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:
AA00010654:00174

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


SVol. 18,








Week En
June 14,


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE / PUBLIC HEAL
DATE OF RELEASE: JUNE 20. 1969 1


SURVEILLANCE SUMMARY
MALARIA United States and Puerto Rico 1968

A\ otal of 2.610 cases of malaria with onset of ill-
ness in 19I6 in the United States or Puerto Rico were
reported to lhe Parasitic Diseases Branch. NCDC. This
compares with 2.855 cases reported in 1967. militaryy per-
sonnel. including recently discharged veterans, accounted
for 2,l1b7 cases and civilians for the remaining 123. The
number of military cases in 1.96b was slightly less than in
1967 hut considerably in excess of the annual totals for
1959 through 19(66: the number of civilian ca,-es was similar
to totals for the past 5 years (Figure 1). Of the 2,610
cases. 2,59S were imported*.\\hile 12 vw re acquired in the
United States: five of the 12 \ere cla--sified as introduced
and seven as induced. Cases were reported from all 50
states and Puerto Rico. but California. Colorado. Georgia.
Kentucky. North Carolina. and Texas accounted for 53


percent of the total. 1 I the location within tlhe-
states of military hases receiing large numbers of \ iet-
naln returnees.
The Paismodium species were identified in 2.: of
the 2,610 cases (97.9 percent). PI. riv'r a counted for
81.4 percent of the infection> (2.12. i case-). while P. ,' -
ciparumrn was diagnosed in 13.2 percent (344 cases): the -
percentages- are identical to those reported in 1967.
(tor tinueod p a' 20'1


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
24th WEEK ENDED CUMULATIVE. FIRST 24 WEEKS
DISEASE MEDIAN
June 14, June 15. 1964 1968 MEDIAN
1969 1968 1969 1968 1964 1968
Aseptic meningitis ...................... 46 67 41 668 755 693
Brucellosis ...................... 4 4 6 64 70 110
Diphtheria ............................ 1 1 67 84 79
Encephalitis, primary:
Arthropod-borne & unspecified ........... 14 19 27 453 398 600
Encephalitis, post-infectious ....... .... 8 8 16 140 256 414
Hepatitis, serum .. ................... 133 90 1 2,423 1,854
Hepatitis. infectious ................ ..891 789 646 21910 20163 19374
Malaria ................................ 40 42 5 1,201 971 133
Measles rubeolaa) ............ .........757 671 4,472 16.642 16,483 172,735
Meningococcal infections, total ........... 48 45 46 1.925 1,551 1,551
Civilian ..............................47 40 1,740 1.400
Military .................. .......... .. 1 5 185 151 -
Mumps ................. ............... 2,182 3,001 58,206 112,005
Poliomyelitis, total .................. 1 1 1 3 23 18
Paralytic ...........................1 1 1 3 23 16
Rubella (German measles) ........... 1,897 1,644 41.364 37,756
Streptococcal sore throat & scarlet fever.... 6.547 6,325 6,350 248,183 246.215 246,215
Tetanus .......... ......... .......... 2 3 8 52 58 81
Tularemia ............................. 8 4 4 68 82 82
Typhoid fever ....... ........ 5 11 9 127 127 160
Typhus, tick-borne (Rky. Mt. spotted fever) 27 8 10 120 63 55
Rabies in animals ....................... 62 46 94 1.758 1 772 2 151

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: .......................... ................ 2 ~Rabies in man: ..................................... 1
Botulism: ......................................... 10 Rubella congenital syndrome: ......................... 5
Leptospirosis: ..................................... 29 Trichinosis: Md.-1, R.I.-6 ............................. 46
Plague: ............................................ Typhus, marine: Ohio-1 ........ .. .......... g
Psittacosis: Conn.- ................................ 14


44a


No. 24


ding
1969







Morbidity and Mortality Weekly Report


JUNE 14, 1969


MALARIA (Continued from front page)


Figure 1
MILITARY AND CIVILIAN CASES OF MALARIA
,o000o UNITED STATES, 1959-1968



2.500



2.000

SI MILITARY

.500



"000-
to




500


CIvILAN_ ....----.

959 a960 '96e 1962 1963 1964 e965 1966 i967 1968
YEAR
P. malariae accounted for 1.2 percent (32 cases) in 196h
whilee (0. percent (. case.-) w-ere due to P. ovale. Mixed
infections, generally due to P. rirar and P. falciparim,
accounted for 1i, percent (46 cases) in 1968. The species
\\as uniletermintd for 2.1 percent (.55 cases) of infections.
I'.S citizens accounted for hi of the 123 civilian
case- and foreign \isitors for the remaining 42 cases.
( .11 l students or teachers accounted for more civilian
cases than an\ other occupational group (40 cases), fol-
lowed hi mirc'hant airmenn (14 cases). Only six cases
\\ re reported in Peace ('orp- volunteers .
The onetr of illn(e- occurred more than 30 days after
arrival in the I united States in 74 percent of the 2.368
ca e- for which hoth date of onset and date of arrival in
thi- country we re knowNn. \s in previous years, a marked
difference in tinme of onset was observed between fal-
ciparumi and ivax malaria: 69). percent of the falciparum
cases became ill within I month after arrival compared
%iith 19.6 percent of tlhe li' ax cases.
There werie -ix malaria fatalities in the united States
in 196s, all ldue t1o P'.falciparuim giving an overall malaria
ca-e fatality ratio of 0.23 percent and a falciparum case
fatality ratio of 1.71 percent.
During 196h. a total of 247 malaria relapses were re-
ported: 191 relapses were second attacks. 44 were third
attacks. 10 Iwere fourth attacks, and two 1 were fifth attacks.
Thu.s a total of .2,57 malaria attacks (2,610 primary at-
itcks pIlu- 247 relap'se) were reported in 196( .
Infection- acquired in Vietnatm accounted for 2,444 of
the 12.5's imported cases (91.1 percent). Only nine of these
2.14l cac(, wre- nonmilitary\ personnel. P. rivax was the
etiologic a-gent in 2.01(6 of the 2,444 cases (82.5 percent),
P. falciparalm in :112 cares (12.S percent). P. malariae in
21 ca-e- (i).s percent), and mixed Plasmodium species in
44 caies (1.h percent). No P. ovale cases were reported
and in 51 case,- (2.1 percent)th( Plasmodium species was


not identified. Army personnel accounted for 86 percent of
the military cases from Vietnam, Marines for 10.2 percent,
and Navy and Air Force personnel for less than one per-
cent of the cases.
Of the 2,008 military returnees from Vietnam who
developed vivax malaria in the United States in 1968, 103
later suffered a vivax relapse, for a relapse rate of 5.1
percent; the corresponding rate for 1967 was 18.4 percent,
and for 1966, 29.8 percent. The relapse rate for falciparum
infections in military Vietnam returnees in 1968 was 0.96
percent (three relapses in 312 infections) as compared
with 6.5 percent in 1967 and 8.8 percent in 1966. The 1968
relapse rates should be considered preliminary estimates
since relapses of 1968 cases will continue to occur in the
future.
Of the cases acquired in the United -t ,.'- the five
introduced cases were all caused hy P. vivax. Four were
epidemiologically related and acquired at a drive-in movie
theater in eastern Alabama in late July; the index case
was not identified and the vector appeared to be Anopheles
quadrimaculatus. The fifth case occurred in a serviceman
at Fort Stewart, Georgia, in early August; one suspect
index case. a Vietnam returnee, was identified: the vector
appeared to he A. crucian-s. Of the seven induced cases,
all had received blood transfusions. Three were due to
P. fal/iparum, three to P. malaria, and one to P. vivax.
One of the falciparum cases was fatal. The infective donor
was identified in all except one P. malaria case: Three
of the donors were Vietnam returnees, two were visitors
from West Africa, and one was an immigrant from the
Philippines.
(Reported by the Parasitic Diseases Branch, Epidemiology
Program, N\CC.)


A copy of the original report from which these data were
derived i ava ilable onl request from
National Communicahle Disease Center
Atln: Chief. Parasitic Diseases Branch
[lpidemiohltgy Program
Atlanta, Georgia 30333

*Terminology
The terminology used in this report is derived from the
recommendations of the World Health Organization.1,2
1. Autochthonous
a) Indigenous malaria acquired by mosquito transmission
in an area where malaria is a regular occurrence.
b) Introduced malaria acquired by mosquito transmission
from an imported case in an area where malaria is not a
regular occurren(-.
2. Imported
SMalarii a(quired outsnli, of a specific area (t'nited States
and Puerto Rico in this report).
3. Induced
Malaria acquired through artificial means, i.e., blood trans-
fusion, common syriines, malariotheraps.
4. Relapsing
Renewal of clinical activity occurring after an interval from
the primary attack greater than that due merely to periodicity.

References:
Termuinoloagy of malaria a.nd of .Malaria Eradication. World
health Organization, 19i63, p. 32.
2\HO Expe.rt Committee on Malaria Tenth Report. WHO
Technical Report Series No. 272, p. 34.


206













During May and .June 1969. an extensive outbreak of
sanlonellosis tdue to Salmonella infantisi occurred among
patients and personnel at a large hospital in Louisiana.
Between May I ant 12, 13 patients and one enployee-
dexeloped gastroenteritis with cultures positive for S. itn-
fantis: 11 had fever and diarrhea as initial symptoms. In
the 7-month period prior to this time. this organism had
been recovered from only four hospitalized patients, the
last being on March 2.
To evaluate the extent of infection among patients,
a stool culture -urtex of 214 symptomatic and asympto-
matic patients was performed between May 14 and `21.
Infection was documented in 54 persons front all areas of
the hospital except in the premature nursery where all 44
infants cultured were negative. Thirty percent of the
positive patients were asymptomatic: 10 percent had fever
w without diarrhea. The positive patients had been admitted
hetaween January31 and Mae 12. The\ ranged in age from
2 months to 76 years (median 44 years). No common pro-
cedures or medications could be implicated in the spread
of infection.
Approximately 25 percent of the physicians and
nurses from various services in the hospital had also
noted gastroenteriti- hetwxeen May 1 and 14. In a culture
survey of staff per-onnel, two of 22 physicians and 12 of
21.5 nurses were positive for S. infants.
All patients in\ ol ed in the outbreak \\re on a regular
or low residue diet except those under 1 year of age. In
addition. most of the intolted physicians regularly ate
meals in the hospital; however, this was not the case for
man> of the nurtes involved. Although the patients' food
is cooked and served separately from employees' food,
the menus are often dlentical and aro prepared in the same
kitchen. Of 2s2 kitchen personnel stool cultured between
Ma\ 16 and 20. six employees were positive for S. infantis.
One of these prepared food for patients and one prepared
salads for both patients and staff. In an en ironmental
culture sure> of the kitchen areas and a ward pantry
conducted on \la\ 19. 20., and June 4. S. infants was re-
coeored from a wooden block used for cutting cooked
meat-. after r samples weri e negative for coliforms and
S. iiifatiii Cultures of chicken, turkey sausage, frozen
egg whittes and yolks. yeast. flour. ice cream tube feed-
ing,. other foods, and ice obtained from the kitchen are
in progre-s.
To ei aluate the continued tran-mi,-ion of infection.
a -ur\ellance -\stein for diarrhea among patients w\as
in-tituted on May '22. Between May 22 and June (3, 66
patients developed diarrhea and wtere cultured four were
po-iti\e for S. infaitis. The hospital bacterioltog lahora-
tory identified four other positive patients. -ll eight had
been admitted prior to May 12. Another culture survey on
June ', and 4 of 13:t aiymptomatic patients admitted be-
tween Ma\ It anid ,June I identified fite- infected patient.
(Table 1). Four of the five palient- had ieen in the hos-
pital betlion May 1 and 12 and hadl bon readmitted. This
rapid decline in tase- in mid-\lay -uggesi t that the main


207


source of infection was no longer present in the hospital
and that continued person-to-person transmission was not
occurring frequently.
Table 1
Prevalence of Salmonella infants, Phage type C1
in Patients by Date of Admission*, a Hospital, Louisiana
N ..Numbr Number _
Date of Admission Nu r Nmr Perrcent
Cultured Positl e
Prior to May 15 23 7 30
May 15 May 21"* 17 2
May 22 May 2b** 79 1 5
After May 2b 3h 0 0
Total lb7 13
-* ) lie nu t inr lud + i. t a tienlt ho d *o, lo lc d i h arrhe ; aft +r
lt 2 .ind hi Ld nei ctitvf i'ultur -.i .
*I'l F f six po IitsiV" jtil-it- ha.d b -en i I th i mt -p1" lI- ro
Ia 1 and n ier<- re.ulmitti d.
The sharp clustering and rapid falloff of cases (Fig-
ure 2) and the identification of N. inlfatii in the en iron-
ment of the kitchen suggest a common source outbreak
related to the central kitchen. It has not been established
whether this source of infection \\as a single contami-
nated food item served at several meals or if the kitchen
environment became contaminated primarily hb a food or a
carrier with subsequent secondary contamination of pre-
pared food or if food was contaminated by a foodhandler
shown to he a carrier. A common food vehicle could not
account for the index cases on pediatric wards. however.
because one infant was receiving only commercially pre-
pared formula and the other three were receiving prepared
baby food. For these cases, infection could hate been
transmitted by infected nurses.
Figure 2
SALMONELLOSIS DUE TO S. INFANTS AMONG
12 HOSPITAL PATIENTS BY DATE OF ONSET
LOUISIANA APRIL-MAY 1969


20 22 24 2628 301 2 4
APRIL


R


6 8 10


,F, H


2 14 16 i B 20
MAY


2 24 26 28


(hKportted by Char/cs T. C'ranway, ).l.V... ('i/. 'Sc-
tih ofn Epidemiology, Loui i .a Satt' Hie artif n o
He /alih;, tini a it'ia//i fruom \ '(/ .
Editorial Comment:
It has ne\xr been h-ho it that a alnioni la outbreak
of ihii- magnitude could he initiated bh onit or i ort, -tool
carriers through per-on-to-person tran-mnil--ion. \lthoinch
-oniw of the profie--ional -taff coiild hae become, inlfect ed
-econdarilN. it i- :ore likely] thaiit tlhw* w+r.n xpo- d to
Ilh -an' ommo '01 b ch 'le.


JUNI- 14, 1969


Morbidity and Mortality Weekly Report


EPIDEMIOLOGIC NOTES AND REPORTS
OUTBREAK OF SALMONELLOSIS Louisiana








208 Morbidity and Mortality Weekly Report


TABLE 111. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 14, 1969 AND JUNE 15, 1968 (24th WEEK)


ASEPTIC ENCEPHALITIS HEPATITIS
MENIN- BRIICEL- DIPHTHERIA Primary including Post- MALARIA
AREA GITIS LOSIS unsp. cases Infectious Serum Infectious
Cum.
1969 1969 1969 1969 1968 1969 1969 1969 1968 1969 1969
UNITED STATES... 46 4 1 14 19 8 133 891 789 40 1,201

NEW ENGLAND............ 31 63 21 40
Mainet............. 1 2 2
New Hampshire...... 4 2
Vermont........... 3 -
Massachusetts...... 29 28 11 30
Rhode Islandl...... 14 2 2
Connecticut........ 2 13 6 4

MIDDLE ATLANTIC...... 4 2 5 4 3 38 128 132 9 138
New York City...... 1 1 3 24 44 53 11
New York, up-State. 2 1 2 6 20 20 23
New Jersey......... 2 2 1 7 18 31 5 49
Pennsylvania ...... 1 1 1 1 46 28 4 55

EAST NORTH CENTRAL... 4 5 5 1 6 143 114 5 116
Ohio................ 1 3 30 21 1 14
Indiana ............ 2 15 11 7
Illinois............ 4 1 1 25 33 4 63
Michigan........... 1 2 5 68 41 31
Wisconsin........... 1 5 8 1

WEST NORTH CENTRAL... 1 2 1 32 51 1 82
Minnesota.......... 1 1 4 9 7
Iowa............... 6 6 6
Missouri........... 1 18 21 23
North Dakota....... 1 2 2
South Dakota....... -
Nebraska ........... 3 3
Kansas............. 1 2 10 1 41

SOUTH ATLANTIC....... 7 1 2 1 9 94 73 9 375
Delaware........... 2 2
Maryland........... 5 19 13 1 11
Dist. of Columbia.. 1 -
Virginia............ 1 1 9 12 15
West Virginia....... 6 3 -
North Carolina..... 3 1 12 6 6 175
South Carolina*.... 5 2 1 30
Georgia............. I 16 22 122
Florida............... 3 1 1 1 27 13 1 19

EAST SOUTH CENTRAL... 4 1 1 2 71 42 32
Kentucky ........... 1 1 37 5 26
Tennessee.......... 3 1 2 21 21 -
Alabama........... 6 4 6
Mississippi........ 7 12 -

WEST SOUTH CENTRAL... 3 3 8 74 66 1 34
Arkansas........... 5
Louisiana.......... 1 3 6 14 20 1 26
Oklahoma........... 7 10 3
Texas.............. 2 2 53 36 -

MOUNTAIN............. 6 1 42 34 5 91
Montana............ 3 1 8 -
Idaho.............. 1 2 2
Wyoming ............ -
Colorado .......... 2 1 18 14 5 79
New Mexico.......... 4 2 4
Arizona............. 1 9 6 1
Utah............... 9 1 1
Nevada............. 4

PACIFIC............... 17 1 2 5 1 38 244 256 10 293
Washington......... 10 1 1 26 37 5
Oregon.............. 3 19 16 6
California.......... 7 1 1 4 1 35 196 203 6 226
Alaska.*........... --- --- --- --- --- --- --- --- 1
Hawaii............. 3 4 55

Puerto Rico .......... 16 21 1


*Delayed reports: Hepatitis, infections: Me.
Malaria: R.I. 1


2, S.C. delete 2, Alaska 2








Morbidity and Mortality Weekly Report 209


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 14, 1969 AND JUNE 15, 1968 (24th WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL
AREA Total Paralytic
AREA Cumulative Cumulative Total Paralytic
------- -- Cum.

UNITED STATES... 757 16,642 16,483 48 1,925 1,551 2,182 1 1 3 1,897

NEW ENGLAND............ 38 833 959 3 62 80 297 1 1 1 170
Maine*............. 4 34 5 6 16 9
New Hampshire...... 2 226 141 1 2 7 -
Vermont............ 2 1 1 3 3
Massachusetts ..... 11 162 280 27 35 113 48
Rhode Island....... 10 1 5 7 34 12
Connecticut........ 25 429 502 2 23 24 131 1 1 1 98

MIDDLE ATLANTIC...... 382 6,142 2,861 11 309 268 252 142
New York City...... 251 4,187 1,258 5 56 55 171 42
New York, Up-State. 28 507 1,039 2 48 43 NN 29
New Jersey.*....... 51 711 471 2 136 96 81 3
Pennsylvania....... 52 737 93 2 69 74 NN b8

EAST NORTH CENTRAL... 82 1,691 3,374 8 257 174 551 541
Ohio ............... 18 284 261 2 90 45 162 41
Indiana ........... 4 449 592 2 33 21 57 31
Illinois ........... 30 337 1,264 39 39 141
Michigan........... 11 161 217 4 78 53 174 234
Wisinsin.......... 19 460 1,040 17 lb 158 94

WEST NORTH CENTRAL... 14 471 332 4 101 78 89 83
Minnesota.......... 1 3 15 4 21 18 45 31
Iowa .............. 12 315 81 12 5 14 31
Missouri............ 16 76 44 26 4 14
North Dakota....... 7 113 3 2 1
South Dakota....... 1 4 1 4 NN -
Nebraska........... 1 125 35 9 6 24 6
Kansas ............. 4 8 14 16 -

SOUTH ATLANTIC....... 55 2,143 1,211 5 335 323 230 348
Delaware ........... 23 311 12 4 5 6 2
Maryland........... 32 73 32 22 25 31
Dist. of Columbia*. 6 9 12 1 2
Virginia ........... 824 260 37 23 44 140
West Virginia...... 159 208 14 8 120 123
North Carolina..... 30 237 265 1 58 65 N` -
South Carolina..... 102 12 48 54 17 2
Georgia............ 1 4 2 59 59 -
Florida............ 2 477 371 2 74 75 17 48

EAST SOUTH CENTRAL... 4 87 423 6 119 134 110 56
Kentucky............ 3 50 92 2 41 51 46 1b
Tennessee.......... 15 54 3 44 46 60 40
Alabama............ 1 69 19 18 4 -
Mississippi.*...... 1 21 208 1 15 19 -

WEST SOUTH CENTRAL... 126 3,816 4,244 5 267 263 282 2 122
Arkansas........... 29 2 27 15 3 -
Louisiana.......... 15 118 2 70 71 5
Oklahoma............ 125 106 1 26 48 11 -
Texas.............. 111 3,544 4,134 4 144 129 268 2 117

MOUNTAIN............... 22 585 860 1 36 24 116 71
Montana............ 2 10 57 1 5 2 9 2
Idaho.............. 54 16 6 10 3 1
Wyoming ............. 49 -
Colorado........... 112 436 6 7 19 30
New Mexico ......... 3 185 80 6 14 5
Arizona............ 17 220 196 9 1 65 30
Utah ............... 3 21 2 1 6 3
Nevada............. 1 5 2 3

PACIFIC.............. 34 874 2,219 5 439 207 255 364
Washington......... 1 54 507 50 35 49 52
Oregon............. 3 178 417 10 16 5 26
California......... 30 615 1,260 5 359 144 170 286
Alaska*............ --- 7 1 --- 11 1 --- ... | ...
Hawaii............. 20 34 9 11 31

Puerto Rico.......... 63 862 315 1 14 17 9 -27

*Delayed reports: Measles: Mass. delete 5, N.J. 3, D.C. delete 1, Miss. 1, Alaska 1
Meningococcal infections: Ind. delete 1
Mumps: Me. 2, Alaska 22
Rubella: Me. 1, Alaska 10








210 Morbidity and Mortality Weekly Report


TABLE II1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 14, 1969 AND JUNE 15, 1968 (24th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA T D 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... 6,547 2 52 8 68 5 127 27 120 62 1,758

NEW ENGLAND......... 1,172 6 14 1 3 7
Maine.*............. 22 1 4
New Hampshire...... 13 -
Vermont ........... 15 6 14 1
Massachusetts.* ..... 163 1 2 I
Rhode Island ....... 67 -
Connecticut........ 892 1

MIDDLE ATLANTIC...... 511 1 9 2 1 13 5 10 2 57
New York City...... 38 5 1 6 -
New York, Up-State. 410 2 1 4 3 3 2 54
New Jersey.......... NN 1 -
Pennsylvania ....... 63 1 1 1 3 2 7 3

EAST NORTH CENTRAL... 627 7 4 2 13 6 111
Ohio ............. 131 1 7 30
Indiana ............ 117 1 2 32
Illinoi s........... 128 5 2 2 2 21
Michigan.......... 192 2 1 4 1 3
Wiscns in.......... 59 1 1 25

WEST NORTH CENTRAL... 196 1 3 1 7 4 1 13 316
Minnesota.......... 3 1 3 79
Iowa ............... 41 2 43
Miss ri.......... 1 4 2 2 96
N rLh Dak,'ti ....... 62 2 41
,'uth Dakota....... 14 1 13
Nibr aska. ......... 74 10
K.ia ........... 2 1 3 3 4 34

SOUTH ATLANTIC....... 718 10 17 21 13 60 12 503
D 1 aware ........... 3 .. I -
Maryland........... 83 3 3 18
Dist, of Columbia.. 2 -
Virginia........... 345 1 5 16 6 260
West Virginia...... 136 1 2 1 3 1 79
North Car ina..... 10 1 5 4 5 20 4
Suth Carolina..... 42 1 2 1 3 -
e rcia ............ 5- 3 7 1 44
Fl rida.......... 4 5 4 3 4 116

EAST SOUTH CENTRAL... 90 4 8 12 8 25 15 289
Ken1tu ky ........... 112 2 2 4 5 4 155
Tonnes ee.......... 763 2 7 8 4 19 9 102
Al ab a ............ 55 1 2 32
Missisippi ....... 60 1 2 -- -

EST "I'TH CEN'TRA.L... 505 13 1 9 17 14 11 238
Arkan ........... 4 1 8 3 1 18
L, i ana.......... 5 1 1 -- 2 15
k ih-a........ 24 1 5 8 37
Tex.i. ............. 477 7 2 9 3 8 168

MOI'INTiAI N ............ 1,445 7 1 18 1 7 1 76
M ana ............ 31 -
S.............. h3 1 2 -1 -
.; i ........... 2 5 1 41
c,1 .ri ......... 1,024 2 1 6 3
S h i ......... 108 1 5 8
Ariz ,. ............ 102 3 19
I'ah............... 115 4 2
.%,vad,, ............. 1 3

'A5 Ti C .............. 383 26 3 2 161
S- I- t. n ....... 315 1 2 -
? --...--.......... 8 6
(al5I rni ...... .. --- 5 19 1 2 161
A 1,, ............ ---


ert R .........- 2 -- -3 1 16

A*elravc, reports: S5T: Me. 6, Ohio delete 1, Alaska 32
I ai ies in animals: lMass. 1, vo. delete 1








Morbidity and Mortality Weekl Report 211






Week No. TABLE IV. DEATHS IN 122 IGNITED STATES CITIES FOR WEEK NI)DED JUNE 14, 1969
24
(By place of occurrence and week of filing certificate. Excludes fetal deaths)

All Causes Pneumonia Under All Causes Pneumonia Under

Area All 5 ars and year Area All 65 years Iandnza All
Ages and over Influenza All Ages and over All Ages ausl
All Ages Causes All Ages Cause


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.----------
Richester, 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.--------


672
209
35
25
35
52
26
16
37
45
51
13
43
30
55

3,386
36
42
151
37
28
55
71
62
1 ,727
33
502
188
54
125
31
36
72
65
38
33

2,577
75
48
668
168
227
124
79
354
32
57
49
35
45
158
26
137
51
36
49
105
54

881
67
18
56
130
31
115
84
263
65
52


423
125
20
16
22
27
21
11
25
24
34
11
29
21
37

1,929
17
26
89
19
20
33
41
27
979
17
265
96
43
78
20
25
48
40
26
20

1,433
43
25
375
102
108
60
44
186
25
24
32
18
26
74
16
90
30
19
29
70
37

554
41
12
30
82
23
77
56
156
47
30


*Estimate based on average percent of divisional total.


SOUTH ATLANTIC:
Atlanta, Ga.-----------
Baltimore, Md.---------
Charlotte, N. C.-------
lacksonville, 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.-----
Kn xvill, 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, I..--------
Tulsa, Okla.-----------

MOUNTAIN:
Albuquerque, N. Mex.---
Colorado Springs, Col .
Denver, Colo.----------
Ogden, Utah------------
Phoenix, Ariz.---------
Pueblo, Colo.----------
Salt Lake City, Utah---
Tucson, Ariz.----------

PACIFTC:
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.----------


1,138
109
229
36
78
101
64
84
33
77
86
197
44

661
95
52
45
150
122
47
41
109

1,170
24
47
28
158
50
66
223
65
182
87
122
50
68

4b0
47
28
122
18
107
27
55
64

1,647
24
38
30
41
95
500
93
34
176
67
93
171
60
146
45
34


601
49
119
17
44
56
26
44
18
60
45
98
25

356
45
29
29
86
63
25
19
60

599
15
25
14
81
25
39
110
38
86
41
56
24
45

233
22
12
68
10
46
16
33
26

982
19
23
22
22
60
288
56
24
113
38
49
91
38
84
34
21


Total 12,600 7,110 428 617

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 325,935
All Causes, Age 65 and over------------------- 188,244
Pneumonia and Influenza, All Ages------------- 17,296
All Causes, Under 1 Year of Age--------------- 14,801







212 Morbidity and Mi



EPIDEMIOLOGIC NOTES AND REPORTS
CASE OF ANTHRAX New Jersey


On March 19, 1969. a 45-year-old worker in a factory
in Camden. New Jersey, was examined by a physician for
a \.s ollen infected lesion abo\e his left eye. The patient
was hospitalized. Exudate from the lesion was cultured
and Bacillus anthracis \\as isolated. Antibiotic therapy
\as initiated and continued for 2 weeks until the man
rco\ ered.
The man wo rked at a factory that produces gelatin
and calcium phosphate from hides and bone. The basic
ra\ material is bone, ground into pieces or chips about 1
inch in diameter, purchased from India and South America.
The material is imported in burlap bags. The patient
worked for periods of 2 to 3 %weeks when shipments were
received, emnptying these bags into a large storage area.
The operation i- excessively dusty, and the patient prob-
ably* became infected by contact with dust harboring the
B. anithracis organisms.
Another single case of anthrax was reported from this
company in 1965. (MMW1R. Vol. 14. No. 35). This employee,
a 29-year-old man. had a lesion on his right knee. His job
brought him into contact with the empty burlap hags used
in shipment of the imported bones. In association with
this precious case. an environmental sampling program
w\as conducted in 1965 at this plant which revealed that
17 of 20 hone samples, three of three dust samples, and
seven of 14 air samples were positive for B. anthracis.
additionally in 1965. 17 production line samples were
obtained and two \ere positive for B. anthracis. Both
positive samples were bone that had been bathed in a 2
percent NaOH solution, the first stage in processing the
bone. The subsequent processing stages. including pro-
longed contact with acid and heat. should destroy all
B. anthracis organisms.
(Reported by Ronald Altmano, 1.D., Director, and Howard
Rosenfeld. l .)., Division of Prerentable Diseases,
and K. Lynn Sciall. Chief. Occupational Health Program,
NVel' Jersey State Orpartment of Health.)
Editorial Comment:
Of 202 anthrax cases reported to NCDC since 1955,
this is only the third case associated with hone: two of
these three \Nerc from this company. The third case was
in a ste\edore in Philadelphia who became infected while
unloading bags of imported bones.


mortality Weekly Report


JUNE 14, 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
ATTN: THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT
ATLANTA, GEORGIA 30333

NOTE: THE DATA iN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO T-E ,, ..: BY THE INDIVIDUAL
STATE HEALTH DEPARTMENTS. THE =E,=..,Ti : 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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