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:
AA00010654:00186

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 COMUNICABLE DISEASE CENTER


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


Vol. 17, No. 12







Week ending

SMarch 23, 1968




PUBLIC HEALTH SERVICE


BUREAU OF DISEASE PREVENTION AND ENVIRONMENTAL CONTROL


EPIDEMIOLOGIC NOTES AND REPORTS
FOLLOW-UP MEASLES Chicago

From March 1 through March 23, 1968, the City of
Chicago recorded 139 cases of measles. While many of
these cases have not yet been clinically confirmed, the
total number of cases for March will undoubtedly fall
below the January and February totals of 276 and 2
respectively. The epidemic curve for the City as a
(Figure 1) has declined from approximately 57 cas
week during January and early February to approxi V M
35 cases per week for the first 2 weeks of Marc i= e
total number of cases for the week ending March 23
yet known.
(Continued on page ,

TABLE I. CASES OF SPECIFIED
(Cumulative totals include revised and


DISEASE


Aseptic meningitis ................... ...
Brucellosis ............................
Diphtheria ................. ...........
Encephalitis, primary:
Arthropod-borne & unspecified ...........
Encephalitis, post-infectious ............
Hepatitis, serum .................. ......
Hepatitis, infectious ....................
M alaria ................................
Measles rubeolaa) .......................
Meningococcal infections, total ...........
C civilian ..............................
Military ..............................
Mumps .................................
Poliomyelitis, total .....................
P aralytic .............................
Rubella (German measles) ...............
Streptococcal sore throat & scarlet fever....
Tetanus ........................... .
Tularemia ................................
Typhoid fever ..........................
Typhus, tick-borne (Rky. Mt. spotted fever) .
Rabies in animals .......................


12th WEEK ENDED


March 23,
1968


March 25,
1967


27
7
8

12
12
82
866
38
980
36
34
2
5.275
4
4
1,672
11,634
3
1
7

73


CONTENTS
I ,_; nd Reports
I I -Chicago ......
Anthrax-Connecticut ............
Current Trends
Measles-United States. ...........
Surveillance Summary
Diphtheria-1965 and 1966 .........
International Notes
-._, -- i ... Measures . ...


29
4


35
21
43
900
46
2,802
42
39
3



1,574
13,359
1
3
7

95


27
6
6



908
2
11,272
79



1
1

11.974
2
3
5


325
19
37

170
104
826
9,888
529
7.225
956
875
81
60,893
15
15
12,222
138,384
25
17
49
3
a41


. . 10 1
. .. 102
. . 102
. . 103
. . 108


ote: DELAYED CASE REPORTS
e reports received in the current week's
1i be included in the cumulative total
ng week and will be accompanied by
tn otnotes. Thus, the cumulative total
in is week's issue includes the current
a yed reports received through last week.
te telegrams, second column, back page.

ES: UNITED STATES
through previous weeks)


MEDIAN
1963 1967


CUMULATIVE, FIRST 12 WEEKS
MEDIAN
1968 1967 1963 1967


335
49
48



9,988
25
105.866
746



5
4

134.601
42
49
74
6
oCa


336
44
28

273
152
440
9,548
480
27,309
704
653
51

3
3
12,160
147,706
34
28
63
8
o a"


TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ......................................... 1 Rabies in man: ..................................... -
Botulism: ........................................ Rubella. Congenital Syndrome: ....................... 3
Leptospirosis: Tex.-l .............................. 4 Trichinosis: Mass.-1, N.Y. Ups.-l, Ohio-2 .............. 10
Plague:.................. ........................ Typhus, marine: ..................................... 2
Psittacosis: Mich.-1 ............................... 8


4- 4 4 +I


S"841
















SI REPORTED CASE


16 23 30 7 14 21 28 4
SEPT OCT


Morbidity and Mortality Weekly Report


FOLLOW-UP MEASLES (Continued from front page)

Figure 1
REPORTED MEASLES CASES BY WEEK OF ONSET
SEPTEMBER 16, 1967 MARCH 23, 1968
CHICAGO, ILLINOIS
nohtdoy
Season


II 18
NOV


25 2


9 16 23
DEC.
WEEK ENDING


10 6 13 20 27
JAN.


MARCH 23, 1968


immun, ot.on
Compoign

lt.i1T


9 16 23
MAR.


Between February 15 and February 20, 1968, an in-
tensive immunization program was conducted by the Chi-
cago Board of Health with the assistance of a team from
NCDC in 334 schools in 21 of Chicago's 76 community
areas (MMWR. Vol. 17, No. 8). A total of 35,242 children
received vaccine.
Reported cases during March continue to occur pri-
marily in preschool children. Of the 118 cases where age
is known, 88 (75 percent) were in children below 5 years
of age. Of the 139 cases recorded between March 1 and


March 23, 86 percent resided in the 21 community areas
included in the February immunization campaign. Because
of the continued occurrence of measles in these areas and
in this age group, further epidemiologic ;n'..-ig.iiion is
in progress.
(Reported by Samuel L. Andelman, M.D., M.P.H., Com-
missioner of Health, William 1. Fishbein, M.D., Medical
Director, Bureau of Health Services, and Hyman G. Orbach,
Ph.D., Epidemiologist, Chicago Board of Health; and a
team from NCDC.)


CURRENT TRENDS
MEASLES United States


For the week ending March 23, 1968, (week 12), 980
cases of measles were reported to NCDC. This is an in-
crease of 318 cases over the total for the preceding week;
six states, New York, Virginia, Florida, Tennessee, Texas,
and California, accounted for 89 percent of the increase
this week. Of these 980 cases, 10 reporting areas reported


more than 25 cases each (Table III, Page 11',. this issue
MMWR); California reported 153 cases and noted that this
total includes delayed reports which cannot yet be dis-
.ir,.i ,i-h.,i from cases occurring in week 12.
(Reported by State Services Section and Statistics Sec-
tion, NCDC.)


EPIDEMIOLOGIC NOTES AND REPORTS
ANTHRAX Connecticut


A presumptive case of cutaneous anthrax occurred in
an employee of a felt manufacturing plant in Connecticut.
On February 7, 196S, the patient who worked in the "pick-
ing and blending" area, an early production stage, noted
a small sore on his right forearm. The lesion increased in
size and a physician was consulted on February 9. He
dressed the wound ant initiated therapy with penicillin.
Two days later, the patient was reexamined and the lesion
had increased to approximately the size of a silver dollar
and had a black weeping center. An indurated crythematous
area surrounded the lesion and tender right axillary lymph-
adenopathy was noted. Because of the occupational his-
tory, a diagnosis of cutaneous anthrax was made and the
patient was admitted to a hospital. Cultures taken upon
admission were negative for Bacillus anthracis. Penicillin
therapy was continued and the patient improved and was
i h.it-. I on February 22.


The felt company which processes imported wool,
karakul, goat hair, and domestic synthetics produces a
wide variety of products. The imported goat hair, which is
purchased as a waste product from a plant that had had
previous cases of human anthrax, is used to manufacture
an abrasive felt material used in industry.
A total of 80 environmental surface swab samples
were taken from the early production phase including the
"picking and blending" area of the plant. One isolation of
B. anthracis was made from a picking machine. Samples
of raw material were obtained and B. anthracis was re-
covered from imported goat hair.
(Reported by James C. Hart. M.D., M.P.H., Director, Pre-
ventable Diseases, Barbara W. -., M.D., M.P.H.,
Chief, Epidemiology Section, and Mr. J. .' '* ,1 In-
dustrial hlygienist, Connecticut State Department of It. .; .
and an EIS Officer.)


~miT







Morbidity and Mortali


Editorial Note:
Despite the absence of bacteriologic confirmation.
the clinical and epidemiologic data are consistent with
the diagnosis of cutaneous anthrax. Therapy with penicillin
does not affect the evolution of the typical cutaneous


MARCH 23, 1968


SURVEILLANCE SUMMARY


DIPHTHERIA


During the two years 1965 and 1966. a total of 373
cases of diphtheria were reported to NCDC. The diagnosis
of diphtheria was bacteriologically confirmed in 298 of
the reported cases: mitis strains comprised 54 percent of
the isolates, gravis strains accounted for 25 percent, and
intermedius made up 15 percent. No significant differences
in case fatality ratios were detected among patients with
illness caused by the different types of Corynebacterium
diphtheriae (Table 1). Approximately one-fifth of 231
strains that were isolated from typical clinical cases and
tested for toxigenicity were non-toxigenic. However, a
-rIl!, irl, greater case fatality ratio was observed in
cases from whom toxigenic strains were recovered (Table 2).

Table 1
Relationship of Case Fatality Ratio to
Type of C. diphtheria

Type of Cases Deaths Case
Cases Deaths
C. diphtheria Fatality Ratio

Mitis 72 9 12.5
Gravis 36 3 8.3
Intermedius 22 2 9.1
Indeterminate 8 1 12.5

Total 138 15 10.9


Table 2
Relationship of Toxigenicity of C. diphtheria
to Case Fatality Ratio


Toxigenicity Cases Deaths Case Fatality Ratio

Toxigenic 182 23 12.6*
Non-toxigenic 49 0 0*

Total 231 23 10.0
*P<.025

The number of diphtheria cases has decreased mark-
edly in the United States over the past 45 years. The 164
cases reported in 1965 represented the fewest cases ever
reported in 1 year from the United States. However, the
ratio of deaths to cases has not changed significantly
since the mid-1920's despite the introduction of antitoxin,
antibiotics, and improvements in the quality of medical
care (Figure 2).
Analysis of the reported cases shows that, as in
previous years, southern states reported the majority of
cases. Alabama, Louisiana, and South Carolina had average
annual incidence rates greater than 0.50 cases per 100,000


- 1965 and 1966


Figure 2
DIPHTHERIA-REPORTED ANNUAL CASE AND DEATH
RATES, AND CASE-FATALITY RATIO
UNITED STATES, 1920-1966
400 A oX. -
1 NTITOXIN


CASE RATE INTROUCTON
S OF TOXOiD

OF TOXOiO
\


RATIO


19i20 1930 19 9 190 9o 0 1970
YEAR
population. However, Montana had the highest average
annual incidence rate for 1965 and 1966. This mainly re-
sulted from a large outbreak of diphtheria that occurred on
an Indian reservation in Montana during the winter of
1965-66 (MMWR, Vol. 15, No. 20). In 1965 and 1966, 18
states reported no diphtheria cases. Most of these states
were located in the Rocky Mountain area or along the
eastern coast north of the Carolinas.
Children accounted for the majority of cases: 75 per-
cent of all diphtheria cases occurred in the 15 years or
under age group and 63 percent of these cases were in
children less than 10 years of age. The incidence rate in
nonwhites (0.42 per 100,000) was 10 times greater than in
whites (0.04 cases per 100,000). The racial disparity in
incidence was noted in all age groups except the 35- to
(Continued on page 108)


ty Weekly Report 103


lesion but does ameliorate systemic symptoms. The major-
ity of cases of industrially associated anthrax in the
United States occur in plants where imported goat hair is
processed. Additionally, persons employed in the early
production phase are at greater risk of developing anthrax.








10 I Morbidity and Mortality Weekly Report


TABLE III (CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
MARCH 23, 1968 AND MARCH 25, 196X7 (12th WEEK)

ENCEPHALITIS HEPATITIS
ASEPTIC Primary
I1(1I I I I >- IPll'I I III I X Prima Post-
'KRE MENINGITIS including Infectious Serum Infectious MALARIA
unsp. cases
.,____._-,_____ -; i- 81968 1968 1968 1967 1968
UNITED STATES... 27 29 7 8 12 35 12 82 866 900 38

NEW ENGLAND.......... 1 2 31 38 1
Maine............... 5
New :iap i re ....... 2 1
Nerm ant ............ -

Massachusetts...... 1 16 27
Rhode Isla.nd....... 1 4
Cnnecticut........ 1 9 4 1

MIDDLE ATLANTIC...... 5 -- 4 3 1 14 122 220 6
New York City..... 3 2 8 40 57
New York, up-State. 1 3 30 23 1
Ne Jersey......... 3 1 28 103 3
Pe nsylvania....... 2 I 1 2 24 37 2

EAST NORTH CENTRAL... 2 1 2 3 9 7 2 154 139 1
Ohio............... 1 3 6 2 37 21
Indiana............ 2 9 22
Illinois........... 1 2 44 29 1
Michigan........... 2 1 3 2 39 49
Wisconsin............ 25 18

WEST NORTH CENTRAL... 2 2 1 1 70 78
Minnesota.......... 1 1 15 11
Iowa............... 22 -
Missouri........... 2 13 63
North Dakota....... 4 2 -
Sout l-t .... -I 2
Nebraska............ 3 3
Kansj:........ ........ 1 11 2

SOUTH ATLANTIC....... 6 7 2 1 3 7 66 70 8
Delaware ........ 5 3
Maryland........... 1 1 1 3 17 15
Dist. of Columbia.. 1 -
Virginia........... 2 2 1 9 19 2
West Virginia....... 3 5 9
North Carolina..... 1 1 1 2 7 5
South Carolina..... 1 1 1
Georgia............. 4 9 -
Florida............ 4 1 -- 3 22 6

EAST SOUTH CENTRAL... 6 2 1 74 74 -
Kentucky........... 2 33 28
Tennessee......... 2 1 15 21
Alabama........... 11 5
Mississippi....... 2 2 15 20 -

WEST SOUTH CENTRAL... 3 5 1 a 2 81 71
Arkansas........... 2 9 -
Louisiana.......... 2 2 6 8
Oklahoma............ 8 5
Texas.............. 3 3 1 5 58 58

MOUNTAIN.............. 10 3 29 40 8
Montana ............ 4 6
Idaho............... 3 1
Wyoming............. 1 9 1
Colorado............. 2 7 6
New Mexico......... 7 11 1
Arizona............. 10 3 8
Utah............... .- -. 4 6
Nevada............

PACIFIC............... 11 10 1 2 6 2 52 239 170 14
Washington.......... 1 29 12 3
Oregon.............. I -- 1 15 16
California......... 10 10 1 2 6 2 50 191 140 9
Alaska............. 3 2
Hawaii............... -

Puerto i. I I .- I 1 16 16 -








Morbidity and Mortality Weekly Report 105


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
MARCH 23, 1968 AND MARCH 25, 1967 (12th WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL
AREA Cumulative Cumulative Total Paralytic
Cum.
1968 1968 1967 1968 1968 1967 1968 1968 1968 1968 1968
UNITED STATES... 980 7,225 27,309 36 956 704 5,275 4 4 15 1,672

NEW ENGLAND........... 44 350 289 2 45 26 305 295
Maine.............. 10 49 2 1 6 25
New Hampshire...... 1 47 63 2 1 22 3
Vermont ............ 5 20 I 19 9
Massachusetts...... 20 176 107 2 24 13 98
Rhode Island....... 3 21 4 28 32
Connecticut........ 23 109 29 12 11 230 128

MIDDLE ATLANTIC ...... 160 972 843 6 165 85 202 190
New York City...... 39 188 130 1 62 16 111 109
New York, Up-State. 92 539 186 2 16 25 NN 25
New Jersey......... 18 178 229 1 46 33 91 56
Pennsylvania....... 11 67 298 2 41 11 NN -

EAST NORTH CENTRAL... 156 1,791 2,137 7 96 70 1,814 364
Ohio............... 15 127 336 20 30 81 87
Indiana............. 31 281 244 1 13 8 149 21
Illinois........... 60 784 326 5 25 14 300 56
Michigan........... 11 111 461 1 29 13 715 96
Wisconsin.......... 39 488 770 9 5 569 104

WEST NORTH CENTRAL... 11 141 1,210 1 40 35 552 75
Minnesota........... 3 6 48 6 7 6 1
Iowa............... 2 40 243 3 6 479 53
Missouri........... 9 39 1 8 9 13
North. Dakota...... 4 55 481 2 35 7
South Dakdta....... 3 38 4 5 NN
Nebraska........... 2 21 361 4 7 21 -
Kansas............. 7 NN 13 1 11 1

SOUTH ATLANTIC....... 88 560 2,802 8 202 147 396 133
Delaware ........... 1 5 24 1 5 10 6
Maryland............ 4 39 56 2 14 18 52 -40
Dist. of Columbia.. 4 9 7 -
Virginia........... 29 124 840 1 15 13 60 23
West Virginia...... 11 134 505 4 12 148 7
North Carolina..... 9 59 584 3 45 30 NN -
South Carolina..... 16 90 39 12 2 12
Georgia.............. 3 10 34 28 -
Florida............. 34 176 684 2 43 29 124 45

EAST SOUTH CENTRAL... 51 166 3,031 3 74 70 286 33
Kentucky............. 1 41 960 1 28 20 152 7
Tennessee.......... 22 38 949 1 21 30 117 26
Alabama............ 12 42 648 12 13 9 -
Mississippi........ 16 45 474 1 13 7 8 -

WEST SOUTH CENTRAL... 241 1,751 10,187 5 197 122 530 2 2 7 156
Arkansas........... 1,200 10 10 -
Louisiana.......... 1 57 46 49 1
Oklahoma........... 8 55 2,958 2 41 7 -
Texas............... 233 1,695 5,972 3 100 56 530 2 2 7 155

MOUNTAIN.............. 28 354 1,691 1 13 16 226 80
Montana............ 62 177 1 13
Idaho.............. 10 171 1 7 -
Wyoming............ 2 33 13 8 -
Colorado............ 18 128 400 1 7 7 102 51
New Mexico......... 36 274 3 17 9
Arizona............. 8 81 354 1 2 51 18
Utah................ 2 138 1 21 2
Nevada............. 2 164 2 2 7 -

PACIFIC.............. 201 1,140 5,119 3 124 133 964 2 2 8 346
Washington........... 30 305 2,565 2 21 11 249 113
Oregon............... 18 238 590 11 10 38 16
California......... *153 574 1,830 1 83 110 620 **2 **2 8 191
Alaska............. 73 2 39 8
Hawaii............... 23 61 9 18 18

Puerto Rico.......... 24 128 820 2 15 7 16 2
*Includes late reports in current week's total, not separately enumerated.
**Contracted out of state.








l0(, Morbidity and Mortality Weekly Report


TABLi: III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MARCH 23, 1968 AND MARCH 25, 1967 (12th WEEK) CONTINUED


STORE IPTOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
AREA SCAREFT FEVER (Rky. Mt. Spotted) ANIMALS
Cum. Cum. Cum. Cum. Cum.
,. r : I ,. I ..- I r I. rb 146 '
UNITED STATES... 11,634 3 25 1 17 7 49 3 73 841

NEW ENGLAND......... 2,210 2 -- 8 30
M ine........... ... 24 7 29
Ne Hpshre...... 38 1 1
Vermon ............ 46- -
Massachusetts...... 450 1
Rhode Island....... -
Connect cut ........ 1,541 -

MIDDLE ATLANTIC ...... 790 1 6 6 1 9
New York City...... 48 3 4 -
New York, Up-State. 624 1 3 1 1 5
New Jersey......... NN -
Pennsylvania........ 118 1 4

FAST NORTH CENTRAL... 1,333 1 3 3 1 8 7 49
Ohio............... 181 1 1 6 4 24
Indiana............ 177 2 10
Illino is........... 346 1 2 1 1 -- 6
Michigan .......... 367 1 1 I 3
isconsin.......... 262 1 1 6

WEST NORTH CENTRAL... 500 1 4 1 3 9 155
Minnesota.......... 29 1 39
Iowa ............... 162 2 36
Misouri........... 23 2 2 4 35
N rih D.knta....... 133 1 31
h Dak ta....... 33 1 -
Nebraska............ 88 1 7
Kansas.............. 32 7

' ,UTH ATLANTIC....... 1,302 2 4 2 13 2 10 101
Delaware........... 16 -
Maryland.............. 211 1 4 2
Dist of Columbia.. 11
Virginia........... 477 I 1 1 3 2 4 54
West Virginia...... 253 1 11
N rth Carolina..... 12 1 -2 2 2
South Carolina..... 16 -
GeC rgia............ 27 1 1 1 7
Florida............ 279 3 4 25

EAST SOUTH CENTRAL... 1,259 2 1 4 7 1 18 279
Kentucky........... 76 I 1 10 127
Tennessee.......... 952 1 3 5 7 141
Alabama............ 59 1 11
ississippi........ 172 1 1 1

EST SOUTH CENTRAL... 925 5 2 4 15 160
Arkansas........... 2 1 16
Louisiana .......... 33 4 1 3 21
k lahoma.. ......... 118 -- 1 8 52
Texas............ .... 772 1 2 3 71

M UNTAIN .............. 1,702 2 I 10
M ntan ............ 24
Idaho.. ......... ... 130
Wy ming......... .. 116 1
C lorado........... 1,022 -
New Mexico......... 137 4
Arizona....... .... 1 5
'tah.... .......... 172 1
Novada.............-

PACIFIC ............. 1,613 1 6 1 5 5 48
Washinton ......... 389 -
Orron............. 114 -
Clifornia......... 962 1 6 1 5 5 48
Alaska............. 102 -
Hawai i ............ 46 -

Puerto Rico......... 6 8








Morbidity and Mortality Weekly Report


TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED MARCH 23, 1968

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


107


All Causes Pneumonia Under All Causes Pneumonia Under
Area A 6 years and 1 year Area All 65 years nd nza ar
rAge and over Influenza All 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.----
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.--------


671
212
26
25
29
46
20
23
16
53
58
19
38
32
74

3,415
43
43
158
53
32
43
61
111
1,658
49
519
239
47
110
24
51
62
53
25
34

2,697
70
34
804
157
227
138
78
376
38
38
64
33
42
150
31
133
42
38
36
122
46

861
69
22
38
119
21
143
79
255
71
44


424
118
16
13
22
25
14
15
11
33
37
14
27
20
59

2,084
21
24
95
34
19
26
33
65
1,021
32
320
137
30
71
12
32
42
31
20
19

1,543
48
19
445
86
124
75
44
222
28
17
36
16
24
84
14
89
23
25
22
77
25

537
41
11
26
81
14
85
50
150
52
27


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.----------


1,155
121
251
38
66
112
55
74
38
86
70
214
30

729
96
78
58
177
132
48
53
87

1,252
47
53
34
173
38
79
250
64
179
76
118
49
92

430
47
27
90
24
113
20
58
51

1,541
24
39
30
68
69
409
90
40
123
55
107
184
41
170
51
41


598
53
118
18
30
72
30
36
19
69
44
92
17

416
51
51
37
112
70
29
28
38

661
28
20
22
90
21
43
117
40
89
40
66
29
56

249
31
18
47
18
56
14
38
27

928
20
23
21
37
47
238
60
29
79
28
58
96
24
107
34
27


Total 12,751 7,440 457 547

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 167,509
All Causes, Age 65 and over------------------- 99,828
Pneumonia and Influenza, All Ages------------- 8,936
All Causes, Under 1 Year of Age--------------- 7,280


Week No.
12












DIPHTHERIA ( outlined r pi 103)

5O-year-old agI group. T' he ratio of female to male case1
Was 1:3; 1 highOer proportion of female ciasos occurred in
both whites and nonwliiitel.
Immuniz tion histories were reported for 279 cases.
Of tIlse cas '''. 16 pOercent. had full immunization. 1 per-
cent lapsed I percent inadequate and 5h percent no
il muniS atfion. During 196) an 1966(, only one death was
reported among 51 cases who were fully immunized. The
tcas fatality ruaios for patients who wero fully immunized
or had lapsed immunization were both -._.,.,I. ITrilm less
(P ..02") than that of the unimmunized group (Table 3).


Table 3
Relationship between Immunization Status
and Case Fatality Ratio*

Imuni nization (Case
('ases Deaths
St atus Fatality Ratio

Full 45 1 2.2
L apsed 34 0 0
Inadeqtuate 3s 2 5.3
None 162 2b 17.3

Total 279 31 11.1

1* l I uh -i t'as^. +:ell>. tiniiilni z;iltion hiltor|,-- 1 r1 unkno'IIn.

(iKepurtd hb/ thfi Spc ih i Iathoycns Unit, Bacterial Dis-
Ia.ese Sect Ntio and Stot itics Section, Epidemniology Pro-


iF1 'NI IltON11:
I"ul! Primn r ,. *ri (thrtec or more, inectins), or a
prim s_ 1 ri ,1 l I t li o' er, completed within 4
I Te of ,I se1 of illne- .
Lap,,ed Pri" r1 -1 or a |>rma rN -rwe, plus booster,
eom!p l t' d more( thll I ears prior to onsil t.
hiadequiate Itn emp leie prim rf series a!t an) tim< prior to

No No ditltheria toxoid had ever ,been received prior






INTERNATIONAL NOTES
QUARANTINE MEASURES


Ahfitioa In mmuini zation Inflormatjion for lnteirnationual
Trarl. 1) 67-it; I: Public Health Servicer
I'ubliuttion .V0. 38,


The folloNwing information should be included in Section 5:

AFRICA
Lesotho (formerly Basutolond) Page 30
Add the following: Cholera vaccination is required from
persons arriving tby air from infected areas.

Add the following:
(holera vaccination is required from persons arriving by
air from infected areas.

'Yellow fever vaccination is required from persons arriving
frnomC infected areas.


MARCH 23, 1968


THE MORBIDITY AND MORTALITY WEEKLY REPORT T WITH A CIRCULAR
r.. F 1 17000, .1 .r* L. C 'HE NATIONAL COMMUNICABLE
** L1 IL CENTER, A*L re .r' ,,,'
DIRECTOR, NATIONAL COMMUNICABLE :-:,. r .r .TER
CHIEF EPIDEMIOLOGY PROGRAM A.D. L =-N J'Q M D
ACTING CHIEF SASTATISCS SECTION IDA L. .mE-ANI M.S.
EDITOR MICHAEL B GREOG.M .O

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
.1 T -r.L w A .r '. 1'. -1 *. L N A FL S O E.t
i : r : c" 1. E T P ( t r ,E
INVESTIGATIONS WHICH ARE OF r r.I.. ,ii. -EEf TO 1 HEi rM
OFFICIALS AND WHICH ARE DIRE( r.L~'t-. i T CONTR L
OF COMMUNICABLE DISEASES. SU-' i-. .j.. -T' ..-[ .-.OUL a t
ADDRESSED TO:
NATIONAL COMMUNICABLE DISEASE CENTER
ATLANTA, GEORGIA 30333
ATTN: 3 R T 3R
"'-...a L" AND MORTALITY WEEKLY REPORT

NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO THE NCDC BS I '-D, .,L'Lu
STATE HEALTH i'-iC'I THE REPORTING *LE.: L I. S
ON SATURDAY *"1' -C ,.---. ON A NATIONAL BASIS --E ELIEAEC
ON THE SUCCEEDING FRIDAY






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Morbidily and Mortality Weekly Report


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