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:
AA00010654:00211

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


Vol. 18, No. 11







For

Week Ending

March 15, 1969


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SELI,I L MiALTH SERVICES AND MENTAL HEALTH ADMINISTRATION
DATE OF RELEASE: MARCH 21. 1969 ATLANTA, GEORGIA 30333


EPIDEMIOLOGIC NOTES AND REPORTS
BOTULISM Chicago, Illinois


On March 6i. 19119. in Chicago, a 4l-year-old iman died
from botulimn. On March 2. heI had 'atitn a latoe ierning
-nack of eggs. onions, and mIushrooms-. The mntishrooims
\\ or home-catlnnted and w ert noted hy thlt patient to have a
spoiled odor. \pproximatel\ 10 hour-. later. hi dot loped
dizzinessi follow ed Ity niau-,'a, diarrhea. diplopia. dys-pagi a.
generalized w\eaknes-, and progre-ssi\e respirator) dis-
tres--. It' remained al'vbrilo. On March 3 he l a, hos-pital-
ized and later that evening sustained a respiratory and
probable cardiac arrest. IIe wa resuscitated, tracheosto-
mized. and placed on a respiratory. Following the arrest.
he remaiined comatose with dilated pupil-. Botulism \\i -
diagnosed and on March 4 tri alent (V, B. and E) ('Clo-
tridium btulinum antiserum \tas administered. Following


triii< ( li hoilu mo d'h litl impro n rt .................i hour
inu l th d (I li. b ii I NI ............
IM iiiu ,n 3 I ii:I









later.
The mu-hroomlul \,ri' gatliered loc all\ ad canned t' n
October 19tiS. The cannini procedure int'ixi d i a- a hin .
-licing. and boiling at aitnio< phiric ipre--irtr for I hour-.
While ,'ah'ld. and --tored at 601t ': 21 quarts \\tri prep red. Prior
t ('o ,' ii ,i i n i4 P l(; ,) 1


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

11th %\EEK ENDED MEDIAN CUMI

DIASE March 15 March 16. 1964 1968
1969 1968 1 1968 1 N6


Aseptic meningitis .......... ..
B ruceIllosis ................. ....
Diphthl ria ......... ....... .. .. ...
Encettphalitis, primary:
Arthropo d-borne & unspecified ...........
Encephalitis. post-intctilous .............
Hl patitis. se rum .... ...................
Hepatitis. Infectious ....................
M alaria ...............................
M eai slis i ru e la) .......................
Mltningo octal intentions, total ...........
C i vl ian ...... ........ ....... .
M military ..............................
M um ps .......... .. ... ... ... ..... ......
Poliomyelitis. total ........... ........
P aralvtic ............ .... ....... .
Rubella iGcrman measles) ........
Streptocrccal sorte throat & scarlet tever.. .
T etanus ............ .... ........ .
T ularem ia ......... ........ ......... ..
T yphoid ftev r ........................
T\iphus. tick-born i Rky. Mt. spotted ife\er
R.habts in animals -


25
1
7

18
7
116
1,221
50
859
91
87
4
3.030


1.803
13,398
1
1
7

a85


11
8
80
848
26
653
74
67
7
5.470
2
2
2,372
11.791
2
1
4
5


34
4
2

30
20
859
11
9.652
80


2
2

13.302
2
2
2

93


9.98
497
5.070
869
822
47
25.258

1
9.432
126.993
18
23
46
1
755


300
12
28

160
93


4 '

882
803
79
55,637
10
10
10,602
126.914
22
16
42
3
796


400fi
29







882


4

126,856
33
46
56
6
81123


TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY

Cuil. Ci
A nthrax: ................... ..... .. ... .. R abi in m an: ........... .
Botulism: Ky.-.......... ........... .. .... 2 Rubt la congenital svndrom : ....
LIptio pir ,is: Calif.-1 .......... ... .. .. ... 10 Trichinosi.s: Calif.-. Colo.- ... .. ....... 17
Plagu : .............. .... .. ... ... ...... T phus. r '
Psittac s: ..... ...... _. ............. .. ...... ... 6


F 1 3,'-i,






Morbidity and Mortality Weekly Report


BOTULISM (Cotitniliied fromr front paye)


to this man's illness. approximately 16 quarts had been
ingested hb several persons \ith no known ill effects.
Laboratory analysis of the patient's serum (prior to
treatment) and leftover mushrooms demonstrated type A
botulinum toxin. The food was found to contain 400.)000
mouse LD 50 doses g. Cultures of thl food are in progret-.




(Reported bi flans Flach. 1.I.. and Louis Kolokoff. i.D1)..
Attending Physicians: fMorgyan J. O'C(onnll. .41.., Acting
Health Commnissioner. Olga [rolnitsky. If.0., Chief Epi-
demiologist, and June cDSalle/s, Bacteriologis.t Labora-
tory, Chicagr o Board of Hiealth; Normian J. Rose, 11.0.,
I.P.H., Chief, Bureau, of Epidemiology, Illinois Depart-
ment of Public Health: and the Anaerobic Bacteriology
Laboratory, Bacterial Reference Unit. Laboratory Program,.
iNCV(; and an EIS Officer.)


Editorial Comment:
Since 1S99, 16 outbreaks of botulism secondary to
ingestion of mushrooms ha\e been recorded. Four were
due to type A.\ one to type B. one to type E. and in the
remaining outbreaks the types were undetermined. It is of
interest that mushrooms are the onl\ oehicle other than
fish that has been responsible for a type E outbreak. The
not infrequent finding of mushrooms as a cause of botulism
and the extremely high toxin liter found in the food re-
sponsible for this outbreak suggest that mushrooms pro-
vide an excellent medium for growth and toxin production
of C. botulinum.
This is the second fatal case of type A botulism
occurring within the past 3 weeks (1MMTR. Vol. Ih. No. 9).
Of the three common toxin types (A. B, and E). type A
hinds most rapidly to tissues. This stresses the import-
ance of early diagnosis and treatment with trivalent anti-
serum.


AN OUTBREAK OF MEASLES IN PREVIOUSLY IMMUNIZED CHILDREN Florida


Between Dec. 28, 1968, and Feb. 2s. 1969, 3225 cases
of measles were reported from Florida: 29:3 of these were
from Duxal County (Jackson\ille). During this Du\al
(ounty epidemic, a private kindergarten in Jacksonville
with an enrollment of 145 children from middle and upper
socioeconomic families reported 2b measles cases (attack
rate 19.3 percent). An unimmunized child \xho became ill
on Dec. 20. 196s. was the index case in the kindergarten
(Figure 1). Sporadic cases then occurred in the kinder-
zarten until the xeek of January Ih when 18 cases were
reported.
Of the 2h cases. 25 had histories of previous immuni-
zation with lixo. attenuated measles virus vaccino with
Measles Immune Glolulin ( \li' In no case wxas the amount
of MIG recorded. Of these 2.5. 24 had been immunized Iby
physicians in the Jacksonville area and one child had
been immunized in Virginia. Dates of vaccination ranged
from October 1963 through September 1965. At the time of
immunization. lb of the 25 children \were under 12 months
of age and seven were from 13 to 20 months of age.* Al-
though vaccine lot numbers were not recorded. it is likely
that more than one lot of vaccinee was used by the physi-


Figure 1
MEASLES CASES IN A KINDERGARTEN BY DATE OF ONSET*
JACKSONVILLE, FLORIDA
DECEMBER 20, 1968 JANUARY 31, 1969


At n n n
DEC
Ofe Or ONSET UsNNOWN (N a CasES


ONSET


cians immunizing in two cities oxer a 2-year period. Pre-
liminary analysis of clinical illness in the 25 previously
immunized children indicates that immunization may have
mitigated the disease in some cases. Convalescent sera
were obtained from seven of the kindergarten cases. Six
of these -exen had been previously immunized and fixe
had been immunized before 12 months of age (Table 1).
Control specimens were obtained from nine non-ill
children in the same kindergarten. All nine had also been
immunized with live. attenuated measles virus vaccine
with M1G: six of these nine had been immunized under 12


Table 1
Rubeolo Hemagglutination Inhibition Titers in Seven Kindergarten Cases of Measles
Jacksonville, Florida February 1969
Time Inter\ al
Present Age \ge at Date of Between Onset Rubeola
(Years) Immunization Immunization of Illness and Serum HI Titer
Collection (Days)
1 6 mos. 3-23-64 9 1:80
2 5 h', mros. 4-17-64 22 1:160
3 5 no vaccine 9 1:40
4 5 9 mos. 7-21-64 17 ,1:320
5 9 mos. 11-19-63 19 -1:320
6 5 13 mos. 5-11-65 20 -1:320
7 .9 mos. 6-30-64 41 1:320


MARCH 15, 1969






Morbidity and Mortality Weekly Report


moniilh- ,ut of \l nine x riii oi hi i n.l a-'l- iant Ilhodi \ ('Ta ibl I).

Ilin iti flronmti I, to 7 Near- \\a-, l'\;noii i-l l irolul i n ll l 1. VE wh
chiid hi ad reii ,i t ed lit\ -,. :t i enati ld nli-- i t ir-u a\lI ccinre
iith MI(i from oni of, lith, phj -imi n iul- \\io had i l l iniz. d
(he kindtcrtaron chhildron. (Of lth fli\o. Ihroln hatd htw n
niit nmize(d before 12 morintlh- of :g. Se'rt fromn lh-o thriot
hald noi dite'table t;nailod\. buil irai from ihl (E\%o rhildrtn
linnto lnit 'd a I: and i l o rl llt o lls n of age' had dhthtearr dl 1
anlihodl (Tabld 3).
Iliet(\ i'rn -b.li 16 and 2;:1. 1919,. a cointl\ x id. ma-,
it1iifuni ti/.lltn program l a-- conduclted iln Di u\ l ( ountu.l :
50,.721 do'i,-- of \xai ine wit* re gi\ n i ith 2illx.7 3 do-.,-7
oiing to pwri'-ihool chiildr-n. In additional .i 17 dlo "'
hadi I'-enll admnini-tered from Nouxt nilhr through J;inuarll
in local clinics and i schooll epidei niic control proglrrui.
Althioui h exact nunmbilers ar unknoi\n. local phl\i-iran-


liiid r I'r l i lirii iIii I r II i
i(on durinli IhO period.
il h'i ir/ y ,1i A I i/, Jr.., .ll P .. Ii. / 1 ./ .
if J I r/, V. /1 l: II .. I'S t ;.), P,, ...
.J li / I t. I l :. /t 'l,, l I t,, r. 3. .




rl i t' u r, mi i / l i ii I11 o l tnI Il t [ f-

;iil. it in x x mi t n I r t



ir.tiii. l 1 a ii i i ii/ l ffii i .
i, l i,.1 i I ,1 i im > t. i Ni i i i ,

Iix x ixixx ii lx l I i II ,i'i I.,
S i f l I x I i I r o n Ii
I I (hd. %ii l l I k/ I? i V


Table 2
Rubeola Hemagglutination Inhibition Titers in Nine Non-Ill Immunized Kindergarten Students
Jacksonville, Florida February 1969

Present Age Age at Date of Date of Huiioli
control l
(Years) Immunization Immunization Serum collectionn HII Titer

I5 13 mxox T-1-61 2-5-69 1 ::32)
9 4 11 moi-. h- 1i- 6 -2 6 -61 1:20(
10 5 Il n1o-. 4-13-6. 2--69 1: (0
11 5 9 mo-. 12: 1-63 2-7-69 1:20
12 5 9 mo-. 2-19- 6i5 2T-769 1 :
13 5 10 mo-. 12-16-63 2-7-69 1:3
14 5 Ih mo> 11-6-61 2-12-69 1:hs0
15 5 I m o 9-1 -63 2-13-69 1: (i(
16 6 11 mui 1-7-64 2-10-69 1l:320


Table 3
Rubeola Hemagglutination Inhibition Titers in Five Students
Jacksonville, Florida February 1969

CoPresent Age Age at Dale of Date of Hubeola
(Years) Immunization Immunization Serum Collection HI Titer
17 5 9 mruo 4-16-64 2- 5-69 1:5
i .5 9 mos. 10-64 -7--69 1::
19 6 10 imo-o -2- 6:3 -7-69 1t:
-0 ( 1:3 m -. 7-2)0-3 --7- 69 1:-20
'21 7 l mu o 7T--63 -1I-)-619 1:10


MADUROMYCOSIS (MADURA FOOT) Florida


On Aug. 24. 196I a 49-L):ar-old man -al a phly.-i an
because of a chronic, hard, indurated granuloinatousr in-
ftction \ith draining sinuses on his left foot. Their patilen
reported a 6-year history of chronic sx\ellini \\hixch lhgian
\ hen he stepped on a hard object, with his -hio- -o on and
bruised his foot. The foot had n-e\er returned to normlii
-ize or configuration. In 1967. -inu ,s- xith drainage of
bloody white e material dexeloped in the foot. The patiienl
reported somiie diusomfort in his ankle hut no a:lilul pain
in his foot. He was full\ iobilile without lo-> of .--n action.
but he had had a 1. lb. \\weight l-- during the I:-it tear.
He ;ga\e no history of ia lpenel rating wouind in hi- foot.


He had remained act! xie at w ork in an orange uro-nx. The
ph\ icimtan diagino -d \lMadur:a foot and referred the patient
to a -tate liedi'al i'chool for confirm at ion.
O{n ph\-ical o t\ ni nation ai t the Il Icdwa l -chuiol.
there weri- noit -\ -te i e i 1 i xcept for tholie related
to the foot iwhi'h w a- nreatl\ -\o1l x en l with nIti me rol-
draining xinu- traitx x over the Idor-al. Ti'dil. and planiar
-urfa '-. There \l:i no wi Illini of the ankle. hut (ti ere
w\re three :r e1m nodi it ith heft inh-uixnal rli-tnx \n -rai
-'howedi e idonce of o-\ rT { toEe s\ Eit of the phalanlLn -
and Ii Itai r-al-. \ tpun h hio )-\ of I -tion k\a- [inerpr'htd
( i ,': i ,! /m :, 9ti


MARCH 15, 1969







92 Morbidity and Mortality Weekly Report


TABLE III CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
MARCH 15, 1969 AND MARCH 16, 1968 (llth WEEK)


ASEPTI( ENCEPHALITIS HEPATITIS
'\I\N- IICiT- lD'lliiil\ Primary including I'-- MALARIA
AREA ll oSIS unp. cases h Serum Infectious
Cum.

UNITED STATES... 25 1 7 18 11 7 116 1,221 848 50 497

NEW ENGLAND.......... 2 1 9 85 38 1 26
Maine. ............- 4 -
New Hampshire...... 4 1 2
Vermont ........... 3 -
Massachusetts...... 1 4 49 19 1 22
Rhode Island....... 1 19 7 -
Connecticut........ 1 5 6 11 2

MIDDLE ATLANTIC...... 4 6 4 50 209 124 5 48
New York City ..... I 5 3 26 53 32 -
New York, up-State. 4 30 20 1 10
New Jersey.......... 2 1 19 76 28 17
Pennsylvania....... 1 1 1 50 44 4 21

EAST NORTH CENTRAL... 5 1 2 7 224 159 5 34
Ohio............... 2 3 33 42 2
Indiana............ 1 10 15 1 2
Illinois........... 1 1 78 55 4 16
Michigan............ 4 3 88 29 13
Wisconsin.......... 15 18 I

WEST NORTH CENTRAL... 1 1 1 2 50 46 6 37
Minnesota.......... 1 1 1 1 9 16 3
Iowa............... 11 7 3
Missouri........... 10 20 2 9
North Dakota....... 1 1
South Dakota........ 8 -
Nebraska............ 1 3
Kansas............. 1 10 3 4 18

SOUTH ATLANTIC....... 3 3 3 82 68 16 174
Delaware........... 1 1 5 1 1
Maryland*.......... 13 13 1 5
Dist. of Columbia.. 3 2
Virginia........... 1 7 14 1 9
West Virginia.t.... 4 6
North Carolina..... 1 2 1 16 10 9 85
South Carolina ..... 6 2 17
Georgia............ 16 8 2 46
Florida............ 2 1 16 10 11

EAST SOUTH CENTRAL... 2 1 65 68 14
Kentucky.......... 1 32 36 10
Tennessee.......... 1 16 23 -
Alabama............ 8 4 4
Mississippi........ 1 9 5 -

WEST SOUTH CENTRAL... 2 81 64 12
Arkansas...- ..... 27 4
Louisiana.......... 1 15 17 8
Oklahoma........... 5 16
Texas.............. 1 1 34 31

MOUNTAIN............. 2 3 70 38 4 37
Montana ...........- 6 2 -
Idaho.............. 2 1 1
Wyoming............. 6 3
Colorado .......... 27 7 4 34
New Mexico......... 3 7 6 1
Arizona............ 2 7 10 1
Utah............... 15 8
Nevada............. 1 -

PACIFIC............... 10 4 4 3 4 43 355 243 13 115
Washington......... 81 25 1 3
Oregon............ 21 14 5
California......... 7 4 4 3 4 43 249 203 9 96
Alaska............. 2 -
Hawaii ............. 3 2 1 3 11

P erto Rico ........ 18 27
*Delayed reports: Hepatitis, infectious: Me. 8, Md. 4, W. Va. 1 (1968)







Morbidity and Mortality Weekly Report 93


TABliT III. CASMS (0 SPi(:FIED1) NOTIFIABLE DISlASiS: UNITED) STATIC

FOR WFFKS ENDED

MARCH 15, 1969 AND MARCH 16, 1968 (tlth WEEK) CONTINUED


MEASLES (Rubvola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RIBELLA
TOTAL
AREA iTotl Paralytic
Cumu lat ive Cumulative .. Pra
!lI 1968 196 196 1.( 96 iI0 ) 1> 11 i') 1 d I
UNITED STATES... 859 5,070 6,208 91 869 882 3,030 1,803

NEW ENCLANDI........... 31 244 247 4 28 44 314 -91
Ma.ine ............. 2 10 1 2 21 -- 9
New lampshiro. ..... 2 60 46 3 9 3
Vermont ............ -- 1 20 2
Massachusett s..... 7 44 104 3 14 22 148 -49
Rhode Isand ....... 3 1 3 4 47 4
Connecticut ........ 22 135 86 1 10 12 69 24

MIDDLE ATIANTIC...... 242 1,479 792 5 110 120 126 -- 86
New York City...... 184 997 149 3 22 22 68 26
New York, Up-State. 27 143 451 17 14 NN 34
New Jerserv......... 18 179 152 1 37 45 58 -- 26
Pennsylvania....... 13 160 40 1 34 39 NN -

EAST NORTH CENTRAL... 174 614 1,616 14 106 89 707 385
Ohio................ 18 63 112 3 31 20 61 33
Indiana............. 94 198 250 4 20 12 46 35
Illinois ........... 32 113 705 3 15 20 151 60
Michigan........... 8 64 100 4 34 28 171 95
Wisconsin.......... 22 176 449 6 9 278 162

WEST NORTH CENTRAL... 28 163 114 8 49 39 441 208
Minnesota.......... 1 3 1 8 6 62 5
Iowa............... 19 87 22 1 6 3 359 85
Missouri.......... 11 9 4 21 7 12 104
North Dakota....... 3 5 51 2 8 13
South Dakota....... 3 4 NN -
Nebraska........... 6 59 19 2 4 4
Kansas ............. 7 10 13 1

SOUTH ATLANTIC....... 135 927 454 19 169 194 196 216
Delaware ........... 8 16 4 3 1 3 --- 8
Maryland*.......... 8 35 16 12 10 -- 35
Dist. of Columbia.. 4 2 7
Virginia............ 72 351 95 7 29 14 10 25
West Virginia...... 8 80 113 1 7 4 91 38
North Carolina..... 33 80 50 19 42 NN -
South Carolina..... 47 8 5 26 39 21 1
Ceorgia............ 1 3 2 28 34 -
Florida............ 14 344 142 4 39 41 61 109

EAST SOUTH CENTRAL... 6 42 118 5 41 71 139 196
Kentucky............ 4 17 40 2 10 27 62 49
Tennessee.......... 2 10 16 2 21 20 72 44
Alabama ............ 33 7 12 5
Misisssippi........ 15 29 1 3 12 103

WEST SOUTH CENTRAL... 174 1,227 1,536 14 116 192 332 1 160
Arkansas............ 2 4 15 10 2 -
Louisiana.......... 8 1 2 33 46 1 -
Oklahoma........... 1 103 73 6 39 1 3
Texas ............. 173 1,114 1,462 8 62 97 328 1 157

MOUNTAIN ............. 17 95 318 2 27 12 164 144
Montana ........... 3 54 2 1 15 4
Idaho.. ............ ... 10 2 5 2 7 -
Wyoming............. 31 2 44
Colorado........... 8 15 110 6 6 18 65
New Mexico.......... 7 41 36 5 30 3
Arizona............ 2 34 73 6 1 89 26
Utah............ .. 1 2 1 3 1
Nevada............. 1 2 2 2

PACIFIC.............. 52 279 1,013 20 223 121 611 317
Washington......... 4 24 275 2 14 19 188 55
Oregon.............. 2 36 220 1 7 11 17 20
California.......... 44 207 497 17 196 82 393 222
Alaska.............. 1 10 3 -3
Hawaii............. 1 2 21 6 9 10 17

Puerto Rico........... 9 125 104 3 14 25 -
*Delayed reports: Measles: Mass. delete 4, Tex. delete 120
Mumps: Me. 5
Rubella: Me. 1, Md. delete 4








94 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MARCH 15, 1969 AND MARCH 16, 1968 (11th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYPID TICK-BORNE RABIES IN
AREA SCARLET FEVER FEVER (Rky. Mt. Spotted) ANIMALS
Cum. Cum. Cum. Cum. Cum.
1969 1969 1969 1969 1969 1969 1969 1969 1969 1969 1969
UNITED STATES... 13,398 1 18 1 23 7 46 1 85 755

NEW ENGLAND.......... 1,587 2
Maine.*.......... 29 1
New Hampshire...... 25 -
Vermont............ 2 1
Massachusetts...... 205 -
Rhode Island....... 70 -
Connecticut........ 1,256 -

MIDDLE ATLANTIC...... 649 2 1 1 8 2 12
New York City...... 26 1 5 -
New York, Up-State. 501 2 1 2 12
New Jersey.......... NN 1 -
Pennsylvania....... 122 1 1 -

EAST NORTH CENTRAL... 1,413 3 2 1 2 5 34
Ohio............... 316 1 2 2 6
Indiana............. 519 1 2 6
Illinois........... 183 1 1 5
Michigan ........... 241 2 1
Wisconsin.......... 154 1 16

WEST NORTH CENTRAL... 614 3 17 130
Minnesota.......... 49 8 39
Iowa................ 186 4 24
Missouri........... 190 3 3 43
North Dakota....... 100 2 18
South Dakota....... 34 -
Nebraska ........... 11 -
Kansas............. 44 6

SOUTH ATLANTIC ..... 1,592 1 6 10 1 5 29 255
Delaware ........... 21 -
Maryland............ 254 1 1
Dist. of Columbia.. 2 -
Virginia........... 673 17 172
West Virginia...... 333 2 5 32
North Carolina..... 18 1 4 1 1
South Carolina..... 81 1 1
Georgia............. 16 1 1 16
Florida............. 196 1 2 4 1 6 34

EAST SOUTH CENTRAL... 1,745 1 3 2 6 1 15 139
Kentucky........... 216 6 84
Tennessee.......... 1,176 1 3 2 5 1 7 44
Alabama............ 171 2 11
Mississippi........ 182 1 -

WEST SOUTH CENTRAL... 878 3 2 1 7 8 89
Arkansas........... 16 4 4
Louisiana.......... 7 2 4
Oklahoma .......... 33 1 2 3 14
Texas.............. 822 1 3 5 67

MOUNTAIN............. 3,208 2 10 3 23
Montana ............ 39 -
Idaho ............ 164 -
Wyoming ........... 314 5 1 7
Colorado............ 2,167 1 1
New Mexico.......... 304 1 2 1 7
Arizona.*.......... 88 1 1 5
Utah............... 132 1 -
Nevada ............. 1 3

PACIFIC................ 1,712 4 1 8 6 71
Washington ......... 524 -
Oregon............. 124 -
California.......... 942 4 1 8 6 71
Alaska ............. 37 -
Hawaii............ 85 -

Puerto Rico..........1 1 1 5
*Delayed reports: SST: Me. 16
Rabies in animals: Wyo. 3, Ariz. 2








Morbidit an1d Mlor'tality W eckly HIReporl


TABHII IV I)IATIHS IN 122 I NIlI1) STAI HS ( ITIIS IO(R WIk I NI)IIl) MARCH 15, 1969

(By place of occurrence and week of filing certificate. Excludes tital deaths)


Area All 65 years and year Area
Influenza All
All Ages Causes


NEW ENGIAND:
Boston, Mass.---------
Bridgeport, Cn n.- -
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.--------


756
254
57
20
30
57
27
20
33
54
54
12
41
27
70

3,628
46
32
150
51
33
31
83
83
1,797
26
705
172
50
120
14
43
78
50
33
31

2,652
66
35
766
162
206
131
84
351
46
48
46
44
58
176
44
105
50
27
44
107
56

878
64
12
45
138
21
122
75
271
66
64


481
156
41
13
23
35
20
7
22
29
36
7
25
17
50

2,131
28
22
77
30
21
21
47
36
1,067
14
406
94
36
78
8
27
52
24
23
20

1,531
44
23
398
103
106
82
52
197
32
22
35
22
37
91
23
80
29
18
35
63
39

550
43
6
29
83
13
78
48
160
49
41


*Estimate based on average percent of divisional total.


SOUTH ATLANTIC:
Atlanta, Ca.-----------
Balt more, Md.---------
Charlotte, N. C.-------
Jacksonville, Fla.-----
Miami, Fla.------------
Norfolk, Va.----------
Richmond, Va.----------
Savannah, Ga ----------
St. Petersburg, Fl.---
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, Ttx.---
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, Coto.
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.----------


I II t llttt iiet i~ttO


All
Ages


1,310
170
264
57
124
108
54
86
38
121
82
155
51

729
110
56
47
158
161
50
33
114

1,240
31
47
25
159
41
80
245
48
169
132
133
61
69

487
46
25
145
26
112
24
48
61

1,792
15
47
48
57
88
592
81
43
152
60
104
222
45
140
45
53


b6 years
-id -c r


697
75
133
33
65
62
32
48
16
100
41
67
25

398
58
26
30
89
80
30
18
67

677
17
25
13
81
22
44
107
29
86
82
83
38
50

281
26
12
84
17
59
16
31
36

1,131
15
26
36
27
59
384
57
41
88
36
52
129
27
94
23
37


and
Influenza
All Ages


63
7
10
2
8
2
4
3
4
8
8
5
2

46
5
5
5
19
6
2
3
1

71
5
1
1
9
4
9
10
1
6
7
3
9
6

25
4
3
6
3
4
3
1
1

66

2

1
4
22
2

9



2
7
4
2


1 year
All
Caused,


Total 113,472 7,877 602 654

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 160,07
All Causes, Age 65 and over------------------- 92,923
Pneumonia and Influenza, All Ages------------- 10,973
All Causes, Under 1 Year of Age--------------- 7,199


Week No.


itL








Morbidity and Mortality Weekly Report


MADUROMYCOSIS (C'iliniicd fro'i page 9/)


a- lhoin "Lacutl and chronic infla mmiator\ reactions
Silth ilceratiuni of (thi epidermis." The le-ions \xere
consitt-l nt %\lth actinomllVcosis or nocardiosis." The'
patientt 01 -tirled on a course of therapy consisling of
(1 g. triple ult' a ill for -I \ eeks antid olloW \ d lb 5 g.
da31 for 2 to 4 mIonths.
(n Dec. 1. 196h. the patient xas seen after 1 month
of treatment and the foot appeared nmarkiedly improved with
less eldema, inflammation, and piurulente. The patient was
seen again during the first week in March: continued
improvement \a.- noted. The sulfa treatment is continuing
and (the patient is ambulatory and working.
(Reportedr by Donald 1. Dieter. M.D., Phyisirian. Eustis.
Florida; E. R. IW'ootdward, l.)., Professor and Head, Ve-
partienit of Surf/ery, and L C. luff, M.D., Professor and
Chairman, Department of Medicine, The J. Hillis Miller
Health ('enter, Uniiiiersity of Florida: J. Basil Hall, M.D.,
Health Officer. Lake County Health Department; E. Charl-
ton Prather. M.D., Director, Division of Epidemiology.
Florida Board of Health; and an EIS Officer.)
RT frence:
1 Frpese J.\\.., t il: Pulmonary infection by Nocardio aster-
od Is. Finding in 11 Cases. J. Thorac Cardiov Surg 46(4):
537. 1963.


INTERNATIONAL NOTES
INFLUENZA 1969
EUROPE
Belgium (reported February) Three strains of influenza
B were isolated during the influenza A2, Hong Kong/68
epidemic in Brussels and the surrounding area.
Denmark (reported January 25) Sporadic cases of
influenza-like disease were noted in various parts of the
country. Serologic evidence of A2 infection was obtained
in five cases.
Finland (reported February 1) An epidemic of influenza
was developing in the general population: 15 strains of
A2 Hong Kong,'6h were isolated, and serologic evidence
was obtained in many cases. Scattered cases had been
noted earlier in January.
France (reported March) Influenza-like disease has
increased in Paris and the surrounding area and in the
eastern, western, and southwestern parts of the country.
In addition, localized outbreaks and sporadic cases were
reported in Lyons. All age groups were affected. The
disease was generally mild. Strains of A2 'Hong Kong 68
were isolated and serologic \ idence of A2, Hong Kong 68
\\as also obtained.
Ireland (reported January 11) A family outbreak of
influenza-like illness associated with A-2 Hong Kong 6S
virus occurred in Dublin in late December following the
return from London of one of the children. There has been
no (e\idetnce of increased incidence in the population
general 1l.


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.
MANAGING EDITOR PRISCILLA B. HOLMAN

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY, 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 CONCLUDES
AT CLOSE OF BUSINESS ON FRIDAY; COMPILED DATA ON A NATIONAL
BASIS ARE OFFICIALLY RELEASED TO THE PUBLIC ON THE SUCCEED
ING FRIDAY.


96


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