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:
AA00010654:00362

Related Items

Preceded by:
Weekly mortality index
Preceded by:
Weekly morbidity report
Succeeded by:
Morbidity and mortality weekly report


This item is only available as the following downloads:


Full Text


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DISEASE CENTER


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Vol. 14, No. 29







Week Ending
July 24, 1965


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


WESTERN EQUINE ENCEPHALITIS Colorado


The first confirmed case of Western equine en-
cephalitis in 1965 in a human has been reported from
Greeley, Colorado. The patient, a 14-year-old white boy,
developed an encephalitic illness on July 12, 1965. Paired
sera demonstrated a fourfold rise in hemagglutination
inhibition titer to Western equine encephalitis. The patient
has recovered.
During the past week reports of clinical horse en-
cephalitis have been coming in from several midwestern
and mountain States. Of the 36 cases in horses reported
from Colorado, 8 have been serologically confirmed and 5
have resulted in death. The one case of clinical horse


CON TEr S


Western Equine Encephalitis, Colorado .
Encephaliti 1964 ...............
Encephalitis, Hale County, Texas ......
Salmonella typhi, Rhode Island ........
International Notes Quarantine Measures


.. .. ..... 245
. .. ..... 246
. .... .. .. 251
.... ..... 251
... .... .. 256


encephalitis in California has also been similarly
confirmed.
Ten WEE-like agents have been isolated from pools
of Culez tarsalis collected in the vicinity of Greeley,
Colorado, during the week ended July 8, 1965. Nine of
these isolates are now confirmed as WEE virus, thus
giving Culex tarsalis infection rates much higher than
those observed during a comparable period last year.
(Continued on page 46)


Table 1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
29th WEEK ENDED CUMULATIVE, FIRST 29 WEEKS
MEDIAN
DISEASE JULY 24, JULY 18, 1960-1964 MEDIAN
1965 1964 1965 1964 1960- 1964


Streptococcal Sore Throat and
Scarlet fever .............
Tetanus .................
Tularemia *................
Typhoid fever .............

Rabies in Animals .........


4.144
8
5
12

67


68
5
3
43
22

565
2,637
39






3.763
5
14
12

96


65
10
3



647
3,730
37
11
9



3.354


16

71


824
133
88
864
453


19,729
233,962
2,082
27
21
6



257.390
132
138
209

2,694


901
219
154
1,046
591


23,131
452,634
1,711
53
42
8
3


263 425
135
184
209
2,674


901
232
229



25,424
382,618
1,373
281
186
-_-



216.572


289
2,266


Table 2. NOTIFIABLE DISEASES


OF LOW FREQUENCY


Cum. Cum.
Anthrax: ................................... 6 Rabies in Man: ...... ........ ..... ...... ... 1
Botulism: .............. ..... ............. 11 Smallpox: ............................... 1
Leptospirosis: La.-1, Ark.-1, Tenn.-1. P.R.-1 ......... 20 Trichinosis: Calif.-3 .. .................... 69
Malaria: ............................... 37 Typhus-
Plague: .................................. Murine: ............................. 16
Psittacosis: Il.-3, Tex.-1 .................. 25 Rky. Mt. Spotted: Il1.-2, Mich.-2, Md.-1, D.C.-1, N.C.-2 133
Cholera: D.C.-1 ............................ 2 Pa.-4, Va.-2, W. Va.-1, Ga.-1, Tenn.-3


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Morbidity and Mortality Weekly Report


WESTERN EQUINE ENCEPHALITIS Colorado
(Continued from front page)

Mosquito population indices in this vicinity are two
to four times what they were during the same period last
year. The temperature during the spring of 1965 has been
unusually cool in the area of Greeley; in past years,
high WEE virus activity has occurred when the spring
temperature generally has been lower than the seasonal
mean. Reports of increased WEE virus activity may be
anticipated within the next few weeks.
(Reported by Dr. C.S. Mollohan, Chief, Section of Epi-
demiology, Colorado State Department of Public Health
and Disease Ecology Section, Technology Branch, CDC,
Greeley, Colorado.)

ENCEPHALITIS 1964
Weekly encephalitis case reports are received at the
Communicable Disease Center from State and local health
departments through the National Morbidity Reporting
System. In addition, the Encephalitis Surveillance Unit
receives encephalitis surveillance forms which supply
more detailed epidemiologic information about each case
reported. Cases are reported in two categories: 1) Post-
infectious encephalitis, defined as illnesses with en-
cephalitic manifestations but with pre-existing diagnosed
infections. Post-infectious encephalitis includes those
cases associated with mumps, measles, rubella, vaccinia,
etc. 2) Primary encephalitis, defined as acute febrile
illnesses with encephalitic manifestations as an intrinsic
part of the disease. This category includes "ARBO" in-
fections, as well as acute encephalitis of unknown
etiology.
During 1964, a total of 3,587 cases of encephalitis,
including 337 deaths, was reported. This represents the
highest total of cases reported to the Encephalitis Sur-
veillance Unit in any one year since its establishment in
1955. It includes an increased number of both categories
of encephalitis cases during 1964 as compared to 1963.
Cases reported for 1964 are shown by etiology in Table 1.
Mumps and measles accounted for over three-quarters of
the 1,585 post-infectious encephalitis cases. There were
582 cases of arthropod-borne encephalitis and outbreaks
due to St. Louis, Western equine, and California encepha-
litis viruses occurred. It was the first time in 3 years
that human illness due to Eastern equine encephalitis
virus was encountered.
The numbers of encephalitis cases reported for the
years 1960-1964 are shown by month in Figure 1 and by
etiologic group in Figure 2. The characteristic pattern of
incidence, with an increase in April or May followed by a
second peak in the late summer and fall, again occurred
during 1964. The highest incidence of cases of post-
infectious encephalitis occurred during the spring, where-
as the cases due to arboviruses were more prevalent
during August and September. A marked increase in cases


of encephalitis of unknown etiology also was noted dur-
ing the latter period. At least some of the reported cases
of encephalitis of undetermined etiology may have been
unrecognized cases of arthropod-borne encephalitis.
The total of 582 cases of arthropod-borne encepha-
litis. which occurred during 1964 and which were desig-
nated confirmed or presumptive,* is the highest since
1956. During the 10-year period of reporting to the En-
cephalitis Surveillance Unit, this total was exceeded
only in 1956 when 625 cases of arthropod-borne encepha-
litis were recorded. A summary of the occurrence of
arthropod-borne encephalitis by etiology over the past
10 years is shown in Table 2. Cases of St. Louis, West-
ern equine and California encephalitis during 1964 are
shown by State in Figure 3.
Table 1
Encephalitis in the United States, 1964
Cases Reported to the
Encephalitis Surveillance Unit, CDC

Number of Percent of
Etiology Cases Cases
Post-infectious Encephalitis 1,585 44.2
Mumps 932 26.0
Measles 300 8.4
Varicella 106 3.0
Rubella 59 1.6
Influenza 14 0.4
Post Vaccinal 8 0.2
Other 166 4.6
Primary Encephalitis 2,002 55.8
Arthropod-borne 582 16.2
Etiology Unknown 1,420 39.6
Total 3,587 100.0

Table 2
Human Cases of Arthropod-Borne Encephalitis
Reported to the CDC Encephalitis Surveillance Unit
1955-1964

Etiology
Year WEE EEE SLE Calif. Total

1955 37 15 107 0 159
1956 47 15 563 0 625
1957 35 5 147 0 187
1958 141 2 94 0 237
1959 14 36 118 0 168
1960 21 3 21 0 45
1961 27 1 42 0 70
1962 17 0 253 0 270
1963 56 0 19 1 76
1964 64 5 470 42 582*

*One case of encephalitis attributed to Tensaw virus
(reported by Indiana) in included in the total.

*For definition of confirmed and presumptive, please consult
CDC Encephalitis Surveillance Report 1964, page 10.


246


Jy 24. 1965













Table 3
(on i rnird and Presumptive Human Cases of
Arthropod-Born' Enit ',phali i by \%o and Sex, 1964*


SLE EE California

L E -
Age
Group E

0-4 13 5 18 10 11 21 3 3 6
5-9 14 9 23 3 3 6 12 7 19
10-14 14 8 22 4 1 5 5 4 9
15-19 8 13 21 1 1 2 1 0 1
20-29 24 24 4h 3 1 4 1 0 1
30-39 29 31 60 6 0 6 0 0 0
40-48 23 36 59 7 0 7 0 0 0
50-9 24 29 53 1 2 3 0 0 0
60-69 36 40 76 0 2 2 0 0 0
TO & over 3S 48 ;6 2 2 4 0 0 0
Unknown 2 2 4 3 1 4 2 0 2
Total 225 45 I17 1010 24 (64 24 14 41'

*Includes 4 cases with unknown age and sex; 5 cases EEE
and 1 case of Tenaw virus infection are not included.



The age and sex distribution of confirmed and pre-
sumptive cases of arthropod-borne encephalitis occurring
in 1964 are shown in Table 3.




Tensaw Virus

A case of clinical encephalitis associated with a
fourfold rise in hemagglutination inhibition titer to Ten-
saw virus was reported from Indiana. The patient was a
13-yvear-old female from Kosciusko County who became
ill on September 17, 1964. A rise of hemagglutination
antibody titer from 40 to 160 was noted between the acute
and convalescent serum specimens.



Arbovirus Isolations

A -ummar% of arbovirus isolations from arthropod
vectors during 1964 is shown in Table 4.
A number of arboviruses, such as Venezuelan equine
encephalitis virus (VEE), Hart Park, Tensaw, Bunyam-
wara, and Cache Valley viruses, were isolated from
mosquito pools. The relationship of these viruses to
human illness is presently undefined.
In Table 5 isolations of arboviruses from birds and
mammals are summarized.
These two tables demonstrate that there was wide-
spread enzootic arbovirus activity in the United States
during 1964.


247


St. Louis Encephalitis (SLE)

There were 470 laboratory-documented cases of St.
Louis encephalitis reported from 14 ti ..I-. Major epidem-
ics were recorded in Harris ( county (III,-inII), Texas, and
the ('ani iln-.Burlincl in County area of New .Irr-.',. I-.li-
demics with smaller numbers of cases occurred in Ken-
tucky, Illinois, Indiana, and I'nn'-.-i .'. The only reported
isolation of ',LL virus from a human source was from a
fatal case in Ohio.



Western Equine Encephalitis (WEE)

The 64 reported cases of Western equine encephalitis
were notified from 10 ',atel. However 31 cases occurred
in two areas, Hale county, Teta-,, and central Colorado,
and mixed infection-; with WEE and SLE were also re-
corded. In these two areas both WEE and SLE have been
isolated from pools of Culex tarsalis mosquitoes.








Table 4
Arbovirus Isolations from Mosquitoes, 1964
Reported to Encephalitis Surveillance Unit, CDC



VIRUS I )OL \TED


Mosquito Species






C. nigripulpus
C. pipiens
C. quinquefasciatus
C. tarsalis
Cs. melanoconion
Cs. melanura
A. infirmatus
A. taeniorhynchus
A. atlanticus
A. crucians
A. quadrimaculatus
A. nigromaculis
A. species
M. perturbans


X .?


July 24, 1965


Morbidity and Mortality Weekly Report


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WU b3 l _) b j ail s
5 M a z> F-4 33








Morbidity and Mortality Weekly Report


Table 5
Arbovirus Isolations from Birds and Mammals, 1964
Reported to Encephalitis Surveillance Unit

Bird or Mammal Virus Isolated
Species EEE SLE WEE

Pheasant X
Exposure Chicks X X
House Sparrow X
Catbird X X
Chimney Swift X
Pigeon X
Redwing Blackbird X
Blue Jay X
Swamp Sparrow X X
Mockingbird X
Robin X
Domestic Goose X
Horse X X
Hamster X
Cat X
Mouse X X
Dog X


California Encephalitis (CE)
Forty-two cases of serologically confirmed or pre-
sumptive California encephalitis were reported, of which
25 cases were in Ohio and occurred primarily during
August and September. There was no obvious geographic
clustering, no county reporting more than two cases. The
outbreak of California virus encephalitis which occurred
in southern Indiana during August and September, 1964,
was spread over five counties. There were 12 confirmed
cases, the oldest patient being 16 years of age. This
marked rise in reported California encephalitis in 1964
is in part due to increased efforts by various laboratories
to test the sera of undiagnosed cases of encephalitis for
California virus antibody.

Eastern Equine Encephalitis (EEE)
Fi\e case~ of Eastern equine encephalitis were re-
ported in 1964, the patients being 2, 5, 17, 38 and 51
:,ears of age respectively. Four of the cases were re-
ported from Florida and one from Georgia. There were
three deaths. one female aged 5 and two males aged 17
and 51.


REPORTED


Figure /

CASES OF ENCEPHALITIS
UNITED STATES, 1960-1964


BY MONTH


JFMAMJJAS ONDJFMAMJ JA
1960 1961


1963 1964


248


July 24. 1965


1962






July 4.4. 1965


Morbidity and Mortality Weekly Report


Figure 2
REPORTED CASES OF ENCEPHALITIS BY ETIOLOGIC GROUP


AND MONTH OF ONSET, 1964


POSTINFECTIOUS


.

I.


/ UNKNOWN
/ ETIOLOGY








.** 0
^**** *.-*0


A S


300-



270-
2f-



240-



210-



180-


-BORNE


0
0.
0
0 u


S0 'N' D


MONTH


2 19


0
I)
0
i






Ii\

:
~i

* 0
S '0

0 0
,0,
\=


Ii


150-


120-


90-



60-



30-



0-


_ I_


J F M A M J J







250 Morbidity and Mortality Weekly Report


Figure 3

HUMAN CASES OF ARTHROPOD-BORNE ENCEPHALITIS
BY STATE, 1964


July 24, 1965








Morbidity and Mortality Weekly Report


ENCEPHALITIS Hale County, Texas, 1964


During the months of July through September 19t.il.
an outbreak of encephalitis occurred in Hale County,
Texas. This county (population 36,798; 1960 census) is
located in the high plains area of the Texas Panhandle,
an area known to be endemic for Western equine encepha-
litis (HEE) and St. Louis encephalitis iSLEI for at least
the past 10 years. During 196l. 70 suspect cases occurred
within Hale County, and 7 more cases were reported
from place- closely adjacent to this county.
Eliological inostigati)on- of 67 of these reported
cases demonstrated otrologicnl evidence of infection
with HEE in 24 cases and SLE in 7. Thirteen cases were
found to be enterovirus-related (8 coxsackievirus B2. 4
echovirus 11, 1 poliovirus ti.p, 3), and were noted to
closely resemble the arbovirus-related cases, both in
relation to the time of onset and clinical manifestations


(Table 1). \mnung the remainder of the reported cases,
2 demonstrated equivocal evidence of SLE infection, 21
had no laboratory evidence of HEE, L.1., or specific
enterovirus infection, and specimens were judir.' in-
adequate or absent in 10 cases. Agglulination-li- i- tests
for leptospirosis were also prrformind on 23 of the sera,
all with no.ittive results.
The overall attack rate for %EE within the countN
was 51.6/J10.UOII. The highe-t rates were among infants
less than 12 months old (707/100,000), and children 1-4
years of age (107/100,000).

(Reported by Dr. Van C. Tupton. Director, Communicable
Disease Division, Texas State Department of Health; and
by the Greeley Field Station, and the Kansas rity Field
Station, CDC).


Table 1
Etiologic Confirmation of Suspected Cases of Central Nervous System Infections, Hale County, Texas 1964

Clinical diadno..is
Etiologic Aseptic Undifferentiated
category Encephalitis meningitis febrile illness Totals
Enteroviruses 4 7 2 13
WEE' 17 5 2 24
SLE* 4 2 1 7
Undiagnosed** 6 5 10 21

Totals 31 19 15 65

*Confirmed or presumptive cases only. (Two equivocal cases of SLE not included)
**An additional 10 cases are excluded in this table, because of lack of specimens for laboratory study.

SALMONELLA TYPHI Rhode Island


An infection with Salmonella typhi in Rhode Island
has been traced by phage typing to a chronic typhoid
carrier of at least 4 years known duration. The carrier,
a woman of 84 years of age, was also known to be the
source of two previous cases of typhoid fever in Rhode
Island in 1961.
The present index case of typhoid was a 12-year-old
Negro female from the city of Providence who was admitted
to the hospital on June 8, 1965. There was a one-week
history of dizziness, anorexia, headache and fever. On
admission the patient had a temperature of 1040 and
signs and symptoms which suggested inclusion of such
conditions as posterior brain tumor, brain abscess and
encephalitis in the differential diagnosis. During the
clinical investigations, febrile agglutinins done by a
quantitative test tube method were:


Typhoid H 1:1280
Paratyphoid B 1:2560


Typhoid O 1:2560
Paratyphoid E 1: 1250


Three specimens of blood cultured on the day of admission
were positive for Salmonella typhi.


The patient responded quickly to therapy with
ampicillin and made a good recovery apart from a parotitis
which developed on the 11th hospital day. There had
been an exposure to mumps one week before admission to
the hospital. Stool and urine cultures made during her stay
in the hospital and a stool culture 2 weeks after discharge
were all negative for Salmonella typhi.
The patient is one of a family of seven children,
none of whom has had a similar illness, and stool cultures
on parents and siblings have been uniformly negative.
However, a next-door neighbor who had been in close
contact with the patient and her siblings was the 84-
year-old woman who was known to be a t phoid carrier.
Phage typing of the Salmonella typhi orgarni-m. from
both the patient and the carrier demonstrated "degraded
N types reacting with the D group of phage". This very
unusual phage type gives a strong epidemiologic indicalion
of the source of infection.
(Reported by Dr. Joseph E. Cannon, Director of Health,
State of Rhode Island Department of Health, and an EIS
Officer).


July 24, 1965


251










252 Morbidity and Mortality Weekly Report


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JULY 24, 1965 AND JULY 18, 1964 (29th WEEK)



Aseptic Encephalitis Poliomyelitis Diphtheria
A'eptic --- i -------------------------- ___
Meningitis Primary Post-Inf. Total Cases Paralytic
Area
Cumulative Cumulative Cum.
1965 196. 1965 1965 1965 1965 1964 1965 1965 1964 1965 1965
UNITED STATES... 35 68 39 13 1 27 53 1 21 42 88

NEW ENGLAND.......... 1 1 1 2 2 -
Maine .............. 1 1 -
New Hampshire...... -
Vermont............ -
Massachusetts...... 1 1 .- -
Rhode Island ....... -
Connecticut ........ 1 1 -

MIDDLE ATLANTIC ...... 8 11 1 1 7 7 5
New York City...... 5 4 1 1 I 3
New York, Up-State. 4 4 -
New Jersey......... 5 2 2 -
Pennsylvania ....... 3 2 1 2

EAST NORTH CENTRAL... 4 9 8 1 1 7 6 3
Chic................ 3 2 2 1
Indiana ............ 1 2
Illinois........... 2 5 3 1 4 4 -
Michigan............ 2 3 1 1 1 -
Wic.oni in......... -

WEST NORTH CENTRAL... 3 2 4 4 5 3 5 2 18
Minnesota.......... 3 2 1 4 1 1 1 1 7
I w ............... 1 1
i souri ............ 2 1 -
North Dakota....... -
South Dakota ....... 1 7
Nebraska........... 3 3 I
Kansa5 .............. 1 1

SOUTH AILANTIC....... 5 2 18 13 23
Delaware........... 1 1 -
Maryland.............. 1 1 -
Dist. of Columbia.. 3
Virginia........... -
beat Virginia ...... -
North Carolina...... 1 1 8 4 2
South Carolina...... 1
Georgia ............ 1 1 11
Florida............ 2 2 1 7 6 6

EAST SOU1H CENTIRAL... 20 4 3 14
Kentucky............ 19 -
Tennessee.......... 1 2 1 -
Alabama............ 2 2 13
Mississippi ........ 1

WEST SOUTH CENTRAL... 12 8 4 1 12 4 1 10 4 19
Arkansas............ 2
Louisiana.......... 1 1 I 1 2
Oklahoma........... 3 I 1 -
Texas.............. 11 7 1 1 11 3 1 9 3 15

MOUNTAIN............. 2 4 5 6 3 3 -
Montana............ -
Idaho .............. -
Wyoming............ 2 2 -
Colorado........... 2 1 1 I -
New Mexico......... 1 3 1 -
Arizona............ 1 4 2 -
Utah............... 2 -
Nevada.............. -

PACIFIC.............. 10 14 5 6 3 2 3 2 5
Washington......... 1 2 2 -
Oregon............. 1 1 1 1
California......... 9 14 4 6 1 1 1 1 4
Alaska.............. -
Hawaii............. -

Puerto Rico -" 6









Morbidity and Mortalilv Weekly Report 253


Table 3. CASES () SPI ( I111) NOl IHABI I DIIt A A 1 I UNITED STA II

WOR WIKS INI)ll)

JULY 24. 1965 AND JULY 18, 1964 (291h H II K) CIoninutd


Brucel- Intectious Hepatitis Metningocucca
loss including Serum Hepatitis Infections Tetanus
Area Total Under 20 years Cumulative
1l. ULnk. 20 v.ir ,l, .v rv T.t.al Cumulative Curm.
1965 1965 1965 1965 1965 1964 1965 1965 1964 1965 196j

UNITED STATES... 6 558 228 306 19,729 23,131 38 2,082 1,711 8 132

NEW ENGLAND.......... 1 30 14 15 1,191 2,282 3 106 47 5
Maine............. 6 2 4 223 748 2 14 5 -
New Hampshire...... 5 2 2 111 166 5 1 1
Vermont............. 3 2 1 67 285 1 6 1 -
Massachusetts ...... 10 6 4 463 471 34 19 3
Rhode Island....... I 1 147 125 14 7 -
Connecticut ........ 5 2 3 180 487 33 14 1

IDDLE ATLANTIC...... 97 33 64 3,483 5,247 7 278 205 8
New York City...... 34 5 29 665 772 3 49 28 -
New York, Up-State. 27 11 16 1,390 2,365 3 75 58 3
New Jersey.......... 18 7 11 641 945 1 74 71 -
Pennsylvania....... 18 10 8 787 1,165 80 48 5

EAST NORTH CENTRAL... 2 97 47 47 3,792 3,509 10 280 238 13
Ohio............... 18 5 13 1,062 925 2 73 63 1
Indiana............ 14 8 6 330 309 1 38 36 6
Illinois........... 2 20 11 8 705 615 2 73 60 4
Michigan........... 36 17 19 1,452 1,403 5 62 53 -
Wisconsin.......... 9 6 1 243 257 34 26 2

WEST NORTH CENTRAL... 1 21 4 12 1,220 1,256 1 107 106 1 9
Minnesota.......... 1 4 3 119 123 21 25 1 6
Iowa............... 10 1 5 452 178 7 6 1
Missouri........... 4 1 3 259 321 1 49 52 1
North Dakota....... 17 49 7 11 -
South Dakota....... 16 106 2
Nebraska........... 1 1 43 32 10 6 -
Kansas............. 2 1 1 314 447 11 6 -

SOUTH ATLANTIC....... 1 51 20 27 2,022 2,185 5 407 357 2 37
Delaware........... 59 41 5 6 -
Maryland........... 6 3 3 375 420 38 25 1
Dist. of Columbia.. 26 34 1 8 12 -
Virginia........... 1 9 6 468 338 48 40 7
West Virginia...... 8 6 2 302 347 1 24 26 1
North Carolina..... 17 8 9 176 393 78 60 5
South Carolina..... 3 2 1 82 75 56 48 3
Georgia............. 2 2 76 52 2 53 46 4
Florida............ 6 1 4 458 485 1 97 94 2 16

EAST SOUTH CENTRAL... 40 19 18 1,410 1,605 1 164 152 1 19
Kentucky........... 18 11 4 494 650 67 52 1 5
Tennessee........... 10 4 6 497 542 1 48 50 5
Alabama............. 5 1 4 240 271 30 32 8
Mississippi........ 7 3 4 179 142 19 18 1

WEST SOUTH CENTRAL... 1 69 34 33 1,716 1,716 4 292 209 4 25
Arkansas............ 6 1 5 229 176 14 19 2 6
Louisiana.......... 8 5 3 293 393 1 163 103 1 4
Oklahoma........... 1 1 1 40 91 1 18 7 1
Texas.............. 54 27 25 1,154 1,056 2 97 80 1 14

MOUNTAIN.............. 23 9 8 1,155 1,410 1 62 62 3
Montana............ 3 2 86 127 2 -
Idaho............... 160 157 8 3 -
Wyoming............ 1 1 33 45 4 3 -
Colorado........... 12 6 6 239 388 13 11 2
New Mexico......... 2 1 1 246 199 10 26 -
Arizona............. 3 226 327 16 5 1
Utah .............. 158 125 1 7 6 -
Nevada.............. 1 7 42 2 8

PACIFIC............. 130 48 82 3,740 3,921 6 386 335 13
Washington......... 2 2 297 441 31 25 -
Oregon............. 11 6 5 309 435 28 20 3
California.......... 113 42 71 2,938 2,844 6 307 273 10
Alaska............. 1 1 164 122 13 7 --
Hawaii............. 3 3 32 79 7 10 -

Puerto Rico 25 20 5 771 572 1 5 30 3 24









254 Morbidity and Mortality Weekly Report


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JULY 24, 1965 AND JULY 18, 1964 (29th WEEK) Continued


Strept.
Measles Sore Th. & Tularemia Typhoid Fever Rabies in
Scarlet Fev. Animals
Area
Cumulative I Cum. Cum. Cum.
1965 1965 1964 1965 1965 1965 1965 1965 1965 1965
UNITED STATES... 1,910 233,962 452,634 4,144 5 138 12 209 67 2,694

NEW ENGLAND.... ..... 73 36,546 16,025 395 3 30
Maine.............. 11 2,764 2,787 92 3
New Hampshire...... 3 381 237 1
Vermont........... 13 1,244 2,258 1 24
Massachusetts...... 32 19,163 4,P86 26 2 1
Rhode Island....... 4 3,885 1,853 6 -
Connecticut........ 10 9,109 4,004 270 1

MIDDLE ATLANTIC...... 224 14,054 51,294 132 2 35 3 109
New York City...... 83 2,107 15,101 2 17 -
New York, Up-State. 49 3,963 12,282 78 2 10 3 98
New Jersey......... 48 2,389 12,045 46 2 -
Pennsylvania....... 44 5,595 11,866 6 6 11

EAST NORTH CENTRAL... 737 53,553 100,865 245 1 11 5 32 11 407
Ohio................ 47 8,741 19,367 19 1 7 8 210
Indiana............ 14 1,715 22,455 87 1 4 9 2 39
Illinois........... 67 2,472 16,099 34 5 1 7 72
Michigan........... 274 25,804 28,412 74 1 1 4 1 40
Wisconsin.......... 335 14,821 14,532 31 1 2 5 46

WEST NORTH CENTRAL... 38 16,260 29,938 144 1 15 1 6 8S 558
Minnesota.......... 2 619 327 2 1 3 111
Iowa............. .... 3 8,938 23,16 17 1 160
Missouri........... 2 2,552 1,005 7 10 4 3 74
North Dakota...... 31 3,593 4,619 80 1 33
South Dakota....... 109 8 8 1 2 1 39
Nebraska............ 449 12 1 1 2 31
Kansas ....,..... 11 NN NN 30 2 102

SOUTH ACLA C ....... 188 24,028 37,597 542 27 3 44 13 368
Delaware............ 498 398 37 4 -
Maryland........... 27 1,094 3,382 120 2 14 4 9
Dist, of Columbia.. 2 71 353 5 -
Virginia........... 44 3,766 12,599 114 5 3 4 257
West Virginia...... 56 13,286 8,369 131 1 17
North Carolina..... 3 372 1,137 2 5 1 13 2
South Carolina..... 11 1,004 4,213 24 3 4 2
Georgia............ 8 612 159 14 2 2 36
Florida ........... 37 3,325 6,987 109 3 3 45

EAST SOUTH CENTRAL... 81 13,434 66,732 720 1 16 21 5 610
Kentucky.............. 2,394 L8,249 20 3 6 1 60
Tennessee........... 42 7,686 23,648 558 1 12 7 4 537
Alabama.............. 23 2,275 18,174 30 1 4 10
Mississippi ........ 1,079 6,661 112 4 3

WEST SOUTH CENTRAL... 153 30,138 70,809 498 2 51 30 9 429
Arkansas........... 1,080 1,051 2 34 10 1 59
Louisiana............. 3 94 96 1 5 1 65
Oklahoma............ 1 201 974 21 8 2 2 76
Texas................ 149 28,763 68,688 477 8 13 5 229

MOUNTAIN.............. 197 19,204 17,642 830 13 14 5 55
Montana............. 34 3,647 2,840 31 2 3
Idaho.............. 54 2,690 1,818 84 -
Wyoming.............. 5 839 240 17 3 1 -
Colorado........... 49 5,524 3,055 345 3 7
New Mexico......... 6 663 390 202 8 11
Arizona............ 31 1,199 6,422 46 5 2 33
Utah............... 18 4,440 1,898 105 8 1
Nevada.............. 202 979 -

PACIFIC.............. 219 26,745 61,732 638 5 1 24 3 136
Washington......... 16 7,195 19,924 66 2 1 6
Oregon............. 20 3,133 8,316 13 2 3 3
California......... 75 12,613 31,991 482 3 1 18 2 125
Alaska............. 142 1,073 8 2
Hawaii............. 108 3,662 428 69 -- 1 -

Puerto Rico 40 2,180 5,296 7 3 11









Moribidity and Mortality \eekl Repiort


Table 4. DEATHS IN 122 UNITfD STATES CITIFS FOR WE'K FNDFD JULY 24, 1965

(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.---------

BAST 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 a------
Duluth, Minn.--------
Kansas City, Kans.----
Kansas City, Mo.------
Lincoln, Nebr.---------
Minneapolis, Minn.----
Omaha, Nebr.-----------
St. Louis, Mo.---------
St. Paul, Minn.--------
Wichita, Kans.---------


690
225
36
29
34
50
23
24
28
42
63
14
48
20
54

3,003
37
32
125
32
24
45
52
75
1,484
32
514
186
42
92
26
48
60
45
26
26

2,526
71
42
708
163
229
115
80
359
40
57
44
31
33
140
33
139
28
32
27
101
54

804
61
33
47
124
19
111
62
236
70
41


404
111
17
17
23
31
16
15
21
27
39
8
30
13
36

1,707
22
19
78
11
10
25
30
40
832
18
290
94
29
57
14
40
40
27
19
12

1,361
38
24
356
102
125
64
39
186
29
26
26
17
20
67
15
88
10
18
18
67
26

472
34
28
25
75
16
65
25
143
40
21


*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.-----------


1,040
107
269
27
55
80
56
75
18
62
58
177
56

567
77
33
34
128
119
41
45
90

1,055
30
31
25
146
41
69
178
51
180
82
98
54
70

355
33
21
104
15
70
14
53
45

1,598
12
36
52
51
60
537
118
28
115
68
99
188
33
124
57
20


Total 11,638 6,370 386 752

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 366,137
All Causes, Age 65 and over------------------- 207,611
Pneumonia and Influenza, All Ages------------- 15,677
All Causes, Under 1 Year of Age--------------- 21,741


Week No.
29








Morbidity and Mortality Weekly Report


INTERNATIONAL NOTES QUARANTINE MEASURES


Immunization Information for International Travel
1963-64 edition-Public Health Service Publication No. 384


The following changes should be made in the list of
Yellow Fever Vaccination Centers in Section 6:



Page 73
ADD


Lansing, Michigan


Center: Ingham County Health Department
119 W. Washtenaw
Telephone 487-6001


Clinic Hours: By Appointment


Fee:


DELETE


City:


Center:





Clinic Hours:



Fee:


ADD


City:


Center:


Yes


Page 78



Houston, Texas


The Methodist Hospital
Texas Medical Center
6516 Bertner


Monday-Friday, 8:00 a.m.-4:00 p.m.
By appointment


Yes


Houston, Texas


The Methodist Hospital
Texas Medical Center
6516 Bertner
Telephone JA 6-3311


July 24, 1965 C


0 cc
o__


TE MORBIDITY AND MORTALITY WEEKLY REPORT. WITH A CIRCULA-
TION OF 13.-00 IE PUBLISHED BY THE COMMUNICABLE DISEASE
CENTER. ATLANTA, GEORGIA 30333.
CHIEF COMMUNICABLE DISEASE CENTER JAMES L. GODDARD. M.D.
CHIEF EPIDEMIOLOGY BRANCH A. D LANGMUIR. M.D.
CHIEF STATISTICS SECTION R. E. SERFLING. PH.D.
ASST. CHIEF. STATISTICS SECTION IDA L. SHERMAN. M.S.
CHIEF, SURVEILLANCE SECTION D. A. HENDERSON. M.D.
EDI TOR: 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 CASES. SUCH
ACCOUNTS SHOULD BE ADDRESSED TO:
THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT
COMMUNICABLE DISEASE CENTER
ATLANTA GEORGIA 30333

NOTE- THESE PROVISIONAL DATA ARE BASED ON WEEKLY TELE-
GRAMS TO THE CDC BY THE INDIVIDUAL STATE HEALTH DEPART.
MENTS. THE REPORTING WEEK CONCLUDES ON SATURDAY; COMPILED
DATA ON A NATIONAL BASIS ARE RELEASED ON THE SUCCEEDING
FRIDA .
SYMBOLS'.--DATA NOT AVAILABLE
QUANTITY ZERO
THE CONSTRUCTION OF THE MORTALITY CURVES IS DESCRIBED IN
.OL. 14. NO. 1.


UNIV. OF FL LIB.
DOCUMENTS DEPT.


,



U.S. DEPOSITORY


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Clinic Hours: By appointment


Fee: Yes




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