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:
AA00010654:00190

Related Items

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

Full Text



NATIONAL COMUNICABL DISEASE CENTER
NATIONAL COMMUNICABLE DISEASE CENTER


Vol. 17, No. 26


WEEKLY

REPORT


Week Ending

June 29, 1968


EPIDEMIOLOGIC NI
FOLLOW-UP BOVINE (


Intensive investigation of the epiZtl~F of bovine
cysticercosis which occurred in March 1968 in cattle from
feedlots in northern Texas (MMWR, Vol. 17, Nos. 16 and
23) has recently been completed. The following informa-
tion summarizes the epidemiologic findings at the feedlots
near Gruver and Hereford, Texas, where the infected
cattle originated.
Investigation near Gruver, Texas, at Feedlot A
Feedlot A, located near Gruver, Texas, is a com-
mercial feedlot with a capacity for 8,000 cattle. The cattle
are shipped to the feedlot from many sources for intensive
feeding. On arrival, cattle are put in one of.34 pens at the


M, AND WELFARE PUBLIC HEALTH SERVICE

[AL HEALTH ADMINISTRATION

CONTENTS
Epidemiologic Notes and Reports
Follow-up Bovine Cysticercosis Texas ........... .241
Cat-Associated Tularemia Georgia ............. .243
Current Trends ,
Measles United States. . .. ..... 244
Pneumonia-Influenza Deaths United States ... 244
Recommendation of the Public Health Service Advisory
Committee on Immunization Practices Influenza
Vaccines 1968-69 . . 246
International Notes
Quarantine Measures .... . . 252

feedlot. While at the feedlot one pen of animals is never
mixed with another pen. Cattle are fed on consignment and
careful records are maintained of the amount and type of
feed given to cattle in each pen. The cattle are fed hay
(Continued on page 242)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and-delayed reports through previous weeks)
26th WEEKENDEDMEDIAN CUMULATIVE. FIRST 26 WEEKS
DISEASE June 29, July 1, 1963 1967 MEDIAN
1968 1967 1968 1967 1963 1967
Aseptic meningitis ... 50 41 38 882 889 763
Brucellosis ........................ 14 8 6 92 133 133
Diphtheria............................... 2 3 88 53 82
Encephalitis, primary:
Arthropod-borne & unspecified ........... 19 28 433 663 -
Encephalitis, post-infectious ............. 12 18 276 467 -
Hepatitis, serum ........................ 97 38 52,049 1,022 20
Hepatitis, infectious .................... 818 650 21,886 19,783
Malaria ................................ 51 31 4 1,052 994 49
Measles rubeolaa) ....................... 502 696 3,020 17,621 54,627 227,487
Meningococcal infections, total ........... 42 25 39 1,659 1,405 1,599
Civilian .............................. 36 25 -- 1,496 1,301 -
Military ........................ ...... 6 --- 163 104 -
Mumps ................................. 1,830 -- -- 115.961 -
Poliomyelitis, total ..................... 3 5 22 11 26
Paralytic ........................ ...... 3 3 22 9 24
Rubella (German measles) ............... 886 898 39,876 36,870 -
Streptococcal sore throat & scarlet fever.... 5.353 5,018 4,791 256,869 276,993 251,397
Tetanus ............................... 5 5 7 69 91 115
Tularemia .............................. 6 8 7 92 79 117
Typhoid fever ........... ................ 10 11 7 144 194 183
Typhus, tick-borne (Rky. Mt. spotted fever) 5 11 11 80 91 82
Rabies in animals ....................... 74 63 70 1.850 2.294 2,294

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ............................. ........ ... 2 Rabies in man: ................................... -
Botulism: Alaska-1 .................................. 2 Rubella, Congenital Syndrome:........................ 3
Leptospirosis: ........................... ......... 13 Trichinosis: Calif.-1 ................................ 36
Plague: ........................................... Typhus, murine:Tex.-3 ............................... 9
Psittacosis: Tenn.-1 ................................ 24







Morbidity and Mortality Weekly Report


JUNE 29, 1968


FOLLOW-UP BOVINE CYSTICERCOSIS (Continued from front page)


initially, and then placed on a carefully formulated mix-
ture of corn silage, sorghum, protein supplement, and
molasses. After the 4-to-5-month fattening period, the
cattle are sent to slaughter.
From January 1 to March 15, of 1,398 cattle from
Feedlot A that were sent to slaughter, only one was found
infected with Cysticercus boris. However, from March 15
to June 12, of 5,870 cattle, originating in Feedlot A, 743
were infected (overall infection rate 12.7 percent). Investi-
gation into the sources for all cattle slaughtered since
January 1, 1968, revealed that the cattle were assembled
from a variety of sources by several commercial buyers.
Some were from a buyer in Oklahoma. When these animals
were shipped, 300 of the fatter cattle were put in pen no. 8,
and the remaining cattle were kept on pasture. After 5
months on pasture, the remaining animals were put in
pens 4, 30, 31, and 33. Another shipment from Mississippi
was pastured and then placed in pen 34. In no instance
was a common factor found for all the infected cattle prior
to entering the feedlot, including grazing of cattle on
sewage irrigated pastures.
At slaughter cattle from pens 4 and 8 were free of
cysticercosis whereas cattle from pens 30, 31, 33, and 34
were highly infected. The infection rates among the cattle
in the 34 pens at the feedlot varied from 0 to 67.6 percent.
Pens 29, 30, 31, 33, and 34 had appreciably higher rates
with rates of 14.4, 47.8, 67.6, 58.2, and 25.4 percent,
respectively. These five pens were in a single line of
six pens. Cattle in pen 32 entered the feedlot at a later
date and therefore had not yet been slaughtered at the
height of the epizootic. In the infected animals, cysts were
found in the masseter muscles, esophagus, liver, heart,
and diaphragm, and the majority of cysts were degenerated
and caseous, indicating that the infections were probably
several months old.
The personnel at the feedlot were investigated for
Taenia saginata. In addition to the manager, seven employ-
ees worked at Feedlot A at the time of the inquiry. Two
former employees, who worked at the feedlot between the
time the cattle entered the feedlot and were slaughtered,
were also questioned. None of the present employees gave
a history suggestive of taeniasis (T. saginata), but a for-
mer employee stated that 1 1/2 years ago he had passed
motile, flat worms, approximately 2 cm long, in his stool.
He had not been treated for his condition. All employees
denied defecation in the feedlot area. It was noted, how-
ever, that the most likely area for defecation the feed
trench silo, located below eye level and on the fringe of
the feedlot was worked in by only a present employee
and the former employee with a history of tapeworm infec-
tion. Stool and anal swab tests were performed on the
present and former employees and were nr- ',i i. for Taenia
eggs. Because of the former employee's history of tape-
worm infection, he was later reexamined, and this speci-
men contained Taenia eggs in abundance.


Feedlot A had one toilet facility. Thedischarge drain-
ed into an earthen sludge pit, located about 6 feet from a
submerged silage hopper also with an earthen bottom. The
close proximity of this human excreta repository to a cattle
feed hopper suggested the.possibility of subterranean see-
page of Taenia eggs as the source of this epizootic. Anal-
ysis of samples of sewage and samples from the cattle
aisles and feed and water troughs, however, showed no
evidence of Taenia eggs.
These data suggest that the animals acquired their
infection in the feedlot and that since a majority of pens
showed no infection, the source of infection was not com-
mon to the entire feedlot, i.e., water or molasses. The
protein supplement and sorghum were not implicated be-
cause they were heated to 1800F., a temperature at which
Taenia eggs can not survive. Infection, spread from a
stool deposited directly on the ground, did not seem likely
because of the widespread infection in separate but ad-
jacent pens. It appears, however, that transmission oc-
curred through a specifically contaminated, locally dis-
tributed, feed ingredient, i.e., hay or corn silage. Hay
could not be implicated because cattle that remained free
of infection had received hay from the same source and
at the same time as cattle that later became infected. The
other feed ingredient, corn silage, was removed daily from
the trench silo for mixing with the other ingredients. It is
significant that one truckload of silage was enough to
feed four or five pens of animals and that five pens in a
row of six pens exhibited high rates of infection. The
probability that contaminated silage was the source of this
epizootic is enhanced by the fact that the former employee
who worked in the trench silo had Taenia eggs in his stool.
The likelihood that he was the source of infection is also
increased by temporal considerations. Since the cattle
were not infected in pasture and since the majority of
cysts were degenerated and caseous, the most likely time
of infection would have been mid-October when the cattle
first entered the feedlot. The former employee had started
working in the feedlot at that time. It is significant also
that pen 32 was empty at the time of this man's employ-
ment and that animals placed in the pen after the man
left his employment remained free of infection.



Investigation near Hereford, Texas, at Feedlot B

Feedlot B is a commercial feedlot with a capacity for
15,000 cattle. Operations are similar to those at Feedlot
A. Prior to March 17, no cysticercosis was reported in the
5,592 cattle sent to slaughter since January 1. In late
March, however, 176 cattle from one pen were sent to
slaughter, and 27 animals were infected. Since then of
6,590 cattle slaughtered, 170 were infected (infection rate
2.3 percent). At the time of investigation, cattle had been
shipped from 49 of the 132 pens at Feedlot B,but because
some of the pen groups had been intermixed at slaughter,
the pens containing the infected animals could not be


242










specifically identified. However, it was estimated that 19
pens contained infected animals. The infected pens were
scattered throughout the feedlot, and few infected pens
bordered on other infected pens. The sources of the 176
cattle in the index pen were investigated, and itwas found
that the animals came from 21 different sources and were
owned initially by at least 47 individuals. No common
factor prior to entering the feedlot could be found.
There were 20 employees and a manager at Feedlot B.
When the manager learned that his cattle were infected, he
had a stool survey performed on his employees by a local
laboratory. All stools were negative. In a second stool
survey, however, one employee was found infected with
Taenia eggs. This person was responsible for the daily
cleaning of the water troughs, but he denied defecation in
the feedlot area. Three employees left.their employment
rather than submit specimens for the first stool survey.
One of these men had been seen on multiple occasions by
his co-workers to defecate in the feedlot cattle driveways
and pens. The opportunity for an employee to defecate in
the feedlot is enhanced by the rolling terrain and the pre-
sence of a single toilet to serve the vast feedlot. Since
the epizootic, the manager has installed chemical toilets
in strategic locations.
The information obtained in this investigation sug-
gests that because of the scattered nature of this infection,
that pastures and a factor common to all animals, i.e.,
protein, hay, silage, and water, would not account for the
epizootic. The most likely mode of spread appeared to be


243


the ground. It was found that one of the laborers habit-
ually defecated in the cattle driveways and pens; however,
he could not be located for stool analysis. Another em-
ployee did have Taenia eggs in his stool, and although he
denied defecating in the feedlot, the ability of Taenia
saginata to force the anal sphincter and fall to the ground
makes it possible for an individual to spread infection
without directly defecating on the ground.



Investigation of Other Feedlots

Other feedlots in the northern part of Texas had shipped
cattle to slaughter that were found infected with cysticer-
cosis. Since the beginning of the year until April 15, 10
feedlots had shipped lots totaling 1,914 animals of which
19 were infected (infection rate 1 percent). The infections
were of a sporadic, enzootic character rather than the
epizootic seen at Feedlots A and B, and the cause of these
isolated cases remains obscure.

(Reported by Dr. J. E. Peavy, Commissioner of Health,
Dr. A. B. Rich, Chief, Veterinary Public Health Division,
and Dr. M. S. Dickerson, State Epidemiologist, Texas
State Department of Health; Dr. George Martin, Livestock
Slaughter Inspection Division, Consumer and Market Serv-
ice, and Dr. Erston Cox, Veterinarian in Charge, Animal
Health Division, Agriculture Research Service, USDA; and
a team from NCDC.)


CAT-ASSOCIATED TULAREMIA Georgia


On April 19, 1968, a 39-year-old woman, residing in
northwestern Georgia, was severely bitten and clawed on
her left hand by her cat. On April 24, she noted chills and
a fever of 1040F., and the following day she developed
painful left axillary lymphadenopathy. She was admitted to
the hospital on April 26 at which time a large draining
purulent wound was observed on her left thumb, and co-
existing pneumonitis was diagnosed. The patient was
treated with penicillin, erythromycin, and tetracycline,
and gradually improved over the next 4 weeks.

Agglutination titers against Francisella tularensis
rose from less than 1:8 on April 27 to 1:320 on May 28.
Sera collected on May 17 and May 28 were non-reactive


when tested against Psittacosis-Lymphogranuloma Vene-
reum antigen, and skin tests performed on June 7 using
cat-scratch fever antigen were also negative.

The patient gave no history of tick bites. The cat
may have acquired the infection from ticks or by feeding
on a tularemia-diseased carcass; however, it remained well.


(Reported by David W. Dreesen, D.V.M., Veterinary Epi-
demiologist, and John E. McCroan, Ph.D., Director, Branch
of Epidemiologic Investigation, Georgia Department of
Public Health; and S. S. Kalter, Ph.D., Southwest Founda-
tion for Research and Education, San Antonio, Texas.)


JUNE 29, 1968


Morbidity and Mortality Weekly Report






Morbidity and Mortality Weekly Report


JUNE 29, 1968


CURRENT TRENDS
MEASLES United States


All nine geographic divisions showed a decrease in
the number of counties or health districts reporting measles
during the 4-week period. May 19 through June 15, 1968,
from those reporting in the comparable 4-week period in
1967 (Table 1). However, the New England division had
more than a twofold increase in the number of counties
reporting a total of 10 or more cases in this 4-week period
in 1968 over the number reporting a similar number of case.
in the corresponding 4-week period in 1967.

From May 19 through June 15, I'"r, (weeks 21-*-4)
measles was reported from 316 counties or health districts,
whereas 592 counties or health districts reported measles
during the comparable 4-week period in 1967. Of these 316
areas, 58 (18 percent) reported a total of 10 or more cases
(Figure 1) as contrasted with 153 of 592 (26 percent) re-
Irin;,' a similar number of cases during the corresponding
4-week period in 1967 (Figure 2).


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



Figure 1
COUNTIES OR HEALTH DISTRICTS REPORTING A TOTAL
OF 10 OR MORE CASES OF MEASLES
MAY 19 JUNE 15, 1968
UNITED STATES, PUERTO RICO, AND VIRGIN ISLANDS

f E- ...... -
4


) *^-- _,F


" -7---^-
/ ,i
s I ,
-;IP i ,:


Table 1
Number of Counties or Health Districts Reporting Measles
During Weeks 21-24, 1967 and 1968,
by Geographic Divisions

Number of Counties
I.r H..,lth Di -tri, Reportinri
Total of
Geographic 1 or More Cases o o
Division 10 or N.ore Cases
Division
1968 1967 1968 1967
May 19- May 21- May 19- May 21-
June 15 June 17 June 15 June 17
United States 316 592 58 153
New England 18 23 8 3
Middle Atlantic 45 55 11 12
East North Central 54 82 8 17
West North Central 13 48 14
South Atlantic 37 90 3 16
East South Central 16 61 1 11
West South Central 59 96 15 30
Mountain 28 58 5 12
Pacific 46 79 7 38
Puerto Rico 5 5 4
Virgin Islands 1 1 -

Figure 2
COUNTIES OR HEALTH DISTRICTS REPORTING A TOTAL
OF 10 OR MORE CASES OF MEASLES
MAY 21 JUNE 17, 1967
UNITED STATES, PUERTO RICO, AND VIRGIN ISLANDS







-. .- ._ --





S* ..- -


A-


PNEUMONIA-INFLUENZA DEATHS United States


A sharp increase in pneumonia-influenza deaths oc-
curred in the United States during the 1967-68 influenza
season (Figure 3). Of the nine geographic divisions of the
United States, all but the Pacific division demonstrated
excess mortality during this period. For the country as a
whole, excess pneumonia-influenza mortality was observed
during the first 6 weeks of 1968.
Since the eighth week of 1968, pneumonia-influenza
mortality has tended to be at levels below the expected in


the East North Central, Middle Atlantic, and South Atlantic
divisions. This phenomenon has been observed as well
for the country as a whole.




(Reported by Respiratory Viral Diseases Unit, Viral Dis-
eases Section, and Statistics Section, Epidemiology Pro-
gram, NCDC.)


244








JUNE 29, 1968


Morbidity and Mortality Weekly Report


Figure 3
PNEUMONIA-INFLUENZA DEATHS IN 122 UNITED STATES CITIES


WEEK NO. 40 44 48 52 4 8 12 16 20 24 28 32 36 40 44 48 52 4 8 12 16 20 24 28 32 36 40 44 48 52 4 8 12 16 20 24 28 32 36
WK ENDED 9 6 4 I 29 26 2 23 21 18 16 13 10 8 5 3 31 28 25 25 22 20 17 15 12 9 7 4 2 30 27 24 23 20 18 15 13 10 7
MONTH 0 N D J F M A M J J A S O N D J FM A M J J A S 0 N 0 J F M A M J J A S
196511966 196611967 196711968


0 WEEK NO. 40 44 48 52 4 8 12 16 20 24 28 32 40 44 48 52 4 8 12 16 20 24 28 32 40 44 48 52 4 8 12 16 20 24 28 32 36
E 196711968 196711968 196711968

151 'I i 350
MOUNTAIN 125 50
MOUNTAIN Iso E.S.CENTRAL MIDDLE ATLANTIC


50


25


WEEK NO. 40 44 48 52 4 8 12 16 20 24 28 32
196711968


PACIFIC
16 CITIES


100



50,


8 CITIES


250

200








40 44 48 52 4 8 12 16 20 24 28 32
1967 T 1968


WS. CENTRAL
13 CITIES 150



100



50



...ls ad enh s h ush esise h ole safea t...Is.. I


20 CITIES












40 44 48 52 4 8 12 16 20 24 28 2 36
196711968


SOUTH ATLANTIC
12 CITIES


WEEK NO. 40 44 48 52 4 8 12 16 20 24 28 32 40 44 48 52 4 8 12 16 20 24 28 32 40 44 48 52 4 8 12 16 20 24 28 32 36
196711968 196711968 196711968


8 CITIES






Morbidity and Mortality Weekly Report


RECOMMENDATION OF THE PUBLIC HEALTH SERVICE
ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES

In lay 196j8 the Public Iealthf Service Advisory Committee on Immuniza-
tion I'racti'ce, completed the follow ing recommendations on influenza
immunization in tfhe (ivilian population.

INFLUENZA VACCINES 1968-69


RATIONALE FOR SELECTIVE USE
OF INFLUENZA VACCINE
Prevention of influenza in the general population
through routine vaccination, although perhaps a goal for
the future, is not presently possible. Two of the limiting
factors are that influenza occurs at intervals and in pat-
terns which are only broadly predictable and that influenza
vaccines are not yet completely adaptable to regular,
widespread use. There continues to be a sound basis,
however, for recommending selective use of influenza
vaccine. The rationale for selective use is based on char-
acteristics of the disease. its epidemiology and virology,
and the efficacy of vaccines .
Influenza is a generally mild epidemic illness which
appears periodically. Its pattern of recurrences provides a
basis for yearly forecasts: type A epidemics occur at. 2-3
year intervals, and type B epidemics, at 3-6 year intervals.
Periodicity is thought to result from antigenic variations
in the prevalent influenza viruses and shifts in the balance
of -usceptibles and immunes in the population. The rela-
ti\e accuracy of influenza forecasts depends on the ex-
tent of recent epidemics and the antigenic changes in
influenza viruses.
Although our best available preventive of influenza,
inactivated vacciness are among the least satisfactory im-
munizing agents in general use today. They have often
been marginally effective, offering rather brief periods of
protection. They also produce local and systemic reac-
tions with relatively high frequency. Public health recom-
mendations in recent years have acknowledged these limi-
tations and have encouraged only selective influenza
vaccination.
Older and chronically ill individuals in the population
are essentially the only ones who have any risk of serious
complications or fatality from influenza. Therefore, annual
influenza vaccination has been recommended for them
while not being recommended for the entire population.
When epidemic influenza is forecast, vaccination pro-
grams might reasonably be extended beyond the high risk
groups to those providing essential community services.
Otherwise, large-scale vaccination programs are not now
warranted and should not take precedence over public
health activities of already established importance.
The following prospectus for influenza in 1968-69 in-
cludes a description of vaccines which will be available
and general recommendations for limited influenza vacci-
nation.

INFLUENZA PROSPECTUS 1968-69 UNITED STATES
During the late fall and winter of 1967-68, all but four
States Oregon. California, Idaho, and Nevada reported


outbreaks of influenza-like illness. A sharp increase in
pneunonia-influenza deaths occurred coincidentally in
eight of the nine geographic divisions of the United States
- the Pacific Division was the only exception.
Forty States confirmed influenza A2 by laboratory
procedures. Viral strains recovered during 1967-68 remain
in the general family of type A2 viruses identified world-
wide since 1957, but show a moderate antigenic shift from
strains isolated in recent years.
No outbreaks of type B influenza were reported in the
United States in 1967-68. The country last experienced
type B influenza epidemics in 1965-66 (East) and 1966-67
(West). Strains of type B virus recovered in other areas of
the world over the past year are antigenically similar to
those identified in the United States in 1965-67.
In view of influenza's periodicity, little or no A2
influenza is expected to occur in the United States during
the 1968-69 season, except possibly on the Pacific Coast.
Scattered type B influenza may be seen, but its total ex-
tent should be minimal.

INFLUENZA VIRUSES AND VACCINES
Formulation of current influenza vaccines is reviewed
annually by the Division of Biologics Standards, National
Institutes of Health, and changes are made when signifi-
cant shifts have occurred in the antigenic characteristics
of prevalent viruses. This regular review is essential,
since vaccine effectiveness depends primarily on the anti-
genicity of component viruses and on how similar :h.
are to viruses occurring in the community.
Optimally constituted influenza vaccines have achieved
60 percent or greater protection against the same or closely
related viral strains. However, vaccines in general civilian
use often have not appeared to achieve this degree of
protection.
Another important factor in vaccine effectiveness is
the amount of antigen administered. In an attempt to mini-
mize the frequency of local and systemic reactions associ-
ated with influenza vaccines, the Division of Biologics
Standards established a limit of 600 chick cell agglutinating
(CCA) units of antigen per adult dose of vaccine for
civilian use.
Limited quantities of a new, highly purified vaccine
of bivalent formulation also with 600 CCA units, were
used in 1967-68. This vaccine. which contains substan-
tially less non-viral material than the regular vaccines,
caused fewer severe reactions.

INFLUENZA SURVEILLANCE
It should be emphasized that decisions on formula-
tions of influenza vaccines and recommendations for their


JUNE 29, 1968










use rely on prompt reporting of epidemiologic and labora-
tory data collected during each influenza season from as
many sources as possible.


INFLUENZA VACCINES 1968-69
As in the 1967-68 influenza season, both bivalent
and polyvalent vaccines will be available. Each vaccine
contains 600 CCA units, but the bivalent vaccine con-
tains a higher proportion of contemporary strains. Poly-
valent vaccine incorporated older strains (types A and
Al), hence less of the recent A2 and B antigens. The
older strains have not been shown to play a significant
role in protecting against currently prevalent viruses;
therefore, the bivalent product should provide greater


protection.
Compositions of the


1968-69 vaccines are shown


below:

CCA Units Per Adult Dose
Type Strain
Bivalent Polyvalent

A PR/8/34 -100
Al Ann Arbor/1/57 100

A2 Japan/170/62 J150 00 200
lTaiwan/1/64 1150 300 100

B Mass/3/66 300 200

Total 600 600



RECOMMENDATIONS FOR VACCINE USE
Until consistently high level and durable protection
can be expected from influenza vaccines and until their
capacity for producing reactions is reduced, routine vacci-
nation of healthy groups of adults and children is not
recommended. This recommendation is particularly rele-
vant in 1968-69, because epidemic influenza is not ex-
pected to occur.
Annual influenza immunization is again recommended
for individuals in groups known to experience high mortality
from epidemic influenza. In particular, immunization with
bivalent vaccine is recommended for persons in older age
groups and for all individuals with chronic illnesses, as
defined below.
Chronically Ill: Persons of all ages who suffer from
chronic debilitating diseases, in. ii ,,n_' cardiovascular,
pulmonary, renal, or metabolic disorders: 1) patients with
rheumatic heart disease, especially with mitral stenosis;
2) patients with such cardiovascular disorders as arterio-
sclerotic heart disease and hypertension, especially show-
ing evidence of frank or incipient cardiac insufficiency;
3) patients with chronic bronchopulmonary diseases such as
asthma, chronic bronchitis, cystic fibrosis, bronchiectasis,
pulmonary fibrosis, pulmonary emphysema, or pulmonary
tuberculosis; and 4) patients with diabetes mellitus and
Addison's disease.
Older Age Groups: During major influenza outbreaks.
especially those caused by type A viruses, increased


247


mortality has regularly been recognized for persons over
45 years of age and even more notably for those over 65.
This association has been particularly marked in individ-
uals with underlying chronic disease.

Vaccination Schedule
All injections should be given subcutaneously.
Persons Vaccinated After July 1963*: Only a single
booster of bivalent vaccine at the dosage level specified
below is necessary for individuals for whom immunization
is indicated and who have been vaccinated as recently as
July 1963. This booster dose is best given in early Decem-
ber. which is approximately one month before the beginning
of the usual influenza season.
Persons Not Vaccinated Since July 1963*: Persons
for whom immunization is indicated and who have not been
vaccinated since July 1963 should receive a primary im-
munization series of bivalent vaccine. The optimal pri-
mary series consists of two doses 2 months apart. Even a
single dose will afford some protection, and a second in-
jection as early as 2 weeks after the first will enhance
the antibody response. Immunizations should be scheduled
to be completed by early December.

Vaccine Dose**
Adults and Children Over 10 Years Old: 1.0 ml. on
one or two occasions as specified above.
Children 6 to 10 Years Old: 0.5 ml. on one or two
occasions as specified above.***
Children 3 Months to 6 Years Old: 0.1-0.2 ml. of vac-
cine on two occasions 1-2 weeks apart, followed by a third
dose of 0.1-0.2 ml. about two months later.***

Reactions
Reactions to regular influenza vaccines are thought
to be related primarily to the non-viral components of the
vaccine and commonly include erythema, induration, and
tenderness at the site of injection. Systemic reactions of
fever, headache, and malaise also occur. but less frequently.
For older individuals who should receive influenza
vaccine but have experienced severe local and systemic
reactions following receipt of regular vaccines, full doses
of a highly purified influenza vaccine should be con-
sidered. Intracutaneous administration of regular vaccines
had previously been used in these older age individuals
but is less effective than full doses of vaccine given by
the subcutaneous route.

Contraindications
Since the vaccine viruses are propagated in eggs. the
vaccine should not be administered to anyone who is
, f..-.-: r .. .: to eggs.


*This date represents the last major change in the A2
component.
**The equivalent dose volume of highly purified vaccine is
indicated by the manufacturer.
***Since febrile reactions in this age group are common fol-
lowing influenzavaccination, an antipyretic may be indicated.


JUNE 29, 1968


Morbidity and Mortality Weekly Report








248 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 29, 1968 AND JULY 1, 1967 (26th WEEK)

ENCEPHALITIS HEPATITIS
ASEPTIC Primary
AREA MENINGITIS CLLOSISDIPTHERIAuding In tious Serum Infectious
unsp. cases
1968 1967 1968 1968 1968 1967 1968 1968 1968 1967 1968
UNITED STATES... 50 41 14 2 19 28 12 97 818 650 51

NEW ENGLAND.......... 3 1 1 21 31 1
Maine.* ............ 1 3
New Hampshire...... 1
Vermont............. -
Massachusetts...... 2 1 13 8
Rhode Island....... 1 1 9
Connecticut........ 1 6 9 1

MIDDLE ATLANTIC...... 4 7 1 3 4 2 34 147 100 3
New York City...... 4 2 1 1 22 43 21
New York, Up-State. 1 I 23 37 2
New Jersey.......... 3 12 43 14 1
Pennsylvania....... 3 1 2 1 38 28

EAST NORTH CENTRAL... 4 9 2 9 6 100 83 4
Ohio............... 1 2 6 1 31 20
Indiana............. 2 2 1 12 6 1
Illinois.......... 1 1 21 1
Michigan ........... 1 5 1 5 45 30 2
Wisconsin.......... 1 12 6

WEST NORTH CENTRAL... 1 1 2 1 2 1 83 54 10
Minnesota.......... 1 1 2 1 13 9 5
Iowa............... 5 2 1
Missouri........... 1 20 39 1
North Dakota........ 4
South Dakota ...... 3
Nebraska............ 2 1
Kansas............ 1 1 36 3 3

SOUTH ATIANTIC........ 7 7 1 3 1 2 50 53 8
Delaware........... 1 6 1 1
Maryland........... 3 2 1 11 17
Dist. of Columbia.. 4-
Virginia........... 7 1 5 9
West Virginia...... 1 2 1
North Carolina..... 5 8 4
South Carolina ..... 1
Georgia............ 2 10 1
Florida............ 3 1 1 15 6 1

EAST SOUTH CENTRAL... 3 4 1 I 26 48 6
Kentucky............ 1 1 4 14 6
Tennessee.......... I 1 1 1 9 19
Alabama............ 1 6 2 -
Mississippi......... 1 1 7 13

WEST SOUTH CENTRAL... 13 8 1 2 5 3 1 1 88 67
Arkansas........... 8 -
Louisiana.......... 10 2 1 5 2 1 1 16 11 -
Oklahoma... ....... 1 2 21 1 -
Texas............... 2 4 2 1 43 55 -

MOUNTAIN............. 1 1 4 6 49 26 5
Montana............ 3 3 -
Idaho............... 2 2 1
Wyoming............ 2 -
Colorado............ 1 4 5 29 10 4
New Mexico......... 1 4 3 -
Arizona.............. 1 4 8 -
Utah................ 5
Nevada ............. -

PACIFIC.............. 14 12 3 6 4 4 46 254 188 14
Washington......... 3 30 25 1
Oregon............. 16 11 -
California......... 11 7 3 3 4 4 46 202 152 4
Alaska.............. 1 3- 3
Hawaii............. 3 1 2 3 9

Puerto Rico.......... 50 25
*Delayed reports: Aseptic meningitis: Okla. 3 cases 1967
Encephalitis, primary: Okla. 1 case 1967, 2 cases 1968
Encephalitis, post-infectious: Okla. 1
Hepatitis, infectious: Me. 2







Morbidity and Mortality Weekly Report 219


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 29, 1968 AND JULY 1, 1967 (26th 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... 502 17,621 54,627 42 1,659 1,405 1,830 3 3 22 886

NEW ENGLAND.......... 49 1,037 760 1 87 57 335 255
Maine...*.......... 1 35 228 6 3 9 9
New Hampshire...... 113 72 7 2 -
Vermont............ 1 29 1 5 2
Massachusetts..* ... 19 333 290 37 29 198 107
Rhode Island....... 1 60 7 4 51 70
Connecticut........ 29 554 81 1 29 19 72 67

MIDDLE ATLANTIC...... 185 3,288 2,039 7 286 219 165 170
New York City...... 106 1,484 387 4 61 36 128 98
New York, Up-State. 44 1,117 461 2 46 53 NN 55
New Jersey......... 28 536 467 102 81 37 17
Pennsylvania....... 7 151 724 1 77 49 NN -

EAST NORTH CENTRAL... 42 3,483 *4,934 10 198 179 551 1 1 1 159
Ohio................ 6 276 1,106 1 52 63 67 31
Indiana............. 7 608 564 2 28 21 32 3
Illinois ........... 9 1,295 854 4 43 43 72 1 1 1 60
Michigan........... 5 233 864 2 58 39 118 31
Wisconsin.......... 15 1,071 1,546 1 17 13 262 34

WEST NORTH CENTRAL... 8 353 2,724 3 86 63 60 9
Minnesota.......... 15 126 19 15 1 -
Iowa............... 3 89 730 1 6 12 54 5
Missouri........... 80 325 1 31 12 4 3
North Dakota....... 5 122 790 3 1 1
South Dakota...... 4 51 4 6 NN -
Nebraska........... 35 610 6 11 -
Kansas............. 8 92 1 17 6 1 -

SOUTH ATLANTIC....... 65 1,321 6,452 4 342 270 130 62
Delaware .......... 1 13 42 1 6 5 6 3
Maryland........... 79 136 1 24 33 3 4
Dist. of Columbia.. 6 21 13 10 8 -
Virginia........... 22 283 1,996 27 29 52 11
West Virginia...... 24 234 1,312 8 20 33 24
North Carolina..... 6 279 834 1 68 55 NN -
South Carolina..... 12 48"6 1 55 24 2 4
Georgia............. 4 29 60 43 -
Florida............. 12 411 1,596 81 51 26 16

EAST SOUTH CENTRAL... 23 521 4,903 5 144 117 103 56
Kentucky............ 2 167 1,276 5 56 34 13 28
Tennessee.......... 54 1,694 48 47 79 22
Alabama............ 3 74 1,283 20 24 7 6
Mississippi ........ 18 226 650 20 12 4 -

WEST SOUTH CENTRAL... 75 4,398 16,679 8 274 199 151 2 2 13 60
Arkansas........... 2 1,400 15 25 2 -
Louisiana.......... 2 146 5 77 80 3 1
Oklahoma...*....... 2 108 3,312 48 13 1 -
Texas............... 73 4,286 11,821 3 134 81 145 2 2 13 59

MOUNTAIN............. 15 910 4,342 1 25 25 92 41
Montana............ 66 275 2 13 3
Idaho.............. 1 17 361 1 11 1 12 4
Wyoming............ 49 177 1 -
Colorado............ 11 469 1,436 7 10 17 15
New Mexico......... 1 82 562 3 13 2
Arizona.............. 2 201 935 1 4 30 13
Utah................ 21 327 1 4 7 4
Nevada............. 5 269 3 2

PACIFIC.............. 40 2,310 11,794 3 217 276 243 8 74
Washington.......... 1 513 5,366 36 24 17 3
Oregon.............. 12 444 1,488 1 17 24 19 16
California......... 26 1,317 4,681 2 152 216 179 8 48
Alaska............. 1 2 125 1 9 16 5
Hawaii.............. 34 134 11 3 12 2

Puerto Rico.......... 3 334 1,957 18 9 23
Delayed reports: Measles: Me. 4, Mass. delete 1, Okla. delete 3
Mumps: Me. 18, Iowa 39
Rubella: Me. 17, Okla. 3







230 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JUNE 29, 1968 AND JULY 1, 1967 (26th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
AREA SCARLET FEVER (Rky. Mt. Spotted) ANIMALS
Cum. Cum. Cum. Cum. Cum.
1968 1968 1968 1968 1968 1968 1968 1968 1968 1968 1968
UNITED STATES... 5,353 5 69 6 92 10 144 5 80 74 1,850

NEW ENGLAND.......... 804 I 40 4 1 62
Maine. ........... 8 50
New Hampshire..... 24 2
Vermont............ 15 40 1 8
Massachusetts...... 104 2 1
Rhode Island ....... 83 -
Connecticut ........ 570 1 2 1

MIDDLE ATLANTIC...... 388 1 10 3 12 1 6 2 17
New York City...... 12 5 7
New York, Up-State. 370 4 3 2 1 11
New Jersey......... NN I1 1
Pennsylvania....... 6 1 1 3 4 2 6

EAST NORTH CENTRAL... 435 8 1 7 2 23 3 3 163
Ohio............... 34 1 -11 l 2 65
Indiana........... 74 1 1 1 2 3 2 59
Illinois........... 98 5 4 8 1 17
Michigan........... 127 2 1 9
Wisconsin .......... 102 1 1 13

WEST NORTH CENTRAL... 164 2 1 7 1 8 2 15 415
Minnesota.......... 14 5 116
Iowa.............. 68 1 4 78
Missouri........... 26 2 1 5 3 3 75
North Dakota....... 35 1 68
South Dakota....... 16 1 1 1 34
Nebraska........... 2 1 3 1 1 21
Kansas ............. 3 1 -- 1 23

SOUTH ATLANTIC....... 653 12 5 1 37 2 47 6 209
Delaware........... 8 -
Maryland............ 165 1 1 7 1 5 3
Dist. of Columbia.. 24 I 1 -
Virginia........... 202 2 1 7 1 21 2 85
West Virginia...... 106 1 1 27
North Carolina..... 2 2 2 2 14 8
South Carolina..... 9 1 I 1
Georgia............. 5 1 9 4 3 31
Florida............ 132 4 1 11 2 55

EAST SOUTH CENTRAL... 925 9 6 1 16 1 9 12 449
Kentucky............ 178 1 1 1 3 1 8 214
Tennessee.......... 640 2 4 10 1 6 3 215
Alabama............ 45 3 1 19
Mississippi........ 62 3 1 3 1 1 1

WEST SOUTH CENTRAL... 400 3 14 3 18 2 12 10 18 345
Arkansas........... 17 4 1 2 I 2 40
Louisiana.......... 1 5 3 1 2 31
Oklahoma............ 15 3 1 3 4 3 104
Texas.............. 367 3 5 2 10 6 6 13 170

MOUNTAIN............. 876 1 5 9 1 2 3 42
Montana............. 19- -
Idaho.............. 113 -
Wyoming............. 7 1 I 1 2
Colorado............ 502 1 2 2 1 2 1
New Mexico........ 135 6 1 19
Arizona............ 57 2 20
Utah............... 43 2
Nevada............. -

PACIFIC.............. 708 1 13 1 3 23 1 14 148
Washington......... 68 1 1 -
Oregon ............. 50 1 1 3 3
California......... 446 11 3 20 1 14 145
Alaska............ 47 -
Hawaii............ 97

Puerto Rico.......... 7 5 1 16

*Delayed reports: SST: Me. 30, N. H. 7








Morbidity and Mortality Weekly Report






TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED JUNE 29, 1968


251


(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 year Area All and In year
ge and over Influenza All Age and over Influenza All
All Ages Causes All Ages Causes


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

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

EAST NORTH CENTRAL:
Akron, Ohio-----------
Canton, Ohio----------
Chicago, Ill.----------
Cincinnati, Ohio------
Cleveland, Ohio-------
Columbus, Ohio--------
Dayton, Ohio----------
Detroit, Mich.--------
Evansville, Ind.------
Flint, Mich.----------
Fort Wayne, Ind.------
Gary, Ind.------------
Grand Rapids, Mich.---
Indianapolis, Ind.----
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.------


663
197
39
25
29
42
19
29
31
60
61
15
46
29
41

3,162
48
36
140
48
41
30
60
94
1,502
45
561
192
40
90
23
35
65
48
31
33

2,595
52
40
715
190
219
121
66
328
39
44
56
28
32
175
38
124
49
35
56
124
64

755
64
8
32
123
30
114
68
204
54
58


404
120
24
17
21
22
11
22
22
31
32
13
29
17
23

1,837
28
25
83
25
23
17
36
52
858
25
321
107
3Q
63
10
25
43
24
21
21

1,452
25
21
381
116
104
69
34
170
23
24
29
14
21
97
24
87
31
19
37
86
40

440
40
4
17
70
15
76
34
118
31
35


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.----------


1,132
129
224
46
51
124
63
81
45
65
61
213
30

578
82
59
44
109
140
38
26
80

1,172
35
44
24
162
45
99
210
57
155
85
122
65
69

470
58
27
123
24
108
33
48
49

1,410
16
51
33
52
87
387
62
32
110
70
99
157
44
131
42
37


Total 11,937 6,748 [ 403 602

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages -------------------------340,201
All Causes, Age 65 and over------------------- 198,171
Pneumonia and Influenza, All Ages------------- 14,804
All Causes, Under 1 Year of Age--------------- 15,577


Week No.
26


576
60
111
19
32
60
34
43
19
55
32
95
16

305
48
26
29
58
73
19
14
38

580
21
25
15
82
23
48
97
31
60
36
66
37
39

269
21
15
72
15
62
19
32
33

885
14
29
22
31
58
246
42
21
65
46
51
94
28
77
33
28










INTERNATIONAL NOTES
QUARANTINE MEASURES


AdditionalI Imminiaion Information for International
Trael. 1967-68 .,- Public Health Service
Publication No. 384


AFRICA
Equatorial Guinea Page 28
Insert the following yellow fever information: Yellow fever
vaccination is required of arrivals from infected areas.


EUROPE
The Netherlands Page 70
Delete the previous note concerning smallpox. Insert:
smallpox vaccination is required of all arrivals except
arrivals from Azores and Madeira Islands, Canary Islands,
Reunion, Bermudas, Canada, French Guiana, Greenland,
Guadeloupe, Martinique, Netherlands Antilles, St. Pierre,
and Miquelon. Surinam, and United States of America.


OCEANIA
Nauru Islands Page 78
Delete the previous information. Insert the following:
Smallpox Smallpox vaccination is required of all arrivals
except arrivals by sea from the following countries and
territories provided that travelers have not been outside
these areas for 14 days before arrival and that these areas
are free of smallpox: Australia, British Solomon Islands,
Christmas (Indian Ocean) and Cocos (Keeling) Islands,
I,! Gilbert, and Ellice Islands, New Zealand, Norfolk
and Ocean Islands, Australian Territory of Papua and New
Guinea, and Tonga.
Cholera Cholera vaccination is required of all arrivals,
1 year of age and over, arriving from infected areas by air.
Yellow Fever Yellow fever vaccination is required of
arrivals, 1 year of age and over, from endemic areas.
























ERRATUM, Vol. 17, No. 24, p. 223
In the article "Follow-up Obscure Disease Related
to African Monkeys," the size of the granules resembling
rickettsia should be (500-600 mp) and not the ( iiii.riii,,
that appears.


JUNE 29, 1968


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION OF 17.000. s PUBLISHED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER, ATLANTA, GEORGIA.
DIRECTOR, NATIONAL COMMUNICABLE DISEASE CENTER
:.- ,i "' ENCE R M.D.
CHIEF. EPIDEMIOLOGY PROGRAM D r.' U, M.D.
ACTING CHIEF, STATISTICS SECTION IDA L. SHERMAN. M.S.
EDITOR MICHAEL B GREGG, M.D.

IN ADDITION TQ JHE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY. TI. N TO .. Co MM u ...M. AL DSE :E
CENTER WELCOMES ACCOUNTS '- .iNTEle T,.: c:L'TB RE a OR CI E
INVESTIGATIONS WHI:.-: ~AE GO" _*-RREN'T ,'.TAi~;T TO HEALTH
OFFICIALS AND WHICH. ARE o'REC.T.Y =L iTED I,, THE CONTROL
j" I.toNICABLE Z*,,_EE: aJ-'l: COMMUNICATIONS SHOULD BE
alDR i:' iED TO:
NATIONAL COMMUNICABLE DISEASE CENTER
.- ., ,:e,:.~G-. 30333
4 ATTN: TE r C'.O.
uoa E, I. AIID r I(CTALITY WEEKLY REPORT

NOTE: THE DATA IN THIS REPORT, ARE g0 .i.ONaI. AND ARE
*IECE -: PIEE L* TELEGRAMS TO T'HE i CC-*': f ii O. a
ita. EL DE ARTMENTS -E lEPlR.iC *EE*< CONCLuJOE
S yiC. :C i FILEDDAT *N T .L A ARE RELE ED
C: i E ::.tEC.,.iL FRIDAY.

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