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:
AA00010654:00179

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 S t V

sFLOr R /^ Vol. 18, N 6





SEP 1989 ;For

Week Ending

j September 6, 1969


U.S. DEPARTMENT OF HEALTH, EDUCATION AND P BLI: HEALTH SERVE E I-EALTH SERVICES AND MENTAL HEALTH ADMINISTRATION
DATE OF RELEASE: SEPTEMBER 12. 1969 ATLANTA, GEORGIA 30333


EPIDEMIOLOGIC NOTES AND REPORTS
IMPORTED BLOOD TRANSFUSION-INDUCED MALARIA
Florida and California

Two cases of blood transfusion-induced Plasmodium
malariae infections in American citizens who had been
hospitalized overseas were recently reported to the NCDC.
Case 1: On June 4. 1969, a 31-year-old woman underwent
a laminectomy in Mexico City for a slipped disc. Post-
operatively, she developed a wound infection and received
whole blood transfusions on June 9 and 28. The wound
infection did not respond to therapy, and on August 13.
the day she returned to the United States, she entered a
Miami hospital. FuIlli'..in transfer to another Miami hos-
pital on August 24, P. malariae parasites were identified
in a peripheral blood smear. The patient gave no history)
of travel to malarious areas in Mexico or elsewhere or
of illicit drug usage.


CONT 1)NTS
Epidemiologic Notes and Rports
Imported Blood Tran.sfuson Induced
Malaria Florida and California ...... 09
A Case- of Tetanus Guam .................. 310
Surveillance Summary
Tet.inus United Stiatrs and Puerto R wo 1967 ....... .:10


Case 2: A 24-year-old naturalized Philippino man with
chronic glomerulonephritis received multiple blood trans-
fusions. while visiting Manila in early 1969. On May 14,
he returned to the United States. Four days later, he com-
plained of fever and shaking chills to a physician at a
hospital in San Francisco. where he was enrolled in a
renal dialysis program. P. malaria organisms were found
(Continued on page 310)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
36th WEEK ENDED CUMULATIVE, FIRST 36 WEEKS
MEDIAN
DISEASE September 6. September 7. 1964 1968 MEDIAN
1969 1968 1969 1968 1964 1968
Aseptic meningitis .................... .. 149 192 141 1.861 2.356 1.745
Brucellosis ............................ 5 3 3 151 148 177
Diphtheria..... ...................... 4 9 7 107 120 120
Encephalitis, primary:
Arthropod-borne & unspecified .......... 44 42 49 778 793 1.176
Encephalitis, post-infectious ............. 1 10 10 239 369 580
Hepatitis, serum ........................ 76 71 568 3.612 2.954 97
Hepatitis, infectious .................... 832 725 31,929 30.240 "
Malaria ................................ 50 63 9 1.925 1.513 249
Measles rubeolaa) ....................... .121 89 414 20,248 19,520 189.095
Meningococcal infections, total ........... 24 23 23 2,347 1,999 2,018
Civilian ................................ 22 23 2,140 1.822 -
Military ............................... 2 207 177 -
Mumps ................................. 363 593 67.735 124.408 -
Poliomyelitis, total ..................... 3 3 10 41 44
Paralytic ............................. 3 2 9 41 41
Rubella (German measles) ............... 206 245 48,789 43.594 "
Streptococcal sore throat & scarlet fever.... 4,140 4.407 4.371 301.726 300.495 300.495
Tetanus ............................... 5 4 5 97 106 152
Tularemia .............................. 6 1 2 103 138 138
Typhoid fever .......................... 9 24 13 198 242 281
Typhus, tick-borne (Rky. Mt. spotted fever) 6 10 12 359 229 217
Rabies in animals ....................... 55 37 63 2,474 2,498 3,130

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ............................................ 3 Rabies in man: ................. ..................... 1
Botulism: .......................................... 11 Rubella congenital syndrome: N.J.-1 ................... 7
Leptospirosis: Calif.-l, Tex.-1 ...................... 50 Trichinosis: Mass.-l, N.J.-l .......................... 156
Plague: ................................ 3 Typhus, urine: ................................... 34
Psittacosis: Minn.-l ............................... 29 Poliomyelitis, non-paralytic: .......................... 1






310


in a p-ripheral ood -mea It. Prior to hi- emigration to th(e
(I'i Ed tale-. he man h1 1,e r e\vperiencd at clinical
ailt;wk Phi I Ippi noe
.'ol lowi n t herapi a1hrb roquin in st andard do-age.
lth i atient- |adI no furldhr d" idence ofl malaria infection.
ifpe*,t, hy M IVa- JiI 1 '1tr. V.JI .. ., Asistant P'rofessor


SEPTEMBER 6. 1969


of cetiicin'. I i '', of Viiaimi Sl' hoo! of Ifedicine : E.
(Char/ton Praother, VJ.l., )irctor., l)i ci 'mo of Eppidemi
ol/gy. Florid S/lae Board of Hlcalth: .aunRi(s Hidarde o i.
i.P.. SPl'S IH fspita. Sat Frawinc-to: and Philip K.
(Cot'it. .ll.. Rutreau of (C'nomiunaicable' iscuase c ,
(aluifornia i *t,. I I of Pbli' He6/ii alt h.


A CASE OF TETANUS Guam


Oin \Mah 19f a lI,-year-old diabetic man in (-tam
carl to the outpatient clinic oi f a local ho-pilal with com-
plaint- of a nail p tlwIture wound, incurred 3 hours earlier.
otn hi- lefl fool. The wound \a- cleaned, and he w\as gi\en
ol anuu- ti\owld and penicillin man1 d di -chiarged He Iaid no
li-lry\ of pre\ ou- Ielanu- toxoid immunization. ()n \Ma.
1:'. le wa- adm1 it/ed to the ho-pital htecause of a tickling
-en-ation of the wound, neck stiffnes-. +and coughing.
On i physical exaniination. hi- neck was stiff but not
rild,. hrealhin \\a- Ihallow, and pathological reflexes
ort< niiormial The left liho l w :i -wollon. bul no induration
or repitu- H1.- noted. He \al- ptien retanu- antitoxin in
dilttld d do,-, of 170.00 unit- daily,. intra\enolus and oral
pi'nicllin. chlorpromazine, a much, relaxant, and tetra-
rc\clh. \ Iwhite blood cell county wn1 13.h(0 hut a cht,-t
X-ray. ceorero-pinhal fluid. and orher laboratory te(ts taken
at aduiin-ltri tere normal. (Culture of the \wound realoed
ol>tIula-<' ney alt ie a' ture w, a- noeali\e.
On \la 1 21 hour- after admission, the neck stiff-
ie-- +:Ia, Morse and difficult, in breathing was noted. On


May 15. abdominal rigitr\ developed. The patient %%a:s
gi\on 500 u5nit- of human tetanu- ilnmunl globulin. \t
noon that lda\. hii- ital signs- vwero nonial, but I hour
later. he e\txrienced (icomul-ion- and died.
A culture of found d iss-ue obliniold at iutop)-y \ a
ipositi\e for ('lostridimii t'tani.

(Rfeportc d by OUiiri ('rz,. V.)1.. I and
the ('ro/mi icabic DIis asI' PrIro/i rm P('otordinaor. Guam
Di partmen'ii Pu 'i IH i! a ii:,i S ial 'r5 ies; andt, tlhe
ReUional Reprt er tii ir '. A\('I '. C SWI.IIA, I t ". lHEK',
Rett io IX, /Sain /'rit ist o.)

Editorial Comment:
Totanu- in the I'nited stater- is predominantly a dis-
*ea;e of ntiddlo-aged and elderl, persons. This case
.-strc(O-es lth need to asiceorain ciarlfull\ tetanus immuni-
zation history at the timnc of injury\ ;nd to gi' prophy-
lactic treatmennl ;s indicated bi tlh immunization status
(human hyperininune globulin and or loxoid for persons
whose iinmunizantion status is not adequate ir.tri.., to
presIent reconmt endal ions.)


SURVEILLANCE SUMMARY
TETANUS United States and Puerto Rico 1967


In 19iJ7. a total of 2L(;:6 ca,-.- of tetanus from :0 state-s
1d :: ca-o- from Puerto Rhio \(cr reported to the NC(DC.
riljr ti 1 anrc fuor.- erter rei r-- d on 2:-: I 1'.-. case- and on
2 Vat'.-, from Piuerto Rico.
1 ht I St it idontr of I ritnu- I at 0.12 [cates pi r
1lii, t( polul at ioni. Hil i tl \s\ a I- I*--tcnli all\ iuncharitng from
sr nid'nu w + rip, ortr.'l for 1'16.)t6i I *'.1 1). Theri, \+ -1 a
it l r i idi ne t t i ale- Ithan in fet aIl- hf i a ratio o 1 3
It ;iri Iti di -t t-i,- i times niore o r1in.n in noRn-
,- la it n hii 1l-. Thl peak inuid nce and th h-ih+
-t -^ fta. h+ r ulit ) r o o lrru ii u the eh \lr(er-- of aTe
(|" Lrt* 2) u l I sI in\(ll eleti n'lonatl -. (+the iodian e;1 of all
sl nlrH- uai- 1i + ar, \\tlih tin T(n rall ca ve falaal yit
rni ) u : a- T po| r"*rit, I. '+' a-. 7i pTrc n! for nI orI ae[ and
1 \cp ,,t < h pors .ni for th0 a1.' -roup- *"' )ear- ;n(d o\(er.
'|'tl -I' <.i- flfaIittml\ ruta( i +ro" -s ilar ho t ho-v from
' e-f U atir w r+ [ot -:iern f J canc 1' dillrent froni thit ra-.,
f tla l\ rlil~ii- -tiIK'( 19:i {lsin sure .:).


The >ouithern-most tier of states continued to have
the highest incidence in the nation (Figure 4). Ill stal(s
thai+ reported cas( in 1967!) also had cas,- during 196i5-66:
\rizona, \Mar Iandl. Nebrakai. Or(eon. and South ('arolina
reportedly cas-es in 1965-i.- i ut not in 19617. The peak sea-
sonial inei:itnct l of tltanu-i occurred from \pril through
O)ctoh, r. but no -o-ea-onal \ariation \'-i noted in nlonaltal
Eetaon Ii
I.aceration- and puncLture woundtt-ere rIth nmo fro-
quenl prLodis-losini injuriH- in 19;t7 and wac and 2-.(I piercu nt. rI-spw(c i\,rip. of the tolal case-. Hotund-
tof ti h foet and hands- atIo n to for :0 .ti and "22.; ptrelnt.
repect iely. of all c-as-s in which a -ile of injury wa-
idlcenified. TI'he ltrme \ a- the cnont nestq pl race for in-
Currimn+ ihe predi,-+posin injur r. The n edi an Incuhation
period for all ciai- 0 :- 7 dl:I .
Pre-e fo 1in7 -\ilpouini- ain clhi iral ot ur-r i t r *-
ported for 177 ca.e-. Relan\+el lohw morjutolll :ais noted


Morbidity and Mortality Weekly Report


MALARIA i(oitinf t d from front fpoi(






Morbidity and Mortality W4


Figure 1
TETANUS MORBIDITY AND MORTALITY
UNITED STATES 1950-1967


1.00o


INCIDENCE RATE
- MORTALITY RATE


S.


SEPTEMBER 6, 1969


1950 1952 1955 1958
YEARS


1961 1964 1966 1968


50 51 52 53 54 55 565 57 58 59 60 61 62 63 64 65 66 67
YEARS

SOURCE. MORBIDITY AND MORTALITY WEEKLY REPORT, ANNUAL
SUPPLEMENTS

in patients with both trismus and local muscle spasm,
while convulsions, either as a presenting symptom or
developing later in the illness, were associated with a
poorer prognosis.
Mortality for persons receiving no serotherapy was
approximately 79 percent. Treatment with various anti-
toxin preparations was associated with lower mortality.
Clostridium tetani was isolated from cultures taken
after onset of illness in 23 of 76 cases.
Immunization data were reported for 50 patients. For
49 of these patients, there was no record of complete pri-
mary immunization; 11 of them had received single boosters

Figure 2
TETANUS CASE FATALITY RATIO
BY AGE GROUPS UNITED STATES 1967
100l


90

80

o 70

: 60

o 50

40
U-


o 30

20

10


10 20 30 40 50 60 70 >70
AGE


Figure 4
GEOGRAPHIC DISTRIBUTION OF NON-NEONATAL TETANUS
CASES AND INCIDENCE RATES
UNITED STATES AND PUERTO RICO 1967


Q..E ... C A
U, W~Q
U,,


[]l


in the 10 years preceding injury and 38 received boosters
within 72 hours after injury; 35 of these 49 patients died.
The one patient with a history of adequate immunization
according to present standards* recovered.
The incidence of neonatal tetanus was 0.233 cases
per 100,000 live births for whites and 2.94 cases per
100,000 live births for nonwhites. All cases of neonatal
tetanus except one occurred in babies delivered outside
the hospital environment to mothers with no history of
immunization or with a history of incomplete immuniza-
tion. The one child born in a hospital, who developed
tetanus, had onset 22 days after discharge, suggesting
that contamination occurred in the home environment. For
all but one infant, the umbilicus was identified as the
site of infection. The exception was a child with exten-
sive neonatal dermatitis which was felt to be secondarily
infected.
The overall incidence in Puerto Rico was 1.4 cases
per 100,000 population. Although this incidence was 10
times that of the United States, a downward trend in tetanus
(Continued on page 316)


weekly Report 311


Figure 3
TETANUS CASE FATALITY RATIO
UNITED STATES 1950.1967






312 Morbidity and Mortality Weekly Report


TABLE III, CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

SEPTEMBER 6, 1969 AND SEPTEMBER 7, 1968 (36th WEEK)


ENCEPHALITIS HEPATITIS
i:' i1tt"im i\ Primary including i'-- HALARIA
AR A iiSerum Infeetious
A R EA t I l l rn -'p c al e-s hl ,i Is mi
Cun.

UNITED STAIL ... I -"

NEW ENGIAND......... 15 2 4 1 81 40 1 67
-Maine-............. 6 6 6
New Ha pshire...... 5 2 2
V- r -1nt ............ -
Mas,.schusetts...... 12 2 3 39 21 44
R d Island ....... I 1 30 9 3
Connecticut........ 2 -- 1 2 1 12

MIDDLE ATLANTIC...... 3 1 7 9 30 162 108 3 223
New York City...... 5 18 23 28 20
New York, up-State. 5 1 1 1 23 8 33
New Jersey.*....... 16 4 10 50 20 86
Pennsylvania....... 13 1 2 8 1 66 52 3 84

EAST NORTH CENTRAL... 26 1 13 8 11 110 72 7 199
Ohio ............... 8 6 3 5 22 15 19
Indiana ............ 9 11 1 19
Illinois........... 3 2 4 17 24 5 119
Michigan........... 6 1 4 1 6 54 27 2 41
isconsin .......... 1 6 5 1

WEST NORTH CENTRAL... 18 1 1 11 2 32 39 8 135
Minnesota......... 18 2 2 4 13 7
Iowa............... 1 4 14 5 13
Missouri........... 1 7 17 1 36
North Dakota....... 4 1 3
South Dakota....... 2 --
Nebraska........... 2 2 3
Kansas............. 1 3 1 7 73

SOUTH ATLANTIC....... 19 2 2 9 8 78 78 5 514
Delaware .......... 2 3 3
Mryland........... 5 2 2 13 11 28
Dist. of Columbia.. 1 1 1 1
Virginia.*......... 2 2 1 6 12 20
West Virginia...... 3 6 8 14 -
North Carolina..... -- 2 8 233
South Carolina..... 8 8 5 3 47
Georgia............ 2 16 18 2 156
Florida............ 1 1 4 22 6 26

EAST SOUTH CENTRAL... 1 1 1 2 56 36 85
Kentucky............ 11 8 67
Tennessee.......... 1 1 1 31 15 -
Alahbama ............ 1 7 4 16
Mississippi........ 1 7 9 2

WEST SocTH CENTRAL... 8 1 2 2 78 52 6 111
Arkansas........... -. 10
Louisiana.......... 4 2 2 14 13 3 40
Oklahoma........... 1 12 4 2 45
Texas.............. 3 1 52 35 1 16

MOUNTAIN ............. 4 2 2 52 35 121
Montana............ 3 1 6 3
Idaho.............. 5 3
Wy ning............ 1 2 -
Co.lrado........... 1 1 1 14 14 102
New Mexico......... 1 7 4 7
Arizona............ 13 3 1
ltah............... 1 5 1 1
Nevada............. 11 4

PACIFIC.............. 1 9 6 1 20 183 265 20 470
Washington........... 5 11 29 5
Org .on............. 3 26 22 9
California........ 14 9 6 1 17 146 213 2U 366
Alaska.............. 2
Hatwaii............. 1 88


*elavedt reports: Aseptic neninpitis: U.Va. delete 2
Rrucellosis: Va. 6
Hepatitis, ; erum: H.J. delete 1
lreattilt), infectlonq: Me. 19, N.J.


delete 2, P.R. 2






Morbidity and Mortality Weekly Report 313


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

SEPTEMBER 6, 1969 AND SEPTEMBER 7, 1968 (36th WEEK) CONTINUED


MEASLES (Rubcola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL
AREA Total Paralytic
Cumulative Cumulative Total Para yt-c




NEW ENGLAND........... 8 1,102 1,148 3 87 116 71 1 24
Maine ............. 8 37 6 6 6 2
New Hampshire..... 238 141 2 7 -
Vermont ........... 3 2 1 6 6
Massachusetts. .... 214 359 1 34 63 15 6
Rhode Island....... 23 5 11 8 6 4
Connecticut........ 8 616 604 2 34 31 38 1 6

MIDDLE ATLANTIC...... 21 7,475 4,006 4 387 358 38 1 10
New York City...... 13 4,905 2,080 73 72 29 6
New York, Up-State. 1 596 1,217 1 72 64 NN 2
New Jersey......... 4 886 599 3 158 126 9 1
Pennsylvania.* 3 1,088 110 84 96 NN -- 1 1

EAST NORTH CENTRAL... 18 2,180 3,762 3 320 236 70 30
Ohio............... 5 375 293 1 121 64 5 4
Indiana ............ 466 671 2 38 29 1 5
Illinois ........... 1 495 1,360 44 53 11 1
Michigan........... 10 273 264 95 70 21 14
Wisconsin.......... 2 571 1,174 22 20 32 6

WEST NORTH CENTRAL... 6 524 383 118 108 13 1 14
Minnesota......... 1 7 16 25 26 1
Iowa................ 329 98 16 6 6 8
Missouri ........... 1 26 81 51 35 3 2
North Dakota....... 2 14 133 1 3 -
South Dakota....... 3 4 1 5 NN -
Nebraska........... 2 138 41 9 6 4 3
Kansas............. 7 10 15 27 1

SOUTH ATLANTIC....... 12 2,490 1,498 3 404 403 31 1 39
Delaware .......... 373 16 8 8 -
Maryland........... 75 96 38 32 9 8
Dist. of Columbia.. 6 1 9 14 -
Virginia........... 883 295 50 35 5 8
West Virginia...... 193 288 18 11 5 16
North Carolina..... 1 315 282 1 68 76 NN -
South Carolina..... 116 12 1 56 56 5 4
Georgia............ 1 2 4 70 81 -
Florida............ 10 533 499 87 90 7 1 3

EAST SOUTH CENTRAL... 107 492 2 144 183 28 1 18
Kentucky........... 63 100 50 84 3 3
Tennessee.......... 17 62 1 54 52 24 13
Alabama...... 4 94 24 26 1 1 1
Mississippi........ 23 236 1 16 21 1

WEST SOUTH CENTRAL... 40 4,496 4,779 4 320 302 46 4 35
Arkansas............ 16 2 30 20 -
Louisiana.......... 120 23 2 85 86 -
Oklahoma............ 136 117 30 50
Texas............... 40 4,224 4,637 2 175 146 46 4 35

MOUNTAIN............ 9 852 977 43 30 24 17
Montana ............ 1 17 58 8 3 2 -
Idaho............... 89 20 8 11 -
Wyoming ............ 51 1 I 1
Colorado............ 140 501 7 10 7
New Mexico......... 1 245 102 6 12 4
Arizona............ 6 351 219 10 1 8 5
Utah................ 1 9 21 2 1 2 -
Nevada............. 1 5 2 3 -

PACIFIC.............. 7 1,022 2,475 5 524 263 42 19
Washington......... 59 515 54 38 1 5
Oregon............ 198 511 15 21 3 2
California......... 7 719 1,412 5 434 190 35 8
Alaska............ 8 2 11 2 2
Hawaii............. 38 35 10 12 3 2

Puerto Rico.......... -- 1,437 403 --- 19 19
*Delayed reports: Measles: Mass. delete 4
Meningococcal infections: Ala. 1
Mumps: Me. 4
Rubella: Me. 2, Pa. 2







314 Morbidity and 114oriality Weekly Reporl


TABLE Il. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

SEPTEMBER 6, 1969 AND SEPTEMBER 7, 1968 (36th WEEK) CONTINUED


STREPTOCCCAL TYPHUS FEVER
ORE THROAT & TETANUS TLLAREMIA ITICK-BORNE RABIES I
AREA SCARLET FEVER (Rky. Mt. Spotted) ANIMALS
Cum. Cun. Cum. Cum. Cum.
S~1>9 1969 1i4f4 1ih 69 1969 14 196 69 1969 1969 1969
UNITED STATES... 4,140 5 97 6 103 9 198 6 359 55 2,474

NEW ENGLAND ....... 555 14 1 9 2 20
Maine................ 13 1 6
New Hampshire...... 12 -- 4
Vermont............ 23 14 2
Massachusetts...... 46 1 6 1
Rhode Island....... 69 -. -- -
Cnnecticut........ 392 1 2 7

MIDDLE ATANTIC...... 82 13 4 1 21 40 5 142
N York City...... 4 6 1 10 -
New York, Up-State. 50 3 3 5 6 5 134
New Jersey......... NN 2 I 2 12 -
Pennsylvania....... 28 2 4 22 8

EAST NORTH CENTRAL... 159 12 10 21 2 8 176
Ohio.............. 37 1 8 7 57
Indiana. .......... 38 1 45
Illin1is........... 8 7 3 9 2 28
Michigan........... 38 4 4 6
Wiscnsin ......... 38 6 1 40

WEST NORTH CENTRAL... 292 7 13 8 8 7 457
Minnesta .......... 10 2 3 3 121
Iowa............... 50 7 1 65
Missouri........... 2 1 -9 3 1 118
Nrh Dakta....... 111 2 58
South Dakta....... 2 1 24
Nebraska......... 59 1 1 12
Kansas............. 58 4 3 1 59

SOUT ATLANTIC....... 519 18 20 31 4 195 12 624
Delare ........... 2 3 -
Maryland........... 41 4 42 3
Dist. cf C; lu- b-.. 2 I --
Virginia........... 102 4 1 57 3 315
est Virginia...... 151 1 2 1 5 93
North Carolina..... N? 2 5 6 1 47 4
Scuth Carolina..... 60 1 2 1 2 29 -
Georgia............ 16 2 3 9 12 3 65
Florida............. 149 9 4 7 6 144

EAST SOUTH CENTRAL .. 864 1 16 2 11 5 28 2 53 3 349
Kentucky............ 102 6 3 8 1 181
Tennessee.......... 601 4 2 10 1 18 1 39 1 116
Alabama............ 76 1 5 3 4 4 46
Mississippi........ 85 1 1 1 3 1 2 1 6

EST SOUTH CENTRAL... 497 1 18 1 18 22 42 13 348
Arkansas.*......... 1 1 1 10 7 25
L isiana.......... 1 7 4 3 26
Olaho-a........... 11 1 1 7 28 2 50
Texas.............. 485 9 6 9 7 11 247

MO NTAIS ............. 847 1 4 1 11 23 14 3 111
Montana ............ 34 1 I -
Idaho.............. 79 3 4 -
vmin............ 12 2 5 1 52
Cilorad:.......... 424 2 3 8 3
Sew Mic......... 216 1 5 1 15
Arizna............ 65 1 1 5 22
Utah............... 17 1 8 2 5
-va ............. 1 1 14

PACIFIC ............. 325 2 9 2 2 2 35 5 2 247
W.ih i ........ 64 1 2 2 2 3 4
Or.,............ 57 6 3
Cliria......... -- 2 8 2 27 2 2 240
A a ............. 20 -
184 -

rt R c.......... --- --- 5 --- --- 6 --- -- 2U
*Delayed reports: SST: 'e. 5
Rabies in animals: Ind. delete 1. Ark. 1






Morbidity and Mortality Weekly Report






Week No. TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED SEPTEMBER 6, 1969
36


315


(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 In afen All
Influenza All Influena All
Ages and over Al l 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, 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.------


690
229
41
31
28
59
26
16
21
48
60
11
36
27
57

2,985
52
35
142
46
26
51
63
54
1,482
33
395
187
44
123
32
38
82
42
28
28

2,381
57
37
678
164
208
99
81
299
40
27
30
31
77
137
34
129
41
34
45
70
63

687
33
19
28
122
23
111
48
203
61
39


406
123
27
20
16
33
17
11
14
32
31
8
19
15
40

1 ,747
27
18
82
32
11
24
38
27
843
21
242
98
29
83
22
27
59
27
18
19

1,339
35
16
373
87
118
47
46
160
29
14
19
16
55
83
18
72
23
19
23
44
42

419
23
14
18
76
14
76
28
111
37
22


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------------
choenix, 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


969
119
182
52
51
82
51
74
29
65
55
164
45

555
64
44
27
116
125
46
32
101

1,008
26
27
17
143
35
57
175
40
177
74
127
54
56

410
34
26
84
22
134
11
46
53

1,318
25
47
10
42
83
334
80
33
108
58
100
157
36
118
46
41


S11,003


S6,222 365 534


Expected Number 11,752 6,700 341 520


Cumulative Total
includess reported corrections
Lr pres ious weeks)


470,908


269,968


22,314


!1,984


*Mortditi data are being collected from Las Vegas Nev.. for possible inclusion n this
Las Vegas, Nev.* table, however, for st.ttstcal reasons these data will be hsted only and not included in
18 10 1 the toldul expected number, or cumulatise total, ontii 5 years of data are collected.






316


TETANUS (('ontin ued from page 311)

in Puerto Rico has b1en appa rentt since 1961 (Table 1).
Of the 39 cases. U1 ~1ere in m1 ale.s and the median age was
5t years. The greatest number of cases occurred from
February through July., a seasonal trend which might be
related to grealtr ouldoor actiilty during the sugar cane
production seta.on.
Table 1
Incidence of Tetanus in Puerto Rico, 1961-67


Number of Incidence
Year Reported Cases per 100,000

1961 193 8.0
19)6 194 7.7
1963 lh9 7.5
1961 179 6.9
1965 70 2.7
1966 59 2.2
1967 39 1.4


(Reported by the Special oPathogens Section. Bacterial
Dis~cses 1ranchn, and the Statistical Services Activity,
Epideniiology Program. CO('.)

\ pI) of tlhi r-ptort from Swhich theh data s r ,re derived is
.tvlaibl on r liqu st from
Nation:d ('ommunl.iab. lD)isease Ceonter
Attn: (Chiof. Sp ecial Pathogen-, Section.
BI t>Trii D)l,,tsi: R Branch. Elpidmiiology Program
Atlanta. (;-orgia 30333

'* i orinlndmirLa ion, of the I'tlS Advisory Committee on Immuni-
li.tlion IPral icei Diphtheri a, T'etatlius, and Pertussis Vac-
cini-s (MM\iR, Vol. 15, No. 4S).
Primary Immunization
Children 2 months through 6 years (Ideally beginning at age
2-:1 month or at Illte trinw of a 6-sieek "check-up" if such
timing i aIi -talb luisheid routine .)
DIlP T- "Ihil rli'. mniondeid single dose given Intramuseu-
I ,rl i n thrf,' o, casion at 4-6 wee(k intervals with a rein-
ftorinL dios ap&iproxinaiit ly on.e year after the third injection.
Adults and children over 6 years
[I)* The recomimnrndd single dose given intramuscularly
or sulotutianousily on It'o o"ca. sions at 4-6 week intervals
.ith ai reinforcin l do ,t approximately one year after the

Booster Immunization
Children 3 through 6 years, (Preferably at lime of school
entr n ,, kind ,rti'artt n or elementary school.)
[)IfP '[he r*ecommended single dose intrramuscularly.
Thereafter and for all other individuals
IT) 1hi- r-i,-rmniendedI single o; e intramuscularly or
u l l iut iiiou I e,vr) In 10 Y oi 1 Io, ft l Ill ui l .nMit -.-* p<1c iflc recommendations a
lO-N, er inN irv tl i dItrirminand from that daie). More fr quent
ro ut0n it. ti: .r tdo- ar not indicated and may be asao-
et iatUd v i tw i ncreascid r> < lt IonIs.
' TO i ii, s r.r lhl t g. ill hor E (1r nmm nl.izaetior at ag*ls oer
6 y-as in thrl ilas f i Ilia regarding it Iftfe , l.. i... I di f ih I ri: and adults l. id bl, .aust o it ihr re. astrin
r ill ll i I liphlherI x icd w-1.h e, The usi e f this
pripair ati ti ibv6 itcs th* i0 t d tr Schick or Molroi-y t-t ing prior to




ERRATUM, Vol. 18, No. 35, p. 308
In tlhe article., "International Notes, Quarantine-
Exemipt Areas." Mr xic.o should not he included as. a
quaranin '-exi'mpl area. Persons trailing hetwleen the
I nitld lalte- and M, \xico are iPtoni) from ,rnallpox \Iac-
cinalion. prolidd the ,y isited only lhes, t1o countries
during tho prffcline 11 days.


SEPTEMBER 6, 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.
DIRECTOR. EPIDEMIOLOGY PROGRAM A. D. LANGMUIR. M.D.


EDITOR
MANAGING EDITOR


MICHAEL B. GREGG, M.D.
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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