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:
AA00010654:00047

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


Vol. 16, No. 44


WEEKLY

R. RT

Week Ending
November 4, 1967


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


PUBLIC HEALTH SERVICE


BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


CURRENT TRENDS
MEASLES 1967

A total of 253* cases of measles was reported for the
week ending November 4, 1967 (week 44), a decrease of 46
cases from the previous week. Week 44 concludes the re-
porting for the first 4-week reporting period of Epidemi-
ological Year '67-'68. and this total of 1.186 cases is
43 percent of the 2,750 reported cases during this same
period last year.
Figure 1 presents the national incidence of measles
by 4-week reporting periods for the second halves of 1964-
1966 and the current 1967 total. The current trend is sea-
sonally upward, but at 43 percent of the 1966 level and
29 percent of the 1965 and 1964 levels.
County and health district data indicate that the re-
ported cases of measles are more localized than a year
'Includes 10 cases from a delayed report from \\ashington.

F
REPORTED CASES OF ME
4-WEE
JULY DECE


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CONTENTS
Current Trends
Measles 1967 .... ....... .. ..... :169
Epidemiologic Notes and Reports-
Outbreak of \lumps Michigan ........ 37
Suspect ed Poliomyeo tis Indiana .. .. 371
International Notes
Secondar\ Case of Smallpo\ Eniland .......... :.(. 7


ago. Only 112 counties or health districts reported measles
for the week ending October 2b. 1967 (week 43). whereas
169 counties or health districts reported measles cases
for the 43rd week in 1966. Figures 2 and 3 demonstrate
the 66 and 29 counties that reported three or more cases
in the 43rd weeks of 1966 and 1967, respectively. Thus. it
is al 1 here are more relatively measles-free
=. ,w1 .1966. These include New England.
She Mountain Regions.
j A (F/igures 2 and 3 on page 370)


27,357


i8 ^ 1965
-- 1966
1967


- -


\ \



S.------- -
N_ .-


26 28 30 32 34 361 38 40 '42' 44 '46 48 50 52
JULY AUG SEPT OCT NOV DEC
WEEK NUMBER


P .2,// I'7'r






Morbidity and Mortality Weekly Report



MEASLES 1967 (Continued from front page)


Figure 2
COUNTIES OR HEALTH DISTRICTS REPORTING 3 OR
MORE CASES OF MEASLES
WEEK ENDING OCTOBER 29, 1966


Figure 3
COUNTIES OR HEALTH DISTRICTS REPORTING 3 OR
MORE CASES OF MEASLES
WEEK ENDING OCTOBER 28, 1967



I F -- --'------


-C \


-/


EPIDEMIOLOGIC NOTES AND REPORTS
OUTBREAK OF MUMPS Michigan


Between July 1 and October 15, 1967, an epidemic of
mumps occurred at a home for 1,200 mentally retarded peo-
ple in Michigan. A total of 100 clinical cases have been
diagnosed among the 450 resident patients known to have
been exposed to mumps, yielding an attack rate of 22.2
percent.
Residents of the home are assigned on the basis of
age. sex. and similar behavior level to one of 36 housing
units: however. most residents mix with persons from
certain other cottages for meals and for other planned
activities.
As of October 15, mumps had been observed in 12 of
the 36 cottages: 77 percent of the cases occurred in four
of these units. Attack rates were greatest (65 and 66 per-
cent) in the two units with the youngest children (average
age 9.5 years). An unusual preponderance (86 percent) of
clinical cases were in males. It should be noted, however,
that 65 percent of males less than 15 years of age were
exposed to mumps, whereas 27 percent of females younger
than 15 were exposed.
A schematic representation of the pattern of exposure
and subsequent spread of illness from cottage to cottage
is shown in Figure 4. The index caxe. a resident of cot-
tage A. aas exposed while at home in mid-June. He devel-
oped mumps on July 1: 2 weeks later, 19 cottage-mates
became ill over a 3-day period. The disease then spread
to cottage B when a patient with mumps from cottage A
spent sa~eral hours with his brother from cottage B. An-
other cottage (J) was exposed when the residents shared
cottage B's playground facilities at a time when mumps
wa;- occurring in cottage B. Sequential exposure of four
other coltages(D.E.(GI,) occurred in a dining hall; mumps
au- initially introduced into this group by infected in-
dividuall from cottage A. Mumps spread in a similar man-
ner to the fixe remaining cottages (C,F.I,K,L).
In c-a a where a definite time of contact could be
slabili -hod. Ithe incubation period varied from 15 to 18


Figure 4
SCHEMATIC REPRESENTATION OF SPREAD OF MUMPS
HOME FOR MENTALLY RETARDED IN MICHIGAN
JULY 1 OCTOBER 15, 1967


.---6
U- -^
( --C
@ -i *--


-6- -


a aer... a""



days. Most patients had a low grade fever for one or 2
days with salivary gland swelling for 3 to 6 days. Tem-
peratures as high as 105F or prolonged fever beyond 7
days were rarely observed. There have been no cases of
mumps central nervous system involvement; three patients,
the youngest of whom was 11 years old, developed orchitis.
Blood samples have been obtained from a selected
group of 600 residents and convalescent sera will be
drawn in early December for antibody studies to define
the rate of subclinical illness.

(Reported by George Agate, lM.., Chief, Division of Epi-
demiology, Bureau of Conmmunity Health, Michigan Depart-
ment of Public Hlealth; and a team of EIS Officers, NCDC.)


NOVEMBER 4, 1967






NOVEMBER 4, 1967


Morbidity and Mortality Weekly Report


SUSPECTED POLIOMYELITIS-Indiana


Additional laboratory evidence has supported the
suspicion of poliovirus etiology in three cases of severe
paralytic disease occurring in Indiana during July and
August 1967 (MMWR, Vol. 16. No. 37).
Case No. 1: A21-year-old white male from Johnson County
who developed profound flaccid quadriplegia remains in
critical condition. Repeated micro-neutralization tests
confirmed the earlier ',i.1..i of a fourfold rise to polio-
virus type 2. Virus isolation attempts were negative.
Case No. 2: A 21-year-old white male from Jackson County
with residual paraplegia showed fourfold rises in neutral-
izing antibody (NA) titer to poliovirus types 1 and 3. NA
titer rose from 1:160 to 1:480 and complement fixation
(CF) titer from <1:4 to 1:16 for type 2. Poliovirus was not
recovered from stool specimens. Specific type etiology,
therefore, remains uncertain.
Case No. 3: Poliovirus type 1 (wild or non-vaccine-like
strain) was isolated from a 34-year-old white male from
Bartholomew County, whose clinical illness was domi-


nated by paraplegia. Serologic studies demonstrated a rise
in neutralizing antibody titer to poliovirus type 1 from
1:60 to 1:160 on paired sera.
Laboratory studies have not confirmed poliovirus
etiology in a 24-year-old male with aseptic meningitis, or
in a 64-year-old male with meningoencephalitis. The
agents of infection in these two "possible" poliomyelitis
cases have not been identified.
The five patients neither had received oral polio
vaccine nor had known contact with recent recipients of
oral vaccine. No additional cases of poliomyelitis-like
paralytic disease in Indiana were uncovered by continuing
surveillance.


(Reported by A. L. Marshall, Jr., M.D., Division of Com-
municable Disease Control, Bureau of Preventire MIedicine,
and Josephine Van Fleet. M.D., Director of Laboratories,
both with the Indiana State Board of Health: Enterorirus
Laboratory and an EIS Officer, NCDC.)


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)

44th WEEK ENDED CUMULATIVE, FIRST 44 WEEKS
MEDIAN
DISEASE NOVEMBER 4, NOVEMBER 5, 1962 1966 MEDIAN
1967 1966 1967 1966 1962- 1966
Aseptic meningitis .......... .. ... 101 67 48 2,588 2,582 1,806
Brucellosis. ............................ 4 3 4 212 213 315
Diphtheria. ............... .......... .. 4 4 10 126 169 226
Encephalitis, primary:
Arthropod-borne & unspecified .......... 37 48 1,395 1,880 -
Encephalitis, post-infectious .......... 8 9 687 646
Hepatitis, serum ................... ..... 51 44 6 6 1,860 1,202,41
Hepatitis, infectious .................... 739 642 32,520 27,084
Malaria .............................. 63 21 4 1,750 406 92
Measles (rubeola)......................... 243 705 1,356 59,616 193,567 365,382
Meningococcal infections, total .......... 34 41 41 1.889 2,981 2,357
Civilian ............................ 33 41 -- 1,770 2,700 -
Military .............................. 1 --- 119 281 -
Poliomyelitis, total ................... .. 3 1 3 29 83 101
Paralytic............................. 3 1 2 25 78 80
Rubella (German measles) ................ 250 255 41,522 43,329 "
Streptococcal sore throat & scarlet fever 7,365 8,204 6,489 375,436 354,037 329,400
Tetanus............................ ... 3 5 4 189 166 232
Tularemia ................... ...... 4 4 150 156 244
Typhoid fever .......................... 9 8 8 361 335 377
Typhus, tick-borne (Rky. Mt. spotted fever). 1 5 2 294 234 217

Rabies in animals ....................... 66 55 57 3,670 3,482 3.482

NOTIFIABLE DISEASES OF LOW FREQUENCY

Cum. Cum.
Anthrax: ..................... ........ ........... 2 Rabies in man: ................... .... .. .. 2
Botulism: ........................................... 2 Rubella, Congenital Syndrome: Md.-1 .................. 6
Leptospirosis: Cal.-3 ................................. 35 Trichinosis:........................... ............ 52
Plague: ............................................. 2 Typhus, murine: Tex.- ............................... 39
P sittacosis: ........ ..................... ..... ..... 38 P olio, U nsp. ..... .. .. ... .......... 4
Excludes report from Washington. State holiday.








372 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
NOVEMBER 4, 1967 AND NOVEMBER 5, 1966 (44th WEEK)


ENCEPHALITIS HEPATITIS
ASEPTIC Primary
AREA MENINGITIS BRUCELLOSIS DIPHTHERIA including Post- Serum Infectious
unsp. cases Infectious
1967 1966 1967 1967 1967 1966 1967 1967 1966 1967 1966
UNITED STATES... 101 67 4 4 37 48 8 51 44 739 642

NEW ENGLAND.......... 2 4 4 2 25 31
Maine.............. 6 14
New Hampshire...... -
Vermont............
Massachusetts...... 2 3 2 9 12
Rhode Island...... 1 2 2 1
Connecticut........ 2 7 4

MIDDLE ATLANTIC...... 9 9 3 9 1 10 30 155 115
New York City ..... 3 5 6 19 50 40
New York, up-State. 2 3 1 2 1 3 51 24
New Jersey......... 7 3 1 2 3 5 20 29
Pennsylvania....... i 1 3 34 22

EAST NORTH CENTRAL... 15 4 5 4 1 2 119 93
Ohio................ 1 2 2 1 25 22
Indiana............. 3 2 9 10
Illinois........... 2 2 1 39 14
Michigan........... 10 1 1 37 43
Wisconsin.......... 1 1 9 4

WEST NORTH CENTRAL... 6 1 6 1 1 42 25
Minnesota........... 6 3 10
Iowa............... 1 3 7 8
Missouri........... 1 19 6
North Dakota....... 2
South Dakota....... 1
Nebraska............ 2
Kansas............. 1 3 9

SOUTH ATLANTIC....... 41 3 2 2 1 108 64
Delaware............ 1 2 8 1
Maryland............ 6 9 14
Dist. of Columbia.. 1 1 1
Virginia........... 34 1 13 13
West Virginia...... 1 10 9
North Carolina .... 8 12
South Carolina..... 1 i
Georgia............. 50 9
Florida............ 1 8 5

EAST SOUTH CENTRAL... 1 9 1 1 2 36 38
Kentucky............. 1 11 18
Tennessee........... 1 2 1 2 14 10
Alabama............ 3 2 7
Mississippi........ 4 9 3

WEST SOUTH CENTRAL... 2 10 4 1 24 4 1 1 47 55
Arkansas............ 9 17 1 7 8
Louisiana.......... 1 1 1 1 3 10 3
Oklahoma............ 1 I -
Texas............... 1 1 3 5 1 1 29 44

MOUNTAIN............. 1 1 3 1 26 43
Montana............ -- 5 1
Idaho............... 1 8
Wyoming............ 2 7
Colorado............ 1 3 1 5
New Mexico......... 1 -- 6 12
Arizona............. 11 8
Utah............... 1 2
Nevada.............

PACIFIC ............. 31 21 1 12 7 2 32 13 181 178
Washington......... --- --- --- 1 --- --- 1 --- 7
Oregon.............. 9 33
California.......... 30 20 12 6 2 32 12 168 131
Alaska.............. -
Hawaii............. 1 6

Puerto Rico 17 12







Morbidity and Mortality Weekly Report 373


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 4, 1967 AND NOVEMBER 5, 1966 (44th WEEK) CONTINUED



MALARIA MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, POLIOMYELITIS RUBELLA
TOTAL
AREA Cumulative Cumulajive Total Paralytic
Cum.
1967 1967 1967 1966 1967 1967 1966 1967 1967 1967 1967
UNITED STATES... 63 243 59,616 193,567 34 1,889 2,981 3 3 25 250

NEW ENGLAND............ 3 885 2,410 1 74 135 30
Maine.............. 239 245 3 11 3
New Hampshire...... 77 80 2 9 -
Vermont........... 42 298 1 4 1
Massachusetts...... 2 373 808 1 35 55 10
Rhode Island....... 62 72 4 16 1
Connecticut........ 1 92 907 29 40 15

MIDDLE ATIANTIC...... 2 23 2,366 18,224 9 310 373 5 31
New York City...... 3 481 8,338 1 54 56 1 9
New York, Up-State. 5 606 2,584 4 77 105 1 6
New Jersey.......... 1 11 524 1,895 4 103 107 12
Pennsylvania....... 1 4 755 5,407 76 105 3 4

EAST NORTH CENTRAL... 2 45 5,777 69,350 8 277 477 3 3 6 30
Ohio................ 1 3 1,166 6,384 1 90 135 4
Indiana............. 621 5,757 4 47 82 3 3 3 4
Illinois........... 23 1,051 11,429 2 59 87 4
Michigan........... 1 1 971 14,712 1 63 126 3
Wisconsin.......... 18 1,968 31,068 18 47 18

WEST NORTH CENTRAL... 2 8 2,901 8,855 5 88 155 3 14
Minnesota.......... 2 123 1,656 21 35 1
Iowa................ 3 763 5,354 2 18 22 1 11
Missouri........... 1 339 536 1 17 60 1
North Dakota....... 1 875 1,181 3 11 1
South Dakota....... 3 58 40 1 7 5
Nebraska........... 649 88 13 8 -
Kansas............. 94 NN 1 9 14 2

SOUTH ATLANTIC........ 36 25 7,090 15,563 3 363 506 2 44
Delaware............ 50 262 7 4 -
Maryland........... 1 169 2,120 50 49 1
Dist. of Columbia.. 24 388 1 14 14 1
Virginia........... 1 6 2,222 2,208 42 66 -
West Virginia...... 10 1,437 5,402 1 35 35 13
North Carolina..... 2 916 513 71 130 1
South Carolina..... 1 511 659 30 52 -
Georgia............. 33 36 236 1 56 65 -
Florida............. 1 6 1,725 3,775 58 91 30

EAST SOUTH CENTRAL... 21 5,370 19,933 1 144 259 1 26
Kentucky............ 8 1,404 4,754 42 90 22
Tennessee.......... 12 1,958 12,428 1 62 89 4
Alabama............ 1,336 1,721 26 56 -
Mississippi........ 1 672 1,030 14 24 1

WEST SOUTH CENTRAL... 4 62 17,806 25,239 2 236 400 8
Arkansas........... 1,404 972 33 36 1
Louisiana.......... 156 99 1 94 149
Oklahoma............ 4 3,358 519 1 18 21 1
Texas............... 62 12,888 23,649 91 194 6 -

MOUNTAIN ............. 7 21 4,778 12,225 2 37 91 19
Montana............ 1 319 1,856 1 4 5 1
Idaho.............. 393 1,645 3 5
Wyoming............ 4 185 214 1 6 -
Colorado............ 7 9 1,603 1,339 13 49 3
New Mexico......... 591 1,148 1 4 10 -
Arizona............. 7 1,035 5,328 5 10 13
Utah............... 383 645 4 1 2
Nevada............... 269 50 3 5 -

PACIFIC.............. 10 35 12,643 21,768 3 360 585 56
Washington......... --- --- 5,555 4,249 --- 35 43 --- -
Oregon............... 3 1,670 1,920 27 37 4
California.......... 10 30 5,098 14,879 3 283 483 44
Alaska.............. 140 571 11 18 2
Hawaii............... 2 180 149 4 4 6
Puerto Rico.......... 5 2,217 3,090 14 17 1







374 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 4, 1967 AND NOVEMBER 5, 1966 (44th 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... 7,365 3 189 150 9 361 1 294 66 3,670

NEW ENGLAND ......... 935 2 1 1 8 1 95
Maine............... 52 22
New Hampshire...... 18 45
Vermont...........- 22
Massachusetts...... 132 1 1 1 4 1 4
Rhode Island....... 55 1 2
Connecticut........ 678 1 3

MIDDLE ATLANTIC...... 200 1 13 1 3 37 35 2 89
New York City...... 3 1 7 1 18 -
New York, Up-State. 142 1 1 1 10 9 73
New Jersey......... NN 1 4 15
Pennsylvania....... 55 4 1 5 11 2 16

EAST NORTH CENTRAL... 467 1 21 12 1 40 22 1 342
Ohio................ 3 4 13 11 117
Indiana............. 51 3 2 11 I 78
Illinois........... 150 10 10 1 6 10 1 65
Michigan........... 176 3 8 22
Wisconsin.......... 87 1 1 2 60

WEST NORTH CENTRAL... 362 16 21 1 20 4 10 858
Minnesota.......... 14 5 2 1 1 169
Iowa............... 133 1 1 3 2 115
Missouri........... 3 8 8 9 1 4 155
North Dakota....... 100 3 146
South Dakota....... 33 1 2 116
Nebraska........... 2 4 2 58
Kansas............. 77 1 10 1 2 99

SOUTH ATLANTIC....... 783 40 10 3 55 116 3 447
Delaware ........... 4 -
Maryland............ 122 2 21 3
Dist. of Columbia.. 17 1 3 6
Virginia........... 234 9 6 28 1 191
West Virginia...... 225 1 2 2 1 60
North Carolina..... 32 7 4 46 3
South Carolina..... 4 1 2 10 5 2
Georgia............. 17 4 5 2 16 15 110
Florida............ 128 18 1 12 2 72

EAST SOUTH CENTRAL... 1,438 30 10 62 53 15 697
Kentucky............ 42 3 1 27 15 3 161
Tennessee.......... 1,109 8 7 11 26 11 482
Alabama............ 206 11 12 12 1 45
Mississippi........ 81 8 2 12 9

WEST SOUTH CENTRAL... 663 46 79 37 1 43 30 816
Arkansas........... 9 5 46 12 15 105
Louisiana.......... 4 4 8 14 1 2 1 66
Oklahoma .......... 3 18 7 16 18 304
Texas.............. 650 34 7 4 10 11 341

MOUNTAIN............. 1,630 2 10 20 9 110
Montana............ 36 1 2 -
Idaho.............. 192 -
Wyoming............. 142 2 1 5
Colorado........... 900 1 1 12 9 10
New Mexico......... 157 1 2 34
Arizona............ 136 3 49
Utah............... 67 6 3
Nevada ............ 9

PACIFIC .............. 887 1 19 6 82 11 5 216
Washington......... --- --- --- 2 --- 2 --- 2 --- 2
Oregon.............. 97 1 1 3 3 4
California......... 640 1 14 3 74 6 5 210
Alaska............. 45 -
Hawaii............. 105 4 3 -

Puerto Rico.......... 2 16 1 7 30








Morbidity and Mortality Weekly Report


DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED NOVEMBER 4, 1967

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


375


All Causes Pneumonia Under All Causes l Pneumonia Under
Area All 65 years and year Area All 65 years and year
Influenza All Influenza All
All Ages Causes All Ages Causes


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

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

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

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


673
211
35
29
26
67
25
20
16
46
55
14
48
20
61

3,281
38
34
157
47
39
44
66
83
1,632
43
483
204
51
107
36
38
49
51
40
39

2,653
67
35
785
167
214
115
88
350
49
54
48
20
65
163
24
129
39
41
42
98
60

813
59
23
34
125
18
135
58
235
74
-52


429
119
28
19
19
40
16
14
12
33
32
9
31
14
43

1,933
19
21
87
26
19
28
36
46
973
26
263
118
30
65
24
23
32
35
32
30

1,517
44
21
439
97
120
63
46
200
29
25
25
13
43
84
11
82
22
24
30
61
38

506
40
15
18
69
17
86
40
140
49
32


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.----------


1,154
146
252
58
89
98
51
85
25
93
53
168
36

664
77
53
40
174
144
50
36
90

1,072
41
40
20
143
24
69
235
37
155
84
95
79
50

384
46
16
113
19
70
22
52
46

1,506
13
42
30
48
78
429
95
37
111
57
102
195
38
155
48
28


7
4
1
1
6
4
66
1
29
8
2
3
2

1
4
2
2

128
3
2
42
3
11
4
3
18
2
3
1
2
1
15

3

5

5
5

43
2

2
7

8
3
14
5
2


Week No.
44


Total 12,200 6,938 391 596

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages -------------------------539,920
All Causes, Age 65 and over-------------------307,867
Pneumonia and Influenza, All Ages------------- 18,840
All Causes, Under 1 Year of Age--------------- 27,477






376


Morbidity and Mortality Weekly Report


INTERNATIONAL NOTES
SECONDARY CASE OF SMALLPOX-

Wandsworth Borough, England


A secondary case of smallpox has occurred in the
mother of the 3-year-old Pakistani child with imported
smallpox .'.I'It\ Vol. 16. No. 42). On October 23, the
child's mother developed three very minor lesions on the
face. The diagnosis of modified smallpox was made and
confirmed by laboratory tests.
The mother presumedly was infected on or about
October 10. the date her child first had a rash. They were
staying in Wandsworth Borough, London. since arrival on
October 1. and were both isolated in hospital on Octo-
ber 17 when the diagnosis of smallpox in the child was
confirmed. Wandsworth Borough, the area in which this ex-

posure occurred and the secondary case experienced onset.
has been declared a smallpox-infected local area as of
October 10. The patients have been transferred to a nearby
smallpox hospital under strict quarantine.
Beginning October 17, all known primary and second-
ary contacts in Wandsworth Borough were vaccinated and
are under surveillance. As of October 31. no other second-
ary cases had been reported.
(Submitted to the Foreign Quarantine Program by Robert
I. Hood, M.D., Chief Medical Officer, International Quairan-
tine, Division of Communicable Diseases, World Health
Organization.)








ERRATUM, Vol. 16, No. 43, p. 363
The correct number of patients whose time of onsets
are shown in Figure 1 is 180, not 189. The title to Fig-
ure 1 should read:
Shigellosis Outbreak Philadelphia, Pa.
Onset of Symptoms of 180 Patients
October 14-21, 1967


NOVEMBER 4, 1967


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION OF 17.000, IS PUBLISHED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER, ATLANTA, GEORGIA.
DIRECTOR. NA IONAL COMMUNICABLE DISEASE CENTER
DAVID J. SENCER, M.D.
CHIEF, EPIDEMIOLOGY PROGRAM A.D. LANGMUIR, M.D.
ACTING CHIEF. STATISTICS SECTION IDA L. SHERMAN, M.S.
EDITOR, MMWR MICHAEL B. GREGG, M.D.

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY, THE NATIONAL COMMUNICABLE DISEASE
CENTER WELCOMES ACCOUNTS OF INTERESTING OUTBREAKS OR CASE
INVESTIGATIONS WHICH ARE OF CURRENT INTEREST TO HEALTH
OFFICIALS AND WHICH ARE DIRECTLY RELATED TO THE CONTROL OF
COMMUNICABLE DISEASES. SUCH COMMUNICATIONS SHOULD BE
ADDRESSED TO:
NATIONAL COMMUNICABLE DISEASE CENTER
ATLANTA, GEORGIA 30333
ATTN: THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT

NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO THE NCDC BY THE INDIVIDUAL
STATE HEALTH DEPARTMENTS. THE REPORTING WEEK CONCLUDES
ON SATURDAY; COMPILED DATA ON A NATIONAL BASIS ARE RELEASED
ON THE SUCCEEDING FRIDAY.


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