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:
AA00010654:00171

Related Items

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


This item is only available as the following downloads:


Full Text



NATIONAL COMMUNICABLE DISEASE CENTER


Vol. 18, No. 18

WEEKLY

REPORT

For
Week Ending
May 3, 1969


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE / PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION
DATE OF RELEASE: MAY 9, 1969 ATLANTA, GEORGIA 30333


EPIDEMIOLOGIC NOTES AND REPORTS
SUSPECT HUMAN RABIES-San Diego County, California
On April 1, 1969, a 2%1-year-old boy from Lakeside,
San Diego County, California, received deep bites on the
lower extremity and suboccipital area of the head in an
unprovoked attack by a bobcat. The animal was killed
and central nervous system tissue was positive for rabies
virus by both direct microscopic and fluorescent anti-
body examination. On the day he was bitten, the boy was
started on post-exposure prophylaxis treatment with
duck embryo vaccine. He received 2 doses per day for
7 days, single daily doses on 7 subsequent days, and a
booster dose on the 21st and 31st days. Rabies hyper-
immune serum was not administered.
On April 18, the boy developed an illness charac-
terized initially by fever and periods of lethargy. On


I ,, i ... ,..1 Ieport 4 .
Suspect II )bes Sa Diego Ca liforni. .1 9
An Outhrl cute Gastroenteri i '..''.

.. ,', L .. ... I.iN
,, .,.. t .,, .. 1967. 5 1
*I rcul" 53
Current Tre /
Measles tates .I .154




April 24, he was admitted to a hospital where he was
alert, but had flaccid paralysis of both lower extremities.
A white blood cell count that day was 13,200 with 65 per-
cent polymorphonuclears, 24 percent lymphocytes, and
(Continued on page 150)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
18th WEEK ENDED CUMULATIVE. FIRST 18 WEEKS
MEDIAN
DISEASE May 3, May 4, 1964 1968 MEDIAN
1969 1968 1969 1968 1964- 1968
Aseptic meningitis ...................... 24 35 32 514 519 504
Brucellosis ............................ 3 3 37 49 72
Diphtheria.............................. 4 1 48 65 65
Encephalitis, primary:
Arthropod-borne & unspecified .......... 21 12 24 353 278 439
Encephalitis, post-infectious ............. 9 30 19 96 187 282
Hepatitis, serum ....................... 112 78 755 1.823 1.344 14,
Hepatitis, infectious .................... 885 796 16.586 15,038
Malaria .............. ............... .. 36 36 9 834 762 100
Measles(rubeola) ....................... 949 706 8.257 11.549 12,018 134.318
Meningococcal infections, total ........... 77 61 61 1.573 1.314 1.314
Civilian .............................. 69 55 -- 1.428 1,185 -
Military ............................... 8 6 145 129 -
Mumps ................................... 2.457 4.905 44.308 89,654 -
Poliomyelitis, total ..................... 3 1 1 18 7
Paralytic ....................... ... 3 1 I 18 6
Rubella (German measles) ............... 2.511 2.522 26.350 25.875 -
Streptococcal sore throat & scarlet fever.... 10.281 8.499 8,822 203.921 199.008 199.008
Tetanus ............................... 1 1 2 35 36 54
Tularemia ............................ .. 1 3 2 31 25 52
Typhoid fever .......................... 12 7 7 83 85 110
Typhus, tick-borne (Rky. Mt. spotted fever) 5 3 1 10 11 11
Rabies in animals ....................... 80 198 98 1.413 1.385 1.611

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: N.J.-l ..................................... 1 Rabies in man: ................... ...... ......... -
Botulism: ......................................... 9 Rubella congenital syndrome:Minn.-1 ........ ........... 5
Leptospirosis: ........................ ............. 14 Trichinosis: N.J.-2, N.Y. Ups.-1 ....................... 31
Plague: .......................................... Typhus, marine: ..................................... 5
Psittacosis: Conn.-l ................................ 10






Morbidity and Mortality Weekly Report


SUSPECT HUMAN RABIES


9 percent monocytes. Cerebrospinal fluid contained 251
leukocytes with 131 polymorphonuclears and 120 mono-
nuclears. The protein was 70 mg percent. Over the next
2 days, progression of paralysis occurred with involve-
ment of the upper extremities. Deep tendon reflexes were
reduced during this period. At no time was there diffi-
culty in ingesting liquids or solid foods. Sensory changes
did not occur and he remained alert. On April 26 and 27,
he developed stupor and then coma. Four days later,
spontaneous respirations ceased. As of May 7, he was
comatose and areflexic and his breathing was maintained
by a respirator.
An indirect fluorescent antibody titer and tissue
culture neutralization liter on serum obtained on April 25
were 1:64 and 1:32, respectively, for rabies. Viral cul-
tures of saliva, stool, urine, cerebrospinal fluid, and
endotracheal washings are in progress.
The bov's home is located on a family chicken farm


(Continued from front page)


in a small community about 20 miles north of the Mexican
border. This area is on the periphery of a region wherd
an epizootic of rabies was recognized in 1966. In that
year, 63 rabid animals were identified by the San Diego
County health authorities; in 1967, 34; and in 1968, 11.
Between 1966 and July 1968, 6,563 animals were trapped
in a program to decrease animal populations. In the first
4 months of 1969, two bobcats and one coyote were found
to be rabid.
(Reported by James Chin, M.D., Head, Epidemiology
and Richard Emmons, M.D., Public Health Medical Offi-
cer, Bureau of Communicable Diseases, California Depart-
ment of Public Health;J.B. Askew, M.D., Health Director,
and Donald Ramra,. M.D., Assistant Health Director, San
Diego County Health Department: V. Robert Allen, M.D.,
Attending Pediatrician, and Edwin Protas, M.D., Pediatric
Resident, University Hospital of San Diego County; and
an EIS Officer.)


AN OUTBREAK OF ACUTE GASTROENTERITIS DURING
A TOUR OF THE ORIENT Alaska


At 3:30 a.m. on May 4, 1969. an international flight
en route from Tokyo to Seattle, Xashington, made an emer-
gency landing at Anchorage. Alaska. after 21 of 42 elderly
person' returning to the IUnited States from a tour of the
Orient developed gastroenteritis. During the 15 hours be-
fore the onset of symptoms, the tour group had traveled
from Bangkok to Tokyo on another airline \with an over-
nigiht stop in Hong Kong. On that flight dinner was served
before the slop in Hong Kong, and breakfast after the stop.
10 and 4 hours, respectivelx, before the outbreak. Retro-
spectitely. illne-- \wa- noted during the stopover in Hong
Kong when at least two persons developed lower abdomi-
nal cramping and diarrhea. within n 2 hours after departure
from Hong Kong for Tokyo, additional persons developed
-imilar -vymptons. The remainder of the ill tourists noted
on0et of s.unptom-, shortly] after embarking for the United
Slates from Tokyo. Nausea and vomiting were also re-
ported, hut fever. chills, and bloody diarrhea were not.


One of the ill tourists, a 71-year-old woman, died 2
hours after the plane departed from Tokyo. Postmortem
examination revealed no gross lesions within the stomach.
large or small intestines. Another ill person was admitted
to the Anchorage hospital and made a gradual recovery
during the next 36 hours. The other 19 persons became
asymplomatic within 12 hours after the onset of symptoms.
Food histories and bacteriologic cultures are now
being processed. Initial epidemiologic studies suggest a
foodlorne outbreak, hut the exact meal and etiology have
not been determined.

(Reported by Donald K. Freedman, M.D., Director. Diei-
sion of Public Health. Alaska Department of Health anl
IWelfare: Byron J. Francis. 41... Il.P.Hl.. Chief. Division
of Epidemiology, I ashington State Department of Health;
the Foreign Quarantine Program, N(CDC, and a team of
EIS Officers.)


MAY 3, 1969







Morbidity and Mortality Weekly Report


SURVEILLANCE SUMMARY
DIPHTHERIA United States 1967


A total of 219 diphtheria cases and 1i1 carriers were
reported to the N(DC in 1967. Surveillance reports were
received on 214 of these cases. For 1967, the diphtheria
incidence and mortality rates and case fatality ratio re-
mained relatively constant compared with 1965 and 1966
(Table 1) (Figure 1). In 1966 and 1967, the incidence of
diphtheria in the South increased, while incidence rates
for the North and West continued to decline slightly. The
highest attack rates were 1.50 in Louisiana, 0.62 in Ala-
bama, and 0.60 in Texas. Attack rates in the other states
were 0.30 or less, and 24 states reported no cases. Diph-
theria continued to be most prevalent in the autumn: 115
of 203 cases (56.7 percent) with known dates of onset
occurred in September, October, and November. The next
highest number of cases occurred in December and Jan-
uary. Seasonal variation was present in the South but
could not be reliably appraised for the North and West,
because of the small number of cases.
The age distribution for the diphtheria cases and
deaths was not significantly different from age distribu-
tions for the years 1959-1966. In 1967, 82 percent of cases
were in persons under 15 years of age and 61 percent of






Table 1
Diphtheria Morbidity and Mortality in the United States
for Selected Year, 1933-1967


Rates per 100,000
Year Cases Deaths Population Case Fatality
Incidence Mortality

*1933 50,462 4.937 40.1 3.9 9.8
1940 15,536 1.457 11.8 1.1 9.4
1950 5,796 410 3.8 .3 7.1
1960 918 69 .51 .04 7.5
1961 617 68 .34 .04 11.0
1962 444 41 .24 .02 9.2
1963 314 45 .17 .02 14.3
1964 293 42 .15 .02 14.3
1965 164 18 .08 .01 11.0
1966 209 20 .11 .01 9.6
1967 219 25 .11 .01 11.4
Sources of Data:
1. Cases Annual Summaries. Notifiable D)iease Natonal Office of
Vital Statistics (NOVS) and NCI C
2. Deaths 1933-1961 National Summnaries, NOV 162-1966 Vital
Statistics of the I'nited States NCHS; 1967, Prelimln;at Data,
based on surveillance reports to Special Pathogens Section. NCDC.
*Based on population data from the Bureau of C rnsus P population Esti-
mates; 1933 and 1940, S-ries P-25, No. 139, 1950, S, ter P-25, No. 165;
1960-1962, Series P-25, No. 259; 1963, Seres P-25. No 7. 27. 1964-19h6,
Series P-25. No. 369; 1967, Series P-25. No. 30.
"*The first year of complete registration


Figure 1
DIPHTHERIA REPORTED ANNUAL INCIDENCE
AND MORTALITY RATES, AND CASE FATALITY RATIO
UNITED STATES, 1920-1967


C.SE FATALITY RATIO-
CSE -FATALITI RuTIO


1920 1930 1940 1950
YEAR


t960 1970


patients were under 10. Of the 211 cases. 117 occurred in
nonwhites or 10 times the rate for whites (0.57 antd .06.
respectively); 54 percent of all ca-.c- xere in female-.
The incidence rates for all age groups and both sexes
were uniformly higher for nontwihites than for w whites.
When cases were classified as to clinical severit of
disease. 4 percent ere mi, percenitt moderate, 10
percent scexore, and 14 percent fatal (Table 2). mnmuniza-
tion histories were available for 179 cases. There were no
deaths among persons \\ho had completed a prinmar i mmu-
nization series. The case fatality ratios for those with
inadequate or no immunization wire, comparable (Table 3).
Diphtheria was confirmed by culture in 15' of ihe 214
cases. but only 95 isolates wIre t\pedl: 76 percent w.ere
mitis type, and Is percent of patients \\ith fmitis t\pe

(f'ontdinuid on paigy 152)


MAY 3, 1969


r r Tll


o r roRoIo






Morbidity and Mortality Weekly Report



DIPHTHERIA (Continued from page 151)


organism- died (Tahle 4): 12 percent \ere uratis strain-
and included one death. No deaths \\ere reported in pa-
tient- with intermediu- and indeterminate type organisms.
For the years 19.9-1967. miti- strain- accounted for 796
(.9 percent) and pra\ i -train- for 333 (24 percent) of the
1.147 riped i-olate-. For the 9-year period. nitis strains
of 1('ur'1b,' : rii dipl: eri~ct accounted for the majority
of isolnae- in the Norlh and the southh (63 and 76 percent.
respecri\ el]): in the \Ht- grai'i -traint awere isolated
much more freqiuenti and x er ro-pon ihle for the majority
of ca-e- (6' percent).
In 1967. 45 percent of tie graii- i olates t kere toxi-
eenic. conicurrin nrith 196i.) (. percent) and 1966 (44 per-
cent) iMhroa- during 19)'9-19;4. 96 percent of gra\is
-train- \\ ere to ilenic t\\ ib no ni ficant \ earl\ differences.
Sur\millane daita on the 1,1 reported diphtheria car-
rier- -hovI" id ith ari ditribulion of carrier- to he co m-
parablte tith that of cae-e: 131 of the carrier-- 'ere non-
'white- and 107 wer It fe:ale-. \ppro\imately one-third of
the carrier- \ere full\ in: iuniized. Pret-umahl\ most car-
rier- bere dotecedi during culture -ur'\e- of contact- of
clinical case-. Tom\i enicin of i-olates fromI !I of the
1,1 carrier- ,ta- -oa-ured and 6;1 percent were nontoxi-
Oenic coir'parted ih 10.' percent nonto\iaenic i-olate-
from case<.





Table 2
Diphtheria Cases by Toxigenicity and Clinical Severity'
United States, 1959-1967


L; ... ...p\-'-To, I
\. I !* P \7 1 I P r<72 t ,(
- -, .- ii.

,, -.1 t
I: I1 I


Table 3
Diphtheria Cases by Immunization Status-
United States, 1967

1 1 1 1 Case
Reported Immunization Statut s F. ....
_____ "_ -_ '* _. ,i .
F LL PrimarN -erie- plus
boo-ser within 4 tears 20 11. 2 0 -
LAPSED Primir,, -eri- but no
booster ithhn past
4 ear-. 14 7 0 i -
INADEQL 'TE Uncompleted primary I
sepns 26 14.5 4 15.4
NONE 119 66.5 17 14.3
Total 19 i I0. 1 1.7
.C ii t -it- .r iT Ime

i aunirction Status









Table 4
Diphtheria Cases and Deaths by
Corynebocterium diphtheriae Type
United States, 1967*

Number of Ca-es
Kno'n Urknoin Number of Ca-e Fatalh Ratio"
Outcome Outcome De

Gra 9 12 I 1.
Inlore.dl l 9 0 O ----
IndetP r, roae -1 -...
Total-0 1 12 5.0



(Repritd by Mc Spec '. Patog es Section. Bacterial
ID'citex Brann., and Sta:ist is SeCFi o. Epidemiology
Program. :7ii Iipi L ria Laboratory. Bacteria! Immunology
t 1i, L2 boratry Pirinsion. \ CDC.'


N oIf i, I Or r fr M h: h !

B 7. h, PC1mmunh1, k Di.-'I ,'.a- (I ,n-fr

B,1 'r:;tt li.-.-.^f Branch. }-ip[id.-m:.r ,>g Pruer.m


MAY 3, 1969







Morbidity and Mortality Weekly Report


PREVENTIVE TREATMENT FOR TUBERCULOUS INFECTION

Recommendations of the National Communicable Disease Center


Most active tuberculosis in the United States today
occurs among persons who were infected with fyrcobac-
terium tuberculosis many years ago.
Because these persons, who are positive tuberculin
reactors, comprise the reservoir of future tuberculosis in
this country, special priority on presenting this progres-
sion from latent to active disease should be an essential
element in modern tuberculosis control programs.
Research conducted during the past decade has estab-
lished that treatment with isoniazid can greatly reduce the
risk of active tuberculosis developing among tuberculin
reactors.
Today, the U.S. Public Health Service, the American
Thoracic Society, and the National Tuberculosis and
Respiratory Disease Association, recommend isoniazid for
persons identified as haring tuberculous infection.

Priority Candidates for Preventive Treatment
While all infected persons may benefit from preven-
tive treatment, priority effort should be made to identify
and treat individuals in the following groups:

1. Positive tuberculin reactors with "pulmonary
fibrosis" or old fibrotic lesions presumably tuberculous in
origin, former tuberculosis patients who have never had
specific chemotherapy or who have had inadequate drug
therapy (e.g., treatment for less than 18 months, no iso-
niazid, etc.). At particularly high risk are persons with
pulmonary lesions of unknown etiology, compatible with
tuberculosis, in which active disease has been excluded.

2. Members of the household of a newly diagnosed
case of tuberculosis, regardless of tuberculin status. Pre-
ventive treatment for these household contacts should
continue for a full year. even when exposure to the infec-
tious case has ended and tuberculin tests remain negative.
Preventive treatment of negative reactors should also be
given other persons who have had close, extended ex-
posure comparable to that of a person living in the same
household with an active case.

3. Persons known to have recently become infec-
ted, i.e., converted from negative to positive tuberculin
reaction.

4. Children who are reactors through the age of
adolescence.

5. School personnel and other adult reactors closely
associated with children.


6. Tuberculin reactors in certain clinical situatiin-
known to lessen their resistance to disea-e: prolonged
corticosteroid treatment, gastrectomy, leukemia. silcosi-,
Ilodgkins' disease, pneunioconiosis, severe or poorly
controlled diabetes, pregnancy, and children Nwith rmiash-l
or whooping cough. In the case of pregnant women. treat-
ment should be started in the last trimestrr.


Isoniazid for Preventive Treatment
A single drug, isoniazid. is generally used for treat-
ment of infection in a dosage of 300 mg. per day for adults
and 10 mg. per kilogram body weight for children not to
exceed 300 mg. per day, to be administered daily for a
period of 12 months.


Effectiveness of Isoniazid
Public Health Service trials that started in 1953
among high risk groups such as infected children, house-
hold contacts of an active case, and persons with fihrotic
lesions in their lungs, have shown a continued reduction
in subsequent cases of tuberculosis ranging from .5 to
b5 percent after one year of isoniazid. These reductions
tend to minimize the effectiveness of isoniazid since some
individuals in the groups studied failed to take the medi-
cation daily.



Interpretation of Tuberculin Tests

Positive Reaction = 10 mm or more of induration
A reaction of 10 mm or more induration to the Mantoux
test. using 5 TU of PPD, represents infection with Vyco-
bacterium tuberculosis. No confirmation test necessary.


"Doubtful" Reaction = 5 mm through 9 mm of induration
Reactions within this range can result from infection
with any one of a number of mycobacteria. including
M. tuberculosis. Clarification may be obtained either by
repeating the test with PPD-tuberculin at a different site
or by simultaneous testing with PPD-tuberculin and
another mycobacterial PPD, if available.



Negative Reaction = 0 mm through 4 mm of induration
No repeat test necessary unless there is other sug-
gestive clinical evidence of tuberculosis.


MAY 3, 1969







154


For the first 28 weeks of Measles Epidemiologic
Year 1968-69*, 12,088 cases of measles were reported to
the NCDC. This is 84 percent of the total cases reported
for the first 28 weeks of the preceding epidemiologic year
(1967-68) and is 51 percent of all cases reported for that
entire epidemiologic year (Figure 2).
During the first 16 weeks of 1969, 9,615 cases of
measles were reported. This is 92 percent and 26 percent
of the cases reported for the comparable periods in 1968
and 1967, respectively. Of the nine U.S. geographic divi-
sions. five showed a continuous increase in reported
cases for each successive 4-week period (Table 5). In
two of the four remaining divisions, increases were noted

*The epidemiologic year for measles begins with week number
41 of the calendar 'ear and ends with week 40 of the suc-
ceeding year.


48,000

44,000-


40,000-

o:
36,000-


32,000-

28,000.


24,000-

20.000-

16,000-

S12.000-

8,000

4,000-

0


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


in the first 12 weeks, with a decrease noted in the last
4-week period. For the entire 16 weeks, four of the nine
divisions and 18 states reported increases in measles
cases for this period in 1969 compared with the same
period last year. One of these four divisions, the Middle
Atlantic, more than doubled the reported cases this year
compared with last year: this division also reported an
increase in 1968 over its 1967 total for the comparable
period. New York City accounted for the majority of this
increase. No other division recorded an increase in
measles cases for these 2 successive years; however,
Connecticut also recorded increases for these 2 years.



(Reported by the Field Services Branch, and Statistics
Section, Epidemiology Program, NCDC.)


15 13 10 7 5
JUN JUL AUG SEP OCT


Morbidity and Mortality Weekly Report



CURRENT TRENDS
MEASLES United States


MAY 3, 1969


Figure 2
REPORTED MEASLES BY 4-WEEK PERIOD, USA, EPIDEMIOLOGIC YEAR 1968-69,
COMPARED WITH 1964-65 THROUGH 1967-68.



REPORTED CASES OF MEASLES BY 4-WEEK
PERIOD, USA, EPIDEMIOLOGIC YEAR 1968-69
-- \ COMPARED WITH 1966-67 AND 1967-68

/ \964-65















;I'
I.
/ 11965-66














S966-67
I/ 1


./6 /- -- -- '

.. .. .. -/' 9 -,88 = ..\ ._







Morbidity and Mortality Weekly Report



Table 5
Reported Cases of Measles, by Geographic Division, United States
First 16 Weeks1969 and Comparable Periods, 1967 and 1968


Total I 1969 1968
Number Cases Per 16 Weeks Comparable Decrease Decrease
4-Week Period Ended* Dec. 31, 16 Weeks Total (Increase) (Increase)
1968 From From
DIVISION through
Jan. 25, Feb. 22, Mar. 22, Apr. 19, Apr. 19,
1969 1969 1969 1969 1969 1968 1967 1968 1967


UNITED STATES
NEW ENGLAND
Main n
New Hampshire
\ Vermont
Massacihu stt
Rhode Island
Connecticut
MIDDLE ATLANTIC
New York City
New York, Upstate
New Jersey
Penns !v atni a
EAST NORTH CENTRAL
Ohio
Indiana
Illinois
Michikan
W isconsi n
WEST NORTH CENTRAL
Minnesota
I ow a
Missouri
North Dakota
South Dakota
Nebraska
Kansas
SOUTH ATLANTIC
Delaware
Maryland
District of Columbia
Virginia
Vest Virginia
North Carolina
South Carolina
Georgia
Florida
EAST SOUTH CENTRAL
Kentucky
Tennessee
Alabama
Mississippi
WEST SOUTH CENTRAL
Arkansas
Louisiana
Oklahoma
Texas
MOUNTAIN
Montana
Idaho
Wyoming
Colorado
New Mexico
Arizona
Utlah
Nevada
PACIFIC
Washington
Oregon
Cali fornia
Alaska
Hawaii


2,008
109

28


1,131
30
2


4


9,615
489
2
160
2
7s
9
238
3,205
2,225
337
:117
326
1,023
116
301
180
105
321
295


176
14
6


2,659 3,817
107 243

31 100
1 1
14 42
6
61 94
812 1,503
568 1,078
0s 164
109 117
55 144
353 333
36 41
121 108
75 44
35 27
86 1 13
113 104

64 71
10 3
3 1

36 29

401 484
19 Ii
6 2

212 205
58 44
49 44
8 24
1 -
48 54
16 5
10 3
5 2

1
633 798
1
7 63
3 1
623 733
78 103
1 1
29 7

9 5
26 59
12 31
1 -

146 244
17 12
7 84
116 144


810
(87)
I1
(10:3)
(1)
67
(53)
(5:1)
(1,668)
(1,775)
122
(51)
(264)
1,323
73
71
783
41
355
(68)
6
(135)
49
71
4
(71)
8
(616)
(126)
38
6
(434)


23
349
213
36
51
19
107
121
26
9
13
47
34

14



20

233
1



1
62

5
13

130
19
6
3

to
10
265


1
264
31



5
9
16


MAY 3, 1969


95

1,492
133
13

595
145
129
72
1
404
49
21
13

15
2,267
3
71
105
2,058
237
4
36

20
107
68


10.425 37,359
402 408
13 Ss
57 169
1 21
145 159
I 27
S15 44
1,537 1,209
450 200
759 286
266 25S7
62 436
2,346 2,908
189 490
372 341
963 461
146 607
676 1,009
227 1,670
7 84
4 38s
63 117
77 626
4 42
27 41;3
8 -
876 4,285
7 27
51 75
6 11
161 1,346
149 748
220 728
10 27S
3 23
269 1.049
260 3,754
71 1,026
45 1.263
45 884
99 581
2,756 13,157
1,323
1 85
101 3,232
2,654 8,517
491 2,713
55 184
11 295
42 20
219 703
48 414
108 628
3 234
5 235
1,530 7,255
381 3.516
321 916
800 2,650
96
28 77


30 58 48 117 r 253 r 209 049 T


Puerto Rico 1 30 58 48 1 17 253: 209 1 249 (44) 1,040
*Includes visions through April 19, 1969.


26,934
6
75
12
20
14
26
(141)
(328)
(250)
(473)
21
374
562
301
(31)
(502)
46 1
333
1,443
77
3:47
54
549
38

(s)
3,409
20
21

1,185
599
505
268
20
780
3,494
955
1,218
839
482
10,401
1,323
54
3.131
5. 63
2,222
129
284
(22)
484
366
520
231
230
5,725
3,135
595
1,850
96
49


4
91
(62)
2
(135)
211
50
32
45
84
489
(3)
(70)
(4)
566
254
51
(25)
42
199
(59)
40
2
4
972
342
200
420
(13)
23


1
1
558
39
121
380
13
5









156 Morbidity and Morlalilt Weekly Report


TABLE 111 CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MAY 3, 1969 AND MAY 4, 1968 (18th WEEK)


ASEPTIC ENCEPHALITIS HEPATITIS
ENIN- BRUCEL- DIPH1HER Primary including Pos- MALARIA
AREA CITIS LOSIS unsp. cases Ine s Serum Infectious
Cum.
_1969 1969 1969 1969 1968 1969 '0 r ,-r I
UNITED STATES... 24 4 21 12 9 II 88 7'n o6 863

NEW ENGLAND.......... 2 10 64 42 32
Maine .............. 2 4
New Hampshire...... 2 2
Vermont............ 1 -
Massachusetts ...... 3 29 22 26
Rhode Island....... I 3 22 10
Connecticut........ 4 10 4 4

MIDDLE ATLANTIC...... 7 2 2 1 35 133 100 2 91
New York City...... 2 1 27 53 2 8
New York, up-State. 2 1 -3 25 24 17
New Jersey.. ...... 3 1 2 20 20 2 32
Pennsylvania....... 1 3 35 54 34

EAST NORTH CENTRAL... 3 8 5 1 11 153 127 4 75
Ohio............... 2 1 1 26 41 1 10
Indiana.............. -- 2 14 15 1 7
Illinois........... 1 2 37 33 32
Michigan........... 3 3 4 1 8 69 29 2 25
Wisconsin........... 7 9 1

WEST NORTH CENTRAL... 2 34 36 4 60
Minnesota. ........ 1 5 4 4 7
Iowa ............... 9 7 5
Missouri ........... 1 4 16 15
North Dakota ....... 2
South Dakota....... 2
Nebraska ........... 1 3
Kansas............. 12 8 28

SOUTH ATLANTIC....... 2 3 2 5 93 95 9 257
Delaware........... 1 I
Maryland........... 21 15 3 8
Dist. of Columbia.. -
Virginia........... I 12 7 12
West Virginia ...... 3 6
North Carolina..... 1 3 12 131
South Carolina..... 4 4 1 24
Georgia............ 14 22 4 64
Florida............ 2 1 2 5 35 29 1 16

EAST SOUTH CENTRAL... 2 2 1 49 64 25
Kentucky........... 1 16 26 20
Tennessee.......... 1 1 1 20 14
Alabama........ 13 15 5
Mississippi......... I 9

WEST SOUTH CENTRAL... 3 1 1 1 1 2 81 66 3 25
Arkansas............ 2 2 5
Louisiana.......... 1 1 16 16 3 18
Oklahoma............. 1 7 7 2
Texas.............. 2 1 1 2 56 41

MOUNTAIN............. 1 2 5 40 21 7 65
Montana............ ---- 2 8 -
Idaho.............. -- 1
Wyoming............ 2
Colorado ........... 1 22 3 7 59
New Mexico......... 5 3
Arizona............ 3 7 3 1
Utah............... 2 8 2 1
Nevada............. -

PACIFIC.............. 6 3 5 3 42 238 245 7 204
Washington......... 1 35 26 5
Oregon ............. 1 2 6 19 5
California......... 5 3 4 3 40 197 196 4 171
Alaska ............ -
Hawaii ............. 4 3 23

PFert Rico.......... 29 10 1

*Dlayed reports: Aseptic meningitis: Minn. 1
Hepatitis, serum: N.J. delete 4, Minn. 1
Hpaiits, infectious: N.J. delete 3








Morbidity and Mortality Weekly Report 157


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

FOR WEEKS ENDED

MAY .3 1969 AND MAY 4, 1968 (18th WEEK) CONTINUED


MEASLES (Ruhbela) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL
AREA Cumul e Cumulative Total Paralytic
Cumul at iveil Cumulat ive


UNITED STATFS... 949 11,549 12,018 77 1,573 1,314 2,457 1 2,511

NEW ENGLAND.......... 66 603 510 7 46 69 242 153
Maine* ............ 2 13 1 4 5 23 19
New Hampshir...... 2 166 69 7 2 1
Vermont............ 2 1 1 15 6
Massa.husetts..*..... 27 116 164 2 21 29 111 53
Rhode Island ....... 9 1 4 6 23 5
Connecticut ....... 37 308 262 4 17 21 68 69

MIDDLE ATLANTIC...... 401 4,014 1,798 13 235 215 129 208
New York City...... 319 2,867 596 1 41 40 113 59
New York, Up-State. 20 379 821 4 39 37 NN 46
New Jersey..*...... 32 374 314 6 102 76 16 1- 1
Pennsylvania ....... 30 394 67 2 53 62 NN 92

EAST NORTH CENTRAL... 88 1,197 2,609 11 202 138 701 515
Ohio* .............. 31 172 221 3 71 37 18 53
Indiana ............ 29 357 419 2 28 18 104 111
Illinois........... 8 202 1,052 2 35 33 66 56
Michigan........... 5 114 163 3 55 38 172 165
Wisconsin ........... 15 352 754 1 13 12 341 130

WEST NORTH CENTRAL... 31 366 261 6 76 64 159 191
Minntso ta.......... 1 8 3 16 16 6 43
Iiwa................ 24 229 51 10 4 119 110
Missouri........... 14 65 2 27 18 6 3
North Dakota....... 6 97 2 18 2
South Dakota ....... 4 4 NN -
Nebraska........... 6 113 28 1 9 6 1 30
Kansas ........... 1 3 8 14 14 9 3

SOUTH ATLANTIC....... 65 1,672 992 16 280 293 181 393
De aware ........... 12 170 8 4 3 3 3
Maryland. *......... 14 28 59 2 27 18 32 35
Dist. of Columbia.. 3 3 6 2 8 10 9
Virginia........... 22 682 194 32 21 25 84
West Virginia.t .... 5 141 163 12 7 44 114
Nrth Carolina..... 2 141 254 6 46 58 NN
South Carolina..t.. 2 83 10 2 42 51 4 6
Georgia........... 1 3 42 57
Florida............ 5 423 295 4 67 68 73 142

EAST SOUTH CENTRAL... 4 60 302 5 85 106 106 I01
Kentucky........... 1 28 76 1 25 41 57 22
Tennessee.......... 2 15 48 2 36 33 49 74
Alabama............ 49 1 14 16 -
Mississippi........ 1 17 129 1 10 16 4

WEST SOUTH CENTRAL... 226 2,680 3,226 7 231 243 282 1 343
Arkansas............. 3 1 23 15 10
Lui siana.......... 1 73 2 2 65 63 6
Oklahoma.......... 2 108 101 23 45 40 162
Texas............... 223 2,496 3,122 5 120 120 232 1 175

MOUNTAIN ............. 27 295 593 32 19 185 99
Montana ............ 4 55 4 2 14 1
Idaho............. 38 11 5 6 7 1
Wyoming ............ 44 _
Colorado............ 11 36 283 6 7 20 51
New Mexico......... 5 124 52 6 8 13
Arizona..*......... 10 90 125 8 1 123 30
Utah. .............. 1 2 18 1 13 3
Nevada .............1 5 2 3

PACIFIC.............. 41 662 1,727 12 386 167 472 508
Washington......... 2 45 431 1 49 27 189 110
Oregn............... 16 140 352 9 15 8 -35
California......... 22 458 911 11 310 115 245 289
Alaska.............. 13 10 1
Hawaii............. 1 6 33 8 10 30- 7

Puerto Rico .......... 60 373 255 1 9 16 29 12

*Delayed reports: Measles: Mass. delete 1, W.Va. delete 14
Meningococal infections: N.J. 21, Ariz. 1
Mumps: Me. 4, Ohio 14
Rubella: Me. 9, Md. 150, W.Va. 14, S.C. 3








158 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MAY 3, 1969 AND MAY 4, 1968 (18th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
AREA SCARLET FEVER ER (Rky. Mt. Spotted) ANIMALS
Cum. Cum. Cum. Cum. Cum.
1969 1969 1969 1969 1969 1969 1969 99 1969 1969 1 1969
UNITED STATES... 10,281 1 35 1 31 12 83 5 10 80 1,413

NEW ENGLAND.......... 1,499 1 1 5
Maine.............. 23 1 4
New Hampshire...... 2
Vermont............. 24 I
Massachusetts...... 273 I --
Rhode Island....... 88 -
Connecticut........ 1,089 -

MIDDLE ATLANTIC...... 465 5 1 1 10 2 38
New York City...... 50 3 1 6 -
New York, Up-State. 247 2 1 2 2 36
New Jersey ........ NN -
Pennsylvania ....... 168 2 2

EAST NORTH CENTRAL... 1,882 3 2 4 10 9 81
Ohio ............... 158 2 6 9 26
Indiana............ 1,236 1 20
Illinois........... 263 1 1 1 1 13
Michigan............ 135 2 1 3 1
Wisconsin.......... 90 21

WEST NORTH CENTRAL... 327 1 4 12 262
Minnesota ........ 20 5 62
Iowa.............. .. 134 2 34
Missouri........... 7 3 2 81
North Dakota ....... 45 33
South Dakota....... 20 13
Nebraska ........... 59 8
Kansas............. 42 1 1 3 31

SOUTH ATLANTIC....... 888 1 9 13 3 12 1 1 20 415
Delaware ........... 5 -
Maryland........... 244 2
Dist. of Columbia.. 2 2
Virginia........... 302 1 1 5 230
West Virginia...... 128 1 2 1 65
North Carolina..... 14 1 5 3 4
South Carolina..... 70 1 I 1
Georgia............ 10 1 2 4 4 33
Florida............ 113 1 4 4 1 2 10 83

EAST SOUTH CENTRAL... 1,378 4 6 2 10 2 6 11 243
Kentucky ........... 196 2 2 2 7 138
Tennessee.......... 1,024 2 5 7 2 6 4 82
Alabama............ 51 23
Mississippi........ 107 I 1 -

WEST SOUTH CENTRAL... 577 8 2 11 1 1 13 186
Arkansas........... 4 6 1 15
Louisiana.......... 10 5 13
Oklahoma........... 23 1 2 1 1 3 31
Texas.............. 540 2 5 9 127

MOUNTAIN ............. 1,548 1 3 1 12 1 1 3 51
Montana .......... 32 -
Idaho.............. 134 -
Wyo. ing ............ 213 5 2 31
Colorado ........... 744 2 1 1 2
New MexiI ......... 160 1 1 3 7
Arizona............ 126 i 1 8
Utah................ 139 1 2
Nevada........................ 1 3

PACIFIC............... 1,717 5 1 17 1 9 132
Washington........ 1,025 1 1
Oregon............. .. 99 -
California.......... 530 4 1 16 1 9 132
Alaska................ 6
Hawaii .............. 57 -

Puerto Rico.......... 12 2 3 1 9

*Delayed reports: SST: Me. 4








Morbidity and Morlalit' Weekly Report 159






Week No. TABLE IV. DEATHS IN 122 UNITED STATES (11TIS FOR WEEK ENDl)D) MAY 3, 1969
18
(By place of occurrence and week of filing certificate. Excludes fetal deaths)

All Causes Pneumonia Under All Causes Pneumonia Under
A rnd I year and I y ea r
Area All 65 years a year Area All 65 years
Ages and over All Ages Causes ges 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.--------


659
217
37
19
32
59
19
17
26
36
58
14
52
34
39

3,313
45
39
138
37
42
45
69
77
1,684
47
497
183
46
119
32
46
85
34
19
29

2,682
69
32
795
158
198
132
96
300
33
43
36
48
48
171
46
145
38
45
49
118
82

850
54
24
49
152
31
96
76
245
84
39


373
106
22
9
21
31
10
10
16
23
34
11
34
23
23

1,900
21
22
84
16
25
26
42
32
959
28
286
102
31
76
23
25
51
21
11
19

1,528
43
23
424
106
106
66
57
170
19
24
23
27
30
96
30
87
14
24
29
82
48

526
38
19
29
95
20
48
51
147
54
25


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.---
CoIorado Springs, Colo.
Denver, Colo.----------
Ogden, Utah------------
Phoenix, Ariz.----------
Pueblo Co .----------
Salt Lake City, Utah---
Tucson, Ariz.----------

PACIFIC:
Berkeley, Calif.-------
Fresno, Calif.---------
Glendale, Calif.-------
Hinolulu, Hawaii-------
Long Biach, 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


1,204
121
276
61
62
114
42
98
49
85
69
199
28

682
112
60
36
143
145
43
47
96

1,228
38
34
32
147
47
89
251
78
134
94
143
64
77

447
42
20
113
26
110
20
59
57

1,691
21
59
24
53
97
524
68
41
165
57
119
175
48
137
47
56

12.756


Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 250,910
All Causes, Age 65 and over------------------- 145,358
Pneumonia and Influenza, All Ages ------------ 14,684
All Causes, Under 1 Year of Age--------------- 11,265








Morbidity and Mortality Weekly Report


MAY 3, 1969


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION OF 18,500 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.

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.


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