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:
AA00010654:00231

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




Morbidity and Mortality



U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE

Prepared byhe 634-513

rTr r.lear. Janiuar, i0. Ilo4 ATLANTA, GEORGIA 30333
PROVISION \L INFORMATION ON SELECTED NOTIFI.BLE )DI' [A.L IN THI L N I .
DE.11HS IN SELECTED ( ITIF rn %\ r1 k FiVk nr> F II, R\ I,.I/1-R%


U
Wekl


P Ti L I.-. f 'P EILL A..- L '1..lillR I' L


POLIOMYELITIS No case- of poiiomveli aere re-
porrte for the week ended l anuar-, -.
This represents the first time that no cases hj.e
been reported lor an, week sincee reporting begin, ac-
cording In the sitaistical records aj ailablc ar the Com-
municable Disease Center. Week\ reporting ot poliomve-
litis began in 1950.
The greatest number of caseC reported foc any one
week was 4,180 for the 38th week tended September 201
of 1952. The highest number of cases reported tor the com-
p:.rable first week of any Near since 19'i1 aj 2? ., in I ?i,..


DIPHTHERIA EiFgh cjeh l*ip iria Pr',
frr CeC a cE jlli lI
lor the Iee- ended d lanu-r A he WO aq f .
Four it rheie case %ere report rn They
Oc.:urred in children of one family,. Three ot the .-hildren
had rn' re e i.e.ld mnmurnizaiiorn one -a Inadequatelv
Sacc inaer d.
Po;ible indircct contact aith an outbreak in Okla-
horr-a iSee MMN 'R, Vol. 12. p. -i2L is under inr.estigaiion,
acc'oc.ding to Dr. Don E. 'ilco N, Siate Epidemiologirt,
Kans4s Slare Board of Health. A lull e ,idemiolooic report
will be includL d in a future is:ue.


Table I. CASES OF SPECIFIED NOTIFIABLE DISEASES. UNITED STATES
(Cum.jla teiv t.-tal inci.jde revi ed and dea.vcd repirti thr:r*eh prtrilu i i
t :E EI E nded eL.xr.u ri LV^, E l-I
Di ease Janury Januarv 3, M1an Med ar.
16__________ 3 i9 1t3 L96- 163,j i9 1963
Aseptic riningtitis ................ .17 i- --- [' 1. -
Brucelloeis ....................... 3 9. 3 3 9
Diphtheria .............. ..... ...... 8 19 8 3 i9
Encephaltint. prtiir infectious .. II I
Encephallril, poEt-iL fct.r.u ....., J ,
Hepacktii, infectiauo Includire
zerum hepair ti. ................ 59)8 6)! 69 I
Me.alet ............................ ,At -,eM ',.. ?.s3- 1. 2 6,26i
MannzncocCal infections .......... 23 r -6 3. nC
Pol ioTye Lt i IT tal .......... [ : I
Paralytic ...................... i 3 1 3
Nonparalytic ................... .
UnapeciL ai d .................... .---
Streptococcal Sore Thr*sr and
Scarlet fever :................. 6,89 3- "" 6,78q 33
Ietanus ........................... 2 1 --
ulareria .............. ....... 9 ,; --- -
iyphoid fae er ................... .. 6 2 6
Rabies in Anin ls .................. .8 .2 55 -8 ..


Table 2. NOTIFIABLE DISEASES OF LOW FREQUENCY


F~si









Morliidilv and Mortality % eekly Report


LASES OF TYPE E BOTULISM
CODMERCIALLY PROCESSED SMOKED WHITEFISH CHUBS
TIna .ee. Alabama and KEnlurky
D..e ., ho.s Ic M ., *- Re2e, ad



Ca.. I 32 ; I; No' D1a.. 1j 16)
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Dean*- *I es un=I


EPIDEMIOLOGICAL REPORTS


Botulism California Figs
The two cases of botulism reported last week from
California were related to the ingestion of home proc-
essed figs. (See MMWR, Vol. 12, p. 437.)
In early October, a dentist and his wife received
home preserved figs from their maid. During the morning
of October 18, the dentist ingested some figs. On October
20, he experienced generalized weakness while working at
his desk. The following day he noted worsening diplopia,
dysphagia, and weakness of his neck musculature. When
hospitalized October 23, his physician noted definite
dysarthria. A lumbar puncture, performed at that time
because the patient showed no signs of improvement, was
normal. On October 25, the diagnosis of botulism was
made. The patient was treated with 50,000 units of biv-
alent (A&B) antitoxin administered over a two-day period.
Despite this thcrap'., the patient died November 3.
The patient's wife ate figs from this same jar on
October 16. On October 18, she began to experience
generalized fatigue and the following day dysphagia and
dysarthria. On October 20, she noticed bilateral ptosis
and worsening of her generalized weakness. Her dyspha-
gia and dysarthria became more severe. On October 23,
because of the persistence of her symprom.s she was
admitted to the same hospital where htr husband was a


patient. Although she was not treated with antitoxin, she
gradually improved and has survived.
The figs had been home preserved by the dentist's
maid. The jar from which the figs wcre consumed by the
dentist and his wife was discarded and could not be
recovered. Figs examined in the remaining lars were
negative for Clostridium botulinum or its toxin. The maid
consumed itgs from another jar and ne.er experienced
symptoms.

(Reported by Dr. Philip K. Condit, ( 1/,'c B,.'re oI Co..r
municable Diseases, California State Dipartri nt .o
Health.)



Editor's Note: Figs have been implicated in at least II
earlier outbreaks of botulism, according to "Fifty years
of Botulism in the United States and Canada" by K. F.
Meyer, M.D., and B. Eddie, D.P.H. These II outbreaks
have resulted in 22 cases, including 12 deaths. Eight of
these outbreaks occurred in California, and one each in
Connecticut, District of Columbia, ard Maryland. Two of
the California outbreaks were due to Type A botulinus
toxin; the Connecticut and Maryland outbreaks were due
to Type B. The specific type in each of the other out-
breaks was unknown.


Ca 16
C.- .1'









Morbidity and Mortality Weekly Report


DEMIC CURVE OF BOTULISM RELATED TO SMOKED WHITEFISH CHUBS
BY DAY OF INGESTION (TENN.-ALA.-KENTUCKY)
=CASE, =FATAL CASE


D- A
A.

ii


EPI




CASES 2.



7

5
4
3
2
16 1 18 19


20 21 22 23 24 25 26 27 28 29 30 I 2' 3 4 '5 6 7 9 0


Botulism California Chili Peppers
To non-fatal cases of botulism were reported in
earl\ 19'3_ in a Los Angeles couple who ingested home
canned chili peppers. This is a delayed epidemiological
report.
Upon awakening January 27, 1963, a 39-year-old
Me\ican female complained of double vision and a swollen
tongue, but she continued performing her usual household
chores. The following morning she had difficulty swallow-
ing, and temporal and occipital headache. She vomited
once. Her family physician prescribed symptomatic therapy.
That evening she commenced to experience epigastric pain
and respiratorl difficulty and was hospitalized. At no time
did she have diarrhea or sensory changes.
On ph\ sical examination, she was found to have ptosis
and bilateral facial paralysis, as well as weakness of the
right medial recrus without obvious strabismus. Pharyngeal
pooling of saliva and difficult' of swallowing were present;
she could not eotrude her tongue. There was moderate
trrsmrru. Her terriperai ure wa. 100F.
On lanuar% 29, she received 40,000 units of bivalent
(A&BI botulnas antttoirn intravenously. A tracheostomy
%as also performed because of increasing respiratory
difficult,; the pa ienr 3as; placed in "a respirator. On
January 31, urinar, retention developed, requiring an
indwelling catheter. On the same day, her temperature rose
ro 1010F. and a right upper lube pneumonia was diagnosed
.lnrlcall', and confirmed b:, X-ray. The pneumonia re-
sponded to an antibiotic.
At the time of his white's admission, the husband
noted diplopia but was not hospitalized until urged to do
so the follooinv mornrin. Upon arising January 28, he
first noted double isior, when he attempted to focus on
distant objects and on lateral gaze. He did not experience
headache, blurred vision, weakness, ataxia, difficulty
swallowing, respiratory difficulty, or fever. At the time of
hospital admission, he ais toun. to have a mild left


esotropia and diplopia, which could be elicited on extreme
lateral gaze and upon attempting to focus on objects more
than 6 feet distant. He was treated with 20,000 units of
bivalent antitoxin on January 29. Diplopia disappeared
January 31.
A third family member, the 9-year-old son, was ad-
mitted for observation on January 29, although he had no
complaints and a negative physical examination. He was
treated prophylactically with 10,000 units of bivalent anti-
toxin; no symptoms developed during three days of obser-
vation. He was not officially recorded as a case.
Epidemiologic investigation revealed that the only
home canned food item consumed during the previous week
was a portion of a quart jar of chili peppers, which the
mother had canned in September, 1962. She had placed the
peppers in open jars, covered them with liquid, boiled them
an indeterminate length of time, and sealed them. Four
quarts had been prepared in this manner. One was the sus-
pect jar; 2 had been consumed previously and one jar re-
mained unopened. The 2 adults had eaten peppers from the
fourth jar in an uncertain amount between January 21 and
January 24. The wife had consumed more than the husband.
The wife had eaten peppers at breakfast January 27. Her
husband had not eaten peppers after January 24. The 9-
year-old son disliked peppers and had eaten none. No
other foods were ingested by both the mother and father
and not by the son.
On laboratory examination, Type A botulinus toxin
was demonstrated by the Los Angeles Health Department
Laboratory from a sample of the remaining portion of the
jar of chili peppers.


(Reported by Robert S. Rocke, M.D., District Health Officer;
C. Carson, Assistant Epidemiologist; G. Kitaoka, P.H.N.,
Los .1fe.c: County Health Department; and Dr. Philip K.
Condit, Chief, Bureau of Communicable Diseases, Cali-
fornia State Department of Health.)


55


SEPTEMBER


OCTOBER








Morbidity and Mortality Weekly Report


TABLE 1
BOTULISM 1963
U. S. A.

MMWR Reference
Outbreak Cases Deaths Food Type Loca,.on Processor Vol. 12

1 2 0 Chili Peppers A Cal.forin Non-commercial This issuee
2 2 0 Liver Paste A New Yok C.'y Commercial pp. 357.386
3 1 1 Green Beans B Wes* V.rgin.a Non-commercial p. 311
4 5 1 Corn B Kentucky Non-commerc.al p. 322
5 2 1 Green Breans B Colorado Non-commercial p. 410
6 3 0 Green Beans B Pennlsylnan a Non-commerc.al p. 430
7 3 2 Tuna Fish E M ch.gon Commec.ol pp. 95,124
8 2 2 Smoked Whitefish E M chigan Commercial' pp. 329.337
9 17 5 Smoked Whitefish Chubs E Tennessee Commercial pp. 329.337.345
A abora
Kentucl
10 6 1 Mushrooms Unknown Calhfoino Non-commercial p. 322
11 1 0 Smoked Whitefish Unknown Minnesola Non-commercial p. 400
12 2 1 Figs Unknown California Non-commerc al This Issue

46 14

*See Commercial Section of Botulism Surveillance Summary.
Source: State Reports received by CDC.


BOTULISM SURVEILLANCE SUMMARY 1963
A total of 12 outbreaks of botulism accounting for
46 cases, including 14 deaths, were reported in the
United States during 1963 (Table 1). The 46 cases during
1963 represent the highest total for any one year since
1939, the eighth highest year since 1899 (Table 2).
Commercially canned or smoked food products accounted
for 4 outbreaks and 24 cases, and home canned food
caused 8 outbreaks, 22 cases.




TABLE 2

CASES OF BOTULISM
HIGHEST YEARS 1899 1963


Cases Outbreaks Year

Ist 89 15 1919
2nd 71 26 1935
3rd 63 15 1921
4th 59 23 1922
5th 50 12 1924
6th 48 15 1931
7th 47 18 1939
8th 46 20 1932
8th 46 12 1963*
10th 44 15 1941
Preliminary Total.
Source: 1899-1949 "Meyer, K.F. and Eddie, B. "Fifty Years of
Botulism in the United States and Canada," George Williams
Hooper Foundation, University of California, Son Francisco.
1950-1963 State reports received by NOVS and CDC.


Cases by State
The 12 outbreaks recorded thi; \Nar iSee Table II
occurred in Stite-. Tennessee, with 12 cases, experi-
enced more cai-e ol botulism than any other State.
Tennessee's, i a-e; aere part of one outbreak, ahich
also involid .ictims in Kentuck\ and Alabama, and was
traced to smokec-d hiltil'lh chubs. C alfornia %as second
with 10 cases, Kcntuck. third alth cases.

Outbreaks by State
Although Calilornia sa_ second in total number of
cases for the ',ear, it 1 ,d he States in the number of
separate outbreaks. California experienced 3 outbreaks,
while Keniucki and Mihiaan each had 2 separate out-
breaks. Both of Michigan'.; outbreaks were related to
commercial pro.ductL .

Type
Type B ('/., rid,,.. h'-iti.i,'r,. toxin was identified
as the etiological agent in of the 12 outbreaks i II
cases). Type E toxin was identified in I outbreaks 22
cases),T:,pe in 2 outbreaks 14 ca.ses'. In the remaining
3 outbreaks 19 ca esei the ivpe was unknown.
TABLE 3
1963 BOTULISM BY SPECIFIC TYPE

Outbreaks Cases Deaths

Type A 2 4 0
Type B 4 II 3
Type E 3 22 9
Unknown 3 9 2

Total 12 46 14
Source: State reports received by CDC.









Morbidity and Mortality Weekly Report




BOTULISM CASES
United States
S1899--1963


SOURCE
1899-949, 'FIFTr YEARS OF BOTUESM IN THE
UNITED STATES AND CANADA by
K F MEYER. MO and
B EDDIE, Ph 0
1950-1963, STATE REPORTS Io NOVS ad CDC


Vehicle
Vegetables were found to be the vehicle in 6 of the
12 outbreaks. Green bean! accounted for 3 separate
ourbreak-, while chili peppers, mushrooms and corn ac-
counted lor one each.
Fish were implicated in 4 separate outbreaks. A
smoked fish product was involved in 3 separate out-

breaks, and a non-smoked fish product involved in the
lourih outbreak. Of the 3 outbreaks related to smoked
fish, 2 were from commercial sources.

Antitoxin Therapy
Of rhe 46 reported cases, 22 received botulinus anti-
toxin during the course of illness. Of the 14 fatalities,
onli. 2 received antitoxin therapy; 20 of the 32 survivors
%ere treated with the antitoxin. The number of fatal and
non-taial cases who did not receive botulinus antitoxin is
presented in Table 4 below.



TABLE 4
1963 BOTULISM GASES AND ANTITOXIN THERAPY


Outbreak
1 Chili Peppers
2 Liver Paste
3 Beans
4 Corn
5 Beans
6 Beans
7 Tuno Fish
8 Smoked Whitefish
9 s,.kr'j Wh-l.I.h Ch..b
10 M.s ;i
11 .h ic,.:h
12 Fp,


Tol Is


Surviving
Cases
2
2
0
4
1
3
1
0
I



id


Type
Specific
Antitoxin
2
0
0
4
1
3
0
0



I0
0-
so


Type
Specific
Deaths Antitoxin
0 0
0 0
1 0
1 0
1 0
0 0
2 1
2 0

S 0
A 0
1
In U'


Although these data might attest the value of anti-
toxin therapy, it has been repeatedly observed that fatal
cases commonly demonstrate a shorter incubation period
and often are diagnosed only posthumously after subse-
quent mTlder cases have occurred. Treated and non-

treated cases are thus in no way comparable in severity.

Commercial
More cases of botulism were due to commercial
products than home canned products during 1963.
Four of the 12 outbreaks involved commercial prod-
ucts; the remainder related to home preserved products.
Commercial outbreaks involved 24 victims, 9 of whom
died. In the non-commercial outbreaks, 22 individuals
were concerned; 5 died.
TABLE 5

1963

Outbreaks Cases Deaths

Commercial 4 24 9

Non-Commercial 8 22 5

Total 12 46 14

Source: State reports received by CDC.


Of the 4 commercial outbreaks in 1963, the first
involved one can of tuna fish, processed in San Francisco
and sold in Detroit. This can led to 3 cases, 2 of which
were fatal. (See MMWR, Vol. 12, pp. 95, 124.) A Canadian
canned liver paste product led to 3 cases of Type B
botulism in Montreal, and 2 non-fatal cases of Type A
botulism in New York City. (See MMWR, Vol. 12, pp. 357,

386.) Two outbreaks were due to smoked fish products.


CASES


SResoicn.a be r pe .r l h n Re c B. A e &. A 1a r1
So..e 5-c cep. .rAe ed b, CDC.








Morlbidity and Mortality Weekly Report


TABLE 6
COUERECIAL BOTULISM OUTBREAKS U S. A.


0 ParGk and Bj1n, I 3
9l., Cle.n 0Jua -
19I P C1 k ... 3 2
0900 CIe.),. I 0 0
1als Tm.,.o Co.,ep 1 0
0910 C.,, 1 I 0
M2 .. 2 2I.







09 0.m ,,. I *
1,1 ....h *
aI. O.o a A


Two cases of Type E botulism from smoked whitefish
occurred in Michigan at the same time as the outbreak
from smoked whitefish chubs in Tennessee, Alabama, and

Kentucky. (See MMWR, Vol. 12, pp. 329, 337, and .-.)
It is believed that the Michigan husband and wife
purchased the suspect smoked whitefish from a commer-

cial roadside stand while on a long weekend vacation in
northern Michigan. This outbreak appears to be unrelated
to the smoked whitefish chub outbreak in Tennessee,
Alabama, and Kentucky, which was recognized a few

days later. A revised epidemic curve and line listing of

the 12 non-fatal and 5 fatal cases included in the smoked

whitefish chub outbreak is presented on pages 2 and 3.


190 S.din,. 1
Spinach I .5 0

I112 1 olteo B



009 Tu 0 2 -
19:4 So ire CS e 1 E


19. 1 % .. 1 E
0a.6.d06I,. .h 0 09 6











In past years, inadequately preserved home canned
products have accounted for the vast majority of botulism

cases. No explanation can be provided for the sudden
occurrence of commercial outbreaks during 1963.


Since 1899, 51 outbreaks of botulism related to com-
mercial products have been reported in the United St[ajs.
Until 1963, all except two had occurred prior to 1942.
Of the 51 outbreaks, 25 have been baLter-IolCgIcal3l'

proved.


A complete list of known outbreaks of botulism,

related to commercial products is presented in Table 6.


Whereas 36 cases of proved Type E botulism had been
described in the United States before 1963 (See Table 2),
22 cases of Type E occurred in 1963 alone. All cases of
Type E during 1963 were related to commercial fish pro-
ducts (smoked whitefish, smoked whitefish chubs and
tuna fish).
A complete table of known proven Type E outbreaks in
the U.S.A. is presented below. This supersedes the table
appearing on page 330 of Vol. 12.


KNOWN OUTBREAKS TYPE E BOTULISM

Year Stae Food Cases Death
1932 New Yok Smoked S.mon 3 1
(Canadion origin)
1934 New York Sprats (German origin) 3 1
1941 California Mushroom Souce 3 1
1950 Alaska Bei.go Flippers 5 0
(Point Hope)
1952 Al..sk B.tlug Flippars I
(Salawik)
1956 AlaIka Beluga Muktuk 3 2
(Kaotbue)
1956 Alasko Beluga M.tLuk 2 1
(Anchorage)
1959 Alako Stink Eggs 1 1
(Hydoburg) (Salmon eggs)
1959 Alsao S.ea or Whale Flipper 7 1
(Scamo Bay)
1960 Alaska Kedukon Salmon 2 2
(Ketchikan) Egg Cheese
1960 Mlnn.eso. Cisco vacuum pocked 2 2
1961 Washingon Uncooked Salmon Eggs 4 1
1963 ichigon Tuno (California packed) 3 2
1963 Z1htgoan Smoked Whitefioh 2 2
1963 Tennessee Smoked Wh.leilsh Chubs 17 5
Alobama (vacuum packed in
Kentucky Michigon)
Totals 58 23
Source: Dr. C. E. Dolman, Professor and Head, Dapartment of
Bocteriology ad immunology, University of Brilish Columbia,
and K. F. Meyr,, M.D., of the Gorge Williams Hoope. Founda-
tion, University of Califonia Medical Cente. San Fraonisco,
Caltaornio.









Morbidity and Mortality Weekly Report






Ca-,li'rnl Icd- all ocher Srte_ in the rn i:mb-r ,.1 our-
bre :akz and c~ie- c.er the p3st oL- ,,ear-. The cumularzlze

number o i -.es 3- oir e ch ',r r_ -ricte i i --ho n beLloa .

60TUL,: Ca.E. U A
TrJTUL CAlt. l"' U IOtuL Ir' AJr D aDU
6 5.:. 0 9I) 1 '. I) 1 -', 19sU 29 14 0i 1949 I00 I #f3 N'60 1960 T. ra.
, .- : i ,1 s ,, .,, j .: ,.J

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.1:u., = m: e u~ a D


---t. u -a am** 4C j:5 *: ula-


TOTAL DEATHS REPORTED IN 108 CITIES
The eekI, 3%er.Oei number -.j rltal Jdeaith- in I
.:irie' tor rth f'.ur--.eek p.:rcd i rndrin, i rinuar. a 12,2; '

as compared i[h an expccred weekly atera.e 'o i1' JI .


Total Deaths Recorded in 108 United States Cities



Uteek Endini

-eck l'ek l,
I' l 12 12 28 I Total At eracee


Obser-ed 12,43- 11 8-3 1 U1 l .4 i s i3.18 4 *8""' 1.2,2

Expected 2.151 12,235 4 123',0 12.,..0 -c,I 2 12,2 .3

Excess 283 -. 2 --6 SS -l88 -


NUMBER

OF

DEATHS


~See Table I .ap I e

(See Table. hape Iil











0 Mlorbidils and Mortalils 1 eekl Heport




Tjblc h ( A.ES OF SPE(IFIED NOTIFIHBIE DISEASES UNITED STATES

FOR WEEKS ENDED


JAN. AR. R 1(.4 AND .IA.NLNAR 19N ( ( 1 I WEEK)





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r ... .. .....
Si t ..' ... .....


S. ~1 .... ........



Fu rt :











Morblidil and [Rorlalil ~eekli Report


Tablt i CASES OF SPECIFIEDD NOTIFIABLE DISEASES UNITED STATES

FOR V EEKS ENDED

I \NL \R R 1964 AND I.1NI ARN 19 ( I.! EE l ( orirnuLd



I-'. ti -.l !.' : r i i : i, i.2 T [ l .
I r..- I i: : ,, p. h-. iuo i 1 .3* g r ru.-. Mipo 1 :,6 i I p ,,-: i g .-r

Area ii-j "r :0 ar: t
I c. r.. T.: l .. : r I r, : u i a t l .-

1 96- i 6- -.- Ic.- i i lit.- i i4,- 1i ) I rl- 1r-

UItITED -AT .. 3 3 5 '.?), '8.- -J i l S1

NEi EIlrLAiD........... I i .6 .4 .Ji 1.11, -
Ma n .............. -i) I .. ;
Nti aH i h i r .... 1 1 j 1-
Ver.:rt.........* ~ H 2 -
Ma-: ch .tt .. i 1 I S t -. 2 1
Rh d 1 i 3---d ....... 1 i i
S.nc E ct iu ........ i) -

MIDDLE L.ANT[C...... 3 3 i;3 65 i.3 ;;I
NIlE Yorki Lit ...... 1 i 7 i i
rl l' Yor UJF-S tatI .3 c. 4 6 L
It.- J-r i f.. ...... i 2 i 13
Pcnni: vIdar .. .... i-. I l7 3-. 731

EAqT IOPFTh CENTRAL.. 13 i1 i ; 33
Or.-. . .
O"i .. .............. 20 -
ind ijan ............
Il noi ........... i I
Michigan........... 1 3 1 -
uL C Ln..... ...... 7

Li?_T N.:'RTH CENT RAL.. 2 i, i, r i,
rlinne r: .......... -
MLE:-:. r ....... .... i -

torth iDkoc a ..... -
ou.rh Dakot a....... -
[ebrai.. .......... t. .. ..
[.an.......... 1:1 i .

SOUITH AT.ATIiC ..... 3 1I I 3, 2 i
D i a ar ........... l
M. r i and........... 8
Di :t. of C iu bit.. I 1i 3
Virginia ........... 1 I 1 -
WUF.t Virenia. ..... .- -
North C rclina..... 3 2 -.
Sou t Cr lar.. .... r- a .
Ger .. .......... -
Ce:-r ir .... ... .-. .
Fiorld ........... -. 2,: [ i 2

EAST LOULTr CE ITPAL.... -I i 3 7 l
KenCucky........... 1 r 1 2
T inr, ee.......... 1 2 i
Ai bat ,i. ............ I L
Hi -' i ppi....... i i 1i

WEST rOLITH CErFRAl.... 32 21 A I
Arkan i ........... .
4LLt i a -......... 3
Ok i ahc. ........... .
"-. -. ............... .. I- t 1 -2 i -

MOlUNAI. ............. 1 i 23 .- -
Montr.. ........... [ 1 .
idah .............. .
y: .....ng........ .
Col or a ....... ....- A -
r w He,, :, ........ 3 1 1 1
Ari z)na.............. -- i
it ah........ ....... [ 7
tV u a3 ............ .. i 1 I

PACIFIC................ 3 6 .,
tar n ington ......... -12 l I ?
Ore or .............. S 3 I 8 It
-Calii rn a.. ........ 22 6 ;
Alisk............... 5 3 1 9 ?


Puerto ic.. .









10 Morbidity and Mortality Weekl% Report


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES UNITED STATES

FOR WEEKS ENDED

JANUARY 4, 1964 AND JANUARY 5, 1963 ( Ist WEEK) Continued


Streptococcal
Meningococcal Sore Throat and Rabies in
Measles Meningitis Scarlet Fever Tetanus Tularemia Animals
Area
Cumulative Cum. Cum. Cu.r..

1964 1964 1964 1963 1964 1963 1964 1964 1964 1964 1964 I t.

UNITED STATES... 2,938 33 33 46 6,789 5,934 2 2 9 9 48 48

NEW ENGLAND.......... 149 2 2 5 570 427 -
Maine............... 6 60 13 -
New Hampshire....... 3 1 8 -
Vermont............. 22 1 27 30 -
Massachusetts...... 57 1 1 2 87 98 -
Rhode Island....... 6 2 19 42 -
Connecticut........ 55 1 1 376 236 -

MIDDLE ATLANTIC ...... 815 5 5 3 330 261 2 2
New York City...... 316 1 1 1 27 20 -
New York, Up-State. 169 2 2 1 217 149 -- 1
New Jersey.......... 181 1 1 60 50 -
Pennsylvania....... 149 1 1 1 26 42 1 1

EAST NORTH CENTRAL... 322 7 377 542 1 1 4 4
Oh; ............... 9 1 ? i 1 '1 3 3
Ir i ja .............. 12 I I [
Sr. ... ........ ? I 31 t6
4.r ... ......... :,6 1 7-:
1.i :.:n: r r.......... h. I I 1 1

SiE T NOP.RiT CENTRAL... l1 3 l. 1-
M nnre oi a ..........
M .... ....... .
i r D ............. .. I


.:,, h Dak:tl........ I I 4 3
r-bra ka a ..........
a l' ....... .. -

rl .rt '. r lk Il I i
i : Dar i ........... I s -
Fj:rld a............ .
*'. I .,.ILTH (ENTRAL... 2 J 3 3 .."'T ., 3 3 6l
j nn I ap. ... ....3 I -" 8
Vir, ,j ............ 1 6 6



l T H i .. .. -
Lr irt in .......... I I I
L.r id t n .. ..... I l i 3 -


I l m .......... .. 61 ? I
Ti N TN .......... ... 1 j 8B I
.nT-.l i ....... .... 16 i i ;, 3 ,- ".- } I5 l







Aw'l,. t n, ......... .. i 1




A I, r i ... ........ 16 2 2 2 1 .. ]
Nr .............. .. 5 2 2 30i j b
M.?u l j F. ... 1 1- p 3 j j -







A rri na ............ 16 .
Ult ho ............... ? 0 I I I 2-
r i' v I n ........... I 3 .
o cr idI. ......... .. I 3b I




FAN IFIC *... ....... ... .' ) 8 8 -I I I -I I
Ar ha ,za ............ 5 I 1l 1]5-
,r i i.n ............. 1 1 -



FA-- IF f 3 ;J -F
Wi-h n tc n......... .. I I l ....-
regon ........ .. 33 -
lit ..rni ......... 7 5 65 536 1
Ali3kn ............. I -

rt ..............
H i. ........ .i 3-

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NOTF ;l .-1 1 t t n.-.- ,- :.- L "a:




UNIVERSITY OF FLORIDA

IIIII lill HlllllIllHiIi
3 4262 08864 3225


Morbidity and Mortalilt Weekly Report


INTERNATIONAL NOTES QUARANTINE MEASURES

Botulism Canada
Two cases, one fatal, of botulism Tv'pe E haie been
reported from British Columbia.
On September 16, a married couple ale puirelled
salmon eggs. A few hours later, during the evening of the
day of ingestion, both experienced abd,-minal pains.
vomiting, and increasing generalized weakness. The',
experienced dizziness and ditficuli. in speech.
The Aie died about 24 hours after ihc meal. Her
widower then was rushed to a hospital for treatment.
Botulinus antitoxin Type E was administered Intrave-
nously. Thereafter, the patient's generalized weakness
slowly improved, although his blood pressure remained
low for several days.
The putrefied salmon eggs had been prepared ac-
cording to methods traditional among Indians ol that
region. Such salmon eggs are prepared in various aa), a.;
salmon egg "cheese" or "stink eggs." The cggs may be
simply left to ferment in a jar for several day in their
own juice, perhaps diluted with water, cr may be put
through a very unsanitary ritual of washing, kneading, and
maturation, until in a few weeks they form a tenacious,
e'il-smelling mass. Because the eggs provide an excel-
lent medium for toxigenesis, very small amounts may
be lethal.
The salmon eggs not consumed at the meal had been
discarded to the garbage dump; a sample aa. retrie\ed.
This sample of the salmon eggs, as well as a portion ot
the wife's stomach taken at autopsy, and gastric %ash-
ings from the hospitalized husband, were submmtrrt for
laboratory tests for botulism. All 3 specimens revealed
Type E botulinus toxin. The titer in the salmon cggs was
unusually high (1,000-3,000 mouse minimum lethal doses
per gram of eggs). A toxigenic strain ol (..'oirri.,.-
hotulinum Type E was isolated from these eggs, as aell
as from the stomach washings and the stomach contents
of the two patients.
(Reported by Dr. C. E. Dolman, Professor aid liH-d.
Department of Bacteriology and Immunologi. I 'ii, rsitr
of British Columbia, in Epidemiological B~liUtli. rti i
Canadian Department of National Health C& Il/arr in
October 1963. and E. W. R. Best, M.D., Chiel. Epidemi-
ology Division, Canada Department of Naliunal Heil'rh
& Welfare.)

The Morbidity and Mortality Weekly Report, with a circulation
of 10,500 is published by the Communicable D.sease Cenrer,
Atlanta, Georgia.
Chief, Communicable Disease Center James L Goddard, M D
Chief, Epidemiology Branch A. D. Longmuir. M D
Chief, Statistics Section R. E. Serflng. Ph.D
Asst. Chief, Statistics Section I. L. Sherman, M.S.
Chief, Surveillance Section D A. Henderson M.D
Editor, MMWR L. K. Altman. M.D.


In addition to the established procedures for reporting morbidity
and morality, the Communicable Disease Center welcomes
accounts of interesting outbreaks or cases. Such accounts should
be addressed to

Lawrence K Arman. M.D Editor
Morb.dty and Morrality Weekly Report
Communcable Disease Center
Atlanta. Georgia 30333



Nores These provm.lanal doa ar based on weekly trferqamm t. rhe Conlmun,
cabl D.sras Crne. by the .nddd.ual Slore health depar.menfs.
Symbols Doa nof walatbte
Quolantry ero
Procedures for cnsnlru-ran of araous mt.ali.ty curve. m.y be oblained frm.
SI'ffis SecI.on Cmmunc .oble D isease CenteP. Public Hedrh Sevnice,
U a Depar.enf of Health Educ.oin, and Welfare, Atlana. Georgra 30333.


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