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*1941-1946 fiscal years (12-month period ending June 30); 1947-1984 calendar years.

Syphilis is still the third most frequently reported communicable disease in the United States, exceeded only by varicella and gonorrhea. Since the initiation of national syphilis control efforts in the 1940s, reported cases of all stages of syphilis declined from an all-time high of 575,600 in 1943 to 69,888 in 1984. However, the trend for reported primary and secondary syphilis has changed direction several times.

After a steady yearly increase since 1977, the total number of cases of infectious syphilis (primary and secondary) decreased 15%, from 33,613 in 1982 to 28,607 in 1984. The rate per 100,000 population decreased from 14.6 in 1982 to 12.2 in 1984.

SYPHILIS (Primary and secondary) – Cases, by sex, United States, 1956-1984

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1956 1958 1960 1962 1964 1966 1968 1970 1972 1974 1976 1978 1980 1982 1984

YEARS

The trend in the number of cases of primary and secondary syphilis varies according to sex. For the first time since 1977, the actual number of cases among men decreased for two consecutive years, from 24,988 in 1982 to 20,576 in 1984 (a 17.6% decrease). For women, the number of cases decreased in only 1 year since 1977, from 9,082 in 1983 to 8,031 in 1984 la 11.6% decrease). However, from 1977 to 1984, rates (cases per 100,000 population) increased 26% for men and 43% for women.

SYPHILIS (Primary and secondary) – Case rates, by sex, and congenital syphilis (under 1 year) cases, United States, 1970-1984

24

1000

[graphic]

P & S CASES/100,000 POPULATION

CONGENITAL SYPHILIS< 1 YEAR

0

0 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984

YEARS

'Primary and secondary syphilis.

Trends for early congenital syphilis (CS) have usually paralleled the trends for primary and secondary syphilis among women. In 1984, although the rate of infectious syphilis decreased, the actual number of reported cases of CS increased.

Factors contributing to the sustained level of early CS since 1981 may include an increase in the incidence of early infectious syphilis among pregnant women, lack of availability of prenatal care, and failure of the prenatal-care system to provide timely serologic testing and prompt follow-up. The increase in cases noted in 1984 is attributed to the above factors and also to improved surveillance due to use of a new CS case analysis form.

SYPHILIS (Congenitai) – Reported cases, by age group, United States, 1983-1984

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Reported cases of congenital syphilis (CS) for all ages decreased from 17,600 in 1941 to 326 in 1984. Neonatal mortality due to syphilis has declined 99% since the 1940s.

The major decrease in the total number of reported cases of CS has occurred in the number of late CS cases (cases reported for children over 1 year of age). This number has decreased from 1,608 in 1970 to 79 in 1984.

The number of cases of early CS (cases reported for children less than 1 year of age) decreased to 107 in 1978 and then increased slowly in the past 6 years. The proportion of cases of early CS to total cases of CS has steadily increased from 17.7% in 1970 to 75.8% in 1984.

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The annual tetanus case rate has remained relatively stable since 1976. Seventy-four cases of tetanus were reported in 1984 in the United States. In addition, 10 cases were reported from Puerto Rico. Only two (2.7%) of the 74 U.S. cases occurred in completely immunized individuals (persons having either completed a primary series or received a booster dose within the last 10 years). An acute injury was identified in 52 (70%) of the cases. Among the remaining 22 cases not associated with an acute wound, six were associated with an abscess, blister, or infection; three occurred in IV drug users; two were associated with dental conditions; two, with gangrene, and two, with skin ulcers. In seven cases no associated condition was identified.

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