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:
AA00010654:00135

Related Items

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

Full Text



NATIONAL OMMUNICABLE DISEASE CENTER


in,


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE / PUBLIC HEALTH SERVICE HEALTHH SERVICES AND MENTAL HEALTH ADMINISTRATION
DATE OF RELEASE: OCTOBER 31, 1969 ATLANTA, GEORGIA 30333


EPIDEMIOLOGIC NOTES AND REPORTS
TULAREMIA Indiana


Two probable cases of pneumonic tularemia (one fatal)
were reported from Vermillion County, Indiana, in October.
The two patients, while on a picnic on Sept. 28, 1969, had
shot a squirrel and extensively handled it before carrying
it back to the picnic site, where it was handled by two
other persons. Three days later, the first patient, a 24-year-
old man, had symptoms of upper respiratory infection; by
October 5, he had fever and shortness of breath and was
hospitalized with a diagnosis of pneumonia. His tempera-
ture was 103.80F., WBC was 18,000 per mm3 with 83 percent
polymorphonuclear cells, and chest X-ray showed pneumonic
infiltrate of the right lung. He was treated with penicillin,
but his pneumonia worsened, and on October 8 he was given
streptomycin, cephalothin, and chloramphenicol. He died


CONTENTS

Epidemiologic Notes and Reports
Tularemia- Indiana ........................ 377
Carbon Monoxide Poisoning New Mexico ......... 378
Malaria in American Tourists Massachusetts
and New York ........................... 379
Smallpox-Chickenpox Diagnostic Problem Utah ..... ..79
International Notes
Smallpox The Americas . ..... ... 384


on October 9. Autopsy revealed extensive pneumonia with
necrotic foci in both lungs and involvement of the liver.
The second patient, a 23-year-old man, was hospital-
ized on October 8 with a 1-day history of severe dyspnea,
(Continued on page 378)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
43rd WEEK ENDEDAN CUMULATIVE, FIRST 43 WEEKS
MEDIAN
DISEASE October 25, October 26, 1964 1968 MEDIAN
1969 1968 1969 1968 1964 1968
Aseptic meningitis ...................... 100 136 67 2,868 3,707 2,500
Brucellosis ............................ 12 4 4 197 189 210
Diphtheria.............................. 3 2 5 145 182 165
Encephalitis, primary:
Arthropod-borne & unspecified ........... 29 72 66 1,059 1,198 1,606
Encephalitis, post-infectious ............ 1 8 8 263 413 637
Hepatitis, serum ........................ 119 116 I 7 4,358 3,750 ( 3 7
Hepatitis, infectious .................... 1,146 980 38,945 37,335
Malaria ................................ 79 49 17 2,539 1.923 385
Measles rubeolaa) ....................... 195 172 731 21,337 20,403 192,862
Meningococcal infections, total ........... 41 27 40 2,542 2,188 2,297
Civilian .............................. 41 25 2.335 2,002 "
Military ..................... ......... 2 -- 207 186
Mumps ................................. 1,123 1,254 72,677 130,821 -
Poliomyelitis, total ..................... 4 4 15 54 54
Paralytic ............................... 4 1 14 54 54
Rubella (German measles) ............... 345 271 --- 51,020 45,452 -
Streptococcal sore throat & scarlet fever.... 7.657 7,969 6,541 344,368 346,329 345,833
Tetanus .............................. 7 2 3 130 146 186
Tularemia ............................. 5 6 123 157 157
Typhoid fever .......................... 13 12 7 268 326 350
Typhus, tick-borne (Rky. Mt. spotted fever) 2 2 425 265 247
Rabies in animals ....................... 35 46 57 2,806 2,881 3,605

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ...................................... 3 Rabies in man: ..................................... 1
Botulism: ........................................ 12 Rubella congenital syndrome: ......................... 9
Leptospirosis: Calif.-l, Ind.-l, Ohio-1 ................ 67 Trichinosis: Mass.-l, NYC-1 ........................ 167
Plague: ............................ ................. 4 Typhus, murine: Tex.-l, Va.-1 ....................... 45
Psittacosis: NYC-1, Ohio-1....................... 37







Morbidity and Mortality Weekly Report


OCTOBER 25, 1969


TULAREMIA (Continued from front page)


cough, profuse diaphoresis, chills, fever, and myalgia,
Chest X-ra) showed multinodular infiltrates in both lungs.
He was initially treated with ampicillin, then within 12
hours received tetracycline with a reduction in fever, and
24 hours later he was given streptomycin. On October 18,
he was still critically ill with severe respiratory distress,
fever, cough, chest pain, and myalgia. He has gradually
improved. A delayed hypersensitivity tularemia skin test
using an investigational antigen1,2 was positive on Octo-
ber 19 .li,,,,,zi, a serum tularemia agglutination test was
negative at that time.
Investigation and/or skin testing of the two other
persons who handled the squirrel, the two others present
at the picnic who did not handle the squirrel, and 15 per-
sons who had contact with the patients identified no other
cases of tularemia. Laboratory studies on tissue specimens
from the first patient, animals collected in the picnic area,
and water samples from the picnic area are in progress.
(Reported by John Batchelder, M.D., Marvin Melton, M.D.,


and other members of the medical ,.,'.,., St. Vincent's Hos-
pital, and Earl Brown, M.D., Robert Costin, M.D., and other
members of the medical staff, University Heights Hospital,
Indianapolis; J. W. Sommerville, M.D., Health if, Ver-
million County; Mr. Herald Demarree, Indiana Wildlife Bi-
ologist, Indiana Department of Natural Resources; Hermann
Rinne, D.O., Director, Division of Communicable Disease
Control, Indiana State Board of Health; and an EIS Uoill; .'.)

Editorial Comment:
Sera collected during the first 4 weeks of illness may
not be positive for Francisella tularensis antibodies by the
tube agglutination test.

References:
1Casper, Elizabeth A., and Philip, Robert N.: A Skin Test Sur-
vey of Tularemia in a Montana Sheep Raising County. Public
Health Reports 84(7):611-615, July 1969.
- r'11i R. N., Casper, E. A., and Lackman, D. B.: The Skin
Test in an Epidemiologic Study of Tularemia in Montana Trap-
pers. J Infect Dis 117:393-402, December 1967.


CARBON MONOXIDE POISONING New Mexico


On Sept. 28, 1969, in Tucumcari, New Mexico, seven
cases of carbon monoxide poisoning (three fatal) occurred
in a family, driving from Springdale, Arkansas, to Cali-
fornia. A filling station operator found their parked car
with six of its seven occupants unresponsive. All seven
were taken to a hospital in Tucumcari; the 13-month-old
baby girl, 3-year-old boy, and 57-year-old grandmother
were dead on arrival. The 7-year-old girl and 4-year-old
boy were flushed, diaphoretic, and febrile with tempera-
tures of 1030F. The girl was comatose and rigid and showed
hyperreflexia. The boy dashed about, occasionally staring
straight ahead, and had a coarse intention tremor. The
father was comatose but flaccid, and the mother showed
marked mental confusion. The four surviving family mem-
bers were treated with intravenous fluids, oxygen, and
chloramphenicol. They gradually improved and were dis-
charged 2 days later.
The mother reported that the family left Springdale in
the afternoon of September 26. They purchased salami,
cooked ham, bologna, bread, tomatoes, milk, mayonnaise,
canned meat, and onion-flavored corn chips from several
local stores for their trip. Items needing refrigeration were
stored in a portable ice chest. On September 27, the family
ate breakfast in a cafe in Oklahoma City and purchased
additional food in Elk City, Oklahoma. They ate a meal of
bread, cheese, mayonnaise, potted meat, and potato chips
later that afternoon while driving. About 15 minutes after
eating, the mother became ill with vomiting and suffered
intermittent blackouts. This was followed by the grand-
mother "going out of her mind." The baby then began vomit-
ing and shortly after this the grandmother did also. The
husband was nauseated, i .i ., and dazed but did not vomit.
They continued driving until 4 a.m. Sunday, September 28,


when they stopped to rest. A state trooper who helped them
restart their stalled car at 5:30 a.m. recalled that at that
time all members were alive with apparently normal mental
function. They stopped again because of their illnesses
at about 7 a.m. Approximately 2 hours later, they were
found by the filling station operation.
Cultures from the dead baby's diarrhea-stained diapers
yielded Salmonella newport. Stool cultures from all sur-
viving family members, obtained after they had received
antibiotics, yielded no enteric pathogens. Autopsy per-
formed on the grandmother at 4 days postmortem found
toxic levels of carboxyhemoglobin in blood obtained from
the liver.
The automobile exhaust pipe was rusted through and
broken off beneath the rear axle. The rear radio speaker
was missing, permitting free air passage between the trunk
and back seat. Tests on the automobile demonstrated toxic
concentrations of carbon monoxide in both the front and
back seats when the car was in motion at 50 mph (200 ppm
in front; 1200 ppm in back) and even higher concentrations
when the car was stopped with the engine idling (1000 ppm
in front; 3000 ppm in back).
It is tentatively concluded that this family probably
initially suffered salmonella gastroenteritis; for this rea-
son they stopped their car. Then carbon monoxide was
responsible for the three deaths and neurological symptoms
in the survivors.

(Reported by Bruce .';..,. M.D., Director of Medical Serv-
ices, Daniel Johnson, Ph.D., Director of Division of Lab-
oratories, and John F. I'.. ''"'., Environmental Services
Section, New Mexico Department of Health and Social Serv-
ices; Carl Reynolds, Resident Inspector, Food and lDri,.


378










Administration, Albuquerque; George W. May, Sanitarian,
Quay County Health Department, Tucumcari; James Chin,
M.D., Head, Bureau of Communicable Diseases, California
State Department of Health; Mildred Scott, M.D., Assistant
Director of Public Health, and Michael Rosa, B.S., Senior
Public Health Sanitarian, San Bernandino County Health


379


Department; John R. Philp, M.D., Health Officer, and R. A.
Brandt, M.D., Coroner, Orange County, California; Sal-
monella-Shigella Unit, Epidemiologic Services Laboratory
Section, Epidemiology Program, NCDC; and a team of
EIS Officers.)


MALARIA IN AMERICAN TOURISTS Massachusetts and New York


In mid-October 1969, the NCDC was notified of two
cases of malaria in U.S. citizens who had returned recently
from a photographic safari in East Africa. The first patient,
a 58-year-old man from Massachusetts, had taken no anti-
malarial suppressive drugs prior to or during his trip in
September and had been symptom-free during his 3 weeks
abroad. On October 8, 1 week after his return, he had
diarrhea and malaise followed 2 days later by chills and
fever. He improved slightly on October 11, but on October
12, had a second fever spi-ke and profound prostration with
disorientation. He then saw his ph. -;. ij1. who obtained a
blood smear and found that 20 to 25 percent of the erythro-
cytes contained malaria parasites. The patient was hos-
pitalized in Boston and treated with quinacrine. The fol-
lowing morning, he was still febrile and markedly obtunded
and was transferred to another Boston hospital, where he
was started on a course of parenteral chloroquine. The
organism was identified as Plasmodium falciparum and his
parasitemia had decreased to a level of less than 1 per-
cent. His status presently includes probable cerebral
malaria as suggested by coma and seizures; a severe con-
sumptive coagulopathy, treated with heparin; and renal
insufficiency requiring peritoneal dialysis.
A second case of P. falciparum malaria was reported
in a 52-year-old woman, residing in Rochester, New York,
who had been a member of the same safari group. On Oct.


16, 1969, she developed low back pain and fatigue; 36 hours
later, she experienced fever (1050F.) and chills and was
admitted to a hospital. The admission diagnosis of malaria
was confirmed by peripheral blood smears showing numer-
ous parasitized red blood cells. Recovery was prompt and
uneventful following administration of suitable antimalarial
therapy.
Approximately 30 other persons accompanied these
patients on the safari. The safari organizers stated that
none of these people had received chemoprophylaxis. All
of the travelers are being advised by their respective travel
agents to contact a physician at once.
The need for suppressive drug therapy for malaria for
persons traveling to areas where the disease is prevalent
was reviewed with the tour organizers, and the current
USPHS recommendations for malaria chemoprophylaxis
were made available to them.

(Reported by N. J. Fiumara, M.D., Director, Division of
Communicable Diseases, Massachusetts Department of
Public Health; A. Sommerville, M.D., Boston; Gordon Moore,
M.D., Massachusetts General Hospital, Boston; Bureau of
Epidemiology, New York State Health Department; Gordon
Currie, M.D., Ward Bullock, M.D., and Arthur Bauman,
M.D., University of Rochester Medical Center; and the
Parasitic Diseases Branch, Epidemiology Program, NCDC.)


SMALLPOX-CHICKENPOX DIAGNOSTIC PROBLEM Utah


On Sept. 25, 1969, a suspect case of smallpox in a
21-year-old man in Ogden, Utah, was reported to the NCDC
by the Utah State Division of Health. The patient had re-
turned from 2 years in Brazil on September 7. He had had
no contact with smallpox and had been vaccinated at age 5
years and again in 1967 prior to departure for Brazil. He
had never had chickenpox. On September 21, he had felt
unusually tired and on September 22, experienced head-
ache, nausea, and warmth. On September 24, he noted a
rash and had a temperature of 1020F. On September 25, he
saw his physician, who notified the county health officer
of this possible case of smallpox.
On physical examination, the patient was alert and
comfortable and had a profuse truncal rash with varying
stages of lesions maculess, papules, vesicles, and crusts).
A healed vaccination scar was seen on his left shoulder.


Although the clinical impression was chickenpox, he was
isolated until the diagnosis could be confirmed. Crusts
and vesicle fluid were sent to the state laboratory and to
NCDC. On September 26, the specimens were reported
negative for smallpox by the fluorescent antibody test at
the state laboratory, and varicella-zoster particles were
identified by electron microscopy at NCDC. Further test-
ing at the state laboratory showed that the particles did
not produce pox on chick allantoic membranes, confirming
that this was not smallpox.

(Reported by Irven Moncrief, M.D., Director, Weber County
Health Department; Russell S. Fraser, M.S., Chief, Lab-
oratory Section, and G. D. Carlyle Thompson, M.D., Direc-
tor, Utah State Division of Health; the Laboratory Division,
NCDC; and an EIS Officer.)


OCTOBER 25, 1969


Morbidity and Mortality Weekly Report






380 Morbidity and Mortality Weekly Report


TABLE III CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
OCTOBER 25, 1969 AND OCTOBER 26, 1968 (43rd WEEK)


A FNI1- BR ituiRI Primary including PI.I- MALARIA
AREA I[IS Ounsp. cases h.. ou Serum Infectious
Cum.
1 IN I r 1r' IL, 2 ,531
.11H LL. :iA L ... I "" I, l -2 ',' 1 1 I,1l.. '4k'. ?7 2,S3-

NEW ENGLAND.......... 1 5 201 55 2 82
Maine.*............ 4 2 7
New Hampshire...... 1 6 1 2
Vermont............ 7 -
Massachusetts...... 1 154 32 1 49
Rhode Island....... 16 10 9
Connecticut......... 4 14 10 1 15

MIDDLE ATLANTIC...... 21 3 5 40 220 219 4 288
New York City...... 9 1 12 31 58 22
New York, up-State. 7 1 1 4 70 31 1 47
New Jersey......... 1 2 11 64 87 1 118
Pennsylvania....... 4 1 2 13 55 43 2 101

EAST NORTH CENTRAL... 18 13 37 23 165 136 2 260
Ohio............... 10 5 15 5 42 48 1 24
Indiana............. 11 4 20
Illinois........... 3 16 1 37 31 1 161
Michigan........... 8 5 5 16 72 49 54
Wisconsin.......... 1 1 3 4 1

WEST NORTH CENTRAL... 14 5 1 22 53 5 178
Minnesota........... 14 2 1 3 12 13
Iowa............... 1 4 9 18
Missouri........... 11 15 42
North Dakota....... 3 3
South Dakota....... 1 1 1
Nebraska........... 1 4
Kansas............. 1 3 13 5 97

SOUTH ATLANTIC ....... 13 8 1 5 5 9 122 101 6 684
Delaware........... 1 1 4 3
Maryland............ 7 2 4 13 23 31
Dist. of Columbia.. 4 2
Virginia............ 2 8 1 1 3 12 26
West Virginia...... 10 5 -
North Carolina..... 25 18 2 272
South Carolina..... 2 1 1 10 6 4 58
Georgia............. 1 23 16 258
Florida............. 1 1 2 5 33 17 34

EAST SOUTH CENTRAL... 5 1 3 2 57 58 1 112
Kentucky............ 1 26 18 86
Tennessee.......... 3 1 3 2 15 25 -
Alabama............ 9 3 22
Mississippi......... 1 7 12 1 4

WEST SOUTH CENTRAL... 5 3 1 1 3 4 71 53 24 203
Arkansas........... 1 1 13
Louisiana........... 1 1 1 2 24 12 1 45
Oklahoma............. 2 8 3 2 60
Texas............... 4 1 1 1 2 38 38 21 85

MOUNTAIN............. 1 1 3 2 39 30 3 130
Montana............ 2 3
Idaho............... 2 2 2 5
Wyoming............ 2 1 -
Colorado........... 1 2 2 13 14 1 109
New Mexico......... 11 4 7
Arizona............. 1 1 8 4 1
Utah............... 2 2 1
Nevada.............. 1 1 4

PACIFIC................ 22 1 3 12 1 35 249 275 32 602
Washington......... 2 1 34 30 5
Oregon............. 1 1 2 21 26 2 16
California......... 20 1 2 11 1 32 190 213 25 469
Alaska.............. 3 3 3
Hawaii............. 1 3 5 109

Puerto Ri .......... 28 29 2 4

delayedd reports: Hepatitis, infectious: Me. 8
Malaria: Me. 1







Morbidity and Mortality Weekly Report 381


TABLE IlI. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 25, 1969 AND OCTOBER 26, 1968 (43rd WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL
AA RETotal Paralytic
AREA Cumulative Cumulative Total Paralytic
Cum.
1969 1969 1968 1969 1969 1968 1969 1969 1969 1969 1969
UNITED STATES... 195 21,337 20,430 41 2,542 2,188 1,123 14 345

NEW ENGLAND......... 3 1,125 1,178 1 100 129 122 2 16
Maine*............. 9 38 7 6 10 1 1
New Hampshire...... 1 240 141 3 7 15 -
Vermont............ 3 2 1 1 -
Massachusetts...... 2 225 367 38 66 25 5
Rhode Island....... 27 6 1 14 9 8 -
Connecticut........ 621 624 38 40 63 1 10

MIDDLE ATLANTIC...... 27 7,604 4,252 15 425 391 87 2 39
New York City...... 11 4,954 2,226 4 81 80 63 10
New York, Up-State. 3 609 1,255 3 82 71 NN 1 19
New Jersey.......... 9 934 654 3 166 134 24 9
Pennsylvania....... 4 1,107 117 5 96 106 NN 1 1

EAST NORTH CENTRAL... 25 2,390 3,939 5 347 266 242 86
Ohio................ 6 400 308 4 130 73 16 8
Indiana............. 468 693 45 36 10 10
Illinois........... 8 .590 1,384 49 60 45 11
Michigan............ 3 318 294 1 98 77 50 35
Wisconsin.......... 8 614 1,260 25 20 121 22

WEST NORTH CENTRAL... 46 679 395 127 118 41 1 28
Minnesota........... 8 16 28 27 6 -
Iowa................ 332 104 19 8 25 8
Missouri........... 1 31 81 52 39 1 -
North Dakota....... 1 16 137 2 3 8 20
South Dakota....... 3 4 1 5 NN -
Nebraska........... 44 282 43 9 9 1 -
Kansas............. 7 10 16 27 1 -

SOUTH ATLANTIC....... 8 2,588 1,548 10 447 435 164 1 24
Delaware............ 394 16 13 8 8 -
Maryland............ 77 103 1 41 36 9 2
Dist. of Columbia.. 26 6 9 16 1 1
Virginia........... 2 888 308 55 41 50 2
West Virginia...... 2 214 297 19 13 70 16
North Carolina..... 1 319 284 4 81 83 NN -- -
South Carolina..... 2 127 12 1 58 58 2 -
Georgia............. 2 4 3 76 87 -
Florida............. 1 541 518 1 95 93 24 1 3

EAST SOUTH CENTRAL... 2 115 501 3 159 198 109 1 17
Kentucky........... 66 103 54 90 18 4
Tennessee.......... 2 19 62 3 64 58 86 11
Alabama............ 6 95 24 27 4 1 2
Mississippi........ 24 241 17 23 1 -

WEST SOUTH CENTRAL... 15 4,726 4,942 5 338 321 76 6 31
Arkansas........... 16 2 31 20 -
Louisiana.......... 1 123 24 1 91 92 1
Oklahoma............ 142 125 2 33 51 14 5
Texas............... 14 4,445 4,791 2 183 158 62 6 25

MOUNTAIN ............. 51 1,001 1,023 49 39 63 16
Montana.A.......... 27 62 58 8 6 19 5
Idaho............... 90 21 11 11 -
Wyoming............. 54 3 -
Colorado............ 141 518 8 11 15 2
New Mexico......... 4 268 122 6 16 1
Arizona............. 20 429 224 10 4 11 3
Utah............... 10 21 4 1 2 5
Nevada............. 1 5 2 3 -

PACIFIC............... 18 1,109 2,652 2 550 291 219 1 88
Washington.......... 1 63 557 56 45 50 25
Oregon............. 200 542 18 22 18 9
California......... 12 790 1,508 2 455 208 138 1 43
Alaska.............. 4 13 10 11 3 4 6
Hawaii............. 1 43 35 10 13 9 5

Puerto Rico........... 48 1,715 441 19 20 66 -
*Delayed reports: Rubella: Me. 1, Mont. delete 1






382 M1irlidlit) and Mortality Weekly Report


TABLE II CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 25, 1969 AND OCTOBER 26, 1968 (43rd WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
TYPHOID RABIES IN
SORE THROAT & TETANUS TULAREMIA YPHOID TICK-BORNE RABS IN
AREA SCARLET FEVER FEVER (Rky. Mt. Spotted) ANIMALS
Cum. Cum. Cum. Cum. Cum.
1969 1969 1969 1969 1969 1969 1969 1969 1969 1969 1969


UNITED STATES... 7,657 7 130 5 123 13 268 2 425 35 2,806

NEW F!.- .' ......... 609 1 1 15 12 1 1 35
Maine.7 ........... 8 I 6
New Hampshire.... 18 5
Vermont............ 1 15 1 14
Massachusetts...... 150 1 7 1 2
Rhode Island....... 39 1 -
Connecticut ........ 394 3 8

MIDDLE ATLANTIC...... 267 2 17 5 1 29 43 5 195
New York City...... 32 2 9 1 1 15 -
New York, Up-State. 222 3 4 6 7 5 182
New Jersey......... NN 3 3 14 -
Pennsylvania....... 13 2 5 22 13

EAST NORTH CENTRAL... 523 1 18 13 1 30 3 3 205
Ohio............... 104 4 10 69
Indiana............ 89 2 2 50
Illinois........... 107 1 9 4 1 14 3 33
Michigan ........... 128 5 5 7
Wisconsin.......... 95 7 1 1 46

WEST NORTH CENTRAL... 429 11 14 10 8 8 517
Minnesota.......... 13 3 4 3 138
Iowa............... 118 1 7 3 80
Missouri............ 11 4 10 3 2 129
North Dakota....... 72 67
South Dakota....... 33 1 24
Nebraska............ 65 1 1 13
Kansas............. 117 4 3 1 66

SOUTH ATLANTIC....... 821 3 24 1 22 1 40 1 240 6 675
Delaware........... 3 2 3 -
Maryland........... 55 1 4 1 48 3
Dist. of Columbia.. 2 -
Virginia........... 235 4 1 81 2 339
West Virginia.*.... 162 1 2 2 5 95
North Carolina..... NN 2 1 6 6 58 5
South Carolina..... 107 1 2 1 30 -
Georgia............. 13 3 7 4 11 15 4 77
Florida............. 246 10 4 1 12 156

EAST SOUTH CENTRAL... 1,551 18 1 14 9 44 62 1 366
Kentucky............ 128 7 8 13 187
Tennessee.......... 891 4 1 13 19 41 125
Alabama............ 373 5 4 5 1 48
Mississippi........ 159 2 1 9 13 3 6

WEST SOUTH CENTRAL... 555 1 24 1 20 28 46 3 409
Arkansas........... 9 1 1 2 13 7 30
Louisiana.......... 7 7 4 3 1 32
Oklahoma............ 26 1 8 28 61
Texas.............. 513 1 15 6 12 11 2 286

MOUNTAIN............. 1,866 6 1 16 26 1 17 1 117
Montana............. 55 1 2 -
Idaho............... 174 4 1 6 -
Wyoming. .......... 147 1 3 5 1 54
Colorado............ 1,128 2 3 9 3
New Mexico.......... 217 1 6 17
Arizona............ 85 3 5 22
Utah ............... 59 12 2 5
Nevada............. 1 1 16

PACIFIC.............. 1,036 11 4 1 49 5 7 287
Washington.......... 808 1 2 2 3 4
Oregon............. 112 1 6 4
California......... -- 10 1 37 2 7 279
Alaska.............. 29 -
Hawaii ............. 87 1 4 -


Puerto Rico.......... 12 6 4 25
*Delayed reports: SST: Me. 14, Wyo. 1
Rabies in animals: W. Va. delete 2







Morbidity and Mortality Weekly Report


Week No. TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED OCTOBER 25, 1969
43
(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 65 years and 1 year
Ages and over Ifluenza All Ages and over Influenza All
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
220
51
28
22
54
25
17
26
55
67
7
43
48
55

3,364
52
38
151
50
44
44
74
76
1,700
28
492
191
41
111
31
32
83
57
26
43

2,703
62
41
770
159
206
142
83
402
39
39
56
40
56
152
50
126
27
43
33
105
72

853
66
22
42
120
44
116
81
234
64
64


440
130
37
17
16
22
18
10
19
27
42
5
26
33
38

1,989
27
25
.84
29
26
28
53
40
1,011
21
265
97
28
74
21
24
53
30
22
31

1,538
33
21
407
94
105
77
49
218
31
17
37
15
43
85
35
92
14
30
22
61
52

536
43
13
19
81
34
74
51
142
41
38


SOUTH ATLANTIC:
Atlanta, Ga.-----------
Baltimore, Md.-------
Charlotte, N. C.-----
Jacksonville, Fla.-----
Miami, Fla.------------
Norfolk, Va.-----------
Richmond, Va.-----------
Savannah, Ga.-----------
St. Petersburg, Fla.---
Tampa, Fla.------------
Washington, D. C.------
Wilmington, Del.-------

EAST SOUTH CENTRAL:
Birmingham, Ala.-------
Chattanooga, Tenn.---..
Knoxville, Tenn.------
Louisville, Ky.--------
Memphis, Tenn.--------
Mobile, Ala.-----------
Montgomery, Ala.-------
Nashville, Tenn.------

WEST SOUTH CENTRAL:
Austin, Tex.-----------
Baton Rouge, La.------
Corpus Christi, Tex.---
Dallas, Tex.----------
El Paso, Tex.-----------
Fort Worth, Tex.------
Houston, Tex.-----------
Little Rock, Ark.------
New Orleans, La.-------
Oklahoma City, Okla.---
San Antonio, Tex.------
Shreveport, La.-------
Tulsa, Okla.-----------

MOUNTAIN:
Albuquerque, N. Mex.---
Colorado Springs, Colo.
Denver, Colo.----------
Ogden, Utah------------
Phoenix, Ariz.-------...
Pueblo, Colo.----------
Salt Lake City, Utah---
Tucson, Ariz.-----------

PACIFIC:
Berkeley, Calif.-------
Fresno, Calif.----------
Glendale, Calif.-------
Honolulu, Hawaii-------
Long Beach, Calif.-----
Los Angeles, Calif.----
Oakland, Calif.-------.
Pasadena, Calif.-------
Portland, Oreg.--------
Sacramento, Calif.-----
San Diego, Calif.------
San Francisco, Calif.--
San Jose, Calif.-------
Seattle, Wash.----------
Spokane, Wash.----------
Tacoma, Wash.----------


1,165
115
260
62
89
85
41
75
34
94
61
208
41

580
82
63
39
107
116
49
38
86

1,165
28
39
22
165
45
70
208
56
174
116
136
56
50

478
52
37
117
16
125
23
67
41

1,701
22
48
38
33
90
558
86
33
161
74
95
180
46
146
55
36


576
52
121
22
45
46
23
38
15
67
36
88
23

310
46
32
32
55
66
17
22
40

640
18
23
12
83
22
36
96
34
96
75
78
37
30

276
28
21
72
7
74
15
34
25

1,036
18
28
25
20
55
332
52
26
99
36
57
112
30
87
36
23


101
10
24
11
3
7
1
2
4
5
3
29
2

22
1
7

3
3
5

3

69


2
14
10
7
8
1
6
7
7
4
3

24
2
4
1
3
7
1


Total 12,727 7,341 420 662

Expected Number 12,268 7,055 392 524


Cumulative Total
(includes reported corrections
for previous weeks)


*Mortality data are being collected from Las Vegas, Nev.. for possible inclusion in this
Las Vegas, Nev.* 24 12 2 3 table, however, for statistical reasons, these data will be listed only and not included in
1 I the total, expected number, or cumulative total, until 5 years of data are collected.


557,098 318,372


25,260 26,432






Morbidity and Mortality Weekly Report


INTERNATIONAL NOTES
SMALLPOX The Americas

To datI in l99 Ifl n he Americas, smallpox has been
reIported from Bra il andl Iruguay (n single case). The caste
in UIruiuai Ni as an importation of ns allpox and occurred in
a; pll on( li \ ho ac(quirod the disease in Brazilt H'.l'. l 0l Vol.
1Y. No. 3:19).
iSmallpox incidence in Brazil lhas increased 32.2 per-
'icent o er that of last year. possil N I i. *. Ii,_' increased
surxeillance. This y ear 2,939 cases have heen reported
compared with 2.22.3 report ed for the same time period
la& \.ear. The Brazilian 8smallpox eradication campaign
(Callpanha de Erradicaylo Da Variola). particularly its
surveillance component. has been intensified during the
past Year. The number of vaccinations is approaching a
level of 2 million per month. Since the beginning of the
program in 1962 through August of this year, approximately
37 million vaccinations have been given: 30 million of
these have heen given since January 1967.
(Reported by the Smallpox Eradication Program, NCDC.)
Ref.ri-nt es:
World Health Organization Weekly Epidemiological Record,
44:f39):55S. Sept. 26, 1969.
Semonal Da Campanha De Erradicacao Da Variola,
Tomo 3, No. 25, Aug. 30, 1969.


OCTOBER 25, 1969


THE MORBIDITY AND MORTALITY WEEKLY REPORT. WITH A CIRCULA-
TION OF 18,500 IS PUBLISHED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER, ATLANTA. GEORGIA.
DIRECTOR, NATIONAL COMMUNICABLE DISEASE CENTER
DAVID J. SENCER. M.D.
DIRECTOR. EPIDEMIOLOGY PROGRAM A. D. LANGMUIR, M.D.
EDITOR MICHAEL B. GREGG, M.D.
EDITOR pro fero ALAN R. HINMAN, M.O.
MANAGING EDITOR PRISCILLA B. HOLMAN
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:
NATIONAL COMMUNICABLE DISEASE CENTER
ATTN: THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT
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
AT CLOSE OF BUSINESS ON FRIDAY; COMPILED DATA ON A NATIONAL
BASIS ARE OFFICIALLY RELEASED TO THE PUBLIC ON THE SUCCEED-
ING FRIDAY.


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