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:
AA00010654:00022

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. 46


WEEKLY

REPORT


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

BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


EPIDEMIOLOGIC NOTES AND REPORTS
HUMAN CASE OF COWPOX Ind-ana
Human cowp..', t .- r. l,r,.: ill j.1, iLr,,-:. ,F, j ..
year-old woman fr..r,, i... i in. l .:.i ntr- .
virologic studies at NCDC. Following contact with a dairy
cow which developed cowpox-like lesions on the udder, the
woman noted lesions on her hands and onset of fever and
malaise on October 30. These lesions progressed through
popular, vesicular, pustular, and crusting stages. Further
clinical and epidemiologic investigations are in progress.
Crust material from the patient, submitted to NCDC on
November 15, revealed suspicious pox virus particles by
electron microscopy. Cytopathic effect was observed in
human embryonic lung fibroblast (RU1) tissue culture on
the 3rd day following inoculation. Electron microscopy of


urr n 1 r .
ur Ll~ M a i, .


this tissue revealed pox virus particles. An agar gel diffu-
sion test was positive for the pox virus group and suggested
cowpox. Definitive diagnosis of cowpox was made on
November 20 when characteristic hemorrhagic pocks on
chicken chorioallantoic membranes were observed. Sero-
logic studies are pending.
(Reported by A.L. Marshall, Jr., M.D., Director, Division
of Communicable Disease Control, Indiana State Board of
Health; E.B. Lett, M.D., Loogootee, Indiana; Viral Exan-
thems Laboratory, and an EIS Officer, NCDC.)


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
46th WEEK ENDED CUMULATIVE, FIRST 46 WEEKS
MEDIAN
DISEASE NOVEMBER 18, NOVEMBER 19, 1962 1966 MEDIAN
1967 1966 1967 1966 1962 1966
Aseptic meningitis ...................... 61 67 45 2,725 2,689 1,914
Brucellosis............................. 8 3 4 222 219 326
Diphtheria................................ 4 1 5 144 172 238
Encephalitis, primary:
Arthropod-borne & unspecified .......... 19 45 --- 1,441 1,948
Encephalitis, post-infectious ..... ...... 9 5 698 657 -
Hepatitis, serum ........................ 51 40 665 1,968 1,280 33,705
Hepatitis, infectious .................... 836 714 34,086 28,396
Malaria ............................... 60 12 4 1,856 429 94
Measles (rubeola)....................... 310 1,166 1,702 60,198 195,563 368,873
Meningococcal infections, total ........... 38 49 46 1,949 3,072 2,454
Civilian ............................ .37 44 1,827 2,780 -
Military.......................... .. 1 5 122 292 -
Poliomyelitis, total ..................... 2 3 3 35 90 106
Paralytic ............................. 3 3 26 85 85
Rubella (German measles)................ 307 263 42,122 43,843 -
Streptococcal sore throat & scarlet fever .. 8,494 8,260 6,436 392,397 369.505 343,445
Tetanus. ............................... 4 3 6 198 171 249
Tularemia .............................. 4 6 2 154 164 255
Typhoid fever .......................... 8 7 10 372 345 406
Typhus, tick-borne (Rky. Mt. spotted fever). 4 1 293 243 218

Rabies in animals ...................... 67 85 72 3,802 3,612 3.612

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: .......................................... 2 Rabies in man:............. .................... .. 2
Botulism: .................................... ..... 2 Rubella, Congenital Syndrome: ....................... 7
Leptospirosis: Calif.-1 .............................. 38 Trichinosis: Tenn.-1 ............. .............. .... 54
Plague: ............................................. 2 Typhus, murine: ................................... 40
Psittacosis: Calif.-1. Minn.-1 ..................... .. 42 Polio, Unsp. Calif.-2 ....... ........... ............ 9


3







Morbidity and Mortality Weekly Report


NOVEMBER 18, 1967


CURRENT TRENDS
MEASLES


A graph of the measles cases reported in the United
States since 1962 is shown by 4-week periods in Figure 3.
Above the graph is a pictorial representation of the amount
of live measles virus vaccine distributed during this period.
The striking decline in incidence of reported cases of
measles appears to be related to increasing vaccine usage.
This decline is also reflected in the geographic dis-
tribution of the counties or health districts reporting 10 or
more cases of measles for 4-week periods. During the first
4 weeks of the epidemiologic years 1966-67 and 1967-68,
60 counties in 24 states reported 10 or more cases. For
the comparable period in 1967, however, 25 counties in 14
states reported 10 or more cases (Figure 4).
A similar reduction is notable in the numbers of coun-
ties reporting three or more cases. For the first 4 weeks

Figure 3
REPORTED CASES OF MEASLES BY 4-WEEK PERIODS
WITH PICTOGRAM OF DISTRIBUTION OF LIVE
MEASLES VIRUS VACCINE
UNITED STATES, 1962-1967
III III Ill III II I
io1 I III III III
SII III


Figure 4
COUNTIES OR HEALTH DISTRICTS REPORTING
A TOTAL OF 10 OR MORE CASES OF MEASLES
OCTOBER 9 THROUGH NOVEMBER 5, 1966


S-ONE MILLION DOSES


of epidemiologic year 1966-67, 56 percent of the 378 re-
porting counties recorded three or more cases. For the
same period of the current year, 38 percent of 279 counties
1967reporting measles recorded three or more cases.
reporting measles recorded three or more cases.


ESTIMATED TOTAL FOR 1967


EPIDEMIOLOGIC NOTES AND REPORTS
HEPATITIS U.S. Visitors to Ontario, Canada


Between July 3 and August 10, 1967, 15 cases of in-
fectious hepatitis occurred among a group of persons who
had either vacationed or worked at a fishing lodge in On-
tario, Canada. Twelve of the cases occurred among approx-
imately 35 persons accommodated by the lodge during
the first week in July. One case involved a guest who
visited the lodge from July 14 through 17. The two remain-
ing cases occurred in kitchen employees of the lodge.
The 15 cases are shown by date of onset in Figure 5.
The index case, a young male kitchen worker whose
duties included dishwashing, waiting on tables, and mak-
ing ice cubes, became ill on July 3, but worked until July 5
when the diagnosis of infectious hepatitis was made.
The dates of onset of the other 14 cases occurred over a
24-day period, July 18 August 10, 1967. One of these


cases was in a female kitchen employee who began work
June 24 and became ill August 7.
Twelve of the 13'cases among theguests were adults,
ages 25-27; the remaining case was a 14-year-old girl
visiting the lodge with her family. All 15 cases, includ-
ing the two ill employees, developed jaundice; nine were
hospitalized. There were no deaths.
The fishing lodge, located on the edge of a lake in
Ontario, consists of individual family cottages equipped
only with bathing facilities. Well-kept privies are distri-
buted throughout the grounds. Three meals a day are served
to the guests in a common dining room, described by
the guests as "immaculate." Drinking water is obtained
from the adjacent lake via an intake pipe extending 200
feet out and 40 feet deep into the lake.
(Continued on page 392)


386







NOVEMBER 18, 1967


Morbidity and Mortality Weekly Report


SURVEILLANCE SUMMARY
HEPATITIS Summer Quarter 1967-68*


During the summer quarter (13-week period from July 2
through September 30, 1967) of the current epidemiologic
year 1967-68, there were 9,521 cases of viral hepatitis re-
ported in the United States, -.pr ...r ;irn,. a rate of 4.8 cases
per 100,000 population for that period (Table 1). This was
an increase of 30 percent over the rate of 3.7(7,298 cases)
reported during the corresponding quarter of the previous
year.
Figure 1 shows the areas in each of the nine geo-
graphic divisions of the U.S. Table 1 lists by division the
number of reported cases, rates, change in number of cases,
and percent change in rates for the summer quarters of
epidemiologic years 1966-67 and.1967-68. The rates were


*Hepatitis morbidity data are summarized in terms of an "epi-
demiologic year," which runs from the 27th week of each year
through the 26th week of the succeeding year.



Figure 1


greater in the summer quarter of 1967-68 in all nine divi-
sions; increases ranged from 9 to 69 percent. The largest
increases were observed in the South Atlantic and West
South Central Divisions (52 and 69 percent, respectively),
whereas the smallest increases were noted in the Mountain
and East North Central Divisions (9 and 14 percent, respec-
tively).
Figure 2 presents the number of reported cases per
100,000 population by 4-week periods from July 1952 through
the 46th week of 1967 (week ending November 18). The
increased rates observed during the first 8 weeks of the
fall quarter of 1967-68 were higher than those in the com-
parable period of 1966-67, further supporting the apparent
reversal of the downward trend in hepatitis incidence,
evident since the peak year (1960-61) of the last epidemic
cycle.

Table 1
Reported Cases and Rates of Viral Hepatitis by Division
Summer Quarter 1967-68 Compared with
Summer Quarter 1966-67

Summer Quarter Summer Quarter Change fuoia
July 3, 1966- July 2, 1967- Summer Quarter
Oct. 1, 1966 Sept. 30, 1967 1966-1967
Division Percent
Cases Rate* Cases Rate* Cases change
in rate.
Total United States 7,298 3.7 9,521 4.8 +2,223 +30
New England 299 2.7 402 3.6 +103 +33
Middle Atlantic 1,229 3.3 1,615 4.4 +386 +33
East North Central 1,132 2.9 1,292 3.3 +160 +14
West North Central 430 2.7 537 3.4 +107 +26
South Atlantic 684 2.3 1,037 3.5 +353 +52
East South.Central 462 3.6 585 4.5 +123 +25
West South Central 606 3.2 1,029 5.4 +423 +69
Mountain 335 4.3 365 4.7 +30 +9
Pacific 2,121 8.6 2.659 10.5 +538 +22
*Reported cases per 100,000 population bled on U.S. census mid-year estimates.









388 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 18, 1967 AND NOVEMBER 19, 1966 (46th 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... 61 67 8 4 19 45 9 51 40 836 714

NEW ENGLAND........... 3 2 1 3 4 45 44
Maine.............. 4 9
New Hampshire...... -
Vermont............. 1 2
Massachusetts...... 1 10 11
Rhode Island....... 1 2 3 2 3 2
Connecticut........ 1 1 2 27 20

MIDDLE ATLANTIC...... 9 6 2 6 19 16 124 136
New York City...... 6 2 2 11 12 40 32
New York, Up-State. 1 1 1 25 42
New Jersey......... 1 4 3 2 1 19 24
Pennsylvania ...... 2 1 1 5 2 40 38

EAST NORTH CENTRAL... 14 7 8 16 3 1 1 142 121
Ohio................ 4 1 7 8 34 25
Indiana............. 4 1 1 2 5 16
Illinois........... 4 3 2 2 58 32
Michigan............ 2 1 1 1 1 33 39
Wisconsin.......... 3 12 9

WEST NORTH CENTRAL... 15 2 3 9 1 51 29
Minnesota.......... 6 1 15 7
Iowa............... 2 2 2 2 10 14
Missouri.............. 18 6
North Dakota....... 2 -
South Dakota...... -
Nebraska........... 1 3
Kansas............. 13 1 3 2

SOUTH ATLANTIC....... 6 10 3 1 2 2 94 66
Delaware .......... 2 1
Maryland........... 5 1 9 17
Dist. of Columbia.. 1 3
Virginia............. 1 1 3 1 1 4 20
West Virginia...... -- 16 8
North Carolina..... 2 5 6
South Carolina.... 6 1
Georgia ...........* 41 4
Florida............ 2 11 6

EAST SOUTH CENTRAL... 5 4 3 1 3 1 2 76 59
Kentucky........... 1 52 16
Tennessee.......... 1 1 1 1 11 21
Alabama........... 4 1 3 2 7 12
Mississippi....... 2 2 6 10

WEST SOUTH CENTRAL... 3 3 1 1 5 1 3 1 71 75
Arkansas .......... 2 1 1 5
Louisiana.......... 1 1 3 9 12
Oklahoma........... 1 1 3 3 9
Texas.............. 2 2 1 58 49

MOUNTAIN............ 1 1 24 30
Montana ........... 4 4
Idaho............. 3
Wyoming.............. -
Colorado............. 1 11 7
New Mexico......... 4 2
Arizona............* 4 11
Utah............... 1 3
Nevada.............. -

PACIFIC............... 23 19 2 2 3 4 22 15 209 154
Washington........ 1 1 10 15
Oregon............. 16 22
California......... 18 19 1 3 3 22 15 180 113
Alaska ............ 2
Hawaii............. 4 2 3 2

Puerto Rico 23 16








Morbidity and Mortality Weekly Report 389


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 18, 1967 AND NOVEMBER 19, 1966 (46th WEEK) CONTINUED


MENINGOCOCCAL INFECTIONS,
MALARIA MEASLES (Rubeola) TOTAL POLIOMYELITIS RUBELLA
AREA Total Paralytic
AREA Cumulative Cumulative Total Paralytic
Cum.
1967 1967 1967 1966 1967 1967 1966 1967 1967 1967 1967
UNITED STATES... 60 310 60,198 195,563 38 1,949 3,072 2 26 307

NEW ENGLAND.......... 12 917 2,473 2 76 141 35
Maine................ 7 261 268 3 12 5
New Hampshire...... 77 80 1 3 9
Vermont............. 42 316 1 4 -
Massachusetts...... 3 380 815 1 36 59 9
Rhode Island....... 62 73 4 17 3
Connecticut........ 2 95 921 29 40 18

MIDDLE ATLANTIC...... 23 19 2,423 18,299 7 319 388 5 26
New York City...... 5 491 8,350 2 56 62 1 8
New York, Up-State. 613 2,592 1 79 106 1 11
New Jersey......... 5 9 554 1,913 2 105 109 6
Pennsylvania....... 18 5 765 5,444 2 79 111 3 1

EAST NORTH CENTRAL... 6 57 5,879 69,709 8 286 490 6 107
Ohio................ 2 4 1,172 6,403 90 141 27
Indiana............. 1 626 5,774 3 50 85 3 1
Illinois........... 4 33 1,091 11,457 1 61 89 18
Michigan........... 7 986 14,901 3 66 127 3 29
Wisconsin.......... 12 2,004 31,174 1 19 48 32

WEST NORTH CENTRAL... 10 2,919 9,013 2 93 158 3 16
Minnesota.......... 124 1,665 21 35
Iowa............... 7 771 5,361 1 19 22 1 15
Missouri........... 339 537 1 18 61
North Dakota........ 1 878 1,262 3 11 -
South Dakota....... 58 40 7 5
Nebraska............. 2 655 148 15 9 1
Kansas............. 94 NN 10 15 2 -

SOUTH ATLANTIC....... 1 51 7,160 15,690 6 370 520 2 15
Delaware........... 50 262 7 5 -
Maryland............. 3 172 2,121 3 53 49 1-
Dist. of Columbia.. 24 388 14 14 1
Virginia........... 12 2,239 2,216 1 43 67 -
West Virginia...... 12 1,456 5,443 35 37 10
North Carolina..... 917 559 1 73 132 1
South Carolina..... I 512 660 30 53 1
Georgia............. 2 39 238 56 68 -
Florida............. 22 1,751 3,803 1 59 95 3

EAST SOUTH CENTRAL... 19 31 5,432 20,097 5 153 267 2 7
Kentucky............ 19 12 1,419 4,773 1 45 93 3
Tennessee.......... 15 1,991 12,488 1 65 92 3
Alabama............ 3 1,348 1,738 3 29 58 1
Mississippi........ 1 674 1,098 14 24 2

WEST SOUTH CENTRAL... 54 17,907 25,549 6 243 416 8 4
Arkansas............ 1,404 979 3 36 36 1
Louisiana.......... 156 99 95 157 -
Oklahoma........... 1 3,359 538 18 21 I -
Texas............... 53 f2,988 23,933 3 94 202 6 4

MOUNTAIN............. 29 4,822 12,330 39 94 8
Montana............. 7 326 1,882 5 5 -
Idaho.............. 2 395 1,664 3 5 -
Wyoming.............. 5 193 217 1 6 -
Colorado........... 3 1,609 1,376 13 49 2
New Mexico......... 6 604 1,153 5 10 -
Arizona............ 6 1,043 5,335 5 13 6
Utah............... 383 648 4 1
Nevada............. 269 55 3 5 -

PACIFIC.............. 11 47 12,739 22,403 2 370 598 2 89
Washington.......... 11 5,590 4,565 1 36 44 23
Oregon............. 9 1,685 2,117 30 37 7
California.......... 6 26 5,142 14,975 1 289 495 2 38
Alaska............. 140 592 11 18 14
Hawaii.............. 5 1 182 154 4 4 7
Puerto Rico.......... 3 2,226 3,230 14 17 2








390 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 18, 1967 AND NOVEMBER 19, 1966 (46th 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... 8,494 4 198 4 154 8 372 293 67 3,802

NEW ENGLAND.......... 1,155 2 1 2 10 1 1 97
Maine............... 31 23
New Hampshire...... 18 1 46
Vermont............. 32 22
Massachusetts...... 252 1 1 2 6 1 4
Rhode Island....... 75 1 2
Connecticut........ 747 1 3 -

MIDDLE ATLANTIC...... 57 13 1 1 38 35 2 93
New York City...... 10 7 18
New York, Up-State. 1 1 1 11 9 2 77
New Jersey......... NN 1 4 15
Pennsylvania....... 47 4 5 11 16

EAST NORTH CENTRAL... 529 1 23 2 14 40 22 5 363
Ohio................ 115 4 13 11 3 130
Indiana............. 47 3 2 11 1 81
Illinois........... 129 1 11 2 12 6 10 1 68
Michigan........... 136 4 8 1 23
Wisconsin.......... 102 1 2 61

WEST NORTH CENTRAL... 441 17 1 22 1 21 4 13 886
Minnesota.......... 9 5 2 1 2 174
Iowa............... 113 2 1 3 1 119
Missouri........... 4 8 1 9 1 10 1 4 160
North Dakota....... 118 3 153
South Dakota....... 46 1 2 116
Nebraska........... 91 4 2 60
Kansas............. 60 1 10 2 3 104

SOUTH ATLANTIC....... 1,144 1 41 10 2 58 116 3 457
Delaware........... 5 -
Maryland............ 122 2 21 1 4
Dist. of Columbia.. 17 3 6
Virginia............ 291 1 10 6 28 193
West Virginia...... 277 1 2 2 1 2 62
North Carolina..... 20 7 4 46 3
South Carolina..... 6 I 2 10 5 2
Georgia............. 36 4 5 2 19 15 113
Florida............. 370 18 1 12 74

EAST SOUTH CENTRAL... 1,483 31 10 64 53 14 719
Kentucky............ 105 4 1 24 15 161
Tennessee........... 1,150 8 7 11 26 13 502
Alabama............ 158 11 12 12 1 46
Mississippi........ 70 8 2 17 10

WEST SOUTH CENTRAL... 792 48 1 80 1 38 42 25 854
Arkansas........... 7 5 1 47 12 14 3 108
Louisiana.......... 2 4 8 1 15 2 1 67
Oklahoma........... 17 3 18 7 16 15 329
Texas............... 766 36 7 4 10 6 350

MOUNTAIN............. 1,384 2 10 20 9 1 111
Montana........... .. 64 2 -
Idaho............... 189 -
Wyoming............ 237 2 I 5
Colorado........... 553 1 1 12 9 10
New Mexico......... 145 1 2 34
Arizona............ 87 3 1 50
Utah............... 109 6 3
Nevada.............- 9

PACIFIC .............. 1,509 2 21 6 1 83 11 3 222
Washington......... 592 2 2 2 2
Oregon.............. 121 1 1 3 3 4
California ........ 704 2 16 3 1 75 6 3 216
Alaska............. 34 -
Hawaii.............. 58 4 3

Puerto Rico......... 9 17 7 30









Morbidity and Mortality Weekly Report






DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED NOVEMBER 18, 1967


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

All Causes Pneumonia Under All Causes Pneumonia U under
Area All 65 years and year Area All 65 years and I yea
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.---------


756
222
36
31
23
58
43
32
29
58
69
17
46
34
58

3,336
58
36
146
42
39
36
72
106
1,755
36
391
197
67
110
28
43
58
48
22
46

2,806
76
42
770
197
249
135
78
343
32
54
53
40
63
185
37
129
51
36
56
125
55

897
55
20
44
139
43
112
86
265
88
45


479
125
23
19
15
31
28
26
23
31
46
14
34
21
43

2,043
29
23
91
22
23
21
36
55
1,080
21
240
115
43
65
24
31
40
29
19
36

1,608
41
27
431
120
124
65
44
206
22
29
31
20
44
102
23
81
25
27
36
69
41

561
36
11
27
85
29
71
50
161
63
28


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 12,846 7,492 456 609

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages -------------------------564,939
All Causes, Age 65 and over-------------------322,255
Pneumonia and Influenza, All Ages------------- 19,726
All Causes, Under 1 Year of Age--------------- 28,707


Week No.


1,197
124
267
44
85
81
46
80
37
107
58
244
24

700
112
39
50
133
142
55
55
114

1,186
34
47
25
192
41
100
204
63
160
100
118
56
46

449
59
22
122
20
99
24
48
55

1,519
18
47
25
56
72
468
69
30
118
58
120
174
29
128
68
39








392


HEPATITIS U.S. Visitors to Ontario, Canada
(Continued from page 386)

Figure 5
HEPATITIS CASES RELATED TO FISHING LODGE
ONTARIO, CANADA-JULY 3-AUGUST 10, 1967
GUEST, PRESENT AT LODGE
JULY I -
D GUEST, PRESENT AT LODGE
JULY 14-17
KITCHEN EMPLOYEE


26 30 4 12 16 20 24 28 I
JUNE JULY
DATE OF ONSET 14-DAY INTERVALS)


9 13 17 21
AUGUST


A routine water sample taken May 28 was negative.
Another sample taken in July showed 15 total coliforms
but was negative for Escherichia coli. Chlorination was
started immediately. In the opinion of the local health
authorities, sanitation facilities at the lodge were quite
adequate. No gastrointestinal illnesses were reported
among the guests in July.
Both the occurrenceof cases over a very short period
of time and the age distribution suggested a common source
outbreak of infectious: -. ier.. xith exposure occurring
during the first week ir .Jul .. \I .but one of the affected
guests were at-the i...i .lurIn: lib- period; this was the
same .time the male kitchen '-.-..r.-r who became ill with
hepatitis was experiencing his acute illness (July 3-5).
The other kitchen employee who became ill was exposed
to the -index case during this same period and subsequent-
ly became ill one month later..
The guest who was not at.' tje lodge during the first
week of July developed' .. o[t,.- approximately 30 days
later on August 10. Hf:" -.-'. none of the guests who had
been at the lodge during the first week of July was pre-
sent during his stay. This guest had a history of contact
with a jaundiced family member who may have had a case
of infectious hepatitis. Thus, this guest may represent
a case of hepatitis unrelated to the common source out-
break.

(Reported by J.S. Bell, Dr. P.H., Chief, Epidemiology,
Ontario Department of Health; William J. Dougherty, M.D.,
Director, and Paul Marzinsky, both with Division of Pre-
ventable Disease Control, New Jersey State Department
of Health; and an EIS Officer.)
Editorial Comment:
Most of the guests of the lodge are U.S. residents;
the 13 guests who recently developed hepatitis were from
four states. Although the cases were geographically wide-
ly separated, the outbreak became apparent by careful
monitoring of individual hepatitis surveillance case re-
cordsE by the New Jersey Stale Department of Health. The
ensuing investigation represented a cooperative effort by
the Canadian health authorities, the epidemiologists of
thll four involved sates, and the Hepatitis Unit, NCDC.


NOVEMBER 18, 1967


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION OF 17,000, IS PUBLISHED AT THE NATIONAL COMMUNICABLF
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.
EDITOR, MMWR MICHAEL B. GREGG, M.D.

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:
NATIONAL COMMUNICABLE DISEASE CENTER
ATLANTA, GEORGIA 30333
ATTN: THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT

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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