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:
AA00010654:00196

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 COMMUNICABLE DISEASE CENTER


Vol. 17, No. 35





Week Ending

Week Ending


U.S. DEPARTMENT OF HEALTH, EDUCATION, ANI

HEALTH SERVICES AND MENTAL HEAL_


EPIDEMIOLOGIC NOTES AND REPORTS
FOOD POISONING New Jersey

An outbreak of food poisoning occurred on May 8 among
200 employees and a group of 45 students who had eaten
in an industrial plant's cafeteria in New Jersey on May 7.
The noon meal on May 7 was incriminated because it was
the only meal eaten at the plant by the student group. Of
72 employees and 40 students questioned, 48 reported ill-
ness (overall attack rate 42 percent). The most frequently
reported symptoms were fever, diarrhea, abdominal pain,
and to a less extent vomiting. The mean incubation period
was 21 hours with a range of 4-46 hours, and the median
duration of symptoms was 50-59 hours.
Differential attack rates for those who ate and did not
eat the various foods implicated veal parmesan or baked


HEALTH SERVICE


Epidemiologic 1TVSiman~oSWports
Food Poisoning New Jersey . ... 321
Outbreak of Syphilis Butler County, Alabama. 322
Follow-Up Arbovirus Disease Maryland ... .328
Summary
Recommendations of the Public Health Service
Advisory Committee on Immunization Practices -
Influenza 1968-69 ....... .. .. .. 323


macaroni or both as the responsible vehicles (Table 1).
Baked macaroni was prepared and first served 4 days prior
to the incriminated meal. The leftover servings were stored
in a refrigerator until the morning of May 7. During the
interim (a weekend) the electricity at the plant was turned
off for a total of 10 1/2 hours. During the power shutdown,
(Continued on page 322)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
35th WEEK ENDED M AN CUMULATIVE. FIRST 35 WEEKS
MEDIAN
DISEASE August 31, September 2, 1963 1967 MEDIAN
1968 1967 1968 1967 1963 1967
Aseptic meningitis ...................... 207 121 68 2,163 1,631 1,234
Brucellosis .................. ........... 4 6 6 145 176 176
Diphtheria................. .............. 5 5 3 110 72 120
Encephalitis, primary:
Arthropod-borne & unspecified ........... 54 70 752 1,044 -
Encephalitis, post-infectious ............. 6 10 357 616
Hepatitis, serum ........ ................ 94 45 6 2,875 1,442 26,540
Hepatitis, infectious .................. .. 856 638 29,519 25.589
Malaria ................................. 71 47 4 1,449 1,323 69
Measles rubeolaa) ....................... 126 172 516 19,481 57.426 239,140
Meningococcal infections, total ........... 32 26 27 1,976 1,642 1,977
Civilian .............................. 30 25 1,799 1,529 -
Military ............................... 2 1 177 113
Mumps ................................. 474 -- 123,812 -
Poliomyelitis, total ...... ... .. ............. -- 2 35 23 66
Paralytic .............................. 2 35 20 59
Rubella (German measles) ............... 272 133 43,345 39,600 -
Streptococcal sore throat & scarlet fever.... 3,668 4,098 3,878 296,099 318,997 287.366
Tetanus ............................... 4 5 5 101 146 167
Tularemia ............................... 7 5 7 137 123 175
Typhoid fever ................... ....... 10 15 11 220 272 272
Typhus, tick-borne (Rky. Mt. spotted fever) 10 16 9 218 232 186
Rabies in animals ....................... 68 67 67 2,446 3,050 3,050

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........................................... 3 Rabies in man: ...................................... -
Botulism: .......................................... 4 Rubella. Congenital Syndrome: .......................... 4
Leptospirosis: Cal.-1 ............................... 26 Trichinosis: ................................... ...... 47
Plague: ......... .................................... 2 Typhus, murine:* ................................. ..... 21
Psittacosis: ......................................... 34
*Delayed Reports: Typhus, Murine: Tex. 1






Morbidity and Mortality Weekly Report


AUGUST 31, 1968


FOOD POISONING (Continued from front page)

Table 1
Attack Rates of Illnesses Related to Different Food Items Offered in Cafeteria
May 7, 1968

Foods Eaten Foods Not Eaten
Food Not o Attack Rate l Not l Attack Rate
IIl Total I11 Total
111 (Percent) III (Percent)
Tonmato Soup 7 13 20 35 41 51 91 45
Veal Parmesan 34 23 57 60 14 41 55 25
Pork Roll 2 5 7 29 46 59 105 44
Corn Beef Hash 7 5 12 58 41 59 100 41
Italian Macaroni 9 5 14 64 39 59 98 40
Baked Macaroni 29 0 29 100 19 64 83 23
Spaghetti & Chicken Livers 6 18 24 25 42 46 88 48
Sandwiches 6 16 22 27 42 48 90 47
Peas 16 13 29 55 32 51 83 39
Corn 14 19 33 42 31 45 79 43
Potatoes 13 14 27 48 33 50 83 40
Cole Slaw 6 5 11 54 42 59 101 42
Tossed Salad 3 4 7 43 45 60 105 43
Potato Salad 2 1 3 67 46 63 109 42
Cottage Cheese 5 9 14 36 43 55 98 44
Canned Fruit 5 7 12 42 43 57 100 43
Jello & Fruit. 1 7 b 13 47 57 104 45
Rice Pudding 4 7 11 36 44 57 101 44
Pie 15 21 36 42 33 43 76 43
Cake 4 9 13 31 44 55 99 44
Ice (ream 2 3 5 40 46 61 107 43
Coffee 16 9 25 64 32 55 87 37
Tea 9 10 19 47 39 54 93 42
Milk 25 27 52 48 23 37 60 38
Rolls 10 14 24 42 38 50 88 43
Bread 5 5 10 50 43 59 102 42
Butter 15 16 31 48 33 48 81 41
Total 48 64 112____


it is possible that the baked macaroni was at room tem-
perature long enough for the multiplication of bacteria in
sufficient numbers to cause illness. The mechanism by
which contamination of the veal parmesan occurred is
unknown. None of the foods served at the suspect meal
were available for culture.
Stool specimens were obtained from 49 individuals-
13 asymptomatic food handlers. 23 symptomatic employees,
and 13 symptomatic students: 24 cultures were positive for
salmonella. Of these. 19 were Salmonella typhi-murium and


five were mixtures of S. typhi-murium and S. typhi-murium
ear. copenhagen. Two of the positive cultures were from
asymptomatic food handlers. These employees were re-
lieved from work until each had three successive negative
stool cultures, taken 24 hours apart. Of the specimens sub-
mitted from symptomatic persons. 62 percent were positive
for salmonella.
(Reported by Ronald Altman, M.D., Acting Director, Di-
vision of Preventable Iisease. New Jersey Department of
Health; and an EIS Officer.)


OUTBREAK OF SYPHILIS Butler County, Alabama


On July 1i, 1968. a private physician reported a case
of secondary syphilis (reactive VDRL test of 1:32 dilu-
tion) in a .11 r-old male in Butler County, Alabama. On
July 19. an interview with the patient for information about
sexual contacts and suspects indicated that eight persons
needed immediate examination. The Venereal Disease Pro-
gram of the Alabama Department of Public Health was noti-
fied, and arrangements were made to establish an examina-
tion and treatment clinic in Butler countyy on the weekend
of July 20-21 and for six field representatives to conduct
in\istigations. The eight contacts and suspects were ex-
amined and questioned about additional persons who might


be directly or indirectly associated with known infections.
This continuous epidemiologic activity resulted in the ex-
amination of 27 additional persons, four of whom had in-
fectious syphilis. Interviews with these patients elicited
names of 47 more contacts and suspects. All examined per-
sons who were clinically and serologically (RPR Card Test)
negative for syphilis were prophylactically treated with
2.4 million units of Benzathine Penicillin G. The clinic
continued on July 21. and two additional primary infec-
tions were diagnosed. Their contacts and suspects were
also located and examined, but none were found to have
(Continued on page 328)


322







AUGUST 31, 1968


Morbidity and Mortality Weekly Report


SUPPLEMENTARY

RECOMMENDATION OF THE PUBLIC HEALTH SERVICE ADVISORY
COMMITTEE ON IMMUNIZATION PRACTICES

The Public Health Service Advisory Committee on Immunization Practices meet-
ing on September 4, 1968, issued the following supplementary recommendations
' .:.'. -,: influenza immunization and control in the civilian population.


INFLUENZA 1968-69


In July 1968, an outbreak of influenza A2 was re-
ported from Hong Kong, the largest outbreak in that area
since 1957. Although strains of influenza virus from this
outbreak cross-react to some extent with some previous
A2 strains, they do show a marked antigenic change from
previous strains. Similar viruses were subsequently iso-
lated from an outbreak in Singapore.
These developments have led to a re-appraisal of the
influenza prospectus for the United States and the follow-
ing recommendations on the use of influenza vaccine.


INFLUENZA VIRUSES AND VACCINE FORMULATION

The continued change in antigenic characteristics
of influenza viruses isolated over the years is well recog-
nized. Minor variations occur almost yearly. Major anti-
genic shifts occur infrequently. When they do, they may
produce widespread disease, as in 1957 when the A2
(Asian) strains first appeared. There have also been
instances when a major change in the virus has not re-
sulted in epidemics, such as the initial appearance of
the Al strains in 1947.
It is felt that the present change in the influenza
virus increases the probability that influenza A2 will
occur extensively in the United States in the 1968-69
season.
As previously forecast, scattered type B influenza
may be seen.
It is only through intensive surveillance that the true
extent of the disease will be determined.
Protection through vaccination depends both upon the
antigenic similarity of the vaccine strain to the virus
prevalent in the community and upon the amount of antigen
administered. Influenza vaccines, under optimal condi-
tions, have achieved 60 percent or greater protection.
When A2 influenza virus appeared in the United States in
1957, vaccines containing only Al antigen gave very little
protection.

Low levels of antibodies against the current strain
(A2/Hong Kong/68) can be demonstrated in the sera of
the persons who had documented influenza during the past
influenza epidemic. Similar observations have been made
in groups of persons vaccinated with the currently avail-
able commercial vaccines. Current vaccines may provide
only limited protection against A2/Hong Kong/68. Better


protection against A2/Hong Kong/68 will require a newly
formulated vaccine.
The development and manufacture of a monovalent
influenza vaccine containing a Hong Kong strain will take
a considerable period of time, and only a limited number
of doses will be initially available.


RECOMMENDATIONS*

It is therefore recommended that currently available
bivalent and polyvalent influenza vaccine be given only
to persons at highest risk of mortality or severe compli-
cations as a result of influenza. When monovalent vaccine
becomes available the same groups should be vaccinated
or revaccinated with it. High-risk groups include persons
with chronic illnesses as defined below and all persons
in the older age group:


Chronically III:

Persons of all ages who suffer from chronic debilitat-
ing diseases, including cardiovascular, pulmonary,
renal, or metabolic disorders:
1) patients with rheumatic heart disease, especially
with mitral stenosis;
2) patients with such cardiovascular disorders as
arteriosclerotic heart disease and hypertension,
especially showing evidence of frank or incipient
cardiac insufficiency;
3) patients with chronic brochopulmonary diseases
such as asthma, chronic bronchitis, cystic fibrosis,
bronchiectasis, pulmonary fibrosis, pulmonary em-
physema, or pulmonary tuberculosis.


Older Age Groups:

During major influenza outbreaks, especially those
caused by type A viruses, increased 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 individuals
with underlying chronic disease.


*Reactions and contraindications are detailed in the Recommen-
dations of the May 1968 meeting of the Committee, as reported
in MM\VR. Vol. 17, No. 26,\Week Ending June 29, 1968.


323







324 Morbidity and Mortality Weekly Report


TABLE I11. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 31, 1968 AND SEPTEMBER 2, 1967 (35th WEEK)

ENCEPHALITIS HEPATITIS
ASEPTIC Primary
AREA MENINGITIS including In ous Serum Infectious MALARIA
unsp. cases
1968 1967 1968 1968 1968 1967 1968 1968 1968 1967 1968
UNITED STATES... 207 121 4 5 54 70 6 94 856 638 71

NEW ENGLAND.......... 8 2 2 2 2 56 30 1
Maine ............. 1 2 -
New Hampshire...... -
Vermont............ 1 -
Massachusetts...... 6 36 9 1
Rhode Island....... 2 2 2 2 2 8 2 -
Connecticut......... 10 17 -

MIDDLE ATLANTIC..... 32 5 10 6 40 125 109 7
New York City...... 10 1 30 58 43 -
New York, up-State. 5 1 2 4 21 29 2
New Jersey......... 16 3 2 2 6 30 24 5
Pennsylvania....... 1 6 4 16 13 -

EAST NORTH CENTRAL... 27 9 20 35 1 110 108 2
Ohio................ 13 2 16 29 28 51 -
Indiana............. 3 2 2 6 9 -
Illinois............ 7 5 2 3 23 12 1
Michigan........... 4 2 1 1 46 30 1
Wisconsin.......... 7 6 -

WEST NORTH CENTRAL... 9 3 2 3 8 2 41 29 5
Minnesota........... 7 2 3 2 1 18 3
Iowa............... 1 1 4 1
Missouri........... 1 1 1 12 16 1
North Dakota....... 1 2 -- -
South Dakota....... 1
Nebraska............. -
Kansas............. 5 9 5 3

SOUTH ATLANTIC....... 15 50 1 5 9 2 2 97 67 46
Delaware........... 2 -
Maryland ......... 3 46 2 3 2 12 7
Dist. of Columbia.. 1 4 -
Virginia........... 3 2 5 7 1
West Virginia...... 10 2 13 4 -
North Carolina..... I 16 9 10
South Carolina..... 1 2 1 -
Georgia........... 11 19 35
Florida............ 4 1 1 2 32 20 -

EAST SOUTH CENTRAL... 35 9 1 1 52 27 -
Kentucky........... 24 13 2
Tennessee........... 9 7 1 1 25 18 -
Alabama ............ 2 3 6
Mississippi........ 2 11 1 -

WEST SOUTH CENTRAL... 11 4 1 4 2 1 1 60 74 1
Arkansas........... 3 1 3 1 1
Louisiana........... 4 1 14 13 -
Oklahoma ........... 13
Texas .*............ 10 1 1 1 43 47

MOUNTAIN............. 8 3 30 21
Montana............ 3 -
Idaho.............. -- -- 3
Wyoming............. 1 -
Colorado........... 8 2 7 7
New Mexico......... 7 2
Arizona............ 5 6 -
Utah............... 8 2
Nevada ............ -

PACIFIC.............. 62 39 1 10 7 3 46 285 173 9
Washington......... 1 18 15 -
Oregon............. 1 3 10 12 -
California.......... 57 37 1 7 7 3 46 252 146 9
Alaska.............. 4 -
Hawaii............. 3 2 1 -

Puert Rico. ......... 27 36 -
*Delayed Reports: Aseptic meningitis: Tex. 11
Encephalitis, post-infectious: Tex. 1
Hepatitis, serum: Tex. 1
Hepatitis, infectious: Me. 3, R.I. 14, Tex. 33







Morbidity and Mortality Weekly Report 325


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 31, 1968 AND SEPTEMBER 2, 1967 (35th WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL
AREA Total Paralytic
Cumulative Cumulative Total Par

1968 1968 1967 1968 1968 1967 1968 1968 1968 1968 1968
UNITED STATES... 126 19,481 57,426 32 1,976 1,642 474 35 272

NEW ENGLAND.......... 4 1,147 837 116 68 69 1 51
Maine.............. 37 238 6 3 1
New Hampshire...... 141 74 7 2 2
Vermont ............ 2 34 1 1 6 -- 3
Massachusetts*..... 4 359 340 63 32 33 1 21
Rhode Island....... 5 62 8 4 10 2
Connecticut........ 603 89 31 26 20 22

MIDDLE ATLANTIC...... 36 4,031 2,246 6 355 270 37 21
New York City...... 29 2,056 450 70 48 36 9
New York, Up-State. 1 1,216 578 63 66 NN 12
New Jersey *........ 6 630 486 4 126 93 1 -
Pennsylvania....... 129 732 2 96 63 NN -

EAST NORTH CENTRAL... 31 3,752 5,342 4 233 223 88 1 74
Ohio................ 2 293 1,139 1 64 79 8 6
Indiana............. 13 670 593 2 30 22 11 26
Illinois........... 4 1,360 942 51 54 1 7
Michigan*.......... 264 919 1 68 52 15 14
Wisconsin.......... 12 1,165 1,749 20 16 54 21

WEST NORTH CENTRAL... 1 380 2,842 4 107 71 24 1 13
Minnesota......... 16 131 26 17 1 -
Iowa .............. 1 98 747 6 14 21 7
Missouri........... 81 332 3 35 15 1 1 1
North Dakota....... 131 861 3 1 1 4
South Dakota....... 4 52 5 6 NN -
Nebraska........... 40 626 6 12 -
Kansas............. 10 93 1 26 6 1

SOUTH ATLANTIC....... 10 1,492 6,854 8 400 314 37 1 32
Delaware ........... 15 45 8 6 1 -
Maryland........... 95 154 2 32 39 6 2
Dist. of Columbia.. 6 22 14 10 1 -
Virginia .......... 297 2,181 1 34 38 1 4
West Virginia...... 2 283 1,382 10 21 11 21
North Carolina..... 1 282 847 76 66 NN 1
South Carolina..... 12 510 56 29 -
Georgia............. 4 34 5 81 49 -
Florida............. 7 498 1,679 89 56 17 5

EAST SOUTH CENTRAL... 1 488 5,167 6 175 128 33 2 20
Kentucky........... 99 1,321 5 77 35 2 1 2
Tennessee.......... 61 1,862 52 54 31 18
Alabama........... 93 1,322 1 25 26 I
Mississippi........ 1 235 662 21 13 -

WEST SOUTH CENTRAL... 24 4,734 17,284 302 218 63 19 13
Arkansas........... 3 1,404 20 30 1 -
Louisiana........... 2 153 87 86 3 -
Oklahoma............ 1 113 3,351 49 16 2 2
Texas* ............ 23 4,616 12,376 146 86 59 17 11

MOUNTAIN............. 8 988 4,613 29 30 40 21
Montana............ 67 282 3 1- -
Idaho............. .. 20 378 11 3 3 2
Wyoming............. 51 180 1 -
Colorado*........... 3 503 1,546 10 13 11 6
New Mexico......... 5 102 579 3 5 1
Arizona.*........... 219 1,014 1 4 13 8
Utah................ 21 365 1 4 7 4
Nevada............. 5 269 3 2

PACIFIC ............. 11 2,469 12,241 4 259 320 83 10 27
Washington......... 515 5,419 37 28 5 1 1
Oregon.............. 5 510 1,579 1 21 25 5 7
California......... 6 1,407 4,947 3 188 254 60 9 14
Alaska.............. 2 133 2 9 6 4
Hawaii............. 35 163 11 4 7 1

Puerto Rico.......... 397 2,103 19 12 10
*Delayed Reports: Measles: Mass. delete 2, N.J. 3, Mich. delete 1, Iowa delete 1, Va. delete 3, Tex. 30,
Colo. delete 5, Ariz. delete 2
Meningococcal infections: Mich. 1
Mumps: Tex. 63
Rubella: Va. 3, Tex. 33






326 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 31, 1968 AND SEPTEMBER 2, 1967 (35th 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... 3,668 4 101 7 137 10 220 10 218 68 2,446

NEW ENGLAND.......... 460 2 46 7 1 70
Maine ............. 53
New Hampshire......- 1 2
Vermont............ 16 46 11
Massachusetts...... 71 1 3 1 3
Rhode Island....... 19 -
Connecticut........ 354 1 3 1

MIDDLE ATLANTIC .... 81 1 13 7 19 1 15 1 35
New York City...... 1 6 9- -
New York, Up-State? 79 4 7 3 2 1 28
New Jersey......... NN 4 6 -
Pennsylvania....... 1 1 3 3 1 7 7

EAST NORTH CENTRAL... 247 1 9 8 1 28 1 8 7 235
Ohio................ 44 1 12 1 6 86
Indiana............ 100 1 2 1 3 1 76
Illinois........... 16 5 5 1 12 2 3 31
Michigan* ......... 48 2 1 1 12
Wisconsin.......... 39 1 2 30

WEST NORTH CENTRAL... 120 6 11 10 7 10 600
Minnesota.......... 20 1 8 184
Iowa............... 26 2 1 1 98
Missouri........... 7 2 7 3 1 86
North Dakota....... 33 1 94
South Dakota...... 9 2 1 4 79
Nebraska........... 4 1 3 1 25
Kansas............. 21 2 2 1 34

SOUTH ATLANTIC....... 606 2 23 1 9 4 48 3 120 12 272
Delaware......... 3 -
Maryland........... 59 1 3 9 1 13 5
Dist. of Columbia*. 18 2 1 1
Virginia............ 182 4 1 2 9 41 5 102
West Virginia...... 200 1 1 32
North Carolina..... 5 2 2 2 2 31 10
South Carolina..... 10 2 3 3 6 -
Georgia............ 2 3 12 26 2 43
Florida............. 127 1 9 2 1 12 3 4 79

EAST SOUTH CENTRAL... 765 13 7 2 28 2 40 12 533
Kentucky........... 33 1 1 1 6 1 9 5 265
Tennessee........... 602 5 5 1 15 1 26 7 245
Alabama............ 44 4 3 22
Mississippi........ 86 3 1 7 2 I

WEST SOUTH CENTRAL... 84 19 6 41 1 30 3 21 7 407
Arkansas........... 9 4 6 14 1 5 2 5 3 51
Louisiana.......... 3 8 6 3 37
Oklahoma .......... 41 8 12 1 9 1 117
Texas ............. 31 7 13 10 7 3 202

MOUNTAIN............ 765 6 13 5 1 65
Montana............ 9 -
Idaho............. 76 -
Wyoming............ 36 1 3
Colorado............ 401 3 2 4 3
New Mexico......... 108 6 26
Arizona............ 40 3 32
Utah................ 95 2
Nevada..............- 1 1 1

PACIFIC ............. 540 16 2 2 37 1 18 229
Washington......... 12 1 2 2
Oregon.............. 49 1 1 4 5
California.. ...... 280 14 1 2 31 1 18 222
Alaska.............. 46 -
Hawaii............. 153 -


Puerto Rico.......... 7 -8 2 17


*Delayed Reports:


SST: Me. 5, N.Y. Ups. 54 cases 1967, 19 cases 1968, Tex. 491
Tetanus: Mich. delete 1
Typhoid: D. C. delete 1
Rabies in animals: Tex. 3








327


(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 I year Area All 65 years and I year
Ages and over Influenza All Age and 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
225
37
40
19
40
20
24
33
63
46
7
35
36
47

3,124
41
41
159
43
33
37
66
84
1,545
41
479
S188
49
90
19
24
70
52
27
36

2,829
54
49
.804
158
248
126
92
409
45
59
48
56
51
145
31
138
31
43
53
105
84

812
56
40
45
96
33
112
92
209
64
65


412
123
18
24
14
26
16
14
25
37
25
5
27
26
32

1,782
15
25
97
27
20
24
35
39
864
21
276
114
33
58
13
17
41
25
19
19

1,641
30
26
440
99
156
70
50
236
30
25
30
20
23
88
12
93
17
30
33
76
57

475
29
29
26
48
24
66
52
117
49
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.----------


Total 12,269 6,940 440 612


Cumulative Totals
including reported corrections for


previous weeks


All Causes, All Ages ------------------------ 448,917
All Causes, Age 65 and over------------------- 259,296
Pneumonia and Influenza, All Ages----------- 18,517
All Causes, Under 1 Year of Age--------------- 21,054


Week No.
35


Morbidity and Mortality Weekly Report






TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED AUGUST 31, 1968


1,176
125
239
51
48
95
51
102
28
75
84
221
57

653
100
49
67
153
140
29
26
89

1,156
41
29
35
163
32
71
209
66
169
71
131
68
71

373
36
29
104
8
74
28
48
46

1,474
20
47
24
49
112
405
71
32
103
64
107
166
36
142
59
37


18 2 12
21 1 1
60 5 5
26 3
51 8 7
13 1 -
59 8 4
47 6 2
100 11 9
25 1 1

376 39 26
52 1 8
25 2 1
45 5 3
108 19 4
75 3 4
15 2
14 -
42 9 4

557 48 75
25 7 -
18 4
17 1 2
72 3 9
9 3 5
35 1 1
94 3 15
26 6 8
86 10 11
30 2 3
67 1 9
36 4 7
42 3 5

229 15 17
18 3 2
17 2
62 9 3
3 1 1
48 2
23 2
30 1 2
28 1 3

879 20 74
17 -
28 3
20 -
27 1 5
62 5
230 7 22
39 5
23 1 1
61 1 5
39 2 1
70 3 7
102 1 4
18 1 4
79 2 10
41 1 1
23 1






328


Morbidity and Mortality Weekly Report


OUTBREAK OF SYPHILIS (Continued from page 322)

syphilis. A total of 1h persons were examined in the two
clinic sessions, and 5S received prophylactic treatment.
Investigation of contacts in other health jurisdictions re-
%ealed one primary infection in Birmingham, Alabama.
Medical and epidelmiologic investigation indicated that the
source of the eight-case chain infection (the 20-year-old
male, four cases detected on July 20. two cases detected
on July- 21. and one case in Birmingham) resided in another
state. \hl .. O._l. four contacts in other states are yet to be
examined, it is believed that all cases in Butler County
related to the source of this outbreak have been identified,
and all persons incubating syphilis have received treat-
ment to prevent further transmission of the disease.


(Reported by W. It. Y. Smith, M.D., C.P.H., Director, Bureau
of Preventable Diseases, Alabama State Department of
Public Health; J. B. Vismukes, M.D., Director, Butler
County Health Department; and Venereal Disease Program,
VCDC.)

Editorial Note:
This report describes a technique known as the "blitz"
which is being employed on a statewide basis in Alabama
and has resulted in a dramatic decrease in reported cases
of infectious syphilis. The 681 cases reported in fiscal
year 1968 (July 1967-June 1-ii.s represent a 36 percent
decrease from the cases reported in fiscal year 1967.
The "blitz" consists of maximum utilization of the
medical and epidemiologic staff and of epidemiologic treat-
ment. and the employment of rapid case-finding techniques
which decrease the time between diagnosis and contact
interview and between elicitation and examination of con-
tacts.




FOLLOW-UP ARBOVIRUS DISEASE Maryland

Following the epizootic of eastern encephalitis among
pheasants. partridges, and horses on the Eastern Shore of
MarIyl and, approximately 11,000 mosquitoes were collected
for laboratory testing. Of the 11.000, approximately 4 u11111
were identified as ('rliseta melanura. The C. melanura
were tested in 90 pools of approximately 50 mosquitoes
each; 57 of the pools were positive for virus, giving a
field ratio for C. melanura of at least 1:81. To date, 47
isolates have been confirmed as eastern encephalitis virus
by duck embryo tissue culture neutralization tests.
The mosquito C. melanura rarely bites man and, to
date. no human cases have been reported from this area.
(Reported by Kenneth Crawiford, D.V.M., Chief, Division
of Veterinary Medicine, Maryland State Department of
Health; and A.rborirus Infections Unit, Virology Section,
Laboratory Program, NCPC.)


AUGUST 31, 1968 <


IL


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION OF 17,000. IS PUBLISHED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER, ATLANTA. GEORGIA.
DIRECTOR, NATIONAL COMMUNICABLE DISEASE .fFJrTF
CHIEF, EPIDEMIOLOGY PROGRAM A.D. LAit,',, ~A M.D.
ACTING CHIEF, STATISTICS SECTION IDA L. ..-.E L M.S.
EDITOR MICHAEL B GREGG. M D

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY ANDMORTALITY, THE N. ** .L r:M M '.E C-SEASE
CENTER WELCOMES ACCOUNTS OF TKt I r G-iAiaEJ i .O CASE
INVESTIGATIONS WHICH ARE OF CURRENT INTEREST Tr0 fC lT
OFFICIALS AND WHICH ARE DIRECTLY '-~I .L i i( CGNTaOL
OF COMMUNICABLE DISEASES. SUCH C' .MM'J. C T'CN >..G IU
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 BN tr" INDIVIDUAL
STATE HEALTH DEPARTMENTS. THE PO" : iE CONCLUDES
ON SATURDAY; COMPILED DATA ON A -. igrN3L p AL- ARE RELEASED
ON THE SUCCEEDING FRIDAY


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