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:
AA00010654:00198

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


'i" .


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

HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION


EPIDEMIOLOGIC NOTES AND REPORTS
OUTBREAK OF ST. LOUIS ENCEPHALITIS
Southeastern, Illinois


CONTENTS
Epidemiologic Notes and Reports
Outbreaks of St. Louis Encephalitis -
Southeastern Illinois .. ..............
Presumptive A2./Hong Kong 68 Influenza -


During the first 2 weeks of September 1968. eight M alario Balmore, Marland .............. .... .... 3.
Malaria Baltimore, Maryland ... .... ,
elderly persons with clinical encephalitis were hospital- International Notes
ized in Eldorado, Illinois, a town of about 3,600 people in Smallpox West and Central Africa . ... 39
Saline County southeastern Illinois. Preliminary serologic
testing has confirmed St. Louis encephalitis in one case -r-old resident of the small neighboring to\n
in which a diagnostic rise in hemagglutination inhibition f h expired on September 10 after a 5-day ill-
(HI) titer from <1:10-1:80 was demonstrated. Acute ser ness ..- .1.-.:.- was made in that case. Ac-
from three other cases have shown HI antibody tit tive f-i .II i. ll.. r ..( revealed two other clinically
against St. Louis encephalitis, but tests cn paired s suspected cases Eie cephalitis with onset on September 11
are pending. Further serologic tests are in progress. tnO d 14 inll8isBg 7 miles from Eldorado.
cases were residents of Eldorado. except for one fa (Continued on page 338)

TABLE I. CASES OF SPECIFIED I ABLE DISEASESUN ED STATES
(Cumulative totals include revised dQ reports i evious weeks)
37th WEEK S Er CUMULATIVE, FIRST 37 WEEKS
EDIAN
DISEASE
EAS September 14, Septembet 1963 -1967 MEDIAN
1968 1967 1968 1967 1963 1967
Aseptic meningitis ...................... 221 131 102 2,575 1,906 1.354
Brucellosis ............................. 5 5 5 153 184 184
Diphtheria.................... ........... 13 9 5 132 88 132
Encephalitis, primary:
Arthropod-borne & unspecified ........... 75 55 869 1.139
Encephalitis, post-infectious ............ 6 10 373 637
Hepatitis, serum ........................ 89 38 617 3038 1,518
Hepatitis, infectious .................... 1,009 857 31,258 27,036 27
Malaria ................................ 65 47 5 1,575 1,402 71
Measles(rubeola) ....................... 115 225 425 19,673 57,845 240,213
Meningococcal infections, total ........... 31 16 26 2,031 1,679 2,044
Civilian ................................ 29 16 --- 1,852 1,566 -
Military ............................... 2 -- 179 113
Mumps ................................. 644 -- 125,052 -
Poliomyelitis, total ..................... .2 39 26 71
Paralytic ............................. 2 39 22 63
Rubella (German measles) ............... 309 153 43,898 39,876 -
Streptococcal sore throat & scarlet fever.... 4,748 5,348 4,246 305,238 328,822 295.333
Tetanus ............................... 5 3 6 111 155 180
Tularemia............................... 4 6 6 142 131 187
Typhoid fever .......................... 19 14 16 263 299 297
Typhus, tick-borne (Rky. Mt. spotted fever) 9 12 9 237 262 207
Rabies in animals ....................... 61 82 82 2.544 3.212 3,212

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........................................... 3 R abies in m an: ........... .......................... -
Botulism: ........................................... 4 Rubella, Congenital Syndrome: .......................... 5
Leptospirosis: .................................... 30 Trichinosis: ................................. ..... 47
Plague: ........................................... 2 Typhus, marine: Tex.-1 ............................. 22
P sittacosis: ..................................... 35


N Vol. 17, No. 37







Week Ending

N September 14, 1968




PUBLIC HEALTH SERVICE






S. i. y and V'1ior -..


-r ,. !i ,-;.c .-t


S1I P TE\MBER 14, 1968


:_OUJTREh OF ST. LOUIS ENCEPHALITIS ((Uoninuer from front page


In addition to the occurrence of frank encephalitis,
cases of aseptic meningitis ha\e also been reported from
this l icinity. Recently three young adults. one in Eldorado
and two in the town of Carmi in White County approxi-
mately 30 miles from Eldorado, were hospitalized with
a-septic meningiis.
Eldorado lies approximately 25 miles south of Mc-
Cleansborough. Illinois. site of a 1964 outbreak of 19
cases of St. Louis encephalitis (MM\\R. Vol. 14. No. 29).
Since 1964 continuing \irological and ecological investi-
gations in Eldorado have shown activity of St. Louis
encephaliti- in Cule.r pipiens mosquitoes and certain
a\ ian species. On September 13,1968. 15 pools of C. pipiens
were collected and are now being processed.


At the present time. intensive surveillance. emphasiz-
ing case confirmation and detection of milder clinical
syndromes, including aseptic meningitis. febrile head-
ache. and other syndromes possibly due to St. Louis en-
cephalitis \irus, is in progress.

(Reported by Allen Kelly, Acting Administrator, Egyptian
Health Department; Dr. E. L. Sederlin, Regional Health
I". Illinois Region V, Chicago. Illinois; Norman J.
Rose., M.D.. M.P.Hl., Chief. Bureau of Epidemiology, and
Richard Vorrissey, M.P.H., Chief. Division of Laborator-
ies. Illinois Department of Public Health; E. I. Pilchard,
M.S., Ph.D., D.V.M.. Zoonoses Research Center, Uni-
cersity of Illinois, 'rbana. Illinois; and three EIS ";: ,


PRESUMPTIVE A2/HONG KONG/68 INFLUENZA Vancouver, Washington


An outbreak of influenza-like disease which occurred
(luring the last 2 weeks of August in seamen aboard a U.S.
Merchant Marine Vessel, returning from the Far East. has
been diagnosed as presumptive A2, Hong Kong 68 influenza
by hemagglutination-inhibition (HI) tests. On September 6.
the S.S. Raleigh, docked in Vancouver. Washington, and
reported that during the \oyage 11 of its 40 crew members
had had an influenza-like illness. In the past 3 months.
the vessel had made one trip to the Far East. and its only
port of call had been n.-_.r the ship docked in Saigon on
August 12 and left on August 18. One crew member became
ill on August 14, two others on August 16. and eventually
eight others became ill. The clinical syndrome was typical
for influenza-like illness: fever. myalgia. cough. headache,
and chills.


On September 6, 1968, 27 crew members including the
11 persons who had been ill were bled and the sera was
tested for HI antibodies on September 12 (Table 1). There
is a fivefold difference in the geometric mean titer (GMT)
against the A2 Hong Kong 68 strain between those with
a history of influenza-like disease and those without a
history. This difference is significant with P 0.01. Al-
though there is a slightly greater than twofold difference
in GMT against A2 Japan 170 62 in these two groups. it
is not statistically significant.
(Lawrence O. Berg, Quarantine Inspector, Portland, Oregon;
Gordon C. Edwards. M.I).. I4.P.H.. Director, Division of
Preventive medical Serrices, and Gatlin R.Brandon, M.P.H.
Director, Section of Public Health Laboratory, Oregon
State Board of Health; Byron J. Francis, I.D., M.P.H.,


Table 1


Persons With Influenza-like Illness
10 or More Days Prior to Docking


Persons With No Influenza-like Illness
During the Voyage


Patient ANTIGENS Pa t ANTIGENS
Patient Patient
No. A2 Hong Kong A2 Jap 170,62 B Mass No. A2 Hong Kong A2 Jap 170 62 B Mass

6 80 80 10 1 10 10 10
10 10 40 10 2 10 20 10
16 80 10 10 3 10 40 '10
17 40 160 20 4 10 160 10
20 80 160 10 5 40 160 10
21 40 80 10 7 10 160 10
22 40 80 20 8 10 10 10
24 h0 40 10 9 40 10 10
25 40 80 10 11 80 160 40
26 40 80 10 12 20 320 10
27 320 640 40 13 10 40 80
14 10 20 10
15 10 10 10
18 10 10 10
19 10 10 10
23 40 160 10


,-n tLi r


10.00


33.64


(;MT'


51.46


75.11







Morbidity and Mortalil


Acting Chief, Division of Epidemiology, Washington State
Department of Health; Respiratory Virus Infections Unit,
Laboratory Program, 'CDC; and an EIS Officer.)

Editorial Note
This investigation illustrates a method for rapid di-
agnosis of influenza as described by several investiga-
tors. 12 Sera from acutely ill and convalescent patients
are collected at one time and the same serologic test (HI


SEPTEMBER 14. 1968


INTERNATIONAL NOTES
SMALLPOX West and Central Africa


As reported to the World Health Organization, small-
pox in the 19 countries of West and Central Africa during
the first 6 months of 1968 decreased markedly from pre-
vious characteristic levels (Figure 1). For the period,
the 19 countries reported 3,982 cases of smallpox com-
pared with 7,891 cases reported during the first 6 months
of 1967. The average number of reported cases for the
first 6 months of the years 1960-67 was 7,108. The char-
acteristic seasonal distribution of smallpox in these
countries is an epidemic upsurge during the dry season
(early in the year) followed by a gradual decline in cases
during the rainy season (generally, May-September) and an
eventual seasonal low during the inter-seasonal months
(September-November). In 1968, however, peak incidence
occurred earlier than usual and reached a level approxi-
mately one-half that of the usual peak incidence. These
findings are in contrast to experience in the remainder of
Africa where reported cases during the first half of 1968
paralleled those reported in 1967.
The changes in the long-term trend of smallpox in
West and Central Africa reflect the activities of the West
and Central African Smallpox Eradication and Measles
Control Program. a collaborative effort of 19 countries
which is jointly assisted-by USAID and the U.S. Public
Health Service and is part of the WHO Global Smallpox
Eradication Program. Since its beginning in January 1967,
the "attack phase" of the regional eradication drive, with
scheduled completion in all but one country by December
1969, has aimed at vaccinating all the population against
smallpox and children age 0-4 years against measles. As
of September 5, 1968, a total of 55 million vaccinations
had been administered in the population of 110,000,000
people. In February 1968 when over 25 million vaccina-
tions had been performed, the first evidence of a sub-
stantial change in the long-term trend of smallpox occurred
(Figure 1).


Figure 1
REPORTED SMALLPOX CASES BY MONTH, 1960-67
AVERAGE, 1967 AND 1968 WEST AND CENTRAL AFRICA
2,0001


600


JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC
SOURCE WHO

The reduction of smallpox incidence together with
the expected seasonal decrease in smallpox incidence
during the current rainy season affords a unique oppor-
tunity to interrupt smallpox transmission. During the
September-November period, presently infected countries
plan to intensify methods of active case detection and
outbreak control.
(Reported by the Smallpox Eradication Program, NCDC.)
Editorial Note:
The year of lowest incidence of smallpox in West and
Central Africa from 1960-67 was 1964. Alhi,.,,l.-1 records
of smallpox occurrence prior to 1960 are incomplete. 1964
was probably the year of lowest incidence in history.
Provisional datasuggest that despite known improvements
in reporting, the incidence of smallpox in June 1968 is
significantly lower than that recorded in June 1964.


EPIDEMIOLOGIC NOTES AND REPORTS
MALARIA Baltimore, Maryland


On April 18, 1968, a Liberian freighter departed from
Buchanan, Liberia, bound for Baltimore, Maryland. On
May 2 while at sea, the third engineer aboard this vessel.
a 27-year-old West German, developed nausea, vomiting.


anJ bilateral costovertebral angle pain. On May 6, 2 days
after arrival in Baltimore. he was hospitalized because of
persistence of these symptoms and the development of
(Continued on page 3-4)


ty Weekly Report 339


or CF) is performed in a single run on the sera in each
group. Geometric mean titers are then calculated for the
acute and convalescent groups and statistically analyzed.
If the difference in GMT is found to be statistically sig-
nificant, a presumptive diagnosis of influenza can be made.
References:
IMilstone. J.H., et al.: 1954 Influenza B Epidemic in the Pacific,
Area. Military Surgeon, 19,16.
S- i N.R., et al.: Rapid Serological Diagnosis of an Outbreak
of Influenza, Brit Med J 2:5249, 1961.


~I--~







340 Morbidity and Mortality Weekly Report


TABLE II1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

SEPTEMBER 14, 1968 AND SEPTEMBER 16, 1967 (37th WEEK)

ENCEPHALITIS HEPATITIS
ASEPTIC Primary
ARE MNG I11 CtI I [IPIHHIii inuIin Post- MALARIA
AREA MENINGITIS including Infectious Serum Infectious MALARIA
unsp. cases
1968 1967 1968 1968 1968 1967 1968 1968 1968 1967 1968
UNITED STATES... 221 131 5 13 75 55 6 89 1,009 857 65

NEW ENGLAND........... 11 4 4 49 44 2
Maine.... .......... 2 1
New Hampshire...... 1
Vermont............ 7 -
Massachusetts...... 6 2 1 14 18 -
Rhode Island....... 3 1 15 7
Connecticut......... 2 1 3 11 18 1

MIDDLE ATLANTIC...... 50 11 11 4 1 20 167 125 9
New York City...... 16 6 2 1 14 59 28 3
New York, up-State. 6 1 1 2 32 30 1
New Jersey..*...... 25 4 3 3 29 17 2
Pennsylvania....... 3 1 5 2 1 1 47 50 3

EAST NORTH CENTRAL... 60 18 38 28 1 7 124 108 1
Ohio................ 10 11 32 23 22 18
Indiana...*........ 2 2 4 7
Illinois........... 5 5 1 2 1 4 40 34 1
Michigan........... 43 2 5 3 55 37
Wisconsin.......... 1 3 12

WEST NORTH CENTRAL... 6 1 2 9 2 2 62 61 6
Minnesota.......... 2 1 2 2 2 16 13
Iowa................... 1 2 5 6 8
Missouri........... 2 25 26 2
North Dakota....... 3 1 2
South Dakota .... 9
Nebraska........... 1 1
Kansas............. 4 11 4

SOUTH ATLANTIC....... 14 42 2 2 7 5 1 2 106 81 27
Delaware ........... 9 5
Maryland............ 9 33 3 9 21
Dist. of Columbia.. 3
Virginia............ 1 2 2 2 1 14 7 -
West Virginia..*... 4 7 1 8 5
North Carolina..... 3 11 15
South Carolina..... 2 8 2
Georgia............ 2 1 39 16 12
Florida............ 1 2 1 1 16 11 -

EAST SOUTH CENTRAL... 14 11 1 2 1 56 82
Kentucky........... 6 -- 24 54
Tennessee.......... 13 4 1 2 12 13
Alabama............ 1 1 16 6
Mississippi......... 1 4 9

WEST SOUTH CENTRAL... 5 10 11 6 2 4 52 111 1
Arkansas........... 33 1
Louisiana...*...... 4 2 2 2 1 2 17 14
Oklahoma........... 5 3 2 1
Texas.............. 1 3 9 1 1 2 33 63

MOUNTAIN............. 3 2 73 29 11
Montana............ 11 4
Idaho............... 1 3
Wyoming............ -
Colorado............ 3 1 6 3 11
New Mexico......... 1 7 3
Arizona............. 31 14
Utah................ 10 2
Nevada............. 7 -

PACIFIC.............. 58 34 11 5 1 49 320 216 8
Washington......... 1 2 36 13 1
Oregon...... ...... 2 3 26 20 1
California......... 54 26 11 1 1 46 254 180 5
Alaska.............. 2 2 2
Hawaii............. 3 6 2 1 1

Puerti Ri.......... 26 14

*Delayed Reports: Diphtheria: La. delete 2
Hepatitis, serum: N.J. 2, Ind. 1
Hepatitis, infectious: Me. 1, N.J. 2, Ind. delete 1, W. Va. delete 1, P.R. 1
Malaria: N.J. 2, La. delete 1







Morbidity and Mortality Weekly Report 341


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
SEPTEMBER 14, 1968 AND SEPTEMBER 16, 1967 (37th WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL
AREA Cumulative Cumulative Total Paralytic
______v _____Cum.
1968 1968 1967 1968 1968 1967 1968 1968 1968 1968 1968
UNITED STATES... 115 19,673 57,845 31 2,031 1,679 644 2 2 39 309

NEW ENGLAND.......... 7 1,157 846 5 121 68 68 1 34
Maine.... ........ 37 239 6 3 6 1
New Hampshire...... 141 74 7 2 2 -
Vermont.............. 2 34 1 1 6 -
Massachusetts...... 4 365 347 63 32 35 1 11
Rhode Island....... 5 62 1 9 4 7 3
Connecticut........ 3 607 90 4 35 26 12 19

MIDDLE ATLANTIC...... 37 4,091 2,261 5 363 275 51 26
New York City...... 30 2,110 456 1 73 48 43 16
New York, Up-State. 1 1,218 585 64 67 NN 9
New Jersey.......... 4 636 487 2 128 93 8 -
Pennsylvania....... 2 127 733 2 98 67 NN 1

EAST NORTH CENTRAL... 18 3,780 5,445 8 245 227 163 1 127
Ohio................ 1 294 1,142 64 80 4 6
Indiana............. 1 672 595 5 35 22 14 7
Illinois........... 4 1,364 977 1 54 54 15 1 80
Michigan........... 2 266 932 2 72 55 35 32
Wisconsin.......... 10 1,184 1,799 20 16 95 2

WEST NORTH CENTRAL... 1 384 2,860 108 72 54 2 16
Minnesota.......... 16 134 26 18 -
Iowa................ 98 749 6 14 35 9
Missouri........... 81 333 35 15 1 2
North Dakota ..... 1 134 870 3 1 17 6
South Dakota....... 4 53 5 6 NN
Nebraska........... 41 628 6 12 1 1
Kansas............. 10 93 27 6 -

SOUTH ATLANTIC....... 5 1,507 6,880 7 410 325 38 1 22
Delaware........... 16 46 8 6 2
Maryland............ 96 158 2 34 43 13 4
Dist. of Columbia.. 6 22 14 10 -
Virginia........... 2 301 2,189 35 40 8
West Virginia...... 288 1,386 11 25 10 9
North Carolina..... 282 849 76 67 NN 1
South Carolina..... 12 511 56 29 1
Georgia............ 4 36 4 85 49 -
Florida............. 3 502 1,683 1 91 56 5 8

EAST SOUTH CENTRAL... 492 5,196 2 185 129 37 2 5
Kentucky............ 100 1,331 84 35 3 1 1
Tennessee.......... 62 1,872 2 54 55 29 2
Alabama............ 94 1,329 26 26 5 1 2
Mississippi ........ 236 664 21 13 -

WEST SOUTH CENTRAL... 21 4,779 17,392 2 305 219 63 1 1 21 14
Arkansas........... 2 1,404 20 31 -
Louisiana.......... 2 155 1 88 86 I
Oklahoma.......... 117 3,351 50 16 2 2
Texas.............. 21 4,658 12,482 1 147 86 61 1 1 19 13

MOUNTAIN............. 3 982 4,655 2 31 31 69 29
Montana............ 58 282 1 4 1 10 -
Idaho............... 1 21 384 11 3 6 -- 2
Wyoming.............. 51 181 1 -
Colorado............. 502 1,561 10 13 31 3
New Mexico......... 102 586 3 5 3
Arizona............. 2 222 1,018 1 2 4 13 21
Utah................ 21 374 1 4 4 -
Nevada............. 5 269 3 2 -

PACIFIC.............. 23 2,501 12,310 263 333 101 1 1 11 36
Washington.......... 5 520 5,431 38 29 29 1 6
Oregon.............. 12 526 1,604 21 25 2 12
California......... 6 1,418 4,964 190 265 53 1 1 10 14
Alaska.............. 2 140 2 10 12 1
Hawaii............. 35 171 12 4 5 3

Puerto Rico.......... 4 407 2,112 19 12 17
*Delayed reports: Mumps: Me. 2
Rubella: Me.1








312 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

SEPTEMBER 14, 1968 AND SEPTEMBER 16, 1967 (37th 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... 4,748 5 111 4 142 19 263 9 237 61 2,544

NEW ENGLAND.......... 474 2 46 7 1 70
Maine.... ......... 6 53
New Hampshire...... 8 1 2
Vermont... I ..... 11 46 11
Massachusetts...... 61 I 3 1 3
Rhode Island ....... 70 -
Connecticut........ 318 1 3 1

MIDDLE ATLANTIC...... 159 13 7 1 21 2 18 3 39
New York City...... 6 6 1 10 -
New York, Up-State. 151 4 7 4 1 4 3 32
New Jersey......... NN 4 6
Pennsylvania....... 2 3 3 1 8 7

EAST NORTH CENTRAL... 446 1 10 8 7 35 8 6 242
Ohio............. .. 66 1 1 13 6 86
Indiana............ 87 2 1 3 1 77
Illinois........... 116 5 5 6 18 2 2 34
Michigan........... 128 2 1 12
Wisconsin.......... 49 1 1 1 3 33

WEST NORTH CENTRAL... 214 8 1 13 1 30 2 9 15 624
Minnesota.......... 10 2 5 190
Iowa.... .......... 77 3 1 1 3 103
Missouri........... 4 2 7 1 23 2 3 2 90
North Dakota....... 14 4 102
South Dakota. ...... 12 1 3 1 4 79
Nebraska........... 87 1 3 1 25
Kansas............. 10 3 2 1 35

SOUTH ATLANTIC....... 561 1 25 9 5 54 2 127 13 290
Delaware ........... 5 -
Maryland........... 39 3 9 1 14 5
Dist. of Columbia.. 4 2 I 1
Virginia........... 211 4 2 9 1 42 4 107
West Virginia....t.. 171 2 34
North Carolina..... 13 2 2 2 34 1 11
South Carolina..... 12 1 3 3 8
Georgia............ 14 3 1 14 26 5 49
Florida............. 92 9 2 4 16 3 3 83

EAST SOUTH CENTRAL... 876 14 1 8 29 2 45 9 549
Kentucky........... 54 1 1 6 10 8 278
Tennessee.......... 612 5 5 16 2 30 1 248
Alabama ........... 111 5 3 22
Mississippi........ 99 3 1 2 7 2 I

WEST SOUTH CENTRAL... 383 1 21 1 42 2 32 1 23 9 419
Arkansas........... 4 14 5 5 1 54
Louisiana.......... 8 6 2 5 1 38
Oklahoma........... 5 8 12 1 11 117
Texas.............. 378 1 9 1 14 10 7 7 210

MOUNTAIN............ 1,068 1 7 1 14 5 4 71
Montana ........... 14 -
Idaho.............. 113 -
Wyoming ............. 27 1 1 3
Colorado............ 568 3 2 4 3
New Mexico.......... 157 1 7 2 30
Arizona............ 107 3 2 34
Utah............... 82 1 3 -
Nevada............. 1 1

PACIFIC.............. 567 2 18 2 2 41 1 2 240
Washington......... 80 1 2 2
Oregon............. 72 I 1 1 5 6
California......... 331 2 16 1 1 34 1 2 232
Alaska ............. 11 -
Hawaii............. 73- -

Puerto Rico.......... 3 8 2 17
*Delayed reports: SST: Me. 3, W.Va. delete 18
Tetanus: Iowa 1







Morbidity and Mortality Weekly Report






TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED SEPTEMBER 14, 1968


(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 1 Area All 65 years and I year
Ages and over Influenz 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.--------


711
225
65
24
22
48
30
10
36
49
66
9
47
35
45

3,137
48
30
118
38
18
36
69
75
1,544
38
508
186
51
119
33
35
76
62
25
28

2,544
59
34
S723
177
218
140
80
305
39
36
53
20
53
157
43
124
38
40
42
100
63

881
51
31
52
156
17
132
68
234
71
69


400
118
33
13
14
23
16
6
24
34
40
7
25
21
26

1,764
19
16
63
24
9
22
39
36
863
18
291
94
32
71
20
25
53
38
16
15

1,386
29
19
402
108
114
62
40
162
22
16
22
6
29
87
21
83
21
20
26
57
40

535
36
20
24
100
12
79
44
127
50
43


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.----------


1,228
143
244
64
96
100
66
68
41
74
78
212
42

764
122
50
34
165
156
44
53
140

1,128
40
37
32
152
56
90
177
60
151
84
127
65
57

439
39
30
134
20
100
15
54
47

1,638
18
38
40
48
99
512
86
44
100
41
106
157
35
187
63
64


635
66
127
29
43
57
35
32
21
57
45
98
25

378
68
32
22
79
73
13
25
66

594
25
16
19
72
30
44
95
39
75
44
68
34
33

246
22
17
76
7
46
14
29
35

1,004
14
20
32
19
62
313
50
35
65
23
57
82
27
113
49
43


Total 12,470 6,942 365 624


Cumulative Totals
including reported corrections for


previous weeks


All Causes, All Ages ------------------------ 472,577
All Causes, Age 65 and over------------------- 272,595
Pneumonia and Influenza, All Ages------------- 19,240
All Causes, Under 1 Year of Age--------------- 22,231


Week No.
37







344


MALARIA continueded from paige 3l39)

olignria. Physical e\aminat ion re\ eald a healthy appearing
male \with a tt'liperaturE of 100I F bilateral costo,\ertebral
anglo tenderness. and h epii tosph0 nom" a0 l Initial labora-
tor\ re-ult- itincludd at normal urinal: isi, a l helimatocrit
o1f 1 Ipercon' t andI a w\hilt cell mountt of 7,9)00( a peripheral
blood smear Iwas obtained Ihut not examined. An X-raI of
the abdomen reIealed caleific densities in the path of
the right ireter which led to an initial diagnosis of ob-
structi, t uropatIh IlHowe\ er, retrograde )pyelogralii s per-
fornmed se eral dasl later. showed that no calhific densities
H I-c in iil tlur ter.
On May 7, t(he BI'N \a- 7s Th i percent, and the hili-
ruhin \a- I.i n percent. On Ma hv and 10, the patient
e\periencetld spiking temperatures to 10.3 F. By the after-
noon of ilMa 10. the hematocrit had fallen to 33 percent,
the hiliruhin had increased to 20.3 mIg percent. the BUN
had risen to li,0 mn percent, and the urinalysis showed
occult blood. Blood smears obtained at this time revealed
a hea\y paras itein ia with Plasmodium falciparum; both
Irophotzoteo and gamnetoc\ytes were present. Chloroquine
therapy \\as immediately instituted, but in less than I1
hour-. the patient developed pulmonary edenma and died.
An autopsy resealed pulmonary congestion and pul-
monary edenma calcific deposits in the ileum. and focal
tubular neurosis and hemoglobin cases in the kidneys.
The heart wxas normal. P. falciparum parasites were found
in the capillaries and small vessels of all organs examined.
Postmortem review of the blood smears taken on May 6
revealed the presence of many P. falciparum parasites.
The patient probably acquired his malaria infection
in Liberia since all previous ports of call had been in
nonmalarious areas. None of his 4l2 crew mates had re-
ported ill prior to arrival in Baltimore. A malaria survey
of the crew could not be conducted before the ship's de-
parture for Canada, but officers of the Medical Services
Branch of the National Department of Health and Welfare
(Ottawa) reported that no illnesses had occurred aboard
the ship \lhen she arrived in Canada.
reportedd by JdI.. Janney, I.D.. M.P.H., Director, Pi-
rision of ('ommunicabcl Disacses. laryland State Depart-
ment of Heaflth: E.J. Ilinman, M .D., Director, USPHS /os-
pital, Bultimtore. M.aryland; the Canadian Department of
/I'alth utlnd el fare ; the Fore ig' Q quarantine Program, \CP(C;
anIl ian ES Officer.)


Editorial Note:
In the .'-'.,-ear period between January 1, 1963. and
July 1 1196i. 1.715 cases of malaria. including 18 deaths,
\eret reported to NC'D(': 12h of these cases, including
five deaths, %were merchant seamen. The case i ilI.
ratio for searen was 11 Iimes that for non-seamen (39.1
deaths per 1,000 cases for seamen versus 2.8 deaths per
1,000 cases for non-seamen). This high fatality ratio in
merchant seamen may have occurred because 1) 55 per-
cent of their malaria infections were due to P. falciparum,
and 2) seamen frequently have their onset of illness at
sea where adequate medical carre may not be available.


SEPTEMBER 14, 1968
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THE '.i. i "i AND MORTALITY WEEKLY REPORT WITH A CIRCU.LA
TION IS PUBLISHED AT THE NATIONAL COMMUN:CASLE
DISEASE CENTER. ATLANTA GEORGIA.
DIRECTOR. NATIONAL COMMUNICABLE DISEASE .". r ER
i SENCER M1
CHIEF. EPIDEMiOLOGY PROGRAM A D. LANtMlMUR *
ACTING CHIEF STATISTICS SECTION IDA L. SHERMAN M.S.
EDITOR MICHAEL B GREGG M0.

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBI D1 T -'.C r i. -TALITY. THE N- T' l'-'. 1 '** _,' ,* .* B. I LI A L.E
CENTER *I L ':'. ACCOUNTS OF Nl 1- ',; .. t R ... E
INVEST IGATONS WHICH ARE OF .- 'H. z iE '-'EALTH
OFFICIALS AND WHICH ARE DIRECTLY RELATED TO THE CONTROL
OF COMMUNICABLE DISEASES. SUCH COMMUNICATIONS SHOULD BE
ADDRESSED TO:
NATIONAL COMMUNICABLE DISEASE CENTER
ATLANTA GEORGIA 30333
*.: r "AND MORTALITY WEEKLY REPORT

NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO THE NCDC BY TH- NL,.' u.vAL
STATE HEALTH -Cr -aMENTS THE REPORTING WEE- Q-uC .
ON SATURDAY; '.''. DATA ON NATIONAL BASIS AA:" ,LF A i
ON THE SUCCEEDING FRIDAY


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