Morbidity and mortality

MISSING IMAGE

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:
AA00010654:00379

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





COMMU CABLE DISEASE CENTER


Vol. 14, No. 7

Y


Week Ending


1965


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


EPIDEMIOLOGICAL NOTES


INFLUENZA
Influenza continues to occur in the Northeastern part
of the country and in other scattered States. Much of the
involvement has previously been described in MMWR,
Vol. 14, Nos. 3-6 inclusive. For a summary of current in-
fornianon the reader is referred to the : .,nljp;,nin'.
chart. Additional anile- reporting influ'l.c(n'. or influenza-
like illness during the past week are Texas, Florida,
Ohio. Wiscon-in. Arkansas, Tennessee, and North Caro-
lina. The reports from Texas, Florida, and Wisconsin
de-cribel focal outbreaks of -.rlog;ic.lly confirmed Type


Epidemiologic Notes
Influenza .. 3
Recommendations of the Public IHealth Service Advisory
Committee on Immunization Practice ...... 6-07


A influenza. Localized outbreaks of influenza-like illness
were reported from counties both in Tennessee and North
Carolina. The occurrence of influenza-like illness in
Arkansas would appear to be -i.IIr,,-I i.. Laboratory in-
vestigation of these latter outbreaks is in pr,''L'ri- -.


Table 1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
7th Week Ended Cumulative, First 7 Weeks
Disease February 20, February 15, Median Median
1965 1964 1960 1964 1965 1964 1960 1964

Aseptic meningitis ................ 21 19 19 190 177 164
Brucellosis .................... ....... 4 5 8 28 45 45
Diphtheria ....................... 4 2 10 22 30 95
Encephalitis, primary infectious .. 25 29 --- 195 204 --
Encephalitis, post-infectious ..... 11 8 --- 88 46

Hepatitis, infectious including
serum hepatitis ......... ...... 796 935 1,231 5,580 6,439 7,837
Measles .......................... 9,235 9,350 11,139 51,859 47,713 62,180
Meningococcal infections .......... 110 49 49 499 377 377
Poliomyelitis, Total .............. 3 3 2 9 55
Paralytic ...................... 1 3 2 5 34
Nonparalytic ................... 2 -- 4 --
Unspecified ................... --- .

Streptococcal Sore Throat and
Scarlet fever .................. 11,972 10,323 9,893 74,663 66,469 64,003
Tetanus ........................... 4 7 "-- 25 34 "
Tularemia ........................... 1 8 --- 36 48
Typhoid fever ..................... 6 9 8 45 50 50

Rabies in Animals ................. .. 85 65 65 642 _2 445


Table 2. NOTIFIABLE DISEASES OF LOW FREQUENCY

Cum. Cum.
Anthrax: 1 Rabies in Man:
Botulism: Smallpox:
Leptospirosis: Hawaii 2 5 Trichinosis: N.Y. Upstate 1 20
Malaria: N.Y. Upstate 1, Wash 1 5 Typhus-
Plague: Hurine: 2
Psittacosis: Utah 1 3 Rky Mt. Spotted: 6








Morbidity and Mortality Weekly Report




EPIDEMIOLOGICAL NOTES INFLUENZA (Continued)


Current pneumonia and influenza mortality reported
to the CDC by 122 U.S. cities (p.63) persists in showing a
slight elevation above the "epidemic threshold." While
the pneumonia-influenza mortality in the New England
States shows a downward trend this week, that in the
Middle Atlantic Division of States continues to rise.
The following chart is a summary of influenza and
influenza-like activity during the 1964-1965 season. It


has been prepared from reports submitted to the Influenza
Surveillance Unil of the CDC by the State Health Depart-.
ments. An attempt has been made to separate the involve-
ment into "widespread" or "scattered, sporadic"
outbreaks in so far as data are available. This differ-
entiation is at times necessarily a subjective one, but is
intended merely to suggest a level of occurrence in the
areas where illness is being recognized.


UNITED STATES INFLUENZA SULMMA RY 1964-65
CONFIRMED OUTBREAKS


Geo. Distribution Lab. Confirmation
First
State or Territory Scattered,
Widespread Scatterd, Recognized Isolation Serology
Sporadic

1964 Puerto Rico X Aug. A2 A
Hawaii X Sept. B B
Oregon X Oct. A
Maine X B

1965 Conn. X Dec. A2 A
N. Jersey X Jan. A2 A
Mass. X A
Pa. X A2 A
Missouri X A2 A
Maine X A
New York X A2 A
Vermont X A
Iowa X A
Michigan X A2 -
Alabama X Feb. A
Kansas X A2 A
Texas X A
Florida X A
Ohio X A
Wisconsin X A

INFLUENZA-LIKE ILLNESSES

1965 N.H. X Jan. -
Miss. X -
Arkansas X -
Tenn. X Feb. -
N. Carolina X -


INTERNATIONAL NOTES INFLUENZA


EUROPE
Eastern Germany
(Information on February 3, 1965). Further tele-
phone reports have been received from the WHO Regional
Virus Reference Center in Prague. The outbreaks caused


by influenza virus A2 appear to have died down in the
Baltic area of Eastern Germany.
U.S.S.R.
(Information on February 3, 1965). Further tele-
phone reports have been received from the WHO Virus












Morbidity and Mortality Weekly Report


PNEUMONIA-INFLUENZA DEATHS IN 122 UNITED STATES CITIES


ALL
CITIES


AEE~ hNC 40 44 48 52 4 8 12 16 20 24 28
A % r ErL'E 6 3 1 29 26 23 23 20 18 15 13
MONTH O N D J F M A M J J
19A2 19


W.N.
CENTRAL
10 CITIES


50-


32 36 40 44 48 52 4 8 12 16 20 24 28 32 3
10 7 5 2 30 28 25 22 21 18 16 13 11 8
A S 0 N J F M A M J J A
19A3 194 I


E.N.
CENTRAL 100
21 CITIES
75

50


25


WK NO 40 44 48 53 4 8 12 16 20 24 28 32 40 44 48 53 4 8 12
1964 1965 1964 1965


16 20 24 28 32


6 40 44 48 53 4 8 12 16 20 24 28 32 36
S 3 31 28 2 30 27 27 24 22 19 17 14 11
S O ND J F M A M J A S
190d4 195


NEW
ENGLAND
14 CITIES









40 44 as 0 .
1964 1965


MOUNTAIN
8 CITIES


100-


75-


150-


25-

...I 1... I... I .... I...I... I... t...I... I .. I.. I


1964 1965

PACIFIC
16 CITIES


E.S
CENTRAL
8 CITIES

*.


I I .I ... I...


I? 16 ?C d 4 ?2? i 40 44 2 5' i 4
1964 1965

w.s
15- CENTRAL
13 CITIES


100-




-50-



~...I... I... t .... 1... l... l... l... l... I... I. .


A ,2 6I 20 ;4 28


j3. 40 4.4 48 53 4 t I., 20 2 i ) C65
1964 1965


100




A50


SOUTH
ATLANTIC
12 CITIES


WKNQC d4 44 46 531 6 12 20 24 76 32 40 44 48 531 4 12 16 20 24 28 32 40 44 48 4 8 12 16 20 24 28 32 36
1964 1965 1964 1965 1964 1965


100-



75-



50-



25-



(i,
WK.NO
200-



150-



100-



50-


dill, IllllrlIlrll II IIII II11111111111I111II II I I I I I I III III I I I IIII III 1111 Ilrl 1111 Ilrlll I


1962 1 .. .. .


m ..I...Insulson earliesI .1 I I ale s...s...s...s....is..In d en n esist. i


I


.I..,I.,..,..I...I...I.-.I


L' ~ ~ ~ ~ ~ ~ 1 n . .|


tLIL IA A& I L I A I I I IIL .I I I, I A A I I I I I I I I I I I I II I I


f.


```


``
'UI


' '


' '


' '


I









Morbidity and Mortality Weekly Report


RECOMMENDATIONS OF THE PUBLIC HEALTH SERVICE ADVISORY
COMMITTEE ON IMMUNIZATION PRACTICE
I. THE ADVISORY COMMITTEE.

II. MEASLES VACCINES STATUS AND RECOMMENDATIONS FOR USE.
ADDENDUM PERTAINING TO THE FURTHER ATTENUATED MEASLES VIRUS VACCINE.

III. STATUS OF GAMMA GLOBULIN PROPHYLAXIS FOR PREGNANT WOMEN EXPOSED TO RUBELLA.

IV. SIMULTANEOUS ADMINISTRATION OF SMALLPOX AND YELLOW FEVER VACCINES.


I. THE ADVISORY COMMITTEE
The Public Health Service Advisory Committee on
Immunization Practice was appointed by the Surgeon Gen-
eral in 1964. Its responsibilities have been outlined as
follows:
"The Advisory Committee on Immunization Practice is
charged with the responsibility of advising the Surgeon General
regarding the most effective application in public health prac-
tice of specific preventive agents which may be applied in com-
municable disease control. Among other factors, the Committee
shall consider desirable immunization schedules, dosages and
routes of administration and indications and contraindications
for the use of these agents. The Committee shall also provide
advice as to various population groups for whom the agents
should be recommended and shall advise regarding the relative
merits and methods for conducting community immunization
programs. It will provide advice and guidance regarding present
and proposed requirements for immunization in international
travel. The Committee shall also advise appropriately regarding
needed programs in research."
At meetings in May and November of 1964 and in July
1964 (with members of the Special Oral Poliomyelitis Vac-
cine Advisory Committee), a number of problems pertaining
to immunization practice were considered and recommenda-
tions formulated. Recommendations pertaining to influ-
enza vaccine use for 1964-65 have been distributed; con-
clusions and recommendations regarding the live atten-
uated oral polio vaccines were published in the Journal of
the American Medical Association on October 5, 1964.
Recommendations pertaining to measles vaccines, the use
of gamma globulin as a prophylactic for pregnant women
exposed to rubella, and the question of simultaneous ad-
administration of smallpox and yellow fever vaccines are
presented below.
Members of the Committee are:
Dr. James Goddard, Chairman; Dr. David T. Karzon; Dr.
Donald A. Henderson, Secretary; Dr. Arthur Lesser, Dr.
Ernest A. Ager, Dr. Theodore A. Montgomery, Dr. Gordon
C. Brown; Dr. Roderick Murrary; Dr. Geoffrey Edsall, Dr.
Paul F. Wehrle.
Dr. F. R. Freckleton, Chief, Immunization Activities,CDC,
Dr. U. P. Kokko, Chief, Laboratory Branch, CDC,
Dr. Benjamin Blood, Office of International Health,
USPHS, and
Dr. Joe L. Stockard, Division of Foreign Quarantine,
USPHS, serve as liaison participants.
The Committee invites the submission of problems
pertaining to the public health application of the various
preventive agents employed in communicable disease
control.


II. MEASLES VACCINES-STATUS AND RECOMMENDA-
TIONS FOR USE

A. Live Attenuated Measles Virus Vaccine (Edmonston
Strain)

Developed in the laboratory of Dr. John Enders, this
vaccine, prepared in chick embryo tissue cultures, was
first tested in 1958 and since has been given to several
million persons in the United States, either alone or in
combination with gamma globulin. The vaccine produces
in the recipient a mild or inapparent, non-communicable
infection which induces active immunity. Although in the
majority the symptoms are minimal, approximately 30-40
percent experience fever of 1030F (rectal) or greater, be-
ginning about the sixth day and lasting two to five days.
However, even those with high fever may experience rela-
tively little disability and minimal toxicity. In 30 to 60
percent a modified measles rash is seen which begins
with or after the subsidence of fever. A few develop mild
cough, coryza and Koplik spots.
An antibody response equivalent to that seen in regu-
lar measles develops in over 95 percent of susceptible chil-
dren. Measured as late as four years later antibody levels
induced by the vaccine have demonstrated a stability
equivalent to that following the natural disease. Protec-
tion upon exposure to measles has been noted for at least
four years after vaccination.
If standardized Measles Immune Globulin is given in
the recommended dose at the same time as the live atten-
uated vaccine, but at a different site and with a separate
syringe, clinical reactions to the vaccine are sharply re-
duced. About 15 percent demonstrate fever over 103F
(rectal); the duration of fever is shortened and the inci-
dence of rash is markedly reduced. Although the frequency
of serological conversion is the same as that following
live attenuated vaccine alone, the level of induced anti-
body attained appears to be slightly decreased. Antibody
titers have been shown to persist for at least three years
and protection against the naturally occurring disease has
been noted for at least two years.
To date, there have been no reports of encephalitis
or other serious reactions following administration of the
live attenuated vaccine to normal children. A few in-
stances of convulsions, apparently of the febrile type and
without known sequelae, have been recorded.









Morbidity and Mortality We ekly Report


B. Inactivated Measles Virus Vaccine
The inactivated vaccine is composed of attenuated
Edmonston strain measles virus in rLI:l'.il'il on monkey
kidney or chick imIIr''. tissue culture, and subsequently
inactivated, concentrated and precipitated. The vaccine
has been customarily administered, in field trials, in a
three dose schedule at monthly intervals. Reactions to the
vaccine are no more frequent than those seen after admini-
stration of alum precipitated products, such as diphtheria
and tetanus toxoids.
Svrologi.Ll conversion after three monthly doses of
inactivated vaccine is induced in :uii percent or more of
susceptible children. Antibody tigers, however, are dis-
tinctly lower than those foll h'.in- the live vaccine and in
most cases decline to undetectable levels over the fol-
lowing year. The-e children, although without detectable
antihod., demonstrate a booster response when given a
fourth dose of vaccine.
Under the conditions of natural 'hallhrnge, the vaccine
has demonstrated an efficacy of between ,'i and 95 per-
cent during the immediate six months follow% ine adminis-
tration. A year after administration, the level of offi.va .1
in control trials has been shown to decline to between 65
and 7j percent. Field trials viiplo.\ ini a fourth or booster
dose have not been reported.

C. Combination Schedules Employing Inactivated and
Live Attenuated Virus Vaccines
If live attenuated vaccine is administered one to three
months after one or two doses of inactivated vaccine,
clinical reactions caused by the live vaccine are sharply
reduced; resultant antibody titers are boosted over those
produced by the inactivated vaccine alone and appear to
be equivalent to those observed following the adminis-
tration of live vaccine. About 10 percent demonstrate fevers
over 1030F (rectal); rash, cough and coryza are rarely ob-
served. Serological conversion occurs in 95 percent given
this combination; antibody has been shown to persist for
at least 14 months in 90 percent of this group.
Under natural challenge, this combination has demon-
strated an efficacy of over 97 percent during a period of
14 months following administration. Although the protec-
tive effect of this vaccine combination probably persists
beyond this time, substantiating data are not yet available.
Infants given inactivated vaccine in three monthly
doses beginning as early as one month of age followed by
live vaccine at 12 months of age also demonstrate sharply
reduced clinical reactions following the live vaccine.
About 5 percent demonstrate fever over 103F (rectal);
rash, cough and coryza are rarely observed. Serological
conversion following the live vaccine occurs in over 95
percent. The duration of immunity, as measured by natural
challenge or persistence of antibodies, has not yet been
assessed in the infant group.


D. Recommendations for Vaccine Use
1) Age
\ ri illy all children will, at some time, have clini-
cally evident measles. Marked by severe constitutional
symptoms and a seven to fourteen ihl\ course, the disease
is of additional concern because of secondary complica-
tions such as bronchopneumonia and encephalitis. The
vast majority of cases of measles occur .iiiunun those under
15 years of age, particularly those i.,'il 2 to 6 years; only
occasionally do cases occur aiiimon adults.
Vaccine use then is indicated primarily for children.
The live virus vaccine should be administered only to
those at least twelve months of age since residual and
maternal antibody may interfere with a response among
those (ciuno.r. The inactivated vaccine :,na\ be given at
any age. Vaccination of adults is rarely indicated since
all but a very small percentage, by history, have experi-
enced the disease. Limited data indicate that in the adult,
reactions to the vaccine approximate those seen in chil-
dren.
2) High Risk Groups
Immunization against measles is recommended partic-
ularly for those especially prone to develop serious com-
plications should they acquire natural measles infection.
Specifically, these include children in institutions and
those with cystic fibrosis, tuberculosis, heart disease,
asthma and other chronic pulmonary diseases.
3) Prevention of Natural Measles Following Exposure
Limited studies reported to date indicate that there is
no protective effect conferred by either vaccine when
given after exposure to the natural disease. However, live
attenuated vaccine administered only a few days previous
to exposure appears to confer substantial protection.
4) Community Programs
Rarely would there appear to be a need in the United
States for mass community immunization programs. Immuni-
zation should be carried out as indicated by private prac-
titioners and through established public health programs.
Particular attention must be given to programs directed at
children in lower socioeconomic areas, since attendance
of this group at the usual well child conferences beyond 6
months of age is particularly poor.

E. Dosage Schedules
Four different dosage schedules can be considered for
use at the present time in the United States. (See table p. 67)

F. Contraindications to Use of the Vaccines
Parenthetically, it should be noted that neither the
live nor the inactivated vaccines contain penicillin.
1) Live Attenuated Vaccine
*a) Pregnancy
*b) Leukemia, lymphoma and other generalized
malignancies








Morbidity and Mortality Weekly Report


*c) Therapy which depresses resistance such as
steroids, irradiation, alkylating agents and antimetabolites.
*d) Severe febrile illness
*Although there are no reports of unusual complica-
tions in any of these conditions excepting leukemia, it
is conceivable on theoretical grounds that potentiation
of the attenuated disease might occur or, in the case of
pregnancy, that damage of the fetus might result. Accord-
ingly, if immunization is indicated, the inactivated vac-
cine should be used.
e) Recent Gamma Globulin Administration
If more than .01 cc/lb. of gamma globulin has been
administered within the preceding 6 weeks, immunization
should be deferred since the administered globulin may
block the vaccine take.
f) Marked Egg Hypersensitivity
Since the virus is grown in chick embryo tissue cul-
ture, the vaccine probably should not be administered to
extremely allergic children as indicated by their inability
to eat eggs or egg products.
2) Inactivated Vaccine
Either monkey kidney or chick embryo tissue culture
may be employed for inactivated vaccine production. (This
will vary according to the manufacturer.) If chick embryo
tissue culture material has been used precautions (as
above) should be taken for possible marked egg sensitivity.
No other contraindications are known.

G. Continued Surveillance
Although several million children in the United States
have received the vaccines without serious complications,
continuing careful surveillance for significant adverse
reactions is of the utmost importance. It is important that
any serious reactions be carefully evaluated and reported
in detail to local and State health officials. The Com-
municable Disease Center will maintain a close surveil-
lance of all such cases.



ADDENDUM

Further Attenuated Live Measles Virus Vaccine
A further attenuated variant of the original Edmonston
strain vaccine has been developed by Dr. Anton Schwarz
and licensed in February, 1965. This strain was derived
by multiple additional passages of the Edmonston strain
in chick embryo tissue culture at lowered incubation
temperatures.
As with the Edmonston strain attenuated measles
vaccine, this further attenuated variant produces in the
recipient a mild or inapi:renl, non-communicable infection
which induces active immunity in almost all -u- i-prible
children to whom it is administered. In initial comparative
studies, the frequency of febrile and exanthematous


symptoms accompanying this infection have been shown
to approximate or perhaps to be slightly less frequent than
those observed in individuals who have received the
Edmonston strain vaccine with Measles Immune Glohulin.
Thus, approximately 5 to 15 percent of individuals ex-
perience fever of 103F. (rectal) or greater be-innine
about the sixth or seventh day and lasting one to five
days; approximately 5 to 15 percent exhibit an exanthem
which is less extensive and prolonged in duration than
that observed in natural measles. No serious complications
have been observed.
The level of hemagglutination-inhibition antibod%
titers induced by this vaccine appear to be comparable to
those achieved following administration of the Edmonston
strain vaccine. Persistence of this antibody for at least
two years has been demonstrated. Observations pertaining
to the duration of immunity under circumstances of natural
challenge have not been reported.
Indications and contraindications for use of this
vaccine are essentially the same as those applicable to
the Edmonston strain vaccine.





Ill. STATUS OF GAMMA GLOBULIN PROPHYLAXIS FOR
PREGNANT WOMEN EXPOSED TO RUBELLA


Although gamma globulin in adequate dosage has
been shown in several studies to suppress the clinical
manifestations of rubella, evidence that it will or will
not prevent congenital malformations anong children of
exposed mothers is lacking. Recently reported exper-
imental studies suggest that gamma Rlobulin may prevent
the clinical manifestations of the disease with limited or
no effect on the occurrence of infection and viremia. A
few instances have been reported in which congenital
malformations of the type associated with rubella in-
fections were observed in infants born of asymptomatic
mothers to whom gamma globulin was administered.

However, neither the experimental studies nor the
isolated Indi\ du.il case observations serve directly to
answer the question as to whether gp:annl globulin may
exhibit a relative effica;< in protection against con-
',lnital malformations in the infant. Extensive studies
dealing specifically with this question are in progrcr- in
the United Kin~.rloim. Definitive results may be nn icipated
within the next year. Until such time as this information
becomes available, it is not possible to formul:>ie concrete
recommendations re~ arding the relative deoir.i~ilitl of
Lamni.i globulin administration to pregnant women exposed
to rubella infections.









Mlorbidity and Mortality weeklyy report




DOSAGE SCHEDULES FOR MEASLES VACCINES


Schedule Type of vaccinee

1 Live, \ttenuated
\accine


2 Live, Attenuated
Vaccine plus Mea
sles Immune (lo-
bulin


3 Live, "Further
Attenuated Vaccine"

4 Inactivated Vaccine


Age Dose-s* and administrationn


12 months
and older


12 months I plus Measles Immune
and older Globulin (.01 cc per pound
at different site with dif-
ferent rirn.'')


12 months
and older


\n., Age 3** (monthly intervals)
plus a booster dose after
one year


Comml ent


Although the live, attenuated vaccinee may be
administered safely with or without the itimul-
taneous admninis-tration of Measles Ilmmune (Glo-
bulin, most physicians will wish to use the two
combined because of the lessened frequency of
clinical reactions.

The li\e attenuated vacciness should be admin-
istered only to those 12 months of age orolder
since residual maternal antibody may interfere
with a satisfactory response .iliriI younger
children.

Clinical reactions f.,ll ..ia the"Further Attenua-
ted Vaccine" are relatively infrequent:M eagles Im-
mune (;lobuln r is not necessary with this Vaccine.

In view of the rapid fall-off in antibody and
evidence of decreasing innunil', following a
primary immunization series, use of this vac-
cine is not preferred except for special groups
in which live attenuated vaccine is contraindi-
cated. The degree and duration of protection
which might be afforded to those given a
booster has not yet been determined.


5 Inactivated Vaccine 12 months 1 dose inactivated vac- The preceding administration of inactivated
followed by Live, and older cine followed in 1 to 3 vaccine serves to reduce the frequency and
Attenuated Vaccine months by 1 dose live -%\.,ril, of clinical reactions following live
attenuated vaccine attenuated vaccine administration.

Under 12 3 doses inactivated vac- The live attenuated vaccine should be admin-
months cine at monthly intervals istered only to those 12 months of age or older
followed by 1 dose live since residual maternal antibody may interfere
attenuated vaccine at 12 with a satisfactory response among younger
months of age or older. children.

*Manufacturers directions ". 'i.-i,; volume of dose asould be followed.
**In view of rapidly 1-. I.r,.',L antibody levels and protection, at least one booster dose about a year later is necessary. Data are not
yet available to indicate when or with what frequency additional booster doses might be required.


IV. SIMULTANEOUS ADMINISTRATION OF SMALLPOX
AND YELLOW FEVER VACCINES
Documented information pertaining to the frequency\
of possiblecomplications when the two are simultaneously
administered is so limited as to preclude jui.d,.r-n.-ni
r',-giirin, the safety of this procedure. When the two
vaccines are administered as a mixture either by scar-
ification (Meers, P.D., Trans. of Royal Soc. of Trop.
Med. and Hyg. 54:493-501, 1960) or by jet injection
(\01-er, H.M., et al., Bull. World Health Or.itniz.zaion
30:7>T3-794, 1964) there appears to be a decreased fre-
quency in seroconversions for yellow fever; the titer of


induced vaccinial antibody also appears to be diminished.
Additional studies, however, would be desirable.Simul-
taneous administration, however, of the two vaccines at
separate sites apparently results in -er' alL'ii .,l responses
equivalent to those observed when the vaccines are
administered singly (Meers, P.D.).
The Committee concluded that since adequate data
are not available concerning the safety of simultaneous
administration of these two agents and since both a.iIen -
have an encephalitogenic potential, it would seem prudent,
when practicable, to separate the administration of these
two agents by an interval of at least 14 days.










68 Morbidity and Mortality Weekly Report



Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

FEBRUARY 20, 1965 AND FEBRUARY 15, 1964 (7TH WEEK)


SEncephalitis Poliomyelitis Diphtheria
Aseptic
Meningitis Primary Post-Inf. Total Cases Paralytic
Area
Cumulative Cumulative Cum.
1965 1964 1965 1965 1965 1965 1964 1965 1965 1964 1965 1965
UNITED STATES... 21 19 25 11 2 9 2 5 4 22

NEW ENGLAND.......... 1 7 -
Maine............... 1 -
New Hampshire...... 1 -
Vermont............ -
Massachusetts...... 5 -
Rhode Island....... -
Connecticut ........ 1 -.

MIDDLE ATLANTIC...... 4 3 4 3 2 2 2
New York City ......1 1 -- 1
New York, Up-State. 1 2 1 2 1 -
New Jersey ......... 1 1 1
Pennsylvania....... 3 2 1 1

EAST NORTH CENTRAL... 1 1 5 2 1 2
Ohio................ -1 1
Indiana............. 1
Illinois........... 1 3 2 -
Michigan........... 1 -
Wisconsin.......... .

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

SOUTH ATLANTIC....... 1 4 3 5 2 2 6
Delaware.............
Maryland............. 2
Dist. of Columbia.. 2 2
Virginia........... 1 1 -
West Virginia...... -
North Carolina..... 3
South Carolina.....
Georgia............. -
Florida............ 3 2 2 2

EAST SOUTH CENTRAL... 1 2 1 1 3
Kentucky........... -
Tennessee........... 1
Alabama ............ 2
Mississippi........ 2 I- 1

WEST SOUTH CENTRAL... 5 1 2 2 4
Arkansas...........- 1 -
Louisiana.......... -
Oklahoma.............
Texas.............. 5 1 1 1 3

MOUNTAIN............. 3 1 -
Montana.............. 1 -
Idaho............... -
Wyoming.............. -
Colorado........... 1 -
New Mexico......... _
Arizona............. 1 -
Utah............... 1 -
Nevada.............. -

PACIFIC.............. 6 7 2 1 1 I -
Washington........... -
Oregon............. -
California......... 5 6 2 1 1 I -
Alaska............... -
Hawaii............. 1 1 .

Puerto Rico --- -- --- --- --- ---











%lMrloidiil and Mortality Weekly Report


Table 3. CASES OF sP( IFIED NOTIFIABLE DISEASES: UNITED STATES

FOR W I IK I NII))

FEBRUARY 20, 1965 AND H BRUARY 15, 1964 (7TH WEEK) (ONI INIlI)


UNITED STATES...

NEW ENGLAND...........
Maine...............
New Hampshire......
Vermont..........
Massachusetts......
Rhode Island.......
Connecticut.......

MIDDLE ATLANTIC......
New York City......
New York, Up-State.
New Jersey.........
Pennsylvania.......

EAST NORTH CENTRAL...
Ohio...............
Indiana............
Illinois............
Michi an ............
Wisconsin..........

WEST NORTH CENTRAL...
Minnesota..........
Iowa...............
Missouri...........
North Dakota.......
South Dakota.......
Nebraska............
Kansas.............

SOUTH ATLANTIC.......
Delaware...........
Maryland ..........
Dist. of Columbia..
Virginia..........
West Virginia......
North Carolina.....
South Carolina.....
Georgia............
Florida............

EAST SOUTH CENTRAL...
Kentucky...........
Tennessee.........
Alabama ...........
Mississippi........

WEST SOUTH CENTRAL...
Arkansas...........
Louisiana..........
Oklahoma............
Texas...............

MOUNTAIN ............
Montana............
Idaho..............
Wyoming ...........
Colorado...........
New Mexico.........
Arizona*...........
Utah................
Nevada............

PACIFIC..............
Washington ........
Oregon............
California.........
Alaska.............
Hawaii.............


Brucel-
losis


Infectious Hepatitis
including Serum Hepatitis


Meningococci 1
Infections


4 r .


Total Under
incl.unk. 20 years


20 years
and over


4 _______ I.


Cumulative
Totals


5,580

337
74
29
30
106
40
58

1,037
181
488
124
244

1,111
343
89
211
415
53

368
33
166
65
2
6
7
89

546
20
106
6
86
124
65
20
29
90

390
126
162
65
37

566
85
90
26
365

306
31
48
23
40
52
72
37
3

919
80
78
683
71
7


6,439

828
308
83
91
146
29
171

1,392
186
673
199
334

909
261
70
114
430
34

430
25
65
95
24
48
11
162

624
7
100
13
92
114
139
20
10
129

442
215
142
57
28

436
63
79
26
268

417
42
40
15
96
80
90
47
7


Cumulative
1965 1964

499 377

28 10
4
1 -

12 3
4 2
7 5

73 46
12 7
17 17
29 9
15 13

65 55
18 19
9 7
14 11
15 15
9 3

19 17
4 3

9 8
3 2
1
1
2 3

104 85
2
5 11
3
15 7
8 5
17 10
12 13
19 6
23 33

27 29
8 5
12 13
7 6
5

62 50
4 4
23 20
8 3
27 23

24 22

1
1 1
7 6
7 8
4 2
3 1
2 3

97 63
4 4
6 3
86 51
1 2
3

2 4


Tetanus


1965

4


Cum.
1965

25

1

1





1

1


-i- 4


Puerto Rico .... __ __ 77 80


~---











70 Morbidity and Mortality Weekly Report


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

FEBRUARY 20, 1965 AND FEBRUARY 15, 1964 (7TH WEEK) CONTINUED


Strept.
Measles Sore Th. & Tularemia Typhoid Fever Rabies in
Scarlet Fev. Animals
Area
Cumulative Cum. Cum. Cum.
1965 1965 1964 1965 1965 1965 1965 1965 1965 1965
UNITED STATES... 9,235 51,859 47,713 11,972 1 36 6 45 85 642

NEW ENGLAND......... 1,585 12,461 2,834 892 1 9
Maine............... 130 1,352 385 68 -
New Hampshire...... 2 186 15 8 -
Vermont............. 8 113 719 15 1 8
Massachusetts...... 903 7,333 492 134 -
Rhode Island....... 226 1,503 195 45 -
Connecticut........ 316 1,974 1,028 622 -- 1

MIDDLE ATLANTIC...... 352 1,829 8,898 737 2 4 2 19
New York City...... 40 214 3,397 40 2 3
New York, Up-State. 121 636 1,754 452 1 2 17
New Jersey......... 32 270 1,886 147 -
Pennsylvania....... 159 709 1,861 98 2

EAST NORTH CENTRAL... 1,618 9,182 9,849 1,450 2 7 6 34
Ohio................ 433 1,811 1,653 263 -- 2 -
Indiana............. 59 387 2,089 192 2 2 1 6
Illinois........... 49 279 2,625 188 1 1 7
Michigan........... 827 4,983 2,633 501 1 8
Wisconsin.......... 250 1,722 849 306 1 4 13

WEST NORTH CENTRAL... 449 3,830 1,202 468 1 3 2 19 124
Minnesota.......... 38 93 21 27 3 33
Iowa................ 99 1,981 489 124 8 43
Missouri........... 86 433 130 6 1 2 2 2 16
North Dakota....... 220 1,203 553 130 -- 7
South Dakota....... 2 25 3 44 1 7
Nebraska........... 4 95 6 -- 4
Kansas............. NN NN NN 137 1 5 14

SOUTH ATLANTIC........ 1,322 7,316 4,761 1,640 12 1 13 8 104
Delaware............ 23 102 52 14 1
Maryland............ 35 151 739 276 5 2
Dist. of Columbia.. 1 10 86 8 -
Virginia........... 231 1,060 1,092 260 3 1 6 87
West Virginia...... 839 5,216 1,449 649 1 2
North Carolina..... 9 111 175 21 2 4
South Carolina..... 55 110 755 44 2 1 1
Georgia............. 24 185 97 46 5 2 7
Florida............. 105 371 316 322 6

EAST SOUTH CENTRAL... 482 2,591 6,600 1,721 9 3 29 226
Kentucky............ 15 171 3,519 90 1 2 9
Tennessee.......... 383 1,771 2,639 1,413 7 2 26 211
Alabama............ 44 451 176 67 1 1 1 6
Mississippi......... 40 198 266 151 -

WEST SOUTH CENTRAL... 1,804 5,961 4,219 987 8 9 14 88
Arkansas........... 430 572 152 4 4 3 3 19
Louisiana.......... 3 11 13 2 1 2 2 24
Oklahoma............ 3 41 36 85 3 1 2 16
Texas.............. 1,368 5,337 4,018 896 3 7 29

MOUNTAIN............. 546 4,115 2,109 1,832 4 1 5 1 15
Montana............. 75 1,327 462 8 2
Idaho............... 104 644 307 164 -
Wyoming............. 7 102 16 78 1
Colorado............ 123 612 231 928 -
New Mexico......... 86 54 233 1 2
Arizona............. 19 114 764 99 2 1 13
Utah................ 199 1,205 187 321 4 -
Nevada.............. 19 25 88 1 -

PACIFIC.............. 1,077 4,574 7,241 2,245 2 5 23
Washington.......... 505 1,447 2,747 613 -
Oregon.............. 167 818 847 31 1 1
California......... 375 1,842 3,001 1,570 1 4 22
Alaska.............. 11 49 600 5 -
Hawaii.............. 19 418 46 26 1 -

Puerto Rico -- 186 550 --- -- -- --- 1











Ilorbidity and Mortality U eeklb Reipor






Table 4. I) ATHS IN 122 1 NITII) STATES CITIES FOR WEEK I NDII) I-HRUARY 20, 1965


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

All PI f -' Fn urn lfa Und, r All I % Pi,, .,. n l. I ..I

Area All 65 years and 1 year Area All 65 years and 1 year
Ages a o Influenza All Influenza All
Ages and over Ages and overAll Ages C
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.--------


991
350
56
30
35
61
31
32
39
81
68
18
60
56
74

3,876
61
47
147
58
35
41
90
112
1,972
54
501
272
57
122
26
58
71
73
45
34

3,035
71
44
951
172
219
151
76
398
53
50
56
51
61
161
41
111
62
32
50
151
74

1,019
60
39
48
149
33
131
102
304
93
60


*Estimate based on average percent of divisional total.


649
220
44
22
30
38
19
20
25
57
41
12
43
33
45

2,248
38
29
73
30
22
22
54
55
1,147
33
275
165
37
68
18
38
42
43
33
26

1,728
41
29
508
109
122
86
52
230
29
29
37
25
39
84
19
66
36
25
33
87
42

652
42
27
26
99
22
95
60
181
62
38


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


1,231
151
265
45
70
98
60
67
45
76
93
202
59

622
78
32
36
136
143
60
37
100

1,198
37
49
27
152
42
76
209
70
199
90
127
58
62

451
27
29
146
20
103
12
62
52

1,869
21
52
38
65
81
622
114
39
114
91
123
218
48
142
50
51


Total 14,292 8,228 772 828

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 95,889
All Causes, Age 65 and over------------------- 54,786
Pneumonia and Influenza, All Ages------------- 4,686
All Causes, Under 1 Year of Age--------------- 5,649


Week No.
7


1,107 74 119
14 -
28 2 1
29 1 2
32 3 6
47 3
350 34 52
68 5 19
31
64 1 6
53 1 7
73 8 4
129 2 12
30 5 1
85 5 6
36 5 -
38 2


" "










Morbidity and Mortality Weekly Report


INTERNATIONAL NOTES INFLUENZA
(Continued from page 62)

Reference Center in Moscow. There are influenza-like
outbreaks in most of the northern cities, in Moscow and
in Central Russia. The outbreaks have probably not yet
reached their peak. Kiev and the Ukraine are also affected
but there is little evidence of disease in the Central
Asian regions of the U.S.S.R. In Siberia an outbreak has
been reported from Novosibirsk.
The epidemic in Leningrad is now known to have
been very large almost as large as in 1957 and the
epidemic in Moscow has also been extensive. Virus A2
was isolated in both cities and children were first affected
but later there were a considerable number of cases in
adults.



On 12 February 1965, information was obtained that
no outbreaks of influenza-like illness had so far been
reported in Switzerland, as well as in the whole of the
Federal Republic of Germany, including West-Berlin.


Finland
(Information dated 10 February 1965).-Outbreaks of
influenza-like illness have been reported during the past
week from several military units in southern and eastern
parts of Finland. The incidence has been of the order of
10 to 20%. The course of the disease was relatively mild.
Serological evidence of infection with virus A2 has been
obtained.
There is no significant increase in incidence of
influenza-like illness among the civilian population,
including children.


Poland
3,522 sporadic cases of influenza-like disease have
been reported in Poland during the first week of February,
including 1,242 in Warsaw. A focus of about 100 cases
among schoolchildren has also been reported from Warsaw
province on 10 February.
(Reported in the Weekly Epidemiological Record of the
World Health Organization, February 12 and 19, 1965.)


UNIVERSITY OF FLORIDA

S111111111111 II11 I II 1111111111111111 11 11
3 1262 08864 2631


THE MORBIDITY AND MORTALITY WEEKLY REPORT. WITH A CIRCULIA-
TION OF 13,000 IS PUBLISHED BY THE COMMUNICABLE DISEASE
CENTER. ATLANTA. GEORGIA 30333.
CHIEF, COMMUNICABLE DISEASE CENTER JAMES L. GODDARD. M.D
CHIEF. EPIDEMIOLOGY BRANCH A. D. -ANGMU'R. M.D.
CHIEF, STATISTICS SECTION R. E. SERFLING. PH D
ASST. CHIEF, STATISTICS SECTION IDA L. SHERMAN. M.S.
CHIEF, SURVEILLANCE SECTION D. A. nENDERSON. M.D.
ASSISTANT EDITOR, MMWR PAUL D. STOLLEY. M.D
IN ADDITION TO Tr-E EaTAB'LISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY. T-E COMMUNICABLE DISEASE CENTER
WELCOME; ACCOUNTS OF INTERESTING OUTBREAKS OR CASES. SUCH
ACCOUNT; SHOULO eE AOORE.-SED TO
TME EDITOR
kiORBIDI TY ANI MORTALIT WEEKLY REPORT
COMMUNICAL BLE ODiEaS CENTER
ATLANTAf C RriA :0 3l
NOTE: --ESE RO .T ONAL DATA ARE BASED ON WEEKLY TELE-
GRAMS TO T-E CDC BY TME INDIVIDUAL ITATE HEALTHH DEPART-
MENTS. TM E RE'ORTING N*'EEK CONCLUDES ON SATuRDAY. COMPILED
DATA ON A NATIONAL EABI. ARE RELEASED ON THE SUCCEEDING
FRIDAY.
SYMEOOL .--.C AT& NOT AVAILABLE
QUANTITY ZERO
THE CONSTRUCTION OF TME MORT ALITY CURVES 15 DESCRIBED IN
VOL. 14, NO I


C
a c
n



a
a4



in
w r
m


m
-
I


m-4 '


0 ,





m
I-
-n

m
MT


JiNIV OF L L113



DOCUMENTS DE T
SE -



'V B'Ps7T


C
c
-I
m




m
m

0 m

* i>




Full Text
xml version 1.0 encoding UTF-8
REPORT xmlns http:www.fcla.edudlsmddaitss xmlns:xsi http:www.w3.org2001XMLSchema-instance xsi:schemaLocation http:www.fcla.edudlsmddaitssdaitssReport.xsd
INGEST IEID ETY5ZFJST_O67VYP INGEST_TIME 2013-02-07T16:52:53Z PACKAGE AA00010654_00379
AGREEMENT_INFO ACCOUNT UF PROJECT UFDC
FILES