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:
AA00010654:00160

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


No. 29


Vwww e-., rEnding

N July 9. 1968




U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFA PUBLIC HEA.TW SERVICE

HEALTH SERVICES AND MENTAL HEALTH ADMINISTRA t ''
c i'R CI J-


EPIDEMIOLOGIC NOTES AND REPORTS
PLAGUE CASE Navajo Reservation Kayenta, Arizona

On July 10, an 8-year-old Navajo Indian girl, living
near Kayenta, Arizona, developed a febrile illness. On the
third day of her illness, she developed a painful left in-
guinal swelling and was hospitalized at the Tuba City
PHS Indian Hospital on July 13 with a clinical diagnosis
of bubonic plague. The child was started on tetracycline
therapy on admission, and streptomycin was added to the
regimen on July 15.She has since shown a gradual but def-
inite improvement in her symptoms.
A culture of a bloody material aspirated from the vi-
cinity of the inguinal adenopathy, that was obtained at
the Tuba City PHS Hospital and sent to the Gallup PH'S


CO jT-iT- '
Epidemiologic Notes and Reports
Plague Case Navajo Reservation Kayenta, Arizona .269
Follow-up Plague Denver, Colorado . .. .270
Fatal Malaria Case California . .... ..270
Outbreak of Tuberculosis Buffalo, New York ........ 270
Subhuman Primate-Associated Hepatitis Oakland
County, Michigan . .. . 271
Current Trends
Arbovirus Disease United States . .. 276

Hospital for further analysis, yielded a Gram-negative
bipolar organism somewhat atypical, but fluorescent anti-
body positive for Pasteurella pestis. This organism was
subsequently identified as P. pestis by phage typing.
Investigation of the area around the girl's home in
Tsegi Canyon, Arizona, has revealed no evidence of a
(Continued on page 270)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
29th WEEK ENDED CUMULATIVE, FIRST 29 WEEKS
MEDIAN
DISEASE July 20, July 22. MEDIAN
1963 1967
1968 1967 1968 1967 1963 1967
Aseptic meningitis ..................... 120 50 51 1,140 1,039 901
Brucellosis ........................... 6 4 5 106 152 152
Diphtheria ........................ ..... 1 1 90 58 90
Encephalitis, primary:
Arthropod-borne & unspecified ........... 26 33 507 748 -
Encephalitis, post-infectious ............. 10 16 --- 307 511 ---
Hepatitis, serum ........................ 100 40 617 2,303 1,157 23,131
Hepatitis, infectious .................... 807 601 24,188 21,587
Malaria ........................ ...... 36 28 3 1,184 1,098 57
Measles rubeolaa) ....................... 276 356 1,911 18,468 56,052 234,172
Meningococcal infections, total ........... 40 30 39 1,769 1,505 1,711
Civilian ..................... ........ 36 27 1,599 1,397 -
Military ............................... 4 3 -- 170 108
Mumps ................................ 960 --- --- 119,335 --
Poliomyelitis, total ..................... 2 2 2 31 15 41
Paralytic ............................... 2 2 2 31 13 37
Rubella (German measles) ............... 353 438 --- 41,358 38,319 -
Streptococcal sore throat & scarlet fever.... 4,319 4,707 4,144 270,055 292,106 263,425
Tetanus ............................... 3 10 8 78 112 132
Tularemia ............................. 5 6 6 118 92 137
Typhoid fever ......................... 10 11 11 166 220 209
Typhus, tick-borne (Rky. Mt. spotted fever) 18 14 17 118 142 118
Rabies in animals ....................... 48 109 75 2,083 2,558 2,558

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: Calif.-1 ............ ..... ..... .......... 3 Rabies in man: .......................... ......... -
Botulism: .......................................... 3 Rubella, Congenital Syndrome: Ill.-l .................... 4
Leptospirosis: Ohio-1 .............................. 15 Trichinosis:* ,Calif.-1, Colo.-l, Mass.-l ................. 40
Plague: ........................... .......... ..... 1 Typhus, murine: Tex.-3 ..............................- 14
Psittacosis: Calif.-1 ................................ 28
*Deldyed reports: Pa. 2 cases 1967, delete 1 case 1968







Morbidity and Mortality Weekly Report


PLAGUE CASE (Continued from front page)


rodent die-off or other possible source for her infection.
The girl denied any contact with wild animals, and no
evidence of prairie dogs or their burrows was found. Res-
idents of the area deny that prairie dogs have inhabited
the area for the past year. Investigations are continuing to


determine the source of the girl's infection.
(Reported by Robert C. wonder Wagen, M.D., Deputy Di-
rector, .avajo Indian Health Area Office, Window Rock,
Arizona; and Ecological Investigations I '*.... r. NCDC,
Kansas City, Kansas.)


FOLLOW-UP PLAGUE Denver, Colorado


No additional human cases of plague have been re-
ported from Denver (MM\WR, Vol. 17, Nos. 27 and .'-i To
date, of 272 processed dead squirrels, 52 were positive
for plague by fluorescent antibody (FA) studies, and 15 of
these 52 were also positive on culture. An additional three
squirrels that had been negative by FA tests were positive


for Pasteurella pestis on culture. Of 50 other mammals
tested, none were positive for plague.
(Reported by Cecil S. Mollohan, M.D., M.P.H., '.'. Fr Section
of Epidemiology, Colorado Department of il, .i', :and Ecol-
ological Investigations Program, NCDC, Kansas City,
Kansas.)


FATAL MALARIA CASE California


On May 23, 1968, 24 hours after returning from service
in Vietnam. a 22-year-old white male American marine.
complaining of headache, fatigue, nausea, and vomiting,
of 5 days duration, presented himself to the emergency
room at a military hospital. He denied any fever. He did
not give a history of malaria or other serious illnesses
while in Vietnam, and he reported having taken his malaria
chemoprophylaxis regularly. On physical examination the
patient appeared moderately ill and had a temperature of
102. 4F. There was slight scleral icterus, and the liver
was enlarged and r,1i.il, tender; there was no splenomegaly.
Initial laboratory studies revealed a hematocrit of 47 per-
cent, a hilirubin of 3.2 mig percent, and an SGOT of 262.
No malaria parasites were noted at this time on a routine
blood smear.
The patient was hospitalized with a diagnosis of in-
fectious hepatitis. He experienced daily fever spikes of
104 F. On the sixth hospital day, he became semicoma-
tose; examination of peripheral blood smears then revealed
a 70 percent parasitemia with Plassmodium falciparum.
Laboratory values at that time included the following:
hematocrit 2( percent, bilirubin 23.6 per mg percent, BUN
120 mg percent. Na 11 maeqL.. K 2.0 meq/L.. CI 64
meq/L.. and ('O0 h meq/L. Hemoglobin was detected in
the urine. Intravenous antimnalaria therapy with quinine
and chloroquine was immediately instituted. In addition.
dexamethasone, heparin, and transfusions of packed red
cells were administered. Because of the electrolyte im-
balance and progressive azotemia, peritoneal dialysis was
instituted on the seventh hospital (day. On the eighth day.
the patient had once again become lucid, his hematocrit


had risen to 37 percent, and his electrolyte abnormalities
had been corrected. Examination of blood films at this
time revealed only a few malaria parasites. Peritoneal
ilI til was discontinued. That evening the patient devel-
oped pulmonary edema which responded to treatment with
digoxin, morphine, rotating tourniquets, and u-th. r.n;,
acid. On the evening of the ninth hospital day, the patient
again developed pulmonary edema which did not respond
to treatment, and he expired. Three hours prior to his death,
his serum potassium level was 6.0 meq/L. No malaria
parasites could be found in blood films taken on the day
of his death.
Postmortem examination revealed dilatation of both
cardiac ventricles, marked pulmonary edema, ,or. l'e- I,
hepatosplenomegaly, and swollen bile-stained kidneys
which showed focal evidence of tubular necrosis. Re-
examination of the blood smears obtained on the day of the
patient's admission to the hospital revealed the presence
of numerous trophozoites of P. falciparum.
(Reported by Philip K. Condit, M.I., M.P.H., Chief, Bureau
of Communicable Disease Control, California Stdte Depart-
ment of Public Health; and George I. Smith, Major, U.S.
Air Force Medical Corps.)
Editorial Note:
This patient developed four complications of falciparum
malaria: cerebral involvement, intravascular hemolysis,
renal failure, and pulmonary edema. The fact that he died
despite a parasitic response to therapy suggests that
severe infection with falciparum malaria may produce
irreversible tissue damage and emphasizes the importance
of prompt diagnosis and treatment of this disease.


OUTBREAK OF TUBERCULOSIS Buffalo, New York


On January 11 1196h, ia \2 r I.1.1 woman in Buffalo,
New York, was found to have far advanced pulmonary
tuberculosis by chest X-ray examination. Microscopic
examination ant cultures of her sputum were subsequently
found lx)sitive for Mycobacterium tuberculosis.


The woman had been employed since September 13,
1967, as a teacher's assistant in two classes (one morn-
ing and one afternoon), located in a church ,uliillng She
was in close contact with the 26 students, age 3 to 5
years old, in these two classes for 2 1/2 hours each day


270


July 20, 1968







Morbidity and Mortality Weekly Report


while she supervised their play and teaching activities
and helped them with their outdoor clothing. She had con-
tact with 29 other students in an adjoining classroom
because she frequently led her students through this room
to the single restroom, used by both classes. The woman
aided all 55 students with their meals. There was limited
ventilation in both rooms because windows were closed
during the cold weather. The woman left her employment
on December 21, 1967, because of her illness.
After tuberculosis was diagnosed in this woman, all
55 students, nine adult school personnel, eight parents
and siblings of the school children, and four church em-
ployees were tuberculin tested on January 26. An addi-
tional 21 close contacts and 14 casual contacts outside
the school were tuberculin tested within the following 3
weeks. The Maritoux method with 5 tuberculin units of
PPD was used and 10 mm of induration was considered a
positive reaction. All students, both teachers, and the
other teacher's assistant were considered close contacts
to the woman. Her close contacts outside the school either
lived in her household or lived elsewhere but had a similar
degree of contact. All others with significant contact were
considered her casual contacts including the remaining
seven adult school personnel.
Of the 111 contacts of the woman, 28 had a positive
reaction (Table 1). Based on both a positive tuberculin
.test and chest X-ray evidence of enlarged hilar lymph
nodes, eight new. active cases of primary tuberculosis
were identified. Two of these were documented tuberculin
converters within the previous year; the other six had no
record of a previous test. There were three other documented
tuberculin converters with negative chest X-rays found
on initial testing and one additional converter with a neg-


ative X-ray found on repeat testing 8 weeks later. Three
of these six converters were under 5 years of age. Primary
tuberculosis, the activity of which count not be determined
at the initial examination, was diagnosed in an additional
four contacts, and 12 others had inactive or probably in-
active tuberculosis. No other converters were identified
on retesting in May of the negative contacts although 23
of the 83 negative contacts were not available for reexam-
ination.
The closeness of contact appeared to be related to
the incidence of new infection in this outbreak. All eight
active primary cases were considered close contacts as
were two of the converters without active disease. Four
of the active cases were students in the index case's
classroom, one was a student in the adjoining classroom,
and three were her own children. Based on available at-
tendance records, the duration of contact did not seem to
be a factor in the outbreak. Each of the four students with
active primary tuberculosis in the source case's room had
an average of 142 cumulative hours of contact (range 118
to 162) and the case in the adjoining room had only 36
hours of contact, while each of the 21 tuberculin negative
students had an average of 148 cumulative hours of con-
tact (range 87.5 to 180 hours).
It is of interest to note that the index case in this
outbreak failed to submit to chest X-ray prior to beginning
her teaching duties.

(Reported by William E. Mosher, M.D., M.P.H., Commis-
sioner of Health, and A. Arthur Grabau, M.D., F.C.C.P.,
Director, Division of Tuberculosis Control, Erie County
Department of Health, New York; Tuberculosis Program,
NCDC; and a Tuberculosis Medical Officer.)


Table 1
Contacts of the Teacher's Assistant with a Positive Reaction to Tuberculin Test
Buffalo, New York January May 1968
Primary Active Primary Cases Inactive or Probably
Cases Converters Activity Undetermined Inactive Cases Total
Age (Years) <5 >5 <5 >5 <5 >5 <5 >5 <5 >5
Close Contacts 6 2 3* 1 2 0 0 2 9 5
Casual Contacts 0 0 0 2 0 2 0 10 0 14
Total 6 2 3* 3 2 2 0 12 9 19
*Includes 2 cases already classified as primary active cases


SUBHUMAN PRIMATE-ASSOCIATED HEPATITIS Oakland County, Michigan


Between May 10 and June 13, 1968, three animal han-
dlers, who had contact with tropical and exotic animals at an
animal brokerage near Detroit, Michigan, developed hepa-
titis, and a fourth animal handler had possible hepatitis.
The 'irst case was in a 17-year-old male who had on-
set of il less on May 1G. Although he began work at the
brokerage on May 2, he had frequent contact with young
chimpanzees during visits to the brokerage in April. On
June 13 after a 3-week prodrome of headache, fatigue,
fever, abdominal pain, and anorexia, he developed jaundice
and had abnormal liver function tests. He had not received
immune serum globulin (ISG) prior to or after becoming
employed at the brokerage.
The second case was in an 18-year-old male who be-
came ill on May 16. He had begun work at the brokerage


February 17 and had not received globulin prophylaxis
since his employment. He experienced a 2-week prodrome
of headache, malaise, anorexia, and developed dark urine
and jaundice on May 31 when liver function tests including
an SGOT and LDH were abnormal.
The third case was a 24-year-old male who began
work at the brokerage on May 13. He became ill on June 13
with headache, fever, chills, and anorexia. He subsequently
developed dark urine which lasted 1 week, but he denied
jaundice and yellow sclerae. Tests ofliver function were not
performed. Prior to working at the brokerage, this patient
had been employed as an animal handler at a zoo, and ac-
cording to zoo policy, he had received ISG in November 1967.
(Continued on page 276)


July 20, 1968


271









272 Morbidity and Mortality Weekly Report


TABLE IlI. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JULY 20, 1968 AND JULY 22, 1967 (29th WEEK)


ENCEPHALITIS HEPATITIS
ASEPTIC Primary
AREA MNINGITIS including Infectious Serum Infectious MALARIA
unsp. cases


I ,, ,, ,'' ,, ., i ,' J,

NEW ENGLAND ........... 6 5 1 1 3 1 38 36
Maine. ........... -- 1 3
New Hampshire ..... -
Vermont.... .. ......- -
Massachusetts....... 1 1 1 19 13 -
Rhode Island........ 6 2 1 1 2 -
Connecticut........ 1 1 1 18 18

MIDDLE ATLANTIC...... 18 6 35 116 78 5
New York City...... 7 2 23 39 30 -
New York, up-State. 24 24 1
New Jersey......... 11 1 10 26 13 3
Pennsylvania....... 2 2 27 11 1

EAST NORTH CENTRAL... 19 6 6 10 2 3 95 89 4
Ohio............... 19 5 8 1 38 20 -
Indiana............ 1 2 1 5 8 1
Illinois........... 1 1 2 22 34 1
Michigan........... 4 1 22 23 2
Wisconsin.......... 8 4

WEST NORTH CENTRAL... 4 2 1 1 1 4 43 55 4
Minnesota .......... 4 1 3 12 8
Iowa.............. 6 10 1
Missouri........... 1 18 28
North Dakota.......-
South Dakota....... -
Nebraska .. ..... -
Kansas.............. 1 1 1 7 9 3

SOUTH ATLANTIC....... 17 3 2 1 10 2 6 72 58 7
Delaware........... 3 2
Maryland........... 2 2 1 1 14 21 1
Dist. of Columbia.. 1 1 1 3
Virginia.......... 13 2 8 6
West Virginia...... 1 6 2
North Carolina..... 1 4 6 8 6
South Carolina..... 1
Georgia............ 2 14
Florida............ 2 2 6 19 15

EAST SOUTH CENTRAL... 6 5 1 1 1 70 54 3
Kentucky............ 3 1 24 21 3
Tennessee.......... 3 1 26 15
Alabama............ 5 3 6
Mississippi......... 1 17 12

WEST SOUTH CENTRAL... 18 17 1 3 5 1 1 50 65 1
Arkansas ........... 5 3
Louisiana .......... 3 3 3 2 1 8 15 1
Oklahoma........... 4 1 1 2 4 5
Texas.............. 11 12 1 33 42

MOUNTAIN.............. 1 1 2 41 31 5
Montana............ 1 1 6 3
Idaho ............. 2 -
Wyoming........... 2- -
Colorado........... 2 15 16 5
New Mexico......... 4 10 -
Arizona............ I 8
Utah............... 3 2
Nevada............. 1

PACIFIC.............. 31 11 1 8 2 2 49 282 135 7
Washington......... 2 I 23 2
Oregon............. 4 I 2 26 8 -
California......... 25 9 1 6 2 2 46 232 121 4
Alaska............. -
Hawaii............. 2 1 4 3

Puerto Rico.......... 5 16 7


* Delayed reports:


Brucellosis: Va. delete 1
Hepatitis, infectious: Me. 1, P.R. 2







Morbidity and Mortality Weekly Report 273



TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JULY 20, 1968 AND JULY 22, 1967 (29th WEEK) CONTINUED



MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL
AREA Total Paralvtic
AREA Cumulative Cumulative Total Para tic
___________ __ Cum.
1968 1968 1967 1968 1968 1967 1968 1968 1968 1968 1968
UNITED STATES... 276 18,468 56,052 40 1,769 1,505 960 2 2 31 353

NEW ENGLAND........... 20 1,116 800 2 90 58 112 1 58
Maine..*............ 35 233 6 3 3
New Hampshire...... 141 74 7 2 1
Vermont............ 1 2 34 1
Massachusetts..* ... 10 358 312 2 40 29 83 1 35
Rhode Island....... 1 60 7 4 16 9
Connecticut......... 9 579 87 29 20 12 11

MIDDLE ATLANTIC........ 104 3,630 2,156 15 319 241 115 59
New York City...... 84 1,719 "417 2 67 40 97 45
New York, Up-State.* 9 1,164 538 6 54 59 NN 13
New Jersey.......... 6 596 477 5 116 86 18 -
Pennsylvania....... 5 151 724 2 82 56 NN

EAST NORTH CENTRAL... 29 3,568 5,077 3 212 194 235 1 61
Ohio................ 4 283 1,118 2 58 67 13 -5
Indiana............. 4 620 584 28 21 11
Illinois........... 11 1,330 879 47 45 21 1 12
Michigan........... 238 878 61 46 25 5
Wisconsin.......... 10 1,097 1,618 1 18 15 176 28

WEST NORTH CENTRAL... 5 366 2,792 3 89 64 41 1 22
Minnesota.......... 15 128 2 21 16 -
Iowa............... 1 94 743 6 12 .19 10
Missouri........... 1 81 330 31 12 9 1 8
North Dakota....... 1 124 825 3 1 9 3
South Dakota ...... 4 52 4 6 NN -
Nebraska........... 2 38 621 6 11 4 -- 1
Kansas ............. 10 93 1 18 6

SOUTH ATLANTIC....... 33 1,404 6,668 9 360 290 95 1 22
Delaware............ 1 15 43 1 7 5 3 -
Maryland............ 3 3 85 145 26 34 17 1
Dist. of Columbia.. 6 22 1 14 10 -
Virginia........... 1 290 2,090 28 35 17 6
West Virginia...... 9 258 1,342- 9 20 39 15
North Carolina..... 281 838 4 73 63 NN 1
South Carolina..... 13 504 1 56 27
Georgia............. 4 32 61 44 -
Florida............ 19 452 1,652 2 86 52 19

EAST SOUTH CENTRAL... 3 541 5,045 1 149 122 85 1 36
Kentucky............ 3 172 1,298 1 58 34 5 1 22
Tennessee.......... 55 1,785 49 50 69 13
Alabama............ 85 1,307 22 25 11 -
Mississippi........ 229 655 20 13 -

WEST SOUTH CENTRAL... 59 4,538 16,953 3 290 211 1 1 17 38
Arkansas............ 1 3. 1,404 20 28 1
Louisiana.......... 2 149 81 82 -
Oklahoma............ 110 3,320 49 16 1
Texas.............. 58 4,423 12,080 3 140 85 1 1 16 37

MOUNTAIN ............. 10 948 4,509 27 26 104 21
Montana............ 66 275 3 6 1
Idaho.............. 20 374 11 1 7 -
Wyoming............ 1 51 178 -
Colorado........... 2 481 1,502 8 11 23 3
New Mexico......... 3 88 573 3 5 -
Arizona............. 4 216 983 1 4 24 14
Utah................ 21 355 1 4 39 2
Nevada............. 5 269 3 2 -

PACIFIC.............. 13 2,357 12,052 4 233 299 173 1 1 9 36
Washington......... 514 5,391 37 25 12 1 1 1 2
Oregon............... 3 457 1,523 1 18 24 15 11
California......... 9 1,349 4,856 3 165 237 127 8 19
Alaska.............. 2 130 2 9 11 2
Hawaii............. 1 35 152 11 4 8 2

Puerto Rico.......... 7 354 2,049 19 10 12 4

Delayed reports: Measles: Mass. delete 4, N. Y. Ups. 1 case 1967, 6 cases 1968
Mumps: Me. 6
Rubella: Me. 8, N. Y. Ups. 73









274 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
FOR WEEKS ENDED

JULY 20, 1968 AND JULY 22, 1967 (29th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
AREA SCARLET FEVER (Rky. Mt. Spotted) ANIMALS
Cum. Cumum um. Cum. Cum.

UNITED STATES... 4,319 3 78 5 118 10 166 18 118 48 2,083

NEW ENGLAND........... 534 1 2 46 5 65
Maine.. *........... 3 50
New Hampshire ...... 5 1 2
Vermont............ 19 46 10
Massachusetts...... 43 1 2 2
Rhode Island....... 52 -
Connecticut........ 412 I 2 1

MIDDLE ATLANTIC...... 116 2 12 7 13 7 2 22
New York City...... 5 1 6 7 -
New York, Up-State* 102 4 7 3 1 1 15
New Jersey......... NN -
Pennsylvania....... 9 1 2 3 5 1 7

EAST NORTH CENTRAL... 381 8 1 8 1 25 1 4 8 192
Ohio.. .*........... 46 1 1 12 2 3 75
Indiana............ 150 1 1 3 5 65
Illinois........... 84 5 1 5 9 1 2 23
Michigan........... 52 2 1 9
Wisconsin .......... 49 1 20

WEST NORTH CENTRAL... 160 3 1 9 8 3 10 515
Minnesota.......... 19 1 6 142
Iowa............... 10 86
Missouri........... 7 2 1 7 3 1 1 77
North Dakota....... 57 2 82
South Dakota.?.... 8 1 1 1 79
Nebraska........... 59 3 1 23
Kansas............. 1 1 26

SOUTH ATLANTIC....... 446 14 7 2 41 11 65 2 222
Delaware....... .. -
Maryland............ 58 1 1 8 1 7 1 4
Dist. of Columbia.. 9 1 2 -
Virginia..*......... 112 2 1 8 2 24 87
West Virginia...... 161 1 29
North Carolina..... 3 2 2 2 5 21 9
South Carolina..... 7 1 2 -
Georgia........... 1 2 1 10 3 9 1 34
Florida............. 94 6 2 11 2 59

EAST SOUTH CENTRAL... 638 9 6 2 21 5 22 6 474
Kentucky........... 77 I 1 5 3 6 4 231
Tennessee........... 508 2 4 11 2 14 2 221
Alabama............. 33 3 1 21
Mississippi........ 20 3 1 2 5 1 I

WEST SOUTH CENTRAL... 599 16 2 28 3 17 1 14 9 370
Arkansas............ 4 4 4 5 1 4 1 1 43
Louisiana.......... 7 5 5 1 3 1 34
Oklahoma........... 14 6 4 1 7 2 109
Texas............... 574 7 2 12 1 6 6 5 184

MOUNTAIN............. 916 1 6 9 2 1 52
Montana............ 18 -
Idaho.............. 95 -
Wyoming ............ 7 1 1 2
Colorado........... 503 1 3 2 2 3
New Mexico......... 110 6 20
Arizona............. 29 -- 1 27
Utah............... 154 2 -
Nevada.. .........

PACIFIC .............. 529 14 L 2 27 1 10 171
Washington .... 11 1 1 1
Oregon ............. 7 1 I 3 -- 3
California......... 360 12 1 23 1 10 168
Alaska ............ 19 -
Hawaii.............. 65 -

Puerto Rico.......... 5 1 6 1 16


* Dilayed reports:


SST: Me. 2, N. Y. Ups. 25 cases 1967, 119 cases 1968, Ohio delete 1, Va. 1, Nev. 6
Rabiis in animals: S. D. 45







Morbidity and Mortality Weekly Report


TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED JULY 20, 1968

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


275


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 s Influenza All
A 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.--------


711
222
43
26
33
51
35
16
26
42
65
14
50
27
61

3,516
70
43
167
45
32
50
65
99
1,687
36
581
183
41
143
25
52
89
38
31
39

2,516
69
40
775
144
182
132
75
332
22
49
39
42
51
151
42
108
39
32
40
93
59

831
50
22
34
136
30
128
65
239
54
73


442
132
28
18
25
28
18
14
16
23
35'
8
40
16
41

2,127
45
27
99
29
15
26
38
48
1,037
22
329
101
26
95
20
41
63
17
19
30

1,460
42
23
422
86
94
72
46
185
18
28
27.
26
30
88
27
80
26
19
27
57
37

471
31
15
13
82
15
74
39
127
32
43


Total 12,424 7,128 450 609

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 376,694
All Causes, Age 65 and over------------------- 218,743
Pneumonia and Influenza, All Ages------------- 16,080
All Causes, Under 1 Year of Age--------------- 17,396


Week No.
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.----------


1,119 539 43 70
109 56 3 3
242 107 4 19
53 25 3 1
50 29 1 3
122 60 2 4
53 28 4 1
75 39 6 4
24 8 1 4
64 51 3
53 28 10 2
244 93 4 29
30 15 2

642 336 31 31
88 48 1 5
66 36 3 4
38 25 6 1
138 76 7 4
126 64 6 6
42 21 4
39 20 4 2
105 46 4 5

1,077 577 40 57
51 31 11 3
38 19
21 11 2 1
152 84 4 10
32 14 1
78 43 5
195 99 3 16
58 28 5 8
137 64 1 6
82 46
107 63 1 3
63 32 6 3
63 43 7 1

418 225 23 33
44 18 6 7
26 19 3 2
125 68 5 14
12 7 1 1
85 42 1 2
26 15 2 2
59 34 1 4
41 22 4 1

1,594 951 28 70
20 16 I
65 38 1 1
33 20 1
50 22 1 7
100 63 4 1
521 321 9 21
71 35 1 2
44 28 1
124 79 3 9
55 32 3
92 54 4
143 79 2 6
35 19 2
154 81 6 9
52 40 1 1
35 24 1








Morbidity and Mortality Weekly Report


HEPATITIS (Continued from page 271)
All three patients denied ingestion of raw shellfish
or contact with a known hepatitis case during the 2 months
prior to their illnesses. All three gave no history of trans-
fusions of blood or blood products or use of parenteral
drugs in the 6 months prior to illness.
There was a fourth possible hepatitis case in a 17-
year-old male who began work at the brokerage in January
1968 and who became ill on June11 with nausea, vomiting,
and diarrhea. He subsequently developed fatigue, loss of
taste for cigarettes, and anorexia. He denied dark urine
and jaundice, and .lihiuit., he was hospitalized for 4 days
beginning June 13, bilirubin and transaminase determi-
nations were not performed. He had received 10 cc of gamma
globulin in February 1968.
The four handlers had been responsible for the care
and cleaning of all animals housed at the brokerage. Pri-
mates housed at the brokerage comprised a variety of spe-
cies, including chimpanzees (implicated in previous hepa-
titis outbreaks ), Celebes apes, and woolly monkeys. No
cases of jaundice had occurred among the chimpanzees
and other primates at the brokerage, and there had not
been a higher than expected death rate among the animals.
Prior to these four cases, five cases of hepatitis with
jaundice had occurred among the owners and employees of
the brokerage. These cases occurred between 1960 when
the brokerage entered into chimpanzee importation and
supply and June 1966 when the brokerage began adminis-
tering ISG at 3- to 4-month intervals to all employees.
However. since January 1968, ISG had not been regularly
administered to personnel at the brokerage.
(Reported by Thomas ictlnerney, M.D., Physician, William
Beaumont Hospital; Frank Condon, M.D.. M4.P.H., Deputy
Director, and Theodore 41. Barr, D.VI.M.. Veterinarian,
Oakland County Health Department; Donald B. Coohon,
D.Y.M., Deputy Chief, Bureau of Epidemiology, Michigan
State Department of Public Health; and an EIS Officer.)
Rc:frTrHnce:
ilillis \illitIm I).: An Outbreak of Infectious Hepatitis Among
Chimpanz-i, Handlers at a united Sta:tes Air Force Base.. Amer
J IHya 7 i(3):316-:32 1961.

CURRENT TRENDS
ARBOVIRUS DISEASE United States
No human cases of arbovirus disease have been re-
ported to NCDC to date in 1968: however, arboviruses,
known to cause disease in man,have been isolated from
mosquitos in Wisconsin (California Group virus) and west
Texas (Western equine encephalitis virus). Cases of equine
encephalitis have been reported from Arkansas, California,
North Carolina, and Texas, although in most cases the
etiology has not been determined.
Because of the unusual amount of rainfall noted this
spring and subsequent increase in the mosquito population
and the presence of a susceptible vertebrate host reservoir,
conditions now exist that favor an outbreak of arbovirus
infection.
(Re ported by Arkansas Stale Board of Health; California
State Department of Public Health; North Carolina State
Board of Health; Texas State Department of Health; Wis-
consin State Department of Health andr Social Services;
and Laboratory Program and Epidemiology ;*...... ..NCDC.)


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION OF 171000. IS PUBLISHED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER, ATLANTA, GEORGIA.
DIRECTOR. NATIONAL COMMUNICABLE DISEASE i-EPTEQ
Ea D .' SENCER, M.D.
CHIEF. EPIDEMIOLOGY PROGRAM A,i. LANGMUIR, M.D.
ACTING CHIEF. STATISTICS SECTION IDA L. SHERMAN, M.S.
EDITOR MICHAEL B. GREGG, M.D.

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITv A',C uG TALITY, THE %a OTi NAL Cir.1lr.lur'C ABLE DISEaSE
CENTER I L.COM' E i ACCOUNTS OF NTE I .. O.j, iRE -IKS C. C A1E
INVESTIGATIONS WHICH ARE OF CURRENT iNT~E-l'T tO .EALIH
OFFICIALS AND WHICH ARE DIRECTLY RELATED TO TIE CONTROL
OF COMMUNICABLE DISEASES. SUCH COMMUNICATIONS SHOULD BE
ADDRESSED TO:
4 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 TME N':1C OY THE INDIVIDUAL
STATE HEALTH DEPARTMENTS. THE ";E'OPTiNG WEEK CONCLUDES
ON SATURDAY COMPILED DATA ON A NATIONAL BASIS ARE RELEASED
ON THE SUCCEEDING FRIDAY.


m
r-
-I
-4
-u=
CC:
gin-
C:




































m
3> r

-0 M


















m





Mc
-s
















Moa
4 M
0m

u


276


July 20, 1968


ieg,

P.. !
o0 <

3-
LL(
u0_
=

LU
. =4