Summary of Notifiable Infectious Diseases and Conditions — United States, 2013
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| MMWR Weekly Vol. 62, No. 53 October 23, 2015 |
| PDF of this issue |
Summary of Notifiable Infectious Diseases and Conditions — United States, 2013
Weekly
October 23, 2015 / 62(53);1-119Preface
The Summary of Notifiable Infectious Diseases and Condition—United States, 2013 (hereafter referred to as the summary) contains the official statistics, in tabular and graphic form, for the reported occurrence of nationally notifiable infectious diseases and conditions in the United States for 2013. Unless otherwise noted, data are final totals for 2013 reported as of June 30, 2014. These statistics are collected and compiled from reports sent by U.S. state and territory, New York City, and District of Columbia health departments to the National Notifiable Diseases Surveillance System (NNDSS), which is operated by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE). This summary is available at http://www.cdc.gov/mmwr/mmwr_nd/index.html. This site also includes summary publications from previous years.
The Highlights section presents noteworthy epidemiologic and prevention information for 2013 for selected infectious diseases and conditions and additional information to aid in the interpretation of surveillance and infectious diseases- and conditions-trend data. Part 1 contains tables showing incidence data for the nationally notifiable infectious diseases and conditions reported during 2013; these tables do not include rows for conditions with zero cases reported in 2013.*The tables provide the number of cases reported to CDC for 2013 and the distribution of cases by month, geographic location, and patients' demographic characteristics (e.g., age, sex, race, and ethnicity). Part 1 also includes a table with the reported incidence of notifiable diseases during 2003–2013 and a table enumerating deaths associated with specified notifiable infectious diseases and conditions reported to CDC's National Center for Health Statistics (NCHS) during 2005–2011. Part 2 contains graphs and maps that depict summary data for selected notifiable infectious diseases and conditions described in tabular form in Part 1. Historical notifiable disease data, annotated as Part 3 in previous releases of this summary will no longer be included beginning with this report. Historical notifiable disease data during 1944–2012 are available online in previous years' summaries (http://www.cdc.gov/mmwr/mmwr_nd). Efforts are underway to post finalized data for years 2004–2012 on CDC WONDER (http://wonder.cdc.gov). The Selected Reading section presents general and disease-specific references for notifiable infectious diseases and conditions. These references provide additional information on surveillance and epidemiologic concerns, diagnostic concerns, and infectious disease-control activities.
Comments and suggestions from readers are welcome. To increase the usefulness of future editions, comments regarding the current report and descriptions of how information is or could be used are invited. Comments should be e-mailed to NNDSSweb@cdc.gov with the following subject line: "Annual Summary".
Background
The infectious diseases and conditions designated by CSTE and CDC as nationally notifiable during 2013 are listed in this section. A notifiable infectious disease or condition is one for which regular, frequent, and timely information regarding individual cases is considered necessary for the prevention and control of the disease or condition. A brief history of the reporting of nationally notifiable infectious diseases and conditions in the United States is available athttp://wwwn.cdc.gov/nndss/history.html. In 1961, CDC assumed responsibility for the collection of data on nationally notifiable diseases and deaths in 122 U.S. cities. Data are collected through NNDSS, which is neither a single surveillance system nor a method of reporting. Rather, it is a 'system of systems', which is coordinated by CDC at the national level across disease-specific programs in order to optimize data compilation, analysis, and dissemination of notifiable disease data. Monitoring surveillance data enables public health authorities to detect sudden changes in disease or condition occurrence and distribution, identify changes in agents and host factors, and detect changes in health-care practices. National level surveillance data are compiled from case notification reports of nationally notifiable infectious diseases and conditions submitted from the state, territory, and selected local health departments to CDC.
Cases are first identified through reports of infectious diseases and conditions from the local level to the state or territory. Legislation, regulation, or other rules in those jurisdictions require health-care providers, hospitals, laboratories, and others to provide information on reportable conditions to public health authorities or their agents. Case reporting at the local level protects the public's health by ensuring the proper identification and follow-up of cases. Public health workers ensure that persons who are already ill receive appropriate treatment; trace contacts who need vaccines, treatment, quarantine, or education; investigate and halt outbreaks; eliminate environmental hazards; and close premises where disease transmission is believed to be ongoing.
Although infectious disease and condition reporting is mandated at the state, territory, and local levels by legislation or regulation, state and territory notification to CDC is voluntary. Selected local, state, and territorial health departments voluntarily notify CDC about nationally notifiable infectious diseases and conditions; the data in these case notifications to CDC are obtained through the reportable disease and condition surveillance systems in place at the state and local levels. Case notification of nationally notifiable infectious diseases and conditions helps public health authorities monitor the effect of these diseases and conditions, measure the disease and condition trends, assess the effectiveness of control and prevention measures, identify populations or geographic areas at high risk, allocate resources appropriately, formulate prevention strategies, and develop public health policies.
The list of nationally notifiable infectious diseases and conditions is revised periodically. An infectious disease or condition might be added to the list as a new pathogen emerges, or a disease or condition might be removed as its incidence declines. Public health officials at state and territorial health departments collaborate with CDC staff in determining which infectious diseases and conditions should be considered nationally notifiable. CSTE, with input from CDC, makes recommendations annually for additions and deletions to the list. The list of infectious diseases and conditions considered reportable in each jurisdiction varies over time and across jurisdictions. Current and historic national public health surveillance case definitions used for classifying and enumerating cases consistently at the national level across reporting jurisdictions are available at http://wwwn.cdc.gov/nndss/conditions.
* No cases of anthrax; diphtheria; eastern equine encephalitis, nonneuroinvasive disease; poliovirus infection, nonparalytic; severe acute respiratory syndrome-associated Coronavirus disease (SARS-CoV); smallpox; St. Louis encephalitis, nonneuroinvasive disease; western equine encephalitis, neuroinvasive and nonneuroinvasive disease; yellow fever; vancomycin resistant Staphylococcus aureus (VRSA) and viral hemorrhagic fevers were reported in the United States during 2013. Data on chronic hepatitis B and hepatitis C virus infection (past or present) are not included because they are undergoing data quality review.
Infectious Diseases and Conditions Designated by CSTE and CDC as Nationally Notifiable During 2013*
Anthrax
Arboviral diseases, neuroinvasive and nonneuroinvasive
California serogroup viruses
Eastern equine encephalitis virus
Powassan virus
St. Louis encephalitis virus
West Nile virus
Western equine encephalitis virus
Babesiosis
Botulism
foodborne
infant
other (includes wound and unspecified)
Brucellosis
Chancroid
Chlamydia trachomatis infection
Cholera (Vibrio cholerae O1 or O139)
Coccidioidomycosis
Cryptosporidiosis
Cyclosporiasis
Dengue virus infections
Dengue fever
Dengue hemorrhagic fever
Diphtheria
Ehrlichiosis/Anaplasmosis
Anaplasma phagocytophilum
Ehrlichia chaffeensis
Ehrlichia ewingii
Undetermined human ehrlichiosis/anaplasmosis
Giardiasis
Gonorrhea
Haemophilus influenzae, invasive disease
Hansen disease (leprosy)†
Hantavirus pulmonary syndrome
Hemolytic uremic syndrome, post-diarrheal
Hepatitis, viral
Hepatitis A, acute
Hepatitis B, acute
Hepatitis B, chronic
Hepatitis B, perinatal infection
Hepatitis C, acute
Hepatitis C, past or present
Human Immunodeficiency Virus (HIV) diagnoses§
Influenza-associated pediatric mortality
Invasive pneumococcal disease (Streptococcus pnuemoniae, invasive disease)
Legionellosis (Legionnaire's Disease or Pontiac fever)
Listeriosis
Lyme disease
Malaria
Measles†
Meningococcal disease (Neisseria meningitidis)
Mumps
Novel influenza A virus infections†
Pertussis
Plague
Poliomyelitis, paralytic
Poliovirus infection, nonparalytic
Psittacosis
Q fever
Acute
Chronic
Rabies
Animal
Human
Rubella†
Rubella, congenital syndrome
Salmonellosis
Severe acute respiratory syndrome-associated Coronavirus disease (SARS-CoV)
Shiga toxin-producing Escherichia coli (STEC)
Shigellosis
Smallpox
Spotted fever rickettsiosis
Streptococcal toxic-shock syndrome
Syphilis¶
Syphilis, congenital
Tetanus
Toxic-shock syndrome (other than streptococcal)
Trichinellosis
Tuberculosis
Tularemia
Typhoid fever (caused by Salmonella enterica serotype Typhi)
Vancomycin-intermediate Staphylococcus aureus (VISA) infection
Vancomycin-resistant Staphylococcus aureus (VRSA) infection
Varicella (morbidity)
Varicella (mortality)
Vibriosis (any species of the family Vibrionaceae, other than toxigenic Vibrio cholerae O1 or O139)
Viral Hemorrhagic Fever
Crimean-Congo Hemorrhagic fever virus
Ebola virus
Lassa virus
Lujo virus
Marburg virus
New World Arenaviruses (Guanarito, Machupo, Junin, and Sabia viruses)
Yellow fever
* This list reflects position statements approved in 2012 by the Council of State and Territorial Epidemiologists (CSTE) for national surveillance, which were implemented in January 2013. No additions or deletions of diseases or conditions were made to the list of nationally notifiable infectious diseases and conditions for 2013, with the exception of leptospirosis, which was approved by CSTE in 2012, but because of delays in OMB approval, was not added to the list of nationally notifiable conditions until 2014. National surveillance case definitions for these infectious diseases and conditions are available at http://wwwn.cdc.gov/nndss/conditions.
† The year 2013 reflects a modified surveillance case definition for this disease per approved 2012 CSTE position statements.
§ AIDS (Acquired Immunodeficiency Syndrome) has been reclassified as HIV stage III.
¶ Includes the following categories: primary, secondary, latent (including early latent, late latent, and latent syphilis of unknown duration), neurosyphilis, and late (including late syphilis with clinical manifestations other than neurosyphilis).
Data Sources
Provisional data on the reported occurrence of nationally notifiable infectious diseases and conditions are published weekly in MMWR throughout the year. After each reporting year, staff in state and territory health departments finalize reports of cases for that year with local or county health departments and reconcile the data with reports previously sent to CDC throughout the year. These data are compiled in final form in this summary, which represents the official and archival counts of cases for each year. The data in these reports are approved by the appropriate chief epidemiologist from each submitting state or territory before being published in this summary. Data published in MMWR Surveillance Summaries or other surveillance reports produced by CDC programs might differ from data reported in this summary because of differences in the timing of reports, the source of the data, or surveillance methodology.
Data in this summary were derived primarily from reports transmitted to CDC from health departments in the 50 states, five territories, New York City, and the District of Columbia (reporting jurisdictions). Data were reported for MMWR weeks 1–52, which correspond to the period for the week ending January 5, 2013 through the week ending December 28, 2013. More information regarding notifiable infectious diseases and conditions, including national surveillance case definitions, is available at http://wwwn.cdc.gov/nndss/conditions. Policies for reporting notifiable infectious disease and condition cases can vary by disease, condition, or reporting jurisdiction. The case-status categories used to determine which cases reported to NNDSS are published by infectious disease or condition and are listed in the publication criteria column of the 2013 NNDSS event code list (Exhibit).
For a report of a nationally notifiable disease or condition to publish in MMWR (formerly described as "print criteria", currently described as "publication criteria"), the reporting state or territory must have designated the infectious disease or condition reportable in their state or territory for the year corresponding to the year of report to CDC. After this criterion is met, the infectious disease- or condition-specific criteria listed in the Exhibit are applied. Where the Exhibit indicates that all reports will be published, this means that cases designated with unknown or suspect case confirmation status will be included in the counts along with probable and confirmed cases. Because CSTE position statements are not customarily finalized until July of each year, NNDSS data for newly added infectious diseases or conditions are not usually available from all reporting jurisdictions until January of the year following the approval of the CSTE position statement.
Final data for certain infectious diseases and conditions are derived from the surveillance records of the CDC program. Requests for further information regarding these data should be directed to the appropriate program.
Office of Public Health Scientific Services
National Center for Health Statistics (NCHS)
- Division of Vital Statistics (deaths from selected notifiable diseases)
Office of Infectious Diseases
National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention
- Division of HIV/AIDS Prevention (AIDS and HIV infection)
- Division of Viral Hepatitis
- Division of STD Prevention (chancroid; Chlamydia trachomatis; gonorrhea; syphilis; and congenital syphilis)
- Division of Tuberculosis Elimination (tuberculosis)
National Center for Immunization and Respiratory Diseases
- Influenza Division (influenza-associated pediatric mortality, initial detections of novel influenza A virus infections)
- Division of Viral Diseases, (poliomyelitis, varicella [morbidity and mortality], and SARS-CoV)
National Center for Emerging and Zoonotic Infectious Diseases
- Division of Vector-Borne Diseases (arboviral diseases)
- Division of High-Consequence Pathogens and Pathology (animal rabies)
Population estimates were obtained from the NCHS postcensal estimates of the resident population of the United States during April 1, 2010–July 1, 2012 (release date: June 13, 2013), by year, county, single year of age (range: 0 to ≥85 years), bridged-race (white, black or African American, American Indian or Alaska Native, Asian or Pacific Islander), Hispanic ethnicity (not Hispanic or Latino, Hispanic or Latino), and sex (Vintage 2012), prepared under a collaborative arrangement with the U.S. Census Bureau. Population estimates for states are available athttp://www.cdc.gov/nchs/nvss/bridged_race/data_documentation.htm#vintage2012. Population estimates for Territories are from the 2012 U.S. Census Bureau International Data Base, available at http://www.census.gov/population/international/data/idb/informationGateway.php
. The choice of population denominators for incidence reported in MMWR is based on the availability of census population data at the time of preparation for publication and the desire for consistent use of the same population data to compute incidence reported by different CDC programs.
. The choice of population denominators for incidence reported in MMWR is based on the availability of census population data at the time of preparation for publication and the desire for consistent use of the same population data to compute incidence reported by different CDC programs.Incidence in this summary was calculated as the number of reported cases for each infectious disease or condition divided by either the U.S. resident population for the specified demographic population or the total U.S. resident population, multiplied by 100,000. For Territories, incidence in this summary was calculated as the number of reported cases for each infectious disease or condition divided by either the Territorial resident population for the specified demographic population or the total Territorial resident population, multiplied by 100,000. When a nationally notifiable infectious disease or condition is associated with a specific age restriction, the same age restriction was applied to the population in the denominator of the incidence calculation. In addition, population data from states in which the disease or condition was not reportable or was not available are excluded from incidence calculations. Unless otherwise stated, disease totals for the United States do not include data for American Samoa, Guam, Puerto Rico, the Commonwealth of the Northern Mariana Islands, or the U.S. Virgin Islands.
Interpreting Data
The completeness of information on notifiable infectious diseases and conditions was highly variable and related to the disease or condition being reported (1–8). Incidence data in this summary are presented by the MMWR week and year (http://wwwn.cdc.gov/nndss/document/MMWR_Week_overview.pdf 
) assigned by the state or territorial health department, with some exceptions, including human immunodeficiency virus (HIV) (presented by date of diagnosis), tuberculosis (presented by date CDC surveillance staff verified that the case met the criteria in the national surveillance case definition), domestic arboviral diseases (presented by date of illness onset), and varicella deaths (presented by date of death). Data were reported by the jurisdiction of the person's "usual residence" at the time of disease or condition onset (http://wwwn.cdc.gov/nndss/document/11-SI-04.pdf ). For certain nationally notifiable infectious diseases and conditions, surveillance data are reported independently to various CDC programs. For this reason, surveillance data reported by other CDC programs might vary from data reported in this summary because of differences in 1) the date used to aggregate data (e.g., date of report or date of disease or condition occurrence), 2) the timing of reports, 3) the source of the data, 4) surveillance case definitions, and 5) policies regarding case jurisdiction (i.e., which jurisdiction should submit the case notification to CDC). In addition, the "date of disease occurrence" of conditions might vary. For infectious diseases, the meaning of the "date of disease occurrence" varies across jurisdictions and by disease and might be a date of symptom or disease onset, diagnosis, laboratory result, reporting of a case to a jurisdiction, or notification of a case to CDC.
) assigned by the state or territorial health department, with some exceptions, including human immunodeficiency virus (HIV) (presented by date of diagnosis), tuberculosis (presented by date CDC surveillance staff verified that the case met the criteria in the national surveillance case definition), domestic arboviral diseases (presented by date of illness onset), and varicella deaths (presented by date of death). Data were reported by the jurisdiction of the person's "usual residence" at the time of disease or condition onset (http://wwwn.cdc.gov/nndss/document/11-SI-04.pdf ). For certain nationally notifiable infectious diseases and conditions, surveillance data are reported independently to various CDC programs. For this reason, surveillance data reported by other CDC programs might vary from data reported in this summary because of differences in 1) the date used to aggregate data (e.g., date of report or date of disease or condition occurrence), 2) the timing of reports, 3) the source of the data, 4) surveillance case definitions, and 5) policies regarding case jurisdiction (i.e., which jurisdiction should submit the case notification to CDC). In addition, the "date of disease occurrence" of conditions might vary. For infectious diseases, the meaning of the "date of disease occurrence" varies across jurisdictions and by disease and might be a date of symptom or disease onset, diagnosis, laboratory result, reporting of a case to a jurisdiction, or notification of a case to CDC.Data reported in this summary are useful for analyzing infectious disease or condition trends and determining relative infectious disease or condition numbers. However, reporting practices affect how these data should be interpreted. Infectious disease and condition reporting is likely incomplete, and completeness might vary depending on the infectious disease or condition and reporting state. The degree of completeness of data reporting might be influenced by the diagnostic facilities available, control measures in effect, public awareness of a specific infectious disease or condition, and the resources and priorities of state and local officials responsible for controlling infectious diseases and conditions, and for public health surveillance. Finally, factors such as changes in methods for public health surveillance, introduction of new diagnostic tests, or discovery of new infectious disease or condition entities can cause changes in reporting that are independent of the actual incidence of infectious disease or condition.
Public health surveillance data are published for selected racial/ethnic populations because these characteristics can be risk markers for certain notifiable infectious diseases or conditions. Race and ethnicity data also can be used to highlight populations for focused prevention programs. However, caution must be used when drawing conclusions from reported race and ethnicity. Different racial/ethnic populations might have different patterns of access to health care, potentially resulting in data that are not representative of actual infectious disease or condition incidence among specific population groups. In addition, not all race and ethnicity data are collected or reported uniformly for all infectious diseases and conditions; for example, the recommended standard for classifying a person's race or ethnicity is based on self-reporting. However, this procedure might not always be followed.
The standardized categories used for classifying race and ethnicity have changed over time, and the transition in implementation to the newest race and ethnicity standard has taken varying amounts of time for different nationally notifiable infectious diseases and conditions. All data submitted to CDC, even those data using the new 1997 standard, are converted to the 1977 standard. Until CDC can accept data using the 1997 OMB standard across all conditions and across all reporting jurisdictions, the data will be converted to the 1977 standard. The current standard is the 1997 Office of Management and Budget (OMB) race and ethnicity standard, which includes the collection of multiple races per person; this should have been implemented by federal programs beginning January 1, 2003. CDC's Tuberculosis, HIV/AIDS, and Sexually Transmitted Diseases programs have implemented the 1997 OMB Standard. In addition, the National Electronic Disease Surveillance System Base System (NBS), which was in development in 1999 and by 2003 was in production by the first state, implemented the 1997 OMB standard. However, progress has been slow in updating the national case notification messaging standard across all reporting jurisdictions to enable CDC to aggregate data collected using the 1997 OMB standard for all nationally notifiable infectious diseases and conditions. Most of the case notification data submitted to CDC are in National Electronic Telecommunications System for Surveillance (NETSS) data format, which uses the 1977 OMB standard, in which race and ethnicity were collected as one variable.
Surveillance data reported to NNDSS are in either individual case-specific form or summary form (i.e., aggregated data for a group of cases). Summary data often lack demographic information (e.g., race); therefore, the demographic-specific rates presented in this summary might be underestimated.
Transitions in NNDSS Data Collection
A total of 57 public health departments (50 state health departments, two city health departments [New York City and the District of Columbia] and five territorial health departments) submitted to CDC notifiable infectious diseases and conditions data for inclusion in this summary. Data collection in NNDSS has undergone various transitions over time. Before 1990, data were reported to CDC as cumulative counts rather than as individual case reports. In 1990, using NETSS, states began electronically capturing and reporting individual cases to CDC without personal identifiers. In 2001, CDC launched the National Electronic Disease Surveillance System (NEDSS), now a component of the Public Health Information Network (PHIN), to promote the use of data and information system standards that advance the development of efficient, integrated, and interoperable surveillance information systems at the local, state, territorial, and national levels. Additional information concerning NEDSS is available at http://wwwn.cdc.gov/nndss/nedss.html.
One of the objectives of NEDSS is to improve the accuracy, completeness, and timeliness of disease reporting at the local, state, territorial, and national levels. A major feature of NEDSS is its ability to capture data already in electronic form (e.g., electronic laboratory results, which are needed for case confirmation) rather than having to enter these data manually, as in NETSS. Certain public health surveillance information systems are NEDSS-compatible. In 1999, CDC initiated development of the NBS, which the first state began using in 2003. Since the NBS launch, states and commercial vendors have developed several other NEDSS-compatible systems.
As of August 2013, all 50 state health departments use NEDSS-compatible public health surveillance information systems: 32 (64%) use state- or vendor-developed systems and 18 (36%) use the CDC-developed NBS. In addition, New York City uses a vendor-developed system and the District of Columbia uses both NBS and a vendor-developed system. In September 2013, Guam began to use NBS selectively as part of the territory's transition plan to use the system for all reportable infectious diseases and conditions. At that time, the remaining territorial health departments were not using NEDSS-compatible systems.
In 2013, CDC began to conceptualize improvements to strengthen and modernize the technical infrastructure supporting NNDSS. In 2014, CDC and selected states began work on the NNDSS Modernization Initiative (NMI), a multiyear commitment to enhance NNDSS surveillance capabilities. An important benefit for public health decision making will be the ability to acquire higher quality data that are more comprehensive and timely. Through NMI, CDC and its state partners will increase the robustness of the NNDSS technological infrastructure so that it is based on interoperable, standardized data and data exchange mechanisms. Additional information is available at http://www.cdc.gov/nmi.
Method for Identifying which Nationally Notifiable Infectious Diseases and Conditions are Reportable
States and jurisdictions are sovereign entities. Reportable conditions are determined by laws and regulations of each state, territory, or local jurisdiction. Some infectious diseases and conditions deemed nationally notifiable by CSTE might not be designated as reportable in certain states or jurisdictions. Only data from reporting states, territories, and jurisdictions that designated the infectious disease or condition as reportable are included in the summary tables. This ensures the data displayed in this summary are from population-based surveillance efforts and are generally comparable across states, territories, and other jurisdictions. When a CSTE- and CDC-recommended nationally notifiable disease or condition is judged by state, territory, or other jurisdiction officials to be not reportable, an "N" indicator for "not reportable" is inserted in the table for the specified reporting state, territory, or jurisdiction and applicable year. Each year, the NNDSS Data Processing Team solicits information from each NNDSS reporting state, territory, and jurisdiction (all 50 U.S. states, the District of Columbia, New York City, and five U.S. territories) about infectious diseases and conditions that are mandated by state, territory, or jurisdiction laws or regulations to be nationally reportable.
Revised International Health Regulations
At its annual meeting in June 2007, CSTE approved a position statement that supports implementation of International Health Regulations (IHR) in the United States (9). CSTE approval followed the adoption of revised IHR in May 2005 by the World Health Assembly (10) that went into effect in the United States on July 18, 2007. This international legal instrument governs the role of the World Health Organization (WHO) and its member countries, including the United States, in identifying, responding to, and sharing information about events that might constitute a Public Health Emergency of International Concern (PHEIC). A PHEIC is an extraordinary event that constitutes a public health risk to other countries through international spread of disease and potentially requires a coordinated international response. All WHO member countries are required to notify WHO of a potential PHEIC. WHO makes the final determination about the existence of a PHEIC.
Health-care providers in the United States are required to report diseases, conditions, and outbreaks determined to be reportable by local, state, or territorial law or regulation. Additionally, all health-care providers should work with their local, state, or territorial health agencies to identify and report events occurring in their location that might constitute a PHEIC. U.S. state and territorial departments of health have agreed to report information about a potential PHEIC to the most relevant federal agency responsible for monitoring such an event. In the case of human infectious disease, the U.S. state or territorial departments of health will notify CDC through existing formal and informal reporting mechanisms (10). CDC will further analyze the event by use of the decision algorithm in Annex 2 of the IHR and notify the U.S. Department of Health and Human Services (HHS) Secretary's Operations Center (SOC), as appropriate.
In the United States, HHS has the lead role in carrying out the IHR, in cooperation with multiple federal departments and agencies. When a potential PHEIC is identified, the United States has 48 hours to assess the risk of the reported event. If authorities determine that a potential PHEIC exists, the United States, as with all WHO member countries, has 24 hours to report the event to WHO. The HHS SOC is responsible for reporting a potential PHEIC to WHO.
An IHR decision algorithm (Annex 2 of the IHR) was developed to help countries determine whether an event should be reported. If any two of the following four questions are answered in the affirmative, then a potential PHEIC exists and WHO should be notified:
- Is the public health impact of the event serious?
- Is the event unusual or unexpected?
- Is there a significant risk of international spread?
- Is there a significant risk of international travel or trade restrictions?
The revised IHR reflects a conceptual shift from the use of a predefined disease list to a framework of reporting and responding to events on the basis of an assessment of public health criteria, including seriousness, unexpectedness, and international travel and trade implications. A PHEIC is an event that falls within those criteria (further defined in a decision algorithm in Annex 2 of the revised IHR). Any one of these four conditions always constitutes a PHEIC and do not require the use of the IHR decision instrument in Annex 2:
- severe acute respiratory syndrome (SARS),
- smallpox,
- poliomyelitis caused by wild-type poliovirus, and
- human influenza caused by a new subtype.
Any other event requires the use of the decision algorithm to determine if it is a potential PHEIC. Examples of events that require the use of the decision instrument include, but are not limited to cholera, pneumonic plague, yellow fever, West Nile fever, viral hemorrhagic fevers, and meningococcal disease. Other biologic, chemical, or radiologic events might fit the decision algorithm and also must be reported to WHO.
Additional information concerning IHR is available at http://www.who.int/csr/ihr/en and http://www.cdc.gov/globalhealth/ihregulations.htm. CSTE also approved a position statement that added initial detections of novel influenza A virus infections to the list of nationally notifiable infectious diseases, beginning in January 2007 (11).
and http://www.cdc.gov/globalhealth/ihregulations.htm. CSTE also approved a position statement that added initial detections of novel influenza A virus infections to the list of nationally notifiable infectious diseases, beginning in January 2007 (11).Acknowledgements
We acknowledge John Florence for his technical review of this report. We acknowledge the following state health departments for review of data for novel influenza A virus infections: Arkansas Department of Health, Illinois Department of Public Health, Indiana State Department of Health, Iowa Department of Public Health, Michigan Department of Community Health, and Ohio Department of Health. We acknowledge all local, state, and territorial health departments in the United States for collecting the data included in this report.
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