Morbidity and Mortality Weekly Report

Weekly / Vol. 59 / No. 41 October 22, 2010

Drivers Aged 16 or 17 Years

National Teen Driver Safety Week — ​
Involved in Fatal Crashes —
October 17–23, 2010
United States, 2004–2008
In 2009, approximately 3,000 teens aged 15–19 years,
died in motor vehicle crashes, approximately 500 fewer Motor vehicle crashes are the leading cause of death among
deaths than occurred in 2008 in this age group (1). During teens in the United States, accounting for approximately one
2004–2008, the percentage of drivers aged 16–17 years third of deaths in this age group (1). Crash risk is highest dur-
involved in fatal crashes decreased by 36% (2). Despite ing the first years of independent driving (2). To characterize
these encouraging trends, motor vehicle crashes remain the trends in fatal crashes involving drivers aged 16 or 17 years,
leading cause of death for teens. CDC analyzed data from the Fatality Analysis Report System
Graduated driver licensing (GDL) programs are widely (FARS) for 2004–2008. This report summarizes the results
credited with contributing to recent declines in teen crash of that analysis, which indicated that, during 2004–2008, a
fatalities. Evaluations of GDL have demonstrated a 20%– total of 9,644 passenger vehicle drivers aged 16 or 17 years
40% reduction in crash risk for the youngest drivers (3). were involved in fatal crashes. During that period, the annual
GDL programs provide longer practice periods, limit driv- population-based rate for drivers aged 16 or 17 years involved
ing under high-risk conditions for newly licensed drivers, in fatal crashes declined 38%, from 27.1 per 100,000 popula-
and require greater participation of parents in their teens’ tion in 2004 to 16.7 in 2008. By state, 5-year annualized rates
learning-to-drive process. This year, during National Teen for drivers aged 16 or 17 years involved in fatal crashes ranged
Driver Safety Week, CDC is launching a new campaign, from 9.7 per 100,000 population in New Jersey and New York
Parents Are the Key, to inform parents how they can help to 59.6 in Wyoming. To further reduce fatal crashes involving
protect the safety of their teen drivers. Campaign materi- young drivers, states should periodically reexamine and update
als are available at http://www.cdc.gov/parentsarethekey. graduated driver licensing (GDL) programs, and communities
CDC also has released the issue brief Policy Impact: Teen should vigorously enforce laws on minimum legal drinking age,
Driver Safety, which is available at http://www.cdc.gov/ blood alcohol concentration (BAC), and safety belt use, all of
motorvehiclesafety/teenbrief. which can reduce the number of fatal crashes among young
Additional information regarding National Teen Driver drivers.
Safety Week is available from CDC at http://www.cdc.gov/ FARS is a census of fatal traffic crashes in the United
motorvehiclesafety/teen_drivers/index.html and from the States maintained by the National Highway Traffic Safety
National Highway Traffic Safety Administration at http:// Administration. For this study, records of drivers involved in
www.nhtsa.gov/Teen-Drivers. fatal crashes during 2004–2008 were examined. A fatal crash

References
1. National Highway Traffic Safety Administration. Fatality Analysis INSIDE
Reporting System (FARS) encyclopedia. Available at http://www-fars.
nhtsa.dot.gov. Accessed October 14, 2010. 1335 HIV Transmission Through Transfusion —
2. CDC. Drivers aged 16 or 17 years involved in fatal crashes—United Missouri and Colorado, 2008
States, 2004–2008. MMWR 2010;59:1329–34. 1340 State Medicaid Coverage for Tobacco-Dependence
3. Shope J. Graduated driver licensing: review of evaluation results since Treatments — United States, 2009
2002. J Safety Res 2007;38:165–75.
1344 Announcements
1345 QuickStats

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention
www.cdc.gov/mmwr
 MMWR Morbidity and Mortality Weekly Report

was defined as one in which at least one vehicle occu- resulted in two fatalities, and 234 (3%) resulted in
pant or nonoccupant (e.g., bicyclist or pedestrian) three or more fatalities.
involved in the crash died within 30 days of the crash. Of the 11,019 persons who died in these crashes,
Analyses were restricted to drivers of passenger vehicles 4,071 (37%) were drivers aged 16 or 17 years; 3,428
(i.e., automobiles, sport utility vehicles, pickup trucks, (31%) were passengers of those drivers; 1,987 (18%)
and vans). Of the 10,048 drivers aged 16 or 17 years were drivers of other vehicles (aged ≥18 years, aged
involved in fatal crashes, 9,644 (96%) drove passenger <16 years, and of unknown age); and 805 (7.3%)
vehicles. U.S. census population estimates for persons were passengers of those other drivers. Another 728
aged 16 or 17 years and persons aged ≥18 years were (6.7%) persons were other road users (e.g., bicyclists
used to calculate rates of fatal crash involvement. To or pedestrians).
examine state-specific rates for drivers aged 16 or A total of 6,280 (65%) drivers aged 16 or 17 years
17 years involved in fatal crashes, 2004–2008 crash involved in fatal crashes were male; 3,429 (36%) of
data and census data were aggregated separately, and drivers in the age group were reported speeding at the
an annualized rate was calculated for each state. The time of the crash. Of the 4,459 (46%) whose BAC
annualized rates then were compared with 2008 levels were known, 3,512 (79%) had zero BAC. Of
state-specific fatality rates for all crashes involving the 947 drivers with a positive BAC, levels ranged
passenger vehicles. from 0.01 g/dL to 0.55 g/dL, with a median of 0.11
During 2004–2008, a total of 9,644 drivers aged g/dL; 678 (72%) of these drivers had a BAC of ≥0.08
16 or 17 years were involved in 9,494 fatal crashes. g/dL, above the legal limit for drivers aged ≥21 years.
A total of 4,705 (50%) crashes involved one vehicle; Drivers aged <21 years, who cannot purchase alcohol
3,976 (42%) involved two vehicles; and 813 (8%) legally, are subject to lower BAC limits in every state
involved three or more vehicles. A total of 8,274 (i.e., >0.00 g/dL, ≥0.01 g/dL, or ≥0.02 g/dL, depend-
(87%) crashes resulted in one fatality, 986 (10%) ing on the state).

The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, 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 2010;59:[inclusive page numbers].
Centers for Disease Control and Prevention
Thomas R. Frieden, MD, MPH, Director
Harold W. Jaffe, MD, MA, Associate Director for Science
James W. Stephens, PhD, Office of the Associate Director for Science
Stephen B. Thacker, MD, MSc, Deputy Director for Surveillance, Epidemiology, and Laboratory Services

MMWR Editorial and Production Staff

Ronald L. Moolenaar, MD, MPH, Editor, MMWR Series
John S. Moran, MD, MPH, Deputy Editor, MMWR Series Martha F. Boyd, Lead Visual Information Specialist
Robert A. Gunn, MD, MPH, Associate Editor, MMWR Series Malbea A. LaPete, Stephen R. Spriggs, Terraye M. Starr
Teresa F. Rutledge, Managing Editor, MMWR Series Visual Information Specialists
Douglas W. Weatherwax, Lead Technical Writer-Editor Quang M. Doan, MBA, Phyllis H. King
Donald G. Meadows, MA, Jude C. Rutledge, Writer-Editors Information Technology Specialists

MMWR Editorial Board

William L. Roper, MD, MPH, Chapel Hill, NC, Chairman
Virginia A. Caine, MD, Indianapolis, IN Patricia Quinlisk, MD, MPH, Des Moines, IA
Jonathan E. Fielding, MD, MPH, MBA, Los Angeles, CA Patrick L. Remington, MD, MPH, Madison, WI
David W. Fleming, MD, Seattle, WA Barbara K. Rimer, DrPH, Chapel Hill, NC
William E. Halperin, MD, DrPH, MPH, Newark, NJ John V. Rullan, MD, MPH, San Juan, PR
King K. Holmes, MD, PhD, Seattle, WA William Schaffner, MD, Nashville, TN
Deborah Holtzman, PhD, Atlanta, GA Anne Schuchat, MD, Atlanta, GA
John K. Iglehart, Bethesda, MD Dixie E. Snider, MD, MPH, Atlanta, GA
Dennis G. Maki, MD, Madison, WI John W. Ward, MD, Atlanta, GA

1330 MMWR / October 22, 2010 / Vol. 59 / No. 41

 MMWR Morbidity and Mortality Weekly Report

TABLE 1. Number and annual rate* of drivers† involved in fatal crashes, by age group — Fatality Analysis Reporting System, United States,
2004–2008
2004 2005 2006 2007 2008 2004 to 2008
Age group
(yrs) Total No. Rate No. Rate No. Rate No. Rate No. Rate No. change (%) Rate change (%)
16 or 17 9,644 2,230 27.1 2,054 24.5 2,020 23.4 1,903 21.8 1,437 16.7 -36 -38
≥18 214,054 45,145 20.5 45,360 20.4 43,963 19.6 42,143 18.5 37,443 16.3 -18 -20
* Per 100,000 population in age group.
† Of passenger vehicles (i.e., automobiles, sport utility vehicles, pickup trucks, and vans).

From 2004 to 2008, the annual number of drivers FIGURE. Annual rate* for drivers† aged 16 or 17 years involved in fatal crashes,
aged 16 or 17 years involved in fatal crashes decreased by age group — Fatality Analysis Reporting System, United States, 1990–2008
45
36%, from 2,230 to 1,437 (Table  1). Continuing
a general decline that began in 1996 (Figure), the 40

population-based rate for drivers aged 16 or 17 years 35

involved in fatal crashes decreased 38%, from 27.1 per 30

100,000 population in 2004 to 16.7 in 2008 (Table 25
1). During 2004–2008, year-to-year decreases in the Rate 20 16 or 17 yrs
rate ranged from 5% from 2005 to 2006 to 23% from 15
17 yrs
16 yrs
2007 to 2008. In comparison, the rate for drivers aged 10
≥18 years involved in fatal crashes declined 20%,
5
from 20.5 per 100,000 population in 2004 to 16.3
0
per 100,000 in 2008. Year-to-year declines in the rate 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
of fatal crash involvement for drivers aged ≥18 years Year
ranged from <1% from 2004 to 2005 to 12% from * Per 100,000 population in age group.
† Of passenger vehicles (i.e., automobiles, sport utility vehicles, pickup trucks, and vans).
2007 to 2008 (Table 1).
Among states, the 5-year annualized rate for
drivers aged 16 or 17 years involved in fatal crashes discretionary travel) because of rising gasoline prices
ranged from 9.7 per 100,000 population in New and adverse economic conditions (3). Economic
York and New Jersey to 59.6 in Wyoming (Table 2). downturns are believed to produce greater cutbacks in
These state-specific rates correlated strongly with 2008 travel for drivers with limited funds, including teens
state-specific fatality rates from all crashes involving (3). Additionally, some teens might delay obtaining
passenger vehicles (Pearson correlation coefficient = drivers licenses for financial reasons during adverse
0.8) (Table 2). economic conditions, reducing the number of overall
miles driven by teens.
Reported by The decline during 2004–2008 in the rate of young
Shults RA, PhD, Ali B, MPH, Div of Unintentional drivers involved in fatal crashes extends a long-term
Injury Prevention, National Center for Injury Prevention downward trend (2). From 1996 to 2008, the rate for
and Control, CDC. drivers aged 16 or 17 years involved in fatal crashes fell
approximately 50%, from 36.0 per 100,000 popula-
Editorial Note
tion (2) to 16.7. GDL programs are widely credited
The results described in this report indicate that with contributing to this decline. A recent review of
the population-based rate for drivers aged 16 or 17 GDL evaluations concluded that the programs have
years involved in fatal crashes continued to decline reduced young driver crash risk by approximately
substantially during 2004–2008, most notably 20% to 40% (4). First implemented in the United
from 2007 to 2008, when the rate decreased 23%. States in 1996 in Florida, GDL programs now oper-
Among drivers aged ≥18 years, the rate decreased ate in 49 states and the District of Columbia.* The
12% from 2007 to 2008. Reasons for the decreases programs initially limit teens’ independent driving
in rates of involvement in fatal crashes are unknown
but they have been attributed, in part, to decreases * Additional information available at http://www.iihs.org/laws/
in the number of vehicle miles traveled (particularly graduatedlicenseintro.aspx.

MMWR / October 22, 2010 / Vol. 59 / No. 41 1331

 MMWR Morbidity and Mortality Weekly Report

TABLE 2. Number and 5-year annualized rate* for drivers† aged 16 or 17 years involved in fatal crashes and 2008 fatality rate from all crashes
involving passenger vehicles, by state§ — Fatality Analysis Reporting System, United States, 2004–2008
5-year annualized rate, Fatality rate from all crashes involving
State 2004 2005 2006 2007 2008 2004–2008¶ passenger vehicles, 2008¶
Alabama 80 63 71 53 45 48.0 18.7
Alaska 4 1 5 10 4 21.4 7.4
Arizona 58 40 47 33 35 24.5 11.9
Arkansas 41 35 35 28 24 40.9 18.2
California 145 143 136 130 67 11.6 8.0
Colorado 50 33 29 30 21 25.0 9.5
Connecticut 19 13 12 12 12 13.8 6.3
Delaware 16 8 6 8 4 35.8 12.4
District of Columbia 3 0 0 0 0 —** 4.6
Florida 140 149 137 138 110 28.8 14.1
Georgia 79 85 83 83 66 29.2 13.6
Hawaii 9 2 3 1 2 — 6.8
Idaho 13 21 15 15 9 32.7 13.1
Illinois 78 69 86 80 31 18.9 7.1
Indiana 73 57 59 49 47 31.6 11.3
Iowa 29 26 27 33 16 30.9 11.9
Kansas 26 29 25 30 19 31.9 11.9
Kentucky 50 50 52 37 31 38.2 16.7
Louisiana 59 27 34 37 30 28.4 18.7
Maine 16 6 18 10 6 30.1 9.9
Maryland 39 38 31 29 31 20.7 9.5
Massachusetts 25 23 27 22 13 12.6 4.9
Michigan 76 58 50 63 47 19.6 8.8
Minnesota 47 43 42 29 22 24.4 7.4
Mississippi 47 55 41 40 26 47.6 25.0
Missouri 80 83 64 57 48 39.4 14.6
Montana 6 6 6 4 13 25.0 19.7
Nebraska 18 20 21 28 18 40.8 10.4
Nevada 15 19 16 13 11 22.1 10.7
New Hampshire 17 4 6 12 4 22.6 9.2
New Jersey 12 33 33 18 21 9.7 6.1
New Mexico 19 19 18 12 17 29.2 15.6
New York 65 58 53 55 33 9.7 5.3
North Carolina 89 79 72 86 57 31.9 14.0
North Dakota 3 2 13 10 6 37.7 13.4
Ohio 73 73 73 61 62 20.7 8.9
Oklahoma 42 42 39 37 31 37.4 18.2
Oregon 18 19 15 18 5 14.7 9.5
Pennsylvania 78 71 60 82 55 19.8 9.9
Rhode Island 6 6 5 6 3 18.0 5.4
South Carolina 41 36 51 39 30 32.0 18.4
South Dakota 6 8 10 8 12 37.3 13.1
Tennessee 67 69 61 56 42 35.4 15.0
Texas 172 161 145 149 121 21.6 11.9
Utah 22 17 21 15 9 20.2 8.5
Vermont 6 3 6 4 4 25.4 11.1
Virginia 57 48 49 42 48 23.5 9.6
Washington 20 25 38 28 19 14.4 6.8
West Virginia 13 14 15 12 9 27.1 18.5
Wisconsin 56 55 50 39 34 29.0 9.3
Wyoming 7 10 9 12 7 59.6 24.8
* Per 100,000 population in age group.
† Of passenger vehicles (i.e., automobiles, sport utility vehicles, pickup trucks, and vans).
§ Includes District of Columbia.
¶ Pearson correlation coefficient = 0.8. Compares state-level annualized rates for drivers aged 16 or 17 years involved in fatal crashes during 2004–2008 with 2008
fatality rates from all crashes involving passenger vehicles.
** Rates suppressed because numerators were <20.

1332 MMWR / October 22, 2010 / Vol. 59 / No. 41

 MMWR Morbidity and Mortality Weekly Report

The findings in this report are subject to at least

What is already known on this topic?
four limitations. First, population-based crash rates do
Teen drivers have the highest motor vehicle crash risk not account for driving exposure. This limitation is of
of any age group, and crashes are the leading cause of
death among teens in the United States.
particular concern because the age at which teens may
begin to drive independently varies by state from 14
What is added by this report?
years to 17 years; therefore, the proportion of persons
The national rate for drivers aged 16 or 17 years
aged 16 or 17 years who are eligible to drive without
involved in fatal crashes declined 38% from 2004 to
2008 to 16.7 per 100,000 population; however, rates adult supervision varies widely by state. Ideally, stud-
among states ranged from 9.7 to 59.6. ies of young driver crash risk would include measures
What are the implications for public health practice? such as the number of miles driven or number of
To further reduce crashes among young drivers, states
licensed teen drivers. Reliable data on these driv-
should ensure that their graduated driver licensing ing exposure measures are not readily available for
programs include all effective measures, including research (2,7). To help facilitate collection of data on
extended learner periods, nighttime driving restric- driving exposure, the Transportation Research Board’s
tions, and passenger restrictions. Subcommittee on Young Drivers recently identified
documenting the amount and type of driving done
under various high-risk conditions, such as nighttime by teens as one of five high-priority research needs
driving or carrying teen passengers. All U.S. GDL (7). Second, the two variables used in calculating the
programs include a nighttime driving restriction, and Pearson correlation coefficient were not completely
42 states and the District of Columbia include a teen independent because fatalities resulting from crashes
passenger restriction. CDC recommends that families involving drivers aged 16 or 17 years were included
of newly licensed teen drivers actively enforce GDL in the 2008 state-specific fatality rates for all crashes
requirements with a parent-teen driving contract (5). involving passenger vehicles. The effect is small, how-
Other factors that likely contributed to the long-term ever, because only 5% of passenger vehicle fatalities in
decline in fatal crashes involving young drivers include 2008 involved a driver aged 16 or 17 years. Third, any
improvements in vehicle and road safety, increased fatalities that occur >30 days postcrash are excluded
seat belt use, and reductions in driving after drinking from FARS. Finally, caution should be used in inter-
alcohol (6). preting the differences in fatal crash involvement rates
State-specific rates of drivers aged 16 or 17 years among states because many factors that vary by state
involved in fatal crashes varied by sixfold. By state, contribute to crash risk.
the strong correlation between rates for young driv- GDL programs vary in makeup; the more com-
ers involved in fatal crashes and fatality rates from prehensive programs are associated with larger crash
all crashes involving passenger vehicles suggests that reductions (8). To further reduce crashes among
state-specific differences in the driving environment young drivers, states should ensure that their GDL
(e.g., degree of urbanization, speed limits, amounts programs include all of the components with dem-
and types of travel, weather, state traffic laws, rates onstrated effectiveness, including extended learner
of licensure, and emergency-care capabilities) have periods, nighttime driving restrictions, and pas-
similar effects on fatal crash risk for drivers of all senger restrictions (9). As GDL programs evolve
ages.† The relatively low rates of crash involvement and additional evaluation results become available,
for young drivers in New Jersey and New York might states should reexamine their programs and consider
be related to licensing policies. New Jersey is the only implementing additional components that have been
state with a minimum licensing age of 17 years; in proven effective. Additionally, communities should
New York City, the minimum age is 18 years, except vigorously enforce existing laws known to be effective
for persons who take a state-approved driver educa- among young drivers and the general driving popula-
tion course and meet other requirements, who may tion, including laws on minimum legal drinking age,
be licensed at aged 17 years. BAC, and safety belt use. Information regarding the
effectiveness of these strategies is available at http://
www.thecommunityguide.org/mvoi/index.html.
† Additional information available at http://www.iihs.org/research/
fatality_facts_2008/statebystate.html.

MMWR / October 22, 2010 / Vol. 59 / No. 41 1333

 MMWR Morbidity and Mortality Weekly Report

Acknowledgments 5. CDC. Parents Are the Key Campaign. US Department of

Health and Human Services, CDC; 2010. Available at http://
The findings in this report are based, in part, on the www.cdc.gov/parentsarethekey/about/index.html. Accessed
contributions of T Lindsey, National Highway Traffic Safety October 18, 2010.
Admin, District of Columbia, and AF Williams, PhD. 6. CDC. Achievements in public health, 1900–1999 motor-
vehicle safety: a 20th century public health achievement.
References MMWR 1999;48:369–74.
1. CDC. WISQARS (Web-based Injury Statistics Query and 7. Transportation Research Board Subcommittee on Young
Reporting System). Atlanta, GA: US Department of Health Drivers. Future directions for research on motor vehicle
and Human Services, CDC; 2010. Available at http://www.cdc. crashes and injuries involving teenage drivers. Washington,
gov/injury/wisqars/index.html. Accessed October 18, 2010 DC: Transportation Research Board; 2009. Available at http://
2. Ferguson SA, Teoh ER, McCartt AT. Progress in teenage crash claire.hsrc.unc.edu/~foss/2008rpt.pdf. Accessed October 18,
risk during the last decade. J Safety Res 2007;38:137–45. 2010.
3. Sivak M. Is the U.S. on the path to the lowest motor vehicle 8. McCartt AT, Teoh ER, Fields M, Braitman KA, Hellinga LA.
fatalities in a decade? Ann Arbor, MI: University of Michigan Graduated licensing laws and fatal crashes of teenage drivers:
Transportation Research Institute; 2008. Available at http:// a national study. Traffic Inj Prev 2010;11:240–8.
deepblue.lib.umich.edu/bitstream/2027.42/60424/1/100969. 9. Williams AF. Contribution of the components of graduated​
pdf. Accessed October 18, 2010. driver licensing to crash reduction. J Safety Res 2007;38:​
4. Shope J. Graduated driver licensing: review of evaluation results 177–84.
since 2002. J Safety Res 2007;38:166–75.

1334 MMWR / October 22, 2010 / Vol. 59 / No. 41

 MMWR Morbidity and Mortality Weekly Report

HIV Transmission Through Transfusion —

Missouri and Colorado, 2008
Transmission of human immunodeficiency was found to be HIV infected, and an investigation
virus (HIV) through transfusion of contami- determined that the patient’s infection was acquired
nated blood components was documented in the from the donor’s blood products. Even though such
United States in 1982 (1). Since then, the risk for transmissions are rare, health-care providers should
transfusion-transmitted HIV infection has been almost consider the possibility of transfusion-transmitted
eliminated by the use of questionnaires to exclude HIV in HIV-infected transfusion recipients with no
donors at higher risk for HIV infection and the use of other risk factors.
highly sensitive laboratory screening tests to identify
infected blood donations. The risk for acquiring HIV Case Reports
infection through blood transfusion today is estimated Donor. In June 2008, a man in his forties donated
conservatively to be one in 1.5 million, based on whole blood at a blood center in Missouri (Figure 1).
2007–2008 data (2). This report describes the first He was a repeat blood donor who reported no HIV
U.S. case of transfusion-transmitted HIV infection risk factors on the routine eligibility screening ques-
reported to CDC since 2002 (3). A blood center in tionnaire. He was not compensated for his blood
Missouri discovered that blood components from a donation. His whole blood donation was screened at
donation in November 2008 tested positive for HIV a reference laboratory for HIV by enzyme immuno-
infection. A lookback investigation determined that this assay (EIA) (Genetic Systems HIV-1/HIV-2 Plus O
donor had last donated in June 2008, at which time EIA, Bio-Rad Laboratories, Redmond, Washington)
he incorrectly reported no HIV risk factors and his and by nucleic acid amplification testing of minipools
donation tested negative for the presence of HIV. One of plasma specimens (MP-NAT) from 16 donations
of the two recipients of blood components from this (Procleix HIV-1 Nucleic Acid Test, Gen Probe,
donation, a patient undergoing kidney transplantation, San Diego, California); both tests were negative.

FIGURE 1. Sequence of events for a case of transfusion-transmitted HIV infection — Missouri and Colorado, 2008

Day 175: MDHSS notified of donor with possible HIV infection

Day 0: Donor’s first blood donation (June 2008)

Day 179: Transplant surgeon for recipient B notified that the donor
of the fresh frozen plasma had tested positive for HIV infection
Day 33: Recipient A receives red blood cells
Day 182: Recipient B has virologic evidence of
Day 35: Recipient A dies from complications of illness HIV infection; antiretroviral therapy is initiated

Day 69: Recipient B receives Day 253: CDPHE completes investigation

fresh frozen plasma during and sends results to CDC
kidney transplant
Day 301: Donor agrees to
Day 168: NAT for donor’s blood tests be interviewed by MDHSS,
positive for HIV infection; blood bank and confirmatory testing
initiates lookback investigation of is completed (April 2009)
previous donations
Day 358: Donor
Day 162: Donor’s second blood enrolls in
donation (November 2008) HIV care

0 14 28 42 56 70 84 98 112 126 140 154 168 182 196 210 224 238 252 266 280 294 308 322 336 350 364
Day

Abbreviations: HIV = human immunodeficiency virus; NAT = nucleic acid amplification testing; MDHSS = Missouri Department of Health and Senior Services;
CDPHE = Colorado Department of Public Health and Environment.

MMWR / October 22, 2010 / Vol. 59 / No. 41 1335

 MMWR Morbidity and Mortality Weekly Report

Components from this donation later were trans- receiving regular hemodialysis for management of
fused into two recipients. No specimens from this kidney failure since July 2005. From that date to the
donation were stored. In November 2008, the man date of kidney transplantation, the patient reported no
donated blood again at the same blood center and behavioral or health-care–related risk factors for HIV
again reported no risk factors on the routine eligibility infection and did not received blood components. The
screening questionnaire. At that time, his blood tested kidney donor tested negative for HIV infection by
positive for HIV by EIA, MP-NAT, and indirect EIA and NAT at the time of organ donation.
immunofluorescence assay (Fluorognost HIV-1 IFA, In December 2008, MDHSS notified the Colorado
Sanochemia Corporation, Vienna, Austria). The man Department of Public Health and Environment
was placed on the list of donors who are indefinitely (CDPHE) that the plasma was from a donor who
ineligible for future donation, all products from this subsequently tested positive for HIV, and CDPHE
donation were destroyed, and the man was notified by notified the recipient’s transplant surgeon. When the
the blood center of his probable HIV infection. The recipient visited the transplant clinic in December
Missouri Department of Health and Senior Services 2008, serum was nonreactive by HIV EIA, but plasma
(MDHSS) was notified of this case on December 4, HIV RNA viral load was 7,240 copies/mL, and CD4
2008. Because of the rare possibility that the donor cell count was very low (48 cells/µL). At this time,
might have been infected shortly before his June 2008 the recipient was placed on antiretroviral therapy. The
donation and donated blood that contained HIV at patient also was receiving mycophenolic acid, a drug
a concentration too low to be detected, an investiga- used to prevent rejection in organ transplantation
tion was initiated to determine whether recipients that is also a potent inhibitor of both lymphocyte
of the June donation had been infected with HIV, proliferation and HIV replication in CD4+ T cells
consistent with regulatory requirements to investigate and macrophages. Physical examination demonstrated
such events. no other signs or symptoms of HIV infection. After
Initially, the donor declined repeated contacts by antiretroviral therapy was initiated, the patient’s HIV
MDHSS to be interviewed. In April 2009, he agreed RNA viral load became undetectable, and CD4 cell
to a brief interview with MDHSS, and an OraQuick count increased to 88 cells/µL in June 2009. HIV EIA
rapid HIV test (OraSure Technologies, Bethlehem, repeated in April 2009 was reactive, but the Western
Pennsylvania) was performed. This test was reactive blot was indeterminate, with reactivity to the nonviral
and confirmed by a positive Western blot at MDHSS. p38 and p42 bands and weak reactivity to gp120.
During his interview, the donor reported he was mar- HIV DNA from blood specimens collected
ried but had sex with both men and women outside from the donor and the recipient was amplified and
of his marriage, including just before his June 2008 sequenced at CDC. Comparison of these sequences
donation. He indicated that the sex often was anony- demonstrated that the virus from the donor and
mous and occurred while he was intoxicated. recipient were greater than 99% identical, confirming
Recipients. The investigation initiated by the that the donor’s 2008 donation was the source of the
blood center identified two recipients of blood recipient’s HIV infection.
components (packed red blood cells and fresh frozen
Reported by
plasma) derived from the donor’s June 2008 donation.
In July 2008, one unit of packed red blood cells from B Laffoon, Missouri Dept of Health and Senior Svcs.
the donor was transfused into a patient in Arkansas A Crutchfield, Colorado Dept of Public Health and
during cardiac surgery. This patient died 2 days later Environment. M Levi, MD, Univ of Colorado at
from cardiac disease; no premortem or postmortem Denver. WA Bower, MD, M Kuehnert, MD, Office
material was available for testing, and it was unknown of Blood, Organ, and Other Tissue Safety, Div Health
whether the patient had been infected with HIV. Care Quality Promotion, National Center for Emerg-
In August 2008, one unit of fresh frozen plasma ing and Zoonotic Infectious Diseases; JT Brooks, MD,
from the donor was transfused into a patient receiving RM Selik MD, WM Switzer, MPH, W Heneine, PhD,
a kidney transplant in Colorado. The recipient’s most A Shankar, MS, MSc, AD Iuliano, PhD, Div of HIV/
recent negative serum test for HIV infection (using AIDS Prevention, National Center for HIV, Hepatitis,
HIV EIA) was in July 2005. The patient had been STD, and Tuberculosis Prevention, CDC.

1336 MMWR / October 22, 2010 / Vol. 59 / No. 41

 MMWR Morbidity and Mortality Weekly Report

Editorial Note FIGURE 2. Number of cases of transfusion-transmitted HIV infection from con-
taminated blood products, by transfusion year — United States, 1985–2008
This report describes the first U.S. case of trans-
18
fusion-transmitted HIV infection reported* to CDC
since 2002 (3) (Figure 2). The sequence of events in 16

this case is consistent with transmission by transfu- 14

sion of HIV-contaminated plasma collected from a 12
donor during the eclipse period of acute infection

Number
10
(i.e., the interval between infection and the develop-
ment of detectable concentrations of HIV RNA in 8

plasma) to a recipient treated with medication that 6

suppressed HIV replication, reduced the CD4 lym-
4
phocyte count, and blunted the humoral response to
2
HIV infection.
In 1999, U.S. blood banks implemented HIV 0
NAT for blood donations to reduce HIV transmis- 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007
Year
sion from recently infected donors. NAT can detect
the presence of HIV earlier in the course of infection in screening by MP-NAT makes this method slightly
than serologic methods, which only detect antibodies less sensitive than ID-NAT (3.8 compared with 6.9
against HIV, thus reducing the window period (i.e., infections prevented per year, respectively); however,
the interval between infection and development of ID-NAT is substantially less cost effective (7).
detectable HIV markers in blood) from 22 days to Widespread adoption of effective HIV testing
approximately 10–15 days (4,5). However, NAT methods to screen donated blood has greatly reduced
cannot detect HIV infections during the eclipse the risk for transfusion-transmitted HIV infection.
period, estimated to average 9 days based on limited The modeled risk for HIV infection from transfu-
data (6). sion of blood products in the United States declined
The Food and Drug Administration (FDA) from one in 450,000–600,000 donations in 1995
requires blood centers to assess donor eligibility to one in 2,135,000 donations from 1995 to 2001
using a screening questionnaire and to test donations after the introduction of NAT in 1999 (8) and was
for infections to reduce the risk for transfusion- recently updated to one in 1,467,000 based on data
transmitted disease.† FDA currently requires testing from 2007–2008, which incorporates the increased
blood donations for HIV using both licensed serologic incidence of HIV among blood donors (2). However,
testing and NAT, which can detect HIV RNA at a even the most sensitive screening technologies cur-
minimum concentration of approximately 5.5 copies/ rently available cannot identify the presence of HIV
mL.§ NAT can be conducted on individual specimens infection during the first few days after infection,
(ID-NAT) or pooled specimens (MP-NAT). The when neither HIV RNA nor HIV-specific antibodies
number of specimens pooled for MP-NAT is based have reached detectable levels.
on manufacturer’s specifications and FDA’s test sen- Transfusion-transmitted HIV infection, although
sitivity requirements.¶ The dilution effect inherent rare, likely is underrecognized, and every case warrants
a detailed investigation. Three previous cases of HIV
* A suspected case of transfusion-transmitted HIV infection in the
United States in 2006 has been identified by a blood center through infection attributable to transfusion of infected blood
donor screening, but not reported to national surveillance. products that tested negative by HIV NAT and EIA
† Additional information available at http://www.fda.gov/bio​
logicsbloodvaccines/guidancecomplianceregulatoryinformation/
because of donation during the eclipse period were
guidances/blood/ucm073445.htm. identified and reported to CDC in 2000 (9) and 2002
§ Additional information available at http://www.fda.gov/downloads/
(10). Assuming that 16 million donations occur each
biologicsbloodvaccines/bloodbloodproducts/approvedproducts/
licensedproductsblas/blooddonorscreening/infectiousdisease/ year** and using the most conservative estimated risk
ucm092036.pdf.
¶ Additional information available at http://www.fda.gov/down​
loads/biologicsblood%20vaccines/guidancecomplianceregulatory​ ** Additional information available at http://www.hhs.gov/ophs/blood​
information/guidances/blood/ucm210270.pdf. safety/2007nbcus_survey.pdf.

MMWR / October 22, 2010 / Vol. 59 / No. 41 1337

 MMWR Morbidity and Mortality Weekly Report

before their HIV diagnosis, 3) inability to confirm

What is already known on this topic?
or rule out transfusion as the source of infection
Transfusion-transmitted cases of HIV infection are because no HIV-infected donors were identified, 4)
rare, but still might occur despite screening question-
naires for deferral of at-risk donations and improve-
underrecognition of HIV infections among recipients
ments in laboratory testing for detecting HIV in blood of potentially infected blood or blood components
products. who recover and might never have been subsequently
What is added by this report? tested for HIV infection, or 5) misclassification of a
This report describes the first case of transfusion- transfusion-transmitted HIV infection in a person
transmitted HIV infection reported to CDC since 2002. who also had other risk factors more frequently asso-
What are the implications for public health practice? ciated with HIV transmission (e.g., male-to-male
Although transfusion-transmitted HIV infection is a
sexual contact or injection drug use) to which that
rare event, clinicians and health departments should infection was attributed. Adoption of CDC’s 2006
evaluate the possibility of such an event in a patient recommendation for routine opt-out HIV testing
with no other known risk factors for HIV infection. If a recommendations, whereby all persons are tested
case of transfusion-transmitted HIV infection is identi- for HIV as part of routine health care unless they
fied, clinicians should report the case through their
decline, might reduce the possibility of unrecognized
public health surveillance system and collaborate
with blood collection centers and health departments transfusion-transmitted infections and possibly reduce
to conduct an investigation. donations by HIV-infected persons being made aware
of their status.§§ Additionally, blood centers might
consider the logistics, costs, and potential benefits of
for HIV infection of one in 1.5 million donations (2),
saving specimens of blood so that retrospective test-
approximately 11 infectious donations and 20 HIV-
ing can be conducted if transfusion-transmitted HIV
positive blood components released each year could
infection is suspected.
potentially infect recipients. In this case, eligibility
Although the risk for transfusion-transmitted
screening questions,†† if answered accurately, would
HIV infection is extremely low in the United States,
have excluded the donor because of his sexual history.
transfusion should be considered along with other
It is the responsibility of persons who donate blood to
possible sources of HIV infection in a patient who
answer screening questionnaires accurately to ensure
has no other HIV risk factors. These investigations
the safest blood supply possible.
are most effective if conducted as soon as they are
Blood collection centers conduct investigations of
recognized and in collaboration with the blood center,
previous donations when a positive antibody or NAT
transfusing health-care facilities, and state and local
result is identified in a repeat donor. However, fewer
health departments. The National Healthcare Safety
than the expected number of cases of transfusion-
Network (NHSN) is a voluntary, secure, Internet-
transmitted HIV infection were reported to CDC
based surveillance system designed to collect data
from 2002 to 2008, a 6-year period when an estimated
from a sample of U.S. health-care facilities to permit
16 million units of blood or blood components were
valid estimation of the magnitude of adverse events
donated annually. Because the number of reported
among patients. The Hemovigilance Module added
cases is lower than expected, risk estimates might have
this year to the NHSN’s Biovigilance Component¶¶
been too high. Alternatively, transfusion-transmitted
was designed specifically to bolster the collaborative
HIV infections might have gone unreported either
capacity of public health and private industry to detect
because of 1) recipient death attributed to the under-
adverse events (e.g., HIV infections) associated with
lying condition or some other cause before detection
transfusion. Findings from Hemovigilance Module
of HIV infection from the receipt of infected blood
surveillance data will be used to improve the safety
or blood components, 2) poor recall by infected per-
of the blood supply in the United States.
sons regarding receipt of blood or blood components
§§ Additional information available at http://www.cdc.gov/mmwr/
†† Additionalinformation available at http://www.fda.gov/ preview/mmwrhtml/rr55/14a1.htm.
biologicsbloodvaccines/bloodbloodproducts/approvedproducts/ ¶¶ Additional information available at http://www.cdc.gov/nhsn/bio.
licensedproductsblas/blooddonorscreening/ucm164185.htm. html.

1338 MMWR / October 22, 2010 / Vol. 59 / No. 41

 MMWR Morbidity and Mortality Weekly Report

References 6. Keele BF, Giorgi EE, Salazar-Gonzalez JF, et al. Identification

1. CDC. Possible transfusion-associated acquired immune and characterization of transmitted and early founder virus
deficiency syndrome (AIDS)—California. MMWR 1982;31:​ envelopes in primary HIV-1 infection. Proc Natl Acad Sci U
652–4. S A 2008;105:7552–7.
2. Zou S, Dorsey KA, Notari EP, et al. Prevalence, incidence, 7. Jackson BR, Busch MP, Stramer SL, AuBuchon JP. The cost-
and residual risk of human immunodeficiency virus and effectiveness of NAT for HIV, HCV, and HBV in whole-blood
hepatitis C virus infections among United States blood donors donations. Transfusion 2003;43:721–9.
since the introduction of nucleic acid testing. Transfusion 8. Dodd RY, Notari EP, Stramer SL. Current prevalence
2010;50:1495–504. and incidence of infectious disease markers and estimated
3. Stramer SL. Third reported US case of breakthrough HIV window-period risk in the American Red Cross blood donor
transmission from NAT screened blood. Transmission population. Transfusion 2002;42:975–9.
2003;43(Supplement):40A. 9. Delwart EL, Kalmin ND, Jones TS, et al. First report of
4. Busch MP, Dodd RY. NAT and blood safety: what is the human immunodeficiency virus transmission via an RNA-
paradigm? Transfusion 2000;40:1157–60. screened blood donation. Vox Sang 2004;86:171–7.
5. Stramer SL, Caglioti S, Strong DM. NAT of the United States 10. Phelps R, Robbins K, Liberti T, et al. Window-period human
and Canadian blood supply. Transfusion 2000;40:1165–8. immunodeficiency virus transmission to two recipients by an
adolescent blood donor. Transfusion 2004;44:929–33.

MMWR / October 22, 2010 / Vol. 59 / No. 41 1339

 MMWR Morbidity and Mortality Weekly Report

State Medicaid Coverage for Tobacco-Dependence Treatments —

United States, 2009
Medicaid enrollees have nearly twice the smoking directed to relevant contacts in each state via telephone
rates (37%) of the general adult population (21%), or e-mail. The response rate was 100%. To validate
and smoking-related medical costs are responsible survey responses, Medicaid programs were asked to
for 11% of Medicaid expenditures (1,2). In 2008, submit documentation of their tobacco-dependence
the Public Health Service released clinical practice treatment coverage policies. Of the 47 programs
guidelines recommending comprehensive coverage that indicated they covered at least one tobacco-
of effective tobacco-dependence medications and dependence treatment, supporting documentation
counseling by health insurers (3). Healthy People 2010 was obtained for 44 (94%) programs. For programs
established a clear objective for Medicaid programs without complete documentation, the information
to cover all Food and Drug Administration–approved given by the respondent was confirmed with a second
medications and counseling for tobacco cessation (4). respondent within that state before being accepted
To monitor progress toward that objective, the Center as accurate.
for Health and Public Policy Studies at the University Among the 51 Medicaid programs, 47 provided
of California, Berkeley, in collaboration with CDC, tobacco-dependence treatment coverage for some
surveyed Medicaid programs in the 50 states and enrollees, 38 covered at least one tobacco-dependence
the District of Columbia (DC) to document their treatment for all Medicaid enrollees, and four
2009 tobacco-dependence treatment coverage and (Connecticut, Georgia, Missouri, and Tennessee)
found that 47 programs offered coverage. Only eight offered no coverage for tobacco-dependence treat-
state programs offered coverage of all recommended ment to their enrollees. Coverage for all enrollees
pharmacotherapy and counseling for all Medicaid was defined as coverage that did not differ between
enrollees, and 16 programs reported coverage for fee- fee-for-service (FFS) and managed-care organization
for-service enrollees that differed from that provided (MCO) enrollees. Coverage for all Medicaid enrollees
for Medicaid managed-care enrollees. Among the was reported for the nicotine patch (34 programs),
33 programs that covered at least one combination bupropion or Zyban* (33 programs), nicotine gum
therapy, the nicotine patch plus bupropion slow (32 programs), varenicline (Chantix) (32 programs),
release (SR) was the one combination covered by all. nicotine nasal spray (28 programs), nicotine inhalers
The Affordable Care Act mandates Medicaid coverage (27 programs), and nicotine lozenges (25 programs).
of tobacco-dependence treatments (5) for pregnant Only five states (Indiana, Massachusetts, Minnesota,
women, beginning October 1, 2010. Coverage of Montana, and Pennsylvania) reported having policies
pharmacotherapy for all Medicaid enrollees will be that require coverage of all recommended pharmaco-
enhanced by January 2014, when states no longer therapies and individual and group counseling for all
may exclude tobacco-dependence cessation drugs Medicaid enrollees.
from covered benefits. Monitoring the extent to which The 2008 Public Health Service guideline identi-
Medicaid programs place limitations on these treat- fies four combination therapies (i.e., two tobacco-
ments can help in evaluating accessibility of tobacco- dependence medications taken simultaneously) as
dependence treatments to Medicaid enrollees. being effective in treating tobacco-dependence: 1)
Medicaid coverage of tobacco-dependence treat- nicotine patch and nicotine gum, 2) nicotine patch
ments has been assessed regularly since 1998 by the and nicotine nasal spray, 3) nicotine patch and nico-
University of California, Berkeley. In November tine inhaler, and 4) nicotine patch and bupropion
2009, a link to an online survey instrument was sent SR (3). The most commonly covered combination of
to previously identified Medicaid personnel for the tobacco-dependence treatments among the Medicaid
50 state Medicaid programs and DC. Respondents
were asked to complete 45 questions regarding treat- * Zyban is a trade name for bupropion. Coverage was assessed
separately for Zyban and bupropion because some programs cover
ment coverage, coverage limitations, outreach activi- one but not the other. Data presented represent coverage for either
ties, and related subjects. Follow-up questions were bupropion or Zyban.

1340 MMWR / October 22, 2010 / Vol. 59 / No. 41

 MMWR Morbidity and Mortality Weekly Report

programs was the nicotine patch and bupropion SR

What is already known on this topic?
(33 programs), followed by the nicotine patch and
nicotine gum (21 programs), the nicotine patch and Prevalence of smoking is nearly twice as high among
Medicaid enrollees than in the general U.S. popula-
nicotine inhaler (21 programs), and the nicotine patch tion, and Healthy People 2010 calls for expanding cov-
and nicotine nasal spray (19 programs). erage for tobacco-dependence treatment to Medicaid
Fewer Medicaid programs covered counseling than programs in all 50 states and the District of Columbia.
pharmacotherapy; 18 programs covered individual What is added by this report?
counseling for all Medicaid enrollees, six programs Although 47 (92%) of 51 Medicaid programs offered
covered only FFS enrollees (with two restricting coverage for some form of tobacco-dependence
coverage to pregnant women), one covered MCO treatment to Medicaid enrollees, only five states offer
enrollees only, and six covered only pregnant women. coverage of all recommended pharmacotherapies
Eight Medicaid programs covered group counseling and individual and group counseling for all Medicaid
enrollees, and 16 states have coverage policies that
for all Medicaid enrollees, three programs covered are not consistent for fee-for-service and managed-
group counseling for FFS only (with two restricting care organization enrollees.
coverage to pregnant women), two programs covered What are the implications for public health practice?
only MCO enrollees, and five programs covered group
To increase the effectiveness of recommended
counseling for pregnant women only.† tobacco-dependence treatments, Medicaid programs
Nationwide, coverage for any tobacco-dependence should inform their enrollees and providers about
treatments increased, from 45 programs (including coverage changes, offer tobacco-dependence treat-
two with coverage only for pregnant women) to 47 ments without barriers or limitations, measure treat-
programs since 2007, the most recent year for which ment usage rates, and assess any remaining barriers
to coverage.
comparable data were reported (6). Nebraska added
coverage for tobacco-dependence treatments for FFS
enrollees and Alabama added individual counseling required coverage for nicotine gum in contracts with
for pregnant women (Table). In addition, Arizona and MCOs, but does not cover this treatment for FFS
Washington expanded coverage previously limited to enrollees. Overall, 16 programs reported coverage
pregnant women to include all Medicaid enrollees. for FFS enrollees that differed from that provided
Overall, 12 Medicaid programs added or expanded for MCO enrollees.
coverage from 2007 to 2009. Reported by
Medicaid enrollment options vary considerably
SB McMenamin, PhD, HA Halpin, PhD, M Ingram,
across and within states. Some states offer only tra-
ditional FFS Medicaid, others enter into contracts Center for Health and Public Policy Studies, Univ of
with MCOs to provide services to Medicaid enroll- California, Berkeley. A Rosenthal, Office on Smoking and
ees. Because some state programs reported different Health, National Center for Chronic Disease Prevention
coverage policies for FFS and MCO enrollees, and and Health Promotion, CDC.
for pregnant women, Medicaid recipients within a Editorial Note
state might have varying degrees of access to tobacco- This report updates previously published informa-
dependence treatments. Some states required that all tion on coverage for tobacco-dependence treatments
MCO contracts provide an agreed upon level of cover- in Medicaid programs (6) and, for the first time, lists
age for tobacco-dependence treatments; other states coverage for FFS, MCO, or all enrollees for each
allow MCOs to determine what coverage they offer. tobacco-dependence treatment in each Medicaid
For example, 32 Medicaid programs covered nico- program and provides data on combination therapies.
tine gum to all enrollees, but nine programs offered Coverage increased in 12 states since 2007, and in
coverage for nicotine gum to their FFS population 16 states, coverage for FFS enrollees differed from
without requirements to provide this coverage in their coverage for MCO enrollees.
MCO contracts (Table). In addition, Rhode Island Public health initiatives and clinical guidelines
† Two programs covered counseling for pregnant women in FFS only.
to reduce tobacco use have called for comprehensive
These two are included under the totals for pregnancy only and for coverage of recommended treatments (3,4). Most state
FFS only (Table). Medicaid programs fall short of this goal. Coverage

MMWR / October 22, 2010 / Vol. 59 / No. 41 1341

 MMWR Morbidity and Mortality Weekly Report

TABLE. State Medicaid program coverage for tobacco-dependence treatments,* by type of coverage and year coverage began —
United States, 2009†
Medication coverage
Year Counseling coverage
coverage Varenicline Bupropion hydrochloride
State/Area began Gum Patch Nasal spray Inhaler Lozenge (Chantix) or Zyban§ Group Individual
Alabama 2008 No No No No No No No No Yes (P)¶
Alaska 2006 Yes Yes Yes No Yes Yes Yes No Yes
Arizona 2008 Yes¶ Yes¶ Yes¶ Yes¶ Yes¶ Yes¶ Yes¶ No Yes (P)
Arkansas 1999 Yes Yes No No No Yes Yes No Yes
California 1996 Yes Yes Yes Yes Yes Yes Yes No No
Colorado 1996 Yes (F) Yes (F) Yes (F) Yes (F) Yes (F) Yes (F) Yes (F) Yes (P) Yes (P)
Delaware 1996 Yes Yes Yes Yes Yes Yes Yes No No
District of Columbia 1996 Yes Yes Yes Yes Yes Yes Yes No No
Florida** 1998 Yes (F) Yes (F) No No Yes (F)¶ Yes (F) Yes Yes (M) Yes (M)
Hawaii†† 1999 Yes Yes Yes Yes Yes Yes Yes No No
Idaho§§ 2007 Yes Yes Yes Yes Yes Yes Yes No No
Illinois 2000 Yes Yes Yes Yes Yes Yes Yes No No
Indiana 1999 Yes Yes Yes Yes Yes Yes Yes Yes Yes
Iowa 2007 Yes Yes No No No Yes¶ Yes No Yes (F)¶
Kansas 1999 No Yes (F) No No No Yes (F) Yes (F) No No
Kentucky 2000 No No No No No No No Yes (P)(F) Yes (P)(F)
Louisiana 1990 Yes Yes Yes Yes No Yes Yes No No
Maine 1996 Yes Yes Yes Yes Yes Yes No¶¶ No Yes
Maryland 1996 No Yes Yes Yes No Yes Yes No Yes
Massachusetts 2006 Yes Yes Yes Yes Yes Yes Yes Yes Yes
Michigan** 1997 Yes (F) Yes No No Yes (F) Yes (F) Yes (F) No Yes
Minnesota 1996 Yes Yes Yes Yes Yes Yes Yes Yes Yes
Mississippi 2001 Yes Yes Yes Yes Yes Yes Yes Yes (P) Yes (P)
Montana 1996 Yes Yes Yes Yes Yes Yes Yes Yes¶ Yes¶
Nebraska 2008 Yes (F)¶ Yes (F)¶ No No No Yes (F)¶ Yes (F)¶ No Yes (F)¶
Nevada 1996 Yes (F) Yes (F) Yes (F) Yes (F) Yes (F) Yes (F) Yes (F) No No
New Hampshire 1996 Yes Yes Yes Yes Yes Yes Yes Yes (P) Yes***
New Jersey 1996 Yes (F) Yes (F) Yes (F) Yes (F) Yes (F) Yes (F) Yes (F) No No
New Mexico 1996 Yes (F) Yes (F) Yes (F) Yes (F) Yes (F) Yes (F) Yes (F) Yes††† Yes (F)†††
New York 1999 Yes Yes Yes Yes No Yes Yes Yes (P)¶ No
North Carolina 1996 Yes Yes Yes Yes Yes Yes Yes No Yes¶
North Dakota 1996 Yes Yes No No Yes¶ Yes¶ Yes Yes Yes
Ohio 1998 Yes Yes Yes Yes Yes Yes Yes No No
Oklahoma 1999 Yes Yes Yes Yes Yes Yes Yes No Yes
Oregon§§§ 1998 Yes (F) Yes (F) Yes (F) Yes (F) Yes (F) Yes (F) Yes (F) Yes (F) Yes (F)
Pennsylvania 2002 Yes Yes Yes Yes Yes Yes Yes Yes Yes
Rhode Island 1994 Yes (M) Yes (M) Yes (M) Yes (M) Yes (M) No No Yes Yes
South Carolina 2004 Yes Yes Yes Yes Yes Yes Yes No No
South Dakota 2001 No No No No No Yes Yes No No
Texas 1996 Yes Yes Yes Yes No Yes Yes No No
Utah 2001 Yes Yes Yes Yes Yes Yes Yes Yes (P)(F) Yes (P)(F)
Vermont 1999 Yes Yes Yes Yes Yes Yes Yes No No
Virginia 1996 Yes (F) Yes (F) Yes (F) Yes (F) Yes (F) Yes (F) Yes (F) Yes (P) Yes (P)¶
Washington 2008 Yes¶ Yes¶ No No No Yes (F)¶ Yes (P) No Yes (P)
West Virginia 2000 Yes Yes Yes Yes Yes No Yes Yes (M) Yes
Wisconsin 1996 Yes¶ Yes Yes Yes No Yes Yes No Yes
Wyoming 2007 Yes Yes No No Yes Yes Yes No*** Yes
Total states/areas 32 34 28 27 25 32 33 8 18
Fee-for-service only (F) 9 9 6 6 8 11 9 3 6
Managed-care organization only (M) 1 1 1 1 1 0 0 2 1
Pregnancy only (P) 0 0 0 0 0 0 1 7 8
Added since 2007 4 3 1 1 3 5 2 2 6
Abbreviations: F = coverage in Medicaid fee-for-service only; M = coverage in Medicaid managed-care organization only; P = Medicaid coverage exclusively for pregnant women.
* Based on response to the question “Does your state Medicaid program cover any of the following tobacco-dependence treatments?” Each state also was asked to provide documentation
of coverage.
† N = 47. In 2009, three states with Medicaid programs (Connecticut, Missouri, and Tennessee) covered none of the tobacco-dependence treatments recommended in the 2008 Public
Health Service Clinical Practice Guideline. Georgia covers bupropion without prior authorization; therefore, it could be used for smoking cessation, although this was not the intention
of the coverage policy.
§ Covered either bupropion or Zyban specifically for smoking cessation.
¶ Treatment added since 2007 survey.
** Some of these treatments are required per managed-care organization contracts although plans have a choice of which treatments to cover.
†† Hawaii previously covered tobacco-dependence treatments only after the gum or patch was used in conjunction with quitline support for 2 weeks. This policy was revised in June 2009
and is no longer contingent on quitline enrollment.
§§ Idaho provides an allowance of $200 per enrollee per year for personal health benefits that can be applied to smoking cessation benefits.
¶¶ Maine covers bupropion, but not specifically for smoking cessation.
*** Response differs from the previous survey because of a reporting error. In most cases, this resulted from the state reporting on managed-care organization coverage policies and not
Medicaid fee-for-service.
††† Fee-for-service covers when there is a valid behavioral health diagnosis other than tobacco dependence.
§§§ Oregon requires that managed-care organizations cover “behavioral and tobacco cessation therapy products” but does not specify coverage of specific tobacco-dependence treatments;
however, most managed-care organizations cover the same treatments covered under fee-for-service Medicaid.

1342 MMWR / October 22, 2010 / Vol. 59 / No. 41

 MMWR Morbidity and Mortality Weekly Report

varies considerably for specific tobacco-dependence they seek to comply with the U.S. Preventive Services
treatments within states and across states. Tobacco- Task Force recommendations. Previous research
dependence treatments are one of the few clinical indicates that knowledge of Medicaid coverage for
preventive services shown to reduce costs (7). Insurers tobacco-dependence treatments among Medicaid-
that provide adequate access and support for per- enrolled smokers is very low (10). To increase the
sons seeking to quit smoking can improve cessation impact of the federal legislation, it is important that
rates substantially, with potential for considerable Medicaid programs inform their enrollees and provid-
improvement in public health and reduction in ers about changes in coverage for tobacco-dependence
medical expenditures (7,8). In Massachusetts, for treatments and offer these treatments without barri-
example, a mandate for Medicaid coverage of tobacco- ers or limitations. In addition, future monitoring of
dependence cessation treatments was associated with Medicaid programs should include measurement of
a 26% decline in smoking rates among Medicaid usage rates of tobacco-dependence treatments and
enrollees (9). assessment of any existing barriers to coverage.
The findings in this report are subject to at least
References
three limitations. First, Medicaid staff members
1. Pleis JR, Lucas JW, Ward BW. Summary health statistics for
self-report information on their Medicaid programs. U.S. adults: National Health Interview Survey, 2008. Vital
Documentation to verify coverage policies was Health Stat 2009;10(242):1–157.
obtained for 94% of programs; where documentation 2. Armour BS, Finkelstein EA, Fiebelkorn IC. State-level
Medicaid expenditures attributable to smoking. Prev Chronic
was not available, errors might have occurred. Second, Dis 2009;6:A84.
MCO contracts were not available from all programs. 3. Fiore MC, Jaen CR, Baker TB, et al. Treating tobacco use
If the state informant did not possess a written contract and dependence: 2008 update. Clinical practice guideline.
Rockville, MD: US Department of Health and Human
or policy specifying that tobacco-dependence treat- Services, Public Health Service; 2008. Available at http://
ments were covered, the response given by the respon- www.surgeongeneral.gov/tobacco/treating_tobacco_use08.
dent was assumed to be accurate. Finally, many MCOs pdf. Accessed April 2, 2010.
offer coverage for tobacco-dependence treatments to 4. US Department of Health and Human Services. Objective
27-8b: increase insurance coverage of evidence-based
Medicaid enrollees, although it is not required per treatment for nicotine dependency. In: Healthy people 2010
contracts with Medicaid. Consequently, reported data (conference ed, in 2 vols). Washington, DC: US Department
might underestimate tobacco-dependence treatment of Health and Human Services; 2000. Available at http://
www.healthypeople.gov/document/html/objectives/27-08.
coverage among MCO enrollees. htm. Accessed April 2, 2010.
Recent federal policy is increasing access to 5. Patient Protection and Affordable Care Act of 2010. Pub. L.
smoking cessation treatments. Section 4107 of the No. 114–48 (March 23, 2010), as amended through May 1,
2010. Available at http://docs.house.gov/energycommerce/
Affordable Care Act has required Medicaid programs ppacacon.pdf. Accessed October 20, 2010.
to cover tobacco-dependence treatments for preg- 6. CDC. State Medicaid coverage for tobacco-dependence
nant women, with no cost-sharing since October 1, treatments—United States, 2007. MMWR 2009;58:​
2010 (5). Section 4106 of the act permits Medicaid 1199–204.
7. Maciosek MV, Coffield AB, Edwards NM, Flottemesch TJ,
programs to cover the A and B level recommenda- Goodman MJ, Solberg LI. Priorities among effective clinical
tions of the U.S. Preventive Services Task Force, preventive services: results of a systematic review and analysis.
including cessation counseling and all Food and Am J Prev Med 2006;31:52–61.
8. Reda AA, Kaper J, Fikrelter H, Severens JL, van Schayck
Drug Administration–approved tobacco-dependence CP. Healthcare financing systems for increasing the use
treatments. States that offer such benefits and adult of tobacco dependence treatment. The Cochrane Library
vaccination benefits, and prohibit cost sharing on 2009;3:CD004305. Available at http://onlinelibrary.wiley.
com/o/cochrane/clsysrev/articles/CD004305/frame.html.
these benefits, will receive a one full percentage point Accessed October 15, 2010.
increase in the Medicaid federal medical assistance 9. Land T, Warner D, Paskowsky M, et al. Medicaid coverage
percentage for expenditures on these services, effective for tobacco dependence treatments in Massachusetts and
January 1, 2013 (3,5). Currently, only eight Medicaid associated decreases in smoking prevalence. PLoS ONE
2010;5:e9770. Available at http://www.plosone.org/article/
programs cover all medications and at least one form info%3adoi%2f10.1371%2fjournal.pone.0009770. Accessed
of counseling for their entire population; the remain- April 20, 2010.
ing 43 Medicaid programs would need to add cover- 10. McMenamin SB, Halpin HA, Bellows NM. Knowledge of
Medicaid coverage and effectiveness of smoking treatments.
age for additional tobacco-dependence treatments if Am J Prev Med 2006;31:369–74.

MMWR / October 22, 2010 / Vol. 59 / No. 41 1343

 MMWR Morbidity and Mortality Weekly Report

Announcements

World Stroke Day — October 29, 2010 Menu of Suggested Provisions for State
October 29 is World Stroke Day 2010. Stroke is Tuberculosis Prevention and Control Laws
the third leading cause of death in the United States Available Online
(1). Approximately 795,000 strokes occur annually Tuberculosis (TB) laws provide authority for state
in the United States, with an estimated cost of more and local TB programs to prevent and control TB, an
than $73 billion (1). The theme for this year’s World airborne infectious disease that sickens approximately
Stroke Day is “One in Six,” to raise awareness that 11,000–12,000 persons each year in the United
one in six persons worldwide will have a stroke in States (1). CDC, in collaboration with the National
their lifetime, and that every 6 seconds, someone Tuberculosis Controllers Association, has developed a
somewhere will die from a stroke (2,3). Menu of Suggested Provisions for State Tuberculosis
This campaign stresses that the occurrence of Prevention and Control Laws. A request by the
stroke is common and widespread, but that stroke Advisory Council for the Elimination of Tuberculosis
can be prevented and stroke survivors can recover and for a model TB prevention and control act prompted
regain their quality of life with care and support. The development of the menu.
campaign recommends the following six actions to The menu features a set of alternative provisions
reduce the likelihood of having a stroke: within each section for consideration by public health
• Know your personal risk factors, including officials and their legal counsel in the enactment,
diagnosed high blood pressure, diabetes, or high promulgation, amendment, or implementation of
cholesterol. laws to prevent and control TB. The menu is intended
• Be physically active and exercise regularly. to serve as a practical resource for public health offi-
• Avoid obesity by eating a healthy diet with lots cials and their legal counsel in their efforts to eliminate
of fresh fruits and vegetables. TB. This document is available at http://www.cdc.
• Limit alcohol consumption. gov/tb/programs/laws/menu/default.htm and http://
• Avoid cigarette smoke. People who smoke www2.cdc.gov/phlp/tbcontrol.asp.
should seek help to stop now.
Reference
• Learn to recognize the warning signs of a stroke
1. CDC. Decrease in reported tuberculosis cases—United States,
and call 9-1-1 right away if someone is suspected 2009. MMWR 2010;59:289–94.
of having a stroke.
CDC addresses stroke prevention through state-
based programs to prevent heart disease and stroke,
through the Paul Coverdell National Acute Stroke
Registry, and through many other partnerships.
Information about stroke and stroke prevention is
available at http://www.cdc.gov/stroke, and additional
information about World Stroke Day 2010 is avail-
able at http://www.worldstrokecampaign.org/pages/
home.aspx.
References
1. Lloyd-Jones D, Adams R, Brown TM, et al. Heart disease and
stroke statistics 2010 update. A report from the American
Heart Association Statistics Committee and Stroke Statistics
Subcommittee. Circulation 2010;121:e46–215.
2. Seshadri S, Beiser A, Kelly-Hayes M, et al. The lifetime risk
of stroke: estimates from the Framingham Study. Stroke
2006;37:345–50.
3. World Health Organization. The atlas of heart disease and
stroke. Geneva, Switzerland: World Health Organization;
2004.

1344 MMWR / October 22, 2010 / Vol. 59 / No. 41

 MMWR Morbidity and Mortality Weekly Report

QuickStats
from the national center for health statistics

Death Rates* For Persons Aged ≥65 Years, with Diabetes as the Underlying or a
Contributing Cause, by Race and Sex — United States, 1981–2007

900

800

700

600

500
Rate

400

300 Black men

Black women
200
White men
100 White women
All persons aged ≥65 yrs
0
1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007
Year
* Rates are age-adjusted per 100,000 U.S. standard population aged ≥65 years. Cause of death is based on
International Classification of Diseases, Ninth Revision (ICD-9) code 250 (Diabetes mellitus) for 1981–1998
and International Classification of Diseases, 10th Revision (ICD-10) codes E10–E14 (Diabetes mellitus) for
1999–2007.

Diabetes is a leading cause of death in the United States and a contributing cause of deaths from many other conditions. In
2007, diabetes was a contributing cause of death 2.4 times as often as it was the underlying cause of death for persons aged
≥65 years. Age-adjusted death rates for deaths with diabetes declined for white and black persons aged ≥65 years from 2005
to 2007, after generally increasing from 1981 to 2002. In 2007, the rate was higher for black men and women than for white
men and women.
Sources: CDC. National Vital Statistics System. Available at http://www.cdc.gov/nchs/nvss.htm.

CDC. Health Data Interactive. Available at http://www.cdc.gov/nchs/hdi.htm.

MMWR / October 22, 2010 / Vol. 59 / No. 41 1345

 MMWR Morbidity and Mortality Weekly Report

Notifiable Diseases and Mortality Tables

TABLE I. Provisional cases of infrequently reported notifiable diseases (<1,000 cases reported during the preceding year) — United States, week ending
October 16, 2010 (41st week)*
Total cases reported
5-year
for previous years
Current Cum weekly States reporting cases
Disease week 2010 average† 2009 2008 2007 2006 2005 during current week (No.)
Anthrax — — — 1 — 1 1 —
Botulism, total 1 82 3 118 145 144 165 135
foodborne — 6 0 10 17 32 20 19
infant — 57 2 83 109 85 97 85
other (wound and unspecified) 1 19 0 25 19 27 48 31 OH (1)
Brucellosis — 97 2 115 80 131 121 120
Chancroid — 31 0 28 25 23 33 17
Cholera — 5 0 10 5 7 9 8
§
Cyclosporiasis 1 145 1 141 139 93 137 543 FL (1)
Diphtheria — — — — — — — —
§¶
Domestic arboviral diseases , :
California serogroup virus disease — 53 1 55 62 55 67 80
Eastern equine encephalitis virus disease — 10 0 4 4 4 8 21
Powassan virus disease — 5 — 6 2 7 1 1
St. Louis encephalitis virus disease — 6 0 12 13 9 10 13
Western equine encephalitis virus disease — — — — — — — —
Haemophilus influenzae,** invasive disease (age <5 yrs):
serotype b — 13 1 35 30 22 29 9
nonserotype b 1 133 2 236 244 199 175 135 OH (1)
unknown serotype 2 181 2 178 163 180 179 217 NY (1), OK (1)
Hansen disease§ 1 35 2 103 80 101 66 87 CA (1)
§
Hantavirus pulmonary syndrome — 16 0 20 18 32 40 26
§
Hemolytic uremic syndrome, postdiarrheal 3 167 6 242 330 292 288 221 MD (1), TX (1), CA (1)
††
HIV infection, pediatric (age <13 yrs) — — 3 — — — — 380
§ §§
Influenza-associated pediatric mortality , — 56 3 358 90 77 43 45
Listeriosis 9 616 22 851 759 808 884 896 VT (1), PA (2), OH (1), ND (1), VA (1), NC (1), FL (1), HI (1)
¶¶
Measles — 55 0 71 140 43 55 66
Meningococcal disease, invasive***:
A, C, Y, and W-135 — 188 5 301 330 325 318 297
serogroup B — 85 2 174 188 167 193 156
other serogroup — 7 0 23 38 35 32 27
unknown serogroup 7 301 9 482 616 550 651 765 NY (1), PA (1), OH (1), MI (1), KY (1), CA (2)
Mumps 14 2,419 18 1,991 454 800 6,584 314 NYC (5), TX (9)
†††
Novel influenza A virus infections — 1 0 43,774 2 4 NN NN
Plague — 2 0 8 3 7 17 8
Poliomyelitis, paralytic — — 0 1 — — — 1
§
Polio virus Infection, nonparalytic — — — — — — NN NN
§
Psittacosis — 4 0 9 8 12 21 16
§ §§§
Q fever, total , 1 98 3 114 120 171 169 136
acute 1 74 1 94 106 — — — CA (1)
chronic — 24 0 20 14 — — —
Rabies, human — 1 0 4 2 1 3 2
¶¶¶
Rubella — 6 0 3 16 12 11 11
Rubella, congenital syndrome — — — 2 — — 1 1
SARS-CoV§,**** — — — — — — — —
Smallpox§ — — — — — — — —
§
Streptococcal toxic-shock syndrome — 134 1 161 157 132 125 129
††††
Syphilis, congenital (age <1 yr) — 165 8 423 431 430 349 329
Tetanus — 6 1 18 19 28 41 27
§
Toxic-shock syndrome (staphylococcal) 1 58 2 74 71 92 101 90 CA (1)
Trichinellosis — 3 0 13 39 5 15 16
Tularemia 1 82 2 93 123 137 95 154 CA (1)
Typhoid fever 4 315 9 397 449 434 353 324 NY (1), WA (2), CA (1)
§
Vancomycin-intermediate Staphylococcus aureus — 70 1 78 63 37 6 2
§
Vancomycin-resistant Staphylococcus aureus — 1 0 1 — 2 1 3
§
Vibriosis (noncholera Vibrio species infections) 9 634 11 789 588 549 NN NN MD (1), VA (1), NC (1), TN (1), TX (2), WA (1), CA (2)
Viral hemorrhagic fever§§§§ — 1 — NN NN NN NN NN
Yellow fever — — — — — — — —

See Table I footnotes on next page.

1346 MMWR / October 22, 2010 / Vol. 59 / No. 41

 MMWR Morbidity and Mortality Weekly Report

TABLE I. (Continued) Provisional cases of infrequently reported notifiable diseases (<1,000 cases reported during the preceding year) — United States, week
ending October 16, 2010 (41st week)*
—: No reported cases. N: Not reportable. NN: Not Nationally Notifiable Cum: Cumulative year-to-date counts.
* Incidence data for reporting year 2010 is provisional, whereas data for 2005 through 2009 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/ncphi/disss/nndss/phs/files/5yearweeklyaverage.pdf.
§ Not reportable in all states. Data from states where the condition is not reportable are excluded from this table except starting in 2007 for the domestic arboviral diseases, STD data, TB
data, and influenza-associated pediatric mortality, and in 2003 for SARS-CoV. Reporting exceptions are available at http://www.cdc.gov/ncphi/disss/nndss/phs/infdis.htm.
¶ Includes both neuroinvasive and nonneuroinvasive. Updated weekly from reports to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and
Enteric Diseases (ArboNET Surveillance). Data for West Nile virus are available in Table II.
** 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. Since April 26, 2009, a total of 286 influenza-associated pediatric
deaths associated with 2009 influenza A (H1N1) virus infection have been reported. Since August 30, 2009, a total of 281 influenza-associated pediatric deaths occurring during the
2009–10 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.
††† CDC discontinued reporting of individual confirmed and probable cases of 2009 pandemic influenza A (H1N1) virus infections on July 24, 2009. During 2009, four cases of human
infection with novel influenza A viruses, different from the 2009 pandemic influenza A (H1N1) strain, were reported to CDC. The one case of novel influenza A virus infection reported to
CDC during 2010 was identified as swine influenza A (H3N2) virus and is unrelated to 2009 pandemic influenza A (H1N1) virus. Total case counts for 2009 were provided by the Influenza
Division, National Center for Immunization and Respiratory Diseases (NCIRD).
§§§
In 2009, 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.
†††† Updated weekly from reports to the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.
§§§§ There was one case of viral hemorrhagic fever reported during week 12. The one case report was confirmed as lassa fever. See Table II for dengue hemorrhagic fever.

FIGURE I. Selected notifiable disease reports, United States, comparison of provisional 4-week
totals October 16, 2010, with historical data

CASES CURRENT
DISEASE DECREASE INCREASE 4 WEEKS

Giardiasis 957

Hepatitis A, acute 88

Hepatitis B, acute 135

Hepatitis C, acute 23

Legionellosis 157

Measles 2

Meningococcal disease 30

Mumps 63

Pertussis 1,048

0.25 0.5 1 2 4
Ratio (Log scale)*
Beyond historical limits

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

Notifiable Disease Data Team and 122 Cities Mortality Data Team
Patsy A. Hall-Baker
Deborah A. Adams Rosaline Dhara
Willie J. Anderson Pearl C. Sharp
Michael S. Wodajo Lenee Blanton

MMWR / October 22, 2010 / Vol. 59 / No. 41 1347

 MMWR Morbidity and Mortality Weekly Report

TABLE II. Provisional cases of selected notifiable diseases, United States, weeks ending October 16, 2010, and October 17, 2009 (41st week)*
Chlamydia trachomatis infection Cryptosporidiosis

Current Previous 52 weeks Cum Cum Current Previous 52 weeks Cum Cum
Reporting area week Med Max 2010 2009 week Med Max 2010 2009
United States 11,466 23,234 26,182 926,824 991,863 78 123 324 6,198 6,058
New England 506 739 1,396 30,738 31,583 1 8 72 368 393
Connecticut — 213 736 7,172 9,195 — 0 66 66 38
Maine† 20 50 75 1,996 1,898 1 1 7 68 44
Massachusetts 384 400 653 15,997 14,886 — 2 8 120 153
New Hampshire 50 41 115 1,903 1,714 — 1 5 44 69
Rhode Island† 22 65 120 2,687 2,939 — 0 2 10 21
Vermont† 30 23 51 983 951 — 1 9 60 68
Mid. Atlantic 1,658 3,292 4,619 132,724 124,691 8 15 37 659 687
New Jersey 431 483 691 20,113 19,404 — 0 1 — 46
New York (Upstate) 592 679 2,530 26,942 24,403 1 3 16 175 182
New York City 87 1,206 2,142 48,595 46,368 — 1 5 70 70
Pennsylvania 548 889 1,092 37,074 34,516 7 9 26 414 389
E.N. Central 849 3,508 4,127 135,036 160,149 13 29 116 1,673 1,432
Illinois 16 788 1,225 27,214 48,904 — 3 17 209 134
Indiana — 332 786 15,015 18,510 — 4 10 133 235
Michigan 601 897 1,420 37,854 36,881 4 5 17 270 231
Ohio 129 960 1,078 38,333 39,055 6 7 24 391 315
Wisconsin 103 415 502 16,620 16,799 3 9 55 670 517
W.N. Central 212 1,334 1,565 53,335 56,732 17 23 81 1,139 925
Iowa 9 186 265 7,822 7,743 — 4 22 281 179
Kansas 15 186 235 7,415 8,634 1 2 9 117 87
Minnesota — 274 331 10,695 11,586 — 0 18 98 271
Missouri 175 495 599 19,856 20,642 4 4 30 329 158
Nebraska† — 93 237 3,776 4,316 3 2 26 205 101
North Dakota — 34 89 1,375 1,422 9 0 18 28 11
South Dakota 13 61 77 2,396 2,389 — 2 6 81 118
S. Atlantic 3,394 4,484 5,681 178,943 200,947 12 19 51 825 925
Delaware 86 85 220 3,487 3,768 — 0 2 7 8
District of Columbia 95 93 177 3,904 5,524 — 0 1 2 6
Florida 653 1,407 1,694 59,115 58,894 4 7 23 307 370
Georgia 272 264 1,229 11,983 32,169 2 5 31 242 289
Maryland† 436 459 1,031 18,571 17,749 1 1 3 30 35
North Carolina 579 785 1,562 32,664 33,356 1 1 12 66 93
South Carolina† 824 523 694 21,663 21,751 1 1 8 76 49
Virginia† 377 596 902 24,594 24,817 3 2 8 80 62
West Virginia 72 70 137 2,962 2,919 — 0 3 15 13
E.S. Central 1,403 1,733 2,415 70,063 74,445 3 4 17 239 186
Alabama† 541 493 748 20,782 21,310 2 1 11 106 57
Kentucky 228 288 642 11,899 9,832 1 1 6 68 52
Mississippi 385 384 780 15,055 19,227 — 0 3 15 16
Tennessee† 249 571 728 22,327 24,076 — 1 5 50 61
W.S. Central 925 2,971 4,578 122,659 131,083 7 8 39 349 461
Arkansas† 279 250 392 9,381 11,673 1 1 3 30 46
Louisiana 389 228 1,076 10,974 23,075 — 1 5 48 46
Oklahoma 257 258 1,374 12,307 11,621 2 1 8 71 105
Texas† — 2,176 3,201 89,997 84,714 4 5 30 200 264
Mountain 733 1,519 1,904 59,573 63,051 6 10 28 451 482
Arizona 332 499 713 20,207 20,865 3 0 3 31 29
Colorado 170 372 617 14,143 15,101 2 2 8 111 123
Idaho† — 69 200 2,971 2,794 1 2 6 79 78
Montana† 12 60 76 2,377 2,413 — 1 4 40 49
Nevada† — 171 337 7,382 8,185 — 0 6 30 19
New Mexico† 173 170 453 6,166 7,212 — 2 10 93 128
Utah 34 116 175 4,780 4,921 — 1 4 54 36
Wyoming† 12 38 79 1,547 1,560 — 0 2 13 20
Pacific 1,786 3,623 5,350 143,753 149,182 11 12 28 495 567
Alaska — 110 148 4,608 4,217 — 0 1 3 6
California 1,332 2,766 4,406 110,661 114,127 4 7 19 282 336
Hawaii — 113 158 4,550 4,874 — 0 0 — 1
Oregon 139 208 468 8,745 8,621 2 3 13 141 159
Washington 315 387 497 15,189 17,343 5 2 8 69 65
Territories
American Samoa — 0 0 — — N 0 0 N N
C.N.M.I. — — — — — — — — — —
Guam — 5 31 232 302 — 0 0 — —
Puerto Rico 92 93 265 4,216 5,986 N 0 0 N N
U.S. Virgin Islands — 9 29 323 416 — 0 0 — —
C.N.M.I.: Commonwealth of Northern Mariana Islands.
U: Unavailable. —: No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum.
* Incidence data for reporting year 2010 is provisional. Data for HIV/AIDS, AIDS, and TB, when available, are displayed in Table IV, which appears quarterly.
† Contains data reported through the National Electronic Disease Surveillance System (NEDSS).

1348 MMWR / October 22, 2010 / Vol. 59 / No. 41

 MMWR Morbidity and Mortality Weekly Report

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 16, 2010, and October 17, 2009 (41st week)*
Dengue Virus Infection
Dengue Fever† Dengue Hemorrhagic Fever§

Current Previous 52 weeks Cum Cum Current Previous 52 weeks Cum Cum
Reporting area week Med Max 2010 2009 week Med Max 2010 2009
United States — 5 29 346 NN — 0 1 4 NN
New England — 0 2 4 NN — 0 0 — NN
Connecticut — 0 0 — NN — 0 0 — NN
Maine¶ — 0 2 3 NN — 0 0 — NN
Massachusetts — 0 0 — NN — 0 0 — NN
New Hampshire — 0 0 — NN — 0 0 — NN
Rhode Island¶ — 0 0 — NN — 0 0 — NN
Vermont¶ — 0 1 1 NN — 0 0 — NN
Mid. Atlantic — 0 9 74 NN — 0 0 — NN
New Jersey — 0 0 — NN — 0 0 — NN
New York (Upstate) — 0 0 — NN — 0 0 — NN
New York City — 0 7 62 NN — 0 0 — NN
Pennsylvania — 0 2 12 NN — 0 0 — NN
E.N. Central — 0 5 35 NN — 0 1 1 NN
Illinois — 0 0 — NN — 0 0 — NN
Indiana — 0 2 10 NN — 0 0 — NN
Michigan — 0 2 8 NN — 0 0 — NN
Ohio — 0 2 12 NN — 0 0 — NN
Wisconsin — 0 2 5 NN — 0 1 1 NN
W.N. Central — 0 2 17 NN — 0 0 — NN
Iowa — 0 1 2 NN — 0 0 — NN
Kansas — 0 1 1 NN — 0 0 — NN
Minnesota — 0 2 13 NN — 0 0 — NN
Missouri — 0 0 — NN — 0 0 — NN
Nebraska¶ — 0 0 — NN — 0 0 — NN
North Dakota — 0 1 1 NN — 0 0 — NN
South Dakota — 0 0 — NN — 0 0 — NN
S. Atlantic — 1 16 174 NN — 0 1 2 NN
Delaware — 0 0 — NN — 0 0 — NN
District of Columbia — 0 0 — NN — 0 0 — NN
Florida — 1 14 150 NN — 0 1 2 NN
Georgia — 0 2 9 NN — 0 0 — NN
Maryland¶ — 0 0 — NN — 0 0 — NN
North Carolina — 0 1 4 NN — 0 0 — NN
South Carolina¶ — 0 3 9 NN — 0 0 — NN
Virginia¶ — 0 0 — NN — 0 0 — NN
West Virginia — 0 1 2 NN — 0 0 — NN
E.S. Central — 0 1 4 NN — 0 0 — NN
Alabama¶ — 0 1 1 NN — 0 0 — NN
Kentucky — 0 1 1 NN — 0 0 — NN
Mississippi — 0 1 1 NN — 0 0 — NN
Tennessee¶ — 0 1 1 NN — 0 0 — NN
W.S. Central — 0 1 4 NN — 0 1 1 NN
Arkansas¶ — 0 0 — NN — 0 1 1 NN
Louisiana — 0 0 — NN — 0 0 — NN
Oklahoma — 0 1 4 NN — 0 0 — NN
Texas¶ — 0 0 — NN — 0 0 — NN
Mountain — 0 2 13 NN — 0 0 — NN
Arizona — 0 1 4 NN — 0 0 — NN
Colorado — 0 0 — NN — 0 0 — NN
Idaho¶ — 0 1 2 NN — 0 0 — NN
Montana¶ — 0 1 2 NN — 0 0 — NN
Nevada¶ — 0 1 4 NN — 0 0 — NN
New Mexico¶ — 0 1 1 NN — 0 0 — NN
Utah — 0 0 — NN — 0 0 — NN
Wyoming¶ — 0 0 — NN — 0 0 — NN
Pacific — 0 5 21 NN — 0 0 — NN
Alaska — 0 0 — NN — 0 0 — NN
California — 0 5 11 NN — 0 0 — NN
Hawaii — 0 0 — NN — 0 0 — NN
Oregon — 0 0 — NN — 0 0 — NN
Washington — 0 2 10 NN — 0 0 — NN
Territories
American Samoa — 0 0 — NN — 0 0 — NN
C.N.M.I. — — — — NN — — — — NN
Guam — 0 0 — NN — 0 0 — NN
Puerto Rico — 94 536 8,199 NN — 0 3 30 NN
U.S. Virgin Islands — 0 0 — NN — 0 0 — NN
C.N.M.I.: Commonwealth of Northern Mariana Islands.
U: Unavailable. —: No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum.
* Incidence data for reporting year 2010 is provisional.
† Dengue Fever includes cases that meet criteria for Dengue Fever with hemorrhage, other clinical, and unknown case classifications.
§ DHF includes cases that meet criteria for dengue shock syndrome (DSS), a more severe form of DHF.
¶ Contains data reported through the National Electronic Disease Surveillance System (NEDSS).

MMWR / October 22, 2010 / Vol. 59 / No. 41 1349

 MMWR Morbidity and Mortality Weekly Report

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 16, 2010, and October 17, 2009 (41st week)*
Ehrlichiosis/Anaplasmosis†
Ehrlichia chaffeensis Anaplasma phagocytophilum Undetermined

Current Previous 52 weeks Cum Cum Current

Previous 52 weeks
Cum Cum Current
Previous 52 weeks
Cum Cum
Reporting area week Med Max 2010 2009 week Med Max 2010 2009 week Med Max 2010 2009
United States 3 10 181 514 821 4 11 309 616 779 — 2 35 90 155
New England — 0 3 3 43 3 2 8 64 227 — 0 2 7 2
Connecticut — 0 0 — — — 0 5 18 16 — 0 2 5 —
Maine§ — 0 1 2 3 — 0 2 14 12 — 0 0 — —
Massachusetts — 0 0 — 9 — 0 4 — 84 — 0 0 — —
New Hampshire — 0 1 1 4 — 0 3 11 16 — 0 1 2 1
Rhode Island§ — 0 2 — 26 3 0 7 21 99 — 0 0 — 1
Vermont§ — 0 0 — 1 — 0 0 — — — 0 0 — —
Mid. Atlantic — 1 15 41 161 — 3 17 166 266 — 0 2 4 44
New Jersey — 0 3 — 91 — 0 2 1 65 — 0 0 — —
New York (Upstate) — 0 15 24 44 — 2 17 162 192 — 0 1 4 6
New York City — 0 3 16 9 — 0 1 3 8 — 0 0 — 1
Pennsylvania — 0 5 1 17 — 0 1 — 1 — 0 1 — 37
E.N. Central — 0 4 28 82 — 2 36 306 258 — 1 6 55 66
Illinois — 0 2 12 33 — 0 1 2 6 — 0 2 4 3
Indiana — 0 0 — — — 0 0 — — — 0 3 28 36
Michigan — 0 1 2 5 — 0 0 — — — 0 1 3 —
Ohio — 0 3 6 12 — 0 1 2 1 — 0 0 — 2
Wisconsin — 0 1 8 32 — 2 36 302 251 — 0 3 20 25
W.N. Central — 1 13 114 146 — 0 261 9 7 — 0 30 11 16
Iowa — 0 0 — — — 0 0 — — — 0 0 — —
Kansas — 0 1 6 6 — 0 0 — 1 — 0 0 — —
Minnesota — 0 6 — 1 — 0 261 — 3 — 0 30 — 3
Missouri — 1 13 106 137 — 0 3 9 2 — 0 3 11 13
Nebraska§ — 0 1 2 2 — 0 0 — 1 — 0 0 — —
North Dakota — 0 0 — — — 0 0 — — — 0 0 — —
South Dakota — 0 0 — — — 0 0 — — — 0 0 — —
S. Atlantic 3 4 19 225 232 — 1 7 52 15 — 0 1 6 2
Delaware — 0 3 17 19 — 0 1 4 2 — 0 0 — —
District of Columbia — 0 0 — — — 0 0 — — — 0 0 — —
Florida — 0 2 8 10 — 0 1 3 3 — 0 0 — —
Georgia — 0 4 19 17 — 0 1 1 1 — 0 1 1 —
Maryland§ 2 0 3 22 37 — 0 2 12 3 — 0 1 2 —
North Carolina — 1 13 91 59 — 0 4 19 3 — 0 0 — —
South Carolina§ — 0 2 3 10 — 0 1 1 — — 0 0 — —
Virginia§ 1 1 13 65 79 — 0 2 12 3 — 0 1 3 2
West Virginia — 0 0 — 1 — 0 0 — — — 0 1 — —
E.S. Central — 1 10 82 124 1 0 2 17 3 — 0 1 6 24
Alabama§ — 0 3 10 6 — 0 2 7 1 — 0 0 — —
Kentucky — 0 2 14 10 — 0 0 — — — 0 0 — —
Mississippi — 0 1 3 6 — 0 1 1 — — 0 0 — —
Tennessee§ — 1 6 55 102 1 0 2 9 2 — 0 1 6 24
W.S. Central — 0 141 20 30 — 0 23 2 1 — 0 1 1 —
Arkansas§ — 0 34 2 4 — 0 6 — — — 0 0 — —
Louisiana — 0 1 1 — — 0 0 — — — 0 0 — —
Oklahoma — 0 105 14 24 — 0 16 2 1 — 0 0 — —
Texas§ — 0 2 3 2 — 0 1 — — — 0 1 1 —
Mountain — 0 0 — — — 0 0 — — — 0 0 — 1
Arizona — 0 0 — — — 0 0 — — — 0 0 — 1
Colorado — 0 0 — — — 0 0 — — — 0 0 — —
Idaho§ — 0 0 — — — 0 0 — — — 0 0 — —
Montana§ — 0 0 — — — 0 0 — — — 0 0 — —
Nevada§ — 0 0 — — — 0 0 — — — 0 0 — —
New Mexico§ — 0 0 — — — 0 0 — — — 0 0 — —
Utah — 0 0 — — — 0 0 — — — 0 0 — —
Wyoming§ — 0 0 — — — 0 0 — — — 0 0 — —
Pacific — 0 1 1 3 — 0 0 — 2 — 0 1 — —
Alaska — 0 0 — — — 0 0 — — — 0 0 — —
California — 0 1 1 3 — 0 0 — 2 — 0 1 — —
Hawaii — 0 0 — — — 0 0 — — — 0 0 — —
Oregon — 0 0 — — — 0 0 — — — 0 0 — —
Washington — 0 0 — — — 0 0 — — — 0 0 — —
Territories
American Samoa — 0 0 — — — 0 0 — — — 0 0 — —
C.N.M.I. — — — — — — — — — — — — — — —
Guam — 0 0 — — — 0 0 — — — 0 0 — —
Puerto Rico — 0 0 — — — 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 reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum.
* Incidence data for reporting year 2010 is provisional.
† Cumulative total E. ewingii cases reported for year 2010 = 10.
§ Contains data reported through the National Electronic Disease Surveillance System (NEDSS).

1350 MMWR / October 22, 2010 / Vol. 59 / No. 41

 MMWR Morbidity and Mortality Weekly Report

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 16, 2010, and October 17, 2009 (41st week)*
Haemophilus influenzae, invasive†
Giardiasis Gonorrhea All ages, all serotypes
Current Previous 52 weeks Cum Cum Current Previous 52 weeks Cum Cum Current Previous 52 weeks Cum Cum
Reporting area week Med Max 2010 2009 week Med Max 2010 2009 week Med Max 2010 2009
United States 233 346 666 14,003 15,022 2,933 5,446 6,325 215,513 242,009 17 59 171 2,272 2,294
New England 10 31 53 1,188 1,421 57 100 196 4,091 3,864 — 3 21 127 155
Connecticut — 5 13 236 242 — 43 169 1,706 1,847 — 0 15 28 42
Maine§ 8 3 12 172 180 — 3 11 136 110 — 0 2 10 17
Massachusetts — 12 20 463 610 39 45 81 1,851 1,519 — 2 8 65 75
New Hampshire — 3 9 118 169 4 3 7 119 83 — 0 2 9 10
Rhode Island§ — 1 7 49 52 14 5 13 232 269 — 0 1 8 7
Vermont§ 2 4 10 150 168 — 0 17 47 36 — 0 1 7 4
Mid. Atlantic 46 60 103 2,392 2,789 419 677 941 27,740 25,077 5 11 34 442 461
New Jersey — 5 13 207 357 116 101 161 4,330 3,800 — 2 7 73 105
New York (Upstate) 30 22 84 899 1,058 99 104 422 4,409 4,564 4 3 20 118 112
New York City 6 16 33 698 682 27 228 394 9,472 8,740 — 2 6 86 57
Pennsylvania 10 14 24 588 692 177 224 342 9,529 7,973 1 4 9 165 187
E.N. Central 29 52 78 2,279 2,384 231 935 1,260 36,850 51,185 3 10 20 392 361
Illinois — 12 24 469 514 8 183 380 6,266 16,288 — 3 9 118 135
Indiana — 5 13 191 239 — 91 218 4,228 5,977 — 1 6 69 65
Michigan 5 13 23 543 543 151 243 472 10,408 11,972 — 0 4 26 18
Ohio 23 16 24 677 666 40 316 372 12,301 12,774 3 2 6 95 82
Wisconsin 1 9 26 399 422 32 93 155 3,647 4,174 — 2 5 84 61
W.N. Central 21 25 165 1,156 1,296 77 275 357 10,863 11,994 2 3 24 132 133
Iowa 3 5 11 232 246 4 32 52 1,323 1,334 — 0 1 1 —
Kansas 2 4 10 177 126 1 37 83 1,510 2,065 — 0 2 12 13
Minnesota — 0 135 136 250 — 41 62 1,515 1,866 — 0 17 25 47
Missouri 9 8 25 340 423 72 125 172 5,222 5,246 1 1 6 66 46
Nebraska§ 2 4 9 178 140 — 22 50 895 1,099 1 0 2 18 21
North Dakota 5 0 8 25 20 — 2 11 94 101 — 0 4 10 6
South Dakota — 2 7 68 91 — 6 17 304 283 — 0 0 — —
S. Atlantic 61 75 143 3,012 2,913 1,033 1,275 1,651 51,660 60,167 4 14 27 609 625
Delaware — 0 5 25 22 16 18 48 796 772 — 0 1 5 3
District of Columbia — 1 4 28 57 21 37 65 1,478 2,160 — 0 1 2 4
Florida 43 39 87 1,715 1,527 215 378 479 15,941 17,017 3 3 9 148 187
Georgia — 11 51 485 594 101 96 421 4,123 10,929 — 3 9 139 123
Maryland§ 3 5 11 210 226 135 132 237 5,346 4,845 1 1 6 54 75
North Carolina N 0 0 N N 201 258 596 10,936 11,356 — 2 9 105 76
South Carolina§ 2 2 9 119 86 239 152 233 6,554 6,805 — 2 7 69 60
Virginia§ 13 9 36 397 361 93 161 271 6,076 5,875 — 2 4 67 71
West Virginia — 1 5 33 40 12 9 20 410 408 — 0 5 20 26
E.S. Central — 5 15 198 337 405 479 698 19,005 21,469 — 3 12 138 139
Alabama§ — 4 8 145 162 139 145 217 6,002 6,080 — 0 3 21 34
Kentucky N 0 0 N N 78 76 156 3,098 2,874 — 0 2 27 19
Mississippi N 0 0 N N 118 109 216 4,249 6,000 — 0 2 10 7
Tennessee§ — 1 10 53 175 70 147 196 5,656 6,515 — 2 10 80 79
W.S. Central 3 8 16 296 413 262 795 1,236 33,115 38,373 2 2 20 103 98
Arkansas§ 2 2 9 102 115 102 74 133 2,885 3,606 — 0 3 14 15
Louisiana 1 3 9 131 168 71 68 441 3,169 7,516 — 0 3 18 17
Oklahoma — 2 7 63 130 89 79 359 3,615 3,683 2 1 15 63 62
Texas§ N 0 0 N N — 570 963 23,446 23,568 — 0 2 8 4
Mountain 18 30 50 1,283 1,346 86 181 262 7,091 7,449 1 5 15 234 202
Arizona — 3 8 126 166 47 63 109 2,381 2,476 — 2 10 89 65
Colorado 13 13 27 551 396 16 53 94 2,105 2,245 1 1 5 66 59
Idaho§ 4 4 9 169 162 — 2 6 87 81 — 0 2 13 3
Montana§ 1 2 7 83 113 — 2 6 86 64 — 0 1 2 1
Nevada§ — 1 11 78 95 — 28 94 1,313 1,435 — 0 2 6 16
New Mexico§ — 2 5 73 105 23 19 41 837 849 — 1 5 34 27
Utah — 4 12 171 254 — 6 15 254 242 — 0 4 18 28
Wyoming§ — 1 5 32 55 — 1 4 28 57 — 0 2 6 3
Pacific 45 53 133 2,199 2,123 363 594 810 25,098 22,431 — 2 9 95 120
Alaska — 2 6 78 95 — 23 37 991 771 — 0 2 19 15
California 24 33 61 1,370 1,384 305 485 692 20,718 18,484 — 0 4 12 39
Hawaii 1 0 4 25 18 — 14 25 581 506 — 0 2 7 27
Oregon 2 9 23 393 329 8 19 43 779 835 — 1 5 53 36
Washington 18 8 75 333 297 50 50 69 2,029 1,835 — 0 4 4 3
Territories
American Samoa — 0 0 — — — 0 0 — — — 0 0 — —
C.N.M.I. — — — — — — — — — — — — — — —
Guam — 0 1 2 3 — 0 4 28 19 — 0 0 — —
Puerto Rico — 1 8 57 137 9 5 14 227 195 — 0 1 1 4
U.S. Virgin Islands — 0 0 — — — 2 7 78 100 — 0 0 — —
C.N.M.I.: Commonwealth of Northern Mariana Islands.
U: Unavailable. —: No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum.
* Incidence data for reporting year 2010 is 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).

MMWR / October 22, 2010 / Vol. 59 / No. 41 1351

 MMWR Morbidity and Mortality Weekly Report

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 16, 2010, and October 17, 2009 (41st week)*
Hepatitis (viral, acute), by type
A B C
Current Previous 52 weeks Cum Cum Current
Previous 52 weeks
Cum Cum Current
Previous 52 weeks
Cum Cum
Reporting area week Med Max 2010 2009 week Med Max 2010 2009 week Med Max 2010 2009
United States 21 30 69 1,191 1,598 31 60 204 2,418 2,592 5 15 44 635 582
New England — 2 5 75 93 — 1 5 42 45 — 1 3 29 53
Connecticut — 0 3 23 18 — 0 2 15 13 — 0 3 19 41
Maine† — 0 1 7 1 — 0 2 11 11 — 0 1 — 1
Massachusetts — 1 4 36 58 — 0 2 8 17 — 0 1 9 10
New Hampshire — 0 1 1 7 — 0 2 6 4 N 0 0 N N
Rhode Island† — 0 4 8 7 U 0 0 U U U 0 0 U U
Vermont† — 0 0 — 2 — 0 1 2 — — 0 1 1 1
Mid. Atlantic 3 4 8 157 229 2 5 10 227 274 — 2 6 83 80
New Jersey — 0 3 11 59 — 1 5 54 83 — 0 2 10 5
New York (Upstate) 3 1 4 51 39 2 1 6 41 46 — 1 4 48 37
New York City — 1 4 53 72 — 2 4 71 56 — 0 0 — 5
Pennsylvania — 1 4 42 59 — 1 5 61 89 — 0 3 25 33
E.N. Central 2 4 8 168 243 — 9 17 369 353 — 2 9 103 72
Illinois — 1 3 39 112 — 2 6 65 97 — 0 1 1 4
Indiana — 0 2 15 16 — 1 5 47 57 — 0 2 21 15
Michigan 1 1 4 50 56 — 3 6 99 107 — 1 6 65 26
Ohio 1 0 5 40 34 — 2 6 80 73 — 0 1 9 24
Wisconsin — 0 3 24 25 — 1 8 78 19 — 0 2 7 3
W.N. Central — 1 13 64 94 2 2 15 94 114 — 0 11 16 17
Iowa — 0 3 6 32 — 0 2 12 28 — 0 1 — 9
Kansas — 0 3 11 7 — 0 2 6 6 — 0 1 1 1
Minnesota — 0 12 14 15 — 0 13 7 20 — 0 9 6 3
Missouri — 0 2 20 19 2 1 3 56 38 — 0 1 6 —
Nebraska† — 0 4 12 18 — 0 2 12 19 — 0 1 3 2
North Dakota — 0 1 — — — 0 0 — — — 0 1 — 1
South Dakota — 0 1 1 3 — 0 1 1 3 — 0 0 — 1
S. Atlantic 5 8 14 284 342 13 16 40 701 713 1 4 8 135 133
Delaware — 0 1 7 3 — 0 2 20 25 U 0 0 U U
District of Columbia — 0 1 1 1 — 0 1 3 10 — 0 1 2 1
Florida 4 3 7 113 146 7 6 12 244 231 — 1 6 44 35
Georgia — 1 3 33 38 2 3 7 118 122 — 0 2 7 30
Maryland† — 0 4 22 39 1 1 6 52 61 — 0 2 20 19
North Carolina 1 0 5 44 34 1 1 16 82 93 1 0 3 36 20
South Carolina† — 1 3 22 50 2 1 4 47 43 — 0 1 1 1
Virginia† — 1 6 40 28 — 1 14 76 74 — 0 2 11 8
West Virginia — 0 2 2 3 — 0 14 59 54 — 0 5 14 19
E.S. Central — 1 3 33 34 3 7 13 279 268 2 3 7 118 81
Alabama† — 0 1 6 9 2 1 5 56 73 — 0 1 5 7
Kentucky — 0 2 13 8 1 2 8 99 64 — 2 5 81 48
Mississippi — 0 1 2 8 — 1 3 27 26 U 0 0 U U
Tennessee† — 0 2 12 9 — 2 8 97 105 2 1 4 32 26
W.S. Central 4 2 19 102 160 5 9 109 373 454 2 1 14 58 45
Arkansas† — 0 3 — 7 — 0 4 32 54 — 0 1 — 2
Louisiana — 0 2 7 5 — 1 4 40 56 — 0 1 5 7
Oklahoma — 0 3 — 3 2 2 19 76 79 2 0 12 23 12
Texas† 4 2 18 95 145 3 5 87 225 265 — 1 3 30 24
Mountain 1 3 8 118 136 — 2 8 94 113 — 1 5 41 40
Arizona — 1 5 56 58 — 0 2 23 38 U 0 0 U U
Colorado 1 1 3 26 44 — 0 3 21 22 — 0 2 7 24
Idaho† — 0 2 6 4 — 0 1 6 11 — 0 2 9 4
Montana† — 0 1 4 6 — 0 1 1 1 — 0 0 — 1
Nevada† — 0 2 12 10 — 0 3 33 27 — 0 1 4 3
New Mexico† — 0 1 3 7 — 0 1 4 6 — 0 2 11 5
Utah — 0 1 8 5 — 0 1 5 4 — 0 2 10 3
Wyoming† — 0 3 3 2 — 0 1 1 4 — 0 0 — —
Pacific 6 5 16 190 267 6 6 20 239 258 — 1 6 52 61
Alaska — 0 1 1 2 — 0 1 3 2 U 0 2 U U
California 5 4 15 153 211 4 4 17 162 185 — 0 4 21 32
Hawaii — 0 2 3 8 — 0 1 1 5 U 0 0 U U
Oregon — 0 2 17 13 — 1 4 34 32 — 0 3 13 15
Washington 1 0 2 16 33 2 1 4 39 34 — 0 6 18 14
Territories
American Samoa — 0 0 — — — 0 0 — — — 0 0 — —
C.N.M.I. — — — — — — — — — — — — — — —
Guam — 0 6 16 4 — 1 6 35 50 — 0 6 28 42
Puerto Rico — 0 1 12 21 — 0 2 16 28 — 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 reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum.
* Incidence data for reporting year 2010 is provisional.
† Contains data reported through the National Electronic Disease Surveillance System (NEDSS).

1352 MMWR / October 22, 2010 / Vol. 59 / No. 41

 MMWR Morbidity and Mortality Weekly Report

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 16, 2010, and October 17, 2009 (41st week)*
Legionellosis Lyme disease Malaria
Current Previous 52 weeks Cum Cum Current
Previous 52 weeks
Cum Cum Current
Previous 52 weeks
Cum Cum
Reporting area week Med Max 2010 2009 week Med Max 2010 2009 week Med Max 2010 2009
United States 46 57 112 2,402 2,759 249 418 2,336 21,637 32,306 21 26 89 1,122 1,130
New England — 3 13 153 170 27 121 423 6,060 11,155 — 1 4 54 53
Connecticut — 0 4 32 47 5 42 200 2,218 3,770 — 0 1 1 5
Maine† — 0 2 9 7 20 12 76 598 743 — 0 1 5 2
Massachusetts — 1 7 77 84 — 36 161 1,876 4,841 — 1 3 37 34
New Hampshire — 0 5 15 11 — 22 63 996 1,235 — 0 1 3 4
Rhode Island† — 0 3 11 14 1 1 35 101 214 — 0 1 5 5
Vermont† — 0 2 9 7 1 4 26 271 352 — 0 1 3 3
Mid. Atlantic 18 15 31 619 998 90 175 694 10,357 14,068 2 7 17 306 330
New Jersey — 2 8 52 180 — 44 195 2,631 4,564 — 0 4 1 86
New York (Upstate) 10 5 19 217 295 66 53 577 2,466 3,391 1 1 6 63 40
New York City — 2 8 108 203 — 2 18 58 937 — 4 14 197 159
Pennsylvania 8 6 16 242 320 24 74 373 5,202 5,176 1 1 3 45 45
E.N. Central 8 11 40 573 593 2 18 161 1,614 2,752 2 2 9 123 148
Illinois — 1 15 118 105 — 1 16 104 134 — 1 7 44 62
Indiana 1 2 6 87 52 — 1 7 64 78 — 0 2 7 20
Michigan 3 3 19 136 131 2 1 14 90 94 — 0 4 26 25
Ohio 4 4 12 186 236 — 0 5 21 45 2 0 5 37 32
Wisconsin — 1 11 46 69 — 16 136 1,335 2,401 — 0 1 9 9
W.N. Central 7 2 19 99 97 3 3 1,395 108 200 1 1 11 60 56
Iowa — 0 2 13 20 — 1 10 75 103 — 0 2 9 10
Kansas — 0 2 8 7 — 0 1 6 18 — 0 2 10 6
Minnesota 4 0 16 27 8 — 0 1,380 — 71 — 0 11 3 23
Missouri 2 0 4 30 49 — 0 1 1 3 1 0 3 20 10
Nebraska† — 0 2 8 11 — 0 2 9 4 — 0 2 15 6
North Dakota 1 0 1 6 1 3 0 15 16 — — 0 1 — —
South Dakota — 0 2 7 1 — 0 1 1 1 — 0 2 3 1
S. Atlantic 6 10 26 414 442 123 60 169 3,172 3,744 15 6 35 296 298
Delaware — 0 3 13 17 2 11 31 538 864 — 0 1 2 4
District of Columbia — 0 4 13 18 — 0 4 19 57 — 0 2 8 15
Florida 2 3 9 141 136 1 2 11 84 76 1 2 7 106 80
Georgia — 1 4 37 46 — 0 2 8 38 — 0 2 3 61
Maryland† 4 2 12 91 115 95 25 74 1,383 1,785 6 1 18 70 61
North Carolina — 0 7 47 48 2 1 9 75 89 5 0 13 45 24
South Carolina† — 0 2 9 9 — 0 3 27 32 1 0 1 4 4
Virginia† — 1 6 52 46 17 15 79 933 671 2 1 5 55 47
West Virginia — 0 3 11 7 6 0 32 105 132 — 0 2 3 2
E.S. Central 2 2 10 103 114 — 1 4 39 31 — 0 3 26 29
Alabama† — 0 2 14 14 — 0 1 2 2 — 0 1 6 8
Kentucky — 0 4 22 43 — 0 1 4 1 — 0 3 6 9
Mississippi — 0 3 9 4 — 0 0 — — — 0 2 2 3
Tennessee† 2 1 6 58 53 — 1 4 33 28 — 0 2 12 9
W.S. Central 1 3 14 109 90 1 2 44 82 174 — 1 31 69 56
Arkansas† — 0 2 12 7 — 0 0 — — — 0 1 2 5
Louisiana — 0 3 7 10 — 0 1 2 — — 0 1 3 5
Oklahoma — 0 4 11 3 — 0 2 — — — 0 1 5 1
Texas† 1 2 10 79 70 1 2 42 80 174 — 1 30 59 45
Mountain — 3 10 124 112 — 0 3 19 50 — 1 3 49 43
Arizona — 1 5 43 36 — 0 1 3 5 — 0 2 22 8
Colorado — 0 5 27 19 — 0 1 2 1 — 0 2 15 24
Idaho† — 0 1 5 5 — 0 2 6 14 — 0 1 2 2
Montana† — 0 1 4 5 — 0 1 1 3 — 0 1 2 5
Nevada† — 0 2 18 12 — 0 1 — 12 — 0 1 4 —
New Mexico† — 0 2 6 9 — 0 2 5 5 — 0 1 1 —
Utah — 0 3 16 22 — 0 1 2 8 — 0 1 3 4
Wyoming† — 0 2 5 4 — 0 1 — 2 — 0 0 — —
Pacific 4 5 19 208 143 3 4 11 186 132 1 3 19 139 117
Alaska — 0 2 2 1 — 0 1 6 5 — 0 1 2 2
California 2 4 19 177 108 3 3 10 125 84 1 2 13 98 86
Hawaii — 0 1 1 1 N 0 0 N N — 0 1 1 1
Oregon — 0 3 11 14 — 1 4 46 33 — 0 1 9 11
Washington 2 0 4 17 19 — 0 3 9 10 — 0 5 29 17
Territories
American Samoa — 0 0 — — N 0 0 N N — 0 0 — —
C.N.M.I. — — — — — — — — — — — — — — —
Guam — 0 1 1 — — 0 0 — — — 0 0 — —
Puerto Rico — 0 1 — 1 N 0 0 N N — 0 2 4 5
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 reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum.
* Incidence data for reporting year 2010 is provisional.
† Contains data reported through the National Electronic Disease Surveillance System (NEDSS).

MMWR / October 22, 2010 / Vol. 59 / No. 41 1353

 MMWR Morbidity and Mortality Weekly Report

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 16, 2010, and October 17, 2009 (41st week)*
Meningococcal disease, invasive†
All groups Pertussis Rabies, animal
Current Previous 52 weeks Cum Cum Current
Previous 52 weeks
Cum Cum Current
Previous 52 weeks
Cum Cum
Reporting area week Med Max 2010 2009 week Med Max 2010 2009 week Med Max 2010 2009
United States 7 16 43 581 742 317 300 1,756 14,429 12,478 27 69 145 2,753 4,314
New England — 0 2 13 27 — 8 20 339 545 3 4 15 185 281
Connecticut — 0 2 2 3 — 1 8 92 44 — 0 14 59 126
Maine§ — 0 1 3 4 — 0 5 36 76 2 1 4 52 46
Massachusetts — 0 1 3 12 — 4 11 164 310 — 0 0 — —
New Hampshire — 0 0 — 3 — 0 3 14 68 — 0 5 12 27
Rhode Island§ — 0 0 — 4 — 0 8 22 36 — 0 2 17 36
Vermont§ — 0 1 5 1 — 0 4 11 11 1 1 5 45 46
Mid. Atlantic 2 1 4 49 82 32 22 64 1,137 970 11 18 41 845 493
New Jersey — 0 2 9 15 — 3 8 99 199 — 0 0 — —
New York (Upstate) 1 0 3 10 17 5 8 27 401 174 11 8 19 423 376
New York City — 0 2 14 14 5 0 9 71 79 — 1 12 112 17
Pennsylvania 1 0 2 16 36 22 9 39 566 518 — 5 24 310 100
E.N. Central 2 2 8 105 134 54 74 173 3,612 2,620 3 2 38 266 211
Illinois — 0 4 19 34 — 12 29 574 556 — 1 22 160 79
Indiana — 0 3 22 28 — 9 26 429 298 — 0 0 — 25
Michigan 1 0 2 17 18 11 22 51 1,022 706 3 1 5 63 63
Ohio 1 1 2 27 34 43 22 69 1,245 911 — 0 12 43 44
Wisconsin — 0 2 20 20 — 6 17 342 149 — 0 0 — —
W.N. Central — 1 6 41 61 156 27 627 1,691 1,800 4 4 16 206 335
Iowa — 0 3 9 8 — 6 25 359 195 — 0 2 7 30
Kansas — 0 2 6 11 — 3 9 129 208 — 1 4 54 67
Minnesota — 0 2 2 11 143 0 601 682 366 — 0 9 26 51
Missouri — 0 3 17 21 5 8 25 291 855 — 1 6 62 62
Nebraska§ — 0 2 5 7 5 2 13 163 123 1 1 4 44 73
North Dakota — 0 1 2 1 3 0 30 41 17 3 0 7 13 4
South Dakota — 0 2 — 2 — 1 5 26 36 — 0 2 — 48
S. Atlantic — 3 7 110 139 11 27 77 1,212 1,373 5 22 73 875 1,783
Delaware — 0 1 2 2 — 0 4 10 12 — 0 0 — —
District of Columbia — 0 0 — — — 0 1 4 6 — 0 0 — —
Florida — 1 5 50 45 7 5 28 258 454 — 0 60 72 161
Georgia — 0 2 9 28 — 3 18 185 205 — 0 13 — 337
Maryland§ — 0 1 6 9 1 2 8 95 120 — 6 14 297 327
North Carolina — 0 2 14 27 — 1 32 124 166 — 0 11 — 414
South Carolina§ — 0 1 10 11 3 5 19 292 216 — 0 0 — —
Virginia§ — 0 2 17 12 — 5 15 176 167 5 10 25 448 449
West Virginia — 0 2 2 5 — 1 13 68 27 — 1 6 58 95
E.S. Central 1 1 4 34 25 2 14 32 589 671 — 3 7 126 126
Alabama§ — 0 2 6 7 — 4 8 154 263 — 0 4 41 —
Kentucky 1 0 2 16 4 — 4 13 208 196 — 0 4 16 43
Mississippi — 0 1 3 3 — 1 6 53 56 — 0 1 1 4
Tennessee§ — 0 2 9 11 2 4 11 174 156 — 1 4 68 79
W.S. Central — 1 9 65 68 17 57 753 2,249 2,619 — 1 30 61 772
Arkansas§ — 0 2 5 6 — 3 29 119 291 — 0 7 21 38
Louisiana — 0 4 12 13 — 1 4 29 134 — 0 0 — —
Oklahoma — 0 7 15 10 1 0 41 54 41 — 0 30 40 30
Texas§ — 1 7 33 39 16 49 681 2,047 2,153 — 0 26 — 704
Mountain — 1 6 45 54 16 22 46 1,008 795 — 1 8 66 94
Arizona — 0 2 11 12 1 7 14 317 200 — 0 5 — —
Colorado — 0 4 14 18 11 4 15 182 188 — 0 0 — —
Idaho§ — 0 2 7 6 4 3 19 170 68 — 0 2 11 8
Montana§ — 0 1 1 5 — 1 12 62 48 — 0 3 16 25
Nevada§ — 0 1 8 4 — 0 7 29 23 — 0 1 5 6
New Mexico§ — 0 1 3 3 — 2 9 84 59 — 0 3 11 22
Utah — 0 1 1 2 — 3 10 154 187 — 0 1 2 12
Wyoming§ — 0 1 — 4 — 0 2 10 22 — 0 4 21 21
Pacific 2 3 16 119 152 29 35 189 2,592 1,085 1 3 12 123 219
Alaska — 0 1 1 6 — 0 6 35 38 — 0 2 12 11
California 2 2 13 79 99 8 25 166 1,912 545 1 2 12 100 197
Hawaii — 0 1 1 5 — 0 6 38 37 — 0 0 — —
Oregon — 1 3 25 29 1 6 16 279 230 — 0 2 11 11
Washington — 0 7 13 13 20 4 38 328 235 — 0 0 — —
Territories
American Samoa — 0 0 — — — 0 0 — — N 0 0 N N
C.N.M.I. — — — — — — — — — — — — — — —
Guam — 0 0 — — — 0 2 — — — 0 0 — —
Puerto Rico — 0 1 — — — 0 1 2 1 — 1 3 36 34
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 reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum.
* Incidence data for reporting year 2010 is 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).

1354 MMWR / October 22, 2010 / Vol. 59 / No. 41

 MMWR Morbidity and Mortality Weekly Report

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 16, 2010, and October 17, 2009 (41st week)*
Salmonellosis Shiga toxin-producing E. coli (STEC)† Shigellosis
Current Previous 52 weeks Cum Cum Current
Previous 52 weeks
Cum Cum Current
Previous 52 weeks
Cum Cum
Reporting area week Med Max 2010 2009 week Med Max 2010 2009 week Med Max 2010 2009
United States 854 924 1,680 39,159 38,756 76 78 206 3,656 3,770 152 268 527 10,769 12,717
New England 3 29 423 1,756 1,904 1 2 51 161 226 — 4 59 256 299
Connecticut — 0 407 407 430 — 0 51 51 67 — 0 53 53 43
Maine§ 3 2 7 100 111 1 0 3 16 16 — 0 1 5 5
Massachusetts — 21 48 945 953 — 1 8 62 86 — 4 16 179 207
New Hampshire — 3 10 138 233 — 0 2 17 32 — 0 2 9 18
Rhode Island§ — 2 17 109 121 — 0 26 2 1 — 0 3 9 21
Vermont§ — 1 5 57 56 — 0 2 13 24 — 0 1 1 5
Mid. Atlantic 51 96 217 4,637 4,559 6 8 31 423 366 7 34 53 1,301 2,385
New Jersey — 18 56 833 963 — 1 4 51 89 — 6 16 257 523
New York (Upstate) 32 24 78 1,193 1,079 5 3 15 164 123 2 4 19 182 180
New York City 2 25 56 1,112 1,048 — 1 7 62 53 2 6 13 244 376
Pennsylvania 17 29 82 1,499 1,469 1 3 13 146 101 3 16 35 618 1,306
E.N. Central 38 80 236 4,213 4,349 3 11 39 608 633 5 26 238 1,418 2,216
Illinois — 27 113 1,455 1,240 — 1 8 90 155 — 9 228 701 518
Indiana — 9 53 369 510 — 1 8 61 78 — 1 5 31 62
Michigan 3 15 45 753 823 — 2 16 144 119 — 4 9 194 192
Ohio 35 24 47 1,106 1,200 3 2 11 122 111 5 6 23 253 987
Wisconsin — 10 44 530 576 — 3 17 191 170 — 4 21 239 457
W.N. Central 40 44 99 2,007 2,219 8 10 39 525 646 21 48 88 1,788 813
Iowa 1 8 35 431 345 — 2 16 139 140 — 1 5 47 47
Kansas 4 7 18 360 333 1 1 6 56 50 2 5 14 210 167
Minnesota — 0 32 178 475 — 0 14 31 185 — 0 5 14 67
Missouri 13 12 44 673 542 4 3 27 209 120 11 42 75 1,472 497
Nebraska§ 9 4 13 200 299 2 1 6 64 80 8 1 4 38 27
North Dakota 13 0 39 46 59 — 0 7 — 7 — 0 5 — 4
South Dakota — 3 8 119 166 1 0 4 26 64 — 0 2 7 4
S. Atlantic 459 267 573 11,706 10,968 17 13 30 558 547 59 41 96 1,987 1,961
Delaware — 3 11 147 115 — 0 2 5 12 — 1 10 37 104
District of Columbia — 1 6 58 82 — 0 1 5 2 — 0 4 21 21
Florida 219 127 227 4,867 4,831 4 4 13 189 135 36 13 54 863 373
Georgia 50 40 129 2,069 1,950 — 1 15 86 56 9 13 38 597 531
Maryland§ 12 15 52 826 659 5 1 6 75 77 3 3 8 107 329
North Carolina 106 29 145 1,449 1,493 7 1 7 58 95 8 2 18 158 336
South Carolina§ 45 20 90 1,240 800 — 0 3 19 27 — 1 5 59 99
Virginia§ 27 18 68 903 860 1 2 15 105 119 3 3 15 119 162
West Virginia — 3 16 147 178 — 0 4 16 24 — 0 11 26 6
E.S. Central 22 52 174 2,862 2,543 — 4 11 191 179 3 11 40 528 674
Alabama§ 4 14 45 657 731 — 0 4 36 40 — 3 10 115 125
Kentucky 6 8 31 458 381 — 1 6 50 61 2 4 28 192 176
Mississippi 1 14 68 926 779 — 0 2 13 6 — 1 4 38 42
Tennessee§ 11 14 53 821 652 — 2 7 92 72 1 4 11 183 331
W.S. Central 125 114 547 4,719 4,565 7 5 68 241 250 41 50 251 1,968 2,384
Arkansas§ 10 10 43 606 521 1 1 5 44 35 — 1 9 51 262
Louisiana 1 21 47 940 945 — 0 2 14 20 — 4 13 199 154
Oklahoma 17 10 46 531 522 1 0 27 21 29 2 6 96 227 234
Texas§ 97 74 477 2,642 2,577 5 4 41 162 166 39 35 144 1,491 1,734
Mountain 14 49 105 2,174 2,496 6 9 33 463 495 3 15 32 623 981
Arizona 4 18 42 754 848 — 1 5 55 53 — 8 18 331 707
Colorado 9 10 23 463 529 2 2 18 154 150 3 2 6 98 82
Idaho§ — 3 9 127 151 4 1 7 77 82 — 0 3 22 7
Montana§ 1 2 7 75 95 — 1 5 36 32 — 0 1 6 11
Nevada§ — 4 22 237 218 — 0 5 28 31 — 0 6 34 65
New Mexico§ — 5 15 233 310 — 1 5 33 33 — 2 9 98 91
Utah — 5 17 248 267 — 1 7 66 101 — 0 4 34 16
Wyoming§ — 1 9 37 78 — 0 2 14 13 — 0 2 — 2
Pacific 102 115 299 5,085 5,153 28 9 46 486 428 13 21 64 900 1,004
Alaska — 1 5 69 55 — 0 1 2 1 — 0 2 1 2
California 59 84 227 3,843 3,858 8 5 35 213 203 12 16 51 742 809
Hawaii 5 4 14 159 279 — 0 4 18 7 1 0 3 17 35
Oregon — 8 48 427 357 2 1 7 78 67 — 1 4 47 43
Washington 38 14 61 587 604 18 3 18 175 150 — 1 22 93 115
Territories
American Samoa — 1 1 2 — — 0 0 — — — 1 1 2 3
C.N.M.I. — — — — — — — — — — — — — — —
Guam — 0 1 4 11 — 0 0 — — — 0 3 1 10
Puerto Rico 1 10 39 423 462 — 0 0 — — — 0 1 4 11
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 reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum.
* Incidence data for reporting year 2010 is 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).

MMWR / October 22, 2010 / Vol. 59 / No. 41 1355

 MMWR Morbidity and Mortality Weekly Report

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 16, 2010, and October 17, 2009 (41st week)*
Spotted Fever Rickettsiosis (including RMSF)†
Confirmed Probable

Current Previous 52 weeks Cum Cum Current Previous 52 weeks Cum Cum
Reporting area week Med Max 2010 2009 week Med Max 2010 2009
United States 2 2 12 139 134 28 17 421 1,254 1,163
New England — 0 0 — 2 — 0 1 3 9
Connecticut — 0 0 — — — 0 0 — —
Maine§ — 0 0 — — — 0 1 2 4
Massachusetts — 0 0 — 1 — 0 1 — 5
New Hampshire — 0 0 — — — 0 1 1 —
Rhode Island§ — 0 0 — — — 0 0 — —
Vermont§ — 0 0 — 1 — 0 0 — —
Mid. Atlantic — 0 2 16 11 1 1 4 50 89
New Jersey — 0 0 — 2 — 0 2 — 57
New York (Upstate) — 0 1 2 — 1 0 3 15 13
New York City — 0 1 1 1 — 0 4 23 6
Pennsylvania — 0 2 13 8 — 0 1 12 13
E.N. Central — 0 1 4 9 1 1 9 87 79
Illinois — 0 1 2 1 — 0 5 28 47
Indiana — 0 1 2 3 1 0 5 43 10
Michigan — 0 0 — 4 — 0 1 1 1
Ohio — 0 0 — — — 0 2 14 17
Wisconsin — 0 0 — 1 — 0 1 1 4
W.N. Central — 0 5 18 18 1 3 21 274 246
Iowa — 0 0 — 1 — 0 1 4 4
Kansas — 0 1 2 1 — 0 0 — —
Minnesota — 0 1 — 1 — 0 1 — 1
Missouri — 0 5 14 7 1 3 20 266 237
Nebraska§ — 0 1 2 8 — 0 1 3 4
North Dakota — 0 0 — — — 0 1 1 —
South Dakota — 0 0 — — — 0 0 — —
S. Atlantic — 1 9 67 62 6 7 60 426 348
Delaware — 0 1 1 — — 0 3 17 16
District of Columbia — 0 0 — — — 0 1 — —
Florida — 0 1 3 — 1 0 2 11 5
Georgia — 0 6 45 48 — 0 0 — —
Maryland§ — 0 1 2 3 1 0 4 42 34
North Carolina — 0 3 11 7 3 1 48 228 229
South Carolina§ — 0 1 1 3 — 0 2 15 15
Virginia§ — 0 2 4 1 1 1 11 113 47
West Virginia — 0 0 — — — 0 0 — 2
E.S. Central — 0 3 20 9 1 4 29 329 243
Alabama§ — 0 1 4 3 — 1 8 68 59
Kentucky — 0 2 6 1 — 0 0 — —
Mississippi — 0 0 — — — 0 2 9 9
Tennessee§ — 0 3 10 5 1 3 20 252 175
W.S. Central 2 0 3 6 8 18 1 408 78 125
Arkansas§ 2 0 1 2 — 17 0 110 37 62
Louisiana — 0 0 — — — 0 1 2 2
Oklahoma — 0 3 3 6 — 0 287 22 43
Texas§ — 0 1 1 2 1 0 11 17 18
Mountain — 0 1 2 14 — 0 2 7 24
Arizona — 0 1 — 8 — 0 1 1 12
Colorado — 0 0 — 1 — 0 1 1 —
Idaho§ — 0 0 — — — 0 1 2 1
Montana§ — 0 1 2 4 — 0 1 1 6
Nevada§ — 0 0 — — — 0 0 — 1
New Mexico§ — 0 0 — — — 0 1 1 1
Utah — 0 0 — — — 0 1 1 1
Wyoming§ — 0 0 — 1 — 0 0 — 2
Pacific — 0 2 6 1 — 0 0 — —
Alaska N 0 0 N N N 0 0 N N
California — 0 2 5 1 — 0 0 — —
Hawaii N 0 0 N N N 0 0 N N
Oregon — 0 1 1 — — 0 0 — —
Washington — 0 0 — — — 0 0 — —
Territories
American Samoa N 0 0 N N N 0 0 N N
C.N.M.I. — — — — — — — — — —
Guam N 0 0 N N N 0 0 N N
Puerto Rico N 0 0 N N N 0 0 N N
U.S. Virgin Islands — 0 0 — — — 0 0 — —
C.N.M.I.: Commonwealth of Northern Mariana Islands.
U: Unavailable. —: No reported cases. N: Not reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum.
* Incidence data for reporting year 2010 is provisional.
† Illnesses with similar clinical presentation that result from Spotted fever group rickettsia infections are reported as Spotted fever rickettsioses. Rocky Mountain spotted fever (RMSF) caused
by Rickettsia rickettsii, is the most common and well-known spotted fever.
§ Contains data reported through the National Electronic Disease Surveillance System (NEDSS).

1356 MMWR / October 22, 2010 / Vol. 59 / No. 41

 MMWR Morbidity and Mortality Weekly Report

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 16, 2010, and October 17, 2009 (41st week)*
Streptococcus pneumoniae,† invasive disease
All ages Age <5 Syphilis, primary and secondary
Current Previous 52 weeks Cum Cum Current
Previous 52 weeks
Cum Cum Current
Previous 52 weeks
Cum Cum
Reporting area week Med Max 2010 2009 week Med Max 2010 2009 week Med Max 2010 2009
United States 123 199 495 11,071 2,339 15 51 156 1,722 1,831 98 240 413 9,495 11,173
New England 1 8 99 599 44 — 1 24 78 60 2 8 22 352 250
Connecticut — 0 92 265 — — 0 22 25 — — 1 10 69 45
Maine§ 1 2 6 95 14 — 0 1 8 7 — 0 3 23 2
Massachusetts — 0 5 54 3 — 1 4 37 37 — 5 15 211 180
New Hampshire — 0 7 59 — — 0 1 3 10 — 0 2 17 13
Rhode Island§ — 0 35 64 15 — 0 2 2 2 2 0 4 30 10
Vermont§ — 1 6 62 12 — 0 1 3 4 — 0 2 2 —
Mid. Atlantic 7 20 54 970 152 4 7 48 271 229 25 33 45 1,351 1,419
New Jersey — 1 8 83 — — 1 5 43 45 2 4 12 187 179
New York (Upstate) 1 3 12 128 61 1 3 19 91 99 1 2 11 104 95
New York City 4 6 25 379 10 3 1 24 94 71 17 18 31 770 873
Pennsylvania 2 7 22 380 81 — 0 5 43 14 5 7 16 290 272
E.N. Central 32 34 98 2,242 525 4 8 18 285 305 1 27 46 1,048 1,229
Illinois — 1 7 76 — — 2 5 69 50 — 9 23 334 597
Indiana — 7 24 439 202 — 1 6 38 62 — 3 13 139 125
Michigan 4 10 27 533 24 1 2 6 66 57 — 4 12 170 192
Ohio 24 15 49 919 299 3 2 6 79 102 1 9 18 370 276
Wisconsin 4 5 22 275 — — 1 4 33 34 — 1 3 35 39
W.N. Central 12 8 182 626 152 1 2 12 112 149 3 5 19 254 253
Iowa — 0 0 — — — 0 0 — — — 0 2 10 21
Kansas — 1 7 77 50 — 0 2 13 16 — 0 3 16 27
Minnesota — 0 179 287 38 — 0 10 44 70 — 1 9 97 60
Missouri 1 2 10 91 53 1 1 3 33 40 3 3 10 122 137
Nebraska§ 5 1 7 106 2 — 0 2 13 10 — 0 2 7 5
North Dakota 6 0 11 50 7 — 0 1 2 4 — 0 1 — 3
South Dakota — 0 3 15 2 — 0 2 7 9 — 0 1 2 —
S. Atlantic 27 49 144 2,600 1,056 3 12 28 432 437 27 54 218 2,224 2,677
Delaware 1 0 3 29 18 — 0 0 — 3 — 0 2 4 25
District of Columbia — 0 4 21 18 — 0 2 7 4 12 2 8 118 147
Florida 14 22 89 1,172 615 2 3 18 158 155 2 20 44 830 836
Georgia 2 10 28 427 314 1 3 12 120 118 1 9 167 394 624
Maryland§ 2 7 31 409 4 — 1 6 44 65 5 6 12 240 239
North Carolina — 0 0 — — — 0 0 — — — 7 31 286 448
South Carolina§ 8 6 25 403 — — 1 4 42 38 7 2 7 117 98
Virginia§ — 0 4 46 — — 1 4 44 36 — 4 22 231 256
West Virginia — 1 21 93 87 — 0 4 17 18 — 0 2 4 4
E.S. Central 8 20 50 980 214 1 2 8 98 116 24 18 39 716 924
Alabama§ — 0 0 — — — 0 0 — — 2 5 12 190 354
Kentucky — 3 16 152 58 — 0 2 13 7 5 2 13 104 50
Mississippi — 1 6 46 41 — 0 2 10 21 16 4 17 177 179
Tennessee§ 8 13 44 782 115 1 2 7 75 88 1 5 17 245 341
W.S. Central 15 18 91 1,419 100 1 5 41 229 276 7 37 58 1,459 2,278
Arkansas§ — 2 9 130 46 — 0 3 14 35 7 3 13 133 203
Louisiana — 1 8 67 54 — 0 3 20 22 — 7 24 317 645
Oklahoma — 1 5 40 — — 1 5 40 50 — 2 6 64 74
Texas§ 15 16 83 1,182 — 1 3 34 155 169 — 25 42 945 1,356
Mountain 19 22 82 1,397 93 1 5 12 188 232 1 9 23 389 430
Arizona 6 8 51 635 — 1 2 7 81 101 — 3 7 124 194
Colorado 12 7 20 423 — — 1 4 54 37 — 2 7 105 78
Idaho§ — 0 2 11 — — 0 2 5 7 — 0 1 2 3
Montana§ — 0 2 16 — — 0 1 1 — — 0 1 1 2
Nevada§ — 1 4 60 35 — 0 1 5 7 — 1 9 86 81
New Mexico§ — 2 9 119 — — 0 4 14 26 1 1 4 38 45
Utah — 2 9 123 49 — 1 4 25 53 — 1 4 33 24
Wyoming§ 1 0 1 10 9 — 0 1 3 1 — 0 0 — 3
Pacific 2 5 14 238 3 — 0 7 29 27 8 42 60 1,702 1,713
Alaska — 1 9 92 — — 0 5 18 18 — 0 1 1 —
California 2 3 12 146 — — 0 2 11 — 7 37 55 1,465 1,523
Hawaii — 0 0 — 3 — 0 1 — 9 — 0 3 27 29
Oregon — 0 0 — — — 0 0 — — 1 1 6 56 42
Washington — 0 0 — — — 0 0 — — — 3 10 153 119
Territories
American Samoa — 0 0 — — — 0 0 — — — 0 0 — —
C.N.M.I. — — — — — — — — — — — — — — —
Guam — 0 0 — — — 0 0 — — — 0 0 — —
Puerto Rico — 0 0 — — — 0 0 — — 1 4 15 182 174
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 reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum.
* Incidence data for reporting year 2010 is provisional.
† Includes drug resistant and susceptible cases of invasive Streptococcus pneumoniae disease among children <5 years and among all ages. Case definition: Isolation of S. pneumoniae from
a normally sterile body site (e.g., blood or cerebrospinal fluid).
§ Contains data reported through the National Electronic Disease Surveillance System (NEDSS).

MMWR / October 22, 2010 / Vol. 59 / No. 41 1357

 MMWR Morbidity and Mortality Weekly Report

TABLE II. (Continued) Provisional cases of selected notifiable diseases, United States, weeks ending October 16, 2010, and October 17, 2009 (41st week)*
West Nile virus disease†
Varicella (chickenpox)§ Neuroinvasive Nonneuroinvasive¶
Previous 52 weeks Previous 52 weeks Previous 52 weeks
Current Cum Cum Current Cum Cum Current Cum Cum
Reporting area week Med Max 2010 2009 week Med Max 2010 2009 week Med Max 2010 2009
United States 127 312 547 11,125 16,974 — 0 68 479 381 — 1 48 310 333
New England 1 15 36 562 884 — 0 3 12 — — 0 1 2 —
Connecticut — 6 20 253 414 — 0 2 6 — — 0 1 1 —
Maine§ — 3 15 157 181 — 0 0 — — — 0 0 — —
Massachusetts — 0 0 — 4 — 0 2 5 — — 0 1 1 —
New Hampshire 1 2 8 106 171 — 0 1 1 — — 0 0 — —
Rhode Island§ — 1 12 27 31 — 0 0 — — — 0 0 — —
Vermont§ — 0 10 19 83 — 0 0 — — — 0 0 — —
Mid. Atlantic 13 32 62 1,245 1,702 — 0 19 119 9 — 0 13 56 1
New Jersey — 9 30 427 360 — 0 3 13 3 — 0 6 11 —
New York (Upstate) N 0 0 N N — 0 9 55 3 — 0 7 29 1
New York City — 0 0 — — — 0 7 32 3 — 0 4 8 —
Pennsylvania 13 21 39 818 1,342 — 0 3 19 — — 0 3 8 —
E.N. Central 47 103 176 3,720 5,271 — 0 13 60 9 — 0 6 24 4
Illinois 5 24 49 969 1,302 — 0 10 33 5 — 0 4 11 —
Indiana§ — 5 35 331 384 — 0 1 2 2 — 0 2 6 2
Michigan 8 33 62 1,102 1,508 — 0 6 23 1 — 0 1 4 —
Ohio 32 28 56 1,042 1,586 — 0 1 2 — — 0 1 1 2
Wisconsin 2 7 22 276 491 — 0 0 — 1 — 0 1 2 —
W.N. Central 9 15 40 619 1,085 — 0 7 25 26 — 0 8 60 74
Iowa N 0 0 N N — 0 1 2 — — 0 2 4 5
Kansas§ — 6 22 225 454 — 0 1 1 4 — 0 2 5 9
Minnesota — 0 0 — — — 0 1 3 1 — 0 1 2 3
Missouri 5 7 23 328 524 — 0 1 3 4 — 0 0 — 1
Nebraska§ N 0 0 N N — 0 3 10 11 — 0 7 27 40
North Dakota — 0 26 31 57 — 0 2 2 — — 0 1 6 1
South Dakota 4 0 7 35 50 — 0 2 4 6 — 0 3 16 15
S. Atlantic 29 37 98 1,733 2,165 — 0 4 22 16 — 0 4 12 2
Delaware§ — 0 3 15 11 — 0 0 — — — 0 0 — —
District of Columbia — 0 4 17 27 — 0 0 — 2 — 0 0 — —
Florida§ 7 15 57 846 1,009 — 0 2 6 2 — 0 1 1 1
Georgia N 0 0 N N — 0 1 4 4 — 0 3 7 —
Maryland§ N 0 0 N N — 0 3 10 — — 0 2 4 1
North Carolina N 0 0 N N — 0 0 — — — 0 0 — —
South Carolina§ — 0 35 75 93 — 0 0 — 3 — 0 0 — —
Virginia§ 12 11 34 412 617 — 0 1 2 5 — 0 0 — —
West Virginia 10 8 26 368 408 — 0 0 — — — 0 0 — —
E.S. Central — 6 22 233 467 — 0 1 7 36 — 0 3 9 27
Alabama§ — 5 22 226 462 — 0 1 1 — — 0 1 2 —
Kentucky N 0 0 N N — 0 1 2 3 — 0 1 1 —
Mississippi — 0 2 7 5 — 0 1 2 29 — 0 2 4 22
Tennessee§ N 0 0 N N — 0 1 2 4 — 0 2 2 5
W.S. Central 23 50 285 2,168 4,174 — 0 14 73 116 — 0 3 13 35
Arkansas§ — 3 32 122 420 — 0 3 6 6 — 0 0 — —
Louisiana — 1 5 40 118 — 0 3 14 10 — 0 1 6 11
Oklahoma N 0 0 N N — 0 0 — 8 — 0 0 — 2
Texas§ 23 41 272 2,006 3,636 — 0 14 53 92 — 0 2 7 22
Mountain 5 20 36 801 1,134 — 0 13 119 77 — 0 15 111 123
Arizona — 0 0 — — — 0 10 80 12 — 0 9 52 8
Colorado§ 5 8 16 322 437 — 0 5 24 36 — 0 11 49 67
Idaho§ N 0 0 N N — 0 0 — 9 — 0 1 1 29
Montana§ — 3 17 161 129 — 0 0 — 2 — 0 0 — 3
Nevada§ N 0 0 N N — 0 0 — 7 — 0 1 2 5
New Mexico§ — 2 8 87 100 — 0 4 13 6 — 0 2 3 2
Utah — 5 17 218 468 — 0 0 — 1 — 0 0 — 1
Wyoming§ — 0 3 13 — — 0 1 2 4 — 0 1 4 8
Pacific — 1 5 44 92 — 0 7 42 92 — 0 4 23 67
Alaska — 0 5 33 54 — 0 0 — — — 0 0 — —
California — 0 0 — — — 0 7 42 65 — 0 4 23 45
Hawaii — 0 2 11 38 — 0 0 — — — 0 0 — —
Oregon N 0 0 N N — 0 0 — 1 — 0 0 — 10
Washington N 0 0 N N — 0 0 — 26 — 0 0 — 12
Territories
American Samoa N 0 0 N N — 0 0 — — — 0 0 — —
C.N.M.I. — — — — — — — — — — — — — — —
Guam — 0 3 14 20 — 0 0 — — — 0 0 — —
Puerto Rico 9 9 30 486 465 — 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 reportable. NN: Not Nationally Notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum.
* Incidence data for reporting year 2010 is provisional. Data for HIV/AIDS, AIDS, and TB, when available, are displayed in Table IV, which appears quarterly.
† 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.
§ Contains data reported through the National Electronic Disease Surveillance System (NEDSS).
¶ Not reportable in all states. Data from states where the condition is not reportable 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/ncphi/disss/nndss/phs/infdis.htm.

1358 MMWR / October 22, 2010 / Vol. 59 / No. 41

 MMWR Morbidity and Mortality Weekly Report

TABLE III. Deaths in 122 U.S. cities,* week ending October 16, 2010 (41st week)
All causes, by age (years) All causes, by age (years)
All P&I† All P&I†
Reporting area Ages ≥65 45–64 25–44 1–24 <1 Total Reporting area Ages ≥65 45–64 25–44 1–24 <1 Total

New England 512 364 104 26 7 11 34 S. Atlantic 1,152 728 305 72 29 17 80

Boston, MA 140 93 33 8 2 4 7 Atlanta, GA 123 69 39 11 3 1 8
Bridgeport, CT 27 22 4 1 — — 2 Baltimore, MD 144 82 45 14 2 1 10
Cambridge, MA 18 14 4 — — — 3 Charlotte, NC 137 102 28 7 — — 12
Fall River, MA 24 21 3 — — — 1 Jacksonville, FL 153 104 38 6 3 2 10
Hartford, CT 40 28 7 4 — 1 4 Miami, FL 78 48 20 5 3 2 11
Lowell, MA 18 13 1 1 1 2 1 Norfolk, VA 59 34 15 4 2 4 2
Lynn, MA 9 5 2 2 — — — Richmond, VA 67 39 22 2 4 — 8
New Bedford, MA 12 11 1 — — — 2 Savannah, GA 54 42 7 2 1 2 —
New Haven, CT 35 23 8 3 — 1 2 St. Petersburg, FL 55 37 12 2 2 2 1
Providence, RI 70 53 13 2 1 1 4 Tampa, FL 165 107 45 8 2 3 12
Somerville, MA 5 3 1 1 — — — Washington, D.C. 111 61 33 9 7 — 5
Springfield, MA 30 19 11 — — — — Wilmington, DE 6 3 1 2 — — 1
Waterbury, CT 24 15 7 — 2 — 5 E.S. Central 710 445 178 48 24 15 63
Worcester, MA 60 44 9 4 1 2 3 Birmingham, AL 145 91 31 11 7 5 12
Mid. Atlantic 1,693 1,197 345 95 35 21 84 Chattanooga, TN 74 61 8 3 2 — 4
Albany, NY 43 34 7 2 — — 1 Knoxville, TN 69 47 14 6 1 1 5
Allentown, PA 31 25 3 2 — 1 1 Lexington, KY 80 47 25 5 3 — 3
Buffalo, NY 81 50 24 4 2 1 4 Memphis, TN 136 82 39 9 3 3 18
Camden, NJ 29 17 10 2 — — 2 Mobile, AL 48 27 15 3 1 2 3
Elizabeth, NJ 14 8 5 — 1 — 2 Montgomery, AL 27 18 8 — — 1 5
Erie, PA 46 34 9 3 — — 2 Nashville, TN 131 72 38 11 7 3 13
Jersey City, NJ 30 19 6 5 — — 1 W.S. Central 1,226 772 299 102 31 22 72
New York City, NY 942 680 183 50 19 10 36 Austin, TX 53 32 18 3 — — 2
Newark, NJ U U U U U U U Baton Rouge, LA U U U U U U U
Paterson, NJ 17 8 8 1 — — 3 Corpus Christi, TX 56 34 17 3 2 — 4
Philadelphia, PA 146 85 35 13 5 8 8 Dallas, TX 183 119 44 10 7 3 14
Pittsburgh, PA§ 40 27 10 1 2 — 4 El Paso, TX 73 55 9 4 4 1 6
Reading, PA 26 23 2 — 1 — 2 Fort Worth, TX U U U U U U U
Rochester, NY 72 52 15 — 4 1 7 Houston, TX 430 239 107 67 12 5 26
Schenectady, NY 24 18 4 2 — — 2 Little Rock, AR 59 40 16 1 1 1 —
Scranton, PA 21 15 5 — 1 — 2 New Orleans, LA U U U U U U U
Syracuse, NY 71 59 10 2 — — 4 San Antonio, TX 208 135 48 11 3 11 11
Trenton, NJ 22 15 4 3 — — — Shreveport, LA 50 39 10 — 1 — 3
Utica, NY 21 17 1 3 — — 1 Tulsa, OK 114 79 30 3 1 1 6
Yonkers, NY 17 11 4 2 — — 2 Mountain 1,059 685 252 64 35 21 60
E.N. Central 1,834 1,217 467 93 23 34 117 Albuquerque, NM 109 75 23 5 4 2 9
Akron, OH 44 29 8 4 1 2 6 Boise, ID 47 33 10 3 1 — 3
Canton, OH 29 19 7 2 1 — 7 Colorado Springs, CO 60 39 15 3 3 — 1
Chicago, IL 238 131 81 21 5 — 23 Denver, CO 78 43 23 5 2 5 3
Cincinnati, OH 87 57 17 9 — 4 9 Las Vegas, NV 308 180 94 15 12 7 17
Cleveland, OH 233 167 58 4 1 3 9 Ogden, UT 23 17 4 2 — — 2
Columbus, OH 176 129 37 3 1 6 9 Phoenix, AZ 176 113 36 13 8 4 10
Dayton, OH 143 103 31 7 2 — 9 Pueblo, CO 33 29 3 1 — — 1
Detroit, MI 117 69 36 6 3 3 2 Salt Lake City, UT 110 75 22 10 1 2 9
Evansville, IN 44 32 11 1 — — 2 Tucson, AZ 115 81 22 7 4 1 5
Fort Wayne, IN 55 37 15 2 — 1 2 Pacific 1,505 1,019 354 73 30 28 116
Gary, IN 18 5 9 4 — — — Berkeley, CA 11 8 2 — 1 — 1
Grand Rapids, MI 55 41 13 — — 1 2 Fresno, CA 107 67 26 6 4 4 6
Indianapolis, IN 191 116 55 11 3 6 7 Glendale, CA 32 27 3 — — 2 5
Lansing, MI 47 34 11 — 1 1 4 Honolulu, HI 82 59 14 6 — 3 7
Milwaukee, WI 80 51 20 7 — 2 6 Long Beach, CA 67 39 19 3 3 3 8
Peoria, IL 42 28 9 2 1 2 7 Los Angeles, CA 221 134 60 17 6 4 19
Rockford, IL 61 39 15 4 2 1 3 Pasadena, CA 18 15 1 2 — — 2
South Bend, IN 36 29 7 — — — 3 Portland, OR 115 74 32 8 1 — 7
Toledo, OH 77 53 15 5 2 2 2 Sacramento, CA 141 100 32 6 — 2 12
Youngstown, OH 61 48 12 1 — — 5 San Diego, CA 147 97 37 9 3 1 6
W.N. Central 562 386 128 34 10 4 37 San Francisco, CA 98 72 24 — 1 1 10
Des Moines, IA 78 54 20 3 1 — 4 San Jose, CA 159 125 26 3 2 3 15
Duluth, MN 31 24 7 — — — 1 Santa Cruz, CA 23 17 5 — 1 — 1
Kansas City, KS 26 16 5 5 — — 1 Seattle, WA 94 61 25 5 1 2 7
Kansas City, MO 120 81 26 9 1 3 8 Spokane, WA 61 41 14 3 3 — 7
Lincoln, NE 35 26 9 — — — 2 Tacoma, WA 129 83 34 5 4 3 3
Minneapolis, MN 47 31 9 3 3 1 3 Total¶ 10,253 6,813 2,432 607 224 173 663
Omaha, NE 86 57 21 5 3 — 6
St. Louis, MO 15 6 4 4 1 — —
St. Paul, MN 51 39 10 2 — — 4
Wichita, KS 73 52 17 3 1 — 8
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.

MMWR / October 22, 2010 / Vol. 59 / No. 41 1359

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