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:
AA00010654:00213

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. 13

WEEKLY

REPORT

For

Week Ending

March 29, 1969


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE / PUBLIC HEALTH SERVICE 4EHEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION
DATE OF RELEASE: APRIL 4, 1969 ATLANTA, GEORGIA 30333


INTERNATIONAL NOTES
SMALLPOX West and Central Africa
During the first 9 weeks of 1969. only 129 cases of
smallpox were reported from West anad central Africa and
only nine of the 19 countries in this area reported cases, l
During the comparable period in 1968, a total of 1,06:1
were reported (Figure 1).
Historically, January and February have marked the
annual upsurge of reported smallpox as a result of the
gathering momentum of dry season epidemics, but in
1969 during these months, transmission remained at un-
precedented low levels. The failure of smallpox to re-
surge this year reflects efforts of the 19-country co-
ordinated regional smallpox eradication and measles
control program being waged by these 19 countries. From
January 1967 through February 1969, 70 million of the


smailltpox Imlpoirtutio, n (':m .r in .-innd hi.ni ..... 10
I tidl.mio. l>ie N lt,: otnt RI tfp rl,r -
Bol u uhm -- 1uivill, KEntucky. .. .... .0
A ('Ca e of lifstioc to,-i N',- .IJ-r-< . .. 107
S.',troontleriti: (;lInw oid .S rin (' ..or.,h .... 1 12


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASESO?4:W STATES
(Cumulative totals include revised and delayed reports through previous weeks)

13th WEEK ENDED CUMULATIVE. FIRST 13 WEEKS
MEDIAN
DISEA March 29. March 30. 1964 1968 MEDIAN
1969 1968 1969 1968 1964 1968
Aseptic meningitis ................... .. 26 28 28 377 357, 359
Brucellosis ............................ 4 4 5 23 23 49
Diphtheria. .................. ............ 6 1 2 38 37 37
Encephalitis, primary:
Arthropod-borne & unspecified .......... 21 16 26 258 188 307
Encephalitis, post-infectious ........ .... 6 10 17 64 115 172
Hepatitis, serum ........................ 116 89 82 1.303 915 10
Hepatitis, infectious .................... ...870 900 11.884 10.792
Malaria ................................ 56 56 7 603 587 75
Measles rubeolaa) .......... ............. 1029 880 9.149 6,839 8.016 94.233
Meningococcal infections, total ............. 85 89 89 1,073 1,009 1,009
Civilian .............................. 69 78 998 917 -
Military ............................... 16 11 75 92 -
Mumps ................................. 2,766 5,163 31.141 66.095
Poliomyelitis, total ..................... 1 1 14 6
Paralytic ................ ...... ...... .. 1 1 14 5
Rubella (German measles) ................ 2,075 1,961 13.996 14.263
Streptococcal sore throat & scarlet fever.... 11.599 11,258 11.683 152.354 150.003 150,003
Tetanus ............................... 1 1 1 23 26 38
Tularemia ................... ............ 1 2 24 18 50
Typhoid fever .......................... 7 7 47 56 70
Typhus, tick-borne (Rky. Mt. spotted fever) 1 1 4 6
Rabies in animals .................. .... 96 94 132 924 966 1,090

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........................................... Rabies in man: ...................... ................
Botulism: .......................................... 2 Rubella congenital syndrome: ......................... 2
Leptospirosis: .................................. ... 11 Trichinosis: ................... ..................... 20
Plague: ................ ............. ........... ... Typhus, urine: .............. ...... 3
Psittacosis: ....................................... 6

*Delayed reports: Trichinosis: Me. 1. N.Y. Ups. delete 1 (1968)







Morbidity and Mortality Weekly Report


MARCH 29. 1969


SMALLPOX (Continued from front page)


FIGURE 1
REPORTED SMALLPOX CASES BY MONTH
1960-67 AVERAGE, 1968 AND 1969
WEST AND CENTRAL AFRICA












large part to a continuing program of intensified surveil-
lance, case investigation, and outbreak control ("eradi-


cation escalation") initiated in September 1968 by the
eight countries then experiencing endemic smallpox:
Dahomey, Guinea, Mali, Nigeria, Niger, Sierra Leone,
Togo, and Upper Volta. The sudden increase in reported
smallpox cases in October 1968 denotes a positive effect
on reporting efficiency (Figure 1). Through deliberate
efforts to search out smallpox cases and to terminate
transmission by rapid focal vaccination among contacts,
endemic smallpox transmission has ceased in all but
three of these countries: Nigeria, Sierra Leone, and Togo.



Reference:
VWorld Health Organization Weekly Epidemiological Record
44(12):205-21l.


SMALLPOX IMPORTATION Cameroon and Ghana


Since Jan. 1, 1969. smallpox cases have been reported
from two West and Central African countries participating
in the Smallpox Eradication Measles Control Program,
which haxe not experienced continuing endemic transmis-
sion of the disease within their own borders for some-
time. C Cameroon, in January. reported seven cases from
two departments in the north. Margui-Wandata (2 cases)
and Diamare (5 cases), adjacent to the Nigerian border.
Ghana reported three cases of smallpox. Neither country,
though subject to frequent importations from endemic areas
in the past, had reported even sporadic cases of smallpox
for several months prior to this.
In Cameroon, the source of infection in both outbreaks
was traced to Banki, Sardaunna Province, North-Eastern
State, Nigeria. Containment measures were immediately
initiated and intensive surveillance established in the in-
fected areas. These cases were the first reported in
Cameroon since June 1968.
In Ghana, the first case involved a 64-year-old linquist
and farmer from the villagee of Akanteng. Eastern Region


(50 miles northwest of Accra), who developed a rash on
December 28, about 10 days after returning home from a
meeting in Kibi, 20 miles away and 85 miles from the
border of Togo. He was admitted to a hospital on Jan-
uary 1 and immediately isolated. His 11-year-old son,
vaccinated unsuccessfully at that time, developed fever
and a rash on January 14 and was subsequently isolated.
It was not known whether the father or the son, who was
supposedly also vaccinated in infancy and again at age 5
years, had vaccination scars. The source of the father's
infections was not known il.in....uh a possibility was
neighboring Togo, a country reporting a high incidence of
smallpox in 1968. A third case of smallpox was reported
on January 31, but no details were provided. These small-
pox cases were the first reported from Ghana since July 1968.



Reference:
lWorld Health Organization Weekly Epidemiological Record, 44
(8):152.


EPIDEMIOLOGIC NOTES AND REPORTS
BOTULISM Louisville, Kentucky


On March 7. 1969. a 53-year-old man developed
symptoms of gastroenteritis. Although symptomatic treat-
ment for "stomach flu" was prescribed, he developed
diplopia. ataxia. dysphagia. and d.i;f. 1i ,. speaking on
March 9. He was hospitalized on March 13 with ocular
palsy and pharyngeal, lingual, and skeletal muscle weak-
ness but without fever or sensory deficits. The admitting
diagnosis was botulism and bivalent (A,B) Clostridium
botulinuin antiserum was administered. After receiving
a total of 30.000 units, the patient showed marked clinical
improvement and has since been discharged from the
hospital.


The only suspicious food in the patient's history
was home-canned tomato juice, consumed on March 6.
After one swallow, the patient discarded the tomato juice
because of its bad taste. The tomato juice was prepared
from homegrown ripe tomatoes. After washing, they were
cooked, strained, reheated without boiling, and poured
while hot into clean, scalded glass jars. A teaspoon of
salt was added. After capping, the jars were vigorously
boiled for 10 minutes. Of a total of 28 jars prepared in
this manner in August 1968, 27 had been consumed
without untoward effects.
Laboratory analysis of the patient's serum, prior to


106










treatment with antiserum, revealed type B, botulinum
toxin. None of the incriminated tomato juice w\as available
for analysis.
(Reported by C. lHernander. M.D).. M.P.ll., Director,
Division of Epidemiology, Khentucky State Department of
Health; Thomas W allace. e .i).. Director of Healthf, Louis-
iille-Jefferson County Health Department; the Anaerobic
Bacteriology Labororatory, bacterial Reference Unit, Lab-h
oratory Program. NCC ('D; and an EIS Officer.)
Editorial Comment:
This is the third outbreak of botulism attributed to
ingestion of tomato juice since 1899.1 The previous two
outbreaks involved three cases with no fatalities. In
those, the toxin type was not determined (Table 1).
In this case, the slow progression of symptoms, the
demonstration of (. botulinum toxin in the blood stream
approximately 1 week after ingestion of the incriminated
vehicle, and the geographic distribution of the outbreak
are all consistent with type B, C. botulinum toxin.


Toble 1
Outbreaks of Botulism Since 1899 Involving Tomato Products


Number of Place of Toxin
outbreaks Cases Deathi, preparation I p.-
Tomaloes I1 29 16 A1 home canned 2 type \
I type It
Tomato juiir 3 4 0 All honmi cannedl 1 lypp B
Tomato relish 1 2 2 lonime anned Unknown
Tomato catsup 1 2 0 ('ommercial
product U'nknor n




Hlferencie:
Meyver, K. E., ind Eddie, B.: Slxty-Five Years of Htuman
Botulism in the United States and Canada:: Epidd miology and
Tabulations of Reported Cases 1899 through 1,164. ;eorge
Willioam Ilooper Foundation, University of (C;ifornia, San
Francisco Medical Center, June 1965.


A CASE OF HISTIOCYTOSIS New Jersey


Recently, a medical problem in which leprosy was
considered in the differential diagnosis occurred in a
Vietnam veteran. In early October 1968, a 19-year-old
American soldier with a maculopapular rash over the arms
and lower trunk, fever, and periorbital edema was admitted
to a hospital in Vietnam. There a chest X-ray revealed a
pleural effusion on the left, but a study of pleural fluid
was not diagnostic. A single thick blood smear was posi-
tive for Plasmodium rivax, and the patient was treated
with chloroquine and primaquine: however, feer persisted.
In addition, the patient reported taking relatively regular
malaria prophylaxis of chloroquine weekly and 25 mg of
DDS daily. Scrub typhus was then considered and tetracy-
cline therapy was begun. Neither fever nor rash improved,
and the patient was transferred to a military hospital in
Japan where the skin lesions were felt to be compatible
with leprosy. The patient was then transferred in mid-
December to a military hospital in New Jersey.
After admission, the patient had almost daily tempera-
ture elevations to 101-102'F. but occasionally for several
consecutive days was without fever. New skin lesions
developed in the involved areas of the lower trunk and
arms and progressed to include the face and chest. Several
skin biopsies were performed. The slides showed a non-
infectious granulomatous process invol ing the dermis and
no acid-fast bacilli. No specific diagnosis was made. A
liver biopsy and several hone marrow studies were normal.
The peripheral white count was normal to low with a de-
crease in lymphocytes, and no abnormal cells were seen.
Multiple cultures of blood and skin lesions were negative
for bacteria and fungi.
The distribution of the skin lesions was not typical
of a particular disease, but the general character was com-
patible with erythema nodosum leprosum as seen in patients


taking DDS. Because the patient had no history of ex-
posure to leprosy in the United States and because his
stay in Vietnam was less than the usual incubation period
for leprosy, this diagnosis seemed unlikely.
Additional thick skin biopsies revealed prominent
proliferation of atypical reticular cells and lymphocytes
and histiocytic cells with many mitotic nuclei in the
perineural and perivascular areas. Microscopic sections
of a lymphoid mass removed from the right axilla showed
diffuse infiltration of atypical histiocytes throughout
sinusoidal areas, and malignant histiocytosis stage 4B
with widespread disease and systemic symptoms was diag-
nosed. On February 14, the patient was begun on IV cyclo-
phosphamide. Three days later, his fever began to sub-
side, he began to feel better subjectively, and the skin
lesions were markedly improved. Recurrent left pleural
effusion has occurred. Cyclophosphamide therapy is
continuing.
(Reported by Ronald Brostek, Lt. ('ol., 11C, Chief. iedi-
cine Division, and Joseph Smith, Lt. Col., if(', Chief.
Preventive Medicine Division, Walson General l/ospital,
Fort Dix, New Jersey; John Gault. Lt. C'ol.. C, Preren-
tive Medicine Division. Office of the Surgeon (General,
Department of the Army: and the Leprosy Surrillance
Unit, Bacterial Diseases Branch, Epidemioloyy Program.
NC(" .)
Editorial Comment:
There have been 45 American servicemen who devel-
oped leprosy subsequent in time to military service during
World War II and the Korean W'ar without known exposure
prior to military service. No cases have been reported in
servicemen who have served in Vietnam, other than in
those who had possible exposure to leprosy either before
joining the service or in other parts of the world.


MARCH 29, 196i9


Morbidity and Mortality Weekly Report







108 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MARCH 29, 1969 AND MARCH 30, 1968 (13th WEEK)


ASEPTIC ENCEPHALITIS HEPATITIS
MENIN- BRUCEL- I)IPITIIERIA Primary including Post- MALARIA
AREA GITIS LOSIS unsp. cases Infectious erum Infectious
Cum.
1969 1969 1969 1969 1968 1969 1969 1969 1968 1969 1969
UNITED STATES... 26 4 6 21 16 6 116 870 900 6 603

NEW ENGLAND........... 3 4 11 66 34 4 31
Maine..*............ 3 1 -
New Hampshire....... 7 1 I 2
Vermont............ 2 -
Massachusetts...... 4 10 22 17 3 25
Rhode Island........ 1 16 6 -
Connecticut........ 3 16 9 1 4

MIDDLE ATLANTIC...... 5 5 4 2 60 164 124 15 67
New York City...... 3 4 3 35 50 41 4
New York, up-State. 1 2 30 23 13
New Jersey.*....... 2 1 16 32 19 15 26
Pennsylvania........ 1 1 7 52 41 24

EAST NORTH CENTRAL... 3 7 4 6 129 130 4 40
Ohio............... 4 1 1 40 47 1 4
Indiana. ........... 3 3 6 3
Illinois............ 1 2 28 39 3 19
Michigan........... 2 3 3 50 31 13
Wisconsin.......... 8 7 1

WEST NORTH CENTRAL... 1 1 32 38 3 43
Minnesota........... .- 12 8 3
Iowa............... 3 10 4
Missouri........... 1 1 9 11 1 11
North Dakota ....... 2 1 2
South Dakota....... 3 1 -
Nebraska........... 4 3
Kansas............. 3 4 1 20

SOUTH ATLANTIC........ 1 4 2 3 125 103 8 197
Delaware........... 1 3 1
Maryland...*...... 1 18 14 5
Dist. of Columbia.. 1 2 1
Virginia........... 1 4 1 8 12 10
West Virginia....... 1 3
North Carolina..... 1 9 10 7 100
South Carolina.*... 3 2 1 18
Georgia............ 41 42 50
Florida............ 1 42 16 13

EAST SOUTH CENTRAL... 2 1 1 1 31 80 22
Kentucky............ 9 16 17
Tennessee.......... 1 1 15 43 -
Alabama............ 3 13 5
Mississippi......... 2 1 4 8 -

WEST SOUTH CENTRAL... 2 3 2 1 62 74 4 18
Arkansas ........... 1 4
Louisiana.......... 3 1 14 15 4 12
Oklahoma.*......... 1 7 10 2
Texas.............. 2 1 41 48 -

MOUNTAIN............ 2 1 1 39 62 2 42
Montana............ 3 9
Idaho.............. 4 1
Wyoming.............. 7 1
Colorado............. 1 22 2 38
New Mexico......... 1 5 3 2
Arizona............ 2 13 13 1
Utah................ 10 9 -
Nevada.............. 1

PACIFIC.............. 12 4 2 1 33 222 255 16 143
Washington.......... 3 1 14 21 1 5
Oregon............. 8 14 5
California.......... 7 3 2 1 33 194 220 15 122
Alaska.............. 5 -
Hawaii............. 2 1 11

Puerto Rit .1......... 79 17 1 1
*Delayed reports: Aseptic meningitis: Md. 1
Encephalitis, primary: Okla. 1
Hepatitis, serum: N.J. delete 4
Hepatitis, infectious: Me. 10, N.J. delete 58, Ind. delete 1, Md. 13 (1969) 1 (1968), S.C. delete 1, Okla. 3, P.R. 1
Malaria: N.J. delete 6







Morbidity and Mortality Weekly Report 10O


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MARCH 29, 1969 AND MARCH 30, 1968 (13th WEEK) CONTINUED



MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL _
AREA Cumulative Cumulative Total Paralytic


UNITED STATES...


NEW ENGLAND..........
Maine..*............
New Hampshire......
Vermont ...........
Massachusett#.....
Rhode Island ......
Connecticut .......

MIDDLE ATLANTIC......
New York CityA....
New York, Up-State.
New Jersey.*A......
Pennsylvania .......

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

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

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

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

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

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

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


1969


1,029

49

10

15
6
18

319
254
29
25
11

77
15
27
8
1
26

29

29







154
43


70
13
6
2

20

1
1




244

43
1
200

29

7

4
9
9



127
7
62
58


1969 1968
6,839 8,016

305 308
2 10
70 48
1
61 123
9 1
162 126

2,022 1,091
1,401 255
202 561
226 221
193 54

767 1,936
90 146
220 316
144 818
79 121
234 535

220 197
1 6
134 39
11 58
5 60
3
69 24
7

1,162 711
65 5
11 40
4
460 139
114 132
91 185
50 8
1 3
370 195

45 197
19 59
11 40
S 39
15 59

1,713 1,980
2
51 1
105 97
1,555 1,882

163 377
3 54
36 11
34
19 148
57 40
46 86
1 2
1 2

442 1,219
34 319
99 254
294 623
13
2 21


969 99 8 1969 I 1969 I M l
! 6 196, 9 I Iqb 68 !ih 96 I 9699 1Q 69h I 1'6


1,073

31
1


16
3
11

131
28
19
46
38

125
39
20
21
37
8

57
9
8
22


6
12

199
3
18
3
29
10
29
32
28
47

54
15
25
8
6

150
17
38
9
86

28
3
5

6
5
6
1
2

298
36
8
244
4


1,009

50
2
6
1
24
4
13

148
28
18
58
44

107
26
16
27
29
9

45
10
3
9
2
4
4
13

222
2
15
8
15
6
50
41
40
45

81
29
24
14
14

210
12
52
42
104

13
1
2

7

1

2

133
23
13
88

c


2,766

293
26
1
25
123
24
94

244
95
NN
149
NN

547
67
50
44
184
202

230
69
122
5
34
NN



287

19

34
97
NN
24

113

70
7
60
3


357

6
48
303

144
20
5

17
6
90
6


594
174
26
371
10
1'


Puerto Rico.......... 18 154 143 3 6 16 12 1 2


*Delayed reports: Measles: Mass. delete 5, N.J. delete 1, Ind. delete 64, Md
Meningococcal infections: Ind. delete 1, d1. 2
Mumps: Me. 4, Md. 13
Poliomyelitis, paralytic: N.Y.C. 1 (1968)
Rubella: Me. 2, Ind. 64, Md. 37


2,075

170
2
10
16
55
3
84

103
36
20
25
22

532
27
116
27
217
145

62
7
39
1
10

4
1

306
5
33
1
73
109

20

65

111
12
68
27
4

297

1
128
168

76

3
2
51
5
11
4


418
118
23
252
3
11


3, S.C. deletr 1








110 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MARCH 29, 1969 AND MARCH 30, 1968 (13th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TPOID 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... 11,599 1 23 1 24 47 1 96 924

NEW ENGLAND .......... 1,975 2
Maine..*............ 32 1
New Hampshire...... 22 -
Vermont............ 13 1
Massachusetts ...... 276 -
Rhode Island....... 113 -
Connecticut........ 1,519 -

MIDDLE ATLANTIC...... 623 4 1 7 8 22
New York City...... 30 2 I 5
New York, Up-State. 406 2 1 8 22
New Jersey......... NN -
Pennsylvania....... 187 1

EAST NORTH CENTRAL... 1,117 3 2 3 6 41
Ohio.............. 284 2 7
Indiana............. 198 1 3 9
Illinois........... 193 1 1 3 8
Michigan........... 218 2 1 1
Wisconsin.......... 224 16

WEST NORTH CENTRAL... 270 1 3 22 165
Minnesota.......... 19 4 46
Iowa............... 57 26
Missouri........... 9 3 14 62
North Dakota....... 69 1 22
South Dakota....... 23 -
Nebraska........... 66 1 1
Kansas.* ........... 27 1 2 8

SOUTH ATLANTIC....... 1,458 6 10 5 21 297
Delaware........... 12
Maryland..A*........ 332 1 -
Dist. of Columbia.. 1 2 -
Virginia.*......... 493 9 192
West Virginia...... 242 2 5 40
North Carolina..... 33 1 4 1 1
South Carolina.*.. 78 1 -- 1
Georgia............. 13 1 18
Florida............ 254 2 4 1 7 46

EAST SOUTH CENTRAL... 1,691 1 2 1 4 7 1 16 171
Kentucky............ 234 1 2 11 102
Tennessee.......... 1,334 1 4 6 1 3 55
Alabama............ 47 2 14
Mississippi........ 76 -- -

WEST SOUTH CENTRAL... 845 3 2 7 18 118
Arkansas........... 17 4 4 8
Louisiana.......... 14 2 1 7
Oklahoma ........... 44 1 2 2 18
Texas.............. 770 3 11 85

MOUNTAIN ............ 2,281 2 10 2 27
Montana ........... 39 -
Idaho............. 84 -
Wyoming............. 225 5 2 10
Colorado........... 1,590 1 2
New Mexico......... 71 1 2 7
Arizona ............ 121 1 5
Utah............... 151 1
Nevada.............- 1 3

PACIFIC.............. 1,339 4 8 3 81
Washington......... 347 -
Oregon ............. 75 -
California......... 775 4 8 3 81
Alaska ............. 91 -
Hawaii .... ......... 51- -

Puerto Rico.......... 3 1 1 3 5
*Delayed reports: SST: Me. 10, Kans. 350, Md. 487, Va. 163, S.C. 1








Morbidity and Mortality ~ eekly leporl







TABIE IV. I)EATIlHS IN 122 1'NITI) S'TATIAIS (CI IIS FOR W l IK INI)Il) MARCH 29, 1969


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


Area


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, P,.-------------
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.--------


A 1

All
Ages


736
257
55
27
33
52
20
11
20
57
72
12
40
35
45

3,492
54
38
164
44
32
43
74
110
1,627
33
600
245
54
123
26
35
86
48
33
23

2,826
76
30
822
175
209
134
79
353
43
59
51
42
81
142
34
154
56
42
56
135
53

816
64
17
32
120
38
97
96
255
56
41


65 years
and over


436
148
29
18
17
28
12
6
13
37
45
8
21
25
29

2,087
31
19
115
28
16
25
46
40
977
22
345
134
46
87
16
24
56
27
21
12

1,653
46
16
467
102
116
86
54
204
29
18
29
19
53
84
21
102
33
27
27
85
35

531
48
13
23
71
27
61
66
150
43
29


and 1 year
Influenza All
All Ages Causes


Area


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


All 165 years
Ages and over


1,265
126
248
62
92
117
61
82
60
97
68
197
55

717
107
49
28
152
169
45
45
122

1,330
53
56
28
173
48
92
234
68
161
89
146
67
115

479
41
35
140
23
101
21
44
74

1,765
20
50
39
45
78
589
84
38
152
55
109
184
43
175
41
63


665
62
128
30
44
51
32
47
23
75
46
100
27

399
63
23
17
94
79
22
28
73

714
36
28
10
93
24
59
112
29
86
44
82
39
72

261
15
20
76
11
57
12
27
43

1,089
18
21
28
23
46
364
50
29
105
34
72
101
30
101
22
45


i I
and
Influenza
All Ages


1 year
All



45
8
11


Total 13,426 7,835 554 593

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 186,970
All Causes, Age 65 and over------------------- 108,604
Pneumonia and Influenza, All Ages------------- 12,144
All Causes, Under 1 Year of Age--------------- 8,376


Week No.
13


.... 1.


Ii ,ji', II H








112 Morbidity and Mi



GASTROENTERITIS Glenwood Springs, Colorado



On ,:in. 2)1. 19tl;). n outbreak of astiroenteritli
occurred among -kier- in (lenwood Sprines.l Colorado.
Questionnaires were sent to a group of 70 skiers: of (he
19 returning thm. 2(6 reported illne-- for an attack rate
of 7.: percent. The\- deSeloped nausea (100 percent).
Xomiing ()95. percent). diarrhea (61 percent, feier (5.i.
lercPni). i and craimp' (39 pIrceint) Is lo 72 hours. after
i- itini thi- -kiing area. No pathogien were identified
from -ltol cultures front eight persons- \ith diarrhea.
Food hi -lories listing all items served at the ski area
cafetria -ure-sted an increased incidence of illnes-
iIIuon1 per-1on- drinking aler or soft drinks made at the
cafeteria: lhoteler. this \\as not considered -tatistically

significant. Four persons who became ill on February 1
ha d had onl a -oft drink. after r used at the cafeteria
came from one of 1to Xells and all -oft drinks \Xere made
ai the cafeteria from commercial syrup, bottled CO,. and
well watlr. The water supply was tested regularly and
was. found Lacceptahle on January 20. However. sample-
collected on Januar\ 29 were -omerely contaminated with
coliform organisms as were repeat samples collected for
confirmation. Investigation found that a sewer line was
broken. dslicharing raw sewage on the ground approxi-
mately .1 1 feet from the cafeteria's primary well and that
the chlorinator used to treat the well water as it entered

the storage tank was also broken. Use of the well was
di-continued and the chlorinator was repaired.
reportedd by Cecil ,s. 3lollohan, II.I.. V.P.11.. Chief,
tScti'on of Epid iiinioogy., amn R. 1). L cidhioldt. P'.E.. Water

iSpp y Spe Dil tl, P', ir Heali:th Engiineeriny Section,
('olorado Stiif e Departmenit of Public lHealth: Ocan J.
Ielly. i.!).. II, ia Officcr. Garfield County HeallA
Department:, and an EIS (; .)


mortality Weekly Report


MARCH 29, 1969


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION OF 17,000 S1 PUBLISHED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER ATLANTA GEORGIA.
DIRECTOR NATIONAL COMMUNICABLE DISEASE CENTER
DAVID J. SENCER, M.D.
CHIEF. EP DEMIOLOGY PROGRAM A. D. LANGMUIR. M.D.
CHIEF, STATISTICS SECTION IDA L. SHERMAN, M.S.
EDITOR M CHAEL B. GREGG, M.D.
MANAG NG 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
INVESTIGATE ONS WHICH ARE OF CURRENT INTEREST TO HEALTH
OFFICIALS AND WHICH ARE DIRECTLY RELATED TO THE CONTROL
OF COMMUN CABLE 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.


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