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:
AA00010654:00156

Related Items

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

Full Text



NATIONAL COMMUNICABLE DISEASE CENTER


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


Vol. 17, No. 21


WEEKLY

N REPORTT


Week Ending
SMay 25, 1968




PUBLIC HEALTH SERVICE


HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION


EPIDEMIOLOGIC NOTES AND REPORTS
FOODBORNE GROUP A STREPTOCOCCAL EPIDEMIC
U.S. Air Force Academy, Colorado

An epidemic of Group A streptococcal pharyngitis
occurred among the cadets at the U.S. Air Force Academy
from April 27 through April 30 (Figure 1). Approximately
600 cadets with severe prostrating illness characterized
by high fever, headache, and sore throat were seen in the
academy hospital clinic on Sunday, April 28; 89 cadets
required hospitalization. Of the 89 hospitalized cadets, 90
.percent had exudative pharyngitis and tender cervical
lymphadenopathy, and 91 percent on throat culture yielded
a Group A, M non-typable T-12 streptococcus. Of 418
cultures taken on April 28, 224 cultures (54 percent) were


CONTENTS
Epidemiologic Notes and Reports
Foodborne Group A Streptococcal Epidemic U.S.
Air Force Academy, Colorado . . 189
Tularemia Follow-Up Vermont . ..... 190
Recommendation of the Public Health Service Advisory
Committee on Immunization Practices -
Typhus Vaccine . ....... .. ...... 191
reported as presumptive B-hemolytic streptococci by the
Air Force Academy Hospital Laboratory; 139 of these
cultures were grouped and typed, and 124 cultures (89
percent) were of the epidemic strain. A random selection
of 100 well cadets, cultured at the time that mass prophy-
laxis was given on April 30, demonstrated an epidemic
strain prevalence of only 2 percent.
(Continued on page 190)


TABLE I. GASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
21st WEEK ENDEDMEDIAN CUMULATIVE. FIRST 21 WEEKS
DISEASE .May 25, May 27, 1963 1967 MEDIAN
1968 1967 1968 1967 1963 1967
Aseptic meningitis ..................... 33 49 35 606 675 586
Brucellosis ............................ 3 5 7 61 92 92
Diphtheria...... : ....................... 1 2 2 69 42 74
Encephalitis, primary:
Arthropod-borne & unspecified .......... 16 22 333 515 -
Encephalitis, post-infectious ........... .. 20 18 --- 231 354 -
Hepatitis, serum ........................ 82 35 7 0 1,619 798 17
Hepatitis, infectious .................... 859 716 17.778 16,549
Malaria .................. ............. 22 38 1 860 798 41
Measles rubeolaa) ....................... 717 2,302 7,851 14,600 48,514 199,332
Meningococcal infections, total ........... 43 50 52 1,440 1,227 1,363
Civilian .............................. 40 47 1,297 1,135 -
Military ............................... 3 3 143 92 -
Mumps ................................. 4,181 --- 102,251
Poliomyelitis, total ..................... 1 1 1 16 9 10
Paralytic ............................. 1 1 1 16 8 8
Rubella (German measles) ............... 2,131 2,024 32,764 29,072 -
Streptococcal sore throat & scarlet fever.... 8,172 9,277 8,670 224,904 244,171 219,826
Tetanus ............................... 2 3 6 46 60 82
Tularemia .............................. 5 4 5 66 61 81
Typhoid fever .......................... 5 9 7 102 133 137
Typhus, tick-borne (Rky. Mt. spotted fever) 9 3 5 32 35 23
Rabies in animals ...................... 58 100 92 1,569 1.891 1.891

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: .................. ........................ 2 Rabies in man: ............................. ...... -
Botulism: ......................................... Rubella, Congenital Syndrome: ............. .. ....... 3
Leptospirosis: Hawaii-1 ............................. 12 Trichinosis: Hawaii-2, Va.-2 .......................... 25
Plague: ............................................ Typhus, murine: Fla.-1 .......... .................... 5
P sittacosis: ....................................... 14







Morbidity and Mortality Weekly Report


FOODBORNE GROUP A STREPTOCOCCAL EPIDEMIC (Continued from front page)


Figure 1
PHARYNGITIS IN CADETS
AIR FORCE ACADEMY OUTPATIENT CLINIC
MARCH 18-22, APRIL 22-MAY 4, 1968


Bul't(i Ul(iL




B 9 Xi P' i~ 2P 1) 29 25 26 pr 28 ~9 10
YLICIW i~Li i Uiii
4kB
Coii O' rlOUiii~D* to (iNi


Following initial fluorescent antibody examination
which indicated that the etiologic agent was a Group A
streptococcus, control measures were instituted. Cadet
classes and dependent and public schools in the area
were suspended from April 29 to May 1. On Tu.--.' 1 ,
April 30, mass prophylaxis utilizing 1.2 million units of
benzathine penicillin G or oral erythromycin was given to
approximately 2,200 cadets who had not previously been
treated. Members of the hospital staff and food handlers
were cultured and treated if the cultures were positive.
Following mass prophylaxis on April 30, a marked reduc-
tion was noted in clinic visits for pharyngitis (Figure 1).
The overall attack rate in the cadet population of
3,012 was 27.5 percent. Squadron attack rates failed to
reveal any significant difference between individual
squadrons.
Because of the explosive nature of this epidemic, a
common source foodborne outbreak was suspected. Several
factors tended to localize the time of exposure to the noon
meal on Friday, April 26. The incubation period of 12-72
hours coincides with the incubation periods described in
previous foodborne outbreaks of streptococcal pharyn-
gitis. 1,2,3,4 A :llgh training class of 58 cadets who did
not eat the noon meal on Friday reported no cases of ill-
ness with onset before 6 p.m. Monday, April 29. From this
group, five cadets subsequently became ill and probably
represent secondary respiratory spread. From a group of
26 persons who ate only the noon meal on Friday with the


cadets, 6 persons became ill with symptoms of strepto-
coccal pharyngitis during the following 48 hours.
Cultures from all food items served at meals from
F-',, evening through Sunday failed to yield Group A
streptococci. Milk and milk products from the same lot
as that served on Friday and I iurd i were also ir. e,1,ii,
Portions of the prepared food items served at the noon
meal on Friday were not available for culture.
An analysis of food histories obtained from both
hospitalized and well cadets pointed to the tuna salad
at the Friday noon meal as the responsible food. An in-
vestigation of the preparation of the tuna salad revealed
that the hard boiled eggs used in the salad had been steamed
and sliced on Thursday, April 25. The sliced eggs were
then placed in large pans and left overnight at 58F. The
salad was then prepared at 6 a.m. April 26, and stored
immediately at 38F. until served at the noon meal. The
suggestion that eggs were.the vehicle of infection is con-
sistent with other reports of foodborne streptococcal epi-
demics that incriminate eggs as the vehicle of transmis-
sion. 1,2,3,1
On April 28 and 29, 229 food handlers in the mess
hall were cultured. Six were positive for Group A strepto-
cocci, three of which were T-12, the epidemic strain.
Histories, physical examinations, throat cultures, and
blood specimens obtained from food handlers who assisted
in preparing the tuna salad, to date, have failed to in-
criminate definitely a single source of the inoculum.
Intensive surveillance for cases of nonsuppurative
sequelae has failed to reveal such complications.
(Reported by Major Roger A .' ... USAF, Laboratory Officer,
U.S. Air Force Academy Hospital Laboratory, Colorado
Springs, Colorado: Cecil S. Mollohan, M.D., M.P.H., Chief,
Section of Epidemiology, Colorado State Department of
Public Health; Streptococcal Disease Section, Ecological
Investigations Program, NCDC, Kansas ~. Kansas; and
two EIS Officers.)

References:
1U.S. Commission on Acute Respiratory Diseases, Fort Bragg,
N.C.: A study of a foodborne epidemic of tonsillitis and pharyn-
gitis due to beta hemolytic streptococcus, type 5. Bull Johns
Hopkins Hosp 77:143-210, 1945.
-t National Office of Vital Statistics: Morbidity and Mortality
Weekly Report, Vol. 4, No. 32, Aug. 19, 1955.
:'U.S. National Office of Vital Statistics: Morbidity and Mortality
Weekly Report, Vol. 5, No. 4, Feb. 3, 1956.
4Farber, R. E. and F. A. Korff. Foodhorne epidemic of Group A
beta hemolytic streptococcus. Public Health Reports 73:203-
209, 1958.


TULAREMIA FOLLOW-UP Vermont


Since the initial report of 32 cases of tularemia from
Vermont (M'l.ln%. Vol. 17, No. 18). eight other cases, diag-
nosed on the basis of clinical and laboratory linrliil-.
have occurred in Vermont in persons who trapped or skinned
muskrats. Also, serologic confirmation has been made on
eight additional cases from the original 32 reported cases.


Of the 40 patients, to date, 34 have had agglutination
titers against Francisella tularensis of 1:160 or higher,
2 to 6 weeks after onset of symptoms. Seven of these 34
patients had fourfold or greater rises in titer in serum
specimens drawn more than 2 weeks apart. Included in
(Continued on page 196)


MAY 25, 1968







Morbidity and Mortality Weekly Report


RECOMMENDATION OF THE PUBLIC HEALTH SERVICE
ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES

The Public Health Service Advisory Committee on Immunization Practices
meeting on February 15, 1968, issued the following recommendation on
typhus vaccine.

TYPHUS VACCINE


TYPHUS
The United States has not experienced an outbreak of
louse-borne (epiderric) typhus since 1922. The last re-
ported case, 1950, did not result from an indigenous source
of infection.
Louse-borne typhus was widespread in many countries
affected by World War II. Since 1945, reported cases have
declined steadily. Effective insecticides and generally
improved standards of living have permitted many popula-
tions to free themselves of louse infestation. A human
reservoir of latent infections persists in many parts of the
world and resurgence of the disease might occur under
conditions of war or disaster. Vaccination of any civilian
population in the United States, however, is unwarranted.

TYPHUS VACCINE
Typhus vaccines of the type available today were
first used widely in World War II. There were no deaths
from typhus among vaccinated persons during the North
African campaign, and incidence of disease in the vacci-
nated was reportedly lower than in the .unvaccinated. In
unvaccinated adults, the case-fatality ratio is reported to
be 20 percent or higher.
Although no controlled studies of typhus vaccine
have been carried out in human populations, experience
from the field and the laboratory suggests that the inci-
dence and severity of typhus cases is diminished among
the vaccinated, especially if booster doses have been re-
ceived.
Typhus vaccine is prepared from formaldehyde in-
activated Rickettsia prowazekii grown in embryonated
eggs. This vaccine provides protection against only louse-
borne (epidemic) typhus; it does not protect against marine
or scrub typhus.

RECOMMENDATIONS FOR VACCINE USE
The rarity of epidemic typhus minimizes the need for
vaccination. Typhus is at present no threat to United
States residents visiting most other countries. This is
true even in places still reporting large numbers of cases
if travel is limited to urban areas with modern hotel ac-
commodations. It is only in mountainous, highland, or
areas where a cold climate and other local conditions favor
louse infestation that a potential threat exists.


Vaccination may be indicated for travelers to rural or
remote, highland areas of Ethiopia, Rwanda, Burundi,
Mexico, Ecuador, Bolivia, or Peru, and mountainous areas
of Asia. Even there, however, the risk of typhus for U.S.
travelers is extremely low. No typhus case in an American
traveler is known to have occurred in recent years. Vac-
cination against typhus is not required by any country as
a condition for entry.
Typhus vaccination is suggested only for the follow-
ing special-risk groups:
1) Such persons as scientific investigators (e.g.,
anthropologists, archaeologists, or geologists),
oil-field and construction workers, missionaries,
and some government workers who live in or visit
areas where the disease actually occurs and who
will be in close contact with the indigenous popu-
lation in such areas.
2) Medical personnel, including nurses and attend-
ants, providing care for patients in areas in which
louse-borne (epidemic) typhus occurs.
3) Laboratory personnel working with Rickettsia
prowazekii.

Vaccination Schedule
Vaccine should be injected subcutaneously.
Primary: Two injections of vaccine 4 or more weeks
apart.*
Boosters: A single injection of vaccine at intervals
of 6 to 12 months for as long as opportunity for exposure
exists. The primary series need never be repeated for
booster doses to be effective.

Reactions
Pain and tenderness at the injection site should be
expected. A few individuals have reportedly experienced
exaggerated local reactions and fever, presumably a mani-
festation of hypersensitivity.

Contraindications
As is the case for all vaccines propagated in eggs,
typhus vaccine should not be administered to anyone who
is '-,. .:r -n m i;.,- to eggs.

*Dose volume should be the amount listed by the manufacturer
for adults or for children.


MAY 25, 1968


A reprint of this PHS Advisory Committee Recommendation is available on request from:
National Communicable Disease Center
Atlanta, Georgia 30333
Attn: Information Office







1v2 Morbidity and Mortalily Weekly Report


TABLE I1 CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MAY 25, 1968 AND MAY 27, 1967 (21st WEEK)

ENCEPHALITIS HEPATITIS
ASEPTIC Primary
AR MENINGITIS including MALARIA
unp. cases g Infectious Serum Infectious
unsp. cases
1968 1967 1968 1968 1968 1967 1968 11968 1968 1967 1968
UNITED STATES... 33 49 3 1 16 22 20 82 859 716 22

NEW ENGLAND ......... I 2 3 23 30 -
ine............... 2 1
New Hampshire...... 2
Vermont............- -
Massachusetts...... 2 11 18 -
Rhode Island..... I 2 3 -
Connecticut........ 3 8 6

MIDDLE ATLANTIC...... 3 6 1 1 1 26 131 124 3
New York City...... 2 1 -- 19 53 53 -
New York, up-State. I 1 1 1 3 24 18 1
New Jersey.......... 2 1 1 19 31
Pennsylvania....... 2 3 35 22 2

EAST NORTH CENTRAL... 5 4 4 7 2 1 144 129 3
Ohio............... 1 2 7 1 62 20 -
Indiana............ 1 7 16 2
Illinois........... 2 1 2 1 27 46 1
Michigan............ 2 2 -- 1 38 33 -
Wisconsin ......... 10 14

WEST NORTH CENTRAL... 1 1 77 36 1
Minnesota.............. 21 7 -
Iowa............ ..... 14 2
Missouri........... 35 25
North Dakota....... -
South Dakota ......- -
Nebraska.......... -
Kansas ............. 1 7 2 1

SOUTH ATLANTIC....... 9 4 3 4 2 4 3 74 102 11
Delaware........... 2 1 1
Maryland .......... 1 1 1 13 7 1
Dist. of Columbia.. 1 2 -
Virginia........... 1 3 1 2 30 -
West Virginia...... 2 9 8 -
North Carolina..... 1 5 10 8
South Carolina..... 3 10 -
Georgia ............ 11 11 1
Florida............. 6 2 3 4 2 28 23 -

EAST SOUTH CENTRAL... 4 3 1 2 29 36
Kentucky............ 2 5 9
Tennessee.......... 2 3 1 9 12
Alabama............ 1 2 6
Mississippi....... 13 9

WEST SOUTH CENTRAL... 6 5 1 1 2 3 1 68 59 1
Arkansas........... 1 2 2
Louisiana.......... 4 1 1 1 3 1 12 15
Oklahoma............ 1 3 3 1
Texas.............. 1 5 51 39

MOUNTAIN............. 2 1 26 31
Montana............ 4 2
Idaho.............. 6- 6
Wyoming............. 1 4
Colorado ........... 2 3 7
New Mexico......... 1 6 7
Arizona............ 4 11
itah ............... 2
Nevada .............. -

PACIFIC.............. 5 27 2 6 8 48 287 169 3
Washington......... 2 31 37 -
Oregon.............. -- 1 1 27 13
California......... 4 11 2 6 5 46 229 119 1
Alaska.............- -
Hawaii ............. 1 16 1 2

P- i .... .... 24 13


Hepatitis, infectious: Me. I







Morbidity and Mortality Weekly Report 193


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MAY 25, 1968 AND MAY 27, 1967 (21st WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL
AREA Cumulative Cumulative Total Paralytic
Cum.
1968 1968 1967 1968 1968 1967 1968 1968 1968 1968 1968
UNITED STATES... 717 14,600 48,514 43 1,440 1,227 4,181 1 1 16 2,131

NEW ENGLAND .......... 65 698 638 1 73 56 327 401
Maine ............. 13 196 1 6 3 5 14
New Hampshire...... 1 80 71 7 2 11 6
Vermont............... 1 25 1 9 5
Massachusetts.*.... 29 250 229 32 29 183 173
Rhode Island ....... 1 52 6 3 24 69
Connecticut........ 35 353 65 21 19 95 134

MIDDLE ATLANTIC...... 206 2,373 1,710 9 241 188 286 318
New York City...... 139 915 303 1 47 31 141 146
New York, Up-State. 39 940 375 38 43 NN 45
New Jersey..?...... 24 400 423 6 90 75 145 121
Pennsylvania....... 4 118 609 2 66 39 NN 6

EAST NORTH CENTRAL... 95 3,047 4,054 5 159 145 1,270 650
Ohio................ 3 243 793 3 43 55 68 320
Indiana............ 23 539 504 20 20 86 26
Illinois........... 23 1,188 661 1 38 31 186 85
Michigan............ 11 197 777 1 45 30 443 71
Wisconsin.......... 35 880 1,319 13 9 487 148

WEST NORTH CENTRAL... 14 313 2,287 5 70 56 437 87
Minnesota........... 13 105 16 12 43 6
Iowa................ 4 77 624 1 5 11 317 64
Missouri........... 5 72 211 3 21 12 8 1
North Dakota....... 2 107 726 3 28 16
Soubh Dakota....... 4 46 4 6 NN -
Nebraska........... 3 32 538 6 9 41 -
Kansas............. 8 37 1 15 6 -

SOUTH ATLANTIC....... 43 1,116 5,594 6 309 235 259 170
Delaware............ 9 36 4 5 7 7
Maryland........... 3 69 99 1 19 29 43 9
Dist. of Columbia.. 6 16 11 8 12 -
Virginia........... 1 219 1,750 1 22 23 17 14
West Virginia...... 2 177 1,084 7 19 51 24
North Carolina..... 3 261 798 2 62 47 NN -
South Carolina..... 2 12 425 1 54 23 5
Georgia............. 3 24 57 34 -
Florida............. 32 360 1,362 1 73 47 129 111

EAST SOUTH CENTRAL... 18 416 4,510 5 125 108 173 94
Kentucky........... 4 118 1,122 1 47 30 16 30
Tennessee.......... 1 51 1,555 3 43 46 153 42
Alabama............ 65 1,198 1 17 20 4 22
Mississippi........ 13 182 635 18 12 -

WEST SOUTH CENTRAL... 173 3,895 15,621 7 254 176 343 1 1 8 98
Arkansas........... 2 1,376 15 22 -
Louisiana.......... 2 123 2 66 67 1 8
Oklahoma........... 103 3,294 2 48 11 20 -
Texas............... 173 3,788 10,828 3 125 76 322 1 1 8 90

MOUNTAIN............. 26 738 3,656 22 24 257 82
Montana............ 64 245 2 17 2
Idaho............... 1 12 337 9 1 9
Wyoming............. 4 48 53 1 -
Colorado............ 7 353 1,088 7 10 68 37
New Mexico......... 3 73 526 3 70 11
Arizona............. 11 164 852 1 4 68 29
Utah................ 19 291 3 25 3
Nevada............. 5 264 3 2 -

PACIFIC.............. 77 2,004 10,444 5 187 239 829 8 231
Washington........ 7 470 4,980 2 31 22 263 63
Oregon.............. 12 387 1,367 16 22 58 11
California.......... 57 1,113 3,879 3 130 185 479 8 153
Alaska.............. 1 1 117 8 13 -
Hawaii............... 33 101 10 2 16 4

Puerto Rico.......... 4 293 1,735 1 16 8 44 1
*Delayed reports: Measles: Mass. delete 1, N.J. 27
Mumps: Me. 3
Rubella: Me. 3








194 1Morbidiil and Mortality Weekly Report


TABLE II. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MAY 25, 1968 AND MAY 27, 1967 (21st 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... 8,172 2 46 5 66 5 102 9 32 58 1,569

NEW ENGLAND.......... 1,333 1 32 1 4 2 56
Maine... ........... 23 1 50
New Hampshire......- 2
Vermont ............ 24 32 1 3
Massachusetts...... 165 2 1
Rhode Island........ 82
Connecticut........ 1,039 1 1 2

MIDDLE ATLANTIC...... 504 8 2 3 1 11 3 13
New York City...... 18 4 6 -
New York, Up-State. 483 4 2 3 1 2 9
New Jersey.......... NN -
Pennsylvania....... 3 3 3 4

EAST NORTH CENTRAL... 803 6 4 1 17 1 2 8 131
Ohio*A............. 116 I 11 1 2 52
Indiana............ 153 I 1 4 48
Illinois........... 141 4 2 1 4 1 1 12
Michigan............ 200 1 1 1 8
Wisconsin........... 193 1 1 11

WEST NORTH CENTRAL... 308 2 6 5 1 15 358
Minnesota .......... 20 6 102
Iowa.............. 105 4 66
Missouri........... 18 2 4 3 2 63
North Dakota....... 61 3 58
South Dakota....... 25 1 1 1 34
Nebraska........... 50 1 19
Kansas.............. 29 1 16

SOUTH ATLANTIC....... 824 9 5 2 27 6 23 5 177
Delaware ........... 2 -
Maryland............ 179 4 2 3
Dist. of Columbia.. 18 1 1 -
Virginia........... 214 2 1 1 5 3 13 76
West Virginia....... 143 1 1 22
North Carolina..... 34 2 2 2 3 7 7
South Carolina..... 12 1 1
Georgia............ 23 1 7 3 20
Florida............ 199 2 1 1 8 1 49

EAST SOUTH CENTRAL... 1,123 2 6 5 13 1 2 10 403
Kentucky........... 60 1 1 1 2 6 188
Tennessee.......... 961 2 2 3 8 1 1 2 197
Alabama............ 60 1 2 18
Mississippi......... 42 2 1 3 -

WEST SOUTH CENTRAL... 442 6 3 9 8 1 1 9 292
Arkansas........... 6 1 1 1 33
Louisiana.......... 12 4 1 I 30
Oklahoma........... 12 1 1 1 3 93
Texas.............. 412 2 3 6 5 1 1 5 136

MOUNTAIN............. 1,594 2 8 2 30
Montana ........... 26
Idaho............... 155 -
Wyoming.. .......... 102 1 2
Colorado............ 895 1 2 I
New Mexico......... 149 5 15
Arizona.............. 127 1 12
Utah............... 140 1 -
Nevada ...........- -

PACIFIC.............. 1,241 8 9 7 109
Washington ......... 233
Oregon............. 93 2 1
California......... 851 8 7 7 108
Alaska.............. 44 -
Hawaii ............. 20

Puerto Rico ......... 3 1 13


* D' I ri r i 1. ., 'I.,l


I. I r 1 I









Morbidity and Mortality Weekly Report






TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED MAY 25, 1968


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

All Causes Pneumonia Under All Causes Pneumonia Under
Area r a I I and I year
Area All 65 years and year Area All 65 years Influenza All
Ages and over Influenza AllAges and overInfluena
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.---------
Pew 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.--------


715
262
50
19
26
54
25
29
22
36
58
11
33
28
62

3,338
53
34
141
49
31
48
65
81
1,630
32
591
190
47
104
29
32
61
54
30
36

2,656
69
32
709
145
224
131
78
386
44
50
48
52
39
141
52
155
35
32
41
122
71

814
62
23
38
131
32
124
63
217
81
43


445
160
26
15
18
26
16
14
18
22
37
10
20
20
43

1,907
31
28
79
23
14
27
46
41
946
21
321
99
34
66
17
19
32
25
22
16

1,501
40
21
371
86
112
68
45
213
27
32
28
28
28
78
28
101
21
21
25
87
41

473
43
12
21
74
23
86
26
118
47
23


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


1,136
140
239
45
64
87
45
71
39
86
70
194
56

679
80
73
32
148
159
43
49
95

1,117
40
29
33
172
42
72
204
60
146
80
127
49
63

441
44
21
115
16
113
18
61
53

1,527
14
36
36
46
103
436
72
43
128
65
90
175
33
159
51
40


Total 12,423 6,994 409 661

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 279,081
All Causes, Age 65 and over------------------- 163,536
Pneumonia and Influenza, All Ages------------- 12,839
All Causes, Under 1 Year of Age--------------- 12,545


Week No.
21


590
67
128
14
32
57
26
36
20
72
35
74
29

366
.39
42
17
85
87
22
25
49

579
26
17
21
86
25
37
91
33
67
40
71
30
35

225
19
13
64
11
45
12
33
28

908
12
19
23
13
65
272
46
30
84
38
53
86
15
87
36
29













TULAREMIA ('Continued from page 1!90

these ) patients are four persons who handled muskrats
andl had minimal sIymptoms or denied illness. The lowest
titer in this group of four was 1:12?)0, and no hrucella
agglutinens (whicih can result in serologic cross reactions)
were found and no hi-stories suggesting prior tularemia were
obtained.
Organ homogenates from muskrats shot or found dead
in Addison County \ermont, between April 26 and May 4
hale ieen cultured dirrotly and also inoculated into guinea
pigs lularensis has been recovered from two of the five
mu-skrats processed to date from one 'b direct culture
and from the other after guinea pig inocul at ion.


(Reported by Ionald S. Bicknell. M1.)., VeryenNes, Ver-
monit: L. S. Walker. V.D., Clark Bryant, 4.D., and H. J.
AndreIis, ,M.D., 1.,. '. Vermont; P. G. erriam, l.D.,
Patholooqist, Rutland Hlospital, Rutland, Vermont; Linus J.
Learn'en. .01.. Director. Bureau of Communicable Disease
Control, and Dymitry PIomart D.V.M., Director. Bureau of
Laboratories, Vermont Department of Health; the Bacterial
Chemistry UI l and the Bacterial Serology Unit, Labora-
tory Program, \'('DC and a team from \('l)C.)


THE MORBIDITY AND MORTALITY WEEKLY REPORT. WITH A CIRCULA-
TION OF 17,000, iS'.- .- c rHE NATIONAL COMMUNICABLE
DISEASE CENTER. A'T '. -
DIRECTOR. NATIONAL COMMUNICABLE DISEASE .Lr'rtM
C, u. SENCER, M.D
CHIEF. EPIDEMIOLOGY PROGRAM L i L ANGMUIR, M.D
ACTING CHIEF, STATISTICS SECTION IDA L SHERMAN, M.S.
EDITOR MICHAEL B GREGG M.O

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORT L i ',t NATIONAL COMMU',' L Ci;- 'iC
CENTER WELCOMES :. ., ,. T : T INTERESTING OU- r. ; 41 -c' r iS
INVESTIGATIONS WHICH ARE OF CURRENT 'c AE T t.-ii
OFFICIALS AND WHICH ARE DIRECTLY L Tr '- ,L O T ii.-L
OF COMMUNICABLE DISEASES. SUCH (C,-aI...,N. : a ,,_ jS '.'0,JL, io
ADDRESSED TO:
NATIONAL COMMUNICABLE DISEASE CENTER
ANTA, GEORGIA 30333
ATTN: ';E EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT

NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND AR-
BASED ON WEEKLY TELEGRAMS TO E Cr THE T INDIVDUA.-
STATE HEALTH C i -ia TI'. THE :- r ,r' -E EK CONCLUDED
ON SATURDAY .C M; i. C. L' ON A ~ ,&L i' ARRE RELEASE'
ON THE SUCCEEDING FRIDAY






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Morbidity and Mortality Weekly Report


MAY 25, 1968

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