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:
AA00010654:00034

Related Items

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

Full Text




Vol. 16, No. 30


WEEKLY

REPORT


Week Ending

July 29, 1967


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


PUBLIC HEALTH SERVICE


BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


EPIDEMIOLOGIC NOTES AND REPORTS
FATAL PLAGUE CASE Colorado

The death of a 12-year-old boy on July 16, 1967, has
been attributed to plague bacillus contracted from a prairie
dog in Elbert County, Colorado. On July 12, the boy had
killed the animal by stabbing it with his pocket knife near
his ranch home.
Two days later the patient became ill with sore throat.
temperature of 105F, and left submandibular adenopathy.
A local doctor prescribed aspirin and cool enemas for the
fever. On July 15, the patient noted increased submandi-
bular swelling and swollen eyes: his temperature had
dropped to 99.8F. The doctor made a provisional diagnosis


CONTENTS
Epidemiologic Noi.s and Reports
Fatal Plagu, Case Colorado. ................ .24
Imported Fatal Case of Rahli Or on . .246
Gastroentritis \irinia. . ... 47
Surveillance Summar\
Malaria Januarr 1 Jul 20., 1967. .............. 47
Rubella 1966 .................. ..... .. 24S
Reported Cases of Infectious Syphili' June 1967 .24


of streptococcal pharyngitis and prescribed Lincocin and
tetracycline. On the morning of July 16. the patient de-
\eloped respiratory distress and died en route to a Denver
hospital.
(ConItinued on page 246)


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
30th WEEK ENDED CUMULATIVE. FIRST 30 WEEKS
MEDIAN
DISEASE JULY 29. JULY 30. 1962 1966 MEDIAN
1967 1966 1967 1966 1962 1966
Aseptic meningitis ..................... 68 87 60 1,106 1,011 888
Brucellosis. ........................... 5 6 153 128 206
Diphtheria ..... .... .......... .. 3 8 5 60 98 149
Encephalitis, primary:
Arthropod-borne & unspecified .......... 34 45 779 802
Encephalitis, post-infectious ........ .. 23 17 534 520 -
Hepatitis, serum ..................... 50 41 582 1,206 771 237
Hepatitis, infectious .................... 648 541 22,228 18.999
Malaria ............................... 50 8 3 1,148 189 51
Measles (rubeola)... ......... ....... .... 286 1,318 2.534 56,335 185,346 350,788
Meningococcal infections, total .......... 26 34 35 1.537 2,482 1,752
Civilian ............................ 26 1.284 1,429 182.864
Military.............................. -- 108 264 -
Poliomyelitis, total .................... 3 4 5 18 45 58
Paralytic.............................. 2 4 5 15 41 47
Rubella (German measles) ............... 327 239 38,646 40,105 -
Streptococcal sore throat & scarlet fever .. 4,770 4,467 3,885 296,830 281,840 261,277
Tetanus................................. 4 4 6 112 92 138
Tularemia .............................. 4 3 8 92 92 161
Typhoid fever .......................... 5 20 16 222 194 225
Typhus, tick-borne (Rky. Mt. spotted fever). 11 16 16 144 134 126

Rabies in animals ........... ..... 94 91 81 2,653 2,532 2,532

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ......... ........ ....... ..... ... ... 2 Rabies in man: Ore.-l ....... ..... ..... ... 1
Botulism: ..................... ...................... 2 Rubella, Congenital Syndrome: ........ .. .... .. 4
Leptospirosis: Iowa-1 ................................. 22 T richinosis: .............. .. ................ ..... 43
Plague: Colo.- ......... ................. ......... 2 Typhus, marine: Ala.-1, Tex.-2 ......................... 27
Psittacosis: ............... ...... .................. 28 Polio, Unspecified IlI.-l .. .. ... .... ..... ..... 3


r--s r'.'o j ut-MUNJI"AL- EO.,'ASE "CENTER





Morbidity and Mortality Weekly Report


JULY 29, 1967


FATAL PLAGUE CASE Colorado
(Continued from front page)


Autopsy specimens of lymph nodes, spleen, kidney,
liver, and lung obtained after embalming, as well as a pre-
embalming blood specimen, were examined at the Plague
Laboratory of the San Francisco Field Station. Direct fluor-
escent antibody studies on all tissues were positive for
Pasteurella pestis. In addition, stained slides of naso-
pharyngeal fluid and lymph nodes revealed organisms mor-
phologically consistent with P. pestis.
Contacts of the original cases were given chemopro-
phylaxis. To date, no secondary cases are known to have
occurred.
Intensive epidemiologic and entomologic investigations
have been undertaken in the vicinity of the patient's home.


A search team has been unable to locate the presumably
infected prairie dog carcass. The Vector Control Division
of the Colorado State Department of Public Health is con-
ducting an extensive search for prairie dog carcasses and
is simultaneously "flagging" prairie dog burrows for col-
lection of fleas and subsequent spraying with 5 percent
Malathion. Laboratory results of the collections are not
yet available.
(Reported by C. S. Mollohan, M.D., Chief, Section of Epi-
demiology, Division of Preventive Medical Services, Colo-
rado State Department of Public Health; Plague Laboratory,
Zoonoses Section, Ecological Investigations Program, San
Francisco Field Station. NCDC; and an EIS Officer.)


IMPORTED FATAL CASE OF RABIES Oregon


A fatal case of imported rabies in a 9-year-old boy has
been reported from Oregon. The child had been bitten by a
neighbor's dog in Cairo, Egypt, shortly before the family
left the country on May 27. I t. traveled by ship to
Marseilles. France, drove by car to Monaco, and traveled
around in Spain and France. The family camped in rural
areas along the way; they noticed many bats which swooped
down at night, but there was no history of a bite. While in
Spain, the boy showed lassitude and nausea, but seemed to
recover quickly from these episodes. The family sailed
from Le Havre, France. on July 11.

When the family arrived in Montreal on July 21, the
boy vomited and appeared ill. The following day his con-
dition was worse. On July 23, he had "sinusitis," severe
headaches, temperature of 38.10C., ropy saliva and diffi-
culty in .r. iih;..,, he later became delirious with fever.
The mother and son flew to Portland, arriving on July 25;
on the plane the child was very irritable, restless, "wild,"
and hallucinatory. He was admitted to the Good Samaritan
Hospital upon arrival.


The patient was noted to have flaccid weakness of the
upper extremities and one leg, and sinusitis. Other physi-
cal findings appeared normal. On July 27, the patient had
hyperethesia in the upper extremities. A tentative diag-
nosis of "encephalitis etiology unknown" was made, with
rabies included in the differential diagnosis. Although
the patient's condition seemed to improve several times
during the course of the illness, he would soon lapse into
coma again. The patient died between 3:00 and 4:00 a.m.
July 31.
Later that day, autopsy specimens of brain tissue were
found positive for rabies by Sellers stain and direct fluo-
rescent microscopy procedures by the Oregon State Board
of Health laboratory.
Preliminary reports indicate that the neighbor's dog
that had bitten the patient had died. Rabies is reported
to be prevalent in the Cairo area at this time.
(Reported by Dr. Monroe Holmes, Veterinary Epidemiolo-
gist, Dr. Edward L. Goldblatt, State Health Officer, and
Mrs. Vivien Runte, Nurse Epidemiologist, all of the Ore-
oon State Board of Health.)


GASTROENTERITIS Virginia


Between April 20 and 23, 1967, an outbreak of gastro-
enteritis occurred among a group of 83 Civil Service offi-
cials who attended a conference in Virginia. Of the 83
participants, 77 were interviewed; 64 reported a gastro-
intcstinal illness beginning either at the conference or
shortly thereafter at home, giving an attack rate of 83 per-


cent. The onset of symptoms, which included non-bloody
diarrhea, abdominal cramps, chills, fever, nausea, vomiting,
and malaise, occurred between 17 and 72 hours (mean 36
hours) after arrival at the conference center. Duration of
illness was from 6 hours to 3 days (mean 24 hours). No
secondary cases were identified.


246







Morbidity and Mortality Weekly Report


The epidemiologic investigation was concentrated on
uncovering the source of the outbreak. Food histories
failed to reveal an item common to the ill group. The time
of arrival and departure from the conference varied greatly
among the affected persons. Consequently, water was sus-
pected as the common source of the agent responsible for
the outbreak.
Rectal swabs were obtained from 62 of the 77 persons
interviewed; 8 of these specimens, all from ill persons,
gave positive reactions of Escherichia coli 0111 by tube
serology. E. coli 0111:B4 was also isolated from one sam-
ple of well water and detected in 7 of 19 water samples by
fluorescent antibody technique. No other bacterial patho-
gens were isolated from either water or stool samples.
Further epidemiologic studies revealed that gastroen-
teritis had occurred among various conference groups at-
tending this center as early as March 1967. A group which
had met there immediately after the Civil Service Commis-
sion officials was also affected; stool specimens sub-
mitted by 6 of 14 members of the group were found positi e
for E. coli 0111:B4 by fluorescent antibody technique.


Examination by the Department of Sanitation of the
Virginia Department of Health revealed a high coliform
count in two of the three wells supplying the conference
center. Construction of all three wells was faulty. One w\as
located within 50 feet of the drainage area of a septic tank.
and another drew water from a stream which is fed by a
contaminated lake.
Control measures were immediately instituted. The
contaminated well ater w as chlorinated for use until a tem-
porary supply could be pumped in and chlorinated using an
erdelator (mobile disinfectant water unit) supplied by a
nearby U.S. Army base. When the drilling of a new well
w\as completed and the nex supply chlorinated, the con-
Laminated wells were permanently closed. No nex cases of
gastroenteritis have been reported since the completion of
these measures.
(Reported by Mack 1. Shanliolit. .D.. State Htealth Con-
,isxsiio, er. and Paul 'thite. I..D.. Bureau of Epidemioloyy,
Division of Disease controll V iryinia State Department of
Health; Stephen Granger, 1.ID.. Health Officer. Faiquier
(County health Department: aind a team of EIS Officers.)


SURVEILLANCE SUMMARY
MALARIA January 1-July 30, 1967


As of July 20, 1967, 1,355 malaria cases with onset
of illness in the United States and Puerto Rico were re-
ported to the Malaria Surveillance Unit. NCDC. Of these.
1,316 cases occurred among military personnel (including 92
recently discharged veterans), and 39 cases in civilians
(Table 1). The 1966 total of 678 cases consisted of 563
military and 115 civilian cases.
Only 3 of the 1,355 patients acquired their infection
in the United States. One became ill with falciparum malaria
in San Francisco following a blood transfusion (MMW\R.
Vol. 16, No. 15, p. 119) and at, Fort Campbell, Kentucky.
two servicemen acquired vivax malaria (MMI\\R. Vol. 16,
No. 29, p. 239). All but 4 of the 1.316 military cases ac-
quired malaria while stationed in Viet Nam.

Table 1
Cases of Malaria, United States
1962-1967*
Year Military** Civilian Total
1962 75 44 119
1963 58 90 148
1964 52 119 171
1965 51 105 156
1966 563 115 678
1967* 1,316 39 1,355

*Reported through July 20, 1967.
**Includes recently discharged veterans.


In 1.313 of the 1.355 cases (96.9 percent). the plas-
modium species was identified (Table 2). Plasmodium rita.r
\\as the etiologic agent in S2 percent of the cases and P.
falciparum accounted for 12.5 percent. Five cases of P.
malaria and six cases of P. ovale were also diagnosed.

The states x\here most of the patients became ill are
those with major military centers. Cases from six states
accounted for 59.5 percent of the total reported. These are
California-107, Colorado-s2. Georgia-110. Kentucky-170.
North Carolina-169. and Texas-16b.


(Reported by Ith ./alaria Surreillancc Unit, Epideniology
Program. NCD('.)

Table 2
Cases of Malaria by Plasmodium Species
United States, 1967*
Plasmodium Species Number Percent
P. v'ira. 1,111 b2.0
P. /alciparum 169 12.5
P. malariae .5 0.4
P. orale 6 0.4
Mixed infections 22 1.6
Undetermined 42 3.1

All Species 1.355 100.0
*Reported through July 20, 1967.


JULY 29, 1967







Morbidity and Mortality Weekly Report


JULY 29, 1967


SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS
JUNE 1967 JUNE 1966

CASES OF PRIMARY AND SECONDARY SYPHILIS: By Reporting Areas June 1967 and June 1966 Provisional Data

Cumulative Cumulative
Reporting Area June Jan June Reporting Area June Jan June
1967 1966 1967 1966 1967 1966 1967 1966
NEW ENGLAND ............... 17 38 181 242 EAST SOUTH CENTRAL ........ 145 186 917 1,125
Maine ..................... I 3 Kentucky ................. 20 11 75 63
New Hampshire............. 5 5 Tennessee............... 22 23 130 140
Vermont .................. 2 1 Alabama .................. 63 119 511 627
Massachusetts ............ 13 29 112 167 Mississippi .............. 40 33 201 295
Rhode Island.............. 2 2 17 17
Connecticut............... 2 6 45 49 WEST SOUTH CENTRAL........ 279 201 1,556 1,285
Arkansas ................. 7 6 67 72
MIDDLE ATLANTIC............ 284 316 1,738 2,075 Louisiana ................ 47 39 309 312
Upstate New York......... 21 26 139 190 Oklahoma ................. 9 11 66 71
New York City............ 162 188 1,035 1,311 Texas .................... 216 145 1,114 830
Pa. (Excl. Phila.)....... 18 11 123 99
Philadelphia............. 28 19 131 128 MOUNTAIN................. 50 35 304 201
New Jersey ............... 55 72 310 347 Montana.................. -4 4 22
Idaho.................... 1 14 1
EAST NORTH CENTRAL........ 226 289 1,577 1,581 Wyoming .................. 4 11 -
Ohio ..................... 34 51 314 294 Colorado................. 1 2 38 25
Indiana ................. 16 9 62 45 New Mexico............... 12 12 80 45
Downstate Illinois ....... 19 14 88 97 Arizona.................. 31 14 144 92
Chicago ................. 66 87 473 513 Utah ..................... 1 1 5 5
Michigan .................. 90 121 624 576 Nevada................... 2 8 11
Wisconsin................ 1 7 16 56
PACIFIC................... 140 167 935 926
WEST NORTH CENTRAL........ 27 34 139 221 Washington............... 2 2 29 20
Minnesota ............... 1 6 20 16 Oregon................... 6 6 26 26
Iowa..................... 2 5 14 33 California............... 132 153 874 863
Missouri................. 12 8 48 92 Alaska................... 1 3
North Dakota............. 1 2 4 Hawaii...................... 6 5 14
South Dakota.............. 4 1 18 23
Nebraska.................. 2 16 20 U. S. TOTAL............... 1,785 1,693 10,435 10,739
Kansas ................... 7 12 21 33
TERRITORIES............... 91 101 472 513
SOUTH ATLANTIC............. 617 427 3,088 3,083 Puerto Rico.............. 87 99 448 500
Delaware................. 5 4 29 19 Virgin Islands............ 4 2 24 13
Maryland................. 53 58 315 276
District of Columbia..... 89 38 356 224
Virginia.................. 27 23 144 146
West Virginia............. 3 4 10 29
North Carolina............ 74 66 357 470 Note: Cumulative Totals include revised and delayed reports
South Carolina........... 68 56 431 458 through previous months.
Georgia................. 92 64 463 518
Florida.................. 206 114 983 943


ANNUAL SURVEILLANCE SUMMARY
RUBELLA 1966


A total of 45,895 cases of rubella was recorded for
the United States during 1966, the first year that this
disease was nationally reportable. A peak of 7,708 cases
was seen during the 4-week period ending May 21, 1966.
Illinois, Indiana, Michigan, Ohio, and Wisconsin reported
32.2 percent of the U.S. total during 1966. Nine states
(Georgia, Kansas. Louisiana, Mississippi. Nevada, New
Jersey. New Mexico, North Carolina, and Oklahoma) re-
ported no cases during this period.
Rubella case rates for 1966 by region are shown in
Figure 1. In each region, the highest rates were recorded
during the spring months. The Mountain Region had the
highest rate, with an early spring peak rate of 145 per
100.000 population, and ihe New England Region was
second highest with 105 per 100,(000 population. The low-
e-I rate; wero noted in the West South Central and Middle
Atlantic Regions.


Examination of the case rates in 24 states which re-
reported rubella prior to 1966 allows comparison of that
year with 1964, the last known epidemic year (Figures
2 and 3). The case rate per 100,000 population for the 24
states was 33.4 in 1966 compared with 365.7 in 1964, a
tenfold difference. In 1964, 21 states had case rates ex-
ceeding 100 and no states had rates less than 50. In con-
trast, during 1966 Arizona and Washington were the only
states with rates of 100 or greater, while 10 states had
rates less than 25.
Nineteen cases of the congenital rubella syndrome
were reported during 1966 and all were from seven states:
Colorado (1), Illinois (3), Michigan (4), Minnesota (7), Ore-
gon (1), Pennsylvania (2), and Virginia (1). Diagnosis of
congenital rubella syndrome can be established with rea-
sonable certainty by laboratory tests on sera collected
when the suspect case is 6 to 12 months old.


248






Morbidity and Mortali


Rubella data by month of report are available for 24
states for the 10-year period 1956-66. Figure 4 demon-
strates the marked rise in total reported cases in 1964 for
this selected group of states. A seasonal increase is
apparent during the months of March, April, and May each
year. A sharp increase in cases occurred in all sections
of the country except the Pacific States during the winter
and spring of 1963-64. This increase was most pronounced
in the Northeast Region with a peak of 47.161 reported
cases in April 1964. The North Central Region reported
27,770 cases, the South 19,538 cases, and the Mountain
States 6,226 cases during the same month. However, not
until the winter and spring of 1964-65 did the far West
note a marked increase in the number of rubella cases
when a peak of 8,975 occurred in March 1965.
The 24 selected states for which morbidity data are
available reported 46 deaths due to rubella during 1960-64.


JULY 29, 1967


Figure 1
RUBFLLA RATES BY REGION AND FOUR-WEEK PERIOD
UNITED STATES, 1966


WEST NORTH CENTRAL

loo


MOUNTAIN



A


.19 26 3 3 8 16 3 3 0 5 3 3 i

PACIFIC





40 2



29 36 26 3 1 6 6 0 D 3D
ru~udJASOND


EAST NORTH CENTRAL

















EAST SOUTH CENTRAL


NEW ENGLAND


MIDDLE ATLANTIC


29 26 .6 .3 2t 6 i so 5 3
so
SOUTH ATLANTIC






ao


29 26 26 2i 2 6 3 i l0 B o 3 1
j r a A l M j l S O N^ O D


ity Weekly Report 249





The North Central and Northeast areas, with 19 and 11
respectively, had the highest number of deaths during this
5-year period. However, these two areas have relatively
large populations. The mortality rates and the death to
case ratios are nearly uniform in all five areas. In addi-
tion to deaths recorded as primarily due to rubella, data
are available on the number of infant deaths attributed to
maternal rubella.* From 1955 to 1964, a total of 112 deaths
including 33 among immature infants were recorded in this
category.** A total of 40(35.7 percent) were noted in 1964.
(Reported by the Childhood Viral Diseases~ Unit, Epidemi-
ology Program. NCDC.)

'Vital Statistics of the united Statei s, Death, and death rate
for eac.h cause. 1955 19It.
'*" nerntion li classification or dist as \\,1.O 7th revision
rubric 7967: "Attributed to maternal rurhnella \lh imma-
turltN ."


WEST SOUTH CENTRAL









9 26 6 A 2 IB 6 1 s 8 S 3 1
4-wEE PERIOD ENDING





Morbidity and Mortality Weekly Report


JULY 29, 1967


Figure 2
RUBELLA CASE RATES FOR SELECTED STATES 1964


ALASKA
D


HAWAII


CASE RATES PER
100,000 POPULATION
| LESS THAN 25
E 25-49

EL 50-99
S100 OR GREATER


Figure 3
RUBELLA CASE RATES FOR SELECTED STATES 1966
ALASKA











HAWAII


CASE RATES PER
100,000 POPULATION
[ LESS THAN 25
1 25-49
S50 99
m 100 OR GREATER


250


PUERTO RICO
F-


PUERTO RICO
D








JULY 29. 1967


Morbidity and Mortality Weekly Report






Figure 4
RUBELLA BY MONTH OF REPORT FOR 24 SELECTED STATES
1955-66*


,20,000


MOUNTAIN





-- A ^ V_


PACIFIC

)0"


)0


O0


)0


)0



SOUTH

10






955 56 7 58 59 60'61 62 63 '64 65 '66


TOTAL 24 STATES















AxhA-A LA


1956 '57 '58 '59 '60 61 62 '63
1966 BY WEEK PERIODS


'64 65 66 67


42000 NORTHEAST


36000


30000


24000


18000


12000


6000





30000


24000


18000
NORTH CENTRAL

12000


6000



1955 '56 57 '58 '59 '60 t '62 '63 64 '65 '66


YEAR


* 1966 BY 4-WEEK PERIODS








252 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
JULY 29, 1967 AND JULY 30, 1966 (30th WEEK)


ENCEPHALITIS HEPATITIS

ASEPTIC Primary
AREA MENINGITIS BilICELLOblS DIPHTHERIA including Post- Serum Infectious
unsp. cases Infectious
1967 1966 1967 1967 1967 1966 1967 1967 1966 1967 1966
UNITED STATES... 68 87 3 34 45 23 50 41 648 541

NEW ENGLAND.......... 21 1 1 1 24 19
Maine.............. 1 3 2
New Hampshire...... 3 1 4
Vermont............ 1
Massachusetts...... 16 1 1 13 5
Rhode Island....... 1 1 4 1
Connecticut............ 3 6

MIDDLE ATLANTIC ...... 8 4 1 10 6 27 21 129 85
New York City...... 4 5 22 16 55 29
New York, Up-State. 2 1 3 1 25 21
New Jersey......... 2 5 2 5 19 8
Pennsylvania....... 2 2 3 2 30 27

EAST NORTH CENTRAL... 9 6 16 4 5 4 1 84 79
Ohio................ 1 2 13 3 1 19 16
Indiana............. 3 1 5 2
Illinois........... 6 1 3 2 39 6
Michigan............ 1 4 2 1 16 45
Wisconsin.......... 1 5 10

WEST NORTH CENTRAL... 9 2 2 3 2 1 1 42 30
Minnesota.......... 2 1 1 1 9 9
Iowa............... 2 2 7 6
Missouri........... 1 24 10
North Dakota...... 1 -
South Dakota....... 9 1
Nebraska ...........- -
Kansas............. 1 1 4

SOUTH ATLANTIC....... 6 23 2 1 3 6 64 35
Delaware............ 2 4 -
Maryland............ 2 1 2 10 7
Dist. of Columbia.. -
Virginia............ 1 1 1 1 6 6
West Virginia...... 6 5 2
North Carolina..... 1 2 3 14 8
South Carolina..... 3 2
Georgia............ 13 5
Florida............. 2 13 2 9 5

EAST SOUTH CENTRAL... 13 7 4 3 1 1 40 34
Kentucky............ 1 8 8
Tennessee.......... 6 1 4 3 1 1 14 15
Alabama............ 6 8 2
Mississippi....... 6 10 9

WEST SOUTH CENTRAL... 4 8 1 3 13 1 1 77 43
Arkansas........... 4 4
Louisiana.......... 1 1 3 11 1 8 6
Oklahoma........... 9 2
Texas............... 3 7 1 2 1 56 31

MOUNTAIN............ 1 3 3 1 19 43
Montana............ 2 2
Idaho............... -- 6
Wyoming............. 2 1
Colorado............ 1 2 1 6 22
New Mexico......... 4 3
Arizona.............. 1 5 9
Utah.............. 2 -
Nevada ............-

PACIFIC.............. 18 16 1 3 7 4 16 11 169 173
Washington......... I 1 15 15
Oregon............. 4 1 17 31
California......... 16 15 1 3 7 4 12 9 132 126
Alaska............. 2 1
Hawaii.............. 2 3

Puerto Rico 2 19 16








Morbidity and Mortality Weekly Report 253


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

J'LY 29, 1967 AND JULY 30. 1966 (30th WEEK) CONTINI'ED


MENINGOCOCCAL INFECTIONS,
MALARIA MEASLES (Rubeola) ENIN TOTCCAL FECTIONSPOLIOMYELITIS RUBELLA
AREA Total Paralytic
Cumulative Cumulative To Par
Cum .
1967 1967 1967 1966 1967 1967 1966 1967 1967 1967 1967
UNITED STATES... 50 286 56,335 185,346 26 1,537 2,482 3 2 15 327

NEW ENGLAND........... 1 6 814 2,184 2 60 112 55
Maine ............. 233 192 3 9 8
New Hampshire...... 74 67 2 9
Vermont............ 42 221 -4 1
Massachusetts....... 1 4 316 753 1 30 43 23
Rhode Island ....... 2 62 72 4 12 4
Connecticut........ 87 879 1 21 35 19

MIDDLE ATLANTIC...... 2 11 2,167 17,818 9 20 -36 1 1 4 37
New York City...... 4 421 8,210 4 44 39 1 17
New York, Up-State. 5 543 2,449 1 60 81 1 20
New Jersey......... 2 1 478 1,842 2 88 82 -
Pennsylvania....... 1 725 5,317 2 58 84 1 1 2

EAST NORTH CENTRAL.. 3 60 5,137 67,512 7 208 382 1 36
Ohio............... 7 1,125 6,309 2 69 102 8
Indiana............ 1 585 5,598 1 29 65 4
Illinois........... 2 25 904 11,230 2 47 74 1 9
Michigan............ 1 1 879 13,867 2 48 102 15
Wisconsin .......... 26 1,644 30,508 15 39

WEST NORTH CENTRAL... 3 11 2,792 8,603 2 66 138 2 9
Minnesota.......... 2 119 1,637 16 33 1
Iowa............... 743 5,272 12 21 1 2
Missouri............ 330 528 1 13 54 -
North Dakota....... 9 834 1,051 1 9 1
South Dakota....... 52 40 6 4
Nebraska........... 621 75 1 12 8 5
Kansas.............. 3 93 NN 6 9 -

SOUTH ATLANTIC....... 12 47 6,716 14,706 2 292 414 1 1 55
Delaware ........... 43 251 1 6 4 8
Maryland........... 1 146 2,083 34 41 1 10
Dist. of Columbia.. 22 380 10 11 -
Virginia............ 1 31 2,121 2,069 34 49 34
West Virginia...... 4 1,346 5,069 20 19 -
North Carolina..... 10 2 841 410 64 102 1 1
South Carolina..... 1 2 506 642 1 28 46
Georgia............ 32 233 -44 57 -
Florida............. -7 1,659 3,569 52 85 -- 3

EAST SOUTH CENTRAL... 16 29 5,073 19,370 1 122 215 1 61
Kentucky............ 16 17 1,315 4,661 34 80 59
Tennessee .......... 9 1,794 12,066 1 51 70 2
Alabama ........... 2 1,308 1,660 24 46
Mississippi........ 1 656 983 13 19 1

WEST SOUTH CENTRAL... 5 34 16,987 23,668 211 358 6 1
Arkansas ........... 1,404 966 28 33 -
Louisiana.......... 1 1 150 93 82 136 -
Oklahoma........... 4 3;320 470 16 18 I -
Texas .............. 33 12,113 22,139 85 171 5

MOUNTAIN ............ 3 28 4,537 11,62 1 27 77 18
Montana............ 2 277 1,800 4 -2
Idaho .............- 374 1,514 1 5
Wyoming............ 178 144 1 6
Colorado.............. 3 21 1,523 1,218 1 12 40 7
New Mexic.......... 573 1,101 3 10 -
Arizona.. ......... .. 4 987 5,218 4 8 8
Utah............... 1 356 586 4 1
Nevada............. 269 43 2 4

PACIFIC............... 5 60 12,112 19,861 2 301 500 -55
Washington......... 9 5,400 3,453 25 37 2
Oregon.............. 16 1,539 1,624 24 32 -6
California......... 4 32 4,888 14,329 2 239 412 25
Alaska ............. 130 332 9 15 -15
Hawaii............. -3 155 123 4 4 7
Puerto Rico.......... 10 2,059 2,452 1 11 10 3








254 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JULY 29, 1967 AND JULY 30, 1966 (30th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
AREA SCARLET FEVER (Rky. Mt. Spotted) ANIMALS
1967 1967 Cum. 1967 Cum. 1967 Cum. 1967 Cum. 1967 Cum.
1967 1967 1967 1967 1967
UNITED STATES... 4,770 4 112 4 92 5 222 11 144 94 2,653

NEW ENGLAND.......... 692 1 3 1 1 3 60
Maine...... I ..... 27 1 15
New Hampshire...... 17 -- 1 35
Vermont............. 31 7
Massachusetts...... 88 1 2 1 1 1 2
Rhode Island....... 53 1
Connecticut........ 476 1 -

MIDDLE ATLANTIC...... 232 9 21 17 4 52
New York City...... 4 5 10
New York, Up-State. 220 1 7 4 4 43
New Jersey......... NN 1 2 6
Pennsylvania....... 8 2 2 7 9

EAST NORTH CENTRAL... 328 1 15 10 2 16 1 15 12 278
Ohio............... 115 4 4 7 3 97
Indiana............. 59 2 2 4 1 4 58
Illinois........... 34 1 7 8 1 1 7 2 56
Michigan........... 81 2 2 6 23
Wisconsin.......... 39 1 3 44

WEST NORTH CENTRAL... 190 10 14 2 13 1 23 630
Minnesota.......... 2 3 1 5 120
Iowa............... 69 1 1 2 2 76
Missouri........... 6 5 4 1 6 1 4 118
North Dakota....... 51 5 111
South Dakota....... 7 1 1 4 90
Nebraska........... 37 1 3 1 40
Kansas............. 18 8 1 2 75

SOUTH ATLANTIC....... 598 25 8 27 2 57 9 348
Delaware........... 5 -
Maryland............ 153 2 11
Dist. of Columbia.. 3 1 -
Virginia........... 145 6 4 1 16 2 167
West Virginia...... 109 2 1 54
North Carolina..... 22 6 3 20 3
South Carolina..... 2 1 2 4 3
Georgia............. 6 3 3 8 1 7 5 79
Florida............. 153 9 1 4 2 45

EAST SOUTH CENTRAL... 940 18 8 32 5 26 14 516
Kentucky............ 78 1 14 2 9 6 114
Tennessee.......... 712 8 5 6 3 13 7 364
Alabama............ 94 7 8 4 1 36
Mississippi........ 56 3 2 4 2

WEST SOUTH CENTRAL... 518 2 19 4 41 27 2 13 18 548
Arkansas........... 1 5 4 26 7 3 1 77
Louisiana.......... 3 3 12 1 46
Oklahoma........... 35 9 4 6 11 177
Texas.............. 483 1 11 3 4 2 4 5 248

MOUNTAIN ............. 676 7 16 8 5 84
Montana ............. 22 I I1 -
Idaho.............. 35 -
Wyoming............ 8 2 4
Colorado........... 384 1 11 8 1 10
New Mexico......... 121 1 24
Arizona............ 61 3 3 41
Utah............... 45 3 1 2
Nevada ............ 3

PACIFIC.............. 596 1 15 4 1 67 6 6 137
Washington......... 62 2 1 1
Oregon............. 42 1 1
California......... 456 1 12 2 1 64 5 6 135
Alaska............. 21 -
Hawaii.............. 15 2 3 3

Puerto Rico.......... 19 9 4 2 25






Morbidity and Mortality Weekly Report







DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED JULY 29, 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 year
over Influenza All Influenza All
Ages and over Causes Ages and over 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.------

fIDDLE 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, Il.---------
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.--------


659
205
39
26
26
58
24
17
32
45
56
7
37
37
50

3,224
48
26
140
46
24
48
79
86
1,621
42
491
186
44
108
28
31
56
51
36
33

2,503
58
44
765
155
203
119
73
281
36
58
38
45
44
150
37
124
39
30
34
113
57

839
56
20
26
130
26
141
75
234
75
56


388
116
16
9
21
30
14
10
25
24
32
5
27
25
34

1,827
28
16
74
25
16
35
40
40
899
27
279
104
29
77
19
18
27
29
24
21

1,370
29
30
399
79
115
64
46
155
20
28
23
26
29
73
23
71
25
22
19
66
28

513
36
12
10
86
20
90
45
136
45
33


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, Te -.--- -----
Baton Rouge, La.-------
Corpus Christi, Tex---
Dallas, Tex------
El Paso, Tex.----------
Fort -orth, Tex.-------
Houston, Tex.----------
Little Rock, Ark.-------
New Orleans, La.-------
Oklahoma City, Okla.---
San Antonio, Tex.------
Shrevcport, La.--------
Tulsa, Okla.-----------

MIOUNTAIN:
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.-----------


1,171
120
254
52
79
98
50
68
35
78
70
214
53

593
87
38
31
104
146
52
28
107

1,021
29
26
23
114
28
60
242
50
166
96
105
53
29

368
29
14
100
15
76
30
54
50

1,502
14
43
26
59
81
465
88
31
116
59
88
175
39
132
50
36


Total 11,880 6,545 386 630

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages -------------------------375,744
All Causes, Age 65 and over-------------------215,249
Pneumonia and Influenza, All Ages------------- 13,673
All Causes, Under 1 Year of Age--------------- 19,028


Week No.
30






256 Morbidity and Mor






ERRATUM: Vol. 16, No. 29 (week ending July 22, 1967)
Last week's MMWR, which should read Vol. 16, No. 29

(week ending July 22, 1967), was mistakenly labeled as

Vol. 16, No. 28 (week ending July 22, 1967). To avoid

confusion with Vol. 16, No. 28 (week ending July 15, 1967),

please correct the following issue as No. 29.


rtal1


ity weekly report JULY 29, 1967
UNIVERSITY OF FLORIDA



3 1262 08864 1922

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

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY, THE NATIONAL COMMUNICABLE DISEASE
CENTER WELCOMES ACCOUNTS OF INTERESTING OUTBREAKS 3R CASE
INVESTIGATIONS WHICH ARE OF CURRENT INTEREST TO HEALTH
OFFICIALS AND WHICH ARE DIRECTLY RELATED TO THE CONTROL OF
COMMUNICABLE DISEASES. SUCH COMMUNICATIONS SHOULD BE
ADDRESSED TO:
THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT
NATIONAL COMMUNICABLE DISEASE CENTER
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
ON SATURDAY; COMPILED DATA ON A NATIONAL BASIS ARE RELEASED
ON THE SUCCEEDING FRIDAY.


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