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:
AA00010654:00216

Related Items

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

Full Text
tL: -l.a .


NATION / COMMUNICABLE DISEASE CENTER
NATIONAL COMMUNICABLE DISEASE CENTER


S U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE / PUBLIC HEALTH SERV :.E IFIEALTH
DATE OF RELEASE: MAY 23. 1969 ATLANTA, GEORGIA


EPIDEMIOLOGIC NOTES AND REPORTS
FATAL CASE OF MALARIA Hartford, Connecticut

A fatal case of I'lasmodiun falcliparum malaria was
reported from Hart.ford. Connecticut. in a (60-year-old
woman. On March 7, 1969. the woman had developed weak-
ness. nausea. vomiting. and diarrhea which were controlled
with paragoric. However, on March 9. her temperature
reached 103* F. On March 10, she felt weak but was afebrile
and able to go shopping. On March 12. she again developed
fever, diarrhea, and malaise, and her husband noted some
disorientation. She was seen by her physician. who found
no neurologic abnormalities and obtained no history of
headache but did note a temperature of 102 F. and mild
dehydration; he prescribed a tetracycline. The woman had
a history of good health except for a colostomy and ab-
dominal-perineal colonic resection for carcinoma of the


Epld [%0;dl ( imr of MalIiria

Sporntricnho-l-i -- (Iri-:gnn
!sitt cosi is U'rtlltd S,
Probable, Ioluli" m -- (' I I
Surva'hm- Summanitr
s ilt -- nit T -d S


rectum 9 years prec iously.On March 12 the physician firsl
learned that the patient and her husband had toured in
Kenya and Tanzania from Feh. I through 2.1. 196t, and had
returned to the United States on Fehruar 2.5. Thel had
not used malaria chemoproph hlaxis.
On March 13. the patient became dyl-pnric and ex-
tremely weak; she continued vomiting. At her ph\-i-ia:n'-
insistence, she agreed to ho .pitalization. When she arrivedd
(Continued on paye 170)


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

20th WEEK ENDED CUMULATIVE. FIRST 20 WEEKS
MEDIAN
DISEASE May 17, May 18, 1964- 1968 MEDIAN
1969 1968 1969 1968 1964 1968
Aseptic meningitis ...................... 15 30 30 553 574 551
Brucellosis ............................ 6 2 6 46 57 85
Diphtheria............................... 8 1 56 66 66
Encephalitis, primary:
Arthropod-borne & unspecified .......... 17 16 30 390 320 493
Encephalitis, post-infectious ............ 6 11 25 110 212 336
Hepatitis, serum ........................ 87 112 2.006 1,539
Hepatitis, infectious .................... ..967 946 755 18462 16913 16596
Malaria ................................ 65 52 5 1,004 839 107
Measles rubeolaa) ....................... 990 943 7,348 13,442 13,797 149,761
Meningococcal infections, total ........... 73 48 62 1.703 1.398 1.398
Civilian ............................. 62 39 1,545 1,258
Military ............................... 11 9 158 140
Mumps ................................. 2,555 4.384 49,408 98,131
Poliomyelitis, total ..................... 1 1 2 18 9
Paralytic ............................... 1 1 2 18 8
Rubella (German measles) ............... 2,801 2,556 32.274 30,714
Streptococcal sore throat & scarlet fever.... 8,751 8,874 8.366 220.063 216,898 216,898
Tetanus ............................... 1 5 5 41 44 57
Tularemia................................ 5 2 2 38 61 61
Typhoid fever ............... .......... 7 5 9 105 97 124
Typhus, tick-borne (Rky. Mt. spotted fever) 12 8 5 33 24 18
Rabies in animals ..................... 59 80 80 1.547 1.544 1.791

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........................................... 1 Rabies in man: Calif.- ....... ............ .. .
Botulism: .......................................... 9 Rubella congenital syndrome: ....................... 5
Leptospirosis: Pa.-l, Va.-l ........................... 18 Trichinosis: N.Y. Ups.-1 ....................... .... 31
Plague: ............................................. Typhus. marine: ............... ................ 5
Psittacosis: ........................................ 12


Vol. 18, No. 20

Wr.r



For

Week Ending

May 17, 1969






Morbidity and Mortality Weekly Report


MALARIA (Continued from front page)


at the hospital that evening, she was comatose and cy-
anotic. Malaria was suspected, and a 10-20 percent para-
sitemia with young trophozoites of P. falciparum was
detected on her blood smear. She expired before therapy
could be instituted.
On postmortem examination, malaria parasites were
found in red cells throughout the body. The liver and


spleen were severely congested and the spleen extremely
friable. The heart and kidneys were normal. The lungs
showed only mild congestion.
(Reported by Hugh B. Friend, M.D., and Eduardo Tolosa,
M.D., Private i". ... :. Hartford; and James C. Hart,
M.D., Director, Division of Preventable Diseases, Con-
necticut State Department of Health.)


SCHISTOSOMIASIS Decatur, Georgia


Recently. schistosomiasis due to Schistosoma man-
soni was diagnosed in five members of a family in Deca-
tur, Georgia. The family's only possible exposure was in
Uganda where they had lived for several years and had
swum in fresh water lakes and streams. They returned to
Georgia in 1967. In January 1969, the father developed
intermittent rectal bleeding. A rectal biopsy performed
during signoidoscopy revealed numerous viable S. man-
soni eggs. The mother and the three children were asymp-
tomatic. Because of the possibility of a common exposure
to schistosome cercariae while in Africa, skin and sero-
logic tests and stool examinations were performed on all
family members. All five members had S. mansoni eggs in
their stools. a positive skin test. and at least one posi-
tive serologic test. Therapy with sodium antimony dimer-
captosuccinate (Astiban*) or other schistosomicidal
agents is planned for the family.


(Reported by Z. V. Morgan, M.D., Decatur; John E. Mc-
Croan, Ph.D., Director, Epidemiologic Investigations
Branch, Georgia State Department of Health; and the
Parasitology Section, Laboratory Division, and the
Parasitic Disease Drug Service, Parasitic Diseases
Branch. Epidemiology Program, NCDC.)


Editorial Comment:
This report illustrates the fact that S. mansoni
infection is often asymptomatic and that individuals with
possible exposure should be screened for schistoso-
miasis. Because the vector snail is not found in the
mainland United States, transmission by symptomatic or
asymptomatic persons could not occur here.


*Available through the Parasitic Disease Drug Service, NCDC.


SPOROTRICHOSIS Oregon


Recently se en cases of sporotrichosis, five cases in
students in high school botany classes and two cases in
workers on a holly farm, were reported from Oregon. In
early December, the students and one worker had hanJler
both holly and sphagnum moss: one worker reported han-
dling only holly. During January all seven persons visited
physicians because of lesions on the fingers and wrists
and in early February sporotrichosis was confirmed by
culture of the lesions. Of four sera from students tested
hb the complement fixation technique, one had a titer of
1:S: the other three had no detectable antibody. All pa-
tients were successfully treated with potassium iodide.
Sporotrichum schenkii was cultured from the sphagnum
moss and water on the school laboratory floor, but cul-
tures of holly from the laboratory were negative. The moss
had been purchased from a local nursery that had obtained
it 2 years ago from a distributor in Philadelphia.


(Reported by Frances Storrs, M.D., Chief Resident, Derma-
tology, University of Oregon Medical School; Gaylord
Weeks, M.D., H. L. Armentrout, M.D., Joseph Emmerich,
M.D., and Merle Pennington, M.D., Private Physicians;
William Miller, Mycologist, Oregon State Public Health
Laboratory; and an EIS Officer.)



Editorial Comment:
Although Oregon and Washington produce approxi-
mately 96 percent of the holly used in the United States,
no previous cases of sporotrichosis associated with trauma
from holly have been reported from these two states.
Only one serum showed detectable antibody by the
complement fixation technique, consistent with the fact
that cutaneous infections usually do not produce circulat-
ing antibody.


SURVEILLANCE SUMMARY
PSITTACOSIS United States 1968*


In the United States during 1968, 45 cases of human
psittacosis were reported compared with 41 cases in 1967.
Case histories were submitted to the NCDC on 37 of the
cases in 196b. Only 17 states reported cases and Cali-


fornia, Michigan, New York, and Texas reported 60 per-
cent of the total. An increase in cases in 1968 over 1967
was noted in 12 states, a decrease in 13 states, and the
same number in 1968 as in 1967 in one state. Cases were


170


MAY 17, 1969







Morbidity and Mortality Weekly Report


reported from seven states that had no cases the previous
year while no cases were reported from nine state- that
had reported cases in 1967. Of the 37 cases, 27 occurred
in the winterr and spring months.
There aere no significant differences in age and sex
di-tribution- of cases in 196It, (Table 1). There were 201
cases in males and 17 in females. Parakeets- w\re the
source of infection in 17 of the 37 cases (4i percent) and
most human cases were related to exposure to pet para-
keets in the home (Table 2).
(RIeporlted by tht Il'trrinarily Public Health Section. Epi-
drmiology 'Pro ram, \('('C.)

*Pro\ i-; nil ,tatt


Table 1
Human Psittacosis Cases by


Age and Sex 1968


Sao---- Tot at
(Yeart) Male Fema .le
0-9 3 2 5
10-19 1 1 2
20-21)3 81 i
310-39 2 3 5

50-59 2 2 4
60-69 4 24;
70+ 0 I 1
Total 20 17 3:7


Table 2
Human Psittacosis Cases by Exposure Categories and Most Probable Source of Infection 1968

Most Probable Source of Infection
Birds. Chicken or Total
Category Parakeet Pigeon Canar n Bs ified hcke Parrot Bird (Cage Hall Dus-t I nknoa n
*Inpecified Duck
Pet Bird Owner 14 1 1 2 lb
Pet Bird Dealer 1 1 3 5
Pet Bird Breeder 1 2 3
Other 1 4 1 1 1 8
I'nknow n 3 3
Total 17 i 1 1 5 1 1 3 37


A copy of the original report from which th,-:< data \erie iris-d is av.iilablt on request from:

National Communi cable Di ,i{.r ('tntfr
Atlanta, (Geortiia 30333
Attn: Chief, V\eterinary Publit health S>ction
Epidemioilogp Program


EPIDEMIOLOGIC NOTES AND REPORTS
PSITTACOSIS United States


Because of the recent report of four human psittacosis
cases from Maryland, three of which were associated with
birds from the same wholesaler (MMIttR. Vol. 1s, No. 19).
a survey of states reporting cases in 1969 was conducted.
As a result, a total of 13 cases were noted. These in-
cluded four cases in Maryland, three case- in Connecti-
cut, two cases in California, and one case each in Georgia.
New Mexico. North Carolina, and Wisconsin. Six of the 13
cases occurred in the fall of 196S. Ten of the 13 cases
occurred in women. The youngest case was age 9 and three
cases were under age 20. There were also two cases be-
tween ages 20 and 39 and seven cases between ages 40
and 59: age was not recorded for one case. The four
Maryland cases and five other cases had definite associa-
tion with psittacine birds that had become ill. Two per-
sons had probable association with pigeons or other wild
domestic birds. one person had no known contact with
birds, and no history waas available for the two remaining
cases. In all instances, the diagnosis was made on the
basis of serology alone and there were no isolates axail-
able for study. Although the psittacine birds associated
with three of the four human cases in Maryland came from


the same wholesaler and were imported through New York
City. only in one of the fi\e other cases associated with
psittacine birds has it been possible to trace the bird to
the same wholesaler. anotherr bird which was also im-
ported through New York City came from a different whole-
saler, and one bird w\as imported through a wholesaler in
California.
(Reported by George L. Humphrey. y ..V... State Public
Health Veterinarian. (alifornia State Departmenti of Pu blic
Health; Jamne ('. Hart. I.D.. V.P.!l.. Director, l)iiv ion
of Preventable Diseases, Connecticut State Departme nt of
Health; John ficCroan, Ph.D., Director. Epiidemiolouic In-
vestigations Branch, Gerorgia Departmentt of Public Health:
Kenneth L. Craiforil. )D..I .. V.P.f!.. Chief. l)iriion of
Ieterinary t edici~tn, ifryla.nd Stale Depairtmen of health
Bruce Storrs. .V)D., director. tVeica a l Serrice, Di) iio
New ex-ico Departmente of Health and Sociii S services;
.artin P. Hlines. .... Mf.P.. D e or. IDii, ion of
Epidenioltogy. \orth 'arolina Staxt H oiiar of Hlealth; and
H. Grant SAkinner. .l.0.. Chief. Communicable Diseases
Section. Wisconlsi State [epartment f Health andi Social
Service s.)


MAY 17. 1969








172 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MAY 17, 1969 AND MAY 18, 1968 (20th WEEK)


ASEPTIC ENCEPHALITIS HEPATITIS
MENIN- BRUCEL- DIPHTHERIA Primary including Post- MALARIA
AREA GITIS LOSIS unsp. cases Infectious Serum Infectious
Cum.
1969 1969 1969 1969 1968 1969 1969 1969 1968 1969 1969
UNITED STATES... 15 6 8 17 16 6 87 967 946 65 1,004

NEW ENGLAND.......... 5 9 73 31 5 39
Maine ............. -. 1 2 2
New Hampshire...... 1 1 2
Vermont............ 3 1 -
Massachusetts...... 4 6 36 16 4 30
Rhode Island....... 1 18 7 1 1
Connecticut ........ 1 2 14 4 4

MIDDLE ATLANTIC...... 2 2 1 2 29 174 121 2 108
New York City...... 14 60 53 8
New York, up-State. 2 31 17 2 21
New Jersey.......... 1 10 37 30 36
Pennsylvania........ 2 1 1 1 3 46 21 43

EAST NORTH CENTRAL... 4 2 5 168 160 2 80
Ohio................ 2 34 31 10
Indiana............ 1 13 14 7
Illinois............. 1 4; 49 2 36
Michigan........... 4 1 2 68 50 26
Wisconsin.......... 11 16 1

WEST NORTH CENTRAL .. 1 1 1 1 48 73 7 69
Minnesota.......... 1 10 11 7
Iowa............... 1 8 20 5
Missouri........... 1 21 28 6 21
North Dakota........ 1 2
South Dakota....... 2
Nebraska............. 1 3
Kansas............. 1 6 13 1 31

SOUTH ATLANTIC....... 4 3 2 4 1 7 110 68 21 332
Delaware........... 1 1 2
Maryland........... 1 1 2 20 18 1 10
Dist. of Columbia. 3 1
Virginia........... 1 1 1 3 9 12 1 13
West Virginia...... 10 1 -
North Carolina..... 1 10 16 8 145
South Carolina..... 3 1 26
Georgia............ 2 19 3 10 119
Florida............ 2 1 5 35 17 16

EAST SOUTH CENTRAL... 2 7 1 1 62 50 7 32
Kentucky........... 1 1 40 21 6 26
Tennessee.......... 1 1 18 16 -
Alabama............ 7 4 1 1 6
Mississippi......... 12 -

WEST SOUTH CENTRAL... 1 1 1 1 64 97 4 30
Arkansas.......... 2 6 5
Louisiana ......... 1 1 1 14 14 3 22
Oklahoma........... 6 21 1 3
Texas............. 1 42 56 -

MOUNTAIN............. 1 5 30 72 3 72
Montana............ 2 11 -
Idaho............... 5 5 3 1 2
Wyoming ............ 2 -
Colorado............ 1 .- 1 28 1 64
New Mexico......... 2 6 1 4
Arizona............ 14 22 1
Utah................ 4 1 1
Nevada............. 1 -

PACIFIC.............. 6 1 7 3 31 238 274 14 242
Washington........... 25 35 5
Oregon............. 2 1 19 17 1 6
California.......... 4 1 7 3 30 189 222 10 194
Alaska............. 1 -
Hawaii............. 4 3 37

Puerto Rico...*...... 29 30 1

*lDelaved reports: Aseptic meningitis: La. 1
Hepatitis, infectious: La. delete 1, P.R. delete 19







Morbidity and Mortality Weekly Report 173


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MAY 17, 1969 AND MAY 18, 1968 (20th WEEK) CONTINUED



MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL
AREA Total Paralytic
AREA Cumulative Cumulative Total Paralytic
Cum.
1969 1969 1968 1969 1969 1968 1969 1969 1969 1969 1969
UNITED STATES... 990 13,442 13,797 73 1,703 1,398 2,555 1 1 2 2,801

NEW ENGLAND........... 36 699 632 7 56 72 372 179
Maine..*............ 4 13 1 5 5 14 3
New Hampshire...... 8 208 112 1 7 1 -
Vermont............ 2 1 1 53 22
Massachusetts...... 12 134 187 4- 26 32 158 59
Rhode Island ....... 9 1 4 6 36 5
Connecticut........ 16 342 318 2 20 21 110 90

MIDDLE ATLANTIC...... 353 4,712 2,127 12 257 232 191 189
New York City...... 269 3,364 776 2 46 46 141 51
New York, Up-State. 30 427 906 4 45 38 NN 29
New Jersey.. ...... 18 417 370 4 108 84 50 18
Pennsylvania....... 36 504 75 2 58 64 NN 91

EAST NORTH CENTRAL... 85 1,357 2,952 9 219 154 476 b34
Ohio............... 10 217 240 3 76 40 38 59
Indiana............. 34 399 516 28 19 80 104
Illinois........... 14 224 1,165 2 37 37 73 50
Michigan........... 4 128 186 4 64 45 120 243
Wisconsin .......... 23 389 845 14 13 165 178

WEST NORTH CENTRAL... 19 397 299 3 80 65 320 313
Minnesota.......... 1 2 13 16 16 45 21
Iowa................ 16 257 73 10 4 226 23U
Missouri............ 1 15 67 3 31 18 27 49
North Dakota....... 6 105 3 7 11
South Dakota....... 4 4 NN -
Nebraska........... 113 29 9 6 5 2
Kansas ............. 1 4 8 14 14 10 -

SOUTH ATLANTIC....... 167 1,918 1,071 8 304 303 187 345
Delaware........... 29 227 8 4 4 4 8
Maryland........... 30 66 29 18 12 24
Dist. of Columbia.. 3 6 8 11 6
Virginia........... 113 805 218 35 21 24 110
West Virginia...... 6 150 175 13 7 77 100
North Carolina..... 6 154 257 4 49 60 NN -
South Carolina..... 2 93 10 1 44 53 5 2
Georgia............ 1 3 1 52 57 1 -
Florida............ 11 455 328 2 70 72 64 95

EAST SOUTH CENTRAL... 7 69 362 14 102 121 119 171
Kentucky........... 7 36 82 11 36 46 52 120
Tennessee .......... 15 50 39 40 66 47
Alabama ............ 1 61 3 17 17 1
Mississippi........ 17 169 10 18 1 3

WEST SOUTH CENTRAL... 221 3,097 3,722 8 244 247 303 1 1 2 231
Arkansas........... 3 2 2 27 15 -
Louisiana..*........ 74 2 3 69 64 -
Oklahoma............ 2 111 103 23 46 52 109
Texas.............. 219 2,909 3,615 3 125 122 251 1 1 2 122

MOUNTAIN............. 69 458 705 1 34 22 163 160
Montana ............ 4 8 57 4 2 30 -
Idaho............. 4 42 11 6 9 5 12
Wyoming.............. 8 44 1
Colorado........... 29 99 346 6 7 14 104
New Mexico......... 9 161 70 6 9 11
Arizona ............. 22 136 153 8 1 76 25
Utah............... 1 3 19 1 2 29 7
Nevada............... 1 5 2 3- -

PACIFIC............. 33 735 1,927 11 407 182 424 579
Washington......... 3 49 463 50 29 132 80
Oregon.............. 6 153 375 9 16 9 39
California......... 18 511 1,056 10 329 127 248 393
Alaska.............. 10 1 11 4 -
Hawaii............. 6 12 33 8 10 31 67

Puerto Rico......... 162 600 289 12 16 14
*Delayed reports: Measles: Me. 2, N.J. delete 2, P.R. delete 25
Meningococcal infections: La. delete 1
Mumps: Me. 1, P.R. delete 9
Rubella: Me. 8, P.R. delete 9







174 Morbidity and Mortality Weekly Report


TABLE 11. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MAY 17, 1969 AND MAY 18, 1968 (20th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE ThIOAT & TETANUS TLIAREMIA TICK-BO RNE AI
AREA SCARLET FEVER VE (Rky. Mt. Spotted)
u. Cuu.. Cun.. lum.
969 96 1969 1969 1969 91969 1969 1969 9 1969 1969
'NITED STATES... 8,751 1 41 5 38 7 105 12 33 59 1,547

NEW ENGLAN........... 1,298 1 1 2 5
ine ............ 14 1 4
New Hapshire...... -
Vermont............ 43 1 1 I
Massachusetts...... 263 1 -
Rhode Isand ....... 2 -
Connect icut........ 876 -

SIDLE ATLANTIC..... 286 6 2 10 4 47
New York City...... 55 4 1 6 -
e York, p-State. 153 2 1 2 3 44
Ne, Jersev......... N
Pennsylvania....... 78 2 1 3

EAST NORTH CENRAL... 747 1 4 2 10 7 92
Ohi... ....... 141 6 2 28
Indian............ 13 1 3 23
Illinois........... 162 1 2 1 1 1 17
Michigan........... 184 2 3 2
Wisconsin.......... 128 .- 1 22

-EI ORTH CETRAL... 377 4 3 4 10 289
Minnesota........... 1 1 1 4 71
a ............... 89 3 39
issouri........... 38 3 2 2 2 3 89
N rt: Daa ...... 12 34
u Da....... 2 13
Nebraska........... 47 I 8
ansas. ............ 52 1 35

50LTH ATIANTIC....... 054 9 13 14 5 11 14 439
Dela are. ........... 7 -
Maryland ........... 1 2
Dist. of Clubia.. 1 2 -
Virginia........... 306 2 238
est Virginia...... 193 1 2 1 2 3 67
N7rth Carolina..... 23 1 5 3 3 7 4
South Carolina..... 42 1 1 -
CGergia............. 14 1 5 3 37
Florida............ 264 4 4 2 9 93

EAST SOlH CENR.AL... 1,44s. 4 7 11 3 12 8 259
Kentucky........... 173 2 2 1 5 147
Tennessee........... 1,344 2 6 8 2 10 2 86
Alaba ............ 94 1 1 1 26
Mississi ppi ....... 13 1 -

-EST SOCTH CENTAL... 726 12 2 4 3 15 3 5 8 205
Arkansas........... 7 1 1 6 2 2 16
Louisiana.......... 2 5 13
Oklah-a ........ 133 1 1 3 2 3 34
Texas...... ..... 58 6 3 9 1 1 5 142

MOrTAI ............. 1,742 2 5 14 1 4 5 62


v2-ing ............ 167 1 1 2 37
Coorado.. ......... 1,16 2 4 2
Nw Mexic ......... 171 1 5 7
Arizona.. ............. l9 1 3 12
rah............... 45 1 3 1
Neda........... 1 -- 3

AC FIC.............. ,17 5 -1 25 1 3 149
a rhinn...... 324 -1 I -
egn............ 94 6 -- -
California......... 644 4 1 18 1 3 149
Aasa.............. .. ... 19
Si. ........... -




Typhoid fever: Me. 1
Rabies in animals: Ariz. 1








Morbidity and Mortality Weekly Report


TABLE IV. DEATHS IN 122 UNITED STATES CITIESS FOR WEEK ENDED MAY 17, 1969

---" (By place of occurrence' anda''eek of filing certificate. Excludes fetal deaths)


All Causes Pneumonia Under All Causes Pneumonia Under
Area All nd 1 year Area All 65 years Infunza All
Ages and or Influenza All Influenza 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.------
Cary, Ind.------------
Grand Rapids, Mich.---
Indianapolis, Ind.----
Madison, Wis.---------
Milwaukee, Wis.-------
Peoria, Ill.----------
Rockford, Ill.--------
South Bend, Ind.-------
Toledo, Ohio----------
Youngstown, Ohio------

JEST 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.--------


702
211
42
30
19
64
27
20
33
49
72
9
41
26
59

3,233
62
44
169
38
25
59
56
82
1,692
32
397
204
37
95
22
45
74
41
25
34

2,605
80
56
674
180
220
164
63
328
35
59
46
43
53
133
32
157
34
27
44
93
84

809
51
29
41
119
23
119
79
213
79
56


420
120
32
16
10
35
14
12
24
26
42
7
29
17
36

1 ,924
37
27
103
30
14
36
31
43
1,003
18
227
113
29
64
15
31
38
21
22
22

1 ,474
51
37
356
115
114
81
38
181
24
30
25
17
39
74
18
95
21
16
29
56
57

474
32
17
26
67
18
72
44
116
51
31


6

122
4
7
6
4

6
7
1
57
1
6
15
2
2

I
1


2

79

2
24
5
8
2
1
7
1
2
4
3
5

2
3

3
1
4
2

30
4
1
2
2

1
1
7
3
9


SOUTH ATLANTIC:
Atlanta, Ca.-----------
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.----------


1,195
134
235
55
76
90
55
90
42
78
69
235
36

615
83
55
40
130
152
42
32
81

1 ,210
35
40
41
157
63
77
232
72
141
92
112
70
78

423
36
21
128
11
104
25
44
54

1,681
20
58
31
49
97
547
87
27
141
51
97
186
44
139
65
42


635
67
131
25
40
50
32
48
21
63
42
98
18

340
43
29
21
77
84
25
18
43

626
20
24
17
78
29
43
127
32
72
40
58
40
46

260
17
17
86
7
66
14
25
28

1 ,034
15
3U
24
28
59
345
47
20
93
27
62
109
32
72
44
27


Total 12,473 7,187 438 598


Cumulative Totals
including reported corrections for


previous weeks


All Causes, All Ages ------------------------. 275,934
All Causes, Age 65 and over------------------- 159,743
Pneumonia and Influenza, All Ages------------- 15,601
All Causes, Under 1 Year of Age--------------- 12,425


Week No.
20







176 Morbidity and M4



PROBABLE BOTULISM Chapel Hill, North Carolina

A previously healthy 6-year-old girl developed nausea
and vomitingg on Maxy 1.1969. Later that evening, she com-
plained of diplopia and was noted to have "crossed eyes"
I)y her mother. She %%as taken to the hospital and was
found to ha\e bilateral ptosis of the eyelids, strabismus,
and restricted range of ocular motion. No dysarthria,
dysphagia, dryness of the mouth, or sensory deficits
were noted and the child was afebrile. On the following
day, she was- hospitalized. Gastrointestinal symptoms
aere absent, hut bilateral facial muscular weakness was
noted. A lumbar puncture as well as skull X-rays. brain
scan, and pneumoencephalograim were normal. Several
challenges with edrophonium chloride were negative.
During succeeding days, the child developed dysarthria
and dysphagia. On May 6, respiratory difficulties ensued
requiring a tracheostomy. Symmetric skeletal muscle
weakness and an irregular pulse were noted on May 8. A
repeat lumbar puncture was again negative. At this point,
the previously considered diagnoses of polyneuritis and
brain stem lesion were felt to lie untenable and the diag-
nosis of botulism was made. The patient was immediately
treated with trivalent A, B, and E botulinum antiserum.
The following da\. improvement in respiration and de-
glutition was apparent. The patient has continued to im-
prove and is now ambulatory.
An epidemiologic investigation failed to elucidate a
contaminated vehicle. Likewise, no illnesses had oc-
curred in the patient's family. schoolmates, or in her
neighborhood.
Sera obtained on the day of admission and on May 8
were tested for mouse toxicity and were negative. A stool
specimen obtained on May 8 was also negative for Clos-
tridium botulinum.
(Reported by if'. Paul Glezen, M.D., Assistant Professor
of Pediatrics, and Orene Vaughan, M.D., Intern, Pediatric
Service, University of North Carolina School of Medicine;
0. D. Garvin, M.D., Orange County Health Department;
and Martin V. lines, D.V.M., M.P.Hl., Director, Division
of Epidemiology, North Carolina State Board of Health;
and a team of EIS Officers.)
Editorial Comment:
The clinical course is quite typical of botulism. The
slow progression of symptoms would suggest type B
botulism rather than type A. In the latter, a rapidly pro-
gressive, fulminant course leading to severe cranio-bulbar
paralysis and respiratory arrest usually occurs. Soil sur-
veys have shown that spores of type B, C. botulinum are
isolated more frequently east of the Mississippi excluding
the Great Lakes area than are types A and El; thus. the
geographic location of this case also favors type B botu-
lism. The absence of demonstrable toxin in the patient's
admission blood might be explained by a small dose of
ingested toxin and its complete binding to myoneural tis-
sue by the time of admission.
Reference:
IMeyer, K. E., and Eddie, B.: Sixty-Five Years of Human
Botulism in the United States and Canada: Epidemiology and
Tabulations of Reported Cases 1899 through 1964. George
Willhams Hooper Foundation, University of California, San
Francisco Medical Center, June 1965.


mortality Weekly Report


MAY 17, 1969


THE MORBIDITY AND MORTALITY WEEKLY REPORT. WITH A CIRCULA-
TION OF 18,500 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.
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.


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