Morbidity and mortality

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Material Information

Title:
Morbidity and mortality
Uniform Title:
Morbidity and mortality (Washington, D.C. : 1952)
Running title:
Weekly mortality report
Weekly morbidity report
Morbidity and mortality weekly report
Abbreviated Title:
Morb. mortal.
Physical Description:
25 v. : ; 27 cm.
Language:
English
Creator:
United States -- National Office of Vital Statistics
Communicable Disease Center (U.S.)
National Communicable Disease Center (U.S.)
Center for Disease Control
Publisher:
The Office
Place of Publication:
Washington, D.C
Publication Date:
Frequency:
weekly
regular

Subjects

Subjects / Keywords:
Communicable diseases -- Statistics -- Periodicals -- United States   ( lcsh )
Mortality -- Periodicals -- United States   ( lcsh )
Morbidity -- Periodicals -- United States   ( mesh )
Mortality -- Periodicals -- United States   ( mesh )
Statistics, Medical -- Periodicals -- United States   ( lcsh )
Statistics, Vital -- Periodicals -- United States   ( lcsh )
Genre:
federal government publication   ( marcgt )
statistics   ( marcgt )
periodical   ( marcgt )

Notes

Additional Physical Form:
Also issued online.
Statement of Responsibility:
Federal Security Agency, Public Health Service, National Office of Vital Statistics.
Dates or Sequential Designation:
Vol. 1, no. 1 (Jan. 11, 1952)-v. 25, no. 9 (Mar. 6, 1976).
Issuing Body:
Issued by: U.S. National Office of Vital Statistics, 1952-Jan. 6, 1961; Communicable Disease Center, 1961- ; National Communicable Disease Center, ; Center for Disease Control, -Mar. 6, 1976.
General Note:
Title from caption.

Record Information

Source Institution:
University of Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
oclc - 02246644
lccn - 74648956
issn - 0091-0031
ocm02246644
Classification:
lcc - RA407.3 .A37
ddc - 312/.3/0973
nlm - W2 A N25M
System ID:
AA00010654:00162

Related Items

Preceded by:
Weekly mortality index
Preceded by:
Weekly morbidity report
Succeeded by:
Morbidity and mortality weekly report

Full Text


s. NATI L CE D E C7/
NATIONAL COMMUNICABLE DISEASE CENTER


Vol. 17, No. 34


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

HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION


INTERNATIONAL NOTES
FOLLOW-UP INFLUENZA LABORATORY FINDINGS
Hong Kong Isolates

Further indication of the magnitude of antigenic dif-
ference between the Hong Kong isolates and the previous
influenza A2 strains (MMWR, Vol. 17, No. 33) may be seen
in the patterns of antibody response from confirmed cases
of influenza occurring during the 1967-68 outbreak in the
United States and from persons recently vaccinated. Table 1
shows the results of hemagglutination inhibition (HI) tests
with paired sera from three such groups: Group I consists
of acute and 'convalescent serum pairs from 32 persons
ages 4 to 75 who had a laboratory confirmed diagnosis of
A2 influenza during the 1967-68 season. Group II consists


International Notes
Follow-up Influenza L.abora C
Findings Hong Kong Isolat ..... 313
Epidemiologic Notes and Reports
Introduced Malaria Alabama . .... 31
Epidemic of Obscure Illness Pontiac. Michigan 315
Cadmium Food Poisoning Minnesota . ... .20


of pre-and post-vaccine serum pairs, from 87 healthy prison
volunteers who received a single dose of 1967-68 commer-
cial polyvalent vaccine in November 1967. Group III con-
sists of pre-and post-vaccine serum pains from 36 elderly
persons (ages 70-74) who received 2 doses of 1967-68 com-
mercial bivalent vaccine in October-November 1967.
(Continued on page 314)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
34th WEEK ENDED CUMULATIVE, FIRST 34 WEEKS
MEDIAN
DISEASE August 24, August 26, 1963 1967 MEDIAN
1968 1967 1968 1967 1963- 1967
Aseptic meningitis ...................... 156 122 74 1,945 1.510 1,177
Brucellosis ...............:............. 9 9 141 170 170
Diphtheria............................... 3 2 2 105 67 113
Encephalitis, primary:
Arthropod-borne & unspecified ........... 45 48 698 974
Encephalitis, post-infectious ............. 9 11 350 606
Hepatitis, serum ........................ 94 52 2.780 1.397
Hepatitis, infectious .................... 856 731638 28613 24,951 26.005
Malaria ................................ 33 42 5 1,378 1.276 65
Measles rubeolaa) .................. ..... 91 175 598 19,336 57,254 238,672
Meningococcal infections, total ........... 47 21 28 1,943 1.616 1,886
Civilian .............................. 47 20 1,768 1,504
Military .............................. I 1 175 112
Mumps ................................. 502 --- 123,275 -
Poliomyelitis, total ..................... 4 35 23 61
Paralytic ............................. 2 35 20 57
Rubella (German measles) ............... 214 178 43,037 39,467 -
Streptococcal sore throat & scarlet fever.... 3,976 4,610 3,933 291,916 314.899 283,488
Tetanus ............................... 5 3 4 98 141 157
Tularemia............................... 4 5 5 130 118 166
Typhoid fever .......................... 6 6 9 211 257 258
Typhus, tick-borne (Rky. Mt. spotted fever) 13 13 11 208 216 181
Rabies in animals ....................... 61 81 75 2,375 2,983 2,983

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........................................... 3 Rabies in man: ................................... .
Botulism: .......................................... 4 Rubella, Congenital Syndrome: ......................... 4
Leptospirosis: La.- ................................. 25 Trichinosis: ........................................ 47
Plague: ............................................ 2 Typhus. marine: N.J.-l ............................... 20
Psittacosis: Ariz.-l ................................ 34


t, Y
;.L' T


*Delayed reports: Trichinosis: Colo. delete 1


Data exclude report from Texas Shortage of Help







Morbidity and Mortality Weekly Report


FOLLOW UP INFLUENZA LABORATORY FINDINGS t('o tiniid fri, frol puy./

Toble 1
HI Antibody Response to Hong Kong 8 68 and Selected Influenza Virus Strains


ro in .\ ii goliii
Iroup

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3. i[ i .. 1.
i,.., [, ..,,. -
11 L 1. \ I ,I ... 1E. 1.

(olderhrl) A2 Tokyo 3 67
Hong Kong h 6h


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GM\* T
Tie r -

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iler:1
1:10()
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Tiler


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I I



S6 12
;(36 10


Showing -4 fold
titer rise





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*(;1 (G omctri nri .in titer, ,f total roup.
* '( n> 'tI l fnt 'ra ii hi tr .tltIpprtx 'im l l \ --k., iftr r J o nsit.

Group I convalescent sera -ho\ed a high goomietric
moan (GM) titer to A2 Japan 170 6.2 one of the two A2
-trains in the current \;accin,. and all serum pairs responded
\ith a Ifourfold or greater rise to that antigen. Similar re-
sults. although with somewhat lower .GM tigers. were olh-
tained with A2 G'corgia 19 67. the strain representing iso-
latos from the 1967-6h influenza outbreak in the United
States. A significant response was also noted with A\2
Tok\o :3 67 which is antiFenicall y- somewhat different
from either of the above virusess and is similar to isolates
from current outbreaks in Australia. New Zealand. and
South Africa. However, antibody response to the Hong
Kong strain was considerably lower. The GM titer of the
convalescent sera was 10 and only 19 percent of the
serum pairs showed a fourfold or greater increase in titer.
The \accinees in Group II had low fourfold response
rates to all strains, including A2 Japan 170,'62. While the
individuals in Group III gave excellent reactions to the
1962 and 1967 A2 viruses as measured by percent of four-


I'u It- ; wccin ,srr c tlli- l t ii 13 k.- lftl'r final injction.

fold responses and rise in GM titer, their response to the
Hong Kong strain was not appreciably increased over that
of Group II.
Homotypic and heterotypic antibody responses of
vaccinees depend both on the potency of the vaccine and
the age and prior influenza experience of the recipient.
This is also true to some extent for individuals recovering
from the natural disease. \While serum antibody titers are
only indirectly related to protection. individuals demon-
strating peak heterotypic antibody titers following immuni-
zation or natural disease would le considered at lowest
risk of infection. The antibody responses in all three groups.
measured with the Hong Kong antigen, are minimal.
These results with human sera confirm the previous find-
ings based on reciprocal HI tests with monospecific animal
sera. The Hong Kongh 68 strain represents a considerable
antigenic change from earlier A2 influenza isolates.
(Reported by the World Health Organization International
Influenza Center for the Americas, NCDC.)


EPIDEMIOLOGIC NOTES AND REPORTS
INTRODUCED MALARIA Alabama


Between August 15 and 19. four cases of malaria were
reported in teenagers who live or vacationed in eastern
Alalama. None of the patients had Ieen in malarious areas.
received blood transfusions, or used common syringes.
'lThe infections were due to I'lasmodium riiaNx, acquired
l,-..i,.l mosquito transmission at a dri\e-in mo\ie theater
during 3 different nights.
M.\i., ann IS-year-oldl male student, first experienced
-sesre headache and backache on August S. This was
followed by an intermittent course of fer' r. chills, and
diaphoresis-. e Iias -hopitalized on August 12. iandl malaria
parasites iwere found in his peripheral blood on August 15.
He. as well as the other three patients. were successfully
treatled with thil recommended 3-day course of chloroquine
followed by 11 days of prinmquine.


D.D.. the 18-year-old girl friend of M.W., became ill
on August 12. She was hospitalized on August 14. and the
(I1 ......i- of malaria was made the following day.
T.B.. a 17-year-old male student. also became ill on
August 12. He was hospitalized on August 18. and the
diagnosis of malaria was made on August 19.
L.H., I 15-year-old female, unlike the other patients,
was not a resident of Alabama: however, she did visit
Alahbama from July 20 to August 11. She became ill on
August 10 but returned to her home in western New York
thel following day. She wias hospitalized on August 16,
and the diagnosis of malaria was made shortly thereafter.
The only factor that all patients had in common was
attendance at a local drive-in movie theater. L.H. attended
on July 26. D.D. and M.W. on July 27. and T.B. on July 28


U'Ui IST 24. 1968


/ I (I I II






Morbidity and Mortality Weekly Report


(Figure 1). Although they attended the same drive-in theater
at other times during the summer, each patient attended
only once during that week. The average time from attend-
ance at the drive-in until onset of symptoms was 14 days.
None of the patients' friends who were with them at the
drive-in became ill.
Thedrive-in theater is located by a state highway and
is surrounded by at least eight ponds. Anopheline mos-
quitoes are prevalent in the area. A major university and
trailer parks are located in the immediate vicinity and a
large Army base is approximately 30 miles away. It is
believed that the malaria parasite donor is probably a
foreign student or a soldier who has returned from South
East Asia to the military base or to the university.
Shortly after the onsets of their illnesses, three of the
patients were reexposed to mosquitoes. M.W. and L.D.,


although they were unknown to each other, both returned
to the drive-in theater on August 10 when they were febrile.
T.B. camped out overnight in a nearby -1h,,I area on
August 15 when he was febrile.
An epidemiologic investigation is underway to locate
the parasite carrier and other possible cases.
(Reported by J. R. Herring, M.D., Lafayette, Alabama;
W. H. Y. Smith, M.D., C.P.H., Alabama State Department
of Public Health; Julia L. Freitag, M.D., Director, Bureau
of Epidemiology, New York State Department of Health;
and a team of EIS Officers.)
Editorial Note:
Transmission of malaria by mosquitoes is now a rare
event in the United States. Previous episodes of intro-
duced malariaduring this decade have been isolated cases
and have been confined to military reservations.


Figure 1
INTRODUCED PLASMODIUM VIVAX MALARIA
ALABAMA, JULY 25-AUGUST 16, 1968

O ATTENDANCE AT DRIVE-IN THEATER

ONSET OF ILLNESS

( REEXPOSURE TO MOSQUITOES WHILE ILL


AVERAGE INCUBATION PERIOD
14 DAYS


5 6 7 8 9 10 II 12 13 14 15 16
AUGUST


EPIDEMIC OF OBSCURE ILLNESS Pontiac, Michigan


On July 2, 1968, an acute febrile illness with marked
constitutional symptoms developed in employees of the
Oakland County Health Department, Pontiac, Michigan.
By the following day, 95 percent of the employees who
had been present in the building on July 1 were ill. Addi-
tional cases continued to occur in some persons newly
exposed during the next 5 weeks. The syndrome was highly
uniform, consisting of fever, chills, malaise, headache,
and myalgia, with onset from 1 to 2 days after initial ex-
posure in the building. The illness was self-limited, last-
ing an average of 3 to 5 days. Some employees complained
of a variety of related symptoms in the ensuing weeks;
however, in many of these cases, there was no clear re-
lationship between recrudescent symptoms and reexposure
in the building, and the majority of employees did not
develop illness upon reexposure. Close contacts of ill
persons were apparently not affected with clinical illness


nor were people in nearby buildings or in the community
at large.
Physical examination of patients in both acute and
convalescent stages of illness was uniformly negative. A
sampling of white blood cell counts showed modest poly-
morphonuclear leukocytosis, but extensive clinical labora-
tory tests failed to show any other abnormalities. Serial
chest X-rays were negative as were electrocardiagramson
patients without pre-existing cardiac disease.
Epidemiologic analysis excluded a water-borne mode
of spread and strongly implicated the air conditioning
system as the source or means of spread of the respon-
sible agent. It has been established that defects in the
air conditioning system permitted cross connections to
exist between bacteriologically contaminated exhaust
ducts and the cool air distribution system in the building.
(Continued on page 320)


JULY


315


AUGUST 24, 1968







316 Morbidity and Mortality Weekly Report


TABLE II. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 24, 1968 AND AUGUST 26, 1967 (34th WEEK)

ENCEPHALITIS HEPATITIS
ASEPTIC 13 111 SD HI Primary
AREA MENINGITIS including Infectious Serum Infectious MALARIA
unsp. cases
1968 1967 1968 1968 1968 1967 1968 1968 1968 1967 1968
UNITED STATES... 156 122 9 3 45 48 9 94 856 731 33

NEW ENGLAND.......... 1 1 4 60 19 1
Maine. ............ 1 -
New Hampshire...... -
Vermont ...........- 3 -
Massachusetts...... 2 33 8 1
Rhode Island.......- -
Connecticut........ 1 2 16 10 -

MIDDLE ATLANTIC...... 32 18 9 2 27 146 133 7
New York City...... 1 18 55 51 3
New York, up-State. 3 5 3 31 37 2
New Jersey......... 28 11 5 3 23 20 2
Pennsylvania....... 1 1 4 2 3 37 25 -

EAST NORTH CENTRAL... 26 16 13 28 9 121 87 1
Ohio.............. 18 2 12 27 1 42 17
Indiana............ -- 6 11
Illinois........... 1 13 35 25
Michigan............ 7 1 1 8 32 30 1
Wisconsin.......... I 6 4

WEST NORTH CENTRAL... 16 2 4 4 2 47 32 1
Minnesota.......... 4 2 1 1 19 11 -
Iowa............... 2 2 1
Missouri............ 9 14 12
North Dakota....... 3 1-
South Dakota ...... 1 -
Nebraska ........... 5 4 1
Kansas............ 1 2 1 6 4

SOUTH ATLANTIC....... 18 25 6 4 4 1 5 74 87 7
Delaware........... 1 3 4
Maryland............. 7. 22 1 2 15 20 1
Dist. of Columbia.. 1 2
Virginia.......... 6 6 3 1 14 19
West Virginia...... 1 3 7 3
North Carolina..... 2 1 7 3 4
South Carolina..... 1 1 2 2
Georgia............. 15
Florida............. 1 1 1 26 21

EAST SOUTH CENTRAL... 20 8 2 2 2 3 45 44 4
Kentucky............ 1 2 2 24 10 -
Tennessee.......... 17 3 2 1 3 13 21
Alabama............ 2 2 1 5 4
Mississippi........ 1 1 7 8

WEST SOUTH CENTRAL... 1 17 3 2 3 2 22 75
Arkansas........... 10 2 4 3
Louisiana.......... 1 2 3 1 2 11 15
Oklahoma........... I1 1 1 7 6
Texas.............. --- 4 --- --- --- --- --- --- 51 ---

MOUNTAIN ............. 5 4 3 1 66 33 3
Montana............ 5 -
Idaho............... I -
Wyoming............. 2 2
Colorado............ 5 2 38 14 3
New Mexico......... 2 1 8
Arizona............ 2 13 8
Utah............... 6 1
Nevada............. -

PACIFIC.............. 37 31 1 8 5 4 44 275 221 9
Washington.......... 2 2 22 26 2
Oregon............. 2 1 7 14
California.......... 32 26 1 8 4 4 44 245 178 7
Alaska............. -- 1 2
Hawaii............. 1 2 1 I 1

Puerto Rico............ 22 33

Delayed reports: Hepatitis, infectious: Me. 1







Morbidity and Mortality Weekly Report 311


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 24, 1968 AND AUGUST 26, 1967 (34th WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS 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... 91 19,336 57,254 47 1,943 1,616 502 35 214

NEW ENGLAND.......... 4 1,145 836 15 116 67 65 1 20
Maine. ........... 37 238 6 3 6 2
New Hampshire...... 141 74 7 2 2
Vermont........ ... 2 34 1 1 1 -- 1
Massachusetts. ..... 1 357 339 15 63 32 38 1 8
Rhode Island....... 5 62 8 4 8 -
Connecticut........ 3 603 89 31 25 12 7

MIDDLE ATLANTIC...... 44 3,992 2,236 8 349 266 60 37
New York City...... 33 2,027 447 1 70 48 56 20
New York, Up-State. 5 1,215 574 4 63 66 NN 15
New Jersey......... 6 621 484 122 92 4 1
Pennsylvania.*..... 129 731 3 94 60 NN 1

EAST NORTH CENTRAL... 15 3,722 5,318 1 228 218 121 1 47
Ohio................ 2 291 1,137 1 63 75 17 10
Indiana............ 4 657 592 28 22 9 7
Illinois........... 1,356 938 51 53 6 1 3
Michigan........... 4 265 917 66 52 24 10
Wisconsin.......... 5 1,153 1,734 20 16 65 17

WEST NORTH CENTRAL... 1 380 2,839 2 103 70 14 1 10
Minnesota.......... 16 131 2 26 17 1 -
Iowa................ 1 98 746 6 14 9 3
Missouri........... 81 332 32 14 1 1 3
North Dakota.. .... 131 859 3 1 3 1
South Dakota........ 4 52 5 6 NN -
Nebraska........... 40 626 6 12 3
-Kansas............. 10 93 25 6 -

SOUTH ATLANTIC....... 5 1,485 6,836 7 392 309 41 1 36
Delaware........... 15 45 .- 8 6 1 1
Maryland............ 1 95 152 2 30 38 9 6
Dist. of Columbia.. 6 22 14 10 3 1
Virginia........... 3 300 2,179 2 33 38 8 3
West Virginia...... 1 281 1,377 10 21 15 19
North Carolina..... 281 847 76 66 NN I
South Carolina..... 12 510 56 29 -
Georgia............. 4 34 3 76 47 -
Florida............. 491 1,670 89 54 5 6

EAST SOUTH CENTRAL... 487 5,149 7 169 127 47 2 18
Kentucky........... 99 1,321 7 72 35 2 1 4
Tennessee .......... 61 1,844 52 53 43 14
Alabama............ 93 1,322 24 26 2 1
Mississippi........ 234 662 21 13 -

WEST SOUTH CENTRAL... 1 4,680 17,214 1 302 215 1 19 1
Arkansas........... 3 1,404 20 28 -
Louisiana.......... 2 152 1 87 85 -
Oklahoma............ 1 112 3,349 49 16 1 2 1
Texas............... --- 4,563 12,309 --- 146 86 --- --- --- 17 ---

MOUNTAIN............. 3 987 4,602 29 27 53 27
Montana............ 67 282 3 3 6
Idaho............... 20 377 11 1 1 -
Wyoming............ 51 180 -- -
Colorado............. 2 505 1,544 10 12 17 6
New Mexico......... 1 97 578 3 5 6
Arizona............ 221 1,011 1 4 23 8
Utah............... 21 361 1 4 4 -
Nevada............. 5 269 3 2 -

PACIFIC.............. 18 2,458 12,224 6 255 317 100 10 18
Washington......... 515 5,418 37 28 1
Oregon............. 9 505 1,572 1 20 25 2 2
California.......... 9 1,401 4,939 5 185 251 94 9 15
Alaska............. 2 133 2 9 3 -
Hawaii............. 35 162 11 4 1 -

Puerto Rico.......... 9 397 2,101 -1 19 12 10

Delayed reports: Measles: Me. 2, Mass. delete 1, N.J. delete 5, Pa. delete 7
Meningococcal infections: Ind. delete 1
Mumps: Me. I
Rubella: Me. 2








318 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 24, 1968 AND AUGUST 26, 1967 (34th 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... 3,976 5 98 4 130 6 211 13 208 61 2,375

NEW ENGLAND............ 423 2 46 7 1 1 1 70
Maine............. 4 53
New Hampshire...... 21 I 2
Vermont ............ 19 46 1 11
Massachusetts ...... 59 1 3 1 1 3
Rhode Island....... 49 -
Connecticut........ 271 I 3 I

MIDDLE ATLANTIC...... 124 12 7 19 14 2 34
New York City...... 5 6 9
New York, Up-State. 116 4 7 3 2 2 27
New Jersey......... NN 4 6
Pennsylvania....... 3 2 3 6 7

EAST NORTH CENTRAL... 248 9 8 27 1 7 12 228
Ohio............... 9 1 12 1 5 2 86
Indiana............ 71 1 1 3 1 75
Illinois........... 71 5 5 11 2 1 28
Michigan........... 61 3 1 1 11
Wisconsin.......... 36 I 7 28

WEST NORTH CENTRAL... 158 1 6 2 11 1 10 7 18 590
Minnesota.......... 28 I 7 176
Iowa............... 38 2 1 1 4 98
Missouri.......... 9 2 7 3 1 4 86
North Dakota....... 14 2 93
South Dakota ....... 6 1 2 1 4 79
Nebraska........... 26 1 1 3 1 25
Kansas............. 37 1 2 1 2 1 33

SOUTH ATLANTIC....... 546 21 8 1 45 7 117 8 260
Delaware .......... 2 -
Maryland........... 105 2 9 12 5
Dist. of Columbia.. 32 2 2 1
Virginia........... 128 4 1 1 9 6 41 2 97
West Virginia...... 139 I 31
North Carolina..... 14 2 2 2 1 29 1 10
South Carolina..... 11 2 6
Georgia............ 2 3 12 26 3 41
Florida............. 113 8 2 11 3 2 75

EAST SOUTH CENTRAL... 901 3 13 7 2 26 3 38 7 521
Kentucky........... 74 1 1 5 8 6 260
Tennessee......... 729 2 5 5 1 14 3 25 238
Alabama............ 43 1 4 3 1 22
Mississippi........ 55 3 1 1 7 2 1

WEST SOUTH CENTRAL... 45 19 2 35 29 1 18 4 397
Arkansas............ 20 4 2 8 4 1 3 2 48
Louisiana.......... 14 8 6 3 2 37
Oklahoma............ 11 8 12 8 116
Texas.............. --- --- 7 --- 13 --- 10 --- 7 --- 196

MOUNTAIN............. 1,082 6 13 5 2 64
Montana............ 16 -
Idaho........... ... 54 1
Wyoming............. 24 1 1 3
Colorado........... 671 3 2 4 3
New Mexico......... 207 6 1 26
Arizona............ 55 3 1 32
Utah................ 55 2
Nevada ............. I -

PACIFIC............. 449 1 16 2 2 35 1 7 211
Washington......... 48 1 2 2
Oregon ............. 47 1 1 4 5
California......... 315 1 14 1 2 29 1 7 204
Alaska............. 23 -
Hawaii ........... 16 -

Puerto Rico.......... 15 8 2 17

Delayed reports: Tetanus: Iowa 1








319


Morbidity and Mortality Weeklk Report






TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED AUGUST 24, 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 year Area All 65 years and 1 year
Ages and over Influenza All A 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, Il1.----------
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.--------


693
220
36
30
20
70
28
18
25
53
54
12
44
35
48

3,075
44
35
143
36
33
43
71
91
1,599
38
409
172
46
105
18
29
62
42
32
27

2,626
79
44
724
197
173
123
103
350
40
70
39
38
54
154
31
107
38
28
46
128
60

771
68
12
43
119
30
98
76
223
60
42


416
118
20
21
13
41
20
14
19
34
33
9
25
19
30

1,747
23
22
90
23
18
27
27
31
924
23
229
79
29
61
14
18
42
20
28
19

1,490
52
31
386
117
100
59
67
198
34
36
20
21
38
72
16
66
23
18
25
74
37

459
38
7
25
74
22
61
43
118
44
27


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 11,897 6,671 403 635

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 436,647
All Causes, Age 65 and over------------------- 252,356
Pneumonia and Influenza, All Ages------------- 18,077
All Causes, Under 1 Year of Age--------------- 20,442


Week No.
34


1,109
141
241
51
86
91
48
54
29
70
53
194
51

625
101
45
37
113
141
42
50
96

1,115
46
39
26
153
30
73
218
56
186
93
114
45
36

432
40
37
11l
20
88
22
53
61

1,451
13
45
28
55
89
441
95
29
97
57
89
155
36
124
60
38







320


Morbidity and Mortality Weekly Report


EPIDEMIC OF OBSCURE ILLNESS
((o t + frls.el p,,y c 31,5)


E\t 11n I e sIeria. l en'I ironmlI lal sampling of air. I, atr.


hkioloial :and toxicologic agen -ts ~a- performed. Throat
s-wah, stools. acute and conIalecent 1era. and. in -onle
ase'-. urine e111e collected on patiinll and their failnld
contact-. In addition, a vari tY( of e\ptrimental anninals
,were re-,plo d in tho I lu dling \ith ia fIbrile response oe-
currin I in iurcc- --i\s testI group,- of' guinea pigs. Nes c r-
thele- to dt e. 11a noli definllio e tiolol0 ic aeont Ihas been
ideintifieod fromIll tlh guinea pigs or from human or environ-
mintal salnples.
(l'lported by Bern+ard Hernmin, Vl.D.. Director, Oakland
(ciunpy llrealth DVepartment: (ieorge AIatle. 31.9.. V.S.P.ft..
'hi[. l0nisioai of EpidJe miologyi, Ilic'higan Department of
1 ub/i IIith, a tra Im from th11e lichiycn Orpartment of
Public Healt:" andt a team from \('0('.)




CADMIUM FOOD POISONING Minnesota


On June 12, 196ih, in St. Louis County, Minnesota.
four persons experienced nausea, upper abdominal distress,
and \orniting within 15-60 minutes after eating an ciening
meal at a local dri e-in restaurant. All recovered within
osevral hours after receiving medical treatment for their
symptoms.
Epidemiologic investigation incriminated cole slaw as;
the likely vehhicle of infection because it. was the only food
eaten by all four persons. Inspect ion of the restaurant facil-
ities disclosed a corroded metal hellf in the refrigerator
which had recently, been plated with cadmium. Cole slaw was
stored uncovered beneath this shelf and received drippings
of foods -tored abo\e (pickles, celery seed dressing, tartar
sauce. and probably catsup). It is postulated that some acid
foods reacted with the cadmium plating, forming cadmium
salts which dripped onto the cole slaw. and that the cadmium
salts did not contaminate the entire jar. but remained con-
centrated on the surface layer: consequently. only four
cases of food poisoning occurred. Laboratory examination
of the cole slaw revealed the presence of cadmium in a
concentration of 6.8 parts per million.
(Reported by AJ.J. luglum, M.D., M.P.II., Executive
". St. Louis County Health Department; and D. S.
I D M.D., M.P.H., Director, Division of Disease Pre-
rention and Control, Minnesota Department of Health.)
Editorial Note:
In pret\ious reports of cadmium food poisoning, as
little as 10 mg of cadmium has been reported to cause the
symptom complex of headache. nausea, salivation, vomit-
ing. diarrhea, and stomach and muscular pains 1 2 to 2
hours after ingestion.
It et re 'nc'e:
li.akr, Timothy D., Iand ianefroN, \illiam C'.: CIamium poisoning
from a refrlgrrator -shIf us-d ais an ilmprovistll arbecue grill.
PUBIl( IE\IAL'l HKP. 76:5,13-511. 1961.


THE '* r AND MORTALITY WEEKL REPORT. WITH A CIRCULAR
TION IS PUBLISHED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER, ATLANTA. GEORGIA
DIRECTOR NATIONAL COMMUNICABLE DISEASE CENTER
OAVIDJ .erri.t M.D.
CHIEF EPIDEMIOLOGY PROGRAM A.D. L M.D.
ACTING CHIEF, STATISTICS SECTION IDA L. EM- l, M.S.
EDITOR MICHAEL B GREGG, M.D

IN ADOoTION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY, THE NATIONAL COMM..' %A i_-,, :;
CENTER WELCOMES ACCOUNTS OF INTERESTING C f i : 1.
INVESTIGATIONS WHICH ARE OF CURRENT '. t TO -" L- T
OFFICIALS AND WHICH ARE DIRECTLY y L -' r I ': ,: :*.T IC
OF COMMUNICABLE DISEASES. SUCH ":MS.'*...T,-I.: .I.LI BE
ADDRESSED TO;
NATIONAL COMMUNICABLE DISEASE CENTER
ATLANTA, GEORGIA 30333
ATTN: 'i F ,i t JR
.i, ,7 AND MORTALITY WEEKLY REPORT

NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO THE NCDC BY THE INDIVIDUAL
STATE HEALTh Li a c' '," -. THE REPORTING WEE IC L .C1 .
ON SATURDAY; i E '- C ON NATIONAL BASIS AE i ELC'i :.
ON THE SUCCEEDING FRIDAY.


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U. ,r-,O- TORY


AUGUST 24, 1968


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