Since 1983, CDC has published the CDC Surveillance Summaries
under separate cover as part of the MMWR series. Each report
published in the CDC Surveillance Summaries focuses on public
health surveillance; surveillance findings are reported for a broad
range of risk factors and health conditions.
Summaries for each of the reports published in the most recent
(December 11, 1992) issue of the CDC Surveillance Summaries (1) are
provided below. All subscribers to MMWR receive the CDC
Surveillance Summaries, as well as the MMWR Recommendations and
Reports, as part of their subscriptions.
TETANUS SURVEILLANCE -- UNITED STATES, 1989-1990
During the period 1989-1990, 117 cases of tetanus were
reported from 34 states, for an average annual incidence of
0.02/100,000 population. Fifty-eight percent of patients were
greater than or equal to 60 years of age, while seven (6%) were
less than 20 years of age, including one case of neonatal tetanus.
Among adults, the risk of tetanus in those greater than 80 years of
age was more than 10 times the risk in persons ages 20-29 years.
The case-fatality rate increased with age, from 17% in persons 40-
49 years of age to 50% in those greater than or equal to 80 years
of age. Only 11% of patients reported receipt of a primary series
of tetanus toxoid before disease onset, while 31% lacked a history
of tetanus vaccination. Tetanus occurred following an acute injury
in 78% of patients. Of patients who sought medical care, only 58%
received tetanus toxoid as part of wound prophylaxis. Tetanus
remains a severe disease that primarily affects unvaccinated or
inadequately vaccinated older adults. Increased efforts are needed
to reduce the burden of tetanus among the elderly. Health-care
providers should take every opportunity to review the vaccination
status of their patients and provide tetanus vaccine when
indicated.
Authors: Rebecca Prevots, Ph.D., M.P.H., Roland W. Sutter, M.D.,
M.P.H. & T.M., Peter M. Strebel, M.D., M.P.H., Stephen L. Cochi,
M.D., Stephen Hadler, M.D., Division of Immunization, National
Center for Prevention Services, CDC.
PERTUSSIS SURVEILLANCE -- UNITED STATES, 1989-1991
The licensure of whole-cell pertussis vaccine combined with
diphtheria and tetanus toxoids as DTP in the 1940s -- and its
widespread use in infants and children -- led to a dramatic decline
in the incidence of reported pertussis. In the prevaccine era, the
average annual incidence and mortality for reported pertussis were
150 cases and six deaths per 100,000 population, respectively. From
1989 through 1991, pertussis cases were reported by state and local
health departments to CDC through two distinct national
surveillance systems: the National Notifiable Diseases Surveillance
System (NNDSS) and the Supplementary Pertussis Surveillance System
(SPSS).
During the period 1989-1991, 11,446 pertussis cases were
reported to the NNDSS (4157 in 1989; 4570 in 1990; and 2719 in
1991), for an unadjusted annual incidence of 1.7, 1.8, and 1.1
cases per 100,000 population in 1989, 1990, and 1991, respectively.
For the period 1989-1991, case reports were received through the
SPSS on 9480 (83%) of the 11,446 patients reported to the NNDSS.
Age-specific incidence and age-specific hospitalization rates were
highest among children less than 1 year of age and declined with
increasing age.
Long-term trends suggest an underlying upward trend in the
reported incidence of pertussis in the United States since 1976.
The peak in reported pertussis cases in 1990 represents the highest
annual incidence of pertussis since 1970. However, the incidence of
pertussis declined 41% from 1990 through 1991.
Whether the long-term upward trend in reported pertussis is a
true increase in incidence is unclear; the observed increase may be
a function of improved surveillance. To better estimate the true
incidence of pertussis, the surveillance system needs to use a
sensitive and specific case definition, and the information
collected needs to be as complete and accurate as possible. Because
available diagnostic tests vary in sensitivity and specificity, the
following steps should be taken to improve surveillance for
pertussis in the United States: a) increase physician knowledge of
the clinical presentation of pertussis; b) encourage more
widespread use of culture, the current "gold standard" of pertussis
laboratory diagnosis; and c) encourage the use of uniform clinical
case definitions as recommended by the Council of State and
Territorial Epidemiologists and CDC.
Authors: Susan F. Davis, M.D., Peter M. Strebel, M.D., M.P.H.,
Stephen L. Cochi, M.D., Elizabeth R. Zell, M.Stat., Stephen C.
Hadler, M.D., Division of Immunization, National Center for
Prevention Services, CDC.
Disclaimer
All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.
**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.
