Morbidity and mortality

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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:
AA00010654:00092

Related Items

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

Full Text






Morbidity and Mortalit



U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARIf 7


PUBLIC HEALTH SERVICE

Prepared by the


For release June 14, 1963


634-5131


ATLANTA 22,


PROVISIONAL INFORMATION ON SELECTED NOTIFIABLE DISEASES IN THE UNITED
DEATHS IN SELECTED CITIES FOR WEEK ENDED JUNE 8, 1963


HEPATITIS There were 688 cases of viral hepatitis
reported for the week ending June 8, 1963. This brings
the total number of reported cases of viral hepatitis during
the first 23 weeks of 1963 to 21,650.
Cumulative totals of viral hepatitis cases for the first
23 weeks for the years 1959-1963, and annual totals for
the years 1959-1962 are shown in the table below:

1963 1962 1961 1960 1959
Viral Hepatitis Cases
Through 23rd Week 21,650 29,277 39,338 17,862 11,036
Total for Year 53,306* 72,733 41,063 22,797
*Provisional
Since 1961 there has been a continued decline in
viral hepatitis cases. The recent epidemic wave, which
peaked in 1961, appears to be declining less rapidly than
the previous wave first noted in 1954 when viral hepatitis


became reportable. In the figure below are
ber of reported cases of viral hepatitis by
since 1954.


ES AND ON


shown the num-
4 week periods


Table 1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous week)
23rd Week Cumulative
Ended Ended First 23 weeks
Disease Median
June 8, June 9, 1958 1962 Median
1963 1962 1963 1962 1958 1962
Aseptic meningitis ............... 41 68 --- 530 479 --
Brucellosis ..................... 3 12 13 148 173 324
Diphtheria...................... 8 1 4 120 200 310
Encephalitis, infectious .......... 39 31 41 660 679 659
Hepatitis, infectious and serum... 688 978 683 21,650 29,277 18,055
Measles........................ 14,143 16,195 17,032 306,582 386,155 333,138
Meningococcal infections ......... 40 34 39 1,307 1,099 1,211
Poliomyelitis, total.............. 5 6 19 61 158 350
Paralytic.................... 4 6 16 52 121 253
Nonparalytic.................. 2 2 21 62
Unspecified .................. 1 1 7 16 35
Streptococcal sore throat
and Scarlet fever ............ 5,764 4,977 --- 201,363 184,409 ---
TleI nu- ........................ 4 5 --- 90 78 ---
Tularem.r ....................... 7 5 --- 93 110 -
Typhoid fever ................... 6 11 11 155 204 244
Typhu's fever, tick-borne,
(Rocky Mountain spotted)...... 11 12 --- 30 40 -
Rabies in Animals ............... 68 73 73 1,799 1,934 1,854


Table 2. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: N. C.- 2 Psittacosis: Ill.-l, Mich.-1 29
Botulism: 5 Rabies in Man:
Malaria: 41 Smallpox:
Plague: Typhus, murine: s. c.-1, Tex.-1 5


07N L ABL SA TJ








190


Morbidity and Mortality Weekly Report







SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS

MAY 1963 AND MAY 1962

CASES OF PRIMARY AND SECONDARY SYPHILIS: By Reporting Area May 1963 and May 1962 Provisional Data


Cumulative Cumulative
Reporting Area May January May Reporting Area May January May
1963 1962 1963 1962 1963 1962 1963 1962
NEW ENGLAND............... 54 34 198 235 EAST SOUTH CENTRAL........ 145 97 632 476
Maine..................... 0 0 2 3 Kentucky................. 13 4 47 47
New Hampshire.............. 0 0 4 2 Tennessee................ 35 26 175 132
Vermont.................. 0 0 1 0 Alabama.................. 65 61 289 269
Massachusetts............. 31 28 101 173 Mississippi.............. 32 6 121 28
Rhode Island............. 6 1 11 13
Connecticut.............. 17 5 79 48 WEST SOUTH CENTRAL........ 267 219 1,171 1,103
Arkansas.................. 20 24 94 81
MIDDLE ATLANTIC.............. 498 346 2,496 2,177 Louisiana ............... 60 90 267 473
Upstate New York......... 54 33 245 225 Oklahoma ................. 20 9 78 37
New York City............ 271 155 1,397 1,149 Texas .................... 167 96 732 512
Pa. (Excl. Phila.)....... 17 6 67 44
Philadelphia............. 57 83 325 347 MOUNTAIN .................. 58 26 220 142
New Jersey............... 99 69 462 412 Montana................... 2 0 2 0
Idaho.................... 1 0 1 1
EAST NORTH CENTRAL........ 162 120 817 688 Wyoming.................. 0 0 5 0
Ohio..................... 34 28 162 122 Colorado ................. 5 6 20 23
Indiana .................. 5 1 22 26 New Mexico............... 15 2 51 23
Downstate Illinois....... 8 11 51 64 Arizona ................. .. 23 15 101 73
Chicago................... 72 64 370 340 Utah..................... 1 0 10 2
Michigan.................. 35 12 183 114 Nevada.................... 11 3 30 20
Wisconsin................ 8 4 29 22
PACIFIC................... 209 137 943 686
WEST NORTH CENTRAL........ 35 21 194 133 Washington............... 3 3 57 13
Minnesota.................. 5 3 32 18 Oregon..................... 6 7 20 24
Iowa..................... 2 0 17 3 California............... 195 126 853 642
Missouri................. 17 13 79 68 Alaska................... i 0 3 2
North Dakota............. 1 0 4 1 Hawaii................... 4 1 10 5
South Dakota............. 2 3 9 18
Nebraska................. 4 0 25 4 U. S. TOTAL ............... 1,952 1,484 9,198 7,998
Kansas................... 4 2 28 21
TERRITORIES............... 90 32 325 169
SOUTH ATLANTIC............ 524 484 2,527 2,358 Puerto Rico............... 88 32 317 162
Delaware................. 1 4 19 21 Virgin Islands............ 2 0 8 7
Maryland................. 59 41 225 218
District of Columbia..... 48 50 297 286
Virginia................. 18 48 122 212
West Virginia............ 4 1 22 12
North Carolina........... 80 54 373 256 Note: Cumulative Totals include revised and delayed reports
South Carolina........... 63 80 280 327 through previous months.
Georgia...............6... 69 73 418 383
Florida.................. 182 133 771 643


EPIDEMIOLOGICAL REPORTS


Trichinosis Wisconsin
During late March and April of 1963 an epidemic of
trichinosis occurred in southeastern Wisconsin. Investi-
gations by local and State health officials disclosed that
all affected persons had consumed summer sausage from
a single lot of sausage made at a local market (Market A)
during the week March 16-23, and sold between March 23
and April 15. Part of the pork used in the sausage was
from a local farm. "Pork trimmings" from hogs slaughtered
on March 8, 11, or 12, used in the sausage were obtained
from a plant in another city.
In early May, investigations were conducted to de-
termine the extent of the outbreak. All physicians in the
county were asked to report cases of trichinosis-like ill-
ness. Histories were obtained and skin tests performed on
reported cases and other family members when possible.


A total of 75 persons in 26 family units were interviewed
and skin tested.
Characteristic symptoms of the illness included
muscle pain, eye and facial edema, fever, gastro-intestinal
symptoms, and occasionally dizziness. Cases were con-
sidered as compatible with trichinosis who had both
muscle pain and edema, with or without other symptoms.
Cases not meeting these criteria but having at least one
of the symptoms were considered questionable. Twenty-
eight of the 75 had illnesses compatible with trichinosis,
30 were questionable, and 17 had no illness. The range of
incubation periods was calculated as being from 3-13
days. Two patients required hospitalization. The epidemic
curve is shown in the accompanying figure.
Skin testing with trichinella antigen prepared at the
Communicable Disease Center was performed on each of
the 75 people interviewed. Ninety-six percent of those
diagnosed as having an illness compatible with trichi-








Morbidity and Mortality Weekly Report


TRICHINOSIS CASES BY DATE OF
WISCONSIN-APRIL, 1963


6
O5-

2-

26 I 5 ^ 10 15
March April


nosis had a positive skin test, while 6
with a questionable diagnosis of trich
cent of those without record of illness
of the outbreak had positive skin tes
antigen, as shown in the table below.
SKIN TEST RESULTS WITH TRICHINEL
WISCONSIN MAY 1963

Number of Nu
Persons Po
Compatible illness 28
Questionable illness 30
No illness 17
Total 75


ONSET in a woman from another city, who developed diarrhea,
fever, and muscle pain on March 8, followed by periorbital
and facial edema beginning on March 15. Although she
~g=OesiaobleCose denied ingestion of summer sausage and rarely are pork of
O-comafibe case any kind, she had on occasion purchased meat from the
same meat market used by the two patients mentioned just
above. Her skin test was positive to trichinella antigen.
All of the suspect lot of sausage had been sold prior
20' 2! 2 30 to recognition of the epidemic. Examination of two small
samples, provided by two of the cases, at the State Lab-
oratory of Hygiene and at the Central Animal Diagnostic

3 percent of those Laboratory gave negative results for viable trichinae. Con-
inosis and 23 per- tinuing studies of these specimens are in process. Blood
during the period sera obtained from 73 of the 75 persons seen are being
ts with trichinella processed; however, results of the bentonite flocculation
and C.F. tests are not yet available. Continuing investi-
gations are underway to determine the source of trichina-
L-LA ANTIGEN
infected hogs.
(Reported by Dr. M. F Ries, Health Officer, Brownsville, Wis-
mber Percent consin; Dr. Joseph Preizler, State Epidemiologist, Wisconsin
sitive Positive State Board of Health; Dr. A. A. Erdmann, Chief Veterinarian,
27 96 State-Federal Cooperative Animal Disease Eradication Program,
19 63 Wisconsin; Parasitology Unit, Laboratory Branch, Communi-
4 23 Disease Center; and a team from the Communicable Disease
50 67 Center.)


All but three of the patients with illnesses compatible
with trichinosis had eaten summer sausage obtained from
Market A between March 23 and April 15, including the
proprietor (onset May 26) who had sampled the sausage
during its preparation. Two of the individuals, a married
couple from a nearby town who did not eat sausage from
Market A, had eaten sausage obtained the last week of
March from a market in another city which used pork
trimmings from the same plant as those obtained by Mar-
ket A. Onsets of illness, with muscle pain, periorbital
edema and diarrhea were on April 10 and 14 in these two
persons; both had positive skin tests. The third case not
related to Market A, and not shown in the figure, occurred


INTERNATIONAL NOTES

Smallpox Sweden

Two additional cases of smallpox were identified
in Stockholm last week bringing to 21 the total number of
cases in the current outbreak. Unique circumstances in-
volving these last two persons, neither of whom were
under surveillance as contacts at the time of their detec-
tion, indicates that the outbreak may perhaps be expected
to continue.
Information made available by Dr. Bo Zetterberg,
Chief, Epidemiology Division, State Bacteriology Lab-
(Continued on page 196)


INFANT DEATHS IN 108 CITIES

The weekly average number of infant deaths in 108 cities
for the four-week period ending June 8 was 746 as com-
pared with an expected weekly average of 726.




TOTAL DEATHS UNDER ONE YEAR OF AGE IN 108 CITIES


(See table, page 195)


DEATHS UNDER ONE YEAR OF AGE IN 108 U.S. CITIES
Average number per week by four-week periods


1. i .Ij t t1960j i Ii "196i i I t___ t t19621


I 1963









'92 Morbidity and Mortality weekly Report


Table i. CASIS OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 8, 1963 AND JUNE 9, 1962


Poliomyelitis, Aseptic
Poliomyelitis, total cases Poliomyelitis, paralytic nonparalytic Meningitis
Cumulative Cumulative
Area
23rd week First 23 weeks 23rd week First 23 weeks 23rd week 23rd week

1963 1962 1963 1962 1963 1962 1963 1962 1963 1962 1963 1962

UNITED STATES...... 5 6 61 158 4 6 52 121 41 68

NEW ENGLAND.............. 1 1 1
Maine ................
New Hampshire........ -
Vermont ............... .
Massachusetts......... -
Rhode Island......... -. 1 -
Connecticut........... 1 1

MIDDLE ATLANTIC............. 8 33 6 20 2 2
New York............... 4 32 4 19 2 1
New Jersey............. 1 1 1 1-
Pennsylvania 3 -1 1

EAST NORTH CENTRAL....... 1 15 10 11 6 9 5
Ohii.................... 4 4 3 4 -
Indiana............... 1 2 3 2 1
Illinois.............. 6 2 5 1 3
Michigan.............. .- 2 2 7 1
Wisconsin.............. I 1 -1 1

WEST NORTH CENTRAL ...... 1 3 7 1 3 4 4 3
Minnesota.............. 1I 2 1 1 2 1 3 3
Iowa.................. 3 2
Missouri.............. 1 3 1 1 1
North Dakota.......... -
South Dakota.......... .- -
Nebraska.............. -
Kansas,................ -

SOUTH ATLANTIC........... 1 7 11 1 6 9 5 44
Delaware. ............. -.
Maryland.............. .
District of Columbia.. -
Virginia .............. 1 2 1 2
West Virginia.......... 1 1 1 1 -
North Carolina......... 2 2 2 2
South Carolina........ -
Georgia .............. 1 2 2
Florida............... 2 4 2 3 5 43

EAST SOUTH CENTRAL....... 3 5 2 3 2
Kentucky.............. 2 2
Tennessee ............. 1 2 -
Alabama ............... 2 1 1 2
Mississippi........... -

WEST SOUTH CENTRAL ....... 5 14 67 5 14 58 2
Arkansas............... 1 1
Louisiana............. 12 5 -12 5 -
Oklahoma.............. 1 1
Texas................. 5 2 60 5 2 52 I -

MOUNTAIN.................... 1 8 1 7 3 3
Montana.............. .. 3 1 2
Idaho .................
Wyoming................ 1 1
Colorado...............
New Mexico...........
Arizona ...............- -
Utah...................
Nevada..................

PAC *IC.................. 2 11 16 2 10 13 13 11
Washington ............
Oregon...... ...... 1 1 1 1 1
California............ 2 10 15 2 9 12 12 10
Alaska...............
Hao Rio.............. -

Puerto Rico ................ 3 6 3 6








Morbidity and Mortality Weekly Report 193


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 8, 1963 AND JUNE 9, 1962 (Continued)


Brucellosis Diphtheria Encephalitis, Hepatitis, Measles
infectious infectious and serum
Area
Cumu- Cumu- 23rd week
lative lative Under 20 &
23rd week 23 weeks 23rd week 23 weeks 23rd week 20 yr. over Total 23rd week
1963 1963 1963 1963 1963 1962 1963 1963 1963 1962 1963 1962
UNITED STATES...... 3 148 8 120 39 31 351 291 688 978 14,143 16,195

NEW ENGLAND............... 4 3 2 32 20 55 60 575 2,298
Maine................. 15 4 19 27 33 336
New Hampshire ......... 2 2 4 4 64
Vermont................ 1 69 208
Massachusetts......... 2 1 10 12 24 19 241 874
Rhode Island.......... 2 2 1 1 2 57 150
Connecticut........... 1 5 2 7 7 175 666

MIDDLE ATIANTIC.......... 4 1 20 7 4 70 68 138 189 2,504 3,553
New York.............. 3 13 4 2 48 43 91 111 1,063 1,557
New Jersey............ 1 2 5 10 15 22 716 1,679
Pennsylvania ......... 1 5 3 2 17 15 32 56 725 317

EAST NORTH CENTRAL....... 10 11 4 4 67 50 124 179 5,217 2,972
Ohio.................. .- 1 1 1 13 11 24 55 825 388
Indiana................ 1 3 9 3 16 24 106 233
Illinois.............. 8 3 1 16 15 33 50 387 831
Michigan............. 1 3 3 2 29 18 47 46 2,300 1,121
Wisconsin............. 1 3 4 4 1,599 399

WEST NORTH CENTRAL....... 3 105 3 35 1 21 21 50 36 665 717
Minnesota............. 7 15 1 6 10 9 44 89
Iowa................. 1 76 1 7 3 15 10 405 469
Missouri.............. 4 1- 1 9 8 17 7 103 31
North Dakota... *........ 1 1 1 1 100 115
South Dakota.......... 2 7 9 1 1 1 4 1 11
Nebraska.............. 5 3 8 12 2
Kansas................ 6 4 2 6 5 NN NN

SOUTH ATLANTIC........... 4 2 23 11 5 27 26 58 125 1,135 771
Delaware.............. 1 1 2 1 15 19
Maryland.............. 1 3 5 3 8 18 108 130
District of Columbia.. 1 1 3 2 5
Virginia .............. 2 3 5 11 18 255 242
West Virginia......... 1 5 4 10 23 378 205
North Carolina......... 1 1 1 2 4 5 9 40 58 15
South Carolina........ 2 6 1 1 3 134 36
Georgia............... 7 1 1 6 -
Florida............... 1 8 9 7 7 15 13 185 119

EAST SOUTH CENTRAL....... 4 9 2 1 30 19 50 124 846 812
Kentucky............. 9 8 18 62 565 192
Tennessee............. 3 2 1 10 8 18 26 239 500
Alabama.............. 1 7 5 2 7 24 17 75
Mississippi........... 1 1 6 1 7 12 25 45

WEST SOUTH CENTRAL....... 10 2 15 2 32 17 50 77 542 1,234
Arkansas.............. 3 1 5 5 16 5 115
Louisiana.............. 2 6 2 8 10 2 4
Oklahoma.............. 2 5 2 2 5 1 5 38
Texas................. 5 2 7 2 19 13 32 50 530 1,077

MOUNTAIN ................ 4 1 2 10 6 36 58 1,201 1,426
Montana.............. ... 3 5 8 6 66 157
Idaho............. .... 3 6 154 26
Wyoming.............. 1 4 7 169
Colorado............... 3 7 15 293 447
New Mexico............ .- 1 4 4 6 NN NN
Arizona............... 2 1 13 15 575 442
Utah.................. 1 1I 1 1 6 88 164
Nevada ................ 18 21

PACIFIC ................... 7 2 12 10 62 64 127 130 1,458 2,412
Washington............ 1 14 9 24 18 158 634
Orego ................ 2 10 9 19 19 605
California............ 4 2 12 9 37 45 82 90 1,175 952
Alaska................ 3 24 61
Hawaii. ............... 1 1 1 2 101 160

Puerto Rico.............. 9 18 3 21 19 12 97








191 Morbidity and Mortality Weekly Report


Tablc 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 8, 1963 AND JUNE 9, 1962 (Continued)


Area


Mrni'E~- ral Streptococcal Tickborne
'... i L Sore Throat & Tetanus Typhus Tularemia Typhoid Fever Rabies in Animals
Scarlet Fever (Rcky Mt.
Cumu- Spotted) Cumu- Cumu-
lative lative lative
23rd wk. 23 weeks 23rd week 23rd wk. 23rd wk. 23rd wk. 23rd wk. t23 weeks 23rd week 23 weeks


~


1963 1963 1963 1962 1963 1963 1963 1963 1963 1963 1962 1963

UNITED STATES.... 40 1,307 5,764 4,977 4 11 7 6 155 68 73 1,799

NEW ENGLAND......... 3 82 682 407 6 18
Maine.............. 1 14 69 9 1
New Hampshire...... 2 9 12
Vermont............ 1 3 17 9 1 5
Massachusetts...... 37 83 86 4 -
Rhode Island ...... 1 8 46 35 -
Connecticut........ 18 458 268 1 -

MIDDLE ATLANTIC..... 7 183 384 256 2 2 20 2 1 47
New York........... 76 276 146 14 2 1 35
New Jersey......... 26 65 47 I -
Pennsylvania....... 7 81 43 63 2 2 5 12

EAST NORTH CENTRAL.. 6 209 745 445 8 5 14 272
Ohio............... 1 60 92 21 2 4 9 161
Indiana ........... 1 25 63 86 1 3 30
Illinois........... 3 31 153 137 3 1 39
Michigan........... 1 67 311 91 1 1 26
Wisconsin.......... 26 126 110 1 1 16

WEST NORTH CENTRAL.. 5 80 154 114 1 1 9 27 16 430
Minnesota........... 3 16 15 7 3 7 7 114
Iowa................ 4 59 42 1 9 5 156
Missouri........... 1 28 3 1 1 1 5 5 1 79
North Dakota....... 1 4 69 45 1 2 13
South Dakota....... 4 6 1 4 53
Nebraska........... 19 1 1 7
Kansas.............. 5 2 18 8

SOUTH ATLANTIC ..... 4 236 595 351 1 3 1 1 32 10 5 288
Delaware.......... 2 5 5 1 -
Maryland............ 1 38 13 30 I 3 -
Dist. of Columbia.. 4 -
Virginia........... 1 59 135 89 4 4 106
West Virginia...... 13 125 63 5 3 2 85
North Carolina..... 39 60 6 1 2 1 5 4
South Carolina..... 13 30 64 1 2 6
Georgia............. 12 2 1 34
Florida............. 2 56 227 94 10 2 3 53

EAST SOUTH CENTRAL.. 4 104 939 695 2 2 1 14 7 10 153
Kentucky ........... 1 22 183 57 1 2 3 73
Tennessee.......... 45 664 604 2 1 9 5 3 68
Alabama............. 3 21 17 6 2 4 4 12
Mississippi........ 16 75 28 -

WEST SOUTH CENTRAL.. 2 137 522 502 1 1 4 1 28 7 19 370
Arkansas........... 8 2 4 1 14 1 1 24
Louisiana.......... 1 56 1 1 5 1 35
Oklahoma........... 27 12 13 1 2 2 32
Texas............... 1 46 509 487 7 6 15 279

MOUNTAIN............ 42 951 942 2 2 2 1 39
Montana............. 3 27 21 -
Idaho.............. 3 70 108 -
Wyoming............. 1 25 31 -
Colorado........... 11 365 279 2 1 -
New Mexico......... 3 232 217 1 21
Arizona............ 7 124 182 2 1 18
Utah............... 11 107 103 -
Nevada............. 3 1 1 -

PACIFIC............. 9 234 792 1,265 1 1 36 8 7 182
Washington........ 1 17 180 318 -
Oregon............. 1 14 13 24 2 1
California......... 6 192 509 873 1 1 31 8 7 172
Alaska............. 5 47 4 1 9
Hawaii............. 1 6 43 46 -- 2 -
Puerto Rico......... 4 13 7 8 6









Morbidity and Mortality Weekly Report 195





Table 4 (C). TOTAL DEATHS UNDER 1 YEAR OF AGE IN REPORTING CITIES



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


For weeks ending For weeks ending
Area 1 /2 6/8 Area 5/ 5/25 6 1
5/18 5/25 6/1 6/8 5/18 5/25 6/1 6/8


NEW ENGLAND:
Boston, Mass.............. 18 6 21 20
Bridgeport, Conn.......... 0 3 2 3
Cambridge, Mass........... 2 0 0 1
Fall River, Mass.......... 4 1 1 1
Hartford, Conn............ 3 6 3 5
Lowell, Mass............... 4 2 2 1
Lynn, Mass................. 0 0 0 0
New Bedford, Mass......... 1 2 1 3
New Haven, Conn........... 12 2 4 7
Providence, R.I........... 3 2 7 3
Somerville, Mass.......... 0 1 0 0
Springfield, Mass.......... 1 3 2 1
Waterbury, Conn............ 2 3 1 2
Worcester, Mass............ 5 5 3 4

MIDDLE ATLANTIC:
Albany, N.Y................ 3 3 2 1
Allentown, Pa............. 1 1 1 4
Buffalo, N.Y.............. 10 14 4 13
Camden, N.J............... 4 10 3 4
Elizabeth, N.J........... 3 2 4 0
Erie, Pa.................. 2 3 2 2
Jersey City, N.J..;....... 3 2 5 5
Newark, N.J............... 9 25 4 6
New York City, N.Y......... 78 82 66 76
Paterson, N.J............. 3 4 3 7
Philadelphia, Pa.......... 29 19 39 20
Pittsburgh, Pa............ 7 10 13 20
Reading, Pa............... 1 4 1 0
Rochester, N.Y............. 5 2 4 10
Schenectady, N.Y.......... 1 0 3 2
Scranton, Pa.............. 2 0 1 1
Syracuse, N.Y.............. 2 4 4 1
Trenton, N.J.............. 2 2 4 1
Utica, N.Y................. 0 1 0 0
Yonkers, N.Y............... 2 3 1 0

EAST NORTH CENTRAL:
.Akron, Ohio............... 5 4 5 3
Canton, Ohio............... 1 4 2 2
Chicago, Ill.............. 41 43 36 58
Cincinnati, Ohio.......... 10 14 10 15
Cleveland, Ohio............ 11 15 15 10
Columbus, Ohio............ 8 13 7 9
Dayton, Ohio.............. 3 3 2 6*
Detroit, Mich............. 32 20 16 26
Evansville, Ind........... 1 2 2 1
Flint, Mich.................... 1 1 4 5
Fort Wayne, Ind........... 4 7 2 2
Gary, Ind................. 1 6 4 4*
Grand Rapids, Mich........ 1 1 3 4
Indianapolis, Ind......... 15 10 8 16
Madison, Wis............. 4 4 5 2
Milwaukee, Wis.............. 5 8 10 11
Peoria, Ill............... 2 1 0 3
Rockford, Ill............. 3 2 1 2
South Bend, Ind........... 2 3 3 2
Toledo, Ohio.............. 1 5 4 7
Youngstown, Ohio........... 2 6 1 1

WEST NORTH CENTRAL:
Des Moines, Iowa........... 2 2 1 1
Duluth, Minn.............. 2 1 3 0
Kansas City, Kans.......... 5 4 3 3
Kansas City, Mo............ 8 3 4 9
Lincoln, Nebr.............. 2 2 4 4
Minneapolis, Minn.......... 8 9 3 20
Omaha, Nebr................ 5 9 5 4
St. Louis., Mo.............. 18 16 15 13
St. Paul, Minn............ 1 3 6 4
Wichita, Kans.............. 3 5 1 1

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

NOTE: All deaths by place of occurrence.


SOUTH ATLANTIC:
Atlanta, Ga.............. 14 13 3 12
Baltimore, Md............. 24 24 8 30
Charlotte, N.C........... 3 3 7 5
Jacksonville, Fla........ 6 6 11 7
Miami, Fla............... 2 2 6 5
Norfolk, Va.............. 1 3 1 3
Richmond, Va.............. 7 5 4 24
Savannah, Ga.............. 6 2 2 5
St. Petersburg, Fla...... 3 4 0 1
Tampa, Fla................ 3 6 6 4
Washington, D.C.......... 6 23 37 6
Wilmington, Del.......... 1 0 0 0

EAST SOUTH CENTRAL:
Birmingham, Ala.......... 3 16 3 9
Chattanooga, Tenn......... 2 1 4 2
Knoxville, Tenn.......... 1 1 3 0
Louisville, Ky............ 16 13 8 6
Memphis, Tenn............. 9 15 11 12
Mobile, Ala............... 8 7 5 2
Montgomery, Ala........... 1 1 6 3
Nashville, Tenn........... 7 4 1 2

WEST SOUTH CENTRAL:
Austin, Tex............. 5 3 0 0
Baton Rouge, La.......... 6 2 1 3
Corpus Christi, Tex...... 3 3 2 4
Dallas, Tex............. 13 19 18 10
El Paso, Tex.............. 9 8 11 6
Fort Worth, Tex.......... 7 6 6 5
Houston, Tex.............. 7 14 19 15
Little Rock, Ark......... 4 6 18 3
New Orleans, La.......... 17 15 26 15
Oklahoma City, Okla...... 7 3 8 7
San Antonio, Tex.......... 10 6 7 11
Shreveport, La........... 3 3 12 1
Tulsa, Okla.............. 3 0 5 4

MOUNTAIN:
Albuquerque, N. Mex...... 3 2 4 2
Colorado Springs, Colo... 3 1 0 2
Denver, Colo.............. 5 8 5 6
Ogden, Utah.............. 1 1 0 3
Phoenix, Ariz............. 8 1 4 11
Pueblo, Colo............. 0 3 3 0
Salt Lake City, Utah..... 4 5 5 4
Tucson, Ariz.............. 2 1 4 4

PACIFIC:
Berkeley, Calif.......... 1 2 3 0
Fresno, Calif............ 4 5 4 2
Glendale, Calif .......... 1 0 0 0
Honolulu, Hawaii.......... 8 3 5 3
Long Beach, Calif........ 3 3 2 9
Los Angeles, Calif....... 25 39 25 31
Oakland, Calif........... 8 3 2 6
Pasadena, Calif.......... 2 2 1 1
Portland, Oreg............ 4 4 7 8
Sacramento, Calif........ 3 0 7 3
San Diego, Calif......... 7 6 8 9
San Francisco, Calif ..... 1 6 9 12
San Jose, Calif.......... 3 7 4 9
Seattle, Wash........... 8 5 9 9
Spokane, Wash............ 3 4 1 1
Tacoma, Wash.............. 0 6 3 2

San Juan, P.R.............. 2 0 4 2


OCurrent Week Mortality for 108 Selected Cities

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


11,902
392
787
6,538




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3 1262 08864 1252


Morbidity and Mortality Weekly Report


oratory, Stockholm, indicates that on June 6 an 85-year-old
woman, who lives with her daughter, went to a hospital
out-patient department for routine follow-up of a chronic
medical problem. The daughter called in advance inform-
ing clinic personnel that the elderly woman had developed
a rash. On arrival at the out-patient clinic, the mother
spent some time in the general waiting room and was then
referred to the dermatology clinic, and again spent some
time in the dermatology waiting room. When seen by phy-
sicians, a clinical diagnosis of smallpox was made. In
all, she had spent some four hours at the hospital and
presumably exposed some 450 persons in the two crowded
waiting rooms. It was noted that on May 28 she had de-
veloped a low-grade fever with dizziness, followed by
the appearance of rash on June 2.
She and her 54-year-old daughter share an apartment
in a boarding house for women housing some 100 occu-
pants. The daughter works as a mortician and on April 26
had prepared the body of smallpox Case 2 of the outbreak
for cremation. She had been placed under surveillance as
a contact and 16 days after her exposure to the dead
woman, having had no symptoms or signs of illness, she
was released from quarantine. She denied any evidence of
illness since being released from surveillance. The total
elapsed time from her contact with the body of Case 2 and
the onset of disease in her mother was 32 days, con-
sistent with two incubation periods of smallpox. Except
for the daughter's exposure, no epidemiologic evidence
could be found linking the mother with a source of small-
pox. Neither the mother nor daughter had been vaccinated
since childhood. The daughter demonstrated a high HAI
titer on June 6, suggesting a recent infection, and in the
absence of an alternative explanation, it may be pre-
sumed that the daughter developed a sub-clinical in-
fection and transmitted virus to her mother. Two very
unusual aspects of smallpox transmission seem apparent.
The daughter, unvaccinated since childhood and exposed
to hemorrhagic smallpox, developed an infection so mild
as to produce no symptoms, yet developed serologic evi-
dence of infection. Despite the presumed absence of any
rash or systemic manifestations of disease, she was ap-
parently able to transmit the illness to her mother.
The inadvertent exposure of the mother during her
eruptive stage to some 450 persons at the hospital, as
well as possible contacts in the boarding house, estab-
lishes an additional large group of contacts in which
cases may yet occur.
An epidemic curve for the outbreak to date is pre-
sented showing the chronologic relationship of the gener-
ations of transmission. Using the median date in the span
of onset dates for each generation, it is apparent that the
median incubation periods for all generations are
strikingly similar.


SMALLPOX ISTOCTIOU
EPIDEMIC CURVE BASED ON DATE O ONSET OF ILLNESS
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