Hysterectomy surveillance - United States, 1994-1999: Problem/Condition: Hysterectomy is the second most frequently performed surgical procedure, after cesarean section, for women of reproductive age in the United States. Approximately 600,000 hysterectomies are performed annually in the United States, and approximately 20 million U.S. women have had a hysterectomy. Reporting Period Covered: This report covers data from 1994 through 1999 Description of System: Estimates of the population of U.S. female, civilian residents were used to compute rates for this study. Population denominators were obtained from the U.S. Bureau of the Census. The National Hospital Discharge Survey (NHDS) was the data source for this report. NHDS is conducted by CDC's National Center for Health Statistics. NHDS is an annual, multistage probability sample of short-stay patients (those hospitalized <30 days) discharged from nonfederal hospitals in the United States. Results and Interpretation: From 1994 through 1999, an estimated 3,525,237 hysterectomies were performed among U.S. women aged >15 years, and the overall hysterectomy rate for U.S. female, civilian residents was 5.5 per 1,000 women. Although statistically significant increases for hysterectomy rates were observed from 1994 (5.1/1,000) through 1998 (5.8/1,000), the increase was limited and the curve remained nearly flat. Women aged 40-44 years had a significantly higher hysterectomy rate compared with any other age group. During the study period, 52% of all hysterectomies were performed among women aged <44 years. In addition, hysterectomy rates per 1,000 in women aged 45-54 years increased significantly, from 8.9 in 1994 to 10 in 1999. The overall hysterectomy rate for women living in the South was 6.5 per 1,000, which was significantly higher than the rate among women who lived in either the Northeast (4.3) or the West (4.8) but not significantly higher than the rate among women who lived in the Midwest (5.4). Uterine leiomyoma, endometriosis, and uterine prolapse were the most frequent diagnoses for women aged >15 years. The percentage of uterine leiomyoma as a primary diagnosis for hysterectomy increased 10.2% for white women, 7.8% for black women, and 23% for women of other races. Among women who had a hysterectomy during the study period, 55% also had a bilateral oophorectomy. The proportion of all vaginal hysterectomies with concomitant laparoscopy (LAVH) increased significantly, from 13% in 1994 to 28% in 1999. During this same period, the percentage of cases of LAVH with concomitant bilateral oophorectomy increased significantly, from 20.4% in 1994 to 42.5% in 1999. Public Health Actions: Continued monitoring of hysterectomy trends will be necessary to evaluate differences in hysterectomy rates by age, most commonly associated diagnoses, whether leiomyomata as a primary discharge diagnosis continues to increase, and whether the increase in LAVH that occurred during the previous decade continues.

Malaria surveillance - United States, 2000: Problem/Condition: Malaria is caused by four species of intraerythrocytic protozoa of the genus Plasmodium (i.e., P. falciparum, P. vivax, P. ovale, or P. malariae). Malaria is transmitted by the bite of an infective female Anopheles sp. mosquito. The majority of malaria infections in the United States occur among persons who have traveled to areas with ongoing transmission. In the United States, cases can occur through exposure to infected blood products, by congenital transmission, or locally through mosquitoborne transmission. Malaria surveillance is conducted to identify episodes of local transmission and to guide prevention recommendations for travelers. Period Covered: Cases with onset of illness during 2000. Description of System: Malaria cases confirmed by blood smear are reported to local and state health departments by health-care providers or laboratory staff. Case investigations are conducted by local and state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System (NMSS). Data from NMSS serve as the basis for this report. Results: CDC received reports of 1,402 cases of malaria with an onset of symptoms during 2000 among persons in the United States or one of its territories. This number represents a decrease of 9.0% from the 1,540 cases reported for 1999. P. falciparum, P. vivax, P. malariae, and P. ovale were identified in 43.6%, 37.2%, 4.8%, and 2.3% of cases, respectively. Nine patients (0.6% of total) were infected by >2 species. The infecting species was unreported or undetermined in 161 (11.5%) cases. Compared with 1999, the number of reported malaria cases acquired in Africa decreased by 13.1% (n = 783), and a decrease of 3.3% (n = 238) occurred in cases acquired in Asia. Cases from the Americas decreased by 1.1% (n = 271) from 1999. Of 825 U.S. civilians who acquired malaria abroad, 190 (23.0%) reported that they had followed a chemoprophylactic drug regimen recommended by CDC for the area to which they had traveled. Four patients became infected in the United States, two through congenital transmission and two through probable induced transmission. Six deaths were attributed to malaria, four caused by P. falciparum, one caused by P. malariae, and one by P. ovale. Interpretation: The 9.0% decrease in malaria cases in 2000, compared with 1999, resulted primarily from decreases in cases acquired in Africa and Asia. This decrease could have resulted from local changes in disease transmission, decreased travel to these regions, fluctuation in reporting to state and local health departments, or an increased use of effective antimalarial chemoprophylaxis. In the majority of reported cases, U.S. civilians who acquired infection abroad were not on an appropriate chemoprophylaxis regimen for the country in which they acquired malaria. Public Health Actions: Additional information was obtained concerning the six fatal cases and the four infections acquired in the United States. Persons traveling to a malarious area should take one of the recommended chemoprophylaxis regimens appropriate for the region of travel, and travelers should use personal protection measures to prevent mosquito bites. Any person who has been to a malarious area and who subsequently develops a fever or influenza-like symptoms should seek medical care immediately and report their travel history to the clinician; investigation should include a blood-film test for malaria. Malaria infections can be fatal if not diagnosed and treated promptly. Recommendations concerning malaria prevention can be obtained from CDC by calling the Malaria Hotline at 770-488-7788 or by accessing CDC's Internet site at http://www.cdc.gov/travel.