This MMWR Supplement presents data related to disease patterns across the United States and describes recent national trends in health status. Indicators of health status (i.e., measures of observed or calculated data on the status of a health condition) were chosen to reflect the range of health issues relevant to CDC's programs that are used across the agency to monitor health. In response to the status of these health issues, CDC works with state and local health systems across the United States on these diseases and others to save lives and protect persons.

The first cases of the current West African epidemic of Ebola virus disease (hereafter referred to as Ebola) were reported on March 22, 2014, with a report of 49 cases in Guinea. By August 31, 2014, a total of 3,685 probable, confirmed, and suspected cases in West Africa had been reported. To aid in planning for additional disease-control efforts, CDC constructed a modeling tool called EbolaResponse to provide estimates of the potential number of future cases. If trends continue without scale-up of effective interventions, by September 30, 2014, Sierra Leone and Liberia will have a total of approximately 8,000 Ebola cases. A potential underreporting correction factor of 2.5 also was calculated. Using this correction factor, the model estimates that approximately 21,000 total cases will have occurred in Liberia and Sierra Leone by September 30, 2014. Reported cases in Liberia are doubling every 15-20 days, and those in Sierra Leone are doubling every 30-40 days. The EbolaResponse modeling tool also was used to estimate how control and prevention interventions can slow and eventually stop the epidemic. In a hypothetical scenario, the epidemic begins to decrease and eventually end if approximately 70% of persons with Ebola are in medical care facilities or Ebola treatment units (ETUs) or, when these settings are at capacity, in a non-ETU setting such that there is a reduced risk for disease transmission (including safe burial when needed). In another hypothetical scenario, every 30-day delay in increasing the percentage of patients in ETUs to 70% was associated with an approximate tripling in the number of daily cases that occur at the peak of the epidemic (however, the epidemic still eventually ends). Officials have developed a plan to rapidly increase ETU capacities and also are developing innovative methods that can be quickly scaled up to isolate patients in non-ETU settings in a way that can help disrupt Ebola transmission in communities. The U.S. government and international organizations recently announced commitments to support these measures. As these measures are rapidly implemented and sustained, the higher projections presented in this report become very unlikely.

The Presidential Childhood Immunization Initiative was developed in 1993 to address major gaps in childhood vaccination coverage in the United States. Eliminating the cost of vaccines as a barrier to vaccination was one strategy of the Childhood Immunization Initiative; it led to Congressional legislation that authorized creation of the Vaccines for Children program (VFC) in 1994. CDC analyzed National Immunization Survey data for 1995-2011 to evaluate trends in disparities in vaccination coverage rates between non-Hispanic white children and children of other racial/ethnic groups. VFC has been effective in ireducing disparities in vaccination coverage among U.S. children. CDC's Office of Minority Health and Health Equity selected the intervention analysis and discussion that follows to provide an example of a program that has been effective in reducing childhood vaccination coverage-related disparities in the United States. At its inception in 1994, VFC was implemented in 78 Immunization Action Plan areas that covered the entire United States; within each area, concerted efforts were made to improve childhood vaccination coverage. The findings in this report demonstrate that there have been no racial/ethnic disparities in vaccine coverage for measles-mumps-rubella and poliovirus in the United States since 2005. Disparities in coverage for the diphtheria-tetanus-pertussis/diphtheria-tetanus-acellular pertussis vaccine were absent, declining, or inconsistent during this period, depending on the racial/ethnic group examined. The results in this report highlight the effectiveness of VFC.

Periodontal disease, or gum disease, is a chronic infection of the hard and soft tissue supporting the teeth and is a leading cause of tooth loss in older adults. Tooth loss impairs dental function and quality of life in older adults. The chronic infections associated with periodontitis can increase the risk for aspiration pneumonia in older adults and has been implicated in the pathogenesis of chronic inflammation that impairs general health. The severity of periodontal disease can be categorized as mild, moderate, or severe on the basis of multiple measurements of periodontal pocket depth, attachment loss, and gingival inflammation around teeth.

The factors that influence the socioeconomic position of individuals and groups within industrial societies also influence their health. Socioeconomic position has continuous and graded effects on health that are cumulative over a lifetime. The socioeconomic conditions of the places where persons live and work have an even more substantial influence on health than personal socioeconomic position. In the United States, educational attainment and income are the indicators that are most commonly used to measure the effect of socioeconomic position on health. Research indicates that substantial educational and income disparities exist across many measures of health. A previous report described the magnitude and patterns of absolute and relative measures of disparity in noncompletion of high school and poverty in 2005 and 2009. Notable disparities defined by race/ethnicity, socioeconomic factors, disability status, and geographic location were identified for 2005 and 2009, with no evidence of a temporal decrease in racial/ethnic disparities, whereas socioeconomic and disability disparities increased from 2005 to 2009.

According to 1981-2009 data, homicide accounts for 16,000-26,000 deaths annually in the United States and ranks within the top four leading causes of death among U.S. residents aged 1-40 years. Homicide can have profound long-term emotional consequences on families and friends of victims and on witnesses to the violence, as well as cause excessive economic costs to residents of affected communities. For years, homicide rates have been substantially higher among certain populations. Previous reports have found that homicides are higher among males, adolescents and young adults, and certain racial/ethnic groups, such as non-Hispanic blacks, non-Hispanic American Indian/Alaska Natives (AI/ANs), and Hispanics. The 2011 CDC Health Disparities and Inequalities Report (CHDIR) described similar findings for the year 2007. For example, the 2011 report showed that the 2007 homicide rate was highest among non-Hispanic blacks (23.1 deaths per 100,000), followed by AI/ANs (7.8 deaths per 100,000), Hispanics (7.6 deaths per 100,000), non-Hispanic whites (2.7 deaths per 100,000), and Asian/Pacific Islanders (A/PIs) (2.4 deaths per 100,000). In addition, non-Hispanic black men aged 20-24 years were at greatest risk for homicide in 2007, with a rate that exceeded 100 deaths per 100,000 population. Other studies have reported that community factors such as poverty and economic inequality and individual factors such as unemployment and involvement in criminal activities can play a substantial role in these persistent disparities in homicide rates. Public health strategies are needed in communities at high risk for homicide to prevent violence and save lives.

During 2001-2005, excessive alcohol use accounted for an estimated average of 80,000 deaths and 2.3 million years of potential life lost (YPLL) in the United States each year, and an estimated $223.5 billion in economic costs in 2006. Binge drinking, defined as consuming four or more alcoholic drinks on one or more occasions for women and five or more drinks on one or more occasions for men, was responsible for more than half of these deaths, two-thirds of the YPLL, and three quarters of the economic costs. Reducing the prevalence of binge drinking among adults is also a leading health indicator in Healthy People 2020 (objective SA-14.3).

Potentially preventable hospitalizations are admissions to a hospital for certain acute illnesses (e.g., dehydration) or worsening chronic conditions (e.g., diabetes) that might not have required hospitalization had these conditions been managed successfully by primary care providers in outpatient settings. Although not all such hospitalizations can be avoided, admission rates in populations and communities can vary depending on access to primary care, care-seeking behaviors, and the quality of care available. Because hospitalization tends to be costlier than outpatient or primary care, potentially preventable hospitalizations often are tracked as markers of health system efficiency. The number and cost of potentially preventable hospitalizations also can be calculated to help identify potential cost savings associated with reducing these hospitalizations overall and for specific populations.

The root of effective disease control and prevention is an informed understanding of the epidemiology of a particular disease based on sound scientific interpretation of evidence. Such evidence must frequently be transformed from raw data into consumable information before it can be used for making decisions, determining policy, and conducting programs. However, the work of building such evidence in public health practice--doing the right thing at the right time--is essentially hidden from view. Surveillance involves acquiring, analyzing, and interpreting data and information from several sources across various systems. Achieving the goals and objectives of surveillance investments requires attention to analytic requirements of such systems. The process requires computer programming, statistical reasoning, subject matter expertise, often modeling, and effective communication skills.