Morbidity and mortality

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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
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The Office
Place of Publication:
Washington, D.C
Publication Date:
Frequency:
weekly
regular

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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:
AA00010654:00044

Related Items

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

Full Text

/ NATION AL COMMUNICABLE DISEASE CENTER


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


BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


CURRENT TRENDS
MEASLES

A total of 223 cases of measles \\as reported for the
40th week (ending Oct. 7, 1967), an increase of 47 cases
o\er the previous week's total. The 4-week total(Sept. 10-
Oct. 7) of S2S cases is approximately 4S percent of the
cases reported for the same period last year.
The reporting for the 40th week concludes the mea-
sles Epidemiologic Year 1966-67 (EY '66-'67). and marks
the end of the summer plateau in measles before the yearly
increase coincident with the opening of school throughout
the nation. In Figure 1. the reported cases of measles
(accumulated by 4-week periods) for EY '66-'67 are com-
pared to the cases notified in EY '65-'66 and EY '64-'6(5.
For EY '66-'67. 70,638 cases of measles have been
reported to the NCDC. representing one-third of the 213,992


(ONITEVN I
C current Trend-
M..- .-.- . . ............ .. : i


An OuthrcIk fl Ga < cntr i md 1 h -', eor
in L.s. \Viitur to ritil h C lumlhi. .. : 6
r.p -hylococ( al Fooi Poi nin N-ir \ Jir- \ .... 7i
-.l,-rn Enc phal ti s- N ,i Jcr-i ..... .... 3
Sunm.ir 4 Ri-ortci (C \uiu.'i I ,tn ..ln.r .967 .. ... .................... .;'9

cases reported in EY '(1 -'f6. The recent epidemiologic
\ear total is the lo Pest one on record.
In spite of these impre-sive figures and trends, mea-
-le- has been a problem in a number of states during the
past 13 weeks. particularly in the three Pacific Coastal
States and in Texas. \\isconsin. and Illinois. These ,-i
states have accounted for oxer half of the measles re-
ported to the NCDC during this period.


Figure 1
REPORTED MEASLES BY FOUR-WEEK PERIODS UNITED STATES
EPIDEMIOLOGIC YEAR, 1966-67 COMPARED WITH 1964-65 AND 1965-66
48.000

44,000-

40,000

o 36,00




a 28,000

24,000
,J /v
S20.000
S/, 9
16,000 \,

12,000 1966 67
z Z -- 5


5 3 31 28 25 25 2 2 20 7 15 12 9 7
NOV DEC DEC JAN RE6 MAR APR MAY JUN JUL AUG SEP OC1
FOUR-WEEK PERIOD ENDING


Vol. 16, No. 40







Week Ending

October 7, 1967



PUBLIC HEALTH SERVICE




Morbidity and Mortality Weekly Report


OCTOBER 7, 1967


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
40th WEEK ENDED CUMULATIVE, FIRST 40 WEEKS
MEDIAN
DISEASE OCTOBER 7, OCTOBER 8, 1962 1966 MEDIAN
1967 1966 1967 1966 1962 1966
Aseptic meningitis ...................... 85 92 78 2,197 2,323 1,591
Brucellosis. ............................ 3 3 8 199 199 286
Diphtheria ................ ... ... ... .14 3 7 115 147 192
Encephalitis, primary:
Arthropod-borne & unspecified ......... 32 65 1,242 1,687 --
Encephalitis, post-infectious ........ ... 4 11 663 616 -
Hepatitis, serum ................... ..... 45 30 ( 1,668 1,069
Hepatitis, infectious .................... 823 593 29,525 24,469 2 1
Malaria ............................... 41 16 4 1,529 324 75
Measles (rubeola)....................... 223 472 805 58.445 190,817 360,887
Meningococcal infections, total ........... 27 34 37 1,772 2,818 2,149
Civilian ............................ 26 33 1,656 2,539 -
Military ............... ..... ..... 1 1 116 279 -
Poliomyelitis, total ..................... 1 3 25 73 87
Paralytic ............................. 1 2 21 68 71
Rubella (German measles) .......... ..... .193 233 40.406 42,374 -
Streptococcal sore throat & scarlet fever .. 5,978 6,058 5,565 345,813 326,761 304,519
Tetanus ................... ............ 4 10 6 174 147 206
Tularemia ........... .................. 2 5 5 140 141 222
Typhoid fever ................. ......... 8 15 15 324 299 333
Typhus, tick-borne (Rky. Mt. spotted fever) 3 7 3 281 222 207

Rabies in animals .................... 59 50 58 3,402 3,233 3,233
NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ................ ................. 2 Rabies in man: ..................... .............. 2
Botulism: ............................... .... ......... 2 Rubella, Congenital Syndrome: ............. .......... 4
Leptospirosis: Ala.-l, Ark.-2, Hawaii-1 ................. 32 Trichinosis: ........................... ........... 49
Plague: ............................................ 2 Typhus, murine: Tex.-l, Puerto Rico-1 ................. 34
Psittacosis: Tex.-1 ............ ........ ........... 36 Polio, Unsp .................... ............ 4

EPIDEMIOLOGICAL NOTES AND REPORTS
PENTACHLOROPHENOL POISONING IN NEWBORN INFANTS St. Louis, Missouri


From April to August 1967, nine cases of a clinically
distinct illness characterized by fever and profuse sweat-
ing occurred in a small nursery for newborns in St. Louis,
Missouri. Two of the cases were fatal. Early in the course
of the outbreak the disease was felt to be an intoxication.
hut the nature of the poison and the mode of exposure of
the patients remained obscure. Only after the ninth case
developed was it discovered that an antimildew agent,
containing a high concentration of sodium pentachloro-
phenate (the sodium salt of pentachlorophenol), was being
used in the hospital laundry. All of the clinical, epi-
demiological, and biochemical evidence indicated that
this outbreak resulted from pentachlorophenol poisoning.
The only identified mode of exposure was skin absorption
of sodium pentachlorophenate residues on diapers and
other fabrics, resulting from the misuse of the antimildew
agent in the final laundry rinse.
The outstanding clinical feature of the illness was
extreme diaphoresis. Attendants consistently noticed that
the infants' clothing and brows were drenched with sweat.
Nevertheless. the neonates nursed avidly. As the disease
progressed, fever rose as high as 103F. respiratory rates
increased, and breathing became labored, though ausculta-
tion of the lungs was normal and cyanosis was absent.
Other common findings included tachycardia, hepato-
megaly. and irritability followed by lethargy. Anorexia.
vomiting, and diarrhea \oere notably absent. Stiffness of
the neck, muscular fasciculations. and convulsions were


not observed. Skin rashes or evidences of inflammation or
irritation of the skin were not seen.
Laboratory tests frequently showed a progressive
metabolic acidosis, proteinuria, a rising blood urea nitro-
gen, and "pneumonia" or "bronchiolitis" on X-ray. Bac-
terial and viral cultures of blood, cerebrospinal fluid,
nose, throat and stool revealed no pathogens. Autopsy
findings of the two fatal cases showed fatty metamorphosis
of the liver in both cases and fatty vacuolar changes in
the renal tubules of one case.
All except one of the seriously ill infants, a fatal
case, were transferred to other hospitals for treatment.
After the first fatal case occurred, the attending physi-
cians suspected a toxic cause and therefore promptly per-
formed exchange transfusions on each of the seriously ill
infants who were subsequently transferred for medical
care. This treatment yielded dramatic results. Within min-
utes to hours, the infants became more responsive and
had less respiratory distress. Fever and sweating dis-
appeared, as did metabolic acidosis. Renal function re-
turned to normal during the next few days. Except for the
two fatal cases, recovery was apparently complete.
The first four cases developed between April 17
and 19 among a group of 25 infants who were in the nursery
during this interval. The first infant to become ill died. p
The institution was closed on April 24 and thoroughly
cleaned and disinfected before re-opening on May 3. A
second cluster of four cases occurred between May 10


334





Morbidity and Mortality Weekly Report


and 15. One of these also was fatal. The average age of
these eight cases, at onset of illness, was 8.9 days.
Several additional suspect cases with fever and sweating
were detected among 13 infants who had been discharged
from the hospital in apparent health between April 17
and May 15.
From the time of the first recognition of the outbreak,
an intensive and persistent search was made for toxic
substances in the environment of the infants. A solid-
stick e aporating deodorizer had been used without change
in practice for 4 years. A commercial exterminator had
sprayed regularly with a carbamate insecticide monthly
for 2 years within the hospital, but never in the nursery.
The management of drugs and the preparation of babies'
formulas revealed no deviations that were likely to per-
mit the introduction of a toxic substance to this many
babi es,
For the preceding 10 months, a commercially avail-
able disinfectant containing a mixture of synthetic phenolic
derivatives had been used extensively and frequently in
the nursery, and had been repeatedly applied to surfaces
that came in contact with infants' skin.
One-dimensional thin-layer chromatography of serum
specimens obtained from the first eight cases was per-
formed. These tests revealed the presence of a phenolic
substance in all test specimens, which was similar to a
phenolic ingredient of the disinfectant. This substance
was thought to be the toxic chemical causing the disease.
The nursery \\as closed and recleaned. Use of the
suspect disinfectant was abandoned, and all equipment
that had been treated with it was discarded or rendered
free of phenolic residues by extensive cleaning with
alcohol. New linens and diapers were purchased and the
nursery reopened July 11.
On August 29, an 8-day-old infant had the acute onset
of an illness identical to the previous eight infants. The
infant received an exchange transfusion and promptly re-
covered. A follow-up survey of infants discharged from
the hospital in July and August revealed six additional
infants who had the characteristic excessive sweating in
a milder form of the same syndrome.
The formerly suspect disinfectant was no longer in
use. Reinvestigation of laundry procedures disclosed a
previously overlooked source of phenols. An antimildew
agent, containing 22.9 percent sodium pentachlorophenate
and 4.0 percent trichlorocarbanilide, was being used in
the terminal rinse of all nursery linens and diapers, de-
spite a warning on the label that the compound "must not
be used" in laundering diapers.
This product had been in use in the laundry since
March 1966. The recommended quantity was one ounce of
powder per laundering cycle, but it was ascertained that
the laundry was actually using 3 to 4 ounces.
Thin-layer chromatography of the serum and urine of
the new case revealed an abnormal substance with charac-
teristics that were identical to those detected in the pre-
vious infants' sera. Further studies in two different lab-
oratories with improved methods of analysis have shown
that. the chemical in the urine and serum of the new case


was pentachlorophenol, and was clearly not one of the
phenolic ingredients in the previously suspected disin-
fectant. Additionally, pentachlorophenol xas identified
in freshly laundered diapers obtained from the nursery.
The quantity of pentachlorophenol varied from 1.5 to 5.7 ing,
per diaper. Pentachlorophenol. when fed to rats, \as found
to be highly toxic and was isolated from urine of surviving
rats in concentrations comparable to that found in the sick
child. Unfortunately, no samples from the earlier cases
remained for these more sophisticated analyses.
Actions have been instituted to prevent further ill-
nesses that might be caused by the misuse of this product.
or two other sodium pentachlorophenate-containing pro-
ducts that are recommended for similar purposes. The
manufacturer has been directed to trace all sales and
shipments of these products during the past 1 months,
and to remove such products from all hospitals and any
establishment that is involved in general laundry work.
The company has voluntarily ceased sale of these three
products.
(Reported by J. Earl Smith, ll.D., Health Commissioner.
Division of Health, Department of Health and Hospitals.
( of St. Louis, lissouri: L. E. Loveless. Ph.D., Chem-
ist. Clinical Laboratories. St. Louis. llissouri: E. A.
Belden, M.D.. Consultant, Communicable Disease Control.
Local Health Services Section. Division of Health, .lis-
souri Department of Public Health and Welfare; the Epi-
demiology and Pesticides Programs of the National Com-
municable Disease Center. Atlanta. Georgia: the Toxi-
cology Section, Occupational Health Program, National
Center for Urban and Industrial Health. Cincinnati. Ohio;
and a team of EIS Officers.)
Editorial Note:
The clinical, laboratory, epidemiological, and patho-
logical findings, as well as the prompt response to ex-
change transfusion. all indicate a toxic. rather than an
infectious, cause of this outbreak. The fever, sweating.
and acidosis are consistent with intoxication with cer-
tain phenolic derivatives. which are known to increase
the metabolic rate. The symptoms described here are re-
markably similar to industrial accidental poisonings re-
sulting from overexposure to pentachlorophenol or its
sodium Ir.- '. The exact manner in which the infants
became poisoned cannot be established, but the most rea-
sonable explanation is absorption through the intact skin
as a result of repeated contact with diapers, blankets,
and linens containing small, but readily absorbable, quan-
tities of sodium pentachlorophenate. The antimildew agent,
which is labelled not for use in laundering diapers or
hospital linens, nevertheless, was in use in this hospital.
Pediatricians, hospital administrators, housekeepers, and
local health authorities should check commercial diaper
services and hospital laundries to ensure that this pro-
duct is not in use.
REFERENCES:
'Bennett, I. L., Jr., James, D. F., and Golden, A.: Severe
acidosis due to phenol poisoning: report of two cases. Ann
Intern Med 32:324-327.
2Gordon, Douglas: How dangerous is pentachlorophenol? Med
J Aust 2:485-488, 1956.
3Blair, D. M.: Dangers in using and handling sodium pentachloro-
phenate as a molluscicide. Bull I\HN 25:597-601, 1961.


OCTOBER 7, 1967




336 Morbidity and Mortality Weekly Report OCTOBER 7, 1967


AN OUTBREAK OF GASTROENTERITIS AND TYPHOID FEVER
in United States Visitors to British Columbia


On September 29, 1967, two physicians from Portland,
Oregon, reported three possible cases of typhoid fever to
the City and State Health Departments. An immediate in-
vestigation revealed that during the third week of August,
a group of 26 youths from the Portland area had travelled
to Cranbrook. British Columbia, to attend an ice hockey
training session. I ri. live of these boys developed
gastroenteritis. In addition. 41 persons from 11 families
went to Cranbrook with their boys or to bring them home.
Although the families stayed at different places in the
area. 36 of the 41 family members developed cases of fe-
brile gastroenteritis. All persons who became ill after
arriving in British Columbia developed their illnesses
between 2 and 11 days after arrival; mean and median
onset dates were 7 days after arrival (Figure 2).
Among a total of 67 persons from Oregon who went to
British Columbia, 61 had gastrointestinal symptoms. Of
these, 80 percent had diarrhea, 64 percent had abdominal
cramps, 54 percent reported fever, 47 percent were nau-
seated, 30 percent vomited. 33 percent experienced head-
ache, 25 percent had chills, and 8 percent had bloody
diarrhea. The shortest duration of illness was one hour,
but several children have had intermittent symptoms for
weeks; the median duration was 4 days. Only one case of
a mild gastrointestinal illness occurred in a household
contact who did not visit British Columbia. Otherwise,
there were no secondary cases. Five children were hos-
pitalized with gastroenteritis; the illnesses of three of
these children were confirmed as typhoid fever.
Case No. 1
This 12-year-old boy arrived in British Columbia on Au-
gust 20, 1967. On August 22, he developed fever, head-
ache, intermittent diarrhea, nausea, and vomiting. He


returned to Portland on August 28 and was said.to have
headache, fever, and malaise. He was seen on several
occasions as an outpatient at which times he denied diar-
rhea. no fever was observed, and there were no abnormal
physical findings or weight loss. Finally, because of the
concern of his grandmother over his sporadic symptoms,
he was hospitalized for observation on September 7. The
first fever spike was observed on September 10. Agglutinin
titers for Salmonella were negative on September 7; on
September 17, liters of 1:20 for group D "0" antigen and
1:80 for group D "H" antigen were observed. On Septem-
ber 15 Salmonella typhi was found on blood culture. Ampi-
cillin was then given for 3 days with continuing diurnal
temperature spikes as high as 105*F. Chloromycetin 250 mg
every 6 hours was substituted, and the patient became afo-
brile within 36 hours.
Case No. 2
This 16-year-old boy arrived in British Columbia on
August 19, 1967. On August 22, he experienced nausea,
vomiting, and severe watery diarrhea for approximately
one week. September 5 he developed pharyngitis, fever,
photophobia, and headache. On September 8, he was ad-
mitted to a Portland hospital with a pulse rate of 104 and a
temperature of 105.8F. On physical examination the abdo-
men was diffusely tender with tenderness to percussion
over the liver. On September 15, rose spots were observed.
The 'O" agglutinin titer rose from 1:80 on September 9 to
1:640 on September 18. During this period, the "H" titer
rose from 1:20 to 1:640. The patient had no history of
typhoid immunization. The erythrocyte sedmentation rate
rose to 46 on September 15. On September 19, a blood cul-
ture yielded S. typhi. There was good clinical response
from ampicillin and IV fluids.
Case No. 3
This 14-year-old brother of Case No. 2 also arrived in
British Columbia on August 19 and developed nausea,
vomiting, diarrhea, fever, and headache on August 22.
Medication was given in Canada, and he became afebrile
after 5 days; diarrhea, malaise, and anorexia persisted.
A fever developed on September 12, and he was hospital-
ized with a temperature of 103.4*F. There was diffuse


Figure 2
ONSET DATES FOR 61 CASES OF GASTROENTERITIS AMONG OREGON RESIDENTS
WHO VISITED CRANBROOK, BRITISH COLUMBIA
AUGUST-SEPTEMBER, 1967 HOCKEY PLAYERS


FAMILY MEMBERS


19 20 21 22 23 24


26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 II 12 13 14


AUG. SEPT.
*TYPHOID FEVER CASES








abdomin ial tenderness, particularly in the right upper
quadrant. On Septembter 16, the "0" a 'nlutinin titer \a-
1:12 ,O and "'l" 1 as 1:50 wiith no hi story of typhoid immu-
nization. On Septeimber 19, S. typhi aas recovt red on blood
culture. 1[t resp-iondee d \ell on ampicilhi and fluidls,
These three boys with typhoid fever were the only
ones from the group of 26 who stayed at a vacation resort
12 miles south of Cranbrook, British, Columbia. at Movie
Lake. This resort consists of several cottages. camping
and trailer accommodations, and a restaurant. As a result
of the Oregon outbreak. Canadian officials initiated an
investigation in an effort to locate any additional typhoid
cases and to determine the source of the outbreak at the
resort. Four laboratory confirmed cases and txo suspect
cases of typhoid fever in Canadians were uncovered, all
of whom were reported to have visited this resort during
the 2-week period when the Oregon families were staying
there. One of these cases is the cleaning lady for the
resort. Further investigation revealed that there w\as a
major plumbing repair at this resort on August 7. 1967.
In 1966. two cases of typhoid fever were diagnosed in
persons living within a 15-mile radius of the area.
Seven boys from Spokane. A i,-I. ., i..... also attended
the session; four of the boys developed gastroenteritis,


but none developed typhoid fexer. In addition to the
Canadian cases of typhoid fexer which were sub-equentl\
discovered, a similar gastrointe-tinal illness \\as occur-
ring among the Cranbrook community when the boys arrived
in the area.
Stool specimens were obtained for culture from all
Oregonians ho visited British Columbia or have subse-
quently became ill. Except for the three confirmed cases
of typhoid fe\er in Oregonians. all other visitors \ere
found negative for enteric bacterial pathogens. Fi\e -tool
specimens were examined for o a and parasites and were
negative. Viral studie- to date ha\e been negative.


(Reported by Edirard Goldb!a('t. Il.D., Stale Iealth Officer,
Iloniror A. lHolmes. D.1.l ., State Public llealt/ Veteri-
narian, aind lirs. Vicicn 'n let P'lblic Health \%trse, all
iri li the Oreyon State Board of llealth: Titomaun L. .leador,
City Heal th Officer. Portland, Oc/et on: John A. Beare.r il.D.,
Chief. Section of Epidenio!ioiy. Wastlinii,.to/ Slate Depart-
men! of Health: H. it. I'ob'ertso,, Chief. Quarantine Di,'i-
siogn, and John It. Duciile, 11.0.. rCief. Epidenmiooigy Dii-
sio/i, both rithl the Department of nationall lIealth and
IWielfare. OUttlla, Canada; iand an EIS Officer.)


STAPHYLOCOCCAL FOOD POISONING-New Jersey


On Wednesday, July 19. 1967. approximately 60 stu-
dents and employees suddenly developed symptoms of
gastroenteritis at a New Jersey State School for Girls.
The illnesses occurred during the afternoon and early
evening with the greatest number of persons reporting to
the infirmary between 4:00 and 6:00 p.m. The symptoms
were primarily nausea, cramps, frequent vomiting, and
severe prostration, which were usually followed by diar-
rhea. The incubation periods were 1 to 9 hour-s with a
mean of 4!i hours. Most of the illnesses lasted 12 hours
or less and the symptoms abated in nearly all patients by
the following day. Hours of onset are shown in Figure 2.


Attack rates were calculated for all foods served by
the school during the 48-hour period prior to the outbreak
(Table 1). The attack rates on the foods served at lunch
on Wednesdayy wecre significant for chicken salad and pota-
to salad. Only one person of hle i7 \\ho became ill report-
ed not to have eaten either item. The attack rates for the
other meals were not unusual.
All 194 students and 45 of the 176 employees ate the
lunch served at the cafeteria on W\ednesday. One hundred
persons (90 students and 10 employ ees) tho ate this meal
were interviewed. Forty-seven persons, including 3 em-
ployees. reported that they became ill on Wednesday. An


TABLE 1
ATTACK RATES FOR FOODS SERVED AT THE NOON MEAL
NEW JERSEY JULY 19, 1967
Ate the Food Did Not Eat Food

Attack Attack
Not Rate Not Rate
Food Item Ill Ill Total Percent Ill Ill Total Percent

Chicken Salad 44 34 78 56 3 10 13 23
Potato Salad 43 27 70 61 4 17 21 19
Lettuce & Tomato 39 30 69 57 8 14 22 36
Hard Boiled Egg 36 29 65 55 11 15 26 42
Olives 26 25 51 51 21 19 40 59
Pickles 33 32 65 51 14 12 26 54
Bread 31 25 56 55 16 19 35 46
Butter 26 25 51 51 21 19 40 52
Lemonade 35 35 70 50 12 9 21 57
Tea 1 4 5 20 46 40 86 54
Ice Cream 40 38 78 51 7 6 13 54
Water 42 39 81 52 5 5 10 50
Chicken Salad 46 36 82 56 1 8 9 11
and/or
Potato Salad

* The ill group includes only those persons who became ill on Wednesday.


OCTOBER 7, 1967


Morbidity and Mortality Weekly Report




338


additional five students reported comparable illnesses
with onsets on Thursday morning, 13 to 22 hours after
the Wednesday lunch. Another student and two employees
reported illnesses at other times during the week which
did not appear to be related to the outbreak. On the basis
of institutional records, an estimated total of 60 to 65
persons probably became ill due to this episode of food
poisoning.
Several types of specimens were collected. Vomitus
or stool specimens were submitted by six ill persons.
Samples of chicken salad and potato salad and home-made
mayonnaise which was used in the preparation of the sal-
ads were obtained. Nasal swabs and material from any
body lesions were also obtained for culture from 46 food
handlers. Coagulase positive staphylococci were isolated
from three vomitus specimens, one stool specimen, the
chicken salad and potato salad, and from the nasal swabs
of 13 food handlers. All were phage typed at the National
Communicable Disease Center. The same phage type,
29/6/47/53/54/75/83A/+, was found in the three vomitus
cultures, the stool culture, both foods and the nasal swab
for the food handler who prepared the salads. No results
are available on the tests for enterotoxin in the food items.
The salads were prepared Wednesday morning and re-
frigerated for several hours until served. Working tempera-
tures in the kitchen were over 80F. Each salad was divid-
ed and stored in two containers which were more than 10
inches deep.
Although the laboratory findings are not conclusive
evidence, they support the epidemiologic premise that
the infective organism was introduced into the salads
during their preparation. The warm, freshly prepared sal-
ads were then placed into containers which were too deep
to permit cooling at the center during the 2- to 3-hour re-
frigeration period. The random distribution of the cases
in regard to serving time suggests that more than one con-
tainer of salad had a substantial inoculum of the infective
organism. Ideal temperature and moisture conditions at


OCTOBER 7, 1967


Figure 1
OUTBREAK OF STAPHYLOCOCCAL FOOD POISONING
NEW JERSEY JULY 19, 1967


12 2 4 6 8
NOON*
HOUR OF ONSET
*LUNCH SERVED FROM 11.50AM TO 1230PM.


10 12
MIDNIGHT


the center of the containers would permit the production
of enough toxin to cause the outbreak. Suitable recommen-
dations were made regarding personal hygiene practices
and methods of handling and storing perishable foods.
(Reported by William J. Dougherty, M.D., Director, and
Howard Rosenfeld, V.M.D., Division of Preventable Dis-
eases, New Jersey State Department of Health.)


EASTERN ENCEPHALITIS-New Jersey


One human and 27 equine cases of Eastern Equine en-
cephalitis (EEE) have been reported from New Jersey.
Initially, two confirmed fatal cases of EEE in horses with
onsets on August 8 and August 16, respectively, occurred
in Cape May County in southern New Jersey at locations
separated by a distance of approximately 10 miles.
A 67-year-old white retired male from Woodbine, Cape
May County, whose residence was located 3 and 7 miles,
respectively, from the two initial equine cases, developed
fever and lethargy on August 16 which progressed to coma
in the next 2 days. Spinal fluid showed pleocytosis and
elevated protein. Blood specimens collected on the 4th
and 16th day after onset revealed a rise in EEE hemag-
glutination inhibition liters from 1:160 to 1:5120. EEE log
neutralization indices of bloods collected on the 4th and
6th days of illness were 2.4 and 2.2. The patient expired
20 days after onset. Subsequently, serologic and virologic


results have provided confirmation for nine additional
equine cases; 16 other equine cases are classified as
clinical suspects. The confirmed equine cases have been
distributed in Cape May, Cumberland, Gloucester, Atlantic,
and Burlington Counties.
New Jersey experienced heavy rainfall throughout the
past summer, and surveillance revealed unusually high
mosquito populations. Aedes sollicitans mosquitoes col-
lected within a mile of the residence of the confirmed
human case have thus far yielded at least two isolations
of EEE virus.

(Reported by W. J. Dougherty, M.D., State Epidemiologist,
Martin Goldfield, M.D., Director, Division of Laboratories,
and Oscar Sussman, D.V.M., Coordinator, Veterinary Pub-
lic Health Program, all with the New Jersey State Depart-
ment of Health.)


Morbidity and Mortality Weekly Report






OCTOBER 7, 1967


Morbidity and Mortality Weekly Report




SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS


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

Cumulative Cumulative
Reporting Area August January August Reporting Area August January -August
1967 1966 1967 1966 1967 1966 1967 1966
NEW ENGLAND............... 36 49 239 321 EAST SOUTH CENTRAL........ 158 232 1,205 1,561
Maine.................. 2 5 Kentucky ............ ... 23 18 110 94
New Hampshire.......... 2 7 7 Tennessee.............. 19 34 185 210
Vermont................ 1 2 2 Alabama................. 81 137 642 876
Massachusetts........... 21 36 141 224 Mississippi............. 35 43 268 381
Rhode Island............ 1 2 23 20
Connecticut............. 12 10 64 63 WEST SOUTH CENTRAL........ 238 263 2,088 1,769
Arkansas................. 8 12 92 97
MIDDLE ATLANTIC.......... 399 366 2,393 2,714 Louisiana................ 48 70 404 431
Upstate New York......... 33 38 195 250 Oklahoma................. 7 10 82 94
New York City........... 259 210 1,436 1,674 Texas.................. 175 171 1,510 1,147
Pa. (Excl. Phila.)...... 16 27 153 134
Philadelphia............ 33 25 215 176 MOUNTAIN................. 51 49 406 284
New Jersey............... 58 66 394 480 Montana ............... 1 4 24
Idaho.................... 2 16 3
EAST NORTH CENTRAL........ 272 302 2,100 2,115 Wyoming................. 12
Ohio.................... 42 64 413 409 Colorado............... 6 4 49 33
Indiana.................. 8 13 94 67 New Mexico............... 29 12 125 65
Downstate Illinois....... 10 16 106 125 Arizona.................. 12 28 182 138
Chicago. ........... .... 105 97 634 685 Utah..................... 1 6 5
Michigan................ 105 107 835 757 Nevada.................. 3 2 12 16
Wisconsin............. .. 2 5 18 72
PACIFIC................... 147 142 1,218 1,186
WEST NORTH CENTRAL........ 43 38 217 284 Washington............... 3 3 35 26
Minnesota................ 9 3 35 22 Oregon................. 2 4 35 36
Iowa.................... 7 9 27 47 California............... 139 134 1,139 1,101
Missouri............ ..... 7 8 63 108 Alaska .................. 1 2 6
North Dakota ............ 2 4 5 Hawaii.................. 3 7 17
South Dakota............ 4 1 24 25
Nebraska................ 11 8 29 30 U. S. TOTAL............... 1,950 1,956 14,128 14,410
Kansas. ............. ..... 3 9 35 47
TERRITORIES............... 86 94 613 654
SOUTH ATLANTIC............ 606 515 4,262 4,176 Puerto Rico.............. 86 92 584 636
Delaware................. 15 9 46 34 Virgin Islands........... 2 29 18
Maryland................ 64 52 429 374
District of Columbia.... 82 48 525 312
Virginia ............... 45 36 218 217
West Virginia........... 3 7 14 49
North Carolina........... 82 62 518 604 Note: Cumulative Totals include revised and delayed reports
South Carolina........... 65 78 566 616 through previous months.
Georgia................. 114 77 666 690
Florida................. 136 146 1,280 1,280




CASES OF PRIMARY AND SECONDARY SYPHILIS: By Reporting Areas September 1967 and September 1966 Provisional data

Cumulative Cumulative
Reporting Area Setember Jan Sept Reporting Area September Jan Sept
1967 1966 1967 1966 1967 1966 1967 1966
NEW ENGLAND............... 27 32 266 353 EAST SOUTH CENTRAL........ 144 194 1,349 1,755
Maine.................... 2 5 Kentucky................. 15 10 125 104
New Hampshire............ 1 7 8 Tennessee................ 36 19 221 229
Vermont ................. 1 3 2 Alabama .................. 66 110 708 986
Massachusetts........... 11 21 152 245 Mississippi.............. 27 55 295 436
Rhode Island............ 3 1 26 21
Connecticut............. 12 9 76 72 WEST SOUTH CENTRAL........ 254 272 2,342 2,041
Arkansas................ 13 19 105 116
MIDDLE ATLANTIC.......... 322 322 2,715 3,036 Louisiana................ 67 51 471 482
Upstate New York......... 31 41 226 291 Oklahoma.............. 6 11 88 105
New York City......... 194 189 1,630 1,863 Texas................... 168 191 1,678 1,338
Pa. (Excl. Phila.)...... 23 10 176 144
Philadelphia............ 26 26 241 202 MOUNTAIN................. 34 35 440 319
New Jersey.............. 48 56 442 536 Montana................ 2 4 26
Idaho................... 2 16 5
EAST NORTH CENTRAL........ 279 293 2,379 2,408 Wyoming................. 12
Ohio.................... 56 67 469 476 Colorado............... 3 2 52 35
Indiana ................. 15 7 109 74 New Mexico............... 11 8 136 73
Downstate Illinois....... 12 18 118 143 Arizona .................. 16 16 198 154
Chicago............... 93 96 727 781 Utah................... 1 3 7 8
Michigan................ 92 98 927 855 Nevada ................. 3 2 15 18
Wisconsin................ 11 7 29 79
PACIFIC.................. 133 130 1,351 1,316
WEST NORTH CENTRAL........ 32 30 249 314 Washington............... 4 6 39 32
Minnesota................ 2 2 37 24 Oregon................. 5 2 40 38
Iowa................ .... 4 8 31 55 California............... 124 118 1,263 1,219
Missouri................ 15 6 78 114 Alaska................... 2 2 8
North Dakota............ 4 5 Hawaii................. 2 7 19
South Dakota............ 3 2 27 27
Nebraska............... 2 9 31 39 U. S. TOTAL............... 1,786 1,844 15,914 16,254
Kansas .................. 6 3 41 50
TERRITORIES .............. 74 96 687 750
SOUTH ATLANTIC............ 561 536 4,823 4,712 Puerto Rico............. 70 92 654 728
Delaware................. 4 6 50 40 Virgin Islands........... 4 4 33 22
Maryland................. 56 42 485 416
District of Columbia..... 100 51 625 363
Virginia................. 16 24 234 241
West Virginia............ 2 5 16 54
North Carolina........... 76 78 594 682 Note: Cumulative Totals include revised and delayed reports
South Carolina.......... 61 65 627 681 through previous months.
Georgia............. 82 91 748 781
Florida................. 164 174 1,444 1,454





340 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
OCTOBER 7, 1967 AND OCTOBER 8, 1966 (40th WEEK)


ENCEPHALITIS HEPATITIS
ASEPTIC Primary
AREA MENINGITIS BRUCELLOSIS DIPHTHERIA including Post- Serum Infectious
unsp. caseTs Infectious

1967 1966 1967 1967 1967 1966 1967 1967 1966 1967 1966
UNITED STATES... 85 92 3 14 32 65 4 45 30 823 593

NEW ENGLAND.......... 2 5 1 44 22
Maine.............. 2 7 7
New Hampshire...... 1
Vermont............. 1
Massachusetts...... 1 -- 20 6
Rhode Island....... 3 -- 8 3
Connecticut........ 1 8 5

MIDDLE ATLANTIC...... 3 17 1 8 25 14 128 95
New York City...... 1 3 5 17 10 40 27
New York, up-State. 3 2 33 14
New Jersey......... 10 5 4 27 26
Pennsylvania....... 2 1 1 3 1 28 28

EAST NORTH CENTRAL... 4 6 12 11 1 110 113
Ohio................ 1 1 9 11 23 23
Indiana............. 1 21 14
Illinois........... 2 -- 1 25 33
Michigan........... 1 3 3 36 42
Wisconsin.......... 1 5 1

WEST NORTH CENTRAL... 7 3 2 5 18 1 58 32
Minnesota.......... 2 2 1 1 2 1 8 7
Iowa............... 1 1 2 6 9
Missouri........... 42 10
North Dakota....... -
South Dakota......
Nebraska........... 2 3
Kansas............. 5 2 16 3

SOUTH ATLANTIC....... 24 8 1 3 4 1 3 98 57
Delaware........... 1 12 2
Maryland............ 1 1 12 10
Dist. of Columbia.. 1 1 1
Virginia........... 3 1 1 5 9
West Virginia...... 4 6
North Carolina..... 3 1 8 8
South Carolina..... 7 3
Georgia.............. 16 3
Florida............ 2 5 1 3 1 33 15

EAST SOUTH CENTRAL... 1 2 5 2 3 61 31
Kentucky ........... 12 14
Tennessee.......... 1 1 1 1 18 8
Alabama............ 5 2 11 6
Mississippi......... 1 20 3

WEST SOUTH CENTRAL... 5 13 9 3 13 1 90 53
Arkansas ........... I 6 3
Louisiana.......... 3 4 9 3 7 1 14 5
Oklahoma............ 2 11 2
Texas.............. 9 5 59 43

MOUNTAIN............. 2 1 2 5 30 40
Montana ........... 11 4
Idaho.............. 3
Wyoming............. 2
Colorado........... 2 2 4 2
New Mexico.......... 11 12
Arizona ............ 1 6 13
Utah............... 1 2 1
Nevada.............. 3

PACIFIC.............. 37 37 6 3 2 18 10 204 150
Washington......... 4 1 1 1 16 5
Oregon ............. 6 1 4 5 28
California......... 25 35 5 2 1 14 10 182 114
Alaska............ 1 1
Hawaii ............. 2 1 2

Puerto Rico 1 11 16






Morbidity and Mortality Weekly Report 311


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 7, 1967 AND OCTOBER 8. 1966 (40th WEEK) CONTINUED



MENINGOCOCCAL INFECTIONS,
MALARIA MEASLES (Rubeola) TOTAL POLIOMYELITIS RUBELLA
TOTAL
AREA Tota Paralytic
Cumulative Cumulative Total Paralyti
Cum.
1967 1967 1967 1966 1967 1967 1966 1967 1967 1967 1967
UNITED STATES... 41 223 58,445 190,817 27 1,772 2,818 21 193

NEW ENGLAND............ 7 865 2,290 1 71 124 30
Maine.............. 239 215 3 10 10
New Hampshire...... 74 80 2 9
Vermont............ 42 239 1 4 3
Massachusetts...... 6 357 787 33 50 5
Rhode Island....... 62 72 4 14 2
Connecticut........ 1 91 897 1 28 37 10

MIDDLE ATLANTIC...... 5 13 2,302 18,064 3 288 343 -5 25
New York City...... 4 472 8,295 51 48 1 13
New York, Up-State. 4 594 2,538 1 70 96 1 9
New Jersey.......... 4 490 1,855 94 102 3
Pennsylvania....... 1 5 746 5,376 2 73 97 3 -

EAST NORTH CENTRAL... 1 34 5,575 68,944 2 251 443 3 51
Ohio................ 2 1,152 6,360 1 81 119 9
Indiana............. 1 5 602 5,716 40 79 -
Illinois........... 1 998 11,376 1 56 83 11
Michigan........... 3 943 14,557 57 119 3 8
Wisconsin.......... 23 1,880 30,935 17 43 23

WEST NORTH CENTRAL... 8 2,873 8,724 3 78 150 3 12
Minnesota.......... 123 1,643 19 34 -
Iowa............... 1 750 5,316 1 16 22 1 12
Missouri............ 4 337 532 1 16 57 -
North Dakota....... 2 872 1,116 1 2 11 -
South Dakota....... 55 40 6 5
Nebraska........... 1 642 77 13 8
Kansas ............. 94 NN 6 13 -

SOUTH ATLANTIC....... 16 21 6,936 15,366 9 343 480 2 8
Delaware............ 1 49 257 1 7 4 -
Maryland............ 1 1 163 2,110 1 44 48 1 1
Dist. of Columbia.. 1 24 383 10 12 -
Virginia........... 5 2,197 2,188 41 59 -
West Virginia...... 6 1,398 5,328 5 32 30 5
North Carolina..... 13 5 861 495 71 125 1
South Carolina..... 1 511 658 29 49 -
Georgia.............. 36 234 1 51 63 -
Florida............ 1 2 1,697 3,713 1 58 90 1

EAST SOUTH CENTRAL... 9 5,230 19,784 5 139 247 1 6
Kentucky........... 3 1,340 4,732 3 40 87 1
Tennessee.......... 6 1,893 12,333 2 59 84 4
Alabama............ 1,329 1,694 26 54 1
Mississippi........ 668 1,025 14 22 1 -

WEST SOUTH CENTRAL... 11 69 17,538 24,742 1 224 381 7
Arkansas........... 1,404 971 1 32 35 -
Louisiana.......... 1 155 99 88 140 -
Oklahoma........... 10 3,351 492 17 19 1
Texas............... 69 12,628 23,180 87 187 6

MOUNTAIN ............. 19 4,705 12,024 33 88 7
Montana............ 7 296 1,832 2 4 -
Idaho.............. 3 389 1,587 3 5 -
Wyoming............ 181 166 6 -
Colorado............ 3 1,577 1,318 13 48 1
New Mexico......... 591 1,133 3 10 -
Arizona............ 1,020 5,302 4 10 5
Utah............... 6 382 641 4 1
Nevada.............. 269 45 3 5 -

PACIFIC............... 8 43 12,421 20,879 3 345 562 54
Washington......... 4 22 5,478 3,711 31 40 20
Oregon.............. 12 1,630 1,843 27 34 3
California......... 2 7 4,995 14,648 3 273 469 22
Alaska.............. 1 145 535 10 15 1
Hawaii.............. 2 1 173 142 4 4 8

Puerto Rico........... 4 2.133 2,854 13 13




342


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIS 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... 5,978 4 174 2 140 8 324 3 281 59 3,402

NEW ENGLAND........... 858 2 1 2 7 1 2 91
Maine.............. 15 2 19
New Hampshire...... 8 44
Vermont............ 48 22
Massachusetts...... 119 1 1 1 3 1 4
Rhode Island....... 59 1 2
Connecticut........ 609 1 1 3 -

MIDDLE ATLANTIC...... 191 12 2 33 1 35 6 80
New York City...... 10 6 1 17 -
New York, Up-State. 141 1 9 9 4 68
New Jersey......... NN 1 3 15
Pennsylvania....... 40 4 1 4 1 11 2 12

EAST NORTH CENTRAL... 467 1 18 12 1 30 22 6 330
Ohio............... 21 4 7 11 5 115
Indiana............. 83 3 2 1 11 1 1 75
Illinois........... 71 1 9 10 3 10 63
Michigan............ 213 2 7 21
Wisconsin........... 79 2 56

WEST NORTH CENTRAL... 276 2 13 21 17 4 11 790
Minnesota.......... 3 3 1 1 4 157
Iowa............... 135 1 1 3 1 106
Missouri........... 5 1 7 8 8 1 1 145
North Dakota....... 86 3 138
South Dakota....... 37 1 2 94
Nebraska........... 2 4 2 54
Kansas............. 8 1 1 10 1 2 96

SOUTH ATLANTIC....... 682 39 1 10 49 113 6 429
Delaware........... 4 -
Maryland............ 87 2 21 3
Dist. of Columbia.. 13 2 5
Virginia............ 185 10 6 27 3 186
West Virginia...... 183 1 2 1 1 1 59
North Carolina..... 30 6 3 44 3
South Carolina..... 16 1 2 10 5
Georgia............ 28 3 1 5 14 15 2 105
Florida............. 136 18 1 11 68

EAST SOUTH CENTRAL... 872 30 9 54 49 7 645
Kentucky............ 19 3 1 23 14 2 151
Tennessee.......... 685 8 6 9 23 5 445
Alabama............ 106 11 10 12 40
Mississippi ........ 62 8 2 12 9

WEST SOUTH CENTRAL... 559 1 42 72 36 2 37 16 737
Arkansas........... 1 5 42 11 1 13 2 99
Louisiana.......... 2 4 7 14 63
Oklahoma........... 58 1 3 18 7 15 8 266
Texas.............. 498 30 5 4 1 9 6 309

MOUNTAIN ............ 1,042 1 9 19 9 1 107
Montana.............. 76 1 2 -
Idaho.............. 73 -
Wyoming............ 45 2 5
Colorado........... 567 1 12 9 10
New Mexico......... 140 1 2 31
Arizona............. 73 3 1 49
Utah............... 68 5 3
Nevada............ 9

PACIFIC .............. 1,031 17 1 6 3 79 11 4 193
Washington......... 333 2 1 2 1
Oregon............. 102 1 1 3 3 4
California.......... 428 13 1 3 3 72 6 4 188
Alaska ............. 64 -
Hawaii............. 104 3 3 -- 3

Puerto Rico.......... 13 16 1 6 1 30


Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 7, 1967 AND OCTOBER 8, 1966 (40th WEEK) CONTINUED






Morbidity and Mortality Weekly Report






DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED OCTOBER 7, 1967


343


(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 1 year
Ages and over Influenza All Ages and over Influenza All
All AgeAges 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.--------


659
211
49
35
19
56
26
28
32
30
51
8
38
23
53

3,039
49
39
137
44
34
44
72
86
1,581
43
344
185
46
105
26
42
70
30
32
30

2,530
68
28
757
146
197
120
87
321
41
33
38
57
73
165
28
116
35
34
41
102
43

797
59
11
36
131
36
106
64
223
76
46


*Estimate based on average percent of divisional total.


411
128
31
23
10
31
15
21
23
9
32
6
32
16
34

1,752
28
23
75
26
23
23
50
39
905
27
193
103
31
68
17
26
39
14
24
18

1,423
40
22
394
86
97
62
57
184
29
17
21
27
54
96
13
72
22
22
24
59
25

480
35
6
20
76
25
63
33
150
49
23


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.----------


1,079
135
288
44
54
71
43
104
36
65
62
193
44

630
103
65
44
120
130
28
31
109

1,135
33
45
35
165
27
91
214
53
163
61
119
48
81

395
38
27
111
20
77
21
49
52

1,471
24
30
38
44
73
437
88
45
110
59
95
160
43
129
50
46


33
3
5
2
2
1
2
1
3
7
3
3
1

22
3
2
1
8
5


3

28
2
1


1
3
9
4
3
3
1

1

18
1
4
3
3
3
1
1
2

40

2

1
2
8
2

5
4

5
3
5
2
1


Total 11,735 6,719 382 620

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 491,454
All Causes, Age 65 and over------------------- 280,285
Pneumonia and Influenza, All Ages------------- 17,261
All Causes, Under 1 Year of Age--------------- 25,113


Week No.
40


1
3
6

72

2
2
13
3

13
3
12
4
7
7
6

35
2
2
7
1
10
2
8
3

59

2






344 Morbidity and M(





ERRATA


Vol. 16, No. 39, p. 331
In the table, "Deaths in 122 United States Cities for Week
Ended September 30, 1967," data for the County of Los
Angeles rather than for the City were inadvertently pub-
lished. Incorrect figures should be changed as follows:


Pneumonia Under
All Causes and 1 Year
65 years Influenza All
All Ages and over All Ages Causes

Los Angeles 459 276 5 23
Pacific Division 1,439 883 26 61
122 Cities Total 11.815 6,665 391 632




Vol. 16, No. 39, p. 332
In the article "Obscure Disease Related to African Mon-
keys- Importation and Use in the United States," the
last two sentences of the 1st paragraph read:

"At least 23 persons have been identified who as-
sisted with the nephrectomy of these monkeys or in
the mincing and trypsinization of their kidneys. Ap-
proximately 1,700 persons are known to have been
exposed to operated monkeys or their kidney tissue;
none of these persons has experienced an unusual
febrile illness to date."


The latter sentence should read:
"Taking into consideration the number of exposures
to individual open monkeys that each of these 23
persons had, there were approximately 1,700 person-
to-open-monkey exposures; "


)rtal


ity Weekly Report OCTOBER 7, 1967
UNIVERSITY OF FLORIDA

III III I lli IIII IIIIIIG IIllII I
3 1262 08864 2011

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 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:
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.


I.


UNIV. OF FL L!B.
DOCUMENTS DEPT






U.S. DEPOSITORY


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