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:
AA00010654:00228

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 t -. VED..
SVol. 18, No. 41




A. 1
For

a s 7K.c Week Ending
October 11, 1969



U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE / PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION
DATE OF RELEASE: OCTOBER 17. 1969 ATLANTA, GEORGIA 30333


EPIDEMIOLOGIC NOTES AND REPORTS
INFECTIOUS HEPATITIS OUTBREAK
College of the Holy Cross, Worcester, Massachusetts

Between Sept. 20 and Oct. 4. 1969, 26 icteric cases of
infectious hepatitis 1 Flirur- 1) developed among the mem-
bers and staff of the varsity football team of the College
of the Holy Cross in Worcester. Massachusetts. The ill-
nesses were of abrupt onset and were characterized by
malaise, weakness, fever, nausea, abdominal pain, dark
urine, and jaundice. Appropriate tests of hepatic function
were consistent with the diagnosis of infectious hepatitis.
The jaundiced patients, all males, were between 19 and
22 years of age with the exception of the team trainer who
was 40. Liver function studies were performed on the re-
mainine asymptomatic varsity football players, coaches.
and managers (total 65). Of the 65. 59 (91 percent) were


r fi\NTF-\T_
Epidemiu logic N .. I
Int ctiou. 1I. .
Hoil Cro '. '
Hepatitis So-l,. I
"Daphne Sore' '


found to have signify aiJ i increased serum gl nm p\ru\ic
transaminase (-I,'l ,_r. I r t .. I 1 Other
athletes. incl I Ih, I -, and
rugby teams. ,.-r. s' '1i ,I laboratory
tests. The clu-t..r,r,_ l 1..I triod of time
coupled with the absence of known exposure to other hepa-
titis cases, ingestion of raw shellfish, or inoculations sup-
ported the hypothesis of a common source outbreak. The
varsity football team reported for practice on August 26
(Continued on page 358)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
41st WEEK ENDEDDIAN CUMULATIVE, FIRST 41 WEEKS
MEDIAN
DISEASE
DISEASE October 11, October 12. 1964 1968 MEDIAN
1969 1968 1969 1968 1964 1968
Aseptic meningitis ...................... 165 159 80 2.689 3,431 2.302
Brucellosis ............................ 6 5 6 182 182 202
Diphtheria ............................ 3 4 4 138 166 153
Enc.ephralnit primary:
Arthropod-borne & unspecified ........... 39 57 47 999 1.089 1,472
Encephalitis, post-infectious ............. 3 4 4 259 401 621
Hepatitis, serum ....................... 95 108 681 4.126 3,500 044
Hepatitis, infectious .................... 923 1,041 36,816 35,328 "
Malaria ................................ 69 101 18 2,304 1.834 342
Measles rubeolaa) ....................... 135 122 679 21,000 20.122 191.496
Meningococcal infections, total ........... 29 30 35 2.469 2.135 2.191
Civilian ..................... ....... ... 29 28 --- 2,263 1.951 -
Military ............................... .- 2 -- 206 184 -
Mumps ................................. 774 1,107 --- 70,639 128.390 -
Poliomyelitis, total ..................... 2 15 48 48
Paralytic ............................. 2 14 48 48
Rubella (German measles) ............... 337 265 50,351 44,889 -
Streptococcal sore throat & scarlet fever... 6.409 7.047 6,266 330.398 331,141 331.141
Tetanus ............................... 2 8 6 121 138 180
Tularemia .............................. 1 2 2 115 157 157
Typhoid fever .......................... 10 12 11 245 305 333
Typhus, tick-borne (Rky. Mt. spotted fever) 5 1 4 415 262 243
Rabies in animals ....................... 41 58 65 2,729 2,788 3,496

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ..................... .... ............... 3 Rabies in man: ...................................... 1
Botulism: .......................................... 12 Rubella congenital syndrome: .......................... 9
Leptospirosis: Fla.-2 .................... ..... 64 Trichinosis: Fla.-1 .................................. 163
Plague: ............................................ 3 Typhus, marine: ..................................... 35
Psittacosis: Calif.-1, Fla.-1, Wis.-1 ................... 35
*Delayed Reports: Leptospirosis: S.C. 1






Morbidity and Mortality Weekly Report


OCTOBER 11, 1969


HEPATITIS (Continued from front page)


Figure 1
26 Icteric Cases of Infectious Hepatitis by Date of Onset
College of the Holy Cross, Worcester, Massachusetts
September-October 1969




1 H


at~


2.DA INTERVALS 22-23


24-25 26-27 26-29 30-
SCPT
ONSET


2-3
OCT


ami the frhman iiteam on September 3. Both teams used the
-:ram athloic and dining facilities, and consequently since
no ca-rss oc curried in freshman players, the exposure period
Win- Ipre.'-ied to be hotween these two dates.
Epidemiologic in-estigation has failed to incriminate
;> e-,\'t- or food- which could have been responsible
for the outhroak, but has focused attention on the prac-
tc+ football fie ld at the College. Several inadequacies in
the fitild's latter s\sterm were recognized. The faucet used
to pro idtei drinking after r is at the end of a series of file


irrigation outlets, which are positioned 6 inches below
ground surface. The drinking water faucet lies in the de-
pendent portion of the system, 5 1, ft. below the level of
the irrigation outlets. Dye studies conducted at the field
hase shown that under certain circumstances surface water
may directly enter the water line.
Children living i .j.,,' i to the practice field custom-
arily use it as a playground. They frequently turn on the
irrigation outlets and bathe in the spray. The children are
reported to occasionally use the area as a bathroom facility
and hate been seen urinating: acts of defecation are sus-
pected. within thet 6 weeks prior to the onset of the out-
break. fi\e cases of hepatitis occurred in persons living in
a deteriorated. unsanitary house imme diately adjacent to
the field. Four of these indi idual- were under 11 years
of age and regularly pla on thei practice field. Continued
in sc-tigation is in progress .
ktfrp'rtsd by Le.iiard Vi.rs. 1.11)., lHead, Section of
In/r tiouus i)m ase' St. ti. e t i hospital, Assistant Pro-
fssi, r if jt ir ini : tGeorietosrn f'nicersiy School of Medi-
,;a,. (i 'on, syl anut to ti' Itfrc,~tser POc artment of Public
IHl a/.ti Ar:riaid ;ut, M. If.. ('omn, ision ert of Health,
itroh tsr I) apartments of IPuli lbea/tl Eei;: Een E. H- "'v
Jr.. Kp i, f ',ioiiii i t, an d \'i 1l) ion if (o'. n n, 'ab'i l) s e se ,. Vasse if'sAu ett- State
Hl /lti i, l partnis li:i a ii an KIS ('' .)


HEPATITIS South Carolino


Btat\ sen Sept. 16 and 23. 1969. 14 members of a Boy
Scout Troop at Sh:a\ AFB. Sunmtr. South Carolina. were ad-
mitted to the hbae hospital with infectious hepatiti-. One'
\at- an adult. age 23. and the rest were between 11 and 15
\etar- of age. All ihad participated in a camp-out held be-
Tn\wen August 14 and 17 on an island in a nearby recreation
area: all hlad attended the camp for a majority of the I days
and had spent at least one night there. The first four pa-
tient- had had acute onset of malaise, fever. weakness.
and anorexia followed hy dark urine: all had abnormal li(ier
function tests. The remaining 10 cases were found by a
li\er function test survey of the i other campers, whho had
attended the camp for varying period- of time. These 10
had elevated serum transamina-s and recalled having slight
malaise, anorexia. and darkening of the urine within lthi
previous 7 to 1) days.
There was no known occasion other than the camp-out
where all 14 patients could hate been exposed. None of
the 14 recalled having had contact with a known case, of
riral hepatitis or gaie a history of raw shellfish ingestion
or blood transfusion within the 2 months prior to illness.
No illnesses sugge-ting hepatitis were reported among
tlirir hou-ehold members. These facts together with th
lu-s-tering of on-st- of illne-- and the interval between at-
tiendane at the camp-out and onset of symptom- (2- to 32
l\-) iti'-gIst a common source exposure occurring some-
Stiir, arine the camp-out.


\t the .camp-out, cooking and eating were done in small
grcoup- of three to six pe-r-ons. No single food except water-
melon Nwas eaten hi a majority of patients. but it was eaten
just -i frequently\ by persons whho did not become ill. There
is no w\:ir -uppl on the island anid \water for drinking.
cooking, and dish washing was obtained from an approved
source on the mainland: ho\ieor. some persons (both ill
anl not ill) drank. cooked, and washed dishes in untreated
lake wat-,r.. ll camper -swamt in the lake during the camp-
out. iatei-r -amples, hobained periodically from the lake,
habe deton a-trated eleiated coliform counts.
No ualtitional cses- weIre identified by a survey of
civilians in the surrounding community near the base. and
the outbreak appears to he limited to the .II. Scout group.
Thie e \c t means of exposure remains unclear.




(Reportr dii lfr i. Uir Q. J. Scrrnai,. Comntanding Sur-
ysei', Ilr :iijuirt rr- T:r tica: Air 'Command, Langley -lfH.
I- 'ii. Ia ri i' S. iSutr /arland, C'apt. James LeA-
m' nn, aId ('ipit. tLoiu I tia. tIfC USAFI, ('apt. Jerry P.
Vosyh/srty. -I SIF ;If sini iirs,,tm, tiuo Engineerring, ands l/Sfyt.
il8 lim 2 '. /,iult.. I S.lF it i ,ary P bli /c Ilalt/, Shaw
.,FI' tisr, I). It. Rt iih.b .I).. ,.' Preventive
Ilrl:ll ii .5r\ i .,s. S i i h ( i'ari,,in Stts Board of II..'.*'.;: and
t/r ,i-i El I


358







OCTOBER 11, 1969


Morbidity and Mortality Weekly Report


DAPHNEE SORE" Alabama


In the past 8 to 10 years, chronic skin granulomas of
the elbow or knee have been seen in children and occa-
sionally adults with a history of swimming in salt water in
the Mobile, Alabama, area. The lesions have been called
Daphnee sores" because several patients lived in or near
the town of Daphne, Alabama, on the east side of Mobile
Bay (Figure 2). The medical records of 21 patients with
this lesion were recently reviewed. The usual history in-
cluded swimming in Mobile Bay, often sustaining an in-
jury while swimming, which was followed 1 to 3 weeks later
by the development of a raised lesion on the elbow or knee.
The lesion was usually about 1 cm in diameter, often was
crusted, and did not heal. There were no systemic symp-
toms or enlarged lymph nodes. Only the chronicity of the
lesion and occasionally secondary infection or bleeding,
resulting from further trauma, caused the individuals to
see a physician.
Most of the patients were between 10 and 19 years of
age; 10 were males and 11 were females (Table 1). They
had been ill from 7 weeks to 2 years before seeking assis-
tance from a physician. Of the 21 medical records, 10 in-
dicated that the patient had a history of trauma, four stated
that the patient had no trauma, and seven did not mention
trauma. Of the 18 patients on whom skin biopsies were
known to have been performed, two were positive for acid-
fast bacilli. Mycobacterium marinum was cultured from the
biopsy specimens from four people, Runyon Group III M. tri-
viale was cultured from one, and one other culture had
original growth that could not be further characterized.


Figure 2
GEOGRAPHIC DISTRIBUTION OF
MYCOBACTERIUM MARINUM
ALABAMA 1960-1969


Se-. ol MIIn,
o 0 o to 0So 0M
~= : 1111:~ -~


Records also indicated that of three children who had been
tuberculin skin tested two had positive reactions.
(Reported by Edward Goldsmith, 1.I).. Health Officer,
Baldwin County, and George 'Newburn, .I.., IHealth Offi-
cer, 4 obile County, Alabama: Frederick S. Wolf, M.D., Di-
rector, Bureau of Preventable Diseases, and Thomas Hosty,
(Continued on page 364)


Table 1
Line Listing of Culture Proven and Other Probable Southern Alabama Mycobacterium marinum Cases


Roeidpnce


M 15 Daphne
M 10 Fairhope
M 58 Mobile
M 16 Fairhope
M 66 Chapman
F 11 Fairhope
F 51 Fairhope
F 15 Mobile
F 11 Mobile
F 14 ?
F 18 Mobile
M 12 Summerdale
F 6 Mobile
M 15 Daphne
M 7 Fairhope
F 13 Daphne
F 5 Bayou le
Batre
M 2 Mobile
F 7 Daphne
M 16 Fairhope
M 16 Daphne
AFB Acid-fast bacilli
ND Not done
+ Positive


359


Location
.:,f L.-- h r


Knee
Heel
Hand
Elbow
Finger
Knee
Arm
Knee
Knee
Knee
Knee
Knee
Leg
Knee
Knee
Knee
Leg

Arm

Elbow
Knee


Interval From
On-, t i... D i.,anl -;-
5 Mo.
7 Wk.
7 Mo.
8 Mo.
2 Yr.
3 Mo.
7 Wk.
1 Yr.
1 Yr.
?>
4 Mo.
1 yr.
2 Mo.
5 Mo.
10 Mo.
,?
2 Mo.




8 Mo.
8 Mo.


When


Dec. 60
Nov. 64
Apr. 67
Apr. 69
Mar. 68
Nov. 68
Apr. 63
Mar. 66
Apr. 66
Sept. 67
Dec. 68
Aug. 69
Jan. 69
Dec. 60
Apr. 67
Apr. 68
Jul. 68


Trauma

+
+

+
+
+
+

9
-






+
+



?
9
+
+


Compatible
Bi..p-\
+
+
+
+
AFB +
AFB +
+
+
+

+
+
+
+
ND
+
ND

+
+
+
+


Mycobacterial
r' ,i ,jr,-
marin um
m arinum
marinum
m arin u
+
ND


*)
-



triviale
ND
ND
ND
ND

ND
ND
ND
ND


Skin
T..-
ND
9
ND
ND
ND
+
ND
ND
+
ND
ND
ND
ND
ND

ND
ND

ND
ND
ND
ND


- Negative
? Unknown







360 Morbidity and Mortality Weekly Report


TABLE Ill. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
OCTOBER 11. 1969 AND OCTOBER 12. 1968 (41st WEEK)


ASFPIIC ENCEPHALITIS HEPATITIS
MF~NN- BRUEI.- 1DH|'iill\ Primary including P-s- MALARIA
AREA Isl T LS unsp. cases Inf u Serum Infectious
Cum.

UNITED STATE ... I r ) -23 I ,. I r. ,2l

NEW ENGLAND.......... 4 6 1 2 81 68 77
Maine.*............. 5 6
New Hampshire...... -- 4 2
Vermont............ 2 3 -
Massachusetts...... 4 5 1 53 35 47
Rhode Island....... 15 11 9
Connecticut........ 1 2 7 14 13

MIDDLE ATLANTIC...... 32 4 8 1 37 140 201 12 265
New York City...... 10 2 23 35 50 22
New York, up-State. 6 1 2 4 28 34 2 43
New Jersey. ........ 13 2 2 7 24 79 7 107
Pennsylvania....... 3 1 2 1 3 53 38 3 93

EAST NORTH CENTRAL... 18 18 34 14 152 137 13 256
Ohio............... 8 11 20 6 41 48 22
Indiana.............. 3 2 3 8 20
Illinois........... 1 6 2 43 8 12 160
Michigan........... 7 3 5 6 57 61 1 53
Wisconsin .......... 3 1 8 12 1

WEST NORTH CENTRAL... 25 1 2 3 1 42 47 3 159
Minnesota............ 25 1 8 18 8
Iowa................ 3 10 5 16
Missouri........... 17 19 41
North Dakota....... 1 3
South Dakota....... 1 1 1 1
Nebraska........... 1 3
Kansas ............. 2 5 4 2 87

SOUTH ATLANTIC....... 23 4 3 2 2 8 74 134 7 579
Delaware........... 2 2 3
Maryland........... 2 1 1 11 11 1 31
Dist. of Columbia.. 2 2
Virginia............ 10 4 7 63 25
West Virginia...... 1 1 -- 10 2 -
North Carolina..... 3 1 2 5 7 4 260
South Carolina..... 5 5 8 2 51
Georgia............ 9 18 174
Florida............ 2 2 2 5 23 23 33

EAST SOUTH CENTRAL... 20 1 68 42 110
Kentucky............ 1 27 8 85
Tennessee.......... 3 29 19 -
Alabama............ 9 1 11 8 22
Mississippi........ 7 1 7 3

WEST SOUTH CENTRAL... 3 1 2 3 105 83 20 174
Arkansas........... 4 2 13
Louisiana.*........ 1 1 2 21 17 43
Oklahoma........... 8 12 1 54
Texas.............. 2 2 1 72 52 19 64

MOUNTAIN............. 1 5 1 42 37 1 127
Montana.*........... 2 1 9 3
Idaho............... 2 1 3
Wyoming............ 2 6 -
Colorado........... 1 1 1 24 1 108
New Mexico......... 1 5 7
Arizona ............ -- --- --- --- 1 --- --- --- 13 --- 1
Utah............... 1 1 2 1
Nevada............. 11 1 4

PACIFIC.............. 40 1 1 3 4 29 219 292 13 552
Washington......... 19 1 31 25 5
Oregon............. 2 12 16 1 14
California.......... 18 1 1 2 3 29 173 249 12 437
Alaska............ 3
Hawaii............. 1 1 2 2 93

Srt. ...... ... ..- 30 37 2
* r ,- [ [ '. [ ;'.,* I- [ : I. i l *,:.It I
Encephalitis, primary: Mont. delete 2
Hepatitis, serum: N.J. 12
Hepatitis, infectious: 'e. 8, N.J. 18







Morbidity and Mortality Weekly Report 361


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 11, 1969 AND OCTOBER 12, 1968 (41st WEEK) CONTINUED


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

ullli r u ol. ilL 1 y 1 ,.,l,, -*,", I .: ,:-" 2,1 l "'" I- J.1'

NEW ENGLAND.......... 2 1,120 1,164 2 97 125 87 2 24
Maine?............. 9 38 6 6 5 1 2
New Hampshire...... 239 141 3 7 5 3
Vermont............. 3 2 1 6 1
Massachusetts...... 2 222 363 1 38 64 28 3
Rhode Island....... 27 6 1 13 9 3 4
Connecticut........ 620 614 37 38 40 1 11

MIDDLE ATLANTIC...... 16 7,564 4,157 4 405 384 73 2 28
New York City...... 8 4,937 2,174 1 77 78 59 5
New York, Up-State. 3 605 1,233 2 79 69 NN 1 11
New Jersey......... 4 923 636 160 132 14 4
Pennsylvania....... 1 1,099 114 1 89 105 NN 1 8

EAST NORTH CENTRAL... 37 2,350 3,886 6 340 258 207 113
Ohio............... 3 393 297 124 70 26 14
Indiana............ 1 468 685 5 45 36 21 19
Illinois........... 14 576 1,379 49 58 31 10
Michigan........... 11 311 284 1 97 74 65 47
Wisconsin.......... 8 602 1,241 25 20 64 23

WEST NORTH CENTRAL... 12 600 393 126 115 41 1 30
Minnesota.......... 8 16 28 27 -
Iowa............... 332 103 18 8 32 -- 18
Missouri .......... 30 81 52 37 2 3
North Dakota....... 15 137 2 3 1 2
South Dakota........ 3 4 1 5 NN -
Nebraska............ 12 205 42 9 8 3 -
Kansas............. 7 10 16 27 3 1 7

SOUTH ATLANTIC....... 8 2,575 1,526 7 427 429 77 1 21
Delaware........... 393 16 12 8 1 -
Maryland............ 77 102 1 40 35 11 2
Dist. of Columbia*. 25 6 9 15 1
Virginia........... 1 885 299 54 40 7 3
West Virginia...... 2 211 293 1 19 13 47 4
North Carolina..... 2 318 283 2 72 82 NN 1
South Carolina..... 2 125 12 57 58 10 3
Georgia............ 2 4 1 72 86 -
Florida............ 1 539 511 2 92 92 1 1 7

EAST SOUTH CENTRAL... 113 497 2 150 194 28 1 8
Kentucky........... 66 100 :1 89 6 1
Tennessee.......... 17 62 2 58 56 22 5
Alabama............ 6 95 24 26 1 2
Mississippi........ 24 240 17 23

WEST SOUTH CENTRAL... 50 4,683 4,889 4 331 313 67 2 2 6 18
Arkansas........... 16 2 31 20 -
Louisiana ........... 2 122 24 1 89 88 1 -
Oklahoma............ 142 125 1 31 50 25 1
Texas............... 48 4,403 4,738 2 180 155 41 2 2 6 17

MOUNTAIN............. 917 1,007 2 49 37 30 23
Montana............ 35 58 8 6 4 9
Idaho.............. 89 21 2 11 11 3 -
Wyoming............. 52 2 -
Colorado........... 141 515 8 11 10 5
New Mexico......... 264 113 6 13 3
Arizona............ --" 377 222 --- 10 3 -- -
Utah............... 10 21 4 1 6
Nevada............. 1 5 2 3 -

PACIFIC .............. 10 1,078 2,603 2 544 280 164 1 72
Washington......... 1 62 546 56 44 46 26
Oregon............. 1 200 534 18 22 16 .4
California......... 8 766 1,479 2 449 199 82 1 16
Alaska .............. 9 9 11 3 4 9
Hawaii.............. 41 35 10 12 16 7

Puerto Rico.......... 49 1,626 434 19 20 31 -
*Delayed reports: Measles: D.C. delete 10
Mumps: Me. 6
Poliomyelitis: Me. delete 1 non-paralytic, add 1 paralytic
Rubella: Me. 3, Mo. 29






362 Morbidity and Mortality Weekly Report


TABLE IIl. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 11, 1969 AND OCTOBER 12, 1968 (41st WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA YPHOID TICK-BORNE RABES IN
AREA SCARLET FEVER FEVER (Rky. Mt. Spotted) ANIMALS
Cum. Cum. Cum. Cum. Cum.
i6 I 969 1( 1969 196 69 1969 1969 1969 1969 1969
UNITED STATES... 6,409 2 121 1 115 10 245 5 415 41 2,729

NEW ENGLAND .......... 799 1 14 12 1 2 31
Maine.*............ 7 1 6
New Hampshire...... 4
Veront............ 11 14 2 11
Massachusetts...... 156 1 7 1 2
Rhode Island....... 38 1 -
Connecticut........ 576 3 8

MIDDLE ATLANTIC..... 268 15 5 1 27 43 9 184
New York City...... 48 7 1 13 -
New York, Up-State. 128 3 4 1 6 7 7 171
New Jersey......... NN 3 3 14 -
Pennsylvania....... 92 2 5 22 2 13

EAST NORTH CENTRAL... 406 2 17 13 1 26 3 3 197
Ohi .............. 50 2 4 9 68
Indiana............ 122 2 2 48
Illincis.......... 30 8 4 12 3 31
Michigan ........... 149 5 4 7
Wisconsin.......... 55 7 1 1 1 43

WEST NORTH CENTRAL... 426 11 13 1 10 8 5 504
Minnesota.......... 5 3 1 4 2 134
Ioa............... 130 1 7 2 76
Missouri........... 12 4 9 3 127
N rth Dakota...... 148 1 66
south Dakota........ 30 1 24
Nebraska........... 94 1 1 13
Kansas............. 7 4 3 1 64

SOUTH ATLANTIC....... 568 21 21 37 2 231 4 662
Delaware. .......... 13 2 3 -
Maryland........... 58 1 4 47 3
Dist. of Columbia.. 2 2 1 -- -
Virginia.......... 201 4 1 -75 1 333
West Virginia...... 136 1 2 2 5 94
North Carolina.... NN 2 5 6 1 57 5
South Carolina..... 2 1 2 1 30 -
Georgia............ 13 4 4 9 1 14 1 71
Florida............ 143 10 4 11 2 156

EAST SOUTH CENTRAL... 1,238 18 12 2 35 1 62 1 361
Kentucky........... 125 7 2 8 13 186
Tnnessee......... 854 4 11 19 1 41 1 123
Alabama............ 202 5 4 5 46
Mississippi........ 57 2 1 4 3 6

WEST SOUTH CENTRAL... 624 21 18 3 28 2 46 11 400
Arkansas........... 16 1 1 1 13 7 29
Louisiana.......... 1 7 4 3 1 30
Oklahoma........... 17 1 7 28 2 61
Texas.............. 590 12 6 3 12 2 11 8 280

.MoNTAIN............. 1,145 6 1 15 24 16 1 116
Montana............ 36 1 2 -
Idaho............... 150 3 5 -
Win............ 98 2 5 1 53
Colrade........... 695 2 3 9 3
Ne~ Mexic ......... 73 1 5 17
Arizona........... --- -- 3 --- 5 -- 22
I'ah............... 93 1 12 2 5
Nevada............. 1 16

PACIFIC.............. 935 11 4 2 46 5 5 274
ashingt n......... 646 1 2 2 3 4
regn.............. 101 1 6 4
Califrnia......... --- 10 1 2 35 2 5 266
Alaska............. 68 -
Hawaii............. 120 3 -

Puert Ric .......... 1 2 10 6 21
*Delayed reports: SST: Me. 12
Tetanus: Ariz. 1
LRMSF: Va. delete 1






Morbidity and Mortality Weekly Report






TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED OCTOBER 11, 1969

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


All Causes Pneumonia Under All Causes Pneumonia .i,,.ler
Area and ya Area All 65 years and nI t. r
Area All 65 years Area A65 y5 years All Influenza All
Ages and over IAl enza s Ages and over
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.2-
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.-------.


742
248
41
27
21
58
31
25
28
50
69
16
41
30
57

3,254
62
51
140
43
30
31
58
67
1,653
41
486
193
35
104
31
41
80
52
29
27

2,629
77
35
699
155
220
138
84
335
32
66
55
37
44
158
63
140
50
40
39
89
73

817
59
23
73
133
27
92
66
223
66
55


448
133
27
18
15
27
23
14
19
33
36
12
24
25
42

1 ,908
29
33
80
33
21
17
33
26
971
27
278
108
26
66
23
27
39
31
21
19

1,494
47
21
381
92
129
62
49
186
21
39
35
12
33
87
30
86
26
31
25
56
46

503
39
11
41
84
13
62
41
127
49
36


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.----------


Total


1,240
160
228
67
87
112
59
91
31
84
55
222
44

592
94
60
40
115
138
36
33
76

1,126
38
52
26
158
33
83
199
55
138
87
114
64
79

489
55
30
138
25
103
33
44
61

1,558
31
47
26
30
95
480
79
35
154
59
99
179
33
129
48
34


12,447


7,092 411


Expected Number 11,983 6,888 366 511


Cumulative Total
(includes reported corrections
for previous weeks)


532,145


304,108


24,367


25,131


Week No.


'Mortality data are being collected from Las Vegas, Nev., for possible inclusion in this
Las Vegas, Nev.* 20 11 1 table, however, for statistical reasons, these data will be listed only and not included in
the total, expected number, or cumulative total, until 5 years of data are collected.
tEstimate based on average percent of divisional total.


I







364


"DAPHNE SORE C.ii / :ii frrom pne : 9

I CIt0.orC. I.' C: I: AlZ17n1! y I ) /pfIrTInI of 1q P bi.

i, 1' Jt i r. IC I. N: t
i't /: iii ni. Ciir erioyy Se'ti ii.


I. 1

Editorial Comment:
The original i-ola ion of If. :rin um n as made from
fish in tii Philtadelpha aq arium in lI6t.1 Human skin
Infectlion1- 0t1h I. mi:ru ( :nr i) a 1-sociIatd with s n-Hi-
in poo10 iinjiuril- ha:\ lht0 n ai led iliiinii pool gran-
ulori ':and ] l eral large outfir -aks ha\ been d1ecri ed".
Il. C 71: inatl "Ucon follow HinH injury and swimming in
pool filled i tih i al ater has been rIeporied from Canada:
Fngland Scotlandi, and following s-imming in the Paci-
fic Ocean' andi in the Potomac Ri\er.'
From 19(0il to the pre-ent. 14 cultures sent to the NCDC
II\ iobacteriologvI LahoratorI haIe been identified as V.
miiriaiid. tRe i*w of the casie hi-tories of these 14 indi id-
ual -howN that -everal of them had a history of trauma
and sa--ociation ith s-alt N\ater. Cases occurred in a Dela-
ware woman injured on a barnacle. two persons from Mary-
land tiih a history of trauma while -simming in Chesapeake
Ba. -a \-wport News\ Virginia. shipyard worker. a Georgia
\oman injured on a North Carolina beach, a Louisiana
o- ter fi-hlnrman, and a \\ashington woman injured on coral
in A\apulco. Mexico.
Association of positive -kin test sensitivity to PPD-S
following infection with i manrinim has been well de-
-crired' ': however, no stud% has been conducted to de-
fin, (the -sinificance of this infection as a causati\e factor
in positive tuberculin tests in children and adults in the
Gulf Coast and Chesapeake Bay areas.


\. rmn ii. .JI-s ih 1).: -pntin us Tubmlitrculosis in Salt aittcr
FI,-l J Infect i) J: 15-320. 192i.
I-. hI i 1i m l Aii \. utt nl.: rS- lmming Pool Gran;uloma. Arch

c0l'in 1D ,.E.1I.: Ii(ile T .I uber uosis Skin Inf action from
,t S~irimmn ni |ici: r+ior of *i rases-.. AcLa dermrat-v*rei e io1 r l1-:

1. \(ren. J-hn h K. mi Biro. r, Hoi rt: Swimlminn Pool (ra nu-
I i Hr.iin. L ,>i t I: 0l i-l-10 13 )9 4.
lhoma 1 I Tr
-. %,lk<. HI |. i ,:.: Sm ('hm i r +tf-ns s of "Swimming
O P >I"I)i) 1 I' 1n 'tti l, (Huii 111d 1J 1/: 5 (0 -109.t 19'I2.
7 ('- > RI .. 1 E I *l : (iut:tifous tisp i.* ('aus-io y Atypi-
l \ I --i I|1ii ,r -: Hi 1rt lif I Io ( hroimo*t n Infection1s ant
HI'i w l If ih I uI jcI I. \ 1h 1I)1rm 952:59-2 1 ll67.
'. f'., fr, rnT r .. tI I il.: 1 i ;I -ul Sensitii ty in Chil ren
Infr+t.-d i+tli ftycnri',i<+ 'riI 1 'ainci. Pdi,1trics 9; tOl. 10 .

' l*:r 'nrt +n. l-ie.rr SiN+++mmine |'+ii a a So)+aurc-+ urlf Non-Sp$+ei-
fS." Tli-|.Tculn I (- t <, imn >. ,.S i J l II.p l Ois < i(:JY; J 1S. 1967.


OCTOBER 11. 1969


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CtRCULA-
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.
ED TOR prof lII 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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