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:
AA00010654:00183

Related Items

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

Full Text

NATIONAL CE D E

NATIONAL COMMUNICABLE DISEASE CENTER


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE


Vol. 17, No. 6


WEEKLY

REPORT

SWeek Ending
February 10, 1968



PUBLIC HEALTH SERVICE


BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


Af LU, A CURRENT TRENDS
ES United States

For T1o.--k I L February 10, 647 cases of mea-
Ssles were report to' CDC. This is an increase of 99
4 ~i. from the to ft',r the previous week, but is 1,916
-. ..a*-i'. I'le r than t _i'..t. cases reported for the sixth
: ,.'W el. in I't.7 /
', :;,-jmb-r oif measles cases reported each
neok f6r '-p I .t ..-k- exceeded 500, the low level of
reported cases in epidemiologic year* 1967-68 compared
with the preceding epidemiologic year is' continuing (Fig-
ure 1). During the first 18 weeks of the current epidemio-
logic year, 6,752 cases of measles were reported; this is
*The epidemiologic year for measles begins with week number
41 of the calendar year and ends with week 40 of the succeed-
ing year.



3,000- REPORTED CASES OF MEA
EPIDEMIOLOGIC YEAR 1'
FIRST 24 WEEK

2,500- I ,,

S,5oo-,

1,000- 3t8

500-
0 1,500- .



1,000-



500


CONTENTS
Current Trends
Measles- United States ................. ...... 49
Influenza- United States ..................... 50
Trends in Meningococcal Disease 1968 . ... 50
Epidemiologic Notes and Reports
Pneumocystis Carinii Pneumonia New Jersey 51
International Notes
Cerebral Spinal Meningitis Palermo, Sicily ....... ..56



a decrease of 16,487 cases from the number reported in
the comparable period in epidemiologic year 1966-67. The
marked seasonal increase in reported measles cases noted
in 1966-67 has not been observed to date in 1967-68.

(Reported by State Services Section and Statistics Sec-
tion, NCDC.)


Figure 1
LSLES BY WEEK, UNITED STATES
967-68 COMPARED WITH 1966-67
S (OCTOBER-MARCH)


r_\


1967-68


42 44
OCT. NOV.


46 48 50 52 2
DEC. JAN
WEEK NUMBER


4 6
FEB.


8










Morbidity and Mortality Weekly Report


CURRENT TRENDS
INFLUENZA United States


In the I'nited States, there is no longer total excess
mortality or excess mortality\ in the group aged 65 and
o\r:. hoI \e\, r. for the country as a hole. -light ecemss
pii' iuinia-influenza mortality continues. Of the nine
ceographic divisions. only four. Newa Enland. South
\tlantic. East South Central. and -est South Central. have
anx excess pneumonia-influenza mortality. In each of these
four divisions, however, her, hre ere fewer deaths in the
si\th \ wk of the year than in the preceding week.
Additional reports of outbreaks of influenza and docu-
mented individual cases of influenza continue to be sub-
mitted to NCDC'. An outbreak of influenza has been re-
ported in Tyonek. Alaska. Paired sera were positive for
A influenza in 16 of 22 patients. Influenza \as reportedly
introduced in Tyonek through a first grade school teacher
in Tyonek waho de eloped influenza on December 30. 1967.
while visiting Kansas City. Missouri. The teacher returned


to Tyonek on January 1. and the outbreak awas first noted
in school children on January 5.
Isolated documented cases of A influenza have been
reported from California. Of interest is that many of the
initial cases occurred in student- who developed the ill-
ness -hortl after returning from Christmas holidays in the
East and Mlid-wst. There has been no evidence of exten-
si\e spread of influenza to other students. and no out-
breaks of influenza have been recognized in California.
to date.

(Reported by Ra/lp, B. t Or. P.1.. Acting Director,
li)isiont of Public health, Alaska Department of Health
and i welfare. The Arctic H/ealth Research Laboratory, Fair-
baunks. Ala~nka; Philip K. Condit. VI.D., M1.P.H., Chief,
Bureau of Communicable Diseases. California State De-
partment of Public Health; and EIS Officers.j


TRENDS IN MENINGOCOCCAL DISEASE 1968


An abrupt increase in the monthly incidence of menin-
gococcal infections occurred in January 1968. The adjusted
incidence rate for December 1967. 1.12 cases per 100,000
population, the lowest rate for this month in at least 8
years. increased to 2.1b cases per 100,000 population in
January (Figure 2): this is the highest monthly rate noted
for January in 12 years. A substantial increase in cases
began in the third week of 1968 when bS cases were re-
ported. followed by 99 and 121 cases for the fourth and
fifth weeks respectively (Table 1). Of the 412 cases re-
ported by the end of the fifth week. 94.1 percent were
civilian cases: only 24 cases were reported by the military.
The South Atlantic and \est South Central geographic divi-
sions account for 50 percent of these 412 cases. States in
these regions with high individual totals include Florida

Figure 2
MONTHLY INCIDENCE OF MENINGOCOCCAL INFECTIONS
UNITED STATES
MEAN MONTHLY RATE
1960-1966


Table 1
Meningococcal Infections
First 5 Weeks, 1967 and 1968

\Week 1967 1968
Number Civilian Military Total Ci\ilian Military Total

1 41 1 42 39 1 40
2 668 76 67 0 67
3 68 5 73 82 3 85
4 41 3 44 89 10 99
5 47 4 51 111 10 191
265 21 286 388 24 412



(22 cases). Louisiana (24 cases). Oklahoma (18 cases),
and Texas (43 cases).
Of 110 meningococcal strains received by NCDC be-
tween January 1 and February 9, 196b. -4.5 percent were
Serogroup B, and 49 percent were .i. _,rl. C strains.
\ilin..,i all divisions submitted strains identified as
Serotype C. 50 percent of all group C strains came from
the South Atlantic division. During 1967, group C strains
accounted for only 20.7 percent of 367 strains submitted
to NCDC.
Of the group C isolates received in 1968, 22 strains
have been subjected to sulfonamide sensitivity ir-r ng
11 of these strains (50 percent) were inhibited by 1.0 mg.
percent or less of sulfadiazine. In contrast, in 1966, 80
percent of group C strains were inhibited by 1 mg. percent
or less of sulfadiazine, and in 1967. 60.5 percent of all
group C strains tested were inhibited at this concentration.

(Reported by Bacterial Diseases Section, E'pidemiology
Proegramn, and Bacterial Reference Unit and Bacterial
Serology Unit, Laboratory Program, NCDC.)


OCT NOV DEC JAN FEE MAR APR MAy JUN JUL AUG
MONTH


FIBRUIARY 10. 1968














A case of Pneumocystis carinii pneumonia in a 6-
month-old male infant with thymic aplasia and lymphoma
occurred in New York City in December 1967. The pa-
tient's growth had been normal until age 3 months, when
anorexia, failure to thrive, upper respiratory symptoms,
and diffuse wheezing, brought the patient to the attention
of a physician. Broad spectrum antibiotics were adminis-
tered by the physician for 1 month without improvement.
Following a spontaneous syncopal attack, the patient was
admitted to a New Jersey hospital on November 14. Ex-
amination showed advanced bilateral interstitial pneumo-
nia, hepatosplenomegaly, and hypochromic, microcytic
anemia. The patient was treated with digoxin, erythromy-
cin, and parenteral iron supplement, but no improvement
was noted.
On November 26, the patient was transferred to a New
York City hospital with the tentative diagnosis of P. carinii
pneumonia. Physical examination revealed an alert, non-
cyanotic, tachypneic child in an oxygen tent. His rec-
tal temperature was 37.70 C., pulse rate was 160 per min-
ute, and respiratory rate was 70 per minute. The chest had
'slight.intercostal retraction and bilateral moist rales in
/ the dependent portion of the lungs. A hard. non-pulsative
liver was palpable 7 cm. below the'right costal margin;
the spleen extended 5 cm. below the left costal margin,
No edema or neuorologic abnormalities were observed.


The laboratory findings of the absence of a thymic
shadow on X-ray, absence of small lymphocytes in the
peripheral blood, failure to demonstrate delayed hyper-
sensitivity with the fluoronitrobenzene skin test, hypo-
gammaglobulinemia,and the demonstration of occasional
doubled walled, nucleated structures compatible with P.
carinii in aspirates of bronchial secretions stained with
methenamine silver, provided the clinical diagnosis of
thymic aplasia and P. carinii pneumonia.
On November 30, an open lung and liver biopsy through
a left thoracotomy incision was performed on the child.
Routine hematoxylin and eosin stains of the lung showed
interstitial widening without the characteristic alveolar
exudate of P. carinii. Mathenamine silver stains, however.
identified numerous P. carinii organisms in the interstitial
spaces. The liver biopsy was read as lymphoma by sev-
eral attending physicians. Pentamidine isethionate*, 4
mg. per kg. I.M. per day. was started after the biopsy and
continued for the recommended 14 days. No adverse re-
actions were encountered. By the fourth day of treatment,
the patient was less short of breath and could be removed
from the oxygen tent. Throughout the next week, the pa-
tient's appetite improved, and the rales gradually disap-
peared; there was definite radiographic evidence of clear-
ing of the pneumonia. Repeat tracheal aspiration at this
(Continued on page 56)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Totals include revised and delayed reports)
6th WEEK ENDED MEDIAN CUMULATIVE, FIRST 6 WEEKS
DISEASE M N ---
DISEASE February 10, February 11, 1963 1967 MEDIAN
1968 1967 1968 1967 1963 1967
Aseptic meningitis ...................... 20 26 25 157 170 158
Brucellosis ............................ 2 7 5 16 24
Diphtheria .............................. 5 4 4 12 16 18
Encephalitis, primary:
Arthropod-borne & unspecified ........... 8 34 82 127 -
Encephalitis, post-infectious ............. .13 13 50 58 -
Hepatitis, serum ... ............... ..... .72 31 827 393 208 4,
Hepatitis, infectious .................... 854 796 4,734 4.497
Malaria ............................... 35 48 2 277 194 14
Measles rubeolaa) ................... ... 648 2,563 8,237 3,002 11.046 38.363
Meningococcal infections, total ........... 82 58 70 494 346 346
Civilian .............................. 81 55 469 322
Military ............................... 1 3 --- 25 24
Mumps ................................. 5,439 27.663 -
Poliomyelitis, total ..................... 1 1 2
Paralytic ............................. 1 1 1
Rubella (German measles) ............... 861 1,030 3,543 3,930 -
Streptococcal sore throat & scarlet fever.... 11,563 12,590 12,072 67.601 67,779 59,022
Tetanus ............................... 2 2 3 10 15 20
Tularemia .............................. 4 1 3 12 14 25
Typhoid fever ........................... 3 6 6 23 34 34
Typhus, tick-borne (Rky. Mt. spotted fever) 3 4 4
Rabies in animals ....................... 82 89 89 429 441 434

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........................................... R babies in m an: ................................... .
Botulism: .......................................... Rubella, Congenital Syndrome:......................... .
Leptospirosis: ...................................... 2 Trichinosis: Mo.-1 ................................... 5
Plague: ............................................ Typhus, marine: V a.-2 ................................ 2
Psittacosis: NYC-2 .................................. 4


FEBRUARY 10, 1968


Morbidity and Mortality Weekly Report


EPIDEMIOLOGIC NOTES AND REPORTS
PNEUMOCYSTIS CARINII PNEUMONIA New Jersey









52 Morbidity and Mortality Weekly Report


TABLE Ill. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

FEBRUARY 10, 1968 AND FEBRUARY 11, 1967 (6th WEEK)


ENCEPHALITIS HEPATITIS
ASEPTIC HI LO(lS PUTHERA Primary Post-
AREA MENINGITIS including Infectious Seum Infectious MARIA
unsp. cases
1968 1967 1968 1968 1968 1967 1968 1968 1968 1967 1968
UNITED STATES... 20 26 5 8 34 13 72 854 796 35

NEW ENGLAND............ 2 2 5 2 2 29 34 2
Maine.............. 2* -
New Hampshire...... 4
Vermont............
Massachusetts...... 1 2 1 20 21
Rhode Island....... 1 2 3 4 4 1
Connecticut........ 1 2 3 5 1

MIDDLE ATLANTIC...... 3 8 4 2 20 114 101 12
New York City...... 1 4 8 34 19 1
New York, up-State. 1 1 4 34 41 2
New Jersey.......... 1 5 6 20* 8 5
Pennsylvania ....... 2 2 2 26 33 4

EAST NORTH CENTRAL... 2 1 2 7 4 1 154 164 2
Ohio................ 4 50 34 1
Indiana............ 1 1 1 11 25
Illinois........... 1 1 53 27 1
Michigan........... 1 1* 4* 1 33 54
Wisconsin........... 1 7 24

WEST NORTH CENTRAL... 1 1 67 54 2
Minnesota.......... 1 14 4
Iowa................ 1 23 14
Missouri........... 20 26
North Dakota ....... 3 1
South Datlota ...... -
Nebraska ...........- 2 1 -*
Kansas............. 4 8 2

SOUTH ATLANTIC..... 1 1 1 10 2 98 86 5
Delaware............ 7 3
Maryland........... 1 1 2 25 28 2
Dist. of Columbia.. 1 -
Virginia........... 19 17 1
West Virginia...... 14 7
North Carolina..... 3 7 1
South Carolina..... 4 -
Georgia............. 10 24 12 1
Florida............. 1 5 8 -

EAST SOUTH CENTRAL... I 3 1 1 2 1 59 63
Kentucky........... 8 16
Tennessee.......... 2 1 18 33
Alabama............ 3 11 10
Mississippi........ 1 1 1 22 4 -

WEST SOUTH CENTRAL... 2 2 3 2 1 86 71
Arkansas........... 1 5
Louisiana........... 1 12 10 -
Oklahoma............. 1 8 9
Texas.............. 2 2 3 65 47

MOUNTAIN............. 1 42 27 7
Montana............ 2
Idaho.............. 3 5
Wyoming............. 2
Colorado........... 11 11 6
New Mexico......... 1 2 3 1
Arizona............ 14 6
Utah............... 7 2
Nevada............. I -

PACIFIC.............. 11 9 2 6 2 44 205 196 5
Washington.......... 1 1 2 14 23
Oregon.............. 9 35
California.......... 7 6 2 4 2 44 176 135 5
Alaska.............. 2 2
Hawaii............... 3 2 4 1 -

Puerto Rico.......... 10 8
* 2 ,, F. rr Fn ,[ r-,. Ii ., Fr r., 1,i.. r, I r.
Fr .h at F t 'Itch. 2
,. tt nl-'"In- .. MIns. 1, New Jersey Delete 4 cases 1967
*I 1 r is 'r so n I .. [r.










Morbidity and Mortality Weekly Report 5:


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

FEBRUARY 10, 1968 AND FEBRUARY 11, 1967 (6th WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL
AREA Total Paralytic
AREA Cumulative Cumulative Total Paralytic
Cum.
1968 1968 1967 1968 1968 1967 1968 1968 1968 1968 1968
UNITED STATES... 648 3,002 11,046 82 494 346 5,439 861

NEW ENGLAND........... 41 136 154 7 28 10 577 147
Maine............... 7 8 2 1 45* 9*
New Hampshire...... 5 15 38 2 8 -
Vermont............ 5 16 1 65 -
Massachusetts...... 30 71 56 4 12 4 371 77
Rhode Island ....... 1 20 1 2 -
Connecticut........ 6 37 16 2 9 5 88 61

MIDDLE ATLANTIC...... 49 336 450 16 59 50 237 70
New York City...... 11 55 54 6 12 9 67 42
New York, Up-State. 14 187 116 1 4 15 NN 6
New Jersey.......... 10 59 138 1 19 20 170 22
Pennsylvania....... 14 35 142 8 24 6 NN -

EAST NORTH CENTRAL... 136 831 956 7 52 34 1,620 176
Ohio................ 7 88 130 2 14 13 63 9
Indiana............. 11 113 127 1 9 4 94 10
Illinois........... 77 396 100 8 7 171 50
Michigan........... 9 50 227 2 16 8 689 44
Wisconsin........... 32 184 372 2 5 2 603 63

WEST NORTH CENTRAL... 15 75 359 3 26 19 791 75
Minnesota........... 16 1 5 4 16 3
Iowa................ 3 28 99 1 2 2 589 -- 49
Missouri ........... 4 14 4 5 71
North Dakota.,..... 8 27 128 1 51 8
South Dakota....... 3 15 3 3 NN -
Nebraska........... 3* 9 87 1 4 21 -
Kansas............. 1 4 NN 1 10 1 43* 14

SOUTH ATLANTIC....... 33 231 1,168 15 113 63 256 41
Delaware............ 9 2 7 2
Maryland............ 12 18 7 9 42 2
Dist. of Columbia.. 4 4 1 3 8 -
Virginia........... 4 40 299 1 10 8 38 12
West Virginia...... 9 64 278 3 8 140 13
North Carolina..... 13 24 257 6 25 12 NN -
South Carolina..... 2 7 12 1 19 2 3
Georgia............. 2 9 1 14 10 -
Florida............. 5 78 282 5 32 12 18 12

EAST SOUTH CENTRAL... 14 56 1,306 3 34 34 236 22
Kentucky............ 6 15 370 8 11 79 9
Tennessee.......... 15 515 12 15 136 13
Alabama............ 4 14 235 3 4 3 9 -
Mississippi........ 4 12 186 10 5 12 -

WEST SOUTH CENTRAL... 231 685 3,784 21 127 59 422 78
Arkansas........... 846 1 4 1
Louisiana.......... 1 22 7 33 27 1
Oklahoma............ 36 883 24 2- -
Texas............... 231 648 2,033 13 66 29 421 78

MOUNTAIN............. 21 120 700 1 5 9 521 32
Montana............ 1 7 138 1 16 3
Idaho.............. 6 72 1 2 1 17 2
Wyoming............ 2 22 12 30 -
Colorado............ 5 42 114 1 3 362* 13
New Mexico ......... 5 16 100 3 21 2
Arizona.............. 7 24 136 1 53 10
Utah. ............. 1 1 23 1 14 -- -
Nevada............. 2 105 1 8 -

PACIFIC.............. 108 532 2,169 9 50 68 779 220
Washington.......... 54 166 1,199 2 8 2 203 51
Oregon.............. 18 132 286 3 6 11 13
California.......... 31 215 604 6 38 58 473 124
Alaska............ 55 2 18 6
Hawaii.............. 5 19 25 1 1 74 26

Puerto Rico.......... 14 37 293 3 14 6
*Delayed Reports: Measles: Nebraska 1
Mumps Maine 17 Kansas 20, Colorado 245
Rubella: Maine 2
Polio, Par: Cal. 1 Case 1967










51 Morhidity and Mortality Weekly Report



TABII II. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

FEBRUARY 10, 1968 AND FEBRUARY 11, 1967 (6th \ Hkh i CONTINUED


STREPTOCO CAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
AREA SCARLET FEVER (Rky. Mt. Spotted) ANIMALS
Cum. Cum. Cum. Cum. Cum.

NITED STATES... 11,563 2 10 4 12 3 23 3 82 429

NEW ESC LAND......... 1,513 1 2 1 7
'.1ii ............... 35* 1 7
Nlw R.pshir ...... 9
V.r 40 t ........... 4U
M.sa husetts...... 258 1 1-
Rio i island .......
C nn t icut ...... 1,171 -

MIDDLE ATLANTIC..... 350 2 3 -- 5 3
New York City...... 17 1 4
New York, Up-State. 267 1 2 1 2
Ne" J rsev ......... NN
Pennsylvania....... 66 1

EAST ORTH CENTRAL... 1,240 2 1 4 7 27
.............. 97 4 6 14
Ind ima............. 153 6
Illin, s........... 318 1 3
i hl, an ........... 4 3 1 I 2
1i nh sin .... .... 269 2


EST NORTH CENTRAL... 827 1 2 4 -2 16 77
Minn' ta ........... 48 4 17
Iow;............... 173 3 21
Mi o ri....... .... 30 1 2 2 2 6 18
N rth Dak ta........ 113 3 14
Souh D,ot ..... 37 1 -
Neb~., ka. .......... 145* 4
Knas.............. 281* 3

OUTH ATLANTIC ....... 1,180 1 3 2 10 48
Delaware...........
Maryland........... 428 -
Dist. of Clumbia.. 1 -
Virginia........... 34 5 26
We~ t Vir inia ...... 218 6
North Carolina..... 18
uth Carolina...... 41 -
Gi ri .......... .. 2 1 1 -
F l rida............ 87 -

EAIT SITH CENTRAL... 1,402 1 25 159
Knt ky......... 55 1159
< nnrs2 .... ... .. 20 4- 12 92
AI,1... ........... .....- I 2 8
'11sipp ......... 7 -3 -

ESI OITI ITRAI 38 I I 15 81
Ark~in ........... I8 63 7 40

k.ioa......... 7 30

.1. ............ I -

I 7 ia ........... 1
IiCr. id ....... I 1 :1 1 7 4-1





N :a.................. i
'1 1. 1.......7








1 IFI .............. 1,77 .' 7


l r t r i. ......... I 7
Ir .Rio............. 70 --

1d i i ............. I .

iairl i ........... 1 2








Morbidity and Mortality \cckl Report 5.






Week No. TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED FEBRUARY 10, 1968
6
(By place of occurrence and week of filing certificate. Excludes fecal deaths)

All Causes Pneumonia Under All Causes Pneumonia Under
Area All 65 years and 1 year Area All 65 years and 1 year
Influenza All A Influenza All
Ages and over fluenza All Ages and over I All
All Ages Causes All Ages Causes


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

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

EAST NORTH CENTRAL:
Akron, Ohio-----------
Canton, Ohio----------
Chicago, Ill.---------
Cincinnati, Ohio------
Cleveland, Ohio-------
Columbus, Ohio--------
Dayton, Ohio----------
Detroit, Mich.--------
Evansville, Ind.------
Flint, Mich.-----------
Fort Wayne, Ind.------
Gary, Ind.------------
Grand Rapids, Mich.---
Indianapolis, Ind.----
Madison, Wis.---------
Milwaukee, Wis.-------
Peoria, Ill.----------
Rockford, Ill.--------
South Bend, Ind.------
Toledo, Ohio----------
Youngstown, Ohio-----

WEST NORTH CENTRAL:
Des Moines, Iowa------
Duluth, Minn.---------
Kansas City, Kans.----
Kansas City, Mo.------
Lincoln, Nebr.--------
Minneapolis, Minn.----
Omaha, Nebr.----------
St. Louis, Mo.--------
St. Paul, Minn.-------
Wichita, Kans.--------


815
261
46
27
42
60
29
23
37
51
72
12
55
35
65

3,389
54
32
155
38
30
44
68
93
1,750
31
485
206
39
105
37
37
58
52
32
43

2,606
68
31
784
177
225
106
90
314
32
49
35
40
57
157
44
135
42
35
35
111
39

903
50
14
62
148
31
134
73
238
90
63


65
18
7

3
4
2
1
4
1
6
1
11
1
6

166
1
4
8


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.---------n
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.----------


1,240
131
264
40
60
100
62
87
40
109
80
216
51

753
105
46
71
146
169
51
53
112

1,288
58
53
22
176
34
84
243
65
177
87
124
85
80

473
47
32
136
25
107
23
45
58

1,712
26
53
24
63
88
509
97
36
111
55
92
208
39
198
57
56


712
64
154
17
35
65
37
47
17
94
52
101
29

423
60
27
50
78
92
19
34
63

709
39
31
15
79
15
41
128
38
93
48
75
49
58

279
20
19
97
18
54
10
30
31

1,052
21
35
18
23
61
316
58
29
71
32
48
116
27
119
36
42


Total 13,179 7,819 698 569

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 89,071
All Causes, Age 65 and over------------------- 53,917
Pneumonia and Influenza, All Ages------------ 5,614
All Causes, Under 1 Year of Age--------------- 3,721













PNEUMOCYSTIS CARINII PNEUMONIA
Wieiliiid Pfrom pj f .5 )

time was negalti for P. cfrinii. On the ITth post-opera-
tie dl, a l ft -ided pneumlothorLax d eloped. Despite
Sclsed tube drainage and antibiotic O ,. r I. the patient
lied from ba( clrial pneumonia and sepsis on December :23.
the 24th post-operalive day. Permission for autopsy was
refused.

An interesting aspect of this case was the fart that a
brother born on July Ih, 1960. also died at age 8 months
with I'.i. ap1lasia and 1 P. rarinii pneumonia. Also a
second brother born 1 month prematurely died at age 3
days on August 7. 1961. with atelectasis and interstitial
pneumonia. A sister age 5 years and a brother age 2 years
\were alive and well.
Serum specimens from the patient. his parents. and the
brother and sister were obtained for use in the develop-
ment of a serologic test for P. rarinii. Sections of the
patient's biopsied lung were inoculated into corticosteroid
treated white rats in the Parasitology Laboratory. NCDC.
To date, neither the inoculated animals nor their controls
have developed any evidence of disease. Attempts will
be made to grow the organism in human embryonic lung
issue culture under varying oxygen and carbon dioxide
concentrations.

(Reported by J. 1). Robbins. 1M.I., Department of Pediat-
rics, Albert Einstein College of Medicine, NeC York City;
Tibor Fodor, M.l)., Chief, Divisiion of Epidemiology, Bu-
reau of Prerentable Diseases, Nev York City Department
of Health: Parasitology Section, Laboratory Program,
A'CDC: and an EIS Officer.)

*Availablh, through Pamrti ic I)i:. s t D)rui aSrvic.r N('D1 '.

ITrae n ames are providtl i for identification only, and inclusion
do-s not imply endorsemnntl by the Public Health Service or the
LUniltd ISttes Dti rtmn nnt of Health. I'ducation, and Welfare.





INTERNATIONAL NOTES
CEREBRAL SPINAL MENINGITIS Palermo, Sicily


An epidemic of cerebral spinal meningitis reportedly
due to meningococci is occurring in Palermo, Sicily. In
January, 25 cases of meningitis were reported; however,
during the first 7 days of February, 28 cases Inclllurdi
seven deaths occurred. Of the 28 cases, 90 percent were
in children; six of the deaths were in children. Laboratory
tests to isolate the moningococci strains responsible for
the epidemic are being conducted by the Hygiene Institute
of the UIniversity of Palermo.

(Reported by the Hygiene Institute of the University of
Palermo, Palermo, Sicily; and the Ministry of Public
Health, Italy.)


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCIoL .
TION OF 17'000, IS F. L.;- T T HE NATIONAL COMMUNICABLE
DISEASE CENTER, AI'L .N .E .. '
DIRECTOR. NATIONAL COMMUNICABLE DISEASE *CETER
C'- i Ser.,:EPR M D
CHIEF, EPIDEMIOLOGY PROGRAM \ i' -..M..un M D
ACTING CHIEF, STATISTICS SECTION IDA L SHERMAN, m S
EDITOR MICHAEL B. GREGG, M D

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPOR"'.EG
MORBIDITY AND MORTALITY. -"E N h .O'r L :.-0~1 l. *.iCfBLE DISEa1j
CENTER WELCOMES ACCOUNTS r' N T E; r.. -.-BR EAni i :A E
INVESTIGATIONS WHICH ARE OF CURRENT INTEREST 0" -ELt.-T
OFFICIALS AND WHICH ARE DIRECTLY RELATED TO THE CONTROL
OF COMMUNICABLE DISEASES. SUCH COMMUNICATIONS 5SIo.'LC- BE
ADDRESSED TO:
NATIONAL ;Ci M 'u'-.:r.- L.E DISEASE CENTER
ATLANTA, .EOQ':-' 1jJi
ATTN: I f OR
M: sli" T r AND MORTALITY WEEKLY REPORT

NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND A-E
BASED ON WEEKLi rELE..-RiA TO THE NCDC IB i-E INDIVIDu.L
STATE HEALTH -.I TIFAu THE REPORTING -EE- *:GNCLuDE,
ON SATURDAY COMPILED DATA ON NATIONAL BASIS rAE REL.E-CED
ON THE SUCCEEDING FRIDAY.









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Morbidity and Mortality Weekly Report


FEBRUARY 10, 1968 OB
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