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:
AA00010654:00143

Related Items

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

Full Text



FNS NI E DI E CC

NATIONAL COMMUNICABLE DISEASE CENTER


Vol. 16, No. 51


WEEKLY

REPORT

Week Ending
December 23, 1967


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


CURRENT TRENDS
INFLUENZA Recent Reports

For the ecek ending December 23, 1967, reports from
24 states indicate that outbreaks of influenza-like illness
are occurring, manifested primarily by an increase in
school absenteeism. Documentation of influenza activity
is not yet available in 14 of these states: Arkansas. In-
diana. Louisiana. Maryland. Mississippi. Missouri, Nebras-
ka. North Carolina. Ohio, Pennsylvania. South Carolina.
Tennessee. \ irn, and Wisconsin. In all the states,
the outbreaks have been focal and sporadic (Figure 1).
In addition to the six states that had documented influenza
activity as of last week (1\M1\R. \ol. 16. No. 50). Georgia.


PUBLIC HEALTH SERVICE


CONTENTS
Current Trends
Influenza Recent Report . . 1
Recommendation of the PHS Advisory Cotmmittee on
Immunization Practices Mlumps Vaccin ... 10
Surveillance Summary
Tuberculosis in the United States, 1966 . 13
Errata for 1966 Annual Supplement to tLl\\ . 1:7

Illinois. Iowa, and Kansas have recently documented out-
breaks (Figure 2).
In Illinois, there have been four isolation of A3 in-
fluenza viruses, three from specimens taken from students
at the University of C .. ._.. and one taken from an out-
break of febrile respiratory illness in southern Illinois.
(Continued on page 30)


TABLE 1. CASES OF SPECIFIED NOTIF:ABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
51st WEEK ENDED CUMULATIVE, FIRST 51 WEEKS
MEDIAN
DISEASE DECEMBER 23, DECEMBER 24. 1962 1966 MEDIAN
1967 1966 1967 1966 1962- 1966
Aseptic meningitis ............. 20 48 39 2,940 2,915 2.115
Brucellosis. .......... ... ...... 4 8 242 243 375
Diphtheria. ............... ......... 3 7 7 202 195 288
Encephalitis, primary:
Arthropod-borne & unspecified .......... 14 32 1,538 2,115 -
Encephalitis, post-infectious ......... 11 8 -- 749 706 --
Hepatitis, serum ... ........ .. ..... .. 37 36 664 2,302 1,463 37,
Hepatitis, infectious .................... 755 613 38,001 31,888
Malaria ............................... 35 13 3 2,056 509 103
Measles (rubeola)...................... 262 998 3.252 61,798 201,778 384,305
Meningococcal infections, total ........... 33 47 50 2,105 3,335 2,762
Civilian ............................ 32 41 -- 1,975 3,010
Military .................. ........... 1 6 --- 130 325
Poliomyelitis, total ......... .... .. 1 1 41 99 115
Paralytic. ........................... 1 1 28 93 93
Rubella (German measles) .............. 375 362 43.853 45,665 -
Streptococcal sore throat & scarlet fever .. 7,421 8,548 6.985 437,454 413.412 381,811
Tetanus.............................. 3 7 3 226 198 273
Tularemia .................... .......... 4 8 165 180 287
Typhoid fever ...................... -... 4 6 393 368 448
Typhus, tick-borne (Rky. Mt. spotted fever) 1 1 1 298 252 224

Rabies in animals ............. ..... .. 36 41 42 4,087 3,908 3,908

TABLE 2. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: .................... ...... 2 Rabies in man:. ..... 2
Botulism: N.Y.C.-2 ............... ........ 5 Rubella, Congenital Syndrome: ..... ...... 9
Leptospirosis: ........ ........ .......... .... .... 45 Trichinosis: Mont.-l ......... .... 60
Plague: ............... .............. .......... 3 Typhus, murine: .............. .............. .... 43
S1 ,. -1 F lI : r ,'r.- 1
No report from Texas due to Monday and Tuesday holidays.















Figure 1
REPORTED INFLUENZA-LIKE DISEASE BY COUNTY
UNITED STATES OCTOBER 29-DECEMBER 27, 1967
[^'''--~-- _


1 ----





\- .N Li/
'* "y ( --> t \





In Kansas. complement fixation tests on groups of
acute and convalescent sera taken from a Kansas City high
school shon a significant rise in geometric mean titer
against the soluble influenza A group antigen but not
against the solutle influenza B group antigen. In addition.
the NCDC Kansas City Field Station has isolated an A2?
influenza \irus from an outbreak in Franklin County.
Four countii- in Ionxa hate reported influenza-like
illnesses resulting in abnormal increases in school ab-
senteeism. Paired -era from persons in ti\o of these out-
breaks hate demonstrated diagnostic rises in complement-
fixing influenza A antibody. One of these t\\o sets of sera
have also demonstrated i. .-ltic rises in lienagglutina-
tion inhibition influenza A2 antibody.
In Georgia. an A influenza \irus has been isolated
from the \tlanta area by the Influenza Laboratory of the
Respirator, \ irus Infections Unit of NCDC.
In Missouri. there have been focal outbreaks of febrile
respiratory illness beginning in the week of December 4.
1967. In St. Louis. six out of nine throat smears from ill
patients at a cit\ hospital %were positive bi the experi-
mental fluore-cent antibody technique. This is presumptive
et idence for A influenza acti it\ in the St. Louis area.
There hate also been focal outbreaks of influenza-
like illine i in Louisiana. Positive throat -mears ha\e been


DECEMBER 23, 1967


Figure 2
INCIDENCE OF INFLUENZA AND INFLUENZA-LIKE
DISEASE BY STATE AS REPORTED TO NCDC
s. OCTOBER 29-DECEMBER 27, 1967
D n--


obtained from two outbreaks using the experimental fluo-
rescen nt antibody technique.
TwNo additional isolation of A2 influenza \irus hate
been reported by the Netw York City Health Department.
Additional outbreaks of influenza-like illness ha\e been
reported from Alabama. Florida. New Jersey. and Oklahoma.
To date there has been no excess mortality for the
country as a whole or for ant\ of the nine geographic dixi-
sions. Mortality figures in the holiday season are often
unrepresentative, howe\er. and a clearer picture may he
available in approximately 3 weeks.

(Reported by Dr. Jo/n, E. McCroan. Georgia Deparntment of
Public Health: Dr. Normian J. Rose and Richarid ,lorrissey,
1.P.H., Illi/ois Department of Publi, Ilal/tl; Dr. Arnold
if. Rece', Iowa State Pepartment of Health; Dr. H'. J.
liHanler. Jr.. louwa State Hypienic Laboratorry; Dr. Donald
E. Wilco.rx, Kainsa.u State Department of Health; Dr. ('haries
T. Caraway and Dr. George II. lHauser, louisian a Stale
D)partmrlnt of H health; r. Itilliam J. Voyayabga. Professor
of /Medicine. Tula-nc Ifirtcrsify. Louisiana; Dr. E. A.
BHelden, Vissouri I'part/nnti of l'ubl/i Hela/th and Welfare;
Dr. Valyard IJonsso/. lPublic Hlbi/tih Laboratory ('ity of
St. Loouis. lli. ouri; Dr. Tiber F'odo r ond r. Stetcpen
lfilian, N,\'w }lork City Health 0Dpar/tm'nt.)


RECOMMENDATION OF THE PUBLIC HEALTH SERVICE ADVISORY
COMMITTEE ON IMMUNIZATION PRACTICES

The P'ub/ic Healtl S, crrici Aairisory Commintti, e io, Immt uniztuion l'ra ii'es mec win. on ( h t. ire ic ' the -' r'onime iations o,/ its U/se it piuht" Aratih anid pre 'i ,ii medical proTjramii s. P" i ,t. :io
of th, ri, s/ eo, ica//io.P I ,s h a be'n p/at n di to icoti 'dl' approrii mately 'n'i(i ran inr e li.'i,. i' el ta /
MUMPS VACCINE/ er/.'i.f
MUMPS VACCINE


Introduction
\ Ilte attenuated munmpp \iri- \.accine has recently hie-
come a ailable for general use. It i. therefore,. appropriate


to describe the circumn-tances under which this a-ccine
might be considered for use.


Morbidity and Mortality Weekly Report



INFLUENZA Recent Reports (Continued from front page)









Morbidity and Mortal


Mumps, one of lithe common communicable diseases.
is olbseried with greae-ll frequency in young school-age
children. llo\\i e r. appro\iii ately .15 percent of reported
cases oc uir after Ithe onset of puberlt. () rt eo idence of
central nervous s\stlenm disease x\wih sequelae is rare,
although meninoigal in\ol\ement appears to be cominnon.
O)rhitis has been reported in up to 20( pereilnt of the
clinical munps casot occurring in post-publirtal males.
Symnptomallc in\ol\venint of other glands and organs is
obser\ ed less frequently.
All naturally acquired mumps infections, including
the estinrlmatd )0 percent whichh are subclinical. confer
durable ilmmuni ty.

Live Mumps Vaccine
Live numlps \acxine is prepared in chick embryo cell
culture. It produces an inapparent, noncommunicablle in-
fection following administration. Febrile reactions and
mumps-like syn ,ptroms havt not been associated with the
vaccine .
More than 95 percent of susceptible x accinees dleelop
detectable antibodies after vaccination. although liters
are lower than those induced by natural infection. The
pattern of antibody persistence parallel.- that -een follow-
ing clinical mumps although at a lower level. The long-
term duration of antibody is unknown at the present time:
individuals have been observed for only t\\o years fol-
lowing vaccination because the actcine is a recent
development.
Excellent protection again-t naturally occurring
niumps has been documented in \accinees for the first
year after vaccination. Limited data on natural exposure
during the second year indicate continuing protection.


Recommendations for Vaccine Use
Live mumps vaccine mna be considered for use in chil-
dren approaching puberty, in adolescents, and in adults,
especially males, if they have not had mumps.* Tihe
vaccine is not specifically conlraindicated for younger
children, hut until more information on the duration of
immunity is available, the vaccine is not recommended
for routine use. Furthermore, mumps immunization should
not be allowed to compromise the effectiveness of public
health programs of already established importance.
Age
Live mumps vaccine should not be administered to
children less than 12 months of age because of the
possible persistence of interfering maternal antibody.

High Risk Groups
Epidemic mumps can be particularly disruptive to
normal routine in large groups of susceptible indi-
viduals. Children living in institutions, for example.
might benefit from vaccination against the disease.


DEI)IEMBR 3, 1967


*Official name: Mumps virus vaccine. live.
**The asimi individual dose recommended by the manufacturer
should be ehmploied.


**'Inactivaited mumnps taie and mumpai h i. ,rmllnu' l buln
tar of lqu-t i<)iona l( ciffr, i v nes unand r the < ir i ul ,-ta!iii


ity Weekly Report 431



Prevention of Natural Mumps Following Exposure
Adults and adolesc-ents who anre -uceptible to mnumps
hy clinical hi-tory present a perple\ing inedical prob-
lum when exposed io mi nUps,**r It is not no\\ known
if live nirumps \accine t ill pr de oside protection when
administered after exposure. There ii, however ri no
contraindictalion to i its us at that timh .

Precautions in Using Live Mumps Vaccine
Severe Febrile Illnesses
Vaccination should hli postponed unlil the patient is
completely relco\ red.
Marked Hypersensitivity to Vaccine Components
Mumps iaccine is priodluced in chick embryo ell cul-
ture and should not he gi\en to ,perons hypersonsi-
li\e to ing4sted oegg protein. \lso, he \accine con-
tains small amount of netirnm cin ->o it should not
be gixen to individuals known to hi se-n-sti\e to this
antibiotic.

Leukemia, Lymphomas, and Other
Generalized Malignancies
Theoretically. attenuated niuimp- iru- infection mnght
be potentia:id by other sox ere under ing diseases,
such as lymphomas and generalized mnallignancies.

Altered Resistance from Therapy
Steroids. alkylating drugs. antinm tablolitles and radi-
ation liny predispose to unto\\rd complications due
to altered resis ance.
Pregnancy
Mumps i\rus infection is not kno\n to exert any un-
townard effects on ile tde\eloping fetus. It is reason-
able on theoreti al grounds, hoxxeoer, to avoid using
the live imulps xac(cine during pregnancy.


Simultaneous Administration of Live Mumps Vaccine
With Other Antigens
In order to evaluate the lixe mumps vaccine adequately.
its simultaneous administration with oiher \ acines should
ie deferred until re-sults of controlled clinical investiga-
tions are available. I'ntil then. t is recommended that
mumps vaccination be separated from other immunization
procedures by about one month henexor possible.


Continued Surveillance
Careful surveillance of mumps is particularly important
no\r that an effective vaccine is available. There is need
to emphasize improved reporting of inumps cases, compli-
cations of cases, patterns of vaccine use. effectiveness
of vaccine after exposure to natural infection, and general
vaccine performance. These data will help to delineate
the epidemiologic characteristics of the disease and to
define future use of the vaccine.











132 Morbidity and Mortality Weekly Report


TABLE 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
DECEMBER 21. 196- AND DECEMBER 2 1966 (51st WEEK)


ENCEPHALITIS HEPATITIS

ASEPTIC Primary
AREA MENINIITIS 100 1 1 is' i1't11 including iouss Serum Infectious
'ases Infectious
unsp. iases


UNITED STATES... 0 48 3 1 32 11 37 36 755 610

NEW ENGLAND.......... 1 2 -42 41
Maine.............. 3
New Hampshire ..... 2
Vermont............ -
Massachusetts...... b 20
Rhode Island ....... 2 5 1
Connecticut ....... 16 15

MIDDLE ATLANTIC...... 1 6 27 IOq 112
New York City...... 4 18 16 10
New York, up-State. 33 27
New Jersey......... 1 -2 20 19
Pennsylvania....... 1 1 40 47

EAST NORTH CENTRAL... 4 5 7 5 I 120 127
Ohio............... 1 2 3 46 23
Indiana............ 8
Illinois........... 2 26
Michigan............ 4 1 5 1 3 53
Wisconsin .......... I 17

WEST NORTH CENTRAL... I 3 I 1 I 47 43
Minnesota.......... 1 1 1 1 23
Iowa.............. -
Missouri........... 2 17
North Dakota........
South Dakota.......
Nebraska ........... 3
Kansas............ 2 6 7

SOUTH ATLANTIC........ 9 2- 9 2 1 73 56
Delaware ........... 5
Maryland .. ........ 3 i i I
Dist. of Columbia.. -
Virginia............ I- 1 1 16
West Virginia...... 9
North Carolina..... 4
South Carolina..... -
Georgia............ 41
Florida ............ 1

EAST SOUTH CENTRAL... 2 7 1 3 6
Kentucky........... 2 -
Tennessee.......... 3 3 1
Alabama... ......... -I
Mississippi ...... 4 7

WEST SOUTH CENTRAL... 5 2 43 3b
Arkansas............ -
Louisiana.......... 2 ] 7
Oklahoma........... 1i 1
Texas .............. --- -- -- -

MOUNTAIN .......... 65 33
Montana ............ 3
Idaho............. -
Wyoming ...... .....
Colorado...........
New Mexico........ 5
Arizona............ 4 9
Utah............... 5
Nevada .............

PACIFIC.............. i 7 6 5 139
Washington.......... 3 6 1
Oregon............. 33
California......... 5 h 15 92
Alaska.............. -
Hawaii ............. 2 I .

Puerto Rico I .5 8







Morbidity and Mortality Weekly Report 133


TABLE 3.CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 2,. 19'7 AND DECEMBER 24, 1966 (51st WEEK) CONTINUED



MENINGOCOCCAL INFECTIONS,
MALARIA MEASLES (Rubeola) TOTAL POLIOMYEI.ITIS RUBELLA
AREA TTal ^ Paralyth
Cumulative Cumulative Toa (- P.rlyti
Cum.
_1967 1967196 1966 1967 1967 1966 1967 1967 1967 1967
UNITED STATES... 35 262 61,798 201,778 33 2,105 3,335 8 375

NEW ENGLAND.......... 16 954 2,584 2 84 154 42
Maine.............. 262 301 3 12 3
New Hampshire...... 78 80 4 11
Vermont............ 42 345 1 2 4
Massachusetts...... 14 409 836 1 38 62 21
Rhode Island ...... 62 75 21 1
Connecticut ........ 101 947 31 44 17

MIDDLE ATLANTIC ... .. : 62 2,621 18,600 6 354 442 33
New York City...... 1 3 523 8,376 1 68 65 1 17
New York, Up-State. 15 656 2,680 3 87 115 5
New Jersey......... 41 652 2,028 113 137 1
Pennsylvania....... I 3 790 5,516 2 86 125 1

EAST NORTH CENTRAL... 67 6,295 70,488 4 290 532 6 139
Ohio ............... 6 1,218 6,471 1 95 157 45
Indiana............ 673 5,832 31 88 -- 8
Illinois........... 3 1,242 11,538 1 67 96 16
Michigan........... 13 1,03Q 15,186 2 76 135 39
Wisconsin.......... 31 2,123 31461 21 31

WEST NORTH CENTRAL... : 7 3,003 9,344 1 101 177 3 20
Minnesota ......... 139 1,688 22 40 2
Iowa............... 3 818 5,463 22 23 7
Missouri........... 340 539 1 22 66 -
North Dakota....... 1 891 1,414 3 11
South Dakota....... 58 40 7 6
Nebraska........... 660 200 15 12 8
Kansas .............. 3 97 NN 10 19 -

SOUTH ATLANTIC....... 1 38 7,385 16,268 8 414 564 2 21
Delaware........ .. 51 267 8 7
Maryland..... ..... 2 182 2,126 1 57 53 1 2
Dist. of Columbia.. 1 26 390 1 16 15
Virginia........... 16 2, 342 2,273 2 47 71 -
West Virginia...... 7 1,484 5,562 38 44 7
North Carolina..... 3 4 939 786 2 88 142 1
South Carolina..... 514 664 1 34 55
Georgia............. 42 244 60 77
Florida............ 8 1,805 3,956 1 66 100 11

EAST SOUTH CENTRAL... 21 9 5,518 20,745 2 168 284 2 12
Kentucky............ 19 1 1,433 4,869 1 48 97 -
Tennessee........... 7 2,050 12,705 1 74 96 12
Alabama ........... 2 1,357 1,808 29 62
Mississippi........ 1 678 1,363 17 29

WEST SOUTH CENTRAL... 3 3 18.129 27,172 2 261 444 10
Arkansas........... 1,404 1,182 41 37 1
Louisiana.......... 3 159 103 2 104 170 I
Oklahoma ........... 3 3,359 666 18 23 1-
Texas .............. --- --- 13,207 25,221 --- 98 214 --- --- 7

MOUNTAIN................ 12 4,907 12,712 40 94 15
Montana ............ 3 337 1,933 5 5 4
Idaho.............. 4 409 1,711 3 5 3
Wyoming ............ 2 206 235 -1 h
Colorado........... 1,632 1,435 13 49 -- 5
New Mexico......... 2 609 1,269 5 10
Arizona............ 1 1.060 5,376 6 13 -
Utah............... 385 686 4 1 I
Nevada............. 269 67 3 5

PACIFIC .............. 5 48 12,986 23,865 8 393 644 93
Washington......... 7 5,681 5,285 38 58 25
Oregon ............ 7 1,713 2,547 1 31 43 0
California......... 3 34 5,269 15,222 7 309 521 37
Alaska.......... .... 141 646 11 18 -11
Hawaii............. 182 165 4 4

Puerto Rico .......... 1 2,243 3,509 15 19








431 Morbidity and Mortality Weekly Report


TABLE 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 23, 10X,7 AND DECEMBER 24. 1966 (51st WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
AREA SCARLET FEVER ___ (Rky. Mt. Spotted) ANIMALS
1967 1967 Cum. 1967 Cum. 1967 Cum. 1967 Cum. 1967 Cum.
1967 1967 1967 1967 1967

UNITED STATES... 7,421 3 226 165 393 1 298 36 4,087

NEW ENGLAND.......... 1,181 3 1 10 2 106
Maine .............. 36 -- 24
New Hampshire...... 19 48
Vermont ............. 24 2 27
Massachusetts...... 337 1 1 6 1 5
Rhode Island ....... 89 2
Connecticut........ 676 2 -

MIDDLE ATLANTIC...... 317 1 40 2 102
New York City...... 14 9 21
New York, Up-State. 266 -1 11 9 2 86
New Jersey......... NN' 1 4 15i
Pennsylvania....... 37 5 4 11 1

EAST NORTH CENTRAL... 97 27 15 43 2 378
Ohio............... .11 4 11 131
Indiana ............ 189 3 2 11 1 86
Illinois........... 164 13 13 7 10 72
Michigan ........... 292 I 25
Wisconsin .......... 215 1 2 64

WEST NORTH CENTRAL... 182 17 23 1 5 963
Minnesota.......... 41 6 2 2 193
Iowa ............... 44 -2 2 -3 -1 134
Missouri........... 3 7 9 10 1 172
North Dakota....... 36 1 170
South Dakota....... 39 2 .- 116
Nebraska........... 4 4 2 1 71
Kansas............. 15 1 10 107

SOUTH ATLANTIC....... 1,015 1 48 12 63 1 120 48
Delaware ..........
Maryland ........... 166 4
Dist. of Columbia.. 23 3 6
Virginia.......... .. 254 1 11 9 8 4 20O
West Virginia...... 183 -1 2 62
North Carolina..... 4b 8 4 47 3
South Carolina..... 58 1 2 10 5
Georgia............. 9 4 5 2 1 18 3 119
Florida............ 270 2 1 2 80

EAST SOUTH CENTRAL... 1,272 I 13 65 3 7 78
Kentucky.... ........ 13 2 15 184
Tennessee.......... 1,167 8 12 6 540
Alabama............ 33 1 12 1 1-2 51
Mississippi........ 59 10 2 17 10

WEST SOUTH CENTRAL... 88 1 55 83 4 4 7
Arkansas ........... a 6 48 1 14
Louisiana...... 2 1 5 8 17 70
Oklahoma .......... 77 4 0 8 1 5 39
Texas .............. ... 40 --- 7 --- --- 11 --- I I

MOUNTAIN............. 1 ,200 I 2
Montana............ 54 -
Idaho.............. 92 -
Wyoming............ 86 5
Colorado ........... 738 i i
New Mexico......... 62
Arizona.......... .. 12i.1 4 -
Utah............... 56 .
Nevada ............

PACIFIC .............. .. 1,19 3 I -1 i 4
Washingt on ........ 14 -
Oregon. ........... .1. I 5 I
California......... 18 8 8
Alaska ............ 4
Hawaii...... .... .. B 4
r -t P.- 1 1 i -







Morbidity and Mortalit) Weekly Report


Week No. TABLE 4. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED DECEMBER 23, 1967
51

(By place of occurrence and week of filing certificate. Excludes fetal deaths)

All Causes Pneumonia Under All Causes Pneumonia Under

Area All 65 years and I year Area All 65 years ad year
Ages and over Influenza All Influenza All
All Ages Causes All Ages Causes


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

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

EAST NORTH CENTRAL:
Akron, Ohio-----------
Canton, Ohio----------
Chicago, Ill.---------
Cincinnati, Ohio------
Cleveland, Ohio-------
Columbus, Ohio--------
Dayton, Ohio----------
Detroit, Mich.--------
Evansville, Ind.-------
Flint, Mich.-----------
Fort Wayne, Ind.------
Cary, Ind.------------
Grand Rapids, Mich.---
Indianapolis, Ind.----
Madison, Wis.---------
Milwaukee, Wis.-------
Peoria, Il1.-----------
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.--------


745
241
40
29
12
55
39
28
23
52
49
16
61
28
52

3,632
62
40
170
43
39
41
74
77
1,938
37
487
208
55
106
41
38
57
49
37
33

2,832
73
21
899
151
207
138
66
452
41
59
42
46
54
173
18
102
44
45


55

864
64
41
34
139
29
1 16
69
243
98
31


459
144
23
19
21
32
29
21
14
28
29
11
38
17
33

2,184
32
27
93
19
23
26
39
40
1,191
17
278
124
42
68
24
26
31
26
35
23

1,659
38
11
509
91
105
85
38
275
28
32
24
24
38
108
8
69
32
24
18
68
34

522
42
22
14
78
23
68
48
150
61
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.----------
.ittle 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.----------


Total 13,210 7,75 530 607

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ---------.---------------- 62 6
All Causes, Age 65 and over------------------- 3 59,32
Pneumonia and Influenza, All Ages------------- 22,108
All Causes, Under 1 Year of Age--------------- j,807


1,194
163
250
46
62
126
54
71
32
63
58
225
44

668
103
54
30
101
175
65
33
107

1,112
38
50
24
172
47
95
184
57
149
66
123
56
51

430
44
34
128
21
59
25
64
55

1,733
25
47
41
53
76
520
87
40
132
63
112
211
55
172
57
42


638 53 55
86 7 6
134 10 10
17 1 3
28 5 2
72 1 7
30 9 3
18 1 1
15 1 2
47 4
37 8 3
109 6 13
25 5

369 17 36
59 1 6
32 6 1
17 2
57 11 5
98 4 12
33 3 2
16 4 2
57 6 7

579 49 86
19 5 2
25 3 5
14 1 6
79 6 14
26 1 3
46 I 8
94 4 17
34 2 9
73 6 8
39 1 4
74 6 6
31 10 1
25 3 3

261 23 13
22 5 3
19 3 3
82 2 3
13 4
35 1 3
15 3
42 1 1
33 4

1,094 38 67
16
29
29 1
31 2
47 7 9
328 7 20
55 3 1
27 3
86 3 6
15 3 1
68 6
112 2 5
41 3
103 4 4
42 2
25 1 5







436 Morbidity and Mortality W eekly Report DECEMBER 23. 1967




SURVEILLANCE SUMMARY
TUBERCULOSIS IN THE UNITED STATES, 1966

During 196ti. the State Health Departments in Ihe ea:- rate of 6,.6t and Puerto Rico a rate of 46.7 per 100,000
I united Statres reported 17.767 niu\ active canos of tuber- population.
cullois,4 ei-ahli-hingl the "tne e:s" rate a 'I2.1 per Estimates for December 31, 1966. sho\\ that on that
100.i)00 population (Table 1). The vorresponding fi'lure that da\y here iore 320.000 persons included in -tate and
Ior 196l ntere 49.0)I6 neo\ ca-es and a rale of -25.3 por local health department tuberculo-si registers. Of this
100.000 population, total. 91.o00 persons were classified as having active
tuberculosis disease. with 37,000 in hospital.s and 53.001

Staie rates ranged from a loi\ of 6(.. in North Dakota reported lto e under care or supervision of clinics, private
to 5,)..) in iaska. The Di-trict of C(olumbia hard a ntew ph\l-iciansn and other medical auspices.

Table 1
New Active Tuberculosis Cases and Case Rates
Each State 1965 and 1966

New Active Cases Case Rate Per Rank According
New Active Cases 10 opulaon to Rate Population
State July 1, 1966
1965 1966 1965 1966 1965 1966

United States ....................... 49.016 47,767 25.3 24.4 195,936,000
Continental United States ............... 48,434 47,361 25.1 24.3 194.947.000
Alabama ............. ................ 1.417 1,214 40.6 34.6 3 7 3,511,000
Alaska ..................... ...... .... 302 147 113.1 55.5 1 1 265,000
Arizona ............. .. ... 573 503 36.4 31.4 7 10 1.603.000
Arkansas ............... ....... ... 649 587 33.4 30.0 10 12 1.956.000
California .... .. .. .. .. .... 4.577 4.658 24.9 24.8 23 24 18.802000
Colorado ....... ...... ... .... 274 223 14.1 114 38 40 1,955,000
Connecticut .................... .......... 335(a) 293(b) 11.8 10.2 40 42 2,878.000
Delaware ..................... ........ 141 173 28.0 33.7 18 8 513.000
Dist. of Col. ............................. 536 553 66.8 68.6 806.000
Florida ........................ .......... 1.521 1,573 26.2 26.7 20 20 5.895.000
Georgia ... ...... ..... ...... ........ .. ... 1.269 1,273 28.9 28.6 14 14 4.446.000
Hawai ............... ..... .... .. 280 259 39.4 35.8 5 4 724.000
Idaho..... ................ ... 52 65 7.5 9.3 47 43 697.000
Illinois .. ............................. 3.250 2.938 30.5 27.2 12 18 10.785,000
Indiana ........ .. ....... .. ..... 1,119 1,051 22.9 21.2 30 30 4.951.000
Iowa ....... .... .. .... 166 184 6.0 6.7 50 49 2,760,000
Kansas.. .. ..... 242 279 10.8 12.3 42 38 2.275,000
Kentucky .................. ... ... .... .. 1,193 1.241 37.6 39.0 6 3 3.181.000
Louislana ............ .. .... ...... 931 1,029 26.2 28.4 21 15 3.617,000
Maine ........................ .......... .. 142 128 14.4 13.1 37 37 978,000
Maryland.................................... 1,234 1.217 34.9 33.7 9 9 3.612,000
Massachusetts ... ... .. .. ... ..... 969 910 18.1 16.8 33 33 5.403.000
Michigan ..... .. .... ...... ..... 2.199 2,263 26.4 26.7 19 19 8,468,000
Minnesota ............. .. .. .... 419 400 11.8 11.2 41 41 3,572,000
Mississippi. ......... .. ....... 661 654 28.6 28.0 15 17 2.337.000
Missouri .................................... 1.043 1,049 23.2 23.0 28 27 4,564,000
Montana ............. ... ...... 133 105 18.9 15.0 31 36 702.000
Nebraska ............ .......... .. 141 132 9.7 9.2 44 44 1,439,000
Nevada ..... ....... .... ... 189 231 43.5 53.6 2 2 431.000
New Hampshire ........... ....... ...... 48 54 7.1 8.0 48 47 677.000
New Jersey ................. .......... 1.674 1.592 24.7 23.1 25 26 6.899,000
New Mexico .......... .. .. ...... 288 267 28.4 26.6 17 22 1,002,000
New York ............. ..... .. 5.869 5,296 32.4 29.1 11 13 18,205,000
North Carolina ............... ......... 1.276 1,266 25.9 25.5 22 23 4.972.000
North Dakota ........... ...... .. 49 42 7.5 6.5 46 50 643,000
Ohio ...... ............. .. 1.729 1.639 16.9 15.8 34 34 10.364,000
Oklahoma ............... .. 605 538 24.7 21.7 24 29 2.477.000
Oregon....... ... ....... .......... ....... 361 386 18.6 19.6 32 31 1.973.000
Pennsylvania.... ........ .. ...... 2.686 2.664 23.2 23.0 29 28 11.601.000
Rhode Island ................. .. ... 140 140 15.7 15.6 36 35 896.000
South Carolina .......... .. .. ....... 758 690 29.7 26.7 13 21 2.588.000
South Dakota ............ .. .. .. 166 158 24.2 23.3 27 25 679.000
Tennessee ............. .. ....... ....... 1.356 1.380 35.2 35.7 8 5 3.866,000
Texas ............... .... ...... 2,583 3,037 24.4 28.3 26 16 10,747,000
Utah.... .. .... .. .... .... .. ... 88 75 8.9 7.4 45 48 1.007.000
Vermont ................. ....... ..... 42 35 10.4 8.5 43 46 411.000
Virginia ................... ............... 1.754 1 573 39.7 35.2 4 6 4.468,000
Washington ............. .. ..... ........ 488 551 16.4 18.1 35 32 3,041,000
West Virginia ................... .. .. 518 544 28.5 30.1 16 11 1.809,000
Wisconsin .............. ............. 560 480 13.5 11.5 39 39 4.167.000
Wyoming ........ .... ........... 21 28 6.4 8.8 49 45 319.000
Puerto Rico (c) ................. 4 4 .

(ai Excludes 152 diagnosed but not officially reported cases
(b) Excludes 235 diagnosed but not officially reported cases.
(c) Not included in totals.
The District of Columbia is classed as a city and is not ranked with the states








DECEMBER 23, 1967


Morbidity and Mortality Weekly Report


ERRATA FOR 1966 ANNUAL SUPPLEMENT TO MMWR
(Vol. 15, No. 53)



The follow ing corrections of the ANN'.AL SUPPLEMENT to the Morbidity and Moritlit) \\eekly

Report on REPORTED INCIDENCE OF NOTIFIABLE DISEASES IN THE UNITED STATES,

1966, released No\ember 1967. are listed below and on page 439. These pages na\ ,' relmooed

fronl this issue for proper insertion into individual copies of Ihe 1966 Annual Supplement.


Page 27, Table 14, East North Central States. Total Number of Deathsl

Ages: tle figures in this column \ere transposed. The published transposed

below corrected:


E- ST NORTH CENTRAL:

Akron. Ohio
Canton. Ohio
( .. .... I. 1.

Cincinnati, Ohio
Cleveland. Ohio
Columbus. Ohio
Day ton. Ohio
Detroit, Mich.
E an\sille, Ind.
Flint, Mich.
Fort Wayne, Ind.
Gary, Ind.
Grand Rapids, Mich.
Indianapolis, Ind.
Madison, W'is.
Milwaukee. Wis.
Peoria. I11.
Rockford, Ill.
South Bend. Ind.
Toledo, Ohio
Youngstown, Ohio


Transposed
137,084

.244
1,761
2.655
8,105
1,782

6,861
2,006
1.674
2,057
5,395
3,116
3,375
1,891
40,302
8,649
11,196

6,524
4,133
18,560
2,197
2,601


\11 Caui-e .\11

versionn is shown



CORRECTED
137,0s

3.375
1.h91

40.302
s,649
11.196
6.524

4.133
15, 60

.2197
2,601
2,244
1,761
2.655
S,105
I ,72
6,b61
2,006
1,674
2,057
5,395
3.116


Page 34, map showing geographic distribution of California and Eastern Encephalitis:

Legend for "20+ cases" should be black: stippling should be deleted from Michigan, see Table 7,

page 12.


Pages 47 and 55, age distribution of cases under 5 years of age: inserts for paralytic polio-

myelitis and for tetanus were transposed. Corrected charts are shown on page 439.







































(Plea:se clip out this page and instrt in the
1966 Annual Supplement to \lI\IR)









DECEMBER 23. 1967








































































0
I











I *


Morbidity and Mortality Weekly Report





CORRECTED CHARTS



1966 ANNUAL SUPPLEMENT TO MMWR

(Vol. 15, No. 53)







PARALYTIC POLIOMYELITIS
0oo REPORTED CASES BY FIVE-YEAR AGE GROI'PS

UNITED STATES, 1966


80




60

t AGES 5 CASES

\ 22
40 : 14
2 21
3 16

204 6
20-



14 2


5 10 ,5 20 25 30


50 60 65 70 75 80


TETANUS
REPORTED CASES BY FIVE-YEAR AGE GROUPS
UNITED STATES, 1966




SAGES 5 CASES

1\ 34
\ I 2

I 3 3


20


. ~7r


0t 15 20 25 30


40


S87







10 60 95


AGE












o- o 440

a----Q0
0-v(






0 (4

v-


_IC&. I_'ME NT: C E P








U.S DEPOSITORY





(Picea:- cs p ouii tin paFI' and insert in the

19f(; annual l Supplenm nt to SI\\HR)


DECEMBER 23, 1967


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION OF 17,000. IS PUBLISHED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER ATLANTA, GEORGIA.
DIRECTOR, NATIONAL COMMUNICABLE DISEASE CENTER
DAVID J. SENCER, M.D.
CHIEF EPIDEMIOLOGY PROGRAM A.D. LANGMUIR, M.D.
ACTING CHIEF. STATISTICS SECTION IDA L. SHERMAN M. S.

EDITOR, MMWR MICHAEL B. GREGG, M.D.

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY, THE NATIONAL COMMUNICABLE DISEASE
- _, E WELCOMESS ACCOUNTS OF INTERESTING OUTBREAKS OR CASE
.i:.TIONS WHICH ARE OF CURRENT INTEREST TO HEALTH
OFFICIALS AND WHICH ARE DIRECTLY RELATED TO THE CONTROL OF
ini--, ^-'. ?L DISEASES, SUCH COMMUNICATIONS SHOULD BE
NATIONAL COMMUNICABLE DISEASE CENTER
ATLANTA, GEORGIA 30333
ATTN: THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT

NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO THE NCDC BY THE INDIVIDUAL
STATE HEALTH DEPARTMENTS. THE REPORTING WEEK CONCLUDES
ON SATURDAY; COMPILED DATA ON A NATIONAL BASIS ARE RELEASED
ON THE SUCCEEDING FRIDAY.


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