TABLE 2p. Annual reported cases* of notifiable diseases, by region and reporting area, United States, U.S. Territories, and Non-U.S. Residents, 2021^† column labels in same order that data fields appears in each record below: Reporting Area Spotted fever rickettsiosis, Total Spotted fever rickettsiosis, Confirmed Spotted fever rickettsiosis, Probable Streptococcal toxic shock syndrome Syphilis, Total, all stages ^§ Syphilis, Congenital ^¶ Syphilis, Primary and secondary tab delimited data: U.S. Residents, excluding U.S. Territories 1,257 43 1,214 145 174,367 2,820 53,034 New England 10 1 9 31 3,779 18 1,416 Connecticut 4 — 4 14 865 6 323 Maine 2 — 2 14 135 — 61 Massachusetts 2 1 1 3 2,051 9 741 New Hampshire — — — — 145 — 73 Rhode Island 1 — 1 — 567 2 209 Vermont 1 — 1 — 16 1 9 Middle Atlantic 60 3 57 7 20,310 103 5,718 New Jersey 39 2 37 4 3,389 48 908 New York (excluding New York City) 10 — 10 2 3,121 17 1,272 New York City 3 — 3 — 9,984 24 2,228 Pennsylvania 8 1 7 1 3,816 14 1,310 East North Central 78 6 72 17 15,348 178 5,698 Illinois 21 2 19 3 5,124 50 1,486 Indiana 16 1 15 9 1,980 20 734 Michigan 6 3 3 2 2,671 42 972 Ohio 30 — 30 3 3,958 51 1,783 Wisconsin 5 — 5 — 1,615 15 723 West North Central 142 4 138 10 8,312 118 3,191 Iowa 4 — 4 N 763 11 339 Kansas 22 1 21 1 803 7 301 Minnesota 3 — 3 4 1,465 15 565 Missouri 102 1 101 5 3,780 66 1,316 Nebraska 5 1 4 — 471 1 185 North Dakota — — — — 106 2 49 South Dakota 6 1 5 — 924 16 436 South Atlantic 360 14 346 33 34,163 374 10,431 Delaware 19 1 18 — 295 1 129 District of Columbia — — — — 870 6 257 Florida 9 1 8 N 16,438 180 4,498 Georgia 25 1 24 10 6,711 93 1,884 Maryland 14 — 14 — U U U North Carolina 185 6 179 18 5,029 42 1,870 South Carolina 23 1 22 1 2,079 19 836 Virginia 73 4 69 2 2,205 18 745 West Virginia 12 — 12 2 536 15 212 East South Central 368 7 361 5 9,515 165 3,055 Alabama 123 3 120 N 2,172 37 761 Kentucky 96 1 95 5 1,558 25 513 Mississippi 31 — 31 N 2,605 64 829 Tennessee 118 3 115 — 3,180 39 952 West South Central 204 5 199 — 30,362 925 7,075 Arkansas 169 4 165 — 2,403 50 990 Louisiana 6 — 6 — 3,480 110 995 Oklahoma 19 — 19 N 3,003 85 1,225 Texas 10 1 9 N 21,476 680 3,865 Mountain 23 1 22 42 14,836 316 4,818 Arizona 16 1 15 — 6,330 181 1,982 Colorado 2 — 2 — 2,303 30 772 Idaho 2 — 2 1 270 5 84 Montana 2 — 2 1 225 9 96 Nevada 1 — 1 17 3,065 45 939 New Mexico — — — — 2,069 44 724 Utah — — — 23 531 2 205 Wyoming — — — — 43 — 16 Pacific 12 2 10 — 37,742 623 11,632 Alaska N N N N 447 5 194 California 8 1 7 N 31,276 518 8,724 Hawaii N N N — 643 20 259 Oregon 2 1 1 N 2,010 27 949 Washington 2 — 2 N 3,366 53 1,506 U.S. Territories — — — — 1,198 10 341 American Samoa N N N N — — — Commonwealth of Northern Mariana Islands — — — — 2 — — Guam N N N — 22 1 7 Puerto Rico N N N N 1,132 9 332 U.S. Virgin Islands — — — — 42 — 2 Non-U.S. Residents — — — — 25 — 6 Total 1,257 43 1,214 145 175,590 2,830 53,381 —: No reported cases - The reporting jurisdiction did not submit any cases to CDC. N: Not reportable - The disease or condition was not reportable by law, statute, or regulation in the reporting jurisdiction. U: Unavailable - The data are unavailable. * Cases are assigned to the reporting jurisdiction submitting the case to NNDSS if the case's country of usual residence is the United States, a U.S. territory, unknown, or country is not reported; otherwise, the case is assigned to the Non-U.S. Residents' category. Country of usual residence is currently not reported by all jurisdictions or for all conditions because this data element is only available in the HL7 generic version 2 and disease-specific message mapping guides. If a jurisdiction sends data in legacy formats, they are not able to send this information. For further information on interpretation of these data, see https://www.cdc.gov/nndss/data-statistics/readers-guides/. † To calculate rates, use the populations provided in Table 8. Note that calculation of rates for the following conditions uses population subgroups as described in note #7 and population counts presented in Table 8: Zika virus infection, congenital; Zika virus disease, congenital; Infant botulism; Congenital rubella syndrome; Perinatal Hepatitis B infection; Perinatal Hepatitis C infection; Haemophilus influenzae, invasive disease; Invasive pneumococcal disease; and Influenza-associated pediatric mortality. Also see Notes #3 and #7. § Includes the following categories: primary; secondary; early non-primary non-secondary (includes cases previously reported as early latent); unknown duration or late (includes cases previously reported as late latent syphilis and cases previously reported as late syphilis with clinical manifestations) and congenital syphilis. ¶ Congenital syphilis cases are usually assigned to the mother's state of residence at the time of delivery. Data for congenital syphilis are aggregated by the infant's year of birth. Notes: These are annual cases of selected infectious national notifiable diseases from the National Notifiable Diseases Surveillance System (NNDSS). NNDSS data reported by the 50 states, New York City, the District of Columbia, and the U.S. territories are collated and published. Cases are reported by state health departments to CDC weekly. Because source datasets may be updated as additional information is received, statistics in publications based on that source data may differ from what is presented in these tables. Source datasets for the 2021 annual tables were officially closed on March 29, 2023. The list of national notifiable Infectious diseases and conditions for 2021 and their national surveillance case definitions are available by navigating to the https://ndc.services.cdc.gov/, Surveillance Case Definitions | CDC web page, selecting "2021" for the notifiable condition list year, checking "Infectious" conditions, and clicking "Get Notifiable List by Year". CSTE adopted the first coronavirus disease 2019 (COVID-19) national surveillance case definition on April 5, 2020, and they approved a revision to the COVID-19 national surveillance case definition, effective August 5, 2020. On June 17, 2021, a revision to the COVID-19 national surveillance case definition was approved, effective September 1, 2021. Publication criteria for the finalized 2021 data are available at https://wonder.cdc.gov/nndss/documents/2021_NNDSS_Publication_Criteria_06072023.pdf, https://wonder.cdc.gov/nndss/documents/2021_NNDSS_Publication_Criteria_03162022.pdf. See also https://www.cdc.gov/nndss/data-statistics/readers-guides/index.html, Guide to Interpreting Provisional and Finalized NNDSS Data. Population estimates for incidence rates are July 1st, 2020, estimates obtained from the National Center for Health Statistics (NCHS) postcensal estimates of the resident population of the United States for April 1, 2010, to July 1, 2020, by year, county, single year of age (range: 0 to 85 years), bridged-race (white, black or African American, American Indian or Alaska Native, Asian, or Pacific Islander), Hispanic ethnicity (not Hispanic or Latino, Hispanic or Latino), and sex (Vintage 2020), prepared under a collaborative arrangement with the U.S. Census Bureau. Population estimates for states released September 22, 2021, are available at https://www.cdc.gov/nchs/nvss/bridged_race/data_documentation.htm, https://www.cdc.gov/nchs/nvss/bridged_race/data_documentation.htm. Population estimates for territories are the 2020 mid-year estimates from the U.S. Census Bureau International Data Base, accessed on March 15, 2022, at https://www.census.gov/data-tools/demo/idb/#/country?YR_ANIM=2022, https://www.census.gov/data-tools/demo/idb/#/country?YR_ANIM=2022. The choice of population denominators for incidence is based on the availability of population data at the time of publication preparation. Annual tables for 2016 and later years are available on https://wonder.cdc.gov/nndss/nndss_annual_tables_menu.asp, CDC WONDER. Annual summary reports from 1993–2015 are available as published in the https://www.cdc.gov/mmwr/mmwr_nd/index.html, Morbidity and Mortality Weekly Report. NNDSS annual tables since 1952 are available at https://stacks.cdc.gov/nndss, CDC Stacks (once in CDC Stacks, select "Annual Reports" in the "Genre" box to the left). For most conditions, national incidence rates are calculated as the number of reported cases for each infectious disease or condition divided by the U.S. resident population for the specified demographic population or the total U.S. resident population, multiplied by 100,000. When a national notifiable infectious condition is associated with a specific age restriction, the same restriction was applied to the population in the denominator of the incidence rate calculation. In addition, population data from reporting jurisdictions in which the disease or condition was not reportable or not available were excluded from the denominator of the incidence rate calculations. Age restrictions in the numerator and denominator are applied for the following childhood conditions: Zika virus disease, congenital (age restriction in numerator and denominator is <1 year) Zika virus infection, congenital (age restriction in numerator and denominator is <1 year) Haemophilus influenzae, invasive disease <5 years (age restriction in numerator and denominator is <5 years) Invasive pneumococcal disease <5 years (age restriction in numerator and denominator is <5 years) Influenza associated pediatric mortality (age restriction in numerator and denominator is <18 years) Infant botulism (age restriction in numerator and denominator is <1 year) Congenital rubella syndrome (age restriction in numerator and denominator is <1 year) Perinatal hepatitis B infection (age restriction in numerator and denominator is ≤24 months) Perinatal hepatitis C infection (age restriction in numerator and denominator is ≤36 months). Data for congenital syphilis are aggregated by the infant's year of birth. The rate for congenital syphilis is based upon the number of reported cases per 100,000 live births, using natality data for 2021 (National Center for Health Statistics https://wonder.cdc.gov/natality.html, Natality 2021, as compiled from data provided by the Vital Statistics Cooperative Program). Congenital syphilis cases are usually assigned to the mother's state of residence at the time of delivery. The mother's race and ethnicity are used for race- and ethnicity-specific rates of congenital syphilis cases. Surveillance data reported by other CDC programs might vary from data reported in these tables because of differences in 1) the date used to aggregate the data, 2) the timing of reports, 3) the source of the data, 4) surveillance case definitions, and 5) policies regarding case jurisdiction (i.e., which jurisdiction should submit the case notification to CDC). Disease data presented in the 2021 tables reflect impacts of the COVID-19 pandemic, such as changes in exposure-related behavior, healthcare-seeking behavior, disease reporting, and public health investigations. Suggested Citation: Centers for Disease Control and Prevention. National Notifiable Diseases Surveillance System, 2021 Annual Tables of Infectious Disease Data. Atlanta, GA. CDC Office of Public Health Data, Surveillance, and Technology, 2024. Available at: https://www.cdc.gov/nndss/data-statistics/infectious-tables/index.html, https://www.cdc.gov/nndss/data-statistics/infectious-tables/index.html. Acknowledgment: CDC acknowledges the local, state, and territorial health departments that collected the data from a range of case ascertainment sources (e.g., healthcare providers, hospitals, laboratories) and reported these data to CDC's National Notifiable Diseases Surveillance System. https://www.cdc.gov/nndss/, National Notifiable Diseases Surveillance System Provided by https://wonder.cdc.gov, CDC WONDER