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:
AA00010654:00207

Related Items

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


This item is only available as the following downloads:


Full Text



NATIONAL COMMUNICABLE DISEASE CENTER


17, No. 47







k Ending
ember 23, 1968


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

H E LT FH .11 L.1 : .I[,ruiEL'T-L HE ALTH 4l'.111


EPIDEMIOLOGIC NOTES AND REPORTS
INFLUENZA United States and Puerto Rico

Reports of documented outbreaks of A2. Il,.. Kong 6
influenza or of influenza-like illness were received from
the following areas during the past week: southeastern
Pennsylvania; Colorado Springs, Colorado: southern Ari-
zona: North Carolina: Seattle, Washington: eastern Oregon:
and Puerto Rico.
In Pennsylvania, febrile respiratory illness rates and
absenteeism rates increased in several industries, uni-
versities, and one high school. Between October 3: and
November 22. an outbreak of A2 Hong Kong '6h influenza
occurred among residents at a home for the elderly;: fi\e
deaths were attributed to the outbreak. It was confirmed by
viral isolations.


Influrn.+.i {onltril st.i -. ;unI Pu.>rt i ic ,
Epilemnic t N tru nt.riti.. 1oii sl \\ in
Vomiting Ii- wi. in FimI i tn ir\ hand i
Norw ilk, Ohio . .


In Colorado Springs. Colorado. an increr- in abal-n-
teti.mn rates in public school and in three m lilar in-
stallations due to influenza-like illnes-- wa o- noted. O(i
of the military installations had an e-iimated .t ack ratio
ol 60-70 percent among its personnel. and another in-talla-
lion experienced a 15 percent attack rate anionitE iith :0.0n{
(Contino ,d oin I lc '; )


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
47thWEEK ENDED M I CUMUI ACTIVE. FIRST 47 4VI BKS
DISEASEMEDIAN
DISEASE November 23. November 25, 1963 1967 MEDIAN
1968 1967 1968 197 1963 97
Asptic meningitis .................... .81 45 45 4,055 2,785 1.964
Brucellosis ............... ......... 8 4 5 207 228 228
Diphtheria. .............................. 6 10 8 215 163 184
Encephalitis, primary:
Arthropod-borne & unspecified ........... 33 19 1- 1,295 1.470
Encephalitis, post-infectious ......... 6 3 438 702
Hepatitis, serum ......................... 152 73 4.189 2,042 3 .
Hepaitis, infectious ...................... 1,178 701 41,343 34.848
Malaria .......................... .... 39 30 3 2.146 1,890 97
Measles rubeolaa) ....................... 245 282 1,414 21,234 60.484 250,745
Meningococcal infections, total .......... 48 28 42 2.321 1,956 2,518
C civilian .............................. 44 27 2,129 1,833
M military ............................... ..4 1 192 123
Mumps ................................. 2.055 137,916
Poliomyelitis, total ..................... 1 3 2 55 41 92
Paralytic ............................. 1 3 2 55 32 85
Rubella iGerman measles) ............... 294 273 46.701 42.395
Streptcoccal sore throat & scarlet fever.... 11.027 7,477 7,477 383,472 400,709 354,430
Tetanus ........... ................. 5 F 151 203 251
Tularemia ............................... 5 2 2 165 156 230
Typhoid fever ............................. 12 7 7 365 378 407
Typhus, tick-borne (Rky. Mt. spotted fever) 3 3 2 273 296 245
Rabies in animals ................ ...... 50 55 57 3 0 3 870 3870

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........................................... 3 Rabies in man: ......... ..........
Botulism: .................. .... ............. ....... 7 Rubella, Congenital Syndrome: ... 5
Leptospirosis: Fla.-l, Tex.-1 ........................ 48 Trichinosis: Iowa-1, Mich.-l, NYC-2. Tenn.- .. 59
Plague: ................... ..... ... ........ 3 Typhus, n : .. 30
Psittacosis: ................. ...................... 40 Poli nsp.: ..............
*Delayed reports: Trichinosis: N.H. delete 1


asd






Morbidity and Mortality Weekly Report


NOVEMBER 23, 1968


INFLUENZA (Continued from front page)


people on the base. Several A2 influenza isolates were
obtained, and additional specimens are being processed.
In southern Arizona, an outbreak of influenza-like
illness occurred in a small town. The illness was de-
scribed as mild and lasted from 5 to 7 days. From Novem-
ber 18-22. school absenteeism rates in an elementary
school in the town increased 60 percent and in a high
school. 400 percent. Laboratory confirmation of the out-
break is pending.
In North Carolina, an outbreak of influenza-like ill-
ness occurred in a group of residents who flew from North
Carolina to Las Xegas and then to Honolulu in early Octo-
ber. The illnesses occurred between October 13 and Novem-
ber 1 and the attack rate was approximately 35 percent.
Sera from 23 ill persons and from 17 persons without ill-
ness showed a greater than fourfold rise in titer to A2 Hong
Kong 6b antibody by the h( c i __lur:i ,.,r..r.,. ii.,,i i ,. tech-
nique. There have been no other reported outbreaks in
North Carolina.
In Seattle. Washington. a mild influenza-like illness
occurred in 20 physicians at a hospital. Four viral iso-
lates with hemadsorption properties of A2 influenza were
obtained.
In eastern Oregon. an A2 influenza isolate was ob-
tained from a patient with influenza-like illness. Although
four or five other cases were associated with this case.
there has been no major outbreak.
In Puerto Rico. an outbreak of influenza occurred be-
tween September 7 and November 16 with 51.65S cases
being reported. The peak of the outbreak occurred during
the weeks ending October 16 and 26 when b.495 and 12,S53
cases, respectively. were reported. This epidemic was
reported as less intense than the January 196S A2 influ-
enza outbreak when approximately 23.000 cases were re-


ported during 1 week along. Five influenza A2 viruses have
been isolated: another isolate was confirmed as an A2/Hong
Kong, 68-like virus.

(Reported by IW. D. Schrack, Jr., M.D., Director, Division
of Communicable Diseases, and James E. Prier, Ph.D.,
Director. Division of Laboratories, Pennsylvania Depart-
ment of Health: Leawis D. Polk, V.D., Deputy Health Com-
missioner for Community Health Services, and Alfred S.
Bogucki, M.D., Director, Division of Epidemiology, Phila-
delphia Department of Public Health; Col. Ralph Singer,
Chief, Communicable Diseases Branch, Preventive Medi-
cine Division, Office of the Surgeon General. Department
of the Army; James Hoffman, M.D., Director of Aviation
Medicine. United States Air Force Academy. Colorado
Springs; Col. Harry Umloff, Hospital Commander, Fort
Carson. Colorado; Richard K. Miller, M.D., Director, El
Paso City-County Health Department, Colorado Springs;
Melvin H. Goodwin, Jr., Ph.D., Director, Preventive Medi-
cal Services, Arizona State Department of Health; Martin
P. Hines. D.YV.., Director, Division of Epidemiology,
North Carolina State Board of Health; Donald R. Peterson,
M.D., Epidemiologist, Seattle-King County Health Depart-
ment, Byron J. Francis, M.D., Head. Division of Epidemi-
ology, and Vern Ashbey, Head. Virology Unit, Division of
Laboratories, IWashington State Department of Health;
Edward Press, M.D., State Health Officer. Oregon State
Board of Health; Louis Mainardi, M.D., Chief, Communic-
able Disease Control, Carlos Vicens. V.D., Director, Pro-
gram for Preventive Medicine. Angeo A. Colon, M.D.,
Director of Institute of Laboratories, and Mrs. Maria Teresa
P. de Perez, Statistician. Puerto Rico Department of Health;
and Respiratory Virus Infections Unit, Laboratory Program,
\CDC.)


EPIDEMIC GASTROENTERITIS, POSSIBLE WINTER VOMITING DISEASE,
IN AN ELEMENTARY SCHOOL Norwalk, Ohio


On October ?0 and 31. 196b. an acute gastrointestinal
illness doeloped in 50 percent(116 of 232) of the students
and teachers of an elementary school in Nornalk. Ohio.
Index cases occurred on the evening of October 29 with
mo-t cases occurring in the 24-hour period between noon
of October 30 and noon of October 31 (Figure 1). The illness
was characterized principally by nausea. vomiting. and ab-
dominal cramps: diarrhea occurred in 44 percent of the
cases (Table 1). The symptoms lasted from 12 to 24 hours
in most instances and seldom more than 4b hours. No
patient was hospitalized, and there were no knoxn sequelae.
Family contacts of primary cases also developed the
syndrome. The secondary attack rate in these families
was 29.- percent (11: ill of 379 at risk). This i- signifi-
cantly different from the :, percent attack rate in both family
contacts of well children who attend this school and in the
community at large a- ascertained ih a telephone sur-ey.
Secondary case- occurred predominantly on November 1.


2. and 3. with an average incubation period of 4S hours
(Figure 2). The attack rate difference between the stu-
dents' mothers and fathers (37 and 22 percent. respec-
ti\ely) and between small and large families were not
significantly different.
Epidemiologic analysis of primary cases excluded a
foodhorne mode of spread as students who brought their
lunches from home had similar attack rates with those who
bought lunch in the school cafeteria. This school, in con-
trast with the other schools in the system which receive
city water, has its own ll this well water could not be
excluded as the mode of spread. The one class with the
lowest attack rate had the lowest reported use of drinking
water on October 29 and 30. Ali,'.,, i, the water is routine-
ly chlorinated, adequate levels of chlorine could not be
demonstrated. Coliform counts on the \well water on Octo-
ber 21 and Noxember 12x were negative. No cross contami-
nation could be demonstrated between the septic tank and


434






Morbidity and Mortality Weekly Report


Figure 1
PRIMARY CASES OF GASTROENTERITIS
BY TIME OF ONSET
NORWALK, OHIO
OCTOBER 29 NOVEMBER 3, 1968


29 30
OCT


Figure 2
CASES OF GASTROENTERITIS IN FAMILY CONTACTS
OF PRIMARY CASES BY DAY OF ONSET
OCTOBER 30 NOVEMBER 7, 1968
401


un 20-
u


31H

12-HOUR PERIODS


I 3


.1..


- ..... ...... 4.. .... ... ..-..


30 31
OCT


3 4


6 7


the well or lbetxeen the septic tank and a waiter oftenerr
used to treat water for drinking in the school. Follonwin
the inm esti action. bottled water was purcha-ed for the
school until the drinking water could be proved safe.
Stool swxlabs and specimens were obtained from pri-
mary and secondary, cases. some asymptomatic children
attending the school, some a-ymptoniatic per ons front
affected families, and food handlers for bacterial and \iral
studies and from some primary\ cases for para.-ilic studite.


Throat w\\ahi, ii er alrio obtained. li-uili- of the-, -iudin -
are ponding.
Food from the Octohl'r 2"r and i) lunch,- at the -'chol
"a" not axailabl l for culture. but milk and food from t(h
October :)0 lunch i ere anal zed for alinoiindla, hiilla.
S(lipi/tYot'o, c cut (i r icui'. and 'olif(ornm-. Nonie (ver r'-
'o\ erred. \\ ell watr \t a- o tainde for Ix, ohtirioluotri aind
%irologitc stutie'.


Table 1
Clinical Data from Primary and Secondary Cases
Norwalk, Ohio
October 29 November 7, 1968

99 Primarl Caes( 100 Seconldary Ca e- Total
Sympr om N number Nu mber Num iber
Percent Perent Percent
with Sym nptonm \ith Symp)om w\itl S ymptom

Nausea 97 9)S 7 7;> 1 ("
\omiting 91 92 76 76 117 ;1
Uhdomnnnal ('ramp) 5,'h 5 9 66 66 121 62
Lethargy :2 5, 54 51 10(i 5:
Diarrhea :3' :!s 51 50 I
Fe\ er I : :() ;i0 i I:
('hills I 5 ) 5


NOVEIt1BI's: 2:3, I!)iH


rrmrrr







436 Morbidity and Mortality Weekly Report


TABLE IlI. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 23, 1968 AND NOVEMBER 25, 1967 (47th WEEK)


ENCEPHALITIS HEPATITIS
ASEPTIC BIII. IPHTERI Primary Post-
AREA MENINGITIS I Including Post- MALARIA
AREA MENINGITIS including Infectious Serum Infectious
unsp. cases
1968 1967 1968 1968 1968 1967 1968 1968 1968 1967 1968
UNITED STATES... 81 45 8 6 33 19 6 152 1,178 701 39

NEW ENGLAND........... 6 7 58 28 3
Maine*.............- 2 1 1
New Hampshire...... -
Vermont............ 1
Massachusetts...... 2 2 22 9 2
Rhode Island..... 2 9 5
Connecticut........ 1 5 24 13

MIDDLE ATLANTIC...... 24 4 1 4 2 74 239 156 5
New York City...... 11 1 57 113 40 1
New York, up-State. 10 2 1 5 49 34
New Jersey.......... 3 3 1 10 46 63 2
Pennsylvania....... 1 1 2 31 19 2

EAST NORTH CENTRAL... 14 11 1 14 11 2 5 165 138 3
Ohio. ............. 3 10 7 1 1 36 46
Indiana............. 2 2 1 11 27
Illinois........... 4 2 1 3 55 18 2
Michigan............ 4 4 3 1 1 51 36 1
Wisconsin .......... 1 5 1 1 12 11 -

WEST NORTH CENTRAL... 2 1 2 1 2 81 23 1
Minnesota .......... 2 1 1 1 30 7
Iowa A ............. 1 I 4 7
Missouri............ 1 14 2 1
North Dakota.......-
South Dakota ..... 16
Nebraska ........... 1 1
Kansas........ ...... 16 6

SOUTH ATLANTIC ...... 1 6 3 2 2 2 9 143 48 4
Delaware........... 1 I 1
Maryland............ 4 1 1 1 23 15
Dist. of Columbia.. 3
Virginia ............ 11 14
West Virginia........ 3 7
North Carolina.*.... 1 1 2 1 2
South Carolina... 1 8 -
Georgia............ 3 1 34 2
Florida ............ 2 8 59 8 2

EAST SOUTH CENTRAL... 5 3 3 1 71 50 10
Kentucky........... 1 36 16 10
Tennessee.......... 3 3 1 23 17
Alabama............ 1 4 3
Mississipp i........ 1 2 8 14

WEST SOUTH CENTRAL... 5 2 1 2 3 67 65
Arkansas........... 1 -- 6 4
Louisiana......... 1 2 1 20 19
Oklahoma........... 1 7 4
Texas. ............. 3 2 1 1 34 38

MOUNTAIN............. 2 1 1 1 2 62 35 4
Montana............ 7 8
Idaho............... 9 3
Wyoming.............. 1 -
Colorado........... 2 1 1 30 7 4
New Mexico......... 1 7 5
Arizona............. 6 9
Utah............... I 1 2 2
Nevada. ......... -

PACIFIC.............. 22 17 2 4 5 55 292 158 9
Washington.......... 1 2 1 1 46 32
Oregon............. 1 24 9 2
California......... 20 15 2 3 5 53 221 112 6
Alaska............. 1 1 4
Hawaii............. 1 1

Puerto R, ....... 20 25


ID l yeid ri- port : I iph t h i a: 'I x. 15
En ephalitis, primn ry: low.i 1
H, tit i >i rum: P.R. I
ihp Hitits, inftct i-u: Mi 3, Ohio
1 l urii: N.C. d

delete 1, S.C. delete 5, P.R. 23








lorrbiditN and Mlortality WV eek Report 137



TAHI. II1. CASI.S OF SPI(FIFIl) NOTIFIABI.I DISEASES: I 'NITli) STATES

FOR WIFKS INI)II)

NOVEMBER 23, 1968 AND NOVEMBER 25, 1967 (47th WEEK) ONTINIED)


MEA LES (Rubh,1 ) MENINGCCOCCAL INFECTION,, MU MPS l IOY llT. 1I II 6
IOTAL

A EA ,,, i | i ,
AREA ilti Ii vfP ''





Mha i in .*. ............ 38 .'? 6 I
NVe ii..E.pshi r ..... 1 77 I 1 1'
Ver 111n t ......... .' 1 t4 1 1 2 0
Masachusett s ...... r 181 I 84 171 3b6 98
Rhode I island .... I 6' 9 4 -
C wiinit ticut ........ 7 h6 1' 9 40 31 61

MIDDLE ATLANTIC...... 4, .73 2,4.50 1 420 320 (
New York City...... 2 .', 315 497 8 86 56O -
New York, iUp-State. 6 1 24 72 81 NN
Nw rse ............. 2 67 3 i64 6 146 103 31
Pennsylvania....... 22 161 766 4 116 80 NS

EAST NORTH CENTRAL... 3 4, 047 5,96) 5 287 274 567 1 1 9
Ohio ............... 2 315 1, 17 4 81 92 30 -
Indiarna ............ 2 704 637 40 31 48
Illino s ........... 5 1,404 1, 38 63 hi 97 -
Michigan........... 6 313 1 1,01 1 84 6 195 1 1
Wisconsin.......... 18 1, 311 2,014 20 21 197 -

WEST NORTH CENTRAL... 6 407 2,'441 I 126 93 235 2
Mlinn ta. .......... 18 135 2 21
I ,a .................. 108 773 10 19 194 -
Mi iurri ........... 81 340 1 4 I 18 29
N ith Da ko ta ...... 138 885 1 19
5,,th Dik tia ....... .4 1 7 NN
N h br,.2... ..... 2 48 656 1 I It
K.ansas ............. 10 94 2 10 2 5

SOUTH ATLANTIC....... 8 1.bt6 7,194 12 463 376 163 6
D, aware........... 17 50 9 7 2
Maryliand ............ 103 174 0 53 14
Dist. of Columbia... 6 .4 1 17 1i -
Virginia........... 319 2,253 a 43 11 7
West Virginia ...... 2 i2 1 ,4 7 13 36 73 ]
North Carolina..... 8 292 926 5 91 75 NN
S ,uth Car lina ..... 19 512 3 61 31 24
Georgia............. 41 9 57
Florida............. 14 536 1,757 3 98 59 39 -

EAST SOUTH CENTRAL ... 503 5. 48 4 208 155 76 6
Kentucky........... 103 1 426 1 94 45 41 1
Tennessee...... ... 1 64 1 4 2 63 67 35 -
Alabama ....... ... 9 1 ,354 27 29
Mississippi ........ 241 674 14

WEST SOUTH CENTRAL... 25 5.130 17,964 5 331 246 9 2
Arkansas........... 2 1,404 20 37 -
Louisiana .......... 1 25 136 1 94 47 13
Oklahoma............. 128 3,359 1 53 18 32
Texas............... 24 4,975 13,045 3 164 4 80 21 17

MOUNTAIN ............ 14 1.056 4,831 41 40 84
Montana ............ 58 328 6 5 4
Idaho.............. 21 395 1 3
Wyoming ............ 54 195 3 1 1
Co lorado ............ 2 520 1,610 1 1 I 13 36
New Mexico......... 8 143 604 11 5 25
Ar i zona............ 3 233 1,047 6 -
Utah ............. .. 21 383 i 4 7
Nevada ............. 1 6 269 3 3

PACIFIC.............. 34 2,7 8 12,77' 311 374 5h 12 3
Washington.......... 83 5,607 7 37 119
Oreg on ............. 8 72 1.689 1 25 30 6
California......... 24 1,5 5 i ,158 5 222 292 334 .
Alaska............. 11 140 3 1 1
Hawa i i ......... .. 35 182 4 4

Puert Kico. ....... 4 8 2,231 1 23

i, b 1 1 ,: I. .
1 R 3I ,







438 Morbidity and Mortality Weekly Report


TABLE IIl CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 23, 1968 AND NOVEMBER 25, 1967 (47th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE RABIES IN
AREA SCARLET FEVER (Rky. Mt. Spotted) ANIMALS
Cum. Cum. Cum. Cum. Cum.
1968 1968 1968 1968 1968 1968 1968 1968 1968 1968 1968
UNITED STATES... 11,027 151 5 165 12 365 3 273 50 3,068

NEW ENGLAND.......... 1,251 4 47 1 13 1 74
Maine. ............. 26 2 55
New Hampshire...... 18 1 1 2
Vermont............ 19 47 i1
Massachusetts...... 179 1 1 7 1 5
Rhode Island........ 131 -
Connecticut........ 878 1

MIDDLE ATLANTIC...... 311 19 3 10 2 34 22 1 50
New York City...... 5 11 2 17
New York, Up-State. 272 4 7 8 5 1 41
New Jersey ......... NN 1 4 7
Pennsylvania....... 34 3 3 3 5 10 9

EAST NORTH CENTRAL... 808 16 11 47 9 6 278
Ohio............... 99 2 1 19 7 1 92
Indiana............ 213 2 1 7 2 90
Illinois.......... 129 8 8 -19 2- 38
Michigan........... 264 3 1 2 16
Wisconsin ..... .. 103 1 2 1 42

WEST NORTH CENTRAL... 857 15 1 b1 38 9 16 760
Minnesota .......... 43 2 2 9 242
Iowa ............... 134 4 2 1 1 119
Missour ........... 5 5 7 6 3 2 110
North Dakoa ....... Ill 2 120
South Dakt ....... 22 1 3 2 4 97
Nebraska........... 104 3 1 1 3 1 1 27
Kansas............. 438 5 3 1 45

SOUTH ATLANTIC....... 1,189 32 12 61 141 7 373
Delaware........... 1
Maryland........... 217 3 9 18 6
Dist. of Columbia.. 3 2 1 1 2
Virginia........... 218 4 3 10 44 3 129
West Virginia...... 222 2 1 49
North Carolina..... 43 3 4 39 12
South Carolina..... 201 4 3 9
Georgia............. 18 3 4 15 26 73
Florida............ 261 12 2 19 3 2 101

EAST SOUTH CENTRAL... 1,596 15 1 9 2 44 2 55 8 656
Kentucky.......... 265 1 1 2 1 10 10 7 345
Tennessee.......... 1,027 6 5 1 19 1 38 1 279
Alabama............ 177 5 2 4 25
Mississippi........ 127 3 2 13 1 3 7

WEST SOUTH CENTRAL... 678 29 47 1 51 1 30 5 470
Arkansas........... 12 5 15 18 6 61
Louisiana.......... 20 10 7 6 1 45
Oklahoma ........... 69 9 15 1 4 119
Texas.............. 577 14 16 1 12 9 5 245

MOUNTAIN............. 2,788 1 9 1 19 5 2 86
Montana............ 43 -
Idaho.............. 121 -- 1
Wyoming.*.......... 648 1 3
Colorado........... 1,450 3 1 3 4 4
New Mexico......... 291 8 2 38
Arizona. ........... 82 1 6 -37
Utah............... 149 -
Nevada ............. 4 -

PACIFIC.............. 1,549 20 4 5 58 1 5 321
Washington ........ 645 1 2 2
Oregon .......... 113 1 1 5 6
California......... 627 18 3 5 51 1 5 313
Alaska ............. 35 -
Hawaii .... ...... .. 129 -

Puerto Ric .............. 6 12 4 1 20


83, P.R. 1

: Me. I


Typhoid: Ariz. .
Rabies in animals







Morbidity and Mortality Weekly Report


Week No. TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED NOVEMBER 23, 1968
47
(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 an a yea
Ages and over Influenza All Ages and over An luenza 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.--------


841
272
54
18
40
63
36
23
19
58
78
13
63
49
55

3,499
50
44
154
45
46
50
66
82
1,760
28
483
224
70
109
27
48
90
54
34
35

2,709
70
42
723
201
173
145
77
405
45
64
60
28
61
156
44
139
38
50
36
93
59

849
62
21
36
133
26
129
83
232
63
64


62
23
5
4
2
2
5
2

2
2

9

5

149
1
10
1
5
2
4
6
4
66
1
2
15
8
8
-
2
4
6
2
2

86
I
1
32
6

2
2
11
I





1
6
3
2
4
3
2
3


32
14
2


3

1
2
4
3

3




132


9
3

1
6
2
67

16
7
3
1
2
2
5
3

5

152
5
2
44
8
7
8
4
23
2
5
3
2
4
9
2
9
4
4
2
2
3

39

1
6
6

7
2
12

5


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.----------


684
62
146
33
37
64
32
42
15
74
53
96
30

379
57
31
25
77
86
30
25
48

562
19
22
17
98
18
36
85
;8
58
33
73
41
34

266
19
11
76
5
71
18
32
34

1,154
20
23
32
25
81
385
43
37
89
50
38
124
27


32


Total 13,323 7,694 508 633

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 596,589
All Causes, Age 65 and over------------------- 342,767
Pneumonia and Influenza, All Ages------------- 3,518
All Causes, Under 1 Year of Age--------------- 28,248







440


EPIDEMIC GASTROENTERITIS
(Continued from page 435)


(Reported by Calvin B. Spencer, M.D., Acting Chief, Conm-
municable Disease Division, Jack Russell, D.V.M., Chief,
and George T. Bear, D.V.M., Assistant Veterinary Epi-
demiologist, Division of Veterinary Public Health, and
William Halferty, Communicable Disease Investigator,
Northwest District, Ohio Department of Health; George F.
L inn, 11M.., Commissioner of Health, Huron County Depart-
me~t of flealth, Norwalk, Huron County, Ohio; and two
EIS Officers.)


Editorial Comment
The precise mode of transmission in this outbreak
has not yet been ascertained. However, characteristics of
the epidemic curves suggest a common source exposure
for the primary cases with a person-to-person spread in
family contacts accounting for secondary cases. Person-
to-person spread was probably responsible for the second-
ary cases, and consequently, one might expect a signifi-
cantly higher attack rate in mothers, who have more inti-
mate contact with sick children, than in fathers, and a
higher attack rate in larger families (five or more mem-
bers) than in smaller families. Although the attack rate in
mothers (37 percent) wias higher than in fathers (22 per-
cent), this difference \as not statistically significant.
Furthermore. attack rates in large and small families were
similar.
The illness is clinically and ,;.i. ;..I .._;. il com-
patible with winter vomiting disease. 1,-'l This disease
has an explosive onset. usually mimics a common source
epidemic, presents with either predominantly upper or
lower gastrointestinal symptoms, and generally occurs in
persons in residential schools between September and
March.
Although no responsible agent has been isolated, a
iral etiology for winter vomiting disease is suspected.
This is supported by the experience of a few investigators
who have been able to transmit infection to volunteers
through aerosolized and ingested bacteria-free fecal fil-
trates. However, more than one agent may be responsible
for this syndrome.

H rfl rencrs:
1Edi tonal, i I inter Vomi LinR i eases. Brit M dcl J, 2:953-954, 1965.
2Reimann. tI. A.: Viral )Dysentery. Amr J Med Sci, 246:404-
109, 1963.
L vitt, Lawrence P., \\olfe, Viula, and Bond, James 0.:
\inter \omiting Disease in Florida Students. Submitted for
Publt I ati n.


NOVEMBER 23, 1968

2- 0
o
u_


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION OF 17.000, IS PUBLISHED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER. ATLANTA. GEORGIA.
DIRECTOR. NATIONAL COMMUNICABLE DISEASE CENTER
DAVID J. I.,F--r M.D.
CHIEF. EPIDEMIOLOGY PROGRAM A.D. L.rrj :1, 1 M.D.
CHIEF. STATISTICS SECTION IDA L. SHERMAN. M.S.
EDITOR MICHAEL B GREGG, M-D0

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY, THE N- T,.*,i EL : :rl.r -IL DISEASE
CENTER WELCOMES ACCOUNTSOF e ;,1- 1 7 : i... re,='r OR CASE
INVESTIGATIONS WHICH ARE OF CUFRE'NT INTEREST TO HEALTH
OFFICIALS AND WHICH ARE DIRECTLY RELATED TO THE CONTROL
OF COMMUNICABLE DISEASES. SUCH COMMUNICATIONS SHOULD BE
ADDRESSED TO:
NATIONAL "**' i A.i- F- rF DISEASE CENTER
ATLANTA, : ,- .''
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 '- -' r ,1. THE REPORTING WEEK *: :1 : ..,
ON SATURDAY; C *-'-i -. ON A NATIONAL BASIS ARE ;1
ON THE SUCCEEDING FRIDAY


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