Morbidity and mortality

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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

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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:
AA00010654:00269

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

' MMU CABLE DISEASE CENTER


Vol. 15, No. 48


WEEKLY

REPORT

Week Ending
December 3, 1966


PUBLIC HEALTH SERVICE


t,, C .WT TRENDS-MEASLES 1966

1,472 cases was reported for the 48th week
ending (December 3), an increase of 522 cases from the
total of the previous week and a decrease of 1,158 from
the total of 2,630 reported for the 48th week in 1965. The
three states reporting the highest numbers of cases for
the 48th week are Texas with 318, Washington with 198,
and Oregon with 125. Six states reported no measles
activity. Twenty states notified at least one but less than
10 cases.
Figure 1 represents the reported cases of measles
for the current epidemiological year (beginning with week
41) in comparison with the same period during the previous
4 years. (Continued on page 414)


5,000





4,000

i,
w
Cin

0
S 3,000-
1-
o
0
a-
w
IL

0 2,000-



Cr

I,000


Figure 1
REPORTED MEASLES IN THE
1966 COMPARED WITH


CONTENTS


Current Trends
Measles- 1966 ..... . ..... 413
Epidemiologic Notes and Reports
Salmonellosis Associated with Carmine Dye ....... ..415
Recommendation of the PHS Advisory Committee on
Immunization Practices
Diphtheria, Tetanus, and Pertussis Vaccines
Tetanus Prophylaxis in Wound Management ... .416
Surveillance Summary
Salmonellosis- August, September, October 1966 418
International Notes
Quarantine Measures .............. ... .. 424


UNITED STATES
1962-1965


1962
I


/-
/


/


1966


13 20 27 3 10 17 24 I 8 15 22 29 5 12 19 26 3 10 17 24 31
AUG. SEPT OCT. NOV DEC.
WEEK ENDING






Morbidity and Mortality Weekly Report


DECEMBER 3, 1966


CURRENT TRENDS-MEASLES 1966
(Continued from front page)


The number of cases reported each week in 1966 has
to date been consistently less than the totals reported
for the comparable weeks in past years. The increased
total reported for the 48th week reflects the expected
increased seasonal incidence.
The counties reporting the highest numbers of measles
cases for October 15 through November 26 are listed in
Table 1. Inclusion in this table is dependent upon the
number of cases occurring for two consecutive weeks
and upon county population. An asterisk indicates the
introduction of epidemic control measures or community
immunization programs in the county.
(Reported by Childhood Viral Diseases Unit, Epidemiology
Branch, CDC.)
Allegheny County, Pennsylvania
In a county-wide measles program held in Allegheny
County, Pennsylvania, on December 4, 1966, an estimated
75 percent of the susceptible children (approximately
52,000) in the age group 1 through 8 years were immunized.
An additional 1,700 children 9 years of age and over also
received the live attenuated measles vaccine. The 57
immunization clinics located throughout the County (which


includes Pittsburgh) were operated by physicians, nurses,
and other volunteers. The community program was spon-
sored by the Allegheny County Medical Society and the
Allegheny County Medical Society Foundation in coopera-
tion with the Allegheny County Health Department.
(Reported by Dr. F.B. Clack, Acting Administrator, Alle-
gheny County Health Department; and Dr. W.D. Schrack,
Jr., Director, Division of Communicable Diseases and
State Epidemiologist, PennsylvaniaDepartment of Health.)


Durham County, North Carolina
Since November 1, 1966, 75 cases of measles have
been reported to the North Carolina State Board of Health
from Durham County (Pop. 118,000). Results of a school
survey conducted in this County during the last week of
November indicated that since mid-October, 115 cases of
school absenteeism due to measles had occurred. Ninety-
five cases were from 9 of the 15 city schools and 50 of
these cases were concentrated in 2 schools. The remain-
ing 20 cases were in 6 of the 13 county schools, with 11
of these cases in one school. The last major outbreak of
measles in Durham County was in 1961.


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
48th WEEK ENDED CUMULATIVE. FIRST 48 WEEKS
MEDIAN
DISEASE DECEMBER 3, DECEMBER 4. 1961-1965 MEDIAN
1966 1965 1966 1965 1961-1965
Aseptic meningitis ......... .. 52 47 39 2,781 1,999 2,003
Brucellosis .......... .. 12 1 7 224 224 362
Diphtheria ............. .. .... 5 182 147 251
Encephalitis, primary:
Arthropod-borne & unspecified .......... 37 30 1.999 1,775
Encephalitis, post-infectious ........ 11 8 --- 677 618 -
Hepatitis, serum .. 35 I 1,344 ) )
Hepatitis, infectious ............... 733 751 751 29806 31,175 39,642
Measles rubeolaa) ........... ...... .... 1472 2.634 2,634 197.830 253,379 405.590
Poliomyelitis, Total (including unspecified) 3 5 93 56 417
Paralytic ........................... ..3 5 88 42 358
Nonparalytic ........................ .. -- --- 9 --
Meningococcal infections. Total ......... 48 69 41 3,178 2,801 2.165
Civilian .... ........ .............. 46 62 --- 2,873 2,600
Military ........................... 2 7 305 201 -
Rubella (German measles) ................ 376 --- 44.495 --- -
Streptococcal sore throat & Scarlet fever .. 9,107 8.230 6,331 385,685 358,625 309.615
Tetanus........ ..... .... ....... 9 7 -- 184 259 -
Tularemia ............................. 2 -- 162 230 -
Typhoid fever ................. ........ 6 15 11 354 422 499
Typhus, tick-borne (Rky. Mt. Spotted fever). 2 242 260 -

Rabies in Animals. ................... 69 77 61 3,732 3,979 3,477

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: .. ... 6 Botulism: ............ ........ ........ .... .... 10
Leptospirosis: Wash-1. Puerto Rico-1 ................. 63 Trichinosis: Calif-1, N.J.-3 ............ ... .. .. 94
Malaria: Calif-4, La-l, Md-1, Miss-1, NC-3, Ohio-1, Pa-4. Utah-I 456 Rabies in Man: ................................. 1
Psittacosis: .................. .......... ........ 44 Rubella, Congenital Syndrome: Minn-2 ................ 23
Typhus, marine: ............ ... .. ......... 26 Plague: .................. .. .................. 5


414







DECEMBER 3, 1966


Morbidity and Mortality Weekly Report


Table I
Counties Reporting Highest Number of Measles Cases

Number of Measles Cases for Week Ending
County t State Pop (000) October November
(1960 Census) 15 22 29 5 12 19 26

II King Washington 935 15 17 6 41 6 48 38

III Spokane Washington 278 19 14 23 42 24 60 14
Snohomish Washington 172 71 55 95 60 3 89 25*
Galveston Texas 140 24 59 16 9 12 2

IV Washington Oregon 92 10 12 69 56 65*
Rutland Vermont 47 25 12 14 5* 4 13 1
Brown Texas 25 1 3 17 13
Parker Texas 23 2 11 18 27 13
Red River Texas 16 2 2 14 11 26
Richardson Nebraska 14 8 41 18 7
McHenry North Dakota 11 3 21 14 10 6 1

* Epidemic control measures or community immunization programs instituted.
t Criteria for listing counties:
I. 25 cases/week for 2 consecutive weeks in a county with at least 1,000,000 population (none listed).
II. 20 cases/week for 2 consecutive weeks in a county with 500,000 to 999,999 population.
III. 15 cases/week for 2 consecutive weeks in a county with 100,000 499,999 population.
IV. 10 cases/week for 2 consecutive weeks in a county with less than 100,000 population.


Since June 1966, the Durham County Health Depart-
ment had administered about 1,300 doses of measles vac-
cine, of which 700 doses have been given in November.
Television, radio, and the newspapers have publicized the
epidemic and have urged that all unimmunized children in


the County receive measles vaccine at the county health
clinics.

(Reported by Dr. O.L. Ader, Durham County Health Dir-
ector, Durham. North Carolina.)


EPIDEMIOLOGIC NOTES AND REPORTS
SALMONELLOSIS ASSOCIATED WITH CARMINE DYE


Since the outbreak of salmonellosis traced to con-
taminated carmine dye in a Massachusetts hospital (MMWR,
Vol. 15, No. 33), additional outbreaks have been un-
covered in hospitals in California, Ohio, Oregon, and
in Exeter, England. Investigation to date has established
that 27 primary and 6 secondary cases of Salmonella cubana
infection are related to contaminated dye. The cases
have occurred in patients hospitalized for diagnostic
studies; carmine dye is used for investigation of gastro-
intestinal disease. It is also extensively used as a
coloring agent in foods, drugs and cosmetics.
The dye, which is manufactured in the United States,
France, England, and Germany, is made from insects of
the species Dactylopius coccus, also known as Coccus
cacti, imported from the Canary Islands and Peru. Nu-
merous lots of the dye have been examined by the U.S.
Food and Drug \diniilr-ition. the Communicable Disease
Center, and several state public health laboratories;
many were found positive for S. cubana. In addition, at
least one shipment of the insects from both Peru and the
Canary Islands haio been found positive for S. cubana.


Since carmine is a natural rather than a synthetic
dye, it is not subject to FDA color certification and is
not required to be specifically listed on food or drug
labels. The dye is used as a pharmaceutical color for
tablet capsules and coatings, suspensions, and syrups.
In foods it may be used in candies, chewing gum, preser-
vatives, seasonings, ice cream, tomato extracts, and many
other products. Sampling of products containing carmine
dye led to the discovery that several brands of candy
and a meat preservative were positive for S. cubana. No
contamination of drugs or cosmetics has yet been reported.
All of the contaminated products, including the dye, have
been removed from the market.
The only cases of human illness traced to contami-
nated carmine dye have been in patients hospitalized for
gastrointestinal diagnostic tests. Although it appears
that the insects are the contaminating vehicle, specific
details about the original contamination of the dye are
not available at this time.
(Reported by the Salmonella Unit, Bacteriology Section,
Epidemiology Branch, CDC.)


415







Morbidity and Mortality Weekly Report


DECEMBER 3, 1966


RECOMMENDATION OF THE PUBLIC HEALTH SERVICE ADVISORY
COMMITTEE ON IMMUNIZATION PRACTICES

The Public Health Service Advisory Committee on Immunization Practices
meeting on October 11, 1966, issued the following recommendations on
diphtheria, tetanus, and pertussis vaccination practices and tetanus
prophylaxis in wound management for the United States.

DIPHTHERIA, TETANUS, AND PERTUSSIS VACCINES

TETANUS PROPHYLAXIS IN WOUND MANAGEMENT


Introduction
Routine immunization against diphtheria, tetanus, and
pertussis during infancy and childhood has been widely
advocated and generally practiced in the United States
during the past 20 years. The effectiveness of these pro-
grams is reflected in the decreasing incidence and mor-
tality due to these diseases. The following recommenda-
tions regarding immunization have been developed on the
basis of this experience and accumulated epidemiologic
and immunologic data.

Diphtheria
There has been an accelerated decline in the annual
incidence of diphtheria since the end of World War II,
and diphtheria is now a rare disease in many areas of the
United States. In 1965, fewer than 175 cases were reported.
However, localized outbreaks continue to appear, accom-
panied by serious complications and a case-fatality ratio
often greater than 10 percent.
The great majority of cases occur in inadequately
immunized individuals. Although most diphtheria is in
children, cases and deaths occur in all age groups. Diph-
theria toxoid, when administered according to recommended
schedules, prevents deaths and greatly reduces clinical
illness and complications. Following adequate immuniza-
tion, protective levels of antitoxin have been observed
to persist for 10 years or more.

Tetanus
Although its incidence in the United States has de-
clined in recent years, tetanus remains an important pub-
lic health problem which can only be eliminated through
universal active immunization. In 1964, nearly 300 cases
of tetanus were reported, the majority in unimmunized
adults. Of these, 180 died, a death to case ratio of more
than 60 percent. Adequate immunization with tetanus
toxoid provides effective and durable protection against
the disease. Furthermore, prior active immunization elim-
inates the need for passive therapy at the time of injury,
thus preventing the considerable morbidity re-uliding from
use of heterologous animal serum. In addition, universal
active immunization will prevent the significant propor-
tion of cases occurring after trivial injury or with unrec-
ognized portals of entry. Other benefits include the pre-
vention of neonatal tetanus and protection to individuals
in various high risk groups.


Tetanus toxoid is highly effective and almost com-
pletely free of side effects. Since it also provides long-
lasting protection, it is an almost ideal immunizing agent.
Because there is no natural immunity to tetanus, no general
contraindications to tetanus toxoid, and since the organism
is ubiquitous, the need for immunization is universal.

Pertussis
Pertussis with its associated high mortality is the
major rationale for DTP immunization in early infancy.
The disease is highly communicable, with attack rates
up to 90 percent among unimmunized household contacts.
Most cases are reported in infants and young children.
In 1964, nearly three-fourths of pertussis deaths occurred
in those under age one some 40 percent of the total
number in infants three months of age or younger. Immuni-
zation is very effective in reducing both incidence and
case fatality. The mortality rate has declined precipi-
tously since the widespread use of standardized per-
tussis vaccines beginning in the mid 1940's. Since the
incidence and mortality decrease with age, while local
and systemic reactions to the vaccine increase, pertussis
immunization is not recommended above the age of six
years.

Preparations Used for Immunization
Diphtheria and tetanus toxoids are prepared by form-
aldehyde treatment of the respective toxins. Pertussis
vaccine is made from a killed bacterial suspension or a
bacterial fraction. The toxoids and pertussis vaccines
are available in both fluid and adsorbed forms. Compara-
tive tests have shown that the adsorbed toxoids are clearly
superior in antibody titer produced and in the durability
of protection achieved. The promptness of antibody re-
sponses following the administration of either fluid or
adsorbed toxoids as boosters is not sufficiently different
to be of clinical importance. Therefore, adsorbed toxoids
are the agents of choice for all primary and booster
immunization.
These antigens are available in various combina-
tions and concentrations for specific purposes. Three
antigens are important for public health use:
1) Diphtheria and Tetanus Toxoids and Pertussis
Vaccine (DTP)
2) Tetanus and Diphtheria Toxoids, Adult T. pf (Td)
3) Tetanus Toxoid (T)


416










All preparations contain comparable amounts of tetanus
toxoid, but the diphtheria component in the adult type of
tetanus and diphtheria toxoids (Td) is only about 10 per-
cent of that contained in the standard DTP preparation
used in infants and young children.


Dosage
Since the antigen concentration varies in different
products, the manufacturers' package inserts provide
specific information regarding the volume of single doses.


Schedules
Recommendations regarding usage of these vaccines
is based upon immunologic and epidemiologic considera-
tions, taking into account the special circumstances of
school entrance and other factors important in disease
transmission.


Primary Immunization
Children 2 months through 6 years(Ideally be-
ginning at age 2-3 months or at the time of a
6-week "check-up" if such timing is an estab-
lished routine.)
DTP The recommended single dose given
intramuscularly on three occasions
at 4-6 week intervals with a rein-
forcing dose approximately one year
after the third injection.

Adults and children over 6 years
Td* -The recommended single dose given
intramuscularly or subcutaneously
on two occasions at 4-6 week inter-
vals with a reinforcing dose approx-
imately one year after the second.


Booster Immunization

Children 3 through 6 years, (Preferably at time of
school entrance, kindergarten or elementary
school.)
DTP The recommended single dose intra-
muscularly.
Thereafter and for all other individuals
Td* -The recommended single dose intra-
muscularly or subcutaneously every
10 years.(When administered as part
of wound management-see specific


*Td is considered the agent of choice for immunization at
ages over 6 years on the basis of data regarding its effective-
ness in primary immunization of older children and adults and
because of increasing reactions to full doses of diphtheria
toxoid with age. The use of this preparation obviates the need
for Schick or Moloney testing prior to immunization.


417


recommendations a 10-year inter-
val is determined from that date).
More frequent routine booster doses
are not indicated and may be asso-
ciated with increased reactions.


Tetanus Prophylaxis in Wound Management
An important part of the management of wounds is
prevention of tetanus. The physician is often faced with
decisions concerning use of tetanus toxoid for active
protection and tetanus antitoxin or tetanus immune glob-
lin (human) for passive protection. The available evi-
dence demonstrates that primary immunization with tetanus
toxoid (initial doses plus the reinforcing dose) provides
a longlasting basis for active protection against tetanus.
Passive protection need be considered only for the in-
dividual without a valid history of at least one injection
of tetanus toxoid; indeed, there is evidence that persons
who have received a single dose will respond adequately
to a single booster dose, even after an interval of several
years.
The following outline summarizes recommendations
for the use of active and passive tetanus immunization
in wound management:
1. Primary immunization or booster dose less than
one year prior to injury:
a. No tetanus prophylaxis required.
2. Primary immunization or most recent booster more
than one year prior to injury:
a. Td** The recommended single dose intra-
muscularly or subcutaneously.
3. Incompletely immunized:
a. Complete primary immunization (See Dosage
and Schedules).
4. Unimmunized:
a. Initiate primary immunization (See Dosage and
Schedules).
b. The decision to use concomitant passive pro-
phylaxis will depend upon medical judgment
after evaluating such factors as location, type
and severity of the wound, degree and kind of
contamination and the time elapsed between
injury and medical attention. If passive h.rapi,
is elected, tetanus immune globulin (human)
is strongly preferred to equine or bovine anti-
serum. It offers the advantages of longer pro-
tection and freedom from undesirable reactions.
The currently recommended prophylactic dose
of tetanus immune globulin (human) is 250
units for wounds of average severity. When
used concurrently, toxoid and antitoxin should
be given in separate syringes and at separate
sites.


**If there is any reason to suspect hypersensitivity to the
diphtheria component, tetanus toxoid (T)should be substituted
for Td (adult type).


DECEMBER 3, 1966


Morbidity and Mortality Weekly Report




418


Should tetanus immune globulin (human) be unavail-
able, equine or bovine antitoxin may be used. The usual
dose is from 3,000 to 5,000 units. Administration should
always be preceded by careful screening for sensitivity.
The following schema is derived from recommendations
by the Committee on Trauma, American College of Sur-
geons: I

Determining Sensitivity to Equine or Bovine Serum
History
1. Inquire specifically regarding previous injections
of equine or bovine serum. Sensitivity frequently
develops after the first injection of animal serum.
If an adverse reaction occurred previously fol-
lowing either serum, do not consider its further
use. (The alternative product can then be sub-
jected to the sensitivity testing described below.)
2. Question the patient with regard to sensitivity to
horse dander or beef products. Either may be
considered a signal for caution.

Skin Tests (Equine or Bovine Antitoxin)
1. Inject intracutaneously 0.02-0.03 ml. of 1:10
normal saline dilution of the tetanus antitoxin.*
The area of infiltration should be about the size
of the head of a pin. A control test with the same
volume of saline should be done for comparison.
2. In 15 minutes or less, a positive reaction will be
manifested by a hive-like wheal and erythema.
The larger the reaction, the greaterthe sensitivity.
A 0.5 cm. wheal may represent a nonspecific
response which may be confirmed by the presence
of a comparable reaction to the saline alone.

Eye Tests
1. Place a drop of 1:10 normal saline dilution of the
tetanus antitoxin in the conjunctival sac of one
eye at the time of the skin test using the same
material is performed. A drop of normal saline in
the other eye can serve as a useful control.


Morbidity and Mortality Weekly Report


2. Within 30 minutes, a positive reaction will be
indicated by redness of the conjunctiva.
3. If no conjunctival reaction occurs following use
of the antitoxin, the eye test may be considered
negative.
4. After the result is apparent, a drop or two of
epinephrine 1:1000 should be instilled in the test
eye.

Interpretations
1. If a positive reaction occurs with skin and/or
eye test, the animal serum employed in the
testing should not be administered. Desensitiza-
tion should not be attempted. The physician may
either test for sensitivity to the other animal
serum or endeavor to obtain tetanus immune
globulin (human).
2. Following a positive reactionto one animal serum,
the other should be subjected to the same skin
and eye tests before considering its use in tetanus
prophylaxis.
3. If history and both skin and eye tests are neg-
ative, the likelihood of a reaction to a standard
dose of the animal serum tested is small, and it
may be administered.*
(As an additional precaution encouraged by some,
0.1 ml. of a 1:10 normal saline dilution of antitoxin may
first be injected subcutaneously.* If no untoward reaction
is observed in 30 minutes, the prophylactic dose may be
given.)



*Wherever animal serum is administered parenterally either
for test or treatment, a syringe with 1 ml. of epinephrine
1:1000 should always be immediately available.


REFERENCE:
1Early Care of Acute Soft Tissue Injuries. The Committee on
Trauma of the American College of Surgeons. W. B. Saunders
Co., Philadelphia and London, 1965, pp. 25-26.


SURVEILLANCE SUMMARY
SALMONELLOSIS-August, September, and October 1966


During the months of August, September, and October
1966, the reported numbers of human isolations of sal-
monellae were 2,408, 1,824, and 1,721 respectively.
The cumulative number of human isolations for the first
10 months of 1966 is 16,460, representing a 5.9 percent
decrease from the total of 17,495 reported for the same
period in 1965. The seasonal pattern continues to be
similar to that observed in 1965. The age and sex dis-
tribution is similar to that in previous months. The
seven most frequently reported human serotypes for the


3 months are listed in Table I; these accounted for
65.8, 66.6, and 64.8 percent, respectively, of all iso-
lations in each month.
The seven most frequently reported salmonella sero-
types from nonhuman sources for August, September, and
October are listed in Table 2. The most prominent non-
human sources for these months were turkeys, chickens,
and livestock feed.
(Reported by the Salmonella Unit, Bacteriology Section,
Epidemiology Branch, CDC.)


DECEMBER 3, 1966





DECEMBER 3. 1966


Morbidity and Mortality Weekly Report



Table 2
The Seven Most Frequently Reported Serotypes from Human Sources -
August, September and October 1966


rotyp August Septemb er October
Serotype
Rank Number Percent Rank Number Percent Rank Number Percent
S. typhi-murium & 1 77h 32.3 1 560 30.7 1 525 30.5
S. typhi-murium
var. copenhagen
S. heidelbery 2 194 8.1 2 157 h.6 2 1 10 8.1
S. newport 3 186 7.7 5 115 6.3 3 129 7.5
S. infants 4 125 5.2 1 120 6.6 5 91 5.3
S. enteritidis 5 107 4.4 3 130 7.1 4 104 6.0
S. thompson 6 98 4.1 7 44 2.4
S. saint-paul 7 96 4.0 6 45 2.5 7 56 3.3
S. blockley 7 -4 2.4
S. typhi 6 70 4.1
Total 1,584 65.8 1.215 66.6 1,115 64.8

Total all serotypes 2.408 1.b24 1,721










Table 3
The Seven Most Commonly Reported Serotypes from Nonhuman Sources -
August, September and October 1966


tAugust September October
Serotype u Speb
Rank Number Percent Rank Number Percent Rank Number Percent
S. typhi-murium 6 1 152 17.6 1 76 13.9 2 60 8.4
S. typhi-murium
var. copenhagen
S. heidelberg 2 7h 9.0 2 70 12.8 1 113 15.8
S. anatum 3 48 5.6 3 38 7.0
S. schwarsengrund 4 47 5.4 6 27 3.8
S. tennessee 5 44 5.1
S. derby 6 38 4.4
S. thompson 7 38 4.4 5 28 3.9
S. infants 4 31 5.7 4 49 6.9
S. saint-paul 5 30 5.5 7 26 3.6
S. montevideo 6 26 4.8 3 53 7.4
S. cubana 7 25 4.6

Total 445 51.5 296 54.3 356 49.8
Total all serotypes 863 546 713

Most Common Sources of Nonhuman Isolations

Turkey 1 201 23.3 1 152 27.8 1 218 30.6
Chicken 2 152 17.6 2 89 16.3 2 128 18.0
Livestock Feed 3 61 7.1 3 52 9.5 3 47 6.6
Powdered Milk 4 57 6.6
Frozen Eggs 5 32 3.7 4 44 6.2
Sewage 4 38 7.0
Animal Feed 5 23 4.2
Porcine 5 41 5.8


419






420 Morbidity and Mortality Weekly Report



CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 3, 1966 AND DECEMBER 4, 1965 (48th WEEK)


ENCEPHALITIS HEPATITIS
ASEPTIC Primary Post- Both
AREA MENINGITIS BRUCELLOSIS including Infectious DIPHTHERIA Serum Infectious Types
unsp. cases
1966 1965 1966 1966 1965 1966 1966 1965 1966 1966 1965
UNITED STATES... 52 47 12 37 30 11 35 733 751

NEW ENGLAND ........... 4 1 2 28 40
Maine................ 3 5
New Hampshire...... 1
Vermont............ 1
Massachusetts...... 2 1 1 13 19
Rhode Island....... 1 1 4 7
Connecticut........ 1 7 8

MIDDLE ATLANTIC...... 19 8 10 6 1 16 113 203
New York City...... 4 4 6 1 13 29 21
New York, Up-State. 1 2 2 1 2 21 112
New Jersey.......... 3 2 4 2 1 29 22
Pennsylvania....... 11 1 34 48

EAST NORTH CENTRAL... 3 5 6 5 2 1 133 120
Ohio............... 2 4 1 16 25
Indiana............ 1 1 13 8
Illinois .......... 1 1 1 1 25 25
Michigan............ 1 1 1 2 1 54 56
Wisconsin.......... 1 1 1 25 6

WEST NORTH CENTRAL... 2 6 1 1 26 43
Minnesota ......... 2 4 1 7 6
Iowa............... 2 12 6
Missouri............. 4 15
North Dakota....... 4
South Dakota....... -
Nebraska............ 3
Kansas............. 3 9

SOUTH ATLANTIC....... 3 3 2 7 7 1 2 60 61
Delaware............ 1 2 -- 2
Maryland............ 1 1 1 20 13
Dist. of Columbia.. 2
Virginia........... 2 7 7
West Virginia...... 4 11
North Carolina..... 1 2 1 4 14
South Carolina..... 1 2
Georgia............ 12 1
Florida............ 1 1 5 5 1 10 11

EAST SOUTH CENTRAL... 12 5 4 I 1 71 58
Kentucky ........... 5 24 30
Tennessee.......... 4 1 1 1 26 21
Alabama............ 2 12 3
Mississippi........ 6 3 9 4

WEST SOUTH CENTRAL... 1 6 1 2 1 2 2 55 44
Arkansas........... 1 1 1 3 10
Louisiana........... 1 2 3 6
Oklahoma........... 8
Texas.............. 6 1 2 41 28

MOUNTAIN. ............ 3 4 1 82 35
Montana............ 1 11 2
Idaho.............. -- -24 1
Wyoming............. 2 2
Colorado............. 6 2
New Mexico......... -- 26 23
Arizona............. 2 9 4
Utah............... 3 1 3 1
Nevada............. -

PACIFIC.............. 7 13 3 6 9 3 13 165 147
Washington.......... 4 2 22 11
Oregon............. 11 27 16
California......... 7 8 3 5 7 3 13 115 101
Alaska............. 1 14
Hawaii............. -

Puerto Rico........... 2 1 1 3 23 31


1 I 1


) I I I I








Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 3, 1966 AND DECEMBER 4, 1965 (48th WEEK) CONTINUED


AREA


UNITED STATES.

NEW ENGLAND.......
Maine............
New Hampshire...
Vermont..........
Massachusetts....
Rhode Island.....
Connecticut......

MIDDLE ATLANTIC...
New York City....
New York, Up-Stat
New Jersey.......
Pennsylvania.....

EAST NORTH CENTRAL.
Ohio .............
Indiana..........
Illinois ........
Michigan ........
Wisconsin.......

WEST NORTH CENTRAL.
Minnesota........
Iowa.............
Missouri........
North Dakota.....
South Dakota.....
Nebraska.........
Kansas...........

SOUTH ATLANTIC.....
Delaware.........
Maryland.........
Dist. of Columbia
Virginia.........
West Virginia....
North Carolina...
South Carolina...
Georgia .........
Florida .........

EAST SOUTH CENTRAL.
Kentucky.........
Tennessee........
Alabama..........
Mississippi......

WEST SOUTH CENTRAL.
Arkansas.........
Louisiana........
Oklahoma.........
Texas............

MOUNTAIN...........
Montana..........
Idaho............
Wyoming ..........
Colorado.........
New Mexico.......
Arizona.........
Utah.............
Nevada...........

PACIFIC............
Washington.......
Oregon..........
California.......
Alaska...........
Hawaii...........
Puerto Rico........


MEASLES (Rubeola)

Cumulative
1966 1966 1965

1,472 197,830 253,379

27 2,518 37,192
11 285 2,914
80 383
6 323 1,387
S 4 825 19,372
73 3,952
6 932 9,184

65 18,413 16,714
6 8,360 3,052
e. 18 2,621 4,348
34 1,968 3,187
7 5,464 6,127

149 69,980 59,883
29 6,444 9,033
5 5,787 2,255
13 11,486 3,395
63 14,987 27,449
39 31,276 17,751

89 9,128 17,211
5 1,674 760
45 5,408 9,235
1 538 2,657
37 1,311 3,982
40 115
1 157 462
NN NN NN

79 15,883 26,319
1 263 510
S 2 2,123 1,216
.. 2 390 110
S 9 2,239 4,190
13 5,494 14,561
20 621 411
2 663 1,148
1 241 627
29 3,849 3,546

229 20,397 15,143
32 4,809 3,195
67 12,607 8,450
10 1,762 2,351
120 1,219 1,147

358 26,106 31,706
982 1,088
99 120
40 578 233
318 24,447 30,265

109 12,497 20,586
13 1,903 3,874
5 1,676 2,977
14 233 861
15 1,407 5,935
51 1,210 688
6 5,351 1,413
5 662 4,616
55 222

367 22,908 28,625
198 4,734 7,461
125 2,338 3,422
31 15,059 13,490
9 615 203
.. 4 162 4,049
71 3,356 2,780


MENINGOCOCCAL. INFECTIONS, POLIOMYELITIS
TOTAL RUBELIA
Total Paralytic
Cumulative Cumulative
1966 966 1965 1966 1965 1966 1966 1966

48 3,178 2,801 3 3 88 376

3 147 144 54
S 12 18 12
9 9
4 8 -
1 62 54 15
S 17 17 3
2 43 38 24

9 413 375 1 1 1 9
S 64 61 9
5 111 107 -
1 119 100
3 119 107 1 1 1

7 502 423 7 84


2 146
3 88
89
1 128
1 51

4 165
35
22
1 64
11
1 6
2 11
16

5 536
5
49
S 14
S 63
4 45
1 134
54
77
95

6 275
95
92
1 59
5 29

7 425
36
2 161
1 22
4 206

94
5
5
6
49
10
13
1
5

7 621
4 52
40
3 507
18
4
17


I


117
48
113
97
48

137
32
12
54
13
3
10
13

530
11
53
11
71
27
110
65
61
121

213
83
68
37
25

351 2
18
192
21
120 2

100
2
13
5
27
11
20
17
5

528
45
36
421
18
8
11 -


- 1







422 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 3, 1966 AND DECEMBER 4, 1965 (48th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER RABIES IN
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE ANIMALS
AREA SCARLET FEVER (Rky. Mt. Spotted)
1966 1966 Cum. 1966 Cum. 1966 Cum. 1966 Cum. 1966 Cum.
1966 1966 1966 1966 1966
UNITED STATES... 9,107 9 184 2 162 6 354 242 69 3,732

NEW ENGLAND........... 1,206 4 1 13 3 2 86
Maine .............. 63 1 26
New Hampshire...... 24 1 30
Vermont............ 2 25
Massachusetts...... 160 2 1 9 1 4
Rhode Island....... 92 -
Connecticut........ 865 2 4 2 1

MIDDLE ATLANTIC...... 421 1 15 57 47 4 221
New York City...... 10 5 25 1
New York, Up-State. 358 2 12 13 4 204
New Jersey......... NN 1 3 8 15
Pennsylvania....... 53 5 12 19 16

EAST NORTH CENTRAL... 595 1 21 20 2 45 20 9 479
Ohio............... 98 1 5 3 21 9 3 200
Indiana............ 75 4 10 1 5 2 111
Illinois........... 4 6 6 11 2 72
Michigan............ 239 6 1 7 1 42
Wisconsin.......... 183 2 1 6 1 54

WEST NORTH CENTRAL... 308 15 19 1 34 4 14 852
Minnesota.......... 6 3 1 1 3 203
Iowa................ 139 2 5 2 157
Missouri........... 14 8 10 1 18 3 1 245
North Dakota....... 118 1 4 53
South Dakota....... 23 4 2 105
Nebraska........... 1 2 2 2 28
Kansas............. 8 1 2 7 1 61

SOUTH ATLANTIC....... 873 2 35 1 13 67 110 10 477
Delaware........... 11 -- 1 2 2
Maryland............ 116 3 1 3 12 26 3
Dist. of Columbia.. 5 2 -
Virginia........... 288 6 2 16 31 2 240
West Virginia...... 245 1 1 2 58
North Carolina..... 13 4 3 6 27 4
South Carolina..... 29 2 1 13 5
Georgia............ 10 8 3 4 19 2 102
Florida............ 156 2 12 12 4 70

EAST SOUTH CENTRAL... 1,550 1 26 24 1 44 43 14 479
Kentucky........... 24 2 2 10 9 6 116
Tennessee.......... 1,070 7 14 22 25 8 321
Alabama............ 171 8 4 6 7 20
Mississippi........ 285 1 9 4 1 6 2 22

WEST SOUTH CENTRAL... 708 3 45 1 73 34 10 8 736
Arkansas........... 4 1 56 4 2 2 82
Louisiana.......... 2 2 12 4 10 2 52
Oklahoma............ 81 3 7 9 7 2 182
Texas............... 625 1 26 6 11 1 2 420

MOUNTAIN ............ 1,723 2 9 17 4 1 96
Montana............ 67 2 -- -- 7
Idaho .............. 72 -
Wyoming............. 63 3 1
Colorado........... 1,095 2 4 2 18
New Mexico......... 287 1 2 1 1 17
Arizona............. 52 1 5 42
Utah................ 76 2 5 3
Nevada............ 11 9

PACIFIC............. 1,723 1 21 3 2 43 1 7 306
Washington. ........ 573 2 13 15
Oregon.............. 36 1 1 4
California.......... 1,033 1 20 3 27 1 7 287
Alaska............ 18 -
Hawaii...... ..... 63 2 -
Puerto Rico.......... 2 53 1 18 18








Mlorbidilv and Mortality Weeklh Report






DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED DECEMBER i, 1966


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

A ll n r, ,

Area All 65 years and 1 year Area All 65 year and yar
Ages and over Influenza All Ages and over Influenza All
All Ages Causes All Ages CausesA


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

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

EAST NORTH CENTRAL:
Akron, Ohio-----------
Canton, Ohio----------
Chicago, Ill.---------
Cincinnati, Ohio------
Cleveland, Ohio-------
Columbus, Ohio--------
Dayton, Ohio----------
Detroit, Mich.--------
Evansville, Ind.------
Flint, Mich.-----------
Fort Wayne, Ind.------
Gary, Ind.------------
Grand Rapids, Mich.---
Indianapolis, Ind.----
Madison, Wis.---------
Milwaukee, Wis.-------
Peoria, Ill.-----------
Rockford, Ill.------
South Bend, Ind.------
Toledo, Ohio----------
Youngstown, Ohio------

WEST NORTH CENTRAL:
Des Moines, Iowa------
Duluth, Minn.-------
Kansas City, Kans.----
Kansas City, Mo.------
Lincoln, Nebr.--------
Minneapolis, Minn.----
Omaha, Nebr.----------
St. Louis, Mo.--------
St. Paul, Minn.-------
Wichita, Kans.--------


770
237
47
32
36
60
38
25
24
41
69
17
49
36
59

3,673
44
34
149
61
53
53
77
102
1,879
54
512
243
54
81
28
53
66
44
37
49

2,714
73
36
786
168
232
118
63
336
46
61
45
30
43
192
31
141
44
31
60
119
59

911
85
25
44
139
37
108
98
277
60
38


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.-------
Chattano6ga, 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


1,363
138
288
72
85
109
64
88
44
102
79
249
45

649
99
60
41
112
155
49
40
93

1,232
56
69
26
140
33
68
248
49
157
105
146
57
78

461
60
25
132
14
104
17
56
53

1,748
22
65
42
44
88
554
125
25
144
76
82
202
37
132
70
40


13,521


702
58
144
27
47
64
29
43
30
78
51
105
26

345
60
22
23
72
76
25
21
46

629
34
38
13
74
18
36
116
28
67
49
80
32
44

253
28
17
69
11
57
11
29
31

1,038
15
35
28
19
51
334
75
19
85
46
43
113
24
79
45
27


7,666


Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 600,251
All Causes, Age 65 and over------------------- 343,715
Pneumonia and Influenza, All Ages------------- 24,542
All Causes, Under 1 Year of Age--------------- 32,065


Week No.


*Estimate based on average percent


I '


SII


of divisional total.






Morbidity and Mortality Weekly Report


DECEMBER 3, 1966


QUARANTINE MEASURES


Immunization Information for International Travel
1965-66 edition- Public Health Service Publication No. 384

Section 2, page 13
Delete the information under Typhoid and Paratyphoid
fever.

Insert:
Typhoid Fever Immunization is recommended for
foreign travel as a personal and public health precau-
tion. Standard course: 2 injections at least 4 weeks
apart. A booster dose at 3 year intervals while in an
infected area. The basic series need not be completed
at any time even if more than 3 years has elapsed since
primary immunization or the last booster dose. Infants
may be immunized from 6 months of age. (For typhoid
vaccine dosage as recommended by the PHS Advisory
Committee on Immunization Practices see Morbidity
and Mortality Report, Vol. 15, No. 29, July 23, 1966).

All information concerning paratyphoid fever vaccination
(pages 20-71) should be deleted.

Section 2, page 15
Under Plague, delete "The standard course need not
be repeated at any time."

Insert:
Persons vaccinated previously need only 2 injections
spaced at a 30-day interval.

Health Information for Travel Leaflets
748, 748B through 7480

748 Travel in Europe
748B Travel in Mexico, Central and South America and
the Caribbean
748C Travel in Asia, Japan, Indonesia, Philippines,
Australia and New Zealand
748D Travel in Africa

Delete all reference to typhoid and paratyphoid fever and
insert the above information concerning typhoid fever.


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION OF 15,600, IS PUBLISHED. AT THE COMMUNICABLE DISEASE
CENTER, ATLANTA, GEORGIA
CHIEF. COMMUNICABLE DISEASE CENTER DAVID J. SENCER, M.D.
CHIEF. EPIDEMIOLOGY BRANCH A.D. LANGMUIR, M.D.
ACTING CHIEF, STATISTICS SECTION IDA L. SHERMAN, M.S.
IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY, THE COMMUNICABLE DISEASE CENTER
WELCOMES ACCOUNTS OF INTERESTING OUTBREAKS OR CASE INVES-
TIGATIONS WHICH ARE OF CURRENT INTEREST TO HEALTH OFFICIALS
AND WHICH ARE DIRECTLY RELATED TO THE CONTROL OF COM-
MUNICABLE DISEASES. SUCH COMMUNICATIONS SHOULD BE ADDRESSED
TO:
THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT
COMMUNICABLE DISEASE CENTER
ATLANTA, GEORGIA 30333
NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO THE CDC BY THE INDIVIDUAL
STATE HEALTH DEPARTMENTS. THE REPORTING WEEK CONCLUDES
ON SATURDAY; COMPILED DATA ON A NATIONAL BASIS ARE RELEASED
ON THE SUCCEEDING FRIDAY.


U.S DEPOSITORY


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