Morbidity and mortality

MISSING IMAGE

Material Information

Title:
Morbidity and mortality
Uniform Title:
Morbidity and mortality (Washington, D.C. : 1952)
Running title:
Weekly mortality report
Weekly morbidity report
Morbidity and mortality weekly report
Abbreviated Title:
Morb. mortal.
Physical Description:
25 v. : ; 27 cm.
Language:
English
Creator:
United States -- National Office of Vital Statistics
Communicable Disease Center (U.S.)
National Communicable Disease Center (U.S.)
Center for Disease Control
Publisher:
The Office
Place of Publication:
Washington, D.C
Publication Date:
Frequency:
weekly
regular

Subjects

Subjects / Keywords:
Communicable diseases -- Statistics -- Periodicals -- United States   ( lcsh )
Mortality -- Periodicals -- United States   ( lcsh )
Morbidity -- Periodicals -- United States   ( mesh )
Mortality -- Periodicals -- United States   ( mesh )
Statistics, Medical -- Periodicals -- United States   ( lcsh )
Statistics, Vital -- Periodicals -- United States   ( lcsh )
Genre:
federal government publication   ( marcgt )
statistics   ( marcgt )
periodical   ( marcgt )

Notes

Additional Physical Form:
Also issued online.
Statement of Responsibility:
Federal Security Agency, Public Health Service, National Office of Vital Statistics.
Dates or Sequential Designation:
Vol. 1, no. 1 (Jan. 11, 1952)-v. 25, no. 9 (Mar. 6, 1976).
Issuing Body:
Issued by: U.S. National Office of Vital Statistics, 1952-Jan. 6, 1961; Communicable Disease Center, 1961- ; National Communicable Disease Center, ; Center for Disease Control, -Mar. 6, 1976.
General Note:
Title from caption.

Record Information

Source Institution:
University of Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
oclc - 02246644
lccn - 74648956
issn - 0091-0031
ocm02246644
Classification:
lcc - RA407.3 .A37
ddc - 312/.3/0973
nlm - W2 A N25M
System ID:
AA00010654:00205

Related Items

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

Full Text

F


I .i'A

-I


NATIONAL COMMUNICABLE DISEASE CENTER


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


HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION


EPIDEMIOLOGIC NOTES AND REPORTS


CONIENTIS


MC LUrLAJMA r'rfCUMUNIAC ATlOanTO, ueorgio iEpidmioloic Notfs lnd Report,
Vycopla, sma pnP11unioniae \tAlnta, (. oria 1
Between September 23 and October 16, 1968, 27 cases Venezu-lan Fquint. neephaliti I: Dad (ounto, Flordl 1i
Pohlomwt hltis in ;a Patient nith Ih nmic 1 )pl .t
of Mycoplasma pneumoniac occurred at a university in and DynsD mm.laIoulinemi. ihH mton, .. .. i. i
Atlanta, Georgia, among the members and pledges of one Transfusion Malaria Fort Sill, Oklahomat .. .. 11
(.lostridiimr Perfringens Food 1'oi)nint -
fraternity; nine persons were hospitalized with clinical New York City ................ 1
pneumonia, four were treated as outpatients, and 14 others ... of Salmonollois
reported illness on questionnaires distributed to the f S '"or. ,
ternity. Symptoms for the cases included malaist Ir I, (
Current 'I r.. .
myalgia, severe headache, dizziness, c zasoza / ort tale tat
and non-productive cough. Physical findings of i, 'o ecommenlat to e Pub ie.lth S..rv.e ...or.
pitalized students included temperature elevation ( o Committeo on i1 Prtracti .- .Mump V(i in.. i
104F.), erythema of the mucous membranes with occ 0 io 1 Intrnar1 -
(Continued on urnt..............

TABLE I. CASES OF SPECIFIC .BLEJ.. UNITED STATES
(Cumulative totals include revise dis ough previous weeks)
45th WEEK E CUMULATIVE. FIRST45 WEEKS
MEDIAN
DISEASE November 9, November 11. 1963 1967 MEDIAN
1968 1967 1968 1967 1963 1967
Aseptic meningitis ...................... 72 72 41 3,895 2.677 1,862
Brucellosis ............................ 4 2 2 196 216 217
Diphtheria.............................. 1 15 5 192 140 171
Encephalitis, primary:
Arthropod-borne & unspecified ........... 20 25 1,239 1.433
Encephalitis, post-infectious ............. 3 1 421 690 -
Hepatitis, serum ........................ 86 57 1 3,959 1.918
Hepatitis, infectious .................... 876 724 39.253 33.253
Malaria ................................. 25 48 3 2,037 1.800 93
Measles rubeolaa) ....................... .214 260 1,235 20,779 59.892 247.629
Meningococcal infections, total ........... 31 22 42 2.253 1.890 2.408
Civilian .............................. 29 20 2.065 1.769 -
Military ................................ 2 2 188 121
Mumps ................................. 1.661 134.062
Poliomyelitis, total ..................... 4 4 53 36 87
Paralytic ............................ .. 1 3 53 29 82
Rubella (German measles) ............... 314 275 46,078 41.815
Streptococcal sore throat & scarlet fever.... 8,230 8,273 7,208 362.954 384,564 340,481
Tetanus ............................... 3 4 4 150 194 234
Tularemia.............................. 1 2 159 150 224
Typhoid fever ......................... 8 6 6 345 364 383
TyphuS, tick-borne (Rky. Mt. spotted fever) 1 2 269 293 239
Rabi. in nio .i- ...................... 55 69 59 2.976 3.745 3.745
TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........................................... 3 Rabies in man: ............ ...... ... ......... 1
Botulism: ........................................ 7 Rubella, Congenital Syndrome: .............. 5
Leptospirosis: 11.-1 .............................. 43 Trichinosis: Conn.-1 ....... .. .............. 55
Plague: .................. ...... ............ ...... 3 Typhus. murin : Ga.- .................... 29
Psittacosis: ................. ................... 40
*Delayed reports: Leptospirosis: Okla. 1
Psittacosis: Calif. delete 1


/i


Vol. 17, No. 45


WEEYIY




Week Ending
SNovember 9, 1968



PUBLIC HEALTH SERVICE












pharyngeal exudate, posterior cervical lymphadenopathy,
and fine, localized rales; four students developed otitis
media. White blood cell counts were within the normal
range, but atypical lymphocytes were present on some
peripheral blood smears. Duration of illness was approxi-
mately 8 days for about one half of the cases. Similar ill-
nesses occurred in five social acquaintances of five mem-
bers and in the father and brother of another member. The
laboratory partner of a non-ill fraternity member developed
clinical primary atypical pneumonia on October 30.
On October 21, serum was collected from 55 members
and pledges. Complement fixation and indirect hemaggluti-
nation geometric mean titers against M. pneumoniae on
sera from 18 non-ill members were 1:13 and 1:28, respec-
tively, and on sera from 18 convalescent students, 1:129
and 1:142, respectively. Complement fixation titers on
these same sera showed no rises against influenza A and
B, para-influenza 1, 2, and 3, adenoviruses, and psitta-
cosis. Cultures of throat washings are in progress.
The epidemic curve suggested a common source of
exposure for the outbreak (Figure 1). The only period when
members and pledges shared a common environment prior
to the outbreak was September 18 when all were present
for pledge initiation and a catered dinner at a local cafe-
teria. Other common exposures which may account for later
cases occurred on September 2b and October 6 and b.
(Reported by McLaren Johnson, Jr., M.D., Atlanta, Georgia;
T. 0. Vinson, M.D., Dekalb County Health Department;


NOVEMBER 9, 1968


Figure 1
RESPIRATORY ILLNESS IN A FRATERNITY
POPULATION BY DATE OF ONSET
ATLANTA, GEORGIA
SEPTEMBER 21-OCTOBER 18, 1968

PLEDGES- FRATERNITY HOUSE NON-RESIDENT
: FI F t- n H H H H




2
MEMBERS FRATERNITY HOUSE NON-RESIDENT








ALL CASES



o nn rr1Th m r-L
2122 23 24 25 2627 28 29 30 1 3 5 6 910 112 13 14 15 16 17 18
SEPT OCT
DATE OF ONSET

John E. McCroan, Ph.D., Director, Epidemiologic Investi-
gations Branch, Georgia State Department of Health; Re-
spiratory Virus Infections Unit, Virology Section, Labora-
tory Program, NCDC; and a team of EIS Officers.)


VENEZUELAN EQUINE ENCEPHALITIS Dade County, Florida


The first reported case in North America of naturally
acquired clinical Venezuelan equine encephalitis (VEE)
occurred in early September in a 53-year-old woman. The
woman was a resident of Dade County, Florida. and had
no history of travel outside southern Florida. She was
hospitalized in mid-September with an illness characterized
by high fe\er. sore throat, cough, dyspnea. severe head-
ache, diplopia. and stiff neck. On admission, a lumbar
puncture revealed 900 white blood cells, 65 percent of
which were mononuclears. Complement fixation and hem-
agglutination-inhibition tests on paired sera demonstrated
fourfold rises in antibody titer against VEE. and neutrali-
zation tests demonstrated a significant titer rise. Stool
cultures for enteroviruses have been negative to date, and
antibody titers against respiratory viruses and other arbo-
virus antigens were negative. The patient is presently
recovering at home.


Although naturally acquired clinical disease due to
VEE had not previously been recognized in North America,
VEE virus had been isolated in mosquitoes and a cotton
rat. Serologic surveys have demonstrated antibody levels
in Seminole and Miccosukee Indian residents in southern
Florida. Intensive studies are underway to elucidate the
human, zootic, and entomologic distribution of the VEE
virus in and around Dade County, Florida.
(Reported by E. Charlton Prather, M.D., M.P.H., Director,
Division of Epidemiology, and Elsie Buff, M.S., Micro-
biologist in Charge, Virology Department, Florida State
Board of Health; Milton S. Saslaw, M.D., M.P.H., Assistant
County Health Director for Disease Control, and other
personnel, Dade County Department of Public Health;
N. Joel Ehrenkranz, M.D., Professor of Medicine, Uni-
versity of Miami School of Medicine; and the Laboratory
Program, NCDC; and two EIS Officers.)


POLIOMYELITIS IN A PATIENT WITH THYMIC DYSPLASIA AND DYSGAMMAGLOBULINEMIA
Washington, D.C.


A case of poliomyelitis in an 8-month-old, unimmu-
nized girl with thymic dysplasia and dysgammaglobulinemia
has been reported from Washington. D.C. The patient was


hospitalized in early June with a diagnosis of pneumonia
4 days after an older sibling had received trivalent oral
poliovaccine. Following admission, a number of gram


Morbidity and Mortality Weekly Report


MYCOPLASMA PNEUMONIAE (Continued from front page)










negative organic sm were cultured, but the pulmonaiir con-
dition proved resistant to antibitiic treatment. A segtnintal
lolhoctoml of the right upper lobe for persi-tent atehlctlsis
did not result in improeemt ent. \Aseptic meiningitis followed
by paralysis of the left lower extremity dlceloped in (the
child I weeks after ho.-pitalizalion and death super\ oned
2 months after the onset of paralysis. At. no time w ast
paralysis of (the muscles of respiration noted.
An antemnortemn i mln unnoglobutliin determination had
demonstrated markedtl low gG( (200 in I percent) and
increased Ig\ (132 mng percent) and I-\ (192 mtg percent)
immunoglobulins. Poliovirus type 3 w\as cultured from
throat swab and stool specimens collected throughout
the course of illness and from nervous tissue cultured at


autopsy. The \irus ha> been charac ,rized ianti *ni<"all1
ias v'ac ine-like. Neutralizing antiho d l tilr-t to [i lioi irii-
t\pi 3 it ere 1:3t. 1:30. and 1:15 on -ora drawti n ai thti on-
sot, 3 vw eks, and (1 weeks. resp. ctlielx. \iolopp fiwnlint-
"o're consistent with polion. el lii p-1 p eIurnonili-, and f It
alymiphocytic, hut othierw ie normal. tll\nru<- ,lawnI .
The case represents an inltaiiice of' partly c m ll-c a ,
occurring in a patient with abnormal globulin "\l, who
had been in recent intinaoe conlaci wilth an oral polio-
.accine recipient.


(Reported by John R. Pael, V.I., i.P.//., rChief, rnm-
municable )isasce C'ontrol, District of of ,1hn1ia )',part-
menit of Pb/lir Heal'th.)


TRANSFUSION MALARIA Fort Sill, Oklahoma


On July 30, 196S. a 25-year-old American woman, the
wife of a U.S. Army officer, was admitted to the obstetrical
service of the base hospital at Fort Sill. Oklahoma, and
delivered a normal child. Because of a postpartum hem-
orrhage, she received six units of whole blood between
July 30 and August 3. She aas discharged from the hos-
pital and remained well until August 16. when she devel-
oped a persistent severe headache, nausea, and fever. She
was hospitalized on August lb and was treated with anti-
biotics for suspected endometrtis. However, o\er the
next 5 days, she continued to have temperatures to 104IF.
On August 22, she became semicomatose. On August 23,
trophozoites of Plasmodium falciparum wtere detected on a
routine peripheral blood smear. She was then treated with
quinine, pyrimethamine. and diaminodiphen yl ulfone (DDS)
and made an uneventful recovery.
The patient had no history of malaria or use of shared
syringes and had not traveled outside the United States.
The six blood donors were all contacted; none had ever
experienced malaria attacks, but three had traveled to
malarious areas within the past 5 years. Serum was otb-
tained from each donor and analyzed for the presence of
malaria antibodies by the indirect fluorescent technique.
Only one donor had a positive serology; the dilution end
points in his serum were 1:256 against P. falciparum and
1:64 against both P. ricva and P. brasilianum, thus indi-
cating a recent P. falciparum infection. The positive donor,
a 21-year-old white American male. had served with the
U.S. Army in Vietnam for 1 year, returning to the United
States on January h1, 196S; otherwise, he had never traveled


to malarious areas. He had no history of malaria and hadi
not been ill while in Vietnam. In February 19i(>. he e'x-
perienced headache and weakness without fecer for Idali-
this illness resolved sponta aeou nl and to dale. lie ha-
remained well. while e in Vietnam. he took a combination
tablet containing 300 mg chloroquine ba--e and 1l mg pri-
maquine base once weekly in addition to 25 nig of DDS
daily. tHe continued the chloroquine-primaquine for s weekk-
and the DDS for i t-2s duii- after returning to the United
States. He used no antimalarial mn dilation thereafter. iHe
donated his Ilood on July 17, 19tit and it was gtien to the
patient on July 30. Blood in late August and rnid-Septeim er 19ts did not contain
malaria par aites; after the last blood i moars were ob-
tained, he \as treated with quinine and p\ rimethanmir.
(Reported by Joami s T. Howell, Captain. VC, I'.1, t ,ir/f
and Philip II. P1'rkins, Captaip a (, .S.1, iPox/. Sat N itarin i,
Prerentire t-t'ditcin I)tr ision. '.S. Reynods' i Armiy Hlo-
pital, Fort Sill. oklali/ ma; and R. L'riy I'arpenter, t 1.1.,
M.P.H.. Director, fii'ision of Epidimioiniogii/. OAklnih,,
State Departmient if 11ra/lt/i.,
Editorial Note:
This is the third tran-fusion-induced case oif 1'. fa/-
ciparum malaria reported in 196t It seems unlikely that
the responsible donor in this case could ha:e acquired
significant immunity to his infection, since he inet er Ihad
clinical attacks of malaria: nontheless, he x wa able tp i
maintain an asymptomatic falciparum infection for a mini-
mum of 6 months. The mechanisms underlying this unusual
host-parasite relationship remain obscure.


CLOSTRIDIUM PERFRINGENS FOOD POISONING New York City


An outbreak of food poisoning occurred on Septem-
her 14. 196b, in New York (City, among members of a comn-
pany following a banquet dinner at a hotel. Of a total of
1,00 members present at the banquet, it was estimated
that more than i900 indliidtuals became ill with t ymptomi


characterized byh headache, nausea, ahb:dominal crurmp .
and diarrhea, citing at n aitack rate of over 50 peircenl. The
mean incubation period twas 15 hour- wilh a ranLe from
2-26.hours. The illne.-> t a miild and la-ted 12-21 hour-.
t I "', cin i r i 'r a ,. ;!


NOVEMBER 9, 1968


Morbidity and Mortality Weekly Report






Morbidity and Mortality Weekly Report


NOVEMBER 9, 1968


CLOSTRIDIUM PERFRINGENS FOOD POISONING (Continued from page 415)


Food histories implicated roast beef as the vehicle of
infection. On the day of the banquet, 90 ribs of beef were
prepared. After cooking, the roasts were deboned. trimmed.
and sliced by machine, processed in succession with no
intervening cleaning or sanitizing of work surfaces. The
meat was then placed in warming cabinets until serving
time. Cultures of "check-up"* roast beef scraps revealed
contamination by Clostridium perfringens while cultures
of cooked hut unsliced whole roast beef were negative for
C. perfringens.
It was believed by the New York City Department of
Health that one or several ribs of beef were contaminated
at the time of delivery to the hotel. Since all meat was


exposed to the same work surfaces during the deboning
and slicing processes after cooking, cross-contamination
could easily have occurred. Incubation in the warming
cabinets created a situation favoring replication. This
would explain the presence of C. perfringens in the roast
beef scraps and its absence in the cooked but intact roast
beef.
(Reported by Carol S. Schaachner, M.D., Epidemiologist,
Tibor Fodor, M.D., Chief, Division of Epidemiology, Bureau
of Preventable Diseases, and Charles Reisberg, Senior
Public Health Sanitarian, New York City Department of
Health.)
*Identically processed beef prepared the following day.


CURRENT TRENDS
MEASLES United States


For the week ending November 9, 1968, 214 cases of
measles were reported to the NCDC. This is a decrease of
18 percent from the 260 cases reported in the comparable
week last year.
From October 6 through November 2, 1968 (weeks 41-44),
565 cases of measles were reported. This is an increase


of 85 cases over the 480 cases reported in the preceding
4-week period but is less than one half of the 1,187 cases
reported during the corresponding 4 weeks in 1967 (Figure 2).
The frequency distribution of states according to the
number of measles cases reported during the 4-week period
(weeks 41-44), in 1967 and 1968 is shown in Table 1. The


Figure 2
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
JUL. AUG. SEP. OCT.
WEEK NUMBER


42 44 46 48 50
NOV. DEC.


3,000-




2,500




2,000-




1,500-




1,000-







Morbidity and Mortali


Table 1
Frequency Distribution of States According to Measles
Cases Reported, Weeks 41-44, 1967 and 1968

Number of State-s
Cases Reported 196, 1967

0 19 11
1-9 20 19
O1-i2 6 7
2>-:25 7 15
"indlutd.- th, Iltri t of ('olumnibi ;.il N w, York C(H .

major difference in the distribution betiwaen 1967 and 196iS
is in the number of states that did not report a single case
of measles and in theu number that reported l25 or more
cases. For this 4-weeik period in 196S, 1S states and the


NOVEMIIIBER 9 19 8


EPIDEMIOLOGIC NOTES AND REPORTS
AN OUTBREAK OF SALMONELLOSIS Shelby County, Tennessee


An outbreak of salmonellosis in\iolving 130 persons
w ho had attended a church supper occurred on October 16.
196b. in Shelby county Tennessee. Of 116 people con-
tacted following the dinner, 98 (h4.5 percent) had been
ill. Onset of illness occurred from 2 to 11h hours after the
dinner with a median onset of 2:, hours. The mean dura-
tion of illnes-s was not determined: however, one third of
the cases were still ill when contacted 5 days after the
supper. Symptoms included diarrhea(90 percent), abdominal
cramps (69 percent). fexer (SO percent). prostration (76
percent). nausea (73 percent), and vomiting (37 percent).
None of those ill required hospitalization. and no deaths
were reported. Stool cultures were obtained from 21 of those
ill. and 21 were positive for salmonella, of which 10 ha\(,
been identified as Salmoniella saint-paul.
Food histories implicated turkey as the vehicle of in-
fection. Cultures of two samples of turkey frozen after the
dinner were positive for S. s uint-pati. This turkey' \was
prepared front frozen turkeys purchased on October 14.
The turkeys were thawed overnight in a refrigerator, un-
wrapped. and held on flat metal trays prior to cooking.
They were cooked in a large steamer for 5-1 2 hours at
400'F. and returned to the same metal trays. The turkeys
were deboned and refrigerated until 3 hours before the
meal. They were then sliced and held at room temperature
until served. Two food handlers were intolted in the prep-
aration of the meal. Neither reported illness, and stool
cultures from both were negative for salmonella. Further
investigation of the food :. ,.ii;r, practices revealed that
the refrigerator in which the meat had been stored \\as not
functioning properly. In addition, the supply of hot water
was inadequate for dishwashing and the bottles of sani-
tizing compound attached to the sink water supply had in-
sufficient solution present in the bottles to allow for any
to he in the sink water supply. Swals from the metal trays
on which the turkeys were placed after thawing as well as
after cooking were positive for S. saint-paul. These trays


had been washed twice prior to culture first, after holding
the raw\ turkey and second, after holding the cooked turkey.
Turkeys from the samei lot as those purchased for
the church dinner were obtained from the distributor. Cul-
tures of swabs from these ivere also positi\ e for salmonella.
S. saint-paul was isolated front other flocks on the farm
on which the turkeys were raised. In addition. ialtmonella
was isolated from the en\ ironment ofl thei iurkie processing
plant from which this lot had originaoild :iidi from -amples
of feed concentrate fed to the flock. (''I I- f ted contained
rendered animal by-products.) Sero'tping i ii ithes i-olate-
has not yet been completed. Further study to trace the
source of contamination i the Ifeed is in progress.

(Reported by Cecil R. Tlcker, ll .).. If.P.tI.. Dir tor .
Diriiton of Prerenta ble Oise-ax an1 / Ii. It. Ar.-r ii. Di-
rector. t emnphis Brauicd L laboratory, ai .1+ II. BHarrit, P )..
Director. Division of Laihbrautries. T lnesse(, ) part' e ii:
of Public Health: Euyen F'c irikh. .I.), D/rectVor,. a,d
Donald R. Daffron, Sanitation p it 'ioin. t nphi -h,/- y
County Health l, partmeni t: Epide.pmpolo/ iu Serrie' L.: r -
tory Section, Epidemiology P'rotrimi, \ Wfl( i! a teutm of
EIS Officers.)

Editorial Note:
Poultry and poultry products are an important source
of epidemic salmonello- is in the I'nited States. Of ) 5 food-
borne outbreaks of salmonella si reported in the N(CDC
Salmonella Surxeillance Reports in 1967. fixe in\ol\ ing
2,195 persons were traced to contaminated turki-y and
seen involving .101 person we\\re traced to contaminated
eggs. The outbreak reported aboie i characteristic of
salmonella outbreak- traced to contaminated poultry. Tur-
keys fed on feed c iotaining contaminated poultry, hI -
products may become infected with salmonellae. During
processing of the infected birds, organt- m- nmayri -pr,;id
through enviro of e n1ironnt of the irocesn-- plant to other
I('o iti:.nid on7 payi ,iy i


ty Weekly Report 417


l)Ditri c of (Colunl ia i di not report ;i -in l h cr-a it rm-;l-
slt i ni c'oni ra.- I I o l 11 itn 1! 7. T h;-, ., nf tl :l1\
iI() chant ge in ti h nurniI r of -ILI(- r-ip>rtn i a L oI( -E o(r -I li('




year.

deicrtiea-,-t in reported l a -- from Itht ci i >a-( riportod in
1967, file >tat; and N-lx York (C t\ -ho,-d ;i r inlt ri a and [nine arv'a. hoNtvd no rhainwE ()f the--A nint. w*i\n
states and the District of C(olumbia did not report a -indte
(c-ae in hlie l- e k- in either \xear and ihrll other -tat-
reported only three case- o- iIn eah year.

(Reported by Stufe Se'r'rices ,Sc(lon, (am/ Snatistift s e-
tion. Epi'demiologi I'Prorami, \('lI)'.)






418


birdl processed at the same time. Potentially contami-
nated hy-products may be returned to the renderer and
incorporated in ne\ hatche- of feed. thus completing the
cycle of infection.
Outbreaks may occur \\hen contaminated processed
turke\ is imporperly handled. In this outbreak, although
cooked adequately to eliminate salmonella, the turkeys
become recontaminated in the kitchen. Although the lexel


NOVEMBER 9. 1968


of recontamination may have been low, the meat was in-
adequately refrigerated prior to serving, permitting the
initial inoculum to multiply. As has been seen many times
in the past. the use of contaminated raw poultry and the
existence of improper food handling combined to produce
an outbreak. By interrupting the cycle of contamination in
the flocks and by improving the education of food handlers,
similar outbreaks may be prevented in the future.


FOODBORNE EPIDEMIC OF SHIGELLOSIS Ohio


S'\eral common source outbreaks of shigellosis oc-
curred in Montgomer. and Butler Counties. Ohio. from
September 2- through October 14. 1968, following the in-
gestion of food supplied 1)\ a caterer in Dayton. Ohio,
(Figure 3). Of a total of 130 individuals known to have
eaten food supplied by this caterer. more than 9, persons
became ill with symptoms characterized hi se\ ere diarrhea
(many \with mucous and blood), fexer, abdominal cramps.


and less frequently, nausea and vomiting, giving an over-
all attack rate of approximately 75 percent. The epidemic
curves demonstrate four common source exposures with
mean incubation periods ranging from 12-70 hours and mean
duration of illness from 6-8 days.
Food histories implicated potato salad and chicken
salad as the vehicles of infection. The food was delivered
(Continued on page 4.4)


Figure 3
SHIGELLOSIS BY DATE OF ONSET*
MONTGOMERY AND BUTLER COUNTIES, OHIO
SEPTEMBER 24-OCTOBER 15, 1968


INCRIMINATED MEAL

I n


OUTBREAK 4


INCRIMINATED MEALS OUTBREAK 3

SI
5

0 ----- ,7 77- 1h-'- I I I I I I

15 OUTBREAK 2

101 INCRIMINATED MEAL

5-


0 7 1 1 F' I l I I I I I I' I I I


OUTBREAK I


Morbidity and Mortality Weekly Report


SALMONELLOSIS (Continued from page 417)


SEPT OCT
12 -HOUR PERIODS
*TIME OF ONSET UNAVAILABLE FOR 7 CASES







NOVEMBER 9. 1968


Morbidity and Mortality Weekly Report


RECOMMENDATION OF THE PUBLIC HEALTH SERVICE ADVISORY
COMMITTEE ON IMMUNIZATION PRACTICES

The Public Health Service Advisory C'om1mitteer on Immnunizattion I'raCtiCer('
meeting( on October 9, 1968. issued the following recommendation oin usr
of attenuated Imumps eirus vaccine in public health ami prer iietire medical
programs, a revision of the initial recomitmeiida(tion which appeared in the
MIMWR, Vol. 16, No. 5/, December 23, 1967.

MUMPS VACCINE


INTRODUCTION
Mumps, one of the common communicable diseases, is
observed with greatest frequency in young school-age
children. However, approximately 15 percent of reported
cases occur after the onset of puberty.
Overt evidence of central nervous system disease
with sequelae is rare in mumps, rilb. i 'i, meningeal in-
vol\ement appears to be common. Orchitis has been re-
ported in up to 20 percent of clinical cases occurring in
post-pubertal males. Symptomatic involvement of other
glands and organs is observed less frequently. Nerve
deafness is a \ery rare. hut serious, complication of
mumps.
All naturally acquired mumps infections, including
the estimated 30 percent which are subclinical, confer
durable immunity.
LIVE MUMPS VACCINE*
Live mumps vaccine is prepared in chick embryo cell
culture. It produces an inapparent, non-communicable in-
fection following administration. Since its introduction
approximately 1 year ago, mumps vaccine has been given
to more than 1 million persons without report of significant
side reactions clearly attributable to vaccination.
More than 95 percent of susceptible vaccinees develop
detectable antibodies after vaccination. Although titers
are lower than those induced by natural infection, the
pattern of antibody persistence parrallels that seen fol-
loxwing clinical mumnps. The long-term duration of vaccine
induced immunity is unknown but 3-year observations show
continuing protection against natural infections and, in
two small groups of children, antibody levels which are per-
sisting without decline.
RECOMMENDATIONS FOR VACCINE USE
Live mumps vaccine may be used at any age from 12
months. It should not he administered to children less
than 12 months old because of possible persistence of inter-
fering maternal antibody. The vaccine is of particular
value in children approaching puberty, adolescents. and
adults, especially males, who have not had mumps parotiti.s
either unilateral or bilateral.*"
Since the Committee's initial statement on lixe.
attenuated mumps vaccine in 1967. further experience
with the vaccinee has been accumulated. In view of e i-
dence showing continued vaccine efficacy and safety,
the Committee has modified its recommendation for
limited vaccinationn of youngg children and now suggests
that consideration le given to immunizing all susceptible
children over 1 year of age. The Committee reaffirms


its position, however, that mumps vaccination programs
should not be allowed to lake priority over essential on-
going health activities.
Vaccine Dose
A single dose of vaccine should he administered sub-
cutaneously in the volume specified by the manufacturer.
Prevention of Mumps Following Exposure
It is not known whether live mumps vaccine will pro-
vide protection when administered after exposure. There is,
however, no contraindication to its use at that lime,**
Precautions in Using Live Mumps Vaccine
Severe Febrile Illnesses:Vaccination should be post-
poned until the patient is completely recovered.
Marked Hypersensitivity to Vaccine Components:
Mumps \accine is produced in chick embryo cell culture
and should not he given to persons hypersensitive to in-
gested egg proteins. Also, the vaccine contains small
amounts of neomycin, so it should not be given to indi id-
uals known to be sensitive to this antibiotic.
Leukemia, Lymphomas, and Other Generalized Malig-
nancies: Theoretically. attenuated mnump- irus infection
might be potentiated by other severe underlying diseases.
such as lymphomas and generalized malignancies.
Altered Resistance from Therapy: Steroids. alkvlat-
ing drugs, antimetabolites. and radiation nma, predispose
to untoward complications due to altered resistance.
Pregnancy: On theoretical grounds, it is reasonable
to avoid using the live mumps vaccine during pregnan..c
Simultaneous Administration of Live Mumps Vaccine
with Other Antigens
In order to evaluate the live mumps vaccinee ade-
quately. its simultaneous administration with other \ac-
cines should be deferred until results of controlled clinical
in\ estigations are a iailable. Until then. it is recommended
that mumps vaccination be separated from other immuni-
zation procedures by about one month whenever pos-ible.

CONTINUED SURVEILLANCE
Careful surveillance of mumps is important. There Is
need to improve reporting of mumps ca es and their con-
plications, to demonstrate continuing \accine effectixe-
ness. and to document pattern- of vaccine u.e,


*()ffi l, i nam : \lumpn Irut- V. i
'^ H iii mumpiI -kin (-t tlh i ur .ni .I u1 Ii<' -i .nltle.- i
.in Unre l t.i nii, ,i r o f immun
I" I* r t i vt ,it* mumpI s u II'IiI in ., i Imn h, Itiii n I IT1t11 1

<- in' u in t ,trnI 's,


419







420 Morbidity and Mortality Weekly Report


TABLE 111 CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 9, 1968 AND NOVEMBER 11, 1967 (45th WEEK)


ENCEPHALITIS HEPATITIS
ASEPTIC Primary
AREA MENINGITIS ii 1 I A In ioincluding Seru Infectious MALARIA
Infectious Serum Infectious
unsp. cases
1968 1967 1968 1968 1968 1967 1968 1968 1968 1967 1968


UNITED STATES... 72 72 4 1 20 25 3 86 876 724 25

NEW ENGLAND........... 3 3 1 6 31 27 1
Maine. ............ I -
New Hampshire.t.... 1 I -
Vermont ............
Massachusetts...... 2 I 20 17
Rhode Island....... 3 1 1
Connecticut........ 1 4 9 8 1

MIDDLE ATLANTIC...... 18 6 2 5 21 105 122 3
New York City...... 8 2 14 36 58 -
New York, Up-State. 2 1 1 2 2 21 13 2
New Jersey.?....... 3 1 -- 1 5 31 19 1
Pennsylvania....... 5 2 3 17 32 -

EAST NORTH CENTRAL... 15 16 5 7 2 3 189 111 4
Ohio............... 5 5 3 6 1 60 37
Indiana............ 2 -- 11 16 2
Illinois........... 3 4 1 1 2 54 32 2
Michigan*.......... 5 7 1 1 1 48 23
Wisconsin.......... .- 16 3

WEST NORTH CENTRAL... 4 4 3 2 5 1 2 37 42
Minnesota.......... 3 4 1 2 17 3
Iowa ............... 3 4 5
Missouri.............. 10 24
North Dakota ....... 2
South Da',ota ..- -
Nebraska .......... 2
Kans ............. 1 5 1 5 6

SOUTH ATLANTIC....... 2 15 3 9 85 91 4
Delaware........... 3 2 -
Maryland .......... 8 1 1 14 20 3
Dist. of Columbia.. 1 4 1 -
Virginia........... 1 1 1 1 16
West Virginia...... 1 7 16
North Carolina..... 1 1 1 2 9 1
South Carolina..... 1 2 8 9
Georgia ............ 26 6
Florida............ 3 3 20 12 -

EAST SOUTH CENTRAL... 2 4 3 1 67 46
Kentucky ........... 1 1 32 21
Tennessee. .... .. ... 1 2 3 14 17
Alabama............ 1 -- 11 1
Mississippi ........ 1 10 7

WEST SOUTH CENTRAL... 4 5 1 1 1 65 57 2
Arkansas... ...... 1 1 2 9
Louisiana.......... 1 1 15 12 2
Oklahoma.* ......... 1 1
Texas.............. 3 3 48 35

MOUNTAIN ............. 3 40 39 4
Montana............ 2 3
Idaho.............. -
Wyoming ........... 1
Colorado ........... 2 5 3 2
New Mexico......... 1 6 26 1
Arizona. .......... 14 3 1
Utah............. 1 6 3
Nevada ........... 5

PACIFIC.............. 24 19 1 6 3 41 257 189 7
Washington.*........ 2 1 -- 36 7 3
Oregon............. 2 2 2 13 14 1
California......... 20 17 1 4 3 39 200 168 2
Alaska............. 8 I
Hawaii ............. --- -- -- --- -

rt, R .* ... .... 27 15

'*Dlayvd reports: Aseptic meningitis: Okla. 1
Encphalitis, primary: Mich. 3
N 43 M A i w1I.h 5 P R 2


HMpatl' S, lfLctious: Me.
Malaria: Wash. 2


H. 11 I r 9. 1 I .







lMorbidili~ anil Mortality! Weekly Reporl 121


TABLE III. CASES OF SPI(:IFII:) NOTIFIABLE DISEASES: UNITED STATES

H)R WEEKS INDEI)

NOVEMBER 9, 1968 AND NOVEMBER 11, 1967 (45th WEEK) CONTINUED


MEASLES (Rub cla) MENINGOOCOCAL INFECTIONS, MMPS POLIOMYELITIS RUIIl.I,
TOTAL
AREA I Pir l i
Cumu lat ive Cumulative --


UNITED STATES... 214 20,779 59,892 31 2,253 1,890 1,661 1

NEW ENGLAND.......... 2 1,189 897 2 132 74 1 9
Maine* ............. ) 25 1 16 -
New Hampshire*..... 141 77 7 1
Vermont............. .2 i4 1 0 I
Massachusetts.*.... 2 374 377 2 6 85 I
Rhode Island....... 6 6' -9 4 10
Connecticut....... 628 93 40 9 77 -

MIDDLE ATLANTIC...... 55 4,334 2,405 6 404 310 73 26
New York City...... 19 2,271 486 1 81 54 26 8
New York, Up-State. 21 1,275 614 72 78 NN 10
New Jersey,....... 13 669 545 2 140 101 47
Pennsylvania. ..... 2 119 760 3 11l 77 NN

EAST NORTH CENTRAL... 34 3,990 5,822 8 280 359 383 7 78
Ohio............... 2 312 1,168 1 77 90 36 2
Indiana............ 5 699 625 38 28 36 1 16
Illinois........... 8 1,394 1,O58 3 63 60 32 8
Michigan........... 5 301 979 4 82 63 126 2 '.
Wisconsin.......... 14 1,284 1,992 20 18 153 16

WEST NORTH CENTRAL... 1 398 2,920 3 123 91 152 3 1-
Minnesota............ 17 135 29 21 1
Iowa......... ..... 104 764 8 18 136 1
Missouri........... 81 339 1 40 17 3 -
North Dakota....... 138 877 1 4 3 8
South Dakota........ 4 58 5 7 NN
Nebraska............ 1 44 653 9 15 4
Kansas ............. 10 94 1 28 10

SOUTH ATLANTIC....... 20 1,571 7,109 5 447 364 132 3 20
Delaware ........... 16 50 1 9 7 3 -
Maryland........... 103 169 1 39 50 16 1
Dist. of Columbia.. 6 24 16 14 6b
Virginia........... 10 315 2,227 1 43 42 5 2
West Virginia...... 9 308 1,444 13 35 47 1 4
North Carolina..... 284 917 85 72 NN I
South Carolina..... 12 512 58 30 19 5
Georgia............ 4 37 1 89 56 -
Florida............ 1 523 1,729 1 95 58 36 7

EAST SOUTH CENTRAL... 501 5,401 2 202 148 52 1 16
Kentucky........... 103 1,407 92 44 20 1 8
Tennessee.......... 62 1,976 2 60 64 30 8
Alabama............ 95 1,345 27 26 -
Mississippi........ 241 673 23 14 2 -

WEST SOUTH CENTRAL... 48 5,037 17,853 1 326 237 117 24 25
Arkansas........... 2 1,404 20 33 1
Louisiana.......... 24 156 1 93 95
Oklahoma.. ......... 125 3,358 52 18 1 -
Texas............... 48 4,886 12,935 161 91 116 21 25

MOUNTAIN ............. 8 1,033 4,793 39 39 95 1 2
Montana............ 58 319 6 5
Idaho............... 21 393 11 3 3 -
Wyoming ............ 54 188 3 1
Colorado........... 518 1,606 11 13 33 11
New Mexico......... 8 130 598 5 24
Arizona.* .......... 226 1,037 4 5 25 1 7
Utah............... 21 383 1 4 10 -
Nevada............ 5 269 3 3

PACIFIC .............. 46 2,726 12,692 4 300 368 439 1 77
Washington ........ 13 579 5,579 1 47 35 115 I6
Oregon............. 7 554 1,676 2 3 30 18 I
California......... 25 1,547 5,116 3 214 288 276 1 4
Alaska.............. 1 11 140 -3 11 3-
Hawaii............. --- 35 181 --- 13 4

Puerto Rico.......... 20 466 2, 22 20 1 31

*D. lad y d r lport : k,1- 1 -: .i del t 1i, N.J. 12. Pa. d>lh>te 1, Ar ;:. l. h. 7
Manin iiili xf m tl fin- : kl- 1. ash. I
Mumps: M- ', N.H. 14. Ari-z. [ ., l,.h. I Il
Rubella: Mr. 1, Ariz. 1, Wih. 17







422 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 9, 1968 AND NOVEMBER 11, 1967 (45th WEEK) CONTINUED



STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
AREA SCARLET FEVER (Rky. Mt. Spotted) ANIMALS
Cum. Cum. Cun. Cum. Cum.
IrI r l at : n wr ,, I as ar r I Tr
UNITED STATES... 8,230 3 150 1 159 8 345 1 269 55 2,976

NEW ENGLAND........... 1,061 4 47 12 1 72
Maine ............. 11 2 53
New Hampshire..... 20 1 1 2
Vermont............ 62 47 11
Massachusetts...... 209 1 6 1 5
Rhode Island....... 55
Connecticut....... 704 2 3 1

MIDDLE ATLANTIC...... 258 19 7 32 22 49
New York City...... 11 11 15
New York, Up-State. 179 4 7 8 5 40
New Jersey.* ....... NN 1 4 7
Pennsylvania ....... 68 3 5 0 9

EAST NORTH CENTRAL... 577 1 15 11 47 9 4 272
Ohio............... 52 2 1 19 7 1 91
Indiana............ 126 2 -1 7 -- 2 88
Illinois........... 152 1 7 8 19 2 1 38
Michigan ........... 139 3 1 14
Wisconsin.......... 108 1 2 41

WEST NORTH CENTRAL...! 188 1 15 15 2 37 9 10 734
Minnesota.......... 30 2 1 2 2 229
Iowa ............... 58 4 2 1 1 117
Missouri........... 4 5 7 1 26 3 2 105
North Dakta....... 60 4 116
Sourt D".iLo .. 22 1 1 -3 2 4 97
Nebra ka........... 7 3 3 1 1 26
Kansas............. 7 5 2 44

SOUTH ATLANTIC....... 883 32 12 4 60 141 12 357
Delaware........... 6 -
Maryland........... 120 3 9 18 1 6
Dist. of Clumbia.. 3 2 1 -
Virginia .......... 175 4 3 10 44 4 124
West Virginia...... 160 2 2 -47
North Carolina..... 23 2 3 2 4 39 12
South Carolina..... 251 4 1 3 9
Georgia........... 7 3 4 1 15 26 4 70
Florida ............ 138 12 2 18 3 3 96

EAST SOUTH CENTRAL... 1,295 15 8 1 40 52 14 639
Kentucky ........... 133 1 1 9 10 11 332
Tennessee.......... 914 6 5 1 17 36 2 275
Alabama............. 60 5 -- 2 4 1 25
Mississippi........ 188 3 2 12 2 7

WEST SOUTH CENTRAL... 776 1 29 1 47 48 1 29 9 459
Arkansas............ 14 1 5 15 17 6 3 61
Louisiana.......... 34 10 7 6 1 2 44
Oklahoma........... 8 9 14 13 118
Texas............... 720 14 16 11 1 9 4 236

MOUNTAIN............. 1,840 1 8 16 5 83
Montana ............. 19
Idaho.............. 161 -
Wyoming. ........... 319 3
Colorado........... 881 3 2 4 4
New Mexico......... 230 8 35
Arizona. ......... 135 4 37
Utah............... 91 4 -
Nevada ............ 4 3

PACIFIC ............. 1,352 20 -4 1 53 -1 6 311
Washington....... 632 2 2
Oregon............... 82 1 5 6
California......... 609 18 3 1 46 1 6 303
Alaska .............. 29 -
Hawaii .......... -

Puerto Rico.......... 6 12 4 1 19
D ,yi< I.y od repo rt : ST: M 15, N.H. 14, Wyo. 300, Ariz. 73, Wash. 565
TI ~ .I .i.
RIl s 5 In i nii I : Ari'. I








Morbidity and Mlortalilt Weekly epolrt 123







Week No. TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED NOVEMBER 9, 1968
45
(By place of occurrence and week of filing certificate. Excludes fetal deaths)

All Causes Pneumonia Under All Causes Pneumonia Under

Area All 65 years n year Area All 65 years and 1 ya
Ages and over Influenza All Ages and over Influenza All
A I 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.--------


798
270
38
27
27
70
35
17
41
48
62
18
53
31
61

3,329
54
39
162
42
28
44
62
86
1,725
42
422
187
45
122
23
38
94
52
21
41

2,635
78
40
757
171
210
121
85
321
40
49
57
27
63
141
37
165
45
48
33
91
56

844
69
18
36
141
29
116
74
229
76
56


458
146
19
16
18
38
20
13
30
21
35
9
28
19
46

2,004
34
28
96
24
18
28
36
46
1,033
27
252
98
29
81
16
25
67
27
15
24

1,453
48
24
400
96
108
60
43
175
27
29
33
14
42
81
20
102
19
30
15
52
35

519
43
11
18
81
22
75
48
133
53
35


SOUTH ATLANTIC:
Atlanta, Ga.-----------
Baltimore, Md.----------
Charlotte, N. C.-------
Jacksonville, Fla.-----
Miami, Fla.-----------
Norfolk, Va.----------
Richmond, Va.----------
Savannah, Ga.-----------
St. Petersburg, Fla.---
Tampa, Fla.------------
Washington, D. C.------
Wilmington, Del.-------

EAST SOUTH CENTRAL:
Birmingham, Ala.-------
Chattanooga, Tenn.-----
Knoxville, Tenn.-------
Louisville, Ky.--------
Memphis, Tenn.----------
Mobile, Ala.-----------
Montgomery, Ala.-------
Nashville, Tenn.-------

WEST SOUTH CENTRAL:
Austin, Tex.-----------
Baton Rouge, La.-------
Corpus Christi, Tex.---
Dallas, Tex.-----------
El Paso, Tex.----------
Fort Worth, Tex.-------
Houston, Tex.----------
Little Rock, Ark.------
New Orleans, La.-------
Oklahoma City, Okla.---
San Antonio, Tex.------
Shreveport, La.--------
Tulsa, Okla.-----------

MOUNTAIN:
Albuquerque, N. Mex.---
Colorado Springs, Colo.
Denver, Col o----------
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.-----------


1,166
125
186
52
82
125
52
89
47
102
75
190
41

646
101
34
55
144
149
44
35
84

1,186
48
37
23
165
59
74
207
40
199
89
125
48
72

440
43
28
106
21
109
24
56
53

1,516
19
41
17
46
94
422
78
27
141
69
91
179
41
151
63
37


Total 12,560 7,185 442 554

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 570,53
All Causes, Age 65 and over------------------- 327,899
Pneumonia and Influenza, All Ages------------- 22,571
All Causes, Under 1 Year of Age-------------- 26,989


1







a-0

o 0o


0 CO

- p
cD


SHIGELLOSIS (Continued from page 18)

by the caterers in an improperly refrigerated truck. The
temperature in the truck was adequate for incubation and
the delivery time sufficient for replication of organisms.
Both incriminated food items were prepared by six food
handllers at the catering -er ice. At least two of these food
handlers reported illnesses compatible with shigellosis
during the week of the outbreaks. Stool cultures from 29
patients and one food handler were positive for Shigella
so/JIei. Inspection of the caterer's kitchen facilities re-
\ealed crowded conditions and many violations of recom-
mended sanitary practices.
(Reported by Cahlin B. Spencer, M.D., Acting State Epi-
demiologist, Jack Russell. D.V.M., Public Health Veteri-
narian. and Charles Croft. M.S.. Vr.Sc., Chief, Public
Health Laboratories. Ohio Department of Health; Robert A.
Voyel, M.D., Health Commissioner, Montgomery County
Health Department; Robert F. MicConaughy, Health Com-
missioner, Butler County Health Department; Joseph E.
Orthoefer. D.V.M., Administrative Assistant to the Com-
missioner of Health, Dayton City Health Department;
Epideimiologic Services Laboratory Section. Epidemiology
Program, N'DC; and a team of EIS Officers.)






INTERNATIONAL NOTES
QUARANTINE MEASURES


Additional Im muniz action Information for international Travel
1967-68 edition-Public Health Service Publication No. 384


The following new Yellow Fever Vaccination Centers
should be included in Section 6:


City and

Center:




Clinic Ho


State: New Rochelle, New York

New Rochelle Department of Public Health
30 Church Street. 10801
Telephone NE 2-2315

urs: Daily. 2:00-4:00 p.m.


Fee: No


City and State: New York City. New York


Center:




Clinic Hours:

Fee:


Pan Medical Associates
77 Park Avenue. 10016
Telephone MU 4-0621

Tuesday, Thursday, and Friday, 2:00 p.m.

No


ERRATUM, Vol. 17, No. 44, p. 412
In the article "Quarantine Measures" under Eloise
Michigan. I\ayne County Department of Health, the tele-
phone number should he changed to "274-2800, Ext. 6b91"
and the "No" after fee to "Yes."


424


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 CENTER
DAVID J, SENCER, M.D.
CHIEF, EPIDEMIOLOGY PROGRAM A.D. LANGMUIR, M.D.
CHIEF, STATISTICS SECTION IDA L. SHERMAN. M.S.
EDITOR MICHAEL B GREGG. M-D,

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY ANDMORTALITY, THE NATIONAL COMMUNICABLE DISEASE
CENTER WELCOMES ACCOUNTS OF INTERESTING OUTBREAKS OR CASE
INVESTIGATIONS WHICH ARE OF CURRENT INTEREST TO HEALTH
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
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 BY THE INDIVIDUAL
STATE HEALTH DEPARTMENTS THE REPORTING WEEK CN :,Iu-.E
ON SATURDAY COMPILED DATA ON A NATIONAL BASIS ARE L r A E C
ON THE SUCCEEDING FRIDAY


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Morbidity and Mortality Weekly Report


NOVEMBER 9, 1968