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:
AA00010654:00136

Related Items

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

Full Text




Vol. 18, No. 49

WEEKLY

REPORT

For
Week Ending
December 6, 1969


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE / PUBLIC HEALTH SERVICE F HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION
DATE OF RELEASE: DECEMBER 12, 1969 ATLANTA, GEORGIA 30333


EPIDEMIOLOGIC NOTES AND REPORTS
FATAL MALARIA Mississippi and Virginia


Two fatal cases of malaria due to Plasmodium fal-
riparu.m were recently reported to the NCDC.
Case No. 1: On Sept. 4, 1969, a 22-year-old Vietnam
eterar, returned to the United States apd stopped taking
malarial suppressives. On September 14, he had a tempera-
ture to 105F. and a chill. When symptoms recurred on the
following day, he was admitted to a local hospital in
Mississippi where the presence of rales suggested pneu-
monia. He was treated with antibiotics for 3 days, but his
condition gradually deteriorated. On September 18, he was
flown to a military hospital.
At the time of transfer he was semicomatose, respon-


CONTENTS
Epidemiologic Notes and Reports
Fatal Malaria Mississippi and Virginia. ............ 425
Botulism California ... ................... 426
Follow-up Tularemia Indiana ................. 427
International Notes
Influenza .......... . . ... 427


which demonstrated a high percentage of red blood cells
parasitized by P. falciparum trophozoites. Intravenous
quinine and supportive measures which included hemodi-
alysis and assisted ventilation were instituted, but the
patient's condition continued to deteriorate, and he expired
on September 22. The autopsy revealed petechial hemor-


sive only to deep pain, dehydrated, and oliguric. A diag- the brain, consistent with cerebral malaria, as
nosis of malaria was confirmed by peripheral blood sm '- (Continued on page 426)

TABLE I. CASES OF SPEC I3 OTIFIABLE DIS UNITED STATES
(Cumulative totals include i and delayed reo i previous weeks)
4 EEF ENDED CUMULATIVE, FIRST 49 WEEKS
*NM IAN
DISEASE Decem ,\ December 7, 1968 MEDIAN
19 1968 1969 1968 1964- 1968
Aseptic meningitis ...................... 7.f 7 5 3, 74 52 3,360 4.194 2,834
Brucellosis ............................ 55 218- 220 235
Diphtheria ............................ 10 Ad S' 3 187 230 197
Encephalitis, primary:
Arthropod-borne & unspecified ........... 23 33 30 1,251 1,363 1,800
Encephalitis, post-infectious ............. 6 8 9 287 448 686
Hepatitis, serum ......................... 114 149 5,021 4,431
Hepatitis, infectious .................... 1,049 966 45,245 43,142 35,647
Malaria ............................. .. 150 31 14 3,010 2,232 472
Measles rubeolaa) ....................... 376 272 1,358 23,108 21,804 199,343
Meningococcal infections, total ........... 39 45 47 2,738 2,401 2,619
Civilian .............................. 39 43 2,524 2,202 -
Military............................... 2 214 199
Mumps ................................. 1,696 2,258 82,235 142,360 "
Poliomyelitis, total ..................... 1 1 17 57 58
Paralytic ............................. 15 57 57
Rubella (German measles) ............... 547 380 53,562 47,371
Streptococcal sore throat & scarlet fever.... 9,886 10.986 9,732 398,794 403.716 396,822
Tetanus ............................... 7 1 7 155 154 216
Tularemia. ............................. 3 135 166 172
Typhoid fever ........................ 9 9 9 318 382 388
Typhus, tick-borne (Rky. Mt. spotted fever) 2 1 449 277 260
Rabies in animals ....................... 60 59 72 3,136 3,197 4.019

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ................... .. .................. 4 Rabies in man: ...................................... 1
Botulism: ......................................... 12 Rubella congenital syndrome: ...... .................. 15
Leptospirosis: Fla.-2 ............................... 83 Trichinosis: Pa.-4 ................................. 177
Plague: .......... ................................. 5 Typhus, marine: Ore.-1 ............................... 48
Psittacosis: Calif.-l ............................... 47







Morbidity and Mortality Weekly Report


MALARIA (Continued from front page)


well as extensive bilateral pulmonary hemorrhage and
evidence of acute renal in-uffiL i"'n,\.
Case No. 2: A '"i.0-ar-.ld man, who had traveled fre-
.lm-nil. in Africa and Southeast Asia, returned to the United
States on Oct. 28, 1969, after a 14-day government spon-
sored trip to West Africa. On arrival in Africa, he had re-
ceived 2.5 cc of intramuscular gamma globulin. It is not
known whether the patient took malarial chemosuppressives
while in Africa. He complained of feeling ill on his return,
and on the following day consulted his physician, who
prescribed antibiotics. On November 4, he was admitted to
a civilian hospital in Virginia with spiking nonperiodic
temperature elevations to 105F. and jaundice. Liver
function tests were abnormal, and the tentative diagnosis
of infectious hepatitis was made; he was given supportive
intravenous fluids. No improvement was noted, and the
patient died suddenly on November 10. Pulmonary edema,


bilateral hydrothorax, early hepatic necrosis, and exten-
sive malarial pigmentation were present at autopsy. A re-
view of peripheral blood smears obtained 3 days before
death showed P. falciparum trophozoites.

(Reported by Durnood L. Blake!,. M.D., Director, Division
of Preventable Disease Control, Mississippi State Board
of Health; Capt. William F. Hallahan, MC USAF, Columbus
Air Force Base, Mississippi; Maj. James H. Knepshirld.
MC USA, Chief, Renal Dialysis Service, Walter Reed Army
Hospital; H. E. Gillespie, M.D., Acting Epidemiologist,
Virginia State Department of Health; Malaria Surveillance
t'.it. the Parasitic Diseases Branch, Epidemiology Pro-
gram, NCDC; and an EIS Officer.)

Editorial Note:
These cases are the sixth and seventh malaria fatali-
ties reported in 1969.


BOTULISM California


On Nov. 29, 1969, an elderly couple was admitted to
the Los Angeles County-University of Southern California
Medical Center hospital with clinical diagnoses of botulism.
On November 26. 24 hours after drinking a small amount of
syrup from a jar of home-preserved figs, the wife had noted
the onset of generalized weakness, dysphagia, and inter-
mittent diplopia. These symptoms persisted for about 48
hours after which she became asymptomatic.
Her husband had eaten 8-10 figs from the jar on Novem-
ber 26. On November 27, he experienced nausea and vomit-
ing followed by weakness, diplopia, and difficulty in swal-
lowing and speaking. On admission on November 29, he had
a respiratory rate of 30. Other findings included a markedly
dry mouth, complete dysarthria, deviation of the uvula to
to the left, and paresis of the fourth and sixth cranial
nerves bilaterally. On admission, arterial blood gases
showed evidence of mild hypoventilation. PruL'r- .. signs
of hypoxia developed, and he required a tracheotomy and
assisted respiration. Four hours after admission, bivalent
AB antitoxin was given in a dose of 30,000 units after a
negative reaction to a skin test and a 100-unit test dose.
One hour after antitoxin administration, the patient became
hypotensive and expired despite resuscitative efforts. His
wife. :hi,,'h -impit.rr.uIlic at the time, was given 20,000
units of bivalent AB antitoxin. Neither he nor his wife had
been febrile at any time.
Pretreatment sera obtained from both patients were
negative for Clostridium botulinum toxin by mouse bio-
assay. A total of five unopened jars of home-preserved figs
were found at the home, in addition to one opened jar. All
were found negative for toxin. It is not known whether the
opened jar was the one implicated in this outbreak.
(Reported by Jan Wilkens, M.D., Attending Physician, Los
Angeles County-University of Southern California Medical


Center; Ralph Tetreault, ( .*,f. Food and Drug Section,
G. A. Heidbreder, M.D., Health Officer, and Ichiro Kamei,
M.D., Chief, Acute Communicable Disease Control Divi-
sion, and Carl Lawrence, Ph.D., Director, Bureau of Lab-
oratories, Los Angeles County Health Department; and
James Chin, M.D., Head, General Ep.ide.;vlgy Section,
Bureau of Communicable Diseases, California Sate De-
partment of Health.)

Editorial Comment:
\lihoumh toxin could not be demonstrated in the ve-
hicles tested in this outbreak, the epidemiology and clinical
descriptions were compatible with the diagnosis of botulism.
This is the i.igh'h outbreak of botulism reported to
NCDC in 1969; to date, 14 cases (five fatal) have been
reported.
Since 1899, (1,2) California, which ranks first in the
United States in the incidence of botulism, has reported
223 outbreaks with a total of 455 cases (275 fatal). Type A
botulinum toxin was the causative organism in 61 out-
breaks, type B in five, and type E in one.
Since 1899, (1,2) in addition to this recent outbreak,
there have been 12 others associated with figs; nine of
these were in California. In these 12 outbr-ak-. 24 individ-
uals were affected with 13 deaths. In only four outbreaks
was the toxin type identified; two were type A and two
were type B. The two type A outbreaks were in California.

References:
(1) Meyer, K. F. and Eddie, B.: Sixty-five Years of Human Botu-
lism in the United States and Canada: Epidemiology and
Tabulations of Reported Cases 1899 through 1964. George
Williams Hooper Foundation, University of California, San
Francisco Medical Center, June 1965.
() National Communicable Disease Center: Botulism in the
United States: Review of Cases, 1899-1967 and Handbook
for F Iilrm,,,luI,.-... Clinicians, and Laboratory Workers.


DECEMBER 6. 1969







DECEMBER 6, 1969


Morbidity and Mortality Weekly Report


FOLLOW-UP TULAREMIA Indiana


Two cases of pneumonia previously reported as prob-
able pulmonary tularemia in two young men in Indianapolis
who had handled a squirrel (MMWR, Vol. 18, No. 43) have
been confirmed as histoplasmosis. The first patient was
hospitalized on Oct. 5, 1969, with fever, shortness of
breath, and pulmonary consolidation documented by X-ray.
He died 4 days later of fulminant pneumonia resistant to
antibiotic treatment. The second patient, a friend of the
first, was hospitalized on October 8 with chills, fever,
profuse diaphoresis, cough, and severe dyspnea; multi-
nodular infiltrates were seen in both lungs on chest X-ray.
Despite initial improvement on tetracycline and strepto-
mycin for the diagnosis of tularemia, the second patient
continued to have daily spiking fever and dyspnea and
developed erythematous popular skin rash. He died with a
tension pneumothorax after 1 month of hospitalization.
Lung tissue from the first patient at autopsy showed
histoplasma organisms by methenamine silver stain. Com-
plement fixation (CF) and antibody precipitin tests per-
formed on serum after 5 days of illness were negative. The
second patient at autopsy also had histoplasma organisms
present in pathologic sections of lung as well as in liver,
spleen, and kidney. The organisms fluoresced with fluo-
rescein-tagged antibody against Histoplasma capsulatum.
In addition, the second patient had a positive CF test, in
high titer, to histoplasmosis, which rose slightly during
his illness. Between the second and third weeks of illness
his serum developed an M-band precipitin (one of five
precipitins which may develop from histoplasma antigenic
exposure) consistent with an immunologic response to
active H. capsulatum infection. Yeast organisms (not yet
identified) are at present growing from a bone marrow cul-
ture taken 1 day prior to the second patient's death.
The tularemia skin test initially read as positive was
later re-evaluated and interpreted as negative because a


skin biopsy showed no lymphocytic infiltration character-
istic of a positive delayed hypersensitivity reaction.
Review of the two patients' activities in the 3 weeks
proceeding their illnesses revealed that they were together
only at a common place of work and during the visit to a
Vermillion County farm on September 28 where they had
shot and handled a squirrel. The farm is located in an area
where histoplasmosis is endemic. Absence of clinical
illness in 47 of the patients' fellow employees and a nega-
tive CF titer for histoplasmosis in the one employee who
was ill during the time the patients were hospitalized made
airborne infection at work unlikely. Histoplasma skin tests
and/or CF titers on sera from three other persons who
accompained the patients on their visit to the farm were
positive. One of these persons had lived on this farm and
raised chickens until she vacated it 9 months prior to the
September 28 visit; she had a high CF titer against histo-
plasmosis and an M-band precipitin. It is not known whether
the patients had entered a chicken coop on the farm during
the visit.
Soil samples taken from the chicken coop on the farm
and from a probable bird roost near the farm have been cul-
tured for histoplasma organisms. Also soil samples from
two other areas where the patients might have been in-
dependently exposed to histoplasmosis are being cultured.
Until these results are available, the chicken coop is
barred to further visits.
(Reported by John Batchelder, M.D., Marvin Melton, M.D.,
and other members of the medical staff, St. Vincent's Hos-
pital; Robert Costen, M.D., Earl Brown, M.D., and other
members of the medical staff, University Heights Hospital,
Indianapolis; J. W. Sommerville, M.D., Health 0'- .
Vermillion County; Hermann Rinne, D.O., Director, Divi-
sion of Communicable Disease Control, Indiana State
Board of Health; and four EIS Officers.)


INTERNATIONAL NOTES
INFLUENZA


Influenza A activity was recently reported to the
World Health Organization from several European countries.
An outbreak in Spain began in late October 1969 and con-
tinued into November when a high incidence of respira-
tory disease was noted in Madrid and in northern Spain in
Lugo and Navarra. All age groups were affected and absen-
tee rates of 10 percent were noted in some schools, ad-
ministrations, and military units. Outbreaks also occurred
during this same time period in Barcelona and its Prov-
ince. By November 25 over 30 percent of all age groups
in this city had been affected. Generally, the disease was
clinically mild, but some cases of bronchopneumonia were


reported especially in patients already hospitalized with
other diseases. Five isolated virus strains from Madrid
and seven from Barcelona were identified as influenza
A2/Hong Kong/68.
In France, a large outbreak of influenza-like disease
was reported in Toulouse and another in Perigueux in mid-
November. In Lyons, a strain of A2/Hong Kong/68 was
isolated from a sporadic case in a 9-year-old child, and
serologic evidence of infection with virus A was obtained
from another sporadic case, an adult who had contact with
relatives coming from Spain.
(Continued on page 432)








428 Morbidity and Mortality Weekly Report


TABLE Il1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
DECEMBER 6, 1969 AND DECEMBER 7, 1968 (49th WEEK)


ASEPTIC ENCEPHALITIS HEPATITIS
FTNIN- BRUCEL- DIPlTIIERIA Primary including Post- MALARIA
AREA GITIS LOSIS unsp. cases infectious Serum Infectious
Cum.
1969 1969 1969 1969 1968 1969 1969 1969 1968 1969 1969
UNITED STATES... 79 5 10 23 33 6 114 1,049 966 150 3,010

NEW ENGLAND.......... 4 1 5 144 68 1 94
Maine.............. 17 6 7
New Hampshire...... 3 4 2
Vermont............. 6 2 -
Massachusetts...... 1 1 91 29 1 59
Rhode Island....... 3 1 13 16 10
Connecticut........ 1 3 14 11 16

MIDDLE ATLANTIC...... 18 4 3 1 53 182 126 30 365
New York City...... 8 2 1 34 42 45. 3 25
New York, up-State. 1 1 1 23 15 5 80
New Jersey.......... 5 1 5 49 42 21 151
Pennsylvania....... 5 1 1 13 68 24 1 109

EAST NORTH CENTRAL... 9 6 9 20 169 154 23 314
Ohio............... 3 1 5 4 36 32 1 29
Indiana............ 5 3 1 1 34 15 26
Illinois........... 3 20 45 19 192
Michigan........... 1 2 3 12 74 56 3 66
Wisconsin.......... 5 6 1

WEST NORTH CENTRAL... 6 2 2 3 3 2 35 44 5 215
Minnesota............ 5 1 2 8 19 14
Iowa.*............ 1 2 1 2 6 10 25
Missouri............ 13 6 45
North Dakota....... 1 1 4
South Dakota........ 2 2 1
Nebraska........... 1 1 4
Kansas............. 2 4 7 5 122

SOUTH ATLANTIC........ 4 2 5 5 3 2 2 98 112 40 771
Delaware........... 5 2 5
Maryland............ 11 15 33
Dist. of Columbia.. 1 1 2
Virginia........... 2 2 2 1 9 5 27
West Virginia...... 5 7 1 4
North Carolina..... 1 1 22 13 26 311
South Carolina..... 2 7 2 64
Georgia........... 16 12 10 274
Florida............ 3 5 2 1 2 1 27 50 1 51

EAST SOUTH CENTRAL... 7 1 1 75 75 158
Kentucky........... 41 31 129
Tennessee.......... 6 1 26 29 -
Alabama.*.......... 1 5 4 25
Mississippi........ 1 3 11 4

WEST SOUTH CENTRAL... 4 1 1 3 6 75 72 27 263
Arkansas........... 1 6 13
Louisiana.t........ 1 1 1 3 2 6 14 46
Oklahoma..?........ 1 12 1 2 77
Texas.............. 2 4 56 51 25 127

MOUNTAIN................ 1 2 56 42 1 138
Montana............ 2 1 3
Idaho............... 4 5
Wyoming............ 5 1 -
Colorado............. 2 11 11 112
New Mexico......... 1 5 5 9
Arizona.*......... 18 9 1
Utah................ 8 5 1
Nevada............. 7 6 1 7

PACIFIC.............. 26 1 1 2 10 3 26 215 273 23 692
Washington......... 1 11 19 7
Oregon.............. 11 3 19 27 2 18
California......... 15 1 1 2 8 3 23 179 218 10 532
Alaska.............. 1 3 1 4
Hawaii ............. 1 5 6 10 131

Puerto Ric ........... 1 15 38 4
*Delayed reports: Aseptic meningitis: Okla. 2, Ariz. 1 Hepatitis, serum: Iowa 1
Diphtheria: La. delete i Hepatitis, infectious: Ala. 17
Encephalitis, primary: Okla. 1 Malaria: Iowa 2








Morbidity and Mortality Weekly Report 429


TABLE 1II. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 6, 1969 AND DECEMBER 7, 1968 (49th WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL
AREA Cumulative Cumulative Total Paralytic
Cum.
1969 1969 1968 1969 1969 1968 1969 1969 1969 1969 1969
UNITED STATES... 376 23,108 21,804 39 2,738 2,401 1,696 1 15 547

NEW ENGLAND.......... 16 1,187 1,256 107 139 246 2 30
Maine.............. 9 38 8 6 64 1 -
New Hampshire...... 244 142 4 8 19 4
Vermont............ 3 3 1 5 -
Massachusetts...... 6 249 380 41 74 66 16
Rhode Island....... 27 39 14 9 24 2
Connecticut........ 10 655 654 40 41 68 1 8

MIDDLE ATLANTIC...... 61 7,862 4,590 5 455 421 115 2 32
New York City...... 12 5,011 2,362 1 87 86 70 13
New York, Up-State. 4 620 1,356 1 89 72 NN 1 2
New Jersey......... 26 1,061 697 2 176 143 45 2
Pennsylvania....... 19 1,170 175 1 103 120 NN 1 15

EAST NORTH CENTRAL... 54 2,738 4,124 4 373 301 508 1 128
Ohio................ .19 511 325 136 82 43 7
Indiana............ 478 719 2 50 43 60 34
Illinois........... 22 730 1,419 52 67 96 1 10
Michigan........... 5 365 322 2 108 88 116 50
Wisconsin.......... 8 654 1,339 27 21 193 27

WEST NORTH CENTRAL... 12 972 447 2 137 128 30 1 21
Minnesota........... 1 10 19 29 29 4
Iowa.*............. 338 144 21 11 19 10
Missouri........... 31 81 56 41 2 -
North Dakota ..... 7 51 138 2 4 6 1
South Dakota....... 3 4 1 5 NN -
Nebraska........... 3 530 51 1 11 9 3 6.
Kansas............. 1 9 10 1 17 29 1 -

SOUTH ATLANTIC........ 112 2,859 1,748 6 477 482 245 1 67
Delaware............ 29 471 18 17 12 5 1
Maryland............ 5 93 103 41 41 10 3
Dist. of Columbia.. 3 35 6 9 17 6 1
Virginia........... 22 950 408 57 47 82 3
West Virginia...... 3 224 315 24 13 102 8
North Carolina..... 4 346 320 1 88 96 NN -
South Carolina..... 134 25 4 63 61 1 -
Georgia............. 2 4 77 93 -
Florida............. 46 604 549 1 101 102 39 1 51

EAST SOUTH CENTRAL... 5 126 503 6 178 215 106 1 35
Kentucky. ......... 3 70 103 3 58 95 25 3
Tennessee.......... 1 21 64 3 74 68 74 30
Alabama............ 1 11 95 27 27 7 1 2
Mississippi........ 24 241 19 25 -

WEST SOUTH CENTRAL... 60 5,058 5,223 6 362 348 115 6 82
Arkansas............ 16 2 1 33 21 -
Louisiana.......... 125 25 98 97 -
Oklahoma............ 142 129 36 55 34 15
Texas............... 60 4,775 5,067 5 195 175 81 6 67

MOUNTAIN ............. 40 1,116 1,074 1 59 45 68 1 15
Montana............ 16 108 58 8 6 10 1 -
Idaho.............. 90 21 13 12 11 3
Wyoming ............ 55 3 -
Colorado............ 141 523 1 13 14 8 7
New Mexico.......... 5 284 154 8 1 16 1
Arizona............. 19 481 234 10 5 23 4
Utah............... 11 21 5 1 -
Nevada.............. 1 8 2 3 -

PACIFIC.............. 16 1,190 2,839 9 590 322 263 1 137
Washington.......... 67 596 57 51 50 32
Oregon.............. 200 585 1 21 25 14 14
California......... 14 863 1,612 8 491 228 162 1 28
Alaska.............. 1 14 11 11 4 28 53
Hawaii.............. 1 46 35 10 14 9 10

Puerto Rico.......... 48 1,985 489 19 20 21 1
*Delayed reports: Measles: Ky. delete 1, Iowa 1








430 Morbidit, and Mortality Weekly Report


TABLE I1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 6, 1969 AND DECEMBER 7, 1968 (49th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES 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... 9,99 7 155 T3 9 T2-- --T -- ll-

NEW ENGLAND.......... 1,437 1 16 16 1 54
Maine ............... 13 1 6
New Hampshire...... -
Vermont ............4 16 32
Massachusetts..... 257 3
Rhode Island...... 138 1 -
Connecticut...... 1,025 6 8

MIDDLE ATLANTIC...... 246 3 22 5 31 47 7 234
New York City.... 15 3 14 1 17 -
Ne Yrk, Up-State 145 3 4 6 7 7 220
NewJersey....... NN 3 -3 15 -
New Jersey.........
Pennsylvania...... 86 2 5 25 14

EAST NORTH CENTRAL... 955 19 17 1 36 3 3 228
Ohio.............. 188 4 1 13 74
Indiana............ 161 5 2 56
Illinois........... 165 10 5 16 3 1 40
Michigan.....313 5 6 9
Wisconsin.......... 128 7 1 49

WEST NORTH CENTRAL... 515 1 13 14 10 8 19 597
Minnesota.......... 10 1 5 4 7 161
Iowa ............... 180 1 7 7 98
Missouri.......... 14 4 10 3 5 142
North Dakota....... 89 71
South Dakota....... 30 1 43
Nebraska............ 163 1 1 14
Kansas............. 29 4 3 1 68

SOUTH ATLANTIC....... 1,016 28 23 50 1 253 15 743
Delaware........... 11 1 2 3 -
Maryland........... 155 1 4 48 3
Dist. of Columbia.. 6 2 3 -
Virginia........... 370 1 4 1 81 9 368
WestVirginia ... 177 1 2 2 5 106
North Carolina..... NN 3 6 11 1 67 5
South Carolina..... 104 1 2 1 32 -
Georgia............ 7 7 4 11 16 4 93
Florida........... 186 12 4 15 1 2 168

EAST SOUTH CENTRAL... 1783 1 23 14 1 47 65 2 388
Kentucky........... 262 7 1 9 13 1 199
Tennessee......... 1,195 4 13 20 43 130
Alabama............. 152 1 7 4 6 1 53
Mississippi........ 174 5 1 14 3 6

WEST SOUTH CENTRAL... 1,036 2 30 23 1 34 1 50 8 455
Arkansas........... 41 2 5 1 14 7 3 33
Louisiana.......... 6 7 4 4 39
Oklahoma.......... 70 1 8 1 31 68
Texas.............. 919 2 20 6 16 12 5 315

MOUNTAIN............. 2,128 7 18 2 32 17 4 122
Montana............ 42 1 3 -
Idaho ............. 197 4 6 -
Wyoming ........... 274 4 5 55
Colorado........... 1,135 2 3 9 3
New Mexico......... 303 1 2 10 4 21
Arizona.*.......... 98 4 6 22
Utah .............. 79 13 2 5
Nevada............ 1 16

PACIFIC.............. 770 12 5 4 62 5 2 315
Washington........ 525 1 2 2 3 4
Oregon............. 163 1 6 4
California......... -- 11 2 4 48 2 2 307
Alaska.............. 40 -
Hawaii............. 42 6 -

Puerto Rico.......... 4 1 13 7 29
*Delayed reports: Tetanus: Ariz. 1








Morbidity and Mortality Weekly Report 431






Week No. TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED DECEMBER 6, 1969
49
(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 I year Area All 65 years and f year
Ages and over Influenza AllAge 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.-------


896
271
42
36
33
91
31
28
28
68
76
19
57
43
73

3,760
67
52
177
46
54
47
70
112
1,872
53
498
256
58
125
21
39
88
56
33
36

2,955
75
46
836
192
222
153
107
399
23
63
51
14
66
189
51
170
42
55
19
111
71

995
53
42
44
159
27
130
101
267
102
70


542
148
28
26
22
46
17
22
19
41
47
13
32
31
50

2,203
41
29
123
24
37
34
47
47
1,094
32
273
143
39
74
13
24
61
27
19
22

1,700
50
29
447
118
118
73
55
226
15
35
30
9
51
122
29
112
27
30
10
68
46

631
29
29
28
100
18
91
65
163
63
45


36
6
2
1
1
5
3
1
3
5
3
1
1

4

173
4
2
5

2
1
2
21
91
4
21
5
2
7




1




5
1




2
1

160

5
2
56
7
16
7
6
25

6
2

2
5
5
4
1
6

3
1

50
2
2
6
4
1


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.---------


1,447
137
321
73
55
121
62
95
40
103
91
303
46

781
111
73
48
149
140
90
64
106

1,458
45
69
26
201
57
93
298
68
181
118
175
48
79

572
63
35
144
20
143
22
70
75

1,815
13
50
41
55
114
640
83
33
113
69
93
203
57
154
43
54


745
65
175
30
24
59
32
49
23
77
54
136
21

427
49
44
35
87
69
48
36
59

733
21
36
16
87
34
51
142
34
77
62
93
28
52

349
37
21
88
15
89
14
36
49

1,085
9
24
28
31
63
371
52
24
70
37
57
116
39
92
31
41


Total 14,679 8,415 565 758

Expected Number 13,012 7,572 470 541


Cumulative Total
(includes reported corrections
for previous weeks)


634,507 362,784 28,192 30,178


23 13 3 1 Mortality data are being collected from Las Vegas. Nev., for possible inclusion n this
Las Vegas, Nev.* table, however, for statistical reasons, these data will be listed only and not included in
the total, expected number, or cumulative total, until-5 years of data are collected.








Morbidity and Mortality Weekly Report


INFLUENZA (Continued from page 427)


In Denmark. two cases due to influenza A were diag-
nosed (erologically: one was in a family contact of a
patient with influenza-like illness who had recently been
in Spain.
In Yugo-lavia in Soptelmber 1969. four cases of in-
fluenza A2 Hong Kong 68 were diagnosed in Zagreb in
an airport worker and his family. By early November an
outbreak of influenza-like illness was occurring in this
city. Two strains of influenza virus A2 Hong Kong 68
were isolated.
In the United Kingdom, three cases of influenza A2
were confirmed in adults; two were in Cambridge where
many cases of influenza-like illness were occurring and
one was isolated from a nurse in London.
In addition to the European outbreaks, an outbreak of
influenza-like illness was reported in a prison in Uganda;
about 100 cases occurred. Influenza virus A was isolated
from two patients and serologic evidence of infection was
obtained from others.
(Compiled from the World Health Organization Weekly Epi-
demiological Record. 44(46, 48, and 49):628, 650, and 653.
rov. 14 and 28 and Dec. 5, 1969.)


DI c('I ln 6. 1969


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WIT. a C(Rc uL a
TION OF 20,000 IS PUBLISHED AT THE NATIONAL OMMuNIC ABLE
DISEASE CENTER. ATLANTA, GEORGIA.
DIRECTOR, NATIONAL COMMUNICABLE DISEASE CENTER
DAVID SENCER M.D.
DIRECTOR. EPIDEMIOLOGY PROGRAM A. D. -~GGuMua M.D.
EDITOR MICHAEL B. GREGG. M.D.
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 N&TIONoL
BASIS ARE OFFICIALLY RELEASED TO.THE PUBLIC ON THE SUCCEED-
ING FRIDAY.


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