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:
AA00010654:00049

Related Items

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

Full Text

PS 2 6o/ ,(Va ) I/, $


P-S 2- 0 ?iNAA/4tMUNICABLE DISEASE CENTER


Vol. 16, No. 15


WPORLY
REIGX


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

BUREAU OF DISEASE PREvENTrrI .in AriD ErviRijro ENTA,_ ror TfiOL


CURRENT TRE
MALARIA IN THE

As of April 17, ,' i r rl -A
had been received b:. I-lri -r,..V ii I r .
military and state I. ij l'?u'i b I.r Trrsi
'.'r. .exceeds the t.,l %. r ...r" 1 r i
tire year of 1966 (T. ,I I "
All but 10 cases '. IP. r:~ r n.ili ir -1
most of whom had been 4nja i r... 'iame
manifest in this countir, L -ri, L i'

1Imported malaria acquired outside of a specific area, U.S.A.
in this report.


k U.\ I F,.\ I
Current Trends
Malaria in the United States ... . .. 117
Influenza United states . ... 121
Epidemiologic Notes and Reports
Blood Transfusion Induced C se of
Falciparum Malaria California ............. 11
Imported Canine Rabies Portland, Ord eon .. ..... 19
International Notes
Quarantine Measure .... . ... ... 121

cases. This substantial increase includes a sharp rise
in vivax infections (Table 2). Three-fourths of these vivax
malaria patients had their onset more than 30 days after
their return.
continued d on page 118)


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
15th WEEK ENDED CUMULATIVE, FIRST 15 WEEKS
MEDIAN
DISEASE APRIL 15, APRIL 16. 1962 1966 MEDIAN
1967 1966 1967 1966 1962 1966
Aseptic meningitis ................ .... 33 31 27 418 426 412
Brucellosis. ............................ .4 3 6 57 56 93
Diphtheria .. ........ .... ......... 5 35 39 67
Encephalitis, primary:
Arthropod-borne & unspecified ........... 30 32 353 367
Encephalitis, post-infectious ........... 29 17 223 246
Hepatitis, serum ............ .. ...... 41 34 ) 568 370 3
Hepatitis, infectious .................... 842 602 11,873 10,432 13
Malaria ................... ......... 21 3 1 586 84 27
Measles rubeolaa) ...................... 2,690 7,578 17,542 34,519 109.383 178.245
Meningococcal infections, total ........... 73 109 100 893 1.530 975
Civilian ............................ 65 102 821 1,332
Military ............................. 8 7 72 198 -
Poliomyelitis, total ................... .. 1 1 1 3 7 19
Paralytic........................ ..... 1 1 1 3 6 14
Rubella (German measles) ................ 1,701 1,898 17,109 20.888
Streptococcal sore throat & scarlet fever 11,810 10,854 9.949 183,193 176,104 162,618
Tetanus................................. 6 3 4 45 28 50
Tularemia ............................. 4 3 39 50 58
Typhoid fever ............ : ........... 11 4 6 93 74 98
Typhus, tick-borne (Rky. Mt. spotted fever) 1 9 10 6

Rabies in animals ........... ...96 106 109 1,301 1,291 1,251

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax ....... .................. .......... 1 Rabies in man ...................... ..
Botulism ............ ............ ............... Rubella, Congenital Syndrome: Tenn.- ....... ..1
Leptospirosis .... ... .. ... .. ........ ....... 9 Trichinosis:N.Y.City-1 .. .. .. .. 22
Plague ......................................... Typhus, marine: Texas-1 ............ ...... ...... 7
Psittacosis .......... ............ ............. 10 ..... .... ... .....








Morbidity and Mortality Weekly Report



MALARIA IN THE UNITED STATES (Continued from front page)


APRIL 15, 19t67


fable 2
Causative Plasmodium Species of Malaria Cases
in the United States, 1966-1967*


feur


Civilian


Annual
Total


1962 75 44 119
1963 58 90 148
1904 52 119 li(
1965 bl 105 1l6
1966 563 115 6'i8
1967' 712 10
'Repoited cases through April 17, 1967.


ALASKA















HAWAII

R


GEOGRAPHIC


1966
Species Nune- I- P ec e
Nuimbe pc'~f


lb16i*
\u,noer I Peice~it


P. vivax 382 60.1 568 84.2
P. falcicium 221 34.7 9o 13.6
P. malarioe 12 1.9 i 0.4
t'. ovate 13 2.0 1 0.1
Mixsa infections 1i.5 1'2 1.1
All cases 636 100.0 699 100.0
*Reported cases through April 17, 1967.


Fiiu.e I
DISTRIBUTION OF 722 LASES OF MALARIA IN 1967*


*REPORTED CASES THROUGH APRIL 17, 1967


PUERTO RICO

D


I he geographic distribution of the 722 cases is shown
in Figure 1. Cases are concentrated in (..lli:.rn.i. Colo-
rado, Georgia, Kentucky, North Carolina, and Texas be-
cause ot the location of military centers receiving re-
turiees in these states.
(Heported by the Parasitic Diseases Section, Epidemzology
Program, NCDC.)
Editorial Note:
The reiaute Importance of specific factors respon-
si:be for this increase in malaria are unclear. The number
of military personnel stationed in \Vernarr.i, their concen-
tration in malarious areas, the species of Plasmodium to
which they are being exposed, the length of the transmis-
sioa season, and the rate at which servicemen are return-
ing to the United States all influence to an as yet unde-
termined degree the number of imported malaria cases.


The increase in vivax malaria is important since the few
episodes of introduced2 malaria in the United States dur-
ing the past 15 years were due to Plasmodium mvar.
Mosquitoes capable of malaria transmission are pres-
ent in most of the country and the possibility of local,
temporary reestablishment of P. vivax in such vectors
exists. The likelihood of such an occurrence is small
and past experience suggests that any introduced cases
would be few and such outbreaks self-limiting. The best
defense against the spread of malaria is intensive s ir-
veillance. Ph* -i. anr, should be encouaged to report all
suspect malaria and each report should be investigated
to verify diagnosis and to determine source of infection.
-ihr I.- 1 malaria acquired by mosquito transmission con-
tracted from an imported case in an area where ma-
laria is not a regular occurrence.


118


Table 1
Maluria Loses Occu.ring in the United States
1962-1967*







APRII. 15, 19f7


Morbidity and Mortality Weekly Report


EPIDEMIOLOGIC NOTES AND REPORTS
BLOOD TRANSFUSION INDUCED CASE OF FALCIPARUM MALARIA California


A vr-e of falciparinum milrin following blood trans-
fusion W.a recently diagnosed in a ;2-yvear-old Negro
male resident of Oakland. California. The patient has re-
sided there for the last o0 years. His only travel abroad
was a brief trio to Mexico City in 1921. He has no his-
tory of drug addiction.
Hie was hospitalized in San Francisco on December 21,
1966. for treatment of myocardial infarction and has re-
mained there since. He was given two units of packed
red cells for anemin on March 4 and 5. On March 12 his
temperature rose to 101F. and exceeded 103F. on each
of the next 3 days. This was followed by spiking fevers
up to 104F.. every other day. Plzm4'lium falciparum
parasites Nwere identified or a routine differential blood
smear and antimalarial therapy was initiated.
Both donors of the packed red cells were identified
as servicemen. One of them had not been abroad and did
not have a history compatible with malaria; his serum
tested by the indirect fluorescent antibody technique con-
tained no antibodies to malaria. The other donor had served
in Vietnam from August 1965 until June 26, 1966. He had
experienced periodic chills, fever, and sweating from 4
days before his departure from Vietnam hr .c'h his 30-day
home leave after arriving in the United States. He was
stationed in Kentucky and there had two additional epi-
sodes of chills, fever, and sweats; the last episode oc-
curred in January 1967. No diagnosis of malaria was ever
made. This serviceman stated that he had continuously


taken the prescribed inmalria prophylaxis (one weekly
tablet of 300 rmg. chloroquine base and 45 mg. I)riOmiqui'ie)
while stationed in Vietnam and for 8 weeks following
departure.
He donated blood in San Francisco on March 2, 1967.
and packed red cells from this donation wr e given to
the patient on March 4. The fluorcesen nt ntibody liier of
the serviceman was 1:80 for P. falciparTin. No parasites
were found in his peripheral blood when examined be-
tween April 1 and 6. His bone marrow showed degenerated
schizonts and pigment, and examination of liver biopsy
material showed diffuse pigmentation.
(Reported by Dr. Philip K. Condit, Director of Epidemio-
logy, and Dr. Rebecca Proctor, Ca'iforn;a State Depvart-
ment of Public Health; Dr. Richard AK. Ferqvson and Paul
Isakson, San Francisco; Col. Arthur Steer, M.C.. U.S. 4.,
Letterman General Hospital, San Francisco; Or. Ervin 1H.
Braff, Director, Disease Control, San Francisco Depart-
ment of Public health; and the Malaria Surveillance Unit,
Epidemiology Program, NCDC.)
Editorial Note:
Since 1957, 11 cases of blood transfusion induced
malaria have been reported to the NCDC. An episode iden-
tical to this present case report occurred in an American
Navy dependent at the Naval Hospital in Naples, Italy,
in November 1966. The species involved in that case was
also P. falciparum, and the donor was a serviceman who
had been stationed in Vietnam.


IMPORTED CANINE RABIES Portland, Oregon


The brain of a 4-year-old part-Pekingese mongrel was
tested by the Laboratory Section of the Oregon State Board
of Health and found positive for rabies by the presence
of Negri bodies and by the fluorescent antibody test on
March 13, 1967, and later by the mouse inoculation test.
The dog. which had no known history of immunization
against rabies, had been purchased in Mexico several
months earlier. When he was taken across the border on
March 1 at San Luis, Arizona, he was probably incubating
rabies. The owner, after entering the United States, re-
turned with the dog to his mobile trailer home on Hayden
Island, a suburb of Portland, Oregon.
On March 6, the dcg was taken to a veterinarian be-
cause of marked pruritis. Alirough the veterinarian could
find no reason for the prurii -. he noted that the dog was
docile but when examined became fairly vicious. During
the course of the examination, the assistant suffered
several deep scratches on the hands and forearms.
After the examination the dog was taken home, but
he ran away and roamed the island until March 12. He
was caught and destroyed after he had bitten three persons
and attempted to bite a fourth. Folli.n,,rg the positive


laboratory examination of the brain, treatment for expo-
sure was begun in the veterinarian's assistant, the three
persons who were bitten, and two others who had had
close contact with the dog the weekend of March 4-5.
The two with the most severe exposures received duck
embryo vaccine plus rabies immune serum; all others re-
ceived DEV only.
Since the animal's whe-eabouts and behavior during
the week he roamed the island in a probably infectious
state were unknown, the incident was publicized to inform
and alert persons who might have had contact with this
dog. Eight dogs and one cat thought to have been exposed
to the rabid dog are under observation in quarantine.
A 90-day quarantine and immunization were recom-
mended for all cats and dogs on the island. The mass
immunization program was conducted on March 17. The
local health department is carrying out a stray animal
control program and is planning a wild animal population
control campaign.
(Reported by Dr. Edward L. Goldblatt, Director, Epidemi-
ology Section, and Dr. Monroe Holmes, Public Health
Veterinarian, Oregon State Board of Health.)


119









120 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

APRIL 15, 1967 AND APRIL 16, 1966 (15th WEEK)


ENCEPHALITIS HEPATITIS

ASEPTIC Primary
AREA MENINGITIS DITt CELLosIs DIPHTHIERIA including Post- Serum Infectious
unsp. cases Infectious
1967 1966 1967 1967 1967 1966 1967 1967 1966 1967 1966
UNITED STATES... 33 31 4 30 32 29 41 34 842 602

NEW ENGLAND .......... 2 2 1 3 2 33 22
Maine.............. -- 2 4
New Hampshire...... 1 1
Vermont............ -
Massachusetts...... 22 12
Rhode Island ...... 2 1 1 2 1 5 1
Connecticut........ I 1 1 3 4

MIDDLE ATLANTIC...... 6 4 6 2 3 15 12 174 91
New York City...... 1 1 1 11 11 52 12
New York, Up-State. 2 1 2 42 24
New Jersey......... 3 1 3 4 1 42 15
Pennsylvania....... 2 2 1 1 38 40

EAST NORTH CENTRAL... 4 4 6 8 10 2 1 141 147
Ohio............... I 3 3 1 36 44
Indiana............ 3 4 14 10
Illinois........... 2 1 8 1 1 38 16
Michigan........... 2 3 2 43 73
Wisconsin.......... 10 4

WEST NORTH CENTRAL.. 1 1 5 1 61 16
Minnesota.......... 1 1 5 1 13 2
Iowa............... 2 5
Missouri........... 38 6
North Dakota....... 1 2
South Dakota.......- -
Nebraska........... 3 1
Kansas............. 4 -

SOUTH ATLANTIC....... 1 1 7 13 4 1 108 71
Delaware............ 1 1
Maryland............ 4 3 1 19 21
Dist. of Columbia.. -
Virginia............ 2 30 16
West Virginia...... 8 2
North Carolina.... 5 9 4
South Carolina .... 1 1 1 -
Georgia.............. 23 15
Florida............ 1 6 2 1 17 12

EAST SOUTH CENTRAL.. 7 9 1 1 3 1 1 61 50
Kentucky........... 1 2 23 18
Tennessee........... 3 2 1 1 1 1 14 23
Alabama............ 2 2 1 12 7
Mississippf........ 1 3 2 12 2

WEST SOUTH CENTRAL... 4 3 2 1 1 1 4 83 55
Arkansas............ 1 3 9
Louisiana.......... 1 11 8
Oklahoma........... 2 1
Texas.............. 4 3 2 I 1 3 67 37

MOUNTAIN............. 2 2 1 31 38
Montana............ 5 2
Idaho.............. 3
Wyoming............ ---- 1
Colorado............ 2 1 3 21
New Mexico......... 1 14 5
Arizona............. 7 5
Utah............... 1 1
Nevada............... 1

PACIFIC.............. 11 5 1 5 3 5 17 15 150 112
Washington......... 1 1 1 13 13
Oregon.............. 1 9 10
California......... 10 4 1 4 3 4 16 15 127 86
Alaska............ ... 1 1
Hawaii.............. 1 -

Puerto Rico 1 35 21














The Morbidity and \Mih.ailI i 1%wkly Report, in large part an archival document, is not
entirely suitable for describing fully the evolution of national efforts for eradication of
measles in 1967. Supplements to the MMWR such as this are prepared in the Office of the
Director, NCDC in an effort to document more broadly the progress of the national campaign
with interpretations of the total effort.

PRESIDENTIAL ANNOUNCEMENT ON MEASLES ERADICATION

President L ndon B. Johnson added the considerable support of his office to the national effort for
measles eradication in the United Stateo in 1967 when he made an announcement from the Texas \\hit,-
House on March 6. On that date, the President released a detailed memorandum from John W. Gardner,
Secretary, Department of Health, Education, and Welfare, portions of which are reprinted:

"Only a few years ago, the parents of our Nation's children saw the dreaded disease of polio
practically eliminated through the use of vaccine.

"Tod:is we are on the threshold of eliminating another dangerous disease measles.

"Since measles vaccine was first licensed and made available to the public in 1963, the number
of cases has plunged downward.

"Our goal is to eliminate measles from the United States in 1967. The Surgeon General's target
for this year is the vaccination of between 8 and 10 million children -all susceptible children
between the ages of one and seven.
"The extensive collaboration-national, State, and local, public and private-which is taking
place throughout the United States assures success in our drive to eliminate measles as a threat
to America's children."


STATUS OF MEASLES CASES

REPORTED CASES OF MEASLES BY FOUR-WEEK PERIODS, UNITED STATES
Epidemiologic Years, 1964-65, 1965-66 and 1966-67
Compared with 10-year Period, 1954-63
160,000
0
140,000
\ -- 1964-65 Epidemiologic Year
S120,000 ---1965-66 Epidemiologic Year
1966-67 Epidemiologic Year
S100,000 RANGE
u / 1954-1963
w 80,000
Uo
I. 60,000
0
& 40,000

20,000 '


44 48 52 4 8 12 16 20 24 28 32 36 40
WEEK NUMBER
The number of cases of measles reported in recent weeks continues to reflect the lowest incidence
since measles data were compiled beginning early in the century. The usual seasonal increase in cases
is not being seen. The weekly number of cases remains remarkably constant.


APRIL 15. 1967


MM11MR SUPPLEMENT





REPORTED CASES OF MEASLES FOR FIRST 12 WEEKS OF 1966


ALASKA
D







HAWAII
H


PUERTO RICO
O


II 0- 199 CASES J 00-2499 CASES
E 200- 999 CASES 2500. CASES


CURRENT GEOGRAPHIC DISTRIBUTION OF MEASLES CASES
The current geographic distribution of reported measles cases in the U.S. for the first 12 weeks in
1967 is contrasted with that in the first 12 weeks of 1966. Arbitrary levels of numbers of cases rather
than the rates are presented for simplicity. It is readily apparent that although measles continues to
be relatively widespread in the U.S., the intensity of its presence is appreciably reduced.
REPORTED CASES OF MEASLES FOR FIRST 12 WEEKS OF 1967
ALASKA
H *77= Pn


AMERICAN MEDICAL ASSOCIATION SUPPORT
As part of its considerable support to the national effort for measles eradication in 1967, the
American Medical Association's Task Force on Health Education to Promote Immunization has prepared
a campaign kit. The kit containing education materials, such as news releases, sample speeches, edi-
torial, radio and television health messages, posters, and literature for the public as well as guides to
program planning has been sent to each State and local medical society. The AMA's efforts in behalf of
comprehensive immunization is apparent in the kit although basic emphasis is on measles vaccination.


HAWAII
D


D oo-






NCDC ASSISTANCE IN CONTROL OF MEASLES EPIDEMICS
One of the four points made by Surgeon General \illll:ln H. ,t'.wart in his initial challenge for
measles eradication in 1967 deals with control of epidemics. In support of this integral part of the total
program, assistance from the National Communicable Di-,.a-e Center including measles vaccine, jet
injlctor quipminnt. and manpower can be made available to all States. A supply of PIInlIn-MIurL, measles
vaccine in .>n, dose vials (for jet injector use only) and Philips Roxane measles vaccine, with measles
immune globulin, in -ingle and ten dose vials is maintained by the NCDC. Epidemiologically trained
personnel, stationed in various state and local health departments and in Atlanta, as well as jet in-
jector equipment, if needed, can usually be dispatched on short notice. In emergencies, assistance can
be requested by State Health Departments by contacting the Immunization Program, NCDC, Area Code
404, 6.i:1.1:l 11. Extension 3741.



COST OF MEASLES EPIDEMICS
Etriiiate- of the annual costs of measles epidemics in a community unprotected by immunhrnization
as compared with the cost of a community-wide immunization program are shown in the table below. The
estimates are based on one million population prior to the use of measles vaccine.



AVERAGE ANNUAL COST OF MEASLES IN A COMMUNITY OF ONE MILLION

Numr Approximate
Number
Direct Costs

Susceptibles (1-12 Yrs.) 50,000
Total Cases of Measles 20,000
Treated at Home 19,800 $200,000*
Treated in Hospital (Avg. 9.5 Days) 120 47,000
Complications 80
Encephalitis 10
Deaths 2
School Days Lost 30,000 100,000
Immune Globulin for Contacts 4,500

Susceptibles Remaining 30,000
$351,500*
TO IMMUNIZE ALL 50,000 SUSCEPTIBLES $100,000

*Does not include any loss of income by parents and other indirect costs.


NATIONAL ORGANIZATIONS SUPPORT MEASLES ERADICATION
The National Communicable Disease Center has had correspondence with a large number of the
Nation's voluntary health, civic and fraternal organizations regarding eradication of measles in 1967.
When informed of the seriousness of measles and the plan for its eradication, there were enthusiastic
offers of support and subsequent encouragement of the organizations' membership to cooperate in all
ways with development of community and State-wide programs. The following excerpts of letters received
from a few of the organizations evidence the level of interest which these groups are showing in efforts
to promote measles eradication.
"... glad to cooperate in every way possible .."
The International City Managers' Association
". we are interested in developing a program in the local communities designed to
eradicate measles."
American Federation of Labor and Congress of Industrial Organizations






".. very interested in such a problem and will assist in every ia%\ ."
National 4-H Club Foundation
". pleased to join in this effort ."
Girl Scouts of the U.S.A.
". you can count on Civitan International to be of assistance... ."
Civitan International
in full support will do e, er' Ihing possible ."
National Social Welfare Assembly, Inc.
". pleased to cooperate ."
American Assoc. for Health, Phys. Education and Recreation
". vitally interested .eager to participate in every possible way .
American Pharmaceutical Association
". .pledged full support to the Surgeon General in his anti-measles campaign ."
U.S. Conference of City Health Officers
". .. very pleased to cooperate ."
National Society for Crippled Children and Adults
".. .welcome the opportunity to assist. .."
National Association of the Deaf
". .. happy to cooperate in the campaign to eradicate measles in the United States in 1967."
National Exchange Club





VACCINATION ASSISTANCE ACT SUPPORT
The map below denotes areas of the U.S. that as of April 1, 1967 had Immunization Project Grant_.
Within the areas encompassed by these projects is 84% of the Nation's population.
Since autumn of 1966, immunization projects have emphasized measles eradication assistance.
Considerable effort and resources have been committed to the development of improved techniques of
systematically immunizing one year olds and other preschool children susceptible to measles and of
optimal surveillance to provide an efficient alert to the introduction and spread of measles as well as
diphtheria, whooping cough, tetanus and poliomyelitis.









Morbidity and Mortality Weekly Report 121


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

APRIL 15, 1967 AND APRIL 16, 1966 (15th WEEK) CONTINUED



MALARIA MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, POLIOMYELITIS RUBELLA
TOTAL
AREA Total Paralytic
Cumulative Cumulative Total Paralyti
Cum.
1967 IIre l r I I ,Ir |r r"
UNITED STATES... 21 2,690 34,519 109,383 73 893 1,530 1 1 3 1,701

NEW ENGLAND.......... 1 32 405 1,321 2 32 72 155
Maine.............. 5 84 149 1 2 7 14
New Hampshire...... 1 68 20 1 7 6
Vermont............. 8 34 202 3- -
Massachusetts...... 13 150 507 1 14 29 57
Rhode Island....... 2 27 57 1 5 18
Connecticut........ 4 42 386 14 21 60

MIDDLE ATLANTIC...... 3 105 1,133 13,229 26 132 166 1 81
New York City...... 1 14 180 6,720 2 20 24 1 39
New York, Up-State. 24 264 1,472 3 33 47 41
New Jersey.......... 2 19 279 1,373 11 55 47 -
Pennsylvania....... 48 410 3,664 10 24 48 1

EAST NORTH CENTRAL... 1 235 2,735 41,537 7 91 224 371
Ohio................ 61 467 3,266 4 37 61 53
Indiana............. 1 19 312 2,494 13 35 34
Illinois........... 41 416 8,571 17 44 56
Michigan........... 39 579 6,897 2 17 62 99
Wisconsin.......... 75 961 20,309 1 7 22 129

WEST NORTH CENTRAL... 117 1,554 5,115 1 38 80 80
Minnesota.......... 13 68 1,238 8 21 7
Iowa............. 15 367 2,782 1 9 12 53
Missouri........... 58 111 315 9 33 6
North Dakota....... 15 585 735 3 9
South Dakota....... 39 3 5 2 2
Nebraska.............. 16 384 42 6 3 3
Kansas............. NN NN NN 1 6 -

SOUTH ATLANTIC....... 7 504 3,904 8,454 10 172 242 1 1 1 144
Delaware............ 1 27 117 5 3 3
Maryland............ 5 68 1,309 20 23 1 1 1 15
Dist. of Columbia.. 11 302 3 6 -
Virginia........... 230 1,219 846 13 31 34
West Virginia...... 51 694 3,293 1 15 8 7
North Carolina..... 4 41 685 145 2 34 48
South Carolina..... 3 98 253 399 2 14 34 21
Georgia.............. 9 23 177 30 41 -
Florida............. 69 924 1,866 5 38 48 64

EAST SOUTH CENTRAL... 160 3,638 12,034 6 88 129 117
Kentucky........... 20 1,015 3,690 2 25 57 13
Tennessee.......... 81 1,216 6,955 1 38 40 103
Alabama............ 45 843 778 3 16 23 1
Mississippi........ 14 564 611 9 9 -

WEST SOUTH CENTRAL... 6 674 11,961 12,541 11 146 231 1 17
Arkansas........... 7 1,312 375 2 16 12
Louisiana.......... 1 12 82 64 4 55 89
Oklahoma............ 5 6 2,445 268 1 8 9 -
Texas............... 649 8,122 11,834 4 67 121 1 17

MOUNTAIN.............. 2 299 2,520 5,913 2 19 56 131
Montana............ 2 183 867 3 28
Idaho............... 59 275 614 1 1 4
Wyoming............ 14 82 1
Colorado............ 2 86 622 641 2 10 32 73
New Mexico......... 44 393 332 3 9
Arizona............ 59 579 3,174 2 8 24
Utah............... 7 224 179 1 2
Nevada............. 42 230 24 2 2

PACIFIC.............. 1 564 6,669 9,239 8 175 330 605
Washington........... 206 3,274 1,791 2 18 19 77
Oregon............. 1 98 818 721 13 15 55
California.......... 252 2,420 6,614 5 136 280 384
Alaska............. 6 87 51 1 8 13 9
Hawaii............... 2 70 62 3 80
Puerto Rico.......... 136 1,205 1,396 7 2 1









122 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

APRIL 15, 1967 AND APRIL !6, 1966 (15th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE BABIES 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... 11,810 6 45 4 39 11 93 1 9 96 1,301

NEW ENGLAND.......... 2,035 4 35
Maine.............. 78 7
New Hampshire...... 26 4 22
Vermont............ 59 6
Massachusetts ...... 221 -
Rhode Island....... 102 -
Connecticut........ 1,549 -

MIDDLE ATLANTIC...... 1,007 5 1 12 2 26
New York City...... 18 3 7
New York, Up-State. 869 I 1 3 2 18
New Jersey......... NN -
Pennsylvania....... 120 1 8

EAST NORTH CENTRAL... 1,157 2 5 1 7 1 6 99
Ohio............... 174 1 3 1 5 45
Indiana............. 159 1 20
Illinois........... 203 2 4 1 1 18
Michigan............ 425 2 2
Wisconsin.......... 196 14

WEST NORTH CENTRAL... 576 1 8 2 22 272
Minnesota.......... 7 60
Iowa............... 183 1 2 3 26
Missouri........... 21 3 4 64
North Dakota....... 226 4 49
South Dakota....... 19 2 33
Nebraska........... 71 6 18
Kansas............. 49 4 3 22

SOUTH ATLANTIC....... 1,332 3 11 5 9 4 19 183
Delaware........... 21 -
Maryland........... 148 -
Dist. of Columbia.. -
Virginia........... 663 1 3 2 11 96
West Virginia...... 211 1 1 4 31
North Carolina..... 36 1 3 2 3 1
South Carolina..... 21 -2 2-
Georgia............ 8 1 2 1 1 3 33
Florida............ 224 1 4 3 1 22

EAST SOUTH CENTRAL... 1,236 1 10 2 5 1 10 1 14 334
Kentucky........... 35 1 1 4 3 61
Tennessee.......... 1,042 1 6 1 3 2 1 11 248
Alabama............ 121 3 1 4 23
Mississippi........ 38 1 1 2

WEST SOUTH CENTRAL... 787 2 9 2 10 16 1 19 239
Arkansas........... 1 1 2 I 3 2 37
Louisiana.......... 2 1 1 2 11 27
Oklahoma........... 94 1 4 1 6 53
Texas.............. 690 6 1 3 2 11 122

MOUNTAIN ............. 1,815 5 6 14 3 30
Montana............ 65 1 1
Idaho............... 126 -
Wyoming............. 24 -
Colorado........... 881 1 6 11 3
New Mexico......... 292 2 7
Arizona............ 174 2 1 20
Utah............... 251 3 -
Nevada .... ...... 2 -

PACIFIC.............. 1,865 7 1 2 23 1 2 7 83
Washington......... 417 -
Oregon.............. 78 1
California......... 1,245 6 1 2 21 1 2 7 82
Alaska.............. 75 -
Hawaii.............. 50 1 -- I

Puerto Rico.......... 5 3 4 3 12










Morbidity and MIortalitl V cekll Report


DEATHS IN 122 UNITED SlATES CITIES FOR WEEK ENDED APRIL 15, 1967

(By place of occurrence and week iI tiiinR, cer itictiat. Ex, iids Iotai darths)


Area


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.---------
Alientown, 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.-------
Trencon, 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.--------


All
Ages


65 years and
Influenza
and over
All Ages


I year
All
Cau ;es


+ + 4 + 3*


764
264
43
28
21
68
33
26
27
62
50
12
33
24
73

3,377
49
38
143
37
36
49
55
74
1,712
35
566
191
60
105
31
38
50
48
30
30

2,649
62
37
753
187
237
110
86
366
42
46
38
25
59
147
32
120
39
34
40
121
68

757
56
21
41
128
20
103
74
189
73
52


483
158
25
14
15
37
28
21
19
37
30
10
25
15
49

2,003
31
22
93
21
26
31
40
40
1,001
17
320
107
43
66
19
23
33
26
20
24

1,515
34
27
394
102
135
62
54
212
28
28
27
12
38
76
22
75
22
25
18
80
44

462
33
15
18
67
15
58
44
125
54
33


49
20
3

1



1



1

10
3



1
3
8






3
1


2
3




1
1


3







1
44
2
6
3
2
13
2
2
2
1
5
13
2
4
1

2

2

42
2
1
9
7
1
5
2
8
2
5
2


'UiTH ATLANTIC:
Atlanta, Ga.-----------
Baltimore, Md.---------
Charlotte, N. C.-------
JacKsonvi I l, Fla. -----
Miami, i ia. ------------
Norfolk Va.-----------.
Rirchmond, Va. ---------
Savaidnah, it.- --------.
St Pet -rsbu-g', Fi.--
'i ipa, F; -----, --
Washinigton, 1. C:------
Wi lningt on, i)o .-------

EAST SOUTH CENTRAL: |
Birmingham, Ala .-------
Chattace.,d, T.e.-------
KR- xv i i Tenn.- -----
I.d1isvi i Ky.- -------
M1mphis, Ts I .---------
Mobile, Ala.-----------
Monrgomery, Ala.-------
Nashville, Tenn.-------

WEST SO3TH CENTRAL:
Austin, T -----------
Baton Kouge, La.-------
Corpus Christi, Tex.---
Dallas, Tey.-----------
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


I-f + --

Al 6 years nd
A ears Inf luenza
Ag n All A over
|AII Ages


I year
All
Causes


1,3r1 617 41 46
129 65 6 5
26/ 141 8 13
36 13 2 1
67 37 1 4
18 54 5
51 29 2 1
92 42 1 3
41 20 2 -
'2 68 6 3
; 40 7 5
171 88 5 3
37 20 1 2

601 334 30 30
111 66 1 3
37 22 4 2
35 26 2
119 71 3 6
125 61 7
46 20 1 4
38 16 3 1
90 50 3 5

1,079 568 31 54
40 26 3 3
34 20 1 2
32 15 2
146 75 2 7
29 16 4 3
87 53 5 5
209 99 3 6
45 26 2 1
167 82 2 9
74 45 2 6
110 55 5
48 30 2 1
58 26 5 4

404 227 20 17
48 22 3 2
21 13 6 1
100 58 3 2
19 14 1 1
93 51 5 2
11 9 -
55 29 1 4
57 31 1 5

1,513 957 39 51
30 20 3 1
55 33 1 3
26 21 -
56 32 1 1
87 62 8 2
454 287 8 18
71 38 1
23 17 1 -
112 75 4
58 33 1 1
69 60 3 3
187 100 3 10
36 23 2 1
142 97 4 3
59 42 1 2
28 17 3 1


12.295


Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 194,788
All Causes, Age 65 and over------------------- 112,850
Pneumonia and Influenza, All Ages------------- 7,843
All Causes, Under 1 Year of Age--------------- 9,784


wete No.
LII


1 I










124


Morbidity and Mortality Weekly Report


CURRENT TRENDS
INFLUENZA 1967


Small outbreaks of laboratory confirmed influenza
have been reported from two states within the past 2
weeks. In southern California, influenza B virus has been
isolated from 13- to 18-year-old boys in several proba-
tionary camps. Complete laboratory characterization is in
progress. The Connecticut State Department of Health
has reported an outbreak of influenza A2 among patients
in a convalescent home in the eastern part of the state.
The type was determined by hemagglutination inhibition:
viral isolates are currently being characterized. Another
small outbreak of influenza has been recognized in the
western part of Connecticut. Complement fixation studies
reveal this is an A virus; further characterization is in
progress.
(Reported by Dr. Philip K. Condit, Chief. Bureau of Com-
municable Diseases, California State Department of
Public Health; Dr. James C. Hart. Director, Bureau of
Preventable Diseases, Connecticut State Department of
Health.)






INTERNATIONAL NOTES
QUARANTINE MEASURES


Immunization Information for International Travel
1965-66 edition-Public Health Service Publication No. 384


The following information should be added to the list of
Yellow Fever Vaccination Centers in Section 6:


Page 73


City:


Center:


Colorado Springs, Colorado


City-County Health Department


Clinic Hours: First & Third Tuesday 11 a.m. 12 noon


UNIVERSITY OF FLORIDA

lll1IIII 111 IIIII III I I
3 1262 08864 2375

APRIL 15, 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, 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.


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