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:
AA00010654:00066

Related Items

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

Full Text






NATIONAL COMMUNICABLE DISEASE CENTER


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


EPIDEMIOLOGIC NOTES AND REPORTS
TYPHOID FEVER California

An epidemic of 31 cases of typhoid fever that occurred
at Stanford University between May 10 and May 31, 1967.,
involved 30 of the 72 members of one fraternity (including
four championship swimmers) and one of the two fraternity-
house cooks. All but three of the 31 patients two fra-
ternity men and the cook were symptomatic: 20 were
hospitalized. Typical symptoms were fe\er to 1040F.
chills, weakness, backache, and headache. There Nwere no
complications or deaths. Stool or blood cultures or both
from all but one of the patients were positive for Salmo-
nella typhi, phage type B1, and the exception had a four-
fold rise in antibody titer.


Epidemiologic Notes ,'cWl.aijjil "
Typhoid Fever-(t C . 177
Salmonella typhi-m I unty, Wi-hmi n 175
Current Trends
Viral Hepatitis, USA 167 . 17
International Notes
Smallpox- Kuwait .............. .. .11

Potato salad prepared ht the cook and s-r\ed at a
luau on May 6 \\as ;at first suspected of being the vehiclee
of infection, but investiataion showed that of the 109
persons who attended the party only 2.5, all fraternity
members, became ill, and none of Ihe 50 wNomen guests
were affected. Furthermore, the attack rate wa,- as high
for members who did not attend the part asi for those
who did. (C'ontinurd on page 178)


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
22nd WEEK ENDED CUMULATIVE. FIRST 22 WEEKS
MEDIAN
DISEASE JUNE 3, JUNE 4, 1962 1966 MEDIAN
1967 1966 1967 1966 1962- 1966
Aseptic meningitis ..................... 23 25 26 697 611 601
Brucellosis. ............ ............ 6 3 3 97 93 145
Diphtheria.......... ................... 2 4 4 43 69 113
Encephalitis, primary:
Arthropod-borne & unspecified ......... 26 28 540 537
Encephalitis, post-infectious ............. 24 23 -- 378 379
Hepatitis, serum ................ ... 24 18 6 822 546
Hepatitis, infectious .................... 519 516 6 17,061 14,729 19,005
Malaria ............................... 38 4 2 836 119 37
Measles (rubeola)....................... 1,670 5,919 13,196 50,139 162,223 292,640
Meningococcal infections, total .......... 41 60 44 1,269 2,110 1,400
Civilian ............................ 37 55 1,173 1,866
Military ............. ................ 4 5 --- 96 244
Poliomyelitis, total ............... .. .. 1 3 10 9 32
Paralytic. ........................... 1 1 9 8 26
Rubella (German measles)................ 1,991 1,628 -- 31,039 34,091
Streptococcal sore throat & scarlet fever .. 7,900 6,504 5,729 252,005 239,423 222,294
Tetanus..................... ......... 6 4 4 65 53 85
Tularemia ...... ........ .............. 1 3 6 59 59 87
Typhoid fever .......................... 1 2 10 132 121 149
Typhus, tick-borne (Rky. Mt. spotted fever). 8 11 6 43 32 28

Rabies in animals .................. ... 76 60 72 1,970 1,905 1.902

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax ........ .......... .................. 2 Rabies in man ...
Botulism ....................... ................... Rubella, Congenital Syndrome .... .. .3
Leptospirosis: Tex.- ................................... 16 Trichinosis: Ore.-2 ........ .. .. .. .34
Plague ............................................. Typhus, marine: Tex.-l ................ .. ... 15
P:ii acuA, is: Neb-1 T-.. "] r19 P i.-. i r n r ... 1


j=S1, 60/9; Vol 161~63 1-







Morbidity and Mortality Weekly Report


TYPHOID FEVER-California
(Continued from front page)


Thirty of the 31 patients ate their meals at the fra-
ternity house. Of the 48 members who ate there regularly,
27 (56 percent) were ill. Of 18 persons who ate there
occasionally, three were ill. Of six members who never
ate there, none were ill. Ten of the 13 student food-
handlers were among the ill.
Clearly, the disease emanated from the fraternity
kitchen, but the source of the epidemic is not known. In
the 6 weeks before the epidemic, at least seven fraternity
members traveled in areas where typhoid fever is endemic,
and two of them had gastroenteritis there. The cook, who
was employed in September 1966, gave no history of


typhoid fever or foreign travel and had never been iden-
tified as a typhoid carrier.
The fraternity-house kitchen was closed, all members
were given typhoid vaccine, and state and campus health
officials are considering antibiotic prophylaxis for all
well members.
(Reported by Philip K. Condit, M.D., State Epidemiologist,
and Henry A. Renteln, M.D., Head, General Epidemi-
ology Section, California State Department of Public
Health; Mary Clark, M.D., Santa Clara County Health
Department; Rodney Beard, M.D., Professor of Pre-
ventive Medicine, -,:. .f i, -'.. ;. .- and an EIS Officer.)


SALMONELLA TYPHI.MURIUM- Yakima County, Washington


An outbreak of gastroenteritis due to Salmonella
typhi-murium occurred over a 15-week period (January -
April 1967) in Yakima County, Washington, and involved
at least 40 persons. No deaths were reported. One case
of meningitis occurred in a newborn whose mother was
symptomatic at time of delivery.
Of the 40 patients, whose symptoms included fever,
nausea, vomiting, cramps, and diarrhea, 33 were hospital-
ized and 39 submitted S. typhi-murium-positive specimens
(37 fecal, 1 blood, and 1 throat swab). There were 32
primary and 6 secondary cases; two patients acquired S.
typhi-murium while hospitalized for unrelated disorders.
Slightly more than half the patients were less than 10
years old; 23 were males, 17 were females.
In interviews with the 15 initial patients (those with
onset of symptoms in the first 4 weeks of the outbreak),
investigators learned that eight-more than 50 percent-
drank raw milk from a dairy that furnished only 1 percent
of the involved area's milk supply.
The dairy was visited, and cultures were done on
samples taken from the environment, farm workers, water,
feeds, cows, calves, and milk; S. typhi-murium was found
in milk from three cows, in feces from one calf, and in
water from the stream that is the water supply for the
cattle. When extensive sampling revealed that the entire
15-18-mile course of the stream was contaminated with
S. typhi-murium, a further search was made and a gunny
sack containing a dead calf was found in the water just
above the highest positive sample station. S.typhi-murium
was isolated from stool from the calf but not from the
organs sampled, which could be accounted for by putri-
faction and overgrowth of any salmonellae organisms that
might have been present.
A contaminated mud-and-water sample was later taken


from the stream above where the calf was found. The
two families who lived just above that point (at the
stream's headwaters) had drunk raw milk purchased from
the incriminated dairy. No organisms were found when
stool samples were tested after the epidemic had ended,
but the families reported having had diarrhea at about
the time of the epidemic.
One hypothesis as to the source of salmonella
contamination is that the calf died of an S. typhi-murium
septicemia and was thrown in the stream. The water
became contaminated and carried the infection to the
dairy herd downstream. The families upstream drank con-
taminated milk from the dairy and subsequently shed
S. typhi-murium in stool. Water from their septic tanks
found its way into the stream, thus accounting for the
presence of S. typhi-murium above the calf.
The dairy involved now sells nothing but pasteurized
milk, and other producers of raw milk in Yakima County
are following suit; however, raw milk is still sold in
many counties of Washington State.

(Reported by Byron J. Francis, M.D., Head, Communi-
cable Disease Control Section, Jack Allard, M.P.H.,
Associate Epidemiologist, Washington State Depart-
ment of Health; and an EIS Officer.)

Editorial Note:
This is the fifth and largest outbreak of salmo-
nellosis due to ingestion of raw milk to be reported to
NCDC since the salmonella surveillance program began
in 1963. Three of the five were due to S. typhi-murium, and
four occurred in the West (California-1, Washington-2,
and Idaho-1), where the practice of drinking raw milk is
more common than in most other parts of the country.


JUNE 3, 1967







Morbidity and Mortality Weekly Report


CURRENT TRENDS
VIRAL HEPATITIS, USA-1967


The reported incidence of viral hepatitis in the United
States hias declined I;'hi, in thepast two months (Figure
1), consistent with the normal seasonal pattern. For the
first. 22 weeks of 1967, 17,883 cases of viral hepatitis
were reported in the United States. This represents a
rate of 9.1 cases per 100,000 population for the 22-week
period. For the comparable period of 1966, 15,275 cases
were reported, for a rate of 7.8. Thus, the rate for 1967
was 17 percent higher than for 1966.
Figure 2 shows the areas in each of the nine geo-
graphic regions of the United States. Table 1 lists by
5.0-- ----------- ------


IWeek Number: 27
'o'


Figure 2


region the number of reported cases, rates, and percent
change in rates for the first 22 weeks of 1966 and 1967.
The rates were greater in 1967 than in 1966 in seven of
the nine regions; increases ranged from 16 to 42 percent.
The largest, increases were observed in the New England
and West. South Central regions (40 and 42 percent, respec-
tively). Two of the nine regions, East North Central and
East South Central, showed decreases in rates(-4 and -18
percent respectively).

(Reported by Hepatitis Unit, Epidemiology Program, NCDC.)


27 27 27 27 27 7 27 7 I 27 I 27 I 27 I 27 I

Table 1
Reported Cases and Rates of Viral Hepatitis by Region
Through 22nd Week of 1966 and 1967

Percent
1966 1967 change
in rates
Region Cases Rate* Cases Rate* 1966
to
1967


Total United States

New England
Middle Atlantic
East N. Central
West N. Central
South Atlantic
East S. Central
West S. Central
Mountain
Pacific


15,275
598
2,530
2,978
995
1,568
1 '.t.,
1,255
720
3,175


17,883
835
3,139
2,832
1,213
1,898
1,240
1,790
835
4,101


*Reported cases per 100,000 population for 22nd week period
(Based on July 1, 1966, population estimates)


JIlNE 3, 1967i








180 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JU NE 3, 1967 AND JUNE 4, 1966 (22nd WEEK)

ENCEPHALITIS HEPATITIS
ASEPTIC Primary
AREA MENINGITIS RCELLOSIS DIPHTHERIA including Post- Serum Infectious
unsp. cases Infectious
1967 1966 1967 1967 1967 1966 1967 1967 1966 1967 1966
UNITED STATES... 23 25 6 2 26 28 24 24 18 519 516

NEW ENGLAND.......... 1 1 1 29 21
Maine.............. 6 5
New Hampshire...... -
Vermont............ 1
Massachusetts...... 1 1 7 6
Rhode Island ...... 4 4
Connecticut........ 12 4

MIDDLE ATLANTIC...... 2 4 3 2 4 6 69 103
New York City...... -- 1 3 4 6 18 16
New York, up-State. 1 26 31
New Jersey ......... 12 25
Pennsylvania....... 2 3 1 13 31

EAST NORTH CENTRAL... 2 2 7 16 3 4 2 92 71
Ohio............... 1 1 2 14 1 1 17 14
Indiana............ 5 13
Illinois........... 1 1 3 3 32 13
Michigan........... 1 4 1 1 19 28
Wisconsin.......... 1 19 3

WEST NORTH CENTRAL... 1 2 1 22 32
Minnesota......... -- 2 3
Iowa............... 2 -- -- 2 17
Missouri............. -- 14 7
North Dakota....... 1 1 1
South Dakota...... -
Nebraska............ 1 2
Kansas............. 3 2

SOUTH ATLANTIC....... 4 4 1 1 4 4 7 3 3 64 54
Delaware............ 10 -
Maryland........... 1 3 1 1 9 25
Dist. of Columbia.. -
Virginia........... 2 1 7
West Virginia...... 2 1 4 4
North Carolina..... -- 1 2 6 1
South Carolina..... 1 1
Georgia............. 1 14 7
Florida............. 2 3 1 1 1 3 2 2 20 9

EAST SOUTH CENTRAL... 4 2 2 3 1 29 40
Kentucky........... 1 10 12
Tennessee.......... 1 1 1 14 24
Alabama............ 2 1 1- 3
Mississippi........ 2 1 1 5 1

WEST SOUTH CENTRAL... 3 7 1 1 1 2 1 66 51
Arkansas............. 1 4
Louisiana.......... 1 1 2 8 8
Oklahoma ........... -- 2 3
Texas.............. 2 6 1 1 1 56 36

MOUNTAIN............. 2 15 16
Montana............ 1
Idaho................ -
Wyoming.............. 4 1
Colorado........... 2 3 5
New Mexico......... 3 3
Arizona............. 3 3
Utah.............. 2 3
Nevada................ -

PACIFIC.............. 8 8 5 2 10 12 6 133 128
Washington........... 1 1 1 1 18 13
Oregon............. 1 10 8
California......... 5 7 3 2 10 11 5 104 106
Alaska............. 1 1
Hawaii............. 3-

Puerto Rico 14 25









Morbidity and Mortality Weekly Report 181


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JINE 3, 1967 AND JUINEi 4. 19X (22ndWEEK) CONTINUED



MALARIA MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, POLIOMYELITIS RUBELLA
AREA Tntal Paralytic
AREA Cumulative Cumulative Total Paralytic
Cum.
1967 1967 1967 1966 1967 1967 1966 1967 1967 1967 1967
UNITED STATES... 38 1,670 50,139 162,223 41 1,269 2,110 1 1 9 1,991

NEW ENGLAND.......... 32 683 1,900 56 96 295
Maine.............. 9 205 181 3 8 29
New Hampshire...... 71 44 2 8 38
Vermont............ 3 41 216 3 36
Massachusetts...... 11 240 680 29 38 47
Rhode Island....... 5 57 68 3 11 39
Connecticut........ 4 69 711 19 28 106

MIDDLE ATLANTIC...... 10 101 1,792 16,712 7 195 236 2 66
New York City...... 14 317 7,929 1 32 34 1 40
New York, Up-State. 1 16 391 2,038 3 46 67 26
New Jersey......... 2 7 411 1,728 3 78 66 -
Pennsylvania....... 7 64 673 5,017 39 69 1

EAST NORTH CENTRAL... 224 4,278 59,175 7 153 326 318
Ohio................ 40 833 5,708 1 56 87 27
Indiana............. 19 523 4,655 21 59 11
Illinois........... 104 765 10,610 4 35 61 55
Michigan.......... 13 790 10,531 2 32 86 62
Wisconsin.......... 48 1,367 27,671 9 33 163

WEST NORTH CENTRAL... 139 2,387 7,660 1 57 116 76
Minnesota .......... 5 110 1,572 12 27 6
Iowa................ 61 685 4,686 1 12 16 61
Missouri........... 1 212 415 12 48 2
North Dakota....... 30 756 910 6 5
South Dakota....... 46 6 6 4 -
Nebraska........... 17 516 71 9 8 2
Kansas............. 25 62 NN 6 7

SOUTH ATLANTIC....... 14 226 5,820 12,477 7 242 344 1 94
Delaware........... 36 211 5 4 1
Maryland............ 1 10 109 1,830 29 34 1
Dist. of Columbia.. 3 19 363 8 7
Virginia........... 2 46 1,796 1,466 1 24 44 30
West Virginia...... 60 1,144 4,414 19 12 11
North Carolina..... 8 10 808 270 1 48 87 -
South Carolina..... 9 434 584 23 42 7
Georgia............. 3 24 223 5 39 46 -
Florida............ 88 1,450 3,116 47 68 45

EAST SOUTH CENTRAL... 41 4,551 17,418 3 111 187 1 67
Kentucky........... 14 1,136 4,353 30 73 15
Tennessee.......... 23 1,578 10,755 1 47 61 51
Alabama............ 2 1,200 1,460 2 22 40 1
Mississippi........ 2 637 850 12 13 1

WEST SOUTH CENTRAL... 6 342 15,963 20,215 7 183 310 1 1 5 58
Arkansas........... 3 1,379 744 1 23 23 -
Louisiana.......... 1 14 137 78 4 71 117 -
Oklahoma............ 5 4 3,298 426 1 12 17 1
Texas............... 321 11,149 18,967 1 77 153 1 1 4 58

MOUNTAIN............... 4 150 3,806 9,805 24 69 154
Montana............ 3 248 1,581 4 1
Idaho............... 6 343 1,128 1 5 2
Wyoming............. 1 54 110 1 3 -
Colorado............. 3 113 1,201 981 10 37 104
New Mexico......... 4 530 964 3 9 -
Arizona............. 11 863 4,647 4 8 44
Utah................ 1 12 303 358 3 3
Nevada............. 264 36 2 3 -

PACIFIC.............. 4 415 10,859 16,861 9 248 426 863
Washington.......... 1 162 5,142 3,043 1 23 34 195
Oregon.............. 45 1,412 1,158 2 24 28 7
California.......... 3 202 4,081 12,439 6 191 346 649
Alaska............. 3 120 123 8 15 -
Hawaii............. 3 104 98 2 3 -


31 1.766 2.022


Puerto Ric ..........


Puerto Rico..........









182 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 3, 1967 AND JUNE 4, 1966 (22nd WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
AREA SCARLET FEVER (Rky. Mt. Spotted) ANIMALS
1967 1967 Cum. 1967 Cum. 1967 Cum. 1967 Cum. 1967 Cum.
1967 1967 1967 1967 __1967
UNITED STATES... 7,900 6 65 1 59 1 132 8 43 76 1,970

NEW ENGLAND.......... 1,593 1 3 46
Maine............... 82 1 12
New Hampshire...... 26 2 27
Vermont............. 188 7
Massachusetts...... 175 1 -
Rhode Island....... 58 -
Connecticut........ 1,064 -

MIDDLE ATLANTIC...... 345 2 7 15 1 1 35
New York City...... 14 3 9 -
New York, Up-State. 301 1 4 26
New Jersey......... NN 1 1 -
Pennsylvania....... 30 1 2 1 1 1 9

EAST NORTH CENTRAL... 670 5 8 10 5 15 187
Ohio.............. 171 4 4 6 79
Indiana............. 86 1 1 2 30
Illinois........... 116 4 7 1 5 39
Michigan........... 167 1 4 2 14
Wisconsin.......... 130 1 25

WEST NORTH CENTRAL... 320 1 3 11 3 23 440
Minnesota.......... 5 1 2 3 81
Iowa............... 162 1 2 4 50
Missouri........... 1 i 3 4 91
North Dakota....... 74 5 72
South Dakota....... 19 1 2 62
Nebraska........... 44 2 32
Kansas............ 15 6 3 52

SOUTH ATLANTIC....... 941 2 15 7 17 1 14 10 261
Delaware........... 9- -
Maryland............. 210 2
Dist. of Columbia.. --
Virginia........... 254 4 2 3 6 137
West Virginia...... 217 1 1 43
North Carolina..... 10 1 5 2 9 3
South Carolina..... 6 1 1 2 3 1 1
Georgia............ 12 1 3 2 1 2 50
Florida............ 223 4 1 4 2 28

EAST SOUTH CENTRAL... 924 1 16 7 1 23 4 9 3 430
Kentucky........... 92 1 11 3 83
Tennessee.......... 745 8 4 5 2 4 3 314
Alabama............ 79 1 6 1 5 2 2 31
Mississippi........ 8 2 2 2 2

WEST SOUTH CENTRAL... 546 11 1 16 17 5 16 399
Arkansas........... 3 1 4 3 1 2 58
Louisiana.......... 1 2 11 2 33
Oklahoma............ 71 7 3 6 119
Texas............... 475 7 3 3 1 6 189

MOUNTAIN............... 1,291 7 15 2 6 4 62
Montana.............. 33 1 1 -
Idaho............... 100
Wyoming............ 7 2 4
Colorado............. 838 1 11 2 6 8
New Mexico......... 148 3 18
Arizona............ 37 3 1 32
Utah............... 127 3 -
Nevada............ 1- -

PACIFIC .............. 1,270 8 3 31 3 2 110
Washington......... 505 2 -
Oregon............... 65 1
California......... 666 6 1 28 3 2 109
Alaska............. 24 -
Hawaii............. 10 2 3-

Puerto Rico.......... 6 1 5 4 -







Morbidity and Mortality Weekly Report


DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED JUNE 3, 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 I year Area All 65 years I nd yezar
Ages and over Influenza All Age and over Influenzag All
All Ages Causes All Ages Causes


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

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

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


715
246
38
35
20
48
24
20
27
52
79
8
55
14
49

3,258
43
32
132
41
25
54
89
73
1,693
43
463
185
46
88
28
41
53
46
39
44

2,520
55
38
728
145
208
123
74
361
45
53
34
34
49
131
32
128
41
30
36
102
73

769
43
15
43
128
23
102
62
240
62
51


423
131
23
29
12
23
11
9
20
35
48
4
33
9
36

1,887
24
19
73
26
12
29
47
42
963
28
268
109
35
59
16
23
32
29
27
26

1,414
30
20
418
80
116
70
38
191
27
28
19
10
29
65
16
79
25
18
23
66
46

475
28
12
26
83
15
68
37
138
38
30


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

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

WEST SOUTH CENTRAL:
Austin, Tex.-----------
Baton Rouge, La.-------
Corpus Christi, Tex.---
Dallas, Tex.-----------
El Paso, Tex.----------
Fort Worth, Tex.-------
Houston, Tex.-----------
Little Rock, Ark.------
New Orleans, La.-------
Oklahoma City, Okla.---
San Antonio, Tex.------
Shreveport, La.--------
Tulsa, Okla.-----------

MOUNTAIN:
Albuquerque, N. Mex.---
Colorado Springs, Colo.
Denver, Colo.-----------
Ogden, Utah-----------
Phoenix, Ariz.---------
Pueblo, Colo.-----------
Salt Lake City, Utah---
Tucson, Ariz.-----------

PACIFIC:
Berkeley, Calif.-------
Fresno, Calif.--------
Glendale, Calif.-------
Honolulu, Hawaii-------
Long Beach, Calif.-----
Los Angeles, Calif.----
Oakland, Calif.--------
Pasadena, Calif.-------
Portland, Oreg.--------
Sacramento, Calif.----
San Diego, Calif.------
San Francisco, Calif.--
San Jose, Calif.-------
Seattle, Wash.---------
Spokane, Wash.---------
Tacoma, Wash.----------


1,050
111
216
49
55
98
49
69
38
61
69
187
48

622
92
42
31
149
115
48
33
112

988
33
31
31
126
40
80
175
43
158
66
104
57
44

434
36
25
114
22
112
17
63
45

1,425
22
40
50
43
63
421
73
30
91
65
92
179
46
111
61
38


Total 11,781 6,662 375 556

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 280,186
All Causes, Age 65 and over------------------- 161,698
Pneumonia and Influenza, All Ages ------------- 10,769
All Causes, Under 1 Year of Age--------------- 14,016


Week No.
22








Morbidity and Mortality Weekly Report


INTERNATIONAL NOTES
SMALLPOX Kuwait


In 1967, through the week ending May 13, Kuwait has
reported 41 smallpox cases with 18 deaths. A relatively
high case fatality ratio of 43.9 percent has been observed.
This epidemic, representing the first reported smallpox
in Kuwait since 1959, is occurring in the nomad pop-
ulation of the districts of Shaddaddia, Makuwa, and
Awazin. The differential diagnosis was extremely diffi-
cult because of a simultaneous epidemic of chickenpox
occurring in the area before and during the smallpox
outbreak. The index patient, a nomad, was known to have
had contact with nomads from an adjacent country.
The following control measures were initiated:
Patients with confirmed smallpox were isolated in one
part of the fever hospital and the suspect cases in another
part. The patients were vaccinated on admission, and on
discharge they were quarantined for 16 days in a building
some distance from the hospital. A house-to-house vac-
cination campaign was conducted by 300 vaccinators, and
by May 6 approximately 95 percent of the population had
been vaccinated.
The age distribution of the cases and deaths are
shown in Table 2. The overall case fatality ratio was
43.9, but for children under age 5 the case fatality ratio
was 60.9 percent.


Table 2

Reported Smallpox Cases and Deaths, Kuwait, 1967

Age Cases Deaths Case Fatality Ratio (%)


6 mos.
6-11 mos.
1-4 yrs.

5-9 yrs.
10-14 yrs.
15 + yrs.


5
2
7


0
3


60.9


Total 41 18 43.9


(SOURCE:
20, 1967.)


WHO Weekly Epidemiological Records Nos. 18-


UNIVER ,ITY OF FLORIDA

_U I ll lllllll I il I tl lllllllll lllI ll
3 1262 08864 2102

THE MORBIDITY AND MORTALITY WEEKLY RE A r.TM .'.CULA.
TION OF 17,000, tS PUBLISHED AT THE NA T. LN r- rCG ,..- :ae L
DISEASE CENTER, ATLANTA, GEORGIA.
DIRECTOR, NATIONAL COMMUNICABLE DISEA:,E E: TF i
CD l _-I .' cE 'C E R M D
CHIEF. E -C.FMI i.CG 2v P D3GRAM C, -.N.:Mu'R UW
ACTING :-. : 1 T i. T.Cj SECTION C.a L i-I'MA
IN ADDITION TO THE ESTABLISHED PRO':EC"E.Vl F 3'i RFOF i ,1
MORBIDITY AND MORTALITY, THE NATIONAL C jUMIjri BLF. DESEA'E
CENTER WELCOMES ACCOUNTS OF INTEREE TN: 'N.u TBSE aiB OR C
INVESTIGATIONS WHICH ARE OF CURREhT ,r.7f- E:t T,-- -E7L TM
OFFICIALS AND WHICH ARE DIRECTLY REL, TE. T-, TM.E .:Cr ,TR .L OF
COMMUNICABLE DISEASES. SUCH COMM'JN': t .i:.N :GULCD BE
ADDRESSED TO:
THE EDITOR
MORBIDITY AND MORTALITY WE- )
T..: T N&C COrMWu' LI; .L DIS -E, *:Er EA

NOTE: TJIE DATA IN THIS REPORT ARF '.i'tOia.L AND ARE
BASED ON WEEKLY TELEGRAMS TO THE NCC.: J 1E .iND'iDust
STAT HEALTH DEPARTMENTS. THE REFiOR'TiN: *.E* :ONCLUDEI
ONSATURDAY; COMPILEDDATA ON A NATI-'-L "-:.: -E iELE.LEO
ON THE SUCCEEDING FRIDAY.


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JINE 1. 1967