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Scientific Data Documentation
National Notifiable Disease Surveillance System, 1989
DESCRIPTION The NNDSS file in WONDER contains nationally notifiable diseases reported weekly by State and Territorial epidemiologists to the Division of Surveillance and Epidemiology (DSE), Epidemiology Program Office (EPO), Centers for Disease Control (CDC), using the National Electronic Telecommunications System for Surveillance (NETSS). The operation of NETSS is facilitated by agreements between CDC and the Council of State and Territorial Epidemiologists (CSTE) on reportable conditions, protocols for formatting and transmitting data, and standard case definitions. Designated staff members in each participating agency provide and prepare the data for weekly publication in the "Morbidity and Mortality Weekly Report" (MMWR). Over 40 diseases are reported through this system. In WONDER, the following variables are available for events reported as individual case records: age, gender, race/ethnicity, county of residence, State, and MMWR week of report; from aggregate records, State and MMWR week of report. Line-listed data are not available from this file. LIMITATIONS Data reported for 1989 by Arizona, California, Nebraska, and Wyoming are represented as aggregate counts, since these states were not reporting individual case data for all of 1989. For some events (amebiasis, aseptic meningitis, chickenpox, Hansen disease (leprosy), measles, mumps, pertussis, rheumatic fever, rubella, and tetanus), cases may be reported to the State health department by number only. For these events, United States distributions by county, age, gender, and race/ethnicity will include only those cases reported as individual records and the distribution will not equal the total cases reported. Case counts by age, gender, and race/ethnicity are available from this file at State level only due to confidentiality guidelines. Data for AIDS, animal rabies, gonorrhea, primary and secondary syphilis, congenital syphilis, and tuberculosis are more likely to be reported as aggregate counts in this file. These data are based on provisional weekly reports to NETSS, and the totals may not agree with the case counts provided by the National Center for Infectious Diseases (NCID) or the National Center for Prevention Services (NCPS) for publication in the MMWR "Summary of Notifiable Diseases." Reports for all other events can be verified by reference to the MMWR "Summary of Notifiable Diseases". VARIABLES Event Codes Disease or Injury Code AIDS 10560 Amebiasis 11040 Anthrax 10350 Aseptic meningitis 10010 Botulism, foodborne 10530 Botulism, infant 10540 Botulism, other 10550 Brucellosis 10020 Chickenpox (varicella) 10030 Cholera 10470 Congenital rubella syndrome 10370 Congential syphilis 10316 Diphtheria 10040 Encephalitis, primary 10050 Encephalitis, post chickenpox 10070 Encephalitis, post mumps 10080 Encephalitis, post other 10090 Gonorrhea 10280 Hepatitis A 10110 Hepatitis B 10100 Hepatitis non-A, non-B 10480 Hepatitis, unspecified 10120 Legionellosis 10490 Leprosy (Hansen disease) 10380 Leptospirosis 10390 Malaria 10130 Measles, imported 10510 Measles, indigenous 10500 Meningococcal infection 10150 Mumps 10180 Pertussis 10190 Plague 10440 Poliomyelitis, paralytic 10410 Psittacosis 10450 Rabies, animal 10340 Rabies, human 10460 Rheumatic fever 11050 Rocky Mountain spotted fever 10250 Rubella 10200 Salmonellosis 11000 Shigellosis 11010 Syphilis, primary and secondary 10310 Tetanus 10210 Toxic-shock syndrome 10520 Trichinosis 10270 Tuberculosis 10220 Tularemia 10230 Typhoid fever 10240 Typhus murine 10260 These five-digit codes are similar to the three-digit codes presently used for reporting notifiable diseases to the MMWR. These codes, although not universally used, are easier and simpler to use than universal coding schemes, such as ICD-9. Note that some events are represented by more than one code (botulism, encephalitis, hepatitis, measles, sexually- transmitted diseases). Selection of more than one event will be possible in a future enhancement of this file in WONDER, such as ALL measles, ALL hepatitis, ALL sexually- transmitted diseases. Selection of an event which produces the message "There were no cases found with these criteria" should be interpreted as no cases reported. Selection of an event will sometimes produce a message that the event is not notifiable in some states. This information can be verified by reference to the MMWR "Summary of Notifiable Diseases," in the table of reported cases by geographic division and area. State and County Codes Coding for States and counties is based on Federal Information Processing Standards (FIPS). This scheme designates a two-digit code for each State based on alphabetical order and a three-digit code for each county generally using odd numbers to allow for the addition of new counties. The code for unknown county is 999. Distributions for the United States include Washington, D.C. and New York City as separate reporting areas. Selection of the State of New York will EXCLUDE New York City. Territories (American Samoa, Guam, Commonwealth of the Northern Mariana Islands, Puerto Rico, and the Virgin Islands) can be selected separately. Selection of a group of states or territories will be possible in a future enhancement of this file in WONDER. Counties reporting zero (0) or less than four (4) cases are not shown. Age Groups Selection by age group will provide distributions from all individual case records. Distributions may not equal total cases reported for the event if some states reported aggregate counts. Gender Selection by gender will provide distributions from all individual case records. Distributions may not equal total cases reported for the event if some states reported aggregate counts. Race/Ethnicity Selection by race/ethnicity will provide distributions from all individual case records. Distributions may not equal total cases reported for the event if some states reported aggregate counts. MMWR Week The weekly report of notifiable diseases covers the week preceding the report's publication. The week begins Sunday and ends on Saturday. The case count for MMWR week represents cases reported and entered into the State's surveillance system during the current reporting week. A week-ending calendar is published by the Division of Surveillance and Epidemiology, EPO, CDC, which is available through the help facility for MMWR week in WONDER. BACKGROUND INFORMATION In 1878 an Act of Congress authorized the 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 collection of information on a weekly basis from state and municipal authorities throughout the United States, and gradually an increasing number of states submitted monthly and annual summaries to the Public Health 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. Responsibility for collecting the weekly data on the notifiable diseases and publishing them in the "Morbidity and Mortality Weekly Report" (MMWR) and the annual "Summary of Notifiable Diseases" resides in the Epidemiology Program Office at CDC. Up until the early 1980's, weekly reports of aggregate counts of the notifiable diseases were made by State health departments to CDC by telephone. However, in 1984 the Epidemiologic Surveillance Project (ESP) was initiated by CDC and the State Epidemiologists in Colorado, Michigan, Minnesota, New York, Washington, and Wisconsin to demonstrate the feasibility of transmitting disease surveillance data electronically from State health department computer systems to the CDC. From those beginnings ESP has steadily grown so that now all of the States, New York City, the District of Columbia, and Puerto Rico are participating, and the name was changed to NETSS to reflect its nationwide scope. Three concepts were integral to the initial design of this system. First, each State health department could continue to use its existing computerized disease surveillance system to transmit data to CDC. Second, specific data concerning each case of a reportable disease would be transmitted to CDC. Finally, these computerized case records would supplant the States' weekly telephone reporting to the NNDSS. This is the system that provides the information that is published in Tables 1 and 2 of the MMWR. Disease surveillance systems vary widely from State to State. The diseases under surveillance, the reporting sources and the size of the systems may differ. NETSS was designed to allow States to use their existing disease databases as much as possible. These State systems have implemented their systems on a variety of computers using different programs and data formats. In October 1991, thirty-eight reporting areas are using a software package called Epi Info for their surveillance system. This is an epidemiologic data base and analysis system that has been developed and supported by the Division of Surveillance and Epidemiology of the Epidemiology Program Office at CDC. In some States CDC has provided technical support. Such support has been limited to consultation regarding system implementation and in some cases 3 to 5 days of onsite technical assistance to computerize their surveillance system. In general, similar steps are followed by all States currently participating in NETSS. 1. Data are reported to the State health department from county health departments, hospitals, physicians, and laboratories. These data are entered into the State/county computer and analyzed for local needs. 2. Weekly, a program is run against the State surveillance data base that selects the records to be transmitted to CDC and converts the record format and codes from the State conventions to the NETSS report format. A subfile of the selected records, in the NETSS format, is created. 3. Most of the State reports are transmitted through the Public Health Network on BT North America (known by users as Dialcom). 4. An electronic mail message containing the weekly NETSS file is sent to the CDC mailbox in Dialcom. 5. CDC staff reads these messages, uploads the data to the CDC mainframe computer, edits it, and then updates the NETSS master database. 6. Each week a summary report is sent to each State describing the number of records transmitted, the number of new records, updates, and records deleted. In addition, coding errors are indicated and a year-to-date summary of the State's reports is included. 7. Should corrections be necessary the State retransmits the correct data and the incorrect record is revised. NETSS data are summarized and published weekly in the MMWR and more extensive analyses are included in the MMWR annual summary.
