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:
AA00010654:00101

Related Items

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

Full Text
F 6o/9.' # a/ao


Morbidity and Mortality



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

PUBLIC HEALTH SERVICE


Prepared by the


634-7131


For release May 24, 1963


ATLANTA 22, GEORGIA


PROVISIONAL INFORMATION ON SELECTED NOTIFIABLE DISEASES IN THE
DEATHS IN SELECTED CITIES FOR WEEK ENDED MAY 18, 1961


BRUCELLOSIS The incidence of human brucellosis
cases in the United States thus far during 1963 continues
the decline noted since 1947. Through the 20th week,
131 cases have been reported; notably 69, over fifty per-
cent of these, have been recorded in Iowa.
Cumulative cases for the first 20 weeks for 1959-
1963 in the United States and for Iowa alone, and total
U. S. cases for the years 1959-1962 are shown in the
table below.

Cases Through
20th Week 1963 1962 1961 1960 1959
United States 131 148 213 332 290
Iowa 69 37 77 187 79

Annual Total -
United States 412* 636 751 892


EPIDEMIOLOGICAL R TS .j
Shigellosis Washingto
An outbreak of shige s recognid town
in southwestern Washingto n, n y absen
teeism rose sharply in three o element
schools on February 1, 1963 (Fig. 1). There was no s
nificant change in the number of absentees at other
schools in the vicinity.
Following recognition of the outbreak, an extensive
case study was conducted on children absent on Friday,
February 1, from the three schools. Twenty (71 percent)
of 28 stool cultures obtained from suspect cases were
positive for Shigella sonnei. Subsequently, 89 percent of
those families with children absent on February 1 were
interviewed by telephone, or in person, four days and
again three weeks after the acute illness. A 10 percent


Table 1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous week)
20th Week Cumulative
Ended Ended First 20 weeks
Disease Median
May 18, May 19, 1958 1962 Median
1963 1962 1963 1962 1958 1962
Aseptic meningitis................ 36 22 --- 443 375 ---
Brucellosis ..................... 8 8 16 131 148 272
Diphtheria ...................... 3 7 7 109 190 286
Encephalitis, infectious .......... 31 25 28 566 564 564
Hepatitis, infectious and serum... 759 1,023 930 19,578 26,266 15,559
Measles ........................ 16,204 20,601 15,376 263,473 333,933 283,157
Meningococcal infections ......... 50 44 44 1,173 984 1,099
Poliomyelitis, total.............. 2 8 18 50 123 299
Paralytic.................... 2 8 14 45 92 215
Nonparalytic................. 2 2 15 52
Unspecified.................. 2 3 16 32
Streptococcal sore throat
and Scarlet fever ............ 7,069 6,773 --- 183,904 167,243
Tetanus ........................ 3 7 --- 75 60
Tularemia ...................... 2 3 -- 72 92
Typhoid fever ................. .. 5 13 13 136 159 206
Typhus fever, tick-borne,
(Rocky Mountain spotted)...... 5 5 --- 12 19
Rabies in Animals ............... 102 100 68 1,587 1,723 1,646

Table 2. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: 1 Psittacosis: Oreg.-1 25
Botulism: 5 Rabies in Man:
Malaria: N.Y.-1, Pa.-l, Iowa-1, Calif.-2 39 Smallpox:
Plague: Typhus, murine: 3


.--


r CM NIALEDSES CNE










Morbidity and Mortality Weekly Report


FIGURE I
PERCENT ABSENTEEISM
SIX ELEMENTARY SCHOOLS
January-February 1963


I-
S OTHER ELEMENTARY SCHOOLS
10-


u O ,
z
1 25 30 I 5
u JAN FEB


sample of those present in school on February 1 was con-
tacted in addition. By these means, a total of 137 primary
cases in school children and 105 secondary cases in
their families have been discovered to date. The epidemic
curves for cases from the three schools are shown in
Figure 2.

FIGURE II
CASES OF SHIGELLOSIS BY DATE OF ONSET
THREE ELEMENTARY SCHOOLS
January-Februory 1963


SCHOOL A.


SCHOOL B.


JAN FEB 4 21
0.


01

o0 SCHOOL C




J0 F
JAN 7 FEB 14 21


The abrupt peak of cases in the three schools on
January 31 suggested a common source exposure. A
school lunch seemed to be the most probable source.
School lunches served at the three affected schools
(A, B, and C) are prepared at school B and distributed to
the other two schools. Secondary cases, in families of
primary cases, occurred as early as February 4.

A significant difference in attack rates was found
between those children who customarily eat lunch at the
school and those who do not eat lunch, as shown in the
table below:


Total No. No. III


Percent Attack Rote


School A Ate Lunch 91 45 50
Did not eat
Lunch 103 10 10

School B Ate Lunch 122 56 46
Did not eot
Lunch 90 2 2

School C Ate Lunch 33 23 70
Did not eat
Lunch 46 1 2

Total Ate Lunch 246 124 50
Did not eot
Lunch 239 13 5



The clinical illness was characterized by abrupt
onset with high fever, diarrhea, vomiting and severe
abdominal cramps. Most children recovered in 3-5 days,
but a small number of cases have had repeated bouts of
diarrhea after 1-3 days of -.II-hc.l. The table below
shows the frequency of symptoms in 75 cases where this
information was obtained:


Symptom No. With Symptom Percent With Symptom

Abdominal cramps 68 91
Diarrhea 71 95
Fever 64 85
Nousea 52 69
Headache 51 68
Chills 41 54
Vomiting 38 51
Muscle Aching 23 31
Bloody stool 10 13


The three food handlers at School B were cultured
10 days after onset of the epidemic. Two had negative
cultures. The third, whose culture was positive for
S. .. sonnei, had not eaten any of the lunches and
denied having clinical symptoms of gastroenteritis. This
food handler did not assist in the preparation of the meals,
but only transported prepared food from the kitchen to one
of the three schools.
Although no single food item or source of contami-
nation could be implicated with certainty, the epidemic
curve with the abrupt onset and the high attack rates for









Morbidity and Mortality Weekly Report


those students eating school lunches indicate that this
was a common source, food-borne outbreak.
(Reported by Dr. E. A. Ager, Head, Communicable Dis-
ease Control, and Dr. IV. R. Giedt, Acting Head of Labora-
tories, Washington State Department of Health; and a team
from the Communicable Disease Center.)



Salmonella Derby Infections in Hospitals
The interstate hospital-associated outbreak of
Salmonella derby infections (See MMWR, Vol. 12, p. 159)
appears to be subsiding, with the onset of the last known
primary case on May 10. Cases have been investigated
and identified as hospital-acquired in 14 hospitals in 5
States, and are tabulated below. A total of 64 cases are
clearly related to hospitalization. There have been three
deaths among these patients.


S. DERBY PRIMARY CASES


Hospital-Associated Date of
Hospital Cases Onset Deaths
NEW YORK
1 6 3/16-3/29 0
2 3 4/20-4/26 0
3 6 4/14-5/2 1
4 2 3/25-4/2 0
5 7 3/10-5/10. 0
6 6 4/21-5/6 0
7 2 4/7-4/26 0
NEW JERSEY
8 1 4/13 0
INDIANA
9 1 4/10 0
PENNSYLVANIA
10 3 4/11-5/1 1
11 4 4/16-4/21 0
12 1 5/8 0
13 21 3/3-4/22 1
CONNECTICUT
14 1 5/2 0

TOTAL 64 3


To date in 1963, 128 other isolations of S. derby have
been reported to the Salmonella Surveillance Unit of the
CDC. Seventy-nine of these have been investigated and
are probably not hospital-associated cases. The remain-
ing 49 isolations are being investigated.
In one of the hospitals, secondary cases have con-
tinued to occur among patients. A total of 77 isolations
have now been reported from 51 cases and 26 asympto-
matic carriers, with approximately 60 percent from patients
admitted for diseases other than gastroenteritis. The re-
maining 40 percent has been reported from the staff
personnel.
Non-human isolations of S. derby have been made
primarily from poultry and swine during the past year.
There has been no significant change in this pattern
during the recent months.
Investigations are continuing in an attempt to identify
a vehicle common to these 14 hospitals.
(Reported by Dr. Harold Fuerst, New York City Health
Department; Dr. Robert Albrecht, New York State Depart-
ment of Health; Dr. Sylvan Fish, Philadelphia Department
of Public Health; Dr. Wm. Schrack, Pennsylvania State
Department of Health; Dr. Wm. J. Dougherty, New Jersey
State Department of Health; Dr. A. L. Marshall, Jr., In-
diana State Department of Health; Dr. Mila E. Rindge,
Connecticut State Department of Health; other State Pub-
lic Health personnel; and teams from the Communicable
Disease Center.)


Equine Influenza Follow-up Report

Reports of equine influenza (See MMWR, Vol. 12,
Page 157) continued to come in from Illinois, Michigan,
Ohio, Pennsylvania, New York and Massachusetts during
the past week. The disease still has not been reported
West of the Mississippi River. Most of the new cases are
being seen in horses that have not been racing pre-
viously, and the disease is also being seen at horse
shows. There is no evidence of transmission of the in-
fection to man although this is still under investigation.
(Continued on page 172)


SUMMARY OF DEATHS AMONG PERSONS 65 YEARS
AND OVER IN 108 U. S. CITIES

The weekly average number of deaths among persons
65 years and over in 108 cities for the four-week period
ending May 18 was 6,452 as compared with an expected
weekly average of 6,513.




WEEK ENDING
WEEK ENDING 4 Week Weekly

4/27 5/4 5/11 5/18 Total Average
Observed 6,688 6,519 6,366 6,233 25,806 6,452
Expected 6,607 6,545 6,481 6,418 26,051 6,513

Excess 81 -26 -115 -185 -245 -61


ecoo- ~--



NUMBER 7 ET n
7 I -wns'-' I
S,000 '
OF
DEATHS


I i Fl -
5.5oo


167


DEATHS AT AGE 65 AND OVER IN 108 U S CITIES
Average number per week by for-week periods


(See table, page 171)


.,.,,...,. T~"mmT~"rrm""~'T~i"~r"iTTrT~m? ~r;
1960 i 1961 1 (962
anaa*ru~lxr


(e talepae1 )


i
----i







1961


8.500











168 Mlorbidit and Mlorlalit W r eckly Reporl



Table i CASIS 01 SPE( IFII) NOTIFIABLE )DISI ASI.S: NITE) STATES

FOR WEIKS FNDEI)

MAY 18. 1963 AND MAY 19, 1962



Poliomyelitis, Aseptic
Poliomyelitis, total cases Poliomyelitis, paralytic nonparalytic Meningitis
Cumulative Cumulative
Area
20th week First 20 weeks 20th week First 20 weeks 20th week 20th week

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


UNIITED STATES...... 2 8 50 123 2 8 45 92 36 22

NEW ENGLAND .............. 1 1
Maine ...................
Nv Hampshire ......... 1
Vernt .............
Massachusetts.........
Rhode Island.........
Co necticut ........ .... -

MIDDLE ATLANTIC.......... 6 30 6 17 1 2
New York.............. 4 30 4 17 1
New Jersey............ 1 1 -
Pennsylvania 1 I 2

EAST NORTH CENTRAL........ 1 13 10 1 11 6 5 2
Ohi ................... 4 4 3 4 1
Indiana ............... 1 3 2 -
Illinois.............. 5 2 5 1 1
Michigan.............. 2 2 4
Wisconsin............. 1 1 1 1

WEST NORTH CENTRAL....... 1 7 1 4 1 1
Minnesota............. 1 I1 1
Iowa................. 3 2 1
Missouri.............. 1 3 1 1
North Dakota.......... -
South Dakota..........
Nebraska .. .......
Kansas................

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

EAST SOUTH CENTRAL........ 3 3 2 2 6 3
Kentuck............... 1 1 5 2
Tennes see ..... ... .... 1 1 1 -
Alabama ............... 2 1 1 1
Missisippi............. 1

WEST SOUTH CENTRAL....... 1 5 12 40 1 5 12 36 9 1
Arkansasu............... 1 -
Luisiaa ............. 1 10 5 1 10 5 5
1, ahoa ................ 2
Tx.as................. 5 2 34 5 2 30 7 1

MOUNTAIN................. 6 5 1
Montana ............... 2 -
Idho................
Wyy in,...............
Coi irad..... ...
New Mexi ..........
Arizon: ............... 3 1
iira. c... ............... 1
evada.................. 1 1


PACIFIC.................. 2 9 15 2 8 12 7 7
Orgn ................. 1 1 1 1 -
1 1 1 1 1 1 -
Cali irnni;.............. 1 8 14 1 7 11 7 7
A aska ............... -
t ............... .. ..... 5 5

Pucreit R-1 i..............i 2 5 2 5











Morbidity and Mortality Weekly Report 169


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MAY 18, 1963 AND MAY 19, 1962 (Continued)



Brucellosis Diphtheria Encephalitis, Hepatitis, Measles
infectious infectious and serum
Cumu- Cumu- 20th week
lative lative Under 20 &
20thweek 20 weeks 20th week 20 weeks 20th week 20 yr. over Total 20th week
1963 1963 1963 1963 1963 1962 1963 1963 1963 1962 1963 1962


UNITED STATES...... 8 131 3 109 31 25 370 323 759 1,023 16,204

NEW ENGLAND.............. 4 1 2 35 25 64 55 715
Maine................. 16 6 22 22 22
New Hampshire.......... 4 2 7 7 5
Vermont ............... 57
Massachusetts......... 2 10 12 24 21 248
Rhode Island.......... 2 1 2 1 1 3 64
Connecticut........... 4 4 8 5 319

MIDDLE ATLANTIC.......... 4 19 5 9 56 62 118 187 1,996
New York............... 3 13 2 6 33 41 74 80 759
New 3ersey............ 1 6 9 15 38 711
Pennsylvania .......... 1 5 3 3 17 12 29 69 526

EAST NORTH CENTRAL....... 10 1 11 3 3 79 40 121 189 6,336
Ohio................... 1 1 1 22 9 32 57 621
Indiana............... 1 3 16 5 21 23 320
Illinois.............. 8 3 1 10 9 19 48 580
Michigan .............. 1 3 1 3 30 15 45 57 2,076
Wisconsin............. 1 1 2 4 4 2,739

WEST NORTH CENTRAL....... 7 95 1 31 24 21 55 58 985
Minnesota............. 7 15 4 7 19 80
Iowa.................. 7 69 1 2 2 5 19 529
Missouri.............. 4 1 11 9 22 10 168
North Dakota.......... 1 2 204
South Dakota.......... 4 1 9 4 3 7 2 2
Nebraska.............. 5 4 1 2 7 1 2
Kansas................ 6 2 5 7 5 NN

SOUTH ATLANTIC........... 2 1 20 6 3 49 26 81 174 1,329
Delaware............... 27
Maryland .............. 3 11 2 13 14 100
District of Columbia.. 2 1 1 4 5
Virginia.............. 7 6 19 32 323
West Virginia......... 1 12 7 19 19 612
North Carolina......... 1 1 1 7 7 14 74 66
South Carolina........ 1 4 2 2 128
Georgia................. 6 1 1 5 -
Florida............... 1 8 1 2 9 3 12 26 68

EAST SOUTH CENTRAL....... 3 9 1 37 39 77 107 724
Kentucky.............. 8 7 15 18 323
Tennessee............. 2 2 1 19 12 32 45 335
Alabama............... 1 7 7 6 13 34 52
Mississippi........... 3 14 17 10 14

WEST SOUTH CENTRAL....... 1 9 13 2 26 20 46 76 749
Arkansas............... 1 3 1 2 3 5 11 49
Louisiana............. 2 8 2 10 16 3
Oklahoma.............. 2 5 1 1 1 6 17
Texas................. 4 5 1 16 14 30 43 680

MOUNTAIN ................. 4 1 1 10 12 63 40 1,622
Montana ............... 3 5 9 5 65
Idaho................. 9 1 187
Wyoming................ 1 3 16
Colorado.............. 1 3 23 12 699
New Mexico............ 1 4 2 6 11 NN
Arizona............... 2 12 4 577
Utah.................. 1 1 2 2 4 4 73
Nevada................ 5

PACIFIC .................. 4 1 12 8 54 78 134 137 1,748
Washington............ 1 1 9 18 28 15 211
Oregon................ 1 9 6 16 23 185
California............ 3 1 11 7 33 53 86 94 1,283
Alaska................ 2 2 4 2
Hawaii.................. 1 1 2 1 46

Puerto Rico.............. 1 9 14 5 19 18 1


20,601

2,659
295
43
90
1,023
130
1,078

4,412
2,283
1,711
418

3,283
791
352
756
955
429

1,133
101
851
14
160
3
4
NN

1,181
16
108
36
356
457
50
39
37
119

1,490
133
1,119
134
104

2,153
4
6
37
2,106

1,420
291
35
5
465
NN
338
286


2,870
842
695
1,167
59
107

140










Nlorbidit% and Mlorlalit WNeekly Report


Tahle 4. (CASiS OF SPE(CI.II:D NOTIFIABL DISIASIS. l NITl) STATE

FOR \ I:EKS FNI):I)


MAY 18, 1963 AND MAY 19, 1962 (Continued)


,.,i :T, T .. .. ..,

NEW ENGLAND......... 3
Ma ine.............. -.
New Hampshire...... -
Vermont............
Massachusetts ..... 1
Rhode Island....... 1
Connecticut........ 1

MIDDLE ATLANTIC..... 9
New York...........
New Jersey.......... 2
Pennsylvania....... 7

EAST NORTH CENTRAL.. 7
Ohio................ 2
Indiana ............ 1
Illinois........... 1
Michigan........... 1
Wisconsin.......... 2

WEST NORTH CENTRAL.. 1
Minnesota.......... -
Iowa............... 1
Missouri........... -
North Dakota........
South Dakota........
Nebraska...........
Kansas.............

SOUTH ATLANTIC....... 7
Delaware............
Maryland............ 3
Dist. of Columbia..
Virginia ...........
West Virginia ......
North Carolina..... 4
South Carolina ....
Georgia............
Florida............

EAST SOUTH CENTRAL.. 2
Kentucky...........
Tennessee..........
Alabama............. 2
Mississippi........

WEST SOUTH CENTRAL.. 7
Arkansas.......... 1
Louisiana..........
Oklahoma............ 4
Texas............. 2

MOUNTAIN............
Montana...........
Idaho..............
Wyoming.............
Colorado...........
New Mexico.........
Arizona.............
Utah...............
Nevada............

PACIFIC............. 14
Washington.........
Oregon............ 1
California......... 13
Alaska.............
Hawaii..............
Puerto Rico.........


Infections


Cumu-
lative
20th wk. 20 weeks
1963 1963


77
12
2
2
37
7
17

170
75
25
70

188
54
24
25
61
24

71
12
4
26
3
4
17
5

214
1
33
4
52
12
37
13
11
51

92
20
41
15
16

124
8
49
26
41

40
3
3
1
11
2
6
11
3

197
15
11
161
5
5

4


Ir r 1 i -.,
Sore Throat & Tetanus Typhus Tulare ia Typhoid Fever Rabies in Animals
Scarlet Fever (Rcky Mt.
Spotted) Cumu-
1 lative
20th week 20th wk. 20th wk. 20th wk. 20thwk. 20 weeks 20th week 20 weeks
1963 T *.* 'i ... i 1, : ...


L


.. I4 6," 3 .1

879 526
56 21
14 6
2 22 -
126 91
46 47
635 339

505 391
291 182
110 78
104 131

792 670 1
107 75 1
101 100 -
145 114
263 184
176 197

198 157
33 29
73 69
S 2
83 55
3

6 2

572 352 1

20 12
S 7
167 164
126 51
125 12
14 16
3 -
117 90 1

963 948
108 50
783 841
11 20
61 37

628 687

6 2
9 16
613 669

1,218 1,257
38 46
102 106
22 21
547 521
295 253
107 137
106 173
1

1,314 1,785 1
521 598
15 39
669 1,111 1
71 7
38 30

43 6 2


I


I I -


I


I ij

1 6


S 1
1 4

S 1

17
13
1
3

7
2
1
2
1
1

8
3
I
4





3 30
1
3

1 4
5
3
2 2
2
S 10

S 12
1
7
4


1 23
9
5
2
1 7

2



1
- 1




- 31
1

2
- 26

2

1 6


- 5


i










Morbidity and Mortality Weekly Report 171





Table 4 (D). TOTAL DEATHS AMONG PERSONS 65 YEARS AND OVER IN REPORTING CITIES



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


Area For weeks ending Area For weeks ending

4/27 5/4 5/11 5/18 4/27 5/4 5/11 5/18


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.... ......
Cary, 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.............


121
24
19
23
34
17
23
23
28
43
13
36
19
44


22
18
109
27
17
24
38
58
991
21
349
120
35
65
15
36
42
19
11
20


39
24
393
84
133
72
37
182
18
18
24
18
35
87
16
76
17
11
26
64
25


46
26
21
58
27
82
39
138
52
34


132
20
17
18
33
11
19
24
26
30
9
27
17
33


25
23
100
26
16
21
38
47
999
23
214
170
34
67
13
26
33
28
23
14


32
27
404
99
116
62
33
219
31
17
31
9
21
74
10
71
9
15
32
55
33


48
20
26
65
20
78
41
138
39
19


136
22
16
25
27
15
20
17
30
45
8
34
18
30


37
27
88
23
16
25
33
41
900
20
271
113
19
57
19
23
35
31
14
20


34
24
402
86
109
71
37
188
31
21
19
11
29
76
12
76
13
13
31
55
29


36*
19
24
68
24
67
49
130
48
29


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


39
140
21
24
59
18
47
12
59
36
105
17


41
28
23
45
62
14
10
37


22
20
13
69
20
29
73
37
87
36
54
31
30


21
15
58
19
51
12
33
32


12
31
37
11
39
331
68
22
78
34
45
121
21
91
46
32


65
119
10
34
36
24
37
18
67
56
93
23


34
26
25
91
59
26
14
34


20
14
11
59
23
33
94
34
67
40
47
23
33


11
10
71
12
41
9
30
20


13
32
23
11
36
330
80
22
74
47
63
114
24
95
26
30


50
131
18
29
53
15
51
17
47
41
93
27


43
21
18
37
62
20
15
40


31
16
15
70
17
38
65
37
75
33
46
21
45


14
15
71
10
57
8
31
23


14
24
26
15
35
296
48
20
45
34
62
116
26
99
33
24


San Juan, P.R............... 10 26 10 17


OCurrent Week Mortality for 108 Selected Cities

4(A) Total Mortality, all ages................... 11,199
4(B) Pneumonia-Influenza Deaths, all ages........ 408
4(C) Total Deaths under 1 Year of Age............. 709
4(D) Total Deaths, Persons 65 years and over..... 6,233


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

NOTE: All deaths by place of occurrence.




UNIVERSITY OF FLORIDA

11111II1 llIIIIIIII1IIII111 IIUII III NI 1 111111
3 1262 08864 1278


Morbidity and Mortality Weekly Report


Dr. M. M. Sigel, I i ,, r-ir of Miami, previously re-
ported that an isolate recovered during the Miami outbreak
belongs to the influenza A group on the basis of comple-
ment fixation tests. The first virus isolate from an out-
break in Kentucky, recovered by Dr. E. R. Doll, University
of Kentucky, has been submitted to the Respiro-virus
Unit, Laboratory Branch, CDC. While complement fixation
tests are not completed, preliminary HI tests indicated
that this isolate is not related to any of the known human
group A influenza virus strains. Further studies of these
isolates are in process.
(Rep'rted hb Drs. Sigel and Doll; the State Heallt Depart-
ments o Illinois(Dr. Franklin Yoder). Michigan Dr. Donald
t uoho l, N e York (Pr. Donald Dean), Ohio (Dr. Paul
Scbhnarrenherger), and Pennsylvania (Dr. Ernest Witie);
the Respiro-virus 'nit, Lbhoratory Branch. CDC; and, a
team from the Cormmunicable Disease Center.)

INTERNATIONAL NOTES QUARANTINE MEASURES

Smallpox Scandinavia
Sweden Stockholm was declared a smallpox in-
fected area on May 16. A seaman who returned from Indo-
nesia in late March is the apparent source of an outbreak
which has now spread through two generations of trans-
mission and has resulted in one fatality. Preliminary
information on cases to date, received from the Ministry
of Health, Sweden, and forwarded by Dr. Reimert T.
Ravenholt, Epidemiologic Consultant, Division of Foreign
Quarantine, U.S. Public Health Service, Paris, is given
below:


Dote of
Onset


Presumed Source
of Infection


pattern of hospital spread observed in other recent out-
breaks. The mildness of. the disease in several of the
earlier cases, resulting in the failure of these patients to
seek medical care and hospitalization, has contributed
to the pattern of community transmission.
The outbreak emphasizes the sinister role of mild or
vaccine-modified cases of smallpox in initiating and
propagating outbreaks of severe disease. Since the out-
break was discovered during the second generation of
indigenous cases, it is possible that Americans recently
in Stockholm have been unknowingly exposed to the
disease, and cases of suspicious febrile illness in such
individuals should receive the utmost scrutiny by clini-
cians and public health authorities.


---.


I


0
=5
C


Last
Vaccination


1 30 M April 6 Indonesia 3 years ago
-2 50 F April 21 Case 1 Childhood
3 80 F April 21 Case # 1 Childhood
4 25 F April 24 Case # 1 Childhood
5 20 F Not known Case # 1 Childhood
6 52 M May 3 Case f 2 Never
7 19 M May 5 Case# 2 Never
8 50 F May 6 Case 3 Not known
9 60 F May 6 Case # 3 Not known
10 65 F May 6 Case i 3 Not known
11 72 F May 8 Case 4 3 Childhood
12 25 M May 11 Case # 4 Never
Fatality
The outbreak was recognized on May 13 when the
diagnosis of smallpox was first suspected in Case #7.
The disease was sufficiently mild in Cases 1, 4, 5 and 12
that medical assistance was not sought. The only fatality
to date occurred in Case #2 who apparently suffered an
acute hemorrhagic form of the disease, diagnosed as
smallpox in retrospect.
This outbreak is of unique interest in that it rep-
resents one of the few epidemics in Western nations
in recent years not evidencing a predominant spread
among hospital contacts. Recent immunization programs
among hospital personnel presumably have altered the


90

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A M=


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