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:
AA00010654:00220

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


A
i.

.:


341


nd 0


For

J uWe
. : Jul


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE / PUBLIC HEALTH SERVICE


DATE OF RELEASE: JULY


EPIDEMIOLOGIC NOTES AND REPORTS
PRIMARY AMEBIC MENINGOENCEPHALITIS Virginia

Three cases of primary amebic imerr,re-i,. e-phI, ,lr-
associated with swimming have occurred in Richmond,
\irg;r.a, this year. In early May, a 17-year-old boy was
admitted to a Richmond area hospital with a diagnosis of
purulent meningitis. No organism was cultured and he died
within 72 hours after admission in spite of antibiotic
therapy. Histologic examination of the brain found amebae
covering the cerebellum. Preliminary information revealed
that the youth had swum in the James River 4 days prior
to the onset of symptoms. Epidemiologic investigation is
continuing.
The second case, a 14-year-old boy, was admitted to
the Medical College of Virginia hospital on July 11. He
frt-qiuenii swam at inland lakes near Richmond, and on
July 2 he went to Lake Chester for the first time where he


18, 1969 ATLANTA,


t > .. I ,

Follow-up
International
Dengue- i
Influenza -
Current Trend
Encephalitis


I. 18, No. 28








ek Ending

y 12, 1969


AL HEALTH ADMINISTRATION




V a 241
. 242
242
. 248

h. . 243


did a considerable am rnTlallrII Tng and underwater swim-
ming. On July 9 he had the onset of headache and fever
and sought medical attention on July 10 because his
symptoms increased in severity. Primary amebic meningo-
encephalitis was diagnosed on admission after motile
amebae were detected on microscopic examination of a
fresh, unstained specimen of spinal fluid. The patient
was treated with intraventricular and intravenous ampho-
tericin B, metronidazole, and chloroquine, but expired
(Continued on page 242)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
28th WEEK ENDED CUMULATIVE, FIRST 28 WEEKS
MEDIAN
DISEASE July 12, July 13, 1964 1968 MEDIAN
1969 1968 1969 1968 1964 1968
Aseptic meningitis ...................... .119 77 57 944 1,020 862
Brucellosis ............................ 4 9 9 89 107 127
Diphtheria. ............................ 4 5 3 80 93 87
Encephalitis, primary:
Arthropod-borne & unspecified ......... 31 24 25 531 481 722
Encephalitis, post-infectious ............. 12 8 14 180 298 487
Hepatitis, serum ........................ 84 67 2,768 2,208
Hepatitis, infectious .................... 730 828 566 25,016 23,389 22,1
Malaria ................................ 40 54 7 1.410 1,161 165
Measles(rubeola) ....................... 318 320 1,871 18,721 18.037 182,610
Meningococcal infections, total ........... 46 36 38 2.102 1,727 1,727
Civilian ............................ 44 36 1.907 1.561 -
Military ........................... ... 2 195 166 -
Mumps ........ .......... ......... 930 1,271 -- 62.891 118,376 -
Poliomyelitis, total ..................... 1 3 2 4 33 31
Paralytic ............................. 1 3 2 4 33 29
Rubella (German measles) ............... 708 431 45,981 41,009 "
Streptococcal sore throat & scarlet fever.... 4,259 4,916 4.515 268,457 265,764 265,764
Tetanus ............................... 3 2 6 68 75 102
Tularemia ................... ... ........ 1 11 10 79 113 113
Typhoid fever .......................... 3 9 8 146 155 197
Typhus, tick-borne (Rky. Mt. spotted fever) 22 9 14 200 102 102
Rabies in animals ....................... 57 85 85 1.998 2.046 2449

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anrira\ : ..................................... ...... 2 Rabies in man: ............................. ........ .
BoaluIsm: ........................................ 10 Rubella congenital syndrome: ......................... 5
Leptaspirosis: Calif.-2, Ohio-1 ................... .... 34 Trichinosis: Ky.-1, N.Y.C.- ......................... 148
Plaeul: N. Mex.-2 .................................. 2 Typhus, murine: ...................... .............. 15
Peittacosis: Tenn.-1 ............................... 21


V .
*y r -'
-% -*.






242


after 72 hours without any response to treatment. Motile
amebae were found in postmortem cisternal and xentricular
fluid.
On July 12, a .2-year-old man was admitted to Rich-
mond Memorial Hospital where following a spinal tap.
primary amebic meningoencephalitis was diagnosed. He
was- then transferred to the medical College of irginia.
The patient had had the onset of headache. nausea and
%omiting on July 10 which increased in se\erits through
July 12. Following the diagnosis, the patient was inne-di-
ately begun on intracisternal and intravenous amphoterncin
B. metronidazole. and chloroquine. Subsequent ci-ternal
taps revealed nonmotile ameba which remained c able on
culture. His condition gradually deteriorated over the
next 2 days. he developed decerebrate posturing and re-
quired artificial ventilation, and he expired on the e en-
ing of July 15. On July 4 he had gone to Lake Chester
where he too had done a considerable amount of under-
water swimming and diving.
A sister of the second case who had also swum in
Lake Chester on July 3 was examined and her spinal fluid
was cultured after she developed a headache and fe\exr.
but no evidence of amebic meningoencephalitis was found.
Companions of the second case were also examined. but
no evidence of disease was noted.
Family members of the third case who had accom-
panied him to Lake Chester but had not done underwater


JULY 12, 1969


-wimming or diving were examined, and nasal cultures for
free-living ameba were obtained. No evidence of disease
wa- noted: however, results of the cultures are pending.
Because of the association of swimming in Lake Chester
with previous and the present fatal cases of amebic men-
ingoencephalitis. county officials closed the lake for
si iming on July 13.

(Reported by William P. Wagner, M.D.. Director, Chester-
fieid County Health Department, C', *.' .1. I r.'..,I
and Richard J.'Duma, M.D., and Read F. McGehee, 4..D.,
Infectious Disease Division, and Cary G. Suter, M.D.,
Cief. \Neurology Division, Department of Medicine, Medi-
cal College of Virginia, Richmond.)


Editorial Comment:
Since 1951-1952. a total of 13 cases of primary amebic
meningoencephalitis have been diagnosed in the Rich-
mond. Virginia, area. This is a uniformly fatal disease
due to a free-living ameba recently identified asNaegleria
gruberi. A prior history of swimming or other aquatic
activity is common to almost all cases of this disease.
Epidemiologic investigations are currently in progress to
define the role of swimming in the transmission of this
disease. Antibiotics, antiparasitic agents, and antimetab-
olites have all been tried unsuccessfully in the chemo-
therapy of this disease.


FOLLOW-UP PLAGUE New Mexico


The 3-year-old hoy in Jemez -ir...'- New Mexico.
with confirmed plague (IMMlihR, Vol. 1. No. 27) has shown
marked improvement following treatment. No other cases
ha\e been reported.
Moderate populations of chipmunks. pack rats. mice
(Genus Peromyscus). and a few rock squirrels were noted
in the area. No dead animals were found. There haxe been
no indications of plague in any of the animals processed


to date. Flea control measures with bait boxes placed on
the ground were initiated on July 14. 1969.
(Reported by Bruce Storrs, M.D., Director, and T. H. Tom-
linson, Jr., M.D., Division of Vedical Services, Neil
Ieber, Vammalogist, and Daniel Johnson, Ph.D., the
Public Health Laboratory, \New i ezico Department of
Health ; and the Ecological Investigations Program, NCDC,
Kansas Kansas, and Fort Collins, Colorado.)


INTERNATIONAL NOTES
DENGUE Puerto Rico


The outbreak of dengue in Puerto Rico is continuing.
During the week rir.o July 13. a total of 1.275 cases
were reported, bringing the total to date to over 6,000
cases. Few cases ha\e been reported from the southern
part of the island where previous Aedes aegypti eradica-
tion efforts had been concentrated. Illnesses have been
mild with many affected persons continuing to work. and
there have been no cases reported with hemorrhagic mani-
festations. A control program of ground spraying is under-
wax in areas reporting illness and additional measures
were begun in areas with high incidence of disease.


Aerial spraying was started in Manati and surround-
ing areas on July 16. and is being considered for a he.a' ils
populated river \alley in eastern Puerto Rico where many
cases have occurred. A survey conducted between July 8
and 14 of 2.544 persons in these areas, found 21.2 per-
cent reporting a ,l.-rnu-.. lk- illness during the previous
4 weeks (Table 1). The aerial spraying is an attempt to
reduce the total number of adult and infected mosquitoes
and to interrupt the cycle of infection. Two cycles of
spraying at 5-day intervals are being used. The interval
is based on the anticipated duration of viremia in infected


Morbidity and Mortality Weekly Report


AMEBIC MENINGOENCEPHALITIS (Continued from front page)







JULY 12, 1969 Morbidity and Mortality Weekly Report 243


Table 1 individuals and the time for development of newly hatched
Cases of Dengue-like Illness During 4 Weeks Aedes aegypti mosquitoes.
Prior to July 8 in the 4-Area Survey


Age Group Number Surveyed Number III Percent Ill
0-4 334 56 16.8
5-9 411 82 20.0
10-19 665 143 21.5
20-39 587 150 25.6
40+ 547 109 19.9
Total 2,544 540 21.2


(Reported by Dr. Ernesto Colon-Yordan, Secretary of
Health, Dr. Raphael Correa-Coronas,, Auxiliary Secretary
of Health for Preventiie Me1dicine, Dr. Luis Mainardi.
Chief. Communicable Disease, Control Program, and Dr.
Angel Alberto Colon, Director, Institute of Laboratories
of Health, Puerto Rico Department of Health; and a team
from NCDC.)


CURRENT TRENDS
ENCEPHALITIS California

Record precipitation during the past winter in Cali-
HOS
fornia particularly in some parts of the San Joaquin Valley FOR
has provided optimum conditions for an outbreak of arthro-
podborne encephalitis there this summer. Large areas of
normally arid land will remain under water :hroulhoiii the
summer enhancing the production of the Culex tarsalis
mosquito, the vector of Western equine (WE) and St. Louis
(SLE) encephalitis, both of which are endemic in large
areas of California.
To lessen the possibility of an epidemic of encepha-
lii-. in addition to the usual annual measures of surveil-
lance of water conditions and mosquito production and
testing specimens from suspected cases for confirmation
of viruses, special efforts are being made. Mosquito con-
trol efforts and surveillance of equine cases have been
intensified, and a special surveillance program for human
cases has been established. Under this surveillance pro-
gram, by early July, over 50 hospitals in the 20 counties
of the Sacramento and San Joaquin Valleys (Figure 1)
began submitting daily reports of hospital admissions with
certain central nervous system conditions to the health
officials of their respective counties. The county officials
send the reports weekly to the state health officials. This
information directs epidemiologists to areas where cases
are occurring. Also a more intensified effort is being made
by state and federal vector control specialists and the
School of Public Health, Berkeley, and the Division of
Infectious and Tropical Diseases, UCLA, to test mos-
quitoes from various locations in the Central Valley and
Imperial and Owens Valleys for arthropodborne viruses.
Weekly encephalitis bulletins are issued to feed back
promptly all the information collected. HOS
As of July 12, no laboratory confirmed human cases
have been detected, and no WE or SLE viruses have been
isolated from the mosquito pools tested.
Health Sec
(Reported by Richard W. Emmons, M.D., and R. Marlor, Rickettsial
M.D., Epidemiologists, Bureau of Communicable Disease Bureau of I
Control, G. Humphrey, D.V.M., Chief, Veterinary Public Health.)


Figure 1
PITALS IN SURVEILLANCE PROGRAM
CASES OF ENCEPHALITIS IN HUMANS
CALIFORNIA- 1969


PITAL


tion, E. H. Lennette, M.D., Chief, Viral and
Disease Laboratory, and R. Peters, Chief,
'ector Control, California Department of Public







244 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JULY 12, 1969 AND JULY 13, 1968 (28th WEEK)


AI-iPTi ENCEPHALITIS HEPATITIS
XiiX- I'Cul.n- DiIlmii Primary including Posl- MALARIA
AREA : SIS unsp. cases infrt... Serum Infectious
Cum.

UNITED STATES... 119 4 4 31 24 12 84 730 828 40 1,410

NEW ENGLAND.......... 15 1 3 1 2 35 34 2 46
Maineo............. 4 3 1 3
New Hampshire......l 2 2
Vermont............ .- 3 -
Massachusetts...... 1 1 1 1 12 14 33
Rhode Island ...... 14 1 6 10 1 3
Connecticut........ 2 1 8 7 5

MIDDLE ATLANTIC...... 13 5 1 3 29 124 150 2 154
New York City...... 6 2 1 16 12 53 13
New York, up-State 3 28 25 2 25
New Jerseys........ 6 1 7 42 35 54
Pennsylvania....... 1 2 3 3 42 37 62

EAST NORTH CENTRAL... 1 6 7 8 80 156 5 138
Ohio............... 4 3 2 22 39 14
Indiana. ........... 1 5 13 10
Illinois.......... 1 2 1 16 49 5 78
Michigan ........... 2 1 5 32 44 35
Wisconsin.......... 5 11 I

WEST NORTH CENTRAL... 3 3 3 1 61 47 2 90
Minnesota.......... 2 2 1 2 11 7
Iowa................ .- 2 8 7 7
Missouri........... 1 1 37 17 1 24
North Dakota....... 1 1 2
South Dakota....... 1 -
Nebraska............ 1 3
Kansas................. 13 10 1 47

SOUTH ATIANTIC....... 4 3 2 2 1 88 65 17 442
Delaware........... 1 3 2
Maryland............ 2 1 11 20 2 18
Dist. of Columbia.. 1 3 2 1
Virginia........... 1 8 3 1 17
West Virginia .... .. 7 1 -
North Carolina..... 1 2 3 6 4 201
South Carolina..... 1 I 15 2 2 41
Georgia............ .... 17 5 7 139
Florida ............ 1 1 24 23 1 23

EAST SOUTH CENTRAL .. 6 3 45 48 52
Kentucky .......... 11 12 42
Tennessee.......... 2 31 29 -
Alabama............... 2 3 3 8
Mississippi........ 1 4 2

WEST SOUTH CENTRAL... 6 3 3 71 50 2 40
Arkansas........... .- 6
Louisiana.......... 3 2 3 14 12 28
Oklahoma ........... 1 16 7 2 6
Texas..... .......... 3 -- 41 31 -

MOUNTAIN.............. 2 4 3 2 1 26 36 1 108
Montana............ 2 3 1 12 -
Idaho................ 2 3
Wyoming............. .
Colorado........... 5 1 93
New Mexico......... 1 1 5 6
Arizona ............ 4 1 12 12 1
Utah ............... 7 4 1
Nevada............. 1 4

PACIFIC.............. 70 2 5 6 6 39 200 242 9 340
Washington......... 4 1 -- 1 1 21 11 5
Oregon............. 24 12 1 7
California......... 10 1 5 4 6 38 153 214 4 258
Alaska............. 56 3 2
Hawaii.............. 1 2 2 4 68

Puerto Rio. .......... .. 40 15 -
c t- 40 15 1

*nela:ed reports: Hepatitis, serun: N.J. delete 15, Ky. 1 (1968)
Hepatitis, infectious: Me. 2, N.J. delete 5







Morbidity and Mortality Weekly Report 245


TABLE IlI. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JULY 12, 1969 AND JULY 13, 1968 (28th WEEK) CONTINUED


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

UNITED STATES... 318 18,721 18,037 46 2,102 1,727 930 1 1 4 708

NEW ENGLAND............ 42 987 1,082 70 88 141 1 67
Maine.*............ 5 35 6 6 27 5
New Hampshire...... 228 141 2 7 1
Vermont ............ 2 1 1 2 3
Massachusetts.*... 12 181 334 31 38 68 28
Rhode Island....... 22 1 6 7 2
Connecticut........ 30 549 570 25 29 44 1 28

MIDDLE ATLANTIC...... 120 7,067 3,466 4 335 304 83 -28
New York City...... 47 4,672 1,635 2 69 65 68 17
New York, Up-State. 15 566 1,155 51 48 NN 7
New Jersey.*....... 18 835 571 1 142 111 15 2
Pennsylvania........ 40 994 105 1 73 80 NN -- 2

EAST NORTH CENTRAL... 22 1,902 3,539 12 288 208 247 187
Ohio............... 7 344 279 9 107 56 46 23
Indiana.*.......... 453 616 34 26 29 28
Illinois........... 6 405 1,319 1 40 47 18 5
Michigan........... 197 238 1 89 62 58 98
Wisconsin.......... 9 503 1,087 1 18 17 96 33

WEST NORTH CENTRAL... 8 489 361 3 111 86 42 6
Minnesota.......... 5 15 1 24 19 1 1
Iowa................ 4 324 93 15 6 19 2
Missouri........... 16 80 2 48 31 15 2
North Dakota....... 2 9 123 3 3 1
South Dakota....... 3 4 1 4 NN -
Nebraska............ 2 128 36 9 6 2 -
Kansas............. 4 10 14 17 2 -

SOUTH ATLANTIC....... 24 2,359 1,370 10 373 351 100 1 1 1 150
Delaware............. 7 369 14 4 6 1 -
Maryland........... 63 82 33 26 5 4
Dist. of Columbia.. 6 9 13 7 1
Virginia........... 1 854 289 46 28 14 37
West Virginia...... 2 164 249 1 18 9 55 49
North Carolina..... 8 299 281 4 66 69 NN -
South Carolina..... 1 110 12 2 54 55 14 6
Georgia............. 1 4 3 64 61 -
Florida.............. 5 499 433 79 84 4 1 1 1 53

EAST SOUTH CENTRAL... 100 464 2 132 148 44 37
Kentucky........... 59 95 4b 57 16 10
Tennessee.......... 17 55 1 50 49 28 20
Alabama............. 3 85 1 21 22 -
Mississippi........ 21 229 15 20 7

WEST SOUTH CENTRAL... 62 4,141 4,482 5 285 286 81 2 66
Arkansas........... 16 2 28 19 -
Louisiana.......... 120 5 74 81 1 -
Oklahoma ........... 5 135 110 1 29 49 3 1
Texas.............. 57 3,870 4,365 4 154 137 77 2 65

MOUNTAIN............. 28 726 929 1 37 27 86 40
Montana.*........... 10 57 5 3 8 2
Idaho............... 4 88 20 6 11 1
Wyoming............ 50 2
Colorado............ 115 479 6 8 5 15
New Mexico......... 5 217 85 6 3 2
Arizona.............. 19 289 212 1 10 1 69 15
Utah............... 6 21 2 1 1 3
Nevada............. 1 5 2 3 -

PACIFIC............. 12 950 2,344 9 471 229 106 127
Washington.......... 57 514 50 37 10 2
Oregon.............. 1 191 454 11 17 17 16
California.......... 7 667 1,340 9 389 162 68 58
Alaska.............. 8 2 11 2 2 -
Hawaii.............. 4 27 34 10 11 9 51

Puerto Rico..........I 58 1,164 347 15 19 22 78

*Delayed reports: Measles: Mass. delete 1, N.J. delete 1
Meningococcal infections: Ind. delete 1
Mumps: Me. 7
Rubella: Me. 13, Mont. 1







246 Morbidity and Mortality Weekly Report


TABLE 111. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JULY 12, 1969 AND JULY 13, 1968 (28th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYP D TICK-BORNE RABIES IN
AREA SCARLET FEVER FEVER (Rky. Mt. Spotted) ANIMALS
Cum. Cum. Cum. Cum. Cum.

UNITED STATES... 4,259 3 68 1 79 3 146 22 200 57 1,998

NEW ENGLAND.......... 697 14 5 2 11
Maine?............. 6 1 I 5
New Hampshire...... 13 -
Vermont............. 13 14 1
Massachusetts...... 70 3 1
Rhode Island....... 56 1 -
Connecticut ....... 539 2 3

MIDDLE ATLANTIC...... 242 1 11 3 1 15 4 24 9 81
New York City...... 13 5 1 6 -
New York, Up-State. 204 2 2 5 5 9 7b
New Jersey......... NN 1 2 3 6 -
Pennsylvania....... 25 2 1 4 1 13 5

EAST NORTH CENTRAL... 289 9 7 13 3 131
Ohio.............. 23 7 35
Indiana............ 81 1 40
Illinois........... 39 6 2 2 2 25
Michigan........... 112 3 4 1 4
Wisconsin.......... 34 4 27

WEST NORTH CENTRAL... 153 4 1 8 4 2 9 372
Minnesota.......... 7 1 2 91
Iowa............... 39 1 54
Missouri........... 10 1 1 5 2 3 105
North Dakota....... 52 1 50
South Dakota....... 17 1 13
Nebraska............. 28 1 1U
Kansas............. 3 3 3 49

SOUTH ATLANTIC....... 500 1 14 19 26 9 108 8 535
Delaware............ 1 2 -
Maryland.* ......... 41 4 25 -
Dist. of Columbia.. 2 2 I -
Virginia........... 73 3 3 36 7 278
West Virginia...... 193 1 2 1 4 1 84
North Carolina..... NN 2 5 4 1 29 4
South Carolina..... 46 1 2 1 1 b -
Georgia............ 1 3 7 4 6 48
Florida............ 144 1 8 4 7 121

EAST SOUTH CENTRAL... 917 1 10 9 1 16 5 32 7 311
Kentucky........... 75 3 2 5 2 163
Tennessee........... 778 4 8 1 12 5 26 1 111
Alabama............ 36 1 2 1 1 34
Mississippi........ 28 1 1 2 3 3

WEST SOUTH CENTRAL... 420 13 11 1 20 4 21 11 271
Arkansas........... 1 10 4 1 21
Louisiana.......... 3 5 2 1 1 1 17
Oklahoma........... 13 1 5 4 14 1 41
Texas.1.............. 404 7 3 9 3 8 192

MOUNTAIN.............. 902 1 8 20 8 1 92
Montana.* ........... 25 -
Idaho.............. 49 3 1 -
Wyoming............. 1 2 5 1 48
Colorado........... 603 1 2 7 3
New Mexico......... 106 1 5 9
Arizona.............. 81 4 22
Utah............... 37 5 2
Nevada............. 1 8

PACIFIC............... 139 6 27 5 7 194
Washington......... 73 1 1 3 1
Oregon............. 49 6 1
California......... --- 5 20 2 7 192
Alaska.............. 17 -
Hawaii .............. -

Puerto Rico ......... 4 1 4 3 I18


*Delaved reports: SST: Me. 8
Tularemia: Tex. delete
I~1SF: Mtd. Delete 1


1, Mont. delete 1







Morbidity and Mortality Weekly Report






TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED JULY 12, 1969

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


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.----

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.--------


All Causes Pneumonia Under All Causes Pneumonia Under

11 65 years and 1 year Area All 65 years Iand 1 f za
Ages and over Influenza All Ages and over Influenza All
All Ages Causes All Ages Causes


747
242
47
30
29
45
35
24
39
55
59
9
29
28
76

3,319
54
28
156
38
37
40
79
79
1,669
37
401
227
56
118
38
56
99
35
31
41

2,701
82
41
692
170
211
142
81
360
47
72
52
40
54
163
32
161
33
38
41
127
62

913
61
20
43
162
30
113
70
275
76
63


446
148
32
23
16
21
20
11
25
28
33
6
21
19
43

1 ,932
22
18
104
15
21
30
48
29
960
19
230
124
40
84
22
39
56
19
26
26

1,528
45
20
370
100
113
88
58
191
30
34
34
21
33
99
16
97
15
25
22
81
36

555
37
11
23
97
21
72
33
169
53
39


*Estimate based on average percent of divisional total.


SOUTH ATLANTIC:
Atlanta, Ga.-----------
Baltimore, Md.--------..
Charlotte, N. C.-------
Jacksonville, Fla.---
Miami, Fla.-----------
Norfolk, Va.-----------
Richmond, Va.-----------
Savannah, Ga.-------...
St. Petersburg, Fla.---
Tampa, Fla.------------
Washington, D. C.------
Wilmington, Del.-------

EAST SOUTH CENTRAL:
Birmingham, Ala.-----
Chattanooga, Tenn.---
Knoxville, Tenn.----
Louisville, Ky.--------
Memphis, Tenn.--------
Mobile, Ala.----------
Montgomery, Ala.----
Nashville, Tenn.------

WEST SOUTH CENTRAL:
Austin, Tex.-----------
Baton Rouge, La.-------
Corpus Christi, Tex.---
Dallas, Tex.-----------
El Paso, Tex.---------
Fort Worth, Tex.------
Houston, Tex.---------
Little Rock, Ark.------
New Orleans, La.-------
Oklahoma City, Okla.---
San Antonio, Tex.----..
Shreveport, La.--------
Tulsa, Okla.-----------

MOUNTAIN:
Albuquerque, N. Mex.---
Colorado Springs, Colo.
Denver, Colo.----------
Ogden, Utah------------
Phoenix, Ariz.---------
Pueblo, Colo.-----------
Salt Lake City, Utah---
Tucson, Ariz.----------

PACIFIC:
Berkeley, Calif.-------
Fresno, Calif.---------
Glendale, Calif.-------
Honolulu, Hawaii-----..
Long Beach, Calif.-----
Los Angeles, Calif.----
Oakland, Calif.--------
Pasadena, Calif.----..
Portland, Oreg.-------
Sacramento, Calif.---
San Diego, Calif.-----
San Francisco, Calif.--
San Jose, Calif.-----..
Seattle, Wash.---------
Spokane, Wash.------...
Tacoma, Wash.----------


1,282
137
229
53
100
109
57
92
51
97
77
240
40

696
78
57
46
123
179
63
39
111

1 ,320
49
51
38
166
49
99
194
63
217
96
158
67
73

496
48
27
127
25
100
40
65
64

1,772
26
66
39
54
108
652
82
42
97
65
81
177
33
152
58
40


Total 13,246 7,601 484 620

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 374,736
All Causes, Age 65 and over------------------- 215,847
Pneumonia and Influenza, All Ages------------- 18,985
All Causes, Under 1 Year of Age--------------- 17,122


Week No.
28


247


1 I







Morbidity and Mortality Weekly Report


INTERNATIONAL NOTES
INFLUENZA South Americo*


()tilrireak- of \X2 Honi Kong 0, influenza have been
confirinr:d in \rgontina. Brazil. (Chilh. and i'ruguay. In
Brazil. a progrves- increase in incidi nce of influenza-
lik> dili-ea-i was os-er'ed in the slate of Guanabara dur-
Il tihe1 irs- 21 eek- of March 1969 and in Belem. Para
State. in Firu:ar and March. Four strains of A2 Hong
Kong (is influenza /wre isolated from residents of Rio de
,Janeiro. (iuanabara. between March 14 and 18 and three
-train- oere rccoxoered from Belem. A survey of 9,0002
per-on- in 11 r-etablishments in Belem revealed that more
than hulf of them had been affected since January 1. with
the highe-t incidence occurring during the week of March 15.
In Argentina. two outbreaks of influenza-like disease
%ere reported between May 7 and 21. The first occurred
in Comodoro Riada ia City in Patagonia. Although school
and labor ab-enteeism remained normal for the season,
Sases were observed especially from May 12-15. Their
number is no\% decreasing. The second outbreak occurred
in the southern suburbs of Buenos Aires City where only
a few case-s ere detected. In both outbreaks. the disease
Ns- mild. and several strains of A2 Hong hr-I.' '68 were
isolated. A third outbreak occurred in Cordoba City and
other cities in Cordoba Province during the first week of
June. Twenty-two strains of A2. Hong Kong 68 were
recox ered.
In Chile, isolated confirmed cases were noted at the
end of May or beginning of June. and in Iruguay an epi-
demic began in mid-June.
(Reported by Dr. E. Pearson and miss Vanuela Vicente,
Deparramento de Viru., Instituto Bacterioloyico de Chile;
Dr. Juan C. Rivadeneira, Director. Institute de Virologia,
Uni`ersidad a\'cional de Cordoba; and the WHO, Interna-
tional Influenza Center for the Americas, Atlanta.)
"Source: o'rd Health Organization Ieekly Epidemmological
Record, .4(23 nnd 26):391, 426.











ERRATUM, Vol. 18, No. 23, p. 204
In the list of Yellow Fever Vaccination Centers, the
fee for yellow fever vaccination at the Ochsner Clinic
should he changed from "No" to "-6.00 for first patient
and $1.00 for each additional member of a family up to a
total of fi\e."'


,1 ULV 12. 1969


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TON OF 18.500 IS PUBL SHED 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.O.
MANAGING EDITOR PRISCILLA B. HOLMAN
IN AODDTION TO THE ESTABLISHED PROCEf'-,E ; '.* REFipOPRT,
MORBIDITY AND MORTALITY, THE NATIONAL C ( AvLMM i C 'EL D0 ,E SE
CENTER WELCOMES ACCOUNTS OF INTERESTIt.IC. '*," 61r OR C -SE
INVESTIGATIONS WHICH ARE OF CURRENT INTEREST -E AL t
OFFICIALS AND WHICH ARE DIRECTLY RELATED TO THI CO rOL.
OF COMMUNICABLE DISEASES. SUCH COMMUNICATIONS ;O' LD BE
ADDRESSED TO:
NATIONAL COMMUNICABLE DISEASE CENTER
ATTN: THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT
ATLANTA. GEORGIA 30333

NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AD A RE
BASED ON WEEKLY TELEGRAMS TO THE NCDC BY THE -.'0.DuAL
STATE HEALTH DEPARTMENTS. THE REPORTING WEEK CONCLUDES
AT CLOSE OF BUSINESS ON FRIDAY: COMPILED DATA ON A NATIONAL
BASES ARE OFFICIALLY RELEASED TO THE PUBLIC ON THE UiCCEED
ING FRIDAY.


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