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:
AA00010654:00138

Related Items

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

Full Text


NATIONAL COMMUNICABLE DISEASE CENT -0. ED&














U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE / PUBLIC HEALTH SERVICE HEALTH SERVI
DATE OF RELEASE: JANUARY 2, 1970 ATLANTA, GEORGIA 30333


INTERNATIONAL NOTES
INFLUENZA
Widespread influenza activity has been occurring in
Europe dur.ir_ the past month with large numbers of cases
and ;depread absenteeism reported.
In the United Kingdom, a sharp rise in influenza
act,.it', was noted during the week ending Dec. 12, 1969,
affecrrg primarily London and southeastern England, with
scattered outbreaks occurring elsewhere.(1) Provisional
data from the General Register Office (2) shove that the
number of deaths attributed to influenza rose from an
average of 4 per week in November to 52 for the week
ending December 12. Pneumonia deaths increased to 1,136
from 750 and bronchitis deaths to 804 from 485. Of the 52
influenza deaths, 79 percent were in persons over age 55.
A fourfold rise in cases diagnosed as influenza was noted
between the last week of November and the first week in


CONTENTS
International Notes
Influenza ................. ............ 449
Quarantine Measures, Smallpox Vaccination
Requirements Australia . ..... 451
Epidemiologic Notes and Reports
Clostridium perfringens Food Poisoning -
Memphis. Tennessee . ..... 450
Current Trends
Encephalitis California . ..... 451

December. Activity has continued to increase in the Lon-
don area with hospitals now accepting emergency cases
only. Widespread industrial absenteeism has been reported,
as well as staff shortages in hospitals and in ambulance,
fire, transportation, post office, and communication serv-
ices. Isolates were confirmed as similar to A2/Hong Kong/
68. (3)
In France, many cases were also reported with epi-
demics in the Departments of Perigeux, Toulouse Lot,
(Continued on page 456)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
52nd WEEK ENDED CUMULATIVE, FIRST 52 WEEKS
MEDIAN
DISEASE
DISEASE December 27, December 28, 1964 1968 MEDIAN
1969 1968 1969 1968 1964- 1968
Aseptic meningitis ...................... 25 80 29 3,484 4,374 2,940
Bruic ll,:. s ............................ 5 7 8 230 232 252
Diphtheria .............................. 4 20 10 213 260 214
Encephalitis, primary:
Arthropod-borne & unspecified ........... 15 23 23 1,319 1,455 1,880
Encephalitis, post-infectious ............. 6 7 10 314 465 713
Hepatitis, serum ........................ .89 105 715 5,359 4,715 37
Hepatitis, infectious .................... .638 685 48,085 45,578
Malaria ....................... ......... 35 55 50 3,216 2,370 559
Measles rubeolaa) ....................... 310 257 1,232 24;600 22,617 203,010
Meningococcal infections, total ........... 36 25 53 2,922 2,521 2,813
Civilian .............................. 34 25 2,664 2,306
Military....................... ...... 2 258 215 -
Mumps ................................. 1,392 1,649 88,375 148,804 -
Poliomyelitis, total ..................... 2 3 17 59 67
Paralytic ............................. 2 3 16 59 59
Rubella (German measles) ............... 429 281 55,168 48,446
Streptococcal sore throat & scarlet fever.... 5,851 8,594 8,594 426,271 435,136 422,918
Tetanus ............................... 3 5 166 163 233
Tularemia............................... 1 3 9 142 175 192
Typhoid fever .......................... 6 7 7 341 408 408
Typhus, tick-borne (Rky. Mt. spotted fever) 2 2 450 279 262
Rabies in animals ....................... 32 51 60 3,286 3.363 4.72

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ......................................... 4 Rabies in man: ....................................
Botulism: Calif.-2 ........... ....................... 14 Rubella congenital syndrome: Ore.-l ................... 16
Leptospirosis: Calif.- Fla.-2 ................... .. 91 Trichinosis: ...................................... 175
Plague: ........................................... 5 Typhus, murine: ................................... 49
Psittacosis: ...................................... 49
*Delayed reports: Leptospirosis: Iowa 5.






Morbidity and Mortality Weekly Report


EPIDEMIOLOGIC NOTES AND REPORTS
CLOSTRIDIUM PERFRINGENS FOOD POISONING Memphis, Tennessee
4

.t .,r .. 1: n ..... lIr. k of gastroenteri- Table 2
rr k ...... i bdi l r- .. I| r- of the Memphis, Food-Specific Attack Rates, Fo
T. ea'- pl,. ii -, Ih..I rP **.I ..ie the noon meal Memphis, Tennes
i 7 0October 22, 196!
,r. S .ty l .It.'ir, ri. I, II, l ,r -'.' \[proximately 67,000
:,. r .r- r.... l ,..I ),. 44l in nine schools were Number of Persons
,nr rv %i i> ...-. ,L .. h,,-alr, of gastroenteri- Who Ate Specified
t11 lr Ah..~ aaintir.t r rpl .I .I p.-r t. Complete food Food Items Food
and ,ill. r -..,rmf :- a r,, I..,irr.,m i fron 102 individuals. Served Not P r en
Of these, 76 persons reported illness characterized by Ill II Total Ill
diarrhea and abdominal cramps without fever. Incubation Braised beef
periods ranged from 3 to 18 hours (mean 10.1 hours Table on rice 74 17 91 81*
1), and duration of illness was 4 to 48 hours (mean 17 Green peas 48 20 68 71
hours). Food specific attack rates incriminated the main Cabbage
entree, braised beef on rice, as the contaminated vehicle pepper
(Table .i. salad 36 12 48 75
Buttered
Table 1 biscuits 46 12 58 79
Incubation Periods for Foodborne Illness Peach
Memphis, Tennessee cobbler 62 22 84 73
October 22, 1969 606 76
Milk 60 16 76 79


Hours Number of Cases
3 1
4 6
5 4
6 3
7 7
8 1
9 6
10 6
11 5
12 13
13 6
14 6
15 3
16 1
17 0
18 2
Unknown 7

Total 76


The beef was purchased from a local packinghouse
which supplied choice beef from a large Oklahoma packer.
Beef roasts were delivered to the schools on October 20
and 21. In each school kitchen, the roasts were cooked for
4 hours the day prior to serving. After being cooled at
room temperature for I'. hours, they were placed in a refri-
gerator for overnight storage. On the morning of serving,
the beef \\as cut into cubes, combined with tomatoes, green
peppers, onions, and flour and cooked for approximately
1 hour at 150 F.
Dr\ l'.. Government commodity rice was delivered to
the Memphis schools on October 15. After washing on
October 22. the rice waas cooked in water in a 450* F. oven
for 1 hour.


* P <.00001


DECEMBER 27, 1969


*odborne Illness
see


Number of Persons
hhu Did NOT Eat
Specified Food
Not Percent
ll Ill Total Ill

2 9 11 18*
28 6 34 82


40 14 54 74

30 14 44 68

14 4 18 78
16 10 26 62


The braised beef and rice were taken from the ovens
at approximately 10:45 a.m. and placed on the steam table
for serving. Serving began at 11:00 a.m. Steam tables were
were maintained at 140* F. throughout the serving time.
Cultures of leftover braised beef on rice were obtained
on October 23. No pathogens were isolated. Clostridium
perfringens was isolated from the stools of 25 of 28 pa-
tients and from raw meat at the Memphis packinghouse.
C. perfringens isolates from the feces of 14 patients and
four samples of the raw beef were serotyped. No common
serotype was identified, but eight isolates from the 14
patients and two of the raw beef samples yielded organisms
which did not react with available antisera.
The U.S. Department of Agriculture is corndu, iing an
r-.-. -r;,, ion at the two packing plants.
(Reported by William H. Armes, Jr., Deputy Commissioner,
Cecil B. Tucker, M.D., Director, Bureau of Preventive
Health Services, W. M. Arnold, li ri r I,, Memphis Branch
Laboratory, and J. H. Barrick, Ph.D., Director, Division
of Biological Laboratories, Tennessee Department of Pub-
lic Health; George S. Lovejoy, M.D., F.A.A.P., Director,
Donald R. Daffron, Administrative Assistant, Sanitation
Division, and R. C. '... ......, Sc.D., M.D., Director, Di-
vision of Communicable Disease Control, Memphis and
Shelby County Health Department; Anaerobic Bacteriology
Laboratory, Bacterial Reference Unit, Bacteriology Section,
Microbiology Branch, Laboratory Division, NCDC; and an
EIS Officer.)
Editorial Note:
The epidemiology and clinical characteristics of this
large outbreak are compatible with C. perfringens food
poisoning. Of the 61 vehicles associated with C. per-









fringens outbreaks reported to NCDC in 1968 (MMWR, Vol.
18, No. 12), 24 involved beef products.
Involvement throughout the Memphis school system
suggests that the contamination of the meat occurred before
it was delivered to the schools. Inadequate cooking at the
schools followed by cooling at room temperature the day
prior to serving may have provided an atmosphere for in-
cubation of the organism. Reheating for 1 hour the fol-


lowing day at 450* F. may not have been sufficient to
kill the organisms.
The inability to demonstrate a common serotype may
be a reflection of the small number of isolates from each
patient submitted for serotyping. More likely, since iso-
lates from eight of 14 patients and the beef did not react
with the 91 types of C. perfringens antisera presently
available, a "nontypable" strain may have been involved.


CURRENT TRENDS
ENCEPHALITIS California


The encephalitis surveillance network set up in Cali-
fornia in June 1969 (MMWR, Vol. 18, No. 28) continued
through September. Hospital surveillance of acute central
nervous system illness was carried out in 54 hospitals
(7,800 beds) in 20 counties in the San Joaquin and Sacra-
mento Valleys. During 17 weeks of surveillance, these
.hospitals reported 46 cases of encephalitis, 76 cases of
aseptic meningitis, and 427 other acute neurologic ill-
nesses. Five cases of encephalitis in the study area were
confirmed by specific antibody titer rise as due to an arbo-
virus and were further characterized as St. Louis encepha-
litis (SLE) virus infection. The five patients were between
14 and 66 years of age, and all recovered completely.
Three of the five patients with SLE virus infection were
hospitalized in survey hospitals and were detected by that
system; the other two were not treated in the hospitals
included in the survey. Central nervous system illness due
to echovirus types 4 and 9,Coxsackie virus B4, and mumps
virus were also recognized in the study area.
For the state as a whole, 57 clinical cases of enceph-


alitis in equines were reported, and serologic tests were
done on specimens from 30 of these equines. Western
equine encephalomyelitis (WEE) virus infection was con-
firmed by fourfold titer rise in two of these equines, and
high stationary levels of antibody to WEE virus were found
in five other unimmunized equines. None of 319 wildlife
specimens tested for arboviruses were positive. SLE virus
has been isolated from 23 of 1,579 pools of Culex tarsalis
mosquitoes collected in the Sacramento Valley during the
period July to September. Positive pools were collected
about the same time and from the same places where human
encephalitis was found.
(Reported by R. W. Emmons, M.D., and R. Marlor, M.D.,
Epidemiologists, Bureau of Communicable Disease Control,
G. Humphrey, D.V.M., Chief, Veterinary Public Health
Section, E. H. Lennette, M.D., Chief, Viral and Rickettsial
Disease Laboratory, and R. Peters, Chief, Bureau of
Vector Control, California Department of Public Health;
and William B. Reeves, Ph.D., Dean, School of Public
Health, University of California, Berkeley.)


INTERNATIONAL NOTES
QUARANTINE MEASURES
SMALLPOX VACCINATION REQUIREMENTS-Australia


In the past, air travelers over 12 months old who
arrived in Australia without valid International Certificates
of Vaccination against Smallpox were compelled by the
Australian health authorities to be isolated for 14 days.
Now, however, travelers over 12 months of age who arrive
by air from Canada or the United States and have not been
outside these two countries or countries situated on the
direct trans-Pacific air routes between Australia and North
America (Fiji Islands, New Caledonia, New Zealand) for
at least 14 days prior to arrival in Australia and who do
not possess a current International Certificate of Vaccina-
tion against Smallpox may be placed under quarantine
surveillance for 14 days from the date of departure from
Canada or the United States. Infants under the age of 12
months remain exempt from Australia's smallpox vac-
cination requirements.


Travelers whose circumstances preclude smallpox
vaccination due to medical contraindication must present
a letter issued by a licensed physician stating that the
traveler is suffering from a condition which makes small-
pox vaccination ill-advised. Recognized contraindications
include (1) pregnancy; (2) eczema; (3) agammaglobulinemia
or hypogammaglobulinemia; (4) a past history of exfoliative
dermatitis, generalized vaccinia, or postvaccinial enceph-
alitis; (5) a history of treatment with immunosuppressive
agents such as corticosteroids, antilymphocytic serum,
alkylating or cytotoxic drugs, or irradiation therapy other
than superficial therapy; and (6) cachexia associated with
malignant or other serious organic disease.


(Reported by the Foreign Quarantine Program, NCDC.)


DECEMBER 27, 1969


Morbidity and Mortality Weekly Report






152 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 27, 1969 AND DECEMBER 28, 1968 (52nd WEEK)


ASEPTIC ENCEPHALITIS HEPATITIS
IMENIN- BRUCEL- )DIPH IIl':A Primary including Post- MALARIA
AREA GCITIS S unsp. cases Infeltious Serum Infectious
Cum.


UNITED STATES... 25 5 4 15 23 6 89 638 685 35 3,216

NEW ENGLAND.......... 1 2 7 81 33 1 103
Maine............. 2 6 8
New Hampshire...... 1 4 1 2
Vermont............. 1 -
Massachusetts...... 41 8 60
Rhode Island ....... 1 2 18' 8 11
Connecticut........ 1 5 15 10 1 22

MIDDLE ATLANTIC...... 2 3 2 39 73 114 6 394
New York City....... 1 24 55 1 28
New York, up-State. -- --- -- -- -- -- -- 15 -- 85
New Jersey.. ...... 1 13 53 8 5 158
Pennsylvania....... 2 3 2 20 36 123

EAST NORTH CENTRAL... 3 1 5 10 1 4 138 98 4 330
Ohio............... 1 3 4 2 33 20 1 33
Indiana ............ 1 15 7 1 28
Illinois........... 1 1 1 1 1 36 18 1 198
Michigan........... 1 1 4 1 50 46 1 70
Wisconsin........... 1 4 7 1

WEST NORTH CENTRAL... 1 1 1 18 42 3 232
Minnesota ........... 1 1 14 14
Iowa*.............. 1 7 28
Missouri........... 1 13 13 45
North Dakota........ 4
South Dakota....... 1 2
Nebraska ........... 1 1 6
Kansas............... 2 8 2 133

SOUTH ATLANTIC........ 2 4 2 3 6 55 77 11 811
Delaware............ 1 5
Maryland ........... 1 5 14 8 42
Dist. of Columbia?. I 4 2
Virginia........... 4 2 5 7 1 28
West Virginia...... 4 2 4
North Carolina..... 4 6 332
South Carolina ..... 3 3 65
Georgia............ 9 6 2 280
Florida............. 2 2 5 25 34 53

EAST SOUTH CENTRAL... 2 1 1 34 20 198
Kentucky........... 13 11 169
Tennessee.......... 1 8 1 -
Alabama............ 1 11 7 25
Mississippi........ 1 1 2 1 4

WEST SOUTH CENTRAL... 2 1 16 43 2 289
Arkansas........... 13
Louisiana*......... 2 1 6 46
Oklahoma........... 6 8 2 81
Texas.............. 10 29 149

MOUNTAIN............ 1 4 30 18 138
Montana............. 3 1 9 3
Idaho.............. 1 5
Wyoming............ 2 -
Colorado........... 1 10 112
New Mexico......... 2 9
Arizona*........... 1 11 4 1
Utah............... 5 3 1
Nevada............. 7

PACIFIC................ 13 1 3 1 5 32 193 240 8 721
Washington........... 1 17 13 7
Oregon............. 1 4 11 10 1 19
California......... 12 1 2 1 5 28 159 202 7 560
Alaska............. 3 12 4
Hawaii............. 3 3 131


Puerto Ric(A......... --- --- I -_ I --- I--- 1 17 1 ___ 4


*Delaved reports: Aseptic meninCitis: Okla. 1 Hepatitis, serum: La. 1
Brucellosis: Okla. 1 Hepatitis, infectious: N.J. 1, D.C. 17, Ariz. 18, P.R. 17
Encephalitis, primary: Minn. 1, Iowa 1 Malaria: Iowa 1
Encephalitis, post-infectious: Minn. I


~






Morbidity and Mortality Weekly Report 453


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 27, 1969 AND DECEMBER 28, 1968 (52nd 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... 310 24,600 22,617 36 2,922 2,521 1,392 16 429

NEW ENGLAND........... 2 1,213 1,379 2 114 139 109 2 47
Maine.............. 10 38 8 6 10 1-
New Hampshire...... 1 248 150 5 8 2 1
Vermont............ 3 4 1 2 -
Massachusetts...... 1 268 386 44 74 29 2
Rhode Island....... 27 94 1 15 9 22 2
Connecticut........ 657 707 1 42 41 44 1 42

MIDDLE ATLANTIC...... 30 8,050 4,743 1 479 443 126 2 31
New York City...... 11 5,039 2,433 89 90 57 3
New York, Up-State. --- 633 1,388 --- 97 75 NN -- -- ---
New Jersey.*....... 13 1,126 721 186 156 69 12
Pennsylvania....... 6 1,252 201 1 107 122 NN 1 16

EAST NORTH CENTRAL... 161 3,288 4,261 5 396 318 503 1 118
Ohio............... 15 568 333 1 140 85 69 8
Indiana............. 16 501 746 1 53 45 18 14
Illinois........... 115 1,129 1,445 1 57 72 80 1 21
Michigan........... 4 402 353 2 118 91 87 29
Wisconsin.......... 11 688 1,384 28 25 249 46

WEST NORTH CENTRAL... 1,238 488 3 142 143 26 1 13
Minnesota.......... 11 19 29 32 -
Iowa................ 338 165 21 14 21 6
Missouri ........... 32 81 1 57 50 2 6
North Dakota........ 81 142 2 4 3 1
South Dakota........ 51 4 1 5 NN -
Nebraska.*........... 716 67 1 14 9 -
Kansas ............. 9 10 1 18 29 1I

SOUTH ATLANTIC....... 49 3,019 1,862 7 510 505 151 1 32
Delaware............ 14 522 23 17 12 2
Maryland............ 100 104 2 43 44 15 -
Dist. of Columbia.. 35 6 9 20 1 -
Virginia........... 12 1,011 460 60 50 28 14
West Virginia...... 226 337 1 25 14 41 7
North Carolina..... 19 373 322 3 99 99 NN 2
South Carolina..... 134 31 1 70 63 6 -
Georgia............. 2 4 78 98 -
Florida............ 4 616 575 109 105 60 1 7

EAST SOUTH CENTRAL... 1 132 508 211 222 51 1 14
Kentucky........... 75 107 85 98 12 4
Tennessee.......... 21 65 77 70 35 7
Alabama............ 1 12 95 28 29 4 1 3
Mississippi........ 24 241 21 25 -

WEST SOUTH CENTRAL... 32 5,227 5,381 7 387 365 76 6 64
Arkansas........... 16 2 34 22- -
Louisiana.......... 125 27 4 105 104 -
Oklahoma............ 143 132 36 57 38 14
Texas............... 32 4,943 5,220 3 212 182 38 6 50

MOUNTAIN............. 17 1,182 1,100 59 46 77 1 31
Montana............ 122 58 8 7 15 1 4
Idaho.............. 90 21 13 12 -
Wyoming............. 55 3 1
Colorado............ 142 526 13 14 29 11
New Mexico......... 290 176 8 1 4 -
Arizona............. 17 526 235 10 5 29 11
Utah................ 11 21 5 1 4
Nevada............. 1 8 2 3 -

PACIFIC................ 18 1,251 2,895 11 624 340 273 1 79
Washington.......... 69 607 2 61 52 123 29
Oregon.............. 201 594 3 25 26 17 7
California......... 18 915 1,648 6 517 244 111 1 37
Alaska.............. 14 11 11 4 11 1
Hawaii............. 52 35 10 14 11 5

Puerto Rico......... .. 2,131 524 -- 19 21


*Delayed reports: Measles: N.J. delete 1, S. Dak. 48, Nebr. 40, P. R. 35
Mumps: P. R. 16
Poliomyelitis: Mont. delete 1 unspecified, add 1 paralytic
Rubella: P. R. 2





154 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 27, 1969 AND DECEMBER 28, 1968 (52nd WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA THD TICK-BORNE RABIES I
AREA SCARLET FEVER FEVER (Rky. Mt. Spotted) ANIMALS
Cum. Cum. Cum. C um. Cum.
1969 1969 1969 1969 1969 1969 1969 1969 1969 1969 1969
UNITED STATES... 5,851 166 1 142 6 341 450 32 3,286

NEW ENGLAND.......... 960 1 16 16 1 57
Maine*.............. 16 1 6
New Hampshire...... 44 5
Vermont ........... 3 16 35
Massachusetts...... 148 1 8 1 3
Rhode Island....... 82 1 -
Connecticut........ 667 6 8- 8

MIDDLE ATLANTIC...... 164 24 5 33 47 254
New York City...... 14 1 17 -
New York, Up-State. -- -- 3 -- 4 --- 6 -- 7 --- 240
New Jersey.*....... NN 4 4 15 -
Pennsylvania........ 164 3 6 25 14

EAST NORTH CENTRAL... 824 19 18 1 37 3 233
Ohio............... 114 4 13 76
Indiana............ 91 6 56
Illinois........... 231 10 5 1 17 3 40
Michigan........... 240 5 6 10
Wisconsin........... 148 7 1 51

WEST NORTH CENTRAL... 261 14 14 10 8 4 624
Minnesota.......... 4 6 4 1 166
Iowa.............. 106 1 7 103
Missouri........... 5 4 10 3 2 149
North Dakota....... 110 77
South Dakota....... 25 1 43
Nebraska........... 7 1 1 14
Kansas............. 4 4 3 1 1 72

SOUTH ATLANTIC....... 973 31 23 2 52 253 14 785
Delaware............ 17 1 2 3 -
Maryland* .......... 217 2 4 48 3
Dist. of Columbia.. 1 2 3 -
Virginia............ 256 2 4 1 81 4 375
West Virginia...... 69 1 2 2 5 114
North Carolina..... NN 3 6 2 13 67 5
South Carolina..... 74 1 2 1 32 -
Georgia............. 11 8 4 11 16 4 111
Florida............. 328 12 4 15 1 6 177

EAST SOUTH CENTRAL... 774 26 15 1 53 65 4 398
Kentucky........... 26 8 12 13 4 206
Tennessee........... 414 4 14 1 23 43 131
Alabama............ 177 8 4 6 55
Mississippi........ 157 6 1 14 3 6

WEST SOUTH CENTRAL... 390 30 26 2 38 51 6 475
Arkansas*.......... 3 2 5 15 7 36
Louisiana.......... 7 6 4 1 42
Oklahoma............. 93 1 9 32 3 75
Texas.............. 294 20 6 2 19 12 2 322

MOUNTAIN............... 1,054 7 1 19 32 17 1 124
Montana............ 40 1 -- -
Idaho............... 215 4 -
Wyoming*........... 32 4 5 1 56
Colorado........... 365 2 3 9 3
New Mexico......... 145 1 10 22
Arizona............. 155 4 6 22
Utah................ 102 1 14 2 5
Nevada............. 1 16

PACIFIC.............. 451 14 6 70 5 3 336
Washington......... 375 1 2 3 3 4
Oregon............. 1 2 6 4
California......... --- 12 2 51 2 3 328
Alaska................ 59 -
Hawaii............. 17 10 -

Puerto Rico.......... ---. 13 --- j j 9 -- ** 29
*Delaved reports: SST: Me. 35, Wyo. 184
Tetanus: N. J. 1, Ild. 1
Rabies in animals: Ark. 2





Morbidity and Mortality Weekly Report 455






Week No. TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED DECEMBER 27, 1969
52
(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 year Area All 65 years and year
Ages and over Influenza All Age 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.T -------
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.T---
Kansas City, Mo.------
Lincoln, Nebr.--------
Minneapolis, Minn.----
Omaha, Nebr.-----------
St. Louis, Mo.--------
St. Paul, Minn.-------
Wichita, Kans.--------


662
208
38
37
23
39
41
16
26
53
64
5
44
28
40

2,950
41
39
150
26
23
37
73
56
1,633
36
297
136
50
113
21
22
85
48
27
37

2,393
66
36
708
147
198
127
52
342
34
54
54
23
53
132
30
86
37
28
35
86
65

698
38
15
34
110
16
76
70
231
75
33


412
121
21
24
12
21
24
9
20
36
38
5
32
20
29

1,718
24
24
86
15
16
24
46
24
952
22
156
74
33
77
13
13
50
29
19
21

1,392
40
21
376
81
119
64
35
213
23
30
24
12
32
79
21
56
21
16
24
64
41

437
27
10
19
77
11
55
39
135
8
16


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.----------


921
114
198
23
90
78
30
57
31
68
41
140
51

395
71
22
18
96
82
32
20
54

922
24
16
13
165
10
66
161
35
175
57
82
54
64

394
33
27
103
24
103
10
47
47

1,562
20
51
28
32
90
455
77
35
163
85
107
146
65
106
47
55


497
54
104
12
58
44
13
23
13
56
26
60
34

193
28
11
13
48
39
15
7
32

480
14
4
4
82
4
37
83
17
79
35
52
31
38

224
13
20
63
9
59
9
25
26

1,005
17
20
19
21
63
309
51
28
111
56
58
83
38
58
38
35


30
4
10

3


1
3
1
2
2
2

22
4


9
5
2

2

53
3
4
5
10
4
4
2
4
3
4
6
3
1

20
1

6
/,
5

1
3

46

2

1

9
7
2
6
3
3
3
2
5

3


Total 10,897 6,358 423 431


Expected Number


Cumulative Total
(includes reported corrections
for previous weeks)


13,304


7,780


508


1- -I I -I


672.078 384.568


29.703


11.908


*Mortality data are being collected from Las Vegas, Nev., for possible inclusion in this
Las Vegas, Nev.* 10 3 2 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.

TEstimate based on ave-age per cent of divisional total






Morbidity and Mortality Weekly Report


INFLUENZA (Continued from front page)
Av.eron, Eure-et-Loire, and Haute-Savoie during the week
of Dec. 12, 1969. (4) From here, activity spread to involve
most of the country and, in particular, the Paris area and
the Charentes, Brittany, Normandy, Tourraine, Burgundy,
Champagne. Jura, and Languedoc. Of 110 paired sera, 35
percent showed evidence of A2 Hong Kh.rit- 6B and 3 per-
cent showed para-influenza virus type 1. All age groups
appear to have,been affected. (1)
In Italy, an epidemic of major proportions was reported
with an estimated 15 to 20 million cases. Strains of A2/
Hong Kh,,r I-were isolated. (4)
In Norway, an intense epidemic due to A2/'Hong Kong/
68 was reported from Tromso and Harstad, and an outbreak
of influenza-like illness was reported in Oslo. (4) Denmark
similarly noted an increase in influenza-like illness. (1)
In Israel, thousands of cases were reported in an out-
break which began during the second week in November.
Twenty-four strains of Hong Kong-like virus were isolated.
In Austria, an epidemic of influenza-like illness was
reported to be spreading rapidly through the southern Prov-
ince of Kiirnten. From southern Belgium, foci of influenza-
like activity were occurring by December 19. (1)
In Spain. the epidemic which began about October 20
in Barcelona and its Province began to decline after reach-
ing a peak between November 15 and 25. Overall mortality
was 40 percent higher in November 1969 than in the same
month of 1968.
Throughout the Federal Republic of Germany in the
south more than the north, outbreaks of influenza-like ill-
ness were reported. Infection with the A2/Hong Kong 68
virus was confirmed.
In -"... i..irl r, outbreaks of influenza-like illness
occurred in Geneva, Bern, Basel, and Zurich. with isolates
of A2 HITori Kong,'68 confirmed in the last two cities.
From an outbreak in Czechoslovakia, strains of A2/
Hong horic r- were isolated.
The outbreak of influenza which began in November
in Croatia and Slovenia, Yugoslavia, spread to the rest of
the country in December. More than 35,000 cases were re-
ported in the first 2 weeks of December in Belgrade. Sever-
al strains of A2 H.re, hr..r 168 virus were isolated.
From an outbreak in Bucarest, Romania, a strain
similar to B;Mass/,66 influenza virus was isolated.
Thus far this season in the United i ,TI,-. there have
been only a few scattered isolates of A2/Hong Kong/68-
like virus and no influenza B isolates. No outbreaks of
upper respiratory illness in the United States except for
Alaska (MM\R. Vol. 18. No. 50) have been attributable
to the influenza virus.
i1eft re 0 I
1) itorld /Ioalt!h Or.ganiaztion HIeekly Kpidemiological Record
44(51,:675, t)* '(I ThIh. ItI',i lrar G( onra .l Provisional Weekly Influenza State-
mhnt 1969. 70 No. 2 for England and Wales, London,
l)ec. 19, 1969.
(3i Ncu, lYork l'ime IDec. 30, 1969.
(4) iaorld IHalth Organization iWeekly EpidemTiological Record
(50):661il, Dec. 12, 1969.
(Reported by the Respiratory Diseases Unit, Viral Dis-
eases Branch, Epidemiology i'. .. .. ... NCDC.)


DECEMBER 27. 1969


THE MORBIDITY AND MORTALITY WEEKLY REPORT. WITn A CIRCULA-
TION OF 20. 00 15 PuBLJS-ED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER, ATLANTA, GEORGIA.
DIRECTOR, NATIONAL COMMUNICABLE DISEASE CENTER
DAVID J SENCER M D
DIRECTOR, EPIDEMIOLOGY PROGRAM A. .- -ANGMULR M.D
EDITOR MICHAEL B GREGG M.D.
MANAGING EI TOR PRISC'LLA B HOLMAN
IN ADDITION TO T.E EC.ABLISHEED AROCEDuRES FOR REPONrTir
MORBIDITY AND MORTAL T THE NATIONAL COMMUNICABLE DISE ASI
CENTER WELCOMES ACCOUNT; OF iNTERESTING O.TBRA- E 5S OR CASE
INVESTIGATION *.ICii ARE OF CL.RRENT INTERESTT TO .nEALT
OFFICIALS AND *.ICH ARE DIRECTLY RELATED TO THE CONTROL
OF COMMUNkCABLE DEASEE SuCH COMMJUNIIC aTIIS SmOIUL.D BE
ADDRESSED O0
NATIONAL COMMUNICABLE DISEASE CENTER
ATTN: THE EDITOR.
MORBD. rv AND MORTALIT W*EEILl REPORT
ATLANTA GEO G-* 30333D l

NOTE: IHE DATf IN THIS R P,'IRT AME PR OiIONAL AND ARE
BASED ON EENLY TELEGRAMS TO THE NCDC BI TH. IND'IDu.AL
STATE HEALTH DEPARTMENT- T.E REPORTIN- *EEK CONCLUDES
AT CLOSE OF BU5INES ON FR'DAT. COMPILED DATA ON A NATIONAL
BASIS ARE OFFICI.LL RELEA~iD T0 TPE PUB6LC GN T.E SUCCEED-
ING FRIDAi.


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