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:
AA00010654:00178

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, 34

.WE Y

ORT

For
SWeek Ending

- August 23, 1969


U.S. DEPARTMENT OF HEALTH, EDUCATION I-lWE L FARE PUBLIC HEALTH SERVICE ( HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION
DATE OF RELEASE: AUGUST 29, 1969 ATLANTA, GEORGIA 30333


EPIDEMIOLOGIC NOTES AND REPORTS
ISOLATION AND CHARACTERIZATION OF
"LASSA" VIRUS Connecticut and New York

A virus has been isolated from sera of two nurses,
who died, and from serum and pleural fluid of a third nurse,
who recovered, from a febrile illness. All three were
American nurses who had been working for the Sudan In-
terior Mission in Niger.ri. Their clinical disease included
fever, pharyngeal ulcers, pneumonitis, pleural effusion,
rash with petechiae, albuminuria, leukopenia, azotemia,
and, in one instance, terminal gastrointestinal hemorrhage.
A fourth case occurred in a laboratory investigator who
was working with the virus.
The first nurse (Case 1) became ill on Jan. 20, 1969,
while working at a mission station in Lassa in Biu-Mubi
region of Nigeria; she was returned by air to the mission


CONTENTS
Epidemiologic Notes and Reports
Isolation and Characterization of "Lassa" Virus -
Connecticut and New York .................. 293
Cutaneous Anthrax Rhode Illand . ... 294
Staphylococcal Food Poisoning -
Nashville, Tennessee . ..... .. 295
International Notes
Venezuelan Equine Encephalitis -
Guatemala and El Salvador . ..... 300

hospital at Jos on January 25 and died there on January 26.
Serum taken at postmortem yielded a virus on later invest-
ii.Ai,.n The second nurse (Case .'1. who had cared for the
first nurse, became ill on February 3. At a later date,
virus was isolated from her serum taken on February 6 and
on the day of her death, February 13. The third nurse
(Case 3) became ill on February 20, after attending the
other two nurses. While acutely ill, she was flown to New
(Continued on page 294)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
34th WEEK ENDED M AN CUMULATIVE. FIRST 34 WEEKS
MEDIAN
DISEASE August 23, August 24, 1964 1968 MEDIAN
1969 1968 1969 1968 1964- 1968
Aseptic meningitis ....................... 146 167 122 1,575 1,957 1,477
Brucellosis ............................ 3 9 9 138 141 164
Dipnnreiia .............................. 6 3 2 100 106 106
Encehprallii primary:
Arthropod-borne & unspecified ........... 26 45 50 693 697 1.077
Encephalitis, post-infectious ............. 10 10 10 231 353 560
Hepatitis, serum ........................ 109 95 6 3.446 2,789 26
Hepatitis, infectious .................... 862 889 8 30,309 28,659 26
Malaria .................................. 65 33 12 1.796 1.379 230
Measles(rubeola) ....................... 147 127 491 20.007 19.307 188.165
Meningococcal infections, total ........... 29 49 31 2,300 1.944 1,944
Civilian ............................... 28 49 2.097 1.769 -
Military ............................... 1 203 175 -
Mumps ................................. 500 566 66.983 123,339 -
Poliomyelitis, total ..................... 1 10 38 40
Paralytic ............................. 1 9 38 38
Rubella (German measles) ............... 320 250 48,361 43,076 "
Streptococcal sore throat & scarlet fever.... 3.747 4.454 4.147 293.965 292,417 292,417
Tetanus ............................... 5 5 92 97 141
Tularemia.............................. 2 4 5 92 130 130
Typhoid fever .......................... 5 6 8 181 211 257
Typhus, tick-borne (Rky. Mt. spotted fever) 15 13 13 340 209 200
Rabies in animals ....................... 53 66 75 2.355 2.393 2983

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........ ...... ....................... .. 3 Rabies in man: ...................................... 1
Botulism: ........................................ 11 Rubella congenital syndrome:. ...... ............... 6
Leptospirosis: Ga.-2, La.-l, Mich.-l ................... 46 Trichinosis: ........................... ............. 154
Plague: ............................................. 3 Typhus, murine: Ohio-2 ........................... 34
Psittacosis: Calif.-2, Ore.-1 ......................... 26 Poliomyelitis, non-paralytic: ....................... .. 1





294


York City and hospitalized on March 4. Virus was re-
covered from sera obtained on March t(. 15, and 16 and
also from pleural fluid on March 6. No irus was- found in
sera obtained on March 30 or April b or in throat and fecal
specimens on April h, at which time. she w as gradually
recovering. The labor atator investigator (Case 4) hecamer
ill in June. Early in his illness, he was gi\(en a trans-
fusion of .it) mal of plasma from the nurse aho had re-
to\etred. \irus w-a- isolated from -runm, throat swahs.
and urine of the fourth patient: \iru> excretion in urine
continued for o\mer 3 week-. \fier serious illness, he re-
cot\ ered.
The xirus front the serurm of (ase : had an incubation
period of ; to dais in \EHOI cell culture., which short-
ened io I da\- odn pa--'ae.1' Baropl ilic '\topla-mic aggre-
Iate'- t crcN e 'e('n in infetw d cells but not in control cells.
The ,\iral a i en t a i lnaiti\: tld I i -odiumi deoox\ cholate
and :Lassed a '2l0 it filter with no loss of ther, but only
trace.- pa:--ed the 100 min filter. The agent did not heomad-
orh 4ont1o golea or niuinea pig orythrocvte at pH 7.2 or
}! haghlutiilai 'oset( red blood clls after acetone ex-
tr t.iuon of infected culture fluid. \ complement fixation
(( F) antigen from \ERO cell fluid reacted from 1:64
with Ion alt- cent -orum from Case 3 and was negative
% ilh acute s'trum. C(on\ales cnt serum neutralized 2.0
log T'CD:, of \imu-. tute serum from Case 3 did not kill
ta1y mice on intracerelral inoculation, although the mice
did deit !Iop detectabl (CF antihody. Adult mice died after
intrac'erlheral inoculation w ith high titer tissue culture
material. but hably nmie did not.


AUGUST 23, 1969


Infectivity of the virus was unchanged when titrated
in the presence of BUDR (5-Bromo-2'-Deoxyuridine). The
development of vaccinia, used as a control, was inhibited
,h. r .,- that of Mayaro(aRNA virus) remained unaffected.
"The virus was inactivated by 0.1 percent BPL (beta-
I[ru ". l't'u,.1.. i It ild 1 nii multiply in Aedes albopictus

Complement fixation tests of serum from Case 3 with
rabies. LCM (Lymphocytic choriomeningitis). herpes, pox-
\irus. NDV (New Castle Disease Virus). EMC (Encephalo-
mnocarditis virus). Marburg. Simian hemorrhagic fever.
and 104 different arbhoiral antigens among which in-
cluded Omsk hemorrhagic ft or., yellow fe\er. Congo and
all known Tacaribe group agents \were negative. The
reactions betw een antisera for epizootic hemorrhagic
disease of deer (New Jersey). group Tacarihe, Rift Valley
ficir. Nairobi sheep disease. Simian hemorrhagic fever
and Marburg viruses, antd ia tissue culture antigen pre-
pared from the unknown \irus were also negative. Further
studies are in progress.

(Reported by J. Casual. Vs, ).. a Bukey .., Yt icky, ., ale
Alrborirus Researcdi Uniit. Ylte I niersity SI 0h1oo of Medi-
cine: Jthn Di1. Frame, 1V.D. ,ldjunct istanl P1rofessor
of I'ropical tiedicine and S hool ,of Pubhlict health and Ad-
mi4nistratire medicine, Columbia atnicr sity, Eldygr Leifer,
41.1.. i (olumbia Presbyterian Iospital. New
York: and the \ewr York City Department of health, New
York State Department of Health, and Connectitcut State
lPeartment of Iealth.)


CUTANEOUS ANTHRAX Rhode Island


In Jul\ 19i)9. cutaneous anthrax was confirmed in a
61-ea:r-old man. a mechanic at a Rhode Island company
that -cours and cards camel's hair and cashmere for spin-
nine into yarn Lb other companies. On July 17. while
cleaning the rollers of a carding machine, this man sus-
taintd sereral cut- on his right hand. By July 19. all the
cutit had healed except for the one on his right index
finger. which progressed from a small puritic papule to
a blue-tlack \esicle. On July 24. he saw a dermatologist
who diiagno-ed cutaneous anthrax and hospitalized him.
The diagnosis ta suilequently confirmed tby culture. On
admissio-n, the main appeared well. was afehrile, had no
axillary adeinopathy. but had ai 1.5 cm notntendr puritic
I-eion on hi right index 'ie.' r By July 25. he had devel-
oped several 2 to 3 tm nontender axillary nodes, and by
Jul\ 27. he de eloped marked t l it. of the finger and
dor.sum of the wrist and a low grade fever of 100 V. 0ie
wtas treated wiith penicillin, made an uneventful recovery.
and was discharged on August 2.
\lhoiugh no cases of anthrax had teen recorded hb
the company in the la:t 10 years, two other probable cases
were found during the int estigation of this confirmed case.
Both men, one with onset in February and one in Xpril.


had had a slow-healing lesion that retrospectively seemed
compatible with cutaneous anthrax: hoth were employed
as mechanics, performing the same work as the confirmed
case. and both hadt incurred minor injuries to the area
where the lesions subsequently te eloped.
The company scours and cards ra\\ hair. processes
that clean anti suhsquently separate and altein the fibers
producing a thick loosely packed rope. The raw hair is
obtained directly from Iran and Afghanistan and a con-
siderable amount is obtained from Mongolia and other
countries through a company in Belgium. Ir. -;t.'.tiion
found that the processing areas at the Rhode Island Com-
pany are dusty, inadeqluately ventilated, and cleaned
sporadically. Of 12 environmental -amples collected, 7
were positive for Bacillus an't-ralts. Of 13 hair samples
collected. 4 were positive: 2 of these were unprocessed
hair and r2 had been scoured. fter additional epidemiologic
in\e-ti action is complt ed, appropriate recommendations
wtill ie made.
(lRfpirt+rd by Joephi E. I'anmon, M1.1.. .P.tI., tDireetor,
KRhoe Islanid apartment of Health; Epidemiological Aid
Serrites L Lboratory. Epidemiology Program. NCC'; and
an EIS Ofrfic e r. (Continued on page 300)


Morbidity and Mortality Weekly Report


"LASSA" VIRUS (Continued from front page)











On May 25, 1969, an outbreak of gastroenteritis oc-
curred among 800 persons attending an organization's
annual picnic in Nashville, Tennessee. A group of 88
people, consisting primarily of persons who called an
organization official to complain of illness, were inter-
viewed by telephone. Seventy of them reported becoming
ill 3 to 5 hours after the picnic with symptoms of malaise,
weakness, anorexia, vomiting, or diarrhea which lasted
from 4 to 24 hours (Figure 1). Of 35 persons who sought
medical assistance at local hospitals, 15 were hospital-
ized overnight. There were no deaths.
Barbecued pork and/or sauce were implicated by food
histories as the vehicles of infection (Table 1). One
woman who did not attend the picnic developed gastro-
enteritis 5 hours after eating barbecued pork brought to her
from the picnic; she ate no other item from that meal.
The pork was purchased frozen on May 20 by a caterer
who refrigerated it at 360F. On May 21 he took it for bar-
becuing to a man in a nearby town who kept the pork
overnight in a refrigerated chest. On May 22 he barbecued
it unwrapped for 12 hours and then wrapped in aluminum
foil for another 12 hours. After deboning, the pork was
picked up by the caterer and returned to Nashville, where
most of it was cut into small pieces, placed in shallow,
covered, disposable aluminum pans, and refrigerated.
About 10 p.m. on May 24, it was taken out of the refriger-
ator and brought to room temperature overnight. On the
morning of May 25, a boiling barbecue sauce was poured
over the meat, and this mixture was placed in thermal
containers and capped. The barbecue sauce had been
prepared by the caterer 3 months earlier and served on
several occasions without known ensuing illness. At the
picnic the meat was transferred to clean disposable
aluminum serving pans.
Staphylococcus aureus organisms were recovered
from all four samples of leftover pork and also from chicken
and coleslaw from plates containing barbecue sauce. The
average staphylococcal count per gram of the latter two
items, however, was much less than that for the leftover


Figure 1
CASES OF FOODBORNE GASTROENTERITIS
BY INCUBATION PERIOD
26. NASHVILLE, TENNESSEE MAY 25, 1969
MEAN
24. 4.1 HRS.

22-

20-

18



14

12

10

a

6-

4-

2-


0 2 3 4 5 6 7 8 9 10 II 12 13 14
INCUBATION PERIOD (HOURS)
barbecued pork. Two samples of barbecued pork not re-
moved from the refrigerator and not handled by the caterer
were also positive for S. aureus. S. aureus was also
cultured from a nasal swab of the man who barbecued the
pork. All S. aureus isolated from the food items and nasal
culture of the foodhandler were phage type 53/83/85, and
all produced enterotoxin A, exclusively.
(Reported by Cecil B. Tucker, M.D., Director, Bureau of
Preventive Health Services, and J. B. Barrick, I -.. i ,
Division of Biological Laboratories, Tennessee Depart-
ment of Public Health; Joseph M. Bistowish, M.D., Direc-
tor, Davidson County Health Department; and an EIS
Officer.)


Table 1
Food History Date from Persons Attending Picnic, Nashville, Tennessee, May 25, 1969
Group A Group B
Persons Who Ate Specified Food Persons Who Did Not Eat Specified Food
Food or Beverage
IFI Not T l Attack Rate I Not T l Attack Rate
Ill Total ill Total
Ill (Percent) Ill (Percent)
Barbecued pork 70 18 88 79.5 0 26 26 0
Barbecue Sauce 59 12 71 83.1 11 32 43 25.6
Coleslaw 48 32 80 60.0 22 12 34 64.7
Beans 60 39 99 60.6 10 5 15 66.7
Bread 59 38 97 60.8 11 6 17 64.7
Butter 15 14 29 51.7 55 30 85 64.7
Chicken 14 29 43 32.6 56 15 71 78.9
Ice Cream 50 30 80 62.5 20 14 34 58.8
Lemonade 12 9 21 57.1 58 35 93 62.4
Cola 53 34 87 60.9 17 10 27 63.0
Orange Drink 10 4 14 71.4 60 40 100 60.0
Coffee 12 6 18 66.7 58 38 96 60.4


AUGUST 23, 1969


Morbidity and Mortality Weekly Report


STAPHYLOCOCCAL FOOD POISONING Nashville, Tennessee





296 Morbidity and Mortality Weekly Report


TABLE IIl. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 23, 1969 AND AUGUST 24, 1968 (34th WEEK)


ASEPTIENCEPHALITIS HEPATITIS
ESNINS- BR L-DIPIIIIRI Primary including P, MALARIA
AREA IT Ounsp. cases I Serum Infectious
Cum.

'iTED T l it.... I. 11 l. I1 j'C' E' I61 1

NEW ENGLAND........... 5 1 -- 1 64 60 64
Maine. ............. 5 6
New Hampshire...... 6 2
Vermont............ 1 3
Massachusetts...... 5 1 31 33 42
Rhode Island....... 8 8 3
Connecticut........ 1 13 16 11

MIDDLE ATLANTIC...... 21 3 9 3 49 144 146 14 213
New York City...... 3 1 31 57 55 1 18
New York, up-State. 2 2 3 35 31 1 32
New Jersey..*...... 12 2 5 11 32 23 4 83
Pennsylvania....... 4 4 1 4 20 37 8 80

EAST NORTH CENTRAL... 27 12 13 3 13 118 120 12 183
Ohio.. ............ 11 6 12 3 30 42 17
Indiana............ 1 9 5 2 17
Illinois........... 7 2 24 35 8 109
Michigan........... 9 -- 5 1 1 10 43 32 2 39
Wisconsin.......... 12 6 1

WEST NORTH CENTRAL... 19 3 1 4 1 30 47 2 121
Minnesota.......... 16 1 10 19 7
Iowa ............... 1 2 1 2 -- 8 2 13
Missouri........... 2 3 14 1 32
North Dakota....... 1 2 3
South Dakota....... -
Nebraska........... 1 4 5 3
Kansas............. 1 3 6 1 63

SOUTH ATLANTIC....... 34 1 2 4 2 8 106 74 12 496
Delaware........... 3 3 3
Maryland........... 12 1 1 11 15 1 27
Dist. of Columbia.. 1 1 1
Virginia........... 2 2 3 15 14 2 20
West Virginia...... 5 3 7 -
North Carolina..... 13 7 3 226
South Carolina..... 8 1 2 2 2 44
Georgia............ -- 5 3 149
Florida............ 7 1 1 6 53 26 1 26

EAST SOUTH CENTRAL... 4 1 3 2 1 1 61 46 7 74
Kentucky........... 1 30 24 2 56
Tennessee.......... 1 2 1 1 22 13
Alabama............. 3 1 3 2 5 16
Mississisppi........ 1 1 6 7 2

WEST SOUTH CENTRAL... 3 4 2 1 54 55 4 t00
Arkansas........... 4 8
Louisiana.......... 4 1 11 11 36
Oklaho~ a *.......... 1 8 7 4 41
Texas.............. 3 1 35 33 15

OUNTAIN............. 2 3 1 37 66 121
Montana .*........... 2 1 4 5 3
Idah .............. 1 1 3
Wy ing. ............ 2 -
Colorad........... 2 11 38 102
New Mexico,......... 6 7
Arizona............ 13 13 1
Utah............... 2 6 1
Nevada............. 4

PACIFIC.............. 1 3 8 1 34 248 275 14 424
Washington......... 14 22 5
Oregon............. 2 23 7 9
California......... 21 3 8 1 34 206 245 14 326
Alaska............. 1 1 2
Hawaii............. 4 82

2., 2 2'


*ellaved reports: As tic nenlnriti1: Hont. 1
Rrucellocis: Va. 20
Encephalitis, prinarv: N.J. delete 1
Hepatitis, infectlous: Ne. 15, Ohio delete 1,
Malaria: we. 2, N.J. delete 1, Iowa 4


Okla. delete 1, P.R. 2






Morbidity and Mortality Weekly Report 297


TABLE ll. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 23, 1969 AND AUGUST 24, 1968 (34th WEEK) CONTINUED


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

1-O i 1'- 2rf o0?7 19,307 1 ,3I'L1 1 .4-* ji) 1 u1

NEW ENGLAND.......... 11 1,094 1,143 2 82 116 45 1 25
Maine. ............ 8 37 6 6 6 6
New Hampshire...... 238 141 2 7 1
Vermont............ 3 2 1 -
Massachusetts...... 11 219 355 33 63 12 4
Rhode Island....... 23 5 1 10 8 6 5
Connecticut........ 603 603 1 31 31 21 1 9

MIDDLE ATLANTIC...... 33 7,430 3,943 6 377 349 72 1 1 1 32
New York City...... 14 4,876 2,027 73 70 70 15
New York, Up-State. 2 593 1,215 2 68 63 NN 5
New Jersey.......... 9 882 591 3 153 122 2 7
Pennsylvania....... 8 1,079 110 1 83 94 NN 1 1 1 5

EAST NORTH CENTRAL... 20 2,119 3,721 2 314 228 123 84
Ohio............... 2 369 291 1 118 63 15 8
Indiana............. 1 466 657 1 35 27 32 23
Illinois........... 6 485 1,356 44 51 17 --
Michigan........... 2 240 264 95 67 21 37
Wisconsin.......... 9 559 1,153 22 20 38 16

WEST NORTH CENTRAL... 3 514 379 2 118 103 13 1 11
Minnesota........... 1 6 16 25 26 -
Iowa.............. 328 97 1 16 6 7 5
Missouri........... 22 81 51 32 2 -
North Dakota....... 1 12 131 1 1 3 1 3
South Dakota ....... 3 4 1 5 N- -
Nebraska........... 1 136 40 9 6 3 3
Kansas............. 7 10 15 25 1

SOUTH ATLANTIC....... 16 2,473 1,480 4 399 392 54 1 45
Delaware........... 373 15 8 8 3 -
Maryland........... 74 95 36 30 12 6
Dist. of Columbia.. 6 9 14 6
Virginia........... 1 883 295 1 50 33 3 5
West Virginia...... 6 191 281 18 10 18 16
North Carolina..... 313 281 66 76 N -
South Carolina. ... 6 116 12 55 56 7 -
Georgia............ 1 4 1 70 76 -
Florida............ 3 522 491 2 87 89 11 1 12

EAST SOUTH CENTRAL... 107 488 1 141 170 35 1 9
Kentucky........... 63 99 1 5C 72 12 2
Tennessee.......... 17 61 53 52 23 5
Alabama............ 4 94 23 25 1 1
Mississippi......... 23 234 15 21 1

WEST SOUTH CENTRAL... 36 4,426 4,728 5 311 301 60 4 34
Arkansas........... 16 2 29 20 1 -
Louisiana.......... 120 21 80 86 -
Oklahoma............ 136 112 1 30 49 4 -
Texas............... 36 4,154 4,593 4 172 146 55 4 34

MOUNTAIN............. 16 834 970 43 30 28 11
MontanaA .......... 16 58 8 3
Idaho............... 89 20 8 11
Wyoming ............ 51 1 -
Colorado............ 4 140 499 7 10 2 5
New Mexico......... 1 242 97 6 7 1
Arizona............. 11 338 219 10 1 13 4
Utah................ 8 21 2 1 6 I
Nevada.............. 1 5 2 3

PACIFIC.............. 12 1,010 2,455 7 515 255 70 69
Washington......... 59 515 54 37 5 5
Oregon............. 198 502 15 20 15 4
California.......... 10 708 1,401 7 425 185 44 27
Alaska............. 8 2 11 2 1 1
Hawaii............. 2 37 35 10 11 5 32

Puerto Rico.......... 15 1,419 397 19 19 5 5
*Delayed reports: Measles: Me. 1, S.C. delete 2
Meningococcal infections: Mont. delete 1
Mumps: Me. 5
Rubella: Me. 4, S.C. 2





29b Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 23, 1969 AND AUGUST 24, 1968 (34th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
TYPHOID T EABIES IN
SORE THROAT & TETANUS TULAREMIA TICK-BORNE RABES IN
AREA SCARLET FEVER (Rky. Mt. Spotted)
t ? ,,-,L -. I -. t ur.

UNITED S T:,!T ,-"2 9 2 5 I1 i5 53 2,355

NEW ENGLA D.......... 405 14 1 8 18
Maine.*............ 17 1 -- 6
New Hampshire...... 20 4
Veront............ 14 2
Massachusetts...... 59 1 5 1
Rhode Island....... 43 -1 -
Connecticut....... 266 5

MIDDLE ATLANTIC...... 153 13 4 19 3 37 7 115
New York City...... 14 6 1 9 -
New York, Up-State. 117 3 3 3 5 5 6 107
New Jersey......... NN 2 1 2 11 -
Pennsylvania....... 22 2 4 1 21 1 8

EAST NORTH CENTRAL... 247 12 7 1 21 1 2 10 164
Ohio................ 34 1 1 8 6 50
Indiana............. 62 1 2 44
Illinois............ 58 7 2 9 1 2 1 27
Michigan.......... 51 4 4 5
isconsin.......... 42 4 1 38

1EST NORTH CENTRAL... 211 7 12 8 8 10 442
Minnesota.......... 3 2 3 4 116
I0.wa............... 24 7 2 64
Missouri........... 3 1 8 3 3 114
NHrth Dakota....... 89 55
south Dakota....... 8 1 24
Nebraska........... 69 1 1 11
Kansas............. 15 4 3 1 1 58

SOUTH ATLANTIC....... 449 18 20 29 4 191 11 601
Delaware......... 2 3-
Maryland........... 40 1 4 1 42 2 3
Dist. of Columbia.. 1 2 1 -
Virginia............ 156 4 56 1 305
West Virginia...... 67 1 2 1 5 1 91
North Carolina ..... Nt! 2 5 6 1 46 4
South Carolina .... 45 1 2 1 2 26 -
Georgia............ 2 2 3 7 12 3 60
Florida............ 138 9 4 7 4 138

EAST SOUTH CENTRAL... 765 15 9 2 22 4 44 3 340
Kentucky ........... 77 6 3 6 178
Tennessee.......... 589 4 8 2 16 3 36 114
Alabama............ 39 4 1 1 3 45
Mississippi........ 60 1 1 2 1 1 3

WEST SOUTH CENTRAL... 530 17 16 21 3 39 5 326
Arkansas.......... 5 1 1 10 6 24
Louisiana......... I 6 4 2 26
Oklahoa.......... 61 1 6 3 26 2 48
Texas.............. 463 9 5 9 7 3 228

MOuTAIN ............. 798 3 2 10 22 14 2 106
Montana............ 21 I -
Idaho.............. 81 3 4 -
yaing............. 12 2 5 1 51
Colorado........... 349 2 3 8 3
Ne Mexico......... 204 1 5 1 14
Arizona............. 76 5 22
'tah............... 55 2 7 2 4
N .vada........... 1 12

ACIFIC.............. 189 7 1 31 5 5 243
Wshingto ......... 61 1 1 2 3 1 4
eo ............. 55 6 3
alifrn:i ....... --- 6 23 2 4 236
Alaska............ .. 36


6 1 _2


* elated reports: SST: Me.
Typhoid:


S.C. delete 1, Okla. delete 1






Morbidity and Mortality Weekly Report






Week No. TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED AUGUST 23, 1969
34
(By place of occurrence and week of filing certificate. Excludes fetal deaths)


299


All Causes Pneumonia Under All Causes Pneumonia Under
Area All 65 years and 1 year Area All 65 years an yea
Ages and over Influenza All Ages and over
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, III.--------.
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.-------.


705
221
62
25
29
60
32
16
23
59
38
8
47
25
60

3,101
56
31
139
45
28
35
59
71
1,544
51
407
189
43
120
31
32
104
53
27
36

2,521
69
42
692
143
199
123
76
314
57
53
44
36
54
176
41
124
33
36
21
118
70

745
51
30
31
125
19
108
51
202
88
40


423
124
42
17
20
30
20
13
16
34
27
3
30
17
30

1 745
30
18
76
20
15
18
32
38
867
27
228
98
25
73
23
23
62
27
20
25

1,409
42
25
368
81
104
55
44
168
38
25
32
17
39
97
29
77
18
19
15
74
42

465
31
19
14
72
13
58
32
136
67
23


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, Col .----------
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.----------


1,050
117
195
43
64
94
45
91
32
81
46
197
45

620
105
64
27
139
127
35
31
92

1 ,212
48
35
49
164
38
79
252
46
164
64
158
41
74

416
48
23
105
14
100
10
59
57

1 ,601
21
47
40
54
85
479
88
35
155
64
93
184
43
127
42
44


Total 111,971 6,712 422 627
Total

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 447,631
All Causes, Age 65 and over------------------- 2156,9
Pneumonia and Influenza, All Ages------------- 21,524
All Causes, Under 1 Year of Age--------------- -20,831





300


Morbidity and Mortality Weekly Report


ANTHRAX (',ontinuTIl from paIg 29;)

Editorial Comment:
The 0e u tion of the10 locl lI-sion ith the resolution
of 1--iti (I s- pit>o sl and surrounding edema followinpr
intihiotir tlihrta1p i classical for ctli .an,1o i. anthrax.
The re nitnt al pt cime ni 1ns ini ait Es significant envriironmentaill con-
Imiint ion :it this plant and may represent inadequate
housiiekeepine. The rtc<"o\erY of H. anthruais from .I of 13
l0- ros sample indicates -a constant risk to employees.
handling those material-.




INTERNATIONAL NOTES
VENEZUELAN EQUINE ENCEPHALITIS
Guatemala and El Salvador

An estiniated 11,00( to ti,)00 horses in Guatemala and
o\ r 600 in EISalvador have died in an epizootic of Vene-
zuelan Equine Encephalitis- hat hegan in June 1969 ap-
parentIl in the Pacific coastal area and spread along the
border between the two countries (Figure 2). Horses are
being vaccinated in bo h countries to form a barrier around
this affected area; 2:10.00) doses of vaccine for use in
horses were supplied hy the U.S. Army Medical Research
and Det elopmenit Command (USAMRD(').

Figure 2
VENEZUELAN EQUINE ENCEPHALITIS
GUATEMALA AND EL SALVADOR
JUNE AUGUST 1969 ,r


Sur\r ilianc of human I as.1--s is heine conducted in
both countries. but to datel the extent of human insolhe-
mnie i.- unknown. THie l asees- of (rncphaliti-s with nine
b hI'iclai and hur:man studies atre continuing .
iKRporitt'ri hy Dfr. (rc .:r V1:.in i ,'.. DIlirc tori of Epid.nmi.
fogy+, ;IIIu 1 ital: )iniiftry 1rf health,: 1ir. EK airdo V1oarro.
/iT1r rtor of Epide.i' m1 T Iy, F Sv nd ador lini stry / of/II 4l1,;
DrT. Ig rm+ h' ;, 1tP /I li e d As .l ,wr. ir j.'SAf/) H at4rfml / i;
I tr4on Sr ,, Pub'irC Ilrealtf Alid ri, 1r, I'S I El S l inor;
/in+J t 'ams frfm U V[I)(OC and a teanm from. Y N'l '.;


AUGUST 23, 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 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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