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:
AA00010654:00168

Related Items

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

Full Text



NATIONAL COMMUNICABLE DISEASE CENTI


Vol. 18, No. 3


WEEKLY

REPORT

For

Week Ending

January 18, 1969


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE / PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION
DATE OF RELEASE: JANUARY 24, 1969 ATLANTA, GEORGIA 30333


EPIDEMIOLOGIC NOTES AND REPORTS
INFLUENZA United States

For the week ending January 18, 1969, total mortality
and pneumonia-influenza mortality reported from 122 U.S.
cities decreased. For this week, total mortality for all
causes was 16,439 and the pneumonia-influenza deaths
totaled 1,436 (Figure 1). This is the first week to show a
decrease in total pneumonia-influenza deaths since excess
pneumonia-influenza mortality began 7 weeks ago. The
Middle Atlantic and East North Central Divisions have
reported a decrease for 2 consecutive weeks while the
West North Central, New England, Mountain, and East
South Central Divisions showed a decrease for the first
time. The Pacific, West South Central, and South Atlantic
Divisions continued to report an increase in pneumonia-
influenza mortality. The overall decline in mortality is


DISEASE


('ONTEINTS
Eptdlminologic Notesn and IR1port,
Influenza Unmitd States. .. .... 17
Outbreak of Infectious fllpatitis Limi: tont
County. Alabama . . .. .. 1i
Closntridirm Perfringens Food Poisoning l.xa ..... 20
Staphyloocccal Food Poisoning Wlaukeshal
County, Wisconsin. . . .. 21
Transfusion Malaria Ionolulu, Hawaii .. ........ 21
Surveillance Summary
Measles United States, 196R .. . 19
Botulism- 1968 . ... .. 21
Summary of Reported Ca'ses of Infectious Syphili. ... 22
International Notes
Smallpox Burma ................. .. 22
Influenza- 1968 and 1969 ................... 23
consistent with the survey conducted during the week
ending January 11 which indicated that influenza activity
was decreasing in most states (MMWR, Vol. 18, No. 2).
(Reported by the Respiratory Diseases Unit, Viral Diseases
Section, Epidemiology Program, NCDC.)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previ
3rd WEEK ENDED I ...\.4V Af Ij'lRST 3 WEEKS


Aseptic meningitis ....................
B rucellosis ............................
Diphtheria .............................
Encephalitis, primary:
Arthropod-borne & unspecified ...........
Encephalitis post-infectious .............
Hepat tits, serum ................ .......
Hepatitis, infectious ...................
M alaria ... ................ .........
Measles rubeolaa) .......................
Memngiao occal infections, total ...........
C civilian ..............................
M military .. ... ... .... ... .... ... ........ .
Mumps ........... .................. .
Poliomyelitis, total ...................
Paralytic ..........................
Rubella (German measles) .........
Streptococcal sore throat & scarlet fever ....
Tetanus .............................
T ularem ia ..............................
Typhoid fe r ......... ... ....
Typhus, tick-borne (Rky. Mt. spotted fever)
Rabies in animals ............. -....


January 18,
1969


t 4


25
5
3

20
10
84
830
31
352
87
87

2,456


462
10.514
2

3
CO


January 20,
1968


18
9
76
823
36
542
82
79
3
5.489


610
11.960
2
1
9
*8


TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cuim. Cum.
Anthrax: .......................................... Rabies in man: ......
BotulismI: .......... ............................. Rubella congenital syndrome: ..
Leptospiruosts: Calif.-1, La.-l .................. ...... 2 Trichinosis: Wis.-l .. .......... I 4
P league: ................. ............... .... .. T yphus mnurine: ...... ... ......... .
P sittacosis: .............. ....................
*Delayed reports: Typhus, marine: Tex. 1(1968)








Morbidity and Mortality Weekly Report



Figure 1
PNEUMONIA-INFLUENZA DEATHS IN 122 UNITED STATES CITIES


JANUARY 18, 1969


ALL CITIES


EPIDEMIC THRESHOLD ---
EXPECTED NUMBER


12 16 20 24 28 32 36
23 20 8 15 13 10 7
M A M J J S


WLtK NO 40 44 48 52 4 8 12 16 20 24 28
1968 i 1969

MOUNTAIN
,J CITIES


40 44 48 52 4 8 12 16 20 24 28
968 1969

E.S CENTRAL
8 CITIES


WEEK NO 40 44 48 52 4 8 12 16 20 24 28 32 40 44 48 52 4 8 12 16 20 24 28 32 40 44 48 52 4 8 12 16 20 24 28 32 36
1968 1969 1968 1969 1968 1969


16 20 24 28 32 36
19 17 14 12 9 6
A M J J A






.IANII RY 18 1969


Morbidity and Mortality Weekly Report


SURVEILLANCE SUMMARY
MEASLES United States 1968


R total of M22,5s case- of iand asle- R ere rporte1 d to
NC'D( during 19is. This is a reduction of tl porceont from
the prelimou- lo\ total of 6'2,705 -a ,- reported in 1967.
Do-pilte iw national trend of dctrea;-ing (ca-e reporrl in
19isL. intcread Populati' on- by Geogr in Ipho ivisio rphi
di\i-lon-, h \ N USA England and t1 h M9ild6 9 tlant9
(Tabl( 1). 'Tho _radual chanbu in the >(a-onal pat!t reported mn asl cases fir.- noted in 19(;7 became t\,.M n
more apparinl in 196tis (l'mure 2).

Table 1
Reported Measles Cases and Case Rate per 100,000
Population by Geographic Divisions
USA 1966-1968


Go((uraphic
Dii-ion



NEw tn.land
lMiddl"e \l)antic
Eait North ( central
\e1-t North central l
So th \rl antic
East South ( ontral
es%(,zt both Contrir l
Mountain
Pacific


Nuifbi -r of
Rt'poritd (Ca ,-


1 96s 1 1967



4.727 : .61tit
4,t26I t6.:3:1

1.l27 .429

5.? 1 1 247

1.100 .51,0 2
2.,,);, 13.,26s


2 0o 1 I (;
2. 6 1 :;

1".702


1t;.4::7
2 1 .) 1

1:i,7t2
1.* 11


( t-' p tr 100,000
opulaitllon


I1 : ; i 7 1 1. 2
I s.i G i5.:
12 *, 7 2 i I .
11 '- 1 (;.> I 10 2
:1.0 1!)6 9 0 l 4
l6 .1 .() t ;
2'-,.0 9 59 11 t",.2

1:1.9 14.S 1 7,.2
1 1l i! :^. ]s !s)h.


In 196 ,. the national nm asles case rate nas 11.3
cases per 100,000 population. "hen the states are grouped
according to reported cases per 100,000 population for
calendar years 1966, 1967. and 196h. the differonce- among
the resulting frequency distributions are striking (Table 2).
In 196S. only 5 (9.6 percent) of the '52 reporting areas
-howed case rates greater than 25 per 100,000 population.
In contrast. the majority of the states. 79 percent and 54
percent in 1966 and 1967. respectie'l\. reported more than


Figure 2
MEASLES CASES BY 4-WEEK PERIODS
USA 1966-1968


5.5 ca-e- per 100,()000 populationl. In li;',. aliro-t v,-
thirdn (;4I) of Ihe .2 t report int artr- r portt d fI',w+r t han
10 cas- s per 100,00) pop) ulation coxrtilar('d xitl oi r -third
(17) in 19617 and on,-t'nth (5)) in r lHif.
Table 2
Frequency Distribution of States* According to Reported
Measles Cases per 100,000 Population
1966-1968

Cases per Nulmbher of State,-
100.000 population (;s 1967 19(66

Les- than 25.0 17 2 4 11
25.0 to 19 0 13 9
50.0 to 999 11 14
100:0 or greater 1I
lniicluli.- th. I .-in i 1 liiml n. ia i u l \N., Y .irk ( 1< .
(Reported by tih c titix Srriion. 'nnd the Stie' s'e-,-
ices Sectin. Epidcmiolboy P'ro1jrani, \')C'.)


EPIDEMIOLOGIC NOTES AND REPORTS
OUTBREAK OF INFECTIOUS HEPATITIS Limestone County, Alabama


Betc een September 9 and December 6, 19t6h. 21 known
cases of infectious hepatitis developed among the students,
faculty, and visitors of a rural public school in Limestone
County. Alabama (Figure 3). The school which includes
grades 1-12 has an enrollment of approximately 750 -tu-
dents. No cases developed in students in grade- 3. 4. or
5, but at least one case occurred in each of the remaining
grades. The patients ranged in age from 6 it 4s \ears-:
13 were male and eight female. Three of the ca-es occurred
in faculty members, and the remaining adult case occurred
in a 24-year-old woman, a resident of another county. :11
da-ys after an isolated, brief \isit to the school. The clus-
tering of 1h of the '21 cases during the :3-,week period be-
twieen Noxember 16 and December 6 and the lack of prior
histories of blood transfusions, injections, raw shellfi-h
ingestion, or contact with a case of hepatitis suggested a
('Continuid t n pau i 20)


Figure 3
CASES OF INFECTIOUS HEPATITIS IN A SCHOOL BY
WEEK OF ONSET LIMESTONE COUNTY, ALABAMA
'I 1 SEPTEMBER 9-DECEMBER 6, 1968


I 1 8 5 1 i 9 6 3
s(t 1 1 0,


i 1


li.iW ; l ,< : 1967 I 19 ;t





Morbidity and Mortality Weekly Report


HEPATITIS (Continued from page 19)


school-centered, common source exposure as the means of
acquisition of infections by these persons.
Preliminary investigation of the school's water supply
and facilities for sewage disposal have revealed some un-
satisfactory conditions which presently implicate the water
as the possible vehicle of infection. Other possible factors


relating to a common source exposure are currently under
investigation.
(Reported by Ira Myers, M.D., State Health Officer, Alabama
State Department of Public Health; Betty W. Vaughn, M.D.,
Tri-County Health Service, Athens, Alabama; and an EIS
Officer.)


CLOSTRIDIUM PERFRINGENS FOOD POISONING -Texas


Following an evening meal, an outbreak of food
poisoning occurred on October 9, 1968, among personnel
stationed at a military base in Texas. Of a total of 900
persons at risk, approximately 500 individuals became ill
with moderately severe abdominal cramps and diarrhea,
mild nausea, and some vomiting. The mean incubation
period was in'. hours with a range of 5-14 hours (Figure
4). Duration of symptoms was approximately 24 hours.
Food histories implicated mushroom gravy as the
vehicle of infection (Table 3). The mushroom gravy was
prepared on the day of the outbreak by three food han-
dlers. The gravy consisted of canned mushrooms and a
butter roux* prepared from flour, butter, salt, pepper,
water, and mushroom juice. The roux and mushrooms were
added to the liquid base 3 hours prior to the meal. After
cooking, the gravy was placed in a 20-gallon vat and kept
warm until serving time. The temperature in the upper part
of the vat was 100( F and 140 F at the bottom. Labora-
tory examination of the foods served at, the meal revealed
contamination with Clostridium perfrinyens serotype PS
66. PS 88, in the salisbury steak** and serotype Hobbs
type 12 in the mushroom gravy. Both serotypes were iso-
lated from the feces of patients.
(Reported by John A. Robinson. M.D., Chief, Epidemi-
ology Division, U.S.A.F. Epidemiologic Laboratory, and
Maurice 0. Messer, Military Public Health Division, a
military base, Texas; and the Anaerobic Bacteriology
Laboratory, Laboratory Program, NCDC.)
*Cooked mixture of flour and fat.
*Sample of steak submitted for laboratory analysis had been
covered with mushroom gravy. Table 3
Table 3


Figure 4
CLOSTRIDIUM PERFRINGENS FOOD POISONING
AT A MILITARY BASE IN TEXAS
oo OCTOBER 8-9, 1968


6 7 8 9 t N 12 I I 2 3 4


OCT 6


HOUR


Summary of Food History Data
Obtained from Personnel at a Military Base, Texas
October 1968


Food or Beverage



Salisbury Steak
Mushroom Gravy
Rissole Potatoes
Whole Grain Corn
Butter
Ice Cream
Straw herry Topping
Milk


Group A
Persons Who Ate Specified Foods


Total


Attack
Rate
Percent


Group B
Persons Who Did Not Eat Specified Foods


Total


Attack
Rate
Percent

92
40
84
76
75
80
78
58


JANUARY 18, 1969


[


5 6
M
oCT 9


7 8 9


"'U\\\`C^^^\\^h\\\^\\ ^UT\\` ^^^^ ^^^T^^ --


%II






JANUARY 18. 1969


Morbidity and Mortality Weekly Report


STAPHYLOCOCCAL FOOD POISONING Waukesha County, Wisconsin


An outbreak of food poisoning occurred on November
10, 196,. in Waukesha County. Wisconsin. among custom-
ers and employees of a food store. Twenty-eight people
were known to harie become ill with s ymlptoms character-
ized 1) \omiting. diarrhea, and severe prostration; of
these, six Individuals required hospitalization andl an
elderl.\ Noman died of acute vascular collapse secondary
to fulminating gastroenteritis. The incubation period was
1 i to ;1 hours.
Food histories implicated baked ham as the vehicle
of infection. The food store had receive d ithe ham fully
cooked from a commercial source. After deboning, the ham
was sliced, glazed with pineapple and syrup, sprinkled
with spices, and placed in a roaster at 120" F awaiting
sale. Cultures of the implicated ham slices. wood block
cutting table, and a nasal swab from the food handler who


had prepared the ham were all positive for Ntaphyoon -'us
aureus phage type 51, 75, 77. Entmcrotoxin group A\ \\a
isolated from the ham sli larly cooki',d, but unopenedl unproi e l -si d harn- %\\r( t' n;ii
tive\ fotr toatgulasi poisitit\t S. ,lmreus. No culure- aere
obtained from t he slicing mac(hi ne.

(Reported by Lyle Fra 'en, I.!).. I)irrfc(or, aiid I II//i i
('. S/rle/r. .S., Itanike.ha t'oi unti fic.iidt Dcpar/m it.
Frank Pauls,. Ph.i.. Assistant P/irce-or. and Ar.Ic, th'/
stad, Vic'robiolo.ist, lfiscon.sin S//a/" .a/ioratory of
gi/ enc. and H. Grant Skinner, M1.I).. /atl Fpl,.lnioK.
Wisconsin Division of fie alth; Laboratory. Food ltl! i'ry/
AssiUociat 's, Ii/'., Iaidison., Iisc' onii; aitim /hr Epid, ;-
ologirtal Ser ices LNib or aory Se tion, E piderniol o!y Pro-
gram, \f')(.)


TRANSFUSION MALARIA Honolulu, Hawaii


On October 17. 1967, a 15-year-old girl in Hawaii
underwent open heart surgery and received se-en units
of whole blood. She was hospitalized again in mid-Decem-
ber 1967 for treatment of a gynecologic abnormality and
received five more units of whole blood. In January 196b,
she began to experience intermittent febrile episodes,
which persisted until mid-April 1968, when Plasmodiumi
malaria parasites were detected on a peripheral blood
smear. She was treated with chloroquine and made an
uneventful recovery. She had never traveled outside the
Hawaiian Islands and had never had malaria previously:
she denied use of shared syringes.
The 12 blood donors were all contacted and inter-
viewed: none gaxe a history of malaria attacks and only
two had ever traveled to malarious areas. Sera were ob-
tained from these two donors in September 196b and ana-
lyzed for the presence of malaria antibodies by the in-
direct fluorescent technique. Only one of the two donors
had a positive serology: the dilution end points in his
serum were 1:4,096 against P. malaria, 1:64 against


P. rii'a.t alnd 1:16 against 1'. falcipaTrum. Those results
indicate that he had a P. malaria infection. This donor
was born in the Philippines in 1911 and emigrated to
Hawaii in 1930. He remained in Hawaii except for a :isit
to the Philippines from December 23, 1966. until Jan-
uary 7, 1967. He denied any history of malaria attack- or
unexplained febrile episodes. He had donated his blood on
October 16, 1967, and it was given to the patient on
October 17. Blood smears were not obtained from this donor
before he was treated with chloroquine and primaquine in
October 1968.

(Reported by Robert Penington. Jr., I1.)., Chief. Epi-
demiology Branch, lHaaii Department of Health.)

Editorial Note:
The responsible donor in this case may hale acquired
his infection during his visit to the Philippines in late
1966. but because P. malaria infections may persist
throughout life. it is also possible that he became infected
prior to his emigration from the Philippines in 1930.


SURVEILLANCE SUMMARY
BOTULISM 1968*


In 1968. nine outbreaks of botulism with 10 cases
including three deaths were reported to the NCDC. In
1967, only three outbreaks involving six cases and one
death occurred. Of the nine outbreaks in 196S, eight were
foodborne and one was a case of wound botulism (MMIVR,
Vol. 17, No. 22). Contaminated vehicles included fish


cured in seal oil and buried underground for 6 months bl
the Eskimos (lMMhR, ol. 17, No. 19). thome-canned
chicken soup causing type B botulism, vegetables, fruit
preserves. improperly cooked hamburger, and commercially
prepared chopped chicken liver causing type A botulism
I(onUinued on page 22)






Morbidity and Mortality Weekly Report


BOTULISM (Continued from page 21)


(MMWR, Vol. 17, No. 48). The incriminated vehicle was
unidentified in two outbreaks.
A total of 21 requests for botulism antitoxin or epi-
demic investigation of suspected outbreaks of botulism
were received by NCDC in 1968. On investigation, 12 of
these outbreaks were found not to be botulism (Table 4).
Of a total of 14 individuals receiving equine Clostridium
botulinum antiserum, two suffered adverse hypersentivity
reactions.


(Reported by the Enteric Diseases Unit, Special Patho-
gens Section, Epidemiology Program, and the Anaerobic
Bacteriology Laboratory, Bacterial Reference Unit,
Laboratory Program, NCDC.)




*Provisional d.ita


Table4
Final Diagnosis of 21 Outbreaks in Which
Botulism Was Initially Suspected 1968

Number of
Final Diagnosis Outbreaks
Outbreaks

Botulism 9
Guillain-BarrT syndrome 3
Carbon monoxide poisoning 2
Ate spoiled food no resultant disease 2
Acute gastroenteritis
Chemical poisoning 1
Probable staphylococcal food poisoning 1
Parasympathetic blockade
of unknown etiology 1
Acute alcoholic intoxication 1
Laboratory accident no resultant disease 1


SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS


CASES OF PRIMARY AND SECONDARY SYPHILIS: By Reporting Areas December 1968 and December 1967 Provisional Data

Cumulative Cumulative
Reporting Area December January December Reporting Area December January Dcmbr
1968 1967 1968 1967 1968 1967 1968 1967
NEW ENGLAND.............. 24 38 341 358 EAST SOUTH CENTRAL........ 88 119 1,344 1,715
Maine................... 5 4 Kentucky................. 4 19 116 181
New Hampshire........... 4 9 Tennessee............... 24 24 317 304
Veront ................ 1 2 1 5 Alabama................ 33 50 541 882
Massachusetts......... 12 22 214 210 Mississippi............. 27 26 370 348
Rhode Island............. 4 32 36
Connecticut............. 6 10 85 94 WEST SOUTH CENTRAL........ 263 256 3,491 3,206
Arkansas................. 6 9 118 129
MIDDLE ATLANTIC.......... 271 305 3,416 3,597 Louisiana................ 54 60 823 675
Upstate New York........ 29 19 332 309 Oklahoma................ 6 5 80 111
New York City.......... 160 160 2,167 2,086 Texas................... 197 182 2,470 2,291
Pa. (Excl. Phila.)...... 17 31 221 265
Philadelphia............ 22 34 239 337 MOUNTAIN................. 54 25 498 566
New Jersey............. 43 61 457 600 Montana.................. 1 3 6 9
Idaho.................... 2 1 5 17
EAST NORTH CENTRAL....... 168 284 2,791 3,261 Wyoming ................. 1 4 13
Ohio................. 33 59 452 637 Colorado................. 1 3 21 60
Indiana................. 21 28 348 202 New Mexico............... 17 6 168 174
Downstate Illinois...... 12 13 208 149 Arizona......... ...... 30 11 246 262
Chicago ................ 57 82 975 989 Utah........... ...... 9 8
Michigan................ 45 102 783 1,258 Nevada................ 3 39 23
Wisconsin............... 25 26
PACIFIC................. 159 106 1,857 1,744
WEST NORTH CENTRAL........ 20 34 386 383 Washington............... 4 4 46 60
Minnesota............... 5 8 56 63 Oregon................... 1 1 40 42
Iowa.................. 5 47 45 California.............. 153 101 1,761 1,631
Missouri .............. 10 16 193 143 Alaska................... 1 3 3
North Dakota............ 5 4 Hawaii................. 7 8
South Dakota ............ 2 2 32 37
Nebraska................ 1 2 23 38 U. S. TOTAL.............. 1.326 .1659 19.093 21.053
Kansas.................. 2 1 30 53 TERRITORIES................. 76 91 113 971
SOUTH ATLANTIC........... 279 492 4,969 6,23 Puerto Rico...... .. 76 90 1,065 934
Delaare............... 8 4 40 71 virgin Islands ........... 1 48 37
aryland.............. 37 43 473 613
District of Columbia.... 49 63 614 800
Vlrginia................ 15 23 293 293
West Virginia............ 1 31 23
North Carolina......... 17 41 538 745 Note: Cumulative Totals include revised and delayed reports
South Carolina........ 29 41 499 777 through previous months.
Georgia................. 59 76 887 968
Florida................ 65 200 1,594 1,933


INTERNATIONAL NOTES
SMALLPOX Burmao


In the Akyah District, Burma, between January 196S
when smallpox wSas introduced from Pakistan, and August
17, a total of Ihl cases with 32 deaths were reported
(Figure 5). Only sporadic cases were reported between


January and April. Then the incidence increased sharply
and reached an epidemic peak in June when 78 cases were
reported (Table 5). Of the 181 cases, 168 (93 percent) were
in children under 15 years of age: 25 cases (14 percent) were


JANUARY 18, 1969









Figure 5
SMALLPOX CASE RATES PER 100,000 POPULATION
IN THE ENDEMIC AREAS OF INDIA AND PAKISTAN
NEAR BURMA 1968


*Area of outbreaks in Burma.


in children under 1 year of age, and the case fatality rate
in this group was 44 percent. For all the cases, the case
fatality rate was 20 percent. All but two persons who died
were examined for vaccination scars and none showed pri-
mary vaccination scars. Of the persons who recovered from
smallpox, 144 were examined for vaccination scars and
only eight had primary vaccination scars.
(Reported by the Smallpox Eradication Program, NCDC.)


Table 5
Smallpox Cases by Month of Onset,
Akyab District, Burma,
January-August 1968

Month of Onset Number of casess

January 15
February 4
March 4
April 23
May 39
June 78
July 14
August 4

Total 181

Editorial Note:
The Akyab District lies at the southwestern tip of
Burma. adjacent to high incidence areas for smallpox in
East Pakistan and near the border of India. Free movement
of the population is known to occur between the Akyab
District and the smallpox endemic areas in East Pakistan.
Burma became free of endemic smallpox o\er 2 years ago.
Smallpox continued to occur in the adjacent areas of East
Pakistan which increased the likelihood that Burma would
become re-infected with smallpox. This epidemic illus-
trates the need for continuing surveillance and contain-
ment programs in countries tiordering endemic areas.
Reference:
'l\orld health Organization iteekly Epidimiologrcal Record,
13(50):650-651.


INFLUENZA 1968 and 1969


Since September 1968, A2/Hong Kong, 68 influenza
activity has been reported from the following countries:
Bermuda (information dated January 4. 1969) During
December many cases of influenza-like illness and 60
confirmed cases of A2 Hong Kong, 68 were reported.
Canada (report received January 20, 1969) Scattered
outbreaks of influenza-like illness were reported in most
parts of Canada. Elevated school and or industrial ab-
senteeism was reported from the provinces of Quebec.
Ontario, and British Columbia. Reported pneumonia-
influenza deaths in Montreal between December 22. 1968,
and January 11, 1969. exceeded the number reported for
the same period last year. A2 Hong Kong 68 influenza
has been documented in all provinces except Newfound-
land, Prince Edward Island, and New Brunswick. Two
influenza B isolations were obtained in Manitoba.
Canal Zone (information dated November 5) Four in-
fluenza isolates were identified as antigenically similar
to A2, Hong Kong 68. and three paired sera had diag-
nostic rises in hemagglutination inhibiting antibody
tigers to A2 Hong Kong 68. Epidemiologic information
on the extent of associated respiratory disease was not
ax ailable.


Federal Republic of Germany (information dated January
8. 1969) From December 21-28. 16 cases of influenza-
like illness occurred in a military unit in Brake on W' ser
(Niedersachsen) following the return of one soldier from
the United States. The disease was reported as clinically
mild. Five strains of a virus antigenically identical to
the A2 Hong Kong 68 \irus were subsequently isolated.
Iceland (information dated December 20) Sporadic in-
fluenza cases associated with a \irus antigenically
similar to A2 Hong Kong. 68 occurred in Reykjaiik, but
as of December 20. no extensive epidemic had occurred.
Japan From September 30-November S. 10 school out-
breaks of influenza were reported in children b-12 years
old. Seven of these outbreaks occurred in the southern
half of the country in the Prefectures of Tokyo. Kana-
gawa, and Osaka and were associated with A2 Hong
Kong 68. The remaining three outbreaks occurred in the
Prefectures of Aomnori and Kanag\\a and were associated
with influenza B.
Netherlands (information dated January :) During Ihe
2 weeks prior to Janu:ar 3. 1969, rapid spread of in-
fluenza occurred in the Netherlands. The di ease xa-
SCintui e ii o n pai 'li'' ,


JANUARY 18, 1969


Morbidity and Mortality Weekly Report







24 Morbidity and Mortality Weekly Report


TABLE II. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JANUARY 18, 1969 AND JANUARY 20, 1968 (3rd WEEK)


ASEPT I ENCEPHALITIS HEPATITIS
?N:1N- BRI'CFI- niliiiRI\ Primary including P~st- MALARIA
AREA 111S LOSI unsp. cases Infi ([iu Serum Infectious
Cum.

UNITED STAIL.... .' I1 1, 6- b i 23 .1 I.'2

NEW ENGLAND............ 1 2 6 53 46 4
Maine............... 2 -
New Hampshire...... 1
Vermont............ -
Massachusetts...... 1 30 13 4
Rhode Island ....... 1 15 8
C nnecticut.......... 1 5 8 23

MIDDLE ATLANTIC...... 4 3 4 33 153 122 2 2
New York City...... 1 2 21 59 51
New York, up-State. 2 1 7 18 24 1 1
New Jersey.*....... 1 3 43 14 1 1
Pennsylvania....... 4 2 33 33 -

EAST NORTH CENTRAL... 4 1 8 3 2 4 166 153 2 5
Ohio................ 4 1 2 58 58 1 1
Indiana............. -8 3 -
Illinois........... 1 2 19 34
Michigan........... 4 3 2 2 53 42 1 4
Wisconsin.......... 1 28 16 -

WEST NORTH CENTRAL... 1 2 45 56 3 3
Minnesota .......... 10 19 -
lowa.............. -- 12 9 -
Missouri........... 1 6 16
North Dakota....... 4 -
South Dakota........ 1 2
Nebraska............. 1 6 2 -
Kansas. .*........... 9 6 3 3

SOUTH ATLANTIC....... 2 3 2 3 3 2 66 69 7 28
Delaware............ 1 -
Maryland........... 2 1 6 14
Dist. of Columbiai. 1 1
Virginia............ 2 1 7 18
West Virginia...... 8 4 -
North Carolina...... 2 5 4 3 19
South Carolina..... 1 1 1 2 6
Georgia............ 14 13 2 3
Florida............. 2 1 2 23 14 -

EAST SOUTH CENTRAL... 1 1 63 63 1 1
Kentucky........... 1 35 29 -
Tennessee.......... 1 15 18 -
Alabama............. 8 9 1 1
Mississippi ........ 5 7 -

WEST SOUTH CENTRAL... 1 1 2 72 69 3 4
Arkansas. .......... 7 2 2 2
Louisiana.......... 24 11 1 2
Oklahoma. ......... 2 6 18 -
Texas.............. I 1 35 38

MOUNTAIN............. .... 1 1 34 27 1 9
Montana............ 4 7 -
Idaho.............. 1 3 9 -
Wyoming............... 1 -
Colorado.*......... 1 1 1 8
New Mexico......... 2 2 1
Arizona............. 6 5 -
Utah................ 19 2 -
Nevada ............- -

PACIFIC.............. 13 6 3 4 38 178 218 12 46
Washington.t ...... 1 7 16 -
Oregon ............. 16 16 1
California.......... 9 6 3 4 38 155 184 12 37
Alaska.*........... 2 -
Hawaii.............. 3 8

Puerto Rico.......... 1 4

*Delayed reports: Brucellosis: Alaska 1(1968)
Diphtheria: Colo. 1(1968)
Encephalitis, primary: D.C. 1(1968)
Hepatitis, serum: N.J. delete 3(1968), Wash. 1(1969)
Hepatitis, infectious: N.J. delete 12(1968), Kans. 5(1968), Okla. 4(1968), Wash. 7(1969)
Malaria: Kans. 1(1968), Ark. 1(1968)






Morbidity and Mortality Weekly Report 25


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITE) STATES

FOR WEEKS ENDED

JANUARY 18, 1969 AND JANUARY 20, 1968 (3rd WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL
AREA Cumulative Cumulative Total Paraiytic
Cumulative Cumulative Toaaayi
__u__ _.


UNITED STATES... 352 821 1,257 87 207 191 2,456 462

NEW ENGLAND........... 8 26 41 7 10 7 368 37
Maine.A........... 2 7 36 2
New Hampshire....... 13 5
Vermont. .......... 7 1
Massachusetts. .... 5 11 18 2 3 3 147 11
Rhode Island....... 1 2 79 -
Connecticut........ 3 13 16 4 5 4 86 18

MIDDLE ATLANTIC...... 93 247 165 9 31 24 96 16
New York City...... 67 145 24 2 3 2 42 9
New York, Up-State. 6 29 106 3 9 1 NN 3
New Jersey........ 8 30 29 3 13 8 54 4
Pennsylvania........ 12 43 6 1 6 13 NN -

EAST NORTH CENTRAL... 47 85 360 16 30 27 748 105
Ohio................ 5 7 65 3 6 8 55 25
Indiana............ 17 26 75 2 2 3 96 16
Illinois ........... 1 6 130 3 5 4 150 8
Michigan........... 8 10 20 7 15 11 94 36
Wisconsin.......... 16 36 70 1 2 1 353 20

WEST NORTH CENTRAL... 11 65 36 8 16 15 212 86
Minnesota. ........ 1 4 1 31 1
Iowa............... 5 12 13 1 157 56
Missouri .......... 39 1 3 7 4 5 21
North Dakota ...... 14 1 8 1
South Dakota...... 2 2 NN -
Nebraska........... 6 14 3 1 2 1 11 -
Kansas A........... 3 3 3 5 -- 7

SOUTH ATLANTIC ....... 101 166 106 21 43 46 127 53
Delaware............ 1 3 20
Maryland............ 8 2 5 1 16 2
Dist. of Columbia.1 1-- --
Virginia ........... 6 24 16 3 3 4 20 3
West Virginia...... 5 16 34 1 2 2 40 16
North Carolina..... 5 2 2 4 8 NN -
South Carolina..... 1 13 2 1 5 8 30 2
Georgia............ 7 10 5 -
Florida........... 89 108 44 4 11 17 21 10

EAST SOUTH CENTRAL... 7 9 33 1 6 6 74 23
Kentucky............ 2 2 4 1 2 2 29 8
Tennessee.......... 2 15 4 4 33 14
Alabama............ 11 6 -
Mississippi........ 5 5 3 6 1

WEST SOUTH CENTRAL... 60 144 241 5 20 40 225 34
Arkansas........... 1
Louisiana.......... 1 3 8 9
Oklahoma........... 1 34 1 10 3
Texas............... 60 143 206 2 11 20 225 31

MOUNTAIN............ 7 31 52 2 10 2 221 37
Montana ............ 1 1 53 -
Idaho.............. 6 1 2 27 -- 5
Wyoming............ 13 -
Colorado............ 2 2 15 39 20
New Mexico......... 1 8 6 2 64 2
Arizona.*........... 4 21 11 1 3 1 35 9
Utah............... 1 3
Nevada.............. 2 1

PACIFIC............. 18 48 223 18 41 24 385 71
Washington ......... 2 66 1 2 2 107 25
Oregon............. 8 17 58 1 1 1 18 8
California......... 10 28 87 16 36 21 257 34
Alaska ............ 1 1
Hawaii ............. 12 2 2 -- 4


Puerto Rico.......... 7 20 9 1

*Delayed reports: Measles: Me. 2(1969), Vt. 1(1968), Mass. delete 2(1968), N.Y.Ups. 16(1968), Minn. delete 9(1969), Ariz. 3(1969)
Meningococcal infections: N.J. 1(1969), D.C. 2(1968), Okla. 1(1968)
Mumps: Me. 12(1969), N.J. 17(1968), Kans. 2(1968), D.C. 6(1968), Ariz. 31(1969), Wash. 135(1969)
Rubella: Me. 1(1969), N.J. 1(1968), Kans. 1(1968), Wash. 19(1969)







26 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JANUARY 18, 1969 AND JANUARY 20, 1968 (3rd WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TUAREMIA TYPHOID TICK-BORNE RABIES IN
AREA SCARLET FEVER FEVER (Rky. Mt. Spotted) ANIMALS
Cum. Cum. Cum. Cum. Cum.
1969 1969 1969 1969 1969 1969 1969 1969 1969 1969 1969
UNITED STATES... 10,514 2 5 5 3 12 1 52 135

NEW ENGLAND........... 1,419 1 1
Maine.*.............. 37 1 1
New Hampshire?..... 41 -
Vermont ............ -
Massachusetts...... 194 -
Rhode Island....... 85 -
Connecticut........ 1,061 -

MIDDLE ATLANTIC...... 359 1 2 1
New York City...... 15 1 1
New York, Up-State. 331 I 1
New Jersey......... NN -
Pennsylvania...... 13 -

EAST NORTH CENTRAL... 914 1 2 3 6
Ohio............... 271 1
Indiana............. 205 3 3
Illinois........... 148 1 1 1
Michigan........... 181 1 -
Wisconsin .......... 109 1

WEST NORTH CENTRAL... 402 1 9 17
Minnesota.*......... 41 1 3
Iowa................ 170 4 7
Missouri........... 1 3 6
North Dakota....... 76 -
South Dakota....... 24 -
Nebraska ........... 9 -
Kansas.*............ 82 1 1

SOUTH ATLANTIC....... 932 1 1 1 1 2 18 46
Delaware ........... 21 -
Maryland ........... 192 -
Dist. of Columbia* 1 1- -
Virginia.......... 187 13 31
West Virginia ...... 153 1 2 6
North Carolina..... 14 1 1 -
South Carolina..... 140 -
Georgia............. 17 1 3
Florida............ 207 2 6

EAST SOUTH CENTRAL... 1,499 2 1 1 8 27
Kentucky.......... 140 7 18
Tennessee.......... 1,213 2 1 1 6
Alabama ........... 8 1 3
Mississippi ........ 138 -

WEST SOUTH CENTRAL... 935 3 5 18
Arkansas*.......... 11 3 1
Louisiana.......... 2 -- 3
Oklahoma............ 79 -
Texas.............. 843 5 14

MOUNTAIN............. 2,595 1 1 2 1 9
Montana ............ 37 -
Idaho. ...... ....... 156 -
Wyoming............. 619 1 3
Colorado.*.......... 1,359 -
New Mexico......... 202 1 3
Arizond............. 94 -
Utah................ 128 -
Nevada............. 1 1 3

PACIFIC.............. 1,459 2 2 7 10
Washington.*........ 553 -
Oregon ............. 85 -
California ......... 752 2 2 7 10
Alaska ............. 5 -
Hawaii ............ 64 -

Puerto Rico.......... 3 1 1
*Delayed reports: SST: Me. 5(1969), N.H. 21(1968 22(1969), Kans. 92(1968), D.C. 3(1968), Ariz. 11(1969), Wash. 639(1969)
Typhoid fever: Ala. delete 1(1968), Colo. 1(1969)
Rabies in animals: Minn. 1(1968), Ark. 1(1968)








Morbidity and Mortality Weekly Report 27






Week No. TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED JANUARY 18, 1969
3
(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 year
Ages and over Influenza All Ages and over Influenza All
All Ages Causes All Ages Causes


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

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

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

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


924
344
56
35
37
61
32
26
45
37
77
13
61
37
63

3,984
51
45
176
53
24
58
79
103
1,876
40
680
249
60
153
31
49
84
89
44
40

3,323
84
34
907
222
256
143
100
402
61
68
73
49
73
190
60
183
57
41
53
149
118

1,103
90
40
54
166
33
150
88
326
75
81


568
192
36
23
27
36
22
18
27
20
51
11
37
19
49

2,330
24
29
108
33
16
34
53
64
1,081
20
391
127
47
104
20
30
45
45
31
28

1,873
53
19
471
124
135
77
62
245
39
35
41
24
44
111
25
113
33
26
32
98
66

670
54
27
29
108
24
94
54
184
49
47


*Estimate based on average percent of divisional total.


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.-----------
Montgo ery, 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.----------


1,537
102
320
69
84
135
83
131
68
104
90
288
63

882
141
67
74
178
201
52
56
113

1,576
55
43
36
187
69
96
323
94
225
97
168
92
91

575
54
32
132
21
148
36
71
81

2,535
23
69
60
51
127
919
130
36
241
86
181
249
80
152
73
58


796
48
158
33
53
66
47
67
28
85
48
129
34

479
70
35
51
106
112
19
35
51

805
31
22
24
90
34
57
119
48
107
57
103
58
55

348
24
16
82
15
86
28
46
51

1,554
13
43
43
26
69
569
69
31
150
58
98
150
51
94
50
40


2
5
4
11
2
1
7
19
5

20
4
3
1
1
4
5

2

139
4
5
5
14
6
5
67
5
11
1
6
5
5

30
2
5
5
1
11
2
2
2

102

5
3
4
3
39
14

12
1
6
7
1
4
2
1


Total 16,439 9,423 11,436 773


Cumulative Totals
including reported corrections for


previous weeks


All Causes, All Ages ------------------------- 50,979
All Causes, Age 65 and over------------------- 29,377
Pneumonia and Influenza, All Ages------------- 4,648
All Causes, Under 1 Year of Age--------------- 2,204







Morbidity and Mortality Weekly Report


INFLUENZA continued d from paye 23)


reported as clinically mild although some deaths had
occurred. All isolated irus strains were antigenically
similar to A2. Hong Kong. 68.
Romania (information dated December 20) Sporadic
cases of influenza-like disease occurred in Bucharest in
November and December 1968. Two strains of a virus
antigenically similar to A2, Hong Kong,'68 were isolated.
Spain During the first week of January. 125 cases of
clinical influenza occurred at a Naval Base in Rota,
Spain. Approximately 30 percent of these patients had
received polyvalent vaccine in October. Laboratory docu-
mentation is pending.

Sweden (information dated December 22, 1968, and Jan-
uary 7, 1969) Scattered cases and small clusters of
influenza-like disease have been reported from central
and western Sweden. Most of the cases occurred in per-
sons or close contacts of people going to Sweden by
flights from the United States. Throat washings from
patients in Gothenburg and the provinces of Dalarna,
Smiland, and Viistmanland have yielded 13 A2/Hong
Kong/68-like isolates.
Thailand (information dated November 1) Since Sep-
tember 1968, 1,682 cases of influenza-like disease in-
volving all age groups were recorded in hospitals and
health centers in Bangkok and Thonburi. As of Nov-
ember 1, 23 strains of A2 influenza virus had been iso-
lated: all 23 were antigenically similar to A2/Hong
Kong/68.

United Kingdom (information dated January 4) Sporadic
influenza cases associated with a virus antigenically
similar to A2/Hong Kong/68 were reported from several
areas in England. Of the 21 strains of the virus isolated,
15 were from people who had returned from the United
States.
On December 21, a localized outbreak of influenza-
like disease occurred in a boy's school in Oxford. Five
strains of an A2,'Hong Kong,68-like virus were isolated.


(Compiled from WHO Epidemiological Record, Vol. 43,
Nos. 44-48, and 51/52 and Vol. 44, No. 2 or reported by
the Virus Unit, WHO Influenza Program, Geneva; S.E.
Acres. Epidemiology Division, Department of National
Health and Welfare, Canada; Dr. S.M. Frazer, Chief,
Medical Officer, Pan American Sanitary Bureau; and
Dr. Stephen Kendra, Head, Communicable Disease Branch,
Prerentice Medical Division, Bureau of Medicine and
Surgery, Navy Department, Washington, D.C.)


JANUARY 18. 1969


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION OF 17,000 IS PUBLISHED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER, ATLANTA, GEORGIA.
DIRECTOR. NATIONAL COMMUNICABLE DISEASE CENTER
DAVID J. SENCER. M.D.
CHIEF, EPIDEMIOLOGY PROGRAM A. D. LANGMUIR, M.D.
CHIEF, STATISTICS SECTION IDA L. SHERMAN. M.S.
EDITOR MICHAEL B. GREGG, M.D.
MANAGING EDITOR PRISCILLA B. HOLMAN

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY, THE NATIONAL COMMUNICABLE DISEASE
CENTER WELCOMES ACCOUNTS OF INTERESTING OUTBREAKS OR CASE
INVESTIGATIONS WHICH ARE OF CURRENT INTEREST TO HEALTH
OFFICIALS AND WHICH ARE DIRECTLY RELATED TO THE CONTROL
OF COMMUNICABLE DISEASES. SUCH COMMUNICATIONS SHOULD' BE
ADDRESSED TO:
NATIONAL COMMUNICABLE DISEASE CENTER
ATLANTA, GEORGIA 30333
ATTN: THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT
NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO THE NCDC BY THE INDIVIDUAL
STATE HEALTH DEPARTMENTS. THE REPORTING WEEK CONCLUDES
AT CLOSE OF BUSINESS ON FRIDAY; COMPILED DATA ON A NATIONAL
BASIS ARE OFFICIALLY RELEASED TO THE PUBLIC ON THE SUCCEED-
ING FRIDAY.


O-qj
< -o



g PIm
oi ID
Fr o
00


1
0 0
('.4 Q
W
>l


m



n "
o r

cI mc -
az w >m
z r m r m



> n m

Sr 3 m zM
m 3mzn
0, Z 4 X

m



-4
0


77 -I







; 73 EPOSiTORy