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:
AA00010654:00153

Related Items

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

Full Text
FS ArlInONAVI$ UNICABLE DISEASE CENTER
)IA _,


HEALTH, EDUCATION, AND WELFARE

BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


EPIDEMIOLOGIC NOTES AND REPORTS
FATAL CASE OF MALARIA Washington, D. C.

On December 4, 1967, a 57-year-old Negro male was
admitted to a Washington, D.C. hospital for a laryngectomy
because of carcinoma of the larynx. Between December 5
and 19, 1967, the patient received three units of whole blood
and one unitof packed cells. His postoperative course was
uncomplicated until January 6, 1968, when his temperature
spiked to 104F. and exceeded 103oF. on each of the next 3
days. On January 9,the patient became comatose. A routine
blood smear obtained on January 11 revealed a 15 percent
parasitemia with Plasmodium falciparum. Chloroquine ther-
Sapy was immediately instituted via naso-gastric tube. The
following day, oral pyrimethamine, intravenous quinine, and


Vol. 17, No. 17


WEEKLY

REPORT


= Week Ending

April 27, 1968




PUBLIC HEALTH SERVICE


CONTENTS
Epidemiologic Notes and Reports
Fatal Case of Malaria Washington, D.C. . 149
Typhoid Fever Tipton County, Tennessee .... 150
Rabies in an Air Force Sentry Dog .............. 152
Coccidioidomycosis New York . ... 152
Surveillance Summary
Tetanus 1965 and 1966 Part II . ... 152
Current Trends
Measles United States . . .. 154


intramuscular dexamethasone were added to the treatment.
On January 12, the patient was found to have hemo-
globinuria and an elevated plasma hemoglobin. His hema-
tocrit dropped from 42 on January 7, to 22 on January 12;
the BUN remained normal. Because of the hemolysis, the
(Continued on page 150)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
17th WEEK ENDED M CUMULATIVE, FIRST 17 WEEKS
MEDIAN C U I FRT1WEK
DISEASE April 27, April 29, 1963 1967 MEDIAN
1968 1967 1968 1967 1963 1967
Aseptic meningitis ...................... 30 33 20 484 496 464
Brucellosis ............................ 8 10 5 46 70 70
Diphtheria .............................. 19 3 66 35 68
Encephalitis, primary:
Arthropod-borne & unspecified ........... 24 21 262 402
Encephalitis, post-infectious ............. 13 20 155 263
Hepatitis, serum ......................... 88 31 791 1,264 635 14,085
Hepatitis, infectious .................... 912 760 1 14,246 13,450
Malaria ................................ 23 42 2 725 661 36
Measles rubeolaa) ....................... 935 2,412 10,603 11,526 39.771 162,029
Meningococcal infections, total ........... 44 63 65 1,247 1,013 1,135
Civilian .............................. 43 60 1,131 937
Military ................... ............ 1 3 116 76 -
Mumps ................................. 4.251 84,727
Poliomyelitis, total ................... 14 5 7
Paralytic .............................. 14 5 6
Rubella (German measles) ............... 1,901 1,921 23,173 20,946
Streptococcal sore throat & scarlet fever.... 9,050 10,104 10,104 190,203 204.347 185,582
Tetanus ............................... 1 1 2 35 52 57
Tularemia .............................. 2 3 3 22 44 61
Typhoid fever .......................... 3 8 4 78 109 105
Typhus, tick-borne (Rky. Mt. spotted fever) 2 4 1 8 14 8
Rabies in animals ....................... 69 96 117 1.270 1,509 1,509

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........................ ............ ...... 1 Rabies in man: .....................................
Botulism: ......................................... Rubella, Congenital Syndrome: ......................... 3
Leptospirosis: Tenn.- 1 .............................. 9 Trichinosis: Mass. 1 ............................... 18
Plague: ................. ......................... Typhus, marine: ..................................... 3
Psittacosis: ............... ...................... 19 Polio, Unsp.: .....................................










patient was treated with mannitol, large amounts of par-
enteral fluid, and transfusions of packed cells. The patient
died on January 1:3 without having regained conscious-
ness. Blood films obtained just prior to his death con-
tained only a few P. falciparum parasites. Autopsy find-
ings included pulmonary edema, pignmntation of spleen
and liver. and cerebral edema with 'P. falciparum parasites
in the cerebral capillaries.
The patient had given no history of malaria, unex-
plained ferer episodes, or travel outside the Washington,
D.C. area. The four persons who donated the blood given
to the patient prior to January 6. 1968. were identified and
their sera examined. Three were U.S. citizens, none of
whom had a history of malaria or unexplained fevers. One
had never been overseas; one had been in western Europe
in 1945-1946: and one had traveled in Central America in
1962. None of the sera of these donors contained fluores-
cent antibodies against malaria. The fourth donor was a
29-year-old Negro male student from \.,. r, He donated
blood on December 7. 1967. which was given to the patient
on December 19. 1967. The donor had come to the United
States on April 5, 1965. and had not traveled abroad since
that time. He denied any history of malaria, unexplained
fever episodes, blood transfusions, or use of commonly
shared syringes. He had not received antimalarial drugs.


APRIL 27, 1968


His serum contained fluorescent antibodies against malaria,
but the Plasmodium species could not be identified. No
malaria parasites were found in thick and thin blood smears
obtained from this donor in January and March 1968. How-
ever, examination of multiple thick and thin blood ifi i-
obtained on April 12, 1968, 1 day after he underwent a
500 ml phlebotomy, revealed the presence of very rare
P. falciparum trophozoites.

(Reported by John R. Pate, M.I.. M.P'.H., Chief, Commu-
nicable Disea se Control, and William E. Long, M.D., Chief,
Epidemiological Service 1: -: .. District of Columbia
Department of Public Health; Malaria Surveillance Unit,
NCDC, and an EIS Officer.)

Editorial Note
The Nigerian donor was clearly the source of malaria
in this case. The absence of a positive history of malaria
suggests that the donor may have been infected early in
life and developed sufficient immunity to allow asympto-
matic parasitemia. The persistence of the P. falciparum
infection for more than 36 months (from at least April 5,
1965. to April 12, 1968) is unusual. The recipient de-
veloped three complications of falciparum malaria: cerebral
involvement with coma, intravascular hemolysis, and pul-
monary edeima.


TYPHOID FEVER Tipton County, Tennessee


On September 27, 1967, a 10-year-old male from Tip-
ton County, Tennessee, became ill with fever, nausea,
vomiting, and diarrhea. During the next. few days, he had
fever and four or five yellow, watery stools per day. He
was seen by a local physician on October 4, and was
hospitalized in Memphis on October 6. D1 ,ri..-rr. studies
including febrile agglutinations were begun. On October 9,
he had a titer of 1:320 against the O antigen of Salmonella
typhi and a bone marrow culture that was positive for
S. typhi. A stool culture taken on October 12 was also
positive for S. typhi; an earlier stool culture had been
negative. The patient was treated with multiple antibiotics
including sodium cephalothin, chloramphenicol, and
ampicillin. The ampicillin was continued for 10 days after
the patient was discharged from the hospital on October 20.
Histories obtained from the patient's family revealed
that no recent illness had occurred among the other eight
family members and that no raw milk had been consumed
by the family. The family also reported that the boy was
careless in personal hygiene after playing in a muddy
pond located on the boy's farm home. Ir, -I lr .n by
public health nurses and the public health sanitarian dis-
closed that the household waste disposal system consisted
of a pit, privy; the privy was so dilapidated that it had
not been used for several weeks prior to the boy's illness.
Human waste was discarded in a shallow hole, which was
near a cistern that provided the family water supply. The


cistern walls were crumbling and porous, and the sani-
tarian advised the family not to use the cistern. Typhoid
vaccination was made available to the household members.
Stool cultures were made on the eight family members
who were not clinically ill. All were negative except for
the cultures of the patient's i,; ,r ..1.1 grandmother. Two
stool cultures taken from her on October 13 and 26 were
positive for S. typhi. When she was questioned about her
illnesses, she answered that she had had "the fever"
about 40 or 50 years ago. She gave no history of other
significant gastrointestinal illnesses. It, was decided to
attempt eradication of the carrier state in the erandri.urd thr.
On November 21. she was started on 500 mg capsules of
ampicillin, three capsules four times per day and 500 mg
probenecid tablets, one tablet four times per day. She re-
sponded well to the large oral antibiotic dosage. A stool
culture taken on January 19, 1968, 10 days after she had
completed a 6-week course of drugs, was -,.i' i..' for
enteric pathogens. Subsequent cultures taken on Jan-
uary 26 and February 19 were also negative. Between
November 17, 1967. and January 29, 1968, five consecu-
tive stool cultures from the boy who had been clinically
ill were also negative. Both the boy and the -r.inmlriiohr
are well at the present time.

(Reported by B. D. Hale, M.)., Director, Hardeman-
Haywood-Tipton County Health Department; and Cecil B.


Morbidity and Mortality Weekly Report


FATAL CASE OF MALARIA (Continued from front page)






Morbidity and Mortali


Tucker, M.D., Director, Division of Preventable Diseases,
Tennessee Department of Public Health.)

Editorial Comment
The reported incidence of typhoid fever has declined
steadily in the United States since 1942 (Figure 1). For
the 5-year period 1963-1967, an average of 694 isolations
of S. typhi have been reported annually, of which at least
one-third are isolations from previously identified typhoid
carriers. Although outbreaks of typhoid fever still occur,
most cases in the United States are now sporadic inci-
dents due to contact with an asymptomatic carrier. Im-
provement in the general level of sanitation in the popula-
tion has probably been the most significant factor in the
decline in incidence and change in pattern of spread of


APRIL 27, 1968


Figure 1
REPORTED INCIDENCE OF TYPHOID FEVER UNITED STATES, 1942-1966





--------TYPHOID


\1

\



1
N,


'S5=


1942 1944 1946 1948 1950 1952 1954 1956 1958 1960 1962 1964 1966


ty Weekly Report 151


typhoid. However, other factors which may have contrib-
uted to this decrease include improved surveillance and
detection of cases and carriers, use of typhoid vaccine
among exposed individuals, and effective antibiotic therapy
to eliminate the carrier state. In 1966, Simon and Miller
reported the use of oral ampicillin to treat long term ty-
phoid carriers. By treating patients with oral doses of 50
to 100 mg of ampicillin per kg body weight for 28 days,
they were able to eliminate the carrier state in 13 of 15
patients including 10 of 11 with gallbladder disease.


REFERENCE
Simon, H. J. and Miller, R. G.: Ampicillin and the treatment of
chronic typhoid carriers: Report on 15 treated cases and a re-
view of the literature. New Eng J Med 274:807-15, 1966.


20.0






Morbidity and Mortality Weekly Report


RABIES IN AN AIR FORCE SENTRY DOG


On February 22. 196i, a 20-month-old German shepherd
being trained at Lackland Air Force Base, Texas, as a
sentry dog, bit his handler. The following day the dog was
found dead; necropsy revealed traumatic injury to the neck
with resulting internal hemorrhage. Presumably, the injury
was inflicted during efforts to regain control of the dog
after the biting incident.
Thedog's head was sent to the USAF IF.I,, r. Il. i,.,, .,I
Laboratory for routine examination for rabies. The direct
fluorescent rabies antibody (FRA) test was positive,
showing aggregates of fluorescent material in cells which
suggested Negri bodies. Three-week-old mice inoculated
intracerebrally with a 20 percent suspension of the brain
material died in 9 days with symptoms typical of rabies;
their brains were FRA positive. Material from this mouse
passage was also lethal for mice. but incubation with
antirabies serum of equine origin neutralized the virus.
The dog had been vaccinated with chicken embryo
origin rabies vaccine on March 16, 1967, May 29, 1967,


and January 9, 1968. No blood was available for neutral-
ization tests to determine whether the dog had developed
.,,ii,'1,.1l The dog had been at the Air Force base since
May 10, 1967, and since that time there had been no known
exposure to rabies. A veterinarian in Tennessee who
examined the dog on May 3, 1967, prior to its shipment to
Texas noted that the dog had no previous injuries except
for a "few fight wounds." The dates of the wounds and
the animals involved were not known. Rabies in wild
animals has been reported in both Texas and Tennessee.
Following the diagnosis of rabies in the dog, the
handler received a 21-day course of duck embryo vaccine.
He has remained asymptomatic.




(Reported by Cyril J. Hodapp, Lt. Col., USAF. BSC, Chief.
Virology Branch. CSAF Epidemiological Laboratory (. i .', i.
Lackland Air Force Base, Texas.)


SURVEILLANCE SUMMARY
TETANUS 1965 and 1966 PART II


In 1965 and 1966 the median age of tetanus patients
in the United States reported to NCDC, excluding neonates,
was 4h years. The average annual age-specific incidence
and mortality rates for tetanus are shown in Figure 1.
Peak incidence occurred among the very young and the
elderly. Case fatality ratios were also maximal at the ex-
tremes of age. Persons between the ages of 10 and 20
years had the lowest incidence and mortality rates. When
neonatal cases were excluded, the case fatality ratio for
patients less than 50 years of age was 55.4 percent as
compared with 76.4 percent for the age group above 50
years. The neonatal case fatality ratio was 77 percent.
The marked increase in both the incidence and case
fatality ratios in adults above the age of 50 years may
result from this age group's not having had the benefit of
immunization in childhood and in the armed forces during
WWII.
The neonatal group accounted for 10 percent of na-
tional tetanus morbidity. Of the 54 neonatal cases reported,
27 occurred among males and 27 among females. Thirty-
nine cases were fatal. 13 recovered, and in two cases
the outcome were unknown. The racial composition of this
group was 34 percent white and 66 percent non-white.
The non-white group had -;'i'i arnil' higher morbidity
and mortality rates. The national incidence rate was 1.34
cases per 100,000 live births, but the incidence was 0.53
per 100,000 non-white births, a tenfold difference. The
mortality rate for non-whites was 0.96 deaths per 100,000
live births. Neonatal tetanus mortality rates in whites and
non-whites have declined more than threefold since 1950-
1959 (3.48 deaths to 0.96 deaths per 1im iii i. Only six
of the neonatal tetanus patients were born in a hospital,
and a physician was in attendance during five of these six


0
S .30
-J
S.
0
a.
0
.10
0
0

u .05
.0
w
I-


Figure 2
TETANUS MORBIDITY AND MORTALITY
AVERAGE ANNUAL RATES BY AGE GROUPS
UNITED STATES, 1965-1966


0 10 20 30 40 50 60
AGE IN YEARS


>70


- INCIDENCE RATES
-- MORTALITY RATES

deliveries. More than 86 percent of the births that were
complicated by neonatal tetanus occurred at home, and a
mid-wife or non-medical person provided the obstetrical
care. The umbilicus was the source of infections in all
cases where a site was identified.
(Reported by Special Pathogens Unit, Bacterial Disease
Section, and Statistics Section, Epidemiology Program,
NCDC.)


APRIL 27, 1968





APRIL 27, 1968


Morbidity and Mortality Weekly Report


EPIDEMIOLOGIC NOTES AND REPORTS
COCCIDIOIDOMYCOSIS New York


On November 8, 1967, a 44-year-old machinery sales-
man, while attending an equipment demonstration in cen-
tral Arizona, drove one of the demonstration machines
outdoors. Clouds of dust were raised by the machine. On
November 20, 2 days after the salesman returned to his
home in New York, he developed a headache and epigas-
tric distress, and subsequently because of these com-
plaints, he spent 4 days in bed. On November 30, he
entered a New York hospital for evaluation of these symp-
toms. Physical examination revealed a temperature of
102F. and a few crepitant rales in the left paravertebral
area. A chest X-ray was taken that showed extensive
bronchopneumonia on the left. Because of a non-productive
cough, his illness was diagnosed as probable mycoplasma
pneumonia, and he was treated with tetracyclines. De-
spite this treatment the patient remained symptomatic.
Further questioning revealed the patient's trip to
Arizona, suggesting coccidioidomycosis as a possible
cause for cough and pneumonia. A gastric aspiration was
performed, and the aspirate cultured. The specimen grew
Coccidioides immitis. Tuberculin and histoplasmosis
skin tests were negative, but a 1:100 coccidiodin skin
test revealed induration of 1 cm after 48 hours. No specific
treatment was given. A chest X-ray taken on December 20
Showed minimal clearing of the bronchopneumonia. The
patient became afebrile, free of headache and cough, and
was discharged on December 16 with the diagnosis of
pulmonary coccidioidomycosis.
At home the patient experienced intermittent severe
headaches, and with recrudescence of fever and increased
severity of headache, the patient was re-admitted to the
hospital on January 5, 1968. Chest X-ray revealed further
resolution, but with persisting left-si'ded mediastinal
lymphadenopathy. Skull X-rays were normal; however,
examination of the cerebral spinal fluid (CSF) showed
10,800 white blood cells per mm3. No differential was
performed and culture of the spinal fluid was reported as
negative. The patient was then transferred to another
hospital for further evaluation. On admission the physical


examination was unremarkable except for very modest
neck stiffness which could not be subsequently documented.
On January 8, lumbar puncture was performed reveal-
ing lymphocytic pleocytosis and elevated protein. Multiple
stains revealed no pathogen. Because of further rise in
CSF cell count and even though blood, urine, stool, and
sputum cultures were negative for fungi, the patient was
started on Amphotericin B therapy intravenously. Serum
collected on December 5, 1967, showed no demonstrable
coccidioidomycosis complement fixing (CF) antibodies;
however, sera collected on January 9, 1968, showed a
CF titer of 1:8.
Because the convention in Arizona was attended by
approximately 550 salesmen and dealers who were exposed
to dust and who might have contracted the disease, an
investigation of the people attending the convention was
made. It was found that these persons came from 46 states
and eight Canadian provinces. Denver, Colorado, and
Racine, Wisconsin, were the only cities in which 10 or
more salesmen and dealers lived. The 31 employees of
the company in Racine who had attended the convention
were bled for CF antibodies, skin tested, and X-rayed
for pulmonary disease. Most of these employees had been
present for the full 2 weeks of the convention in contrast
to the majority of other people attending who were present
for 1 week or less. All 31 persons had negative skin tests
and complement fixation tests for coccidioidomycosis. No
active lesions were found in any of the chest X-rays. In
view of the findings, further investigation was not felt to
be warranted at this time.
(Reported by Susan J. Standfast, M.D., M.P.H., Assistant
Professor, Department of Community Health, and D. K.
Vedder, M.D., Instructor, Department of Medicine, Divi-
sion of Infectious Diseases, The Albany Medical College
of Union University, Albany, New York; D. H. Grant Skin-
ner, M.D., Chief, Communicable Diseases Section, Wis-
consin Division of Health; and the Mycoses Section,
Ecological Investigations Program, NCDC, Kansas City,
and EIS Officers.)


CURRENT TRENDS
MEASLES United States


For the week ending April 27, 1968 (week 17), 935
cases of measles were reported to NCDC. The number of
cases reported in the 4-week period ending April 20 shows
a slight increase in reported cases over the preceding
4-weeks (Figure 1 and Table 1).


During the first 16 weeks of 1968, 10,591 cases of
measles were reported. This is 28 percent and 9 percent
of the cases reported for the comparable periods in 1967
and 1966, respectively. The number of cases by division
(Continued on page 154)












and state per 4-week period for the 16 weeks is shown in
Table 1. Although there is considerable variation in the
number of cases reported from week to week, four divi-
sions (Middle Atlantic. South Atlantic, East South Cen-
tral, and West South Central) showed an increase in re-
ported cases during each 4-week period. In four of the
olher five divisions, the increases occurred during the
first 12 weeks. but the 4-week period ending April 20
showed a decrease in reported cases from the preceding
4-week total.
Also shown in Table 1 is the 16 weeks total for 1968
and the totals for comparable periods in 1966 and 1967
with the decrease or increase in 1968 from these years.


APRIL 27. 1968


The New England and Middle Atlantic divisions show an
increase in cases reported in 196h from the cases reported
during this period in 1967. Massachusetts. Connecticut,
New York City and Upstate. New York, account for the
increases in these divisions. All the other seven divi-
sions showed -,i1iii. ni decreases from 1967; however,
four states (Indiana, Illinois, Kansas, and % .. li neli in
these seven divisions showed an increase. In 38 of the
50 states the difference in the cases reported in 1967
and 1968 was greater than the number of cases reported
in each state in 1968.
(Reported by State Services Section, and Statistics Sec-
tion, Epidemiology Program, 'NCl)C.)


Figure 3
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


2,000


/


/ \964-65





I / 1 965-66

/r \


I ,, t










\e
I'--,- -.'


1966-67


s"- --


1) a 2 Z4 0 *l 1 5 I 0 1 S
ro oe u FB I-AO A4 s(- 0


Morbidity and Mortality Weekly Report



MEASLES (Continued from page 153)


48,000


44,000


40,000


S36,000


S32,000


S28.000
0

24,000
a.

S20.000


0 16.000
a

12,000
;z

8.000


4,000


I0


/




I.,


4 2 30 27 24 23 20 18 15 13 10 7 5
NOV DEC DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT
FOUR-WEEK PERIOD ENDING


e.ooc


sslsa


N


4 2





APRIL 27, 1968


Morbidity and Mortality Weekly Report


Table I


Reported Cases of Measles, by Geographic Division, United States,
First 16 Weeks 1968 and Comparable Periods, 1966 and 1967

Total 1968

Number Cases Per 16 Weeks Comparable Decrease
Four-Week Period Ended* Dec. 31 16 Weeks Total (Increase)
DIVISION 1967 From
through
Jan. 27 Feb. 24 Mar. 23 Apr. 20 Apr. 20 1967 1966 1967 1966
1968 1968 1968 1968 1968


UNITED STATES
NEW ENGLAND
Maine
New Hampshire
Vermont
Massachusetts
Rhode Island
Connecticut
MIDDLE ATLANTIC
New York City
New York, Upstate
New Jersey
Pennsylvania
EAST NORTH CENTRAL
Ohio
Indiana
Illinois
Michigan
Wisconsin
WEST NORTH CENTRAL
Minnesota
Iowa
Missouri
North Dakota
South Dakota
Nebraska
Kansas
SOUTH ATLANTIC
Delaware
Maryland
District of Columbia
Virginia
West Virginia
North Carolina
South Carolina
Georgia
Florida
EAST SOUTH CENTRAL
Kentucky
Tennessee
Alabama
Mississippi
WEST SOUTH CENTRAL
Arkansas
Louisiana
Oklahoma
Texas
MOUNTAIN
Montana
Idaho
Wyoming
Colorado
New Mexico
Arizona
Utah
Nevada
PACIFIC
Washington
Oregon
California
Alaska
Hawaii


1,811
61
7
3

27
1
23
208
32
131
34
11
561
69
88
258
31
115
44

15
3
16
3
4
3
143

12
2
19
47
3
4
2
54
39
8
15
8
8
365

1
42
322
72
2
6
17
26
7
14


318
87
76
141

14


2,376
123
1
26

69

27
269
59
118
58
34
567
29
78
257
39
164
47
2
7
3
25

6
4
181

16
2
39
32
34
9

49
61
39

11
11
594


1
593
105
7
1
9
45
16
24
1
2
429
118
87
218

6


3,058
159
2
18

80

59
487
97
290
78
22
642
29
115
248
41
209
83
4
2
52
14

11

226
5
11

66
45
22'
3
1
73
79
7
23
23
26
819


39
780
172
53
3
7
52
13
43
1

391
100
75
215

1


3,346
131
3
9
1
42

76
606
262
215
100
29
576
62
91
200
35
188
53
1
17
5
22
1
6
1
334
2
12
2
37
25
161
2

93
135
44
7
30
54
977


10,591
474
13
56
1
218
1
185
1,570
450
754
270
96
2,346
189
372
963
146
676
227
7
41
63
77
4
27
8
884
7
51
6
161
149
220
18
3
269
314
98
45
72
99
2,755

1
100
2,654
491
63
11
42
211
48
108
3
5
1,530
381
321
800

28


37,359 117,898
408 1,403
88 157
69 26
21 204
159 538
27 61
44 417
1,209 13,880
200 6,948
286 1,565
287 1,450
436 3,917
2,908 44,080
490 3,750
341 2,773
461 8,804
607 7,188
1,009 21,565
1,670 5,505
84 1,337
388 3,005
117 371
626 745
42 3
413 44

4,285 9,082
27 120
75 1,375
11 307
1,346 956'
748 3,485
728 150
278 426
23 177
1,049 2,086
3,754 13,296
1,026 3,902
1,263 7,511
884 1,229
581 654
13,157 13,790
1,323 425
85 68
3,232 312
8,517 12,985
2,713 6,548
184 990
295 655
20 89
703 680
41.4 465
628 3,452
234 193
235 24
7,255 10,314
3,516 1,852
916 795
2,650 7,539
96 58
77 70


26,768 107,307
(66) 929
75 144
13 (30)
20 203
(59) 320
26 60
(141) 232
(361) 12,310
(250) 6,498
(468) 811
17 1,180
340 3,821
562 41,734
301 3,561
(31) 2,401
(502) 7,841
461 7,042
333 20,889
1,443 5,278
77 1,330
347 2,964
54 308
549 668
38 (1)
386 17
(8) (8)
3,401 8,198
20 113
24 1,324
5 301
1,185 795
599 3,336
508 (70)
260 408
20 174
780 1,817
3,440 12,982
928 3,804
1,218 7,466
812 1,157
482 555
10,402 11,035
1,323 425
84 67
3,132 212
5,863 10,331
2,222 6,057
121 927
284 644
(22) 47
492 469
366 417
520 3,344
231 190
230 19
5,725 8,784
3,135 1,471
595 474
1,850 6,739
96 58
49 42


Puerto Rico 15 40 73 81 209 1,249 1,485 1,040 1,276
*Includes revisions through April 27. 1968





156


ENCEPHALITIS HEPATITIS
ASEPTIC ll III OllPiT IPrimary Post-
AREA MENINGITIS including infectious Serum InfectiousIA
unsp. cases
1968 1967 1968 1968 1968 1967 1968 1968 1968 1967 1968
UNITED STATES... 30 33 8 19 24 21 13 88 912 760 23

NEW ENGLAND.......... 2 2 3 34 32 5
Maine.A........... 3 2 1
New Hampshire...... 1 1 -
Vermont............ 1
Massachusetts...... 2 1 19 12 3
Rhode Island....... 2 3 -
Connecticut........ 1 2 8 15 1

MIDDLE ATLANTIC ..... 5 4 7 5 27 138 144 2
New York City...... 1 1 1 3 17 50 36 1
New York, up-State. 1 2 22 45 -
New Jersey......... 2 3 2 4 22 21 1
Pennsylvania....... 2 3 2 4 44 42

EAST NORTH CENTRAL... 1 7 1 1 8 5 3 144 118 3
Ohio................ 1 2 3 1 38 26
Indiana............. 3 3 6 27
Illinois............ 1 3 1 2 1 49 39
Michigan............ 2 1 39 21 3
Wisconsin........... 1 12 5

WEST NORTH CENTRAL... 1 2 4 1 1 80 55
Minnesota.......... 1 1 22 5
Iowa............... 1 17 9
Missouri.......... 32 35
North Dakota....... 2 -
South Dakota.......
Nebraska .......... 1
Kansas............. 1 4 1 9 3

SOUTH ATLANTIC....... 4 1 5 4 5 4 3 97 64 2
Delaware ........... 1 3
Maryland ........... 2 11 10
Dist. of Columbia.. 1 1 -
Virginia........... 1 5 1 20 23
West Virginia....... 1 -- 7 7
North Carolina...... 3 13 4
South Carolina..... 4 1
Georgia.............. 11 9 2
Florida............. 3 2 1 3 32 7 -

EAST SOUTH CENTRAL... 1 5 2 2 41 49 1
Kentucky........... 1 14 18
Tennessee.......... 3 2 15 15
Alabama............ 2 5 9
Mississippi......... 2 7 7 1

WEST SOUTH CENTRAL... 7 1 13 2 1 1 1 75 99
Arkansas........... 7 5
Louisiana.......... 1 1 2 1 1 11 9
Oklahoma............ 1 5 5
Texas.............. 6 13 52 80

MOUNTAIN............ 48 42 4
Montana............ 7 5 1
Idaho............... 1 4
Wyoming............. 2 3
Colorado............ 19 3 2
New Mexico......... 2 14
Arizona............ 5 11 -
Utah............... 11 2 1
Nevada............. 1

PACIFIC.............. 11 15 3 4 51 255 157 6
Washington.......... 3 1 1 24 15 1
Oregon............. 2 2 1 16 18 1
California......... 5 12 2 2 50 215 124
Alaska............. -
Hawaii............. 1 2 4

Puerto Rico........... 1 24 30
*Delayed reports: Hepatitis, infectious: Me. 2


Morbidity and Mortality Weekly Report


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

FOR WEEKS ENDED
APRIL 27, 1968 AND APRIL 29. 1967 (17th WEEK)







Morbidity and Mortality Weekly Report 157


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

APRIL 27, 1968 AND APRIL 29, 1967 (17th WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL
AREA Total Paralytic
AREA Cumulative Cumulative Total Paralytic
;Cum.
1968 1968 1967 1968 1968 1967 1968 1968 1968 1968 1968
UNITED STATES... 935 11,526 39,771 44 1,247 1,013 4,251 14 1,901

NEW ENGLAND.......... 36 510 471 4 64 42 337 305
Maine.*............ 13 121 4 2 17 21
New Hampshire...... 1 57 69 6 2 5 1
Vermont............ 1 22 1 20 -
Massachusetts...... 17 235 179 28 19 159 87
Rhode Island....... 1 27 1 5 1 42 86
Connecticut........ 18 203 53 3 20 18 94 110

MIDDLE ATLANTIC...... 194 1,764 1,298 15 208 150 165 208
New York City...... 78 528 226 4 39 24 119 129
New York, Up-State. 33 787 298 1 36 36 NN 40
New Jersey. ....... 51 321 309 1 71 61 46 38
Pennsylvania....... 32 128 465 9 62 29 NN 1

EAST NORTH CENTRAL... 135 2,481 3,119 2 131 111 1,210 272
Ohio............... 10 199 552 1 35 41 142 99
Indiana. .......... 24 396 375 18 14 129 11
Illinois.'......... 59 1,022 484 30 23 107 33
Michigan........... 11 157 641 1 36 24 334 57
Wisconsin.......... 31 707 1,067 12 9 498 72

WEST NORTH CENTRAL... 24 251 1,764 4 55 44 576 103
Minnesota.......... 7 84 1 15 9 19 4
Iowa................ 9 50 418 4 9 444 98
Missouri........... 1 64 129 1 11 11 1 1
North Dakota....... 14 91 642 2 92
South Dakota....... 4 45 4 6 NN
Nebraska........... 27 446 1 5 7 17
Kansas............. 8 NN 1 14 2 3

SOUTH ATLANTIC....... 95 979 4,601 5 273 199 319 371
Delaware............ 7 27 3 5 5 2
Maryland............ 6 57 81 1 17 25 48 5
Dist. of Columbia.. 6 12 1 10 5 16 1
Virginia........... 28 189 1,417 19 16 54 54
West Virginia...... 9 158 854 6 16 72 58
North Carolina..... 34 254 746 1 58 41 NN -
South Carolina..... 18 344 1 48 19 7 14
Georgia............. 3 23 1 48 33 -
Florida............ 18 287 1,097 64 39 117 237

EAST SOUTH CENTRAL... 29 343 3,918 2 102 95 126 141
Kentucky............ 2 100 1,065 40 29 18 52
Tennessee.......... 1 46 1,344 2 32 39 89 56
Alabama.t .......... 4 76 916 14 17 17 33
Mississippi........ 22 121 593 16 10 2 -

WEST SOUTH CENTRAL... 280 3,035 13,799 3 237 153 438 6 144
Arkansas........... 1,348 1 14 16 2 -
Louisiana.*........ 1 2 87 61 59 9
Oklahoma............ 100 3,256 44 10 2
Texas............... 279 2,933 9,108 2 118 68 434 6 135

MOUNTAIN............. 48 539 2,909 1 16 20 199 59
Montana............ 63 200 2 8 2
Idaho............... 11 310 3 1 7 -
Wyoming............. 42 20 -
Colorado........... 22 233 791 7 10 110 32
New Mexico.......... 2 50 456 3 20 6
Arizona............. 11 119 645 1 2 42 16
Utah................ 13 16 243 2 2 2
Nevada............. 5 244 1 3 2 10 -

PACIFIC.............. 94 1,624 7,892 8 161 199 881 8 298
Washington.......... 30 411 3,781 1 26 20 274 74
Oregon.............. 9 330 1,020 14 17 36 8
California......... 50 850 2,915 6 111 153 508 8 194
Alaska.............. 96 8 7 1
Hawaii.............. 5 33 80 1 10 1 56 21

Puerto Rico.......... 27 236 1,366 15 8 40 15
*Delayed reports: Measles: N.J. 3, Ind. delete 41, Ala. delete 37, La. delete 2
Meningococcal infections: La. delete 1
Rubella: Me. 4, Ala. 37, La. delete 1







158 Morbidity and Mortality Weekly Report


TABLE III CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

APRIL 27. 1968 AND APRIL 29, 1967 (17th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
AREA SCARLET FEVER (Rky. Mt. Spotted) ANIMALS
Cum. Cum. Cum. Cum. Cum.
1968 1968 1968 1968 1968 1968 1968 1968 1968 1968 1968
UNITED STATES... 9,050 1 35 2 22 3 78 2 8 69 1,270

NEW ENGLAND............ 1,287 1 1 2 5 51
Maine.. ........ 30 4 48
New Hampshire...... 2
Vermont............ 17 1 1
Massachusetts...... 198 -
Rhode Island ....... ll -
Connecticut....... 931 1 1 1

MIDDLE ATLANTIC...... 329 6 1 10 11
New York City...... 21 3 6
New York, Up-State. 224 3 1 7
New Jersey......... NN -
Pennsylvania....... 84 1 3 4

EAST NORTH CENTRAL... 727 3 4 10 2 85
Ohio ............... 111 1 7 44
Indiana............ 137 I 19
Illinois........... 132 -2 2 1 8
Michigan............ 202 1 1 2 6
Wisconsin.......... 145 1 8

WEST NORTH CENTRAL... 334 2 5 4 25 293
Minnesota.......... 29 11 78
Iowa................ 90 3 49
Missouri........... 19 2 3 3 6 52
North Dakota....... 109 2 53
South Dakota....... 32 1 1 34
Nebraska ........... 11 2 13
Kansas.............. 44 1 1 14

SOUTH ATLANTIC....... 1,272 7 4 20 2 7 5 146
Delaware ........... 2 -
Maryland............ 246 4 2
Dist. of Columbia.. 15 I1 1
Virginia............ 387 2 1 3 1 5 71
West Virginia...... 188 2 20
North Carolina..... 16 2 2 2 1 2 4
South Carolina..... 73 -
Georgia............. 9 1 7 1 13
Florida............. 336 2 3 2 36

EAST SOUTH CENTRAL... 1,509 4 4 11 1 13 356
Kentucky............ 389 1 1 I 8 164
Tennessee........... 925 3 7 5 177
Alabama............ 86 1 15
Mississippi........ 109 2 3 1

WEST SOUTH CENTRAL... 579 5 2 3 1 8 10 232
Arkansas........... 8 1 1 1 1 27
Louisiana.......... 11 4 1 25
Oklahoma........... 28 1 I 3 74
Texas............. 532 1 1 1 5 7 106

MOUNTAIN.............. 1,790 2 6 1 21
Montana............. 53 -
Idaho.............. 109 -
Wyoming..*........ 233 1 -
Colorado............ 1,081 1 2 1
New Mexico......... 180 3 1 11
Arizona............ 107 --- 8
Utah............... 27 -
Nevada... .......... -

PACIFIC.............. 1,223 7 1 7 8 75
Washington......... 297 -
Oregon............. 195 1 1 -
California......... 593 7 6 8 75
Alaska.............. 22 -
Hawaii............. 116 -

Puerto Rico.......... 10 1 12
*Delayed reports: SST: Me. 21, Wyo. 4






Morbidity and Mortality Weekly Report






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


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


All Causes Pneumonia Under All Causes Pneumonia Under
Area d yera Area 1A y dand year
Area All 65 years and year Area All 65 years and
Ages and over Influenza All and over Influenza All
All Ages Causes As All Ages Causes


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

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

EAST NORTH CENTRAL:
Akron, Ohio-----------
Canton, Ohio----------
Chicago, Ill.---------
Cincinnati, Ohio------
Cleveland, Ohio-------
Columbus, Ohio--------
Dayton, Ohio----------
Detroit, Mich.--------
Evansville, Ind.------
Flint, Mich.----------
Fort Wayne, Ind.------
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.--------


739
268
49
31
24
60
23
21
32
41
49
8
48
30
55

3,258
49
28
140
43
35
39
70
79
1,704
61
438
177
58
98
23
40
77
45
28
26

2,645
67
36
719
172
187
153
89
378
44
45
51
54
66
154
28
124
51
32
39
90
66

821
59
27
39
127
17
123
64
245
81
39


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.-----------


Total


4


1,186
157
248
38
62
95
67
79
26
86
76
197
55

618
92
47
42
129
117
42
36
113

1,084
46
21
25
150
28
80
201
49
158
82
101
60
83

442
49
21
118
21
113
18
44
58

1,509
18
46
23
47
84
427
107
33
127
53
99
162
44
138
59
42


12.302


7.069


Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 229,385
All Causes, Age 65 and over------------------- 135,326
Pneumonia and Influenza, All Ages------------- 11,191
All Causes, Under 1 Year of Age--------------- 10,125


Week No.
17









ADDENDUM, Vol. 17, No. 16, p. 140
The following editorial note should be added to the
article "Foodborne Disease Outbreaks 1966 and 1967:
Editorial Note
A list of the 273 outbreaks from which these data
were derived is available on request from: Chief. Enteric
Diseases UInit. Bacterial Diseases Section. Epidemiology
Program, N(DC.










ERRATUM, Vol. 17, No. 16, p. 141.
In the article "Follow-up Malaria Ceylon," the
third sentence in the second paragraph is incomplete. It
should read: "No secondary cases were discovered de-
spite prompt widespread investigation and follow-up which
included five serial mass blood surveys in which 1,815
blood films were taken.


APRIL 27, 1968


THE MORBIDITY AND MORTALITY WEEKLY REPORT. WITH A CIRCULA
TION OF t7000, IS PUBLISHED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER, ATLANTA. GEORGIA.
DIRECTOR, NATIONAL COMMUNICABLE i'~ Erji ._MTER
LA D,,. `, .: '. M- D0
CHIEF. EPIDEMIOLOGY PROGRAM A.D. L r. ..Lr.i- M.D.
ACTING CHIEF, STATISTICS SECTION IDA L SHERMAN, M.S.
EDITOR MICHAEL B. GREGG, M.D

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDI) Ci .I. )- T ALITY, THE N. T .r' L ..ur,_,,..t L e : &SE
CENTER it L .. .t, CCOUNTS F *''1 7 cEf I .- --aFrr a .- "5,
INVESTIGATIONS WHICH ARE OF CUR ."' r *r.r. t-rFT HEALTH
OFFICIALS AND WHICH ARE DIRECTLY L 'u T-J Ir,.- i0.TROL
OF COMMUNICABLE DISEASES, SUCH .: :Mr.'.n c i'C : -'- OD BE
ADDRESSED TO:
NATIONAL COMMUNICABLE DISEASE CENTER
ATLANTA. GEORGIA 30333
ATTN: THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT

NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO THE NCDC BY THE INDIVIDUAL
STATE HEALTH ,. "r tr ..T THE REPORTING WEE- CONCL'j.OES
ON SATURDAY ( t 'i L i i.'r ON A NATIONAL BASIS -l R ELF 5;Ei-
ON THE SUCCEEDING FRIDAY






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