Morbidity and mortality

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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:
AA00010654:00030

Related Items

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

Full Text


FS z,


L COMMUN CABLE DISEASE CENTER


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE / PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION
DATE OF RELEASE: DECEMBER 26, 1969 ATLANTA, GEORGIA 30333


CURRENT TRENDS
DYSENTERY Guatemala and United States

During 1969, an increase in severe dysentery was re-
ported from towns and villages throughout Guatemala
(MMWR, Vol. 18, No. 42). This increase was confirmed by
an-analysis of dysentery mortality data for the past 2 years
which supported the existence of a recent widespread epi-
demic with high mortality in many communities. Clinical,
bacteriologic, serologic, and autopsy studies identified
the etiologic agent as Shigella dysenteriae, type 1 (Shiga's
bacillus). The epidemic has shown no signs of abating with
outbreaks occurring in many communities during November.
Outbreaks in neighboring countries indicate that regional
spread has occurred.
Community and family common source outbreaks were
documented, but no single vehicle was found responsible
for transmission over wide geographic areas. Person-to-
person spread probably accounted for the introduction of
new cases into communities and for the few cases often
seen preceding and following the explosive common source
outbreaks.
Patients often presented with severe colitis. The
signs and symptoms were mucus and bright red blood in
the stool and severe tenesmus usually with only mild or
no fever. The symptoms of colitis found in this form of
shigellosis were frequently confused with amebiasis.
Patients usually did not respond to commonly used anti-
microbial drugs because the organism was resistant to
tetracycline, chloramphenicol, novobiocin, and sulfa drugs;
however, ampicillin, erythromycin, and large doses of
penicillin seemed effective. In some patients, in whom the
true diagnosis was not suspected, palliative colostomy
was performed unnecessarily.
During the epidemic in Central America, isolations
of the organism in the United States were reviewed for
possible association. Since the beginning of nationwide
shigellosis surveillance in January 1965 through Oct. 31,
1969, 20 isolations of S. dysenteriae, type 1 have been
reported in the United States. Nine of the 20 were reported
in the third quarter of 1969 (Figure 1). Of these 20, Texas
reported five; Illinois three; Massachusetts, Connecticut,
and California two each; and Minnesota, Florida, Louisiana,
Kansas, and New Jersey one each. Travel histories were


CONTENTS
Current Trends
Dysentery Guatemala and United States ......... 441
Epidemiologic Notes and Reports
Jack-O' Lantern Mushroom Poisoning -
New York City ................... ...... 442
Outbreak of Tuberculosis South Carolina ......... ..442
Outbreak of Typhoid Fever Connecticut
and Massachusetts . ... ........ .. 448
Summary of Reported Cases of Infectious Syphilis 443


recently obtained on 11 persons from whom this organism
was isolated. Nine persons acquired infection in Mexico,
one in Central America, and one in Ethiopia. The other
nine persons could not be contacted. There were no re-
ports of secondary spread among household contacts in
this country. Serologic studies are in progress for identi-
fication of any subclinical cases among contacts. The
diagnosis of dysentery due to S. dysenteriae, type 1 should
be suspected in all patients with colitis who have recently
traveled to Central America.



ISOLATE TP TYPE 1
UNITED Sl JANUARY TOBER 1969

10 TO








I 2 3 4 1 2 3 4 I 2 3 4 I 2 3 4 I 2 3 4 I 2 3 4
1965 1966 1967 1968 1969 1970
YEAR, BY QUARTER


(Reported by Dr. Cesar Mendizabal Morris, Director of
Epidemiology, Ministry of Public Health and Social Assist-
ance of the Government of Guatemala; Dr. Leonardo J. Mata,
Chief, Division of Microbiology, Institute of Nutrition of
Central America and Panama, Guatemala; the Enteric
Diseases Section, Bacterial Diseases Branch, Epidemi-
ology Program, NCDC; and a team from NCDC.)


v>-^
S Vol. 18, No. 51






SFor
SWeek Ending
December 20, 1969







Morbidity and Mortality Weekly Report


DECEMBER 20, 1969


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
51stWEEK ENDED CUMULATIVE, FIRST 51 WEEKS
MEDIAN
DISEASE December 20, December 21, 1964 1968 MEDIAN
1969 1968 1969 1968 1964- 1968
Aseptic meningitis ...................... .48 45 39 3,458 4,294 2,915
Brucellosis ............................ 3 4 4 224 225 244
Diphtheria.............................. 16 5 5 209 240 204
Encephalitis, primary:
Arthropod-borne & unspecified ........... 20 32 32 1,302 1,432 1.857
Encephalitis, post-infectious ............ 12 6 8 307 458 706
Hepatitis, serum ........................ 123 7274 5,269 4,610 371
Hepatitis, infectious .................... 1.037 815 47,411 44,893
Malaria ............................... ..103 27 13 3,180 2,315 509
Measles rubeolaa) ....................... 482 293 998 24,203 22,360 201,778
Meningococcal infections, total .......... 67 36 47 2.886 2,496 2,762
Civilian .............................. 53 32 --- 2,630 2,281 -
Military .............................. 14 4 --- 256 215 -
Mumps ................................. 2,302 2,409 86.983 147,155 ---
Poliomyelitis, total ..................... 17 57 60
Paralytic ............................. 15 57 57
Rubella (German measles) ............... 628 437 -- 54,739 48.165 ---
Streptococcal sore throat & scarlet fever.... 10,008 11,203 8.548 420,201 426,542 413,412
Tetanus ............................... 2 4 3 164 160 226
Tularemia .............................. 1 3 3 141 172 180
Typhoid fever .......................... 7 7 6 335 401 401
Typhus, tick-borne (Rky. Mt. spotted fever) 1 450 277 261
Rabies in animals ....................... 53 55 45 3.252 3.312 4 112

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........................................... 4 Rabies in man: ............................... .....
Botulism: ........................................... 12 Rubella congenital syndrome: .......... .............. .
Leptospirosis: ...................................... 83 Trichinosis: ......................
Plague: ............. ................ ..... ... .. .. 5 Typhus, murine: La.-1 .......................... ..
P sittacosis: ..................................... 49
*Delayed Reports: Trichinosis: Alaska: Delete 2.


EPIDEMIOLOGIC NOTES AND REPORTS
JACK-O' LANTERN MUSHROOM POISONING New York City


On Oct. 17. 1969. in New York City. a family of four
ate a dinner of il hop-. rice, escarole, and mushrooms.
Between 1 and hi,,r- I i. r all four experienced vomiting
and abdominal cramps. The family. ,- -reir at ile emer-
geney room of I... d hospital and ir.I, r r' i-tr lavage.
They were gixenratropine and were discharged improved.
Duration of symptoms was approximately 4 hours.
As the u h-lr.).w : had been .rl,.;r., h b he family
earlier that (I i n i l,- N i .1 -.. ,rir. l-. attention
focused on them i- i. probable ,uni'l,,,i iI..I vehicle.
Ti ere identified .r Ih.- II.-rhbir .,, of the New York
Botanical Garden as Jack-O' Lantern mushrooms(('lytocybe
illudern), a poisonous variety indigenous to the north-
eastern I'nited States with growth occurring on hardwood
stumps from \ugust 'i ..,.-ii October. This type of mush-
room is usually responsible for seasonal mushroom poison-
ing in this region. They are called Jack-O' Lantern mush-


rooms because of their phosphorescent gills that render
them luminous at night. Onset of illness from Clytocybe
usually occurs within 2 hours after incr -ilior. and nausea
and vomiting may be severe. They contain muscarine re-
sponsible for muscarinic symptoms that respond to treat-
ment with atropine. Poisoning due to the genus C,'y.'v.,,'r
is uncommon in the United -t r[--. most cases of mycetis-
mus in the United States are due to the genus Amanita.

(Reported by Leo II. Buchner, M.D., Epidemiologist, and
Vincent F. Guinee, M.D., Director, Infectious /.'Pi ..,
Control, Karen Putterman, M.D., Health *.'* in Training,
and Tibor Fodor, M.D., Chief, Division of Epidemiologic
Intelligence, and Jerry Zitter, Supervisory Bureau of Food
and Drugs, Neu York City Health Department; and Dr.
Clark T. Rogerson, Senior Curator of Crytoyamic h..aj.,
New York Botanical Garden.)


OUTBREAK OF TUBERCULOSIS South Carolina


In January 1969, far-advanced active tuberculosis with
capitation was diagnosed in a 'I .. ,air.-,l man in Charles-
ton County. South Carolina. Fourteen weeks earlier, he
had seen his private physician because of "pain in aldo-


men" and because he was "unable to work" and "unable
to keep down food." He was started on antacid therapy.
The patient returned to work, but in January his employer
requested assistance for him from the local health depart-


442









Morbidity and Mortali


ment. The public health nurse saw him and noted weight
loss, constant coughing with heavy expectoration, and
fever; he was hospitalized, and tuberculosis was bac-
teriologically confirmed by a positive sputum culture.
Because he worked in a closed area in a tire and
battery shop and lived in a crowded, heavily populated
poor community on James Island, his household, work, and
community contacts were tuberculin tested in January. Of
the 147 persons who were tuberculin tested, 58 had reac-
tions of 10 mm or more induration (positive), 86 had reac-
tions of 0 to 9 mm induration (negative and doubtful), and
three tests were not read (Table 1). Following X-ray of
the 147 contacts, six active cases and two inactive cases
were diagnosed; all eight had positive tuberculin tests.
Two patients with active tuberculosis were hospitalized,
and the other four were placed on triple chemotherapy and


DECEMBER 20, 1969


Table 1
Results of Examination in January 1969 for Tuberculosis on 147 Contacts, South Carolina

Positive
Type of Contact Reactors Placed Tuberculosis Negative Tests Not Total
Read
on Isoniazid Diagnosed

Household 2 3 0 0 5
Work 10 0 11 0 21
Community 38 5* 75 3 121

Total 50 8 86 3 147
*Two placed on isoniazid only.





SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS
CASES OF PRIMARY AND SECONDARY SYPHILIS: By Reporting Areas November 1968 and November 1969 Provisional Data
Cumulative Cumulative
Reporting Area November Jan. Nov. Reporting Area November Jan. Nov.
1969 1968 1969 1968 1969 1968 1969 1968
NEW ENGLAND............. 21 32 333 320 EAST SOUTH CENTRAL........ 52 120 874 1,258
Maine................... 1 9 3 Kentucky................ 8 11 143 112
New Hampshire........... 8 6 Tennessee............... 17 24 280 291
Vermont................. 1 Alabama.................. 6 31 219 508
Massachusetts........... 9 17 186 202 Mississippi.............. 21 54 232 347
Rhode Island............ 6 4 42 30
Connecticut............. 5 11 87 79 WEST SOUTH CENTRAL....... 228 298 3,267 3,229
Arkansas................. 17 6 203 112
MIDDLE ATLANTIC.......... 320 340 3,560 3,222 Louisiana................ 37 52 633 768
Upstate New York....... 23 34 247 303 Oklahoma............... 10 5 81 73
New York City........... 199 239 2,413 2,083 Texas................... 164 235 2,350 2,276
Pa. (Excl. Phila.)...... 16 16 137 205
Philadelphia ............ 20 12 200 217 MOUNTAIN.................. 38 42 575 448
New Jersey.............. 62 39 563 414 Montana.................. 8 7
Idaho.................... 1 9 3
EAST NORTH CENTRAL....... 241 224 2,482 2,621 Wyoming.................. 2 1 7 5
Ohio................. 36 36 372 419 Colorado................ 2 3 43 20
Indiana................ 48 34 368 328 New Mexico.............. 14 19 241 151
Downstate Illinois....... 27 14 251 192 Arizona.................. 14 16 191 217
Chicago.................. 76 77 875 918 Utah.................... 1 1 16 9
Michigan................. 49 62 590 739 Nevada................... 5 1 60 36
Wisconsin................ 5 1 26 25
PACIFIC............. ..... 192 152 1,904 1,631
WEST NORTH CENTRAL........ 51 39 372 364 Washington............... 1 3 55 42
Minnesota................ 9 7 54 51 Oregon................... 5 42 39
Iowa.................... 3 10 38 47 California............... 185 148 1,795 1,542
Missouri................. 28 17 170 181 Alaska................... 1 7 2
North Dakota............. 11 5 Hawaii.................. 1 5 6
South Dakota............. 5 25 30
Nebraska................. 4 3 33 21 U. S. TOTAL............... 1,551 1,612 17.887 17,754
Kansas .................. 2 2 41 29
TERRITORIES ......... 80 81 1,059 1,038
SOUTH ATLANTIC............ 408 365 4,520 4,661 Puerto Rico.............. 78 79 1,043 989
Delaware................. 1 38 32 Virgin Islands........... 2 2 16 49
Maryland............... 31 34 386 422
District of Columbia.... 49 42 537 554
Virginia................. 9 17 265 275
West Virginia............ 3 2 18 30
North Carolina........... 42 27 475 519 Note: Cumulative Totals include revised and delayed reports
South Carolina........... 43 27 521 470 through previous months.
Georgia................. 115 69 990 829
Florida.................. 115 147 1,290 1,530


ity Weekly Report 443



are being followed on an outpatient basis. The two with
inactive tuberculosis as well as the other 50 positive re-
actors were placed on isoniazid.
In August 1969, follow-up tuberculin tests on 77 of
the 86 persons with negative reactions in January showed
that four persons had converted. Two were placed on
isoniazid. The other two had not been X-rayed as of De-
cember 1969. No additional cases were found.


(Reported by David B. Gregg, M.D., Director, and Eliza-
beth Turner, R.N., Community Health Nurse, Tuberculosis
Control Division, South Carolina State Board of Health;
and the Public Health Advisor, Tuberculosis Branch, Divi-
sion of State and Community Health Services, NCDC, as-
signed to the Tuberculosis Control Division, South Carolina
State Board of Health.)







1II Morbidity and Mortality Weekly Report


TABLE II. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 20, 1969 AND DECEMBER 21, 1968 (51st WEEK)

ASEPTIC ENCEPHALITIS HEPATITIS
MENIN- BRCEL- DIHIIIERI Primary including PosI MALARIA
AREA GITIS LOSIS unsp. cases if -lnos Serum Infectious
Cum.
____,._ "_,_______I__, __ I Ir,' l'.. I I .' IM,5 I I-4.
UNITEC ,iAIL... 3 1 20 32 12 123 1,037 815 10 3,180

NEW ENGLAND........... 1 8 127 46 4 102
Maine.............. 11 5 8
New Hampshire.... 3 1 2
Vermont ........... .- 8 -
Massachusetts...... 1 2 58 24 60
Rhode Island....... 13 11 11
Connecticut........ 6 34 5 4 21

MIDDLE ATLANTIC...... 7 3 2 2 45 197 120 20 388
New York City...... 3 -- 2 23 57 16 1 27
New York, up-State. 1 1 1 7 62 47 5 85
New Jersey......... 3 9 41 23 2 153
Pennsylvania....... 2 1 6 37 34 12 123

EAST NORTH CENTRAL... 9 4 5 3 11 165 123 6 326
Ohio. ............. 1 2 2 1 63 35 2 32
Indiana............ 7 9 27
Illinois........... 1 1 1 2 2 25 30 1 197
Michigan........... 7 1 2 9 53 44 3 69
Wisconsin.......... 17 5 1

WEST NORTH CENTRAL... 1 3 2 1 4 26 35 5 228
Minnesota.* ....... 1 1 2 8 7 14
Iowa. ............. 3 1 5 11 27
Missouri........... 1 8 12 45
North Dakota........ 2 4
South Dakota........ 1 1 2
Nebraska........... 1 5
Kansas............. 1 1 2 4 4 131

SOUTH ATLANTIC....... 6 3 3 3 4 92 90 25 800
Delaware............ 5
Maryland ........... 1 16 12 34
Dist. of Columbia.. 1 2 2
Virginia........... 1 2 9 12 27
West Virginia...... 3 3 4
North Carolina..... 3 25 13 21 332
South Carolina..... 1 12 5 1 65
Georgia............ 12 1 278
Florida............ 2 3 2 3 25 33 2 53

EAST SOUTH CENTRAL... 5 1 3 4 77 36 17 198
Kentucky........... 3 2 47 10 17 169
Tennessee.......... 2 1 17 17 -
Alabama............ 2 10 7 25
Mississippi........ 3 3 2 4

WEST SOUTH CENTRAL... 1 12 2 6 83 70 13 287
Arkansas........... 1 1 4 13
Louisiana.......... 7 2 8 18 46
Oklahoma.*......... 1 2 8 79
Texas............... 1 5 3 69 44 13 149

MOUNTAIN........... 1 9 1 36 70 138
Montana............ 1 1 1 3
Idaho............... 1 3 5
Wyoming............ 7 5 -
Colorado........... 2 5 26 112
New Mexico......... 4 25 9
Arizona. ........... 1 14 9 1
Utah................ 3 6 1
Nevada............. 3 7

PACIFIC.............. 19 6 8 6 40 234 225 13 713
Washington........... 3 16 24 7
Oregon............. 1 3 22 13 18
California......... 16 5 8 6 37 192 186 13 553
Alaska............. 2 4
Hawaii............. 2 2 131

Puerto Rico.......... --- --- --- -... --- --- --. 23 "-- 4
*Delaved reports: Diphtheria: Ariz. 1 Hepatitis, Infectious: Ohio: Delete 2, Minn.: 1, Okla.: 9
Encephalitis, Primary: N.H.: 1, Minn. 1 Malaria: Iowa: 2
Hepatitis, Serum: Iowa: 1







Morbidity and Mortality Weekly Report 445


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 20, 1969 AND DECEMBER 21, 1968 (51st WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MIMPS POLIOMYELITIS RUBELLA
TOTAL
AREA Total Paralytic
AREA Cumulative Cumulative Total Paraytic
Cum.
1969 1969 1968 1969 1969 1968 1969 1969 1969 1969 1969
UNITED STATES... 482 24,203 22,360 67 2,886 2,496 2,302 15 628

NEW ENGLAND.......... 17 1,211 1,319 4 112 139 410 2 34
Maine.............. 1 10 38 8 6 76 1 5
New Hampshire*..... 2 247 150 5 8 23 2
Vermont............ 3 3 1 16 2
Massachusetts .... 12 267 385 3 44 74 129 13
Rhode Island....... 27 65 14 9 11 1
Connecticut........ 2 657 678 1 41 41 155 1 11

MIDDLE ATLANTIC...... 114 8,021 4,712 10 478 440 98 2 17
New York City...... 12 5,028 2,408 89 89 68 5
New York, Up-State. 8 633 1,387 6 97 74 NN 1 6
New Jersey.......... 43 1,114 720 3 186 156 30 4
Pennsylvania....... 51 1,244 197 1 106 121 NN 1 2

EAST NORTH CENTRAL... 177 3,127 4,229 9 391 313 600 1 155
Ohio............... 28 553 331 1 139 84 40 7
Indiana............. 2 485 740 52 45 70 22
Illinois........... 130 1,014 1,437 2 56 71 85 1 17
Michigan............ 4 398 343 5 116 89 137 40
Wisconsin.......... 13 677 1,378 1 28 24 268 69

WEST NORTH CENTRAL... 36 1,150 484 139 139 138 1 111
Minnesota.......... 11 19 29 29 53 -
Iowa................ 338 165 21 14 56 104
Missouri........... 32 81 56 49 1 1
North Dakota....... 4 81 142 2 4 12 2
South Dakota....... 3 4 1 5 NN -
Nebraska........... 32 676 63 13 9 16 4
Kansas....... ..... 9 10 17 29 1 -

SOUTH ATLANTIC....... 24 2,970 1,820 21 503 499 158 1 44
Delaware........... 508 20 17 12 1 -
Maryland............ 7 100 103 41 44 8 2
Dist. of Columbia.. 35 6 9 17 6 1
Virginia........... 8 999 441 2 60 50 58 19
West Virginia...... 1 226 326 24 14 69 17
North Carolina..... 354 322 7 96 99 NN -
South Carolina..... 134 30 5 69 63 5 2
Georgia............. 2 4 78 96 -
Florida............ 8 612 568 7 109 104 11 1 3

EAST SOUTH CENTRAL... 131 508 7 211 222 136 1 32
Kentucky........... 75 107 4 85 98 26 11
Tennessee.......... 21 65 2 77 70 103 19
Alabama............ 11 95 28 29 7 1 2
Mississippi........ 24 241 1 21 25 -

WEST SOUTH CENTRAL... 72 5,195 5,314 8 380 360 224 6 70
Arkansas........... 16 2 1 34 21 1 -
Louisiana.......... 125 25 1 101 103 -
Oklahoma............ 143 132 36 56 64 19
Texas............... 72 4,911 5,155 6 209 180 159 6 51

MOUNTAIN ............. 24 1,165 1,095 59 46 98 29
Montana............ 122 58 8 7 11 3
Idaho.............. 90 21 13 12 1 -
Wyoming............ 55 3 2 4
Colorado............ 1 142 525 13 14 33 7
New Mexico......... 4 290 172 8 1 11 -
Arizona............. 19 509 235 10 5 22 11
Utah................ 11 21 5 1 18 4
Nevada............. 1 8 2 3 -

PACIFIC.............. 18 1,233 2,879 8 613 338 440 1 136
Washington.......... 1 69 605 59 51 186 49
Oregon............. 201 592 22 25 27 13
California.......... 17 897 1,636 8 511 244 149 1 42
Alaska.............. 14 11 11 4 78 30
'Hawaii............. 52 35 10 14 2

Puerto Rico........... 2,096 512 -19 21
*Delayed Reports: Measles: Mass.: Delete 3
Mumps: N.H.: 19






116 %lorbidily and Mortality Weekly Report


TABLE II1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 20, 1969 AND DECEMBER 21, 1968 (51st WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA T D TICK-BORNE RABIES IN
AREA SCARLET FEVER FEVER (Rky. Mt. Spotted) ANIMALS
Cum. Cum. Cum. Cum. Cum.
1969 1969 1969 1969 1969 1969 1969 1969 1969 1969 1969
UNITED STATES... 10,008 2 164 1 141 7 335 450 53 3,252

NEW ENGLAND........... 1,427 1 16 16 1 2 57
Maine .............. 17 1 6
New Hampshire...... 2 5
Vermont............ 35 16 2 35
Massachusetts...... 184 1 8 1 3
Rhode Island....... 50 1-
Connecticut........ 1,139 6 8

MIDDLE ATLANTIC...... 226 23 5 2 33 47 7 254
New York City...... 18 14 1 17 -
New York, Up-State. 189 3 4 6 7 7 240
New Jersey.......... NN 3 1 4 15 -
Pennsylvania....... 19 3 1 6 25 14

EAST NORTH CENTRAL... 913 19 18 36 3 1 233
Ohio............... 145 4 13 76
Indiana............ 176 6 56
Illinois........... 224 10 5 16 3 40
Michigan........... 229 5 6 1 10
Wisconsin.......... 139 7 1 51

WEST NORTH CENTRAL... 364 14 14 10 8 14 620
Minnesota.......... 12 6 4 1 165
Iowa............... 160 I 7 3 103
Missouri........... 10 4 10 3 2 147
North Dakota....... 51 5 77
South Dakota....... 33 1 43
Nebraska........... 76 1 14
Kansas............. 22 4 3 1 3 71

SOUTH ATLANTIC....... 942 30 23 50 253 11 771
Delaware.......... 2 1 2 3 -
Maryland........... 76 1 4 48 3
Dist. of Columbia.. 6 2 3 -
Virginia........... 301 2 4 1 81 371
West Virginia...... 228 1 2 2 5 3 114
North Carolina..... NN 3 6 11 67 5
South Carolina..... 201 1 2 1 32 -
Georgia............ 6 8 4 11 16 7 107
Florida............ 122 12 4 15 1 1 171

EAST SOUTH CENTRAL... 1,422 1 26 15 1 52 65 3 394
Kentucky........... 205 1 8 12 13 1 202
Tennessee.......... 842 4 14 1 22 43 131
Alabama........... 254 8 4 6 2 55
Mississippi........ 121 6 1 14 3 6

WEST SOUTH CENTRAL... 874 30 1 26 1 36 51 4 467
Arkansas........... 27 2 5 1 15 7 1 34
Louisiana.......... 3 7 1 6 4 1 41
Oklahoma ........... 12 1 9 32 2 72
Texas.............. 832 20 6 17 12 320

MOUNTAIN ............ 2,642 7 18 32 17 123
Montana............ 41 3 -
Idaho............. 255 4 6 -
Wyoming.............. 335 4 5 55
Colorado........... 1,413 2 3 9 3
New Mexico......... 326 1 10 22
Arizona............ 155 4 6 22
Utah............... 117 13 2 5
Nevada............. 1 16

PACIFIC .............. 1,198 1 14 6 3 70 5 11 333
Washington......... 963 1 2 3 3 4
Oregon............ 136 1 1 2 6 4
California......... --- 12 2 2 51 2 11 325
Alaska ............. 72
Hawaii.............. 27 1 10

Puerto Rico.......... --- -- 13 --- --- 7 --- -- 29





Morbidity and Mortality Weekly Report






TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED DECEMBER 20, 1969


(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 yar Area All 65 years and I year
Ages and over Influenza All Ages and over Influenza All
All Ages Causes All Ages Causes


NEW ENGLAND:
Boston, Mass.----------
Bridgeport, Conn.-----
Cambridge, Mass.------
Fall River, Mass.-----
Hartford, Conn.-------
Lowell, Mass.---------.
Lynn, Mass.-----------
New Bedford, Mass.----
New Haven, Conn.------
Providence, R. I.-----
Somerville, Mass.-----
Springfield, Mass.----
Waterbury, Conn.------
Worcester, Mass.------

MIDDLE ATLANTIC:
Albany, N. Y.----------
Allentown, Pa.--------
Buffalo, N. Y.--------
Camden, N. J.----------
Elizabeth, N. J.------
Erie, Pa.-------------
Jersey City, N. J.----
Newark, N. J.----------
New York City, N. Y.--
Paterson, N. J.-------
Philadelphia, Pa.-----
Pittsburgh, Pa.-------
Reading, Pa.----------
Rochester, N. Y.------
Schenectady, N. Y.----
Scranton, Pa.----------
Syracuse, N. Y.-------
Trenton, N. J.--------
Utica, N. Y.----------
Yonkers, N. Y.--------

EAST NORTH CENTRAL:
Akron, Ohio-----------
Canton, Ohio----------
Chicago, Ill.----------
Cincinnati, Ohio------
Cleveland, Ohio-------
Columbus, Ohio--------
Dayton, Ohio----------
Detroit, Mich.--------
Evansville, Ind.------
Flint, Mich.----------
Fort Wayne, Ind.------
Gary, Ind.------------
Grand Rapids, Mich.---
Indianapolis, Ind.----
Madison, Wis.---------
Milwaukee, Wis.-------
Peoria, Ill.----------
Rockford, Ill.--------
South Bend, Ind.------
Toledo, Ohio----------
Youngstown, Ohio------

WEST NORTH CENTRAL:
Des Moines, Iowa------
Duluth, Minn.----------
Kansas City, Kans.----
Kansas City, Mo.------
Lincoln, Nebr.--------
Minneapolis, Minn.----
Omaha, Nebr.----------
St. Louis, Mo.--------
St. Paul, Minn.-------
Wichita, Kans.-----.---


760
227
52
27
22
50
24
17
31
66
64
20
57
33
70

3,342
56
43
151
36
24
44
63
71
1,699
40
501
155
54
130
30
41
81
51
33
39

2,591
69
32
746
112
209
144
90
367
51
48
52
28
54
151
40
115
40
36
33
122
52

816
56
24
38
124
33
101
59
233
80
68


482
140
34
18
14
28
12
14
20
44
38
17
35
21
47

2,039
33
27
99
25
17
22
40
37
1,032
29
294
87
36
79
18
26
57
29
23
29

1,434
37
21
386
60
109
80
48
191
36
28
30
14
35
84
22
73
24
22
23
75
36

494
37
15
22
69
23
60
39
140
55
34


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.----------


1,215
150
266
51
66
127
48
85
35
105
67
158
57

665
105
60
37
124
154
45
32
108

1,268
53
47
30
158
52
86
259
68
148
114
132
68
53

487
66
25
119
23
93
32
75
54

1,628
25
47
35
57
112
427
84
47
152
63
91
173
68
161
46
40


679
75
152
22
36
75
22
52
19
85
42
72
27

366
58
35
25
66
76
29
19
58

687
26
27
17
98
26
52
117
37
72
60
81
44
30

280
32
16
72
14
50
21
45
30

1,012
20
27
22
28
73
273
50
36
95
36
63
102
45
92
33
17


Total 12,772 7,473 534 646

Expected Number 13,220 7,720 496 545


Cumulative Total
(includes reported corrections
for previous weeks)


661,181


378,210 29,280


.1 .1 .1. ~ I __________ J _________ I


Las Vegas, Nev.*


31,477


*Mortality data are being collected from Las Vegas, Nev.. for possible inclusion in this
table, however. for statistical reasons, these data will be listed only and not included in
the total, expected number, or cumulative total, until 5 years of data are collected.


Week No.
51


muI I ~









448 Morbidity and Mor


EPIDEMIOLOGIC NOTES AND REPORTS
OUTBREAK OF TYPHOID FEVER
Connecticut and Massachusetts

Four cases of typhoid fever have been traced to a
grinder (submarine, hero, poor boy) sandwich shop in
Hartford. Connecticut.
The first case was identified on August 8 following
isolation of Salmonella typhi from a stool specimen of a
22-year-old woman in Hartford: she had become ill with
fever and headache on July 11 and subsequently developed
diarrhea. On August 25. in Springfield, Massachusetts, two
other cases in siblings. ages 10 and 9 years, who had be-
come ill on July 11 and 18, respectively. were identified.
These children had visited their aunt in A.l- -T, Connecti-
cut. a Hartford suburb, on June 27 and 29. The fourth case
was in a 24-year-old man who regularly ate at the shop and
who became ill in October.
When the first three cases were found to be due to
S. typhi, phage type F-1 (a relatively uncommon type in
New England), an investigation was begun. It was learned
that the three patients had eaten in several of the same
eating establishments in the Hartford area. Stool speci-
mens were obtained from all employees of these restaurants;
S. typhi phage type F-1 was isolated from three specimens
of a 50-year-old cook working at a grinder shop near Hart-
ford. She had come to the United States from Lebanon 12
years ago and had begun working in the shop in March 1969.
She ga L a history of a febrile illness of 1-month's dura-
tion requiring hospitalization 19 years ago in Lebanon.
Her 21-year-old son, who helped make the grinders, was
found to have S. typhi phage type F-1 in a second speci-
men. He gave no history of recent illness and no past his-
tory of typhoid fever, and a third specimen from him shortly
after the second was negative. Both the mother and son
were placed on long-term ampicillin therapy and were not
to work at the shop until follow-up stool cultures were
negative.
(Reported by Nortoin Chaucer, M.D., Health Director, and
Dorothy 'larkinl, t.N., Public Health Nurse, Hartford
Ilealth Department; John C. Ayrea, M.D., Commissioner of
'Public Health, 'r.- ..,.i' Massachusetts; John A. Mana-
c'lla, M.D., Director of Iealth, Windsor, Connecticut;
larmes C. Hart. M.ID., ( Section of Epidemiology,
C'onrnectic t State Department of Health; and an EIS Officer.)


tal


ity Weekly Report DECEMBER 20 1969 < -


LL (Wc
T;E MORB.D0TV AND MO TALIT, WEEIL RE EPORP T WT,* A CIRCuLA.
TC OF :., i... .I PBLI.I- .EO .T T1E NATIONAL COMMuNICABLE O
DISEASE CENTER, ATLANTA. GEORGIA. 0-
DIRECTOR, NATIONAL COMMUNICABLE DISEASE CENTER
DAVID J. SENCER, M.D
DIRECTOR, EPIDEMIOLOGY PROGRAM A. D. LANGMUIR, M.D.
EDITOR MICHAEL B. GREGG, M.D.
MANAGING EDITOR PRICILLA B HOLMAN
IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY, THE NATIONAL COMM'NC aBLE DISE A.SE
CENTER WELCOMES ACCOUNTS OF INTERESTING OUTBREAKS OR C .SE
INVESTIGATIONS WHICH ARE OF CURRENT N TIEREE' TO rEAL T
OFFICIALS AND WHICH ARE DIRECTLY RELATED TIO IE CONTROL
OF COMMUNICABLE DISEASES. SUCH COMMUNICATIONS SHOULD BE
ADDRESSED TO:
NATIONAL COMMUNICABLE DISEASE CENTER
ATTN: THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT
ATLANTA, GEORGIA 30333
NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO THE NCDC BY THE INDIVIDUAL
STATE HEALTH DEPARTMENTS. THE REPORTING WEEK CONCLUDES
AT CLOSE OF BUSINESS ON FRIDAY; COMPILED DATA ON A NATIONAL
BASIS ARE OFFICIALLY RELEASED TO THE PUBLIC ON THE SUCCEED-
ING FRIDAY.