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:
AA00010654:00175

Related Items

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

Full Text



NATIONAL COMMUNICABLE DISEASE CENTER




-- %










U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE FiabL C HEALTH EhVICE EALTH !LR.ICS. AND


DATE OF RELEASE: JUNE 27


EPIDEMIOLOGIC NOTES AND REPORTS
PRESUMPTIVE PLAGUE New Mexico

A case of presumptive plague in an IS-year-old man
has been reported from Placitas, New Mexico. a town
about 15 miles northeast of Albuquerque. The man was
hospitalized on June 15 with shaking chills, fever, and
pain in the right groin. Physical examination showed right
inguinal ... h, .1 ....1 i,, and a large area of "dusky
erythema" over the right inguinal area extending to the
upper thigh. Laboratory examination of material from the
lesion revealed gram negative, bipolar-staining, nonmotile
rods. Fluorescent antibody tests conducted at the state
laboratory were positive for Pasteurella pestis. Animal
inoculation tests are in progress.
The patient lived with 20 to 30 friends in a "hippy
colony" consisting of several tents and adobe huts in an
area known to have endemic plague.


Vol. 18, No. 25


For

Week Ending


1969 ATLANTA GEORGIA 30333


CONT N
Ef.pidlmnd,,a Not, anl ,d "' 1969
Pri-,umplntiv Plagut Nrw M.i. ........
Trichinu-is RIlho Island. .. ... .. 21
Dl)ihthl'ria Oulthr k P in.a i '
County, (alifornia .
Surv,-i llanc Sumninaris
P, a l i U nitd Stat at.- 196 .
lnflurnza Unitrtl Statu 196 -t9 .. .
Salmonellouis January, Fr bruar., tand Maf h 196f! ... 221
Recommendation of the Public H ialth er. i(i
Advisory Committee on lmmuni/atiann
Prattice- Influenza ............... ..... 2 (


To date, over 100 small animals including two dead
mice (Genus Peroamyscus) have been collected in the
colony and are being studied for evidence of plague.
Control measures ha\e been instituted and epidemi-
ologic and ecologic studies are continuing.
((Contiinud on page 21.)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)

25th WEEK ENDED CUMULATIVE. FIRST 25 WEEKS
DISEASE MEDIAN
June 21, June 22, 1964 1968 MEDIAN
1969 1968 1969 1968 1964- 1968
Aseptic meningitis ...................... 45 78 46 713 833 725
Brucellosis ............................ 8 7 7 72 77 117
Diphtheria ................. ......... 2 68 84 79
Encephalitis, primary:
Arthropod-borne & unspecified ........... 16 18 34 469 416 635
Encephalitis, post-infectious ........... 13 8 17 153 264 430
Hepatitis, serum ........................ 94 101 2,518 1.955
Hepatitis, infectious ...... ..... .. .. .... 866 895 22,783 21.058 20117
M alaria .................... ........... 56 31 10 1.257 1.002 143
Measles rubeolaa) ....................... 624 522 3,225 17,270 17.005 175,960
Meningococcal infections, total 44 65 53 1968 1,616 1,616
Civilian ........................... ...40 59 1,780 1,459
Military ............................ .... 4 6 6 188 1579
Mumps ................ ............... 1559 2,128 59,778 114,133
Poliomyelitis, total ......................- 1 3 23 19
-l- 1 3 23 19
Paralytic ............................ 1 3 23 17
Rubella (German measles) .......... ..... 1.878 1307 43,428 39,063
Streptococcal sore throat & scarlet fever.... 6,029 5,457 5,498 254,424 251,672 251,672
Tetanus ................ 5 6 6 57 64 86
Tularemia .............................. 8 5 5 76 87 87
Typhoid fever ......................... 4 6 6 131 133 169
Typhus, tick-borne (Rky. Mt. spotted fever) 14 13 15 134 76 72
Rabies in animals ....................... 61 52 80 1 1821 1 824 231

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........... .............................2 Rabies in man: ................ ........ .......
Botulism: ...................................... 10 Rubella congenital syndrome: .......... ..... 5
Leptospirosis: .. ................................ 28 Trichinosis: Alaska-1, N.Y. Ups.-1, R.I.-1 I ........ I141
Plague: ... .......... ................. ......... T phus marine: Ohio-1, Tex.-1 ... 11
Psittacosis: Conn.-2, Minn.-l ......................... 17
'Delayed Reports: Leptospirosis: La. delete 1
Trichinosis: Mo. 92
Typhus, marine: Ohio 1







Morbidity and Mortality Weekly Report


JUNE 21, 1969


PLAGUE (Continued from front page)


(Reportedi by Bruce Storrs. M.)., Director, and T. HI. Tom-
linson, Jr., M.D).. Division of Medical Services, Eva
IWaillen. 11... District Health Officer, District III, Brian
filler,. chief General Sanitation Section. and the Public


Health Laboratory, New Mexico Department of Health;
and the Ecological Investigations Program, NCDC, Kansas
City, Kansas, and Fort Collins, Colorado.)


TRICHINOSIS Rhode Island


An outbreak of trichinosis with seven known cases
occurred among the members of two Eastern European immi-
grant families in early June in Rhode Island. All had on-
set of clinical sign- and symptoms within 2 to 10 days
(mean 6 da ys) after eating an uncooked smoked Eastern
European style sausage prepared by a neighborhood butcher.
Their most common clinical symptoms were periorbital
edema, fver, malaise, and myalgia of the extremities and
neck. All had eosinophilia, ranging from 13 to 57 percent.
One patient experienced gastrointestinal symptoms 24 to
-4 hours after eating the suspect sausage, and one was
hospitalized for several da.s-. The seen patients were
cihen thiabendazole and showed impro cement within 4t
hour-: onl ii nimal -ide effects of this drug were noted.
Serologic tests and mus-cle biops studies for trichinosis
are pOentlin .
\ll -c\en patient- reported consuming "hardy por-
lions" of the saui age from May '\2h through .June 1, 1969.
One, per-on who reported eatting 2 \ards of the sausage
suffered only a mill illneIi.s possibly because he as re-
ceiking crtit o teroid therapy\ for a corneal transplant.
The iutchlr had prepared 3) Ihs. of the sausage from
fre-h pork hut s that were ground. seasoned, stuffed into
animal cai-ngs. alnd smoked for I da\s in a cold smoke-
house. The smoking was done bx a friend of the butchers


who had not previously smoked sausage. The result of
laboratory testing of leftover sausage by pepin-hydrochloric
acid digestion is pending.
The Consumer and Marketing Service of the U.S. De-
partment of Agriculture (USDA) was notified of the out-
break and through the cooperation of the involved busi-
nesses in permitting a review of their shipping invoices,
purchase records, and animal records was able to trace
the pork from the butcher's shop to the wholesaler, pack-
ing plant, and slaughterhouse. It was found that the sus-
pect swine were slaughtered on May 21 or 22. The only
swine commercially slaughtered at the plant on those 2
days were from three livestock dealers in Littleton, 20
miles from Boston, Massachusetts, an area where garbage
feeding of swine is practiced. Presently, the Animal Health
Division. USDA. is attempting to trace the implicated
swine from the dealers to the original herds.

(Reported by Joseph E. Cannon. M.D., Director of Health.
Rhode Island Department of Health; John Spaulding, D.V.M.,
M.S., Head of the Toxicology Group, Consumer Protection
Program, consumer r and Marketing Service, and Norman E.
Schulz, D.V.M., Staff Veterinarian, Bacterial and Para-
sitic Diseases of Swine, Animal Health Division, USDA;
and an EIS Officer.)


DIPHTHERIA OUTBREAK Pacoima, Los Angeles County, California


During March and April 19l9, soe\n cases, and two
carrier of diphtheria were identified among 11 members
of a famril in Pacm oin. California. On March 1. the index
case. an s-year-olt bho. had onset of clinical diphtheria
and within the following week. fixe others including the
mother d,\ elopld -itilar illnesses. All 11 persons in the
farmil\ were then quarantined in a ho-pital; the six clini-
cally ill people had culture, positive for ('C rynebac('triuim
Uph/t/'riac: two carriers in the family w'-re alt identi-
fied. The -.ix i patients were treated with penicillin and
antitoxin, and the carriers recei\ied penicillin. Five pa-
tints- including the mother soon responded it therapy and
i ere di charged afttr two conscutie cutlture- wore' nega-
tii' IThe other patient and t wo carriers remained in
quarantin' at the ho-pital because they continued to have
po'itive culturt-: after a sub-equent court s of crythromy-
Itcarnme negati\ e and the patient- were
di-charced in M\a.
M\lan ii I* on \pril "21. a pro iouslA culture negative
family Coinher, i a 1-yiear-ohi irl. had on-el of sort throat
and feoir. She felt h'bettr withinn 21 hours after treatment t
with pwniocillin: hnot \ier, a throat culture on A\pril 26


showed toxigenic C. diphtheria. She was hospitalized
on April 2S, was treated with antitoxin and penicillin,
and was discharged in mid-May following negative cul-
tures. On April 29 the seven family members remaining at
home were cultured and although none had symptoms, two
previous cases developed recurrent positive throat cul-
tures. These seven were treated with erythromycin but
because of gastrointestinal side effects, treatment was
changed to parenteral penicillin. By May 23, all seven
were culture negative.
Eight of the 11 members were inadequately immunized
while the immunization status for two was unknown. Of
the eight, two were totally unimmunized and six partially
immunized. The one adequately immunized family member,
a 12-year-old hoy, had remained culture negative as had
his 1-year-old sister whose immunization status was
unknown n.
Although a search was conducted, no source of in-
fection could he found for the family. Following the
initial cases. 33 neighborhood contacts of the patients
were cultured; all were negative. After the case ii _-
nosed on \pril 24, two families who frequently visited the


214










infected family were also cultured. No persons in one
family but three of four children in the second family had
cultures positive for C. diphtheriae on May 6. This family
was quarantined and the three carriers successfully treated
with penicillin.
In mid-March immunization clinics were held at the
two schools attended by the initial cases. In addition,
on May 12 a follow-up clinic was conducted.


215


(Reported by Robert ock, M.l)., District l tealthl officer,
Magda Bartok, M.)., Senior Public flealth Phyisiciani, and
JanIe Mcinnis, Supervising Public Iealth Nursei, East
Valley Health District, Los Ant ylens County: Ichiro Kamri,
M.D.. Chief, and Robert Murray, Epidemiology Analyst,
Acute Communicable Disease Control Division, County
of Los Angeles Health Department, andl an EIS Officer.)


SURVEILLANCE SUMMARY
POLIOMYELITIS United States 1968


In the United States during 196S, a total of 48 cases
of paralytic poliomyelitis were reported to the NCDC, a
slight increase o\er the 40 cases reported in 1967. The
increase was attributed to a rise from nine to 20 polio-
myelitis cases in Texas. The cases in Texas were re-
ported from 11 southern counties, with four counties re-
porting two or more cases (Hidalgo-6, Bexar-3. Val Verde-2,
and Sutton-2). The number of non-Texas cases had de-
clined from 37 in 1966, to 31 in 1967, to 28 in 196s. The
non-Texas cases in 1968 were widely distributed among
lb states and the District of Columbia with some cluster-
ing in the Midwest (Figure 1). Five of the b2 non-Texas
cases two from Illinois and one each from Iowa, Michi-
gan, and New York developed poliomyelitis after travel
in the southwestern United States or in Mexico; four of
them had traveled to Mexico, including one who had traveled
to Japan prior to Mexico, and one had been to Texas. In
all five cases travel had occurred within the accepted 4
to 30-day incubation period.
Figure 1
PARALYTIC POLIOMYELITIS CASES BY COUNTY
UNITED STATES 1968


>','r f
f V
-1*


Most of the 196b cases (31 of 1b) were in infants
and preschool children: only two of these 31 had received
any immunization against poliomyelitis. Of the total 48b
cases, 40 had never been immunized and the remaining
eight were inadequately immunized according to current


Table 1
Paralytic Poliomyelitis Cases by
Age and Poliovirus Type
United States 1968
Age Group Poliovirus Type
(Years) 1 2 3 Unknown Total

0-4 20 4 4 3 31
5-9 0 1 0 2 3
10-14 2 0 0 2 4
15-19 1 0 0 0 1
20-29 1 1 0 2 4
30-39 1 1 0 2
240 2 0 0 1 3

Total 27 7 4 10 48

recommendations (MMNVWR, Vol. 16. No. 33). Fixe patients
died. none of whom was immunized. The polioxirus type
was established in 3K of the 48 cases (Table 1). Only
four known cases were attributed to type 3 poliovirus. the
lowest number yet recorded in the history of the polio-
myelitis surveillance program.
In 196., there were two cases in patients who had
received poliovaccine in the 30 days preceding illness
(Table 2). One, a 3-month-old infant, developed paralysis
in the left leg 16 days after ingestion of tri\alent oral
polioxaccine (TOPV) and parenteral administration of
DPT in the left leg. Poliovirus type 2 was isolated from
stool and proved to le antigenically vaccine-like. The
other case. also in a 3-month-old boy, occurred on June 5.
The patient had received type 1 monoxalent poliovaccine
(MOPV) on April 22. 196h. and type 3 MOPV on Mla\ 21.
1968. This case was considered to be poliomyelits asso-
ciated with MOPV type 3.
There were four instances in 196S of paralytic di--
ease in family or other close contacts of recent recipients
of oral poliovirus vaccine. Two of these cases occurred
in preschool children (ages 9 months and 19 months) and
f('ontinued on paiqe 216)


Table 2
Paralytic Illness in Oral Vaccine Recipients 1968
Case Prior Immunization IType of Vaccine Interval between
No. Location Age Sex IPV OPV Administered Administration and Onset Isolate Type
1 Ohio 3 mos. M 0 0 Trivalent 16 days


2 Ohio 3 mos. M 0 Mlonovalent-l Monov alent-3

'for type I ''1:S pe 2 ( 1:10), nd t i 3 1: ,6).
for txpc 1 (t:SO0) t4en 2 (1:10), ad meltyx 3 1:lfi0).


JUNE 21, 1969


Morbidity and Mortality Weekly Report


13 days


None*
During Illnes


--i


Sail.d id enti,.i tier on <..,'h ld t-,






Morbidity and Mortality Weekly Report


JUNE 21, 1969


POLIOMYELITIS (Continued from page 215)

Table 3
Paralytic Disease in Close Contacts of Oral Vaccine Recipients 1968

Contact Isolate
Contact Interval Isolate 4-Fold

Case Prior Type of between Administration Genetic Antibody
No. Location Age Sex Immunization Relationship Vaccine and Onset Type Characterization Rise

1 D.C. 9 mos. 0 Sister Trivalent 31 days 3 Vacc.-like No*
F
2 Mich. 19 mos.. 0 Neighbor Trivalent 36 days 2 Pending No
F

S N.Y 30 yrs. 0 Daughter Trivalent 10 days 2 Pending Yes
F
4 Maine 24 yrs. 3 doses Son Trivalent 6b days 2 Vacc.-like No
F IP\


Pifient haid a\n5amnm tlobulineml and thymic dyspl-r'ia.
a third in a 30-,oar-old aoman. None of them had a history
oft iinuni zt zation. The fourth cae t, was in a 24-\ ear-old
wo man who had receix ed three doses of inacti\ated ac-
cine, the I l-t being 10 years prior to on- et1 of illnes-
(Table 3).
(iR porttpi hd by \r \urotrop I irail I) ieal"s- Sr tion,
V'ira l)s rtie s tra T ..'i, E/pidri log/y Prograi, \'C)C.)


RECOMMENDATION OF THE PUBLIC HEALTH SERVICE
ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES
INFLUENZA


INTRODUCTION
The nationwide epidemic of \2 influenza in the I'nited
States in the full and \winter of 19tW5-69 showed the impact
of a major antigteic change in the preialent influenza
irut-s. The Hong Kong strain respon-thle for the epi-
demic t1as the nt ost (listincti\ e I ariant anmonl A2 influenza
\iruses identifir d -ince initial appearance of the A2 sulb-
type in 1957. T' he 19(;i-(9 epidemic highlighted again
the problems that are encountered in rapidly de eloping
and producing -iffitcient quantitie- of vaccine incorporat-
ing a ne\k antigen.
FortY-four States reported widespread outbreaks of
Honi Kong strainr influenza: in -ix. involvement V as less
xtei>ni\ e. In all nine geographic dixi-ion- of the country.
e\tIesi pneumoniaa and influenza mortality peaked sharply
in earl Januar\ 1969.
In December 1965. \hashington State reported an out-
iroak of t\pe influenza concurrent itith Hong Kong
-train \1. In Januiary and F b!)ruar\ 1969. 1i, additional
Statrit rqportid typeo B influenza: it Va widespread only
in Slair in thie cenlral part of the country. Unlike Hong
Kont train \2 influenza alhich affected all age group-.
type B influenza illne.- occurred primarily. in chool-aige
i ildretn.

INFLUENZA VIRUS VACCINES
'111t l)till ion of B rlo it i- S( andardl National In ti-
fu *'- uf I^'sii lr\ r oliul kri- r i influoenuza \acine fornim-


elation. and. when indicated, recommends revision to in-
clude contemporary antigens. After characterization of the
\2 Hoong ong irus in September 1968, a monovalent vac-
cine incorporating the new strain was recommended.
while some influenza vaccines have achieved 60 per-
cent or greater effectiveness in protection against the
same or closely related virus strains, vaccines in general
civilian use often have not been this effective. Final data
on vaccine field trials conducted in the 1968-69 influenza
season are being compiled. Preliminary data indicate the
mono\alent Hong Kong strain \accine was considerably
le-ss effective than would have been desirable.
For 1969-70, both standard and highly purified bi-
\alent influenza vacciness will he available. The recom-
mended adult dose will contain 400 chick cell agglutinat-
ing(CCA) units offlong Kong strain antigen(A2 'Aichi /2 68)
and 300 CC'A units of type B antigen (B'Mass' 3 66). The
highly purified vaccine is equivalent in potency to the
standard vaccine but contains less non-viral protein.


RECOMMENDATIONS FOR VACCINE USE
It is unlikely that there will he more than sporadic
cases of influenza idue to \:2 strains in the 1969-70 season.
Type B influenza mnay appear in areas where it did not
occur in 19 (s-;9.
I'nt I good pro t ii tion i- Iro\idt e consistently blv
influInza :wacine. it is not recommnendued for hea.lhh\ adults
and chihdrnn.


216


A\ cop of thI r iport fromn w hiich theoe daatai were derived i;
axai lalde on raoqu-it from
National c(ommunic-ll i t I)iease Center
Altn: C chief, N-iurotropic Viral Dis) a>-nts Section,
Viral l)i-. .-e. n liernch,
Ep-idp mSl Atl antt Gtorcia 303e 3










Acknowledging its limited effectiveness, vaccine
should he considered only for persons of any age with
certain chronic debilitating conditions: 1) rheumatic heart
disease, especially mitral stenosis: 2) such cardio\ ascular
disorders as arteriosclerotic heart disease and hyperten-
sion, particularly with evidence of cardiac insufficiency:
3) chronic bronchopulmonary diseases. such as asthma,
chronic bronchitis, cystic fibrosis. hronchiectasis. pul-
monary fibrosis, pulmonary, emph ysema. and ad\ anced
pulmonary tuberculosis: or 4) diabetes mellitus or Addi-
son's disease.
Although the indications of vaccination are less
clear, older persons, who may have incipient or potential
chronic disease, particularly cardiovascular and broncho-
pulmonary, should also he considered candidates for
Vaccination.


VACCINATION SCHEDULE
The primary series consists of 9 doses administered
subcutaneously, preferably 6 to wexceks apart. (Dose


217


volume for adults and children is specified in the manu-
facturers' labeling.) Persons at high risk who regularly
receive influenza vaccines and had 1 or more doses of
the mono\alent vaccine containing Hong Kong strain
antigen in the 19h-i69 season require only a single full
dose booster of bivalent vaccine. Immunization should be
scheduled for completion hy, early December.
Local or mild systemic reactions to standard influenza
vaccines are common. They occur in up to i0 percent of
adults and appear to be related primarily to the non-xiral
components of the vaccine.
Individuals who should receive influenza vaccine but
haxe had severe local or sstemic reactions to the stand-
ard vaccine might he given a high purified vaccine sub-
cutaneously.

PRECAUTIONS
Influenza vaccine should not be administered to ani -
one who is clearly hypersensitive to eggs because the
vaccine \iruses are grown in embryo donated chicken eggs.
Ma. 196i9


SURVEILLANCE SUMMARY
INFLUENZA United States 1968-69


During the 196,-69 influenza season in the United
States, there xwas widespread influenza activity due to the
A2 Hong Kong 6b strains and some activity due to in-
fluenza B. The first documented introduction of the Hong
Kong strains was in early September 1968 (MMRil Vol. 17.
No. 36). Additional introductions of the virus hy interna-
tional travelers occurred throughout the fall with an
occasional small outbreak in a military population. Out-
breaks in the civilian population were fir-t documented in
October, became more frequent in Noxemberl were wide-
spread throughout the country in December, peaked in
early January 1969, and declined in late January. In all,
44 state-- the District of Columbia. and Puerto Rico re-
ported widespread influenza A2 activity. Three states
(Mississippi, Oklahoma. and Texas) reported regional
activity and three states (is-consin. Nebraska, and Hawaii)
reported only isolated outbreaks. There was laboratory
e(idtence for activity by the Hong Kong strains in all
-tates except Ne\ada. All strain-- which were examined
were almost identical antigenically to the initial strain-
isolated in Hong Kong in July 196B.
Pneumonia-influenza mortality (Figure 2) first ex-
ceded ddd the epidemic thre-hold during ite week ending
December 7. 196b, h\ which time 36 states the District
of Columbia, and Puerto Rico had experienced one or more
outbreaks. The number of excess death- rose sharply and
peaked during the week ending January 11, 1969. In each
of the nine major geographic di isions of the United States.
a sharp wa\e of excess deaths was oh-ser\ed. Pneunionia-
influenza mortality wxa- paralleled by increase- in the
total number of deaths in the 1292 monitored I.S. ciiesm
(Figure ;,).


During January 1969. influenza activity dtue to the
Hong Kong strains declined with only sporadic outbreaks
occurring in rural artas and in populations not in\ol ed
in the early part of the wave. In the last w eek of January,
ho\io ev- r. four states reported outbreak- of influenza B.
which augmented the report of an isolated outbreak of
influenza B in December from the state of \ashington.
Then in February many additional reports of influenza B
were received. In all, 37 slatel had one or more case- of
influenza B and 20 states had one or more outbreaks. All
influenza B strains which were examiined were closely
related to the B lassachu,-etts 3 6;6 vaccine strain.
widespread d influenza B activity wa< reported in a
hand throughout the central United States ranging from
Minnesota and Wisconsin down to the northern half of
Texas. Almost no influenza B occurred in New England
or Netw York. Influenza B predominantly involved school-
age children, especially those in elementary y school. In a
few areas absenteeism i xas as high or higher than that oh-
ser ed during the wa~e of A.2 onong ng acti ity. Although
some excess mortality was till occurring in the I united
States at the time of the type B outbreaks, the three regions
with the greatest excess mortality at thi tiimr (Newx Eng-
land. Middle Atlantic. and Pacific) reported the leart
influenza B. Thus. the exces-s morlilit a-;ii probably dtu
to residual influenza A.
(Reported by Viral liseates Braini. Ep idenmioloy Pro-
yrram. \('D '.)
\ ..|..\ of th, r ..-. rt from w hrt h, -. ** .1.i %. r. ,.r .
1- avtilabh -.n r us t from
V i r 1n t (*'nmmunia D I (ti "- r
\11in: Chi f. Viral I. a- l1 I .[ I Pi m o 'I, ram
\I i, t. (rt r ia :'t0i,:l3t


JUNE 21. 1969


Morbidity and Mortality Weekly Report









Morbidity and Mortality Weekly Report


JUNE 21, 1969


Figure 2
PNEUMONIA-INFLUENZA DEATHS IN 122 UNITED STATES CITIES


ft1i E ( 4 44 11 4 I 12 4 2 2 2"1 12 6 If 6 '"i 1 8 12 t w 206 2I 8 1 7
WIN- 3 3 0 i i2 4 3 24 2320 03 13 0
1966 |9fc 196r| 968


W N CENTRAL E N CENTRAL
0 CITIES o00 21 CITIES 200









w0 5330










.EI 1i 40 44 48 d2 a 0 20 24 2 4 8 16 C


MOUNTAIN E S CENTRAL 500
8 CITIES 80w e CITIES .^


++ + 44 46 .* ... 4. 8 Z i ?4 a Z .
*9& 969

oo, PACIFIC
16 CITIES















|*CEEI< < 4 8 'i 4 a 1 i K 4 ue s
%68 | 969


0 44 OS >? 4 a S2 16 20 24 28 3Z
9468 I L969

WS CENTRAL 200
13 CITIES






50








40 44 48 1 4 8 12 t 20 24 M ?
I9681 99


4a0 44 48 2 4 6 12 6 20 4 26 N'
*5 2. 64 8 Z U z2 1*4 i 9 6
F968 1 969



NEW ENGLAND
14 CITIES




















40 44 48 52 4 Q 4 8 II ,
t968, i 969

MIDDLE ATLANTIC
20 CITIES





















40 44 4 iZ Z 6 4 28 36
968 ] '969

SOUTH ATLANTIC
12 CITIES









S




40 44 4 V 4 8 02 6 2 28 236
196 1 t%9


1600


1.400


1.300

1.200



,OO



8.00


ALL CITIES


- EPIDEMIC THRESHOLD
- EXPECTED UMBER


"' ''"''"'i"''"''"'"''"''"""'' "'"''''"''"'''"'"''"''"''"''






JUNE 21, 1969


Morbidity and Mortality Weekly Report


Figure 3
MORTALITY IN 122 UNITED STATES CITIES


PNEUMONIA-INFLUENZA
ALL AGES


ALL CAUSES AGE UNDER I


t^^^^


kmLL hLLL


219


WEENO 1 8 12 86 o 1 28 13 40 52 4 8 2 16 M 23 28 3236 40 4 82 4 8 12 4 aW a2 32 a M "a8
SENDEO 2 28 2 52220 7 15 12 3 7 4 z X 27 24 23 18 15 3 0 0 7 5 2 0 28 25 2 22 19 17 $4 12 9 6 4 29 2
4NTH F AM u A S N S J F M M j a 5 O N 0 F M a J S 0 N D
1963 i9&8 1969


AM*;~








220 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 21, 1969 AND JUNE 22, 1968 (25th WEEK)


ASEPTIC ENCEPHALITIS HEPATITIS
01- BRtEL- DIHTHINs Primary including Pst- MALARIA
AREA It S IS unsp. cases lnf.r< I 1 Serum Infectious
Cum.

UNITED STATES... 45 8 1 16 18 13 94 866 895 56 1,257

NEW ENGLAND ........ 4 78 42 3 43
Maine*............. 2 2
New Hampshire...... 4 2
Vermont ............ -
Massachusetts...... 41 25 3 33
Rhode Island....... 22 7 2
Connecticut........ 4 11 8 4

MIDDLE ATLANTIC...... 9 3 3 3 34 154 165 138
New York City...... 2 2 1 18 50 60 11
Neu York, up-State. 2 6 23 16 23
New Jersey.......... 6 1 10 48 39 49
Pennsylvania....... 1 1 1 1 33 50 55

EAST NORTH CENTRAL... 8 1 6 8 5 7 103 151 7 123
Ohio................ 4 5 1 4 24 48 14
Indiana ............ 3 4 12 11 1 8
Illinois........... 1 1 2 2 16 33 4 67
Michigan........... 1 1 3 3 42 43 2 33
Wisconsin.......... 9 16 1

WEST NORTH CENTRAL... 1 6 1 43 45 1 83
Minnesota .......... 1 1 1 16 7
Iowa.............. 4 6 6 6
Missouri........... 21 13 23
North Dakota ....... 3 2
South Dakota........ 1 1 -
Nebrask a............ 6 3 3
Kansas............. 1 8 3 1 42

SOUTH ATLANTIC....... 7 1 2 1 6 84 68 10 385
Delaware ........... 2
M.ryland........ .. 1 2 10 25 11
Dist. of Columbia.. 1 2 1
Virginia........... 1 21 5 15
West Virginia...... 3 12 -
North Carolina..... 2 3 175
south Carolina..... 6 18 1 30
Georgia............ 11 2 10 132
Florida ............ 1 1 4 18 18 19

EAST SOUTH CENTRAL... 3 1 1 3 59 36 1b 48
Kentucky........... 3 20 14 15 41
Tennessee.......... 1 1 1 31 17 -
Alabama ............ 2 2 2 6
Mississippi........ 6 3 1 1

WEST SOUTH CENTRAL... 2 1 1 3 59 14 1 35
Arkansas........... 1 5 14 5
Louisiana.*........ 2 9 13 1 27
Oklahoma.......... 6 8 3
Texas .............. 2 1 1 39 39 -

MOUNTAIN............. 8 2 52 67 91
Montana............. 8 2 5
Idaho.............. 5 1 2
Wyoming.............. 1 -
Co lrado............ 1 26 42 79
New Mexico......... ~ 4 10 4
Arizona. ........... 12 5 1
Utah ............... 1 3 3 1
Nevada............. 4

PACIFIC............. 7 1 4 2 3 37 234 247 18 311
Washington......... 2 1 2 44 16 5
Oregon............. 11 9 6
California......... 5 1 4 2 2 35 177 221 12 238
Alaska............ -- I- 1
Hawaii............. 1 1 6 61

P.re .. Rn.............. -- 30 24 1

De'laved reports: A.eptic meninpitis: Ariz. delete 1, Alaska 1
Hepatitis, serum: Ariz. 1
Hepatitis, infectious: Me. 6, La. delete 1, Alaska 2







Morbidity and Mortality Weekly Report 221


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 21, 1969 AND JUNE 22, 1968 (25th WEEK) CONTINUED



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

UNITED STATES... 624 17,270 17,005 44 1,968 1,616 1,559 3 1,878

NEW ENGLAND........... 30 866 1,002 4 66 86 248 1 155
Mainet.............. 5 34 5 6 2 b
New Hampshire...... 226 141 2 7 1 2
Vermont............ 2 1 1 1 -
Massachusetts ...... 11 167 300 3 30 37 116 46
Rhode Island ...... 18 1 5 7 38 15
Connecticut........ 19 448 525 1 24 28 90 1 84

MIDDLE ATLANTIC...... 305 6,447 3,056 7 315 279 256 92
New York City...... 189 4,376 1,378 3 59 57 184 42
New York, Up-State. 22 529 1,079 1 49 44 NN 24
New Jerseyv ........ 65 776 499 2 137 102 72 19
Pennsylvania....... 29 766 100 1 70 76 NN 7

EAST NORTH CENTRAL... 45 1,736 3,441 9 266 187 416 459
Ohi o............... 6 290 270 3 93 51 52 lu2
Indiana............ 2 451 601 2 35 24 82 25
Illinois........... 4 341 1,286 39 39 30 130
Michigan........... 19 180 228 4 82 57 114 123
Wis cnsin ...... 14 474 1,056 17 16 138 73

WEST NORTH CENTRAL... 3 474 345 2 103 83 49 29
Minnesota.......... 3 15 1 22 19 1 1
Iowa............... 2 317 86 12 5 16 9
Missouri........... 16 80 1 45 30 6 3
North Dakota....... 7 117 3 5 6
South Dakota....... 1 4 1 4 NN -
Nebraka.................. 1 126 35 9 6 21 4
Kansas............. 4 8 14 16 4

SOUTH ATLANTIC....... 43 2,186 1,256 8 343 338 135 139
Delaware ............ 8 319 12 4 5 5 -
Maryland........... 8 40 79 32 23 9 17
Dist. of Columbia.. 6 9 13 5
Virginia............ 14 838 261 4 41 27 49 57
West Virginia...... 159 210 1 15 8 23 42
North Carolina..... 8 245 273 58 67 NN -
South Carolina..... 4 106 12 1 49 54 9 9
Georgia............ 1 4 59 60 -
Florida........... 1 478 399 2 76 81 40 -

EAST SOUTH CENTRAL... 9 96 426 6 125 139 77 92
Kentucky........... 8 58 93 4 45 51 23 55
Tennes C ........... 1 16 54 2 46 48 54 34
Alahama............ 1 71 19 20 3
Mississippi........ 21 208 15 20 -

WEST SOUTH CENTRAL... 123 3,939 4,323 7 274 266 137 519
Arkansas........... 29 2 1 28 15 lb6
Louisiana.......... 118 2 4 74 72 -
Oklah ma ........... 2 127 106 26 48 2
Texas.............. 121 3,665 4,213 2 146 131 137 2 321

MOUNTAIN ............. 46 631 886 36 24 76 50
Montana ............ 10 57 5 2 4 2
Idaho .............. 12 66 16 6 10 1 -
Wyoming............. 49 -
Coloradoi........... 2 114 458 6 7 15 J4
New Mexico......... 2 187 81 6 1i ii
Arizona............. 28 248 199 9 1 39 1
Utah............... 2 5 21 2 1 1 -
Nevada ............. 1 5 2 3

PACIFIC............... 20 895 2,270 1 440 214 165 -- J37
Washington ......... 54 512 50 36 29 29
Oregon............ 5 183 432 10 16 1 1
California........ 14 629 1,291 1 360 150 128 -
Alaska.* ........... 8 i 1 11 7 -
Hawaii.$........... 1 21 34 11 71

Poertr Ri ........... 1 973 331 14 i 18 i3 -

*Delaved reports: Measles: Mle. 1, lass. delete 6, R.I. 8, Alaska 1
Meningococcal infections: N.J. delete 1
Mumps: He. 13
Rubella: Me. 19, Alaska 18, Hawaii 149








222 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 21, 1969 AND JUNE 22, 1968 (25th 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... 6,029 5 57 8 76 4 131 14 134 61 1,821

NEW ENGLAND......... 1,167 14 3 7
Maine. ........... 3 1 4
New Hampshire...... 12 -
Vermont............ 18 14 1
Massachusetts...... 219 2 1
Rhode Island....... 64 -
Connecticut........ 846 1

MIDDLE ATLANTIC...... 410 1 10 2 13 3 13 3 60
New York City...... 38 5 1 6
New York, Up-State. 334 2 1 4 2 5 3 57
New Jersey ......... NN 1 -
Pennsylvania....... 38 1 2 3 1 8 3

EAST NORTH CENTRAL... 473 7 3 7 13 7 118
Ohio ................ 154 7 30
Indiana............. 86 1 4 36
Illinois........... 91 5 2 2 1 22
Michigan........... 89 2 4 3
Wisconsin.......... 53 3 4 2 27

WEST NORTH CENTRAL... 243 3 7 4 1 7 323
Minnesota.......... 2 1 1 80
Iowa............... 54 1 44
Missur i........... 3 4 2 2 9b
North Dakota....... 72 41
South Dakota....... 25 1 13
Nebraska........... 79 1 10
Kansa ............. 8 3 3 3 37

SOUTH ATLANTIC....... 591 10 1 18 1 22 8 68 9 512
Delaware........... 2 1 -
Maryland........... 64 1 4 2 20
Dist. of Columbia.. 2 1 -
Virginia .......... 324 1 2 3 19 4 264
West Virginia...... 78 1 2 1 3 79
North Carolina..... 3 1 5 4 1 21 4
South Carolina..... 76 1 2 1 3 -
Georgia............ 6 3 7 2 2 2 46
Florida ............ 38 5 4 3 3 119

EAST SOUTH CENTRAL... 1,128 3 7 8 1 13 1 26 9 298
Kentucky........... 112 1 3 2 5 4 159
Tennessee.......... 769 2 4 7 1 9 1 20 4 106
Alabama............ 134 1 1 33
Mississippi........ 113 1 2 -

WEST SOUTH CENTRAL... 561 13 3 12 17 2 16 5 243
Arkansas........... 3 1 8 1 4 18
Louisiana .......... 5 1 2 1 16
Oklahoma........... 21 1 5 1 9 37
Texas.............. 537 7 2 4 9 3 4 172

MOUNTAIN............. 1,194 1 1 1 8 2 20 7 3 81
Montana ........... 6
Idaho .............. 91 1 3 1
Wyoming............ 3 2 5 41
Colorado........... 796 1 1 2 6 3
New Mexico......... 16 1 5 8
Arizona *........... 84 1 4 1 22
Utah ........... .... 54 1 5 2
Nevada............. 1 2 5

PACIFIC.............. 262 6 26 3 18 179
1W shington......... 130 -1 1 2 1 1
SOreg gn............. 6 -
California........ --- 5 19 1 17 178
A aska ............ 68 -


P rt Ri .........1 1 3 3 16

*Delaved reports: SST: Me. 3, Alaska 16, Hawaii 193
Kahies in animals: Ariz. 2








223


Morbidity and Mortality Weekl Report







Week No. TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED JUNE 21, 1969


(By place of occurrence and week of filing certificate. Excludes fetal deaths)

All Causes Pneumonia Under All Causes Pneumonia Under

Area All 65 years and 1 year Area All 65 years and I year
Ages and over Influenza All Ages and oveInfluenza 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.--------


700
201
49
29
27
50
26
24
31
46
66
10
45
40
56

3,393
50
38
176
50
40
36
78
101
1 ,665
42
493
196
37
113
22
42
105
41
411
33

2,501
59
36
712
160
161
12
79'
337
33
59
41
38
66
138
47
122
37
38
34
101
57

803
61
36
28
131
32
114
55
233
63
50


SOUTH ATLANTIC:
Atlanta, Ca.-----------
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, TPX------------
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 ,137
141
233
49
64
116
52
74
44
b3
56
197
48

649
95
49
42
137
139
56
31
100

1,183
24
41
35
183
33
84
199
71
190
89
98
79
57

437
41
17
112
29
94
25
54
65

1 ,a75
13
47
20
40
113
471
82
34
128
60
84
198
53
139
58
35


Total 12,3 Jo 6,975 1 41 581


Cumulative Totals
including reported corrections for


previous weeks


All Causes, All Ages ------------------------- 331,31
All Causes, Age 65 and over ------------------- 195,10
Pneumonia and Influenza, All Ages------------- 17,712
. -








Morbidity and Mortality Weekly Report


SURVEILLANCE SUMMARY

SALMONELLOSIS January, February, and March 1969

During Jtanuary. February. anrd \March 1969. the total

nmiher1 s of -almionella isolation.s from humans vwere 1.671.
1.029. and 1,165. respe(ctixIely. and th1 weekly averages
for the( 3 monlthi \\ero 3134. 257. and 291, respectiXely.
(Figure 4). For ihI- same months. 599. SlT. and 73h non-
human i-olation- \,ere reported (Tahle 4 ).
Figure 4
REPORTED HUMAN ISOLATIONS OF SALMONELLA
IN THE UNITED STATES


















Table 4
10 Most Frequently Reported Salmonella Serotypes
From Humans and Nonhumans
Joruary, February, and March 1969

Hurnan

Serotyp .) Number P Percent
td/,/,ii fI m 1' 1 133 29.3
,rritil i. :;26ti h.4


Ih '<,t 211 6.3




') i n AirI I41 G .o

typl, 97 2.5


: I,, ,.
derbyf 70 lI


Total all -'rotype- 3,.s6i
*n l ud'd .Ar. 1 .n n 39 1 o
Nonhunian

Seroti pe Number Percent
typliiinm rium* 3;i(i 17.0
hAl /Ihrn; 231; 10.7
rio(lcrar-snix iilr k- ii r, iii i rf 110 5.1
sainlt-if l i 105 4.9
tIIfI/PI, Isn h7 4.0
, iiillr ri i 0O 3.7
amtum 70 3.2
,im s buctt e 5,3 2.5
c ft rIrtili d 50. 2.3
, *Islai.st 19 2.3

S i total 1 .2 1 55.
Totl all l -eror pe 21.5 '.


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' I ) it rI, r
i r )I I rinw h hIb


JUNE 21, 1969


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION OF 18,500 1S 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 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.


224


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