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:
AA00010654:00288

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



COMMUNICABLE DISEASE CENTER


dad


U.S. DEPARTMENT OF HEALTH, EDUCATION,


EPIDEMIOLOGIC NOTES AND REPORTS
SHIGELLOSIS Ogden, Utah i

Fifteen cases of ..,i.',', sonnei infection were f
among three neighboring families in Ogden, Utah, dur '
April and May of 1966. On April 3, 1966, a .c ur-ol.*l
female of Mexican descent was hospitalized with convul-\
sions, fever and diarrhea; S. sonnei was isolated from a
stool culture. The patient was treated with antibiotics and
recovered uneventfully. The Weber County Health Depart-
ment nurse then visited the child's family to investigate
the source of the infection.
The patient lived in a small house with 13 other family
members. Between April 1 and April 23 all members of
the family had been ill. All had had diarrhea and abdom-


0y' V Vol. 15, No. 27

-s*




Week Ending

July 9, 1966



FJFARE PUBLIC HEALTH SERVICE


CONTENTS S
Epiemii sic I Reports
I r te h ... ... .............. 2
~ Pol my jtiks- 1965 ........ ...... 226
P patltls e and Spring Quarter ........ ... 230
Reported ('ase fectious Syphilis ......... 2'29
Internatik, na ote
In l ti t nn Israel ..................... 231
e.i sures .................. 236

inal cramps but the incidence of fever, nausea and vomit-
ing was variable; no bloody diarrhea was noted. Stool
specimens were obtained from each member of the family
and 11 of the 13 specimens were positive for S. sonnei.
The conditions in the home were conducive to the spread
of the infection once it had been introduced. It was learned
(Continued on page 226)


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
27th WEEK ENDED CUMULATIVE, FIRST 27 WEEKS
MEDIAN
DISEASE JULY 9, JULY 10, 1961-1965 MEDIAN
1966 1965 1966 1965 1961-1965
Aseptic meningitis ...................... 40 32 32 805 774 734
Brucellosis.............................. 10 3 7 106 119 200
Diphtheria............................ 5 2 5 84 84 143
Encephalitis, primary:
Arthropod-borne & unspecified.......... 37 31 --- 685 801 --
Encephalitis, post-infectious ............. 17 9 -- 469 425
Hepatitis, serum ............. ........ 30 472 552 680 8,659 24,185
0 472 552 18,659 4 24.185
Hepatitis, infectious .................. .. 416 17,368
Measles rubeolaa).. ..-............... 2061 2,594 4,680 180.620 230,081 365.760
Poliomyelitis. Total (including unspecified) 3 10 28 24 103
Paralytic ............................ 3 7 26 20 86
Nonparalytic ........................... --- 4 -
Meningococcal infections, Total .......... 29 42 28 2.359 2.002 1,476
Civilian ........ ... ..... ........ 27 40 2,098 1.833 -
Military............................... 2 2 -- 261 169 -
Rubella (German measles) .............. 541 --- 38,931 -
Streptococcal sore throat & Scarlet fever 4.584 4,291 3.533 .'..;. i 248.733 218.283
Tetanus .......................... .4 1 118 -
Tularemia.............................. 6 5 74 122 -
Typhoid fever ......................... 7 6 13 159 190 192
Typhus, tick-borne (Rky. Mt. Spotted fever). 5 12 86 99 -
Rabies in Animals. ............... ...64 45 70 2.306 2,505 2.227

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........... ............. 3 Botulism: Calif.-l ... .... ... ... ..... ... 4
Leptospirosis: Hawaii-10. ............. ..... ... 38 Trichinosis: Ill.-1, N.Y.C.-l .. ............ .....53
Malaria: Pa.-6, N.Y.C.-l, Miss.-1, Va.-l .......... ... 154 Rabies in Man: ..... ...... .......... 1
Psittacosis: .. ... .. ..... .. . 23 Rubella. Congenital Syndrome: .... 18
Typhus, marine I 12 Plal-. rar,-i I
*Delayed Report.


PS~ ?.i^9: VB "I







Morbidity and Mortality Weekly Report


EPIDEMIOLOGIC NOTES AND REPORTS
SHIGELLOSIS Ogden, Utah
(Continued from front page)


that the children in this family played with the children
of another family that lived across the street.
This second f:.iI.. of 10 members was then visited
and it was found that two children were also positive for
S. sonnei. The conditions in this home showed a high
standard of personal and domestic hygiene.
Surveys of laboratory records in local hospitals and
inquiries of local pediatricians and druggists suggested
that there had been no generalized increase in gastro-
intestinal illness in Ogden. One hospital laboratory had
isolated S. sonnei on April 27 but at the time of the sur-
vey had not yet reported it to the State Health Depart-
ment. An investigation of the circumstances of this isolate
revealed that it was obtained from an 18-month-old girl
whose mother had been taken ill with diarrhea and fever
on April 25. The child then developed fever, vomiting and
diarrhea on the following day, and was admitted to hos-
pital where S. sonnei was isolated from a specimen. Sub-
sequent rectal swabs obtained on May 20 from both the
mother and the child were still positive for S. sonnei. This
family had lived seven houses from the first two families
and although no specific direct contact between this third
family and either the first or second family could be
established, there appeared to be a great deal of close
contact among individuals in this lower socioeconomic
neighborhood.
Further inquiries made of the first family revealed
that the 16-year-old daughter had recently returned home
from a State institution. She had been in this institution


for approximately one year, returning home about one
week prior to the occurrence of the first case of shigellosis
in her family. She gave a history of gastrointestinal dis-
ease with cramps, nausea, diarrhea and fever within the
month prior to her discharge from the institution, but
specimens had not been obtained for laboratory studies.
There was no evidence uncovered of any increase in
diarrheal disease in the institution at that time.
Subsequent laboratory studies of the first two families
were conducted one month after the onset of illness. These
consisted of the culture of rectal swabs takehi daily for 3
days in succession starting on May 17. Six individuals,
all members of the second family, still yielded cultures
positive for S.sonnei. Cultures of specimens obtained from
40 individuals at the State institution in which the 16-year-
old girl had lived were all negative for shigellae.
These 15 cases of S. sonnei infection found in Ogden,
Utah, during April and May 1966 are thought to represent
a limited community outbreak transmitted by person-to-
person contact. This apparently resulted from the reintro-
duction of a 16-year-old member of one family into the
community from a State institution where she recently had
been ill with gastroenteritis.

(Reported by Dr. G.D. Carlyle Thompson, Director of Pub-
lic Health, Dr. R.W. Sherwood, Director, Preventive
Medicine and Medical Ft. '.: Dr. A.A. Jenkins,
Director of Communicable Disease, all of the Utah State
Department of Health, and an EIS Officer.)


ANNUAL SURVEILLANCE SUMMARY
PARALYTIC POLIOMYELITIS 1965


The final total of paralytic poliomyelitis cases re-
ported to the Poliomyelitis Surveillance Unit of CDC during
1965 is 61 cases. This total is based on the "best avail-
able paralytic case count," the criteria being cases with
residual paralysis at 60 days and cases reported initially
as paralytic polio but which were not followed up. The
national total for 1965 is the lowest yet recorded and is
approximately two-thirds the total in 1964. Forty-three of
the 61 cases occurred from May through August (Figure 1).
Alihhiu'h a summer seasonal peak was not evident in 1964,
the summer incidence is again discernible, but in a slight
degree, in 1965. The geographic distribution of the para-
lytic polio cases is shown in Figure 2; Texas reported the
highest incidence of 18 cases, the majority of which were
located near the Mexican-United States border.
The paralytic cases are presented by age group and
sex in Table 1. Consistent with the trend noted since
1960, approximately one-half of these cases were in chil-


Table 1
Paralytic Poliomyelitis by Age and Sex
United States, 1965


Age Group


Male


Female


Total


Percent


Deaths


0-4 17 14 31 50.8 1
5-9 2 8 10 16.4 1
10-14 4 3 7 11.5 1
15-19 2 0 2 3.3 0
20-29 2 2 4 6.6 1
30-39 2 1 3 4.9 1
40+ 3 1 4 6.6 0

Total 32 29 61 100 5

dren under 5 years of age, eight of whom were infants under
one year of age. Five deaths occurred, two in adult males
(Text continued on page S28)


226


JULY 9. 1966







Morbidity and Mortality Weekly Report


Figure 1
PARALYTIC POLIOMYELITIS CASES
BY DATE OF ONSET, 1961 1965


Figure 2
PARALYTIC POLIOMYELITIS, 1965
61 CASES BY COUNTY, UNITED STATES


SOURCE Poho.~. '.. Surveillance Unit


1961 1962 1963 1964 1965


227


JULY 9. 1966









Morbidity and Mortality Weekly Report


ANNUAL SURVEILLANCE SUMMARY
PARALYTIC POLIOMYELITIS 1965
(Continued from page 226)


and three in female children. Fifty-one of the 61 cases
were in white persons, 5 in Negroes; in 5 cases the
race was not reported.
The age and vaccination status of the 61 cases are
presented in Table 2. As in previous years, poliomyelitis
tended to occur in unimmunized young children. More than
70 percent of the cases had received neither oral nor in-
activated poliovaccine; only 8 of the 61 cases (13.1 per-
cent) had received oral vaccine and only 16 of the 61
cases (24.2 percent) had received inactivated vaccine.
Two children developed paralytic poliomyelitis within
30 days after receiving oral polio vaccine. A one-year-old
female from Louisiana received type III vaccine on January
5, 1965, and developed paralysis on January 17, 1965. A
5-year-old female from Illinois developed a paralytic ill-
ness on December 21, 1965, after receiving trivalent oral
polio vaccine 12 days earlier. Type III poliovirus was


isolated from a stool specimen from the latter patient on
December 31, 1965; however, Coxsackie B3 was isolated
from the spinal fluid.
Eight individuals developed paralytic poliomyelitis
within 60 days after a contact had received oral polio
vaccine. Of these, in three instances type II poliovirus
was recovered from the stool of the patient and in five
instances type III poliovirus was recovered; type I virus
was also isolated from the stool of one patient in the
latter group. Among these eight persons, one death oc-
curred; the postmortem findings in the central nervous
system were characteristic of poliomyelitis. Six of the
eight contact cases had never received oral polio vaccine.
In three of the eight contact cases non-polio entero-
viruses could be implicated. Coxsackie A4 was isolated
from a stool specimen of a patient from Michigan. Cox-
sackie B4 was isolated from the stool of a sibling of a


Table 2
Paralytic Poliomyelitis by Age Group and History of IPV
Classified by Number of OPV Doses, United States, 1965


Cross-classification


IPV Status


10-14


Age Groups


15-19


-4 ------ I -+*-.


4+
1-3
0
4+
1-3
0
4+
1-3
0


4+
1-3
0
4+
1-3
0
4+
1-3
0
unk.


2



1



1







1







5


10


4
3


7


IPV = Inactivated polio vaccine
OPV = Oral polio vaccine
= Indicates none


228


JULY 9, 1966


20-29


30-39


Total


OPV Status


Monovalent
3 OPV



2 OPV



10PV



Trivalent
2 OPV



1 OPV



No OPV


2



1

1
1







1


2


2
7
43
1

61


Total


1

3


4











Morbidity and Mortality Weekly Report


Table 3

Polio\irus Isolations From Paralytic (Cases.
United States. 19.5,-65


Numbers

Year Best Avail.
Paralytic
Count

1958 3,301
1959 5.472
1960 2,218
1961 29
1962 691
1963 336
1964 91
1965 61


of Cases
-------lT Percent

Specimens of Cases -
Submitted* Sti died


1.479
2,775
1,072
481
472
242
77
50


44.8
50.7
48.3
5S.0
68.3
72.0

S4.6
83.3


virusess Identified

T pe
I II I11


898
1,881
603
231
300
160
21
19**


--nk.
Unk.


Percent of
Total Specified
Type
II


194
22S
219
145
100
31
24
11**


'Includes all paralytic cases on AwhIh one or more fecal specimens were examined for virus isolation. State and local health depart-
ment laboratories and laboratories. in academic centers reported these results through State (op)ldPmloniLsts t tthe PohomSehlti
Surveillance Unit.
**Poliovirus type I and type III oere isolated from the same fecal specimen of one c ase from New. York.


patient from Maryland. A falling antibody titer to ECHO
30 was observed in paired sera of a patient from Florida.
Specimens from 50 of the 61 paralytic cases of polio-
myelitis were submitted to a laboratory for isolation. Iso-
lates were obtained from 37 of the 50 cases studied (74
percent).
The distribution of virus types identified since 1958
is shown in Table 3. Type II poliovirus has become rela-


tively more frequent over the past 5 years, especially dur-
ing the last 2 years. Of the eight type II isolates during
1965, three came from individuals who had a known con-
tact with a person proved to be excreting type II virus or
with a person recently vaccinated with trivalent oral
poliovaccine.
(Reported by the Poliomyelitis Surveillance Unit, Epi-
demiology Branch, CD('.)


SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS
JUNE 1966 AND JUNE 1965
CASES OF PRDI1ARY AD SECONDARY SYPHILIS: Reporting Area June 1966 and June 1965 Prvisional Data
Co luative I i C.r.lat .
RP rting Area June Jan Jne Rortin Ar.a Je an June
-- 4 ---
lne................... 1 1 Kentcky ................. ii 14 63 76
e nmpsh7n............ -* 19 TFnsse... .......... 3 55 31
Ver.mt .............. Alabama................. 19 238 627 792
Massachuasets......... 29 14 167 136 Missisippi.............. 33 5 I 29 79
Rhde Island.... ........ 2
Cnnecticut.............. 6 15 49 68 WEST SOUH CENTRAL.......... 1 06 1,285 1,160
Arkansas.............. 6 20 72 122
IDDLE ATLANTIC ......... 316 380 2082 2,296 iuisian..... ........... 39 3 31
state New Y rk......... 26 33 191 238 Oklah a.............. 1 71 72
New York City........... 188 230 1,312 1,381 Texas.................... 1I5 1 2 630 642
Pa. (Excl. Phia.)...... 11 22 9 82
New Jersey.......... 72 84 352 i63 Monana.............. 22 8
Idah ... .........
EAST NORni CENTRAL....... 289 268 1,585 1,507 Wyi-ving ......... .... 2
Ohio...... .......... 51 62 294 319 Cl ado. ................ 2 3 17
lndiana................ 9 7 45 32 New Mexico .............. 12 6 45 56
Donstatc Illinois....... 14 15 99 112 Arizon..... .... 14 25 92 i59
Chicago............ .... 87 112 13 620 ucah.................... 1 5 8
Michgan. .............. 121 62 577 379 'Naada ................... 5 11 34
Wi onran........1. 1i0 57 45
PACIFIC................ ... 167 184 928 1,045
WEST NORTH CENTRAL ........ 34 37 220 251 Washngton............... 2 5 2
Minnesota................ 6 9 17 51 regon.................. 6 2 26 18
Iowa... ............ 5 33 10 California.............. 153 176 866 970
issur..... ........... 8 18 92 126 Alaska................ i 3
'Narh DaK ta .... ........ 4 ..... .......... 1 14 11
South Dakia............. 1 3 23 26
ebraska ................. 2 6 20 30 TOTAL ....... .. 1,693 2,098 10,755 11,604
a. sas ......... .......... 12 1 31 7 1 -
'n W i i0il 81 508 401
427 584 3,082 3,378 76 496 394
4 5 19 29 Islands......... 2 12 7
'ar-yland............... 43 279 206
.stri.ct f C.lumbia.... 38 42 227 251
23 47 147 176
4 8 29 36
Nlrth Car inia....-.. ... 66 76 471 498 tNr: Cuaulatie Tol iclde re 1 ved and dlaye' raprlts
Soh Car a........... 56 4 458 427 through previous 'h.
Georgia...... ... ... 64 115 8509 559
Florida.... ......... 114 174 143 1,196


JULY 9. 1966


229








Morbidity and Mortality Weekly Report


SURVEILLANCE SUMMARY
HEPATITIS Winter and Spring Quarters
Epidemiological Year 1965-66*


The total cases and the reported incidence of viral
hepatitis in the United States in the last two quarters of
the epidemiological year 1965-66 are the lowest reported
for those quarters since 1958-59. The continuing decline
in incidence since 1960-61 peak year is shown in Figure 3.
There were 9,208 cases of viral hepatitis reported in
the United States during the winter quarter, and 7,744
cases reported during the spring quarter of the epidemio-
logical yor 1965-66 (Table 4). This represents rates of


4.7 and 4.0 cases per 100,000 population for these two
quarters, respectively (Table 5). The total reported cases
for the 12-month period is 32,413, and represents an annual
incidence of 16.6 cases per 100,000 population.
(Reported by the Hepatitis Surveillance Unit, CDC.)


*Hepatitis morbidity data are summarized in terms of an "Epi-
demiological year," which runs from the 27th week of each
year through the 26th week of the succeeding year.


Table 4
Number of Reported Cases of Viral Hepatitis
Per Quarter
(Values include revised and delayed reports through
current week)


Epidemi-
ological
year

1958-59
1959-60
1960-61
1961-62
1962-63
1963-64
1964-65
1965-66


Summer Fall Winter Spring Total
quarter quarter quarter quarter year


3,262
4,630
8,940
14,229
10,273
8,969
7,590
7,361


4,243*
6,434
12,403
15,637
1 '.-
10,256
9,350*
8,100


7.088
9,793
23,026
18,028
13,805
12,118
10,311
9,208


4,864
9,917
19,898
13,626
9,861
9,330
7,876
7,744


19,457
30,774
64,267
61,520
45,322
40,673
35,127
32,413


Epidemi-
ological
year


Table 5
Reported Cases of Viral Hepatitis Per
100,000 Population Per Quarter
(Population as of January 1, middle of
epidemiological year)


Summer Fall Winter Spring
quarter quarter quarter quarter


Total
year


1958-59 1.9 2.4 4.0 2.8 11.1
1959-60 2.6 3.6 5.5 5.5 17.2
1960-61 4.9 6.8 12.7 11.0 35.4
1961-62 7.7 8.5 9.8 7.4 33.3
1962-63 5.5 6.1 7.4 5.3 24.2
1963-64 4.7 5.4 6.4 4.9 21.4
1964-65 3.9 4.8 5.3 4.1 18.2
1965-66 3.8 4.2 4.7 4.0 16.6


* 1 week period'


230


JULY 9, 1966








Morbidity and Mortality Weekly Report




INTERNATIONAL NOTES
VIRAL HEPATITIS IN ISRAEL


Viral hepatitis has been a notifiable disease in Israel
since 194s. The trend of reported cases is presented in
Table 6, which gives the attack rate per 100,000 popula-
tion for each year since 1950. The incidence of viral
hepatitis in Israel has varied erratically from a low of
50.9 per 100,000 in 1957, to a high of 130.1 per 100,000
in 1960. Most of the fluctuation in total cases from year
to year is accounted for by the extent of the seasonal
increase, the variations of which are evident in Figure 4.
This pattern contrasts sharply with experience in the
United States and Europe where long-term cyclic swings
have been observed with an interval of 7-10 years between
peaks. The average attack rate of 77.4 per 100,000 in
Israel for reported cases of viral hepatitis over the entire
period of 1953-1964 is approximately 4 times higher than
that of the U.S., but roughly comparable to rates observed
in Western Europe and Scandinavia.
Another contrast in patterns is seen from analysis of
the seasonal distribution of cases by geographic area in
the United States. These indicate that the winter peak
incidence is much more pronounced in colder climates
(Hepatitis Surveillance Report No. 20, September 30, 1964).
Incidence has appeared to change very little from season
to season in the semitropical areas of the United States,
but increases -ignifr. anil during the winter months in
States with colder climates. Israel's warm climate is
equivalent to or warmer than that of the southern United
.rai--. yet Israel annually experiences a large increase
in incidence during winter.


Table 6
Reported Cases of Viral Hepatitis -
State of Israel 1950

Number of
ear
Reported Cases

950 1,139*
951 1,462*
952 990*
953 1.051
954 1,458
955 1,189
956 1,249
957 1,006
958 1,585
959 1,447
960 2,798
961 1,470
962 2,351
963 2,082
964 1,720


Ministry of Health
1964

Attack Rate per
100,000 Population

914.6*
104.1*
68.2*
63.0
84.8
66.1
66.7
50.9
78.0
69.2
130.1
65.7
100.8
85.6
68.1


'Numbers and rates for Jewish population only.
Each year the preponderance of cases has been in the
population under 10 years of age. It is, in fact, the in-
creases in the numbers of cases among children that
accounts for most of the seasonal peaks.
(Contributed by the Ministry of Health, State of Israel; Dr.
Daniel Brachott, Assistant Director General of the Ministry
and Principal Investigator for the Cooperative Hepatitis
Project; Hepatitis Unit, Epidemiology Branch, CDC.)


Figure 4
REPORTED CASES OF VIRAL HEPATITIS
BY MONTH SINCE 1953 STATE OF ISRAEL


-r


A -------


1953 1954 1955 1956 1957 1958 1959 1960 1961


JULY 9. 1966


231


S500
I-
2

S400
0.

m 300
U.
0
C 200


z 100


1962 1963 1964 1965










232 Morbidity and Mortality Weekly Report



CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JULY 9, 1966 AND JULY 10, 1965 (27th 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... 40 32 10 37 31 17 5 2 30 416 472

NEW ENGLAND.......... 3 1 14 34
Maine.............. 3 7
New Hampshire...... 3
Vermont............
Massachusetts...... 3 5 14
Rhode Island...... 1 6
Connecticut........ 1 5 4

MIDDLE ATLANTIC...... 3 5 8 1 13 59 75
New York City...... 1 4 4 5 9 21
New York, Up-State. 2 1 23 20
New Jersey......... 1 1 2 7 13 12
Pennsylvania....... 1 1 14 22

EAST NORTH CENTRAL... 2 2 4 2 4 2 1 67 84
Ohio............... I 1 19 15
Indiana............. 1 9 9
Illinois........... 2 1 3 1 3 2 5 6
Michigan........... 1 30 47
Wisconsin.......... 1 4 7

WEST NORTH CENTRAL... 2 1 1 1 1 1 22 16
Minnesota.......... 1 5
Iowa............... 1 1 1 -7 5
Missouri.............. 1 1 6 5
North Dakota.......
South Dakota.......
Nebraska...........- 3
Kansas............ 4 3

SOUTH ATLANTIC....... 7 1 7 4 2 2 1 2 25 45
Delaware............. 1
Maryland............. 1 1 9 9
Dist. of Columbia.. 1 2
Virginia............ 1 7 3 2
West Virginia...... 2 3
North Carolina.... 3 3
South Carolina .... 1
Georgia............ 1 2 1
Florida............. 5 3 2 1 6 24

EAST SOUTH CENTRAL... 3 6 4 3 5 1 41 32
Kentucky........... 6 3 13 13
Tennessee.......... 1 15 9
Alabama............ 1 7 9
Mississippi........ 3 4 2 2 6 1

WEST SOUTH CENTRAL... 6 8 13 2 2 3 3 30 51
Arkansas.......... 1 1 3
Louisiana.......... 1 1 2 2 7 9
Oklahoma........... 1 1 1
Texas.............. 4 6 11 2 2 3 21 39

MOUNTAIN............... 1 2 1 1 13 27
Montana............ 1 1 -1 1
Idaho.............. 2 2
Wyoming ............
Colorado............ 2 1 1 4
New Mexico........ 3 7
Arizona............. -5 10
Utah............... 1 3
Nevada ............

PACIFIC.............. 16 15 4 3 9 9 145 108
Washington ......... 1 1 I 12 7
Oregon............... 2 1 13 3
California.......... 12 11 3 2 9 9 119 90
Alaska.............. 1 7
Hawaii.............. 2 -

Puerto Rico.......... 14 22









Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JULY 9, 1966 AND JULY 10, 1965 (27th WEEK) CONTINUED


MENINGOCOCCAL INFECTIONS, POLIOMYELITIS
MEASLES (Rubeola) TOTAL RUBELLA
Total Paralytic
AREA
Cumulative Cumulative Cumulative
1966 6 1966 1966 1966 1965 1966 1966 1966

UNITED STATES... 2,061 180,620 230,081 29 2,359 2,002 3 3 26 541

NEW ENGLAND.......... 14 2,150 36,355 1 108 99 77
Maine.............. 1 190 2,742 8 12 5
New Hampshire...... 65 377 9 5 2
Vermont............ 1 219 1,188 1 4 2
Massachusetts...... 1 744 19,109 42 34 24
Rhode Island....... 72 3,870 12 14 7
Connecticut ........ 11 860 9,069 33 32 39

MIDDLE ATLANTIC...... 123 17,516 13,499 5 271 265 30
New York City...... 52 8,158 1,957 1 39 45 5
New York, Up-State. 59 2,209 3,784 76 69 23
New Jersey......... 4 1,850 2,279 2 76 73
Pennsylvania....... 8 5,299 5,479 2 80 78 2

EAST NORTH CENTRAL.. 770 65,878 51,931 3 369 261 1 193
Ohio............... 77 6,212 8,632 1 98 71 9
Indiana............. 95 5,473 1,678 64 36 22
Illinois............. 39 11,095 2,324 72 66 54
Michigan .......... 223 13,089 25,293 99 56 55
Wisconsin.......... 336 30,009 14,004 2 36 32 53

WEST NORTH CENTRAL... 85 8,475 16,134 3 131 105 1 7
Minnesota.......... 5 1,618 614 31 21 -
Iowa............... 42 5,207 8,921 3 21 7 5
Missouri.......... 11 523 2,513 51 47 1
North Dakota....... 25 1,012 3,528 7 7 1
South Dakota....... 2 40 109 4 2
Nebraska........... 75 449 8 10
Kansas............. NN NN NN 9 11

SOUTH ATLANTIC....... 150 14,177 23,817 6 389 396 1 65
Delaware............ 3 243 495 4 5 1- 1
Maryland............. 11 2,055 1,036 1 39 38 7
Dist. of Columbia.. 2 376 64 9 6
Virginia........... 41 1,907 3,906 1 50 46 -- 19
West Virginia...... 33 4,912 13,133 3 15 23 7
North Carolina..... 7 375 361 95 77 -
South Carolina..... 3 615 980 1 45 56 1
Georgia............. 230 598 56 51 1 -
Florida............ 50 3,464 3,244 76 94 30

EAST SOUTH CENTRAL... 184 18,902 13,262 2 209 160 1 92
Kentucky............ 5 4,553 2,374 79 67 11
Tennessee.......... 113 11,774 7,575 68 46 77
Alabama............ 51 1,614 2,252 1 43 28 4
Mississippi........ 15 961 1,061 1 19 19 -

WEST SOUTH CENTRAL... 299 22,985 29,880 3 343 287 3 3 22 1
Arkansas.......... 966 1,080 31 14
Louisiana.......... 3 91 91 129 161 -
Oklahoma............ 4 465 199 18 17 1
Texas.............. 292 21,463 28,510 3 165 95 3 3 21 1

MOUNTAIN ............. 205 11,286 18,821 1 75 61 37
Montana............ 49 1,785 3,583 4 2 1
Idaho.............. 31 1,401 2,607 5 8 -
Wyoming............. 10 143 831 1 6 4 -
Colorado............ 33 1,163 5,422 38 13 19
New Mexico......... 5 1,068 652 10 10 -
Arizona............. 56 5,149 1,141 8 16 17
Utah................ 17 534 4,393 6
Nevada............. 4 43 192 4 2 -

PACIFIC.............. 231 19,251 26,382 5 464 368 1 39
Washington.......... 16 3,405 7,169 35 28 1 8
Oregon.............. 44 1,492 3,095 1 30 28 16
California.......... 137 14,020 12,456 4 380 292 7
Alaska............. 30 221 138 15 13 2
Hawaii ............. 4 I_ 3 524 7 -
Puerto Rico.......... 41 2,324 2,096 8 4 1










234 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JULY 9, 1966 AND JULY 10, 1965 (27th 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... 4,584 4 75 6 74 7 159 5 86 64 2,306

NEW ENGLAND.......... 906 2 1 4 1 2 46
Maine.............. 74 -- 1 16
New Hampshire...... 4 1 13
Vermont ............ 51 15
Massachusetts...... 21 2 1 1 1 2
Rhode Island....... 60
Connecticut....... 696 3 -

MIDDLE ATLANTIC...... 119 1 10 1 33 1 22 7 159
New York City...... 4 3 1 15 -
New York, Up-State. 113 1 2 6 1 10 7 149
New Jersey.......... NN 1 6 8
Pennsylvania....... 2 4 6 4 10

EAST NORTH CENTRAL... 361 7 12 1 24 1 5 11 322
Ohio................ 69 3 3 1 10 3 4 165
Indiana............ 68 1 3 1 3 73
Illinois........... 90 1 5 3 1 2 1 29
Michigan........... 87 2 4 2 28
Wisconsin.......... 47 1 6 1 27

WEST NORTH CENTRAL... 194 6 5 13 2 22 514
Minnesota.......... 1 4 116
Iowa............... 31 1 -4 2 108
Missouri........... 6 4 2 5 1 6 170
North Dakota....... 101 11
South Dakota....... 2 1 51
Nebraska........... 4 1 1 2 13
Kansas............. 50 2 2 1 7 45

SOUTH ATLANTIC....... 454 18 1 8 1 29 1 40 8 296
Delaware ........... 10 -
Maryland........... 57 1 1 6 14
Dist. of Columbia.. 6 -
Virginia........... 81 3 2 8 11 4 178
West Virginia...... 113 1 I 2 39
North Carolina..... 2 1 2 3 1 11 1
South Carolina.... 48 1 1 5 I -
Georgia............ 2 6 1 3 1 46
Florida............ 135 7 1 5 1 32

EAST SOUTH CENTRAL... 822 1 5 15 18 8 2 294
Kentucky........... 23 1 2 2 1 1 50
Tennessee.......... 602 1 1 9 7 7 1 229
Alabama............ 131 3 4 5 12
Mississippi........ 66 4 3

WEST SOUTH CENTRAL... 512 16 5 27 1 13 5 9 484
Arkansas........... 1 2 4 20 1 1 52
Louisiana.......... 4 3 4 22
Oklahoma........... 27 1 1 3 1 4 4 3 130
Texas.............. 484 9 1 4 6 280

MOUNTAIN............. 836 1 4 8 2 3 1 44
Montana............. 28 1 7
Idaho.............. 41
Wyoming............ 6 -
Colorado........... 484 I 3 1 2 7
New Mexico.......... 156 1 1 1 6
Arizona............. 83 1 1 1 22
Utah............... 36 1 3
Nevada............. 2 1 2

PACIFIC.............. 380 2 10 2 3 17 2 147
Washington......... 21 1 2 1
Oregon............. 20 1 I -
California......... 319 2 9 2 2 12 2 146
Alaska ............. 13 -
Hawaii............. 7 2
Puerto Rico.......... 1 2 30 6 8








Morbidity and Mlortality Weekly Report






DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED JULY 9, 1966


235


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

All Causes Pneumonia Under ...
Area All years and I year Area All 65 years and year

Ages and over InfluenzaCa ll Ages and over Influena All
All Ages Causes All Ages Causes


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

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

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

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


786
225
61
37
41
64
33
23
34
60
60
17
53
22
56

4,008
53
53
170
51
50
46
87
107
2,250
42
481
205
68
89
29
34
67
39
37
50

2,865
70
42
855
162
260
133
80
380
54
50
45
27
60
171
46
121
47
34
38
122
68

823
53
25
33
142
18
134
63
251
65
39


491
131
43
23
23
33
16
17
22
35
36
13
40
17
42

2,569
37
36
97
30
33
28
54
63
1,506
22
288
114
52
59
19
17
36
22
23
33

1,681
40
28
479
100
164
77
46
221
36
20
23
15
36
98
22
76
30
20
23
82
45

525
40
14
19
89
14
83
35
167
43
21


*Estimate based on average percent


SOUTH ATLANTIC:
Atlanta, Ga.-----------
Baltimore, Md.---------
Charlotte, N. C.-------
Jacksonville, Fla.-----
Miami, Fla.------------
Norfolk, Va.-----------
Richmond, Va.----------
Savannah, Ga.----------
St. Petersburg, Fla.---
Tampa, Fla.------------
Washington, D. C.------
Wilmington, Del.-------

EAST SOUTH CENTRAL:
Birmingham, Ala.-------
Chattanooga, Tenn.-----
Knoxville, Tenn.-------
Louisville, Ky.--------
Memphis, Tenn.---------
Mobile, Ala.-----------
Montgomery, Ala.-------
Nashville, Tenn.-------

WEST SOUTH CENTRAL:
Austin, Tex.-----------
Baton Rouge, La.-------
Corpus Christi, Tex.---
Dallas, Tex.-----------
El Paso, Tex.----------
Fort Worth, Tex.-------
Houston, Tex.----------
Little Rock, Ark.------
New Orleans, La.-------
Oklahoma City, Okla.---
San Antonio, Tex.------
Shreveport, La.--------
Tulsa, Okla.* ---------

MOUNTAIN:
Albuquerque, N. Mex.---
Colorado Springs, Colo.
Denver, Colo.----------
Ogden, Utah------------
Phoenix, Ariz.---------
Pueblo, Colo.----------
Salt Lake City, Utah---
Tucson, Ariz.----------

PACIFIC:
Berkeley, Calif.-------
Fresno, Calif.---------
Glendale, Calif.-------
Honolulu, Hawaii-------
Long Beach, Calif.-----
Los Angeles, Calif.----
Oakland, Calif.--------
Pasadena, Calif*.------
Portland, Oreg.--------
Sacramento, Calif.-----
San Diego, Calif.------
San Francisco, Calif.--
San Jose, Calif.-------
Seattle, Wash.---------
Spokane, Wash.---------
Tacoma, Wash.----------


1,037
93
266
33
64
68
30
89
23
61
63
204
43

565
72
65
44
110
133
36
29
76

1,034
26
22
26
146
28
58
181
39
210
68
126
50
54

405
42
23
101
18
91
34
51
45

1,360
15
47
36
58
53
392
98
31
104
54
90
152
36
104
49
41


Total 12,883 7,644 525 609

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 348,889
All Causes, Age 65 and over------------------- 201,727
Pneumonia and Influenza, All Ages------------- 15,804
All Causes, Under 1 Year of Age--------------- 18,039


Week No.


of divisional total.










Morbidity and Mortality Weekly Report


INTERNATIONAL NOTES QUARANTINE MEASURES


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


The following information should be added to the list of
Yellow Fever Vaccination Centers in Section 6:

Page 73


City: San Bernardino, California


Center: San Bernardino County Health Department


Clinic Hours: Wednesday. 10 a.m. (by appointment)


Fee: Yes


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, MS
EDITOR: MMWR DJ M MACKENZIE M. B
F R C P E
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





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