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:
AA00010654:00014

Related Items

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

Full Text



NATIONAL COMMUNICABLE DISEASE CENTER
NATIONAL COMMUNICABLE DISEASE CENTER


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

BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


EPIDEMIOLOGIC NOTES AND REPORTS
TYPE E BOTULISM Chicago, Illinois

Three cases (one fatal) of foodborne intoxication
caused by Clostridium botulin" F1t",
gefilte fish prepared from fresh s 'h,\L. #y
Chicago in the week er,.lin, lurI V n
On Saturday, June Ii, .'r K p.m., a 57-Y
old housewife served I, ,r- I 11 ,1, lu I
consisting of gefilte fish wit h eradish on .. 1)
bottled soft drink. The ". ...1 two I ."'.- .
gefilte Ii-h the man ate one' n. An hour later
housewife's pro'.r,,.i i l. u sr. hr-r- -ur~ lr .. 1 ,
of milk and a h..il porvron .:.I rlh.* r,,


Vol. 16, No. 24







Week Ending
June 17, 1967



PUBLIC HEALTH SERVICE


CONTFEN r
Epidemiologic Notes and Reports
Type F Botulism Chicago. Illinois .. ..... 1l::
Tuberculosis Buffaluo NeN York .. ... 1'1"
Rubella Floyd (County, Georgia . .. 1

radish. About 6 hours after lunch, the housei- t' I'f l1
nauseated, complained of heartburn, and vomited set(eral
times. The vomiting resumed Sundax morning. s hours lat('r.
accompanied by weaknes-. dizziness. dry mouth. abldom-
inal distention. and constipation. She al so had noticeable
hoarseness and slurred speech, but no diplopia. Sunday
evening, after becoming dyspneic and hypotensi e (BP
.11 .1 11 1,. ,- h.. ,r ,. h I.. .1 p -1 ,, I I1 1. ,,,I .


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
24th WEEK ENDED CUMULATIVE, FIRST 24 WEEKS
MEDIAN
DISEASE JUNE 17, JUNE 18, 1962 1966 MEDIAN
1967 1966 1967 1966 1962- 1966
Aseptic meningitis .................... .. 45 41 38 792 676 659
Brucellosis ............................ 6 7 111 95 158
Diphtheria ................... ....... 1 2 4 49 72 129
Encephalitis, primary:
Arthropod-borne & unspecified ........... 27 28 599 588
Encephalitis, post-infectious ..... ...... 21 13 417 414 -
Hepatitis, serum ........................ 43 33 920 600
Hepatitis, infectious .................... 742 594 646 18,459 15,914 20.273
Malaria ............................... 41 5 2 911 133 42
Measles (rubeola)........................ 1.239 4.472 12,224 53,038 172,735 319,225
Meningococcal infections, total .......... 34 61 48 1,346 2,230 1,505
Civilian .............:............... .. 33 56 1.248 1,978
Military .............................. 1 5 -- 98 252 -
Poliomyelitis, total ................. 2 2 10 12 36
Para iic ............. 2 2 9 11 29
Rubiella German measles) ................ 1,805 1.350 34,718 37,110
Streptococcal sore throat & scarlet fever .. 6,295 6,777 6.142 265,699 252.957 234.840
Tetanus................................ 8 8 8 80 66 98
Tularemia. ...... ...................... 3 4 8 65 68 109
Typhoid fever .......................... 4 6 9 176 133 162
Typhus, tick-borne (Rky. Mt. spotted fever) 10 14 10 66 55 49

Rabies in animals .. ........ ....... ... 97 94 70 2,154 2,091 2.088

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum Cum
Anthrax ............................... .... 2 Rabies in man ... .... ..
Botulism .. ........................... .. ... Rubella, Congenital Syndrome .3
Leptospirosis .......... .... ..... .... 17 Trichinosis ........... 37
Plague ......................... ..... ...... Typhus, marine: Tex.-1 ................... .. 17
Psittacosis ................................ .. ..... 20 Polio, Unsp. ..... 1







Morbidity and Mortality Weekly Report


TYPE E BOTULISM Chicago, Illinois
(Continued from front page)


the patient continued to have difficulty with breathing and
hypotension, but she remained mentally alert. Tuesday
morning she had a cardiac arrest and was resuscitated,
but afterwards was unresponsive and required mechanical
respiration. The patient remained in a deep coma and died
Thursday morning. June 15.
The man also had vomiting, abdominal distention,
constipation, and hoarseness beginning 22 hours after he
had eaten the fish and persisting for 2 days. He was ad-
mitted to Cook County Hospital on Monday, June 12. A
diagnosis of intestinal obstruction was first considered;
however, the diagnosis of botulism was made shortly after
admission. He was treated with nasogastric suction and
intravenous fluids with prompt response.
The pregnant daughter-in-law had a dizzy spell late
Saturday afternoon and another dizzy spell with vomiting
Sunday afternoon. This was followed by several hours of
nausea, weakness, and a slight distortion of hearing. She
recovered spontaneously. The fetus remained viable.
The diagnosis of the first case presented difficulties
because of the predominance of vomiting, which was re-
lated to a previous history of hiatal hernia, and the knowl-
edge that this symptom is not commonly associated with
the classical form of botulism. When the second case was
recognized as botulism, the diagnosis of the first case
became evident.
Botulinum antiserum for types A and B (Lederle) was
administered to the first patient on Wednesday after she
had been in coma for more than 24 hours. The outbreak
was reported to NCDC on Wednesday afternoon, and type E
antiserum was promptly dispatched from Atlanta and admin-
istered on Wednesday evening. 9 hours before the patient
died. The second and third patients were recovering by
the time the diagnosis of botulism was made. Antiserum
was not given.
An extract of the gefilte fish prepared with a buffered
gelatin solution inoculated intraperitoneally into mice
with appropriate antibotulinum sera and controls revealed
type E botulinum toxin. Titrations of the amount of toxin
are in process.
Serum samples taken from the first patient on the
first. second, and third day of illness were inoculated into
mice according to the same procedure. All mice except
those receiving heat-treated extract or extract with type E
antiserum developed typical signs of botulism and died
within 24 hours. Sera from the other two patients obtained
5 days after the gefilte-fish lunch had equivocal activity.
Some of the mice that were not protected with type E anti-
serum showed suggestive signs of botulism but most re-
covered.
The ..lil,., fish had been made by the housewife from
a fresh "Lake Superior" whitefish(actually caught in Lake


Michigan or Lake Erie) purchased at a local supermarket
on or about April 20. The entire fish was ground to a fine
paste, blended with fresh eggs and onions, shaped into
patties the size of a hamburger bun. and simmered in water
in an open pot for 4 hours. Part of this "cooked" mixture
was put in a sterilized jar. which was capped and re-
frigerated immediately. It remained unopened in the refrig-
erator (temperature 44'F ascertained later) for 7 weeks,
until June 10, when the gefilte fish was served cold. The
other portion of gefilte fish was kept in an open dish in
the refrigerator and consumed without ill effects within a
few days of its preparation.

(Reported by Dr. Samuel Andelman, Commissioner of Health,
Chicago Board of Health: Dr. Norman Rose, State Epi-
demiologist, Illinois Dept. of Public Health; Dr. Frederick
Stenn, Wesley Memorial Hospital. ... .. Dr. Roger
Benson, Cook County Hospital, Chicago; the Laboratory
Program, VCDC; and an EIS (. )



Editorial Note: A recent survey (1) of fresh fish caught in
Lakes Michigan. Superior, Huron, and Erie has shown that
1 to 9 percent of fish in each lake and 59 percent of fish
from certain areas of Lake Michigan have toxin-producing
Cl. botulinum type E in their intestines. Thus, a fish from
the Great Lakes has the potential for causing botulism
if it is improperly processed and stored and not re-cooked
before being eaten.

A study by C. F. Schmidt, et al., (2) showed that
spores of Cl. botulinum type E have the unique capability
of germinating and producing toxin at temperatures as
low as 38F if stored under anaerobic conditions for sev-
eral weeks. The storage of this homemade gefilte fish in
a sealed jar in a home refrigerator for 7 weeks provided
adequate conditions for the production of type E toxin.
It is worthy of note that each of these patients had
vomiting as a presenting symptom. The extensive report
of the type E botulism outbreak in Tennessee related to
smoked whitefish (3) revealed that \mrri;r was one of
the commonest symptoms. Thus, type E botulism is dif-
ferent in this respect from the classical forms of the
disease.

REFERENCES:
1. Bott, T.L. et al. Clostridium botulinum type E in fish
from the Great Lakes. J. Bact 91:919-924, March 1966.
2. Schmidt, C.F. et al. Growth and toxin production by
type E Clostridium botulinum below 400F. J. Food
Science 26:626-630, Nov-Dec 1961.
3. Koenig, M.G. et al. Clinical and laboratory observa-
tions on type E botulism in man. Med. 43:517-545, 1964.


JUNE 17, 1967







Morbidity and Mortality Weekly Report


TUBERCULOSIS Buffalo, New York


On May V1, 1967, a -I6-year-old, female, second-grade
teacher in a public elementary school in Buffalo was found
to hate a markedly positive sputum smear for acid-fast
bacilli. This sntdy \as prompted by a recent abnormal
chest x-ray which was interpreted as showing moderately
advanced pulmonary tuberculosis. She had been x-rayed
on several earlier occasions, most recently in August
1965. because of an extensive family history of tubercu-
losis. All earlier chest roentgenograms were considered
normal. She had had no tuberculin skin tests. The diagnosis
of pulmonary tuberculosis was further confirmed when a
culture of the sputum grew innumerable colonies of Vlyco-
bacterium tuberculosis after only 2 weeks of incubation.
Her school attendance record from September 1966
to May 1967 had been flawless.
On May 17, Mantoux tests, using intermediate strength
PPD. were given to students, teachers, and employees at
the school by a team from the Erie County Health Depart-
ment. Of the S44 students present and tested on May 17.
eight reacted positively (9 mm induration or greater). Three
of these were among the 25 pupils of the teacher with
active tuberculosis. One of the other reactors was a second-
grader, and one had been in this teacher's class the pre-
vious year. All 25 students in her class had had negative
Heaf tests the year before, and all were tested in May 1967.
A fourth pupil in the teacher's class was subsequently ad-
mitted to a local hospital for an unrelated problem and was
found to have converted to a positive tuberculin reaction
on repeat testing. In contrast to the normal chest x-rays
of her classmates and the other reactors, the x-ray of this
patient was abnormal and revealed an enlarged hilar lymph
node.
The teacher's son, a student at the school, was not
skin tested in the survey. However, a tuberculin skin test,
performed by a private physician, was found to be positive.
All students with positive tuberculin tests were started on
antituberculous ( l. rmiih--r ... Six of the 36 adults tested
had positive reactions. Chest roentgenograms showed no
evidence of pulmonary pathology.
In view of the extensive exposure of the class and
the initial skin test results, repeat tuberculin testing of


the 21 negative pupils in her class was done on June 7,
1967 (5 weeks after contact was broken). Two additional
converters were discovered at this time. Thus, a total of
six tuberculin conversions were detected among the 25
students. The distribution of the reactors in the class-
room is depicted in Figure 1. Additional skin testing of
the class and the rest of the school is planned for the
near future.

Figure 1
SEATING OF POSITIVE TUBERCULIN REACTORS IN
SECOND-GRADE CLASSROOM, BUFFALO, MAY 1967


S DESK
0






El El II 0

El D 0 l





(FRONT OF CLASSROOM)


21 FEET FEET
----- 21 FEET ------


LEGEND
] POSITIVE REACTOR'S DESK
OPERABLE WINDOW
aS INOPERABLE WINDOW
m BLACKBOARD
SAtR GRID


Beginning in the fall of 1967, all public and parochial
school teachers in the city of Buffalo will be required to
have an annual tuberculin test. If positive, periodic chest
x-ray examinations will be obtained. These precautions
are being instituted in an effort to avert outbreaks such
as the one described here.
(Reported by William R. Elsea, M.D., Deputy Commissioner,
and A. Arthur Grabau, M.D., Director of the Division of
Tuberculosis Control, Erie County (N.Y.) Health Depart-
ment; and the Tuberculosis Program, NCDC.)


RUBELLA Floyd County, Georgia


During February 1967, an increase in rash illness
was reported from Glenwood School, a suburban elementary
school in Floyd County, Georgia. Between mid-January
and April, 101(21.8 percent) of the 464 students developed
a rash, which was relatively benigh in most instances
and caused few prolonged absences from school.
All patients interviewed had a maculopapular rash,
predominantly on the face and extremities; 33 percent
demonstrated cervical lymphadenopathy and sore throats.


Less frequent symptoms included conjunctivitis, pruritis,
cough, and coryza.
The first reported case occurred in mid-January, but
most students noticed the rash after mid-February. The
outbreak appeared in two clusters; in the first, 46.5 per-
cent (47 of 101 cases) developed a rash between February
22 and March 3. The second cluster (31 cases) was re-
ported from March 11 to March 16 (Figure 2).
(Continued on page 200)


JUNE 17, 1967








196 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 17, 1967 AND JUNE 18, 1966 (24th WEEK)

ENCEPHALITIS HEPATITIS
ASEPTIC Primary
AREA MENINGITIS 115 I(I.LOMIS DIPli'HElUA including Pot- Serum Infectious
unsp. cases Inectious
1967 1966 1967 1967 1967 1966 1967 1967 1966 1967 1966
UNITED STATES... 45 41 6 1 27 28 21 43 33 742 594

NEW ENGLAND........... 1 3 1 2 34 15
Maine.............. 3 3
New Hampshire...... -
Vermont........... -
Massachusetts...... 2 1 2 13 6
Rhode Island....... 1 1 3
Connecticut........ 18 2

MIDDLE ATLANTIC...... 8 5 2 4 1 14 15 146 76
New York City...... 2 2 1 7 12 71 22
New York, up-State. 2 2 1 25 26
New Jersey......... 2 1 5 2 18 12
Pennsylvania....... 4 1 2 1 2 32 16

EAST NORTH CENTRAL... 7 8 8 7 4 1 1 94 108
Ohio............... 7 5 1 1 22 17
Indiana............ 2 3 7 11
Illinois........... 2 1 2 3 30 38
Michigan........... 3 4 1 1 30 39
Wisconsin.......... 5 3

WEST NORTH CENTRAL... 1 1 1 1 4 31 37
Minnesota............ 1 1 1 4 4 2
Iowa................ 1 13
Missouri........... 1 23 21
North Dakota........ -
South Dakota........ -
Nebraska............ 1 -
Kansas............. 2 1

SOUTH ATLANTIC........ 6 3 3 1 6 2 1 85 73
Delaware............ 1 5
Maryland............ 2 5 26 21
Dist. of Columbia.. i 1
Virginia........... 2 15 12
West Virginia...... 2 3 4
North Carolina..... 1 5 6
South Carolina..... 2
Georgia............ 1 8 15
Florida............ 3 1 1 1 1 23 12

EAST SOUTH CENTRAL... 1 6 1 1 3 2 50 48
Kentucky........... 3 25 18
Tennessee.......... 1 2 12 14
Alabama............ 1 1 3 3
Mississippi....... 3 1 2 10 13

WEST SOUTH CENTRAL... 5 8 1 1 5 1 1 4 58 42
Arkansas........... 1 3 3
Louisiana.......... 4 1 1 2 1 1 11 11
Oklahoma............ 2 2
Texas.............. 1 7 1 3 3 42 26

MOUNTAIN.... ......... 1 1 3 73 37
Montana............. 2 1
Idaho.............. 1 14
Wyoming............. 2 1
Colorado........... 1 4 2
New Mexico......... 1 48 5
Arizona............ i 2 7 8
Utah............... 9 6
Nevada............. -

PACIFIC............... 17 9 9 5 5 21 12 171 158
Washington......... 1 14 11
Oregon............. 1 15 16
California......... 9 8 7 5 5 21 11 141 121
Alaska.............. 6
Hawaii............. 8 1 4
Puerto Rico 19 56








Morbidity and Mortality Weekly Report I


CASES OF SPECIF11D NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

I'JNIE 17. 1967 ANI) J'NI: IS, 1966 (2Jith W I:l) ( C(N'INI II)


MENINGOCOCCAL. INFECTIONS,
MALARIA MEASLES (Rubeola) NIN TOTAI. IPOLIOMYEIITIS RUBELLA
AREA ,
Cumulative Cumulativt --


UNITED STATES... 41 1,239 53,038 172,735 34 1,346 2,230 9 1,805

NEW ENGLAND ........... 10 731 2,051 57 103 248
Maine.............. 2 214 189 3 8 36
New Hampshire...... 71 50 2 8 25
Vermont............ 41 217 3 34
Massachusetts...... 7 269 716 29 41 60
Rhode Island....... 60 72 4 12 36
Connecticut........ 1 76 807 19 31 57

MIDDLE ATLANTIC..... 16 68 1,953 17,252 5 205 256 2 95
New York City...... 1 21 359 8,045 1 35 36 1 25
New York, Up-State. 13 425 2,198 3 50 74 70
New Jersey......... 5 18 456 1,803 78 71
Pennsylvania....... 10 16 713 5,206 1 42 75 1

EAST NORTH CENTRAL... 198 4,690 63,007 7 169 350 418
Ohio................ 111 1,042 6,011 3 62 97 43
Indiana............. 5 538 5,140 1 22 60
Illinois........... 14 817 10,953 3 40 65 137
Michigan........... 19 833 12,014 34 94 114
Wisconsin.......... 49 1,460 28,889 11 34 124

WEST NORTH CENTRAL... 3 142 2,647 8,176 2 62 124 21
Minnesota........... 1 111 1,606 1 15 30 8
Iowa ............... 10 723 5,000 12 16 6
Missouri ........... 1 83 298 503 12 50 1
North Dakota....... 2 780 954 7 5
South Dakota....... 47 38 6 4
Nebraska........... 16 596 75 1 11 8 1
Kansas............. 2 30 92 NN 6 9 -

SOUTH ATLANTIC........ 3 175 6,214 13,469 7 258 369 1 92
Delaware............ 1 37 233 5 4 12
Maryland............ 1 2 119 1,979 2 31 34 1 11
Dist. of Columbia.. 1 20 369 9 9
Virginia........... 1 45 1,890 1,732 2 27 48 19
West Virginia...... 44 1,280 4,658 19 12 22
North Carolina..... 2 825 321 50 92 -
South Carolina..... 33 478 605 1 24 43 -
Georgia............ 1 3 29 228 43 55 -
Florida............ 44 1,536 3,344 2 50 72 27

EAST SOUTH CENTRAL... 71 4,764 18,291 2 115 193 1 194
Kentucky........... 25 1,194 4,509 1 33 74 171
Tennessee.......... 34 1,649 11,313 47 61 22
Alabama............ 10 1,277 1,559 1 23 42 1
Mississippi........ 2 644 910 12 16 1

WEST SOUTH CENTRAL... 193 16,434 21,827 5 194 321 5 10
Arkansas........... 11 1,399 954 24 23
Louisiana.......... 2 143 85 3 77 122 -
Oklahoma............ 3 3,306 450 1 13 17 1
Texas.............. 177 11,586 20,338 1 80 159 4 10

MOUNTAIN............. 3 111 4,051 10,594 25 71 173
Montana............ 10 262 1,661 4 7
Idaho............... 9 356 1,279 1 5 6
Wyoming.............. 4 68 129 1 4 -
Colorado........... 3 64 1,338 1,085 10 37 116
New Mexico......... 2 541 1,042 3 9
Arizona............ 16 900 4,965 4 8 44
Utah............... 6 317 397 4 -
Nevada............. 269 36 2 4 -

PACIFIC.............. 16 271 11,554 18,068 6 261 443 554
Washington......... 4 56 5,331 3,278 24 35 35
Oregon.............. 24 1,460 1,264 24 29 31
California.......... 9 184 4,523 13,259 6 203 361 473
Alaska ............. 2 124 165 8 15 5
Hawaii.............. 3 5 116 102 2 3 -10
Puerto Rico.......... 35 1,867 2,137 1 9 8 1










198 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 17, 1967 AND JUNE IS, 1966 (24th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
AREA SCARLET FEVER (Rky. Mt. Spotted) ANIMALS
1967 1967 Cum. 1967 Cum. 1967 Cum. 1967 Cum. 1967 Cum.
1967 1967 1967 1967 1967

UNITED STATES... 6,295 8 80 3 65 4 176 10 66 97 2,154

NEW ENGLAND.......... 867 2 3 50
Maine............... 46 1 13
New Hampshire...... 3 1 28
Vermont............ 7
Massachusetts...... 131 2 1
Rhode Island....... 96 1 1
Connecticut........ 591 -

MIDDLE ATLANTIC...... 430 7 16 4 7 1 40
New York City...... 26 3 9 -
New York, Up-State. 383 1 5 1 1 31
New Jersey......... NN 1 1 2 2 -
Pennsylvania........ 21 2 1 2 4 9

EAST NORTH CENTRAL... 564 3 10 8 11 5 6 202
Ohio............... 113 1 1 4 4 80
Indiana............. 32 1 2 1 1 1 3 35
Illinois........... 145 5 7 1 3 43
Michigan........... 209 1 2 4 18
Wisconsin.......... 65 1 26

WEST NORTH CENTRAL... 222 4 1 12 1 5 1 1 22 484
Minnesota......... 2 2 1 3 93
Iowa.............. 69 1 2 3 58
Missouri............ 38 2 3 1 1 4 97
North Dakota....... 56 8 81
South Dakota........ 9 1 3 68
Nebraska........... 36 1 32
Kansas............. 12 1 7 1 1 1 55

SOUTH ATLANTIC....... 676 2 19 7 17 3 24 13 283
Delaware........... 21 -
Maryland........... 114 2 2 2
Dist. of Columbia.. 7 1
Virginia........... 274 4 2 7 5 143
West Virginia...... 88 1 1 2 48
North Carolina..... 22 5 2 1 12 3
South Carolina..... 2 1 2 3 2
Georgia............ 3 3 3 2 1 6 59
Florida............ 145 2 6 1 4 30

EAST SOUTH CENTRAL... 787 1 17 7 1 26 1 11 12 458
Kentucky............ 62 1 13 4 5 96
Tennessee........... 531 8 4 5 4 6 327
Alabama............. 88 1 7 5 1 3 1 33
Mississippi........ 106 2 2 1 3 2

WEST SOUTH CENTRAL... 648 1 14 2 21 1 20 6 25 448
Arkansas........... 4 1 8 5 1 1 64
Louisiana .......... 1 1 3 2 11 1 37
Oklahoma........... 40 1 8 3 10 134
Texas............... 607 7 3 1 4 2 13 213

MOUNTAIN............. 1,305 7 15 6 7 70
Montana............. 32 1 1 -
Idaho............ .. 126 -
Wyoming............. 3 2 4
Colorado............ 780 1 11 6 8
New Mexico......... 154 3 21
Arizona........... 43 3 3 36
Utah................ 166 3 3-
Nevada............. 1 1 1

PACIFIC.............. 796 1 9 3 1 64 1 6 8 119
Washington.......... 113 2 1
Oregon.............. 58 1 1 1
California.......... 564 6 1 1 61 1 5 8 118
Alaska............. 51 -
Hawaii.............. 10 2 -

Puerto Rico........... 3 1 6 4 1 20
















Week No.
24


lorlbidlity and Mortality WeeklN Report






DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED Jl'NI 17. 1,67


(By place of occurrence and week of filing certificate. Excludes fetal deaths)

All Causes Pneumonia Under All Causi
Area All 65 years and 1 year Area All 61
Ages and over Influenza All Ages a,
All Ages Causes


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.------
Gary, 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, lowa------
Duluth, Minn.---------
Kansas City, Kans.----
Kansas City, Mo.------
Lincoln, Nebr.--------
Minneapolis, Minn.----
Omaha, Nebr.-----------
St. Louis, Mo.--------H
St. Paul, Minn.-------
Wichita, Kans.--------


697
205
37
24
34
60
31
28
27
50
68
16
45
18
54

3,281
46
27
163
41
30
36
78
102
1,635
38
494
176
39
107
37
42
75
44
38
33

2,606
72
42
783
157
213
112
85
352
47
56
56
23
46
123
40
133
20
29
42
114
61

795
50
18
27
119
32
120
79
221
72
57


439
121
26
13
20
26
21
17
19
37
43
11
36
12
37

1,944
29
21
93
23
19
22
47
57
944
23
290
103
27
68
27
29
42
26
28
26

1,440
39
25
400
96
111
63
49
208
27
23
32
7
31
62
26
88
12
17
23
64
37

479
33
15
12
70
24
69
47
130
43
36


SOUTH ATLANTIC: 1,082 553 24 54
Atlanta, Ga.------------ 121 63 5 7
Baltimore, Md.---------- 245 122 2 18
Charlotte, N. C.------- 29 9 I
Jacksonville, Fla.----- 69 35 2 2
Miami, Fla.------------ 81 41 6
Norfolk, Va.----------- 48 31 3
Richmond, Va.---------- 75 33 6
Savannah, Ga.---------- 38 17 1 1
St. Petersburg, Fla.--- 68 53 3 2
Tampa, Fla.------------ 65 34 3
Washington, D. C.------ 202 93 4 5
Wilmington, Del.------- 41 22 1 5

EAST SOUTH CENTRAL: 647 331 24 45
Birmingham, Ala.------- 94 44 3 4
Chattanooga, Tenn.----- 47 23 1 4
Knoxville, Tenn.------- 47 32 2
Louisville, Ky.-------- 109 53 6 10
Memphis, Tenn.---------- 141 73 3 14
Mobile, Ala.----------- 41 16 2 4
Montgomery, Ala.------- 49 27 3 3
Nashville, Tenn.-------- 119 63 4 6

WEST SOUTH CENTRAL: 1,138 559 37 89
Austin, Tex.----------- 37 18 6 3
Baton Rouge, La.------- 49 27 1 11
Corpus Christi, Tex.--- 39 17 4
Dallas, Tex.----------- 151 66 6 9
El Paso, Tex.- ------- 41 18 1 2
Fort Worth, Tex.------- 81 37 2 2
Houston, Tex.----------- 249 106 3 25
Little Rock, Ark.------ 54 27 1 2
New Orleans, La.-------- 171 85 5 13
Oklahoma City, Okla.--- 90 58 4 8
San Antonio, Tex.------ 86 45 6
Shreveport, La.-------- 39 24 4 3
Tulsa, Okla.---------- 51 31 4 1

MOUNTAIN: 411 242 26 22
Albuquerque, N. Mex.--- 40 21 3 2
Colorado Springs, Colo. 20 11 3 1
Denver, Colo.----------- 101 62 4 8
Ogden, Utah------------ 25 12 4
Phoenix, Ariz.--------- 98 61 8 2
Pueblo, Colo.---------- 22 11 2
Salt Lake City, Utah--- 46 31 5 4
Tucson, Ariz.---------- 59 33 1 1

PACIFIC: 1.547 958 35 74
Berkeley, Calif.------- 21 14 1 1
Fresno, Calif.--------- 49 21 3
Glendale, Calif.-------- 42 32 1
Honolulu, Hawaii------- 33 17 4
Long Beach, Calif.----- 62 49 1 2
Los Angeles, Calif.---- 482 317 9 24
Oakland, Calif.--------- 94 55 3 6
Pasadena, Calif.------- 31 28 2
Portland, Oreg.--------- 115 73 2 5
Sacramento, Calif.----- 57 27 1 3
San Diego, Calif.------ 88 52 1 2
San Francisco, Calif.-- 179 93 1 6
San Jose, Calif.------- 32 20 2 1
Seattle, Wash.--------- 156 91 7 6
Spokane, Wash.--------- 61 41 1 5
Tacoma, Wash.---------- 45 28 6 3

Total 'i2,204 6,945 386 617

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 305,018
All Causes, Age 65 and over------------------- 175,825
Pneumonia and Influenza, All Ages------------ 11,595
All Causes, Under 1 Year of Age--------------- 15,278

















RUBELLA Floyd County, Georgia
(( / iilnued i /rm p//IeC 195)


Figure 2
CASES OF RASH ILLNESS, FEBRUARY MARCH 1967*
GLENWOOD SCHOOL, FLOYD COUNTY, GEORGIA

TOTAL ENROLLMENT 464






*3- nl!!-R Th


FEBRUARY MARCH
196T
ONSET DATE OF RASH
I CASE WITH ONSET 1120/67



attackk rate- \ere highest in grader one, two. three,
and eight. These first grade had the largest number of cases
and the highest percent ill. with 46 of h4 children (54.8
percent) developing a rash. No sex difference in the occur-
rence, of the rash illness \\as distinguishable.
Four paired sera from (Glenwood cases shoN\ed a
diagnostic rise (fourfold increase) in 1H antibody for
rulella. Three of these patients were in the first grade.
Preliminary data indicate that rubella irus h as cultured
from three of six Glcenrood patients from whom throat
s-wahl- \ere collIctid; included isl a case with a diagnostic
foulrold rise in rubella antihod\ titer. Fi\e other sero-
logically confrlined c- a(s \were found in nearby schools.
(Irportdri by/ (Glriire PerkinA/ 11.I)., Iistrirt Director of
PItblic Healthl. ,JohI/ E. IVtroai. Ph.D.. Director, Epi-
idmioulo r1ic Inr /iiti ationsl Se ction, and Thomas .lcK'in/ley,
Epidemioelogis!, Ueoryia Deportment oi Public Health; andi
a tl'm from i \('DC.)


UNIVERSITY OF FLORIDA


III111 IIIIIllll l llllllI1111 lI 11
3 1262 08864 1955

JUNE 17, 1967


THE MORBIDITY AND MORTALITY WEEKLY REPORT. WITH A CIRCULA-
TION OF 17.000, IS PUBLISHED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER, ATLANTA, GEORGIA.
DIRECTOR, NATIONAL COMMUNICABLE DISEASE CENTER
DAVID J. SENCER, M.D.
CHIEF, EPIDEMIOLOGY PROGRAM A.D. LANGMUIR, M.D.
ACTING CHIEF, STATISTICS SECTION IDA L. SHERMAN, M.S.

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY, THE NATIONAL COMMUNICABLE DISEASE
CENTER WELCOMES ACCOUNTS OF INTERESTING OUTBREAKS OR CASE
INVESTIGATIONS WHICH ARE OF CURRENT INTEREST TO HEALTH
OFFICIALS AND WHICH ARE DIRECTLY RELATED TO THE CONTROL OF
COMMUNICABLE DISEASES. SUCH COMMUNICATIONS SHOULD BE
ADDRESSED TO:
THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT
NATIONAL "*.*.N F DISEASE CENTER
ATLANTA, : 3- .jj

NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO THE NCDC BY THE INDIVIDUAL
STATE HEALTH DEPARTMENTS, THE REPORTING WEEK CONCLUDES
ON SATURDAY; COMPILED DATA ON A NATIONAL BASIS ARE RELEASED
ON THE SUCCEEDING FRIDAY.




C
m

0


r m
m m
C






a a


mz rn
o "



Sm m


Sm



0
Z
4












0m
mn oa
Sm mjo
w _0
















m
z
-
a
r~





















5-o


-n <
-1
PB


Morbidity and Mortality Weekly Report