pendium presents an overview of vaccine-preventable diseases, indications and contraindications for use of immunobiologics for adults, and immunization recommendations for adults in specific age groups and with specific vaccine needs. Over the past few years, behavorial-risk factors, and particularly the effects of alcohol consumption, have become matters of concern to both the public health community and the population at large. In 1984, the MMWR published statistics from a six-state survey on eight of these factors. Three had to do with alcohol (acute and chronic heavy drinking and drinking and driving). Some of the adverse effects of alcohol and their risk factors were delineated in other major articles. Fetal alcohol syndrome was portrayed both as a known leading cause of mental retardation and birth defects (its prevalence is perhaps 1-2 cases/1,000 births) and as potentially preventable. Alcohol's relationship to traffic fatalities and to homicides, suicides, and unintentional injuries was explored in other articles. An Erie County, New York, study found that over 38% of traffic-fatality victims were legally intoxicated at the time of death, as were 22% of suicide and 32% of homicide victims. A nationwide study of motorvehicle-related fatalities among young drivers showed that an alarming 42% of these deaths were alcohol-related. Recently, work-related diseases and injuries have been of primary public health interest. The National Institute for Occupational Safety and Health (NIOSH) has published a suggested list of the 10 leading work-related diseases and injuries; in 1984, the MMWR published summaries on two of these: occupational cancers (other than lung) and severe occupational traumatic injuries and traumatic deaths. The first article listed selected occupational agents potentially associated with different cancers (5). It pointed out that estimates on the percentage of cancers caused by occupational agents, particularly synthetic ones, ranged from less than 4% to over 20%. The second article indicated that occupational traumatic injuries were responsible for 10,000 deaths each year (6). Occupational trauma is second only to motorvehicle incidents as a cause of unintentional death in the United States. The articles stress the preventability of these two categories of work-related disease and injuries and indicate NIOSH's commitment to documenting their occurrence. Lung and breast cancer were both major topics in 1984. Several articles pointed to the increase, particularly among women, in respiratory cancers, the vast majority of which are caused by smoking. Lung cancer now equals breast cancer as the leading cause of cancer death among women in several states. It is predicted that this will soon be the case nationwide. One of the most publicized cancer articles involved data from CDC's Cancer and Steroid Hormone Study (7). Investigators reported that (1) use of "high-progestogen" oral contraceptives (OCs) before age 25 does not increase a woman's risk of developing breast cancer before age 37, and (2) use of OCs before the first full-term pregnancy does not increase the risk of developing breast cancer before age 45. Finally, the weekly MMWR issued news of important infectious disease outbreaks, while at the same time trying to emphasize long-term national health priorities. Included among the major infectious disease stories of the year were the following: the larger-than-normal outbreak of influenza, the ongoing problem of chronic diarrheal illness caused by drinking raw milk, the near demise of measles, and the increasingly frequent reports of gonorrhea due to chromosomally mediated resistant Neisseria gonorrhoeae. These often were found along with articles planned specifically to promote public awareness of major public health threats. The front page of the MMWR was devoted to fetal alcohol syndrome (FAS) during FAS Public Awareness Week, to poisoning among young children during National Poison Prevention Week, and to the impact of policy and procedure changes on hospital days among diabetic nursing home residents during National Diabetes Month. The final pre-holiday issue carried an article on toy safety and offered guidelines from the U.S. Consumer Product Safety Commission and the Toy Manufacturers of America for selecting and using safe toys. In a year of fast-breaking medical stories, the 1984 volume of the MMWR reflects the diversity of potentially preventable health events facing the nation. It also shows the responsiveness of CDC and the public health community to these. This issue of the Annual Summary recaps data contained in many of these articles and summarizes other important information about events that affect the nation's health. Together with the weekly MMWR, these summaries give an overview of major public health trends in the United States. References 1. CDC. Antibodies to a retrovius etiologically associated with acquired immunodeficiency syndrome (AIDS) in populations with increased incidences of the syndrome. MMWR 1984;33:377-9. 2. CDC. Hepatitis B vaccine: evidence confirming lack of AIDS transmission. MMWR 1984;33:685-7. 3. CDC. Vietnam veterans' risks for fathering babies with birth defects. MMWR 1984;33:457-9. 4. CDC. Adult immunization: recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR 1984;33:1S-68S. 5. CDC. Leading work-related diseases and injuries - United States. MMWR 1984;33:125-8. 6. CDC. Leading work-related diseases and injuries United States. MMWR 1984;33: 213-5. 7. CDC. Oral contraceptive use and the risk of breast cancer in young women. MMWR 1984;33:353-4. History of Morbidity Reporting and Surveillance in the United States In 1878, an Act of Congress authorized collection of morbidity reports by the Public Health Service to establish quarantine measures for diseases such as cholera, smallpox, plague, and yellow fever. In 1893, another Act authorized the weekly collection of information from state and municipal authorities throughout the United States, and gradually an increasing number of states submitted monthly and annual summaries to the Public Heath Service. It was not until 1925, however, that all states began to report regularly. Responsibilities for data collection and analysis were subsequently transferred several times within the Public Health Service. The Communicable Disease Center acquired responsibility for the venereal disease program in 1957, the tuberculosis program in 1960, the collection of data on nationally notifiable diseases in 1961, and the foreign quarantine program in 1967. The changing characteristics of diseases have necessitated modifications in the reporting system and the addition of new diseases. In 1970, the Communicable Disease Center was renamed the Center for Disease Control (CDC) to reflect a broader mandate in preventive health services. Over the years the surveillance systems maintained by CDC have expanded, and emphasis has shifted as certain diseases have had lower incidences and other diseases have taken on new aspects. In addition, CDC's increasing interest in noncommunicable diseases is reflected in new programs in family planning, nutrition, occupational hazards, congenital birth defects, chronic diseases, dental health, behavioral risk factors, and violence epidemiology. The Consolidated Surveillance and Communications Activity (CSCA) was established in 1978 in the Bureau of Epidemiology to provide ongoing examination of surveillance efforts, including Morbidity and Mortality Weekly Report (MMWR) statistics. The Activity's primary responsibility was to work with state health departments and units within CDC to propose, coordinate, and evaluate future changes in surveillance activities. In 1980, CDC was officially reorganized and renamed the Centers for Disease Control. In the reorganization, CSCA (now the Division of Surveillance and Epidemiologic Studies [DSES]) and the responsibility for publishing the MMWR were transferred to the newly created Epidemiology Program Office. Data Sources Data on the reported occurrence of notifiable diseases are routinely published in the MMWR and compiled in final form in the Annual Summary from annual reports submitted by the state and territorial departments of health. Also included in the Annual Summary are data from national surveillance activities of various programs at CDC. It should be noted that the MMWR morbidity surveillance system and the national surveillance programs are separate. Notifiable disease reports published in the MMWR are the authoritative and archival counts of cases. Data from surveillance records for selected diseases, which are useful for detailed epidemiologic analyses, are published on a periodic basis. Case-report totals from surveillance activities may not always agree exactly with those published in the MMWR because of differences in the timing of reports or because of refinements in case definition. The Epidemiology Program Office gratefully acknowledges the CDC units listed below for their contributions of statistical data from surveillance program records. Requests for further information regarding these data should be directed to the appropriate source. Center for Environmental Health Chronic Diseases Division (congenital malformations) Center for Health Promotion and Education Office of the Director (homicide and suicide) Division of Nutrition (pediatric nutrition) Center for Infectious Diseases AIDS Program (acquired immunodeficiency syndrome) Division of Bacterial Diseases (toxic-shock syndrome) Division of Vector-Borne Viral Diseases (arboviral infections, dengue, and plague) Center for Prevention Services Office of the Director (fluoridation) Division of Quarantine (cholera, plague, and refugees) Division of Tuberculosis Control (tuberculosis) Division of Sexually Transmitted Diseases (condylomata acuminata, genital herpes, gonorrhea, syphilis, chancroid, granuloma inguinale, lymphogranuloma venereum, and pelvic inflammatory disease) Epidemiology Program Office Division of Surveillance and Epidemiologic Studies (years of potential life lost) National Institute for Occupational Safety and Health Division of Surveillance, Hazard Evaluations, and Field Studies (occupational hazards) Totals for the United States, unless otherwise stated, do not include data for American Samoa, Guam, Puerto Rico, the Virgin Islands, Commonwealth of the Northern Mariana Islands (CNMI), and the Pacific Trust Territory, which includes the Republic of Marshalls, Republic of Palau, and the Federated States of Micronesia. Data from the Pacific Trust Territory exclude those for CNMI. Data from California are provisional and are included in order not to delay publication of this document. The California Department of Health Services should be contacted for final data. Data in the Annual Summary should be interpreted with caution. Some diseases such as plague and rabies that cause severe clinical illness and are associated with serious consequences are probably reported quite accurately. However, diseases such as salmonellosis and |