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:
AA00010654:00206

Related Items

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

Full Text



NATIONAL COMMUNICABLE DISEASE CENTER


Vol. 17, No. 46


.r EX.LY




Week Ending

November 16, 1968


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

HEALTH SERVICES AND MENTAL HEALTH AD

EPIDEMIOLOGIC NOTES AND REPORTS
INFLUENZA United States l. I


The first documented outbreak of influenza A2 Hong
Kong. 6 in a civilian population in the United States
recently occurred in Needles, California. The outbreak
involved 300 to 500 of the town's 5,000 residents, and
extended over a 6-week period with the peak incidence
occurring in the week of October 2'h-No'\ember 3. The
clinical syndrome consisted of sore throat, fever. pro-
found malaise, myalgia. and cervical adenopathy, and the
illness lasted for approximately 1 to 2 weeks. Attack rates
were highest in the high school population with absentee-
ism rates as high as 10 to 20 percent. Students in the
junior high and grade schools appeared to be unaffected.


Laboratory confirmation of the outbreak included 21
con. alescent sera which l showed a himan:glutination-
inhibition (HI) titer to A\2 Hong Kong si influenza of
greater than 1:32 in 17 specimen., and a complement fixa-
tion (CF) titer to influenza .\ of greater than 1::32 in 13
specimens. A iral isolatIe with heniad-orbing propertie-
tC'ntioinuiii 11d e .'i


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
46th WEEK ENDED CUMULATIVE, FIHST 46 WEEKSS
MEDIAN
DISEASE November 16. November 18. 1963 1967 \IEDIAN
1968 1967 1968 1967 1963 1967
Aseptic meningitis ...................... 78 63 44 3.974 2,740 1.914
Brucellosis ............................ 3 8 6 199 224 224
Diphtheria. ............................. 2 13 5 194 153 172
Encephalitis. primary:
Arthropod-borne & unspecified ......... 21 18 1,261 1,451 -
Encephalitis, post-infectious ......... 10 9 432 699 -
Hepatitis, serum ........................ 78 51 4.037 1,969 33,705
Hepatitis. infectious ...... ........ 899 894 40,168 34.147
Malaria ................................ 69 60 4 2.108 1.860 94
Measles rubeolaa) ....................... 215 310 1.539 20.989 60.202 249.331
Meningococcal infections, total ........... 19 38 46 2,273 1,928 2.454
Civilian .............................. 19 37 2,085 1.806
Military ............................... 1 -- 188 122 -
Mumps .................................. 1,777 135,846 -
Poliomyelitis. total ............... .. .. ... 1 2 2 54 38 90
Paralytic ............................. 1 1 54 29 84
Rubella (German measles) ............... 319 307 46,406 42,122 -
Streptococcal sore throat & scarlet fever.... 8.863 8.668 7,333 372.317 393,232 346,917
Tetanus ............................... 1 4 5 151 198 245
Tularemia .............................. 1 4 4 160 154 228
Typhoid fever ........................... 6 7 7 351 371 394
Typhus, tick-borne (Rky. Mt. spotted fever) 1 1 270 293 243
Rabies in animals ....................... 41 70 72 3.017 3.815 3.815

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........................................... 3 Rabies in man: .. ........ .. ................ 1
Botulism: ........................................... 7 Rubella. Congenital Syndrome: ...... .. 5
Leptospirosis: Calif.- .................. .......... 46 Trichinosis: .......... ..... ..... ..... ....... 55
P league: ...... ................ .... ........... 3 T yphus, m urine: L a.-l -...... ... .. 30
Psittacosis: ................. .. ..... .... 40
*Delayed reports: Leptospirosis: Hawaii 2







Morbidity and Mortality Weekly Report


INFLUENZA (Continued from front page)


of \2 influenza was isolated from the throat washing of
one patient. Further studies to identify this virus are in
progress.
Other reports of influenza activity have been received
from New Jersey, Colorado, Utah, Alaska, and Illinois.
In New Jersey, during the week ending November 16. an
outbreak of influenza-like disease occurred in a hospital
for mentally retarded individuals. Symptoms consisted
of fever, cough, and coryza. and lasted for approximately
3 days. A significant difference in CF titer on a series
of unpaired acute and convalescent specimens indicated
influenza A infection. HI titers on these specimens pro-
Sided evidence of A2 influenza infection. An isolate was
obtained, and has been characterized as an A2,'Hong
Kong. 66-like virus.
In Colorado, reported influenza-like illnesses increased
from 62 cases for the week ending November 2 to 670 and
656 reported cases for the weeks .iri_ November 9 and
16. respectively. Absenteeism rates in industries doubled
in the past 2 weeks, and absenteeism rates and febrile
respiratory illnesses increased in several colleges. A
Denver hospital suspended all routine operations last week
because of an influenza-like disease in the nursing staff.
Laboratory confirmation of influenza activity in Colo-
rado includes a CF tier rise to influenza A from less than
1:h to greater than 1:2:"6 on acute and convalescent sera
on two college students. and an HI titer rise to A2. Hong
Kong '6 influenza from 1:20 to greater than 1:640. In
addition, five viral isolates, identified as A2 Hong Kong '6h-
like strains, were isolated from patients in a children's
hospital for asthmatics in Denter.
In Salt Lake City. IUtah. A2 Hong Kong (S-like \irus
was isolated from a man who had onset of an influenza-
like illness on Notember 2, the day he returned from Cali-
fornia. Epidemiologic investigation of this case revealed
secondary -pread to his wife on November 9 and to a
-econd person on Nooember 5 who had been at a church
mieetin on November 3 attended 1h the index case. Six


other persons who worked with this second person sub-
sequently developed an influenza-like illness and five
relatives of these six cases then developed an influenza-
like disease. Serologic studies on these patients are
pending.
Although there had been no observed increase in
absenteeism rates in schools or industries under active
surveillance in Anchorage, Alaska, four isolatesof A2 Hong
Kong.'68-like virus were obtained from patients with in-
fluenza. Seven other Alaskan communities have reported
clinical evidence of influenza. These outbreaks are pre-
dominantly involving adults 20 years of age or older.
In Illinois, an influenza A2, Hong Kong. 68-like virus
was isolated from a student with influenza at a university
student health center. Although the husband and children
of the student developed similar illnesses, no other cases
have been reported from the university.

(Reported by Dr. Louis F. Saylor, Director of Public Health
Dr. Philip K. Condit, Chief, Bureau of Communicable Dis-
eases, and Dr. James Chin, Epidemiologist, California
State Department of Public Health; Dr. Ronald Altman,
Acting Director. Division of Preentable Diseases, Newu
Jersey State Department of Health: Dr. C. S. lollohan,
Chief, Section of Epidemiology. Colorado State Department
of Public Health. Dr. Jerry J. Eller, Chief, Virology Sec-
tion, US Army 4Medical Research and Nutrition Laboratory,
Fitzsimmon General Hospital, DOcrecr. and Dr. Elliot Ellis,
Chief, Pediatrics Service, a hospital, Denier; Dr. Robert
II'. Sherwood, Director, Preventire 4ledicine. Utah Depart-
ment of Health and Welfare. Elmer Felts, (hief. Virology
Unit, Arctic Health Research Laboratory, Fairbanks, and
Donald K. Freedman, Director, Dirision of Public Health,
Alaska Department of IHealh and 1 c/fare, Dr. \orman J.
Rose, Chief, Bureau of Epidemiolo'y. and Richard A.
Morrissey, Chief, Dirision of Labroratories. Illinois De-
partment of Public Health: Respiratory Iirus Infections
Unit, Laboratory Program 5.NCDC and EIS Officers.)


CURRENT TRENDS
INFECTIOUS SYPHILIS


National case reporting of new\l acquired syphili-
(prinmary and secondary >tage) began in 1911. After 1941.
caei total, increased annually to an all-lime peak of
11(.!93)2 ca i- in 1946 (Table 1). Large decrease- \rere
reported annually hy all states after 1946. and in 1956. a
loi point of 6.3:92 reported primary and secondary sei s
\\a- reached. ta reduction of 91 percent from the 1916
tola.l
In 19.i7. hoit\ er., a -mall incrnse in the national
-\ ph1ili morbidity occurred, follo wed in succeeding years
li incroia-- of increasing magnitude. Inl 1960, this in-


crease o\er the pre\iout Xear iwas 6. percent. After 1960.
cases increased a at decreasing rate and reached a peak
of 23,335 cases in 1963.
In 1966 and again in 1967, a decrease in cases oc-
curred, and for 1965. a decrease of Sh.: percent is pro-
jected on the basis of reported ca-e- through October
(Table 2). The national decline in reported ca-es ha- not
heen paralleled in some reporting area : 12 areas reported
more cases during January-()ctober 1965i lihan during
January-October 196.5. a period in which h ca>es for ith
total United States declined 16.9 percent (Table 3). Oetcr


NOVEMBER 16, 1968








Morbidity and Mortality Weekly Report


Table 1
Reported Cases of Primary and Secondary Syphilis
United States,* 1946-1968**

1 ar I ... 1 ,, I ,--. 1 .. ..

1',11- 1 1 I I .1 ,. I I .' I n ,

I I I-1 I I ', .
I' ii' I 1I I i.. I n .

I I -, Iu .- I 1 1. n1.1. I I I


1"1 ,_ I, ', .! I I I I I i.- I .

'I i, I ,,,1 I' ,1

*Includes Alaska t lie nnin in i 959. includes Ha a, ii
heginning in 1960.
**l196 estimated from January-October.

half of the total increase in cases reported by these 12
areas occurred in Texas. with Indiana. Louisiana, and the
District of Columbia accounting for most of the remaining
increase. The increase in eight stateswas not significant.
(Reported by the Venereal Disease Program, NCDC.)


Table 3
12 Areas Reporting More Cases During January-October
1968 than During January-October 1965


Texas
Indiana
Louisiana
District of (Columbia
New M\exico
Maryland
Oregon
Rhode Island
Maine
North Dakota
Iowa
Kansas


January\ -()Otolber Ca -u'

1fI96. )ih Increase

1. 129 2.)li 90)1
47 293 246
hS4 717 133
lIb 523 1()5
95 132 37
390 102 12
33 39 6
Ih '23
2 5 3


35 37 2
5 26 1


Total 12,778 1 ,210 1,462


Table 2
Summary of Reported Cases of Infectious Syphilis

CASES OF PRIMARY AND SECONDARY SYPHILIS: By Reporting Areas October 1968 ind October 1967 Provis-onal DSta

Otber Cumulative Cumulative
October 1ctobr200. -
Reporting Area Ja 0 c Reporting Area
1968 1967 1968 1967 1968 1967 1968 1hb7
NEW ENGLAND............... 9 34 285 291 EAST SOUTH CENTRAL ....... 89 138 1,136 1 48,
Maine .... ..... ...5 Kentucky............. 1. 17 L01 142
New Hampshire............ 2 9 Tennessee ... ....9 52
Vermont .... ... 3 Alabama .................. 33 76 47
Massachusetts............ 22 23 185 167 Missssipp ....... ....... 28 14 289 108
Rhode Island ........... 23 2
Connecticut........ 3 4 68 79 WEST SOUTH CENTRAL........ 325 351 2930
Arkansas ................. 5 21 106 i10
MIDDLE ATLANTIC........... 368 289 2,885 2.998 Louisiana................ 74 71 717 49
Upstate New York........ 56 32 269 257 Oklahoma............... 10 7 69 95
New York City.......... 252 150 1,848 1.778 Texas................... 236 252 2.038 1.92S
Pa. (Excl. Phlla.) ...... 13 32 188 207
Philadelphia........... 16 30 205 270 MOUNTAIN.................. 36 58 402 50
New Jersey............... 31 45 375 486 Montana ................. 1 5 5
Idaho ....... ........... 2 16
EAST NORTH CENTRAL....... 260 297 2.399 2,672 Wyoming.............. 2 1 3 3
hio ............... .. 36 47 383 51b Colorado................. 2 3 17 55
Indiana.................. 34 29 293 146 New Mexico............ .. 1 0 21 132 157
Donstate Illinois ...... 36 4 182 121 Artzona.......... .. 20 27 200 229
Chicago....... .... .... 88 79 841 807 Utah.................... 8
Michigan .............. 65 135 676 1,060 Nevada.................. 2 5 35 20
Wisconsin............... 3 24 22
PACIFIC... ..... ....... 210 134 1,540 ,505
WEST NORTH CENTRAL....... 41 45 327 293 Washington ............. 4 8 39 5
Minnesota................ 6 8 44 45 Oregon ............... 9 2 39
Ioa..................... 6 6 37 37 California............. 197 123 1,-60 1-05
Missour ......... ......... 20 18 166 96 Alaska................... I 3
North Dakota......... .. 5 3 Hawa i. .... ..... ....... .. 6 7
South Dakota........... 4 30 31
Nebraska.............. 3 3 19 34
Kansas ........ ........ 6 6 26 47 ITORI .... ..... 956
:ERRITORIES. .............. 107 8. 9 6 76
SOUTH ATLANTIC........... 402 98 4,325 5.268 Puerto Rc.............. 00 82 7
Delaware .............. 5 1i 32 60 Virgin Islands.......... 6
Maryland................ 36 54 402 535
District of Columbia..... 61 85 523 661
Virgn.a............. 25 24 261 258
West Virginia........ I 4 9 20
North Carolina........... 8 61 494 53 Note Cumulative Totals include revised and delayed reports
South Carolina.......... .b 57 -43 h68 through previous months.
Georgia.................. 87 73 75 86 1
Florida........ ......... i 130 1,382 1. 57


INTERNATIONAL NOTES
TYPHOID FEVER Cuba


An outbreak of typhoid fever occurred in eastern
Cuba during August and September 196b. In the week
ending August 24. 92 confirmed cases were recorded and


in the following 5 weeks approximately 67 cases per week
were reported. The outbreak had subsided 1,, the week


NOVEMBER 16, 1968








428 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 16, 1968 AND NOVEMBER 18, 1967 (46th WEEK)


ENCEPHALITIS HEPATITIS
ASEPTIC Primary
AREA MENINGITIS BRI IS DIPHTHERI including Post- MALARIA
ARA MENIN IS Ig infectious Serum Infectious MALARIA
unsp. cases
1968 1967 1968 1968 1968 1967 1968 1968 1968 1967 1968
UNITED STATES... 78 63 3 2 21 18 10 78 899 894 69

NEW ENGLAND............ 2 2 2 49 45 3
Maine................. 5 4
New Hampshire...... -5
Vermont ............ -
Massachusetts...... 23 10 3
Rhode Island.......- 2 2 11 3
Connecticut........ 2 5 27

MIDDLE ATLANTIC...... 21 9 1 1 2 3 21 144 187 12
New York City...... 6 6 1 2 11 24 40
New York, up-State. 2 1 3 2 10 26 1
New Jersey......... 4 1 4 35 81
Pennsylvania....... 9 2 4 75 40 11

EAST NORTH CENTRAL... 10 14 7 7 1 5 153 142 3
Ohio................ 5 4 3 7 1 30 34
Indiana............ 1 4 1 12 5 1
Illinois........... 4 1 -1 3 36 58 1
Michigan........... 4 2 2 1 65 33 1
Wisconsin .......... 10 12

WEST NORTH CENTRAL... 6 3 2 61 51 3
Minnesota .......... 6 1 7 15
Iowa. ............. 6 10 1
Missouri........... 1 25 18
North Dakota....... 1 2
South Dakota....... -
Nebraska ........... 3 3
Kansas ............. 1 18 3 1

SOUTH ATLANTIC....... 8 6 4 1 1 2 94 89 30
Delaware........... 2 -
Maryland.......... 1 5 1 13 9
Dist. of Columbia..
Virginia........... 1 1 3 1 2 42 4 4
West Virginia...... 2 8 16 1
North Carolina..... I 6 5 11
South Carolina..... 5 1 1
Georgia............ 41 13
Florida............ 3 20 11 -

EAST SOUTH CENTRAL... 3 5 1 1 53 76 1
Kentucky .......... 19 52
Tennessee........... -1 1 25 11 -
Alabama............ 2 4 1 6 7 1
Mississippi........ 3 6 -

WEST SOUTH CENTRAL... 4 5 1 2 1 3 60 71 1
Arkansas.*.......... 2 1 -
Louisiana.......... 2 1 2 1 2 11 9 1
Oklahoma.......... 2 11 3
Texas.............. 2 2 1 36 58

MOUNTAIN............. 1 1 1 38 24 4
Montana ........... 3 4
Idaho.............. 3 2
Wyoming........... .. -
Colorado........... 1 9 11 2
New Mexico......... 1 5 4
Arizona............ 16 4
Utah............... 1 2 1
Nevada ...... ..... -

PACIFIC.............. 26 23 1 6 2 4 41 247 209 12
Washington......... 4 1 1 50 10 -
Oregon ................ 1 5 14 16 2
California......... 21 1 1 4 4 35 181 180 6
Alaska............. 2 -
Hawaiit i............ 4 2 3 4

Pu t i .......... --- ] p 23


EnK pjh I I t L i pr .r'r : ,H w ii I

il i, ii I ttiou-: 5. 1 At," 2, 11,w 1i








Morbidity and Mortality Weekly Report 12'



TABLE 11I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 16, 1968 AND NOVEMBER 18, 1967 (46th WEEK) CONTINUED



MEASLES (Ruhbeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RU BELA.
TOTAL
AREA Cumulative Cumulative T I r t
T c~......... I TOTA


UNITED STATES...

NEW ENGLAND...........
Maine.. ..........
New Hampshire......
Vermont.............
Massachusetts. ....
Rhode Island .......
Connecticut........

MIDDLE ATLANTIC......
New York City......
New York, Up-State.
New Jersey.........
Pennsylvania .......

EAST NORTH CENTRAL...
Ohio ...............
Indiana............
Illinois...........
Michigan...........
Wisconsin. ........

WEST NORTH CENTRAL...
Minnesota.t........
Iowa................
Missouri............
North Dakota.......
South Dakota.......
Nebraska ...........
Kansas..............

SOUTH ATLANTIC.......
Delaware ..........
Maryland ...........
Dist. of Columbia..
Virginia...........
West Virginia......
North Carolina.....
South Carolina.....
Ceorgia.............
Florida.*..........

EAST SOUTH CENTRAL...
Kentucky...........
Tennessee...........
Alabama............
Mississippi ........

WEST SOUTH CENTRAL...
Arkansas...........
Louisiana .........
Oklahoma...........
Texas...............

MOUNTAIN.............
Montana.............
Idaho..............
Wyoming.............
Colorado. .........
New Mexico..........
Arizona............
tah ...............
Nevada..............

PACIFIC...............
Washington.........
Oregon.. .........
California .........
Alaska .............
Hawaii. ............


215

25





16


46
21
3
20
20

24
1
3
5
6
9

2









13
1
-







2

3

3

1






68



65

9





5
4




27
2
I I
14-


I 1., 1


I.,. I _
20,989 60,202

1,213 909
38 261
141 77
2 34
378 380
22 62
632 95

4,380 2,424
2,292 491
1,278 614
671 554
139 765

4,014 5,879
313 1,172
702 626
1,399 1,091
307 986
1,293 2,004

401 2,930
18 135
104 771
81 339
138 878
4 58
46 655
10 94

1,580 7,160
17 50
103 172
6 24
319 2,239
310 1,456
284 917
15 512
4 39
522 1,751

502 5,432
103 1,419
63 1,991
95 1,348
241 674

5,105 17,907
2 1,404
24 116
128 3,359
4,951 12,988

1,042 4,822
58 326
21 395
54 193
518 1 ,60
135 604
230 1.043
21 383
1 269

2,752 12,739
581 5, 90
564 1,685
1,561 5,142
13 1 4
35 182


2,273

133
6
7
1
70
9
40

408
84
72
140
112

282
77
39
63
83
20

125
29
10
40
4
5
9
28

451
9
40
16
44
13
86
58
90
95

204
93
61
27
23

326
10
93
52
161

39
6
11
3
1 1



3





17
3


1,928

76
3
3
1
36
4
29

317
56
79
103
79

267
90
31
61
66
19

93
21
19
18
3
7
15
10

370
7
53
14
43
35
73
30
56
59

153
45
65
29
14

243
36
95
18
94

39
5
3
1
13
5


Puerto Rico .... .. ... --- 1 -66 ,b --- I [ ~-


I!.I ~: 1 I I I I I


1,777

214
7
16
26
108
20
37

82
33
NN
49
NN

489
34
35
69
163
188

333
1
254
5
61
NN
10


140
1
6

17
74
NN
12

30

73
39
34



146


23
122

123
21
7

31
23
18
23








430 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 16, 1968 AND NOVEMBER 18, 1967 (46th 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.


NNEW ENGLAND.......... 977 4 47 1 1 1 73
Main'.* 1 I 54
New Hampshi re...... 2
Verm nt............ 47 -- -11
Mas husett ...... 125 1 5
Rhode Island....... 91
Connect t i ut........ 720 2 3 1

MIDDLE ATLANTIC...... 132 19 7 32 22 49
New York City...... 6 11 -
New York, Up-State. 110 4 7 8 5 40
New Jersey ......... NN 4 7
Pennsylvania...... 16 3 -- 5 10 9

EAST NORTH CENTRAL... 527 1 16 11 47 9 272
Ohi ................ 46 2 1 19 7 91
Indiana ............ 60 2 1 7 88
Illinois........... 113 1 8 8 19 2 38
Michigan........... 202 3 1 14
Wisc osin ......... 106 2 41

WEST NORTH CENTRAL... 552 15 15 1 38 9 10 744
Minnesota .......... 59 2 4 233
Iowa ............... 130 4 2 -1 1 118
Missourii........... 4 5 7 26 3 3 108
North Dakota....... 135 2 118
South Dakota........ 17 1 -3 -2 -4 97
Nebraska ........... 177 3 3 1 26
Kansas............. 30 5 1 3 44

SOUTH ATLANTIC....... 1,119 32 12 1 61 141 9 366
Delaware........... 6 1
Maryland.......... 148 -3 -- 9 18 -
Dist. of Columbia.* 1 2 -
Virginia .......... 478 4 3 10 44 2 126
West Virginia..... 191 2 2 1 48
North Carolina.... 18 -2 3 4 -39 12
South Carolina..... 132 4 3 9 -
Ge11 3 4 15 26 3 73
Florida............ 134 -12 2 1 19 3 3 99

EAST SOUTH CENTRAL... 1,442 15 8 2 42 1 53 9 648
Kentucky........... 236 1 1 9 10 6 338
Tennessee.......... 998 6 5 1 18 1 37 3 278
Alabama. ............ 136 -5 -- 2 4 25
Mississippi ........ 72 3 2 1 13 2 7

WEST SOUTH CENTRAL... 749 29 47 2 50 29 6 465
Arkansas ........... 27 5 15 1 18 6 61
Luisiana.......... 13 10 7 6 1 1 45
Oklahoma. .......... 54 9 1 15 13 1 119
Texas .............. 655 14 16 11 9 4 240

MOUNTAIN............. 2,022 1 1 9 16 5 1 84
Montana ........... 39
o M ... .88 1
Idaho............. 8 1.. 8 -
Wyoming.. 426 1 1 3
Wyom in g........
Colorado. ........... 1,051 3 2 4 4
New Mexico......... 177 -- 8 1 36
Arizona ............. 88 4 37
Utah ................ 153 1 5 -- -
Nevada. .............

PACIFIC............... 1,343 -20 4 53 5 316
Washington ......... 485 2 2
Oregon ............ 95 I 1 5 6
California ......... 645 18 3 46 1 5 308
Alaska............. 20 -
Hawaii ........... 98


2, Hawaii 133


Puerto Rico .......... --- I --- 12 1 --- I I --- --- --- 19


')cillv d r, port -: SST: Me. 4, D.C. 41, Wyo








Morbidity and Mortality W'eekl Report


Week No. TABLE IV. DEATHS IN 122 [INITEl) STATES CITIES FOR WI EK ENI)I1) NOVEMBER 16, 1968
46
(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 year Area All 65 years a"d 1 year
Influenza All A Influenza All
Ages and over AgesAges and over 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.--------


737
245
38
33
34
66
19
26
22
46
69
11
51
26
51

3,407
52
51
141
42
42
34
75
77
1,701
31
500
187
69
146
28
32
84
34
43
38

2,654
54
33
776
133
176
134
73
465
36
53
34
31
52
166
28
131
49
38
36
89
67

849
64
27
42
172
23
109
69
208
64
71


432
134
24
18
21
40
8
15
16
26
40
7
33
14
36

1,976
29
33
75
17
27
25
45
39
966
17
299
98
44
99
19
22
52
19
29
22

1,469
27
17
410
79
94
73
29
256
21
23
18
17
37
93
16
80
27
24
24
53
49

505
36
17
24
111
19
59
46
114
38
41


SOUTH ATLANTIC:
Atlanta, Ga.-----------
Baltimore, Md.----------
Charlotte, N. C.-------
Jacksonville, Fla.-----
Miami, Fla.------------
Norfolk, Va.----------
Richmond, Va.----------
Savannah, Ca.----------
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, 114
123
245
43
93
83
34
8(
29
76
73
187
48

632
79
52
40
119
136
61
35
110

1,149
37
41

140
40
90
237
75
162
78
129
37
59

515
56
30
151
31
110
13
53
71

1,666
18
33
28
41
1 I16
493
88
51
143

96
176
36
191


Total 12,73 7 17J -*b 26

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 3,
All Causes, Age 65 and over------------------- j.;
Pneumonia and Influenza, All Ages------------- 23,
All Causes, Under 1 Year of Age--------------- 761












TYPHOID FEVER continued d from page 427)

ending October 5 when only two cases were reported. I
Most of the case-s ere in the cities of Bayamo and
Holquin in Oriente Province (Figure 1). A physician. who
had worked in two hospitals in Bayamo for 2 years prior
to his arrival on October b, 196b, in Miami, Florida, re-
ported that the source of the epidemic was a contaminated
town water supply. He reported that during the epidemic,
about 90 percent of the approximately 123,000 residents
in Bayamo had been immunized against typhoid fever.


Figure 1

PROVINCE IN CUBA EXPERIENCING
TYPHOID FEVER EPIDEMIC


NOVEMBER 16, 1968 g--c
0~ n
4--


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION OF 17,000. IS P'.JEL -.-F -T THE NATIONAL COMMUNICABLE
DISEASE CENTER. ATL--J.- : -
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 AND MORTALITY, THE -, T -*, .:MMUNICABLE DISEASE
CENTER WELCOMES ACCOUNTS OF .1 ': E '..TN OUTBREAKSOR CASE
INVESTIGATIONS WHICH ARE OF CURR 5 T .'iT f_ TO HEALTH
OFFICIALS AND WHICH ARE DIRECTLY -~L-=i'.* :* 'HE CONTROL
OF COMMUNICABLE DISEASES. SUCH COMMUNICATIONS SHOULD BE
ADDRESSED TO:
NATIONAL COMMUNICABLE DISEASE CENTER
ATLANTA, GEORGIA 30333
ATTNi 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 CONCLUDES
ON SATURDAY; COMPILED DATA ON A NATIONAL BASIS ARE RELEASED
ON THE SUCCEEDING FRIDAY.


Since approximately 900 Cuban refugees enter the
United States each week, (luring the epidemic, the follow-
ing control measures were established at the Cuban Ref-
ugee Emergency Center (CREC') in Miami: (1) a rectal
swab culture was performed for each refugee arriving from
Oriente Province; (2) typhoid vaccine was administered to
these refugees; (3) the refugee was asked to report imme-
diately to a physician if he became ill; and (4) the health
department at the refugee's destination was notified that
the person was from an area experiencing an epidemic of
typhoid fever and of the medical treatment administered at
the CREC. In addition, personnel at the CREC were given
typhoid boosters.
As of October 10, all 600 rectal swab cultures per-
formed at the CREC were negative for Salmonella typhi
and no cases of typhoid fever had occurred among the
refugees or their contacts within the United States. On
October 15, because no cases had occurred and because
arriving refugees no longer reported the epidemic, the
control measures at the CREC were lifted.

(Reported by Dr. Jack McKenzie, Director, and Dr. Antonio
Tagle, Assistant i' -, .'..r Medical Services, Cuban Ref-
ugee Emergency Center, Miami; Dr. William R. Stinger,
Acting-Director, Dr. Milton S. Saslaw, Assistant County
Health Director, Disease Control, and Dr. Myriam A.
Bosch, Epidemiologist, Dade County Department of Public
Health; Dr. E. Charlton Prather, Director, Division of
Epidemiology, andi Mr. Robert A. Graves, Director, Miami
Regional Laboratory, Florida State Board of Health;
Medical 0" .. Foreign Quarantine Program, NCDC, as-
signed to the Cuban Refugee Program; and an EIS Officer.)

Reference:
IPan American Salnit.ry Bureau Regional Office of the World
Health Organization: Weekly Epidenmological Report. 40(46):260.


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