

— Minnesota, 2008

Patient

Month of 

illness onset

Patient age 

at illness onset Clinical syndrome† Outcome Hib vaccination status

1 January 15 mos Meningitis Survived 2 doses at 2 and 5 months (PRP-OMP)§

2 February 3 yrs Pneumonia Survived 0 doses

3 November 7 mos Meningitis Died 0 doses

4 November 5 mos Meningitis Survived 2 doses at 2 and 4 months (PRP-TT)¶

5 December 20 mos Epiglottitis Survived 0 doses

* Defined as isolation of H. influenzae from a normally sterile site in a Minnesota resident.

† One patient had meningitis with subdural abscess.

§ Hib vaccine, capsular polysaccharide polyribosomal phosphate (PRP)–outer membrane protein (OMP), 2-dose primary series.

¶ Hib vaccine, PRP-tetanus toxoid, 3-dose primary series.

FIGURE 1. Number of reported cases of invasive Haemophilus 

influenzae type b (Hib) disease in persons aged <5 years — 

Minnesota, 1992–2008

0

2

4

6

8

10

12

1992 1994 1996 1998 2000 2002 2004 2006 2008

Year

No. of cases

0

20

40

60

80

100

Hib DTaP PCV

Vaccine type

Percentage

Dose 1

Dose 2

Dose 3

FIGURE 2. Percentage of infants* who, by age 7 months, had 

received 1, 2, and 3 doses of Haemophilus influenzae type b 

(Hib) conjugate vaccine, diphtheria and tetanus toxoids and 

acellular pertussis (DTaP) vaccine, and pneumococcal conjugate vaccine (PCV) — Minnesota Immunization Information 

Connection, 2008

* Born during November 1, 2007–March 31, 2008; N = 25,699.
60 MMWR January 30, 2009

shortages are difficult to manage. Health-care providers must 

maintain sufficient stocks on hand for every child brought for 

vaccination each day. During shortages, local supply/demand 

mismatches can occur, resulting in missed doses (9,10). Hib 

vaccine supply problems can be further complicated because 

the primary series for the recalled products consists of 2 doses, 

but the primary series for the available products consists of 3 

doses. Regardless of brand or product used, full vaccination 

with the primary series of Hib vaccine by age 7 months is 

critical to protect children from disease. Providers who have 

questions regarding Hib vaccine supply needed to complete 

the primary vaccine series should contact their state health 

departments. Combination products may be used for any or 

all doses of the Hib primary series. Further, if combination 

vaccines are the only vaccines available to providers, a combination product should be used to complete the primary Hib 

series, even when this results in receipt of additional doses of 

another antigen. In response to the findings described in this 

report, MDH is working with vaccination providers and other 

partners to resolve any local supply problems. As the vaccine 

supply resolves, MDH will expedite resumption of the booster 

dose in communities where Hib cases have been reported.

Invasive Hib disease in children aged <5 years is a nationally 

notifiable condition. Health-care providers should promptly 

report all suspected cases of Hib to their local health department. CDC routinely analyzes national surveillance data for 

invasive Hib disease in children aged <5 years. As of January 

13, 2009, no other increases in Hib cases in children aged <5 

years had been reported from other states or territories. CDC 

is working with health departments to identify areas of suboptimal primary Hib series coverage that might lead to increased 

transmission and disease. Prompt recognition and reporting 

of Hib cases is important both in understanding the impact 

of the Hib vaccine shortage and in guiding recommendations 

for resuming routine booster vaccination and catch-up of 

undervaccinated children.

Acknowledgments

This report is based, in part, on contributions by S Jawahir, 

S Ersted, L Triden, J Harper, MS, K Como-Sabetti, MPH, Minnesota 

Dept of Health.

References

1. CDC. Haemophilus b conjugate vaccines for prevention of Haemophilus 

influenzae type b disease among infants and children two months of age and 

older: recommendations of the ACIP. MMWR 1991;40(No. RR-1).

2. CDC. Interim recommendations for the use of Haemophilus influenzae type b (Hib) conjugate vaccines related to the recall of certain 

lots of Hib-containing vaccines (PedvaxHIB and Comvax). MMWR 

2007;56:1318–20.

3. CDC. Continued shortage of Haemophilus influenzae type b (Hib) conjugate vaccines and potential implications for Hib surveillance—United 

States, 2008. MMWR 2008;57:1252–5.

4. Schuchat A, Hilger T, Zell E, et al. Active bacterial core surveillance of the emerging infections program network. Emerg Infect Dis 

2001;7:92–9.

5. CDC. Progress toward elimination of Haemophilus influenzae type b disease among infants and children—United States, 1987–1993. MMWR 

1994;43:144–8.

6. Whitney CG, Farley MM, Hadler J, et al. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate 

vaccine. N Engl J Med 2003;348:1737–46.

7. Gray SJ, Trotter CL, Ramsay ME, et al. Epidemiology of meningococcal 

disease in England and Wales 1993/94 to 2003/04: contribution and 

experiences of the Meningococcal Reference Unit. J Med Microbiol 

2006;55:887–96.

8. Oh SY, Griffiths D, John T, et al. School-aged children: a reservoir for 

continued circulation of Haemophilus influenzae type b in the United 

Kingdom. J Infect Dis 2008;197:1275–81.

9. Freed GL, Davis MM, Clark SJ. Variation in public and private supply of pneumococcal conjugate vaccine during a shortage. JAMA 

2003;289:575–8.

10. Stokley S, Santoli JM, Willis B, Kelley V, Vargas-Rosales A, Rodewald LE. 

Impact of vaccine shortages on immunization programs and providers. 

Am J Prev Med 2004;26:15–21.

Notice to Readers

American Heart Month — February 2009

As part of American Heart Month, February 6 is National 

Wear Red Day, a day when persons across the United States 

wear red to show their support for women’s heart disease awareness. Heart disease is the leading cause of death in the United 

States for both men and women, with women accounting for 

nearly half of those deaths (1). 

In 2006, 7.9 million persons in the United States reported 

ever having a heart attack (1). The major signs of a heart attack 

are chest pain or discomfort; pain in the arm or shoulder; pain 

in the jaw, neck or back; shortness of breath; and feeling weak, 

light-headed, or faint. Although the most commonly experienced symptom of a heart attack for both men and women is 

chest pain or discomfort, women are more likely than men to 

experience other symptoms, such as shortness of breath, pain 

in the back or jaw, or nausea (2). Women also are more likely 

than men to delay seeking emergency treatment for a heart 

attack. Receiving immediate treatment substantially increases 

the chance of surviving a heart attack (2).

Additional information on women and heart disease prevention is available at http://www.cdc.gov/women/heart. 

Information on National Wear Red Day activities is available at 

http://www.nhlbi.nih.gov/health/hearttruth/wrd/index.htm. 

Information on CDC’s heart disease programs is available at 

http://www.cdc.gov/dhdsp.
Vol. 58 / No. 3 MMWR 61

References

1. American Heart Association. Heart disease and stroke statistics—2009 

update. Dallas, TX: American Heart Association; 2009. Available at http://

circ.ahajournals.org/cgi/reprint/117/4/e25. 

2. National Institutes of Health; National Heart, Lung, and Blood Institute. 

Women and heart attack. Available at http://www.nhlbi.nih.gov/actin-

time/haws/women.htm.

Erratum: Vol. 57, No. 53

In the report, “Racial/Ethnic Differences in the Birth 

Prevalence of Spina Bifida — United States, 1995–2005,” an 

error occurred in the second sentence of the Editorial Note. 

The sentence should have read: “The previous study revealed 

that from October 1995–December 1996 (before the folic acid 

fortification mandate) to October 1998–December 1999 (after 

the January 1998 mandate deadline), the prevalence of spina 

bifida decreased from 2.62 to 2.02 per 10,000 live births, a 

decrease of 22.9% (3).”
62 MMWR January 30, 2009

QuickStats

from the national center for health statistics

Percentage of Adults Aged >18 Years Who Had Ever Been Tested for Human 

Immunodeficiency Virus (HIV),* by Age Group and Sex — National Health 

Interview Survey, United States, 2007†

* Based on responses to the following question: “Except for tests you may have 

had as part of blood donations, have you ever been tested for HIV?” Persons 

who refused to respond or who answered “Don’t know” (approximately 5% of 

respondents combined) were not included.

† Estimates are based on household interviews of a sample of the civilian, 

noninstitutionalized U.S. population. 

§ 95% confidence interval.

In 2007, overall, 36.6% of adults aged >18 years reported ever being tested for HIV. For both men and women, the 

percentage of persons who ever had an HIV test was highest among adults aged 25–34 years and 35–44 years and 

lowest among adults aged >65 years. The percentages who had ever had an HIV test were higher for women than men 

in age groups 35–44 years and below, not significantly different for men and women at ages 45–64 years, and higher 

for men than women at ages >65 years.

SOURCE: Heyman KM, Schiller JS, Barnes P. Early release of selected estimates based on data from the 2007 National 

Health Interview Survey. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health 

Statistics; 2008. Available at http://www.cdc.gov/nchs/about/major/nhis/released200806.htm.

0

20

30

40

50

60

70

>18 18–24 25–34 35–44 45–64 >65

Age group (yrs)

Percentage

Male

Female

§

10

Overall
Vol. 58 / No. 3 MMWR 63

TABLE I. Provisional cases of infrequently reported notifiable diseases (<1,000 cases reported during the preceding year) — United States, 

week ending January 24, 2009 (3rd week)*

Disease

Current 

week

Cum 

2009

5-year 

weekly 

average†

Total cases reported 

for previous years States reporting cases

2008 2007 2006 2005 2004 during current week (No.)

Anthrax — — — — 1 1 — —

Botulism:

foodborne — — 0 14 32 20 19 16

infant — — 1 99 85 97 85 87

other (wound and unspecified) — 2 0 21 27 48 31 30

Brucellosis — 1 1 80 131 121 120 114

Chancroid — — 0 28 23 33 17 30

Cholera — — 0 2 7 9 8 6

Cyclosporiasis§ 2 3 2 130 93 137 543 160 FL (2)

Diphtheria — — — — — — — —

Domestic arboviral diseases§,¶:

California serogroup — — — 40 55 67 80 112

eastern equine — — — 3 4 8 21 6

Powassan — — — 1 7 1 1 1

St. Louis — — 0 10 9 10 13 12

western equine — — — — — — — —

Ehrlichiosis/Anaplasmosis§,**:

Ehrlichia chaffeensis 1 6 2 863 828 578 506 338 TN (1)

Ehrlichia ewingii — — — 9 — — — —

Anaplasma phagocytophilum — — 1 546 834 646 786 537

undetermined — — 0 71 337 231 112 59

Haemophilus influenzae,††

invasive disease (age <5 yrs):

serotype b — 1 0 28 22 29 9 19

nonserotype b 2 6 3 175 199 175 135 135 MN (1), OK (1)

unknown serotype 4 16 4 188 180 179 217 177 NY (1), GA (1), FL (1), AZ (1)

Hansen disease§ 1 1 1 72 101 66 87 105 CA (1)

Hantavirus pulmonary syndrome§ — — 0 16 32 40 26 24

Hemolytic uremic syndrome, postdiarrheal§ — 4 1 243 292 288 221 200

Hepatitis C viral, acute 6 26 13 847 845 766 652 720 VT (1), NY (1), MI (1), WI (1), WA (1), CA (1)

HIV infection, pediatric (age <13 years)§§ — — 3 — — — 380 436

Influenza-associated pediatric mortality§,¶¶ — 2 1 90 77 43 45 —

Listeriosis 5 21 11 687 808 884 896 753 VT (1), PA (1), OH (2), CO (1)

Measles*** — 1 0 134 43 55 66 37

Meningococcal disease, invasive†††:

A, C, Y, and W-135 — 2 5 306 325 318 297 —

serogroup B 1 1 3 161 167 193 156 — MN (1)

other serogroup — — 1 31 35 32 27 —

unknown serogroup 5 22 17 595 550 651 765 — PA (1), OH (3), WA (1)

Mumps 3 12 9 400 800 6,584 314 258 NE (1), MD (1), NC (1)

Novel influenza A virus infections — — — 2 4 N N N

Plague — — 0 1 7 17 8 3

Poliomyelitis, paralytic — — — — — — 1 —

Polio virus infection, nonparalytic§ — — — — — N N N

Psittacosis§ — — 0 10 12 21 16 12

Q fever total §,§§§: — 1 1 94 171 169 136 70

acute — 1 0 82 — — — —

chronic — — — 12 — — — —

Rabies, human — — 0 1 1 3 2 7

Rubella¶¶¶ — 1 0 17 12 11 11 10

Rubella, congenital syndrome — — — — — 1 1 —

SARS-CoV§,**** — — — — — — — —

Smallpox§ — — — — — — — —

Streptococcal toxic-shock syndrome§ — 1 3 133 132 125 129 132

Syphilis, congenital (age <1 yr) — — 7 244 430 349 329 353

Tetanus — 1 0 16 28 41 27 34

Toxic-shock syndrome (staphylococcal)§ 1 4 1 70 92 101 90 95 CO (1)

Trichinellosis 1 1 0 37 5 15 16 5 CO (1)

Tularemia — 1 0 110 137 95 154 134

Typhoid fever — 12 6 401 434 353 324 322

Vancomycin-intermediate Staphylococcus aureus§ 1 3 0 36 37 6 2 — OH (1)

Vancomycin-resistant Staphylococcus aureus§ — — — — 2 1 3 1

Vibriosis (noncholera Vibrio species infections)§ 1 11 1 452 549 N N N FL (1)

Yellow fever — — — — — — — —

See Table I footnotes on next page.
64 MMWR January 30, 2009

TABLE I. (Continued) Provisional cases of infrequently reported notifiable diseases (<1,000 cases reported during the preceding year) — 

United States, week ending January 24, 2009 (3rd week)*

—: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. 

* Incidence data for reporting year 2008 and 2009 are provisional, whereas data for 2004, 2005, 2006, and 2007 are finalized.

† Calculated by summing the incidence counts for the current week, the 2 weeks preceding the current week, and the 2 weeks following the current week, for a total of 

5 preceding years. Additional information is available at http://www.cdc.gov/epo/dphsi/phs/files/5yearweeklyaverage.pdf. § Not notifiable in all states. Data from states where the condition is not notifiable are excluded from this table, except starting in 2007 for the domestic arboviral diseases and 

influenza-associated pediatric mortality, and in 2003 for SARS-CoV. Reporting exceptions are available at http://www.cdc.gov/epo/dphsi/phs/infdis.htm. ¶ Includes both neuroinvasive and nonneuroinvasive. Updated weekly from reports to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, VectorBorne, and Enteric Diseases (ArboNET Surveillance). Data for West Nile virus are available in Table II.

** The names of the reporting categories changed in 2008 as a result of revisions to the case definitions. Cases reported prior to 2008 were reported in the categories: Ehrlichiosis, 

human monocytic (analogous to E. chaffeensis); Ehrlichiosis, human granulocytic (analogous to Anaplasma phagocytophilum), and Ehrlichiosis, unspecified, or other agent 

(which included cases unable to be clearly placed in other categories, as well as possible cases of E. ewingii). †† Data for H. influenzae (all ages, all serotypes) are available in Table II.

§§ Updated monthly from reports to the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Implementation of HIV reporting 

influences the number of cases reported. Updates of pediatric HIV data have been temporarily suspended until upgrading of the national HIV/AIDS surveillance data 

management system is completed. Data for HIV/AIDS, when available, are displayed in Table IV, which appears quarterly. ¶¶ Updated weekly from reports to the Influenza Division, National Center for Immunization and Respiratory Diseases. Two influenza-associated pediatric deaths occurring during 

the 2008-09 influenza season have been reported.

*** No measles cases were reported for the current week. ††† Data for meningococcal disease (all serogroups) are available in Table II.

§§§ In 2008, Q fever acute and chronic reporting categories were recognized as a result of revisions to the Q fever case definition. Prior to that time, case counts were not 

differentiated with respect to acute and chronic Q fever cases. ¶¶¶ No rubella cases were reported for the current week.

**** Updated weekly from reports to the Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases. 

* Ratio of current 4-week total to mean of 15 4-week totals (from previous, comparable, and subsequent 4-week periods 

for the past 5 years). The point where the hatched area begins is based on the mean and two standard deviations of 

these 4-week totals.

Figure I. Selected notifiable disease reports, United States, comparison of provisional 

4-week totals January 24, 2009, with historical data

Notifiable Disease Data Team and 122 Cities Mortality Data Team

Patsy A. Hall

Deborah A. Adams Rosaline Dhara

Willie J. Anderson Michael S. Wodajo

Lenee Blanton Pearl C. Sharp

Ratio (Log scale)*

DISEASE

0.25 0.5 1 2 4

Beyond historical limits

DECREASE INCREASE

CASES CURRENT

4 WEEKS

425

52

102

42

78

1

26

12

415

Hepatitis A, acute

Hepatitis B, acute

Hepatitis C, acute

Legionellosis

Measles

Mumps

Pertussis

Giardiasis

Meningococcal disease
Vol. 58 / No. 3 MMWR 65

TABLE II. Provisional cases of selected notifiable diseases, United States, weeks ending January 24, 2009, and January 19, 2008

(3rd week)*

Reporting area

Chlamydia† Coccidiodomycosis Cryptosporidiosis

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

2008

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

2008

Current 

week

Previous 

52 week Cum 

2009

Cum 

Med Max Med Max Med Max 2008

United States 9,437 21,611 25,238 37,778 54,771 93 122 322 354 585 40 103 433 112 203

New England 354 707 1,053 1,322 1,613 — 0 1 — — — 5 20 3 46

Connecticut — 210 473 — 186 N 0 0 N N — 0 2 2 38

Maine§ 51 51 72 175 146 N 0 0 N N — 0 6 1 —

Massachusetts 204 327 623 818 1,027 N 0 0 N N — 1 9 — 5

New Hampshire 19 41 64 81 115 — 0 1 — — — 1 4 — 3

Rhode Island§ 59 55 208 176 130 — 0 0 — — — 0 3 — —

Vermont§ 21 16 52 72 9 N 0 0 N N — 1 7 — —

Mid. Atlantic 1,877 2,760 5,091 6,261 5,992 — 0 0 — — 5 12 34 18 24

New Jersey — 430 576 269 1,230 N 0 0 N N — 0 2 — 2

New York (Upstate) 426 532 1,857 851 384 N 0 0 N N 4 4 17 8 1

New York City 1,100 1,047 3,412 3,584 2,094 N 0 0 N N — 2 6 3 7

Pennsylvania 351 803 1,078 1,557 2,284 N 0 0 N N 1 5 15 7 14

E.N. Central 1,165 3,502 4,285 4,081 10,546 — 1 3 1 3 6 25 126 20 43

Illinois 85 1,071 1,407 642 3,306 N 0 0 N N — 2 13 — 5

Indiana 235 377 713 836 1,071 N 0 0 N N 1 3 12 1 1

Michigan 649 826 1,226 2,221 2,472 — 0 3 — 2 — 5 13 1 14

Ohio — 796 1,261 — 2,487 — 0 2 1 1 5 6 59 14 15

Wisconsin 196 315 615 382 1,210 N 0 0 N N — 9 46 4 8

W.N. Central 400 1,269 1,696 2,275 3,306 — 0 2 — — 3 16 68 9 13

Iowa — 174 239 346 484 N 0 0 N N — 4 30 — 6

Kansas 23 181 529 339 213 N 0 0 N N — 1 8 — —

Minnesota — 264 339 101 891 — 0 0 — — 3 4 15 3 —

Missouri 231 484 566 1,097 1,263 — 0 2 — — — 3 13 3 2

Nebraska§ 87 83 244 210 186 N 0 0 N N — 2 8 2 3

North Dakota — 35 58 3 125 N 0 0 N N — 0 2 — 1

South Dakota 59 55 85 179 144 N 0 0 N N — 1 9 1 1

S. Atlantic 1,887 3,643 6,329 7,837 8,785 — 0 1 — — 15 17 47 39 37

Delaware 103 69 150 292 179 — 0 1 — — — 0 2 — 1

District of Columbia — 127 201 239 405 — 0 0 — — — 0 2 — 1

Florida 906 1,368 1,571 3,542 3,461 N 0 0 N N 8 7 35 16 16

Georgia 4 523 1,307 83 1,153 N 0 0 N N 5 4 13 12 10

Maryland§ 280 444 693 1,255 891 — 0 1 — — 2 1 4 3 —

North Carolina — 0 1,208 — 7 N 0 0 N N — 0 16 5 —

South Carolina§ 95 478 3,042 937 1,520 N 0 0 N N — 1 4 1 5

Virginia§ 472 621 1,059 1,361 1,024 N 0 0 N N — 1 4 1 1

West Virginia 27 60 102 128 145 N 0 0 N N — 0 3 1 3

E.S. Central 636 1,571 2,302 3,642 4,042 — 0 0 — — — 2 9 2 8

Alabama§ — 441 547 206 1,422 N 0 0 N N — 1 6 1 5

Kentucky 219 245 373 859 650 N 0 0 N N — 0 4 — 2

Mississippi 417 408 1,048 1,436 581 N 0 0 N N — 0 2 — 1

Tennessee§ — 535 792 1,141 1,389 N 0 0 N N — 1 6 1 —

W.S. Central 589 2,781 3,530 1,970 7,491 — 0 1 — — 1 6 164 1 2

Arkansas§ 321 276 455 922 715 N 0 0 N N — 0 7 — 1

Louisiana 200 417 775 852 807 — 0 1 — — — 1 5 — —

Oklahoma 68 142 391 196 714 N 0 0 N N 1 1 16 1 1

Texas§ — 1,934 2,343 — 5,255 N 0 0 N N — 3 149 — —

Mountain 536 1,261 1,806 2,501 3,524 65 88 182 254 302 1 8 37 5 15

Arizona 336 470 650 1,022 1,065 65 86 181 253 294 — 1 9 1 3

Colorado 133 266 578 795 830 N 0 0 N N — 1 12 — 3

Idaho§ 28 63 314 34 151 N 0 0 N N 1 1 5 2 5

Montana§ — 58 87 45 178 N 0 0 N N — 1 3 1 1

Nevada§ — 176 415 277 650 — 0 6 1 2 — 0 1 — —

New Mexico§ — 132 455 194 308 — 0 3 — 3 — 1 23 1 3

Utah — 104 253 49 331 — 0 2 — 3 — 0 6 — —

Wyoming§ 39 31 58 85 11 — 0 1 — — — 0 4 — —

Pacific 1,993 3,698 4,460 7,889 9,472 28 33 159 99 280 9 8 20 15 15

Alaska 103 85 178 223 143 N 0 0 N N 1 0 1 1 —

California 1,409 2,878 3,307 6,221 7,168 28 33 159 99 280 5 5 14 9 11

Hawaii 46 104 164 208 266 N 0 0 N N — 0 1 — —

Oregon§ 185 186 631 404 553 N 0 0 N N 1 1 4 3 4

Washington 250 404 527 833 1,342 N 0 0 N N 2 1 12 2 —

American Samoa — 0 20 — — N 0 0 N N N 0 0 N N

C.N.M.I. — — — — — — — — — — — — — — —

Guam — 4 24 — 1 — 0 0 — — — 0 0 — —

Puerto Rico 102 117 333 308 132 N 0 0 N N N 0 0 N N

U.S. Virgin Islands — 13 23 — 26 — 0 0 — — — 0 0 — —

C.N.M.I.: Commonwealth of Northern Mariana Islands.

U: Unavailable. —: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. 

* Incidence data for reporting year 2008 and 2009 are provisional. Data for HIV/AIDS, AIDS, and TB, when available, are displayed in Table IV, which appears quarterly.

† Chlamydia refers to genital infections caused by Chlamydia trachomatis. § Contains data reported through the National Electronic Disease Surveillance System (NEDSS). 
66 MMWR January 30, 2009

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending January 24, 2009, and January 19, 2008

(3rd week)*

Reporting area

Giardiasis Gonorrhea

Haemophilus influenzae, invasive

All ages, all serotypes†

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

2008

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

2008

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

Med Max Med Max Med Max 2008

United States 129 303 590 430 714 2,100 5,883 6,818 9,498 16,993 30 46 81 105 189

New England 2 24 49 16 74 44 97 171 131 245 1 2 8 2 13

Connecticut — 5 14 — 23 — 50 129 — 41 — 0 7 — —

Maine§ 2 3 12 8 2 1 2 6 4 3 1 0 2 2 1

Massachusetts — 8 17 — 26 34 38 69 108 173 — 0 5 — 9

New Hampshire — 2 11 2 10 — 2 6 4 3 — 0 1 — 1

Rhode Island§ — 1 8 — 6 8 5 13 13 25 — 0 7 — —

Vermont§ — 3 13 6 7 1 0 3 2 — — 0 3 — 2

Mid. Atlantic 27 60 108 89 136 391 619 987 1,399 1,327 2 10 18 22 32

New Jersey — 6 14 — 31 — 97 167 85 378 — 1 7 — 8

New York (Upstate) 16 21 51 35 23 93 117 407 218 92 2 3 13 8 7

New York City 3 16 29 29 39 220 191 633 698 259 — 2 6 2 4

Pennsylvania 8 15 46 25 43 78 213 268 398 598 — 4 9 12 13

E.N. Central 21 48 88 64 136 398 1,195 1,650 1,513 4,138 1 7 17 15 31

Illinois — 11 32 3 41 20 362 485 251 1,276 — 2 7 1 15

Indiana N 0 0 N N 85 147 284 322 512 — 1 12 3 —

Michigan 2 12 22 12 25 225 306 657 812 975 — 0 2 1 2

Ohio 16 17 31 44 48 — 274 531 — 1,033 1 2 6 10 11

Wisconsin 3 8 20 5 22 68 80 176 128 342 — 0 2 — 3

W.N. Central 6 28 143 37 49 110 316 425 642 912 3 3 15 9 12

Iowa — 6 18 — 17 — 29 50 46 99 — 0 1 — 1

Kansas — 3 11 — 5 8 41 130 103 57 — 0 3 — —

Minnesota — 0 106 — 1 — 54 92 13 222 3 0 10 3 —

Missouri 2 8 22 21 16 67 149 193 386 453 — 1 6 5 9

Nebraska§ 3 4 10 11 5 28 26 47 61 63 — 0 2 1 2

North Dakota — 0 3 — 1 — 2 6 — 9 — 0 3 — —

South Dakota 1 2 10 5 4 7 8 20 33 9 — 0 0 — —

S. Atlantic 36 54 88 109 126 451 1,250 2,007 2,276 3,382 14 12 25 37 53

Delaware — 1 3 1 3 16 19 44 46 68 — 0 2 — 1

District of Columbia — 1 5 — 1 — 53 101 127 131 — 0 2 — —

Florida 22 24 57 78 55 258 445 522 1,095 1,308 7 3 9 18 8

Georgia — 9 27 — 31 1 193 455 30 454 2 2 8 8 21

Maryland§ 6 5 12 12 10 76 118 212 317 342 3 1 6 5 12

North Carolina N 0 0 N N — 0 831 — — — 1 9 3 1

South Carolina§ — 2 6 4 6 31 180 829 299 612 — 1 7 — 4

Virginia§ 7 7 19 13 17 64 182 486 333 433 — 1 7 — 5

West Virginia 1 1 5 1 3 5 14 26 29 34 2 0 3 3 1

E.S. Central 1 8 22 3 13 193 544 837 1,230 1,649 1 3 8 3 11

Alabama§ — 4 12 — 8 — 169 218 67 642 — 0 2 1 2

Kentucky N 0 0 N N 76 89 153 293 282 — 0 1 — —

Mississippi N 0 0 N N 117 140 401 469 225 — 0 2 — 1

Tennessee§ 1 3 13 3 5 — 163 297 401 500 1 2 6 2 8

W.S. Central 4 7 20 9 9 192 927 1,297 672 2,867 2 2 8 2 4

Arkansas§ 1 2 8 1 3 83 87 167 268 243 — 0 2 — —

Louisiana — 2 10 1 4 86 169 317 332 430 — 0 1 — —

Oklahoma 3 3 9 7 2 23 50 124 72 319 2 1 7 2 4

Texas§ N 0 0 N N — 616 729 — 1,875 — 0 2 — —

Mountain 13 27 62 32 65 65 203 337 286 637 6 5 14 11 26

Arizona 3 3 8 9 8 34 63 93 123 173 4 2 11 8 10

Colorado 9 10 27 9 23 29 57 99 109 144 2 1 5 2 4

Idaho§ 1 3 14 7 3 — 3 13 — 11 — 0 4 — —

Montana§ — 1 9 6 2 — 2 7 — 3 — 0 1 — 1

Nevada§ — 1 8 — 5 — 36 129 31 182 — 0 2 — 2

New Mexico§ — 1 7 1 7 — 22 47 19 99 — 0 4 — 3

Utah — 6 18 — 14 — 9 20 2 23 — 1 5 1 6

Wyoming§ — 0 3 — 3 2 2 9 2 2 — 0 2 — —

Pacific 19 53 112 71 106 256 601 759 1,349 1,836 — 2 6 4 7

Alaska — 2 10 4 2 17 10 18 42 19 — 0 2 1 —

California 13 35 56 53 80 178 494 633 1,118 1,515 — 0 3 — 1

Hawaii — 1 4 1 1 5 11 22 24 34 — 0 2 2 —

Oregon§ 2 8 18 9 21 28 22 48 54 89 — 1 4 1 6

Washington 4 8 70 4 2 28 57 90 111 179 — 0 2 — —

American Samoa — 0 0 — — — 0 1 — — — 0 0 — — C.N.M.I. — — — — — — — — — — — — — — —

Guam — 0 0 — — — 1 15 — 1 — 0 0 — —

Puerto Rico — 2 13 — 1 2 5 25 6 8 — 0 0 — —

U.S. Virgin Islands — 0 0 — — — 2 6 — 6 N 0 0 N N

C.N.M.I.: Commonwealth of Northern Mariana Islands.

U: Unavailable. —: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. 

* Incidence data for reporting year 2008 and 2009 are provisional. 

† Data for H. influenzae (age <5 yrs for serotype b, nonserotype b, and unknown serotype) are available in Table I.

§ Contains data reported through the National Electronic Disease Surveillance System (NEDSS). 
Vol. 58 / No. 3 MMWR 67

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending January 24, 2009, and January 19, 2008

(3rd week)*

Reporting area

Hepatitis (viral, acute), by type†

A B Legionellosis

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

2008

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

2008

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

Med Max Med Max Med Max 2008

United States 14 44 76 58 126 14 67 93 112 189 27 44 145 97 111

New England — 1 7 — 6 — 1 7 1 2 2 2 16 2 2

Connecticut — 0 4 — 1 — 0 7 1 — 2 0 5 2 —

Maine§ — 0 2 — 1 — 0 2 — 1 — 0 2 — —

Massachusetts — 0 5 — 3 — 0 1 — 1 — 0 2 — —

New Hampshire — 0 2 — — — 0 2 — — — 0 5 — —

Rhode Island§ — 0 2 — 1 — 0 1 — — — 0 14 — —

Vermont§ — 0 1 — — — 0 1 — — — 0 1 — 2

Mid. Atlantic 2 5 12 6 24 3 8 14 7 31 9 14 59 25 27

New Jersey — 1 4 — 6 — 2 7 — 15 — 1 8 — 7

New York (Upstate) 1 1 4 2 4 3 1 6 5 — 4 5 19 11 2

New York City — 2 6 1 8 — 1 6 — 4 — 2 12 1 5

Pennsylvania 1 1 6 3 6 — 2 8 2 12 5 6 33 13 13

E.N. Central — 6 16 11 17 2 8 15 25 22 4 9 40 21 36

Illinois — 2 10 2 5 — 3 6 — 4 — 1 10 — 8

Indiana — 0 4 — — — 1 4 — — — 1 6 1 —

Michigan — 2 7 4 8 — 2 6 5 6 — 2 16 3 11

Ohio — 1 4 5 2 2 2 12 20 10 4 3 18 17 16

Wisconsin — 0 2 — 2 — 0 1 — 2 — 0 3 — 1

W.N. Central — 4 16 2 15 1 2 7 7 5 — 2 9 — 3

Iowa — 1 7 — 7 — 0 2 — — — 0 2 — 1

Kansas — 0 3 — 1 — 0 3 — 1 — 0 1 — —

Minnesota — 0 8 — 1 — 0 4 — — — 0 4 — —

Missouri — 1 3 2 1 1 1 4 6 4 — 1 7 — —

Nebraska§ — 0 5 — 4 — 0 2 1 — — 0 4 — 2

North Dakota — 0 0 — — — 0 1 — — — 0 0 — —

South Dakota — 0 1 — 1 — 0 0 — — — 0 1 — —

S. Atlantic 4 7 14 18 20 2 17 34 31 65 6 8 22 27 21

Delaware — 0 1 — — — 0 1 — 3 — 0 2 — —

District of Columbia U 0 0 U U U 0 0 U U — 0 2 — 1

Florida 4 2 8 10 11 1 6 12 12 16 5 3 7 11 9

Georgia — 1 4 3 3 — 3 8 10 8 — 0 4 4 2

Maryland§ — 1 4 5 4 1 2 4 1 6 1 2 10 6 5

North Carolina — 0 9 — — — 0 17 7 16 — 0 7 6 1

South Carolina§ — 0 3 — — — 1 4 — 9 — 0 2 — 1

Virginia§ — 1 5 — 2 — 2 7 1 3 — 1 4 — 1

West Virginia — 0 1 — — — 1 4 — 4 — 0 3 — 1

E.S. Central — 1 9 3 2 — 7 13 8 16 — 2 10 5 6

Alabama§ — 0 2 1 — — 2 6 2 5 — 0 2 — —

Kentucky — 0 3 — 2 — 2 5 1 5 — 1 4 1 5

Mississippi — 0 2 1 — — 1 3 1 — — 0 1 — —

Tennessee§ — 0 6 1 — — 3 8 4 6 — 1 5 4 1

W.S. Central — 4 12 — 5 2 13 23 9 11 — 1 9 1 2

Arkansas§ — 0 1 — — — 0 4 — — — 0 2 — —

Louisiana — 0 1 — 1 — 1 4 1 4 — 0 2 1 —

Oklahoma — 0 3 — — 2 2 8 3 — — 0 6 — —

Texas§ — 4 11 — 4 — 8 19 5 7 — 1 5 — 2

Mountain 5 4 12 8 8 — 4 12 1 12 4 2 8 10 5

Arizona 4 2 11 7 4 — 1 5 — 7 3 0 3 8 1

Colorado 1 0 3 1 2 — 0 3 — 2 — 0 2 — 2

Idaho§ — 0 3 — — — 0 2 — — — 0 1 — —

Montana§ — 0 1 — — — 0 1 — — — 0 1 — —

Nevada§ — 0 3 — — — 0 3 — 1 1 0 2 2 1

New Mexico§ — 0 3 — 2 — 0 2 — 1 — 0 1 — —

Utah — 0 2 — — — 0 3 1 1 — 0 2 — 1

Wyoming§ — 0 1 — — — 0 1 — — — 0 0 — —

Pacific 3 9 24 10 29 4 6 29 23 25 2 4 10 6 9

Alaska — 0 1 — — — 0 2 1 — — 0 1 — —

California 3 7 24 10 25 4 5 19 21 21 2 3 8 6 8

Hawaii — 0 2 — 1 — 0 1 — 1 — 0 1 — —

Oregon§ — 0 3 — 3 — 1 3 1 3 — 0 2 — 1

Washington — 1 5 — — — 1 10 — — — 0 3 — —

American Samoa — 0 0 — — — 0 0 — — N 0 0 N N

C.N.M.I. — — — — — — — — — — — — — — —

Guam — 0 0 — — — 0 0 — — — 0 0 — —

Puerto Rico — 0 2 1 — — 0 5 — 3 — 0 1 — —

U.S. Virgin Islands — 0 0 — — — 0 0 — — — 0 0 — —

C.N.M.I.: Commonwealth of Northern Mariana Islands.

U: Unavailable. —: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. 

* Incidence data for reporting year 2008 and 2009 are provisional. 

† Data for acute hepatitis C, viral are available in Table I.

§ Contains data reported through the National Electronic Disease Surveillance System (NEDSS). 
68 MMWR January 30, 2009

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending January 24, 2009, and January 19, 2008

(3rd week)*

Reporting area

Lyme disease Malaria

Meningococcal disease, invasive†

All serotypes

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

2008

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

2008

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

Med Max Med Max Med Max 2008

United States 37 445 1,454 160 392 9 21 44 24 43 6 19 47 25 47

New England — 44 260 10 64 — 0 6 — 2 — 0 3 — 3

Connecticut — 0 0 — — — 0 3 — — — 0 1 — —

Maine§ — 3 73 — — — 0 1 — — — 0 1 — —

Massachusetts — 10 114 — 45 — 0 2 — 2 — 0 3 — 3

New Hampshire — 13 141 3 18 — 0 2 — — — 0 0 — —

Rhode Island§ — 0 0 — — — 0 1 — — — 0 0 — —

Vermont§ — 4 40 7 1 — 0 1 — — — 0 0 — —

Mid. Atlantic 12 250 1,004 53 214 2 4 14 2 9 1 2 6 2 4

New Jersey — 31 211 — 71 — 0 0 — — — 0 2 — 2

New York (Upstate) 7 99 702 13 8 2 0 5 2 — — 0 3 — 1

New York City — 0 4 — 5 — 3 10 — 7 — 0 2 1 —

Pennsylvania 5 93 532 40 130 — 1 3 — 2 1 1 5 1 1

E.N. Central 6 11 146 13 25 — 2 7 2 14 3 3 9 6 11

Illinois — 0 12 — 2 — 1 5 — 9 — 1 5 — 7

Indiana — 0 8 — — — 0 2 — — — 0 4 — —

Michigan — 1 10 1 2 — 0 2 — 2 — 0 3 — 2

Ohio — 1 5 1 1 — 0 3 2 3 3 1 4 6 1

Wisconsin 6 9 129 11 20 — 0 3 — — — 0 2 — 1

W.N. Central — 8 156 — 1 1 1 10 1 — 1 2 8 3 3

Iowa — 1 8 — 1 — 0 3 — — — 0 3 — 1

Kansas — 0 1 — — — 0 2 — — — 0 2 — 1

Minnesota — 4 152 — — 1 0 8 1 — 1 0 7 1 —

Missouri — 0 1 — — — 0 3 — — — 0 3 2 1

Nebraska§ — 0 2 — — — 0 2 — — — 0 1 — —

North Dakota — 0 1 — — — 0 0 — — — 0 1 — —

South Dakota — 0 1 — — — 0 0 — — — 0 1 — —

S. Atlantic 13 63 219 67 80 5 4 15 9 10 — 3 10 7 8

Delaware 4 12 37 11 23 — 0 1 1 — — 0 1 — —

District of Columbia — 2 11 — 3 — 0 2 — — — 0 0 — —

Florida 2 2 10 8 1 4 1 7 4 3 — 1 3 3 4

Georgia — 0 3 — — — 1 5 — 3 — 0 2 1 1

Maryland§ 6 28 158 41 45 1 1 7 1 4 — 0 4 — —

North Carolina — 0 7 — — — 0 7 2 — — 0 3 2 —

South Carolina§ — 0 2 2 — — 0 1 — — — 0 3 — 3

Virginia§ 1 13 53 5 7 — 1 3 1 — — 0 2 1 —

West Virginia — 1 11 — 1 — 0 0 — — — 0 1 — —

E.S. Central — 1 5 1 — 1 0 2 1 2 — 1 6 — 5

Alabama§ — 0 2 — — — 0 1 — 1 — 0 2 — —

Kentucky — 0 2 — — — 0 1 — 1 — 0 1 — 3

Mississippi — 0 1 — — — 0 1 — — — 0 2 — —

Tennessee§ — 0 3 1 — 1 0 2 1 — — 0 3 — 2

W.S. Central — 2 8 — — — 1 11 — — — 2 7 — 3

Arkansas§ — 0 0 — — — 0 0 — — — 0 2 — —

Louisiana — 0 1 — — — 0 1 — — — 0 3 — 2

Oklahoma — 0 0 — — — 0 2 — — — 0 3 — 1

Texas§ — 2 8 — — — 1 11 — — — 1 5 — —

Mountain 1 0 16 2 — — 0 3 — 2 — 1 4 2 4

Arizona — 0 2 — — — 0 2 — 1 — 0 2 — —

Colorado 1 0 1 1 — — 0 1 — 1 — 0 1 — —

Idaho§ — 0 1 — — — 0 1 — — — 0 1 1 —

Montana§ — 0 16 — — — 0 0 — — — 0 1 — —

Nevada§ — 0 2 — — — 0 3 — — — 0 1 1 1

New Mexico§ — 0 2 — — — 0 1 — — — 0 1 — —

Utah — 0 1 1 — — 0 1 — — — 0 1 — 3

Wyoming§ — 0 1 — — — 0 0 — — — 0 1 — —

Pacific 5 4 13 14 8 — 3 10 9 4 1 5 19 5 6

Alaska — 0 2 — — — 0 2 — — — 0 2 1 —

California 5 3 8 13 8 — 2 8 8 3 — 3 19 2 4

Hawaii N 0 0 N N — 0 1 — — — 0 1 — —

Oregon§ — 1 3 1 — — 0 2 1 1 — 1 3 1 2

Washington — 0 9 — — — 0 7 — — 1 0 5 1 —

American Samoa N 0 0 N N — 0 0 — — — 0 0 — — C.N.M.I. — — — — — — — — — — — — — — —

Guam — 0 0 — — — 0 2 — — — 0 0 — —

Puerto Rico N 0 0 N N — 0 1 1 — — 0 1 — —

U.S. Virgin Islands N 0 0 N N — 0 0 — — — 0 0 — —

C.N.M.I.: Commonwealth of Northern Mariana Islands.

U: Unavailable. —: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. 

* Incidence data for reporting year 2008 and 2009 are provisional. 

† Data for meningococcal disease, invasive caused by serogroups A, C, Y, and W-135; serogroup B; other serogroup; and unknown serogroup are available in Table I.

§ Contains data reported through the National Electronic Disease Surveillance System (NEDSS). 
Vol. 58 / No. 3 MMWR 69

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending January 24, 2009, and January 19, 2008

(3rd week)*

Reporting area

Pertussis Rabies, animal Rocky Mountain spotted fever

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

2008

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

2008

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

Med Max Med Max Med Max 2008

United States 92 184 403 323 361 16 103 168 66 263 3 32 145 22 8

New England — 9 32 2 81 1 7 20 7 7 — 0 2 — — Connecticut — 0 4 — 7 1 4 17 4 — — 0 0 — —

Maine† — 0 5 1 1 — 1 5 1 1 N 0 0 N N

Massachusetts — 7 24 — 71 N 0 0 N N — 0 1 — —

New Hampshire — 1 4 1 1 — 0 3 — 3 — 0 1 — —

Rhode Island† — 1 7 — — N 0 0 N N — 0 2 — —

Vermont† — 0 2 — 1 — 1 6 2 3 — 0 0 — —

Mid. Atlantic 9 18 38 35 52 4 33 67 12 52 — 1 6 — 2

New Jersey — 1 6 — 6 — 0 0 — — — 0 2 — 1

New York (Upstate) 2 7 28 6 6 4 9 20 12 16 — 0 5 — —

New York City — 0 5 — 8 — 0 2 — 2 — 0 2 — 1

Pennsylvania 7 8 31 29 32 — 21 52 — 34 — 0 2 — —

E.N. Central 19 33 189 84 71 — 3 28 1 1 — 2 15 — 1

Illinois — 7 43 6 10 — 1 21 1 1 — 1 11 — 1

Indiana — 1 27 2 — — 0 2 — — — 0 3 — —

Michigan 1 6 14 13 6 — 0 8 — — — 0 1 — —

Ohio 18 10 176 62 47 — 1 7 — — — 0 4 — —

Wisconsin — 2 7 1 8 N 0 0 N N — 0 1 — —

W.N. Central 21 17 118 101 45 — 3 13 — — 1 4 32 1 1

Iowa — 3 21 — 7 — 0 5 — — — 0 2 — —

Kansas — 1 13 — 2 — 0 0 — — — 0 0 — —

Minnesota — 2 26 — — — 0 10 — — — 0 0 — —

Missouri 13 6 50 89 30 — 1 8 — — 1 4 31 1 1

Nebraska† 7 2 33 11 4 — 0 0 — — — 0 4 — —

North Dakota — 0 1 — — — 0 7 — — — 0 0 — —

South Dakota 1 0 7 1 2 — 0 2 — — — 0 1 — —

S. Atlantic 25 17 44 63 35 11 34 88 34 184 2 13 71 20 3

Delaware 1 0 3 2 — — 0 0 — — — 0 5 — —

District of Columbia — 0 1 — 2 — 0 0 — — — 0 2 — —

Florida 7 6 20 27 4 4 0 37 7 100 — 0 3 — —

Georgia — 1 8 — 2 — 5 42 — 13 — 1 8 — 1

Maryland† 1 2 8 7 9 — 8 17 6 23 1 1 7 2 1

North Carolina 16 0 15 19 10 7 9 16 11 19 — 3 55 16 1

South Carolina† — 2 11 8 3 — 0 0 — — — 1 9 — —

Virginia† — 3 12 — 5 — 11 24 9 29 1 2 15 2 —

West Virginia — 0 2 — — — 1 9 1 — — 0 1 — —

E.S. Central — 8 29 12 18 — 3 7 4 7 — 3 23 — — Alabama† — 1 5 1 4 — 0 0 — — — 1 8 — —

Kentucky — 2 11 8 2 — 0 4 4 1 — 0 1 — —

Mississippi — 2 5 1 11 — 0 1 — 1 — 0 3 — —

Tennessee† — 2 14 2 1 — 2 6 — 5 — 2 19 — —

W.S. Central 6 30 157 7 4 — 1 11 2 3 — 2 41 1 — Arkansas† — 1 20 — 2 — 0 6 1 3 — 0 14 1 —

Louisiana — 1 7 — — — 0 0 — — — 0 1 — —

Oklahoma 1 0 21 1 — — 0 10 1 — — 0 26 — —

Texas† 5 26 150 6 2 — 0 1 — — — 1 6 — —

Mountain 8 15 34 12 38 — 1 8 — 2 — 1 3 — 1

Arizona — 3 10 1 9 N 0 0 N N — 0 2 — —

Colorado 6 3 7 6 16 — 0 0 — — — 0 1 — —

Idaho† 2 1 5 4 — — 0 0 — — — 0 1 — —

Montana† — 1 11 — 3 — 0 2 — — — 0 1 — —

Nevada† — 0 7 — 1 — 0 4 — — — 0 2 — —

New Mexico† — 1 8 — — — 0 3 — 2 — 0 1 — 1

Utah — 4 17 1 7 — 0 6 — — — 0 1 — —

Wyoming† — 0 2 — 2 — 0 3 — — — 0 2 — —

Pacific 4 25 82 7 17 — 3 13 6 7 — 0 1 — — Alaska 3 3 21 6 8 — 0 4 2 4 N 0 0 N N

California — 8 23 — — — 3 12 4 3 — 0 1 — —

Hawaii — 0 2 — 2 — 0 0 — — N 0 0 N N

Oregon† — 3 10 — 7 — 0 3 — — — 0 1 — —

Washington 1 6 62 1 — — 0 0 — — N 0 0 N N

American Samoa — 0 0 — — N 0 0 N N N 0 0 N N

C.N.M.I. — — — — — — — — — — — — — — —

Guam — 0 0 — — — 0 0 — — N 0 0 N N

Puerto Rico — 0 0 — — — 1 5 — 1 N 0 0 N N

U.S. Virgin Islands — 0 0 — — N 0 0 N N N 0 0 N N

C.N.M.I.: Commonwealth of Northern Mariana Islands.

U: Unavailable. —: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. 

* Incidence data for reporting year 2008 and 2009 are provisional. 

† Contains data reported through the National Electronic Disease Surveillance System (NEDSS). 
70 MMWR January 30, 2009

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending January 24, 2009, and January 19, 2008

(3rd week)*

Reporting area

Salmonellosis Shiga toxin-producing E. coli (STEC)† Shigellosis

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

2008

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

2008

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

Med Max Med Max Med Max 2008

United States 308 889 1,489 1,189 1,968 9 82 251 80 135 122 431 611 635 761

New England 1 17 63 20 552 — 3 14 1 51 — 2 7 — 44

Connecticut — 0 11 11 484 — 0 1 1 44 — 0 0 — 38

Maine§ 1 3 8 7 2 — 0 3 — 1 — 0 6 — —

Massachusetts — 12 52 — 52 — 0 11 — 5 — 1 5 — 5

New Hampshire — 2 10 1 7 — 1 3 — 1 — 0 1 — 1

Rhode Island§ — 2 9 — 3 — 0 3 — — — 0 1 — —

Vermont§ — 1 7 1 4 — 0 3 — — — 0 2 — —

Mid. Atlantic 28 88 177 111 209 1 6 192 4 14 5 44 96 38 58

New Jersey — 12 30 — 56 — 0 3 — 3 — 12 38 3 28

New York (Upstate) 14 26 60 29 24 1 3 188 3 3 3 11 35 5 3

New York City 1 20 53 23 61 — 1 5 1 6 — 13 35 19 18

Pennsylvania 13 27 78 59 68 — 1 8 — 2 2 4 23 11 9

E.N. Central 40 93 194 134 211 — 11 74 4 16 44 74 121 169 181

Illinois — 25 72 3 70 — 1 10 — — — 19 35 5 75

Indiana 3 9 53 5 4 — 1 14 — — — 10 39 1 39

Michigan 5 17 38 26 55 — 2 43 1 5 1 3 20 14 2

Ohio 32 26 65 88 48 — 3 17 2 4 39 42 80 136 47

Wisconsin — 14 50 12 34 — 4 20 1 7 4 7 33 13 18

W.N. Central 21 49 151 62 77 4 12 59 13 5 4 17 40 7 30

Iowa — 8 16 — 17 — 2 21 — 3 — 3 12 — 4

Kansas — 7 31 3 8 — 1 7 1 — — 1 5 1 —

Minnesota 17 13 70 17 1 4 3 21 4 — 3 5 25 3 —

Missouri 3 14 48 31 38 — 2 11 6 2 — 3 14 2 17

Nebraska§ 1 4 13 6 12 — 2 29 2 — 1 0 3 1 —

North Dakota — 0 7 — — — 0 1 — — — 0 5 — —

South Dakota — 3 9 5 1 — 1 4 — — — 0 9 — 9

S. Atlantic 98 245 457 464 422 2 14 50 34 19 16 58 100 117 161

Delaware 1 2 9 1 4 — 0 2 — 1 — 0 1 1 —

District of Columbia — 1 4 — 4 — 0 1 — 1 — 0 3 — 1

Florida 53 97 174 201 254 — 2 11 12 10 5 14 34 31 71

Georgia 15 43 86 45 40 — 1 7 2 — 4 20 48 23 54

Maryland§ 13 13 36 32 33 1 2 10 7 1 2 2 8 13 3

North Carolina — 24 106 143 1 — 1 19 12 — — 3 27 32 —

South Carolina§ 1 18 55 16 37 — 0 4 — 1 — 8 32 5 25

Virginia§ 13 19 42 23 28 1 3 25 1 1 5 4 35 12 7

West Virginia 2 3 6 3 21 — 0 3 — 4 — 0 3 — —

E.S. Central 8 58 138 61 123 1 5 21 5 10 5 34 67 24 137

Alabama§ — 15 47 25 43 — 1 17 1 3 — 7 18 2 30

Kentucky — 9 18 15 22 — 1 7 — 2 — 3 24 3 21

Mississippi — 14 57 — 27 — 0 2 — 1 — 4 18 — 51

Tennessee§ 8 14 60 21 31 1 2 7 4 4 5 17 46 19 35

W.S. Central 18 135 265 36 67 — 6 27 — 5 24 93 215 174 42

Arkansas§ 10 11 40 14 11 — 1 3 — — — 11 27 3 2

Louisiana 3 17 50 9 28 — 0 1 — — 1 11 25 4 12

Oklahoma 5 14 36 8 6 — 1 19 — — 3 3 11 8 6

Texas§ — 91 179 5 22 — 5 12 — 5 20 64 188 159 22

Mountain 30 59 110 70 113 — 10 39 2 11 11 21 53 54 36

Arizona 13 19 45 33 33 — 1 5 2 1 7 12 34 38 18

Colorado 13 12 43 13 26 — 3 18 — 2 4 2 11 4 10

Idaho§ 3 3 14 10 6 — 2 15 — 1 — 0 2 — —

Montana§ — 2 8 3 2 — 0 3 — 3 — 0 1 — —

Nevada§ 1 3 9 11 11 — 0 2 — — — 4 13 10 4

New Mexico§ — 6 33 — 23 — 1 6 — 3 — 1 10 2 3

Utah — 6 19 — 5 — 1 9 — 1 — 1 3 — —

Wyoming§ — 1 4 — 7 — 0 1 — — — 0 1 — 1

Pacific 64 112 521 231 194 1 10 51 17 4 13 28 82 52 72

Alaska 2 1 4 4 3 — 0 1 — 1 — 0 1 1 —

California 51 81 507 194 153 1 6 39 16 3 12 26 74 46 63

Hawaii 1 4 15 13 18 — 0 2 1 — — 1 3 — 3

Oregon§ 2 7 20 12 20 — 1 8 — — — 1 10 4 6

Washington 8 12 124 8 — — 2 36 — — 1 1 24 1 —

American Samoa — 0 1 — 1 — 0 0 — — — 0 0 — 1

C.N.M.I. — — — — — — — — — — — — — — —

Guam — 0 2 — — — 0 0 — — — 0 3 — —

Puerto Rico 1 9 29 3 25 — 0 1 — — — 0 4 — —

U.S. Virgin Islands — 0 0 — — — 0 0 — — — 0 0 — —

C.N.M.I.: Commonwealth of Northern Mariana Islands.

U: Unavailable. —: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. 

* Incidence data for reporting year 2008 and 2009 are provisional. 

† Includes E. coli O157:H7; Shiga toxin-positive, serogroup non-O157; and Shiga toxin-positive, not serogrouped.

§ Contains data reported through the National Electronic Disease Surveillance System (NEDSS). 
Vol. 58 / No. 3 MMWR 71

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending January 24, 2009, and January 19, 2008

(3rd week)*

Reporting area

Streptococcal diseases, invasive, group A

Streptococcus pneumoniae, invasive disease, nondrug resistant†

Age <5 years

Current 

week

Previous 

52 weeks Cum

 2009

Cum 

2008

Current

 week

Previous 

52 weeks Cum 

2009

Cum 

Med Max Med Max 2008

United States 56 84 181 209 306 20 33 55 57 127

New England — 4 31 1 18 1 1 11 1 8

Connecticut — 0 26 — — — 0 11 — —

Maine§ — 0 3 — 1 — 0 1 — —

Massachusetts — 1 8 — 15 — 0 4 — 6

New Hampshire — 0 2 1 2 — 0 1 — 2

Rhode Island§ — 0 9 — — — 0 2 — —

Vermont§ — 0 3 — — 1 0 1 1 —

Mid. Atlantic 14 17 43 31 73 1 3 15 4 25

New Jersey — 2 11 — 16 — 1 4 — 5

New York (Upstate) 8 6 17 12 17 1 2 15 4 8

New York City — 4 10 4 17 — 0 5 — 12

Pennsylvania 6 6 16 15 23 N 0 2 N N

E.N. Central 11 15 42 43 54 1 5 15 10 24

Illinois — 5 16 7 16 — 1 5 — 7

Indiana 3 2 9 3 5 — 0 5 — —

Michigan 3 3 10 8 14 — 1 5 2 8

Ohio 5 5 14 24 16 1 1 4 8 6

Wisconsin — 1 10 1 3 — 0 4 — 3

W.N. Central 1 5 39 10 10 2 2 11 5 8

Iowa — 0 0 — — — 0 0 — —

Kansas — 0 5 1 1 — 0 3 1 1

Minnesota — 0 35 — — 2 0 9 2 —

Missouri — 2 10 3 8 — 1 2 2 5

Nebraska§ — 1 3 4 — — 0 1 — 2

North Dakota — 0 3 — — — 0 2 — —

South Dakota 1 0 2 2 1 — 0 1 — —

S. Atlantic 20 21 37 77 74 9 6 16 22 29

Delaware 1 0 2 2 — — 0 0 — —

District of Columbia — 0 4 — 2 — 0 1 — —

Florida 6 5 10 19 24 3 1 4 5 4

Georgia 8 4 14 24 14 5 1 4 8 4

Maryland§ 2 3 8 11 18 — 1 4 5 11

North Carolina — 2 10 5 2 N 0 0 N N

South Carolina§ 2 1 5 9 5 1 1 6 4 5

Virginia§ 1 3 9 5 7 — 0 6 — 5

West Virginia — 0 3 2 2 — 0 1 — —

E.S. Central 1 3 9 9 8 1 2 6 1 1

Alabama§ N 0 0 N N N 0 0 N N

Kentucky — 1 3 — 2 N 0 0 N N

Mississippi N 0 0 N N — 0 3 — 1

Tennessee§ 1 3 6 9 6 1 1 5 1 —

W.S. Central 4 9 28 19 10 1 5 16 6 7

Arkansas§ — 0 2 — — — 0 2 1 2

Louisiana — 0 2 — 1 1 0 3 4 1

Oklahoma 3 2 8 14 3 — 1 3 — 1

Texas§ 1 6 25 5 6 — 3 13 1 3

Mountain 4 9 20 12 50 3 4 11 7 24

Arizona 1 3 9 8 15 1 2 7 5 15

Colorado 3 2 8 3 13 2 1 4 2 5

Idaho§ — 0 2 — 1 — 0 1 — 1

Montana§ N 0 0 N N — 0 1 — —

Nevada§ — 0 1 — 2 N 0 0 N N

New Mexico§ — 1 8 1 13 — 0 3 — 1

Utah — 1 4 — 6 — 0 4 — 2

Wyoming§ — 0 2 — — — 0 1 — —

Pacific 1 3 8 7 9 1 0 2 1 1

Alaska 1 1 4 2 1 N 0 0 N N

California — 0 0 — — N 0 0 N N

Hawaii — 2 8 5 8 1 0 2 1 1

Oregon§ N 0 0 N N N 0 0 N N

Washington N 0 0 N N N 0 0 N N

American Samoa — 0 12 — — N 0 0 N N

C.N.M.I. — — — — — — — — — —

Guam — 0 0 — — — 0 0 — —

Puerto Rico N 0 0 N N N 0 0 N N

U.S. Virgin Islands — 0 0 — — N 0 0 N N

C.N.M.I.: Commonwealth of Northern Mariana Islands.

U: Unavailable. —: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. 

* Incidence data for reporting year 2008 and 2009 are provisional. 

† Includes cases of invasive pneumococcal disease, in children aged <5 years, caused by S. pneumoniae, which is susceptible or for which susceptibility testing is not available 

(NNDSS event code 11717).

§ Contains data reported through the National Electronic Disease Surveillance System (NEDSS). 
72 MMWR January 30, 2009

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending January 24, 2009, and January 19, 2008

(3rd week)*

Reporting area

Streptococcus pneumoniae, invasive disease, drug resistant†

All ages Aged <5 years Syphilis, primary and secondary

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

2008

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

2008

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

Med Max Med Max Med Max 2008

United States 31 52 105 150 290 1 8 23 10 31 93 242 303 390 633

New England 1 1 48 2 5 — 0 5 — — 4 5 14 12 15

Connecticut — 0 48 — — — 0 5 — — — 0 3 — —

Maine§ — 0 2 — 2 — 0 1 — — — 0 2 — —

Massachusetts — 0 0 — — — 0 0 — — 3 4 11 9 12

New Hampshire — 0 0 — — — 0 0 — — 1 0 2 3 1

Rhode Island§ — 0 2 — 2 — 0 1 — — — 0 5 — 2

Vermont§ 1 0 2 2 1 — 0 1 — — — 0 2 — —

Mid. Atlantic 3 4 13 4 22 — 0 2 — 1 30 32 52 87 93

New Jersey — 0 0 — — — 0 0 — — — 4 10 5 11

New York (Upstate) 1 1 5 1 3 — 0 1 — — 1 3 7 1 1

New York City — 1 6 — 7 — 0 0 — — 28 20 36 72 57

Pennsylvania 2 1 9 3 12 — 0 2 — 1 1 5 12 9 24

E.N. Central 5 12 41 32 83 — 2 7 2 13 15 23 38 46 69

Illinois — 0 7 — 31 — 0 2 — 7 2 7 19 6 29

Indiana — 2 31 — 12 — 0 5 — — 2 3 10 4 4

Michigan — 0 3 2 4 — 0 1 — 1 6 3 21 15 10

Ohio 5 7 18 30 36 — 1 4 2 5 4 6 15 19 23

Wisconsin — 0 0 — — — 0 0 — — 1 1 4 2 3

W.N. Central — 2 9 5 23 — 0 2 — 1 2 8 14 10 26

Iowa — 0 0 — — — 0 0 — — — 0 2 — —

Kansas — 1 5 — 7 — 0 1 — 1 — 0 5 — —

Minnesota — 0 0 — — — 0 0 — — — 2 6 1 5

Missouri — 1 5 5 16 — 0 1 — — 2 4 10 9 21

Nebraska§ — 0 0 — — — 0 0 — — — 0 2 — —

North Dakota — 0 0 — — — 0 0 — — — 0 0 — —

South Dakota — 0 1 — — — 0 1 — — — 0 1 — —

S. Atlantic 21 21 53 86 121 1 3 13 6 10 26 55 106 127 90

Delaware — 0 1 — — — 0 0 — — — 0 4 2 —

District of Columbia — 0 3 — 3 — 0 1 — — — 2 9 14 6

Florida 17 13 30 62 74 — 2 12 5 8 6 19 37 55 51

Georgia 4 6 23 21 38 1 1 5 1 2 — 13 51 — 3

Maryland§ — 0 2 1 1 — 0 1 — — 5 7 14 11 12

North Carolina N 0 0 N N N 0 0 N N 14 5 19 32 6

South Carolina§ — 0 0 — — — 0 0 — — 1 2 6 3 4

Virginia§ N 0 0 N N N 0 0 N N — 5 16 10 8

West Virginia — 1 9 2 5 — 0 2 — — — 0 1 — —

E.S. Central 1 5 20 13 23 — 1 4 1 2 6 21 37 36 54

Alabama§ N 0 0 N N N 0 0 N N — 8 17 9 25

Kentucky — 1 6 6 6 — 0 2 1 — 2 1 10 5 4

Mississippi — 0 2 — — — 0 1 — — 4 3 19 5 5

Tennessee§ 1 3 18 7 17 — 0 3 — 2 — 8 19 17 20

W.S. Central — 2 7 6 8 — 0 2 1 2 4 42 63 29 116

Arkansas§ — 0 4 5 — — 0 1 1 — 3 2 19 19 4

Louisiana — 1 6 1 8 — 0 1 — 2 1 10 31 7 25

Oklahoma N 0 0 N N N 0 0 N N — 1 5 3 10

Texas§ — 0 0 — — — 0 0 — — — 26 47 — 77

Mountain — 2 14 — 4 — 0 4 — 1 — 9 16 6 28

Arizona — 0 0 — — — 0 0 — — — 5 13 — 13

Colorado — 0 0 — — — 0 0 — — — 1 7 3 6

Idaho§ N 0 1 N N N 0 1 N N — 0 2 — —

Montana§ — 0 1 — — — 0 0 — — — 0 7 — —

Nevada§ N 0 1 N N N 0 0 N N — 1 6 1 5

New Mexico§ — 0 1 — — — 0 0 — — — 1 4 2 4

Utah — 1 13 — 4 — 0 4 — 1 — 0 2 — —

Wyoming§ — 0 1 — — — 0 0 — — — 0 1 — —

Pacific — 0 1 2 1 — 0 1 — 1 6 44 64 37 142

Alaska N 0 0 N N N 0 0 N N — 0 1 — —

California N 0 0 N N N 0 0 N N 4 40 58 27 124

Hawaii — 0 1 2 1 — 0 1 — 1 — 0 3 4 3

Oregon§ N 0 0 N N N 0 0 N N 2 0 3 2 2

Washington N 0 0 N N N 0 0 N N — 3 9 4 13

American Samoa N 0 0 N N N 0 0 N N — 0 0 — — C.N.M.I. — — — — — — — — — — — — — — —

Guam — 0 0 — — — 0 0 — — — 0 0 — —

Puerto Rico — 0 0 — — — 0 0 — — 1 3 11 4 1

U.S. Virgin Islands — 0 0 — — — 0 0 — — — 0 0 — —

C.N.M.I.: Commonwealth of Northern Mariana Islands.

U: Unavailable. —: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. 

* Incidence data for reporting year 2008 and 2009 are provisional. 

† Includes cases of invasive pneumococcal disease caused by drug-resistant S. pneumoniae (DRSP) (NNDSS event code 11720).

§ Contains data reported through the National Electronic Disease Surveillance System (NEDSS). 
Vol. 58 / No. 3 MMWR 73

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending January 24, 2009, and January 19, 2008

(3rd week)*

West Nile virus disease†

Reporting area

Varicella (chickenpox) Neuroinvasive Nonneuroinvasive§

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

2008

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

2008

Current 

week

Previous 

52 weeks Cum 

2009

Cum 

Med Max Med Max Med Max 2008

United States 251 505 1,001 787 1,367 — 1 76 — — — 1 73 — 1

New England — 10 22 16 39 — 0 2 — — — 0 1 — — Connecticut — 0 0 — — — 0 2 — — — 0 1 — —

Maine¶ — 0 0 — — — 0 0 — — — 0 0 — —

Massachusetts — 0 1 — — — 0 0 — — — 0 0 — —

New Hampshire — 5 13 11 21 — 0 0 — — — 0 0 — —

Rhode Island¶ — 0 0 — — — 0 1 — — — 0 0 — —

Vermont¶ — 4 17 5 18 — 0 0 — — — 0 0 — —

Mid. Atlantic 37 43 81 100 184 — 0 8 — — — 0 4 — — New Jersey N 0 0 N N — 0 1 — — — 0 1 — —

New York (Upstate) N 0 0 N N — 0 5 — — — 0 2 — —

New York City N 0 0 N N — 0 2 — — — 0 2 — —

Pennsylvania 37 43 81 100 184 — 0 2 — — — 0 1 — —

E.N. Central 56 135 312 284 457 — 0 8 — — — 0 3 — — Illinois 4 23 66 38 11 — 0 4 — — — 0 2 — —

Indiana — 0 0 — — — 0 1 — — — 0 1 — —

Michigan 11 55 116 75 226 — 0 4 — — — 0 2 — —

Ohio 38 46 106 164 220 — 0 3 — — — 0 1 — —

Wisconsin 3 4 50 7 — — 0 2 — — — 0 1 — —

W.N. Central 37 21 71 68 70 — 0 6 — — — 0 21 — — Iowa N 0 0 N N — 0 2 — — — 0 1 — —

Kansas — 6 40 2 26 — 0 2 — — — 0 3 — —

Minnesota — 0 0 — — — 0 2 — — — 0 4 — —

Missouri 37 9 51 66 43 — 0 3 — — — 0 1 — —

Nebraska¶ N 0 0 N N — 0 1 — — — 0 8 — —

North Dakota — 0 39 — — — 0 2 — — — 0 11 — —

South Dakota — 0 5 — 1 — 0 5 — — — 0 6 — —

S. Atlantic 47 86 173 101 244 — 0 3 — — — 0 3 — — Delaware — 1 5 — — — 0 0 — — — 0 1 — —

District of Columbia — 0 3 — 4 — 0 0 — — — 0 0 — —

Florida 34 29 87 78 53 — 0 2 — — — 0 0 — —

Georgia N 0 0 N N — 0 1 — — — 0 1 — —

Maryland¶ N 0 0 N N — 0 2 — — — 0 2 — —

North Carolina N 0 0 N N — 0 0 — — — 0 0 — —

South Carolina¶ — 13 67 1 43 — 0 0 — — — 0 1 — —

Virginia¶ — 20 81 — 72 — 0 0 — — — 0 1 — —

West Virginia 13 11 33 22 72 — 0 1 — — — 0 0 — —

E.S. Central 4 17 101 16 52 — 0 7 — — — 0 8 — 1

Alabama¶ 4 17 101 16 52 — 0 3 — — — 0 3 — —

Kentucky N 0 0 N N — 0 1 — — — 0 0 — —

Mississippi — 0 2 — — — 0 4 — — — 0 7 — —

Tennessee¶ N 0 0 N N — 0 2 — — — 0 3 — 1

W.S. Central 51 113 435 150 158 — 0 8 — — — 0 7 — — Arkansas¶ — 9 55 — 19 — 0 1 — — — 0 1 — —

Louisiana — 1 10 2 5 — 0 3 — — — 0 5 — —

Oklahoma N 0 0 N N — 0 1 — — — 0 1 — —

Texas¶ 51 107 422 148 134 — 0 6 — — — 0 4 — —

Mountain 16 39 90 42 154 — 0 12 — — — 0 22 — — Arizona — 0 0 — — — 0 10 — — — 0 8 — —

Colorado 16 14 44 16 68 — 0 4 — — — 0 10 — —

Idaho¶ N 0 0 N N — 0 1 — — — 0 6 — —

Montana¶ — 5 27 21 24 — 0 0 — — — 0 2 — —

Nevada¶ N 0 0 N N — 0 2 — — — 0 3 — —

New Mexico¶ — 3 18 5 18 — 0 2 — — — 0 1 — —

Utah — 11 55 — 43 — 0 2 — — — 0 5 — —

Wyoming¶ — 0 4 — 1 — 0 0 — — — 0 2 — —

Pacific 3 2 8 10 9 — 0 38 — — — 0 23 — — Alaska 3 1 6 9 2 — 0 0 — — — 0 0 — —

California — 0 0 — — — 0 37 — — — 0 19 — —

Hawaii — 1 5 1 7 — 0 0 — — — 0 0 — —

Oregon¶ N 0 0 N N — 0 2 — — — 0 4 — —

Washington N 0 0 N N — 0 1 — — — 0 1 — —

American Samoa N 0 0 N N — 0 0 — — — 0 0 — — C.N.M.I. — — — — — — — — — — — — — — —

Guam — 1 17 — 4 — 0 0 — — — 0 0 — —

Puerto Rico 2 7 20 5 24 — 0 0 — — — 0 0 — —

U.S. Virgin Islands — 0 0 — — — 0 0 — — — 0 0 — —

C.N.M.I.: Commonwealth of Northern Mariana Islands.

U: Unavailable. —: No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum. 

* Incidence data for reporting year 2008 and 2009 are provisional. 

† Updated weekly from reports to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases (ArboNET Surveillance). 

Data for California serogroup, eastern equine, Powassan, St. Louis, and western equine diseases are available in Table I.

§ Not notifiable in all states. Data from states where the condition is not notifiable are excluded from this table, except starting in 2007 for the domestic arboviral diseases and 

influenza-associated pediatric mortality, and in 2003 for SARS-CoV. Reporting exceptions are available at http://www.cdc.gov/epo/dphsi/phs/infdis.htm. ¶ Contains data reported through the National Electronic Disease Surveillance System (NEDSS). 
74 MMWR January 30, 2009

TABLE III. Deaths in 122 U.S. cities,* week ending January 24, 2009 (3rd week)

Reporting area

All causes, by age (years)

P&I†

Total Reporting area

All causes, by age (years)

P&I†

Total

All

Ages >65 45–64 25–44 1–24 <1

All

Ages >65 45–64 25–44 1–24 <1

New England 481 355 89 25 7 5 40 S. Atlantic 1,238 804 304 68 30 32 72

Boston, MA 147 98 28 15 3 3 12 Atlanta, GA 59 22 14 5 — 18 3

Bridgeport, CT 32 26 4 — 1 1 3 Baltimore, MD 177 105 55 10 3 4 11

Cambridge, MA 14 13 1 — — — 2 Charlotte, NC 87 67 10 7 3 — 6

Fall River, MA 29 24 4 1 — — 3 Jacksonville, FL 146 98 38 9 1 — 12

Hartford, CT 36 25 8 2 1 — 1 Miami, FL 75 52 12 7 4 — 2

Lowell, MA 20 13 6 — 1 — 3 Norfolk, VA 58 38 11 3 4 2 6

Lynn, MA 6 4 2 — — — 1 Richmond, VA 215 133 64 10 4 4 13

New Bedford, MA 24 16 7 1 — — 2 Savannah, GA 64 46 14 2 — 2 4

New Haven, CT U U U U U U U St. Petersburg, FL 50 34 10 2 4 — 3

Providence, RI 50 41 9 — — — — Tampa, FL 218 155 51 7 4 1 11

Somerville, MA 5 5 — — — — — Washington, D.C. 77 44 23 6 3 1 1

Springfield, MA 31 21 4 4 1 1 4 Wilmington, DE 12 10 2 — — — —

Waterbury, CT 25 22 3 — — — 1 E.S. Central 962 619 237 64 20 21 76

Worcester, MA 62 47 13 2 — — 8 Birmingham, AL 204 139 44 14 4 3 19

Mid. Atlantic 2,169 1,505 467 102 24 71 135 Chattanooga, TN 76 46 19 6 3 2 7

Albany, NY 55 32 16 3 1 3 5 Knoxville, TN 104 68 27 8 — 1 4

Allentown, PA 30 21 6 2 1 — 2 Lexington, KY 79 58 14 3 2 2 6

Buffalo, NY 91 70 12 5 1 3 10 Memphis, TN 203 132 57 8 3 3 18

Camden, NJ 23 14 5 3 1 — — Mobile, AL 112 66 27 8 5 5 7

Elizabeth, NJ 26 18 7 1 — — 1 Montgomery, AL 33 22 7 3 1 — 5

Erie, PA 51 40 10 1 — — 4 Nashville, TN 151 88 42 14 2 5 10

Jersey City, NJ 15 8 5 1 — 1 1 W.S. Central 1,277 849 288 80 32 28 56

New York City, NY 1,125 803 247 45 11 19 60 Austin, TX 96 63 20 5 3 5 6

Newark, NJ 51 29 13 5 3 1 2 Baton Rouge, LA U U U U U U U

Paterson, NJ 15 8 6 1 — — 4 Corpus Christi, TX 70 48 20 2 — — 6

Philadelphia, PA 272 151 58 19 4 40 22 Dallas, TX 235 150 49 19 10 7 7

Pittsburgh, PA§ 46 30 12 4 — — 3 El Paso, TX 103 79 18 4 1 1 4

Reading, PA 35 28 5 1 — 1 1 Fort Worth, TX — — — — — — —

Rochester, NY 154 118 27 5 1 3 17 Houston, TX 412 251 107 33 12 9 11

Schenectady, NY 24 20 3 1 — — — Little Rock, AR 82 46 22 7 4 3 2

Scranton, PA 39 31 5 2 1 — 1 New Orleans, LA U U U U U U U

Syracuse, NY 53 39 13 1 — — 1 San Antonio, TX U U U U U U U

Trenton, NJ 19 15 3 1 — — — Shreveport, LA 89 64 20 4 — 1 8

Utica, NY 22 13 9 — — — 1 Tulsa, OK 190 148 32 6 2 2 12

Yonkers, NY 23 17 5 1 — — — Mountain 911 609 208 62 20 12 68

E.N. Central 2,245 1,500 533 132 39 41 152 Albuquerque, NM U U U U U U U

Akron, OH 64 39 18 4 1 2 — Boise, ID 52 42 8 2 — — 8

Canton, OH 43 34 9 — — — 4 Colorado Springs, CO 87 57 14 8 7 1 4

Chicago, IL 366 234 93 27 8 4 21 Denver, CO 88 52 26 7 1 2 8

Cincinnati, OH 80 51 19 5 — 5 10 Las Vegas, NV 217 148 53 12 1 3 25

Cleveland, OH 203 138 46 13 5 1 6 Ogden, UT 40 29 8 2 — 1 4

Columbus, OH 176 108 44 13 2 9 19 Phoenix, AZ 125 76 30 14 3 2 9

Dayton, OH 157 115 26 9 6 1 19 Pueblo, CO 34 23 9 1 1 — 1

Detroit, MI 177 80 69 18 5 5 6 Salt Lake City, UT 122 80 26 9 5 2 3

Evansville, IN 55 43 10 2 — — 7 Tucson, AZ 146 102 34 7 2 1 6

Fort Wayne, IN 81 58 16 4 1 2 8 Pacific 1,828 1,301 380 83 38 25 195

Gary, IN 20 8 7 1 3 1 1 Berkeley, CA 14 12 2 — — — 1

Grand Rapids, MI 57 43 13 — — 1 2 Fresno, CA 151 104 34 8 3 2 18

Indianapolis, IN 246 176 55 6 3 6 17 Glendale, CA 34 27 6 1 — — 6

Lansing, MI 71 53 18 — — — 3 Honolulu, HI 96 66 27 1 1 1 8

Milwaukee, WI 119 80 23 15 1 — 7 Long Beach, CA 68 37 25 5 — 1 8

Peoria, IL 56 39 12 3 1 1 5 Los Angeles, CA 245 165 46 15 13 6 34

Rockford, IL 70 55 10 3 1 1 5 Pasadena, CA 22 19 2 — — 1 1

South Bend, IN 41 26 7 4 2 2 2 Portland, OR 146 95 38 10 2 — 10

Toledo, OH 113 83 27 3 — — 3 Sacramento, CA 197 147 38 8 2 2 28

Youngstown, OH 50 37 11 2 — — 7 San Diego, CA 147 114 22 6 4 1 12

W.N. Central 658 417 170 32 18 21 59 San Francisco, CA 116 83 24 6 — 3 15

Des Moines, IA 170 113 42 8 2 5 14 San Jose, CA 280 215 45 9 8 3 37

Duluth, MN 43 22 15 3 2 1 4 Santa Cruz, CA 37 30 4 2 1 — 3

Kansas City, KS 8 3 2 1 1 1 1 Seattle, WA 107 73 26 3 2 3 6

Kansas City, MO 88 61 19 — 5 3 5 Spokane, WA 61 44 12 3 1 1 5

Lincoln, NE 56 42 10 3 1 — 1 Tacoma, WA 107 70 29 6 1 1 3

Minneapolis, MN 45 23 16 4 — 2 6 Total¶ 11,769 7,959 2,676 648 228 256 853

Omaha, NE 111 66 30 6 6 3 17

St. Louis, MO 49 33 9 3 — 4 3

St. Paul, MN 58 32 21 4 — 1 5

Wichita, KS 30 22 6 — 1 1 3

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.

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U.S. Government Printing Office: 2009-523-019/41152 Region IV ISSN: 0149-2195