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:
AA00010654:00152

Related Items

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

Full Text
T/NAIONL COMMUNICABLE DISEASE CENTER


HEALTH, EDUCATION, AND WELFARE


Vol. 17, No. 16


WEEKLY

REPORT


Week Ending

= April 20, 1968




PUBLIC HEALTH SERVICE


BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


SURVEILLANCE SUMMARY
FOODBORNE DISEASE OUTBREAKS-1966 and 1967

In 1966,25 states and in 1967, 37 states reported out-
breaks of foodborne diseases to NCDC. These surveillance
data have been compiled in an effort to characterize and
to quantitate diseases caused by foodborne outbreaks, to
study the types of vehicles and sources of contamination
particularly when interstate products are involved, and to
sugget possible control measures.
Although the data collected in 1966 and 1967 did not
include every foodborne outbreak in the United States,
various trends and the predominance of certain etiologic
agents became apparent. The total number of people af-
-fected in the 273 reported foodborne outbreaks in 1967


CONTENTS
Surveillance Summary
Foodborne Disease Outbreaks-1966 and 1967. 137
Epidemiologic Notes and Reports
Bovine Cysticercosis-Texas. . ... 140
International Notes
Follow-up Malaria Ceylon . ...... 141
Quarantine Measures . .. ........ .. 148


were 22,171 (Table 1). There were 15 associated deaths
and 118 secondary cases. The etiology was confirmed in
160 of the 273 outbreaks (Table 2). Salmonella was the
cause of most illness and accounted for 12,836 cases in
35 outbreaks. Beef, turkey, eggs and egg products, and
(Continued on page 138)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
16th WEEK ENDEDMEDIAN CUMULATIVE, FIRST 16 WEEKS
DISEASE April 20, April 22, 1963 1967 MEDIAN
1968 1967 1968 1967 1963 1967
Aseptic meningitis ...................... 27 40 20 454 463 445
Brucellosis ............................ 6 3 7 38 60 67
Diphtheria.............................. 2 2 47 35 65
Encephalitis, primary:
Arthropod-borne & unspecified ........... 12 25 238 381 -
Encephalitis, post-infectious ............. 14 20 -- 142 243 -
Hepatitis, serum ......................... 73 36 1,176 604
Hepatitis, infectious ..................... 798 799 6 13.332 12,690 13
Malaria ............................... 38 37 2 702 619 34
Measles rubeolaa) ......................; 816 2,084 11.832 10,668 37,359 151.426
Meningococcal infections, total ........... 54 58 67 1,204 950 1,048
Civilian ................................ 50 57 1,089 877 -
Military ................... ...... ..... 4'4 1 115 73 -
Mumps ................................. 4,323 -- 80,476 -
Poliomyelitis, total ................... .. 1 1 14 5 7
Paralytic ............................. 1 1 14 5 6
Rubella (German measles) ............... 1,915 1,900 21,232 19,025
Streptococcal sore throat & scarlet fever.... 11.215 10,690 10,452 181,048 194.243 177,503
Tetanus ............................... 3 5 5 34 51 55
Tularemia............................... 1 2 2 20 41 58
Typhoid fever .......................... 9 8 7 75 101 101
Typhus, tick-borne (Rky. Mt. spotted fever) 2 6 10 7
Rabies in animals ....................... 87 112 112 1.201 1.413 1.404

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........................................... 1 Rabies in m an: ......................................
Botulism: .......................................... Rubella, Congenital Syndrome: .......................... 3
Leptospirosis: Fla.-2 ................................ 8 Trichinosis: Calif.-l, Ohio-4 ................... ........ 17
Plague:............................................ Typhus, marine: ........... ...................... 3
Psittacosis: N.Y. Upstate-7 .......................... 19















[. I I. .


Bacterial
S. typhosa
Other salmonella
li --ll i
C. perfringens
C. botu!ineum
Staphylococcus

E. coli
Brucella
Other bacterial
Parasitic
Trichinella spiralis
Other parasites
Viral Viral hepatitis
Chemical
Unknown**


Morbidity and Mortality Weekly Report


FOODBORNE DISEASE OUTBREAKS (Continued from front page)

Table I
Etiology of Foodborne Illnesses Reported to NCDC
1966 and 1967


1966


Outbreaks*
Number Percent

67 37.0
1 0.6
22 12.2
3 1.7
h 4.4
i 2.2
26 14.4




3 1.7
4 2.2
4 2.2


Cases
Number Percent

4,067 51.1
7 0.1
1,285 16.1
76 1.0
I 14. 16.9
10 0.1
860 10.8




483 6.1
7 0.1
7 0.1



159 2.0
3,727 46.8


*1


APRIL 20. 1968


1967


Outbreaks*
Number Percent


2 0.7
20 7.3

14.0
37 13.6
1 0.4


Cases
Number Percent

17,056 76.9
51 0.2
12,494 56.4
547 2.5
2,529 11.4
5 0.0
1,339 6.0

70 0.3
21 0.1


47
42
5
196
10
*I -1.'


0.2
0.2
0.0
0.9
0.0
22.0


Total 181 100.0 7,960 100.0 273 100.0 22,171 100.0
*Etiology proven or suspected on epidemiologic and or clinical grounds.
**Includes all outbreaks in which no etiology was established or suggested.
All percentages less than 0.05 are represented as 0.0.
Table 2
Etiology of Confirmed and Unconfirmed Outbreaks and Cases of Foodborne Illness, 1967

Outbreaks Cases
Etiology Confirmed Unconfirmed Total Confirmed Unconfirmed Total
Number Percent Number P,.r. l u r P.r. .- i.unlr Pr Nu -r P. re o.w.i Nurl..-r P.-r. nt Nunhi-r Peri rn

Bacterial 111 40.7 54 I:' It.. I.n l i;~, ** '.2 7 1 I'i n .l t:.1
S. typhosa 3 1.1 2 u.7 i l.a jl U.2 3 u.u 54 u.2
Other salmonella 27 9.9 8 2.9 35 12.8 12,494 56.4 342 1.5 1-'.s th 57.9
-hi il. 6 2.2 1 0.4 7 2.6 547 2.5 40 0.2 587 2.6
C. perfringens 19 7.0 10 3.7 29 10.6 -' :..1 11.4 964 4.3 3,493 15.8
C. botulinum 2 0.7 1 0.4 3 1.1 5 0.0 1 0.0 6 0.0
*Fuph. I, ..... ,j- 32 11.7 23 8.4 55 20.1 1,339 6.0 575 2.6 1,914 8.6
Enrorop irhoa, rnir
E. coli 2 0.7 2. 0.7 4 1.5 70 0.3 49 0.2 119 0.5
Brucella 20 7.3 2 0.7 22 8.1 21 0.1 2 0.0 23 0.1
Streptococcus 5 1.8 5 1.8 51 0.2 51 0.2
Parasitic 38 14.0 5 1.8 43 15.8 47 0.2 5 0.0 52 0.2
Trichinella
spiralis 7: 13.6 5 1.8 42 15.4 42 0.2 5 0.0 47 0.2
Other parasites 1 0.4 1 0.4 5 0.0 5 0.0
Viral-
Viral hepatitis 9 3.3 9 3.3 196 0.9 196 0.9
Chemical 2 0.7 4 1.5 6 2.2 10 0.0 22 0.1 32 0.1
Miscellaneous 8 2.9 8 2.9 928 4.2 928 4.2
Unknown 42 15.4 42 15.4 1,880 8.5 1,880 8.5

Total 160 58.6 113 41.4 273 100.0 17,309 78.1 4,862 21.9 22,171 100.0

IHepatitis cases only confirmed clinically.









milk were the vehicles most frequently responsible for
salmonella outbreaks (Table 3). Clostridium perfringens
caused illness in 3,493 people in 29 outbreaks. Beef was
the most common vehicle in outbreaks caused by this
organism. Staphylococcal food poisoning accounted for
illness in 1,914 persons in 55 outbreaks in which beef,


pork, fish, and vegetables were the most common vehicles.
When the data were studied to determine the locations
of outbreaks, it was found that the largest number of out-
breaks, 94, occurred at home, but the number of people
involved were only 323 (Table 4). In contrast, outbreaks
(Continued on page 140)


Table 3
Vehicles Associated with Foodborne Illness by Etiology, 1967
(Confirmed Outbreaks/Unconfirmed Outbreaks)
Vehicle
Etiology Other Vege- Shell- Other
Turkey Chicken Egg Milk Beef Pork their Vege- Fruit Shell- OtherWater Other Unknown
g T meat table fish fish
S. typhosa 1/2 2


Other salmonella
Shigella
C. perfringens
C. botulinum
Staphylococcus 1
Enteropathogenic
E. coli
Brucella
Streptococcus
Trichinella
spiralis
Other parasites
Viral hepatitis
Chemical
SMiscellaneous
Unknown


3/3*


1/0 2/1 2/1 4/1* 1/1 0/1* 0/2


1/0* 3/0*


9/5* 0/1 2/0*


1/1
3/1* 1/0 1/1 4/1 9/0 6/1 4/0 6/0


0/1 2/0

1/0
1/0
4/0 5/0


0/1
0/2 1/1
2/0


7/2 6


0/16


0/2 0/40


0/1


1/0
0/6* 0/1


0/4


1/0 1/4 0/1 1
1/3 2
1/0 0/4 1
0/3 0/1 0/1 0/7 14


Total 8/8 5/2 3/2 6/18 23/14 7/44 6/10 8/5 1/1 5/4 10/1 6/10 11'19 44
1Five outbreaks with two vehicles; one outbreak with three vehicles.
2One outbreak with two vehicles.
*Includes some outbreaks due to meat and/or gravy and/or dressing.

Table 4
Place of Acquisition of all Foodborne Illness by Etiology, 1967

Place of Acquisition
Etiology Medical
Home Restaurant Banquet School Store tittin Other Unknown Total
Institution
S. typhosa 3 1 1 5
Other Salmonella 10 9 5 6 1 4 35
Shigella 1 2 1 3 7
C. perfringens 1 9 10 6 2 1 29
C. botulinum 3 3
Staphylococcus 10 23 2 6 6 1 6 1 55
Enteropathogenic E. coli 2 2 4
Brucella 15 7 22
Streptococcus 1 1 1 1 1 5
Trichinella spiralis 31 10 1 42
Other parasites 1 1
Viral hepatitis 5 3 1 9
Chemical 3 3 6
Miscellaneous 5 1 1 1 8
Unknown 5 10 6 12 3 1 2 3 42

Total outbreaks 94 69 25 35 10 5 29 6 273
Number of Persons Ill 323 1,386 11,373 4,129 282 335 4,026 317 22,171


APRIL 20, 1968


Morbidity and Mortality Weekly Report






I o)


follow ing banquets accounted for more than 50 percent of
all reported illness with 11,373 people affected in 25 out-
break-. In 35 outbreaks 4.129 persons became ill after
ingesting contaminated food served in schools. Food served
at restaurants \as responsible for 69 outbreaks in which
1,3h6 persons became ill.


APRIL 20, 1968


More outbreaks occurred in the last 6 months of the
year than in the first 6 months (Table 5).

(Reported by Enteric Diseases Unit, Bacterial Diseases
Section, and Statistics Section. Epidemiology Program,


Table 5
Monthly Incidence of Outbreaks of Foodborne Illness by Etiology, 1967


Etiology

S. typhosa
Other salmonella
-1i, e 1i ,
C. perfringens
C. botulinum
Staphylococcus
..... 't ....- E coli
Brucella
Streptococcus
Trichinella spiralis
Other parasites
Viral hepatitis
Chemical
Miscellaneous
Unknown

Total Outbreaks


Month


Jan. Feb.

1
2 1


Mar. Apr. May June July


1
4 1


5 2
1


3 1 5 5


2
1
4 3


1
4 4 5

1 2


4 7 3 3 5 6


Aug. Sept. Oct.


5 6 3
1 3
2 1 2
1
7 5 5
9


Nov. Dec. Unknown Total


4 2
1
8 S


3 1
2 2 1


5
35
1 7
2 29
3
55
4
1 22
1 5
42
1
9
6
8


1 5 3 3 4 5 4 3 3 3 6 2 42

19 18 19 21 22 21 24 26 26 29 29 14 5 273


EPIDEMIOLOGIC NOTES AND REPORTS
BOVINE CYSTICERCOSIS Texas


\n epizootic of bovine cysticercosis has been reported
from northern Texas. During the period from March 15 to
April 1, 1965, 771 cattle from two large commercial feedlots
were slaughtered in packing plants under the United States
Department of Agriculture Inspection Program; 346 cattle
(45 1" r., i were found to be infected with Cysticercus
boris. Infected cattle are known to have beer shipped
plants in Oklahoma, Nebraska. Colorado. Missouri, Kansas,
Iowa. Texas. and Florida.
The following notice appeared in the Federal Register
Vol. 33, No. 71, April 11, 1968:
.Notice is hereby given that the contagious.
infectious, and communicable disease of
livestock known as cysticercosis exists in
cattle on the premises specified below. Ac-
.rlrn l..,, such premises are hereby quaran-
tined because of said disease, and the inter-
state movement of cattle from such premises
is prohibited except as provided in this part:
a) Dean Cluck Feedlot, (,r,,. r Texas, known
and described as the north 200 acres of the
west half of Sec. 12 of Block 3 B, GHNH, in
Sherman County, Texas.


b) Hereford Cattle Feeders, Inc., Hereford,
Texas, known as and described as a premise
of 524.04 acres out of the north part of Sec.
27, Block K-4, Certificate No..' 1I. in Deaf
Smith County, Texas.
An investigation is now in progress to determine the
mode of spread of this zoonosis and the extent of the
movement of infected cattle into retail channels.

(Reported by J.S. Stein, Director, Livestock Slaughter
Inspection Division, U.S.D.A.; Dr. George Martin, Staff
Officerin i" ''. .* Branch, LivestockSlaughter Inspection
Division, U.S.D.A.: Dr. A.B. Rich, ': .. '. Division of
Veterinary Public Health, Texas State Department of
Health; and a team from NCDC,)


Editorial Note
Cysticercus bovis is the intermediary stage of the
beef tapeworm of man, Taenia saginata. In the United
States, the majority of bovine cysticercosis exists on the
West Coast. In 1967, 14 Il,, cattle (0.05 percent of the
cattle slaughtered in the United States in 1967) were found
to be infected at postmortem inspection, and l1i.455 of


Morbidity and Mortality Weekly Report


FOODBORNE DISEASE OUTBREAKS (Continued from page 139)






Morbidity and Mortality


these cattle were from feedlots in California (Table 6).
The present epizootic is unusual because of its high
infection rates and its location in Texas.
Man acquires Taenia saginata by eating inadequately
cooked "measly" beef (beef infected with cysticercosis).
Infection is subsequently spread to cattle by human indis-
criminate defecation in cattle pastures and feed pens or
through the distribution of sewage and septic tank effluent
onto pastures where cattle graze.
The treatment for Taenia saginata is Quinacrine or
Niclosamide1.

'Available through Parasitic Disease Drug Service. NCDC.)


APRIL 20, 1968


State Cases

Arizona 303
California 10,455
Colorado 334
Texas 777
All other states 2,538

Total United States 14,407
*Source: Livestock Slaughter Inspection Division, U.S.D.A.


INTERNATIONAL NOTES
FOLLOW-UP MALARIA Ceylon


The conditions contributing to the recent outbreak of
malaria in Ceylon (MMWR, Vol. 17, No. 11) and the geo-
graphic spread of the epidemic have been further inves-
tigated. Annual case records of Plasmodium vivax, the
species responsible for the epidemic, show that P. vivax
was effectively controlled during the eradication efforts
of the'Anti-Malaria Campaign (AMC) which began in 1958.
By 1963, P. vivax had virtually disappeared from Ceylon
with only eight cases occurring in 1963. During a period
of 35 months, January 1963 through December 1965, no
indigenous cases of P. vivax malaria were detected in
Ceylon, and all but one of the 40 cases in these 3 years
were investigated and classified as imported. In 1966 and
1967 the incidence of P. falciparum and P. malariae re-
mained constant, while the number of P. vivax cases pro-
gressively increased. This increase was small during 1966
when the total for the year reached six cases with no more
than two cases reported in any one quarter. During 1967,
however, the number of indigenous cases began to increase
rapidly (22 cases in the first quarter, 92 in the second
quarter, 686 in the third, and 2,217 in the fourth quarter
of 1967). The total of 3,017 confirmed cases of indigenous
P. vivax infections far exceeded the annual totals in the
decade before (1958 with 781 cases, 1959 with 1,126 cases,
and 1960 with 376 cases). In January 1968, P. vivax cases
reached 16,851 and in February increased to 42,056 cases.
The number of slides collected and P. vivax cases from
1958 to 1968 are graphically illustrated in Figure 1.
Records of investigations of the early P. vivax cases
were reviewed. The first indigenous case of P. vivax
discovered in Ceylon in 35 months was reported by a
passive case detection post (PCD) of the AMC in the
Kurunegala Division of Ceylon (Figure 2). No secondary
cases were discovered despite prompt widespread inves-
tigation and follow-up which included five serial mass
blood films were taken. In January 1966, in this same
division, two more indigenous cases of P. vivax malaria
were found in one village through active case detection
(ACD) canvassing of the AMC. No evidence was found to
relate the late 1965 case and the two January 1966 cases.
Later in 1966, four new cases of indigenous P. vivax were
discovered thatwere related to the two January 1966 cases.


Figure 1
NUMBER OF SLIDES COLLECTED AND P. VIVAX CASES
PER MONTH, CEYLON, JANUARY 1958-FEBRUARY 1968
1,000.000
soawo











a I
10,000



1,000



a\\ i


\ I

0 I
\, -o


S-.. --- P CSES




1958 1 9S I 1960 I 1961 I 1962 i 1963[ 1964 1 1965 6 1966 7 1967 1968
YEAR

In 1967, indigenous P. vivax spread in the AMC
central region, where malaria remained confined for the
first 9 months of the year. In October, P. vivax malaria
was reported from the Elahera gemming area of the Matale
Division, an area visited by transient gem miners from all
parts of Ceylon. Many gem miners became infected and
apparently spread P. vivax to other regions of Ceylon.
Figure 3 shows the divisions reporting indigenous P. vivax
malaria by quarter from 1966 through February 1968. It also
illustrates thatthe outbreak was localized in one division.
Kurunegala, until it reached the gem mining area in Matale,
and then spread throughout Ceylon.
(Continued on page 14iR)


Weekly Report 141


Table 6
Numbers of Beef Carcasses Infected With Cysticercus bovis,
United States, 1967*











Figure 2
CEYLON SUPERINTENDENT HEALTH SERVICES (SHS)
DIVISIONS AND ANTI-MALARIA CAMPAIGN (AMC) REGIONS


Attempts have been made to explain the reappearance
of indigenous P. ,ivaxr malaria in epidemic form after a
35-month absence from Ceylon. A review of the prompt
and thorough case investigations of the original P. ivarx
cases in the Kurunegala Division provided no evidence
Ihat these cases were imported. This led to examination
of the AMC surveillance system to ascertain whether or
not P. ',irax transmission could have persisted from 1963
to 1967 at a low. undetected level.
In 1967, 1,453,984 blood slides were examined. This
is an Annual Blood Examination Rate (ABER) of 19 percent
for the population of the malarious area of the country.


APRIL 20, 1968


' ."
Rf --* .


Table 7
Available Vector Density Data (A. culicifacies Females), 1964-1966

July-October. 1964 July-October. 1965 July-October, 1966
Anti-Malaria Fr I ......l I 1 (ricifacies Females per A. culicifacies Females per A. culicifacies Females per
Campaign Region Stations Females* Ent. Station Females* Ent. Station Females* Ent. Station

Northern 16 76 4.75 311 19.44 574 35.88
Central 16 38 2.38 1,444 90.25 .140 146.25
Eastern 8 0 0.00 0 0.00 24 3.00
Southern 1 1 0.13 30 3.75 132 16.50

Total It8 115 2.40 1,785 37.19 3,070 63.96
"Numerrr: r prf snt totil t. culti cacifio f cmlt~ timn.nthly knockdown siray c to h.: .


Morbidity and Mortality Weekly Report


FOLLOW UP MALARIA (Continued from page 14I)


This is an impressive effort. The ABER for the endemic
area, however, was 39 percent, while the epidemic area
had an ABER of only 6 percent-largely consisting of
slides collected by PCD. The efficiency of the ACD net-
work in detecting all positi e cases also may be questioned,
because a very large number of cases were found by mass
blood surveys. For example, during 1967, 19 percent of
total blood slides came from ACD and yielded 4 percent
of positive cases; 62 percent of the total slides came from
PCD and yielded 51 percent of positive cases, while mass
blood survey slides accounted for the remaining 19 percent
of slides and 45 percent of positive cases. In addition a
random check of age and sex distribution of 480 ACD
slides collected in the Kurunegala Division (the original
focus of the P. cirax epidemic) revealed that only 4.2
percent of the slides were taken from males older than 15
years. In contrast 41.5 percent of indigenous P. vivax
cases occurred in males older than 15 years. This fact is
probably due to occupational hazards. Adult males fre-
quently sleep in field huts while performing chena iljundl
"strip and burn") cultivation. These adult males are at
special risk of contracting malaria since h'., sleep either
out-of-doors or under one-walled temporary structures,
difficult to find or spray. Because the men are frequently
away from their villages during visits of surveillance
agents, the group at highest risk has the fewest number of
blood films taken.
Background information supplied about the malaria
vector, Anopheles culicifacies, indicates that the weather
conditions in 1966 and 1967 were conducive to the trans-
mission of malaria. Reportedly, 1966 and 1967 were years
of abnormally light rainfall, particularly in the dry zone
(Figure 2) where the October to January monsoon did not
occur in many areas, and such periods of drought have
traditionally increased the vector population. After DDT
spraying was withdrawn from most of the country in April
1963 and from the remainder of the country in April 1964,
vector density was expected to increase. The increase
occurred and was particularly apparent in the Central
Division where the current epidemic started (Table 7).
In summary, the reasons for the current epidemic seem
to be (1) an increase in the mosquito vector after DDT
spraying was withdrawn in 1963 and 1964, (2) an increase


n -tON.


ON-AIAHIit5OU






APRIL 20, 1968


1st Quarter


Morbidity and Mortality Weekly Report



Figure 3
SHS DIVISIONS REPORTING INDIGENOUS P. VIVAX
CASES BY QUARTER, 1966-1968


1966


2nd Quarter


2nd Quarter


1st Quarter


3rd Quarter




2
s




7











3rd Quarter


14 10 14 10
y-/ l3


1968
1st Quarter


SHS DIVISION KEY
1. Jaffna 9. Matara
2. Vavuniya 10. Rotnopura
3. Anuradhapura 11. Kandy
4. Matale 12. Kegalla
5. Batticaloa 13. Galle
6. Badulla 14. Kalutara
7. Kurunegala 15. Colombo
8. Puttalam


in the mosquito vector due to light rainfall in 1966 and
1967, and (3) a small reservoir of undetected cases of
malaria in 1963-1965, primarily in the 15 years or older
male working population. The geographic spread of the


epidemic was from Kurunegala to the gem mining area of
Matale and then throughout the rest of Ceylon.
(Reported by the Department of Health Services, Colombo,
Ceylon, and the Malaria Eradication Program. NCDC.)


4th Quarter


13 g^
''^ l "


4th Quarter






141 Morbidity and Mortality Weekly Report


ABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

APRIL 20, 1968 AND APRIL 22, 1967 (16th WEEK)


ENCEPHALITIS HEPATITIS
ASEPTIC: Primary
RYA MNINGI 1TIS including Infectious Serum Infectious MALARIA
unSp. cases
19 68 IY 1968 1968 .- i 1^; 1P
UNITED STATES... 27 40 6 2 I '- j

NEW ENGLAND .......... 1 3 5 46 34 2
Maine .............. 1
New Hampshire...... 1 3
Vermont ............ 2 1
Massachusetts....... 1 21 13
Rhode Island....... 1 1 2 2 2 -
Connecticut........ 1 3 19 15 2

MIDDLE ATLANTIC...... 3 4 6 6 1 13 153 133 4
New York City ... 4 3 6 44 35 2
New York, op-State* 1 1 1 3 35 31 -
New Jersey......... 2 3 1 -2 2 3 24 28 2
Pennsylvania ...... I 1 50 39 -

EAST NORTH CENTRAL... 3 6 3 5 2 4 119 136 2
Ohio................ 2 1 1 3 1 50 28
Indiana.. ......... 3 1 -- 13 13
Illinois ........... 1 33 50 -
Michigan.......... 1 2 1 1 3 16 35 2
Wisconsin.......... 7 10 -

WEST NORTH CENTRAL... I 3 33 48 1
Minnesota.......... -- 2 11 7
Iowa...... ...... 1 4 5
Missouri........... 11 31
North Dakota.......
South Dakota ...... .
Nebraska........... 2 1
Kansas............. 7 3

SOUTH ATLANTIC....... 3 2 2 1 1 2 1 59 83 14
Delaware........... 3 3
Maryland........... 1 2 1 16 17 1
Dist. of Columbia.. 2 -
Virginia........... 2 -- 9 25 1
West Virginia...... 2 10
North Carolina..... 1 1 10 5
South Carolina..... 1 2 -
Georgia............ 16 9 6
Florida............. 1 1 2 9 7 1

EAST SOUTH CENTRAL... 5 6 2 1 60 66
Kentucky ........... 2 31 26
Tennessee.......... 2 3 2 1 16 17
Alabama............ I 1 5 13
Mississippi........ 2 8 10

WEST SOUTH CENTRAL... 4 1 1 1 1 4 1 1 101 102 1
Arkansas ........... 3 7
Louisiana.......... I 1 4 1 1 18 6 -
Oklahoma...........1 1 21 12
Texas.............. 3 1 59 77

MOUNTAIN ............ 1 1 40 27 3
Montana............ 1 2 1
Idaho.............. -- -3
Wyoming............. -
Colorado........... 1 14 4 2
New Mexico......... 2 13 1
Arizona............ 9 7
Utah............... 10 2
Nevada ............ -

PACIFIC.............. 9 21 1 3 5 47 187 170 1II
Washington......... 1 2 1 1 22 16 1
Oregon ............. 20 17 2
California......... 8 19 3 4 46 145 135 8
Alaska............. 2 -
Hawaii............. -- -

Puerto Rico ......... 17 20

*Delayed reports: Aseptic meningitis: Okla. 1
Encephalitis, primary: Okla. 1 case 1967
Hepatitis, infectious: N.Y. Upstate 14 cases 1967, 1 case 1968, Okla. 5
Malaria: Okla. 1





Morbidity and Mortality Weekly Report 145



TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

APRIL 20, 1968 AND APRIL 22, 1967 (16th WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, fMUPS POLIOMYELITIS RUBELLA
TOTAL
AREA Cumulative Cumulative Total Paralytic
C__ um.
1968 1968 1967 1968 1968 1967 1968 1968 1968 1968 1968


UNITED STATES... 816 10,668 37,359 54 1,204 950 4,323 14 1,915

NEW ENGLAND.......... 29 474 408 60 37 425 459
Maine.............. 13 88 4 2 18 24
New Hampshire...... 56 69 6 1 1 7
Vermont............ 1 21 1 26
Massachusetts...... 11 218 159 28 17 207 89
Rhode Island....... 1 27 4 1 67 160
Connecticut........ 18 185 44 17 16 106 179

MIDDLE ATLANTIC...... 162 1,567 1,209 14 193 137 284 277
New York City...... 71 450 200 3 35 21 154 139
New York, Up-State. 72 754 286 5 35 34 NN 67
New Jersey*........ 13 267 287 4 70 55 130 64
Pennsylvania....... 6 96 436 2 53 27 NN 7

EAST NORTH CENTRAL... 165 2,387 2,908 2 129 102 1,570 406
Ohio ............... 4 189 490 1 34 40 229 135
Indiana............. 56 413 341 1 18 14 142 10
Illinois ........... 60 963 461 30 19 277 113
Michigan........... 4 146 607 35 21 464 59
Wisconsin.."....... 41 676 1,009 12 8 458 89

WEST NORTH CENTRAL... 14 227 1,670 2 51 41 438 80
Minnesota.......... 1 7 84 1 14 9 25 -
Iowa* ............. 1 41 388 1 4 9 271 41
Missouri........... 3 63 117 10 9 5 1
North Dakota....... 8 77 626 2 92 17
South Dakota....... 4 42 4 5 NN -
Nbraska........... 27 413 4 7 11 1
Kansas............. 1 8 NN 13 2 34 20

SOUTH ATLANTIC....... 21 884 4,285 12 268 186 171 162
Delaware........... 7 27 3 5 13 2
Maryland............ 1 51 75 16 23 21 8
Dist. of Columbia.. 1 6 11 9 3 2
Virginia........... 1 161 1,346 19 15 22 12
West Virginia*..... 8 149 748 6 16 75 59
North Carolina..... 220 728 57 38 NN -
South Carolina..... 2 18 278 1 47 15 4 13
Georgia............ 3 23 47 33 -
Florida............. 8 269 1,049 11 64 38 36 66

EAST SOUTH CENTRAL... 43 351 3,754 1 100 91 215 99
Kentucky.......... 1 98 1,026 40 26 47 24
Tennessee.......... 2 45 1,263 1 30 39 156 65
Alabama............ 38 109 884 14 16 6 10
Mississippi........ 2 99 581 16 10 6 -

WEST SOUTH CENTRAL... 263 2,757 13,157 11 235 150 495 6 135
Arkansas............ 1,323 13 16
Louisiana.......... 3 85 6 62 59 -
Oklahoma............ 1 100 3,232 2 44 8 3 -
Texas............... 262 2,654 8,517 3 116 67 492 6 135

MOUNTAIN............. 23 491 2,713 1 15 19 177 40
Montana............ 63 184 1 2 9 -- 3
Idaho............. .. 11 295 3 1 6 3
Wyoming............ 2 42 20 -
Colorado............ 18 211 703 7 10 81 22
New Mexico.......... 3 48 414 3 6 -
Arizona............ 108 628 1 2 56 12
Utah............... 3 234 1 18
Nevada............. 5 235 2 2

PACIFIC.............. 96 1,530 7,255 11 153 187 548 8 257
Washington........ 29 381 3,516 1 25 20 182 55
Oregon*........... 17 321 916 14 14 2 27
California.......... 49 800 2,650 10 105 144 342 8 169
Alaska.............. 96 8 2 -
Hawaii.............. 1 28 77 9 1 20 6


Puerto Rico........... 14 209 1,249 15 7 38 1


*Delayed reports: Measles: Me. 2, N.J. 29, Ill. delete 38, Iowa delete 16, W.Va. delete 8, Okla. 16, Ore. delete 13
Meningococcal infections: Okla. 1
Mumps: Me. 8, Okla. 2
Poliomyelitis, paralytic: Okla. 1 case 1967
Rubella: Me.2, Ill. 38, W.Va. 8, Ore. 13







116 Morbiditv and Mortality Weekly Report



ABII1 III (CASIS OF SPECIFIED NOTIFIABLE DISEASES: [ NITEI) STATlS

FOR WEEKS ENDED

APRIL 20, 1968 AND APRIL 22. 197 (16th WEEK) CONTINUED


STREPIOCO AL TYPHUS FEVER
S)RE TLOAlT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
AREA SCARLET FEVER (Rky. Mt. Spotted) ANIMALS

,r, ,rI" r~ I 4 I ,: [ *, H e r" I* o I0t 15
NITED TATES... 11,215 3 34 1 20 9 75 2 6 87 1,201

EW ENGLAND........... 1,536 2 46
Main *............. 22 44
Nw mpshire...... 1 2
Verm t. ........... 24
Hass a house t ...... 303 -
Rhod I land ....... 169
Conn. ticut........ 1,017 -

MIDDLE ATLANTIC .... 749 6 2 9 1 11
New York City...... 27 3 1
New York, Up-State. 689 3 1 1 7
New Jersey ........ NN -
Pennsylvania....... 33 1 2 4

EA T NORTH CENTRAL... 1,416 3 4 1 10 19 83
OhiN ............. 37 1 1 7 15 44
Indi ............ 2- 1 2 19
Iri .. i ....... .....416 2 1 1 8
M.i..i..a................ 269. 1 1 1 4
i n i ....... 12 I 8

EST "'ORT I CENTRAL ... 1,445 2 1 5 4 23 268
Mi.inn a......... 47 13 67
Iow. .............. I1,120 3 46
Mi, u i ........... 13 2 1 3 3 2 46
Nh' r nk tt a....... 94 5 51
S D.k ........ 1 1 34
Ncb(.i3k.......... .6 11
,n: ....... 7 1 13

SO'TH ATLANTIr ....... 984 3 7 4 2 20 2 5 7 141
D1 ) i lr ............ -
Maryland........... 4 2
DisL. of C lumbia.. I 1 1 -
Virini a.......... 26 1 2 1 3 2 4 2 71
rWst Virginia...... 248 18
North tro ina..... 6 2 2 2 4
S uth CIar Iina..... 54
c, re ............. 28 1 1 7 2 12
Flirid............ 142 2 2 3 3 34

EA T iOTH CENTRAL... 1,408 4 4 11 1 16 343
K n ......... .. 56 1 1 1 6 156
Tinnc, ec. .......... 1,181 3 7 9 172
Alia ba ........... 103 1 I 1 15
Mii, ppi........ 68 2 3 1

WE T SO0 H CENTRAL... 811 5 1 3 7 13 222
Ark. ............... 13 27
Sina.......... 4 1 1 25
Ok .ho ........ 27 1 1 5 71
:x.s............ 771 1 5 7 99

MUNTAIN.............. 1,513 2 1 6 4 20
i .................... 50
Idh. b .. ........... 127
Wy ming.g?............ 68 1 1 1
Coloirado........... 819 1 2 1
New Meico......... 192 3 4 10
Arizona ............ 68 8
Utah ............... 189 1
Nevada ... ........ -

PACIFIC.............. 1,353 7 6 4 67
Washngton ......... 425 -
Oregon......... .... 178 -
California ......... 678 7 6 4 67
Alaska............. 17 -
Hawaii............. 55

Puerto Rico.......... 5 1 11

*Delay(d reports: SST: Me. 6, Kans. 1, Okla. 4, Wyo. 142, Utah 48 cases 1967






Morbidity and Mortality Weekly Report






TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED APRIL 20, 1968

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


All Causes Pneumonia Under All Causes Pneumonia Under

Area All 65 ears and 1 year Area All 65 years fand year
Influenza All Influenza All
Ages and over I Ages and over
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.-------
SReading, Pa.-----------
Rochester, N. Y.------
Schenectady, N. Y.----
Scranton, Pa.---------
Syracuse, N. Y.-------
Trenton, N. J.--------
Utica, N. Y.-----------
Yonkers, N. Y.--------

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

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


692
215
53
13
23
58
28
15
17
60
76
7
31
35
61

3,504
48
39
132
57
33
59
54
103
1,689
35
573
268
59
122
10
36
64
52
30
41

2,534
69
33
677
176
206
116
88
331
45
52
58
44
52
148
36
123
25
25
34
112
84

926
52
23
44
149
29
128
85
271
90
55


426
127
38
12
15
29
17
12
14
30
44
5
17
20
46

2,035
30
19
75
35
14
35
35
53
966
22
327
159
40
78
7
24
43
26
21
26

1,407
44
20
359
101
111
63
47
175
31
21
36
21
35
83
13
72
14
18
23
74
46

555
33
19
25
88
22
79
50
154
57
28


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.----------


1,191
151
271
49
56
107
45
71
36
96
80
176
53

699
94
67
56
127
177
57
24
97

1,128
33
48
27
155
37
84
193
58
179
93
134
36
51

442
33
36
121
23
103
30
47
49

1,619
19
53
25
54
99
486
69
28
120
59
91
183
35
162
73
63


613
53
133
24
36
60
18
39
18
76
45
82
29

389
51
38
39
76
85
29
15
56

602
21
24
13
75
22
46
85
34
92
53
79
19
39

268
20
25
69
15
58
23
25
33

951
15
31
20
25
60
304
36
19
62
32
52
95
21
88
46
45


Total 12,735 7,246 419 605


Cumulative Totals
including reported corrections for


previous weeks


All Causes, All Ages ------------------------ 217,081
All Causes, Age 65 and over------------------- 128,257
Pneumonia and Influenza, All Ages------------- 10,749
All Causes, Under 1 Year of Age--------------- 9,535


Week No.
16










INTERNATIONAL NOTES
OUARANTINE MEASURES


A *t.i ; J.icyit a mw ,;*hii. ri I fot fn /r Ill h i'ioti t
Tr ii. 1? I9 67 6" / itioii. Public Healt1 Ser Iic e
P l>licrcifin ,Vw. 384


The follow ing information should be included in Section o5:


AFRICA
Sao Tome and Principe Page 33
De lete all information concerning yellow feser.
Insert: Yellio fe\er vaccination Is required of all arrivals.*


ASIA
Saudi Arabia Page 61
Delete previous information concerning cholera.
Insert: (During t he period from \arch i9 to October 15, 196h),
cholera vaccination is required of all arrivals froin infected
local areas and frorn countries any parts of which are
infected. The certificate must shoow two injections at not
less than 7 davs and not more than 30 days interval. For
resaccination carried out within 6 months of a recorded
vaccination or reacecination, a single injection renders
the certificate salidfor a additional 6 months. In addition.
arrivals from these countries are required to submit a
certif icae. dal ed not more than 7 doas he fore their departure,
recording t the negative results of stool culture. This
certificate must be dpli\ered by a licensed laboratory and
attested to hb the health authority.*


EUROPE
France Page 67
Delete the pre ious not concerning smallpox.
Insert: Smallpox staccination is required of all arrivals
except arrivals from Azores and Madeira Islands, Canary
Islands. Bermuda. Canada. Greenland. Netherlands Antilles,
St. Pierre and Miquelon. Surinam, and United States of
America.

Ireland Page 69
Delete the note concerning -isallpox.
Insert: Smallpox vaccination is required of all arrivals
except arrivals from Azores and Madeira Islands, Canary
Islands. Reunion. Bermuda ('Canada, French Guiana. Green-
land, Guadeloupe. Martinique. Netherlands Antilles, St.
Pierre and Miqutelon, Surinam, and United States of America.

*' oiiftirmnti, f rlii- I m uciur* with thr Re,, ulat in-: ma l h open
S| usu .in th*e urd Ih'T r. Ith th ( mnizauon in il mo l hunicatl ion
h h tf hw lh Ut I'sm i '^ r ; il i o n .1

APRIL 20, 196E


THE *E'-:**'" ANDMORTALITY WEE iLY REPORT W IT A CIRCULA
TION I* 'i- IS -' -r C '*E NATIONAL COMMUNiCABLE
DISEASE CENTER, A' l' I- ,I .-
DIRECTOR. NATIONAL COMMUNICABLE DISEASE t 'Et,
i. :f^:EB MOD.
CHIEF EPIDEMIOLOGY PROGRAM A.. **.M M0
ACTING CHIEF, STATISTICS SEC TON tOA L. 4HElMaN M.S.
EDITOR MICHAEL GREGG. MO

IN ADDIT .', ,I T-., ESTABLISHED ; *' .r, r r,. F E EPC- nll .,
MORBIDV .US l*Dsr -. r...aL -.: .: -.'i .*aBLE DS( L .
CENTER *FL: %- i. 7 _r. 5
.i:r r., WHICH APE OF CU I r t iAF:I E LTt
S- -'. WHICH ARE DIRECTLY -Lt tIC i T ,.'"ONTlL
OF COMMUNICABLE DISEASES SUCH .u..f.-.r.C', -C. i .LG Be
ADDRESSED TO:
NATIONAL *'. L r.bLt, DISEASE CENTER
ATLANTA, -. :,:.1j]
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 B' T'E ~NDF.,ru,.L
STATE HEALTH -i; 7 -.; .'' THE REPORTING *EF. '"O'.,L'iF
ON SATURDAY l.*' ,.,. i ON NATIONAL BASIS a-E E L ktEEL,
ON THE SUCCEEDING FRIDAY






a
C
C



a 3
Sm
a m
00

-

c- C)
3:
0 L` -a
m m



SI-o n
0 10 r
C ;; e3


a M
U S* -nn T o

< 0.

-t z

Sm










F L LIB
If,"EkiJTC DEPT






L DEPOE:TORI,
C
-









00

m

"




^s


Morbidity and Mortality Weekly Report


a


0_10
>
-

mLe