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:
AA00010654:00222

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


and :
X- e.




a~02b


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE /PUBLIC HEALTH SERVICE HEALTHH SERVICES AND MENTAL HEALTH ADMINISTRATION
DATE OF RELEASE: AUGUST 8, 1969 ATLANTA, GEORGIA 30333


EPIDEMIOLOGIC NOTES AND REPORTS
HEPATITIS Cook County, Illinois

Between May 25 and July 12, 1969. 16 cases of viral
hepatitis were reported among patients at e 300-bed com-
munity hospital in Cook County, Illinois. Twelve of these
patients had been previously hospitalized on a single
surgical ward from Feb. 24 to March 31, 1969, and had
contact with a nurse who became jaundiced on March 29
(Figure 1). The other four cases represented sporadic
occurrences of hepatitis. The 12 associated patients'
symptoms included malaise, arthralgias, and jaundice.
Hepatitis was confirmed by laboratory tests in all 12,
and sera from six of nine patients tested were positive
for Australia anligrn The range of possible incubation
periods for all patients was from 71 to 114 days with a
mean of 92 days. The eight female and four male patients
ranged in age from 21 to 60 years. All 12 had undergone


CONTENTS
Epidemiologic Notes and Reports
Hepatitis Cook County, Illinois .. ......... 269
Arthropodborne Encephaltis Unit'd ~ tes ..... .. 27T
Blood Transfusion Induced Malaria New York City 271
International Notes
Smallpox Worldvide ......... ... ............ 271




surgery and two had received blood transfusions: 10 of
the 12 had received halothane anesthesia. None gate a
history of contact with a known hepatitis case outside
the hospital or ingestion of raw shellfish.
In a comparison group of 35 other surgical patients
hospitalized on the same ward between February 24 and
March 31, none had received transfusions, and 29 had
undergone halothane anesthesia. The mean duration of
(Continued on paye 270)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
31st WEEK ENDED CUMULATIVE. FIRST31 WEEKS
MEDIAN
DISEASE MEDIAN
DISEASE August 2. August 3, 1964 1968 MEDIAN
1969 1968 1969 1968 1964 1968
Aseptic meningitis ...................... 75 144 72 1.156 1.402 1.104
Brucellosis ............................ 7 9 6 111 125 144
Diphtheria.............................. 3 1 86 100 99
Encephalitis, primary:
Arthropod-borne & unspecified .......... 43 28 41 620 552 841
Encephalitis, post-infectious ............ 14 11 Q3 204 328 533
Hepatitis, serum ........................ 95 96 I 3.065 2.498
Hepatitis, infectious .................... 963 906 27,656 25,979 21
Malaria ................................ 87 42 3 1.633 1.268 192
Measles (rubeola) ....................... 231 226 844 19.540 18,765 186,190
Meningococcal infections, total........... 43 24 40 2.210 1.840 1,840
Civilian ........................ ...... 41 24 2.008 1,667
Military ............................... 2 202 173
Mumps ................................. 724 947 65.310 121.236 -
Poliomyelitis, total ................ ..... 1 2 3 6 37 37
Paralytic ............................. 1 2 3 6 37 37
Rubella (German measles) ............... 335 425 47,316 42,181
Streptococcal sore throat & scarlet fever.... 4,541 4,703 4.202 281,750 279.110 279,110
Tetanus ............................... 5 3 6 82 85 124
Tularemia ............................. 1 2 3 87 123 123
Typhoid fever ......................... 5 9 11 161 185 229
Typhus, tick-borne (Rky. Mt. spotted fever) 19 15 15 277 149 150
Rabies in animals .................... .50 58 70 2203 2208 2740

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: .............................. ........ .... 3 Rabies in man: ...................................... 1
Botulism: ......................................... 11 Rubella congenital syndrome: ......................... 6
Leptospirosis: Kans.-l ............................ 38 Trichinosis: Calif.-2. Pa.-1 ........................... 151
Plague: ......................................... 3 Typhus, murine: Tex.-14 ............................- 31
Psittacosis: Pa.-l .................................. 23


~t:
cT


5;' *i' *if






Morbidity and Mortality Weekly Report


AUGUST 2, 1969


HEPATITIS (Continued from front page)


hospital stay was 9.4 days for the 12 persons who later
developed hepatitis and 6.5 days for the comparison group.
Ten of the 12 hepatitis patients had received IM Demerol*,
from the involved nurse compared with 22 of the 35 pa-
tients in the comparison group. No break in the nurse's
aseptic technique could be ascertained.
The nurse most likely contracted her hepatitis from
an accidental needle puncture which occurred in the
second week of January. The needle was contaminated
with blood from a multiply-transfused patient who devel-
oped jaundice in the third week of January. The nurse
probably transmitted her disease between February 24
and March 31 while caring for the 12 patients. The exact
route of transmission is not known. To date, no secondary
infections have been reported.
(Reported by Norman J. Rose, M.D., M.P.H., Chief, Bureau
of Epidemiology, Illinois Department of Public Health;
Colette M. Rasmussen, M.D., M.P.H., Chief, Division of
Preventive Medicine, Cook County Department of Public
Health; and an EIS Officer.)
*Trade names are provided for identification only, and inclu-
sion does not imply endorsement by the Public Health Service
or the United States Department of Health, Education and
welfare.


Editorial Comment:
The clinical history, incubation period, and lack of
contact with known hepatitis during the 2 months prior to
onset of symptoms are consistent with the epidemiology
of classic serum hepatitis. Moreover, the presence of
Australia antigen in sera from 67 percent of the patients
is compatible with the I'riiI.- of Princel and Blumberg
et al2 who demonstrated Australia antigen in 77 percent
and 41 percent, respectively, of cases of posttransfusion
hepatitis. The latter investigator found Australia antigen
in only 22 percent of infectious hepatitis cases.
In this outbreak the nurse represented the only ex-
posure common to all 12 patients. In 10 of the 12 cases
the parenteral route of infection was a possibility; in all
12 a fecal-oral route might be implicated. The exact
method of transmission is not known. Close surveillance
of household contacts is being maintained in order to
detect potential secondary spread of the disease.
References:
Prince, A. M.: An antigen detected in the blood during the
incubation period of serum hepatitis. Nat Acad Sci, 60(3):914,
July 1968.
- I'..I l .i B. B et al.: Australia antigen and hepatitis. JAMA
207(10):1895, March 10, 1969.


Figure 1
CASES OF HEPATITIS BY PERIOD OF HOSPITALIZATION
AND DATE OF ONSET, A HOSPITAL, COOK COUNTY, ILLINOIS
JAN. 4 JULY 19, 1969




- i -














7 .,a,*, .



ARTHROPODBORNE ENCEPHALITIS United States


Record precipitation during the past year in many
areas of th-e rountr has provided optimum conditions for
the occurrence of outbreak- of arthropodborne encephalitis
ti:- -umnmr. Bec-ause of this possibility, surveillance for
human aind quine encephaliti- cas-- has been intensified
in mran s-rate-. t the present time. there are two active
foci of arthropodborne encephalitis: the Columbia River
Basin in Oregon and Washington and north and north-
central Florida.


Two counties in northern Oregon (Morrow and Uma-
tilla) and three in southern Washington (Benton. Franklin,
and Yakima) all part of the Columbia River Basin -
reported approximately 110 cases of clinical equine en-
cephalitis. Two cases in nashington and three in Oregon
were confirmed as westernn Equine Encephalitis, with
laboratory data on the others pending. No human cases
were reported. Surveillance and mosquito control efforts
have been initiated.


270









In Florida, two human cases of Eastern Equine En-
cephalitis were reported. A 10-year-old girl from Orlando
expired on June 18, after a 6-day illness characterized
by high fever, nuchal rigidity, severe headache, and con-
vulsions. Eastern Equine Encephalitis virus was isolated
from brain material obtained at postmortem. A 6-month-
old boy with similar symptoms became ill on July 7. Paired
sera specimens taken on July 9 and 22 showed a diag-
nostic rise in complement fixation antibody titer against
Eastern Equine Encephalitis antigen from negative to
1:16. This child is from Tallahassee but probably ac-
quired the disease in neighboring Madison County, where
he was visiting during the 2 weeks prior to illness. Madi-
son County has reported Eastern Equine Encephalitis
in the past, with four human cases recorded in 1965. In
addition, clinical equine encephalitis is occurring in the
north and northcentral part of Florida, extending from the
western border as far east as Gainesville. Surveillance


271


and mosquito control activities have been increased.
Cases of equine encephalitis were recently confirmed
in California, Georgia, Minnesota, and Texas: no human
cases were reported.

(Reported by Philip Condit, M.D., Chief, Bureau of Com-
municable Diseases, California State Department of Pub-
lic Health; David Dreesen, D.V.M., State Veterinarian,
Georgia Department of Public Health; D. S. Fleming,
M.D., Director, Division of Disease Prevention and Con-
trol, Minnesota Department of Health; Monroe Holmes,
D.V.M., Public Health Veterinarian, Oregon Department
of Health; M. S. Dickerson, M.D., State Epidemiologist,
Texas State Department of Health; J. Byron Francis, M.D.
Chief, Division of Epidemiology, Washington State De-
partment of Health; and the Ecological Investigations
Program, NCDC, Kansas City, Kansas, and the Viral
Diseases Branch, Epidemiology Program, NCDC.)


BLOOD TRANSFUSION INDUCED MALARIA New York City


Two cases of transfusion induced Plasmodium fal-
ciparum malaria from New York City were reported to the
NCDC.
Case No. 1: On March 10, 1969, a 64-year-old diabetic
white man developed melena and was admitted to a hos-
pital where he received 10 units of whole blood before
undergoing resection of a bleeding gastric ulcer. He was
discharged 2 weeks later but was readmitted on April 7
with fever, jaundice, and anemia. A peripheral blood smear
taken on April 10 contained large numbers of ring forms
and gametocytes as well as occasional schizonts of P.
falciparum. Quinine, pyrimethamine, and sulfadiazine
therapy cleared the asexual parasitemia; however, hemo-
lytic anemia, azotemia, and obtundation became more
serious and the patient died on April 22. Autopsy showed
cerebral edema, centrilobular necrosis and malarial pig-
ment in the liver, and bile casts in the kidney.
Of the 10 blood donors, nine were located; six were
frequent donors who were considered unlikely sources of
infection, two were civilians who had never traveled to
malarious areas, and the ninth was a veteran who returned
from Southeast Asia in March 1968 but denied ever having
clinical symptoms of malaria. This man's serum had a 1:256


indirect fluorescent antibody titer against P. falciparum.
Case No. 2: On March 26, 1969, a 50-year-old white
man with calcific mitral stenosis and pulmonary hyper-
tension underwent open-heart surgery for replacement of
the mitral valve. During the procedure he required 11 units
of whole blood, 14 units of plasma, and 8 units of plate-
lets. On April 4 he developed fever, shaking chills, and
mild leukopenia, and on April 5 P. falciparum ring forms
were identified in the peripheral blood. He recovered after
receiving standard doses of chloroquine.
The plasma and platelet donors could not be im-
plicated as sources of infection. Of the 11 whole blood
donors, five were frequent donors and two of the remain-
ing six donors had a history of travel to malarious areas.
One woman had visited the Middle East in 1966. The
second donor was a Ghanian citizen who entered the
United States in January 1969. To date, efforts to obtain
peripheral blood smears and sera from these two individ-
uals have been unsuccessful.
(Reported by Drs. C. C. Wang, S. W. De Ramos, and H. B.
Shookhoff, Division of Tropical Diseases, and Dr. V. F.
Guinee, Director, Bureau of Preventable Diseases, New
York City Health Department.)


INTERNATIONAL NOTES
SMALLPOX Worldwide


From January 1 through June 27, 1969, 19,104 cases
of smallpox were reported to the World Health Organiza-
tion*, a decrease of 44 percent from the 33,887 cases re-
ported during the same period in 1968. Based on current
trends, an estimated 45,000 cases will be recorded in
1961 (Figure 2).
At the beginning of 1969, 27 countries were con-
sidered endemic for smallpox. Five of these countries


recorded cases in 1968 but have recorded no cases in
1969; four of the five, Liberia, Swaziland, Upper Volta,
and Zambia, have been reclassified as "provisionally
endemic." One country, Yemen, which did not record
cases in 1968 has recorded cases in 1969.
Brazil is the only country in the Americas reporting
smallpox cases to date in 1969. The Brazilian eradica-
(Continued on page 976)


AUGUST 2, 1969


Morbidity and Mortality Weekly Report







272 Morbidity and Mortality Weekly Report


TABLE Il1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 2, 1969 AND AUGUST 3, 1968 (31st WEEK)

AET ENCEPHALITIS HEPATITIS
MNESI- BR PHL- Rniin R Primary ir-.. I .. MALARIA
AREA IT unsp. cases Infct lous Serum Intectlous
Cum.

I. IlTEL :TATE'.. .. '. ?* 1 5 3 'ub al? IAJJ

NEW ENGLAND .......... 1 3 4 90 70 10 59
Maine ............. 7 6 4
New Hampshire...... 1 2
Vermont............ 2 8
Massachusetts...... .- 2 48 25 5 40
Rhode Island....... 1 2 2 16 12 3
Connecticut........ 1 16 19 5 10

MIDDLE ATLANTIC ...... 1 9 3 34 190 111 11 184
New York City...... 3 2 24 71 47 16
New York, up-State. 3 26 25 28
New Jersey ........ 4 4 53 14 6 72
Pennsylvania....... 1 1 2 1 3 40 25 5 68

EAST NORTH CENTRAL... 6 3 8 8 133 161 11 166
Ohio................ 3 3 7 4 27 35 2 16
Indiana............ 1 6 16 1 14
Illinois........... 44 43 7 9b
Michigan........... 3 3 49 55 1 37
Wisconsin.......... 1 7 12 1

WEST NORTH CENTRAL... 5 3 3 2 29 39 1 108
Minnesota .......... 4 2 1 5 12 7
Iowa............... 1 1 14 4 9
Missouri........... 1 5 10 28
North Dakota....... 2 1 2 3
South Dakota ....... -- 3
Nebraska........... 3
Kansas............. 4 8 1 58

SOUTH ATLANTIC....... 1 3 1 1 9 117 106 15 470
Delaware ........... 1 5 2
Maryland........... 7 2 35 14 4 23
Dist. of Columbia.. 2 1 1
Virginia........... 1 6 6 18
West Virginia...... 15 2 -
North Carolina..... 4 1 16 8 8 220
South Carolina..... 2 6 1 41
Georgia............ 7 53 3 142
Florida............ 4 1 1 1 4 31 16 23

EAST SOUTH CENTRAL... 9 1 5 1 61 44 63
Kentucky........... 2 1 20 9 53
Tennessee.......... 1 1 2 21 20
Alabama. .......... 8 8
Mississippi........ 3 12 9 2

WEST SOUTH CENTRAL... 10 2 3 3 2 3 88 58 12 77
Arkansas........... 8 8
Louisiana.......... 2 3 2 14 17 1 32
Oklahoma............ 1 1 3 2 9 30
Texas.............. 2 1 2 63 39 2 7

MOUNTAIN............. 5 1 1 3 7 57 29 6 118
Montana............ 4 8 8 1 3
Idaho.............. 1 I 1 -- 3
Wyoming............ 1 1 -
Colorado........... 1 1 2 3 13 3 5 I1U
New Mexico......... 10 6 6
Arizona............ 13 5 1
Utah............... 3 7 6 1
Nevada............. 4 4

PACIFIC .............. 22 2 13 8 10 30 198 288 21 388
Washington......... -- 9 22 19 5
Oregon............. 3 1 14 21 1 8
California......... 22 2 13 5 9 21 162 223 8 292
Alaska ............ 2 2
Hawaii ............. 23 12 81

P ert Ricr-........ 13 32 1

*Tlelaed reports: Asertic neninvitis: Alaska delete 23
llpnatlttis infectious: ?e. 1, N.J. delete 9, Ala. 2







Morbidity and Mortality Weekly Report 273


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 2, 1969 AND AUGUST 3, 1968 (31st WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL
AREA Cumulative Cumulative Total Paralytic
Cum.
1969 1969 1968 1969 1969 1968 1969 1969 1969 1969 1969
UNITED STATES... 231 19,540 18,765 43 2,210 1,840 724 1 1 6 335

NEW ENGLAND........... 25 1,061 1,123 3 74 92 93 1 33
Maine ............ 5 35 6 6 3 6
New Hampshire...... 237 141 2 7 -
Vermont ............ 3 2 -- 1 -
Massachusetts.*... 10 202 349 31 41 39 9
Rhode Island....... 22 5 2 8 7 7 2
Connecticut........ 15 592 591 1 27 30 44 1 16

MIDDLE ATLANTIC...... 71 7,296 3,723 10 353 329 90 29
New York City...... 40 4,821 1,850 1 71 68 88 9
New York, Up-State. 6 582 1,184 4 60 55 NN 10
New Jersey.......... 844 580 3 145 118 2 2
Pennsylvania....... 25 1,044 109 2 77 88 NN 8

EAST NORTH CENTRAL... 49 2,032 3,647 4 301 220 136 54
Ohio.*............. 5 359 287 2 115 60 20 -- 12
Indiana............. 10 465 643 34 26 23 13
Illinois........... 23 452 1,342 41 51 15 4
Michigan........... 2 221 253 1 92 63 28 3
Wisconsin.......... 9 535 1,122 1 19 20 50 22

WEST NORTH CENTRAL... 3 507 372 1 116 97 19 1 7
Minnesota.......... 5 15 25 22 4 -
Iowa................ 1 325 96 15 6 4 4
Missouri.*......... 22 81 51 31 6 2
North Dakota....... 10 128 3 -
South Dakota....... 3 4 1 5 NN -
Nebraska........... 2 135 38 9 6 5 1
Kansas............. 7 10 1 15 24 1

SOUTH ATLANTIC....... 17 2,426 1,448 9 393 378 95 1 66
Delaware........... 373 15 1 8 7 8 4
Maryland............ 65 94 35 28 2 3
Dist. of Columbia.. 6 9 14 -
Virginia........... 9 881 293 49 30 38 14
West Virginia...... 3 177 269 18 9 28 23
North Carolina..... 1 307 281 66 75 NN -
South Carolina..... 110 12 1 55 56 5 1
Georgia............. 1 4 5 69 73 -
Florida............. 4 512 474 2 84 86 14 1 21

EAST SOUTH CENTRAL... 1 105 479 2 139 159 41 1 1 1 37
Kentucky........... 1 61 99 49 64 9 11
Tennessee.......... 17 57 52 51 30 25
Alabama............ 4 92 2 23 24 1 1 1 1
Mississippi........ 23 231 15 20 1 1

WEST SOUTH CENTRAL... 47 4,337 4,613 3 297 296 73 2 32
Arkansas........... 16 2 29 20 -
Louisiana.......... 120 10 1 79 83 -
Oklahoma........... 136 111 29 49 1 -
Texas............... 47 4,065 4,490 2 160 144 72 2 32

MOUNTAIN............. 6 790 954 2 41 29 94 30
Montana............ 16 58 2 8 3 1 1
Idaho.............. 88 20 6 11 1 -
Wyoming............. 51 -
Colorado ........... 136 492 7 10 33 8
New Mexico......... 4 236 88 6 19 14
Arizona............ 2 306 219 10 1 26 4
Utah............... 7 21 2 1 14 3
Nevada.............. 1 5 2 3 -

PACIFIC................ 12 986 2,406 9 496 240 83 47
Washington......... 58 515 51 37 11 3
Oregon............. 1 197 483 1 12 18 3 4
California......... 5 688 1,371 8 412 172 62 24
Alaska.............. 8 2 11 2 1 5
Hawaii.............. 6 35 35 10 11 6 11

Puerto Rico......... 38 1,323 374 2 17 19 24 13

*Delayed reports: Measles: Mass. delete 1
Meninnococcal Infections: Ohio delete 1
Mutrms: Me. 9, Ohio 2
Rubella: Me. 4, Mo. 32






274 Morbidity and Mortality Weekly Report


TABLE Ill. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 2, 1969 AND AUGUST 3, 1968 (31st WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TYP0D TICK-BORNE RABIES IN
AREA SCARLET FEVER (Rky. Mt. Spotted) ANIMALS
Cum. Cum. Cum. Cum. Cum.
l. Lra r I 4 I I r [ 4 2 u3a



NEW ENGLAND.......... 589 14 1 6 1 14
Maine.*............ 6 1 -- 5
New Hampshire...... 3
Vermont............ 25 14 2
Massachusetts...... 87 1 4 1
Rhode Island....... 24 -
Connecticut........ 447 3

MIDDLE ATLANTIC...... 176 1 13 4 1 17 1 27 5 99
New York City...... 12 1 6 1 1 8
New York, Up-State. 135 3 3 5 5 3 92
New Jersey......... NN 2 6 -
Pennsylvania...... 29 2 4 1 16 2 7

EAST NORTH CENTRAL... 380 11 7 14 5 150
Ohio................ 51 1 7 44
Indiana........... 98 1 1 41
Illinois........... 68 7 2 3 1 26
Michigan........... 97 3 4 1 5
Wisconsin.......... 66 4 2 34

WEST NORTH CENTRAL... 178 5 10 6 1 8 6 414
Minnesota.......... 9 I 2 2 104
owa................ 86 1 7 2 61
Missouri........... 2 1 7 2 1 10O
North Dakota ...... 30 1 53
South Dakota....... 9 1 24
Nebraska............. 32 1 10
Kansas.............. 10 3 3 1 54

SOUTH ATLANTIC....... 576 3 17 20 1 29 15 159 11 572
Delaware........... 7 1 2 3-
Maryland........... 59 1 1 4 2 36
Dist. of Columbia.. 1 2 1 -
Virginia............ 147 4 6 52 6 297
West Virginia...... 126 1 2 1 5 87
North Carolina..... NN 2 5 6 3 42 4
South Carolina..... 74 1 2 1 1 11
Georgia............ 4 2 2 3 7 3 10 1 53
Florida............. 158 8 4 7 3 131

EAST SOUTH CENTRAL... 965 13 9 1 17 2 35 6 331
Kentucky........... 140 6 2 5 2 173
Tennessee.......... 709 4 8 12 2 29 1 114
Alabama............ 42 2 1 1 1 3 41
Mississippi........ 74 1 1 2 -- 3

WEST SOUTH CENTRAL... 542 1 15 1 15 21 31 13 301
Arkansas.*.......... 2 1 10 6 23
Louisiana.......... 1 6 1 4 2 3 22
Oklahoma........... 8 1 6 21 45
Texas.............. 531 1 8 4 9 4 10 211

MOUNTAIN ............ 1.022 2 8 1 21 12 95
Montana.*........... 74 1 -
Idaho............. 41 3 3 -
Wyoming............ 2 2 5 -- 48
Colorado........... 630 1 3 7 3
New Mexico......... 140 1 5 9
Arizona.*.......... 42 4 22
Utah............... 93 5 2 3
Nevada............. 1 10

PACIFIC............. 113 6 30 5 3 227
ashingon......... 14 1 1 3 2
Oregon............. 41 6 2
Californi......... --- 5 23 2 3 223
Alaska.............. 26 -
Puer Ri- .......... 2 2 5 18
.Urt .......i... 4 2 5 .- 12

elavei reports: SdT: "e. 1 Ark. 5, Ariz. 60
Tetnu..: 'ont. 1, Ariz. delete 1
St os-: Inwa 4
babies in anials: Ark. 2







275


Morbidity and Mortality Weekly Report






Week No. TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED AUGUST 2, 1969


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

All Causes Pneumonia Under All Causes Pneumonia Under

Area All 65 years and y Area All 65 years nd yea
over Influenza All Influenza All
Ages and over Ages and overCauses
All Ages Causes All Ages Causes


NEW ENGLAND:
Boston, Mass.---------
Bridgeport, Conn.-----
Cambridge, Mass.------
Fall River, Mass.----.
Hartford, Conn.-------
Lowell, Mass.--------.
Lynn, Mass.-----------
New Bedford, Mass.----
New Haven, Conn.------
Providence, R. I.-----
Somerville, Mass.-----
Springfield, Mass.----
Waterbury, Conn.------
Worcester, Mass.------

MIDDLE ATLANTIC:
Albany, N. Y.---------
Allentown, Pa.--------
Buffalo, N. Y.--------
Camden, N. J.---------
Elizabeth, N. J.----..
Erie, Pa.-------------
Jersey City, N. J.----
Newark, N. J.---------
New York City, N. Y.--
Paterson, N. J.----...
Philadelphia, Pa.----.
Pittsburgh, Pa.-------
Reading, Pa.----------
Rochester, N. Y.---...
Schenectady, N. Y.----
Scranton, Pa.-------..
Syracuse, N. Y.-------
Trenton, N. J.-...----
Utica, N. Y.----------
Yonkers, N. Y.-----...

EAST NORTH CENTRAL:
Akron, Ohio-----------
Canton, Ohio----------
Chicago, Ill.----.--..
Cincinnati, Ohio------
Cleveland, Ohio------.
Columbus, Ohio-------.
Dayton, Ohio----------
Detroit, Mich.------..
Evansville, Ind.---...
Flint, Mich.----------
Fort Wayne, Ind.------
Gary, Ind.------------
Grand Rapids, Mich.---
Indianapolis, Ind.----
Madison, Wis.---------
Milwaukee, Wis.------
Peoria, Ill.-----------
Rockford, Ill.------..
South Bend, Ind.------
Toledo, Ohio----------
Youngstown, Ohio---...

WEST NORTH CENTRAL:
Des Moines, Iowa---...
Duluth, Minn.-------..
Kansas City, Kans.----
Kansas City, Mo.-.....
Lincoln, Nebr.-------
Minneapolis, Minn.----
Omaha, Nebr.----------
St. Louis, Mo.------..
St. Paul, Minn.-----..
Wichita, Kans.-----...


630
173
33
21
21
49
33
22
26
79
47
13
46
24
43

3,181
40
43
139
48
33
35
67
81
1 ,460
43
588
193
56
112
20
41
76
50
24
32

2,418
54
45
627
172
175
96
84
359
47
47
38
31
39
149
40
131
51
34
44
99
56

858
57
26
55
136
20
119
78
248
59
60


365
85
22
13
11
31
22
15
20
36
25
11
29
21
24

1,837
23
26
76
25
19
22
36
37
842
25
324
118
38
72
16
29
46
27
17
19

1,305
32
25
318
100
89
47
54
179
35
25
20
14
22
78
21
82
26
21
26
61
30

503
39
17
28
79
15
70
47
131
38
39


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


1 195
138
275
46
80
83
56
92
41
76
55
204
49

727
118
59
51
141
168
53
40
97

1,199
50
32
24
199
42
68
182
63
162
120
136
54
67

476
39
22
124
19
119
24
66
63

1 ,602
13
54
28
48
89
553
77
31
125
74
98
161
39
136
39
37


Total 12,286 6,807 410 700

Cumulative Totals
including reported corrections for previous weeks

411,660
All Causes, All Ages -------------------------411,660
All Causes, Age 65 and over------------------- 23,
Pneumonia and Influenza, All Ages------------- 20,317
All Causes, Under 1 Year of Age--------------- 19,026







276


Morbidity and Mortalilt Weekly Report


SMALLPOX '( .tied from payr 271)


Figure 2
REPORTED CASES OF SMALLPOX IN THE WORLD
1955-1969
30C000




225.00 -




-5A000

I 5.000












tion program h:a beln intensified during the past vear.
Oith almoi .O.t ; million Raccination- admini- tered since
the program eian. total of s6t cae-- ha\e been re-
corded since Januar 19169. a l*c rease of :l0 percent from
the number recorded for the -ani i period in 1965s.
.M allpo\ icidence in he 19 countrie- of \\est and
centrall Africa continue- to decline and reached record
Io leIels- during the first hal f f 1969. Onli three coun-
trie-. Sierra Leone. and Togo. have reported
case- -ince April. O\er so million persons hase been
ac cinated -i ~c the regional eradication program began

in January 1967. Based on current trends in smallpox
incidence in this area and considering that the initial
vaccination program will essentially be completed during
19t9. the \\est and Central African countries could be-
come free of smallpo\ sometime this year.
Recorded cases of smallpox during 1969 in East and
Southern Africa declined more than 50 percent from the
number reported in 1968 for the same period: smallpox
incident e is presently at a record lows.
Smallpox incidence in Asia declined by 40 percent
in 196tr and appears to be declining at a comparable rate
in I969. There appears to be a modest decline in inci-
dence of -mallpox in India. although reporting is incom-

plte- and sur eillance acti\itie- limited. In Indonesia an
inten-ate eradic tion program h~ich began in July 1968
h- proaure- i 7el beden extended throughout the country;
hoecer. the reported incidence to date is little different
from that in 1 Is Inten-ified ainl l ore complete reporting
in .\liha ni-rn and Nrpal re-ulred in an increa-e in noti-
fic ations- n:l m ae further in reas- in 19ia 9 for Nepal.
\ miark ed ie in e ise I.... 1ap tern obicered in 1969
n Ef.t-i Pak-it.an uiih in 19?t recor l d it- highet- t ini-
in *r inr a tcse. i Paki f -tan has reported an in-
sea-ce in smallpo- in India.
pl eteni sr el n t limited In I I ndon \esi a
inesieerdcain rgrmwhc bean inJ 1 968
ha pr-rs itel benetel dthogou-h cuty


AUGUST 2, 1969


THE MORBIDITY AND MORTALITY WEEKLY REPORT WITH A CiRCULA-
T ON OF 18 500 IS PUBLISHED AT THE NATIONAL COMMUNICABLE
SDSEASE CENTER. ATLANTA. GEORGIA.
DIRECTOR NATIONAL COMMUNICABLE D SEASE CENTER
AVID J. SENCER, M.D.
CHIEF EP DEMIOLOGY PROGRAM A. 0. LANSGMURE M.D*
EDITOR MICHAEL B. GREGG MD
MANAGING EDITOR PR SCILLA B HOLMAN
N ADDiTION TO THE ESTABLISHED PROCEDURES FOR REPORT-NG
MORBID TY AND MORTAL TY, THE NATION AL COMULNiCABLE DISEASE
CENTER WELCOMES ACCOUNTS OF INTEREST 1, OUTBREAKS OR CASE
INVESTIGATIONS WHICH ARE OF CURRENT INTEREST TO HEALTH
OFFICE ALS AND WHICH ARE DIRECTLY RELATED TO THE CONTROL
OF COMMUNICABLE DISEASES. SUCH COMMNC AT ONS SHOULD BE
ADDRESSED TO:
NATIONAL COMMON CABLE D SEASE CENTER
ATTN: THE ED TOR
MORBIDITY AND MORTALITY WEEKLY REPORT
ATLANTA, GEORGIA 3033

NOTE: THE DATA INk TH S REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO THE NCOC BY THE NDO VDUAL
STATE HEALTH DEPARTMENTS. THE REPORTING WEEK CONCLUDE
AT CLOSE OF BUS NESS ON FRIDAY, COMPILED DATA ON A NATIONAL
BASIS ARE OFFtCIALLY RELEASED TO THE PUBLIC ON THE SUCCEED
ING FRIDAY.


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