Note: In these datasets, a person is defined as up to date if they have received at least one dose of an updated COVID-19 vaccine. The Centers for Disease Control and Prevention (CDC) recommends that certain groups, including adults ages 65 years and older, receive additional doses.

On 6/16/2023 CDPH replaced the booster measures with a new “Up to Date” measure based on CDC’s new recommendations, replacing the primary series, boosted, and bivalent booster metrics The definition of “primary series complete” has not changed and is based on previous recommendations that CDC has since simplified. A person cannot complete their primary series with a single dose of an updated vaccine. Whereas the booster measures were calculated using the eligible population as the denominator, the new up to date measure uses the total estimated population. Please note that the rates for some groups may change since the up to date measure is calculated differently than the previous booster and bivalent measures.

This data is from the same source as the Vaccine Progress Dashboard at https://covid19.ca.gov/vaccination-progress-data/ which summarizes vaccination data at the county level by county of residence. Where county of residence was not reported in a vaccination record, the county of provider that vaccinated the resident is included. This applies to less than 1% of vaccination records. The sum of county-level vaccinations does not equal statewide total vaccinations due to out-of-state residents vaccinated in California.

These data do not include doses administered by the following federal agencies who received vaccine allocated directly from CDC: Indian Health Service, Veterans Health Administration, Department of Defense, and the Federal Bureau of Prisons.

Totals for the Vaccine Progress Dashboard and this dataset may not match, as the Dashboard totals doses by Report Date and this dataset totals doses by Administration Date. Dose numbers may also change for a particular Administration Date as data is updated.

Previous updates:

• On March 3, 2023, with the release of HPI 3.0 in 2022, the previous equity scores have been updated to reflect more recent community survey information. This change represents an improvement to the way CDPH monitors health equity by using the latest and most accurate community data available. The HPI uses a collection of data sources and indicators to calculate a measure of community conditions ranging from the most to the least healthy based on economic, housing, and environmental measures.

• Starting on July 13, 2022, the denominator for calculating vaccine coverage has been changed from age 5+ to all ages to reflect new vaccine eligibility criteria. Previously the denominator was changed from age 16+ to age 12+ on May 18, 2021, then changed from age 12+ to age 5+ on November 10, 2021, to reflect previous changes in vaccine eligibility criteria. The previous datasets based on age 16+ and age 5+ denominators have been uploaded as archived tables.

• Starting on May 29, 2021 the methodology for calculating on-hand inventory in the shipped/delivered/on-hand dataset has changed. Please see the accompanying data dictionary for details. In addition, this dataset is now down to the ZIP code level.

View daily updates and historical trends for California Coronavirus Full Vaccination Rate. Source: Our World in Data. Track economic data with YCharts ana…

On 6/28/2023, data on cases by vaccination status will be archived and will no longer update.

A. SUMMARY This dataset represents San Francisco COVID-19 positive confirmed cases by vaccination status over time, starting January 1, 2021. Cases are included on the date the positive test was collected (the specimen collection date). Cases are counted in three categories: (1) all cases; (2) unvaccinated cases; and (3) completed primary series cases.

1. All cases: Includes cases among all San Francisco residents regardless of vaccination status.

2. Unvaccinated cases: Cases are considered unvaccinated if their positive COVID-19 test was before receiving any vaccine. Cases that are not matched to a COVID-19 vaccination record are considered unvaccinated.

3. Completed primary series cases: Cases are considered completed primary series if their positive COVID-19 test was 14 days or more after they received their 2nd dose in a 2-dose COVID-19 series or the single dose of a 1-dose vaccine. These are also called “breakthrough cases.”

On September 12, 2021, a new case definition of COVID-19 was introduced that includes criteria for enumerating new infections after previous probable or confirmed infections (also known as reinfections). A reinfection is defined as a confirmed positive PCR lab test more than 90 days after a positive PCR or antigen test. The first reinfection case was identified on December 7, 2021.

Data is lagged by eight days, meaning the most recent specimen collection date included is eight days prior to today. All data updates daily as more information becomes available.

B. HOW THE DATASET IS CREATED Case information is based on confirmed positive laboratory tests reported to the City. The City then completes quality assurance and other data verification processes. Vaccination data comes from the California Immunization Registry (CAIR2). The California Department of Public Health runs CAIR2. Individual-level case and vaccination data are matched to identify cases by vaccination status in this dataset. Case records are matched to vaccine records using first name, last name, date of birth, phone number, and email address.

We include vaccination records from all nine Bay Area counties in order to improve matching rates. This allows us to identify breakthrough cases among people who moved to the City from other Bay Area counties after completing their vaccine series. Only cases among San Francisco residents are included.

C. UPDATE PROCESS Updates automatically at 08:00 AM Pacific Time each day.

D. HOW TO USE THIS DATASET Total San Francisco population estimates can be found in a view based on the San Francisco Population and Demographic Census dataset. These population estimates are from the 2016-2020 5-year American Community Survey (ACS). To identify total San Francisco population estimates, filter the view on “demographic_category_label” = “all ages”.

Population estimates by vaccination status are derived from our publicly reported vaccination counts, which can be found at COVID-19 Vaccinations Given to SF Residents Over Time.

The dataset includes new cases, 7-day average new cases, new case rates, 7-day average new case rates, percent of total cases, and 7-day average percent of total cases for each vaccination category.

New cases are the count of cases where the positive tests were collected on that specific specimen collection date. The 7-day rolling average shows the trend in new cases. The rolling average is calculated by averaging the new cases for a particular day with the prior 6 days.

New case rates are the count of new cases per 100,000 residents in each vaccination status group. The 7-day rolling average shows the trend in case rates. The rolling average is calculated by averaging the case rate for a particular day with the prior six days. Percent of total new cases shows the percent of all cases on each day that were among a particular vaccination status.

Here is more information on how each case rate is calculated:

1. The case rate for all cases is equal to the number of new cases among all residents divided by the estimated total resident population.

2. Unvaccinated case rates are equal to the number of new cases among unvaccinated residents divided by the estimated number of unvaccinated residents. The estimated number of unvaccinated residents is calculated by subtracting the number of residents that have received at least one dose of a vaccine from the total estimated resident population.

3. Completed primary series case rates are equal to the number of new cases among completed primary series residents divided by the estimated number of completed primary series residents. The estimated number of completed primary series residents is calculated by taking the number of residents who have completed their primary series over time and adding a 14-day delay to the “date_administered” column, to align with the definition of “Completed primary series cases” above.

E. CHANGE LOG

• 6/28/2023 - data on cases by vaccination status are no longer being updated. This data is currently through 6/20/2023 (as of 6/28/2023) and will not include any new data after this date.
  
• 4/6/2023 - the State implemented system updates to improve the integrity of historical data.
• 2/21/2023 - system updates to improve reliability and accuracy of cases data were implemented.
• 1/31/2023 - updated “sf_population” column to reflect the 2020 Census Bureau American Community Survey (ACS) San Francisco Population estimates.
• 1/31/2023 - renamed column “last_updated_at” to “data_as_of”.
• 1/22/2022 - system updates to improve timeliness and accuracy of cases and deaths data were implemented.
• 7/15/2022 - reinfections added to cases dataset. See section SUMMARY for more information on how reinfections are identified.
• 7/15/2022 - references to “fully vaccinated” replaced with “completed primary series” in column “vaccination_status".
• 7/15/2022 - rows with “partially vaccinated” in column “vaccination_status” removed from dataset.

Note: In these datasets, a person is defined as up to date if they have received at least one dose of an updated COVID-19 vaccine. The Centers for Disease Control and Prevention (CDC) recommends that certain groups, including adults ages 65 years and older, receive additional doses.

Starting on July 13, 2022, the denominator for calculating vaccine coverage has been changed from age 5+ to all ages to reflect new vaccine eligibility criteria. Previously the denominator was changed from age 16+ to age 12+ on May 18, 2021, then changed from age 12+ to age 5+ on November 10, 2021, to reflect previous changes in vaccine eligibility criteria. The previous datasets based on age 12+ and age 5+ denominators have been uploaded as archived tables.

Starting June 30, 2021, the dataset has been reconfigured so that all updates are appended to one dataset to make it easier for API and other interfaces. In addition, historical data has been extended back to January 5, 2021.

This dataset shows full, partial, and at least 1 dose coverage rates by zip code tabulation area (ZCTA) for the state of California. Data sources include the California Immunization Registry and the American Community Survey’s 2015-2019 5-Year data.

This is the data table for the LHJ Vaccine Equity Performance dashboard. However, this data table also includes ZTCAs that do not have a VEM score.

This dataset also includes Vaccine Equity Metric score quartiles (when applicable), which combine the Public Health Alliance of Southern California’s Healthy Places Index (HPI) measure with CDPH-derived scores to estimate factors that impact health, like income, education, and access to health care. ZTCAs range from less healthy community conditions in Quartile 1 to more healthy community conditions in Quartile 4.

The Vaccine Equity Metric is for weekly vaccination allocation and reporting purposes only. CDPH-derived quartiles should not be considered as indicative of the HPI score for these zip codes. CDPH-derived quartiles were assigned to zip codes excluded from the HPI score produced by the Public Health Alliance of Southern California due to concerns with statistical reliability and validity in populations smaller than 1,500 or where more than 50% of the population resides in a group setting.

These data do not include doses administered by the following federal agencies who received vaccine allocated directly from CDC: Indian Health Service, Veterans Health Administration, Department of Defense, and the Federal Bureau of Prisons.

For some ZTCAs, vaccination coverage may exceed 100%. This may be a result of many people from outside the county coming to that ZTCA to get their vaccine and providers reporting the county of administration as the county of residence, and/or the DOF estimates of the population in that ZTCA are too low. Please note that population numbers provided by DOF are projections and so may not be accurate, especially given unprecedented shifts in population as a result of the pandemic.

IntroductionCOVID-19 vaccine inequities have been widespread across California, the United States, and globally. As COVID-19 vaccine inequities have not been fully understood in the youth population, it is vital to determine possible factors that drive inequities to enable actionable change that promotes vaccine equity among vulnerable minor populations.MethodsThe present study used the social vulnerability index (SVI) and daily vaccination numbers within the age groups of 12–17, 5–11, and under 5 years old across all 58 California counties to model the growth velocity and the anticipated maximum proportion of population vaccinated.ResultsOverall, highly vulnerable counties, when compared to low and moderately vulnerable counties, experienced a lower vaccination rate in the 12–17 and 5–11 year-old age groups. For age groups 5–11 and under 5 years old, highly vulnerable counties are expected to achieve a lower overall total proportion of residents vaccinated. In highly vulnerable counties in terms of socioeconomic status and household composition and disability, the 12–17 and 5–11 year-old age groups experienced lower vaccination rates. Additionally, in the 12–17 age group, high vulnerability counties are expected to achieve a higher proportion of residents vaccinated compared to less vulnerable counterparts.DiscussionThese findings elucidate shortcomings in vaccine uptake in certain pediatric populations across California and may help guide health policies and future allocation of vaccines, with special emphasis placed on vulnerable populations, especially with respect to socioeconomic status and household composition and disability.

As of 10/27/2022, this dataset will no longer update. To continue to access updated vaccination metrics given to SF residents, including newly added bivalent boosters, please navigate to the following page: COVID-19 Vaccinations Given to SF Residents Over Time.

A. SUMMARY This dataset represents the COVID-19 vaccinations given to San Franciscans over time. All vaccines given to people who live in San Francisco are included, no matter where the vaccination took place (the vaccine may have been administered in San Francisco or outside of San Francisco).

B. HOW THE DATASET IS CREATED Information on doses administered to those who live in San Francisco is from the California Immunization Registry (CAIR), run by the California Department of Public Health (CDPH).

C. UPDATE PROCESS Updated daily via automated process

D. HOW TO USE THIS DATASET Different vaccines have different dosage requirements. For example, the Moderna and the Pfizer vaccines require two doses in order for a resident to complete their primary vaccine series (as of December 21, 2021). Each dose is recorded separately in its respective dataset column. Other vaccines, such as Johnson & Johnson, would only require a single dose for a resident to complete their primary vaccine series (as of December 21, 2021). The Pfizer vaccine for children under 5 requires three separate doses. Single dose vaccines counts are recorded in a separate column.

Summing the NEW_1ST_DOSES, NEW_2ND_DOSES, NEW_SINGLE_DOSES columns would give you the total count of primary vaccine series doses administered on a given day. To count the number of individuals who have completed their primary vaccine series on a given day, use the NEW_SERIES_COMPLETED column. To count the number of individuals vaccinated (with any primary series dose) for the first time on a given day, use the NEW_RECIPIENTS column.

To count the number of individuals who got a vaccine booster on a given day, use the NEW_BOOSTER_RECIPIENTS column. To count the number of booster doses administered on a given day, use the NEW_BOOSTER_DOSES column. To count the total number of individuals who have received a booster over time, use the CUMULATIVE_BOOSTER_RECIPIENTS column. To count the total number of booster doses that have been administered over time, use the CUMULATIVE_BOOSTER_DOSES column.

In our public dashboards we combine this dataset with the US Census's 2019 five-year American Community Survey population estimates to estimate the percent of San Franciscans vaccinated.

Created for the 2023-2025 State of Black Los Angeles County (SBLA) interactive report. To learn more about this effort, please visit the report home page at https://ceo.lacounty.gov/ardi/sbla/. For more information about the purpose of this data, please contact CEO-ARDI. For more information about the configuration of this data, please contact ISD-Enterprise GIS. table_name indicator_name Universe source timeframe source_url

life_expectancy_countyhealthrankings_2020 Life Expectancy Total Population County Health Rankings 2018-2020 https://www.countyhealthrankings.org/app/california/2022/measure/outcomes/147/data

obese_est_adult_lachs_2018 Obese Estimate (#) Adults (Ages 18 Years and Older) LAC Health Survey 2018 www.publichealth.lacounty.gov/ha/LACHSDataTopics2018.htm

obese_perc_adult_lachs_2018 Obese Percent (%) Adults (Ages 18 Years and Older) LAC Health Survey 2018www.publichealth.lacounty.gov/ha/LACHSDataTopics2018.htm

overweight_est_adult_lachs_2018 Overweight Estimate (#) Adults (Ages 18 Years and Older) LAC Health Survey 2018 www.publichealth.lacounty.gov/ha/LACHSDataTopics2018.htm

overweight_perc_adult_lachs_2018 Overweight Percent (%) Adults (Ages 18 Years and Older) LAC Health Survey 2018 www.publichealth.lacounty.gov/ha/LACHSDataTopics2018.htm

diabetes_est_adult_lachs_2018 Ever Diagnosed with Diabetes Estimate (#) Adults (Ages 18 Years and Older) LAC Health Survey 2018 www.publichealth.lacounty.gov/ha/LACHSDataTopics2018.htm

diabetes_perc_adult_lachs_2018 Ever Diagnosed with Diabetes Percent (%) Adults (Ages 18 Years and Older) LAC Health Survey 2018 www.publichealth.lacounty.gov/ha/LACHSDataTopics2018.htm

regular_source_of_care_est_adult_lachs_2018 Reported Having a Regular Source of Health Care Estimate (#) Adults (Ages 18 Years and Older) LAC Health Survey 2018www.publichealth.lacounty.gov/ha/LACHSDataTopics2018.htm

regular_source_of_care_perc_adult_lachs_2018 Reported Having a Regular Source of Health Care Percent (%) Adults (Ages 18 Years and Older) LAC Health Survey 2018 www.publichealth.lacounty.gov/ha/LACHSDataTopics2018.htm

depression_est_adult_lachs_2018 Ever Diagnosed with Depression Estimate (#) Adults (Ages 18 Years and Older) LAC Health Survey 2018www.publichealth.lacounty.gov/ha/LACHSDataTopics2018.htm

depression_perc_adult_lachs_2018 Ever Diagnosed with Depression Percent (%) Adults (Ages 18 Years and Older) LAC Health Survey 2018www.publichealth.lacounty.gov/ha/LACHSDataTopics2018.htm

perceived_safe_est_adult_lachs_2018 Perceived Their Neighborhood to Be Safe from Crime Estimate (#) Adults (Ages 18 Years and Older) LAC Health Survey 2018 www.publichealth.lacounty.gov/ha/LACHSDataTopics2018.htm

perceived_safe_perc_adult_lachs_2018 Perceived Their Neighborhood to Be Safe from Crime Estimate (%) Adults (Ages 18 Years and Older) LAC Health Survey 2018 www.publichealth.lacounty.gov/ha/LACHSDataTopics2018.htm

dental_care_est_child_lachs_2018 Had Dental Care within the past Year Estimate (#) Children (Ages 17 Years and Younger) LAC Health Survey 2018www.publichealth.lacounty.gov/ha/LACHSDataTopics2018.htm

dental_care_perc_child_lachs_2018 Had Dental Care within the past Year Percent (%) Children (Ages 17 Years and Younger) LAC Health Survey 2018www.publichealth.lacounty.gov/ha/LACHSDataTopics2018.htm

no_usual_source_est_chis_2020 No usual source of care Estimate (#) Total Population California Health Interview Survey 2020 https://ask.chis.ucla.edu/AskCHIS/tools/_layouts/AskChisTool/home.aspx

no_usual_source_perc_chis_2020 No usual source of care Percent (%) Total Population California Health Interview Survey 2020 https://ask.chis.ucla.edu/AskCHIS/tools/_layouts/AskChisTool/home.aspx

delayed_care_est_chis_2020 Delayed or didn't get medical care last year Estimate (#) Total Population California Health Interview Survey 2020 https://ask.chis.ucla.edu/AskCHIS/tools/_layouts/AskChisTool/home.aspx

delayed_care_est_chis_2020 Delayed or didn't get medical care last year Percent (%) Total Population California Health Interview Survey 2020 https://ask.chis.ucla.edu/AskCHIS/tools/_layouts/AskChisTool/home.aspx

covid_vax_one_or_more_est_2022 COVID-19 Vaccination 1+ Dose Estimate (#) Population 6 months and older LAC DPH Sep-22 publichealth.lacounty.gov/media/coronavirus/vaccine/vaccine-dashboard.htm

covid_vax_one_or_more_perc_2022 COVID-19 Vaccination 1+ Dose Percent (%) Population 6 months and older LAC DPH Sep-22 publichealth.lacounty.gov/media/coronavirus/vaccine/vaccine-dashboard.htm

covid_vax_full_est_2022 COVID-19 Fully Vaccinated Estimate (#) Population 6 months and older LAC DPH Sep-22publichealth.lacounty.gov/media/coronavirus/vaccine/vaccine-dashboard.htm

covid_vax_full_perc_2022 COVID-19 Fully Vaccinated Percent (%) Population 6 months and older LAC DPH Sep-22 publichealth.lacounty.gov/media/coronavirus/vaccine/vaccine-dashboard.htm

covid_vax_one_or_more_children_est_2022 COVID-19 Vaccination 1+ Dose - Children under 5 Estimate (#) Population older than 6 months and under 5 years LAC DPH Sep-22 publichealth.lacounty.gov/media/coronavirus/vaccine/vaccine-dashboard.htm

covid_vax_one_or_more_children_perc_2022 COVID-19 Vaccination 1+ Dose Children under 5 Percent (%) Population older than 6 months and under 5 years LAC DPH Sep-22 publichealth.lacounty.gov/media/coronavirus/vaccine/vaccine-dashboard.htm

covid_vax_one_or_more_youth_est_2022 COVID-19 Vaccination 1+ Dose - Youth 5-17 Estimate (#) Population 5-17 years LAC DPH Sep-22publichealth.lacounty.gov/media/coronavirus/vaccine/vaccine-dashboard.htm

covid_vax_one_or_more_youth_perc_2022 COVID-19 Vaccination 1+ Dose Youth 5-17 Percent (%) Population 5-17 years LAC DPH Sep-22 publichealth.lacounty.gov/media/coronavirus/vaccine/vaccine-dashboard.htm

covid_vax_one_or_more_adults_est_2022 COVID-19 Vaccination 1+ Dose - Adults Estimate (#) Population 18 and older LAC DPH Sep-22 publichealth.lacounty.gov/media/coronavirus/vaccine/vaccine-dashboard.htm

covid_vax_one_or_more_adults_perc_2022 COVID-19 Vaccination 1+ Dose Adults Percent (%) Population 18 and older LAC DPH Sep-22 publichealth.lacounty.gov/media/coronavirus/vaccine/vaccine-dashboard.htm

insured_pop_est_acs_2020 Insured population # Civilian noninstitutionalized population 2016-2020 ACS - S2701 https://data.census.gov/cedsci/table?g=0500000US06037&tid=ACSST5Y2020.S2701

insured_pop_perc_acs_2020 Insured population % Civilian noninstitutionalized population 2016-2020 ACS - S2701 https://data.census.gov/cedsci/table?g=0500000US06037&tid=ACSST5Y2020.S2701

mch_indicators_2019 Babies Born with Positive MCH Indicators Babies born in time frame Strong Start Index 2016-2019 https://infogram.com/1pj576jwy166z1s6ywvk32l5lkammrym3wy?live

current_asthma Percent of Adults (Ages 18 Years and Older) with Current Asthma Adults Los Angeles County Health Survey 2018 https://www.publichealth.lacounty.gov/ha/HA_DATA_TRENDS.htm

no_med_insurance Percent of Insured Adults (Ages 18 Years and Older) Who Reported a Time Without Medical Insurance in the past 12 Months. Adults Los Angeles County Health Survey 2011 https://www.publichealth.lacounty.gov/ha/HA_DATA_TRENDS.htm

transportation_problems Percent of Adults (Ages 18 Years and Older) Who Reported That Transportation Problems Kept Them from Obtaining Needed Medical Care in the past Year. Adults Los Angeles County Health Survey 2007 https://www.publichealth.lacounty.gov/ha/HA_DATA_TRENDS.htm

Context

Vaccinations provide people the ability to develop immunity to particular diseases. When the majority of a population is vaccinated, “herd immunity” protects those who have not been vaccinated by blocking the spread of these diseases. A medical research paper published by The Lancet in 1998 suggested an association between the Measles/Mumps/Rubella (MMR) vaccine and Autism spectrum disorders. The paper was later fully-retracted due controversy surrounding the lead author, who had financial conflicts of interest and allegedly manipulated the study data. However, it generated worldwide concern over the safety of MMR and other types of vaccines, including Diphtheria/Tetanus/Pertussis (DTP).

In California by 2010, the growing trend for parents to opt out of having their children receive vaccines over the following decade coincided with the largest Pertussis outbreak in more than 60 years. Reduced vaccination frequency was also linked to a high-profile measles outbreak in 2014 that began at Disneyland. The resulting California state legislation (Senate Bill 277), signed June 2015, made it much more difficult for parents to opt out of vaccinations for their children. The data set will allow you to explore individual public and private school vaccination rates of incoming Kindergarten students for the 2000 to 2014 school years.

Content

The data are records for every school with ten or more students reporting the number of incoming Kindergarteners who provided either proof of immunization, personal beliefs exemption (PBE), or permanent medical exemption (PME). Annual records for the 2000-2001 through 2014-2015 school years have been formatted and combined. Common variables in these annual data sets included in the merged file are the number of students, school name, school county, the number of PBEs, PMEs, and number of students vaccinated for:

• Diphtheria/Tetanus/Pertussis (DTP)
• Polio
• Measles/Mumps/Rubella (MMR)

One additional file contains 5 years of county-level Pertussis case numbers and rates. Another additional data file contains the number of infant Pertussis cases for infants under three months old for each county in California between 2014-2015.

Geographic data are available in a file based on scripted geocode calls using the ggmap R package to find latitude and longitude data using the school names and county names. Not all calls returned a valid coordinate, so additional indicator variables in this file indicate the quality of the match. The isSchool indicator variable is 1 if the geocode search meta data included "school" and the countyMatch indicator is 1 if the latitude and longitude coordinates are contained within the appropriate county in CA.

References:

1. Retracted Lancet Research Article
2. Report on 2010 Pertussis Outbreak

Acknowledgements

Individual data files and detailed annual reports for every school year in this data set are provided by the California Department of Public Health (CDPH). Individual schools and licensed child care facilities are required to report immunization information to CDPH every year to maintain compliance with the California Health and Safety Code. Additional details as well as child care and 7th grade data files can be found on the CDPH website: https://www.cdph.ca.gov/programs/immunize/Pages/ImmunizationLevels.aspx

County level case data were pulled from the following report: https://archive.cdph.ca.gov/programs/immunize/Documents/Pertussis_Report_1-7-2015.pdf

Infant Pertussis data were reported to CDPH as of 2/10/2016. Additional Pertussis reports can be found here: https://www.cdph.ca.gov/programs/immunize/Pages/PertussisSummaryReports.aspx

Inspiration

While the Disneyland measles outbreak received much media attention, Pertussis outbreaks in California present great health risks to infants and the elderly. Can you predict which counties and schools are at greatest risk for outbreaks and/or quantify the association between vaccination rates and the number infant Pertussis cases?