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:
AA00010654:00048

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


SVol. 16, No. 33


WEEKLY

REPORT


Week Ending

- August 19, 1967



PUBLIC HEALTH SERVICE


BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


EPIDEMIOLOGIC NOTES AND REPORTS
IMPORTED MALARIA New York City

A case of malaria due to Plasimodium falciparum was
reported from New York City on August 17, 1967. The 24-
year-old female patient had returned on August 6. 1967.
from a trip around the world. On August 11 she developed
fever, headache, malaise, nausea and vomiting, followed
by chills on August 13. She w\as treated with antibiotics
until admitted to the hospital on August 16. On admission
she was in a stupor and had a temperature of 1071F. Malaria
was then suspected and P. falciparum organisms were de-
tected in the peripheral blood. Antimalarial treatment was
promptly initiated.


CONTENTS
Epidemiologiic Not,, .nod Reports
Imported lari Ne York Cit . ... 277
ltuman Exposur, to Rabid BAL Rhode Iland S.
RFcommendtion of the PIHl Advisorv Comrnitmte
on Immuniz.iuon Prcutie. --
Polelmi v -i \ c ine ..... .............. 7S


The patient had toured the globe with 46 other per-
sons, none of whom had used malaria chemprophylaxis en-
route. Their itinerary included stops in Japan. Taiwan.
Hong Kong, Singapore. Thailand. India. Pakistan. Iran,
Turkey, and Greece. Since the other group members also
could have been infected with malaria while overseas, the
(Continued on page 284_)


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
33rd WEEK ENDED CUMULATIVE, FIRST 33 WEEKS
MEDIAN
DISEASE AUGUST 19, AUGUST 20, 1962 1966 MEDIAN
1967 1966 1967 1966 1962 1966
Aseptic meningitis .. ....... ... 107 142 88 1.386 1,327 1,114
Brucellosis. ... .. .......... 7 11 10 170 149 233
Diphtheria .. .......... .. .... 3 4 4 65 112 153
Encephalitis, primary:
Arthropod-borne & unspecified .......... 43 120 923 1,000 -
Encephalitis, post-infectious .... .... .. 10 8 -- 593 550
Hepatitis, serum .................... ... ... 46 33 643 1.344 877 25367
Hepatitis, infectious .................... 683 610 24,216 20,691
Malaria ............................. 20 15 3 1,232 218 56
Measles (rubeola)....................... 230 694 919 57,075 187,674 355,346
Meningococcal infections, total ........... 23 32 26 1.602 2,600 1,858
Civilian ................................ 21 28 1,491 2,332 -
Military .............................. 2 4 111 268 -- -
Poliomyelitis, total ............. .... ..... ..2 2 2 22 61 65
Paralytic.............................. 2 2 2 19 57 57
Rubella (German measles) ................ 253 229 -- 39,289 40,917 -
Streptococcal sore throat & scarlet fever .. 4,477 3,838 3.193 310.222 294.323 272,741
Tetanus................................ 7 5 5 140 105 159
Tularemia.............................. _4 7 10 113 109 185
Typhoid fever ....... ................... 6 11 11 248 227 250 .
Typhus, tick-borne (Rky. Mt. spotted fever) 14 6 13 192 168 158

Rabies in animals ..... ......... 86 92 81 2.903 2,771 2,771

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........................................... 2 Rabies in man:.............. ................ 2
Botulism: ...................... ...................... 2 Rubella, Congenital Syndrome: ..................... 4
Leptospirosis: U tah-1 ............................... 25 T richinosis: ............. ....... ...... ....... 45
Plague: ............ ................ ........... 2 Typhus, marine: Tex.-1 ............................. 29
Psittacosis: .................. ................ ... 31 Polio, Unsp ........ ....... ..... .. ....... 3


r'-. ''4 -(a /V / .oj1







Morbidity and Mortality Weekly Report AUGUST 19. 1967

RECOMMENDATION OF THE PUBLIC HEALTH SERVICE ADVISORY
COMMITTEE ON IMMUNIZATION PRACTICES

The Public Health Service Advisory Committee on Immunization Practices meeting on May 26,
1967, issued the following recommendation on poliomyelitis vaccines, a revision of the initial
recommendation which was released as a supplement to the P Surveillance Unit Re-
port #285, September 1964.
POLIOMYELITIS VACCINES


Introduction
Widespread use of poliovirus vaccines has resulted in the
virtual elimination of paralytic poliomyelitis in the United
States. To insure continued freedom from the disease, it
is necessary to pursue regular immunization of all chil-
dren from early infancy.
Following the introduction of poliovirus vaccine in
1955. paralytic poliomyelitis declined from 18,308 cases
in 1954 to a low of 61 cases in 1965. A national survey in
September 1966, showed that 70 percent of all children 1-4
years of age had received at least three doses of oral
poliovirus vaccine (OPV)*, inactivated poliovirus vaccine
(IPV)**, or both. Approximately 90 percent of all children
5 years old and older had been adequately vaccinated.
Nevertheless. low immunization rates can still be
found in some population groups, both urban and rural. In
1966, 108 cases of paralytic poliomyelitis were reported in
the United States and Puerto Rico, reversing the downward
national trend. The majority of the 1966 cases occurred in
unimmunized children less than 5 years of age in south
Texas. These cases illustrate the possibility of outbreaks
where incomplete immunization exists.
With widespread use of poliovirus vaccine, laboratory
surveillance of enteroviruses indicates that circulation of
wild polioviruses has diminished markedly. It can be as-
sumed that inapparent infections with wild strains will no
longer contribute significantly to maintaining immunity in
the general population. Therefore, it is essential not only
to continue active immunization programs for infants and
children but also to make special efforts to raise the low
immunization rates existing in certain segments of the
population. Identification of population groups requiring
special immunization programs should he undertaken through
surveys, both of immunization history and serologic status.

Poliovirus Vaccines
From the introduction of IPV in 1955 until the live atten-
uated vaccines became widely used in 1962, more than 400
million doses of IPV were distributed in the United States.
Primary immunization with IPV plus regular booster doses
provided a high degree of protection against paralytic
disease.
Monovalent OPV, types 1, 2, and 3, have been widely
u-ed in the United States since 1961-62. Trivalent OPV
was introduced in 1963.


'*'he official narnm s of the- products in use are: 1) Poliovirus
Vc:in-, liv Oral. Ty'p 1; 2) Poliovirus Vaccine, Live,
Oral. Type 2: 3) Polioviru-s V~acine, Live, Oral, Type 3;
4) Poliovirus Va:cinef, Live, Oral, Tri vulnl.
**'Ihr ffici;l name of the product in us- is: Poliomyelitis
\v vr iac.


OPV is more widely used than IPV in this country be-
cause it is easier to administer and produces an immune
response which. without regular booster doses, appears to
be similar to immunity induced by natural poliovirus in-
fection. Trivalent OPV has largely replaced the mono-
valent forms because of simplicity of scheduling and
record-keeping.
A primary series of trivalent OPV, consisting of three
adequately spaced doses, will produce an immune response
to all poliovirus types in well over 90 percent of the re-
cipients. Using the immunization schedule recommended
in this report, possible interference with immunity pro-
duced by wild enteroviruses is minimized. Immunization
may, therefore, begin in any season.
For community protection during an epidemic, it is
better to immunize against the prevalent poliovirus type.
For this purpose, type-specific monovalent OPV is pref-
erable to trivalent OPV.
Very rarely, cases of -.. ri ii. poliomyelitis have oc-
curred in recipients of OPV or their close contacts within
30 days of vaccine feeding. Careful analysis indicates a
ratio of no more than one case of "vaccine-associated"
paralytic disease for every three million doses of OPV
administered.

Vaccine Usage
Oral Poliovirus Vaccine (OPV)
Primary Immunization
Trivalent OPV
Infants: The three-dose immunization series
should be started at 6 to 12 weeks of age,
simultaneously with the first DTP inoculation.
The second dose should be given no less
than 6 and preferably 8 weeks later. The third
dose is an integral part of primary immuniza-
tion and should be administered 8 to 12
months after the second dose.

Children and Adolescents: In children and
adolescents through the level of high school,
the primary series should consist of three
doses, the first two doses given 6 to 8 weeks
apart, and the third, 8 to 12 months after the
second. If circumstances do not allow for the
optimal interval between the second and third
doses, the third may be given as early as 6
weeks after the second.

Adults: Routine poliomyelitis immunization
for adults residing in the continental United
States is not currently necessary because of
the extreme unlikelihood of exposure. How-
ever, any unimmunized adult who may be at







Morbidity and Mortal


increased risk by virtue of contact with a
known case or travel to epidemic or endemic
areas should receive trivalent OPV according
to the schedule outlined for children and ado-
lescents. Persons employed in hospitals,
medical laboratories, and sanitation facili-
ties might also be considered as having an
increased risk. especially if poliomyelitis is
occurring in the area.
Pregnancy of itself is not an indication
for vaccine administration. nor is it a con-
traindication when immunization is required.

Monovalent OPV
An alternative immunization procedure for in-
fants. children, and adolescents is to gi e the
separate monovalent OPV types at intervals of
6 to 8 weeks. The recommended sequence of
types is 2, 1. 3. A fourth OPV dose. hut of tri\a-
lent vaccine. should be given b to 1:2 months af-
ter the third dose of monovalent OPV. The spe-
cial role of monovalent OP\ in epidemic control
is discussed below.

Follow-up Doses
School Entrance
On entering elementary school, all children \lhi
have completed the primary OP\ series should
be given a single follow-up dose of tri\alent
OPV. All others should complete the primary
series.

Routine "Boosters"
On the basis of current information, there is no
indication for regular or routine "booster" doses
of OP\.

Increased Risk
A single dose of trivalent OPV may be adminis-
tered to anyone \\ho has completed the full pri-
mary series described abo\e and has an in-
creased risk of exposure by \irtue of contact
with a known outbreak, travel to epidemic or en-
demic areas, or occupation. However, the need
for such an additional dose has not been estab-
lished. If there is uncertainty about the adequacy
of previous immunization, a single dose of trita-
lent OPV should be given.

Inactivated Poliovirus Vaccine (IPV)
Primary Immunization
All Ages: Four parenteral doses should be given.
three at approximately monthly intervals and the
fourth, a reinforcing dose, 6 to 12 months after
the third. This schedule may be integrated with
DTP immunization beginning at 6 to 1i weeks of
age.


Booster Immunization
Single booster doses every 2 to 3 years hate
been recommended to insure adequate levels of


AUGUST 19. 1967


ity Weekly Report 279

antibody. The need for IP\ booster- could hi
obliated hi a full course of OP\. For individ-
uals at particular risk as docribed pre piously.
at least one dose of tri alent OP\. and prefer
ahly a full primary series. is recommended.


Epidemic Control'
For operational purposes in the Inited States. an
"epidemic" of polionmelitis is now defined as two or
more case- caused by the same type irus during a
4-week period in a circumscribed population -uch as
that of a city. county, or metropolitan area. An epi-
demic of poliomit.litts can ib controlled b) an emer-
gency mono\alent OP\ immunization program. As soon
a: possible. the type of polioiirus rekpon-ible should
be determined and the epidet ic area defined. withinn
the pidennic area. all persons oter 6 eooks of age
\who are not completely immunized or w hose inmmuniza
tion statu- is uncertain -Iould pIromptlY receive one
dose of type-specific mono\alent OPV.


Simultaneous Administration of Live Virus Vaccines
Data on simultaneous admini-traiion of liNe \irus \ac-
cines are not sufficient io develop comnprehensi\e rec-
ommendations. but there are ohbious practical advan-
tages to combining taccines, and investigations are
under\ait which l should help to define optimal prac-
tites. lihen combined admini- traction i- indicated.
a ailable data do noi seugest that unde-irahle respon--
es \ill result. The fIollow\ine comment presents current
attitude> toward ,-chedulin, accination with three ma-
jor li\e \ir-u \accines-polio. nmea-les, and smallpox.
It has been generally recommended that immuniza-
tions with li\e virus taccin-e he separated by at least
one month when\ r possible. The rationale for this
recommendation is the theory that superimposed reac-
tions and diminished antibodyl responses might result
if t\o or more li\e tiru- vaccines were given simul-
taneously. Ideally, the initial doe s, of oral poliovirus
vaccinee should haie been cgien before a child reaches
one year. the age for giving lite attenuated measles
virus vaccine Administration of polio and measles an-
tigens should ie separated by at least one month. It is
likewise desirable to separate measles and smallpox
vaccinations by one or more months because both of
these antigens may produce febrile reactions.
\hen. ho\\e\r. immunization program effectite-
ness is hindered or when Ihe threat of concurrent ex-
posures exists, the relevant live \irus vaccines should
be given at the same time. Observations do not indi-
cate that this \ill cause a _- '. increase in ad-
\erse reactions or depressed antibody responses to
either antigen.





*For epidemic control monoatien OP\V pe and 3 n re ar e il-
tble from the Natiomn l Cnimunicabni, Disease C(,n i-r on rn-
qILuest of the State Ile,dith Departlntt.







280 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 19, 1967 AND AUGUST 20, 1966 (33rd WEEK)


ENCEPHALITIS HEPATITIS
ASEPTIC Primary
AREA MENINGITIS BRUCELLOSIS DIPHTHERIA including Post- Serum Infectious
nsp cases Infectious
unsp. cases
1967 1966 1967 1967 1967 1966 1967 1967 1966 1967 1966
UNITED STATES... 107 142 7 3 43 120 10 46 33 683 610

NEW ENGLAND........... 2 9 6 3 1 12 22
Maine.............. 1 3
New Hampshire......- -
Vermont.............- 1
Massachusetts...... 1 8 6 2 2
Rhode Island....... 1 1 1 3 3
Connecticut........ 1 7 14

MIDDLE ATLANTIC...... 9 6 1 4 9 1 12 16 95 66
New York City...... 3 4 2 2 10 13 35 16
New York, up-State. 3 1 1 25 19
New Jersey.......... 2 1 1 5 2 2 13 9
Pennsylvania....... 1 2 1 1 1 22 22

EAST NORTH CENTRAL... 29 8 5 15 15 5 3 128 151
Ohio................ 11 1 12 10 1 1 27 27
Indiana............ 1 1 2 9 6
Illinois........... 15 5 5 1 2 1 46 50
Michigan............ 1 1 3 2 1 38 66
Wisconsin.......... 1 1 1 8 2

WEST NORTH CENTRAL... 3 1 1 3 2 4 37 28
Minnesota........... 2 1 2 2 5
Iowa............... 1 1 2 5 11
Missouri............ 2 26 11
North Dakota....... 2 3 -
South Dakota....... 1
Nebraska .......... 1 -
Kansas............. -

SOUTH ATLANTIC........ 11 24 2 4 6 1 2 95 54
Delaware ........... 1 1
Maryland........... 9 1 1 1 20 14
Dist. of Columbia.. 2 -
Virginia........... 2 2 3 15 7
West Virginia...... 15 3 5
North Carolina..... 1 4 8
South Carolina..... 1 4 1
Georgia............. 39 7
Florida............ 2 6 1 3 7 11

EAST SOUTH CENTRAL... 12 12 1 4 45 39
Kentucky ........... I 19 9
Tennessee.......... 8 2 I 16 17
Alabama............ 4 5 1 3 6
Mississippi........ 4 3 7 7

WEST SOUTH CENTRAL... 4 39 2 72 1 2 2 72 61
Arkansas........... 1 1 4
Louisiana.......... 1 4 1 4 1 2 16 18
Oklahoma............ 9 7 1
Texas.............. 3 35 59 2 48 38

MOUNTAIN............. 4 23 25
Montana............. 2 2
Idaho.............. 3 1 1
Wyoming............ 1
Colorado........... 1 1 12 2
New Mexico......... 5 8
Arizona............ 3 8
Utah............... 3
Nevada..............-

PACIFIC.............. 36 43 9 5 4 25 10 176 164
Washington......... 3 1 3 3 24 17
Oregon............. 2 1 10 24
California......... 28 42 6 3 4 20 10 142 119
Alaska............. 3
Hawaii............. 5 1 1

Puerto Rico 17 21









Morbidity and Mortality Weekly Report 281


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 19, 1967 AND AUGUST 20, 1966 (33rd WEEK) CONTINUED



MALARIA MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, POLIOMYELITIS RUBELLA
TOTAL
AREA Cumulative Cumulative Total Paralytic
Cum
1967 1967 1967 1966 1967 1967 1966 1967 1967 1967 1967
UNITED STATES... 20 230 57,075 187,674 23 1,602 2,600 2 2 19 253

NEW ENGLAND .......... 8 838 2,230 2 67 113 19
Maine.............. 234 194 3 9 2
New Hampshire....... 74 79 2 9
Vermont............ 42 225 1 4
Massachusetts...... 7 337 773 32 44 2
Rhode Island....... 62 72 4 12 3
Connecticut........ 1 89 887 2 25 35 12

MIDDLE ATLANTIC..... 2 21 2,225 17,925 5 261 307 -- 5 27
New York City...... 2 9 445 8,247 46 43 1 13
New York, Up-State. 11 568 2,508 4 65 87 1 13
New Jersey.......... 1 481 1,844 1 92 91 -
Pennsylvania....... 731 5,326 58 86 3 1

EAST NORTH CENTRAL... 40 5,277 68,161 5 223 399 1 1 1 58
Ohio................ 6 1,136 6,326 3 74 108 8
Indiana............. 587 5,646 30 69 14
Illinois........... 7 934 11,317 52 76 7
Michigan........... 4 906 14,183 1 51 105 1 1 1 3
Wisconsin.......... 23 1,714 30,689 1 16 41 26

WEST NORTH CENTRAL... 1 14 2,823 8,661 1 68 140 1 1 3 2
Minnesota.......... 120 1,639 16 33 1
Iowa............... 1 745 5,303 13 22 1 1
Missouri........... 332 529 1 14 54 -
North Dakota........ 1 12 857 1,075 1 9
South Dakota........ 52 40 6 4 -
Nebraska........... 1 624 75 12 8 -
Kansas ............. 93 NN 6 10 1 1 2

SOUTH ATLANTIC....... 1 17 6,807 15,009 1 304 443 2 17
Delaware............. 43 256 6 4
Maryland............ 1 149 2,095 1 38 46 1
Dist. of Columbia.. 22 381 10 11 -
Virginia............ 4 2,171 2,108 37 53 3
West Virginia...... 6 1,368 5,158 21 20 2
North Carolina..... 5 847 462 66 110 1
South Carolina..... 507 654 29 47 2
Georgia............. 32 233 44 63 -
Florida............ 2 1,668 3,662 53 89 10

EAST SOUTH CENTRAL... 6 22 5,126 19,559 1 124 224 1 75
Kentucky............ 6 2 1,318 4,693 34 82 58
Tennessee........... 12 1,825 12,194 1 52 73 16
Alabama............ 5 1,321 1,673 25 49 1
Mississippi......... 3 662 999 13 20 I

WEST SOUTH CENTRAL... 3 75 17,177 24,084 3 215 365 7
Arkansas........... 1,404 966 28 33 -
Louisiana.......... 2 151 98 2 85 137 -
Oklahoma............ 1 22 3,347 474 16 18 1
Texas.............. 53 12,275 22,546 1 86 177 6

MOUNTAIN............. 16 4,594 11,810 27 81 8
Montana............ 4 281 1,802 4 -
Idaho............... 2 377 1,542 1 5 -
Wyoming............ 180 145 1 6 -
Colorado........... 4 1,543 1,276 12 42 5
New Mexico......... 576 1,118 3 10 -
Arizona............. 3 1,008 5,264 4 10 2
Utah................ 3 360 620 4 -
Nevada............. 269 43 2 4 -

PACIFIC.............. 7 17 12,208 20,235 5 313 528 47
Washington........... 3 5,417 3,478 1 28 37 7
Oregon.............. 3 1,566 1,701 25 33 11
California.......... 4 11 4,930 14,459 4 247 439 23
Alaska.............. 133 467 9 15 5
Hawaii............. 3 162 130 4 4 1
Pl,,r-t R-i,.o 1 12 2099 1 59 19 in


. .. ......


I I








282 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 19, 1967 AND AUGUST 20, 1966 (33rd 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... 4,477 7 140 4 113 6 248 14 192 86 2,903

NEW ENGLAND ......... 524 2 1 1 3 1 2 73
Maine .............. 13 16
New Hampshire ...... 37
Vermont............. 16 -- 2 17
Massachusetts...... 63 1 1 1 2 1 2
Rhode Island....... 39 1
Connecticut........ 393 1 1-

MIDDLE ATLANTIC...... 159 11 21 18 1 60
New York City...... 3 5 10
New York, Up-State. 150 1 7 4 1 50
New Jersey......... NN 1 2 7 -
Pennsylvania ....... 6 4 -- 2 7 10

EAST NORTH CENTRAL... 342 1 16 1 11 2 21 1 18 8 296
Ohio ...... ....... 14 4 1 5 1 10 3 102
Indiana............. 97 1 3 2 1 7 1 1 64
Illinois........... 86 7 1 9 2 7 2 59
Michigan........... 109 2 6 23
Wisconsin.......... 36 1 2 48

WEST NORTH CENTRAL... 285 10 19 14 2 27 696
Minnesota.......... 3 I 7 133
Iowa............... 57 1 1 2 -2 89
Missouri........... 4 5 7 7 1 5 128
North Dakota....... 82 6 128
South Dakota....... 26 1 2 1 92
Nebraska ........... 26 3 1 3 43
Kansas ..... ....... 90 9 1 3 83

SOUTH ATLANTIC....... 619 1 33 9 32 4 85 7 378
Delaware ........... 1 -
Maryland............ 110 2 1 16 1
Dist. of Columbia.. 7 1 I
Virginia........... 90 1 7 3 1 19 2 176
West Virginia...... 187 1 2 1 1 54
North Carolina..... 6 6 3 1 36 3
South Carolina..... 12 1 2 7 4
Georgia............. 7 3 4 8 1 9 4 90
Florida ............ 199 14 1 7 1 54

EAST SOUTH CENTRAL... 916 22 8 2 41 5 36 10 546
Kentucky............ 103 3 1 1 17 2 13 5 128
Tennessee.......... 636 8 5 7 3 17 5 379
Alabama............ 130 8 9 6 37
Mississippi........ 47 3 2 1 8 2

WEST SOUTH CENTRAL... 490 4 30 2 54 1 30 3 17 22 607
Arkansas ........... 5 1 32 7 3 6 2 83
Louisiana.......... 1 3 1 4 1 13 4 54
Oklahoma........... 42 1 14 6 7 13 207
Texas.............. 447 4 21 4 4 4 3 263

MOUNTAIN ............. 671 7 16 8 2 91
Montana............. 12 1
Idaho............... 81
Wyoming............. 5 2 5
Colorado............ 427 11 8 10
New Mexico......... 59 2 28
Arizona............. 19 3 43
Utah............... 68 3 2
Nevada...............

PACIFIC .............. 471 1 16 4 1 70 1 7 7 156
Washington......... 75 2 1 1 1
Oregon............. 31 1 -- 2
California......... 340 1 13 2 1 66 5 7 153
Alaska ............. 21 -
Hawaii.............. 4 2 3 -

Puerto Rico.......... 3 110 1 26








Morbidity and Mortality Weekly Report


DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED AUGUST 19, 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 and 1 year Area All 65 years and I year
S Influenza All Influenza All
Ages and over All Ages Causes Ages and over 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.--------


633
211
44
26
21
52
22
14
25
51
58
13
31
25
40

2,963
42
37
130
42
33
40
67
83
1,471
38
419
185
43
83
24
47
73
44
30
32

2,312
62
36
674
160
191
125
75
271
38
46
34
30
41
143
29
105
43
30
39
77
63

807
63
31
42
125
25
114
71
217
62
57


371
108
24
20
13
27
16
10
17
29
33
11
24
15
24

1,668
26
23
78
32
17
23
35
43
808
22
233
100
26
42
18
30
40
28
20
24

1,266
38
19
355
86
106
66
43
147
30
29
22
14
29
63
15
65
16
19
27
42
35

480
32
16
22
77
17
66
44
130
41
35


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*----------


Total


1,035
142
226
45
51
88
51
74
37
53
57
171
40

540
97
33
23
132
94
37
37
87

1,085
34
27
20
155
29
72
189
54
175
66
101
86
77

362
30
21
116
18
83
9
47
38

1,479
16
50
24
55
50
477
76
32
114
65
72
170
35
138
67
38


11,216


6,263


Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages -------------------------409,908
All Causes, Age 65 and over-------------------234,225
Pneumonia and Influenza, All Ages------------- 14,704
All Causes, Under 1 Year of Age--------------- 20,798


Week No.
33


*Estimate based on average percent


of divisional total.














IMPORTED MALARIA New York City
(Continued from front page)

epidemiologists in the 10 states in which they reside
were contacted and requested to inform the travellers of
the occurrence of malaria in one of their travel compan-
ions. They were successful in notifying within 24 hours
all but one of the 46 travellers of their potential exposure.
One traveller was contacted while vacationing on a beach
and one individual was located in a hospital where she
was being treated for diabetes. The final member of the
tour was located 3 days after the information had been
received at the NCDC. None of the travellers have ex-
perienced symptoms suggestive of malaria to date.

(Reported by Dr. B. H. Kean, Professor of Tropical Medi-
cine, Cornell University; Dr. Tibor Fodor, Chief, Division
of Epidemiology, and Dr. Howard B. Shookoff, Chief,
Division of Tropical Diseases, both of the New York City
Health Department; DHEW Region H, New York City; and
the Malaria Surveillance Unit, Epidemiology Program,
NCDC.)





HUMAN EXPOSURE TO A RABID BAT Rhode Island

The first rabid bat found in Rhode Island was reported
by the Rhode Island Department of Health Laboratories on
June 12, 1967. An 11-year-old boy was bitten on June 10
when he attempted to pet the "sleeping" bat. The child
was immediately taken to a hospital where the single
puncture wound on the right thumb was cleansed with benz-
alkonium chloride and a booster dose of tetanus toxoid
was administered. The bat was caught in a shoebox later
that day; in a short time it died and was buried in the
backyard.
On Monday, June 12, an alert local dog officer inves-
tigated the incident. The bat was unburied and brought
to the Rhode Island Department of Health Laboratories
where it was tentatively identified as a little brown bat
(Myotis lucifugus). Examination of the brain with Seller's
stain yielded equivocal results but direct fluorescent
microscopy identified rabies virus. Subsequently, the
diagnosis was confirmed in Rhode Island using intracere-
I,rll inoculated mice and at the National Communicable
Disease Center by fluorescent antibody technique.
Within 2 hours after the diagnosis was made, prophy-
lactic treatment was begun. Since completion of a full
regimen of treatment, the child has, to date, remained well.
Prior to this report, Rhode Island was the only state
of the 48 states of the U.S. mainland that had never re-
ported a rabid bat.

(Reported by Joseph E. Cannon, M.D., Director of Health,
Rlode Island Department of Health.)


284


UNIVERSITY OF FLORIDA

_I IIII I__ _III _II fIII II i hI f 1 ff1111 1 iI 1 f11 1
3 1262 08864 2045

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.


0


o >
Sm
m
->





> M >11
i

0z z >m

> >

zn Z
M m e 0c








0m

-o
m z -n
'of
z


0
-4


UNIV. OF FL Lt I-: ...
DOCUMENTS C--iz






U.S. DEPOSITORY

3-





m
mo
m
!n a

-s.


AUGUST 19, 1967


Morbidity and Mortality Weekly Report