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:
AA00010654:00292

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

FC S 2.N /9. E/9,' //
COMMUNICABLE DISEASE CENTER


Vol. 15, No. 16




A. REPORT
MAY
Week Ending

April 23, 1966



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


EPIDEMIOLOGIC NOTES AND REPORTS
HUMAN RABIES Colorado

The first case of human rabies reported in Colorado
since 1931 died in Fitzsimons General Hospital, Denver,
Colorado, on April 2, 1966.

The patient was an 11-year-old girl who lived with
her parents at Widefield, a community about 7 miles
southeast of Colorado Springs, and who had not been
out of the general area for the past year. On March 23
she became ill with fever, sore throat, and "runny"
nose; the following day she was kept home from school.
On March 25 she seemed better and returned to school,
but that evening she experienced severe sore throat,


CONTENTS
Epidemiologic Notes and Reports
Human Rabies Colorado . ..... 133
Surveillance Summary
Reported Cases of Infectious Syphilis March 1966 134
Tuberculosis Mortality in the United States 1964. 135
Recommendations of the Public Health Service
Advisory Committee on Immunization Practice ..... ..136
International Notes Quarantine Measures . 144


muscular pains, profuse vomiting, and she refused food
and liquids. The same symptoms persisted on March 26
and 27, and on March 28 the patient was taken to Ft.
Carson where a tentative diagnosis of viral gastro-
enteritis was made. On the way home she lapsed into
coma and later in the evening evidenced spasmodic


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
16th WEEK ENDED CUMULATIVE, FIRST 16 WEEKS
MEDIAN
DISEASE APRIL 23. APRIL 24, 1961-1965 MEDIAN
1966 1965 1966 1965 1961-1965
Aseptic meningitis .................. ... 20 17 28 443 454 389
Brucellosis ............................ 6 7 9 59 63 110
Diphtheria .......................... 10 2 8 50 69 100
Encephalitis, primary:
Arthropod-borne & unspecified ......... 31 30 393 478
Encephalitis, post-infectious ............ 25 19 271 238
Hepatitis, serum .... ... .............. 30 399 12405 16334
9 12,405 1
Hepatitis ............... ........... 644 11,063
Measles rubeolaa) ....................... 8,514 11,832 17,460 117,800 151.426 200,921
Poliomyelitis, Total (including unspecified) 3 7 6 44
Paralytic ..................... ......... 3 6 4 39
Nonparalytic ........................ -- 2
Meningococcal infections, Total ........ 98 67 52 1,632 1,382 944
Civilian ............................ 91 62 1,427 1.261 --
MilinarN .. ....... .......... ..... ... 7 5 205 121- -
Rubella (German measles) ................ 1,792 22,613 -
Streptococcal sore throat & Scarlet fever .. 10,808 9,717 8,238 186,513 177,503 154,383
Tetanus ............................ .6 7 34 60 -
Tularemia .............. .......... ... 1 47 58 -
Typhoid fever .................... 7 4 7 83 102 113
Typhus, tick-bome (Rky. Mt. Spotted fever). 9 6
Rabies in Animals ...... ___ .......... 113 148 112 1.402 1,689 1,336

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........ ...... ....... ..... ... 2 Botulism: ...... .. .. .. ....... .. .. .... 1
Leptospirosis: .............................. .. 9 Trichinosis: NY Upstate-1, Ohio-i ........ ....... 35
Malaria: Va.-2 .. ......... ....................... 86 Rabies in Man: .......... ......... ....... 1
Psittacosis:.. ........................... .. 16 Rubella, Congenital Syndrome: .............. .. .... 10
Typhus, murine: .......... ...... .. .. ....... 6 ..... .......... ..... ................







Morbidity and Mortality Weekly Report


APRIL 23, 1966


EPIDEMIOLOGIC NOTES AND REPORTS
HUMAN RABIES Colorado (Continued)


contractions of the mouth muscles, severe salivation and
convulsive seizures. She was transferred to Fitzsimons
General Hospital in Denver on March 29 in coma, where,
late in the afternoon, she became cyanotic and had
respiratory failure. Mouth to mouth resuscitation being
unsuccessful, she was placed in a respirator.
The patient expired at 6:00 p.m., April 2, and an
autopsy was performed early. Brain material was positive
for rabies by impression smears and by fluorescent
antibody technique. Further laboratory studies are in
progress but have not yet been completed.
There is no known exposure to a rabid animal in
this case. The local health department has said there is
some evidence that the child was bitten by a dog 10
months ago, but there is no valid history of this and the
animal was neither quarantined nor examined for rabies.


Two cases of animal rabies have been reported from
El Paso County during 1966, one in a cat and one in a
skunk. The last previous rabies reported from the County
was in 1960 when there were three cases.
Due to the prevalence of stray dogs and cats in the
general area of Colorado Springs, a rabies quarantine
covering the southern half of El Paso County was declared
early in March 1966. This quarantine has since been ex-
tended to cover the entire county; an animal vaccination
campaign was initiated at the time quarantine was started
in March. "ir i. dogs and cats are being destroyed.
(Reported by Dr. C. S. Mollohan, Chief, Section of Epi-
demiology, Dr. R. L. Cleere, Director of Public Health,
and Dr. M. D. Baum, Chief, Veterinary Section, Division
of Preventive Medical Services, all of the Colorado
State Department of Public Health.)


SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS

MARCH 1966 AND MARCH 1965

CASES OF PRIMARY AND SECONDARY SYPHILIS: By Reporting Areas March 1966 and March 1965 Provisional Data

Cumulative Cumulative
March March
Reporting Area Jan Mar Reporting Area Jan Mar
1966 1965 1966 1965 1966 1965 1966 1965
NEW ENGLAND............... 43 48 141 126 EAST SOUTH CENTRAL......... 199 207 574 619
Maine.................... 1 2 1 Kentucky ................ 13 12 37 42
New Hampshire............ 1 1 4 5 Tennessee................ 28 46 78 150
Vermont ................. 1 1 Alabama .................. 108 104 292 315
Massachusetts............ 31 34 96 74 Mississippi.............. 50 45 167 112
Rhode Island............ 1 1 5 7
Connecticut.............. 8 12 33 39 WEST SOUTH CENTRAL........ 222 192 665 577
Arkansas.................. 19 19 53 53
MIDDLE ATLANTIC........... 432 411 1,113 1,178 Louisiana ................ 79 42 175 161
Upstate New York......... 47 49 108 133 Oklahoma ................. 10 13 41 42
New York City........... 280 249 709 719 Texas.................... 114 118 396 321
Pa. (Excl. Phila.)....... 21 16 62 45
Philadelphia............. 24 17 67 56 MOUNTAIN.................. 28 51 94 159
New Jersey............... 60 80 167 225 Montana.................. 5 2 10 5
Idaho.................... 1
EAST NORTH CENTRAL........ 246 274 734 734 Wyoming..................- -
Ohio..................... 50 54 139 151 Colorado................. 4 1 13 6
Indiana.................. 4 2 18 14 New Mexico............... 6 10 22 31
Downstate Illinois....... 16 11 52 52 Arizona ................. 10 32 43 90
Chicago................... 104 147 259 316 Utah ..................... 2 1 4 8
Michigan ................. 70 52 240 188 Nevada................... 1 5 2 18
Wisconsin................ 2 8 26 13
PACIFIC.................... 123 201 457 529
WEST NORTH CENTRAL........ 31 51 131 117 Washington............... 7 5 15 25
Minnesota................ 2 15 7 24 Oregon................... 6 2 11 10
Iowa ....... ............ 7 3 22 7 California............... 105 192 422 485
Missouri ................. 14 24 60 57 Alaska................... 1 2 3
North Dakota............. 4 Hawaii................... 5 1 7 6
South Dakota............. 3 5 16 13
Nebraska ................. 3 4 10 11 U. S. TOTAL............... 1,837 2,012 5,473 5,751
Kansas.................... 2 12 5
KasTERRITORIES............... 83 74 245 198
SOUTH ATLANTIC............. 513 577 1,564 1,712 Puerto Rico.............. 82 74 241 197
Delaware................. 3 3 6 14 Virgin Islands........... 1 4 1
Maryland................. 55 39 134 108
District of Columbia..... 43 54 111 133
Virginia.................. 30 21 75 92
West Virginia............ 3 4 18 13
North Carolina........... 76 82 251 255 Note: Cumulative Totals include revised and delayed reports
South Carolina........... 78 68 232 214 through previous months.
Georgia.................. 76 85 275 278
Florida................... 149 221 462 605


134


















According to the final figures recently released by
the National Center for Health .na-ii( -. 8,303 deaths
from tuberculosis were reported in the United States during
1964 compared to 9. 1.1 deaths in 1963. The classification
of the tuberculosis deaths in 1964, by form of disease
and by sex and race of the patients, is set out in Table 1.


The decrease of 1,008 deaths from 1963 to 1964
represents the largest annual decline (10.8 percent) in
tuberculosis mortality recorded since 1954. The trend of
the tuberculosis death rates from 1940 to 1964 is shown
in Figure 1. In 1954, the mortality rate for the United
States, including the States of Alaska and Hawaii, was
10.2 per 100,000 population (16,527 deaths), whereas in
1964 the rate was 4.3 per 100,000 population (8,303
deaths).

Much of this improvement in tuberculosis mortality
in the United States is attributed to the widespread use,
since the early 1950's, of chemotherapeutic drugs in the
care and treatment of tuberculosis. Similar changes have
been reported for many other countries throughout the
world.


(Reported by the Statistical Unit,
CDC.)


Figure 1
TUBERCULOSIS DEATH RATES
CONTINENTAL UNITED STATES
1940 through 1964


60-
50-
40-
0
30-




S15
0


0:
L 10


a
t4
m
4


Tuberculosis Branch,


d i 561 W YEARS16
YEARS


Table 1
Tuberculosis Mortality, United States, 1964


Deaths Rates/100,000 Population
Color
Sex
Respiratory Other Forms Total Respiratory Other Forms Total


White
Male 4,292 236 4,528 5.2 0.3 5.5
Female 1,419 145 1,564 1.6 0.2 1.8

Total 5,711 381 6,092 3.4 0.2 3.6

Non-white
Male 1,371 156 1,527 12.5 1.4 13.9
Female 564 120 684 4.9 1.0 5.9

Total 1,935 276 2,211 8.6 1.2 9.8

All Races
Male 5,663 392 6,055 6.0 0.4 6.4
Female 1,983 265 2,248 2.0 0.3 2.3

Total 7,646 657 8,303 4.0 0.3 4.3


APRIL 23, 1966


Morbidity and Mortality Weekly Report




SURVEILLANCE SUMMARY
TUBERCULOSIS MORTALITY IN THE UNITED STATES, 1964


135


I __


. I







Morbidity and Mortality Weekly Report


APRIL 23, 1966


RECOMMENDATIONS OF THE PUBLIC HEALTH SERVICE ADVISORY
COMMITTEE ON IMMUNIZATION PRACTICE



At its meeting of February 18, 1966, the Public Health Service Advisory Com-
mittee on Immunization Practice issued two statements. The first deals with measles
vaccines and is a revision of the initial recrwamendations which appeared in the MMWR,
Vol. 14, No. 7 (February 20, 1965) and No. 36 (September 11, 1965). The second state-
ment deals with the current status of methodology in the prevention of transfusion-
associated hepatitis.







I. MEASLES VACCINES-STATUS AND RECOMMENDATIONS FOR USE


Highly effective, safe vaccines are available for
eliminating measles in the United States. Virtually all
children will at sometime have clinically evident measles
unless protected by vaccine. Measles is often a severe
disease and is of particular concern because of frequent
complications including broncho-pneumonia, middle ear
infection and encephalitis. Moreover, the encephalitis
which follows measles approximately once per 1,000
cases often results in permanent brain damage and sub-
sequent mental retardation. An average of one measles
death occurs in every 10,000 cases.

All susceptible children by virtue of not having had
natural measles or measles vaccine should be immunized.
Programs directed toward vaccinating children at about
one year of age should be established by all communities.
Also of particular importance is the immunization of
susceptible children entering nursery school, kindergarten
and elementary school, since they are often responsible
for transmission of measles to other children in the
community.

A. Live Attenuated Measles Virus Vaccines (Edmonston
and Schwarz Strains)

Live attenuated measles virus vaccines prepared from
the Edmonston strain or Schwarz (further attenuated)
strain are available for use in the United States. The
Edmonston strain is propagated in either chick embryo or
canine kidney cell cultures and may be given alone or
simultaneously with Measles Immune Globulin according
to manufacturers' directions. The Schwarz strain is
prepared only in chick embryo cell culture and is suitable
for administration without Measles Immune Globulin. The
live attenuated measles virus vaccines produce a mild or
inapparent, non-communicable infection. Fifteen percent
of those receiving either Edmonston strain with Measles
Immune Globulin, or Schwarz strain, may experience fever


of 1030F (rectal) or greater, beginning about the sixth day
and lasting no longer than five days. Edmonston strain
alone may have about twice the frequency of such re-
sponses. However, the great majority of reports indicate
that even children with high fever experience relatively
little discomfort or minimal toxicity and reactions often
go unnoticed by the parents.

An antibody response develops in virtually all
susceptible children given live attenuated measles virus
vaccines. The level and persistence of antibody induced
by Edmonston strain administered alone is similar to that
seen following regular measles. Antibody titers attained
following Edmonston strain with Measles Immune Globulin
or following Schwarz strain are slightly lower. However,
with all three vaccine schedules, protection against
naturally occurring measles appears to be long lasting.

On the basis of experience with more than 10 million
doses administered in the United States, live attenuated
measles virus vaccine appears to be one of the safest
immunizing agents in use. To date, serious reactions
associated with the live attenuated measles virus vac-
cines have been very rare. In some few instances, febrile
convulsions without known sequelae, have been recorded.


B. Inactivated Measles Virus Vaccines

Inactivated vaccines derived from Edmonston strain
measles virus and prepared in either chick embryo or
monkey kidney cell cultures are available. These vac-
cines are administered in a three dose schedule at month-
ly intervals with subsequent boosters. Reactions are not
more frequent than after administration of diphtheria and
tetanus toxoids.

Following the primary immunization with inactivated
measles virus vaccines, the protection achieved has been


136












satisfactory for the first few months, but has been shown
to decline rapidly thereafter. In view of the greater effica-
cy and the safety of live attenuated measles virus vac-
cines, inactivated vaccines are not recommended except
in those instances where the use of live vaccines is
contraindicated.

Combined schedules employing inactivated vaccines
followed by live vaccines have been used (Table 2).
However, there are not sufficient advantages to recom-
mend the use of these schedules; and, furthermore, there
have been preliminary observations of untoward local
tissue reactions when live attenuated measles virus
vaccines have been administered to individuals previously
immunized with inactivated measles vaccines.

C. Recommendations for Vaccine Use

1) Age

Vaccine is indicated primarily for children who have
not had measles. For maximum efficacy, live attenuated
measles virus vaccines should be administered to those
at least 12 months of age. However, they may be given to
infants 9-12 months of age with the realization that there
may be a slight reduction in efficacy, particularly if
Measles Immune Globulin is administered with the vaccine.
Vaccination of adults at the present time is rarely nec-
essary because most individuals are serologically immune
by age 15. Limited data indicate that in the adult, reac-
tions to vaccine are no more common than in children.

2) High Risk Groups

Immunization against measles is particularly impor-
tant for children with chronic illnesses such as heart
disease, cystic "ilbro-i-, and chronic pulmonary diseases
and, indeed, for any individual prone to serious compli-
cations following natural measles.

3) Prevention of Natural Measles Following Exposure

If administered up to and including the day of expo-
sure to natural measles, live attentuated measles virus
vaccines are usually effective in preventing disease.
Limited studies reported to date indicate, however, that
there is no protection conferred by the vaccines when
given at longer intervals following exposure.

D. Community Immunization Programs

1) Ongoing Programs

Universal immunization as part of good health care
should be accomplished through routine and intensive
programs conducted in physicians' offices and public
health clinics. Programs aimed at immunizing children at
about one year of age should be established by all com-
munities. In addition, susceptible children entering


137


nursery school, kindergarten and elementary school should
receive vaccine because of their particular role in com-
munity spread of natural measles.


2) Community-wide Mass Programs

Mass immunization programs may he useful to supple-
ment the ongoing administration of live attenuated measles
virus vaccine in communities or segments of communities
in which the proportion of individuals so protected is
known to be low. However, the following points should
be considered in a community-wide mass immunization
program:

a. The active cooperation of as many physicians as
possible in addition to the official health agencies
normally concerned with the care of children is important.

b. Since live attenuated measles virus vaccines are
administered parenterally, an adequate number of medical
and nursing personnel are required.

c. Despite the acknowledged high incidence of
measles and its frequent, serious complications, substan-
tial effort may he required to achieve complete community
support.

d. Since measles vaccine is contraindicated in some
children, preliminary screening to identify such individuals
is desirable in mass measles immunization programs and
should he provided where capability exists.

e. Although a number of children may have febrile
reactions following live attenuated measles virus vac-
cine, experience in community-wide campaigns and in
private medical practice indicates that only a small
fraction of these reactions requires medical attention.
Parents should be made aware of the reasonable expec-
tations of such reactions in order that no undue concern
develops after the program is underway.

3) Control of Measles Epidemics

Measles surveillance can pinpoint potential out-
breaks in ample time to institute effective control.
Several studies have shown that measles epidemics can
be curtailed or halted by vaccination of selected groups
of children in a community, particularly the susceptibles
in nursery school, kindergarten and the first two or three
grades of elementary school. However, once measles is
widely disseminated in a community, it may be necessary
to immunize susceptible children of all ages in order to
alter the course of an epidemic.

E. Immunization Schedules

Recommended immunization schedules are shown in
Table 2, page 139.


APRIL 23, 1966


Morbidity and Mortality Weekly Report







138


F. Precautions in the Use of Live Attenuated Measles
Virus Vaccines
1) Severe Febrile Illnesses
Vaccination should be postponed.
2) Tuberculosis
Exacerbations of tuberculosis by natural measles
infection have been noted, and by analogy might theoreti-
cally accompany infection with live attenuated measles
viruses. (An observed basis of similarity between the
natural and attenuated viruses is their ability to suppress
tuberculin skin test positivity.) Therefore, individuals
with active tuberculosis should be under treatment when
live attenuated measles virus vaccines are given. Al-
though tuberculin skin testing prior to age one year is
desirable as part of ideal health care for individual
patients, it should not be a routine prerequisite in com-
munity measles immunization programs. For children
included in these programs, the risk from natural measles
often far outweighs the theoretical hazards of possible
exacerbation of undiagnosed tuberculosis.
3) Recent Immune Globulin Administration
Following the administration of more than 0.01 ml/
pound of immune globulin, immunization should be deferred
from six weeks to three months depending on the relative
dosage administered, since the persistence of measles
antibody in the globulin may interfere with response to
to the vaccine.
4) Marked Hypersensitivity to Vaccine Components
Measles vaccines produced in chick embryo cell
cultures should not be given to children sensitive to egg
protein as indicated by their inability to eat eggs or egg
products. Similarly, vaccines produced in canine cell cul-
tures should not be administered to children highly
sensitive to dog hair or dog dander.
5) Concurrent Use of Live Attenuated Measles Virus Vac-
cines With Other Live Virus Vaccines
Theoretical possibilities of superimposed reactions
and suppressed antibody responses have led to general
acceptance of the desirability of not administering more
than one live antigen at a time when they can efficiently
he given separately. Ideally, primary oral poliomyelitis
immunization should be completed prior to the time indi-
cated for measles vaccine and the two antigens separated


APRIL 23, 1966


by at least one month. Since smallpox and measles vac-
cines may each produce febrile reactions, similarly, there
is merit in administering them at different times. When
combined administration is elected for reasons of patient
inaccessibility or threat of concimitant exposures,
current information from field investigations would suggest
that results comparable to those following separate ad-
ministration can be anticipated.


G. Contraindications to Use of Live Attenuated Measles
Virus Vaccines
If measles immunization is indicated for persons with
diagnoses listed in the following three groups, inactivated
measles vaccine should be used.

1) Leukemia, Lympomas and Other Generalized Malig-
nancies

Although there are no reports of unusual complications
of vaccine administration in children with severe under-
lying diseases other than leukemia, it is conceivable on
theoretical grounds that in such individuals, potentiation
of the attenuated measles virus infection might occur.

2) Altered Resistance from Therapy with agents such as
steroids, alkylating drugs, antimetabolites, and irradiation.

3) Pregnancy
Purely on speculative grounds, there is reluctance
to risk fetal damage which might theoretically be related
to attenuated measles virus infection.

H. Continued Surveillance
Intensive surveillance of measles and its complica-
tions is needed to appraise the effectiveness of national
immunization programs. Such surveillance activities can
delineate failures to achieve adequate levels of protec-
tion and the definition of groups in which epidemic con-
trol programs should be instituted.
Although more than 10 million doses of measles
vaccine have been administered in the United States,
continuous and careful review of adverse reactions is of
utmost importance. All serious reactions should be
carefully evaluated and reported in detail to local and
State health officials. The Communicable Disease Center
should maintain close surveillance of all such experiences.


II. PREVENTION OF TRANSFUSION-ASSOCIATED HEPATITIS


The riskof viral hepatitis following blood transfusion
represents a serious and continuing problem. A number of
reports indicate that the incidence of clinical hepatitis
is greater among recipients of blood obtained from certain
categories of donors. The risk also becomes greater as
the number of transfusions increases. In addition, the


case-fatality rate of transfusion-associated hepatitis
increases with advancing age.
Evidence has been advanced both for and against the
effectiveness of immune globulin in the prophylaxis of
transfusion-associated hepatitis. ,lihough the adminis-
tration of immune globulin in a dose of 10 ml at the time


Morbidity and Mortality Weekly Report







Morbidity and Mortalii


of the transfusion and again one month later has been
reported by some investigators to be effective in reducing
the number of cases, evidence of the 'ff,. .. of this pro-
cedure is lacking in other carefully conducted trials. In
view of these uncertainties, existing data do not provide
a basis for allocating supplies of immune globulin for its
routine administration to recipients of blood transfusions.


APRIL 23, 1966


Table 2

IMMUNIZATION SCHEDULES FOR MEASLES VACCINES


Type of Vaccine

Live attenuated
measles virus
vaccine
(Edmonston "rr r, i

Live attenuated
measles virus
vaccine
(Edmonston Strain)
plus Measles Immune
Globulin


3 Live "further
attenuated" measles
virus vaccine
(Schwarz Strain)

4 Inactivated
Vaccine


Inactivated vaccine
followed by live
attenuated measles
virus vaccine


Doses* and
Age
Age Administration

12** Months 1
and Older



12** Months 1 plus Measles
and Older Immune Globulin
(.01 ml per lb.
at different site
with different
syringe)

12** Months 1
and Older


Any Age










12 Months
and Older






Under 12
Months


3 (monthly
intervals) plus a
booster dose at
one year






1 dose inactivated
vaccine followed in
1 to 3 months by 1
dose live attenu-
ated measles virus
vaccine

3 doses inactivated
vaccine at monthly
intervals followed
by 1 dose live
attenuated measles
virus vaccine at 12
months or older.


Comments


Although the live attenuated measles
virus vaccine may be administered
safely with or without Measles
Immune Globulin, many physicians
will wish to give the two simultane-
ously because of the lessened
frequency of clinical reactions.


Clinical reactions approximate those
observed in schedule 2; Measles
Immune Globulin is not recommended
with this vaccine.

In view of the rapid fall-off in
antibody and evidence of decreasing
immunity following a primary immuni-
zation series, use of this vaccine is
not recommended except for special
groups in which live attenuated
measles virus vaccine is contra-
indicated.




The preceding administration of
inactivated vaccine serves to reduce
the frequency and severity of clinical
reactions following live attenuated
measles virus vaccine administration.
Local tissue reactions have been
Noted in some instances.


ty Weekly Report 139




Several methods for lowering the incidence of trans-
fusion-associated hepatitis are available. More attention
should be directed toward enforcement of adequate
standards of donor quality, development of central regis-
tries for the identification of known or suspect carriers,
and encouraging the practice of using blood and potenti-
ally icterogenic blood products only when necessary.


Schedule

1


5


*Manufacturers' directions regarding volume of dose should be followed.
**May be given to infants between 9 months and 1 year with the expectation of slightly decreased efficacy especially
if administered simultaneously with Measles Immune Globulin.









1410 %lorbidily and Mortality Weekly Report



CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

APRIL 23, 1966 AND APRIL 24, 1965 (16th 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... 20 17 6 31 30 25 10 2 30 644 695

NEW ENGLAND.......... 1 1 2 1 2 1 35 41
Maine............. 3 14
New Hampshire...... 1 3
Vermont............ 1
Massachusetts...... 1 2 1 1 1 27 15
Rhode Island....... I 3
Connecticut........ 1 4 5

MIDDLE ATLANTIC...... 2 3 10 10 4 14 85 124
New York City...... 2 1 4 11 8 21
New York, Up-State. 2 4 2 1 31 56
New Jersey.......... 5 2 2 19 18
Pennsylvania....... 1 2 3 1 27 29

EAST NORTH CENTRAL... 3 2 5 2 4 4 92 137
Ohio................ 3 2 30 30
Indiana............ 1 11 8
Illinois........... 2 1 4 28
Michigan............ 3 1 1 4 2 41 60
Wisconsin.......... 6 11

WEST NORTH CENTRAL... 2 1 39 65
Minnesota............ 1 1 3
Iowa............... 1 5 42
Missouri........... 28 4
North Dakota....... -- 2
South Dakota....... 4
Nebraska........... 1
Kansas............. 3 11

SOUTH ATLANTIC....... 2 4 5 5 1 1 1 91 61
Delaware............ 1
Maryland........... 3 31 8
Dist. of Columbia.. -
Virginia........... 1 1 8 22
West Virginia...... 8 4
North Carolina..... 2 1 4 1 12 5
South Carolina..... 1 2
Georgia............. 1 16 2
Florida............ 3 1 1 15 17

EAST SOUTH CENTRAL... 1 1 1 1 3 1 81 38
Kentucky........... I 35 8
Tennessee.......... 1 1 1 3 17 14
Alabama............ 19 11
Mississippi........ 1 10 5

WEST SOUTH CENTRAL... 3 3 1 2 1 1 58 51
Arkansas............ 2 1 9 3
Louisiana.......... 1 1 10 8
Oklahoma............. 2 -
Texas............... 3 1 38 40

MOUNTAIN............. 1 2 1 9 17 40
Montana............. 9 3 2
Idaho............... 2 3
Wyoming.............. 1 1
Colorado............ 1 2 13
New Mexico......... 6 9
Arizona ............ 3 5
Utah............... 2 7
Nevada............. 1-

PACIFIC............... 9 3 1 4 8 10 1 10 146 138
Washington.......... 13 5
Oregon.............. 1 18 7
California.......... 9 3 1 3 8 10 1 10 110 121
Alaska............. 1 3
Hawaii .... ......... 4 2

Puerto Rico.......... 29 20









Morbidity and Mortality Weekly Report


(ASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

APRIL 23, 1966 AND APRIL 24, 1965 (16th WEEK) CONTINUED


MEAS
AREA

1966

UNITED STATES... 8,514

NEW ENGLAND.......... I 81
Maine ..............i 8
New Hampshire...... 5
Vermont............. 2
Massachusetts...... 31
Rhode Island....... 4
Connecticut........ 31

MIDDLE ATLANTIC...... 651
New York City...... i 228
New York, Up-State. 93
New Jersey......... 77
Pennsylvania....... 253

EAST NORTH CENTRAL... 2,543
Ohio............... 484
Indiana............. 279
Illinois........... 233
Michigan........... 291
Wisconsin.......... 1,256

WEST NORTH CENTRAL... 390
Minnesota........... 99
Iowa............... i 223
Missouri............ | 56
North Dakota....... 10
South Dakota.......
Nebraska ........... 2
Kansas............. NN

SOUTH ATLANTIC........ 628
Delaware........... 3
Maryland............ 66
Dist. of Columbia. 5
Virginia........... i110
West Virginia..... 192
North Carolina..... 5
South Carolina..... 27
Georgia ........... -
Florida ............ 220

EAST SOUTH CENTRAL... 1,262
Kentucky............ 212
Tennessee.......... 556
Alabama............. 451
Mississippi........ 43

WEST SOUTH CENTRAL... 1,249
Arkansas............ 50
Louisiana.......... 4
Oklahoma............ 44
Texas.............. 1,151

MOUNTAIN............. 635
Montana............. 123
Idaho............... 41
Wyoming............ 7
Colorado............ 39
New Mexico.......... 133
Arizona............. 278
Utah................ 14
Nevada...............

PACIFIC.............. 1,075
Washington......... 61
Oregon............. 74
California......... 925
Alaska............. 7
Hawaii............. 8
Puerto Rico.......... 89


LES (Rubeola)

Cumulative
1966 1965
117,800 151,426

1,399 28,388
154 2,083
25 335
204 493
538 15,785
61 3,094
417 6,598

13,786 6,368
6,948 687
1,448 2,063
1,473 1,102
3,917 2,516

44,080 28,680
3,750 5,893
2,773 1,111
8,804 1,060
7,188 15,370
21,565 5,246

5,505 11,626
1,337 369
3,005 6,419
371 1,757
745 2,728
3 63
44 290
NN NN

9,082 17,265
120 390
1,375 646
307 27
956 2,659
3,485 10,289
150 206
426 713
177 478
2,086 1,857

13,296 9,706
3,902 1,870
7,511 5,345
1,229 1,744
654 747

13,790 21,447
425 832
68 54
312 125
12,985 20,436

6,548 11,868
990 2,794
655 1,746
89 623
680 2,555
465 469
3,452 496
193 3,057
24 128

10,314 16,078
1,852 4,800
795 2,276
7,539 7,043
58 106
70 1,853
1,485 1,052


MENINGOCOCCAL INFECTIONS, POLIOMYELITIS
TOTAL RUBELLA
TOTAL Total Paralytic

Cumulative Cumulative
S1966 19 1965 1966 1965 166 1966 1966

98 1,632 1,382 6 1,792

1 73 70 257
7 8 5
7 4 2
3 2 5
1 30 23 123
5 11 7
21 22 115

9 176 181 87
1 25 27 32
1 48 43 53
4 51 61 -
3 52 50 2

20 244 168 372
6 67 51 33
2 38 23 166
3 46 43 79
6 68 28 94
3 25 23 -

7 87 75 1 126
1 22 15 1 12
1 13 2 113
S 33 37 -
3 3 1
1 3 2
3 6 9
1 7 7 -

19 263 276 1 139
S 3 3 -
2 25 26 7
6 4
5 38 29 23
1 9 22 16
5 53 42
2 36 44 5
S 41 35 1
4 52 71 88

10 139 99 356
5 62 44 230
1 41 29 120
4 27 20 6
9 6 -

15 247 224 3 15
1 13 12 -
5 95 126 -
1 10 16 1
8 129 70 2 15

S 56 49 176
3 1 11
1 7 3
1 2 50
32 11 17
9 7 -
8 14 91
5 4
2 2 -

17 347 240 1 264
2 21 17 1 85
5 20 18 20
9 289 198 141
1 14 4 12
3 3 6
2 3 1









142 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

APRIL 23, 1966 AND APRIL 24, 1965(16th WEEK) -CONTINUED


STREPTOCOCCAL TYPHUS FEVER RABIES IN
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE ANIMALS
AREA SCARLET FEVER (Rky. Mt. Spotted)
966 1966 Cum. 1966 Cum. 1966 Cum. 1966 Cum. 1966 Cum.
1966 1966 1966 1966 1966


UNITED STATES... 10,808 6 34 47 7 83 9 113 1,042

NEW ENGLAND........... 1,677 2 1 3 3 16
Maine.............. 86 -
New Hampshire.....,. 25 6
Vermont............ 4 3 10
Massachusetts...... 295 2 1 -
Rhode Island....... 124 -
Connecticut........ 1,143 --- 3 -

MIDDLE ATLANTIC...... 413 5 3 20 1 10 103
New York City...... 22 3 3 11 -
New York, Up-State. 326 3 10 98
New Jersey......... NN 3 -
Pennsylvania....... 65 2 3 1 5

EAST NORTH CENTRAL... 1,307 1 3 12 2 15 13 198
Ohio................ 177 3 6 104
Indiana............ 275 1 3 2 7 45
Illinois........... 177 1 1 5 1 2 2 15
Michigan........... 281 1 2 2 17
Wisconsin.......... 397 1 1 3 2 17

WEST NORTH CENTRAL... 325 1 2 3 1 9 1 25 305
Minnesota.......... 14 4 55
Iowa............... 160 3 1 69
Missouri.......... 16 1 2 1 4 12 118
North Dakota...... 76 5
South Dakota....... 26 -- 5 33
Nebraska .......... 7 1 1 7
Kansas.............. 26 2 1 1 3 18

SOUTH ATLANTIC....... 1,421 8 6 15 6 14 181
Delaware........... 32 -
Maryland............ 232 5
Dist. of Columbia.. 2 -
Virginia........... 440 2 6 2 6 122
West Virginia...... 288 1 1 3 21
North Carolina..... 19 2 2 -3 -
South Carolina..... 116 I 1
Georgia............ 3 3 1 3 23
Florida............. 289 4 I 2 15

EAST SOUTH CENTRAL... 1,879 1 2 12 7 12 197
Kentucky........... 449 2 1 1 27
Tennessee........... 1,241 6 4 9 164
Alabama............. 112 1 2 4 2 2 6
Mississippi ....... 77 -

WEST SOUTH CElNRAL... 1,023 2 8 11 3 1 24 303
Arkansas........... 2 2 2 9 1 38
Louisiana.......... 3 3 1 1 1 17
Oklahoma............ 74 1 16 84
Texas............... 944 3 1 1 7 164

MOUNTAIN ............. 1,408 1 1 1 6 7 25
Montana............ 84 4 6
Idaho.............. 156 -
Wyoming............ 16 -
Colorado........... 667 1 1 2 1
New Mexico......... 249 5
Arizona............ 81 1 2 12
Utah................ 155 1 3
Nevada............ 1 1

PACIFIC............. 1,355 3 1 1 5 5 74
Washington........ 450 -
Oregon.............. 35 -
California......... 763 3 1 3 5 74
Alaska............. 59 -
Hawai 4.. 1


......... .,... .
Puerto Rico .......... 7 4 15 3 3






Morbidity and Mortality Weekly Report






Week No. Table 4. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED APRIL 23, 1966


143


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

All Causes Pneumonia Under All Causes Pneumonia Under
Area All 65 years and 1 year Area All 65 years and year
Ages and over Influenza Ca s Ages and over influenza 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.--------


733
215
32
30
30
61
26
17
27
54
69
8
63
30
71

3,682
41
44
195
51
37
42
68
74
1,871
37
572
226
60
114
23
46
70
54
30
27

2,782
71
52
878
142
201
127
81
369
32
50
43
39
58
199
33
111
32
39
30
121
74

942
51
24
53
135
33
132
70
289
102
53


458
122
21
18
25
39
17
12
13
33
39
8
45
20
46

2,240
22
26
113
30
23
28
46
41
1,150
18
338
131
44
74
9
29
52
25
23
18

1,556
44
27
484
92
107
69
47
206
17
32
25
19
34
99
17
64
17
18
18
71
49

614
40
16
30
92
23
89
49
167
72
36


*Estimate based on average percent of divisional total.


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

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

WEST SOUTH CENTRAL:
Austin, Tex.-----------
Baton Rouge, La.-------
Corpus Christi, Tex.---
Dallas, 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.----------


1,290
129
281
58
73
91
54
93
33
101
93
233
51

612
99
53
45
121
115
37
45
97

1,043
30
37
31
143
26
76
175
59
182
82
86
54
62

444
43
16
124
13
115
21
54
58

1,664
18
60
29
40
77
448
99
49
134
59
98
213
37
190
64
49


Total 13,192 7,705 631 658

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 212,971
All Causes, Age 65 and over------------------- 124,032
Pneumonia and Influenza, All Ages------------- 10,541
All Causes, Under 1 Year of Age--------------- 10,801








144 Morbidity and Mo






INTERNATIONAL NOTES-QUARANTINE MEASURES


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


Page 15-Plague
Paragraph 2, Line 4


Delete "The complete standard course need not be
repeated at that time."


Insert "Anyone who has had a previous vaccination
against plague should receive two injections
spaced at a thirty day interval. Children may
be vaccinated against plague at the age of
three months."


rtality Weekly Report


APRIL 23. 1966


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULAR.
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.
EDITOR: MMWR D.J.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
COMMUNICABLE DISEASES. SUCH COMMUNICATIONS SHOULD BE
ADDRESSED TO:
THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT
COMMUNICABLE DISEASE CENTER
ATLANTA. GEORGIA 30S33
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 NATIONALBASIS ARE RELEASED
ON THE SUCCEEDING FRIDAY.


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