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:
AA00010654:00017

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 E1D







U P T A D, AND.. WEFR ?









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


BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


EPIDEMIOLOGIC NOTES AND REPORTS
NOSOCOMIAL STREPTOCOCCAL INFECTIONS
New Jersey

Between April o2 and May h. 1967. file cases of noso-
comial beta-hemolytic streptococcal infections occurred
on the obstetrical-gynecological services of a moderate-
sized hospital in New Jersey. Three cases of endometri-
tis occurred in women \\ho had delivered 3i to 60 hours
previously. The fourth case was in a patient a ho decel-
oped peritonitis and septicemia 36 hours after a sultotal
abdominal hysterectomy. A postoperative wound infection
developed in a fifth woman 2 days after tuhal ligation. The
fourth patient died with overwhelming sepsis: the others
recovered ".11ii,: ir,c antibiotic therapy.


CONTENTS

N,.i comria Str.pt -oc, Ill-olati,,n- N-, J-re
Pl u.- A\riz- ui: ... ................ 2.
( current I'renids
1,ningo,,n Inh'-tion January-Jun- 1C96T .... 223
Intrnaton. 1 Not'
Sulfounaulmn -I, i- tant (;roup \ M i-nin occci .. 22
Poli mi Nic ra . . .


An investigation \aas initiated after the first four
infections. Throat culture- were taken from all personnel
who had worked on the obstetrical or surgical ser ices dur-
ing the time these patients were hospitalized. No Group A
beta-hemolytic streptococci ere found. \hen the fifth
(Continued oft paje 222)


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
27th WEEK ENDED CUMULATIVE, FIRST 27 WEEKS
MEDIAN
DISEASE JULY 8, JULY 9, 1962 1966 MEDIAN
1967 1966 1967 1966 1962- 1966
Aseptic meningitis ................... 41 40 33 929 805 759
Brucellosis. ........................... 4 10 7 137 112 174
Diphtheria .............. ..... 3 5 5 55 84 141
Encephalitis, primary:
Arthropod-bome & unspecified ...... .. 31 37 694 689 -
Encephalitis, post-infectious ........ 14 17 480 473
Hepatitis, serum ................... ...... 55 30 519 1.077 683 22,000
Hepatitis, infectious .................... 537 415 20,322 17.377
Malaria .............................. 43 9 2 1,037 158 44
Measles rubeolaa) ........................545 2.061 4.614 55.066 180.739 339.840
Meningococcal infections, total ... ... 36 29 29 1,439 2,358 1,634
Civilian ............................ 36 27 1,335 2,097 -
Military....... ....... ............. 2 104 261 -
Poliomyelitis, total ................... .. ..- 4 5 11 30 48
Paralytic ............................. 4 5 9 28 37
Rubella (German measles) ... ............ 607 541 37,471 39,025 -
Streptococcal sore throat & scarlet fever .. 4.949 4,634 3.987 281.664 269,144 248,733
Tetanus. ............ ... .... .. .... ..... 3 4 5 93 75 118
Tularemia .. ..... ......... .... 3 6 6 78 78 131
Typhoid fever ......................... 7 7 9 195 163 190
Typhus, tick-borne (Rky. Mt. spotted fever). 20 5 6 110 87 86

Rabies in animals ............... 70 64 64 2,367 2,315 2,315

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax .... ......... ....... .... ............ 2 Rabies in man .... .......... .................
Botulism: Ill.-2 ................ ... ......... .. 2 Rubella, Congenital Syndrome .. ......... ... 6
Leptospirosis: Hawaii-1 ... ...................... 19 Trichinosis: NYC-1, Calif.-I ....... .. ........ 42
Plague .......................................... .. Typhus, marine: Texas-2 ............................. 21
Psittacosis: Texas-1, Calif.-2 ............. .. .... 26 Polio, Unsp. ........... 2. . -


Vol. 16, No. 27







Week Ending
July 8, 1967



PUBLIC HEALTH SERVICE






Morbidity and Mortality Weekly Report



NOSOCOMIAL STREPTOCOCCAL ISOLATIONS New Jersey
(Continued from front page)


case became apparent on May 8, further studies were under-
taken. The patient, operating room, and nursing schedule
records were examined. Fifteen individuals who had had
common contact with more than one of the infected patients
were questioned about recent infections, had blood drawn
forASO titers, and had cultures taken of their nose, throat,
and rectum. Vaginal cultures were also obtained from the
nursing staff.
All physicians and nurses denied symptoms of recent
infection, and none had been in contact with all of the
cases. However, one physician had delivered the first
case and was present at the operations on the fourth and
fifth cases. The second culture survey demonstrated that
this physician was carrying a beta-hemolytic Group A
streptococcus in his nose, but not in his throat. All cul-
tures obtained from other personnel were negative for
Group A streptococci. A streptococcal organism of the same
type (M:nontypable, T:28) was isolated from both the index
case and the fatal case. The streptococcus isolated from
the fifth case was a different type (M:12, T:12). Unfortun-
ately, isolates from the remaining two cases were not
saved and could not be typed.


One nurse had performed the perineal preparations of
the first three cases. She had no contact with the other
cases. Serologic studies revealed that she had an elevated
ASO titer.
The exact means by which all cases acquired infec-
tion could not be established. It was hypothesized that the
physician, a nasal carrier of beta-hemolytic Group A strep-
tococci, transmitted this pathogen to the index and fourth
cases. The nurse may have acquired the organism by con-
tact with the physician, become asymptomatically infected,
and transmitted streptococci to the second and third
cases at the time of perineal preparations. The origin of
the organism responsible for the fifth case, which was
unrelated to the other cases on the basis of typing, could
not be established.
The physician was treated with oxacillin and his nasal
cultures became free of streptococcus. No further cases
have occurred since May 8.

(Reported by Dr. William J. Dougherty, Director, Division
of Preventable Disease Control Programs, New Jersey
State Department of Health; and an EIS Officer.)


PLAGUE Arizona


On June 25, 1967, a 4-1/2-year-old Navajo boy who
lives on a large Navajo Indian reservation in Arizona
suddenly developed fever, malaise, headache, and painful
swelling of the left axilla. The symptoms persisted and
he was admitted to the Public Health Service Indian Hos-
pital in Tuba City on June 27 with a temperature of 1040F.,
chills, and tender ail-nr:.,p.r of the left axilla. No history
of recent contact with animals was obtained. A chest
X-ray was normal, and a lumbar puncture revealed normal
cerebrospinal fluid.
A gram stain of material aspirated from the left axilla
revealed gram-negative rods. A sample of this material
and a blood culture were examined by the Zoonoses Sec-
tion, Ecological Investigations Program, NCDC, in San
Francisco. Test animals were inoculated with these speci-
mens and typical plague lesions resulted. Subsequent
subcultures of these lesions yielded gram-negative, bipolar
stainingmicroorganisms which were identified as Pasteur-
ella pestis by phage reactions, agglutination tests, and
fluorescent antibody stains.
The child was initially treated with penicillin, strep-
tomycin. and tetracycline. Penicillin was omitted after
the diagnosis of bubonic plague was established. The
child responded well to -. r I. and, though still hos-
pitalized, had almost completely recovered by July 5.


The immediate vicinity of the patient's home in the
Tuba City service area was investigated; no dead animals
were discovered. However, die-offs have been observed
this year among two separate prairie dog colonies lo-
cated 6 miles south of the child's home. The most recent
die-off had occurred about 3 weeks before the onset of
the patient's illness, and Pasteurella pestis was isolated
from a pool of 20 fleas collected from this colony. The
child apparently had not visited this area and had not
travelled recently in any area other than that near his
home. None of the other 14 members of the patient's family
had been ill at the time of onset of illness; all have re-
mained well following sulfonamide prophylaxis.
Additional ecologic and epidemiologic investigations
are continuing in an effort to establish the means by which
the infection was acquired and to further define the ex-
tent of plague activity in the Tuba City service area.



(Reported by Dr. Melvin H. Goodwin, Director, Preventive
Medical Services, Arizona State Department of Health;
Dr. Robert C. Vanderwagen, Chief, Community Health
Services and Plague Control Officer, Window Rock, Ari-
zona; Zoonoses Section, Ecological Investigations Pro-
gram, NCDC, San Francisco, California.)


JULY 8, 1967







Morbidity and Mortality Weekly Report




CURRENT TRENDS
MENINGOCOCCAL INFECTION January-June, 1967


The total of 1,403 cases of meningoccal infection
reported to the National Communicable Disease Center for
the first 26 weeks of 1967 represents a 40 percent de-
crease from the 2.329 cases notified for the comparable
period in 1966. As shown in Figure 1, the 1967 monthly
attack rates are the lowest recorded since 1963. The
seasonal pattern has remained consistent with that estab-
lished in previous years.
In Table 1. the 26-week totals for 1967 and 1966 are
divided into military and civilian cases and listed hb
geographic region. The 1967 military total dropped to
104 cases (7.4 percent) from 259 cases (12.5 percent) in
1966. In both categories in all hut one region, the num-


hers of 1967 cases are lower than those for 1966: more
military cases were reported in the Middle Atlantic Region
in 1967 than in 1966.
The sulfadiazine sensitivity of meningococci sub-
mitted to the NCDC from 1964 through the first 26 weeks
of 1967 is illustrated in Figure 2. The sensitivity pattern
of the 365 strains isolated in 1967 is very similar to that
observed in 1966. Forty-ito percent of the 1967 strains
were resistant to a concentration of one milligram per-
cent of sulfadiazine.
(Reported by the Bacterial Dieases Section. Epidemi-
ology Program. and the Bacterial Serology Unit, Bacteri-
ology Section. Laboratory Program, XCDC.)


Figure 1
REPORTED CASES OF MENINGOCOCCAL INFECTION, UNITED STATES, 1960-1967*
MONTHLY RATES PER 100,000 POPULATION ADJUSTED TO AN ANNUAL BASE


1961 1962 1963


9966 967 3968 1969


Table 1
Meningococcal Infection United States
First 26 Weeks of 1966 and 1967

1967 1966

Mili- Civil- Mili- Civil-
tary ian Total tary ian Total

United States 104 1,299 1,403 259 2,070 2.329

New England 1 56 57 4 103 107
Middle Atlantic 36 183 219 28 238 266
East North Central 1 178 179 5 362 367
West North Central 2 61 63 17 111 128
South Atlantic 10 259 269 39 343 382
East South Central 7 110 117 39 168 207
West South Central 6 193 199 76 264 340
Mountain 3 22 25 4 69 73
Pacific 38 237 275 47 412 459


SUSCEPTIBILITY
120,


Figure 2
OF MENINGOCOCCI


TO SULFADIAZINE*


..... 1964 (267 STRAINSI
-- 1965 (339 STRAINS)
-- 1966 (754 STRAS)
1967 (365 STRAINS)


*ISOLATED FROM OLOOD OR CEREBROSPINAL FLUiO SUuMITTED TO THE NCDC


JULY 8, 1967


1960
*THRU JUNE







224 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
JULY 8, 1967 AND JULY 9, 1966 (27th WEEK)


ENCEPHALITIS HEPATITIS
ASEPTIC Primary
AREA MENINGITIS BRUCELLOSIS DIPHTHERIA including Post- Serum Infectious
unsp. cases Infectious
1967 1966 1967 1967 1967 1966 1967 1967 1966 1967 1966
UNITED STATES... 41 40 4 3 31 37 14 55 30 537 415

NEW ENGLAND........... 1 2 1 21 14
Maine............... 3
New Hampshire...... -
Vermont............- -
Massachusetts...... 1 9 5
Rhode Island....... 1 1
Connecticut........ 1 12 5

MIDDLE ATLANTIC...... 4 3 2 7 5 1 29 13 91 59
New York City...... 1 1 1 4 19 5 39 9
New York, Up-State. 5 1 9 27 23
New Jersey.......... 2 1 1 1 1 7 12 13
Pennsylvania....... 1 1 2 1 13 14

EAST NORTH CENTRAL... 1 2 1 5 2 4 1 1 64 67
Ohio................ 5 1 1 16 19
Indiana............. 6 9
Illinois............ 1 2 1 1 19 5
Michigan........... 1 3 1 18 30
Wisconsin .......... 5 4

WEST NORTH CENTRAL... 1 2 2 1 2 1 37 22
Minnesota.......... 1 1 1 1 11 5
Iowa............... 1 1 4 7
Missouri............ 1 14 6
North Dakota....... -
South Dakota ....... 1
Nebraska............. 4
Kansas...... ...... 1 4 4

SOUTH ATLANTIC....... 4 7 2 2 7 3 2 90 25
Delaware........... 2 1
Maryland.......... 1 1 2 1 12 9
Dist. of Columbia.. 1
Virginia........... 2 1 2 1 7 1 32 3
West Virginia..... 1 2
North Carolina..... 6 3
South Carolina..... 4 -
Georgia............ 24
Florida............ 5 1 9 6

EAST SOUTH CENTRAL... 4 3 5 3 1 21 41
Kentucky............ 5 13
Tennessee.......... 5 1 1 7 15
Alabama............ 4 4 7
Mississippi........ 3 2 5 6

WEST SOUTH CENTRAL... 8 6 2 1 13 1 3 51 30
Arkansas.......... 1 1 3 1
Louisiana.......... 1 2 1 2 7
Oklahoma............ 1 5 1
Texas............... 8 4 2 11 43 21

MOUNTAIN.............. 1 2 24 13
Montana............ 1 6 1
Idaho............... 2
Wyoming............ -
Colorado............ 2 2 1
New Mexico......... 6 3
Arizona ............ 6 5
Utah................ 4 1
Nevada...............

PACIFIC.............. 18 16 7 4 4 23 9 138 144
Washington......... 1 I 13 12
Oregon.............. 2 I 18 12
California......... 16 12 7 3 3 23 9 106 119
Alaska............. 1 1
Hawaii............. 1 2 -

Puerto Rico 8 16







Morbidity and Mortality Weekly Report 225


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JULY 8, 1967 AND JULY 9. 1966 (27th WEEK) CONTINUED


MENINGOCOCCAL INFECTIONS,
MALARIA MEASLES (Rubeola) MENIN OCOCCAL SECTIONS, POLIOMYELITIS RUBELLA
TOTAL
AREA Cumulative Cumulative Total Paralytic
Cum.
1967 1967 1967 1966 1967 1967 1966 1967 1967 1967 1967
UNITED STATES... 43 545 55,066 180,739 36 1,439 2,358 9 607

NEW ENGLAND.......... 2 19 792 2,150 1 58 108 95
Maine.............. 1 229 190 3 8 6
New Hampshire...... 72 65 2 9 2
Vermont............ 1 42 219 4 8
Massachusetts...... 14 304 744 29 42 47
Rhode Island....... 1 60 72 4 12 4
Connecticut........ 4 85 860 1 20 33 28

MIDDLE ATLANTIC...... 18 15 2,054 17,635 8 227 271 2 79
New York City...... 7 394 8,158 2 38 39 1 29
New York, Up-State. 1 3 464 2,351 1 54 76 50
New Jersey......... 2 5 472 1,827 2 83 76 -
Pennsylvania....... 15 724 5,299 3 52 80 1-

EAST NORTH CENTRAL... 54 4,988 65,878 9 188 370 96
Ohio................ 8 1,114 6,212 1 64 98 9
Indiana............. 6 570 5,473 4 25 64 11
Illinois........... 10 864 11,095 1 44 73 4
Michigan........... 3 867 13,089 2 41 99 37
Wisconsin........... 27 1,573 30,009 1 14 36 35

WEST NORTH CENTRAL... 1 16 2,729 8,475 63 131 30
Minnesota........... 1 1 116 1,618 15 31 -
Iowa............... 6 736 5,207 12 21 13
Missouri........... 1 326 523 12 51 -
North Dakota....... 6 796 1,012 1 7 10
South Dakota....... 51 40 6 4
Nebraska........... 1 611 75 11 8 6
Kansas............. 1 93 NN 6 9 1

SOUTH ATLANTIC........ 14 89 6,541 14,177 6 275 388 1 59
Delaware............. 42 243 5 4 2
Maryland........... 4 140 2,055 33 39 1 6
Dist. of Columbia.. 21 376 10 9 -
Virginia........... 41 2,037 1,907 3 31 49 23
West Virginia...... 17 1,329 4,912 20 15 20
North Carolina..... 4 2 836 375 3 58 95
South Carolina..... 3 489 615 24 45 1
Georgia............. 8 1 30 230 43 56 --
Florida............. 2 21 1,617 3,464 51 76 7

EAST SOUTH CENTRAL... 63 4,966 18,902 2 119 209 1 26
Kentucky........... 11 1,287 4,553 34 79 3
Tennessee.......... 32 1,726 11,774 1 48 68 22
Alabama.......... 19 1,302 1,614 24 43 1
Mississippi........ 1 651 961 1 13 19 1 -

WEST SOUTH CENTRAL... 2 116 16,795 22,985 5 204 343 5 15
Arkansas........... 1 1,401 966 25 31 -
Louisiana........... 2 2 148 91 2 82 129
Oklahoma........... 1 3,313 465 1 14 18 I
Texas.............. 112 11,933 21,463 2 83 165 4 15

MOUNTAIN ............ 68 4,310 11,286 25 74 52
Montana............ 275 1,785 4 -
Idaho............... 4 365 1,401 1 5 -
Wyoming............ 1 78 143 1 6 -
Colorado........... 34 1,470 1,163 10 37 19
New Mexico......... 3 565 1,068 3 10 -
Arizona............ 20 955 5,149 4 8 33
Utah............... 6 333 534 4 -
Nevada................ 269 43 2 4 -

PACIFIC.............. 6 105 11,891 19,251 5 280 464 155
Washington.......... 2 14 5,380 3,405 24 35 8
Oregon.............. 19 1,507 1,492 24 30 8
California.......... 2 63 4,744 14,020 5 221 380 133
Alaska.............. 1 126 221 9 15 3
Hawaii.............. 2 8 134 113 2 4 3
Puerto Rico.......... 12 1,969 2,324 1 10 8 1







226 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JULY 8, 1967 AND JULY 9, 1966 (27th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
ARSCARLET FEVER (Rky. Mt. Spotted) ANIMALS
1967 1967 Cum. 1967 Cum. 1967 Cum. 1967 Cum. 1967 Cum.
1967 1967 1967 1967 1967
UNITED STATES... 4,949 3 93 3 78 7 195 20 110 70 2,367

NEW ENGLAND........... 951 1 2 2 57
Maine.............. 50 14
New Hampshire...... 2 34
Vermont............. 26 7
Massachusetts...... 205 1 2 1
Rhode Island....... 36 I 1
Connecticut ........ 634 -

MIDDLE ATLANTIC...... 197 7 20 1 14 1 44
New York City...... 7 3 10
New York, Up-State. 189 1 6 4 1 35
New Jersey......... NN 1 2 1 6 -
Pennsylvania....... 2 2 4 9

EAST NORTH CENTRAL... 275 1 11 1 10 11 5 12 11 236
Ohio................ 52 1 2 4 3 7 6 93
Indiana............. 36 2 2 1 1 2 40
Illinois........... 74 5 1 8 1 2 4 51
Michigan........... 68 2 4 2 22
Wisconsin.......... 45 1 1 30

WEST NORTH CENTRAL... 295 6 14 2 8 1 21 548
Minnesota.......... 3 2 3 102
Iowa............... 73 1 2 4 66
Missouri........... 15 3 4 1 2 1 1 106
North Dakota....... 140 5 96
South Dakota....... 6 1 1 4 75
Nebraska........... 30 1 2 1 37
Kansas............. 28 8 1 3 66

SOUTH ATLANTIC ...... 579 1 21 7 3 22 10 42 11 314
Delaware........... -
Maryland............ 59 2 3 10
Dist. of Columbia.. 1 -
Virginia........... 213 1 5 3 1 10 5 155
West Virginia...... 190 1 1 1 52
North Carolina..... 5 6 2 3 15 3
South Carolina..... 4 1 2 4 3 -
Georgia............. 7 3 3 3 5 3 4 2 68
Florida............ 101 6 1 4 3 36

EAST SOUTH CENTRAL... 1,018 17 7 2 30 2 18 5 484
Kentucky........... 48 1 13 1 7 2 106
Tennessee.......... 740 8 4 5 1 7 3 342
Alabama............ 133 7 2 8 4 34
Mississippi........ 97 2 2 4 2

WEST SOUTH CENTRAL... 499 1 16 1 29 22 9 16 484
Arkansas........... 4 1 14 7 1 64
Louisiana.......... 3 3 11 3 42
Oklahoma........... 9 6 9 151
Texas.............. 499 1 9 3 4 2 4 227

MOUNTAIN ............. 476 7 15 2 8 1 74
Montana............ 23 1 -- -
Idaho............... 39 -
Wyoming............. 6 2 4
Colorado........... 272 1 11 2 8 8
New Mexico......... 78 22
Arizona............. 27 3 36
Utah............... 31 3 1 1
Nevada ............ 3

PACIFIC.............. 659 14 1 4 65 6 2 126
Washington......... 52 2 1 1 1
Oregon.............. 25 1 1
California.......... 527 11 1 2 62 5 1 124
Alaska............. 29 -
Hawaii.............. 26 2 3 -

Puerto Rico.......... 5 8 4 21








Morbidity and Mortality Weekly Report






DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED JULY 8, 1967


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

All Causes Pneumonia Under All Causes Pneumonia Under
Area All 65 years and year Area All 65 years and 1 year
Ages and over Influenza All Age and Influenza All
All Ages Causes 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, Iowa------
Duluth, Minn.---------
Kansas City, Kans.----
Kansas City, Mo.-------
Lincoln, Nebr.---------
Minneapolis, Minn.----
Omaha, Nebr.----------
St. Louis, Mo.--------
St. Paul, Minn.-------
Wichita, Kans.--------


605
212
25
30
26
46
30
15
22
41
53
7
35
13
50

2,829
48
42
144
34
25
29
49
85
1,465
33
356
168
31
95
39
34
49
39
32
32

2,336
56
41
665
143
204
118
75
310
29
35
41
31
54
149
36
119
31
36
35
81
47

634
32
24
21
111
27
80
74
180
48
37


366
109
13
25
20
30
16
12
18
18
32
5
22
7
39

1,577
28
25
74
21
16
16
27
42
816
15
182
87
20
63
25
15
31
25
21
28

1,254
26
23
374
69
97
64
41
148
17
19
17
18
39
81
17
70
16
20
23
50
25

370
18
13
10
69
16
53
36
102
31
22


*Estimate based on average percent of divisional total.


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.---------


Total


1,003
88
187
44
59
81
52
100
17
81
75
180
39

449
64
36
23
84
115
44
16
67

964
26
37
28
147
39
67
176
39
175
70
72
43
45

374
29
18
127
20
64
19
50
47

1,336
23
61
32
44
80
361
75
36
111
57
84
159
32
95
46
40


36
3
6

1
1
5
2

3
7
6
2

22
4
3

6
3
2
2
2

37
5


3

2
5
5
2
1
6
5
3

16
3
3
5
3
2




19

2

1

3
1

4
1
1
2

3

1


II l P


in -An


5 A99


------ ~ ------I
Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages -------------------------339,542
All Causes, Age 65 and over-------------------195,235
Pneumonia and Influenza, All Ages------------- 12,609
All Causes, Under 1 Year of Age--------------- 17,104


Week No.
27


L


. ...


.







Morbidity and Mortality Weekly Report


INTERNATIONAL NOTES
SULFONAMIDE-RESISTANT GROUP A MENINGOCOCCI


During April 1967, an Army laboratory in South Viet-
nam conducted a survey for meningococcal carriers. From
the total number of persons studied, one Group A, one
group C, and seven Group B strains were identified. All
of these strains were sulfadiazine resistant. The Group A
strain was not inhibited by one milligram percent of sul-
fadiazine, but was inhibited by five milligrams percent.
All strains were sensitive to penicillin.
Sulfonamide-resistant Group A meningococci have
been reported from North Africa, Holland, and Vietnam
during the first 6 months of 1967.

(Reported by Dr. Malcolm S. Artenstein, Chief, Department
of Bacteriology, Walter Reed Army Institute of Research;
and Dr. Harry A. Feldman, Chairman, Committee on Me-
ningococcal Infections, Commission on Acute .
Diseases, Armed Forces Epidemiological Board.)




POLIOMYELITIS Nicaragua


An epidemic of poliomyelitis affecting all areas of
Nicaragua has been reported to the Pan American Health
Organization by the Ministry of Health. More than 300
paralytic cases with 39 deaths have been reported to date.
Approximately 90 percent of the cases have been in chil-
dren under 4 years of age.
A vaccination program on Sunday, July 11, was carried
out in 1,500 centers in all 16 Departments of Nicaragua.
Type I poliovirus was isolated from stool specimens
from paralytic cases at the Middle American Research
Unit in Panama.

(Reported by Dr. Charles Williams. Deputy Director, Pan
American Health Organization; Dr. Karl Johnson, Director,
Middle American Research Unit: and a team from NCDC.)





ERRATUM: Vol. 16, No. 26, p. 210
In the Influenza Recommendations for 1967-68. the
word 'not' should be deleted from the second sentence of
the second paragraph so that the sentence reads: "Type
B strains were similar to those isolated in the 1965-66
season but did show antigenic differences from earlier
type B strains."


JULY 8, 1967
UNIVERSITY OF FLORIDA



3 1262 08864 2078


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 .r-C.'.. M.D.
ACTING CHIEF, STATISTICS SECTION IDA L. .iSl..- t 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 COMMUNICABLE DISEASE CENTER
ATLANTA, GEORGIA 30333

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


c


m
o



g z L,
4 m>




nm z -
n O>





> r- > M
ZmZ




""n
R Z -i



r-
z



0
UIn m FL L -


































0 _

Z
0 m
nr
or
-i
7Q



























?-I

*n "

?:^~


UNIV. OF FL LI1.
DOCUMENTS DEPT.






U.S. DEPOSITORY