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:
AA00010654:00025

Related Items

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

Full Text



NATION AL COMMUNICABLE DISEASE CENTER


Vol. 16, No. 50


WEEKLY

REPORT


Week Ending

December 16, 1967


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


PUBLIC HEALTH SERVICE


BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


CURRENT TRENDS
INFLUENZA Further Reports

Influenza-like illnesses continue to he reported from
Michigan, now including the upper peninsula. This week,
the first 2 isolates of influenza virus, both A., were re-
ported. One specimen was from Detroit, and the other from
Ann Arbor. Other states also reported influenza-like dis-
ease (Figure 1).
In Alabama, outbreaks of influenza-like illnesses
were reported from five counties. In Mobile County, during
the week of December 3, approximately (.7,II persons
visited their family physicians with complaints consistent
with influenza. A group of 12 acute versus 13 convales-
cent, matched unpaired sera taken from this outbreak


'ONIN i N'iS
(Curren t ITr ndi
nflu n, i-FurLth r rp rs .
Influenq a-1967 ... .. .... .....
M' as.I, s-United, State-
Epidemioilogi Nolc and p H ,trt
Botulism-Bronx.\ Net\ York ...
Human Pla ut -( o .. .......
Mtumps-i as n (CountN KtnlukiiA ..
M1alarui t lod Trun fusion Induc,,d ('
Surveillance Summary1
Malaria a -19 N67t ...Not ...... ..
International Note.-Quarantin.s Mea-ures .


demonstrated a fourfold rise in geometric mean titer against
the soluble influenza A antigen by the complement fixa-
tion test.
In Tulsa, Oklahoma, for the week of December 3. an
outbreak of febrile illness in a parochial high schooll led
(Continued on page 418)


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 & unspecif
Encephalitis, post-infectiou .. .
Hepatitis, serum ..... 4... .
Hepatitis, infectious. ... ..'..... ..
Malaria ............. .. .
Measles (rubeola)......H ...........
Meningococcal infection CA ..........
Civilian ........ .). .......
Military.............. ........
Poliomyelitis, total .......
Paralytic .............. .. ..
Rubella (German measles).. .. '
Streptococcal sore throat & scr 3f
Tetanus. .............. ......
Tularemia ...........................
Typhoid fever .........................
Typhus, tick-borne (Rky. Mt. spotted fever).

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


50th WEEK ENDED


DECEMBER 16,
1967


DECEMBER 17.
1966


33
4
4

29
12
44
714
24
1,437
58
52
6
1
1
385
8,042
4
4
1


64


MEDIAN
1962 1966


34
4
11



758
2
3,249
58


2
2

8,042
4
4
5


64


CUMULATIVE. FIRST 50 WEEKS

MEDIAN
1967 1966 1962 1966


2,920
240
199

1.524
738
2,265
37,235
2.021
61,537
2,072
1.943
129
41
28
43.478
429.808
223
165
393
297

4,048


2,867
239
188

2,083
698
1,427
31,275
496
200.780
3,288
2.969
319
98
92
45.303
404,864
191
176
364
251

3,867


2,076
347
282


36,394
103
380,794
2,683


114
92

375,078
270
277
437
222

3,867


NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ....... ...... .......... ....... 2 Rabies in man: ................. ... 2
Botulism: ......................................... 3 Rubella, Congenital Syndrome: ............ 9
Leptospirosis: L.A.-1, Maine-1, N.Y. Upstate-1. Texas-1.. 45 Trichinosis: Kans.-I, N.Y. Upstate-1 .. .. ... .... 59
Plague: Colo.-l ................. ........ ......... 3 Typhus, marine: Texas- ............................ 43
P ltd.a: ..ji T-=nn .1 44 P.li... Un-:p 13


,


,


,


.


. 1 7
. 1 17
I ISi















Figure 1
INCIDENCE OF INFLUENZA AND INFLUENZA-LIKE
DISEASE BY STATE AS REPORTED TO NCDC.
OCTOBER 29 TO DECEMBER 20, 1967


to approl\iniat tel\ 30) percent ab-entieism. Matched sera
from this outbreak failed to -ho\ rises to influenza. adeno-
\i rus. and para-influenza antiglen-. In the neighboring
count\ of Bart ll \ lle. an outbr'eaik of febrile illneis- ri-
sulted in :25 to 30 percent ahl-entol(iis in the puble high
school. MaUtched l -ra from amrule and coni.alo>(ontll groups
of pirsoin- sho c('d a siir lnificant increal- t in tirter to the
-oluhliC influenza A antigc n.
An increa-i in incidence of reo-piratory illness is
alo ocrcurring in Ni\\ York Slate. Iln N '\ York (it-y and in
i\\e-lch -iter and Dutchli-- (ountl t.i focal onutreaks o of
fIcbrili- r'-spir:itorr v illncs>-- hai e led to incroasd sc hool
al)-r'1!f/te i -ml. .\ n influenIa \ iru-, \\a- i oluatd from out-
break- in a prliaEto institution in Dulchesw-- (Counly and inl
No\\ ork Cit\. There i- no -erohogic document action of
influenza in these areas to dale.
School ah-enleeli-i iincireased in four Mar land counil-
tie Thie alstrientleist m \\as atriblitd to ;m illness. charac-
loriz(,d 1)h fl'\er. htladache. cough \\wih as-onlatd chest
pain. 1 or1( throal. neck pain. and nausea. Diaginostic
studios are in proure--.
In cniral O()hio. one - i-i (ilt to it 1\Indromn c onIsi'-llIi' of fe tr, upper respira-
tor s \n)plomsi. m, alia, and diarrhnll. No dl; a no-i- has
boIn nladte.


DECEMBER 16, 1967


IIIn(1sess consisting of fever. sore throat, headache.
and substernal pain. lasting from 2 to 3 days hate oc-
curred in 4 junior high schools in Washington. D.C. In-
creased absenteeism from 15 to 25 percent \\as noted in 2
of these schools.
In northern Georgia. increased school absenteeism
due to a flerile respirator\ illness \as reported. Due to
the increased absenteeism. one -chool closed 2 day-
earlier than expected for the Christiiias holida-.
From each area. in xhich influenza activity has not
yet hben documented. -pecimtens for virus isolation and
serology are being processed. NCD( has confirmed the
results previously reported from Michigan and Florida
(M\l\R. Vol. 1(. Nos. IS and 19). and from Oklahoma.
(Rfeportld by Thonmae SN. fHly. PA.D., and 11.Y. Smi/,i
11.I). '.P.il.. labamna State Dcpart. iit of Public Health:
Silliamn E. Long/. 11.).. I)itrict of ('olumbia Drpartment of
PiUblic Heualth; J. E. t. ('roan., P,..I)., Georgia VD.parrtmn1ot
of IPuibic l' eal/th; John 11. ./nney. 1.1).. l.P.II.. uarylaol
Stait Dcpartment o(f Hl'althi ; (eor/fi 11 .. A aii, i V. .,
i.N.P.t.l., iand I lari'e Br 'rker. 11.0I, Vichigao Dc)partmcnt
of iuhli lc alt Tibir i or Frieor. 1i.l .. and Sr ep/ih n r lit/ an,
11.).. \enr York City I) repartmtoto of Hfiealt/: Rudilph,
o)ibe! l.D., and Julia L. i 'reitay, .I)., \ric York S;tat
Department of llc lt,; t'alrin B. Spe'icer, 11.0.. and H. L.
Carpnctr. 11.)., Oklahtoma Stafe rcpar/neit of Health. l
Editorial Note: In this series of \IMMl reports concerning
influenza-like diseases in 1967. the terms "influenza A"
or ". influenza" haie been used to denote the results of
testing hb the complement fixation and innrunofluore'scent
techniques. These terms refer to the infltuenza A group of
viruses and not specifically Io the influenza type \A irus
as typified by tlhe Pr hb 1i strain. Th'e complement fixation
techniques using the soluble influenza antien. \\%ill dis-
tinguish among influenza groups A B. and ('. huit will not
distinguish among iype A. t\pe* \I. and type 1.. Heirma-
ilulilnation inhtiltion technique- and \iru- nrie traliz/ation
tecrhniques permit furtir r tipe s-pi ci fic characterization
of the \irus. Thu-. tlhe terms "influenza A\.)" or "A,\ in-
flutenza." hate b ieen u-sd only when these iwo techniques
hatie been employed. Since the fall of 19.7, th( onlVy iA'p
of A influenza. \ahich has been oe ident in iil- country. is
that v which has been caused,.by \) i-rains of the virus.


INFLUENZA 1967


lIing cau<('. \\lhen o\exc S-s mortality\ i- dut, to influenza. it
hias hlon enernvallel oblts(,'r\ d thai tho phoak in 'idinti, of
mortality\ hiu- follo d tIhe Ipeak influei .a morbndil\ hb. a
po(riod ofl i'lpro\ at(l: *I k,,ek-.
Editorial Note: TIli, b:-is o- f h, co1n-.triu lioni of ithe \i-
i onI Pn I tuPania- Influen a M\ortal1ut lhart i- dh-cribld in
\Mh Itl. \ol. H1. No. 1.


Morbidity and Mortality Weekly Report




INFLUENZA Further Reports (Contcinud from front page)


The pneunlollia a;lnd influEnza mor;tilt \ mra!ph- for t;tach
of the nire, major to'o" roi,;phl' di\ i -l[lon- of the I niNrd Stats-
arn pir,-odtd in Vitlure -2- Thto: rialh \ ti. noi t (*,cvoedid
th( opmi-c' t( hrc,-hold for pgr od of :' Tr.-' aiut ti k-
In ;an\ of the-+( re'ason-. ()hi\ ht'n i h, inorla!ts i \ r cM'e di-
Ihe itr,-h)old for iorw r ian 2 :2 (*c I-o( t1 we t- k t it' c n-
-idorrtd t o 1iw pro-i:ll|lp t" (e i wtlie r, for ;t ,ommoln under-








IIIECMBIIER 16. 1967


Morbidity and Mortality Weekly Report


Figure 2
PNEUMONIA-INFLUENZA DEATHS IN 122 UNITED
1967-1968


STATES CITIES


W. N. CENTRAL
I 10 CITIES


40 44 48 52 4 8 12 16 20 24 28 32
196711968


MOUNTAIN 150
8 CITIES


-25


40 44 48 52 4 8 12 16 20 24 28 32
196711968


PACIFIC
16 CITIES


100



50


WEEK NO 40 44 48 52 4 8 12 16
196711968


20 24 28 32


40 44 48 52 4 6 12 16 20 24 28 32 40 44 48 52 4 8 1 16 20 24 28 32 36
196711968 196711968

350
E. S. CENTRAL MIDDLE ATLANTIC
8 CITIES 300 20 CITIES

250

200 1' r

150I r -


i001

50
.. ,--in l "1".I. .n '. r--1. ioo-t


U,
I
< 25
w

Li-
0 WEEK NC
cJ
W
m
S 125
Z
z
100


75


50


25



WEEK N(


W.S. CENTRAL
13 CITIES


100



50*




40 44 48 52 4 8 12 16 20 24 28 32
196711968


V~Ni rT


24 28 32 40 44 48 52 4 8 12 16 20 24 28 32 36
196711968


SOUTH ATLANTIC
12 CITIES


40 44 48 52 4
1967 1968


8 12 16 20 24 28 32 36


EPIDEMIOLOGIC NOTES AND REPORTS
BOTULISM Bronx, New York


In Bronx.New York, botulism has occurred in a father
(MIC) and his son (AC), following ingestion of home-prepared
peppers. On December 9, 4S hour- after eating a hamburger
sprinkled with home-prepared chopped green and red pep-
pers, MC developed mild abdominal cramps. nausea, and
transient diarrhea. During the next 3 days, he developed
the onset and progression of lethargy. blurred vision .
diplopia. dysphonia, dry mouth. dysarthria, dysphagia.
neck muscle weakness, and urinary hesitancy. AC, o8
hours after ingestion, developed generalized weakness.
lethargy, blurred vision, diplopia. dry mouth. dysarthria.


M( and AC were hospitalized on December 13 andi 1
respectively. Upon examination, each patient showed pro-
nounced lethargy, dilated reactive pupils. ptosis, palatal
erythema. dysarthria. dysphagia, and bilateral VI noner\
palsies. Mentation was unaffected. The New York City
Department of Health promptly\ provided AB botulinum
antitoxin, and on December 14. each man received 100,000
units of botulinum antitoxin AB intravenously. On Decem-
ber 15, each received 10.)000 units of type E antitoxin.
Following the AB antitoxin. AC demonstrated a transient
((onltitfr ed ,,i payr .'20)


40 44 48 52 4 8 12 16 20
1967 11968


usIrahesitadassionals usinalistlessinalin


.l i h I I I ... I I h s I I I I I m I i I I I.,


I








Morbidity and Mortality Weekly Report


BOTULISM Bronx, New York
(Continued from paye 419)


erythenmatous rash. By December 16. both patients were
-ignificantly improved. The suspect peppers were ob-
tained from the patients' home by officials of the New
York C'ity Department of Health. Samples nere distributed
to the New York (City Department of Health laboratory and
NCDC laboratory for analysis. Mouse protection tests at
NCDC identified type B hotulinum toxin in a pre\louslH
unopened jar of the home-prepared peppers: however, to
date, no toxin has been identified from the patients' sera
or the opened jar of peppers.
The peppers had leen prepared by MC in late Septem-
her 1967. Preparation involved \arming the peppers in a
frying pan for 5 minutes, and placing them in one of 2
glass jars. One jar contained olive oil, and the other \\ine


vinegar. The jars were closed \with screw caps and stored
at room temperature. During the fall. MC and AC periodi-
cally ate chopped peppers from the jar containing wine
vinegar. Several weeks prior to his present illness. AC
noted transient blurring of vision after eating a pepper. No
other family member ceer ate the peppers. Further labora-
tory investigations are in progress at the New York City
Department of Health and NCDC.
(Reported by Vincent F. (;uiner, .D... Director. Bureau
of Pre rentable diseases, and Tibor Fodor, il.D., Chief,
Vl)iision of Epidmiiologyy Bureau of Prci notable diseases ,
\Nw York City Department of Health; Stewart Cook, V.D.,
,\euroloyy Resident, Jacobi Hospital, Bronr. .\'e York;
und (an EIS Officer.)


HUMAN PLAGUE Colorado


\ case of meningeal plague in a 6(O-year-old oil rigger
has been reported from C(olorado. The patient, from Rio
Blanco County. became ill with chills and fe-er on Sep-
tember S. 1967. He was treated xith parenteral penicillin
for pustular pharingitis,. but on Septemher 10. d\ eloped
left axillary adenopathy. On September 14. he was trans-
ferred to a Den\er hospital where he developed nuchal
rit ditx on Septembeiir Ih. A -pinal tap yielded turbid fluid,
a smear of w\ which reixealed gram negati i\ rods. Subse-quent-
1. P'tsteur lbi pe tis was identified from Ihe spinal fluid


at NCDC. The patient was treated with Chloromycetin. and
he recolored after a long period in the hospital. There x-as
no history of exposure to rodents: however, further ecologic
inest-igations will eli conducted.
This is the fir-t plague case from Rio Blanco Count'.
and only the fourth case ever reported as occurring in
Colorado.
(Reported by ('. S. Vlolloban. 11.0.. V.P.H .. Chief. Epidim-
ioloyy Scrtion, C'olrudo Sta:e Pepartment of I'tulic Health;
and Bacterial Re feren ce I it. La bor:tvry Pro,,gramtt \1), C'.)


MUMPS Mason County, Kentucky


Be-tween June 1 and December 16. 1967. 1)7 cases of
mutpi in Mason Count Kentucki (pop. IS,75)0). Th(, majority of
,casi- ocurrd -in school children \wit h 2S6 cae, amoni
the 1.i)0( enrolled school children: 101 caoe- w\ere in pro-
-chool children, and 17 cases- Nere in adults, Data. ac-
quired h.\ que-tionaire and h\ school absentee record.-
Nielded ioth the di- trihulit n of cas(-s in \lason County
bot\ween .lJune I aind (December 16I. and the epidenlic ure
for tcase aiuong -chool children between Aluguet 26 and
December 16 (Figure :1). The peak incidence occurred in
()lctobr w illh the laret- l oiubreakt s occurring iln tlhe tOrange-
huir i and \\oodleih schools (Figure 1). \( the 2 s hools.
101 and .1I cai -,-, re-pect\ i l\,. were reported through
De) vimher 16. Highe,-t attack ratxe were noted in tho fir-t


and second grade children, \ith -onit \hat lower rate- in
the third and fourth urade children. ()O i -ptiradic cast es
ha\o been noted beyond the fourth rade (Tahle 1). \nall-
"i- of individual classroom outireak- iohl t\ed thal cases
continuoitd to occur foror2 or iimotrer, ont following lthe
initial classroom ca>e. Data al-o -ho\%ed that clinical
niutips d1, -elolet d in 29 per OenT of the mahil- and ii i7
percent of thel femiiales- In tlhe 2 hool-.

Ca('ais, ha\o no\io been nowie ino 7 of the N remaining
grade, -rtools (Figure 1), i.n: ludtino -2; cio- in t a) shing-
tlon -thool. (Clin 'al ilnt 4-?se hIa e il u n plipcal and il d.
itlh school ah.-eni e a\ i rainit I to .i dal per child. No
-eoriout- ioti phl atiin- or fatalitie- hav b, Itn reported Ito


DECEMBER 16, 1967





DEC('LMBIR 16, 1967


Morbidity and Mortality Weekly Report


A reoies of ph\sl ian reporlod cae., of mump- int
Mason County since 19)0. sho\\s a pattern of l- ear cycles
with the mo(st recent lwak- il tille sprng, of' 1960 anod 1061.
.A1 county grade ilchools \ere inaol\ed in these 2 epi-
dlemics. In contrast, cas I for 1967 were first reported by
physicians in June (2 cases) ithi the highest number
being reported in (),ol)cer (11 A;ses). \ detailed epidemi-
ologic investigation l of the cIrrInt outbreak is in progress.


(/epor/ld by J/amn lt's ill// Il.P.l ., Ad/ miniistra/t r, Cr. tinl
('Iounty HaI u//h )pf ir/n/ nt, fan/, ('(oi /nt/0, I Kenta.s' 'y;
(. llcrnaimi ('z, M1.)., fl'.P .. )irrct/r, )i vision of Epi-
demiolohgy. Ke'tlicky Stal/ D0parlment of li'alli;: and 2
EIS Officers.)


Figure 3
CASES OF MUMPS IN SCHOOL CHILDREN
BY DATE OF ONSET TOTAL OF NINE SCHOOLS
Mason County, Kentucky August 26, 1967


Table 1
Mumps Attack Rate by Grade
Orangeburg and Woodleigh Schools
Mason County, Kentucky
August 26-December 16, 1967

Attack Rate (Percent)

School (enrollment) Grade

1 2 3 4 5 6 7 8

Orangeburg (416) 54 40 17 30 2 12 3 11

Woodleigh (344) 41 26 17 13 3 2 -


Figure 4
CASES OF MUMPS IN SCHOOL CHILDREN
BY DATE OF ONSET IN EACH OF NINE SCHOOLS
Mason County, Kentucky August 26-December 16, 1967

MAYSLICKn


i-i


61V WARD


m R


MINERVA




LEWISBURG




FOREST AVE




WASHINGTON







ST PATRICK'S




WOODLEIGH






O2
ORANGEBURG





-2
.0 t i





::: :_ -4


WEEK OF ONSET


DEoC | Fc B .


MALARIA Blood Transfusion Induced Cases


Between August and No\ember 1967, three cases of
blood transfusion induced malaria waere reported to the
Malaria Surveillance Unit,.
Case No. 1: In May 1967, a 55-year-old woman, a resident


of Hungary. came to the United States for treatment of
idiopathic thrombocytopenia. Her illness wlas diagnosed
in 1955; she had a splenectomy in 1956. and had been
(C('otitnued on page 422)


,o li~
iln ria
968


WFF1 OF ONSET














treated with corticosteroids since 1961. Following her
arrival. she was admitted to a New York City hospital.
Between June 5 and 20, she received platelet transfusions
from 1-21 donors and 7 units of whole blood. On July 6,
she developed a temperature of 106F. and shaking chills.
Examination of peripheral blood smears on July 7. showed
Plasmodium orale parasites. The patient responded favor-
ably to chloroquine. hut died 2 weeks later from thrombo-
cytopenia.
The patient had no history of malaria, and allegedly
had not resided in malaria endemic areas. Examination of
sera from the blood and platelet donors, showed one donor
whose serum contained fluorescent antibodies against all
4 human Plasmodium species in a dilution of 1:S0. indicat-
ing past malaria infection from an undetermined species.
This Nigerian male. however, did not recall having had
malaria. Blood smears from this man on 2 subsequent
dates, did not contain malaria parasites.
Case No. 2: On August 5, 1967, a 29-year-old white female.
resident of Jacksonville. traveled b5 air to Mexico City.
The next day, she developed appendicitis and underwent
an appendectomy, receing 1 unit of blood during the
operation. She returned to Jacksonville on August 10. and
developed chills and fexer on August 14. These symptoms
recurred periodically for 3 weeks when P. malaria para-
sites were detected on a peripheral blood smear. She re-
sponded favorably to chloroquine therapy. She had no
prxe ious history of unexplained episodes of fe er, and had
never been outside the United States or Canada prior to
August 5.
Case No. 3: On November 1, 1967. an h-month-old white
female infant x\ith a 5-month history of recurrent fevers
Sas admitted to a New Haven. Connecticut hospital. The
infant (as born on February '5. following a normal preg-
nancy and delivery: she received 2 unit- of whole blood
during the first ;- i hours of life because of Rh incompati-
bility. She was healthy until 3 months of age when she
deeloped episodes of lo\\ grade foe\r. These recurred
until age 6 month, wxhen her temperature increased to
1(0^F. She was hospitalized on September 15. in Bristol.
Connecticut. Ph.i -ial examination rex\aled that the infant
had hepattoplenomegaly. Culture and bone marrow studies
were- reported negatix The infant wxas discharged 1 \\eek
later. She was afebrile for the follow ing :3 weeks, then
high flxer recurred. TIhe infant % as rehospitalized. Anti-
bodic treatment w\as ineffectic and she w as transferred
to a New llax\ n hospital for further valuation.


DECEMBER 16, 1967


Physical examination revealed a well-developed,
febrile, lethargic child with hepatosplenomegaly. Multiple
laboratory investigations were normal except for a sedi-
mentation rate of 27. An open liver biopsy and spleno-
portagram were performed; no gross abnormalities of liver
or spleen were seen. Liver histology was normal except
for slightly swollen Kupffer cells containing dark pigment.
The presence of this pigment prompted examination of
peripheral blood smears in which P. malariae were found.
The patient was given chloroquine. and her fever defer-
vesced completely within 36 hours.
The patient had never been outside Connecticut. and
her parents had no history of malariaor travel to malarious
areas. The two persons who donated blood for the exchange
transfusion were identified, and their sera examined. The
first donor, a 31-year-old Greek male, arrived in this coun-
try from Sparta. Greece, in 1966. He had no history of un-
explained fe\er episodes, and his serum contained no
fluorescent antibodies against malaria. The other donor.
a 32-year-old male from Oaxaca, Mexico, came to Connecti-
cut in 1956 where he remained except for a brief visit to
Mexico City in 1963. He had no history of malaria or un-
explained fever episodes. Peripheral blood smears did
not contain malaria parasites, but his serum contained
fluorescent antibodies against malaria (P. malaria and
P. tira.r 1:160: P. orale 1:80: and P. falciparum 1:I1ii
(/Reported by Howard B. Shookhuoff. chief )Divisiii of
Tropical Di)seases. ,te' York City Health Department;
L. .1. If. achtcl, .II.. Jacksounrilc. Florida; K. (harlton
Prathlr, M1.I)., t.P.tt.. Director. Division of Epidemiology,
Florida State Board of Health; U1r. David Barry, /ledicial
Student, Yale Unirersilty School of fiedicine: ani Barbara ('.
'Christir., 1.0.. I(.P.I.. Chief, Epider iiouloy Di ision.
Coinniicticint State' Departmtint oxf Ilula/.)

Editorial Comment:
Case 1 is the first transfusion induced P. o rate infection
reported to NCD('. Case 2 developed her malaria 9 da.\
after her arriIal in Mexico. This internal is too short for
mos-quito transmitted P. malaria infection. but is com-
patible with transfusion induced infection. Inestitiations
are continuing to identify the donor. It is noteworthy that
the donors in casess 1 and 3 did not haxe a past history
of malaria despite the positive serologic findings. lHow-
ieer, both were natives of malarious areas. They may
have been infected early in life and acquired sufficient
itmmunitl to allou asnimptomatic parasitemia.


SURVEILLANCE SUMMARY
MALARIA 1967

Epidemniolo- inform attion a rcei\le on- ,: ttt a-- to N itember 1.. 1967,7 bh te Malaria SurxMillance Unit.
of mialarin \\ itth on et in the Uniit 'd Sta.it- from .ainuary I Of itht ,- 2 171 I ,-t- o wore in sori', iom n wiho acquired


Morbidity and Mortality Weekly Report




MALARIA Blood Transfusion Induced Cases
(Continued from page 421)










infection in Vietnam (Table 2). Only seven of the 2,303
cases acquired infection in the l'nited State-: three blood
transfusion induced cases (\MMI\,RI, Vol. 16, Nos. 15 and
the present issue): two introduced cases (MM\R, Vol. 16.
No. 2:I: one cryptic case (MMWIi Vol. 16. No. :;); and
one congenital infection (MM\1 ., Vol. 16, No. ,7).*
The Plasmodium species was identified in 97.3 per-
cent of all cases (Table :).
Table 2
Cases of Malaria, United States
1962-1967*

Military
Year Acquired in Acquired Ci t ian Total
Vietnam ElI \ where
1962 0 75i 1- 119
1963 7 51 90 14s
1964 14 :,s 119 171
1965 3.5 1i I105 156
1966 5b35 25 137 247
1967** 2,174 20 109 2.303

'Through November 1-. i1!tiT
*'Inr lud( rec-ntl (iix i < ariii I ran-.


Table 3
Cases of Malaria by Plasmodium Species
United States, Jan. 1-Nov. 15, 1967

Species Military (iilian Total Percent

P. vicaar 1.h27 71 1,9hI 2.5)
P. falciparuin 267 17 2'hl 12.,
P. malaria S 1 12 0.5
P. orale I 11 11 0)..
Mixed infections 3, 0 3i. 1.5
Inknow n )7 63 .7

Total 2,194 109 2,3103 100.



'Maloria Terminology

tracrtd from :mn inlort il .,t i .i .i tr' l r ii.ii.it-Lt i- i t
r'euii tr occurron ',.
Induc(-d m0l.1 ri't .gust d thr uc, ,rtif, i r-I m >
therapy bI l-ld t ran -fu-- 1 n, P. iITn M T %i i :-.

(rpu tie an i\,ilat ai I ii alo T t d \ ith
e( ind erti iu t t 'i h hr-pwrh
oloic int -stieation.


CURRENT TRENDS
MEASLES United States


For the week ending December 16 (aweek 50). 425 cases
of measles were reported to N('D(. Although there has
been an increase in moeasls- cases reported during the
last 2 weeks, the cases reported are less than one-third
of the reported cases in these \weeks a year ago.
For the 4-week period. Nmon hrer 5 through Decem-
')er 2 weeks s 45-48), 21 countries or health districts reported


a total of ten or more cases of measles from 291 reporting
areas. During the comparable period in 19i66. 94 counties
reported a total of ten or more cases from 432 reporting
areas. Figure 5 indicates the reporting counties or health
districts in these two periods. It is interesting to note
that 19 of the 21 reporting areas for this period in 1967
include a large metropolitan area.


Figure 5
COUNTIES OR HEALTH DISTRICTS REPORTING A TOTAL OF
10 OR MORE CASES OF MEASLES IN 4-WEEK PERIOD


NOVEMBER 6-DECEMBER 3, 1966


At ,--




$4


* q


NOVEMBER 5-DECEMBER 2, 1967


I-


1


5-.
4


DECEMBER 16, 1967


Morbidity and Mortality Weekly Report


t *
I


r


rr:






424 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 16, 1967 AND DECEMBER 17, 1966 (50th WEEK)


ENCEPHALITIS HEPATITIS

ASEPTIC Primary
AREA MENINGITIS BiHt.1LOSIS DIPlHTHERIA including Post- Serum Infectious
unsp. cases ecous
1967 1966 1967 1967 1967 1966 1967 1967 1966 1967 1966
UNITED STATES... 35 33 4 2 27 29 14 62 44 734 714

NEW ENGLAND........... 3 1 1 1 38 20
Maine.............. 2 2
New Hampshire...... -
Vermont............ -
Massachusetts...... 3 1 7 9
Rhode Island....... 7 1
Connecticut........ -- I 22 8

MIDDLE ATLANTIC...... 2 3 4 12 2 22 25 132 142
New York City...... 1 6 19 10 48 22
New York, up-State. 3 2 3 44 23
New Jersey.......... 1 1 4 1 12 13 12
Pennsylvania....... 2 1 2 2 27 85

EAST NORTH CENTRAL... 2 5 2 7 7 4 4 2 132 129
Ohio............... 2 5 1 35 18
Indiana ............ 1 8 11
Illinois........... 1 2 1 2 1 4 2 59 24
Michigan........... 2 3 1 2 21 59
Wisconsin.......... 1 1 9 17

WEST NORTH CENTRAL... 2 1 4 41 65
Minnesota........... 1 4 14 14
Iowa................ 7 3
Missouri........... 1 --- 9 36
North Dakota ....... 7 1
South Dakota ...... -
Nebraska........... I -
Kansas............. 3 11

SOUTH ATLANTIC....... 4 6 2 1 1 2 50 71
Delaware.........- 2 -- 6 1
Maryland........... 1 10 21
Dist. of Columbia.. -
Virginia.......... 3 2 0 15
West Virginia ..... -- 6- 8 6
North Carolina .... -- I 1 1 7
South Carolina.... 1 2
Georgia............ -- 9 11
Florida........... 1 3 -- 5 7

EAST SOUTH CENTRAL... 2 4 2 3 75 54
Kentucky........... 40 22
Tennessee ......... 1 2 3 17 12
Alabama............. 4 11
Mississippi........ 1 2 2 -- 14 9

WEST SOUTH CENTRAL... 2 3 2 3 3 2 2 72 50
Arkansas............ 2 4
Louisiana.......... 1 1 2 1 2 19 9
Oklahoma........... 2 5 5
Texas........... .... 3 -1 1 1 I- 46 32

MOUNTAIN .......... 1 40 49
Montana............. 4
Idaho.............. 8
Wyoming............. -
Colorado........... 16 1
New Mexico......... 10 24
Arizona ........... 6
Utah............... 9
Nevada............

PACIFIC............ 20 10 8 3 4 33 10 154 134
Washington ............ 8 1 8 13 I
Oregon ............. 7 12
California......... 10 7 3 4 26 10 129 94
Alaska ............
Hawaii........... 2

Puerto Rico -- 28 14









Morbidity and Mortality weekly Report 125


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITEI) STATES

FOR WEEKS ENDED

DECEMBER 16, l196 AND ID(CIMBER I', 196 (50th WEIIK) CONTINI I:l)



MALARIA AE (Ru MENINGOCOCCAL INFECTIONS, LIO Ill
MALARIA MEASi.ES (Rubcol0a) 1 TOTAL POLIOMYELITIS RUBEI.A
AREA .. .... .. l
Cumulative Cuinu la ive T


UNITED STATES... 36 425 h6,537 .00, 8 43 2,07. 1,288 4 1

NEW ENGLAND.......... 3 938 2,57 1 82 151 58
Maine.............. 6 97 12 10
New Hampshire...... 7 80 I 4 9 1
Vermont ............ -45 1 4
Massachusetts...... -2 35 t6 37 62 8
Rhode Island ....... 2 75 6 21 4
Connecticut ........ i 9 939 31 43 4

MIDDLE ATLANTIC...... 5 42 2.559 18,530 11 348 434 5 33
New York City...... 1 6 510 8,172 5 67 65 1 13
New York, Up-State. 1 12 641 2,656 2 84 114 1 13
New Jersey......... 16 611 2,006 3 113 132 6
Pennsylvania....... 3 8 787 5,496 1 84 123 3 1

EAST NORTH CENTRAL... 2 138 6,228 70,321 7 286 521 6 92
Ohio............... 1 1.202 6,456 94 151 9
Indiana............ 13 669 ,817 31 88 8
Illinois........... 74 1.2 9 11.535 5 66 93 17
Michigan........... 2 9 1,026 15,120 2 74 135 3 28
Wisconsin.......... 21 2.192 31,393 21 54 30

WEST NORTH CENTRAL... 4 42 2,997 9,289 6 100 170 3 31
Minnesota.......... 3 139 1,684 1 22 36 4
Iowa............... I 32 816 5,451 3 22 22 23
Missouri........... 340 539 2 21 65
North Dakota....... 4 890 1,389 3 11
South Dakota....... 58 40 7 6
Nebraska........... 3 660 186 15 11 3
Kansas ........... .. 1 )4 NN 10 19 2

SOUTH ATLANTIC....... 8 52 7,347 16,141 7 406 558 2 63
Delaware........... 51 267 8 7
Maryland........... 1 2 180 2.125 1 56 49 1 30
Dist. of Columbia.. 25 390 15 15
Virginia........... 11 2,326 2,265 2 45 70 3
West Virginia...... 14 1,477 5,542 38 44 -15
North Carolina..... 6 8 935 738 86 142 1
South Carolina..... I 1 514 664 1 33 55
Georgia............ 42 243 1 60 77
Florida............ 16 1,797 3,907 2 65 99 -- 15

EAST SOUTH CENTRAL... 1 22 5,509 20,704 4 166 283 2 9
Kentucky........... 2 1,432 4,852 2 47 97 -
Tennessee.......... 20 2.043 12,684 1 73 95 8
Alabama............ 1,357 1,807 29 62 -
Mississippi........ I 677 1,361 1 17 29 2

WEST SOUTH CENTRAL... 1 48 18,126 26,954 4 259 439 10
Arkansas........... 1,404 1.168 41 37 1
Louisiana.......... 156 103 3 102 166 1 -
Oklahoma............ 1 3,359 659 18 23 -
Texas.............. 48 13,207 25,024 1 98 213 7 -

MOUNTAIN.............. 9 25 4,895 12,614 40 94 27
Montana ........... 3 134 1,913 5 5
Idaho............... 6 405 1,703 3 5 -
Wyoming............ 2 204 235 1 6 4
Colorado........... 7 6 1,632 1,431 13 49 7
New Mexico......... 1 1 607 1,232 5 10 -
Arizona............. 1 6 1,059 5,370 6 13 15
Utah............... 1 385 665 4 1
Nevada............. 269 65 3 5 -

PACIFIC............... 6 53 12,938 23,655 5 385 638 99
Washington.......... 3 20 5,674 5,177 1 38 58 46
Oregon............. 4 1,706 2,527 30 42 3
California.......... 3 29 5,235 15,151 4 302 516 46
Alaska............. 141 636 11 18 4
Hawaii............. 182 164 4 4


Puert Rio 2 .242 _


Puerto Rico.


2,242









126 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 16, 1967 AND DECEMBER 17, 1966 (50th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABI 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... 10,277 7 223 6 165 4 393 297 48 4,048

NEW ENGLAND.......... 1,038 3 1 10 1 1 104
Maine............... 25 24
New Hampshire...... 18 48
Vermont ............ 50 25
Massachusetts ...... 214 1 6 1 1 5
Rhode Island....... 138 1 2
Connecticut........ 593 2 3

MIDDLE ATLANTIC...... 338 16 1 40 35 3 100
New York City...... 6 9 21 -
New York, Up-State. 296 1 11 9 3 84
New Jersey......... NN 1 4 15
Pennsylvania....... 36 5 4 11 16

EAST NORTH CENTRAL... 997 1 27 15 1 43 22 4 376
Ohio............... 228 4 1 15 11 131
Indiana............ 155 3 -2 11 1 2 86
Illinois........... 261 13 13 7 10 71
Michigan ........... 223 1 6 8 1 24
Wisconsin.......... 130 1 2 1 64

WEST NORTH CENTRAL... 631 1 17 1 23 21 4 9 955
Minnesota.......... 23 1 6 2 1 2 191
Iowa................. 220 2 1 2 3 5 133
Missouri........... 2 7 9 10 1 2 172
North Dakota....... 92 166
South Dakota....... 59 1 2 116
Nebraska ........... 176 4 2 70
Kansas ............. 59 I 10 2 107

SOUTH ATLANTIC....... 1,047 1 47 1 12 63 119 1 476
Delaware........... 8
Maryland.......... 135 2 21 4
Dist. of Columbia.. 3 6
Virginia ........... 300 10 1 2 9 28 205
West Virginia...... 247 -1 2 2 1 62
North Carolina..... 15 1 8 4 47 3
South Carolina..... 30 1 2 10 -5 2
Georgia............ 19 4 5 21 17 1 116
Florida............ 293 23 1 -12 78

EAST SOUTH CENTRAL... 1,677 33 1 13 1 65 53 16 778
Kentucky........... 114 4 -2 24 15 4 177
Tennessee........... 1,276 8 1 8 1 12 26 11 540
Alabama ............ 143 I- 1 I 12 12 1 51
Mississippi........ 144 10 2 17 10

WEST SOUTH CENTRAL... 728 3 54 3 83 1 43 43 7 902
Arkansas........... 8 6 1 48 1 13 14 1 113
Louisiana.......... 4 8 17 2 2 70
Oklahoma........... 19 4 2 0 8 16 1 354
Texas............... 701 3 40 7 5 11 3 365

MOUNTAIN. ............ ', 180 j 11 1 22 2 115
Montana ............ 34 2 2
Idaho............... 283
Wyoming.......... 269 2 1 5
Coloriado ........... 1,138 2 1 12 9 10
New Mexi ............ 169 -1 1 34
Ar i zona ............. i I 4 2 54
Utah ............... 148 3
Nivada ............. 9

PACIFIC. ........... 1,641 2 6 86 5 242
W s hington ......... 458 2 2 2
Or iR n............ 162' 1 1 3 3 4
Calii flnri. ........ )26 I 18 3 78 6 5 236
Alaska ............2 -
Hlitw i i .............. 63 3 -

Puerto Rico ......... 9 18 8 3 35








Morbidity and lMortality We ekly Report







DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED I)DCEMBER 16. 196'


(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 years and 1 year
g 1 Influenza All Influcnza Al
Ages and over Influens As 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.--------


800
248
48
28
32
64
31
14
32
45
65
16
46
41
70

3,574
39
43
153
44
40
45
59
94
1,862
40
534
199
60
109
22
44
55
54
44
34

2,823
68
37
877
151
212
92
95
450
45
59
38
35
64
153
30
144
40
29
43
111


827
60
14
70
128
21
100
72
246
50
66


493
139
27
20
25
36
21
.'3
23
22
40
14
36
23
44

2,120
25
32
92
27
23
19
33
53
1,085
20
337
97
47
66
12
30
33
31
34
24

1,626
39
27
471
80
124
49
51
261
31
32
25
16
46
90
15
99
23
21
26
30


509
41
11
37
83
15
62
46
140
32
42


SOUTH ATLANTIC:
Atlanta, Ca.------------
Baltimore, Md.---------
Charlotte, N. C.-------
Jacksonville, Fla.-----
Miami, Fla.------------
Norfolk, Va.-----------
Richmond, Va.-----------
Savannah, Ca.----------
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.-----------


1,266
128
275

70
116
66
119
37
85
72
211
49

650
11
46
39
130
151
65
35
73

1, 150
50
28
37
168
24
85
199
57
169
81
136
58
58

416
42
30
118
16
81
22
64
43

1,592
20
54
32
53
73
457
97
46
120
51
105
176
35
175
58
40


Total 13,098 7,615 484 623

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 616,464
All Causes, Age 65 and over------------------- 352,168
Pneumonia and Influenza, All Ages------------- 21,575
All Causes, Under 1 Year of Age---- -------- 31,204


Week No.


*Estimate based on average percent of divisional total.










428 Morbidity and Mo





INTERNATIONAL NOTES
QUARANTINE MEASURES


Ali / ional Ilmm uni/tioli //tlnformatlio/n for 1tcr/ / diolI//
Trure'/-l)19'7-Rt8 litio ri-Pit/, i Htlraltl/ Srroirr e Pili/li ralion
\X. 3l.'


Section 5
AFRICA
Malawi -Page 31

UInder cholera add: and from India and Pakistan.*


Somalia (Northern and Southern)- Page 34
I'ndi r y o llo\ fI' er. insert the following information:
Yellow fec(,r \alcination is required of all arriIals from
infected area.l No (.'rt ificate i- required for travelers \ho
arri\o in and remain in BerhbOra or Hargoisa.


United Arab Republic Page 38
Add to the pro\ ious cholera Information: and from Burma.
East Paki-tan. India, Indonesia. Mainland China, Nepal,
Philippines. Thailand. and1 Vietnam.* The certificate re-
cording the negative results of stool culture must he is-
sued h\ a licenedt laboratory and attested to bI the health
authority.'


ASIA


Iran Page 56
In the note concernin cholera, deltce: Iraq.
Thailand.




S*l o'tn ilrn lr .I-. d 1 m t- ur- E Ith tin1 R' tfiiltliti.-
lp.' n 1' alu '-.tson, .Ind lh,' \ rid I -'.ilth ()I n. ion I
imuni i ti

Insert:





may\ b. *
inl r< mi-


ERRATUM, Vol. 16, No. 49, p. 416.
In the article "Measles-Chicago." (Reported hI
Samuel I,. Andelson. M.D.. M.P.H., -hould lIe corrected to
rad :
(Reported bY Samuel L. \ndolman, M.D.. M.P.IL.)


reality Weekly Report


DECEMBER 16, 1967


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION OF I7,000. IS PUBLISHED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER, ATLANTA, GEORGIA.
DIRECTOR, NATIONAL COMMUNICABLE DISEASE CENTER
DAVID J. SENCER, M.D.
CHIEF F N r' Y PROGRAM A.D. LANGMUIR, M.D.
ACTING "' IS r TICS 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
S7 '.i i. DISEASES. SUCH COMMUNICATIONS SHOULD BE
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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