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:
AA00010654:00425

Related Items

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


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Morbidity and Mortalit



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

PUBLIC HEALTH SERVICE


Prepared by the


For release May 29. 1964


I COMMUNICAB1 DISES


ATLANTA, GEORGIA 30333


PROVISIONAL INFORMATION ON SELECTED NOTIFIABLE DISEASES IN THE [UNI
DEATHS IN SELECTED CITIES FOR WEEK ENDED MAY 23, 1964

MEASLES


The total of 30,910 cases of measles for the week
ended May 23 is the largest reported for any of the 21
weeks in 1964. This year's cumulative total of 341,146
cases compares with the 279,444 cases reported for the
comparable period of 1963, and the median of 293,070
cases for the first 21 weeks of the 5-year period, 1949-
1953.
Alabama reported 7,101 of this week's cases. The
majority of these represent delayed reports, according to
W. H. Y. Smith, M.D., Director, Bureau of Preventable
Diseases, Alabama State Department of Public Health.
This week's figure was greater than the total of 7,088
cases reported for the preceding 20 weeks. The abrupt
increase in the reported cases of rubeola for the last


3 weeks in Alabama is seen in the table below:

Week Ended Cases

April 4 77
11 35
18 373
25 11
May 2 419
9 1723
16 4014
23 7101

Alabama is experiencing outbreaks of both rubeola
and rubella throughout the State according to Dr. Smith.


Table I. CASES OF SPECIFIED NOTIFIABLE DISEASES. UNITED STATES
(Cumulative cotals include revised and delayed reports through previous weeks)
21st Week Ended Cumulative. First 21 Weeks
Disease May 23, May 25, Median Median
1964 1963 1959 1963 1964 1963 1959 1963
Aseptic meningitis ................ 39 20 --- 587 465 ---
Brucellosis .................. .... 11 6 10 160 136 223
Diphtheria ........................ 6 2 7 103 114 276
Encephalitis, primary infectious.. 52 34--- 721 -605 ""
Encephalitis, post-infectious ..... 27 --- 368
HepatitLs, infectious including
serum hepatitis ................ 671 750 773 18,330 20,371 20,371
Measles ........................... 30,910 15,956 17,864 341,146 279,444 293,070
Meningococcal infections .......... 43 50 39 1,246 1,237 1,138
Poliomyelitis, Total ............. 6 1 9 31 54 169
Paralytic ...................... 4 1 6 24 48 113
Nonparalytic ................... 2 6 --- 6 2
Unspecified .................... -- --- 1 4
Streptococcal Sore Throat and
Scarlet fever .................. 8,670 6,171 --- 219,810 190,101 ---
Tetanus ............................ 5 6 --- 83 82 ---
Tularemia ................ ....... 5 8 --- 97 81
Typhoid fever ..................... 7 10 13 144 146 216
Rabies in Animals ................. 102 79 74 1,945 1,666 1,664

Table 2. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: 2 Psittacosis: 14
Botulism: 9 Rabies in Man:
Leptosplrosis: Fla 1, Calif 1 9 Smallpox:
Malaria: N.C. 35 Typhus-
Plague: Murine: 4
SRky Mt. Spotted:N.J. 1r Va 3. W.Va 1 22


-- --


IJ/a









Morbidity and Mortality Weekly Report


CHIMPANZEE-ASSOCIATED HEPATITIS 1963


During 10-' 1 cases of infectious hepatitis in
the United States traced epidemiologically to exposure to
non-hun'an primates were reported to the Hepatitis Sur-
veillance Unir, CDC. Three outbreaks were responsible
for 11 of these 1I cases Isee table below).
The first outbreak (cases 1-51 occurred at a university
in Oklahoma, according to F. R. Hassler, M.D., Chief,
Communicable Disease Control and Laboratory Services,
Oklahoma State Department of Health. In early November,
2 chimpanzees were shipped from Sierra Leone via the
West Coast to a psychologist; they were housed in animal
quarters adjacent to his home. Because one of the animals
had a severe respiratory infection, contact with humans
was limited to those necessarily involved in the care of
animals. B( tween December 26, 1962 and January 1", 1963,
5 of the persons who did have close contact with the
chimpanzees developed hepatitis. One of the psycholo-
gists, who remained well, was believed to have had icreric
hepatitis at age 12. Investigators were unable to trace
these cases to any other possible common source.
The second outbreak (cases 6-8) involved 3 of 26
animal handlers and veterinarians at a U.S. Army Base.
Two importers shipped a total of 26 chimpanzees to the
base during March. In late April and early May, 2 officers
and I enlisted man, all closely involved in the care of
these animals, developed infectious hepatitis. No other
common source could be found to account for this outbreak.
Case 9 occurred 51', months later at the same Army
base, in an animal caretaker who began work in July, and
was not exposed to any of the animals responsible for the
earlier outbreak. A new shipment of chimpanzees had
arrived in August; this man was the only one of 10 in-
dividuals exposed who developed hepatitis. Some of these
same workers, however, were exposed to the earlier ship-
ment and had received immune globulin infections in May.


Case 10 was a young New Yorker who worked for the
importer supplying chimpanzees to the above Army base.
Although he regularly handled chimpanzees, he began
work in April, well after the initial shipments had beer
made. Because of hepatitis he stopped work in early June,
before the animals shipped in August to the Army base
would have arrived at the importing house.
The last outbreak (cases 11-13) occurred at an Air
Force base where chimpanzees are used in psychological
and space research. Case 11 had been hospitalized in
November 1961, because of an elevated SGOT which was
found during a survey of all veterinary personnel, prompted
by the occurrence of several cases of chimpanzee-
associated hepatitis at that time. His second illness, in
1963, was severe and prolonged. Although 7 separate ship-
ments of young chimpanzees were made to this institution
during early 1963, the 3 cases were compatible with ex-
posure to a single shipment in May.
Since the original report by Hillis' in 1961, in which
11 of 21 animal handlers and veterinarians developed
hepatitis following exposure to recently imported chim-
panzees, an additional 76 cases of hepatitis occurring after
exposure to these and other non-human primates have been
collected through the cooperation of State health depart-
ments and the Division of Foreign Quarantine, U.S.P.H.S.
The repetitive occurrence of these outbreaks lends
credence to the idea that, under the proper circumstances,
certain species of newly-imported primates can transmit
hepatitis to humans. No instances are known of such
transmission involving animals which had been in the
United Stares for longer than 6 months.
(Reported by Hepatitis Stbrreillance Unit, CDC.)
I. Hillis, William D.: An Outbreak of Infectious Hepatitis
Among Chimpanzee Handlers ar a U.S. Air Force Base.
Am. J. Hyg. 73:316, 1961.


Days from Arrival
Case No. Place Age Sex Occupation Icterus of Chimp to Onset

1. Oklahoma 36 F Psychologist's wife Yes 59
2. Oklahoma 10 F Psychologist's daughter No 60.70
3. Oklahoma 11 M Psychologist's san No 60-70
4. Oklahoma 47 F Psychologist Yes 54
5. Oklahoma 31 M Handy Man Yes 49
6. U.S. Army Base 24 M Handler Yes 29 or 53
7. U.S. Army Base 26 M Pathologist Yes 31 or 55
8. U.S. Army Base 27 M Veterinarian Yes 15 or 39
9. U.S. Army Base 25 M Handler Yes 63
10. N.Y. Importer 15 M Handler Yes 55
11. U.S. Air Force Base 24 M Handler Yes 26
12. U.S. Air Force Base 26 M Veterinarian No 13 or 58
13. U.S. Air Force Base 27 M Handler No 50.60


174









Morbidity and Mortality Weekly Report


STAPHYLOCOCCAL FOOD-BORNE OUTBREAK
UP-STATE NEW YORK CONVENT


INCUBATION PERIOD


DURATION OF ILLNESS


U)
8.




J 4.
m

2.


2


72"1


0 2 3 4 56 0
HOURS


STAPHYLOCOCCAL FOOD POISONING New York


An outbreak of staphylococcal food poisoning affected
21 of the 44 Sisters who ate lunch at an up-State New York
Convent. The sick Sisters experienced nausea, vomiting
and diarrhea with onsets from 3 to 6 hours after the meal
(see graph above). In addition to the above symptoms, 16
had abdominal cramps and 15 had chilly sensations. The
duration of symptoms is shown in the' graph to the right
above. None had elevated temperatures nor required hos-
pitalization, no deaths were noted.


Illness According to Food Consumption
Up-State New York Convent


Food
Creamed Salmon
Boiled Egg
Kidney Beans
Boiled Potatoes
Carrot Salad
Boiled Carrot
Turnip
Chicken
Corn
Catsup
Cranberry
Bread & Butter
Tea
Milk
Coconut Pie


No.
Eating
33
10
32
38
28
3
6
3
4
8
6
25
20
15
39


February 5, 1964

No. Attack No. Not
III Rate (%) Eating
16 49 11
5 50 34
14 44 12
19 50 6
13 46 16
1 33 41
2 33 38
1 33 41
1 25 40
3 37 36
2 33 38
12 48 19
12 60 24
5 33 29
21 54 5


Attack
Rate (%)
45
47
58
33
50
48
50
48
50
50
50
47
37
55
0


Analysis of the food histories for the suspect meal re-
vealed that, among the 39 Sisters who consumed coconut
pie for dessert, 54 percent became ill. No cases were noted
among the 5 who did not eat the pie. For other food items,
rates among those eating and not eating were similar. Ten
coconut meringue pies were consumed at the luncheon; all
had been purchased from a commercial bakery and donated
to the Convent by a friend, The pies were baked between
5:00 and 9:00 p.m. the day prior to ingestion, were left in
an unheated garage (estimated temperature 35-500 F) over
night and were delivered at 8:30 the morning of ingestion.
They remained at room temperature for 3 hours thereafter.
Two days after the baking of the suspect pies,a health
department physician examined the cook responsible for
their preparation. The cook was noted to have a healing
carbuncle on one of her fingers as well as moderate mucoid
nasal discharge. Cultures of the cook's nasal discharge,
wound, and the suspect pies all grew coagulase positive
staphylococci.


Phage types were as follows:
Cook (finger and nose)
Pies (2)
Pie (1)


52A, 79
6, 47, 53, 54, 75, 77, 83A
79, 7, 42E, 53, 77, 83A


(Reported by William R. Elsea, M.D., Director, Division of
Communicable Disease Control, Erie County Health Depart-
ment, and Dr. Robert M. Albrecht, Director, Epidemiology
Division, New York State Department of Health.)


175


HOURS




-u


176 Morbidity and Mortality Weekly Report




MENINGOCOCCEMIA 1962
luring 1962, totals of 2,150 cases and 649 deaths due to meningococcal infection were reported in the United States.
Children under 5 accounted for 418 (64 percent) of the deaths from this disease category; 189 deaths, or 29% of the total,
occurred in infants under 1. The percentage of total mortality contributed by each age group fell progressively with ad-
vancing age as indicated in the graph below.


DEATHS DUE TO MENINGOCOCCAL INFECTION*
UNITED STATES, 1962
PERCENTAGE OF TOTAL DEATHS BY AGE


20


i"


a10


25 and over


YEARS OF AGE

Source Vital Statotics of 7Th United States, 1962


MENINGOCOCCEMIA Washington


Washington state reported a fatal case of meningo-
coccemia in an 81-year-old Seattle woman, who had been
essentially confined to her son's home because of a hip
fracture suffered in 1956.
At 11:00 p.m., March 9, she experienced nausea and
vomiting, and went to bed. The following morning her
temperature was 1030F, she became mentally confused
and weak to the point of being unable to rise from bed.
She was admitted to a hospital that afternoon where she
was semi-stuporous and in shock blood pressure 90'40,
pulse 120, respiration 30). with a temperature of 1020F.
Physical examination revealed multiple hemorrhagic
petechiae on the hard palate. There were no abnormal
neurological findings. Her white blood count was 9,700,
with a marked shift to the left; urinalysis demonstrated
bacteriuria. Admitting diagnosis was acute pyelone-
phritis, antibiotic treatment was started.
B) noon March 11, physicians noted petechiae on her
conjunctiaae, as well as on her hard palate, and apurpuric
eruption on her chest. A lumbar puncture was performed;
the cerebrospinal Iluid contained 670 white blood cells
per cubic milliliter (98 percent polhmorphonuclear) and
a large number of red blood cells.


Two blood cultures, obtained shortly after admission,
became positive for \risseria meningidilis, Type B, on
March 12. A repeat spinal tap at that time demonstrated
"18 cells, all polymorphonuclear; no red blood cells were
noted. Cultures of her cerebrospinal fluid, obtained after
administration of antibiotics, did not reveal any growth.
The patient's hospital course was complicated by
renal shutdown, focal seizures, gastrointestinal bleeding
and coma. She died March 17.
On the morning prior to the onset of her illness, the
patient had been taken to a shopping center; this was the
only time she was out of her home for several weeks. She
had no known exposure to meningococcal disease or any
other illness, and had little contact with anyone other
than her son. She did have exposure to a newspaper boy 7
to 9 days prior to the onset of her illness. Cultures were
not obtained prior to antibiotic prophylaxis of the son and
newspaper boy.

(Reported by Donald R. Peterson, 1 D.. M,'.P.H., Director,
Division of Ep:ide-r':vlog. and Communicable Disease Control,
Scailre.King Crunt) Department of Pubiir Health, and E. A.
Ager, M.D., Chrct, Dir ision of Epidrr',ioloR. Uashington State
Department of lralih.










Morbidity and Mortality Weekly Report


REPORTED CASES OF POST-INFECTIOUS ENCEPHALITIS FOR APRIL
5 Weeks Ending 4 4, 4 11, 4 18, 4 25, 5 2
Inciting Cause
Reporting Area Mumps Chickenpox Measles Rubella Influenza
NEW ENGLAND
Connecticut 1 __ 2
MIDDLE ATLANTIC
New York U p-State 4 1
Pennsylvania 6 3 2 2
EAST NORTH CENTRAL
Ohio 5 1 2
Illinois 21 10
Michigan 5
SOUTH ATLANTIC
Virginia 1 2
Georgia 2
EAST SOUTH CENTRAL
Tennessee 2
WEST SOUTH CENTRAL
Texas I
MOUNTAIN
Utah 2
PACIFIC
Oregon 1 1
California 23 10 25 1
U.S. TOTAL 65 15 50 5 1
(States not reporting a case not listed.)

POST-INFECTIOUS ENCEPHALITIS April


A total of 1'" cases of post-infectious encephalitis
was reported for the 5-week period in April. (See table
right.) This figure compares with the 63, 51 and 25 cases
reported for March, February and January, respectively
(See MMWR Vol. 13, pp. 143, 102 and -46).

Although mumps continued to be the chief inciting
cause, accounting for 65 cases in April, its percentage of
the total reported cases continued to decline. There were
50 cases of mea.les (rubeola.i post-infectious encephalitis
reported, a sharp increase above the Is, 6 and 2 cases
reported for each of the respective preceding months. The
decreasing proportion of mumps cases since january and
the increasing proportion of measles cases during the
same period of time may be compared in the following
table:



SALMONELLOSIS
Fourteen members of 3 Minneapolis families experi-
enced diarrhea shortly after the acquisition of pet turtles.
Salmonella panamr was cultured from 2 victims and the
families' pet turtles.
During a 4 day period in early January, a father and
his 5 children experienced diarrhea and abdominal
cramps. S panara was cultured from tnr -i-\ear-old U.n.
When no specific food or meal could be incriminated, re-
cently acquired family pets were suspect. S. panarra was
cultured from a turtle swab and turtle water. This pet
ate only commercial turtle food; its water was changed
every 3 days and dumped into the kitchen sink.
This finding stimulated retrospective investigation
of a S. panama isolate, reported in October. A 2-vear-old


Mumps
Cases ". Total


Measles
Cases % Total


January 22 88 2 8

February 39 76 6 12

March 37 59 15 24

April 65 47 50 36

A total of 5 cases of post-infectious encephalitis due
to rubella was reported. All 5 cases were reported in the
New England and Middle Atlantic States. Through April,
10 cases of rubella post-infectious encephalitis were
reported; all were reported from the above 2 geographic
regions.
No case of vaccinia encephalitis has been reported
thus far in 1964



- Minnesota
girl was hospitalized for 10 days because of diarrhea;
during this time her parents also experienced diarrhea and
cramps. Two turtles had been purchased 2 months earlier.
The girl had been scolded several times for sucking
pebbles taken from the turtle dish. The turtles were given
to an aunt, whose husband and 4 of her 5 children later
experienced diarrhea, cultures, taken 5 weeks after the
illness, were negative. A cloacal swab from one turtle
was positive for S panamna. The turtle had been fed
commercial turtle food and fish eggs.

' Rtport'd b D Flem:ng. .A.D Dire tor. .i r sion o/
Disease Prei entio and Controil lrnneuota Department
ol Health. and an El/ oSj /C r i


177










178


Morbidity and Mortality Weekly Report


CHANCROID
A total of 1.242 cases of chancroid (exclusive of known military cases) was reported for the fiscal year 1963. This
figure is the lowest recorded in the period since 1941 (see figure below). After a peak in 1947, when 9,039 cases were re-
ported. the number of reported cases declined sharply in the ensuing years until 1958. Since then, little change has been
noted in the annual figure.

CHANCROID
REPORTED CASES BY FISCAL YEAR, 1941-1963
.000I


6000

0
U)
Ssoo
u
4000


Exclusive of known Militory Coaes


1941 42 '43 '44 45 46 47 h~ 49 '50 51 52 53 54 '56 6 57 58 59 56 '61 62 63
Source VO Bronch, COC


INFECTIOUS SYPHILIS April
A total of 1,874 cases of infectious syphilis 'primary and secondary) was reported for the month of April (see table
opposite page). This figure compares to 1,756 cases reported one year ago.
The total for the first 4 months of 1964 is 7,513 cases, compared to 7,186 reported for the comparable period of 1963.
This represents an increasee of 3 per cent.
During the first 4 months, the New England, the East North Central, the West North Central, the South Atlantic, the
Mountain and Pacific areas have shown increases in reported cases compared to the corresponding period one year ago.
A graph of the reported cases by month from 1962 is shown below.


REPORTED PRIMARY AND SECONDARY SYPHILIS
UNITED STATES-1962, 1963. 1964


2500




2000



1500


Exenlive of known Miltory Co,0


---1964
-- 1963
-1962


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







SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS


CASES OF PRIMARY AND SECONDARY SYPHILIS:


By Reporting Area April 1964 and April 1963 Provisional data


Cumulative Cumulative
Reporting Area April Jan April Reporting Area April Jan April
1964 1963 1964 11964 1964 1963 1964 1963


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

MIDDLE ATLANTIC...........
Upstate New York.........
New York City............
Pa. (Excl. Phila.).......
Philadelphia.............
New Jersey...............

EAST NORTH CENTRAL........
Ohio ...................
Indiana. ................
Downstate Illinois.......
Chicago................
Michigan................
Wisconsin................

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

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


1,853
243
1,094
42
118
356

751
183
24
51
287
192
14

200
50
10
87

21
19
13

2,192
37
190
188
92
16
320
311
394
644


1,989
190
1,129
49
268
353

664
131
17
41
303
148
24

155
26
15
59
3
7
21
24

1,997
18
165
249
104
18
291
216
349
587


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

U. S. TOTAL..............


1.874


1.756


831
68
200
45
518

181
5
4
6
7
86
56
4
13

866
21
29
807
4
5


7.513


161
-

4
15
32
79
10
21

693
54
14
617
2
6


7.186


TERRITORIES............... 69 56 265 234
Puerto Rico.............. 65 55 256 229
Virgin Islands........... 4 1 9 5




Note: Cumulative Totals include revised and delayed reports
through previous months.


A ~ __ .__ _


- APRIL 1964


APRIL 1963











180 qorliitlity itid Mlorlalilt

Table 3 CASES O)F SPI( III) N(T1 IIAB1. DL)I:ASEI I NlTI) STATES

FOR W'1 IKS FNDDI)

MAY 23, 1964- AND) MAY 25, 1963 ( 21st W'FEK)


Encephalitis
Aseptic
Arcninpit Primary P ,- -Inf. P. li.myelat 1l T.tal Cases p. l'my Ilaii- Paralytic
Area Cumulati v Cumulat ive

1964 1963 1964 1964 1964 1963 1964 1963 1964 1963 1964 19b3


UNITED STATE:... 39 20 52 27 6 1 31 54 4 1 24 48

NEW ENGLAND.......... 3 2 1 I
Haine............. 1 1
New Hampshire...... -
Vermont........... -
Massachusetts...... -
Rhode Island........ -
Connecticut ........ 2 -

MIDDLE ATLANTIC..... 11 3 17 1 1 5 5 1 5 5
New York City...... 1 5 1 -
New York, Up-State. 1 2 2 4 2 4
New Jersev......... 6 7 1 2 I 2 -
Pennsylvania....... 3 3 3 1 1 -

EAST NORTH CENTRAL... 3 2 10 1 3 15 3 12
Ohio............... 3 2 4 2 3
Indiana............. 2 1 -
Illinois............ 3 1 6 1 5
Michigan........... 3 2 1 1 3 3
Wisconsin........... 1 1 1

WEST NORTH CENTRAL... 6 1 1 -
Minnesota......... 6 1 1
Iowa................. -
Missouri........... -
North Dakota....... -
South Dakota.....- -
Nebraska............ -
Kansas............. -

SOUTH ATLANTIC ...... 1 8 1 2 14 6 2 11 5
Delaware........... .- -
Maryland........... 1 1 1 1-
Dist. of Columbia. -
Virginia............ 2 1 1 1
West Virginia.... 1 1 -
North Carolina..... 1 5 2 2 2
South Carolina..... 1 1 2 1 2 -
Georgia ............ 1 1 1 -
Florida............ 4 4 2 4 2

EAST SOUTH CENTRAL... 3 5 1 1 3 3 1 2
Kentucky........... -
Tennessee.......... 1 1 1 1 [
Alabama............ .- 1 2 2 1 1
Mississippi ........ 3 4 -

EST SOUTH CENTRAL... 1 3 2 1 1 12 1 1 12
Arkansas............- -
Louisiana.......... 1 1 i 1 10 1 10
Oklahoma .............. -
Texas.............. 2 1 1 2 1 2

OUNTAIN ............. 3 1 3 1 1 2 1
Montana............
Idaho.............. .. 1 -
Wyoming ............ 1 1 1 -
Colorado............ 3 1 I -
New Mexico ......... -
Arizona..........-..
Utah............... .
Nevada............

PACIFIC.............. 17 7 6 21 1 0 1 9
Washington......... 2 1 1 1
Oregon............. 2 1 1 1 1
California......... 14 7 6 18 8 7
Alaska............. .
Hawaii ............. 1 -


Puerto Rico -_ 1- 3 -I 1 3










Morbidity and Mortality Weekly Report 181


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MAY 23, 1964 AND MAY 25 1963 ( 21st 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... 11 160 6 103 671 324 282 65 18,330 20,371 7 144

NEW ENGLAND.......... 2 4 21 53 22 26 5 1,909 2,292 7
Maine.............. 4 18 15 11 4 652 1,058 -
New Hampshire...... 1 1 136 160 -
Vermont............. 4 4 238 30 -
Massachusetts...... 2 3 9 1 6 2 372 680 4
Rhode Island...... 13 2 9 2 105 53 3
Connecticut.......... 11 4 6 1 406 311 -

MIDDLE ATLANTIC...... 1 3 4 130 75 55 4,145 3,884 2 24
New York City...... 1 12 4 8 595 519 2 10
New York, Up-State. 1 61 43 18 1,841 1,735 4
New Jersey......... 2 28 13 15 765 597 1
Pennsylvania....... 1 2 1 29 15 14 944 1,033 9

EAST NORTH CENTRAL... 19 6 94 49 39 6 2,781 3,246 1 30
Ohio............... 1 22 14 8 728 941 17
Indiana............ 1 9 6 3 238 306 5
Illinois........... 12 6 11 5 6 462 706 4
Michigan........... 2 39 20 19 1,149 1,135 3
Wisconsin.......... 3 13 4 3 6 204 158 1 1

WEST NORTH CENTRAL... 3 77 18 30 15 8 7 1,042 953 1 12
Minnesota.......... 2 10 3 1 1 1 91 157 -
Iowa............... 3 45 5 2 1 2 156 163 3
Missouri........... 4 8 4 4 259 379 1 5
North Dakota....... 2 41 27 -
South Dakota....... 12 1 3 2 1 102 47 1
Nebraska........... 10 2 1 1 22 72 -
Kansas............. 2 7 9 5 4 371 108 3

SOUTH ATLANTIC....... 3 15 2 22 71 38 24 9 1,765 2,173 30
Delaware........... 3 2 1 40 28 -
Maryland............ 13 8 5 341 247 1
Dist. of Columbia.. 1 1 29 64 -
Virginia........... 6 20 5 7 8 262 478 7
West Virginia...... 9 7 2 296 345 -
North Carolina..... 1 5 4 1 330 560 10
South Carolina..... 3 61 83 3
Georgia............ 3 6 2 17 1 1 40 88 1
Florida............ 2 2 19 11 7 1 366 280 8

EAST SOUTH CENTRAL... 8 4 38 24 13 1 1,254 2,125 1 20
Kentucky........... 3 7 1 6 528 620 7
Tennessee.......... 1 1 23 20 3 444 862 1 7
Alabama............. 3 2 5 1 4 173 302 5
Mississippi........ 1 1 3 2 1 109 341 1

WEST SOUTH CENTRAL... 12 15 48 24 20 4 1,329 1,355 10
Arkansas............ 3 11 6 5 150 157 5
Louisiana.......... 1 5 14 9 5 289 248 1
Oklahoma........... 1 75 72 3
Texas.............. 7 10 23 9 10 4 815 878 1

MOUNTAIN ............. 1 13 1 39 7 8 24 1,182 1,390 1
Montana............ 2 1 1 111 201 -
Idaho.............. 3 3 111 215 -
Wyoming ............ 1 1 38 21 -
Colorado........... 15 3 4 8 350 295 -
New Mexico......... 1 1 2 2 171 167 -
Arizona............ 1 12 12 258 316 1
Utah................ 1 10 4 1 3 107 165 -
Nevada............. 1 36 10 -

PACIFIC............... 3 11 12 168 70 89 9 2,923 2,953 2 10
Washington......... 11 25 8 11 6 324 499 1
Oregon.............. 1 12 5 7 324 401 -
California......... 3 10 1 123 54 69 2,128 1,974 2 9
Alaska............. 4 1 3 89 61 -
Hawaii.............. -I 4 2 2 58 18 -


Puerto Rico 3 6 6 314 301 6


mow











182 Morbiditi and lorlalit Weekly Report


Tabler CASES OF SPECIFIED NOTIFIABLE DISEASES UNITED STATES

FOR WEEKS ENDED
MAY 23 1964 AND MAY 25 1965 ( 21s WEEK) Coniinucd


Strept occcal
Menlngococcal Sore Throat and Rabies in
Measles Meningitis Scarlet Fever Tetanus Tularemia Animals
Art a
Cumulative Cum. Cum. Cum.
196. 1964 1964 1963 1964 1963 1964 1964 1964 1964 1964 1964

L'NITED STATES... 30,910 43 1,246 1,237 8,670 6,171 5 83 5 97 102 1,965

NEW ENCLAND.......... 693 1 37 79 1,056 873 I 12
Maine .............. 1.5 5 13 29 11 10
New Hampshire...... 5 2 8 3 -- 1
Verm..,nt ............ 30 1 2 7 12 1
Massachusetts ...... 250 1 16 37 131 122 -
Rhoid Island....... 63 2 7 41 61 -
C'nnecticut........ 200 13 18 840 664 -

MIDDLE ATLANTIC...... 2,281 5 119 173 449 431 1 4 -- 5 46
New York City...... 675 20 22 27 33 -
New York, Up-State. 343 1 44 53 280 253 1 1 4 62
New Jersey.......... 587 14 25 93 2 -
Pennsylvania....... 676 4 41 73 142 52 1 1 2

EAST NORTH CENTRAL... 6,121 3 192 204 1,008 697 1 7 1 9 15 251
Ohio................ 1,239 1 55 57 170 83 1 1 10 132
Indiana ............ 98 32 24 107 69 I 1 12
Ill inois .......... 858 1 41 31 103 104 1 4 1 6 2 61
Michigan........... 2,037 1 46 66 411 270 1 1 2 20
Wiisc ansin .......... 1,003 18 26 217 171 1 26

WEST NORTH CENTRAL.. 2,332 2 74 72 301 145 3 1 26 23 614
Minnesota.......... 21 14 13 31 16 1 10 188
Iowa............... 1,904 3 4 99 39 1 1 3 204
Missouri........... 22 1 42 26 8 8 2 1 14 2 104
North Dakota....... 313 I 6 3 110 68 2 35
South Dakota....... 4 53 4 5 54
Nebraska ........... 72 4 17 1 16
Kansas............. NN 5 5 10 8 13

SOUTH ATLANTIC....... 2,299 10 275 229 821 460 1 36 17 16 279
Delaware........... 20 4 1 19 -
Marland........... 307 20 33 68 36 2
Dist. of Columbia.. 1 1 9 4 14 -
Virginia........... 964 3 33 54 211 213 1 5 3 6 175
West Virginia...... 290 1 20 13 231 82 1 1 18
North Carolina..... 24 2 46 38 31 8 10 4 3
S.iuth Carolina..... 136 1 43 13 44 33 3 -
Geora............ .... 1 1 27 12 4 3 1 10 46
Florida............ 556 1 73 61 199 85 14 7 37

EAST SOL'TH CENTRAL... 8,775 7 123 100 1,225 892 1 11 16 10 278
Kentucky............ 299 1 42 21 94 88 1 I 38
Tennessee........... 1,276 4 42 45 1,042 725 1 5 11 8 227
Alabama............ 7,101 2 22 18 11 15 4 3 2 13
Mississipp......... 99 17 16 78 64 1 1 -

WEST SOUTH CENTRAL... 3,154 4 118 130 740 680 10 1 22 18 289
Arkansas............ 24 2 12 8 10 1 2 9 4 76
Louisiana.......... 5 85 53 2 3 3 -- 1 29
Oklahoma........... 36 4 26 12 15 I 12 3 62
Texas.............. 3,089 2 17 43 716 661 5 1 10 142

MOUNTAIN ............. 1,112 3 47 40 1,533 1,007 2 2 9 5 76
Montana............ 146 3 28 29 I 2 -
Idaho............... 41 1 3 30 129 -
Wyoming............... 78 3 1 1 29 1 1 4 -
Colorado............. 180 1 10 II 873 577 2
New Mexico......... 18 1 20 2 348 I 2 38
Arizona............ 256 3 6 143 140 3 36
Utah............... 76 1 3 11 108 103 3 -
Nevada............. 317 7 3 2 -

PACIFIC................. 4,143 8 261 210 1,537 986 1 9 12 102
Washington......... 1,333 19 16 509 381 1 1 -
Oregon............. 740 16 11 25 12 1
California.......... 2,025 8 213 173 897 546 8 12 101
Alaska............. 11 6 5 29 33 -
Hawaii............. 34 7 5 77 14 -

Puerto Rico 256 16 4 8 22 31 9










183


Mloridit anidl Mortality Weekly Report


I hl, { (A) TOlAL DIATHS IN RI-PORTING CITIES


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

For weeks ending For weeks ending
Area 5/ 5/ 53 52 Area29 56
5/2 5/9 5/16 5/23 ______ _____5/2 2/9 5/16 5/23


NEW ENGLAND:
BoEon, 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, .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, Ihch. .......
Indianapolis, Ind. ........
Madison, Ws. ..............
Milwaukee, Wis. ...........
Peoria, Ill ................
Rockford, Ill. ............
South Bend, Ind. ..........
Toledo. Ohio ...............
YoungEou.n, Ohio............

WEST NORTH CENTRAL:
Des Moines, Iowa............
Duluth, -inn. ..............
Kansas City, Kans. ........
Kansa: City, Mo. ..........
Lincoln, Nebr. .............
Minneapolis, linn. ........
Omaha, Nebr. ..............
St. LouiL Mo. ............
St. Paul, Minn. ..........
Wichita, Kans. ............


213
48
34
30
48
23
25
19
45
71
14
62
30
57


48
30
1.0
41
29
48
74
80
1,625
38
520
150
.49
105
18
35
70
36
25
24


46
38
724
172
189
102
74
271
26
53
27
40
47
164
33
118
28
38
50
92
61


33
40
24
121
27
124
65
206
72
45


207
46
35
25
53
16
29
25
41
75
9
35
24
51


43
38
156
46
25
29
83
87
1,681
31
403
180
50
99
20
36
50
41
22
29


69
31
719
155
191
114
79
390
29
46
34
31
47
142
27
124
36
24
44
82
56


75
19
41
144
39
106
87
201
60
36


290
45
31
28
55
40
24
29
53
71
14
43
33
77


42
40
131
54
35
35
88
98
1,703
35
422
182
44
90
29
54
50
57
25
34


69
23
733
187
194
100
85
395
42
56
39
29
50
140
27
129
38
23
36
103
75


49
26
38
127
23
115
85
219
62
63


223
42
30
24
63
31
27
33
46
57
9
43
28
54


45
38
115
41
30*
42
66
110
1,678
24
496
222
56
92
33
30
45
49
27
37


62
28
699
136
181
122
81
369
33
54
44
43
52
156
34
139
36
21
44
112
66


55
28
45
130
24
112
68*
244
53
57


SOUTH ATLANTIC:
Atlanta, Ga. .............
BalEimore, 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. .............


122
240
49
68
84
65
74
40
78
55
215
52


90
43
30
156
107
37
37
100


30
26
19
134
35
60
191
71
172
50
101
44
48


31
24
119
24
93
18
47
36


San Juan, P.R. .............. 25 30 ( ) (--
------


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.....


11,403
373
727
6,308


NOTF: 1dl deaths by place al occurreace.


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


I I I '









Morbidity and Moriality Weekly Report


184


UNIVERSITY OF FLORIDA


3 1262 0I864 2771
3 1262 05864 2771


TOTAL DEATHS REPORTED IN 108 CITIES


The utekl average number of loral deaths in 10
ic tses for the four-teek period ending May 2' was Il ,,(l
as Compared with an expected weekly average of 11,561.


o01r4S


Week Ending

4 Week Weekly
5 2 5 9 5 16 5 23 Total Average

Observed 11,479 11,180 11,381 11,403 45,443 11,361
Expected 11,690 11,603 11,517 11,433 46,243 11,561

Excess .211 -423 -136 -30 -800 -200


TOTAL DEATHS RECORDED IN 1OB U 8 CITIES
A _v_* ImIb p. 8J flt U. .N* wSo


'LJOOI
ovec


(See table, page 183)


INTERNATIONAL NOTES QUARANTINE MEASURES
Imrunizaion Information for International Travel
1963-64 EdIron Public Health Sen-ice Publication No. 384
City: Kalamazoo County Health Department
Center: at Upjohn Company Industrial
Health Department

Tel: Fireside 5-3571, Ext. 2556
Clinic Hours: By appointment
Fee: No


L'N' L I F 3 L'
DOCUMEr DEPT







U S DEPOSITORY


THE MORBIDITY AND MORTALITY WEEKLY REPORT. WITH A CIRCULA-
LATION OF 11.000 IS PUBLISHED BY THE COMMUNICABLE DISEASE
CENTER, ATLANTA. GEORGIA.
CHIEF. COMMUNICABLE DISEASE CENTER JAMES L. GODDARO, M.D.
CHIEF, EPIDEMIOLOGY BRANCH A. D. LANGMUIR. M.D.
CHIEF, STATISIC TIC CION R. E. SERFLING. PH.D.
ASST. CHIEF, STATISTICS SECTION 1. L. SHERMAN. M.S.
CHIEF. SURVEILLANCE SECTION D. A. HENDERSON. M.D.
EDITOR. MMWR L. K. ALTMAN. M.D.
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. ALTMAN, M.D.. EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT
COMMUNICABLE DISEASE CENTER
ATLANTA. GEORGIA 50533
NOTES THESE PROVISIONAL DATA ARE BASED ON WEEKLt. TELE-
GRAMS TO THE COMMUNICABLE DISEASE CENTER BY THE INDIVIDUAL
STATE HEALTH DEPARTMENTS.
SYMBOL LS -- DATA NOT AVAILABLE
QUANTITY ZERO
PROCEDURES FOR CONSTRUCTION OF VARIOUS MORTALITY CURVES
MAY BE OBTAINED FROM STATISTICS SECTION. COMMUNICABLE DIS-
EASE CENTER. PUBLIC MEAL T[ SERVICE. U.S. DEPARTMENT OF
E ALT EDUCATION AND WEL FARE. ATLANTA. GEORGIA 30335.


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