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:
AA00010654:00018

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


Vol. 16, No. 28







Week Ending

July 15, 1967


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


PUBLIC HEALTH SEP .' E


BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


EPIDEMIOLOGIC NOTES AND REPORTS
VIRAL HEPATITIS Rush County, Indiana

Seventy-five cases of viral hepatitis occurred among
the 20.000 residents of rural Rush County. Indiana. oxer
a 5-month period from January through May 1967. Of this
total. 45 cases were related to Manilla School. a public
school with grades 1-12 in Walker Township. These cases
occurred in three discernible clusters over the 5-month
period. The other 30 cases occurring in the County in-
cluded three small contact spread outbreaks: only one of
the cases among the 30 could be related to the school
group. In Figure 1, the 75 cases are shown by date of
onset and by association with the school.


( ONTINTS

Ipid.,m li ai, No ,~- ,Inu i liip, -
\"r*] I!, E1t1, KuAh C' iun n, h n.n
\ ini, U r n to
).Jiir (.U tio Loui i.in ........
ur < i iln' umm r*N
SmAl 1pi x in thfl knilt1,I L .ttI I19 ; t .


The lower half of Figure 1 depict- all case- related to
Manilla School. Cases in -tuldent and staff are sho\xn in
the open hoxes a whereas case- in household and familY
contacts of students are shown in the black boxes. The
(Co ntinuei on pa/!/r 23u)


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
28th WEEK ENDED CUMULATIVE, FIRST 28 WEEKS
MEDIAN
DISEASE JULY 15, JULY 16, 1962 1966 MEDIAN
1967 1966 1967 1966 1962 1966
Aseptic meningitis .............. .. .. ... ..59 57 49 990 862 792
Brucellosis......................... 12 8 10 149 120 189
Diphtheria............... ...... ....... 1 3 56 84 143
Encephalitis, primary:
Arthropod-borne & unspecified ........... 21 33 715 722 -
Encephalitis, post-infectious ............. 15 14 495 487 -
Hepatitis, serum ................... ... 40 23 1,117 706
Hepatitis, infectious .................... 665 488 566 20.987 17.865 22566
Malaria .... ............. ........... 33 7 4 1,070 165 48
Measles (rubeola)....................... 534 1,871 4.047 55,602 182,610 344.726
Meningococcal infections, total .......... 37 38 38 1.477 2,396 1.672
Civilian ............................. 36 37 --- 1,372 2,134
Military............. ..... ....... ... 1 1 105 262 -
Poliomyelitis, total .................... .. 2 1 5 13 31 53
Paralytic.............................. 2 1 5 11 29 42
Rubella (German measles) ................ 394 507 37,871 39.532 ---
Streptococcal sore throat & scarlet fever 5,439 3,876 3,876 287,124 273.020 253,248
Tetanus ............ ............. ........ 7 8 5 100 83 124
Tularemia.............................. 4 6 10 82 84 143
Typhoid fever ......................... 7 5 8 205 168 197
Typhus, tick-borne (Rky. Mt. spotted fever) 15 14 11 125 101 97

Rabies in animals ....................... 82 51 94 2.449 2,366 2.366

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax ............................................ 2 Rabies in man ................. ..... .. .
Botulism .. .......................................... 2 Rubella, Congenital Syndrome ............ .. .. 4
Leptospirosis ....................................... 20 Trichinosis: NYC-1... .. ... ..... ... ... .... 43
Plague: Ariz.-l ...................................... 1 Typhus, murine:Tex.-l, W.Va.-l ....----------- .. .23
P sittacosis ........... ... ..... ................. 27 P olio, U nsp. ........ ..... .... .. ..... 2







Morbidity and Mortality Weekly Report


VIRAL HEPATITIS Rush County, Indiana
(Continued from front page)


Figure 1
CASES OF VIRAL HEPATITIS BY DATE OF ONSET, RUSH COUNTY, INDIANA
JANUARY MAY, 1967
CASES UNRELATED TO SCHOOL


HRrfRfI n


CASES RELATED TO SCH


m R


IOOL SCHOOL END OF SCHOOL
CLOSED SCHOOL CLOSED MAY 26
S22-27


n M nn 13 9181t48


4 8 12 16 20 24 28 I 5 9 13 17 21 25 I 5 9 13 17 21 25 29 2 6 10 14 18 22 26 30 4 8 12 16 20 24 28


JAN.
O STUDENT OR STAFF
] INDICATES GRADE


MAR.
DATE OF ONSET


index case was a 3rd-grade male who became ill on Janu-
ary 23, approximately one month after visiting in another
state in a home with a known hepatitis case. The next
five cases had dates of onset 21 to 39 days after the onset
of illness in the index case. Of these initial six cases,
four were in 3rd-graders who sat in the same row of desks
in the same classroom.
Two other clusters of cases among students and staff
are apparent in the Figure. The second cluster began
March 13 when a 10th-grade male, a frequent basketball
companion of case number two, became ill 29 days after
onset of illness in his friend. Fourteen other cases oc-
curred during the subsequent 22-day period, ending April 2.
One of these was the only teacher who became ill; she
worked with students in grades 9-12. Twelve of the remain-
ing 13 cases can be explained in terms of known exposure
to previous cases friends, classmates, Sunday School
companions, basketball teammates, and bus companions.
A third cluster of cases extending over a 14-day period
began on April 15 when a 9th-grade female developed
illness. Likewise, the other ill children in this cluster
had known exposures, similar to those in the second clus-
ter. The final case in this cluster became ill April 29.
No new cases occurred in students or staff during May.
Through May 31, there were 11 cases of hepatitis with
jaundice among preschool or adult relatives of Manilla
School students. Five cases were in siblings less than
20 years of age, three in parents of students, and three
in relatives who lived in other households. As shown in
Figure 1, the earliest onset date among this group was


March 13 and the latest, May 27. None of these 11 persons
had received gamma globulin prior to onset of illness.
Upon recognition of the outbreak related to Manilla
School, certain preventive measures were instituted by
the Rush County Health Department. Improved personal
hygiene and school sanitation were stressed; social activ-
ities were reduced to a minimum. The school was tem-
porarily closed on March 31, after the students had returned
to school for 4 days following spring vacation from
March 22-27. School was not reopened until April 17. Al-
though gamma globulin was not administered routinely,
46 of the 292 students in the school did receive this pre-
ventive measure from private physicians.
Twenty-three of the 33 student cases occurred among
172 children in grades 1-6, an attack rate of 13.4 percent.
Among these, seven were '.rd.jr ,.] r- and six were 4th-
graders. The remaining 10 cases occurred among 120 stu-
dents in grades 7-12 (an attack rate of 8.3 percent). None
of the 33 ill students had received gamma globulin prior to
onset of illness.
An additional 30 cases of viral hepatitis occurred ir
Rush County in persons who had no association with th(
Manilla School cases. Twenty-three of these cases were
in persons under 20 years of age and 7 were in adults;
onsetdates are shown in the upper half of Figure 1. Among
this group, there were three small but distinct outbreaks
plus a fourth group of cases probably unrelated to each
other. Ten of the cases with onset dates in January and
February represent a localized outbreak in a recreation
facility in Rushville; the index case had become ill in


JULY 15, 1967


nmn n rf n


nR


FEB
I CONTACT
INDICATES TEACHER


YEAR







Morbidity and Mortality Weekly Report


late December. Another outbreak involved a single resi-
dence from which there were four cases over a 4-month
period. A third group of cases centered around a single
grade in Haven School, involving six children over a 2-
month period. There is one possible association of the
latter outbreak with a Manilla related case. The remaining
10 cases in Rush County could not be related to each other
or to the Manilla cases.
(Reported by Dr. A. L. Marshall. Director, Divisioni of
('ommunicable Disease Control, and Mr. Robert ii -
Chief Inrestiator, Division of Comrmunicable Disease


Control, Indiana State Board of lHealth: Dr. Frank Green,
Health 0 for Rush County. Rushrille. Indiana, and
an, EIS Officer.)
Editorial Note:
The Manilla School outbreak xas typical of contact
spread infectious hepatitis. based on several character-
istics: the occurrence of illnesses, primarily among young
children, with three discernible clusters of cases over a
5-month period, and in almost all cases, history of ex-
posure to previous cases at appropriate intervals prior to
onset of illness.


ANNUAL SURVEILLANCE SUMMARY
SMALLPOX IN THE UNITED STATES 1966


Although the last confirmed cases of smallpox in the
United States occurred in 1949, the National Communicable
Disease Center maintains a continuing national vigilance
for introduced smallpox. In 1966. the NCDC provided
clinical, epidemiological. and laboratory assistance in the
diagnosis of 46 cases of suspicious vesicular disease
reported from 20 states and Puerto Rico.
In 14 instances (involving 16 patients. 3 of whom
were in one family), the Smallpox Eradication Program con-
ducted an epidemiological appraisal. Of this group of
patients, eight had recently traveled overseas, five of
whom had been in smallpox epidemic or endemic regions
during the 2 weeks prior to their arrival in the U.S. Small-
pox Health Alert Notices had been issued by the Foreign
Quarantine Program to each of the five at the port of entry:
these were instrumental in stimulating them to seek medi-
al aid when their illnesses began.
In the remaining 30 cases, laboratory specimens from
a variety of sources in the states were referred to the
Vesicular Disease Virus Laboratory for diagnosis. Speci-
mens were subjected to one or more of the following.tests
depending upon the information available at the time it
was received: culture in embryonated eggs; tissue culture
(RU 1 human embryonic lung fibroblast and HEP-2 cell
lines); agar gel diffusion; electron microscopy; and oc-
casionally the complement fixation test for antigen. Sera
submitted for study were subjected to either complement
fixation or hemagglutination inhibition antibody testing.
Smallpox was considered by the reporting authority
as the primary clinical diagnosis in 17 of the 46 cases.
In two other cases, smallpox was included in the differ-
ential diagnosis. In no instance was the diagnosis of
smallpox confirmed. Negative culture results on the
chorioallantoic membrane in each of three successive
passages coupled with negative electron microscopic and
agar gel diffusion tests were accepted as sufficient to
rule out the presence of variola or vaccinia virus. In 7 of


the 17 cases. a \irus other than variola x\as identified
as the etiologic agent.
Of the 46 cases studied, a specific etiology was es-
tablished in 18 (Table 1). The agents detected were iden-
tified by means of five different laboratory tests. In only
five cases was the original clinical diagnosis confirmed;
in an additional 13 cases, agents were recovered that
revealed a different diagnosis: in S2 cases. no etiologic
agent was identified.
In 13 cases, the referring clinical diagnosis was
"vaccinia" or "vaccination reaction." Eleven of the pa-
tients had a history of exposure to vaccinia either by
vaccination or by contact with a vaccinated sibling with-
in 3 weeks preceding onset of illness. Etiologic agents
were identified in the specimens from only 4 of these 13
patients: two suffered from \accinial infections, in both
cases exzema vaccinatum: varicella and Herpes Simplex
were serologically identified in the other two patients.
(Reported by the Smallpox Eradication Program and the
Vesicular Disease Laboratory. Viral Eranthems Unit.
Laboratory Program, \CDC.)
Table 1
Laboratory Diagnosis in Cases of Vesicular Disease
for which NCDC Assistance Sought

Laboratory Diagnosis Made
Laboratory
Primary Clinical Confirmed Confirmed Diagnosis Total
Diagnosis Clinical Other Total Not Made
Diagnosis Diagnosis
Smallpox. RO SP 0 7 7 10 17
Vaccinia, RO Vace. 1 2 3 9 12
Varicella, RO Var. 2 1 3 5 8
Herpes, RO herpes 2 1 3 2 5
Other* 0 2* 2 2 4
5 13 18 28 46
total (10.9%) (28.3%) (39.1) (60.9%) (100%)

'Hlepaitis- 1; Impetigo 1; Ki aposis- 1; Encephaliti 1
"Co\sackle A-16 i (Serology), Entero virus 1 (Electron Microscopic


JULY 15, 1967







232 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JULY 15, 1967 AND JULY 16, 1966 (28th WEEK)

ENCEPHALITIS HEPATITIS

ASEPTIC Primary
AREA MENINGITIS BRI ICLLOSS DIPHTHERIA including Post- Serum Infectious
unsp. cases Infecious
1967 1966 1967 1967 1967 1966 1967 1967 1966 1967 1966
UNITED STATES... 59 57 12 1 21 33 15 40 23 665 488

NEW ENGLAND.......... 1 1 4 1 24 13
Maine............... 3 3
New Hampshire......- 3 -
Vermont........... -
Massachusetts...... 1 3 I 12 5
Rhode Island ....... I 1 2
Connecticut........ 1 5 3

MIDDLE ATLANTIC...... 4 10 3 10 14 10 109 65
New York City...... 2 2 2 7 5 37 18
New York, up-State. 1 3 5 1 27 19
New Jersey......... 1 4 4 2 3 21 12
Pennsylvania....... 1 3 1 3 1 24 16

EAST NORTH CENTRAL... 10 4 1 9 2 3 2 1 113 90
Ohio ............... 2 8 2 25 19
Indiana............. 1 3 9
Illinois........... 1 1 2 1 45 9
Michigan.......... 7 3 1 1 2 32 48
Wisconsin.......... 8 5

WEST NORTH CENTRAL... 1 3 5 2 2 1 45 24
Minnesota........... 1 3 1 2 1 7 1
Iowa................ 2 1 5 11
Missouri ........... 30 7
North Dakota....... -
South Dakota........ 1
Nebraska............ 2 1 1
Kansas ............ 2 3

SOUTH ATLANTIC ....... 5 13 2 4 1 2 3 65 36
Delaware .......... -
Maryland............ 1 1 1 15 5
Dist. of Columbia.. 1 2
Virginia........... 1 1 1 17 8
West Virginia...... 1 10 4
North Carolina..... 2 1 3 5
South Carolina..... 1 3 3
Georgia............. 2 7
Florida............. 3 8 3 1 12 4

EAST SOUTH CENTRAL... 8 3 2 1 1 1 2 29 34
Kentucky........... 7 17
Tennessee............. 8 1 1 1 2 11 10
Alabama ............ 1 1 2
Mississippi........ 2 1 1 10 5

WEST SOUTH CENTRAL... 11 5 2 2 5 4 59 66
Arkansas ........... 2 10
Louisiana.......... 1 1 2 4 6 18
Oklahoma........... 5 1
Texas............. 11 4 1 1 3- 46 37

MOUNTAIN ............ 2 -40 26
Montana.............. 0
Idaho........ ..... 3 2
Wyoming............ -
Colorado........... 2 6 5
New Mexico.......... 4 10
Arizona ............ 13 7
Utah ....... ...... 4 1
Nevada ..... ..... ..

PACIFIC.............. 20 18 2 2 3 5 19 8 181 134
Washington......... 1 2 19 17
Oregon............. 1 1 12 11
California......... 12 15 1 1 3 4 19 7 150 92
Alaska ...........*... I 10
Hawaii ............. 1 4
Puerto Rico 24 38








Morbidity and Mortality Weekly Report 233


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JULY 15, 1967 AND JULY 16, 1966 (28th WEEK) CONTINUED


MENINGOCOCCAL INFECTIONS,
MALARIA MEASLES (Rubeola) MNINOCOCCAL POLIOMYELITIS RUBELLA
TOTAL
AREA Total Paralytic
Cumulative Cumulative Total Paralytic
Cum.
1967 1967 1967 1966 1967 1967 1966 1967 1967 1967 1967
UNITED STATES... 33 534 55,602 182,610 37 1,477 2,396 2 2 11 394

NEW ENGLAND............ 8 800 2,158 58 110 59
Maine.............. 4 233 192 3 9 14
New Hampshire...... 72 65 2 9
Vermont ............ 42 219 4 15
Massachusetts...... 4 308 74R 29 43 14
Rhode Island....... 60 72 4 12 4
Connecticut ........ 85 862 20 33 12

MIDDLE ATLANTIC...... 7 81 2,135 17,702 8 235 275 1 1 3 67
New York City...... 17 411 8,178 38 39 1 12
New York, Up-State. 1 59 523 2,384 5 59 79 1 1 1 54
New Jersey.......... 2 5 477 1,833 2 85 77 -
Pennsylvania....... 4 724 5,307 1 53 80 1 1

EAST NORTH CENTRAL... 1 54 5,042 66,538 7 195 374 94
Ohio................ 2 1,116 6,226 2 66 100 3
Indiana............. 9 579 5,549 25 64 3
Illinois........... 12 876 11,189 1 45 74 47
Michigan........... 1 5 872 13,363 3 44 99 14
Wisconsin.......... 26 1,599 30,211 1 15 37 27

WEST NORTH CENTRAL... 1 32 2,761 8,522 63 132 1 1 1 17
Minnesota.......... 1 117 1,621 15 31 -
Iowa............... 2 738 5,229 12 21 1 1 1 4
Missouri........... 3 329 523 12 52 10
North Dakota....... 18 814 1,034 1 7 3
South Dakota....... 1 52 40 6 4
Nebraska.............. 7 618 75 11 8 -
Kansas............. 1 93 NN 6 9 -

SOUTH ATLANTIC........ 11 81 6,622 14,338 10 285 398 1 34
Delaware............ 1 43 250 5 4 -
Maryland............ 1 2 142 2,070 1 34 39 1 3
Dist. of Columbia.. 1 22 377 10 10 -
Virginia............ 1 29 2,066 1,939 3 34 49 -
West Virginia...... 15 1,344 4,968 20 16 19
North Carolina..... 6 2 838 389 2 60 99 -
South Carolina..... 3 492 641 3 27 45 2
Georgia............ 2 32 231 43 57 -
Florida............ 3 26 1,643 3,473 1 52 79 10

EAST SOUTH CENTRAL... 1 34 5,000 19,152 1 120 210 1 23
Kentucky........... 2 1,289 4,653 34 79 7
Tennessee.......... 30 1,756 11,904 1 49 68 14
Alabama.......... 1 1,303 1,622 24 44 2
Mississippi........ 1 1 652 973 13 19 I -

WEST SOUTH CENTRAL... 1 83 16,878 23,252 1 205 350 5 5
Arkansas........... 1,401 966 25 32 -
Louisiana.......... 1 1 149 91 82 132 -
Oklahoma............ 1 3,314 467 14 18 1 -
Texas............... 81 12,014 21,728 1 84 168 4 5

MOUNTAIN............ 6 59 4,369 11,422 1 26 76 28
Montana............. 275 1,789 4 3
Idaho.............. 3 368 1,454 1 5 -
Wyoming............ 78 143 1 6 -
Colorado............ 5 22 1,492 1,1721 1 11 39 25
New Mexico.......... 1 6 571 1,093 3 10 -
Arizona............ 18 973 5,182 4 8 -
Utah............... 10 343 546 4 -
Nevada............. .- 269 43 2 4

PACIFIC.............. 5 102 11,995 19,526 9 290 471 67
Washington......... 4 5,384 3,412 1 25 35 2
Oregon............. 8 1,515 1,564 24 30 6
California......... 4 79 4,823 14,119 7 228 387 55
Alaska.............. 2 128 310 9 15 -
Hawaii............. 1 9 145 121 1 4 4 4
Puerto Rico.......... 46 2,015 2,376 10 9 2







234 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JULY 15, 1967 AND JULY 16, 1966 (28th 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... 5,439 7 100 4 82 7 205 15 125 82 2,449

NEW ENGLAND............ 714 1 2 57
Maine .............. 29 14
New Hampshire...... 27 34
Vermont ............ 70 7
Massachusetts...... 74 1 2 1
Rhode Island....... 35 1
Connecticut........ 479 -

MIDDLE ATLANTIC...... 353 7 1 21 3 17 44
New York City...... 8 3 10 -
New York, Up-State. 325 1 1 7 4 35
New Jersey......... NN 1 2 6
Pennsylvania....... 20 2 2 3 7 9

EAST NORTH CENTRAL... 323 2 13 10 14 1 13 16 252
Ohio................ 81 2 4 4 7 1 94
Indiana............. 41 2 2 4 1 11 51
Illinois........... 54 5 8 1 1 5 51
Michigan........... 115 2 4 1 23
Wisconsin.......... 32 1 3 33

WEST NORTH CENTRAL... 187 6 14 8 1 15 563
Minnesota.......... 2 1 5 107
Iowa............... 34 1 2 4 70
Missouri........... 33 3 4 2 1 106
North Dakota....... 66 4 100
South Dakota....... 7 1 1 1 76
Nebraska........... 27 2 37
Kansas.............. 20 8 1 1 67

SOUTH ATLANTIC....... 778 3 24 7 22 7 49 11 325
Delaware........... 3 -
Maryland............ 55 2 10
Dist. of Columbia.. -
Virginia........... 251 5 3 4 14 3 158
West Virginia...... 171 1 1 1 53
North Carolina..... 2 6 2 2 17 3
South Carolina..... 23 1 2 4 3
Georgia............. 12 3 3 5 1 5 3 71
Florida............. 260 3 9 1 4 4 40

EAST SOUTH CENTRAL... 799 1 18 7 30 2 20 15 499
Kentucky............ 38 1 13 7 2 108
Tennessee.......... 653 8 4 5 2 9 12 354
Alabama............ 61 7 8 4 1 35
Mississippi........ 47 1 3 2 4 2

WEST SOUTH CENTRAL... 667 1 17 4 33 4 26 2 11 21 505
Arkansas........... 4 4 18 7 2 3 1 65
Louisiana.......... 2 3 3 1 12 1 43
Oklahoma............ 30 9 3 3 6 8 159-
Texas.............. 635 1 10 3 4 2 11 238

MOUNTAIN ............. 954 7 1 16 8 1 75
Montana............ 24 1 1-- -
Idaho.............. 32
Wyoming............ 5 2 4
Colorado............ 631 1 11 8 1 9
New Mexico......... 110 1 1 22
Arizona............ 60 3 36
Utah................ 90 3 1
Nevada............. 2 3

PACIFIC .............. 664 14 4 1 66 6 3 129
Washington......... 43 2 1 1
Oregon............. 30 1 1
California ......... 503 11 2 1 63 5 3 127
Alaska............. 33 -
Hawaii............. 55 2 3 -


Puerto Rico .......... 12 8 I I 4 1 I 1 22








235


Morbidity and Mortality Weekly Report






DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED JI'LY 15. 19,


(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 1 year Area All 65 ears and year
Ages and over Influenza All Ages and over 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.--------


759
268
41
29
21
37
21
17
25
61
61
11
53
48
66

3,264
59
32
163
44
23
27
73
91
1,714
47
426
187
56
92
31
36
58
49
27
29

2,603
34
49
718
162
203
113
86
378
38
54
50
37
52
152
35
121
39
33
46
134
69

861
55
50
48
132
24
124
84
209
73
62


422
149
19
18
13
16
11
11
15
30
32
7
30
28
43

1,839
36
22
95
21
9
15
36
42
986
31
210
94
40
59
20
20
34
25
21
23

1,439
16
26
378
99
99
68
47
190
26
23
33
19
34
88
21
73
17
21
27
86
48

515
37
28
31
88
15
66
51
125
41
33


*Estimate based on average percent of divisional total.
**Two-week total; previous week total not available due to
vacation of personnel.


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


1,228
164,
280
28
65
95
48
65
29
76
82
212
84

724
123
50
57
180
115
55
43
101

1,037
34
30
24
143
34
88
190
50
150
78
110
47
59

486
53
16
124
25
136
22
54
56

1,651
20
48
34
52
72
521
94
35
130
58
,2
204
45
143
56
47


12,613


597
66
120
12
39
45
22
36
18
57
47
89
46

380
66
23
34
93
64
26
15
59

535
22
18
12
69
15
51
84
21
76
42
69
27
29

297
31
13
65
14
76
18
38
42

981
16
18
23
23
49
315
53
25
84
37
52
111
28
77
38
32


7,005


Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages -------------------------352,129
All Causes, Age 65 and over-------------------202,223
Pneumonia and Influenza, All Ages------------- 12,993
All Causes, Under 1 Year of Age--------------- 17,788


Week No.
28




UIIIIVERSITY OF FLORIDA

2IIII 2 08 6 9111011 lllll1 lI IIII1111
3 1262 08864 1930


236


EPIDEMIOLOGIC NOTES AND REPORTS
VACCINIA VIRUS TRANSMITTED TO DAIRY CATTLE
Louisiana


Following smallpox vaccination of some dairy farm
employees in Claiborne Parish. Louisiana. on May 4.1967.
16 of 85 cows on the farm developed lesions on the teats
and udders which were clinically compatible with vaccinia
virus infection. The veterinarian who diagnosed the cases
originally suspected pseudocowpox, a virus believed to
cause milker's nodules: this virus is antigenically differ-
ent from cowpox and vaccinia viruses which are anti-
genically related. The diagnosis was revised when it was
learned that three employees, including two who operated
the -,-iii,.. machines, had recently received smallpox
vaccination. Strict isolation and sanitary techniques in-
stituted early were believed to have prevented the infec-
tion from spreading to the other cattle.
(Reported by Dr. Charles T. Caraway, Chief, Section of
Epidemiology, Louisiana State Board of Health; and an
EIS Officer.)
Editorial Note:
This outbreak, similar to some which have occurred
in other states and in other countries, points out possible
hazards which can occur after vaccination of dairy workers.
These hazards include the serious economic disruption
of milk production from infected cattle as well as the
possibility of direct contact transmission from cattle to
humans who have little or no immunity. Dairy workers
should be warned by those administering smallpox vaccine
of the necessity for maintaining good sanitary hygiene
such as the constant washing of hands between cows
when milking and keeping the vaccination site covered
until the scab drops off. Otherwise, the dairy worker should
refrain from milking dairy cows during the time of the
vaccination reaction.


JULY 15, 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 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.


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