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:
AA00010654:00053

Related Items

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

Full Text

FSTIOL COICAE DI E CE '
NATIONAL COMMUNICABLE DISEASE CENTER &>


Vol. 16, No. 32


WEEKLY

REPORT

Week Ending
August 12, 1967


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


PUBLIC HEALTH SERVICE


BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


CURRENT TRENDS
MEASLES

A total of 222 cases of measles was reported for the
week ending August 12, 1967, revealing the steady sea-
sonal decline expected in the summer. The 4-week total
(weeks 29-32) of 1,153 cases is 26.4 percent of the total
of 4,370 cases for the comparable period last year which
in itself was a record low incidence.
Figure 1 presents incidence by 4-week periods for the
second half of 1964, 1965. 1966. with current totals for
1967. During the past 3 years, the lowest incidence of
reported cases has occurred in September. followed by a
steady rise beginning in October. In 1964 and 1965, the
frequencies of reported cases rose at the same rate. but
in 1966 the rise was distinctly less marked. In the sum-
mer of 1967 the reported incidence has been less than one
third of that in comparable weeks of 1966.
The numbers of reported cases for the nine geographic
divisions and for each state for the past 4 weeks are


CONTENTS
Current Trend le ... ....
lEpitimioloEi Not-,- and Rcport
Gastroentertt ti \M nnenOta ...
Bat R bi ich an . .
Shigellosi- Kan .- .i
Reported Ca, -s of Infectious -yphiiih Jui 1967
Recommendation of the PtlS Adv\s.or Committee
on Immunization Practiwc. M VaUi. \Vaccine .


265
276
. 265
. .. 269


shown in Table 1. along with 4-w-eek totals for comparable
periods in 1962-66. Low current incidence is notable
Il. ._h..ur the country. In all divisions the frequency of
reported measles is less than half that of 1966 and much
less than that of previous years-. Moderate numbers of
cases are still being reported in California. Illinois. North
Dakota, Tennessee. Texas. Virginia. and \isconsin. In
many of these states reporting of measles has been tra-
ditionally more complete than in other areas. In most states
efforts to improve reporting have been intensified.


Figure 1
REPORTED CASES OF MEASLES IN THE UNITED STATES
FOUR-WEEK TOTALS JULY-DECEMBER, 1964-1967


1964
-- 1965
1966
1967


N,
V

'-S
N., -, -
N -- -
N -
N ---


26 28 30 32
JULY AUG


34 36 38' '40 42 44 '46' '48 '50' 521
SEPT OCT NOV DEC
WEEK NUMBER


27,357
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12-



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Morbidity and Mortality Weekly Report




Table 1
Reported Cases of Measles, United States
Four Weeks Ending July 22 to August 12, 1967
With 4-Week Totals for Comparable Period 1962-66


AUGUST 12, 1967


Geographic Week Ending 4-Week Totals
Divisions
and States July 22 July 29 August 5 August 12 1967 1966 1965 1964 1963 1962


UNITED STATES

NEW ENGLAND
Maine
New Hampshire
Vermont
Massachusetts
Rhode Island
Connecticut
MIDDLE ATLANTIC
New York City
New York Upstate
New Jersey
Pennsylvania
EAST NORTH CENTRAL
Ohio
Indiana
Illinois
Michigan
Wisconsin
WEST NORTH CENTRAL
Minnesota
Iowa
Missouri
North Dakota
South Dakota
Nebraska
Kansas
SOUTH ATLANTIC
Delaware
Maryland
District of Columbia
Virginia
West Virginia
North Carolina
South Carolina
Georgia
Florida
EAST SOUTH CENTRAL
Kentucky
Tennessee
Alabama
Mississippi
WEST SOUTH CENTRAL
Arkansas
Louisiana
Oklahoma
Texas
MOUNTAIN
Montana
Idaho
Wyoming
Colorado
New Mexico
Arizona
Utah
Nevada
PACIFIC
Washington
Oregon
California
Alaska
Hawaii
Puerto Rico


357 286 288 222


11 18
4 8
5 6
1 1
1 3
60 65
7 2
1 2
25 16
1 18
26 27
11 9
2 1

- 1
9 6


57 47


3 1

24 31
8 4
1 2
12 2

9 7
45 29
9 17
29 9
4 2
3 1
75 34
3

6
66 33
40 28


1,153 4,370 5,148 8,332 9,437 10,065

30 62 208 818 398 920
1 2 28 187 29 137
2 13 3 10 8 1
6 15 66 57 47
22 17 107 372 163 488
2 15 94 29 73
3 24 40 89 112 174
69 205 609 927 1,841 1,876
25 58 224 237 1165 1,156
34 118 130 467
3 11 162 167 348 520
7 18 93 56 328 200
196 1,427 2,034 1,955 2,484 2,339
14 98 128 278 518 229
8 72 90 235 136 136
51 68 184 588 256 256
31 754 660 487 961 1,032
92 435 972 367 613 686
48 135 161 255 226 230
3 18 8 5 12 36
6 73 34 117 87 62
3 6 28 6 42 29
31 38 88 115 79 91
3 12 5 12
5 -
NN NN NN NN NN
179 608 471 579 876 923
6 3 26 30 240
7 25 67 25 142 67
3 4 1 2 5
101 159 78 130 187 210
28 165 243 217 289 231
5 64 9 15 34 17
15 12 14 18 32 16
2 8 24 14 2
23 172 45 123 146 135
104 365 219 722 540 450
27 40 21 177 299 65
57 261 127 364 198 337
13 41 41 158 22 27
7 23 30 23 21 21
224 691 447 1,004 749 643
3 1 54 203 1
2 7 12 3 4 9
11 7 2 32 26 7
208 677 432 915 516 626
109 337 474 762 796 1,035
2 12 77 206 115 234
7 77 103 86 97 106
2 2 7 5 2 10
47 97 113 102 197 320
5 22 17 51 NN NN
32 72 91 160 287 236
14 55 65 138 95 127
1 14 3 2
194 540 525 1,310 1,527 1,649
30 50 28 49 111 136
48 118 53 369 146 300
96 287 249 813 942 786
5 81 28 12 220 67
15 4 167 67 108 360
72 181 129 360 32 177







AUGUST 12, 1967


Morbidity and Mortality Weekly Report


EPIDEMIOLOGIC NOTES AND REPORTS
GASTROENTERITIS


Of approximately 140 nurses who attended a one-day
meeting in Duluth. Minnesota. on May 97, 1967. 56 are
known to hale had gastroenteritis following the noon
luncheon. Onset of symptoms occurred from 6 to 31 hours
after the meal, with the mean incubation period being 14
hour-. The diarrhea and severe intestinal cramps lasted
for a Ife hours to 1-1 2 days. No stool cultures \\ere ob-
tained from the nurses.
Detailed health history and food records were obtained
from 110 of the nurse- w\ho had been at the meeting. As
shown in Table 2, the attack rates of the nur-es who ate
or did not eat specific iteUls on the menu seem to impli-
caie the chicken salad.
A sample of leftover chicken salad scored at the lun-
cheon \xas obtained from the caterer on May 29 and sub-
mitted to the Minnesota Department of Health Laboratory
for hacteriologic examination. The total plate count .ho\\ed
5 million organisms per gram of sample. Anaerobic cul-
ture showed C'ostridiium pc frinfUens. Other food samples
submitted w ere negative for pathogens.
According to the caterer, the chicken salad wxas pro-
pared the morning of May a27 from precooked, diced. frozen
chicken. The caterer had in his establishment an unopened


Table 2
Attack Rates of Gastroenteritis in Nurses
Duluth, Minnesota May 27, 1967

SUijl noI r-.i

it DI nI I
-\n .\tlla, k N01 \tt sk



Sr.,m I .5 1 9 i" ,

.nm 'i ,i 51 Vr N :


25-pound bo\ of diced chicken purchased from the same
company at the samie time as the meat used in the salad.
Labooratory examination of a sample from thi- ho\ indi-
cated that the total plate count %as one million organisms
per gram: ho\ eer, anaerohic culture fIailed to grow any
Clostridium organins.


(irpor1td by Dr. A. J. 1Iouiluxni. Deputy IHeath Officei ,
S/. Louis Cooufy fII, alth )portm ent. /DI)ulut. fViicsota,;
and lr. ). S. F!ciing.. Vircrlor, Division of Disci cs Pre-
'C otifn a(iod ('I trol, tline.ota Ocpar tment of lHealth.)


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

32nd WEEK ENDED CUMULATIVE, FIRST 32 WEEKS
MEDIAN
DISEASE AUGUST 12, AUGUST 13, 1962 1966 MEDIAN
1967 1966 1967 1966 1962- 1966
Aseptic meningitis ... ............ 100 81 60 1,279 1,185 1,026
Brucellosis .......... .. 3 7 8 163 138 226
Diphtheria. ... .. .... .. 1 9 1 62 108 152
Encephalitis, primary:
Arthropod-borne & unspecified ........ 53 39 880 880
Encephalitis, post-infectious ...... 28 9 583 542 -
Hepatitis, serum .. ..... ... 42 29 1,293 844
Hepatitis, infectious .................... 646 523 587 23,533 20081 24826
Malaria .......................... .. .. 28 11 3 1,212 203 53
Measles rubeolaa) ....................... 222 790 1,415 56,846 186,980 354,163
Meningococcal infections, total ... ... 16 43 34 1,581 2,568 1,832
Civilian ........................... 15 43 1,472 2,304 -
Military .............................. 1 --- 109 264 -
Poliomyelitis, total ..... . 1 4 4 20 59 64
Paralytic. ............. .... ....... 1 4 4 17 55 55
Rubella (German measles) .......... .. 187 302 39,036 40,688
Streptococcal sore throat & scarlet fever .. 4.709 4,249 3,855 305.746 290,485 269,548
Tetanus ............. ... .. .. .. 7 2 8 131 100 155
Tularemia ...................... ....... 7 8 8 109 102 175
Typhoid fever ......................... 9 10 13 242 216 244
Typhus, tick-borne (Rky. Mt. spotted fever) 18 12 12 178 162 152

Rabies in animals ...................... 80 77 62 2,809 2,679 2,679

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ............. ... .... .. ..... 2 Rabies in man: ............. .. ..... 2
Botulism: .. ............. .Ig n .. ..... 2 Rubella. Congenital Syndrome: ................. ..... 4
Leptospirosis: Calif.-2 ................... ...... 24 Trichinosis:......... .. .. ...... ..... 45
Plague: ................... ........................ .. 2 Typhus, marine: ........... ...................... 28
P sittacosis: .................... ........... ..... 31 P olio. U nsp. .. ..... .... -.. ... 3






Morbidity and Mortality Weekly Report


AUGUST 12, 1967


BAT RABIES Michigan


On May 26, a bat flew into a home in Lansing, Michi-
gan, at 4 a.m. and hit a 2-year-old girl on the neck. The
child was sleeping in her crib in an upstairs room when
the bat apparently gained entrance through an open, screen-
less window of an adjacent room. Her 16-year-old brother
brushed the bat from her neck with a blanket and killed it.
The child was taken to a Lansing hospital emergency room
for examination and treatment. Upon the recommendation
of the family doctor, the bat was recovered the same morn-
ing and taken to the Michigan Department of Public Health
laboratory where brain material was found positive for
rabies. Rabies treatment initiated that same day consisted
of 14 daily doses phenolized rabbit brain origin "Semple"
vaccine followed by seven daily doses of duck embryo
origin vaccine. After the 21st day the child appeared to
have no known significant vaccination reaction.


In June, a resident of Williamston noticed his 3-month-
old puppy barking at a bat on the ground I ,l'..I- its wings.
The bat was killed and sent to the Michigan Department
of Public Health laboratory where it was diagnosed as
rabid. There were no known human exposures from this
bat. The puppy was destroyed since it had had no previous
rabies immunization and exposure could not be determined.
In both of these cases the bats were identified as
the Large Brown Bat, Eptesicus fuscas, an insect-eating
bat common to most parts of the United States.
These two cases are the first instances of bat rabies
reported from Ingham County. Since 1956, a total of 27
cases of rabies in bats has been recorded in Michigan.


(Reported by Dr. Dean S. Tribby, Public Health Veteri-
narian, Ingham County Health Department.)


SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS
JULY 1967 AND JULY 1966


CASES OF PRIMARY AND SECONDARY SYPHILIS: BY REPORTING AREAS JULY, 1967 AND JULY, 1966 PROVISIONAL DATA

Cumulative Cumulative
Reporting Area JULY JAN-JULY Reporting Area JULY JAN-JULY
1967 1966 1967 1966 1967 1966 1967 1966
NEW ENGLAND ............... 22 30 203 272 EAST SOUTH CENTRAL ........ 132 204 1,048 1,329
Maine.................... 2 2 2 5 Kentucky................. 13 13 87 76
New Hampshire ........... 2 5 7 Tennessee................ 36 36 166 176
Vermont ................. 2 1 Alabama .................. 50 112 561 739
Massachusetts............ 8 21 120 188 Mississippi.............. 33 43 234 338
Rhode Island.............. 5 1 22 18
Connecticut.............. 7 4 52 53 WEST SOUTH CENTRAL........ 289 221 1,850 1,506
Arkansas................. 9 13 84 85
MIDDLE ATLANTIC........... 256 273 1,994 2,348 Louisiana................ 48 49 356 361
Upstate New York......... 24 22 163 212 Oklahoma................. 9 13 75 84
New York City............ 142 153 1,177 1,464 Texas .................... 223 146 1,335 976
Pa. (Excl. Phila.)....... 13 8 136 107
Philadelphia............. 32 23 163 151 MOUNTAIN.................. 52 34 355 235
New Jersey................ 45 67 355 414 Montana.................. 1 4 23
Idaho.................... 3 16 1
EAST NORTH CENTRAL........ 240 232 1,828 1,813 Wyoming .................. 2 12
Ohio..................... 57 51 371 345 Colorado ................. 5 4 43 29
Indiana.................. 13 9 86 54 New Mexico............... 14 8 96 53
Downstate Illinois....... 8 12 96 109 Arizona................. 27 18 170 110
Chicago................... 56 75 529 588 Utah ..................... 5 5
Michigan................. 106 74 730 650 Nevada .................. 1 3 9 14
Wisconsin................ 11 16 67
PACIFIC................... 138 118 1,071 1,044
WEST NORTH CENTRAL........ 29 25 174 246 Washington............... 6 3 32 23
Minnesota ................ 6 3 26 19 Oregon................... 5 6 33 32
Iowa..................... 6 5 20 38 California............... 126 104 1,000 967
Missouri................ 8 8 56 100 Alaska................... 1 2 2 5
North Dakota.............. 1 2 5 Hawaii................... 3 4 17
South Dakota.............. 2 1 20 24
Nebraska.................. 2 2 18 22 U. S. TOTAL................ 1,732 1,715 12,179 12,454
Kansas................... 5 5 32 38
nTERRITORIES.............. 55 47 527 560
SOUTH ATLANTIC............. 574 578 3,656 3,661 Puerto Rico.............. 51 44 498 544
Delaware................. 1 6 31 25 Virgin Islands.......... 4 3 29 16
Maryland ................. 53 46 365 322
District of Columbia..... 87 40 443 264
Virginia ................. 29 35 173 181
West Virginia............. 1 13 11 42
North Carolina........... 80 72 436 542 Note: Cumulative Totals include revised and delayed reports
South Carolina........... 70 80 501 538 through previous months.
Georgia.................. 90 95 552 613
Florida.................. 163 191 1,144 1,134


268





Morbidity and Mortality Weekly Report


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 measles vaccines, the second revision of the
initial recommendation which appeared in the MMWR, Vol. 14, No. 7 (February 20, 1965). (The
first revision, appeared in the IMMiR. Vol. 14. ,No. 36, September 11. 1965.)


MEASLES VACCINES


Introduction
Highly effective, safe vaccines are available for elimi-
nating measles in the United States. Collaborative efforts
of professional and voluntary medical and public health
organizations are directed toward eradicating the disease
in 1967. Unless protected by vaccine, virtually all chil-
dren will at some time have clinically evident measles.
Measles is often a severe disease: it is of particular con-
corn because of frequent complications, including bron-
chopneumonia, middle ear infection, and encephalitis.
Encephalitis, which follows measles in approximately one
of every 1,000 cases, often causes permanent brain dam-
age and subsequent mental retardation. An average of one
measles death occurs for every 10,000 cases.
All susceptible children-those who have not had
natural measles or measles vaccine-should be immunized.
It is particularly important to immunize children that are
still susceptible on entering nursery school, kindergarten
and elementary school, because they are often responsible
for transmission of measles to other children in the com-
munity. Communities should establish programs directed
toward vaccinating all children at about one year of age.

Live Attenuated Measles Virus Vaccine (Edmonston and
Schwarz Strains)
Live attenuated measles virus vaccine* prepared from
the Edmonston or Schwarz (further attenuated) measlps
virus strains is widely used in the United States. The
Edmonston strain is propagated in either chick embryo or
or canine renal cell culture: it may be given alone or with
Measles Immune Globulin according to the manufacturers'
directions. The Schwarz strain is prepared only in chick
embryo cell culture; it is suitable for administration with-
out Measles Immune Globulin.
The live attenuated measles virus vaccines produce
a mild or inapparent, non-communicable infection. Fifteen
percent of those receiving either the Edmonston strain
with Measles Immune Globulin or the Schwarz strain ex-
perience fever, with temperatures of 1030F (rectal) or
higher, beginning about the sixth day after vaccination
and lasting no longer than 5 days. About twice as many
(30 percent) of those receiving Edmonston strain without
Measles Immune Globulin have similar responses. The
great majority of reports indicate that even children with
high fevers experience relatively little discomfort and

*The official name of the product in use is: Measles Virus
Vaccine, Live, Attenuated.


minimal toxicity. As a result, febrile reactions often go
unnoticed by the parents.
An antibody response develops in virtually all sus-
ceptible children who are given live attenuated measles
virus vaccines. Edmonston strain vaccine administered
without Measles Immune Globulin induces a level and per-
sistence of antibody corresponding to that seen following
regular measles. Antibody titers in response to Edmonston
strain with Measles Immune Globulin or to Schwarz strain
are slightly lower. However, all three of these vaccine
schedules appear to confer lasting protection against nat-
urally occurring measles.
Experience with more than 20 million doses adminis-
tered in the United States by early 1967 indicates that
live attenuated measles \irus vaccines are among the
safest immunizing agents available. To date, serious re-
actions associated with their use have been very rare.

Recommendations for Vaccine Use

Age
For maximum efficacy, live attenuated measles virus
vaccine should be administered when children are at
least 12 months old. It can be given to infants at 9 to
12 months of age realizing that the proportion of vac-
cine responses may be slightly reduced. The pro-
portion is further decreased if Measles Immune Glo-
bulin is administered with the vaccine. Vaccination
of adults at the present time is rarely necessary, be-
cause nearly all individuals are immune by age 15.
Limited data indicate that reactions to vaccine are
no more common in adults than in children.

High Risk Groups
Immunization against measles is particularly impor-
tant for children with chronic illnesses, such as
heart disease. cystic fibrosis, and chronic pulmonary
diseases, as well as for children with malnutrition
and those living in institutions.

Prevention of Natural Measles Following Exposure
Live attenuated measles virus vaccine can usually
prevent disease if administered before or on the day
of exposure to natural measles. Limited studies re-
ported to date indicate that protection is not con-
ferred when vaccine is administered after the day of
exposure, nor are adverse effects induced by measles
immunization following exposure.


AUGUST 12, 1967





270


Precautions in the Use of Live Attenuated Measles Virus
Vaccines

Severe Febrile Illnesses
Vaccination should be postponed until recovery is
complete.

Tuberculosis
The exacerbations of tuberculosis that have been re-
lated to natural measles infection, by analogy might
accompany infection with live attenuated measles
virus. Therefore, any individual with known active
tuberculosis should be under treatment when given
measles vaccine. Although tuberculin skin testing is
desirable as part of ideal health care, it need not be
a routine prerequisite in community measles immuni-
zation programs. The protection against natural mea-
sles outweighs the theoretical hazard of possible
exacerbation of tuberculosis infection by the admin-
istration of vaccine.

Recent Immune Globulin Administration
After administration of immune globulin, immuniza-
tion should be deferred for 3 months. Persistence of
measles antibody from the globulin may interfere with
response to the vaccine.

Marked Hypersensitivity to Vaccine Components
Measles vaccine produced in chick embryo cell cul-
ture should not be given to children hypersensitive to
ingested egg proteins. Similarly, vaccine produced in
canine cell culture should not be administered to
children highly sensitive to dog hair or dog dander.
To date, no reactions of the anaphylactic type fol-
lowing measles vaccine have been reported in the
United States.

Contraindications to Use of Live Attenuated Measles
Virus Vaccine

Leukemia, Lymphomas, and Other Generalized Malig-
nancies
Administration of live attenuated measles virus vac-
cine to children with leukemia has occasionally been
followed by severe complications such as fatal giant
cell pneumonia. Theoretically, attenuated measles
virus infection might be potentiated by other severe
underlying diseases, such as lymphomas and gener-
alized malignancies.

Altered Resistance from Therapy
Steroids, alkylating drugs. antimetabolites, and radia-
tion may predispose to untoward complications due to
altered resistance.

Pregnancy
Purely on speculative grounds, physicians are reluc-
tant to risk causing fetal damage that might theoreti-
cally be related to attenuated measles virus infection.


AUGUST 12, 1967


Management of Patients with Contraindications to Live
Attenuated Measles Virus Vaccines
If immediate protection against measles is required for
persons in whom use of live attenuated measles virus vac-
cine is contraindicated, passive immunization with Mea-
sles Immune Globulin (dose 0.25 ml/kg) should be given
as soon as possible after a known exposure. It is impor-
tant to note, however, that the preventive dosage of Mea-
sles Immune Globulin effective in normal children may not
be equally so in children with acute leukemia. Inactivated
measles virus vaccines* may induce longer lasting protec-
tion than provided by Measles Immune Globulin, but many
children with leukemia and those receiving immunosup-
pressive drugs respond poorly.

Prior Immunization with Inactivated Measles Vaccine
Atypical measles, sometimes severe, following exposure
to natural measles, has occasionally been observed in
children previously immunized with inactivated measles
virus vaccines. Untoward local reactions such as indura-
tion and edema have at times been observed when the live
measles virus vaccine was administered to persons who
had received inactivated vaccine previously.
Despite these reported instances of unusual associa-
tions, children who have been given inactivated measles
vaccine should also be given the live vaccine for full and
lasting protection against natural infection.

Simultaneous Administration of Live Virus Vaccines
Data on simultaneous administration of live virus vac-
cines are not sufficient to develop comprehensive recom-
mendations; but there are obvious practical advantages to
combining vaccines, and investigations are underway
which should help to define optimal practices. When com-
bined administration is indicated, available data do not
suggest that undesirable responses will result. The fol-
lowing comment presents current attitudes toward sched-
uling vaccination with three major live virus vaccines-
polio, measles, and smallpox.
It has been generally recommended that immuniza-
tions with live virus vaccines be separated by at least
one month whenever possible. The rationale for this rec-
ommendation is the theory that superimposed reactions
and diminished antibody responses might result if two or
more live virus vaccines were given simultaneously. Ide-
ally, the initial doses of oral poliovirus vaccine should
have been given before a child reaches one year, the
age for giving live attentuated measles virus vaccine.
Administration of polio and measles antigens should be

*Inactivated vaccines derived from Edmonston strain measles
virus and prepared either in chick embryo or monkey cell cul-
tures are available (Measles Virus Vaccine, Inactivated).
These vaccines should be administered in a three-dose sched-
ule at monthly intervals with a subsequent booster 6 months
later. Following primary immunization with inactivated mea-
sles virus vaccine, the protection achieved in normal children
has been satisfactory for the first few months, but has been
shown to decline rapidly thereafter. Inactivated measles virus
vaccines should not be used for immunizing normal children.


Morbidity and Mortality Weekly Report










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.
When. however, immunization program effectiveness
is hindered or when the threat of concurrent exposures
exists, the relevant live virus vaccines should be given
at theI same time. Observations do not indicate that this
will cause a significant increase in adverse reactions or
depressed antibody responses to either antigen.



Community Immunization Programs


Ongoing Programs
Universal immunization as part of good health care
should he accomplished through routine and intensive
programs carried out in physicians'offices and public
health clinics. Programs aimed at immunizing chil-
dren against measles at about one year of age should
he established by all communities. In addition, all
susceptible children entering nursery school. kinder-
garten. and elementary school should receive vaccine
because of their particular role in community spread
of natural measles.


Community-wide Mbss Programs
Ma-ss immunization programs can be useful supple-
ments to the continuing use of live attenuated mea-
sles virus vaccine. Many have been organized as part
of community measles eradication campaigns. The
following points should be considered in planning
mass immunization programs:


1. The active cooperation of private ph ysicians
and official health agencies normally con-
cerned with the care of children is important.

2. Because live attenuated measles virus xac-
cines are administered parenterally, adequate
numbers of medical and nursing personnel are
required.

3. Despite increased public awareness of mea-
sles and its frequent, serious complications,
substantial effort may be required to attain
complete community support.

4. Although a number of children may have feb-
rile reactions to live attenuated measles virus
vaccine, extensive experience in community-
wide campaigns and in private medical prac-
tice indicates that only a small fraction of
these reactions requires medical attention.
Parents should be told what reactions to ex-
pect, to avoid undue concern after the program
gets underway.


Control of Measles Epidemics
Studies have shown that measles epidemics can he cur-
tailed or halted in a community by prompt administration
of live attenuated measles \irus vaccine to selected
groups of children. particularly the -usceptibles in nurs-
ery school. kindergarten, and the first two or three grades
of elementary school. Hoelcer, once measles is widely
disseminated in a community, it may be necessary to im-
munize susceptible children of all ages to alter the course
of the epidemic.

Continued Surveillance
Careful surveillanceo f measles and its complications is
necessary for appraising the effectiveness of national
inmasles immunization programs. particularly measles
eradication efforts. Such activties can delineate failures
to achieve adequate leIels of protection and definegroups
for which epidemic control program- should be instituted.
Although more than 20 million doses of measles virus
vacciin had been administered in the United States by
early 1967. continuous and careful review of adverse re-
actions i.- till important. \11 serious reactions should be
carefully evaluated and reported in detail to local and
State health officials so thai collaborative national sur-
veillance can be effective.




Immunization Schedules
Recommended immunization schedules are shown in the
table belox\:

IMMUNIZATION SCHEDULES FOR
MEASLES VACCINES

Type of Yaccine Age Doses & Administration*

Live attenuated 12~* months
measles virus and older
vaccine (Edmon-
ston Strain)

Live attenuated 12** months 1
measles virus and older Plus Measles Immune
vaccine (Edmon- Globulin (0.01 ml per lb.
ston Strain) plus at different site with
Measles Immune different syringe)
Globulin

Live "further 12** months 1
attenuated" and older
measles virus
vaccine
(Schwarz Strain)

*Manufacturers' directions regarding administration should be
followed.
**May be given to infants between 9 months and 1 year with the
expectation of slightly decreased efficacy especially if ad-
ministered simultaneously with Measles Immune Globulin.


AUGUST 12, 1967


Morbidity and Mortality Weekly Report






272 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 12, 1967 AND AUGUST 13, 1966 (32nd WEEK)


ENCEPHALITIS HEPATITIS

ASEPTIC Primary
AREA MENINGITIS BRUCELLOSIS DIPHTHERIA including Post- Serum Infectious
AREA MENINGITIS cases Infectious
unsp. cases
1967 1966 1967 1967 1967 1966 1967 1967 1966 1967 1966
UNITED STATES... 100 81 3 1 53 39 28 42 29 646 523

NEW ENGLAND........... 1 10 1 1 2 28 16
Maine.............. 1 7
New Hampshire...... -
Vermont............ 1
Massachusetts...... 9 1 16 2
Rhode Island....... 1 1 1 4 2
Connecticut........ 1 6 4

MIDDLE ATLANTIC...... 6 6 5 3 4 5 15 73 92
New York City...... 1 1 2 1 4 12 5 20
New York, up-State. 1 1 1 1 19 31
New Jersey.......... 3 1 1 2 28 18
Pennsylvania....... 1 4 2 1 3 1 21 23

EAST NORTH CENTRAL... 9 6 1 22 15 4 2 2 74 74
Ohio................ 1 3 19 11 1 1 14 29
Indiana............. 2 5 8
Illinois........... 3 1 1 4 3 1 17 7
Michigan........... 5 2 1 1 34 27
Wisconsin.......... 1 -- 4 3

WEST NORTH CENTRAL... 2 2 1 2 33 41
Minnesota.......... 2 1 2 1
Iowa................ 1 1 3 16
Missouri........... 22 19
North Dakota....... 1
South Dakota....... -
Nebraska........... 2 -
Kansas............. 5 4

SOUTH ATLANTIC........ 22 12 10 4 11 8 3 92 57
Delaware............ --- I 1
Maryland............ 19 1 1 2 2 1 16 14
Dist. of Columbia.. 2 -
Virginia........... 1 1 1 13 9
West Virginia...... 4 3 6 -
North Carolina..... 2 1 1 8 8
South Carolina..... 2 1
Georgia............ 19 15
Florida............. 7 4 3 9 6 1 25 10

EAST SOUTH CENTRAL... 11 3 4 2 2 32 29
Kentucky............ 2 1 9 7
Tennessee.......... 1 1 4 2 2 18 8
Alabama............ 1 5 6
Mississippi........ 8 8

WEST SOUTH CENTRAL... 9 10 3 2 1 3 81 42
Arkansas........... 1 1 4 3
Louisiana.......... 2 1 1 3 15 6
Oklahoma........... 4 1
Texas.............. 6 10 1 1 58 32

MOUNTAIN............. 1 2 28 17
Montana............. 1
Idaho .............. 7
Wyoming............ 1
Colorado............ 1 5
New Mexico......... 3 4
Arizona............ 1 14 7
Utah............... 2 1
Nevada............. -

PACIFIC.............. 42 32 8 8 6 23 7 205 155
Washington.......... 1 1 1 15 9
Oregon............. 4 1 I 14 24
California.......... 28 32 7 7 5 22 7 175 120
Alaska.............. -
Hawaii.............. 9 1 2

Puerto Rico 1 16 23








Morbidity and Mortality Weekly Report 273


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 12, 1967 AND AUGUST 13, 1966 (32nd WEEK) CONTINUED



MENINGOCOCCAL INFECTIONS,
MALARIA MEASLES (Rubeula) TEN COCCAL FEI POLIOMYELITIS RUBELLA
AREA T-ta Parvalyti
Cumulative Cumulative Tta Par
Cum.
1967 1967 1967 1966 1967 1967 1966 1967 1967 1967 1967
UNITED STATES... 28 222 56,846 186,980 16 1,581 2,568 1 1 17 187

NEW ENGLAND............. 12 830 2,220 65 113 45
Maine.............. 234 194 3 9 -4
New Hampshire...... 74 78 2 9 -
Vermont ............ -42 225 1
Massachusetts...... 11 330 765 32 28
Rhode Island ...... 62 72 42 1
Connecticut........ 1 88 886 23 35 -

MIDDLE ATLANTIC...... 1 19 2,204 17,907 2 257 303 1 1 5 14
New York City...... 7 436 8,236 6 42 1 9
New York, Up-State. 8 557 2,502 61 87 3
New Jersey ......... 1 1 480 1,844 2 92 88
Pennsylvania....... 3 731 5,325 58 86 1

EAST NCRTH CENTRAL... 5 35 5,237 67,965 4 218 397 37
Ohio............... 3 1,130 6,324 1 71 107
Indiana............. 587 5,621 30 68
Illinois ......... 5 7 927 11,257 2 52 76 7
Michigan............ 5 902 14,117 1 50 105 14
Wisconsin.......... 20 1,691 30,646 15 41 12

WEST NORTH CENTRAL... 8 2,809 8,657 67 140 2
Minnesota.......... 120 1,639 16 33 1
Iowa.............. 1 744 5,302 3 22 1 1
Missouri........... 1 332 529 13 54 -
North Dakota....... 5 8P5 1,072 -1 9- 2
South Dakota ....... 52 40 6 4
Nebraska........... 1 623 75 12 8
Kansas............. 93 NN 6 10 1

SOUTH ATLANTIC....... 7 22 6,791 14,946 6 304 433 2 14
Delaware........... 43 256 6 4
Maryland........... 2 149 2,095 2 37 45 1
Dist. of Columbia.. 22 380 10 11 -
Virginia........... 8 2,167 2,098 1 37 52 -
West Virginia...... 7 1,362 5,133 21 20 1
North Carolina..... 5 1 843 453 1 67 106
South Carolina..... 507 653 1 29 46 2
Georgia............. 32 233 44 63 -
Florida............. 2 4 1,666 3,645 1 53 86 9

EAST SOUTH CENTRAL... 14 5,104 19,517 123 223 1 12
Kentucky............ 1 1,316 4,693 34 82 3
Tennessee .......... 11 1,813 12,165 51 73 8
Alabama............ 1,316 1,663 25 49 -1
Mississippi........ 2 659 996 13 19 -

WEST SOUTH CENTRAL... 3 52 17,102 23,943 212 363 7
Arkansas........... 1,404 966 28 33 -
Louisiana.......... 3 151 98 83 136
Oklahoma............ 3,325 474 16 18 1
Texas.............. 52 12,222 22,405 85 176 6

MOUNTAIN............. 22 4,578 11,759 27 80 20
Montana............ 277 1,801 4 2
Idaho.............. 375 1,531 1 5
Wyoming.............. 1 180 145 1 6 -
Colorado........... 12 1,539 1,269 12 41 15
New Mexico......... 1 576 1,115 3 10 -
Arizona.............. 8 1,005 5,254 4 10 2
Utah............... 357 601 4 1
Nevada.............. 269 43 2 4 -

PACIFIC.............. 12 38 12,191 20,066 4 308 516 40
Washington.......... 3 7 5,414 3,462 2 27 37 -
Oregon.............. 1 15 1,563 1,682 1 25 33 4
California.......... 8 15 4,919 14,406 1 243 427 23
Alaska.............. 1 133 391 9 15 4
Hawaii............. 162 125 4 4 9

Puerto Rico .......... 3 2,087 2,557 12 10 -








274 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 12, 1967 AND AUGUST 13, 1966 (32nd 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... 4,709 7 131 7 109 9 242 18 178 80 2,809

NEW ENGLAND........... 553 1 2 3 1 9 71
Maine .............. 20 1 16
New Hampshire...... 37
Vermont.............- 8 15
Massachusetts...... 120 1 2 1 2
Rhode Island....... 65 1
Connecticut........ 348 1 1 I- I -

MIDDLE ATLANTIC...... 7 11 21 1 18 6 59
New York City...... 5 5 10 -
New York, Up-State. -- 1 7 4 5 49
New Jersey......... NN 1 2 1 7 -
Pennsylvania....... 2 4 2 7 1 10

EAST NORTH CENTRAL... 223 15 10 19 2 17 2 289
Ohio............. .. 31 4 4 2 9 99
Indiana............. 9 2 2 6 1 1 64
Illinois........... 74 7 8 2 7 1 57
Michigan........... 62 2 6 23
Wisconsin.......... 47 1 46

WEST NORTH CENTRAL... 207 10 2 19 14 1 2 24 669
Minnesota.......... 3 1 2 126
Iowa............... 67 1 1 2 8 87
Missouri........... 13 5 1 7 7 1 4 123
North Dakota....... 23 6 122
South Dakota....... 10 1 1 2 91
Nebraska............ 23 3 1 1 40
Kansas............. 71 9 1 4 80

SOUTH ATLANTIC....... 724 6 31 1 9 3 32 12 81 14 370
Delaware ........... 5 -
Maryland............ 96 2 4 15
Dist. of Columbia.. -
Virginia........... 253 6 3 1 18 4 174
West Virginia...... 282 1 1 2 1 1 54
North Carolina..... 5 6 3 5 35 3
South Carolina..... 19 1 2 3 7 1 4
Georgia............. 12 3 1 4 8 1 8 3 86
Florida............ 52 5 14 1 7 7 53

EAST SOUTH CENTRAL... 1,052 21 8 5 39 1 31 7 528
Kentucky............ 10 2 1 2 16 1 11 1 115
Tennessee.......... 791 8 5 1 7 14 5 374
Alabama............ 89 8 9 6 1 37
Mississippi........ 162 3 2 2 7 2

WEST SOUTH CENTRAL... 504 26 4 52 29 1 14 14 585
Arkansas........... 5 3 31 7 3 4 81
Louisiana.......... 4 3 3 12 1 50
Oklahoma............ 29 1 14 6 1 7 7 194
Texas............... 471 17 1 4 4 4 2 260

MOUNTAIN ............. 811 7 16 8 89
Montana............. 30 1 1
Idaho............. 24 -
Wyoming............. 2 2 5
Colorado............. 462 1 11 8 10
New Mexico......... 173 1 26
Arizona............ 62 3 43
Utah................ 52 3 2
Nevada.............. 6 -- -- 3

PACIFIC............. 628 15 4 1 69 6 4 149
Washington......... 94 2 1 1 1 1
Oregon.............. 56 I 2
California......... 417 12 2 65 5 4 146
Alaska .............. 44 -
Hawaii ............. 17 2 3 -

Puerto Rico.......... 2 1 10 4 1 26






Morbidity and Mortality Weekly Report






DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED AUGUST 12, 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 1 year
Ages and over Influenza All Influenza All
All Ages Causes AAll 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, I11.--------
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.--------


712
237
45
20
17
68
31
16
21
42
61
17
60
27
50

2,882
39
34
138
44
56
52
63
93
1,442
39
352
178
40
82
36
47
45
38
33
31

2,474
58
14
716
160
165
105
90
341
40
47
43
70
40
148
50
136
38
24
34
100
55

765
57
21
52
119
23
99
54
237
67
36


430
131
32
13
11
31
22
12
16
26
33
12
38
17
36

1,601
21
17
65
23
32
32
37
33
815
18
180
86
28
49
32
36
25
24
29
19

1,329
30
11
369
96
79
52
55
179
25
25
20
32
25
82
23
84
22
13
15
58
34

464
34
16
28
76
15
65
30
141
43
16


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

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

WEST SOUTH CENTRAL:
Austin, Tcx.-----------
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.----------


1,039
109
245
47
56
62
41
84
26
77
58
183
51

548
99
55
33
82
108
44
40
87

1,146
72
39
28
141
29
92
182
69
158
100
122
49
65

385
44
16
107
14
85
17
55
47

1,440
16
41
31
38
72
448
98
27
99
58
61
176
46
130
55
44


Total 11,391 6,306 357 583


Cumulative Totals
including reported corrections for


previous weeks


All Causes, All Ages -------------------------398,692
All Causes, Age 65 and over-------------------227,962
Pneumonia and Influenza, All Ages------------- 14,375
All Causes, Under 1 Year of Age--------------- 20,226


Week No.
32












EPIDEMIOLOGIC NOTES AND REPORTS
SHIGELLOSIS Clay County, Missouri


On August 9, 1967, a family outbreak of gastroenteri-
tis which resulted in the death of two children was brought
to the attention of the Clay County Health Department by
a private physician and the pathologists of the North Kan-
sas City Memorial Hospital. Investigation revealed that
five of eight family members developed diarrhea and fever:
twin daughters experienced onset on August 4, another sis-
ter on August 5, a brother on August, 6, and the mother on
August 8 (Table 3). One of the twins and the younger sis-
ter died the night of August 7, the first with dehydration.
hyponatremia, and acidosis, and the latter due to aspira-
tion. The mother and son were hospitalized with symptoms
of fever and diarrhea and have now recovered. The other
twin recovered rapidly without special treatment. Stool
cultures from four of the five cases grew Shigella flexneri.

Table 3
Family Outbreak of Shigella flexneri
Clay County, Missouri August 1967

Family Members Age Onset Stool Cultures

Father 31 No illness Negative
Mother 28 8/8/67 Positive
Son 13 No illness Negative
Son 11 No illness Negative
Son 8 8/6/67 Positive
Daughter* 7 8/4/67 Positive
Daughter 7 8/4/67 Positive
Daughter* 6 8/5/67 None taken

*Fatal Case

Epidemiologic investigations uncovered no illness in
the immediate neighborhood, a suburb of Kansas City,
Missouri. The family had not attended any group meals
nor visited outside the home. All foods available in the
kitchen were cultured, but no particular item could be
implicated. Tacos and hamburgers from nearby restaurants
were possible sources of infection.
The Clay County Health Department inspected and
sampled the family water supply; no coliform organisms
were found. The septic tank showed no evidence of mal-
function. A door-to-door neighborhood epidemiologic and
rectal swab survey was conducted to determine prevalence
of diarrheal illness and asymptomatic carriers. Results
are pending.


(Reported by Dr. Paul A. Lindquist, Medical Director, Clay
County Health Department; the Missouri Division of Health;
and the Ecological Investigations Program, IA ansas City,
Kansas, NCD(I.)


AUGUST 12, 1967


UNIVERSITY OF FLORIDA

_III III III _________1_1______1_ _INIII__II~II I III I 1III1
3 1262 08864 1914

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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Morbidity and Mortality Weekly Report