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:
AA00010654:00140

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 11. =










a, Z* ..2 .-



U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE / PUBLIC HEALTH !RPvi E :' HEALTH SERVICES


DATE OF RELEASE: NOVEMBER 7,


EPIDEMIOLOGIC NOTES AND REPORTS
AN OUTBREAK OF AFRICAN SLEEPING SICKNESS
AMONG AMERICANS ON SAFARI United States

On Sept. 8, 1969, an outbreak of African sleeping
-ickn1rs was reported among a group of Americans recently
on safari in East Africa. There were two confirmed cases
of tr)parnoi-rni .- with Trypanosoma rhodesiense infec-
tion and a probable third, all in Caucasian members of a
single hunting party that originated in Uganda.
On September 1, the first patient, a 49-year-old busi-
nessman and former diplomat who had just arrived in Geneva
from a rronlh.1...rg safari, had onset of fever in association
with an infected lesion on his chest wall. On September 5,
he sought hospitalization in Geneva because of fever and
some respiratory distress.
On admission, he had fever (1030F.), generalized
lymphadenopathy, hepatosplenomegaly, and an abscessed


Vol. 18, No. 44


For

Week Ending


1969 ATLANTA, GEORGIA 30333,


CONT f0y r
Epidemiologic Notes and Report.-
An Outbreak of African I ..
Among Americans on Safari ates .... .
Staphylococcal Food Poisoning .-
Memphis, Tennessee ....... .. _
Measles Washington, D.C....... .. ... I 87
International Notes
Animal Rabies England . 392


insect bite on his thorax. A peripheral blood smear showed
parasitemia with T. rhodesiense, and he was treated with
Suramin.* Because on admission there had been some sug-
gested CNS involvement and because several subsequent
lumbar punctures were abnormal, he was started on a course
(Continued on page 386)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
44th WEEK ENDED CUMULATIVE, FIRST 44 WEEKS
MEDIAN
DISEASE November 1, November 2, 1964- 1968 MEDIAN
1969 1968 1969 1968 1964- 1968
Aseptic meningitis .................. .... 99 110 67 2,967 3,817 2,582
Brucellosis ............................ 2 3 3 199 192 213
Diphtheria ................ ... .......... 3 8 8 148 190 169
Encephalitis, primary:
Arthropod-borne & unspecified ........... 18 29 41 1,078 1,227 1,641
Encephalitis, post-infectious ............. 8 6 8 271 419 646
Hepatitis, serum ........................ 107 124 686 4,465 3,874 32412
Hepatitis, infectious ..................... 1,011 1,047 39,961 38.382
Malaria ................................ 92 88 21 2,632 2,011 406
Measles rubeolaa) ....................... 185 161 705 21,552 20.591 193,567
Meningococcal infections, total ........... 22 30 41 2.565 2,218 2,357
Civilian ................................. 22 28 2,358 2,030 -
Military ............................... 2 207 188 -
Mumps ................................. 1,155 1,580 73,841 132,401 -
Poliomyelitis, total ..................... 2 15 54 54
Paralytic ............................. 2 14 54 54
Rubella (German measles) ............... 289 317 51,309 45.769 -
Streptococcal sore throat & scarlet fever.... 7,879 8,765 7,876 352,850 355,094 354,037
Tetanus ............................... 2 1 4 133 147 190
Tularemia .............................. 4 1 4 127 158 158
Typhoid fever .......................... 8 12 8 277 338 358
Typhus, tick-borne (Rky. Mt. spotted fever) 8 3 2 433 268 249
Rabies in animals ....................... 50 56 1 56 2.856 2,937 3676

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........................................ ... 3 R abies in m an: ...................................... 1
Botulism: .......................................... 12 Rubella congenital syndrome: ......................... 9
Leptospirosis: N.C.-I, Tex.-1 ......................... 69 Trichinosis: N.J.-2, Tenn.-1 ............................ 170
Plague: N.M.-1 ...................................... 5 Typhus, murine: Ark.-l, Ohio-1 ........................ 47
Psittacosis: ...................................... 37






Morbidity and Mortality Weekly Report


NOVEMBER 1, 1969


AN OUTBREAK OF AFRICAN SLEEPING SICKNESS (Continued from front page)


of Mel B.* lie improved markedly and. now back in this
country. has neither diffuse nor focal neurologic deficits.
His wife, age 12 years, remained on safari after her
husband left East Africa. On September 3. she sought
medical attention for a mild pyrexia, which she had had
for 12 days. She was flown out of the bush at that time to
the local medical center. On admission, she was febrile
(1053F.) and delirious. She had a leukocytosis of 20,000
with shift to young forms and heavy parasitemia with T.
rhode iense, but her lumbar puncture was normal. She
had numerous insect bites which. according to family mem-
bers interviewed later, were known to have been caused
by the tsetse fly. She received prompt treatment with anti-
biotics, steroids, and Suramin, but rapidly developed pur-
pura, jaundice, and anuria, and, following convulsions
and coma, died on September 6.
The white hunter who led this party on safari is re-
ported to have a positive blood smear for trypanosomiasis.
His history and condition are presently unknown.
One of the above couple's three children, who remained
with his mother during most of the safari and who pre-


sumably had similar exposures, is not known to have been
bitten by a tsetse 'l. and at the time continues asympto-
matic. Tests to identify subclinical parasitemia have been
negative.
Seven other American citizens a family of four, a
couple, and a single college girl had recently been on
safari with this same guide in the same general area a.
the first group. All seven members of the second group
were contacted; serologic studies were nlc.ilie for tryp-
anosomiasis on all seven.
(Reported by Dr. Helen Bruce, I.1.. ... Director for Com-
municable Diseases, and Dr. Melvin Tess, Health Com-
missioner, St. Louis Department of Health; Dr. Jay Ward
Smith, Menlo Park, California; Dr. Richard Levine, Denver.
Colorado; Dr. Caryl A. Potter, Jr., St. Joseph's, Missouri,
the Temple Buell College Student Health Services, Denver.
Colorado; Dr. Kanti M. Patel, Kampala, Uganda; a physi-
cian, Geneva, Switzerland; the Parasitic Diseases Branch.
Epidemiology Program, NCDC; and an EIS Officer.)
*Available through Parasitic Disease Drug Service, Parasiti
Diseases Branch, Epidemiology Program, NCDC.


STAPHYLOCOCCAL FOOD POISONING Memphis, Tennessee


On Oct. 4, 1969, an outbreak of severe gastroenteritis
occurred among individuals who patronized two branches
of a restaurant in Memphis, Tennessee. Nirn .-ihri-.'- per-
sons were identified as having illness within a few hours
after eating barbecued pork sandwiches (Figure 1). Most
complained of nausea, vomiting, abdominal cramps, diarrhea,
and chills; 10 were hospitalized for dehydration or pros-
tration, and one was admitted in impending shock. There
were no deaths. Of 14 other persons who ate at the restau-
rant with a person who later became ill but did not become
ill themselves, seven had eaten barbecued pork sandwiches
and se en had not.
The barbecued pork was prepared at the main restaurant
from pork shoulders barbecued over an open pit until thor-
oughly cooked, then placed on cooling racks in heavy paper,
and allowed to come to room temperature over 8 to 12 hours.
After this process of "sweating," the pork was an -. 11
dehoned. cut into small pieces by hand. and made into
patties. On October 3. however, a new method of making
the patties using a hamburger pattie machine had been
initiated. It was hoped that this method would allow sand-
w-iches to he made more quickly. hbut the texture of pork
and the nexo technique combined to cause repeated break-
tdowns of ithe machine. This necessitated extensive handling
of the meat for prolonged periods without refrigeration.
afterr the patties wiere made. they were delivered in boxes
it the branch ret-taurants, where they were placed in warmers
unil thei time of sale. The sandwiches were made with
coEr, nercial buns and with barbecued pork and coleslaw
made ; I the main restaurant. Most. of the implicated batch
of santlwiches were iold between 11:00 a.m. and 3:00 p.m.
on October 4.


FIGURE 1
CASES OF FOODBORNE GASTROENTERITIS
MEMPHIS, TENNESSEE OCT. 4, 1969


2 3 4 5 6
ONSET-HOURS AFTER EATING


7 a


Stuphylococcus aureus was reco vred from two sample-
of barbecue sandwiches with counts exceeding 30 million
per gram. S. uareus was also cultured from two employees


386


Illln,









with obviously infected cuts on their hands and from the
work table at the main restaurant. The phage type of all
isolates was 6/47/53/54/75/83a. There were no cases of
similar illness reported from the central restaurant, where
the sandwiches were not kept in warmers but were sold
soon after being made.
(Reported by Cecil B. Tucker, M.D., M.P.H., Director,
Bureau of Preventive Health Services, W. M. Arnold, Direc-


387


tor, Memphis Branch Laboratory, and J. H. Barrick, Ph.D.,
Director, Division of Biological Laboratories, Tennessee
Department of Public Health; George S. Lovejoy, M.D.,
F.A.A.P., Director, Donald R. Daffron, Administrative
Assistant, Sanitation Division, and R. C. Rendtorff, Sc.D.,
M.D., Director, Division of Communicable Disease Control,
Memphis and Shelby County Health Department; and an
EIS Officer.)


MEASLES Washington, D. C.


Between Aug. 17 and Sept. 17, 1969, 24 cases of
measles were reported from Junior Village, a 13-cottage
children's facility under the direction of the District of
Columbia Department of Public Welfare. During the pre-
ceding 2 years, no measles cases had been reported there.
Junior Village is divided into two cottage groups, one
group for children under 5 years of age and one for those
over 5, with 20 to 70 children per cottage and minimal con-
tact among residents of different cottages. All cases of
measles were in the younger age group; 14 (58 percent)
occurred in cottage H, eight (33 percent) in cottage A, and
two (9 percent) in infirmary boarders. Of the first four
cases diagnosed between August 17 and 22, one was an
infirmary boarder who rarely left the building, two were
from cottage H, and one was from cottage A. About 1 1/2
weeks prior to the outbreak (August 6-11), these four
children had all been in a single infirmary room with minor
ailments otitiss or a mild viral syndrome). While no child
with a diagnosis of measles was in the infirmary at that
time, a 17-month-old child (Case 1, Table 1) with a high
fever and cough occupied the same room. The child had
chronic eczema and was noted by the infirmary-staff to
have a "change in his skin condition" while ill; no further
clinical data were available. He was found later to have a
positive serology for measles and had not received mea-
sles vaccine. Thus he presumably was the index case. He
may have acquired his measles during his weekly visits to
the dermatology clinic at a nearby hospital.
Sera were obtained from 15 of the cases (Table 1);
these sera had hemagglutination inhibition titers to mea-
sles ranging from 1:40 to 1:640. Acute phase sera were
not obtained early enough for meaningful comparison.
Measles virus was isolated from six of 13 patients from
whom nasal pharyngeal specimens were obtained. None of
the 24 patients had received measles vaccine.
A review of the immunization procedures at the village
showed that during the 2 preceding years it had been a
routine practice to immunize all new admissions who did
not have a documented history of measles or measles
vaccination. For several months prior to the ourhr.- jl.
however, fewer immunizations were administered due in
part to the large patient turnover and summer vacation.
Regular administration of vaccine immunization has been
reestablished.


Table 1
Serologic Data on 15 Cases of Measles, Junior Village
Washington, D. C. August-September 1969

Case Age Date of Date Sera Titer Viral
Yr. Mo. Onset Were Obtained (HI) Isolation*
1 1 5 Aug. 5 Sept. 11 1:640
2 2 1 Aug. 17 Sept. 9 1:160
3 3 4 Aug. 20 Sept. 9 1:320
4 1 10 Aug. 22 Sept. 9 1:160
5 3 3 Aug. 27 Sept. 9 1:640
6 2 2 Aug. 28 Sept. 9 1:640
7 2 2 Sept. 1 Sept. 9 1:320
8 1 9 Sept. 2 Sept. 9 1:160
9 1 5 Sept. 3 Sept. 9 1:80 Positive
Sept. 23 1:320
10 2 2 Sept. 4 Sept. 9 1:40 Positive
Sept. 23 1:80
11 3 7 Sept. 5 Sept. 9 1:320
12 2 3 Sept. 5 Sept. 9 1:160 Positive
13 2 3 Sept. 5 Sept. 9 1:160
Sept. 23 1:320
14 1 10 Sept. 7 Sept. 9 1:40 Positive
Sept. 23 1:160
15 3 3 Sept. 7 Sept. 11 1:320
Sept. 23 1:160
*There were two additional isolations in children from whom no
sera were obtained.



(Reported by Reginald James, M.D., Medical Officer, Junior
Village, District of Columbia Department of Public Wel-
fare; William E. Long, M.D., Chief, Epidemiology Divi-
sion, and the Bureau of Laboratories, District of Columbia
Department of Public Health; the Public Health Advisors,
Immunization Branch, State and Community Services Divi-
sion, and Viral Exanthems Laboratory, Laboratory Divi-
sion, NCDC; and an EIS Officer.)


Editorial Comment:
Prior to the epidemic, there had been six cases of
measles reported in the District of Columbia since the be-
ginning of 1968. The situation at Junior Village exempli-
fies the necessity to maintain routine measles immuniza-
tion on a continuing basis.


NOVEMBER 1, 1969


Morbidity and Mortality Weekly Report






:188 Morbidity and Mortality Weekly Report


TABLE II1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 1. 1969 AND NOVEMBER 2, 1968 (44th WEEK)


A\FPTIC ENCEPHALITIS HEPATITIS
FNINS- BRUCEI- Ii iUllHill Primary including I1'Ii- MALARIA
AREA ITIS LSIS unsp cases l l, Serum Infectious
Cum.


UNITED AlAI :L ... IB '" I,," I ,')jll 1,02 2,6 2

NEW ENGLAND............ 2 2 1 5 97 53 82
Maine.............. 24 7 7
New Hampshire..... 3 4 2
Vermont............. 9 3 -
Massachusetts...... 2 36 22 49
Rhode Island....... 1 7 9 9
Connecticut ....... 2 2 1 2 18 8 15

MIDDLE ATLANTIC ...... 11 1 2 2 49 185 187 23 311
New York City...... 2 1 1 31 63 75 22
New York, up-State. 2 1 1 1 26 31 21 68
New Jersey.......... 1 15 43 29 1 119
Pennsylvania....... 6 1 2 53 52 1 102

EAST NORTH CENTRAL... 23 1 2 12 9 188 166 8 268
Ohio............... 1 2 6 1 45 41 24
Indiana ............ 4 18 18 1 21
Illinois............ 9 1 1 2 42 52 6 167
Michigan............ 9 5 6 75 45 1 55
Wisconsin.......... 8 10 1

WEST NORTH CENTRAL... 12 2 1 20 65 3 182
Minnesota.......... 11 2 1 4 22 13
lowaa .............. 3 21 19
Missouri............ 1 7 9 42
North Dakota....... I 3
South Dakota........ .- I
Nebraska........... 2 1 4
Kansas............ 3 12 3 100

SOUTH ATLANTIC....... 14 1 1 3 1 2 4 97 127 5 689
Delaware........... 1 3
Maryland ........... 2 9 11 1 32
Dist. of Columbia.. 2 2 2 2
Virginia............. 2 1 7 9 26
West Virginia. .... 1 1 1 1 8 3 -
North Carolina..... 5 1 1 1 23 13 1 273
South Carolina..... 2 9 4 58
Georgia............ 15 30 3 261
Florida............ 2 1 2 24 54 34

EAST SOUTH CENTRAL... 5 2 1 73 32 23 135
Kentucky............ 2 1 37 9 22 108
Tennessee.......... 1 1 1 19 13 -
Alabama............ 2 6 5 1 23
Mississippi........ 11 5 4

WEST SOUTH CENTRAL... 10 1 3 6 3 117 88 9 212
Arkansas............ 2 11 6 13
Louisiana.......... 1 3 3 44 19 45
Oklahoma.*............ 2 1 3 10 12 9 69
Texas.............. 8 52 51 85

MOUNTAIN............. 1 1 2 2 2 4 40 43 1 131
Montana............ 3 3
Idaho............... 1 4 5
Wyoming............ 2 -
Colorado........... 1 1 2 3 9 33 1 110
New Mexico......... 1 8 2 7
Arizona............ 1 12 3 1
Utah................ 1 4 1 1
Nevada............. 1 4

PACIFIC............... 21 3 4 3 31 194 286 20 622
Washington......... --- ---- --- --* --- 5 --- 5
Oregon............. 3 12 18 16
California.......... 18 3 4 3 28 178 257 20 489
Alaska.............. 3 3
Hawaii............. 3 4 3 109


Puerto Rico .......... I 18 24 4
*Delaved reports: Encephalitis, primary: Okla. 1
Hepatitis, infectious: N.hl. 6, W. Va. delete 1
malaria: Iowa 1






Morbidity and Mortality Weekly Report 389


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 1, 1969 AND NOVEMBER 2, 1968 (44th 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... 185 21,552 20,591 22 2,565 2,218 1,155 14 289

NEW ENGLAND ......... 4 1,129 1,184 1 101 130 161 2 19
Maine.............. 9 38 7 6 24 1 1
New Hampshire..... 1 241 141 1 4 7 9 1
Vermont............ 3 2 I I -
Massachusetts...... 1 226 369 38 67 63 4
Rhode Island....... 27 6 14 9 6 1
Connecticut........ 2 623 628 38 40 58 1 12

MIDDLE ATLANIC ...... 19 7,624 4,289 2 427 394 54 2 37
New York City...... 9 4,963 2,252 1 82 80 48 8
New York, Up-State. 1 610 1,264 82 72 NN 1 9
New Jersey ........ 8 943 656 166 134 6 7
Pennsylvania ....... 1 1,108 117 1 97 108 NN 1 13

EAST NORTH CENTRAL... 44 2,434 3,956 3 350 272 339 53
Ohio............... 2 402 310 1 131 76 36 -
Indiana............. 2 470 694 45 38 38 12
Illinois........... 26 616 1,386 49 60 62 7
Michigan........... 8 326 296 2 100 78 72 27
Wisconsin.......... 6 620 1,270 25 20 131 7

WEST NORTH CENTRAL... 38 746 398 1 128 120 57 1 17
Minnesota.......... 1 9 18 28 29 2 2
Iowa.*............ 336- 104 19 8 43 13
Missouri........... 31 81 1 53 39 1
North Dakota....... 6 22 138 2 3 10 I
South Dakota....... 3 4 1 5 NN -
Nebraska. ......... 31 338 43 9 9 2 -
Kansas............. 7 10 16 27 1 -

SOUTH ATLANTIC....... 8 2,596 1,570 4 451 442 126 1 33
Delaware............ 1 395 16 13 8 1 -
Maryland........... 77 103 41 38 8 2
Dist. of Columbia.. 26 6 9 16 3 -
Virginia........... 1 889 326 55 42 18 1
West Virginia...... 214 299 19 13 42 12
North Carolina..... 4 323 284 3 84 85 NN -
South Carolina..... 127 14 58 58 8 1
Georgia............ 2 4 1 77 88 -
Florida............. 2 543 518 95 94 46 1 17

EAST SOUTH CENTRAL... 1 116 501 2 161 200 61 1 22
Kentucky............ 66 103 54 92 13 4
Tennessee.......... 1 20 62 1 65 58 41 16
Alabama............ 6 95 1 25 27 5 1 2
Mississippi........ 24 241 17 23 2 -

WEST SOUTH CENTRAL... 52 4,778 4,989 2 341 325 120 6 44
Arkansas........... 16 2 1 32 20 -
Louisiana.......... 1 124 24 91 92 -
Oklahoma. .......... 142 125 34 52 20 7
Texas............... 51 4,496 4,838 1 184 161 100 6 37

MOUNTAIN............. 8 1,009 1,025 1 50 39 74 17
Montana............. 4 66 58 8 6 1 4
Idaho............. 90 21 11 11 2 1
Wyoming............. 54 3 -
Colorado............ 141 518 8 11 14 4
New Mexico......... 2 270 122 6 40 -
Arizona............. 2 431 226 10 4 11 4
Utah............... 10 21 1 5 1 6 4
Nevada............. 1 5 2 3 -

PACIFIC.............. 11 1,120 2,679 6 556 296 163 1 47
Washington......... --- 63 566 --- 56 46 --- --- --- ---
Oregon.............. 200 546 18 23 11 9
California......... 10 800 1,522 6 461 211 108 1 29
Alaska.............. 13 10 11 3 38 6
Hawaii............. 1 44 35 10 13 6 3

Puerto Rico........... 21 1,736 446 19 20 22
*Delayed reports: Measles: N.J. 1, Iowa 4, Nebr. 25
Heningococcal infections: Okla. 1
Mumps: N.H. 9






1390 Morbidity and Mortality Weekly Report


TABLE IIl CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 1, 1969 AND NOVEMBER 2, 1968 (44th X FFIK) ONTINl'TD


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA P 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... 7,879 2 133 4 127 8 277 8 433 50 2,856

NEW ENGLAND.......... 611 1 1 16 2 14 1 5 40
Maine.............. 12 1 6
New Hampshire.... 16 5
Vermont ............ 22 1 16 4 18
Massachusetts ...... 152 1 7 1 1 3
Rhode Island...... 24 1 -
Connecticut........ 385 2 5 8

MIDDLE ATLANTIC...... 289 17 5 29 1 44 4 199
New York City...... 20 9 1 15 -
New York, Up-State. 193 3 4 6 7 4 186
New Jersey........ N 3 3 1 15 -
Pennsylvania...... 76 2 5 22 13

EAST NORTH CENTRAL... 626 18 2 15 1 31 3 6 211
Ohio.............. 43 4 1 11 2 71
Indiana............ 138 2 4 .- 50
Illinois........... 142 9 4 14 3 1 34
Michigan........... 149 5 5 7
Wisconsin.......... 154 7 1 3 49

WEST NORTH CENTRAL... 233 11 14 10 8 11 528
Minnesota.......... 33 3 4 5 143
Iowa.............. 76 1 7 3 83
Missouri........... 4 10 3 1 130
North Dakota...... 99 2 69
South Dakota....... 20 I 24
Nebraska............ 1 1 13
Kansas ............ 5 4 3 1 66

SOUTH ATLANTIC....... 807 24 22 1 41 6 246 6 681
Delaware............ 6 2 3 -
Maryland............. 65 1 4 48 3
Dist. of Columbia.. 16 2 1 2 -
Virginia........... 248 4 1 81 2 341
West Virginia...... 194 1 2 2 5 2 97
North Carolina..... NN 2 6 6 6 64 5
South Carolina..... 79 1 2 1 30 -
Georgia.............. 6 7 4 11 15 2 79
Florida............ 193 10 4 12 156

EAST SOUTH CENTRAL... 1,662 1 20 14 44 1 63 4 370
Kentucky........... 150 7 8 13 2 189
Tennessee.......... 997 4 13 19 41 1 126
Alabama. .......... 211 6 4 1 6 1 49
Mississippi........ 304 1 3 1 13 3 6

WEST SOUTH CENTRAL... 801 1 25 20 1 29 46 7 416
Arkansas........... 18 1 2 2 13 7 30
Louisiana.......... 2 7 4 3 32
Oklahoma........... 39 1 8 28 2 63
Texas.............. 742 15 6 1 13 11 5 291

MOUNTAIN............ 2,584 6 1 17 1 28 17 117
Montana............ 42 1 2 -
Idaho... I ........ 191 4 6 -
Wyoming.*............ 885 1 4 5 54
Colorado............ 1,118 2 3 9 3
New Mexico......... 225 1 1 7 17
Arizona*. .......... 62 3 6 22
Ut'ah.............. 61 12 2 5
Nevada ............. 1 16

PACIFIC.............. 266 11 4 2 51 5 7 294
Washington......... -. --- 1 --- 2 --- 2 --- 3 --- 4
Oregon............. 133 1 6 4
California......... --- 10 1 2 39 2 7 286
Alaska............. 57 -
Hawaii.............. 76 4 -

Puerto Rico.........1 12 6 25
*Delayed reports: SST: N.H. 13, Wyo. 590
Tetanus: Ala, 1
Typhoid fever: Ariz. 1






Morbidity and Mortality Weekly Report


Week No. TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED NOVEMBER 1, 1969
44
(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 Al 5 years and year
Influenza All In luenza
Ages and over All Ages Causes Ages and over All Ages Causes
All Ages Causes All Ages Causes


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

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

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

WEST NORTH CENTRAL:
Des Moines, Iowa------
Duluth, Minn.---------
Kansas City, Kans.----
Kansas City, Mo.-------
Lincoln, Nebr.--------.
Minneapolis, Minn.----i
Omaha, Nebr.----------
St. Louis, Mo.--------
St. Paul, Minn.-------
Wichita, Kans.--------


688
215
52
20
21
61
23
16
27
50
62
9
48
14
70

3,114
42
53
154
37
34
37
76
S89
1,381
33
498
199
57
129
26
36
101
53
33
46

2,703
61
48
743
149
225
132
80
369
38
58
51
90
54
165
31
113
41
28
49
124
54

872
50
20
40
143
23
126
77
251
90
52


428
119
35
16
14
33
16
11
20
33
33
6
31
13
48

1,825
18
28
80
23
19
14
55
S49
809
21
291
108
34
76
18
26
70
30
23
33

1,503
41
29
385
78
125
64
44
193
22
28
31
39
35
82
21
79
26
22
33
86
40

553
34
13
25
100
16
88
35
155
63
24


43
18
6
2


1

2

2
1
5

6

141
2
4
4
3
3
1
7
3
70

3
17

4
1
2
3
6
4
4

77
1
2
23
2
3
2
2
6
2
4
2
9
3
2
3
3

2
3
2
1

24
3
2
3
1
1
1

7
2
4


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.----------


1,239
137
240
46
68
132
62
100
30
87
65
215
57

654
94
55
55
133
123
60
38
96

1,167
62
60
25
148
50
84
199
61
144
89
131
52
62

468
53
26
123
15
98
22
53
78

1,666
13
59
41
47
100
551
74
52
129
55
109
141
51
150
48
46


12,571


685
68
147
22
33
61
37
51
13
67
35
116
35

354
54
24
30
77
67
31
14
57

589
36
35
11
65
21
51
88
35
68
40
78
28
33

245
23
13
59
10
53
14
29
44

961
9
30
29
20
68
305
42
37
81
29
59
78
36
78
33
27


7,143


Expected Number 12,384 7,136 404 526


Cumulative Total
(includes reported corrections
for previous weeks)


569,669


325,515


25,741


*Mortality data are being collected from Las Vegas, Nev.. for possible inclusion in this
Las Vegas, Nev.* 17 10 1 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.
+Estimate based on average percent of divisional total


1






Morbidity and Mortality Weekly Report


INTERNATIONAL NOTES
ANIMAL RABIES England

On Oct. 18, 1969. the first case of rabies since 1922
in an animal that had completed compulsory quarantine was
confirmed in Camberley. Surrey. England. The dog, a small
mongrel terrier, had been imported from (r. ri..in. and had
been released after 6 months quarantine at a kennel in
Folkestone on October 4. It behaved normally for about 1
week and then developed signs suggestive of rabies. On
October 14, it was missing from its home from 7:45 a.m.
until 8:35 a.m. About this time, it attacked and killed a
cat. bit the milkman's shoe. and bit its owner. It was then
caught and confined and died on October 18. That day rabies
was confirmed by fluorescent .rn l...il test. In July, rabies
had been confirmed in a dog that was undergoing quarantine
at the same kennel as this current case, but there had been
no direct contact between the two animals: in addition,
between January and April, nine known cases of rabies
occurred in the area of Germany where the dog had been
living.
At present 29 persons, mostly children, are receiving
antirabies vaccine. The dog's owner had bites on the hand
and lower leg and is the only one with bites in which the
skin was broken; she had received primary immunization
with a course of Semple brain tissue vaccine in India 3
years ago. The majority of the other patients receiving
vaccine had contact with the animal during the days after
its release from quarantine and before October 14 when it,
may have licked either mucous membranes or skin. It is
difficult to determine what constitutes an abraded skin in
many of these persons who ranged in age from 2 to 6 years.
The Ministry of Agriculture has placed under "House
Arrest" for a period of 6 months all dogs in the locality.
These dogs will be allowed out only if they are muzzled
and on a lead. An attempt is being made by veterinary
officers to inform all households with dogs about the possi-
ble exposure to the rabid dog when it was loose on Octo-
ber 14.
(Reported by Dr. C. A. MacPherson, Divisional Medical
Officer, Surrey County Council; Dr. David L. Miller, Epi-
demiologist, Central Public Health Laboratory Service,
Colindale; and Medical 0" '. Foreign Quarantine Pro-
gram, London.)
Editorial Comment:
Dogs from certain designated rabies-free areas are
exempt from rabies vaccination as a condition of entry into
the United States. The recent diagnosis of rabies in an
imported dog does not change the status of the United
Kingdom as a rabies-free area, and no additional entry re-
quirements will be placed on dogs imported from this area.
Since 1922 in England, there have been three cases
of rabies out of a total of 100,000 susceptible animals in
quarantine,.
Reference:
ILondon Times, October 30, 1969.


NOVEMBER 1, 1969


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITg A CIRCuLA-
TION OF 18,500 IS PUBLISHED AT THE NATIONAL COMMNUICABLE
DISEASE CENTER, ATLANTA, GEORGIA.
DIRECTOR, NATIONAL COMMUNICABLE DISEASE CENTER
DAVID J. S.NC." M D
DIRECTOR. EPIDEMIOLOGY PROGRAM A. D. LANCM,.IR M.D
EDITOR MICHAEL B. GREGG M D.
EDITOR pro ten ALAN R. .,lNAN M.D.
MANAGING EDITOR PRISCILLA B MOL.AN
IN ADDITION TO THE ESTABLISHED PROCE3ILRES FOR REfOR TNl
MORBIDITY AND MORTALITY, THE NATIONAL COIMMuNIL ALE D0SE PSE
CENTER WELCOMES ACCOUNTS OF INTERESTIIC Ou I ERE a 5R CASE
INVESTIGATIONS WHICH ARE OF CURRENT ,rdTEREiB TO .iEALIT
OFFICIALS AND WHICH ARE DIRECTLY RELATED TO TrE 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: --E CAT'1 N -T-l ...lr E E O .IO,':iGAc' L AND AsF
BASED ON AWEEALI TELECRA Mi: TO TE NiD, aB T-E INDiviDu*L
STATE HE.L ,T .-.E' aR TMA ENTI T7 E AE 'r T= ii WEEC CONCLuDES
AT CLOSE O1F bu'NEti OC- F Q6Da .. IP-LEDC. C-..A CN A NATIONAL
BASIS ARE :.Ff LL I RELE- OD T* T i E UB LIC C'N T E LuCCE CEr
ING FRIDAY.


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