Morbidity and mortality

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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:
AA00010654:00194

Related Items

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


This item is only available as the following downloads:


Full Text



NATIONAL COMMUNICABLE DISEASE CENTER


U.S. DEPARTMENT OF HEALTH, EDUCATII

HEALTH SERVICES AND ME

EPIDEMIOLOGIC NOTES AND REPORTS
TRANSFUSION MALARIA Seattle, Washington
On May 12, 1968, a 54-year-old white American wo-
man entered a hospital in Seattle, Washington, for insertion
of an aorto-iliac bypass graft. On May 13, the day of her
operation, she received 7 units of whole blood. Her post-
operative course was uncomplicated, and she was dis-
charged on May 22. On May 26, she developed low abdom-
inal pain, nausea, vomiting, and fever, and was rehospi-
talized with a temperature of 104F. During the next 8
days, she experienced daily temperature spikes up to
105F. On June 4, numerous trophozoites of Plasmodium
falciparum were identified on a routine differential blood
smear. The patient gave no history of malaria, travel in
malarious areas, or usage of commonly shared syringes.


Vol. 17, No. 32


WEEKLY

REPORT

Week Ending
August 10, 1968




PUBLIC HEALTH SERVICE


''Trnsfusion MaJar F Seattle, Washington .... 297
bubhum Pf sociated Hepatitis New Jersey .. 298
S-r-q-b ..reene County, Alabama . ... 298
Follow- I 'p suspect Wound Botulism California 304
Current Trends
Meningococcal Infections United States .......... 299
International Notes
Quarantine Measures ..... . 304

On June 4, the patient received 1 gm of choloroquine phos-
phate orally, followed by 500 mg on each of the next 6
days. She became afebrile on June 7; blood smears taken
at this time revealed only a few trophozoites of P. falci-
parum, and no trophozoites were detected on June 10. Be-
tween May 27 and June 14, her hematocrit decreased from
(Continued on page 298)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
32nd WEEK ENDED CUMULATIVE, FIRST 32 WEEKS
MEDIAN
DISEASE August 10, August 12, 1963 1967 MEDIAN
1968 1967 1968 1967 1963 1967
Aseptic meningitis ...................... 186 102 60 1,587 1,281 1,026
Brucellosis ............................ 2 3 8 127 163 163
Diphtheria................. ........... 1 1 100 62 108
Encephalitis, primary:
Arthropod-borne & unspecified ........... 44 53 597 884 -
Encephalitis, post-infectious ............. 7 28 --- 333 585 -
Hepatitis, serum ........................ 93 42 5 7 2584 1,299 24,826
Hepatitis, infectious .................... 840 646 26.824 23,535
Malaria ................................ 30 28 4 1,296 1.213 63
Measles rubeolaa) ....................... .202 222 921 19,038 56,848 237,409
Meningococcal infections, total ........... 29 16 25 1,870 1,571 1,832
Civilian ............................. 27 15 1,695 1,462 -
Military ............................... 2 1 --- 175 109 -
Mumps ................................. 714 --- 121,949 -
Poliomyelitis, total ..................... 1 1 3 33 21 59
Paralytic ............................. 1 1 3 33 18 53
Rubella (German measles) ............... 319 187 --- 42,494 39.036 -
Streptococcal sore throat & scarlet fever.... 4,499 4,710 4.190 283,590 305,796 275,262
Tetanus ............................... 3 7 7 88 131 152
Tularemia ............................. 7 7 123 109 155
Typhoid fever .......................... 10 9 10 196 244 244
Typhus, tick-borne (Rky. Mt. spotted fever) 15 19 12 162 187 162
Rabies in animals ....................... 64 74 69 2,262 2,814 2,814

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........................................... 3 Rabies in man: ..................................... -
Botulism: .......................................... 4 Rubella, Congenital Syndrome: ......................... 4
Leptospirosis: Ga.-1, La.-l ........................... 21 Trichinosis:N.J.-2, R.I.-1, W. Va.-2 ..................... 48
Plague: ............................................ 1 Typhus, murine: Tex.-4 ................................ 18
Psittacosis: Calif.-l ................................. 31


J






298 Morbidity and Morta


TRANSFUSION MALARIA -
47 to 26 percent and her BUN increased from 9 to 45 mg
percent. Both parameters subsequently returned to normal,
and the patient was discharged from the hospital in early
July.
The donors of the 7 units of blood were contacted,
and only one had ever traveled in a malarious area. This
man, a 22-year-old American Negro, had served in the U.S.
Army in Vietnam from July 2'4 1966, until March 31, 1967,
when he returned to the United States. While in Vietnam
he had taken a combination tablet containing 300 mg chlo-
roquine base and 45 mg primaquine base once weekly in
addition to 25 mg diamino-diphenylsulfone (DDS) daily.
He continued his chloroquine-primaquine tablets for 6
weeks after returning to the United States. He denied a
history of malaria or commonly shared syringes and had
experienced no unexplained illnesses except for a 3-day
febrile episode in late May 1967 which resolved sponta-
neously. On May 2, 1968, 13 months after returning from
Vietnam, he donated the infected blood. Serum was ob-
tained from this donor on June 14, 1968, and analyzed for
the presence of antibodies to malaria by the indirect fluo-
rescent antibody technique: serum dilution end points were
1:80 against P. falciparum, 1:40 against P. ovale, and
1:20 against both P. vivax and P. malariae. These values
are consistent with a recent P. falciparum infection. Also


I


SUBHUMAN PRIMATE-ASSOCIATED HEPATITIS New Jersey


Between April 1 and June 1, 1968, five animal hand-
lers, who cared for approximately 50 subhuman primates*
caged as pets in an area of a private.home in Toms River, -
New Jersey, developed hepatitis. The onsets of illness
were April 1, 3, 5, May 29, and June 1. All patients were
males from 17 to 33 years of age, and all experienced-
nausea, upper abdominal discomfort, voipiting, fever, and
jaundice. Bilirubin determinations ranged from 3.2 to 8.2
mg percent and SGOT's from 51 to. 590. Three patients
were hospitalized; there were no deaths. Noineof the pa-
tients gave a history of contact with'a jaundiced person
or ingestion of raw shellfish during the 2 months prior to
their .Ir.--. and all denied transfusions of blood and"
the self administration of parenteral drugs during the 6
months prior to onset of illness.
The three animal handlers who had onsets of illness
during the first week in April had begun work at the home
from 2 to 6 months before becoming ill, and they left their
employment 1 to 3 days after their illness began. The
other two animal handlers each began work 1 month prior
to developing hepatitis. One of these, however, worked
only 4 days. May 1-4; he developed hepatitis on June 1.
Neither of these two men had been employed during the
onsets of illness of the first three cases.


The five patients had been responsible for cleaning
the cages of the primates and feeding the animals. Their
duties required them to come into close physical contact
with the animals, and all five had been either bitten or
scratched on the hands or forearms by the primates. Al-
though seven other persons also had close contact with
the animals, they reported no illness. Transaminase de-
terminations performed on June 13 on these seven persons
were normal.
Between April and June 1, 1968, the collection of
primates in the home included six woolly monkeys, five
spider monkeys, 19 capuchins, 17 ringtail monkeys, two
Celebes apes, and two black siamangs. There have never
been any chimpanzees on the premises. Of the animals in
the home, 23 were acquired after January 1, 1968, and 19
of these were under 1 year of age. No cases of jaundice
had occurred in the animals or in the employees of the
two animal firms which supplied the primates acquired
since January.

(Reported by Ronald Altman, M.D., Acting Director, Di-
vision of Preventable Diseases, and Paul Marzinsky, Sen-
ior Field Representative, New Jersey State Department of
Health; and two EIS Officers.)


TUBERCULOSIS Greene County, Alabama


In December 1967, a 51-year-old fifth grade teacher in
Greene County, Alabama, developed fever, night sweats,
weakness, anorexia, weight loss (11 Ibs in 1 month), and


a productive cough. On January 27, 1968, she was hos-
pitalized with hemoptysis. A tuberculin test at that time
was negative; however, a chest X-ray was uggef-'ier of





lity Weekly Report August 10, 1968


(Continued from front page)
on June 14, this donor's hemoglobin electrophoresis was
normal, but the red cells were deficient in glucose-6-phos-
phate dehydrogenase. Blood smears obtained from the
donor on July 2 were free of malaria parasites; he then
underwent a 500 cc phlebotomy and further blood smears
were obtained on the next day; again, no malaria parasites
were detected.
(Reported by Donald R. Peterson, M.D., M.P.H., Epidemi-
ologist, Seattle-King County Department of Public Health,
Seattle, Washington.)


Editorial Comment
The persistence of asymptomatic P. falciparum in-
fection in the responsible donor fora minimum of 13 months
suggests that he had acquired ignificani immunity to his
infection. However, since the patient had never traveled
in malarious areas prior to his arrival in Vietnam and since
he had no history of clinical malaria attacks, the acquisi-
tion of such immunity is difficult to explain. It is con-
ceivable that despite the schizonticidal effects of his
suppressive therapy, the strain of P. falciparum which
caused his infection was able to persist in his peripheral
blood at densities sufficient to stimulate immunity but
insufficient to cause symptoms.


- ---- -- --- --










tuberculosis and a direct sputum smear was positive for
acid fast bacilli. She was transferred to the district tu-
berculosis hospital where cultures were positive for Myco-
bacterium tuberculosis and radiologic studies demonstrated
far advanced pulmonary tuberculosis.
Since the woman had had negative X-ray on July 20,
1966, in Dallas, Texas, another X-ray was not required
when she was employed by the Greene County school sys-
tem in September 1966. She had been well until October
1966 when following the death of her mother, she had a
"nervous breakdown" and temporarily stopped teaching.
In October 1967, she noted the onset of cough with a
"rattling" in the left anterior chest and consulted a phy-
sician. A tuberculin test was negative, and a chest X-ray
was not taken. She was treated for her symptoms and im-
proved. In November 1967, during routine school tuberculin
testing, the woman had a test reaction of 5 mm induration.
This test was considered of doubtful significance and
there was no follow-up. Upon review in January 1968, the
X-ray.taken in July 1966 was still considered negative.
The patient lived alone and gave no history of contact
with a known or suspected tuberculosis case. Following
the diagnosis of her case, 15 friends and relatives were
tuberculin tested; six had positive reactions, and all six
had negative chest X-rays. In the school where the woman
taught, all available students and adults who had not had
a previous positive tuberculin test were tested and 34 had
positive reactions (Table 1). All 41 students in the pa-
tient's fifth grade class were tested and 20 (48.8 percent)
were positive; four of these 20 positives had been pre-
viously tested in Novemberl967 and had negative reactions.
Of the 40 students in the other fifth grade in the school,
28 were tested and only one was positive. Of the 34 per-
sons with positive reactions, two were hospitalized with


299


active primary tuberculosis one was a student in the
patient's room and the other was a third grade student in
a room across the hall. Three others were considered in-
active primaries and two had chest X-rays suggestive of
tuberculosis. These five as well as the other 27 persons


Table 1
Results of Tuberculin Testing in the Patient's School
Greene County, Alabama February 1968


Number Number
Grade Positive Negative


1
2
3
4
5
6
7
8
9
10
11
12

Total


with positive


Percent
Total Positive


786 820 4.1


tuberculin tests and negative X-rays were


treated with isoniazid.
(Reported by Frederick S. Wolfe, M.D., Director. Division
of Tuberculosis Control. Bureau of Preventable Diseases.
Alabama Department of Public Health; Sidney J. W'illiams.
M.D., Health Officer, Greene County; Tuberculosis Pro-
gram, NCDC; and an EIS Officer.)


CURRENT TRENDS
MENINGOCOCCAL INFECTIONS United States


The monthly incidence of meningococcal infections
in the United States for May, June. and July 1968 remained
below the mean monthly rate for the period 1960-1966
(Figure 1). For the first 6 months of 1968 a total of 1,661
meningococcal infections were reported in the United
States compared with 1,405 reported for the first 6 months
of 1967. The Middle Atlantic. South Atlantic, and West
South Central divisions reported the largest increases in
reported infections compared with the previous year (Table
2). Military cases accounted for 9.8 percent of the 6-
month total (163 of 1.661) in 1968 compared with 7.4 per-
cent of the total (104 of 1,405) for the similar period in
1967.
Of 355 meningococcal isolates received by NCDC
between January 1 and June 30, 1968. for serogrouping
and sulfadiazine sensitivity testing, 157 or 44.2 percent
were identified as Serogroup B, 143 or 40.3 percent as
Serogroup C, 20 or 5.6 percent as either Serogroup X. Y,
or Z, and the remainder were not typed.


Figure 1
MONTHLY INCIDENCE OF MENINGOCOCCAL
INFECTION UNITED STATES, 1960-1968


3.0-


MEAN MONTHLY RATE
-- 1960-1966
MONTHLY RATE
--- 1966-1967
--- 1967-1968


SEP OCT NOV. DEC. JAN FEB MAR APR MAY JUN. JUL AUG
MONTH
(Continued on page 304)


August 10, 1968


Morbidity and Mortality Weekly Report







:30( Morbidity and llorialily Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

_AUGUST 10, 1968 AND AUGUST 12, 1967 (32nd WEEK) .._


ENCEPHALITIS HEPATITIS
ASEPTIC Primary- Pos
AREA MENINGITIS including Infectious Serum Infectious MALARIA
unsp. cases
I r,- I "s r I ,r" I 14r I I r :[ I r" II lr I O
l ]1[1' iT E .. F., r.n ),]

NEW ENCIANI.......... 6 1 4 36 28

New Hampshire...... -1 1
Vermont ............ -- 4 -
Massachusetts..... 3 16 16
Rhode Island....... 3 4 4
Connecticut.......... 4 11 6

MIDDLE ATLANTIC...... 23 6 6 5 34 148 73 1
New York City...... 8 1 2 18 48 5
New York, up-State. 3 1 1 4 39 19
New Jersey......... 9 3 2 1 12 38 28
Pennsylvania. 3 1 3 2 23 21 1

EAST NORTH CENTRAL... 37 9 13 22 2 4 129 74 1
Ohio................ 30 1 10 19 2 46 14
Indiana............ 1 2 1 13 5
Illinois........... 1 3 3 1 1 26 17
Michigan........... 5 5 1 1 39 34 1
Wisconsin.......... 5 4

WEST NORTH CENTRAL... 4 1 1 50 33 5
Minnesota .......... 2 1 1 20 2
Iowa............... 1 -- 4 3
Missouri............ 1 9 22
North Dakota .......- 2-
South Dakota .. .. 4
Nebraska........... 4 1
Kansas............. 7 5 5

SOUTH ATLANTIC........ 33 22 1 5 10 5 46 92 7
Delaware........... 1 4 1
Maryland........... 19 1 4 1 16 1
Dist. of Columbia.. 2
Virginia........... 29 I 3 1 6 13 1
West Virginia...... 1 1 3 1 6
North Carolina..... 2 14 8 5
South Carolina .....- 1 2
Georgia..*......... 9 19 -
Florida........... 2 1 4 1 10 25

EAST SOUTH CENTRAL... 2 11 1 4 1 42 32
Kentucky ........... 1 2 15 9
Tennessee .......... 1 1 1 4 -- 17 18
Alabama ........... 1 3 5
Mississippi........ 8 7 -

WEST SOUTH CENTRAL... 23 11 2 5 3 1 84 81 -
Arkansas........... 1 6 4 -
Louisiana.......... 7 2 1 5 1 1 12 15
Oklahoma............. 2 1 8 4
Texas .............. 16 6 1 58 58

MOUNTAIN ............ 3 1 1 34 28 8
Montana............ 7 1
Idaho............... -- 1 7
Wyoming............ 1 1
Colorado........... 3 1 1 13 8
New Mexico......... 4 3
Arizona............ 4 14
Utah............... 4 2
Nevada ............. -

PACIFIC.............. 58 42 8 4 42 271 205 8
Washington........ I I 29 15
Oregon............. 4 -- 1 2 10 14
California......... 55 28 10 7 4 40 229 175 5
Alaska ............. I 1 I-
Hawaii ............. I 9 2 1 3

Puerti HR- ........... 1 16 16

Delayed reports: Encephalitis, primary: Me. 1
Encephalitis, iost-infectious: Pa. delete 1
Hepatitis, infectious: Me. 2, Ga. 31







Morbidity and Mortality Weekly Report 301


TABLE 1II. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
AUGUST 10, 1968 AND AUGUST 12, 1967 (32nd 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... 202 19,038 56,848 29 1,870 1,571 714 1 1 33 319

NEW ENGLAND............ 7 1,141 822 2 94 65 82 1 48
Maine..*........... 35 234 6 3 1 3
New Hampshire...... 141 74 7 2 2 -
Vermont............ 2 34 1 1 6 2
Massachusetts...... 4 364 330 1 42 32 48 1 32
Rhode Island ....... 5 62 7 4 8 7
Connecticut........ 3 594 88 1 31 23 17 4

MIDDLE ATLANTIC........ 82 3,855 2,204 9 338 256 69 43
New York City...... 50 1,900 436 68 46 67 22
New York, Up-State. 22 1,206 557 3 58 61 NN 21
New Jersey.......... 7 608 480 4 122 91 2 -
Pennsylvania..*.... 3 141 731 2 90 58 NN -

EAST NORTH CENTRAL... 28 3,676- 5,237 6 227 210 148 1 49
Ohio................ 1 288 1,130 2 62 71 12 10
Indiana............. 643 587 1 29 22 16 4
Illinois........... 5 1,347 927 51 52 9 1 3
Michigan........... 2 256 902 3 65 50 20 17
Wisconsin.......... 20 1,142 1,691 20 15 91 15

WEST NORTH CENTRAL... 5 377 2,820 3 100 67 10 1 12
Minnesota.......... 15 131 1 23 16 2 1
Iowa................ 96 744 6 13 8 6
Missouri........... 81 332 1 32 13 1 3
North Dakota........ 3 131 845 3 1 -- 2
South Dakota....... 4 52 5 6 NN
Nebraska........... 2 40 623 6 12 -
Kansas............. 10 93 1 25 6 -

SOUTH ATLANTIC....... 20 1,471 6,790 3 380 303 60 1 40
Delaware............ 15 43 1 8 6 9 2
Maryland............ 94 149 28 37 6 1
Dist. of Columbia.. 6 22 14 10 -
Virginia........... 3 296 2,167 30 37 2 3
West Virginia...... 8 279 1,362 9 21 24 24
North Carolina..... 282 842 1 75 66 NN 1
South Carolina.... 12 507 56 29 -
Georgia.............. 4 32 73 44 -
Florida............ 9 483 1,666 1 87 53 19 10

EAST SOUTH CENTRAL... 3 486 5,104 1 160 123 38 1 18
Kentucky.. ........ 103 1,316 64 34 8 1 3
Tennessee.......... 1 58 1,813 51 51 24 14
Alabama............ 1 93 1,316 24 25 5 1
Mississippi........ 1 232 659 1 21 13 1 -

WEST SOUTH CENTRAL... 28 4,634 17,102 297 212 103 1 1 18 23
Arkansas........... 3 1,404 20 28 1 -
Louisiana........... 2 151 84 83 -
Oklahoma........... 111 3,325 49 16 2 i 1
Texas.............. 28 4,518 12,222 144 85 100 1 1 17 23

MOUNTAIN............. 8 971 4,578 29 27 40 37
Montana............. 67 277 3 -
Idaho.............. 20 375 11 1 3
Wyoming............ 51 180 1 -
Colorado............ 2 494 1,539 10 12 10 17
New Mexico......... 4 92 576 3 8 6
Arizona............. 2 221 1,005 1 4 19 14
Utah................ 21 357 1 4
Nevada............. 5 269 3 2 -

PACIFIC.............. 21 2,427 12,191 5 245 308 164 10 49
Washington.......... 515 5,414 37 27 18 I
Oregon.............. 5 488 1,563 1 19 25 23 7
California.......... 16 1,387 4,919 4 176 243 101 9 28
Alaska.............. 2 133 2 9 10 11
Hawaii............... 35 162 11 4 12 3

Puerto Rico.......... 9 383 2,087 19 12 16 2

Delayed reports: Measles: Pa. delete 2, S. C. delete 1, Ky. delete 76
Rubella: Me. 2, S. C. 1







:32 Morbidiit and Mortality Weekly Report


TABI. 11. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 10, 1968 AND AUGUST 12, 1967 (32nd WEEK) CONTINUED


STREI TOC LOCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
AREA SCARLET FEVER (Rky, Mt. Spotted) ANIMALS
Cu. Cum. Cur ,. Cum. Cum.
r I.. 1. ii I a -r *


INITED
SNE ENG LAND.......... 585 2 4 6 2 7 2 68
Sin ....... .... 11 2 53
St' Ha'.pMiir .. .. 12 I 2

iss hus tt ...... 99 2
Rhde i l ...and ... ...
Snn t ........ 367 1 3 -

MIDDLE ATLNTIC. ...... 150 12 7 1 20 1 14 5 31
Se. Yor. ity ...... 1 6 1 9
N.,. Y Srk, p-Satt. 148 4 7 3 1 2 5 24
SJ.rse ......... NN 5 6
Pe sylv.nia ........ 1 2 3 6 7

AST sRTH CENTRAL... 251 8 8 26 6 10 210
............ 45 1 12 4 7 84
:.n i ........ .. .4 3 1 3 2 70
11 inis ........... 46 5 5 10 2 1 25
ihi an..... ..... 74 1 10
43 -ni-.......... 43 21

WESI OR r CENTRAL... 4 9 8 4 9 559
ti -1.. ....... 22 5 164
............... 43 1 1 91
iss r .......... 7 3 1 1 81
rth Dak ..... 88
S 3. t-, ..... 4 1 1 79
ebr-.ka.......... 58 3 1 1 25
Ka ............ 2 31

S1OTH ATLANTIC ....... 389 2 19 8 43 10 87 8 243
Delaware. ........ .. 2
Maryland ........... 59 1 2 9 3 10 5
Dist, of Columbia. 2 2 1
Virginia........... 117 4 1 8 3 31 1 92
West Vir inia...... 31
North Carol ina..... 2 2 2 2 27 9
South Carolina..... 1 2 2 6 -
C rg i a ............ 3 11 11 2 38
Florida............ 13 6 2 11 2 5 67

EAST SOUTH EENTRAL... 834 10 6 1 24 2 29 14 506
Kentuc.ky............ 18 1 1 5 6 5 248
Tennesse......... 640 3 4 13 2 19 9 236
Alabama. ........... 106 -3 3 21
iss ssip ........ 70 3 1 1 6 1

WEST SOUTH CENTRALI... 490 1 18 32 5 26 2 16 6 388
Arkansas........... 6 4 6 4 1 1 45
Louisiana.......... 16 1 7 6 3 1 35
Oklah-ma........... 3 8 3 9 1 8 1 114
Texas ............. 465 7 12 2 10 1 7 3 194

MOUNTAIS............. 99 6 12 5 1 59
na..... .. ... 12 -
Idaho. .............. 123 1
Ir ................ 123 1 -
Wy ruing ............ 14 --1 3
Colorado........... 676 3 2 4 3
ew Mexi ......... 111 6 23
Arizna........ 3 1 30
i .tah............... 32 2 -
N va ........... -

PACIFIC.............. 587 15 1 1 30 1 9 198
ashin ....... 41 -1 2 1 1
region ............. 59 -1 1 4 1 5
Ca lifrnia......... 378 13 1 24 1 7 192
Alaska ........... .. 20
awaii ........... 89 -


Puerto Ri, .......... 7 6 -- I I 17

Drlayed reports: SST: Ne. 5
Typhoid: Ar.i. I
Rihi, .s in animals ; K D. 6, D.C. I







303


Morbidity and Mortality Weekly Report






TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED AUGUST 10, 1968


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

All Causes Pneumonia Under IAll Causes Pneumonia Under
Area All 65 years and 1 year Area All 65 years and 1 year
Age and over Influenza All Ages 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.--------


672
210
30
22
25
51
39
25
33
53
54
17
49
21
43

3,073
54
27
136
35
40
52
48
62
1,506
32
503
160
66
122
26
31
75
38
28
32

2,527
59
28
S741
158
196
123
97
329
42
48
49
23
59
154
56
131
38
24
27
104
41

745
56
32
29
125
23
104
78
199
56
43


416
129
16
15
13
32
23
16
22
38
34'
9
30
13
26

1,785
31
16
72
26
21
30
36
27
870
21
288
86
45
74
18
21
48
18
17
20

1,370>
34
15
366
95
86
68
55
183
28
25
26
11
38
77
27
78
17
19
19
76
27

460
33
20
12
76
19
69
47
123
35
26


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.----------


Total 11,858 6,642 384 582

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages -------------------------412,893
All Causes, Age 65 and over-------------------239,020
Pneumonia and Influenza, All Ages------------- 17,278
All Causes, Under 1 Year of Age------------- 19,207


Week No.


1,167
148
229
50
67
81
69
79
35
74
79
224
32

591
78
56
41
107
138
45
40
86

1,087
29
47
25
141
50
72
178
66
180
76
107
61
55

445
50
24
119
10
90
30
62
60

1,551
20
48
31
44
88
475
75
30
121
59
90
200
33
152
47
38



















Division


New England
Middle Atlantic
East North Central
West North Central
South Atlantic
East South Central
West South Central
Mountain
Pacific

Total United States


Jan. -June 1968 Jan. June 1967
Total Total


1,661


1,405


(Reported by the Bacterial Diseases Section and Statistics
Section, Epidemiology Program, and the Bacterial Serology
Unit and Bacterial Reference Unit, Bacteriology Section,
Laboratory Program, NCDC.)


EPIDEMIOLOGIC NOTES AND REPORTS
FOLLOW-UP SUSPECT WOUND BOTULISM California


The 44-year-old farm laborer who developed a clinical
syndrome suggestive of botulism following a compound
fracture (1MMWR, Vol. 17, No. 22) has gradually improved.
He is fully ambulatory with residual mild muscle weakness.
Attempts to isolate Clostridium botulinum from the wound
were unsuccessful. and toxin could not be demonstrated
in this patient's serum. The case has been reported as
wound botulism.
(Reported by Philip h. Condit, M.I)., M.P.H., Chief, Bu-
reau of Communicable Diseases, California State Depart-
ment of Public Health; Wlilliam Defries, M.D.. Health
Officer. Fresno County Health Department; Fresno General
il.. ,; .*' and an EIS Officer.)


INTERNATIONAL NOTES
QUARANTINE MEASURES


Additional Immunization Information for International
Travel, 1967-68 edition, Public Health Service
Publication No. 384

The following information change should be made in Sec-
tion 6.

Page 85
Under District of Columbia: Washington, USPHS Out-
Patient Clinic, Clinic Hours,

Delete: Tuesday. Thursday, and Friday 3:00 p.m., Re-
gistration. 2:15 p.m.
Insert: Monday. Tuesday, Thursday, and Friday 2:00 p.m.,
Registration. 1:45 p.m.


August 10, 1968


MENINGOCOCCAL (Continuedi from page 29t9)

Table 2
Reported Meningococcal Infections
United States
January through June 1968 and 1967


S UNI OF O L LIB
S DOCu'.'E IT DEPT






J,S E EPOSITORY


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Morbidity and Mortality Weekly Report


THE MORBIDITY AND MORTALITY WEEKLY REPORT. WITH A CIRCULA-
TION OF 17.000, S F.'.BL' '- EC T THE NATIONAL COMMUNICABLE
DISEASE CENTER. ATL i :
DIRECTOR. NATIONAL COMMUNICABLE DISEASE CENTER
DAVID SENCERB M'
CHIEF, EPIDEMIOLOGY PROGRAM A.D. L ANCMU' M I
ACTING CHIEF. STATISTICS SECTION IDA L. S.ERMAN MS.
EDITOR MICHAEL B GREGG, MD.

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY. THE IlO'NA COMMUNICABLE DISEASE
CENTER WELCOMES ACCOUNTS OF *NI E AEi IN OUTBREAKSOR CASE
INVESTIGATIONS WHICH ARE OF CUR1E''ri NiNT ; TO HEALTH
OFFICIALS AND WHICH ARE DIRECTLY iEL.T D TO TIE CONTROL
OF COMMUNICABLE DISEASES. SUCH C kOMMJI C ifCIN;- SHOuLD BE
ADDRESSED TO:
NATIONAL COMMUNICABLE DISEASE CENTER
ATLANTA, GEORGIA 30333
ATTN: THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT

NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO THE NCDC 15 I"E INDIVIDUAL
STATE HEALTH DEPARTMENTS. THE REPORTING -EE'I 'ONC.LDEI
ON SATURDAY; COMPILED DATA ON NATIONAL B3AS5 RE RELEASED
ON THE SUCCEEDING FRIDAY.


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