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:
AA00010654:00154

Related Items

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

Full Text

N L CE D E Co /7
NATION AL COMMUNICABLE DISEASE CENTER


EPIDEMIOLOGIC NOTES AND REPORTS
TULAREMIA Vermont

Between March 25 and April 20, 1968, an acute febrile
illness developed in 32 persons who gave a history of
trapping, shooting, or skinning muskrats in Addison and
Rutland Counties, Vermont. The febrile illness was usually
accompanied by generalized myalgia, headache, epitroch-
lear and axillary adenopathy, and hand ulcers. Exudate
from the hand ulcer of one patient was positive to Fransiella
tularensis by the direct fluorescent antibody technique.
Sera were obtained from 29 of the 32 patients from 2 to 4
weeks after onset of symptoms. Twenty-two patients had
agglutination titers against F. tularensis of 1:320 or
higher; the highest titer was 1:10,240. Of six patients who


SVol. 17, No. 1


WEEKLY

REPORT

Week Ending

May 4, 1968



PUBLIC HEALTH SERVICE


CONTENTS
Epidemiologic Notes and Reports
Tularemia Vermont ......................... L61
Salmonella Contamination of Enzymatic Drain Cleaners. 162
Current Trends
Measles United States, Puerto Rico, and
the Virgin Islands . ..... ..... 163
International Notes
Quarantine Measures . .. ... 168

had two serum specimens drawn at least a week apart,
four showed rises in titer. Two other persons who handled
muskrats but were not ill had agglutination titers of 1:320
or higher. Seventeen patients received oral tetracycline
therapy and improved gradually, while two other patients,
within 48 hours after receiving streptomycin, showed a
(Continued on page 162)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
18th WEEK ENDED CUMULATIVE, FIRST 18 WEEKS
MEDIAN
DISEASE May 4, May 6 1963 1967 MEDIAN
1968 1967 1968 1967 1963 1967
Aseptic meningitis ...................... 35 32 27 518 528 493
Brucellosis ............................ 3 2 4 49 72 73
Diphtheria.............................. 3 3 67 38 73
Encephalitis, primary:
Arthropod-borne & unspecified ........... 12 29 274 431
Encephalitis, post-infectious ............. ..30 19 185 282
Hepatitis, serum ....... ........... ... 79 45 5 1,343 680 1,
Hepatitis, infectious ................... 797 769 15,044 14,219
Malaria ................................ 36 33 2 761 694 36
Measles rubeolaa) ........................ 685 2,389 11,272 12,162 42.160 173,301
Meningococcal infections, total .......... 61 50 75 1,308 1.063 1,193
Civilian ................... ........... 55 44 1,186 981 -
Military ............................... 6 6 122 82
Mumps ................................. 4,895 89.627 -- -
Poliomyelitis, total ..................... 1 1 1 15 6 7
Paralytic ............................ .. 1 1 15 5 6
Rubella (German measles) ............... 2,506 1,727 25,725 22,673 -
Streptococcal sore throat & scarlet fever.... 8,390 10,524 8,822 198,720 214.871 194,351
Tetanus ............................... 1 2 4 36 54 68
Tularemia .............................. 3 5 2 25 49 63
Typhoid fever .......................... 7 6 7 85 115 112
Typhus, tick-borne (Rky. Mt. spotted fever) 3 10 1 11 24 9
Rabies in animals ....................... 93 102 98 1,363 1 611 1,611

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: R.I.-1 ..................................... 2 Rabies in man: ......................................
Botulism: ......................................... Rubella, Congenital Syndrome:...... ............. .... 3
Leptospirosis: .................. ................... 9 Trichinosis: ..................... .................. 18
Plague: ............................ ........ .. Typhus, marine: ....................... 3
Psittacosis: ...................................... 19


HEALTH, EDUCATION, AND WELFARE

BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL







Morbidity and Mortality Weekly Report


TULAREMIA (Continued from front page)


prompt response by lysis of fever and resolution of symp-
toms. There were no fatalities.
All but one of the symptomatic patients were male,
and they ranged in age from 11 years to 69 years with a
median age of 29 years. The average interval from the
patients' first contact with muskrats to onset of symptoms
was 6 days and the duration of illness was from I to 4
weeks. No patient gave a history of insect bites or of
handling rabbits.
Prior to this epidemic, no animal or human cases of
tularemia had ever been reported from Vermont. These
persons who developed tularemia had contact with musk-
rats from three streams (Otter Creek. Little Otter Creek,
and Lewis Creek) and their tributaries that flow into Lake
Champlain. Although an increase in the number of dead
muskrats was noted this spring by hunters and game offi-
cials. these people also noted an increase in the number
of live muskrats.
The association of this disease with muskrats, an
aquatic mammal, and the occurrence of human cases at


the end of winter when arthropod-borne transmission is
unlikely, suggests that water-borne transmission was the
manner by which the muskrats were infected. This pattern
of tularemia transmission is well established in many of
the Rocky Mountain states. Contamination of water with
F. tularensis presumptively occurs via decomposition of
dead diseased wildlife, such as rabbits or field mice.
Bacteriologic studies are now underway on specimens
of water, mud, muskrats, rabbits, foxes, turtles, and in-
sect life obtained from the area.

(Reported by Dr. Donald S. Bicknell, Vergennes, Vermont;
Dr. Linus J. Leavens, Director, Bureau of Communicable
Disease Control, and Dr, Dymitry Pomar, Director, Bureau
of Laboratories, Vermont Department of Health; the Bac-
terial ( :. ., .'-, Unit, Laboratory Program, NCDC; and a
team from NCDC.)

REFERENCE
Iparker, R. R., et at: National Institutes of Health Bulletin:
No. 193, 1951.


SALMONELLA CONTAMINATION OF ENZYMATIC DRAIN CLEANERS


Enzymatic drain cleaners are products containing
dried enzyme preparations, desiccated bacterial cultures,
and dry fillers or carriers. These products are used to
decongest and to clean drains, septic tanks, grease pits,
waste ponds, dishwashers, potato peelers, wash sinks,
and other kitchen and bathroom equipment. They are recom-
mended for use in schools, hospitals, sanitariums, hotels,
creameries, and food processing plants, and are claimed
to be nonpathogenic.
In the autumn of 1967, the Chicago Board of Health
reported the isolation of salmonellae from an enzymatic
drain cleaner; this 'irmine was confirmed by the Epidemio-
logical Services Laboratory Section, NCDC. In early 1968,
the Connecticut State Department of Health notified the
Salmonellosis Unit, NCDC, that it had isolated six sal-
monella serotypes from another brand of enzymatic drain
cleaner. To determine the extent and source of salmonella
contamination of these products, the Consumer and Mar-
keting Service, U.S. Department of Agriculture and the
Epidemiological Services Laboratory, NCDC, performed
bacteriologic examinations on samples of drain cleaners.
The USDA survey included 68 samples of enzymatic
cleaners from 28 firms. Of the 68 samples, 26 (38 percent)
contained salmonella. The 26 positive samples repre-
sented nine different firms; 19 firms had products that did
not yield salmonellae. Salmonella O groups from positive
samples included B, C, CI, C2, El, E2, E4, and G. Some
of the enzymatic cleaners included in the survey were from
reserve samples that had been stored at the USDA labora-
tory for as long as 2 years. Positive samples obtained
from these stored products indicate the viability of sal-
monella in these compounds when stored at ambient tem-
peratures.


The Epidemiological Services Laboratory examined
both the finished product and constituent ingredients of
the drain cleaner previously found to contain salmonella
by the Connecticut State Department of Health. Twelve
samples of the products and samples of 11 different con-
stituents were provided by the U.S. Food and Drug Admin-
istration. All 12 of the product samples examined were
found to contain salmonellae, ..,'ldinr a total of seven
serotypes. Only two of the constituent ingredients, cellu-
lase and lipase, were found to contain salmonellae. Both
enzyme preparations had been manufactured by the same
firm. The serotypes found in the drain cleaner were Sal-
monella california, S. infants, S. lexington, S. meleagridis,
S. montevideo, S. oranienburg, and S. inrnber,.. The
cellulase was positive for S. california, S. montevideo,
and S. .. *'f,'e '., ... and the lipase for S. california, S. lex-
ington, and S. montevideo. Constituent ingredients found
negative for salmonellae included bacterial mix, anhydrous
disodium phosphate, anhydrous monosodium phosphate,
propylene oxide, propylene glycol, sodium thiosulphate,
protease, amylase, urea, and nitrilio sodium acetate.
\ltlo.)ugh these studies show salmonella contamina-
tion of enzymatic drain cleaners, to date, no cases of
salmonellosis attributable to enzymatic drain cleaners
have been documented.

(Reported by Samuel L. Andelman, M.D., Commissioner of
Health, .:. i Brolnitsky, M.D., Chief Epidemiologist,
Herbert L. S','.t.- Ph.D., Epidemiologist, and Hyman
Orbach, Ph.D., Epidemiologist, Chicago Board of Health;
Barbara Christine, M.D., and James Hart, M.D., Connecti-
cut State Department of Health; The U.S. Department of
Agriculture; the U.S. Food and Drug .dminr. .tr.ltion; and


MAY 4, 1968







MAY 4, 1968 Morbidity and Moi


the Epidemiological Services Laboratory Section, and
Salmonellosis Unit, Epidemiology Program, NCDC.)

Editorial Note
As a result of the USDA survey, a policy concerning
use of enzymatic cleaners in federally inspected meat and


rtali


`"~"


CURRENT TRENDS
MEASLES United States, Puerto Rico, and the Virgin Islands


From March 24 through April 20, 1968 (weeks 13-16),
392 counties or health districts reported one or more cases
of measles. This is a decrease of 339 counties from the
731 counties or health districts reporting measles during
the corresponding 4-week period in 1967. Based on report-
ing, this indicates an increase in the number of "measles
free" areas. Of these 392 counties, 70 (18 percent) re-
ported a total of 10 or more cases (Figure 1), whereas 240
of 731 counties (33 percent) reported a similar number of
cases during the comparable 4-week period in 1967 (Fig-
ure 2).
Figure 1
COUNTIES OR HEALTH DISTRICTS REPORTING A TOTAL
OF 10 OR MORE CASES OF MEASLES
UNITED STATES, PUERTO RICO, AND THE VIRGIN ISLANDS
MARCH 24-APRIL 20, 1968

/^jV ^ --T~^J


Figure 2
COUNTIES OR HEALTH DISTRICTS REPORTING A TOTAL
OF 10 OR MORE CASES OF MEASLES
UNITED STATES, PUERTO RICO, AND THE VIRGIN ISLANDS
MARCH 26-APRIL 22, 1967


In five of the nine geographic divisions the number
of counties or health districts, reporting measles during
this 4-week period this year, was less than one-half the
number reporting cases in the comparable 4-week period in
1967 (Table 1). The Middle Atlantic division was the only
division that did not show any decrease in the number of
counties or health districts reporting cases. However, one
state (Pennsylvania) in that division showed a decrease
from 19 counties in 1967 to 13 in 1968.

Table 1
Number of Counties or Health Districts Reporting Measles
During Weeks 13-16, 1968 and
1967 by Geographic Divisions
Number of Counties
or Health Districts Reporting
Total of
Geographic 1 or more cases 10 r more cases
Division 1968 1967 1968 1967
Mar. 24- Mar. 26- Mar. 24- Mar. 26-
Apr. 20 Apr. 22 Apr. 20 Apr. 22
United States 392 731 70 240
New England 19 26 4 3
Middle Atlantic 53 51 12 11
East North Central 72 105 10 19
West North Central 24 56 1 16
South Atlantic 46 107 4 33
East South Central 25 76 3 25
West South Central 68 141 20 60
Mountain 29 79 4 31
Pacific 56 90 12 42
Puerto Rico 5 5 2 5
(health districts)
Virgin Islands 1 1 -



The measles data from Puerto Rico and the Virgin
Islands have been included on the maps (Figures 1 and 2).
Although measles cases were reported from all five health
districts in Puerto Rico during the 4-week period, March 24
through April 20, 1968, only two health districts (East and
South) reported a total of 10 or more cases. All five health
districts reported a total of 10 or more cases in the corre-
sponding 4-week period in 1967.
(Reported by State Services Section, and Statistics Sec-
tion, Epidemiology Program, NCDC.)


ty Weekly Report 163


poultry establishments was adopted by theTechnicalServ-
ices Division, Consumer and Marketing Service, USDA. A
copy of this policy may be obtained on request from:
Laboratory Branch, Technical Services Division, Con-
sumer and Marketing Service, USDA, P. O. Box 348, Belts-
ville, Maryland 20705.






164 Morbidity and Mortality Weekly Report


TABLE 111. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MAY 4, 1968 AND MAY 6, 1967 (18th WEEK)

ENCEPHALITIS HEPATITIS
ASEPTIC Primary
HRI ( tL)LS: IPIIIHERI lin Post- MALARIA
AREA MENINGITIS Including Infectious Serum Infectious
unsp. cases
____ i +Pf L6 I UNITED STATES... 35 32 3 12 29 30 79 797 769 36

NEW ENGLAND.......... 1 1 2 3 1 1 42 25 2
Maine............... 4 5
New Hampshire...... 2
Vermont............ I
Massachusetts....... 1 2 1 22 7 1
Rhode Island....... 1 1 1 1 10 1 -
Connecticut........ 4 11 1

MIDDLE ATLANTIC...... 3 5 1 2 2 22 101 184 3
New York City...... 1 1 .11 2 43
New York, up-State. 2 1 24 37
New Jersey......... 1 2 1 6 21 70 2
Pennsylvania....... 2 1 1 5 54 34 1

EAST NORTH CENTRAL... 3 3 5 9 5 4 127 120 5
Ohio............... 1 1 1 5 1 41 19
Indiana............ 1 15 19
Illinois........... 2 1 2 2 33 37 4
Michigan.......... 1 4 4 2 29 39 1
Wisconsin.......... 1 9 6

WEST NORTH CENTRAL.. 1 1 1 36 62 2
Minnesota.......... 1 4 17
Iowa............... 1 1 7 9
Missouri........... 16 26
North Dakota........ 4
South Dakota ..... 1
Nebraska ........... 1 3
Kansas............. 8 2 2

SOUTH ATLANTIC....... 9 4 2 5 10 4 95 73 15
Delaware .......... 3 7
Maryland.A......... I 2 3 15 13
Dist. of Columbia..
Virginia ........... 3 7 8
West Virginia...... 2 1 6 9
North Carolina..*.. 2 1 1 12 3 4
South Carolina..... 4 -
Georgia............ 1 22 17 10
Florida............ 4 2 8 29 16 1

EAST SOUTH CENTRAL... 1 1 3 64 43 1
Kentucky............ 26 12
Tennessee.......... 3 14 16
Alabama.A ......... 1 15 I
Mississippi.......... 9 15 -

WEST SOUTH CENTRAL... 10 6 1 3 1 3 66 79 2
Arkansas............ 2 2 2
Louisiana.......... 5 1 1 2 1 2 16 7 2
Oklahoma............ 1 1 7 10 -
Texas.............. 2 4 I 1 41 60

MOUNTAIN................ ..... 1 2 1 21 16 2
Montana............ 8 2
Idaho............... I
Wyoming........... 1 2
Colorado.......... 1 3 3 2
New Mexico......... 1 5 1
Arizona............ 1 3 5
Utah................ 2 1
Nevada.............. I 1

PACIFIC............... 9 11 6 7 44 245 167 4
Washington.......... 26 8 2
Oregon............. 1 19 17 -
California......... 8 8 5 7 44 196 140 2
Alaska......... ... 2 -
Hawa ii............. 1 3 4

P rt Hi ,.......... 9 9

*Delayed reports: Aseptic meningitis: N.C. delete 1
Diptheria: Ala. 1
Encephalitis, primary: Md. 1 case 1967
Hepatitis, infectious: Me. 1








Morbidity and Mortality Weekly Report 165


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MAY 4, 1968 AND MAY 6, 1967 (18th 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... 685 12,162 42,160 61 1,308 1,063 4,895 1 1 15 2,506

NEW ENGLAND......... 81 540 507 5 69 47 442 444
Maine...*........... 14 140 1 5 2 9 48
New Hampshire.. ... 11 68 69 1 7 2 2 3
Vermont............ 1 22 1 36 -
Massachusetts *.... 11 194 187 1 29 23 276 185
Rhode Island....... 1 31 1 6 2 39 92
Connecticut........ 59 262 58 1 21 18 80 116

MIDDLE ATLANTIC...... 108 1,866 1,399 10 218 164 204 306
New York City...... 68 596 244 1 40 26 136 171
New York, Up-State. 29 816 319 1 37 41 NN 37
New Jersey..*....... 315 336 5 76 66 68 68
Pennsylvania....... 11 139 500 3 65 31 NN 30

EAST NORTH CENTRAL... 128 2,609 3,372 6 137 117 1,579 655
Ohio............... 22 221 571 2 37 44 89 153
Indiana.*......... 23 419 414 18 14 216 87
Illinois........... 30 1,052 558 3 33 25 159 175
Michigan.,. ........ 6 163 672 1 37 25 508 43
Wisconsin.......... 47 754 1,157 12 9 607 197

WEST NORTH CENTRAL... 10 261 1,860 2 57 46 489 91
Minnesota.......... 1 8 92 1 16 9 27 1
Iowa................ 1 51 460 4 9 305 81
Missouri........... 1 65 135 11 11 16 -
SNorth Dakota....... 6 97 669 2 73 8
South Dakota....... 4 46 4 6 NN -
Nebraska........... 1 28 458 1 6 9 24 1
Kansas............. 8 NN 14 2 44 -

SOUTH ATLANTIC....... 26 1,005 4,777 20 293 204 173 305
Delaware............ 1 8 32 3 5 6 9
Maryland........... 2 59 85 1 18 26 35 29
Dist. of Columbia.. 6 12 10 6 -
Virginia........... 5 194 1,494 2 21 17 10 17
West Virginia...... 10 168 907 1 7 16 48 43
North Carolina..... 254 760 58 43 NN -
South Carolina..... 18 ,352 3 51 19 8 62
Georgia............. 3 23 9 57 33 -
Florida............. 8 295 1,112 4 68 39 66 145

EAST SOUTH CENTRAL... 13 356 4,130 4 106 99 333 163
Kentucky............ 3 103 1,073 1 41 29 157 19
Tennessee.......... 2 48 1,401 1 33 41 156 76
Alabama............ 76 1,050 2 16 18 20 68
Mississippi........ 8 129 606 16 11 -

WEST SOUTH CENTRAL... 190 3,225 14,404 5 242 161 417 1 1 7 135
Arkansas.......... 1 1 1,351 1 15 19 1 -
Louisiana.......... 2 104 2 63 59 3
Oklahoma........... 100 3,272 44 10 7 -
Texas............... 189 3,122 9,677 2 120 73 409 1 1 7 132

MOUNTAIN............. 26 573 3,171 3 19 21 241 78
Montana............ 63 233 2 14 1
Idaho.............. 11 319 3 6 1 12 1
Wyoming............. 2 44 21 10 -
Colorado...*........ 14 255 879 7 10 103 42
New Mexico......... 2 52 478 3 19 2
Arizona............. 6 125 723 1 2 45 27
Utah ............... 2 18 261 3 34 5
Nevada............. 5 257 3 2 4 -

PACIFIC.............. 103 1,727 8,540 6 167 204 1,017 8 329
Washington.......... 20 431 4,081 1 27 20 279 56
Oregon............ 22 352 1,138 1 15 17 42 16
California.......... 61 911 3,139 4 115 158 663 8 246
Alaska.............. 97 8 10 2
Hawaii............. 33 85 10 1 23 9

Puerto Rico........... 19 255 1,445 15 8 17 4
*Delayed reports: Measles: N.H.1, Mass. delete 52, N.J. delete 6, Colio.
Mumps: N.H. 5
Rubella: Me. 5, Ind. 41







166 Morbidity and Mortality Weekly Report


TABLE III CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MAY 4, 1968 AND MAY 6, 1967 (18th 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... 8,390 1 36 3 25 7 85 3 11 93 1,363

NEW ENGLAND.......... 1,049 1 2 2 53
Maine. ........... 48 48
New Hampshire...... 45 2
Vermont............ 116 1 2
Massachusetts...... 178 1 1
Rhode Island....... 145 -
Connecticut........ 517 1 1

MIDDLE ATLANTIC...... 377 6 10 11
New York City...... 32 3 6 -
New York, Up-State. 305 3 1 7
New Jersey......... NN -
Pennsylvania....... 40 3 4

EAST NORTH CENTRAL... 832 3 4 3 13 19 104
Ohio.................... 93 1 3 10 2 46
Indiana............. 242 1 12 31
Illinois........... 129 2 2 1 3 11
Michigan........... 234 1 1 6
Wisconsin........... 134 1 2 10

WEST NORTH CENTRAL... 469 2 5 4 1 1 18 311
Minnesota.......... 29 7 85
Iowa................ 124 4 53
Missouri........... 2 3 3 4 56
North Dakota....... 81 53
South Dakota....... 20 1 1 1 1 34
Nebraska........... I 3 16
Kansas............. 214 I 14

SOUTH ATLANTIC ...... 692 1 8 1 5 1 21 2 9 10 156
Delaware ........... 15 -
Maryland............ 107 4 1 3
Dist. of Columbia.. 1 1-
Virginia........... 130 2 1 3 2 7 71
West Virginia...... 190 20
North Carolina..... 9 2 2 2 2 4
South Carolina..... 17 1 1 -
Georgia............. 45 1 7 1 14
Florida............ 179 2 1 1 1 4 8 44

EAST SOUTH CENTRAL... 1,384 4 4 11 1 10 366
Kentucky.......... 322 1 1 1 7 171
Tennessee............ 927 3 7 3 180
Alabama..*......... 103 1 15
Mississippi ....... 32 2 3 1 -

WEST SOUTH CENTRAL... 571 5 2 5 8 18 250
Arkansas........... 14 1 I 1 28
Louisiana.......... 3 4 1 3 28
Oklahoma............ 23 1 1 6 80
Texas.............. 531 1 2 3 5 8 114

MOUNTAIN............. 1,841 2 1 7 4 25
Montana............ 28 -
Idaho ............ 102 -
Wyoming.*.......... 120 1 1
Colorado............ 1,221 1 2 1
New Mexico........ 165 1 4 2 13
Arizona............. 56 2 10
Utah............... 149 -
Nevada .............. -

PACIFIC.............. 1,175 7 2 9 12 87
Washington ......... 182 -
Oregon.............. 184 1 2 1 1
California......... 723 7 1 7 11 86
Alaska............. 32 -
Hawaii.............. 54 -

Puerto Rico .......... 11 1 12
*Delayed reports: SST: Me. 20, Ala. 1, Wyo. 106








167


Morbidity and Mortality Weekly Report






TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED MAY 4, 1968


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

All Causes Pneumonia Under All Causes Pneumonia Under
Area All 65 years and 1 year Area All 65 years and 1 year
Ages and over Influenza All Ages and over Influenza All
All Ages Causes All Ages Causes


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

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

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


704
228
44
24
24
59
31
15
30
46
58
17
51
25
52

3,385
49
37
163
34
26
45
60
78
1,670
37
597
206
48
118
14
38
69
48
20
28

2,654
62
35
769
180
229
108
71
346
43
64
42
33
49
153
28
160
28
26
47
106
75

769
57
16
48
134
17
82
68
229
66
52


430
136
26
23
17
30
16
9
14
28
37
9
33
16
36

1,976
23
20
94
21
12
30
34
40
993
25
334
108
35
73
9
26
37
26
15
21

1,476"
35
14
410
105
106
53
36
195
25
35
30
15
36
83
15
103
17
21
31
69
42

476
32
10
30
88
11
56
38
133
49
29


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


1,126
117
229
35
68
107
53
84
42
77
69
183
62

657
88
57
42
116
159
37
58
100

1,143
39
62
25
158
32
64
236
59
139
65
146
46
72

425
43
28
103
17
88
26
52
68

1,689
23
63
33
43
89
540
87
42
120
64
104
185
37
160
58
41


597
50
115
21
36
62
27
50
22
65
40
78
31

362
45
28
25
70
97
19
29
49

600
21
30
16
81
18
29
107
21
78
41
80
30
48

266
21
17
71
12
51
16
32
46

1,024
19
31
21
18
56
333
51
31
72
33
58
109
27
95
41
29


Total 12,552 7,207 427 613

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 241,939
All Causes, Age 65 and over------------------- 142,534
Pneumonia and Influenza, All Ages------------- 11,619
All Causes, Under 1 Year of Age--------------- 10,738


Week No.
18







Morbidity and Mortality Weekly Report


INTERNATIONAL NOTES
QUARANTINE MEASURES


Additional Immunization Information for International
Travel! 19i7-68 edition, Public Htlalth Service
Publication No. 384


The following information should be included in Section 5:


AFRICA
Central African Republic Page 27
Delete all previous information concerning yellow fever.
Insert: Yellow fever \ vaccination is required of all arrivals,
1 year of age and over.*

"('nformity of this measure with thr Regulations may b. open
to qlultion and thr \uorld HItalth Organization is in communi-
al ion T ith thb* health administration concerned.







ERRATA

Vol. 17, No. 15, p. 136.
In the article "Tetanus 1965 and 1966 Part I,"
in Figure 5, the block representing Puerto Rico should
be omitted. The data in this 3-part series on tetanus in-
clude only the cases that were reported in the United
States: it does not include the cases that were reported
in Puerto Rico.

Vol. 17, No. 16, p. 140.
In the article "Bovine Cysticercosis Texas," the
third sentence in the first paragraph is incomplete. It
should read: "Infected cattle are known to have been
shipped to plants in Oklahoma, Nebraska, Colorado, Mis-
souri, Kansas, Iowa, Texas, and Florida."


Vol. 17, No. 17
p. 149
In the "Contents," the article "Coccidioidomycosis
- New York ... 152" should be changed to "Coccidioido-
mycosis New York.. .. 153" and the article "Measles-
United States 154" should be changed to "Measles -
United States 153."
p. 152
In the article "Tetanus 1965 and 1966 Part II," in
the second sentence in the first paragraph, "Figure 1"
should be changed to "Figure 2."
Also in this article in the third paragraph, the sixth
sentence is incomplete. It should read: "The national in-
cidence rate was 1.34 cases per In 11iii live births, but
the incidence was 0.53 cases per 100,000 white births
versus 5.47 cases per 100,000 non-white births, a tenfold
difference."
p. 153
In the article "Measles United .rlte-," in the
second sentence in the first paragraph, "(Figure 1 and
Table 1)" should be changed to"(Figure 3 and Table 1)."


THE MORBIDITY AND MORTALITY WEEKLY REPORT. WITH A CIRCULA-
TION OF 17,000, IS P'L' --.1E '" 'ME NATIONAL COMMUNICABLE
DISEASE CENTER, ATL r.T :E,.,e .
DIRECTOR, NATIONAL COMMUNICABLE DISEASE CENTER
OAVID F'.iET MD.
CHIEF, EPIDEMIOLOGY PROGRAM AD a. ". MD.
ACTING CHIEF, STATISTICS SECTION IDA L. SHERMAN, MS.
EDITOR MICHAEL B. GREGG, MO,

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
u;&.g> 1 r1I i e u R o iL. -r E TI A 7 ? i.i_ : GTlri. *1 Si C L F 5F S
:E, 'ER A* L *:'EE. i.;. i... O T N E E9E 5T'-*- u i 6BE.E r*n*> *i CA ,
I -.1: i.-TONi WHICH ARE .-. ..,CE'". T -,T ;T 10 -EA L TH
:,rFI L I N1 WHICH ARE E.' IE' L 'r tL'. EC 1 F IoNT
OF COMMUNICABLE DISEASES. SUCH COMMUNICATIONS SHOULD BE
ADDRESSED TO:
NATIONAL COMMUNICABLE DISEASE CENTER
ATLANTA, GEORGIA 30333
ATTN: Cb tL C'2R
',B 6'," AND MORTALITY WEEKLY REPORT

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


m
a


o
BI
3.


o r a
0 M
m








3 <
m f '






z n <
n -t
r or




z
,- a



o
I
a
r


I: r i ,F -L I, LB





'Dr "


F







a
Om
wa



ma


MAY 4, 1968


o *
C4
o e
0


-a

= In
z