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:
AA00010654:00158

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
NATIONALL /OMMUNICABLE DISEASE CENTER


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

HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION


EPIDEMIOLOGIC NOTES AND REPORTS
TAENIASIS Rhode Island

On May 9, 1968, a 40-year-old female X-ray technician
from Rhode Island recognized tapeworm proglottids in her
stool. For approximately 2 months the patient had ex-
perienced mild abdominal cramps, borborygmi, and a change
in her bowel habits from relative constipation to bowel
movements on arising each morning. Because she believed
that she was infected with pinworms, she had mistakenly
been looking at her stools each day until May 9 when she
first sighted the tapeworm segments.
The patient gave no history of recent travel. She ate
rare beef, often sampling raw hamburger during its prepara-
tion, but she'rarely ate pork. She purchased all her meat
in a single Rhode Island supermarket.


PUBLIC HEALTH SERVICE


CONTENTS
Epidemiologic Notes and Reports
Taeniasis Rhode Island . ..... ....209
Trichinosis Ohio ........................... 210
Suspect Botulism California . . 211
Malaria New York ...... ............... 211
Summary of Reported Cases of Infectious Syphilis ... ..212
International Notes
Method of Recording Date of International
Certificates of Vaccination . . ... 213
Plague Central Java, Indonesia .. . ..214
Current Tr-nd-
Measles i. .. . .. . 213
Measles United States .. . ...215
Surveillance Summary
Measles Mortality- United States. 1966 . 215
The patient's stool was examined and found to contain
T:. '., P''- She was treated with oral Atabrine. but this
was not successful. She was then treated with Niclosamide
(Yomesan)* and she stated that within a day her bowel
(Continued on page 210)


TABLE I.-CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed report through previous weekly
23rd \rEEK EfJDED r M i. AT I. E FIF::T23 'EELT
DISEASE JLiNE 8. ..ILTE 10. 1963- 1967 MED.i:tL,
1968 1967 1968 1967 1963 1967
Aseptic meningitis ...................... 48 48 24 687 746 635
Brucellosis ............................. 3 13 6 67 111 111
Diphtheria............... ........... .. -5 70 49 78
Encephalitis, primary:
Arthropod-borne & unspecified ........... 28 32 374 573 -
Encephalitis, post-infectious ............. 6 18 247 396 ---
Hepatitis, serum .................. ...... 70 55 622 1,-762 877 18
Hepatitis, infectious ...................... 780 646 19,378 17.714
Malaria ................................ 31 34 4 928 870 43
Measles(rubeola) ....................... 592 1,614 7,564 15,965 51,799 214,200
Meningococcal infections, total ........... 33 43 43 1.507 1,311 1,456
Civilian .............................. 33 42 1,361 1.214 -
Military .............................. 1 --- 146 97 -
Mumps ................................. 3.012 108,983 -
Poliomyelitis, total .......... ...... ...1 3 18 10 17
Paralytic ............................. 1 2 18 9 15
Rubella (German measles) ............... 1,531 1,850 --- 36,034 32,913 -
Streptococcal sore throat & scarlet fever ... 6,889 7,454 6,757 239.309 259.532 234. 052
Tetanus ............................... 3 7 5 54 73 89
Tularemia ............................. 1 3 7 77 65 94
Typhoid fever .......................... 9 39 7 116 173 156
Typhus, tick-borne (Rky. Mt. spotted fever) 9 14 10 54 57 34
Rabies in animals .................. .... 66 87 87 1,680 2,054 2,054

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ....................... .................. 2 Rabies in man: .....................................
Botulism: Calif.-1 ................................... 1 Rubella, Congenital Syndrome: ......................... 3
Leptospirosis: Kans.-1 .............................. 13 Trichinosis:N.Y.C-1, Wash.-1........................ 28
Plague: ............... .......................... Typhus, murine:Tex.-l ....... ..................... 6
Psittacosis: Pa.-l. Tex.-1l....... ................... 18





Morbidity and Mortality Weekly Report


TAENIASIS (Continued from front page)


habits returned to the jrr xous normal pattern. Her stools
ill be examined periodically to see if the entire worm was
removed.
The commercial source( of beef for the single super-
I'.irii. from which the autochthonous case purchased her
meat were traced. It was found that two of the sources
were slaughter houses in Nebraska and Iowa that had pro-
cessed Texas cattle infected with C. bo is
during the epizootic that first appeared in mid-March
(MMlWR. Vol. 17. No. 16). An investigation is now under-


way to determine if there are more autochthonous cases of
taeniasis in this region.
At the same time that this autochthonous case was
found, two imported cases of taeniasis, one in an Ethiopian
and the other in a Lebanese, were also reported in Rhode
Island.
(Reported by Joseph E. Cannon, M.D., M.P.H., I'r, ,,..
Rhode Island Department of Health; and an EIS ),i ,' .)

*Available through Parais i isen~D )rtu Service


TRICHINOSIS Ohio


An outbreak of trichinosis has been reported from
\\IItI. I tI. Lake County. Ohio, in an Italian family. Be-
tween March 9 and March 25, 196S, four of seven family
members developed symptoms compatible with trichinosis
and were later found to have positive serologic tests for
trichinosis: two other persons in the family had symptoms
and laboratory data highly suggestive of trichinosis, and
one member was possibly infected (Table 1). The most
common symptoms were fever, periorbital edema, and mus-
cle ache. Suessenguth-Kline flocculation tests for trichi-
nosis were positive for all four of the four patients tested.
No muscle biopsies were performed. All patients were
treated at home with corticosteroids, and all have recovered.
Investigation revealed that the family had consumed
pork purchased in mid-February 1968 from two sources.
Pork butts, purchased from a packing company in Ohio,
were ground into sausage by the family and used in mak-


ing spaghetti sauce.
was well-cooked and
It was also eaten on


The family reported that the sauce
was eaten on March 7 and March 9.
two occasions by the family's physi-


cian who has remained well. On exa nmiation, a sample
of sausage used in this sauce was negative for trichina
larvae

The family also purchased fresh -ausage from another
packing company in Ohio. Tfis sausage was soaked in oil
at home for several days and then eaten raw by at least
six of the seven family members. The dates and amount of
consumption of the sausage by each family member were
unobtainable, but the sausage was eaten on several occa-
sions by most of the family. Cases 1 and 2. who had the
earliest dates of onset and who were severely ill, do a
majority of the food preparation for the family and may
have had the greatest, exposure. No person outside the
household ate this raw sausage. When tested, the sausage
was found to be infected with an average of three trichina
larvae per 50 gn of sausage.

It is unlikely that the pork used in the spaghetti sauce
was the source of infection since the onser of systemic
symptoms in three of the cases occurred only 2 days after


Toble 1
Case Data in Family Outbreak of Trichinosis
Willoughby, Ohio, March 9 March 25, 1968

Age Date of Serology: Pork Eaten
Case (years) Sex Onset of Symptoms WBC Eosinophils Suessenguth-Kline Spaghetti Raw
-..I. ,r,,- Flocculation Sauce Sausage

1 27 F March 9 Fever, Nausea, 14,700 29% Positive Yes Yes
Periorbital edema,
Muscle ache
2 24 F March 9 Fever, Nausea, 6,900 12% Positive Yes Yes
Periorbital edema,
Muscle ache
3 5 M March 9 Rash, Periorbital 14,000 25% Positive Yes Yes
edema
4 61 M March 14 Slight muscle Not tested Not tested Not tested Yes Un-
ache certain
5 30 M March 15 Fever, Periorbital s :"," 21% Not tested Yes Yes
edema, Muscle
ache
6 60 F March 25 Conjunctival 6,300 7% Positive Yes Yes
hemorrhage
7 2 M March 25 Rash 14,150 14% Not tested Yes Yes


210


JUNE 8, 1968






JUNE 8, 1968


Morbidity and Mortali


consumption. These signs and symptoms of larval migra-
tion and.muscle infiltration, generally, do not appear prior
to the sixth day after ingestion of trichinous meat. There-
fore it is likely that the raw sausage soaked in oil was the
source of trichinosis.
No cases of trichinosis were reported to the Lake
County Health Department in 1967 and only these seven
cases have been reported in 1968. However, two cases in


ty Weekly Report 211


neighboring Cuyahoga County are presently under investi-
gation for possible relationship to this outbreak.

(Reported by Ralph A. Masterson, D.V.M., M.P.H., .
Epidemiology Section, Jack Russell, D.V.M., Chief, Veteri-
nary Unit, and Ohio Department of Health Laboratory, Ohio
Department of Health; and Fred C. Kluth, M.D., it .'. ,'.. .,.
Ohio.)


SUSPECT BOTULISM California


A 49-year-old executive became ill on the evening of
May 15, 1968, on his way home to San Diego after attending
a convention in Wisconsin. His illness began with nausea,
vomiting, and abdominal pain. After arriving home that
same evening, he continued vomiting for 48 hours and was
admitted to a hospital on May 17. On.admission, he was
severely dehydrated and had mild respiratory distress.
Radiologic examination showed dilated loops of small
bowel. A diagnosis of bowel obstruction was made, and
at operation on May 18, a volvulus was found and reduced;
however, an adynamic ileus was also present. Over the
next 2 days the patient had increasing respiratory dif-
culty, and a tracheostomy was performed. The patient also
developed symmetrical extraocular muscle weakness,
ptosis, poorly reacting pupils, dysphagia, dry mouth, and
neck muscle weakness. Deep tendon reflexes remained
normal and no sensory impairment was found. Review of
medications used prior to and during surgery revealed no
obvious drug which might have caused these symptoms.
The edrophonium test for myasthenia gravis was
negative. Blood counts, serum chemistries, and cerebral
spinal fluid studies were within normal limits.
On May 19 a diagnosis of botulism was considered
and the patient was given 100,000 units of types A and B
botulinum antitoxin without response; however, there was
an apparent improvement when 10,000 units of type E
antitoxin were given on May 19 and again on May 20. In
spite of these temporary improvements the patient devel-
oped bronchopneumonia, became comatose, and died on
May 25. Autopsy examination revealed no specific findings
other than the bronchopneumonia. No evidence of intra-
cranial tumor, cerebral arterial thrombosis, or hemorrhage
was found.
The patient had attended a convention in Wisconsin
on May 13 through 15, immediately prior to the onset of his
illness. Review of the patient's food history at the con-
vention and in the days prior to the meeting and review of
the convention menu revealed no highly suspect food source.
Approximately 265 persons from 42 states had been
at the convention with the patient. An intensive telephone
survey of 256 of these persons was undertaken on May 20
and 21 by state epidemiologists, city health officials, and


EIS officers. No other persons with symptoms suggestive
of botulism were found. It was learned that30 persons had
transient gastrointestinal illness during and after the
convention, and an additional eight had equivocal, mild
subjective neurologic symptoms during this period. Food
histories did not implicate any single item as a possible
source of illness. Overindulgence and late hours may have
accounted for some if not all of these mild symptoms. Bio-
assay of serum specimens obtained from the patient and
from 11 of the persons with equivocal symptoms were
negative for botulinum toxin. Smoked and canned salmon
and other food served at the convention were obtained for
mouse bioassay and for culture. All these tests have been
negative.
In summary, a patient died from an illness which was
clinically compatible with botulism. However, laboratory
and epidemiologic evidence did not confirm this diagnosis.
(Reported by John J. Dapolito, M.D.; J. B. Askew, M.D.,
Director of Public Health, San Diego County Health De-
partment; Philip K. Condit, MD., Chief, Bureau of Com-
municable Diseases,, and the State Public Health Lab-
oratories, California State Department of Public Health;
Olga Brolnitsky, M.D., Chief Epidemiologist, Communi-
cable Diseases, and Samuel Andelman, M.D., Commis-
sioner, Chicago Board of Health; Norman J. Rose, M.D.,
Chief, Bureau of Epidemiology, Illinois Department of
Public Health; H. Grant Skinner, M.D., Chief, Section of
Communicable Disease Control, and S. L. Inhorn, M.D.,
Director, State Laboratory of Hygiene, Wisconsin State
Department of Health and Social Services; Food and Drug
Administration, Washington, D.C.; Laboratory 'Program,
NCDC; State Epidemiologists and City and County Health
Officials in 39 other states; and many EIS Officers.)

Editoral Note
The inability to demonstrate circulating botulinum
toxin in serum does not exclude the diagnosis of botulism
in this case. In botulism, there are no specific postmortem
changes. Therefore the lack of autopsy findings in this
case does not support or negate the diagnosis, but it does
exclude intracranial lesions which might cause a similar
syndrome.


MALARIA New York


On January 23, 1968, a 62-year-old woman was admitted
to a New York City hospital for introduction of a bypass
for an occluded left femoral artery. Following surgery, the
patient's postoperative course was unremarkable until


February 21 when her temperature rose to 1020F. She ex-
perienced spiking fevers up to 1040F. every other day until
March 1. Then, between March 1 and 11 with the exception
(Continued on page 212)






212


of March 7. she had daily fever spikes with shaking chills.
Physical examination on March 6 showed enlargement of
the li\er, and the possibility of hepatitis was considered.
On March 11, examination of a routine blood smear revealed
the presence of Plasmodium vivax parasites. Following
treatment with chloroquine, the patient showed prompt
clinical improvement.
The patient was born in Austria and came to the United
States many years ago. She had never lived in malarious
areas and had no history of unexplained fevers, blood
transfusions, or use of commonly shared syringes. Because
of a progressive decline of the hematocrit, the patient
received seven units of whole blood between February 1
and 7, 1968. Four of the seven donors could be located.
One donor was a 22-year-old veteran who had served in
Vietnam from July 21, 1966, until July 21, 1967. He gave
no history of malaria while overseas. However, on Septem-
ber 8, 1967, he developed daily fever spikes for which he
was admitted to an Army hospital on September 12, 1967;
vivax malaria was then diagnosed. Over a 3-day period he
was treated with a total of 1.5 gm of chloroquine base and
was then given eight tablets of chloroquine-primaquine to
he taken once a week for eight weeks.
On February 1, 1968, he donated blood in New Jersey
which was given to the patient in New York City on Feb-


ruary 4. The donor had denied both his military duty and
his hospitalization for malaria to the blood bank. Examina-
tion of blood films from the donor taken in March 1968 re-
vealed the presence of P. vivax parasites. Another donor,
in Oklahoma, had served in Korea in 1960-1961, and had
traveled in Mexico for several weeks in 1965. He did not
give a history of malaria and no parasites could be detected
in his blood. The two other contacted donors had not re-
sided in malarious areas and gave no history -ug.,--i.i
of malaria.
The donor in New Jersey had also donated blood on
December 15, 1967. This blood was given to a patient in
New York City on December 28, 1967, together with another
unit of blood. This recipient did not experience symptoms
compatible with malaria although she did develop hepatitis
6 weeks after hospitalization.


(Reported by Vincent F. Guinee, M.D., Director, Bureau of
Preventable Diseases, and Howard B. Shookhoff, M.D.,
Chief. Tropical Disease Division, New York City Depart-
ment of Health; Herbert I. Horowitz, M.D., New York City;
and Martin Goldfield, M.I., Director, Dieision of Labora-
tories, and Ronald Altman. M.D., I. ', Director, Division
of Preventable Diseases, New Jersey State Department of
Health.)


SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS
CASES OF PRIMARY AND SECONDARY SYPHILIS: By Reporting Areas May 1968 and May 1967 Provisional Data
Cumulative Cumulative
Reporting Area May Jan. May Reporting Area May Jan. May
1968 1967 1968 1967 1968 1967 1968 1967
NEW ENGLAND............... 23 40 148 164 EAST SOUTH CENTRAL ........ 129 179 615 772
Maine.................... 1 2 Kentucky................. 8 17 46 55
New Hampshire........... 1 5 Tennessee................ 43 19 142 108
Vermont................. 2 Alabama.................. 41 110 270 448
Massachusetts............ 16 22 89 99 Mississippi.............. 37 33 157 161
Rhode Island............. 2 7 19 15
Connecticut .............. 4 11 37 43 WEST SOUTH CENTRAL........ 335 295 1,493 1,277
Arkansas................. 11 15 57 60
MIDDLE ATLANTIC............ 226 304 1,283 1,473 Louisiana................ 97 58 359 262
Upstate New York......... 23 32 85 118 Oklahoma................. 16 15 39 57
New York City............ 141 174 819 873 Texas ....................... 211 207 1,038 898
Pa. (Excl. Phita.)....... 15 14 80 105
Philadelphia............. 11 29 113 122 MOUNTAIN .................. 45 44 223 256
New Jersey............... 36 55 186 255 Montana................... 2 1 4 4
Idaho.................... 1 3 13
EAST NORTH CENTRAL....... 248 262 1,263 1,351 Wyoming.................. 3 7
Ohio................... 33 51 207 280 Colorado................. 1 7 9 37
Indiana ................. 38 9 151 46 New Mexico................ 15 10 63 70
Downstate Illinois....... 19 17 72 69 Arizona.................. 27 16 122 113
Chicago.................. 96 76 437 407 Utah..................... 3 2 4
Michigan................. 58 108 386 534 Nevada................... 3 20 8
Wisconsin ................ 4 1 10 15
PACIFIC................... 178 125 760 795
WEST NORTH CENTRAL........ 36 29 158 116 Washington .............. 6 5 23 27
Minnesota................ 1 7 16 19 Oregon................... 5 6 16 20
Iowa..................... 4 2 16 12 California............... 167 113 718 742
Missouri................. 17 8 78 36 Alaska................... -
North Dakota............. 2 2 1 Hawaii................... 1 3 5
South Dakota............. 5 3 19 14
Nebraska................ 2 6 16 16 U. S. TOTAL............... 1,702 1,745 8,206 8,674
Kansas................... 5 3 11 18
KaTERRITORIES............... Ill 84 464 381
SOUTH ATLANTIC........... 482 467 2,263 2,470 Puerto Rico.............. 110 80 439 360
Delaware................. 5 10 17 24 Virgin Islands........... 1 4 25 21
Maryland................. 35 45 185 262
District of Columbia..... 49 59 284 265
Virginia................. 27 18 117 117
West Virginia............ 2 1 14 7
North Carolina............ 54 56 305 283 Note: Cumulative Totals include revised and delayed reports
South Carolina........... 39 67 231 363 through previous months.
Georgia.................. 72 58 348 371
Florida................. 199 153 762 778


Morbidity and Mortality Weekly Report


MALARIA (Continued from page 211)


JUNE 8, 1968






JUNE 8, 1968


The World Health Organization has recently called
attention to the requirement in the "International Sanitary
Regulations"I that all dates should be recorded in the
following sequence:


Day
e.g. 2


Month
May


WHO points out that difficulties continue to arise because
of the use of arabic figures for recording the month. In the
United States and some other countries, it is the custom to
write the month (either in letters or arabic numerals) be-
fore the day. However, it is a common practice in many


countries to follow the format indicated above. Thus. an
American physician who vaccinated one of his patients on
November 2, 1965, may have written the date as "11 2 '65."
A quarantine inspector in Europe would assume that such
a Certificate was issued on February 11, 1965. He would,
therefore, consider the Certificate invalid because of appar-
ent issuance more than 3 years prior to the present time.
No misinterpretation is possible, however, if the date were
indicated as prescribed by WHO. that is. "2 Nov. 65."
(Reported by Foreign Quarantine Program, NCDC.)
Reference:
l\orld Health Organization: International Sanitary Regulations,
Third Annotated Edition. 1966, page 49, Geneva.


CURRENT TRENDS
MEASLES Florida


Mass measles eradication programs have been con-
ducted in 25 of Florida's 67 counties since November
1966. Over 3 million of the state's 6 million population
reside in the counties where these programs were held.
Additionally, routine measles vaccination has been on-
going in all counties through private practitioners and
health department clinics. Presently 60.of the state's 67
counties participate in a Birth Certificate Follow-up Pro-
gram which promotes -immunizations. Reported cases of
measles decreased from 3,976 cases in calendar year
1966 to 1,b06 in 1967.
At the end of the eighth week of 1968, Orange County
(population 305,500)had reported 20 percent of the 102 mea-
sles cases reported in Florida. Orange County had not con-
ducted a county-wide eradication program. During the fol-
lowing 8 weeks, 168 measles cases werereported in the
state and 94 cases (56 percent)were reported from Orange
County (Figure 1). Epidemiologic investigation showed that
the cases were occurring in elementaryschools of low and
middle socioeconomic groups and that approximately 17,000
children in Orange County weresusceptible. Accordingly,
an epidemic control program was planned.
From May 13 through May 22, 1968, selected elemen-
tary schools were visited by immunization teams, and
susceptibles in the schools were administered measles
vaccine. Parents were also encouraged to bring suscepti-
ble preschool children to the schools. Of the county's 70
elementary schools, 23 schools, representing 25 percent
of the county's elementary school population, were visited.
Measles vaccine was administered to 4,511 school chil-
dren and 404 preschool children. During the program, an
additional 25 cases of measles were reported in Orange
County.
(Reported by E. Charlton Prather, M.D., M.P.H., Director,
Division of Epidemiology, Florida State Board of Health;
and an EIS Officer.)


Figure 1
REPORTED CASES OF MEASLES BY
4-WEEK PERIODS, EPIDEMIOLOGIC YEAR 1967-68
FLORIDA



100,


- FLORIDA
FLORIDA MINUS
ORANGE COUNTY
----------- ORANGE COUNTY


4 2' 301 27' 24' 23 20' 18 1 I 0 o 7' 5
NOV DEC DEC JAN rEB MAR APR MAY JUN JUL AUG SEP OCT
4 -WEEK PERIOD ENDING


Morbidity and Mortality Weekly Report


INTERNATIONAL NOTES
METHOD OF RECORDING DATE OF
INTERNATIONAL CERTIFICATES OF VACCINATION





Morbidity and Mortality Weekly Report


INTERNATIONAL NOTES
PLAGUE Central Java, Indonesia


On FebIruanr. 21. 1;is the N('DC wa- notified that an
outireiak of Lubonih plague wias occurring in centrall ,JaIa.
Intdoneia. In re-pon-e to a reque-t from the Indonesian
\lin-try of health, an N('DC team wa- sent to assist in
the i n\tntigation and control of the opidlt ic.
From January 1 through March 2.3. 1 96b. 90 reported
i-cse of plague with 36 deaths occurred in 10 villlg.-e in
two subdii-trictsr of Bojolali Regency. Central Ja\a. In-
dones>ia(Figure 2) These subdistricit are located between
two \olcanic mountains. Merapi activee) and Merhabu (in-
actixe). and the infected are Jaia. approximately 300 miles from Djakarta. The peak in-
cidence of the epidemic occurred in the \xeek ending Feb-
ruar' 3 when 21 cas-es were reported. althoughh cases w ere
reported in all age group- up to the age of 60 years. 56
percent of the cases x- ere in person- under 21 years of age
(Figure 3). There was no sex related preponderance of
(cases or death hs.


Figure 2
CASES OF PLAGUE BY DATE OF ONSET
INDONESIA JANUARY 1 MARCH 23, 1968


Figure 3
DISTRIBUTION OF
PLAGUE CASES AND DEATHS BY AGE
INDONESIA JANUARY-MARCH 1968


AGE GROUP
YEARS)


-.-.--4--------4--------4 1-4 I I


6 13 20
jAN


7 3 0 i7 24
FEB
WEE ENDING


2 6 23
MAR


Of the 90 cas-es. seven were classified ias pneumonic
pla gue. A hu-lband, wife. and child who died during the
w'teek of March s had strontgl suspect pneumonic plague:
-ublsequently, four -econdary cases with clinically apparent
pneumonic plague owre found. No additional pneumonic
ca-ses occurred. apparently due to the quarantine imposed
upon the households and -ubvillagies in which the initial
ca-se occurred d nd the treating of all residents in the
quarantined area with prophylactic antibiotics.
During the outbreak. field studies were conducted to
surv.' thel rat and flea populations in Bojolali. The most
frequently captured roxlent wuas Rttua r/atmu, dtiardi and the
most common ectopara-ite harvested from captured rodents
was X.eiopsylla rheopi s. In subtvillages that had been
-prayeid with DDT prior to February 21. the flea index was


approximately 1.0 Ilea per rat: in unsprayed areas. the
indices ranged from 0.I to 3.3 fleas per rat. Ectoparasite
control \was continued bI, several teams who dusted and
-sprayed 'ill with DDT on a planned basis. villagee by
Village. and hb a mobile team that effected vector control
within a 2'00 meter radiui- around each new reported case.
Several x accination te:ilms conducted an immunization
program using standard methods as well as p.'-I, jR guns
in an effort to proxy idea u liffer of immune subjects through-
out the two subdistricts. Of the 12.693 persons (82 per-
cent of the population ini the two subdistricts) who had
received one dose of vaccine by March 2Sh. approximately
50( percent had received a single dose of live attenuated
vaccine: the remaiinng .50 percent received killed vaccinee
and would require a booster dose.
At the request of the Indonesian Ministry of Health.
the NCDC team helped train Indonesian health personnel
in epidemiologic methods. methods for conducting rodent
and ectoparasite sur\eys. methods for fumigating ships.
and in the use of bacterial agglutination and passive hem-
agglutination tests.
In addition to the 90 cases reported from January 1
tlhr,.l, l March 23. 1963S. one ease occurred in the first
week of April: this case is presently being investigated.
No new cases were reported after the first week of April.


(ReIported lby Dr. J. Suliantii. Director General, Commun1i-
cable Vitceas ('Control, Indonesia; Ecological Invesitiga-
tiomns Programt, \CDC, Kansas City. Kansas; and a team
from V\)('.)


JUNE 8, 1968


ri


TLn,






Morbidity and Mortality Weekly Report


CURRENT TRENDS
MEASLES United States


For the week ending June 8, 1968. (week 23). 592
cases of measles were reported to NCDC. This is a de-
crease of 133 cases from the total of 725 cases reported
for the preceding week. In addition, the 592 measles
cases reported for the current week are 1,022 fewer than
the 1,614 cases in 1967. and 16,218 fewer than the cases
reported for the corresponding week in 1964 (Figure 4).


During the first 23 weeks in 1968. 15.965 cases of
measles have been reported to the NCDC. This is 31 per-
cent. 9.5 percent, 7.5 percent, and 3.9 percent of the
cumulative totals reported to NCDC for the same time
periods in the years 1967 through 1964. respectively.
(Reported by State Services Section and Statistics See-
tion, Epidemiology Program, NCDC.)


Figure 4
REPORTED CASES OF MEASLES BY WEEK
UNITED STATES, 1967-68 COMPARED WITH
1963-64 TO 1966-67 (DECEMBER-JUNE)








--\ \.




"- -/-- ""---


SURVEILLANCE SUMMARY
MEASLES MORTALITY United States, 1966


A total of 261 deaths have been attributed to measles
occurring in 1966 in the United States. This total is 15
measles deaths less than the 276 recorded in 1965 and 160
less than the 421 recorded in 1964. The death rate for 1966
is 0.13 deaths per 100,000 population. This is the third
year in which the death rate fell below 0.20 deaths per
100,000 population (Figure 5); the other 2 years were 1963
(0.19) and 1965 (0.14).


(Reported by State Services Section and Statistics Sec-
tion, Epidemiology Program, NCDC.)


Figure 5
REPORTED MEASLES CASES AND DEATHS
PER 100,000 POPULATION
UNITED STATES, 1912-1967

" "- '-- --. .
V


JUNE 8. 1968







216 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
JUNE 8, 1968 AND JUNE 10, 1967 (23rd WEEK)


ENCEPHALITIS HEPATITIS
ASEPTIC Primary
ASMENPTIS "t AOSIS DIP11FT*T A including Post MALARIA
AREA MENINGITIS t Including Infectious Serum Infectious
unsp. cases
1965 1967 1968 1968 1968 1967 1968 1968 1968 1967 1968
UNITED STATES... 48 48 3 28 32 6 70 780 646 31

NEW ENGLAND.......... 3 3 1 3 1 1 29 18
Maine.............. 2 2
New Hampshire...... -
Vermont.............
Massachusetts...... 3 2 1 1 1 17 7
Rhode Island....... 1 2 4 5
Connecticut........ 1 6 4

MIDDLE ATLANTIC...... 12 10 11 5 2 23 140 97 9
New York City...... 9 1 6 16 42 24 2
New York, up-State. 1 1 16 15 2
New Jersey.......... 2 8 2 4 4 43 21 1
Pennsylvania....... I 3 1 1 2 39 37 4

EAST NORTH CENTRAL... 5 5 6 7 6 131 108 5
Ohio................ 5 1 2 4 2 30 19
Indiana............ 1 1 12 11
Illinois........... 2 1 1 2 44 34 2
Michigan........... 1 I 2 42 33 3
Wisconsin........... 2 3 11 -

WEST NORTH CENTRAL.. 4 1 3 2 3 36 45 6
Minnesota .......... 4 9 9
owa............... 1 6 2
Missouri ........... 11 23 1
North Dakota....... 5
rout' Pr' -t ... 3 ,1 -
Nebra ka ........... I 1
Kans,,s............. 1 I 1 1 8 5 5

SOUTH ATLANTIC....... 4 1 6 1 62 71 2
Delaware............ 5 10
Maryland............ 1 1 1 17 10 2
Dist. of Columbia.. 2 -
Virginia.............. 1 5 8
West Virginia...... 1 8 4
North Carolina..... 1 -
South Carolina..... 4
Georgia............. 1 25
Florida...*........ 1 5 20 13

EAST SOUTH CENTRAL... 1 6 1 2 2 58 43
Kentucky............. I 23 14
Tennessce.......... 1 1 1 24 12
Alabama............. 4 6
Missssippi........ 6 2 7 11 -

WEST SOUTH CENTRAL... 7 4 1 2 1 58 78 1
Arkansas........... -1 1 1 3
Louisiana........... 3 2 1 1 5 7 1
Oklahoma............ 21 4
Texas............... 4 2 31 64

MOUNTAIN............. 1 17 18 1
Montana............ 8 1
Idaho.............. -
Wyoming ............ 1
Colorado........... 6 1
New Mexico ......... 5 6
Arizona........ ....... 3 2
Utah............... 1 2
Nevada.......... ..... -

PACIFIC.............. 16 16 3 5 38 249 168 7
Washington.......... 1 2 1 -- 13 14
Oregon............. 1 17 8
California.......... 12 5 2 4 37 219 146 7
Alaska.............. .- 1-
Hawaii.............. 3 9 -

Puerto Rico..* ........ 1 15 32
,[ ,, r ,J,. I r r r... -I F I .. r ,
Hepatitis, serum: P.R. 1
Hepatis, infectious: P.R. 11







Morbidity and Mortality Weekly Report 217


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
JUNE 8, 1968 AND JUNE 10, 1967 (23rd WEEK) CONTINUED



MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL

AREA Cumulative Cumulative Total Para ytic
Cum.
1968 1968 1967 1968 1968 1967 1968 1968 1968 1968 1968


UNITED STATES... 592 15,965 51,799 33 1,507 1,311 3.012 1 1 18 1,531

NEW ENGLAND........... 86 876 709 3 78 57 281 353
Maine.. ........... 30 212 6 3 5 21
New Hampshire...... 80 72 7 2 2 10
Vermont............ 1 28 I 5 6
Massachusetts.*.... 38 315 262 2 35 29 190 112
Rhode Island....... 1 60 7 4 18 55
Connecticut........ 48 449 75 1 22 19 61 149

MIDDLE ATLANTIC...... 163 2,737 1,886 6 253 200 193 302
New York City...... 94 1,137 338 3 50 34 129 150
New York, Up-State. 40 1,005 412 2 42 47 NN 74
New Jersey.......... 23 463 439 90 78 64 69
Pennsylvania....... 6 132 697 1 71 41 NN 9

EAST NORTH CENTRAL... 95 3,268 4,492 6 170 161 739 248
Ohio............... 6 258 931 1 45 59 23 62
Indiana............. 4 568 533 21 20 22 2
Illinois........... 30 1,231 803 39 37 74 43
Michigan........... 4 206 814 3 50 34 303 49
Wisconsin.......... 51 1,005 1,411 2 15 11 317 92

WEST NORTH CENTRAL... 8 325 2,516 1 77 60 249 24
Minnesota.......... 13 121 1 18 14 19 -
Iowa............... 4 81 713 5 12 198 17
Missouri.......... 73 215 26 12 1
North Dakota....... 2 111 778 3 4
South Dakota........ 4 47 4 6 NN -
Nebraska........... 2 35 580 6 10 32 1
Kansas............. 8 .62 15 6

SOUTH ATLANTIC....... 21 1,156 6,039 5 317 251 175 83
Delaware........... 1 12 36 1 5 5 8
Maryland............ 72 117 21 29 19 15
Dist. of Columbia.. 6 19 11 9 3 -
Virginia........... 9 237 1,845 1 23 25 50 10
West Virginia...... 2 183 1,236 1 8 19 66 10
North Carolina. *.. 3 264 823 62 50 NN -
South Carolina..... 12 445 54 23 2 -
Georgia............ 3 26 58 43 -
Florida............. 6 367 1,492 2 75 48 35 40

EAST SOUTH CENTRAL... 25 483 4,693 2 130 113 226 77
Kentucky............ 4 163 1,169 1 49 32 47 29
Tennessee.......... 1 54 1,615 44 47 161 33
Alabama.*.......... 7 69 1,267 18 22 18 15
Mississippi........ 13 197 642 1 19 12 -

WEST SOUTH CENTRAL... 105 4,162 16,241 3 258 189 343 1 1 10 84
Arkansas........... 2 1,388 15 24 1
Louisiana.......... 2 141 1 68 74 -
Oklahoma........... 105 3,303 48 12 -
Texas.............. 105 4,053 11,409 2 127 79 342 1 1 10 84

MOUNTAIN............. 41 825 3,940 24 25 140 52
Montana............ 1 66 252 2 10 -
Idaho.............. 3 15 347 10 1 3 3
Wyoming............ 1 49 64 1 4
Colorado............ 26 416 1,274 7 10 28 26
New Mexico......... 77 539 3 10
Arizona............ 10 178 884 1 4 43 23
Utah............... 19 311 1 4 42
Nevada............. 5 269 3 2

PACIFIC.............. 48 2,133 11,283 7 200 255 666 8 308
Washington........... 3 491 5,275 1 33 24 69 25
Oregon.............. 8 412 1,436 16 24 61 12
California.......... 37 1,195 4,339 4 139 197 511 8 216
Alaska.............. 1 122 1 1 8 13 52
Hawaii.............. 34 111 1 11 2 12 3


Puerto Rico..ak.......j 7 309 1,832 17 8 16 2


*Delayed reports: Measles: Me. 17, Mass. delete 2, N.C. delete 1, Ala. delete 4, Okla. 2
Meningococcal infections: P.R. 1
Mumps: Me. 12, Mo. 295
Rubella: Me. 34







218 Morbidity and Mortality Weekly Report


TABLE 111. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 8, 1968 AND JUNE 10, 1967 (23rd 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... 6,889 3 54 1 77 9 116 9 54 66 1,680

NEW ENGLAND............ 1,305 1 40 4 1 59
Maine.. ............ 10 50
New Hampshire...... 46 -- 2
Vermont............. 69 40 1 6
Massachusetts...... 227 2 1
Rhode Island....... 76 -
Connecticut........ 877 1 2

MIDDLE ATLANTIC...... 413 9 3 11 4 1 15
New York City...... 12 5 6 -
New York, Up-State. 388 4 3 2 1 1 11
New Jersey......... NN -
Pennsylvania....... 13 3 3 4

EAST NORTH CENTRAL... 499 6 4 2 20 2 13 150
Ohio................ 41 1 11 1 8 60
Indiana............. 70 1 1 3 56
Illinois........... 158 4 2 2 7 1 2 15
Michigan........... 156 1 8
Wisconsin.......... 74 1 11

WEST NORTH CENTRAL,.. 281 2 6 5 2 11 377
Minnesota.......... 26 2 107
Iowa............... 79 3 71
Missouri........... 2 2 4 3 2 66
North Dakota....... 68 2 61
Sourh Dakot ....... 13 I 1 1 34
Nebraska........... 93 -- 1 1 19
Kansas............. 1 2 19

SOUTH ATLANTIC....... 590 11 5 2 31 5 33 8 190
Delaware... ....... 1 -
Maryland............ 120 1 5 1 3 3
Dist. of Columbia.. 1 -- -
Virginia........... 191 2 1 6 15 5 82
West Virginia...... 146 1 24
North Carolina..... 1 2 2 2 4 11 7
South Carolina..... 6 1 1 -
Georgia............. 26 1 1 8 2 1 23
Florida............. 99 4 9 1 2 51

EAST SOUTH CENTRAL... 1,277 7 6 13 2 6 15 422
Kentucky............ 100 1 1 2 1 1 6 198
Tennessee.......... 958 2 4 8 1 3 9 206
Alabama............. 175 2 1 18
Mississippi........ 44 2 1 3 1

WEST SOUTH CENTRAL... 687 7 1 10 1 9 2 6 12 310
Arkansas........... 1 1 1 3 36
Louisiana.......... 4 4 I 1 30
Oklahoma.......... 37 2 2 1 4 2 97
Texas.............. 646 2 6 5 1 2 7 147

MOUNTAIN............ 897 3 8 1 2 37
Montana........... 31 -
Idaho.............. 87 -
Wyoming..*......... 17 1 2
Colorado........... 455 I 2 1 1
New Mexico......... 137 5 1 17
Arizona .............. 105 1 17
Utah............... 65 2 -
Nevada...........

PACIFIC.............. 940 3 11 4 15 3 120
Washington......... 162 -
Oregon............. 102 1 1 2 3
California......... 581 2 10 4 13 3 117
Alaska............. 40
Hawaii. ............ 55

Puerto Rico ........ 8 5 15
*Delayed reports: SST: Me. 14, Wyo. 16
Tetanus: P. R. 4







Morbidity and Mortality Weekly Report


219


Week No. TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED JUNE 8, 1968
23
(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 year Area All 65 years and 1 yea
over Influenza All 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, Miinn.---------
Kansas City, Kans.----
Kansas City, Mo.------
Lincoln, Nebr.-------
Minneapolis, Minn.----
Omaha, Nebr.-----------
St. Louis, Mo.--------
St. Paul, Minn.-------
Wichita, Kans.--------


667
216
49
24
31
63
25
26
23
48
27
9
45
37
44

3,359
46
44
143
46
35
52
75
112
1,656
42
495
200
63
99
33
53
85
27
21
32

2,732
64
29
799
170
245
127
99
311
48
44
48
24
61
175
44
130
29
35
40
114
76

893
63
13
27
150
40
137
98
252
53
60


416
118
31
14
23
42
14
21
13
30
23
9
29
23
26

1,942
34
29
78
30
14
32
42
60
958
19
280
105
44
53
21
29
56
16
18
24

1,555,
39
20
417
103
118
72
55
174
32
26
29
12
47
97
20
99
15
26
25
75
54

524
41
6
14
81
24
94
59
141
36
28


Total 1 12,805 17,228 1 398 641

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 302,849
All Causes, Age 65 and over------------------- 177,029
Pneumonia and Influenza, All Ages------------- 13,560
All Causes, Under 1 Year of Age--------------- 13,691


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.----------


1,231 630 37 52
143 55 10
296 156 5 10
49 30 1 2
74 43 1
95 55 1 7
50 21 5 1
73 40 3 9
44 15 2 2
87 68 8
77 38 7 4
191 85 2 5
52 24 3 1

688 359 26 33
82 41 1 5
73 32 7 10
25 16 1
136 73 9 4
174 88 3 8
48 26 1
27 16 2 1
123 67 4 3

1,223 638 48 92
50 30 4 3
44 20 2 4
19 7 4
165 88 2 14
48 32 4 6
69 35 3 5
224 98 5 16
59 37 8 2
196 94 4 10
68 41 2 5
144 76 4 14
54 24 2 7
83 56 8 2

499 270 21 20
41 17 5 -
34 25 4 2
144 77 7 7
17 10 2 1
114 51 4
27 19 3 1
58 36 3
64 35 2

1,513 894 31 60
15 14 -
48 22 2 7
27 19 -
48 25 5 5
102 64 2 3
411 240 7 14
78 45 2 8
32 23 1
114 67 2 3
63 41 1
96 57 4
161 79 4
48 27 1 -
177 108 9 6
51 32 1
42 31 1 3






Morbidity and Mortality Weekly Report


ERRATUM, Vol. 17, No. 22, Page 208


Table 6 in the article "Salmonellosis January.
February, and March 196S." is incorrect. The following
table is a corrected table:


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


Human a Non-human
,. I ,j) n I .. I ,
-~~ ---r-- ... -........ -- t---
yphi-mitria 97 27.3 yph m r m 13.7
ricil6r :25I 6 7.1 heidelbrr y 2 01 9-4
2. a >46 6.h anaol 1S04 h.6
*terit s 31 6.4 monteridro Il 1 3.
2103 5.6 44 nla d b15 4,9

J,'apotI 1S9l 5. 1 ruh a S 4,i
p' 131 3.6 infant 6 1 3.0
ry I 3. mp n 57 27
4, kl' y .13 2.6 neiahiuettl 3 2 .6
b/i,,mp ,n 91 2.53 snftlrnbhri 53
Subtortal 2.5 3 7)0.2 Subtotal 1,229 37.6

Total all srotypes 3.611 Total all serolypes 2.134


THE .-,* AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION j~ .. IS PUBLISHED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER. ATLANTA. GEORGIA.
DIRECTOR. NATIONAL COMMUNICABLE DISEASE CENTER
DAVID J. SENCER, M.O
CHIEF, EPIDEMIOLOGY PROGRAM A.D. LANGMUR., M.D.
ACTING CHIEF STATISTICS SECTION IDA L SHERMAN M.S.
EDITOR MICHAEL B. GREGG. MO.

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
1 1 =..T AND MOR -.*_T T.r- L I'- "r..L :IIUMU r.,.: -aE.6L DISEASE
C Ei T F ELCOMES --*: I I**.*I. '*Nri- **. v r.r 0 C
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 -.E .*50 .Oni L AND ARE
BASED ON WEEKLY TELEGRAMS TO T-E N:i-,. S TH I .rDi. E..aD L
STATE HEALTH DEPARTMENTS THE A:. AI-. sEE. E iE .I. f.
ON SATURDAY; COMPILED DATA ON A T -, S 'L : ARE ELE- i
ON THE SUCCEEDING FRIDAY.


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