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:
AA00010654:00123

Related Items

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

Full Text

FS., o/> I i 2z//y



Morbidity and Mortality



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

PUBLIC HEALTH SERVICE


Prepared by the


634-5131


For release November 8, 1963 ATLANTA, GEORGIA 30333 Vol. 12, No. 44
PROVISIONAL INFORMATION ON SELECTED NOTIFIABLE DISEASES IN THE UNITED STATES AND ON
DEATHS IN SELECTED CITIES FOR WEEK ENDED NOVEMBER 2, 1963


POLIOMYELITIS Nine cases of poliomyelitis, 5 para-
lytic, were reported for the week ending November 2. Three
cases were reported from Alabama, while single cases
were reported from New York, /New Jersey, Wisconsin,
Virginia, Florida, and Mississippi.
The 9 cases bring the total th in 19 62.
The cumulative total remains ~ f t
number reported last year.
POLIOMYELITIS CUMULATEDD WEE ST THROUGH 44TH


Paralytic


Total


362


POLIOMYELITIS (SIX WEEK TOTAL:


Paralytic
Total


90 175 331 775 1721


EPIDEMIOLOGICAL REPORTS
MALARIA
An outbreak of Plasmodium falciparum malaria in-
volving 6 clinical and 3 asymptomatic cases was discov-
ered when the M/V Ranborg, a Norwegian freighter of the
Zim line, arrived from West Africa, docking first at
Philadelphia, Pennsylvania, and then at Newark, New
Jersey..Aboard the vessel were 37 officers and crew, as
well as 2 women and one child. All but 4 of these 40
individuals aboard were Scandinavian. The vessel carried
cocoa beans and coffee.
When the M/V Ranborg arrived in Philadelphia (see
graph page 366) on October 19, two members of the crew
complained of similar symptoms: chills, headache, muscle
pains and fever. One complained also of a severe poste-
rior occipital pain. Both men were seen by a physician


Table 1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous week)
44th Week Cumulative
Ended Ended First 44 weeks
Disease Median --- ---
November 2, November 3, 1958 1962 Median
1963 1962 1963 1962 1958 1962
Aseptic meningitis ............... 48 71 --- 1,586 2,232 --
Brucellosis ..................... 4 4 10 314 347 627
Diphtheria ...................... 10 9 32 226 375 608
Encephalitis, infectious .......... 28 23 39 1,336 1,601 1,601
Hepatitis, infectious and serum... 783 921 921 36,685 46,438 32,325
Measles ........................ 1,448 1,653 1,640 365,379 451,293 403,312
Meningococcal infections ......... 41 32 34 2,031 1,809 1,913
Poliomyelitis, total.............. 9 16 88 362 740 2,892
Paralytic..................... 5 13 65 307 587 1,988
Nonparalytic.................. 2 2 11 37 109 600
Unspecified.................. 2 1 12 18 44 304
Streptococcal sore throat
and Scarlet fever ............ 5,838 5,549 --- 284,973 264,553 -
Tetanus ........................ 4 4 --- 230 242
Tularemia...................... 10 3 -- 255 244
Typhoid fever. .................... 13 23 22 464 543 719
Typhus fever, tick-borne,
(Rocky Mountain spotted)...... 2 --- 170 211
Rabies in Animals............... 83 57 57 3,220 3,178 3,178

Table 2. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: 4 Psittacosis: 67
Botulism: 34 Rabies in Man: 1
Malaria: Pa. 1, Minn. 1, Calif. 1 86 Smallpox:
Plague: Typhus, murine: 26


Wekl


Il







Morbidity and Mortality Weekly Report


EPIDEMIC CURVE OF MALARIA OUTBREAK
M/V RANBORG (By date of onset)


IN PORT .r..:-
---AT TRANS-ATLANTIC-
CONAKRY, PASSAGE
GUINEA /^
~ tl


4B.-
-"?




AT
PORT
NEWARK,
NEW
JERSEY


-LEGEND -
-* CASE NO.

D *CLINICAL
CASE




O *ASYMPTOMATIC
CASE
aiSCOEREL-


SEPTEMBER OCTOBER


who came to the ship. Case #4, the more severely ill of the
two, continued to experience these symptoms and was
hospitalized in Philadelphia on October 21. At that time;
he had an irregularly spiking fever with a range from 103
to 106.8F. He was initially diagnosed as having viral
influenza and was treated with tetracycline.
Case #5 remained aboard the MiV Ranborg on its run
to Newark but, by the time of the ship's arrival on the
21st, his symptoms had worsened in severity. On October
23, he was found comatose in his bunk and was rushed
to a Newark hospital. At the time of his admission, he
was stated to have had a stiff neck. A spinal tap was
performed shortly after admission, revealing a protein of
60 mg. percent. No abnormal cell count was noted.
This patient's white blood count was 10,000, and
the smear showed a marked shift to the left with 40 band
cells. His hematocrit was 47. On physical examination,
no papilledema, exudates, or hemorrhages could be demon-
strated on fundoscopic examination. His spleen could not
be palpated. There were slightly increased responses to
the deep tendon reflexes, but there was no Babinski sign
present. There was no stiff neck noted.
On October 21, another crew member became ill (Case
i, This man experienced symptoms identical to those
of his shipmates: chills, headache, muscle pains and
fever. On October 24, he, too, became comatose and was
hospitalized immediately at the same Newark hospital.
fHe experienced an irregularly spiking temperature
which reached a maximum of 1050F. On physical exami-
nation, his neck was supple. The fundi revealed no papil-
ledema, exudates or hemorrhages. There was no spleno-


megaly. Babinski signs were present, bilaterally. His
white blood count was 9,000 with a shift to the left (40
bands). His hemoglobin was 78 percent. No hemoglo-
binuria was discovered.
Both cases #5 and #6 were initially diagnosed as
viral encephalitis.
On October 24, on a routine complete blood count
performed on Case #5, the laboratory technician noted
"funny little things" in the red blood cells, and called
them to the attention of the physician. The diagnosis of
cerebral malaria became apparent.

At about the same time October 23, Case #4, hospi-
talized in Philadelphia, was found to have a positive
malaria smear, also. Therapy for this patient was changed
to Chloroquine phosphate. The same drug was given to
Cases #5 and #6 in Newark. All responded.
After the local health authorities were notified, an
epidemiological investigation was begun by the New
Jersey State Health Department.
A review of the ship's log revealed that the M/V
Ranborg sailed from ports in Texas and Louisianain
early August for the West Coast of Africa, arriving at
Lobito, Angola, on August 30 (see map p. 368). She re-
mained in port until September 11, when she sailed for
Matadi, Republic of Congo, arriving at this Congo River
port on September 13. She remained there for 7 days. On
September 20, the M/V Ranborg sailed for Abidjan, Ivory
Coast, arriving September 24. At this port, she took on
coffee beans, and then departed for Takoradi, Ghana.
Enroute, the vessel unloaded some cargo at Tema, Ghana.
Once in port at Takoradi, the vessel remained for four


366


IN PORT
AT
TAKORADI,
GHANA


DOCKED
"--I

i



5-
S4-
3
I2-








Morbidity and Mortality Weekly Report


MALARIA CASES ABOARD M/V RANBORG

Case No. Rating Age Onset Termination Parasetemia Symptoms Comment
SYMPTOMATIC CASES
1 Chief 29 October 9 October 15 Yes Chills, headache, Recovered spontaneously.
Engineer muscle pain, fever Smear positive on October 24.
2 Chief 35 October 4 October 17 Refused smear Chills, headache, Recovered spontaneously
Steward muscle pain, fever
3 Oiler 54 October 12 October 17 No smear taken Chills, headache, Died two days prior to
muscle pain, coma, arrival at Philadelphia.
subnormal temperature No medical care.
4 Seaman 32 October 19 October 26 Yes Chills, headache, Hospitalized in Phila-
muscle pain, fever, lelphia. Initial diag-
and severe posterior nosis: viral influenza.
occipital pain
5 Seaman 18 October 19 Yes Chills, headache, Hospitalized in Newark.
muscle pain, fever, Initial diagnosis: viral
and coma encephalitis.
6 Engine 18 October21 Yes Chills, headache, Hospitalized in Newark.
Boy muscle pain, fever, Initial diagnosis: viral
and coma encephalitis.
ASYMPTOMATIC CASES
7 Wife of 31 October 25 Yes Asymptomatic Discovered on survey of crew.
Chief Regularly took "prophylactic"
Engineer quinine.
(Case 1)
8 Seaman 16 Yes Asymptomatic Discovered on survey of crew.
9 Seaman 17 Yes Asymptomatic Discovered on survey of crew.


days for loading of cocoa beans. On October 1, she left
for Conakry, Guinea, her last African port of call, arriving
October 4. She remained 3 days and departed October 7.
In all these ports except Tema, the crew was granted
shore leave. At no time were any of the men known to
have ventured further inland than the city limits of the
port of call. In all ports, the crew remembers distinctly
that there was a heavy infestation of mosquitoes. In fact,
mosquitoes were noted aboard ship while in these ports.
None of the crew members became ill while in Africa.
On October 9, two days out of Conakry, the chief
engineer (Case #1) of the M/V Ranborg complained of
chills, headache, muscle pains and fever. His symptoms
continued intermittently until the 15th. No physician was
aboard the freighter during the voyage and, therefore, no
smear was taken. The chief engineer recovered spon-
taneously.

On October 11, the chief steward (Case #2) also
complained of chills, headache, muscle pains and fever.
His symptoms subsided without benefit of medical treat-
ment by October 17.
A 54-year-old oiler (Case #3) had a similar onset of
symptoms October 12, but these became more severe. His
temperature became subnormal for 2 days. He became
comatose and died October 17. None aboard suspected the
cause of his illness. His body remained aboard ship
since it was but two days out of Philadelphia. On arrival
October 19, the death was reported. The partially decom-
posed body was removed for autopsy, which revealed on
gross examination a cerebral infarct. Microscopic slides
are currently being examined.


Notably, 24 of 36 crew members were vaccinated
against yellow fever while at Lobito, Angola, on Sep-
tember 3. An identical ratio is true of the 9 cases, 6 of
whom received this vaccine. The possibility of this
outbreak being induced malaria secondary to administra-
tion of the yellow fever vaccine appears to be ruled out
by an incubation period which would be, at the least, 50
days. None of the crew were known to have been tattooed
or received other injections.

Prophylactic therapy against malaria had been pas-
sively offered to the crew from two days prior to through
7 days following the M/V Ranborg's visit to Africa.
Quinine sulfate was available in the mess room during
this period of time; however, few took the drug.

The M/V Ranborg was in port at Port Newark when
the diagnosis of malaria was first made. At that time,
blood smears were taken voluntarily of most crew mem-
bers. Three of these smears were positive (Cases #7, 8,
and 9). Because the M/V Ranborg was scheduled to con-
tinue on to Canada without a physician aboard, all re-
maining crew members were treated with Chloroquine
phosphate in a total dosage of 2.5 grams. This drug was
administered as follows: 1.0 gram initial dose, 0.5 grams
6 hours later, 0.5 grams the following day, and 0.5 grams
on the third day.


(Reported by Dr. W. F. Dougheity, Director, Division of
Preventive Disease, New Jersey State Department of
Health; Dr. W. D. Schrack, Jr., Director, Division of Com-
municable Disease Control, Pennsylvania State Depart-


367







Morbidity and Mortality Weekly Report


ment of Health; Dr. Sylvan Fish, Philadelphia Department
of Public Health; and a team from the Communicable
Disease Center.)

Editor's Note: Plasmodium falciparum is the predominant
type of malaria along the hyperendemic West Coast of
Africa. The two chiefvectors are Anopheles gambiae and
A. funestus, both of which are widely distributed through-
out the region. According to Dr. George MacDonald in his
book entitled "The Epidemiology and Control of Malaria,"
page 77, "A. gambiae is catholic in its choice of breeding
place with a bias towards sunlit open pools and A. Junes-
tus is associated with vegetated swamps, grassy river-
sides and such-like water. Their likes are such that
except in dense forest there are few places where one or
the other, if not both, are not prevalent."
In Conakry, the edges of the swamps are approxi-
mately 6-8 kilometers from the center of the city, but
mosquitoes are plentiful within the port area, especially
in pocketed sections. Transmission is definitely known
to occur within the city.
The data pertaining to the incubation periods sug-
gests one or two cities as the most likely source or
sources for the outbreak aboard the M/V Ranborg. The
two most likely cities would be Conakry and Takoradi.
Interestingly, the only other malaria fatality recorded
thus far in 1963 was a 28-year-old Norwegian seaman, who
worked aboard the MLS Corneville, a freighter chartered


by a Norwegian shipping line. This victim was dead on
arrival at a Norfolk, Virginia, hospital in April. He had
been aboard the MLS Corneville on a voyage from the
West Coast of Africal .An autopsy confirmed the presence
of malaria parasites in the spleen. The specific type of
malaria, however, is not as yet known to the Communica-
ble Disease Center.
Prior to this year, the last fatal case of falciparum
malaria reported to the Communicable Disease Center oc-
curred in 1959. A 47-year-old, white female missionary,
who had spent the previous two months in Haiti, became
ill shortly after returning to the United States, complain-
ing of persistent diarrhea for more than a week. Then she
noted chills and fever and was admitted to the hospital
in a semi-delirious state. Her illness was fulminating,
characterized by high spiking fever, central nervous
system depression, and anemia. A blood smear revealed
the presence of P. falciparum and the patient was treated
with chloroquine. Despite vigorous therapy, the patient
rapidly went into congestive heart failure complicated by
pulmonary edema, hypotension and renal shut-down.
Shortly thereafter, the patient died. Post-mortem examina-
tion revealed subendocardial hemorrhage, toxic myocardial
degeneration, chronic passive congestion of the liver and
spleen, congestion of the lungs, and renal edema. The
final diagnosis was falciparum malaria, congestive heart
failure, and renal shut-down.


368








Morbidity and Mortality Weekly Report



TEXAS PSITTACOSIS CASES
Dne (c-men Token ad Colpl.n Fi-ia Toe-s
Clinical Onl"
C..e Humb DIte I., Spc.ien 2nd Scin 3 SI .e.n th Sydien
1ST OUTBREAK
I AIl 21 June 4 Jun 7 J. 17 Ju.. 24
1/128 1/128 1/64 1/64
2 A Il 22 Aprl 30 May 27 Jun 4 June 17
1/64 1/128 1/128 1/64
3 April 22 Mo, 20 J..uS Ju 11
1/16 1/32 1/32
4 Apl0 24 .y 30
5 Aprl 24 Je 5 Juno 12 Jun. 18 J.un 26
1/16 1/32 1/32 1/32
6 April 24 M 6 M 27 Jue 4 J.n I0
Noneoclire_ 1/32 1/32 1/32
7 Aprl 25 ApI 26 June J une 10 J.un 17
1/9 J11644 1/64 1/64
a Apri 28 May 2B Jun 7 J.un. 14 J.un 21
1/32 1/32 1/32 132
2ND OUTBREAK
9 May 24 Juno 6 June 11
1/ 32 1/32
10 Ma., 24 Jun 4 June 10 -J. 14 J2o 24
_No c1/32 1/32 1/64
It May 27 June 14 Jul 9
1/32 Negate
S-i-....k.-bn


Psittacosis Texas
Between April 21 and May 27, 11 employees of a small
plant in Texas which processed turkeys from the surround-
ing area, became ill with mild symptoms including chills,
dry cough, chest pains, general malaise, and fever to
1020F. The 4 physicians attending these patients speci-
fically requested complement fixation tests for psittacosis.
As a result, Texas State Department of Health authorities
began an epidemiologic investigation.
Eight of these cases had onset dates between April 21
and April 28, 1963, while 3 cases had onset dates between
May 24 and May 27, 1963, thus indicating that there were
two separate exposures, roughly one month apart.
A veterinary epidemiologist obtained the specific
date on which each flock of turkeys had been processed
during the months of April and May, and then, by relating
the onset dates with the known incubation period of
psittacosis (4 to 15 days), the suspected flocks were
narrowed to those processed between April 10and April 16,


for the first outbreak. During this period of time, five
separate and distinct flocks were processed. The birds
which remained on the five different farms were then bled
for laboratory tests. A single flock was found to be in-
fected. The date of its processing was April 11.
In a similar manner, the second outbreak was traced
to an infected flock processed May 14.
The remaining birds of both infected flocks were
placed under the jurisdiction of the Texas' Animal Health
Commission, which instituted proper therapy and quaran-
tine measures.
(Reported by J. E. Peavy, M.D., Commissioner of Health,
and M. S. Dickerson, M.D., Epidemiologist, Communicable
Disease Division, Texas State Department of Health.)
Editor's Note: A total of 67 cases of psittacosis have
been reported thus far in 1963. Of these, 16 have been
reported from Texas. In only one of the past 3 years has
Texas reported cases of psittacosis. In 1961, 23 cases
occurred in another outbreak in a poultry processing plant.


TEXAS TURKEY ORNITHOSIS


Infected Flock
Sloughtered
4

3

2


APRIL


369







Morbidity and Mortality Weekly Report


Staphylococcol Food Poisoning North Dakota
On September 27, 1963, 225 students and teachers of
a North Dakota school became ill with nausea, vomiting,
and prostration 2-6 hours after eating a lunch served in the
school cafeteria. Forty-three required hospitalization, the
maximum period being 24 hours.
A tentative diagnosis of staphylococcal food poison-
ing was made by physicians treating these victims, and the
incident was reported to the County Health Officer. He, in
turn, called the State Epidemiologist to request additional
epidemiologic assistance in investigating the outbreak.
The school is a consolidated elementary and high
school combined under one roof. The school cafeteria feeds
approximately 550 students and teachers each day.
The luncheon included egg salad and tuna salad
sandwiches, as well as tomato soup, milk, and ice cream.
Histories )f illness and foods consumed were obtained by
interviews conducted classroom byclassroom three days
later.
Among 109 first and second graders eating at the
cafeteria only one reported being ill. These two classes
had eaten at the earliest of three luncheon sittings held
according to classroom groups. The rest of those ill were
from groups eating later. A tabulation of food histories
comparing those ill with those not ill is, as follows:


Attack Rate
Foods Ate Did Not Eat Per Hundred
Served Well III Total Well III Total Ate Did tot Eat
Egg 109 179 288 150 12 162 62.2 7.4
Tuna 41 0 41 218 191 409 46.7
Tomato soup 167 135 302 92 56 148 44.7 37.8
Milk 192 144 336 67 47 114 42.8 41.2
Ice Cream 212 154 366 47 37 84 42.0 44.0


As will be noted, 179 ot the 191 ill individuals had
consumed egg salad sandwiches. Nine had eaten tuna fish
salads in.addition, but none had eaten tuna sandwiches
only. Three individuals developing the disease gave a
history of having eaten neither type of sandwich.
The eggs utilized in the preparation of egg salad were
boiled in the morning prior to the meal, and peeled there-
after by six food handlers. They were then ground up in a
mechanical grinder and stored in a refrigerator until the
following morning, at which time the cook added mayon-
naise, using her hands as well as a large spoon to mix the
salad. The salad was then left at room temperature until
additional cooks arrived and spread the sandwiches. The
sandwiches remained in the kitchen at room temperature
until serving time, which began at approximately 11:00 a.m
and was concluded at 1:00 p.m. It is of interest that many
employees complained about the temperature in the kitchen
due to unseasonably hot weather being experienced in
North Dakota at that time.
Bacteriologic study confirmed a heavy growth of
staphylococci from the remaining egg salad, but not from
the mayonnaise. No tuna salad was available for labora-
tory study.


No skin lesions or infections could be found among the
food handlers to account for introduction of the organism.
Because the vast majority of cases occurred among in-
dividuals eating during the later part of the serving period,
it may be postulated that the organism was introduced at
the time of spreading of the sandwiches rather than at the
time the salads were made, although it is also possible
that the increased time before consumption allowed rapid
bacterial growth and enterotoxin production.
North Dakota Public Health officials concluded the
outbreak was due to staphylococcal enterotoxin and that
the organism was introduced by food handlers with bac-
terial growth augmented by the high temperature in the
kitchen.
(Reported by G. L. Wiltse, M.D., Wabpeton County Health
Officer; A. B. Johnsgard, Sanitarian. Division of Environ-
mental Sanitation; H. D. Neugebauer, Field Representative;
and Kenneth Mosser, Director, Division of Preventable
Disease, North Dakota State Department of Health.)



Dengue-Like Illness Puerto Rico
During the past week, 1,067 cases of dengue-like
illness were officially reported to the Puerto Rico Depart-
ment of Health, bringing the total of reported cases in
1963 through November 2 to 17,838.
(Reported by Dr. Victor A. Gonzalez, Director, Bureau of
Health, Puerto Rico Department of Health.)




INTERNATIONAL NOTES

Dengue Fever Jamaica
During the 2 week period ending October 19, 292
additional cases of dengue fever were reported in Jamaica,
thus bringing the cumulative official total for the year to
978 cases. For a 3 week period ending October 19, cases
had been reported in all of the 14 Jamaican parishes,
according to the October 23 issue of the Weekly Epidemi-
ological Report of the Pan- American Sanitary Bureau.

TABLE I
DENGUE ATTACK RATES BY CONSTITUENCY
FOR KINGSTON METROPOLITAN AREA

Socio- Coases No. of No. of
Economic Som e Par Housing Housing Units Housing Units
Group Constituency P.p. Co... 100 Unit. With Caes With Cos..

A 210 26 12.8 47 10 21.3
UB 864 125 14.5 185 66 35.6
Total 1074 151 14.1 232 76 32.7
C 464 37 7.9 107 21 19.6
D 466 27 5.8 113 14 12.4
Middle E 731 33 4.5 179 21 11.7
F 900 59 6.6 146 39 26.7
G 166 6 3.6 30 3 10.0
Total 2727 162 6.0 575 98 17.0
H 325 12 3.7 80 11 13.8
Lo*wr I 321 IS 4.7 75 10 13.3
J 587 23 3.9 118 12 10.2
Total 1239 50 4.0 273 33 12.1
Taol City 5040 363 7.2 1080 207 19.2


370






Morbidity and Mortality Weekly Report


During the period October 14-17, a stratified random
sample survey was conducted in the Kingston-St. Andrews
corporate area as part of which the question "Have you
had dengue fever in the past year?" was asked of re-
spondents. On the basis of preliminary analysis of re-
sponses to this question, attack rates for "dengue fever"
have varied from 4 percent in the lower socioeconomic
areas to 14 percent in the upper group (see table p. 370).
It is impossible, however, to determine whether this
represents a real difference in disease incidence or simply
a difference in awareness of health problems and response
to the questioning. The overall attack rate was 7 percent,
indicating that approximately 25,000 cases of dengue-like
illness occurred in the Kingston metropolitan area this
year, based on the 1960 census figures of 376,520 persons.
The vast majority of these cases were obviously not
officially reported to the Ministry of Health, thus account-
ing for the discrepancy in the number of officially reported
cases.
Age specific attack rates indicate higher incidences
in the 10-14 and 15-24 year age groups (see table right ),
although the differences in the various age groupings are
not striking. The attack rates for females is slightly
higher than for males.


TABLE II
DENGUE ATTACK RATE BY AGE AND SEX
FOR KINGSTON METROPOLITAN AREA

Cases Sample Population Attack Rate
Age M F Total M F Total M F Total
0-4 15 11 26 432 447 879 3.4 2.5 3.0
5-9 21 25 46 360 372 732 5.8 6.7 6.3
10-14 29 18 47 264 248 512 11.0 7.3 9.2
15-24 35 63 98 306 472 778 11.4 13.3 12.1
25-39 38 49 87 412 586 998 9.2 8.4 8.7
40+ 21 38 59 486 655 1141 4.3 5.8 5.2
Total 159 203 363 2260 2780 5040 7.0 7.3 7.2




No epidemiologic conclusion can be reached as to
the type of dengue virus causing the illness. The rates
are lower than those observed currently in Puerto Rico
(about 25%), but show a similar age distribution with
highest rates in young adults and lowest in both the very
young and the over 40 age groups.


(Reported by Dr. A. A. Peat, Chief Medical Officer,
Ministry of Health, Jamaica, and a team from the
Communicable Disease Center.)


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 November 2 was 6,186 as compared with an
expected weekly average of 6,330.

WEEK ENDING
4 Week Weekly
10/12 10/19 10/26 11/2 Total Average


Observed 6,205 6,317 6,182 6,042 24,746 6,186

Expected 6,234 6,297 6,362 6,428 25,321 6,330


Excess -29 20 -180 -386 -575 -144


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


(See table, page 375)


371


--









372 Morihidity and M1ortality Weekly Report


Table i. CASES O(1 SPE( IFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED


NOVEMBER 2, 1963 AND NOVEMBER 3, 1962


Poliomyelitis, Aseptic
Poliomyelitis, total cases Poliomyelitis, paralytic nonparalytic Meningitis
Cumulative Cumulative
Area
44th week First 44 weeks 44th week First 44 weeks 44th week 44th week
1963 1962 1963 1962 1963 1962 1963 1962 1963 1962 1963 1962


UNITED STATES...... 9 16 362 740 5 13 307 587 2 2 48 71

NEW ENGLAND.............. 8 7 8 7 2 3
Maine ................. 2 2 1 -
New Hampshire........- -
Vermont ............... 1 1
Massachusetts...... .. 3 6 3 6 2
Rhode Island.......... 1 1
Connecticut.......... 2 1 1 2 1

MIDDLE ATLANTIC........... 2 1 114 75 1 1 90 54 1 7 2
New York............... I 9 57 1 6 39 5 2
New Jersey............ 1 1 4 7 1 3 7 1 -
Pennsylvania 101 11 81 8 2 -

EAST NORTH CENTRAL....... I 8 52 109 5 41 80 2 6 4
Ohio.................... 1 8 19 1 4 17 -- 3
Indiana................ 4 18 3 14
Illinois.............. 3 17 48 2 16 33 1 2 1
Michigan............... 3 15 17 2 15 13 1 4
Wisconsin............. 1 1 8 7 3 3 -

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

SOUTH ATLANTIC............ 2 2 64 58 1 2 54 5 6 9
Delaware............... I 1 3
Maryland............... 3 1 1 1 1
District of Columbia. 2 1 -
Virginia .............. 1 19 8 13 8 3
West Virginia........... 3 5 3 5 1 1
North Carolina........ 1 3 11 1 3 9 -
South Carolina........ 7 6 6 6 -
Georgia................ 19 14 18 13 -
Florida ............... 1 1 9 11 1 1 9 8 5 1

EAST SOUTH CENTRAL....... 4 68 67 3 63 55 1 6 2
Kentucky............. 1 26 1 20 -
Tennessee ........... 8 10 8 5
Alabama............... 3 51 22 2 46 22 1 3 2
Mississippi........... 1 8 9 1 8 8 3

WEST SOUTH CENTRAL....... 1 25 295 1 24 230 8
Arkansas.............. 5 14 4 14 1
Louisiana............ 14 24 14 21 -
Oklahoma.............. 1 21 1 16 3
Texas................. 6 236 6 179 4

M0 -TAIN................. 5 15 4 11 1 8
Mantana................ 4 -- 3 -
Idi h ................ .. 1 2 1 1 -
Wy tng............... 2 1 -
C il rado.............. 2 1 1 6
N 'xici............. -
Arizo a............... 3 3 3 3 2
ith.................. 2 2- -
Nev.r d ................

PACIFIC.................. 4 21 76 4 18 72 17 31
UWshingt n ............ 2 5 2 5 1 1
Or on ................ 2 5 1 5 1
Ca i rua. ........... 4 17 66 4 15 62 15 30
Alaska ................. -
PiHawa i ................ 5 12 4 12

Piert" Rico ..............j 1 5 12 4 12








Morbidity and Mortality Weekly Report 373


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 2, 1963 AND NOVEMBER 3, 1962 (Continued)



Brucellosis Diphtheria Encephalitis, Hepatitis, Measles
infectious infectious and serum
Area
Cumu- Cumu- 44th week
lative lative Under 20 &
44thweek 44 weeks 44th week 44 weeks 44th week 20 yr. over Total 44th week
1963 1963 1963 1963 1963 1962 1963 1963 1963 1962 1963 1962
UNITED STATES...... 4 314 10 226 28 23 381 346 783 921 1,448 1,653

NEW ENGLAND.............. 1 8 3 1 62 59 130 89 105 105
Maine................. 33 17 50 32 6 25
New Hampshire........... 9 13 25 3 -
Vermont............... 1 7 2 11 5 4 2
Massachusetts......... 6 6 11 19 42 16 58
Rhode Island........... 2 3 1 4 7 3 14 3
Connecticut........... 1 6 12 18 4 65 17

MIDDLE ATLANTIC.......... 7 22 7 9 69 83 152 171 223 150
New York............... 4 13 4 7 38 50 88 106 75 55
New Jersey............ 1. 4 9 10 19 22 56 48
Pennsylvania.......... 2 5 3 2 22 23 45 43 92 47

EAST NORTH CENTRAL....... 39 2 26 58 57 123 121 295 537
Ohio.................. 1 10 16 28 41 88 65
Indiana............... 6 2 8 7 3 10 10 56 27
Illinois.............. 20 12 12 13 26 17 58 25
Michigan .............. 5 3 25 24 49 47 57 164
Wisconsin............. 8 2 4 1 10 6 36 256

WEST NORTH CENTRAL ....... 2 168 39 5 3 17 4 30 38 43 128
Minnesota............. 1 9 15 1 2 6 9 2 11
Iowa.................. 1 125 1 1 2 1 3 4 8 65
Missouri.............. 12 1 7 2 10 13 5 6
North Dakota........... 2 2 1 1 1 1 27 45
South Dakota........... 10 12 1 i -
Nebraska.............. 6 8 3 1 4 8 1
Kansas................ 6 1 1 2 6 3 NN NN

SOUTH ATLANTIC.......... 1 20 4 54 3 4 48 40 88 93 232 92
Delaware.............. 1 1 1 3 -
Maryland.............. 1 7 8 15 6 36 1
District of Columbia.. 1 1 1 3 4 1 1 -
Virginia.............. 1 10 5 6 11 19 60 26
West Virginia.......... 1 7 1 8 12 95 36
North Carolina........ 4 1 3 25 8 33 28 6 1
South Carolina........ 17 1 1 2 11 15 -
Georgia................. 3 18 1 1 1 4 9 1
Florida............... 3 3 14 2 2 2 11 13 11 7 27

EAST SOUTH CENTRAL ...... 1 14 1 20 1 37 16 55 150 56 48
Kentucky.............. 3 13 3 17 44 33 13
Tennessee............. 6 3 15 13 28 28 20 32
Alabama ............... 1 5 1 14 5 5 57 1
Mississippi........... 3 1 4 5 21 3 2

WEST SOUTH CENTRAL....... 35 3 48 2 21 18 41 54 86 64
Arkansas............... 8 2 2 4 6 9 1
Louisiana............. 8 3 30 2 2 4 11
Oklahoma............... 5 6 2 2 4 -
Texas.................. 14 10 2 17 10 29 30 86 63

MOUNTAIN................. 9 5 1 9 5 31 39 122 .67
Montana............... 3 2 7 4 58 78
Idaho.................. 3 3 20 16
Wyoming............... 1 I -
Colorado ............. 3 4 12 12 27
New Mexico............. 2 4 1 5 2 NN NN
Arizona............... 3 7 11 16 25
Utah.................. 5 1 1 2 3 6 11 21
Nevada................. 1 5

PACIFIC.................. 21 4 9 3 60 64 133 166 286 362
Washington ........... 15 9 27 21 50 116
Oregon ................ 3 3 9 12 19 30 56
California............ 17 4 9 3 34 46 80 101 157 91
Alaska................ 8 14 25 49 31
Hawaii.................. 1 68

Puerto Rico.............. 1 12 10 5 15 24 56 37










3741 lorlpiditv and Mortality Weekly Report


Tahlh i. CASES OF SPICIHFID NOTIFIABLE DISEASES: INITII) STATES

FOR WEEKS FNDED


NOVEMBER 2, 1963 AND NOVEMBER 3, 1962 (Continued)


Meningococcal Streptococcal Tickborne
Infections Sore Throat & Tetanus Typhus Tularemia Typhoid Fever Rabies in Animals
Scarlet Fever (Rcky Mt.
Area Cumu- Spotted) Cumu- Cumu-
lative lative lative
44th wk. 44 weeks 44th week 44th wk. 44th wk. 44th wk. 44th wk. 44 weeks 44th week 44 weeks
1963 1963 1963 1962 1963 1963 1963 1963 1963 1963 1962 1963

UNITED STATES.... 41 2,031 5,838 5,549 4 10 13 464 83 57 3,220

NEW ENGLAND......... 124 443 406 12 31
aine............ 18 19 7 2 2
New Hampshire..... 4 15 5 15
Vermont............ 5 42 1 -13
Massachusetts...... 58 72 60 6 1
Rhode Island....... 11 28 38 -
Connecticut........ 28 309 254 3 -

MIDDLE ATLANTIC..... 5 277 228 190 1 83 5 4 105
New York........... 4 130 154 108 1 43 2 1 77
New Jersey......... 41 36 53 5 5
Pennsylvania....... 1 106 38 29 35 3 3 28

EAST NORTH CENTRAL.. 6 315 482 388 1 2 55 15 15 494
Ohio............... 2 82 77 60 1 22 7 8 289
Indiana............ 1 46 82 90 7 3 2 47
Illinois........... 2 62 64 60 10 2 2 69
Michigan .......... 92 182 88 1 11 3 1 47
Wisconsin.......... 1 33 77 90 1 5 2 42

WEST NORTH CENTRAL.. 1 123 122 162 5 26 19 11 838
Minnesota.......... 24 5 7 3 6 6 219
Iowa............... 7 34 47 3 4 2 302
Missouri........... 1 36 8 5 4 16 6 3 144
North Dakota....... 13 62 66 32
South Dakota....... 7 9 3 1 2 91
Nebraska........... 25 4 1 1 30
Kansas............. 11 4 30 1 2 20

SOUTH ATLANTIC...... 8 371 679 562 1 3 65 10 8 460
Delawar ........... 4 5 5 4 1
Maryladd............ 2 53 8 4 11 -
Dist. of Columbia.. 1 7 4 3 -
Virginia........... 1 83 228 134 8 3 4 175
West Virginia...... 1 20 181 168 7 1 2 111
North Carolina..... 1 68 32 26 1 1 10 1 15
South Carolina..... 20 47 28 2 6 1 10
Georgia............ 30 2 3 2 2 75
Florida............ 2 86 172 191 17 2 2 72

EAST SOUTH CENTRAL.. 4 144 1,060 1,161 1 2 65 2 4 245
Kentucky........... 31 21 84 13 1 113
Tennessee........... 2 66 997 938 1 25 3 112
Alabama ........... 1 24 10 10 1 11 2 20
Mississippi........ 1 23 32 129 1 16 -

WEST SOUTH CENTRAL.. 5 183 614 477 4 2 85 32 2 616
Arkansas............ 1 12 2 3 2 34 3 75
Louisiana.......... 74 5 5 25 1 45
Oklahoma........... 31 24 5 1 6 2 53
Texas.............. 4 66 583 467 20 28 443

MOUNTAIN............ 2 72 1,252 1,096 1 2 18 3 124
Montana............ 3 76 27 -
Idaho .............. 6 44 107 -
Wyoming............. 7 128 16 -
Colorado............ 20 463 483 6 16
New MIxico......... 4 285 261 2 5 37
Arizona............ 11 98 129 7 3 57
Utah............... 2 18 158 73 -- 3
Nevada ............. 3 11

PACIFIC............. 10 422 958 1,107 2 55 10 307
Washington......... 4 38 252 317 3 -
Oregon.............. 1 32 17 23 2 12
California......... 2 328 534 685 2 47 10 286
Alaska.............. 12 60 8 I 9
Hawaii............. 3 12 95 74 2


- 1 1 13


Puerto Rico........


2 3









Morbidity and Mortality Wccklly Repolrt





Table 4 (D). TOTAL DEATHS AMONG PERSONS 65 YIARS 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.)0


375


Area For weeks ending Area For weeks ending
10/1A a 10/19 10/26 11/2 ___r10/12 e10/19
10/12 10/19 10/26 11/2 10/12 10/19 10/26 11/2


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, 11 .............
Cincinnati, Ohio..........
Cleveland, Ohio............
Columbus, Ohio............
Dayton, Ohio..............
Detroit, Mich.............
Evansville, Ind...........
Flint, Mich...............
Fort Wayne, Ind...........
Cary, Ind.................
Grand Rapids, Hich ........
Indianapolis, Ind.........
Madison, Wis...............
Milwaukee, Wis.............
Peoria, Ill...............
Rockford, Il .............
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 ...........


132
18
21
18
29
18
11
12
31
28
12
16
21
48


29
26
88
30
23
16
36
49
912
18
237
103
28
63
20
18
31
26
17
10


29
16
402
98
125
67
40
197
20
18
21
14
31
87
7
64
20
11
18
54
38


38
17
20
84
19
82
54
127
44
40


154
23
24
24
32
29
18
12
24
53
12
34
17
48


37
13
85
18
12
18
38
47
982
31
238
97
35
82
15
29
40
22
17
12


42
20
346
86
125
55
48
172
30
16
32
17
30
70
20
69
5
22
24
54
39


40
23
14
84
14
76
38
151
41
33


127
15
17
19
32
11
12
16
16
45
9
19
8
31


25
13
90
23
12
25
37
55
969
26
265
111
38
68
17
25
32
20
16
25


25
9
345
91
105
64
58
189
21
27
25
16
38
89
11
75
16
15
25
64
34


33
16
22
94
25
75
54
135
49
34


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......
Col,,rado 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.............


71
125
11
25
32
22
49
17
53
25
85
15


48
23
24
40
43
20
18
44


20
21
13
64
17
30
62
39
76
37
54
28
32


11
10
67
13
56
5
40
27


11
29
15
19
48
313
46
25
59
32
72
88
14
71
31
18


49
109
19
32
40
19
36
10
48
26
83
25


40
26
18
56
69
14
17
56


17
13
10
49
14
27
64
25
80
41
49
18
28


16
14
65
17
37
10
34
26


14
27
26
24
39
306
39
30
64
31
56
111
22
76
33
22


58
133
14
34
41
30
40
11
58
41
82
17


39
30
29
75
65
23
13
46


20
17
11
53
16
31
96
36
61
33
46
21
29


12
12
68
7
33
6
31
18


14
28
22
11
25
279
37
21
76
30*
43
110
22
90
37
28


San Juan, P.R.............. 10 11 9 (---)


OCurrent Week Mortality for 108 Selected Cities

4(A) Total Mortality, all ages.................... 11,091
4(B) Pneumonia-Influenza Deaths, all ages........ 405
4(C) Total Deaths under 1 Year of Age............. 776
4(D) Total Deaths, Persons 65 years and over..... 6,042


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

NOTE: All deaths by place of occurrence.


1


! I I




UNIVERSITY OF FLORIDA

3 1262 088II64 0510 I IIII IIIIII
3 1262 08864 0510


Morbidity and Mortality Weekly Report


QUARANTINE MEASURES

Immunization Information for International Travel
1962 Edition
Public Health Service Publication No. 384

The following information should be added to the
list of Yellow Fever Vaccination Centers in Section 6:

Page 73

City: Rochester, Minnesota
Center: Mayo Clinic
Section of Clinical Pathology
Clinic Hours: Tuesday, p.m. By Appointment Only
Fee: Yes


Page 74
City:
Center:
Clinic Hours:
Fee:


In addition to the established procedures for reporting
morbidity and mortality, the Communicable 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


DOCUMENTS DEPOT





U.S. DEPOSITORY'


Bozeman, Montana
Gallatin County Health Department
Wednesday 1:00 p.m.
Yes


1he 1963-64 edition of the booklet "Immunization
Information for International Travel" is on sale at the
Superintendent of Documents, Government Printing Office,
Washington, D. C., 20402. The cost is 354 a copy with a
25% discount on orders of 100 or more copies delivered to
the same address. Copies of the 1902 edition should
be destroyed.














Note
Next week's edition of the "Morbidity and Mortality
Weekly Report" will arrive one day later than usual due
to the occurrence of Armistice Day, November 11.


m

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376