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:
AA00010654:00176

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
' NATIONAL COMMUNICABLE DISEASE CENTER


Vol. 18, No. 29






For

Week Ending
July 19, 1969


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE / PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION
DATE OF RELEASE: JULY 25, 1969 ATLANTA, GEORGIA 30333


INTERNATIONAL NOTES
DENGUE FOLLOW-UP Puerto Rico

During the week ending July 18, 1969, an additional
1,595 cases of dengue were reported in the outbreak in
Puerto Rico. Cases have now been reported from 68 of
the 77 administrative regions of the island. The first of
two rounds of aerial spraying with an ultralow volume
ihiopho-phair insecticide was conducted in two areas
with a high incidence of cases; ground spraying is under-
way in other areas. Figure 1 shows the distribution of
cases through July 11.
A localized outbreak of 38 cases of dengue occurred
among 3,800(attack rate 1 case per 100 persons per week)
Puerto Rican National Guardsmen at an encampment area
during the week of July 13, the first week of summer train-
ing. Since the encampment area was clean, sprayed daily,


and had no evidence of breeds sis or an adult popu-
lation of Aedes aegypti mosquitoes, the men must have
acquired their infections prior to their arrival.
Paired sera were collected from persons in several
areas of Puerto Rico and serologically tested at the pub-
(Continued on page 250)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
29th WEEK ENDED M N CUMULATIVE, FIRST 29 WEEKS
MEDIAN
DISEASE July 19. July 20, 1964 1968 MEDIAN
1969 1968 1969 1968 1964 1968
Aseptic meningitis ...................... 72 120 62 1.018 1,140 924
Brucellosis ............................ 6 6 5 97 113 133
Diphtheria............................... 1 6 3 81 99 90
Encephalitis, primary:
Arthropod-borne & unspecified ........... 23 26 35 555 507 757
Encephalitis, post-infectious ............. 4 12 16 184 310 503
Hepatitis, serum ........................ 102 96 617 2,870 2,304 22744
Hepatitis, infectious .................... 830 786 25,860 24,175
Malaria ................................ 74 37 16 1,484 1,198 181
Measles rubeolaa) ....................... 328 273 1.418 19,056 18.310 184,028
Meningococcal infections, total ........... 32 40 40 2.135 1,767 1,767
Civilian ......................... ... 28 36 1,936 1,597 ---
Military ............................... 4 4 199 170 --
Mumps ................................. 889 968 63,783 119,344 -
Poliomyelitis, total ..................... 2 2 4 35 35
Paralytic ............................. 2 2 4 35 35
Rubella (German measles) ............... 547 348 46.529 41,357 -
Streptococcal sore throat & scarlet fever.... 4,073 4.360 4,353 272.667 270,124 270,124
Tetanus ............................... 4 4 5 73 79 112
Tularemia .............................. 1 5 5 80 118 118
Typhoid fever ......................... 3 11 11 149 166 208
Typhus, tick-borne (Rky. Mt. spotted fever) 21 18 18 221 120 120
Rabies in animals ....................... 69 49 75 2.067 2.095 2558

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ................... ................... ...... 2 Rabies in man: ...................................... 1
Botulism: ........................................ 10 Rubella congenital syndrome: ............... ........ 5
Leptospirosis: Tex.-1 ............................. 35 Trichinosis: .................................... 148
Plague: .................. .................. ...... 2 Typhus, marine: Ohio-1, Tex.-1 ..................... 17
Psittacosis: Pa.-l ................................ 22





Morbidity and Mortality Weekly Report


JULY 19, 1969


DENGUE (Continued from front page)


Figure 1
DISTRIBUTION BY HEALTH DISTRICT OF 6,301
CASES OF DENGUE REPORTED AS OF JULY 11, 1969
PUERTO RICO


NG
r I


lic health laboratory and at NCDC. A high percentage of
the serum pairs demonstrated a rise in hemagglutination-
inhibition (HI) and complement fixation (CF) titers with
several group B arbouiruses and many of the remaining
pairs had very high HI and CF tigers in each of both
paired sera (Table 1). Sera collected early in the illness
of one person without previous group B arbovirus infec-
tion had a primary CF rise with dengue II (Table 2).
Several viruses hare been isolated from acute serum
inoculated into newborn mice and LLCMK. and Aedes
albopictus cell cultures. Preliminary identification of two
strain- indicates that they are more closely related to
dengue II.
(Reported by Dr. Erneto Colon-Yordan, Secretary of
Health for Precentive Medicine, Dr. Raphael Correa-


Table 1
Laboratory Data on Paired Sera by Location

Number With
Location Number of Group B Titer Rise
Serum Pairs by HI or CF

Manati 19 13
Catafla, Tan Alta 37 24
Guaynabo 7 5

Total 63 42




Table 2
Laboratory Data on Sera Collected Early in Disease
from One Case

Dengue Type Yellow
Serum I II III IV Fever
Specimen HI CF HI CF HI CF HI CF HI CF

| Jl 1 1- 1 1-ll 1 11 -
II S60 < 320 128 40 6 20 S 80 <8




Coronas, Auxiliary Secretary of Health for Preventive
medicine, Dr. Luis Mainardi, '. Communicable Dis-
ease Control Program, and Dr. Angel Alberto Colon,
!i. ...*'.. Institute of Laboratories of Health, Puerto Rico
Department of Health; Col. Hector Sanpayo, Mledical
Officer, National Guard Camp; and a team from NCDC.)


EPIDEMIOLOGIC NOTES AND REPORTS
FATAL CASE OF IMPORTED MALARIA Michigan


About Ma% 13. 1969. a 41-year-old horticultural con-
sultant developed feer and chills while visiting relatives
in Southfield. Michigan. Because of the man's religious
conviction-s he did not seek medical attention. The pa-
tient died on MaL 20. and an autopsy was performed at
the reque-t of the medical examiner. The heart blood and
red cell- within the capillaries of all the tissues examined
contained numerous rine-form- of Plasmodium fatciparum.
No garnetocytes could he identified.
For the past 6 years the patient, his wife, and two
children had lied in Johannesburg. South Africa. While
there, he had made -seeral business trips to Angola.
On April 27. 1969. the entire family flew to Angola
and spent 6 tday there before arriving in Michigan on
May 11 \ia Lisbon and Boston. The wife -tated that her


husband had been in excellent health prior to his terminal
illness. No member of the family had ever taken malaria
chemoprophylaxis. The other three I'anilx members have
remained asymptomatic despite their refusal to accept
chloroquine therapy.
(Reported by Bernard D. Berman, Ml.D., I''. i .vr. Oakland
County Department of Health; and George H. Agate, M.D.,
Chief, Division of Epidemiology, Michigan Department of
Public !I/. .i''.
Editorial Comment:
The usual 10 to 16-day intrinsic incubation period of
falciparum malaria would place the exposure between
April 26 and May 2, 1969. From April 27 thruuh May 3,
1969. the patient and his family had been in Angola, a
country where falciparum malaria infection is endemic.


250







JULY 19, 1969 Morbidity and Mortality Weekly Report



HOSPITAL OUTBREAKS OF GASTROENTERITIS DUE TO SALMONELLA INFANTS
United States


Since April 1, 1969. five separate outbreaks of gas-
troenteritis due to Salmonella infants have occurred in
hospitals in Connecticut, New Jersey, Louisiana (\l\1N R
Vol. 18, No. .'I Tennessee, and, most recently, Mas-
sachusetts. Epidemic characteristics of the first four out-
breaks (the fifth is currently being studied) were those of
a common source exposure with subsequent secondary
spread. However, to date, no common source has been
documented in any of the outbreaks.
The occurrence of five separate hospital outbreaks
due to S. infants during a 3-month period is distinctly
unusual. Although S. infants is a rather common serotype.
no frequent association with hospital outbreaks has pre-
viously been documented. For example, dLring the 6-year
period, 1963-1968. S. infants was involved in only one of
43 hospital outbreaks of salmonellosis recorded in sur-
veillance reports of the Salmonellosis Unit, NCDC.
Some overall increase in the incidence of S. infants
isolations from humans was also noted during the first 5
months of this year-an increase not accounted for solely
by the above five outbreaks. During this period, 452 iso-
lations (6.1 percent of the total) were made versus only
332 (5.0 percent of the total), in 1968.


Therefore. it would appear quite possible that a com-
mon contaminated source may have been responsible for
some if not all of these hospital outbreaks and for the
overall increase of S. infants isolations. Laboratory
studies are in progress to characterize organisms from
each of these episodes to evaluate the possibility of a
single common source.
(Reported by James C. Hart, M.D., Director, Division of
Preventable .'' Connecticut State Department of
Health: Charles T. Caraway, D.V.M., Chief, Section of
Epidemiology, Louisiana State Department of Health;
Nicholas J. Fiumara. 4I.D., Director, Bureau of Com-
municable Diseases, iassachusetts Department of Public
Health; Ronald Altman, ..D., Director, Division of Pre-
ientable Diseases, Neir Jersey State Department of
Health; Cecil B. Tucker. l.D., Director and Deputy Com-
missioner for State Services, Division of Preventable
Diseases, Tennessee Department of Public Health; and a
group of EIS Officers.)

Editor's Note:
The Salmonellosis Unit of the NCDC is interested in
learning the details of any outbreak, hospital or other-
wise, due to S. infants.


SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS


CASES OF PRIMARY AND SECONDARY SYPHILIS: By Reportine Areas June 1968 and June 1969 Provisional Data
Cumulative Cumulative
Reporting Area June Jan Jue Reporting Area June Jan. June

NEW ENGLAND.............. 33 18 168 165 EAST SOUTH CENTRAL........ 59 126 515 741
Maine................... 1 3 2 Kentucky................. h 12 97 58
ew Hampshire........... 2 3 Tennessee................ 1 42 157 184
Vermont................. Alabama ................ 25 40 122 310
Hassachusetts........... 18 10 101 99 Hississippi. ............. 11 32 139 189
Rhode Island............. 2 2 16 21
Connecticut...... ...... t1 6 45 43 WEST SOTH CENTRAL ........ 297 222 1.788 1,705
Arkansas................ 24 10 90 67
MIDDLE ATLANTIC.......... 256 279 1,828 1.582 Louisiana................ 53 60 329 419
Upstate New York........ 16 17 161 102 Oklahoma................ 5 4 43 43
Hew York City........... 160 182 1,248 1 .001 Texas................... 215 148 1,326 1 .176
Pa. (Excl. Phil.)....... 16 28 76 128
Philadelphia............ 24 8 111 121 HDUNTAIN.................. 56 41 288 264
New Jersey............ 40 44 252 230 Montana.................. 3 5 4
Idaho.............. .. 2 4 3
EAST NORTH CENTRAL ........ 194 193 1,255 1,456 Wyoming.................. 1 4 1
Ohio.................... 21 26 178 233 Colorado................. 1 25 9
Indiana................. 23 25 173 176 New Mexico.............. 25 12 127 75
Donstate Illinois...... 19 13 130 85 Arizona................ 18 20 92 142
Chicago................. 776 6 4W0 513 Utah..................... 1 5 6 7
Michigan................. 50 51 316 437 Nevada.................. 6 3 25 23
wisconsin............... 5 2 8 12
PACIFIC............. ..... 171 103 950 844
WEST NORTH CENTRAL....... 30 24 162 182 Wanhington............... 7 2 27 25
Hinnesota................ 2 2 16 18 Oregon. ................. 2 3 22 19
Iowa............. 1 ......3 20 19 California............... 161 98 897 797
Missouri................. 16 9 83 87 Alaska................ 1 1 -
North Dakota........... I 4 5 6 Hawaii................... 3 3
South Dakota............. 4 7 23
Nebraska............... 4 1 15 17 U. S. TOTAL............. 1.483 1.384 9.394 9.570
Kansas................... 6 1 16 12
[ERRITORIES ............. 122 117 636 583
SOUTH ATLANTIC ........... 387 378 2,440 2.631 Puerto Rico............. 120 113 628 552
Delaware......*...*...... 5 1 21 18 Virgin Islands........... 2 4 8 31
Maryland................. 41 37 224 222
District of Columbia..... 54 50 277 324
Virginia................. 18 26 124 143
West Virginia............ 1 5 9 19
North Carolina........... 32 38 270 343 Note: Cumulative Totals include revised and delayed reports
South Carolina........... 41 32 294 263 through previous months.
Georgia......-- ..:....... 93 52 489 400
Florida.................. 1n2 137 732 899






Morbidity and Mortality Weekly Report


JULY 19. 1969


CURRENT TRENDS
ROCKY MOUNTAIN SPOTTED FEVER


During the first 28 weeks of 1969. a total of 200
cases of Rocky Mountain Spotted Foeer from 22 states
were reported to the NCDC. a twofold increase over the
100 cases reported for that period in 1966 and nearly a
twofold increase over the 125 cases in 1967 (Figure 2)
(Table 3). A majority of states reporting cases this year
(17 of 22) also reported cases last year. Although county
data were not available from all states, from five states
reporting county distribution, it appears that generally
cases are occurring in the same areas as last year
(Figure 3).

Figure 2
STATES REPORTING CASES OF ROCKY MOUNTAIN
SPOTTED FEVER THROUGH FIRST 28 WEEKS OF 1969









V
T- -



-7'






states reporting cases. Of the 145 cases including nine
deaths from these states. 84 were in males and 43 in
females: sex was not reported in Ib cases (Table 4). Of
these cases. 102 were in persons under 20 years of age
and 69 were in children under 10 years of age.

Table 4
Age and Sex Distribution of Rocky Mountain
Spotted Fever Cases from Nine States*
for First 28 Weeks of 1969


Age Group I sex Total
(Years) '.I I. r I.- i r. kr,, n
I i _i I. -I,
II I'" i 'h
I -' I I I :



30-:39 1 1 2
40-49 4 9
50-59 3 3
t0 1 5
knownn I b 19

r .,, i i I t 1 __ 1 I 1 ,

Oklaihunmi I ^s^llc; -f,- \Viriinti a, :itd #:a:,>hirlnauo

Although the 200 caes- reported through the first h2
weeks of 1969 is greater than the mean (119 cases) for
the -sam period for 'he years 1952-1955 and 1962-196*.


Table 3
Cases of Rocky Mountain Spotted Fever
by State for First 28 Weeks of 1967, 1968, and 1969

Area 1967 1968 1969
United States 125 100 200
New England -
Maine -
New Hampshire -
Vermont -
Massachusetts -
Hhod Island -
Connecticut -
Middle Atlantic 17 7 24
New York Cit -
New York. Up-State 4 1 5
New Jersey 6 1 6
Pennsylvania 7 5 13
East North Central 13 3
Ohio 7 2 -
Indiana 1
Illinois 5 1
Michigan -
tHisconsin -
West North Central 1 3 '
Minnesota -
lo0 a 1
Missouri 1 1
North Dakota
South Dakota 1 1
Nebraska -
Kan-as


South Atlantic
Delaware
Maryland
Dilrict of Columbia
\ irginia
Wiest Virginia
North Carolina
south Carolina
Georgia
Florida
East South Central
Kentuck
Tertine--c,
Alabama
Mi sisippi
West South Central
Xrkansa--
Louisiana
Oklahoma
Texa-
Mountain
Montana
Idaho
W oming
Colorado
New M\e\ico
Arizona
Utah
Nevada
Pacific
\ a-higneton
Oregon
California
Alaska
HaPaii
Puerto Rico


49 54 108
-2
10 6 2S

14 22 36
S- 4
17 16 29
3 2 6
5 6 6

20 17 32
7 3 5
9 12 26
4 1 1


"2 7


there has been a wide range in reported cases from a high
of 170 in 1952 to a low of 66 cases in 1963.
(Reported by the Statistics Section, and Viral Diseases
Branch, Epidemiology Program, CC('.)
*Data inot pre.antly ioaitab le for 1956-1961.


252





Morbidity and Mortality Weekly Report


Figure 3
COUNTY DISTRIBUTION OF ROCKY MOUNTAIN SPOTTED FEVER CASES
IN FIVE STATES FOR FIRST 26 WEEKS 1969 AND 1968


MARYLAND

'* Inr-pr^n- 1
r ''* s.. I"-r-V -


,' .- '. / I.

I ,-
/ 3..J.
" ^ .:" *.,, s'_


VIRGINIA


r '>

-" : *'* '., -. .Z ,',
: : -..' .1 r.
(H .>
C. ..-e-----..- -- --


f-I4
^,A

"-'
N' '" .

.- #. il


- _- "' "^" "* :: -


NORTH CAROLINA


w- r- -
y-- -.- -*-p J-~

rr' 4- .--i~ \

L ---~_._. b '-4-~


/.----- r-r-'5 -- ---
4
t'.
'S1
~5- iM -t-.4d1
I **'- pj
'=4 -",L~
-


TENNESSEE


r~~~-tow r- -, ,qar 77
*J &J~ -Ic
I -
2 -rr' =-.


-._,
j -t -- --/


OKLAHOMA


JULY 19, 1969


253






Morbidity and Mortality Weekly Report


SURVEILLANCE SUMMARY
ENCEPHALITIS United States 1967


In the Inited State- during 1967, a total of 2.36S
case- of encephalitis including 245 deaths were reported
to the NCDC (Table 5) compared with 3.102 cases re-
corded in 1906t. This reduction from 1966 can be accounted
for. in part, by the lack of known arbo\iral outbreak- in
1967. Just o\ r half of the reported cases in 1967 were of
unknown etiology. Of the remain der, b3 ere of arboviral
eliotlo while 995 were associated with childhood infec-
tion- (iiia-le-, mumps. chiikenpox. and rubella). Despite
the lack of a known arboviral outbreak in 1967, an in-
creased number of cas-es occurred in the s-unmrer months.
Thin increase cannot he entirely attributed to confirmed
enteroliral or enter\ ral-a-s-ociated cases. but rather to
cases of unknown etiology.
The distribution of cases of Western Encephalitis
~ 1., Eastern Encephalitis (EE). California (CE). and St.
Louis Encephalitis (SLE) is presented in Figure 4. With
one exception. all arhoviral cases were confirmed by virus


isolation or diagnostic fourfold rise or fall in :irIIboiL
titers between acute and convalescent specimens. Seven
cases of CE (one from Iowa and six from Ohio) were re-
ported as CE on the basis of clinical and epidemiologic
fI;.irn,- supported by serologic evidence other than four-
fold changes in titer. All reported cases of CE occurred
in the childhood and adolescent age groups. while the
reported cases of other types of arbovirus infection affected
all age groups.
In 1967 there were 26 confirmed encephalitis cases
associated with entero\iral infection (Table 6). As in
1966. males were apparently affected more frequently than
females (17 in males compared with nine in females). Cox-
sackie B-5 and ECHO 9 were the enteroviral types most
commonly associated with encephalitis in 1967.
The number of cases, deaths, and death to case ratio
for reported cases of encephalitis associated with mea-
sles, mumps, chickenpox. and rubella are shown in Table 7.


Table 5
Etiology of 2,368 Cases of Encephalitis, Including 245 Deaths
Reported to the Neurotropic Viral Diseases Unit, NCDC, 1967


category y and Etiology


I. Arbo iral
W-estern Encephalitis
Eastern Encephalitis
California Encephalitis
St. Louis Encephalitis
Venezuelan Encephalitis
II. Enteroviral
(Confirmed)
III. Associated with
Childhood Infections
Measles
Mumps
C hick enpox
Rubella
IV. Associated with
Respiratory Illnesses
Adenovirus
tVycopluasma pneumoniae
V. A--ociation with
Immunization
Post-vaccinial
VI. Other
Lymphoc tic choriomeningitis
lierpe si- plex
Herpes zoster
In fecious mononutleosis
VII. I'nknown and Complex
Etiology
I'nknown
Complex


Cases

Number


Percent
of Total


100.0


Deaths


Number


Percent
of Total


*1 I. + +


1.1

41.7






.1




.'2

1.7






51.0


I t -t +


Total


J S A 9 S


100.0


JULY 19, 1969


Death to Case
Ratio
(Percent)






JULY 19, 1969


Morbidity and Mortality Weekly Report


Table 6
Cases of Confirmed Enteroviral Encephalitis and All Cases Associated
with Enteroviral Isolations, by Age Group and Etiology


Age Sex Conf. Total Cox.-B5 Other Cox. A &B ECHO-9 Other ECHO
Group Isol. Total Total Total Total
roup Male Female Conf. Isol. Conf. sol. Conf. so. onf. Isol.

<1 3 4 2 2 1 1
1-4 3 19 2 7 1 3 8 1
5-9 5 4 9 45 6 4 5 1 29 4 5
10-14 2 0 2 9 1 1 1 1 6 1
15-19 2 1 3 11 1 1 1 6 2 3
20-29 1 2 3 11 5 2 5 1 1
30-39 1 0 1 8 3 1 1 4
40+ 0 1 1 1 1 1
Unk. 1 0 1 4 1 1 3
Total 26 112 6 26 9 13 4 61 7 12


Figure 4
HUMAN CASES OF ARTHROPODBORNE ENCEPHALITIS
B-Y STATE, 1967
WESTERN ENCEPHALITIS AND EASTERN ENCEPHALITIS

i- T--- -., ', i



i -
,6 1


ENCEPHAIT IS
I---? "


S0)


ST LOUIS ENCEPHALITIS f"\


-

---i-r^ ^-c-
--

I'---- J
---
I f----) \ t--r 7


Table 7
Encephalitis Associated with Childhood Illnesses

Death to Case
Etiology Number Number Ratio
of Cases of Deaths percentt

Measles 62 6 9.7
Mumps 849 8 .9
Chickenpox 77 21 31.2
Rubella 7 2 28.6
Total 995 40 4.0


Notably the number of encephalitis cases and deaths asso-
ciated with measles decreased from 219 and 29 in 1966 to
62 and 6 in 1967. The number of cases associated with
mumps, however, increased from 628 in 1966 to 849
in 1967 while the reported deaths decreased from 10 to 8.
It is well recognized that a large proportion of cases of
mumps reported as encephalitis actually represent benign
aseptic meningitis. The low death to case ratio probably
reflects the low incidence of true encephalitis associated
with mumps infection. In light of the r.- rnl, recognized
association of Reye's syndrome (acute encephalopathy
with fatty degeneration of the viscera) with chickenpox, it
may be that this entity accounts for the substantial pro-
portion of the deaths attributed to chickenpox "encepha-
litis" since Reye's syndrome, as thus far reported, bears
a high mortality.


(Reported by the Neurotropic Viral Diseases Unit, Viral
Diseases Branch, Epidemiology Program, and the Arbo-
virology Unit, Virology Section, Laboratory Division,
NCDC.)


A copy of the report from which these data were derived
is available on request from

National Communicable Disease Center
Attn: Chief, Neurotropic Viral Diseases Unit
Viral Diseases Branch, Epidemiology Program
Atlanta, Georgia 30333


255






256 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JULY 19, 1969 AND JULY 20, 1968 (29th WEEK)


ASEPTIC ENCEPHALITIS HEPATITIS
MENIN- BRUCEL- DIPIHHERIA Primary including Post- MALARIA
AREA ITIS OSIS unsp. cases Infectious Serum Infectious
Cum.

UNITED STATES... 72 6 1 23 26 4 102 830 786 74 1,484

NEW ENGLAND.......... 1 1 65 42 2 48
Maine .............. 1 4 3
New Hampshire...... 3 2
Vermont............ -
Massachusetts...... 1 30 19 2 35
Rhode Island....... 21 1 3
Connecticut........ 1 9 18 5

MIDDLE ATLANTIC...... 4 1 6 2 55 186 90 4 158
New York City...... 1 2 48 40 39 13
New York, up-State. 1 1 36 24 2 27
New Jersey*........ 1 5 49 2 56
Pennsylvania....... 2 1 2 2 2 61 27 62

EAST NORTH CENTRAL... 5 1 10 6 11 104 95 13 151
Ohio............... 1 6 5 2 26 38 14
Indiana ............ 1 5 5 10
Illinois........... 1 1 1 1 24 22 12 90
Michigan........... 3 3 8 46 22 1 36
Wisconsin.......... 3 8 1

WEST NORTH CENTRAL... 4 1 1 1 46 43 7 97
Minnesotat......... 3 1 5 12 7
Iowa.............. .... 3 6 7
Missouri............ 20 18 2 26
North Dakota........ 1 1 2
South Dakota....... 1 -
Nebraska............ 1 12 3
Kansas............. 4 7 5 52

SOUTH ATLANTIC....... 12 2 1 3 47 72 6 448
Delaware........... 1 3 2
Maryland........... 8 1 2 15 14 1 19
Dist, of Columbia.. 1 1
Virginia........... 2 11 8 1 18
West Virginia...... 1 6 -
North Carolina..... 4 8 6 4 205
South Carolina..... 5 1 41
Georgia............ 6 14 139
Florida............ 1 19 23

EAST SOUTH CENTRAL... 2 1 1 1 87 71 11 63
Kentucky........... 2 56 24 11 53
Tennessee.......... 1 I 8 26
Alabama............ 11 4 8
Mississippi........ 1 12 17 2

WEST SOUTH CENTRAL... 9 1 1 3 3 1 58 50 17 57
Arkansas........... 5 6
Louisiana.......... 5 3 3 12 8 2 30
Oklahoma ........... 4 4 15 21
Texas.............. 4 1 1 1 42 33 -

MOUNTAIN............. I 49 41 4 112
Montana............ 2 6 2 2
Idaho.............. 1 2 3
Wyoming............ 2 2
Colorado........... 1 25 15 2 95
New Mexico......... 4 4 6
Arizona ........... 12 8 1
Utah... ..... ....... 5 3 1
Nevada........... 1 4

PACIFIC.............. 35 1 5 8 1 32 188 282 10 350
Washington......... 1 4 23 5
Oregon ............. 1 1 13 26 7
California......... 12 1 5 6 1 31 171 232 10 268
Alaska............ 23 1 2
Hawaii............. --- --- --- --- --- ... --- --- 68

Puerit Ric .......... 20 16 1

*Delaved reports: Aseptic meningitis: Iowa 1, Ariz. 1
Brucellosis: Iowa 2
Encephalitis primary: Minn. 1
Hepatitis, infectious: Me. 3, N.J. 11






Morbidity and Mortality Weekly Report 257


TABLE 11I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JULY 19, 1969 AND JULY 20, 1968 (29th WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL
AREA Cumulative Cumulative Total Paralytic
Cum.
1969 1969 1968 1969 1969 1968 1969 1969 1969 1969 1969
UNITED STATES... 328 19,056 18,310 32 2,135 1,767 889 4 547

NEW ENGLAND............ 31 1,024 1,099 70 90 134 1 39
MaineA............ 5 35 6 6 2 -
New Hampshire.*.... 1 237 141 2 7 1 -
Vermont............. 1 3 2 1 -
MassachusettsA .... 7 186 341 31 40 44 13
Rhode Island....... 22 1 6 7 21 5
Connecticut........ 22 571 579 25 29 66 1 21

MIDDLE ATLANTIC...... 113 7,166 3,569 5 340 319 162 43
New York City...... 64 4,736 1,719 69 67 144 25
New York, Up-State. 7 573 1,164 5 56 54 NN 12
New Jersey.......... 10 845 577 142 116 18 1
Pennsylvania.*..... 32 1,012 109 73 82 NN 5

EAST NORTH CENTRAL... 38 1,950 3,569 9 297 211 181 162
Ohio................ 4 348 283 7 114 58 16 7
Indiana............ 453 618 34 26 6 19
Illinois........... 13 418 1,330 1 41 47 18 52
Michigan.*.......... 7 214 241 1 90 62 40 51
Wisconsin.......... 14 517 1,097 18 18 101 33

WEST NORTH CENTRAL... 5 494 367 112 89 29 17
Minnesota ......... 5 15 25 21 -
Iowa................ 324 95 15 6 12 4
Missouri............ 16 81 48 31 5 4
North Dakota....... 1 10 124 3 1 5
South Dakota....... 3 4 1 4 NN -
NiiDra-. ........... 132 38 9 6 11 4
Kansa ... ......... 4 10 14 18

SOUTH ATLANTIC....... 23 2,382 1 403 7 380 360 103 1 100
D la-.ar ....... ...... 373 15 1 5 7 8 -
MKryiand.............. .3 85 2 35 26 25 9
Di:i. of C.u.-Ibi .. 6 9 14 1
VLrgjiia........... 13 867 290 2 48 28 31 32
We!r V.r.n.3 ...... 2 166 258 18 9 38 56
P.orth Cir.:.Ana ..... 4 303 281 66 73 NN -
South Cir. Ilnh ..... 110 12 54 56 1 -
CE:rgi ........... 1 1 64 61 -
Fl.:riaa........ .... 499 .~52 2 81 86 1 2

EAST ~.0liTH CENTRAL... 2 102 465 4 136 149 54 33
Kentuckv ........... 1 60 96 3 49 58 13 25
T-nnEi EE .......... 17 55 1 51 49 38 8
Alabma............ 3 8.5 21 22 3 -
M.: ; i ppi ........ I 22 229 15 20 -

iUEST SDOiTn CENTRAL... 89 4.230 4... 2 285 289 87 2 55
Arka i ........... 16. 2 28 19 -
Louo i n.a ......... 120 7 74 81 -
Oklah.mn ........... 1 136 111 29 49 -
Texas............... 88 3,958 -,.23 154 140 87 2 55

MOUNTLALIN............. 19 250 39 37 27 56 49
Montana.*.......... 1 Ib 5' 5 3 2 1
Idaho .............. 886 2 6 11
Wyr ............... 51 -
Colorado........... 115 *81 6 8 5 10
Ne. Mexicc ......... 9 226 88 6 19 -
Arizona............ 8 247 216 10 1 25 27
UtIh....... .... .. 1 7 21 2 1 5 11
Nevad............... 1 5 2 3 -

PACIFIC.............. 8 958 2,357 7 478 233 83 49
kiihingtcn......... 5 5 51 50 37 5 3
Orego ............. 4 195 457 11 18 8 15
CalifornTi......... 4 671 1,3-9 7 396 165 68 24
Alasks............. 8 2 11 2 2 7
Hawa il ............. -- 2i 35 -'- 10 11 --- --- -

Puerto Rico .......... 60 I,22? 354 15 19 9 -

*Delayed reports: Measles: N.H. 8, Mass. delete ?, Pa. delete 14, Mich. 10, Mont. 5
MenLngococccaJ iriectioni: Minn. 1
Mumps: N.H. 3
Rubella: Me. 1







258 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JULY 19,1969 AND JULY 20, 1968 (29th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
AREA SCARLET FEVER FEVER (Rky. Mt. Spotted) ANMAL
Cum. Cum. Cum. Cum. Cum.
1969 19619 6969 1969 1969 1969 1969 1969 1969 1969 1969


UNITED STATES... 4,073 4 73 1 80 3 149 21 221 69 2,067

NEW ENGLAND........... 629 14 5 1 12
Maine. ............ 1 1 5
New Hampshire...... 1
Vermont. ........... 14 1 2
Massachusetts...... 81 3 1
Rhode Island....... 36 -
Connecticut........ 511 3

MIDDLE ATLANTIC...... 209 11 3 15 2 26 1 82
New York City...... 12 5 6 6-
New York, Up-State. 167 2 2 5 5 1 77
New Jersey......... NN 2 6 -
Pennsylvania....... 30 2 4 2 15 5

EAST NORTH CENTRAL... 257 2 11 7 1 14 6 137
Ohio............... 39 1 1 7 3 38
Indiana............. 69 1 40
Illinois........... 63 1 7 2 1 3 25
Michigan........... 54 3 4 4
Wisconsin.......... 32 4 3 30

WEST NORTH CENTRAL... 150 5 8 4 2 14 386
Minnesota......... 3 1 1 5 96
Iowa............... 36 1 3 57
Missouri........... 1 1 5 2 1 106
North Dakota....... 35 1 51
South Dakota....... 8 1 13
Nebraska........... 67 1 10
Kansas................ 3 3 4 53

SOUTH ATLANTIC....... 380 14 1 20 1 27 13 121 15 550
Delaware........... 8 1 2 -
Maryland........... 75 4 5 30 -
Dist. of Columbia.. 2 1 -
Virginia............ 172 1 4 2 38 9 287
West Virginia...... 89 1 2 1 1 5 1 85
North Carolina..... NN 2 5 1 5 3 32 4
South Carolina..... 11 1 2 1 1 7 -
Georgia............ 5 3 7 1 7 1 49
Florida ............ 20 8 4 7 4 125

EAST SOUTH CENTRAL... 1,065 10 9 16 1 33 7 318
Kentucky........... 132 3 2 5 3 166
Tennessee.......... 737 4 8 12 1 27 1 112
Alabama............ 87 2 1 3 37
Mississippi........ 109 1 1 2 3

WEST SOUTH CENTRAL... 468 1 14 11 20 5 26 9 280
Arkansas........... 1 10 4 21
Louisiana .......... 1 6 2 1 2 19
Oklahoma........... 8 1 5 4 18 1 42
Texas.............. 460 7 3 9 1 4 6 198

MOUNTAIN............... 814 1 2 8 20 8 1 93
Montana ........... 20 -
Idaho............. 19 3 -
Wyoming. ......... 3 2 5 48
Colorado............ 422 1 2 7 3
New Mexico......... 185 1 5 9
Arizona............. 1 1 4 22
Utah............... 165 5 1 3
Nevada............. 1 8

PACIFIC.............. 101 6 1 28 5 15 209
Washington......... 5 1 1 3 1
Oregon.............. 62 6 1 2
California.......... --- 5 1 21 2 14 206
Alaska............ .. 34 -
Hawaii.~............ ... ... .


Puerto Rico.......... 4 4 3 I 1


*Delayed reports:


SST: Me. 1, Wyo. 3, Hawaii 133
Tetanus: Minn. 1







259


Morbidity and Mortality Weekly Report






Week No. TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED JULY 19, 1969


"Z (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 a Area A 6 and 1 year
All ad over In nan All ll 65 years All
Ages and over Ages and over Influenza All
All Ages Causes All Ages Causes


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

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

EAST NORTH CENTRAL:
Akron, Ohio-----------
Canton, Ohio----------
Chicago, Ill.--------
Cincinnati, Ohio------
Cleveland, Ohio------
Columbus, Ohio------
Dayton, Ohio----------
Detroit, Mich.-------
Evansville, Ind.------
Flint, Mich.-----------
Fort Wayne, Ind.-------
Gary, Ind.------------
Grand Rapids, Mich.---
Indianapolis, Ind.----
Hadison, 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, No.------
Lincoln, Nebr.--------
Minneapolis, Minn.----
Omaha, Nebr.---------
St. Louis, Mo.--------
St. Paul, Minn.-------
Wichita, Kans.--------


687
212
40
26
31
60
21
21
26
58
56
16
42
33
45

3,167
36
35
151
38
72
38
72
59
1,687

399
189
48
105
28
31
81
51
19
28

2,582
54
24
728
189
186
112
79
361
42
46
56
39
48
137
37
140
38
39
54
116
57

868
62
42
56
160
41
104
62
209
68
64


425
110
31
19
22
39
11
14
14
34
35
13
29
24
30

1,885
20
23
92
25
43
20
52
30
1,003

222
105
29
71
14
23
51
27
13
22

1,455
26
11
355
112
94
64
45
210
29
21
35
17
35
79
17
100
24
24
40
77
40

536
43
27
32
94
28
65
33
131
45
38


SOUTH ATLANTIC:
Atlanta, Ga.-----------
Baltimore, Md.---------
Charlotte, N. C.------.
Jacksonville, Fla.-----
Miami, Fla.------------
Norfolk, Va.-----------
Richmond, Va.-----------
Savannah, Ga.-----------
St. Petersburg, Fla.---
Tampa, Fla.------------
Washington, D. C.------
Wilmington, Del.-------

EAST SOUTH CENTRAL:
Birmingham, Ala.-------
Chattanooga, Tenn.-----
Knoxville, Tenn.-------
Louisville, Ky.--------
Memphis, Tenn.----------
Mobile, Ala.----------
Montgomery, Ala.-------
Nashville, Tenn.-------

WEST SOUTH CENTRAL:
Austin, Tex.------------
Baton Rouge, La.------.
Corpus Christi, Tex.---
Dallas, Tex.-----------
El Paso, Tex.----------
Fort Worth, Tex.--------
Houston, Tex.----------
Little Rock, Ark.------
New Orleans, La.-------
Oklahoma City, Okla.---
San Antonio, Tex.------
Shreveport, La.--------
Tulsa, Okla.-----------

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

PACIFIC:
Berkeley, Calif.-------
Fresno, Calif.---------
Glendale, Calif.-------
Honolulu, Hawaii-------
Long Beach, Calif.----
Los Angeles, Calif.----
Oakland, Calif.--------
Pasadena, Calif.-------
Portland, Oreg.-------.
Sacramento, Calif.----
San Diego, Calif.----..
San Francisco, Calif.--
San Jose, Calif.-------
Seattle, Wash.---------
Spokane, Wash.----.--.
Tacoma, Wash.----------


Total 112,463 7,133 498 610

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 387,162
All Causes, Age 65 and over------------------- 222,961
Pneumonia and Influenza, All Ages------------- 19,481
All Causes, Under 1 Year of Age--------------- 17,731


1 ,124
135
234
37
88
100
66
76
46
75
56
178
33

753
125
51
38
125
177
65
60
112

1 ,269
51
57
34
162
31
101
247
70
166
94
117
78
61

486
42
31
122
23
125
27
56
60

1,527
24
48
28
41
98
436
82
37
145
60'
102
169
39
130
43
45


t I






260


Morbidity and Mortality Weekly Report


EPIDEMIOLOGIC NOTES AND REPORTS
TYPHOID FEVER FOLLOW-UP Oregon


Following the outbreak of typhoid fever in a mission-
ary family in Oregon en route to North Dakota from the
Philippines (MMR., Vol. 18, No. 23), three isolates of
Salon11ea ltyphi were received at the NCDC from recent
typhoid fever cases in Pasay City, Philippines. The iso-
lates were phage type B1, the same as the phage type
responsible for the illnesses in the missionary family.
This is a rare phage type in the United States accounting
for only 1 to 2 percent of strains typed at the NCDC.
These laboratory data support epidemiologic information
pointing to Pasay City as the likely place where this
family was exposed.
(Reported by Jacinto J. Dizon. MI.D., Chief, Disease
I. .. .. Center. Department of Health, Manila; and
the Enteric Bacteriology Unit, Bacteriology Section,
Microbiology Branch, Laboratory Division, NCDC.)











ERRATA
Vol. 18, No. 28, P. 242
In the article "Primary Amebic Meningoencephalitis
- Virginia" in the section "Reported by ." include
"John Thornton, M.D., Chief of Pathology, Johnson Willis
Hospital, Richmond.)"


Vol. 18, No. 23, p. 204.
In the article "Quarantine Measures" under the
Overseas Medical Center, Detroit, Michigan, under clinic
hours and fee, delete: Saturday, 9:00-5:00 by appointment
and No. Insert: 9:00-5:00 Monday, Tuesday, Thursday,
and Friday; Saturday 9:00-1:00 by appointment only and
Yes.


JULY 19. 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. GRE' G M
MANAGING EDITOR PRISCILLA B. mOLUMA
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.


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