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Notice to Readers

National Emergency Medical Services

Week May 18–24, 2008 In the United States, injury is the leading cause of death for persons aged 1–44 years. Prehospital emergency medical services (EMS) have a substantial impact on the care of the injured and on public health. At an injury scene, EMS providers determine the severity of injury, initiate medical management, and identify the most appropriate facility to which to transport the patient.

Every day, under any circumstances, approximately 750,000 EMS providers serve their communities. National EMS Week (May 18–24, 2008) brings together local communities and medical personnel to promote safety and recognize the dedication of paramedics, emergency medical technicians, first responders, firefighters, police, and others who provide often heroic, lifesaving services as a routine part of their jobs.

National EMS Week will feature activities that support this year's theme, Your Life is Our Mission. In support of National EMS Week, CDC is launching a series of fact sheets on the treatment of blast injuries for EMS responders and physicians in trauma and emergency departments. These fact sheets are available online at http://www. emergency.cdc.gov/blastinjuries.

In partnership with the American College of Emergency Physicians, CDC also is sponsoring an online course, Bombings: Injury Patterns and Care, which is designed to provide the latest clinical information regarding blast-related injuries from terrorism. The course is available at http://www. bt.cdc.gov/masscasualties/bombings_injurycare.asp. This online course and the blast injury fact sheets are supported by CDC's Terrorism Injuries Information, Dissemination and Exchange (TIIDE) Project. TIIDE was established through a cooperative agreement to link acute care and EMS to state and local injury-prevention programs for terrorism preparedness and response.

Recreational water illness (RWI) is spread by swallosing, breathing, or having contact with contaminated wat: from swimming pools, water parks, interactive fountain spas, lakes, rivers, or oceans. The most commonly reported RWI is diarrhea caused by pathogens such a Cryptosporidium, Norovirus, Shigella, Escherichia co 0157:H7, and Giardia. Children, pregnant women, and persons with compromised immune systems are at greates risk for RWIs. Infection with Cryptosporidium can be in threatening in persons with weakened immune systems Other RWls include various skin, ear, eye, respiratory, and neurologic infections.

In 2007, state and local health departments across thé country investigated more RWI outbreaks than ever before This upsurge was driven by an increase in the number o reported RWI outbreaks caused by Cryptosporidium. : chlorine-resistant parasite, and was primarily associated with treated recreational water venues, such as pools, water parki and interactive fountains. Although seven such RWI our breaks caused by Cryptosporidium were identified in 2014 (1), CDC has received preliminary reports of 18 tha: occurred during 2007 (CDC, unpublished data, 2008) anj expects to receive more as the 2007 count is finalizei Because Cryptosporidium is chlorine resistant, even a wel maintained pool can transmit this parasite. Therefore, publi health officials, pool operators, and beach managers work together to educate the public regarding preventing RWIs by keeping Cryptosporidium and other pathogens ou of all recreational waters, treated and untreated (e.g., oceans and lakes). RWI prevention guidelines for pool staff members are available at http://www.cdc.gov/healthyswimming twelvesteps.htm. Suggestions for pool users are available 1 http://www.cdc.gov/healthyswimming/pdf/pool_user_ tips.pdf.

To help promote healthy recreational water experience public health officials also can participate in developmer of the national Model Aquatic Health Code (MAHC. Currently, no complete pool code exists at the national level In 2005, local, state, and federal public health officials and representatives from the aquatics sector met to develop i strategic plan to prevent RWIs, with the top recommendi tion calling for a national model code that would provide uniform guidelines for the design, construction, operation and maintenance of treated recreational water ventes Although it will not provide a set of federal regulations MAHC will give state and local agencies a tool with which to update their own codes. Information regarding partiupation in the development of MAHC is available at http: www.cdc.gov/healthyswimming/model_code.htm.

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Notice to Readers

National Recreational Water Illness Prevention Week May 19-25, 2008 The week of May 19–25, 2008, marks the fourth annual National Recreational Water Illness Prevention Week. This yearly observance provides an opportunity for public health agencies to increase awareness of recreational water illness and promote healthy recreational water experiences.

s: Suggestions for how public health professionals can pronote healthy swimming during National Recreational later Illness Prevention Week are available at http://www. dc.gov/healthyswimming/tools.htm. Additional informason is available at http://www.cdc.gov/healthyswimming/ ealth_dept.htm.

Reference
1. CDC. Surveillance for waterborne disease and outbreaks associated

with recreational water-United States, 2003–2004. MMWR
2006;55(No. SS-12):1–30.

QuickStats

FROM THE NATIONAL CENTER FOR HEALTH STATISTICS

Percentage of Women Aged >25 Years Who Had a Papanicolaou (Pap)
Smear Test* During the Preceding 3 Years, by Age Group and Education

Level — National Health Interview Survey, United States, 2005*

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The likelihood of having a Pap smear test during the preceding 3 years increased with education level in each of
the age groups. Overall, older women were less likely to be tested; the lowest rate (46.1%) was among women
aged >65 years who had not completed high school. Nine out of 10 women aged 25–44 years with some college
or more reported having a Pap smear test during the preceding 3 years, the highest rate of any group.
SOURCE: CDC. Health, United States, 2007: with chartbook on trends in the health of Americans. Hyattsville,
MD: US Department of Health and Human Services, CDC; 2007. Available at http://www.cdc.gov/nchs/data/
hus/hus07.pdf

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TABLE I. Provisional cases of infrequently reported notifiable diseases (<1,000 cases reported during the preceding year) - United States week ending May 10, 2008 (19th Week)*

5-year Current Cum weekly

Total cases reported for previous years Disease

week 2008 averaget 2007 2006 2005 2004 2003 States reporting cases during current week (No Anthrax Botulis foodborne

31 20 19

16 20 infant

21

87 97 85 87 76 other (wound & unspecified)

25 48 31 30 33 Brucellosis

1
21
3 128 121 120 114 104

NE (1)
Chancroid

2 20

1
24
33

17 30 54 NY (1), NC (1) Cholera

0
7

8
6

2 Cyclosporiasis

26 16 91 137 543 160 75
Diphtheria
Domestic arboviral diseases $.1:
California serogroup

44
67

80 112 108 eastern equine

4
8 21

14 Powassan

1
1
1

1 St. Louis

10
13

12 41
western equine
Ehrlichiosis/Anaplasmosis$.**.
Ehrlichia chaffeensis

2 26

5 809 578 506 338 321 NE (1), MD (1) Ehrlichia ewingii Anaplasma phagocytophilum

6

731 646 786 537 362 undetermined

1
2 136 231 112

59

44
Haemophilus influenzae,
invasive disease (age <5 yrs):
serotype b

11
22 29

9
19

32 nonserotype b

3
62

3 179 175 135 135 117 MN (2), NC (1) unknown serotype

4
84

5 186 179 217 177 227 NY (1), NE (1), TN (1), AZ (1) Hansen diseases

27

2 98 66 87 105 95 Hantavirus pulmonary syndrome

3
32 40

26

24 26 Hemolytic uremic syndrome, postdiarrheals

30
3 287 288 221

200 178 OH (1), WA (1) Hepatitis C viral, acute

9 207 15 841 766 652 720 1,102 PA (1), OH (2), MI (1), FL (1), TX (1), WA (1), OR 2 | HIV infection, pediatric (age <13 yrs)$$

6

380 436 504 Influenza-associated pediatric mortalitys. 11

72

1
76 43
45

N MI (1), FL (2)
Listeriosis

165

10

791 884 896 753 696 TN (1), WA (1), CA (4) Measles***

62

1
42 55 66 37

56 AR (1), CA (2)
Meningococcal disease, invasivettt:
A, C, Y, & W-135

118
6 311
318 297

NE (1), FL (1), TX (2) serogroup B

62
2 154 193 156

WA (1) other serogroup

14

1

32 32 27 unknown serogroup 6 263 14 570 651 765

MO (1), FL (1), OR (2), CA (2) Mumps

206 102 780 6,584 314 258 231 NY (1), FL (1), WA (1) Novel influenza A virus infections

1
N

N N
Plague

1

7
17
8
3

1 Poliomyelitis, paralytic

1 Poliovirus infection, nonparalytics

N
N

N
Psittacosis

1
10 21

16
12

12 Q fever::$$$ total:

16

173

169 136 70 71 acute

12 chronic

4 Rabies, human

3
2

7 Rubella

12
11
11
10

7 FL (1) Rubella, congenital syndrome

1
1

1 SARS-CoV$,***

0

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

Incidence data for reporting years 2007 and 2008 are provisional, whereas data for 2003, 2004, 2005, and 2006 are finalized. + Calculated by summing the incidence counts for the current week, the 2 weeks preceding the current week, and the 2 weeks following the current week, for a total :

preceding years. Additional information is available at http://www.cdc.gov/epo/dphsi/phs/files/5yearweeklyaverage.pdf. $ Not notifiable in all states. Data from states where the condition is not notifiable are excluded from this table, except in 2007 and 2008 for the domestic arboviral diseases

and influenza-associated pediatric mortality, and in 2003 for SARS-COV. Reporting exceptions are available at http://www.cdc.gov/epo/dphsi/phsfintdis.htm. 1 Includes both neuroinvasive and nonneuroinvasive. Updated weekly from reports to the Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vects":

Borne, and Enteric Diseases (ArboNET Surveillance). Data for West Nile virus are available in Table II. ** The names of the reporting categories changed in 2008 as a result of revisions to the case definitions. Cases reported prior to 2008 were reported in the caters

Ehrlichiosis, human monocytic (analogous to Ě. chaffeensis); Ehrlichiosis, human granulocytic (analogous to Anaplasma phagocytophilum), and Ehrlichiosis, unspecried,

other agent (which included cases unable to be clearly placed in other categories, as well as possible cases of E. ewingii). # Data for H. influenzae (all ages, all serotypes) are available in Table II. $$ Updated monthly from reports to the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Implementation of HIV report

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

management system is completed, Data for HIV/AIDS, when available, are displayed in Table IV, which appears quarterly. 17 Updated weekly from reports to the Influenza Division, National Center for Immunization and Respiratory Diseases. Seventy-one cases occurring during the 2007–08 inimese

season have been reported. *** Of the three measles cases reported for the current week, two were indigenous, and one was imported. +++ Data for meningococcal disease (all serogroups) are available in Table li

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

differentiated with respect to acute and chronic Q fever cases. 111 The one rubella case reported for the current week was imported. *** Updated weekly from reports to the Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases.

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FABLE I. (Continued) Provisional cases of infrequently reported notifiable diseases (<1,000 cases reported during the preceding year) – nited States, week ending May 10, 2008 (19th Week)*

5-year Current Cum weekly

Total cases reported for previous years

week 2008 averaget 2007 2006 2005 2004 2003 States reporting cases during current week (No.) wallpoxi eptococcal toxic-shock syndromes

3 53

3 118 125 129 132 161 MN (2), NV (1) philis, congenital (age <1 yr)

44 7 336

349 329 353 413 tanus

2

25 41 27 34 20 xic-shock syndrome (staphylococcal)

19

2. 85 101 90 95 133 chinellosis

2
0 6 15 16 5

6 aremia

1

2 128 95 154 134 129 phoid fever

118

420 353 324 322 356 CA (1) ncomycin-intermediate Staphylococcus aureus

3

28
6
2.

N ncomycin-resistant Staphylococcus aureuss

0
2
1
3

N riosis (noncholera Vibrio species infections) 2 50

2 377 N N N

N FL (1), WA (1) llow fever No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Incidence data for reporting years 2007 and 2008 are provisional, whereas data for 2003, 2004, 2005, and 2006 are finalized. Calculated by summing the incidence counts for the current week, the 2 weeks preceding the current week, and the 2 weeks following the current week, for a total of 5 preceding years. Additional information is available at http://www.cdc.gov/epo/dphsi/phs/files/5yearweeklyaverage.pdf. 3 Not notifiable in all states. Data from states where the condition is not notifiable are excluded from this table, except in 2007 and 2008 for the domestic arboviral diseases and influenza-associated pediatric mortality, and in 2003 for SARS-CoV. Reporting exceptions are available at http://www.cdc.gov/epo/dphsi/phs/infdis.htm.

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

Notifiable Disease Data Team and 122 Cities Mortality Data Team

Patsy A. Hall
Deborah A. Adams Rosaline Dhara
Willie J. Anderson Carol Worsham
Lenee Blanton

Pearl C. Sharp

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TABLE II, Provisional cases of selected notifiable diseases, United States, weeks ending May 10, 2008, and May 12, 2007
(19th Week)*
Chlamydiat
Coccidioidomycosis

Cryptosporidiosis
Previous

Previous

Previous
Current 52 weeks Cum Cum Current 52 weeks Cum Qum Current 52 weeks Cum
Reporting area

week
Med Max 2008 2007

week Med Max

2008 2007 week Med Max 2008 United States 11,700 21,138 24,739 359, 172 390,885

134 339 2,426 2,728

36 87 974 1.145 New England 254 688 1,516 12,284 11,738

1
1

16 72 Connecticut 118 218 1,093 3,296 2,957

N

6 Maines

46 50

67
941 928

N

6

5 Massachusetts 313 660 6,197 5,623

11

30 New Hampshire

39
73 678 697

1

1

5 15 Rhode Islands

63 61
98 1,140 1,237

3

3 Vermont

20
10
32
32 296
N

N

1
4

13 Mid. Atlantic 2,461 2,759 4,891 52,569 51,497

12 120 157 New Jersey 219 406 520 6,629 7,923

N

N

8

3 New York (Upstate) 563 556 2,044 9,613 8.862

N

N

5
4

20 47 New York City 1,166 951 3,192 21,209 18,360

N

N

2

10 27 Pennsylvania 513 802 1,754 15,118 16,352

N
N

2 6 103
E.N. Central
1,328 3,403 4,371 59,605 66,376

1
16 12

7 20 134 259 Illinois 10 1,014 1,711 15,096 18,494

N

0
N
N

2
13

24 Indiana 296 387 655 7,411 7,877

N

0
N
N

2
41

34 Michigan 829 752 1,198 16,822 14,188

1

2
12
10
2 4

11
Ohio
75 866 1,530 13,253 18,615

1
4
2

4 5 60 76 Wisconsin 118 377 612 7,023 7,202

N

0
N
N

1

7 59 63 W.N. Central 664 1,218 1,693 22,402 22,748

77

3

7 16 125
lowa
143 164 251
3,128 3,192

N
0
N

61

44 Kansas 200 152 529 3,260 2,802

N

16

19 Minnesota 256 335 4,372 4,963

34 57 Missouri

284 465
551 8,635 8,352

3

14

45 Nebraskas

37
88 161 1,527 1,889

0
N
N

24 32 North Dakota

31
65 506 651

N

6

1 South Dakota

53
81
974 899

N

16 16 S. Atlantic 3,163 3,931 7,511 66,340 72,940

2 2

14 20 65 241 Delaware 44 65 144 1.344 1,287

0

4

6 District of Columbia 149 115 200 2,233 2.217

0

0
3

5 Florida 1,298 1,285 1,556 24,730 18,178

N

10

9 35 118 Georgia 4 737 1,514 771 15,375

0

5 15 72 Marylands 469 683 7,546 6,729

1

2
North Carolina
272 206 4,656 7,917 11,207

0
N

1
18

9 South Carolinas 732 459 3,345 10,148 7,542

0
N

1
15

11 Virginia 664 485 1,061 10,587 9,245

1

6 12 West Virginia

62
96 1,064 1,160

N
E.S. Central
1,215 1,505 2,392 27,944 31,216

64 37 Alabama 480 605 7,545 9,286

0

1
14

17 Kentucky 304 196 302 3.835 2,751

0

1
40

5 Mississippi 370 300 1,048 6,413 8,598

11 Tennessee 541 512 716 10,151 10,581

18 12 W.S. Central 544 2,620 4,425 47,108 42,885

1
1

28
Arkansas
324 221 455 5,247 3,250

0
0
N

8

8 Louisiana 304 851 4,125 7,126

1

4

3 Oklahoma 220 245 416 4,558 4,605

N

1
11

14 Texas 1,778 3,922 33,178 27,904

0
N
N

3
16

33 Mountain

295
1,321 1,839 12,863 27,155

89 170 1,642 1,813

9 567 88 Arizona 52 416 679 1,091 8,709 85 168 1,611 1,761

12 Colorado 11 288 488 1,837 6,594

N

17 Idahos 15 57 233 1,317 1,491

N

21 Montana 36 48 363 1,032 1,017

0
Nevadas
116 183 400
3,460 3,437

6
17 17

6

3 New Mexicos 152 562 2,016 3,583

3
11
12

9
Utah
65 124 216 2,099 1,877

7

3
23

484

9 Wyoming

18
34
11
447

1
Pacific
1,776 3,311 4,502 58,057 64,330
39 39 217 764 897

20

19 Alaska

56
91 126 1.478 1,815

0
N
N

2

1 California 1,554 2,797 4,115 50,768 50,401

39 217 764
897

0 Hawaii

111
151 1,848 2,112

0
N
N

4

1 Oregon 166 192 403 3,850 3,388

N

0
N
N

16

17 Washington

112 613
113 6,614
N

N
N

0 American Samoa

0
32
62
41

N
N

0
C.N.M.I.
Guam

5
34
50
296

0
Puerto Rico
163 112 612 2,489 2,880

N
U.S. Virgin Islands

4
27
192
72

0
C.N.M.I.: Commonwealth of Northern Mariana Islands.
U: Unavailable. No reported cases. N: Not notifiable. Cum: Cumulative year-to-date counts. Med: Median. Max: Maximum.

Incidence data for reporting years 2007 and 2008 are provisional. Data for HIV/AIDS, AIDS, and TB, when available, are displayed in Table IV, which appears quarterty.
Chlamydia refers to genital infections caused by Chlamydia trachomatis.
Contains data reported through the National Electronic Disease Surveillance System (NEDSS).

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