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:
AA00010654:00197

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, EDUCATION, AND WELFARE


Vol. 17, No. 36


WiftKLY

R EFC' T


Week Ending

September 7, 1968



PUBLIC HEALTH SERVICE


HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION


EPIDEMIOLOGIC NOTES AND REPORTS
INFLUENZA

To date, in addition to the epidemic in Hong Kong,
outbreaks of influenza-like illness have been reported
from Singapore, the Philippines, Taiwan, and Indonesia.
A2 strains from Singapore and Taiwan have been found to
be similar to those from Hong Kong. None of these areas
has had a major influenza outbreak during the past 2-3
years.
On September 2, 1968, two cases of influenza-like
illness in Atlanta, Georgia, were reported. The first case
was a man who became ill with a typical influenza-like
illness characterized by fever, malaise, cough, and myalgia
4 days after his return to the United States from the Far


CONTENTS
Epidemiologic Notes and Reports
Influenza . .... ......
Outbreak of Typhoid Fever Missouri .
Primary Amebic Meningoencephalitis Virginia .
Vaccinia Outbreak Indiana. . .
Current Trends
Measles United States . .....


. 229
. .. 330
330
. .. 336

. 331


East; 2 days later his wife, who had not left the United
States, also became ill. A2 influenza virus isolates from
both have been shown to be similar to
ht rains. With the continuous air
a traffic fro r East, it is quite likely that
(Continued on page 330)


TABLE I. CASES OF SPECIFIED NOTIFY DIS CASES: U TED S
(Cumulative totals include revised and de 1b reports through _u it 's)
36th WEEK EN MEDIAN ULATIVE, FIRST 36 WEEKS
DISEASE V MEDIAN
DISEASE September 7, Sep 6 1963 MEDIAN
1968 l 19 $ 68 1967 1963 1967
Aseptic meningitis ...................... 191 144 2,354 1,775 1.280
Brucellosis ................. ........... 3 3 8 148 179 179
Diphtheria .............................. 11 7 7 121 79 127
Encephalitis, primary:
Arthropod-borne & unspecified ........... 42 40 794 1,084
Encephalitis, post-infectious ............. 10 11 367 627 -
Hepatitis, serum ........................ 71 38 568 2,946 1,480 27,108
Hepatitis, infectious ..................... 723 590 30,248 26,179
Malaria ................... ............. 60 32 2 1,509 1,355 70
Measles rubeolaa) ..................... .. 92 194 450 19,558 57,620 239,590
Meningococcal infections, total ........... 23 21 24 2,000 1,663 2,018
Civilian .............................. 23 21 1,823 1,550 -
Military............................... 177 113
Mumps ................................. 593 -- -- 124,406 ----
Poliomyelitis, total ..................... 2 3 3 37 26 71
Paralytic ............................. 2 2 2 37 22 60
Rubella (German measles) ............... 243 123 43,588 39,723 -
Streptococcal sore throat & scarlet fever.... 4,401 4,477 3.957 300.505 323,474 291,323
Tetanus ............................... 4 6 5 105 152 172
Tularemia .............................. 1 2 2 138 125 178
Typhoid fever ........ .................. 24 13 13 244 285 283
Typhus, tick-borne (Rky. Mt. spotted fever) 10 18 12 228 250 198
Rabies in animals ....................... 37 80 67 2,483 3.130 3.130

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: .......................... ................ 3 Rabies in man: ................ .... ... ...... ...... -
Botulism: ......................................... 4 Rubella, Congenital Syndrome: Tenn.-l ................. 5
Leptospirosis: Fla.-l, Hawaii-2, Tenn.-1 .............. 30 Trichinosis: ...... .......... ....... .......- 47
Plague: .................. .................... ...... 2 Typhus, marine: .................................. 21
Psittacosis: W.Va.- ................................. 35






Morbidity and Mortality Weekly Report


SEPTEMBER 7. 1968


INFLUENZA (Continued from front page)


there have been other introductions of the new A2 strains
into the United States; however, to date, no outbreaks of
influenza-like illness have been reported from the Atlanta
area or elsewhere in the United States.
(Reported by Dr. W. Charles Cockburn. Chief Medical


- -'.. ,:. Virus Diseases, WHO, Geneva; John E. McCroan,
Ph.D., State Epidemiologist, Georgia Department of Public
Health; and the Respiratory Virus Infections Unit, Lab-
oratory Program, and the Respiratory Viral Diseases Unit,
Epidemiology Program, NCDC.)


OUTBREAK OF TYPHOID FEVER Missouri


An outbreak of typhoid fever has occurred among 200
persons who attended a Church of God (Independent Holi-
iness) summer camp in Audrain County, \li--.... from
August 1 to August 11, 1968. Persons attending the camp
were from Missouri. Illinois, Oklahoma, Arizona, Kansas,
and Mississippi. Investigations in each of the states in-
volved have documented 35 clinical cases of typhoid,
including 19 cases in Missouri 15 cases in Illirn-, and
one case in Oklahoma, in the 175 persons contacted to
date. Cultures from eight cases were positive for Sal-
monella typhi; two of these isolates were phage typed
and are type C-1. Stool cultures are being obtained from
all persons who attended the camp. and investigation for
the vehicle of infection is in progress.
The phage type C-1 is relatively uncommon and ac-
counted for only 12.4 percent of 1,817 isolates of S. typhi
typed in the United States between 1956 and 1961. There-


fore, any case of typhoid fever from whom S. typhi C-1 is
isolated may be related to this outbreak and should be
investigated. Any documented cases should be reported
to NCDC.
(Reported by E.A. Belden, M.D., M.P.H., State Epide-
miologist, Missouri Department of Health and Welfare;
Mr. William Johnson, Sanitarian, Audrain County Health
Department; Norman J. Rose, M.D., M.P.H., State Epi-
demiologist, and Mary Louise Brown, M.S., Division of
Laboratories, Illinois Department of Public H..i'b, D.L.
Carpenter, M.D., M.P.H., State Epidemiologist, Oklahoma
State Department of Health; D.E. Wilcox, M.D., State
Epidemiologist, Kansas State Department of Health; M.H.
Goodwin, Ph.D., State Epidemiologist, Arizona State
Department of Health; D.L. Blakey, M.D., M.P.H., State
Epidemiologist. Mississippi State Board of Health; and a
team of EIS Officers.)


PRIMARY AMEBIC MENINGOENCEPHALITIS Virginia


On August 13, 1968, a 15-year-old female resident
of the State of i; t, r, ..n was admitted to the Medical
College of Virginia Hospital. Richmond, Virginia, with
a : .1 history of illness that began with frontal headaches.
anorexia, and parosmia. The headaches became more se-
vere, and on August 12 nausea, vomiting, and nuchal
rigidity developed. The patient was seen by a local phy-
sician and referred to the hospital.
Previous history included frequent earaches, which
required myringotomy when she was a child. Also, 8 days
prior to admission, the patient had swum in an inland
lake near Richmond. and the following day she had swum
in achlorinated pool. There was no history of head trauma
or known exposure to any other cases of meningitis.
On admission the patient was 1. i 'ar.; and febrile
(temperature 103 F). Other vital signs were normal. There
was no c._* ii ,111I r abnormality of nasal or gingival mucosa
or tympanic membranes. She had nuchal rigidity and a
Babinski reflex on the right.
Lumbar puncture revealed increased cerebral spinal
fluid pressure of 300 mm 1120. The fluid was cloudy and
contained 310 RBC( mm3 and 300 XB(' 'mm3 of which
initially ~7 percent were neutrophils, Motile forms of
anebae were seen in the fluid. After preliminary investi-


gation, these were felt to be Naegleria sp.
The patient was treated with emetine, chloroquine,
metronidazole, and tetracycline antibiotics. Despite this
therapy, the patient became comatose and died in pulmonary
edema on the second hospital day.
This is the ninth case of primary amebic meningo-
encephalitis to be diagnosed at the Medical I olaIl.' of
Virginia: six of these were 1951-52 cases diagnosed re-
trospectively from necropsy specimens. These patients
all presented with fulminating purulent ii..rTreri-. failed
to respond to antibiotic therapy, and died within 48 hours
after admission. A history of swimming in inland lakes
was common to all. The causative organism, the free-
living Naegleria sp.. was isolated from the last two cases.
An epidemiologic investigation is being carried out
to find additional cases and to evaluate the role of swim-
ming in inland lakes in the pathogenesis of this condition.
(Reported by Paul C. White, Jr., M .D., Director, Bureau of
Epidemiology, Virginia State Department of Health. Rich-
imond; William P. Wayner, M1.D., Director, Chesterfield
countyy Health Department, Chesterfield. Virginia; Richard
J. Dumai, M.D.. Infectious Disease Division, Department
of Medicine, tiedical College of Virginia, Richmond; and
and an KIS Officrr.)


330







SEPTEMBER 7, 1968


Morbidity and Mortality Weekly Report


CURRENT TRENDS
MEASLES United States


For the first time since 1912*, the number of reported
cases of measles on a weekly basis has been fewer than
100. For the week ending September 7,1968, only 92 cases
were reported to NCDC.
From August 11 through September 7, 1968. (weeks
33-36). 566 cases of measles were reported. This is a
decrease of 350 cases from the 916 cases reported for the
preceding 4-week period. Although the usual seasonal
pattern of decreased incidence of measles in the summer
is evident in Figure 1, the percentage decrease between
1968 and 1967 is less than the percent decrease of 1967


from each of the previous 3 years. Because of the ex-
tremely low incidence of reported cases of measles during
1967 and 1968, the ordinate (vertical) scale (Inset Figure
1) has been changed from multiples of 4,000 to 500 cases
in order to compare more readily the decrease between
1967 and 1968.

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

*Year when reporting of measles morbidity began on a national
basis.


Figure 1
REPORTED CASES OF MEASLES BY 4-WEEK PERIODS, UNITED STATES
JULY DECEMBER, 1964-1968


REPORTED CASES OF MEASLES BY 4-WEEK PERIODS
UNITED STATES, JULY DECEMBER, 1967 AND 1968


1967
1968


26 28 30 32 34 36 38 40 42 44 46 48 50 52
JUL. AUG. SEP OCT NOV. DEC.
WEEK NUMBER I


1964
1965
1966
1967
1968


\\ -

II


34 36 38 40 42
SEPT OCT
WEEK NUMBER


44 46 48
NOV


3.000-


2,500-


2,000


0 1,500

5 1,
z 1,000"


(27,357) '



\


32

o
Z
V)
12-
I
r-


500


26' '28
JULY


30 32'
AUG


50
DEC


52'


':








332 UMorbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

SEPTEMBER 7, 1968 AND SEPTEMBER 9, 1967 (36th WEEK)

ENCEPHALITIS HEPATITIS
ASEPTIC 1110 I. .OS, IPHIIERIA Primary
AREA MENINGITIS including Infectious Serum Infectious MAARIA
unsp. cases
1968 1967 1968 1968 1968 1967 1968 1968 1968 1967 1968
UNITED STATES... 191 144 3 11 42 40 10 71 723 590 60

NEW ENGLAND.......... 6 4 4 2 37 44 2
Maine.............. -- 3 5
New Hampshire....... 2 -
Vermont.............-
Massachusetts...... 4 2 3 21 26 1
Rhode Island....... 2 2 1 9 7 -
Connecticut ........ 2 2 6 1

MIDDLE ATLANTIC...... 33 19 9 2 14 109 80 34
New York City...... 22 5 5 28 38 2
New York, up-State. 2 1 1 8 11 -
New Jersey..*....... 14 -- 3 21 20 -
Pennsylvania....... 9 8 2 5 52 11 32

EAST NORTH CENTRAL... 42 24 8 21 1 2 72 89 1
Ohio............... 17 9 3 19 1 15 11 -
Indiana............. 2 1 3 1
Illinois........... 5 11 4 2 1 24 36 -
Michigan ........... 18 3 1 1 27 34 -
Wisconsin.......... I 5 5 -

WEST NORTH CENTRAL... 7 6 2 11 2 1 1 39 35 -
Minnesota.......... 4 4 2 1 1 13 10 -
Iowa............... 1 2 4 2 5 3
Missouri............ 1 1 1 17 9 -
North Dakota....... 2 4 1
',o-th Da'ota. 1
Nebraska.............- 2 1
Kans,.s............. 1 11

SOUTH ATLANTIC....... 22 49 3 2 2 2 78 54 4
Delaware............. 1 3 3
Maryland........... 7 43 1 11 11
Dist. of Columbia.. -
Virginia............ 3 4 1 12 11 3
West Virginia...... 4 1 14 1 1
North Carolina..... 3 1 -- 8 2 -
South Carolina..... 1 1 5 3 -
Georgia............ 18 16 -
Florida............ 3 1 3 2 6 7 -

EAST SOUTH CENTRAL... 12 7 1 2 1 1 1 36 29 5
Kentucky............ 1 1 -- 1 8 11 1
Trnnessee........... 10 3 1 1 1 15 10 -
Alabama.. .......... 2 1 4 5 3
Mississippi........ 1 1 1 9 3 1

WEST SOUTH CENTRAL... 7 5 8 2 4 1 52 74 1
Arkansas........... 16 -
Louisiana.......... 4 8 2 13 16 -
Oklahoma........... 1 4 4 5 1
Texas.............. 7 1 35 37

MOUNTAIN............. 5 4 35 31
Montana............ 4 6 8 -
Idaho............... -- 5 7
Wyoming............ 2 2
Colorado............ I 1 14 1 -
New Mexico......... 1 4 -
Arizona............ 3 14
Utah............... -- 1 1
Nevada ............

PACIFIC .............. 57 30 6 6 3 48 265 154 13
Washington......... 2 1 29 10 1
Oregon............. 2 3 22 12
California......... 50 22 6 6 3 45 213 130 12
Alaska............. 2
Hawaii ............. 5 5 1

r ., r... ...... I 30 14
*Delayed reports: Hepatitis, infectious: N.J. 5, Ala. 1








Morbidity and Mortality Weekly Report 333


TABLE Il. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

SEPTEMBER 7, 1968 AND SEPTEMBER 9, 1967 (36th 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... 92 19,558 57,620 23 2,000 1,663 593 2 2 37 243

NEW ENGLAND........... 3 1,150 840 116 68 67 1 25
Maine. *............ 37 238 6 3 4 4
New Hampshire...... 141 74 7 2 1
Vermont............. 2 34 1 1 8 -
Massachusetts...... 2 361 343 63 32 24 1 9
Rhode Island ....... 5 62 8 4 14 -
Connecticut........ 1 604 89 31 26 17 11

MIDDLE ATLANTIC ...... 27 4,054 2,255 3 358 273 51 23
New York City ..... 24 2,080 453 2 72 48 50 14
New York, Up-State. 1 1,217 583 1 64 67 NN 9
New Jersey......... 2 632 486 126 93 1 -
Pennsylvania..*..... 125 733 96 65 NN --

EAST NORTH CENTRAL... 10 3,762 5,387 4 237 225 143 1 67
Ohio................ 293 1,139 64 80 4 4
Indiana............. 1 671 593 30 22 32 12
Illinois........... 1,360 952 2 53 54 11 1 3
Michigan........... 264 921 2 70 53 13 10
Wisconsin.......... 9 1,174 1,782 20 16 83 38

WEST NORTH CENTRAL... 3 383 2,848 1 108 72 50 1 1 2 24
Minnesota.......... 16 132 26 18 1 -
Iowa................ 98 748 6 14 29 8
Missouri........... 81 333 35 15 1 1 1 2
North Dakota........ 2 133 862 3 1 19 15
South Dakota........ 4 52 5 6 NN -
Nebraska........... 1 41 628 6 12 -1
Kansas ............. 10 93 1 27 6 -

SOUTH ATLANTIC....... 11 1,502 6,870 3 403 320 53 1 16
Delaware........... 1 16 46 8 6 2 -- 3
Maryland............ 1 96 157 32 41 6 1
Dist. of Columbia.. 6 22 14 10 -
Virginia..*......... 3 299 2,188 1 35 38 2 1
West Virginia...... 5 288 1,383 1 11 24 24 -- 2
North Carolina..... 282 848 76 67 NN 1
South Carolina..... 12 511 56 29
Georgia............ 4 34 81 49 -
Florida............. 1 499 1,681 1 90 56 19 9

EAST SOUTH CENTRAL... 3 492 5,177 7 183 129 33 2 14
Kentucky............ 1 100 1,325 7 84 35 2 1 10
Tennessee.......... 1 62 1,864 52 55 31 4
Alabama...*......... 94 1,325 26 26 I -
Mississippi........ 1 236 663 21 13 -

WEST SOUTH CENTRAL... 25 4,758 17,336 1 303 218 43 1 1 20 29
Arkansas... ........ 2 1,404 20 30 -
Louisiana.......... 2 155 87 86 1
Oklahoma............ 4 117 3,351 1 50 16 1 2 5
Texas............... 21 4,637 12,426 146 86 42 1 1 18 23

MOUNTAIN............ 1 979 4,632 29 30 53 25
Montana...*........ 58 282 3 7
Idaho............... 20 380 11 3 9 6
Wyoming............ 51 181 -- -
Colorado. ........... 502 1,555 10 13 6 8
New Mexico......... 102 581 3 9 2
Arizona............ 1 220 1,015 1 4 17 9
Utah............... 21 369 1 4 5 -
Nevada............. 5 269 3 2 -

PACIFIC.............. 9 2,478 12,275 4 263 328 100 10 20
Washington........... 515 5,422 1 38 29 4 1 I
Oregon............. 4 514 1,593 21 25 2 6
California.......... 5 1,412 4,954 2 190 261 68 9 8
Alaska............. 2 138 2 9 2 2
Hawaii............. 35 168 1 12 4 24 3

Puerto Rico.......... 6 403 2,108 19 12 5 1


*ueiayed reports: Measles: Pa. delete 4, Va. delete 1, Ala. 1, Ark. delete 1,
Meningococcal infections: Ala. 1
Mumps: Me. 1







33 1 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

SEPTEMBER 7, 1968 AND SEPTEMBER 9, 1967 (36th 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... 4,401 4 105 1 138 24 244 10 228 37 2,483

NEW ENGLAND............ 426 2 46 7 I 70
Maine. ........... 6 53
New Hampshire...... 17 1 2
Vermont ............ 41 46 11
Massachusetts...... 41 1 3 1 3
Rhode Island....... 26 -
Connecticut........ 295 1 3 1

MIDDLE ATLANTIC ...... 128 13 7 1 20 1 16 1 36
New York City...... 5 6 9 -
New York, Up-State. 122 4 7 1 4 1 3 1 29
New Jersey......... NN 4 6
Pennsylvania........ 1 3 3 7 7

EAST NORTH CENTRAL... 198 9 8 28 8 1 236
Ohio................ 7 1 12 6 86
Indiana............ 60 2 1 3 76
Illinois........... 45 5 5 12 2 1 32
Michigan........... 26 2 1 12
Wisconsin .......... 60 1 30

WEST NORTH CENTRAL... 222 1 7 1 12 19 29 7 9 609
Minnesota .......... 8 1 2 1 185
Iowa ............... 65 2 1 1 2 100
Missouri........... 3 2 7 19 22 1 2 88
North Dakota....... 80 4 98
Souh D 9 2 1 4 79
Nebraska............ 25 1 3 1 25
Kansas ............. 32 1 3 2 34

SOUTH ATLANTIC....... 583 1 24 9 1 49 5 125 5 277
Delaware ..........- -
Maryland........... 55 3 9 13 5
Dist. of Columbia.. 9 2 1 1
Virginia........... 179 4 2 9 41 1 103
West Virginia...... 200 1 2 2 34
North Carolina..... 2 2 2 2 3 34 10
South Carolina..... 23 2 3 2 8 -
Georgia............- 3 1 13 26 1 44
Florida............ 115 9 2 12 3 1 80

EAST SOUTH CENTRAL... 1,006 1 14 7 1 29 3 43 7 540
Kentucky........... 99 1 1 6 1 10 5 270
Tennessee.......... 734 5 5 1 16 2 28 2 247
Alabama........... 97 1 5 3 22
Mississippi........ 76 3 1 7 2 1

WEST SOUTH CENTRAL... 530 1 20 41 30 1 22 3 410
Arkansas........... 1 4 14 5 5 2 53
Louisiana.......... 3 8 6 3 37
Oklahoma............ 55 8 12 1 10 117
Texas............... 471 1 8 13 10 7 1 203

MOUNTAIN............. 763 6 13 5 2 67
Montana ........... 26 -
Idaho.............. 81 -
Wyoming............ 17 1 I 3
Colorado ........... 432 3 2 4 3
New Mexico......... 85 6 2 28
Arizona............ 52 3 32
Utah. .. ........... 60 2
Nevada............. 10 1 1

PACIFIC.............. 545 16 2 2 39 1 9 238
Washington......... 47 1 2 2
Oregon ............. 49 1 1 4 1 6
California......... 282 14 1 2 33 1 8 230
Alaska.................. 8 -
Hawai ......... ..... 159 -

Puert Rico.......... 3 8 2 17
*Delayed reports: SST: Me. 5








Morbidity and Mortality Weekly Report


TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED SEPTEMBER 7, 1968


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


335


All Causes' Pneumonia Under All Causes Pneumonia Under
Area All 65 years and 1 year Area All 65 years and year
Ages 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.--------


648
229
20
22
24
45
32
21
21
47
65
14
37
17
54

2,908
44
31
139
38
36
45
46
55
1,540
21
392
177
44
110
21
35
35
25
22
32

2,498
83
28
723
150
215
132
84
326
43
43
40
37
63
158
26
105
33
31
31
88
59

695
46
19
26
124
25
95
73
199
56
32


396
125
13
20
17
27
24
12
15
23
40
11
21
11
37

1,696
22
20
83
24
20
36
28
27
880
12
221
106
30
70
13
22
32
11
15
24

1,438
44
20
402
96
111
75
49
193
28
25
26
20
42
89
10
63
16
21
18
56
34

414
22
16
14
68
22
62
45
110
42
13


31
12
2


3
1

1
3
7

2



128
2

6
3
3

2
4
71
1
16
6
2
4

1
6


1

128
2

42
7
10
11
3
11
2
6
2
3
3
11
2
6
3
2
1
1


*Estimate based on average percent of divisional total.


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.----------


1,073
139
226
31
66
89
65
76
52
70
48
154
57

560
80
53
35
138
107
61
23
63

1,080
27
36
19
156
38
89
194
74
165
64
90
45
83

374
37
21
101
10
77
19
47
62

1,362
20
43
21
50
92
382
98
42
99
45
86
171
39
106
37
31


5
2
3
4
5
7
2

30
1
5
5
16
1
2



33
3
1

1
2
2
3
2
6

3
1
9

14
4
1
3
2

1

3

26
1


1
4
8
2


1
2
4
1
1
1


Total 11,198 6,367 358 553


Cumulative Totals
including reported corrections for


previous weeks


All Causes, All Ages ------------------------ 460,115
All Causes, Age 65 and over------------------- 265,663
Pneumonia and Influenza, All Ages------------- 18,875
All Causes, Under 1 Year of Age--------------- 21,608


Week No.
36







33 6


EPIDEMIOLOGIC NOTES AND REPORTS
VACCINIA OUTBREAK Indiana


On \pril 24, 19li6. during a school immunization pro-
graini. I 7-.ear-old girl received a primary smallpox vacci-
nation on the right arm, despite a history of eczema in her
failily: -she had a normal primary response. Her 16-month-
old brother developed sc\ ere eczema vaccinatum 9 days
liter and was hospitalized and treated with Vaccinia Im-
mune Globulin. Subsequently the four other members of the
fail i d1eelopoed accinia of varying severity. The inter-
\al- between vaccination of the girl and onset of illness
in the other family members were 9 days for the 16-month-
old brother. 14 days for her 5-year-old sister, 4-year-old
sister, and 2-l1 2-)ear-old brother, and 16 days for the
mother. Other than the 7-year-old girl, no family member
had been previously vaccinated. Vaccinia virus was iso-
lated from specimens taken from two of the six family
members. All patients recovered with no residua.
Investigation revealed that the family lived in crowded
conditions, and that the -,Ilir,'- and mother of the vacci-
nated child had close and prolonged contact with her.


(Reported by Thomas Cortese, M.I., Dermatologist, Marion
County General Hospital, Indianapolis, Indiana; Marvin
Cornblath, M.D., American Red Cross Consultant for the
Distribution of Vaccinia Immune Globulin, University of
Illinois College of Medicine, Chicago, Illinois; A. L. Mar-
shall, Jr., M.D., Director, Division of Communicable Disease
Control, Indiana State Board of Health; and the Domestic
Operations Section, Smallpox Eradication Program, and
the Vesicular Disease Laboratory, Viral Exanthems Unit,
Virology Section, Laboratory Program, NCDC.)


Editorial Note:
Although the 16-day interval between date of vacci-
nation of the girl and onset of illness in her mother is
within the incubation period range known for vaccinia,1
the mother may have been infected by her 16-month-old
son, who had extensive skin involvement 7 days prior to
onset of the mother's symptoms.
Outbreaks of vaccinia and herpesvirus infection in
families or in other small groups such as patients on pedi-
atric wards have been reported.2 Incidents of multiple
cases of eczema vaccinatum have occurred among members
of families, in schoolrooms, or on pediatric wards after a
mass vaccination campaign has saturated the particular
group with vaccinia virus.3,4 However, there have been
no previous reports of vaccinia outbreaks of this size from
a single source of vaccinia.

1If4crenccs:
INcff, John M., (tt an.: Compl ications of Smallpox Vaccination.
N Kn, MIAd 276:125-13,2. 1967.
2"1ndltm n, B.1 l ,t l.: K<;posi's Vairicelliform Eruption; Report
of ; \ti ard IEl ideml i Ann P1 diat Fen" n 1(1):61-73, 1954-55.
'I ,I 1 i .. Filomna I B., qt ial.: Outbreaks of Vaccinia in
.1 Irmphit.i us F li ,' uLs HIospital. Arch I)-rm 85:533-4, 1962.
'lirrlot, It., ct al.: Severe Vaccinia Epidemic in Eczemattous
Intifntl. Bull Sor Fr I)erm Syph i63:63(4):409-12J. 1956.


SEPTEMBER 7. 1968 5C
0=
o_
U-


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 C',TER
-i. ,: j rs a MOD.
CHIEF. EPIDEMIOLOGY PROGRAM A.D. L 'G.Mu M.O.
ACTING CHIEF, STATISTICS SECTION IDA L. SHERMAN. M.S.
EDITOR MICHAEL B GREGG MD

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
I:, '.,- T. AND MORTALITY, THEN : .*L : Gi-..C BL E DISEASE
,:iI,; i WELCOMESS ACCOUNTSOF i ',"iI 'B r t i OR CASE
-E.. -Ni WHICH ARE OF CURRENT INTEREST TO HEALTH
SC.L: r-&. WHICH ARE DIRECTLY RELATED TO THE CONTROL
OF COMMUNICABLE DISEASES. SUCH COMMUNICATIONS 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 1 T-E INDIVIDUALL
STATE HEALTH DEPARTMENTS. THE 'OAiTiN: *EE. CONCLUDES
ON SATURDAY COMPILED DATA ON A N lGi~r.L "eA.i. -E RELEASED
ON THE SUCCEEDING FRIDAY.


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