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:
AA00010654:00016

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


ALTH, EDUCATION, AND WELFARE

tEAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


EPIDEMIOLC TC NOTES AND REPORTS
NOSOCOMIAL ISOLATIONS OF
CLOSTRIDIUM PERFRINGENS Oregon


Three cases of postoperative gas gangrene due to
Clostridium perfringens occurred on the surgical wards of
a moderate-size hospital in Oregon between April 22 and
May 9, 1967. One patient died as a result of the infection.
Only one or two cases of gas gangrene had occurred at
this hospital in each of the past 5 years.
The index case was a 57-year-old Mexican male dia-
betic who underwent cholecystectomy on April 21, 1967.
The gallbladder was opened during surgery; Cl. perfringens
was subsequently cultured from the contents. Fifteen hours
after surgery the patient became febrile and developed


Vol. 16, No. 26


WEEKLY

REPORT


SWeek Ending
= July 1, 1967



PUBLIC HEALTH SERVICE


CONTENTS
Epidemiologic Notes and Reports
Nosocomial I olations of
Clostridium perfringens Oregon . 209
Recommendation of the PIIS Advisory ( committee
on Immunization Practices
Influenza Vaccine 1967-6 . . 210
Annual Sur villance Summary
Poliomyelitis 1966 . . 212
International Notes
Quarantine Me sure . . 215

marked icterus, tachycardia, and leucocytosis. He re-
mained septic for the next 2 days despite massive anti-
biotic therapy with chloramphenicol and penicillin. Shortly
before death on April 24, crepitation was noted along the
right thoracic wall. C1. perfringens and E. coli were cul-
(Confinued on page 210)


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
26th WEEK ENDED CUMULATIVE, FIRST 26 WEEKS
MEDIAN
DISEASE JULY 1, JULY 2, 1962 1966 MEDIAN
1967 1966 11967 1966 1962- 1966
Aseptic meningitis ...................... .39 43 38 888 765 727
Brucellosis ............................. 8 2 6 133 102 169
Diphtheria.............................. 3 3 52 79 136
Encephalitis, primary:
Arthropod-borne & unspecified ........... 29 27 663 652
Encephalitis, post-infectious ............. 18 26 -466 456
Hepatitis, serum ................... ..... 38 30 598 1,022 653 21448
Hepatitis, infectious .................... 650 506 19,785 16.962
Malaria ............................... 31 6 3 994 149 44
Measles (rubeola)....................... 694 2,718 6,803 54.521 178.678 335,226
Meningococcal infections, total ........... 23 40 39 1,403 2.329 1,599
Civilian ............................ 23 35 --- 1,299 2,070 -
Military............................. 5 -- 104 259 --
Poliomyelitis, total ................... .. 13 6 11 26 44
Paralytic ............................. 12 3 9 24 33
Rubella (German measles) ................ 894 599 -- 36,864 38,484 ---
Streptococcal sore throat & scarlet fever .. 4,952 4.791 4,573 276.715 264,510 244,442
Tetanus................................. 5 4 8 90 71 115
Tularemia .............................. 8 2 7 75 72 122
Typhoid fever .......................... 6 7 7 188 156 183
Typhus, tick-borne (Rky. Mt. spotted fever) 10 10 11 90 82 75

Rabies in animals ......................... 63 70 73 2.297 2,251 2.248

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum
Anthrax ............................................ 2 Rabies in man ........ ....... ....... -
Botulism ........................................... Rubella, Congenital Syndrome .... .... ..... ...... 6
Leptospirosis .............................. 18 Trichinosis: Colo.-1, NYC-2 ........ ..... 40
Plague ............................................. Typhus, murine: Texas-1 ........................ 19
Psittacosis: Mont.-1 ................................. 23 Polio, Unsp... .... ........... _. .. ....... 2






Morbidity and Mortality Weekly Report


NOSOCOMIAL ISOLATIONS OF CLOSTRIDIUM PERFRINGENS Oregon
(Continued from front page)


tured from the wound, the wound drain, and from lung
tissue at autopsy.
The second case was a 66-year-old male who had
previously undergone bilateral amputation of the lower
legs for arteriosclerosis. On April 26, an additional por-
tion of his right thigh was removed because of progressive
vascular ischemia. At this time, the skin flaps were left
open. The patient became incontinent postoperatively and
contaminated the open wound with feces. A culture of the
wound on April 30 revealed Cl. perfringens, Streptococcus
fecalis, micrococcus, and Proteus species. On May 2, he
became febrile and crepitation appeared around the wound
edge. He survived the infection after disarticulation of
the right hip and massive penicillin therapy.
The third patient was a 47-year-old chronic alcoholic
woman who underwent surgery for small bowel obstruction
on May 8. The evening after surgery she developed fever
and abdominal guarding, and the next day was noted to
have an erythematous, indurated abdominal wall with crepi-
tation. The patient was transferred to another hospital
where she recovered from the infection following therapy
with antibiotics and hyperbaric oxygen. A fecal fistula
was later discovered between the anterior abdominal wall
and the large bowel.


Epidemiologic investigation followed closure of the
operating area from May 10 through 16 for cleaning and
disinfection. The autoclaves had been operating properly,
and no contamination of instruments, disinfectant solu-
tions, or gloves could be demonstrated. Cl. perfringens
was isolated from nearly three-fourths of the environmental
cultures taken -hrujgl.,.u, the hospital during the investi-
gation. Consistently larger numbers of clostridia were
recovered from cultures taken on the west side of the hos-
pital where excavation and construction had been in prog-
ress for several months. The climate had been unusually
dry and the hospital was allegedly very dusty during the
epidemic period.
Cross infection on the ward was considered unlikely,
but could not be definitely excluded. Only two of the three
patients were present on the same ward concomitantly,
and the first of these patients died 8 days before the
appearance of gas gangrene in the second. Despite the
high degree of contamination in the environment with Cl.
perfringens, the most likely source for these three infec-
tions was considered to be endogenous microorganisms.

(Reported by Dr. Edward L. Goldblatt, State Epidemiolo-
gist, Oregon State Board of Health; and an EIS Officer.)


RECOMMENDATION OF THE PUBLIC HEALTH SERVICE ADVISORY
COMMITTEE ON IMMUNIZATION PRACTICES

The Public Health Service Advisory Committee on Immunization Practices
meeting on May 26, 1967, issued the following recommendations regarding
influenza immunization and control in the civilian population.

INFLUENZA 1967-68


Influenza Prospectus 1967-68 United States

During the winter and spring of 1966-67, the influenza
reported in the United States was limited to minor out-
breaks and individual cases. Type A2 influenza virus was
recovered only from several small outbreaks in the eastern
States. Type B virus was identified in the Southwest,
particularly in California and Arizona. Excess mortality
attributed to pneumonia and influenza did not reach the
national "epidemic threshold" at any time, and it did not
remain elevated for more than a single week in any of
the country's geographic divisions.
No significant ,r,li,.-;,. changes were demonstrated
in the relatively few strains of type A2 influenza virus
recovered during the year in the United States and abroad.
Type B strains were similar to those isolated in the 1965-66
season but did not show antigenic differences from earlier
type B strains.


The relatively little disease caused by A2 influenza
viruses in the 1966-67 season permitted the general level
of susceptibility to increase, particularly in the eastern
States where the last major outbreaks of A2 illness were
observed in 1964-65. Thus, substantial numbers of cases
of A2 influenza can be expected to occur during the 1967-68
season, especially in the eastern part of the country. Be-
cause in 1965-66 and 1966-67 most areas of the United
States experienced type B influenza caused by strains
related to those still prevalent, no significant amount of
type B infection is likely to occur in the coming year.


Influenza Viruses and Vaccine Formulation

Influenza viruses are known to undergo continual antigenic
change. Minor variations, as discerned by laboratory pro-
cedures, occur frequently. Moderate changes can result in
increased numbers of influenza cases, presumably on the


210


JULY 1, 1967





Morbidity and Mortality Weekly Report


basis of the population's heightened susceptibility to the
-ariant. Major antigenic shifts occur infrequently. When
their do. they may produce widespread or even pandemic
disease. The most recent major type A influenza virus
%ariant is the A2 (Asian) strain which appeared in 1957.
The protection afforded by a particular influenza vac-
cine antigen, like that conferred by natural infection,
is directed primarily against the same or similar infecting
strains. This relationship has been most easily observed
at the time of major antigenic shifts, iliii.l h the relative'
effectiveness of vaccines may also be reduced when less
marked changes occur.
During the 25 years since development of inactivated
influenza vaccines, the appearance of three major anti-
genic variants emphasize the need for regular up-dating of
vaccine formulations. When Al influenza virus appeared
in the United States in 1947, vaccine containing only A
antigen gave very little protection. Similarly, marked in-
effectiveness of type Al antigen was observed in 1957
when the A2 strain appeared; and when an essentially dis-
tinct strain of type B influenza virus appeared in 1954.
vaccines containing the previous type B strains were no
longer satisfactory.
In general, it has been recognized that the relative
effectiveness of influenza vaccine depends on the degree
of similarity between strains incorporated in the vaccine
and the viruses prevalent in the community. Yearly review
of epidemiologic and laboratory data on vaccines and pre-
valent viruses is required to ensure that the proposed
vaccine formulation is suitable for the next year's forecast.


Influenza Vaccines 1967-68


Two influenza vaccine formulations will be available for
use in the 1967-68 season. A newly introduced bivalent
vaccine containing only contemporary A2 and B strains is
for general use to provide greater protection against cur-
rent strains of influenza. The traditional polyvalent vac-
cine incorporates older strains (types A and Al) as well
as newerA2 and B antigens in order to stimulate a broader
immunologic response. The older strains do not play a
significant role against the currently prevalent viruses.
Both the bivalent and polyvalent vaccine formulations
contain the same total quantity of influenza antigens -
600 chick cell agglutinating (CCA) units. This limit is
set in order to minimize the frequency of local and sys-
temic reactions. The bivalent vaccine includes consider-
ably greater representation of contemporary A2 and B
strains than is possible in polyvalent vaccine which re-
tains A and Al antigens. Bivalent vaccine should provide
greater protection against current, strains of influenza than
has previously been possible.
The A2 strains included in both vaccine formulations
are the same as were used in 1966-67. Because of anti-
genic changes in prevalent type B strains, however,
B Maryland 1 59 has been replaced by B Massachu-
setts, 3 66.


Bivalent (A2 and B Strains) Influenza Virus Vaccine-1967


Type


Strain


Japan, 170/.62
(Taiwan 1./64

B Massachusetts/3/66


CCA Units per ml


150
150


Total


Polyvalent (A,A1,A2, and B Strains) Influenza Virus
Vaccine-1967


Type


Strain


PR/8/34
Ann Arbor 1/57
Japan.'170/62
Taiwan/1/64
Massachusetts/3/66


CCA Units per ml


100
100
{100 200
100
200


Total


600


Vaccine Usage

Annual influenza immunization is not currently indicated
for all individuals, but should be given to persons in
groups known to experience high mortality from epidemic
influenza. In particular, immunization with bivalent vac-
cine is recommended for persons in older age groups and
for all individuals with chronic illnesses such as those
discussed below:

Chronically Ill

Persons of all ages who suffer from chronic debili-
tating diseases including cardiovascular, pulmonary,
renal, or metabolic disorders; in particular:

1. Patients with rheumatic heart disease, especially
with mitral stenosis.
2. Patients with such cardiovascular disorders as
arteriosclerotic heart disease and hypertension,
especially showing evidence of frank or incipient
cardiac insufficiency.
3. Patients with chronic bronchopulmonary diseases
such as asthma, chronic brochitis, bronchiectasis,
pulmonary fibrosis, pulmonary emphysema, or pul-
monary tuberculosis.
4. Patients with diabetes mellitus and Addision's
disease.

Older Age Groups

During major influenza outbreaks, especially those
caused by type A viruses, increased mortality has
regularly been recognized in persons over 45 years
of age and even more notably in those over 65. This
association has been particularly marked when under-
lying chronic illnesses were also evident.


JItLY 1. 1967






212


Persons in Institutions

Patients residing in nursing homes, chronic disease
hospitals, and comparable environments should be
considered at particular risk since their living arrange-
ments may allow greater spread of disease once an
outbreak has been established.

Some increased mortality was observed among preg-
nant women during the 1957-58 influenza A2 epidemic
both in this country and abroad. Subsequently, there has
been no indication of increased risk. Routine influenza
immunization during pregnancy is not recommended unless
the individual also falls into one of the "high risk" cate-
gories noted above.
Physicians contemplating general vaccination pro-
grams for industrial, school, and other such groups must
weigh the expense of the programs against the likelihood
of extensive illness. When widespread epidemics of in-
fluenza are forecast, officials responsible for maintaining
community services are justified in recommending the use
of influenza vaccine in selected adult groups if above-
average levels of absenteeism would disrupt satisfactory
operations.

Dosage and Schedule
Persons Not Vaccinated Since July 1963

Persons who require immunization and have not been
vaccinated since July 1963 should receive a primary
immunization series of bivalent vaccine. The primary
series consists of an initial subcutaneous dose, fol-
lowed by a second, two months later. It may be noted
that even a single dose can afford some protection.
A second injection as early as two weeks after the
first one will enhance the antibody response.
Immunization should begin as soon as practicable
after October 1 and ideally should be completed by
early December. It is important that immunization be
carried out before influenza occurs in the immediate


area, because there is a two-week interval between
vaccination and maximal development of antibodies.

Summary


Adults and children 10 and older
1.0 ml subcutaneously on two
specified above.

Children 6 to 10 years*
0.5 ml subcutaneously on two
specified above.


occasions as



occasions as


Children 3 months to 6 years*
0.1-0.2 ml of vaccine given subcutaneously on
two occasions, separated by one to two weeks
followed by a third dose of 0.1-0.2 ml about two
months later.

Persons Vaccinated After July 1963
Only a single booster of bivalent vaccine at the dos-
age level specified for the primary series is necessary
for individuals requiring immunization who have been
vaccinated as recently as July 1963. This booster
dose is best given in early December, before the on-
set of the anticipated influenza season.
For those in older age groups who have previ-
ously experienced undue reactions to influenza vac-
cine, a booster dose of 0.1 ml given by careful intra-
cutaneous injection can be expected to induce an
antibody response which is somewhat comparable to
that induced by the 1.0 ml subcutaneous dose. The
intracutaneous route is not recommended, however,
in other circumstances.

Contraindication
Since the vaccine viruses are propagated in eggs, the
vaccine should not be administered to anyone who is
hypersensitive to eggs or egg products.
*Since febrile reactions in this age group are common following
influenza vaccination, an antipyretic may be indicated.


ANNUAL SURVEILLANCE SUMMARY
POLIOMYELITIS 1966


The final total of paralytic poliomyelitis cases re-
ported to the National Communicable Disease Center dur-
ing 1966 is 102 cases. This total is based on the "best
available paralytic case count," that is, cases with known
residual paralysis at 60 days and those reported initially
as paralytic poliomyelitis but on which no 60-day final
report has been received. A 60-day followup surveillance
form was submitted in 1966 for all but 2 of the 102 cases.
Allhough the 1966 total is 41 cases more than were re-
ported for 1965 and 11 cases more than the 1964 total, it


is the third lowest national total on record. The contrast
of the reported cases for the past 3 years with those for
1961-1963 is evident in Figure 1.
The geographic distribution of the paralytic polio-
myelitis cases is shown in Figure 2. Of the 102 cases, 66
occurred in the type 1 poliovirus epidemic in southern
Texas. This outbreak, one of the largest in recent years,
involved primarily unimmunized preschool children of low
socioeconomic background. An additional two cases were
in children who had onset of illness in other states, but


Morbidity and Mortality Weekly Report


RECOMMENDATION OF THE PUBLIC HEALTH SERVICE ADVISORY
COMMITTEE ON IMMUNIZATION PRACTICES
(Continued from page 211)


JULY 1, 1967






JULY 1. 1967


Morbidity and Mortality Weekly Report


Figure 1
PARALYTIC POLIOMYELITIS, 1961-1966
CASES BY WEEK OF ONSET


1961 1962 1963 1964 1965 1966


Figure 2
PARALYTIC POLIOMYELITIS, 1966
102 CASES BY COUNTY, UNITED STATES


*'NATURALLY ACQUIRED" CASE
S'"VACCINE ASSOCIATED" CASE
-" -'


PUERTO RICO
H


i~9


213







Morbidity and Mortality Weekly Report


POLIOMYELITIS 1966
(Text continued from page 212)


were thought to have acquired their disease while in the
epidemic areas of Texas and Mexico.
The 36 "non-Texas" cases were widely distributed
among 20 states. Only one county. Los Angeles County in
California. reported as many as three cases. Two cases
were reported from only two counties. King County in
Washington, and Cook County in Illinois.
The incidence of paralytic poliomyelitis increased
during the months of May, June. and July, as shown by
week of onset in Figure 3. This was due primarily to the
epidemic in Texas which began in April and reached a
peak in July. Texas cases declined in the fall but did not
disappear. The 36 cases which occurred outside Texas
were spread throughout the year without a summer peak.
Over 75 percent of the paralytic poliomyelitis cases
were in children less than 5 years of age. In Table 1 the
cases are listed by age and sex. Seven deaths were attrib-
uted to poliomyelitis.
The poliovirus type was identified in 51 of the 66
Texas cases and in 27 of the 36 "non-Texas" cases. The
breakdown of polioxirus types is listed in Table 2.
As shown in Table 3. 21 of the 36 "non-Texas"
cases and 53 of the 66 Texas cases were in children who
had never received any polio \accine. Only seven children
were considered adequately immunized. Two Texas cases.
both in unvaccinated children, had had household contact
with children who had recently received oral vaccine.
Five cases of paralytic disease occurred in oral
vaccinee recipients and were considered "vaccine-
associated cases." This entity is defined as those cases
occurring in individuals living outside an epidemic area.
withonset of illness between 4 and 30 days after adminis-
tration of oral poliovirus vaccine. and with residual para-
lysis at 60 days. These persons acquired a paralytic ill-


ness at intervals of 9 to 2s days after receiving oral
vaccine. One illness followed a single dose of mono-
valent type 1 vaccine, one followed a single dose of
monovalent type 3 vaccine, and the remaining three fol-
lowed doses of trivalent vaccine. Strain characterization
studies identified the only isolate studied as "vaccine-
like."

Table 1
102 Reported Cases of Paralytic Poliomyelitis
By Age Group and Sex
United States 1966

Age Group Male Female Total Deaths

0-4 50 29 79 5
5-9 5 5 10 1
10-14 1 2 3 0
15-19 1 0 1 0
20-29 2 1 3 0
30-39 5 0 5 1
40+ 1 0 1 0

Total 65 37 102 7


Table 2
Poliovirus Types in Texas and "Non.Texas" Cases
United States 1966

Type Mixed or
Cases Total
1 2 3 Unknown Type

Texas 48 2 1 15 66

"Non-Texas" 12 11 5 8 36

Total 60 13 6 23 102


Figure 3
102 REPORTED CASES* OF PARALYTIC POLIOMYELITIS
BY WEEK OF ONSET UNITED STATES 1966


* WEEK OF ONSET UNKNOWN FOR ONE "NON-TEXAS" CASE


214


JULY 1, 1967


STEXAS CASE
S: "NON-TEXAS" CASE


4 8 12 16 20 e4 28 32 36 40 44 48 52
WEEK NUMBER








Morbidity and Mortality Weekly Report



Table 3
Immunization Histories of 102 Reported Cases of Paralytic Poliomyelitis
United States 1966


Vaccine


No vaccine
IPV alone
Mono OP\ alone
Mono OPV + IPV
Tri OPV alone
Tri OPV + IPV
Molno + Tri

Tot a I


Number of Cases


Texas

53
4
,1
3
0


Non-Texas

21
3
6
G


Total

74
7
9
2
9
0
1

102


Number of casess with Adequate
Primary Immunization*


Texas

0
0





1
0I


Non-Texas

0

1

0


*Adequate primary ininizniation considered:
4 doses of IPV for all ages
3 doses of :,monialent OPV for children and adults
2 do(se 0Io 'ri\alent OPV for all ages
3 doses of mnonovaleni OPV plus one dose of trivalent


An additional four cases of paralytic illness occurred
in family or close community contacts of xaccinees in
1966. Three of these cases occurred in adults between
:0 and 30 years of age, and the intervals between admin-
istraiion of vaccine and onset of illness in the contacts
were 11, 23, and 24 days. Isolates of type 2 poliovirus
were made in each of these 3 cases. The fourth case was


OPV for infants


in a 2-year-old child in contact \ith a neighbor who had
received type 1 poliovirus vaccine 21 days previously.
Strain characterization studies identified the isolates as
"vaccine-like" in each instance.

(Reported by the Neirotropic Viral diseases Unit, Epi-
diemiology Program, NCIC('.)


INTERNATIONAL NOTES
QUARANTINE MEASURES


PHILIPPINES-International Certificates of Vaccination
or Revoccination Against Smallpox and Cholera

American citizens planning travel to or through the
Philippines are alerted that their International Certificates
of Vaccination or Revaccination Against Smallpox and
Cholera must be up to date, complete in detail and bear
the "approved stamp". Otherwise they will be subject to
vaccination against smallpox on arrival in the Philippines.
and to vaccination against cholera if they visit a country
infected with cholera before arriving in the Philippines.
The traveler will be subject also to vaccination against
cholera on departure since the disease is endemic in the
Philippines. There is a fee for vaccination.
International Certificates of Vaccination must bear
the "approved stamp" prescribed by the health adminis-
tration of the country in which the vaccination is per-
formed. In the United States it is generally the stamp of
the local or state health department. The traveler is urged
toreview his itinerary and to comply with the requirements
before he leaves the United States if he wishes to avoid
delay, revaccination or possible detention.


MEXICO AND USA-Smallpox Vaccination Requirements

The Public Health Service was advised that Mexico
discontinued the requirement of a smallpox vaccination
certificate for persons entering that country from the
United States on June 19, 1967, provided they had visited
no other countries other than the United States or Mexico
within 14 days prior to crossing the border.


RELOCATION OF FOREIGN QUARANTINE PROGRAM
On June 22, 1967, the Foreign Quarantine Program
was mo\ed to the National Communicable Disease Center
at 1600 Clifton Road, N.E.. Atlanta, Georgia 30333.
(Telephone: Area Code-404, 633-3311).
Under the reorganization of the Public Health Service,
effective January 1, 1967, the Foreign Quarantine Divi-
sion became a program of the National Communicable
Disease Center, Bureau of Disease Prevention and En-
vironmental Control.
Dr. Arthur S. Osborne, Medical Director, is Chief of
the Program, and Dr. John H. Hughes, Scientist Director,
is Deputy Chief.


J1LY 1. 1967


TIotit I
Total

0
1
4
1
0








216 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
JULY I, 1967 AND JULY 2, 1966 (26th WEEK)


ENCEPHALITIS HEPATITIS

ASEPTIC Primary
AREA MENINGITIS III(A IIOsbt DIPlTIIERl including Post- Serum Infectious
unsp. cases Infctious
1967 1966 1967 1967 1967 1966 1967 1967 1966 1967 1966
UNITED STATES... 39 43 8 29 27 18 38 30 650 506

NEW ENGLAND.......... 1 1 31 24
Maine.............. 3 6
New Hampshire...... 1 1
Vermont............ 1
Massachusetts...... 1 8 8
Rhode Island....... 9 1
Connecticut........ 1 9 8

MIDDLE ATLANTIC...... 7 2 2 4 2 3 13 16 101 90
New York City...... 2 1 1 3 12 21 21
New York, up-State. 1 2 1 2 37 34
New Jersey......... 1 1 3 1 3 1 14 12
Pennsylvania....... 3 1 2 1 6 1 29 23

EAST NORTH CENTRAL... 9 2 10 5 5 1 2 83 57
Ohio................ 1 6 3 20 9
Indiana............ 2 2 6 4
Illinois........... 1 2 2 1 21 18
Michigan........... 5 1 1 3 1 1 30 23
Wisconsin.......... 1 1 6 3

WEST NORTH CENTRAL... 1 1 1 1 1 2 54 26
Minnesota........... 1 9 4
Iowa............... 1 1 1 2 8
Missouri.......... 2 39 9
North Dakota......
South Dakota ...... 1
Nebraska........... 1 -
Kansas. ........ ....-. I 3 4

SOUTH ATLANTIC....... 2 3 5 3 53 66
Delaware............ 1 3
Maryland............. 2 1 17 11
Dist. of Columbia.. -
Virginia............ 1 1 9 15
West Virginia...... 1 2 5
North Carolina..... 3 8 7
South Carolina..... 1
Georgia............ 10 6
Florida........... ..... 1 1 1 6 18

EAST SOUTH CENTRAL... 4 9 3 1 47 26
Kentucky............ 13 6
Tennessee .......... 1 3 1 1 19 11
Alabama............ 2 -
Mississippi ........ 1 6 2 13 9

WEST SOUTH CENTRAL... 7 8 4 3 1 1 1 1 67 43
Arkansas ........... 1 4
Louisiana.......... 2 1 2 1 1 11 7
Oklahoma ........... 1 1 -
Texas.............. 4 8 1 1 1 1 55 32

MOUNTAIN ............. 1 4 26 17
Montana............ 1 3 -
Idaho ........ ....... -2 2 4
Wyoming.............. 1
Colorado........... 4 10 6
New Mexico.......... 3 3
Arizona............. 8 2
Utah............... 1
Nevada.......... -

PACIFIC.............. 11 19 4 9 5 22 9 188 157
Washington......... 3 2 25 7
Oregon............. 1 11 9
California.......... 7 14 4 7 5 22 9 152 140
Alaska.............. 1
Hawaii ............. 5 -. -.. -

Puerto Rico- 25 21







Mlorbidity and Mortality Weekly Report 217


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JULLY I, I9X6 AND JULY 2, 1966 (26th WEEK) CONTINl'Ii)



MALARIA MEASLES (Rubcol) MENINGOCOCCAL INFECTIONS, POLIOMYEIIS RUBELLA
TOTAL
AREA "--- -- i -
AREA Cumulative Cumulative Total] Ptralytic
Cum.
1967 1967 196 1966 1967 1967 1966 1967 1967 1967 1967
UNITED STATES... 31 694 54,521 178,b78 23 1,403 2,329 9 894

NEW ENGLAND............ 16 773 2,136 57 107 161
Maine.............. 7 228 189 3 8 21
New Hampshire...... 72 65 2 9 13
Vermont............ 1 42 218 3 1
Massachusetts...... 8 290 743 29 42 53
Rhode Island....... 60 72 4 12 7
Connecticut........ 81 849 19 33 66

MIDDLE ATLANTIC...... 5 47 2,039 17,512 9 219 266 2 174
New York City...... 19 387 8,106 36 38 1 30
New York, Up-State. 19 461 2,292 2 53 76 142
New Jersey......... 5 4 467 1,823 1 81 74 -
Pennsylvania....... 5 724 5,291 6 49 78 1 2

EAST NORTH CENTRAL... 2 93 4,934 65,108 3 179 367 144
Ohio................ 17 1,106 6,135 1 63 97 4
Indiana............. 1 14 564 5,378 21 64 9
Illinois........... 1 9 854 11,056 43 73 25
Michigan........... 12 864 12,866 1 39 99 52
Wisconsin.......... 41 1,546 29,673 1 13 34 54

WEST NORTH CENTRAL... 1 47 2,713 8,390 63 128 13
Minnesota.......... 1 115 1,613 15 31 1
Iowa................ 5 730 5,165 12 18 4
Missouri........... 25 325 512 12 51 8
North Dakota....... 8 790 987 1 7
South Dakota....... 4 51 38 6 4
Nebraska........... 4 610 75 11 8 -
Kansas............. 1 92 NN 6 9 -

SOUTH ATLANTIC........ 11 108 6,452 14,027 5 269 382 1 78
Delaware........... 2 42 240 5 4 2
Maryland.......... 6 9 136 2,044 1 33 38 1 3
Dist. of Columbia.. 1 21 374 1 10 9 1
Virginia........... 66 1,996 1,866 1 28 48 45
West Virginia...... 15 1,312 4,879 20 12 9
North Carolina..... 5 834 368 2 55 95 -
South Carolina..... 486 612 24 44
Georgia............ 29 230 43 56 -
Florida............. 15 1,596 3,414 51 76 18

EAST SOUTH CENTRAL... 1 50 4,903 18,718 117 207 1 35
Kentucky............ 1 22 1,276 4,548 34 79 8
Tennessee.......... 23 1,694 11,661 47 68 27
Alabama............ 2 1,283 1,563 24 42 -
Mississippi........ 3 650 946 12 18 1

WEST SOUTH CENTRAL... 4 118 16,679 22,686 2 199 340 5 2
Arkansas............ 1,400 966 25 31 -
Louisiana.......... 3 146 88 2 80 129 -
Oklahoma............ 4 1 3,312 461 13 18 1
Texas............. 114 11,821 21,171 81 162 4 2

MOUNTAIN............. 99 4,242 11,081 25 73 91
Montana............. 7 275 1,736 4 3
Idaho............... 2 361 1,370 1 5 -
Wyoming.............. 9 77 133 1 5 -
Colorado............. 53 1,436 1,130 10 37 52
New Mexico......... 10 562 1,063 3 10 -
Arizona............ 13 935 5,093 4 8 33
Utah............... 5 327 517 4 3
Nevada............. 269 39 2 4 -

PACIFIC.............. 7 116 11,786 19,020 4 275 459 196
Washington.......... 10 5,366 3,389 24 35 22
Oregon............... 19 1,488 1,448 24 29 12
California......... 7 86 4,681 13,883 4 216 376 161
Alaska.............. 1 125 191 9 15 1
Hawaii............. --- --- 126 109 --- 2 4 --
Puerto Rico.......... 1 40 1,957 2,283 9 8 -







218 Mlorbidit\ and Mhortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

illY' 1 1.96' AND JILY 2, 1966 (26th WEEK) (ONTINI'ED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANU.S 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... 4,952 5 90 8 75 6 188 10 90 63 2,297

NEW ENGLAND ......... 807 1 1 2 2 55
Maine.............. 8 1 14
New Hampshire...... 21 1 32
Vermont............. 33 7
Massachusetts...... 161 1 1 2 1
Rhode Island........ 44 1
Connecticut ........ 540

MIDDLE ATLANTIC...... 344 7 1 20 13 1 43
New York City...... 7 3 1 10
New York, Up-State. 310 1 6 4 1 34
New Jersey......... NN 1 2 5
Pennsylvania....... 27 2 2 4 9

EAST NORTH CENTRAL... 248 10 1 9 11 2 7 7 225
Ohio ............... 50 1 4 4 87
Indiana............ 27 2- 1 2 1 1 2 38
Illinois........... 56 5 7 1 2 2 4 51
Michigan............ 68 2 4 1 20
Wisconsin .......... 47 29

WEST NORTH CENTRAL... 200 1 6 14 1 6 1 24 527
Minnesota.......... 2 2 3 99
Iowa.............. 39 -1 2 2 62
Missouri.......... 17 3 4 1 1 1 4 105
North Dakota....... 56 4 91
South Dakota....... 28 1 1 1 71
Nebraska............ 56 -- I 4 36
Kansas ............. 2 8 1 6 63

SOUTH ATLANTIC....... 537 1 2 j 7 2 19 4 32 9 303
Delaware ...........
Maryland............ 139 2 2 7
Dist. of Columbia.. 7 1 -
Virginia........... 114 1 3 2 9 2 150
West Virginia...... 158 1 1 2 51
North Carolina..... 7 1 6 2 2 1 3
South Carolina..... 1 1 4 3 -
Georgia............ 3 3 3 2 1 4 66
Florida ............ 99 6 1 4 1 33

EAST SOUTH CENTRAL... 788 17 7 1 28 3 16 9 479
Kentucky........... 24 13 1 6 5 104
Tennessee.......... 638 8 4 5 2 6 4 339
Alabama............ 63 7 6 4 34
Mississippi........ 63 2 2 1 4 2

WEST SOUTH CENTRAL... 488 1 15 7 28 22 1 9 5 468
Arkansas........... 4 5 13 7 I 64
Louisiana .......... 2 3 1 3 11 39
Oklahoma........... 27 1 9 1 6 142
Texas .............. 459 1 8 3 4 2 5 223

MOUNTAIN............. 865 7 15 6 2 73
Montana... ....... 22 -1 1 -
Idaho .............. 34
Wy ming............ 1 2 4
Colorado........... 604 1 11 6 8
New Mexico......... 142 1 22
Arizona............ 33 3 36
Utah............... 29 -
Nevada............. 1 3

PACIFIC.............. 675 1 14 3 1 65 6 4 124
Washington ......... 96 2 I
Oregon.............. 43 1 I 1
Cali fornia. ......... 520 1 11 1 1 62 5 4 123
Alaska............. 16
Iawail ............... --- --- 2 --- --- -3


Puerto Rico..........1 1 8 -4 20






lorbidil anid lortlalitl \\ cekl HReporl


DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED Jl'.Y 1. 1967


(By place of o- currenc, and week of filing


certificate. Excludes fetal deaths)


65 v, ars
ind over


and
lnf lu enza
All Ages


1 year
All
A!I Is


Area


All
Ages


65 years
and over


-11 -----ll -t I- I


NEW ENGLAN):
Boston, Mass.--------.
Bridgepo i Cn. -----
Cambridg Mass.------
Fall River, Mass.-----
Hartford, Conn.-------
Lowell, Mass.---------
Lynn, Mass.-----------
New lBedford, Mass.----
New Haven, Conn.------
Providence, R. I.-----
Somerville, Mass.-----
SpringfieId, Mass.----
Waterbury, Conn.------
Worcester, Mass.------

MIDDLE ATLANTIC:
Albany, N. Y.---------
Allentown, Pa.--------
Buffalo, N. Y.--------
Camden, N. J.---------
Elizabeth, N. J.------
Eric, 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, Iowa------
Duluth, Minn.---------
Kansas City, Kans.----
Kansas City, Mo.------
Lincoln, Nebr.--------
Minneapolis, Minn.----
Omaha, Nebr.----------
St. Louis, Mo.--------
St. Paul, Minn.-------
Wichita, Kans.--------


759
259
40
22
23
68
30
19
20
62
74
9
44
41
48

3,088
36
25
137
36
29
40
78
120
1,504
33
470
203
53
102
26
34
65
44
25
28

2,557
65
35
709
184
196
101
82
363
45
55
37
33
59
125
33
153
31
31
40
129
51

844
69
25
53
125
28
118
68
231
74
53


*Estimate based on average percent of divisional total.


e01'TH ATLANTIC:
At lanta, C -----------
Baltimore, Mld.---------
Chairlotte, N. C.-------
JaIksonvi ir Fla.-----
Miarni FIa.------------
Nrfilk, VI.-----------
Ri h ind, Va.-----------
.avnnnah, i;, .----------
St. Prt rsburrg F .---
T.aip., l -----------
nsh' ingt n, I). (. ------
Wi lmirti t ', l I .-------

EAST Or1'It rENTRAl,:
Bhi t anigy han, A1 /i.--------
Cht t ...... I n -----
Kn stvi i Tfn in.-------
Lu isv ll Kv.* ------
Hi mph i nn. .......--------
MbiilI Ala.-----------
M.Int ,om ry, Al.i.-------
Nla v ille, tl n. -------

WEST OOCTH CENTRAL.:
Austin, Tco.-----------
IBttn R Corpus Christi, 'i .---
Dallas, T El Pas Tr i .---- ------
Fort W1,rth, Tf .-.------
[I ust i. T": .--- --------
Little RoK k, Ark.------
NMw Orl ins, La.-------
Okla:homa City, Okli.---
San Anti ni. T x.------
Shrrvepocrt, Ia.--------
Tulsa, Okla.---------

MOUNTAIN:
Albuquerque, N. Mex.---
Colorado Springs, Colo.
Denver, Col .--------
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.----------


1,093
126
225
43
49
110
42
68
29
83
71
196
51

581
98
44
44
116
129
33
43
74

1,084
27
20
10
134
51
68
198
46
181
84
133
50
62

389
41
12
113
24
89
22
48
40

1,580
12
50
39
52
56
497
97
39
150
60
82
172
37
143
47
47


and
Influenza
All Ages


Total 111,975 6,674 385 752


Cumulative Totals
including reported corrections for


previous weeks


All Causes, All Ages ------------------------- 329,048
All Causes, Age 65 and over------------------- 189,420
Pneumonia and Influenza, All Ages------------- 12,327
All Causes, Under 1 Year of Age--------------- 16,609


Week NH.
26


219


I ytar
All
Causrs








Morbidity and Mortality Weekly Report JULY 1, 1967
UNIVERSITY OF FLORIDA


;IIIIIII1MIIIII II1MBIIHI III IMIII
3 1262 08864 1948

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. L-N.M"ru M.D.
ACTING CHIEF, STATISTICS SECTION IDA L. ;m "I n 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 :MM..,r,. :iL. DISEASE CENTER
ATLANTA, ,: 'C'. J,.r :)

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.


o I
m





n <
A *C 0
m o m





m za






x m
-4
. v 3.Z



r





Z
-4

F-
"i m m -4










z
r-


LU.S. LE,EPT O EP







U.S. DEPOSITORY


m

mo

m

C m
In






m

roL
p