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:
AA00010654:00151

Related Items

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

Full Text


NATIONAL C MMUNICABLE DISEASE CENTER


Vol. 17, No. 13


WEEKLY

REPORT


Week Ending

March 30, 1968


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


PUBLIC HEALTH SERVICE


BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


EPIDEMIOLOGIC NOTES AND REPORTS
FOOD POISONING Loredo, Texas

An outbreak of gastroenteritis presumably due to
staphylococcal food poisoning occurred Thursday, March 21,
following a noon meal served to school children at 16
elementary schools in Laredo, Texas. Ill children began
reporting to the emergency room of the city's hospital at
3:00 p.m., Thursday, with symptoms of vomiting and ab-
dominal cramps, and during the remainder of the afternoon
and evening, a total of 615 children were seen. Treatment
was symptomatic, no cases were hospitalized for more
than a few hours, and no deaths occurred.
Symptom and food histories were obtained from 5,540
(9,5 percent) of the 5,824 school children who consumed


CONTENTS
Epidemiologic Notes and Reports
Food Poisoning Laredo, Texas ..
Kala-azar Baltimore, Maryland .
Fatal Case of Malaria ...............
Meningococ i I ... -. i'.itland, Oregon .
Measles . .
Current Tren
I .a e .
,r iI ,i-, ,i 7


11.. 1.


. . 109
. 110

. . 111
113
.113


i i)


l, n, Il ol. 1. .',i'* / i ... 11 <*. ,P, *

schools om 4.9 pe n 4.2 percent. Symptoms
included ab percentt, vomiting (70.4
(Continued on page 110)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
13th WEEK ENDEDMEDIAN CUMULATIVE, FIRST 13 WEEKS
DISEASE March 30, April 1, 1963 1967 MEDIAN
1968 1967 1968 1967 1963 1967
Aseptic meningitis ...................... 28 23 27 353 359 359
Brucellosis ............................ 4 5 5 23 49 54
Diphtheria .............................. 1 6 4 37 34 50
Encephalitis, primary:
Arthropod-borne & unspecified ........... 17 19 187 292
Encephalitis, post-infectious ............. 10 20 --- 114 172 ---
Hepatitis, serum ........................ 89 48 ( 915 488
Hepatitis, infectious .................... 898 847 10,783 10,395 10
Malaria ................................ 56 49 4 585 529 25
Measles rubeolaa) ....................... 851 2.660 10,949 8,061 29,969 116,815
Meningococcal infections, total ........... 89 64 71 1,046 768 817
Civilian .............................. 78 53 -954 706
Military ............................... 11 11 92 62
Mumps ................................. 5,160 66,056 -
Poliomyelitis, total ..................... 1 15 3 6
Paralytic ..............................- 1 15 3 5
Rubella (German measles) ............... 1,932 1,469 14,168 13,629 "
Streptococcal sore throat & scarlet fever.... 11,069 11.944 11,683 149,535 159,650 146,284
Tetanus ............................... 1 4 1 26 38 43
Tularemia .............................. 1 4 2 18 32 51
Typhoid fever .......................... 7 7 7 56 70 79
Typhus, tick-borne (Rky. Mt. spotted fever) 1 4 8 6
Rabies in animals ....................... 87 137 11, 928 1.095 1.090

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: .......................................... 1 Rabies in man: ......................................
Botulism: ......................................... Rubella, Congenital Syndrome: ......................... 3
Leptospirosis: N.J.-l, Calif.-l* ....................... 6 Trichinosis: Ohio-1 ................................ 11
Plague: ................. ................... ....... Typhus, murine: .....................................
Psittacosis: Mich.-l, Ohio-2 .................. 11 Polio, Unsp.: ............................. .......
*Delayed report










percent) headache (11.5 percent). and diarrhea (19.4
percent). Incubation periods ranged from 1 to 9 hours.
with the large-st number of cases occurring 3 to 6 hours
after con-sumption of the meal.
School lunches in Laredo are prepared in a central
kitchen and distributed to the variouss elementary schools.
Items served at the March 21 lunch included chicken salad.
lettuce and tomato, french fried potatoes, cupcakes. hot
rolls, and milk. Food histories implicated chicken salad
as the food responsible for the outbreak (Table 1).
Preparation of the chicken salad began Wednesday
afternoon, March 20. when frozen hen.s were boiled for 3
hours. After cooling. the hens were deboned. cooled with
a fan. ground into small pieces, placed in 12-inch-deep
aluminum pans, and stored overnight in a cooler which
was maintained at 42-45F. The following morning, pickles,
pimento, and mayonnaise were added to the chicken, and
the mixture was blended in an electric mixer. The food
was placed in thermal carriers and transported to the
schools by trucks. None of the schools had facilities for
refrigerating food. and the salad was kept at room temper-
ature until served between 11:30 and 12:00 a.m. March 21
was a cold day in Laredo. and the heating systems were
operating in all classrooms. Several persons mentioned
that rooms where the food had been stored were stuffy.
and several teachers commented that the chicken salad
was warm when consumed. At some of the schools, the
food arrived at 9:15 a.m., while at others it arrived at


MARCH 30. 1968


10:30 a.m. The schools which received the food at an
earlier time had a -icifl-i .rnll higher attack rate (32.6
percent) than those which received the food at 10:30 (18.4
percent).
Cultures of the chicken salad taken from the central
kitchen grew coagulase-positive .'.., .. .... aureus
and two gram-negative organisms tentatively identified
as pseudomonas and Esche'ric/ia coli. Nose, throat, and
fingernail cultures taken from the 17 food handlers dis-
closed one person with a positive nasal culture for S. aureus
and two other persons with positive throat cultures. No
furuncles. abscesses, or hand or ilr,. r lesions were de-
tected in any of the food handlers. Further bacteriologic
studies, including phage typing and toxigenicity of the
staphylococcal isolates are in progress.
Recommendations for prevention of further outbreaks
included delivering the school lunches as late in the
morning as possible. installing refrigeration facilities in
the schools. eliminating deep pans for storage of warm
meat. and removing the staphylococcal carriers from food
handling until repeat cultures are negative.

(Reported by J. E. Peary, M.D., M.P.H., Commissioner
of Health, and M. S. Dickerson. M.D., M.P.H., Director,
Communicable Disease .' ..... Texas State Department
of Health; Jose L. Gonzalez, P.E., MI.P.H., Administrator,
Laredo-Webb County Health Department; and a team of
EIS Officers.)


Table 1
Food Histories of Students Consuming School Lunch
Laredo, Texas March 21, 1968

ATE DID NOT EAT
Food
ell Ill Total Attack Rate (Percent) Well Ill Total Attack Rate (Percent)

C l.i a 1 1 .i -, 7 4 7 ti.
Lettuce and tomato 3279 1103 4382 25.2 897 261 1158 22.5
French fries 3858 1252 5110 24.5 318 112 430 26.0
Cupcakes 3954 1264 5218 24.2 222 100 322 31.1
Hot rolls 3793 1261 5054 25.0 383 103 486 21.2
Milk 3547 1211 4758 25.5 629 153 782 19.6


KALA-AZAR Baltimore, Maryland


An 1-year-old Greek male immigrant was admitted to a
Baltimore hospital on March 25, 1968, with a 10-week
history of weakness, malaise, weight loss, fever, chills,
night sweats, vomiting, pallor, and epistaxis. An enlarged
spleen and liver were palpated on physical examination.
There were no skin lesions, heart murmurs, or peripheral
lymphadenopathy. Admission hematocrit was 35 percent,
white cell count -' -i11 per a'ni (34 percent polymorpho-
nuclear leukocytes, 36 percent lymphocytes, 26 percent


monocytes, and 2 percent ....-irithil.--I platelets 110,000
per mm3, and reticulocytes 3.0 percent. Liver function
tests revealed an albumin-globulin ratio of 3.4/5.8, 3-,
cephalin ilIn l. rI, and a thymol turbidity of 19.0. The
temperature chart showed two daily paroxysms as high as
103.8F.; the first occurred regularly between 4 a.m. and
8 a.m., the second at 8 p.m. Infectious mononucleosis,
malignant disease, tuberculosis, and chronic malaria were
included in the differential diagnosis. A sternal bone


Morbidity and Mortality Weekly Report


FOOD POISONING (Continued from front pag')









marrow aspirate contained numerous intracellular bodies
characteristic of Leishmania donovani (e.g. Leishman-
Donovan bodies). Therapy with Pentostam* (sodium stibo-
gluconate) was begun on March 31, 1968.
The patient's father had worked as a shepard in rural
Greece before the family immigrated to the United States
in March 1967. All family members had been in close con-
tact with dogs and poultry. An uncle died in 1967 of a rup-
tured echinococcal cyst. Serologic evaluation of the patient
and his family for leishmaniasis and echinococcosis is
planned at NCDC.
(Reported by Dr. Philip A. Tumulty, Professor of Medicine,
Johns Hopkins University School of Medicine; Dr. James E.
Peterman, Chief, Communicable Diseases, Baltimore City
Health Department; Dr. John H. Janney, Jr., Acting Chief,
Division of Communicable Diseases, Maryland State Health
Department; and the Parasitic Disease Drug Service, NCDC.)
Editorial Comment:
Kala-azar (visceral leishmaniasis) is an infectious
reticuloendothelial disease characterized by chronicity,


irregular fever, enlargement of the spleen and often of the
liver, and the presence in these and other organs of the
protozoa Leishmania donovani. The disease is endemic in
the Mediterranean basin, the Sudan, India, East Pakistan,
China, the Soviet Union, and certain areas of South America.
Several species of sandfly (Phlebotomus) act as the vector.
Infected dogs constitute an important animal reservoir.
Kala-azar (visceral leishmaniasis) must be dl -,nr, u,- h.-i
from oriental sore cutaneouss leishmaniasis) and espundia
(American leishmaniasis) which are clinically and geo-
graphically distinct disease associated with the same
genus, Leishmania. Pentavalent antimony compounds are
the treatment of choice against non-resistant strains.'
*Available through Parasitic Disease Drug Service, NCDC.

REFERENCE:
1Most, H.: Drugs for parasitic infections. The Medical Letter,
5, 89, 1963.
Trade names are provided for identification only, and inclusion
does not imply endorsement by the Public Health Service or the
United States Department of Health, Education, and Welfare.


FATAL CASE OF MALARIA


On August 16, 1967, a 20-year-old serviceman who
was on temporary leave in Hawaii from duty in Vietnam
was admitted to an Army hospital. He had a 2-day history
of chills and fever. On admission, physical findings in-
cluded nuchal rigidity, trismus, hepatosplenomegaly,
,bilateral Babinski's reflexes, and hyperactive bilateral
deep tendon reflexes with unsustained clonus. Within an
hour after admission, the patient became semicomatose and
disoriented. A blood smear revealed a 10 percent parasitemi a
with Plasmodium falciparum. Between August 16 and 19,
his hemoglobin dropped from 13.7 to 9.8 gm percent, and
the hematocrit from 40.5 to 31.5 percent. The white blood
count showed a mild leukocytosis with a left shift. The
BUN on admission was 25 mg percent. Total bilirubin was
3.0 mg percent with the direct fraction being 0.6 mg per-
cent. The serum specimen showed evidence of hemolysis.
Urinalysis revealed a specific gravity of 1.037 with 1+
albumin. Spinal fluid pressures were at the upper limits of
normal. The EEG changes were compatible with a diffuse,
acute destructive process. The total blood volume was
increased, mainly by the plasma component. Chest x-rays
showed pulmonary edema and a pneumomediastinum. The
parasite count on August 17 was 50,400 per mm3.
The patient was given 650 mg of quinine intravenously
and 250 mg of chloroquine every 8 hours. Because of


anuria, fluids and mannitol were administered with good
initial response, but later the urinary output decreased
again. The patient was given dexamethasone and cephal-
othin because of a pulmonary infiltrate. Heparin was ad-
ministered as intravascular coagulation was suspected.
During hospitalization, pneumothorax developed bilater-
ally. On August 18, his temperature rose to 103oF., but
was subsequently maintained between 98 and 100F.
The patient failed to respond to therapy and died on
August 19. Postmortem examination revealed cerebral
malaria with edema, pulmonary congestion and edema with
bilateral hydrothorax, and acute congestion of spleen,
liver, and kidneys.


(Reported by Alvin E. Smith, CPT, MC. USA, and Robert
McNamara, CPT, MC, USA, Tripler General Hospital,
Hawaii; and Robert Penington, Jr., M.D., Chief, Epi-
demiology Branch, Hawaii State Health Department.)


Editorial Comment
This represents the second fatal case of falciparum
malaria reported in the United States in 1967. It illustrates
the rapidity with which cerebral signs and symptoms can
develop in infections with P. falciparum.


MENINGOCOCCAL DISEASE Portland, Oregon


On the evening of February 10, 1968, a 26-year-old
male developed fever and weakness which was followed
several hours later by nuchal rigidity and petechial rash.
He was admitted to a hospital early on the morning of
February 11. Cultures of spinal fluid and blood were posi-
tive for Neisseria meningitidis Group B that was subse-


quently found to be sensitive to sulfadiazine at a con-
centration of 0.1 mg percent. Despite treatment with high
doses of penicillin, chloramphenicol, and sulfadiazine.
the patient died on February 12.


(Continued on page 11S)


MARCH 30, 1968


Morbidity and Mortality Weekly Report










A 20-year-old female, a fellow employee. who had
close contact with the patient on February 9, was started
on a 5-day course of penicillin prophylaxis which con-
si-ted of 1.6 million units orally per day on February 12.
approximatelyy 12 hours after the final dose of penicillin.
she developed fe\er and chills. She was admitted to the
hospital on February 19. and that same day. a Grotp B
meningococcus with an antibiotic sensitivity pattern
similar to the first patient's organism was isolated from
blood and throat cultures. She was successfully treated
with sulfonarnides and penicillin. ,\. inmningitidis was re-
covered from the nasopharynx of a third person, an asymp-


MARCH 30, 1968


tomatic contact of the second case, despite the fact that
this contact had received 3 days of 1 million units of
penicillin as prophylaxis.
(Reported by Thomas L. Meador, M.I)., City Health ,*r.. 'r.
Portland Oregon; and an EIS Officer.)
Editorial Comment:
It is well established that l.' r lln even when given
in doses higher than used here, usually fails to eradicate
the meningococcal carrier state. If a meningococcal strain
proves to be sulfonamide-sensitive, as in these cases,
use of sulfonamides is still the only reliable means for
eradicating nasopharyngeal carriage.


MEASLES Rockport, Montana


On March 2. a physician's communicable disease re-
port to the Montana State Board of Health initiated the
uncox ring of a community-wide measles epidemic in Teton
County, in northwestern Montana. The 48 cases, entirely
confined within a Hutterite colony known as Rockport,
(population 85) demonstrated unusual age specific attack
rates for a measles epidemic in the continental United
States.
The index case was a 9-year-old male. After exposure
to known measles cases in another Hutterite colony on
January 3, the boy returned to his home in Rockport where
on January 14, he developed measles. A first wave of 11
cases occurred among his primary contacts 10 to 20 days
later. Beginning February 8, a second wave of 23 cases
further spread measles throughout the colony. (Figure 1).
Analysis of the cases by age (Table 2) shows a 94
percent attack rate for all persons in the colony age 20


Table 2
Reported Measles Cases by Age
Rockport, Teton County, Montana, 1968 (Jan.-March)
Age Group P Case Rate Per
Population Cases
(Years) 100 Population

Under 1 3 1 33.3
1-5 13 12 92.3
6-10 14 14 100
11-15 7 7 100
16-20 14 14 100
21 and over 34 0 0

Total 85 46 56.5



years or younger: three children, 1-year-old or less, who
received measles vaccine before the second epidemic


Figure 1
MEASLES CASES Bt DATE OF ONSET
ROCKPORT, TETON COUNTY, MONTANA
JANUARY-MARCH 1968 U


25 30


MARCH


4
FEBRUARY


19 24


Morbidity and Mortality Weekly Report


MENINGOCOCCAL DISEASE (Continued from paye 111)


10 15 20
JANUARY


14






Morbidity and Mortali


wave, did notdevelop measles. There were no cases among
the 34 persons in the colony over age 20 years. Of partic-
ular interest is that 18 cases (38 percent) occurred in the
14-20 year age group. One patient, a 20-year-old female,
was hospitalized because of severe bronchitis and dehy-
dration. The last known measles outbreak in this colony
occurred prior to 1947 before the colony moved to Montana
from McGrath, Canada.


MARCH 30, 1968


CURRENT TRENDS
MEASLES United States


A total of 851 cases of measles were reported for the
week ending March 30, 1968. This is 1,809 cases less
than the 2,660 cases reported for the corresponding week
in 1967.
During the 4-week period. February 25 through March 23,
1968 (weeks 9-12), 3,006 cases of measles were reported
to NCDC. This is an increase of 623 cases over the total


for the preceding 4-week period, but is only 27 percent.
8.2 percent, and 6.8 percent of the cases reported for the
comparable 4-week periods in the years 1967, 1966. and
1965 respectively (Figure 2). The seasonal increases in
1966-67 and 1967-68 are more readily seen in the Figure 2
inset.


Figure 2
REPORTED MEASLES BY FOUR-WEEK PERIODS UNITED STATES
EPIDEMIOLOGIC YEAR, 1967-68 COMPARED WITH 1964-65, 1965-66, AND 1966-67


REPORTED CASES OF MEASLES BY 4-WEEK PERIODS-UNITED STATES
EPIDEMIOLOGIC YEAR 1967-68. COMPARED WITH 1966-67
,ooo1


/.


1966-67


1967-8 __


4 2 30 27 24 23 20
NOV. DEC. DEC JAN FEB. MAR. APR.
FOUR-WEEK PERIOD


18
MAY
ENDING


15 13 10 7 5
JUN. JUL AUG. SEP OCT


ty Weekly Report 113



There are 14 Hutterite colonies known in Montana.
These people live in complete economic and social iso-
lation from the mainstream of life in Montana. Efforts have
been initiated to reach all colonies for immunization of
persons with no previous history of measles.
(Reported by Mary E. Soules, M.D., State Epidemiologist,
and Mr. Don Pratt, Public Health Advisor, Montana State
Board of Health; and State Services Section.)


48,000


44,000-


40,000-


O
36,000-

a
S32,000-
Li
w
Li
3
a 28,000-
0
U.
O 24,000-
a
EL
w
S2 0,000

UL
o 16,000-

.LJ
CD
S12,000-
r


8,000


4,000 -


0






Morbidity and Mortality Weekly Report


MARCH 30, 1968


SURVEILLANCE SUMMARY

NEWLY REPORTED ACTIVE TUBERCULOSIS CASES United States 1967


Reports from state health departments, based on pro-

iisional information. indicate that 15,441 new active

tuberculosis cases \were reported for thie United States.

during 1967. These preliminary figures suggest that the

final count for the year will show a decrease in new ac-

ti.e cases compared with 1966 (.17,767 cases).

althoughh the decrease in new active tuberculosis

crasei- as 5 percent for the United States as a whole.




NEW ACTIVE TUBERCULOSIS CASES AND CASE RATES

EACH STATE, 1966 AND 1967


Continental U.S ....
Alaba ....... .....
Alaska ............. .
rion ...........
Arkansas ............
California ...........
Colorado .............
Connecticut .........
Delaware .............
District of Columbia
Florida .........
Georgia ..............
Hawaii ..............
Idaho .......
Illinois ...........
Indiana ............
Iowa ...... ....
Kasas ..............
Kentucky .............
Louisiana ..........
Maine ...........
Maryland ............
Massachusett ........
Hichigan .............
Minnesota ............
HiMlatsppi .........
Missour .............
Montana .............
Nebraska .............
Nevada .............
New Hampshire ........
New Jersey ..........
New Mexico ...........
New York .............
North Carolina ......
North Dakota .........
Ohio .................
Oklahon ...........
Oregon ............
Pennsylvania ........
Rhode Island ........
South Carolina ......
South Dakota .........
Tenessee ........
Texas ............
Utah ...... .......
Vermont ...... ......
Virginia ...........
Washington ...........
West Virginia ........
Wisconsin ..........
-.- '- .- --


47.617 24.4
1.249 35.5
147 54.0
487 30.1
589 30.1
4.653 24.6
239 12.1
293(a) 10.2
173 33.8
619 76.6
1.574 26.5
1.270 28.5
262 36.5
65 9.4
2,959 27.6
981 19.9
181 6.6
266 11.8
1.344 42.2
1,000 27.8
128 13.0
1,200 33.2
924 17.2
2.425 29.0
380 10.6
658 28.3
1.046 23.2
96 13.7
126 8.7
229 50.4
54 7.9
1,601 23.2
267 26.1
5,345 29.3
1,284 25.7
43 6.6
1,507 14.6
500 20.3
387 19.8
2,675 23.1
140 15.6
698 27.0
159 23.3
1.413 36.4
3,135 29.2
74 7.3
35 8.o
1,599 35.5
555 18.6
489 27.3
475 11.4


24.3 44,981 22.9


1,214 34-6
147 55.5
503 31.4
587 30.0
4,658 24.8
223 11.4
293(a) 10.2
173 13.7
553 68.6
1.573 26.7
1.273 28.6
259 35.8
65 9.3
2.938 27.2
1.051 21.2
184 b.7
279 12.3
1.241 39.0
1,029 28.4
128 13.1
1.217 33.7
910 16.8
2.263 26.7
400 11.2
654 28.0
1.049 23.0
105 15.0
132 9.2
231 53.6
54 8.0
1,592 23.1
267 26.6
5.296 29.1
1.266 25.5
42 6.5
1.639 15.8
538 21.7
386 19.6
2.664 23.0
140 15.6
690 26.7
158 23.3
1,380 35.7
3.037 28.3
75 7.4
35 8.5
1.573 35.2
551 18.1
544 30.1
480 11.5


L,515 42.8
107 39.3
436 26.7
498 25.3
4.228 22.1
239 12.1
418 14.3
127 24.3
477 59.0
1.601 26.7
1,110 24.6
353 47.8
55 7.9
3.049 28.0
1,033 20.7
160 5.8
219 9.6
1,086 34.1
912 24.9
120 12.3
1,177 32.0
910 16.8
1,923 22.4
376 10.5
604 25.7
888 19.3
87 12.4
128 8.9
152 34.2
42 6.1
1.448 20.7
248 24.7
5,030 27.4
1.255 25.0
51 8.0
1,525 14.6
410 16.4
322 16.1
2,716 23.4
148 16.4
688 26.5
128 19.0
1.223 31.4
3.195 29.4
65 6.3
44 10.6
1,416 31.2
522 16.9
501 27.9
445 10.6
i .. .. ,


(a) Excludes 235 diagnosed cases not officially reported.
(b) Not included In totals.

* Rate per 100,000. Population based on U.S. Bureau of Census. Current
Population Reports. Series P25, No. 380. November 24, 1967.
(March 8. 1968)


the decline was less for the large cities (3 percent) than

for the rest of the country (6 percent).

In 37 states the 1967 provisional case rates were

lower than the 1966 rates; in 11 states the rates were

higher; and in two states there was no change. The case

rates for the states ranged from a high of 47.8 per 100,000

population in Hawaii to a low of 5.8 in Iowa.

(Reported by Tuberculosis Program, NC[(C.)




NEW ACTIVE TUBERCULOSIS CASES, 1966 AND 1967

Cities of 250,000 or More Population


I1966 1966 1967
C ITiS9
Provisional Final Proviaonal
Akron. Ohio .................... 42 42 42
Albuquerque, N. ex. ............ 31 31 40
Atlanta (Fulton Co.), Ga. ..... 291 288 230
0iior Mo 701 691 673
Bgaltlimore, I ................. 701 691 673
Birmingham. Ala. ............... 187 187 172
Boston, Mass ................. 290 283 278
Buffalo, N.Y. ................... 215 229 190
Chicago. 111. ...... .......... 1,996 1.977 2,038
Cincinnati. Ohio ............. .. 134 10 142
Cleveland, Ohio ................ 262 285 284
Columbus. Ohio .................. 104 108 86
Dallas. Texa ................. 186 186 237
Dayton. Ohio .7............... 72 81 91
Denver, Colo ................. .. 102 94 78
Detroit. Mich. ................. 1.070 1,070 963
El Paso. Texas .................. 155 157 92
Ft. Worth. Texas .............. 106 112 101
Honolulu, Hawai ............. 124 122 186
Houston (Harris Co.). Texas ..... 531 531 620
Indianapolis (Marion Co.). Ind. 320 303 304
Jersey City, .J. ................ 133 131 116
Kansas City. ......... ... 181 181 146
Long each Calif ............ 103 101 56
Los Angeles. Calif. ............. 917 924 885
Louisville (Jefferson Co.). Ky. 223 218 192
Memphis (Shelby Co.), Tenn ..... 163 141 170
Miami (Dade Co.), Fla. .......... 361 365 354
Milwaukee, Wisc. ................ 222 162 188
Minneapolis, inn. ............. 69 74 72
Nashville (Davidson Co.), Tenn. 121 143 148
Newark N.J. ................. 213 315 291
New Orleans, La. ................ 260 260 205
Hew York. N.Y .......... ...... 3.607 3.663 3,590
Norfolk. Va. ............... 100 95 138
Oakland Calif. .............. .. 117 121 82
Oklahoma City. Okla. ............ 85 89 99
Omaha (Douglas Co.). Nebr. ....... 77 77 64
Philadelphia, Pa. .............. 961 952 940
Phoenix. Arlz. ................. 131 129 94
Pittsburgh. Pa ............... 276 276 275
Portland. Ore, .......... ...... 168 167 118
Rochester. N.Y. ................. 113 119 85
Sacramento, Calif. .............. 134 133 127
St. Lo is. Mo. ................. 328 303 285
St. Paul, Minn. ............... 49 53 57
San Antonio. Texas .............. 220 220 295
San Diego, Calif. .......... .... 104 102 138
San Francisco Calif. .......... 419 419 366
San Jose. Calif. ...... ....... 55 54 12
Seattle. Wash ...... ....... 134 128 148
Tampa, Fla. ..................... 89 89 93
Toledo, Ohio ........... ..... 59 69 63
Tu son. rz. ................... 71 71 54
ulsa. Okla. ............ ..... 70 65 65
Washington. D.C. ............... 619 553 477
Wichita, Kans. .....3........ 32 39 31
Total 56 Cities ............... 17,903 17928 17,426
Remainder of U.S. ............. 30.123 29.839 28.015
United States ................. 48026 47767 45.441


Data shown are for county
ior principal city.


where information is not available separately
(Harch 8. 1968)


ASEPTIC MENINGITIS United States


For 1967, a preliminary total of -.*:74 cases of aseptic

meningitis were reported to NCDC. As in previous years,

a characteristic summer peak was again observed (Fig-

ure 3). Although this peak coincides with that of reported


encephalitis, and although many agents cause both syn-

dromes, there is no clear relationship between total num-

bers of cases of encephalitis and :i-rpii" n.'n;rngilis re-

ported to NCDC over the past 4 years (Figur,. 4).


- I


. s.* I ** -r.- I ... *I ..






Morbidity and Mortality


Preliminary totals of non-poliomyelitis enterovirus
isolates reported from 19 state laboratories for 1967 are
summarized in Table 3. Although these represent a very
small percentage of all cases of enterovirus associated
disease, this tabulation may roughly reflect the frequency
of occurrence of these agents. Two agents were responsi-
ble for the major part of these isolates: Coxsackie B5,
which was recovered over wide areas of the country, and
ECHO 9, which was recovered extensively, but in a some-
what more focal distribution.

(Reported by Neurotropic Viral Diseases Unit, Viral Dis-
eases Section, and Statistics Section, NCDC.)



Figure 3
REPORTED CASES OF ASEPTIC MENINGITIS BY MONTH
UNITED STATES, 1964-1968


MARCH 30, 1968


ot 3000-
4

I-



LD
0



0

Z 2000-
ux

z


0





\
[]


1964 1965 1966
*1967 PRELIMINARY WEEKLY REPORTS.


1967


Table 3
Non-Poliomyelitis Enterovirus Isolates
1967

ECHO Virus Coxsackle
Division-- State ---Total
4 6 9 11 Other -9 A16 B1 B2 B3 B4 B5 Other
North East
Massachusetts 1 2 3
Connecticut
East North Central
Ohio 1 72 4 13 90
Illinois 1 3 4 41 49
Michigan 1 2 3 6 1 2 3 1 16 6 41
West North Central
Minnesota 1 2 1 19 23
Missouri 1 1
Kansas 7 7
South Atlantic
Virginia 1 1 11 1 14
North Carolina 9 7 2 17 6 1 30 1 73:
Georgia 1 1 8 10
East South Central
Kentucky 2 1 4
Tennessee 1 1 1 27 30
West South Central
Arkansas 1
Louisiana 1 1 10 1 2 1 2 8 26
Texas 1 1 2 I 5
Mountain
Utah 1 7 3 It
Pacific
Washington 1
California* 2 1 1 6 3 1 7 22
Total 7 18 99 3 37 21 9 2 10 2 6 b18 11 413

Associated with reported encephalitis only.


Weekly Report 115


Figure 4
CASES OF ENCEPHALITIS AND ASEPTIC MENINGITIS

4000 YEARLY TOTALS 1964-1967*
S-- ASEPTIC MENINGITIS

0------0 ALL REPORTED ENCEPHALITIS

C) }----- PRIMARY ENCEPHALITIS


0 -


---- PaELIMINAR DATA






1 16 Morbidilv and M1irtalit% Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED) STATES

FOR WEEKS ENDED

MAR( I ol. 196S AND APRIL I. 1I6" (14th WIlK)


ENCEPHALITIS HEPATITIS
ASEPTIC 111 11 Primary Post-
\,{FIIi IDDPrisHary Post- MAlARIA
M\REA MNINGITIS including Infectious Serum Infectious
unsp. cases
1 ,. I,.-- I 7'T.


NEW ENGLAND........... 4 1 34 45
Maine..... ......... 1 7
New Hampshire ....... 1 3
Vermont. ........... .
Massachusetts...... 4 1 17 14
Rhode Island........ 6 7
C nnecticut........ 9 14 -

MIDDLE ATLANTIC...... 4 7 28 124 151 6
New York City...... 3 2 20 41 29 1
New York, up-State 1 23 30
New Jersey........ 5 19 55 3
Pennsylvania....... 1 5 2 41 37 2

EAST NORTH CENTRAL... 5 5 5 5 ? 8 130 135 1
Ohio ............... 2 1 47 20
Indiana ............ 1 2 4 6 35
Illinois............... 2 1 2 39 28
Michigan........... 3 I 1 1 5 31 41 1
Wisconsin.......... 7 11

WEST NORTH CENTRAL... 2 1 38 51 4
Minnest.............. 1 1 8 13
Iowa................ 2 10 2 2
Missouri..... ....... 11 24
North Dakota....... 2
outh Data .... 1
Nebra ka............ .- 4 3
Kans s ............... 4 6 2

SOUTH ATLANTIC....... 3 2 1 2 1 1 103 100 18
Delaware............ 3 -
Maryland........... 1 1 1 14 18
Dist. of Columbia.. I- 1
Virginia............ 1 12 20
West Virginia...... I 3 6
North Carolina .....2 10 5 10
South Carolina..... 2 3
Georgia............. 42 38 8
Florida............ 1 1 16 10

EAST SOUTH CENTRAL... 4 2 2 4 80 53 1
Kentucky............ I 1 1 16 15 1
Tennessee.......... l 1 4 43 18
Alabama........... 2 13 5
Mississippi ........ 8 15

WEST SOUTH CENTRAL... 3 3 1 2 73 76 10
Arkansas........... 1 1 3
Louisiana........... 1 15 10 1
Oklahoma............ 9 7 9
Texas... .......... 3 1 1 1 48 56

MOUNTAIN ............. 1 61 45 1
Montana............ 9 8
Idaho........... .... 4 5
Wyoming.................. 1
Colorado........... 1 22 16 1
New Mexico......... 3 3
Arizona............. 13 4
Utah............... 8 9 8
Nevada............. -

PACIFIC.............. 12 11 1 2 2 2 51 255 191 15
Washington ......... 1 21 30 5
Oregon............. I 14 14
California......... 11 6 1 2 2 1 49 220 147 5
Alaska ......... .... I -
Hawaii............. 1 4 5 5

Puerto Rco........... 17 26 1

*Delayed reports: Diphtheria: Tex. delete 1 case 1967, delete 1 case 1968
Hepatitis, infectious: N.Y. Upstate 2 cases 1967, I case 1968; N.J. delete 4






Morbidity and Mortality Weekly Report I 17


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MARCH 30, 1968 AND APRIL 1, 1967 (13th WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL
AREA Cumulative Cumulative Total Paralytic
Cum.
1968 1968 1967 1968 1968 1967 1968 1968 1968 1968 1968
UNITED STATES... 851 8.061 29,969 89 1,046 768 5,160 15 1,932

NEW ENGLAND.......... 27 377 345 4 50 28 487 468
Maine.....*......... 10 73 2 1 14 7
New Hampshire. .... 1 48 64 3 6 1 8 1
Vermont............ 5 20 1 2
Massachusetts...... 9 185 131 24 13 302 284
Rhode Island....... 3 21 4 56 63
Connecticut........ 17 126 36 1 13 13 107 111

MIDDLE ATLANTIC...... 117 1,086 923 22 187 97 239 316
New York City...... 67 255 148 5 67 18 114 150
New York, Up-State. 17 556 218 2 18 29 NN 47
New Jersey... ..... 22 197 239 12 58 38 125 119
Pennsylvania....... 11 78 318 3 44 12 NN --

EAST NORTH CENTRAL... 169 1,960 2,302 11 107 76 1,449 400
Ohio............... 19 146 363 6 26 31 36 60
Indiana............. 35 316 260 3 16 11 180 21
Illinois........... 58 842 350 2 27 16 194 148
Michigan........... 10 121 498 29 13 514 42
Wisconsin.......... 47 535 831 9 5 525 129

WEST NORTH CENTRAL... 8 149 1,239 5 45 37 745 80
Minnesota.......... 6 52 4 10 8 75 5
Iowa................ 40 248 3 7 450 59
MisSouri............ 9 39 1 9 9 9 4
North Dakota........ 5 60 499 2 70 6
South Dakota........ 3 39 4 5 NN -
Nebraska........... 3 24 362 4 7 30 3
Kansas............. 7 NN 13 1 111 3

SOUTH ATLANTIC....... 169 719 3,089 20 222 155 341 96
Delaware............. 5 24 1 2 5 13 2
Maryland........... 1 40 60 1 15 18 34 14
Dist. of Columbia.. 4 10 1 8 14
Virginia........... 15 139 920 15 13 61 22
West Virginia.*.... 8 132 577 2 6 13 124 5
North Carolina..... 126 185 614 5 50 32 NN -
South Carolina..... 16 111 2 41 12 9 6
Georgia............. 3 14 6 40 30 -
Florida............. 19 195 759 2 45 32 86 47

EAST SOUTH CENTRAL... 57 223 3,216 6 80 79 289 69
Kentucky............ 19 60 970 1 29 21 19 18
Tennessee.......... 2 40 1,028 3 24 36 198 48
Alabama ............ 22 64 695 1 13 13 19 3
Mississippi........ 14 59 523 1 14 9 53 -

WEST SOUTH CENTRAL... 187 1,938 11,177 12 209 129 522 7 227
Arkansas........... 1,253 2 12 12 -
Louisiana.......... 1 63 6q 52 49 1
Oklahoma............ 55 3,118 41 7 6 -
Texas............... 187 1,882 6,743 4 104 61 516 7 226

MOUNTAIN ............. 36 390 1,995 13 16 300 78
Montana............ 62 178 5 3
Idaho.............. 1 11 203 1 20 1
Wyoming ............ 1 34 13 5 1
Colorado........... 25 153 447 7 7 114 47
New Mexico......... 4 40 333 3 57 5
Arizona............. 5 86 427 1 2 68 21
Utah................ 2 217 1 17 -
Nevada............. 2 177 2 2 14

PACIFIC.............. 81 1,219 5,683 9 133 151 788 8 198
Washington.......... 14 319 2,922 2 23 15 201 54
Oregon.............. 16 254 636 2 13 12 39 4
California.......... 49 623 1,988 5 88 122 493 8 120
Alaska.............. 74 2 33 12
Hawaii...*.......... 2 23 63 9 22 8

Puerto Rico.......... 15 143 945 15 7 27 13

*Delayed reports: Measles: N. J. delete 3, W. Va. delete 10, Hawaii delete 2
Meningococcal infections: N.H. 1
Mumps: Me. 3
Rubella: Me. 4, W. Va. 10






11 Morbidity and Mortalil) Weekly Report


TABI.I II1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MARCH i. 1968 AND APRIl 1i. 1X (ltrh 'I I tk (CONTINI II)


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
AREA SCARLET FEVER (Rky. Mt. Spotted) ANIMALS
Cum. Cum. Cum. Cum. Cum.
I rn I 'It It I Ir l n: I .fx 14ib, Ii,8hh l16b8
UNITED STATES... 11,069 1 26 1 18 7 56 1 4 87 928

NEW ENGLAND........... 1,684 2 8 38
Maine... .......... 22 8 37
Nw Hampshire ...... 1
Z-er-o ct............
Massachusetts...... 301 1
Rhode Island ....... 208
Co"nneticut........ 1,153 1

MIDDLE ATLANTIC ..... 475 6 1 7 1 10
New York City...... 40 3 1 5 -
New York, Up-Stat,. 368 3 1 1 6
New Jersey......... NN -
Pennsylvania ....... 67 I 4

EAST NORTH CENTRAL... 1,177 3 3 1 9 10 59
Ohio............... 244 1 6 5 29
Indiana............. 186 1 1 3 13
Illinois........... 270 2 1 1 1 7
Michigan......... 235 1 1 3
Wisconsin.......... 242 1 1 7

WEST NORTH CENTRAL... 511 1 2 4 3 14 169
Minneso ta.......... 42 3 42
Iowa............... 201 1 37
Missouri........... 8 1 2 2 2 6 41
North Dakota........ 100 2 33
South Dakota....... 49 1 -
Nebraska........... 94 1 8
Kansas............. 17 I- 1 8

SOUTH ATLANTIC....... 1,367 2 4 3 16 1 3 14 115
Delaware ........... 4 -
Maryland............ 585 4 2
Dist. of Columbia.. 9 -
Virginia............ 390 1 1 3 2 7 61
West Virginia...... 192 2 13
North Carolina..... 18 1 2 2 1 1 2
South Carolina..... 19 -
Georgia............. 19 1 3 4 1 8
Florida............. 131 3 4 29

EAST SOUTH CENTRAL... 1,792 2 4 2 9 1 14 293
Kentucky........... 88 1 1 6 133
Tennessee.......... 1,454 3 1 6 7 148
Alabama ............ 133 1 1 12
Mississippi........ 117 1 1 2 1

WEST SOUTH CENTRAL... 815 5 1 1 4 18 178
Arkansas........... 11 4 20
Louisiana.......... 4 1 2 23
Oklahoma........... 34 1 1 1 6 58
Texas............. 770 1 2 6 77

MOUNTAIN ............. 1,709 2 I 10
Montana............ 47
Idaho.... ........ 110 -
Wyoming.......... 158 1
Colorado............ 971 1 1
New Mexico......... 224 4
Arizona............ 110 5
Utah................ 89 -
Nevada...... .....- -

PACIFIC.............. 1,539 6 5 8 56
Washington......... 319 -
Oregon............. 220 -
California......... 907 6 5 8 56
Alaska............. 21 -
Hawaii ............ 72 -

Puerto Rico.......... 2 10

*Delayed reports: SST: Me. 9, Wyo. 73







Morbidity and Mortality Weekly Report






TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED MARCH 30. 1968


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

All Causes Pneumonia Under All Causes Pneumonia Under
A r e a a n d 1 y e a r A r e a e s d fe a r
Area All 65 years and year Area All 65 years and 1 year
Ages and over Influenza All Ages and ove 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.---------
ew York City, N. Y.--
Paterson, N. J.--------
Philadelphia, Pa.-----
Pittsburgh, Pa.-------
Reading, Pa.-----------
~tochester, N. Y.-------
Schenectady, N. Y.----
Scranton, Pa.---------
Syracuse, N. Y.-------
Trenton, N. J.---------
Utica, N. Y.-----------
Yonkers, N. Y.--------

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

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


749
245
36
29
35
64
27
17
28
64
64
11
42
35
52

3,236
48
31
151
51
32
32
60
64
1,587
39
595
180
33
98
30
38
57
45
29
36

2,628
86
37
741
195
224
103
88
363
59
58
31
49
43
145
35
122
46
22
46
79
56

790
64
18
30
131
26
111
85
224
57
44


482
142
20
19
28
38
19
24
24
44
38
9
34
20
33

1,914
28
19
87
24
19
23
37
31
938
23
342
118
20
67
17
26
27
22
20
26

1,538
47
17
413
124
106
61
59
197
45
38
16
27
26
103
19
76
33
15
28
51
37

492
41
14
16
85
18
66
57
130
35
30


35
13
2
1

2
1
1
1
8
4


3


133
3

4
5
2
2
3
2
62
3
27
3

7
1

6
2
1


147
8
3
39
12
22
5
3
19
1
3
3
1

9
1
3
4
3
4
1
3

37
4
1
4
6
2
4
1
8
4
3


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 Roge, 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.---------n
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 12,475 7,190 473 597

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 179,984
All Causes, Age 65 and over------------------- 107.018
Pneumonia and Influenza, All Ages------------- 9,409
All Causes, Under 1 Year of Age--------------- 7,877


Week No.
13


1,267
122
280
62
88
105
61
89
33
113
73
193
48

612
107
47
41
118
132
49
31
87

1,171
50
38
30
175
40
70
239
58
158
88
114
57
54

474
43
20
139
13
137
25
45
52

1,548
23
45
34
54
72
466
72
35
137
57
101
177
35
150
47
43









INTERNATIONAL NOTES
QUARANTINE MEASURES


.h/ditiona! Immuizaioai Information for Iliternationl
ITrarel. 9167-68 ediion'. Public HIealt h Scrrier
l'ublication |Ylo. 38S


The following information should be included in Section 5:

ASIA
Aden and Protectorate of South Arabia Page 51
Delete Adenl and Protectorate of South Arabia. Insert:
Southern Yemen formerlys Aden and Protectorate of South
Arabia). Note: Smallpox. cholera, and yellow fever immuni-
zation requirements remain the same.

Burma Page 52
I'nder Burnia in the column, Recommendations byI the Coun-
t '. delete the' information concerning y)llow fever. In the
column "Required" under yellow fe\er, after the words
infected areas, insert: certificatee required from travelers
(ho arrive within 9 days of departure from an endemic
zone or infected area.

Cyprus Page 54
Under smallpox add: except travelers arriving from an
European country that is free from smallpox.

Iraq Page 57
l'nder smallpox insert: Smallpox x vaccination required when
arriving from infected areas.



EUROPE
Belgium Page 65

Delete the note concerning smallpox and insert: Smallpox
vaccination is required from all arrivals. except arrivals
from European countries. Azores and Madeira, Canary
Islands. Reunion, Bermuda, Canada, French Guiana, Green-
land, Guadeloupe. Martinique, Netherlands Antilles. St.
Pierre and Miquelon, Surinam, and the United States of
America. This exemption is extended to travelers who
have been resident for more than 14 days in these countries
immediately before arrival in Belgium. The certificate
is, however, required from arrivals from all infected local
areas.

Greece Page 68
Delete the note concerning smallpox and insert: Smallpox
vaccination is required from all arrivals, except arrivals
from European countries, Cyprus, Turkey. Azores and
Madeira, Canary Islands, Reunion. Bermuda. Canada,
French Guiana, Greenland, Guadeloupe, Martinique, Nether-
lands Antilles, St. Pierre and Miquelon, Surinam, and the
United States of America. The certificate is, however,
required from arrivals from all infected local areas.


MARCH 30, 1968


THE g vR.,-. AND MORTALITY WEEKLY REPORT WITH A CIRCULAR'
TION I' :'S. IS T-.Ei. '."r. r T'HE NATIONAL COMMUNICABLE
DISEASE CENTER, A' L A ..*-.
DIRECTOR, NATIONAL COMMUNICABLE DISEASE '. T E
.a.,a *S L E M.IO.
CHIEF, i"**'*r. *' 'Ai .iGRAM L..DUNU' M.D.
ACTING :...~r "'T. T.'. T SECTION r.a L 'AR~-MAN M.S.
EDITOR MICHAEL 8. GREGG, MO.

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
,.*.C. i ,C 1 .,_. T v r, *E NATIONAL COMMU'-t. ABLE DIS" ASE
E ri L .* :, t .:*. .E ', INTERESTING OU' B-FT" i Qfn CI:
INVESTIGATIONS WHICH "0--, F .*.*" t'i i.' fiP I E.L T.
OFFICIALS AND WHICn .N" I**' .; i L I .L t fi.. t E CONTROL
OF COMMUNICABLE 0D*:c-.. r.*N. :0"" .' .*.' *. : N5 S..-OuEL BE
ADDRESSED TO:
NATIONAL .-*,M .*M ,: t DISEASE CENTER
ATLANTA, :*, ."*' ,:,
ATTN: THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT

NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO THE NCOC BI ITe INIMI nDU L
STATE HEALTH DEPARTMENTS THE Ar Fr T i*.; *Ei. CONCLuDEL
ON SATURDAY; COMPILED DATA ON A-' I..r:L IASa. ARE ELESEu
ON THE SUCCEEDING FRIDAY






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