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:
AA00010654:00063

Related Items

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

Full Text







Morbidity and Mortality



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

PUBLIC HEALTH SERVICE


Prepared by the


0B ISA CNE


Reor


MElrose 4-5131


For release November 16, 1962 ATLANTA 22, GEORGIA Vol. 11, No. 45

PROVISIONAL INFORMATION ON SELECTED NOTIFIABLE DISEASES IN THE UNITED STATES AND ON
DEATHS IN SELECTED CITIES FOR WEEK ENDED NOVEMBER 10, 1962


POLIOMYELITIS Thirty- ses of plti)yelitis
(28 paralytic) were report e week ending lvember
10, representing a mark grease / r the 16 cases
(13 paralytic) noted the ?Tea ding weeWfo d exceeding
the total noted for the co le week in 1961 when 30
cases (23 paralytic) were n /
Many of these cases, r 'e wgert cLk .'roim 16
States, represent delayed reports. -1i.l para-
lytic poliomyelitis caused by Type I poliovirus has been
noted among the Negro residents of Boomer, West Virginia
(population 2,092). All four cases from West Virginia this
week occurred in this outbreak. Eight other instances of


paralytic illness have been reported from Boomer and
nearby Carbondale, West Virginia. The last case had
onset on November 6. All but two cases were school aged
children attending the same school from these communi-
ties. Inactivated vaccine was used extensively in
October.
The four paralytic cases reported from Illinois this
week represent delayed reports from Chicago, which has
noted 32 cases of paralytic poliomyelitis thus far this
year. No new case has been noted in the past three
weeks. The Arkansas report consisted of cases noted in
Fayetteville, where a Type I outbreak ultimately ac-


Table 1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous week)
45th Week Cumulative
Disease Ended Ended First 45 weeks
Median
November 10, November 11, 1957 1961 Median
1962 1961 1962 1961 1957 1961
Aseptic meningitis ............... 35 74 -- 2,250 2,892
Brucellosis ..................... 3 13 11 349 511 665
Diphtheria...................... 7 13 22 383 494 683
Encephalitis, infectious .......... 28 27 34 1,536 1,461 1,625
Hepatitis, infectious and serum... 807 1,039 435 47,211 63,918 19,227
Measles......................... 1,890 2,284 2,284 453,177 397,137 405,051
Meningococcal infections ......... 32 29 36 1,838 1,849 1,987
Poliomyelitis, total.............. 37 30 76 770 1,210 5,282
Paralytic .................... 28 23 56 610 787 2,606
Nonparalytic................. ....5 5 14 111 293 1,872
Unspecified. .................. 4 2 6 49 130 804
Streptococcal sore throat
and Scarlet fever ............ 4,687 5,525 -- 269,187 274,008
Tetanus ........................ 8 --- --- 250
Tularemia ...................... 9 -- --- 253 -
Typhoid fever ................... 12 10 18 550 715 753
Typhus fever, tick-borne,
(Rocky Mountain spotted)...... 3 --- --- 214
Rabies in Animals............... 44 58 60 3,218 2,990 3,365


Table 2. NOTIFIABLE DISEASES OF LOW FREQUENCY

Anthrax: Psittacosis: wis. 1, Pa. 1
Botulism: Rabies in Man:
Malaria: N. C. 1, N. Dak. 1 Smallpox:
Plague: Typhus, murine:










Morbidity and Mortality Weekly Report


counted for ten paralytic cases including one fatality.
Over 37,000 persons received Type loral polio vaccine in
a vaccination campaign which took place on November 4.
The totals for poliomyelitis incidence from the 1st
through the 45th week for 1962 and the past four years is
shown in the f..ll.'*in' table:


POLIOMYELITIS (1ST THROUGH 45TH WEEK) 1958-1962


1962 1961 1960 1959 1958

Parolytic 610 787 2,053 5,189 2,681
Total 770 1,210 2,962 7,858 5,358




EPIDEMIOLOGICAL REPORT

Salmonella typhimurium Epidemics Northwestern States

In September and October 1962, over 300 cases of
Salmonella typhtmurium were found to have occurred in
Spokane, Washington. An intensive investigation revealed
the source of infection as cream pies from one bakery and
suggested that thousands of additional cases may have
occurred in .-h .1,ic r..n and adjacent States.
Between September 24 and October 19, 1962, 27 sal-
monella isolations were obtained from Spokane County
hospitals, an unusually large number for this county of
300,000. It became apparent that many of the cases were
likely linked epidemiologically for the following reasons:

1. 25 of the 27 cases yielded Salmonella typhimurium.
Although the most common serotype in this area and in
the U. S., S. typhimurium does not normally account
for 90 percent of isolates.
2. Only two cases were in young children (ages 2 and 3
respectively). The remainder ranged from adolescent
to elderly in age.

3. The majority of cases were unrelated socially and
lived in no geographic proximity to one another. No
geographic concentration, either in the city cases or
rural cases, was demonstrable.
4. The majority were from high-middle and high socio-
economic groups.
5. Multiple case occurrences in families were rare. Only
two families had more than one case, and no families
more than two cases.
6. Most of the cases were socially active individuals who
not uncommonly ate in restaurants or other food service
establishments away from from.
The 25 cases due to S. typhimurium were selected for
study. Searching interviews were conducted and several
of the cases were interviewed two and three times in an


effort to uncover clues which might lead to the recogni-
tion of a common denominator. From the maze of food
items reported consumed in a variety of eating places, it
was possible to focus on either banana cream pie or
chocolate cream pie as definite possibilities. The dates
on which 10 of the 25 had eaten banana or chocolate cream
pie could be identified; the dates of eating were between
September 14 and September 20. Two schools, one college,
two restaurants out of the county, six restaurants within
the county, and one hotel were listed as places of con-
sumption of the cream pies. Because two of the eating
places identified (the hotel and the college) were learned
to have served large identifiable populations, the investi-
gation was directed to these places.

Hotel Luncheon Epidemic
A church group of 180 women was served a luncheon
on September 24 at the hotel. Starting with the 2 original
cases who ate banana cream pie at the hotel on September
24 and asking whom they and subsequently contacted
persons sat next to, it was possible to locate and inter-
view 65 women by telephone. Of the 65 interviewed, 30
gave a history of experiencing illness within 96 hours
after eating at the hotel. A distribution of these by date
of onset is as follows:

Date No. Ill
September 24 1
September 25 5
September 26 13
September 27 8
September 28 2
Date Unknown I
Total 30

The most frequent symptoms were diarrhea ('.~ ,
chills (50%), fever (50%), abdominal pain (50%), nausea
(27%), and bloody stools (10%). Only two of the 30 had
been hospitalized and, as far as is known, stool speci-
mens were obtained only from these two cases. As indi-
cated above, these yielded Salmonella typhimurium.
A tabulation of food histories is shown below:


Persons Who Ate Persons Who did not
Food Item Specified Foods eat Specified Foods
Total III % III Total III % ;II

Salad 61 29 47.5 4 1 25.0
Creamed Chicken 63 30 47.7 2 0 00.0
Peas 58 29 50.0 7 1 14.3
Banana Pie 53 29 54.7 12 1 8.3
Apple Pie 4 0 00.0 61 30 49.2







Morbidity and Mortality Weekly Report


It was felt, at this point, that the data obtained from the
65 contacted persons who attended the luncheon, though
inconclusive, were generally in support of the hypothesis
that banana or chocolate cream pies were likely sources.

The College Outbreak
Attention was next turned to a college in the Spokane
vicinity. An 18-year-old student at that college had eaten
chocolate cream pie there on September 29 and had devel-
oped illness on October 1. A review of infirmary records
revealed that 42 persons in early October had been put to
bed in the infirmary for illness compatible with salmonel-
losis. Chocolate cream pie had been served for dinner at
the college on September 29 and September 30. It was
learned that the source of the 80 pies was identical with
that of the hotel church luncheon. A survey form was
drafted, mimeographed, and distributed to the college
students called together by the president of the college
in an emergency meeting on October 25. Of 719 resident


DATE OF ONSET* OF ILLNESSES
AT THE COLLEGE


DATE OF ONSET KNOWN
FOR 209 OF THE 238 STUDENTS ILL


SEPTEMBER OCTOBER


students, 626 completed questionnaires. Two hundred and
thirty-eight (238) students indicated that they had ex-
perienced gastrointestinal illness in late September or
early October, (an overall attack rate of 38 percent).
Distribution of cases by date of onset indicates an ex-
plosive outbreak.
Symptoms reported by the 238 students were as
follows: diarrhea (65%), nausea or vomiting (56%), chills
(48%), fever (44%), and abdominal cramps (36%). The du-
ration of illness was under 5 days in approximately 80%
of the cases.
Attack rates were computed for only one item of food,
chocolate cream pie. Among 414 who stated that they ate
pie at approximately 5:30 P.M. either on September 29 or
30, 190 reported illness (46%) and among 212 who stated
that they did not eat this food, 48 (23%) reported illness.
Several problems were considered in the interpretation
of these findings. Firstly, the interval between eating
the suspected food and completing the questionnaires
was 26 to 27 days and recall without benefit of interview
could be expected to be far less than perfect. Secondly, it
will be noted that many cases occurred well beyond the
expected incubation period and undoubtedly represented
secondary infections occurring in relatively crowded
dormitory quarters. Thirdly, illness was reported by some
prior to consumption of the suspected food. These cases
and at least a few which occurred after consumption of
the pie may have been due to other agents. The two-fold
disparity in reported attack rates between those who did
and those who did not report pie consumption was felt to
be highly significant.


Source of Infection

The source of the cream pies served at the hotel and
the college was a local bakery, a large producer of pies
of several types. Ingredients used in cream pies were

(Continued on page 360)


TOTAL DEATHS RECORDED IN 108 UNITED STATES CITIES


The weekly average number of total deaths in 108 cities for the four-week period ending
November 10 was 11,432 as compared with an expected 11,129 weekly average.


WEEK ENDING 4 WEEK WEEKLY
10/20 10/27 11/3 11/10 TOTAL AVERAGE

OBSERVED 11,767 11,056 11,410 11,495 45,728 11,432
EXPECTED 10,918 11,054 11,199 11,346 44,517 11,129

EXCESS 849 2 211 149 1,211 303


355










356 Iorbiditl, and lMortalitl N' c


TablIe (AAS1S 01- SPE(l I1L)D NOT B111 II 1) ISt AM, I NIII) 1SA 1S

FOR \WHK' i I NI) I)

NOVEMBER 11, 1961 AND NOVEMBER 10, 1962



Poliomy litis, Aseptic
P,11,myelitis, T lil Cases Poliomyelitis, Paralytic Ni parlyLt Meningitis
Ci nulative Cumulative
Area
45th week First 45 weeks 45th week First 45 weeks 45th week 45th week

1962 1961 1962 1961 1962 1961 1962 1961 1962 1961 1962 1961

UNITED STATES ..... 37 30 770 1,210 28 23 610 787 5 5 35 74

NEW ENGIAND.............. 1 4 8 38 3 7 26 1 1 2
Maine................. -
New Hampshire......... 2 -
Vermont............... 1 4 1 11 3 9 1 1
Massachusetts. ........ 6 14 6 8 1
Rhode Island.. ...... I I 1
Connect it ........... 1 5 1 3

MIDDLE ATLANTIC.......... 7 72 313 4 52 207 2 3 2
New York.............. 7 54 233 4 37 150 2 1 2
New Jersey............ 7 35 7 28 -
Pennsylvania......... 11 45 8 29 2

EAST NORTH CENTRAL....... 11 9 120 157 9 8 87 98 1 5 28
Ohi .................. 2 19 45 2 17 21 2
India na............ 3 21 16 3 15 9 -
Illinois............. 5 1 53 33 4 1 37 16 4 20
Michigan.............. 2 3 19 31 2 3 15 27 3
Wisconsin............... 3 8 32 2 3 25 1 1 3

WEST NORTH CENTRAL....... 3 37 72 2 26 32 1 4 10
Minnesot. ............. 7 6 7 6 3 6
Iowa .................. 7 18 3 9 1
Missouri ............ 1 10 24 1 5 7
North Dakota.. ....... 4 4 2 1
S6uth Dakot .......... 2 1 3 1 1 1 1
Nebraska .............. 8 8 8 4
Kansas.............. .. 9 4 4

SOUTH ATLANTIC......... .. 9 2 66 209 6 2 58 152 2 4
Delawr. ............. 2 1 -
Maryland.. ...... ... 1 2 39 1 29
District of Colubia.. 2 3 1 3
Virginia.............. 9 13 9 13 2 2
West Virginia......... 4 10 31 4 10 21 -
North Carolina....... 2 13 21 2 11 11
South C1ariLna........ 6 34 6 26
Ceorgia............... 2 16 30 13 23
Florida............... 2 8 36 2 7 25 2

EAST SOUTH CENTRAL....... 3 1 69 90 3 1 58 51 4 6
Kentucky ........ .... 3 28 27 3 23 5 3
Tennessee............. 10 26 5 10 1
Alabama............... 1 22 11 1 22 11 6
Mississippi........... 9 26 8 25 -

WEST SOUTH CENTRAL....... 7 2 302 145 5 2 235 79 2 7 5
Arkansas.............. 5 1 19 20 3 1 17 9 2 1 2
Louisiana............. 1 25 51 1 1 22 40 -
Oklahoa .............. 21 4 16
Texas............... 1 237 70 1 180 30 6 3

MOUNTAIN.................. 2 1 16 45 2 1 12 26 1 2
Montaal .............. 4 4 3 2
Idaho ................. 2 14 1 6 -
Wyoming.......... .... 2 1
Colorado............... 1 1 3 8 1 1 2 8 -
New Mex ico........... 3 -- 2
Ariona .............. 4 8 1 4 6
Utah .................. 1 8 1 4
Nevad ................. -

PACIFIC................. 4 1 80 141 3 75 116 1 1 9 15
Washington............ 5 26 5 26 2 2
Org on ................ 1 6 17 5 8 1 1 -
Caliiorni. ............ 3 1 69 93 3 65 77 1 6 13
Alaski.................
w i ................ 5 5

Puerto Ric' .............. 11 7 11 7










Morbidity and Mortality Weekly Report 357


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 11, 1961 AND NOVEMBER 10, 1962 (Continued)


Brucellosis Diphtheria Encephalitis, Hepatitis, Measles
Infectious Infectious and Serum
Area
Cumu- Cumu- 45th week
lative lative Under 20 &
45th week 45 weeks 45th week 45 weeks 45th week 20 yr. over Total Total 45th week
1962 1962 1962 1962 1962 1961 1962 1962 1962 1961 1962 1961

UNITED STATES...... 3 349 7 383 28 27 418 334 807 1,039 1,890 2,284

NEW ENGLAND.............. 4 1 3 3 66 39 105 51 116 421
Maine................. 31 10 41 8 24 66
New Hampshire......... 3 1 4 8 16
Vermont............... 1 11 7
Massachusetts......... 1 25 22 47 29 40 317
Rhode Island.......... 1 2 1 1 2 4 1
Connecticut........... 2 1 1 1 6 5 11 2 25 30

MIDDLE ATLANTIC.......... 1 9 12 6 6 85 93 178 123 235 209
New York............... 4 10 2 6 38 48 86 69 59 110
New Jersey............ 1 1 13 15 28 23 39 30
Pennsylvania.......... 1 4 1 4 34 30 64 31 137 69

EAST NORTH CENTRAL....... 78 10 3 3 73 64 143 205 809 374
Ohio.................. 1 1 3 26 14 41 54 139 29
Indiana................ 5 5 7 3 11 29 10 38
Illinois.............. 55 2 2 17 17 35 61 24 182
Michigan.............. 6 3 23 29 52 58 284 58
Wisconsin............. 11 1 4 3 352 67

WEST NORTH CENTRAL...... 2 136 1 86 2 16 11 42 75 77 94
Minnesota............. 13 24 1 4 4 9 38 18 35
Iowa................. 2 80 15 5 2 11 21 49
Missouri.............. 4 5 5 2 14 2 11 2
North Dakota.......... 2 7 1 1 1 1 33
South Dakota.......... 11 15 1 3
Nebraska.............. 12 18 1 2 6 7 15 5
Kansas................ 14 1 2 I 1 5 NN NN

SOUTH ATLANTIC........... 27 3 110 2 1 52 29 85 182 88 132
Delaware.............. 2 2 2 1
Maryland............... 1 2 3 5 12 5 21
District of Columbia.. 2 3 1 4 3
Virginia.............. 13 12 7 2 11 41 11 32
West Virginia......... 2 14 3 17 18 32 53
North Carolina........ 2 11 1 17 4 21 51 9 11
South Carolina........ 10 16 3
Georgia ............... 3 37 6 3 9 17 3
Florida................ 8 3 36 1 1 3 11 16 27 26 8

EAST SOUTH CENTRAL....... 16 1 29 4 1 39 16 63 156 85 216
Kentucky.............. 1 1 1 10 2 20 30 13 15
Tennessee............. 7 7 3 17 8 25 69 66 157
Alabama............... 6 1 15 10 3 13 23 6 27
Mississippi........... 2 7 2 3 5 34 17

WEST SOUTH CENTRAL....... 34 1 113 2 3 27 21 48 54 47 158
Arkansas.............. 9 18 1 1 3 3 6 14 2 3
Louisiana............. 8 1 10 5 5 10 7 3
Oklahoma.............. 6 6 3 1 4 1 1
Texas................. 11 79 1 2 16 12 28 32 41 155

MOUNTAIN................. 12 9 2 8 3 29 43 179 167
Montana............... 1 6 4 25 115
Idaho................. 1 1 4 7 10
Wyoming............... 1 1 1 4
Colorado .............. 2 7 11 60 12
New Mexico............ 2 1 5 5 9 NN NN
Arizona............... 3 6 8 16 26
Utah................... 4 1 3 2 6 4 66 2
Nevada................ 3 5 2

PACIFIC.................. 33 11 6 11 52 58 114 150 254 513
Washington............ 2 16 9 27 18 116 228
Oregon................ 3 5 10 15 32 24 45
California............ 28 6 6 9 30 37 69 92 78 159
Alaska ................ 1 5 1 1 2 8 20 74
Hawaii ................ 1 1 1 16 7

Puerto Rico.............. 35 6 9 15 14 17 17











358 NMorbidity and Mortality WXeekly Report


TabIhl ( ASF OF SPFCIFIH D NOTIFIABLE DISFASiS. I NITL D STATES

FOR WEEKS INDFD

NOVEMBER 11, 1961 AND NOVEMBER 10, 1962 (Continued)


Meningococal Streptococcal Tickborne
Infections Sore Throat & Tetanus Typhus Tularemia Typhoid Fever Rabies in Animals
Scarlet Fever (Rcky Mt.
Area Cumu- Spotted) Cumu- Cumu-
lative lative lative
45th wk. 45 weeks 45th week 45th wk.45th wk. 45th wk. 45th wk. 45 weeks 45th week +5 weeks
1962 1962 1962 1961 1962 1962 1962 1962 1962 1962 1961 1962

UNITED STATES.... 32 1,838 4,687 5,525 8 3 9 12 550 44 58 3,218

NEW ENGLAND......... 110 411 184 11 2
Maine.............. 16 35 3 2
New Hampshire...... 3 17 -
Vermont ............ 4 9 6 -
Massachusetts...... 43 62 59 8 -
Rhode Island....... 13 55 30 -
Connecticut........ 31 233 86 -

MIDDLE ATIANTIC..... 4 326 258 203 1 55 7 4 142
New York........... 145 152 125 1 28 4 4 91
New Jersey......... 80 53 31 12 1
Pennsylvania....... 4 101 53 47 15 3 50

EAST NORTH CENTRAL.. 9 355 373 401 2 1 4 90 6 5 705
Ohio............... 3 105 98 74 1 43 5 1 357
Indiana............ 3 30 42 77 1 1 1 13 3 182
Illinois........... 1 80 38 89 17 1 1 90
Michigan........... 2 118 121 73 1 11 40
Wisconsin.......... 22 74 88 1 1 6 36

WEST NORTH CENTRAL.. 1 98 117 161 3 5 2 27 6 18 845
Minnesota.......... 19 17 13 1 1 3 200
Iowa............... 11 34 41 2 2 1 9 326
Missouri........... 1 23 6 4 5 2 20 3 3 145
North Dakota...... 8 33 26 2 48
South Dakota....... 6 1 1 1 2 98
Nebraska............. 17 1 2 2 1 21
Kansas............. 14 25 75 7

SOUTH ATLANTIC...... 6 282 504 429 2 3 2 1 99 5 6 326
Delaware............ 1 35 1 2 2 -
Maryland........... 2 22 10 4 3 2
Dist. of Columbia.. 7 2 7 -
Virginia........... 2 62 118 68 1 18 2 126
West Virginia...... 1 16 198 104 5 5 1 127
North Carolina..... 65 54 23 3 6 -
South Carolina..... 18 15 24 9- -
Georgia............. 11 6 2 1 24 9
Florida............. 46 100 202 2 -- 1 25 3 62

EAST SOUTH CENTRAL.. 2 118 799 1,041 3 54 6 4 330
Kentucky............ 2 34 43 41 10 3 2 116
Tennessee.......... 47 659 957 3 26 3 2 191
Alabama............ 20 9 15 11 23
Mississippi........ 17 88 28 7 -

WEST SOUTH CENTRAL.. 1 151 580 763 1 1 121 4 16 567
Arkansas........... 1 16 1 3 1 1 31 6 65
Louisiana.......... 66 3 3 31 1 20
Oklahoma............ 7 7 2 6 28
Texas................ 62 569 755 53 4 9 454

MOUNTAIN.............. 59 757 1,001 43 1 34
Montana................ 5 23 63 10
Idaho............... 3 76 65 1- -
Wyoming............. 5 22 102 3- -
Colorado........... 9 225 326 8 4
New Mexico......... 6 171 285 12 1 13
Arizona............ 14 120 140 8 17
Utah............... 9 120 17 -
Nevada............ 8 3 -

PACIFIC.............. 9 339 888 1,342 1 50 10 4 267
Washington......... 1 22 198 455 I- -
Oregon.............. 1 21 28 29 I 17
California......... 7 284 608 713 1 47 10 4 250
Alaska ............. 8 50 78 -
Hawaii .............. 4 4 67 1 -
Puerto Rico......... ....- 9 3 1 2 16 19











Morbidity and Morlalit, \X eekl Report




Talhle (A). TOTAL DEATHS IN RIPORTIING CITIES


359


(Tables 4(A), 4(B), 4(C), and 4(D) will be published in sequence covering a four-week period.0

For weeks ending For weeks ending
Area 102 Area 10/2 27 11/

10/20 10/27 11/3 11/10 10/20 10/27 11/3 11/10


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 ............


216
41
40
35
60
24
28
29
69
62
17
35
32
56


28
41
130
45
45
41
97
118
1,687
47
403
247
30
109
31
47
61
51
31
41


60
29
853
150
192
116
80
350
41
50
31
28
40
162
43
166
19
26
43
114
59


47
24
28
147
37
134
49
257
85
47


242
43
37
32
58
38
32
29
34
68
14
39
24
55


46
31
146
34
33
35
77
85
1,613
34
509
187
22
100
19
44
46
36
23
31


64
37
694
160
196
102
83
331
44
51
37
23
49
149
37
108
28
32
30
98
55


63
17
48
113
19
112
102
251
83
49


262
46
37
27
46
23
27
29
61
68
17
40
28
66


48
37
157
55
35
43
66
114
1,650
41
485
225
18
97
17
32
88
39
24
34


61
40
777
148
190
120
88
340
30
46
43
33
33
139
27
115
29
21
45
104
63


49
20
51
135
35
113
73
257
57
51


115 I 121 1 92 102


215
41
60
70
48
97
42
66
63
206
31


92
51
24
90
105
50
38
60


250
46
87
72
58
78
32
71
73
227
40


67
43
26
90
103
44
29
54


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. .............


51
43
142
57
28
45
78
97
1,717
44
503
124
20
110
29
32
71
32
43
34


54
31
780
158
210
132
102
339
47
30
38
34
52
148
29
128
32
30
31
99
52


58
27
39
103
24
129
65
259
41
64


254
53
64
78
58
93
33
75
67
223
34


93
53
26
123
127
52
34
69


225
29
56
75
56
93
27
57
76
193
39


72
46
25
149
144
44
33
73


23
39
28
131
32
53
172
78
190
77
111
65
52


34
14
105
12
115
14
66
40


San Juan, P.R. .............. 31 41 17 26


OCurrent Week Mortality for 108 Selected Cities

4(A) Total Mortality, all ages.................. 11,495
4(B) Pneumonia-Influenza Deaths, all ages........ 402
4(C) Total Deaths under 1 Year of Age............. 763
4(D) Total Deaths, Persons 65 years and over..... 6,446


14
40
55
42
55
517
103
45
111
50
92
242
58
162
55
54


28 39 34
25 20 32
20 30 29
118 153 146
36 35 37
71 66 66
156 187 131
64 56 56
172 163 179
61 84 95
98 110 83
50 43 57
51 66 61


33 40 75
23 19 16
134 102 112
14 15 16
87 73 63
25 17 13
53 45 54
49 56 33


16 16 27
49 64 55
30 42 22
40 44 51
53 51 49
506 533 507
68 100 102
36 35 37
96 117 110*
53 48 63
93 95 82
186 181 191
46 29 37
141 132 126
48 49 59
37 31 37


*Estimate based on average percent of divisional total
Totals for previous weeks include reported corrections.

NOTF: All deals by place of occrrece.




UNIVERSITY OF FLORIDA


3 1262 08864 1757


Morbidity and Mortality Weekly Report


found to include water, dried skim milk powder, sugar,
salt, vegetable shortening, dried egg albumen, vanilla and
corn starch. Cocoa and banana flavoring are employed for
chocolate and banana pies respectively. After baking of
the pie shell, a filling consisting of all ingredients ex-
cept albumen is cooked. The whipped albumen is then
folded into the filling without further cooking. The pies
are usually topped with a meringue composed of frozen
egg albumen, sugar, water, and agar stabilizer. Occa-
sionally a whipped cream topping composed of shortening,
milk powder, water and agar stabilizer is added to the
meringue for final topping. A 10 minute baking at 4500 F
is used for finishing the topping.
Sources of all ingredients were determined and the
events of the past several months were carefully re-
viewed. Only one deviation from a routine operation at
the bakery was found. For several years, an out-of-state
concern had supplied the dried egg albumen but on August
15, after running out of this product, a 25 lb. bag of dried
egg albumen was purchased from a local creamery. This
was used and a 50 lb. bag was purchased on August 19
from the same source and used until about October 14
when a shipment of the out-of-state egg albumen arrived.
Until that time, 36 of the 50 lbs. had been used (14 lbs.
still remained). it appears that use of the second shipment
coincided closely with the occurrence of the epidemic in
the Spokane area. If this product is actually responsible,
from knowledge (a) that one lb. is used for 100 pies and,
therefore, for 600 servings, (b) that 36 lbs. were used, and
(c) that approximately 46% of the pie eaters became sick,
it seems possible that a total of approximately 10,000
cases of salmonellosis may have resulted from consump-
tion of pies from this bakery alone (36 lbs. x 100 x6 x.46).
The other possible source of the outbreak, in addi-
tion to the dried egg albumen, was the fresh frozen egg al-
bumen used for meringue. This material was also obtained
from the same local creamery, which prepares 30 lb. cans
of it from eggs obtained from a wide production area.
Over 135 establishments were found to have received
pies from this bakery. Included were restaurants, clubs,
military posts, schools, churches, hotels, supermarkets,
a hospital, and a college located in Washington, as well
as adjacent States. After a review of this list and dates
of shipments of cream pies, it was clear that every case
of confirmed salmonellosis from whom a history of con-
sumption of cream pie had been obtained could be linked
to a specific shipment from this bakery.
Laboratory examinations of food and environmental
specimens are in progress.
(Reported by Ernest A. Ager, M.D., Chief, Communicable
Disease Control, Washington State Department of Health;
Hampton Trayner, M.D., Spokane City Health Department;
E. O. Ploeger, M.D., Spokane County Health Department;
and a team from the Communicable Disease Center.)


INTERNATIONAL NOTES QUARANTINE MEASURES
No Report.










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