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:
AA00010654:00021

Related Items

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

Full Text


NAT L CE D E C.60
NATIONAL COMMUNICABLE DISEASE CENTER


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


BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


INTERNATIONAL NOTES
OBSCURE DISEASE RELATED TO
AFRICAN GREEN MONKEYS
Identification of Agent


An infective agent has been established in guinea pigs
from the brain and kidney of one patient and the blood of
two additional patients.
Guinea pigs inoculated intraperitoneally with original
material became febrile after incubation periods ranging
from 4 to 10 days. The pigs remained febrile for up to 6
days but, although they failed to thrive, they did not die.
Intraperitoneal passage of whole heparinized blood taken
during the febrile stage has been passage both intra-
peritoneally and intracerebrally in guinea pigs through five


CONTENTS
International Notes
Obscure Disase Related to African Green Monken s
Identification of A0 ent . . 35
Importation and Use of Monkeys in U.S. . 35
Imported Case of Smallpox London, England ...... 360
Epidemiologic Notes and Reports
Hepattiis- Arkansa. ...................... 354
Pentachlorophenol Poisoning in Neabjrn Infant,
Statement by Manufacturer . .. .. 360

passages. The incubation period has shortened to 3 days
and most guinea pigs die from 13 to 15 days after inocula-
tion. At autopsy affected guinea pigs were found to have
marked splenomegaly, variable degrees of lung consolida-
tion with and without pleural effusion, occasional hemor-
rhages in the kidneys, congestion, and in the late stages
macroscopic areas of apparent degeneration in the liver.
(Continued on page 354)


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)


DISEASE


Aseptic meningitis ................... ..
Brucellosis.................................
Diphtheria ............................
Encephalitis, primary:
Arthropod-borne & unspecified ...........
Encephalitis, post-infectious ..............
Hepatitis, serum ........................
Hepatitis, infectious ....................
M alaria ...............................
Measles rubeolaa) .......................
Meningococcal infections, total ...........
C civilian ........................ .
Military........ ................. .
Poliomyelitis, total .................. ...
Paralytic................. ..........
Rubella (German measles) ................
Streptococcal sore throat & scarlet fever ..
Tetanus ................. ......... ......
Tularemia ...........................
Typhoid fever ..........................
Typhus, tick-borne (Rky. Mt. spotted fever).

Rabies in animals .......................


42nd WEEK

OCTOBER 21,
1967 A.


108
4
3

31
3
54
845
78
360
30
30

1

328
8,445
3
3
10
6

64


CUMULATIVE, FIRST 42 WEEKS

MEDIAN
1967 1966 1962- 1966


2,395
204
119

1,309
668
1,762
31,039
1,633
59,063
1,828
1,711
117
26
21
40,987
360,799
183
147
342
291

3,562


2,462
209
158

1,783
630
1,128
25,721
368
192.131
2,900
2,619
281
77
72
42,820
339,292
160
146
321
226

3,348


1,717
303
207


31,071
81
362,725
2,251


94
77

316.934
224
239
354
213

3,348


NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........................................... 2 Rabies in man: ........ .... ...... ... ....... 2
Botulism: ......................................... 2 Rubella, Congenital Syndrome: ............... ..... 5
Leptospirosis: Ala.-I ............... .......... ....... 33 Trichinosis: ............. ... ................ 51
Plague: ............... ............................ 2 Typhus, marine: Ark.- ................. ...... ...... 35
Psittacosis: Mich.-1 ........................ .. ..... 38 Polio. Unsp. Ark.-1 ....... .. ... 5


Vol. 16, No. 42







Week Ending

October 21, 1967




PUBLIC HEALTH SERVICE


I I


,


,






354


The testes were occasionally enlarged. No scrotal reac-
tions typical of rickettsial infections were seen. The blood
of moribund guinea pigs failed to clot.
Rickettsia have been looked for extensively in impres-
sion smears of various tissues stained with Giemsa,
Machiavello and nucleic acid stains. No rickettsia have
been seen. However, in infected guinea pigs, cells have
been found in the liver containing large numbers of intra-
cytoplasmic bodies. These are of uniform size (500-600 mg),
and in staining and morphological characteristics, resem-
ble rickettsia.
Passage material has been inoculated into tissue cul-
tures and both adult and suckling mice in an attempt to
adapt the agent to systems other than guinea pigs. Thus
far L cells and BHK-21 cells have shown signs of de-
generation after 6 days at 37cC. Tissue culture fluids from
these systems were inoculated into guinea pigs and these
became ill 4 days after inoculation.
Paired serum samples from patients in Frankfurt and
Marburg were tested in a complement fixation test against
an antigen prepared from infected guinea pig spleen. Two
units of complement were used in the test. None of the
sera was anticomplementary. A summary of the results is
given in Table 1.


OCTOBER 21, 1967


Table 1
SERUM SPECIMEN


Patient Days after onset Reciprocal
of disease CF titer
Frankfurt
A 2 <4
30 32
B 11 8
39 16
C 4 <4
25 32
D 2 4
22 32
Marburg
A 11 64
43 16
B 11 16
43 32
C 9 16
41 64
Control guinea pig immune serum 32


(Reported by Dr. C. E. Gordon Smith, Microbiological Re-
search Establishment, Porton, England.)


Importation and Use of Monkeys in U.S.


Further information obtained on the importation of
African green monkeys into the U.S. during the months of
July and August 1967 during and immediately preceding
the outbreak in Germany indicates that 1,752 of these
monkeys (Cercopithecus aethiops) were imported by five
U.S. firms. The animals were shipped to the U.S. by six
different exporters from three different countries: Kenya,
Ethiopia, and Somali Republic; none were imported during
this period from Uganda. During these same months, 1,715
African green monkeys were distributed directly by the
five importers or through other dealers to 41 different users.
To date, specific epidemiologic information regarding
the use of, and human contact with, 1,608 (93.,8 p..:-r.r i
of these 1,715 monkeys has been obtained. Of.the 1,608
monkeys, 1,419 (88.2 percent) were originally purchased


for tissue culture purposes, either in vaccine production,
vaccine testing, diagnostic work, or for research. The
remainder were purchased primarily for other types of
medical research, although a few were purchased as pets
or for exhibition in zoological parks. Of the 1,608 ani-
mals, 1,075 have been subjected to surgery or necropsy;
141 persons were involved in surgical or necropsy proce-
dures or in the mincing and trypsinization of their kidneys.
Taking into consideration the number of exposures to
monkey tissues that each of these 141 persons had, there
were approximately 6,220 significant exposures; none of
these exposures so far has been followed by an unusual
febrile illness.

(Reported by Foreigh i.'...- ..' Program, NCDC.)


EPIDEMIOLOGIC NOTES AND REPORTS
HEPATITIS Arkansas


During a 13-week period from July 15 through Octo-
ber 7, 1967, 91 cases of viral hepatitis were reported in
two Arkansas Counties, Benton and Washington. By con-
trast, in all of 1966, only 30 cases of viral hepatitis were
reported from the two Counties (combined 1960 popula-
tion, 92,069).
Investigation indicated that 51 of the 91 cases had
had known exposure to a single truckstop in \\ -ln1.r,'i..r
County. Nine additional cases were in persons without a
history of exposure to the truckstop but with a history of
contact with at least one of the 51 cases with known ex-
posure. The remaining 31 cases occurred among persons
without any known exposure to the truckstop and with no


history of contact with a hepatitis case exposed to the
truckstop.
The 51 cases with known exposure to the truckstop
are shown by week of onset in the lower half of Figure 1.
The onset dates ranged from August 13 to September 22.
Thirty-three persons in this group gave a history of fre-
quent exposure to the truckstop and its services. The
other 18 persons gave a history of either single exposure
or exposure over a few days during a 9-week period be-
ginning June 1 and extending through August 26.
The truckstop, located on a major highway, includes
a cafe and pool hall in addition to its service station
facilities. Many of the area's teenage males frequent the


Morbidity and Mortality Weekly Report


OBSCURE DISEASE RELATED TO AFRICAN GREEN MONKEYS
(Continued from front page)










truckstop in order to play pool and/or meet with friends.
All of the 51 cases gave a history of drinking some
beverage at the cafe, in addition to water in most in-
stances. In three instances, water was the only item con-
sumed. Only 11 of the 51 admitted eating foods served in
the cafe.
The age and sex distribution of the 51 cases is shown
in Table 2. Forty-one (80 percent) were aged 11 to 30.
Among all cases there were 44 males and only 7 females,
and in the age group 11 to 30, males outnumbered females
9 to 1. The striking preponderance of cases among young
males reflects the age-sex character of the usual clien-
tele of the truckstop.

Figure 1
CASES OF VIRAL HEPATITIS IN TWO ARKANSAS COUNTIES
(BENTON AND WASHINGTON)
BY WEEK OF ONSET, JULY9-OCTOBER 7, 1967
CASES WITH NO KNOWN EXPOSURE AT TRUCKSTOP



M 4



CASES WITH EXPOSURE AT TRUCKSTOP
D NO HISTORY OF CONTACT WITH
PRE VIOUS CASE
IS
HISTORY OF CONTACT WITH
O PREVIOUS CASE
STORY OF CONTACT W.IH CASE
WHO HAD EXPOSURE AT TRUCKSTOP


I5 22 29 5 12 19 26 2 9 16 23 30 7
JULY AUG SEPT OCT

Of the 51 cases, three occurred among personnel or
relatives of personnel of the truckstop. These three in-
cluded: a waitress who only worked at the truckstop dur-
ing the last week in August; the husband of a waitress
who worked at the truckstop from late July through Au-
gust 20; and the nephew of the owner of the cafe. Eleven
cases were in high school boys, seven of whom were on
the football team. Nine other cases were in truck drivers

Table 2
AGE AND SEX DISTRIBUTION OF 51 CASES OF VIRAL
HEPATITIS WITH KNOWN EXPOSURE TO TRUCKSTOP

Age Males Females Total
0-10 1 2 3
11-15 7 1 8
16-20 15 2 17
21-25 8 1 9
26-30 6 6
31-40 4 1 5
41+ 3 3
Total 44 7 51


355


who routinely frequented the truckstop. No deaths were
reported.
There were nine cases of hepatitis among persons
without a history of known exposure to the truckstop but
with a history of contact with one of the cases who did
have direct exposure. The weeks of onset of these nine
cases, indicated by blackened boxes, are shown in the
upper half of Figure 1. Dates of onset ranged from Au-
gust 13 to October 7.
Five of these nine contact cases had been exposed
to the same individual, a dishwasher at a motel who vis-
ited the cafe frequently. One of the five worked the same
shift at the motel, whereas the other four listed the dish-
washer as a close friend. Two other contact cases, be-
longing to the same family, frequently cared for a niece
who was a case with known exposure to the cafe. The
eighth contact case sat near this same niece in school.
The last contact case occurred in a teenage boy who had
close contact with three truckstop related cases.
Thus, epidemiological evidence suggested that the
truckstop was the probable source of infection for 60
cases of viral hepatitis. 51 through direct exposure and
9 through intermediate contacts. Over the period July 5
to September 6, 1967, four sanitary inspections revealed
various inadequacies at the truckstop cafe, including lack
of suitable towels, inadequate cleaning and garbage dis-
posal items, and an overflowing grease trap. A common
well serves both the cafe and the service station. The
septic tanks of the cafe and service station are located
at least 50 yards from the well. However, water specimens
obtained on three different days in early September re-
vealed abnormal bacterial contamination. Terminal chlori-
nation was instituted on September 20.
During the corresponding 13-week period in Benton
and Washington Counties, 31 other cases of viral hepatitis
were reported; none of these could be related directly to
the truckstop, to the 51 cases with known exposure to the
truckstop, or to the 9 cases with no known exposure but
with a history of contact with a truckstop exposed case.
These 31 .cases are shown by week of onset in the upper
half of Figure 1. Only three of these cases, indicated by
hatched boxes, gave a history of contact with a previous
hepatitis case. The other 28 cases, indicated by open
boxes, gave no history of contact. The dates of onset for
the 31 cases ranged from July 15 to September 28. Fifteen
of the ill persons in this group were under 20 years old,
and 16 were over 20 years of age. There were 21 males
and 10 females. Ten cases occurred among three house-
holds. Among the 31 cases, there were two deaths.
In summary, the 91 cases of viral hepatitis in these
two counties broadly fall into two categories: 60 cases
related to the truckstop, and 31 cases probably represent-
ing the sporadic occurrence of viral hepatitis in the com-
munity. Several observations support the impression of a
common source outbreak within the former category: the
large number of cases in truck drivers; the disproportunate
number of cases in young males who use the cafe for
leisure activity; the three cases in truckstop personnel
(Continued on page 369)


OCTOBER 21, 1967


Morbidity and Mortality Weekly Report








Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 21, 1967 AND OCTOBER 22, 1966 (42nd 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... 108 59 4 3 31 56 3 54 37 845 681

NEW ENGLAND......... 1 1 3 3 43 26
Maine.............. 2 9
New Hampshire...... 2 3
Vermont..........- -
Massachusetts...... 1 2 1 19 7
Rhode Island....... 1 2 5 3
Connecticut........ 1 15 4

MIDDLE ATLANTIC ...... 11 8 1 2 9 16 21 157 104
New York City...... 7 4 5 11 11 64 36
New York, Up-State. 1 1 1 3 25 25
New Jersey......... 2 1 2 1 6 34 17
Pennsylvania....... 2 2 1 2 1 3 1 34 26

EAST NORTH CENTRAL... 8 8 10 13 1 3 1 134 114
Ohio................ 4 2 8 10 1 27 27
Indiana............. 1 2 14 8
Illinois........... 3 2 1 1 62 22
Michigan........... 1 2 1 2 29 47
Wisconsin.......... 1 1 1 2 10

WEST NORTH CENTRAL... 1 3 3 4 5 1 45 55
Minnesota.......... 1 3 3 1 1 8 5
Iowa............... 2 7 13
Missouri........... 2 24 28
North Dakota...... -
South Dakota....... -
Nebraska........... 1 1 2 5
Kansas............. 1 4 4

SOUTH ATLANTIC....... 33 6 1 4 2 1 78 69
Delaware............ 1 6 1
Maryland........... 24 13 14
Dist. of Columbia.. 1 2
Virginia........... 1 1 13 9
West Virginia...... 3 1 10 4
North Carolina..... 3 3 1 7 9
South Carolina..... 3 2
Georgia............ 18 7
Florida............ 2 5 1 7 21

EAST SOUTH CENTRAL... 5 7 1 5 63 39
Kentucky............ 24 8
Tennessee.......... 4 5 4 26 19
Alabama............ -- 3 5
Mississippi........ 2 1 1 10 7

WEST SOUTH CENTRAL... 5 4 1 2 6 1 1 82 36
Arkansas........... 3 13 5
Louisiana.......... 2 1 1 1 1 13 6
Oklahoma .......... 1 15 2
Texas.............. 2 4 1 2 1 41 23

MOUNTAIN............. 1 1 3 24 38
Montana............ 1 3 7
Idaho............. 1 3
Wyoming............ -
Colorado............ 1 3 4 16
New Mexico......... 6 10
Arizona............ 5 1
Utah............... 5
Nevada............. 1

PACIFIC .............. 44 22 7 10 1 34 10 219 200
Washington......... 3 1 20 22
Oregon............. 3 1 1 1 5 13 32
California......... 33 18 6 8 1 29 10 185 145
Alacka............. 1 1
Hawa i ............ 8 -
Puerto Rico1 1 31 18







Morbidity and Mortality Weekly Report 357


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 21, 1967 AND OCTOBER 22, 1966 (42nd WEEK) CONTINUED


MENINGOCOCCAL INFECTIONS,
MALARIA MEASLES (Rubeola) MENINGOCOCCALFECTI POLIOMYELITIS RUBELLA
AREA Total Paralytic
AREA Cumulative Cumulative Total Paralytic
Cum.
1967 1967 1967 1966 1967 1967 1966 1967 1967 1967 1967
UNITED STATES... 78 360 59.063 192,131 30 1,828 2,900 1 21 328

NEW ENGLAND.......... 9 880 2,346 73 127 40
Maine................ 239 226 3 10 1
New Hampshire...... 1 77 80 2 9 --
Vermont.............. 42 278 1 4 3
Massachusetts...... 8 369 789 34 51 9
Rhode Island ....... 62 72 4 15 2
Connecticut ....... 91 901 29 38 25

MIDDLE ATLANTIC...... 5 12 2,317 18,151 5 297 355 5 18
New York City...... 1 2 476 8,316 1 52 50 1 9
New York, Up-State. 4 598 2,575 2 73 100 1 4
New Jersey......... 1 2 492 1,868 1 97 105 5
Pennsylvania....... 3 4 751 5,392 1 75 100 3 -

EAST NORTH CENTRAL... 3 72 5,686 69,156 9 262 460 3 93
Ohio................ 1 4 1,159 6,370 5 87 129 11
Indiana............. 1 13 617 5,743 2 42 79 13
Illinois........... 1 17 1,023 11,411 1 57 83 5
Michigan........... 6 956 14,636 1 59 122 3 38
Wisconsin.......... 32 1,931 30,996 17 47 26

WEST NORTH CENTRAL... 1 10 2,887 8,771 1 81 154 3 17
Minnesota.......... 123 1,645 1 20 35 -
Iowa............... 5 755 5,327 16 22 1 12
Missouri........... 1 1 338 535 16 60 --
North Dakota....... 874 1,147 2 11 1
South Dakota....... 55 40 6 5 -
Nebraska........... 4 648 77 13 8 4
Kansas............. 94 NN 8 13 2

SOUTH ATLANTIC....... 16 55 7,025 15,481 6 355 492 2 13
Delaware............ 1 50 260 7 4 -
Maryland........... 3 168 2,116 2 48 48 1 2
Dist. of Columbia.. 24 384 1 12 14 -
Virginia........... 17 2,214 2,205 1 42 64 3
West Virginia...... 12 1,413 5,369 1 34 31 -
North Carolina..... 16 14 894 505 71 127 1
South Carolina..... 511 658 1 30 50
Georgia.............. 36 234 53 63 -
Florida............. 8 1,715 3,750 58 91 8

EAST SOUTH CENTRAL... 22 79 5,333 19,864 2 142 251 1 12
Kentucky........... 22 51 1,396 4,736 1 42 89 -
Tennessee.......... 23 1,932 12,398 1 60 85 12
Alabama............ 2 1,334 1,701 26 54
Mississippi......... 3 671 1,029 14 23 1

WEST SOUTH CENTRAL... 1 58 17,671 24,976 2 232 392 1 7
Arkansas........... 1,404 971 33 35 1
Louisiana.......... 156 99 2 93 146
Oklahoma........... 1 3 3,354 503 17 21 1
Texas............... 55 12,757 23,403 89 190 6

MOUNTAIN............. 22 14 4,737 12,109 2 35 90 31
Montana............. 1 3 306 1,841 1 3 5 1
Idaho............... 2 393 1,629 3 5
Wyoming............. 181 170 1 6 -
Colorado............ 21 6 1,590 1,321 13 48 25
New Mexico......... 591 1,139 3 10 -
Arizona............ 3 1,025 5,317 1 5 10 5
Utah............... 382 645 4 1 -
Nevada............. 269 47 3 5 -

PACIFIC.............. 8 51 12,527 21,277 3 351 579 104
Washington.......... 3 13 5,514 3,921 37 43 36
Oregon............. 12 1,655 1,868 27 36 10
California.......... 4 23 5,040 14,793 2 278 479 45
Alaska.............. 140 551 1 11 17 12
Hawaii............. 1 3 178 144 4 4
Puerto Rico.......... 63 2,205 2,966 13 17





358
Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 21, 1967 AND OCTOBER 22, 1966 (42nd WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
ARSCARLET FEVER (Rky. Mt. Spotted) ANIMALS
AREA
1967 1967 Cum. 1967 Cum. 1967 Cum. 1967 Cum. 1967 Cum.
1967 1967 1967 1967 1967
UNITED STATES... 8,445 3 183 3 147 10 342 6 291 64 3,562

NEW ENGLAND.......... 569 2 1 7 1 2 95
Maine............. 22 2 22
New Hampshire...... 45
Vermont.............. 22
Massachusetts...... 239 1 I 3 1 4
Rhode Island....... 65 1 2
Connecticut........ 243 1 3 -

MIDDLE ATLANTIC...... 215 12 34 35 6 87
New York City...... 10 6 17 -
New York, Up-State. 162 1 9 9 5 73
New Jersey......... NN 1 4 15 -
Pennsylvania....... 43 4 4 11 1 14

EAST NORTH CENTRAL... 587 20 12 4 39 22 6 338
Ohio................ 42 4 4 13 11 117
Indiana............. 186 3 2 11 1 2 77
Illinois........... 131 10 10 5 10 1 64
Michigan............ 141 3 8 21
Wisconsin.......... 87 -2 3 59

WEST NORTH CENTRAL... 455 15 21 17 4 9 834
Minnesota.......... 13 4 1 1 1 162
Iowa............... 150 1 1 3 106
Missouri........... 5 8 8 8 1 4 151
North Dakota....... 66 143
South Dakota....... 24 1 2 116
Nebraska........... 77 4 2 2 57
Kansas............. 120 1 10 1 2 99

SOUTH ATLANTIC....... 1,035 1 39 10 50 2 116 3 440
Delaware............ 12 -
Maryland............ 147 2 21 3
Dist. of Columbia.. 5 2 6
Virginia............ 264 9 6 1 28 2 190
West Virginia...... 395 1 2 1 1 59
North Carolina..... 31 6 4 1 46 3
South Carolina..... 5 1 2 10 5 2
Georgia............. 19 1 4 5 14 15 1 107
Florida............. 157 18 1 11 70

EAST SOUTH CENTRAL... 1,882 30 10 4 58 1 52 11 674
Kentucky............ 63 3 1 1 24 14 2 155
Tennessee.......... 1,007 8 7 1 10 1 26 8 467
Alabama............. 145 11 2 12 12 1 43
Mississippi........ 667 8 2 12 9

WEST SOUTH CENTRAL... 600 1 46 2 77 1 36 3 41 18 776
Arkansas........... 3 5 1 45 1 11 14 1 103
Louisiana.......... 2 4 1 8 14 1 1 2 65
Oklahoma............ 38 3 18 7 1 16 7 284
Texas.............. 557 1 34 6 4 1 10 8 324

MOUNTAIN ............. 1,834 1 2 1 10 19 9 2 110
Montana............. 42 1 2 -
Idaho ............. 60 -
Wyoming............. 156 2 5
Colorado............ 1,259 1 1 1 12 9 10
New Mexico......... 179 1 2 2 34
Arizona............. 81 3 49
Utah............... 57 1 6 3
Nevada............... 9

PACIFIC.............. 1,268 17 6 1 82 11 7 208
Washington......... 414 2 2 2 1 2
Oregon............. 119 1 1 3 3 4
California......... 600 13 3 1 74 6 6 202
Alaska.............. 79 -
Hawaii ............. 56 3 3

Puerto Rico.......... 8 16 6 30






359


Morbidity and Mortality Weekly Report






DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED OCTOBER 21, 1967


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

All Causes Pneumonia Under All Causes Pneumonia Under
Area All 65d year Aand i year
Area All 65 years and I year Area All 65 years influenza All
Ages and over Influenza All Ages and over Al l
All Ages Causes All Ages Cause


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.------

rIDDLE 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.--------


779
306
34
26
32
56
24
14
30
54
50
13
48
32
60

3,378
54
40
177
43
28
51
57
89
1,670
29
489
219
45
113
22
48
59
74
33
38

2,642
76
39
769
128
233
132
69
327
59
42
44
18
46
178
40
150
36
32
42
124
58

859
53
26
37
132
23
122
75
277
70
44


493
176
21
21
21
31
18
11
23
29
33
11
34
21
43

1,977
29
21
106
26
13
30
36
46
995
18
250
118
30
80
18
34
36
44
23
24

1,475
47
19
404
86
111
71
36
189
31
24
25
9
30
92
26
95
22
14
28
74
42

517
35
11
17
80
15
73
47
162
47
30


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.----------


1,204
149
298
39
54
94
43
69
39
81
82
208
48

650
80
57
31
112
145
73
29
123

1,165
38
55
37
196
34
99
202
46
153
84
103
61
57

453
44
19
142
14
89
29
49
67

1,719
23
56
43
43
80
545
92
51
116
69
92
192
45
176
54
42


641
69
174
20
29
49
26
37
19
68
49
79
22

327
44
24
24
68
65
34
15
53

558
19
22
17
97
12
49
92
31
72
43
49
25
30

249
21
13
69
14
44
21
28
39

1,063
20
35
28
24
45
355
59
37
72
42
42
107
31
101
40
25


Total 12,849 7,300 445 649

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 515,538
All Causes, Age 65 and over------------------- 293,969
Pneumonia and Influenza, All Ages------------- 18,035
All Causes, Under 1 Year of Age-------------- 26,287


Week No.
42







Morbidity and Mortali


HEPATITIS Arkansas (Continued from page 355)

and their families; the abruptly rising and falling epidemic
curve; and the single exposures of 18 individuals with
subsequent compatible incubation periods. Although a
specific vehicle could not be identified as the source of
infection at the truckstop, contaminated water was con-
sidered as the possible common vehicle.
(Reported by John T. Herron, M.D., State Health Officer,
Arkansas State Board of Health; and an EIS Officer.)


PENTACHLOROPHENOL POISONING IN
NEWBORN INFANTS
Statement by Manufacturer

In follow-up to the report of nine cases of penta-
chlorophenol intoxication due to a laundry agent (MMWR,
Vol. 16, No. 40), the manufacturer has released this state-
ment:
."The product involved in this incident, Loxene, and
a similar product, Loxsit, are manufactured by Wyandotte
Chemicals Corporation. No other Wyandotte product con-
tains sodium pentachlorophenate. The company has direct-
ed its 70 laundry field representatives to request each
laundry to which the products have been sold to return
these products to the manufacturer.
"These are technically excellent products which can
provide real benefit to the public if used properly. Con-
tainers of Loxene have a label which warns against using
the product for laundering diapers or hospital linens. Had
these warnings been observed, this unfortunate incident
would not have occurred."

INTERNATIONAL NOTES
IMPORTED CASE OF SMALLPOX London, England

On October 18, 1967, the Ministry of Health of the
United Kingdom reported a confirmed case of smallpox
in a 3-year-old Pakistani child who arrived in London
from Karachi on October 1, 1967, on Pakistani Airline
715. She had a valid certificate of revaccination against
smallpox dated September 13, 1967. The child was ad-
mitted to the hospital on October 16, 1967, because of
a vesicular rash that appeared on October 14. The origi-
nal diagnosis was chickenpox but was changed on Octo-
ber 17 to smallpox on the basis of an agar gell diffusion
test. The mother, who was the only close contact, was
hospitalized voluntarily in order to take care of the child.
London is not an infected local area for smallpox since
the case was imported. Karachi has reported smallpox
cases since August 1967.


ERRATUM: Vol. 16, No. 40, p. 339
In the Table "Cases of Primary and Secondary
Syphilis" for September 1967 and 1966, the number of
cases reported for Wisconsin (11) was in error. The cor-
rect figures should read:


Reporting Area

EAST NORTH CENTRAL
Wisconsin
I .S. TOTAL


Cumulative
September Jan-Sept

1967 1967


1,776


2,369
18
15,904


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ity Weekly Report OCTOBER 21, 1967
UNIVERSITY OF FLORIDA



3 1262 08864 2003

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
ATLAN1A, 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.