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:
AA00010654:00377

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
Ft e. / i


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Morbidity and Mortality



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

PUBLIC HEALTH SERVICE


Prepared by the


I *'l'rlll: p .1~ll~


For release December 18, 1964 ATLANTA, GEORGIA 30333 Vol. 13, No. 50
PROVISIONAL INFORMATION ON SELECTED NOTIFIABLE DISEASES IN THE UNITED STATES AND ON
DEATHS IN SELECTED CITIES FOR WEEK ENDED DECEMBER 12, 1964
SPECIAL REPORT Meningococcal Meningitis
Rabies EPIDEMIOLOGIC NOTES


Only one case of human rabies has been reported
thus far this year (see MMWR, Vol. 13, No. 38), as in
1963. The figure opposite shows the incidence of human
rabies since 1938. The decline in cases has paralleled
the decline in animal rabies cases which began in 1946
and continued until 1960.
Since 1960, there has been a slight upward trend in
reported cases of animal rabies. This trend, due to an
increased incidence of rabies in wild animals, has
accelerated during 1964. There are 4,353 cases of animal
rabies reported thus far this year as compared to 3,608
cases for thesimilar period of 1963; a21 percent increase.
The increased number of animal rabies cases is largely
accounted for by an increased incidence of skunk rabies
in the midwest and fox rabies in Virginia and Tennessee.


REPORTED HUMAN RABIES
SY YEAR
UNITED STATES. 1938-1963


'F %o1 26 W4 '466 4'U o' 4 S'9 5 '64
YEAR


Table 1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
50th Week Ended Cumulative. First 50 Weeks
Disease December 12, December 14, Median Median
1964 1963 1959 1963 1964 1963 1959 1963
Aseptic meningitis ................ 35 30 --- 2,075 1,771 ---
Brucellosis ....................... 3 4 9 383 347 562
Diphtheria ........................ 3 20 20 278 282 564
Encephalitis, primary infectious.. 47 29--- 3,112 -,4-
Encephalitis, post-infectious ..... 3 -- 763 1,495
Hepatitis, infectious including
serum hepatitis ................ 722 857 945 36,367 41,385 41,385
Measles ........................... 3,249 3,440 4,283 454,334 380,794 413,519
Meningococcal infections .......... 58 45 45 2,615 2,253 2,116
Poliomyelitis, Total .............. 6 22 117 429 1,321
Paralytic ...................... 4 13 90 366 859
Nonparalytic ................... 2 --- 15 46 ---
Unspecified .................... -- --- 12 17
Streptococcal Sore Throat and
Scarlet fever .................. 8,887 8,404 --- 377,357 325,667 ---
Tetanus ........................... 5 4 --- 266 270 ---
Tularemia ......................... 5 --- 312 277
Typhoid fever .................... 5 10 433 520 786
Rabies in Animals ............ 51 51 4,353 3,608 3,470

le 2. NOTIFIABLE DISEASES OF LOW FREQUENCY
SC19 eJ Cum. Cum.
Anthrax: 5 Psittacosis:Ariz. 45
Botulism: 15 Rabies in Man: 1
Leptospirosis: 102 Smallpox:
Malaria: Calif. 1 9 Typhus-
Plague: Mrine: 23
__ Rky Mt. Spotted: N. C. 2 222


633-3311







438


In the United States, the national incidence of
meningococcal meningitis has shown but a slight increase
(figure 1). Through the 50th week of this year, 2,615
cases were reported compared to 2,253 cases for the
comparable period last year.
During the past 18 months, meningococcal infections
have assumed a special significance because of outbreaks
among military recruits, caused primarily by Group B
strains which are resistant to the usual prophylactic
and therapeutic doses of sulfonamide drugs. The resulting
lack of an effective chemoprophylactic agent is of concern
to both military and civilian health officers. Since 1963,
when significant numbers of sulfonamide-resistant menin-
gococcal infections were first recognized at the San
Diego Naval Training Center, the problem has been under
intensive study. During recent months, a similar problem
has been recognized among military recruits stationed at
Fort Ord, California. On the advice of the Surgeon General
of the Army, the assignment of new basic trainees to
Fort Ord as of October 11, 1964 was discontinued and all
basic training at that facility during the month of December
was stopped.
The occurrence of meningococcal infections in
California and at Fort Ord during the past 5 years is
summarized in Table 1. A progressive increase in the
number of cases per year is evident both in California
and at Fort Ord. The increasing number of cases at Fort
Ord, however, has not been paralleled by an increasing
number of cases in Monterey County. Most striking is the
fact that in 1964 through mid-November, Monterey County
reported only one case of meningococcal meningitis
exclusive of cases from Fort Ord.

Table 1
MENINGOCOCCAL INFECTIONS IN CALIFORNIA, 1960.64 (THROUGH NOVEMBER 14)

Monterey County Fort Ord
Year California Exclusive of Trainees Dependents Total
Fort Ord
Cases Deaths Cases Deaths Cases Deaths
1960 209 3 3 1 2 1 5 2
1961 236 10 5 0 7 1 12 1
1962 334 7 36 0 3 0 39 0
1963 388 16 53 5 5 0 58 5
1964 473 1 84** 11 7 1 91 12
SThrough Novembe 14.
Six additional cases of meningitis, 3 of which were fatal, occurred among trainees within
2 weeks following completion of basic raining at Fort Ord. Four other localized menin.
gococcl infections occurred among trainees (urethlitis, conjunctivitis, and maxillary sinusitis).


The month of onset of the 101 meningococcal in-
fections and the deaths among Fort Ord personnel and
their dependents in 1964 are shown in Figure 2. Not
included in this total are 3 additional cases of meningitis,
including one death, that occurred away from Fort Ord in
October, one in a dependent, and two in non-dependent
civilians. All had contact with a Fort Ord trainee several
days prior to the onset of disease.
It is apparent that a substantial reduction in the
number of cases per month occurred in September and


Figure I

MENINGOCOCCAL INFECTIONS
REPORTED BY YEAR
UNITED STATES, 1920-1964*


20 0O '40
YEAR
STmROUG6 DECEMBER 5. 1964


50 '60 64

SPRELIMIARYV DATA


Fgure 2.

MENINGOCOCCAL INFECTIONS AND DEATHS
BY MONTH OF ONSET
FORT ORD, CALIFORNIA-1964*


I CASE

3 DEATH


,"\\ \ I

JAN FEB MAR APR MAY JUN JUL AUG SEPTOCT NOV

*CASES REPORTED THROUGH NOVEMBER 17.


Morbidity and Mortality Weekly Report


SPECIAL REPORT Meningococcal Meningitis

MENINGOCOCCAL MENINGITIS


n_


_


U






Morbidity and Mortality Weekly Report


October following the August peak. This coincided with
the introduction of a number of prophylactic measures to
be described.
The disease among military personnel has been one
of recruits, occurring almost solely during the 8 weeks
of basic combat training, or shortly thereafter. (Figure 3)
During the past several months there has been a tendency
for the disease to occur during the last 4 weeks of basic
combat training or within one week after its completion,
rather than during the first 4 weeks, as was formerly the
case. An explanation for this change has not been ap-
parent.
Rates of nasopharyngeal carriage have been monitored
regularly. Recent results indicate that the meningococcal
carrier rate among inductees arriving at Fort Ord ranges
from 15 ro 25 percent. By the seventh week of training,
this rate may reach as high as 80 percent. The cumulative
carrier rate by the end of basic combat training approaches
100 percent. Most of the strains from both cases and
carriers have been Group B; Group C strains have ac-
counted for approximately 10 percent of the isolates.
The outstanding characteristic of the meningococci
recently prevalent is sulfonamide resistance. With re-
cognition at Fort Ord in 1963 that sulfonamide-resistant
strains were present and that prophylaxis failed to reduce
carrier rates, prophylaxis with sulfonamides was ter-
minated in May, 1963. During the latter part of 1963, up
to 90 percent of all strains isolated were resistant; thus
far, in 1964, the proportion of resistant strains has
generally been somewhat lower although varying widely
from 10 to 80 percent. Approximately half of the cases
have been caused by resistant organisms. Almost all
sulfonamide-resistant strains have been Group B, al-
though a few resistant Group C strains have been iden-
tified.
Since no effective chemoprophylactic agent was
available, older but nonetheless useful procedures
designed to reduce the degree of contact among recruits
and to decrease their susceptibility to the disease-
assumed primary importance. Several such measures were
put into effect during August and September. These
included: (1) reduction of the recruit input at Fort Ord
from 1100 men per week to 800 men per week; (2) institution
of a platoon system to further restrict contact between
men, not only to their own company, but to a single
platoon: (3) cancellation of all leaves during the 8-week
training period and prior to being transferred to their
next duty station; (4) complete restriction of recruits to
their company area; (5) the provision of additional barracks
space to provide a minimum of 72 square feet of space per
recruit; and (6) the provision of a minimum of a one-week
free period for cadre personnel between recruit groups.
The reduction in cases during September and October
followed institution of these measures. The temporary
discontinuation of recruit training, however, precludes a
full evaluation of the effect of these measures.
Cases at Fort Ord have been satisfactorily treated
with penicillin G in high doses (1,000,000 units or more


Figure 3.

MENINGOCOCCAL MENINGITIS
AMONG FORT ORD TRAINEES
BY WEEK OF BASIC COMBAT TRAINING
1964*


WEEK OF TRAINING

*THROUGH OCTOBER 31.


Figure 4.

MINIMUM INHIBITING CONCENTRATION
OF SULFADIAZINE
FOR 210 ISOLATES OF MENINGOCOCCI*
1963-1964
60
a



a o
w
tF 50-
9
2
I 40

30
0
S20-

a.

.05 .01 05. 10 3.0 50 10
MG PER CENT SULFADIAZINE

*FROM BLOOD OR CEREBROSPINAL FLUID SPECIMENS
SUBMITTED TO THE COMMUNICABLE DISEASE CENTER.


every 2 hours parenterally), with or without the addition
of a sulfonamide drug. There has been no evidence to
*suggest that sulfonamide-resistant strains are any more
or less virulent than the sensitive strains, nor has there
been evidence suggesting that any of the deaths were
due to antibiotic failure.
The occurrence of outbreaks of meningococcal
meningitis due to Group B strains is in sharp contrast to
previous experience.Group A strains have been responsible
for most epidemics in the past, and Group C strains have
been occasionally associated with outbreaks.

(Continue to page 444)


439









440 Morbidity and Mortality Weekly Report


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 12, 1964 AND DECEMBER 14, 1963 (50TH WEEK)


Aseptic Encephalitis
Aseptic
Meningitis Primary Post-Inf. Poliomyelitis, Total Cases Poliomyelitis, Paralytic
Area
Cumulative Cumulative
1964 1963 1964 1964 1964 1963 1964 1963 1964 1963 1964 1963
UNITED STATES... 35 30 47 3 6 117 429 4 90 366

NEW ENGLAND........... 1 1 2 9 2 9
Maine............... 3 3
New Hampshire...... -
Vermont............. 1 1
Massachusetts..... 3 3
Rhode Island ...... 1 1 -
Connecticut........ 2 2 2 2

MIDDLE ATLANTIC..... 6 2 14 1 15 122 13 98
New York City...... 1 2 2 1 2 -
New York, Up-State. 2 2 1 10 10 9 7
New Jersey.......... 3 9 3 4 2 3
Pennsylvania....... 2 1 107 88

EAST NORTH CENTRAL... 2 5 4 24 58 16 47
Ohio............... 2 3 8 2 4
Indiana............ 3 9 4 6 3
Illinois........... 1 2 6 17 5 16
Michigan............ 1 1 1 3 20 2 20
Wisconsin........... 3 9 1 4

WEST NORTH CENTRAL... 3 1 1 1 10 8 8 6
Minnesota.......... 1 3 4 2 4
Iowa............... 1 1 -
Missouri........... 1 1 4 1 3 -
North Dakota....... 1 1 1 -
South Dakota....... 1 1
Nebraska........... 1 1
Kansas.............. 3 1 1 -

SOUTH ATLANTIC....... 1 1 2 3 35 102 3 28 88
Delaware............ 1 1
Maryland........... 1 1 1
Dist. of Columbia.. 1 -
Virginia........... 1 2 -- 4 21 4 16
West Virginia...... 1 1 4 1 1 4
North Carolina..... 12 5 7 4
South Carolina..... 3 8 3 7
Georgia............ 1 3 22 1 3 21
Florida............ 1 1 11 39 1 9 34

EAST SOUTH CENTRAL... 2 1 1 6 73 5 67
Kentucky........... 1 1 -
Tennessee.......... 3 11 2 10
Alabama............. 2 53 2 48
Mississippi .... 1 1 9 1 9

WEST SOUTH CENTRAL... 4 2 1 1 12 27 10 26
Arkansas............ 1 1 4 3
Louisiana........... 1 14 14
Oklahoma........... 2 3 1 2 1
Texas.............. 3 9 8 8 8

MOUNTAIN ............. 3 4 20 2 10 8 1 5 6
Montana............ 1 1 -
Idaho.............. 1 1 1 1
Wyoming............ 2 2 -
Colorado........... 3 4 19 1 1 2 1 1
New Mexico......... 5 1 -
Arizona............ 3 3
Utah............... 1 -
Nevada............. I 1 1 1

PACIFIC.............. 13 13 4 1 3 22 3 19
Washington......... 1 2 2
Oregon............. 1 2 1 1
California......... 10 11 4 1 2 18 2 16
Alaska............... -
Hawaii............. 3 1 -

Puerto Rico 5 4









Morbidity and Mortality Weekly Report 441


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 12, 1964 AND DECEMBER 14, 1963 (50TH WEEK) CONTINUED


Infectious Hepatitis
Brucellosis Diphtheria including Serum Hepatitis Typhoid Fever
Area Under 20 years Age
Cum. Cum. Total 20 years and over Unknown Cumulative Cum.
1964 1964 1964 1964 1964 1964 1964 1964 1964 1963 1964 1964

UNITED STATES... 3 383 3 278 722 346 321 55 36,367 41,385 8 433

NEW ENGLAND.......... 2 44 44 19 24 1 3,226 4,781 17
Maine.............. 39 12 8 3 1 996 2,169 -
New Hampshire...... 4 4 256 589 -
Vermont............. 5 4 1 375 143 -
Massachusetts..... 2 5 9 4 5 741 1,174 8
Rhode Island....... 7 7 217 115 6
Connecticut........ 7 3 4 641 591 3

MIDDLE ATLANTIC ...... 8 10 133 61 72 7,912 8,233 68
New York City...... 5 25 11 14 1,261 1,293 34
New York, Up-State. 4 49 23 26 3,419 3,558 15
New Jersey.......... 2 16 3 13 1,295 1,200 2
Pennsylvania...... 4 3 43 24 19 1,937 2,182 17

EAST NORTH CENTRAL.. 50 11 126 61 61 4 5,853 6,606 2 84
Ohio............... 5 24 13 11 1,532 1,810 1 22
Indiana............ 1 1 9 6 3 486 608 22
Illinois........... 29 9 29 9 20 1,118 1,360 23
Michigan........... 6 1 59 32 27 2,316 2,530 11
Wisconsin.......... 9 5 1 4 401 298 1 6

WEST NORTH CENTRAL... 1 165 36 43 27 13 3 1,996 1,848 1 32
Minnesota........... 9 18 5 1 2 2 226 283 3
Iowa............... 1 104 14 10 4 359 328 4
Missouri........... 10 1 9 5 4 496 602 1 15
North Dakota....... 2 2 1 1 64 102 2
South Dakota....... 21 3 1 1 135 141 1
Nebraska............ 13 5 5 3 2 74 125 3
Kansas............. 6 7 8 8 642 267 4

SOUTH ATLANTIC....... 1 40 76 80 40 33 7 3,377 4,156 3 98
Delaware........... 2 1 1 76 80 -
Maryland........... 1 20 11 9 620 524 8
Dist. of Columbia.. 69 108
Virginia........... 17 18 6 5 7 543 814 11
West Virginia...... 1 1 15 13 2 482 648 -
North Carolina..... 4 1 10 6 4 546 1,057 20
South Carolina..... 7 1 1 152 166 12
Georgia............ 14 32 6 2 4 112 171 1 28
Florida............ 4 35 8 8 777 588 2 19

EAST SOUTH CENTRAL... 18 30 45 31 11 3 2,466 3,725 43
Kentucky............ 6 15 11 1 3 865 1,125 10
Tennessee.......... 5 2 13 7 6 873 1,422 19
Alabama............ 4 23 5 5 479 592 8
Mississippi........ 3 5 12 8 4 249 586 6

WEST SOUTH CENTRAL... 46 2 41 56 30 23 3 2,860 2,812 41
Arkansas............ 6 3 3 1 2 289 306 15
Louisiana.......... 4 12 8 7 1 675 577 6
Oklahoma........... 9 1 132 122 9
Texas.............. 27 2 25 45 22 20 3 1,764 1,807 11

MOUNTAIN ............. 30 2 59 19 7 33 2,238 2,616 1 13
Montana............ 5 3 2 190 331 -
Idaho.............. 9 9 316 440 -
Wyoming........... 2 2 93 43 1
Colorado............ 15 5 2 8 588 533 -
New Mexico........ 1 1 12 9 3 324 329 1 5
Arizona............ 2 1 12 12 487 593 7
Utah............... 26 4 2 -2 189 328 -
Nevada............. 1 51 19 -

PACIFIC............... 1 24 1 28 136 58 77 1 6,439 6,608 1 37
Washington......... 13 7 3 1 647 1,076 2
Oregon............. 2 4 4 644 770 -
California ......... 1 22 1 15 107 46 61 4,736 4,513 1 35
Alaska............. 12 9 3 290 206 -
Hawaii ............ 6 6 122 43

Puerto Rico 13 13 8 5 954 857 13








442 Morbidity and Mortality Weekly Report


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
DECEMBER 12, 1964 AND DECEMBER 14, 1963 (50TH WEEK) CONTINUED


Streptococcal
Meningococcal Sore Throat and Rabies in
Measles Meningitis Scarlet Fever Tetanus Tularemia Animals
Area
Cumulative Cum. Cum. Cum.
1964 1964 1964 1963 1964 1963 1964 1964 1964 1964 1964 1964
UNITED STATES... 3,249 58 2,615 2,253 8,887 8,404 5 266 3 312 120 4,353

NEW ENGLAND.......... 901 2 91 131 907 572 9 1 1 36
Maine.............. 151 7 19 65 80 28
New Hampshire...... 49 2 4 6 2
.Vermont............. 34 4 6 1 17 1 5
Massachusetts...... 247 1 38 59 351 92 9 1 1
Rhode Island....... 79 11 12 30 34 -
Connecticut........ 341 1 29 31 454 349 -

MIDDLE ATLANTIC....... 203 6 343 320 350 323 1 23 1 6 123
New York City...... 21 2 48 49 13 30 -
New York, Up-State. 64 1 103 102 287 175 1 9 6 115
New Jersey......... 23 1 107 50 61 6 -
Pennsylvania....... 95 2 85 119 50 57 8 1 8

EAST NORTH CENTRAL... 435 8 354 351 797 811 51 24 19 597
Ohio............... 76 2 93 99 73 100 14 2 17 307
Indiana............ 23 1 55 46 147 93 15 2 1 31
Illinois........... 14 4 96 72 97 104 14 14 114
Michigan........... 199 1 78 99 367 341 7 2 57
Wisconsin.......... 123 32 35 113 173 1 4 1 88

WEST NORTH CENTRAL... 182 5 150 138 412 262 1 18 59 22 1,293
Minnesota.......... 1 1 33 28 6 24 1 5 2 8 413
Iowa............... 54 9 7 115 65 6 1 2 452
Missouri........... 20 3 68 41 4 48 4 32 4 190
North Dakota........ 95 20 16 178 105 5 71
South Dakota....... 1 3 7 18 10 1 15 2 94
Nebraska........... 11 7 25 1 36
Kansas............. NN 1 10 14 91 10 2 9 37

SOUTH ATLANTIC....... 254 16 525 413 832 727 2 65 31 13 590
Delaware.......... 3 7 4 21 2 -
Maryland........... 41 58 54 17 4 3
Dist. of Columbia.. 17 8 3 5 1 -
Virginia........... 32 1 64 88 193 368 8 7 8 317
West Virginia...... 150 35 23 249 200 1 2 38
North Carolina..... 4 8 95 80 16 34 1 16 7 5
South Carolina..... 6 2 59 24 64 39 5 -- 2
Georgia............ 1 5 87 34 34 12 1 5 15 119
Florida............ 58 120 94 198 50 25 1 3 106

EAST SOUTH CENTRAL... 240 2 195 152 1,529 1,745 35 1 33 33 637
Kentucky.............. 65 64 34 149 264 8 4 1 63
Tennessee.......... 153 2 62 70 1,192 1,338 14 1 21 32 491
Alabama............. 12 43 25 89 13 8 3 20
Mississippi........ 10 26 23 99 130 5 5 63

WEST SOUTH CENTRAL... 233 5 242 203 881 908 1 30 1 107 14 619
Arkansas............. 4 33 14 1 1 8 1 66 2 147
Louisiana.......... 129 81 2 6 4 6 3 76
Oklahoma........... 9 15 35 12 40 1 20 3 97
Texas.............. 220 5 65 73 866 861 1 17 15 6 299

MOUNTAIN ............. 423 1 97 80 1,485 2,032 6 1 53 2 143
Montana............ 110 1 3 65 78 19 1
Idaho.............. 56 4 6 79 90 1 -
Wyoming............ 1 5 7 58 279 2 1 11
Colorado............. 16 22 21 633 633 -- 8
New Mexico.......... 147 39 5 247 517 1 52
Arizona............ 9 8 13 125 187 1 2 68
Utah............... 80 7 20 277 247 1 23 3
Nevada............. 4 1 11 5 1 1 11

PACIFIC.............. 378 13 618 465 1,694 1,024 29 3 10 315
Washington......... 162 48 40 332 160 3 -
Oregon............. 26 2 27 34 35 30 I I 11
California......... 159 11 523 362 1,135 742 23 2 10 304
Alaska............. 6 7 15 31 53 -
Hawaii.............. 25 13 14 161 39 2 -

Puerto Rico 54 34 10 7 10 1 65 1 27








Morbidity and Mortality Weekly Report





Table 4 (B). REPORTED PNEUMONIA-INFLUENZA DEATHS IN REPORTING CITIES


(Tables 4(A), 4(B), 4(C), and 4(D) will be published in sequence covering a four-week period.)o


443


For weeks ending For weeks ending
Area ___________ Area/21 1 11/2
11/21 11/28 12/5 12/12 11/21 11/28 12/5 12/12


NEW ENGLAND:
Boston, Mass.............. 12 4 8 13
Bridgeport, Conn........... 2 4 4 6
Cambridge, Mass........... 1 -
Fall River, Mass.......... 2 2 -
Hartford, Conn............ -
Lowell, Mass.............. 3 3 2
Lynn, Mass................ 3 2 1 4
New Bedford, Mass......... 1 3 1 1
New Haven, Conn............ 1 1
Providence, R.I........... 1 6 6
Somerville, Mass........... 2 2 1*
Springfield, Mass......... 2 5 1 7
Waterbury, Conn............ 1 1 -
Worcester, Mass........... 8 1 6 6

MIDDLE ATLANTIC:
Albany, N.Y............... 1 -
Allentown, Pa............. 1 2 3
Buffalo, N.Y.............. 3 5 4 10
Camden, N.J............... 3 2 2 2
Elizabeth, N.J............ 1 1 -
Erie, Pa.................. 2 1 3 5
Jersey City, N.J.......... 5 6 10 3
Newark, N.J............... 9 5 4 7
New York City, N.Y........ 67 57 65 77
Paterson, N.J............. 5 1 3 7
Philadelphia, Pa.......... 9 25 14 15
Pittsburgh, Pa............ 7 2 10 3
Reading, Pa............... 3 2 2 4
Rochester, N.Y............ 11 7 14 11
Schenectady, N.Y........... 1 2
Scranton, Pa.............. 3
Syracuse, N.Y.............. 2 3 1
Trenton, N.J............... 1 1 5 2
Utica, N.Y................. 6 5 3 2*
Yonkers, N.Y............... 2 1 3

EAST NORTH CENTRAL:
Akron, Ohio............... 1 -
Canton, Ohio.............. 5 1 2 2
Chicago, Ill.............. 32 35 36 44
Cincinnati, Ohio........... 6 3 8 6
Cleveland, Ohio........... 3 6 2 4
Columbus, Ohio............. 3 5 4 2
Dayton, Ohio.............. 1 3 2 4
Detroit, Mich............. 12 13 10 13
Evansville, Ind........... 4 2 2
Flint, Mich............... 1 2 2
Port Wayne, Ind........... 3 1 5 1
Gary, Ind................. 3 2 5 3
Grand Rapids, Mich........ 2 3 8 5
Indianapolis, Ind ......... 9 3 5 6
Madison, Wis.............. -
Milwaukee, Wis............ 2 1 3
Peoria, Ill............... 2 -
Rockford, Ill............. 3 4 3
South Bend, Ind........... 3 1 1 1
Toledo, Ohio.............. 4 6 6 8
Youngstown, Ohio.......... 1 1 4 -

WEST NORTH CENTRAL:
Des Moines, Iowa........... 5 2 1
Duluth, Minn .............. 2 -
Kansas City, Kans......... 2 3 1 3
Kansas City, Mo........... 4 4 3 3
Lincoln, Nebr............. 4 1 2
Minneapolis, Minn......... 2 1 1 3
Omaha, Nebr............... 3 5 2
St. Louis, Mo.............. 9 9 7 7
St. Paul, Minn............. 1 1 1
Wichita, Kans............. 2 2 7 4

*Estimate based on average percent of divisional total.
Totals for previous weeks include reported corrections.

NOTE: All deaths by place of occurence.


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


= I = =


oCurrent Week Mortality for 108 Selected Cities

4(A) Total Mortality, all ages...................
4(B) Pneumonia-Influenza Deaths, all ages........
4(C) Total Deaths under 1 Year of Age............
4(D) Total Deaths, Persons 65 years and over.....


12,286
555
786
6,857





I 3 II0IIIII 8 4 2557IIII ll ll l l
3 1262 08864 2557


Morbidity and Mortality Weekly Report


SUMMARY OF PNEUMONIA AND INFLUENZA DEATHS

The weekly average number of pneumonia-influenza
deaths for the four-week period ending December 12 was
489 as compared with an expected weekly average of 522.


Week Ending
Week En g 4 Week Weekly
11 21 11 28 12/5 12/12 Total Average

Observed 489 425 485 555 1,954 489
Expected 504 516 528 539 2,087 522

Excess -15 -91 -43 16 -133 -33


PNEUMONIA -INFLUENZA DEATHS in 108 O S CITIES
Al'err Mme p, WeP iAl by Foar- WMe rio# a


NLWASE
OF
DEATH


Pr.dI


R


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S- -- -


1\,' \ U 1 A
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S l,- 11 ,


*yre arE .eG. r b "-ID IClPI


(See table, page 443)


MENINGOCOCCAL MENINGITIS
(Continued from Page 439)


Substantial evidence, however, has accumulated
that the Group B sulfonamide-resistant strains are at this
time widely distributed throughout the civilian population.
Ivleretal1 have shown that 25 percent of strains isolated
from Los Angeles area civilian cases of meningococcal
meningitis since mid-1963 were resistant to 10mg percent
of sulfadiazine. In Figure 4 are shown the results of
sulfonamide sensitivity testing of 210 isolates from
blood or cerebrospinal fluid submitted to the Communicable
Disease Center. Sixty percent of these strains came from
States other than California, and all but a few of the
strains were Group B. Thirty-seven percent of the strains
required 1.0 mg percent or more of sulfadiazine for in-
hibition; the sensitive strains were inhibited by 0.1 mg
percent or less.
Resistance of meningococci to sulfonamides has
not been accompanied by changes in resistance to peni-
cillin or other antibiotics. It is important to emphasize
that the presence of sulfonamide resistance in no way
precludes successful treatment of clinical cases with
penicillin G.
(Data submitted by Dr. Philip Condit, Chief, Bureau of
Communicable Diseases, presented in "Epidemiological
Notes" (October 30, 1964), California Department of
Health; Colonel Adam Rapalski, Chief, Preventive
Medicine Division, Department of the Amy; and Labora-
tory Branch, CDC. Summary prepared in Investigations
Section, Epidemiology Branch, CDC.)


REFERENCE:

1 vler, D., Leedom, J. M., Thrupp, L. D. Wehrle, P. F., and Portnoy,
B.: Studies of naturally-occurring sulfadiazine-resistant meningococci.
Presented at the Fourth Interscience Conference on Antimicrobial
Agents and Chemotherapy. October 26-28, 1964, New York City.


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