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:
AA00010654:00161

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 WEI1

HEALTH SERVICES AND MENTAL HEALTH ADMINI!


EPIDEMIOLOGIC NOTES AND REPORTS
HUMAN INFECTION WITH THE AGENT OF
CANINE ABORTION New York
On January 12, 1968, a female laboratory technician
in Ithaca, New York, had accidental oral contact with the
agent of canine abortion while pipetting these organisms.
Approximately 3 weeks later she developed a grippe-like
illness, characterized by low grade fever, night sweats,
malaise, and fatigue. Multiple, walnut-sized, posterior
cervical lymph nodes appeared 5 weeks after her contact
with the organisms. The lymph nodes increased in size
and became painful, and the patient had difficulty holding
her head erect.
A blood culture obtained on March 1 was positive for
the agent of canine abortion. The specific agglutination


Epidemiologic Notes and Reports
Human Infection with the Agent of Canine Abortion New York
Canine Abortion New York ........ ... 285
Tick Paralysis Oregon . . ... 286
Simultaneous Leptospirosis and Vivax Malaria Georgia 286
Current Trends
Measles United States . . ... 287
Excess Mortality United States . ... 288
Surveillance Summary
Trichinosis United States 1967 . . 289
Recommendation of the Public Health Service Advisory
Committee on Immunization Practices Immune Serum
Globulin for Prevention of Viral Hepatitis . 290
titer against this organism was 1:100 after being negative
4 months before; it subsequently rose to 1:250 on April 10.
Treatment with tetracycline, streptomycin, and sul-
fonamides was initiated on March 1. Gradual improvement
(Continued on page 286)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
31st WEEK ENDED MEDIA CUMULATIVE, FIRST31 WEEKS
DISEASE
DISEASE August 3, August 5, 1963 1967 MEDIAN
1968 1967 1968 1967 1963 1967
Aseptic meningitis ...................... 143 72 64 1,401 1.179 999
Brucellosis .............. :............. 9 7 6 125 160 160
Diphtheria .............................. 1 1 99 61 99
Encephalitis, primary:
Arthropod-borne & unspecified ........... 28 49 -- 552 831 --
Encephalitis, post-infectious ............. .11 23 327 557 -
Hepatitis, serum ........................ 94 50 2,491 1.257 24
Hepatitis, infectious .................. .. 902 655 6 25,951 22,889
Malaria ............................... 42 36 1 1,266 1.185 59
Measles rubeolaa) ...................... 234 288 1,145 18,915 56,626 236,488
Meningococcal infections, total ........... 24 24 40 1.841 1,555 1,795
Civilian .............................. 24 24 -- 1,668 1,447 -
Military .............................. 173 108 -
Mumps ................................. 946 121,235
Poliomyelitis, total ..................... 1 1 6 32 20 55
Paralytic ............................. 1 1 5 32 17 50
Rubella (German measles) ............... 419 203 42,172 38,849 -
Streptococcal sore throat & scarlet fever.... 4,703 4,202 4,081 279,086 301.086 271,407
Tetanus ............................... 3 3 6 85 124 145
Tularemia .............................. 2 6 6 123 102 148
Typhoid fever ......... ................. 10 10 12 185 235 235
Typhus, tick-borne (Rky. Mt. spotted fever) 15 15 15 147 168 150
Rabies in animals ....................... 56 84 70 2,191 2,740 2.740

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: .................. ......................... 3 Rabies in man: ...................................... -
Botulism: ......................................... 4 Rubella, Congenital Syndrome: ......................... 4
Leptospirosis: Ga. 2, Hawaii-1 ........................ 19 Trichinosis: Mass.-l, N.J.-l, N.Y.C.-1.................. 43
Plague: ........................................... 1 Typhus, marine: .................................... 114
Psittacosis: Mass.-l, Tex.-1 .......................... 30


f






286


in symptomsi and diminution in the size of limphadenopathy,
Nwere noted after 5 days and temperature elevations sub-
sided after 10 ldays of therapy. The enlarged 1imph nodes
disappeared after appro\ximatel\ I month of treatment.
\ secondd fmciale worker in the laboratory had an iden-
iteal episode of accidental contact with these organisms
on June 31. Blood cultures and serology at that time were
negative. The patient was treated with oral tetracycline
for 2 weeks. Although she denied symptoms during the
course of treatment. her specific agglutination tiler against
the agent rose to 1:500 later in June.
(Relported by L. E. Carmichael, D.V.M., Ph.D., Cornell
, ni err iy; ,Samnurl R. Barol. M.I)., Ithrac New York;
Robert II. Broad, ..).. Tompkins County Health Depart-
ment, .\ ei Y ork-,; ani Julia L. Freitay, M.I)., Director,
Bureau of Epidemiology, Neu' Ynork State Department of
lHealth.)
Editorial Note
Since (1962 several reports have appeared of high abor-
tion rates in dogs, mainly beagles, associated with a gram-


AUG ST 3. 1968


negative organism not, previously described. ''1 Surviving
offspring of these dogs are weak and develop lymphade-
nopathy while infected male dogs develop epididymitis
and testicular atrophy. Cases have been recognized *hr.,imh.
out the United States. Europe. and Australia. The disease
appears to be highly infectious in dogs, and extensive
outbreaks have occurred in large commercial kennels.
Human infection with this organism has not been
previously reported. Current studies indicate that the or-
ganism resembled Brucella suis iotype 3 bacteriologically
and rough Brucella cultures sorologically.3,4 A separate
species classification for this agent. "Brucella canis",
has been proposed and is now under consideration.

References:
I('armic hal, L. E., and Bruner, D. \\.: Cornell Vet, in press.
2Taul, L K., et al: alpine e abortion duo, toi an unclassified gram-
nnegative bacterium. Vet Med 62:543-.1 1967.
Diaz, R., ct al: Antigenic relationship of the gram-negative
organism causing canine abortion to smooth and rough brucellae.
J Bact 95:61S-21, 1968.
4Jones, L. M., et al: Taxonomic position in the Genus Brucella
of the ca usative agent of canine abortion. J Bact 625-30, 1968.


TICK PARALYSIS Oregon


The first case of tick paralysis to he identified in
Oregon in 196S occurred on July b1 when a6-year-old girl
complained of a tingling feeling in her toes, fingers, and
tongue. On July 19. she complained of difficulty in walk-
ing. and on July 20. she was unable to walk and was hos-
pitalized. Phstical examination revealed bilateral nystag-
mus on far lateral gaze and minimal control of voluntary
movements of arms. legs, and head with inability to resist
pressure. There were no urinary or gastrointestinal ab-
normalities. Spinal fluid examination and blood counts
were normal. The physician. in checking for nuchal rigidity,
noticed a tick at the base of her hairline on the back of
her neck. He removed the tick following the local appli-


cation of alcohol. The patient recovered within 2 days
although pain persisted in the calves of her legs.
The girl had been to camp in New York on July 1 and
returned to Oregon on July 12. Her mother had visited the
camp on July 8 and had removed one tick from her daughter
at that time.
The tick removed by the physician has been identified
by the Oregon State Board of Health Public Health Labora-
tory and the Rocky Mountain Laboratory, NIAID, NIH,
DHEW, as Dermacentor variabilis.
(Reported by M. A. Holmes, D.V.M., M.P.H., Public Health
Veterinarian, Epidemiology Section, "'.. .* State Board of
Health.)


SIMULTANEOUS LEPTOSPIROSIS AND VIVAX MALARIA Georgia


On \May 15.1 191S, a 49-year-old Ceylonese physician
Sas hospitaliztd with fevers, shaking chills, and severe
myalain of 12 it 21 hours duration. His previous health
had heen good. Since his arrival in the Inited Slates in
earl \ipril. lih had been studying live' Leptoxpira organisms
in a laboratory in ;Georgia. On Ma hi 6i he had spilled some
li\%( Lpc tospira organi-sms on his hands but had discounted
thi incident because he had no skin abrasions. On May 8
ie had been hiking in northern Georgia, but he denied any
anim al contact or tick bites.
Ilpon admission to the hospital on May 15. he was
Ihakiing ith seoere, rigors, perspiring profusely, and com-
plaining of ixtremre miyalgia. His temperature \ as 1041F.
eli hiad no rash. icteru-. conjunctival suffusion, or spleno-
me'al \dmi--sion laboratory studies including a CBC,
urinalv-is. bilirumbn. BN. electrolytes, a malaria smear,


and Leptofspira agglutination tests were normal. Febrile
agglutinins were negative except for a typhoid H titer of
1:80. Six blood specimens were drawn and submitted for
bacterial and I eptospira cultures.
On the day after admission, blood smears were again
obtained, and a few trophozoites of Plasmodium vivax were
found. Chloroquinc therapy y was begun. However, 24 hours
later, the patient's temperature was still 10)4F., and he
continued to have rigors andt severe myalgia. Repeat malaria
smears at this time showed no parasites. Because lepto-
spirosis was suspected, the patient was started on penicillin
(20 million units per day). In addition, since the patient's
recent hiking trip raised the possibility of a rickettsial
disease and because his relative bradycardia suggested
the possibility of salmonellosis, he was also treated with
chloramphenicol (1 gm every h hours). He soon became


Morbidity and Mortality Weekly Report


HUMAN INFECTION WITH THE AGENT OF CANINE ABORTION
(Continued from front page)









afebrile, his myalgia disappeared, and he noted a marked
subjective improvement. He made an uneventful recovery,
and after 14 days treatment with penicillin, 5 days treat-
ment with chloramphenicol, and therapy with primaquine,
he was discharged from the hospital.
The six blood cultures submitted on the day of his
hospitalization became positive for Leptospira organisms
on May 23. Preliminary typing procedures identified the
organism as identical with or very similar to L. javanica,
bne of the organisms the patient had been studying in his
laboratory. Leptospira agglutination tests revealed a 1+ re-


action against L.javanica 4 days after his onset of illness
and a 3+ reaction at 15 days.
The final diagnosis was asymptomatic vivax malaria
and acute laboratory-acquired leptospirosis.

(Reported by Epidemiological Services Laboratory Section,
Epidemiology Program, NCDC; John E. McCroan, Ph.D.,
State Epidemiologist, Georgia Department of Public Health;
and Jonas A. Shulman, M.D., Assistant Professor of Pre-
ventive Medicine, Emory University School of Medicine,
Atlanta, Georgia.)


CURRENT TRENDS
MEASLES United States


During the 4-week period, June 16 through July 13,
1968, (weeks 25 28), measles was reported from 257
counties or health districts. This is a decrease of 59
counties from the 316 counties or health districts reporting
measles in the preceding 4-week period (weeks 21-24),
and is 173 fewer than the 430 counties or health districts
reporting measles during the corresponding 4-week period
in 1967. Of these 257 counties, 32 (12 percent) reported a
total of 10 or more cases (Figure 1) as contrasted with 69
of 430 counties or health districts (16 percent) reporting
a similar number of cases during the comparable 4-week
period in 1967 (Figure 2).
All geographic divisions, except New England and
Middle Atlantic, showed a substantial decrease in the
number of counties or health districts reporting measles
in the 4-week period, June 16 through July 1.3, 1968, from
those reporting measles in the comparable 4-week period
in 1967 (Table 1). The New England and Middle Atlantic
divisions were the only divisions showing an increase in
the number of counties or health districts reporting a total
of 10 or more measles cases in the 4-week period in 1968
over the corresponding 4-week period in 1967.

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


Table 1
Number of Counties or Health Districts Reporting Measles
During 4-week period, June 16 July 13, 1968
By Geographic Divisions

Number of Counties or Health
Districts Reporting
Total of
Geographic Total of
Division 1 or more cases 10 or more cases
Division
1968 1967 1968 1967
June 16- June 18- June 16- June 18-
July 13 July 15 July 13 July 15
United States 257 430 32 69
New England 18 19 4 2
Middle Atlantic 48 34 11 6
East North Central 38 64 3 6
West North Central 16 24 3
South Atlantic 28 65 6 7
East South Central 12 45 2 6
West South Central 46 69 4 17
Mountain 20 45 1 12
Pacific 31 65 1 10
Puerto Rico 5 5 1 5
Virgin Islands -


Figure 1 Figure 2
COUNTIES OR HEALTH DISTRICTS REPORTING A TOTAL COUNTIES OR HEALTH DISTRICTS REPORTING A TOTAL
OF 10 OR MORE CASES OF MEASLES OF 10 OR MORE CASES OF MEASLES
JUNE 16 JULY 13, 1968 JUNE 18 JULY 15, 1967


AUGUST 3, 1968


Morbidity and Mortality Weekly Report











Excess deaths were observed in the United States in
the 28th. 29th, and 30th weeks of 1968. Excess mortality
was demonstrated in both total mortality and in the age
group 65 and over. During these weeks. unusually hot weather
has prevail '1 in the New England, Middle Atlantic, and
Pacific divisions of the country. i Similar episodes of ex-
cess mortality occurred in the Middle Atlantic division
during the summer of 1963 (MM\R. Vol. 12, No. 28), and
in the Middle Atlantic and West North Central divisions
during the summer of 1966 (\MMVR, Vol. 15, No. 29).
This summer the excess mortality noted for the country
as a whole reflects 3 consecutive weeks of excess in both
the Middle Atlantic and Pacific divisions; however, neither
division has had excess pneumonia-influenza mortality.
New England, which has had 5 consecutive weeks of slight


AUGUST 3, 1968


excess pneumonia-influenza mortality, had excess deaths
from all causes only in the 28th week.
The mortality in 122 United States Cities is presented
in Figure 3. In the summer of 1966, excess mortality was
demonstrated in deaths from all causes and from pneumonia
and influenza.Mortality in children under 1 was unaffected.
This summer, excess mortality has been reflected in deaths
from all causes hut has been less apparent for pneumonia-
influenza.
(Reported by Statistics Section, and Respiratory Diseases
Unit, Viral Diseases Section, Epidemiology Program,
NCDC.)
Reference:
IU.S. Dept. of Commerce, Envirounmental Science Services Ad-
ministration, Environmental Data Service, and U.S. Dept. of
Agriculture, Statistical Reporting Service: Weekly Weather and
Crop Bulletin. 55(24-31), 1968. Edited by J. L. Baldwin.


Figure 3
MORTALITY IN 122 UNITED STATES CITIES


U roo
6,500

S6,000
900
Z PNEUMONIA- INFL
800 ALL AGES
700
600
500
400
300
1.100
1.000 ALL CAUSES AGE
900
800
700
600
500
400
300

ML 4 u N NI ,s
MONFM FMAM44


UNDER I






i f ,


2a40 44 4V 22 4 S 0 N a4 U 32440 44 46 11 4 0 It 4 4D24 22 32 34 40 44 44 52
l0 5 5 34 = 2 4S 2346IT a 3 41 4 2 5r ? 214 23 go II 13 I0 7 5 2 30 28
SON D JFMAUJ A ON a4 FMAMJJ SO N D
R 19d


Morbidity and Mortality Weekly Report


EXCESS MORTALITY United States


44kic~


;a~`~3~i4P;8~UIIL1






AUGUST 3, 1968


Morbidity and Mortality Weekly Report


SURVEILLANCE SUMMARY
TRICHINOSIS United States 1967*


In 1967 fewer cases of trichinosis were reported than
in any previous year (Figure 4). This decline has been
especially evident in the past 2 years; the 67 cases in
1967 represent approximately half of the 115 cases re-
ported in 1966 and a third of the 199 cases reported in
1965. This decline has occurred despite an intensification
of-surveillance of trichinosis throughout the country. Dur-
ing the past 21 years, the reported incidence of trichinosis
has varied from 200 to 500 cases per year. In 1967, for the
first time, no deaths attributable to trichinosis were re-
ported. No large outbreaks occurred in 1967, and the largest
clusters reported were two separate episodes involving
two families, each with three cases.
Figure 4
CASES OF TRICHINOSIS IN UNITED STATES 1947-1967












The 67 cases were reported from 24 states. New York
reported the highest incidence with 15, 12 of which were
reported from New York City. Washington state reported
the second highest number with six cases, followed by
Massachusetts and Kansas with five each, California and
New Jersey with four each, and Maryland with three, Two
or fewer cases were reported from the other 17 states. An
analysis of the geographic distribution of'trichinosis for
the past 8 years (1960-1967) revealed that the New Eng-
land and Middle Atlantic states reported the highest mean
attack rates while the South Atlantic, East South Central,
and West South Central states reported the lowest mean
attack rates (Figure 5). The extent to which these rates
represent true differences in incidence or variations in
recognition and reporting is unknown.
Figure 5
TRICHINOSIS MEAN ATTACK RATE BY AREA 1960-1967











ATTACK RATE / tO,000O




Preliminary data
* Preliminary data


An analysis of the 67 cases by age and sex showed
that the mean age of the male patients was 38.0 years and
the mean age of the female patients was 36.7 years. There
were 33 cases in males and 34 cases in females (Table2).
Table 2
Cases of Trichinosis by Age and Sex 1967
Age Males Females Total Percent
0-9 1 1 1.5
10-19 4 4 8 11.9
20-29 9 3 12 17.9
30-39 1 13 14 20.9
40-49 10 4 14 20.9
50-59 5 5 10 14.9
60-69 3 1 4 6.0
70 or > 1 1 1.5
Unknown 1 2 3 4.5
Total 33 34 67 100.0

In 53 of the 67 cases, pork products were incriminated
as the source of infection (Table 3). Sausage was impli-
cated in 18 cases and "hamburger" in 5 cases. The place
where the suspect meat had been consumed was reported
for 53 cases. There were 35 cases acquired in homes, 16
acquired in restaurants, and 2 acquired at markets where
the meat was sold (Table 4). The source of meat was
determined in 44 cases. All of these 44 cases had pur-
chased the implicated meat from commercial sources, and
none were due to farm grown, home processed pork. Of the
67 persons with trichinosis, 29 reported that the meat had
been cooked or partially cooked, 21 consumed raw meat,
and the preparation of meat was unknown in 17 cases.
Table 3
Source of Infection for Cases of Trichinosis 1967
Food Cases
Pork Products
Fresh sausage 12
Salami (sausage) 3
Chops 3
Cured "Italian" sausage 2
Chopped pork 2
Frankfurters 2
Cured "Polish" sausage 1
Bacon 1
Pork steak 1
Pork roast 1
Unspecified 25
Subtotal 53
Non-Pork Products
Hamburger 5
Unknown 9
Total 67

The diagnosis of trichinosis was based on a combina-
tion of historical information, clinical manifestations.
muscle biopsies, and skin and serologic tests. The mean
incubation period in the 67 cases was 9 days, and the
mean period between date of onset and time of diagnosis
was 23 days. Elevated eosinophil counts (greater than 5
(Continued on page 296)


289






Morbidity and Mortality Weekly Report


RECOMMENDATION OF THE PUBLIC HEALTH SERVICE
ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES

In JuneI 1968 the Public Health Service Advisory Committee on Immunization Prac-
tices completed the following recommendations on the use of Immune Serum Globulin
for Prerention of Viral Hepatitis.

IMMUNE SERUM GLOBULIN FOR PREVENTION OF VIRAL HEPATITIS
(Infectious Hepatitis and Transfusion-Associated Hepatitis)


INFECTIOUS HEPATITIS
The agent that causes human infectious hepatitis
has not yet been identified hut is presumed to be a virus.
No vaccinee is available. administrationn of immune serum
globulin I1-1-i to exposed persons can. however, afford a
high degree of protection against infectious hepatitis.
ISG substantially reduces the frequency of overt clinical
disease, although inapparent infection may occur. Follow-
ing such infection. life-long active immunity is thought
to develop.
Patients with infectious hepatitis have been shown to
excrete irus in stool as much as 2 to 3 weeks before and
2 weeks after onset of jaundice. Viremia has been demon-
strated approximately 2 weeks before and less than 1 week
after onset of jaundice.
Transmission of the disease is principally by the
fecal-oral route and is most likely to occur under condi-
tions of inadequate sanitation or close contact with
infected individuals. Direct person-to-person spread of
infection otherwise is unusual. Transmission is also
possible by the parenteral route. The incubation period of
infectious hepatitis is relatively long, in most cases be-
tween 15 and 50 days (average 25 to 30 days).

IMMUNE SERUM GLOBULIN
Immune serum globulin is prepared for intramuscular
injection from large pools of plasma(1,000 or more donors)
obtained from venous and or placental blood. The product
is a 16.5 percent solution of globulin prepared by cold
alcohol fractionation. Serum hepatitis has not been trans-
mitted by ISG of this type.

USE OF IMMUNE SERUM GLOBULIN
FOR PREVENTING INFECTIOUS HEPATITIS
The decision to administer ISG should be based on
assessment of the epidemiologic circumstances specifi-
cally, whether the exposure could result in infection. The
administration of ISG is relevant when there is: 1) definite
exposure to a known case or source of infection, or 2)
anticipated continuous or intermittent exposure.
ISG given after known exposure should be given as
soon as possible. Its prophylactic value decreases as
time increases after exposure. The use of ISG more than
5-6 weeks after exposure is not indicated.
Dosage
The dosage patterns of ISG in common use have been
derived primarily from field and clinical observations.

* lhr official name of the product in use is: Immune Srerum Globulin
(lumun). Polioimyelitis Immune Globulin (Iluman) is an equiva-
lent product arnd niy atlsoI he used; other immune globulin
produce t- aret not t suitable.


Data from these observations provide operational guide-
lines on which to base recommendations.
Under most conditions of exposure, protection has
been afforded by giving 0.01 ml. of ISG per pound of body
weight (0.01 ml.ilb. or approximately 0.02 n.r kg ). This
dosage may he conveniently simplified (Table 1):

Table 1

Pr-r- n'- H,-, hih l l- i l1i Du- ia(ml 1
up to 50 0.5
50-100 1.0
over 100 2.0
*' within limits, larger doses of ISG provide longer-lasting but not
necessarily more protection. Higher doses are. therefore, used
under certain circumstances, (see sections "Institutional Con-
tacts" and "Travelers to Foreign Countries").

Household Contacts: There is good evidence that
close personal contact, such as occurs among permanent
or even temporary household residents, is important in
spreading infectious hepatitis. Secondary attack rates are
high for household contacts, particularly children and
teenagers. \hhuiliri. secondary attack rates are somewhat
lower for adults, their illnesses tend to be more severe.
For these reasons, ISG is recommended for all household
contacts who have not already had infectious hepatitis.
School Contacts: \hhlihou the highest incidence of
hepatitis is among school-age children, contact at school
is usually not an important means of r in-m;tting this
disease. Therefore, routine administration of ISG is not
indicated for pupil or teacher contacts of a case. However,
when epidemiologic study has clearly shown that school
or classroom contact is responsible for continued trans-
mission of disease, it is reasonable to administer ISG to
individuals at risk.
Institutional Contacts: In contrast to schools, con-
ditions favoring transmission of infectious hepatitis exist
in institutions such as prisons and facilities for the men-
tally retarded. Sporadic cases as well as epidemics have
frequently been reported in such institutions. ISG ad-
ministered to patient and staff contacts of cases in the
doses shown in Table 1 effectively limited the spread of
disease in these circumstances.
Where infectious hepatitis exists endemically, partic-
ularly in very large institutions with high rates of admis-
sion and discharge, residents and staff personnel may be
subject to frequent and continuing exposure. Under these
conditions, use of ISG has not resulted in eradication of
hepatitis. However, it has been shown to provide temporary
protection when administered in doses of 0.02 to 0.05 ml./lb.


AUGUST 3, 1968










at the time of admission or employment. It may be neces-
sary to readminister ISG in the same dose after 6 months
if the risk is felt to persist.
Hospital Contacts: Routine proph: l. r. administra-
tion of ISG to hospital personnel is not indicated. Emphasis
should be placed on sound hygienic practices. Intensive,
continued education programs pointing out the risks of ex-
posure to infectious hepatitis and the recommended pre-
cautions should be directed toward hospital personnel who
have close contact with patients or infectious materials.
For those accidentally inoculated with blood or serum
of patients with hepatitis, the appropriate prophylactic
dose of ISG is that recommended in Table 1. There is no
reason to give a larger dose because ISG appears to be
effective in preventing only infectious hepatitis, not
transfusion-associated (serum) hepatitis (see section
"Transfusion-Associated Hepatitis").
Office and Factory Contacts: Routine administration
of ISG is not indicated for persons in the usual office or
factory situation exposed to a fellow worker with hepatitis.
Common Source Exposures: When a vehicle, such as
food or water, is identified as a common source of infec-
tion of multiple hepatitis cases, administration of ISG
should be considered for all those exposed to the source.
Pregnancy: Current information does not indicate
that pregnancy in itself should alter the recommendations
for ISG prophylaxis.
travelers to Foreign Countries: The risk of infec-
tious hepatitis for U.S. residents traveling abroad varies
with living conditions and the prevalence of hepatitis in
the areas to be visited. Travelers may be .at no greater
risk than in the United States when their travel involves
ordinary tourist activities and little exposure to uncooked
foods or water of uncertain quality. For these travelers,
ISG is not recommended.
For travelers visiting areas where hepatitis is a major
health problem who may be exposed to-infected persons
and to contaminated food and water, there is increased
risk of acquiring hepatitis. A single dose of ISG is recom-
mended for them as shown in Table 2 which gives guide-
lines for U.S. residents traveling in foreign countries. (Large
geographic areas have been defined for ease in interpreta-
tion and because information is inadequate to permit devel-
oping more precise boundaries.)
For individuals who reside abroad in areas where
hepatitis is common, the risk of hepatitis is greatly in-
creased and appears to continue so for years. Experience
has shown that regular administration of ISG offers at
least partial protection against hepatitis. It is recom-
mended that prophylactic ISG be repeated every six months
at doses indicated in Table 2.*
Reactions
Intramuscular administration of ISG rarely is followed
by adverse reactions. Discomfort may occur at the site of
injection, especially when larger volumes are used. A
few instances of hypersensitivity have been reported, but
-:,: -. ,-.-,- have used up to 0.05 ml./lb. each 5-6 months
rather than the 5 ml. for adults recommended here.


Table 2
Guidelines for ISG Prophylaxis of Infectious Hepatitis
for U.S. Residents Traveling or Living in Foreign Countries*
(see text for additional details)
Short-Term Extended Travel
Person's Travel or Residence
Area Weight (1-2 months) (3-6 months)**
(lbs.) ISG Dose (ml.) ISG Dose (ml.)

Africa
Asia
North America
Central America up to 50 0.5 1.0
Mexico (Rural) 50-100 1.0 2.5
Pacific Region
Philippine Islands over 100 2.0 5.0
South Pacific
Islands
South America

Europe
North America
Canada
Caribbean Islands
Mexico (Urban) Routine ISG prophylaxis is not indicated
Pacific Region
Australia
Japan
New Zealand
*In all travel, care should be exercised in consuming uncooked
foods and water of uncertain quality.
**Repeat every 6 months of travel or residence.
in view of the very large number of persons who have re-
ceived ISG, the risk is exceedingly small.
ISG should not be administered intravenously because
of the danger of severe reactions.
Antibody against gamma globulin may appear follow-
ing administration of ISG although its clinical significance
is unknown. When ISG is indicated for prophylaxis of in-
fectious hepatitis, this theoretical consideration should
not preclude its administration.

TRANSFUSION-ASSOCIATED HEPATITIS
The risk of transmitting viral hepatitis by blood trans-
fusion is a serious and continuing problem. Several re-
ports indicate that the incidence of clinical hepatitis is
greater among recipients of blood obtained from certain
categories of donors. The risk also becomes greater as
the number of transfusions increases. Furthermore, the
case-fatality rate of transfusion-associated hepatitis in-
creases with advancing age.
Evidence has been advanced both for and against the
effectiveness of ISG as prophylaxis of transfusion-asso-
ciated hepatitis. Alr,.oh some investigators have re-
ported that 10 ml. of ISG at the time of the transfusion and
again 1 month later reduced the number of cases, other
equally careful studies have not substantiated this claim.
Existing evidence provides no adequate basis for recom-
mending that ISG be given routinely to recipients of blood
transfusions.
Among the means of effectively lowering the incidence
of transfusion-associated hepatitis are: careful selection
of donors, development of central registries of known or
suspect carriers, and use of blood and potentially ictero-
genic blood products only when necessary.


AUGUST 3, 1968


Morbidity and Mortality Weekly Report







2'02 Morbidity and Mortality Weekly Report


TABLE Ii. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 3. 1968 AND AUGUST 5, 1967 (31s WEEK)


ENCEPHALITIS HEPATITIS
ASEPTIC lA Primary
AREA MENINGITIS including Infectious Serum Infectious MALARIA
unsp. cases
1968 1967 1968 1968 1968 1967 1968 1968 1968 1967 1968
UNITED STATES... 143 72 9 28 49 11 94 902 655 42

NEW ENGLAND.......... 9 1 1 1 65 29 3
Maine. .-........... 1 1
New Hampshire......
Vermont........... 8 -
Massachusetts...... 6 1 25 17 3
Rhode Island....... 2 1 12 3
Connecticut......... 1 1 19 8

MIDDLE ATLANTIC...... 8 12 1 3 7 27 111 109 8
New York City...... 1 3 2 3 19 47 21
New York, up-State. 1 1 3 25 19
New Jersey..t...... 7 5 1 3 14 41 2
Pennsylvania ....... 3 1 3 2 25 28 6

EAST NORTH CENTRAL... 12 6 8 20 2 3 161 107 2
Ohio............... 9 1 7 13 35 20 1
Indiana............ 1 1 -16 6 1
Illinois........... 4 4 43 43
Michigan........... 2 1 3 1 3 55 33
Wisconsin.......... 1 12 5

WEST NORTH CENTRAL... 10 2 1 2 4 2 39 31 3
Minnesota........... 6 1 1 1 1 12 3
Iowa................ 1 1 2 1 4 7
Missouri........... 2 1 1 10 11
North Dakota....... 2 -
South Dakota. ..... -- 3
Nebraska........... 2 1
Kansas............. 8 9 3

SOUTH ATLANTIC....... 20 14 5 1 7 1 7 106 72 12
Delaware............ 5 3 -
Maryland........... 4 4 3 14 14
Dist. of Columbia.. 4 1 2
Virginia............ 1 2 2 6 9 -
West Virginia...... 1 3 2 4
North Carolina..... 3 8 5 10
South Carolina..... 5 1 2 2
Georgia............. 5 53 14
Florida........... 7 1 2 1 7 16 19

EAST SOUTH CENTRAL... 6 9 1 44 33
Kentucky........... 1 9 13
Tennessee.......... 1 4 1 20 9
Alabama.. ......... 3 2 6 5
Mississippi......... 2 2 9 6

WEST SOUTH CENTRAL... 28 9 2 3 5 4 59 66
Arkansas........... 3
Louisiana.......... 6 1 2 3 1 3 18 13
Oklahoma........... 1 5 4 2 6 -
Texas.. ........... 21 2 1 39 44

MOUNTAIN ........... 3 1 1 29 20 9
Montana............ 8 2 -
Idaho.............. 1
Wyoming............ 1 2
Colorado........... 2 1 1 3 9
New Mexico......... 6 4
Arizona............ 5 9
Utah............... 6 3
Nevada...., .... .. -

PACIFIC................ 50 19 8 3 6 51 288 188 5
Washington.......... 4 1 19 18 2
Oregon............. 2 3 1 21 16
California.......... 43 14 5 3 6 50 223 154 3
Alaska............. 2- -
Hawaii............. 3 2 23

Puerto Rio *........ 1 32 19

Delayed reports: Diphtheria: Tex. 4
Encephalitis, post-infectious: Fla. 2
Hepatitis, serum: N.J. delete 4
Hepatitis, infectious: Me. 4, N.J. delete 26, S.D. 4, Ala. I, P.R. 26
Malaria: Me. I








Morbidity and Mortality Weekly Report 293


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 3, 1968 AND AUGUST 5, 1967 (31st WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUIPS POLIOMYELITIS RUBELLA
TOTAL
AREA Total Paralytic
AREA Cumulative Cumulative Total Paralytic
Cum.
1968 1968 1967 1968 1968 1967 1968 1968 1968 1968 1968
UNITED STATES... 234 18,915 56,626 24 1,841 1,555 946 1 1 32 419

NEW ENGLAND.......... 12 1,134 810 1 92 65 138 1 79
Maine.. ........... 35 234 6 3 5 3
New Hampshire...... 141 74 7 2 2 -
Vermont ............ 2 34 1 1 14 8
Massachusetts ..... 4 360 319 41 32 86 1 46
Rhode Island....... 5 62 7 4 5 10
Connecticut........ 8 591 87 1 30 23 26 12

MIDDLE ATLANTIC...... 70 3,775 2,185 3 329 254 75 59
New York City...... 60 1,850 429 1 68 46 57 31
New York, Up-State. 6 1,184 549 55 61 NN 27
New Jersey.......... 3 601 479 118 89 18 1
Pennsylvania....... 1 140 728 2 88 58 NN -

EAST NORTH CENTRAL... 42 3,648 5,202 3 221 206 190 1 97
Ohio................ 287 1,127 1 60 70 17 4
Indiana. ........... 13 643 587 28 22 17 -5
Illinois........... 9 1,342 920 1 51 50 14 1 7
Michigan.. ........ 9 254 897 62 49 39 22
Wisconsin.......... 11 1,122 1,671 1 20 15 103 59

WEST NORTH CENTRAL... 3 372 2,812 3 97 67 23 1 6
Minnesota.......... 15 131 1 22 16 1 -
Iowa... ........... 96 743 6 13 13 1
Missouri........... 81 331 31 13 4 1 2
North Dakota....... 3 128 840 3 1 5 3
South Dakota........ 4 52 1 5 6 NN -
Nebraska ........... 38 622 6 12
Kansas............. 10 93 1. 24 6 -

SOUTH ATLANTIC....... 30 1,452 6,768. 3 377 297 91 1 49
Delaware............. 15 43 7 6 4 4
Maryland............ 6 94 147 1 28 35 17 1
Dist. of Columbia.. 6 22 14 10 3 -
Virginia............ 293 2,159 1 30 36 9 13
West Virginia...... 7 271 1,355- 9 21 35 21
North Carolina..... 1 282 841 1 74 65 NN I
South Carolina..... 13 507 56 28 1 1
Georgia.............. 4 32 73 44 -
Florida............ 16 474 1,662 86 52 22 9

EAST SOUTH CENTRAL... 14 559 5,090 1 159 123 76 1 23
Kentucky............ 4 179 1,315 64 34 38 1
Tennessee.......... 1 57 1,802 51 51 34 20
Alabama............ 7 92 1,316 1 24 25 4 3
Mississippi........ 2 231 657 20 13 -

WEST SOUTH CENTRAL... 28 4,606 17,050 4 297 212 101 17 46
Arkansas........... 3 1,404 20 28 -
Louisiana........... 2 151 3 84 83 -
Oklahoma........... 111 3,325 49 16 1 3
Texas............... 28 4,490 12,170 1 144 85 101 16 43

MOUNTAIN ............. 7 963 4,556 2 29 27 88 19
Montana............. 1 67 277 3 10 1
Idaho.............. 20 375 11 1 1 -
Wyoming.............. 51 179 1 -
Colorado............ 6 492 1,527 2 10 12 38 9
New Mexico......... 88 575 3 3 1
Arizona............. 219 997 1 4 12 7
Utah............... 21 357 1 4 24 1
Nevada............. 5 269 3 2 -

PACIFIC.............. 28 2,406 12,153 4 240 304 164 1 1 10 41
Washington.......... 1 515 5,407 37 25 8 1 1
Oregon.............. 12 483 1,548 18 24 7 4
California.......... 15 1,371 4,904 4 172 242 108 1 1 9 28
Alaska.............. 2 132 2 9 4 4
Hawaii............. 35 162 11 4 37 4

Puerto Rico.......... 18 374 2,084 19 12 20
Delayed reports: Measles: Mass. delete 5, Ind. delete 2, Mich. 3, Iowa 1, P.R. 2
Mumps: Me. 9, P.R. 10
Rubella: Ind. delete 5






291 Morbidity and Mortality Weekly Report


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

AUGUST 3, 1968 AND AUGUST 5, 1967 (31st 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... 4,703 3 85 2 123 10 185 15 147 56 2,191

NEW ENGLAND.......... 439 2 46 5 1 66
Maine........... 9 1 51
New Hampshire...... 15 -- 2
Vermont............ 46 10
Massachusetts ...... 41 1 2 2
Rhode Island....... 31 -
Connecticut......... 343 1 2 -- 1

MIDDLE ATLANTIC...... 180 12 7 5 19 6 13 1 26
New York City...... 10 6 8 -
New York, Up-State. 166 4 7 3 1 1 19
New Jersey.......... NN 5 5 5 6 -
Pennsylvania ....... 4 2 -3 1 6 7

EAST NORTH CENTRAL... 382 8 8 1 26 1 6 4 200
Ohio................ 52 1 12 1 4 77
Indiana. ........... 86 1 1 3 2 68
Illinois........... 94 5 5 1 10 2 1 24
Michigan.......... 77 2 1 1 10
Wisconsin.......... 73 1 21

WEST NORTH CENTRAL... 111 4 9 8 4 16 544
Minnesota ......... 15 1 7 159
Iowa..? ............ 13 1 1 1 4 91
Missouri........... 6 2 7 3 1 3 80
North Dakota........ 31 82
South Dakota....... 5 1 1 1 79
Nebraska............ 2 3 1 24
Kansas............. 39 2 29

SOUTH ATLANTIC....... 599 1 17 1 8 2 43 5 77 7 234
Delaware ........... 4 -
Maryland ........... 99 I 1 9 7 1 5
Dist. of Columbia.. 7 2 2 -
Virginia........... 223 1 4 1 8 2 28 2 91
West Virginia...... 129 1 1 31
North Carolina..... 2 2 2 2 25 9
South Carolina..... 9 1 1 4
Georgia............. 15 1 3 1 11 11 2 36
Florida............ 113 6 2 11 2 1 62

EAST SOUTH CENTRAL... 883 1 10 6 23 1 27 7 492
Kentucky ........... 37 1 1 5 6 7 243
Tennessee........... 725 1 3 4 13 1 17 227
Alabama............. 56 3 3 -21
Mississippi.? ..... 65 3 1 5 1 1

WEST SOUTH CENTRAL... 535 17 1 32 1 21 14 4 382
Arkansas.. ........ 2 4 6 4 1 44
Louisiana.......... 27 6 6 3 -- -34
Oklahoma..* ........ 18 1 8 1 6 7 2 113
Texas ............... 488 7 12 8 6 2 191

MOUNTAIN ............. 889 6 11 2 5 4 58
Montana ........... 18 -
Idaho.............. 83 1
Wyoming............ 22 -1 1 3
Colorado............ 557 -3 2 2 4 3
New Mexico .......... 74 ~ 6 2 23
Arizona............. 41 2 2 29
Utah............... 88 2
Nevada............. 6

PACIFIC.............. 685 1 15 1 1 29 1 12 189
Washington......... 90 1 2 -
Oregon.............. 59 1 1 4 1 4
California......... 422 1 13 23 1 11 185
Alaska.............. 15 -
Hawaii ... ........ 99

Puerto Rico........ 3 6 1 1 17

SDelayed reports: SST: Me. 5, Ind. delete 55, Miss. 85, Ark. 6, P.R. 5
Tetanus: Iowa 1
Typhoid: Okla. 1








Morbidity and Mortality Weekly Report






TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED AUGUST 3, 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 Influenza All
Age and over Ages and over All Ages Causes
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.--------


716
201
46
24
26
56
23
21
24
107
51
14
45
26
52

3,120
41
36
130
44
31
41
82
86
1,537
44
496
161
50
106
18
49
68
46
23
31

2,369
59
35
616
200
175
127
59
324
41
47
38
33
35
144
30
125
42
33
50
94
62

766
57
29
33
127
30
90
56
236
59
49


418
106
28
15
17
32
14
15
18
62
27
11
31
15
27

1,750
26
22
68
18
19
26
42
40
859
25
267
83
30
72
13
37
42
25
18
18

1,288
36
22
309
116
87
65
28
174
33
22
19
21
18
84
16
69
25
16
28
64
36

464
34
20
18
77
22
60
37
134
36
26


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


Total 11,715 6,442 389 636

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 401,035
All Causes, Age 65 and over------------------- 232,378
Pneumonia and Influenza, All Ages------------- 16,895
All Causes, Under 1 Year of Age--------------- 18,625


Week No.
31


1,087
103
263
42
53
98
46
52
31
90
69
198
42

630
114
39
41
127
149
42
28
90

1,117
34
41
19
159
29
73
210
61
185
97
111
40
58

434
45
25
102
24
97
27
65
49

1,476
20
63
33
43
87
448
69
43
97
44
95
166
56
118
60
34







296


TRICHINOSIS (' nti .edi from page 289)

Table 4
Cases of Trichinosis by Place Consumed
and Source of Meat 1967
Source
Place Consumed
P lac C u ('Commercial Farm Unknown Total

Home 29 0 6 35
Restaurant 12 0 4 16
Market 2 0 0 2
Unknown 1 0 13 14
Total 44 0 23 67


percent) were reported in 50 cases. Periorbital edema was
reported in 45 cases. In 35 cases, the patients had both
elevated eosinophil counts and periorbital edema. Hospital
discharge summaries were obtained for 18 confirmed cases,
and the signs and symptoms found in these 18 cases are
presented in Table 5.


Table 5
Clinical Findings in 18 Confirmed Cases
1967


of Trichinosis


Clinical Findings Cases
Eosinophilia 16
Periorbital edema 15
Myalgia 15
Fever 14
Diarrhea 8
Headaches 7
Chills 6
Lethargy 6
Malaise 5
Sweats 4
Nausea 3
Vomiting 2
Edema of extremities 2
Abdominal pain 2
Diplopia 2
Dizziness 1
Conjunctival hemorrhage 1

Total Cases 18


Sera were collected from 52 of the 67 patients. The
diagnosis was confirmed by various serologic tests in 49
cases. Muscle biopsy was performed in 29 cases, of which
20 were positive. There were 19 cases that demonstrated
both a positive serologic test and a positive muscle biopsy.
There were nine cases with negative biopsies but positive
serologic tests, and two cases with negative serologic
tests but positive biopsies.


(Reported by Parasitic Diseases Section, Epidemiology
Program, NCDC.)


A copy of tht1 original report from which thir!- data were de-
rived i avail Iable on requesV t from:
NiCtional ( ommunicablh Di easm ("enter
Atlanta, Georgia 31333
A tn: (hief, Par;a itic I)ise .c:s Section,
Epidemiology Program


AUGUST 3. 1968

oL


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULAR
TION OF I7.000, 1L. 1",_'- ':. "- THE NATIONAL COMMUN- CABLE
DISEASE CENTER, &.I L T- N r 'E .. A
DIRECTOR NATIONAL COMMUNICABLE DISEASE CF, Fri
L.L.'u S 'I.:ER M.D.
CHIEF, EPIDEMIOLOGY PROGRAM u IA'':M.I.I M.D.
ACTING CHIEF, STATISTICS SECTION IDA L. SHERMAN. M.S.
EDITOR MICHAEL B, GREGG, MD

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY, THE i CG.rA. COMMUNICABLE DISEASE
CENTER WELCOMES ACCOUNTS OF T E E : .r, ; OUTBREAKSOR CASE
INVESTIGATIONS WHICH ARE OF C' '-S. R T irTEREST GtO .EA -r1
OFFICIALS AND WHICH ARE ',"lEC L, LaL laE TO THE *.Or.rTOL
OF COMMUNICABLE DISEASES. SUCH COMMUNICATIONS n.~COiO BE
ADDRESSED TO:
NATIONAL COMMUNICABLE DISEASE CENTER
ATLANTA. GEORGIA 30333
ATTN: THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT

NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO r"E F.:D.; Av rHE INDIVIDUAL
STATE HEALTH DE' A. Tr thN i THE : TiN: *iEK CONCLUDES
ON SATURDAY CI: M-L A T I ON A *. 1 '- -L BAi5 ARE RELEASED
ON THE SUCCEEDING FRIDAY.


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