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:
AA00010654:00202

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 C MMUNICABLE DISEASE CENTER




















HEALTH SERVICES AND MENTAL HEALTH,, ,i'i ji TI


EPIDEMIOLOGIC NOTES AND REPORTS
STAPHYLOCOCCAL FOOD POISONING
Ponce, Puerto Rico

An outbreak of food poisoning occurred on Septem-
her 3, 196i. in Ponce. Purto Rico. among doctors. nurses,
student nurses. and employees of the Ponce District Hos-
pital following a luncheon in the hospital cafeteria. Of a
total of 416 employees eligible to eat the noon meal, as
many as 143 individuals may have become ill with symp-
toms characterized by abdominal pain. headache. dizzi-
ness. ormiting, and less frequently diarrhea giving an at-
tack rate of 32 percent. The epidemic cure suggests a
common source of exposure and a short incubation period
with a mean of 4 hours (Figure 1).


Vol 17, No. 41







eek Ending

12, 1968


\I t!Zl t.


I I h m'll Nstu T
I h, od .* N < n I".o I'
ir n: fnul r M r t I all i, : .

S a It .... I. .


Ihiim.-,I i .l m t rio ,* -I n t -i : '.


Food histories implicated ham a- tihe sehich of inflc-
tion (Tahle 1). The ham was prepared b1 a caterin.r -i, ni
on the day of the outbreak anId deli iered to Ihe I cafer trial.
I\hile in Iransit the food ~Ms kept at room terlpenr uren
(t(*', t/i i .o7i n ",n


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)

41st WEEK ENDED CUMULATIVE. FIRST 4 1 aEIEKS
-MEDIAN
DISEASE October 12. October 14, 1963 1967 MEDIAN
1968 1967 19Ri8 19 7 li l
Aseptic meningitis ....... ....... .. 158 89 68 3.434 2.302 1,659
Brucellosis ............. ......... 5 8 8 182 202 205
Diphtheria ...... ................... ... 4 2 6 157 113 153
Encephalitis, primary:
Artiropod-borne & unspecified .......... 54 38 1,080 1,289
Ent ephalitts. post-intectious ......... .. 4 2 401 667
Hepatitis serum .. .......... .. .. 107 40 3,494 1,709
H ipattil,, infectious .................... 994 669 35,282 30,195 30 4
Malaria .... ................................. 101 23 7 1.834 1.556 84
.Measle. (rul iola) .. ....... .... .. 113 267 800 20,113 58.712 243,198
Meningococcal intfctions, total ........... 30 27 35 2.135 1.783 2,191
Civilian ................. .......... 28 26 1,951 1,666
Military. ..... ...... ...... ..... 2 1 184 117
Mlumps ..... ............ .. ...... 1,106 128.384 -
Poliomyelitis, total ..................... 2 48 27 75
Paralytic ........................ 2 48 23 70
Rubella (German measles) ............... 252 248 44.869 40,659
Stri ptocuccal sore throat & scarlet fever.... 6,663 6,546 5,906 330,209 352,764 315,204
Tetanus ....... ..................... 8 7 6 138 180 210
Tularemia .............................. 2 4 4 156 144 205
Typhoid fever ........ ............. ..... 11 9 11 304 333 338
Typhus, tick-borne (Rky. Mt. spotted fever) 1 4 4 262 286 226
Rabies in animals ................ .... 55 76 65 2,783 3.496 3,496

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Curi
Anthrax: .............. .. ............... .. 3 Rabies in man: ..... .. ................ ..
Botulism: ........ .... ........ ........... ..... l Rub lla, Congenital Svndrome: ..... 5
Leptospirosis: La.-1, N.C.-I, N.Y. Ups.- .............. 36 Trichinosis: N.H.-1, N.Y.C.-I ................ 52
Plague: ......... ........... ............ 2 Typhu r:inu e:* .25. 3
Psittacosis: Conn.-l, N.Y.C.-2 ........ ...... ..... 38
*Delayed reports: Typhus, marine: Tex.-l


It. q { .






Morbidity and Mortality Weekly Report


STAPHYLOCOCCAL FOOD POISONING (Continiri d rom froit page)


Figure 1
CASES OF FOOD POISONING, BY INCUBATION PERIOD
PONCE DISTRICT HOSPITAL, PUERTO RICO
20- SEPTEMBER 3, 1968


3 4 5 6 7
INCUBATION PERIOD (HOURS)


8 9 >9


(CutItret- of leftoNer hain. \omitui from patients. and nose
and throat specinmnn- from food handlers at the catering


Table 1
Attack Rates for Specific Food Items

Persons who ATE Persons who did NOT
specified food eat specified food
Food attackk Attack
II1 Not Total Rate III Not Total Rate
Ill Ill
Percent Percent

Rice with
sausages 64 120 1b4 3.5 6 29 35 17
Ham 71 124 195 36 0 25 25 0
Pie 47 101 148 3:2 24 48 72 33
Bread 53 124 177 30 1S 25 43 42
Milk 67 141 20b 32 4 b 12 33
Beans 32 45 77 42 39 104 143 27



service, all grew abundant Staphylococcus aureus, coagu-
lase positive. Inspection of the caterer's kitchen facilities
revealed crowded conditions and several violations of
recommended sanitary practices.


(Reported by Hernardo Pineirro, M.D).. Medical Director.
and Mo1desto KeyIes Reyes. .SS.. Reiyional Superrisor.
Environmental Healtie Southern Healt/ Region; Luis
llainardi, !.D).. 4.P.H.. 'Chief, Communicable Disease
Control, Carlo.s N. Vicens, .I.. Director, Program for
Prerentiie Medicine, and Anyel A. ('olon, M.D. Ph.D.,
Director. Institute of Laboratories. Puerto Rico Department
of Public Health: and EIS Officers.)


TRANSFUSION MALARIA Dallas, Texas


In \pril 19)ih. a e3 ear-old man with chronic renal
failure underwent bilateral nephrectomnis and incidental
,plrnectclomv in preparation for a renal transplant. Post-
operalixel\. he aas, maintained on biweekly hemodialysis.
On July 20. he developed chills and fever, and on July 30,
P/a .(niliufm ma/ulrire parasites were detected on a routine
blood l imear. Previous blood smears were then reviewed
and parasites were detected from as early as July lS. The
pa)ieit \\as treated with chloroquine and prinaquine, and
he made an uno.entful recmoer\. He had no history of
mailria or use of shared syringes and had not traveled
uut-ide the Inited States except for two brief trips across
the border from Te\a- into northern Mexico. 15 years pre-
Sitously. However. in thle preoperattie treatment of his renal
insufficiency and during his postoperative hemodialysis.
he had rc ll\ed .i 5 units of \\ hole blood.
Of the 55 blood donors, 3:3 (wrer located and inter-
Sieeied; none gae\ a history of malaria, but 13 had trat eled
to malarious area,- Serum was obtained from eight of the
13 and analyzed for the presence of malaria antibodies hy
the indirect fluorescent technique. Only one of the eight,
a 21-y ear-old Nigerian exchange student. had a positive
-erologic ltst. The dilution end points in his serum were
1:2,5(ti again-t P'. malaria, 1:640 against P. falciparum,.
and 1:160 against P. or'a/l and P. vira.x; these results


indicated a recent P. nalariae infection. Blood smears
were obtained from this donor on several occasions, hut
no malaria parasites were detected. On August 23. 1968.
10 ml of his fresh blood were given intravenously to a
volunteer recipient, and on September 10. P. malariae
parasites were detected in the volunteer's peripheral blood.
On repealed questioning, the '.- r i donor denied ha% ing
had malaria at any time in his life. He had been well since
arriving in the United States in June 1966: he had not used
antimalarial drugs. The blood which he donated on June 15
was given to the patient on June 17.
(Reportedi by James P. Luby. M.I).. and Paul 1l. SoutherIn
Jr., 1.1)., Department of Internal Medicine, I i of
Te.as Southwestern Medical School at Dallas; Inal J. I ir-
lett, 4M.)., M.P.H., Dallas C lHealth Department; M.S.
Dirckerson. V.I).. V.P.H.. Director. ('ommunicable Disease
ODcision, TerXs State Depairtment of Health; atnd Peter G.
C'oitacous, M.D., /lead. Section on Primate tMalaria, Lab-
oratory of Parasite Chemotherapy, nationall Institute of
Health, Chamblee, Georgia.)
Editorial Note:
P/asmiodium malaria is endemic in Nigeria. Infections
caused by1 this species are noted for their chronic and
benign nature (relapses have been noted after more than
20 years in some cases) and tendency to persist at \ery


378


OCTOBER 12. 1968










Iio parasil t d n-ille in ihe iinilitiun host. Thoe ihienc'e
of a li!tor\ of illner s- it the responsible donor -TuI -'-t,-
Ihait h haid contritlid lalairi a a a : c hild and acquiirtd
s-ufftict r tien ini it y to permit his subsequent s iiitonat


fo r I I IO ( I I I i ih I k Ii I r I t I I l I ,f t ,. I o (- (.
I o i (iir IlIt p tr it n1n 1T h< 1 hl-o h if I I I

tof !,erphiral b tlood + tarn .


SUSPECT SCRUB TYPHUS Kansas


On March 21, 196,. a :21 -ear-old e (r icew ian \\ho had
just arrived in Topoka, Kansas. after 13 months of duty in
Vietnatilm co ildniine of fe\er. iiala-,il painful swelling inl
the left groin. and a papuhlar lesion on the left' thigh. (On
March 26 he coni ulted ai physician \\ho i rescribed ulfta-
diazinre, nd i oi Marchu 2T he \ns hospitalized for diagnostic
i\ all il tion
On admission. the patient's \i\\or ta.~ -slighitly en-
lairged and lhi- pleen \N :as pulpalite; hie had a 3-4 (i tell tnder
left inguinal node and ia raised papule on Ithe anterolaloral
i-spect of hib left le Lahoratory studies revealed homia-
turia and a icerehbral spinal fluid pleoc\to i s consisting ofi
12 lymphoc\tes. He also had a direct reacting hliruliin of
4. 1,iigni per 100 nl. SN ptrce'nt of t which was unconjugated.
Other liter function tests \iw re normal, and febrile aggluti-
nins \etre unren\aling. Cultures. including one of fluid
taken from the inguinal tlymph node, and direct staining of
the lyniph aspirate x\ere all negative. On March i31, the
possibility of plague w\\a considered, and after several
blood specimens \ere taken, the patient \\was started on
chloramnicetin and strepro'tycin. His temperature t\as
normal 4S hours later. Examination on April 5 revealed a
round ulcer-like lesion on the anterior left hip and a 1-2
cm left inguinal node. The patient has no\\ recovered.
During the la-t month of the patient's ser ice in Viet-
nanm, he had worked and slept in a warehouse. He reported
ha\ iIl seen and heard rats, hut he denied ha\ ing handled
them or seen anv dead animals.
The patient's military record showed that he had re-
cei\ed an injection of plague vaccine on March 15, 196S.
A serum titer to Pasteurella pcstits of 1:1I28 was demon-
strated in the patient's acute phase serum, but this was
believed compatible with the immunization history. Sera.
drawn on April 5 (12 days after onset of illness) and on
April 25.had a titer of 1:640 for Rickettsia !It ts!Ou mtus/ i,.


using ain indirect i n ti oltluor'Ir nt (to-. \ tot phiE I1
fixation lesl1 for the spot f d f'e\ r group \wa- n' nit\f ll
hoth -era. Thit bi h I l it r I a I patible I I ti a re tni t I n
feer i n \n it i i / *It s /;: s. at it I -l rotr i t -TI 'i I I tI
Ithe dit oaso \\is s Irnh t phu-.
(/etpor/.t I ill ///in Hu1 / .i// l P). Vt 5.1, 1 -A y.
Kanh as : C dwiph t /D n r. ,n,, l, 1, (, I S. 1 ,- H ? f 1: '/ /,
11./ .. ( /, /. D)t part Tnt of i< t i k ft s / ii P' / i It
Re'e/ .lrme y In.1/ith'e of ',e Irch: Vir,'s 1)Pis a- ,n f,
F /ul/l '!ic hnl 'est/ ti ot1 Program,. \C '. A/,: l/' ,
Ka'< as; ind
Editorial Note:
Scruah Iyphus is not a noltifiable li cu in i i- I nTltd
States but is reported optionally hY s-tale-. n 9it 1 it
only one case has been reported to N(')( that i an ill
leltnam returnee reported from Floriua in 19tii. Hto\e\ -r.
129 cases of scrub typhus \ ere reported tly the arinold
services for the 2-year period. 19 ti-1967 (Ta ul. 2).


Table 2
Scrub Typhus in U.S. Troops in Vietnam*
January 1966 December 1967


Year Ser\ ice Branch

1966 Armni
Nax.\ and Marines
Air Force
1967 Army
Navy and Marines
Air Force


*Ia Ie on I I'1-p rt o1 Milit, ry A,-
Morb lit <\ |> \,dilln ilon iDi Eno- i- .
theu It mL"na.


Number of iatre per 1.i00l
Cases Troop- per Year

:7 i0.2
1 II.I)1
1 01.01
54 0.2


I urI tj ( 'O ili \ '\ tl
ts ,lt, '- O(il ,' \ \(t \ ,


SURVEILLANCE SUMMARY
MEASLES United States


For the t\eek ending October 5. 19io) (week 40), there
were 10s cases of measles reported to the NCDC. This is
a decrease of 116 cases from the 224 cases reported in (the
corresponding week last year. The number of cases re-
ported in the 4-w\eek period ending October 5. 196'. shows
a slight decrease in reported cases from the 1-r. 1..-_ 4
weeks (Figure 2, inset).
For epidemiologic year* (EY) 1967-l6l. a total of 23.,s;i
case- of measles were reported to the NC'DC. This number
is the lo\es- recorded total for any epidemiologic ear and
represents 34 percent. 11 percent, and 9 percent of the
cases reported for EY 1966-t7. 1965-1)6. and 1961-65. re-
spectixely. This reduction, in addition to reflecting a


.etead\ impro\ ement in immunization -tattun. al-0 ref'<-
impro\ed reporting techniques at the state le\ l: se\,ral
states initiated individual ca-e in\ ettiiation program-
which resulted in a significant number of cate- hlein, ie-
leted from official record (Nei .Jer-eo\. M\M11 Vol. 17.
No. 24 and Los Angee-., 1\111R. \ol. 17. No. ;25). >nw
investigations resulted in reporirhng additionall ca e- (Loil-
isiana. M\\R. \o01. 17. No. : S). ( Continued effort- In rth-
coming year should resutill in further imr prot\ ient- in t it,
accuracy of reporting.
Beginning in EY 19t66-ti7 a clhant e Itt thi -'ea ional
pattern of reported neoa-loe- \\as noted (1 iur' 2). Th -
f( :' : C z +7 1: 1<: )


OCTiO1 aI 12. 19SI


Morbidity and Mortality Weekly Report







380


44,000


40.000


S36.000


S32,000


28,000
0

S24,000
or

<- 20,000
u

S16,000
t~a
12,000
z

8,000


4,000


0


4 2 30
NOV DEC DEC


27 24 23 20 18
JAN FEB MAR APR MAY
4-WEEK PERIOD


OCTOBER 12, 1968


BY 4-WEEK PERIOD, USA
ARS 1966-67 AND 1967-68


15 13 10 7 5
JUN JUL AUG SEP OCT


Table 3
Reported Measles by Geographic Divisions, USA, Epidemiologic Years,
1964-65 through 1967-68 and Percent Change from Preceding Epidemiologic Year


(eographic e
Di\ iion



'niird S rtale
No\i England
\iddhlt, \tlianitlc
Eat North ( central
TT\\et North Central
South \tlantie
EIa-t 0outl CO(nItral
\\i-t South Centrial

PaI ifi I


'lb i %I4 11 Tm it( ti i Tic r, ,r pr- ,it T ', T pi t mi., ,Tl l ,, -i, NT tr.


chiang e i- i \ o n more I\idiT ntl in the current opiemnliologic
year (Figure 2. inset).
In Tabhl 3. the reported case- of mea1sh1 s Ihy geo-
graphic div i.ion for EY 1967-6S are conlpared \\ith the
c;i--- reported for FY 1966-67, 1965-66. and 1964-6t.7. Dur-
in- the :2 opldemioloItU \ ear- prior to the initiation of the


national measles eradication program in October 1966,
five of the nine geographic divisions showed an increase
in th'e caes reported from the preceding epidemiologic
year (the Middle Atlantic. East North Central, and East
South Central in EY 1965-66 and the New England and
Mountain in EY 1964-65): however, in EY 1966-67. all


Morbidity and Mortality Weekly Report



MEASLES (Continued from page 379)

Figure 2
REPORTED MEASLES BY 4-WEEK PERIOD, USA
EPIDEMIOLOGIC YEARS 1964-65 THROUGH 1967-68


4 8,000


964-65 REPORTED MEASLES
EPIDEMIOLOGIC YE





/ I 965-66

/ \
/ /

I










1966 67


/ /\
S \ I






I/ \


/, 1966-67 ,


1967-6 6"


1966-607


1964-635


Percent
decrease
from
1964-65


PercTent
decrease
from
1966-107

66.2
7.5
52.9




.T.3
5. 3
7 .0.
17.2
72.4
75.2
79.7


1,268
4,470
.6t 257
.110 6
524
1,992
SOIl
5.i47
1.:162
3.157


N number
of'
caI VSe

70.t63
1,179
2,923
7,256
3,557.
7.9641
6 .2 8 3
201.144
5.491
15 .40


Percent
decrease
from
1965 -t6


59.4
,7.1)
90.7

-T-1.32
71 .f
21.1
5S.6
30.9


Number
of
cases

213.992
2,902
22,542
77,616
9,656
17,430
22,162
25.9231
13.272
22.4s9


Numr er
of
cases

266.310
42,448
16.295
59,955
lb.013
27,391
15.596
32,357
22,947
30.M )N


Percent
decrease
from
1963-64

45.7
125.5
71.b
44.6
42.5
34.8
77.8
55.2
11.9
55.0










gexographic d i \ ons sho ed a -uhsti a t inl di(cr'i- : ix i\
of the nie lho\eid more* han i 'i ) percent rduiclion.
For EI 196tiT-ts, the l nation a- a \\hiol' -hoxi\ l appro\-
imateol\x thoi aiii' rzito of d(icrie:i' from 196t -6il a, x a -
notedl inEY 196lt667 I roim tht- prec d-xling xlpidemiloHgic t\ ar.
Ilo\w \ e'r, thre'i \' ori, l o 'oL'ra|phic" (1\ l ioxtn- thai did lnot
follow\ this palttrn. The Ne\ England and Mliddil Atlunlic
dii sions shoi ed an incroia e'. ThEl'. iIcr o t's li rI'-
flo'ct inadequate immi unization mainii n'incei proil graii l ml fol-
lo\wing mai s inimunization programs ilth lith e'\xi'plion oi
their East Nortlh centrall di\ixion. xx hich hadl noted tihe high-


than a-; noted for thix p/ rtfnxx pid l n \I I- 1f oi

iith ,% (' :,(, a- i 1n d rt pori 'ed I x x' p-in h i i

d niiolhi ex ar.
(1,'/portr/ hy stutf Nt'r, s+ (S i/,+ i / ?,d '/ 'o N,, X
tion, Epol'] ,' mioln y P o rnpan. ('1)('.

* I b. pub s~+ p d ~1d ,
I I o f t e 'ts iF + I + i [ t ll in n+ ( ++ + F ( } +


FOODBORNE DISEASE OUTBREAKS January-June 1968


During (the first i mnonth- of 196s, 31 states. \ashing-
ton. D.C.. and Puerto Rico reported 115 lOutbreaks of food-
borni disease- to N('DC (Figure :1). These sur\eilllanic
data hIa\le bn compiled n an effort Ito charactcxrizo and
to ulllantiate disease.-, caused ib\. foodborn(- outbreak-. to
studtl tith t.(i)'s of \ hlicil-s and sources of conlanmination
particularly het n inter-.tate products s arI t inxol\ o(l and to
su'gge'st possible control nlmasur.s.
althoughh the data collectted re.lpr-esent onlv a small
percentage of the total number of outbreaks that occur in
th'e United Statles. variouss trends stand tlhe predomixnance of
certain etiologic agent h('ecaine apparent. Thie total nuixx -
her of people affected in the 115 outbreaks during the fir-t
6 months of 196b wa 7,663 (Tahle 4). The etiology waI-
confirmed in (t9 of the 115 outt)reaks (6( percent). Clostri-
dium /prfringenis was most frequently the cau-x of illness
and accounted for 2,761 cases in 2l1 outbreak-. Staphy lo-
coccal food poisoning was second accounting for 2.391
cases in 29 r outbreaks. Turkey, beef. anid chicken were the


Figure 3
REPORTED OUTBREAKS OF FOODBORNE ILLNESS
USA AND PUERTO RICO JANUARY-JUNE 1968






-
A- ,

--




.-... c



v-lhicles nio- t frequently re-pon ibile for ('. pyCrjri ,n ct i
outbreaks (Tablt 5). Pork. heff. etgetable-'. and chicken
(i'o tiwri e on. pa,'ii 3Si )


Table 4
Etiology of Confirmed and Unconfirmed Outbreaks of Foodborne Illness
January June 1968


Etiolog\


Bacterial
Brucella
(. botulinum n
C. perfringeuns
E. coli
Salmonella
Shigella
Staphylococcus
Streptococcus
Parasitic
Trichinello spiralis
Viral
Hepatitis
Shemrical

Miscellaneous

'nknown

Total


Outbreaks
Confirmed Unconfirmed Total
N ., i,,h. r i'. r. ..,,h. r I'- r. ..,1 \. r' P r

5b 50.5 21 1.`2 79 6b.7


6


1 .9
17 14.b
1 .9
13 11.3
1 .9
21 18.3
4 3.4
1.7
2 1.7
2.6
2 2.6
5.2


69 60.0


Confirmed
,...I I.. r I'P -

6,476 84.4


Inconfirmed Total

,-- ..--- -- ------- --


An\ value Il.- than .I is omitted


O('(itlBIl{ 12, 1968


Morbidity and Mortality Weekly Report


-rll

3
470i
->i-



74
Wo


29.9
4.7
S.hS
2.5
30.2
b.3
.1


1 .9
l! .9


1
2,291
360
677
195
2,317
635
7


136
136
33


7,0 ti6 92.1







0611
2 19 1





13t6 1.7
till


136
1:' .6


1 : .1

Ii 5.1


7 .t6;6 [lxtxo


3



20

46


2.6 9

.9

17.4 20

40.0 115


1,01 1 11.4


,


+_







Morbidity and Mortality Weekly Report


OCTOBER 12, 1968


FOODBORNE DISEASE OUTBREAKS (Continued from page 381)

Table 5
Vehicles Associated with Foodborne Illness of Specific Etiologyl
January June 1968

Other Other
Etiology Turkey Chicken Egg Milk Beef Pork e Vegetables Shellfish O r Water Other Unknown
meat Fish

Bacterial
Brucella 1
C. botulinum 1 1 1 1
(. perfrinfge/.2' 9* 3* 9* 1 1 1
E. celi 1 1 1 1
Salmonella 1" 1 2 3 3 1 3 1
H II 1
Staphylococcus 1 3 4 5 6 1 5 1 2 4 2
Streptococcus 1 1 1 1 1

Parasitic

spiralis 3

Viral
Hepatitis 2 1

Chemical: 1 1 2 2 4

Miscellaneous 1

Inknow n 1 1 1 3 1 3 3 1 1 4

Total 15 10 6i 1 23 14 6 16 4 5 3 11 10

I I I1 I d ,, I,", ,N prO (" n N, N+ IC
-2Thr outIbrakI v ith Uts o chicle,-
'(Onr <-iltr-ak i th tin hi lr
I's' ,i tbriak i\ iti t-wo hwt'l(* d t iu oullrak \i th three hietl,
*Includes some outhrak- Lue to niat and ,o t ra;i I an d or dres ing


Toble 6
Sources of Contamination of Vehicles in Foodborne Illness by Etiology
January June 1968

Packaged or Commnercially Home Unknown -
Etiology hulk food prepared food prepared unspecified

Bacterial
Brucella 1
('. botulin um 1 2 1
'. perfrineins 2 7 2 10
E. coli 2 1 1
Salmonella 1 8 2 3
Shigella 1
Staphylococcus 1 17 9
Streptococcus 4 1

Parasitic
Trichinella
ispiralis 1

\iral
Hepatitis 1 1 1
Chemical 7 1 1

Miscellaneous 1

Total 48 13 26
*.4upe' cteti not proven


382







OCTOBER 12, 1963


Morbidity and Mortality Weekly Report


Table 7
Places of Acquisition of Foodborne Illness by Etiology
January June 1968


Etiology

Bacterial
Brucella
C. botulinum
C. perfringens
E. coli
Salmonella
Shigella

Streptococcus

Parasitic
Trichinella
spiralis

Viral
Hepatitis
Chemical
Miscellaneous

Inknow n

Total outbreaks

Number of persons


Honme


Restaurant


Banquet



1
5
1


6


+ + I- +


32 37

316 1,913


17

1,458


School



























2,750


Store







1

4




1






1
1


1!0
143


Medical
institution




1


1

243


Other






1
2


1










1



7

40


________ A ____________ U __________ A ________ L _______ 4 ____________ 4 ________ 1


Unknown Total


20

115

7, 6+,


were the most often incriminated vehicles in staphylococcal
outbreaks.
When the data were studied to determine the source of
contamination of the Nehicles involved in the foodhorne
outbreaks (Table 6). it was found that lb (42 percent) were
contaminated during processing in a commercial establish-
ment for public consumption. 13 (11 percent) contaminated
during processing in the home, and t (7 percent) contami-
nated in preparation for marketing. The largest number of
outbreaks (37) occurred in restaurants and involved 1,913
individuals (Table 7). The largest number of cases oc-
curred in schools (2.750) accounting for 11 outbreaks.
while 32 outbreaks took place in homes, only 316 persons


were affected. Illness due to brucella. C. botulbnum, and
Trichinella spiralis tended to occur at home and that due
to C. perfringens and S. aurcius in public facilities.
(Reported by Enitecric Oiseaxses nit, Baictrial Oiea ses
Section, E pilcmiiology Program. and Laiboratory Proir-aum.
N'CDC.)

\
National (Comnunn!. Atlant; G(iui r i :0(i: 33
Attn Chl'. nterl c Disea 'nit
Bacte-rial Di ea.' S 'tion
EpidcmioloNC Pro-gram


HUMAN LISTERIOSIS United States 1967


In 1967 a total of 60 human cases of listeriosis were
reported to NCDC from 24 states. At least 10 of the 60
cases (16.7 percent) were fatal. Of the 50 cases where
sex was reported. 34 were males and 16 were females
(Table b). More cases occurred in infants less than 1 year
old than in any other age group. Infecting serotypes were
,identified in 38 of the 60 cases and the most frequently
identified was Listerin monocytogenes type 1 b (Table 9).
Listeriosis is not a reportable disease. However.
cases are being voluntarily reported toNCDC with increas-
ing frequency. At present there is only limited information
on the p ii,*.* i-' epidemiology, epizootiology, clinical


manifestations, laboratory diagnosis, and reservoirs of
this disease. Interested laboratories and public health
departments are encouraged to contribute complete case
histories, cultures for serotyping. and sera for serologic
i;- ....- to NCDC. Cultures and ,era may be addres-ed
to:

National Communicable Disease C'enter
Atlanta, Georgia 30333
Attn: Chief. Bacterial Serology Unit
Laboratory Program

(Continued on page 388)


:383:






384 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 12, 1968 AND OCTOBER 14, 1967 (41st WEEK)

ENCEPHALITIS HEPATITIS
ASEPTIC Primary
AREA NINGITIS including PostMALARIA
AREA MENINGITIS including Infectious Serum Infectious MALARIA
unsp. cases
1968 1967 1968 1968 1968 1967 1968 1968 1968 1967 1968
UNITED STATES... 158 89 5 4 54 38 4 107 994 669 101

NEW ENGLAND.......... 10 1 2 6 68 37 3
Mainet.............. 2 5 1
New Hampshire...... 2
Vermont............ 3 -
Massachusetts...... 6 1 35 15 3
Rhode Island ....... 2 2 2 11 4
Connecticut............. 4 14 15

MIDDLE ATLANTIC...... 22 3 8 1 36 153 83 11
New York City...... 10 2 22 50 19 2
New York, Up-State 1 1 2 3 34 30 2
New Jerseyf ........ 8 1 2 5 31 20
Pennsylvania....... 3 1 2 1 6 38 14 7

EAST NORTH CENTRAL... 48 10 34 18 10 137 97 5
Ohio.............. 13 2 20 15 48 45
Indiana............. 6 2 8 10 4
Illinois........... 5 3 6 8 4 1
Michigan........... 23 5 5 3 10 61 34
Wisconsin.......... I 1 12 4

WEST NORTH CENTRAL.. 1 1 6 47 39 3
Minnes ta.......... 1 1 18 9 1
Io a. ............ 3 5 5
Missouri............ 2 19 16
North Dakota....... 1
Dj: -lw ra 1 -
Nebra a ...........- 3
Kans s ........... ..- 4 4 2

SOUTH ATLANTIC....... 8 13 2 2 2 3 134 61 6
Delaware........... 2
Maryland ........... 3 9 1 11 8
Dist. of Columbia.. 1
Virginia........... 2 1 2 2 63 13
West Virginia...... 2 9 -
North Carolina..... 1 1 7 5 5
South Carolina ..... I- 8 4
Georgia............ 18 15
Florida............. 3 2 1 23 6 1

EAST SOUTH CENTRAL... 3 31 2 1 3 42 45
Kentucky............ 14 8 16
Tennessee.......... 1 6 1 1 2 19 14
Alabama............ 7 1 8
Mississippi........ 2 4 1 7 15

WEST SOUTH CENTRAL... 9 4 1 1 2 83 81 1
Arkansas........... 1 2 10
Louisiana.......... 1 1 1 1 17 27 1
Oklahoma ........... 2 12 4
Texas............... 6 3 1 52 40

MOUNTAIN ............. 3 1 1 5 3 38 29 8
Montana. .......... 2 10 2
Idaho............... 1 1
Wyoming............ 6
Colorado............ 1 1 1 8
New Mexico......... 5 13
Arizona............. 2 1 1 13 10
Utah......... ..... 1 1 2 2 -
Nevada ............. 1 3

PACIFIC.............. 54 26 2 4 9 3 43 292 197 64
Washington......... 1 1 1 25 11 -
Oregon.............. 4 2 1 16 20 2
California ......... 49 22 1 3 9 3 41 249 166 61**
Alaska............. .- -
Hawaii ............. 2 2 -

ct ,- ..... .... 35 24

*Delayed reports: Aseptic meningitis: Mont. I **Delayed military case reports
Encephalitis, primary: Mont. 4
Hepatitis serum: N. Y. Upstate 6
Hepatitis infectious: Me. 1, N. J. delete 5
Malaria: Iowa I







Morbidity aid Mortality Weekly Report 38.


TABLE III CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED) STATES

FOR WFEKS ENDED

OCTOBER 12, 1968 AND OCTOBER 14, 1967 (41st WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MPS POLIIOMYE ITI RI A
TOTAL
AREA T-tal P.ir.i I i <
Cumulative Cumulative
,:,I IL
ab il ba 10 16.. ... I.. I I

NEW ENGLAND .......... 1 1,169 870 1 125 73 116 34
Ma ine.* ........... 38 246 6 3 13 -
New Hampshire ...... 141 76 7 2
Vermont .......... 2 34 1 1 23
Massachusetts......... 1 368 361 64 34 56 1 -
Rhode Island....... 6 62 9 4 9
Cnnecticut....... 614 91 1 38 29 13 16

MIDDLE ATLANTIC...... 16 4,135 2,305 6 386 292 39 12
New York City...... 11 2,174 474 2 78 51 30 2
New York, Up-State. 5 1,232 594 1 69 71 NN 9
New Jerseyv......... 614 490 3 134 96 9 1
Pennsvlvania.. .... 115 747 105 74 NN

EAST NORTH CENTRAL... 27 3,886 5,614 1 258 238 264 9(
Ohio ............... 297 1,155 70 82 17 I 6
Indiana ............ 685 604 1 36 25 33 1 2
Illinois........... 1 1,379 1,006 58 56 50 0
Michigan........... 7 284 950 74 58 44 2
Wisconsin.......... 19 1,241 1,899 20 17 120 3

K.EST NORTH CENTRAL... 3 39 2,888 114 80 119 4 8
Minnesta .......... 16 134 27 19 1 3
Iowa ............... 1 103 750 7 16 98 -2 2
Missouri........... 81 337 37 16 1 2 1
North Dakota ....... 2 137 874 3 2 17 2
South Dakota.......... 4 55 5 6 NN
Nebraska ........... 42 644 8 13 2
Kansas ............. 10 94 27 8

SOUTH ATLANTIC....... 5 1,533 6,969 8 429 349 98 3 12
Delaware ........... 16 49 8 7 3
Maryland ........... 102 165 1 35 46 I 1
Dist. of Columbia.. 6 23 1 15 11 -
Virgin a ........... 1 306 2,197 1 40 41 2
West Virginia...... 1 293 1,401 1 13 33 55 7
North Carolina..... 1 283 880 2 82 71 NN 1
South Carolina..... 12 511 1 58 29
r a............ 4 36 1 86 53 -
FI rida ............ 2 511 1,707 92 58 27 3

EAST S1'THl CE:NTRAL... i 497 5,254 4 194 140 27 2 4
Kentucky........... 100 1,345 89 41 10 1 i
Tnness.......... 62 1,909 1 56 5 16
Alabama............ 1 95 1,332 26 26
Missi sippi........ 240 668 23 14

WEST SOUTH CENTRAL... 25 4,889 17,613 3 313 230 75 15
Arkansas ........... 2 1,404 20 33 -
Louisiana.......... 24 156 88 91 1
Oklahoma............ 2 125 3,351 50 17 1
Texas.............. 23 4,738 12,702 3 155 89 73 2 15

MOUNTAIN............. 1 1,008 4,723 2 36 33 77 21
Montana............ 58 303 6 2 6
Idaho.............. 21 391 1 3 3
Wyoming ........... 52 181 1 -
Colorado............. 515 1,584 1 11 13 28 -
New Mexico......... 113 I 591 3 11 1
Arizona.1 .......... 1 223 1,022 1 3 4 15 7
Utah............... 21 382 1 4 14 2
Nevada........... 5 269 3 3 -

PACIFIC .............. 34 2,603 12,476 5 280 348 291 51
Washington......... 6 546 5,501 4 44 31 66 I 8
Oregon............. 4 534 1,643 1 2 7 1
California.......... 24 1,479 5,017 199 276 219 11 37
Alaska. ........... 9 140 3 10 5
Hawaii............. 35 3 175 12 4-

Puerto Rico .......... 10 434 2,142 20 13 9

*Delayed reports: measles: N.J. delete 32, Pa. delete 5, Ariz. delete 6, Alaka 7
Mumpb: Me. 21
Rubella: Me. I







386 Morbidity and Mortality Weekly Report


TABLE 111. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 12, 1968 AND OCTOBER 14, 1967 (41st 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.
,,r 1I : I r I -" rrr Ir I Ir [are
UNITED STATES.. 6,663 8 138 2 156 11 304 1 262 55 2,783

NEW ENGLAND.......... 641 3 47 1 9 1 1 72
Maine..*........... 20 53
New Hampshire...... 29 2
Vermont ............ 17 47 11
Massachusetts...... 131 1 1 5 1 1 5
Rhode I land....... 50 -
Connect iut......... 394 2 3 1

MIDDLE ATLANTIC...... 123 17 7 2 26 19 1 44
New York City....... 3 10 2 14-
New Y rk, Up-State. 105 4 7 5 4 1 37
New Jersey......... NN 4 6 -
Pennsylvania....... 15 3 3 9 7

EAS I NRTH CENTRAL.. 396 2 13 1 11 1 40 1 9 2 255
Ohi" ............... 39 -1 1 1 17 1 7 86
Indi n.na............. 112 1 3 1 3 1 83
Illino s........... 58 5 1 8 19 2 1 36
Mihian ........... 127 1 3 1 14
s nsin.......... 60 1 I 36

1FST NORTH CENTRAL... 204 13 15 34 9 18 694
Mirnesta .......... 27 2 1 6 214
I-wa ............... 75 4 2 1 1 110
M sur ......... 4 7 25 3 6 101
North Dakrta....... 59 -- 3 108
South Dakota. *..... 19 3 1 4 97
Nebraska........... 4 3 3 1 25
Kansas............. 20 5 2 2 39

SOITH ATLANTIC....... 786 4 32 11 1 56 139 10 328
Delaware .......... 1 1
Mary land........... 71 3 9 18 5
Dist. of Columbia.. 3 2 1 -- 1
Virginia......... 270 4 3 9 42 4 116
West Virginia...... 200 2 2 1 42
North Carolina..... 22 2 2 2 39 1 13
South Carlina..... 60 1 4 4 9 -
Ceorgia........... 19 3 3 4 14 26 2 61
Flrida ............ 140 12 2 1 17 3 2 89

EAST SOUTH CENTRAL... 1,351 15 8 4 35 51 8 590
Kentucky........... 113 1 1 2 8 10 5 301
Iennessee.......... 1,026 6 5 16 35 3 261
Alabama............ 105 5 2 4 22
Mississippi........ 107 3 2 2 9 2 6

WEFT SOl'T CENTRAL... 671 25 1 45 40 28 5 439
Arkansas........... 8 4 15 11 6 54
Lou i iana.*r........ 53 9 1 7 6 1 41
k lahoma........... 18 8 12 13 117
Texa .............. 592 12 15 11 8 5 227

MO(NTAIN. ............ 1,228 1 1 8 15 5 1 79
Montana............ 23 -
Idaho ....... ...... .. 69 -
Wyoming............ 25 1 1 3
C lorado............. 848 3 2 4 4
NSw Mexico ........ 130 8 33
Arizona ............ 87 1 1 3 36
Utah ............... 43 4 -
Nevada............. 3 1 1 3

PAC IFIC.............. 1,263 1 19 4 2 49 1 9 282
Washington......... 631 1 2 2
Oreg n ............. 67 1 1 5 6
California.......... 482 1 17 3 2 42 1 9 274
Alaka .............. 24
Hawa i i ........... 59

P rrto Ri .......... 7 10 3 1 18

*D1layed reports: SST: Me. 29
Tetanus: La. delete I


Rabies in animal


.D). 18







Morbidity and Mlortality Weekhl Report






TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED OCTOBER 12, 19%8


(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 year Area All 65 years and year
Age and over Influenza All Ages and over Influenza All
All Ages Causes All Ages Causes


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

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

EAST NORTH CENTRAL:
Akron, Ohio-----------
Canton, Ohio----------
Chicago, Ill.---------
Cincinnati, Ohio------
Cleveland, Ohio-------
Columbus, Ohio--------
Dayton, Ohio----------
Detroit, Mich.--------
Evansville, Ind.------
Flint, Mich.----------
Fort Wayne, Ind.------
Gary, Ind.------------
Grand Rapids, Mich.---
Indianapolis, Ind.----
Madison, Wis.---------
Milwaukee, Wis.-------
Peoria, Ill.-----------
Rockford, Ill.--------
South Bend, Ind.-------
Toledo, Ohio----------
Youngstown, Ohio------

WEST NORTH CENTRAL:
Des Moines, Iowa------
Duluth, Minn.---------
Kansas City, Kans.----
Kansas City, Mo.------
Lincoln, Nebr.--------
Minneapolis, Minn.----
Omaha, Nebr.----------
St. Louis, Mo.--------
St. Paul, Minn.-------
Wichita, Kans.--------


650
210
45
28
26
35
17
20
31
48
53
10
41
24
62

3,130
53
36
126
36
30
40
65
116
1,597
39
391
197
48
97
25
57
77
40
20
40

2,572
65
37
750
186
224
99
78
349
35
50
40
34
54
161
34
114
35
35
47
106
39

821
42
25
45
146
37
97
72
229
71
57


415
129
32
14
18
24
12
11
20
26
32
9
29
16
43

1,801
33
24
71
18
17
26
40
49
920
21
211
110
29
61
18
36
49
24
15
29

1,444
37
22
416
109
109
57
44
177
24
24
26
11
38
86
16
67
17
24
27
79
24

512
32
18
23
84
30
67
40
137
44
37


*Estimate based on average percent


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.-----------


1,294
144
260
60
111
101
79
82
39
92
77
210
39

588
86
36
41
103
145
44
37
96

1,122
43
46
36
172
37
76
199
36
173
90
116
55
43

441
34
34
118
12
116
27
42
58

1,575
15
56
31
44
87
511
102
35
122
49
101
144
42
144
57
35


Total 12,193 6,900 387 606

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 520,889
All Causes, Age 65 and over------------------- 299,681
Pneumonia and Influenza, All Ages------------- 20,845
All Causes, Under 1 Year of Age--------------- 24,703


Week No.


of divisional total.

















Reported Cases


\g' G(roup


Table 8
of Human Listeriosis by Sex and Age
United States, 1967


Total


Fern ale


10-19


THE MORBIDITY ANDMORTALITY WEEKLY REF
TION OF 17.000 IS PUBLISHED AT THE NAT
DISEASE CENTER, ATLANTA, GEORGIA
DIRECTOR, NATIONAL COMMUNICABLE DISEASE
CHIEF EPIDEMIOLOGY PROGRAM
CHIEF, STATIST CS SECTION
EDITOR M


IN ADDITION TO THE ESTABLISHED PROCEI
MORBIDITY AND MORTALITY, THE NATIONAL C
CENTER WELCOMES ACCOUNTS OF INTEREST
INVESTIGATIONS WHICH ARE OF CURRENT
13 OFFICIALS AND WHICH ARE DIRECTLY RELA
OF COMMUNICABLE DISEASES, SUCH COMMU
1 ADDRESSED TO:
NATIONAL COMMUNICABLE
ATLANTA. GEORGIA 30333
ATTN: THE EDITOR
MORBIDITY AND MORTALITY


388


0- 49
5O- 9 8 1


0-69 3 1 1

7i or 70 2 1 3

I'nknovn 7 7: 10

Total 34 1 50




Table 9

Human Listeriosis by Infecting Serotype
United States, 1967


('a I InfIcting Serotype



17 h1)
1 4a





Idl

1 .I

'22) I' nknovvwn*

Total 60

I oc h n,, i-,Alatu \ i- .Nu mI)TI th i to NC(1 '.



i'Spor:ei bIy Zooi r s' Surrc i i I' t t. Veteriin ry
P'ub /Jc thIlh s'i c'tii o Epiideiniaoloj/ i" and Bac-

('riolo/gy Sectio n, I.ahoridtory Program \C'f)('



\ I fip\ i !h,' riw[il report from wh h tlhf, dat er
l ~b onI r ij l t from"
V 0tt -n1t (*IIMTl) imlIII lbl I)]D --; --l ('-,te.r
\l).>t t .L. ( ,. m mul'lt, :U' ."i:t r

\tin- ( hi, '. Zoono -e ur\ i.llt.in,- ['IIit. V t rmnn r.
P 'll t I i.th <'ti. S pirl

NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO THE NCDC BY THE INDIVIDUAL
STATE HEALTH DEPARTMENTS THE REPORTING WEEK CONCLUDES
ON SATURDAY; COMPILED DATA ON A NATIONAL BASIS ARE RELEASED
ON THE SUCCEEDING FRIDAY


n


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a



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Xm


.-'.FCiI 114


Morbidity and Mortality Weekly Report


OCTOBER 12, 1968


& --d

PORT, WITH A CIRCULA-
IONAL COMMUNICABLE
O co
>- Co
E CENTER --
J. SENCER, M.D.
LANGMUIR M.D.
IDA L SHERMAN MS ___-<0
ICHAEL B GREGG. M D >

DURES FOR REPORTING ___
OMMUNICABLE DISEASE
NG OUTBREAKS OR CASE
*, O HEALTH
S -'-. CONTROL
NICATIONS SHOULD BE
DISEASE CENTER

WEEKLY REPORT


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