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:
AA00010654:00224

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


U.S. DEPARTMENT OF HEALTH, EDUCATION. AND W AAE
DATE OF RELEASE: E

EPIDEMIOLOGIC NOTES AND REPORTS
ACUTE GASTROENTERITIS AMONG TOUR GROUPS
TO THE ORIENT United States

In July and August 1969, outbreaks of acute gastro-
enteritis occurred in two separate groups of tourists re-
turning to the United States from similar, organized tours
to the Orient. Both tours included 1 week in Tokyo and
another in Hong Kong with an optional excursion to Bang-
kok before rendezvousing in Hong Kong for the return flight.
The first group traveled via a scheduled commercial
airliner, departing from Boston on July 11 and returning on
July 26. Between 12 1/2 and 21 hours after leaving Hong
Kong on the homeward flight on July 25, nine persons
developed an illness characterized by diarrhea (100 per-
cent), abdominal cramps(100 percent), nausea (89 per .nri.
and vomiting (78 percent) (Figure 1) and were hospitalized


O Vol. 18, No. 35






For

Week Ending

August 30, 1969


HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION
GEORGIA 30333


CONTENTS
I ogic Notes and Reports
Oite Gastroenteritis Among Tour Groups to the
Orient United States ......................... 301
Salmonellosis Following Ingestion of Muktuk
(Whale Meat) Alaska .................... 303
Measles Cleveland, Ohio ..................... 303
Follow-up Diphtheria Phoenix, Maricopa
County, Arizona .......................... 303
International Notes
Quarantine-Exempt Areas United States ......... .308

in Chicago en route. Upon questioning, an additional 15
individuals among the total of 59 persons on the tour re-
ported a similar illness of lesser severity also on July 25.
The illness was self-limited and persisted less than 24
hours without specific treatment in nearly all cases.
The only meal all persons on the tour had eaten in
common was the dinner aboard the Hong Kong to Tokyo
(Continued on page 302)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
35th WEEK ENDED M N CUMULATIVE. FIRST 35 WEEKS
MEDIAN
DISEASE 964 1968 MEDIAN
1964- 1968
1969 1968 1969 1968 1964- 1968
Aseptic meningitis ...................... 148 207 121 1.714 2.164 1,604
Brucellosis ............................ 3 4 6 140 145 169
Diphtheria.............................. 3 5 5 103 111 111
Encephalitis, primary:
Arthropod-borne & unspecified ........... 41 54 70 734 751 1,127
Encephalitis, post-infectious ............ 7 6 9 238 359 569
Hepatitis, serum ........................ 91 94 56 3.537 2,883
Hepatitis, infectious .................... 766 856 31.080 29,515
Malaria ................................ 79 71 10 1,875 1.450 240
Measles rubeolaa) ....................... 125 124 468 20,131 19.431 188,681
Meningococcal infections, total ........... 23 32 27 2,322 1,976 1.977
Civilian .............................. 21 30 -" 2,117 1.799 -
Military............................... 2 2 205 177 -
Mumps ................................. 383 476 67,368 123,815
Poliomyelitis, total ..................... 2 10 38 42
Paralytic ............................. 2 9 38 38
Rubella (German measles) ............... 218 273 48,579 43,349
Streptococcal sore throat & scarlet fever.... 3,611 3,671 3,878 297,581 296.088 296,088
Tetanus ............................... 5 5 92 102 146
Tularemia .............................. 5 7 7 97 137 137
Typhoid fever .......................... 7 7 10 189 218 269
Typhus, tick-borne (Rky. Mt. spotted fever) 14 10 10 353 219 211
Rabies in animals ....................... 64 68 68 2.419 2.461 3.050

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........................................... 3 Rabies in man: ..................................... 1
Botulism: .......................................... 11 Rubella congenital syndrome: ..... ...................... 6
Leptospirosis: Ill.-l. N.C.-1, Tex.-1 ................. 48 Trichinosis: ........................................ 154
Plague: ............................................ 3 Typhus, marine: ..................................... 34
Psittacosis:* Calif.-1................................ 28 Poliomyelitis, non-paralytic ........................... 1
*Delayed Reports: Leptospirosis: S.C. delete 1
Psittacosis: Md. 1






Morbidity and Mortality Weekly Report


GASTROENTERITIS (Continued from front page)


AUGUST 30, 1969


Figure 2
GASTROENTERITIS IN A TOUR GROUP RETURNING TO
SMIAMI, FLORIDA, FROM THE ORIENT-AUGUST 1969


ONSET. HOURS AFTER COMMON MEAL


NOT BE DETERMINED FORt CASE


flight. Analysis of attack rates for those who ate and did
not eal specified food items on the menu failed to inerim-
inlte a vehicle Furthermore. examination of rhe catering
service premises and water supply for the airliner dis-
closed no breaks in sanitar\ procedures. There \\ere no
other reports of illness among passengers on other air-
lines served these foods prepared by the same caterer on
the same da(. Bacteriologic examination of fecal speci-
men- obtained from .0 of the 59 tour members revealed 11
isolate- of non-clholera hibrios. 5 i' r/o piaraaihr mtoflyticus.
9 A.Iro .i ./; 'loi i ,, and 5 Sa fii/on /a species (2
S. mi hattf1 and I ea ch of S. aatnaum.. S. neurington, and
S. k 4fin, k .1f), Illne-.s w -a hit e t correlated with the isola-
lion of non-cholera xibrio-: l- percent of those ill har-
boreid th organism r oersu 12 percent of those \\ho re-
mained nt 'll. Bacterial agg;lutination tests. etplo ing the
organi-ms i-olated in this outbreak as altigt iens, sho\lwed
no -ignificant differences in titers hotrteen acute and
con% ale-cent sera.
\ second group left Miami otn July 25 %ia a chartered
aircraft and returned A\uu-t 10. During the return flight.
fiSl persons became ill with gastroenteritis Ietween Tokyo
iand Seattle and required medical attention upon arrival in
Seiatile. Subsequently I 12" of trhi l6i2 members of the tour
group located in \iami were questioned. Of these 1291
pers-on. a total of 5:2 reported illness witth the follow ing
-smptom-: diarrhea (77 percent). nausea (37 percent),
omiting (26; percent), and abdominal cramps (26f percent).
Thie on-elt of illne-ss e\ ended ier 11 das 1 ,,r 2).
the first ci-e crcurred 1 tda after arrival in Hong Kong
and the la-tt ct-e- leteloped I dat s after returning to
lia: i. The ,,erage duration of illnes- tas 2 dar s. No
-ingle meal or common vehicle was implicated bsI food
historic, -
Bacterirologic eamirnation of fecal -petittmen- oh-
iained from 117 of li2 tour meimb, r- res-ulted in h isolate--
of notn- holera ibro-. 5 l '. ptI r" f ah mnt/ itJ tt t i tantmotn f bi.
and 1 r' *.r None of the-s enilteric patlhogens
could he iin urinated as- tlih -ole i'au- e of illne-s in thii
outlbreak.


i K p rtf*d s2') 1 r:iiti. i, V.I).., <'i,ir{ Eptdi, +iiti;t, .
lr '!ririi l',iri o* IIii. lt : imin I le.i '. V.I .. <'ii,'f.
l: : ,f t p +' i 11- + I t f p r b* of /tf N1 -1

l i.b l : \ .f / 1 F ,in,,r: ,. t.l.. I -,) r. ten i) l, of
b',,nitii/.+ b. i t < f Us: V.ii i ts tx [p ) i/n ftmi t'f


'Public health: Vilton Saslawu, M.D., Acting Director, Dade
(ounty ialt/ih Department, Iiatimi, E. Charlton Prather,
lV.D., Dircttor. Division of Epidemiology, Florida State
Board of lHealtlh: IH. L. Smith, Ph.D.. Director, Vibrio
t'rferndrtc L laboratory, Department of licrobioloyy, Jeffer-
sonl Id.ica l 'oley. I" ,-' \a chum Ego2, .I).,
WilH Intcrniatioitl IPostdoctoral Reite'arrh Fellor, assigned
to tI t oreifn Q arantinie i ('C)C: Foreign Quaran-
lint PIrogram, and Epidtic'iolgical Ser'ic,' s Laboratory
Section. Epidl'mioloyy Progrtram. ('C'); anif at teIa of EIS
Office rs.

Editorial Comment:
Twso cla-ses of organit-m iz 1'. ,. ...
andt non-cholera \ilrio. were i olated from specimens
from these two outbreaks in travel groups to Asia as well
as from an earlier one in May (MM1oR. Vol. 1b. Nos. b1
and !',I. \ total of 12 persons in these three outbreak.
had V. pa raketneolyticrus isolated from fecal specimens: 11
of the 12 experienced acute diarrheal illness. V. para-
/atoittcl aica is a well-documented cause of food poison-
ing in Japan and is responsible for the summer peak of
gastroenteriti- there. 1 This halophilic organism has teen
re:adil isolated from coastal seati aters in the Orient in-
cluding those of .. -I.. ong Kong. and Toky.o.- The
role of nont-cholera vibrio as a cause of diarrheal illne-s
is les swell defined, although recent report- document ilt
etiologic relationship ith illness in such w-idely sepa-
rated arn-eas a East Pakistani and ('zecholo\iakia. These
Itwo otrgan-isms ha\e not hieen described t.- ciau-ses- of acutle
astrroenteritis within the I'nited ( Slates.
Durin tihe pa-t 2 t-ar-. the \(ND( has looked for
those organisn-- in stperi ien- from outbreak- of food
poisoning and other diarrhial illnes--e- in the I'nited
State-. To tlate. no isolates he a een r ecorred except
from tra f-leris to the Orient ais reported abloe.


Figure 1
GASTROENTERITIS IN TOURISTS, HOSPITALIZED,
FOLLOWING A TOUR IN THE ORIENT JULY 1969"


OUR OF ONSc






Morbidity and Mortalit


References:
lZen-Yoji, II., Sakai, S., Terayama, T., Kudo, Y.. and lenoki,
M.: Epidemiology, enteropathogenicity, and cla sification of
Vibrio parahaemolyticus. J Infect Dis 115:436-444. 1965.
2Thatcher, F. S. and Clark, D. S., Microorganisms in Food.
University of Toronto Press, Toronto, 1968.


AUGUST 30, 1969


SALMONELLOSIS FOLLOWING INGESTION OF MUKTUK (WHALE MEAT) Alaska


On August 8, 1969. an outbreak of salmonellosis oc-
curred among residents of Tanunak. Alaska, an Eskimo
village on the coast of the Bering Sea. Of the 264 resi-
dents, 102 developed acute gastroenteritis characterized
by fever, myalgia, headache, nausea, and vomiting: 95
percent of those ill had eaten raw muktuk (whale skin and
blubber), 8 to 16 hours prior to the onset of symptoms.
Duration of illness ranged from 3 to 9 days. Fifteen of the
most seriously ill Eskimos were hospitalized; there were
no deaths.
The muktuk, an Eskimoan delicacy, was obtained
from the tail of a dead whale that had washed ashore near
the village. The tail was distributed among the 43 families
in the village. In most cases, the blubber was eaten raw


within a few hours: however, some ate the delicacy the
following day.
Salmonella enteritidis was cultured from stools of all
15 hospitalized patients and from the muktuk.
(Reported by Donald K. Freedman, M .D., Director, Diii-
sion of Public Health, and Rose Tanaka, Director. South
Central Regional Laboratory, Alaska Department of Health
and lWelfare: the Alaska \ative Miedical Center, India,;
Health Service, and the Arctic Health Research Center,
Ecological Inve stigations Program, Anchorage, and Enteric
Bacteriology I nit, Bacteriology Section, Microbiology
Branch, Laboratory Division, and Salmone -
Unit, Epidemioloyical Services Laboratory Section, Epi-
demiology Program, \CDC; and EIS Officers.)


MEASLES Cleveland, Ohio


In Cleveland, Ohio, during June 1969. 13 children in
10 Spanish-American families developed measles. The
index case had onset of illness on June 14 and the other
12 cases between June 23 and 27. The children ranged in
age from 16 months to 6 years, and only one may have
been immunized. The source of infection for the index
case was not determined, but the other 12 children had
attended Sunday school with the index case on June 15.
A 14th case occurred on July 6 in a medical student who
had contact with the one hospitalized case. An immuni-
zation clinic was held at the church on July 3 in an effort
to control the outbreak. No other cases have been reported.
Over the past year, all reports of measles cases in
Cleveland have been reviewed. Prior to this outbreak,
there were reports of 31 cases; 17 of these could not be
investigated because the name of the patient was not


recorded. 12 cases were found not to be rubeola. and 2
were confirmed as rubeola. These two confirmed cases
were contracted overseas.
(Reported by E. Frank Ellis, 1.D., Yf.P.H., Director, and
Ralph J. Fintz, M.I)., Chief, Bureau of Child Hygiene,
Cleveland Department of Health: George A. Nankervis,
Ph.D., Mi4.., Assistant Professor of Pediatrics and Direc-
tor, Viral Diagnostic Laboratory, Cleveland Metropolitan
General Hospital; John G. Starr, M.D., Kaiser Community
Health Foundation, Cleveland; and an EIS Officer.)
Editorial Comment:
This outbreak, following a period in Cleveland dur-
ing which no indigenous rubeola cases could be confirmed,
illustrates the existence of groups with low levels of im-
munization in metropolitan areas, particularly in low
socioeconomic segments of the population.


FOLLOW-UP DIPHTHERIA Phoenix, Maricopa County, Arizona


Between Nov. 1, 1968, and May 1, 1969, 12 cases of
diphtheria were reported from Phoenix, Maricopa County,
Arizona (MMWR, Vol. 18, No. 19). Since that time, nine
additional cases have occurred in this same area. The
clinical syndrome for all nine cases was the same as that
for the previous cases: acute onset of fever, sore throat.
malaise, and nonproductive hacking cough. There were no
fatalities among the last nine cases, all were hospital-
ized, and two had clinical residual: one, an enlarged
heart, and the other, a palatal weakness and gait dis-


turbance. All were treated with penicillin and subsequent-
ly had at least two negative throat cultures. Of the nine
cases. five were not immunized, two were partially im-
munized. and two had no record of immunization.
Except for two pairs of brothers, who were ill at the
same time as their other brother, no association among
the patients or common areas of exposure, such as parks,
schools, day-care centers, neighborhood youth councils,
or Head Start programs was found.
(Continued on page 308)


ty Weekly Report 303


'Melntyre. :and Ftelcs J. C.: ('harcteritstrt of non-
cholera vibrioa, from ca-s of human diarrho ti. Bull. \\l10
32:627-632, 1965
4Aldova, Eva. Lazncko a, E. S.. and Litivt a. J.: 1-ol ti.n
of nonagglutin.ahl irio,- from an enteritis outbreak in
Czechoslovaki a. J [nf ct Di 18:25-31. 196S.







304 Morbidity and Mortality Weekly Report


TABLE III CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 30, 1969 AND AUGUST 31, 1968 (35th WEEK)

ENCEPHALITIS HEPATITIS
BRUCEL- DPIITHIIHAII Primary including Po,1- MALARIA
AREA IS I LOSIS unsp. cases h.lIi l,s Serum Infectious
Cum.
CI .
I IFD iTE, 1- I 3 ..1 '- *1 .'b -B .' :*, 1,0B 5

NEW ENGLAND............ 3 1 3 5 110 57 2 66
Maine ............. 2 2 6
New Hampshire ...... 4 2
Vermont............. 1 1 1 -
Massachusetts...... 2 1 3 64 36 2 44
Rhode Island....... 1 2 23 8 3
Connecticut ........ 2 16 10 11

MIDDLE ATLANTIC...... 19 8 9 33 123 125 7 220
New York City..... 10 5 20 23 58 2 20
New York, up-State. 4 2 2 6 39 21 1 33
New Jersey.*....... 2 6 24 30 3 86
Pennsylvania....... 5 1 5 1 37 16 1 81

EAST NORTH CENTRAL... 30 17 20 2 9 97 110 9 192
Ohio............... 13 10 16 1 22 28 2 19
Indiana ............ 4 6 2 19
Illinois............ 3 2 2 2 1 13 23 5 114
Michigan........... 14 4 2 7 46 46 39
Wisconsin.......... 12 7 1

WEST NORTH CENTRAL... 22 2 7 3 2 1 21 41 6 127
Minnesota .......... 21 2 3 2 3 18 7
Iowa............... 2 4 5 1 13
Missouri........... 8 12 3 35
North Dakota ....... 3
South Dakota ....... 1 1
Nebraska............. 3
Kansas............. 1 1 4 9 3 66

SOUTH ATLANTIC....... 15 1 2 5 1 15 86 96 13 509
Delaware............ 3 2 3
Maryland........... 10 1 2 6 12 1 28
Dist. of Columbia.. 1 4 1
Virginia........... 3 5 5 20
West Virginia ...... 7 12 -
North Carolina..... 1 10 16 7 233
South Carolina ... 1 2 44
Ceorgia............ 1 20 11 5 154
Florida............. 4 1 1 15 33 32 2b

EAST SOUTH CENTRAL... 12 1 64 52 11 85
Kentucky ........... 1 31 13 11 67
Tennessee............ 6 1 30 25 -
Alabama............ 6 3 lb
Mississippi ........ 3 11 2

WEST SOUTH CENTRAL... 15 1 2 1 3 67 60 5 105
Arkansas............ 1 3 3 2 10
Louisiana........... 5 2 1 3 16 14 1 37
Oklahoma........... 2 2 43
Texas............... 9 1 46 43 15

MOUNTAIN ............. 2 3 25 30 121
Montana............. 3 1 1 3 3
Idaho................ 3
Wyoming............. -
Colorado........... 2 7 7 102
New Mexico......... 2 2 7 7
Arizona............. 10 5 1
Utah................ 5 8 1
Nevada............. 4

PACIFIC ............. 29 3 10 1 25 173 285 26 450
Washington ......... 11 7 18 5
Oregon ............. 3 7 10 9
California......... 17 3 7 1 25 156 252 20 346
Alaska ............. .. 4 2
Hawaii.............. 1 3 1 6 88

er R........ 1 32 27 2

O*elaved reports: A eptle nenineitis: N.J. delete 8, S.C. delete 1
Brucellosis: N.J. delete I
i'epatttis, infectious: Me. 5







Morbidity and Mortality Weekly Report 305


TABLE Ill. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 30, 1969 AND AUGUST 31, 1968 (35th WEEK) CONTINUED


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

UNITED STATES... 125 20,131 19,431 23 2,322 1,976 383 9 218

NEW ENGLAND........... 6 1,098 1,145 2 84 116 34 1 16
Maine*.............. 8 37 6 6 3
New Hampshire...... 238 141 2 7
Vermont ............ 3 2 1 1 -
Massachusetts ..... 1 21R 357 33 63 6 2
Rhode Island....... 23 5 1 11 8 5 4
Connecticut........ 5 608 603 1 32 31 22 1 7

MIDDLE ATLANTIC...... 24 7,454 3,979 6 383 355 56 1 31
New York City...... 16 4,892 2,056 73 70 51 16
New York, Up-State. 2 595 1,216 3 71 63 NN 6
New Jersey......... 882 597 2 155 126 5 1
Pennsylvania....... 6 1,085 110 1 84 96 NN 1 8

EAST NORTH CENTRAL... 43 2,162 3,752 3 317 232 103 58
Ohio................ 1 370 293 2 120 64 9 1
Indiana............. 466 670 1 36 29 17 8
Illinois........... 9 494 1,360 44 51 2
Michigan........... 23 263 264 95 68 28 31
Wisconsin.......... 10 569 1,165 22 20 49 16

WEST NORTH CENTRAL... 3 518 380 118 107 2 1 3
Minnesota.......... 6 16 25 26 1 1
Iowa*.............. 329 98 16 6 1 --
Missouri........... 3 25 81 51 35 -
North Dakota........ 12 131 1 3 2
South Dakota........ 3 4 1 5 NN -
Nebraska........... 136 40 9 6 --
Kansas............. 7 10 15 26 1

SOUTH ATLANTIC....... 5 2,478 1,490 3 401 400 35 1 37
Delaware............ 373 15 8 8 -
Maryland............ 1 75 95 2 38 32 6 2
Dist. of Columbia!. 6 8 14 3
Virginia........... 883 295 50 34 7 5
West Virginia...... 2 193 283 18 10 16 18
North Carolina..... 1 314 282 1 67 76 NN -
South Carolina..... 116 12 55 56 1 -
Georgia............ 1 4 70 81 -
Florida............. 1 523 498 87 89 5 1 9

EAST SOUTH CENTRAL... 107 489 141 176 21 1 18
Kentucky............ 63 99 50 77 8 10
Tennessee........... 17 61 53 52 11 8
Alabama............ 4 94 2j 26 2 1
Mississippi........ 23 235 15 21 -

WEST SOUTH CENTRAL... 30 4,456 4,753 5 316 301 64 4 23
Arkansas........... 16 2 1 30 20 -
Louisiana.......... 120 22 3 83 86 -
Oklahoma............ 136 113 30 49 2 -
Texas............... 30 4,184 4,616 1 173 146 62 4 23

MOUNTAIN............. 9 843 977 43 30 31 12
Montana............ 16 58 8 3 1 -
Idaho............... 89 20 8 11 1 -
Wyoming............ 51 1 2 1
Colorado........... 140 501 7 10 1 7
New Mexico.......... 2 244 102 6 12 3
Arizona............. 7 345 219 10 1 14 1
Utah............... 8 21 2 1 -
Nevada............. 1 5 2 3 -

PACIFIC.............. 5 1,015 2,466 4 519 259 37 20
Washington.......... 59 515 54 37 1 4
Oregon............... 198 507 15 21 6 1
California.......... 4 712 1,407 4 429 188 29 11
Alaska............. 8 2 11 2 -
Hawaii.............. 1 38 35 10 11 1 3

Puerto Rico.......... 18 1,437 397 19 19 12 1
*Delayed reports: Measles: Mass. delete 2, Iowa 1
Meningococcal infections: D.C. delete 1
Mumps: Me. 2






306 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 30, 1969 AND AUGUST 31, 1968 (35th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TICK-BORNE RABIES I
AREA SCARLET FEVER FV"ER (Rky. Mt. Spotted) ANIMALS

; : Cur. 6



NEW ENGLAND......... 514 14 8 1
Maine ............. 1 6
Naer......ire ...... 4
SeN Hanpshire...... 7 4
Vermont............ 23 14 2
Massachusetts..... 92 5 1
Rhode Iland...... 32 1
Connecticut ....... 360 1 5

MIDDLE ATLANTIC..... 156 13 4 1 20 3 40 22 137
w Yrk City..... 10 6 1 1 1 -
New York, p-State. 125 3 3 5 1 6 22 129
ew Jersey.......... N 2 1 1 12 --
Pennsylvania....... 21 2 4 1 22 8

EAST NORTH CENTRAL.. 284 12 3 10 21 2 5 169
Ohio............... 21 1 8 50
Indiana........... 98 1 2 46
Illinois........... 32 7 1 3 9 2 1 28
ichigan........87 4 4 1 6
Wisconsin.... .... 46 2 6 1 39

EST SORTH CENTRAL... 58 7 1 13 8 8 8 450
innesota .......... 3 2 3 2 118
Iwa............... 14 7 64
issouri......... ... 1 1 9 3 3 117
Sorth Dakota....... 24 1 56
uth Data....... 7 1 24
Nebraska........... 1 1 1 1 12
Kansas............ 3 4 3 1 1 59

SOUTH ATLANTIC....... 343 18 20 2 31 1 191 11 612
Delasare ........... 2 3 -
Maryland........... 43 1 4 42 3
Dist. of Celumbia. 2 1 -
Virginia........... 77 4 56 7 312
est Virginia... 111 1 2 1 5 2 93
North Carolina.... NN 2 5 6 46 4
South Carolina..... 29 1 2 1 1 27 -
Georgia............ 5 2 3 2 9 12 2 62
Florida........... 75 9 4 7 13

EAST OTH CENTRAL.. 708 15 9 1 23 7 51 6 346
Kent ........... 14 6 3 2 8 2 180
Tennessee.......... 541 4 8 1 17 2 36 1 115
Alaa............ 5 4 1 3 4 1 46
ississippi....... 28 1 2 1 2 5

-EST SOUTH CENTRAL... 481 17 1 17 22 3 42 8 334
Arkansas........... 5 I 1 10 1 7 24
Louisiana ....... 1 6 4 3 26
Oklahoa......... 1 6 2 28 48
Texas.............. 475 9 1 6 9 7 8 236

IMOUNTAIN............. 949 3 10 1 23 14 2 10U
ntana........... 25 1 1 -
Idan.............. 77 3 4 -
yoming. ......... 23 2 5 51
Colrado........... 620 2 3 8 3
SMe ........ 92 1 5 14
Arizona............ 42 5 22
tah.............. 70 7 2 1 5
Nevada............. 1 1 13

PACIFIC.............. 118 7 2 33 5 2 245
ashigton........ 1 1 2 3 -
re ............ 35 6 3
California......... -" 6 2 25 2 2 23b
1 .12


r r _


Typhoid fever: La. 1
-cSF: O.(. delete 1







Morbidity and Mortality Weekly Report






TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED AUGUST 30, 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 year Area All 65 years nand 1 year
Influenza All Influenza All
Ages and over flAesz As Ages and over ll esC Au
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.--------


688
219
45
25
27
62
25
15
25
58
54
11
40
36
46

3,175
39
46
137
45
28
34
62
84
1,612
33
484
191
38
108
21
39
72
41
29
32

2,546
53
33
694
154
230
142
76
329
39
57
42
48
46
155
42
127
34
46
47
93
59

829
59
28
41
136
33
84
77
207
79
85


379
112
28
17
17
32
16
6
17
26
29
10
24
20
25

1,848
22
30
78
26
18
22
41
39
934
19
269
104
22
76
9
27
47
25
19
21

1 ,428
30
21
354
83
127
73
45
185
24
30
26
26
25
91
25
81
18
30
30
61
43

501
37
15
21
87
24
52
44
126
49
46


1

88


25

5
6
2
10

2
3
7
6
1
6
3
1
5
2
2
1

23


2

1
3
1
4
3
9


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 Ant nio, 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.-----------


1,187
130
227
57
105
102
42
84
38
100
77
170
55

616
115
42
34
123
137
45
35
85

1,175
51
49
23
164
43
77
231
63
133
104
111
60
66

436
41
25
119
14
124
21
49
43

1,620
19
43
26
50
115
486
82
47
138
57
101
192
48
133
42
41


Total 12,272 6,804 426 620

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 459,903
All Causes, Age 65 and over------------------- 263,742
Pneumonia and Influenza, All Ages------------- 21,950
All Causes, Under 1 Year of Age--------------- 21,451


Week No.
35


__ 1






308


Morbidity and Mortality Weekly Report


DIPHTHERIA (Continued from page 303)

A random -urt ey for diphtheria immunization status.
conducted in ith South Phoenix area from August 4 through
6, showed that 42 percent of the 5 to 14-year-old children
Iere full\ immunized* and that 15 percent had never been
inoculated with diphtheria toxoid.
From August Ih through 21. a community-\idel diph-
theria vaccination program was conducted in the South
Phoenix area. \\ith the stimulus of news media coverage
and volunteers, conducting door-to-door publicity, I- 111111
persons received Td or DTP inoculations. A follow-up
vaccination program for booster doses is planned for
Nov ember 1969.
(Reported by S. F. Farnmesorth, M.)., Director, and
Joseph Pinto, VM.D., Director, Medical Services, and Lad
Sezera, M.)D., Director. Bureau of Communicable Disease
Control, 3laricopa County Health Department; and an EIS
Officer.)

1*Fui Primary series three or more injections), or a primary
series plus a booster, completed within 4 years of onset of
illness.






INTERNATIONAL NOTES
QUARANTINE-EXEMPT AREAS United States


To facilitate international travel, the United States is
seeking to increase the number of travelers who can be
exempted from routine quarantine inspection on arrival at
I'.S. ports of entry. Many passengers come from countries
that are free from quarantinable diseases: nevertheless,
travelers visiting such countries and then continuing to
the United States have been undergoing duplicate in-
spections.
Islands of the Caribbean have been free of smallpox
since 1951 and of fellow fever since 1959 and have ade-
quate safeguards against introduction of quarantinable
diseases (plague. cholera, yellow fever, smallpox, typhus,
and relapsing fever). Effective August 8, 1969, the list
of previously quarantine-exempt areas (Aruba, Bahama
Islands. Bermuda Islands. British Virgin Islands, Canada
and Miguelon and St. Pierre Islands, Curacao. Greenland,
Iceland, Jamaica. Mexico, and Panama Canal Zone) has
been expanded to include Bonaire, Dominican Republic,
Cayman Islands. Haiti. Trinidad, Tobago, and islands of
the Leeward and Hindward groups of the lesser Antilles.
(Reported by the Foreign Quarantine Program, NCDC.)


AUGUST 30, 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, D
CHIEF. EPIDEMIOLOGY PROGRAM A. 0. LANGMUIR, MD.
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 OUTBREAK 5 OR C 5E
INVESTIGATIONS WHICH ARE OF CURRENT INTEREST "O *E AL T
OFFICIALS AND WHICH ARE DIRECTLY RELATED TO THE -coNTOL
OF COMMUNICABLE DISEASES. SUCH COMMUNICATIONS 5*-..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 PROVISION. ae.C APE
BASED ON WEEKLY TELEGRAMS TO THE NCDC BY THE INDII DUAL
STATE HEALTH DEPARTMENTS. THE REPORTING WEEK CONCLUDES
AT CLOSE OF BUSINESS ON FRIDAY; COMPILED DATA ON a NA I I'NOA
BASIS ARE OFFICIALLY RELEASED TO THE PUBLIC ON THE SUCCEED-
ING FRIDAY.

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