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    RJR0000001283101062
    700603437
http://legacy.library.ucsf.edu/tid/pqp55a00/pdf
                           CDC                                                      Januar y 28, 2000 / Vol . 49 / No . 3


                                                                                  49 Tobeccu UsaAm on9 Md dIe and High
                                                                                       SMod Su,dents -
                                                                                       United Steles,ti9S
                                                                                  SS Update : InAU enza Aqmly-
                                                                                       Udted states,1Y99-2000 Season
                                                                                  S1 Rograa cToward Poliom yelke
                                                                                       Erade Nio n- Chatl,169 6-IiD9
                                                                                  e OutWeat d Shqelq sonnei Inteaions
                                                                                       A ssociatad wilh Ealing a Nato naty
                           MORBIDITY AND MORTALITY                                     Diatnbmed ep-Oalilomu,Oregon,
                                                                                       and Washingbn, Janwr y 2000
                           WEEKLY REPORT                                          01 Noticeto Resdert




                                     Tobecoo Use Among Middle and High School Students-
                                                      UnHed State a, 1999

                             The prevalen ce of cigarette smo king natio nwide among high school students
                          inc reased dur ing the 199os (1 ) ; more than 80% of current adul t tobacco users started
                          smok ing cigar ette s before age 18 yea rs (2 ) . To determine the pre valence of cigar ette ,
                          smok eless tabac co (i .e ., chewing tobacco and snuff), cigar, pipe , bidi, and kretek use
                          among middle scho ol and high school students nationwide, the Amer ican Legacy
                          Foun dafion, In collaboration with the CDC Foundati on, conducted the National Youth
                          Tabacc o Survey (NYTS) during the fall of 1999 . This repor t summar Izes data from the
                          NYTS on cu rrent us e of tobacco products , w h ich indi cate that 12 .8% of mi ddle school
                          students and 34 .8% of high school stud ents use any type of tabac co ; that the low
                          prevalence of current cigarette smoki rig obse rved among black high school students
                          throughou 1 the 1990s is not foun d among middl e school students (1 j ; and that the
                          percentages of high school students who currently use ddis and kreteks (two new
                          forms of tobacc o in the Uni ted States) are almost as high as the proportion who use
                          smok eless tobac co .
                             The school-ba sed 1999 NYTS empl oyed a thre e-stage cluster sampl e des igned to
                          produce a nationally representati ve sample of stud ents in grades 6-12 . The tirst-stage
                          sampl ing Irame conta Ined 1306 primary sampli ng units (PSUs), each conpri sing a
                          large county or a group of smal ler adjacent counties . From the 1306 PSUS, 66 wer e
                          selected from 16 strata formed on the basis of the degree o1 urbani zation and the
                          relative perc enta ge o1 black and Hispani c students in the PSU . PSUs were selected
                          with probabi lity proportional to wei ghled school enrol Irnent . At the second sampl ing
                          stage, 145 school s from the 66 PSUs were selected with probabi lily proponl onal to
                          weighled school enrolIment . To ensur e separate anelysis of black and Hispanic stu-
                          dents, schools wi Ih substa ntial numb ers of black and Hispa nic students wur e sampled
                          at higher rates than all other schools through a weighted meas ure of size . The thl yd
                          stage of sampl Ing cons isted of randoml y selecting appr oxi matel y five intacl classes of
                          a requi red subJ act (e .g ., Engl ish or social studi es) across grades 6-12 from each par-
                          ticipati ng school . All students in the selected classes wer e ellgibl e to participate . A
                          weighti ng factor was appl ied to each student record to adj ust for nonresponse and for
                          the varying probabil ities of selection, includi ng those resul ting from the oversampt ing
                          of black and Hispanic students . Number sofstudeMsinracial/ethnicgroups other than
                          black, white , and Hispanic wer e too smal I for meani ngful anal ysis . The weights wer e
                                              U.S . DEPARTMENT OF HEALTH & HUMAN SERVICES




http://legacy.library.ucsf.edu/tid/pqp55a00/pdf
                           50          M       M           W               R           Jenuer                                  y           26,                 2000

                           Tobaao Use-Continued

                           scaled so that the wei ghted count of students equaled the tota I sampl e size and the
                           weighted proporti ons o1 students in each grade matched nati onal population propor-
                           tions . For the 1999 NYTS, 15,058 students in 131 schools oompl eted ques Gonnai res .
                           The school response rate was 90%, and the student respons e rate was 93%, resulting
                           in an over all response rate of 84%,
                              For the NYTS, students compl eted an anonymous ,self-admi nisteredquestionnaire
                           that included questions about tobacco use, exposure to environmental tobacco
                           smok e, mi nors' ability to purchas e or otherwise obtai n tobacco products , know ledge
                           and attitudes about tobacco, and fami liarity with pro- and anti-tobacco med a mes-
                           sages . SUDAAN was used to compute 95% conli dance intervals, whi ch were used to
                           determine d1f erences betwee n subgr orQs at the pc0 .05 level . Differences betwee n
                           prevalence estimate s wer e cons ide red stati stically signilicant il the 95% conti dence
                           inte rvals did not overlap . Current use of bidi s, cigarettes, cigars, kreteks, pipes, and
                           smok eless tobacco was defi nod as use on one or more of the 30 days preceding the
                           survey . Any current tobac co us e was deli ned as usin g any of these produc ts on one or
                           moreof the 30 days precedingthe survey .

                           M Iddle Scho ol Stu dents
                              Amon g midde school (grades 6-8) students , the ove rall prevalence of any current
                           tobacco use was 12 .8% (Table 1) . Cigarettes (9 .2%) were the most prevalent type of
                           tobacco used, fol lowed by ciga rs (6 .1%) . Cigar sae smoki ng rat es wer e simi lar among
                           boys and girls and amon g racial/ethni c groups . Boys wer e slgnili cantl y ma e likely


                           TABLE 1 . Percent ege of students In ml ddl e achool (grades 9-9) and hl gh school (gra des
                           9-12) currently' using tobacco products, by type of tobacco product, sex, and
                           race/ethnlchy- Unlted States, National Youth Tobacco Survey, 1999
                                                                     aes                                             RacMEthMelty
                                                       Mile                       Fernsle             Whlk                    Black           Hispanic                   Total
                           Typeottobacce
                             product            %      195% CIt)            %       (95% CI)      %      (95Y. CI)    %        (96% CI)     %      (95%CI)       %        (95%0)
                           Any Ya es
                             Mtldlsschool      14 .2     (± 2 .2)      11 .3         H-22)       11 .6   (32 .3)     14 .4      (•-2.7)    152     (t5 .2)     12.8        (t2 .0)
                             Hgh school        38 .1     (23 .2)       31 .4         (33 .1)     39 .4   (23 .2)     24 .0      (i4.2)     30 .7   (24 .4)     34.8        (!2 .7)
                           Ciperet te
                             Middlsschod        9 .6     (i1 .7)           8 .8      (`-1 .7)     8.8     1=2 .01     9 .0      (!1 .8)    11 .0   (! 4 .1)      9 .2      ('-1 .6)
                             High school       28 .7     (x2 .8)       28 .2         (?3 .3)     32 .8    (!3 .1)    15 .8      (33.8)     25 .8   (34 .7)     211 . 4     (22 .7)
                           amokeless
                             MItlM e school     4 .2     (3 1 .3)           1 .3     (+_ 0 .5)    3.0     (a 1 .1)    1 .9      ('- 0.9)    2.2    (i 0 .9)      2 .7      (±0 .7)
                             High school       11 .6     (±2 .8)            1 .5     (30 .6)      8.7     (22 .1)     2.4       (31 .3)     3.6    (21 .6)       6 .6      (21 .6)
                           Cigar
                             Mitldl e school    7 .8     ('_ 1 .3)          4 .4     (11 .3)      4.9     (± 1 .0)    8.8       (S 2.3)     7.6    (2 2 .9)      6 .1      (e 1 .1)
                             High school       20 .3     (± 1 .9)      10 .2         (a 1 .6)    16 .0    (11 .6)    14.8       (3 3.5)    13.4    (+_ 2 .9)   16 .3       (3 / .4)

                           Pipe
                             Middl a school     3 .5     (3 0 .8)           1 .4     (S 0.6)      2.0     (± 0 .6)    2 .0      (! 0.9)     3 .8   (3 1 .7)      2.4       (+_ .6)
                                                                                                                                                                                0
                             High school        4 .2     (+_0.9)            1 .4     (30 .5)      2.6     (30 .8)     1 .8      (t0 .9)     3 .8   (+_1 .4)      2.8         .
                                                                                                                                                                           (305)
                           ami
                             Mltldl e school    3 .1     (± 0.8)            1 .8     (3 0 .6)     1 .8    (±0 .5)     2 .8      (11 .3)     3 .5   (11 .6)       2.4          0
                                                                                                                                                                           (3 .5)
                             High school        6,1      (f 1 .0)           3,8      (3 1 .0)     4 .4    (i 0 .9)    5 .8      412 .1 )    5 .6   (1 2.1)       6.0       (t .8)
                                                                                                                                                                              0

                           KroteY
                             Middl 6 school     2 .2     (*_ 0.6)           1 .7     (2 0 .7)     1 .7    (f 0 .7)     1 .7     (3 0 .8)    2 .1   (2 0.6)       1 .9      (± 0.6)
                             High school        6 .2     (i 1 .1)           5 .3     (! 1 .5)     6 .5    (t 1 .5)    2 .8      (3 1 .5)    5 .5   (± 1 .9)      6.8       (t 1 .2)

                           • Used lotscco on one or mor e of the 30 days prec edig lhe eurvey .
                           +Cmdi dance Iner val .
                           1 Use o1 Cgar e11es, emokebss IobaccC, cipars, plpss, sitll s, or krstaks .




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                          Vol .49/No.3                         MMWR                                       51

                          Tobacco Use-Continued

                          than girlsto usesmokelesstobacco(4 .2%and 1 .3%,respectively),smoke cigars(7 .8%
                          and 4 .4%, respedi vely), and smoke tobacco in a pipe (3 .5% and 1 .4%, respectively) .
                          Black students were signific antly more likely than white students to amok e cigars
                          (8 .8% and 4 .9%, respectively) .

                          High Schoo I Stud ants
                              Amon g high school (grades 9-12) students, the over all prevalence of any current
                          tobacco use was 34 .8% . Cigar ettes (28 .4%) wer e the most preval ent type uf tabac cu
                          used, followed by cigars (15 .3%) . Boys were significantl y mor e likely than girls to use
                          smok eless tobacco (11 .6% and 1 .5%, respectlvely), smoke cigars (20 .3% and 10 .2'/,,
                          respec tivel y), smoke tobacco in a pipe (4 .2% and 1 .4%, respecti vely), and smok e bidis
                          (6 .1% and 3 .8%, respectively) . White and Hispani c students wer e signi ficantl y more
                          f ikely than bl ack students to smoke clgar ettes (32 .8%, 25 .8%, and 15 .8%, respec tlvel y) .
                          Whi te students wer e significantl y mor e likely than bla ck and Hispanic students to use
                          smdc eless tobac co (8 .7%, 2 .4%, and 3,6%, respectively) .
                          Repor ted by ; C Healton, Dr PH, P Mes seri, PhD, J Reynolds, M PH, C Wolfe, The A m ericen Legacy
                          Foundation , Washingt on, DC. C Stokes, MEd. CDC Foundation, A1lanta, Georgia . J Ross, MS,
                          K Flinl, MA, W Robb, MS, Macro International Inc., Celverton, Maryland . M Farrelly, PhD,
                          Research Triangle Instilul a, Research Triangle Park, Norlh Carolina. Office on Smoking and
                          Health, National Center for Chronic Disease Prevention and Health Promolion, CDC .
                          Edltorlal Note :Thi a repor t is the first to meas we the prev alence of current tobac co use
                          among a nati onal ly representa tive sample of mi ddle school students and the first to
                          reportAhe prevalence of current bldi andkretekuseamong analionallyrepresentati ve
                          sampl eof middle and high school students .Although previous national surveyshave
                          shown that cigarette smoking rates among black high school students have been
                          increas ing, Wac k students stil I wer e smoki ng at muc h lower rates than other high
                          school students (1,3,4) .However,iheilydings intNsrepod Indicatethat currenlciga-
                           rette smoking prevalence among middle school black students was similar to rates
                           among whi te and Hispani c students ard that current cigar use prevalence among mid-
                           dle school black students was significantl y higher than among white students . Future
                           surveys shoul d evaluale whethe r the rate of increase in smok ing rates among black
                           sludeMs has accelerated and whether the difference in amok ing rates between black
                          and whi te high school students are disappea ring . In addi tion, nar e research is neede d
                          to determin e whether black youth are finding smoking appealing and socially
                           accepta ble .
                              Current use of novel tobac co products, such as bidis and kreteks, is an emer ging
                           publ ic heal M problem among U .S . youth (5 ) . Cigarettes remai n the most widely used
                           lobaccoproducl byyoulh ; however,recent lrendsunder score the import ance of moni-
                           tori ng the rates at w hich youth ado pt other tob acco produc ts . The soc ial and culture I
                           factors related to differing patter ns of tobac co product use across sex and racial/ethni c
                           groups requi re addtional sludy .
                              The 1999 NYTS estimates for high school students will be compar ed with those of
                           the Monitoring The Futur e(MTF) study and the Youth Risk Behav ior Survey (YRBS),
                           the other nati onal school -base d surveys . Compari son of NYTS estim ates w ith those of
                           other nation al surveys must be interpreted with cauti on for sever al reasons . First,
                           YRBS and MiF wer e calduc ted dur ing spring 1999, and NYTS was conduct ad dur Ing
                           September -October 1999, a dill erent academi c year . W ithl n each grade, the tall school
                           populati on is approximat ely 6 months young er than the spring school popul ation .




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                           62       M      M      W      R      Januar                  y     26,           2000

                           Tobacco Use-Continued

                           This ditference can be expect ed to lead to higher esti mates of ever smoking in lhe
                           spring surveys and may lead to higher estimates of current smoki ng . Second, lhe
                           tobacco industry increased the whole sale price ol tobac co products dur ing 1999, but
                           also provi ded substanti al price discounts dur Ing the same period, making dete rmina-
                           tion 01 the precise etfect ot retai 1 prices on smok ing rates difficult . However, prelimi-
                           nary per capita consumption estimates from the U .S. Departmen t of Agriculture
                           sugges t cigarette consumpti on has decreased in 1999, sugges ting that the prevalence
                           among youth also may have decreased (6) . Third, the NYiS is a single -topic survey
                           (tabacc o), and MTF and YRBS are mul ti-top ic surveys . The effect of the number of
                           topics surv eyed on the resu Ilin g estima tes is unknown . Finally, NYTS had a 90%
                           school respons e rate, a higher reported school response rate than YRBS and MTE
                           Some schools that participated in the NYTS may not participate in YRBS or MTF.
                              The findi ngs in thi s report are subj ect to at least two limita8 ons . First, thes e data
                           apply only to youth who attended mi ddle or high school and are not repr esentab ve of
                           all per sons In thi s age gr oup . Few per sons aged <16 year s do not atte nd school and,
                           in 1997, on ly 4% of 16-y ear-olds and 6% of 17-y ear-olds w ho had not compl eted hi gh
                           school wer e not enrolled in a high school program (7 ) . The dropout rate for young
                           adults aged 16-24 yearsvariesgreatlyby race/ethni city (7 .6%,white ;13 .4%, black ;and
                           25 .3%, Hispani c) (7 ) . Second, "any current tabac co use' m ight be underestimate d in
                           this report because It does not include a measure of 'roll-your -own' tobac co smok-
                           ing .
                              To evaluate the poten tial imp act of the expan ding leve Is of tobacco preventi on
                           effor ts nati onwide and in the indiv Idual slates , survel Ilance of trends In tobacco use
                           among youth must be continue d and expan ded . YRBS has provided national and
                           state-speci fic survel Ilance of tobac co use among high school students since 1991 (8 ) .
                           The NYTS and state-specific youth tobac co surveys are exte nding this surveillance
                           eftor t to middle school students and across a wider range of evaluati on variables,
                           includ ing knowle dge and a8I tudes about tobacco, exposure to envi ron mental tobac co
                           smok e, familiarity with pro-s moki ng and antismoki ng media messages, and expos ure
                           to tobacco-use preventi on curriculum in schools . CDC has prepared 'Bes I Practices'
                           guidelines tohel pstatesdeter minefundingpr ioritlesandtopl anand carryoute8ec-
                           tive compre hensive Icb acco-use preventi on and oontr ol programs (9 ) . If current pat-
                           terns of smoki ng beha vior per sist, an eslima ted 5 mi Ilion U .S . per sons w ho were age d
                           518 years in 1995 coul d die prematur ely from smoking-re lated illnes ses (10), Impl e-
                           mentatio n of the 'B est Practlces' guldellnes, along with nationwide prevent ion
                           effor ts, enlor cement of the proposed Food and Drug Admi nlstration rules, increases
                           In the excisetax on tobacco products, and increased avai IabilRy ot smok ing cessation
                           treatment opti ons, coul d dramati cally reduc e thes e proj ected deaths .
                           References
                            1 .CDC.Tobaccouseamong high schoolstutlsnts-Unhed States,1997.MMWR199s ;47 :229-33 .
                            2 . CDC. Preventing lobacco use among young people : report of the Surgeon Qeneral . Atlanl a,
                               Oeorgia : US Depar tment of Heatlh and Human Services, Pubnc Health Servlce, CDC, Nation al
                               Cenler for Chronlc Diseese Preventlon and HeaOh Prom otb n, C61ce on Smoking and Hea6h ,
                               1994.
                            3 . CDC. Tobacco use among U .S. raclaVethnk minor hy groups-Air loan Amerlcans, American
                               Inda ns and Alaska Natives, Asian Americens and Pacific Lclander a, and Hispanics : a report
                               of the Surgeon Oeneral . Atlan la, Georgia : US Department of Health and Human Services,




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                           Vo1 .49/ No.             3            M           M            W            R            53

                           Tobacco Use -Continued
                                CDC,Natiunal Center tor Chronic Disease Prevention and Heatlh Prom otion -Dllice on Smoking
                                and Health, 1998 .
                             4 .Unlversity ol Michigan . Monltor ing the Future Survey . World-Wide Web slle http ://
                                monaor ingthetuture .or gidata/99tlata .hl mts1999da1 a_cigs . Accessed Decem bar 17, 1999 .
                             5 . CDC . Bidi use am ong urban youth -M assachusetts, M arch-A pr11 1999, M M W R 1999 ;48 : 796-9 .
                             6 . USDA . Cigarette production, expor Is, and tlomestic consumption down In 1999 . World-Wide
                                 Web slte htlpa/usda .man nlib .cornell .edu/reporta/erssor/specialtyltbs-bb71999/1bs245s .asc.
                                Accessed December 21, 1999.
                             7 . National Center tor Educalion Statistks . Dropout rates In the United States, 1997 . Washing ton,
                                 DC: US Department ot Education, 1999 (NCES 99-082) .
                             8 . CDC. Youlh risk behavlo r survey-Unitetl States, 1997 . MMWR 1999 ;47(no. 55-3) .
                             9 . CDC. Best practices 1or com prehensive tot>a coo contr oHAuguat 1999 . Atlanta, Georgia : US
                                 Department o1 Health and Human Services, CDC, National Center for Chronic Disease
                                 Preventlon and Health Prom otion, OBice on Smoking and Heatlh, 1999 .
                            10 . CDC . Pro)ecled smoking-r elat ad deat hs among youl h-UnRe d Stales . MMWR 1996;45:971-4 .




                                     Update : Influenza ActlVi ty - Unfted States, 1 9 9 9-20 017 Season

                               Intlue nza activity in the Uni ted States began to increase subs tanN ally dur ing mid-
                            December 1999, and as of January15,200g,laboralory-confirmed Intluenza inlectlons
                            have been reported Irorn all nine surveillance regions . The predomi nant viruses iso-
                            lated thi s season have been intl uenza type A(H3N2) viruses that have been circulating
                            in the Uni ted States for the last two infl uenza seasons and are wal I-matc had to thl s
                            season's vaccine . This repor t summa rizes in/l uenza activity In the United State s dur ing
                            October 3, 1999-Januar y 15, 2000 .'
                               Duri ng October 3-)anuary 15, the highes t percentage of patient visits to U .S . senti-
                            nel phys icians for in11 uenza-I ike illnes s(ILqt was 6% duri ng the week ending Januar y
                            1(week 52) (Figure 1) . Duri ng that week, the percentage of pati ent visits lor ILI was
                            elevate d above baseline levels (0,4 :) in all nine regions . For the week ending Januar y
                            15 (week 2), 4% of overall patl ent visits wer e for ILI .
                               Duri ng October 3-January 15, the highest numb ers of state and territorial epide mi-
                            ologi sts report ing either wide spread or regional Inilue nza adivity5 duri ng any week s
                            were 42 duri ng the wee k endi ng Januar y,e (week 1) and 43 during the week endi ng
                            Januar y15(week 2) . For theweek endirgJa nuary 15, 31 states reportedwi despr ead
                            activi ty, and 12 states report ad regional activity . The highest percentage of deaths
                            a8r ibuled to pneumoni a and intlue nza (P&I ) in the 122 Cities Morta lity Repor ting Sys-
                            tem was 10 .5% duri ng week 2 . Thi s was above the epi demi c thre shol dioi 7 .4% lor that
                            week and increased from 9 .3% in week 1(Figure 2) .
                               Since the week ending October 3, the World Health Organization collabo rating
                            Iaboratoriesand the National Resplraloryand EntericVirusSurvel)IanceSystem labo-
                            ratorl es in the Unl ted States have tested 41,034 respirator y sped mens for infl uenza

                                e our components o1 the In1We nza surveiNance system have been described (1 ) .
                            iDellned as temperatur e 210g F(t37 .8 C) plus ellher cough or sore Ihroat .
                            SLevels ot activity are I) no activity ; 2) spcr adio-spor addcaly occur ring ILI or culWroc onfir med
                             In11u enza wtth no oulbr saks detected ; 3) reglo nal-outbr saks ot ILI or cukure-c ontlr med In1W -
                             enze In coun lies with a combined population of <50% o11he states population ; and 4) wide-
                             spread-outbreaksof ILlorcuMu re-contlr med influenza In counties with a combined population
                             ot 25g%of the state's population .
                            1The epidemic threshokl Is 1 .845 slander d devlatio ns above the seasonal baseGne . The exp ected
                             seasonal baseGne Is proje metl using a robust regression procedure In which a perlodic regres-
                             slon model Is applled to observed peroantag es o1 deatns trom P&I since 1983 .




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                           54                    MMWR                                                        Januar y 28, 2000

                           Influenza Adivity -Continued

                           FIQUR E 1 . Percent age of pat lent visitsto send nel physicians for Influenz a•Ilke Illness;
                           by week of report - United States, 1997-98 and 1998-A9 seasons (weeks 40-20)
                           and 1999-2000 season (weeks 40-2)




                                                                                                                     5

                                            1997-9              8     1998-09                1999-2              000
                                                         Week and Influenza S eason
                           ' Detin ad as temper ature 2100 F(z37.8 C) plus elthe r cough or sore throat .


                           viruses ; o1 these , 7361 (18%) tested posi tive . Of the positive specimens , 7338 (99-7%)
                           were type A, and 23 (0 .3%) wer e type B . For the week ending Januar y 15, 21% ol
                           specimen s tested for influenza viruses wer e posilive, a decrease from the highest
                           level of 33% dur Ing the week end ng December 25 . Oi the 1665 influenz a A isolates
                           subtyped as of Januar y 15, 1659 (99 .6%) were H3N2 viruses, and six (0 .4%) wer e HiN1
                           vl r9s es .
                               CDC has characterized anti geni cally 246 intluenza viruses received Irom U .S .labo-
                           ratori es since October 1 . OI the 239 infl uenza A(H 3N2) viruses tested, 214 (90%) wer e
                           simi Isr to the vaccine strain A/Sydney! 05/97, and 25 (10%) showed somewhat redJce d
                           titers to ferret anti sera produc ed agai nsl the A/Sydney/ 05/97 virus. All four of the U .S .
                           in11 uenza type B viruses aMi geni cally oharacterized asr e similar to BBeljing/184/93-
                           like vlru s, whl ch is represen ted in the current vaccine by the B/yamanashV 166198
                           virus . Of the three Iniluenza A(H1N7) viruses antige nically characterized, two were
                           similar to ABeijing/262/95,the HiNi component of the current vaccine, and one was
                           related mar e closely to the antigeni c variant A/New Caledonia J20J99 . This is the thl yd
                           consecuti ve winter that the Intl uenza A/Sydney/05/97- like (H3N2) viruses have been
                           the predani nant infl uenza viruses .
                           Reported by : Participatin g stateand terrilorial epidemlologlsls and state public health laboratory
                           directors. World Health Organization collab oraling laborator les . Natlonal Enteric Virus 8urveil-
                           lance System Organization collaborating laboratories . Sentinel Physicians Influenza
                           Surveillance System .Sunreillance SystemaBr,DivoiPublbHealth Surveillance andIntormetics,
                           Epdem iolo gy Program Office ; Mortality Statistics Br, Div ot Vital Statisllc s, National Cenler for




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                           Vol . 49 ! No.        9            M           M            W           R           65

                           Influenze Activity -Continued
                           FIGURE2 . Parcentageof mortality attributable to pneumon ia and Influenza (P&1) In
                           122 cities, by week of report - United States, 1996-2000




                                     IU       EU       90       0    o     w     Io       14       m     o
                                            tY%            19W          1pYa         IGeB                 T000
                                                                        Week and Year

                           'The epidemic threshold Is 1 .645 standard deviations above the seasonal baseline . The
                            expected seasonal basellne Is projected using a robust regression procedure In which a
                            periodic regression model Is applied to observed percentages of deathslrom P&1 ance 1983 .


                           Health Stetistics ; WHO Collabor eting Center for Reference and Research on Influen za, Respira-
                           tory and Enter ovirus Br, and Influenza Br, Div of Viral and Rickettsial Diseases, Natlonal Cenler
                           fo r Inf ectio us Diseases ; and an EIS OBicer , CDC .
                           Editorial Note: For the 1999-2000 season, influenza activity began to increase in
                            mid-December, appro ximalely 4 weeks earlier than in the 1997-98 season, and
                            7-8 wee ks earlier than in the 1998-99 season . Inlluenz a seasons are usual ly variabl e in
                            onset, duration, timing o1 peak periods, and regional and overall health impac t from
                            year to year . As ct January 15, 20D0, the per centage of pati ent vislts 1or ILI to senbne I
                            physicians, lhe perc enta ge ot respir ator y specimens testing posltive for infl uenza, and
                            the number of state and terrRori al epidembbg ists repor8ng either widespread or
                            regional influe nza activity hav e been simi lar to the last tw o seasons . Recent declines
                            in visits to senti nel physicians for ILI and in the percentage of respiratory spec imens
                            testing pos ilive for inlluenz a viruses suggest that i nfluenz a activity may have pea ked
                            na ti on al ly .
                                As of Januar y 15, the percentage of moda lity a8rl bulabl e to P&I in the 122 Cities
                            MortalityRepor ting System had notye tbeguntodec line, andlhel evelof10 .5%was
                            higher than any week during the last two A(H3N2) seasons . During the previ ous
                            3 yea r s, P&1 m o rlality level s have peak ad b elw een 8 .8% and 9 .1 % of all deal h s . Th Is
                            indi cator o1 influe nza activity typically lags behind other intlue nza surve illanc e Indl Ca-
                            lors by appr oximatety 2 weeks . Increased P&I morta lity could be caused by several




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                           56        M      M      W        R   Januar                  y      28,           2000

                           Influenza Activity - Continued

                           faclors, including high levels of intl uenza infection, deaths associated with oth er res-
                           pirator y Infections, and changes made this season to the case definition for repor ting
                           P&Ideaths (1 ) .
                              During winter months, olher infectiou s path ogens such as respiratory syncyt ial
                           virus (RSV), aden oviruses , paraint luenza viruses, rhinovir uses, coronavi rus, myco-
                           plasm a, and bacterial infedio ns also can cause resp irato ry illness . For examp le,
                           national survel Ilance data indicate that RSV activity has been vd despread this season
                           (2 ) ; RSV activ ity peaks duri ng the winter months (3 ) .
                              ARh ough viral cullu re of resp iral ory specimen s obtained 1-4 days after illness
                           onset remains the "gold slandar d' for conli rming Inlluenza virus infect ion, several
                           commer cial rap d dia gnostic tests are available to test respiratory specimens for influ-
                           enza. Such tests have reported sensitivities and specilirAties of 65%-87% and 93%-
                           100%, respectively, and include tests that detect only influe nza type A, or tests that
                           detect both Infl uenza type A and type B viruses, but do not distingui sh betwee n them
                           (4,5 ) . Rapl d di agnosl ic tests use var ious clinl cal speci mens and have not been com-
                           pared in a contr oiled study .
                              Four prescripti on anti viral agents are appr oved for treating uncumpl icated in11u-
                           enza . Amantad no and rima ntadi ne are appr oved for treating infl uenza A, whi le the
                           neuraminldase inhibi lor drugs zanamlv Ir and oseltami vir are appr oved to treat both
                           intl uenza A and B(6-!l ) . Amantadi no and rimanladi no also are appr oved for prophy-
                           laxis of intlue nza A, but neither zanami vir nor oseltami vir are approved for prophylac-
                           tic use. On Januar y 12, the Food ard Drug Admi nistration issued an advi sory le8e r
                           emphasi zing that phys icians shoul d 1) always consi der the pos sibility of prima ry or
                           con comitan t baclerial infection when making treatmeM decisions for patients wit h
                           suspected intluenza, and 2) use special caulion i1 prescribing zanamivirto patients
                           with under lying asthma or chronic obstructi ve put monar y disease (9 ) . AII four anlivi-
                           ral agents can reduc e the dur ation of Intl uenza symptoms by approxl mate ly i day if
                           treat ment is started with in 48 hours of sympt om onset, but dilfer substan tially in
                           adver se effects, appr oved age-gr oup use, and cost (7-8,10 ) . CDC has issued a sum-
                           mary concer ning the use of the neuraminldase Inhlbitors (7) . None of the antiviral
                           medic ations used to treat in11 uenza are berrafi cial in treating othe r infec tious di seases .
                              Despite the useotrapiddiagnost ictestsand availabilityofneurami nidaseinhibitor
                           drugs, influe nza vaccinati on remai ns the mos t Importa nt meas ure to protec t persons
                           against inlluenza . At this time of year, Influenza vaccine supplies are limited, but
                           unvaccinated persons athighriskfor compi ications from influenza (e .g .,persons aged
                           265 years ; adul ts and children who have chronic disorde rs ol the pul monary (Includ-
                           ing asthma] or cardlovascufarsystem and chronlcmetaboli cdiseases(including dia-
                           betes) ; and women in thei r second or thl yd lrlme ster of pregnanc y) should cons ider
                           vaccinati on if influenza vaccine is avai lable in thei r area (6) .
                              Influenza surveill ance data coil eded by CDC are updated weekl y from October
                           through May . Summary reports are avallab le through CDC's voice In/ormat ion
                           system, telep hone (888) 232-3228, lax (888) 232-3299 (req uest docume nt number
                           361100), or thr ough CDC's Nati onal CeMer for Infectious Diseases, Division oi Viral
                           and Ricketts ial Diseases, Intl uenza Branch World-Wide Web slle, tatp: //www .cdc .gov/
                           ncidod/diseases/ilu/week ly .htm .

                           References
                            1 . CDC . Mluenza acllvlty-Unlled States, 1999-2000 season . MM WR 1999 ;48 :1039 -42 .




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                          Vo1 .49lNo.3                            MMWR                                            67

                          Influenza Adivity -Continued

                           2 . CDC. Nation al Respiratory and Enteric Virus Survelllan ce System- current Irends Avallab Is
                              at hnpWVntw .edc.gov/ncltlod /dvrNnrevs s/trends .htm . Accessed January 2000 .
                           3 . CDC. Updat e : respiratory syncy0al virus adivity-Unlled Slates, 1998-1999 season . MMWR
                              1999 ;48 :110",1115.
                           4 . Leon ard GP, Lelb H, Birkhea d GS, et al, Compar ison ot repld detectlon methods 1or Inf luenza
                              Avlrusandthelrvalueinhea6h-car emanagement ollnstitutio nallzedgerialricpatients .JClin
                              M icroblol 1994 ;3 2 :70-4 .
                           5 . Anonymous. Rapid tllagno stic tests tor In11 uenz a . The M edical Letl er 1999;4 1 :121-2 .
                           6 . CDC. Prevention and comr ol ollnlluenza : recommendetions ol the Advisor y CommiOee on
                              Immunization PracLces (ACIP). MMWR 1999 ;48(n o . RR-4) .
                           7 . CDC. Neuraminidase inhibflors for treatment of influen zaA and Binfect'pns. MMWR1999 ;
                              48(n o. RR-14).
                           8 . Arw nymous. Two neuramin Idess inhibitor s tor treatment of InlWenza The Medcal Letter
                              1999 :41 91-3.
                           9 . Food and Drug Administrati on . PubOc heatl h advisory letter : safe and appr oprlate use o1
                              Intlu enza drugs . Rockvllle, Marylan d : US Depanm enl of Heatlh and Human Services, Food
                              and Drug Administralion, Januar y 12, 2000 .Availableat h8p:l/vmw .ida.govlcderldrug/
                              advisor y/iniluenza .htm.
                          10 . Dem Ichell V, Jeffe rson T, Rivetti D, et al . Prevention and early treatm ent of in11u enza In heaah y
                              adul ts . Vacdne 2000 ;18 :957-1030.




                                    Progress Toward Pollomye Iitis Eradication - Chad, 1996-1999

                              In 1988, the World Health Organization (WHO) resolved to eradicate poliomyel itis
                          global ly by Decembe r 31, 2000 (1 ) . Polio eradicati on activities have been conducted in
                          WHO's African Regi on (AFR) since 1996, and recently have been accelerated (2 ) . In
                          1997,centralAlricancountr iesbegan conductingNationaf Immuniz ation Days (NIDs)'
                          and establi shed surveil lance systems for acute flaccid paralysis (AFP) . This report
                          summar izes progres s towar d poli o eradication and the establ ishment of AFP surve il-
                          lance in Chad.

                           Routine V accination
                              Chad (popul ation : 6 .4 m Illion) is a republic in cenlr al sub-Sa haran Atr ica and is the
                           lifth largest Alrican couna y in area . After three decades of civil war, the damage to
                           Chad'sinfrastructure a6ected the delivery of health-careservices,Includingvaccina-
                           lion c over age. Mos t heal th-c are pr ovi der s practice in the c epit al, N'dja mena, andie w
                           trainedpereonnel arestatloned in periurban andruralareas .Slnce1990, reported rou-
                           tine infant vaccinati on coverage (e .g.,threedosesoioral poliovirusvaccine [OPV]) has
                           been 10%-25% . This percenta ge is cons istent wi th the conti nued reporting of clinically
                           and virologic ally confirmed pol io cases from the most popul ated areas of souther n
                           Chad (Figure 1) .

                           Su pplem entar y Va ccinaki on Act Ivi tbs
                              Chad impl emenled NIDs with OPV for the /lrst time during February-Mar ch 1997,
                           foil owed by two mor e round; dur ing Febr uar "a rch 1998 and November -Decem ber
                           1998 . Approx imat ely 800,000 (90%) children aged <5 years were vaccinated during
                           each round . Vaccine vial monitors (VVMs) f were used to ensure that potent vaccine

                           ' ans over a short period (days to weeks) In which two doses of oral poiov Irus
                            vaccine are administer ed to aB chlki ren, usually aged c5 years, regardless of vacdnatlon
                            histor y, with an inler val of 4-6 week s between doses .
                           tA heat-sensltive label that changes color If vaccine has been exposed to heat, wh Ich degrades
                            the Nal conten ts .




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                          88                                         MMWR                             Januar y 28, 2000

                          Pollom yelit Is Eradication -Oontinued
                          FIGURE1 .Laboretory-oonflrmed cases of poliomyel It Is -Chad, 1999'




                           • n .33 .

                           was administered at each vaccinati on site . Two rounds of intens ilied, door-to-door
                           NIDs wer e conduct ed in Dece mber 1999 and January 2000 . Coverage data are not yet
                           available .
                           AFP Survell lance
                              Duri ng 1995-1997, Chad collected inlo rmati on about clin ically confir med cases of
                           paralytic polio thr ough a passive survelllance system ; 402, 331, and 326 clinically diag-
                           nosed poli o cases in 1995, 1996, and 1997, respectively, wer e repor ted ; however, re-
                           porling accura cy and compl etenes s dur ing thi s period are questionabi e because no
                           standard case definition was used and few of the cases were investigated turlher (3) .
                              In 1997, AFP and wi Id pol iov irus surveillance began to include clinical and virologi c
                           case Investiga I/ons ; stool specimen s were collected from four AFP cases . Despite
                           shipment delays, the regional reference laborato ry in Bangui conl irmed wild
                           poliovi rus type I in one specimen . AFP case repor ting and stool spec Imen collection
                           increas ed in 1998 ; 14 AFP cases were Iden tili ed and inves ligated lrom Januar y to
                           October 1998, confir ming wild poliovi rue type 1 in four cases (Table 1) . Surveillance
                           activities decreased in late 1998 ; no cases wer e report ed from October 1998 to Apr il
                           1999 .




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                           Vo1 . 491 No .          3            M           M            W            R              59

                           Paliom yel'n is Eradication - Continued

                              In May 1999, the M inistry of Health (MO H) established the national service of inte-
                           grated active surveillance to monit or AFP, meas les, malaria, yellow fever, meni ngitis,
                           and chol era . Five nati onal surveillance offi cers began to traln heaRh-c are personnel on
                           active AFP surveillan ce in all provinces, and the first internationa I team of three
                           W HOl CDC Stop Trans m ission of Polio epide m iot ogis ts w ere sent to Chad .
                              In 1999, 182 AFP cases wer e reported; two stool specimens were collected from
                           133 of thes e cases . Fort y-ni ne AFP cases wer e identi tied thr ough retrospe ctive record
                           review, and thes e cases w ere subs equenll y confi rme d as pol io using the clin ical clas-
                           sitica9o n syst em . As of Decemb er 1999, the Bangui regional reference laboratory
                           reported final virus isolati on and intratypl c differ eMi ati on resu Its lor 85 of the 133 AFP
                           casesfor which two specimens werecollected . Wildpolioviruswasconfirrnedin33o1
                           85 cases . Resul ts have not been repor ted for 48 o1 th e 133 cases for whi ch two spec i-
                           mens wer e co Ilected .
                              Two of the mat n indic ator s used to m anitor AFP surveillance are the repor ted non-
                           polio AFP rate (4 ), whi ch is used to assess the sensl tlvity of detection and accuracy o1
                           rep o rt In g su spec ted cases (ta rget : a rate of >1 n o n po lio AFP case per 100, 0D0 ch ildre n
                           aged <i 5 years annual ly), and the propor tion of AFP cases lrom whic h two spec imens
                           have been collecled within 2 weeks of paralysi s onset (target : two adequate stool
                           spec imeas trom >80% of AFP cases) . In Chad in 1999, the rlonpoli o AFP rate was 1 .496 .
                           Two stool specimens withi n 2 weeks ot paralysis onset were collected from 46% o1
                           reported AFP cases ; specime n arrlval at the labor alor y vd thin 3 days occurred In 11%
                           oithecases,and11%ofthepersonswithcasesrecelvedclinicaltollow-up examina-
                           tWns .
                           Reported by Inleg rated Surveillarqe Unit and Expan ded Program of Immunizatio n, Mirestr y of
                           Health, N'djam ena, Republic of Chad; World Health Organization Country Office, N'djam ens,
                           Repudic of Chad . World Health Organization Regional Offroe for Africa, Harare, Zim babw e .
                           Vaccines and Other Biolo gicals Dept. World Health Organization, Geneva, Switzer land . Robert
                           Koch Institute, BerCn, Germany . Epidem blo gy and Surveil lance Div and Vaccine Preventab le
                           Disease Eradicatic n Div, National Immunization Program ; and an EIS Officer, CDC.

                            Nonpo rate Is calculated using the 52 cases ddscar ded as nonp oBo through negativ e
                            labo retory resu6s.

                           TABLE 1 . Raporhxl cases of acute flaccid paralysis (AFP), confirmed pollomyelitis,
                           confirmed wild virus, and nonpol lo AFP rate- Chad, 1995-1999

                                                    AFPpses             Confirmed           Wlldvlrus         Nonpollo AFP
                           Year                      reported           pollocaaes          confirmed             rate•
                           1995                           0                4021                 -                     -
                           1996                           0                3311                 -                     -
                           1997                          4                 3261                                  1
                           1998                         14                   45                                  4
                           1999                        182                  821                 33                   1 .49

                           ' Calculat ad as num ber of AFP eases not caused by po9o per 100,000 populetion aged <15 year s.
                           tClinlcaly oonllr med .
                           SConlirmed through wild virus isolati on .
                           tClinicaly and vAkf vlrusconfirmed .
                           Source :WorldHeatlhOrgankation (WHO)A/ricanRegion Expan dud Program ofImmunlzation
                           Plan of Action 1999, Mlnistr y of Heallh , N'tljamena, Chad, and WHO polio eradcatlon updat e :
                           available on the WorldWitle Web at httpYl w,wtnt .wh o .IntNaccines /polio/cese.as p . References
                           to sites of non- CDC organizations on the Inter net are proNtled as a servlce to MM WA readers
                           anddonotconstituteorimptyendorsementoftheseorganlzations orthelrprogramsbyCDCor
                           the U .S . Depanm ant of Heatlh end Hum an Servlcea CDC Is not responsible tor the conlent of
                           pages at these sltes .




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                          ee            M    M     W     R       Jenuar                   y      28,           2800

                          PoGom yelil is Eradication - Continued

                          Editorial Note : Chad connects western and cent ral Afri ca wh ere poli o is endemi c .
                          Three decades of civil war have left Chad wi th a damaged heal th intra struct u re, sever e
                          fins ncial problems, and limited human resourc es . These factors and a large mobil e
                          poput ation (e .g ., nomads, migrant work ers, and refugees ) have led to low routine cov-
                          erage with three doses of OPV and continued widespread transmisslon of wild
                          poliovi rus .
                             Chad's MOH is increasingl y successful in Impl ementi ng WHO's recommendati ons
                          tor supplement at OPV vaccination and intensitied surveillance . Enhance d AFP and
                          w ild poli ovi rus surv eillance has demonstr ate d that Chad is still a subs tanti al reservoi r
                          for poli ovirus tran smission in Airic a . Criti cal chall enges to survei Ilance are lack of
                          transpor taGon and communication, inaccessibility of some regions during the rainy
                          season (June to October ), techni cal proble ms In conse rving and iranspor ting stool
                          specimens, and popul ation moveme nts that mekefollow-up difficult . Impr oved sur-
                          vei Ilance vd II depend on betle r coordi na8 on among all levels of gover nment and local
                          nongover nmental organizations, and cooper ation across inte rnat lorral border s .
                             MOH priorR fes for 2000 are to impiement high quali ty NIDs, par6 cularly in the
                          pcpul ated areas of southe rn Chad and among nomadi c groups, ard to mai ntain and
                          Impr ove the qual ity o1 AFP surv eillance . Progr ess in thes e areas should enabl e Chad
                          to reach the poti o eradi cation goal .
                          References
                          1 . Workl Heatlh Assemblq . Global eredicalio n ot poliom yeAt Is by the year 2000 : resolut Ion of
                             the 41st World Heahh Assem bly . Geneva, SrMz erland : World Health Organization, 1988 (Reso-
                             lutio n no. WHA 41 .28) .
                          2 . CDC. Progress lower d global pofom yerilis eradication-Alrican Region, 1998-Apr II 1999 .
                             M M W R 1999;46 :513-6.
                          3 . Ministry of Health . N'djamena, Republic of Chad : Plan of Actlon, Naliona I Service of Expande d
                             Program o1 Immunizallon, Decern ber 1998 ;3-4 .
                          4 . World Health Organization . Field guide for supp lementary activities aimed at achieving pollo
                             eradicatio n, 1996 revision . Geneva, Swltzer Isnd : World Heahh Organization, 1997 ; append ix
                             11 :78 .




                           Public Health Disp atch

                                                    Outbrsak of Shigella sonnel Infections
                                            Associated with PPeti ng a Netlonally Distrib uted Dip -
                                              California, Oregon, and Was hington, Ja nuary 2000

                              A multlstat e outbreak of Shigell a sonnei infections with at least 30 culture-
                           confi rmed cases in California, Oregon, and Washington has been linked to eating a
                           nationally distributed five-layer dip . Symptom onsets occurred duri ng January 10-23,
                           2000 ; case-linding is ongoing . The implicated product is manufactured by Senor
                           Felix's Mexican Foods' (Baldwin Park, Calgornia) and dlslrlbuted under the brand
                           names Senor Felix's 5-Layer Party Dip (sold In 16-ounce, 20-ounce , and 41-oun ce con-
                           tainer s), Del icioso 5-laye r Party Dip (33-ounce contai ner s), and Trade r Joe's 5-Laye r
                           Party Dip (20-oun ce contai ner s) . The dip consists of layers of bean, salsa, guac amole ,
                           n acho che ese, an d so u r crea m .
                            Use~ o- tram es and commercial sourc es is for ldenti4cafion only and does not constilut e
                            endorsement by CDC or the U .S . Department of Heanh and Hum an Services .




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                           Vol .49lNo.3                           MMWR                                          51

                           Shigella - Continued

                              On Januar y 21, the company voluntar ily recalled the pr oduds . The recall appl ies to
                           all product s pre pared vd thout pre servatives and that have an e>qti ration date of Febru-
                           ary 9 or earlier, and all products prepared with preservatives and that have an explra-
                           tion date of Mar ch 4 or earlier . Cons umers who have these products shoul d avoi d
                           eag ng them and should return them to thei r pl ace of pur cha se .
                              S . sonnei infection can cause abdominal cram ps, fever, and bloody diarrhea .
                           Symptoms usually develop 1-3 days after eating comam inated food . Many cases
                           resolve without medical atten lion, but persons with severe infect lons may benet it
                           from anti biolic treatment . General infor mation on Shige Ila inlection is avai lable at
                           http7/ww w .cdc .gov/ nc idod+ db m d/di sease irdo/ shigel losisq .htm.
                           Reported by : Los Angeles County HeaRh Dept, Los Angeles ; San Diego County Health Dept,
                           San Diego ; Cel'rfor nia Dept of Health Svcs, Ber keley, Cal'rfor nia . M u ltnom eh Cou nty Heahh Dept,
                           Portland ; Clackamas County Heallh Dept, Oregon Gty ; Oregon Health Div, Ponland, Oregon .
                           Pudic HeaUh-Seaele and King County, Seattle ; Washirglon Dept of Health, Seattle, Washing-
                           ton . Foodborne and Diarrheal Diseases Br, Div of Bacterial and Mycotic Diseases, NaUon al
                           Center for Infecfious Diseases, CDC .



                           Notice to Readers

                                                          Update : Penicillin G Availability

                              In October 1999, the Food and Drug Admi nistration (FDA) and CDC anno unced a
                           shor tage of penicil lin G (potassium and sodium) 1or intra venous injection as a result
                           ol decreased produc lion by a major manufacturer (1 ) . In response to the shortage,
                           FDA has identi fied a tempor ary altemate suppl ier of peni cillin G sodium, Biochemi e
                           GrnbH, Kund, Austria, The company has suppi ied peni cillin G to the Unlted State s
                           since Decem ber 9, 1999 . This prod uct is distribuled by Geneva Pharmaceuticals,
                           Inc . (Broomfi eld, Colorado), and should be aval lable through whol esale suppl iers .
                              Because quanti Ues are limited, Geneva Pharmac euU cals Is operating under a drug
                           shor lage allocation program . Foremergency allocations, contact Jenny Whilelrouse ,
                           Custom er Support Supervisor, Geneva Pharmaceuti cals, telephone (303) 438-4399 ;
                           fax (303) 727-4656 ; e-mall : jenny .whltehouse@gx .novar tis .com) . Anoth er source oi
                           penidll in G potassium in frozen bags is Baxter Corporation (Deediel d, Illinois) at
                           httpa/www .baxter .oom' . If peni r111in cannot be obtai ned, alternative treatment recom-
                           mendations for some Infectlons can be found at http!lwww .cdc .gov/nchstpl
                           dstNpeni cillinG .htm .
                              CDC requests case reports from physiol ans about patfen ts with neurosyphilis
                           or congenital syphilis who have been treated with an aRernative regimen from
                           September 1, 1999, to February 15, 20g0 . To repo rt such pers ons, a form may be
                           downloaded trom httpl/www .cdc .g ov/nchstpldstd /PenGForm .Mm , cump leted, and
                            mai led to CDC's National Center for HIV, STD, and TB PrevenU on, Corporate Squar e
                            Boule vard, AU anta, GA 30329, or may be reques ted by telepho ne, (404) 639-8191 .

                            Reference
                            1 .CDC .ShortageolIntravenouspenldlin G-Unlled Statea MMWR1999 ;4e :974.


                            ' e e{ renees to shes of non- CDC organ i=allo ns on the Int ernet are provIde d as a service to
                             MM WR reatlers and do not constitute or Imply antlo rsemenl of these organfzatb ns or their
                             progr eme by CDCor the U .S . Depertment ot Health and Human Services .




   RJR0000001283101062
   700603450
http://legacy.library.ucsf.edu/tid/pqp55a00/pdf
                           62    M    M   W   R   Januar   y   28,   2000




   RJR0000001283101062
http://legacy.library.ucsf.edu/tid/pqp55a00/pdf
   700603451
                          Vol.49/ No.3                                             MMWR                                              63



                          FIGUR E I. Selected not iflable d lseaae report s, compar Iso n of provi slonal4'w eek totels
                          ending January 22, 2000, with historical date - United States

                                                                                                                        CASESCURPENT
                                                        DISEASE DECREASE                                        INCREASE 4 W EEKS



                                                 Hepatitis A

                                                  HepstXls B

                             Hepatit'Is,C1Non-A, Non-B

                                              Leglo nello sls

                                            Measl es, Total

                             MeM ngococce I Inlecllons                                                                                 103

                                                      Mu m ps                                                                             5


                                                    Pertu ssls                                                                         153


                                                    Rubella'                                                                              0
                                                                                                                                 T

                                                              00125 a o .0625 0,125 0.25         0 .6        1       2        4


                                                                                   Ratio (Log Scale)t

                                                                           ~i Beyond Historical Llmlts


                           • No rubella cases were repor ted ior 1he current 4-week period, ylekArlg a re11o for week 3 of
                            zero (0),
                            Ratio ot current 4-wesk lotal to mean o1 15 4-week totae (irom praYlou e, comper able, and
                            subsequent 4-week perlods for the past 5 years ) . The point where the natched area beglns is
                            baeed on ihe mean and iwo standard deYlat lons of these 4-week lotals .



                                   TABLE 1 . Summary - provislonal cases of selected notlflable diseases,
                                    United Stales, cum ulative, week ending January 22, 2000 (3rd Week)

                                                                          Cum .9000                                                      Cum .3eDe

                          Anar ss                                                        HN InlssOon, peditrk' /
                          BruceAOaN'                                                     Raga
                           ChN era                                                       Poamy MGe, prepis
                           Con2 enilsl rubelle syrHr eme                                 PMIYC Vsi!'
                           Cycloryarask'                                                 RebbR Nlmen
                           DyMlw M                                                       Reeky Mnunle F spelb d Ievm (Paef )
                           EnapMlnp. Celeomle soroproup NrsI'                            Slrepbmsa I tlvae se, Invw a Grouy A
                                        eniern equi e                                     Slreploacs IlmkMod ry itlrvne '                       ~2
                                        SlLOUi'                                           SYVMis.Oayeme It
                                        weslern equne'                                   TsNmu
                           EhrfeNO sis human yrenWesyb (HOE)'                             Te,le-ey,CCkeylV eme                                   <
                                        human monocyk (HI.E)'                            Trltl:n>ri
                           Hmsan D leene'                                                TYP/wtlMV ar                                           12
                           HenlevYUSpusnonr ysynEreme'I                                  Yelowb vw
                           Hemolyk ursmic synhome , pca-Lierrknl'

                            -:ne repm es ases
                            ' NoI noyfu ale in all stales .
                           ' V pe .lau weekly Irom reporl s lo IOe Divaq n ol VirN anE R[Mesakl D'see ses, Nek nN Cenur rm Inlso/ous Deroa sn (NCIC) .
                           sUpGnaE momnIy Imm epa b lo sne Divbbn q HNN E5 RrveMCn -0vv elllero . wtl Eptle micl opY . Ne4mM CaMe r lo,
                            HIV, eTD, .ne TS Pr.venlbn (NCHSrP). Isl u dala Dsambe r 26. IpGS.
                            r Updelee trom rapons Iu the e'MSicn of STD ~evsnlion, NCNSTP




  RJR0000001283101062
  700603452
http://legacy.library.ucsf.edu/tid/pqp55a00/pdf
                                 64         MMWR                     January28,20DD



                                   TABLE II. Provisional cases of selected nolHlable diseases, Un Ited Stafes,
                                       weeks ending January 22, 2000, and January 23, 1999 (3rd Week)

                                                  AIDS              ChLn6r0Iae        hyptaa2 orlaloqe     ~
                                             um . um.      m,                                       um.        m              um .
                           RepnrNn2 Ana     20001 159Y a1DG 1999 2060                               1pW 2060 1ppD             2600


                                  GLA ND                  24     e39      1 143
                                                                  67


                         V1                                          31    22
                         M ass                            21        441    4eJ                                2
                         H .I .                                              112
                         Conn.                                      250    4/1
                         MID .ATLANrIC - 401                        415 4,021
                         Upri le N .Y -  16                          N     N
                         N .Y.     Clly 234                               2,1 &T
                         N J .        16                             4/ 617
                         Pe.        -   73                          374 1,Le1

                         EN . CENiMI - 45                         2,859 5 .072            5                   4         17                    6
                         Dhe       -                               291 0 .460             4                             12                    2
                         IM .                                      229 666                                               2                    I
                         11        16                             1,Oda 1,416                                            1                    1
                         Mich.     22                              702 ]Ja                                     x
                         Wls .                   6                 614 717                                    N         N2                    1
                         W N. CENTML             - 21               506 1,561              1          T        5                   7
                         6Nn .                   3                  t16 41e                                              2                    5
                         Iowd                            4           22   26
                         Mo.               -         3              2e2 T52                                                                   1
                         N . Dek.                 -                         43
                         S .Dak                                      66   60
                         Nebc 1                                      13    215
                         ne  tU                                              26y

                         S.       ATLANTIC           4e6          2,564 6 .257                        2        2         5                    7
                         Del .                                     1s6   1U
                         M0.     ]Y                                 20 )62
                         DC       1                                106     N
                         V.    -  42                               161 661
                         W. Va                                            1W
                         N .C .             66                    1,011 1,2a5                                            2          -        2
                         S,C .              33                     1366 2,010                                                                 1
                         De .              - 2                      63 1,681                                                       U         U
                         He.               262                               1,516                                       1                    1
                         ES       CENTNAL                60         462   1,Y56                                          7                    3
                         Ny .              15                       315    355                                           2         U         U
                         Tenn .            36                               66.1                                         3                    2
                         Ala               - 2Y                     146    65Z                                           1          .        1
                         Mas                                                283                                           1

                         W .6. CENTFAL           - 517            1,499 4,a26                                                                 a
                         Ark .    -              16                13E R2                                                                     I
                          ..               14                             1,p60                                                               1
                         DIJe .             6                       2157  462
                         TeM .             478                    1 .110 6.01<
                         MDUNT              AN           66       1 .066 1 .662                       2        6         4                    4
                         Monl .                                                                                4
                         IC.ho                       4              6/  26
                         WYO .                                      66  87
                         Colo.      -             26                166 35]
                         N . M av .                                       a12
                         Ak.                 . 3                    Ox Tea
                         UIM                -                       217 l56               N          N                    t
                         Nw .                 3                     113 101

                         PACIFIC                     16           a,On e,166              12         32        5          7
                         W .Yi                       2             677 526                N           N
                         Urep .                                    145 P31                             2                  3
                         CNn                 -           4        2,061 ] .056           12          30        5         4
                         Aleska                                    102 104
                         Hawal                -      10                   165

                         Dua                         m             26                                          N         N         U
                         PR .              1             61               U                                                        U
                         vI .              -             -U                                    -U                  -     U         U
                         Amsr.Semn                                        U                           U            -     U         U
                         CN .M.I .         -         ~           ~          U                         U                  U         U
                         N :NUln6ldu ble U :Unevalade           :noreycNdnsss C.NfA.I:Commems eIIhMNCr MrnMSlen MeNs
                         •M . ida naes may M rpa W threu9h 6oN Ihe Na6c nN aeNroNC Teleearnm Wilee 1an e Syslem for SurvNlanoe (NETSS) and t0e
                         1PWi[ NeeIP LeEOnbry MlormCliunSyYem (%ILIS/ .
                          Up0eH6 monNy trom rporls 1 . Ne DLIYon ol NNMDS fiwen6o+Sw eillanro and Eptlemlolpy . N .Ibn el Cnib r lv HIY. STDI and
                          Ta Vrevenfon, 4m uydele D .nm6ar 26. 1690 .
                         SChlemydu rNxs to 2enM1d hlal loee coseE by C .lndcmaYS . TaNls raltorME 10 N> DIVYb n 61 6TD Prevanbn . NC/ISTV.




   RJR0000001283101062
   70060 3453
http://legacy.library.ucsf.edu/tid/pqp55a00/pdf
                                Vo1. 49 1 No .                3              M          M           W           H           65



                               TABLE II. (Cont'd.) Provlslonal cases of selected not Hiable diseases, UnN ed States,
                                       wee ks ending January 22, 2000, and January 23, 1999 (3rd Week)

                                                                                                     LaglontlIOYu
                                               Cum                Cum.        um .      cornm .      m .     um .        m.
                                               2000               1p99       9UCD        1998       106U    1p99        9000        1989
                         UNIT ED 6TATES        5.570              20,594        60       166         16         37      15          20
                         NEW ENGLAND             260                 411            .       1       2          2        7
                         Mtr<                         2                1            -           .   2
                         NH                           3                t                        .       .               y
                         N.                           1                3            -           -       .
                         Muv.                    11p                 166            ~       1           .      I
                         PI                                           31            -           .   -
                         Cann .                  125                 20i            ~           -       .           .
                         MID . ATIANfIC          326               2.316            ~       3       - 10                    123
                         LyMa9N .Y                SS                 ID2            ~       .        .                       6
                         N .Y Gy                                   1,104            ~       .        -   4                       s
                         NJ .                      1/                510            ~       -        .  2                       46
                         P6 .                    262                 60D            ~       3       ~  /                               64
                          EN. CENfML           1 .615              3.1)9       20          97        5          15      ~            7
                         Mio                      11>                9D9         .         .         4          3       -            4
                          In6                    166                 356            .           -   -         I             .              .
                         III .                   Q6                1,131                                        3               .     .
                         MICN .                  /55                 C09       20          39        1         6                      .
                         Ws.                     J6p                 374         .         56        .         2        U            0
                         W.N. CENTML             197               1 .015       6          1/       1               .       .         2
                         Mnn .                    55                 193            ~           ~       .           .       .              .
                         law6                     tY                  13
                         Mo .                    113                 591        6          1<        1         ~            .         1
                         N . Dek.                         .              3
                         S, D.k.                      6               12            ~       .       .          .            .              .
                         N.b .                        1              113            ~       .       -         -             .
                         6111t.                       .               93            .       .       -               .       -        1

                         5. ATLANTIC           2.017               6.153        3           5       3        2          3  36
                         DN.                      T6                   90        .          -       -        1           .  2
                         ME .                     fi9              1,051        .           3       2               .   2  25
                         DA.                     It]                 2.         -           -        .              .    .   .
                         ve .                    572                 605        ~                                        .   .
                         Wvs                                           5)                   1       N         N
                         NC.                   1,010               1 .151       3           1       1         1         1            4
                         SC.                     110               1 .079
                         Ga                       63                52p          ~          ~       -               .       .              .
                         Fl. .                        ~            1 .190        ~          .           .      ~            .              .

                         E .6. CE/IIfU 1         309               1,742       11           6        -        1         ~            3
                         Cy.                     1)1                 234         -                   .        1          .            .
                         bnn .                                       53U                    3        .          .        .
                         AM.                     136          .      674        3           f        .         .         .            3
                         Ml.c .                     ~                30'

                         W .S . CENrk4L          636               3 .005        ~          ~           .           .       .              .
                         Ark .                    p1                  75         ~          -           .      -            .              .
                         Le                                        1ACi
                         Okle.                   116                 266         ~          -       .          .            .              .
                         Ter                     627               1,663         -          .       ~         -             .              .

                         MOUNTAIN                /5G                567        10          13        1        1             .              .
                         Monl .
                         Id .no                    4                   6                    3       1               .       .              .
                         W/o .                     2                   2        9           a
                         Cdo .                   227                  75                    1       ~                       .              .
                         N .Me. .                                     63        1           S
                         Arl¢ .                  12p                337
                         INO                      36                 lt
                         Nnv.                     50                 73          .          .           .           .       .              .

                         PACIf1C                 566               1,f1o6      10         41            4       6       2           12
                         W6sh .                  150                  112       1         -                                 .         .
                         Dng,                      5                   44       2           .               N           N            ~
                         q41 .                   /17               1 .696       7         27 4              6           P           12
                         N6M .                    16                   16
                         /YwM                         ~               33                                                    N         N
                         Guam              ~
                               .    13
                                     5PR   Y]                                    -                      .               N           N
                         YL        .     U                                       .         U        ~           U       ~            U
                         Amn.Semaa  ~    U                                       ~         U        -           U       ~            U
                         CNM.I .    U                                                      U        ~           U       ~            U
                         N : Nol nnliAa Ne U: Lku veksbls - : nc r69d1 ed u90i




 RJR0000001283101062
 70A60 3454
http://legacy.library.ucsf.edu/tid/pqp55a00/pdf
                               66         M    M            W            R   Januar                  y         28,             2000



                              TABLE II. (Cont'd .) Provislonal cases of selected notifiable diseases, Un Ited States,
                                      weeks ending January 22, 2000, and January 23, 1999 (3rd Week)
                                                                                                           ~To~na.
                                                                              RabMM Mb cl                  NETSS                        PHL 6f
                                              cum .         Wm .              m         m.         Cum .      an.            Cum .               am   .
                          Rep>lln9 Ma •       2U00          1999             2000      1999        8 00       1999           anoo                1999
                        UNRED STATES           20             71         127                U6    S4e              1 .192    145                 1 .490

                                                                              1)            36    42                75        3                     64
                        NEW ENGLAND
                                                                               3            2     4                 7                                4
                        M .in9
                        N.H .                                                                        6                              R                3

                        I/t                                                   2             7                        9       -                       5
                        M .v                                    2            6              13    zz                4e                              42
                         R.I                                                                4                        2                              1D
                        Com.                                    -            6              10    10                13                              20

                        MID. ATLANTIC                         20             SY             34 /6                   192       3                    1))
                                                                                                                    20        3                     49
                        L4qa k N .Y                           2              29             IS  6
                                                                                                                    59                              77
                        N .V Clry                             6               U             U  7
                        NJ .                                  2               0             14                      76
                        P.                                    1               -              5 3                    37

                         EN . CENTRAL                           7                                   62              227      27                    216
                         CMo                                                                        42              45       19                     e)
                         MJ                                                                                                                         14
                         a                                                                                          e1                              e4
                                                                                                    2U              5e        3                     66
                         MM .
                                                                                                      -             45        5                     23
                         Yls.
                         W .N.CENfR\L                                                       29    24                44       24                     69
                                                                                                    1                7       11                     25
                         MH .
                         bv.9                                                                 S    4
                         Mo .                                                                i     e                n
                                                                                                                    5        v
                         N D6k .                                                             s                                1
                         S Dat                                                              1D                       z       1
                         Nnh .                                                                        1              s
                         N .n[ .                                                              i       .              )

                                                5               e            S)             51    93                173                            V2
                                                                                              3    I                  S                              6
                                                3               1            4                9     ¢a               43
                                                                4                                                    9       U                       U
                                                                 -           i6             7      9                  5                             39
                                                                                            4                         2
                                                2                -           21             19    54                 64                             72
                                                                 -           2                                        S                             26
                                                    -                                                                                               )0
                                                                 1           14               9    -                 32                             21
                                                -

                                                                 -           -                2     18               9B                             62
                                                                                                     4               20        U                     U
                                                    -            -           -                Y                      1e                             41
                                                    -            -                            -   20                 2E         .                   19
                         MK.                        -            .                                  4                36        -                     2

                                                                                                                                                    171
                         W .S .CENfRAL              -           2            ~                s    7                 29       7
                         AA .                                                      -                  7              6        6                      15
                                                                 1                            .                      1        -                      32
                          A
                         oM. .                                                     -          5                       6                               2
                                                                                                                                                    122
                         Lc                         -            t           -                                       u       1

                         MDUNT AIN              1                3           11             11    9)                 95      31                     123
                                                                 1           6                      3                1
                         Mml
                         Mebu                                        -                              9                2                                   7
                                                                                                    1                2        -                          9
                         Wrp .
                                                                                                    4                31 10
                         CNO.
                         N .Mee .                   -            i                                  e                1)                              1s
                                                                                                                                                     13
                         AI¢.                                                                      Pp                16  e                           39
                         U1an                                                                        YB              10      15                      16
                                                                                                     t3              14        -                     10
                         Nw .

                                               11               YB            5             20    264               r66      23                     296
                         PACIRC
                         W.N .                      -            1                                    1                  •    2                      s0
                         ap .                       1            t                                    10             11      19                      26
                                                                                                    247             22e                             2q
                         C.N .                 10               26
                                                                                                       5              6       2                       2
                         Nnkc
                                                                                                                     22       -                      21
                         Ww9/1
                                                        -                                                                4    U                       U
                                                                                   1          3                          3    U                       U
                                                        -       U                             U                       U       U                       U
                                                        ~       U            -                U                       U       U                       U
                                                        ~       U            -                U                       U       U                       U
                         N . Nol nefrutle    U Lhev 9ileda    : no npptle6 uw .
                         'MhWd c969. m .Y b Iapor1.01brou9b Ooh 9,9 N.OOna I EIw1/pYC TNecpmmn Yc9bnc SyN m lpr Sw Nllence (NET65) m01be
                          P.d k HstlN Ltla .bry HM mNin Syttem (PHLa) .




   RJR0000001283101062
   700603455
http://legacy.library.ucsf.edu/tid/pqp55a00/pdf
                               Vo1 . 49/ No .                 3               M        M              W              R               67



                               TABLE II . (Cont'd .) Provlslona I cases of selected nolltiable diseases, UnN ed Slates,
                                        wee ks ending Janu ary 22, 2000, and January 23, 1999 (3rd Week)
                                                                                                            tyDN nl .
                                                                                                     (9rlmary 6 6ecandwy)            TuberwbsI .

                                                                                m,                      um .        m.               m.         m.
                            11e9o Nn y Ars.     Q9DD              1996        YOOD    1969             a1DD       1W9             21100        1909/

                          UNITED STATES           24J              66]         <I     456                151      )UJ

                         NEW ENGLA ND                                                       12
                         M ana
                         NA                                                                  3
                         VI
                         Mess
                          RI
                         Conn                                     1
                         MID .ATLANTC 2 50                                       3                         9
                         LIpaW le N Y 1 5                                        3
                         N    Y (Dty  1 13
                          N J.      -               QS
                          Fe .                      7
                          E .N . CENFML            67 162                         1         75
                          pw   10 72                                                         1
                          /d    3  1
                          /I .  6]                                                          60
                          Md .            55                  24
                          Wis                         22                                     >
                          W .N. CENTRAL            20             49                        40
                          MM.                 4                   4                          9
                          bea       6
                          Mo .   10                           ]6                            26
                          N.    DeM
                          5 Dak
                          NMr.                -                   5                          2
                          Mans .              -                   4                          1
                          S.       ATLANTIC                   )   47                         24            74         140             16           26
                          DBI                    -                2                           1                                                     2
                          W.                  1                   S                                        6           19                              6
                          D .C .                              2                              U                           E             ~               2
                          Ve .                I                           -                                12
                                                                                                           33          11              -
                          W.    Va
                          N .C     4                          11                             6             1D          37
                          6C      I                           ID                             3              4          12
                          La .                                                               S              -          52
                          Fle .                       -             11                                                 20              .
                          E .S . CENNUL              7             107                                     6           65             11            16
                          Np .                       1               9                                     1            6                            <
                          Am                                        1D                                                 n               4
                          Ale .                      2              ID                                     7           24              1            16
                          Mn                         4               9

                          W 6.CENTSAL                1              70                                     12          45                          99
                          /fk .                      1               6                                      1           1              -
                          La                          -              2                                                  D                           U
                          DNa .                       -             25                                      5          10                            2
                          Tex .                       ~             37                                      6          YS                           DT

                          MWNT AIN                 46               37                                      9           5              3               E
                          Mcnl                                       1
                          ueno                       2               2
                          WTe.
                          Colo .                     2                6
                          N .Me. .                  6                 4
                          Nli .                    2J                 6
                          Utah                       2                8
                          Nev .                      D                                                      .            .                             1

                          VlCFIC                    65              131                                     6           14            2!           506
                          WmA .                      2                I                                     2                          9               4
                          0,90 .                     4                2                                                  I                             6
                          CNa .                     75              1]0                                     4           13            I6           265
                          Akaka                      I                                                                                                 2
                          HaxfX                        -              4                                                      .             .
                          euem                            ~           I           U
                          P.F .                                                   U                        12           14                 -           .
                          VI.                             -          U            U                                     U                  ~           U
                          Amar. Semaa                     ~          U            U                                     U                              U
                          C .NMI .                        ~          U            U                                     U                              U

                          N : Not roI1M ble U : LMVaPWe - : rc reporle d useF
                          • Idiv Iduel oaaes m aY be repwle d trau9h baN 0e Na4u nal aaclronb Telanvnmu qu ticns 6yslem for 6urveele nc . (NEfSS) erC the
                           Pupk HWIb Labcralory InlcrmellonS/slem (DNLb) .
                          1CUmuhliva rporls N Drovkiorel luberwlesis c6ees for 1999 are mavMW e(' U') lor sane erees u .b9 the Tuberwlmre blorlna5m
                           6yalem (T6U)_




   RJR0000001283101062
   700603456
http://legacy.library.ucsf.edu/tid/pqp55a00/pdf
                              68                                                                              MMWR                                         January 28, 2000



                        TABLE III . Provisiona I cases of selected notiliable diseases preventable by vaccination,
                                             United States, weeks ending Janu ary 22, 2000,
                                                     and January 23, 1999 (3rd Week)
                                                   n luen : .e.                              .            e    ,        by       Pe               ee.
                                                     7- n
                                                ImeeNe  1                                                     eno0a                      po                e
                                               m .          m .                   m       m.            m.       ml        m
                         Reper6ng Area
                        UNRf    D   STATES
                                             2g8V/
                                             20
                                                          1999
                                                              47
                                                                                 20DU 1gN YOgY f9eB 2gg9 RgOU go 2DGC YgOC 19gg                    -
                        NEW ENCLAND
                        MehO
                        NH
                        VI .
                        Men                -                      1
                        RI.              -
                        Cww .            -                                           -            3             .        S       .

                        MD     ATLANTIC        3                  9                 2         43               11       33       -       -             -       -       ~
                        Ltslz b N .Y 3                            3                  -         2                1        1                -            -
                        N Y CIr                                                     2         30               10       10                -                    -       ~
                        NJ.                                       I
                                                                  5                            G                         5       V       -         U           -
                        h.           -                             -                 .            2             .       II       .        .            .       .           .
                        E.N. CENIRAL 3                            6                56        2U1               31       40       -       1          -          ~       I
                        Chb         2                             6                26         35                6        6       ~       -          -          -       ~
                        InE .                                                                                                    U       -         U           -
                        11
                        McA .            1                        -                31        16!               25       31       .       1             -       ~       1
                        Vh                                        -                  -         2                -        3

                        W.N.   CENfRAL         1                  2                44         47                9       /6       -       -             -       -
                        Mm .                                      -
                        b.®                                                         2                                    1       -                             -
                        Mo.              1                                         42         41                9       13                -                    -
                        N . Dek.                                                                                         -       u                 u
                        S D6k .           -                       -
                        Nob .                                                                     4             -        4
                        Nvs                                                                       2             -        -       U       -         U

                        S .ATLANrIC 5                         n                    i6            54            15       33
                        Del .                                                                                                    u                 u
                        6fl        4                          n                     4            26             4       13       U       -         u
                        D.c .                                                        .            e
                        Ve                -                           -              -            1                      1       -
                        W .V6                                                                                                    U                 U
                        NC .             1                            -            12            10                      6
                        S .C .                                                       -                                   2       U                 U
                        Da.              -                                           -           11                      1       -
                        iq               -                            -
                        E& CENTRAL -                              S                20            31             4       16
                        I(Y.                                      I                  .            4                 .    2       .            .        .       . ..
                        Tenn .   -                                2                               4                      3       -       -             -
                        Ala .   -                                                   5            14             2        6       -       -             -       ~       ~               ~
                        Ms .             -                            -            13             a             2        5       -       -             -       ~       ~               -

                        W .S .CENfRAL -                           5                 4            47             3        9       -       -             ~       -       -               -
                        Ark.        -                                               4             3             3        2                •
                                                                                                                             -   U                 U
                        Le .       -                                  -                           I
                        Chla.            -                        4                      -       14                 ~    3       Il      -         U           -       -           '   -
                        Tot                                                              .       29                 .    4       U       -         U

                        MIXMi AIN 5                               3                33            N              9       25       -       -             -       -       -               -
                        Mont
                        tlMo     1                                                       .            i             .    i       .            .        .       .               .        .
                        Wro                                       I
                        Cob      3                                                 m             ID             2        9
                        N      Mea           -                    2                 6             3             6        6       -       -             -       -       -               ~
                        Atl .                                                       9            17              -       1       -       -             -       -       -                .
                        WN                1                                          3            7                              -       -             -       -
                        Nev               -                           -              5            6             1        6       -       -             -       -       -               ~

                        PAqflC                2                   )               142        451               82       140          -   -             -       -       -               !
                        W.M.                                                         -            2                          .
                        Oreg                 f                    2                10         11                6         S      U       -         U           -       -               5
                        Dtld                 -                    4               132        437               76       134      -       -          -          -       -               ~
                        A .tlu               -                    1                             1               1         1                                    -       -
                        NawN                 -                            -. .                                               -   U       -         U
                        Duwn                                                                                             I       U       -         U
                        R.R               -                                                           1             -    6                -
                        Y .1              -               u                              -        u                 -    u       u       -             u           ~   ~               u
                        Am6r .5amoe                  - U                                 -        U                 -    u       U       -             U           ~   ~               u
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                                vol . 49 r No. 3                                           MMWR                                                                    6o



                                  TABLE Ill . (Cont'd.) Provislona I cases of selected notiHable diseases preventable
                                           by vacclnation, United States, weeks ending January 22, 2000,
                                                           and January 23, 1g89 (3rd Week)


                                                     m .      m.               m . wn .    un .    m.
                           NepurOn9 Ama            PODD tp99           12Y000   Y000 1p9 WW 90p9 1989                               2000           Y000 1'.                 0
                         UNRE            D   BTATES               al    I00        I       2   19      54       123         187
                         NEW    ENDLAND 4 10 - - 2  12 25 56
                         MWe        I   i!   -   -     -  -
                         NH .      -    i    7     S      -
                         Vt        1    I    !   17       5
                         Mau .   1  9   U  -  2  U   -   31
                         ql.    -   -   U  -   -   U   -  -
                         Cann .   1   -    .  -  -   -  -  -
                         MID,          ATLANTIC 4 13                                           - -  -               1 2 4
                         Ltaut a N .Y.   I  1  -  -                                            -   1                2   1
                           YAY                5                                                        -
                         NJ.             1            5           V         -          -               U        -           I        U             -                    ~
                         P..                 -             2               .           .           .       .            .       .     .                .                .

                         E .N . GENTHA L                          10      12 ~  - 1                    19 55 34                       -            -                    ~
                         Ohb       4   9                           -       -   15                      54   30                                      -                   -
                         Fd .                -            2            U           -                   U    -                        U             -                    -
                         11 .                         .           .     .          .            1          .                1        .              .                   .
                         NkO.             6           1           ~            -           -           -            1       1         ~            ~                    ~
                         Wrc.                         .           .        .           .           .       .            .     2       .                .                .
                         W.N.           CENfa4L                       17       9       ~        1      1        1       1    4        -            -                    ~
                         MFO .                        .           .        .                               .            .       .     .                .                .
                         bwa    2   1  ~                                                        1               1           2         ~            ~                    -
                         Mo . 15  6  -  -                                                       1               1           -                       -                   ~
                         N . DM .            -            -           U        -           -           U            -        -       U             -                    ~
                         S . Dak.                     .                    .           .           .    .               .     .      .              .                   .
                         N .d .                       .       t                        .           .                    .                              .                .
                         Kanc                        ~        1         U          -           -       U            -        2       U             -                    ~
                         8.             ATLANlC                   6       10       ~           -       1        1   5         16      -            -                    -
                         Del .                U               -                ~                U               -                    U             -                    -
                         M1 .             2           E           U            -           ~           U            -       9        U             -                    -
                         D .D .              -             -
                         Va.              ~               -           -            -            1               1           -                          -                .
                         w . v. .                     u                    -                       U                                 u                 .                .
                         N.C .42-17SC
                              .           -           2           U            -           -           U            -       -        U             ~                    -
                         Ca .                         .           .        .           .           .        .           .    .       .              .                   .
                         Fla .                        .           .        .           .           .       .            .    .        .                .                .

                         E .S . CEN4NL I                                   S       -           -       -        ~    2       4        -            ~                    -
                         Ky .       .-                                     .        .              .        .        .                .                .                .
                         Ton .                      -                 •                    -                .               -         -            '                    -
                         Ale .            I  1  -                              -           -           ~            2       3         -            ~                    -
                         Ma.               -   3
                         WS.CENTML  - 3  -  - 2  ~ 1                                                                        I         -            ~                    •
                         A,k.   -  I    -     .   I                                                                         -                       .                   .
                         Le .  - -  U   -  -   U    .                                                                         .      U             -                    .
                         CkN . -  I   U  -    -   U                                                                         -        U                                  -
                         Tea . -  1   U   -   2   U                                                                         -              1                   U

                         MWNf     AIN   3   15   - -  1 20 25 ]4                                                                      ~            -                    -
                         Menl          -    -    -    -  -  ~                                                                         ~            ~                    ~
                         tlNO       I   2    ~    -   - -  -  14                                                                      -            -                    -
                         Vlyu        .    .    .    .   .     -                                                                       .                .                .
                         Cale .    4        17         11     6                                                                       -            -                    ~
                         N .Mar . I    I    N    N    N 8   9  3                                                                      -            -                    ~
                         Art            3
                         Uun   1                           2              ~            ~           -   2                    7         -            -                    -
                         Nrv. -                            1              .            .           1 -  -                   1         .             .                   .

                         PACIFlC    36  25 1  1                                                11 1   4   54                          -            ~                    -
                         Wapr       3    2   ~                                                  I    1    1                                         ~                   -
                         DraY~     5   9  N  N                                                 N  U   3    1                         U             ~                    -
                         CtlM . 28  ia   1  1                                                  e   .    .  52                        -             -                    -
                         Nahi     -  2
                         Hawall                               -           2        U           -           B        U        •                 ~   U

                         (Lam    -  -  U  -  -  U  ~                                                                         -       U             -                    -
                          .
                         P0            -
                         vt    -  U  U   -  U  U   •                                                                         U       U                     -            U
                         Amn.BSnoa  - U  U  - U  U  -                                                                        U       U             -                    U
                         CNML    -  U  U  -  U  U  -                                                                         U       U             -                    U
                         NNolnoaleMe               U :UnavYable        . :nerapttNEn .ac




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        LIZti Z..~~O q

http://legacy.library.ucsf.edu/tid/pqp55a00/pdf
                           Vol . 49 1 No . 3                                       MMWR                             71




                                                    Contrlbu tore to the Prod uctlon o1 the M MWR (1Neek ly)
                                          Week ly NoRR able Diwase Morbl dtly Data and 122 Cllin Mortall ty Date
                                                                   Sam uel l . Gre sacbse, D.V .M ., M .P.H.
                                       state support Team                                   CDC Ope rationa Tea m
                                       HeEen Fcpan                                           Certl M, KnaMea
                                       Jose Aponle                                           Daboiah A . Adam .
                                       Paul Gengeros e, M .P. H.                             WiIFe J . Mders on
                                       GeialE Jones                                          Paby A . HNI
                                       Devi d Nitac hke                                      Kelh7n Snavdy
                                       Cerol A . Wms ham                                     6na Zynick i




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                          72                                                       M M W R Januar y R8, 2000


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                                                                                                                  Ceren R. Wbs nW
                           Disease Contrd and PrevenE on             Mana gng Ecnor,
                             Lynne 8 Wdc ox, M.D ., M .P .H .                                                   Deskkp Publishinp
                                                                     MMN R (wee kly)
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                                                     .   . overnmen r n g a:                      g     on




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