In case you were wondering....

     In my July 24, 2014 post, I told you that despite wearing my nano-fiber-infused insect-repellant clothing, once it was removed I was bitten by a mosquito in Dominica in the Eastern Caribbean. In my May 31, 2014 post, you saw that Chikingunya virus had appeared in the Caribbean and the number of infected people was growing.
   In case you were wondering....I survived without contracting any mosquito-borne illness, at least any acute ones.  I had a ten day flu-like illness which was a little disconcerting, but nothing extraordinary, and I probably got it by drying out my throat and becoming susceptible to viruses of all kinds, caused by sleeping in front of a blowing air conditioner unit on my overnight in San Juan, returning from Dominica.
   Chikingunya is not on the regulatory list of diseases that are required to be reported by states. Since it is not a nationally reportable illness (but can be reported to ARBOnet).  Because of the distribution of  constitutional federalism, public health laws and information is in the jurisdiction of the states, and the federal government (i.e., CDC) is not empowered to require that states report any illness not adopted by regulatory processes.  In fact, the list of diseases that states are required to report is fairly short. April 23, 2003 was the last update to the reportable disease list:

Ex. Ord. No. 13295. Revised List of Quarantinable Communicable Diseases

Ex. Ord. No. 13295, Apr. 4, 2003, 68 F.R. 17255, as amended by Ex. Ord. No. 13375, §1, Apr. 1, 2005, 70 F.R. 17299, provided:

By the authority vested in me as President by the Constitution and the laws of the United States of America, including section 361(b) of the Public Health Service Act (42 U.S.C. 264(b)), it is hereby ordered as follows:

Section 1. Based upon the recommendation of the Secretary of Health and Human Services (the “Secretary”), in consultation with the Surgeon General, and for the purpose of specifying certain communicable diseases for regulations providing for the apprehension, detention, or conditional release of individuals to prevent the introduction, transmission, or spread of suspected communicable diseases, the following communicable diseases are hereby specified pursuant to section 361(b) of the Public Health Service Act:

(a) Cholera; Diphtheria; infectious Tuberculosis; Plague; Smallpox; Yellow Fever; and Viral Hemorrhagic Fevers (Lassa, Marburg, Ebola, Crimean-Congo, South American, and others not yet isolated or named).

(b) Severe Acute Respiratory Syndrome (SARS), which is a disease associated with fever and signs and symptoms of pneumonia or other respiratory illness, is transmitted from person to person predominantly by the aerosolized or droplet route, and, if spread in the population, would have severe public health consequences.

(c) Influenza caused by novel or reemergent influenza viruses that are causing, or have the potential to cause, a pandemic.

    Even though CDC is constrained with what it can require states to report and is limited to this list, they have created a great "work around" that does not violate the federalism principle or the law, giving states jurisdiction over public health matters. CDC developed a relationship with a non-government organization, the Council of State and Territorial Epidemiologists (CSTE) to develop common case definitions to allow reporting through this channel. Some strict-federalists may see this as having the effect of taking power from the states in public health matters, but no one has ever challenged this relationship or process.  It is often the best source of data of illnesses and surveillance of illnesses in the U.S. and makes up the backbone of the National Notifiable Diseases Surveillance System (NNDSS).

    Now, since it is now clear why the data reported by CDC is not from CDC --- take a look at the map CDC published on Aug. 19th. The map created below is based on ARBOnet data, used by CDC to report as of Aug 19, 2014, the number of people infected with Chikingunya.  The states with these reports are in medium blue on the map. These were cases acquired by travelers coming back from traveling to infected areas. Florida is the only state with cases of transmission WITHIN the state, and is particularly of concern since it is spreading so rapidly. We may yet see more states with local transmission.