Morbidity and mortality

MISSING IMAGE

Material Information

Title:
Morbidity and mortality
Uniform Title:
Morbidity and mortality (Washington, D.C. : 1952)
Running title:
Weekly mortality report
Weekly morbidity report
Morbidity and mortality weekly report
Abbreviated Title:
Morb. mortal.
Physical Description:
25 v. : ; 27 cm.
Language:
English
Creator:
United States -- National Office of Vital Statistics
Communicable Disease Center (U.S.)
National Communicable Disease Center (U.S.)
Center for Disease Control
Publisher:
The Office
Place of Publication:
Washington, D.C
Publication Date:
Frequency:
weekly
regular

Subjects

Subjects / Keywords:
Communicable diseases -- Statistics -- Periodicals -- United States   ( lcsh )
Mortality -- Periodicals -- United States   ( lcsh )
Morbidity -- Periodicals -- United States   ( mesh )
Mortality -- Periodicals -- United States   ( mesh )
Statistics, Medical -- Periodicals -- United States   ( lcsh )
Statistics, Vital -- Periodicals -- United States   ( lcsh )
Genre:
federal government publication   ( marcgt )
statistics   ( marcgt )
periodical   ( marcgt )

Notes

Additional Physical Form:
Also issued online.
Statement of Responsibility:
Federal Security Agency, Public Health Service, National Office of Vital Statistics.
Dates or Sequential Designation:
Vol. 1, no. 1 (Jan. 11, 1952)-v. 25, no. 9 (Mar. 6, 1976).
Issuing Body:
Issued by: U.S. National Office of Vital Statistics, 1952-Jan. 6, 1961; Communicable Disease Center, 1961- ; National Communicable Disease Center, ; Center for Disease Control, -Mar. 6, 1976.
General Note:
Title from caption.

Record Information

Source Institution:
University of Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
oclc - 02246644
lccn - 74648956
issn - 0091-0031
ocm02246644
Classification:
lcc - RA407.3 .A37
ddc - 312/.3/0973
nlm - W2 A N25M
System ID:
AA00010654:00006

Related Items

Preceded by:
Weekly mortality index
Preceded by:
Weekly morbidity report
Succeeded by:
Morbidity and mortality weekly report

Full Text

F5 :0/7. / 1/2zV


Morbidity and Mortality



U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE 4

PUBLIC HEALTH SERVICE w j


Prepared by the


I S L C DS E N


For release July 19, 1963


ATLANTA 22, GEORGIA


PROVISIONAL INFORMATION ON SELECTED NOTIFIABLE DISEASES IN THE Up
DEATHS IN SELECTED CITIES FOR WEEK ENDED JULY 13, 1963


POLIOMYELITIS Eleven cases of poliomyelitis, in-
cluding 8 paralytic, were reported for the week ending
July 13, 1963. This is well below the total of 25 cases
(14 paralytic) for the corresponding week in 1962. The
figure on page 230 demonstrates the comparative incidence
of poliomyelitis through the 28th week in 1958, 1960,
1962, and 1963.
Three cases reported this week from Alab'ama in-
cluded one from Walker County where there have now
been four cases, all paralytic, with onsets of illness
between June 3 and July 2. The two cases from Penn-
sylvania are from the Carlisle area (Cumberland and
Perry Counties) where 21 cases have occurred. Mass
community programs were conducted in the Carlisle area
in late June, with Type I oral polio vaccine (See MMWR,
Vol. 12, pp. 205 and 221). A total of approximately


102,000 doses of vaccine were dispe'the two-
county population of approximately 150,000.
Two cases of poliomyelitis occurred in widely sepa
rated areas in Tennessee. Single cases occurred in four
other States, including Wisconsin, South Carolina, Mis-
sissippi, and Oregon.
Cumulative totals for the first 28 weeks of 1963
and the preceding four years are shown in the table
below, together with the most recent six week totals:

Poliomyelitis (Cumulated Weekly) 1st Through 28th Week
1963 1962 1961 1960 1959
Paralytic 92 189 180 454 974
Total 113 252 277 612 1,458
Poliomyelitis (Six Week Totals) 23rd Through 28th Week
Paralytic 44 74 53 217 569
Total 57 100 92 281 877


Table 1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous week)
28th Week Cumulative
Disease Ended Ended Median First 28 weeks
July 13, July 14, 1958 1962 Median
1963 1962 1963 1962 1958 1962
Aseptic meningitis .............. 49 54 --- 705 711
Brucellosis ..................... 14 10 29 188 222 416
Diphtheria ...................... 2 3 9 140 225 344
Encephalitis, infectious .......... 31 43 43 845 855 824
Hepatitis, infectious and serum... 607 749 563 24,767 33,024 20,329
Measles........................ 4,886 4,817 5,138 344,685 427,799 378,053
Meningococcal infections ......... 37 27 39 1,510 1,270 1,406
Poliomyelitis, total .............. 11 25 94 113 252 612
Paralytic .................... 8 14 69 92 189 454
Nonparalytic. ................ 2 8 20 12 42 115
Unspecified.................. 1 3 5 9 21 43
Streptococcal sore throat
and Scarlet fever ............ 3,786 3,395 --- 222,060 203,677 _
Tetanus ......................... 5 4 --- 126 118
Tularemia...................... 15 7 145 143
Typhoid fever ................... 27 12 22 220 273 353
Typhus fever, tick-borne,
(Rocky Mountain spotted) ...... 11 11 --- 66 97 --
Rabies in Animals................ 71 99 84 2,165 2,326 2,185


Table 2. NOTIFIABLE DISEASES OF LOW FREQUENCY
Anthrax: 2 Psittacosis: Ill. 1
Botulism: 5 Rabies in Man:
Malaria: Ga. 1 49 Smallpox:
Plague: Typhus, murine: 8


Wekl








Morbidity and Mortality Weekly Report

CURRENT U.S. POLIO INCIDENCE
COMPARED WITH YEARS 1958, 1960, and 1962


oatA rODO .M-.0-1 OFISCE O1 -4T StT7(tS
A.n c. COMUIC-E 01SEW$ CNTEA


Week 12 19 26 2 9 16 23 2 9 6 23' 30
Ending JAN FEB MAR

EPIDEMIOLOGICAL REPORTS


Typhoid Fever Pennsylvania

From July 3 to July 12, 1963, twenty-three cases of
clinically diagnosed typhoid fever were reported to the
Pennsylvania State Department of Public Health. Each
of the 23 cases attended one of two sessions of a re-
ligious encampment in Franklin County, Pennsylvania.
The first session was held June 16 June 29 and the
second July 8-12. The camp was not operative during the
interim.
The majority of cases reported had attended the
first encampment, which included 155 children and 20
adults. Although most who attended were Pennsylvania
residents, it is known that several resided in Virginia,
West I' ireni. and Florida, and perhaps other States as
yet not known. At present, 10 patients are hospitalized
in South-Central Pennsylvania hospitals.
This preliminary report is included to alert the States
to this possible source of typhoid fever in campers who
may have returned from the Franklin County, Pennsyl-
vania, area.
(Reported by Dr. W. D. Schrack, Jr., Director, Division of
Communicable Disease Control, State Department of
Health, Pennsylvania.)

Salmonella derby Epidemic Follow-up Report

The interstate epidemic of hospital-associated
Salmonella derby infections, first noted in March, con-
tinues. (See MMWR Vol. 12, pp. 220, 199, 182, 173, 167,
and I From March I to July 8, a total of 775 isola-
tions of S. derby has been reported from 25 States and
the District of Columbia. (Table 1). Of these, 601 have


I3' 20 27 4 II IS 25 8 I5 22 29' 6 13
APR MAY JUN JUL


TABLE I REPORTED 5. DERBY ISOLATES MARCH 1, 1963 JULY 8, 1963
No, Hospitals Hospital Community Under
State Involved Associated Acquired Unknown Investigation Total


Alabama,,
Conneclcu

Distri of
Columbia
Georgi.


[ndoi.

Maryland
Massachusetts
Michigan
Minnesota


New M..exico..
New York
North Corolina


Rhodo Island


Woshiglo.

TOTAL


2
11 3 5
3 4 I I
2 3 1 1

I 2



2 1
4 3 2
4 5 9 3 9


4

40 601 71 31 72


Mo. ,. -n. oh ota reretn c .,overi.s oosuvI m,,er Iomoo o ,e y ro o
of -.-.. s .,, hos, ials.
SAt least 3 caso s represent iT action acquired from conto minated turkey oll,



been classified as "hospital-associated" infections and
have occurred in 40 hospitals in 10 States. The problem
is concentrated largely in the Northeastern portion of the
country. During this same period there have been 71 in-
fections classified as 'community acquired." These have
been reported from all parts of the country. Their fre-
quency has been comparable with the normal endemic
incidence of 5. derb) isolations (approximately 20 per


2301








Morbidity and Mortality Weekly Report


Since the epidemic began, 16 fatalities have been
reported among patients from whom S. derby was isolated
(Table II). Most of these patients were suffering from
serious debilitating or life threatening diseases; however,
in at least one instance the Salmonella infection was
considered "a highly contributing" factor in the patient's
death.

TABLE 2 FATALITIES ASSOCIATED WITH THE ISOLATION
OF S. DERBY DURING HOSPITALIZATION

AGE AND SEX
STATE OF PATIENT OTHER DIAGNOSIS
1. Pennsylvania 80 M Chronic duodenal ulcer with
obstruction
2. Pennsylvania 18 F Staphylococcal pneumonia
3. Pennsylvania 64 M Diabetes mellitus
4. Pennsylvania 50 F Ulcerative Colitis
5. Pennsylvania 56 F Melanoblastoma
6. Pennsylvania 74 F Ulcerative Colitis
7. Pennsylvania 78 F Hypertensive cardiovascular
disease
8. Pennsylvania 81 M Fractured hip
9. Pennsylvania 53 M GI Surgery
10. Pennsylvania 69 M Carcinoma bladder
11. Pennsylvania 9 M Myeloblastoma
12. Pennsylvania 63 M Pulmonary carcinoma
13. Pennsylvania F Fractured hip
14. Pennsylvania 74 F Renal failure, hepatic failure
15. New York 30 F Hodgkins Disease
16. New York 59 M Carcinoma bladder

In each of the involved hospitals a consistent epi-
demiologic pattern has been observed. The initial isola-
tions have been recognized among patients with gastro-
intestinal disease, often post operative and usually during
the second week of hospitalization. Multiple cases have
appeared in widely separated parts of the hospital within
relatively short intervals of time. (Continued on page 236)


PNEUMONIA-INFLUENZA DEATHS

The number of pneumonia-influenza deaths reported
for all ages by the 108 cities exceeded the epidemic
threshold and is mainly due to the increases above epi-
demic levels reported for the past two successive weeks
by the Middle Atlantic States as shown in the figure.
Increases in the number of pneumonia-influenza deaths
during the past week were also reported by the West
North Central and Mountain States. The increase in the
Middle Atlantic States followed a moderate heat wave.


UNITED STATES
Ioe cities


SUMMARY OF DEATHS AMONG PERSONS 65 YEARS
AND OVER IN 108 U. S. CITIES

The weekly average number of deaths among persons
65 years and over in 108 cities for the four-week period
ending July 13 was 6,413 as compared with an expected
weekly average of 6,076.
During the first week of the recent four-week period,
the number of deaths among persons 65 years and over
was slightly below the expected number, but in the second
week showed an increase which culminated in an excess




WEEK ENDING
WEK-----4 Week Weekly
6/22 6/29 7/6 7/13 Total Average

Observed 6,073 6,285 ,285 6,331 6,961 25,650 6,413
Expected 6,140 6,094 6,053 6,015 24,302 6,076
Excess 67 191 278 946 1,348 337


of 946 over the expected number in the fourth week
(ending 7/13). Localization of this excess has been
mainly in the Middle Atlantic States.


DEATHS AT AGE 65 AND OVER IN 108 U CITIES
Average number er eek by four-week periods


DEATHS'
NUMBER--- ----- --- ..
OF I 1:1,
IDEATHS ... ,,,









(See table, page 235)


MIDDLE ATLANTIC
z z 1 .c, ies is ,k a
cities

15D









232 Morbidity and Mlortality Weekly Report



Table .i CASES OF SPECIFIED NOTIFIABLE D1)ISASES I UNITED STATES

FOR WEEKS INDEI)D

JULY 13, 1963 AND JULY 14, 1962



Poliomyelitis, Aseptic
Poliomyelitis, total cases Poliomyelitis, paralytic nonparalytic Meningitis


Area




UNITED STATES......

NEW ENGLAND..............
Maine..................
New Hampshire.........
Venr ont ...............
Massachusetts.........
Rhode Island ..........
Connect icut...........

MIDDLE ATLANTIC ..........
New York..............
New Jersey............
Pennsylvania

EAST NORTH CENTRAL.......|
Ohio ..................
Indiana...............
Illinois. ..............
Michigan ..............
Wisconsin .............

WEST NORTH CENTRAL.......
Minnesota.............
Iowa ..................
Missouri ..............
North Dakota..........
South Dakota..........
Nebraska ..............
Kansas................

SOUTH ATIANTIC ...........
Delaware .............
Maryland ..............
District of Columbia..
Virginia..............
West Virginia.........
North Carolina........
South Carolina........
Georgia ...............
Florida...............

EAST SOUTH CENTRAL.......
Kentucky..............
Tennessee.............
Alabama...............
Mississippi...........

WEST SOUTH CENTRAL.......
Arkansas..............
Louisiana.............
Oklahoma..............
Texas.................

MOUNTAIN .................
Montana...............
Idaho.................
Wyoming...............
Colorado ..............
New Mexico............
Arizona...............
Utah..................
Nevada................

PACIFIC ..................
Washington............
Oregon................
California............
Alaska................
Hawaii ................


Cumulative Cumulative
28th week First 28 weeks 28th week First 28 weeks 28th week 28th week
1963 1962 1963 1962 1963 1962 1963 1962 1963 1962 1963 1962

11 25 113 252 8 14 92 189 2 8 49 54

3 3 1



2 2 I
I i


2 2 32 36 1 2 24 23 1 2
1 5 34 1 5 21 -
1 1 2 1 1 2
2 26 1 18 1 2

i 2 18 13 1 12 8 10 4
5 5 3 5 2 2
2 3 2 1
2 7 4 1 6 1 3 2
2 2 4
1 2 1 -

3 3 13 1 3 7 2 5 1
2 3 2 3 5 1
2 5 2 2
1 1 5 1 1 2






1 1 13 16 1 1 10 13 1 9


1
2 2 1 2 2
1 1 3 1 1 3 1 1
3 2 3 2
1 3 1 2 1
1 2 2
3 6 3 4 5

6 2 17 10 6 1 15 6 1 10 4
2 5 1 3 1 2
2 4 3 2 4 1 1 1
3 11 2 3 9 2 1 1
1 2 1 2 8

11 16 125 6 16 99 4 6 21
1 1 1
1 13 8 1 13 7 -
1 2 1 1
9 2 114 5 2 91 4 5 20

1 9 7 1 2
3 2 1 -

-2
I 1
1 1 2

3 3
1 1


1 3 14 27 2 12 23 1 1 16 10

1 2 2 1 2 1 -
3 12 25 2 11 21 1 16 10


Puerto Rico.............. 1 4 8 1 4 8 -










Morbidity and Mortality Weekly Report 233


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
FOR WEEKS ENDED

JULY 13, 1963 AND JULY 14, 1962 (Continued)



Brucellosis Diphtheria Encephalitis, Hepatitis, Measles
infectious infectious and serum
Area Cumu- Cumu- 28th week
lative lative Under 20 &
28th week 28 weeks 28th week 28 weeks 28th week 20 yr. over Total 28th week
1963 1963 1963 1963 1963 1962 1963 1963 1963 1962 1963 1962
UNITED STATES ...... 14 188 2 140 31 43 281 285 607 749 4,886 4,817

NEW ENGLAND.............. 1 7 1 3 29 24 57 33 186 627
Maine................. 1 22 9 31 12 12 70
New Hampshire ......... 3 5 8 1 2
Vermont............... 1 1 2 23 60
Massachusetts......... 1 5 1 2 5 7 11 112 328
Rhode Island.......... 2 2 3 5 9 49
Connecticut........... 1 4 6 4 30 118

MIDDLE ATLANTIC.......... 1 5 21 9 7 55 73 128 145 1,012 893
New York.............. 3 13 5 7 36 43 79 94 646 570
New Jersey............ 3 2 16 18 22 204 226
Pennsylvania.......... 1 2 5 4 17 14 31 29 162 97

EAST NORTH CENTRAL ....... 1 16 1 17 1 6 44 49 93 130 1,590 1,046
Ohio.................. 1 3 6 11 17 47 151 117
Indiana............... 1 3 1 4 3 2 5 9 80 60
Illinois.............. 10 -" 7 2 5 13 18 32 113 115
Michigan.............. 2 3 1 1 30 20 50 34 832 458
Wisconsin............. 1 2 3 3 8 414 296

WEST NORTH CENTRAL ....... 5 122 36 3 14 7 27 47 126 315
Minnesota............. 7 15 1 1 1 10 1 23
Iowa.................. 5 90 1 5 2 7 16 73 75
Missouri.............. 7 I 2 2 4 15 28 150
North Dakota .......... I 21 57
South Dakota.......... 7 10 4 10 1 3 10
Nebraska .............. 5 8 2 1 3 3
Kansas................. 6 2 1 1 2 2 NN NN

SOUTH ATLANTIC........... 3 8 29 8 8 34 18 55 65 566 320
Delaware .............. 12 7
Maryland.............. 3 1 12 6 18 16 117 39
District of Columbia 1 1 3 1 -
Virginia .............. 3 1 4 6 12 11 118 105
West Virginia......... 1 4 1 5 7 174 62
North Carolina........ 1 -1 10 2 12 15 3 7
South Carolina........ 9 1 2 2 90 40
Georgia............... 3 3 10 1 3 3 1 1 -
Florida............... 1 8 4 5 1 1 2 10 50 60

EAST SOUTH CENTRAL....... 1 8 10 3 2 18 23 41 90 166 196
Kentucky .............. 2 6 4 10 35 48 35
Tennessee ............. 4 2 1 2 5 7 17 98 132
Alabama............... 1 2 8 3 4 7 14 3 14
Mississippi........... 2 2 7 10 17 24 17 15

WEST SOUTH CENTRAL....... 2 15 17 1 1 39 29 69 50 228 274
Arkansas .............. 3 1 5 3 8 3 9 -
Louisiana ............. 2 2 2 13 6 19 10 3
Oklahoma .............. 4 6 1 1 1 36 11
Texas................. 6 8 21 20 42 36 183 260

MOUNTAIN ................. 1 7 1 7 11 44 56 481 514
Montana................. 1 1 2 1 57 60
Idaho................. .. 6 9 55 21
Wyoming ............... 1 1 1 1 12
Colorado.............. .- 1 6 10 121 153
New Mexico ............ 1 4 3 7 2 NN NN
Arizona ............... 3- 12 33 182 170
Utah.................. 3 2 5 7 62 96
Nevada ................*** 3 4 2

PACIFIC.................. 7 2 8 13 41 51 93 133 531 632
Washington............. 2 9 7 17 38 33 67
Oregon................ 2 1 7 8 15 13 52 169
California ............ 4 2 8 10 23 35 58 76 325 305
Alaska.................. 2 1 3 5 71 8
Hawaii................ i 1 50 83

Puerto Rico .............. 10 12 1 13 11 12 73









lMorbidit and 1Mortalily weekly y Report


I.hh i (A.AI.t, OF SPf(.1FIID NOI'IFIABLI DISIASFS: VNITID STAllS

iFOR W I:KS FNI)ID

JULY 13, 1963 AND JULY 14. 1962 (Continued)


Infections

Art k Cumu-
lative
28th wk. 28 weeks


UNITED STATES....

NEW ENGLAND ........
Maine..............
New Hampshire......
Vermont............
Massachusetts......
Rhode Island.......
Connecticut........

MIDDLE ATIANTIC.....
New York...........
New Jersey.........
Pennsylvania.......

EAST NORTH CENTRAL..
Ohio ..............
Indiana ...........
Illinois..........
Michigan ...........
Wisconsin..........

WEST NORTH CENTRAL..
Minnesota,..........
Iowa...............
Missouri...........
North Dakota......
South Dakota.......
Nebraska...........
Kansas,.............

SOUTH ATLANTIC......
Delaware...........
Maryland...........
Dist. of Columbia..
Virginia...........
West Virginia......
North Carolina.....
South Carolina.....
Georgia............
Florida ............

EAST SOUTH CENTRAL..
Kentucky...........
Tennessee..........
Alabama ............
Mississippi........

WEST SOUTH CENTRAL..
Arkansas...........
Louisiana..........
Oklahoma ...........
Texas...............

MOUNTAIN............
Montana............
Idaho..............
Wyoming ............
Colorado...........
New Mexico ........
Arizona....***........
Utah...............
Nevada.............

PACIFIC.............
Washington.........
Oregon.............
California .........
Alaska.............
HaW3i4


37

2







4

2
2





















1

2
2
3























1




4

2

2

4
1



3














13
2
1
9
1


1,510

93
16
4
3
42
9
19

206
95
29
82

238
69
30
41
71
27

89
18
5
30
4
5
19
8

286
2
44
4
69
15
51
13
22
66

117
25
51
21
20

150
10
62
29
49

52
3
4
4
12
4
8
14
3

279
21
18
225
8
7


r Throat & Tetanus
Scarlet Fever


28th week


3,786

304
34
46

50
7
167

132
80
34
18

349
13
59
62
140
75

110
4
23

40
5

38

243
1
37

41
72
9
21

62

774
65
651
14
44

596

1
42
553

769
30
60
4
244
219
96
101
15

509
63
7
410
8
21


3,395

204
4

1
49
16
134

141
103
12
26

269
14
84
37
80
54

100
8
24
5
53
3

7

226

6
1
60
73
9
53

24

666
26
614
1
25

492

1
2
489

609
6
47
7
266
94
125
64


688
30
19
597
30
12


28th wk.


I L I I ...
Typhus
(Rcky Mt.
Spotted)

28th wk.


Tularemia Typhoid Fever

Cumu-
lative
28th wk. 28th wk. 28 weeks


Rabies in Animals


28th week


71 99

2

I -
1I




3 5
2 4

1 1

13 40
7 6
3 4
1 29
1 1
1

32 24
3 3
16 11
6 2
2
1 7
4
1

4 7



2 4
1 3


1


5 9
2 4
3 3
2


3 6



3 6


Cumu-
lative
28 weeks


2,165

24
1
12
10
1



64
49

15

366
223
35
54
32
22

529
134
201
95
17
59
14
9

321



119
94
5
6
40
57

175
82
78
15


427
32
37
33
325

47



2
21
24



212

1
202
9


Puerto Rico......... 5 6 4 3 11 1 9


. ..........










Morbidity and Mortality Weekly Report





Table 4 (D). TOTAL DEATHS AMONG PERSONS 65 YEARS AND OViR IN RIPORTINC; CITIES



(Tables 4(A), 4(B), 4(C), and 4(D) will be published in sequence covering a four-week period.)o


235


Area For weeks ending Area For weeks ending

6/22 6/29 7/6 7/13 6/22 6/29 7/6 7/13


NEW ENGLAND:
Boston, Mass..............
Bridgeport, Conn..........
Cambridge, Mass...........
Fall River, Mass..........
Hartford, Conn ...........
Lowell, Mass ..............
Lynn, Mass................
New Bedford, Mass ........
New Haven, Conn ...........
Providence, R.I...........
Somerville, Mass..........
Springfield, Mass.........
Waterbury, Conn...........
Worcester, Mass ...........

MIDDLE ATLANTIC:
Albany, N.Y...............
Allentown, Pa.............
Buffalo, N.Y ..............
Camden, N.J...............
Elizabeth, N.J............
Erie, Pa ..................
Jersey City, N.J..........
Newark, N.J ...............
New York City, N.Y........
Paterson, N.J.............
Philadelphia, Pa..........
Pittsburgh, Pa ............
Reading, Pa...............
Rochester, N.Y ............
Schenectady, N.Y.,........
Scranton, Pa..............
Syracuse, N.Y.............
Trenton, N.J..............
Utica, N.Y ................
Yonkers, N.Y ..............

EAST NORTH CENTRAL:
Akron, Ohio .. .............
Canton, Ohio..............
Chicago, Ill..............
Cincinnati, Ohio ..........
Cleveland, Ohio...........
Columbus, Ohio ............
Dayton, Ohio..............
Detroit, Mich.............
Evansville, Ind ...........
Flint, Mich ...............
Fort Wayne, Ind ...........
Cary, Ind .................
Grand Rapids, Mich ........
Indianapolis, Ind.........
Madison, Wis ..............
Milwaukee, Wis ............
Peoria, Ill ...............
Rockford, Ill .............
South Bend, Ind...........
Toledo, Ohio..............
Youngstown, Ohio..........

WEST NORTH CENTRAL:
Des Moines, Iowa.........
Duluth, Minn.............
Kansas City, Kans ........
Kansas City, Mo..........
Lincoln, Nebr............
Minneapolis, Minn........
Omaha, Nebr ..............
St. Louis, Mo ............
St. Paul, Minn...........
Wichita, Kans ............


142
30


93
20
21
12
28
10
14
17
19
64
10
25
20
32


23
22
67
24
11
18
39
37
880
21
256
95
33
67-
16
25
36
19
13
25


33
17
351
89
111
63
38
174
21
26
21
17
34
58
13
60
12
16
24
62
35


35
14
18
70
14
80
36
125
45
23


132
23
11
35
19
12
12
22
36
42
12
47
15
46


156
45
24
17
34
26
17
26
17
50
12
23
16
50


32
25
100
14
27
32
49
55
1,321
31
251
65
23
58
20
25
47
12
24
27


29
22
376
89
110
55
47
284
25
15
22
22
27
81
7
64
20
19
19
65
30


21
10
14
101
24
76
26
136
41
18


SOUTH ATLANTIC:
Atlanta, Ga ..............
Baltimore, Md............
Charlotte, N.C...........
Jacksonville, Fla........
Miami, Fla...............
Norfolk, Va ..............
Richmond, Va.............
Savannah, Ga.............
St. Petersburg, Fla......
Tampa, Fla...............
Washington, D.C..........
Wilmington, Del..........

EAST SOUTH CENTRAL:
Birmingham, Ala..........
Chattanooga, Tenn........
Knoxville, Tenn..........
Louisville, Ky...........
Memphis, Tenn............
Mobile, Ala..............
Montgomery, Ala..........
Nashville, Tenn..........

WEST SOUTH CENTRAL:
Austin, Tex..............
Baton Rouge, La..........
Corpus Christi, Tex......
Dallas, Tex ..............
El Paso, Tex.............
Fort Worth, Tex..........
Houston, Tex.............
Little Rock, Ark.........
New Orleans, La..........
Oklahoma City, Okla......
San Antonio, Tex.........
Shreveport, La...........
Tulsa, Okla..............

MOUNTAIN:
Albuquerque, N. Mex......
Colorado Springs, Colo...
Denver, Colo.............
Ogden, Utah ..............
Phoenix, Ariz............
Pueblo, Colo.............
Salt Lake City, Utah.....
Tucson, Ariz .............

PACIFIC:
Berkeley, Calif..........
Fresno, Calif............
Glendale, Calif..........
Honolulu, Hawaii.........
Long Beach, Calif........
Los Angeles, Calif.......
Oakland, Calif...........
Pasadena, Calif..........
Portland, Oreg...........
Sacramento, Calif........
San Diego, Calif.........
San Francisco, Calif.....
San Jose, Calif..........
Seattle, Wash ............
Spokane, Wash ............
Tacoma, Wash.............


66
138
15
31
53
27
39
14
55
43
76
18


53
19
21
69
62
29
15
43


24
14
18
55
15
38
81
46
100
41
55
35
27


19
13
55
6
44
8
31
22


17
26
24
23
30
309
51
28
73
29
60
86
22
87
31
32


55
102
12
32
53
19
43
11
60
39
83
16


47
36
22
75
44
11
16
41


16
12
8
75
22
33
89
23
75
33
61
29
36


10
8
55
15
43
7
23
32


12
28
28
22
34
274
70
34
85
35
56
106
17
70
39
22


18
13
115
45
38
24
59
67
1,013
21
345
107
30
61
8
27
35
48
30
23


46
25
385
104
139
71
40
169
24
21
23
25
32
82
23
87
6
16
22
89
32


58
14
16
111
20
71
40
137
52
30


San Juan, P.R.............. 21 13 16 18


aCurrent Week Mortality for 108 Selected Cities

4(A) Total Mortality, all ages ................... 12,340
4(B) Pneumonia-Influenza Deaths, all ages ........ 459
4(C) Total Deaths under 1 Year of Age............ 840
4(D) Total Deaths, Persons 65 years and over..... 6,961


Totals for previous weeks include reported corrections.

NOTE: All deaths by place of occurrence.








236 Morbidity and Mo




Common sources of infection such as contact with
possibly infected persons, exposure in specific locations,
common therapeutic or diagnostic procedures or common
medications have been notably absent. In some hospitals
secondary spread of infection has become a difficult and
continuing problem. This has complicated epidemiologic
analysis.
The almost simultaneous appearance of these in-
fections in many hospitals in several States clearly in-
criminated some common source of infection in interstate
movement. The following possibilities have been con-
sidered: 1) interchange of patients or personnel; 2) use of
diagnostic or therapeutic agents; and, 3) dietary items.
Intensive investigations for these possibilities were
carried out in 22 hospitals. The first two could be clearly
excluded. The third, dietary items, presented a wide
range of potentially suspect foods. Histories of foods
consumed during the period of 48 hours prior to onset
among approximately 200 of the "initial" patients re-
vealed that most were receiving highly restricted diets.
Thus many potential food items could be excluded from
further consideration. Only one particular item of food
was almost universally consumed by the patients. This
was raw or undercooked eggs.
Therefore a careful search was made of sources of
the eggs supplied to 15 hospitals in 3 States. Among a
large number of egg farms identified, only those in two
localized geographic areas could possibly have supplied
these 15 hospitals. Samples of eggs (235 dozen), pooled
chicken droppings (5400 specimens) and poultry feed
(58 specimens) were obtained from both areas. S. derby
was recovered from one sample of feed and 4 pooled
samples of cracked eggs in one of these areas.
Upon review of the data accumulated, the Surgeon
General of the Public Health Service released the follow-
ing recommendation on July 11, 1963:
"There is sufficient epidemiological and bacteri-
ological evidence to suggest that everyone should avoid
buying and using cracked or unclean eggs. Persons who
are ill, especially infants, the elderly, and individuals
suffering from gastrointestinal diseases or malignancies
should not be fed raw or undercooked eggs. An under-
cooked egg is one in which the white is not firm."
"It is recognized that cracked eggs are used for a
variety of commercial purposes. So long as eggs used for
these purposes are thoroughly cooked and the final
product is not recontaminated, there is no inherent danger
to the continued use of these eggs for this purpose.
Thorough cooking will effectively sterilize the product."
(Based on studies conducted by State and' local health
officials, the Food and Drug Administration, the staffs
of numerous hospitals and teams from the Communicable
Disease Center.)


rtal


UNIVERSITY OF FLORIDA


3 1262 08864 1237
lily Weekly Report




INTERNATIONAL NOTES QUARANTINE MEASURES

Smallpox Sweden
Two additional cases of smallpox were reported from
Stockholm on July 11 and July 12, respectively. One of
these, an 89-year-old female patient in a mental hospital,
had onset of rash and fever on July7, 15 days after onset
of illness in Case 23, a 73-year-old woman also hospital-
ized at this institution.
The total number of confirmed cases that has oc-
curred during the outbreak is 25, including four deaths.



jj' OF FL L'O
DOC" I ME. E TS DEPT





U.S. DEPOSITORY


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