Morbidity and mortality

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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:
AA00010654:00157

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
I 6 /


rMENT OF HEALTH, EDUCATION, AND WELFARE


Vol. 17, No. 22







_ Week Ending

June 1, 1968




PUBLIC HEALTH SERVICE


HEALTH SERVICES AND VEINT"L HEALTH ADMINISTRATION


EPIDEMIOLOGIC NOTES AND REPORTS
RELAPSING FEVER Washington

In March 1968, relapsing fever developed in 11 of 42
persons in two groups of Boy Scouts (age 11 to 14 years)
and three Boy Scout Leaders who camped at Brown's
Mountain, about 7 miles from Spokane, Washington. Brown's
Mountain in Ponderosa pine and fir tree country has an
elevation of 3,000 feet. The camp site consists of two old,
poorly-kept log cabins a large cabin with a sleeping
capacity for nine and a small cabin with room for four
persons. The two troops (Troops A and B) camped at the
*site on March 2 and March 16, respectively.
The illness was characterized by fever greater than
1030 F., severe headache, prostration, and myalgias (Table 1)


CONTENTS
Epidemiologic Notes and Reports
Relapsing Fever ashington . . 197
Anthrax Massachusetts and Rhode Island ... 198
Suspect Wound Botulism California . 199
Suspect Botulism California. . ... ..199
Current Trends
Measles United States, Puerto Rico, and the
Virgin Islands . .... . 00
Measles Upstate New York ................... 201
Annual Surveillance Summary
Malaria 1967 .................. ......... 201
International Notes
Quarantine Measures ................. . 203
Surveillance Summary
Salmonellosis January, February, and March 1968 .. ..20
which occurred 3 to 9 days after the camp out; no rashes
were noted. The median incubation period was 7 days. The
initial episode of fever lasted from 3 to 6 days and was
followed by one to three relapses. Of the 11 patients.
(Continued on page 198)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
22nd WEEK ENDEDMEDIAN CUMULATIVE, FIRST 22 WEEKS
DISEASE June 1, June 3. 1963 1967 MEDIAN
1968 1967 1968 1967 1963 1967
Aseptic meningitis ...................... 33 23 26 639 639 611
Brucellosis ............................ 3 6 5 64 98 98
Diphtheria................... ........... 1 2 4 70 44 78
Encephalitis, primary:
Arthropod-borne & unspecified ........... 13 26 346 541 --
Encephalitis, post-infectious ............. .10 24 241 378 -
Hepatitis, serum ........................ 72 24 1,692 822
543 17,890
Hepatitis, infectious ................... 818 519 18,598 17068
Malaria ................................ 37 38 3 897 836 43
Measles rubeolaa) ....................... 725 1,671 7,304 15,361 50,185 206,636
Meningococcal infections, total ........... 33 41 44 1,474 1,268 1,400
Civilian ............... .............. 30 37 1,328 1,172 -
Military ............................... 3 4 -- 146 96 -
Mumps ................................. 3,353 105,664 -
Poliomyelitis, total ..................... 1 1 1 17 10 13
Paralytic ............................. 1 1 1 17 9 11
Rubella (German measles) ............... 1,694 1,991 34,469 31,063 -
Streptococcal sore throat & scarlet fever... 7,454 7,907 6,504 232,390 252,078 226,621
Tetanus ............................... 5 6 4 51 66 85
Tularemia .............................. 10 1 3 76 62 86
Typhoid fever .......................... 5 1 3 107 134 147
Typhus, tick-borne (Rky. Mt. spotted fever) 13 8 6 45 43 29
Rabies in animals ....................... 45 76 76 1.614 1.967 1,967

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
A nthrax: ........................................... 2 R abies in m an: ..................................... -
Botulism: .......................................... Rubella, Congenital Syndrome: ......................... 3
Leptospirosis: ...................................... 12 Trichinosis: Ohio-i ................... .............. 26
Plague: .......................................... Typhus, marine: ........ ............................ 5
Psittacosis: Mont.-l, Ohio-1 ................ ......... 16





Morbidity and Mortality Weekly Report


RELAPSING FEVER (Continued from front page)


Table 1
Symptoms During Initial Episode of Relapsing
Fever in 11 Cases, Washington, March 1968

Sy mptomi Numbter

Feer (al bo eI 10 3 F.) 11
Prostrat ion 11
Headache 10
\Myal gias
Cough 1
Sore Throat 1
Nausea and Vomiting 1
Diarrhea 1

three had 1 relapse of fe\or. five had two relapses, and
one had three relapses of fever: two patients had no re-
lapses after the initial episode. Each success\ e relapse
tended to become shorter in duration, and conversely, the
afebrile periods between relapses became longer with each
succeed ng occurrence.
Differential attack rates Ib sleeping location showed
that nine of 12 persons (75 percent) who had slept in the
large cabin on the two occasions became ill. However,
only one of 22 persons who camped in tents on the two
camp outs contracted the illness (Table 2).
Laboratory investigation identified typical spirochetes
on a iWright stained blood smear from one patient during
his second relapse. The white blood cell counts for eight
patients who had these performed were uniformly] within
(he normal range (nean 7.000)). Differential counts showed
no preponderance of lymphocytes or polymorphonuclear
liulkocytes. Serologic tests performed for Colorado tick
fever and Rocky M*ountain spotted fever antibodies were-
negati e, and heterophile tests for infectious mononucleosis
n-eri nepgatlie.
Investigation of the Brown's Mountain camp site re-
vialed that the general area abounds with ground squirrels


(Citellus), and burrows were seen in numerous places a;
the camp site. including under the cabins. Large roden-
nests were found in a small basement of the large cabin
and in the attics of both cabins. Thirteen ticks of the
genus Ornithodoros were collected from the rodent nest-
ing material and the rotting \ alls of the cabins. All 13
ticks have been examined at the Rocky Mountain Labora-
tory. Hamilton. Montana, and identified as 0. herrsi; two
were found infected with Borrelia by feeding experiments
Results on the other ticks are pending.

(Reported by Byron J. Francis, I.D.. Acting Chief, iDii-
sion of Epidemiology, and Roy W. .?. *.. Advisory Sani
tarian, Division of Enrironmental Servicr s Wa11shington
State Department of Health; Stuart A. Daris,. M.P., Spo
kane City Health Officer; E. 0. Ploeger, M.D., M.P.1H.
Spokane County Health Officer; W. Burgdorfer, Ph.D.. Re,
search Entomologist medicall). Rocky Mountain Labora
toryH,IAD, Hannton. Montana; and an EIS i.'.'',* r.


Editorial Note
The following cases of tick-borne relapsing fever'
have been reported to NCDC since 1960:

No. of Cases by State
Year
California Nevada Oregon Texa-

1960 6 1 3
1961 8 1
1962 1 -
1963 -
1961 -
1965 -
1966 5 -

*It should be noted that tick-borne relapsin. fever is an option.
ally reported disease.


Table 2
Attack Rates for 11 Cases of Relapsing Fever by Sleeping Location
Washington March 1968

Troop A Troop B Total

Attack Attack Attack
Number of Number Rate Number of Number Rate Number of Number Rate
Persons III Percnt Persons Ill Percent Persons I11 Percent

Group in Large Cabin h 6 75 4 3 75 12 9 75
Group in Small Cabin 4 0 0 1 1 25 8 1 13
Group in Tents 0 0 0 ) 5 22 1 5 22 1 5

Whole Group 12 6 50 30 5 17 42 11 26


ANTHRAX Massachusetts and Rhode Island


A confirmed case of anthrax occurred in a 47-year-
olt female employee of a combing mill in Massachusetts.
The patient who lived in Rhode Island noted a small


prurilic painless pimple on the lateral aspect of her riglt
forearm on April 14. Over the next week the lesion in-
creased in size. She was seen by a physician on April 23


JUNE 1, 1968







JUNE 1, 1968


Morbidity and Mortali


who obtained a culture from the lesion and began the
patient on penicillin and teir,,i i lin,-. At that time the
entire forearm was swollen and a rim of blisters surrounded
the lesion. Tender right axillary lymphadenopathy was
also present. Over the next 10 days the patient gradually
improved. The culture taken on April 23 was positive for
Bacillus anthracis.
The combing mill in Massachusetts which employs
35 persons has never reported a case of anthrax in its
23-year history. It produces an alpaca "top" which is
sent to local knitting mills and also washes imported
Asian cashmere and camel hair which are rebaled and then
processed by other companies. All 130 surface swab sam-
ples taken at the mill were negative for B. anthracis.
However, hair samples of cashmere yielded B. anthracis
while samples of alpaca and camel hair were negative.


ty Weekly Report 199


(Reported by Heinrich Brugsch, M.D., Occupational
Hygiene Physician, Department of Labor and Industries,
Commonwealth of Massachusetts; and Joseph E. Cannon,
M.D., Director of Health, Rhode Island Department of
Health; and a team of EIS Officers.)
Editorial Note
Laboratory investigation points to imported cashmere.
a hair product implicated in other cases of anthrax, as the
most likely source of infection. Alpaca may have become
contaminated in the washing tanks since the same bath is
used at other times to scour cashmere. Prior studies in
goat hair mills have shown that B. anthracis distributes
well in scouring tanks.1
Reference:
Brachman, P. S.. Plotkin, S. A., Bumlord, F. H., and Atchison,
M. M.: An epidemic of inhalation anthrax, the first in the 20th
century. II. Epidemiology. Amer J Ilyg 72:6, 1960.


SUSPECT WOUND BOTULISM California


A case of probable botulism due to a wound infection
with Clostridium botulinum has been reported from Fresno.
California. On May 3,1968, a 44-year-old male farm laborer
fell from a haystack and sustained a compound fracture
of his left wrist. The same day as the accident the wound
was surgically debrided and the fracture reduced.
On May 10, the patient complained of "fullness in his
throat," difficulty in swallowfig, and difficulty in sleep-
ing because of the accumulation of secretions in his mouth.
On May 12, the patient developed diplopia and impaired
vision, and was hospitalized. These symptoms persisted,
and in addition, the patient developed blurred vision,
paralysis of lateral gaze, and ptosis. At one time, anisocoria
was noted, but the pupils remained reactive. Facial mus-
cles, masseters, pharyngeal, laryngeal, and sternocleido-
mastoid muscles progressively weakened, and respiratory
difficulty developed which required a tra'cheostomy. Mus-
cles of the upper and lower limbs weakened although deep
tendon reflexes remained normal. No sensory impairment
was noted. Blood counts, serum chemistries, cerebrospinal
fluid studies, electrocardiogram, and electroencephalogram
were all within normal limits.
The patient's food history revealed no likely vehicle
for botulinum toxin. The wound at the fracture site showed
no sign of infection, and radiologic examination showed
no evidence of gas formation in the surrounding tissues.
The wound site was cultured, and results are pending.
Bioassay of the patient's serum revealed no evidence of
circulating botulinum toxin. A clinical diagnosis of botu-
lism probably resulting from wound infection with C. botu-
linum was made. The patient was given polyvalent A, B,


E, and F botulinum antitoxin on May 17, and has sub-
sequently improved.

(Reported by Philip K. Condit, M.D., M.P.H., Chief, Bureau
of Communicable Diseases, California State Department
of Public Health; William Defries, M.D., Health Officer,
Fresno County Health Department; Fresno General Hos-
pital; and an EIS Officer.)

Editorial Note
Botulism resulting from wound infection with C. botu-
linum is rare. Three case reports of wound botulism have
been reported in the United States: all were due to C. botu-
linum type A and all three patients died.l *,2 One case
resulted from infection of a compound fracture, one re-
sulted from infection of a gunshot wound, and another
resulted from infection of a deep laceration. In each case,
the wound was grossly purulent, and in two of the cases
the wounds were also infected with other organisms.
The clinical course of this case is consistent with a
diagnosis of botulism. Confirmation of the diagnosis of
wound botulism depends on the results of cultures now in
progress. The negative serum bioassay does not exclude
the diagnosis since the serum was obtained 7 days after
onset of symptoms.
References:
1Davis, J. B., Malman, L. H., and \'iley, M.:Clostridium botu-
linum in a fatal wound infection. JAMA 146:646-648. 1951.
lHampson, C. R.: A case of probable botulism due to wound
infection. J Bact 61:647, 1951.
3Thomas, C. G.. Koleher, M. F., and McKee, A. P.: Botulism,
a complication of Clostridium botulinum wound infection. AMA
Arch Path 51:623-62S. 1951.


SUSPECT BOTULISM California


On May 16, 1968, a 21-year-old female in San Bernardino,
California, developed headache, sore throat, and blurring
of vision. Over the next 2 days she became short of breath.
had difficulty in swallowing with inability to protrude her
tongue, and developed weakness of all four extremities.
On May 19, she was hospitalized.


On admission the patient was semicomatose and had
difficulty in responding to simple commands, keeping her
eyes open. and moving her extremities. There was weak-
ness of all extra-ocular muscles with marked limitation of


(Continued on page 200)






Morbidity and Mortality Weekly Report


SUSPECT BOTULISM (Continued from page 199)


left lateral gaze. A lumbar puncture performed on admis-
sion a-s within normal limits. On May 20. the patient
de etloped respiratory arrest and a tracheostomy w as per-
formed.
On May 20, the patient received 10l0()(00 units of
types A and B antitoxin. She has since recovered some
strength in her extremiiies and ocular muscles.
A history subsequently obtained from the patient's
famiily disclosed that the patient prepared homemade soup
from home-canned \egetables at her grandmother's home in
Lancaster. California. on May 14. The contents of one
can smelled unusual. The patient tasted the vegetables .
thought they tasted Iad. and discarded the can and vege-


tables. The soup which was made from other cans of vege-
tables was eaten by the rest of the family, and all have
remained well.
Bioassay of the patient's serum which was obtained
before the antitoxin was given was negative for botulinum
toxin. The can of vegetables that the patient tasted and
discarded could not be found; the other vegetables yielded
no (lostridium botulinum when cultured.
(Reported by Philip Condit, lM.I., M.P.H., Chief, Bureau
of Communicable Diseases, California State Department
of Public Health; Mterle Cosand, M.I., Health *.'r,',,
and Mildred Scott. ./D., Assistant Health ."'... San
Bernardino County Health Department; and an EIS ,if'- '.)


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


During the 4-ixeek period. April 21 through May lb.
196b. (weeks 17-20). measles was reported from 3:1 coun-
ties or health districts in the United States. whereas 700
counties or health districts reported measle- cases (luring
the comparable 4-week period in 1967. Of these 3:l areas.
hS (22 percent) reported a total of 10 or more cases (Fig-
ure 1) as contrasted with 222 of 700 counties (32 percent)
reporting a similar number of cases during the correspond-
ing --neek period of 1967 (Figure 2). In addition, the
percentage of areas reporting only a single case of mea-
-les during this 4-week period in 196b increased to 33
percent from the 25 percent which had been recorded dur-
ing the comparable period in 1967.
.AI nine geographic divisions showed a decrease in
the number of counties or health districts reporting mea-
sles during the 4-week period. April 21 *l-...i,.h May Ih,
196h. from thos-c reporting in the corresponding 4-week
period in 1967 (Table 3). However. two divisions (New\
England and Middle Atlantic) showed an increase in the
number of counties or health districts reporting a total of
10 or more cases in this 4-week period in 196s over the
comparable 4-week period in 1967. The states of Connecti-
cut and New York were primarily responsible for the in-
creases.
Figure 1
COUNTIES OR HEALTH DISTRICTS REPORTING A TOTAL
OF 10 OR MORE CASES OF MEASLES
APRIL 21 THROUGH MAY 18, 1968


c d


-
'al


' ,I


U.


,1 I

a. '


p..


4 ( ~


Table 3
Number of Counties or Health Districts Reporting Measles
During Weeks 17-20, 1967 and 1968, by Geographic Divisions

Number of Counties or
Health Districts Reporting:
1 or more cases Total of
10 or moe ascase
Geographic 196i 1967 196b 1967
Di ision April 21- April 23- r 21- April 23-
May Ih May 20 May 18 May 20

United States 3hl 700 84 222
New England 17 28 7 4
Middle Atlantic .16 54 15 11
East North Central 75 104 14 25
West North Central 23 56 2 12
South Atlantic 39 99 5 25
East South Central 24 65 2 20
\est South Central 67 119 19 46
Mountain 29 79 9 27
Pacific 61 96 11 52

Puerto Rico 4 5 3 0
Virgin Islands 1

Figure 2
COUNTIES OR HEALTH DISTRICTS REPORTING A TOTAL
OF 10 OR MORE CASES OF MEASLES*
S_ APRIL 23 THROUGH MAY 30, 1967


* rP


..r k.


--L
- *- % ;,
7


21111


JUNE 1, 1968






Morbidity and Mortality Weekly Report


There were 24 states recording counties reporting a
total of 10 or more cases in this 4-week period in 1968
(weeks 17-20) as compared with 40 states recording coun-
ties reporting a total of 10 or more cases in the compara-
ble 4-week period in 1967. Of these 24 states, 7 (29 per-
cent) had only one county reporting a total of 10 or more
cases, as contrasted with 8 of 40 states (20 percent) with
only one county or health district -.,p:r;rirn a total of 10
or more cases during the corresponding 4-week period in
1967.


Measles cases were reported from four of the five
health districts in Puerto Rico during the 4-week period,
April 21 through May 18, 1968; however, only three health
districts reported a total of 10 or more cases (Table 3).
All five health districts reported a total of 10 or more
cases in the comparable 4-week period in 1967. No cases
of measles were reported from the Virgin Islands during
weeks 17-20, 1968 but four cases were reported in the
corresponding 4-week period in 1967.
(Reported by State Services Section and Statistics Section.)


MEASLES Upstate New York


During the first 6 months of epidemiologic year 1967-
68, 885 cases of measles were reported in Upstate New
York (New York State exclusive of New York City). For
the corresponding periods in 1966-67, 407 cases were re-
ported and in 1965-66, 1,836 cases were reported (Figure 3).
Approximately 20 percent of the measles cases reported in
Upstate New York during the current epidemiologic year
occurred in preschool children (Table 4).

Figure 3
REPORTED MEASLES CASES BY MONTH
UPSTATE NEW YORK
EPIDEMIOLOGIC YEARS 1965-1966, 1966-1967, 1967-1968
600
1......... 965-1966
--- 1966-1967


S-- 1967-1968


/ / -


I V---- \

"I
...'. f






!" \
ai;


NOV. DEC. JAN. FEB. MAR. APR. MAY JUN. JUL. AUG. SEP. OCT.
MONTH


Table 4
Reported Measles Cases by Age,
Upstate New York, November 1967 April 1968

Age Group Cases Upstate Cases in
(Years) New York Five Counties*

Under 1 22 15
1-4 158 121
5-9 555 422
10-14 112 86
15 and over 31 17
Unknown 7 0

Total 885 661
*Albany, Columbia, Monroe, Oneida, and Onondaga

Of the cases reported this year in Upstate NewYork,
75 percent were reported from five counties: Albany County -
154 cases, Columbia- 71 cases, Monroe- 54, Oneida- 317,
and Onondaga 65. However, these same five counties in
1965-66 and 1966-67, reported only 2 percent and 13 per-
cent, respectively, of the cases reported in Upstate New
York. These five counties represent 18 percent of the Up-
state New York population (1960 census).
Between September 1965 and March 1968, the Vacci-
nation Assistance Unit of the New York State Health De-
partment distributed 490,217 doses of measles vaccine in
Upstate New York and of these approximately 88,000 doses
were distributed in Albany, Columbia, Monroe, Oneida,
and Onondaga Counties.
(Reported by Julia L. Freitag, M.D., Director, Bureau of
Epidemiology, New York State Health Department; and
an EIS C'". -.)


ANNUAL SURVEILLANCE SUMMARY
MALARIA 1967


The Malaria Surveillance Unit of the NCDC has re-
ceived epidemiologic information on 2,815 cases of malaria
with onset of illness in 1967 in the United States and
Puerto Rico. This is the largest number of cases recorded
in the United States for any year since 1952. Military
personnel (including recently discharged veterans) ac-
counted for 2,669 cases, and nonmilitary persons (civilians)
accounted for 146 cases. The number of civilian cases
has shown only a relatively slight increase but the num-
ber of military associated cases has increased fivefold


as compared with 1966 (Figure 4). Of the 2,815 cases, all
but seven acquired the infection abroad. These seven
cases were classified as introduced (2), congenital (1),
induced (3), and cryptic (1).*
Although malaria patients had the onset of illness in
all but one of the states, the geographic distribution of
cases showed marked concentrations in California, Colo-
rado, Georgia, Kentucky, North Carolina, and Texas due
to the location in these states of major military centers.
(Continued on page 202)


JUNE 1, 1968


500-


400-



300,

200

200-


1001






Morbidity and Mortality Weekly Report


MALARIA (Continued from page 0OI)


sooo,


soo
$000
2000







500


Figure 4
MILITARY AND CIVILIAN CASES OF MALARIA
UNITED STATES, 1956-1967


956 1595 195 199 1960 1961 1962 i963 1964 1965 196M 1967

Of all cases, 80 percent occurred in males in the 20-
29 year age group, reflecting the large number of military
cases. Malaria in females occurred only in the nonmilitary
group, of which they comprised 29 percent.
As shown in Table 5, the Plasmodium species was
identified in 2,735 of the 2,815 cases (97.2 percent).
Plasmodium rivax was diagnosed in 81 percent and P. fal-
ciparumi in 13 percent of the infections. This compares
with 56 percent and 33 percent, respectively, in 1966
(MMWR, Vol. 16, No. 25). The number of cases due to


MLITAry
colml. -


Figure 5
EPIDEMIOLOGIC ASSESSMENT OF STATUS OF MALARIA
JUNE 30, 1967*


i AREAS IN WHICH MALARIA HAS DISAPPEARED. _
BEEN ERADICATED, OR NEVER EXISTED

I. .. i_ AREAS IN CONSOLIDATION PHASE

AREAS WHERE MALARIA TRANSMISSION OCCURS OR MIGHT OCCUR

'WHO Wrekly EpdemIolog.c Record, 43:(5174-75. Feb. 2, 1968.


202


JUNE 1, 1968


,
-=---


Table 5
Cases of Malaria by Plasmodium Species
United States, 1967
Species Total Percent

P. vivax 2,290 81.4
P. falciparum 362 12.9
P. malariae 19 0.7
P. ovale 18 0.6
Mixed Infections 46 1.6
Undetermined 80 2.8

Total -. h 100.0

P. ovale increased to 18 from the 13 cases reported in
1966. In 1967, 19 cases of P. malaria were reported as
compared with 12 in 1966.
The onset of illness occurred within 30 days after
arrival in the United States in only 20 percent of the 2,563
cases for which both date of onset and date of arrival are
known. A marked difference in this interval is apparent in
vivax and falciparum malaria: 56 percent of the falciparum
cases occurred within 1 month after arrival as compared
with only 15 percent of the vivax cases.
Former Peace Corps Volunteers and foreign visitors
to the United States accounted for 48 percent of the 146
civilian cases. In 1967, 21 cases occurred in former Peace


-,/


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C ~

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,r.






JUNE 1, 1968


Morbidity and Mortali


Corps Volunteers as compared with 30 in 1966 and 17 in
1965. All but two of the 21 Volunteers had been stationed
in West Africa. Of the 146 civilian cases, 49 were reported
in foreign visitors to the United States. This compares
with 30 cases in 1966 and 19 in 1965 in foreign visitors.
Malaria infections acquired in Vietnam accounted for
2,629 of the 2,808 imported cases (93.6 percent). P. vivax
was the etiologic agent in 2,175 of these 2,629 cases
(82.7 percent), P. falciparum in 329 cases (12.5 : i-. cr i.
P. malariae in 12 cases (0.5 percent), and P. ovale was
found in only one case. Mixed infections were diagnosed
in 44 cases (1.7 percent), and the Plasmodium species was
not identified in 68 cases (2.6 percent). A history of
malaria while in Vietnam was given in 48 percent of the
cases. In 267 persons, the malaria infection acquired in
Vietnam did not result in clinical illness until after dis-
charge from the military service.
In 1967, two deaths, both due to P. falciparum, were
reported. One of these occurred in a serviceman who had
acquired his infection in Vietnam (MMWR, Vol. 17, No. 13).
The other fatal case involved a civilian airline flight
engineer who had acquired his infection in West Africa
(MMWR, Vol. 17, No. 4).
Only seven malaria cases acquired their infection in
the United States. Two cases of introduced malaria oc-
curred in servicemen at Ft. Campbell, Kentucky, in June-
July 1967; the etiologic agent was P. vivax (MMWR, Vol.
16, No. 29), One case of congenital malaria due to P. ma-
lariae was detected in an infant in California (MMWR,
Vol. 16, No. 37). A case of induced falciparum malaria
occurred in a 62-year-old man in San Francisco following
a blood transfusion (MMWR, Vol. 16, No. 15); a post-
transfusion case of ovale malaria was diagnosed in a 55-
year-old woman in New York City, and an infant in Con-
necticut acquired a P. malariae infection following an


ity Weekly Report 203


exchange transfusion ,''1I\R., Vol. 16, No. 50). A case
classified as cryptic occurred in a 41-year-old man in
Bowling Green, Kentucky (MMWR, Vol. 16, No. 35).
(Reported by Malaria Surveillance Unit, Parasitic Diseases
Section, Epidemiology '. ,..-. -. NCDC.)

Editorial Comment
The occurrence of malaria in the United States among
individuals who have resided in malarious areas suggests
that some travelers neglect to use chemoprophylactic
drugs. In the countries indicated on the map (Figure 5),
malaria is still sufficiently widespread to warrant prophy-
laxis. A weekly dose of 300 mg chloroquine base taken
orally starting the week prior to exposure and continuing
at least 4 weeks after leaving the endemic area is recom-
mended. This will provide protection against P. falciparum
infections with the exception of those strains which have
acquired resistance to the drug. Infections caused by
P. vivax, P. malariae, and P. ovale will be suppressed by
this regimen and the possibility of clinical malaria devel-
oping after cessation of chemoprophylaxis must be recog-
nized. In this event, therapy with chloroquine followed
by 15 mg primaquine base orally once a day for 14 days
will eliminate the parasite in most cases.

Reference:
1 worldd Health Organization: Chemotherapy of Malaria. WHO
Technical Report No. 375, Geneva, 1967.

*Malaria Terminology
Introduced malaria acquired by mosquito transmission con-
tracted from an imported case in an area where malaria is not
a regular occurrence.
Induced malaria acquired through artificial means, i.e.,
malario-therapy, blood transfusion, common syringes.
Cryptic an isolated case of malaria, not associated with
secondary cases, as determined through appropriate epidemio-
logic investigation.


A copy of the original report from which these data were derived is available on request from:
National Communicable Disease Center
Atlanta, Georgia 30333
Attn: Chief, Malaria Surveillance Unit,
Parasitic Diseases Section, Epidemiology Program


INTERNATIONAL NOTES
QUARANTINE MEASURES


Additional Immunization Information for International
Travel, 1967-68 edition, Public Health Service
Publication No. 384

The following information should be included in Section 5:
ASIA
Qatar Page 61
Under cholera, after "1 year of age and over", delete all
information and insert: Vaccination certificate is required


of all arrivals from West Pakistan. The certificate must
show two injections at an interval of 1 week.


Union of Soviet Socialist Republics-Pages 63 and 74
In the note concerning cholera, insert: Afghanistan, and
Malaysia.*

*Conformity of this measure with the Regulations may be open
to question and th world health Organization is in communi-
cation with the health administration concerned.







201 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 1, 1968 AND JUNE 3, 1967 (22nd WEEK)

ENCEPHALITIS HEPATITIS
ASEPTIC Primary
AREA MENINGITIS including infectious Serum Infectious MALARIA
unsp. cases
,4r 14. I, II-r I r' tJ I r- r I"ro I I -' r 1 .8
.. :: t r.u i., .. .i- I 'I I i- I I -, j


NEW ENGLAND.......... 1 2 6 34 29 I
Maine... .......... 6
New Hampshire...... -
Vermont....... .....
Massachusetts.... 2 15 7
Rhode Island....... 1 10 4
Connecticut........ 5 9 12 1

MIDDLE ATLANTIC...... 3 2 1 4 17 105 69 4
New York City...... 1 11 34 18
New York, up-Statet 1 1 1 18 26
New Jersey......... 1 3 30 12
Pennsylvania ....... 2 3 2 23 13 4

EAST NORTH CENTRAL... 4 2 4 7 2 199 92 2
Ohio................ 2 1 2 2 1 44 17 1
Indiana ............ 2 12 5 -
Illinois........... 1 26 32 1
Michigan........... 2 4 1 109 19
Wisconsin.......... I 8 19

WEST NORTH CENTRAL... 1 1 1 1 30 22 4
Minnesota........... 1 4 2 -
Iowa ............... 1 5 2
Missouri............ 3 14 1
North Dakota....... I -
South Dakota ...... 3 -
Nebraska ........... 3 -
Kansas............. -- 1 12 3 3

SOUTH ATLANTIC....... 4 4 1 2 4 4 10 84 64 16
Delaware........... 4 10 -
Maryland............ -- 10 9
Dist. of Columbia.. 1-
Virginia........... 1 2 9 1
West Virginia...... 2 4 4
North Carolina..... 1 1 5 6 3
South Carolina..... 1
Georgia............- 39 14 9
Florida............ 2 2 1 1 4 10 13 20 3

EAST SOUTH CENTRAL... 1 4 1 3 1 54 29 2
Kentucky ........... 1 26 10 -
Tennessee.......... 1 1 1 15 14
Alabama............ 1 2 2 2
Mississippi........ 2 1 11 5 -

WEST SOUTH CENTRAL... 6 3 1 2 1 1 73 66 3
Arkansas...........,. 2 -
Louisiana.......... 3 1 2 1 14 8
Oklahoma........... 16 2 3
Texas.............. 3 2 1 1 41 56

MOUNTAIN............. 2 42 15 1
Montana............ 10
Idaho............. -
Wyoming............... 1 4
Colorado........... 1 2 16 3 1
New Mexico......... 3 3
Arizona............ 4 3
Utah ............... -- 8 2
Nevada............. -

PACIFIC.............. 12 8 1 1 5 1 38 197 133 4
Washington.......... I 27 18 2
Oregon............. 1 7 10
California......... 10 5 1 1 3 1 38 163 104 2
Alaska............. 1 -
Hawaii ............. 2 3

Puerto Rico. ...... 18 14 1

S 1 F I








Morbidity and Mortality Weekly Report 205


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 1, 1968 AND JUNE 3, 1967 (22nd 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... 725 15,361 50,185 33 1,474 1,268 3,353 1 1 17 1,694

NEW ENGLAND.......... 80 775 670 2 75 56 297 341
Maine.. .*........... 13 205 6 3 2 6
New Hampshire....... 80 71 7 2 15 7
Vermont............ 1 28 I 3 -
Massachusetts. *.... 32 279 240 1 33 29 170 152
Rhode Island....... 1 57 1 7 3 28 59
Connecticut........ 48 401 69 21 19 79 117

MIDDLE ATLANTIC ...... 201 2,574 1,811 6 247 195 169 265
New York City...... 128 1,043 317 47 32 129 175
New York, Up-State. 25 965 391 2 40 46 NN 37
New Jersey......... 40 440 430 90 78 40 51
Pennsylvania....... 8 126 673 4 70 39 NN 2

EAST NORTH CENTRAL... 126 3,173 4,278 5 164 152 1,012 324
Ohio................ 9 252 833 1 44 56 48 96
Indiana............ 25 564 523 1 21 20 81 35
Illinois........... 13 1,201 765 1 39 35 66 24
Michigan........... 5 202 790 2 47 32 371 58
Wisconsin.......... 74 954 1,367 13 9 446 111

WEST NORTH CENTRAL... 4 317 2,426 6 76 57 458 142
Minnesota...... .... 13 110 1 17 12 25 1
Iowa............... 77 685 5 12 274 115
Missouri........... 1 73 212 5 26 12 116 16
North Dakota........ 2 109 756 3 18 10
South Dakota....... 4 46 4 6 NN -
Nebraska............ 1 33 555 6 9 25
Kansas. *........... 8 62 15 6

SOUTH ATLANTIC....... 21 1,136 5,820 3 312 242 134 109
Delaware... ........ 3 .1 36 4 5 5 8
Maryland........... 3 72 109 2 21 29 27 9
Dist. of Columbia.. 6 19 11 8
Virginia........... 9 228 1,796 22 24 29 27
West Virginia...... 4 181 1,144 7 19 38 36
North Carolina..... 1 262 808 62 48 NN -
South Carolina..... 12 434 54 23 6 1
Georgia.............. 3 24 1 58 39 -
Florida............. 1 361 1,450 73 47 29 28

EAST SOUTH CENTRAL... 6 462 4,551 2 128 111 90 60
Kentucky.. ........ 1 159 1,136 1 48 30 29 16
Tennessee.......... 2 53 1,578 1 44 47 57 44
Alabama... ........ 1 66 1,200 18 22 2 -
Mississippi........ 2 184 637 18 12 2 -

WEST SOUTH CENTRAL... 160 4,055 15,964 1 255 183 270 1 1 9 104
Arkansas........... 2 1,379 15 23 -
Louisiana.......... 2 137 1 67 71 8 2
Oklahoma............ 103 3,299 48 12 13 -
Texas............... 160 3,948 11,149 125 77 249 1 1 9 102

MOUNTAIN............. 46 784 3,806 2 24 24 201 63
Montana............ 1 65 248 2 9 -
Idaho .............. 12 343 1 10 1 1 10
Wyoming............. 48 54 1- -
Colorado............ 37 390 1,201 7 10 94 22
New Mexico.......... 4 77 530 3 17 2
Arizona............. 4 168 863 1 4 67 23
Utah............... 19 303 1 1 3 13 6
Nevada............. 5 264 3 2 -

PACIFIC.............. 81 2,085 10,859 6 193 248 722 8 286
Washington.......... 18 488 5,142 1 32 23 173 59
Oregon.............. 17 404 1,412 16 24 25 11
California......... 45 1,158 4,081 5 135 191 488 8 205
Alaska.............. 1 120 8 16 4
Hawaii.............. 1 34 104 10 2 20 7

Puerto Rico.......... 9 302 1,766 16 8 8 3
*Delayed reports: Measles: Mass. delete 3, Del. delete 1, Ky. 40
Meningococcal infections: Ala. 1
Mumps: Kans. 60
Rubella: Me. 11







206 Morbidity and Mortality Weekly Report


TABLE Ill. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 1, 1968 AND JUNE 3, 1967 (22nd 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... 7,454 5 51 10 76 5 107 13 45 45 1,614

NEW ENGLAND............ 1,214 1 8 40 4 2 58
Maine..*........... 11 50
New Hampshire...... 2 2
Vermont............ 8 40 2 5
Massachusetts...... 163 2 1
Rhode Island....... 138 -
Connecticut........ 900 1 -

MIDDLE ATLANTIC...... 771 1 9 3 11 1 4 1 14
New York City...... 26 1 5 6 -
New York, Up-State. 268 4 3 2 1 1 1 10
New Jersey......... NN -
Pennsylvania....... 477 3 3 4

EAST NORTH CENTRAL... 541 6 4 1 18 2 6 137
Ohio................ 108 1 11 1 52
Indiana............ 105 1 1 5 53
Illinois........... 79 4 -2 1 5 1 1 13
Michigan ........... 123 1 1 8
Wisconsin.......... 126 11

WEST NORTH CENTRAL... 274 2 6 5 1 2 8 366
Minnesota.......... 29 3 105
Iowa............... 126 2 68
Missouri........... 42 2 4 3 1 64
North Dakota....... 34 1 59
Snurh D.kola....... 17 1 1 34
Nebraska........... 3 1 1 1 19
Kansas............. 23 1 1 17

SOUTH ATLANTIC....... 688 2 11 5 2 29 5 28 5 182
Delaware ........... 2 -
Maryland........... 129 4 2 3
Dist. of Columbia.. 7 1 -
Virginia........... 255 2 1 1 6 2 15 1 77
West Virginia...... 109 1 I 2 24
North Carolina..... 5 2 2 2 7 7
South Carolina..... 33 1 I
Georgia............ 5 1 7 2 2 2 22
Florida............ 123 2 4 1 1 9 I 1 49

EAST SOUTH CENTRAL... 885 1 7 1 6 13 2 4 4 407
Kentucky........... 92 1 1 2 4 192
Tennessee .......... 695 2 1 4 8 1 2 197
Alabama............ 44 1 2 1 1 18
Mississippi........ 54 2 1 3 1

WEST SOUTH CENTRAL... 434 1 7 9 8 3 4 6 298
Arkansas........... 9 1 1 1 1 33
Louisiana.......... 3 4 1 1 30
Oklahoma ........... 29 1 1 3 3 2 95
Texas............. 393 2 6 5 1 4 140

MOUNTAIN ............. 1,478 1 3 8 1 1 5 35
Montana ............ 19 -
Idaho.............. 58 2
Wyoming.. ....... 16 1
Colorado.......... 1,151 1 2 1 1 1
New Mexico......... 79 5 1 16
Arizona........... 107 4 16
Utah .............. 48 1 2 -
Nevada.............

PACIFIC.............. 1,189 8 2 11 8 117
Washington......... 256 -
Oregon.............. 96 2 2 3
California......... 640 8 2 9 6 114
Alaska............. 28 -
Hawaii............. 169

Puerto Rico......... 4 1 2 15
*Delayed reports: SST: Me. 19, Wyo. 13







Morbidity and Mortality Weekly Report


207


Week No. TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED JUNE 1, 1968
22
(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 a Area All 65 years and 1 year
Ages and over Influenza All Age 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.--------


678
211
38
23
36
50
25
17
19
56
71
7
35
26
64

3,074
27
37
123
38
25
32
56
51
1,655
27
474
S174
43
88
18
33
60
49 "
29
35

2,306
61
32
657
137
181
110
58
362
40
57
41
30
25
144
20
95
36
37
37
91
55

676
41
19
53
96
24
86
56
194
64
43


420
110
27
17
22
30
20
11
11
34
47
5
16
20
50

1,824
21
24
76
12
12
23
29
25
980
16
268
95
29
61
11
S23
44
29
19
27

1,304
38
J7
374
80
90
67
32
198
28
23
24
14
16
79
6
66
25
20
17
55
35

423
32
16
31
55
18
51
36
118
36
30


*Estimate based on average percent of divisional total.


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.-------
Ch$' rnooga, Tenn.-----
Knoxv_ le, Tenn.-------
Louis !le, 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


1,001
115
188
52
83
79
42
88
24
63
69
170
28

552
101
27
39
98
114
55
28
90

997
37
43
20
158
36
55
164
46
177
74
96
51
40

348
33
21
85
16
91
11
38
53

1,306
15
48
24
48
73
339
80
40
112
61
74
141
30
133
63
25


I 4 4 i


10,938 6,243


Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 290,019
All Causes, Age 65 and over------------------- 169,779
Pneumonia and Influenza, All Ages------------ 13,162
All Causes, Under 1 Year of Age--------------- 13,050






Morbidity and Mortality Weekly Report


SURVEILLANCE SUMMARY
SALMONELLOSIS January, February, and March 1968


In January, February, and March 1968, the total num-
bers of salmonellae isolations from humans were 1,362,
1,161, and 1,088, respectively, and the weekly averages
for the 3 months were 272, 290, and 272, respectively
(1 I-,i'. 6). In Table 6, the 10 most frequently reported
serotypes from human sources are listed.


Figure 6
REPORTED HUMAN ISOLATIONS OF SALMONELLA
IN THE UNITED STATES



















For the same 3 months 579, 1,036, and 519 nonhuman
isolations were reported. The marked increase in the
February total from the January total represents delayed
reports from January. The 10 most frequently reported
nonhuman serotypes are listed in Table 6.


Table 6
Summary of 10 Most Frequently Reported Serotypes
from Humans and Nonhumans
January, February, and March 1968


Human Nonhuman

+ .. I .-.. ...ent
+----t t---------------* ----

S. Aid elbery 2'56 10.3 heidelberg 201 15.3
S. sai't-paol 216 9.9 S' anatum 184 14.0
S. eneritids 231 9.3 S. montevideo 118 9.0
S. afaatai 2103 h.1 S. saint-paul 105 8.0
S. report lb9 7.6 S. cubana 7 6.6
S. typhi 131 5.3 S. eimsbuttel 51 3.9
S. ithoimp'f 91 3.7 S. infantis 41 3.1
S. drby S9 3.6 S. snftenbrry 36 2.7
S. bloi khy 69 -2. S. thompson 34 2.6
Total 2. 492 69.0 Total 1,312 61.5

Total all erolpei 3.611 100.1) Total all .erotlpes 2,134 100.0



(Reported by Salmonellosis Unit, Bacterial Diseases Sec-
tion, Epidemiology Program, NCDC.)


A copy of thII original reports from which these
data w(rr doriv(ed i.; available on request from:
National 'Communicable Disease Center
Atlanta, G(eorgi. 30333
Attn: Chief, Salmonello.sis Unit
Bacterial I)iSiases Section
Epidemiology Program


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA*
TION OF 17,000, tS PUBLISHED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER, ATLANTA, GEORGIA.
DIRECTOR. NATIONAL COMMUNICABLE DISEASE CENTER
F. ,- Fi.': M.O.
CHIEF. EPIDEMIOLOGY PROGRAM A. .r.-M., M.D.
ACTING CHIEF, STATISTICS SECTION" IDA L. SHERMAN. M.S.
EDITOR MICHAEL B. GREGG. MD

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
'..,:., j._iT ANDMORTALITY, THE c ri -i 3 '.: E- L E DISEASE
.,,~ -r T WELCOMES ACCOUNTS OF r E E i -. :. -. Ou T -,,E OR CASE
INVESTIGATIONS WHICH ARE OF CURRENT INTEREST TO HEALTH
OFFICIALS AND WHICH ARE DIRECTLY RELATED TO THE CONTROL
OF COMMUNICABLE DISEASES. SUCH COMMUNICATIONS SHOULD 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 TE N CC P'' THE INDIVIDUAL
STATE HEALTH D An ,'n rS THE ,r_ T r. *EEK CONCLUDES
ON SATURDAY : L-i" ,-.- T A ON A -M 1, :-, ?L ,,. ARE RELEASED
ON THE SUCCEEDING FRIDAY






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