'' ''_ILLNESS AMONG INDIANS JAND ALASKA NATIVES 1970 to 1978 INDIAN HEALTH SERVICE Emery A. Johnson, M.D., Director Joseph N. Exendine, Dr. P.H., Deputy Director DIVISION OF RESOURCE COORDINATION Donald Swetter, M.D., Director OFFICE OF PROGRAM STATISTICS Mozart 1. Spector, Director VITAL EVENTS BRANCH Aaron O. Handler, Chief U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service U.S Health Services Administration / Indian Health Service Division of Resource Coordination , oF Office of Program Statistics DHEW Pubtlication™No- HSA) 79-12040 , ''(be Ga GG owe] — . ''RA 408 049 U54 919.0 FOREWORD PUBL Information reflecting the relative occurrence of diseases is an effective yardstick for measuring not only the current health status, but also the past as well as the future health horizons of any popula- tion. This is especially true of the Indian and Alaska Native populations for which the U.S. Pub- lic Health Service, through its Indian Health Serv- ice component, has responsibility for the provision of comprehensive health care. This information, together with various demographic variables, allows for logical planning of medical care facilities and competent evaluation of present and past programs. Problem areas meriting special attention and areas of significant accomplishments are brought out by the study of specific diseases, some of which are unique to the Indian and Alaska Native population. This report summarizes notifiable disease data for calendar years 1970-78. Data for the 9-year period are included to show trends in various diseases as well as to offer a quick reference source for program planning and evaluation. A brief de- scription of the demographic characteristics of the Indian and Alaska Native population is included as well. Wherever possible, comparisons are made with data for the general population, as derived from data furnished by the Center for Disease Control of the Public Health Service. However, certain additional diseases not reported nationally are included in this report because of their relatively greater impor- tance among Indians and Alaska Natives. A number of employees of the Indian Health Service contributed to the production of this pub- lication. Its content and format were designed by Aaron Handler, Chief, Vital Events Branch. Popu- lation estimates used for the computation of rates were prepared under the direction of Gaile Maller, Chief, Population Statistics Branch. Clerical sup- port for these two branches were provided by Dorothy Graham and Marilyn Tulsa, respectively. Mr. Handler reviewed the report’s copy prepara- tion and printing. Mozart I. Spector, Director, Office of Program Statistics, provided general di- rection throughout the entire publication process. Lo Emery A. Johnson, M.D. Assistant Surgeon General Director, Indian Health Service iii 202479 '' ''TABLE OF CONTENTS Page Foreword _...---.-----_--__-_______------2 ee 7 iii Introduction -____------------------------------- b.}---------..--- 1 The IHS Indian and Alaska Native Service Population ~__.--_-_- 1 Leading Notifiable Diseases ~------------2-----------+--+-~----- 2 Otitis Media _____---_------------------------------------------- 3 Strep Throat ________-___-_____.------- eee a 4 Intestinal Infectious Diseases --....----.------------------------ 4 Impetigo ___---___----------------------------------------__---- 4 Respiratory Diseases __-___--_-_----------.----------------_____- 5 Venereal Diseases _._-.------------------------------------------ 5 Childhood Diseases -_-__.---------------------------------------- 6 Chickenpox __.__.--_---------------------------------------- 6 Mumps ___-_-_----------------------------------------__---- 6 Measles ___------------------------------------------------- 6 Trachoma __---------------------------------------------------- 6 Tuberculosis ~--------------------------------------------------- 7 '' ''Table A. Table B. Table C. Table D. Table E. Table F. Table G. Table H. Table I. Table J. Table K. Table ‘L. TEXT TABLES AND FIGURE Percent Distribution of the Population by Age and Sex, Indians and Alaska Natives Residing in the IHS Serv- ice Area and U.S. All Races, 1970 .__________________ Rank Order of Rates of Twenty Leading Reported New Cases of Notifiable Diseases in 1978 Among Indians and Alaska Natives and These Diseases for Each Year 1970-1978 ______--___-_----_ eee Rate and Percent Change In Rates for Twenty Leading Notifiable Disease Categories Among Indians and Alaska Natives, 1970 and 1978_______-______-____-- Number of New Cases of Twenty Leading Notifiable Diseases and Percent Within Each Disease Category That Were Pediatric or Adult, Indians and Alaska Natives, 1978 ___________________-_-__-__--- Rates of Reported New Cases of Otitis Media Among Indians and Alaska Natives and Annual Percent Change by Indian Health Service Area and Program Office, 1970-1978 ___---------------------------------- Rates of Reported New Cases of Strep Throat Among Indians and Alaska Natives for Selected Indian Health Service Areas, 1978 .______-____---------------------- Rates of Reported New Cases of Selected Intestinal In- fectious Diseases Among Indians and Alaska Natives and Annual Percent Change, 1970-1978 ._____________-_ Percent Distribution of Reported New Cases of Gastro- enteritis Among Indians and Alaska Natives by Age, 1970-1978 ___________-_--_____----------------------- Rates of Reported New Cases of Impetigo Among In- dians and Alaska Natives for Selected Indian Health Service Areas, 1970-1978 _________________------------ Percent Distribution of Reported New Cases of Im- petigo Among Indians and Alaska Natives by Age, 1972-1978 _______________-----. e+ +++ Indian Health Service Areas or Program Offices with the Two Highest Rates of New Cases of Influenza and Pneumonia, 1970-1978 .________----_----------------- Percent Distribution of Reported New Cases of In- fluenza and Pneumonia Among Indians and Alaska Natives by Age, 1970-1978_________-_----------------- Page 10 10 11 11 12 12 13 vii ''Table M. Table N. Table O. Table P. Rates of Reported New Cases of Venereal Diseases Among Indians and Alaska Natives and the United Sinton, All Races, 1966-1978 22 Percent Distribution of Reported New Cases of Vene- real Diseases Among Indians and Alaska Natives by OO VPRO OLOT 8. so ee a Percent Distribution of Reported New Cases of Tra- choma Among Indians and Alaska Natives by Age, OPOMONRS 2 eee ee Rates of Reported New Cases of Tuberculosis Among Indians and Alaska Natives and the United States Pop- ulation by Race; 1955-1978." APPENDIX TABLES AND FIGURES Table 1. Table 2. Table 3. Table 4. Table 5. Figure A. Figure B. Figure C. viii Number of Reported New Cases of Notifiable Diseases by Indian Health Service Area and Program Office, Bach. Calendar Year 1970-1978. _....-2- ee so se Rates of Reported New Cases of Notifiable Diseases by Indian Health Service Area and Program Office and U.S. All Races, Each Calendar Year 1970-1978_______ Number of Reported New Cases of Notifiable Diseases by Month Among IHS Service Population, Each Calen- dare vear 1970-1978 -. 3. ioe Number of Reported New Cases of Notifiable Diseases by Age Among IHS Service Population, Each Calendar Wear 1070-108 =e Total Estimated Notifiable Disease Population by Area and Program Office, Calendar Years: 1965-1978 _______ HSA-406, Ambulatory Patient Care Report __________ HSM-134, Monthly Report on New Cases of Notifiable WDINGASC Sis 33 ete FS ek a HSM-44-1, Clinical Record Brief, IHS Patient Services Page 15 15 16 16 Page 17 26 35 44 53 54 56 58 ''Illness Among Indians and Alaska Natives 1970-1978 INTRODUCTION The absence of disease or infirmity does not in it- self constitute a healthy person or population. Health is also a state of social well-being. Therefore the cultural values of the Indian and Alaska Na- tive people are considered in the development of a total package of preventive, curative and rehabilita- tive services. Environmental hazards and the lack of adequate sanitation facilities and limited safe wa- ter supplies are conducive to the spread of infectious diseases. These must also be considered in the evolution of a total health care delivery system. Morbidity from “childhood” diseases among the American Indian and the Alaska Native populations is unusually high, especially from otitis media, in-' fluenza, pneumonia, dysenteries and gastroenteritis, streptococcal infections, chickenpox, mumps, and their associated complications. Thus the health care delivery system of the Indian Health Service has taken these requirements into account in the de- velopment of a comprehensive health care delivery system. Through the implementation of special programs for specific diseases like trachoma and otitis media and the intensification of immunization programs, the health gap between the United States general population and the Indian and Alaska Native popu- lation is being narrowed. A better understanding by the Indian and Alaska Native people of the health aspects of day to day life is also playing a large part in the improvement shown throughout this report. This report summarizes data on the number of new cases of ‘notifiable diseases reported for Indians and Alaska Natives served by Indian Health Serv- ice (IHS) hospitals and clinics for calendar years 1970-1978. The statistics are based on information — for each patient visit reported on the “Ambulatory Patient Care Report”, HSM-406 (Appendix Figure A); the “Monthly Report on New Cases of Noti- fiable Diseases”, HSM-134 (Appendix Figure B) used by selected facilities in Aberdeen Area and Bemidji Program Office; and the Clinical Record Brief”, HSM-44-1 (Appendix Figure C). These forms are submitted by hospitals, health centers and other | field facilities operated by the Indian Health Service, and to a lesser extent by facilities and individual physicians under contract. Disease categories presented in this publication (termed “notifiable diseases”) include those which are reported to the Center for Disease Control (CDC) of the Public Health Service, DHEW, as part of its disease surveillance program. Additional di- sease categories which may be reported optionally to CDC as well as those of specific interest among the American Indian population are also included. The Indian Health Service (IHS) is divided ad- ministratively into 8 Areas and 4 Program Offices. Indian people residing in California served by the IHS are included in reports of the Phoenix Area. Data for the Bemidji Program Office were included in those for the Aberdeen Area prior to 1973. Similar reports entitled “IlIness Among Indians” have been published by the Indian Health Service for calendar years 1955, 1960, for each year 1962- 1967 and for the 5-year period 1965-1969. _ THE IHS INDIAN AND ALASKA NATIVE SERVICE POPULATION In calendar year 1978 an estimated 678,000 In- dian and Alaska Native people were served by the Indian Health Service. Of this number, about 69,000 were Aleuts, Eskimos, and Indians of Alaska, collectively known as Alaska Natives. The other 609,000 were Indians living on or near the more than 250 Federal Indian reservations scat- tered throughout the States, most of which are west of the Mississippi River. In computing Indian and Alaska Native rates for reported cases of noti- fiable diseases, the population base is the estimated service population less those few residing in parts of Aberdeen Area and Bemidji Program Office (only 1.0 percent of the IHS service population in calendar year 1978) who were not covered by the notifiable disease reporting forms. ''In many of its characteristics the Indian and Alaska Native population served by the Indian Health Service differs markedly from the general population of the United States. These differences, such as employment status, size of family, educa- tional attainment, type of housing, and median age, should be considered when comparisons are made with data for other population groups. There also exists a large mass of cultural, transitional and. social differences between the Indian population and other population subgroups of the United States. The most striking difference is in the age distri- bution of the Indian population. Table A shows the percent distribution by age and sex in 1970 for the U.S. general population and the Indian and Alaska Native population residing in the IHS service area. Forty-two percent of the Indian and Alaska Native service population was under 15 years of age in 1970. In the general population this age group ac- counted for approximately 28 percent of the total in 1970. The median age for the Indian and Alaska Native service population was 18.4 years in 1970 as compared to 28.1 years for the general U.S. popula- tion. The comparatively high rate of new cases of childhood diseases among Indians and Alaska Natives is explained, at least in part, by the higher propor- tion of children in this population. Therefore, just to keep the new case rates among Indians and Alaska. Natives constant, considerable energy and resources must be expended in the provision of health care to the American Indian and Alaska Native population. Another type of difference between the two popu- lations is the wide diversity of ways in which “noti- fiable diseases” are reported in the general popula- tion to the U.S. Center for Disease Control (CDC), compared with the highly standardized manner in which notifiable disease data are reported to the IHS. Various forms, procedures and key personnel are involved in the CDC reporting operation, where- as only three forms, the Ambulatory Patient Care Form, the Monthly Report on New Cases of No- tifiable Diseases, or the Clinical Record Brief (Ap- pendicies A, B and C) are used throughout Indian Health Service hospitals and clinics. As a result of this standardization of data collection for noti- fiable disease reporting throughout the IHS, the number of new cases reported by IHS may be more complete than such counts reported to CDC by other authorities. Estimates of the American In- dian and Alaska Native population covered by the notifiable disease statistics in this report for calen- dar years 1970 through 1978 appear in Table 5. “2 LEADING NOTIFIABLE DISEASES The 20 most frequently reported diseases among Indians and Alaska Natives for calendar year 1978 appear along with their rank. 1970-1978 in Table B. For each of the 9 years covered by this report, otitis media has been the leading cause of morbidity. In 1971, strep throat, scarlet fever replaced gastro- enteritis as the second leading cause. In each of the following 6 years, gastroenteritis and strep throat ranked 2 and 8, respectively. In 1978 these positions reversed when strep throat once again became the second leading disease category. Starting in 1972 data for strep throat and scarlet fever were collected and tabulated separately. This change has had no effect on the ranking of leading notifiable diseases since there has been fewer than 60 new cases of scarlet fever reported during each of these years except for 1978 (108 new cases). Data for impetigo were first collected in 1972. It ranked in fifth position in 1972 and 1973 and in fourth position for each year thereafter. Noticeable im- provements in ranked positions (a drop of 5 posi- tions or more) since 1970 for the population of all ages have occurred for trachoma, mumps, and measles, partly as a result of immunizations, early detection, and treatment provided by IHS. Consid- erable shifting in the rankings of scabies since 1972 is evidenced by sharp increases in reported disease rates for this cause during this 6-year period. : The rates for the 20 major diseases throughout IHS for calendar year 1978 are shown in Table C. Otitis media was the number one reportable disease for each Area or Program Office except Tucson, where it ranked 12. There were only 27 new cases of otitis media reported for Tucson in 1978. Most Areas and Program Offices were constant in their rankings of the 10 leading diseases shown in Table B, except for the relatively few gastroenteritis cases that Alaska, Bemidji and Phoenix experienced. In the Tucson Program Office, scabies ranked 3 and chickenpox ranked 7 in 1978. Table C shows that of the 20 leading notifiable diseases in 1978, the disease rates for scabies had a large percent increase since 1972 (the year in which this disease category was first tabulated). Scabies has had a rapid increase in its rate per 100,000 population in the last 4 years. From 1972 and thereafter the rate of new cases of scabies per 100,000 population was as follows: 4.0, 6.5, 10.0, 52.6, 209.8, 375.38 and 494.2. This increase in the new case rate for scabies may par- tially be the result of an upswing of this disease which has been noted throughout the country and may partially be the result of an improvement in disease identification and reporting. (The entry for ''“scabies” is written-in on the APC form rather _than a separate box provided for this disease cate- gory—See Attachment A). Of the 20 leading no- tifiable diseases in 1978, reductions in their rates since 1970 occurred for only 7. These diseases and the percent reductions in their rates since 1970 were as follows: Measles (down 85 percent), Tra- choma (down 81 percent), Mumps (down 73 per- cent), Rubella (German Measles) (down 63 per- cent), Tuberculosis (down 57 percent), Syphilis, all forms (down 48 percent), and Influenza (down 17 percent). The majority of new cases for the leading causes of disease continue to occur to persons under 15 years of age. However, as shown in Table D, only 6 of the 20 leading reportable diseases (influ- enza, gonococcal infections, syphilis, all forms, rheu- matic fever, tuberculosis, and puerperal septicemia) had fewer than 50 percent of the new patient caseload under the age of 15 years. OTITIS MEDIA Otitis media is recognized as one of the most serious health problems among Indians and Alaska Natives. As a sensory disability, it involves an in- flammation of the middle ear which can lead to deafness. There is a strong relationship between otitis media and impoverished living conditions. The occurrence of otitis media is usually the result of upper respiratory infections. Crowded living condi- tions and poor nutrition increase the susceptibility of the Indian population to upper respiratory infec- tions and otitis media. A review completed in 1969 of middle ear disease among the Indian and Alaska Native population defined the population at greatest risk to otitis media as that group of children under the age of two. If the first attack occurs before the first birth- day, the risk of repeated attacks is greatly in- creased. In 1978, 25.1 percent of all new cases of otitis media reported were children under 1 year of age, 63.6 percent of all new cases reported were children below the age of 5 years. Some cases of otitis media can result in permanent damage such as badly scarred or punctured eardrums which require major reconstructive surgery. A more detailed description! of the onset of otitis media follows: -The primary pathologic process is a block- age of the eustachian tube resulting from an inflammatory process. The resultant negative pressure in the middle ear causes secretions (initially sterile) to accumulate. At this early stage otologic examination reveals a dull tym- panic membrane showing possible signs of mild inflammation. Characteristic symptoms, which increase in intensity with duration of illness, include intermittent or continuous earache, a feeling of fullness in the ear, fever and malaise, and sporadic hearing loss. With the invasion of virulent bacteria into the middle ear, acute suppuration soon occurs, and the eardrum ap- pears markedly abnormal in color and position. At this stage both severe throbbing pain and marked hearing loss are experienced. If pres- sure increases from pus accumulation, the ear- drum may rupture, discharging a mixture of blood and pus and relieving pain. If the infection is controlled at this stage, the inflammatory swelling of the eustachian tube normally sub- sides and symptoms disappear. In severe cases with recurrent attacks and inadequate care, a potentially destructive state of disease may develop—chronic suppurative otitis media—in which the eardrum is permanently perforated and dangerous complications become possible. Recurrent purulent discharge and residual hear- ing impairment of increasing severity are cardinal symptoms of this chronic stage. Since 1964, acute otitis media has ranked as the leading disease among Indians and Alaska Natives. In 1978, a total of 68,775 new cases were reported as compared with 44,008 new cases in 1970, a numerical increase of 56 percent. As Table E indi- cates, the rate of new cases of otitis media among Indian and Alaska Native people per 100,000 popu- lation increased from 9,745.0 in 1970 to 11,099.2 in 1978 (an increase of 14 percent). Four IHS Areas or Program Offices experienced significant declines in their otitis media morbidity rates between 1970 and 1978. These decreases were in Billings (down 47 percent), Tucson (down 40 percent), Bemidji (down 11 percent since 1973)? and Navajo (down 11 percent). Notable increases in the rates of new eases of otitis media per 100,000 population 1970- 1978 were observed for Alaska (up 66 percent), Oklahoma (up 57 percent) and Albuquerque (up 30 percent). Tucson and Oklahoma have had rela- tively low otitis media morbidity rates throughout the period 1970-1978, as compared with those of the other IHS Areas and Program Offices. In Fiscal Year 1971, Congress appropriated funds especially for an otitis media program. These funds, Middle Ear Infection and Associated Hearing Loss: Epi- demiology, Functional Impact and Plan for Medical Man- agement. Health Services Research Study, Institute of Medicine, National Academy of Sciences. Washington, D.C., February, 1972. * Data for the Bemidji Area Program Office included in those for the Aberdeen Area prior to 1973. ''further supported by allocations resulting from the President’s message, enabled the Indian Health Serv- ice to institute the type of program which was needed to bring this serious problem under control. Emphasis has been placed on taking care of the acute cases in an attempt to prevent the chronic stage at a latter date. Case finding and treatment measures were established with emphasis on con- trolling the infection in children under 2 years of age. Additional funds have been provided to per- form surgery to restore functional hearing. Screen- ing and treatment measures were made available to identify complications and after affects and to rehabilitate patients. Prior to 1971, the new case rate for otitis media per 100,000 population experienced an increasing trend. In 1962, the first year for which data were collected for the entire calendar year, the rate was 3,801.7 new cases per 100,000 population. With each year, except for 1965, the new case rate climbed higher. An expanded otitis media intervention program which IHS implemented in 1971 has curtailed this increasing trend. Since one of the objectives of the otitis media program was to carry out a case find- ing program, it is not surprising that the morbidity rate continued upward from 1971 to 1972. In fact, one would expect this to occur. Between 1972-1973 the number of new cases reported increased by 0.4 percent while the population served increased 2.0 percent. Thus the 1973 rate was reduced to 12,103.6 new cases per 100,000 population. This rep- resented a decrease in the new case rate of 1.5 per- cent from the 1972 level. Except for increases of 1.6 percent in the otitis media case rate 1976/ - 1975 and 6.2 percent during 1978/1977, the annual rate of new cases of otitis media per 100,000 popu- lation has declined from that of the previous year for 4 of the 6 years since 1972. STREP THROAT Strep throat ranked as the third most prevalent notifiable disease each year since 1972. In 1978 strep throat overtook gastroenteritis to become the second leading notifiable disease. The disease cate- gory ranked 3 in 1970 and 2 in 1971. Since 1970, the Area with the highest rate of new cases of strep throat per 100,000 population has been the Navajo Area. In fact, since 1970 the rate of new cases of strep throat per 100,000 ‘population for the Navajo Area has been about double that of the comparable rate for all IHS Areas and Pro- gram Offices combined, as presented in Table F. 4 Table F displays new case rates for strep throat for the 4 Areas with the highest rates 1970 to 1978. In 1971, 1972 and 1978, the Billings Area was the Area with the second highest strep throat rate; in 1973 and 1974, the Albuquerque Area held the second highest positions; and during the years 1975 to 1977, the Phoenix Area’s rate was second to the Navajo Area’s strep throat rate. INTESTINAL INFECTIOUS DISEASES Table G presents new case rates per 100,000 population for 7 intestinal infectious diseases. Gas- troenteritis has ranked as the second leading noti- fiable disease 1972-1977 and bacillary dysentery has ranked between 8 and. 12 (1970-1978) among the leading notifiable diseases. Within the intestinal infectious diseases category, only food poisoning and salmonellosis have shown declines in new case rates since 1970 (down 33 and 28 percents, respec- tively). However, gastroenteritis has experienced a 25 percent new case rate reduction since 1972, with rate reductions occurring in each year except for the period 1974-1975, when a 2.0 percent increase between annual new case rates occurred. The proportion of new cases of gastroenteritis among the various age categories has remained fair- ly constant between 1970 and 1978, as can be seen in Table H. About one-fourth of all cases each year (1970-1978) have been almost equally distributed among the 4 age groups: under 1, 1 to 4, 5 to 24, and 25 years or more. IMPETIGO Impetigo is a staphylococcal skin disease charac- terized by the appearance of pustules or skin lesions. If lesions are widespread, fever, malaise, headache or anorexia may develop. It generally occurs in areas where personal hygiene (especially the use of soap and water) is neglected and people are crowded. It occurs sporadically and as small epi- demics in families and summer camps, with various members developing recurrent illness due to the same staphylococcal strain. It may be transmitted through contact with a person who has the impetigo skin lesion or a person who has no signs of the disease (an asymptomatic nasal carrier of a patho- genic strain). Some carriers transmit the disease more effectively than do others. Whether the disease may be spread through contact with contaminated . toys or other objects or through airborne trans- mission has not been determined. There is a 4 to 10 day period of incubation before impetigo skin lesions appear. ''Information concerning the number of new cases of impetigo was first collected in 1972. In that year, impetigo was the fifth leading notifiable disease. Impetigo held the fifth position again in 1973 and has been the fourth leading notifiable disease since 1974. Navajo, Phoenix, and Tucson have experi- enced the 3 highest impetigo rates among the IHS Area and Program Offices each year since 1972, as shown in Table I. There has been some shifting in the age distribution of impetigo patients during the years 1972 to 1978, as indicated in Table J. The under 1 year category has remained relatively stable as a percent of all impetigo patients (be- tween 6 and 8 percent). There has been a slight downward shift in the 1 to 4 years of age group (from 42 percent in 1972 to 40 percent in 1978). The 5 to 9 years of age group has also had a down- ward shift in its age composition (from about 31 percent of the total in 1972 to about 26 percent in 1978). The 10 to 14 years of age group has re- mained relatively stable (roughly between 11 and 12 percent). There has been an upward shift in the 15 years or more age group (from 8 percent of all impetigo patients in 1972 to 13 percent of impetigo patients in 1978). RESPIRATORY DISEASES Pneumonia and influenza ranked 5 and 6, respec- tively, among notifiable diseases in 1978. Flu, or influenza, is an acute respiratory illness whose symptoms include fever, cough, sore throat, a “runny” nose, and general muscular aches. Most patients recover completely within a week, although many continue to feel unusually tired for some time. In the aged or the chronically ill, however, flu is a life-threatening illness. Together with pneumonia, it was the fifth leading cause of death in the gen- eral population of the United States in 1977 and the sixth leading cause of death among the Indian and Alaska Native population in that year. The IHS influenza new case rate per 100,000 population has fluctuated over the years as shown in Table K. During 1972-1978, U.S.E.T. and Navajo experienced the highest new case rates for in- fluenza for 6 of these 7 years (each one leading for 3 of these years). Since 1973, there was a gradual downward shift in the IHS-wide pneumonia new case rate from 3,624 new cases per 100,000 population in 1973 to 2,945 new'cases per 100,000 population in 1977. This rate increased to 3,197 in 1978. The Navajo Area had the highest pneumonia new case rate per 100,000 population for 7 of the 9 years between 1970 to 1978. Between 1970 and 1978, the age distribution of influenza patients has remained fairly constant and has closely approximated the age distribution of the IHS service population identified during the 1970 Census of Population as indicated in Table L. In contrast, between 55 and 60 percent of new pneu- monia cases, however, were reported for patients below the age of 5 years, while only 13 percent of the IHS service population was included in this age group. VENEREAL DISEASES In 1978, gonococcal infections ranked 7 and syphilis, primary, secondary, and early latent ranked 14 as leading notifiable diseases among American Indian and Alaska Native people. As pre- sented in Table M, both forms of venereal disease increased steadily between 1966 and 1972. Both forms showed declines in 1973 and 1974, slight upward turns in 1975, and then both showed declines from the previous year’s rate in 1976, 1977 and 1978. Comparable rates for these disease categories for the U.S. All Races population are also shown in Table M. In 1978, the Indian and Alaska Native gonorrhea new case rate per 100,000 population was 2.6 times that of the U.S. All Races, while the syphilis, all stages rate was 3.0 times that of the U.S. All Races. As cited in Table M, the Center for Disease Control estimates that there is a sub- stantial amount of under reporting of new cases of gonorrhea and syphilis for the U.S. All Races popu- lation. IHS has a highly standardized controlled disease reporting system which is used throughout all IHS facilities. IHS is probably obtaining more complete counts of venereal disease cases through use of this system than is the case nationally. The gonococcal infection new case rates per 100,000 population in 1978 were highest in the Alaska, Navajo and Aberdeen Areas. The rate for gonococeal infections in the Navajo Area has ranged from 66 to 76 percent above the rate for the IHS All Areas population during the past 4 years. The Navajo Area in 1978 also had the highest new case rate per 100,000 population for syphilis, all stages. The Navajo Area new case rate for early syphilis (primary, secondary, and early latent of less than 1 year’s duration) has been 2.3 times that of the IHS All Areas during each year 1975-1977 and was 2.4 times that of the IHS All Areas in 1978. The age distribution of patients with new cases of gonococcal infection reported has remained fairly constant between 1972 and 1978, as shown in Table N. About 2 percent were below age 15, 55 to 57 per- cent were between the ages of 15 to 24 years and 36 to 39 percent were 25 to 44 years of age. ''The age distribution of patients with new cases of syphilis, all forms, has remained stable between 1972 and 1978 for the under 15 years of age group, 4 to 7 percent of all cases reported. The 15 to 24 years of age group comprised between 30 to 35 percent of all new cases } reported 1972 to 1978, except for 1975 and 1976 when 87 and 39 percents of all new cases, respectively, were patients in this age category. CHILDHOOD DISEASES Childhood diseases in 1978 were the eighth, thir- teenth, and eighteenth leading reportable diseases among Indians and Alaska Natives. These diseases were chickenpox, mumps and measles, respectively. Since 82 percent of the new cases of otitis media occurred to persons under 15 years of age, it may also be characterized as a childhood disease. Chickenpox—This disease was the eighth leading notifiable disease among Indians and Alaska Natives in 1978. It has ranked either 8th or 9th among all no- | tifiable diseases during the last 9. years. The rate of new cases of chickenpox experienced a steady rise be- tween 1970 and 1976 and dropped below its 1972 level in 1978 (548 new cases per 100,000 population in 1978). Approximately one-half of all new cases oc- curred to children under 5 years of age in 1978. Mumps—The number of new cases of mumps has varied greatly during the past 7 years from a low of 585 new cases reported in 1978 to a high of 2,039 new cases reported during 1973. About 43 percent of new mumps cases reported during 1978 were for children 5 to 9 years of age. Measles—The measles immunization program of the Indian Health Service was implemented in the fall of 1963. In that year, 5,631 new cases were re- ported, which represents a rate of 1,595.2 new cases per 100,000 population. The next year saw a decrease of 54.6 percent in the number of new cases reported. During the period 1970-1978, there has been a gradual decline in the measles new case rate per 100,000 population. In 1970 the rate was 262 new cases per 100,000 population. During 1971, 1975 and 1976 the rate approximated 150 new cases per 100,000 population. During the years 1973, 1974 and 1977 the rate for measles approximated 175 new cases per 100,000 population. In 1977 the IHS rate would have been lower were it not for a measles outbreak which occurred in the geographic area of the Tucson Program Office. In 1978 the rate dropped to an all time low of 41 new cases per 100,000 popu- lation. 6 TRACHOMA Trachoma is an inflammation of the conjunctiva which is always caused by infective material from the eye of someone who has trachoma. Every case of the disease comes from some other case, directly or indirectly. It cannot arise in any other way. When infectious material is transferred from a trachoma- tous eye to a-well eye, there is set up a conjunctivi- tis which is characterized by a follicular response of the inner, upper eyelid. The conjunctivitis of trachoma differs from the simple form of conjuncti- vitis in that it tends to become chronic and the conjunctivae tend to become thickened and rough. From the roughness of the conjunctiva the disease has received its name. The,Greek word from which our word trachoma is derived means rough. The important thing to remember about the disease of trachoma is that trachoma is a mildly infectious disease of the eye, with a tendency to chronicity that may compromise vision. Despite the fact that trachoma is all but extinct in the U.S. general population, it had been a serious health threat to the Indian and Alaska Na- tive population, primarily the Indian population in the Southwestern United States. The high incidence areas of trachoma and generally characterized as areas of poor hygiene, poverty, and crowded living conditions. While susceptibility is general, it affects children more frequently than adults. In 1966, prior to the funding of a special trachoma program in 1967, there were 1,712.7 new cases of trachoma per 100,000 Indians and Alaska Natives. The rates in the Phoenix and Navajo Areas were 5,943.0 and 4,024.5 new cases, respectively. In 1967, the trachoma rate for the total IHS All Areas was reduced by almost 50 percent and the Phoenix and Navajo rates were reduced to 2,568.9 and 2,189.1, respectively. Further decreases in the IHS All Areas rates have been realized each year with the exception of a slight increase in 1971. The IHS rate in 1971 was 36 percent of the 1966 rate. The Phoenix Area rate in 1971 was 28 percent of the 1966 rate. The 1971 rate for the Navajo Area was 38 percent of its 1966 rate. : In 1978, the 357 new case rate per 100,000 popu- lation of trachoma for the Navajo Area and the 101 new case rate per 100,000 population for the Phoenix Area were 3.0 and 0.8 times, respectively, that of the IHS All Areas rate of 119. About 48 percent of the new trachoma cases in 1978 were reported for persons in the 5 to 14 years of age group as shown in Table O. The trachoma screening program of the IHS is aimed at the school age population and thus the proportion of active cases identified among persons in this age group ''may be higher than in the other age groups. A reduction in the number of new trachoma cases re- ported has been the result of the teaching of per- sonal hygiene practices by IHS public health nurses, community health representatives and other health personnel as well as a general improvement in sani- tary conditions in the Indian and Alaska Native liv- ing environments. In addition, an intensive treatment program for cases of active disease was carried out. In 1972, 2,874 new cases were detected while in 1978, only 739 new cases were discovered despite an in- creased effort to detect trachoma cases by special trachoma control teams as well as through other case finding means. This is an indication of the success of the trachoma control program. While complete eradication of this disease may not be pos- sible, efforts must continue to maintain surveillance measures as well as to treat the sequelae of chronic cases. TUBERCULOSIS For many years tuberculosis has been a major health problem among the Indian population’. Though the number of persons with tuberculosis disease has declined since the advent of chemo- therapy, tuberculosis is still considered a major problem by many people in the field, both lay and , professional. The new active reported case rate re- corded by the Indian Health Service in 1955 was 758.1 per 100,000 population (Table P), and the mortality rate was 55.1 deaths per 100,000 popula- tion. The 1978 figures for new active cases showed a marked decline to 66.0 new cases per 100,000 popula- tion; the 1977 tuberculosis death rate for Indian and Alaska Native people residing in the 25 reservation States was 4.5 deaths per 100,000 population. The decline in both morbidity and mortality and ‘Analysis abstracted and updated from: Evaluation of the Tuberculosis Control Program of the Indian Health Service, Ad Hoc Committee on Indian Health, American Lung Asso- ciation, revised April 1975, New York, N.Y., Contract No. HSM 110-738-370. the low infection rates among children can be at- tributed to the major emphasis and effective tuber- culosis program of the Indian Health Service. The present new active case rate is approximately 5 times that of the United States population. The 409 new cases in 1978 were distributed among all Indian Health Service Areas and so the number in any one Area or Program Office was relatively small. Efforts are continuing to erradicate the scourge of tuber- culosis among the Indian and Alaska Native popula- tion. The Indian Health Service has a tradition of concern and awareness regarding tuberculosis. This has been maintained to the present. Chest X-rays are used, tuberculin skin testing is done and sputum specimens are collected when there is a question that tuberculosis disease may be present. From 1955 to 1968, there were dramatic gains in decreasing the rate of tuberculosis for the Indian Health Service. In 1964 there was a slight increase over the previous year. This was followed by two more years of substantial decline. Since 1966, the rate remained fairly stable through 1971, then began to drop. The rate of tuberculosis for the past 9 years has declined 57 percent. There has been a considerable rise and fall in tuberculosis new case rates among Alaska Natives from year to year, but the general trend from 1955 to 1978 has been downward. The significantly higher rates prior to 1962 were the result of including some newly reported inactive cases, while the rates for years following 1962 are based on newly reported active cases only. The rate of new cases of tuber- culosis identified in the U.S. has decreased yearly since 1955. The gap, however, between the U.S. rate and the IHS rate has been narrowed consider- ably during this time period (ie.. in 1955 the Indian and Alaska Native new case rate was 758.1, while that for the U.S. All Races was 60.1; by 1978, the Indian and Alaska Native rate was 66.0 while that for the U.S., All Races was 13.1). ''Table A. Percent distribution of the population by age and sex, Indians and Alaska Natives residing in the IHS Service Area and'U.S. All Races, 1970 Age Indians and Alaska Natives United States All Races Total Male Female Total Male Female PV ARCS. 3 a en eee 100.0 49.1 50.9 100.0 48.7 51:3 Under 5 yeas 0. ehh eh ee Ts wake J 13; 1 6.5 6.6 8.4 4.3 4.1 Boo yeas. a ae wets 15.1 7.6 75 9.8 5.0 4.8 lOsl4 years... ke ee 14.2 El TA 10.2 5.2 5:0 PoeTo Wears. to. a as 1:3 5.6 6:7 GA 4.7 4.7 2024 Yeats <7: oi re eas 7.0 315 3.7. Pe 3.9 4.2 2ORCUWERNS orc). fe 5.8 2.8 3.0 6.6 33 35 SOCSe Veale: ee a: 5:3 Zo 2.8 56 2.8 2.8 Sor se eaten, 2) 665, ceehc se 4.8 23 25 5.5 2.7 2.8 AO7AA Wears’. ool. tues pee. 4.4 25k 20 5.9 2.9 3.0 AG “GONGaS oo. sae. cena ae. ; 3.9 1.9 2.0 6.0 2.9 3:1 BO-54 VOaVs iS ee) 5 oe Foes ogee 33 1.6 Lf 5.5 2.6 2.9 O0=09 YOaNs..66 2s a ie. ee 3.2 1.5 1.6 4.9 2.3 2.6 GO-G4 Veals oe old 2.6 1.3 13 4.2 2.0 2:2 OS OD YEAS ee ey et 2.3 1.2 12 3.4 6 1.9 7O-7TA VOaNS. 2 eos oe ER ces 1:5 0.8 0.8 oo, Tal 1.6 TOSTONCANS oss. Sie fe 1.0 0.5 0:5 1.9 0.8 el 80-84 Years: 6. a ee cee Me eae 0.6 0.3 Os 1:2 0.4 0.8 85+ years 2 ....6045 Pow kd asain ea ins 0.6 0.2 0.3 Q;.7 0:3 0.4 Median age (years) .............. 0. cea ee 18.4 18.0 18.7 28.1 26.8 29.3 Table B. Rank order of the rates of twenty leading reported new cases of notifiable diseases in 1978 among Indians and Alaska Natives and these diseases for each year 1970-1978 Disease 1978. 1977°.1976 1975 1974: 1973" 1972 1974" 1970 Acute Olitisimedia. wt... ee ee ee We ee 1 i 1 r 1 1 1 1 1 Sttepithifoat. 20... Sig ee Re 2 3 3 3 3 3 3 ee 3 Gast Genteritis se ctasie/t 2 cae one are Pr ees SE oak 3 2 2 a 2 2 i 3 2 IMPCUEO: «ns Syl ce... eed. sos ee Bae ee lek 4 4 4 4 4 5 5 NA NA PReUMonia = ite teeyS eS uso es BG ae 5 5 6 5 5 6 4 5 4 WINN Zany. locas. i ee ok ee a He 6 6 5 6 6 4 6 4 5 Gonockceaslthfections: 07) 680. ee 7 7 7 ZL 7 7. 7d 6 6 CHICKENDOKN. Sie foc ek es ea eco eS ae 8 8 8 9 9 8 9 8 8 SCabiOS wes. ais os Coa coh wae bee ca ek Rik ost 9 10 13 17 19 19 20 NA NA Bacillary dysentery 3. esr. osc ce bec oe ode Rapids ha ss ORT ek 10 9 9 8 8 10 10 9 12 Infectious hepatitis ©. : vres.s.. en Ba ee 11 1l 12 11 ll 12 12 10 10 PRACHONAG. 2 cc isd os heciuw sth oe oe, Ree 12 12 11 10 10 9: 8 7 7 SMUlbS ast eS Se ee 13 13 10 14 12 1k 11 £1 9 SyphilisalbfOrms’: ress alive. celeb es dae 14 14 14 aP5 13 13 13 12 La Rheumatic feveg.. cc. . acee. os ee Si EMM cnbins oe oo pGaae fees 15 15 16 16 16 16 17 16 16 Tuberewlesis; new. actives... ose.) oc oa lee oa oe oboe he whee 16 17 17 15 13 14 15 14 14 Puerperalssepticemia .. 0. an eho aad oa eso ool abh eee 17 18 18 19 17. 18 18 L7 172 WVieasies (GRUDEOIA) ks eee oa ba da eae ooo coven od Pattee o 18 16 15 13 14 15 14 13 11 Rubella.(German measles) 0.0.2.0... ccc eke itececctccevevenectes 19 19 19 18 18 17 16 15 15 SCanlettever 2 in ee eg Cte an os vies ol cata oon 20 20 20 20 20 20 19 NA NA ‘Strep throat, scarlet fever in 1970 and 1971. ?Puerperal septicemia reported January thru June, 1970, and July thru December, 1971. NA Not available. ''Table C. Rate and percent change in rates for twenty leading notifiable disease categories among Indians and Alaska Natives, 1970 and 1978 (Rates of reported new cases per 100,000 population) Rate of reported oe new cases change in rates Disease 1978 1970 1970-1978 Acute otitis media ....... 11,099.2 9,745.0 + 13.9 Strep throat ........... i 6,200.2 4,699.6! + 31.9 Gastroenteritis ........... 6,039.5 5,060.3 + 19.4 Impetigo ................ 3,942.1 3,445.52 + 14.4? Pneumonia .............. 3,197.0 3,059.4 + 4.5 Influenza ................ 2,133.5 2,569.3 - 17.0 Gonoccocal infections .... 1,219.9 1,182.0 + 3.2 Chickenpox.............. 547.6 457.9 + 19.6 Scabies ................. 494.2 4.07 +12,255.0? Bacillary dysentery....... 441.7 255.5 + 72.9 Infectious hepatitis ...... 361.0 269.9 + 33.8 Trachoma ............... 119.3 616.5 - 80.6 Mumps ................. 94.4 355.4 - 73.4 Syphilis, all forms........ 88.9 172.1 - 48.3 Rheumatic fever ......... 66.8 31.0 + 115.5 Tuberculosis, new active . 66.0 154.1 - 57.2 Puerperal septicemia .... 60.8 44.5° + 36.67 Measles (Rubeola) ....... 40.7 262.6 - 84.5 Rubella (German measles) 23.4 63.1 - 62.9 Scarlet fever............. 17.4 12.8 + 35.9? 'Strep throat, scarlet fever in 1970. °1972 rate. Table D. Number of new cases of twenty leading notifiable diseases and percent within each disease category-that were pediatric or adult, Indians and Alaska Natives, 1978 Total Pediatric new (under 15 years) (15 years and over) cases a a Disease reported! ~ Number Percent Number Percent Acute otitis media ...........0..000 0. cee eee eee 68,775 56,330 81.9 11,462 16.7 Strep throat 2.0.00... eee eee 38,419 20,632 53.7 17,447 45.4 Gastroenteritis 0.0.0.0... 0000s 37,424 23,703 63.3 13,319 35.6 Impetigo’... ei a UE Ae cee 24,428 20,950 85.8 3,263 13.4 Pneumonia .......... 0.02.00. ccc cece cece eee 19,810 13,137 66.3 6,326 31.9 Influenza... 2.2 ee 13,220 5,342 40.4 7,798 59.0 Gonococcal infections ....000000. 00. eee eee 7,559 139 1.8 7,362 97.4 Chickenpox... 0.2.06. 3,393 3,260 96.1 80 2.4 Scabies 2.05... ee 3,062 1,703 55.6 1,354 44.2 Bacillary dysentery ..........0.0.0.0..00.0.00000000. 2,737 1,808 66.1 894 32.7 Infectious hepatitis .........0.0.....0.0.0000000. 2,237 1,383 61.8 837 37.4 Tractioma: . 0.6. Pee ec elec eee . 739 393 53.2 343 46.4 MUMPS 2... ccc cece tenet cece nace 585 493. 84.3 88 15.1 Syphilis, all forms ...00.00 0000000 c cece eee eee eee 551 40 7.3 508 92.2 Primary, secondary, early latent................ 282 20 7.1 262 92.9 Syphilis, other forms ................. 000 cee ee 269 20 7.4 249 92.6 Rheumatic fever ........... 0.00 cece cece eee eee eee 414 149 36.0 260 62.8 Tuberculosis, new active ...............00 0c ee eee 409 46 11.2 363 88.8 Puerperal septicemia ...................00000 cee 377 7 1.9 369 97.9 Measles (Rubeola) ..........0.... 0000 cece eee eee 252 228 90.5 20 7.9 Rubella (German measles) ................0,.05. 145 130 89.7 15 10.3 Scarlet fever... 0... 108 99 91.7 8 74 ‘Includes cases with age not reported. ''Table E. Rates of reported new cases of otitis media among Indians and Alaska Natives and annual percent change by Indian Health Service Area and Program Office, 1970-1978 (New case rate per 100,000 population) IHS Area 1978 1977 1976 1975 1974 1973 1972 1971 1970 All Areas os . 11,099.2 10,451.7 10,957.0 10,784.1 10,958.2 12,;103:6 12,289.8 10,742.4 9,745.0 Aberdeen ........ 14,364.3 11,608.8 12;522:3 11,644.4 14-129°0 12,612.2 16,258.2 12,894.9 11,954.9 Bemidit: ca. ceo. 11,269.2 \ 10,623.5 14,841.3 11,794.8 12;545.7 12,697.3 Bes a peerkes _— Alaska ee, 9,520.5 8,057.1 8,667.1 8,761.1 8,991.6 9,487.1 8,361.4 8,159.7 S723e1: Albuquerque ..... 10,098.0 8,969.5 10,974.0 9,537.8 9,713.6 12,663.4 11,049.5 7,024.5 7,789.4 BillAGS «here ee. 9,473.9 12,871.3 15,279.2 11,516.0 1 9222 13,298.0 16,772.4 15,3372 17,779:3 NEWaIO ek ee 17,820.8 16,948.4 15,798.7 17,150.8 17,767.0 20,987.5 19,350.0 16,401.1 16,002.8 Oklabomae=. 020. >: 5,632.8 4,495.8 4,246.6 4.3722 4,007.1 4,692.2 4,917.4 4,217.2 3,588.1 PROGHIK:: 3 A 11,636.1 12,206.8 14,894.9 14,660.8 16,929.0 14,842.5 15, 370:7 16,164.1 11,686.9 Portland®. soe. 10,546.1 11,339.3 10,792.5 9,358.2 9,552.9 11,484.4 10,369.5 7,900.5 8,671.9 MESON SS! : 190.4 343.1 397.1 2077 217.4 326.6 449.1 3177 ig OS Eee k: 8,501.5 8,012.1 9,488.8 10,448.9 16,659.7 13,576.3. 3 14,540:9 16,901.4 8,118.0 Annual percent change 1978/ 1977/ 1976/ 1975/ 1974/ 1973/ 1972/ 1971/ 1977 1976 1975 1974 1973 1972 1971 1970 All Areas ....... + 6.2 - 4.6 +16 - 16 - 95 =a) +144 ee TOre Aberdeen ........ +77 aS 75 + 46 -11.8 -22.4 +26.1 7 9 Benidjite ses) #36, 1 -28.4 +25.8 - 6.0 - 1.2 a -— — Alaska: 32... +18.2 - 7.0 - ll =-2.6 - 5.2 +13:5 Teo + 42:6 Albuquerque ..... +12.6 -18.3 +15:1 - 18 -23.3 +14.6 +573 - 9.8 Billings 2 oe -26.6 -15.8 +32. 7 - 3.4 -10.3 -20.7 +94 = SB: 7. Navajo 245. -.00° +5:2 + PS - 79 - 3.5 -15.3 + 8:5 +18.0 iy cee Oklahoma: <8. 2 +25:3 +. 5:9 - 29 #209. |. -14.6 - 46 +16.6 £475 Phoenikes ss - 47 -18.0 + 1.6 -13.4 e141. - 3.4 - 49 +°38.3 Portlands 330.2. . - 70 el +15.3 - 2.0 -16.8 +10.8 +313 <1 73.9 THCSONS a. es -44.5 -13.6 +91.2 - 4,5 -33.4 -27.3 +41.4 US EL +. 6.1 -15.6 - 9.2 -37.3 +22], - 6.6 -14.0 +108.2 —-—- Bemidji included in Aberdeen prior to 1973. *Rate not calculated (less than 5 new cases). Table F. Rates of reported new cases of strep throat among Indians and Alaska Natives for selected Indian Health Service Areas, 1978! All IHS Selected IHS areas Areas and Ratio Calendar Program Albu- ° Navajo/ year Offices querque Billings Navajo Phoenix All Areas UO Ref eet ee 6,200.2 6,739.5 6,995.6 13,397.0 51722 22 LOT Pee SA ae 6,436.3 7,601.5 6,420.8 12,879.7 1,827 2.0 TOTO a eee 6,556.2 G239.2. 5,743.9 12,478.2 9,411.5 19 17D ok 6,787.2 6,195.4 6,326.8 14,461.5 6,962.8 2a. TOTS eo 6,515.4 8,666.5 6,075.0 13,174.1 6,731.1 2.0 MOS Sha eens 7,445.5 10,286.5 8,442.3 14,166.6 7,234.8 1.9 LOU cae oe sais, 7,542.2 10,068.4 11,882.5 14,107.4 7,881.3 19 TOPE Se a RS 6,456.5 6,584.8 9,368.3 11,457.4 7,801.6 1.8 DOAK eee 4,699.6 4,125.8 5;223.6 9,970.2 847.4 2:1 ‘Areas shown are those with the 4 highest new case rates of strep throat, 1970-1978. Rates are per 100,000 population. 10 ''Table G. Rates of reported new cases of selected intestinal infectious diseases among Indians and Alaska Natives and annual percent change, 1970-1978 (New case rate per 100,000 population) 1978 1977 1976 1975 1974 1973 1972 1971 | 1970 Amebiasis ............ 2.3 2.9 2.6 1.5 2.0 2.9 2.6 3.0 2.2 Bacillary dysentery .... 441.7 485.5 _ 411.3 595.4 495.0 455.1 480.9 416.0 255.5 Botulism ...........-. * 2.2 2.4 1.1 2.0 1.7 -—- NA NA Food poisoning (bacterial) 2.7 3.2 3.5 4.0 7.2 4.6 4.0 NA ~~ NA Gastroenteritis ........ 6,039.5 6,550.8 7,123.4 7,420.7 7,276.7 7,627.8 8,015.5 6,064.2 5,060.3 Salmonellosis......... 13.4 16.0 17.9 ° 21.5 29.1 36.3 30.6 13.7 18.6 Typhoid fever......... 0.0 * . * 2.3 0.8 1.5 . * Annual percent change 1978/ 1977/ 1976/ 1975/ 1974/ 1973/ 1972/ 1971/ 1977 1976 1975 1974 1973 1972 1971 1970 Amebiasis ............ -20.7 +11.5 + 73.3 -25.0 - 31.0 +11.5 - 13.3 +36.4 Bacillary dysentery.... - 9.0 +18.0 - 30.9 +20.3 + 88 - 54 + 15.6 +62.8 Botulism ...........-. 7 - 83, +118.2 -45.0 + 17.7 -- NA NA Food poisoning (bacterial) -15.6 - 8.6 - 12.5 - 44.4 + 56.5 +15.0 NA NA Gastroenteritis ........ - 78 - 8.0 - 4.0 + 2.0 - 46 - 48 + 32.2 +19.8 Salmonellosis......... -16.3 -10.6 - 16.7 -26.1 - 19.8 +18.6 +123.4 -26.3 Typhoid fever......... * * * * +187.5 -46.7 * * NA Not available. * Rate not calculated, less than 5 cases reported. Table H. Percent distribution of reported new cases of gastroenteritis among Indians and Alaska Natives by age, 1970-1978 Total . Percent distribution cases, . Calendar all All Under 1 to 4 5 to 9 10 to 14 15 to 24 . 25 years year ages! ages! 1 year years years years years or more 1978.0... eee eee 37,424 100.0 25.9 23.7 8.0 5.7 9.5 26.1 1977 ooo ccc eee 38,575 100.0 25.6 24.6 7.9 6.1 9.4 27.0 1976... 0.0... eee eee 38,273 100.0 27.6 24.3 74 5.8 8.9 25.3 1975 ooo eee eee 38,926 100.0 24.9 25.6 8.6. 6.3 8.8 24.8 1974.0... eee 35,563 100.0 24.9 24.6 8.9 6.7 8.5 24.2 1973.0 lake eee 36,575 100.0 26.0 24.9 9.1 6.2 7.9 23.5 1972 00. 37,685 100.0 25.3 24.9 10.2 6.7 7.9 21.7 POT 3 eco. ss a 27,931 100.0 25.4 27.4 9.7 5.5 6.9 212 1970... ce eee 22,852 100.0 26.0 26.6 10.3 5.9 49 24.3 ‘Includes age not reported, not shown separately. 11 ''Table |. Rates per 100,000 population of reported new cases of impetigo among Indians and Alaska Natives for selected Indian Health Service Areas, 1972-1978! Calendar All year areas Navajo Phoenix Tucson TOTS. eee 3,942.1 6,281.7 5,202:7 8,269.9 LOTTE hee: 4,151.4 6,010.9 6,654.3 6,262.8 © 1976. =: 4,149.5 6,153.5 7,170.8 5,673.1 1975: (Re 3,991.9 7,012.8 5,267.7 6,080.1 1974. Bee 3,449.2 4,995.8 5,397.2 T8072. 19735 3,759.0 5,385.6 5,613.0 7,991.5 1972 i oes: 3,445.5 5,228:7 5,381.0 6,287.8 ‘Areas shown are those with the 3 highest new case rates of impetigo, 1972-1978. : + Table J. Percent distribution of reported new cases of impetigo among Indians and Alaska Natives by age, 1972-1978 Total Percent distribution cases, Calendar all All Under “tod 5 to9 10 to 14 15 years year ages! ages! 1 year years years years or more MS oo Bao ae 24,428 100.0 7.8 40.0 26.2 11.8 13.4 17 7 ee 24,446 100.0 Tt 40.5 26.8 12.2 12.6 TOV6 3... oo 22,295 100.0 6.9 40.8 ars L2ty: 11.8 LOO oe ioe 20,940 100.0 5.8 41.7 28.1 12-2 E.5) OTA ie ae 16,857 100.0 5.9 42.2 29.1 LES. 10.5 BOWS. eee 18,024 100.0 6.2 42.8 29.8 11-5 9.1 TOPOS on, Soe ee 16,199 100.0 6.1 42.3 31.1 133 8.3 ‘Includes age not reported, not shown separately. 12 ''“~ Table K. Indian Health Service Areas or Program Offices with the two highest rates of new cases of influenza and pneumonia, 1970-1978 (Rates per 100,000 population) . Influenza Pneumonia Area Area Area Area me with with 2nd pi with with 2nd Calendar highest highest highest highest year es oad rate rate ateas rate rate Navajo Albuquerque Navajo Aberdeen 1978........ 2,133.5 3,261.2 3,139.3 3,197.0 5,382.4 4,448.8 Navajo Albuquerque Navajo Aberdeen 1977........ 1,731.6 2,609.4 2,583.2 2,944.8 4,760.2 4,241.7 Bemidji Phoenix Aberdeen Navajo 1976........ 3,595.8 5,862.5 5,208.5 3,237.0 5,035.6 4,742.2 Navajo Phoenix Navajo Aberdeen 1975........ 2,999.7 5,594.9 3,360.7 3,107.2 5,285.7 4,245.3 Aberdeen Bemidji Phoenix Navajo 1974........ 3,097.9 5,454.4 4,806.7 3,209.4 5,215.3 4,858.1 USET Billings Navajo Phoenix 1973........ 3,987.3 10,560.5 7,569.3 3,624.2 6,537.7 5,031.7 USET Albuquerque Navajo Tucson 1972........ 3,083.9 8,380.3 4,409.4 3,620.7 6,526.9 6,170.7 USET Phoenix Navajo Phoenix 1971........ 3,431.9 9,088.9 5,761.9 3,002.0 5,731.4 4,927.7 Billings Aberdeen Navajo Billings 1970........ 2,569.3 5,588.5 4,534.0 3,059.4 6,607.1 5,061.4 13 ''Table L. Percent distribution of reported new cases of influenza and pneumonia among Indians and Alaska Natives by age, 1970-1978 Total new Percent distribution cases Disease and all All Under 5 to 14 15 to 44 45 years calendar year ages! ages! 5 years years years or more Influenza MOO a ee ee eG 13,220 100.0 14.0 26.4 44.2 14.8 TOIT ee ae 10,197 100.0 17.0 30.3 38.0 14.1 ISTO es 19,320 100.0 14.8 26.9 42.2 15.6 107 Santo eck eS oc: 15,725 100.0 17.8 26.9 39.2 15.6 MOTs es a 15,140 100.0 15s) 35.5 35:1 12.6 WIS. ee ee ee 19,119 100.0 13.0 23.6 44.3 Toy Ue ee a 14,499 100.0 13.4 26.4 41.4 15.2 Oe hy ee dos 15,807 100.0 16.2 30.5 33:7 15:0 VOTO re ee 11,603 100.0 13.8 27:3 37.8 18.0 Pneumonia AUIS ee oi 2 19,810 100.0 54.8 115 14.6 173 OF ee EN ea 17,341 100.0 9/25 Pa 139 16.3 NOVO cf Se a 17,392 100.0 57:6 10:5 13.8 17.4 DO ROR ee Not ee 16,299 100.0 95:5 10.6 14.6 18.4 NOG 15,685 100.0 54.4 11.9 10.8 21.8 NO A ee 17,378 100.0 55:5 11.9 13:3 16.4 Oa i ee 17,023 100.0 61.8 L1:2 11.4 13.9 MOT a 13,827 100.0 55.2 13.4 10.6 13.9 Ne Orr ee ee 13,816 100.0 59.9 Aaa 9.9 13:1 ‘Includes cases with age not reported, not shown separately. 14 ''Table M. Rates of reported new cases of venereal diseases among Indians and Alaska Natives and the United States, All Races, 1965-1978 (Rates per 100,000 population) : Gonorrhea Syphilis, all stages — Indians and U.S., All Indians and U.S., All y Alaska Natives Races! Alaska Natives Races! 1978 ......... tb kesevbsrgewes 1,219.9 468.3 88.9 30.0 1977 occ cece eee 1,393.7 465.9 129.2 30.0 1976 occ eee ee 1,580.2 470.4 166.4 33.7 1975 cece eee 1,731.7 469.2 172.3 37.7 1974 ooo ccc eee 1,667.2 428.7 148.7 52.0 1973 oo cece eee 1,794.2 404.9 149.9 42.0 1972 occ eee 1,923.6 371.6 207.8 44.2 O71 cece eee 1,647.5 328.2 180.5 47.0 1970 ooo cee eee 1,182.0 297.5 172.1 45.3 1969 2... 1,026.6 268.6 161.8 46.3 1968.0... cece 842.3 235.7 145.8 48.8 1967 oo. ccc eee ee 751.7 207.3 99.9 52.5 1966 20. eee eee 727.8 181.9 89.3 54.4 1965 2.00 eee eee 716.6 169.6 93.0 58.9 Reported Morbidity and Mortality in the United States, Annual Summary 1978, Center for Disease Control, DHEW, Volume 27, No. 53, October, 1978, and previous years. ADEQUACY OF REPORTING CASES OF VENEREAL DISEASE FOR THE U.S. ALE RACES Gonorrhea: The Center for Disease Control (CDC), DHEW, reports that 1,000,177 cases of gonorrhea were repor ted to CDC for the U.S. All . Races population in calendar year 1977. CDC estimates that there were between 1.6 and 2.0 million cases of gonorrh ea (treated and untreated) in the U.S. in 1977. Syphilis: CDC reports that 64,473 cases of syphilis, all stages were reported to CDC for the U.S. All Races population in calendar year 1977. CDC estimates that there were 325,000 cases of syphilis, all stages (treated and untreated), in the U.S. in 1977. Source: V.D. Fact Sheet, DHEW, Pub. No. (CDC) 77-8195, Calendar Year 1977 (to be published in 1979). Table N. Percent distribution of reported new cases of venereal diseases among Indians and Alaska Natives by age, 1970-1978 Total new Percent distribution cases Disease and all All Under 15 to 24 25 to 44 45 years calendar year ages! ages! 15 years years years or more Gonorrhea 1978 000 ene 7,559 100.0 1.8 56.2 36.7 4.5 1977 occ ccc eee 8,207 100.0 2.3 57.1 35.8 4.0 1976 ooo cece eee 8,490 100.0 2.7 57.1 35.5 4.2 1975 ccc cece 9,084 100.0 2.3 57.2 36.1 4.1 1974 occ eee ee 8,148 100.0 2.8 55.9 36.6 3.6 1973 0c eens 8,603 100.0 2.4 56.7 35.7 4.2 1972 occ een eee 9,044 100.0 2.2 54.2 38.6 3.9 LO71 cece eee 7,588 100.0 1.4 43.9 32.4 3.8 1970 00. cee eee 5,338 100.0 1.6 33.3 46.5 5.6 Syphilis, all forms 1978 00 eee 551 100.0 7.3 34.7 32.7 24.9 1977 oo eens 761 100.0 5.7 31.1 34.7 27.5 1976 2.0 894 100.0 3.6 38.9 34.6 22.3 1975 occ eee 904 100.0 7.1 37.3 35.8 20.4 1974... .......042. Lone ee des 727 100.0 5.1 29.9 37.1 23.3 1973 200 ec aee 719 100.0 4.6 31.6 34.1 27.5 1972 occ ees 977 100.0 6.0 30.5 35.2 22.6 L971. 831 100.0 3.7 27.4 40.4 21.2 1970 2... ec ee ee 777 100.0 4.3 22.8 46.7 24.2 ‘Includes cases with age not reported, not shown separately. 15 ''Table O. Percent distribution of reported new cases of trachoma among Indians and Alaska Natives by age, 1970-1978 Total Percent distribution cases Calendar all All Under 5to9 10 to 14 15: t0,24 25 to 44 45 years year ages' ages! 5 years years years years years or more 1970 eo a 739 100.0 10.0 , 2a 21.7 19.8 123 14.3 TOUT Fe 1150 100.0 11.1 24.6 25.8 L736 Lis 8.3 1976 ea 1,629 100.0 9.2 24.2 28.0 16.5 11.6 9.2 TOT 5 ae he. 1,885 100.0 11.8 21k 25.9 16.1 12.8 13 ESTAS Oe 1,900 100.0 7.8 25:8 28.7 L79 8.5 10.1 HOJ3 te 2,401 . 100.0 7.0 31.4 30.7 13.0 9.0 7.6 TODD ee aaa ee 2,874 100.0 5.6 24.0 34.7 122 6.9 6.8 COPA te, 2,841 100.0 5.8 28.7 30:7 14.8 7.6 7.6 TOFOe 2,/84 100.0 7.6 30.0 24.3 16:5 10.1 8.9 ‘Includes age not reported, not shown separately. Table P. Rates of reported new cases of tuberculosis among Indians and Alaska Natives! and the United States population by race, 1955-1978 (Rates of new cases per 100,000 population) Calendar Indian and Alaska ; LES: WS. U:S: year Alaska Natives : Indian Native All Races? White? All others? TOT 8 ee Sees 66.0 62.8 91.8 13.1 8.6 406 WOOP ee 62.8 58.2 99.6 13.9 9.2 44.8 DOUG ee Gs. 69.4 59.2 158.5 : 15.0 9.9 48.0 HO7D 102.2 102.4 100.5 15.9 10.7 50.9 OTA 79.8 74.5 122.4 14.4 9.7 45.1 OTB a8 rc. e 107.6 102.4 150.7 14.8 10.2 46.3 Be ae 100.6 94.3 151.4 15.8 : 10.8 50.3 NOTA Sy cs 157.4 152.0 200.3 17.1 Th:7 53.8 TOF ara 154.1 154.1 154.0 18.3 12:4 59.0 19690 ase: 140.8 141.6 ° 134.3 19.1 a3 59.7 TAG Bric 133.8 128.0 179.1 21.3 15.3: 65.1 SUDA Ae 155.8 152:7 179.8 23.0 16.6 70.2 POGOe ce ei 141.7 127.8 247.8 24.4 17.9 71.9 TOGO 201.5 160.5 507.8 25.3: 18.6 74.9 1964 © Oe 237.8 184.1 630.2 26.6 19.9 76.5 1968 a 234.0 192.3 534.9 28.7 21:7 81.5 T9623 ree 257.7 209.4 - 604.7 28.9 21.9 80.1 1OG1 oe 318.8 284.8 562.8 37.0 NA NA OGG ok) Sau : 322.4 292.3 547.5 39.4 NA NA NOOO eo ee: 418.0 338.2 1,048.0 42.6 NA NA W959 Rs 485.0 — 421.8 978.7 47.5 NA NA 1987 i et 565.2 426.9 1,649.7 51.0 NA NA M956 680.6 474.3. | 2,283.8 54.1 NA NA WOO 58 er oe oe 758.1 563.2 2;325.7. 60.1 NA NA ‘Indian and Alaska Native data 1955-1961 include some newly reported inactive cases while the later years include newly reported active cases only. : *Source: Center for Disease Control, Atlanta, Ga., DHEW; Morbidity and Mortality, Volume 27, Number 53, 1978 and Tuberculosis, States and Cities, Pub, No. 77-8249, 1978, and earlier annual editions. NA _ Not available 16 ''LT Table 1. Number of reported new cases of notifiable diseases by Indian Health Service Area and Program Office, Calendar year 1970 Indians and Indians Aberdeen Alaska Natives all areas (Includes Albu- Disease all areas except Alaska Bemidji) Alaska querque Billings Navajo Oklahoma Phoenix Portland Tucson USET Acute otitis media .................. 44,008 41,109 6,903 2,899 2,579 4,823 14,651 3,555 5,737 2,175 1 685 Amebiasis ..............000222- 00 eee 10 10 — _— — _ =_ 5 4 _ 1 _ Bacillary dysentery.................. 1,154 1,144 105 10 174 75 593 30 57 30 6 74 Botulism .......0....00 00.00 eee eee _ = — = — — = = = _ — — Chickenpox ..............00000e eee ee 2,068 1,938 278 130 141 99 770 139 289 158 3 66 Diphtheria................00 000 e eee 3 se 3 _ = 1 2 _ — = — _ _ Food poisoning (bacterial) ........... NA NA NA NA NA NA NA NA NA NA NA NA Gastroenteritis .................0000 22,852 22,503 3,337 349 1,916 2,445 9,019 1,587 2,397 701 641 460 Gonococcal infections............... 5,338 4,649 978 689 237 315 2,318 232 270 200 35 64 Hepatitis, infectious ................. 1,219 1,139 87 80 22 141 684 73 94 29 6 3 Impetigo ........ 0... c eee eee eee NA NA ~ NA NA NA NA NA NA NA NA NA NA Infectious mononucleosis ........... NA NA NA _NA NA. NA NA NA NA NA NA NA Influenza .. 0.0.0... eee eee eee 11,603 11,265 2,618 338 739 1,516 3,438 1,048 565 995 25 321 Measles (Rubeola) ...............-4- 1,186 1,163 273 23 31 164 169 286 86 58 — 96 Meningitis, aseptic .................. 304 41 _ 263 11 5 — 6 16 3 — _ Meningoccal infection............... 10 10 5 _ 3 = _ 1 ~ 1 _ _ Mumps ...........00.00 cece eee eee 1,605 1,532 110 73 91 89 865 132 138 56 11 40 PIABUC «5. kc ec ce be eee ee _ — —_ _ — — —_ _ — _ aa — Pneumonia ...............00 eee eee 13,816 13,304 1,895 512 874 1,373 6,049 1,006 1,271 394 120 322 Poliomyelitis ..................00005- 1 1 _ — — _ — — — — 1 = Puerperal septicemia! ............... 28 28 1 = _ 10 _ 10 7 = — _ Rabies . 2.282.020.0028 eee eee _ = — = _ — — _ — — _ — Rheumatic fever .................0.. 140 138 16 2 3 12 69 12 10 3 9 4 Rocky mt. spotted fever ............. 1 1 — _ — 1 —_ — _ — _ _ Rubella (German measles) .......... 285 267 35 18 22 23 95 50 10 15 2 15 . Salmonellosis .........0......0. 000005 84 80 54 4 _— 2 _ 6 15 3 — _ Scabies ..............200065 ceuease NA NA NA NA NA NA NA NA NA NA NA NA Strep throat, scarlet fever ........... 21,223 - 19,276 3,264 1,947 1,366 1,417 9,128 1,005 416 1,589 81 1,010 Syphilis, all forms ............-2.... , 777 764 49 13 71 28 554 14 41 4 3 ie Pri., sec., early latent.............. 597 586 41 11 60 16 419 13 33 3 — 1 Other forms .............000-- 000s 180 178 6 2 11 12 135 1 8 1 3 1 Trachoma ............0. cece eee eee 2,784 2,784 12 — 357 -~ 125 1,092 127 1,015 15 40 1 Trichinosis . 20... .c ec cee eee ees 4- 4 1 _ 2 — = 1 — — ~ — Tuberculosis, new active ............ 696 : 618 98 78 75 39 249 25 91 25 13 3 Tulareniia’.. 2... t eet eka: 2 2 1 ~ = _ = = _ 1 — =_ Typhoid fever ..................0000- 1 1 _ =_ — 1 _— — _ _ aad Viral encephalitis .................0. 12 12 _ =_ 7 1 — _— 4 = = — - Whooping cough.................... : 35 31 1 4 =— 2 — 5 18 2 3 _— 'Reported Jan. thru June, only NA_ Not available ''8T Table 1. Number of reported new cases of notifiable diseases by Indian Health Service . Calendar year 1971 and Program Office, Indians and Indians Aberdeen Alaska Natives all areas (Includes Albu- Disease all areas except Alaska Bemidji) Alaska querque Billings Navajo Oklahoma Phoenix Portland Tucson USET AGUTE-OUNS MEdIA es oe e. 49,478 45,283 7453 4,195 2,380 4,232 15;221 4,316 8,099 2,014 32 1,536 PURCDIASIS a a bi es 14) 14 1 - — _ _ a 10 _ 3 _ Bacillary dysentery oes... .4 0 ree. 1,916 1,867 68 49 182 100 852 34 418 62 24 127 Bonsai es — — —_ — —_ — — _ — — _ _ CHICKENPOX A. i ee eS 2,261 2,139 349 122 132 158 688 169 385 128 55 75 Piohithienas os. se oe Ay 15 _ a _ — 10 — 3) _ — Food poisoning (bacterial) ........... NA NA NA NA NA NA NA NA NA NA NA NA GaSIFOBRIEHINS: G8. oe eo caainc ses 27,931 27,697 37953 234 1,937 2,445 11,057 1,299 4,623 1,155 998 630 Gonococcal, infections: .20 ess. 7,588 6,300 1;397 1,288 298 379 2,676 297 874 230 89 60 Fepatitis; infectious 20s 62ers ockiek ts 1,706 1,637, 310 69 196 122 581 169 186 43 20 10 WIDCH BO Me ee a a es NA NA NA NA NA NA ‘ NA NA NA NA Infectious mononucleosis ........... NA NA NA NA NA NA NA Ney NA NA WANUCN Carts Se ee ee, 15,807 15,210 1,940 597 1,161 1277 5,0. 4 2,887 san Zo 826 Measles (Rubeola) ..............8... 746 744 68 2 33 Bo 81 290 73 36 11 97 Meningitis, aseptic .................. 44 22 8 22 L _ 1 7 4 _ 1 _ Meningoccal infection............... E 1 — — — _ — a = _ 1 MUINDS i eet eee ne ee 1,330 1,261 309 69 74 104 381 120 127 57 67 2 PIGBUR ee i. vee sees _ _ _ — — — _ _ _ _ = — PRCUMOMA 2655 20 a, ko os 13,827 13,100 1,873 Tod 697 137 5,319 935 2,469 371 358 321 EPONOMMYRNLIS: ‘Tuberculosis, new active for Tucson, included in Phoenix Area. ''9G Table 2. Rates of reported new cases of notifiable diseases by Indian Health Service Area and Program Office, and U.S. All Races Calendar year 1970 (Rate per 100,000 population) Indians and Indians Aberdeen U.S. Alaska Natives all areas (Includes Albu- All Disease all areas excent Alaska Bemidji) Alaska querque_ Billings | Navajo Oklahoma Phoenix Portland Tucson USET Races Acute otitis media ............ 9,745.0 10,253:1 41,954.9, 5,723.1. «7,789.4. 17;7/9.3° 16;002:8: 3:588.1. “11,686.9:." 8,671:9 * 8,118.0 NA AGNERIASIS Hehe oi ees os oe 2:2 20 — — _ — 0.0 * * _ Be: - LA Bacillary dysentery............ 255.5, 285.3 181.8 19.7 531.6 276.5 647.7 30.3 116.1 119.6 61.7 877.0 6.8 EROLORStiiiee eae, yk i ee NA NA NA NA NA NA NA NA NA NA NA NA x2 “ GRIBRENDOK 28 os 457.9 483.4 472.8 256.6 425.9 365.0 841.0 140.3 588.7 630.0 * 782.2 NA Baniithteriat 5 ee * * — — * * —_ — — _ — - 0.2 Food poisoning (bacterial) ..... NA NA NA NA NA NA NA NA NA NA NA NA NA Gastroenteritis 2 ic eo... 5,060.3 5,612.5 5,801.7 689.0 5,786.9 9,013.2 9,851.1 1,601.88 4,883.0 2,794.9 6,587.9 5,451.5 NA Gonococcal infections ......... 1,182.0 1,159.5 1,693.7 1,360.2 716.825 1,161.25) 2.5319 234.2 550.0 797.4 359.7 758.5. “2985 Hepatitis, infectious ........... 269.9 284.1 150.7 157.9 66.4 519.8 747.1 73.7 191-5 115.6 61.7 * 27.9! IWPOteDe eee ie NA NA NA NA NA NA NA NA NA NA NA NA NA Infectious mononucleosis ..... NA NA NA NA NA NA NA NA NA NA NA NA NA INMUCN Zao Ae er ee oe. 2,569.3 2,809.6 4,534.0 66753./-. 2,232:0 <5 5885. »-3;755:2:. 1,087.8! 1,151.0... 39672 256.9 3,804.2 NA Measles (Rubeola) ............ 262.6 290.1 472.8 45.4 93.6 604.6 184.6 288.7 175.2 2313 — 1,137.7 23:3 Meningitis, aseptic ............ 67.3 10.2 _ 519.2 33.2 1.8 _ 6.1 32.6 * os a a2 Meningoccal infection......... 22 25 0.9 oS * = — * as * _ _ 1:2 Mumps? 457.5558 ee $ 355.4 382.1 190.5 144.1 274.8 328.1 944.8 £332 281.1 223.3 3 474.0 55.6 Plabie we se ee = _ _ _ - _ ~ oe _ = ~ _ 0.0 Pneuimorttia:.......0. 225. ee 3,059.4 3,318.2 3,281.8." 1,010;8°. 2,639.8. 5,061.4. 6,607.1. 10154 <= 2,589.2; .1,570:9 °1,233.3.- <3,816.1 NA Potiomyelitis’ fo. 200.8 Pe * * _— — — _ aa _ = — x — 0.0 Puerperal septicemia ......... 6.2 7.0 * _ 36.9 ~ 10:4 14.3 _ _ = NA ables Mier RR _ _ — _ _ _ — — = oo 0.0 Rheumatic fever .............. 35.0 34.4 27.7 * * 44.2 75.4 121 20.4 * 92.5 * 1.6 Rocky mt. spotted fever ....... * * _ - _ * _— _— _ _ — ~~ 0.2 Rubella (German measles) .... 63.1 66.6 60.6 S35 66.4 81.1 103.8 50.5 20.4 39.9 * 177.9 27.8 SalmonellOsis.u.. igi oe 18.6 20.0 93.5 * _ * — 6.1 30.6 * ~ — 10.8 SCADIOS ei ert ee es NA NA NA NA NA NA NA NA NA NA NA NA NA Strep throat, Scarlet fever ..... 4,699.6 4,807.2 5,662.7): 3,843.7. - 4,125.8 5,223;6° 9,970:2- -1,0144 847.4. . 6,335.5 832.5. 11,970;0 NA Syohilis; all forms e005... 25% 17201 1906..." 81.4 25.7. 214.4 103.2 605.2 14.1 83.5 * x x 45.5 Pri., sec., early latent........ 132:2 146.2 71.0 a7 181.2 59.0 4D RT E321 67.2 * _ * 10.92 Othertformsr. ii 39.9 44.4 10.4 * 33:2 44.2 1475 * 16.3 * * * 34.63 lWieaGnOmaa kk er eS 616.5 694.4 20.8 — 1,078.3 460.8 1,192.8 1282 2,067.7 59.8 411.1 * NA THGHINOSIS® ey oe Te. oes * * * — * — _ * _ _ _ — 0.1 Tuberculosis, new active ...... 154.1 154.1 169.7 154.0 226:5 143.8 272.0 25:2 185.4 99.7 133.6 * 18.2 Milareitias eis Ge * * * _ _ — _ — = * _ — 0.1 Fyphoidaever.. =... ac - vin * * ee ue eS * pee ait a Sees a = 0.2 Viralencephalitis «. . 22.02.0205. 2F 3.0 — _ 244 * ~ — * _ _ = NA WHOODINE COUSHi as. aso rors. 78 Fal * * — * — 2A me 0:5 36.7 * * * Rate not calculated, less than 5 cases reported. NA Not available. 'U.S. rate for Hepatitis A. “U.S. rate for Syphilis, primary and secondary. 3U.S. rate for Syphilis, early latent and other. ''LG Table 2. Rates of reported new cases of notifiable diseases by Indian Health Service Area and Program Office, and U.S. All Races Calendar year 1971 (Rate per 100,000 population) Indians and Indians Aberdeen US. Alaska Natives all areas (Includes Albu- All Disease _allareas except Alaska Bemidji) Alaska querque Billings Navajo Oklahoma Phoenix _ Portland Tucson — USET Races Acute otitis media ............ 10,742.4 11,066.8 12,894.9 8,159.7 7,024.5 15,337.2 16,401.1 4,217.2 16,1641 7,900.5 317.7. 16,901.4 NA Amebiasis? ...............--.-. 3.0 3.4 * = — =_ _ —_ 20.0 — * — 1.3 Bacillary dysentery............ 416.0 456.3 117.7 95.3 537.2 362.4 918.1 33.2 834.2 243.2 238.3 1,397.4 NA Botulism ....... Ny idle cebu leeeee NA NA NA NA NA NA NA NA NA NA NA NA 0.0 Chickenpox...............0005 490.9 522.8 603.8 237.3 389.6 572.6 741.3 165.1 768.4 502.1 546.0 825.3 NA Diphtheria................204. 3.3 3.7 _ = —_ _ 10.8 10.0 — _ _ 0.1 Food poisoning (bacterial) ..... NA NA NA NA NA NA NA NA NA NA NA NA NA Gastroenteritis ................ 6,064.2 6,769.0 6,147.3 455.2 5,717.1 8,860.9 11,914.2 1,269.3 9,2266 4,530.8 9,907.7 6,932.2 NA Gonococcal infections ......... 1,647.5 1,539.7 2,417.0 2,505.3 879.5 1,373.5 2,883.5 290.2 =1,744.3 902.2 883.6 660.2 328.1 Hepatitis, infectious ........... 370.4 400.1 536.4 134.2 578.5 442.1 626.0 165.1 371.2 168.7 198.6 110.0 28.9) Impetigo ..............0.. 200 NA NA NA NA NA NA NA NA NA NA NA NA NA Infectious mononucleosis ..... NA NA NA NA NA NA NA NA NA NA NA NA NA Influenza .................200- 3,431.9 3,717.2 3,356.5 1,161.2 3,426.7 4,628.0 5,488.9 880.4 5,761.9 3,573.7 2,114.6 9,088.9 NA Measles (Rubeola) ............ 162.0 181.8 117.7 * 97.4 199.3 87.3 283.4 145.7 141.2 109.2 1,067.3 36.5 Meningitis, aseptic ............ 9.6 5.4 13.8 42.8 * -- * 6.8 * — * = 2.5 Meningoccal infection......... * * = _ — — — — — _ _ * 1.1 Mumps .............0-2000 eee 288.8 308.2 534.6 134.2 218.4 376.9 410.5 117.3 253.5 223.6 665.1 242.1 65.3 Plague ...........00 0. cece eee = = = — = = = — — — = ae 0.0 Pneumonia ................-5- 3,002.0 3,201.5 3,240.6 1,414.1 2,057.2 2,743.4 5,731.4 913.6 4,927.7 1,455.4 3,554.1 3,532.1 NA Poliomyelitis .................. * * = = _ — — — * — — — 0.0 Puerperal septicemia?......... 10.0 11.2 24.2 _ — _ — 7.8 41.9 = * * NA Rabies ................0000005 — _ = = — — = _ _ — — — 0.0 Rheumatic fever ...........6.. 43.6 48.9 74.4 * 56.1 47.1 46.3 28.3 89.8 _ 49.6 * 2.2 Rocky mt. spotted fever ....... : * * * = — = —_ * — = = = NA Rubella (German measles) .... 78.8 87.7 112.5 * 88.5 43.5 52.8 60.6 143.7 176.5 89.3 165.1 21.9 Salmonellosis...............-- 13.7 14.9 * * * _ ~ * 89.8 — 69.5 * 10.6 Scabies .................00004 NA NA NA NA NA NA NA. NA NA NA NA NA NA Strep throat, scarlet fever ..... 6,456.5 6,854.7 8,133.5 3,279.5 65848 9,368.3 11,457.4 1,399.2 7,801.6 6,307.9 362.8 7,867.5 NA Syphilis, all forms ............. 180.5 198.5 98.6 37.0 315.9 97.9 476.3 45.0 237.5 19.6 89.3 = 47.0 Pri., sec., early latent........ 122.5 133.2 57.1 37.0° 215.5 54.4 333.0 26.4 167.6 * — — 11.6 Other forms ................ 58.0 65.3 41.5 NA 100.4 43.5 143.3 18.6 69.9 * 89.3 — 35.4° Trachoma ..............0--00- 616.8 694.3 36.3 — 525.4 804.6 1,519.3 65.5 1,632.6 * §=1,072.2 143.0 NA Trichinosis ..............-. a7 i an — a — — — — i — — — 0.1 Tuberculosis, new active ...... 157.6 152.0 138.4 2.3 112.2 137.7 176.7 52.8 387.2 82.4 307.8 * 17.1 Tularemia ...............-2005 * * * — — _— * — * — — “— 0.1 Typhoid fever...............-. * * — = — _ — _— * — _— 0.2 Viral encephalitis ............. 5.0 5:6 * _ * _ _ 12.7 * — — * NA Whooping cough®.............. 4.6 3.4 * 13.6 _ — — 49 10.0 -- _— — 1.5 %* Rate not calculated, less than 5 cases reported. NA Not available. 'U.S. rate for Hepatitis A. 2Amebiasis and Puerperal septicemia reported July thru December only. 3Includes Syphilis other forms. 4U.S. rate for Syphilis, primary and secondary. °ULS. rate for Syphilis, early latent and other. ®Whooping cough reported May and July thru December only. ''86 Table 2. Rates of reported new cases of notifiable diseases by Indian Health Service Area and Program Office, and U.S. All Races Calendar year 1972 (Rate per 100,000 population) Indians and Indians Aberdeen LES: Alaska Natives all areas (Includes Albu- : All Disease all areas except Alaska Bemidji) Alaska querque Billings | Navajo Oklahoma Phoenix Portland Tucson USET Races Acute otitis media ............ 12,289.8 12,780.1 16,258.2 8,361.4 11,049.5 16,7724 19,350.0 4,917.4 15,370.7 10,369.5 449.1 14,540.9 NA Aipiebiasis cai i. e.4 be 2. 2:6 2.9 — _— * _ * = * — * * Lisl Bacillary dysentery............ : 480.9 502.6 227.3 306.7 536.8 188.9 1,243.9. 33.0 503.2 2355 332.0" 18515 9.7 PRINSEN a 6 ate i eS — — — _— — — _ ao = = oe — 0.0 OCKENDON a 555.8 594.5 584.5 245.4 862.8 324.3" '21-077:0 176.3 57I53 679.5 3320 508.9 87.3 Dinnnekia.. ees ee es 4.3 4.5 — * * -— 13.8 _ * — ~ — 0.1 Food poisoning (bacterial) ..... 4.0 3.8 10.3 * * — _ _ 13:7. = * — NA Gastroentedtis:. 0.8 Se 8,015.5 8,676.6 8,560.6 2,718.1 7,456.8 10,139:7 15,837.2 2,300.8 9,591.8 5,725.2 10,642.5 10,848.9 NA Gonococcal infections ......... 1,923.6 1,820.6 208d 2749S BF ANA” V543;2)" 33788 329:1 .2 14142 -1,0925 $93:6° 1,017.3 37E6 Hepatitis, infectious ........... 277.8 295.0 550:3 139.9 337.6 288.7 360.4 103.7 294.5 239.4 58.6 487.2 26.0! WHEEHEO ee. ee, 3,445.5 3;653:2 3,987.3»: 1,780.8. °3,359.0 3,018.7 . 5,228°7:.. 1306.9 . 5,381.0 »-4,057.4.° 6.2878 4,352.5 NA Infectious mononucleosis ..... 4.0 4:3 17.1 * * * _ * * — _ * NA Infugn7a co. 6... 3,083.9 3,245.1 39821" 17792355 24,4094" 4:244'8 ~ 36283 ° 1217.3" 3,904:6 - 2.9881. 2.0113 83803 NA Measles (Rubeola) ............ 105.5 114.6 99.1 32.6 O77, 114.0 88.2 27:3 319.9 262.5 97.6 162.4 15:5 Meningitis, aseptic ............ 43.2 45.5 15.4 24.9 28.9 — 145.7 15:1 33:2 — * _ 22 Meningoccal infection......... * * * -- = _ * _ - _ — — 0.6 MUNN DS 6 rs ee Po odes 286.1 303.1 415.3 149.5 418.4 527.5 370.0 5377 475.9 123:5 283.1 227.4 38.4 PASO eos oe eG — _ — = _ — — — — _ _ — 0.0 POCUMONIa ae inde se. ck eek S. 3,620.7 3797-7 4,946.0 - 2,202.5 2,545.2" 2,576.8 6;526.9..-1,182.4 -5,226:0 1,455.4 = 6,170.7 . 3,183.2 NA ROMOMIMCHHS 6656). oes 5 1.4 ~ * — — — _ * — * * 0.0 Puerperal septicemia ......... 44.5 46.7 54.7 26.8 * oar 101.0 19.8 66.3 68.3 * NA Raplesta. ecm. Vo. OM: * * _ — _ — * — ~ _— ~ _— 0.0 Rheumatic fever .............. 65.1 63.6 78.6 76.7 54.8 49.9 65.9 32.1 134.6 *~ 136.7 * 2.0 Rocky mt. spotted fever ....... 1.9 1.9 * * * — * = — _ _- NA Rubella (German measles) .... 68.7 #hA 70.1 49.8 86.6 57-0 92.5 28.3 132.6 73.4 * * iz3 Salimanevlosisn. 22% 677. vaso. ws . “SO 32:5 20.5 153 * — 47.8 12:3 91.7 _ 97.6 75.8 10.6 S@qviCSHe rs a ties. i ag 4.0 3.8 * * _ — _ * * 30.9 _ a NA Scarlettéever irs eee 12.8 14.1 54.7 * 23:1 _ * * 25.4 * * NA Strep alaOdt as ee veces sll. 15422 7,962.0 7,248.1 4,178.8 10,068.4 11,882.5 14,107.4 1,516.3 7,881.3 9,037.6 1,923.5 8,228.7 NA SVPDINS, AU 1ORMS <3. hee. 207.8 220.6 126.5 105.4 308.8 74.9 543.3 47.1 234.0 54.0 214.8 * 44.2 Pri., sec., early latent........ 111.9 119.9 59.8 47.9 184.7 42.8 304.1 29.2 113.1 38.6 * * 11.87 INEPIONMS 622 Sie oe 95.9 100.7 66.7 545 124.1 3221 239.2 LED 120.9 te ay * 32.45 Tach Onda! 646253 Py te ae | 6143 687.1 37.6 * 510.8 456.2 2,050.9 104.7 914.7 * 292.9 * NA TWASRINOSIS oso Fe rte se OO. * * * * _ _ _ — os _— _ = 0.0 Tuberculosis, new active ...... 100.6 94.3 135.0 151.4 92.3 103.4 110.6 69.8 S112 232 Tie? * 15.8 IU aR EIAY far. 88s 20 5 os Soe * * a _ _ a _ — * ~ = -- 0.1 Ty pnOis fever fc ta. * * = — — _ * * = _ * _ 0.2 Viral encephalitis ............. 6.0 5:0 * 13.4 * — LiF * * _ _ _ NA Whooping’cough®: 7.8: 6.2 6.0 * * * _ * * a * * 1.6 2F3 * Rate not calculated, less than 5 cases reported. NA_ Not available. 1U.S. rate for Hepatitis A. 2U.S. rate for Syphilis, primary and secondary. 3U.S. rate for Syphilis, early latent and other. ''62 Table 2. Rates of reported new cases of notifiable diseases by Indian Health Service Area and Program Office, and U.S. All Races Calendar year 1973 (Rate per 100,000 population) Indians and Indians U.S. Alaska Natives all areas Albu- All Disease all areas except Alaska Aberdeen Bemidji Alaska querque Billings Navajo Oklahoma Phoenix Portland Tucson USET Races Acute otitis media ......... 12,103.6 12,429.4 12,612.2 12,697.3 9,487.1 12,663.4 13,298.0 20,987.5 4,692.2 14,842.5 11,484.4 326.6 13,576.3 NA Amebiasis ...............-. 2.9 3.3 _ — = * — * * * — * = 1.1 Bacillary dysentery......... 455.1 508.7 281.3 55.0 24.5 364.1 206.9 1,464.7 63.0 499.1 148.2 317.0 479.5 108 Botulism .................. 0.8 — — = 7.5 _ = — = — = = = 0.0 Chickenpox..............-. 619.2 659.7 519.6 439.7 293.8 892.0 722.2 905.5 254.9 944.7 437.0 1,373.5 1,055.0 97.7 Diphtheria................. 6.0 6.1 _ _ * * * 22.0 _— — * — -- 0.1 Food poisoning (bacterial) .... 4.6 4.7 * _— * = * * * * * 67.2 * NA Gastroenteritis ............. 7,627.8 8,296.2 8,721.6 7,491.2 2,260.1 7,034.6 9,108.4 14,303.0 2,504.6 10,612.2 5,096.1 9,125.0 11,253.2 NA Gonococcal infections ...... 1,794.2 1,716.5 2,933.0 722.4 2,418.4 1,606.2 1,987.9 2,961.9 361.8 1,964.1 1,185.7 864.5 820.5 404.9 Hepatitis, infectious ........ 296.1 289.9 596.9 133.5 346.6 149.6 413.7 4228 141.6 250.5 216.6 ‘76.8 170.5 24.2! Impetigo ..............205. 3,759.0 3,972.8 3,791.8 3,832.0 2,041.7 3,421.3 3,516.5 5,385.6 1,974.6 5,613.0 3,758.5 7,991.5 4,486.4 NA Infectious mononucleosis .... 3.3 3.5 * — * * — * * * * * — NA Influenza .........6...0004 3,987.3 4,212.7 5,385.0 4,585.8 2,177.3 3,548.3 7,569.3 4,726.7 1,152.3 4,880.6 6,483.2 4,226.3 10,560.5 NA Measles (Rubeola) ......... 74.5 77.6 83.7 62.8 49.0 96.0 84.1 87.1 46.6 88.0 87.4 115.3 117.2 12.7 Meningitis, aseptic ......... 27.3 29.8 * * * * * 80.8 11.0 22.9 — 1153 * 2.3 Meningoccal infection...... 1.5 * * = * — — * * — * — _ 0.7 Mumps ...........-.00000- 425.2 432.9 236.2 149.2 363.5 2456 711.7 876.1 135.2 394.0 387.6 326.6 1,087.0 36.2 Plague ...............0005. = — = — — — — — — — _— — _ 0.0 Pneumonia ................ 3,624.2 3,718.1 4,015.1 3,109.5 2,870.4 2,870.9 3,698.8 6,537.7 1,392.6 5,031.7 1,744.3 3,842.1 2,887.9 NA Poliomyelitis ............... 1.9 2.1 a — _ — * * * — — * — 0.0 Puerperal septicemia ...... 41.7 43.2 49.4 39.3 30.1 19.8 35.1 97.6 15.5 42.1 = * * NA Rabies ...............22--- * = — _— * — — — — — a = — 0.0 Rheumatic fever ........... 66.7 69.4 75.1 39.3 45.2 39.5 56.1 114.4 32.9 99.4 19.0 153.7 85.3 1.9 Rocky mt. spotted fever .... 3.5 4.0 * — = * * — 10.1 — — — * NA Rubella (German measles) ... 44.6 48.1 64.4 39.3 17.0 48.0 42.1 46.2 29.2 68.8 26.6 134.5 85.3 13.3 Salmonellosis .............. 36.3 40.1 42.9 * * * = 82.9 5.5 68.8 * 124.9 117.2 11.4 Scabies .................5. 6.5 7.0 15.0 — * * — * * 21.0 * 48.0 * NA Scarlet fever............... 4.8 5.4 17.2 — — 16.9 * * * * — * — NA Strep throat ............... 7,445.5 7,766.6 8,214.9 5,111.9 4,866.9 10,286.5 8,442.3 14,1666 1,922.5 7,234.8 8,801.4 3,755.6 5,243.0 NA Syphilis, all forms .......... 149.9 157.6 124.6 47.2 288.5 169.3 70.2 363.0 62.2 162:5 26.6 182.5 * 42.0 Pri., sec., early latent..... 80.3 87.2 58.0 * 24.5 90.3 316 219.3 36.6 84.1 26.6 — * = =11.9° Other forms ............. 69.6 70.4 66.6 * 64.0 79.0 38.6 143.7 25.6 78.4 — 182.5 * = =§=©30.1° Trachoma ..............005 500.7 561.0 42.9 _ 17.0 765.0 420.7 1,496.2 35.6 918.0 19.0 278.6 * NA Trichinosis ..............-. — — — ~ — — — — — — =< _ — 0.1 Tuberculosis, new active ... 107.6 102.4 184.7 70.7. 150.7 101.6 133.2 120.7 64.0 124.4° 45.6 (4) x 148 Tularemia ................. 1.3 1.4 = =— _ _ = — 4.6 * — — = 0.1 Typhoid fever.............. * — — _ = — * * _— — * = 0.3 Viral encephalitis .......... 5.0 5.4 17:2 47.1 1.9 as — * * * — — — NA Whooping cough........... 6.3 7.0 23.6 * — _ 28.0 * 6.4 * — an ane 0.8 * Rate not calculated, less than 5 cases reported. NA_ Not available. ‘U.S. rate for Hepatitis A. °ULS. rate for Syphilis, primary and secondary. 3U.S. rate for Syphilis, early latent and other. “Tuberculosis, new active for Tucson included in Phoenix Area. ''0€ Table 2. Rates of reported new cases of notifiable diseases by Indian Health Service Area and Program Office, and U.S. All Races Calendar year 1974 (Rate per 100,000 population) Indians and Indians : . US. Alaska Natives all areas r Albu- All Disease all areas except Alaska Aberdeen Bemidji Alaska querque Billings Navajo Oklahoma Phoenix Portland Tucson USET Races Acute otitis media ........... 10,958.2 11,202.0 11,129:0.12,545.7. 8,991.6 . 9,713.6.11,922.2 17,7670 4,007.1 16,929.0 9,552.9 217.4 16,659.7 NA PUMICIIOSIG ga i te 2.0 24 * = * * _ —_ —_ * - * * 3 Bacillary dysentery........... 495.0 554.3 283.6 427.8 16.7 270.8 169.1 1,626.0 39.9 478.4 104.8 1,143.7 5770 NA MOMINR EN 0). oa6 es cols: 2.0 o 18.6 _ — — — _ “— _ 0.0 CHIGKERDOX c.5 eo. lek 490.7 508.9 563.0- 381.1. 343:2 1716.3: 484.7 710.4 175.5 688.5 482.7 519.8 587:5:. - 722 Diphimenia’ ness). Sek s ss ie 78 * ~ * * — 24.9 150 — _ - 0.1 Food poisoning (bacterial) .... te 74 33.9 * * _ _ 4:3 5:3 _ * — * NA GasiFoenieritis 6. 2. 7,276.7 7,869.8 $134.0 6,052 2,493.3 81140 8.2586 13:077:8 1,739:0 10543:1. 5187.6 12,1172 14,7084 NA Gonococcal infections ........ 1,667.2 1,588.2 2,666:9°.. 661-1 2,300.3. 1,591.3. 18974 24648 303:2. 21574 1,0403- 1457-8 1437.3...4321 Hepatitis, infectious .......... 376:4 378.1 641.3 241.1 359.9 2625 472.6 655: 108.2 480:3° 486-5: 2080. 125.91 -19.5' ET 17 a a ee Oe 3,449.2 3,576.9 38047. 36400 24190 3,/022:3% 31185 4,995:8..1,325:9: 5,397.2: 3,315:2 7,807.2 3,976.1 NA Infectious mononucleosis .... 64 4.6 36.0 * 9.3 * — _ * * * * —_ NA MpIeNee 6 ees oe ae 3,097.9 3;185.3 5454.4 4,806.7: 2,393.1 2:7876 1,686:9"'3,736:5 °2,0785 3,359:9 3,154.4 “1,758.1 4,028:6 NA Measles (Rubeola) ........... 86.6 95.0 266.7 62.2 18.6 63.6 289.8 81.9 22.2 60.1 44.9 94.6 146.9 10.5 Meningitis, aseptic ........... 15.1 12.9 * _ 33.4 * * 25.9 qa 24.4 _ *« * L5 Meningoccal infection........ * * _ —_ * — pa * _ _ _ — ~ 0.6 Ree is eek 187.0 193.4 527.0 132-2 <« 135:5 94.0 113.9 189.6 86.9 133.9" =329:3 85.1 3358: 29:0 Rp ee st * x a aoa — _ * _ -, — — —_ 0.0 Pireimoiita <<... 5 ise. cea 3,209.4 3,261.6 4,078.7 4,301.2 2,788.2 2,906.4 3,225.5 4858.1 9475: 52953: 1,474.3 . 3,922.5: 3839:7 NA POHOnWElIS o>: oos0. fess 1.4 1.4 - — * = _ * — , * _ * x 0.0 Puerperal septicemia ........ 60.0 61.6 48.7 * 46.4 16.6 44.9 146.1 173 101.3 — * * NA Pitas 4 ete tS 1.2 * ~ _ * * = —_ * = — _ — 0.0 Rheumatic fever ............. 69.4 724 110.1 * 44.6 116.1 65.6 109.8 203 84.5 * TET 136.4 1.8 Rocky mt. spotted fever ...... 3:3 SF * — _ — _ * 8.9 * = — = NA Rubella (German measles) ... 54.8 57.0 101.6 46.7 Si.8 44.2 69.0 64.2 28.4 56.3 44.9 122.9 94.5 5.6 MANMOMONOSIS ore es 29.1 29.7 40.2 * 24.2 13.9 * 42:5 TA 56,3 _ 14:3:5 94.5. 10.4 SEARS er ee St ek 10.0 9.9 _ 38.9 17-1 * _ * * 9.4 48.6 132-3 * NA SCGMECIEVel ij. 6 Cri ee ees 4.5 4.6 * _ * * — 5,2 * * — 473 * NA Sen MH ei css. as 6,515.4 6,733.0 6,703.2 5,444.5 4,760.2 8,666.5 6,075.0 31,174.1 1,895.9 6,731.1 4,329.3 3,128.6 6,032.4 NA Syphilis, all forms: '.: <. 2.2: . 148.7 158.9 65.6 * 66.9 279.1 1104 311.8 55:0 251.5 37:5 1ES:4 x 460 Pri., sec., early latent....... 80.2 86.9 29.6 * 26.0 138.2 48.3 180.2 32.8 146.4 22.5 * *: 12.1? OUNEEIOHNS 3550 ows 68.5 72.0 36.0 * 40.9 140.9 62.1 131.6 22.2 105.1 * 104.0 2h WRACWNNG (2. occ gi tes 388.8 432.1 48.7 ne 39.0 373.0 345.0. 1,370:2 38.2 440.9 * 473 115.4 NA THCHIAOSIS S555668 Feo... * * _ * _ = * — * _ _ _— o 0:1 Tuberculosis, new active ..... 79.8 74.5 127.0 467 1224 93.9 169.0 48.7 49.6 120.1 22.5 * — 143 Tulapetnia ors: es * * — _ _ = * * * — = — = 0.1 Tyenuie fever: see 1.6 1.6 — - * _ — * * x = — a 0.2 Viral encephalitis ............ 34 3:7 10.6 _ * * * * _ * — * * NA Whooping cough............. 4.5 48 * * * _ * * * o a = 84.0 L2 * Rate not calculated, less than 5 cases reported. NA_ Not available. ‘U.S. rate for Hepatitis A. 2U.S. rate for Syphilis, primary and secondary. 3U.S. rate for Syphilis, early latent and other. ''T§ Table 2. Rates of reported new cases of notifiable diseases by Indian Health Service Area and Program Office, and U.S. All Races Calendar year 1975 (Rate per 100,000 population) Indians and Indians U.S. Alaska Natives all areas Albu- All Disease all areas except Alaska Aberdeen Bemidji Alaska querque Billings Navajo Oklahoma Phoenix Portland Tucson USET Races Acute otitis media ......... 10,784.1 11,019.7 11,644.4 11,794.8 8,761.1 9,537.8 11,516.0 17,150.8 4,372.2 14,660.8 9,358.2 207.7 10,448.9 NA Amebiasis ................. 1.5 1.5 _ — _ _ _ * o * _ = * 1.3 Bacillary dysentery......... 595.4 662.1 181.2 _ 21.9 289.4 84.9 1,908.8 50.7 639.3 2394 4343 423.9 NA Botulism .................. 1.1 * ae _— 9.1 _ _— _ * _ _ — — 0.0 Chickenpox................ 525.8 551.5 518.7. 305.2 305.2 311.0 387.1 926.0 192.4 512.2 947.1 311.6 1,213.6 78.1 Diphtheria................. 4.4 4.7 _ _ * —_ _ 5.8 = 27.6 _ = = 0.1 Food poisoning (bacterial) .... 4.0 4.3 * * * — 17.0 * * * — _ * NA Gastroenteritis ............. 7,420.7 8,054.4 7,788.6 4,280.8 1,979.2 6,693.0 6,540.8 14,714.0 1,670.2 10,620.2 4,686.1 7,949.4 11,737.3 NA Gonococcal infections ...... 1,731.7 1,647.6 2,405.9 643.4 2,454.4 1,622.5 1,592.7 3,006.0 336.8 1,818.6 1,003.4 793.1 299.3 472.9 Hepatitis, infectious ........ 356.9 344.6 460.4 222.7 462.4 219.0 146.0 682.6 128.9 309.5 271.1 141.6 58.2 16.8! Impetigo .................. 3,991.9 4,062.4 3,884.9 3,018.8 3,386.4 2,966.5 3,307.7 7,012.8 1,149.4 5,267.7 3,629.9 6,080.1 2,568.6 NA Infectious mononucleosis .... 4.6 4.7 16.7 49.5 * * * * * * * — = NA Influenza ................6. 2,999.7 3,147.2 2,914.2 2,284.7 1,732.5 2,693.4 1,9154 55949 1,485.5 3,360.7 2,387.1 1,520.0 2,959.3 NA Measles (Rubeola) ......... 160.5 170.9 243.7 74.2 71.3 32.5 57.7 327.3 40.4 195.3 21.1 66.1 698.3 11.4 Meningitis, aseptic ......... 15.8 14.3 25.0 * 29.2 = _ 28.0 * 27.6 _ — _ 2.1 Meningoccal infection...... 1.9 2.1 _ * _ _ — 49 * _ * — — 0.7 Mumps ................... 153.8 165.8 193.7. 305.2 51.2 113.6 91.7 215.5 52.4 353.8 154.9 103.9 83.1 28.0 Plague ................000. 1.3 1.5 = _ _ _ 5.8 _ _ _ — _ 0.0 Pneumonia ................ 3,107.2 3,160.7 4,245.3 3,225.0 2,648.1 2,174.2 2,954.6 5,285.7 959.7 4,147.5 1,566.7 2,596.3 1,928.5 NA Poliomyelitis ............... * * _ — * _ — * =_ _ — — — 0.0 Puerperal septicemia ...... 40.4 43.0 41.7 41.2 18.3 * _— 80.6 16.3 90.3 * 56.6 * NA Rabies ........... Lecce eee * * — = = = * * * _ = — = 0.0 Rheumatic fever ........... 68.8 66.8 81.2 107.2 85.9 56.8 122.3 88.0 32.6 66.3 28.2 94.4 49.9 2.0 Rocky mt. spotted fever .... 4.4 49 * _— — — _ * 6.9 _ 42.2 _— _— NA Rubella (German measles) ... 40.6 39.2 64.6 * 53.0 32.4 34.0 60.9 10.3 36.9 17.6 * 108.1 78 Salmonellosis .............. 21.5 23.6 54.2 41.2 * 18.9 _ 39.5 * 35.0 _ * * 10.6 Scabies ................... 52.6 36.4 12.5 — 191.9 — * 16.4 8.6 31.3 59.9 896.9 * NA Scarlet fever ........... Lae. 7.8 8.7 10.4 41.2 = * * 6.6 4.3 * = 85.0 * NA Strep throat ............... 6,787.2 6,841.7 5,307.7 6,573.7 6,319.6 6,195.4 6,326.8 14,461.5 1,317.1 6,962.8 2,468.0 3,842.5 5,336.7 NA Syphilis, all forms .......... 172.3 181.8 77.0 ~~ 66.0 91.4 229.9 81.5 376.7 59.2 248.8 45.8 160.5 66.5 38.0 Pri., sec., early latent ..... 95.1 100.9 45.8 49.5 45.7 110.9 47.5 222.1 26.6 138.2 31.7 * * - 42:9? Other forms ............. 77.2 80.9 31.2 * 45.7 119.0 34.0 154.6 32.6 110.6 * 132.2 46° 25.15 Trachoma®:...2..4..,...:.7: 359.4 392.0 39.6 74.2 78.6 370.5 183.4 1,088.9 31.8 440.4 24.6 56.6 83.1 NA Trichinosis ................ * * * — _ — — _ — _ _— — 0.1 Tuberculosis, new active ... 102.2 102.4 110.4 49.5 100.5 16.2 = 237.7 74.8 57.6 316.94 42.2 (*) — 16.0 Tularemia ................. * * —_ _ _ * = — * — — = _ 0.1 Typhoid fever.............. * — = — * — _ — ae — — — _ 0.2 Viral encephalitis .......... 1.9 1.9 * = * _ _ a = * = * * NA Whooping cough........... 4.0 4.5 * — — — = 9.0 * _ _ * x 08 * Rate not calculated, less than 5 cases reported. NA_ Not available. 1U.S. rate for Hepatitis A. °U.S. rate for Syphilis, primary and secondary. 3U.S. rate for Syphilis, early latent and other. ‘Tuberculosis, new active for Tucson included in Phoenix Area. ''6S Table 2. Rates of reported new cases of notifiable diseases by Indian Health Service Area and Program Office, and U.S. All Races Calendar year 1976 (Rate per 100,000 population) Indians and Indians U.S; Alaska Natives all areas Albu- All Disease all areas except Alaska Aberdeen Bemidji Alaska querque Billings Navajo Oklahoma Phoenix Portland Tucson USET Races Acute otitis media ......... 10,957.0 11,221.0 12,522.3 14,841.3 8,667.1 10,974.0 15,279.2 15,798.7 4,246.6 14,894.9 10,792.5 397.1 9,488.8 NA AMNEDIGSIS co. sce. cs cae Crs 2.6 29 _ _ _ * _ * _ 2d. = * * 14 Bacillary dysentery......... 411.3 447.7 162.0 x 95.4 225.1 127.0 1,024.4 35:9 866.3 34.6 810.4 2788 NA Boatisite.. oon, 0. ca5 5 2.4 * — _ 18.0 _ _ —_ * _ — _ =— 0.0 GIIGKENDOX i... eee 641.9 682.7 746.6 1,381.4 288.1 1,094.0 4580 1,063.2 156.1 F170 ATL. + 235:0-.. 7993: 96 Digntheria 5 ioe. . 2.8 29 * — * * — * * a _— _ _ 0.1 Food poisoning (bacterial) .... 3.5 19 * — 18.0 _ — * * — —_ * * NA Gastroenteritis ............. 7,123.4 7,685.6 8,649.7 4,908.7 2,2456 7,469.6 6,693.4 12,696.2 1,718.0 11,024.7 3,435.9 10,025.1 9,237.9 NA Gonococcal infections...... 1,580.2 1,518.6 2,065.5. S71.G@ 21141) 1,475.4: -1,487.8--2,668.0 395,.6,.. 4,855.5" = 949:0 65655 - 269.5 4/05 Hepatitis, infectious........ elad 233.9 471.8 90.4 608.7 349.6 90.3 312.4 112-7 293.0 79.7 40.5 74.3 15% IEHEO, coo eS 4,149.5 4,248.8 4,982.3: 3,510.9.3,288.2 3,371.9 3,701 6153-5... 17233.0- 7,170:8. 3,432.4 - 5,673.1 3,150:6 NA Infectious mononucleosis .... 3.4 2 * * 9.0 * x — * * = * _ NA lnhiehiza 2 OS Se 3,595.8 3,757.7, 4,951.5 5,862.5 2,191.5 4,540.0 4,801.1 4,081.7 1,401.6 5,208.5 4,274.0 3,322.8 4,414.5 NA Measles (Rubeola) ......... 149.8 164.0 131:3 57.6 27.0 74.2 S0:2*> 3124 45.1 280.3 155.9 * 158:0 49:2 Meningitis, aseptic ......... 16.8 17.6 16.4 * 9.0 * * 25.4 5.8 57.9 = * _ 1.6 Meningoccal infection ...... * * * — * — _ = _— * — _ = 0.8 Mumpsess 8s 0 oe 327.2 358.9 133.3 131.6 52.2 262.2 113.7. = 850.0 67.6 459.4 34.6 664.6 1AB.2 179 PARC ee cece ee 1.1 — — ~ _ * — 4.0 — _ _ — 0.0 PiieURMOHia 2.2... ce 3,237.0 3,260.01 5,035.6 3,001.2 3,036.1 2,540.2 4,139.1 4,742.2 9124: 4,231.9 1,759.5" 4,019.8 2518.6 NA Poliomyelitis.......0..65... Ty 1.0 _ os TEP _ 3.3 * 0.8 1.8 _ _ 9.3 0.0 Puerperal septicemia ...... 52.9 52.9 73.8 57.6 52:2. 15.9 90.3 84.8 19.2 61.5 — 89.1 34:2 NA Rabies: 8 iy ae * * — — — * a * _ _ = a 0.0 Rheumatic fever ........... 75.0 76.4 110.8 * 63.0 129.8: 83.6 86.4 41.7 79.6 27.7 113.5 102.3 13 Rocky mt. spotted fever .... 3.9 4.4 * * — * = _ 9.2 * — _ — NA Rubella (German measles) ... 32.4 33.8 55.4 * 19.8 37.1 16.7 53.9 4.2 56.1 * * 65.1 5.8 Salmonellosis <2 ho o23 2.2 17.9 195 28.7 ~ x 212 - 32:5 _ 32.6 — 97.3 x 10:7 SEAWIOS ase Me 209.8 180.6 102.6 476.9 4628 87.4 * 19.8 1 222.4 — 4,587.1 * NA SCanetsever sc... 6:1 5.4 10.3 * 12.6 * ~ * * * * 48.6 — NA Strep thrOgt-s i 6,556.2 6,650.7 4,559.7 8,918.3 5,737.2 7,239.2 5,743.9.12,4782 1425.8 9:411:5 2:,739-7: 3,371.4 4,395.9 NA Syphilis, all forms.......... 166.4 £75:2 118 58.3 90.0 190.7 10033 = 3727. 62.6 197.1 114.3 89.1 x Ooty Pri., sec., early latent ..... 87.3 93.8 36.9 * 30.6 103:3 130 203.0 18.4 124.8 83.1 — x. 4262 OUICHAOIMS 6.4.25... 79.1 81.4 34.9 49.3 59.4 87.4 26.7 169.7 44.2 12:3 31.2 89.1 x. 226° TRACHOMA... ..60.Gsc ke: 303.2 332.7 41.0 * 46.8 2/55 3240 ° 9134 41.7 256.8 312. 202:6 * NA AERINOSIS 2204. . sys es: * * * _ * * _ _ — — — aa - 0.1 Tuberculosis, new active ... 69.4 59.2 94.4 576° 158.5 * 73.6 69.0 50.1 97.74 17:3 (‘) — 15.0 Wularenmia.-. . 9165 » 2947... 804 Diphtheria i 20s. ©: * * = = _ = _ * — — — _ oo 0.0 Food poisoning (bacterial) .... 2d, 2.5 * * * 14.4 * * _ * = NA Gastroenteritis 2... 6,039.5 6,529.9 95124-33692 2.1014: .:5,414.8:- 8.2333 29,776: 2,027.1: 27,438:5 4,218A 8,833.9: 8.4352 NA Gonococcal infections ........ 1,219.9 1,109.0 T,736:8 311.2: 2.11072 892.8 1,300.9 2,021.1 243.3. 1TIA5: 68h 2° | 6845. 5157-4685 Hepatitis, infectious.......... 361.0 387.8 934.3. 282.1. °-145.7 358.0 149.3 560.6 74.1 380.7. 405.3 eee JAA 13%! IMipetigo a cc 3,942.1 4,126.3 5 ,035:8 “3,701.1. 2,462.8. - 3,114.7. 2,992.4 6,281.7 31,481.72. 5,202.7. 2,807.4 8,269:9. 4;361.3 NA Infectious mononucleosis .... 3.9 4.0 * * * ~ 20.1 _— * 6.9 — * _ NA IpflGeN ae ooo es 2:1335 2,197.7 2,767.7 1,858.8. 1,617.6 .-3,139.3..-4,628.3 .3,264:2.° 1100.2 .2,028:2 2,200:9 --648:6 1,259:8 NA Measles (Rubeola) ........... 40.7 42.5 68.7 49.8 26.2 313 54.6 50.4 18.1 30.5 36:5 49.4 Pog 12:3 Meningitis, aseptic ........... 13.2 13.6 20.4 * 10.2 * 17:2 23.3 6.3 12.5 es * 3.0 Meningoccal infection........ * * * _ * _ _ * — * _ oa a 12 WINS .. ae one e 8 eos ok 94.4 102.9 48.3 49.8. 26.2 67.1 43.1 204.7 T1114 62.3 29.6 35.3 81.0 78 PlaStiey epee ht Sea a — — — — — _ _ _ _ — — = _ 0.0 Pneumonia se séc ik es eeu 3,197.0 3,200.6 4,448.8 3,219.8 3;168.2 . 2,783:5. 3,087.1 5,382.4 10742 32105: 1,695.9 - 2,735.5 -2:725.8 NA Pohiomyelitistre 3 65 ee 0.9 Led _ _ ~ * oo * * * = — _ 0.0 Puerperal septicemia ........ 60.8 64.1 66.9 * 35.0 20.1 25.8 121.1 37.8 98.3 — 63:5 58.9 NA RAD IES 6 ee ee * * = — — * _ — * = _ — - 0.0 Rheumatic fever ............. 66.8 67.7 55.) 24.9 59.7 85.0 63.2 1:35:11 36:3 63.7 26.6 155.1 * 0.6 Rocky mt. spotted fever ...... 1.6 1.8 * — =_ - _ — 47 _ _ _ NA Rubella (German measles) ... 23.4 25 44.6 24.9 32.1 112 28:7 39.1 11.0 * * * * 8.4 Salmonellosis:.2 i220: 13:4 13.8 29.7 * 10.2 112 28.7 113 5S 18.0 ~~ 35:3 x 13.5 Sealnies: 7a ces tC Se 494.2 52077 562.3" 3485 28h3 561.6 8788 544.0 95 443.0 — 6,027.9 110.5 NA Scarlebtever: ) 2 OR es ee lr ee 4 — _ _ _ = — _ 1 - — = 3 GINCKGNDON Serio. ess kk Sees 2,969 325 420 610 448 364 221 69 65 45 140 147 136 DiphWietia =, sose65.65. e308 lk 29 4 3 7 3 4 3 — 1 1 1 1 1 Food poisoning (bacterial) ......... 22 4 _ 8 2 A: 3 = _ _ = 4 GAStrOENtaritiS:: 45600... be ces 36,575 2,785 2,356 3,143: 2,401 27774. 2,999 2,382 3775 3;210 4,823 3,512 2,412 - Gonococcal infections ............. 8,603 739 690 765 662 647 Te 551 741 674 1,003 817 597 Hepatitis, infectious. = ..6..5 125... 1,420 96 108 120 89 107 80 TL 127 108 207 192 109 MimMestioGe eee ee ek 18,024 1,181 1,174 1325 1,125 1,071 1,162 1,409 27325 1,905 2,418 1,692 1,247 Infectious mononucleosis ......... 16 2 _ 4 2 2 — 2 _— os 2 _ z INMMED Zeiss! were eS at eek 19,119 ~~ 6,879 6,183 1,859 928 611 283 PALE 222 302 562 5/71 502: Measles (Rubeola) ................ 357 32 26 39 36 51 32 22: 24 18 33 28 16 Meningitis, aseptic ................ 131 35 10 7 6 8 25 3 12 10 5 - "aD Meningoccal infection............. 7. i o E = Z oo — ae _ 3 _ IVS io ae sc eee Gees Bas os 2,039 177 252 375 307 271 148 70 78 42 99 128 92 MGC He Cha Reet oe aes -- a — _— — =_ — — _ _ _ = — PRCUMONI a: a0 ee ee 17,378 3,042 2713 2,608 1,655 1,388 1.429 418 599 637 1,040 941 908 PONOMIVEHTHSA< ck chose te ces ee oes 9 _ a 2 1 1 a a — 2 = 2 Puerperal septicemia ............. 200 19 20 29 14 18 20 7 9 13 20 3 18 Meier ees 1 ~ = — _ _ _ ~ — 1 _ = _ Rheumatic fever.:......5. 0.0. 6.05. 320 24 36. 34 22 21 22 9 21 19 44 40 28 Rocky mt. spotted fever ........... 17 — _ 1 2 4 4 3 2 A: a = Rubella (German measles) ........ 214 18 15 32 29 23 22 13 16 10 13 15 8 SaAMOnelOsis'i 6 sack occa Gn 174 Dy: 19 22 15 16 18 q 6 11 11 18 14 SRARIG 62 Eo a Acs oo 31 _ 6 ~ _ 1 2 5 4 5 5 3 SCAHOIICVE!. 528 cca es 23 NA NA NA NA NA NA NA NA NA NA NA NA Stvepithioate:s. 05... sass a Se. 35,701 4,447 3,946 4,307 2,918 2,730 2,219 1,453 2,192 2,003 3,737 3,013 2,740 Syanilis;alifOmis.é.0.-... 02.2. 719 55 80 78 51 60 60 32 68 47 87 be 49 Pri., sec., early latent....... Be 385 24 25 43 23 29 25 22 40 26 60 32 36 Oihertoniis 464 ek. bck es 334 31 55 35 28 3h 35: ‘10 28 21 27. 20 13 WaGhOmas. 820 00 40.2 eStats - 2,401 115 297 294 223 229 155 158 188 97 272 173 200 TRGUIROSIS# es ac Pie. at, _ = ~ _ a ~ ~ _ _ — _ _ — Tuberculosis, new active .......... 526 NA NA NA NA NA NA NA NA NA NA NA NA WlarenQia caer... 6 825585 ee 6 a aa _ = 3 — — 3 _ _ = _ Typhom sever ns. oo ees) oe I 4 _ 1 1 a _— 1 — _ — Vitalencepnaltis <)2. 0665... cb. 24 Z 3 a 1 2 2 ~ 5 — £ 3 = Wheoping.cough ¢ vee ee. 30 - _ 8 Bs 2 6 _ 4 _ ~~ 4 I NA_ Not available ''6€ Table 3. Number of reported new cases of notifiable diseases by month among IHS Service Population Calendar year 1974 Disease Total January February March April May June July August September October November December Acute otitis media ................ 53,555 6,860 6,661 6,403 5,063 4,700 2,843 2,799 2,446 3,076 3,126 3,832 5,746 Amebiasis .................0.0005. 10 2 1 — 3 = os = 1 1 1 — 1 Bacillary dysentery................ 2,419 296 140 117 127 190 189 123 150 269 161 283 374 Botulism ...............00...00 00. 10 5 _ 1 — — _ — = 2 1 _ 1 Chickenpox..................0000. 2,398 294 253 278 337 325 194 103 69 70 76 139 260 Diphtheria...................000.. 35 6 3 2 / 5 5 9 = 3 1 — = 1 Food poisoning (bacterial) ......... 35 4 1 4 3 2 7 _ 4 4 1 1 4 Gastroenteritis ...............000.. 35,563 3,117 2,088 2,137 2,341 3,047 2,732 2,401 2,829 3,444 2,940 3,683 4,804 Gonococcal infections............. 8,148 785 553 665 598 746 572 654 635 745 598 726 871 Hepatitis, infectious ............... 1,838 151 149 115 109 134 142 147 137 150 147 179 278 Impetigo ...............000..0000. 16,857 1,677 1,177 1,050 1,067 1,193 1,079 1,346 1,861 1,743 1,495 1,445 1,724 Infectious mononucleosis ......... 25 1 2 1 2 3 _ 1 a 3 3 a 1 Influenza ............0......00000. 15,140 893 3,783 3,983 2,095 726 297 273 277 418 563 661 1,171 Measles (Rubeola) ................ 423 30 24 55 92 46 33 27 22 24 18 21 31 Meningitis, aseptic ................ 74 5 4 3 _ 2 4 9 12 10 6 8 11 Meningoccal infection............. 2 1 _ — _ = = = _ — 1 oo _ Mumps ..................0. cee e ee 914 112 86 68 70 84 63 46 26 69 110 98 82 Plague ............0.0. 0. cece eee 3 1 — _ _ _ _ _ _ — _ 2 _ Pneumonia ....................... 15,685 1,927 2,327 1,910 1,522 1,464 1,426 482 480 699 793 924 1,731 Poliomyelitis ..................0.0.. 7 _— _ ~ - _— _ 1 1 1 — 2 2 Puerperal septicemia ............. 293 15 18 23 20 48 30 27 23 14 25 16 34 Rabies ...:..........0....0 ccc eee 6 _— 1 1 = = _ — 1 2 — = 1 Rheumatic fever .................. 339 31 31 39 23 34 32 22 15 24 31 20 37 Rocky mt. spotted fever ........... 16- — — 1 2 _— 6 4 2 1 — = _— Rubella (German measles) ........ 268 27 15 18 23 47 26 16 24 14 11 19 28 Salmonellosis..................0.. 142 10 7 9 5 8 26 10 10 17 14 12 14 Scabies ..............0..0. cee eee 49 3 6 5 2 1 5 1 2 2 3 13 6 Scarlet fever...................... 22 1 6 2 2 1 3 2 = 1 2 1 1 Strep throat ..................00.. 31,842 4,492 3,490 3,612 2,769 2,629 1,670 1,765 1,524 - 1,845 1,910 2,346 3,790 Syphilis, all forms................. 727 60 45 73 56 79 77 52 36 53 55 49 92 Pri., sec., early latent............ 392 32 23 44 28 45 30 24 16 33 34 29 54 Other forms .................... 335 28 22 29 28 34 47 28 20 20 21 20 38 Trachoma .............0..0c eee 1,900 208 200 243 _ 286 159 173 129 103 117 139 143 Trichinosis ...............0..0000- 3 o _ — = —_ a “ — 2 1 = - Tuberculosis, new active .......... 390 NA NA NA NA NA NA NA NA NA NA NA NA Tularemia ...............00..00 00. 3 ~ = 2 _ _ _ — — 1 _ a — Typhoid fever..................0.. 8 NA NA NA NA NA NA NA NA NA NA NA NA Viral encephalitis ................. 17 3 _ _ 5 — 2 3 — — 2 Whooping cough.................. 22 = — 1 1 _ 3 _— 2 7 _— 3 5 NA Not available. ''OF Table 3. Number of reported new cases of notifiable diseases by month among IHS Service Population Calendar year 1975 Disease Total January February March April May June July August September October November December Acute otitis médias oe... eek. 96,569 10,216 6,273 6,334 4,896 3,646 3,065 2,991 3)275 3,527, 4,064 4,109 4,173 PIMEDIASIS 6s ee ae 8 _ oo 1 1 = 2 — — dt 2 — Bacillary dysentery’... 0020.62 3,123 435 78 173 229 188 238 201 444 462 330 181 164 BOUUISIA 3 Ae ee ee 6 1 _ 2 _ Z _ q _ ~ — — CHIGKERDOX,. oe soot 2,758 510 195 329 341 295 240 102 87 45 146 213 255 DIPMURStla Zio coe ee 23 7 6) 1 6 1 _ _ - _ _ i 2 Food poisoning (bacterial) ......... 21 _— as 2 1 _ 4 I 1 4 1 1 5 Gastroenteritis 6 a0. ohte. eu... 38,926 4,930 1,632 2,157 2,469 2,260 2,440 2,780 4,973 4,280 4,759 3,723 2,025 Gonococcal infections ............. 9,084 1,070 483 624 672 693 647 739 964 921 811 779 681 Hepatitis, infectious..........2.. 2.0. 1,872 320 169 172 212 134 122 129 166 116 107 88 13% IMpPeGH 0: wan ne Wes ce be 20,940 2,608 1,032 1,164 1,250 1,102 1,275 1,578 2,424 2,402 2,320 2,106 1,679 Infectious mononucleosis ......... 24 1 2 2 S 8 3 _ 3 2 — > _ INGUEIZO: i ee Oaks 15: 735 5,932 3,931 1,719 679 317 211 286 299 600 656 575. 530 Measles (Rubeola) ................ 842 36 25 44 66 89 104 124 74 47 60 79 94 Meningitis, aseptic -............... 83 — 1 2 5 13 6 iS J, 19 11 3 3 Meningoccal infection............. 10 _ 1 1 _ _ - 2 4 2 _ = MuUnIpS. 25. Sorte tes ieee 807 75 46 77 76 77 79 71 58 So 50 90 13 PIBCHOr cs nee ea rite ook nea aT = — oo _ 2 _ 1 I a ~ 1 1 PReumMonia iin coer. uk. 16,299 3,466 2,529 2,089 1,673 1,076 1,187 366 559 698 670 932 1,054 POMOMIVENUS 23558 oss 4 a ~ — 1 — _ 1 — 1 _ — 1 Puerperal septicemia ............. 212 30 2 20 21 24 21 10 9 28 12 16 19 Ra@wlcn 4c. 86. 62.0 eek ca 4 i 1 _— 1 oo _ 1 — =~ _ _ _ Rheumatic fever; 02. .4005..0.0.24.: 361 48 46 36 38 24 22 23 17 25 LOSE 28 23 Rocky mt. spotted fever ........... 23. 1 1) = 1 4 _ 1 _ 3 _ = 2 Rubella (German measles) ........ 213 28 14 18 28 17 18 16 19 15 16 id. 17: SalmonellosiS.e2v. ge. ovsege ec. 113 17 y, 3 14 5 8 3 15 20 10 3 8 SGANES Ss on ae Vo es 276 9 13 17 18 18 20 18 18 38 38 59 10 DOAMBETEVET a Pe eS aes 41 2 1 3 4 4 5 _ 2 2 6 8 4 Sttep throat i Peak ee. ee. 35,603 5,591 2571 3,089 2,738 2,113 LVS 1,769 2;523 2;725 3,226 3,767 3,716 Syphilis: all forms... se 904 136 64 82 71 65 68 53 63 86 84 59 73 Prisvsee:, early latenti.;....... xs... 499 84 38 44 35 37 34 28 40 38 41 33 47 Othepqorms. e662 6 Fo A 405 52 26 38 36 28 34 25 23 48 43 26 26 ACIOMIe = 2,64 or Ses eo Re: 1,885 217 167 156 392 110 116 78 120 73 186 167 103 Pe RINOSIS ft sas 1 _— — ae 2 = = — o L — = _ Tuberculosis, new active .......... 536 NA NA NA NA NA NA NA NA NA NA NA NA Tee ies ade es S — - _ _ 1 1 — — _ _ — E Typhoid teverses8s 2. ee i ~ _ — a 1 = -- = _ — — oc Viral encephalitis sos... ee, 10 3 _ 2 = _ 2 _ =— 1 2 _ _ WhOODIRE-COURNT 2.5 eee Zi 1 ~_ 2 — _ 1 2 2 6 3 — 3 NA Not available. ''Iv Table 3. Number of reported new cases of notifiable diseases by month among IHS Service Population Calendar year 1976 Disease Total January February March April May June July August September October November December Acute otitis media ................ 58,871 5,732 7,146 9,141 4,678 4,541 4,008 3,341 3,363 3,729 3,975 4,341 4,876 Amebiasis ................0.0.000. 14 _ 1 _ 2 — 2 _ — 5 2 2 _ Bacillary dysentery................ 2,210 175 95 76 91 151 251 226 268 345 232 167 133 Botulism ..........00..0....00 000. 13 — 1 — ~ - _ _ 3 5 1 — 3 Chickenpox.............0...20005. 3,449 370 372 491 390 430 451 175 84 72 139 204 271 Diphtheria. ....................08. 15 _ 4 - ~ 3 2 _ 2 1 _ : 1 2 Food poisoning (bacterial) ......... 19 8 1 — _ 2 2 2 _ 2 — = 2 Gastroenteritis .................... 38,273 2,815 1,868 2,154 1,821 2,255 3,698 3,346 4,192 4,915 4,416 3,675 3,118 Gonococcal infections ............. 8,490 795 564 561 507 601 895 790 845 827 777 653 675 Hepatitis, infectious............... 1,465 145 123 112 140 106 130 96 131 140 145 98 99 ‘Impetigo ...........0..0..00.0.0002. 22,295 2,451 1,513 1,516 1,026 1,247 1,716 2,208 2,446 2,355 2,109 1,942 1,766 Infectious mononucleosis ......... 18 3 2 3 1 1 1 — 2 1 1 - 3 Influenza .........0...00...000 000. 19,320 1,187 6,270 6,627 812 458 356 233 465 708 788 736 680 Measles (Rubeola) ................ 805 113 121 165 98 115 65 31 20 18 27 12 20 Meningitis, aseptic ................ 90 3 4 = 8 4 15 1 4 36 3 4 8 Meningoccal infection............. 4 2 — 2 — — — _ —_ — — - _ Mumps ..................0 000s eee 1,758 129 107 153 167 230 200 113 81 85 134 177 182 Plague ...... 0... eee ee 6 — _— — _— — 3 — 2 _ aoa — 1 Pneumonia ...................000. 17,392 1,754 2,227 3,120 1,736 1,562 1,653 497 640 995 783 1,095 1,330 Poliomyelitis...................... 9 — 2 1 2 — 2 = _— 1 —~ 1 — Puerperal septicemia ............. 284 47 25 17 9 14 47 © 9 22 44 6 19 25 Rabies ....... 0... eee eee eee 3 ~ - 2 — 1° -- — _ = — — i Rheumatic fever .................. 403 37 21 35 31 33 54 22 41 31 22 42 34 Rocky mt. spotted fever ........... 21 1 1 2 2 — 5 4 1 2 _— 1 2 Rubella (German measles) ........ 174 22 22 21 13 12 20 13 12 13 5 12 9 Salmonellosis..................005 96 11 5 5 8 3 18 1 4 19 3 8 11 Scabies -.00. 6.06. ce cece eee leas 1,127 164 88 87 76 68 141 58 71 53 55 107 159 Scarlet fever.......0.0..000....00. 33 5 3 4 3 4 6 — 1 = — 5 2 Strep throat ..................00.. 35,226 4,038 3,749 3,751 2,572 2,332 2,403 2,134 2,288 2,599 2,856 2,900 3,604 Syphilis, all forms................. 894 83 77 89 72 84 102 69 57 71 78 56 56 Pri., sec., early latent............ 469 47 46 42 44 35 38 49 29 29 48 33 29 Other forms .................0.. 425 36 31 47 28 49 64 20 28 42 30 23 27 Trachoma ...............2000 eee 1,629 267 160 157 165 147 118 119 95 92 113 102 94 Trichinosis ................. Poe. 4 — 1 — = 1 _ — _— _ _ _ 2 Tuberculosis, new active .......... 373 NA NA NA NA NA NA NA NA NA NA NA NA Tularemia .......0. 00000... 0000 5 _ 1 2 _ ~ _ 1 _ _ _ 1 Typhoid fever................000.. 1 1 — _ _ — _ — — — _ _ _— Viral encephalitis ................. 14 — — 1 3 6 2 _ —_ 1 1 _ _ Whooping cough.................. 30 11 1 1 1 1 6 — 1 5 2 1 _— NA Not available. ''GV Table 3. Number of reported new cases of notifiable diseases by month among IHS Service Population Calendar year 1977 Disease Total January February March April May June July August September October November December Acutevotitis Média’... 22,...0 2.6. 61,546 5,668 L483: °8'831 5,739 4,312 373k 3,435 3,906 4,208 3,996 5.113 5,424 Palicinasts a ce Ly = 2 1 a 2 L 1 3 4 _ ie a Bacillary dysentery................ 2,859 132 117 107 138 169 216 291 456 D2? 274 22) 205 PN ran i os ae 13 Y 1 = - _ 2 “= 2 == 7 _ DRIOMEIIOK 5. ee oc 3,336 442 397 562 490 355 266 157 UE. 90 68 164 228 DIA ick oh ath eae 4 — = 1 ~ — _ — 1 a _ — 2 Food poisoning (bacterial) ......... 19 1 . — _ 2 2 1 _ 2 _ 4 6 GastOemienitis 2 ee eae 38,575 2,604 1,977 2,623 2,484 2,481 2,608 3,010 4,408 5.559 3,596 3,879 3,346 Gonococcal infections............. 8,207 667 673 616 669 697 693 766 647 BED 679 681 644 Hepatitis, infectious............... 1,640 141 106 152 94 117 104 95 147 19)... 145 158 190 IMAPICHEO oo ee eh: 24,446 2,075 1,465 1,556 1,290 L222 1,639 2,092 3,458 3,165 259s. 27333 1,863 Infectious mononucleosis ......... 22 a = 4 2 2 1 2 5 3 _ an = Wlteneas es ols. Poa. 10,197 744 11451 2,780 1,861 469 283 229 346 517 501 545 THA Measles (Rubeola) ................ 443 36 41 142 47 39 26 16 21 9 22 20 24 Meningitis, aseptic ................ 70 3 1 5 3 9 3 1 5 22 1 4 3 Meningoccal infection............. 4 as _ — = 1 — 2 _ — — = a DADS eo a i eo. bee uh ako 179 142 162 105 E21 67 43 49 3H 60 65 85 Rigel 2 en ec aS oe Seki 6 = _ _— _ — _ 1 _— 3 1 1 _ PRELINONIC so eee ees, 17,341 1,568 2,610 2,664 1,839 1,320 1,021 766 F32 1,415 781 1,087 1533 ROWORAVENUIS 806. ose edd 5 1 1 _— _ : 1 _— = —_ — 1 _ Puerperal septicemia ............. 285 18 26 19 25 35 26 22 IS 50 11 : 14) 24 PSS eshte 2 4. — _— i: _ —_ _ — _ _ — =e Rheumatic fever ict. lie. 453 40 48 53 43 36 25 28 28 65 28 29 30 Rocky mt. spotted fever ........... il 1 1 — — 2 4 1 — 2 = _ _ Rubella (German measles) ........ 149 8 7 14 19 12 13 22 15 15. 10 9 5 SalmManenesise | cies 2 Ava ces oes 94 5 L Ts 6 5 9 10 6 25 4 4 6 MCA ICR ie ies wah eo eee oo 2,210 215 202 195 202 186 133 107 103 241 224 238 169 MGAHEETEV Oe i siec sya see 40 2 4 5 2 : 2 1 2 — 4 6 5 d BUBOMITOAe sce. fs cia x ct 37,901 3,641 3,269 4,655 3,256 2,791 2215 2,025 2,438 2,893 2,925 3,961 3,832 SYprINS..All TOMS 25. PS. 761 60 5k: 67 oS 60 63 68 77 90 66 54 52 Pri.sec. early: latent....0..5.... 392 32 24 34 26 27 38 32 47 36 38 St 27. PIO TIS 2 os Soe be 369 28 ay 38 27 33 25 36 30 54 28 23 phy Treromiae ce oe 1,458 147 96 115 104 96 87 80 84 85 100 99 5 / ACHINOSIS 3 ete ee eae 2 ~ — _ — — _ — — Z _ —_ Tuberculosis, new active .......... 370 NA NA NA NA NA NA NA NA NA NA NA NA NI ele aa kk 5 _ — _ ak — 1 _ 1 1 -- 1 TV PNM IRMEN §.6 058 ok Secs es 2 _ = 1 — — — _ _ = a =— - Virde-encepivalitis..-.c26.00 oe 17 2 2 1 = 1 3 Z 1 4 — 2 _ Whoopie cough 2 iy a 19 — a: 2 3. 1. 2 5 4 a it I: NA_ Not available. ''PV Table 3. Number of reported new cases of notifiable diseases by month among IHS Service Population Calendar year 1978 Disease Total January February March April May June July August September October November December Acute otitis media ................ 68,775 8,678 7,547 8,625 5,508 5,111 4,922 4,220 4,268 5,169 4,624 4,864 5,239 Amebiasis .................000 eee 14 1 2 1 2 1 1 _ 2 2 — 1 1 Bacillary dysentery................ 2,737 160 132 129 121 213 323 309 328 328 297 214 183 Botulism ............4.22.0000 0008 4 2 _ — — 1 _ _ _ — 1 _ = Chickenpox...........0 00. e eee eee 3,393 383 371 457 393 517 413 159 83 93 97 191 236 Diphtheria.....................00. 2 _ : 1 — — _ 1 _ = = — =. = Food poisoning (bacterial) ......... 17 — -— 1 — 1 _ 2 4 3 1 = 5 Gastroenteritis .................... 37,424 3,133 2,177 2,237 2,118 2,866 3,318 3,284 3,739 4,403 3,798 3,147 3,204 Gonococcal infections............. 7,559 669 569 572 477 551 631 683 741 768 701 580 617 Hepatitis, infectious ............... 2,237 289 188 221 108 154 217 120 189 165 162 219 205 Impetigo ......... 0.0... 24,428 2,328 1,598 1,600 1,307 1,318 1,907 2,456 2,839 2,858 2,524 1,917 1,776 Infectious mononucleosis ......... 24 1 1 2 2 1 1 3 1 1 _ 3 8 Influenza ......... 0... cee eee eee 13,220 3,389 2,604 1,742 616 406 341 277 294 643 610 629 1,669 Measles (Rubeola) ................ 252 24 14 17 20 19 33 24 15 20 14 12 40 Meningitis, aseptic ................ 82 4 6 7 12 2 4 5 2 18 11 5 6 Meningoccal infection............. 4 1 1 — _ 1 _ ~ _ 1 — _— _ Mumps ...........0..0 cece eee eee 585 74 2 79 78 82 54 29 27 31 27 24 18 Plague .......... 0.0 c cece eee eee = —_ = — _ — = — — _ — _ — Pneumonia ..............00e0 eee ee 19,810 2,618 2,738 2,776 1,807 1,491 1,488 1,013 935 1,506 1,000 991 1,447 Poliomyelitis ...................00- 6 = — — _ 2 _ — 1 2 _ 1 — Puerperal septicemia ............. 377 27 49 35 30 28 39 17 37 56 19 10 30 Rabies ............ 0... eee eee eee 2 _ — = — — — 1 _ 1 _— _ = Rheumatic fever .................. 414 41 29 48 33 27 42 23 42 47 38 18 26 Rocky mt. spotted fever ........... 10 _ os _ = _ 1 3 2 3 — 1 _ = Rubella (German measles) ........ 145 14 10 5 10 11 13 14 7 16 4 9 35 Salmonellosis..................05. 83 2 4 4 3 6 7 9 13 16 7 2 10 Scabies .......... 0.0.0 cece 3,062 292 292 335 271 219 149 144 179 267 284 246 384 Scarlet fever ..................205. 108 3 8 13 20 17 — 4 — 7 21 1 14 Strep throat .................2005. 38,419 5,031 3,935 - 3,722 2,680 2,898 2,422 2,235 2,438 3,062 2,976 3,139 3,881 Syphilis, all forms ................. 551 55 39 53 40 41 58 53 45 57 43 31 36 Pri., sec., early latent............ 282 30 21 26 23 18 29 24 23 28 23 17 20 Other forms ...............0000- 269 25 18 27 17 23 29 29 22 29 20 14 - 16 Trachoma ............000. ceed eeee 739 74 106 71 70 68 49 51 61 51 53 34 51 THIGHINOSIS: 252.00. . eee vane 5 3 _ — — 1 1 _— _— _ _ _— ee Tuberculosis, new active .......... 409 NA NA NA NA NA NA NA NA NA NA NA NA Tularemia ........0....00....00005 _ _ pee ee fa — — — —_ — — _ — Typhoid fever..................00. 5 2 1 — — —- a _ _ 2 _ _ _ Viral encephalitis ................. 14 1 3 — — 3 1 1 1 3 £ _ _ Whooping cough.................. 26 5 5 6 2 1 — 4 — — 1 NA_ Not available. ''vv Table 4. Number of reported new cases of notifiable diseases by age among IHS Service Population Calendar year 1970 Under 1 1to4 5 to 9 10 to 14 15 to 24 25 to 44 45 to 64 65 years Age not Disease Total year years years. years years years years and over reported Acute.otitis:media =... 6.0 pc ccc eles 44,008 10,606 15,733 5,890 2,945 LIT 2,741 957 457 69 AIDEDIASIS thee hy an 10 _ 1 i. 2 L 2 1 1 _ Bacillary dysentery...............05. 1,154 272 407 112 56 53 23 TT 44 _ BOLUS Gis Si in ae on ed — = i ae — — Bas a _ NA CHICKEN Of 2,068 337 980 520 49 Ta 14 6 5 4 DiPhtenas oi. eee 3 _ _ 1 1 _ d: — _ — Food poisoning (bacterial) ........... NA NA NA NA NA NA NA NA NA NA Gosfoenicrits te ek ie BS 22,852 5,950 6,086 2,360 1,349 1aZe S167 T5710 873 85 Gonococeal: infections.22) . 227. 2.46 5,338 12 13 14 45 1,778 2,483 222 BD 7 HEGANtS; IMIECHOUS 2.2 1,219 a1 278 375 126 77 181 45 19 ee CG eran ee a i NA NA NA NA NA NA NA NA NA NA Infectious mononucleosis ........... NA NA NA NA NA NA NA NA NA NA HVLC Ren eee ere ag hie ee ae 11,603 365 13236 1,674 1,495 1275 3514 1,549 542 15 Measles (Rubeola) << -...0........... 1,186 246 531 269 80 11 TA: 4 9 2 Meningitis; aseptic 20... sek 41 17 8 6 Z 4 2 _ 2 _ Meningoccal infection............... 10 2 2 2 2 1 1 = _ _ NitmSee ee eee 1,605 42 352 698 197 92 92 19 1. 29 BAGUIO Der Te eee — _ _ = es ~ a ae — o— PMeemiOnid 0's chee eS 13,816 3,197 5,078 1,411 402 240 1,130 1 037 779 30 PONOINYCRLS sae! eRe a 1 — — _ _ _ 1 _ as ee Puerperal septicemia ............... 28 — _ = — 11 17 — on rote RODIES 242. area pe _ _ _ _ _ — — = a — Rireerntatio fever... 3605.28) 9a 140 1 3 24 3S 39 28 7 3 — Rocky mt. spotted fever ............. 1 _ — 1 = _ aa — a Rubella (German measles) .......... 267? 89 94 47 20 7 6 _ 3 1 Satmianetiosis: 2 22 7s aes acs: 84 18 23 9 Z 3 13 5 2 _- Sede Se es oe ay Sah tes NA NA NA NA NA NA NA NA NA NA Strep throat, scarlet fever ........... 21:2233 493 . 2723 4,049 3,502 3,108 4,133 929 297 40 SYDHNS: difonns... sc. 5... es Td al 8 4 10 177 363 139 49 3 Pri see. early latent... css 597 9 4 4 9 155 294 89 20 a GiMerqOnns: se. oS a. as. a ee 180 Z 4 _ 1 22 69 50 29 Mi PRGENOMA 68ers ee dt ee 2,784 19 192 833 676 459 280 161 88 76 WCINMOSIS eee ere 4 — — a 2 _ 1 _ — = Tuberculosis, new active ............ 696 af 26 24 25 48 245 132 108 3 TULarOn de ee ea 2 _ “= 1 _ _ _ 1 — _ PVGMI EVER oc Face ees 1 _ _ 1 — — a — _ _ WitaCHCCDHGNUS: oot. elie eck 1? 2 3 _ 2 os 5 _ _ = Whooping: coush = 3. 02 a, “a0 16 13 2 _ = ~ _ — _ NA Not available. ‘Excludes 263 cases of aseptic meningitis not available by age for Alaska Area. “Excludes 18 cases of rubella not available by age for Alaska Area. ''cP Table 4. Number of reported new cases of notifiable diseases by age among IHS Service Population Calendar year 1971 Under 1 1to4 5 to 9 10 to 14 15 to 24 25 to 44 45 to 64 65 years Age not Disease Total year years years years years years years and over reported Acute otitis media .................. 49,478 11,491 17,660 6,654 3,135 2,289 2,291 886 396 481 Amebiasis ..............00.00000 eee 14¢ 5 3 _ _ 2 2 — 2 _ Bacillary dysentery.................. 1,916 374 639 170 85 104 217 117 65 96 Botulism ...............0000 0c cece ee — ~ — — — — — os — = Chickenpox.............0020 cece eee 2,261 309 1,023 677 64 16 14 7 8 21 Diphtheria ...................0.000.. 15 = 1 4 — _ 5 2 3 _— Food poisoning (bacterial) ........... NA NA NA NA NA NA NA NA NA NA Gastroenteritis ...................... 27,931 7,100 7,638 2,701 1,537 1,928 3,382 1,750 795 1,100 Gonococcal infections ............... 7,588 21 17 12 56 3,328 2,461 254 36 115 Hepatitis, infectious ................ 1,510! 33 350 477 200 191 170 49 16 24 Impetigo... 0.0... eee NA NA NA NA NA NA NA NA NA NA Infectious mononucleosis ........... NA NA NA NA NA NA NA NA NA NA Influenza... 0... eee eee 15,807 530 2,035 2,759 2,058 2,309 3,544 1,790 586 196 Measles (Rubeola) .................. 746 220 297 131 58 18 11 4 3 2 Meningitis, aseptic .................. 44 6 1 2 6 2 5 = _ _ Meningoccal infection............... 1 — ~ — 1 _— _ — — — Mumps ...........0 0.00 cece eee 1,330 14 320 620 209 79 57 6 6 19 Plague ......... 0.000000 cece eee eee _ = _ — _— _— = _ — — Pneumonia .............000 0c eee ee 13,827 2,801 4,825 1,420 426 437 1,024 1,093 833 241 Poliomyelitis ...................222.. 2 — — 1 — 1 _ _ _ _ Puerperal septicemia?............... 46 = _ o = 24 19 2 1 _ Rabies ................ 0. cece eee ee _ - — — _ _ _ _ _ _ Rheumatic fever ................... 181° 2 6 25 39 43 35 18 12 1 Rocky mt. spotted fever ............. 2 — = 1 — 1 — _ = — Rubella (German measles) .......... 329’ 120 79 52 17 45 10 1 3 2 Salmonellosis. .................0004. 63 37 12 2 1 1 3 5 1 1 Scabies 2.0.2.0... 0.000 ccc eee NA NA NA NA NA NA NA NA NA NA Strep throat, scarlet fever ........... 29,738 663 3,810 6,389 5,470 6,084 5,320 1,210 245 547 Syphilis, all forms ................... 831 15 3 6 7 228 336 133 43 41 Pri., sec., early latent.............. 564 5 2 6 6 176 240 73 16 21 Other forms ...................00- 267 10 1 a 1 52 96 60 27 20 Trachoma ..............0 cee eee eee 2,841 7 154 816 871 420 217 148 68 140 Trichinosis ..............0..02e eee = _ _ _ = — _ = = _ Tuberculosis, new active ............ 726 5 33 11 16 66 210 139 110 32 Tularemia 2.0... ..0..0. 2.000. c eee eee 3 _ — 2 _ —_ 1 = — _ Typhoid fever..................00005 1 — _ — _ _ — 1 _ _ Viral encephalitis ................... NA NA NA NA NA NA NA NA NA Whooping cough.................... 21° 11 4 3 _ _— 2 1 — — NA Not available. ‘Excludes 196 cases in Albuquerque Area not available by age. 2Amebiasis and Puerperal septicemia reported July thru December only. 3Excludes 1 case in Alaska Area and 19 cases in Albuquerque Area not available by age. 4Excludes 4 cases in Alaska Area and 19 cases in Albuquerque Area not available by age. 5Whooping cough reported May and July thru December only. ''oF Table 4. Number of reported new cases of notifiable diseases by age among IHS Service Population Calendar year 1972 Under 1 1 to4 5 to 9 10 to 14 15 to 24 25 to 44 45 to 64 65 years Age not Disease Total year years years years years years years and over reported Acute otis media .: ox .,.. 2. oon vk 57,781 14,571 23,569 7,499 3,779 3,000 3,093 1,134 435) 701 Fa ca] ={0|* (1 ae eee aR 12 _ 4 1 — _ 3 i 4 2 Bacillary dysentery..... ye tala 2,261 487 734 241 103 1127 248 151 86 84 POUUS ee on se -— ~ oe — = — — _ — _ NCKEMDOXK © OF. ace tos. get ae da <2 2613 374 1,281 779 89 22 20 9 13 26 Parneney 6 ol os oe ce aes a 20 = 1 4 1 4 6 4 _ Food poisoning (bacterial) ........... 19 2 2 2 4 6 3 _ - — Gastroenteritis; <5 25.53. eecsicac ce. 37,685 9,539 9,392 3,838 2,516 2,992 4,630 2,559 991 1,228 Gonococral infections <. 0.2.56. .6.. 5. 9,044 26 20 34 155 4,903 3,488 323 25 105 iepatttis, IMECUOHS ..... 0.0. 655.20. 1,306 49 263 356 184 175 192 65 9 13 MRO ot hc. vw wi is 16,199 986 6,850 5,031 1,833 668 463 148 72 148 Infectious mononucleosis ........... 19 1 4 2 4d 9 2 —_ —_ rE WMIChee Se ee Se re 14,499 400 1,543 1,983 1,844 2,473 3,528 Lt 488 519 Measles (Rubeola) .................. 496 165 181 88 27 15 10 1 6 2 Meningitis, aseptic; 2.2. ...-,. 002... 203 53 31 26 29 38 21. 2 s _ Meningoccal infection............... 2 1 1 _ — — — _ _ = Petes oo 1-34) 14 371 614 180 68 62 6 ce 23 Ree ogee 5 ee —_ _ a _ _ _ —_ _ — _ PPORUMOMIAS <.6ccr 33 17,023 4,354 6,161 1,378 526 548 1,388 1,324 1,038 306 PORVEHHIS : 25 it oF oe ooo os ce notes 7 _ =~ — 2 2 2 — _ 1 Puerperal septicemia ............... 209 — — _ 5 142 60 2 —_ _— Mea ee epee es he 1 a _ — o a 1 — — _ Frmeuimauc fEVEL 6... ceils so. a case orks 306 2 13 59 52 78 15 16 9 2 Rocky mt. spotted fever ............. 9 _ 1 1 i: i. 5 — _ _ Rubella (German measles) .......... 325 110 95 68 21 19 6 1 1 2 SEIMIONGNOSIS ho Foe ese 144 73 31 6 5 3 8 8 7 1 ;S 212711 2 ge I a a es 19 2 a 6 7 1 7 — — _ Soanletrevel so. eee, 60 4 151 30 7 5 2 = — 1 Uy aOR 8 Ls ae Bee es, 35,460 637 4,680 7,247 6,506 7,358 6,430 1,420 226 956 SVOHIs au4tONTIS oS... ae. 977 26 6 6 21 298 344 148 73 55 er,,-see., early latent 2.6... since ss 526 11 3 3) 15 206 205 46 12 23 GHRGR OMNIS Fe fo, we 451 15 3 1 6 92 139 102 61 32 PIBOWAIEIA na hs oa 2,874 9 153 691 996 351 198 118 76 282 WMA BOSIS og a 4 — _ ~ _ 2 ~~ — 2 _ Tuberculosis, new active ............ 473 NA NA NA NA NA NA NA NA NA Meteo oi So, OSS 2 _ = _ _ ao 2 _ — — RUIGIANOUBE so a te 4 _ _ _ _ — i 2 i — Viral encephalitis .. 222.00. 300: 28 8 Z 5 2 P 3 o L — Whooping cough’. ....5.. 22.2... 022; 29 20 6 2 _ _ _ 1 NA_ Not available. ''LY Table 4. Number of reported new cases of notifiable diseases by age among IHS Service Population Calendar year 1973 Under 1 1to4 5 to 9 10 to 14 15 to 24 25 to 44 45 to 64 65 years Age not Disease Total year years years years years years years and over reported Acute otitis media .................. 58,036 14,477 22,348 7,322 4,180 3,552 3,344 1,313 570 930 Amebiasis ................0000000005 14 1 3 1 — — 4 2 dL 2 Bacillary dysentery.................. 2,182 487 791 200 100 111 217 151 100 25 Botulism ............000. ccc eee eee 4 —_ — — 2 _ 2 = _ _ Chickenpox............0000 eee eee 2,969 402 1,324 979 147 30 22 9 18 38 Diphtheria......................000. 29 — 1 1 5 8 11 3 _ _ Food poisoning (bacterial) ........... 22 1 2 3 1 6 5 2 2 = Gastroenteritis ...................00. 36,575 9,501 9,115 3,331 2,261 2,882 4,478 2,677 1,436 894 Gonococcal infections............... 8,603 15 27 36 128 4,874 3,067 324 39 93 Hepatitis, infectious ................. 1,420 52 228 352 237 205 199 68 27 52 Impetigo ............ 0... c cee eee ee 18,024 1,118 7,/13 5,371 2,064 779 547 208 110 114 Infectious mononucleosis ........... 16 1 _ 2 3 7 2 1 _ — Influenza ............. Devic dedicee ge 19,119 505 1,977 2,240 2,279 3,796 4,669 2,339 658 656 Measles (Rubeola) .................. 357 131 99 59 24 19 16 4 3 2 Meningitis, aseptic .................. 131 33 20 22 14 17 18 3 1 3 Meningoccal infection ............... 7 — 1 1 _ 1 2 1 1 _— Mumps .............000c eee eee eens 2,039 19 541 983 262 115 85 16 12 6 Plague .................0 0c eee eee — _ — _ = — _ = = — Pneumonia ...............0000e eee 17,378 4,268 5,382 1,450 616 711 1,605 1,530 1,326 490 Poliomyelitis ....................00.. 9 — _ _ 1 7 1 = — _ Puerperal septicemia ............... 200 2 _— _ 2 131 64 1 — _ Rabies ............. 0.00. e eee eee 1 — _ 1 — _ _ — - — Rheumatic fever .................... 320 6 14 36 60 65 81 32 18 8 Rocky mt. spotted fever ............. 17 | 2 2 7 — 3 3 - — = Rubella (German measles) .......... 214 94 60 23 11 20 1 1 1 3 Salmonellosis.................0.0005 174 89 28 6 5 3 13 8 18 4 Scabies 5. eee aes . 31 -- 6 9 1 6 5 3 1 — Scarlet fever..................00006. 23 4 7 2 4 3 _ _ 2 Strep throat .............. ee ueeeeeee 35,701 542 4,596 7,195 6,522 7,435 6,731 1,633 373 674 Syphilis, all forms ................... 719 11 8 6 8 227 245 138 60 16 Pri., sec., early latent.............. 385 2 2 3 4 154 143 53 16 8 Other forms ...................0.. 334 9 6 3 4 73 102 85 44 8 Trachoma ............00 ccc c eee e eee 2,401 15 152 755 736 313 216 128 54 32 TrichinOSisS-.. 0s. ee ee = _ _ — = _ _ — _— — Tuberculosis, new active ............ 526 NA NA NA NA NA NA NA NA NA Tularemia .............00.0 022000 6 — _ _ 2 _ 1 2 1 _— Typhoid fever..................2205. 4 a 1 _ _— = 1 2 — — Viral encephalitis ................... 24 6 _— — 3 2 4 — 3 6 Whooping cough.................... 30 18 7 1 _ 1 _ = — 3 NA_ Not available. ''87 Table 4. Number of reported new cases of notifiable diseases by age among IHS Service Population Calendar year 1974 10 to 14 Under 1 1to4 5 to 9 15 to 24 25 to 44 45 to 64 65 years Age not Disease Total year years years years years years years and over reported Acute otitis: media: 520.6426 oe. 53555 13,224 21,148 6,791 3,870 3,164 3,006 1,214 530 611 AMeDIasiSe oe A a oe 10 2 ~ 2 _ ~ i — 3 2 Bacillary dysentery: ......0.2....5 00.3 2,419 464 756 240 114 169 306 174 Ed? 84 BOMsia fos ee 10 _ — a 2 — 8 _ _— _ CHIEKEN DOK, cei hia, von cee 2,398 302 1,106 785° 125 29 14 7. 12 18 Dipibeniag ccs 35 — 1 _ 4 11 12 5 1 1 Food poisoning (bacterial) ........... 35 2 6 3 1 5 8 5 5 - Gastmemtenus <0 8 AN fea: 35,563 8,850 8,751 3,150 2,368 3,006 4,557 2,723 1,336 822 Gonesocca} infections... 2.05.42. 8,148 24 34 5] 125 4,558 2,944 257 38 120 Hepatitis, infectious ................. 1,838 59 341 410 314 278 232 103 28 tS MPEH EO: sek se on ek 16,857 1,001 7,119 4,899 1,934 849 574 216 123 142 Infectious mononucleosis ........... 25 Z 1 2 8 9 3 _ _ = MeN Zale = OR ee 15,140 409 1,879 2,713 2,663 2,674 2,636 1,448 454 267 Measles (Rubeola) .................. 423 145 130 53 23 15 6 2 i 48 Meningitis, aseptic .................. 74 2} 11 11 A 13 6 1 = sae Meningoccal infection............... 2 qd: _ ~ —_ _ a _ _ 1 MES) tet ee ee 914 14 224 398 153 53 40 8 2 22 BlatUee sees br. Tn ; 3 = = 1 1 = a 1 = = PREUIMONIA <<. «Sieg ck cs once scree 15,685 3,378 5,158 1,333 540 507 1,189 2,264 1,161 155 PONGHIVENITS o8 oe eee ly. Z — — _ _— 6 4 — => oe Puerperal septicemia ............... 293 1 J 2 2 201 85 1 — - MAWES aioe gral Sha. aes De Ae 6 _ = 1 _ ~ 2 1 1 AF Rheumatic fever ............000...00. 339 22 21 42 63 7, 81 23 9 21 Rocky mt. spotted fever ............. 16 dL: 2 1 5 4 2 _ ~ 1 Rubella (German measles) .......... 268 116 67 19 21 a: yf 5 1 21. SaiMONeliOSIS..>. oo, se se 0n cave Godel. 142 60 27 7 5 8 1 12 10 2 SCADIOSS oo. icctiotea gcse chs SE TR 49 2 10 9 8 11 6 i 2 _ SGanlebqevenc se kee a see 22 2 4 6 5 3 2 _ — _ Strep inal soy cise oe 31,842 478 4,159 6,411 6,134 6,799 5,722 1,413 313 413 SViMiisal tonne... ... 2 fee 727 14 9 5 9 217 270 99 70 34 Prizsec., early latent ..... 055000... 392 4 6 4 6 143 160 39 19 11 WENGER IONS. So 335 10 3 1 3 74 110 60 51 23 WeaGHOMIAy oo ee 1,900 14 134 490 546 341 161 118 74 22 WHCIINOSIS ~ 3.55 eh a — 1 _ ~ = — 1 = 1 Tuberculosis, new active ............ 390 NA NA NA NA NA NA NA NA NA WOHARERMA ss, ck 8 — — — 1 1 _ dL FNMDNOIGFOVER: ooo os. eee oie neo 8 = 1 — 3 — = _ 4 Viral-encephalitis 0. ok 17 2 3 9 — 2 = 1 - WROODIDECGOUBING 36 oy. 6 oe oc. oc 22 11 7 4 ~ — — — _ = NA Not available. ''6P Table 4. Number of reported new cases of notifiable diseases by age among IHS Service Population Calendar year 1975 Under 1 1 to 4 5 to9 10 to 14 15 to 24 25 to 44 45 to 64 65 years Age not Disease Total year years years years years years years and over reported Acute otitis media .................. 56,569 14,420 22,808 6,388 3,601 3,386 3,453 1,328 620 565 Amebiasis ..................00000 005 8 _ 1 2 _ 2 2 1 — Bacillary dysentery.................. 3,123 612 1,023 302 162 207 366 244 170 37 Botulism ................ 00000 e eee : 6 _ _ 1 = 1 2 2 = ao Chickenpox ...............2005 feusys - . 2,768 322 1,254 913 150 35 20 17 12 35 Diphtheria: hs hk oe ee ee 23 1 1 4 1 8 4 4 = — Food poisoning (bacterial) ........... 21 1 2 4 3 1 2 4 4 _ Gastroenteritis ...................00. 38,926 9,710 9,962 3,357 2,455 3,408 5,012 2,946 1,705 371 Gonococcal infections ............... 9,084 23 23 23 136 5,193 3,281 319 48 38 Hepatitis, infectious ................. 1,872 78 353 398 381 274 246 100 19 23 Impetigo ........... 0. e eee eee eee 20,940 1,207 8,728 5,892 2,551 1,165 784 292 161 160 Infectious mononucleosis ........... 24 — _ 4 7 7 5 1 — — Influenza... 0... eee eee eee 15,735 563 2,231 2,219 2,011 2,538 3,623 1,774 679 97 Measles (Rubeola) .................. 842 225 375 153 45 15 8 5 9 7 Meningitis, aseptic .................. 83 31 5 11 6 14 8 7 1 — Meningoccal infection............... 10 _ — _ _ 2 2 3 2 1 Mumps .....0.....00 0c cece e eee eee 807 7 219 340 135 52 36 15 1 2 Plague ...... 2.0.0 7 _ 1 1 2 _ 2 1 — _ Pneumonia ................0.200000- 16,299 3,723 5,327 1,228 494 850 - 1,529 1,460 1,533 155 Poliomyelitis ....................0008 4 a = ao 1 _ 1 2 — = Puerperal septicemia ............... 212 2 1 _ 6 130 66 5 2 — Rabies ................ 020 4 a — _ 1 — 2 1 Rheumatic fever .................... 361 5 25 41 81 85 77 24 22 1 Rocky mt. spotted fever ............. 23 _ 2 4 6 6 4 1 — = Rubella (German measles) .......... 213 83 58 30 11 13 10 —_ 4 4 Salmonellosis ................00 eee 113 43 22 2 1 9 14 9. 13 — Scabies ......0....0.. 00000 eee eae 276 14 50 42 53 55 38 14 10 _ Scarlet. fever................00220 00. Al 4 13 14 5 4 1 — — _ Strep throat ..................00000. 35,603 668 4,669 7,180 6,970 7,328 6,497 1,557 413 321 Syphilis, all forms................00. 904 29 16 4 15 337 324 111 73 5 Pri., sec., early latent .............. 499 4 6 4 9 211 190 55 16 4 Other forms .................2005. 405 15 10 _ 6 126 134 56 57 1 JraGhOMa nc... ee cc eee eee eee 1,885 7 215 398 488 303 241 163 50 20 Trichinosis ..........0...00 0000 eee iL _ — — ~ 1 - _ — _ Tuberculosis, new active ............ 536 NA NA NA NA NA NA NA NA NA Tularemia ........0..0. 0000 cee eee 3 _ _ 2 1 = — —_ _ _ Typhoid fever.................22000- 1 _ — 1 _ _ _ — aa — Viral encephalitis ...............2... 10 5 2 1 _ 1 1 _ _ — Whooping cough.................... 21 17 1 3 ea = — ~ _— _ NA Not available. ''og Table 4. Number of reported new cases of notifiable diseases by age among IHS Service Population Calendar year 1976 Under 1 1to4 5 to9 10 to 14 15 to 24 25 to 44 45 to 64 65 years Age not Disease Total year years years years years years years and over reported Acute otitis media .................. 58,871 15,496 23/159 6,918 3,687 3,465 3,705 1,339 633 469 PYREDIABIS oa She Gees cig te, 14 _ 1 = iL — 5 4 3 — Baedlary ‘dysentery... 0.26.5 ee ek 2,210 453 686 209 Lk 148 250 199 a5 18 ESOMINS oe, ee sey 18 1 1 2 1 3 1 2 2 _ CTHORENDON S60 fais ok Se ENS he as 3,449 398 617 1,138 184 49 21 8 16 18 BNE ie ee ee kee peas 15 1 2 - 3 4 3 2 — Food poisoning (bacterial) ........... 19 — 3 2 4 6 = 4 _ —_ GASIOEINEMUS... 2 ee 38,273 10,559 9,302 2,823 2:21) 3,421 4,947 3,006 1,724 280 Gonococcal infections ............... 8,490 23 25 35 147 4,850 3,014 323 32 41 Hepatitis, infectious................. 1,465 90 237 345 210 236 230 tS 28 14 WDEURO eo oie ee ek 22,295 1,528 9,091 6,096 2,828 1,307 842 335 138 130 Infectious mononucleosis ........... 18 — 2 3 5 5 3 — _ sae MMH eee eS 19,320 655 2,201 2,729 2,466 3,630 4,529 2,191 827 92 Measles (Rubeola) .................. 805 222 285 170 72 31 9 4 4 8 MENINGITIS; AaSePUG 6 65550 5 oe 3 90 42 is 4 8 14 8 — 1 — Meningoccal infection............... 4 _ 2 1 _ ~ _ 1 _ — 1 LL ON Si i i se ae a a ne 1,758 21 447 906 198 77 72 Ly. 8 12: GRC ee ee ae gh 6 _ 1 — 1 4 _ _ _ a PACUTMONIA fick oe. ete ce 17,392 4,219 5,806 1,264 555 818 1,576 1,549 1,482 123 PONOMVCIUS:. ose ook. ol 555 soaked. 9 — ~ = _ 8 1 — — ae Puerperal septicemia ............... 284 2 A 1 6 186 80 6 Z — RRAINCS se Pe ee tee 3 1 _ _ _ ao 1 _ 1 INMCUINAIC TEVED 2 ites... 403 13 36 45 56 79 92 52 26 4 Rocky mt. spotted fever ............. 21 — 2 2 Z i) 5 2. 1 _ Rubella (German measles) .......... 174 76 44 15 15 14 4 3 3 _ Salmonellosis... . hg ee oe 96 46 14 2 2 5 11 14 2 - SCADIESt Cs ae fs Soe ye Elo, eee 1,127 67 202 178 168 231 196 61 23 . DECKER IOVE! 68 col GS ois 33 2 a: AM: ak 3 5 — _— _ SHED UINOaU © Oy ke): 35;226 586 4,123 7,248 6,705 7,748 6,596 1,632 369 219 Syphilis allsforms: «0.805. Sse 894 12 6 6 9 348 309 116 83 6 Pri., sec., early latent.............. 469 4 4 5 4 199 182 55 13 3 Omemornns rs a Be 425 8 2 — 5 149 127 61 70 3 AVaChOina 628 eek 1,629 10 140 394 456 269 189 89 61 21 SERIGEHNOSIS. She ee oes ia 4 = — — 1 1 2 — — a Tuberculosis, new active ............ 373 NA NA NA NA NA NA NA NA NA ANEMIA ee eh SC, at Pee 5 — — _ _ 3 1 i ~ _ TYPNGIFEVEL fii. 5 cok bb ab cs of _ _ ~ ~ _ 1 _ _ Vitalcencepnantis . ees 000228, 14 3 _ 1 1 3 ‘4 ~ 2 _ WOODING COURRS oe ale. eek ok 30 19 6 2 _ 1 ~ 1 1 _ NA Not available. ''TG Table 4. Number of reported new cases of notifiable diseases by age among IHS Service Population Calendar year 1977 Under 1 1to4 5 to 9 10 to 14 15 to 24 25 to 44 45 to 64 65 years Age not Disease Total year years years years years years years and over reported Acute otitis media .................. 61,546 15,610 23,965 7,437 3,857 3,887 3,942 1,508 592 748 Amebiasis:. rma som 23. NEXT OF KIN RELATIONSHIP ADDRESS 24. PERSON TO NOTIFY (if not next of kin) RELATIONSHIP ADDRESS 25. ADDITIONAL INFORMATION-INCLUDE POSTAL ADDRESS IF NOT ABOVE. 28. 26. ICDA DIAG. CODE » HOSP. ACQ. INFEC. OR ACCIDENT ESTABLISHED DIAGNOSES (including complications). USE STANDARD TERMINOLOGY ONLY. reason as (3) (4) (s (Continue on Reverse) 32. POST-OP INFECTION (6) 29. ICDA 30. FOR DIAG.| 31. OPERATION |(Enter (1), (2) CODE or (3) from 28 above) OPERATIVE AND SELECTED PROCEDURES DATE YES NO (Continue on Reverse) 35. NAME OF FACILITY TRANSFERRED TO: 36. FACI | CODE | DISPOSITION (cHECK one) DIED WITHIN 48 HOURS 1. DISCHARGED 4- WITH AUTOPSY 37. CLINICAL SERVICE DISCHARGED FROM: 38. CLINICAL s 5 - WITHOUT AUTOPSY ERV. CODE 2. TRANSFERRED DIED AFTER 48 HOURS 6 - WITH AUTOPSY 39. CONSULTATIONS (number) IRREGULAR * DISCHARGE 7 - WITHOUT AUTOPSY 43. PLACE OF INJURY 40. DATE OF INJURY 41, ALLEGED CAUSE OF INJURY (include hospital accidents) 42. 1cD A CODE R H 46. DUE TO . DUE TO 48. UNDE ( cause) peat 51. REVIEWED BY 49. DATE 50. ATTENDING PHYSICIAN S SIGNATURE HSA-44-1 (Formerly HSM-44-1) 1-74 58 : ''ae pt Soe Mas ac ae '' ''oo i veene ''ET SEN ''