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For 1984, 131 cases of brucellosis were reported to CDC. The reported occurrence sharply decreased from 1947 until 1965 because of widespread adoption of dairy-product pasteurization and the bovine-brucellosis eradication program. The downward trend continued at a slower rate until 1978, when a plateau of approximately 0.1 cases/100,000 population/year was achieved.
Only one case of diphtheria was reported in 1984. The patient was a 66-year-old female. This represents the lowest total since such reporting began for what once was a major cause of infant morbidity and mortality. The slight increase in the incidence of diphtheria beginning in 1973 and peaking in 1975 represented cutaneous cases reported from Washington State. In the period 1980-1984, five or fewer cases of diphtheria were reported each year- all of which were noncutaneous cases- and 12 (75%) of the 16 cases in that period were among persons 20 years of age or older. Age distributions of persons with recent cases and of persons participating in serosurveys showed that many adults had inadequate levels of circulating antitoxin. These findings indicate that providers of health care need to ensure that adults are adequately vaccinated against diphtheria and tetanus in accordance with the recommendations of the Immunization Practices Advisory Committee (ACIP).
GONORRHEA – Rates, by year, United States and large cities,' 1968-1984
From 1975 to 1984, rates of gonorrhea declined by 20% for the United States and declined by 17% for combined metropolitan areas.
Age-specific rates per 100.000 population showed that teenagers and young adults were at highest risk for acquiring gonorrhea. Of all reported gonorrhea cases, nearly 40% were accounted for by persons 20-24 years old, and 25% by persons 15-19 years of age. The highest morbidity for males occurred for the 20- to 24-year age group, and the highest for females, for those 15-19 years old. This substantially higher morbidity for younger persons, particularly teenage females, may place them at higher risk for sequelae of gonococcal infection such as pelvic inflammatory disease and infertility.
The number of reported cases of gonorrhea decreased by 2.4% from 900,435 in 1983 to 878,556 in 1984. Gonorrhea rates per 100,000 population declined from 387.6 to 374.8 during the same period.
The decline in gonorrhea rates occurred throughout the United States; however, reported rates from the South Atlantic area remained highest for the country.
GONORRHEA – Reported penicillinase-producing Neisseria gonorrhoeae (PPNG) cases, United States, 1976-1984
Gonococcal antimicrobial resistance has assumed increasing importance since the first reported case of penicillinase-producing Neisseria gonorrhoeae (PPNG) occurred in the United States in 1976. Between 1976 and 1982, the number of reported PPNG cases increased from 98 to 4,457, then decreased to 3,720 in 1983, but increased again in 1984 to 4,110. In addition to PPNG, chromosomally mediated resistant N. gonorrhoeae (CMRNG) was recognized as an important problem in early 1983, when the first large domestic outbreak occurred in North Carolina. More than 400 cases of CMRNG from 22 other states were reported in 1984. Spectinomycin-resistant N. gonorrhoeae has not yet become a significant problem in this country.
The decline in gonorrhea cases in 1983 may be attributed to one or more of the following: 1) more effective control efforts, 2) improved general surveillance and earlier detection of cases to decrease transmission, 3) variations in reporting, 4) changing biological properties of the gonococcus, 5) changing patterns of host-population susceptibility, or 6) changing sexual behavior within the populations at risk for acquiring gonorrhea. The increase of PPNG cases reported in 1984 resulted from sustained domestic transmission, primarily in three large outbreaks (Los Angeles, New York, Florida).