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:
AA00010654:00114

Related Items

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

Full Text
FS A.-fo /9:(?,#I



Morbidity and Mortality


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


Prepared by the


I 6O MU IABEDSES CNE


U
Wekl


634-5131


For release December 13, 1963


ATLANTA, GEORGIA 30333


PROVISIONAL INFORMATION ON SELECTED NOTIFIABLE DISEASES IN THE UNITED STATES AND ON
DEATHS IN SELECTED CITIES FOR WIEK ENDED DECEMBER 7, 1963


BOTULISM Two cases of botulism, one fatal, were
reported from Colorado for the week ended December 7.
Both cases were related to the ingestion of home-canned
green beans.
These 2 cases bring the cumulative total to.41 reported


thus far in 1963.
for any one year s
An epidemiol
found on page 410


PSITTACOSIS A total of 8 cases of psittacosis were
reported for the week ended December 7. Two cases were
reported from Connecticut, and 6 from Nevada. These cases
bring the cumulative total to 78 thus far in 1963. For a
comparable period of 1962, 74 cases were reported.


This figure represents the highest total The 6 Nevada cases are described in an epidemiologi-
ince 1947, when 44 cases were reported. cal report this week, on page 410. The 2 cases reported
logical report of the Colorado cases is from Connecticut are unrelated epidemiologically. One is
9. a delayed report, with ugust.




DEC I- ,--

Table 1. CASES OF SPECIFIED NOTIFIABLE DISE 'f"S, UNITED ST A
(Cumulative totals include revised and delayed reports t ugh devious -. k'


49th Week C]&WHive
Ended Ended E e 49 weeks
Disease Median
December 7, December 8, 1958 1962 Median
1963 1962 1963 1962 1958 1962
Aseptic meningitis ............... 36 43 --- 1,741 2,441 --
Brucellosis ..................... 5 14 12 340 376 684
Diphtheria....................... 11 9 27 259 432 762
Encephalitis, infectious .......... 27 28 30 1,462 1,732 1,731
Hepatitis, infectious and serum... 874 911 911 40,517 50,659 37,154
Measles ........................ 3,695 3,693 4,092 377,324 464,829 417,027
Meningococcal infections......... 42 51 51 2,206 2,009 2,130
Poliomyelitis, total.............. 4 8 49 408 856 3,173
Paralytic.................... 3 5 33 349 678 2,200
Nonparalytic................. 1 3 6 41 125 637
Unspecified ............ ..... 10 18 53 336
Streptococcal sore throat
and Scarlet fever ............ 7,529 6,992 --- 317,019 293,538
Tetanus ........................ 5 4 --- 266 278 -.
Tularemia...................... 3 11 --- 272 280 -
Typhoid fever ................... 16 16 16 512 605 785
Typhus fever, tick-borne,
'(Rocky Mountain spotted)...... 2 --- 176 214
Rabies in Animals ............... 80 60 64 3,538 3,425 3,425

Table 2. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: 4 Psittacosis: Conn.- 2, Nev. 6 78
Botulism: Colo. 2 41 Rabies in Man: 1
Malaria: Mass. 1, Conn. 1, Maryland 2 101 Smallpox:
Plague: Typhus, murine: 27


Vol. 12, No. 49


----







Morbidity and Mortality Weekly Report


DIPHTHERIA Eleven cases of diphtheria were reported
for the week ended December 7, which brings the total to
259 cases thus far in 1963. For a comparable period in
1902, i2 cases were reported.
Six of these cases were reported from Florida; all
occurred in lacksonville. Further epidemiologic investi-
gation is in progress.
Florida, thus far in 1963, has reported a total of 23
cases of diphtheria. Florida's 23 cases, which is the
second highest State total, account for 9 percent of the
nation's diphtheria cases. Louisiana has reported 33 cases
(13 percent of the national total).


TYPHOID FEVER A total of 16 cases of typhoid fever
were reported for the week ended December 7. This figure
brings the total thus far in 1963 to 512 cases. For a compa-
rable period in 1962, 605 cases were reported.
The 4 cases reported from Virginia occurred among
members of one family. According to Dr. James B. Kenley,
Virginia State Department of Health, additional suspects
are under surveillance; cultures are in progress.
The 3 cases of typhoid reported from South Carolina
were from scattered geographical regions of the State, and
are unrelated epidemiologically. The remaining nine cases
were reported by eight different States.


EPIDEMIOLOGICAL REPORTS


Botulism Colorado


The 2 cases reported this week from Colorado are
related to the ingestion of home-canned green beans.
A 41-year-old widow and her 10-year-old daughter ate
home-canned green beans at their evening meal at approxi-
mately -:00 p.m., December 1. About 71 hours later, the
mother experienced the onset ot symptoms including
respiratory difficulty and prostration. By 8:30 a.m. the
following morning, she was found dead in bed. An autopsy
recalled no apparent cause of death.
During the early morning of December 3, the daughter
suddenly experienced respiratory distress and prostration.
She was admitted immediately to a Denver hospital. She
was placed in an iron lung. A physician diagnosed botu-
lisin and administered 120,000 units of bivalent (A and B)
botulinus antitoxin on the day of admission. Subsequently,
she has received 300,000 additional units and has im-
proved, but, as of December 11, she was still in aniiron
lung and continued to have difficulty swallowing and
speaking. It was learned later that she had consumed a
much smaller quantity of the green beans.
A 15-year-old brother was not home at the time of the
meal. did not cat any of the beans, and has not become ill.
( /,,silrdir h tiilu rnl and toxin has been identified
in the can of beans which was ingested. Toxin has also
been identified in gastric contents of the mother (taken at
post mortem). Mice injected with the toxin died, while
mice protected by bivalent antisera survived. Attempts to
determine whether the type was A or B are in progress.
It is unknown how or when the food was preserved.
The family's food consisted in large part of home-canned
products. So far, C. botulinum has not been cultured from
the family's other home-preserved products.

iReporteid I Dr. Robert fnncr. ener r Department of
llealthl and lHospitals, and Dr. (. .. Mollohan. State Ept-
drmIilngvst. Colorado State Department of Public Health.)


Psittacosis Nevada

The 6 cases of psittacosis reported this week repre-
sent the first reported cases of this disease in Nevada.*
All 6 occurred in Las Vegas. Five of the cases occurred
in one family of 5; the other was an isolated case.
In early November, a physician, age 53, his wife, and
3 children became ill. The father developed a severe and
extensive pneumonia, which prevailed for several weeks
despite antibiotic therapy. His wife had extensive pul-
monary infiltrates, but made a quicker recovery. A 19-year-
old daughter was sick for 2 weeks, and the 2 other chil-
dren for one week with milder respiratory symptoms. All
were treated with tetracycline.
About 2 months previously, the family had purchased
a parakeet which had been ill throughout most of the 2
months' period. The parakeet died in early November,
about the time the 5 family members experienced their
first symptoms. The bird was discarded before the nature
of the family's illness was suspected.
This family had acquired the parakeet from a local
aviary, which has since been temporarily closed. Psitta-
cosis was not demonstrated in the birds remaining on sale.
The aviary's records on birds sold prior to the closing
of the establishment were inadequate to permit further
local epidemiologic study. Investigation of the aviary and
its suppliers is in progress.
The 6th Nevada case occurred in a 57-year-old male
who was a diagnostic problem at a hospital before his
complement fixation test led to the diagnosis of psittaco-
sis. lie is not known to have had a parakeet.
Except for the above 6 cases, no other cases or sus-
pect cases are known at present.
* Records available to 1941.
SReported by Dr. Otto Ravenholt. Clark County Health De-
partment, Las Vegas, and Lionel M. Groves, M.P.H..
Director. Public Health Laboratories. Nevada State
Department of Health.)








Morbidity and Mortality Weekly Report 411


Staphylococcal Food Poisoning Michigan
At least 52 individuals experienced gastroenteritis
after they consumed in their homes German chocolate
cakes which had been purchased from a Flint, Michigan,
store. The victims experienced nausea, vomiting, diarrhea,
and, in some cases, prostration. About 20 people were
treated in the emergency room of a local hospital; 5 were
hospitalized. There were no fatalities.
When the emergency room staff noted that several
people had consumed the suspect cake, the local health
department was notified. Approximately 200 of these cakes
remained on sale at the store at that time; sales of the
cakes were halted. All cakes previously sold and those
remaining had been prepared by one baker.
Cultures taken of 10 cakes at the store revealed
coagulase positive Staphylococcus aureus, Phage Type


80/81, in each cake. The baker was found to have lesions
on his hands. Identical organisms of the same phage type
were obtained from these lesions.
(Reported by Dale W. Brooks, Director, Division of En-
vironmental Health, Flint, Michigan, and Dr. George H.
Agate, Epidemiologist. Michigan Department of Health).



Dengue Fever Puerto Rico
During the week ended December 7, 1,011 cases of
dengue fever were officially reported to the Puerto Rico
Department of Health. This brings the 1963 total to
22,872 cases.
(Reported by Rafael Timothee, M.D. Director, Preventive
Medical Services, Puerto Rico Department of Health, and
a team from the Communicable Disease Center.)


TOTAL DEATHS REPORTED IN 108 CITIES

The weekly average number of total deaths in 108
cities for the four-week period ending December 7 was
11,228 as compared with an expected weekly average of
11,881.


NUMBEh


OF


DEATHS


WEEK ENDING
4 Week Weekly
11/16 11/23 11/30 12/7 Total Average

Observed 11,073 11,457 9,615 12,766 44,911 11,228
Expected 11,693 11,827 11,948 12,056 47,524 11,881

Excess -620 -370 -2,333 710 -2,613 -653


TOTAL DEATHS RECORDED IN 108 U.S. CITIES
Average number per week by four-week periods
13,500


i3,000 .INFLUENZA A
INFLUENZA B

12,500


12,000
RECORDED
DEATHS*

11,500


000 "EXPECTED


10,500 T


i0 n o .


Period number I

*BY PLACE OF OCCURRED


7 131 7 1 I 7 131 7
1960 1 1961 1962 1 1963


NCE


**CALCULATED FROM 1954-'60 EXPERIENCE


(See Table, page 419)


~~ ~-~~~~~---~--~ ~ --~ --- ~--~~~-~~~~~~~-~~~-~ ~ ~ ~-~~-~-~~~
~~,,,,,,,,,-,,,,, ,,, ~ ,,,,,,,,,,.,,,,,,,, ,.,,,-,,,,,,







Morbidity and Mortality Weekly Report


TABLE 1
REPORTED DIPHTHERIA CASES
BY RACE AND GEOGRAPHIC REGION
UNITED STATES, 1962


Geographic Region


White


Race
Non-White


Unknown


Number


Total
Percent


NORTHEAST
New England 2 2 4 0.9
Middle Atlantic 15 6 21 4.9 10
East North Central 14 2 16 3.7/

WEST
West North Central 92 15 107 24.8
Mountain 5 5 1.2 27
Pacific 6 6 1.4 /

SOUTH
South Atlantic 33 92 125 28.9
East South Central 13 22 35 8.1 63
West South Central 35 78 113 26.2 /

U. S. TOTAL 209 223 432 100

Puerto Rico 56 56 -


DIPHTHERIA SURVEILLANCE SUMMARY 1962


A total of 432 cases and 175 carriers were reported to
the Diphtheria Surveillance Unit by the health departments
of 36 States, the District of Columbia, and Puerto Rico
during 1962 (See Map).
Reductions in morbidity and mortality attributed to
diphtheria were again noted in 1962 in keeping with annual
trends over the previous 3 decades (see Figure 1). This
decline was evident in all regions except the West North
Central. The South (South Atlantic, East and West South
Central regions) again reported the largest number of
cases and the highest attack rates in the country.
Although there has been a reduction in cases of and
deaths from diphtheria since 1933, the case fatality rate
has remained relatively constant (see Figure 1). Except
for a few small community outbreaks of diphtheria, the
majority of reported cases during 1962 occurred either
singly or as intra-familial clusters.


During 1962, the 16 States and the District of Colum-
bia included in the three regions comprising the South
accounted for 274 (63 percent) of the 432 cases reported
for the entire nation (see Table 1). The reduction of cases
in the South in 1962 was proportionally greater than the
overall national decline. Partially responsible was the
substantial reduction of cases in Texas, from 192 to 78
(accounting for a 15 percent drop in its share of the na-
tional total). This striking decrease was reflected in the
West South Central regional figures as well as in those for
the entire South.
An autumnal peak in incidence was noted in all sec-
tions of the country again during 1962, with regional peaks
varying from August for the South to September for the
West and October for the Northeast.
Diphtheria remains a disease of children with 75 per-
cent of cases occurring in those under 15 years of age and






Morbidity and Mortality Weekly Report


z
I =LESS THAN I



o
0 =REPORR MORE
S = REPORTED CASE


50 percent in those 5-14 years (approximate school ages).
The 5-9 age group experienced the greatest percentage of
cases, a change from the 1-4 group which had the highest
rare in the past. The percentage of adult cases remained
the same as in 1961.
A geographic analysis of age distribution reveals
that 27 percent and 33 percent of cases in the Northeast
and West, respectively, were over the age of 20, compared
with 11 percent in the South (see Table 2). This difference
may be attributed to the higher concentration of non-whites
in the South than elsewhere, and is probably attributable
to socio-economic factors rather than racial predisposition.
The age distribution of non-white cases reveals a
preponderance of childhood diphtheria with only 6 percent
of'the total number of non-white cases occurring over the
age of 20, compared with 31 percent of the cases among
whites.
For the first time since reporting to the Diphtheria
Surveillance Unit began, non-white cases have exceeded
white cases (see Table 1). This trend may be explained
by a singular reduction in white cases in the West South


Central region over past years. This shift to non-white
case preponderance emphasizes the previously reported
higher attack rates in the non-white group. It also offers
evidence against the once frequent observation that
clinical diphtheria was rare in this group.

Of the 432 cases reported in 1962, 339 (78 percent)
were bacteriologically confirmed, comparable to results
obtained in 1961.
A total of 280 of these isolates were further analyzed
for toxigenicity and/or type. Toxigenic strains accounted
for 250 (90 percent) of the 277 specimens tested, pointing
to the fact that a small but definite number of cases of
clinical diphtheria may be caused by non-toxigenic
organisms.
Of the 185 cultures typed, 93 (50 percent) were mitis,
57 (31 percent) gravis, 30 (16 percent) intermedius, and
5 (3 percent) indeterminate types. These figures represent
a slight reduction in mitis and increase in intermedius
isolations compared to 1961.
Geographic distribution of the various types again
followed a pattern established in past years: 68 (73 per-


413







Morbidity and Mortality Weekly Report


Figure I
DIPHTHERIA IN THE UNITED STATES
REPORTED CASE, DEATH AND CASE FATALITY RATES
1933-1961


SOURCE: NATIONAL MORBIDITY REPORTS


YEAR


cent) of 93 mitis strains were isolated in the South, while
38 (67 percent) of the 57 gravis cases occurred in the West.
The degree of clinical involvement was recorded in
344 ,iP percent) of the 432 reports. Thirty-three (10 per-
cent) were fatal, 46 (13 percent) severe, 106 (31 percent)


moderate, and 159 (46 percent) mild cases.
Age distribution of fatalities is remarkable in that
45 percent of all deaths occurred in the 1-4-year-old group
as compared with only 25--percent of cases, indicating
the greater risk in this category.


*TENTATIVE


414







Morbidity and Mortality Weekly Report


TABLE 2
REPORTED DIPHTHERIA CASES BY AGE GROUP AND GEOGRAPHIC REGION UNITED STATES, 1962


Age Group
Geographic Region 0-4 5-9 10-14 15-19 20-29 30-39 40-49 50+ Unknown Total Percent over Age 20
NORTHEAST
New England 2 1 1 4 100.0)\
Middle Atlantic 3 6 9 2 1 21 4.8) 27
East North Central 2 4 2 1 4 1 1 1 16 40.0)
WEST
West North Central 14 26 20 10 7 6 7 17 107 34.6)
Mountain 1 2 1 1 5 40.0) 33
Pacific 2 4 6

SOUTH
South Atlantic 37 38 29 10 5 3 2 1 125 8.1)
East South Central 13 11 8 1 2 35 8.6) 11
West South Central 35 36 21 4 3 8 3 2 1 113 14.3)/
U. S. TOTAL 107 127 89 27 23 21 14 21 3 432 18.4
Puerto Rico 21 10 4 8 6 3 2 2 56 23.2


For the first time in recent years, no significant
difference was noted in the mortality rate by type or
organisms: 4 percent for gravis vs. 5' percent for mitis.
However, the usual greater severity of cases associated
with gravis type organisms is implied by the fact that 57
percent of mitis cases were classified as mild as opposed
to 37 percent of the gravis infections.
Immunization histories were obtained from 374 (87
percent) of the 432 cases. Fully 73 percent (274) had never
received any toxoid prior to illness, while only 8 percent
(30) were considered fully immunized by Diphtheria Sur-
veillance Unit criteria (series completed or booster re-
ceived within the past 4 years). See table below.


SEVERITY OF DIPHTHERIA CASES BY RACE AND IMMUNIZATION STATUS
UNITED STATES, 1962

Total
Severity Full Lapsed Inadequate None Unknown All Races
Mild 18 17 13 92 19 159
Moderate 7 13 6 67 13 106
Severe 2 6 33 5 46
Fatal 1 3 27 2 33
Total 26 35 25 219 39 344
Severity Unknown 4 5 5 55 19 88
Total Cases 30 40 30 274 58 432


Severity of illness was much greater in unimmunized
than fully immunized cases. Severe or fatal illnesses were
recorded in 4 percent of the immunized group compared with
27 percent among unimmunized individuals. In contrast,
69 percent of immunized and 42 percent of unimmunized
cases were considered mild.
In terms of complications, unimmunized cases account-
ed for 72 percent of all reported complications, including
86 percent of all fatalities (See tables above).


DIPHTHERIA CASES BY REPORTED COMPLICATIONS AND
IMMUNIZATION STATUS UNITED STATES, 1962



Immunization Status
Complications* Full Lapsed Inadequate None Unknown Total

BronchQpneumonia 1 4 5
Bullneck 1 3 1 5
Myocarditis 1 1 2 10 1 15
Nephritis 3 3
Neuritis 1 1 1 3
Otitis -
Tracheotomy 1 1 3 19 1 25
Other 3 1 4

Total 3 4 6 43 4 60
*Some cases had more than one complication.


The above figures are comparable with data reported
in past years.
The one fatal case with full immunization was a 16-
year-old white female from New Jersey who received a
toxoidd booster" in 1961. She had entered the country
as an immigrant in 1958 and had lived in various orphan-
ages during the 3 year interval. There is some question
whether she had ever received a primary series preceding
the booster.
The immunization status of carriers was substantially
higher than that of cases in 1962, as noted in previous
years. Of the 175 reported carriers, 47 (27 percent) were
fully immunized and 68 (39 percent) had never received
toxoid, compared with 8 percent and 73 percent, respective-
ly, for cases.
(Reported by Diphtheria Suri lancee Unit, Communicable
Disease (enter).


415








116 Nlorbidity ,ad Mlorlalit i1 Weekly 1elport


Ta.ble CASES OF SPE( II1I) NOTIFIABLE DISEASES: I N I1I) ,5I AII S

FOR WEEKS ENDED

DECEMBER 7, 1963 AND DECEMBER 8, 1962


Poliomyelitis, Aseptic
Poliomyelitis, total cases Poliomyelitis, paralytic nonparalytic Meningitis


Area


Cumulative Cumulative
49th week First 49 weeks 49th week First 49 weeks 49th week 49th week


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

UNITED STATES...... 4 8 408 856 3 5 349 678 1 3 36 43

NEW ENGLAND.............. 8 9 8 8 2
Maine.......... ...... 2 2
New Hampshire.........-
Vermont ............... 1 1 1
Massachusetts......... 3 7 3 7
Rhode Island.......... -
Connecticut........... 2 1 2 1

MIDDLE ATLANTIC......... 2 118 83 1 94 61 1 2
New York............. 2 11 60 1 7 41 1 2
New Jersey............ 4 9 3 9
Pennsylvania 103 14 84 11

EAST NORTH CENTRAL....... 3 55 134 3 44 101 1 7
Ohio.................. .- 8 20 4 18 1
Indiana............... 2 4 23 2 3 18
Illinois.............. 17 59 16 42 -- 4
Michigan .............. 1 17 21 1 17 17 3
Wisconsin............. 9 11 4

WEST NORTH CENTRAL....... 7 38 6 27 7
Minnesota............. 4 7 4 7 6
Iowa ................. 7 3
Missouri..... ....... 10 5
North Dakota........... 1 5 3
South Dakota.......... 1 1 1 1
Nebraska................ 1 8 1 8
Kansas................

SOUTH ATLANTIC............ 93 76 1 81 66 10 2
Delaware .............. 1 1
Maryland.............. 3 2 1 1
District of Columbia. 1 2 -
Virginia.............. 21 8 16 8
West Virginia......... 3 17 3 17
North Carolina........ 5 13 4 11
South Carolina....... 8 6 -7 6 2
Georgia.............. 21 17 20 14
Florida ............... 30 11 1 29 8 8

EAST SOUTH CENTRAL...... 73 80 67 67 2 4
Kentucky.................- 29 23 2
Tennessee............ 11 12 10 6 -
Alabama............... 53 22 48 22 2 1
Mississippi .......... 9 17 9 16 1

WEST SOUTH CENTRAL....... 27 325 26 250 3 3
Arkansas.............. 5 22 4 19 -
Louisiana............. 14 28 14 25
Oklahoma.............. 1 31 1 22 -1 2
Texas................. 7 244 7 184 2 1

MOUNTAIN................. 5 20 4 15 1 1 2
Montana ............... 4 -- 3
Idaho.................. 2 I
Wyoming................ 2 1
Colorado.............. 4
New Mexico............ 1 2 2
Arizona............... 1 3 4 3 3 -
Utah.................
Nevada.................2

PACIFIC ................. 1 4 22 91 1 2 19 83 2 17 16
Washington ............ 2 5 2 5 1 1
Oregon ............... 2 7 1 5
Califrnia ........... 1 4 18 79 1 2 16 73 2 15 15
Alaska ................
Hawaii..... .......... '

Puerto Rico .............. 5 12 4 12








Mlorbidil and Mortality Weekly Report 417


TIihbl i. (.AS. S OF SPE(IFII) NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 7, 1963 AND DECEMBER 8, 1962 (Continued)



Brucellosis Diphtheria Encephalitis, Hepatitis, Measles
infectious infectious and serum
Area
Cumu- Cumu- 49th week
lative lative Under 20 &
49th week 49 weeks 49th week 49 weeks 49th week 20 yr. over Total 49th week
1963 1963 1963 1963 1963 1962 1963 1963 1963 1962 1963 1962
UNITED STATES...... 5 340 11 259 27 28 409 411 874 911 3,695 3,693

NEW ENGLAND.............. 1 8 58 50 109 123 180 171
Maine ................. 36 23 59 48 3 37
New l'ampslhire......... 4 8 13 6 -
VermonL............... 1 2 1 3 3 9 59
Massachusetts........... 6 10 8 18 42 31 32
Rhode Island......... 2 2 2 16 26
Connecticut........... 6 8 14 8 111 43

MIDDLE ATLANTIC.......... 8 2 24 5 10 97 116 213 139 857 508
New York .............. 4 13 2 5 72 76 148 82 448 163
New Jersey............ 1 4 6 16 22 20 257 74
Pennsylvania.......... 3 2 7 3 5 19 24 43 37 152 271

EAST NORTH CENTRAL....... 3 49 1 35 1 3 72 67 143 152 755 1,507
Ohio.................. 18 14 34 42 137 104
Indiana............... 6 10 7 5 12 26 185 32
Illinois.............. 1 23 17 3 9 11 20 32 246 88
Michigan................... 6 1 5 1 38 36 74 44 152 448
Wisconsin............. 2 14 2 1 3 8 35 835

WEST NORTH CENTRAL....... 1 4177 1 42 4 21 4 28 45 247 326
Minnesota ............ 9 15 3 2 5 8 50
Iowa.................. 1 132 1 1 2 1 3 5 22 120
Missouri.............. 12 1 1 1 12 2 43
North Dakota .......... 2 3 3 3 3 223 107
South Dakota........... 11 1 13 10 13 2 1
Nebraska.............. 6 10 1 1 7 5
KYnsas................ 7 2 2 8 NN NN

SOUTH ATLANTIC............ 22 6 65 9 3 30 30 66 123 562 173
Delaware .............. 3 4
Maryland ............. 7 1 8 8 76 5
District of Columbia 1 4 41
Virginia.............. .- 11 2 6 11 20 21 72 34
West Virginia......... 1 3 6 11 11 264 66
North Carolina ........ 5 5 4 8 4 12 51 12 9
South Carolina ....... 17 1 2 3 2 63 1
Georgia............... 3 18 1 1 7 1
Florida............... 3 6 23 3 3 4 6 11 16 34 53

EAST SOUTH CENTRAL ....... 14 1 22 3 3 36 13 57 69 345 99
Kentucky.............. 3 1 1 19 4 31 15 242 13
Tennessee ............. 6 3 2 1 9 5 14 31 99 80
Alabama ............... 5 1 16 8 3 11 10 2 4
Mississippi........... 3 1 1 1 13 2 2

WEST SOUTH CENTRAL....... 1 37 54 4 24 27 52 48 116 93
Arkansas.............. 1 9 3 4 1 5 11 2 3
Louisiana.............. 8 33 5 6 11 7 2
Oklahoma............... 5 7 1 1 2 4 -
Texas.................. 15 11 4 14 19 34 26 114 88

MOUNTAIN ............. ... 9 5 11 6 46 44 115 248
Montana............... 1 1 29 28
Idaho.................. 6 1 44 31
Wyoming................. 1 1 3 4 7 3
Colorado................ 3 3 1 19 13 16 100
New Mexico............ 2 6 1 7 7 NN NN
SArizona................ 3 8 13 14 42
Utah .................. 5 1 1 2 12 44
Nevada................ 1

PACIFIC..................... 23 4 5 5 60 98 160 168 518 568
Washington............. 9 9 20 40 157 150
Oregon.............. 3 4 6 10 33 66 42
California............ 18 4 5 5 43 83 126 90 180 181
Alaska................ 4 4 5 113 15
Hawaii................. 2 2 180

Puerto Rico.............. 1 13 14 3 17 30 88 10








118 Morbidity and Mortality Ic ekle Report


1abhe 3. ( ASES OF SPI (CII:I1) NOTI IABLI )DSI ASIS I NI I 1) I IIs

FOR WFIEiKS I:NDI I)

DECEMBER 7. 1963 AND DECEMBER 8, 1962 (Continued)


M .. [r .. I T rE
Infections Sore Throat & Tetanus Typhus Tularemia Typhoid Fever | Rabics in Animals
Scarlet Fever ______ (Rcky Mt.
Aa Cumu- Spotted) Cuiu- Cumu-
lative lat ive lative
49th wk. 49 weeks 49th week 49th wk. 49th wk. 49th wk. 49th wk. 49 weks 49th uw ek 49 weeks
1963 1963 1963 1962 1963 1963 1963 1963 1963 1963 1962 1963

UNITED STATES.... 42 2,206 7,529 6,992 5 2 3 16 512 80 60 3,538

NEW ENGLAND......... 130 749 577 13 32
Maine .............. 19 64 62 2 2
New Hampshire...... 4 1 9 15
Vermont............ 6 25 1 14
Massachusetts...... 58 73 91 6 1
Rhode Island....... 12 60 74 -
Connecticut........ 31 526 341 4

MIDDLE ATIANTIC..... 10 311 453 380 1 88 6 5 118
New York............ 8 147 310 219 45 6 5 89
New Jersey......... 48 74 74 -
Pennsylvania....... 2 116 69 87 1 37 29

EAST NORTH CENTRAL.. 7 341 770 772 2 2 3 66 7 5 529
Ohio................ 3 98 105 136 1 28 3 2 306
Indiana............ 1 45 108 109 1 7 1 52
Illinois........... 3 70 128 140 1 2 13 1 75
Michigan............ 95 256 224 2 13 2 49
Wisconsin.......... 33 173 163 5 3 47

WEST NORTH CENTRAL.. 1 134 356 252 1 29 26 24 944
Minnesota.......... 1 28 11 14 3 8 9 255
Iowa............... 7 54 63 3 3 8 325
Missouri........... 39 42 14 1 19 10 3 172
North Dakota....... 15 128 126 1 3 39
South Dakota ...... 7 8 6 1 4 1 98
Nebraska........... 25 1 I 32
Kansas............. 13 113 28 2 23

SOUTH ATLANTIC...... 3 404 543 617 1 2 10 82 16 4 510
Delaware........... 4 1 4 1
Maryland........... 57 24 9 -- 1 12 2
Dist. of Columbia.. 8 5 1
Virginia........... 86 200 130 4 13 12 207
West Virginia...... 21 248 138 7 2 3 114
North Carolina..... 1 77 19 31 1 1 1 17 16
South Carolina..... 1 23 45 24 3 9 10
Georgia............ 34 2 2 1 2 2 1 82
Florida............ 1 94 281 1 18 78

EAST SOUTH CENTRAL.. 2 149 1,350 1,001 69 8 5 271
Kentucky.......... 31 68 90 13 3 3 122
Tennessee.......... 1 70 1,245 803 29 5 2 129
Alabama............ 1 25 15 11 11 20
Mississippi....... 23 22 97 16 -

WEST SOUTH CENTRAL.. 6 202 747 815 2 1 86 12 12 668
Arkansas............ 14 1 2 34 5 87
Louisiana.......... 1 81 7 6 -- 26 49
Oklahoma............ 1 35 23 21 1 1 6 1 59
Texas.............. 4 72 716 786 1 20 6 12 473

MOUNTAIN ............ 2 78 1,549 1,220 1 20 132
Montana........... 3 77 25 1 1-
Idaho.............. 6 89 103 -
Wyoming............ 7 148 109 -
Colorado........... 1 21 592 373 -- 6 16
New Mexico......... 4 417 299 6 40
Arizona............ 1 12 121 188 -- 7 62
Utah............... 20 105 118 -- 3
Nevada ............. 5 5 11

PACIFIC ............. 11 457 1,012 1,358 59 5 5 334
Washington ......... 40 267 330 3 -
Oregon.............. 33 30 32 2 13
California......... 9 357 617 770 51 5 5 312
Alaska.............. 1 13 63 116 1 9
Hawaii.............. 1 14 35 110 I -


Puerto Rico....8... .8. 5 1 -


- -I 14


13


14







Miorbidity and .Moralilv Weeklv Report




1.hl1t 1(A). TOTAL DEATHS 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 Area
11-16 11-23 11-30 12-7 11-16 11-23 11-30 12-7


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...........
Clev-land, 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 ..........
Tolcdo, 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. ............


233
49
24
29
62
19
18
28
59
66
12
47
23
44


39
39
144
49
37
44
87
103
1,528
31
462
186
51
106
9
29
58
45
28
27


61
30
758
152
203
133
79
348
38
44
50
25
56
161
37
150
29
24
30
92
60


48
27
22
143
32
96
70
253
70
41


228
44
25
31
54
29
16
29
58
67
20
45
26
53


42
38
136
34
31
43
84
77
1,658
26
509
192
60
97
39
37
66
42
26
32


71
28
818
159
203
107
101
319
29
29
37
31
61
128
44
115
28
42
45
115
57


61
28
37
125
17
117
90
249
66
60


224
29
34
18
37
37
27
18
40
70
10
38
16
58


53
40
91
34
27
30
65
90
1,509
30
472
56
61
85
28
35
52
22
20
30


44
30
681
128
163
113
75
282
30
52
43
30
41
115
32
99
28
28
28
100
71


40
27
39
119
19
96
56
193
74
46


162
31
26
31
64
15
24
27
60
54
16
59
29
61


45
34
184
45*
52.
43
71
92
1,682
46
505
265
42
123
29
53
62
41
22
31


66
34
783
181
235
138
89
373
47
57
41
22
61
212
39
165
38
19
45
119
52


73
29
41
149
29
146
112
306
69
60


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. .......... 24
Fresno, Calif. ........... 51
Glendale, Calif. .......... 57
Honolulu, Hawaii............ 37
Long Beach, Calif. ........ 60
Los Angeles, Calif. ....... 480
Oakland, Calif. ........... 92
Pasadena, Calif. .......... 36
Portland, Oreg. ........... 80
Sacramento, Calif. ........ 65
San Diego, Calif. ......... 81
San Francisco, Calif. ..... 197
San Jose, Calif. .......... 44
Seattle, Wash. ............ 133
Spokane, Wash. ............ 60
Tacoma, Wash. ............. 47

San Juan, P.R. .............. 17


130
238
30
60
70
47
70
37
74
64
174
40


78
44
27
87
133
41
38
83


24
33
33
133
36
60
169
46
180
76
126
37
43


26
14
126
19
88
17
56
42


156
276
29
58
70
69
69
45
97
73
191
45


97
49
30
161
121
37
17
92


32
24
25
141
35
54
174
41
174
74
103
53
41


25
14
121
16
98
14
48
53


72
213
39
57
41
52
76
38
74
63
213
40


67
47
22
63
91
47
20
58


31
18
29
118
30
55
135
35
166
33
60
27
18


20
15
92
17
85
14
58
28


18 13 24
39 36 50
39 24 36
36 36 50*
73 58 55
450 397 600
83 74 112
35 41 30
139 68 i 127
63 54 66
85 74 102
212 176 r 231
29 38 40
128 105 212
49 54 58
38 30 57

37 (---) (---)


OCurrent Week Mortality for 108 Selected Cities

4(A) Total Mortality, all ages.................... 12,766
4(B) Pneumonia-Influenza Deaths, all ages......... 470
4(C) Total Deaths under 1 Year of Age............ 833
4(D) Total Deaths, Persons 65 years and over..... 7,148


NOTF: All deaths by place of occurrence.


419


142
307
48
71
89
49
96
41
60
79
232
41


88
47
43
157
125
38
47
119


31
34
34
141
38
98
172
68
191
121
128
62
74


40
29
106
17
106
14
60
63


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


r







421) Morbidity and Moi





INTERNATIONAL NOTES QUARANTINE MEASURES

Poliomyelitis Canada
Two cases of paralytic poliomyelitis were reported
from Canada for the week ended November 30. This brings
the cumulative total to 111 paralytic cases thus far in 1963.
Both cases reported were from Quebec. Quebec's 1963
total is 101 cases. For comparable periods in 1962 and
1961, 52 and 112 cases were reported, respectively.
(Reported in the Weekly Bull tin, Canadian Department of
National Health and Welfare.)


rlalilt Weekly Report


UNIVERSITY OF FLORIDA

IIII III IIIIII llllI II IIiiI I
3 1262 08864 0403


In addition to the established procedures for
reporting morbidity and mortality, the Com-
municable Disease Center welcomes accounts of
interesting outbreaks or cases. Such accounts
should be addressed to:

Lawrence K. Altman, M.D., Editor
Morbidity and Mortality Weekly Report
Communicable Disease Center
Atlanta, Georgia 30333


jr.l OCF 'L L'B
OC .i;MENTS DEP'





U.S. DEPOSITORY


x
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rnn

0 >
0 0

'I I>
ill

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The Morbidity and Mortality Weekly Report, with a circu-
lation of 10,500 is published by the Communicable Dis-
ease Center, Atlanta, Georgia.
Chief, Communicable Disease Center James L. Goddard, M.D.
Chief, Epidemiology Branch A. D. Longmuir, M.D.
Chief, Statistics Section R. E. Serfling, Ph.D.
Asst. Chief, Statistics Section I. L. Sherman, M.D.
Chief, Surveillance Section D. A. Henderson, M.D.
Editor, MMWR L. K. Altman, M.D.


POP
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