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:
AA00010654:00343

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

FS/ M i DISEASE CENTO ER
SMU B DISEASE CENTER


Vol. 15, No. 52

WEEKLY

REPORT

Week Ending
December 31, 1966


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


CURRENT TRENDS
MEASLES 1966

For the 52nd week (ending December 31, I't.i,.
1,080 cases of measles were reported, representing an
increase of 132 cases over the preceding week but a
decrease of 2,320 cases from the total of 3,400 for the
52nd week in 1965. The substantial decrease in numbers
of reported measles cases in 1966, particularly during
the month of December, is compared to the numbers
reported for the previous 4 years in Figure 1. The States
recording the highest numbers of measles cases for the
52nd week are Texas with 219 cases and Arkansas with
207.


5,000-





4,000-

V)
w



cr
0
<
S 3,000



L-
0 2,000-
(E




0
0D


I ,000


CONTENTS
Current Trends
Measles- 1966 ............. ............ 449
Malaria- 1966 .................. ... 51
Epidemiologic Notes and Rep rts
Transfusion Induced Malaria- Nw York City 151
Sylvatic Plague New Mexsieo . ....... 53
Index Volume 15 196 . ........ ... 15

A total of 23 counties reported "outbreaks" of mea-
sles from October 15 through December 24 (Table 1).
The weeks in which certain counties have undertaken
special control measures are indicated in the Table.
(Reported by the Childhood Viral Diseases Unit, Epi-
demiology Branch, CDC.) (Table 1 on page 450)


Figure 1
CURRENT U.S. MEASLES INCIDENCE COMPARED WITH YEARS, 1962-1965


13 20 27 3 10 17 24 I 8
AUG. SEPT


15 22 29 5 12 19 26 3 10 17 24 31
OCT. NOV DEC.


WEEK ENDING






450


Morbidity and Mortality Weekly Report


CURRENT TRENDS MEASLES-1966 (Continued from front page)

Table 1. Counties Reporting "Outbreaks" of Measles*


State


Arkansas
Colorado
Kentucky
Michigan
Mississippi
Nebraska
North Carolina
Oklahoma
Oregon
Oregon
Tennessee
Texas
Texas
Texas
Texas
Texas
Texas
SWs-hihngton
Washington
Washington
Washington
Washington
Wisconsin


County


Ouachita
Pueblo
Menifee
Wayne
Oktibbeha
Richardson
Durham
Kay
Lane
Washington
Maury
Brown
Hutchinson
Parker
Pecos
Red River
Travis
Benton
Franklyn
King
Snohomish
Spokane
Waupaca


Pop.
(1,000's)

32
119
4

26
14
112
51
163
92
42
25
34
23
12
16
212
62
23
935
172
278
35


November
5 12 19

10
6 26
1 15
10 71 16
59
8 41 18
1 34


3 3
12 69
25
3

18
6
14
3 1


1 18
56 65t
14
17 13
2 50
27 13
7 14
11 26
5 20


DECEMBER 31, 1966


December
3 10 17


42 64
35 9
25 16
33 31
8 13
7 18
112
5 3
7 4
10 19
30 36
5 30
4 15
29 50
21 23
49
12 12


*Criteria for "outbreaks":
Pop. at least 1.000,000: 25 cases for 2 consecutive weeks. Pop. 100,000-499,999: 15 cases for 2 consecutive weeks.
Pop. 500.000-999,999: 20 cases for 2 consecutive weeks. Pop. less than 100.000: 10 cases for 2 consecutive weeks.
TImmunization program begun according to reports received by MMWR.

CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
52nd WEEK ENDED CUMULATIVE, FIRST 52 WEEKS
MEDIAN
DISEASE DECEMBER 31, JANUARY 1, 1961-1965 MEDIAN
1966 1966 1966 1965 1961-1965
Aseptic meningitis ........... .. .. .25 47 27 2,933 2,145 2.135
Brucellosis .......................... 5 16 9 240 261 400
Diphtheria. ............... ............. 9 4 5 204 165 298
Encephalitis, primary:
Arthropod-borne & unspecified ......... 29 23 -- 2.130 1,880 --
Encephalitis, post-infectious ............ 6 13 -- 711 654 --
Hepatitis, serum ........................ 21 1.483
674 808 3 33.648 42,891
Hepatitis, infectious, 608 32.467
Measles rubeolaa) ... ....... ....... 1,080 3.400 3,668 202,797 265.501 421.847
Poliomyelitis, Total (including unspecified) 2 7 10 99 67 446
Paralytic ............................ 2 4 10 93 50 382
Nonparalytic .......................... -. --- -... 9
Meningococcal infections. Total .......... 40 83 53 3,373 3,051 2,356
Civilian ............ ... ........... .34 78 3.042 2.835 -
Military .............. ........... 6 5 --- 331 216 -
Rubella (German measles) ................ 234 --- --- 45892 --- ---
Streptococcal sore throat & Scarlet fever 8,551 7,759 6,094 421.688 389,813 339,479
Tetanus .................................. 2 12 --- 194 285 --
Tularemia ............................. 8 9 --- 185 247 -
Typhoid fever .......................... 3 19 13 369 461 528
Typhus, tick-borne (Rky. Mt. Spotted fever) 1 249 262 -

Rabies in Animals ... .. ......... 84 85 61 3,984 4,248 3.711

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: .... ...... ..... .............. ...... 7 Botulism: ............. ......... ................. 10
Leptospirosis: Md.-l, NY UpS.-1 ..................... 72 Trichinosis: ........ ......................... .... 95
Malaria: Ala.-1,Cal.-7. Mass.-l, Mich.-1.N.C.-4, W.Va.-I 517 Rabies in Man: ............. ... .......... .... 1
Psittacosis: Minn.-1 ................ ...... ........ 47 Rubella, Congenital Syndrome: ..................... ... 23
Typhus, murine AXi -1 T, % -1 3 P Pij,:-u. 5














A case of blood transfusion induced malaria in a
64-year-old man has recently been reported from New York
City. The patient had onset of chills and fever on Octo-
ber 29, 1966; Plasmodium falciparum parasites were found
in blood smears. He had not traveled outside the United
States since he emigrated from Italy in 1913 and he did
not have a history of self-inoculations. Because of contin-
uous massive bleedings from the renal pelvis, the patient
had received 70 units of blood over the 2-year period prior
to onset of malaria.
During the 2 months preceding the onset of illness
he received two units of blood on September 6 and 20,
and on October 14, 1966. Five of the six blood donors
were located and none of them had a history of malaria,
overseas travel, blood transfusions or drug addiction.
The sixth donor was identified as a 28-year-old male
Ghanaian who had resided in New York City from July
ihrnuA:h November 1966. He had donated blood on Octo-
ber 14. At the time of the investigation, the donor had
returned to Ghana. The blood bank records do not indicate
a history of malaria in this donor, but malaria is known
to be endemic in Ghana.


(Reported by Dr. Tibor Fodor, Chief, Division of Epi-
demioloyy and Diagnosis, and Dr. Howard B. ',.4 "'
Chief, Tropical Disease Division, both of the Bureau of
Preventable Diseases, of New York Department of
Health: and Dr. Murray Wittner, Department of P .
Albert Kinstrin (olleye of Mfedicine, Bronx, New York.)

Editorial Note:
Since 1957, 10 cases of blood transfusion induced
malaria have been reported to the Communicable Disease
Center. Of these, 7 cases were due to P. malaria, one
to P. vivax, one to a mixed infection of P. malaria and
P. falciparum, and in one case the plasmodium species is
unknown. In only one instance was the infectious blood
donor identified (New York City, 1958).





Reference:
IBrady, Jacob A., and Dunn, Frederick 1..: Malaria Sur-
veillance in the United States, 1958. Amerr J. Trop. Med.
8(6):635-639. (Nov.) 1959.


CURRENT TRENDS
MALARIA 1966


A large increase in the number of cases of malaria
in persons returning from overseas has been reported to
the Parasitic Diseases Section of the Communicable
Disease Center through November 1966. These imported*
cases enhance the risk of focal re-establishment and
transmission of malaria in this country and the subsequent
occurrence of introduced cases. Similarly, the possibility
of transmission of malaria through blood transfusions may
result in induced cases of malaria. This report provides
current surveillance information on malaria in the United
States and is issued in an effort to alert public health
officials and practicing physicians to the increasing
likelihood that they may encounter this disease.
From January 1 to November 29, 1966, the Malaria
Surveillance Unit received epidemiologic information on
390 cases of malaria with onsets in the United States.
klh,,ueh a substantial number of cases occurring during
this period may still be reported, the current total is
already more than twice the number reported during the
whole of 1965, and a larger total than for any year in the
past decade (Figure 2). Seventy-eight of the cases with


onset in the United States occurred in civilians and 312
cases in military personnel.t The number of civilian
cases thus far in 1966 is comparable to that reported in
preceding years. The number of military cases with onsets
!hriu,'i.h October 1966 has shown more than a ninefold
increase compared with the same period in 1965. A rising
trend has been apparent in the occurrence of military
cases as the year has progressed. An additional 278 cases
were diagnosed in American servicemen overseas who
were subsequently transferred to the United States for
treatment.
All but 4 of the 390 cases have been in persons who
acquired their infection abroad. Two cases of Plasmo-
dium aivax malaria from Fort Knox, Kentucky, in May
were in 5-and 3-year-old .l.nir-.i (MMIR Vol. 15, No. 21).
The diagnosis was confirmed by the Parasitology Unit
of the Laboratory Branch, CDC, on the basis of exam-
ination of the blood slides. Such epidemiologic evidence
as the children's negative history of travel and blood
transfusions and their proximity to large numbers of
personnel returning from malarious areas in Asia suggested


*Definitions of malaria terminology used:
Imported malaria acquired outside of a specific area (U.S.A. in this report).
Introduced malaria acquired by mosquito transmission contracted from an imported case in an area where malaria is not a regular
occurrence.
Induced- malaria acquired through artificial means, i.e., malariotherapy, blood transfusion, common syringes.
includes veterans discharged from the Armed Forces in 1965 or 1966.


DECEMBER 31, 1966


Morbidity and Mortality Weekly Report


EPIDEMIOLOGIC NOTES AND REPORTS
TRANSFUSION INDUCED MALARIA-New York City







Morbidity and Mortality Weekly Report


DECEMBER 31, 1966


that the most probable mode of infection was by introduc-
tion. Transmission probably occurred during the late
summer of 1965 with delayed primary attacks following a
prolonged incubation period; however, the specific source
of infection has not been identified. One case of congen-
ital malaria due to-P. malaria was detected in August in
Chicago, a rare form of transmission not likely to be
witnessed frequently in the United States (MMWR, Vol. 15,
No. 34). A case of induced falciparum malaria occurred
in a 64-year-old man in New York ( Ir following a blood
transfusion (MMWR, Vol. 15, No. 52).

Figure 2
MALARIA
MILITARY AND CIVILIAN, UNITED STATES
1956-1966*


M- lB T N 19 96 15$ W 961 92 593 I96 I96 I196 1963
*TMROUG MV 29. 1966

Editorial Note:
Several effects of the increased prevalence of malaria
in the United States may be anticipated. These include
the likelihood that physicians unfamiliar with malaria
may encounter cases of either imported or introduced
malaria and that these infections may be caused by drug-
resistant forms of P. falciparum.
Since the incubation period of malaria can be so
much longer than international travel itineraries, phy-
sicians in private practice are increasingly likely to be
consulted by a patient who has malaria. These may be
servicemen who are often given prolonged home leave
upon their return from overseas duty. Recently discharged
veterans are also likely to be found infected; thus far in
1966, 62 persons had their onset of malaria after their
discharge from military service.
The importance of an accurate diagnosis and the
quality of the blood film on which it is inevitably based
cannot be overemphasized. Because of the general lack
of experience in malaria techniques, these films are often


of very poor quality. The following instructions may
serve as a guide for the preparation of blood films for
malaria diagnosis. The ideal smear is one which incor-
porates a thick and a thin film as illustrated in Figures
3 through 5.

Guide for Preparation of Malaria Blood Films:
1. Manufacturers' "pre-cleaned" slides are not con-
sidered clean enough for use in malaria diagnosis.
Prior to use, such slides should be washed in mild
detergent, rinsed thoroughly in warm running water,
then distilled water, and dipped in ethyl alcohol
(90-95 percent). Slides may then be wiped dry with
a lintless cloth or tissue for immediate use or
stored in 95 percent alcohol until needed.
2. The patient's finger should be cleaned with alco-
hol and wiped dry with a clean cloth or gauze.
3. After the finger is punctured with the blood lan-
cet, allow a large globule of blood to form.
4. Place cleaned surface of slide against drop of
blood and with a quick circular motion, make a
film the size of a dime in the middle third of one
end of the slide. Ordinary newsprint should be
barely legible through such a wet drop (Figure 3).
Excessive mixing or stirring with a second slide
leads to distortion of blood cells and parasites.


Figure 3


in all their ph .lu .nr p.lr
tance of the t iae~ ..1: 1 -t..d
films for the ,p S ,1 '1..
parasites will b, W ril -rl ..frdr



5. The finger should then be wiped dry and a small
drop of blood gently squeezed from the puncture
and placed at the edge of the middle third of the
same slide (Figure 4).


Figure 4


6. Apply a clean "spreader" slide to the edge of the
small drop ata 45 angle and allow the blood to
extend about two-thirds of the slide width: then


452









keeping even contact, push the spreader forward
along the slide. This will produce an even layer
of red blood cells with a ''-. lh.rine" at the
lower edge (Figure 5).

Figure 5


7. The blood film should be kept horizontal and pro-
tected from dust and insects while the thick film


453


dries (minimum of 6 hours at room temperature).
8. Label the slide in the upper part of the thin film
with the date and the name or initials of the pa-
tient as illustrated (Figure 5).

It is requested that thick and thin blood smears for
confirmation of the diagnosis of malaria be sent through
the State Health Department Laboratories to the National
Malaria Repository, Parasitology Section, Laboratory
Branch, Communicable Disease Center, Atlanta, Georgia.
Epidemiologic and therapeutic questions on malaria in the
United States should be directed to: Parasitic Diseases
Section (Malaria Surveillance Unit), Communicable Disease
('enter. Atlanta, Georgia 30333; telephone Area Code 404
633-3311. Extension 3676.


EPIDEMIOLOGIC NOTES AND REPORTS
SYLVATIC PLAGUE-New Mexico


On December 12, 1966, the New Mexico Department of
Public Health was informed of a die-off of jack rabbits,
cottontail rabbits, and pack rats in DeBaca County. A
plague surveillance team sent to the area to collect spec-
imens and to ir. .-r ii._ the extent of the epizootic de-
termined that the die-off extended at least 15 miles east
and south of Fort Sumner. Reports now indicate that a
major portion of the County is involved.
Pasteurella pestis was isolated from tissue of a
cottontail rabbit that had recently died about 12 miles
south of Fort Sumner. Identification was made by micro-
biologic reactions including positive fluorescent anti-
body inhibition test, lysis by phage at 370C and 2)0-250C.
positive agglutination test, biochemical reactions, and
the demonstration of typical p.Iilarjui."i. in guinea pigs.
By these same methods, P. pestis was isolated and iden-
tified from fleas (Thrasis fotus) obtained from a second
cottontail rabbit trapped 8 miles south of Fort Sumner.
Fleas (Hoplopsyllus glacialis affinis) combed from other
cottontail rabbits were injected into guinea pigs; lesions


produced were characteristic of plague and were presump-
tively positive for P. pestis by fluorescent antibody test.
Organisms compatible with P. pestis have been observed
in tissues of other rabbits and pack rats trapped, shot, or
found dead in the area. Laboratory studies are continuing
on additional tissues and ectoparasites.
In DeBaca County, rabbits are trapped and netted for
live shipment to other states by railway express or truck
for use as fox food and the training of race dogs. On the
day that plague was confirmed in the current epizootic,
a shipment of rabbits awaiting transport to Florida was
stopped. A shipment which had been made to Missouri 3
days previously is currently being traced. Unofficial in-
formation indicates that at times during the past few years
shipments have also been made to New Jersey, Massachu-
setts, Indiana. and Hyoming.
Following confirmation of P. pestis infection, the
New Mexico Department of Game and Fish issued an order

(Continued on page 460)


INDEX VOLUME 15 1966


AMEBIASIS
Epidemic Reports
South Carolina, 343
ANTHRAX
Epidemic Reports
Delaware, 162
Massachusetts, 201
BOTULISM
Epidemic Reports
California, 349. 359
Indiana, 386
New York, 65


CARBON MONOXIDE POISONING
Epidemic Reports
Illinois, 145
CHOLERA
Summary
Current, 343, 348
CLOSTRIDIUM PERFRINGENS
Epidemic Reports
Oregon, 426
Wisconsin, 103


(Continued on page 454)


DECEMBER 31, 1966


Morbidity and Mortality Weekly Report






Morbidity and Mortality Weekly Report


DECEMBER 31. 1966


INDEX VOLUME 15 1966 (Continued)


DIPHTHERIA
Epidemic Reports
Michigan, 116
Montana, 171
South Carolina, 326
Recommendation of the PHS Advisory Committee on
Immunization Practices-Diphtheria, Tetanus, and
Pertussis Vaccines. 416
E. COLI DIARRHEA
Epidemic Reports
Illinois, 94
ENCEPHALITIS, ARTHROPOD-BORNE
Epidemic Reports
Louisiana, 262, 340
Missouri, 301. 335
Ohio. 340
Texas. 261, 274, 281, 290, 301. 309, 334, 335
Summary
Annual. 265
Current. 371

ENCEPHALITIS, POST-INFECTIOUS
Summary
Annual, 263
Current, 3, 125, 283. 359

ENCEPHALOPATHY
Epidemic Reports
Maryland, 117

FILARIASIS
Epidemic Reports
Kentucky, 161

GASTROENTERITIS
Epidemic Reports
Connecticut, 254
New Jersey, 393
Oregon, 426

HEPATITIS
Epidemic Reports
New Jersey, 393
New York, 9
Wisconsin, 219
Summary ,
Current, 16, 86, 230
International
Israel, 231
Recommendation of the PHS Advisory Committee on
Immunization Practices-Hepatitis, 138
INFLUENZA
Epidemic Reports
Alaska, 62
Arizona, 82
California, 45, 54
Colorado, 94
Florida, 44
Georgia, 44
Idaho, 62, 82
Illinois, 83
Iowa, 83
Maine, 45, 119


Massachusetts, 44
Michigan. 83
Nebraska, 119
Nevada. 83
New Jersey, 62
New York, 83
Ohio, 94
Oklahoma, 94
Oregon, 85
Pennsylvania, 85
Rhode Island, 45
Texas, 100
Vermont, 65
Virginia, 92
Washington. 54
Summary
Current. 44, 53, 61, 65, 75. 82, 93, 102, 119, 127
Annual, 360 (1965-66 Season)
International
Canada, 65
Czechoslovakia, 45
Great Britain. 26, 52
Hungary, 45
Netherlands. 52
Romania, 52
Summary, 65, 92
Laboratory Findings, 54
National Pneumonia-Influenza Mortality Chart, 19, 46.
63, 84, 102, 127, 363
Recommendation of the PHS Advisory Committee on
Immunization Practices-Influenza. 238

INVESTIGATIONAL VACCINES PROGRAM
Lab. Branch. CDC, 132

MALARIA
Epidemic Reports
Florida, 272
Illinois, 289
Kentucky, 177
New York, 451
Summary
Annual, 187
Current, 25, 33, 101. 283, 451
MEASLES
Epidemic Reports
Arkansas, 433, 448
Connecticut, 379
Kentucky, 60, 67, 443
Maine. 379
Massachusetts, 379
Michigan, 41, 73, 370
Missouri, 370
Montana, 400
New Jersey, 17, 357, 392
New York, 379
North Carolina, 414
Oklahoma, 402
Oregon, 400, 401
Pennsylvania, 414
Rhode Island, 18, 402
Vermont, 370
.i- l,.ihrr i.n. 402
Wisconsin, 400


454






DECEMBER 31, 1966


Morbidity and Mortality Weekly Report


INDEX VOLUME 15 1966 (Continued)


Wyoming, 395
Summary
Current, 2, 34, 74, 111, 147, 178, 209, 302, 342, 358,
369, 378, 387, 394, 402, 413, 426, 433, 443, 449
Annual, 384 (1965 Measles Mortality)
Measles Vaccine Distribution, 425
Statement on Eradication of Measles, 376
Recommendation of the PHS Advisory Committee on n
Immunization Practices-Measles, 136
MENINGITIS, ASEPTIC
Epidemic Reports
New Jersey, 341
South Carolina, 195
Summary
Current, 194, 327
MENINGOCOCCAL INFECTION
Epidemic Reports
Arkansas, 162
Armed Forces, 43
Summary
Current. 43, 55, 66, 85, 109, 162, 274
MERCURY POISONING
International
Guatemala. 35
MORTALITY (EXCESS)
Related to Heat Wave, 245
PARAGONIMIASIS
Epidemic Reports
Arkansas, 110
PLAGUE
Epidemic Reports
California, 169
New Mexico, 218, 262, 453
Texas, 377
Utah, 193
Summary
Current, 262
International
Viet Nam, 8
POLIOMYELITIS
Epidemic Reports
Texas, 217, ..'. 273, 310
Summary
Current, 179
Annual, 226
QUARANTINE MEASURES
8, 24, 40, 72, 100, 124, 144, 168, 176, 236, 272,
288, 300, 308, 348, 1':l. 440, 448
RABIES
Epidemic Reports
Colorado, 133, 412 (Revocation)
South Dakota, 325
Summary
Current, 311, 318
Annual, 291
RECOMMENDATIONS OF THE PHS ADVISORY COM-
MITTEE ON IMMUNIZATION PRACTICES
Diphtheria, T, ran,J-. and Pertussis, 416
Hepatitis, 138


Influenza, 238
Measles. 136
Smallpox, 404
Typhoid and Paratyphoid A & B, 247
REPORTED DEATHS (IN 122 U.S. CITIES)
27, 46, 47, 63, 64, 84, 102, 127, -1 .. 363
SALMONELLOSIS
Epidemic Reports
Arizona, 153
Massachusetts, 282
New Jersey, 185, 200
New York, 185, 200
Pennsylvania, 185, 200
Washington, 282
Associated with Carmine Dye, 415
Associated with Nonfat Dry Milk. 385
Summary
Current, 154, 211, 255, 317, 418

SHIGELLOSIS
Epidemic Reports
Florida, 441
Illinois, 170
Utah, 225
Wisconsin, 1
Summary
Current, 146, 327, 442
SMALLPOX
International
Britain, 152, 160, 184, 202, 260, 290,
Canada, 80
Recommendation of the PHS Advisory Committee on
Immunization Practices-Smallpox, 404
STAPHYLOCOCCAL FOOD POISONING
Epidemic Reports
Illionis, 81
STREPTOCOCCAL INFECTION
Epidemic Reports
Washington, 324
SYPHILIS
Summary
Current (Tables) 11, 67, 95, 134, 211, 229. 275,
319, 351, 403, 435
TUBERCULOSIS
Summary
Current, 27
Annual, 135,434
PHS Recommendations on the Use of BCG Vaccine in
the U.S., 350
TYPHOID FEVER
Epidemic Reports
Maryland, 237
Nebraska, 333
Recommendation of the PHS Advisory Committee on
Immunization Practices-Typhoid and Paratyphoid
A & B Vaccine, 247
VESICULAR STOMATITIS VIRUS
Epidemic Reports
Colorado, 186
New Mexico, 186


455







456 Morbidity and Mortality Weekly Report



CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 31, 1966 AND JANUARY 1, 1966 (52nd 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... 25 47 5 29 23 6 9 4 21 608 674

NEW ENGLAND.......... 2 4 2 34 30
Maine.............. 1 8
New Hampshire...... 1 1 3
Vermont............. 1
Massachusetts...... 2 1 14 15
Rhode Island....... 2 -- 8 1
Connecticut........ 2 10 2

MIDDLE ATLANTIC...... 2 6 6 7 1 11 105 111
New York City...... 1 4 6 2 10 29 28
New York, Up-State. 1 1 1 1 34 36
New Jersey......... 1 4 13 21
Pennsylvania....... 1 29 26

EAST NORTH CENTRAL... 2 6 1 7 2 1 95 125
Ohio................ 5 1 18 27
Indiana........... 5 9 12
Illinois........... 1 1 21 10
Michigan........... 1 1 2 38 65
Wisconsin.......... 1 1 9 11

WEST NORTH CENTRAL. .. 3 1 1 2 31 24
Minnesota.......... 1 11 6
Iowa............... 3 1 8 4
Missouri............ 2 3 4
North Dakota........ 3 1
South Dakota....... 2
Nebraska........... 1 1
Kansas............. --- 5 6

SOUTH ATLANTIC....... 2 4 2 3 2 1 1 1 54 95
Delaware............. 9
Maryland........... 1 13 44
Dist. of Columbia.. 7
Virginia........... 2 4 10
West Virginia...... 2 12
North Carolina..... 3 8 6
South Carolina..... 1 3
Georgia............. 9
Florida............. 2 1 2 1 1 9 13

EAST SOUTH CENTRAL.. 1 1 3 1 1 1 30 35
Kentucky............. 6 17
Tennessee.......... 1 1 15 13
Alabama............. 1 1 7 2
Mississippi........ I 3 2 3

WEST SOUTH CENTRAL... 1 4 1 1 6 1 44 49
Arkansas............ 1 1 6
Louisiana.......... 1 1 10 7
Oklahoma............. 3 5
Texas.............. 1 4 6 30 31

MOUNTAIN............. 5 2 7 1 1 49 57
Montana............ I 3 1 1
Idaho.............. 3 4
Wyoming............ 6
Colorado........... 2 4 2 27
New Mexico......... 1 2 11 7
Arizona............ 31 5
Utah................ 1 1 2 6
Nevada.............. 1

PACIFIC.............. 17 16 3 4 2 1 5 166 148
Washington......... 1 4 1 1 2 18 12
Oregon............. I 35 11
California......... 14 12 3 3 2 3 112 115
Alaska.............. 1 9
Hawaii........... .. 1 I I1

Puerto Rico........... I 17 21








Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 31, 1966 AND JANUARY 1. 1966 (52nd WEEK) CONTINUED


AREA



UNITED STATES...

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.............


MEASLES (Rubeola)


1966

1,080


H w i .. ... .. .. .
Puerto Rico .......... 79


Cumulative


1966 1965
202,797 265,501

2,604 37,488
307 2,949
80 383
348 1,457
844 19,505
75 3,972
950 9,222

18,617 19,423
8,381 4,127
2,687 4,512
2,033 4,140
5,516 6,644

70,625 64,776
6,511 9,277
5,834 2,366
11,555 4,565
15,221 28,161
31,504 20,407

9,386 17,578
1,690 950
5,478 9,309
539 2,688
1,439 4,045
40 116
200 470
NN NN

16,331 27,301
268 519
2,133 1,365
390 176
2,268 4,325
5,580 14,872
827 419
664 1,262
244 655
3,957 3,708

20,837 16,356
4,877 3,805
12,754 9,043
1,842 2,358
1,364 1,150

27,609 32,207
1,389 1,195
108 134
672 244
25,440 30,634

12,785 21,100
1,935 3,928
1,715 3,119
236 879
1,467 6,009
1,282 694
5,386 1,588
690 4,658
74 225

24,003 29,272
5,342 7,619
2,596 3,520
15,254 13,864
646 215
165 4.054
3,588 3,009


MENINGOCOCCAL INFECTIONS,
TOTAL


1






1

7
2
1
3
1

3

1




2
1
2
1







1






6
2






2




4
1



12
1
1
1
1

1







1


12


12


Cumulative
1966 1965
3,373 3,051


155
12
11
4
62
21
45

448
67
115
140
126

536
158
89
97
135
57

179
41
23
66
11
6
13
19

569
7
54
15
67
50
142
55
79
100

288
97
98
62
S 31

448
38
171
24
215

95
5
5
6
49
10
13
2
5

655
58
42
533
18
4


POLIOMYELITIS


Total


Paralytic
Cumulative
1965 1966 1966

7 2 93


S 19 11 I 1


457


1 66

40


-
r 4 -


-


RUBELLA


1966

234

14
4


8
2


15
3
9

3

62
7
2
3
12
38

28
1
19

8




21

1

12
4



4

20
3
15
2


1



1

21



6

15



52
15
10
24

3








458 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 31, 1966 AND JANUARY 1, 1966 (52nd 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... 8,551 2 194 8 185 3 369 249 84 3,984

NEW ENGLAND........... 1,131 4 1 2 13 3 1 89
Maine.............. 32 26
New Hampshire...... 38 31
Vermont............ 1 27
Massachusetts...... 281 2 1 2 9 1 4
Rhode Island....... 83 -
Connecticut........ 697 2 4 2 1

MIDDLE ATLANTIC...... 331 15 1 62 49 232
New York City...... 12 5 25 1
New York, Up-State. 319 2 15 13 215
New Jersey......... NN 3 8 16 -
Pennsylvania....... 5 1 14 20 16

EAST NORTH CENTRAL... 928 21 1 24 46 20 3 496
Ohio................ 134 5 3 21 9 2 206
Indiana............. 85 4 11 5 113
Illinois........... 169 4 1 9 7 11 1 75
Michigan............ 384 6 7 43
Wisconsin.......... 156 2 1 6 59

WEST NORTH CENTRAL... 363 15 20 34 4 18 926
Minnesota.......... 8 3 1 1 2 222
Iowa................ 137 2 5 2 168
Missouri........... 8 11 18 3 6 260
North Dakota....... 158 I 2 63
South Dakota....... 26 4 6 123
Nebraska........... 1 1 2 2 29
Kansas............. 33 1 2 7 1 61

SOUTH ATLANTIC....... 751 1 38 16 70 114 6 508
Delaware........... 3 1 2
Maryland............ 162 3 5 12 27 3
Dist. of Columbia.. 11 2 2
Virginia........... 200 6 3 16 31 3 256
West Virginia...... 174 1 1 60
North Carolina..... 34 4 3 6 27 4
South Carolina..... 2 1 15 5 1
Georgia............ 8 8 3 4 22 110
Florida............ 159 1 15 13 3 74

EAST SOUTH CENTRAL... 1,047 28 4 28 47 44 16 521
Kentucky........... 22 2 2 10 9 4 125
Tennessee.......... 897 9 4 18 24 26 12 353
Alabama ............ 117 8 4 6 7 21
Mississippi........ 11 9 4 7 2 22

WEST SOUTH CENTRAL... 748 48 1 76 36 10 9 770
Arkansas........... 7 5 1 57 5 2 1 86
Louisiana.......... 12 4 10 4 59
Oklahoma........... 61 3 8 10 7 1 185
Texas............... 680 28 7 11 1 3 440

MOUNTAIN ............. 1,908 2 1 15 16 4 8 107
Montana............. 47 2 7
Idaho............... 99 -
Wyoming............. 44 6 1
Colorado........... 1,318 2 2 3 2 18
New Mexico......... 222 1 2 1 2 20
Arizona............. 109 I 5 6 50
Utah............... 66 1 3 5 3
Nevada ............. 3 1 9

PACIFIC.............. 1,344 1 23 4 2 45 1 23 335
Washington......... 336 13 15
Oregon.............. 46 1 2 1 5
California ....... 851 21 4 2 29 1 23 315
Alaska.............. 51
Hawaii. ............ 60 2
Puerto Ric........... 2 54 19 20







Morbidity and Mortality 'Wekl Report






DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED DECEMBER 31, 1966


459


52 (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 1 year
Ages and over Influenza All Ages an er Influenza All
Ages and overAll Ages Causes A and over 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.-------


783
239
44
29
41
71
51
24
30
32
81
14
52
21
54

3,610
67
45
153
52
51
32
88
87
1,828
45
549
190
63
105
18
42
52
67
39
37

2,651
72
34
790
148
210
137
105
354
47
52
38
29
56
147
31
112
49
40
36
105
59

778
43
19
40
144
17
101
62
209
93
50


488
134
27
20
33
37
28
17
21
20
58
10
35
14
34

2,093
34
26
83
38
31
19
56
34
1,053
32
312
100
42
72
14
24
32
32
30
29

1,485
46
18
405
97
115
77
55
193
25
25
24
11
39
80
19
76
25
28
27
69
31

458
26
12
23
78
12
61
34
122
62
28


1
9
4
2

3
5

37
1
1
3
7
1
2
2
12
6
2


*Estimate basedd on average percent of divisional total.


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.-----------


1,138
105
280
62
65
87
51
91
28
72
83
186
28

550
85
25
33
88
136
45
41
97

970
31
30
23
118
39
67
167
38
189
76
106
37
49

512
66
22
137
18
133
26
62
48

1,441
29
43
40
51
78
308
66
25
119
91
91
218
66
132
51
33


Total 12,433 7,086 463 611

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 650,413
All Causes, Age 65 and over------------------- 372,232
Pneumonia and Influenza, All Ages------------- 26,394
All Causes, Under 1 Year of Age--------------- 34,696


Week No.







460


Morbidity and Mortality Weekly Report


SYLVATIC PLAGUE-New Mexico
(Continued from page 453)

on December 23, 1966, prohibiting the hunting and trap-
ping of rabbits in DeBaca County. Other control measures
include general publicity for personal protection and plans
for a dusting program for communities in the area.
Including the recent epizootic in DeBaca County, P.
pestis has now been isolated from wild rodents, rabbits,
hares, and/or their fleas in 23 of New Mexico's 32 coun-
ties. The prairie dog and rabbit have been associated with
cases of human plague most often. Since 1949 there have
been 22 human cases, five of which are known to have
developed infection following contact with rabbits.

(Reported by Dr. Thomas H. Tomlinson, Associate Direc-
tor; Daniel E. Johnson, Ph.D., Chief, Public Health
Laboratories; and Bryan Miller, M.S., Chief, Vector Con-
trol Division, all of the New Mexico Department of Public
Health.)


DECEMBER 31, 1966


O 0

o 0


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.


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