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:
AA00010654:00358

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
COMMUNICABLE DISEASE CENTER


Vol. 15, No. 31







uWeek Ending
. ugust 6, 1966


U.S. DEPARTMENT OF HEALTH, EDUCATION, AND


ENCEPHALITIS TEXAS C(ON TENTS


During the last week of July and the first week of
August 1966, 13 cases of encephalitis are known to have
occurred among adults from one area of Dallas. These
patients have all been admitted to one hospital in Dallas:
they range in age from 35 to 71 years. The area in which
the patients reside is one in which flooding occurred
earlier in the year, with resultant large mosquito pop-
ulations. Early serum specimens from 5 of the 13 cases
have been submitted to the State Laboratory in Austin.
Three of the five specimens showed positive titers for
CF-antibody to Group B arboviruses, suggesting that
these cases may represent St. Louis encephalitis viral


Epidemriologi' Not.es and Reports
Encephaliti Texas ............. ......... 261
Eastern Enc.ephalitis Louisiana .. .. 262
Current Trends
Plague ..... .... ... ... ...... 2(62
Malaria Death in American Civilian . 272
Annual Sur\ei llance Summnar
Encephalitis ............ .263
Quarantine Measures
International Certificates of \ ac nation . 272



infection. An intensive program of control and investigation
is underway.
(Reported by Dr. Van C. Tipton, State Epidemiologist,
Texas State Department of Health.)


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
31st WEEK ENDED CUMULATIVE, FIRST 31 WEEKS
MEDIAN
DISEASE AUGUST 6, AUGUST 7, 1961-1965 MEDIAN
1966 1965 1966 1965 1961-1965
Aseptic meningitis .................... 89 64 64 1.100 968 952
Brucellosis. .. .... ..... 3 5 8 125 140 241
Diphtheria. .. ..... 1 1 2 99 89 160
Encephalitis, primary:
Arthropod-borne & unspecified ....... 38 41 825 952
Encephalitis. post-infectious ........ 13 13 532 483
Hepatitis, serum ................... .. 43 813 26.800
Hepatitis, infectious ........... 555 519 682 19.548 20790 26800
Measles rubeolaa) .... .. .. .... 844 1.145 1,807 186.154 236.488 380,528
Poliomyelitis, Total (including unspecified) 10 6 9 53 35 146
Paralytic ..... ... ... 9 5 8 48 30 121
Nonparalytic ........................ 1 --- 5 -
Meningococcal infections. Total ........ 43 40 33 2.526 2.167 1.618
Civilian .. .... .. ... 43 36 2,262 1,988
Military ...... ..... ............ 4 --- 264 179
Rubella (German measles) ............... 281 --- 40.316 --- --
Streptococcal sore throat & Scarlet fever .. 4.396 4.081 3.446 286.026 265,358 232,721
Tetanus. ......... . .. 6 12 97 150 -
Tularemia ........... .. ... 2 3 89 148 -
Typhoid fever . ... 12 15 15 206 229 252
Typhus, tick-borne (Rky Mt. Spotted fever). 16 15 148 168

Rabies in Animals...................... 70 74 66 2,595 2,848 2.542

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum Cum.
Anthrax: .. 4..... .... .. Botulism: ... .. ... 4
Leptospirosis: Hawaii-2 ......... .. 42 Trichinosis: Conn.-l .......... 58
Malaria: Pa.-1. Ill.-l, Calif.-1 .......... .. 187 Rabies in Man: ... 1
Psittacosis: Conn.- .. .......... .............. 26 Rubella, Congenital Syndrome ... ............ 18
Typhus. marine: ....... .............. 14 Plague: .. ..... 4







Morbidity and Mortality Weekly Report


AUGUST 6, 1966


EPIDEMIOLOGIC NOTES AND REPORTS
EASTERN ENCEPHALITIS Louisiana


Through the week ending July 30, 1966, the Louisiana
State Board of Health received reports of 135 cases of
encephalitis in horses. This number is the largest known
to have occurred since 1947. The cases were distributed
over 17 parishes, with a marked concentration in the area
immediately west and north of the City of New Orleans.
Eastern encephalitis virus has been isolated from two
brain specimens obtained from horses in Jefferson and
Lafayette parishes, respectively. Several additional
cases have been confirmed by serological testing. Vac-
cination of horses is being carried out, and it is estimated
that 80 percent of the equine population in the area has
been immunized to date.
During the same period of time, eight cases of primary
encephalitis in humans have been reported in Louisiana.
An intensive search for other cases in the City of New
Orleans and in the epizootic area uncovered 16 additional
illnesses, suggestive of central nervous system infection.
Sera from 12 patients were tested for hemagglutination-
inhibiting antibody to the virus of Eastern encephalitis
and were negative.
A survey of mosquitoes in the greater New Orleans
area revealed a late emergence this year of Mansonia
perturbans along the western margin of the City. As a
result, this species was unusually prevalent in July.
Aedes sollicitans, a suspected vector for human cases of
Eastern encephalitis, was generally scarce as a result of
mosquito abatement programs in and surrounding Orleans
Parish. Samples of the mosquito population and blood
specimens from wild birds are currently being tested for
the presence of arboviruses.


Figure 1
DISTRIBUTION OF HORSE CASES OF ENCEPHALITIS
LOUISIANA, 1966


In summary, although an epizootic of Eastern enceph-
alitis has been occurring in horses in Louisiana, there
is no evidence for a concurrent human outbreak.
(Reported by Dr. Frank Wheeler, Veterinarian, Dr. John
M. Bruce, Chief, Epidemiology Section, and Dr. George
H. Hauser, Director of Laboratories, Louisiana State
Board of Health; and a team from CDC.)


CURRENT TRENDS PLAGUE


Five cases of bubonic plague in humans have been
reported to the Communicable Disease Center to date in
1966. Four of these cases have been confirmed bac-
teriologically as Pasteurella pestis infection, and one
remains suspect on clinical grounds. A line listing of
the cases is shown in Table 1. The first two cases were
previously reported in MMWR, Vol. 15, Nos. 23 and 26
respectively.
The third case of P. pestis infection is a 7-year-old
Navajo girl who became ill on July 8 with fever, con-
fusion, abdominal pain and a lump in the left groin. At
the time of admission to the Indian Health Service Hos-
pital at Tuba City, Arizona, on July 12, she was found
to have a temperature of 1020F. and a 1x 1% inch tender
lymph node in the left groin. The lymph node was aspirated,
and though no organisms could be seen in the smear of


the aspirate, P. pestis was isolated from culture of both
the aspirate and the patient's blood. The patient has
responded to treatment with streptomycin, sulfonamides
and tetracycline. Identification of the organism as P.pestis
was confirmed on July 18 by the San Francisco Field
Station of the Communicable Disease Center.

There was no known contact of this patient with
field rodents, and no evidence of rodent mortality in the
area of her home. The family did raise domestic rabbits,
some of which died shortly after the patient. Sera have
been obtained from other members of the patient's fani;l
and from their domestic dogs. The home of this family
was dusted with 5 percent nmalurltion. and similar dusting
was carried out in the nearby rodeo grounds where a small
ceremonial was soon to take place.


262













Table 1
Human Cases of Bubonic P, .eu. 1966

Admit
Case Sex Age ted to Resi- Lab- Remarks
Hospital dence oratory

1 M 5 5/23/66 Monument Confirmed Fatal
Valley,
Utah

2 M 72 6/10 66 Rio Arriba Confirmed Recovered
County,
N.M.

3 F 7 7 ,12/66 Shonto, Confirmed Recovered
Ariz.

4 F adult 7/19/66 Santa Fe, Suspect Recovered
N.M.

5 F 14 7/26/66 Pecos, Confirmed Recovered
SN.M.

A suspect case of bubonic plague was reported by
the New Mexico State Department of Health on July 20.
1966. The patient, an adult female, was admitted to a
hospital in Santa Fe on July 19 with chills and a tem-
perature of 1040F. At that time flea bites were noted on
her left leg, and she complained of pain in the left groin.
Physical examination revealed enlarged nodes in the left
femoral region. The patient was treated immediately with
chloramphenicol, and tetracycline was added to her
treatment regimen the -..ll,.. r._ day. The patient had a
good response to therapy and subsequently has completely
recovered from her illness. This case could not be con-


263


firmed bacteriologically. \cute and convalescent sera
will be tested for the presence of plague antibodies.
Although the source of illness has not been identified,
the patient is known to have handled a dead squirrel in
the yard of her house 1-5 days prior to illness. In addition,
dead chipmunks have been found on her property, and
the patient had recently cleaned chipmunk nests from
rocks in this area. Numerous rodents have been collected,
and appropriate studies of these animals are in process.
The fifth case of plague to occur in 1966 was reported
by the New Mexico State Department of Health on July 26,
1966. The patient is a 14-year-old female who lives near
the town of Pecos, New Mexico, in San Miguel County.
The child first felt ill on the evening of July 24. and by
the next day had developed fever, headache, nausea,
vomiting, malaise and pain in the right groin. She was
admitted to the hospital on July 26 with a temperature of
105.8F., an enlarged lymph node in the right femoral
region, and lesions on the right foot resembling insect
bites. Blood cultures were taken prior to treatment with
tetracycline. She has responded well to therapy. Organisms
have been isolated from the blood culture and were iden-
tified as P. pestis by the New Mexico State Department
of Health Laboratory.
Two days before her illness, the child walked in
the hills around her home, an area in which there are
many rodents. Studies of the area are being carried out
by the New Mexico State Department of Health.

(Reported by Dr. Dean Tirador, Chief, Community Health
Services, Window Rock Field Office, Division of Indian
Health, Window Rock, Arizona; and Dr. T.H. Tomlinson,
Associate Director, and Mr. Bryan Miller, Chief, Vector
Control Division, New Mexico State Department ofHealth.)


ANNUAL SURVEILLANCE SUMMARY
ENCEPHALITIS 1965


For the year 1965, a total of2,703 cases of encephalitis
including 173 deaths were reported to the Neurotropic
Viral Diseases Unit of the Communicable Disease Center.
These cases are shown by etiology in Table 2. Over one-
half of the cases were encephalitis of unknown etiology;
36 percent of the cases were post-infectious encephalitis;
11 percent of the cases were caused by arthropod-borne
viruses.
All encephalitis cases reported for the years 1962-65
are shown by month in Figure 2. A characteristic seasonal
pattern was again seen in 1965, with a small increase in
incidence in the spring and a large increase in the late
summer. The numbers of reported cases by etiologic group
for each month are shown in Figure 3. The highest inci-
dence of post-infectious encephalitis occurred during the
spring, whereas the cases due to the arthropod-borne


viruses peaked during August. The composite character of
the distribution of encephalitis with no known etiology
suggests that many cases would fall into the post-infectious
and arbovirus categories if etiology were specified.

POST-INFECTIOUS ENCEPHALITIS
As in previous years, the most frequent of the enceph-
alitides traditionally classified in the post-infectious group
was mumps, followed by measles and varicella. The rela-
tive frequencies of the commonly reported post-infectious
encephalitides are compared for the years 1960 through
1965 in Table 3. Figure 4 shows that encephalitis asso-
ciated with mumps, measles and varicella all have their
period of greatest incidence in the spring.
Of encephalitides of low frequency, there were 19
cases of herpes simplex, 11 of which were fatal, reported


AUGUST 6, 1966


Morbidity and Mortality Weekly Report







Morbidity and Mortality Weekly Report


from nine States. Eight cases of encephalitis following
smallpox vaccine were reported in 1965, but there were
no fatalities. North Carolina reported one fatal case of
encephalitis in a 3-year-old girl who had received yellow
fever vaccine; the 17-D strain of yellow fever virus was
isolated from the brain by Laboratory Branch, CDC. Influ-
enza accounted for 17 cases of encephalitis; lymphocytic
choriomeningitis 8 cases; herpes zoster 2 cases; and
adenovirus 2 cases.


Table 2
Etiology of 2 7; Cases of Encephalitis
Reported to the CDC, United States, 1965


Post-infectious
Mumps
Measles
Varicella
Influenza
Herpes simplex
Post-vaccinal
Lymphocytic
choriomeningitis
Rubella
Herpes zoster
Adenovirus
Arthropod-borne
WEE
California
SLE
EEE
Etiology Unknown
Total


No. of Cases


172
59
58
8


1,425
2,703


Percent of Total


100.0


Figure 2
REPORTED CASES OF ENCEPHALITIS BY MONTH
UNITED STATES, 1962 1965
6001 I I I


IN


AUGUST 6, 1966


Figure 3
REPORTED CASES OF ENCEPHALITIS BY ETIOLOGIC
GROUP AND MONTH OF ONSET. 1965


J F M A M J J
MONTH


A S 0 N D


Table 3
Cases of Commonly Reported Post-Infectious
Encephalitis by Etiology, 1960-1965
Etiology
Year Vari- Post-
Mumps Measles cella Rubella Influenza Vaccinal
1960 700 299 95 24
1961 402 276 75 -- 8 8
1962 358 337 76 40 7
1963 671 239 84 30 3
1964 932 300 106 59 14 8
1965 634 171 112 7 17 9


Figure 4
POST-INFECTIOUS ENCEPHALITIS ASSOCIATED WITH
MEASLES, MUMPS, VARICELLA AND RUBELLA
BY MONTH OF ONSET, UNITED STATES, 1965


90
------ MUMPS
80 ----- MEASLES
VARICELLA
---- RUBELLA
70
S60
50

30
40
20 7

.5 --- S-^
4 F M A M J J A s o N o
MONTH


264


JrU AJ SONDFMAM J ASOND FMAMJ JA ONDJFMAM JA SONDJ
1962 1963 1964 1965


A


A


A








AUGUST 6, 1966


Morbidity and Mortality Weekly Report


ARTHROPOD-BORNE ENCEPHALITIS* the largest total of WE cases reported since encephalitis
A total of 297 confirmed or presumptive cases of surveillance began in 1955. California encephalitis was
arthropod-bone encephalitis with onsets of illness in recognized more frequently in 1965 than previously. The
1965 has been reported. By comparison with the previous geographic distribution of all arbovirus encephalitis cases
10 years this was a year of intermediate arbovirus activity; is depicted in Figure 5. The marked seasonal incidence
however, the 172 cases of Western encephalitis represent of arbovirus encephalitis is shown in Table 4.
*Cases ,i arth-lpod-b-rn, encephalitai have been las-siirid intr,, c, firmed and prsumltiv ntttgorins, b th b l wh.h ar, H a -irudd ,t It fin l ,fil a

Figure 5
HUMAN CASES OF ARTHROPOD BORNE ENCEPHALITIS BY STATE. 1965


WESTERN ENCEPHALITIS


EASTERN ENCEPHALITIS





I--, c -^

t^ / -- %--T .-; .,

-- i J -." I ,_ /


ST LOUIS ENCEPHALITIS


CALIFORNIA ENCEPHALITIS


Table 4
Confirmed and Presumptive Human Cases of Arthropod-borne Encephalitis by Month of Onset, 1965

Number of Cases


Month


January ........
February .
March .
April ....... ..
M ay ..... .... .
June ....... .
July ...........
August .. ...
September ......
October ........
November ......
December ......
Unknown .......
Total ......


Western E.

0
0
O)
0


2
16
114
30
3
1
0
6
172


S.L.E.

0
0
0
0
0
0
3
26
25
4
0
0
0
58


Etiology

Eastern E.

0
0
0
0
0
1
4
2
0
1
0
0
0
8


California

0
0
0
0
0
1
7
23
24
3
0
0

59
59


Total


0
0
0
0
0
4
30
165
79
11
1I
0
7
297


265








266


Western Encephalitis (WE)
The most frequently demonstrated arbovirus causing
human encephalitis in 1965 was WE. As compared to 64
laboratory confirmed or presumptive cases reported in
1964, there were 172 such cases in 1965 in association
with an extensive epidemic in several of the north central
and mountain states. People of all ages were affected;
there were four deaths due to WE. WE virus activity in
humans was documented in 14 States, and sizable out-
breaks occurred in Montana, North Dakota, Wyoming,
Colorado, Kansas and Texas.


California Encephalitis (CE)
Fifty-nine cases of serologically confirmed or pre-
sumptive California encephalitis were reported for 1965.
This was the first year in which more than a few cases

F
REPORTED CASES
ETIOLOGY UNKNOWN -
196


300


280


260


240


220


200


S 180
w
U,

160-
0

m 140

z


AUGUST 6, 1966


due to this virus were recognized. Cases were reported
from six States: Ohio, Indiana, Wisconsin, North Caro-
lina, Iowa and Minnesota. The cases in Ohio occurred in
16 counties. Al! but one of the cases of California enceph-
alitis occurred in persons under 20 years of age. Males
were affected more than females, probably due to exposure
in heavily wooded areas. There were no fatalities due to
California encephalitis.

St. Louis Encephalitis (SLE)
In 1965, by contrast to 1964, there were no major
urban outbreaks of St. Louis encephalitis. A total of 58
sporadic cases of SLE were reported from 12 States, but
only Texas and Colorado reported more than a single case
in any one county. Cases of SLE occurred in all age
groups. In 1965 there were no deaths reported due to SLE.


figure 6
OF ENCEPHALITIS WITH
BY MONTH, UNITED STATES,
2 1965


1962 1963 1964


Morbidity and Mortality Weekly Report








Morbidity and Mortali


Eastern Encephalitis (EE)
Eight cases of Eastern encephalitis, including four
fatalities, were reported in 1965 from five States: Florida,
Georgia, Maryland, New Jersey and North Carolina. EE
virus was isolated from the brain of two children in Georgia,
ages 6 and 7 years, and from the brain of a 74-year-old
female in Maryland. Outbreaks of EE in horses occurred
in States along the eastern seaboard.


ENCEPHALITIS OF UNKNOWN ETIOLOGY
During 19ni more than 1,400 cases of encephalitis of
unknown etiology were reported to the Neurotropic Viral
Diseases Unit, accounting for approximately 50 percent of
all reported encephalitis cases, Eu er\ stale except Indiana
and New Hampshire reported cases in thi, category. Noti-
fication of deaths in this classification was incomplete;


AIUUST 6. 196fi


Figure 7
REPORTED CASES OF ENCEPHALITIS, UNKNOWN ETIOLOGY
BY GEOGRAPHIC DIVISION, UNITED STATES, 1965


1401 MOUNTAIN AND PACIFIC


U.


J F M A M J J A S O N D


NEW ENGLAND AND MIDDLE ATLANTIC


60- SOUTH ATLANTIC. EAST SOUTH CENTRAL
AND WEST SOUTH CENTRAL
40-

20-

0-
J F M A M J J A S O N D
MONTH


ty Weekly Report 267



nonetheless, the 97 cases reported represented a death-to-
case rate of (6.~ percent,
In 1961 and 1965, all cases of encephalitis of un-
known etiology showed an abrupt seasonal peak in late
summer (Figure 6). This late summer peak is similar to
that characteristic of arthropod-horne encephalitis. Figure
7 illustrates the monthly incidence of encephalitis of
unknown etiology in 1965 for four regions of the U.S. A
sharp increase in incidence of encephalitis of unknown
etiology in the Mountain and Pacific divisions is evident
in August and September; it was in these two divisions
that the majority of arthropod-borne encephalitis cases
occurred in 1965. By contrast, along the eastern seaboard
where there was little human arthropod-borne disease,
there was no seasonal peak of encephalitis of unknown
etiology.









268 Morbidity and Mortality Weekly Report



CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 6, 1966 AND AUGUST 7, 1965 (31st WEEK)


ENCEPHALITIS HEPATITIS
ASEPTIC Primary Post- Both
AREA MENINGITIS BRUCELLOSIS including Infectious DIPHTHERIA Serum Insectious Types
unsp. cases
1966 1965 1966 1966 1965 1966 1966 1965 1966 1966 1965
UNITED STATES... 89 64 3 38 41 13 1 1 43 555 519

NEW ENGLAND.......... 19 4 5 1 3 1 3 39 27
Maine ........... 1 2 6 2
New Hampshire...... 1 -- 1 5
Vermont.............
Massachusetts...... 15 2 1 2 1 1 17 16
Rhode Island....... 2 1 2 1 5 2
Connecticut........ 1 1 1 1 10 2

MIDDLE ATLANTIC...... 9 9 12 13 1 25 84 103
New York City...... 1 1 3 3 12 15 32
New York, Up-State. 3 1 2 2 1 1 31 30
New Jersey.......... 2 3 5 7 11 11 23
Pennsylvania....... 3 4 2 1 1 27 18

EAST NORTH CENTRAL... 10 5 1 10 2 4 1 54 94
Ohio................ 1 1 6 8 24
Indiana............ 1 3 15
Illinois........... 5 3 3 1 7 13
Michigan............ 3 1 4 1 30 38
Wisconsin.......... 1 1 1 6 4

WEST NORTH CENTRAL... 3 3 2 1 1 52 17
Minnesota.......... 3 2 1 2 1
Iowa...............* 12 5
Missouri........... 1 33 6
North Dakota....... 1
South Dakota....... -
Nebraska........... 3 1
Kansas............. 1 2 4

SOUTH ATLANTIC....... 4 4 2 5 1 1 61 60
Delaware........... -
Maryland........... 1 1 6 10
Dist. of Columbia..
Virginia........... 1 1 I 1 12 8
West Virginia ...... 3 11
North Carolina..... 1 1 12 8
South Carolina..... 1 I
Georgia ............ 12 6
Florida............ 1 2 3 15 17

EAST SOUTH CENTRAL... 6 7 1 1 1 1 26 31
Kentucky........... 4 5 11
Tennessee.......... 1 2 1 1 14 5
Alabama............. 1 1 1 13
Mississippi........ 5 1 6 2

WEST SOUTH CENTRAL... 11 15 1 1 4 1 43 37
Arkansas........... 1 8 6
Louisiana........... 2 1 2 -- 8 5
Oklahoma............ 1 4 1
Texas............... 8 15 1 1 1 23 25

MOUNTAIN ............. 1 1 2 8 37 18
Montana.............. 4 2
Idaho ........... -
Wyoming............. 1 1
Colorado .......... 1 2 7 8 2
New Mexico......... 6 1
Arizona ............ 11 9
Utah............... 1 7 3
Nevada ............

PACIFIC.............. 26 16 3 7 2 12 159 132
Washington ......... 3 2 26 12
Oregon............. 1 23 9
California ......... 23 11 3 5 2 12 108 108
Alaska............. 2 3
Hawaii............. 2 2

Puerto Rico.......... 32 54










Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS END)D)

AUGUST 6, 1966 AND AUGUST 7, 1965 (31st WEEK) CONTINUED


MEASLES (Rubeola)
AREA-- --..
Cumulative
1966 1966 1965

UNITED STATES ... 844 186,154 236,488

NEW ENGLAND.......... I 19 2,203 36,615
M.i: 1 ............. 194 2,772
New Hampshire........ 8 75 381
Vermont............ 221 1,245
Massachusetts ...... 8 761 19,191
Rhoea Iland....... 72 3,892
Connecticut ...... 1 880 9,134

MIDDLE ATLANTIC...... 54 17,836 14,348
New York City...... 13 8,223 2,215
New York, Up-State. 34 2,447 4,021
New Jersey......... i 2 1,844 2,477
Pennsylvania....... 5 5,322 5,635

EAST NORTH CENTRAL... 235 67,747 54,506
Ohio...............i 6 6,315 8,785
Indiana............ 17 5,615 1,784
Illinois........... 14 11,244 2,552
Michigan........... 116 13,983 26,064
Wisconsin.......... 82 30,590 15,321

WEST NORTH CENTRAL... 44 8,647 16,321
Minnesota........... 1 1,638 621
Iowa................ 26 5,298 8,962
Missouri........... 1 529 2,559
North Dakota....... 16 1,067 3,618
South Dakota....... 40 112
Nebraska............. 75 449
Kansas............. NN N NN

SOUTH ATLANTIC ...... 145 14,851 24,454
Delaware........... 251 501
Maryland............ 7 2,090 1,125
Dist. of Columbia.. 380 73
Virginia........... 21 2,090 4,000
West Virginia...... 29 5,098 13,438
North Carolina..... 21 431 375
South Carolina..... 10 652 1,005
Georgia............. 233 612
Florida............. 57 3,626 3,325

EAST SOUTH CENTRAL... 63 19,433 13,538
Kentucky............ 4 4,665 2,406
Tennessee.......... 58 12,124 7,749
Alabama............ 1,660 2,288
Mississippi........ 1 984 1,095

WEST SOUTH CENTRAL... 152 23,820 30,339
Arkansas........... 966 1,081
Louisiana.......... 5 98 102
Oklahoma............ 470 201
Texas............... 147 22,286 28,955

MOUNTAIN............. 40 11,664 19,407
Montana............. 1 1,801 3,668
Idaho............... 6 1,520 2,739
Wyoming.............. 144 841
Colorado............ 13 1,231 5,570
New Mexico.......... 7 1,108 674
Arizona............. 9 5,227 1,239
Utah................ 4 590 4,473
Nevada............. 43 203

PACIFIC .............. 92 19,953 26,960
Washington.......... 5 3,458 7,205
Oregon.............. 31 1,655 3,157
California.......... 46 14,375 12,730
Alaska.............. 8 340 154
Hawaii.............. 2 125 3.714
Puerto Rico........... 52 2,504 2,231


MENINGOCOCCAL INFECTIONS,
TOTAL


1


II


Cumulativ-
1966 T~ 1


966













2
3






5
1









9
2

3
5


1









9
5
1
1
2


2

































3
1




1

















2


2



1
2
















1

2


10


2,526

113
9
9
4
44
12
35

297
41
84
87
85

391
107
66
75
104
39

140
33
22
54
9
4
8
10

421
4
43
11ii
47
23
104
46
57
86

217
80
72
46
19

359
33
136
18
172

81
4
5
6
42
10
10
1.
4

507
37
33
418
15
4


2,167

110
6
6

35
14
33

285
50)
77
76
82

297
79
39
80
64
35

109
22
7
50
7
2
10
11

422
6
39
8
48
24
82
57
53
105

169
68
50
31
20

297
14
166
18
99

68
2
8
5
13
10
16
12
2

410
32
29
326
16
7
5


POLIUMYELITIS
Total Pa

1966 1965 1966

10 6 9





-


1


1 -



2


1 1


1


S 1

















9 2
1 -













1

8 2


S- 1
I 1










-







3


1
2

9 42

1 1

8 40


48 281

30
S 10

S 4
6
2
8

35
9
26



86
5
5
5
S 10
15
51


1



27

2

3
10



12

43
23
19
1


1



1

29

1

10

18



29
15
5
8
1

I


i-i I I ~ I ~-


1


!


1










270 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 6, 1966 AND AUGUST 7. 1965 (31st 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... 4,396 6 97 2 89 12 206 16 148 70 2,595

NEW ENGLAND .......... h6 1 4 1 2 4 62
Maine.............. 60 1 22
New Hampshire...... 32 2 21
Vermont............ 33 1 17
Massachusetts...... 86 21 1 1
Rhode Island....... 84
Connecticut........ 321 3 1 1 -

MIDDLE ATLANTIC...... 186 11 35 4 32 173
New York City...... 2 4 -
New York, Up-State. 181 2 7 1 12 162
New Jersey......... NN 1 7 1 10
Pennsylvania ....... 3 4 6 2 10 11

EAST NORTH CENTRAL... 315 7 12 2 28 1 11 4 355
Ohio............... 25 3 3 1 13 6 2 176
Indiana............ 66 1- 3 1 2 79
Illinois ........... 43 1 5 3 1 5 1 37
Michigan............ 112 4 29
Wisconsin.......... 69 1 6 1 34

WEST NORTH CENTRAL... 156 6 8 16 2 21 591
Minnesota..........- 5 136
Iowa............... 33 1 4 4 124
Missouri........... 5 4 3 8 1 5 183
North Dakota........ 109 1 2 21
South Dakota........ 8 2 5 61
Nebraska........... 1 17
Kansas ............. 2 2 1 49

SOUTH ATLANTIC....... 381 2 25 9 1 38 7 68 12 333
Delaware........... 3 1 -
Maryland........... 35 1 2 1 7 4 20 1
Dist. of Columbia.. 2 -
Virginia........... 81 4 2 8 3 20 2 189
West Virginia...... 169 1 1 1 40
North Carolina..... 9 1 3 2 3 15 3
South Carolina..... 6 1 1 6 5
Georgia............ 1 6 2 1 7 5 61
Florida............ 77 9 9 4 39

EAST SOUTH CENTRAL... 710 11 17 4 25 3 23 15 329
Kentucky........... 6 1 2 3 2 4 8 66
Tennessee.......... 646 1 9 3 11 1 15 7 248
Alabama............ 45 6 4 6 4 12
Mississippi ........ 13 3 2 1 5 3

WEST SOUTH CENTRAL... 481 2 20 2 34 2 23 6 8 528
Arkansas........... 2 2 2 26 1 2 1 57
Louisiana.......... 1 5 3 2 7 -- 1 25
Oklahoma ..........- 1 4 8 4 1 138
Texas.............. 479 1 12 1 7 5 308

MOUNTAIN ............ 1,008 1 5 1 9 3 4 54
Montana............ 16 7
Idaho ...... ..... 32 -
Wyoming ............ 15 -
Colorado........... 641 1 3 2 8
New Mexico......... 180 1 1 3 11
Arizona........... 73 1 1 2 -1 26
Utah............... ... 51 3- -
Nevada............. 2

PACIFIC.............. 543 2 14 3 2 28 1 2 170
Washington ......... 59 1 11 5
Oregon ............. 18 1 -- 1 2
California ......... 389 2 13 3 1 14 -1 2 163
Alaska ............. 46 -


Puerto Rico......... 31 6 8










Morbidity and Mortality Weekly Report


DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED AUGUST 6, 1966

(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 I year
Ages and over Influenza All 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 -------


651
229
42
28
25
57
17
20
23
45
44
10
31
22
58

2,867
45
26
160
40
36
44
55
70
1,449
26
420
172
41
82
23
42
55
31
21
29

2,390
53
42
711
165
219
121
79
304
32
31
38
31
55
154
28
110
22
24
28
97
46

736
55
9
40
109
25
85
73
229
70
41


387
133
26
18
19
33
7
14
17
27
25
5
17
9
37

1,580
17
15
86
21
18
25
26
32
778
16
245
90
29
48
15
33
34
21
13
18

1,281
33
20
362
92
101
63
39
168
20
12
22
15
32
86
15
70
12
17
19
52
31

449
36
7
21
63
19
54
46
135
45
23


*Estimate based 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.----------


1,073
116
226
53
57
95
62
70
21
69
61
196
47

632
83
55
39
143
140
44
40
88

1,159
54
41
25
150
34
60
220
49
193
89
137
59
48

371
27
25
98
19
92
17
53
40

1,506
25
52
31
36
58
449
88
46
90
68
104
197
34
138
46
44


Total 11,385 6,298 368 667

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 398,678
All Causes, Age 65 and over------------------- 230,111
Pneumonia and Influenza, All Ages------------- 17,648
All Causes, Under 1 Year of Age--------------- 20,761


Week No.

31








272 Morbidity and Mo





CURRENT TREND
MALARIA DEATH IN AMERICAN CIVILIAN


The first civilian death associated with malaria in
1966 has been reported to the Communicable Disease
Center. A Negro minister from Florida and his wife arrived
in Liberia, West Africa, on June 20. They stayed in
Monrovia for 2 days before proceeding to a small village
18 miles from the capital where they remained until July 2.
During their trip they took no malaria prophylaxis and no
precautions against mosquitoes.
On July 12 while enroute to the United States by ship,
the minister complained of weakness and feverishness.
After the ship docked in Baltimore, Maryland, the couple
travelled by train to Ocala, Florida, arriving on July 17.
During the entire week the minister remained alert but was
tired and feverish; suddenly on July 18 he died.
Postmortem examination demonstrated a heavy in-
fection with Plasmodium falciparum; parasites were found
in all organs, including sections of brain. A peripheral
blood smear from his wife revealed that she was also
infected with P. falciparum: she has responded to treat-
ment.
(Reported by Dr. E. Charlton Prather, Director, Division
of Epidemiology, Florida State Board of Health; Dr.
James B. Stapleton, Director. Marion County Health
Department, Ocala, Florida.)








QUARANTINE MEASURE
INTERNATIONAL CERTIFICATES OF VACCINATION
PHS-731


The Division of Foreign Quarantine of the USPHS has
been informed that a large number of persons traveling
abroad from the United States fail to have their Interna-
tional Certificates of Vaccination or Revaccination against
Smallpox and Cholera properly completed and validated
before departure.
In order to be valid, all such certificates for small-
pox and cholera vaccination require the "Approved Stamp"
of the Health Officer of the area in which the vaccination
has been performed. The certificate should bear the name
and the signature of the person being vaccinated, his sex,
date of birth, and the signature of the physician who did
the vaccination. Any amendment of this certificate, or
erasure, or failure to complete any part of it, may render
it invalid and may subject the traveler to surveillance or
detention by quarantine authorities at the point of arrival
abroad or at U. S. ports of entry.
In areas in the United States where there is no local
Health Officer, certificates may be sent or taken to the
State Health Officer for validation. This validation is a
requirement of the International Sanitary Regulations.


rtal


ity Weekly Report AUGUST 6, 1966





THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION OF 15,600. IS PUBLISHED AT THE COMMUNICABLE DISEASE
CENTER, ATLANTA. GEORGIA.
CHIEF, c :M"'.jN. ILE DISEASE CENTER DAVID J EI',CE. M.D.
CHIEF, L -.,EM LG: I BRANCH A.D. L-aN, .. 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:

TI:, C'iTOR
MORBIDITY AND M"'I -LITY WEEKLY REPORT
COMMUNICABLE DISEASE CENTER
ATLANTA, GEORGIA 30333
NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO THE CDC BY THE INDIVIDUAL
STATE HEALTH DEPARTMENTS. THE REPORTING WEEK CONCLUDES
ON SATURDAY: COMPILED DATA ON A NATIONAL BASIS ARE RELEASED
ON THE SUCCEEDING FRIDAY.


U.




U.S. DEPOSITORY


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