WPCdj #5&SCxHP=SM"3%7ݢp(%qYVA?P/n*>aJ#ު77AJ VAD9`y*kU2O5ՎU7o2_ve0b*1!?.OAgB9 P]x>#oj 'Mj=ƕ*o2 5ęu G{"d]䖔s$,9azTN.B0XQz\>i_=UzoF>|A#" 05>5 0j5 0^6 0O7 0=8 0(9 0: 0: 0; 0< 0= 0t> 0gS? 0w? 0X@ B@ 0@ 0A 0SB 0C 0C 0D 0E 1F 0 G 0G 0H 0I 0fJ 00K 0L 0L 0M 0N 0wO 0IP 0Q 0Q 00R 0<R 0S 0>S 0vT 0`T 0`T 0`KU 0`U 0` V 08kV 0V 02uW 0W 0:X 0YX 0_6Y 0 Y 0jZ 0 \ D/] D+] C] 0^ D/_ 0_ 06` 0` 0:a 0^a 0<Xb 0Nb D5bU6cU>McU*c"cc D5c B d D5)d B^d D5{d Cd D5d Bd D1e D5Me B*e D5e B*e D5 f B*@f D5jf B7f B7fff D5 g g g g g g g CBg C\g Cvg Cg Cg Cg Cg Cg Ch C,h,h,h,h,h,h,h,h,h,h,h,h,h,h,h,h,h,h,h,h,h,h,h,h,h,h,h,h,h,h,h,h,h 0@Fh 0Bhhhhhhhhhh 0Dhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh B* j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j j jf6ja8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8j8jNjHP LaserJet 6MPT||T0(9 Z6Times New Roman RegularX($USUS.,ԄrAZ"Arial Regular!"#%&'()xFGaeimquy}Bullet ListBullets List,  AZArial  d3#37=CIQYag1.a.i.(1)(a)(i)1)a) i)D, p*:i+003|xU ,|AZArial 2J+M 0_level1  X 2( ` hp x 223  ..  5+ ` hp x 5  2G+M 0_level2   /%` ` hp x /23  ..  5+ ` hp x 5  2D+M 0_level3   ," hp x ,23  ..  5+ ` hp x 5  2A+M 0_level4  ` ) hp x )23  ..  5+ ` hp x 5  2>+M 0_level5   &hhp x &23  ..  5+ ` hp x 5  2;+M 0_level6   #p x #23  ..  5+ ` hp x 5  28+M 0_level7  h  p x 23  ..  5+ ` hp x 5  25+M 0_level8   pp x 23  ..  5+ ` hp x 5  22+M 0_level9    x 23  ..  5+ ` hp x 5  2JM 0_levsl1  X 2( ` hp x 223  Ԁ  5+ ` hp x 5  2GM 0_levsl2   /%` ` hp x /23  Ԁ  5+ ` hp x 5  ((%$X9XXX2A3  0  X9XXX(O;$0  2#  a  .3  0` (#(#(b$0  0` (#(#2#   .3  0 ` (#` (# d(xir$0  0` (#(#0 ` (#` (#2#(  0  )3  0 (# (#($0  0` (#(#0 ` (#` (#0 (# (#2#(  a  )3  0h(#(#(F$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#2#(   )3  0h(#h(#($0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#2#  0  )3  0(#(#({$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#2#  a  )3  0p(#(#2DM 0_levsl3   ," hp x ,23  Ԁ  5+ ` hp x 5  2AM 0_levsl4  ` ) hp x )23  Ԁ  5+ ` hp x 5  !"#%&'()xCEKQW]cioAutoList1        2>M 0_levsl5   &hhp x &23  Ԁ  5+ ` hp x 5  2;M 0_levsl6   #p x #23  Ԁ  5+ ` hp x 5  28M 0_levsl7  h  p x 23  Ԁ  5+ ` hp x 5  25M 0_levsl8   pp x 23  Ԁ  5+ ` hp x 5  22M 0_levsl9    x 23  Ԁ  5+ ` hp x 5  2JM 0_levnl1  X 2( ` hp x 223   5+ ` hp x 5  2GM 0_levnl2   /%` ` hp x /23   5+ ` hp x 5  2DM 0_levnl3   ," hp x ,23   5+ ` hp x 5  2AM 0_levnl4  ` ) hp x )23   5+ ` hp x 5  2>M 0_levnl5   &hhp x &23   5+ ` hp x 5  2;M 0_levnl6   #p x #23   5+ ` hp x 5  28M 0_levnl7  h  p x 23   5+ ` hp x 5  25M 0_levnl8   pp x 23   5+ ` hp x 5  22M 0_levnl9    x 23   5+ ` hp x 5  0.Normal<:Definition T<AA:Definition L , 5+ ` hp x 5  5+ ` hp x 586Definition(''&H1      XXX(&H2  XXX(&H3  XXX(&H4 XXX XXX(&H5  XXX(&H6  XXX20Address8MM6Blockquote , , 5+ ` hp x 5   5+ ` hp x 5,*CITE,dl*CODEK\<6X9`(Courier NewKXXXS]\  `&Times New RomanS42Emphasis64Hyperlink    <:FollowedHype    4go2Keyboard K\<6X9`(Courier NewK XXXS]\  `&Times New RomanS<:Preformatted/%  ,Kk %#/K\<6X9`(Courier NewKXXXS]\  `&Times New RomanS/%  ,Kk %#/<:zBottom of 7O(X7  ?^%2A`Arial?7P(X7  XXXS]\  `&Times New RomanS)1dxd'dxd d<:zTop of For7S(X7  ?^%2A`Arial?7P(X7  XXXS]\  `&Times New RomanS)2dxd0KS.SampleK\<6X9`(Courier NewKS]\  `&Times New RomanS0.Strong 8dl6TypewriterK\<6X9`(Courier NewKXXXS]\  `&Times New RomanS42Variable: 8HTML MarkupB      2 0CommentB  (O$$$$$)!dxdx<6X9`(Courier New\  `&Times New Roman%2A`Arial    bbbb)!dxdx  ddddd)!dxdxP Pd )!dxdxdhhhh)!dxdx ddd)! dxdxkkkk)!dxdx&P d dmmmm)!dxdx&p d Pdoooo)!dxdx&p Pd dqrqr)!dxdx3+0 d d d3+0 d d d)!dxdxdd(d2d40conditionsintheUnitedStates.Tominimizetheburdenplacedonthosewhoreportthe 0 data,CDClimitstheamountofinformationcollectedforeachcase._NNDSS_Ԁdataareusedtomonitor @ diseasetrends,evaluatepublichealthprograms,andidentifyunusualoccurrencesofconditionsthatmay  requirefurtherepidemiologicinvestigationatthelocallevel. p Forsomepublichealthpurposes,effectiveactionrequiresadditionaldetailsoneachcase.  @ Supplementaldatacollectionsystemshavethereforebeendevelopedforsomeofthediseasesreported   to_NNDSS_.Thesesystemsmaybelesscomprehensiveintermsofpopulationsrepresentedbutprovide p   moredetailedinformationoncharacteristicsoftheoccurrenceofdisease.Forexample,casesof 0   hepatitisarereportedweeklyto_NNDSS_ԀforpublicationintheMorbidityandMortalityWeeklyReport  @  (_MMWR_).Inaddition,theViralHepatitisSurveillanceProjectcollectsdataonriskfactorsfordifferent    typesofviralhepatitisinselectedgeographicareas.Thesedatahavebeenusedtodocumentthe x  importanceofbehaviorsassociatedwithsexualactivityanddruguseasriskfactorsfortransmitting 8  hepatitisBvirusandtotargeteducationandvaccinationprograms. H  Controlofsomeconditionsrequiresmoredetailedinformationthancanbeobtainedfeasiblelyfroma x  largegroupofcliniciansorinstitutions.Networksofselectedhealthcareprovidershavethereforebeen 8  organizedtomeetthesetargetedinformationneeds.Forexample,CDCsSentinelEventNotification H SystemforOccupationalRisks(SENSOR)targetsgroupsofhealthcareprovidersasacomponentofa  comprehensiveapproachforobtainingdataonwhichtobaseeffortstopreventworkplacerelated x morbidity.TheNational_Nosocomial_ԀInfectionsSurveillanceSystem(_NNIS_)receivesreportsfroma 8 selectedgroupofhospitalsontheincidenceandcharacteristicsofhospitalacquiredinfections.Data H fromthissystemhavebeeninstrumentalinalertinghealthauthoritiestotheemergenceofantibiotic  resistantstrainsofbacteria,whichinturnhasledtothedevelopmentofrecommendationsforthe x appropriateuseofantibiotics. 8 Vitalstatistics:Vitalrecords(e.g.,births,deaths)aretheprimarysourceofsomeofthemost  fundamentalpublichealthinformation.Dataonteenbirths,accesstoprenatalcare,maternalrisk x factors,infantmortality,causesofdeath,andlifeexpectancyareamongthestaplesofpublichealth 8 informationprovidedbyvitalstatistics.Vitalstatisticsareoftenthemostcompleteandcontinuous H informationavailabletopublichealthofficialsatthenational,state,andlocallevels;thetimely   availabilityofthesedataiscriticallyimportant. x! IntheUnitedStates,thelegalauthorityforvitalregistrationrestswiththestatesandterritories.CDCs H# NationalCenterforHealthStatistics(_NCHS_)producesnationalvitalstatisticsbycollectingdatafromthe $ vitalrecordsofthestates._NCHS_Ԁworkswiththestatestoensureauniformnationaldatabasethrough x % thepromotionofstandarddatacollectionformsanddatapreparationandprocessingproceduresand 8!& alsoprovidespartialfinancialsupportforstatesystems. !H' Healthstatus,riskfactors,andexperiencesofpopulations:Sincethedeterminantsofmanyhealth x#) problemsarebehavioral,environmental,orgenetic,healthagenciesneedinformationthatisnotreadily 8$* availablefrommedicalrecordsontheprevalenceofvarioustypesofbehaviorandonaccesstocare. $H + Thus,regularlyconductedsurveysofthegeneralpopulationareneededforpublichealth.Thesesurveys %!, rangefromlargescaleassessmentsofthegeneralpopulationtoassessmentstargetedathighrisk(i.e., x&!- particularlyvulnerable)populations.Thisneedisparticularlyacuteatthestateandlocallevels.Surveys 8'". provideinformationon:1)baselinehealthstatus,2)morbidity,3)prevalenceofbehavioralriskfactors,4) 'H#/ useofhealthcareservicesandidentificationof_underserved_Ԁpopulations,and5)potentialforexposureto ($0 toxicagents.Informationgeneratedfromthesurveysisusedindevelopingpreventionandcontrol x)$1 programsandinensuringadequatedeliveryofhealthservices. 8*%2 Potentialexposuretoenvironmentalagents:Informationonexposurestoenvironmentalagentscanbe +'4 usedinevaluatingtheriskstohealthfromnoninfectiousdiseases,injuries,andcertaininfectious x,'5 diseases.Forexample,measurementofairborne_particulates_Ԁisusefulinassessingrisksrelatedto 8-(6 pulmonarydisorderssuchasasthmaandlungcancer.Informationonvectorsthatmaycarryagentsof -H)7 infectiousdiseaseisimportantinevaluatingtheriskforacquiringsuchinfections. .*8 ЇPrograminformation:Dataneededtooperatepublichealthprogramsincludethenumberofclients  servedandthecostsofservicesrendered.Thesedataareusefultopublichealthofficialsinassessing p theeffectivenessofpublichealthprograms,comparingprograms,documentingtheneedforcontinuinga 0 particularprogram,andmaintainingaccountabilityfortaxdollarsspent. @   Informationfromotherorganizations:Datausefulforpublichealtharecurrentlyorpotentiallyavailable x fromorganizationswhosefunctionsmaynotberelatedtothoseofCDCandstateandlocalhealth 8  departments.DatafromtheBureauoftheCensus,forexample,areneededforboththereliable  H computationofratesandtheproperadjustmentofratesforcomparisonovertimeorindifferent   geographicareas.TheEnvironmentalProtectionAgency(EPA)compilesenvironmentalairmonitoring x   datatoassesscompliancewithstandardsforairpollutantsestablishedbytheCleanAirAct.Data 8   collectedthroughthissystemareusedbypublichealthofficialsforhazardalertswhenpollutantsexceed  H  federalstandardsandinstudiesoftheeffectsofairpollutantsonmorbidityassociatedwithrespiratory    diseases.TheOccupationalSafetyandHealthAdministration(OSHA)andtheBureauofLabor x  Statisticscompiledataontheoccurrenceofworkrelatedinjuriesandillnessesandexposuretohazards 8  intheworkplace,whichcanbeusedforsurveillanceandresearch.TheDepartmentofTransportation H  operatestheFatalAccidentReportingSystem,usedinpublichealthtoassessriskfactorsformotor   vehiclerelatedinjuriesanddeaths.CrimestatisticsgatheredbytheFederalBureauofInvestigation x  (FBI)assistinevaluatingthepublichealthimpactofintentionalinjuries,andtheConsumerProduct 8  SafetyCommissioncollectsdataoninjuriesrelatedtoconsumerproducts. H Informationonthehealthcaresystem:Informationisalsoneededonthehealthcaresystemandthe x healthimpactresultingfromchangesinthesystem.CDCprovidesagreatdealofinformationtomonitor 8 thecapacityofthehealthcaresystem,utilizationofthesystem,andaccesstohealthinsuranceand H servicesbytheAmericanpeople.Thesedatainclude:inventoriesofhealthcareproviders;patternsof  utilizationofhealthservicessuchashospitalizationratesanduptakeofnewtechnologies;andaccessto x healthcareandbarriers(bothfinancialandnonfinancial)toaccess. 8      #XTX 5l#XXTA[Q@ dAUFAppendixB K1 dF  @ @@ DataVerificationandValidation pV @2\޾1111!F@@*#XTXF#5 XXTԈ DataverificationandvalidationhelptoensurethatthedataCDCusestoassessperformanceisof mS sufficientquality.ThefollowingdatasystemshavebeenreferencedintheCDCPerformancePlanas - sourcesfordatausedinassessingprogramimplementationandeffectiveness.   BehavioralRiskFactorSurveillanceSystem = #  In1984,CDCinitiatedtheBehavioralRiskFactorSurveillanceSystem(_BRFSS_),aunique,statebased    surveillancesystemdesignedtocollectprevalencedataonbehavioralrisksandconditionsthataffect    health.Statesconductmonthlytelephonesurveysusingastandardizedquestionnairetodeterminethe  k  distributionofbehavioralriskfactors.SurveyresponsesareforwardedtoCDC,wherethedataare E+  aggregatedandpublishedatyearsend.The_BRFSS_Ԁprovidesflexible,timely,andongoingdata   collectionthatallowsforstatetostateandstatetonationcomparisons.Participatingstatesusedata   derivedfromthe_BRFSS_Ԁtoidentifydemographicvariationsinhealthrelatedbehaviors,targetservices, k  addressemergingandcriticalhealthissues,proposelegislationforhealthinitiatives,andmeasure E+  progresstowardstateandnationalhealthobjectives.Thesystem'sbroadnetworkofinformation   gatheringalsoenablesstatestoevaluatetheirdiseasepreventionandhealthpromotionefforts.  The_BRFSS_ԀsurveyinstrumentisathreepartquestionnairedevelopedjointlybyCDCandthestates: E+ "!%"5  5  !%}O2F3  0    Corecomponent:Thefixedcoreisastandardsetofquestionsaskedbyallstateson  demographiccharacteristicsandbehaviorsthataffecthealth(e.g.,tobaccouse,alcohol o consumption).The rotatingcoreincludestwosetsofquestions,eachaskedinalternatingyears I/ byallstates,thataddressdifferenttopics.Theemergingcoreconsistsofuptofivequestions  thattypicallyfocusonlatebreakingissues.Thesequestionsareaddedtothecoreforoneyear  andevaluatedatyearsendtodeterminetheirpotentialvalueinfuturesurveys.!%}OO݌{(#(# Ќ5  5  "!%"5  5  !%S2F3  0    OptionalCDCmodules:Thesearesetsofquestionsonspecifictopics(e.g.,smokelesstobacco U; use,arthritis)thatstatescanopttoincludeintheirquestionnaires.!%SgS݌(#(# Ќ5  5  "!% "5  5  !%T2F3  0    Stateaddedquestions:Thesequestionsaredevelopedoracquiredbyparticipatingstatesand  addedtotheirquestionnaires.!%TU݌{(#(# Ќ5  5  Eachyear,statesandCDCagreeonthecontentofthecorecomponentsandoptionalmodules.For ! easeofcomparabilityanduse,manyofthequestionsaretakenfromestablishednationalsurveys.More " than30validityandreliabilitystudiesattesttothequalityandvalidityofdataderivedfromthe_BRFSS_. {#  ClinicalLaboratoryImprovementsActof1988(_CLIA_) #XTX 5H#XXT !% #XTXlX#5 XXTTheClinicalLaboratoryImprovementsActof1988(_CLIA_)isdesignedtoensurethesoundandscientific !& developmentofnewlaboratorymethods._CLIA_Ԁincludesstandardsthatmustbemetbeforecertification "' ofalaboratorymethod.Thesestandardsincludeanexactingseriesofinternalandexternalevaluations. ]#C( Amongtheinternalchecksisthedevelopmentofadetailedproceduresmanualforeachmethod. $ ) Manualsmustbeverifiedandapprovedbyseniorlaboratorypersonnelwhowerenotdirectlyinvolvedin $ * thedevelopmentofthemethod._CLIA_Ԁalsoprovidesdetailedspecificationsforqualitycontroland %!+ calibrationoflaboratoryequipment.Furtherinternalcontrolisprovidedthroughregularreviewfroma ]&C", designatedQualityAssuranceOfficertaskedwithensuringthatgenerallyacceptedinternationalscientific '#- standardsarebeingfollowedinthedevelopmentofthemethod.Externalevaluationandcontrolare '#. providedthroughregularonsiteinspectionsbystatutorilyapproved,independentinspectionteams. ($/ Inspectorsreviewtheinternalproceduresestablishedbytheorganizationtoensurecompliancewith ])C%0 _CLIA_Ԁstandards.Todate,CDChaspassedallonsite_CLIA_Ԁinspections.  *&1 _   `     h      p   _   .*7 GroupBStreptococcalDiseaseSurveillance,partoftheActiveBacterialCoreSurveillance  (ABCs)   In1989,CDCinitiatedactivesurveillanceforgroupBstreptococcal(_GBS_)diseaseaspartoftheActive  BacterialCoreSurveillance(ABCs)system,anactivesurveillancesystemforseveralpathogensthat jP causeinvasivedisease.Surveillancewasconductedinfivegeographicareasthatwereawarded * contractsafteracompetitiverequestforproposals.In1994,activesurveillancefor_GBS_Ԁdiseasewas  includedasacoreactivityofthenewlyestablishedEmergingInfectionsProgram(_EIP_)network,a  cooperativeagreementprogramthataddressesimportantpublichealthissuesrelatedtoinfectious j P diseases.In1999,the_EIP_Ԁnetworkcomprisedeightstates;allparticipatedinABCsandconducted *  activesurveillanceforinvasive_GBS_Ԁdisease.    Specificobjectivesfor_GBS_Ԁdiseasesurveillanceareto:1)assesstheimpactofCDCprevention j P  guidelinespublishedinMay1996,2)determinetheextenttowhichcontinuingcasesofearlyonset_GBS_ *   diseasearepreventablethroughcurrentpreventionstrategies,3)identify_serotypes_Ԁresponsiblefor   diseasetoguidevaccinedevelopment,4)evaluateprogressintheeliminationof_serotype_Ԁbdisease,5)   detectpossibleemergenceofdiseaseduetoothercapsulartypes,and6)determinepossible jP  preventablereservoirsofthebacteria.Datacollectionfocusesondiseaseoccurrence.State *  surveillanceofficerscontactpersonnelinallmicrobiologylaboratoriesthatprocessbacterialcultures   fromsterilesitestofindcasesof_GBS_.Laboratoryauditsarealsoconductedsemiannuallytodetect   possible_underreporting_.Dataaretransmittedelectronicallyfromthe_EIPs_ԀtoCDCsABCsteamona jP monthlybasis.AnnualsurveillancereportsaremadeavailableontheInternetattheABCswebsite. * Laboratorytestingofisolatescollectedaspartofsurveillanceisperformedinreferencelaboratories.  Electronicfilescontainingresultsoflaboratorytestingofeachstatesisolatesarefedbacktothatstate  onamonthlybasis. jP   Routinelaboratoryauditstoensurethecompletenessofdatacollectionrepresentatremendousstrength  ofthesystem.Eachmonth,CDCstaffreviewdataandtransmitpotentialerrorstostatepersonnelfor  evaluation.Performancestandardsforactivesurveillancehavebeenestablishedineachsitetopermit jP aggregationofdatacollectedviasomewhatdifferentapproaches.Detailedinstructionsforcompletionof * casereportformsensureconsistencyacrosssites.StatesurveillanceofficersandCDCsABCsteam  holdmonthlyconferencecallstoaddresslogisticalandtechnicalaspectsofthesystemandmeet  annuallytoreviewandupdateprotocols,presentspecialstudies,anddiscussinnovations.Sitevisitsare jP currentlyconductedonanasneededbasis,butannualsitevisitsareplanned. *  Easyaccesstothedataisprovidedthroughawebsitethatincludesthebasicprotocolandonepage " yearlysurveillancereportsforeachpathogen.Additionalinformationon_GBS_Ԁisavailableonawebsite jP# focusedonthatinfection,withmanymaterialstargetedtopregnantwomenorhealthcareprovidersand *$ publichealthworkersconcernedwithpregnantwomen. %   Theprincipallimitationof_GBS_ԀdiseasesurveillancethroughtheABCsisthatitisnotconducted j!P' throughouttheUnitedStates.Substantialgeographicvariationintheincidenceofinvasive_GBS_Ԁdisease *"( hasbeennoted,anditisunclearwhetherstatesoutsideABCsareashaveexperiencedchangesinthe ") incidenceof_GBS_Ԁdiseasethatarecomparabletothosenotedinthesurveillanceareas.Onewayof #* addressingthislimitationistoincreasetheavailabilityofABCsmethodsandtools.Throughthewebsite j$P + andfrequentpublications,CDCisattemptingtoprovideotherstatehealthdepartmentswithinformation *%!, thatcanhelpthemassesswhethertheeffortsinvolvedinconductinginvasive_GBS_Ԁdiseasesurveillance, %!- particularlyforearlyonsetdiseaseininfants<7days,arefeasibleintheirlocales. &".  IntegratedResourcesInformationSystem *($0  CDCsIntegratedResourcesInformationSystem(IRIS)isacollectionofapplicationstoassist ($1 managementinbudget,staffing,andprojectplanning,tracking,andreporting.TheIRISbudget )%2 applicationprovidesdetailedbudgetinformationbyCDCcomponent.Itallowsmanagerstoviewbudget r*X&3 reportsgroupedbyavarietyofoptions.IRISstaffingisaviewonlyapplicationdesignedtoallowusers 2+'4 toquicklyaccesspersonneldatareportsandprojectemployeesalariesforaspecifiedtimeperiod.The +'5 projectsapplicationallowsmanagerstoplan,track,andmanagevarioustypesofprojects.This ,(6 applicationprovidesaccesstoprojectdata,resources,andadministrativefunctions.Allinformationfora r-X)7 projectmustbemaintainedintheIRISprojectscomponenttoensureconsistencyandreliabilityofdata. 2.*8 TheIRISreportsapplicationisthedata.retrieval,andreportingcomponent. .*9 Ї ,!"#%&'()(xx !"#%&'() NationalHealthandNutritionExaminationSurvey   TheNationalHealthandNutritionExaminationSurvey(_NHANES_)isaprogramofstudiestoassessthe  healthandnutritionalstatusofadultsandchildrenintheUnitedStates.Startedintheearly1960s,  _NHANES_Ԁistheonlynationalsourceofobjectivelymeasuredhealthdatacapableofprovidingaccurate bH estimatesofbothdiagnosedandundiagnosedmedicalconditionsinthepopulation.Findingsfromthe " surveyareessentialfordeterminingratesofmajordiseasesandhealthconditionsandfordeveloping  publichealthpoliciesandpreventioninterventions.Thesurveyscreens15,000householdsperyearand  selects3,500.Fromthissample,5,000personsareinterviewedandexaminedannually.Samplesare b H recruitedfrom15countiesorclustersofcountieseachyear.Samplescomprisesufficientnumbersto "  providereliableestimatesbygenderandagegroupfornonHispanicwhites,MexicanAmericans,and    AfricanAmericans.    Dataarecollectedviahealthinterview,physicalexamination,andclinicalandlaboratorytests. "   Interviewsareconductedinrespondentshomes.Physicalexaminationsareperformedinspecially   designedmobileexaminationcentersthattraveltosurveylocationsthroughoutthecountry.These   centersallowforthecollectionofdataonchronicconditions,nutritionalstatus,medicalriskfactors, bH  dentalhealth,vision,illicitdruguse,bloodleadlevels,foodsafety,andotherfactorsthatarenotpossible "  toassessbyuseofinterviewsalone.Themedicalteamconsistsofaphysician,dentist,medicaland   healthtechnicians,anddietaryandhealthinterviewers;trainedbilingualstaffconductthehousehold   interviews. bH Anadvancedcomputersystemusinghighendservers,desktopPCs,andwideareanetworkingisused  tocollectandprocessall_NHANES_Ԁdata,nearlyeliminatingtheneedforpaperformsandmanualcoding  operations.Householdinterviewersusenotebookcomputerswithelectronicpensfordatacollectionin bH thefield.Datacollectedinthemobileexaminationcentersareautomaticallytransmittedviaaframe " relaynetworkintocentraldatabases.SurveyinformationisavailabletoCDCwithin24hoursof  collection.  Informationfrom_NHANES_Ԁisdisseminatedthroughanextensiveseriesofpublicationsandarticlesin " scientificandtechnicaljournals.SurveydataarealsoavailableonCDROMandcomputerdiskettes.In  previousyears,datawereavailableforanalysisapproximately31monthsaftercollection.Agoalisto  improvethetimelinessofdatadissemination.Thecomputerizedsystemhasalreadysubstantially bH improvedaccesstothedatafromthefield. "  Acomprehensivequalityassuranceprogramisinstitutedbeforedatacollectionbegins,withappropriate " trainingthatrequiressignificantpracticetimeforthehealthexaminersandinterviewers.Training bH# focusesonhandsonexperienceratherthandidacticmethods.Duringdatacollection,healthexaminers "$ andsurveystaffmeetregularlytodiscussoperations,updates,andproblems.Staffareretrainedas % needed.  & _NHANES_Ԁreliesonbothpassiveandactivemonitoringsystemsforoperationalandcontentrelated ""( qualitycontrol.Passivequalitycontrolusesautomatedcomputerproceduresfordetectingdata ") anomalies.Aftercarefulanalysis,appropriateactivitiescanbeundertakentoresolveanydatacollection #* issues.Activequalitycontrolreliesonexaminerfeedbacktoidentifyandevaluateproblemsandselect b$H + remedies._NHANES_Ԁprimarilyreliesonphysicalmeasurementsfromwellestablishedbiomedical "%!, procedures.Inmostinstances,thesemeasurementsrepresentthegoldstandarddataagainstwhich %!- selfreporteddatamightbevalidatedforothersubjectivedatacollectionmodalities.Newtechnologies &". underconsiderationareevaluatedtodetermineiftheyprovidevalidestimatesofthecondition,risk b'H#/ factor,ormeasurementforwhichtheyarebeingused.Theevaluationmightincludeascientific "($0 literaturereview,expertworkshop,orvaliditystudy. ($1    `     .*9 UF U U  NationalHealthInterviewSurvey   TheNationalHealthInterviewSurvey(_NHIS_)istheprincipalsourceofinformationonthehealthofthe  civilian,noninstitutionalizedpopulationoftheUnitedStates.Thepurposeofthe_NHIS_Ԁistomonitorthe  healthoftheU.S.populationthroughthecollectionandanalysisofdataonabroadrangeofhealth bH topics.Astrengthofthesurveyistheabilitytodisplaythesehealthcharacteristicsbymany " demographicandsocioeconomicfactors._NHIS_Ԁdataareusedwidelythroughout_DHHS_Ԁtomonitortrends  inillnessanddisabilityandtotrackprogresstowardachievingnationalhealthobjectives.Thedataare  alsousedbythepublichealthresearchcommunityforepidemiologicandpolicyanalysis. b H The_NHIS_Ԁisacrosssectionalhouseholdinterviewsurvey.Samplingandinterviewingarecontinuous    throughouteachyear.Householdschosenforinterviewsareaprobabilitysamplerepresentativeofthe    targetpopulation._NHIS_Ԁdataarecollectedannuallyfromapproximately43,000householdsincluding b H  about106,000persons.Surveyparticipationisvoluntary,andtheconfidentialityofresponsesis "   ensured.Theannualresponserateis>90%ofeligiblehouseholdsinthesample.   The_NHIS_Ԁhasthreemodules: bH   !"#%&'()(Fxx,!"#%&'()"!%"5  5  !%2F3  0    Thebasicmoduleremainslargelyunchangedfromyeartoyearandallowsfortrendanalysis.   Datafrommorethanoneyearcanalsobepooledtoincreasethesamplesizeforanalytic   purposes.Thebasicmodulecontainsafamilycore,asampleadultcore,andachildcore bH throughwhichdataarecollectedonthefamilyunitandfromonerandomlyselectedadultand " child.!%˖݌(#(# Ќ5  5  "!%"5  5  !%<2F3  0    Periodicmodulescollectmoredetailedinformationonsomeofthetopicsincludedinthebasic  module.!%<݌bH(#(# Ќ5  5  "!%"5  5  !%2F3  0    Topicalmodulesrespondtonewdataneedsastheyarise.!%݌"(#(# Ќ5  5  Dataarecollectedthroughapersonalhouseholdinterviewconductedbystaffemployedandtrainedby  theU.S.BureauoftheCensusaccordingtoproceduresdelineatedbyCDC.Dataarereviewedand bH analyzedextensivelytoensuretheirvalidityandreliability.Thesurveysampleisdesignedtoyield " estimatesthatarerepresentativeandthathaveacceptablysmallvariations.Beforetheactualsurvey,  cognitivetestingisperformedbyCDCsQuestionnaireDesignResearchlaboratory,andpretestsare  conductedinthefield.Oncecollected,dataarecarefullyedited,checked,andcomparedtodatafrom bH earliersurveysand/orindependentsources.Staffmemberscalculatedescriptivestatisticsandperform "  indepthanalyses,whichresultinfeedbackontheanalyticusefulnessofthedata. ! Inthepast,ithastakenapproximately26monthsforthesurveydatatobereleasedforagivenyear. bH# Improvingthetimelinessof_NHIS_Ԁdataisa_GPRA_Ԁperformancemeasure. "$  NationalHospitalDischargeSurvey   & TheNationalHospitalDischargeSurvey(_NHDS_),conductedannuallysince1965,isanational j!P' probabilitysurveydesignedtomeettheneedforinformationoncharacteristicsofinpatientsdischarged *"( fromnonfederal,shortstayhospitalsintheUnitedStates.The_NHDS_Ԁcollectsdatafromasampleof ") approximately300,000inpatientrecordsacquiredfromanationalsampleofabout500hospitals.The #* _NHDS_ԀprovidesnationalandregionalestimatesofU.S.inpatienthospitalutilizationbythedemographic j$P + characteristicsofpatientsdischarged,conditionsdiagnosed,andsurgicalandnonsurgicalprocedures *%!, performed.Approximately95%ofeligiblesamplehospitalsrespondtothesurvey. %!- The_NHDS_Ԁusestwodatacollectionmethods:1)amanualsysteminwhichhospitalstafforstaffofthe j'P#/ U.S.BureauoftheCensusabstractdatafrommedicalrecords,and2)anautomatedsysteminwhich *($0 CDCpurchasesmachinereadablemedicalrecorddatafromcommercialorganizations,statedata ($1 systems,hospitals,orhospitalassociations.Approximately40%ofhospitalsprovidedatathroughthe )%2 automatedsystem.Dataaregenerallyavailableabout17monthsaftercollection.Timelinessisbeing j*P&3 addressedaspartofthe_GPRA_Ԁeffort. *+'4 Anongoingqualitycontrolprogramhelpstoensuretheaccuracyof_NHDS_Ԁdata._NHDS_Ԁdatahavebeen ,(6 foundtobeagoodreflectionofinformationfoundinmedicalrecords.Whatisnotknownisthedegree j-P)7 towhichmedicalrecordinformationreflectsactualperformance. *.*8  .*9  NationalImmunizationSurvey   TheChildhoodImmunizationInitiative(_CII_)isoneofmanyfederal,state,andlocalprogramsmountedto  raisevaccinationlevelsinyoungchildren.The_CII_Ԁestablisheda1996goalofincreasingvaccination  levelsfor2yearoldchildrentoatleast90%formeaslesmumpsrubella,diphtheriaandtetanus_toxoids_ bH andpertussisvaccine,oral_poliovirus_Ԁvaccine,andI  _Haemophilus_Ԁ_influenzae_IjanA  ݀typebvaccine.Inaddition, " the_CII_Ԁestablishedagoalfor1996toincreasevaccinationlevelsfor2yearoldchildrentoatleast70%  forthreeormoredosesofhepatitisBvaccine.  TheNationalImmunizationSurveyӀ(_NIS_)isusedtoassessprogresstowardsthesegoals._NIS_Ԁdata &  providecurrent,populationbased,stateandlocalestimatesofvaccinationcoverageproducedbya    standardmethodology.Quarterlydataarecollectedviahouseholdinterviewsin50states,theDistrictof    Columbia,and27urbanareas.Interviewsareconductedbytelephonewithrandomlyselected f L  households..Eachquarter,CDCcalculatesestimatesofvaccinationcoveragelevelsandmakesvalid &  comparisonsofstateeffortstodelivervaccinationservices.CDCuses_NIS_Ԁdatatoevaluateprogress   towardsnationalvaccinationgoalsandtoidentifystateswiththehighestandlowestimmunizationrates.   Toensuretheaccuracyandprecisionofcoverageestimates,immunizationdataforsurveyedchildren &  arealsocollectedthroughamailsurveyoftheirpediatricians,familyphysicians,andotherhealthcare   providers.Theparentsandguardiansof_NIS_Ԅeligiblechildrenareaskedduringthetelephoneinterview   forconsenttocontact_childrens_'medicalproviders.Typesofimmunizations,datesofadministration,and fL additionaldataaboutfacilitycharacteristicsarerequestedfromimmunizationprovidersidentifiedduring &  thetelephonesurveyofhouseholds._NIS_Ԁestimatesofvaccinationcoveragethereforereflecta  comparisonofinformationprovidedbybothimmunizationprovidersandhouseholds.   NationalVitalStatisticsSystem  &  Vitalstatisticsareoftenthemostcompleteandcontinuousinformationavailabletopublichealthofficials  atthenational,state,andlocallevels.TheNationalVitalStatisticsSystemisresponsibleforthenations  officialvitalstatistics.Theregistrationofvitalevents!births,deaths,marriages,divorces,fetaldeaths! nT isastatefunction,andvitalstatisticsareprovidedthroughstatebasedregistrationsystems.Since . 1902,thefederalgovernmenthasobtaineduseoftherecordsforstatisticalpurposesthrough  cooperativearrangementswiththeresponsibleagenciesineachstate.Standardformsforthecollection  ofdataandmodelproceduresfortheuniformregistrationofeventsaredevelopedandrecommendedfor nT stateusethroughcooperativeactivitiesofthestatesandCDC.CDCalsoprovidestrainingand .  instructionalmaterialstothestatesaspartofongoingtechnicalassistance. ! Thepurposeofcollectingthedataistomonitortrendsovertimethroughvitallifeevents.Vitalrecords nT# andreportsoriginatewithprivatecitizens,suchasthefamilyaffectedbytheevents,physicians,or .$ funeraldirectors.Bylaw,birthregistrationisthedirectresponsibilityofthehospitalofbirthorthe % attendantatthebirth.Intheabsenceofanattendant,theparentsofthechildareresponsiblefor  & registeringthebirth.Althoughproceduresvaryfromhospitaltohospital,personalinformationisusually n!T' obtainedfromthemother;medicalinformationmaybeobtainedfromthechartorfromaworksheet ."( completedbythebirthattendant.Reportingrequirementsvaryfromstatetostate;ingeneral,the ") completedcertificatemustbefiledwiththestateorlocalregistrarwithin10daysofbirth.Publisheddata #* representallcountiesandplacesof10,000ormorepopulation.Electronicfilesincludedataforstates, n$T + counties,largecities(populationof100,000ormore),andmetropolitanstatisticalareas. .%!, Bylaw,deathregistrationisthedirectresponsibilityofthefuneraldirectororpersonactingassuch.The &". funeraldirectorobtainsthedatarequired,otherthanthecauseofdeath,fromthedecedentsfamilyor n'T#/ otherinformant.Theattendingphysicianprovidesabestmedicalopinionaboutthecauseandmanner .($0 ofdeath;laterthisinformationiscodedbythestateorCDCaccordingtouniformcodes.Demographic ($1 informationisalsorecorded.Ifnophysicianwasinattendanceorifthedeathwasduetootherthan )%2 naturalcauses,themedicalexaminerorcoronerinvestigatesthedeathandprovidesthecauseand n*T&3 manner.Reportingrequirementsfordeathvary,butingeneralthecompletedcertificatemustbefiled .+'4 within3to5daysofthedeath.Publisheddataincludeallcountiesandplacesof10,000ormore +'5 population.Electronicfilesincludedataforstates,counties,largecities(populationof100,000ormore), ,(6 andmetropolitanstatisticalareas. h      p  n-T)7  .*9 _FetaldeathsarealsoreportedthroughtheNationalVitalStatisticsSystem.Allfetaldeathsof20weeks  ormoregestationthatoccurintheUnitedStatesarerecorded.Alinkedbirth/infantdeathfileallowsfor  theanalysisofdemographicandhealthcharacteristicsfromcertificatesoflivebirthsincombinationwith  causesofdeathandotherdatafromdeathcertificatesofinfantswhodiedbeforetheirfirstyearoflife. Z@ ThelinkedfilesetincludesinformationonalltheinfantswhodiedintheUnitedStateseachyear,aswell  asinformationonalllivebirths.Anadditionalfileincludesinformationondeathrecordsnotlinkedto  birthcertificates.Thematchrateisabout97%98%.Dataareorganizedbycalendaryear.  Provisionalandfinalestimatesofthenumberofmarriagesanddivorcesareobtainedfromeachstate   abletoprovidethesefigures.Sincedataarenotavailablefromallstates,nationaldivorceratesarenot    produced.Detailedcharacteristicsofmarriagesanddivorceshavenotbeenavailablesince1996.    Vitalstatisticsdataarecollectedusinguniformproceduresandareaccurateandconsistent.Thedata   arereportedassoonastheyareanalyzedbyCDCstaff.Monthlyprovisionalnumbersandratesare   publishedintheNationalVitalStatisticsReports.Thesefiguresarebasedonapproximatecountsofthe   numberofeventsthatoccurredinagivenstate;anestimationprocedureisusedtoconvertthese ^D  occurrenceestimatesintostatespecificestimatesofthenumberandrateofresidentevents.   PreliminarydatacollectedthroughtheNationalVitalStatisticsSystemaremadeavailabletothepublic   approximately10monthsaftertheendofthecollectionyear.Dataarepresentedfora12monthperiod   andarepublishedsemiannuallyintheNationalVitalStatisticsReports.Finaldataarereleasedabout18 ^D monthsaftercollectionviaNationalVitalStatisticsReports,publicusedatatapes,CDROM,Series " Reports,theInternet,andjournalarticles.Useofelectronicproductshavegreatlyincreasedthe  accessibilityofthedataandreducedthecoststoresearchersandotherusers.  ThedatacollectedthroughtheNationalVitalStatisticsSystemrepresentallregisteredvitaleventsinthe &  UnitedStatesandadequatelyrepresentthetrueratesofevents.Tomoreaccuratelyrecordbirthand  deathinformation,newbirthanddeathcertificatesarebeingdesignedthroughacollaborativeeffortwith  states,researchers,andotherinterestedparties.Therevisedcertificatesreflectchangingdataneedsand fL emergingpublichealthapplications;theywillbeimplementedin2003. &   SentinelSurveillanceforChronicHepatitisC   AlthoughalargenumberofpersonsintheUnitedStatesarechronicallyinfectedwithHCVandmanywill nT developchronicliverdisease,theburdenofdiseasehasnotbeenwellcharacterized.Thereisno .  ongoingsurveillance,andfewpopulationbasedstudieshavebeenconductedfromwhichtodetermine ! theincidenceandprevalenceofchronicliverdiseaseandtherelativeproportionofcasesattributableto " viralhepatitisandotheretiologies.Tobegintocollectthisinformation,CDCestablishedapilot nT# surveillancesystemforchronicliverdiseasein1998.Thedatacollectionsystemhasthreecomponents: .$ "!%"5  5  !%2F3  0    Astandardinterviewquestionnaire,developedbyCDC,isusedbyallsitestoensure  & comparabilityofdataandfacilitateaggregationofdataasappropriate.Theinstrumentincludes n!T' questionsfromotherestablishedsurveillancesystemsandfrompreviousstudiesofchronicliver ."( disease.Questionsfocusondemographiccharacteristics,clinicalinformation,qualityoflife ") issues,andexposuresandriskfactors.!%݌#*(#(# Ќ5  5  "!%"5  5  !%u2F3  0    Astandardformisusedtoabstractclinicalandlaboratoryinformationfromthepatientsclinical n$T + chart.Thisinformation,collectedconsistentlyacrosssites,includesdataneededtodetermine .%!, diseaseetiology,treatmenthistory,medicationuse,andotherrelevantclinicalinformation.!%u݌%!-(#(# Ќ5  5  "!%"5  5  !%2F3  0    AserumsampleiscollectedandsenttoCDCtoidentifyserologicmarkersforviralhepatitis.!%݌&".(#(# Ќ5  5  Animportantcharacteristicofthepilotisitscomprehensiveness.Forthefirsttime,allpatientswith .($0 chronicliverdiseaseinseveralgeographicareasarebeingidentifiedusingacommonmethodology,with ($1 consistentinformationcollectedinallsites.Thegoalistoexpandtheuseofthemethodologyanddata )%2 collectioninstrumentstoothersitesthroughouttheUnitedStatestodevelopacomprehensivepictureof n*T&3 theoccurrenceandcharacteristicsofchronicliverdiseaseandtomonitortrends. .+'4    `     h      p  .*9 Althoughqualityassuranceandqualitycontrolinstrumentsarestillunderdevelopment,several  validationstudieshavebeenconducted.Toassessthecompletenessofreporting,CDCconducteda  surveyofprimarycarepractitionersandareviewofallfirsttimeliverbiopsies.Thesestudiesindicated  thatoverallsurveillancewascomprehensiveandwassuccessfulinidentifyingthevastmajorityof Z@ patientsinthetargetpopulation.Areviewofarandomlyselectedsubsetofchartsfailedtorevealany  significanterrorsinchartabstraction.Toassesstheoverallvalidityofthestudy,earlypreliminaryresults  havebeencomparedtothefewexistingrelevantdata.Thisevaluation,demonstratingthattheincidence  ofnewlydiagnosedchronicliverdiseasehasincreasedinrecentyears,isalreadycontributingtoCDCs Z @ effortstomoreaccuratelyestimatetheburdenofillnessfromchronicliverdisease.    U.S.SentinelPhysicianSurveillanceforInfluenza     Establishedin1982,theU.S.SentinelPhysicianSurveillanceforInfluenzaisoneoffourprimarysources b H  ofinfluenzasurveillancedata.Thesentinelphysiciansurveillancesystemisanactivesystemof "   surveillanceconductedfromOctoberthroughMay.Eachweekduringthatperiod,severalhundred   volunteerphysiciansaroundthecountryreportthetotalnumberofpatientsseenandthenumberofthose   patientswithinfluenzalikeillnessbyagegroup. bH  Duringthe199798influenzaseason,27statesandtheDistrictofColumbiaelectedtoparticipateina   pilotprogramtoupgradethesentinelphysiciansurveillancesystem.ThepilotmergedCDCsnational   sentinelsurveillancesystemandstatebasedsystemsintooneintegratedsystembasedoncommon bH methodologiesandstandards.Duringthe199899influenzaseason,theenhancedsentinelphysician " surveillancesystemwasexpandedtoinclude40statesandtheDistrictofColumbia,andanInternet  reportingsystemwasdeveloped.Statesareresponsibleforestablishing,recruiting,andmaintaining  statebasedsentinelphysiciangroupsandforensuringthatdataarecollectedandtransmittedregularly bH toacentraldatarepositoryatCDC,whichisupdateddaily.CDCisresponsibleforcoordinatingthe " systemnationally,maintainingthereportingsystems,processingandanalyzingthedata,and  maintainingtheInternetsite.Effortstoimprovethesystemarecontinuous.    Sentinelphysicianscanreportdataviaanyofthreemethods:1)Internetreporting,2)touchtonephone " reporting,or3)facsimiletransmissionwithmanualentryofdata.AprogramdevelopedbyCDC  integratesthethreesourcesofdataanduploadsthedatatotheInternetsite.Dataareavailabledailyto  eachstatecoordinator.Asummaryofinfluenzaactivityisavailabletothegeneralpubliceachweek. bH CDChasundertakenacontinuousprocesstosimplifyuseofthesystem,clarifycasedefinitions,and ! offermultipleoptionsforinputandaccess.Withdailyupdatesandweeklysummaries,theinformationis " extremelytimelyandpertinentfordecisionmaking.CDCepidemiologistsanalyzethedataforoutlying bH# informationandperformroutinechecksforcoherence.Statecoordinatorsroutinelycheckthetimeliness "$ ofreportingandtroubleshootproblemsatthelocallevel.Guidelinesareprovidedtosentinelphysicians % foroptimaltimingofspecimencollectionforvirologictestingoncertainpatients.Thereisnowayto  & ascertainthatthedataoninfluenzalikeillnessisfreeoferror,but,asthenumberofparticipatingsentinel b!H' physiciansincreases,thepotentialconsequencesoferrorsdecrease.Giventhatsentinelsurveillance ""( providesanindexofcurrentinfluenzaactivity,consistentreportingbyastablegroupofphysiciansis ") imperativefordatareliability.Increasingsentinelphysiciansitesandsentinelphysicianparticipationin #* eachstatewouldgreatlyincreasethevalidityofthedata. b$H +  YouthRiskBehaviorSurveillanceSystem  %!- CDCestablishedtheYouthRiskBehaviorSurveillanceSystem(YRBSS)in1990.Oneofthe &". componentsisanationalschoolbasedsurveythatwasfirstconductedin1990andhasbeenrepeated j'P#/ bienniallysince1991.ThenationalYouthRiskBehaviorSurvey(YRBS)measuressixcategoriesof *($0 priorityhealthriskbehaviorsthatcontributetotheleadingcausesofmortalityandmorbidityamongyouth ($1 andadultsintheUnitedStates:1)behaviorsthatcontributetounintentionalandintentionalinjuries;2) )%2 tobaccouse;3)alcoholandotherdruguse;4)sexualbehaviorsthatcontributetoHIVinfection,other j*P&3 sexuallytransmitteddiseasesandunintendedpregnancy;5)dietarybehaviors;and6)physicalactivity. *+'4    `     h      p      .*9 TheYRBSisadministeredinthespringtonationallyrepresentativesamplesofstudentsingrades912  attendingbothpublicandprivateschools.Professionaldatacollectors,trainedspecificallyfortheYRBS,  areusedasfieldstafftoensurestandardadministrationprocedures.TheYRBSSusesathreestage  clustersampletoselectschoolsandclassesofstudentswithinschools.AfricanAmericanandHispanic Z@ studentsareoversampledtoprovideaccurateestimatesforthesesubgroupsineachsurveycycle.By  combiningdatafrommultiplesurveycyclesitisalsopossibletoobtainaccurateestimatesforAsianand  NativeAmericanyouth.Thesamplesizetotalsapproximately12,000studentspersurvey.School  responseratesaverage76%;studentresponseratesaverage88%. Z @ TheYRBSquestionnaireisdesignedforselfadministrationbyuseofacomputerscannablebooklet.    Thequestionnairehasbeenmodifiedasneededtoaddressemergingpublichealthproblems.A    reliabilitystudyofthequestionnaireconductedin1993demonstratedthatstudentsreportedhealthrisk Z @  behaviorsreliablyovertime.Psychometricworkhasdemonstratedthatthequestionnaireyields   accurateandhighqualitydata.Standardizeddataeditingandcleaningproceduresimprovedata   accuracyandconsistency.Dataarereleasedwithin12monthsofdatacollectionandaremadeavailable   tothepublicviatheInternet.AnewpsychometricstudyofthequestionnaireisplannedforSpring2000.  Z@   5  5#XTX 5X#&qx %XXT*$ddd Xdd Xdd X(#(#,!dd +  &f &  #XTX %&qx#XXTAppendixC ~d KeyImprovementsintheCDCFY2003PerformancePlan#XTX)#&qx %XXT1'%h  f 1 #&qx % %&qx##XTX %&qx#5 XXTAsofDecember31,2001,CDChasachievedorexceededtargetssetfor145ofthe217performance  measuresinCDCsFY2001PerformanceReport.Only20targetswerenotmet,anddataisoutstanding   for52oftheperformancemeasurescontainedintheplan.Measureswithoutstandingdatawillbe v \ reportedonassoonasresultsbecomeavailable.Weanticipatethat#XTX 5`#5 XXTԀwewillhavedataavailable#XTX 5P#5 XXTԀfor45 6  measuresinCY02and6measures#XTX 5#5 XXTԀinCY03;onemeasurewillnotbeavailableuntilCY04.However,    atthispoint,CDChasachievedorexceeded88%ofitstargetsforwhichdataisavailable.    NumberstellonlypartofCDCsperformancestory.Inanongoingefforttoimproveourperformance 6  planandreport,wehaverecentlyextensivelyrevisedourplan.Eachsectionoftheplannowaddresses   eachofCDCsidentitythemesingreaterdetail.Thesethemesare:protectingthehealthandsafetyof   Americans,providingcredibleinformationtoenhancehealthdecisions,andpromotinghealththrough v\  strongpartnerships.Inaddition,morecompletedescriptionsaboutCDCsprograms,theirintended 6  results,andongoingactivitieshavebeenprovided.   InFY2001,CDCachievedorexceededavarietyofgoalsineachoftheidentitythemeareas. v\  !"#%&'()(Fxx!"#%&'() ProtectingthehealthandsafetyofAmericans:   "!%"5  5  !%2F3  0    ProtectingAmericansfrominfectiousdiseasesbeginswithwellstaffedandwellequippedstate z` andlocalhealthdepartments.InFY200157sitesincluding50state,sixlocal,andoneterritorial :  healthdepartmentwerefundedfortheEpidemiologyandLaboratoryCapacity(ELC)programto  strengthentheircapacitytoidentifyandrespondtopublichealththreats.Becauseofoutbreaks  suchasWestNilevirusandthethreatofotheremerginginfectiousdiseases,expandingthis z` programtoalleligiblestateandlocalhealthdepartmentsbecameakeypriority.!%[݌: (#(# Ќ5  5  "!%"5  5  !%2F3  0    InMarch2000apanelofexpertsreviewedextensiveinformationfromavarietyofsourcesand  concludedthatmeaslesisnolongeranepidemicintheUnitedStates.Theeliminationof z` endemicmeaslesfromtheUSisanhistoricpublichealthachievementandthefulfillmentofa :   goalexpressedbypublichealthexpertsevenbeforethefirstvaccinewaslicensedin1963.In ! 2000therewereonly86casesofindigenousmeaslesreportedintheUS.!%݌"(#(# Ќ5  5  "!%"5  5  !% 2F3  0    TheUShasseendramaticreductionsinperinatalHIVtransmissionratesinthepastdecade.In : $ 1999,anestimated300to400babieswerebornwithHIVinfection,comparedto1,000to2,000  % USinfantsbornwithHIVinfectionduringtheearly1990s.Thesedeclinesreflectthesuccessof !& widespreadimplementationofPHSrecommendationsforroutinecounselingandvoluntaryHIV z"`' testingofpregnantwomenandtheuseofzidovudine(AZT)byinfectedwomenduring :# ( pregnancyanddeliveryandfortreatmentoftheinfantafterbirth.Revisedguidelineswere #) publishedin2001.!%  ݌$ *(#(# Ќ5  5  "!%"5  5  !%H2F3  0    Thediabetescontrolprograms(DCP)!fundedinall50states,theDistrictofColumbia,and :& ", eightterritories!identifyhighriskpopulations,improvethequalityofcare,involvecommunities &"- incontrollingdiabetes,andincreaseaccesstocarewithmeasurablesuccess.Forexampleofa '#. 2yearperiodtheNewYorkDCPreducedhospitalizationratesby35%anddecreasedlower z(`$/ extremityamputationsratesby39%.InMichiganalongstandingDCPhasproduceda45% :) %0 lowerrateofhospitalizations,a31%lowerrateoflowerextremityamputations,anda27%lower )%1 deathrateforparticipants.#XTX 5,#5 XXT!%H݌*&2(#(# Ќ5  5  "!%"5  5  !%M2F3  0    Becausemostfirerelateddeathsandinjuriesoccurwhileresidentsareasleepeffective :, (4 detectionandalertingsystemsareessential.Indeedaworkingsmokealarmcanreducetherisk ,(5 ofdeathbyabout50%.In2.5yearsCDCs14statesmokealarminstallation/educationprogram -)6 hasinstalledover100,000smokealarmsinhomes.Thisprogramhasbeencreditedwithsaving z.`*7 150lives.!%M݌:/ +8(#(# Ќ5  5  Providingcredibleinformationtoenhancehealthdecisions:   "!%"5  5  !%u2F3  0    InFY2001CDCcontinuedtoexpandtheinformationontheamountandtypesofenvironmental  chemicalsthataffectpeopleshealth.CDCcannowmeasurethepresenceofmorethan200  suchsubstancesincludingmetals,pesticides,dioxins,andothersinbloodandurine.To  communicatethesefindingstothepublic,CDCproducedaNationalReportonHumanExposure ^ D toEnvironmentalChemicalsinFY2001.Thisreportprovidesthepublicanassessmentofthe "  USpopulationsexposuretoenvironmentalchemicalsthatmaycausecancer,birthdefects,and    respiratorydiseases,andotherillnesses.Informationfromthisreportwillalsoaidinmonitoring    theeffectivenessofprogramsdesignedtoreduceexposures.!%u݌f L (#(# Ќ5  5  "!%"5  5  !%2F3  0    ThehealthofAmericascommunitieshingesontheexpertiseofthepublichealthworkforce!   theyareourfirstlineofdefenseagainstvirtuallyallhealthproblemsinourcommunities.   Trainingisanimportantaspectofimprovingpublichealthperformance.CDCcontinuesto fL  implementnewsystemstobroadentrainingoptionsnationallyandinternationally.CDC &  designedtheLifeLongPublicHealthLearningSystemandincreasedtrainingopportunities   throughdistancebasedleaningtechnology.CDCexceededthedistanceleaningperformance   targetbyexpandingtherangeofprogramsofferedandincreasingthenumberofparticipants. fL The135,000distancelearningparticipantsinFY1999surpassedthenumbertargetedthrough &  FY2002.InFY2000CDCincreasedthenumberofparticipantsto148,000.!%݌(#(# Ќ5  5  "!%"5  5  !%2F3  0    CDCtranslatesoccupationalresearchfindingintovariousmediaforworkers,employers,policy fL makers,andpractitioners.Inadditiontoexpandinginformationonitswebsite,theNational &  InstituteforOccupationalSafetyandHealth(NIOSH)operatesatollfreetelephoneserviceto  answerpublicinquiries!oftenprovidinglifesavingadvicetocallers.Since1995callstothis  linehaveincreasedby60%.InFY2000,inquiriesonhealthcaretopicsincreased100%over fL 1999.!%݌& (#(# Ќ5  5   Promotinghealththroughstrongpartnerships:   "!%"5  5  !%"2F3  0    ThroughtheGlobalAIDSProgram,CDCisworkingwithexpertsfromUSandinternational *  agenciessuchasHRSA,USAID,CAREC,UNAIDS,WHO,andUNICEFtohelpministriesof ! healthinAfrica,Asia,andLatinAmericaaddressthedevastatingimpactofHIV/AIDS.InFY " 2001CDCexpandedprogramstosupportimprovenationalsurveillanceprogramsto22 jP# countriesandtopreventperinataltransmissionofHIVto13countries.!%"f"݌*$(#(# Ќ5  5  "!% "5  5  !%%2F3  0    CDCsBioterrorismPreparednessandResponseprogramisacrosscutting,collaborativeeffort  & amongmultipleCDCoffices,ATSDR,FBI,FEMA,DOJ,APHL,FDA,USAMRIID,NACCHO,and j!P' VA.ThroughthisprogramCDCprovidesfundingto50states,fourlocalities,andoneUS *"( territorytoenhancesomeoralloftheirareasofbioterrorismpreparedness.CDCachievedor ") exceededalltargetsforFY01bioterrorismmeasures.!%%O%݌#*(#(# Ќ5  5  "!% "5  5  !%'2F3  0    Aslongaspoliotransmissionoccursanywhereintheworld,itremainsathreattoAmerican *%!, children.CDCcontinuestocollaboratewithmanypartnersincludingWHO,RotaryInternational, %!- USAID,theTaskForceforChildSurvivalandDevelopment,UNICEF,andotherinternational &". agenciestobolsterpolioeradicationeffortsbyprovidingscientificassistanceandfinancial j'P#/ support.Thiscollaborationisuniqueamongpublichealthinitiativesfortheunprecedentedlevel *($0 ofpartnership.Thisglobalinitiativeisontargetforcertificationofpolioeradicationby2005. ($1 Globalpolioincidencehasdeclinedmorethan99%from1988to2000,about250,000liveshave )%2 beensavedand4millioncasesofchildhoodparalysishavebeenavoided,andthenumberof j*P&3 polioendemiccountriesdroppedfrom125toonly20attheendof2000.In2000theAmerican *+'4 RegionofWHOcompleteditsninthyearwithoutareportedcaseofpolio.CDCdidnotmeetthe +'5 targetforpurchaseofpoliovaccinesinFY2001largelybecausethepriceofthevaccine ,(6 increasedby27%thusdecreasingtheamountofvaccineCDCwasabletopurchase.!%'7(݌j-P)7(#(# Ќ5  5   .*9 Ї@*_  Z@   A[Q@ dA #XTX 5#XXTAppendixD  K1  PerformanceMeasurementLinkageswithBudget,CostAccounting, pV InformationTechnologyPlanning,CapitalPlanning, { andProgramEvaluation#XTX.#5 XXT   {.@1111!.@ _Clinger_ԄCohenAct #XTX 50#XXT   #XTX0#5 XXTCDCiscurrentlyimplementingtherequirementsunderthe_Clinger_ԄCohenActof1996(CCA)for w ] informationtechnology(IT)capitalinvestmentplanning,monitoring,andperformancemeasurement. 7  TheInformationTechnologyInvestmentReviewBoard(_ITIRB_)processhasbeenestablishedandwas   releasedCDCwideonJanuary5,1999,viatheCDCIntranet.CCAcompliancebecameacomponentof    theCDCbudgetplanningprocessfortheFY2001budget.MajorITinvestmentsassociatedwithbudget w ]  initiativesrequiredrespondingtothe _Raines_ԀRulesaspartofthesubmission. 7     `     h      p AlsoincompliancewithCCA,CDChasdevelopedseveralcomponentsoftheagencysinformation   technologyarchitecture,suchascertainhealthdatastandards,networkingandtelecommunications w]  architecture,informationsecurity,andthemajorityoftheagencysadministrativeprocedures.More 7  extensiveworkonothercorebusinessprocesses,informationflows,processanddatamodelsis   ongoing.  InadditiontoeffortsintheimplementationofCCA,CDChasawellintegrated_GPRA_ԀandIRMStrategic 7 PlanthatalignsITproductsandserviceswithCDCseverchangingmissionneedsanddirections.The  IRMstrategicgoals,strategiesandperformancemeasuressupportthemission,missiongoals,and  CDCs_GPRA_Ԁperformanceplan.#XTX 5@1#