Morbidity and mortality

Morbidity and Mortality



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

PUBLIC HEALTH SERVICE


Prepared by the


IhCMUNICAB:LE DISEAEi]


For release March 27, 1964 ATLANTA, GEORGIA 30333 Vol. 13, No. 12
PROVISIONAL INFORMATION ON SELECTED NOTIFIABLE DISEASES IN THE UNITED STATES AND ON
DEATHS IN SELECTED CITIES FOR WEEK ENDED MARCH 21,1964

RUBELLA


On the basis of r
Health Departments in,
a nationwide epidemic
to be in progress A ri
late last fall in the n
observed only during
appears to have spread
the exception of Minn
a marked rise in rep<
creases were observed
East North Central ai
Atlantic, East Souti.
Mountain areas. Labor
agent in specimens fr
polished in New York C


reports from several local and Stare other areas, the diagnosis has been made on the basis of
the various regions of the country, clinical characteristics of the illness.
of rubella (German measles) appears Rubella is optionally reported on an annual basis to
se in reported cases was first noted the Communicable Disease Center by several States.
northeast, with peak incidence being Statistics from 25 States and the District of Columbia for
the past few weeks. The outbreak the past 10 years are summarized in the graph, page 94 ,
d rapidly to the south and west. With which demonstrates the recent pattern of occurrence. The
esota, all States queried have noted similarity of the patterns observed in the various geo-
orted rubella cases. In general, in- graphic areas to that seen for the nation as a whole is of
1 in January in the Mid-Atlantic and interest. The Pacific Stares (Washington and Oregon)
areas, and in February in the South demonstrate a curve similar in shape to that observed in
Central, West South Central, and other areas, rent one-year shift to the
actor) identification of the eliologic right. A si a rved previously in pat-
om typical cases has been accom- terns of i occurrence.
ity, Philadelphia, and Cleveland; in ase aurn o page 95)

Table 1. CASES OF SPECIFIED NOTIFIABLE SEAES UNITED ST
os unlopg 5


tCumulative totals include revised and delayea re nrougn previous we w
12th Week Ended \ Cumulat ve. /trst 12 Weeks
Disease March 21, March 23, Median Median
1964 1963 1959 1963 4 64 1963 1959 1963
Aseptic meningitis ................ 28 14 --- 312 268 --
Brucellosis ....................... 6 11 11 84 76 117
Diphtheria ........................ 2 10 6 3 81 193
Encephalitis, primary infectious.. 27 2 363 1 --
Encephalitis, post-infectious ..... 14 2. -124
Hepatitis, infectious including
serum hepatitis ................ 935 908 908 11,285 12,960 12,960
Measles .......................... 16,892 14,746 15,519 108,045 129,117 136,645
Heningococcal infections .......... 66 57 57 679 691 685
Poliomyelitis, Total .............. 3 1 8 16 37 99
Paralytic ......................... 3 1 5 13 32 57
Nonparalytic ................... --- 3 2 ---
Unspecified ................... --- 3 ---
Streptococcal Sore Throat and
Scarlet fever .................. 11,062 11,199 --- 127,578 120,080 -
Tetanus ........................... 2 5 --- 44 42 ---
Tularemia ........................ 2 1 --- 68 48 ---
Typhoid fever .............. ........ 5 11 9 75 74 99
Rabies in Animals ................. 112 90 95 928 785 923

Table 2. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: 1 Psittacosis: Mich. 1, Calif. 1 9
Botulism: 6 Rabies in Man:
Leptospirosis: 5 Smallpox:
Malaria: N.Y. UP-State 1, Calif. 1 21 Typhus-
Plague: Murine: 2
_Rky Mt. Spotted: 3


634-5131


60/9 15/1iv;








o9 Morbidity and Mortality Weekly Report






RUBELLA

UNITED STATES, 1953-1962
ANNUAL TOTALS 26 REPORTING STATES
CASES


j
/
/
I
/
/
I
/


Pacific States
East North Central States
United States (26 States)
-United States (26 States)


1953


YEAR


\
\
\

''--
\aa










Morbidity and Mortality Weekly Report


The clinical characteristics of the disease now oc-
curring have varied somewhat within the spectrum of signs
and symptoms classically described for rubella. The most
frequently described as maculopapular, beginning first on
the face and neck, with rapid progression to trunk, arms,
hands, legs, and feet. Cervical, occipital, and post-
auricular lymphadenopathy has been a prominent feature
in reported cases; while most patients have experienced
mild fever, the maximum level has nor been impressive.
In some areas, arthralgia resembling that of rheumatoid
arthritis has been nored. In general, the disease lasts
3-7 days and has been symptomatically mild. Most of the
victims are children of school age, but cases have also
occurred among pre-school children, as well as adults,
although with a lower order of frequency. Prophylaxis with
gamma globulin has been used widely in the first trimester
of pregnancy and in a few instances physicians have
elected to perform therapeutic abortion of pregnant females
who experienced the disease.
Current epidemiologic reports of rubella from several
States are included in this issue.


Thus far in 1964, 8417 cases of rubella are reported.
For the comparable period of 1963, 1605 cases were
reported. The following graph depicts rubella cases for
each of the first 12 weeks of 1963 and 1964.


CASES
1,500.










400
00
soo.
200
100


REPORTED RUBELLA
MASSACHUSETTS, 1963-1964
BY WEEK


1963 ,---.
_..- .-N. --


1 2 3 4 5 6 7 8 9 10 HI 12
WEEK


NEW ENGLAND


Massachusetts
Reports of rubella cases are about 5 times greater
than for the comparable period of 1963, one of Massachu-
setts' high years for this disease. Rubella cases reported
in Massachusetts during the past 11 years are shown in
the graph below:


RUBELLA
MASSACHUSE T TS, 1953-1963
ANNUAL TOTALS
CASES
15,000





10,000 /




5,000.


2.,000.
1.000

1953 54 55 56 '57 '58 59 60 '61 62 '63
YEAR


The illness has affected large numbers of teenagers
and adults, as well as school children.
The epidemic appears concentrated in the eastern re-
gion of the state; considerably fewer cases are reported
in the Berkshire (western) area. There is no normal in-
crease in school absenteeism, nor is there an unusual de-
mand for gamma globulin.
Clinically, the rash is more extensive in individual
cases than seen in past epidemics, and is accompanied by
the usual adenopathy; arthralgia is not an uncommon
symptom, according to Dr. Louis Weinstein. The arthral-
gia is noted particularly in adolescent females, affecting
the proximal interphalangeal joints, and occasionally the
large joints, resembling rheumatoid arthritis. It appears
usually as the rash disappears, and may persist for as
long as one week.
(Reported by Nicholas J. Fiumara, M. D., M.P.H.. Director,
Communicable Diseases Massachusetts Department of
Public Health, and Louis Weinstein, M. D., Professor of
Medicine, Tufts University School of Medicine).




Rhode Island
Thus far in 1964, Rhode Island has recorded 50 per-
cent more cases of rubella than were reported during the
entire year, 1963. The epidemic began in late December,
and has mushroomed since. Whereas cases are occurring
throughout the state, reporting is heaviest in Warwick,




i


Morbidity and Mortality Weekly Report


Cranston and Providence. A graph of the reported rubella
cases in Rhode Island for this year, 1963 and 1958 (the
last epidemic year) is shown:


REPORTED RUBELLA
RHODE ISLAND, 1958, 1963-1964
SY MONTH


J F M A M J A 'S 0 D
MONTH

The disease appears to altect school age children,
6-10, primarily, but cases in university and college popu-
lations have accounted for about 8 percent of the state's
total.
The demand for gamma globulin, specifically re-
quested for known rubella contacts, has increased marked-
ly. In February, 1963, 45 vials were requested for rubella
contacts; 644 vials were dispensed this February. More
than 600 vials were requested through March 20, compared
with 126 for the entire month of March, 1963.
(Reported by James Bowes, M. D., Chief. Divirson of
Epidemiology, Rhode Island State Health Department).


MIDDLE ATLANTIC

New York City
Rubella cases are reported at about 17 times the num-
ber for the comparable period one year ago, and the 1964
totals through March 20 almost equal the total number of
cases (8,888) reported for 1955, the last epidemic year in
New York City. Case reports increased last April, May and
June, then declined to normal. The epidemic began in
late fall, and case reports jumped markedly in January. A
table comparing January-March, 1963-1964 follows:


1964 1963
January 1441 67
February 3296 103
March 325* 340
*Through March 20 only 8562* 510


Rubella virus was isolated from throat swabs of 8
cases of typical rubella in New York City by Dr. Robert
Green and his associates at New York University School
of Medicine by the interference technique in African green
monkey kidney cultures. The virus was also isolated
from nasopharyngeal secretions in some cases as early as
7 days prior to the appearance of the rash and as late as
14 days after resolution of the rash. Rubella virus was
demonstrated also in 3 fetuses obtained from therapeutic
abortions performed 8 to 28 days after illness in the
mother. One patient had received gamma globulin the day
of exposure, but she experienced clinical illness 20 days
later.

(Reported by Dr. Harold T. Fuerst. Director, Bureau of
Preventable Disease Ner York City Department of Health;
Robert H. Green, M.D Associate Professor of Medicine,
Michael R. Balsama, M.D.. Instructor in Medicine. loan
P. Grles, Research Associate Professor of Pediatrics,
Saul Krugman, M.D.. Professor of Pediatrics, and George
Myrick. M.D., Professor of Medicine, New. York Unrversrty.)







New York State

Reporting of rubella cases has shown a marked in-
crease each month since November. The following table
compares the cases reported from November to February
during the past 3 years. (Figures exclude New York City).


1963-1964 1962-1963 1961-1962

Nov. 135 58 54
D.c. 264 91 81
Jan. 1202 214 143
Feb. 3855 400 247



Although increased numbers of cases are reported
throughout New York State, about 40 percent of February's
cases occurred in Nassau County. The southern and
eastern regions of the Stare also report large numbers of
rubella cases.

The rubella outbreak has led to increased demands
for gamma globulin for exposed expectant mothers.


(Reported by Robert M. Albrecht, M.D., Director, Epidemi-
ology Division. New York Slate Department of Health).


CASta


*kch *0O 041l









Morbidity and Mortality Weekly Report


Pennsylvania


EAST NORTH CENTRAL


Large numbers of cases of an exanthamatous disease
have been reported from several areas in Pennsylvania.
An interfering agent, presumably rubella virus, .was
isolated from 4 patients by the interference technique in
primary African green monkey kidney tissue cultures at
the Virus Diagnostic Laboratory, Children's Hospital,
Philadelphia, the reference laboratory for the Department
of Health, Commonwealth of Pennsylvania.
In Allegheny County rubella is epidemic, with more
than 300 cases per week reported during March. The total
number of cases reported thus far in 1964 has already ex-
ceeded the total reported for all of 1963, as shown in the
following table listing the total cases reported annually
since 1961:


1964 1963 1962 1961
Total Cases 1425* 1202 650 571

"through March 13 only.



A minor epidemic was noted during the spring of 1963,
resulting in 258 cases 'reported for March of that year.
April was the peak month last year, with 358 cases re-
ported.
This year's epidemic affects elementary school
children primarily. The outbreak began in the highest
socioeconomic area of the county and has spread con-
centrically from southwest to southeast. At present, few
cases are reported north of the Ohio river. At the Uni-
versity of Pittsburgh, an outbreak of the disease has been
observed among students. During the Christmas vacations,
two students were exposed to German measles outside
the county, and came down with the illness following
return to school. Roommates of these two students subse-
quently developed the illness, followed in turn by 115
other classmates.
Gamma globulin distribution specifically for rubella
has increased about 700 percent over that observed in pre-
ceding years but, 'to date, .only one case of the illness
has been reported in a pregnant woman.


(Reported b\ Ailliam D. Schrack, Jr., M.D.. D.P.H., Direc-
tor of Communicable Diseases, Pennsylvania Department
of Health; g erner Henle, M.D., Director of Laboratories,
and Ronald Altman, M.D., Virus Diagnostic Laboratory,
Children's Hospital, Philadelphia; and Edwin Brown, M.D.,
Chief, Division o(Disease Control, and Herbert R. Domke,
M.D., Health Oflicer, Allegheny County Health Department).


Ohio

An increase in the frequency of reported cases of
rubella was noted first in Ohio in December 1963; reports
have skyrocketed since. A table comparing cases reported
during the period November through March with a similar
period last year demonstrates this sharp rise:


1963 1964 1962 1964
November 38 32
December 283 71
January 315 145
February 788 467
March 1,940* 623
*1st 3 weeks only.


Although the illness has affected school age children
primarily, about one percent of Ohio State University stu-
dents have experienced rubella during this outbreak.

From 6 clinical cases, an interfering agent, presum-
ably rubella virus, was isolated by the ECHO 11 inter-
ference technique in primary African green monkey kidney
tissue cultures, 'according to Dr. Fred Heggie.

Rubella virus was serologically identified by Dr.
Heggie, in specimens from a Cleveland nursing instructor
whose clinical illness was accompanied by neutralizing
titer rise from less than 1:2 to greater than 1:16. This
patient experienced marked arthralgia in her hands. One of
the other clinical cases from which an interfering agent
was isolated occurred in a Lorraine County student, 50
percent of whose schoolmates developed clinical rubella
within a two-week period. Further laboratory work in-
volving tissue cultures of 47 throat swabs from Lorraine
County cases or known contacts have failed to reveal evi-
dence of enterovirus infection, including ECHO, Cox-
sackie B, and polio virus, according to Dr. Martha Lepow,
Cleveland Metropolitan General Hospital.

(Reported by Dr. Harold A. Decker, M.P.H., Division of
Communicable Diseases, Ohio State Department of Health;
Fred Heggie, M.D., Research Fellow in Pediatrics and
Preventive Medicine, Western Reserve University; and
Dr. Martha Lepow, Cleveland Metropolitan General Hos-
pital).









Morbidity and Mortaliyv weekly Report


WEST NORTH CENTRAL


Illinois


Illln,.i has an S. percent increase in reported rubella
cases for January 1 March 1%', 1I,4, as compared with
the same period of 1963. This increase is noted :hroughour
the rlartL, but especially in Kane, Lake, LaSalle, Lop.in,
McLean. Piatn, Warren, and Henry Counties. These coun-
ties have reported more cases for the first 12 weeks of
11,4- than for the entire year 106 (see map below). Cook,
Macon, and 'innebago Counties also have reported high
incidences of rubella this year.


Minnesota

Rubella, which is not a reportable disease in Minne-
sota, does not appear to be unusually prevalent this year.
In Minneapolis, 116 cases were reported to date, com-
pared with 102 for the comparable period of 1963. A one
to 3 percent increase in school absenteeism was noted
earlier this month in St. Paul, where mumps and atypical
rashes were noted.
Viral studies from students at Carleton College,
where an exanthematous disease occurred, have not
identified a specific etiologic agent.
Although the State does not supply gamma globulin
for pregnant females with known exposure to rubella,
there has been no increase in calls concerning gamma
globulin.
(Reported by D. S. Fllemring. M.DI., Director, Division of
Disease Prevention and Control, Minnesota Department r
of Health.)




SOUTH ATLANTIC

Maryland

More than twice as many cases are reported thus far
in 1964 than during the entire year, 1963, in Maryland.
Approximately 90 percent of this year's cases are re-
ported from 6 counties, and over 50 percent of these are
from the city of Baltimore and Balrimore and Prince
Georges Counties.
In Baltimore County, about 15-20 percent of the
3400 students in 2 schools checked were affected. Adults
in the same families and older schools teachers also
experienced the same clinical illness. The disease is
characterized by a mild rash spreading from the face
over the trunk, a mild fever to 1010, post auricular and
post occipital lymphadenoparhy and has an equal sex
and school grade distribution.
(Reported by John H. Janney, M.D., Acting Chief, Divi-
sion of Fpidemioloug, Mar land ltate Department of
Health.)


North Carolina


The disease is considered to be underreported in
Illinois on the basis of requests for gamma globulin for
pregnant females exposed to rubella.

(Reported by Norman 1. Rose. M.D C(/'ii Bureau of Fp-.
demiology, Illinois Departnmrit of Public Hiuall, .


Clinical rubella or rubella-like illness is prevalent
in North Carolina, a spot check within that State indi-
cates. Rubella is not an officially reported disease in
North Carolina. At least 3 cities are affected. The out-
break began in mid-February, and continues strong in


REPORTED RUBELLA OUTBREAKS


0 -14 TOyLS CCeo #"I
o WRCESUEO Oate 4I4


-- ,:









Morbidity and Mortality Weekly Report


some areas while tapering in others. Physicians in most
communities have diagnosed rubella clinically, but other
physicians prefer the diagnosis of "viral exanthem."
Raleigh has experienced the epidemic for the past 6
weeks; it appears to be continuing. The illness is char-
acterized by the rash; many victims also have post-
auricular nodes and sore throat. There has been a high
absenteeism rare in school students.
Greensboro has been affected for 4 weeks. Chief
victims are elementary school children, but University of
North Carolina student nurses and some 50-and 60-year
olds were noted to have the same disease. The 'rash
lasts 3 days; in some it is noted to fade, then return for
another day. The illness is definitely not erythema in-
fectiosum, according to the physicians.
In Asheville, a similar illness has occurred during
the past 4 weeks, but physicians have not diagnosed it
as rubella. Many victims have experienced arthritis;
occasional cases of encephalitis have been observed.
Camp Lejeune doctors have noted typical rubella at
that Marine base.
(Reported b% Fred T. Foard, M.D., Director of Epidemi-
ology, and Jacob Koomen, M.D., M.P.H., Assistant Sec-
retary and State Health Director, North Carolina State
Board of Health.)


Georgia
In the metropolitan Atlanta area physicians report a
marked increase in incidence of a rash disease similar in
rrost patients to rubella. In Dekalb County a telephone
survey of public school principals was performed to de-
termine the extent of "rash disease" in the community.
Although average daily attendance was not significantly
different from 1963, it was found that a large percentage of
absenteeism was attributed to this rash disease.
Fifteen of 20 elementary schools reported the presence
of the illness. Principals in these schools estimated ap-
proximately 75 percent of their absenteeism was secondary
to this disease. In these elementary schools 26 teachers
(all females) were affected.
Among high schools surveyed four of six had rash
illness among the pupils but it was considered to be
causing less than 10 percent of absenteeism at present.
Four high school teachers had contracted the rash illness.
Scattered outbreaks were reported to have occurred
before February 1964 but the disease first became apparent
in the community during the week of February 23.
Elementary and high schools were affected simul-
taneously. County health department records of gamma
globulin administered to pregnant women for possible
rubella exposures indicated a marked increase during
that same week.


Week of Onset of Rash Illness in DeKalb County
Elementary Schools and Number of Doses of Gamma Globulin
Administered by the Health Department to Pregnant Women
for Possible Rubella Exposure

Week Starting
Before
2/2 2/2 2/9 2/16 2/23 3/1 3/8 3/15
Schools Affected 3 1 0 0 4 3 7 ?
Gamma Globulin
Administration 1 0 0 1 6 8 7 9




In most elementary schools the disease first appeared
in the lower grades Eight of 14 elementary schools re-
ported either the first or second grades to be first affected.


Elementary School Grades First Affected by Rash Illness,
DeKolb County, Georgia


The estimated duration of illness as reported by the
school principals generally varied from two to five days
for both pupils and teachers. Among Negro patients dura-
tion of illness was 9 days to 2 weeks in several cases.
The three colleges in the area have had only scat-
tered cases prior to spring vacation.
(Reported by Dr. W. J. Murphy, Director, Epidemiologic
Investigations Branch, Georgia Department of Public
Health, Dr. T. O. Vinson, Director of Public Health,
DeKalb-Rockdale District, Dr. Marion S. Dressier, DeKalb
County Health Department).





EAST SOUTH CENTRAL

Kentucky

About 60 percent more rubella cases are reported
thus far in 1964 in Kentucky. For the first 12 weeks of
1964, 730 cases were reported; 461 cases were reported
for the comparable period a year ago.
The outbreak is scattered throughout the entire State,
although not every county has reported increased numbers.
The cases are reported in school and pre-school age
children primarily.
The demand for gamma globulin is the greatest ever
in the State.
(Reported by ]. Clifford Todd, M.P.H., State Epidemiolo-
gist, Kentucky Department of Health.)









Morbidity and Mortality Weekly Report


Tennessee

RubtL lil1 is reported in at least 6 counties, predomi-
nantly in eastern Tennessee. Most severely hit is Roane
(Counri. population 1O,'12), 35 miles west of Knoxville.
The illnt.e appeared first in late January and peaked
during the last 2 weeks in February In Roane County the
outbreak boosted absenteeism to 20 percent, resulting in
the lo-.ing of 6 schools; all but one have reopened.
The illness" is concentrated in the elementary school
group; infrequent cases occur in pre-school and adult
ige groups.
(linicall%, it is characterized by a pruritic maculo-
papular rash, accompanied by mild fever and palpebral
conjunctivitis, as well as post-Lervical, post-occipital
and post-auricular lymphadenopathy. No other unusual
adenopathy and no splenomegaly are observed. The rash
,haracterisricall. is noted first on the face and neck,
with progression to the hands and feet; resolution occurs
in the same sequence. The duration of illness usually is
2-4 days, during which time the patients are only mildly
symptomatic. Several children have reported one or 2
recurrences within a 4 week period.
The disease has not been reported in Memphis or
western counties. None of the other areas involved has
been affected as severely as Roane County.
1', poitrd by Cecil B. Tucker, M.D., M.P.H., Director,
Pereentable Diseases, Tennessee Department of Public
Health.)


To date, no apparent increase in rubella cases has
been noted in the Shreveport metropolitan area in western
(Reported by C. T. Caraway, D.V.M.. M P.H.. Assistant Chief.
Fpidrem, ,li.\ Section, Louisiana Stair Bruard of lHealthI.



MOUNTAIN

Colorado

Rubella became epidemics in Colorado in late Janu-
ary. The total number reported through the 11th week
( '30 cases)exceedsthe total for 1963 (1219 cases).
A graph of Colorado's reported cases since 1947 is
shown on the opposite page.

In 1959, rubella cases increased in March, so the 2
epidemics are not as yet comparable.
(Reported by Cecil S. Molloban, M.D., M.P.H., Chief of
Epidemiolog). Colorado State Department of Public
Health.)



PACIFIC
Washington
Rubella does not appear to be epidemic in the State
of Washington. Case reports are slightly higher than one
year ago, but are not comparable to the peak year, 1959,
when 10,625 cases were reported.
(Reported by Ernest A. Ager, M.D.. Chief. Communicable
Disease Control, Washington State Department of Health).


WEST SOUTH CENTRAL


Louisiana


The 3 parish metropolitan New Orleans area has
noted a sharp increase in the occurrence of rubella
cases, which started apparently during the week ended
February 1-. While rubella is not a reportable disease in
Louisiana, practicing pediatricians estimate the present
outbreak to be more extensive than any observed in the
past 2 decades.
The State Health Department has noted a brisk in-
crease in requests for gamma globulin. During March,
196 342 cc. of the substance were dispensed, whereas,
already to date this month, 984 cc. were distributed.
Demands for the serum remain heavy. The great bulk of
of this increase is believed due to requests for rubella
proprh laxis in pregnant females, since hepatitis case
reponing is about the same as last year. (Gamma globulin
requests characteristically are primarily for prophylaxis
of these 2 diseases.i


4





INFLUENZA

Pneumonia and influenza deaths in 12 reporting
reporting cities in the Pacific Coast region increased
only slightly during the past week (90 deaths reported
as compared to 88 during the previous week). This figure
has remained above the epidemic threshold during the
past 5 consecutive weeks, however. Pneumonia and
influenza deaths in 108 cities representing the country
as a whole were below threshold during the past week.
Regions other than the Pacific Coast have shown no
sustained elevations.


100ll









101


Morbidity and Mortality Weekly Report





REPORTED RUBELLA
COLORADO, 1947-1963


CASES
3,600



3,000


2,000.


1,500.


1,000.


600.


200.


1947 '48 '49 '50 '51 '52 '53 '54 '55


'56 '57 '58 '59 '60 '61 '62 '63


YEAR


California


Oregon


During the past week, serologic evidence of in-
fluenza A2 virus infection was obtained in 12 sporadic
cases, representing widely separated areas in northern
California. To date, a total of 34 serologically confirmed
cases have been reported from 10 counties all but two
of these counties lying in the northern part of the State.
(In addition to the 12 confirmed cases reported this week,
a total of 22 cases were confirmed serologically in two
recent institutional outbreaks. See MMWR, Vol. 13, p. 86.)
No clearcut community-wide epidemics observed in the
Stare thus far this year, although several areas in north-
ern California have noted an increasing incidence of
influenza-like disease during recent weeks, accompanied
in some instances by moderately elevated school absen-
teeism. This trend has been observed in several commu-
nities in Humboldt County, as well as in the San Fran-
cisco Bay area.
(Reported b) Phil:p K. Condit, M.D.. Chief. Bureaz of
Communicable Discoa Sltte Depart rent of Health,
Berkeley, Calilornit.,


A total of 4,224 cases of influenza-like disease
were reported to State health officials in Portland during
the past week. Benton, Josephine, and Umatilla counties
were the areas showing greatest increase in case reports
during this period. The Portland metropolitan area has
experienced only mild involvement to date. Serologic
studies performed at the Oregon State laboratories have
thus far implicated influenza A, virus in 8 cases seen
during recent outbreaks.
(Reported hb Dr Grant Skinner, Director, Epidermiology
Section, State Board ol Health, Portland. Oregon.)


WASHINGTON

Recently described outbreaks of influenza-like dis-
ease are currently subsiding in most affected areas
in the State.
i Reported b\ Ernest A. .4ger. M.D.. Chief. Ditision o/
Epider.olog~. State Department of Health, 01rmpia,
H a shi.gti.,n. I


*1 r 1









Morbidity and Mortality Weekly Report


ENCEPHALITIS
A total of 51 cases of post infectious encephalitis
were reported during February (See table right ). This
compares with 29 cases reported for January (See MMWR.
Vol. 13, p. 46).
Mumps was the chief inciting cause, accounting for
19 cases I"6 percent) in February. In January, mumps
cases totalled 22 (88 percent).
Reports of unspecified post infectious encephalitis
are included in the category of primary encephalitis. The
monthIl summary lists only chose cases for which an
eriology has been specified, either at the time of the
report to CDC, or by later communication.


REPORTED CASES OF POST-INFECTIOUS ENCEPHALITIS
FOR FEBRUARY
4 Weeks Ending 2 6, 2 15, 2 22. 2'29

INCITING CAUSE
German
REPORTING AREA Mumps Chickenpox Measles Measles Pertussis
NEW ENGLAND
Massoachusetts 1
MIDDLE ATLANTIC
New York Up-State 4 I 2
Pennsylvania 2
EAST NORTH CENTRAL
Ohio 3 1 1
Illinois 9 3
Michigan 3
SOUTH ATLANTIC
Florida I
EAST SOUTH CENTRAL
Tennessee 1
WEST SOUTH CENTRAL
Arkansas 1
MOUNTAIN
Wyoming 1 ________ ____
PACIFIC
Washington 3 1
Oregon 2
Calilornia 8 I 1
U. S. TOTAL 39 3 6 2
(States not reporting case not listed)


SUMMARY OF DEATHS AMONG PERSONS 65 YEARS
AND OVER IN 108 U.S. CITIES

The weekly average number of deaths among persons 65
years and over in 108 cities for the four-week period ending
March 21 was b,826 as compared with an expected weekly
average of 7,0'0.




DEATHS at AGE 65 and OC
Average Number per Week
toOr, -T


NUMBER
OF .500'-
DEATS


Pniod No -


Week Ending
2.'29 3'7 3,14 3.'21 4 Week Total Weekly Average

Observed 6,883 6.912 6,837 6,671 27,303 6.826
Expected 7,107 7,087 7,060 7,026 28,280 7,070

Excess 224 -175 -223 -355 -977 -244


ER in 108 U.S. CITIES
by Four Week Periods
T


I. NFLLUENZA A


PLACE OF OCCun i **C LA-- L O_ MO*S -- 1 FffECE
rlf OCO jR W *CA At EDt now .r EirnrW uCI


102


(See table, page 107)







SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS


FEBRUARY 1964 FEBRUARY 1963


CASES OF PRIMARY AND SECONDARY SYPHILIS:


By Reporting Area February 1964 and February 1963 Provisional Data


Cumulative Cumulative
Reporting Area February Jan Feb Reporting Area February Jan Feb
1964 1963 1964 1963 1964 1963 1964 1963
NEW ENGLAND............... 39 32 82 75 EAST SOUTH CENTRAL........ 114 109 227 221
Maine.................... 1 1 Kentucky................. 13 12 19 21
New Hampshire ............ 2 1 3 2 Tennessee................ 44 33 72 70
Vermont.................. Alabama ................. 51 47 120 102
Massachusetts............ 22 13 53 37 Mississippi.............. 6 17 16 28
Rhode Island............. 2 1 4 3
Connecticut.............. 13 16 22 32 WEST SOUTH CENTRAL........ 231 214 410 459
Arkansas................. 18 10 32 30
MIDDLE ATLANTIC............ 490 455 881 984 Louisiana ............... 50 56 99 105
Upstate New York......... 55 39 112 85 Oklahoma................. 8 13 17 37
New York City............ 294 268 504 574 Texas.................... L55 135 262 287
Pa. (Excl. Phila.) ....... 11 10 23 24
Philadelphia.............. 35 62 56 126 MOUNTAIN.................. 46 48 95 86
eew Jersey............... 95 76 186 175 Montana.................. 1 1 -
Idaho...................... 1 3 -
EAST NORTH CENTRAL......... 187 146 384 302 Wyoming................. 5 3 5 3
Ohio..................... 55 34 107 61 Colorado................. 5 1 12
Indiana.................. 3 3 15 9 New Mexico............... 26 10 50 18
Downstate Illinois....... 16 11 26 21 Arizona................ 12 23 25 39
Chicago .................. 69 66 137 149 Utah ................... 4 3
Michigan ................. 39 29 91 56 Nevada................... 1 7 6 11
Wisconsin..................... 5 3 8 6
PACIFIC................... 206 187 449 393
WEST NORTH CENTRAL........ 64 33 115 68 Washington............... 3 13 11 30
Minnesota................ 17 4 24 13 Oregon................... 9 2 17 7
Iowa..................... 1 3 6 3 California............... 191 168 414 350
Missouri................. 32 13 52 26 Alaska................... 1 1 3 2
North Dakota............. Hawaii ................. 2 3 4 4
South Dakota.............. 4 2 13 5
Nebraska ................. 9 6 15 10 U. S. TOTAL............... 1,943 1,631 3,756 3,527
Kansas .................... 1 5 5 11 ...
TERRITORIES............... 68 53 133 109
SOUTH ATLANTIC............ 566 407 1,113 939 Puerto Rico............. 66 52 129 105
Delaware................. 9 3 21 13 Virgin Islands........... 2 1 4 4
Maryland ................. 42 42 80 90
District of Columbia..... 49 52 95 115
Virginia................. 15 26 51 51
West Virginia............ 3 3 4 6
North Carolina........... 94 48 161 138 Note: Cumulative Totals include revised and delayed reports
South Carolina........... 98 53 146 114 through previous months.
Georgia.................. 98 58 185 155
Florida................... 158 122 370 257












104 lMorbidilt and Mlorlalily Weekly Report


Tablic CASES OF SPECIFIED NOTIFIABLE DISEASES. UNITED STATES

FOR WEEKS ENDED

MARCH 21, 1964 AND MARCH 21. 1963 ( 12rh WEEK)


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... 28 14 27 14 3 1 16 37 3 1 13 32

EW ENGAND............. .
Maine ............ -
New Hampshire...... -
Vermont ............ -
Massachusetts....... --
Rhode Island....... -
Connecticut ........ .

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

EAST NORTH CENTRAL... 5 3 3 3 1 9 1 7
Ohio ............... 1 1 2 1
Indiana............ 2 -
Illinois........... I I 2 1 5 1 4
Michigan........... 3 1 2 2
Wisconsin .......... -

WEST NORTH CENTRAL... 2 5 1 1
Minnesota.......... 2 5 1 -
Iowa ........ ..... -
Missouri............ -
North Dakota ....... -
South Dakota ....... -
Nebraska ........... -
Kansas............. -

SOUTH ATLANTIC....... 1 2 3 1 9 3 1 6 2
Delaware ...........
Maryland........... .
Dist. of Columbia.. -
Virginia ........... .
West Virginia...... -
North Carolina..... .- I 1 4 2 1 1 2
South Carolina...... 1 1
Georgla............ 1 1 1 -
Florida............ 2 3 3

EAST SOUTH CENTRAL... 7 1 1 -
Kentucky.......... 5 -
Tennessee.......... 2 -
Alabama............. -
Mississippi........ .

WEST SOUTH CENTRAL... 3 1 9 9
Arkansas........... -
Louisiana.......... -
Oklahoma........... .
Texas.............. 3 1 -

MOUNTAIN.............. 2 1 1 1 1 1
Montana............ -
Idaho ................ -
Wyoming............ -
Colorado........... 1 I 1 1 i
New Mexico......... -
Arizona............. -
Utah..... ........ -
Nevada...............

PACIFIC...... ....... 6 7 6 1 7 1 1 6
Washington........ 1 -
Oregon............. 2 1 -
California.......... 6 7 5 4 1 1 5 1 1 4
Alaska............. -
Hawa i ............. -

Puerto Rico 2 2 2 2











Morbidity and Mortality Weekly Report 105


Table 3 CASES OF SPECIFIED NOTIFIABLE DISEASES UNITED STATES

FOR WEEKS ENDED

MARCH 21, 1964 AND MARCH 23. 1963 ( 121h 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 1966 1964 1964 1964 1964 1964 1964 1964 1963 1964 1964

UNITED STATES... 6 84 2 43 935 474 412 49 11,285 12,960 5 75

NEW ENGLAND........... 1 83 37 44 2 1,298 1,642 6
Maine .............. 27 9 18 466 753 -
New Hampshire...... 3 1 2 117 110 -
Vermont............. 19 14 3 2 159 23
Massachusetts...... 1 11 4 7 241 493 3
Rhode Island........ 9 4 5 56 37 3
Connecticut........ 14 5 9 259 226

MIDDLE ATLANTIC...... 1 4 216 97 119 2,511 2,518 11
New York City...... 1 52 15 37 363 283 2
New York, Up-Stare. 84 46 38 1,143 1,157 3
New Jersey......... -- 2 36 7 29 400 383
Pennsylvania....... 1 1 44 29 15 605 695 6

EAST NORTH CENTRAL... 1 13 6 158 88 66 4 1,664 2,062 3 16
Ohio............... 36 16 18 2 457 615 2 13
Indiana............ 1 10 5 5 137 174 1 2
Illinois........... 10 6 40 21 19 258 436 I
Michigan.......... 63 39 24 723 726
Wisconsin.......... 1 2 9 7 2 89 111 -

WEST NORTH CENTRAL... 1 45 8 62 31 19 12 715 561 2 9
Minnesota........... 2 1 11 6 4 1 52 102 -
Iowa............... 1 21 2 1 1 106 92 1 3
Missouri........... 4 25 9 12 4 179 240 1 2
North Dakota....... 1 32 11 -
South Dakota....... 8 3 1 2 78 15 1
Nebraska........... 8 1 I 17 41 -
Kansas............. 1 7 20 14 6 251 60 3

SOUTH ATLANTIC....... 2 6 1 10 82 47 32 3 1,082 1,393 16
Delaware............ 14 21 -
Maryland............ 15 6 9 196 152 -
Dist. of Columbia.. 3 1 2 22 49 -
Virginia........... 2 10 6 3 1 162 316 2
West Virginia...... 24 21 1 2 204 203 -
North Carolina..... 1 10 7 3 203 378 9
South Carolina..... 1 3 2 1 1 36 61 1
Georgia............. 2 2 5 4 1 3 24 48
Florida............ 1 2 14 4 10 221 165 4

EAST SOUTH CENTRAL... 1 3 1 4 52 38 14 760 1,307 9
Kentucky............. 13 10 3 342 395 4
Tennessee........... 1 19 13 6 254 489 4
Alabama............. 1 2 2 12 10 2 107 209 1
Mississippi........ 1 1 1 8 5 3 57 214 -

WEST SOUTH CENTRAL.. 4 5 87 49 35 3 799 848 4
Arkansas........... 10 7 3 99 111 1
Louisiana.......... 1 2 10 8 2 150 139 -
Oklahoma........... I 4 2 2 47 51 3
Texas.............. 1 3 63 32 28 3 503 547 -

MOUNTAIN ............ 7 48 18 6 24 764 961 -
Montana............ 3 1 1 1 66 150
Idaho............... 3 3 58 145
Wyoming............. 2 2 31 9 -
Colorado............ 19 8 4 7 220 205 -
New Mexico......... 1 9 7 2 133 116 -
Arizona............ 11 11 162 216 -
Utah............... 5 1 1 71 111 -
Nevada.............. 23 9 -

PACIFIC.............. I 5 5 147 69 77 1 1,692 1,668 4
Washington......... 5 14 5 9 179 273
Oregon............. 6 3 3 176 249
California......... 5 123 60 63 1,239 1.099 4
Alaska ............. 1 1 56 38 -
Hawaii............. 3 1 2 42 9

Puerto Rico 2 3 12 9 3 129 139 5












106 Morbidilt and Mortality Weekly Report


Table 3 CASES OF SPECIFIED NOTIFIABLE DISEASES. UNITED STATES

FOR WEEKS ENDED

MARCH 21. 1964 AND MARCH 23. 1963 ( 12Ih WEEK) Conranucd


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... 16,892 66 619 691 11,062 11,199 2 44 2 68 112 928

NEW ENGLAND......... 1,144 3 21 50 1,331 1,276 1
Maine.............. 50 1 2 9 42 39 -
New Hampshire...... 47 2 12 3 1
Vermont............ 58 1 16 45 -
Massachusetts...... 786 2 10 20 168 174 -
Rhode Island....... 71 2 6 217 79 -
Connecticut........ 132 7 12 876 936 -

MIDDLE ATLANTIC..... 2,386 5 68 93 742 806 1 20
New York City...... 752 1 10 10 47 52 -
New York, Up-State. 616 4 25 30 444 385 1 19
New Jersey......... 506 14 15 94 188 -
Pennsylvania....... 512 19 38 157 181 1

EAST NORTH CENTRAL... 5,110 9 111 117 2,023 1,444 1 5 7 7 87
Ohio................ 1,246 3 36 31 626 311 1 1 5 44
Indiana............ 1,562 3 16 16 246 113 1 1 1 7
Illinois........... 641 2 24 18 185 208 2 4 1 12
Michigan........... 944 1 29 36 575 373 1 1 9
Wisconsin.......... 717 6 16 391 439 1 15

WEST NORTH CENTRAL... 609 9 35 40 497 371 2 21 39 290
Minnesota.......... 21 1 8 8 43 40 1 11 87
lowa............... 378 2 1 120 109 1 14 95
Missouri........... 72 8 17 19 159 16 2 13 12 62
North Dakota ..... 131 3 1 96 170 15
South Dakota....... 2 59 2 18
Nebraska........... 7 1 8 1 8
Kansas.............. NN 4 1 20 35 6 5

SOUTH ATLANTIC........ 1,938 12 157 146 1,072 881 17 10 17 167
Delaware............ 30 2 1 12 7 -
Maryland........... 144 12 23 68 47 1
Dist. of Columbia.. 28 1 4 3 11 -- -
Virginia........... 518 1 13 36 296 297 1 3 12 121
West Virginia...... 269 13 9 440 257 7
North Carolina..... 42 26 24 42 53 7 1 2
South Carolina..... 190 3 18 10 66 35 2 -
Georgia............ 10 14 8 9 33 6 1 16
Florida............. 707 7 55 32 128 152 6 4 21

EAST SOUTH CENTRAL... 1,933 7 55 52 1,438 1,416 1 6 1 16 12 150
Kentucky............ 532 2 10 16 166 52 1 1 20
Tennessee.......... 1,059 1 25 25 1,212 1,251 1 3 1 11 11 127
Alabama............ 28 1 10 7 11 57 3 3 3
Mississippi........ 314 3 10 4 49 56 1

WEST SOUTH CENTRAL... 97 6 53 71 439 1,061 7 10 24 147
Arkansas........... 42 4 5 6 10 I 1 3 38
Louisiana.......... 13 4 46 24 6 6 3 4 15
Oklahoma........... 42 3 15 70 25 9 4 14
Texas.............. 27 357 1,020 3 13 80

MOUNTAIN.............. 968 3 32 23 1,982 2,464 2 1 4 9 37
Hontana............ 179 98 50 1 -
Idaho............... 75 I 89 202 -
Wyoming........... 3 1 1 20 92 1 1- -
Colorado............ 282 7 5 1,058 1,283 -- -
New Mexico......... 32 3 16 2 319 445 1 3 20
Arizona............ 266 2 5 142 262 6 17
Utah............... 36 1 9 256 130 1 2
Nevada............. 95 4 1 -

PACIFIC.............. 2,707 14 147 99 1,538 1,480 5 3 29
Washington......... 926 13 11 329 647 -
Oregon............. 301 5 4 44 26 -
California......... 1,407 12 122 79 995 731 5 3 29
Alaska ............. 64 1 3 4 113 58 -
Hawaii............. 9 1 4 1 57 18 -

Puerto Rico 301 8 10 2 2 16 2










Morbidity and Morallity Weekly Heport





T.ibh 4 (D) TOTAL DEATHS AMON( PERSONS (5 YEARS AND OV'R IN REPORTING (I1TIIS



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


107


Area For weeks ending Area For weeks ending

2/29 3/7 3/14 3/21 2/29 3/7 3/14 3/21


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, I11.............
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............


134
28
16
23
40
11
22
15
29
42
3
31
20
35


11
21
80
26
22
25
29
53
1,024
17
312
106
41
67
16
26
50
18
17
14


36
19
389
119
Ill
62
58
184
26
21
27
14
35
89
24
84
20
16
21
53
42


40
14
19
107
12
83
42
173
37
45


166
20
18
21
19
17
19
16
21
37
8
25
18
48


24
19
83
30
25
29
47
44
1,016
29
333
101
42
68
14
31
39
16
20
16


37
32
407
104
148
87
47
191
20
22
15
14
31
82
17
80
14
19
31
72
31


38
16
26
79
25
76
54
113
45
44


137
19
15
19
22
15
24
20
30
44
9
31
17
40


18
18
88
25
13
26
39
46
1,020
16
336
101
33
79
15
43
44
31
21
13


34
24
384
98
94
56
57
182
25
26
23
18
36
83
15
102
23
18
21
62
31


34
17
19
73
15
72
43
144
48
33


NOTE: All deaths by place ol occurrence.


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, Cclo .............
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..........
Porcland, Oreg............
Sacramento, Calif ........
San Diego, Calif.........
San Francisco, Calif.....
San Jose, Calif..........
Seattle, Wash ............
Spokane, Wash............
Tacoma, Wash.............


58
131
13
43
41
26
53
22
75
46
105
22


47
36
22
59
83
31
20
62


26
15
11
67
11
44
113
38
109
42
59
28
26


10
12
92
13
68
7
25
40


19
21
39
14
35
288
49
23
105
36
60
121
22
87
34
23


55
151
23
57
61
30
62
26
75
47
96
14


57
31
17
74
54
26
18
58


20
9
15
74
26
26
75
26
98
52
67
38
43


20
15
71
11
52
6
24
36


16
30
36
19
49
322
57
21
68
43
47
114
28
100
34
34


62
138
21
20
44
16
51
18
65
38
88
23


55
27
19
80
69
28
17
51


19
18
12
78
19
34
94
33
88
35
52
25
40


21
9
72
13
64
5
30
27


11
22
44
20
44
355
73
22
103
56
51
133
34
89
39
29


San Juan, P.R.............. 11 8 10 (---)


oCurrent Week Mortality for 108 Selected Cities

4(A) Total Mortality, all ages.................... 11,942
4(B) Pneumonia-Influenza Deaths, all ages........ 554
4(C) Total Deaths under 1 Year of Age............. 784
4(D) Total Deaths, Persons 65 years and over..... 6,671


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









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 information should be added to the list of
Yellow Fever Vaccination Centers in Section 6:

Page 69


City:


Santa Ana, California


Center:

Clinic Hours:

Fee:


Orange County Health Department

Wednesday, 2:00 p.m.

No


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:

Lawrence K. Alrmon. M.D., Editor
Morbidity and Mortality Weekly Report
Communicable Disease Center
Atlanta, Georgia 30333



NoHes: Themu provisional dae are bored on weekly telegraml te e Croa* ni.
cabe Dioelre Center by rkh Individual Stoae health departments.
Symbols- Dane nor aevlable
oQuauity ere
Procedure for conucllftJn of vraous mortality curve. mer e oeblanld from
Srotirtics Section, Comminncable Disease Cnfter, Public Neelsh Service,
U. S. Deporrteni of Healhk, Education, and Welfare, Atlmure, Cmrloe JOJn3.


The following correction should be added to the list of
Yellow Fever Vaccination Centers in Section 6:

Page 73

City: Albuquerque, New Mexico

Center: Lovelace Clinic
4800 Gibson Blvd., S.E.
Telephone 265-1211 Ext. 362


Clinic Hours:


UNIV Or cL IB
SDOC MENTS DEPT





U S DEPOSITORY


Friday, 2:00 p.m.


Fee:


The Morbidity and Mortality Weekly Report, with a circulation
of 10,800 is published by the Communicable Disease Center,
Atlanta, Georgia.


Chef, Communicable Disease Center
Chief. Epidemiology Branch
Chief, Statistics Section
Asst. Chief, Statistics Section
Chief, Surveillance Section
Edrtor, MMWR


James L. Goddard, M.D.
A. D. Langmuir, M.D
R. E. Serfling, Ph.D.
I. L. Sherman, M.S.
D. A. Henderson, M.D.
L. K. Altman, M.D.


1018


IIIiVERS17y OF FLORIDA


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