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:
AA00010654:00229

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 CE R 1
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U.S. DEPARTMENT OF HEALTH, EDUCATION. AND WELFARE PUBLIC HEALTH IERvi'E HEALTHH SER CE AND MENTAL mEALTi D ADMINISTRATION
DATE OF RELEASE OCTOBER 2a 1969 ATLANTA GEORGIA 30333


EPIDEMIOLOGIC NOTES AND REPORTS
PLAGUE New Mexco

On Oct. 17, 1969, a case of plague was reported from
New Mexico in a I i., ,er-o.l girl from Los Alamos. On
Septeniher 29, she had onset of malaise, fever. shaking
chill. raised red lesions on her left arm. and tenderness
of the neck and left axilla. These symptoms became worse.
and on October 1, she was hospitalized. She gave no his-
tory of contact with wild rodents, but had been on an out-
ing on September 28 to collect piiton nuts pineconess).
On admission, she had a temperature of 102.4 F. and
marked left axillary Iriphl dIlerip iih\ with erythema ex-
tending to the left breast. Blood cultures were done, and
she was given 250 mg tetracycline intramuscularly and
was started on 250 mg or allh four times per day. On Octo-
ber 3, the blood cultures were positive for gram-negative


I .. I' .

Iintctionu Hc' tit rts Chl*^hir<" (touni ,.

Food and I)ru. A in %tr. t in arninr
('C ni. lm na l t )l re nlt ilon ..... ........ : 66
Intern *tiuaon c .t-'
D"-cn ernt Gu temala ................. .. i. 67
Sur seitlanct Summ niar
Inceiphalhtt I 'niir d Statis 196S .. . 69
Summ r, of Riportetd Cases of Inftou .Sphil ...... 371



rods, that were -ensiti\e to tetracycline, ampicillin, and
chlorampheniaol. Ampicillin in doses of 500 mg orally four
times per day was started. On October 5. she became
afebrile and was i.- i,.i. *i.. She continued medication at
(Col!ti1ued oi page 366)


TABLE I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
42nd WEEK ENDED CUMULATIVE. FIRST 42 WEEKS
MEDIAN
DISEASE October 18. October 19. 1964 1968 MEDIAN
1969 1968 1969 1968 1964 1968
Aseptic meningitis ...................... 79 140 61 2,768 3.571 2,410
Brucellosis ............................ 3 3 4 185 185 206
Diphtheria.............................. 3 14 5 142 180 158
Encephalitis. primary:
Arthropod-borne & unspecified ........... 31 37 56 1,030 1,126 1.540
En(ephaliti.. post-infectious ............. 3 4 4 262 405 630
Hepatitis .?rum ....................... 107 134 4.239 3.634
Hepatitis, infectious .................... 947 1,027 37,791 36.355 31
Malaria ............................... 153 40 26 2.459 1.874 368
Measles rubeolaa) ....................... 125 136 635 21.142 20.258 192,131
Meningococcal infections, total ............ 32 26 39 2,501 2.161 2,251
Cilliarn ........................... 31 26 --- 2.294 1,977
Miliialr ............................. 1 1 207 184
Mumps ................................. 897 1.177 -- 71,554 129.567
Poliomyelitis, total ..................... 2 2 15 50 50
Paralytic ............................. 2 1 14 50 50
Rubella (German measles) ............... 312 292 --- 50.675 45,181
Slreptioocral sore throat & scarlet fever.... 6.179 7.219 6.625 336.696 338.360 338,360
Tetanus ............................. 2 6 6 123 144 183
Tularema .. 3 3 118 157 157
T)phoid fe- r ... ... .. 10 9 10 255 314 343
Typhus. tick-borne Rl Mi rpotdll. i..iril 8 3 : 421 265 245
Rabies in animals .. .. ... 4' 47 58 2 773 2 835 3.561

TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum Cum
Anhrax: ........ ...... .. .. 3 Rbe n man I
Botulism: ... ........ .... .. 1 Rub lla rnrngenriai s nadroirri.
Lepiospirosis. .... .... 64 Tiichinou l-i: N J -1. Ohi.I- .
Plague: N. Mex.-1 Tipnu- murine Ala -1 T -7 4.3
Psittacosis: 35






Morbidity and Mortality Weekly Report


OCTOBER 18, 1969


PLAGUE (Continued from front paie')


home. and although mild milaise persisted. she was able
to return to school hy October 14. The patient also had
persistent fluctiuant left axillary adenopath, which was
-ub'sequentll inciisod and drained. SChe i- prtrseontly asytmp-
lomlat ic and \ell.
On October 1.1, phage ipinlg of the blood cultures was
positive\ for Pa uret'lla pe tis.
The patient had contact witl a family dog cat. and
two pet rabbits. all of avhich ha;e remained well. There
hae been no other illnesses in her family members who
also went on the outing on September 2b.


Trapping of animals in the area where the family out-
ing was held is being done in an effort to determine the
source of the girl's infection.




(Reported by Bruce Storrs., 41.)., Director. and T. II. Tom-
linisol. Jr.. M1.0.. Division of Medical Services, Bryan
Miller, Chief, (Gen'ral Sajitation Section, and the Public
Ilraith Laboratory, \Ne'' Iexic'o department of Health; and
Irene 1'. Boone, 1.l).. Pho-ysician, Los Alamos.)


FOOD AND DRUG ADMINISTRATION WARNING
CONTAMINATED DETERGENT SOLUTION


The Food and Drug Administration on October 20
issued a nationwide warning against use of 49 types of
urethral catheter trays and kits produced by (. R. Bard
Inc. because of the possibility of serious infection. The
catheter tra s and kits contain a detergent solution, Deter-
uicide. which has been found contaminated with pseudo-
monas a potential harmful bacteria, and its use may result
in se\ re genital urinary infections.
Dr. Herbert L. Ley. FDA Commissioner, said it was
particularly urgent that nursing and convalescent homes.
doctors, and urologic clinics he made aware of the po-
tential hazard. ('. R. Bard Inc. of Murray Hill, New Jersey.
recalled the products only from its distributors and hos-
pitals in the united States and Canada. The FDA has
extended the recall to all others who would have occa-
sion to use then.
The Detergicide solution is intended for cleansing
and sanitizing the external area of catheter insertions.
The urethral catheter trays and kits list the detergicide
component on the outside label of the package in one of
the following ways 1 ( ,li r I.. ". "' r',. i.1' Prep
Solution "Cleanolution. an-i lution". or "Antiseptic Towel-
lette".
Hospital authorities hai e reported infections asso-
ciated with the use of the contaminated Detergicide. Ac-
cording to FDA all other components of the catheter trays
and kit- were found to eli sterile.
All hospitals, urologic clinics. nursing and convales-
cent homes and doctors are urged to promptly check their
stock and immediately return any of the recall products to
the-ir supplier. If no kits are available. the ones on hand
can Ie used. but thel Detergicide cleansing solution must
be discarded and replaced by a sterile solution.
Editorial Note:
Twenty kits from a particular lot number of the pack-
aged dterg.ent solution \were examined in the laboratories


of the NCDC. All were found to be contaminated with a
pure growth of about 10.000 to 100.000 colonies per ml
of a pseutdomonas-like bacterium resembling Pseudomonas
kingii and classified as EO-1. The cultural characteristics
are defined as follows:
After inactivation of benzalkonium in the original
solution, growth on blood agar at 35-37C. yields colonies
0.5 to 1.0 mm in diameter at l-:20 hours. The colonies are
convex, circular, smooth, translucent to semiopaque and
nonpigmented. Colorless colonies, less than 0.5 mm in di-
ameter. are produced on MacConkey agar at 18-20 hours.
By 48-72 hours the colonies are approximately 1.0 mm in
diameter. The organisms are gram-negative, medium-sized
rods. frequently with bipolar staining.
The outstanding characteristic of the EO-1 organisms
is the production of a nonsoluble yellow pigment on TSI
or Kligler agar slants. This may not be evident until in-
cubated 4S-72 hours. Pigmentation is not observed on a
nutrient medium such as Heart Infusion agar. Occasional
nonpigmented strains have been encountered.
In an oxidation-fermentation (OF) medium. acid is
produced from glucose oxidatiwely. Most strains also pro-
duce acid from xylose. lactose, sucrose, and maltose in
an OF medium. Mannitol usually remains neutral or becomes
w eakly acid.
Cultures on agar slants ha\e become nonviable in
3-4 da ys. Agar-stab cultures ha\e been maintained for
several weeks.




(Reported by Microbiological Control Section, Bacterial
Diseases Branch, Epidemiology Program, and the Bacterial
Reference Unit, Bacteriology Section. Microbiology Branch,
Laboratory )irision, 'C'DC.)


366







OCTOBER 18, 1969


Morbidity and Mortality Weekly Report


INTERNATIONAL NOTES
DYSENTERY Guatemala


In January 1969, an increase of severe dysentery was
reported from three villages in South Guatemala. Subse-
quently, reports of a similar severe form of diarrhea were
received from" towns and villages in widely scattered parts
of the country. Cases occurred in all age groups, with high
mortality rates especially in school and pre-school children.
Shigella dysenteriae type 1 (Shiga's bacillus) was isolated
in August and has since been confirmed by bacteriologic
and serologic methods in several areas where outbreaks
have occurred.
Severe rains and flooding may have been a factor in
recent spread. Similar flood conditions in neighboring
countries and reports of dysentery near international bor-
ders raise the possibility of involvement of areas outside
Guatemala.
In vitro antibiotic sensitivity studies have indicated
that the organism is resistant to tetracycline, chloram-
phenicol, novobiocin, and sulfamethoxpyridazine. Pre-
liminary results indicate that erythromycin, kanamycin,
and nalidixic acid are clinically effective. An epidemiologic
investigation is in progress.
(Reported by Dr. Cesar A. Mendizabal Morris, Director of
Epidemiology, Ministry of Public Health and Social Assist-
ant of the Government of Guatemala, Guatemala, Central
America; Dr. Leonardo J. Mata, Chief, Division of Micro-
biology, Institute of Nutrition of Central America and Pan-
ama, Guatemala, Central America; and an EIS Officer.)

Editor's Note:
Shigella dysenteriae 1 is an extremely rare serotype
accounting for only a fraction of one percent of all isolates


reported in the United States. Recently, however, there
has been a significant increase in the number of isolates
reported. In 1964 none were reported. in 1965 there was
one; in 1966 and 1967. there were two each \ear and in 1968
three. In 1969. however, a total of 12 isolates have thus
far been reported, nine in the third quarter. Epidemiologic
information available on five of these isolates indicates
that four infections were acquired after travel to Mexico
and one after travel to Ethiopia.
The last reported outbreak of dysentery due to the
Shiga bacillus in the United States occurred in the summer
of 1938.1 The outbreak spread from a group of migrant
Mexican workers to individuals in the City of Owosso.
Michigan. Person-to-person transmission was the alleged
mode of transmission. The disease was of a virulent type
with 10 deaths among 45 recognized cases, a fatality rate
of 22.2 percent, all in children under age S. A similar high
fatality rate was reported by Japanese workers early in the
century when the disease was endemic in that country.
Patients who develop diarrhea during or after travel
to Mexico or countries of Central America should be cul-
tured to rule out S. dysenteriae I infections. The severe
form of the disease has a characteristic picture of diarrhea
with blood and mucous usually with tenesmus, dehydra-
tion. prostration, and fever. Milder forms of the disease
cannot be differentiated from diarrhea due to a variety of
other causes. A serologic test is available to assist in
diagnosis.
Reference:
lBlock, N. B., and Ferguson, \\.: An Outbreak of Shiga Dysen-
tery in Michigan, 1938. Amer J Public Health, 30:43-52, 1910.


EPIDEMIOLOGIC NOTES AND REPORTS
RAT-BITE FEVER Oklahoma and Texas


In July and August 1969, Oklahoma and Texas reported
one case each of rat-bite fever. The first case was in a
19-month-old boy from Major County, Oklahoma, who, while
sleeping on July 21, was bitten on the index finger of the
right hand by a rat. Ten days later, he was hospitalized
with a temperature of 104'F. and a generalized blanching
macular rash, which had been present for 1 day. The finger
lesion appeared indurated, but no organomegaly, joint in-
flammation, or regional lymphadenopathy was noted. His
hematocrit was 34 percent; the white blood cell count was
10,300 per mm3 with 48 percent polymorphonuclear cells,
23 percent bands, and 27 percent lymphocytes; the blood
was negative for febrile agglutinins; and urinalysis was
normal. Blood obtained on admission was cultured and
after 3 days grew Streptobacillus moniliformis. Parenteral
penicillin was started on admission; 36 hours later the
child was afebrile and after 72 hours the rash had disap-


peared. The patient was discharged on August 7 after 1
week of parenteral penicillin.
The second case was in a physician's 9-year-old son.
who on August 3 was bitten by a caged rat at a retail pet
store in Houston. Five days later, he was hospitalized
with headache, a temperature of 102'F., a bluish-red macular
rash over the trunk and extremities, a pustular lesion with
a necrotic center on the finger ii --ri to the bitten finger,
and polyarthritis. Admission cultures of both the finger
pustule and blood grew S. moniliformis. The child was
treated with 2 million units of intravenous penicillin per
day with resolution of all signs and symptoms within 48
hours.
Six hooded rats had been purchased by the pet store
owner in Houston on July 15. These rats were a male and
female and their litter of four raised by a boy who had
(Continued on page 368)











earlier bought the male and female from a different pet
store. One rat was sold to an unidentified I *-., ar-.lI girl
and two were sold as food for snakes. The remaining three
showed no signs of illness. but oropharyngeal culture of
each grew S. moniliformis. Oropharyngeal cultures of four
gerbils, three hamsters, and one mouse in the shop were
negative. The owner of the pet store has raised rats for 3
years and has sold an average of five to six per month: he
had not previously noted disease in any of the animals.
(Reported by Charles Baker, hM.P., R. ). M.D.,
and William M.D., Physiciansr, Knid, '* .',.. iCecil
Reinstein, ..D., Director, Garfield County Health Depart-
me-nt; R. LeRoy Carpenter, M.D.. Director, Division of
Epidemiology, Oklahoma State Department of Health; John
R. hlontgomery, V.ID., and John B. Young, M.D., Baylor
universityy apartmentt of Pediatrics; Robert McLean, M.D.,
Director. Comnmunicable Disease Division, and Charles A.
Pig ford, M.P., Director, Houston City Health Department;
M. S. Dickerson, .D)., Director, Communicable Disease
Division, Texas State Department of Health; and EIS
Officers.)
Editorial Comment:
Rat bites frequently occur in metropolitan areas with a
population of tIiI.Duni or more persons but are only occa-
sionally a problem in rural or farming communities. Rat


OCTOBER 18, 1969


bites have increased in frequency coexistent with and
proportional to the urbanization of the United States. The
estimated present rate is 15 to 30 rat bites per 100,000
population per year or approximately 14,000 rat bites per
year.
Death from rat bites is rare and usually occurs in babies
or immobile adults. In a study in Baltimore, rat-bite fever
was reported to develop as secondary infection of the in-
jury in up to 11 percent of cases.2 In the United States rat-
bite fever is commonly due to S. moniliformis. This illness
is characterized by a 3 to 10 day incubation period, re-
current spiking fever, regional 1,ntmh.,l.-rop.ihi,, arthritis,
and bluish-red macular rash. If not treated, rat-bite fever
may be fatal in up to 10 percent of cases.2 Penicillin is
the drug of choice, and streptomycin has been found effec-
tive in treating some patients who did not respond to peni-
cillin.3 Control of rat-bite fever is best accomplished by
programs to reduce the rat population.
teferences:
IScott, H. G.: Rat Bite: Epidemiology and Control, USDHEW,
PHS Publication 1966.
2Richter, Curt P.: Incidence of Rat Bites and Rat Bite Fever in
Baltimore. JAMA 128:324-26, 1945.
'Morton, Harry E.: Streptobacillus Moniliformis in Bacterial and
Mycotic Infections of Man. Dubos, Rene J. and Hirsch, James
G. (ed.). 4th edition, J. P. Lippincott Co., Philadelphia 1965,
p. 767.


INFECTIOUS HEPATITIS Cheshire County, New Hampshire


During the first 9 months of 1969, an outbreak of in-
fectious hepatitis due to person-to-person transmission
occurred in Cheshire County. New Hampshire. The epidemic
involved 25 patients (Figure 1), twenty of whom resided in
the town of Winchester (pop. 2,411, 1960 cen.), a rural
community in the southwestern corner of the state; five
resided elsewhere but had contact with patients in Win-
chester. Seen cases occurred among household members
and 18 among close relatives, neighbors. or friends. Cases
ranged in age from 9 to 43 years with most (10) occurring
in the 10-14 age group. There wsre 17 males and eight
females.
All patients had classical symptoms of hepatitis in-
cluding jaundice and or dlark urine: 12 were hospitalized
and had abnormal li\er function studies. None gave a his-
tor\ of parenteral inoculation. ingestion of raw -hi-llfi-h.
or know n exposure to contaminated foods or drinking water.
The -tandards of hygiene within the households of the
majority of patients were low; children were unkempt
and oercrowdred in inadequate housing. The poor environ-


Figure 1
CASES OF INFECTIOUS HEPATITIS BY MONTH
OF ONSET, CHESHIRE COUNTY, NEW HAMPSHIRE
JANUARY-SEPTEMBER 1969


-;:


JAN. FEB. MAR. APR. MAY JUNE JULY AUG. SEP.
MONTH OF ONSET


Morbidity and Mortality Weekly Report


RAT-BITE FEVER (Continued from page 367)










mental sanitation and close interpersonal contacts strongly
suggested a fecal-oral route of transmission.
Local health officials and physicians have stressed
the importance of good hygienic practices. Immune serum
globulin has been administered to family contacts of several
patients; however, three additional cases have been re-


369


ported from the Winchester area in October. These cases
are currently under investigation.
(Reported by Walter Kaupas, f.D .. .P.H., State Epidemi-
ologist, and Arthur Van Buskirk, Public Health Advisor,
Communicable Disease Control Bureau, \'ew Hampshire
Division of Public Health; and an EIS '". *. .)


SURVEILLANCE SUMMARY
ENCEPHALITIS United States 1968


In the United States during 1968, a total of 2.283 cases
of encephalitis (260 fatal) were reported to the NCDC


(Table 1). This. ompares with 2,368 cases (245 fatal) re-
ported in 1967. (Continued on page 370)


Table 1
Cause of 2,283 Cases of Encephalitis (260 Fatal) Reported to NCDC, 1968

Total Cases Fatal Cases
Death Case
Category and Cause Number Percent Number Percent Ratio (Percent)
Number Number
of Total of Total
Arboviral 130 5.7 9 3.5 6.9
WEE 17
EEE 12 6
CE 66
SLE 35 3
VEE
Enteroviral (Confirmed) 66 2.9 1 0.4 1.5
Associated with Childhood Infections 502 22.0 20 7.7 4.0
Measles 19 1
Mumps 408 2
Chickenpox 69 17
Rubella 6
Associated with
Respiratory Illnesses 17 0.7 4 1.5 23.5
Influenza 7 3
Adenovirus 4
M. pneumoniae 5 1
RSV 1
Associated with Immunization 13 0.6 3 1.2 23.1
Post-vaccinial 12 3
Post-DPT 1
Other 45 2.0 12 4.4 26.7
LCM 2
Herpes simplex 35 12
Herpes zoster 5 -
Infectious mononucleosis 2
Roseola 1
Unknown and Complex Etiology 1,510 66.1 211 81.2 14.0
Diagnostic for 1 or more agents 77 2
Diagnostic for 2 or more agents 1 -
Unknown 1,431 209
Total 2,283 100 260 100 11.4
*Although not included in the formal reporting, the only documented symptomatic human infection with Venezuelan Equine
Encephalomyelitis virus in the United States occurred in Florida in 1968.


OCTOBER 18, 1969


Morbidity and Mortality Weekly Report











The 130 cases of arhouiral encephalitis reported in
196( are an increase from h,3 cass- in 1967 and reflect an
increased number of ca- ,- of St. I.ouis encephalitis and
Eastern equine OnecephaIilom)etis in Illinois and New'
J er-eS,. respect ely (Figure 2). In addition in 196S,. the
fir-t ricontizedl natiur itSll acquired human c ase of Vene-
zuelan equine encepha ilo mlitis in the I united State-s oc-
curred in Floridia.


Figure 2
HUMAN CASES OF ARTHROPODBORNE
ENCEPHALITIS BY STATE, 1968

EASTERN EQUtNE ENCEPHALCOMYELITIS AND
WESTERN EQUINE ENCEPHALOMYELiTS
o *4


.. '

-,': + .... 'J .+ :- .
t ^ t '


OCTOBER 18, 1969


Encephalitis associated with isolation of enteroviruses
accounted for 137 of the reported cases in 1968. ECHO 30
and ECHO 9 were the most frequently isolated entero\iral
types associated with encephalitis (Table 2).
In 1968. the number of cases of encephalitis asso-
ciated with measles was 19 (1 fatal) (Table 'I This is the


Table 2
Cases of Encephalitis Associated with Enterovirus
Isolation by Age Group and Type of Enterovirus

"-" ., \ I.'i ., I LI II :I I I 1, ln l-lh h..r I,,a.,

<1 1 1
1-4 2 1 5 3 3 14
5-9 2 7 7 9 6 31
10-14 1 3 5 13 2 24
15-19 1 4 9 14
2'0-29 1 3 4 10 4 22
30-39 7 1 10 18
10 + 1 1 1 3
UInkno wn 10 10
Total 7 23 37 55 15 137


''' : + ''

\ '
\


T OUiS ENCEPHAlT S





11 :+:9
k ]+ ..

.+ +"3 +.
+- ,


Table 3
Encephalitis Associated with


.1


CALIFOR NII ENCEP IITS t





-.





\4~if ~. t


I CSES

I- CAlSE


Table 4
Reported Cases of Measles and Measles Encephalitis
in the United States 1960-1968

a Cases of Cases of Rate per 100.000
Measles Measles Encephalitis Measles Cases
I i, ii I ll .I' .'I ;.
19)1 423,919 276 65.1
19;62 461,530 337 70.0
19r63 3Rb',16 2319 62.1
1961 45h,0h3 300 65.6
1965 261,9041 171 65.3
1966 201.136 219 107.3
1967 62.705 62 98.9
196( 22,617 19 84.0


Morbidity and Mortality Weekly Report


ENCEPHALITIS (Continued from page 369)


Childhood Illnesses







Morbidity and Mortali


lowest figure yet reported: in 1967. there were 62 measles
encephalitis cases (6 fatal) and in 1966, 219 (29 fatal)
(Table 4). The number of cases of encephalitis associated
with mumps in 196b (48 cases, 2 fatal) (Table 3) was ap-
proximately one-half the number reported in 1967 (849 cases,
8 fatal). This reduction cannot be entirely explained by
decreasing incidence of mumps in the United States be-


OCTOBER 18, 1969


SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS


CASES OF PRIMARY AND SECONDARY SYPHILIS: By Reporting Areas September 1968 and September 1969 Provisional Data

Cumulative Cumulative
Reporting Area September Jan. Sept. Reporting Area September Jan. Sept.
1969 1968 1969 1968 1969 1968 1969 1968
NEW ENGLAND.............. 34 34 284 259 EAST SOUTH CENTRAL........ 100 77 749 1,049
Maine.................... 2 7 3 Kentucky............... 7 12 122 90
New Hampshire........... 7 2 Tennessee................ 42 27 239 250
Vermont ................. 1 Alabama.................. 26 24 197 444
Massachusetts............ 17 27 167 163 Mississippi.............. 25 14 191 265
Rhode Island.............. 5 31 26
Connecticut............. 10 7 71 65 WEST SOUTH CENTRAL........ 319 271 2.715 2,606
Arkansas................. 24 14 161 101
MIDDLE ATLANTIC............ 324 330 2.889 2,514 Louisiana................ 57 58 527 642
Upstate New York.......... 22 38 206 213 Oklahoma................. 6 4 57 58
New York City............. 201 222 1,988 1,592 Texas.................... 232 195 1 ,970 1,805
Pa. (Excl. Phila.)....... 9 14 106 17b
Philadelphia.............. 17 20 162 189 MOUNTAIN.................. 68 31 480 370
New Jersey............... 75 36 427 344 Montana.................. 2 1 8 7
Idaho..................... 2 8 2
EAST NORTH CENTRAL........ 259 247 1,951 2,137 Wyoming.................. 5 2
Ohio..................... 32 48 282 347 Colorado................. 1 2 35 15
Indiana................... 39 28 272 260 New Mexico............... 28 19 207 122
Downstate Illinois...... 25 24 196 142 Arizona .................. 28 8 156 181
Chicago ................. 90 76 693 753 Utah..................... 1 13 8
Michigan ................. 71 65 490 612 Nevada.................... 6 1 48 33
Wisconsin................ 2 6 18 23
PACIFIC................... 200 171 1,501 1,169
WEST NORTH CENTRAL........ 38 31 277 284 Washington............... 5 44 35
Minnesota............... 7 4 39 38 Oregon................... 5 6 33 30
Iowa ..................... 4 5 30 31 California............... 188 163 1,414 1,197
Missouri................. 12 12 126 144 Alaska................... 2 1 6 2
North Dakota............. 2 1 10 5 Hawaii.................... 1 4 5
South Dakota.............. 6 4 15 30
Nebraska.................. 2 24 15 U. S. TOTAL ............... 1,726 1.621 14,498 14t382
Kansas.................... 5 5 33 21
TERRITORIES............... 101 71 894 850
SOUTH ATLANTIC ............ 384 429 3,652 3,894 Puerto Rico.............. 99 71 883 810
Delaware................. 3 4 33 27 Virgin Islands............ 2 11 40
Maryland................. 34 45 316 352
District of Columbia..... 51 56 432 451
Virginia ................. 33 25 223 233
West Virginia............ 2 15 27
iorth Carolina........... 27 33 371 464 Note: Cumulative Totals include revised and delayed reports
South Carolina........... 48 46 437 395 through previous months.
Georgia.................. O 88 785 673
Florida..................... 106 132 1 ,040 1,272


ty Weekly Report 371



tween 1967 and 1968. The high death-to-case ratio for
encephalitis associated with chickenpox (24.6 percent)
(Table 3) suggests that many of these cases may be fatty
degeneration of the viscera (Reye'sk Syndrome).
(Reported by Neurotropic Viral Diseases Unit. Viral Dis-
eases Branch and the Statistical Services Actirity. Epi-
demiology Program, NCOC.)






372 Mlorbidit and Mortality Weekly Report


IABLI Il. ( A'SIS OF SPIFIEII) NOTIFIABLE DISEASES: IGNITED STATES

FOR WEEKS ENDED

OCTOBER is, 1969 AND OCTOBER 19, 1968 (i2nd WEEK)

F n n [ n i **F i a
i.: .- : lr 1I "*[A1 IA
F\ i" ; ,nl- p, M n I I Serum Infectious



USITEI '" I :,

NEW ENciAND ......... 1 2 3 119 61 2 79
.aine.......... -- 11 6 -
NeC H. pshir, ...... 1 2 2 -
V r.t.it. ........... .- 2 5
Masach uett ...... 1 2 1 62 24 1 48
Rhode Isi i. ..... 2 1 17 6 9
( nnectic t........ 1 1 25 18 1 14

I)DDLE AILA\TIC ..... 21 1 6 40 136 186 19 284
st Yrk Ci....... 23 40 57 22
N. Y rk, ~ p-Stat. 2 1 1 10 31 3 46
Ne crey. ....... 2 17 53 51 10 117
Penn ivinza. ....... 11 3 33 47 6 99

EA i NORTH CENTRAL... 1S 1 12 11 22 161 165 2 258
h ............. 2 8 10t 7 43 35 1 23
Indian. ............. 1 1 24 16 20
IIlin is.. ......... 2 1 1 1 5 23 55 160
.MihigdRn........... 3 3 9 63 52 1 54
Wiscnsin .......... 8 7 1

WEST NORTH CENTRAL... 2 3 1 -- 25 38 7 173
Mi nne ta .......... 2- 3 8 13
Swa. .............. 1 7 8 18
Missouri.......... 4 15 1 42
North Dakota ....... 1 3
South Dakta ...... 1
Ncbr. ka ........... 1 6 1 1 4
Kansas. ............ 1 5 6 5 92

SOITH ATLANTIC....... 7 5 3 4 109 124 99 678
Delaware ........... 5 3
Maryland........... 1 17 14 31
Dist. of Columbia. 1 1 2
Virginia........... 1 2 1 -- 14 23 1 26
es t Virginia....... 1 1 12 4 -
North Carolina..... 3 1 1 28 3 10 270
S-uth Carolina..... 1 4 10 3 54
Georgia............ 9 17 84 258
Florida ............ 1 1 4 19 52 1 34

EAST SOUTH CENTRAL... 5 2 2 1 2 57 84 1 111
Kentucky. ......... 2 2 24 42 1 86
Tennessee............ 2 2 1 14 18 -
Alabama ............ 3 17 7 22
Mississippi........ 2 17 3

EST SOUTH CENTRAL... 5 3 1 73 76 5 179
Arkansas............ 1 1 11 13
Louisiana.......... 1 12 14 1 44
Ok lah1ma.......... 7 4 4 58
Texas.............. 4 3 53 47 64

MOUNTAIN............. 4 2 47 41 127
Montana ........... 3 1 4 3
Idaho .............. 9 3
Wyoming.............. 1 4 -
C lorad ..... ...... 1 16 12 108
New Mxico......... 8 7 7
Arizona............. 14 4 1
tah................ 1 3 5 1
Nevada............. 1 4

PA IFIC.............. 7 3 12 1 36 220 252 18 570
Washingtn ......... 6 27 25 5
Oregon .............- 1 16 16 14
Cali frnt...... 11 2 12 1 36 172 205 7 444
Alask......... .. 1 1 3
tHaa i.......... .. I 4 5 11 104

-' I 16 21 2

*n la el rep rIt : Di htheria: Ariz. 1
Irpatiti, s.erun: Ariz. 6
hepatitis, infectious: "e. 11, Ariz. 17
".laria: Iowa 2







Morbidity and Mortality Weekly Report 373


TABLE II1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 18. 1969 AND OCTOBER 19, 1968 (42nd WEEK) CONTINUED


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

UNITED STATES... 125 21,142 20,258 32 2,501 2,161 897 14 312

NEW ENGLAND.......... 2 1,122 1,170 2 99 125 100 2 22
Maine ............. 9 18 1 7 6 5 1 2
New Hampshire...... 239 141 3 7 2 -
Vermont............ 3 2 1 2 1
Massachusetts...... 1 223 363 38 64 36 10
Rhode Island....... 27 6 13 9 3 -
Connecticut........ 1 621 620 1 38 38 52 1 9

MIDDLE ATLANTIC...... 13 7,577 4,187 5 410 386 50 2 28
New York City...... 6 4,943 2,196 77 80 35 10
New York, Up-State. 1 606 1,240 79 69 NN 1 3
New Jersey......... 2 925 637 3 163 132 15 7
Pennsylvania....... 4 1,103 114 2 91 105 NN 1 6

EAST NORTH CENTRAL... 15 2,365 3,912 2 342 261 267 72
Ohio................ 1 394 298 2 126 72 20 b
Indiana............. 468 693 45 36 40 17
Illinois........... 6 582 1,381 49 58 72 7
Michigan........... 4 315 291 97 75 51 13
Wisconsin.......... 4 606 1,249 25 20 84 29

WEST NORTH CENTRAL... 33 633 395 1 127 115 38 1 12
Minnesota........... 8 16 28 27 -
Iowa................ 332 104 1 19 8 34 10
Missouri............ 30 81 52 37 2 -
North Dakota....... 15 137 2 3 1
South Dakota........ 3 4 1 5 NN -
Nebraska........... 33 238 43 9 8 2 1
Kansas............. 7 10 16 27 1

SOUTH ATLANTIC....... 5 2,580 1,534 10 437 432 91 1 35
Delaware............ 1 394 16 1 13 8 4 1
Maryland............ 77 103 40 36 5 2
Dist. of Columbia.. 1 26 6 9 15 1 1
Virginia........... 1 886 302 1 55 40 10 12
West Virginia...... 1 212 294 19 13 43 13
North Carolina..... 318 284 5 77 83 NN 4
South Carolina..... 125 12 57 58 6 -
Georgia............. 2 4 1 73 86 -
Florida............. 1 540 513 2 94 93 22 1 2

EAST SOUTH CENTRAL... 113 500 6 156 197 34 1 26
Kentucky........... 66 103 3 54 90 5 2
Tennessee.......... 17 62 3 61 57 23 21
Alabama............ 6 95 24 27 5 1 3
Mississippi........ 24 240 17 23 1 -

VEST SOUTH CENTRAL... 28 4,711 4,918 2 333 320 80 6 22
Arkansas........... 16 2 31 20 -
Louisiana.......... 122 24 1 90 92 -
Oklahoma........... 142 125 31 50 23 8
Texas.............. 28 4,431 4,767 1 181 158 57 6 14

MOUNTAIN.............. 16 950 1,015 49 38 41 21
Montana.*........ 35 58 8 6 5 1
Idaho............... 1 90 21 11 11 3
Wyoming............. 53 2 1
Colorado........... 141 516 8 11 13 1
New Mexico......... 264 117 6 3 3
Arizona............. 15 409 224 10 4 11 8
Utah............... 10 21 4 1 6 7
Nevada.............. 1 5 2 3 -

PACIFIC.............. 13 1,091 2,627 4 548 287 196 1 74
Washington......... 62 551 56 45 63 30
Oregon.............. 200 540 18 22 24 7
California......... 12 778 1,492 4 453 205 99 1 27
Alaska.............. 9 9 11 3 8 3
Hawaii.............. 1 42 35 10 12 2 7

Puerto Rico.......... 41 1,667 436 19 20 16 12
*Delayed reports: Measles: Ariz. 17
Mumps: Me. 10, Ariz. 8
Rubella: Me. 1, Mont. delete 4, Ariz. 15







374 Morbidity and Mortality Weekly Report


TABLE III. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER IS, 1969 AND OCTOBER 19, 1968 (42nd WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER
SORE THROAT & TETANUS TULAREMIA TICK-BORNE RABIES I
FEVN.R ANIMALS
AREA SCARLET FEVER 1)FR (Rky. Mt. Spotted) ANIMALS
Cumr. Cum. Cum. Cum. Cum.
lib) 1969 | l69 1969 1 69 1969 i969 1969 1969 1969' 1969


UNITED STATES... 6,179 2 123 3 118 10 255 8 423 44 2,773

NEW ENGLAND......... 533 1 14 12 1 3 34
Maine .............. 5 1 6
New Hamp hire. ..... 24 1 5
Verm, nt............ 18 14 2 13
Massachusetts...... 152 1 7 1 2
Rhode I land ....... 42 1
Connect iut........ 292 3 8

MIDDLE ATLANTIC ..... 221 15 5 1 28 43 6 190
New York City...... 22 7 1 1 14 -
New York, lp-State. 152 3 4 6 7 6 177
New Jersey......... NN 3 3 14 -
Pennsylvania....... 47 2 5 22 13

EAST NORTH CENTRAL... 587 17 13 3 29 3 5 202
Ohio............... 86 4 1 10 1 69
Indiana........... 121 2 48
Illinois........... 117 8 4 1 13 3 2 33
Michigan........... 172 5 1 5 7
Wisconsin.......... 91 7 1 2 45

WEST NORTH CENTRAL... 318 11 1 14 10 8 5 509
Minnesota.......... 13 3 4 1 135
Iowa............... 111 1 7 1 77
Missouri........... 15 4 1 10 3 127
North Dakota....... 67 1 67
South Dako0ta....... 41 1 24
Nebraska ........... 55 1 1 13
Kansas ............. 16 4 3 1 2 66

SOlTH ATLANTIC....... 815 21 21 2 39 8 239 9 671
Delaware........... 16 2 3 -
Maryland........... 66 1 4 47 3
Dist. of Columbia.. 8 2 1 -
Virginia............ 282 4 1 6 81 4 337
West Virginia...... 189 1 2 2 5 3 97
North Carolina..... NN 2 5 6 1 58 5
South Carolina..... 98 1 2 1 30 -
Georgia............ 5 4 4 2 11 1 15 2 73
Florida............. 151 10 4 11 156

EAST SOUTH CENTRAL... 1,175 18 1 13 35 62 4 365
Kentucky.* ......... 162 7 8 13 1 187
Tennessee.......... 710 4 1 12 19 41 2 125
Alabama............ 142 5 4 5 1 47
Mississippi........ 161 2 1 4 3 6

WEST SOUTH CENTRAL... 625 2 23 1 19 28 46 6 406
Arkansas........... 10 1 1 13 7 1 30
Louisiana.......... 5 7 4 3 1 31
Oklahma........... 33 1 1 8 28 61
Texas.............. 577 2 14 6 12 11 4 284

MOUNTAIN.............. 1,448 6 15 2 26 16 116
Mntanaa............ 35 1 2 -
Idah .............. 225 1 4 5 -
Wy ing............ 195 2 5 53
S rado ............ 596 2 3 9 3
NS Mrxio......... 262 1 1 6 17
Ari rna.*........... 59 3 5 22
............... 76 12 2 5
N,-n ............... .. 1 16

C I .............. 457 11 4 2 48 5 6 280
,hi .t .......... 268 1 2 2 3 4
...........55 1 6 4
C lif .......... --- 10 1 2 37 2 6 272
............. 77 -
57 3 -

rt R....... 2 2 12 6 21


* elated reports: SST:


Ky. 2, Ariz. 117







Morbidity and Mortality Weekly Report


375


Week No. TABLE IV. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED OCTOBER 18, 1969
42
(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 andnza year
Influea All a Influenza All
Ages and over 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.--
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, lowa------
Duluth, Minn.-------..
Kansas City, Kans.----
Kansas City, Mo.------
Lincoln, Nebr.--------
Minneapolis, Minn.----
Omaha, Nebr.----------
St. Louis, Mo.--------
St. Paul, Minn.-------
Wichita, Kans.-----...


713
242
42
23
24
50
22
21
30
48
60
12
55
22
62

3,151
36
34
128
40
38
38
68
79
1 ,665
31
399
176
56
114
26
30
96
38
20
39

2,522
56
33
752
194
178
137
63
344
45
42
44
27
57
133
24
123
42
28
36
106
58

868
66
21
45
129
32
127
95
218
75
60


447
138
34
18
18
27
10
13
22
34
37
9
31
13
43

1 ,843
19
24
78
19
22
22
31
42
984
14
218
98
30
71
18
21
67
20
16
29

1,393
33
20
395
112
99
72
35
197
29
23
23
9
33
75
10
62
20
19
14
77
36

516
38
9
25
74
25
75
67
120
45
38


SOUTH ATLANTIC:
Atlanta, Ca.-----------
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, Teo.-----------
El Paso, Tex.----------
F ,rt Worth, Tex.------.
Houston, Tex. ----------
Little R New Orleans, La.-------
Oklahoma City, Okla.---
San Antonio, Tex.- ----
Shrevcport, 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 ,066
135
209
44
58
58
60
96
39
72
65
180
50

695
117
51
48
138
132
59
50
100

1,248
51
52
25
154
48
86
250
62
162
95
131
59
73

444
29
31
119
27
114
17
55
52

1,438
25
44
21
44
84
380
61
37
109
69
95
175
32
158
56
48


50
10
1
2
3

11
2
1
6
10
2
2

37
2
2

18
2
3
7
3

39
2


2
3
4
2
5
7

2
3
9

22
2
3
6
4
2
2
1
2

42
2


3

7
1
2
4
2
4
2
1
11
2
1


Total 12,145 6,883 474 616

Expected Number 12,076 6,956 375 511


Cumulative Total
(includes reported corrections
for previous weeks)


544,371


311,031


24,840


25,770


1Mortality data are being collected from Las Vegas. Nev., (or possible inclusion in this
Las Vegas, Nev.* table, however, for statistical reasons, these data will be listed only and not included in
18 9 1 the total, expected number, or cumulative total, until 5 years of data are collected.







376 Morbidity and Mortality Weekly Report OCTOBER 18, 1969



THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION OF 18,500 IS PUBLISHED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER. ATLANTA, GEORGIA. ma
DIRECTOR, NATIONAL COMMUNICABLE DISEASE CENTER
DAVID J. SENCER. M.D.
ODRECTOR. EPIDEMIOLOGY PROGRAM A. D. LANGMUIR. M.D.
EDITOR MICHAEL B. GREGG, M D
ED TOR pro terY ALAN R. HINMAN, D
MANAGING EDITOR PRISCILLA B. HOLMAN
IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING -
MORBIDITY AND MORTALITY, THE NATIONAL COMMUNICABLE DISEASE O
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: U),
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 i
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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