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:
AA00010654:00279

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

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COMMUNICABLE DISEASE CENTER

S .' .( ,/ ., /
.i i/ t
re ~. 1


PUBLIC HEALTH SERVICE


MEASLES 1966

Oregon
An epidemic control program against measles in one
Oregon Health Jurisdiction in the Portland area prompted
two adjoining Jurisdictions to undertake similar programs
for the protection of their children. This is one of thelar-
gest epidemic control measles immunization programs to
date in the United Stales. Approximately 24,000 children
from kindergarten roughh the third grades are to receive
measles vaccine in the city of Portland, Washington County
and Multonomah County during the 3-week program which
began November 23, 1966.
HuI-hn'l..'n County. which has reported a total of 147
measles cases during the 4 weeks ending November 19


CONTENT S
I l-pdemiohlo 'i Notos and ep rlt,
Me sl." 1966i . . 101
SummrnarS of Rleported Case, of Infcliou,, S?%phii ..... 103
]Iecommneindiat on of the Pul Iic Health Srvw i, advisoryy
Commit e on Immuniza tion IPractices
Smallpox \accine ............... 101
Revocation of )iagnosis
Rabies Colorado . 112


(MdMWR, Vol. 15, Nos. 44-46), initiated the program. The
neighboring Health Jurisdiction of Portland notified 5
cases for the week ending November 19. Thus, in order to
abort the spreading epidemic, Portland and Multonomah
County decided to participate in this cooperative effort.
(Continued on page' ( 2)


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
47th WEEK ENDED CUMULATIVE, FIRST 47 WEEKS
MEDIAN
DISEASE NOVEMBER 26, NOVEMBER 27. 1961-1965 MEDIAN
1966 1965 1966 1965 1961-1965
Aseptic meningitis ........ ...... 41 48 39 2,716 1,952 1,964
Brucellosis............... .......... 1 6 8 212 223 354
Diphtheria ..... ... ..... .... 12 3 8 182 147 247
Encephalitis, primary:
Arthropod-borne & unspecified ........... 24 17 1,960 1,745 -
Encephalitis, post-infectious ..... ... 9 10 666 610
Hepatitis, serum ........ 575 776 0 30,42 1.309 39
Hepatitis, infectious ................... 694 29,070 9
Measles rubeolaa) ...... .. ..... ..... 950 1,414 2,316 196.372 250,745 401,998
Poliomyelitis, Total (including unspecified) 2 2 20 90 56 412
Paralytic .............. ......... 2 10 85 42 353
Nonparalytic ....... ........... .. -- 9
Meningococcal infections. Total ........ 57 40 42 3.128 2,732 2.139
Civilian .... .................. ..... 46 39 2,825 2,538
Military.................. ......... 11 1 303 194
Rubella (German measles) ................ 292 -- 44,119 .
Streptococcal sore throat & Scarlet fever .. 8,263 6,806 6,548 376,578 350.395 304,044
Tetanus................... ...... ... 4 7 --- 175 252 -
Tularemia ....................... ... 1 2 --- 160 230 -
Typhoid fever ................. ..... 2 13 11 347 407 491
Typhus, tick-borne (Rky. Mt. Spotted fever). 2 2 --- 241 258 -

Rabies in Animals ................ ... 57 51 64 3,663 3,902 3,436

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: .. 6 Botulism: Ind.-2 10
Leptospirosis: Tenn.-l ... ..... .. .... ..... 61 Trichinosis: .. .. ... ... 90
Malaria: Ky.-4, N.C.-8 .. .... ... . 440 Rabies in Man: .. .. .. .......... 1
Psittacosis: Pa.-2, Mass.-1 .. .......... ... 44 Rubella. Congenital Syndrome: ... ..... 21
Typhus, marine: .... ..... ... ..... 26 Plague: ....... ........ .. 5


Vol. 15, No. 47

"-4 ir




Week Ending
November 26,1966





Morbidity and Mortality Weekly Report



MEASLES 1966 continued d from front page)


The program is sponsored by the three local Health
Jurisdictions. the local medical societies, the school sys-
temus, and 'he Oregon State Board of Health.
(Reported by Dr. Edeard Goldblatt, State Epidemiologist,
Orrgu/ State Roard of Health.)
Snohomish County, Washington
\ 3-day communi\t-wide program to control an outbreak
ol mcasles in Snohomish county Washington. was coom-
pleted on Nor ember 30, 1966. Approximately 7.000 children
Ironic kindergarten through sixth grades were \accinated.
The uirgoncl of this program was indicated bi the 9?10
cae- of measles reported during the 3-week period ending
No e lichr :>. 19. i, (MMI\VR. Vol. 15. Nos. .3. 15). Fmphasis
\ as pla ed on availability of private physicians for inm-
munizat on oC younger children. The community program
was conduc,-td by tLe Snohomish County Health Departient
with support from the Snohomnis ('County Medical Society.
\\ashirngtoin ia' Depiartment of lHealth. and the ('DC.
(Reip i'd b y 1D. iii:a A/yer, Sta'e Epide' miologist.
lit ali/n! jt i "t I.t Hl, h 1 puii c client .,
Kay County, Oklahomc
From September to Novemrer IS, 19nfi, 94 cases of
measles were report d froni Kay County Oklalhoma. nmost
of which occurred in t\ao of the county's four elementary
schools. \ppro\ima ] (i 00 children in the first through
third grade c v eslimated to h i susceptible. Preschool
children and a( : su ceptible school-age children in ithe
four gramrmar school- were immunized in a vaccination
campaign schet!iiild for No member '2 ;and 29. Jet inj actor
guns were used. A school surveillance system for measler
is planned and the u-e of physician reporting improved
-( as to gi\o an index of the success or failure of the
immunization effort.
(Reportrd hy Or. Li Roy ('arpenter. Slate Epid,;nrioagi '.
Oklah ,o, a State Oc partment of le'alth .)
Rhode Island
On Sunday. January 23, 1966, The Rhode Island
Medical Society and the Rhode Island Department of
Health conducted the first Statewide END MEASES
campaign in which 33,S53 children (67.2 percent of esti-
mated susceptibles) were immunized. Another 2,589
children were vaccinated in the 39 follom-up clinics held
through June 1966. thereby increasing the number immu-
nized to 36.442 or 70 percent of estimated susceptibles.
\n intensive surveillance system including case
investigation has been instituted. All physicians harte
been reminded that measles is reportable to the State
Department of Health within 24 hours of suspected iI ,.;
nosis. School nurses, nursery school directors, andi the
district visitingg nurses have all agreed to report sus
pelted cases of measles in order that each case be
investigated. In an effort to discover pockets of sus-
ceptibles, all Head Start programs aire being contacted
and iii. i r, installations are encouraged to immunize
dependent's children, many of whom have moved to Rhode
Island since June. Plans are underway to include measles
vaccine in the routine school immunization program.


NOVEMBER 26, 1966


The first confirmed case of measles since June was
h r,..-. I. during the week ending November 12 in an
S-year-old boy from Warren, Rhode Island, who had not
been out of the state or had contact with another case of
measles. The child had been immunized on END MEASLES
Sunday in January and probably represents a case of
raccine failure. The child had not received gamma glob-
ulin either prior to or after the measles immunization.
Serological confirmation will be sought and a sur-
vey to determine measles -,- -.r.i ,il, is to be under-
taken in the child's school.
(Reported by )r. Joseph E. Canrnon, Director of Health,
Rhode Island Department of lriiilthi;and an EIS Officer.)

CURRENT TRENDS
A total of 950 cases of measles ias reported for
lie 47th week (ending Novermber 26, 1966), a decrease of
-209 cases from the total of the previous week and a de-
crease of 464 cases from the total of 1.114 reported for
the 47th v:eek of 1965. The tree states reporting the
highest number of caies for the 17th week are Texas with
196. ;i. ... with 97, and Oregon with 96. Ten states
reported no measles activity.
The 24 counties reporting 10 or more cases for the
4-tth week ( ...i .. November 19) are in 14 different states
and are listed in Table 1: the geographic distribution of
(T'ait continued ot pa'rle 1i2)

Table 1
Counties Reporting Highest Number of Measles Cases
Week Ending November 19, 1966


County

Snohomish '
Spokane
Okl ihbeha
\tashington *
King
Durham
\ l i -i. r. 4
P arker
Pueblo
Douglas *
Mil waukee
Webster
Richardson
Brown
Ectror
Menifee
Ward
Rutland*
Bastrop
(ialveston
Wood
Red River
L am ar
Alameda


Staate

Washington
Washington
lississ sippi
Oregon
\Washington
North Carolina
Pennsy lvania
Texas
Colorado
Oregon
Wisconsin
West Virginia
Nebraska
Texas
Texas
Kentucky
North Dakota
Vermont
Texas
Texas
Texas
Texas
Texas
California


Number of Cases

89
6 0
59
iSt
34
27
27
26
25
24
23
18
17
17
15
15
13
12
12
12
11
10
10


Total 660
*Eupidemic control measures or mass immunization programs
have been inst iluted, are in proRre'ss, or are planned< for th'r
no'ar future.








NOVIMIAI RH 26, 1966


Morbidity and Mortality Weekly Report



Figure 1
COUNTIES OR HEALTH DISTRICTS REPORTING MEASLES
WEEK ENDING NOVEMBER 19, 1966


J1




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I : I


S.s
* L A



02 2
d-o--*

/'.r; \ ffl^V



L -- Uy-~


9





J/ ^


U Y"
+'


SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS
OCTOBER 1966 AND OCTOBER 1965

CASE OF PRP LY F'0 SECOTNARY SYPHILI: By Re rating A -ea- er 165 i d t 66 P


PRp ti A 0, t ber0 R, i A
Repurting Arf*-. l_ O! R ,porting Ar.-
I 19 196S 19i 6 1465

Mane ................ 3 2 K nt .. ..... ....
New 0ps,- i re........... 0 2 iAnnse.........
Verm ont .....*........... Alabama............
assabh1s 1tts ........... 3 31 26 240 5 s .ssipp.........
Rhad Is lind............ 4 25 18
C o -t, It ............ 81 18 8 WET SOU21 CENTRAL..


MIDDL ATLANTIC...........
Upstate Neu Y rk.......
New York City...........
Pa. (ExI Phila.) ......
Philadelphia ............
N Jery .............

EAST ORTH CENTRAL ......
Ohi .......... .........
Indiana. .................
Do-nstate I.liois .....
Chicago...............


WEST NORTH CENTRAL......
.MAnesta. ..............
iowa....................
Missour ................
Nirth Dakta.............
$ uth Dkta .............


.OATH ATLANTIC.............
1 .vlai ......... .. ....
LIT lLA2T


1966 ~ 1 ;66 hr3
...... 15 1
....... 28 57
105
36 47 476 i

...... 267 2 .306 198


Ark.an-s ................ 17 1. 15 57
Okiah a. ............. 6 8 i 18 I 7
Treas ... ........... 175 1 1, 11

MOUNTAIN.... .............. 53 3" 373 '63
mLonr- ........... ....... 3 30 1,
da ............. 7 -
C 1 .ri .............. 6 3 4
NA Mec ..... ............ 87
Arizona................. .. 18l
Utah................ 1 1 4 5
vaiida1................. 1 E 0

PACIFIC.................. I 5 I 1, 57 I

as hing L. ............ 35 1
OTERRI- ................... I 1 842 72
Califrt ia .............. 126 36 1,348 1,7
S................ 1

STOTAL. ......... 1,76 18,006
TERRI TRIE................ 92 91 842 726
LAR1r i Ri .............. 9 3 i 18 7)
V 1r44 IsIanas.. .... i S 24 1.
V4 LI


N to C-htla-t e Tritals
through previous


103


i)







n
I '


' '


.- o. .:: : ,o o .,, o..,,..
-. I j






Morbidity and Mortality Weekly Report


RECOMMENDATION OF THE PUBLIC HEALTH SERVICE ADVISORY
COMMITTEE ON IMMUNIZATION PRACTICES

The Public Health Service Adrisory Committee on Immunization Practices meeting on
October 11, 1966, issued the following recommendations on ;smnallpor vaccination practices
in the United States.

SMALLPOX VACCINE


Introduction
In the United States. protection of the community
against smallpox through routine vaccination of infants
and revaccination of older children and adults represents
the principal mechanism of defense against the indigenous
spread of the disease once introduced. This approach to
community protection, as with all practices in preventive
medicine, demands continuing reassessment of the po-
tential risk of the disease in comparison to the efficacy
and risk associated with preventive procedures.

The Risk of Introduced Smallpox
The risk of introduction and subsequent transmission
of smallpox in the United States is difficult to appraise.
thoughh no recognized cases of smallpox have occurred
in the United States since 1949. a sizable reservoir
of endemic smallpox persists in Asia. Africa and South
America. In 1965. over 63,000 cases were reported to the
World Health Organization; undoubtedly. many times this
number of cases occurred but were not recorded. A sub-
stantial proportion of smallpox cases are known to ha\e
occurred in urban centers.
Travel both by United States citizens and other
nationals to and from smallpox endemic areas and this
country is increasing annually. As seen recently in
Europe, quarantine measures offer, at best. only partial
protection against the introduction of smallpox. The
traveler who has been vaccinated improperly or vac-
cinated with impotent vaccine or who bears a spurious
vaccination certificate, is fully capable of developing
the disease after passing quarantine inspection. Such,
in fact, did oecur in the United States as recently as
1962: A Canadian boy in apparently good health entered
the United States through New York City from Brazil
with a seemingly valid vaccination certificate. He devel-
oped smallpox after arriving in Canada less than 24
hours later.
In 75 instances during the past 18 years in which
smallpox has been introduced into non-endemic areas,
nationals of the country involved have been responsible
for over three-fourths of the introductions. Should
smallpox be introduced into the United States, it is
similarly most probable that a United States citizen
returning from abroad would serve to introduce the disease.

Smallpox, particularly variola major, remains a highly
virulent disease even with excellent medical care. The
mortality rate among unvaccinated persons was 40 percent
in Sweden and in England during the outbreaks of 1962-63.
Since few physicians in practice today are acquainted


with clinical smallpox, it is not surprising that in several
recent European outbreaks the disease remained unrec-
ognized until the third generation of cases, or even later.
During a 1966 outbreak in England. the diagnosis of
smallpox was not made until the fourth cycle of trans-
mission and 23 cases had already occurred, more than
10 weeks after the first identifiable case. Should the
disease be introduced into the United States, a similar
course of \vents could occur.

Smallpox Vaccination Efficacy and Risks
The efficacy of smallpox vaccine has never been
precisely measured in controlled trials. It is. however,
generally agreed that vaccination with fully potent
vaccine confers a high level of protection for at least
three years and provides substantial but waning immunity
for 10 years or more. Protection against a fatal outcome
of the disease appears to extend over a longer period,
perhaps for decades.
Smallpox vaccination, as with other medical pro-
cedures, is associated with a definite, measurable risk
of morbidity and, rarely, death. A comprehensive national
survey to ascertain the frequency of complications
associated with vaccination in the United States during
1963 has recently been completed. I Among more than
6,000,000 primary vaccinees and nearly\ S,000,000 revac-
cinees and their contacts. 12 cases of encephalitis
following vaccination. 9 cases of vaccinia necrosum,
and 108 cases of eczema vaccinatum occurred. Seen
persons died. A substantial number of less serious
complications, some of which resulted in hospitalization,
were also recorded. All deaths and virtually all compli-
cations occurred among those vaccinated for the first
time.

Furthermore, from these same data. it appeared
that over half of the complications could have been
prevented had contraindications to vaccination been
more closely observed. Additionally, it was noted that
complication rates were at least twice as high among
children under one year of age as among other children.

If the routine practice of vaccinating infants and
young children were to be terminated. consideration
would need to be given to the consequence of the later
primary vaccination of a large number of adults requiring
protection by virtue of military service, traivl abroad,
or employment in medical or allied health professions.
(Over half of all cas-es occurring following introduction of
smallpox to non-endiemic areas have been transmitted in
the hospital -.i;in. ) It is estimated that these three


NOVEMBER 26, 1966









categories would involve between one and two million
primary x accinations annually.
Available data suggest that if primary vaccination
were delayed until adulthood and administered to indi-
viduals faced wiith potential -smallpox exposure, tlhe
number and seriousness of complications occurring tiach
year would, in fact, be considerable greater than at
present.

Other Prophylactic Agents
In recent years, Vaccinia Immune (lobulin and
certain anti iral compounds have been tested and reported
by some to he effective it conferring protection against
-niallpox when ministeredd shortly after posture e to
the disease. \t presenIt, hoxexer, none appears to be a
satisfactory alternative to vaccination. .nd most imphor-
tant, none confers protection lasting more than a few
weeks. Thus. unless the first introduced ease can be
promptly and correctly diagnosed and all contacts quickly
identified and treated, interruption of subsequent rans-
mission of the disease by using lhe>e material- is
virtually impossible. \s previously pointed out, prompt
diagnosis of the first introduced case has heen their
exception rather than the rule in recent European out-
breaks.
Of added practical importance are the association of
considerable gastrointestinal toxicity witl the antiviral
compounds and the critically short supply of Vacciinia
Immune Globulin. In brief, therefore, none of these
prophylactic agents is suitable for mass use at the time
of a real or potential outbreak.

Conclusions and Recommendations
In recent years. international travel has increased
substantially while the res-ervoir of endemic smallpox
has changed but little. Correspondingly. the potential for
the introduction of smallpox into the United States has.
if anything. increased.
The 1966 World Health assemblyy agreed to embark
upon an intensive 10-year smallpox program. Based upon
the effectiveness of vaccination campaigns in man, of
the developing countries, there is every reason to antic-
ipate the success of this program. Eradication of endemic
smallpox represents, the most direct attack upon the
problem and the only sure means for protecting the IUnited
Stats.
Until eradication is achieved or. at least, nears
re lization, vaccination. .iii,..,_. not wholly without
risk, clearly represents the only currently practicable
approach for community protection in the Inited States.
Considering the comparative risks of smallpox to the
United States contrasted with the risks of vaccination.
it is therefore important, at this time, to continue the
present practice of widespread, routine smallpox vac-
cination in early childhood with subsequent revaccination.

*All persons regardl-ss of age. entering the l nitel States from
non-exenmpt areas are reiitired to be vaccinated or revaeci-
nated within three years unless vaccination is medically con-
traidicaledi. TIhe International sanitary Regulations provide


Recommendations for Smallpox Vaccination
The following -,nallpox iAc(c nation practice are
recon lmendedl for the I ioted State-: (See Foornote*)
1. Time of Voccination
Primary Vaccination
a. Duiringthe second year of I ife (i.e.. ho_ itwl on
l-t. and 2nd. birthdays).
1). \t any age- undet r conditions of expo.ure
or foreign travel,
Revaccination
a. \I time of tntry into -letmeni tary school.
Ib. \t three-year inter als for:
1) Persons who conveiably, might he ex-
posod inendclnic or potentiall, endemch
areas by %irtue of international travel.
2) Persons likely to be exposed bh. nw(,-\l\
introduced infection into the 'nirted
States, particularly:
a) Hospital personnel. including phi -
sicians. nurses, attendant, lah-
oratory and laundry workers.
h) Other medical. public health, and
allied profession-.
c) \lorticians and other mortuary
workers.
c. \t approximatel-y O1-year interial- for all
others.
7. Site of Vaccination
On the skin over the insertion of the deltoid
muscle or on the posterior aspect of the arm o er
the triceps muscle.
?. Methods of Vaccination
Multiple Pressure Method2
A small drop of vaccine is placed on the dry.
cleansed skin and a series of press--ures is
made within an area about 1 h' in diameter
with the side of a sharp. sterile needle hell
tangtentiall\ to the -kin. The pressures are
made with the side of the needle. For primary
vaccination. 10 pressures are adequate: for
re\aieination. -3 pressure- should be made.
The remaining vaccine should ble wiped off
with dry. sterile gauze. Preferably, nodressing
should be applied to the site.
Other Vaccination Techniques
Vaccination may be performed with other
devices shown to be equally effective in
assuring takes.
Jet Injection Method
Using vaccine specifically man ufactured for
this purpose. the recommended dose is in-
oculated intradermally with a jet injection
apparatus. Excess vaccine should be wiped
off with dry. -terile gauze. Preferably. no
dressing should be applied to the site.

that "If a vaccinator is of the opinion that vaccination is
contraindicated ont medical ground, he shouldd provide the
persons ~uith written rea-o un irl in thiat t>pini non. ihi
health authorities mia tak into a unt."'


NOVIE:MBI:R 26, 196(i


Morbidity and Mortality Weekly Report









4. Interpretation of Responses*
The vaccination site should be inspected 6 to 8
(lays after \accination. The response should be
interpreted as follows:
Primary Vaccination
A primary vaccination which is successful
should show a typical Jennerian vesicle. If
none is observed. vaccination procedures
should be checked and vaccination repeated
with another lot of vaccine until a successful
result is obtained.
Revaccination
Following revaccination, two responses are
defined by the WHO Expert Committee on
Smallpox eliminating use of older terms such
as "accelerated" and "immune":2
a. "Major reaction"
A vesicular or pustular lesion or an area of
definite palpable induration or congestion
surrounding a central lesion which may be a
crust or ulcer. This reaction indicates that
virus multiplication has most likely taken
place and that the revaccination is suc-
cessful.
b. "Equivocal reaction"
Any other reaction should be regarded as
equivocal. These responses may be the
consequence of immunity adequate to
suppress virus multiplication or may
represent only allergic reactions to an
inactive vaccine. If an equivocal reaction
is observed, revaccination procedures
should be checked and revaccination
repeated with another lot of vaccine.
5. Types of Vaccine
Smallpox vaccine is presently available both in
the glycerinated and the lyophilized form. Both
forms, when properly preserved, afford excellent
protection. The glycerinated form requires constant
refrigeration at all stages in its transport and
storage at temperatures recommended by the
manufacturer. Comparatively minor storage dif-
ficulties may reduce its potency sufficiently to
decrease efficacy in vaccination and particularly
in revaccination. Even in excellent medical
facilities, the glycerinated vaccine is often
stored under improper conditions. Use of the much
more stable lyophilized vaccine would insure
more consistently effective vaccination. Due care
must be exercised to provide proper handling of
the lyophilized vaccine after reconstitution as
described by the manufacturer.
6. Contraindications to Vaccination
a. Eczema and other forms of chronic dermatitis
in the individual to i e vaccinated or in a
households contact. If vaccination is required
*i'o r iurp e of i atii ng c rtil atr for it. trna ttionl trav l,
pri ,ry 'lur iations- uilt be I ,% pct d. lthoun h d suabl|,
in: p rctit n of rlvafe (mn;it on i- not I anatrt* l t r .


NOVEMBER 26, 1966


for an individual with dermatitis because of
potential exposure in an endemic area. Vac-
cinia Immune Globulin should be administered
to the affected individual at the same time as
the vaccine. If there is real need to vaccinate
an individual who may create a hazard for a
household contact with dermatitis, consid-
eration should be given to separation of the
vaccinee and his contact until a crust has
developed.
b. Pregnancy. Vaccinia virus may, on occasion,
cross the placental barrier during any stage of
pregnancy and infect the fetus. Virtually all
cases of fetal vaccinia have followed primary
vaccination. If vaccination is indicated be-
cause of potential exposure in an endemic
area. Vaccinia Immune Globulin should gen-
erally be given simultaneously with the vac-
cine, particularly if she is undergoing primary
vaccination.
c. Patients with leukemia, lymphoma, and other
reticuloendothelial malignancies or dysgamma
globulinemia or those under therapy with
immunosuppressive drugs such as steroid and
antimetabolites or receiving ionizing radiation.
If exposure should, by chance, occur, or if
vaccination is absolutely essential, Vaccinia
Immune Globulin should be administered.
7. Vaccinia Immune Globulin (VIG) (See Appendix)
a. Prophylaxis-0.3 ml. kg.'by the intramuscular
route.
h. Treatment-0.6 ml .kg. by the intramuscular
route:
1) In eczema vaccinatum, \accinia necrosum
or auto-inoculation vaccinia of the eye.
VIG may be effective.
2) For severe cases of generalized vaccinia,
VIG may be helpful in treatment. Such
cases, however, almost invariably have a
favorable outcome.
Note: For postvaccinal encephalitis, VIG
is of no value.
8. Thiosemicarbazones
Certain of the thiosemicarbazone derivatives are
reported by some to show a short-term protective
effect against smallpox and possibly a thera-
peutic effect in individuals with severe vaccinal
complications. These are experimental drugs and
are not available for general use; their potential
usefulness remains to be established.

REFERENCES
INeff. John M., eot al. Smallpox V cintion Comn lical ion -
United Sta i.s 1963.1. NatMionl Surve. 11. Hosults Oltl named
by Four Stateride Surveys. To he putblished -N V Itngland
Journal of Medicine.
2*V110 Technial Report Series No. 2'n3, 1t1 Expert Com-
iittee on smallpox. 1964.
*Ilnternational .anitary R .e uln tions. Article S (,Footnote 9D),
World IH allh OrR niz action, G( ne; a, I96ti.


Morbidity and Mortality Weekly Report





NOVEMBER 26, 1966


Morbidity and Mortality Weekly Report


APPENDIX
'omnmittce of Arnericnln cRd C'ross I'o,, u er
('onsultant.s for th/e Distribution of V'a ciniac umnie U(lobulint
VIG may be obtained within a few hours from any of the listed Regional
Blood Centers of the American Red Cross following approval by a consultant


()fflict
(115) i t-Sh200.
Ext. I ll


1. Moses (rossmnl, i.D.)
University of California
San Francisco General Hospital
(Ward 83) Room 334)
San Francisco, California 9-1110
Alternate: Sidney Susmnian, V.D.
(Same Address)
2. Horace Ilotdes, f.I).
The Mount Sinai Hospital
New York, New York 10029
Alternate: Eugene Ainhnider. 1V.).
(Same Address)
3. C. Henry Kempe, V.ID.
University of Colorado School of Medicine
4200 East Ninth Avenue
Denver, Colorado 80220
Alternate: Vincent A. Fuliinili, 1.D.
(Same Address)
Alternate: Henry K. Silre,. .1).
(Same Address)
3. James 11. Pert, V.I).
The American National Red Cross
Washington. D.C. 20006
Alternate: Robert H. Parrott. 41.).
The Children's Hospital of the
District of Columbia
2125 13th Street. N.W.
Washington. D.C. 20009
5. Ralph V. Platou, V.D..
Tulane University School of Medicine
1430 Tulane Avenue
NeS Orleans, Louisiana 70112
Alternate: tlaryuret H.I). Smith. 1.).
(Same Address)
Alternate: Norman C. WIooiy. 1V.).
(Same Address)
6. Irr'ing SchJlman, 1.1),.
Ilniersity of Illinois College of Medicine
S40 Wood Street
Chicago. Illinois 60612
Alternate: tVarrin Cornblaih, 11 ..
(Same Address)


7. Paul F. Wehrle. V.D.
Los Angeles County General Hospital
1200 North State Street
Los Angeles. California 90033
Alternate: John t. Leedom, I.t .
(Same Address)
Alternate: Allen 11 Mathies, V.D).
(Same Address)

Edward L. Huescher, Lt. Col.. V.C.
Walter Reed Army Medical Center
\ashington. D.C. 20012
Alternate: Malcolm S. Aretenstein, 1.D.
(Same Address)


Distribution to the Armed Forces


(Sanml)


(212) s76-115h
or 876-1 000.
E\t. 732 or (40
(Same)


(303) 399-1211



(303) 399 -1211.
Ext. 7535
(303) 399-1211.
Ext. 755.
(202) S5>7-35-43
or 737- )300.
Et. 543
(-_- I, 3h7-4220.
Ext. 2 S




(5I04) 523-:33
Ext. 831


(504) .523-;3 1,.
Ext. 3s0
(' l i -523 ;-33S1.
Ext. 531

(312) 663-6711



(312) 663-6714


(213) 225-3115.
Ext. 2231


(213) 225-3115.
Ext. 7285
(213) 225-3115,
Ext. 2231

(202) 576-37-57
or 723-1000.
Ext. 3757
; -. 576-347S
or 723-1000,
Ext 347S


iforlt{'
(115) 651-0475




(41.) 56i1 -h296


(5 1i) 627-;6!91


(911) 762-114S


(8:03) 322-41457



(303) 355- 1032

(3(03) 355-7990


(301) 656-h375


(301) 365-0h10


(5)04) h33-8301



(501) Mi1-4304

(504) 199-9049


(312) 835-0160



(312) 835-1774


- 'i 2S7-9S5S



(213) 2.S--1597

(213) 799-7006


(301) 29i-6211h


(301o) 299-611


Telephone







Morbidity and Mortality Weekly Report



CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 26, 1966 AND NOVEMBER 27, 1965 (47th WEEK)


AREA



UNITED STATES. ..

NEW ENGLAND..........
Ma ine..............
New Hampshire......
Vermont. ...........
Massachusetts......
Rhode Island ......
Connecticut.........

MIDDLE ATLANTIC......
New York City......
New York, Up-State.
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.............


Puerto Rico ..........


ASEPTIC
MENINGITIS


1966 T 1965
41 48

1 | 2


BRUCELLOSIS


1966
1


ENCEPHALITIS
Primary post-
including Infectius
unsp. cases
1966 1965 1966
24 17 9

1 1


- 1


13 22


13 20

-


DIPHTHERIA


1966


1965


Serum


1966


HEPATITIS
Infectious
including
unsp. cases
1966


f I F F


4

3

1


4 12
3

1 12
S i -


Both
Types

1965
575

27
5
2
1
14
1
4

87
26
26
9
26

129
33
11
16
60
9

10
2

2
1

1
4

45

6

21
4
3
2

7

39
13
16
5
5

31
7
6

18

33
5

11
11
6
7
3


174
29
6
127
10

20







MIoriiiliy and Mortalityv Weekl Report


CASES OF SPECIFIED NOTIFIABLE DI)ISASES: 1:NITIID STAIRS

FOR WIFKS INDID)

NOVEMBER 26, 1966 AND NOVEMBER 27, 1965 (47th WEEK) CONTINUED


AREA



1**i. l. 1 Ti

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

MIDDLE ATLANTIC......
New York City...
New York, Up-State.
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..........


MEASL


1966


ji /


ES


(Rubcola)

Cumu lat ie


1966



2,491
274
80
317
821
73
926

18,348
8,354
2,603
1,934
5,457

69,831
6,415
5, 82
11,473
14,924
31,237

9,039
1,669
5,363
537
1,274
40
156
NN

15,818
262
2,121
388
2,230
5,495
601
661
240
3,820

20,168
4,777
12,540
1,752
1,099

25,748
982
99
538
24,129

12,388
1,890
1,671
219
1,392
1,159
5,345
657
55

22,541
4,536
2,213
15,028
606
158

3,285


1965



37,14
2,89
38
1,37
19,357
3,95
9,181

16.22.


2,870 I
4,285
3,047
6,020

58,798
8,996
2,187
3,215
27,157
17,243

17,111
759
9,187
2,638
3,950
115
462
NN

26,117
509
1,205
94
4,185
14,435
410
1,120
626
3,533

14,826
3,010
8,324
2,347
1,145

31,553
1,088
116
226
30,123

20,479
3,842
2,963
858
5,916
687
1,398
4,601
214

28,494
7,433
3,405
13,408
203
4,045

2,759


MEN







5
9
3
5
7
1


2


IINGO(COCCAL ]
TOTAL


66 1966



3 144
12
9
4
2 61
17
1 41

16 404
2 64
1 106
9 118
4 116

4 493
2 144
85
87
127
2 50

3 161
35
22
2 63
11
5
9
1 16

11 531
5
49
S 14
S 63
41
1 133
1 54
9 77
95

2 269
2 95
92
58
24

2 418
36
2 159
21
202

94
S5
:- 5
6
49
10
S 13

5

16 614
4 48
3 40
9 504
18
4

16


NrCTIONS,
L Total


{ 1965 1966



142 -
18
9
8
53
16
38

364


59
105
96
104

413
114
47
110
95
47

134
32
12
53
12
3
10
12

513
10
50
11
68
26
109
64
60
115

208
79
67
37
25

340
18
186
21
115

98
2
13
5
27
11
20
17
3

520
41
36
417
18
8


POL IOMYELITI I


1965


Par11ytic
I Culn I y it i vi

1966 19, 66


1 2


11 I -~ 1


RUBELI66


1966


I


I


,








410 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 26, 1966 AND NOVEMBER 27, 1965 (47th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER RABIES IN
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE ANIMALS
AREA SCARLET FEVER (Rky. Mt. Spotted)
966 1966 um 1966 Cum. 1966 Cum. 1966 Cum. 1966 Cum.
1966 1966 1966 1966 1966
UNITED STATES... 8,263 4 175 1 160 2 347 2 241 57 3,663

NEW ENGLAND.......... 1,381 4 1 13 3 1 84
Maine............... 49 25
New Hampshire...... 15 1 29
Vermont............ 25
Massachusetts..... 167 2 1 9 1 4
Rhode Island ....... 78 -
Connecticut......... 1,072 2 4 2 1

MIDDLE ATLANTIC..... 144 14 57 1 47 8 217
New York City...... 10 5 25 1
New York, Up-State. 122 12 13 5 200
New Jersey...... .. NN 2 8 15 -
Pennsylvania....... 12 5 12 1 19 3 16

EAST NORTH CENTRAL... 1,157 20 20 1 42 19 2 470
Ohio................ 103 4 3 1 21 9 197
Indiana............. 110 4 10 4 2 109
Illinois........... 133 4 6 5 10 70
Michigan ........... 228 6 6 41
Wisconsin........... 573 2 1 6 53

WEST NORTH CENTRAL... 476 15 19 33 4 18 838
Minnesota.......... 10 3 1 1 5 200
Iowa................ 236 2 5 155
Missouri........... 7 8 10 17 3 3 244
North Dakota....... 147 1 49
South Dakota....... 17 4 6 103
Nebraska ........... 1 1 2 2 -3 26
Kansas ............. 58 1 2 7 1 61

SOUTH ATLANTIC....... 870 1 33 12 1 67 1 110 9 467
Delaware........... 17 2 -
Maryland........... 71 3 2 1 12 26 3
Dist. of Columbia.. 16 2 -
Virginia............ 272 6 2 16 31 4 238
West Virginia...... 288 1 1 2 56
North Carolina..... 29 4 3 6 27 4
South Carolina..... 22 2 1 13 5 -
Georgia............ 4 1 8 3 4 1 19 1 100
Florida............. 151 10 12 2 66

EAST SOUTH CENTRAL... 1,087 1 25 24 43 43 8 465
Kentucky ........... 24 2 2 10 9 3 110
Tennessee.......... 937 1 7 14 22 25 4 313
Alabama............. 95 8 4 6 7 20
Mississippi........ 31 8 4 5 2 1 22

WEST SOUTH CENTRAL... 481 42 1 72 34 10 10 728
Arkansas ........... 1 4 1 55 4 2 80
Louisiana.......... 10 4 10 1 50
Oklahoma .......... 45 3 7 9 7 4 180
Texas .............. 435 25 6 11 1 5 418

MOUNTAIN............. 1,021 2 9 17 4 95
Montana............. 37 2 7
Idaho.............. 94 -
Wyoming............ 92 3 1 -
Colorado............ 388 2 4 2 18
New Mexico......... 241 1 2 1 16
Arizona............. 66 1 5 42
Utah............... 103 2 5 3
Nevada ............. 1 9

PACIFIC.............. 1,646 2 20 3 41 1 1 299
Washington......... 540 11 15
Oregon............. 46 1 1 4
California.......... 1,011 2 19 3 27 -1 1 280
Alaska.............. 16 -
Hawaii............. 33 -
Puerto Rico......... 17 -
.. .... 53 1 17 18















DEATHS IN 122 UNITED STATES (ITIS FOR WIEIK ENDED NOVEMBER 26, 1966


urrenct ,and wck I Il 'rti i i itg, Exclud-~ f etal deli ths)


Area


NEW ENGLAND:
osIton, Mass.---------
Bridgeport Con.-- --
Cambridge, Mlass.------
Fall River, M-ss.-----
Hart ford, Conn.-------
Lowell, Mas. ---------.
Lynn, Mass.-----------
New Bedford, Ma ss -----
New Hnven, onn.------
Providence, R. I.-----
Somriville, MaIs.- --
Springfield, Mass.---
Waterbury, Conn.------
Worcester, Mass.------

MIDDLE ATLANTIC:
Albany, N. Y.---------
Allent wn, Pa.--------
Buffalo, N. Y.--------
Camden, N. I.----------
Elizabeth, N. J.------
Erie, Pa .-------------
Jersey City, N. J.----
Newark, N. J.---------
New Y.rk City, N. Y.--
Ptatrson, N. J.-------
Philadelphia, Pa.-----
Pitt sburgh, Pa.-------
Reading, Pa.----------
RIch.tster, N. Y.------
tSchtntctady, N. Y.----
Scrant on, Ps.--------
Syracuse, N. Y.-------
TrPnton, N. J.--------
Ut ica, N. Y.----------
Yonkers, N. Y.--------

EAS1 NORTH CENTRAL:
Akron, Ohio-----------
Canton, Oh ...----------
Chicago, Il.*--------
Cincinnati, Ohio------
Clevelaid, 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.-------
P oria, Ill.----------
R ckford, 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.--------


All 165 years and
A Inf luAnza
Ages and over A Ag
All Apes


706
255
40
23
26
54
35
13
21
40
66
12
47
26
48

1.504
50
35
129
32
24
33
75
62
1,593
45
490
140
32
112
114
26
55
38
27
24

2,271
55
25
656
151
170
110
84
295
39
47
27
28
44
124
25
143
29
31
42
88
58

684
39
18
26
124
17
89
57
216
55
43


419
145
23
14
13
32
25
1 1
12
20
37
7
28
18
34

1,743
24
20
67
19
11
16
44
31
917
23
274
71
26
73
12
13
40
22
20
i5

1.263
38
11
346
85
79
57
48
161
26
31
18
17
28
67
14
93
18
20
23
49
34

404
27
15
16
71
11
50
31
122
39
22


I year
All
Causcs


14
14
2

1








3



118
2







6
65
4
13
-












7

5

1
2

1
2

104
4
1
33



3
17

2
i
2
1
7

5
1
4

1
3

32
1
1
3
4


4
14
2
3


*Estimate based on average percent of divisional total.


SOUTH ATIANTIC:
At lantai, (a.---.--------
anI 1t mioI e, Md. ----------
Charli t N. C.--------
acksnvil I., Fl; .-----
Miari, Fla.------------
Norfolk, Va.-----------
RichmInd, Va.----------
Savannah, Ga. ---------
St. Petersburg, Fla.---
Tampa, Fla.------------
Washington, D. C.------
Wilmington, DoI.-------

F.AnT SOI TI CENTRAL:
Birmingham, Ala.-------
Chattanoga, Tenn.-----
inox:vill Tcn.-------
Louisville, Ky.---------
Memphis, Tenn.---------
,Iobile, Ala.------------
Montgomery, Ala.-------
Nashville, Tcnn.-------

WEST SOUTH CENTRAL:
Austin, Tex.-----------
Baton Rouge, La.-------
Corpus Christi, T'x.--
DallaF, Tex.-.----------
El Paso, Trx.----------
Fort Worth, Tcx ------
ioiustoi Tox.---- -----
Littli Rock, Ark. -----
New Orilans, La.--------
Oklahoma City, Okl.--
San Antonio, Toc.------
Shreveport, La.--------
Tulsa, Okla.-----------

'oUNTAIN:
Albuquerque, N. MI::.---
( lorado Springs, Colo.
D never, C lo. ----------
Ogden ,Utah------------
Phoenix, Ariz.---------
Pueblo, Clio.----------
Salt Lake City, Utah---
Tucson, Ariz.--------..

PACIFIC:
Berkeley, Calif.-------
Fresno, Calif.---------
Glendale, Calif.-------
Honolulu, Hawaii-------
ong ach, Calif.-----
Los Argeles, 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 10,883 6,126 362 546

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 586,640
All Causes, Age 65 and over------------------- 336,002
Pneumonia and Influenza, All Ages------------- 24,075
All Causes, Under 1 Year of Age--------------- 31,301


65 year-s


All



49
14
12



4
I

4


5
1


954
115
198
41
62
58
44
76
36
47
73
161
43

585
66
35
40
158
137
23
31
95

919
36
19
18
133
19
102
139
51
188
68
77
37
32

394
36
20
100
it.iO
23
96
22
41
56

1,329
15
36
26
32
61
402
89
32
69
62
92
152
42
129
46
44


and
Inf I unza
All ARCs


35




1
I






4
6
7


21

2
2

13






3

3

3
1













26
5
3


2


3
3

8
3
1

2
1


1

26


2
1

9



5
1
2
4
1


Week No.


(By prince of i-


Mlorbidity and lMortality \\cc






412 Morbidity and Mo





MEASLES 1966 (Continued from page .02)

counties and health districts reporting one or more cases
of measles for the week is shown in Figure 1. This is
the largest number of counties reporting 10 or more cases
for one week so far in the 1966-67 epidemiological year.
Snohomish and Spokane Counties in Washington notified
89 and 60 cases respectively, the highest numbers for the
46th week. Texas has the most counties reporting 10 or
more cases.
(Reported by the Childhood Viral Diseases Unit, Epide-
miology Branch, CDC.)


REVOCATION OF DIAGNOSIS
RABIES Colorado

The original death certificate of an 11-year-old girl
who died in Denver, Colorado, on April 2, 1966, stated
that the cause of death was encephalitis, acute, rabies
suspected (MMWR, Vol. 15. No. 16). The Laboratory of
the Colorado State Department of Public Health had
reported on April 3 that the fluorescent antibody test for
rabies on brain tissue from the case was positive. Ac-
cordingly, an extensive rabies control program was
conducted in the area where the case was believed to
have been exposed.
Further laboratory studies were undertaken in the
Colorado State Department of Public Health Laboratory
and elsewhere. Mouse inoculation failed to reveal rabies
virus. Therefore, the diagnosis has not been confirmed.
On the death certificate, the cause of death has been
corrected to "encephalopathy. acute, etiology undeter-
mined." The case has been deleted from the cumulative
total of human rabies cases in 1966.
(Reported by Dr. C.S. Mollohan, Chief, Epidemiology
Section, Colorado State Department of Public Health.)






ERRATUM, Vol. 15, No. 45, p. 386
The following information was omitted in the article
entitled "Salmonellosis Associated with NonfatDry Milk."
The serotypes contaminating Starlac Instant Nonfat Dry
Milk were Salmonella binza and S. worthington.


reality Weekly Report


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.


UNIV OF PL L'-1
DOCuMrENTS DEF'






U.S. DEPOSITORY


NOVEMBER 26, 1966


a:-~
0 tor
0



H- T1
i3 C~4
O
W N
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