Morbidity and mortality

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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
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The Office
Place of Publication:
Washington, D.C
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Frequency:
weekly
regular

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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 )
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federal government publication   ( marcgt )
statistics   ( marcgt )
periodical   ( marcgt )

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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.

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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:
AA00010654:00159

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


V

Vol. 17, No. 25


WEEKLY

REPORT


Week Ending
June 22, 1968


PUBLIC HEALTH SERVICE


HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION


CURRENT TRENDS
MEASLES United States

During the 4-week period, May 19 through June 15,
1968, (weeks 21 24), 2,684 cases of measles were re-
ported to NCDC. This is a decrease of 700 cases from the
preceding 4-week period and is 39 percent of the 6,831
cases reported for the corresponding 4-weeks in 1967
(Figure 1). The seasonal pattern of a gradual increase in
the number of cases reported in each 4-week period since
December 2, 1967, has ended, and the anticipated down-
ward trend has begun.
The cumulative number of measles cases reported for
the first 24 weeks of 1968 is 16,597. During the compara-
ble 24-week period in 1967 the reported cases totaled
53,043. Similarly, for the previous 3 years (1966, 1965,
and 1964) the totals were 172,735, 220,468, and 422,640,
respectively. Based on reporting for the past 3 years, in
which 84 percent of the reported cases occurred in the


CONTENTS
Current Trends
Measles United States ............... ....... 229
Measles Philadelphia, Pennsylvania . ... 230
Epidemiologic Notes and Reports
Measles Los Angeles County, California ........ 230
Salmonellosis Wisconsin. ............. .... 231
Food Poisoning Spokane, Washington. . ... 232
International Notes
Outbreaks of Pesticide Poisoning Middle East. 234
Surveillance Summary
Human Leptospirosis United States 1967 ... 235


first 24 weeks, an estimate of the total cases for the year
1968 would be 19,700. With an increased emphasis on
measles surveillance which may result in change of di-
agnosis and reduction in the cases reported (MMWR, Vol. 17,
No. 24) and continued emphasis on immunization, this
e-.rm e1 j yearly total could be reduced.
(Reported by State Services Section, and Statistics Section,
Epidemiology Program, NCDC.)


Figure 1
REPORTED CASES OF MEASLES BY 4-WEEK PERIODS UNITED STATES
EPIDEMIOLOGIC YEAR 1967-68, COMPARED WITH 1966 --


1967-68


4 2 30 27 24 23 20 18
NOV. DEC. DEC. JAN. FEB. MAR. APR. MAY
4 -WEEK PERIOD ENDING


15 13 10 7 5
JUNE JULY AUG. SEPT. OCT.


12,000



10,000



8,000
w
UJ
4

0 6,000

u

4,000 -


2,000-



0








Morbidity and Mortality Weekly Report


EPIDEMIOLOGIC NOTES AND REPORTS
MEASLES Los Angeles County, California


As part of Ihe Los Angeles County Measles Surveil-
lance P"r. .r ,,. the 92 measles cases reported in Los
Angeles County* for the period March 31 "lr.ul'l June 1,
196s. have been investigated. The reporting source was
contacted by telephone and when additional information
Nwas needed, the patient or his parent w as also contacted.
This follow-up study revealed that only 42 of the 92 re-
ported cases had histories compatible with rubeola. Of
these 42 measles cases, four were in children under 1 year
of age, and the majority of cases (79 percent) occurred in
children in the lower middle and lower socioeconomic
groups (Table 1).

Table 1
Rubeola Cases in Los Angeles County, California,
by Age and Socioeconomic Groups
March 31 June 1, 1968

Ae G p Socioeconomic Group
Age Group
(Years) Case Upper Upper Lower Lower
Middle Middle

Under 1 4 4
1-4 10 1 1 8
5-9 14 3 6 5
10-14 7 2 2 3
15 & over 7 3 4

Total 42 2 7 13 20

Analysis of the 50 cases incorrectly reported as mea-
sles showed that the largest proportion of this group rep-
resented rubella cases (41). The diagnosis of the other
nine cases was changed to allergy (3), chicken pox (2),
scarlet fever (1), roseola (1), measles vaccine reaction(1),
and pediculosis (1). The initial report was made by physi-
cians in 11 cases and by nurses (usually school nurses

*Ex<-luding Long Beach, Pasadena, and Vernon.


who had not seen the pi.ill.-n in the other 39 cases. Of
the 41 cases in which the diagnosis was changed to ru-
bella, 34 were reported as measles by the physician or
nurse when each had meant German measles. In the other
seven cases, the history of illness was typical of rubella,
and therefore, the diagnosis was changed. The age dis-
tribution of the 41 cases of rubella (Table 2) revealed
that nearly all the cases occurred in individuals in the
second decade of life, a distribution typical of the natural
occurrence of this disease. I
Table 2
Age Distribution of Rubella Cases in Los Angeles County,
California, Originally Reported as Rubeola
March 31 June 1, 1968

Age Group
(Years)

Under 1 0
1-4 2
5-9 2
10-14 23
15-19 12
20-24 1
25-29 1

Total 41

(Reported by B. A. Kogen, M.D., Director, Immunization
Project, and Chief, Acute Communicable Disease Control,
and Gerald A. Heidbreder, M.D., Health Officer, Los An-
geles County Health Department; Philip A. Condit, M.D.,
M.P.H., Chief, Bureau of Communicable Diseases, Cali-
fornia State Department of Public Health; and an EIS
Officer.)

Reference:
1Sevcr, J. L., et al: Rubella: Frequency of Antibody Among
Children and Adults. Pediatrics 35(6):996-998, 1965.


CURRENT TRENDS
MEASLES Philadelphia, Pennsylvania


From January 1 :hri.,l.- June 3, 1968, Philadelphia
reported 37 cases of measles (Figure 2). This is an in-
crease of 10 cases over the total of 27 cases reported from
Philadelphia for 1967. Review of age distribution of re-
ported cases for 1968 (Table 3) reveals that 23 of the 37
cases were in children 5 years of age or less. Of the 37
cases, 15 were in school children. No secondary cases
have been reported within the school system this year
probably because Philadelphia employs a system of in-
tensive measles case follow-up and vaccination of family
and classroom contacts.


Of the 37 cases reported this year, 28 (76 percent)
occurred in residents of two contiguous health di-trircl
located in a low socioeconomic area of the center litv
(Figure 2); these two health districts reported 12 (44 per-
cent) of the city's 27 cases in 1967. Of the 28 cases re-
ported in 1968 from these two districts, 21 occurred in
children of Puerto Rican extraction (Table 4). although
they compose approximately 2 percent of Philadelphia's
population, 57 percent of the city's reported measles
cases in 1968 occurred in this group. Since early 1967 the
special children's health service projects which serve


JUNE 22, 1968






Morbidity and Mortality Weekly Report


Figure 2
REPORTED CASES OF MEASLES BY HEALTH DISTRICTS
PHILADELPHIA, PENNSYLVANIA
JANUARY 1 JUNE 3, 1968


Table 3
Age Distribution of Reported Measles Cases

Age
(Years) Cases Percent

Under 1 4 11
1-5 19 51
6-10 12 32
11-15 2 6
Over 15 0 0

Total 37 100


Table 4
Distribution of Reported Measles Cases
By Population Groups

Population Group Cases Percent

Puerto Rican 21 57
Negro 12 32
Other 4 11

Total 37 100


these two areas with the highest concentration of re-
ported cases have become fully operational.
(Reported by Lewis D. Polk, M.D., Deputy Health Com-
missioner for Community Health Services, and Sylvan
Fish, M.D., Chief of Communicable Disease Control, City
of Philadelphia Health Department; and an EIS Officer.)


EPIDEMIOLOGIC NOTES AND REPORTS
SSALMONELLOSIS Wisconsin


From April 16 to May 12, 1968, 10 cases of gastro-
enteritis due to a dulcitol negative strain of Salmonella
typhimurium occurred in nine families of three adjacent
towns in northeastern Wisconsin (Figure 3). In addition to
the 10 documented cases, another three cases of sympto-
matic diarrhea, not cultured bacteriologically, also occurred
among the nine families. Infants in the families were
apparently at greater risk when compared with older mem-
bers since all children under the age of 5 years were af-
fected while only three of 29 persons older than 5 years of
age were symptomatic (Table 5). Of the 10 bacteriologically
confirmed cases, six, all under 3 years of age, were hos-
pitalized from 5 to 13 days. Four of the six infants had
bloody diarrhea.
Epidemiologic investigation showed that all of the
involved families had purchased Easter chicks or ducklings
from a single pet store. A total of 650 chicks were sup-
plied to the pet shop by a local hatchery. The hatchery
also sold 600 other Easter chicks locally, but no cases of
clinical illness could be traced to this source. Baby ducks
were purchased by the pet shop from an Ohio dealer and


Figure 3
SALMONELLOSIS ASSOCIATED WITH EASTER CHICKS
AND DUCKS BY DATE OF ONSET
WISCONSIN APRIL 14-MAY 12, 1968


E POSITIVE CULTURE
[~] SYMPTOMATIC (WITHOUT CULTURE)


EASTER SUNDAY




Pm Ti i n


r Fni n1


14 15 16 I 17 192 21 22 23 24 2s 2 27( 2 29 2 3 I 2 3' 4 5 10 II 12
APRIL MAY
DATE OF ONSET

were received in three separate lots of 100 each, arriving
at the pet shop on April 2, 9, and 12, respectively.
On May 16, eight of the nine families were recultured.
Of 27 specimens taken, eight were positive for the epi-
demic strain. In addition, cloacal swabs were taken from
13 chicks from the original 650 sold by the pet shop, and
(Continued on page 232)


JUNE 22, 1968






Morbidity and Mortality Weekly Report


SALMONELLOSIS (Continued from page 231)


Table 5
Attack Rates for Diarrhea in Nine Families

Age Group Number of Cases of Attack Rate
(Years) Persons Diarrhea (Percent)
5 10 10 100
5 li 1 12
15 21 2 10
Total 39 13 33

the epidemic strain was recovered from twoof these birds.
Specimens from the cages where the chicks had been
kept also yielded ducitol negative S. typhimurium as well
as S. tennessee and S. muenchen.
(Reported by Grant Skinner, M.D., Section of Com-
municable diseasee Control, Eleanor Christenson, Enteric
Bacteriology Section, and Frank Pauls, Ph.D., Assistant


Director, State Laboratory of Hygiene, Wisconsin State
Department of Health and Social Services; and an EIS
Officer.)

Editorial Comment:
In 1966 and 1967, in a selected group of 803 salmo-
nella non-host adapted strains submitted to the Enteric
Bacteriology Unit, Bacteriology -. i,,m Laboratory Pro-
gram, NCDC, 18 or 2.2 percent were dulcitol nrgatli-I
Because of the infrequency of dulcitol ni'L,,litei sal-
monella. the Wisconsin State Department of Health and
Social Services was alerted to the possibility of this epi-
demic when they began to recover strains with this char-
acteristic in specimens sent to their state laboratory for
analysis. Subsequent epidemiologic Inr,.--tal rn con-
firmed that a common source outbreak of salmonella was
occurring.


FOOD POISONING Spokane, Washington


An outbreak of food poisoning occurred in Spokane,
Washington, following a convention banquet at a large
hotel on May 4. Of the 1.052 persons who ate the banquet
meal, 784 (75 percent) were questioned and 113 reported
being ill, yielding an overall attack rate of 14.4 percent.
The major symptoms of illness were diarrhea and abdominal
cramps (Table 6). The mean incubation period was 13
hours with a range from 2 to 29 hours (Figure 4), and the
durations of illness (determined by diarrhea) ranged from
3 to 99 hours with a median of 12 to 24 hours (Table 7).
Four persons consulted a physician, and no one was hos-
pitalized.
Analysis of food histories obtained from the 784
persons suggested prime rib as the vehicle of infection
(Table 8). Samples of all food items served at the banquet

Table 6
Symptoms and Severity (113 Cases)
Food Poisoning Outbreak
Spokane, Washington May 1968

Number With Percent
Syptommptom
Symptom
Diarrhea 103 91.2
Cramps 76 72.6
Headache 44 38.9
Nausea 42 37.0
Prostration 39 34.5
(hills 29 25.7
S eating 15 13.3
\Muscle aches 14 12.4
Smiting 11 9.7
Fever 8 7.1
Documented Fever 2 1.8
Bloody Diarrhea 1 0.9


Table 7
Duration of Diarrhea in 83 Cases

Duration of Diarrhea Number of Cases
(Hours)
0- 1 27
12 24 27
24 36 4
36 48 16
48-60 1
60 72 5
72 or more 3
Total 83


were obtained for culture. The prime rib contained greater
than 18 million Clostridium perfringens per gm and the
prime rib au jus had in excess of 30 million per pm. C.
perfringens, type 89, was present in four of five specimens
from the roast beef served at the banquet, an untypable
strain was present in two of the five, and Hobbs. type 13,
was present inthe prime rib au jus in addition to the other
two types. No pathogens were isolated from the other foods.
Samples of prime rib obtained within 1 month after the
outbreak from two of the three packing houses supplying
the hotel were also positive for C. perfringens, but types
are not yet known for these isolates.
Of 19 stool specimens cultured for organisms, 11
were positive for C. perfringens, type 89, two specimens
were positive for C. perfringens which uwerr nuo aggluiinated
by available typing sera, and six were negati.ie for C.
perfringens. Of the 113 ill persons, 10 cases reported no
diarrhea, but they did have abdominal cramps and/or nausea.
Some of the 10 were positive for C. perfringens, type 89.
Qu,,-ionir,in of the people seemed to indicate that
people from Spokane City and County had a higher attack rate


JUNE 22, 1968





JUNE 22, 1968


Morbidity and Mortality Weekly Report


Figure 4
HOURS FROM BANQUET TO ONSET OF SYMPTOMS (85 CASES)
FOOD POISONING OUTBREAK
SPOKANE, WASHINGTON MAY 1968

















L. "


I 2 3 4 5 6 7 8 9 10 II 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
HOURS


Table 8
Summary of Food Histories Food Poisoning Outbreak
Spokane, Washington May 1968

Ate Did Not Eat

Food Number Number Total Attack Number Number Total Attack Percent
Rate Rate Difference
Ill Not Ill Number Rate Ill Not Ill Number ate D
Percent Percent
Crab Cocktail 102 478 580 17.6 11 193 204 5.4 12.2
Green Salad 92 446 538 17.1 21 225 246 9.3 7.8
Baked Potato 103 478 581 17.7 10 193 203 4.9 12.8
Prime Rib 113 643 756 14.9 0 28 28 0.0 14.9
String Beans 102 479 581 17.6 11 192 203 5.4 12.2
Hard Roll 86 424 510 16.9 27 247 274 9.9 7.0
Chocolate Eclair 90 429 519 17.3 23 242 265 9.5 7.8
Milk 34 123 157 21.7 79 548 627 12.6 9.1
Coffee 87 423 510 17.1 26 248 274 9.5 7.6


than people from other parts of the state. When this pos-
sibility was investigated, it was learned that the banquet
was held in several dining rooms and at different times,
7-8 p.m., 8-9 p.m., and 9-10 p.m., and that the group from
Spokane City and County ate in one dining area (Area A)
and at a later time(8-10 p.m.) than the other groups. When
attack rates were obtained for location and time of eating,
Area A had higher attack rates than the other areas. In-
vestigation of the foods served in the various dining areas
revealed that all foods came from the same source. All
the meat for Area A and the major portion of the meat for
the main dining room were obtained from 30 roasts which
were handled uniformly until completion of slicing. Then
approximately 150 servings went to Area A and the other
450 went to the main dining room. The roast beef in dining
Area A had not been placed in warmers after slicing while
that served in the main dining room had been placed in


warmers. The lack of warming combined with the late
serving (40 to 120 minutes after slicing) may explain the
higher attack rate in dining Area A. The data suggest that
the beef may have been uniformly contaminated originally
and that handling procedures after cooking were responsible
for the differing attack rates in the various dining areas.
Appropriate remedial changes in kitchen procedures have
been made.
(Reported by Byron J. Francis, M.D., Acting Chief, Di-
vision of Epidemiology, and James A. Bessey, Advisory
Sanitarian, Division of Environmental Services, Washington
State Department of Health;Stuart A. Davis, M.D., Spokane
City Health Officer, and Roy Olson, Supervising Sani-
tarian, Spokane City Health Department; E.O. Ploeger,
M.D., M.P.H., Spokane County Health Officer; Anaerobic
Bacteriology Laboratory, Bacterial Reference Unit, Labo-
ratory Program, NCDC; and a team of EIS .'". ...)


F 4I 71


Mi i2






234


Morbidity and Mortality Weekly Report


JUNE 22, 1968


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
25th WEEK ENDED MEDIAN CUMULATIVE, FIRST 25 WEEKS
MEDIAN -
DISEASE June 22, June 24, 1963 -1967 MEDIAN
1968 1967 1968 1967 1963 1967
Aseptic meningitis .......... ...... ... 78 57 37 832 848 722
Brucolloh si ............................ 7 8 7 78 125 125
Diphtherita ............. ............ 3 3 86 53 79
Eniephalitis. prim ary:
ArthropdhornI unsp cificd ........... 18 35 4. 121 635 -
Eii phalitis. post-intc ctious ........... 8 32 263 449 -
H~ pattis, scrum ... ...... 100 64 577 1.952 984 20
Het atitis. in.r i, l s .................... 895 679 21.066 19 133
Malaria .... ................. 31 52 4 1.001 963 45
Mea1 s (ruibola) ................ ...... 522 888 3,999 17.119 53,931 224.467
M ning ,cccal intrctions. total ........... 65 34 50 1.617 1,380 1,555
Civilian ................... ........... 59 28 -- 1,460 1.276 -
Military ............. ................ 6 6 157 104 -
Mumps ............... ......... ..... 2,128 114,074 -
Poliomyelitis, total ..................... -- 1 1 19 11 19
Paralytic ............................. 1 19 9 17
Rubella (G(;rmani illiasles) .......... ........ 1,307 1,232 38,970 35,972 -
Streptococcal sre throat & scarlet fever... 5.438 6,093 5,498 251.479 271,975 246,225
Tetanus .................. ........ 6 5 7 64 86 107
Tularemia ........ ....................... 5 3 5 86 71 114
Typhoid lvr. .......................... 7 6 9 134 183 172
Typhus, tick-borno (Rky. Mt. spotted lever). 13 13 15 75 80 69
Rabies in animals .............. .... ... 51 80 90 1.776 2.,231 2.231

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........................................... 2 Rabies in man: ......................................
Botulism: ............. ....... ...... ........... 1 Rubella, Congenital Syndrome:......................... 3
Leptospir sis: ...................................... 13 T richinosis: ................... ..... ............... 35
Plague: ........................-...... Typhus, murine: ............ .......... ............. 6
Psittacosis: Tex.-3, Calif.-l .. ......... ........... 23


INTERNATIONAL NOTES
OUTBREAKS OF PESTICIDE POISONING1- Middle East

During June and July 1967, four separate outbreaks (Table 10). Onset of symptoms occurred an average of 2.3
of pesticide poisoning occurred in the Middle East. The hours after ingesting the contaminated bread at the break-
first three outbreaks were in Doha, Qatar, and the fourth fast meal with a range from 30 minutes to 10 hours. In the
was in Hofuf, Saudi Arabia. Of the persons exposed, 874 outbreaks, more males seemed to be affected than females
persons were hospitalized and 26 of these persons died (Table 11). The exact reasonsfor this male preponderance
(Table ',i it was estimated that another 500 to 750 people were not known, but it was postulated that often the wage-
were also poisoned but that their symptoms were not severe earner ate a larger breakfast than the other family members
enough for them to seek medical care or hospitalization. and possibly ingested more of the chemical.
The poisonings were caused by ingesting bread made Epidemiologic investigation showed that the source of
from flour contaminated with endrin.* exposure was bread contaminated with endrin. Laboratory
The patients' symptoms included headache, abdominal analysis found the bread, flour used to make the bread,
discomfort, nausea and dizziness, sudden loss of con- and the flour sacks to be contaminated with endrin. Al-
sciousness, vomiting, and convulsions symptoms com- though the flour had been transported to the countries in
patible with acute chlorinated hydrocarbon intoxications two separate ships, both ships involved had also, on the

Table 9
Summary of Number of Persons Hospitalized and Deaths in Four Outbreaks

Outbreak Date (1967) Number of Persons Number of Fatality Rate
Hospitalized Deaths (Percent)

First Doha June 3-5 490 7 1.4
Second Doha July 2 13 0 0.0
Third Doha July 3-4 188 17 9.5
Hofuf July 14-15 183 2 0.4

Total 874 26 3.1






Morbidity and Mortality Weekly Report


Table 10
Most Common Symptoms Given by Persons
in Two of the Four Outbreaks


Percentage with Indicated Symptoms

First Doha Outbreak Hofuf Outbreak
Symptoms (Number of Persons (Number of Persons
Interviewed-110) Interviewed-54)

Vomiting 69 83
Convulsions 65 67
Abdominal
Disconfort 48 19
Nausea and
Dizziness 38 28
Headache 60 2
Sudden Loss of
Consciousness 5 4

same voyage, carried large shipments of the chemical.
Investigation showed that the endrin was stored above
the flour on both ships and that the endrin had leaked
through faulty containers onto the flour.


The governments of both Qatar and Saudi Arabia have
taken the following steps to prevent a similar incident in
the future: (1) All foodstuffs are to be inspected before
delivery of the food is accepted. This inspection requires
that the ship's captain provide a list of dangerous goods
carried on board the ship, that the cargo as well as stowage
diagrams be examined to determine the presence and
location of toxic chemicals on the ship, and that a sanitary
inspector verify the cargo and inspect it for any contami-
nation of foodstuffs that may have occurred. (2) Foodstuffs
accepted for delivery are to be brought from the ship to
shore in one of three barges painted white to designate
for food only.

(Reported by Pesticides Program, NCDC.)

Reference:
Weeks, D.E.: Endrin Food Poisoning. Bull Wld Hlth Org 37:499-
512, 1967.

*Endrin is 1,2,3,4,10, 10-hexachloro-6,7 epoxy-l,4,4a,6,7,S,8a-
octahydro-l-4-endo-endo-5-S-dimethanonaphthalene, an insec-
ticide used in agriculture against soil and foliage insects.


Table 11
Sex Distribution of Hospitalized Persons in Three of the Four Outbreaks

Percentage of Each Sex

Sex First Doha Outbreak Third Doha Outbreak Hofuf Outbreak
(Number of Persons (Number of Persons (Number of Persons
Interviewed-110) Interviewed-169) Interviewed-54)

Male 63 68 69
Female 37 32 31


SURVEILLANCE SUMMARY
HUMAN LEPTOSPIROSIS United States 1967*


Although no outbreaks of human leptospirosis were
reported to NCDC in 1967, 51 separate cases of human
leptospirosis were reported. The 51 cases were distributed
among 16 states with California and Hawaii reporting nine
cases each, Louisiana reporting eight cases**, and Iowa
reporting seven cases; 12 other states reported three or
fewer cases.
Additional information was submitted to NCDC on 43
of these 51 cases. Evaluation of the 43 cases by date of
onset showed that July, August, and September were the
months of highest incidence with six, eight, and six cases,
respectively (Table 12). Analysis of the sex distribution
of these 43 cases revealed that the majority of cases
occurred in males (32 of 43 cases) (Table 13). Age was
known in 38 of the 43 cases. Among males, the 10 tol9-
year and the 50 to 59-year age groups each had 6 cases,

*Preliminary data.
**In addition to the eight cases reported from Louisiana with
dates of onset in 1967, Louisiana reported two cases with
onset of illness in 1966.


Table 12
Monthly Distribution of Human Leptospirosis by Date of Onset
United States, 1967

Month Number of Cases
January 2
February 2
March 3
April 1
May 3
June 1
July 6
August 8
September 6
October 1
November 1
December 1
Unknown 8
Total 43

(Continued on page 240)


JUNE 22, 1968







236 Molrbi4dil% and M1 rtalily Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 22, 1968 AND JUNE 24, 1967 (25th WEEK)

ENCEPHALITIS HEPATITIS
ASEPTIC SIS IA Primary
ASEPMEIGTIC il HR[ incl 9 n Infectious Serum Infectious

unsp. cases
1968 1967 1968 1968 1968 1967 1968 1968 1968 1967 1968
UNITED STATES... 78 57 7 18 35 8 100 895 679 31

NEW ENGLAND.......... 1 1 3 42 25 1
Maine.............. 2 3
New Hampshire .... 1
Vermont............ -
Massachusetts...... 2 25 13
Rhode Island........ 1 1 7 3 -
Connecticut........ 1 8 5 1

MIDDLE ATLANTIC...... 8 5 3 9 34 166 109 8
New York City ..... 1 2 29 60 50 3
New York, Up-State. 1 1 1 2 16 26
New Jersey......... 6 3 1 3 1 40 12 3
Pennsylvania....... 1 1 3 2 50 21 2

EAST NORTH CENTRAL... 6 5 8 9 1 5 151 103 1
Ohio................ 4 2 1 5 1 3 48 26
Indiana............ 4 3 11 7
Illinois........... 1 2 2 33 36 1
Michigan........... 1 1 1 1 2 43 25
Wisconsin.......... 16 9

WEST NORTH CENTRAL... 1 1 45 53 3
Minnesota .......... 1 16 13
Iowa................ 6 5 1
Missouri........... 13 29 1
North Dakota....... 3 1
South Dakota ...... 1 1
Nebraska........... 3
Kansas............. 3 5 1

SOUTH ATLANTIC......... 11 5 4 2 5 3 68 69 5
Delaware........... 3
Maryland............ 3 1 2 25 14
Dist. of Columbia.. 1 2 1
Virginia............ 2 5 14 2
West Virginia...... 3 1 12 5 1
North Carolina..... 1 1 1 4 3 9 1
South Carolina...... 1 2
Georgia............. 2 7
Florida............ 5 3 1 1 18 14 1

EAST SOUTH CENTRAL... 4 8 1 1 3 35 43 2
Kentucky............ 14 15
Tennessee.......... 6 1 1 3 17 18
Alabama............ 1 2 1 2 1
Mississippi........ 3 3 8 1

WEST SOUTH CENTRAL... 28 8 3 2 74 90
Arkansas........... 14 4
Louisiana........... 22 3 2 2 13 11
Oklahoma............ .- 8 9
Texas.............. 6 5 1 39 66

MOUNTAIN............... 2 3 67 31
Montana.............. 5 1
Idaho.............. I- 1 2
Wyoming.............. 1 5
Colorado............ 1 2 42 6
New Mexico......... 10 10
Arizona ........... 5 3
Utah............... 1 3 4
Nevada............. 1

PACIFIC.............. 21 26 1 2 6 6 48 247 156 11
Washington......... 1 16 8 4
Oregon............. I 2 9 6 1
California......... 19 21 1 2 5 6 46 221 137 6
Alaska............. 5
Hawaii.............. 1 4 1 1

Puerto Rico.......... 24 23

*Delayed Reports: Hepatitis, infectious: N.H. I







Morbidity and Mortality Weekly Report 237


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
JUNE 22, 1968 AND JUNE 24, 1967 (25th 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... 522 17,119 53,931 65 1,617 1,380 2,128 19 1,307

NEW ENGLAND......... 47 985 744 6 86 57 247 365
Maine. ........... 30 221 6 3 13 18
New Hampshire*..... 113 72 7 2 1 1
Vermont............. 1 28 1 11 1
Massachusettst..... 24 315 282 2 37 29 119 167
Rhode Island....... 1 60 7 4 32 39
Connecticut........ 23 525 81 4 28 19 71 139

MIDDLE ATLANTIC...... 191 3,103 1,992 11 279 210 217 256
New York City...... 120 1,378 368 2 57 36 119 158
New York, Up-State. 40 1,073 442 1 44 51 NN 32
New Jersey*........ 22 508 463 6 102 80 98 59
Pennsylvania....... 9 144 719 2 76 43 NN 7

EAST NORTH CENTRAL... 67 3,441 4,841 13 188 176 435 224
Ohio................ 9 270 1,089 6 51 62 53 47
Indiana............ 9 601 550 3 26 21 48 12
Illinois........... 22 1,286 845 39 43 62 79
Michigan........... 11 228 852 4 56 38 40
Wisconsin.......... 16 1,056 1,505 16 12 272 46

WEST NORTH CENTRAL... 13 345 2,677 5 83 63 41 35
Minnesota........... 15 125 1 19 15 25 -
Iowa............... 5 86 725 5 12 25
Missouri........... 4 80 300 4 30 12 2 3
North Dakota....... 4 117 782 3 1 1
South Dakota....... 4 47 4 6 NN -
Nebraska........... 35 606 6 11 1 1
Kansas.............. 8 92 16 6 13 5

SOUTH ATLANTIC....... 45 1,256 6,344 15 338 264 165 129
Delaware........... 12 40 5 5 5 34
Maryland............ 6 79 127 1 23 32 29 6
Dist. of Columbia.. 6 20 1 13 9 10 1
Virginia............ 1 261 1,930 4 27 27 22 21
West Virginia...... 2 210 1,297 8 20 45 18
North Carolina..... 8 273 834 2 67 53 NN -
South Carolina..... 12 486 54 24
Georgia............. 4 29 1 60 43
Florida............. 28 399 1,581 6 81 51 54 49

EAST SOUTH CENTRAL... 3 498 4,853 5 139 117 200 48
Kentucky........... 1 165 1,254 51 34 73 21
Tennessee.......... 54 1,671 2 48 47 118 18
Alabama............ 2 71 1,281 2 20 24 9 9
Mississippi........ 208 647 1 20 12 -

WEST SOUTH CENTRAL... 79 4,326 16,561 3 266 197 208 11 44
Arkansas........... 2 1,400 15 25 -
Louisiana.......... 2 143 1 72 78 1 5
Oklahoma............ 109 3,311 48 13 -
Texas............... 79 4,213 11,707 2 131 81 207 11 39

MOUNTAIN............. 26 895 4,243 24 25 90 36
Montana............ 66 268 2 8 1
Idaho.............. 16 359 10 1 4 -
Wyoming.............. 49 168 1 -
Colorado............ 22 458 1,383 7 10 16 12
New Mexico.......... 1 81 552 3 1 6
Arizona............. 3 199 922 1 4 40 16
Utah .............. 21 322 1 4 21 -1
Nevada............. 5 269 3 2 -

PACIFIC.............. 51 2,270 11,676 7 214 271 525 8 170
Washington........... 5 512 5,356 1 36 24 10 6
Oregon.............. 15 432 1,469 16 24 10 11
California.......... 31 1,291 4,595 6 150 212 489 8 147
Alaska.............. 1 124 1 9 5 1
Hawaii.............. 34 132 11 2 11 5

Puerto Rico.......... 16 331 1,917 1 18 9 18
*Delayed Reports: Measles: Mass. delete 16, N.J. delete 4
Mumps: Me. 5, N.H. 1
Rubella: Me. 4








238 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 22, 1968 AND JUNE 24, 1967 (25th 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... 5,438 6 64 5 86 7 134 13 75 51 1,776

NEW ENGLAND............ 1.057 1 40 4 1 61
Maine.*............. 18 50
New Hampshire.t.... 2
Vermont............. 19 40 7
Massachusetts ...... 159 2 1
Rhode Island....... 77 -
Connecticut........ 784 1 2 1 1

MIDDLE ATLANTIC...... 240 9 3 1 12 1 5 15
New York City...... 13 5 1 7 -
New York, Up-State. 214 4 3 2 1 11
New Jersey......... NN -
Pennsylvania....... 13 3 1 4 4

EAST NORTH CENTRAL... 535 8 6 21 1 3 5 160
Ohio............... 152 1 1 1 2 3 65
Indiana............. 113 1 1 57
Illinois........... 79 5 4 8 1 17
Michigan........... 144 2 1 -- 9
Wisconsin.......... 47 1 1 12

WEST NORTH CENTRAL... 115 2 6 2 7 2 12 400
Minnesota......... 20 2 111
Iowa............... 26 1 1 1 14
Missouri........... 3 2 4 3 4 72
North Dakota....... 43 2 67
South Dakota....... 3 1 1 1 34
Nebraska........... 20 1 2 1 1 20
Kansas............. 1 2 22

SOUTH ATLANTIC....... 574 1 12 5 1 36 6 45 8 203
Delaware..........- -
Maryland........... 119 1 1 1 6 1 4 3
Dist. of Columbia.. 25 1 -
Virginia............ 179 2 1 7 3 20 1 83
West Virginia...... 123 I 26
North Carolina..... 4 2 2 2 2 14 1 8
South Carolina..... 2 I 1 -
Georgia............ 3 1 9 4 3 28
Florida............. 119 4 1 11 2 3 55

EAST SOUTH CENTRAL... 778 1 9 6 15 8 8 437
Kentucky............ 54 1 1 2 1 6 206
Tennessee.......... 649 2 4 10 5 2 212
Alabama............. 37 1 3 I 19
Mississippi........ 38 3 1 3 1 -

WEST SOUTH CENTRAL... 386 4 11 4 15 1 10 4 10 9 327
Arkansas........... 2 3 4 1 1 2 38
Louisiana.......... 6 1 5 2 3 1 1 31
Oklahoma........... 24 1 3 2 4 2 101
Texas.............. 354 2 1 8 1 6 4 6 4 157

MOUNTAIN............... 854 4 9 1 1 39
Montana............ 8 -
Idaho.............. 58 -
Wyoming............. 9 1 1 2
Colorado........... 445 1 2 1 1
New Mexico. ........ 145 6 1 18
Arizona............ 88 18
Utah............... 101 2 -
Nevada.............- -

PACIFIC............... 899 12 1 1 2 20 1 1 7 134
Washington......... 138 -
Oregon............... 76 1 1 1 1 3 3
California......... 624 11 1 17 1 1 7 131
Alaska ......... .. 17 -
Hawaii.............. 44 -- -

Puerto Rico......... 3 5 1 1 1 16

*Delayed Reports: SST: Me. 5, N.H. 7, Del. 1





239


Morbidity and Mortality Weekly Report






TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED JUNE 22, 1968


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

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


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

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

EAST NORTH CENTRAL:
Akron, Ohio-----------
Canton, Ohio----------
Chicago, Ill.----------
Cincinnati, Ohio-----
Cleveland, Ohio------
Columbus, Ohio--------
Dayton, Ohio----------
Detroit, Mich.--------
Evansville, Ind.------
Flint, Mich.----------
Fort Wayne, Ind.------
Gary, Ind.-----------
Grand Rapids, Mich.---
Indianapolis, Ind.----
Madison, Wis.---------
Milwaukee, Wis.------
Peoria, Ill.-----------
Rockford, Ill.--------
South Bend, Ind.-----
Toledo, Ohio----------
Youngstown, Ohio----

WEST NORTH CENTRAL:
Des Moines, Iowa------
Duluth, Minn.----------
Kansas City, Kans.----
Kansas City, Mo.-------
Lincoln, Nebr.---------
Minneapolis, Minn.----
Omaha, Nebr.----------
St. Louis, Mo.--------
St. Paul, Minn.-------
Wichita, Kans.--------


710
217
54
29
22
69
25
15
17
60
58
16
49
18
61

3,086
41
38
129
45
33
45
53
65
1,492
38
508
212
51
92
24
52
66
54
15
33

2,573
73
38
757
140
202
138
99
316
49
60
56
31
84
127
28
119
30
30
31
101
64

829
64
25
46
132
36
110
73
218
77
48


420
113
44
16
17
41
11
12
12
31
29
9
30
14
41

1,782
17
21
65
24
20
28
25
34
851
24
299
119
35
61
15
35
49-
29
7
24

1,479
41
18
425
89
103
72
51
177
33
29
39
12
61
80
16
70
16
20
22
60
45

490
47
14
19
89
19
65
36
126
46
29


SOUTH ATLANTIC:
Atlanta, Ga.-----------
Baltimore, Md.---------
Charlotte, N. C.-------
Jacksonville, Fla.-----
Miami, Fla.-----------
Norfolk, Va.-----------
Richmond, Va.-----------
Savannah, Ga.-----------
St. Petersburg, Fla.---
Tampa, Fla.------------
Washington, D. C.------
Wilmington, Del.-------

EAST SOUTH CENTRAL:
Birmingham, Ala.-------
Chattanooga, Tenn.-----
Knoxville, Tenn.-------
Louisville, Ky.--------
Memphis, Tenn.-------
Mobile, Ala.-----------
Montgomery, Ala.-------
Nashville, Tenn.-------

WEST SOUTH CENTRAL:
Austin, Tex.-----------
Baton Rouge, La.------
Corpus Christi, Tex.---
Dallas, Tex.--------
El Paso, Tex.----------
Fort Worth, Tex.-------
Houston, Tex.-----------
Little Rock, Ark.------
New Orleans, La.-------
Oklahoma City, Okla.--
San Antonio, Tex.------
Shreveport, La.--------
Tulsa, Okla.------------

MOUNTAIN:
Albuquerque, N. Mex.---
Colorado Springs, Colo.
Denver, Colo.----------
Ogden, Utah------------
Phoenix, Ariz.---------
Pueblo, Colo.----------
Salt Lake City, Utah---
Tucson, Ariz.----------

PACIFIC:
Berkeley, Calif.-------
Fresno, Calif.---------
Glendale, Calif.-------
Honolulu, Hawaii-------
Long Beach, Calif.-----
Los Angeles, Calif.----
Oakland, Calif.--------
Pasadena, Calif.-------
Portland, Oreg.--------
Sacramento, Calif.-----
San Diego, Calif.------
San Francisco, Calif.--
San Jose, Calif.-------
Seattle, Wash.---------
Spokane, Wash.---------
Tacoma, Wash.----------


1,148
109
230
49
60
124
45
84
41
97
66
177
66

652
101
33
43
156
134
39
51
95

1,222
52
51
24
159
28
100
244
75
156
86
113
70
64

419
37
29
127
14
88
21
56
47

1,549
13
47
26
44
92
448
80
33
121
55
99
199
61
157
46
28


3
2
4

40
7
3

1
1
1
3
5
4
4
4
3
4

15
2
4
2

2
1
3
1

25

1

1
3
11
2

1
1

2

3


Total 1 12,188 6,873 391 598

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 328,260
All Causes, Age 65 and over------------------- 191,421
Pneumonia and Influenza, All Ages------------ 14,400
All Causes, Under 1 Year of Age--------------- 14,973


Week No.
25


_ I --- I II r --, 1






240 Morbidity and M4


HUMAN LEPTOSPIROSIS (Continued from page 235)

and among females, the 0 to 9-year age group had the
highest incidence with it e cases (Table I oI In the cases
where history of exposure and or contact was available,
the greatest number of cases were in persons who were
exposed in their homes to cats and dogs (9 cases), or
rodents (4 cases). Two cases with suspected rodent ex-
posure occurred in military personnel returning from Viet-
nam. Accidental exposure in the laboratory accounted for
two other cases, and in another three cases, cattle and
swine were incriminated as possible infectious sources.
In 37 cases, the presumptive infecting serotype was
established by supportive clinical, epidemiologic, or
laboratory ',r.lirie- The most frequently reported serotype
in 1967 was Leptospira 4y,_ijae:mji 19 cases (Table 14).
.. I j ).. .
Taoie-. 1/ .'.
Cases of Leptiespl'ros. by Sex a n'ge Distribution
United .States, 1967 :


ortali


A ,_... ;r.,p To i I
Mil,. Femalnle
0-9!' 2 -5 7
10 19 .6 2 8
20 20 ,'' 6
30-39 4 'J'T -- 4
40-49 4 "1 5
50-59 6 6
60-69 -1 1
70-79 1 1
Unknown 5 5

Total 32 11 43

Table 14
Distribution of 43 Cases of Leptospirosis
by Presumptive Infecting Serotype

Presumptive Infecting
Number of Cases
Serotype or Serogroup

L. canicola 19
L. icterohaemorrhagiae 5
L. icterohaemorrhagiae or canicola 3
L. grippotyphosa 3
L. pomona 2
L. pyrogenes 2
L. autumnalis 1
L. tarassovi (hyos) 1
L. icterohaemorrhagiae or autumnalis 1
Unknown 6

Total 43

(Reported by Veterinary Public Health Section, Veterinary
Public Health Laboratory Unit, Epidemiological Services
Laboratory Section, and Statistics Section, Epidemiology
Program, NCOC.)
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, Veterinary Public Health Section
Epidemiology Program


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ty Weekly Report JUNE 22, 198
o-

-r'E MO~e T' AND MORTALITY WEEKLY REPORT, WITH A CIRCULAR" -I
.' F T1 G'* t PiL. L. l T HE NATIONAL COMMUNICABLE
t., CE CEITE ATL AN I A GiOF,' ,. ..M
DIRECTOR, NATIONAL COMMUNICABLE DISEASE CENTER
DL--..J ,ECER M. >
CHIEF, EPIDEMIOLOGY PROGRAM 0A D t&NMu I M .0
ACTING CHIEF, STATISTICS SECTION IDA L. ,MERMAN M.S. u-
EDITOR MICHAEL B. GREGG. M D.

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING Z
6 L".'E ANlMGuOFr IL.I1T -I1 iE NATrO'r IL .OMuE ABLE DISE ASE
:E0TlEA *ELCClIAEE A,:COuNTSO C.- ET ESTINC CuTB._.CA i CASE __
INVESTIGATIONS WHI -- AE COF :-*- E RC, r idTrF ES T TO HEALTH
OFFICIALS AND WHICH. ARE DliR .C Lt I RELATED TO TIE CONTROL
OF COMMUNICABLE D iE AS i S-2.C. OMMUNIC TNN5 S-OQuLD BE
ADDRESSED TO:
NATIONAL COMMUNICABLE DISEASE CENTER
ATLN T .: EORGIA 30333
ATTN: THE E Ci TC,
MORBIDITY AND MORTALITY WEEKLY REPORT

NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO TI- NI :GC BY THE INDIVIDUAL
STATE HEALTH CiL.RiMLNi- THE AFrGT.N,:, WEE- CONCLuDES
ON SATURDAY :OMi ED DAT IA ON A NATIONAL BASiS AE EELE SED
ON THE SUCCEEDING FRIDAY