Morbidity and mortality

MISSING IMAGE

Material Information

Title:
Morbidity and mortality
Uniform Title:
Morbidity and mortality (Washington, D.C. : 1952)
Running title:
Weekly mortality report
Weekly morbidity report
Morbidity and mortality weekly report
Abbreviated Title:
Morb. mortal.
Physical Description:
25 v. : ; 27 cm.
Language:
English
Creator:
United States -- National Office of Vital Statistics
Communicable Disease Center (U.S.)
National Communicable Disease Center (U.S.)
Center for Disease Control
Publisher:
The Office
Place of Publication:
Washington, D.C
Publication Date:
Frequency:
weekly
regular

Subjects

Subjects / Keywords:
Communicable diseases -- Statistics -- Periodicals -- United States   ( lcsh )
Mortality -- Periodicals -- United States   ( lcsh )
Morbidity -- Periodicals -- United States   ( mesh )
Mortality -- Periodicals -- United States   ( mesh )
Statistics, Medical -- Periodicals -- United States   ( lcsh )
Statistics, Vital -- Periodicals -- United States   ( lcsh )
Genre:
federal government publication   ( marcgt )
statistics   ( marcgt )
periodical   ( marcgt )

Notes

Additional Physical Form:
Also issued online.
Statement of Responsibility:
Federal Security Agency, Public Health Service, National Office of Vital Statistics.
Dates or Sequential Designation:
Vol. 1, no. 1 (Jan. 11, 1952)-v. 25, no. 9 (Mar. 6, 1976).
Issuing Body:
Issued by: U.S. National Office of Vital Statistics, 1952-Jan. 6, 1961; Communicable Disease Center, 1961- ; National Communicable Disease Center, ; Center for Disease Control, -Mar. 6, 1976.
General Note:
Title from caption.

Record Information

Source Institution:
University of Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
oclc - 02246644
lccn - 74648956
issn - 0091-0031
ocm02246644
Classification:
lcc - RA407.3 .A37
ddc - 312/.3/0973
nlm - W2 A N25M
System ID:
AA00010654:00225

Related Items

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

Full Text
'I I / A /Y

TIONAL COMMUNICABLE DISEASE CENTER E. No. 37
,No. 37



A.-.JK *)

F .

Wee

SSeptember ,69


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE / PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION
DATE OF RELEASE: SEPTEMBER 19. 1969 ATLANTA. GEORGIA 30333


INTERNATIONAL NOTES
TYPHOID FEVER Europe
From August 30( through September 17. 1969, .1 case.
of typhoid fever with two deaths were reported in resi-
dents of file European countries who had -ta:yed at a sin-
gle resort hotel in Hammamet. Tunisia. All 51 persons had
stayed at the hotel for 2 to 3 weeks between June 30 and
August 5. and all had onset of illness between Augu-st
and 25. The first case was reported from Hamburg on
August 20. i,1. .. i r i which 22 other canse were reported
from the Federal Republic of Germany (Table 1). 15 cases
from Switzerland, eight caes- from (he UInited Kingdom.
three cases from the Netherlands. and two casis from
Austria. No secondary spread was noted within these
countries.
Salmonella typhi was isolated from all cases. Three-
fourths of the isolates have been typed and were phage
type Ela.


('cON iE'N Ir


E~pide>miolaNr it tnd R eort. .
Outir ~ k of S \ ph \tuhii nomah ( >una ()rt on- ... 1
1MO lcs \aimorc. h1ir ml .......... :
,ur\ cI i in <' o fulnmar ,

Lnt^-,i Satl" IU6s .......... ........... :

Travel hi tories- were olt gained from all .1i per-on-
and showed that all had been at the hotel at the -an e
time. onlt on Jul\ 24. whilee at the re-ort, the\ had taken
organized tours from the hotel into neighboring tilluce-
w here main ate foods in local restaurantii. ome per'-on.
had camped out in tents and had drunk untreated wat er
from local wells.
Investigation at the hotel ih local authoritic- found
no breaks s in anitar procere in food I ... no
ti'o nti.ed on page 31s)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
37th EEK ENDED MEDIAN CUMULATIVE FIRST 37 WEEKS
DISEASE September 13, September 14. 1964 1968 MEDIAN
1969 1968 1969 1968 1964 1968
Aseptic meningitis ...................... 168 220 131 2,031 2.576 1,906
Brucellosis ............................ 8 5 5 160 153 183
Diphtheria.............................. 2 14 5 109 134 132
Encephalitis, primary:
Arthropod-borne & unspecified .......... 40 76 76 818 869 1.225
Encephalitis, post-infectious ........... 4 6 8 243 375 589
Hepatitis, serum .................. .... 95 89 61 3,707 3,043 679
Hepatitis, infectious .................... 963 1,010 32,900 31,250
Malaria .............................. .. 79 66 25 2,005 1.579 274
Measles rubeolaa) ................. ...... 129 115 397 20.387 19,635 189.492
Meningococcal infections, total ........... 29 31 26 2.375 2,030 2.044
Civilian .............................. 29 29 2.168 1.851 -
Military ............................... 2 --- 207 179 -
Mumps ................................. 449 644 --- 68,190 125,052 -
Poliomyelitis, total ..................... 2 2 12 43 44
Paralytic ............................. 1 2 10 43 43
Rubella (German measles) .............. 231 318 --- 49,021 43.912 -
Streptococcal sore throat & scarlet fever. ... 4,240 4.751 4.261 305.982 305.246 305,246
Tetanus ............................... 6 6 6 103 112 155
Tularemia .............................. .5 4 6 108 142 142
Typhoid fever ............... ........ .6 19 14 205 261 291
Typhus, tick-borne (Rky. Mt. spotted fever) 8 9 9 367 238 225
Rabies in animals ....................... 50 60 82 2,524 2,558 3.212

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cun..
Anthrax: ........................................... 3 Rabies in man: ......................................
Botulism: .................................... ...... 11 Rubella congenital syndrome: ......... .. ............ .. 7
Leptospirosis: Calif.-2, Ga.-1, Ohio-. .................. 54 Trichinosis: R.I.-2............... .......... ..... 158
Plague: ........................................... 3 Typhus, marine: .......... ........................... 34
Psittacosis: Wis.-l ................................. 30 Poliomyelitis, non-paralytic: ....................... ...
Poliomyelitis, unspecified: Ariz.-1 .................... 1






318


Table 1
Distribution within Germany of 23 Cases

Locait ion Numlx'r of ('ie.'
North Rhline- \e- halia 1.
H m uiir t ;3
Bl, aria 2
Berlin
Rhlii nel and- P uai nat'o 1
B:alen-\t urttexnhlerg 1

o'iltai na rion of ri nkini l a;tler. andl no pre' \ious report-
of illnes-- compatible l ihl typhoid firer. The only qut---


SEPTEMBER 13. 1969


tionahle practice was the ouse of untreated sewage water
for wxaterin the ln. ed that the si. t \a -t-l tt e ource
of infection might haite been the iwiitimming pool whhich
might haxe Ihecn conlsminatei d hly guests who hadi walked
on thte x t gra-, and then entered the pool: however.
some of the ill per-ons denied -sinnlinin at the hotel. The
sourcc of infection for this outbreak rcnmains undetermined.
(Re'ported by the Foreig' Quarantine Program, t'C()C;
Proifessr It erner Aiters. Direct tor. Epidemiology De part-
mentii, Huindi ye uirdhe itf an. Herlii Federal Republic
of Ge rmany, and a 41d ia.l officer, Foreiln Quararntine
Program, Li ondo)n.)


EPIDEMIOLOGIC NOTES AND REPORTS
OUTBREAK OF SYPHILIS Multnomah County, Oregon


\n outhrieak of -\philis with fix(e cases occurred in
earlx 196i) in Mul(iniirah (Count\. Oreogn. The first case
xa-. reported on .anuar\ (i hb a private physician \\ho
dig no-ed primary sphilis (riealtie VID)I test of s dilu-
tion.- darkfield positive) in a 3t-voar-old mnan. One off
ltwo clonitact narned h) this iman iwa- located and found to
ha\e earl\ latent S)plihili- (revuti\oe \DRL test of 1:16
dilution-) on lanuarv 10. Sthe had been hospitalized 2:1
dasi prior to lie diagnosis of si'philis for pelc ic inflai-
matory disia-ci ,. Durinii her Iti days of hospitalize action.
no -serolohic -t I- for -1phlilis \wrre performed. She named
-ix persons including tli(h first patient wxho had been re-
cent l exposed to her. Four of thel other fi\ e persons were


located and examined within the next 2 weeks. Two were
found to haxe primary syphili-. one early latent syphilis,
and one was not infected. The remaining contact wasi not
located.

(Reported by (. A.1 .l nike. .I. ., fI.P.11. Actiiny Director,
IVeiereal Oisease Section, Oregon State Department of
Iealh(,l and the IVenereal Diseasi e Prograim. \('IC.)

Editorial Comment:
This outbreak emphasizes the need for routine sero-
logic testing for syphilis 1t\ hospital- and the inclusion
of syphilis in the differential diagnosis if symptoms are
present.


MEASLES Baltimore, Maryland


Between July 2:1 and august 9. 19(i9. an outbreak of
n-ea-le- wiith 10 ca-ei-(Figure I)occurred in unimmunized
children. ages- 1 to 7 years. in a po\vrt\I area of Balti-
more. The outbreak Iwa- unco\lredl on AuguSt 6, follow-
ingl t ilh diagno-i- o)f mlltale- in a 6-year-old girl \lho wa-.
-s.on at rhe outpatient clinic of a local hospital. Through
immediate int'i tigation in her neighborhood, eight other
case- Nwere found. The source of infection for the index
car-e .\\ undetermined. Meas-les vwas confirmed in two
children Ix\ a ri-e in liter let\weein acute and coniale--
coent sera.
On tlugui t 9. an immunization clinic was held in this
conirmunit :i at lo al poverty agency: employees of the
health center publicized the clinic by a door-to-door dis-
trihution of leaflets and with broadcasts front a sound truck.


Figure 1
MEASLES CASES BY DATE OF ONSET
BALTIMORE, MARYLAND
JULY 22-AUGUST 10, 1969



u,


Forty-eight preschool children stand 79 school children
attended and were immunized against measles.
During this clinic session. measles was recognized
in a 13-month-old child. who was the cousin of an earlier
case and who lived outside the area receiving publicity
for this clinic. This child's neighborhood was then sur-
((ontinued on page 324)


SURVEILLANCE SUMMARY
COMPLICATIONS OF SMALLPOX VACCINATION United States 1968


Durlnrin g 1!i an estimated 5,5914.001 primary vac-
cination and l .57 1.00 rm vaccinations i 'ere administered
to re-ide'nt- of the I nite-d Stats. (O)\r half of the primary\
\caiiinlations wxrei- in children tinder the age of 5 ears.
iil e theI majority of r\ acci nations weren in per-ons o er
the age of t10 \ear. \ total of 572 'rnpllicaltions oif iac-
inatiiion \ith nine iheatlh- \ere recorded (T:th l 2) for tan
rinidence of 71.7 compllic nations per million primnar \av t
cination antd 1.7 "omplication- per million re\ ar ina-
lion. The age rouii) under 1 \ear of age a:ppiehareld al


greatest risk: there xwere 112. 1 complications and five
deaths per million infants given primary \accinations.
(Reported by the Domectic Operatiofns :..t o Smallpox
Eradication Program, NC)('.)

lNStionil Conmumniai.l I)* Diu ,-* ( nlh'er, nit(tI ,tates- Immu-
_niation Survey 1967, iC)'. Pli)-mim r 196i i 2n1.
S "p of lh*. report from wh(-h t:h<.tn dait' r( d riv i 'l i "
'' )T ,hi il ion r i,,u ,t from
attionialt mmicnuio 1i -lil is t .- o nter
A\tn: rsmallipx Eri arton ..r..r..i


Morbidity and Mortality Weekly Report

TYPHOID FEVER Wt'onried from front payg)






SEPTEMBER 13, 1969


Morbidity and Mortality WV.Aly i.porrt


Table 2
Complications of Vaccination by Diagnosis and Vaccination Status

Age Number of Number of C('as
(Years) Vaccinations Post\accinial Vaccinia Eczema Generalized Accidental Other Total
Encephalitis Necro-uml a~ lnatum 1niI \accinia Intection
Primary Vaccinations*:
< 1 614,000 4 (3)+ 0 5 43 7 10 69
1-4 2,733,000 6 1 31 47 91 40 216
5-9 1.553,000 5 (1)+ 1 (1)+ 11 20 32 8 77
10-14 295,000 0 0 1 2 1 1 5
15-19 111,000 0 1 (1)+ 2 3 2 0 b
20+ 288,000 1 2 7 13 4 5 32
Unknown 0 0 1 3 5 2 11
Total 5,594,000 16 (4), 5 (2), 5h 131 142 66 418*
Revaccinations:
<1 0 0 0 0 0 0 0 0
1-4 47h Ia'i 0 0 1 0 1 1 3
5-9 1,643,000 0 1 (1). 4 1 3 2 11
10-14 1.440,000 0 0 1 0 0 0 1
15-19 1,217,000 0 1 2 0 0 0 3
20+ 3,796,000 0 4 (1). 0 9 3 6 22
Total 8,574,000 0 6 (2)+ 8 10 7 9 40
Contacts:
<1 0 0 4 0 9 1 14
1-4 0 0 38 (1)+ 1 16 6 61
5-9 0 0 8 0 7 0 15
10-14 0 0 0 0 2 0 2
15-19 0 0 1 0 1 0 2
20+ 0 0 9 1 9 0 19
Unknown 0 0 0 0 0 1 1
Total 0 0 60 (1)+ 2 44 8 114
Grand Total 1 16 (4)+ 11 (4) 126 (1)- 143 193 83 572
*Includes 31 patients with unknown vaccination status. +D aths .ltributlble to vaccina shown in parentheses.

INTERNATIONAL NOTES
SMALLPOX West and Central Africa
For the first 7 months of 1969, 445 cases of smallpox reported, in June, 10 cases, and in July, 34 cases were
were reported from the 19 countries of West and Central reported to the World Health Organization (Table 3).
Africa compared with 4,236 cases reported during the Of the 34 cases reported in July 1969, 31 occurred in a
same period in 1968 (Figure 2). In May, 26 cases were single outbreak in Lokossa village (Adjohoun Sous-
Table 3
Provisional Number of Smallpox Cases by Month West and Central Africa

1969 1968
Country* Total Total Same Total for
January February March April May June July to Date Period Year

Cameroon 11 3 1 15 84 87
Chad 5 5
Dahomey 3 31 34 318 359
Ghana 3 2 5 24 26
Guinea 12 4 16 275 330
Liberia -- 5 5
Mali 1 1 57 58
Niger 2 5 14 1 6 28 664 678
Nigeria 67 77 13 13 6 4 3 183 1,700 1,832
Sierra Leone 23 30 3 14 10 80 688 1,143
Togo 13 6 3 51 10 83 376 784
Upper Volta 40 100
Total 134 124 34 83 26 10 34 445 4,236 5,407
-No Cases *No cases reported from Central African Republic, Congo (B), Gabon, Gambia, Ivory Coast, Senegal, and Mauritania.
(Continued on page 324)







320 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED) NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

SEPTEMBER 13, 1969 AND SEPTEMBER 14, 1968 (37th WEEK)

ENCEPHALITIS HEPATITIS
'[|r N- BM Ii HII *lVlio Primary including I'l- MALARIA
,nw Primary i i Serum Infectious MALARIA
AREA unsp. cases Id'liue
Cum.

i t [i 'F I .. '5 't, I 4 2 vn15

NEW ENGLAND.......... 16 2 4 128 51 1 68
Maine.t............ 4 4 6
New IHampshire ...... 3 2
Vermont............ 9 7 -
Massachusetts...... 5 1 2 83 14 44
Rhode Island....... 11 20 15 1 4
Connecticut........ 1 2 9 11 12

MIDDLE ATLANTIC...... 42 2 1 11 47 134 166 14 237
New York City...... 9 2 24 35 59 20
New York, up-State. 2 1 1 23 32 3 36
New Jersey.......... 20 2 3 3 36 28 11 97
Pennsylvania....... 11 1 5 19 40 47 84

EAST NORTH CENTRAL... 40 -- 12 38 1 5 136 124 5 204
Ohio. ............. 24 9 32 1 1 34 22 1 20
Indiana............. 9 4 19
Illinois........... 2 1 1 38 40 2 121
Michigan........... 8 1 5 4 50 55 2 43
Wisconsin.......... 6 1 5 3 1

WEST NORTH CENTRAL... o 3 3 2 39 62 8 144
Minnesota.......... 5 1 1 5 16 1 8
Iowa. ............. 3 3 1 8 6 14
Missouri........... 8 25 4 40
North Dakota....... 1 3
South Dakota....... 9
Nebraska........... 1 10 1 3
Kansas............. 1 8 4 3 76

SOUTH ATLANTIC....... 18 8 7 5 113 106 15 529
Delaware........... 1 1 1 9 3
Maryland........... 3 2 1 27 9 28
Dist. of Columbia.. 1 3 1
Virginia .......... 2 8 14 20
West Virginia..... 6 1 2 8 -
North Carolina..... 2 14 3 2 235
South Carolina..... 5 1 2 6 8 47
Georgia............ 14 39 13 169
Florida............. 3 2 2 3 38 16 26

EAST SOUTH CENTRAL... 8 1 1 2 4 33 56 3 88
Kentucky............ 3 12 24 1 68
Tennessee.......... 3 1 1 2 2 15 12 -
Alabama............. 2 3 16 2 18
Mississippi........ 2 3 4 2

WEST SOUTH CENTRAL... 11 2 1 7 1 81 52 19 130
Arkansas........... 11 10
Louisiana.......... 2 1 3 1 14 17 40
Oklahoma............ 3 3 11 2 45
Texas.............. 6 2 I 45 33 19 35

MOUNTAIN............. 3 6 1 2 58 73 1 122
Montana............ 2 11 3
Idaho.............. 1 3 1 3
Wyoming............. 4 -
Colorado ............ 2 1 9 6 1 103
New Mexico......... 3 3 7 7 7
Arizona.*............ 16 31 1
Utah ............... 1 1 3 10 1
Nevada.............. 14 7 4

PACIFIC.............. 21 2 6 11 2 25 241 320 13 483
Washington......... 1 1 1 53 36 5
Oregon............. 1 1 14 26 1 10
California......... 14 2 5 11 1 24 162 254 12 378
Alaska............. 2 2
Hawai ............. 5 12 2 88

P.rt- Rco- ......... 29 28 2

*'elaved renorts: Aseptic neninpiti: Iowa 1, Ariz. 1
Rrucellnsis: Va. 1
lncephalltis, prinarv: P.R. 3
Hepatitis, infectious: 'e. 9, Ohio delete 1, P.R. 22
"alaria: Iowa 1







Morbidity and Mortality Weekly Report 321


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

SEPTEMBER 13, 1969 AND SEPTEMBER 14, 1968 (37th WEEK) CONTINUED


MEASLES (Rubeola) MENINGOCOCCAL INFECTIONS, MUMPS POLIOMYELITIS RUBELLA
TOTAL
AREA Total Paralytic
AREA Cumulative Cumulative Total Paralytic
Cum.
1969 1969 1968 1969 1969 1968 1969 1969 1969 1969 1969
UNITED STATES... 129 20,387 19,635 29 2,375 2,030 449 2 1 10 231

NEW ENGLAND.......... 6 1,108 1,154 4 91 121 61 1 29
Maine*............. 8 37 6 6 8 5
New Hampshire..... 238 141 1 3 7 -
Vermont............ 3 2 1 3 1
Massachusetts...... 1 215 362 3 37 63 27 7
Rhode Island....... 4 27 5 11 9 4 7
Connecticut........ 1 617 607 34 35 19 1 9

MIDDLE ATLANTIC..... 11 7,496 4,043 3 390 363 26 1 16
New York City...... 6 4,911 2,110 2 75 73 22 11
New York, Up-State. 596 1,218 72 64 NN 3
New Jersey ........ 2 898 605 158 128 4 -- 1
Pennsylvania....... 3 1,091 110 1 85 98 NN 1 1

EAST NORTH CENTRAL... 47 2,227 3,780 5 325 244 107 38
Ohio ............... 1 376 294 2 123 64 11 8
Indiana............ 4- 466 672 38 34 12 9
Illinois........... 30 525 1,364 2 46 54 17 2
Michigan........... 7 280 266 95 72 12 5
Wisconsin.......... 9 580 1,184 1 23 20 55 14

WEST NORTH CENTRAL... 5 529 384 3 121 108 34 1 19
Minnesota........... 7 16 1 26 26 2 -
Iowa............... 329 98 2 18 6 15 15
Missouri........... 26 81 51 35 17 -
North Dakota....... 14 134 1 3 -
South Dakota....... 3 4 1 5 NN -
Nebraska........... 5 143 41 9 6 4
Kansas............. 7 10 15 27 1 -

SOUTH ATLANTIC....... 10 2,500 1,503 6 410 410 43 1 21
Delaware............ 1 374 16 8 8 1 1
Maryland............ 75 96 1 39 34 4 -
Dist. of Columbia.. 6 9 14 1 -
Virginia........... 883 297 1 51 35 12 2
West Virginia...... 4 197 288 18 11 14 9
North Carolina..... 1 316 282 1 69 76 NN -
South Carolina..... 1 117 12 1 57 56 2 2
Georgia............. 2 4 70 85 -
Florida........... 3 536 502 2 89 91 9 -- 1 7

EAST SOUTH CENTRAL... 2 109 492 144 185 17 1 10
Kentucky........... 2 65 100 50 84 5 6
Tennessee.......... 17 62 54 54 12 2
Alabama............ 4 94 24 26 1 1
Mississippi........ 23 236 16 21 1

WEST SOUTH CENTRAL... 31 4,527 4,800 2 321 304 59 4 31
Arkansas........... 16 2 30 20 -
Louisiana.......... 120 23 1 85 87 1
Oklahoma........... 136 117 30 50 3 -
Texas.............. 31 4,255 4,658 1 176 147 56 4 30

MOUNTAIN............. 6 858 981 2 45 32 33 1 14
Montana............ 17 58 8 4 4 1
Idaho.............. 89 21 8 11 1 -
Wyoming............ 51 1 3
Colorado............ 140 504 1 8 10 5 3
New Mexico.......... 2 247 102 6 6 3
Arizona............. 4 355 219 10 2 12 1 -
Utah................ 9 21 1 3 1 5 4
Nevada............. 1 5 2 3 -

PACIFIC.............. 11 1,033 2,498 4 528 263 69 1 1 1 53
Washington......... 59 520 54 38 15 13
Oregon.............. 198 523 1 16 21 7 5
California.......... 10 729 1,418 3 437 190 28 1 1 1 9
Alaska.............. 8 2 11 2 -
Hawaii............... 1 39 35 10 12 19 26

Puerto Rico.t ........ 32 1,480 407 19 19 31 4
*Belayed reports: Measles: N.J. 10, P.R. 11
Meningococcal infections: La. delete 1
Mumps: Me. 6, P.R. 6
Rubella: Me. 1






322 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

SEPTEMBER 13, 1969 AND SEPTEMBER 14, 1968 (37th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA POI TICK-BORNE RABIES IN
AREA SCARLET FEVER FEVER (Rky. Mt. Spotted) ANIMALS
Cum. Cum. Cum. Cum. Cum.
1969 96 1969 1969 1969 1969 1969 1969 1969 1969
UNITED STATES... 4,240 6 103 5 108 6 205 8 367 50 2,524

NEW ENGLAND.......... 424 14 9 20
Maine*............. 6 -- 6
New Hampshire...... 17 4
Vermont ......... 14 2
Massachusetts...... 92 6 -
Rhode Island....... 32 1 -
Connecticut........ 277 1 7

MIDDLE ATLANTIC...... 171 1 14 1 5 21 2 42 5 147
New York City...... 4 1 7 1 10 -
New York, Up-State. 158 3 1 4 5 6 5 139
New Jersey......... NN 2 2 2 14 -
Pennsylvania........ 9 2 4 22 8

EAST NORTH CENTRAL... 326 12 10 1 22 1 3 7 183
Ohio............... 35 1 8 5 62
Indiana............ 127 1 45
Illinois........... 90 7 3 1 10 1 3 1 29
Michigan ......... 9 4 4 1 7
Wisconsin.......... 65 6 40

WEST NORTH CENTRAL... 167 3 10 13 8 8 11 468
Minnesota.......... 7 1 3 3 2 123
Iowa............... 63 7 2 67
Missouri........... 4 2 3 9 3 2 120
North Dakota....... 57 2 60
South Dakota....... 9 1 24
Nebraska........... 17 1 -- -- 12
Kansas............. 10 4 3 1 3 62

SOUTH ATLANTIC....... 655 1 19 20 1 32 2 197 9 633
Delaware........... 2 2 3 -
Maryland ........... 27 4 42 3
Dist. of Columbia.. 2 1 -
Virginia........... 196 4 57 5 320
West Virginia...... 183 1 2 1 5 93
North Carolina ..... N 2 5 6 1 48 4
South Carolina..... 83 1 2 1 1 30 -
Ceorgia............ 7 1 3 3 9 12 1 66
Florida............ 157 9 4 1 8 3 147

EAST SOUTH CENTRAL... 803 16 11 4 32 2 55 5 354
Kentucky........... 109 6 3 6 1 9 1 182
Tennessee.......... 568 4 10 1 19 39 4 120
Alabama............. 64 5 4 4 46
Mississippi ........ 62 1 1 3 1 3 6

WEST SOUTH CENTRAl... 452 18 18 22 1 43 10 358
Arkansas........... 8 1 1 10 7 1 26
Louisiana.......... 9 7 4 3 2 28
Oklahoma........... 3 1 7 28 3 53
Texas............. 432 9 6 9 1 8 4 251

MOI1TAIN .... ........ 962 1 5 3 14 23 14 111
Montana ........... 25 1 1 -
Idaho.............. 104 3 4 -
yom in............. 17 2 5 52
Colorado............ 461 2 3 8 3
Nw Mexico ......... 208 1 5 15
Arizona............ 83 1 2 5 22
tah............... 64 3 11 2 5
NI-vada ............. -- 1 14

PACIFIC.............. 280 9 1 3 36 5 3 250
i shinito ......... 61 1 2 2 3 4
t rg ............. 68 1 1 6 3
Caifrnia ........ 8 27 2 3 243
ai i*............ 131 -

Puerto Rico......... 3 6 20


Tetanus: P.R. 1
Tvnhoid fever: Hawaii 1








Morbidity and Mortality Weekly Report


Week No. TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED SEPTEMBER 13, 1969

37 (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 yea Area All 65 years and I year
Ages and over Influenza All Ages and ov Influenza All
All Ages Causes er 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.--------


666
203
38
22
18
57
25
29
24
49
44
14
50
36
57

3,093
61
31
139
50
26
36
57
74
1 ,562
40
398
206
46
116
25
33
83
47
29
34

2,696
79
36
760
183
202
138
89
326
40
51
46
33
42
1 09
34
129
38
48
45
115
61

833
69
26
40
116
23
102
96
222
68
71


370
105
26
12
13
30
15
18
15
27
17
9
28
18
37

1,779
31
21
88
25
17
28
35
37
885
25
210
105
35
75
16
25
47
21)
21
24

1 ,500
48
25
302
121
111
76
39
170
27
27
28
20
31
108
11
80
20
31
30
62
43

488
45
19
17
71
14
67
51
126
42
36


Total 12,378 6,857 447 641

Expected Number 11,766 6,716 344 517


Cumulative Total
includess reported corrections


-4 81 7


76 8t 25


)7 761


22.625


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.---------n
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.----------


1,227 565 49 83
157 67 6 13
263 119 3 16
48 16 1 5
93 47 2 11
103 46 5
67 33 3 1
78 41 6 10
41 15 4 5
87 68 3 3
74 36 10 5
167 77 9 5
49 20 2 4

629 323 33 38
103 53 1 5
39 20 5 5
36 22 2 2
116 60 17 7
160 78 2 12
45 29 1 2
45 20 4 4
85 41 1 1

1,212 608 44 72
44 2() 6 3
32 19 3
27 18 2
179 71 2 11
35 21 2 2
96 54 6 7
253 111 3 10
50 24 1 2
148 69 4 6
88 45 3 7
116 64 7 11
56 31 1 6
88 61 9 2

443 248 12 30
52 22 5 2
36 16 1 3
121 69 3 7
19 9 4
99 63 6
18 13 1
59 31 1 6
39 25 2 1

1,579 956 42 63
18 12 -
39 23 1 1
30 23 2
62 29 1 9
91 50 2 1
477 292 10 14
72 39 3
30 19 1 -
160 104 3 5
48 31 2 4
107 51 4 8
161 95 3 4
39 26 6 1
127 80 7 6
68 49 2 3
50 33 2


________________ ______,_ ____ I I ,
"Mortahllt data are being collected from Las V\ s, Ne-o. foi possible inclusion n i this
Las Vegas, Nev.* 20 8 tble, hover, tot stistical e thet's h dita ili br listed oni) and not included in










SMALLPOX (C.onIinud :from page 319)
Figure 2
REPORTED SMALLPOX CASES BY MONTH, 1960-67
AVERAGE, 1968 AND 1969
WEST AND CENTRAL AFRICA






;;---- -- -~: --- ;- -




Pr fet ire.) in -oih,' I. TIr DlaholmeT In \AuUst. a s-cond
outbreak. unrelated (o ihe fir-l. as detlected in westIern
DhoII ( outi-Prefectur I)'\himiii, ). The fir-st caie
Iin the -, on 1t l ,hreak wa0 in a 1-month-old
Da oI e\a nt ili. who w\;> soen in mid-i.Jui at a nm dical
center i I'oo Prliminar\ laboratory\ reports indicate
tiat a s-- of ilwk npo\ aI \ell a1s sniallpox art occur-
rin i in ihi outbreak. Epidemiologic inwie.tig.ion and
optlid il c control i-eau res arIr e undt rwalv.
Since the 1,I inning of field ac1iiitise in January 1967
of ith I ..-a-siteid 1 Vst \frican Smallpox Eradication
\M a-lc-> (Conroi I' .., 01.9 million smallpo\ x accina-
ion- Lae be, n b i- l rin tcred throughout this 19-country
aira. [ he're T'i rotal pol ulit ion is e-timat: d at 119 mil-
lion p,'o)pl e.




1:i ii/o Ii .*< *?!, f!,iu"'.J io:o< i ..;* R,-r, t ,r.:, : i:6-:.-,>(;. Si.ptnmb~rr 5,


MEASLES i.,iritiiiiid rom page 318)
l edl for other raue. ,but none was detected. On August
1t. an ii n innini ai ion clinic ~as held in this area. and S2
p|recho
    M\eIl-rs -ur'eillance i- continuing in these two areas.
    IKi,/'rTl i '/ R bet FaerTr/ 11.1.. 1..11H... Commffissioner
    /l, t l h. ,iI .VT:, ,i T V .T 1V.I.. Ilr.P.11.. Director,
    I ii T iii 1 m nic ,b : l)e u sri lialtimnore City Health


    s n nf COt(il:iniii.ci' tlj Dil S'tIraS and the Public Hlealth
    ..lii.i or\ :ssi ;iii/jp I, te aorylmid Stnate Irmmunrsization
    fl:ryiirS;d Satt, Htlutii lrepartnment: Tanmadiye
    I' -, y V.D.. l'ij <'t lire t < r, and lWi liat Poi pe, 31.D.,
    .l'.H.. :i<,ii:a D1irecor, 'ro ilicn, oniprel er irce Veigyh-
    hii on. fit'
    ADDENDUM, Vol. 18, No. 35, p. 303
    In itl ariircle "Follow-up Diphtheria Phoenix.
    Mari iinl- and ; not rcalin i ply lhal antimitcrohial,- htlae replaced anti-
    loi n inte treatment of confirmed or suspected raises of
    \Intitn mu-s he "i\en as early a possible

    in ih ilhnss--. althoughh antimicrhinal- haie leen demon-
    -Iraf t o l e hL, of S alue in eradicaltinl the orTanism from
    Ixh pIal'nts iand carrier-, they do not affect lhe clinical
    IotiirT- of illn+ss. -

    1L, i7+,1,ir,. I.,: I [,ly+h <-n++:>. (%r,ir { 1',-i+i/rc ;Thrrapy I'if9(;-
    'I (,I ,I s -. mil K IA iI, Bcrij T Ii t. \l. ( d.). I. Ii.
    . I, 1 1 I'h l llfh. I I t Kif i, I (.. IK5l-6(' I.


    SEPTEMBER 13, 1969


    THE MORBIDITY AND MORTALITY WEEKLY REPORT. WITH A CIRCULA-
    TION OF 18,500 IS PUBLISHED AT THE NATIONAL COMMUNICABLE
    DISEASE CENTER. ATLANTA, GEORGIA.
    DIRECTOR, NATIONAL COMMUNICABLE DISEASE CENTER
    DAVID J. SENCER, M.D.
    DIRECTOR, EPIDEMIOLOGY PROGRAM A. D. LANGMUIR. M.D,
    EDITOR MICHAEL B. GREGG. M.D.
    MANAGING EDITOR PRISCILLA B. HOLMAN
    IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
    MORBIDITY AND MORTALITY, THE NATIONAL COMMUNICABLE DISEASE
    CENTER WELCOMES ACCOUNTS OF INTERESTING OUTBREAKS OR CASE
    INVESTIGATtONS WHICH ARE OF CURRENT INTEREST TO HEALTH
    OFFICIALS AND WHICH ARE DIRECTLY RELATED TO THE CONTROL
    OF COMMUNICABLE DISEASES. SUCH COMMUNICATIONS SHOULD BE
    ADDRESSED TO:
    NATIONAL COMMUNICABLE DISEASE CENTER
    ATTN: THE EDITOR
    MORBIDITY AND MORTALITY WEEKLY REPORT
    ATLANTA, GEORGIA 30333

    NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
    BASED ON WEEKLY TELEGRAMS TO THE NCDC BY THE INDIVIDUAL
    STATE HEALTH DEPARTMENTS. THE REPORTING WEEK CONCLUDES
    AT CLOSE OF BUSINESS ON FRIDAY; COMPILED DATA ON A NATIONAL
    BASIS ARE OFFICIALLY RELEASED TO THE PUBLIC ON THE SUCCEED-
    ING FRIDAY.

    U


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