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:
AA00010654:00045

Related Items

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

Full Text




NATIONAL COMMUNICABLE DISEASE CENTER


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


Vol. 16, No. 16


SWFrKIY

N REPORT

Week Ending
April 22, 1967



PUBLIC HEALTH SERVICE


BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


CURRENT TRENDS
MEASLES 1967

The total of -, ii., cases of measles reported for the
16th week (ending April 22) represents a change from the
weekly incidence which has been prevalent for the past 8
weeks. Since the week ending February 25, from 2,500 to
2,700 cases have been reported weekly. This week's total,
however, is a decline of 622 cases from the preceding
week and represents a fourfold decrease from the incidence
in the comparable week in 1966.
The decrease in the 16th week is accounted for by de-
clines in eight of the nine geographic divisions, primarily
in the South Atlantic, West South Central and Mountain


CONTENTS


Current Trends


i. I r-, l



states. Ti.
incidencidence .
week.
A mode
ported from F dt
(Reported by the
ology Program, NCI


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
16th WEEK ENDED CUMULATIVE, FIRST 16 WEEKS
MEDIAN
DISEASE APRIL 22. APRIL 23, 1962 1966 MEDIAN
1967 1966 1967 1966 1962 1966
Aseptic meningitis ...... .......... 41 20 20 459 446 441
Brucellosis................... .......... 3 6 9 60 62 106
Diphtheria. ... ...... .. 10 10 35 49 69
Encephalitis, primary:
Arthropod-borne & unspecified ........... 26 31 379 398 -
Encephalitis, post-infectious ........... 20 25 243 271
Hepatitis, serum .... ....... .. 36 30 604 400 14,568
Hepatitis, infectious .................... 802 645 816 12,681 11,077568
Malaria ........................... 37 2 2 622 86 29
Measles rubeolaa) ....................... 2,068 8.515 17,460 36,702 117.898 195,705
Meningococcal infections, total ........... 58 99 67 951 1,629 1,048
Civilian ....... ........... 57 92 -878 1,424
Military .................. .......... .. 1 7 73 205 -
Poliomyelitis. total ......... .. ... I 1 4 7 22
Paralytic....... ..............1 1 4 6 17
Rubella (German measles) ............ 1,965 1,792 -- 19,090 22,680
Streptococcal sore throat & scarlet fever 10,686 11,140 9,717 193.970 187,244 173,070
Tetanus.......... ....................4 6 5 49 34 55
Tularemia .................. .2 1 41 50 61
Typhoid fever ........... ........... 8 7 7 101 81 102
Typhus, tick-borne (Rky. Mt, spotted fever) 1 9 10 7
Rabies in animals ...... ....... ... 112 113 113 1,413 1,404 1,363

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax .................. ...........Rabies in man .......
Botulism .......................................... Rubella. Congenital Syndrome ..... ........ 1
Leptospirosis: Calif.-l ............... .. ...... 10 Trichinosis: Ky.-2, NYUpS.-1. Tenn.-l ... .. 26
Plague ....................... .... ............. Typhus, marine ............................. ... 7
Psittacosis: Tenn.- ............................... 11 ............ .............







Morbidity and Mortality Weekly Report


APRIL 22, 1967


SURVEILLANCE SUMMARY
HEPATITIS Winter Quarter
Epidemiologic Year 1966-67*


During the winter quarter (January 1- April 1, 1967) of
the current epidemiologic year, 10,875 cases of viral hepa-
titis were reported in the United States. This represents a
rate of 5.5 cases per 100,000 population. Tables 1 and 2
show the number of cases and rates, respectively, for this
quarter in relation to those observed during the last 10
epidemiologic years.
Figure 1 presents the number of reported cases per
100.000 population by 4-week periods from July 1952
through April 1, 1967. Following the peak year (1953-54)
of the first epidemic cycle, there was a downward trend to
a low point during 1957-58, 4 years after the peak. During
the subsequent year (1958-59), a distinct upswing of the
curve was noted during the early part of 1959. Similarly,
following the peak year (1960-61) of the second epidemic
cycle, a low point appears to have been reached during the


year 1965-66, 5 years after the peak. There now appears to
be another upswing during the first 3 months of 1967.
Following the peak winter quarter incidence in 1960-61
(12.6), as shown in Table 2, successive winter quarters
through 1965-66 reflect a continuing decline in rates. This
downward trend was reversed during the winter quarter of
the current epidemiologic year. In that quarter a rate of 5.5
was observed, compared with 4.8 during the winter quarter
of the proceeding year (1965-66). A similar reversal in
successive winter quarterly rates occurred in 1958-59, 2
years before the peak year (1960-61) of the second epi-
demic cycle.
(Reported by the Hepatitis Unit, Epidemiology Program,
NCDC.)
*Hepatitis morbidity data are summarized in terms of an "Epi-
demiologic year." which runs from the 27th week of each year
through the 26th week of the succeeding year.


Table 1
Number of Reported Cases of Viral Hepatitis Per Quarter
(Values include revised and delayed weekly reports
through current week)

Epidemi- Summer Fall Winter Spring Total
oogic Quarter Quarter Quarter Quarter Year
Year
1956-57 3,469 4,115 5,019 3,938 16,541
1957-58 2,925 2,782 4,414 3,876 13,997
1958-59 3,262 4,243* 7,088 4,864 19,457
1959-60 4,630 6,434 9,793 9,917 30,774
1960-61 8,940 12,403 23,026 19,898 64,267
1961-62 14,229 15,637 18,028 13,626 61,520
1962-63 10,273 11,383 13,805 9,861 45,322
1963-64 8,969 111 '2.. 12,118 9,330 40,673
1964-65 7,590 9,350* 10,311 7,876 35,127
1965-66 7,361 8,100 9,208 7,744 32,413
1966-67 7,298 9,150 10,875
*14-week periods


Table 2
Reported Cases of Viral Hepatitis
Per 100,000 Population Per Quarter
(Population as of January 1, middle of epidemiologic year)
Epidemic Summer Fall Winter Spring Total
ooc Quarter Quarter Quarter Quarter Year
Year
1956-57 2.1 2.4 2.9 2.3 9.7
1957-58 1.7 1.6 2.5 2.2 8.0
1958-59 1.9 2.3 4.0 2.7 10.9
1959-60 2.6 3.6 5.4 5.5 17.1
1960-61 5.0 6.9 12.6 10.9 35.4
1961-62 7.8 8.5 9.7 7.3 33.3
1962-63 5.5 6.1 7.3 5.2 24.1
1963-64 4.8 5.4 6.3 4.9 21.4
1964-65 4.0 4.5 5.3 4.1 17.9
1965-66 3.8 4.2 4.8 4.1 16.9
1966-67 3.7 4.6 5.5


126









Morbidity and Mortality Weekly Report


EPIDEMIOLOGIC NOTES AND REPORTS
MELIOIDOSIS


Melioidosis is a rare, often severe, pneumonic and
sy stemic disease frequently accompanied by cutaneous
aN.d visceral pyogenic lesions. As of February 1967, 35
c.ses with 8 deaths have occurred among the United
States troops stationed in Viet Nam. As a result of mili-
tary personnel movements to and from Viet Nam and the
variable incubation period of this disease, it is quite
possible that one or more cases may come to the atten-
tion of civilian health authorities in the United States.
The etiologic agent, Pseudomonas pseudomallei, was
first isolated by Whitmore and Krishnaswami in 1910 from
autopsy lesions in a group of Rangoon beggars who had
died from a glanders-like illness. The organism is a gram-
negative. aerobic, filamentous rod which often demon-
strates bipolar staining with Hright's stain. It will grow
quite well on trypticase soy, blood, or MacConkey's agar
at 37C; characteristically, the colonies demonstrate
wrinkling after incubating 48 hours.
The epidemiology in man is poorly understood. The
organism is said to be endemic in the rodent population
of Southeast Asia, and has been found in the damp soil,
in well and surface water, and on market fruit and vege-


tables of that area. It is a highly communicable disease
of mules. donkeys, and rodents. Up to 15 percent of nor-
imal individuals in endemic areas may have positive sero-
logic reactions to the organism, but the clinical disease
is unusual in man. Outbreaks have been reported among
sheep, goats, and swine. Several modes of transmission
to man have been postulated: by inoculation of the organ-
ism into inapparent cutaneous lesions; by droplet spread
to the respiratory tract, and by ingestion of contaminated
food or water. Man-to-man transmission has not been dem-
onstrated.
The clinical manifestations of the illness are highly
variable. Most commonly it appears as an acute pneumo-
nitis accompanied by malaise, high fever, chills, cough,
occasional hemoptysis, chest pain. leukocytosis and a
normochromic, normocytic anemia. There may be a necrotic
cutaneous ulcer or pustule at the inoculation site with
regional 1 "iph ,i ri. oil,. and lymphangitis. The clinical
course is frequently complicated by septicemia with re-
sultant metastatic abscesses in all the viscera and the
appearance of meningitis, myocarditis, hepatomegaly,
(Continued on back page)


SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS


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

Cumulative Cumulative
Reporting Area March Jan Mar Reporting Area March Jan Mar
1967 1966 1967 1966 1967 1966 1967 1166
NEW ENGLAND............... 33 43 102 140 EAST SOUTH CENTRAL ........ 150 199 472 568
Maine.................... 1 2 Kentucky................. 14 13 30 37
New Hampshire............ 1 1 4 4 Tennessee................ 17 28 59 75
Vermont.................. 1 2 1 Alabama.................. 77 108 269 293
Massachusetts........ .... 23 31 63 96 Mississippi.............. 42 50 114 163
Rhode Island.............. 2 1 6 5
Connecticut .............. 7 8 27 32 WEST SOUTH CENTRAL......... 234 222 739 658
Arkansas.................. 15 19 37 53
MIDDLE ATLANTIC............ 325 432 894 1,123 Louisiana................ 55 79 152 171
Upstate New York......... 30 47 68 109 Oklahoma................. 5 10 29 40
New York City............ 204 2. 532 721 Texas.................... 159 114 521 394
Pa. (Excl. Phila.)....... 20 7' 74 62
Philadelphia............. 23 24 67 67 MOUNTAIN.................. 56 28 159 95
New Jersey............... 48 60 153 164 Montana.................. 5 1 9
Idaho.................... 5 12
EAST NORTH CENTRAL........ 305 246 769 737 Wyoming.................. 2 2 -
Ohio..................... 57 50 156 139 Colorado................. 8 4 20 13
Indiana.................. 17 4 29 18 New Mexico............... 12 6 44 22
Downstate Illinois....... 15 16 37 54 Arizona.................. 24 10 75 45
Chicago.................. 92 104 226 259 Utah..................... 1 2 1 4
Michigan................. 122 70 314 240 Nevada................... 4 1 4 2
Wisconsin................. 2 2 7 27
PACIFIC.................. 179 123 476 492
WEST NORTH CENTRAL........ 15 31 58 127 Washington............... 6 7 17 15
Minnesota................ 3 2 10 6 Oregon ................... 7 6 14 11
Iowa..................... 2 7 6 20 California ............... 165 105 440 457
Missouri................. 3 14 17 60 Alaska................... 1 2
North Dakota............. 4 Hawaii................... 1 5 4 7
South Dakota............. 4 3 11 16
Nebraska................. 3 3 9 9 U. S. TOTAL ............... 1,817 1.837 5,207 5,498
Kansas................... 2 5 12
TERRITORIES............... 90 83 212 245
SOUTH ATLANTIC............ 520 513 1,538 1,558 Puerto Rico.............. 85 82 202 241
Delaware................. 3 3 11 6 Virgin Islands........... 5 1 10 4
Maryland................. 52 55 165 135 __
District of Columbia..... 61 43 164 108
Virginia.................. 24 30 75 75
West Virginia............. 2 3 4 18
North Carolina........... 41 76 171 249 Note: Cumulative Totals include revised and delayed reports
South Carolina............ 79 78 221 232 through previous months.
Georgia.................. 67 76 236 275
Florida................... 191 149 491 460


APRIL 22, 1967









128 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

APRIL 22, 1967 AND APRIL 23, 1966 (16th WEEK)


ENCEPHALITIS HEPATITIS
ASEPTIC Primary
AREA MENINGITIS OIS DIPTHRA including Pt- Serum Infectious
unsp. cases Infectious
1967 1966 1967 1967 1967 1966 1967 1967 1966 1967 1966
UNITED STATES... 41 20 3 26 31 20 36 30 802 645

NEW ENGLAND.......... 1 3 2 3 1 34 36
Maine............... 3
New Hampshire...... 3 2
Vermont............ 1
Massachusetts ..... 1 2 1 13 27
Rhode Island....... 1 1 -2 2 -
Connecticut........ 1 1 15 4

MIDDLE ATLANTIC...... 4 2 6 10 16 14 133 85
New York City..... 2 3 1 13 11 35 8
New York, Up-State. 1 4 31 31
New Jersey......... 3 2 5 2 2 28 19
Pennsylvania....... 1 1 1 39 27

EAST NORTH CENTRAL... 7 3 6 5 3 4 140 92
Ohio................ 3 3 2 28 30
Indiana............. 4 2 1 17 11
Illinois............ 1 3 50 4
Michigan...... .... 3 1 1 2 35 41
Wisconsin........... 1 10 6

WEST NORTH CENTRAL... 1 1 48 40
Minnesota.......... 1 7 1
Iowa............... 1 5 5
Missouri........... 31 28
North Dakota........ 2
South Dakota........ -
Nebraska........... 2 1
Kansas............. 3 3

SOUTH ATLANTIC....... 2 2 1 1 5 3 2 1 83 90
Delaware........... 3
Maryland............ 2 2 17 31
Dist. of Columbia.. -
Virginia........... 1 1 1 25 8
West Virginia...... 10 8
North Carolina..... 2 4 10 11
South Carolina..... 2 1
Georgia.............. 9 16
Florida............. 1 3 7 15

EAST SOUTH CENTRAL... 6 1 2 1 3 65 82
Kentucky........... 2 26 35
Tennessee........... 3 1 2 1 3 17 17
Alabama............. 12 20
Mississippi........ 10 10

WEST SOUTH CENTRAI... 1 3 4 2 2 1 102 58
Arkansas ........... 2 7 9
Louisiana.......... 4 1 6 10
Oklahoma............ 12 1
Texas.............. 1 3 2 77 38

MOUNTAIN............. 1 2 1 27 17
Montana............ 1 1 3
Idaho............... 2
Wyoming.............- -
Colorado........... 2 4
New Mexico......... 13 6
Arizona............ 1 7 3
Utah............... 2 2
Nevada............. 1

PACIFIC............... 21 9 3 4 7 14 10 170 145
Washington ......... 2 1 16 13
Oregon............. 1 2 1 17 17
California......... 19 9 3 3 4 13 10 135 110
Alaska............. 2 1
Hawaii.............. 4

Puerto Rico 19 29









Morbidity and Mortality WVeekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

APRIL 22. 1967 AND APRIL 23, 1966 (16th WEEK) CONTINUED


MALARIA MEASLES (Rubola) ENINGOCOCAL NFECIONS, POLIOMYELITIS RUBELLA
AREA
___________ { _____ _____ ___ ___ ,., I.,,


UNITED STATES...

NEW ENGLAND..........
Maine..............
New Hampshire......
Vermont ...........
Massachusetts......
Rhode Island.......
Connecticut ........

MIDDLE ATLANTIC......
New York City......
New York, Up-State.
New Jersey.........
Pennsylvania .......

EAST NORTH CENTRAL...
Ohio ...............
Indiana............
Illinois ..........
Michigan ..........
Wisconsin..........

WEST NORTH CENTRAL...
Minnesota .........
Iowa...............
Missouri ..........
North Dakota.......
South Dakota.......
Nebraska ..........
Kansas.............

SOUTH ATLANTIC.......
Delaware...........
Maryland............
Dist. of Columbia..
Virginia...........
West Virginia......
North Carolina.....
South Carolina.....
Georgia ...........
Florida............

EAST SOUTH CENTRAL...
Kentucky............
Tennessee..........
Alabama ...........
Mississippi.......

WEST SOUTH CENTRAL...
Arkansas ..........
Louisiana..........
Oklahoma............
Texas. .............

MOUNTAIN.............
Montana...........
Idaho...............
Wyoming............
Colorado...........
New Mexico.........
Arizona.............
Utah...............
Nevada..............

PACIFIC..............
Washington.........
Oregon.............
California.........
Alaska.............
Hawaii..............


2,068

16
4
1

9

2

77
20
22
9
26

173
23
29
45
28
48

111
16
21
6
41
3
24
NN

381

7

127
54
43
25

125

115
11
47
40
17

416
11
3
7
395

193
1
20
6
81
21
49
10
5

586
242
98
230
9
7


36,702

421
88
69
34
159
27
44

1,210
200
286
288
436

2,908
490
341
461
607
1,009

1,670
84
388
117
626
42
413
NN

4,285
27
75
11
1,346
748
728
278
23
1,049

3,753
1,026
1,263
883
581

12,487
1,323
85
2,562
8,517

2,713
184
295
20
703
414
628
234
235

7,255
3,516
916
2,650
96
77


117,898 58

1,403 5
157
26 -
204 -
538 3
61
417 2

13,880 7
6,948 1
1,565 1
1,450 1
3,917 4

44,080 11
3,750 3
2,773 1
8,804 2
7,188 4
21,565 1

5,505 2
1,337 1
3,005
371
745
3
44
NN I

9,082 14
120
1,375 3
307
956 2
3,485 1
150 4
426 1
177 3
2,086

13,296 3
3,902 1
7,511 1
1,229
654 1

13,790 4
425
68 4
312'
12,985

6,548
990
655
89
680 -
465
3,452
193
24

10,314 12
1,852 2
795 1
7,539 8
58
70 1

1,485


1,629

73
7
7
3
30
5
21

175
25
48
51
51

244
67
37
47
68
25

87
22
13
33
3
3
6
7

261
3
25
6
36
9
53
36
41
52

140
62
41
28
9

246
13
94
10
129

56
3
1
1
32
9
8

2

347
21
20
289
14
3


7 2 -


129


1,965

142
16

19
38
2
67

74
29
44

1

409
31
28
122
101
127

70
4
60
3
1

2


138
6
12

53
5

1

61

301
256
40
5


29



29

126
7


59

59
1


Puerto Rico .......... 44


1,249


7 2 -


i









130 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

APRIL 22, 1967 AND APRIL 23, 1966 (16th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
ARSCARLET FEVER (Rky. Mt. Spotted) ANIMALS
AREA
1967 1967 Cum. 1967 Cum. 1967 Cum. 1967 Cum. 1967 Cum.
1967 1967 1967 1967 1967
UNITED STATES... 10,686 4 49 2 41 8 101 9 112 1,413

NEW ENGLAND.......... 1,912 3 38
Maine.............. 87 7
New Hampshire...... 14 3 25
Vermont............ 57 6
Massachusetts...... 286 -
Rhode Island....... 97 -
Connecticut........ 1,371 -

MIDDLE ATLANTIC...... 632 5 12 2 28
New York City...... 17 3 7 -
New York, Up-State. 530 I 3 2 20
New Jersey......... NN 1
Pennsylvania....... 85 i i 8

EAST NORTH CENTRAL... 937 2 5 2 9 1 13 112
Ohio.............. 131 3 1 5 50
Indiana............. 195 1 20
Illinois........... 183 2 4 1 18
Michigan........... 243 2 4 2 4
Wisconsin.......... 185 1 6 20

WEST NORTH CENTRAL... 497 1 1 9 2 30 302
Minnesota.......... 16 1 2 62
Iowa............... 197 1 2 5 31
Missouri........... 6 3 6 70
North Dakota....... 170 5 54
South Dakota....... 20 6 39
Nebraska........... 52 2 20
Kansas.............. 36 1 5 4 26

SOUTH ATLANTIC....... 1,108 11 5 1 10 4 11 194
Delaware........... 24 -
Maryland........... 163 -
Dist. of Columbia.. 1 -
Virginia............ 335 3 2 7 103
West Virginia...... 296 1 1 3 34
North Carolina..... 52 3 2 3 1
South Carolina..... 14 2
Georgia............. 17 1 2 1 1 33
Florida............ 206 4 1 4 1 23

EAST SOUTH CENTRAL... 1,273 2 12 5 2 12 1 15 349
Kentucky............ 335 1 4 4 65
Tennessee.......... 802 6 3 2 4 1 9 257
Alabama ........... 118 1 4 4 2 25
Mississippi........ 18 1 2 1 -- 2

WEST SOUTH CENTRAL... 843 1 10 1 11 16 1 19 258
Arkansas........... 1 3 1 3 4 41
Louisiana.......... 2 1 2 11 1 28
Oklahoma............ 144 1 5 1 5 58
Texas.............. 697 6 3 2 9 131

MOUNTAIN............. 1,775 5 14 9 39
Montana............ 78 1 1 -
Idaho.............. 80 -
Wyoming............. 42 -
Colorado........... 1,109 1 11 2 5
New Mexico......... 142 1 8
Arizona............ 211 2 6 26
Utah............... 111 3
Nevada............. 2 -

PACIFIC.............. 1,709 1 8 1 3 26 2 10 93
Washington......... 330 -
Oregon............. 83 1
California......... 1,139 6 1 3 24 2 10 92
Alaska............. 38 -
Hawaii............. 119 1 2 2 -

Puerto Rico.......... 9 3 4 1 13









Morbidity anid Mortalily icek- RHeport






DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED APRIL 22, 1967

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


All Causes Pneumonia Under All Causes Pneumonia Under
Area All 65 years Area and 1 year
Are All 65 years All 65 Influenza All
Ages and over Influenza All Ages and over Inlue A
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.--------


750
250
27
28
34
55
20
22
28
44
63
20
63
27
69

3,361
44
39
128
41
44
33
70
91
1,636
25
595
225
52
87
27
46
43
62
32
41

2,640
72
34
774
169
210
127
87
334
35
57
44
47
54
166
30
139
28
24
38
103
68

864
50
29
35
129
26
116
56
290
70
63


453
138
20
17
20
36
12
18
20
29
30
14
37
16
46

1,963
26
22
67
26
27
24
42
36
961
19
332
126
29
57
16
36
22
39
25
31

1,546
45
24
440
106
118
72
50
193
27
25
29
28
29
93
16
84
15
17
22
67
46

529
32
21
23
82
19
71
36
162
50
33


*Estimate based on average percent


SOUTH ATLANTIC:
Atlanta, Ga.-----------
Baltimore, Md.---------
Charlotte, N. C.-------
Jacksonville, Fla.-----
Miami, Fla.------------
Norfolk, Va.-----------
Richmond, Va.-----------
Savannah, Ca.-----------
St. Petersburg, Fla.---
Tampa, Fla.------------
Washington, D. C.------
Wilmington, Del.-------

EAST SOUTH CENTRAL:
Birmingham, Ala.-------
Chattanooga, Tenn.-----
Knoxville, Tenn.-------
Louisville, Ky.--------
Memphis, Tenn.---------
Mobile, Ala.-----------
Montgomery, Ala.-------
Nashville, Tenn.-------

WEST SOUTH CENTRAL:
Austin, Tex.-----------
Baton Rouge, La.-------
Corpus Christi, Tex.---
Dallas, Tex.-----------
El Paso, Tex.-----------
Fort Worth, Tex.-------
Houston, Tex.----------
Little Rock, Ark.------
New Orleans, La.-------
Oklahoma City, Okla.---
San Antonio, Tex.------
Shreveport, La.--------
Tulsa, Okla.-----------

MOUNTAIN:
Albuquerque, N. Mex.---
Colorado Springs, Colo.
Denver, Colo.----------
Ogden, Utah------------
Phoenix, Ariz.---------
Pueblo, Colo.----------
Salt Lake City, Utah---
Tucson, Ariz.----------

PACIFIC:
Berkeley, Calif.-------
Fresno, Calif.----------
Glendale, Calif.-------
Honolulu, Hawaii-------
Long Beach, Calif.-----
Los Angeles, Calif.----
Oakland, Calif.--------
Pasadena, Calif.-------
Portland, Oreg.--------
Sacramento, Calif.-----
San Diego, Calif.------
San Francisco, Calif.--
San Jose, Calif.-------
Seattle, Wash.---------
Spokane, Wash.---------
Tacoma, Wash.----------


Total


1,294
126
293
54
69
101
72
90
40
105
99
204
41

629
93
68
43
119
114
48
36
108

1,054
32
36
30
154
56
67
161
51
164
72
100
51
80

421
44
21
112
11
110
26
37
60

1,595
22
49
34
50
81
488
99
37
114
56
76
202
24
162
54
47


12,608


7,208


Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 207,396
All Causes, Age 65 and over------------------- 120,058
Pneumonia and Influenza, All Ages------------- 8,301
All Causes, Under 1 Year of Age--------------- 10,427


Week No.


I I I


of divisional total.









132


MELIOIDOSIS (Continued from page 127)


spenomegaly, arthritis, or osteomyelitis. The course may
be fulminant with a sudden onset, a rapidly developing
septicemia andor pneumonia with a marked cholera-like
gastrointestinal syndrome ending in early death. Localized
disease may occur without pneumonitis, such as osteo-
myelitis. hepatic abscess, and cellulitis. Occasionally,
the illness may be manifested as an asymptomatic upper
lobe chronic pneumonia, with or without cavitation, which
clinically mimics tuberculosis. Latent infection occurs in
which clinical illness does not become apparent until
several months or several years after the patient has left
the endemic area. One man with such a picture developed
cavitary pulmonary lesions 5 years after leaving South-
east Asia. Inapparent infection is much more common.,than
clinical illness. One study reported that S.3 percent of
Thai military personnel had diagnostically elevated com-
plement fixation antibody titers to Ps. pseudomallei.
The clinical disease had a mortality of 80 to 95 per-
cent in the pre-antibiotic era. Presently, mortality ranges
from 25 to 40 percent. Death can occur within 72 hours
from time of onset of symptoms in the acute septicemic
form of the illness; more commonly, it follows a 3- to
4-w\eek period of progressive clinical deterioration.
Diagnosis is confirmed by isolation of the Ps. pseu-
domullei from an abscess or draining sinus tract, sputum,
blood, urine, cerebral spinal fluid, or visceral biopsy
material. Serological responses in patients are variable.
However, a rising titer demonstrated by agglutination
or complement-fixation tests is helpful in the diagnosis.
The organism is relatively resistant to antibiotics.
In general, it has been found to be moderately but vari-
ably sensitive to tetracycline and sulfadiazine, chloram-
phenicol, kanamycin, novobiocin, and resistant to coly-
mycin, streptomycin, cephalosporin, and ampicillin. Drug
resistance has developed during therapy in some patients.
The Armed Forces have treated severely ill individuals
with a combination of drugs with doses as large as chlor-
amphenicol 12 gm. per day, kanamycin 4 gm. per day,
and novobiocin 6 gm. per day. Sensitivity studies are
important in the selection of the appropriate antibiotics.
Combination therapy should be initiated as soon as the
diagnosis is suspected and modified according to the re-
sults of tube dilution studies of antibiotic sensitivity.
Therapy should be maintained for a minimum of 4 weeks.
(Reported by the Preventive Medicine Division, Office
of the Surgeon General, Department of the Army; and the
Hospital Infections Unit, Bacterial Diseases Section,
Epidemiology Program, NCDC.)

REFERENCES:
Biegeleisen, L.Z., Jr., Mosquera, R.M. and Cherry, W.B.: A
case of human melioidosis: clinical, epidemiological and
laboratory findings. Amer J Trop Med 13:89, 1964.
Ertrug, C.: Melioidosis. Dis Chest 40:693, 1961.
Nerbin, H.L., Alexander, A.D., and Yager, R.H.: Melioidosis -
a military medical problem? Milit Med 128:538, 1963.


UNIVERSITY OF FLORIDA

1lllllilillIIIII I IIIIIIIH III IIlII 111111111
3 1262 08864 2235

.PRIL 22. 1967


THE MORBIDITY AND MORTALITY WEEKLY iF= I T ,:uJLa-
TION OF 17,000, IS PUBLISHED AT THE N&TO ri. r -.*.M .JNIIC h. LE
DISEASE CENTER, ATLANTA, GEORGIA.
DIRECTOR, NATIONAL COMMUNICABLE DISEi Sit N T
CHIEF. EPIDEMIOLOGY PROGRAM a M. '' u
ACTING CHIEF, STATISTICS SECTION .L *i' ur M 9

IN ADDITION TO THE ESTABLISHED PR-,:C*.' .. ci=.RTING
MORBIDITY AND MORTALITY, THE NATIONAL ,. C.r.u r'.'. -r '.-Ei SE
CENTER -- *-'." t E COUNTS OF IN TERE:T -C T e i RCi
INVESTING t'-:. -|:H ARE OF CURRENT T.-_-. iT T3 IE l. T
OFFICIALS AND WHICH ARE DIRECTLY RE.--T T.: T,_ :Cr*TjnL OF
COMMUNICABLE DISEASES. SUCH COMm.,"*.. T .'l -I1.-0 0 BE
ADDRESSED TO:
THE EDITOR
MORBIDITY AND MORTALITY E .e- i EG-T
NATIONAL COMMUNICABLE Dl: 1 r : T
ATLANTA, GEORGIA 30333
NOTE: THE DATA IN THIS REPORT A*C '''.' -'jP.L rD '
BASED ON WEEKLY TELEGRAMS TO THE N :: T-.N iO.'u
STATE HEALTH DEPARTMENTS. THE RE .- T'N.. I : --.L uu S
ON SAT'.- i: -'-'''ILEO DATA ON A NAT ,:.i.L &.'A : .'- ELET- ED
ON THE *.' : : O,-,C. FRIDAY.


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