Morbidity and mortality

MISSING IMAGE

Material Information

Title:
Morbidity and mortality
Uniform Title:
Morbidity and mortality (Washington, D.C. : 1952)
Running title:
Weekly mortality report
Weekly morbidity report
Morbidity and mortality weekly report
Abbreviated Title:
Morb. mortal.
Physical Description:
25 v. : ; 27 cm.
Language:
English
Creator:
United States -- National Office of Vital Statistics
Communicable Disease Center (U.S.)
National Communicable Disease Center (U.S.)
Center for Disease Control
Publisher:
The Office
Place of Publication:
Washington, D.C
Publication Date:
Frequency:
weekly
regular

Subjects

Subjects / Keywords:
Communicable diseases -- Statistics -- Periodicals -- United States   ( lcsh )
Mortality -- Periodicals -- United States   ( lcsh )
Morbidity -- Periodicals -- United States   ( mesh )
Mortality -- Periodicals -- United States   ( mesh )
Statistics, Medical -- Periodicals -- United States   ( lcsh )
Statistics, Vital -- Periodicals -- United States   ( lcsh )
Genre:
federal government publication   ( marcgt )
statistics   ( marcgt )
periodical   ( marcgt )

Notes

Additional Physical Form:
Also issued online.
Statement of Responsibility:
Federal Security Agency, Public Health Service, National Office of Vital Statistics.
Dates or Sequential Designation:
Vol. 1, no. 1 (Jan. 11, 1952)-v. 25, no. 9 (Mar. 6, 1976).
Issuing Body:
Issued by: U.S. National Office of Vital Statistics, 1952-Jan. 6, 1961; Communicable Disease Center, 1961- ; National Communicable Disease Center, ; Center for Disease Control, -Mar. 6, 1976.
General Note:
Title from caption.

Record Information

Source Institution:
University of Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
oclc - 02246644
lccn - 74648956
issn - 0091-0031
ocm02246644
Classification:
lcc - RA407.3 .A37
ddc - 312/.3/0973
nlm - W2 A N25M
System ID:
AA00010654:00129

Related Items

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

Full Text




NATIONAL COMMUNICABLE DISEASE CENTER


Vol. 16, No. 34


~p
44Cd 1'


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


Week Ending
S August 26, 1967



PUBLIC HEALTH SERVICE


BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


EPIDEMIOLOGIC NOTES AND REPORTS


c(ON t NTs


nHIGbLLUOI Vermont .1iidn mi, Nt. 's ii Roi-t

During July 1967. approximately 140 persons were af- 'iphy-l< ,ocl I.., F p. n I i- ;..r ...... .. "
fected with acute gastroenteritis at a summer camp in \ o em
month. The most prominent signs and symptoms of il n .. n-.,phti ... 2 .h ih
were diarrhea. nausea, headache, fever, malaise.
cramps, and dizziness. Less than 50 percent of 4, e ill fro 6 to Ui6 ars of age and 12.5 staff members. Epidemi-
vomited. The illness was mild with a durationlb to tti, invei nation revealed that most cases occurred in
72 hours. One of the campers had bloody diarr o nly to naex tlf illness. the firsi from July 4 to and the
one patient required more intensive care than a t e second fro9f- ly 13 to 1S (Figure 1, page 286). Attack
provided at the camp infirmary. r \ rates for NF'e ir. camp \\ere 6.4 and 20.0 percent in the
Approximately -50 persons made up the caml first 1 .r.. ,\aves. respectively. Fi\e of six persons
dent population at the lime of the outbreak: 325 c r;h._ .'/ (Coi/,inued on page 286)

CASES OF SPECIFIED NOTiF SEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
34th WEEK ENDED CUMULATIVE, FIRST 34 WEEKS
MEDIAN
DISEASE AUGUST 26, AUGUST 27, 1962 1966 MEDIAN
1967 1966 1967 1966 1962 1966
Aseptic meningitis ......... .. ... 112 150 74 1,499 1,477 1.177
Brucellosis................... ..... 7 10 170 156 243
Diphtheria ............ ........ ... 1 1 3 66 113 156
Encephalitis, primary:
Arthropod-bore & unspecified .......... 48 111 972 1.111 -
Encephalitis, post-infectious .. ........ 11 10 -- 604 560 -
Hepatitis, serum ................... ..... .51 35 638 1.395 912 26,005
Hepatitis, infectious .................... 735 535 24,951 21,226
Malaria ............................... 41 12 3 1,273 230 59
Measles rubeolaa) ....................... 175 491 832 57,250 188,165 356.342
Meningococcal infections, total ........... 22 43 28 1.624 2,643 1.886
Civilian ............................ 21 39 -- 1,512 2.371 -
Military.............................. 1 4 --- 112 272 -
Poliomyelitis, total .................... .. 1 4 23 61 69
Paralytic ............................. 3 19 57 57
Rubella (German measles) ................ ..178 204 39,467 41,121 -
Streptococcal sore throat & scarlet fever .. 4,603 3.797 3,797 314,825 298,120 276,674
Tetanus................................. 3 5 5 143 110 169
Tularemia .............................. 5 5 5 118 114 186
Typhoid fever ........................... 6 9 13 254 236 265
Typhus, tick-borne (Rky. Mt. spotted fever). 14 13 11 213 181 166

Rabies in animals ....................... 71 75 74 2.974 2,846 2,846

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
A nthrax: ........................................... 2 R abies in m an: ............. ......... ......... 2
Botulism: .... ........................ .......... 2 Rubella, Congenital Syndrome: .... ..... ........ .. 4
Leptospirosis: ....................................... 25 Trichinosis:................. ..... ..... .... 45
Plague: ............................................. 2 Typhus, murine: ................................... 29
Psittacosis: ........... .... ... ... ....... ....... 31 Polio, Unsp. M d.-l .......... ... 4


~lc~' ei~ 6Lj/Y~~ /C?/~*r







286


Figure 1
SHIGELLOSIS AT A CAMP IN VERMONT
JULY 1-29, 1967


[ TOTAL CASES
L t.: -; .- CONFIRMED
C-:: L- ONLY ONE
RECTAL SWAB CULTURE


4 6 8 0 12 14 16 iA
JULY
DATE OF ONSET


ill during the first wave who were examined bacteriologi-
cally for enteric pathogens were found to be shedding
- .. sonnei in their stools. In the second wave, one
rectal swab was obtained from each patient reporting to
the camp infirmary, and 45 percent were positive for
S. sonnei.
Attack rates among campers by geographic residence
in the camp were not significantly different in either wave.
Comparisons of employee groups affected in the first wave
by duties and geographic residence in the camp were in-
conclusive due to the low numbers involved. In the sec-
ond wave, however, there appeared to be a greater risk
of infection among employees working in the camp stables,
as 8 of 21 (38 percent) were affected in contrast to 17 of
the camp.
Sewage contamination of the major well at camp was
implicated as the most probable source of infection. All
disposal of body wastes at the camp is by water carriage
to a series of septic tanks with drain fields. The camp
is located on a hill underlain with rock sloping downhill
just below the surface. Because of the underlying rock.
all water drainage from the camp eventually reaches a
gravel aquifer located in a level area at the lowest point
in the camp. The well in question draws water from a 70-
foot depth, just above the underlying rock that continues
to slope into the water-hearing strata. Several water foun-
lains in the most active areas of camp, including the
stable area, are fed by this well. Neither the water from
this well nor that of the two other water systems at the
camp was chlorinated at the time of the outbreak. On
July 10, heavy contamination with coliforms was detected


AUGUST 26, 1967


in samples from the camp water system processed by the
Vermont Department of Health.
On August 7, fluorescein dye was placed in three sep-
tic tanks uphill from the well: within 45 minutes dye was
found in a small pool on the surface of the ground about
200 feet away and 40 feet below one of the septic tanks.
Six days later water from the well contained the dye. Thus
underground channeling could have led a stream of sewage
from one or more of the septic tanks into water being
drawn by the well. The first areas to receive water from
the well are the stables: the higher attack rates observed
in the stable employees may provide additional support
that the illness was waterhorne, at least in the second
w ave.
Food histories obtained from the resident camp popu-
lation for July 11-14 indicated that a significantly greater
number of ill persons consumed milk than did well persons
at lunch and supper on July 11. The milk supplied to the
camp was pasteurized. Inspection of the dairy did not re-
veal any significant sanitary deficiencies and there was
no history of illness among dairy employees. No illness
is known to have occurred at two other camps receiving
the same milk. The camp received seven or eight 40-quart
containers of milk daily. From these containers, milk was
poured into 2-quart pitchers for serving. Some milk was
usually left in the pitchers following a meal. It is possible
that this milk could have been placed in less than full 40-
quart containers and served again at the following meal.
It is known that the food handler who poured milk on
July 11 had diarrhea on that day and was culturally positive
for S. sonnei in an initial survey of the kitchen help on
July 10. There is a possibility that he contaminated the
milk, which could then have incubated at less than re-
frigerator temperatures during and just after mealtime.
During the second wave, emergency measures were in-
stituted to provide appropriate medical attention and to pre-
vent spread of illness to unaffected persons at the camp.
A number of sanitary deficiencies in the kitchen, as well
as in the general camp operation, were found during the
investigation of the outbreak. Prompt correction of the
major deficiencies, particularly the provision of safe drink-
ing water, was made as soon as the second wave of ill-
ness was evident. No new cases of shigellosis have oc-
curred since July 28.
(Reported by Dr. Robert Aiken, State Health Commissioner,
Dr. Linus Leavens, State Epidemiologist, and other per-
sonnel from the Vermont Department of Health; and a team
from NCDC.)
Editorial Note:
The epidemiologic features of this epidemic of shigel-
losis, occurring in two waves, strongly suggest repeated
exposure to the same common vehicle. Intermittent con-
tamination of the unchlorinated water supply seems to be
the most likely source for these two waves of illness,
.irlib.,li potentially contaminated milk cannot be con-
clusively excluded.


Morbidity and Mortality Weekly Report



SHIGELLOSIS Vermont (Continued from front page)








AUGUST 26, 1967


Morbidity and Mortality Weekly Report


SURVEILLANCE SUMMARY
PSITTACOSIS 1966


\ otal of 5)() human cases of plittacosis o wre reported
from n19 sate in 19ti. 11 cases fewer than in 1965. This
is the lowe- total reported since 1951 when 25 were re-
corded (Figure :2).
Parakeets and pigeons, the two most common res-ernoir
hosts since 1962. accounted for 73 percent of the 4.5 ease-
for which exposure data wer e furnished. Parakeet- \\~re
listed as the most probable source of infection for 21
cases (53 percent), and pigeons for 9 (20 percent). Pet-
hird owner, \\ith 21 of the 45i reported case.- (17 percent).
comprised the largest expol-ure category The only case
reported which could he con-idered as occurring in a poul-
tr\ procesor a r- in a 9-year-old child ho helped his
mother gather chicken egg- for subsequent sale. Two com-
ion-source outbreak, which implicated pet parakeet- \\ere
reported: one inmolled a man and wife and the other. a
mother and three children.
Of the i5l human cases studied. 29 (- I percent) oc-
curred in males. The ages ranged from :i to 12 \ear-. w ith
a mean of 1i and a median of 46.
The geographic di-tribution of the 0 caise- wa-
similar to that of the 61 cases reported in 196i. Si\len of
the 19 -tates reported human case- in both 195 i:and 19li6i:
6i states that reported in 1965 did not record an\ casee in
1966. The following states notified three or more human


Figure 2
REPORTED HUMAN PSITTACOSIS CASES'
1 1950-1966


1fF 'n imr?


ca-is in 19i66: Toe\as-10. \isconsin-S. \Ma--achusetts-l.
Penn.-\x1lania-. (California-;,. \linne-ota-3. and Tennes-

Fi\ e ca.-- niere reported in which there \\ere no
knowxin auiani contact- within the month prior to onset. No
turkey\. chicken. or other a tian ornithosis outbreaks were
notified in 9tiH .
Reportcd i y 11w i r i2 i ari Iui lir ll '/, S action. Epi-
dc, /ologn, Progranm. \ (' '.j


REPORTED CASES OF POST-INFECTIOUS ENCEPHALITIS
SECOND QUARTER ENDING JULY 1, 1967 (WEEKS 14-26)


State

Ar zona ...... .. .
Caliform a .. .......
Connecticut ...
Florida .. ....
Illino is .. .. ... ... .
Louisiana ..........
M aryland .. .....
Massachusetts ..... ...
M ichigan ................
M innesota .. ... ......
Neti\ York, Ipstate .
Oregon ..... ..... ...
P cnns l ania .. ..... ....
Rhode Island ....... ..
South Dakota ... ...
Tennessee ... ...
T exas ...... .. .........
\ irginia ...............
W\\ashington ......

Second Quarter Total
196 7 ...... ..
196 6 ... ... ... ... ..
Cumulative Total (Weeks 1-26)
196 7 ... .... ... ... ..
1966 ..........


\lumps Mea les Chickenpuo


Ib
43

51


26
27
Ib


16





1
9


243
137


1
1
13
67


33


Other Spe'cified


Influenza-1
Herpes Simplek.-3,


Herpe- Zuosir-1. Coxsackie Virus-1


Herpes-1
Influenza-1
Herpe. Simplex-1
Post-Vaccinal-1

Influenza-1
Herpes Simplex-1



Staphylococcal-1

Pneumonia-1
Herpes Zoster-1. Post-\ accinal Mca- les-l


~liiU








288 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 26, 1967 AND AUGUST 27. 1966 (34th WEEK)

ENCEPHALITIS HEPATITIS

ASEPTIC Primary
AREA MENINITIS BRUCELLOSIS DIPHTHERIA including Post- Serum Infectious
unsp. cases o

1967 1966 1967 1967 1967 1966 1967 1967 1966 1967 1966
UNITED STATES... 112 150 1 48 111 11 51 35 735 535

NEW ENGLAND........... 1 30 1 4 19 26
Maine.............. 1 1 3
New Hampshire...... 2
Vermont............ 1
Massachusetts...... 1 22 4 8 9
Rhode Island....... 7 2
Connecticut........ 1 10 9

MIDDLE ATLANTIC...... 18 12 3 3 24 17 135 73
New York City...... 1 5 21 12 51 17
New York, Up-State. 5 1 1 3 2 37 15
New Jersey ......... 11 4 -1 3 2 20 15
Pennsylvania ...... 1 2 1 1 27 26

EAST NORTH CENTRAL... 16 6 28 21 1 88 98
Ohio................ 2 2 27 16 17 16
Indiana............. 12 3
Illinois........... 13 1 3 25 21
Michigan............ 1 3 2 1 30 52
Wisconsin.......... 1 4 6

WEST NORTH CENTRAL... 2 4 8 2 1 32 31
Minnesota.......... 2 1 1 2 1 11 3
Iowa............... -- 1 8
Missouri........... 1 12 12
North Dakota....... 5
South Dakota........ 1 1 1
Nebraska........... 4 1
Kansas............. 2 4 6

SOUTH ATLANTIC........ 25 17 1 4 2 2 2 3 87 46
Delaware........... 1 1 4 1
Maryland........... 22 1 2 1 20 10
Dist. of Columbia.. 2 1
Virginia........... 5 19 5
West Virginia...... 1 5 3 3 2
North Carolina..... 1 1 3 7
South Carolina..... 3
Georgia............. 1 15 6
Florida............ 1 3 1 1 2 2 21 11

EAST SOUTH CENTRAL... 8 22 2 4 1 44 45
Kentucky............ 2 2 2 10 13
Tennessee.......... 3 1 1 1 21 12
Alabama............ 2 5 5
Mississippi........ 1 19 3 8 15

WEST SOUTH CENTRAL... 7 27 3 63 2 4 1 75 53
Arkansas........... 2 3 5
Louisiana.......... 2 1 11 4 1 15 11
Oklahoma........... 1 4 1 5 6 -
Texas............... 4 22 47 2 51 37

MOUNTAIN.............. 4 1 2 33 16
Montana............ 4
Idaho ............. 1
Wyoming............ 2 1
Colorado........... 1 14 3
New Mexico.......... 2 1 8 3
Arizona............ 2 1 8 4
Utah................ -
Nevada............ -

PACIFIC............... 31 36 5 4 2 20 12 222 147
Washington.......... 2 5 1 1 26 15
Oregon............. 1 1 14 19
California......... 26 31 4 3 2 19 11 178 110
Alaska............ 2 3
Hawaii............. 2 2 -

Puerto Rico 33 39









Morbidity and Mortality Weekly Report 289


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 26, 1967 AND AUGUST 2-, 1966 (34th WEEK) CONTINUED



MALARIA MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, POLIOMYELIT RUBELLA
TOTALLIOEITIS RUBELLA
AREA Cumulative Cumulative Total Paralytic
Cum.
1967 1967 1967 1966 1967 1967 1966 1967 1967 1967 1967
UNITED STATES... 41 175 57,250 188,165 22 1,624 2,643 1 19 178

NEW ENGLAND........... 1 6 844 2,233 67 118 -- 22
Maine.............. 1 4 238 195 3 9 1
New Hampshire...... 74 80 2 9
Vermont ........... 42 225 1 4 -
Massachusetts...... 2 339 774 32 48 5
Rhode Island....... 62 72 4 13 5
Connecticut........ 89 887 25 35 11

MIDDLE ATLANTIC...... 5 11 2,236 17,953 5 266 315 -5 23
New York City...... 1 2 447 8,260 2 48 44 1 14
New York, Up-State. 1 6 574 2,516 1 66 89 9
New Jersey......... 1 3 484 1,845 92 95 -
Pennsylvania....... 2 731 5,332 2 60 87 3

EAST NORTH CENTRAL. .. 41 5,318 68,306 4 227 407 1 38
Ohio................ 1 1,137 6,331 1 75 112 5
Indiana............. 5 592 5,665 1 31 70 -
Illinois........... 4 938 11,326 1 53 76
Michigan........... 11 917 14,247 1 52 107 1 7
Wisconsin.......... 20 1,734 30,737 16 2 25

WEST NORTH CENTRAL... 5 2,828 8,666 2 70 141 3 7
Minnesota .......... 120 1,639 1 17 34 1
Iowa............... 1 746 5,303 1 14 22 1
Missouri........... 332 530 14 54
North Dakota....... 2 859 1,078 1 9 -
South Dakota ....... 52 40 6 4
Nebraska........... 2 626 76 12 8
Kansas............. 93 NN 6 10 2

SOUTH ATLANTIC....... 14 29 6,836 15,077 5 309 446 1 2 15
Delaware............ 2 45 256 6 4 1
Maryland............ 1 3 152 2,096 38 46 1 1 2
Dist. of Columbia.. 22 382 10 11 -
Virginia........... 1 8 2,179 2,126 1 38 53 3
West Virginia...... 9 1,377 5,181 21 20
North Carolina..... 12 847 476 66 113 1
South Carolina..... 3 510 654 29 47 1
Georgia............ 2 34 234 3 47 63 -
Florida........... 2 1,670 3,672 1 54 89 -

EAST SOUTH CENTRAL... 2 23 5,149 19,586 2 126 230 1 19
Kentucky............ 1 3 1,321 4,694 1 35 84 -
Tennessee......... 19 1,844 12,208 1 53 74 18
Alabama............ 1 1,322 1,677 25 50 -
Mississippi......... 1 662 1,007 13 22 -

WEST SOUTH CENTRAL... 2 36 17,213 24,193 215 366 7
Arkansas.......... 1,404 970 28 33
Louisiana.......... 2 1 152 99 85 137 -
Oklahoma........... 1 3,348 474 16 18 1
Texas............... 34 12,309 22,650 86 178 6

MOUNTAIN.............. 10 8 4,602 11,856 27 84 14
Montana .......... 1 282 1,803 4 1
Idaho............. 377 1,547 1 5 -
Wyoming............. 180 157 1 6 -
Colorado........... 9 1 1,544 1,277 12 45 12
New Mexico........ 2 578 1,130 3 10
Arizona............. 3 1,011 5,277 4 10 1
Utah ............. 1 1 361 622 4 -
Nevada............. 269 43 2 4 -

PACIFIC............... 7 16 12,224 20,295 4 317 536 40
Washington......... 1 1 5,418 3,487 28 37 1
Oregon............. -6 1,572 1,722 25 33 9
California.......... 3 9 4,939 14,487 4 251 447 27
Alaska.............. 133 467 9 15 2
Hawaii.............. 3 162 132 4 4 -
Puerto Rico.......... 1 2 2.101 2.632 12 11









290 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 26, 1967 AND AUGUST27, 1966 (34th WEEK) CONTINUED

STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
A SCARLET FEVER (Rky. Mt. Spotted) ANIMALS
AREA
1967 1967 Cum. 1967 Cum. 1967 Cum. 1967 Cum. 1967 Cum.
1967 1967 1967 1967 1967


UNITED STATES... 4,603 3 143 5 118 6 254 14 213 71 2,974

NEW ENGLAND.......... 513 2 1 3 1 1 74
Maine.............. 35 16
New Hampshire...... 18 37
Vermont ............ 15 1 18
Massachusetts...... 26 1 1 2 1 2
Rhode Island....... 75 1
Connecticut ........ 344 1 1-

MIDDLE ATLANTIC...... 115 11 2 23 4 22 2 62
New York City...... 5 5 2 12 -
New York, Up-State. 107 1 7 3 7 2 52
New Jersey......... NN 1 2 7 -
Pennsylvania........ 3 4 2 1 8 10

EAST NORTH CENTRAL... 327 16 1 12 21 18 8 304
Ohio............... 36 4 5 10 1 103
Indiana............. 80 3 2 7 1 2 66
Illinois........... 55 7 1 10 2 7 1 60
Michigan............ 122 2 6 2 25
Wisconsin........... 34 1 2 50

WEST NORTH CENTRAL... 177 10 1 20 14 3 8 704
Minnesota.......... 3 3 1 2 135
Iowa............... 63 I 1 2 2 91
Missouri........... 1 5 1 8 7 1 2 130
North Dakota ..... 73 128
South Dakota....... 4 1 2 92
Nebraska............ 28 3 2 1 44
Kansas............. 5 9 1 1 84

SOUTH ATLANTIC....... 613 1 34 9 1 33 4 89 8 386
Delaware........... 5 -
Maryland............ 108 2 16 1 2
Dist. of Columbia.. 1 1-
Virginia............ 173 7 3 2 21 3 179
West Virginia...... 162 1 2 1 1 2 56
North Carolina..... 6 6 3 2 38 3
South Carolina..... 13 1 2 7 4 -
Georgia............ 11 3 4 1 9 9 90
Florida............ 135 1 15 1 7 2 56

EAST SOUTH CENTRAL... 855 1 23 1 9 3 44 4 40 19 565
Kentucky........... 60 3 1 1 18 13 128
Tennessee.......... 757 8 1 6 1 8 4 21 12 391
Alabama............ 1 9 9 6 1 38
Mississippi........ 38 3 2 1 9 6 8

WEST SOUTH CENTRAL... 531 1 31 2 56 30 23 19 626
Arkansas........... 5 2 34 7 6 3 86
Louisiana.......... 6 3 4 13 2 56
Oklahoma........... 40 1 14 6 13 7 214
Texas............. 485 1 22 4 4 4 7 270

MOUNTAIN ............. 989 7 16 8 1 92
Montana............ 22 1 -
Idaho............... 57 -
Wyoming............ 2 5
Colorado............ 665 1 11 8 10
New Mexico......... 127 1 28
Arizona............ 72 3 43
Utah............... 46 3 1 3
Nevada............ 3

PACIFIC ............. 483 16 4 70 2 9 5 161
Washington......... 59 2 1 1 1
Oregon.............. 74 1 1 2 1 3
California......... 334 13 2 66 1 6 4 157
Alaska............. 12
Hawaii.............. 4 2 3


Puerto Rico.......... 4 I 10 I __4 ___ __- __ 26








Morbidity and Mortality k eekl Report


Week No. 34 DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED A GUST 26 196-

(By place of occurrence and week of filing certificate. Excludes fetal deaths)

All Causes Pneumonia Under All Causes Pneumonia Under
Area All 65 years and 1 year Area All 6 years and 1a ear
Ages and Influenza All Influenza All
Ages and over A Aess and over Ages Causes
All Ages Causes All Ages Causes


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

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

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


718
213
38
26
41
52
24
18
24
52
70
13
52
44
51

3,181
50
34
119
42
26
36
73
84
1,643
35
476
180
43
113
26
37
59
53
24
28

2,467
55
46
677
168
197
125
90
354
34
51
44
44
38
133
37
109
22
35
43
114
51

764
53
28
29
136
22
107
56
225
55
53


454
124
25
17
26
24
12
14
18
33
45
10
35
34
37

1,876
28
21
66
29
17
22
50
45
947
21
280
107
32
62
16
26
37
32
17
21

1,355
32
28
351
98
101
74
53
187
22
20
20
23
26
82
21
64
11
23
26
61
32

475
40
17
18
99
16
67
23
134
32
29


*Estimate based on average percent of divisional total.


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.------
Wilminigton, Deli.------

EAST SOLUITH CENTRAL:
Birmingham, Ala.-------
Chattanooga, Tenn.----
Kn oville, Ten. .------
Louisville, Ky.--------
Memphis, Tenn.---------
Mobile, Ala.-----------
Nontgomery, Ala.-------
Nashville, Tenn.-------

WEST SOUTH CENTRAL:
Austin, Tex.-----------
Baton Rouge, La.-------
Corpus Christi, Tex.---
Dallas, Tex.-----------
El Paso, Tex. ----------
Fort Worth, Tex.-------
Houston, Te.----------
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.-----------


145
49
29
92

970
38
48
28
132
49
67
176
48
128
74
90
53
39

415
36
15
102
20
109
24
50
59

1,479
15
42
43
44
71
470
87
27
135
55
80
153
30
135
58
34


80
12
10
4
5
6
5
i



17


31
7
5
3
5

4
3
4

66
4
3
3
7
6
6
11
3
8
3
10
2


23


Total 11,686 6,591 400 618

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 421,574
All Causes, Age 65 and over------------------- 240,807
Pneumonia and Influenza, All Ages------------- 15,102
All Causes, Under 1 Year of Age--------------- 21,414








292


EPIDEMIOLOGIC NOTES AND REPORTS
STAPHYLOCOCCAL FOOD POISONING Georgia


Separate outbreaks of staphylococcal food poisoning
occurred almost simultaneously on Monday, July 17, 1967,
among persons attending private gatherings in two differ-
ent areas of metropolitan Atlanta, Georgia. Approximately
2 to 5 hours following the consumption of German choco-
late cake, 11 persons at each of the gatherings experienced
sudden onset of nausea, vomiting, and diarrhea.
The cakes had been baked by an Atlanta bakery. Ac-
cording to the information available. 113 German chocolate
cakes were distributed to several outlets on the morning
of the outbreaks. The layers had been baked 2 days be-
fore on July 15. Icing was made Monday morning just prior
to distribution. Freshly prepared icing was used with the
exception of four or five cakes which were covered with
icing left over from July 15.
The icing recipe called for sugar, margarine, butter.
frozen whole eggs. condensed milk, canned coconut.
pecans, and water. Ingredients were boiled 15 minutes in
preparation. The bakery's standard practice for leftover
icing is to reboil it for 10 minutes. Both procedures would
have killed staphylococci. Since more than 1I,1 '". '" l
coagulase positive staphylococci per gram were recovered
from the incriminated cakes, it is questionable as to
whether the leftover icing was reboiled on this occasion.
Staphylococci isolated from the cakes reacted with
phages 6,53, 83A and produced enterotoxin A. Efforts are
in progress to extract and test for enterotoxin in the cakes.
Prior to the outbreak, German chocolate cakes were
refrigerated at outlets but not at the bakery. They are
now being refrigerated at the bakery also. and the prac-
tice of using leftover icing has been discontinued.

(Reported by Dr. John E. McCroan. Chief Epidemiologist,
and Mr. Thomas McKinley, Assistant Epidemiologist, Epi-
demiologic Inve.tigations Branch, Georgia Department of
Public Health.)


AUGUST 26, 1967
UNIVERSITY OF FLORIDA


II1I I III I III 1111 II II 1111111
3 1262 08864 1906


THE MORBIDITY AND MORTALITY WEEKLY REPORT. WITH A CIRCULA-
TION OF 17,000, IS PUBLISHED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER, ATLANTA. GEORGIA.
DIRECTOR, NATIONAL COMMUNICABLE DISEASE CENTER
DAVID J. SENCER, M.D.
CHIEF, EPIDEMIOLOGY PROGRAM A.D. LANGMUIR, M.D.
ACTING CHIEF. STATISTICS SECTION IDA L. SHERMAN, M.S.

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY, THE NATIONAL COMMUNICABLE DISEASE
CENTER WELCOMES ACCOUNTS OF INTERESTING OUTBREAKS OR CASE
INVESTIGATIONS WHICH ARE OF CURRENT INTEREST TO HEALTH
OFFICIALS AND WHICH ARE DIRECTLY RELATED TO THE CONTROL OF
COMMUNICABLE DISEASES. SUCH COMMUNICATIONS SHOULD BE
ADDRESSED TO:
THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT
NATIONAL COMMUNICABLE DISEASE CENTER
ATLANTA, GEORGIA 30333

NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO THE NCDC BY THE INDIVIDUAL
STATE HEALTH DEPARTMENTS. THE REPORTING WEEK CONCLUDES
ON SATURDAY; COMPILED DATA ON A NATIONAL BASIS ARE RELEASED
ON THE SUCCEEDING FRIDAY.




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