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:
AA00010654:00147

Related Items

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

Full Text



NATIONAL COMMUNICABLE DISEASE CENTER


Vol. 17, No. 4


WEEKLY

REPORT


Week Ending

January 27, 1968


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


PUBLIC HEALTH SERVICE


BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


CURRENT TRENDS
INFLUENZA United States
There continues to be total excess mortality, excess
pneumonia and influenza mortality, and excess mortality
in the group aged 65 and over in the United States; how-
ever, excess mortality appears to have reached a peak
(Figure 1). Pneumonia and influenza deaths were above
the epidemic threshold in all divisions except the Moun-
tain division. This is the first week in which there has
been excess mortality in the Pacific division, where the
major source of excess deaths appears to be in the state
of Washington. This is consistent with previous reports of
influenza outbreaks in that state (MMWR, Vol. 17, No. 1)
and recently received additional reports.
To date, the only states which have not officially


CONTENTS
Current Trends CONTENTS
Influenza United States ........ . 29
Preliminary Influenza Laboratory Findings . 31
Measles . .... . ....... 32
T1 : I ,-; 1 ,; Notes and Reports
SI ..F leningococcal Infection Mississippi .. 32
Rabies in a Cat. i .... Vaccination with LEP
Vaccine-Pennsylvania . ..... ... .. 33
Fatal Case of Malaria-Delaware . . 34
Hepatitis Outbreak Amboy, Washington . .... 34
Annual Surveillance Summary
Meningococcal Infection . ..... ... 33
International Notes
Influenza 1967-68 .................. ........ 31
Further Reports of Influenza-like Illness . 32
Quarantine Measures .............. ...... 40

reported influenza-like illness to NCDC this season are
Alaska, Arizona, California. Hawaii, Idaho, and Nevada.
Although outbreaks of influenza-like illness have been
(Continued on page 31)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)


DISEASE


Aseptic meningitis ................... ...
Brucellosis ..........................
Diphtheria..... ......................
Encephalitis, primary:
Arthropod-borne & unspecified...........
Encephalitis, post-infectious .............
Hepatitis, serum .......................
Hepatitis, infectious ....................
Malaria ...............................
Measles (rubeola)........................
Meningococcal infections, total...........
Civilian ..........................
Military ................. ..... ......
Mumps .......... ..................
Poliomyelitis, total .................. ..
Paralytic ................. ..........
Rubella (German measles) ................
Streptococcal sore throat & scarlet fever
Tetanus ............................
Tularemia .............................
Typhoid fever .........................
Typhus, tick-borne (Rky. Mt. spotted fever).
Rabies in animals .......................


4th WEEK ENDED

JANUARY 27 ..e Y 28,


MEDIAN
1963 1967


851
4
7,060
50






10,177
4
5
9

81


CUMULATIVE, FIRST 4 WEEKS

MEDIAN
1968 1967 1963 1967


106
2
8

66
32
260
3,043
157
1,817
289
275
14
17,390


1,898
42,136
5
5
17
2
287


+ 4


115
13
6

79
32
138
2,830
89
6,011
235
218
17

1
1
2,047
43,290
10
13
19
4
.28


115
18
13



S3,103
9
21,879
235



1
1

36,482
11
17
19
3
928


TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: .......... ...... ... ............... Rabies in man: ..................
Botulism: ........................................... Rubella, Congenital Syndrome: ......................
Leptospirosis: Tenn.-1 ............................. 1 Trichinosis:. Conn.- ................................ 3
Plague: ......................................... .. Typhus, murine: ................................ .
Psittacosis: ............... .... ....... ..... 2 Polio, Unsp........................... ... .....







Morbidity and Mortality Weekly Report


PNEUMONIA-INFLUENZA


JANUARY 27, 1968


Figure 1
DEATHS IN 122 UNITED STATES CITIES
1967-1968


WEEK NO 40 44 48 52 4 8 12 16
WK ENDED 9 6 4 I 29 26 26 23
MONTH 0 N D J F M A
1965 1966


20 24 28 32 36 40 44 48 52 4 8 12 16 20 24 28
21 18 16 13 10 8 5 3 31 28 25 25 22 20 17 15
M J J A S 0 N D J F MA M J J
196611967


32 36 40 44 48 52 4 8 12
12 9 7 4 2 30 27 24 23
A SO N 0D J F M
1967 1968


16 20 24 28 32 36
20 18 15 13 10 7
A M JJ A S


25-


0 WEEK NO 40 44 48 52 4 8 12 16 20 24 28
IC 196711968

2 125-
z MOUNTAIN


100


75









WEEK N(


200



150



100



50


32


8 CITIES


50




,hheIssil,,Hihl.IhInd., Ihn, Ihl
40 44 48 52 4 8 12 16 20 24 28 32
1967 1968


PACIFIC
16 CITIES
150



100



50


E. N. CENTRAL 125-
21 CITIES
100-

75

50-

25


40 44 48 52 4
1967 11968


8 12 16 20


E.S. CENTRAL
8 CITIES


250

r2 200

150
200



50

s l si naII Cs l lei n als In(is ....I. ,o
40 44 48 52 4 8 12 16 20 24 28 32
1967 11968


W.S.CENT AL
13 CITIES 150




1 100



_- 50



Ioo.


NEW ENGLAND
14 CITIES


24 28 32 40 44 48 52 4 8 12 16 20 24 28 32 36
196711968


MIDDLE ATLANTIC
20 CITIES












,.,I, h lu, 1e,,,h ,,h 1, sIn h,,Inl, ule ,h,,
40 44 48 52 4 8 12 16 20 24 28 32 36
196711968


SOUTH ATLANTIC
12 CITIES












.. .1.. w1 ,1 ., I


WEEK NO 40 44 48 52 4 8 12 16 20 24 28 32 40 44 48 52 4 8 12 16 20 24 28 32 40 44 48 52 4 8 12 16 20 24 28 32 36
196711968 196711968 196711968


ALL CITIES


. ...- I I I I I J


W N. CENTRAL 250
10 CITIES
200


150


I _100




Ihdh Indh ... I,,,h ,,h Il,,,h, .h ,j













reported from Colorado, Montana. New Mexico, Utah, and
Wyoming, in general, activity in the Mountain division has
not appeared to be as widespread as that in the eastern
and central United States. In the eastern and central United
ii, -. influenza activity appears to be decreasing. In


most areas, school and industrial absenteeism has re-
turned to normal rates.

(Reported by Respiratory Diseases U(nit. Viral Diseases
Section, NCDC.)


PRELIMINARY INFLUENZA LABORATORY FINDINGS


Preliminary laboratory findings of reciprocal hemag-
glutination inhibition tests on influenza viruses including
recent isolates from the 1967-68 season indicate that the
current viruses constitute a homogeneous group of strains
closely related to isolates from the 1966-67 influenza
season. While the newer isolates stimulate the production
of broadly reacting serum antibodies, these strains do
continue to show an antigenic drift away from the A2/Tai-


wan/1/64 component of the current vaccine. Their rela-
tionships to the second vaccine A2 component. A2 Japan
170/62; vary; but, in general, the recent isolates appear
to be antigenically closer to this strain than to A2'Tai-
wan/ 164.
(Reported by the WHO International Influenza Center for
the Americas, National Communicable Disease Center.
Atlanta.)


INTERNATIONAL NOTES
INFLUENZA 1967-68


Further official reports of influenza activity were
received by the World Health Organization from the fol-
lowing countries:
Norway: During November, local outbreaks of influenza-
like illness occurred in western Norway. Serologic evi-
dence of infection with A2 virus was obtained.
(Jan. 9, 1968)* Since the beginning of January, a high
incidence of influenza-like illness has been reported in
Oslo. A strain of virus A2 was isolated.
(Jan. 18, 1968) Influenza is now widespread in east
Norway. Several strains of virus A2 have been isolated.
United Kingdom: (Dec. 12, 1967) At the end of
November, an outbreak of influenza-like disease was re-
ported in a boys' boarding school in north England. Two
influenza A2 strains were isolated from this outbreak.
(Dec. 29, 1967) Influenza activity was noted in London
in approximately the third week of December.
(Jan. 5, 1968) In the first week of 1968, a sharp rise
in influenza deaths occurred in England and Wales. Over
50 percent of the deaths occurred in persons aged 75 years
or over.
Denmark (Dec. 13, 1967) Serologic evidence of
influenza A was obtained in early December from three
patients in various parts of the country, although no sig-
nificant increase was noted in reported clinical influenza.
(Jan. 6, 1968) In middle and late December 1967, a rise
in reported cases of influenza occurred in the greater
Copenhagen area. The disease was reported as generally
mild.
Yugoslavia (Jan. 10, 1968) An influenza epidemic
associated with virus A2 has been reported in Croatia. In


eastern Yugoslavia no outbreaks of influenza-like disease
have been reported.
Italy (Jan. 5, 1968) An epidemic of influenza-like
disease has been occurring in Rome. Two strains of in-
fluenza A2 virus have been isolated.
Netherlands (Jan. 5, 1968) Small localized out-
breaks of influenza-like illness have occurred since mid-
December in the western part of the country. Strains of
virus A2 have been isolated, and serologic evidence of
infection with virus A has been obtained. The disease
seems to be spreading to the eastern part of the country.
Federal Republic of Germany (Jan. 19, 1968) In
Niedersachsen in the past 10 days an increase in inci-
dence of influenza-like illness in children and adults has
been noted. Four strains of virus A2 were isolated.
Sweden (Jan. 15, 1968) A slight increase in the
incidence of influenza-like illness has been reported from
the cities of Halsinborg, Malmo and Goteborg. on the west
coast. In three cities and in Eskilstuna serologic evi-
dence of infection with A2 virus has been obtained in
approximately 20 cases.
Switzerland (Jan. 13, 1968). Finland (Jan. 3, 1968),
and France (Jan. 18, 1968) No increases in incidence of
influenza-like illness have been reported to date for this
season from Switzerland, Finland, or France.

(Compiled from the Weekly Epidemiological Record, WHO,
Vol. 42, Nos. 50-52 and Vol. 43, Nos. 1-4.)


*Dates in parentheses refer to date of original information
submitted to WHO.


JANUARY 27, 1968


Morbidity and Mortality Weekly Report



INFLUENZA United States (Continued from front page)






Morbidity and Mortality Weekly Report



FURTHER REPORTS OF INFLUENZA-LIKE ILLNESS


The following reports from the (anal Zone and Jamaica
of influenza-like disease hate been received hI NC(DC:
Canal Zone Influenza A2 Outbreaks of influenzia-
like illness-- began in the second ateek of Decembet r 1967
in the (anal Zone. An \2 influenza viruss \vas isolated.
It i- interesting that this is thel first tiime the ('anal Zone
and the United States ha\i noted simultaneous outbreaks
of A'2 influenza. The outbreaks \%-re otrurring before the
annual Christnias increase in tra el to and from thoelnited
States.
(Reiported by Sidney B. l/ark, IV.)., Chief. Division of
Prr ritiire Vedicine. Canal Zone lHealth Department, andt
hKiir V. Jo/sto. .D. D1. Director. Viddle America Research
I'in. \iati onal lnisitutr e of tlealth. laltlr Heed Army
Ini/itmre ,,f rHescarchi, Balboa lleiihts, Canal Zone.)

Jamaica Influenza B In late No\ember and earlv
December !9ii7. a number of persons with influenza-like
illness a\ere seen at the University of the ,West Indies
hospital in Kingston. Jamaica. The illnesses consisted of
feker. cough. cor;za. and rather striking myalgia. In some
cas-es acute illness lasted as long 1 s 1 week with cough


ANUI'ARY 27, 1968


often persisting a second week. Hemnagglutination inhibi-
tion tests demonstrated diagnostic rises against influenza
B antigens in six paired sera, and diagnostic rises against
A2 antigens in two paired sera: tIo paired sera were diag-
nostic for influenza B infection by complement fixation
tests. The data are suggestive of influenza B activity,
the first reported in the \western hemisphere this season:
the possibility of influenza A\ infection cannot he elimi-
nated at this time. Further laboratory investigation is in
progress.
Jamaica had major epidemics of A2 influenza in 1957
and 1963. Smaller focal outbreaks of A2 influenza occurred
in the latter months of 1965. No major outbreaks of in-
:Il- r.i I .id .illness have been observed on the island
since October 196). Influenza B has never attained epi-
demic proportion in Jamaica.
(Reported by Dr. Louis S. Grant, lead. Department of
ilicrobiology. I'iir'ersity of t/e Wliest Indies, Kingston.
Jamaica: Dr. Lesl/ie Sperne, Dire-tor. Trinidad Regionalo
Virus Laboratory; Dr. C. ('. hliedderburn. Chief le dii al
Officer, Minisltry of Health. Kingston, Jamaica; and an
EIS Officer.)


CURRENT TRENDS
MEASLES


During the first 4 weeks of 196h. 1,h17 cases of
measles were reported to NCDC. This is less than one
third of the 6,011 cases reported for the comparable 4
\eeks in 1967 (Figure 2). Similarly. it is 5.7 percent of
the 5-year mean (31.S97) for the first 4 N weeks of years
195S-62 that preceded the general availability of measles
vaccine. A seasonal increase in reported measles cases is
noted in this 4-week total.
Of the 5.41 cases of measles reported for the week
ending January 27, 968. 127 (23.5 percent) were reported
from Chicago. These cases are now the subject of inten-
sive epidemiologic investigation.

(Reported by State Sei Seri ct Sion and Statistics Sec-
tion, \'CD('.)


Figure 2
REPORTED CASES OF
MEASLES BY FOUR-WEEK PERIODS UNITED STATES
EPIDEMIOLOGIC YEAR 1967-68 COMPARED WITH 1966-67
4-,o,


EPIDEMIOLOGIC NOTES AND REPORTS
FOLLOW-UP MENINGOCOCCAL INFECTION Mississippi


Since January 19, 196.h. two additional cases (case 9
nm January 21 and case 10 on January 22) of meningococcal
infection hate occurred at a Miissssippi state hospital
(MMI\ ol. 17 No. 3). Both cases, confirmed hacteri-
ologically as G(roup 1 meningococci. occurred in residents
from the -ame floor as the pre~tious eight cases. Since
January 15,. no ldeths ha e occurred, atnd since January 22,
no other cases of meningococcal infection have been re-
ported in residiens either from the floor with 10 cases or


from any other building of the hospital.

(Reported by William Jaquith,. M.D.. James Ilead, M.D.,
and Mlanningy Hudfson, i.D., Mississippi State Hospital,
S' ississippi; A. L. Gray. 4.l)., I.P.II.. Execu-
tire 0'r .. -, and Durward L. Blakey. M.D., M .P.II., Direc-
tor, Pre rentable Disease Control, Miississippi State Board
of lHealth; and Epidemiological Services Laboratory See-
tion, NCO)', and a team of EIS Officers.)


)() r, 21 i~ I '1 (D
*~I i)L( iili iLX rr)l Ill I Yr IU(C ULI UI If'l ~iCI
'OU rr I1'W (*ii*S





JANUARY 27, 1968


Morbidity and Mortality Weekly Report


ANNUAL SURVEILLANCE SUMMARY
MENINGOCOCCAL INFECTIONS 1967


During 1967, 2,164 cases of meningococcal infection
were reported to NCDC. This was a decrease of 36 percent
from the 3,381 cases reported during 1966. The incidence
rates from June through December 1967 were the lowest
observed since 1960 (Figure 3), and the incidence rates
for each month were lower than those for comparable months
in 1966. The usual seasonal upward trend in monthly rates
became apparent in October 1967, and further increases
may be expected in the first quarter of 1968.

Figure 3
COMPARISON OF 1967 MONTHLY MENINGOCOCCAL
INFECTION RATES WITH HIGH, LOW, AND MEAN
MENINGOCOCCAL INFECTION RATES FROM
5.o 1960 TO 1966


Table 1
Meningococcal Infection- United States
1966- 1967
1966 1967
Division
Cases Percent Cases Percent

North East 159 4.7 87 4.0
Middle Atlantic 428 12.6 357 16.5
East North Central 536 15.9 296 13.7
West North Central 178 5.3 103 4.8
South Atlantic 597 17.6 425 19.6
East South Central 293 8.7 179 S.3
West South Central 455 13.4 276 12.7
Mountain 93 2.8 41 1.9
Pacific 642 19.0 400 i,.5
U.S. Total 3,381 100.0 2,164 10U.()


- --- HIGH MONTHLY RATE. 1960-1966
LOW MONTHLY RATE, 1960-1966
* MEAN MONTHLY RATE, 1960-1966
ugriT ,- .ATE, 1967


had been isolated mainly
patients. Consistent with


from blood or spinal fluid of
the findings in recent years.


S JAN. FEB. MAR. APR. MAY JUNE JULY AUG. SEPT OCT. NOV DEC
MONTH
Decreases in reported cases from 1966 were noted in
1967 for all nine U.S. geographic divisions (Table 1):
however, the proportion of cases reported from each divi-
sion to the total number of reported cases for the year did
not change significantly between the two 2 years.
Meningococcal infections among military personnel
and their dependents decreased approximately 60 percent
from the 1966 total of 331 cases to 131 cases in 1967.
These 131 cases represent 6.1 percent of the cases re-
ported in 1967; in contrast, in 1966, the military-associated
cases comprised 9.8 percent of the reported cases.
In 1967, 367 strains of Neisseria meningitidis were
submitted to NCDC for laboratory analysis. These strains


the predominant serogroup was group B (Table 2). Of 356
meningococcal strains subjected to sulfadiazine sensi-
tivity tests, 157 strains (42.3 percent) were not inhibited
by 1.0 mg. percent of sulfadiazine. In 1966. 40 percent
of the strains tested were not inhibited by a similar con-
centration of sulfadiazine.

Table 2
Strains of Neisseria meningitidis Submitted to NCDC
1967*

Serogroup Number Percent

A 2 0.5
B 242 66.0
C 76 20.7
D 0 0.0
X 1 0.3
Y 27 7.4
Z 8 2.2
Not typed and
"rough" strains 11 2.9
TOTAL 367 100.0
*Excludes 22 isolates presently being processed.

(Reported by the Bacterial Diseases Section, Epidemiology
Program, and the Bacterial Serology Unit, Bacteriology
Section, Laboratory Program, NCDC.)


EPIDEMIOLOGIC NOTES AND REPORTS
RABIES IN A CAT FOLLOWING VACCINATION WITH LEP VACCINE Pennsylvania


A cat that had been vaccinated against rabies with
chick-embryo low egg passage modified live virus vaccine
(LEP) in September 1961, October 1964, and September
1967, developed rabies in October 1967 and died. On
September 29, 1967, after being vaccinated on September 7,


the cat began walking with a unilateral hind leg lameness
of unexplained origin. The veterinarian could not recall
into which leg he had injected the vaccine on September 7.
On October 1, he examined the animal, and found it to be
(Continued on page 34)




Morbidity and Mortality Weekly Report


JANUARY 27, 1968


RABIES IN CAT (Continued from paye 33)


i'. fo _* from generalhzed posterior ataxia. The cat seemed
to be in pain and a as unruly w hen handled. Body tempera.
ture and front leg reflexes w ere normal. On October 4, an
-acending paralysis of both hind legs began. followed by
generalized paralysis, and death on October 9. A provi-
sional diagnosis of vaccine-associated rabies was made:
the diagnosis was confirmed by fluorescent antibody and
mouse inoculation tests.

A veterinary helper and the cat's owner ere bitten
by the cat on October 1 and 3, respectively. Both persons
underwent antiralies treatment without any untoward
effects.


(Reported by E. J. Witte. V.1M.0.('i, Veterinary Public
Health Section, Pennsylvania Department of Health.)
Editorial Comment: This incident emphasizes the neces-
sity of following the manufacturer's recommendations con-
cerning LEP vaccine. This vaccine is intended for use in
dogs and cannot be given safely to any other species. It
does not cause viremia and is not present in the central
nervous system (( \% of dogs after injections except
rarely in very young puppies, but may be found in the CNS
of other species if they become ill as a result of the vac-
cination. For vaccinating cats against rabies, killed vac-
cine or chick-embryo high egg passage vaccine IIlEPi is
recommended.


FATAL CASE OF MALARIA Delaware


In the I'nited States in 1967. only one fatal case of
malaria \asreported to N('D('. The patient was a I' .'ear-
old \merican civilian flight engineer who arrived on No-
cvember 16, 1967. in New York (ity from Lisbon, Portugal.
At that time. he experienced high ferers, chills, and leth-
argy. He stayed in a hotel in New York City until Novem-
ber Ih when he traveled to his home in Delaware. On
November 22, he waas admitted to a Delaware hospital in
semi-stuporous condition with persistent chills, fever,
sweats. abdominal pain, diarrhea, and vomiting. His tem-
parature was. 103'"F. The differential diagnoses included
cholangitis, hepatitis, and cirrhosis. The hematocrit
dropped from 42 percent on admission to 31 percent on
November 24. During this time. the BUN increased from
33 to S2 nig. percent, and the total bilirubin from 3.6 to
10 mg. percent. Examination of peripheral blood smears
on November 21 revealed a heavy infection with Plas-
mnodium falciparum parasites. Antimalarial treatment was
ordered, but the patient died within a few hours. Autopsy


revealed pigmentation of liver. spleen, and edema of the
brain with widespread presence of P. falciparum parasites
in these organs.
The patient had been employed from 1961 to 1963 by
an airline in the Congo. Until September 14, 1967, his
flight schedule included ;l,'hr in Europe and other conti-
nents, including South America and, possibly, Asia. His
travel movements during the 2-month period prior to No-
vember 16, 196i7, included visits to Portuguese Guinea,
and, possibly, other West African countries.

(Reported by ('. K. Berger, M.D., Wilmington, Delaware;
F. I. Hudson, 4M.)., Exrecutire Secretary and State Epi-
demiologist, and E. P. Gliw'a, 4I.).. Deputy State Health
('. Delaware State Board ofHfealth; and an t l,, r i;:,, .)

Editorial Comment: The history of this patient emphasizes
the importance of considering the 1.- -. iliIIr. of malaria
infection in patients with fever who have traveled in
malarious countries.


HEPATITIS OUTBREAK Amboy, Washington


From 1964 to September 1967. no cases of hepatitis :
were reported from Amboy. Washington (1960 population
1.1 7 however, from August 29 through December 30,
1967. 10 cases of viral hepatitis were reported from Am-
boy. Investigation revealed that 13 cases were related to
a single private well (Well I) in Amboy, including two in-
dex cases Nwith date of onset on August 29. and 11 cases
with dates of onset between October 6 and 19 (Figure 4).
The remaining 27 cases were secondary to the common
source outbreak: these cases had dates of onset between
Notvamber 1 and Dectember 30.
Cases Directly Related to Well I
The two index cases were a mother and her daughter
(family A). living in a trailer near Well I. -,i,.rl after
onset of illn-ss in i ,ini A. family A moved their trailer
to another location. Histories obtained from the mother
and daughter in family A did not reveal the source of their


Figure 4
CASES OF VIRAL HEPATITIS BY WEEK OF ONSET
AMBOY, WASHINGTON AUGUST-DECEMBER 1967

E] INDEX CASE. FAMILY A

] CASE RELATED TO WATER
SUPPLY, WELL I

SC] SECONDARY CASE


.Fqf


~rvTTh


0 1 I 1 i +-- f
31 7 14 21 28 5 12 19 26 2 9 16 23 30 7 14 21 29 4
AUG SEPT. OCT NOV. DEC. JAN
WEEK ENDING









infections. The site near Well I was vacant until Septem-
ber 15. when family B moved into that trailer lot. Within 5
weeks of family B's arrival, the 11 other cases of hepatitis
related to Well I occurred among family B and visitors to
their trailer. It is important to note that family A had no
history of contact with family B or with any of the other
cases related to Well I.
Of the five members of family B, four developed hepa-
titis from 22 to 35 days after moving into the area. A fifth
case, with date of onset on October 18, occurred in a rela-
tive of family B who had visited in the trailer from Septem-
ber 17 to September 22. Four other cases occurred among
10 guests who attended one of two dinners given by family
B on September 15 and 20. The menus served at the two
dinners were different except for water. Of the six non-
ill guests, four did not drink any water served at the
dinners. Two other cases occurred in grandchildren of
family B. These children visited the trailer frequently,
drank water from Well I. but did not attend either of the
dinners. Their dates of onset were October 9 and 15.
Among these 11 cases related to Well I, six were less than
20 years of age, and five were over 20 (Table 3).



Table 3
Cases of Viral Hepatitis by Age and
Probable Mode of Transmission
Amboy, Washington August-December 1967

Cases Related to Secondary Cases
1'ell A* Spread by Person-to
Age Person Transmission
A ge ---------------
Number Cumulative Number Cumulative
Percent Percent
1-4 0 0 1 4
5-9 4 36 13 52
10-14 1 45 4 67
15-19 1 55 4 81
20-29 4 91 1 85
30-39 0 3 96
40+ 1 100 1 100
Total 11 100 27 100
*Two index cases not included.



A sanitarian who inspected Well I on October 23,
1967, found the well unsatisfactory due to its depth (15
feet), construction (hand dug), and close proximity to the
septic tank (16 feet). A water sample, taken on the day
of inspection, had a coliform count compatible with sewage
contamination. A dead mole was found in the well, and
mole tunnels were seen to enter it. The well was con-
demned on the day of inspection. Fluorescein dye studies
conducted later demonstrated leakage of dye from the
sewage system onto the ground near the well.


Secondary Cases
Among the 27 secondary cases, 22 were in persons
less than 20 years of age, and 5 in persons greater than
20 years of age (Table 1) in contrast with the age distri-
bution of cases related to Well I. Three cases occurred in
families of two cases related to Well I. One of these
families (family C one original case and two secondary
cases) lives in an area called Amboy Vista, a develop-
ment consisting of six low rental housing units with a
common water source (Well II), and an area where a high
degree of social intermingling occurs among families. This
was the first family to develop hepatitis in this develop-
ment area.
From November 1 to December 30, 11 other cases
occurred in Amboy Vista families. Of these 11 cases,
eight were in children age 10 years or under and two of
the remaining three cases were in adults in a household
with earlier cases. A third case. a 15-year old boy. was
the only case in his family. Since family C experienced
the first case of hepatitis in the Amboy Vista area, atten-
tion is focused on them as a possible means of spread in
this neighborhood. Although only one child of this family
had overt hepatitis, the other children might have had
subclinical illnesses in late October or early November
(a transaminase determination was abnormal in mid-
January on one of these children). Since coliform counts
of water samples from Well II were negative and since
the well is located 250 feet from the septic tank and at a
considerably higher elevation, it appears that Amboy
Vista cases resulted from person to person transmission,
possibly involving anticteric or unrecognized cases in
the area.
Two of the remaining secondary cases (plus one who
lived in Amboy Vista) gave histories of frequent and
moderately close contact with a hepatitis case in family
B whose date of onset was October 12. Dates of onset
of these three secondary cases were November 1.9, and 9.
Of the other 11 cases, nine were in students at Amboy
School; their dates of onset ranged from November 10 to
December 25. These cases had probable exposures to
other ill students at the school, either to the three cases
in children, directly related to Well I, or to the eight chil-
dren who live in Amboy Vista. The remaining two second-
ary cases were the parents of one school case.
The epidemic of hepatitis which occurred in Amboy,
during the later months of 1967 consisted of two parts:
an initial common source outbreak related to a contami-
nated water supply, followed by 27 cases probably result-
ing from person to person transmission in households and
in the school.
(Reported by Byron J. Francis, M.D., M.P.H., Head of
Communicable Disease Control, Division of Epidemiology,
Washington State Department of Health; D. A. Champaign.
M.D., M.P.H., Health Officer, Clark-Skamania Health
District, Washington; and an EIS Officer.)


JANUARY 27, 1968


Morbidity and Mortality Weekly Report





36 Morbidity and Mortality Weekly Report


TABLE II1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JANUARY 27, 1%8 AND JANUARY 28, 1%7 (4th WEEK)


ENCEPHALITIS HEPATITIS
ASEPTIC Primary
ASEPTIC I I III including ost- MALARIA
AREA MENINGITIS including Infectious Serum Infectious
unsp. cases
1968 1967 1968 1968 1968 1967 1968 1968 1968 1967 1968
UNITED STATES... 29 38 5 14 20 4 81 877 811 45

NEW ENGLAND........... 4 1 1 1 3 24 37
Maine............... ~ ~ 5
New Hampshire ...... -
Vermont.... ...... -
Massachusetts...... 3 1 1 3 10 16
Rhode Island....... 1 4 3
Connecticut ........ 1 9 12

MIDDLE ATLANTIC...... 5 9 5 2 23 131 139 11
New York City...... 2 10 44 51 1
New York, up-State. 1 1 16 39 1
New Jersey......... 2 7 1 8 37 21 5
Pennsylvania....... 3 4 1 4 34 28 4

EAST NORTH CENTRAL... I 4 3 8 1 2 154 148
Ohio................ 8 1 1 46 30
Indiana............ 4 21
Illinois........... 1 1 45 16
Michigan ........... 1 2 2 50 63
Wisconsin.......... 1 9 18

WEST NORTH CENTRAL... I -- 1 57 47
Minnesota .......... 1 20 13
Iowa............... 11 4
Missouri. ........... 17 26
North Dakota........ 3 1
South Da-,ta .. I
Nebraska............ -
Kansas.............. 5 1 1

SOUTH ATLANTIC .... 2 3 3 1 80 85 7
Delaware ........... 1 -3 5
Maryland ........... 1 11 24 3
Dist. of Columbia.. 2
Virginia........... 2 4 14
West Virginia...... 1 9 15
North Carolina ..... 5 5
South Carolina ..... 1 3 5
Georgia........... 36 9 2
Florida............ 1 7 8

EAST SOUTH CENTRAL... 3 9 78 59 13
Kentucky............. 27 14 12
Tennessee........... 30 25
Alabama............ 3 9 5 8
Mississippi........ 16 12

WEST SOUTH CENTRAL... 3 1 5 2 1 1 1 100 89 3
Arkansas........... 3 8 1
Louisiana.......... 5 1 1 8 5 2
Oklahoma ............ 11 23 7
Texas .............. 3 1 1 66 69

MOUNTAIN............. 1 I 34 49
Montana............ 4 1
Idaho ...... ....... 3 3
Wyoming............. 7
Colorado........... 1 3 3
New Mexico.......... 9 26
Arizona............. 7 6
Utah ............... 8 3
Nevada.............

PACIFIC............. 10 2 4 -51 219 158 10
Washington........ 24 16
Oregon ............ 14 9 45
California......... 9 9 2 4 37 184 96 10
Alaska..............
Hawaii.............. 1 2 1

Puerto Rico...........







Morbidity and Mortality Weekly Report 37


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JANUARY 27, 1968 AND JANUARY 28, 1967 (4th WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL
AREA Total Paralytic
Cumulative Cumulative Total Par

1968 1968 1967 1968 1968 1967 1968 1968 1968 1968 1968
UNITED STATES... 541 1,817 6,011 97 289 235 4,345 546

NEW ENGLAND............ 19 61 48 4 11 7 465 102
Maine.............. 7 5 1 22 6
New Hampshire...... 3 3 1 2 2 4- 4
Vermont ............. 4 1 1 28
Massachusetts...... 8 27 31 3 3 265 41
Rhode Island....... 1 1 2 53 20
Connecticut........ 7 23 5 1 5 3 93 35

MIDDLE ATLANTIC...... 40 208 271 2 30 37 272 62
New York City...... 8 32 34 6 7 50 29
New York, Up-State. 25 131 68 1 2 11 12
New Jersey......... 4 34 108 8 14 222 18
Pennsylvania....... 3 11 61 1 14 5 3

EAST NORTH CENTRAL... 201 563 613 9 36 22 1,287 123
Ohio................ 4 69 57 2 10 9 75 21
Indiana............. 13 88 96 1 4 3 85 5
Illinois........... 128 260 62 3 7 4 176 7
Michigan........... 11 31 161 2 13 4 375 26
Wisconsin.......... 45 115 237 1 2 2 576 64

WEST NORTH CENTRAL... 7 62 218 6 21 10 335 21
Minnesota.......... 11 3 4 1 2
Iowa................ 2 23 38 1 2 297 20
Missouri........... 2 3 8 4 3 1 -
North Dakota....... 2 16 74 1 29 1
South Dakota..'.. .. 1 3 14 1 3 1 -
Nebraska.... ....... 3 73 1 2 6 -
Kansas............. 14 NN 2 7 1 -

SOUTH ATLANTIC....... 37 143 689 17 63 44 323 37
Delaware............ 3 11 1
Maryland............ 4 12 7 2 3 6 21 2
Dist. of Columbia.. 2 2 4 1 9 -
Virginia........... 3 19 199 2 6 6 29 2
West Virginia...... 13 47 121 2 8 116 19
North Carolina..... 1 3 122 5 13 9 -
South Carolina..... 2 4 3 4 12 2 1 2
Georgia............. 2 2 8 2 7 4 90
Florida............. 10 54 222 2 19 9 46 11

EAST SOUTH CENTRAL... 12 39 599 18 24 19 293 19
Kentucky............ 4 8 86 4 6 6 38 4
Tennessee.......... 15 235 3 7 7 186 15
Alabama............. 3 8 118 1 1 2 29 -
Mississippi........ 5 8 160 10 10 4 40 -

WEST SOUTH CENTRAL... 118 359 1,909 30 67 39 290 25
Arkansas............. 253 1 2 -
Louisiana.......... 1 19 4 13 17 1 -
Oklahoma............ 2 36 456 11 18 2 4 -
Texas............... 116 322 1,181 14 34 20 285 25

MOUNTAIN.............. 20 72 467 1 3 6 104 22
Montana............. 1 2 112 1 18 2
Idaho.............. 6 35 1 14 -
Wyoming............ 4 17 19 3
Colorado............ 11 26 94 1 1 1 15
New Mexico......... 1 7 73 3 22 -
Arizona............ 3 14 66 1 27 2
Utah............... 12 4
Nevada............. 75 1 -

PACIFIC.............. 87 310 1,197 10 34 51 976 135
Washington.......... 21 87 677 4 6 1 255 29
Oregon............... 18 76 205 2 3 4 40 -- -20
California.......... 46 133 255 4 25 44 631 79
Alaska............. 46 2 30 4
Hawaii............... 2 14 14 20 3

Puerto Rico.......... 6 15 166 1 11








38 Morbidit and Mortality Weekly Report


TABIIE 11. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JANUARY 27, 196X AND JANUARY 28, I1',7 (4th WEEK) CONTINUED


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

I nn rr I ", I ,: f ri I ,r I ,- I, f I 1 '
U'NITED STATES... 11,150 4 5 3 5 1 17 2 89 287

NEW ENGLAND.......... 1,575 -- I I 3
Maine.............. 20 1 3
New Hanpshire...... 23
Vermont............ 25
Masshusetts...... 233
RhJod Island....... 119
Conne ticut........ 1,155 -

MIDDLE ATLANTIC...... 03 1 1 5 2 3
New York City ...... 14 4- 4
New York, Up-State. 197 1 1 1 -- 1 2
New Jersey......... NN -
Pennsylvania....... 92 1

EAST NORTH CENTRAL.. 989 1 2 1 1 3 2 20
Ohio............... 110 1 3 8
Indiana ............ 165 6
Illinois............ 169 1 2
Michigan........... 276 1 1 2
Wisconsin.......... 269 1 2

WEST NORTH CENTRAL... 336 1 I 2 24 50
Minnesota.......... 54 5 10
Iowa............... 125 9 16
issouri........ ... 5- 2 3 10
North Dakota ....... 79 4 8
Sourh Dakot ....... 23 1 -
Nebraska............ 2 3 4
Kansas............. 48 2

SOUTH ATLANTIC....... 1,280 1 1 1 2 7 31
Delaware........... 12
Maryland........... 368 1
Dist. of Columbia.. 11
Virginia............ 409 2 7 17
West Virginia...... 297 4
North Carolina..... 29 -
South Carolina..... 31
Georgia ........... 14 3
Florida............ 109 -- 7

EAST SOUTH CENTRAL... 1,583 3 32 113
Kentucky............ 58 17 42
Tennessee.......... 1,307 3 14 67
Alabama............. 128 1 4
Mississippi........ 90 -

WEST SOUTH CENTRAL... 1,061 1 1 15 52
Arkansas........... 5 1 4
Louisiana.........- 1 4
Oklahoma........... 63 7 18
Texas............... 993 1 1 6 26

MOUNTAIN............. 1,832 1 2 2 4
Montana.......... 53
Idaho ............. 136 -
Wyoming............ 202
Colorado ........... 1,032 1 1
New Mexico......... 220 -
Arizona ............ 72 2 4
Utah.............. 117 -
Nevada............. -

PACIFIC................ 2,191 1 1 2 4 11
Washington ........ 1,010
Oregon............. 186 -
California.......... 921 1 1 2 4 11
Alaska ............ 20 -
Hawaii............. 54 -

Puerto Rico.......... 21







Morbidity and Mortality Weekly Report






TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED JANUARY 27, 1968


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

All Causes Pneumonia Under All Causes Pneumonia Under

Area All 65 years n Area All 65 years and I yea
Influenza All Influenza All
Ages and over Inlu e All Ages and over Influena 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, Il.--------
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.--------


964 648 81 46
290 183 23 20
66 47 10 2
48 33 4
43 32 3 1
68 33 3 5
51 31 6 3
27 19 -
31 25 1 -
65 42 2 5
94 68 10 3
13 9 3 -
56 37 10 2
48 36 -
64 53 10 1

3,926 2,400 248 179
50 32 2 4
33 25 1 1
154 88 3 8
42 23 6 3
45 28 5 2
48 28 3 2
95 67 13 2
144 77 9 6
1,921 1,167 107 75
50 25 8 5
575 316 8 40
292 187 18 11
69 50 10 -
136 91 27 10
31 24 2 -
53 35 7 4
51 32 3 1
69 48 8 4
28 22 5 1
40 35 3 -

2,990 1,709 151 156
53 34 3
41 28 5 1
795 440 32 32
221 143 11 8
232 117 16 24
139 73 2 13
115 66 9 6
403 222 12 27
61 37 5 2
49 27 5 3
64 38 6 3
43 17 10 2
54 42 9 -
185 104 4 9
66 33 2 3
131 78 6 9
53 28 4
29 19 5 1
41 24 3 1
137 95 7 3
78 44 2 2

1,043 723 71 22
77 53 10 5
23 14 4 -
44 27 5 4
183 135 7 1
35 25 2 -
149 99 3 2
81 51 7 3
305 206 15 6
75 61 4 -
71 52 14 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.----------


1,565
209
371
55
112
110
49
153
49
104
91
206
56

978
135
91
81
235
193
54
43
146

1,632
54
61
39
211
48
112
266
111
214
149
161
83
123

512
40
38
141
19
123
26
62
63

1,918
31
67
36
47
92
461
108
49
138
64
111
211
44
306
93
60


883
100
221
25
61
63
25
87
23
94
57
94
33

563
66
54
59
145
99
28
25
87

924
37
34
19
118
27
68
137
80
106
88
80
50
80

317
26
26
81
17
68
18
37
44

1,196
24
41
25
28
53
274
62
37
94
38
62
127
25
194
69
43


Total 15,528 9,363 1,015 692
Estimatedexpected no. 13 376 7.756 615 646
Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 61,757
All Causes, Age 65 and over------------------- 37,608
Pneumonia and Influenza, All Ages------------- 4,053
All Causes, Under 1 Year of Age--------------- 2,542


Week No.








40 Morbidity and M






INTERNATIONAL NOTES
QUARANTINE MEASURES


Iria ai atio InI ormh ation for InoT irnalin/al Trar/ e
I1!,7-G;S itiio-PuSlic H all tl Scrrie P'bqlihction \ o.


Page RR

Inder Chicago. Illinois. United Air Lines Medical
Department. O'Hara Field Slation, 60010. Clinic Hours,

Delete: By \ppointmonti

Insert: Friday, 10 a.m {) 11 a.m., by appointment


Page 89
Add:


City and State Monroe. La. 71201

Center Quachit a Parish health Init
2913 DeSiard Street
TIlelphon 325-0-154

Clinic Hours Wednesday 1 to 3 p.m.

Fee None


Page 90

Under Rochester, Minnesota. Mayo Clinic. Clinic
Hours,

Delete: Tuesday. 11 a.m.. by appointment

Insert: By appointment only


mortality Weekly Report


JANUARY 27. 1968


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA*
TION OF I7000. IS PUBLISHED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER. ATLANTA. GEORGIA.
DIRECTOR NATIONAL COMMUNICABLE DISEASE '"- E D
SENCER. M..
CHIEF EPIDEMIOLOGY PROGRAM A.D. LANGMUIR. M.D.
ACTING CHIEF STATISTICS SECTION DA L SHERMAN M.S.
EDITOR MICHAEL B GREGG, M D

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDII .. --' I :F 7 I.. HE '. I I. '. e L DISEASE
CENTER r'- .r*: .. ... 7 .OF '. *' '**.-. re OR CASE
INVESTIGATIONS WHICH ARE OF CURRENT INTEREST TO HEALTH
OFFICIALS AND WHICH ARE DIRECTLY RELATED TO THE CONTROL
OF COMMUNICABLE DISEASES SUCH COMMUNICATIONS SHOULD BE
ADDRESSED TO:
NATIONAL *'' 0.r DISEASE CENTER
ATLANTA I
ATTN..
S- MORTALITY WEEKLY REPORT

NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO THE NCOC BY THE INDIVIDUAL
STATE HEALTH .. ItENTS THE REPORTING WEE i .l- L u :F
ON SATURDAY ..'" DATA ON A NATIONAL BASIS FLE. --FL
ON THE SUCCEEDING FRIDAY


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