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The number of reported cases of vaccine-preventable diseases has decreased steadily in the past decade. While the number of cases of H. Influenzae increased between 2000 to 2001, cases of rubella, measles, Hepatitis B, mumps, Hepatitis A, and pertussis all decreased among children under 5. However, since most Hepatitis B infections among infants and young children are asymptomatic, the reported number of cases likely underestimates the incidence of Hepatitis B in young children. Over 20 percent of pertussis cases occurred in infants younger than 6 months who were too young to have received all three doses of a pertussis-containing vaccine. Mumps and rubella were at record low levels across all ages.
Although much progress has been made in reducing the number of reported cases of vaccine-preventable diseases, several of these diseases are still common. The number of cases of pertussis, Hepatitis A and H. Influenzae remains substantial and indicates a continuing need to promote immunization efforts. In fact, rates of Hepatitis A have had the greatest decline among children in the States where routine childhood vaccination is recommended.
Child Abuse and Neglect
State child protective services received reports alleging the maltreatment of approximately 3 million children in 2001. Over half of these reports were received from community professionals, while the remainder were received from family, friends, relatives, or neighbors of these children.
In 2001, investigations by State child protective services agencies determined that an estimated 903,000 children were victims of abuse or neglect, equivalent to a rate of 12.4 per 1,000 children under 18 years of age. Approximately 59 percent of all victims suffered neglect, 18.6 percent physical abuse, 9.6 percent sexual abuse, 6.8 percent psychological maltreatment, and 19.5 percent other forms of maltreatment. Some children suffered multiple types of maltreatment.
Victimization was highest among the youngest children. In 2001, 27.7 percent of victims were ages birth to 3, while 5.4 percent were ages 16-17. Among the estimated 1,300 children who died of abuse and neglect, children younger than 1 year accounted for 40.9 percent of fatalities and children younger than 6 years accounted for 84.5 percent. Of the child fatalities that occurred in 2001, 82.8 percent involved a parent.
The data were obtained from the National Child Abuse and Neglect Data System, the primary source of national information on abused and neglected children known to state child protective services agencies.
As of December 31, 2002, 9,220 cases of AIDS in children younger than 13 had been reported in the United States. Pediatric AIDS cases represented less than 2.1 percent of all cases reported through 2002.
In 2002, 158 new AIDS cases in children were reported, with 88 percent of them transmitted before or during birth (perinatal transmission). Since 1993, the number of new cases of pediatric AIDS due to perinatal transmission has declined substantially. A major factor in this decline is the increasing use of treatment before, during and after pregnancy to reduce perinatal HIV transmission. In 1994, the U.S. Public Health Service recommended this treatment for all HIV-positive pregnant women, and in 1995, routine HIV counseling and voluntary testing for all pregnant women was recommended. It is expected that the perinatal transmission rate will continue to decline with increased use of aggressive treatments and obstetric procedures, such as elective cesarean section.
Racial and ethnic minorities are disproportionately represented among pediatric AIDS cases. The number of pediatric AIDS cases ever reported in Black non-Hispanic children is 3.4 times that of White non-Hispanic children and 2.6 times that of Hispanic children.
In 2000, there were 3.4 million hospital discharges of children ages 1 to 21, or 4.0 discharges per 100 children.
Diseases of the respiratory system were the major causes of hospitalization for children ages 1-9 and accounted for 33 percent of their discharges. Hospital discharge rates generally decrease until age 10 and increase during later adolescence.
While injuries are the leading cause of death for children older than 1 year, this category accounted for only 9 percent of the hospital discharges of children ages 1-14 in 2000. Pregnancy and childbirth accounted for 68 percent of discharges among young women ages 15-21. Mental disorders were the second leading cause of hospitalization for adolescents.
Hospital Discharge Trends
Since 1985, there has been a 38 percent decrease in overall hospital discharge rates for children ages 1-14 years.
Between 1985 and 2000, there was a 44 percent decline in the hospital discharge rate for diseases of the respiratory system in children in this age group.
Three diagnostic categories (respiratory diseases, injury, and digestive diseases) accounted for 45 percent of the discharges of children ages 1-14 years in 2000.
Childhood death rates have generally declined over the past several decades. Based on preliminary data, there were 12,249 deaths of children ages 1-14 in 2001. Unintentional injury continues to be the primary cause of death for this age group. Among children ages 1 to 4, injuries accounted for 33.2 percent of all deaths, followed by deaths due to congenital malformations (birth defects), malignant neoplasms (cancer), homicide, and diseases of the heart. Unintentional injuries comprised 39.4 percent of all deaths among children 5 to 14, followed by malignant neoplasms, congenital malformations, homicides, suicides, and diseases of the heart.
Childhood Deaths Due to Injury
In 2001, injuries caused the deaths of 1,701 children ages 1-4 and 2,802 children ages 5-14. Among children ages 1-4, motor vehicle crashes, drowning, and fire were the most common causes of injury death. Motor vehicle crashes were the most common cause of injury death among children ages 5-14, followed by deaths due to drowning and fire.
In addition, 394 children ages 1-4 were the victims of homicide and 590 children ages 5-14 were the victims of homicide or suicide.
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