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:
AA00010654:00028

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


U.S. DEPARTMENT OF HEALTH, E ND WELFARE

BUREAU 0 EVENIlT ONMENTAL CONTROL


Vol. 16, No. 43







Week Ending

October 28, 1967



PUBLIC HEALTH SERVICE


INTERNATIONAL NOTES,., CONTINENT
NI -E's 1 o'N
OBSCURE DISEASE RELATED TO AFRI AN MONK EYS ....... es d to African Monkey
Identification of Agent I fications of Ag nt . . .361
S Information for International
.- 3S4 . . .. ..36S
Further information regarding the 1. i i. NoteI and Report
N\, urveillance South Texas . .362
agent, responsible for the obscure dise .. I ,. ... -- ellosis Philadelphia. Pa . . .
green monkeys has been released front i. 1, it phthe -ri-a bama .. . . .363
Research Establishment in Porton. Erngland. create small pleomorphic structures either in the form of
HISTOLOGY: Liver larger spheres or smaller almost bipolar granules. The)
The early passage guinea pig livers contained no ob- were as a general rule basophilic and stained a dark pur-
vious degenerative or inflammatory changes. Single cells ple with H & E and reddish-purple with Giemsa. In see-
or groups of 2 or 3 cells could, however, be found scat- tions treated according to \Mahia\ ello. the granules stained
tered about the liver and were found to contain varying bright red. Feulgen preparations revealed Feulgen-positive
amounts of granules. These granules were either clumped material in the cytoplasm in the same situation as the
together to fill the whole cytoplasm or appeared as dis- (Continued on page 362)

CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
43rd WEEK ENDED CUMULATIVE, FIRST 43 WEEKS
MEDIAN
DISEASE OCTOBER 28, OCTOBER 29, 1962 1966 MEDIAN
1967 1966 1967 1966 1962- 1966
Aseptic meningitis ................... ..... 89 53 53 2,487 2,515 1,770
Brucellosis.............................. 4 1 5 208 210 311
Diphtheria. .......... ... ............. 5 7 9 122 165 216
Encephalitis, primary:
Arthropod-borne & unspecified .......... 47 49 -- 1,358 1,832 --
Encephalitis, post-infectious .......... 10 7 -- 679 637 -
Hepatitis, serum ................ ... 47 30 1.809 1,158
Hepatitis, infectious .................... 741 721 751 31.779 26,442 31,753
Malaria ............................... 54 17 1 1,687 385 81
Measles (rubeola)............. .. ........ 299 731 1,061 59,362 192,862 363,933
Meningococcal infections, total ........... 27 40 41 1,855 2,940 2,297
Civilian ............................ 26 40 -- 1,737 2,659
Military....... ... ............ 1 -- 118 281 -
Poliomyelitis, total ................ .- 5 5 26 82 98
Paralytic.............................. 5 5 21 77 78
Rubella (German measles) ................ .285 254 41,272 43,074 -
Streptococcal sore throat & scarlet fever 7,372 6,541 5,977 367,684 345,833 322,911
Tetanus ................................ 3 1 7 186 161 228
Tularemia.............................. 3 6 7 150 152 241
Typhoid fever .......................... 10 6 6 352 327 371
Typhus, tick-borne (Rky. Mt. spotted fever) 1 3 2 292 229 215

Rabies in animals ......... ....... 42 79 61 3.604 3,427 3,427

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: .................. ....................... 2 Rabies in man: .. ....... ................. .... ..... ....... 2
Botulism: ........................................... 2 Rubella, Congenital Syndrome: ...... ....... ... 5
Leptospirosis: ....................................... 33 Trichinosis: N.Y.C.-1 .. .......... ... .. 52
Plague: ..................................... ...... 2 Typhus, marine: Ark.-1, Tex.-2 ....... ... ... ...... 38
P sittacosis: ...................................... 38 P olio. U nsp. .......... ....... 5
Excludes report from Nevada, State holiday.














granules in H & E preparations. The granules were also
PAS positive and stained brown with Von Kossa's method.
After hydrochloric acid treatment, however, Von Kossa's
reaction was negative, but when the same sections were
counterstained with H & E, the granules were found un-
damaged within the cells and staining a dark purple color.
In guinea pigs of the 3rd and 4th passage, small focal
necrotic lesions could be found in the liver. In some livers,
these necrotic areas were often confluent and formed
sharply circumscribed areas. Usually no granules were
found in the centre of the completely necrotic liver cells,
but comparatively large numbers of granules were found in
the cells surrounding the periphery of the necrotic zones.
In cells undergoing early degeneration without changes in
the nucleus, the cytoplasm appeared to contain small num-
bers of discrete granules.
No characteristic lesions have been found in any other
organ except that reticulo-endothelial cell proliferation
was very marked in lymphoid tissue.
HAMSTERS
One-day-old hamsters inoculated either IP or IC with
5th passage guinea pig blood taken in the febrile stage
became sick on P.I.D. 9 and 10. Tissues have been re-
moved for histology and also have been further passage
in suckling hamsters.
GUINEA PIGS
Infective guinea pig blood does not infect guinea pigs
through intact skin. nor does the disease spread from in-
fected to uninfected guinea pigs in the same cage.
ANTIBIOTIC SENSITIVITY
Seven groups of guinea pigs were used in the experi-
ment. Five groups, (a), (b), (c), (d), and (e). were inocu-
lated with infective guinea pig blood on Day 0.
Group (a) received terramycin (12.5 mg/day) starting
Day 0.
Group (b) received chloramphenical (37.5 mg/day)
starting Day 0.
Group (c) received terramycin (12.5 mg/day) starting
Day 4 (i.e. when guinea pigs were febrile).
Group (d) received chloramphenical (37.5 mg/day)
starting Day 4.
Group (e) remained as infectivity controls.
The two remaining groups, (f) and (g), were antibiotic
controls, (f) receiving terramycin and (g) receiving chlor-
amphenical daily in the doses shown above.


OCTOBER 28, 1967


Neither terramycin nor chloramphenical prolonged the
course of the illness although guinea pigs treated with
both antibiotics had lowered temperatures. Antibiotic con-
trol guinea pigs remained well. After a week's course of
antibiotics, these same antibiotic control guinea pigs were
infected experimentally and antibiotics continued. They
remained afebrile but the course of the illness was not
prolonged and they died on P.I.D. 9.
TISSUE CULTURE
Two continuous vervet monkey kidney cell lines
(VERO) and BHK21 have been inoculated as cover-slip
preparations with infected guinea pig material and exam-
ined after fixation in formol saline or methanol at various
intervals after infection. VERO cells have shown no changes
so far but BHK21 cells have developed a peculiar vacuoli-
zation and small bodies have been seen. More work is un-
der way following this observation.
SEROLOGY
Convalescent sera from febrile guinea pigs and pa-
tients have been tested against rickettsial pox, typhus,
and Rocky Mountain spotted fever antigens in a comple-
ment fixation test. All were negative at dilutions of 1/5.
Convalescent (19 day) sera from febrile guinea pigs
were tested in a haemagglutination-inhibition test against
Semliki Forest, Sindbis, Chikungunya, Japanese encepha-
litis, Dengue 1, Dengue 2, Tembusu, Langat, West Nile,
Yellow Fever, Louping-ill, Bunyamwera, and Tahyna anti-
gens and all were negative. An antigen prepared from in-
fective guinea pig spleens was tested against these same
sera in a complement fixation test. The sera were slightly
anticomplementary but appeared to fix complement. This
is being confirmed.
Immune guinea pig serum has been tested against psit-
tacosis antigen in a complement fixation test. The results
were negative. Known psittacosis antiserum was also
negative when tested against an antigen prepared from
spleen of infected guinea pigs.
FILTRATION
The infective agent does not pass through gradocol
membranes up to average pore diameters of 340 mr. Results
of filtration using larger pore sizes are not yet available.



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


EPIDEMIOLOGIC NOTES AND REPORTS
ENCEPHALITIS SURVEILLANCE South Texas


Following extensive flooding in the Rio Grande Val-
ley in Texals, sharp increases in mosquito populations
were reported from that, area. Several species have been
detected including Culexr tarsalis, the principal vector of
Western Equine Encephalitis (WEE). Of 60 pools of C.tar-
Halis thus far subjected to viral isolation procedures, one
yielded WEE virus. Other encephalitis viruses have not
been detected in these mosquitoes.


In addition to local spraying programs, extensive
aerial spraying utilizing the ultra low volume Malathion
technique has been carried out. Low-flying airplanes have
distributed 3 fluid ounces of 95 percent Malathion per acre
in particle size of 50-60 micra. A marked decline in mos-
quito counts subsequently occurred.
Two cases of encephalitis in horses were diagnosed
clinically in Cameron County in early October; one of


Morbidity and Mortality Weekly Report



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











these was fatal. Acute serum from that horse revealed a
hemagglutination inhibition titer of 1:160 against WEE
virus. No cases of human arbovirus encephalitis have been
confirmed, though several suspected cases were individ-
ually investigated as part of the intensive surveillance
program.


363


(Reported by Aedes aegypti Program, NCDC: IVan C. Tipton,
M.D., Director. Division of Communicable Disease Control, Pre-
ventive lledical Services. and J. Irons, Sc.D., Chief of Labo-
ratories, Texas State Dept. of Health: NCDC Ecological Inves-
tigations Laboratories. Ft. Collins, Colorado: l450flt Special
Aerial Spray Flight, TAC, U.S. Air Force; and an EIS )


SHIGELLOSIS Philadelphia, Pennsylvania


On October 16, 1967, the Epidemiology Division of
the Philadelphia Department of Health was notified of an
outbreak of gastroenteritis at a small private college. Of
the 594 students and 107 staff members, 180 persons be-
came ill between October 14 and 23; 84 percent experi-
enced onset on October 15 and 16 (Figure 1). Symptoms
consisted of stomach cramps, severe diarrhea, dizziness.
fever up to 104oF., and malaise. Duration of illness was
from 2 to 7 days.
Most of the 436 students who resided at the college
ate all their meals in the college cafeteria; it was not
possible to incriminate any one meal as a common source.
Following an alumni banquet held at the school on Octo-
ber 14, at least 20 of 258 guests subsequently became ill.
However, three students who did not eat at the college on
October 14 or 15 became ill. A few students and staff
members who rarely ate meals at the college also became
ill; they indicated that they did drink from water fountains
in the school. The only factor in common to all those who
became ill is the consumption of water, or food which had
been prepared using water, from the school water system.
Investigation of the water system revealed that a
waterline had broken in the kitchen on October 8, result-
ing in the flooding of the kitchen and cafeteria. Cross-
connections were found between the sewage and fresh water
system which could have resulted in backflow of sewage
into the fresh water system as a consequence of the tran-
sient negative pressure during the break in the waterline.
From rectal swabs taken from 152 ill persons, 100
bacteriologic cultures yielded Shigella sonnei. Rectal
swabs were also obtained from 316 students and staff mem-
bers who were not ill; 13 cultures yielded S. sonnei. Water
samples taken on October 18 yielded 5 E. coli per 100 ml;
no shigellae were isolated from the water.
It was concluded that the outbreak probably resulted
from the presence of S. sonnei in the water system for
1 or 2 days. The inoculum would have to have been of suf-
ficient size to overcome the chlorine in the water. Foods
such as fruit drinks and gelatine puddings which were pre-


Figure 1
SHIGELLOSIS OUTBREAK PHILADELPHIA, PA.
ONSET OF SYMPTOMS OF 189 PATIENTS
OCTOBER 14-21, 1967


5-
05

40
a 40

Z


13 14


15 16 17 18 19 20 21 22 23 24


pared using this water on October 9 or 10 could have led
to further exposure when served later in the week.
(Reported by Lewis D. Polk, M.D., Deputy Health Commis-
sioner, Community Health Services; Kristine S. Knisely,
M.D., Senior Physician, Division of Health Production;
Alfred Bogucki, M.D., Director, Division of Epidemiology;
Sylvan Fish, M.D., Chief, Communicable Disease Control;
Browne C. Lucas, P.E., M.P.H., Chief, Environmental
Engineering Section, Division of Environmental Health,
all with the Department of Health, City of Philadelphia,
Pa.; and an EIS Officer.)


DIPHTHERIA Alabama


In addition to the 14 diphtheria cases including two
deaths recently reported from Alabama (MMWR, Vol. 16,
No. 41), four more confirmed cases, two of which were
fatal, were reported to the Alabama State Department of
Health. One case occurred in a 1-year-old Negro female
from Dallas County, one case in a 7-year-old Negro female
from Mobile County, and two fatal cases in a farm family


from Thomaston, Alabama. The latter cases lived in Ma-
rengo County which is due west of Dallas County, the
site of 11 of the 14 previously reported cases.
The first recent death was in a 6-year-old unimmu-
nized Negro child who expired on October 26, 1967. The
child's 42-year-old mother died the following day. Both
(Continued on page 368)


OCTOBER 28, 1967


Morbidity and Mortality Weekly Report


.m P=








364 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
OCTOBER 28, 1967 AND OCTOBER 29, 1966 (43rd 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... 89 53 4 5 47 49 10 47 30 741 721

NEW ENGLAND.......... 1 5 2 1 32 33
Maine.............. 2 5
New Hampshire...... -
Vermont.............
Massachusetts...... 4 1 -- 13 16
Rhode Island....... 1 1 -
Connecticut ........ 1 16 12

MIDDLE ATLANTIC...... 29 5 4 11 20 11 108 137
New York City...... 3 2 1 8 18 7 41 40
New York, up-State. 1 2 1 14 34
New Jersey......... 23 1 1 1 3 27 32
Pennsylvania....... 2 2 3 1 26 31

EAST NORTH CENTRAL... 6 6 1 19 5 1 3 125 111
Ohio................ 15 2 31 22
Indiana............. 3 1 18 6
Illinois........... 2 2 2 1 18 28
Michigan............ 5 1 1 3 53 46
Wisconsin.......... 1 1 5 9

WEST NORTH CENTRAL... 4 7 3 9 1 2 32 46
Minnesota........... 4 7 2 2 1 2 10 4
Iowa............... 1 2 1 3
Missouri........... 1 12 31
North Dakota....... 3
South Dakota....... -
Nebraska........... 1 3
Kansas................ 3 6 4

SOUTH ATLANTIC....... 16 5 2 1 1 1 2 89 96
Delaware........... 3
Maryland............ 15 1 22 26
Dist. of Columbia.. 1 2
Virginia........... 1 20 5
West Virginia...... 13 6
North Carolina..... 2 2 11
South Carolina..... 2 4
Georgia............. 5 32
Florida ........... 1 5 1 2 21 10

EAST SOUTH CENTRAL... 1 2 1 1 53 38
Kentucky........... 23 19
Tennessee.......... 1 2 1 13 8
Alabama............ 9 10
Mississippi........ 8 1

WEST SOUTH CENTRAL... 5 6 1 3 10 3 1 4 80 52
Arkansas........... 1 1 4 7
Louisiana.......... 2 2 3 4 2 1 3 12 12
Oklahoma............. 1 8 3
Texas............... 2 4 1 5 1 56 30

MOUNTAIN............. 1 1 1 1 2 2 31 41
Montana ............ 1 2 3
Idaho.............. 1 7
Wyoming............ 1 2
Colorado........... 1 1 1 2 2 19 4
New Mexico.......... 3 11
Arizona............ 4 10
Utah............... 1 4
Nevada.............. --- ..--- --

PACIFIC.............. 26 16 1 15 11 3 20 12 191 167
Washington.......... 4 3 2 1 13 24
Oregon............. 2 1 11 16
California.......... 18 12 1 14 9 3 19 12 166 121
Alaska.............- -
Hawaii................ 2 1 1

Puerto Rico 14 24









Morbidity and Mortality Weekly Report 365


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 28, 1967 AND OCTOBER 29, 1966 (43rd WEEK) CONTINUED



MALARIA MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, POLIOMYELITIS RUBELLA
TOTAL
AREA Total Paralytic
Cumulative Cumulative Total Paralytic
Cum.
1967 1967 1967 1966 1967 1967 1966 1967 1967 1967 1967
UNITED STATES... 54 299 59,362 192,862 27 1,855 2,940 21 285

NEW ENGLAND.......... 3 2 882 2,377 73 132 31
Maine.............. 239 235 3 11 1
New Hampshire...... 77 80 2 9
Vermont............. 42 292 1 4 1
Massachusetts...... 2 2 371 795 34 53 5
Rhode Island....... 1 62 72 4 16 4
Connecticut........ 91 903 29 39 20

MIDDLE ATLANTIC...... 10 16 2,333 18,186 4 301 363 5 31
New York City...... 2 478 8,325 1 53 53 1 9
New York, Up-State. 2 3 601 2,578 73 102 1 10
New Jersey......... 6 11 503 1,882 2 99 106 9
Pennsylvania....... 2 751 5,401 1 76 102 3 3

EAST NORTH CENTRAL... 1 46 5,732 69,251 7 269 470 3 54
Ohio................ 4 1,163 6,373 2 89 132 13
Indiana ............ 4 621 5,749 1 43 81 3
Illinois........... 5 1,028 11,422 57 85 3
Michigan........... 1 14 970 14,684 3 62 125 3 24
Wisconsin.......... 19 1,950 31,023 1 18 47 11

WEST NORTH CENTRAL... 2 6 2,893 8,828 2 83 154 3 28
Minnesota.......... 123 1,648 1 21 35 -
Iowa............... 5 760 5,347 16 22 1 22
Missouri........... 338 536 16 60 -
North Dakota....... 1 874 1,177 1 3 11 -
South Dakota....... 55 40 6 5 -
Nebraska........... 1 649 80 13 8 6
Kansas............. 1 94 NN 8 13 2

SOUTH ATLANTIC........ 18 40 7,065 15,515 5 360 499 2 21
Delaware............. 50 260 7 4 -
Maryland........... 168 2,120 2 50 48 1 6
Dist. of Columbia.. 24 386 1 13 14
Virginia........... 1 2 2,216 2,205 42 64 -
West Virginia...... 14 1,427 5,381 34 32 11
North Carolina..... 17 20 914 511 71 130 1
South Carolina..... 511 658 30 52
Georgia............. 36 236 2 55 64
Florida............. 4 1,719 3,758 58 91 4

EAST SOUTH CENTRAL... 15 5,348 19,904 1 143 255 1 4
Kentucky........... 1,396 4,745 42 90 1
Tennessee.......... 14 1,946 12,418 1 61 87 3
Alabama............ 1 1,335 1,711 26 54 -
Mississippi........ 671 1,030 14 24 1 -

WEST SOUTH CENTRAL... 2 73 17,744 25,136 2 234 396 7 1
Arkansas........... 1,404 972 33 36 -
Louisiana.......... 2 156 99 93 148 -
Oklahoma........... 4 3,358 513 17 21 1 -
Texas.............. 69 12,826 23,552 2 91 191 6 1

MOUNTAIN ............. 5 20 4,757 12,152 35 91 15
Montana............ 12 318 1,848 3 5 1
Idaho.............. 393 1,642 3 5 -
Wyoming............. 181 170 1 6 -
Colorado............ 4 4 1,594 1,331 13 49 7
New Mexico.......... 1 591 1,141 3 10 -
Arizona............ 3 1,028 5,325 5 10 4
Utah............... 1 383 645 4 1 3
Nevada............. -- --- 269 50 --- 3 5 --- --- ---

PACIFIC.............. 13 81 12,608 21,513 6 357 580 100
Washington.......... 8 41 5,555 4,084 4 35 43 32
Oregon............... 12 1,667 1,887 27 36 4
California.......... 5 28 5,068 14,836 2 280 480 48
Alaska.............. 140 560 11 17 16
Hawaii............. 178 146 4 4
Puerto Rico .......... 7 2,212 3,028 1 14 17 -







366 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 28, 1967 AND OCTOBER 29,1966 (43rd 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... 7,372 3 186 3 150 10 352 1 292 42 3,604

NEW ENGLAND.......... 1,008 2 1 7 1 95
Maine.............. 22 22
New Hampshire...... 11 45
Vermont............. 31 22
Massachusetts...... 101 1 1 3 1 4
Rhode Island....... 28 1 2
Connecticut........ 815 1 -- 3 -

MIDDLE ATLANTIC...... 190 12 1 1 34 35 87
New York City...... 9 6 17 -
New York, Up-State. 161 1 1 1 9 9 73
New Jersey......... NN 1 4 15
Pennsylvania....... 20 4 4 11 14

EAST NORTH CENTRAL... 478 20 12 39 22 3 341
Ohio................ 29 4 13 11 117
Indiana............. 88 3 2 11 1 1 78
Illinois........... 76 10 10 5 10 64
Michigan............ 197 3 8 1 22
Wisconsin.......... 88 2 1 60

WEST NORTH CENTRAL... 317 1 16 21 2 19 4 14 848
Minnesota.......... 4 1 5 1 2 1 6 168
Iowa............... 122 1 1 3 7 113
Missouri........... 17 8 8 1 9 1 151
North Dakota....... 74 143
South Dakota ..... 12 1 2 116
Nebraska........... 72 4 2 1 58
Kansas............. 16 1 10 1 99

SOUTH ATLANTIC....... 798 1 40 10 2 52 116 4 444
Delaware .......... 1 -
Maryland........... 162 2 21 3
Dist. of Columbia.. 2 2 6
Virginia........... 221 9 6 28 190
West Virginia...... 255 1 2 1 2 1 1 60
North Carolina..... 7 1 7 4 46 3
South Carolina..... 6 1 2 10 5 2
Georgia............. 24 4 5 14 15 3 110
Florida............ 120 18 1 1 12 70

EAST SOUTH CENTRAL... 1,134 30 10 4 62 52 8 682
Kentucky........... 78 3 1 3 27 14 3 158
Tennessee.......... 871 8 7 1 11 26 4 471
Alabama........... 95 11 12 12 1 44
Mississippi....... 90 8 2 12 9

WEST SOUTH CENTRAL.. 788 46 2 79 1 37 1 42 10 786
Arkansas........... 5 1 46 1 12 1 15 2 105
Louisiana.......... 4 8 14 1 65
Oklahoma .......... 29 3 18 7 16 2 286
Texas............... 759 34 1 7 4 10 6 330

MOUNTAIN............ 1,764 2 10 1 20 9 110
Montana............ 60 1 2
Idaho.............. 164 -
Wyoming............ 179 2 1 1 5
Colorado............ 1,088 1 1 12 9 10
New Mexico........ 121 1 2 34
Arizona ............ 103 49
Utah............... 49 6 3
Nevada............. --- -- __

PACIFIC.............. 895 1 18 6 82 11 3 211
Washington........ 382 2 2 2 2
Oregon.............. 87 1 1 3 3 4
California........ 323 13 3 74 6 3 205
Alaska ............. 50 -
Hawaii.............. 53 1 4 -
Puerto Rico.......... 7 16 -- 6 30








Morbidity and Mortality Weekly Report






DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED OCTOBER 28, 1967

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


All Causes Pneumonia Under All Causes Pneumonia Under
Area All 65 years and year Area All 65 years and I year
Ages and over Influenza All Ages and over All Ages Causes
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.--------


826
359
38
23
17
55
20
24
32
41
50
12
51
28
76

3,173
44
35
137
36
34
40
66
80
1,635
30
496
177
49
96
21
50
44
44
24
35

2,596
78
37
733
179
187
120
69
362
35
52
42
31
36
163
52
126
34
33
46
118
63

838
75
25
38
138
27
107
81
221
70
56


506
196
26
13
15
34
16
14
22
18
34
6
34
22
56

1,854
25
14
90
14
22
23
41
38
953
13
295
90
32
63
15
31
33
29
18
15

1,444
50
23
384
101
96
68
39
191
23
27
32
14
27
92
21
86
21
23
28
67
31

502
40
15
20
94
15
67
57
117
45
32


44
24


112
5



6
2

1
1










5
112
3
2
7
3


5
3
46

22
9
2
4
1
1


1
2

129
2
1
41









1
8
8
4

18
3
7
4
1

4
7
6
3
4
1
5
5

37
5

5
3
2
6
5
8
2
1


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.----------


1,101
138
221
29
60
103
45
89
26
78
72
196
44

628
90
45
49
121
143
53
39
88

1,047
32
43
30
145
42
77
189
51
145
64
124
48
57

406
45
20
118
16
87
21
47
52

1,567
21
50
31
34
80
500
105
28
108
68
95
183
36
142
43
43


551
60
97
13
33
61
22
44
5
63
36
91
26

331
44
22
29
73
75
26
20
42

556
18
23
20
89
22
43
84
36
67
30
68
25
31

240
18
13
69
13
55
13
28
31

976
17
31
22
19
47
331
51
21
64
35
56
123
21
84
30
24


Total 12,182 6,960 414 594

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 527,720
All Causes, Age 65 and over------------------- 300,929
Pneumonia and Influenza, All Ages------------- 18,449
All Causes, Under 1 Year of Age--------------- 26,881


Week No.
43


5
8
11
3

27
3
2

10
5
1
2
4

44
5


7
6
3
8

5
1
4
3
2

19
9
3
2
2
2

1






368


Morbidity and Mortality Weekly Report


DIPHTHERIA Alabama (Continued from page 363)

cases were clinically diagnosed as diphtheria and con-
firmed by bacteriologic examination. Among the nine
siblings of the dead child, five have positive cultures for
Corynebacterium diphtheria from nasopharynx specimens.
and two of the five also have positive cultures from cu-
taneous lesions. The father's cultures are negative to
date.
Neighborhood and school culture surveys and a vicin-
ity immunization program are underway.
(Reported by i'.H.Y. Smith, M.D., Director, Bureau of
Preventable Diseases: William J. Donald, M.D., Director,
Bureau of County Health Services; Thomas Hosty, Ph.D.,
Director, Bureau of Laboratories, all with the Alabama
State Department of Public Health: and an EIS Officer.)







INTERNATIONAL NOTES
IMMUNIZATION INFORMATION FOR
INTERNATIONAL TRAVEL PHS 384


The 1967-68 edition of the booklet "Immunization
Information for International Travel" is available at the
Superintendent of Documents, Government Printing Office,
Washington, D.C. 20402 at 40c a copy. There is a dis-
count of 25 percent when 100 copies or more are ordered
and delivered to the same address.
The principal changes include the recommendations
of the Surgeon General's Committee on immunization
practices, and changes in the immunization requirements
of other countries.
Information in the booklet is kept current in the
Morbidity and Mortality Weekly Report, published by the
National Communicable Disease Center, Atlanta, Georgia
30333.







ERRATUM: Vol. 16, No. 42, p. 358
The correct number of reported cases of streptococcal
rore throat and scarlet fever from Mississippi for week
il.r., October 21 was 167 cases. Typographical error on
Weekly Telegraphic Report showed (667 cases.


OCTOBER 28, 1967


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION OF 17,000, IS PUBLISHED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER, ATLANTA, GEORGIA.
DIRECTOR, NATIONAL COMMUNICABLE DISEASE CENTER
DAVID J. SENCER, M.D.
CHIEF, EPIDEMIOLOGY PROGRAM A.D. LANGMUIR, M.D.
ACTING CHIEF, STATISTICS SECTION IDA L. SHERMAN, M.S.
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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