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:
AA00010654:00142

Related Items

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

Full Text

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NATIONAL COMMUNICABLE DISEASE CENTER


dad


Vol. 18, No. 46

WEEKLY

REPCRI



k k Ending

imber 15, 1969


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE-/ PUBLIC HEALTH SI
DATE OF RELEASE: NOVEMBER 21, 1969 ATI


EPIDEMIOLOGIC NOTES AND REPORTS
OUTBREAK OF TUBERCULOSIS IN A HIGH SCHOOL
Abbeville, Alabama
On March 24, 1969, active far-advanced bilateral pul-
monary tuberculosis was. diagnosed in a 17-year-old 11th
grade student in Abbeville, Henry County, Alabama. He had
been ill for some time but had continued to attend school.
Following the diagnosis of his case, 379 students in
his school in grades 7-12 were tuberculin tested on April 1
using jet injector guns and intermediate strength PPD; 77
(20.3 percent) had a reaction of 10 mm or more at 48 hours
(positive) (Table 1) and 14 (3.7 percent) had a reaction of
5 to 9 mm (doubtful). Students in grades 8 and 12 had been
tuberculin tested on Dec. 11, 1968, as part of the county
health department's first school skin testing program; two


Epidemiologic Notes and Reports
Outbreak of Tuberculosis in a High School -
Abbeville, Alabama. ....... .............. 401
Potential Trichinosis Outbreak Averted Vermont...... 403
Outbreak of Shigellosis Medford, Oregon . 403
Cutaneous Anthrax North Carolina. . .408



of 36 eighth graders and 16 of 48 12th graders who had had
negative tests in December were positive when tested in
April. Of 147 family and neighborhood contacts of the in-
dex case who were also tuberculin tested, 24 had a posi-
tive reaction; 10 of the 24 had had negative tests within
the previous 9 months. Of the 27 students who rode the
school bus with the index case and who were included in
(Continued on page 402)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
46th WEEK ENDED CUMULATIVE, FIRST 46 WEEKS
DISEASE MEDIAN
November 15, November 16, 1964 1968 MEDIAN
1969 1968 1969 1968 1964- 1968
Aseptic meningitis ...................... 75 85 63 3,146 3,975 2,689
Brucellosis ............................ 2 3 4 206 199 221
Diphtheria............................. .. 12 3 4 167 209 172
Encephalitis, primary:
Arthropod-borne & unspecified ........... 31 27 39 1,159 1,276 1,728
Encephalitis, post-infectious ............. 3 10 7 275 432 657
Hepatitis, serum ........................ 110 78 4 4,702 4,038 33,705
Hepatitis, infectious ................... 1,076 902 754 42,192 40,168 05
Malaria ................................ 62 70 12 2,744 2,108 429
Measles rubeolaa) ....................... 303 242 1,166 22,141 21,055 195,563
Meningococcal infections, total ........... 28 19 46 2,625 2,270 2.454
Civilian ............................... 26 19 2,414 2,079 -
Military............................... 2 211 191 -
Mumps ................................. 1,679 2,029 76.966 136,113 -
Poliomyelitis, total ..................... 2 2 16 56 56
Paralytic ............................. 2 1 15 56 56
Rubella (German measles) ............... 443 319 52,214 46,405 -
Streptococcal sore throat & scarlet fever.... 9,551 8,886 8,260 370,563 372,468 369.505
Tetanus ............................... 4 1 4 144 151 198
Tularemia .............................. 1 1 4 128 160 164
Typhoid fever .......................... 2 6 7 291 354 371
Typhus, tick-borne (Rky. Mt. spotted fever) 1 1 437 270 256
Rabies in animals ....................... 153 44 72 2,972 3,038 3,815

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ...................................... .. ... 3 Rabies in man: ...................................... 1
Botulism: ..................................... 12 Rubella congenital syndrome: La.-l, Nebr.-2. Ore.-l ........ 13
Leptospirosis: Calif.-2 ............................... 74 Trichinosis: ........................................ 170
Plague: ............ ....................... 5 Typhus, marine: ..................................... 47
Psittacosis: Pa.- ............................. .. 40







Morbidity and Mortality Weekly Report


NOVEMBER 15, 1969


TUBERCULOSIS (Continued from front page)

Table 1
Results of Two Tuberculin Skin Testing Programs at a School in Alabarta

April 1 May 7*
Grade Number Positives/ Percent Number Positives/ Percent
Number Tested Reactors Number Tested Converters
7 3/62 4.8 2/59 3.4
8 3 40 7.5 0/37 0.0
9 4/51 7.8 2/47 4.4
10 19/78 24.4 3/59 5.1
11 32/84 38.1 5/52 9.6
12 16/64 25.0 5/48 10.4
Total 77/379 20.3 17/302 5.6
*Those students positive in April were not retested in May.


Table 2
Data on Eight Cases of Tuberculosis Henry County, Alabama, 1969

Contact Diagnosis Tuberculin Tests Sputum
Case Age Grade Sex History Date 12/11/69 4/1/69 Roentgenogram Culture -e at Diagnosis

1 17 11 M Index Case 3/24/69 No Test No Test Bilat. + Far-advanced
Infiltrate
2 16 11 F Classmate 5/23/69 No Test 15 mm Negative + Minimal
and Friend
3 17 12 F Classmate 5,'26/69 Negative 15 mm Negative + Minimal
4 19 12 M Friend 5/26/69 No Test 20 mm Negative + Minimal
5 73 M Neighbor 6/2/69 Negative* 10 mm Left Pleural + Mod.-advanced
Effusion
6 14 8 M Friend 6/9/69 Negative 20 mm Right Hilar + Minimal
Adenopathy
7 28 F Family 6/19/69 No Test 20 mm Bilat. Hilar + Minimal
Adenopathy
8 16 11 M Classmate 6/26/69 No Test 22 mm Bilat. Minimal
and Friend Infiltrate
"Tested on Dec. 11, 1968, because he was a school employee at another school where tuberculin testing was also being done.


the 379 students tested in the school and the school bus
driver who was also tuberculin tested, 22 (78.6 percent)
had positive reactions.
Roentgenograms were obtained from 235 persons with
reactions of 5 mm or more and sputum containers were dis-
tributed for voluntary submission of specimens: four per-
sons had roentgenographic findings compatible with recent
tuberculosis infection, and three of these four had positive
sputum1 cultures. Three other persons whose roentgeno-
grams appeared normal had sputum cultures positive for
Mycobacterium tuberculosis (Table 2). The 17-year-old boy
and the seven contact cases were hospitalized at the state
tuberculosis hospital.
On May 7, all students who had had negative or doubt-
ful reactions on April 1 were retested, and 17 were found to
have positive reactions. These students submitted sputum
specimens and had roentgenograms taken, but no new
cases were identified.


On October 1, all students in all schools in Henry
County were tuberculin tested. About 230 students who had
attended the implicated school during the previous school
year and had had negative tuberculin tests in April and
May were included; four had become reactors. Each of the
four had a history of contact with the index case or a
secondary case.
Throughout this investigation, any student who had a
reaction of 5 mm or more and no previous history of a posi-
tive tuberculin test was started on ayearof isoniazid therapy.
A total of 290 contacts of the index case or subsequent
cases in this outbreak were placed on isoniazid.

(Reported by F. S. Wolf, M.D., Director, Bureau of Prevent-
able Diseases, Alabama State Health Department; George
E. Johnson, M.D., Health Officer, and Nan Clenny, R.N.,
Public Health Nursing Supervisory, Henry County Health
Department; and an EIS Officer.)


402














In the fall of 1967, a cooperative survey was begun to
determine the prevalence of trichinosis in the black bear
population of the northeastern United States. The survey -
still in progress is being carried out by the Parasitic
Diseases Branch, Epidemiology Program, NCDC, and wild-
life conservation personnel of Maine, New Hampshire, New
York, Pennsylvania, West Virginia, and Vermont. Samples
of bear tongue and diaphragm are collected by game biolo-
gists as hunters register their kill at Department of Fish
and Game checking stations in each state and are then sub-
mitted to NCDC for laboratory examination. Of 138 bears
examined since 1967, three have been found infected.
In October 1969, samples of tongue and diaphragm from
a bear killed in Vermont were found to be infected with
trichina larvae. The Vermont Fish and Game Department
were notified, and they, in turn, contacted the hunter. It
was learned that the hunter, a woman, had shot the bear on


403


Sept. 3, 1969, and had eaten one meal of well-cooked bear
meat with no ill effects. She then sold the remainder of the
bear to the local game club for their annual feast; between
25 and 50 persons were expected to attend. Fortunately,
the feast had not yet taken place. The game club was noti-
fied that the bear meat was infected with trichina larvae,
and a recommendation was made that the meat be destroyed
and that if any other bear meat were used for the feast, it
should be treated as if it were pork and cooked hnror.ughi..
The game biologist when he collected the tongue and
diaphragm samples from the bear found meat in its stomach.
He reported that hunters in this area often attract bears by
setting out raw meat scraps. This practice may provide a
possible means of trichinosis transmission to bears.

(Reported by Charles H. Willey, Game Biologist, Vermont
Fish and Game Department; and an EIS Officer.)


OUTBREAK OF SHIGELLOSIS Medford, Oregon


Between July 23 and Aug. 17, 1969, in Medford, Oregon,
37 persons developed an acute illness characterized by
abdominal cramps, diarrhea, fever, and headache, and two
children presented with febrile convulsions. Six persons
required hospitalization; there were no fatalities. Shigella
sonnei was recovered from stool cultures of 15 patients.
Table 3 shows the age and sex distribution of the
cases. Eight family groups were affected, and the index
case in each family was a child between the ages of 2 and
6 years. The only factor common to these children was their
use of a municipal wading pool between July 20 and 25.
This small wading pool was filled with chlorinated water
from the large regular swimming pool and drained at the
end of each day. A water sample from the wading pool on
August 14 had a chlorine level of 0.5 parts per million and
gross contamination with coliform organisms.
It could not be proved that the index cases acquired
their infection at the wading pool, and no parents gave a
history of their child having waded while having diarrhea,
but the gross coliform contamination despite chlorination
makes such an occurrence plausible. Factors contributing
to such a possibility include 1) the smaller size of the
wading pool with higher concentrations of any fecal inocu-
lum, 2) the habits of children, some not yet toilet trained
and uninhibited in their ingestion of pool water, 3) inacti-
vation of chlorine by ultraviolet light, and 4) lack of a
systematic measuring of chlorine levels in the wading
pool.


Table 3
Age and Sex Distribution of Cases, Outbreak of Shigellosis
Medford, Oregon Summer 1969

Age Male Female Total
(Years)
<1 0 0 0
1-3 1 5 6
4-6 5 3 8
7-12 4 5 9
13-21 1 1 2
>21 3 4 7
Unknown 4 1 5
Total 18 19 37



The primary control measure instituted in this outbreak
was the closing of the wading pool for the remainder of the
season to avoid recontamination by secondary cases in the
community. Fluid therapy and antibiotic treatment of in-
dividual patients were handled by private physicians. After
these measures, the outbreak quickly abated with no further
shigella isolates reported in subsequent months.
(Reported by A. Erin Merkel, M.D., Health Officer, and
Orie S. Moore, Chief Sanitarian, Jackson County Health
Department; Gatlin Brandon, M.S., Director, Oregon State
Public Health Laboratory, and Monroe Holmes, D.V.M.,
Acting Director, Epidemiology Section, Oregon State Board
of Health; and an EIS Officer.)


NOVEMBER 15, 1969


Morbidity and Mortality Weekly Report



POTENTIAL TRICHINOSIS OUTBREAK AVERTED Vermont







1(0 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
NOVEMBER 15, 1969 AND NOVEMBER 16, 1968 (46th WEEK)


ASEPTIC ENCEPHALITIS HEPATITIS
MENIN- BRIICEL- DIPIIH1EIA Primary including Post- MALARIA
AREA GITIS unsp. cases Infectious Serum Infectious
Cum.
1969 1969 1969 1969 1968 1969 1969 1969 1968 1969 1969
UNITED STATES... 75 2 12 31 27 3 110 1,076 902 62 2,744

NEW ENGLAND.......... 4 1 3 134 52 2 91
Maine............. 20 8 7
New Hampshire...... 1 8 5 2
Vermont............ 9 -
Massachusetts...... 4 53 23 56
Rhode Island....... 2 26 11 1 10
Connecticut........ 1 18 5 1 16

MIDDLE ATLANTIC ..... 15 4 1 46 212 144 4 322
New York City...... 2 2 1 31 79 24 22
New York, Up-State. 2 40 10 1 69
New Jersey.?........ 3 2 6 40 35 2 126
Pennsylvania....... 10 7 53 75 1 105

EAST NORTH CENTRAL... 14 8 7 1 9 164 153 2 277
Ohio............... 3 4 3 1 41 30 1 25
Indiana............. 1 18 12 1 25
Illinois............ 3 2 1 1 3 25 36 170
Michigan........... 7 2 2 5 71 65 56
Wisconsin.......... 1 9 10 1

WEST NORTH CENTRAL... 3 2 1 36 61 2 190
Minnesota.......... 3 1 12 7 1 14
Iowa..................... 4 6 20
Missouri........... 2 8 25 42
North Dakota....... 1 1 3
South Dakota....... 1 1
Nebraska........... 4 3 4
Kansas............. 7 18 1 106

SOUTH ATLANTIC....... 7 1 3 9 12 117 94 11 710
Delaware........... 2 1 4
Maryland............ 2 1 1 1 13 13 33
Dist. of Columbia.. 5 2
Virginia........... 1 1 1 3 2 11 42 26
West Virginia. .... 13 8 --
North Carolina.*... 3 1 1 28 6 10 285
South Carolina.... I 7 5 58
Georgia............ 5 262
Florida............ 8 38 20 40

EAST SOUTH CENTRAL... 4 3 60 53 135
Kentucky.*......... 18 19 108
Tennessee.......... 2 3 21 25 -
Alabama............ 2 7 6 23
Mississippi........ 14 3 4

WEST SOUTH CENTRAL... 6 1 12 1 1 1 2 84 60 12 231
Arkansas........... 1 2 13
Louisiana.......... 1 10 1 1 1 2 16 11 45
Oklahoma............ 14 11 2 72
Texas.............. 6 2 53 36 10 101

MOUNTAIN.............. 2 2 42 38 4 137
Montana............ I 1 3 3
Idaho.............. 3 5
Wyoming............ 1 -
Colorado............. 1 1 17 9 2 112
New Mexico......... 4 5 2 9
Arizona........... 16 16 1
Utah............... 1 1 2 1
Nevada............. 2 6

PACIFIC............... 22 7 6 39 227 247 25 651
Washington.......... 2 43 50 5
Oregon.............. 5 1 20 14 16
California.......... 17 6 4 38 163 181 13 506
Alaska............. --- -- --- --- --- --- --- 2 --- 3
Hawaii............. 1 1 12 121

Puerto Rico .......... 18 24 4
*Delayed reports: Aseptic meningitis: Iowa 1, Ariz. 2
Encephalitis, primary: Iowa 5, W. Va. delete 5
Hepatitis, serum: Ky. 1
Hepatitis, infectious: N.J. delete 1, S.C. delete 3, N.C. delete T, La. 31
Malaria: Iowa 1, N.C. 1







Morbidity and Mortality Weekly Report 405


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 15, 1969 AND NOVEMBER 16, 1968 (46th 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... 303 22,141 21,055 28 2,625 2,270 1,679 15 443

NEW ENGLAND.......... 19 1,152 1,207 105 134 352 2 38
Maine.............. 9 38 7 6 60 1 6
New Hampshire...... 1 243 141 4 8 13 7
Vermont............ 3 2 1 28 2
Massachusetts...... 6 235 372 41 70 105 16
Rhode Island....... 27 22 14 9 50 6
Connecticut........ 12 635 632 39 40 96 1 1

MIDDLE ATLANTIC...... 32 7,684 4,396 5 437 404 76 2 24
New York City...... 9 4,980 2,292 3 85 84 51 8
New York, Up-State. 610 1,294 1 83 72 NN 1 7
New Jersey.......... 17 978 671 1 169 136 25 2
Pennsylvania....... 6 1,116 139 100 112 NN 1 7

EAST NORTH CENTRAL... 84 2,574 4,014 7 358 282 453 1 78
Ohio................ 48 462 313 1 133 77 74 8
Indiana............. 2 476 702 1 46 39 34 13
Illinois........... 18 661 1,399 2 51 63 67 1 6
Michigan........... 11 343 307 1 101 83 87 34
Wisconsin........... 5 632 1,293 2 27 20 191 17

WEST NORTH CENTRAL... 37 880 401 2 130 125 63 1 26
Minnesota........... 17 18 1 29 29 11 9
Iowa................ 336 104 19 10 27 8
Missouri............ 31 81 53 40 12 -
North Dakota........ 10 43 138 2 4 10 9
South Dakota........ 3 4 1 5 NN -
Nebraska........... 27 443 46 1 10 9 3 -
Kansas............. 7 10 16 28 1 -

SOUTH ATLANTIC....... 33 2,651 1,636 5 466 451 115 1 41
Delaware............ 6 401 17 13 9 -
Maryland............ 3 80 103 41 40 4 7
Dist. of Columbia.. 28 6 9 16 -
Virginia........... 1 907 373 1 57 44 25 5
West Virginia.*.... 6 220 310 24 13 65 17
North Carolina..... 1 326 284 3 87 86 NN 5
South Carolina..... 4 131 17 59 58 2 2
Georgia............. 2 4 77 90 -
Florida............. 12 556 522 1 99 95 19 1 5

EAST SOUTH CENTRAL... 116 502 3 168 204 77 1 78
Kentucky........... 66 103 55 93 30 3
Tennessee.......... 20 63 1 69 61 35 74
Alabama............ 6 95 25 27 12 -1 1
Mississippi........ 24 241 2 19 23 -

WEST SOUTH CENTRAL... 62 4,882 5,105 2 345 326 116 6 46
Arkansas........... 16 2 32 20 -
Louisiana.......... 1 125 24 1 93 93 2
Oklahoma.*......... 142 128 34 52 4 3
Texas.............. 61 4,599 4,951 1 186 161 112 6 41

MOUNTAIN............. 29 1,056 1,042 1 52 39 52 24
Montana............ 20 92 58 8 6 6 5
Idaho.............. 90 21 11 11 3 1
Wyoming ........... 54 3 -
Colorado............ 141 518 9 11 14 3
New Mexico.......... 5 275 135 1 7 5 4
Arizona............. 4 446 230 10 4 18 9
Utah............... 11 21 5 1 6 2
Nevada............. 1 5 2 3 -

PACIFIC............... 7 1,146 2,752 3 564 305 375 1 88
Washington......... 67 581 57 47 210 36
Oregon.............. 200 564 1 20 24 38 16
California.......... 7 821 1,561 2 466 217 115 1 28
Alaska........... --- 13 11 --- 11 3 -- -
Hawaii.............. 45 35 10 14 12 8

Puerto Rico.......... 18 1,784 481 19 20 18 -
*Delayed reports: Meningococcal infections: W. Va. 3
Mumps: Okla. 11
Rubella: Okla. 5







406 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 15, 1969 AND NOVEMBER 16, 1968 (46th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS .FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABES
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... 9,551 4 144 1 128 2 291 437 53 2,972

NEW ENGLAND.......... 1,109 1 16 15 1 8 49
Maine................ 18 1 6
New Hampshire...... 35 5
Vermont............. 35 16 8 27
Massachusetts...... 177 1 8 1 3
Rhode Island....... 107 1 -
Connecticut........ 737 -. 5 8

MIDDLE ATLANTIC...... 338 1 18 5 31 46 4 212
New York City...... 29 1 10 1 17 -
New York, Up-State. 244 3 4 6 7 4 198
New Jersey......... NN 3 3 15 -
Pennsylvania....... 65 2 5 24 14

EAST NORTH CENTRAL... 690 19 15 32 3 3 216
Ohio............... 79 4 11- 1 72
Indiana............ 130 4 2 52
Illinois........... 138 10 4 15 3 36
Michigan........... 189 5 5 7
Wisconsin.......... 154 7 1 49

WEST NORTH CENTRAL... 379 11 14 10 8 7 559
Minnesota.......... 39 3 4 2 148
Iowa............... 124 1 7 3 88
Missouri........... 3 4 10 3 2 132
North Dakota....... 108 69
South Dakota....... 19 1 43
Nebraska............ 72 1 -1 13
Kansas.............. 14 4 3 1 66

SOUTH ATLANTIC....... 1,154 1 28 22 46 246 12 704
Delaware........... 10 2 3 -
Maryland............ 77 1 4 48 3
Dist. of Columbia.. 2 2 -
Virginia........... 534 1 4 1 81 6 351
West Virginia...... 216 1 2 2 5 2 102
North Carolina..... NN 1 3 6 9 64 5
South Carolina..... 133 1 2 1 30 -
Georgia............. 5 7 4 11 15 2 83
Florida............. 179 12 4 14 2 160

EAST SOUTH CENTRAL... 1,681 2 22 14 45 63 5 380
Kentucky............ 169 7 8 13 2 195
Tennessee.......... 1,029 4 13 19 41 1 127
Alabama............ 231 6 4 6 2 52
Mississippi........ 252 2 5 1 14 3 6

WEST SOUTH CENTRAL... 886 27 1 21 29 48 9 430
Arkansas........... 9 2 1 3 13 7 30
Louisiana.......... 20 7 4 3 3 36
Oklahoma........... 68 1 8 29 2 66
Texas.............. 789 17 6 13 12 4 298

MOUNTAIN............. 2,121 6 17 28 17 1 118
Montana. .......... 49 1 2 -
Idaho............. 169 4 6 -
Wyoming............. 348 4 5 1 55
Colorado............ 1,092 2 3 9 3
New Mexico......... 294 1 7 17
Arizona............. 99 3 6 22
Utah............... 70 12 2 5
Nevada............. 1 16

PACIFIC................ 1,193 12 4 2 55 5 4 304
Washington......... 887 1 2 2 3 4
Oregon............... 159 1 6 4
California......... --- 11 1 2 43 2 4 296
Alaska .............. ..... .... -
Hawaii ............. 147 .- 4 -

Puerto Rico.......... 2 12 7 3 28
*Delayed reports: SST: Mont. delete 3








Morbidity and Mortality Weekly Report 407






Week No. TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED NOVEMBER 15, 1969
46
(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 a Area All 65 years and I year
Ages and over Influenza All Ages and over Influenza All
All Ages Causes All Ages Causes


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

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

EAST NORTH CENTRAL:
Akron, Ohio-----------
Canton, Ohio----------
Chicago, Il1.---------.
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.--------


701
212
40
23
32
46
26
23
28
65
62
14
44
35
51

3,481
54
37
142
44
33
42
89
91
1,763
46
504
182
61
121
28
44
94
45
24
37

2,690
82
45
703
135
216
181
68
390
73
59
43
48
51
151
31
124
42
46
30
91
81

835
47
25
40
139
21
115
78
229
68
73


418
119
29
13
18
31
16
15
16
36
41
10
28
21
25

2,086
30
29
85
23
23
22
59
47
1,054
25
291
94
44
81
20
29
69
20
15
26

1,562
55
32
391
80
118
94
44
216
56
35
22
25
35
81
15
78
30
24
22
56
53

494
31
16
18
85
14
65
49
131
48
37


44
12
5
7

2
1

1

8
1
2

5

146
2
4
7
5
1
5
7

71
2
10
12

3
4
3
2
2
3
3

89

4
18

3
7
7
11
2
2
1
1
9
5
6
4

4
3

2

24
1
2
2

1
2
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.-----------


1,300
143
274
49
132
98
59
97
37
88
73
194
56

581
100
46
22
91
112
43
52
115

1,139
26
49
26
173
42
63
210
52
168
79
129
55
67

444
44
24
119
16
96
39
49
57

1,459
19
37
24
67
80
370
116
37
115
60
95
151
64
149
44
31


Total 12,630 7,317 473 610

Expected Number 12,636 7,311 429 532


Cumulative Total
(includes reported corrections
for previous weeks)


595,197


340,130


26,667


!8,327


1 Mortality data are being collected from Las Vegas. Nev., for possible inclusion in this
Las Vegas, Nev.* 14 5 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.








Morbidity and Mortality Weekly Report


CUTANEOUS ANTHRAX North Carolina

A case of cutaneous anthrax was recently reported
from North Carolina. The patient, a 45-year-old man,
worked as a twister in a worsted wool mill; he had worked
there for about 15 years. On Aug. 10, 1969, he developed
a "pimple" on the ulnar side of his right wrist, which was
pruritic but not painful. Si,,rl, thereafter, a central ves-
icle with dark fluid appeared which was surrounded by
several smaller vesicles. Within a week, the lesion be-
came larger and the vesicular area became depressed;
containing a black eschar. The lesion was surrounded by
edema and inflammation. Approximately 1 week after the
appearance of the initial lesion, a second lesion appeared
on the lateral aspect of the middle finger of the right hand
and proceeded through the same evolutionary stages as
the first lesion.
The patient gave no history of fever or chills but did
note a red streak extending halfway up the ulnar surface
of the right forearm. On August 20, he consulted his physi-
cian and on August 22 was admitted to a local hospital
with initial *ii.Truno-t. impression of nonhealing ulcer;
anthrax and malignancy were included in the differential
diagnosis. The lesion was excised on August 23; micro-
scopic examination revealed extensive necrosis of the
epidermis and dermis. -,uL'r-i;.-L' of ischemic necrosis.
Cultures taken at this time were ni,-g.,ii'-. The patient was
placed on penicillin, discharged, and, except for secondary
infection, made an uneventful recovery.
An environmental sampling program was conducted at
the mill on October 23; 27 surface swabs within the plant
and 15 gross samples of wool were obtained from lots with
which the patient was working at the time of onset of ill-
ness. Bacillus anthracis was not recovered from any of
these specimens. The wool being processed at the time of
his infection was a mixture of domestic and Australian
wool. This is the first reported case from this plant that
employs about 350 people.
(Reported by Martin P. Hines, D.V.M., Director, Division
of Epidemiology, John Freeman, D.V.M., Chief, Section of
Veterinary Public fl..:;,,'. North Carolina State Board of
Health; A.M. Covington, M.D., Rockingham, North Caro-
lina; Z.F. Long, M.D., Director, Richmond County Health
Department, Rockingham; and two EIS Officers.)

Editorial Note:
The clinical details would support the diagnosis of
cutaneous anthrax. Two simultaneous cutaneous lesions
in one patient has not previously been reported from the
United States, but has been reported in other countries.
Whether this represents a co-primary infection or secondary
spread from the initial foci is not clear.
Of 211 cases of anthrax reported in the United States
since 1955, 33 including this case have been associated
with wool. The majority, 106, have had contact with im-
ported goat hair.
Reference:
1. Brachman, Philip S.: Anthrax. The New York Academy of
Scien' *, Conference on Unusual Isolates from Clinical
Material, Nov. 5-8, 1969, (To be published).


NO EMBER 15. 1969


THE MCRBID, T AND MORTALITY AEEALV REPORT WHTM A CIRCULA-
TION OF 18 00 -i PUBL.i HED T THeE NATlONAL COMMuNICABLE
DiSEASE CENTER ATLANTA GEORGIA
DIRECTOR NATIONAL COMMUNICABLE DISEASE CENTER
DAlDO j SENCER. M D
DIRECTOR EPiDErIOLOC R PROGRAM A D. LANGMUIR. M.D.
EDITOR MUIC4AEL B GREGG M.D
ED'OIT p0.. rTem ALAN R. INMAN M.D.
MANAGINC EDITOR PRISCILLA B. HOLMAN
*N ADDITION TO THE ESTABTI.I`.ED PROCEDURES FOR REPORTING
MORBIDITv AND MORTAL TV. THE NArTINAL COMMUNICABLE DISEASE
CENTER -ELCOMES ACCOuNTSOF INTERESTING OuTBREA5 OR CASE
INVESTIGATIONS *H.ICH ARE OF CURRENT INTEREST TO HEALTH
OFFICIALS AND A*ICM ARE DIRECTLY RELATED TO TrE CONTROL
OF COMMUNICABLE DISEASES SuC I COMMuN' NATIONS SHOULD BE"
ADOIRESIED TO
NATIONAL. COMMI.,NIC A BLE DISEASE CENTER
ATTN. Tr.I EDITOR
MORBIDITY AND MORT AII T I EEKLY REPORT
ATLANTA GEORrI j10 3
NOTE THE DATA IN THIm REPORT ARE PRO-eSIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO THE NCOC BY THE INDIVIDUAL
STATE HEALTH DEPARTMENTS. THE REPORTING WEEK CONCLUDES
AT CLOSE OF BUSINESS ON FRIDAY COMPILED DATA ON A NATIONAL
BASIS ARE OFFICIALLY RELEASED TO THE PUBLIC ON THE SUCCEED-
ING FRIDAY.


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