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:
AA00010654:00227

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 WELFARE / PUBLIC HEALTH SE vl(
DATE OF RELEASE: OCTOBER 10. 1969 ATLANTA


On t
in South
awakening
nausea,
was trea


Vol. 18, No. 40








Wt ending
Oct 4, 1969


EPIDEMIOLOGIC NOTES AND REPORTS
BOTULISM South Bend, Indiana Epidemiologic Notes and Report,
Botulism South Bend, Indiana .. .. :45
the morning of Sept. 18, 1969, a 42-year-old woman C e f Pulmonary Meoids Oklhom
R babies Exposure iakim;a l; ashington. 7ii
Bend, Indiana, noted dizziness and dry tongue on International Norte
g. Approximately 3 hours later, she developed ( holera HIon Kong. Matcu. and Korea . 317
Surveillance Summary
vomiting, and generalized weakness for which she Foodborne Disease Outhbr*aks Unitd States.
ered with anti-emerti medicaltin 1) h. er hV ,;cin January-June 1969 ....... ... 3 .


The next day she noted dysphagia, dysarthria, diplopia, and
ptosis of the eyelids. Her sensorium Nwas intact and she
was afebrile. The following day (September .:,, because of
progression of symptoms and the onset, of respiratory dis-
tress, she was hospitalized. There she was noted to have
dilated unreactive pupils. A lumbar puncture revealed ele-
vated pressure but normal protein and no cells. Following


lumbar puncture, the patient sustained a respiratory arrest:
endotracheal intubation was carried out and she was placed
on a respirator and was treated with steroids and tetracy-
cline. At this time, differential diagnosis included viral
encephalitis, idiosyncratic reaction to prochlorperazine,
and myasthenia gravis.
continued d on page 346)


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

40th WEEK ENDED CUMULATIVE, FIRST 40 WEEKS
MEDIAN
DISEASE October 4, October 5, MEDIAN
1964- 1968
1969 1968 1969 1968 1964- 1968
Aseptic meningitis ...................... 145 165 85 2.525 3,272 2,213
Brucellosis ............................ 3 8 4 176 177 197
Diphtheria ............................. 8 17 7 135 162 147
Encephalitis, primary:
Arthropod-borne & unspecified ........... 62 45 45 962 1.032 1.425
Encephalitis, post-infectious ......... 4 8 8 256 397 616
Hepatitis, serum ........................ 114 109 4,019 3,392 29.761
Hepatitis, infectious .................... 957 979 35,867 34,287
Malaria ................................ 62 47 16 2,235 1,733 324
Measles rubeolaa) .......................167 107 472 20,875 20.000 190.817
Meningococcal infections, total ........... 26 23 34 2.440 2,105 2.149
Civilian ........................... .26 22 2,234 1,923
Military ............................... 1 206 182 -
Mumps ................................ 624 854 --- 69.859 127,283 -
Poliomyelitis, total .................... 1 1 13 48 48
Paralytic ............................. 1 1 11 48 48
Rubella (German measles) ............... 331 262 49.982 44,624 -
Streptococcal sore throat & scarlet fever.,. 6,652 6,969 5,986 323.977 324.094 324,094
Tetanus ............................... 4 6 6 118 130 173
Tularemia .............................. 6 5 114 155 155
Typhoid fever ......................... 11 6 12 235 293 324
Typhus, tick-borne (Rky. Mt. spotted fever) 7 5 5 411 261 241
Rabies in animals ...................... 47 153 53 2,688 2,730 3.420

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........................................... 3 Rabies in man: ................................ ...... 1
Botulism: Ind.-1 .................................... 12 Rubella congenital syndrome: N.C.-1 ..................... 9
Leptospirosis: Calif.-1 ............................... 61 Trichinosis: ........................................ 162
Plague: ............................................ 3 Typhus, marine: ..................................... 35
Psittacosis: ..................................... 32
*Delayed report: Leptospirosis: Me.-1.












On September 22, a history of eating fish, caught in
Canada. was elicited. and the i ,r,,.-.- of botulism was
considered. The patient was treated with trivalent (A,B,
and E) hotulinumn antiserun on September 23. after which
lihr clinical status progre-ssiely improved. By September 29.
she no longer required assisted ventilation and on Octo-
lher I she became aibulatory.
The aoiman s-hared all meals with two or more indi\i-
duals. bult no unexplained neurologic illness had occurred
arnIon thr-se- a-sociates or in the community. The patient
had acces- to numerous home-canned vegetables from her
oan home and from her neighbors. While these were cooked
prior to eating, the patient habitually tasted their contents
before cooking.
Mice injected with sera obtained from the patient on
Sepet'niber 211. 22, and 23 developed typical symptoms of
botulism and died. The identification of a specific botu-
linum toxin was not possible due to insufficient serum
aii able for examination. The contaminated vehiclee re-
main- unknown.
(RI ported by James Wack, V.D)., and George Plain, M.lI..
1'fysiioans South Bend; Louis E. How. V.D.. Director of
P ib'ic Health. St. Joseph's County; Hermann E. Rinne,
1).0.. director. Division of Communicable Disease Control,
li iarn State Board of Health; Anaerobic Bacteriology


OCTOBER 4, 1969


Laboratory. Bacterial Reference 'nit, Laboratory Division,
\'COt: and an EIS *.)

Editorial Comment:
This is the sixth outbreak of botulism reported to
NCD( in 1099: 12 persons ere affected and there were
four deaths.
Since lh991- Indiana has reported six outbreaks of
botulism: 23: persons iwere affected with 10 deaths. Of
the five previoou- outbreaks, three were idue to type A and
two to type B toxin.
\Athough the vehicles tested in this outbreak were
negative for toxicity, the patient's habit of tasting home-
canned food prior to cooking might explain her exposure
to botulinum toxin. The paucity of serum a\a liable for ana-
lysis in this case underscores the desirability for elini-
cinas to obtain 20-.30 ce of serumi on ad is -ion for future
reference from all patients with obscure illne-s.


M\hoir, K. E. .cni 1t die 1t.: S -fi- \ i t e V r: tifuman Botu-
iism in the t- nitd Stie-. ioit Cin.d.: pid m ic i olz a nd Tabu-
Ictins <>r e Ri port lCd 1(tSi99 Ilrouyli, -tic t. (titd orcr tillians
tlceir Fo-dEetone i nto itesc c uf adi forn -c, -in lre iscoi
\It-l (tene'er. J unT .l65.
Nlcttcna ('omimunie<';tl c ites-tb ('t-nter: tk!iueisem it t nihited
-tctc Us: -w -f C ^ es 1 'iS) iit>7 anil H dbek for i-
ieetci Ia (tia- a eilerm riirk-rs


A CASE OF PULMONARY MELIOIDOSIS Oklahoma


On Sept. 16. 19!69. a 22-year-old soldier, who had
returned to Oklahoma on September 4 after 5 months in
\ietnam. was admitted to a military hospital in Oklahoma
(' t with a diagnosis of pulmonary melioidosis. He gate
a historic of ha:ting had chill.s fecer. a miinimally produc-
ti\e cough. and pleurisY on August 7 while on active duty
in ('u-('hi, Vietnam. This illness had been diagnosed as
ibrinchitis: no specific therapy was -gi\n. He had been
:1-a pto ma i when he returned to Oklahona. After 1 eek-k
ih hal again deelopedl a productive cough, and 4 days
lalrr hi- sputum becarn streaked with blood. 1He had not
riru-lei outsi-,d i he I'nited States before his duty in

On adeisi--in to the hospital, he hadl a temperature of
1 p .tlF.. p-ule( rate of 90 per niin., and Ilotx pre--ure
of 1:;;) ,i. Tubular breath -ounds and cour-s rales were
ih-rd i e-r tih upper right posterior hemithorax and a 1 Icm
-i rin co~,red with eschar was seen on the right lateral
sin.
Tlhi initIl laboratory \alue- included a hemoglobin
otf 1e percent., hmatocrit of ;7 percent, and white blood


cell count of 17,500 per rnr: \with (.t; percent neutrophils,
6 percent hands 19 percent Inmph ocyrtes, perc-ent mono-
c\ltes, and t) percent eosinophile-. I rinalys-i- was normal.
An area of con ido o-iat ntaintingi a 2 cm ca eity in the
posterior -csment tof the right upper lole was seen on chest
X-ray antd within 2'l hour- after adri ission. Pseudomonas
pcadtomaci wat- lde-ionstratet in thte -putu1m b the fluo-
rescent anitieod technique. Interilediate strength PPD
failed to elicit any reaction and no acid-fast organisms
were s-en in th-e putmt -s ear. P. p \ /ou mal:i was iso-
nlted from tl -putu:~ r te-t- conlucted at two different
laboratorie- -S ra for IP. .- ..i,, i:,-i ant i be(l testing are
being going otined frot tihe pa:ea ct and 10 of his family
contacts.
On 1Sepi-tbl r I tii, pa ciinr ia- -tarred on oral tetra-
eyeline. :i g per da) for :l, id -\ 1(e was- I .. I cr.ia d on
October I and i- curreon- l a-\nitr otmallce.
IlReporrtei y la .It- i \it., lre t S..ttF. tOk'alaoma *" .
H. L? rk y (airpe nt li .I.. ir,:ol : iP inion of Epidemi-
ol'ejy,

Morbidity and Mortality Weekly Report




BOTULISM South Bend, Indiana (Continued from front page)





OCTOBER 4, 1969


Morbidity and Mortality Weekly Report


RABIES EXPOSURE Yakima, Washington


On Aug. 2, 1969. in Yakima, HWashington, a 4-month-
old pet skunk, while being bathed, bit two of its owners.
On August 11, it was noted to be irritable and within 36
hours developed paralysis of the right hind leg. On August
12, the animal was taken to a veterinary hospital, where
it developed extensive paralysis, had convulsions, and
died on August 17. Its brain was found positive for rabies
by the fluorescent antibody test.
The owners had purchased the skunk in early July
from a pet store that had obtained it in June from a local
skunk breeder and trapper. Whether the skunk was wild or
had been bred in captivity could not be determined. It had
been vaccinated with a modified live virus tissue culture
rabies vaccine (ERA porcine tissue culture vaccine) on
July 29.
Between July 29 and the animal's death, a total of 20
people including the two owners, both of whom had received
deep bites, were exposed to the skunk. Eleven of them
were felt to have sufficient exposure to warrant antirabies
prophylactic therapy; consequently, seven were treated with
duck embryo vaccine and rabies antiserum and four with
duck embryo vaccine only. Five of these 11 had reactions
associated with this prophylactic therapy.
(Reported by Leland S. Harris, M.D., Health Officer, IYakima


County; Joyce Campbell, lmmunofluorescence Unit, and
Joseph DiCaprio, I.D.., Head. Diagnostic Section. Division
of Laboratories, and Byron J. Francis, M.D., Chief. Dii-
sion of Epidemiology. Washington State Department of
Health: and an EIS Officer.)

Editorial Comment:
Although there is no absolute method of differentiat-
ing between street rabies and vaccine-induced rabies, it
is possible that this was a case of \accine-induced rabies.
The interval between vaccination and onset of illness in
the skunk is compatible with \accine-induced rabies, and
the animal had been immunized with a live virus vaccine
which is recommended for use only in domestic animals
(dogs. cats, cattle, sheep, goats, and horses). Wild ani-
mals, such as skunks and foxes, can be safely immunized
with an inactivated virus vaccine or with HEP canine kid-
ney tissue culture modified live virus rabies vaccine .
The Public Health Service Advisory Committee on
Immunization Practices recommends that a wild animal
that has bitten a person should be submitted to a laboratory
immediately for sacrifice and examination, rather than
being held under quarantine as is done with dogs and cats
(MMHIR, Vol. 16, No. 19).


INTERNATIONAL NOTES
CHOLERA Hong Kong, Macau, and Korea*


Between July 5 and Sept. 3, 1969, cholera appeared in
Hong Kong for the first time since 1966. Seven indigenous
cases were reported; there were no deaths. Six patients
had onset between July 5 and 14 and the seventh had onset
on September 3. None had been immunized against cholera
in the 6 months prior to illness. All cases were confirmed
as serotype Inaba, biotype El Tor. The patients had a total
of 99 family and household contacts, 91 of whom were
located, isolated, and discharged from isolation after
having negative stool specimens.
Six patients resided in various parts of the Kowloon
Peninsula and one on the western coast of the New Terri-
tories mainland. No isolates of Vibrio cholerae had been
recovered from night soil samples in Kowloon or the New
Territories prior to the onset of illness in the first case.
No cases have been reported from Hong Kong island al-
huuh V. cholerae has been isolated from night soil
samples at various times since May 14.


Hong Kong was declared free of cholera on Sep-
tember 15.
Cholera was documented in Macau on Sept. 20, 1969,
for the first time in over 5 years, when bacteriologic exami-
nation confirmed the disease in a middle-aged man. Two
additional cases have since been reported. The strain of
vibrio is not yet known.
Since 1950 cholera has been reported from both Hong
Kong and Macau in 1961, 1962, 1963, and 1964. In addition,
one case of cholera was reported from Hong Kong in 1966.
On September 9 cholera was reported from the two
west coast Provinces of Cholla-Pukto and Chungchong-
Namdo in the Republic of Korea. As of September 24. 872
cases and 71 deaths including 15 cases and one death
from Seoul have been reported.

'Source: I orld Health Organization i eekly Epidemiological
Record, 44(31,32,39, and 40): 431, 4S5, 490. 563, and 572,
Aug. 1 and 8, Sept. 26. and Oct. 3, 1969.






Morbidity and Mortality Weekly Report


OCTOBER 4, 1969


SURVEILLANCE SUMMARY
FOODBORNE DISEASE OUTBREAKS United States January-June 1969


During the first 6i months of 196i9. 144 outbreaks of
food poionin ing .ffectinl .5,:37 people were reported from
10 sites I ... 1). In the comparable months of 196S.
Ill. outbreak- inxolhing 7.((i3 persons were reported from
:11 states. For thi.- period in 19(t9. bacterial etiology ac-
counted for the majority) of all foodhorne outbreaks of known
etiologi (Figure 2). followed hi chemical food poisoning.

Figure 1
NUMBER OF OUTBREAKS OF FOODBORNE ILLNESS
BY STATE, JANUARY-JUNE 1969










-_
G--- -
S *

( ; -. 1 ; :





Parasitric and iral agl ents were Incriminated in le-- than 5
percent of the outbreak- of known etiologyi anl no etiology
could lie determined in 20 percent of reported outbreaks.
Slaphi locoicrcl food pIi-oninI u-a the mlost common spe-
cific t, pe anid atc(ountlte, for nearly\ 2:, percent of all out-
breaks and 2> percent of all patients (Table 1). In the
correp ending )period iin 196(;. -taphllococcal enterotoxins
also caused p[)r(.-entt of thei reported outbreaks hut af-
feTled 3:1 percent of all patients. For these 6i months in
lil(ii). f('io.rdtjiini pr rriii ,yf .n food poisoning was the sec-
ond mo-lt comm-onl reported lype representing :22 percent
of total oulibrak- and 1)t ptertent of all patient-: in 196h.
Ihe rcspec(ie figures were In and 36 percent. Salmonella
Nia in third place in 1969 causing 11 percent of reported
outireak- and 14 percent tf c as-s: this corresponds to 12
percent and 9 percent, rt-especti (, ly for I196S For the first
i ninrtl- iof 199! (ihe atbo\te three ltpe-s woere- responsible
for .7 peirct nt of all outbreak- -:nd bl percent of all ill
inhi idual-. coml:ared \with .55 percent and 76 percent.
respect ely, for 190'1 .
The number of people ill per outbreak was tabulatled
... ..r.l-, to -sp)cific ty pe for the firts 6 months of 196i,
and 19ti9 (Ta'lile 2). Outhreaks of s:aphylococcus,. Trichi-
nr1i spir li, i che,-mial food poisoning, and unknown type
in\c ed -nmall groupl- of person- (1--s than Il, in both
i-ear-. n I!)(1't outlre-aks of -almonello-i- int oled groups
approimiately twici a-s large as thote in 199i. Outbreaks
of r'. prrfringc in 196(i involved groups numbering 5


times as many individuals as outbreaks in 1969. The
median number of persons involved in a foodborne out-
break considering all etiologies. however. remained rela-
tively constant for the 2 years with nine for 1968 and
seven for 1969. Attack rates were greater than 75 percent
for (. botulinum, staphylococcal. and chemical food poi-
soning: were between 50 and 75 percent for C'. perfringena,
salmonella, and unknown type food poisoning; and less than
50 percent for Esc'herichia coli and hepatitis food poisoning.
The three most commonly incriminated vehicles were
beef. pork. and fowl (Table 3). There was one outbreak
related to milk. Twenty percent of the con aminations oc-
curred in food serve ice establishments. 13 percent in food
processing establishments, and 11 percent in homes. In
60 percent of outbreaks, the site of contamination could
not be determined (Table 4).
The majority of foodborne outbreaks (73 percent) oc-
curred in homes and restaurants: however, these repre-
sented only 31 percent of the total people ill. "While food
poisoning in schools accounted for 12 percent of out-
breaks. it accounted for nearly 45i percent of all persons
affected. These figures are consistent wiith those for the
previous Year. Illness due to C. botulinum, staphylococcus,


Figure 2
FOODBORNE DISEASE OUTBREAKS BY
CAUSATIVE ORGANISM,
UNITED STATES, JANUARY-JUNE 1969

PARASITIC
2 8% VIRAL
S 21%
FL


(Continued on page ;;:


348







OCTOBER 4, 1969 Morbidity and Mortality Weekly Report






Table 1
Outbreaks of Foodborne Illness by Etiology
January-June 1968 and 1969


Etiology


BACTERIAL
B cereus
Brucella
C botuhnumt
C perfnngens
E coli
Salmonella
Shigella
Staphylococcus
Streptococcus
Multiple ettologies

PARASITIC
Trichnella spiralis

VIRAL
Hepatitis

CHEMICAL
Monosodium glutamate
Mushroom
Other chemical

MISCELLANEOUS

UNKNOWN

TOTAL


Total Outbreaks Total Patients Total Outbreaks Total Patienils


Number


Percent Number

68 7 7.056

9 2
35 4
18 2 2,761
3 5 382
12 2 680
1 195
25 2 2.391
4 3 641


20 174

115 1000


9 1


136 1 7


Number Percent

97 ,7 4



32

It,

13


30 20 8


3 +


Number Percent

4 h64 84 4


730 13 2


5.537 1000


Table 2
Number of People III Per Outbreak of Foodborne Illness by Etiology
January-June 1968 and 1969


Number ,i Persons
Etiology Ill I',P Outbreak Number oi
Median Range Outbrealk


BACTERIAL
8 ivn"ur
Brucella
( hrrtl ltultr
perlnngcts

Salmonella
Shllgella
Staphlylococcus
Strreptococcus
Multiple ellOlogies

PARASITIC
Tr hmella ispirahi

VIRAL
Hepatitis

CHEMICAL
Monosodium gluitaate
Mushroom
Other chemical

MISCELLANEOUS

UNKNOWN

TOTAL


3 2.4


9 1.1304


I |tto

Number of Persons
III Per Outbreak
Median Rangie



5 -5

14 2-501
31 2(,36
75 3.400
54 18 -61
7 2-500
3 3
30


4 2-7


5 4-12


5 5 2-25


*Not apphelable


349


Number of
Outbreaks



0
I

5
32


3
35




4


3
2



2
7

0

30


i






350 Morbidity and Mortality Weekly Report OCTOBER 4, 1969





Table 3
Vehces AIsociated with Outbreaks of FmIbent Illness by Etiology'
January-June 1969
Selective Comparatve Data January-June 1968

-I















Ta 4 4








F PeSin FSNeo' U :i i nk2
VIRAL
ti"i






[( 01i AtI ++
















Table 4
Probable Source of Contamination in Foodborne Outbreaks by Etiology
January-June 1969
Selective Comparative Data January-June 1968

Food Prcessing Food Service Unknown
Etiogy Establishments Establishments Homes Unspecified Total

BACTERIAL
B crcus 1 I

C pTrrmgens 5 10 1 16 32
I c Salmonella 3 4 1 8 16
Shgella 1 2 3
Staphyloc~ccus 2 9 4 20 35
Strepococcus I 2
Multiple etologies I I

PARASITIC
Trnchnela spiralis 2 I 4

VIRAL
lepatitis I 3

CHEMICAL
Monnosejum glutamate 1
Mushrm 2
Other chemical 4 12 7

UNKNOWN I 29 30

I'll t I '- 1I 1: I -J

I. IT -1L It; 4 I H I t







OCTOBER 4, 1969


Morbidity and Mortality Weekly Report


Table 5
Outbreaks of Foodborne Illness by Etiology and Place of Acquisition
January-June 1969
Selective Comparative Data January-June 1968




Eology


BACTERIAL
B crecus
C bohunum
C perfrnnge
b cli
Salmonella
Shlgella
Slaphylocccus
SIreplococcus
Multiple etiulogies

PARASITIC
Trrchmclla spirals

VIRAL
Hepalrlls

CHEMICAL
Morosodium glutamale
M itshroom
Other chemical

UNKNOWN

TOTAL 196

TOTAL 19b8

Number of persons it I h9

Number of persons ill 1968


4



S I o 3 1 4i

I0 0 32 0 I 0

h 03 Jo4 5W0 2.4( I 19

143 0 316 01 2 .7( 0


I I

0 7

0


32
Is
3
35

I



4


3




7

30

144

115

5,537

7.63


Table 6
Outbreaks of Foodborne Illness by Specific Etiology and Month of Occurrence
January-June 1969
Selective Comparative Data January-June 1968


Etiology


Apr May


Total


BACTERIAL
B. cereus 1 I
C botulinum 1 4 5
C perfringens 3 9 4 5 8 3 32
E colt 1 1 2
Salmonella 2 3 2 6 2 1 16
Shigella 3 3
Staphylococcus 2 3 6 10 9 5 35
Streptococcus I I 2
Multiple etiologies I 1

PARASITIC
Trichinella spiralis 2 1 1 4

VIRAL
Hepatitis I I I 3

CHEMICAL
Monosodium glutamate I I
Mushroom I 1 2
Other chemical 1 2 3 1 7

UNKNOWN 7 4 4 4 9 2 30

TOTAL 1969 16 22 26 29 37 14 144

TOTAL 1968 12 21 21 21 24 16 115


351


3




j 19
I
1I







352 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
OCTOBER 4, 1969 AND OCTOBER 5, 1968 (40th WEEK)


APTIC ENCEPHALITIS HEPATITIS
MEIx- I KCEL- DIIPITIIEA Primary including Post- MALARIA
AREA CITIS unsp. cases Infetrous Serum Infectious
Cum.

I..,[ TE TaTE I ... I 5 B j -.5 11 957 Q 379 I 62 2 0

NEW ENGLAND........... 8 5 1 2 95 62 2 77
Maine.............. 4 8 6
New Hampshire...... 6 1 2
Vermont............ 2 4 -
Massachusetts...... 2 1 1 56 30 47
Rhode Island....... 1 11 9 2 9
Connecticut........ 5 4 2 16 10 13

MIDDLE ATLANTIC...... 23 9 7 53 158 145 9 253
New York City...... 3 33 62 92 1 22
New York, up-State. 2 1 3 2 24 23 2 41
New Jerseyt*....... 13 10 42 100
Pennsylvania....... 5 8 4 8 30 30 6 90

EAST NORTH CENTRAL... 22 23 17 14 172 128 5 243
Ohio............... 9 19 13 4 36 19 1 22
Indiana............ 1 13 5 1 20
Illinois........... 2 1 2 27 40 2 148
Michigan........... 12 2 3 8 91 53 1 52
Wisconsin .......... 5 11 1

WEST NORTH CENTRAL... 22 3 4 4 1 4 40 70 3 156
Minnesota. ........ 21 2 3 1 1 3 12 28 8
Iowa .*............. 1 1 1 6 5 16
Missouri........... 1 17 15 1 41
North Dakota....... 1 1 2 3
South Dakota ....... 7 -
Nebraska........... 2 2 3
Kansas............. 1 3 11 2 85

SOUTH ATLANTIC....... 23 1 1 1 2 104 106 27 572
Delaware............ 3 3 3
Maryland........... 15 11 17 1 30
Dist. of Columbia.. 2 1 2
Virginia........... 1 6 5 25
West Virginia...... 3 1 5 23 -
North Carolina..... 5 1 37 7 20 256
South Carolina..... 3 7 49
Georgia............ 26 16 5 174
Florida............ 1 1 11 27 1 33

EAST SOUTH CENTRAL... 11 1 2 1 46 68 1 110
Kentucky............ 2 19 14 85
Tennessee.......... 3 1 1 16 28 -
Alabama............. 4 1 1 20 1 22
Mississippi........ 2 1 10 6 3

WEST SOUTH CENTRAL... 6 6 3 2 9 78 69 1 154
Arkansas........... 1 5 4 13
Louisiana.......... 3 2 1 6 13 12 43
Oklahoma........... 1 1 8 2 53
Texas.............. 2 6 3 52 51 1 45

MOUNTAIN............. 4 1 10 4 29 57 2 126
Montana............ 2 1 2 2 3
Idaho............... 3
Wyoming............ 4 -
Colorado............ 2 9 4 -- 35 2 107
New Mexico......... 1 4 5 7
Arizona............ 16 8 1
Utah................ 1 4 1
Nevada............. 2 3 4

PACIFIC.............. 26 5 9 2 29 235 274 12 539
Washnrgtorn......... 2 31 22 5
Oregon............. 3 1 21 13 13
California......... 22 5 7 1 29 180 235 8 425
Alaska............. 1 1 1 3
Hawaii............. 2 3 4 93

Puerto Rico.......... 6 22 2
*Delayed reports: Encephalitis, primary: Iowa 3
Hepatitis, infectious: N.J. 3
Malaria: Minn. 5






Morbidity and Mortality Weekly Report 353


TABLE Il1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 4, 1969 AND OCTOBER 5, 1968 (40th 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 196 1969 1969
UNITED STATES... 167 20,875 20,000 26 2,440 2,105 624 11 331

NEW ENGLAND........... 2 1,118 1,163 1 95 124 82 1 27
Maine*............. 9 38 6 6 1
New Hampshire...... 1 239 141 3 7 6 -
Vermont............ 3 2 1 1 2
Massachusetts...... 1 220 362 37 64 36 5
Rhode Island....... 27 6 12 9 12 4
Connecticut........ 620 614 1 37 37 27 1 15

MIDDLE ATLANTIC...... 24 7,548 4,130 5 401 379 62 2 22
New York City...... 8 4,929 2,163 76 76 32 B
New York, Up-State. 1 602 1,227 77 b8 NN 1 8
New Jersey......... 14 919 626 2 160 130 30
Pennsylvania....... 1 1,098 114 3 88 105 NN 1 6

EAST NORTH CENTRAL... 30 2,313 3,859 3 334 257 165 73
Ohio................ 4 390 297 124 70 16 3
Indiana............. 467 685 1 40 35 18 17
Illinois........... 12 562 1,378 49 58 34 6
Michigan........... 6 300 277 1 96 74 20 25
Wisconsin.......... 8 594 1,222 1 25 20 77 -- 22

WEST NORTH CENTRAL... 24 588 390 4 126 114 36 1 20
Minnesota.......... 8 16 2 28 27 11 7
Iowa............... 332 102 18 7 18 11
Missouri........... 2 30 81 1 52 37 6 -
North Dakota....... 15 135 1 2 3
South Dakota....... 3 4 1 5 NN -
Nebraska........... 22 193 42 9 8 1 2
Kansas............. 7 10 16 27 1

SOUTH ATLANTIC....... 21 2,577 1,522 5 420 421 55 1 25
Delaware............ 9 393 16 2 12 8 3 2
Maryland ........... 77 102 39 34 5 3
Dist. of Columbia.. 35 6 9 14 2 -
Si r. .. .. .... -' 1 .1 1 3
i,:t v,; .... 8 IC I,' ",1 2 1, 1 I -- 11
'. I. : I i r.u. .. .I. l i. I ?' 1


; Ir .. ....... 2 1 _


MOl I .... j .. .. I 111 3. 25
IT 'OT. n .: ['. L j '*6 I.o 1- 1 25
T- niu ..... .. I,,,, I Il 7
T .-Sr, .. ... .. .. 2 ,6 i 18
AlI t. ............ 2 .. I -
-, I .: ., ...... 2 3 1 -

uE1 I'OlUTH iLi.TRAL .. 33 -,h33 -6 3 317 31, 4 44
lr in r: .. ......... 1 3 1- -
L .. in r ........ i. 8 -
k I i]h rn ............ 2 l l:' ; -- I
Te ,a ............ .. 13 3 ,],.55 *,'1 1 l'. 1: 4 43

MOilTAiIAIN ... ....... 26 '' I .',1 I I -; .. 21
Mon ,jni. ...... I 7 3 5 h 5
,n.......... .... ... 1 -1 -- 1




Lit i ................ I ..1 I I 1 1


PA: IF i .............. i ,te .i6 4 5 42 275 00O 1 74
L ai : h. n r...n ... ..... 1 k 1 5.,-i ,1 2 ; 26
Olr ecn .......... .. I 1q .3 16 1 I -- 6
Li i a r,,.rnia ....... I58 I ,I5 1 c I'9 51 1 1 33
Ala. ka ............. t "Q 5 1


Puert P.c., ........... 33 1 57 1 2

*Delaved report;: leasles: lie. 1
P. pins: Me. II






354 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 4, 1969 AND OCTOBER 5, 1968 (40th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TICK-BORNE
AREA SCARLET FEVER FEVER (Rky. Mt. Spotted) ANIMALS
Cum. Cum. Cum. Cum. Cum.
1969 1969 1969 1969 1969 1969 1969 1969 1969 1969 1969
UNITED STATES... 6,652 4 118 114 11 235 7 411 47 2,688

NEW ENGLAND.......... 804 1 14 12 1 1 4 29
Maine............. 7 1 6
New Hampshire...... 32 4
Vermont............. 14 4 9
Massachusetts...... 105 1 7 1 1 2
Rhode Island....... 26 1 -
Connecticut........ 634 3 8

MIDDLE ATLANTIC...... 188 15 5 2 26 1 43 6 175
New York City...... 5 7 1 2 13 -
New York, Up-State. 148 3 4 5 1 7 5 164
New Jersey......... NN 3 3 14 -
Pennsylvania....... 35 2 5 22 1 11

EAST NORTH CENTRAL... 447 1 15 13 3 25 3 8 194
Ohio............... 91 1 2 1 9 5 68
Indiana............ 93 2 46
Illinois........... 100 8 4 2 12 3 1 31
Michigan........... 92 5 4 7
Wisconsin......... 71 7 2 42

WEST NORTH CENTRAL... 216 1 11 13 9 8 10 499
Minnesota.......... 6 3 3 2 132
Iowa.............. 68 1 7 3 74
Missouri............ 14 1 4 9 3 2 127
North Dakota....... 66 2 65
South Dakota....... 17 1 24
Nebraska .......... 8 1 1 13
Kansas............ 37 4 3 1 1 64

SOUTH ATLANTIC....... 609 21 21 1 37 4 230 5 658
Delaware............ 12 2 3 -
Maryland........... 104 1 4 47 3
Dist. of Columbia.. 15 2 1 -
Virginia........... 121 4 1 76 2 332
West Virginia...... 134 1 2 1 2 5 94
North Carolina..... NN 2 5 6 4 56 5
South Carolina..... 49 1 2 1 30 -
Georgia............ 4 4 4 9 13 70
Florida.............. 170 10 4 11 3 154

EAST SOUTH CENTRAL... 1 260 18 12 33 61 1 360
Kentucky........... 142 7 6 13 1 186
Tennessee.......... 788 4 11 19 40 122
Alabama ........... 168 5 4 5 46
Mississippi....... 162 2 1 4 3 6

WEST SOUTH CENTRAL... 591 21 18 3 25 1 44 8 389
Arkansas........... 6 1 1 3 13 7 29
Louisiana.......... 7 7 4 3 29
Oklahoma........... 67 1 7 28 2 59
Texas.............. 511 12 6 9 1 9 6 272

MOUNTAIN............. 1,583 5 14 24 16 115
Montana............. 1 -
Idaho.............. 130 3 5 -
Wyoming............ 434 2 5 52
Colorado........... 750 2 3 9 3
New Mexico......... 137 1 5 17
Arizona............. 69 2 5 22
Utah.............. 62 11 2 5
Nevada ............. 1 -- 1 16

PACIFIC.............. 954 2 11 4 2 44 5 5 269
Washington......... 816 1 2 2 3 4
Oregon............. 67 1 6 4
California......... --' 2 10 1 1 33 2 5 261
Alaska............. 17 -
Hawaii............. 54 1 3 -

Puerto Rico.......... 1 8 6 1 21

*Delayed reports: SST: Me. 3







355


Morbidity and Mortality Weekly Report






Week No. TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED OCTOBER 4, 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 and I year
Ages and over Influenza All Ages and over Influenza All
All Ages Causes All Ages Causes


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

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

EAST NORTH CENTRAL:
Akron, Ohio-----------
Canton, Ohio----------
Chicago, Ill.---------
Cincinnati, Ohio------
Cleveland, Ohio-------
Columbus, Ohio--------
Dayton, Ohio----------
Detroit, Mich.--------
Evansville, Ind.------
Flint, Mich.----------
Fort Wayne, Ind.------
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.---------
Kannr r ily, .an .- --
Kansas C ti,. Mo.------.
Lincoin, N tbr.--------
Minneapol, Minn.----
Omaha, Nbr.------........---
St. Louts, Mo.--------.
St. Paul, Minn.-------
Wichita, Kuan.--------


761
272
56
26
20
74
19
21
28
49
54
21
43
29
49

3,229
44
40
135
40
31
47
60
82
1,630
45
496
161
42
123
28
36
78
44
29
38

2,553
58
43
700
160
204
129
64
352
31
49
41
49
49
157
47
132
44
38
42
103
61

808
77


137


21.
'37
R1
21-
72
jo


460
144
34
23
14
40
15
14
19
33
29
13
27
19
36

1 ,865
22
26
84
22
16
32
30
47
944
25
259
77
27
89
18
21
54
24
22
26

1 ,371
37
21
356
77
109
70
21
193
14
28
22
22
36
90
23
78
24
24
26
62
38

481
45
10
20
84
8
t6
-4
121
47
36


Total 12,248 6,774 413 617

Expected Number 11,904 6,828 358 512


Cumulative Total
(includes reported corrections
for previous weeks)


519,718


297,016
1


23,956


14,535


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

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

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

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

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


1 ,062 538 34 37
111 52 3 3
248 119 3 12
60 34 4 2
81 43 2 1
85 44 3
52 24 I
61 26 3 1
32 8 3 3
86 73 7 -
62 30 5 5
148 71 3 5
36 14 1 1

648 343 25 30
115 48 3 5
42 23 3 4
48 29 1 2
111 71 13 3
139 66 2 6
39 24 1
43 22 1
111 60 3 8

1,149 548 31 90
36 18 5 2
47 25 1 2
26 8 1 4
169 75 4 14
54 26 1 15
74 30 1 6
197 92 4 8
55 27 2 4
150 73 4 7
81 46 5
143 72 1 16
40 19 4 2
77 37 3 5

446 232 20 21
54 22 2 4
22 16 5 1
121 65 3 6
17 12 4
104 60 1 3
14 10 1
48 23 3
66 24 5 3

1,592 936 32 61
26 17
43 20 1
34 23 1 1
23 9 4 2
95 65 2 4
560 301 15 26
81 43 1 6
30 26 1 -
132 76 4
67 42 2
104 61 1 5
137 75 1 4
47 31 3 1
126 87 1 3
56 40 1 1
31 20 1 1


*Mortality data are being collected from Las Vegas, Nev.. for possible inclusion in this
Las V, a= :, r.,1. *. 1 5 table, however, for statistical reasons, these data will be Isted only and not included in
the total, expected number, or cumulative total, until 5 years oa data are collected.










FOODBORNE DISEASE (',', iura from page 348)


and Tri, Ine"a spirali, tended to In, caused by foods palen
ai homfI aind hos-t dS u to (. p~i'rii ie n' b\ foods serx\cd
in public facilieir (T1l':III ). 1The mornhld 1 incidence of
foodlholrn ouldirolAk: h -)i'cit'ic (1\I)p( is prosofntd in
Tablh (;.
In aIhliion to the-o foodborne oulbreaks, there were
- wi\ ilrrt k- r late:c id to \( htI r.
ierprtd hy /Ent 'rji /'/Inds s Sf' inin. linr Epidernmiloh lic
,i' e ] l u ora't' 71 n i fr HIpirmii Raiceiicas Broacnh,
nrin the Kh / fli /li-i l Sc'mrfrh ~' A(ivi .fp ideit'miol/o(y Pr)o-
Irum ,' n'.

\ ,f I r f fr 1.

i:it.n, ii (/iflilitilt .Lbb It i ( I (ntcr
B. t'trr < .l h .. .. <*- tlri nli


OCTOBER 4, 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.Ot
DIRECTOR, EPIDEMIOLOGY PROGRAM A. 0. LANGMUIR M.D.
EDITOR MICHAEL B. GREGG. M.D.
EDI TOR pro tmr ALAN R. HINMAN. M.D.
MANAGING EDITOR PRISCILLA B. HOLMAN
IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY, THE NATIONAL COMMUNICABLE DISEASE
CENTER WELCOMES ACCOUNTS OF INTERESTING OUTBREAKS OR CASE
INVESTIGATIONS WHICH ARE OF CURRENT INTEREST TO HEALTH
OFFICIALS AND WHICH ARE DIRECTLY RELATED TO THE CONTROL
OF COMMUNICABLE DISEASES. SUCH COMMUNICATIONS SHOULD BE
ADDRESSED TO:
NATIONAL COMMUNICABLE DISEASE CENTER
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.


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