Morbidity and mortality

F5 S ()0/'I /1//9
COMMUNICABLE DISEASE CENTER .


Vol. 15, No. 19



UDETTW PBI EVI

a-_ "SWe n-Ending

W = ay 14, 1966



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


EPIDEMIOLOGIC NOTES AND REPORTS
FILARIASIS Kentucky

A case of filariasis, diagnosed in a 32-year-old male
residing in Harlan, Kentucky, was reported on March 6,
1966, to the Division of Epidevnilop., Kentucky State
Department of Health. The patient, a native of Bihar in
northeastern India, arrived in the United States in Decem-
ber 1965.
On the evening of March 5 the patient reported to the
hospital emergency room complaining of intermittent,
crampy abdominal pain since 1 p.m. that day. Bowel
movements that day had been normal, and there was no
nausea or vomiting. Physical examination revealed slight
tenderness in the umbilical region but no other abnormal


CON TEN TS
Epidemiologic Notes and lHeRx)rts
Filariasis- Kentucky ........ .... ..
Human Case of Anthrax Delaware ...............
Sul fonamide-Resistant Meningococcal Infeclion-Ark..
Current Trends
Meningococcal Infection 1966 ... ......
International Notes
Quarantine Measures ......... ... .....
Cholera Vaccination .. .. ... ..


S161
S162
S162

S162

S168
S168


I'indjir-. Urinalysis was normal but the white blood count
was elevated with 7 percent eosinophils. The patient was
given an injection which relieved the pain and he returned
home.
About 2 a.m. he was awakened by severe abdominal
pain and at once returned to the hospital. He seemed to
be in considerable pain and appeared mildly dehydrated.


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
19th WEEK ENDED CUMULATIVE. FIRST 19 WEEKS
MEDIAN
DISEASE MAY 14, MAY 15, 1961-1965 MEDIAN
1966 1965 1966 1965 1961-1965
Aseptic meningitis ................ 33 26 22 521 542 464
Brucellosis................ ....... 7 4 5 71 73 139
Diphtheria..................... ......... 2 6 53 73 109
Encephalitis, primary:
Arthropod-borne & unspecified ......... 21 32 454 566 --
Encephalitis, post-infectious ............ 24 18 317 296 --
Hepatitis, serum ............... ..... 25 605 890 14,314 18,852
Hepatitis, infectious ............ ...... .. 660 12,866
Measles rubeolaa) .................... 8,095 8,944 19.855 142,179 182,245 258,041
Poliomyelitis, Total (including unspecified) 1 3 8 7 51
Paralytic ............................ 1 2 7 5 45
Nonparalytic ............ ............. 2 -
Meningococcal infections, Total ......... 88 77 56 1,886 1,611 1,136
Civilian .............................. 83 64 1,659 1,464 -
Military................................ 5 13 227 147 -
Rubella (German measles) ...... ...... 1,915 -- 28.324 ----
Streptococcal sore throat & Scarlet fever .. 9,246 7,678 7,428 215.961 202,029 176,856
Tetanus.................... ........ 5 4 42 72 -
Tularemia ............ ................ 5 48 68 -
Typhoid fever .......................... 8 10 7 105 120 131
Typhus, tick-borne (Rky. Mt. Spotted fever). 1 3 --- 11 12
Rabies in Animals....................... 79 96 95 1.681 1.947 1,623

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ..... ..... ......... ............. 2 Botulism: ..... ..... .. ... .. .. 1
Leptospirosis: Ark.-1 .............. ....... .... 13 Trichinosis: Iowa-2 ........ ....... ........ 39
Malaria: N.J.-l, Ill.- ........................... 101 Rabies in Man: ........... ............ ... 1
Psittacosis: ................................... ... 16 Rubella, Congenital Syndrome: Pa.-1, Minn.-1 ....... 12
Typhus, murine: ............................. ..... 6 ... ........ ....






Morbidity and Mortality Weekly Report


EPIDEMIOLOGIC NOTES AND REPORTS
FILARIASIS Kentucky (Continued)


Again there were no abnormal physical findings other than
some upper abdominal tenderness. However, laboratory
studies showed a leucocytosis with 7 percent eosinophils
on one occasion and 13 percent on a repeat examination.
The patient gave a history of having suspected
filariasis 2 years ago while he was in India. Since eosin-
ophilia was found, filariasis was suspected. Subsequently,
a blood smear collected after midnight revealed micro-
filariae of Wuchereria bancrofti. The patient was started
on a course of treatment with di.-irt .,rl'.rni,in,- and


showed good subjective response. Follow-up studies to
demonstrate the presence or absence of the micro-filariae
in the out-patient's blood are planned.

(Reported by Dr. C. Hernandez, Medical Director, Divi-
sion of Epidemiology, Kentucky State Department of
Health; Henry Evans, M.D., Attending Physician, Depart-
ment of Medicine, Daniel Boone Clinic; and V. B. Lak-
hani, M.D., Resident in Medicine, Harlan Appalachian
Regional Hospital, Harlan, Kentucky.)


HUMAN CASE OF ANTHRAX-Delaware


A case of anthrax was reported from Delaware on
March 19, 1966. The patient is a 55-year-old male who has
worked at a goat hide tanning company for 24 years. Most
recently he has been employed as a trimmer of hides that
have received preliminary treatment in an acid bath.
On March 2 he developed a cutaneous pustular lesion
on the dorsum of his left hand. His condition was such
that he was admitted to hospital on March 5; material
from the lesion obtained for cultures was positive for
Bacillus anthracis. Treatment was given with penicillin
and chloramphenicol. The patient made a good recovery
and was discharge from hospital on March 14.
Goat hides imported for tanning at this factory come
from Jamaica, India, Nigeria, Ethiopia, Iran and Pakistan.
Since 1936 there have been 10 cases of cutaneous anthrax


reported among employees of the factory. The most recent
case prior to the current case occurred in 1962. This
patient, also a 55-year-old male, assisted in unpacking
raw hides imported from India in barrels and put them in
vats preliminary to a "soaking" operation; he subsequent-
ly developed a lesion on the right forearm. Vaccination
with the anthrax cell-free vaccine for employees who
work in the high risk areas of the plant is now being
considered by the company officials.

(Reported by Dr. E. F. Gliwa, Deputy State Health Of-
ficer, Delaware State Board of Health; Dr. Joseph M.
Barsky, Jr., Attending Physician, :; .t-,, ir..,,. Delaware;
and Investigations Section of Epidemiology Branch,
CDC.)


SULFONAMIDE-RESISTANT MENINGOCOCCAL INFECTION Batesville, Arkansas


A fatal case of confirmed meningococcal meningitis
in a 5-month-old child who lived in Batesville, Arkansas,
has been reported from Little Rock, Arkansas. The onset
of illness was March 21, 1966. On March 25 the child's
sister, who had been given a sulfonamide drug for pro-
phylaxis, developed meningococcal meningitis. Culture
of her spinal fluid yielded group B meningococci which
were later shown to be sulfonamide-resistant. The patient
responded well to penicillin therapy and has made a com-
plete recovery.
(Reported by Dr. J. T. Herron, State Health Officer,
Arkansas State Health Officer; and an EIS Officer, CDC.)


Editorial Note:

This report illustrates one of the rarely occurring
secondary family cases of meningococcal meningitis and
emphasizes the problem of sulfonamide prophylaxis when
the infecting strain of meningococcus is resistant to
sulfonamide drugs. Although penicillin is the agent of
choice in therapy, its usefulness as a prophylactic agent
is controversial and has not been critically evaluated.
Penicillin does not eradicate meningococci from the naso-
pharynx even when given orally as penicillin V at a dos-
age of 4,800,000 units daily.


CURRENT TRENDS
MENINGOCOCCAL INFECTIONS


For the week ended May 14, 1966, 88 cases of men-
ingoeoccal infection, of which 5 cases are in military
personnel and 83 cases in civilians, have been reported
to the Communicable Disease Center. The cumulative
total for the first 19 weeks of this year is 1,886, an in-
crease of 17.1 percent over the 1,611 cases reported


during the comparable period in 1965. Figure 1 shows the
weekly number of cases reported through the 19th week
of 1966. The anticipated downward trend has not yet
become established.
(Reported by the Investigations Section, Epidemiology
Branch, CDC.)


162


May 14, 1966







May 14, 1966













140-




120-




100-




1O-
w
80-



w
60-





--
& 40-
0
Q.
X:


Morbidity and Mortality Weekly Report






Figure 1
MENINGOCOCCAL INFECTIONS BY WEEK OF REPORT

1965, 1966 AND MEDIAN, 1961-65

UNITED STATES


1961-65 MEDIAN


JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC

MONTH






SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS-APRIL 1966 AND APRIL 1965

CASES OF PRIMARY AND SECONDARY SYPHILIS: By reporting areas April 1966 and April 1965 Provisional Data
Cumulative Cumulative
Reporting Area April Jan Apr Reporting Area April Jan Apr
1966 1965 1966 1965 1966 1965 1966 1965
EW ENIAND............. 24 30 164 156 AST SOUTH CENTRAL........ 194 226 768 845
Kaine................ 1 1 3 2 Kentucky................. 4 8 41 50
New Hapshire....... 1 4 6 Tennessee................ 27 48 105 198
Vermont................ Alabama.................. 106 114 398 429
Massachusetts. ...... 14 22 110 96 Mississippi.............. 57 56 224 168
Rhode Island............ 6 1 11 8
Connecticut...... .... 3 5 35 44 WEST SOUTH CENTRAL... ..... 198 166 857 743
Arkansas............... 10 29 63 82
MIDDLE ATANTIC .......... 333 374 1,446 1,552 Louisiana............... 44 46 215 207
Upstate New York........ 33 39 141 172 Oklahoma................. 13 7 54 49
New York City............ 213 217 922 936 Texas.................... 131 84 525 405
Pa. (Excl. Phila.)...... 14 18 76 63
Philadelphia............ 20 31 87 87 OUNTAIN.................. 32 42 127 201
Hew Jersey............. 53 69 220 294 Montana................. 7 1 16 6
Idaho...... ............. I 1 1
EAST NORTH CENTRAL....... 279 299 1,014 1,033 Wyoming.................. -
Ohio.................... 58 62 197 213 Colorado............... 4 4 17 10
Indiana................ 4 6 22 20 New Mexco.......... 5 9 27 40
Downstate Illinois...... 16 35 68 87 Arizona................. 13 23 58 113
Chicago................. 80 109 339 425 Utah................. 4 8
Michigan................ 110 77 350 265 Nevada................. 2 5 4 23
Wisconsi................ 11 10 38 23
PACIFIC.................. 173 148 630 677
WEST NORTH CENTRAL....... 30 45 158 162 Washington............... 2 8 17 33
innesota........... ..... 1 6 8 30 Oregon................... 7 2 18 12
Ioua..................... 2 22 7 California.............. 163 137 585 622
Missouri................. 13 26 73 83 Alaska................... 2 3
North Dakota............. 4 Hawaii ................... 1 1 8 7
South Dakota........... 4 6 20 19
Nebraska................. 5 7 14 18 U. S. TOTAL............. 1.846 1.861 7,311 7,612
Kansas................... 5 17 5 ....
IERRITORIES............... 81 64 326 262
SOUTH ATLANTIC............ 583 531 2,147 2,243 Puerto Rico.............. 78 64 319 261
Delaare.............. 4 9 10 23 Virgin Islands........... 3 7 1
Maryland................. 45 26 179 134
District of Columbia.... 44 29 155 162
Virginia................. 28 21 103 113
West Virginia........... 3 6 21 19
North Carolina........... 81 87 332 342 Note: Cumulative Totals include revised and delayed reports
South Carolina........... 81 60 313 274 through previous months.
Georgia.................. 93 91 368 369
Florida.................. 204 202 666 807


163







164 Morbidity and Mortality Weekly Report



CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MAY 14, 1966 AND MAY 15,1965 (19th WEEK)


ENCEPHALITIS HEPATITIS
ASEPTIC Primary Post- Both
AREA MENINGITIS BRUCELLOSIS including Infectious DIPHTHERIA Serum Infectious Types
unsp. cases
1966 1965 1966 1966 1965 1966 1966 1965 1966 1966 1965
UNITED STATES... 33 26 7 21 32 24 2 25 660 605

NEW ENGLAND.......... 1 1 1 2 1 39 43
Maine........... ... 8 6
New Hampshire...... 3
Vermont............ 1 3
Massachusetts...... 1 1 14 20
Rhode Island...... 1 1 1 9 7
Connecticut....... 1 7 4

MIDDLE ATLANTIC...... 4 4 1 9 9 7 12 116 109
New York City...... 2 1 2 6 6 30 19
New York, Up-State. 1 1 1 2 1 35 43
New Jersey......... 2 1 6 2 4 21 23
Pennsylvania....... 1 5 1 30 24

EAST NORTH CENTRAL... 5 1 11 2 1 127 111
Ohio................ 2 1 8 33 27
Indiana............ 5 14
Illinois........... 2 2 2 1 17 19
Michigan........... 1 1 68 38
Wisconsin............ 4 13

WEST NORTH CENTRAL... 1 2 4 2 2 3 1 32 34
Minnesota.......... 1 1 1 1 3 1 7 1
Iowa............. 1 1 1 13 9
Missouri.......... 9 13
North Dakota....... -
South Dakota...... 2 2
Nebraska............ 2
Kansas............. 2 3 7

SOUTH ATLANTIC..... 4 6 3 1 3 57 41
Delaware........... 2 1 2 5
Maryland .......... 1 12 6
Dist. of Columbia.. -
Virginia........... 1 1 5 8
West Virginia...... 2 5 3
North Carolina..... 1 2 4 1
South Carolina..... 7 5
Georgia.............. 10 2
Florida............ 1 3 1 1 12 11

EAST SOUTH CENTRAL... 1 2 49 43
Kentucky........... 19 16
Tennessee.......... 1 20 11
Alabama............. 2 4 4
Mississippi........ 6 12

WEST SOUTH CENTRAL... 8 3 1 1 1 61 50
Arkansas............ 9 2
Louisiana.......... 1 14 4
Oklahoma......... -
Texas.............. 7 3 1 1 1 38 44

MOUNTAIN............. 2 2 26 40
Montana............ 1 2
Idaho.............. 3 8
Wyoming............ 1 I
Colorado........... 4 5
New Mexico......... 6 6
Arizona............. 2 1 9 11
Utah............... 1 2 7
Nevada............-

PACIFIC.............. 9 10 3 6 10 1 6 153 134
Washington......... 1 1 10 20
Oregon ............. 1 14 9
California.......... 8 9 3 4 10 1 6 126 101
Alaska............ 2 4
Hawai .............. 1-

Puerto Rico.......... 20 18







Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS INDED

MAY 14, 1966 AND MAY 15, 1965 (19th WEEK) CONTINUED


MEASLES (Rubeola)
AREA --
Cumulative
1966 1966 1965

UNITED STATES... 8,095 142,179 182,245

NEW ENGLAND.......... 64 1,623 32,270
Maine............... 4 170 2,274
New Hampshire...... 1 34 350
Vermont............ 5 209 678
Massachusetts...... 22 608 17,633
Rhode Island....... 79 3,506
Connecticut........ 32 523 7,829

MIDDLE ATLANTIC...... 492 15,376 8,355
New York City...... 178 7,585 942
New York, Up-State. 80 1,659 2,444
New Jersey......... 52 1,630 1,437
Pennsylvania....... 182 4,502 3,532

EAST NORTH CENTRAL... 2,673 52,009 35,978
Ohio............... 408 4,981 7,044
Indiana............. 228 3,639 1,255
Illinois........... 394 9,856 1,534
Michigan............ 603 8,730 18,528
Wisconsin.......... 1,040 24,803 7,617

WEST NORTH CENTRAL... 353 6,696 13,698
Minnesota.......... 26 1,475 471
Iowa................ 305 3,915 7,492
Missouri........... 2 383 2,171
North Dakota....... 19 850 3,118
South Dakota....... 4 70
Nebraska........... 1 69 376
Kansas............. NN NN NN

SOUTH ATLANTIC....... 672 10,920 19,649
Delaware........... 5 157 429
Maryland........... 107 1,629 808
Dist. of Columbia.. 8 346 38
Virginia........... 102 1,182 3,146
West Virginia..... 172 3,943 11,148
North Carolina.... 19 204 239
South Carolina.... 27 498 833
Georgia............ 21 213 538
Florida............ 211 2,748 2,470

EAST SOUTH CENTRAL... 668 15,651 11,146
Kentucky............ 91 4,176 2,069
Tennessee.......... 546 9,396 6,285
Alabama.............. 16 1,295 .1,895
Mississippi........ 15 784 897

WEST SOUTH CENTRAL... 1,351 17,582 25,614
Arkansas............ 202 730 1,039
Louisiana.......... 1 75 64
Oklahoma............ 28 393 138
Texas............... 1,120 16,384 24,373

MOUNTAIN............ 611 8,386 14,432
Montana............. 106 1,261 3,001
Idaho.............. 97 844 1,974
Wyoming............ 100 708
Colorado........... 49 832 3,782
New Mexico......... 151 837 508
Arizona............ 176 4,174 693
Utah............... 23 305 3,593
Nevada............. 9 33 173

PACIFIC.............. 1,211 13,936 21,103
Washington.......... 236 2,398 6,080
Oregon.............. 54 968 2,578
California.......... 895 10,406 9,842
Alaska.............. 18 79 112
Hawaii .............. 8 1 8 2,491
Puerto Rico........... 133 1,806 1,369


0 ri | .'., ., 1 iTi' L .
TOTAL

Cumulati
1966 196 -
T 1966r


88

3



2




3
4
1
3

15
4
4
2
2
3

8
1
2
5





16

1



10
1
2
2

7
1
4
1
1

8
1
2
1
4

2

18







18
3
2
12
1


1,886

82-
7
7
3
33
7
25

209
33
59
57
60

281
77
48
53
74
29

104
25
15
43
4
3
7
7

306
3
30
7
42
10
72
40
44
58

166
70
51
33
12

279
16
110
12
141

69
4
5
3
37
9
9

2

390
27
26
319
15

4


T r i


ive
1965

1,611

80
9
5
2
28
11
25

224
35
57
67
65

194
56
27
53
33
25

86
18
4
40
4
2
9
9

319
4
32
4
36
23
54
50
41
75

117
53
34
22
8

243
12
136
16
79

54
1
7
2
12
8
16
6
2

294
22
23
238
6

3
3


Total

1966 1965 19i

1


Paralytic
Cumulative
56 1966


RUBELLA


1966

1,915

264
12

1
96
20
135

85
27
51

7

618
50
61
197
135
175

141

133
1
7

-


266
9
23
1
92
22

15

104

181

165
16


7



7

127

2
2
37

79
7


226
81
35
107
1
2


ii i ii___


i







166 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MAY 14, 1966 AND MAY 15, 1965 (19th WEEK) CONTINUED


STREPTOCOCCAL TYPHUS FEVER RABIES IN
SORE THROAT & TETANUS TULAREMIA TYPHOID TICK-BORNE ANIMALS
AREA SCARLET FEVER (Rky. Mt. Spotted)
1966 1966 Cum. 1966 Cum. 1966 Cum. 1966 Cum. 1966 Cum.
1966 1966 1966 1966 1966


UNITED STATES... 9,246 5 42 48 8 105 1 11 79 1,681

NEW ENGLAND........... 1,425 2 1 3 3 25
Maine.............. 144 1 3
New Hampshire...... 20 1 9
Vermont ........... -- 1 13
Massachusetts...... 223 2 1 -
Rhode Island....... 53 -
Connecticut........ 985 -- 3 -

MIDDLE ATLANTIC...... 422 1 7 24 1 3 116
New York City...... 21 3 12 -
New York, Up-State. 364 3 3 110
New Jersey ........ NN 1 1 6 -
Pennsylvania....... 37 3 3 1 6

EAST NORTH CENTRAL... 1,258 3 12 1 16 13 241
Ohio................ 182 3 1 8 5 129
Indiana............. 194 I 3 1 6 55
Illinois........... 171 1 5 2 18
Michigan........... 548 1 2 1 20
Wisconsin.......... 163 I 3 1 19

WEST NORTH CENTRAL... 379 1 3 3 1 12 1 14 363
Minnesota.......... 15 8 77
Iowa............... 193 1 4 2 79
Missouri........... 5 1 3 1 5 4 134
North Dakota....... 75 6
South Dakota....... 8 34
Nebraska........... 5 1 7
Kansas............. 78 2 2 1 26

SOUTH ATLANTIC ..... 1,015 1 9 6 4 23 7 11 223
Delaware........... 50 -
Maryland............ 349 6 1
Dist. of Columbia.. 3
Virginia........... 244 2 3 9 2 6 140
West Virginia...... 203 1 1 30
North Carolina..... 5 1 1 2 2 3 1 1
South Carolina..... 36 1 1 2 -
Georgia............ 7 3 1 1 1 3 34
Florida............. 118 4 2 1 18

EAST SOUTH CENTRAL... 1,238 2 13 8 5 232
Kentucky............ 123 2 1 1 35
Tennessee.......... 982 7 4 4 188
Alabama............ 93 2 4 2 9
Mississippi........ 40 1 -

WEST SOUTH CENTRAL... 1,128 1 9 11 1 6 1 20 348
Arkansas........... 2 9 1 1 1 40
Louisiana.......... 1 3 1 1 2 1 20
Oklahoma............. 161 1 5 99
Texas............... 966 1 4 1 2 13 189

MOUNTAIN............. 1,187 I 1 6 1 1 4 35
Montana........... 33 7
Idaho............... 102 -
Wyoming........... 15 -
Colorado............ 577 1 2 1 1 1 2
New Mexico......... 269 5
Arizona........... 74 1 3 20
Utah............... 117 1 3-
Nevada............. 1

PACIFIC.............. 1,194 1 6 1 1 7 6 98
Washington......... 367 -
Oregon............. 23 1
California......... 706 1 6 1 1 4 6 98
Alaska............. 33 -
Hawaii.............. 65 2 -


Puerto Rico ......... 2 19 4 1 5







Morbidity and Mortality Weekly Report






DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED MAY 14, 1966


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

All Causes Pneumonia Under All Causes Pneumonia Under
Area All 65 years and 1 year Area All 65 years and I year
Ages and over Inluenza All Ages and over Inflnza All
All Ages Causes All Ages jCauses


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,--------


754
251
53
31
35
53
19
21
28
49
72
16
47
27
52

3,422
53
39
176
43
33
29
69
103
1,677
36
505
251
32
112
25
48
60
53
39
39

2,716
59
44
798
166
214
141
89
374
49
58
34
37
50
172
44
124
30
29
39
104
61

862
58
31
43
113
27
125
75
244
79
67


487
152
30
21
24
32
14
15
20
32
42
11
34
21
39

2,032
29
18
103
28
21
20
36
57
1,000
Z2
288
149
20
79
13
34
39
29
24
23

1,523
30
29
430
101
103
83
53
193
33
29
22
24
35
91
26
83
17
17
23
60
41

531
42
17
24
71
17
89
44
135
53
39


Total 12,676 7,329 548 615

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 250,877
All Causes, Age 65 and over------------------- 145,891
Pneumonia and Influenza, All Ages------------- 12,198
All Causes, Under 1 Year of Age------------- 12,763


Week No.


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.-------I
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.-----------


1,267 685 54 67
134 54 1 15
295 169 14 18
49 27 4 5
79 36 2 4
82 53 2
45 20 2
103 59 2 3
43 19 3 1
86 71 3 -
71 41 9 6
232 106 13 10
48 30 3 1

578 302 37 33
83 43 2 3
29 19 3 3
43 26 3 2
99 51 19 3
132 63 6 12
47 20 2
33 18 1 4
112 62 3 4

1,090 586 44 74
45 20 4 2
31 15 1 2
23 12 1 2
133 68 6 6
26 13 5 1
100 57 1 9
178 80 6 15
56 29 2 4
165 88 1 7
81 47 1 5
114 66 4 13
65 42 4 8
73 49 8 -

441 248 29 25
64 27 6 4
28 17 5 1
115 74 5 8
26 16 3 1
94 49 3 5
26 19 1 2
45 24 3
43 22 6 1

1,546 935 38 71
21 16 1 2
57 26 2 6
31 21 2
50 22 3 3
74 49 2 2
503 315 10 23
50 30 1
28 20 1
68 42 -
79 46 1 6
115 70 3 1
196 104 8 13
36 16 2 4
119 76 4
73 50 4 4
46 32 1


*Estimate based on average percent of divisional total.










168 Morbidity and Mo







INTERNATIONAL NOTES QUARANTINE MEASURES



Immunization Information for International Travel-1965-66
edition-Public Health Service Publication No. 384


Section 5 ASIA and EUROPE


Union of Soviet Socialist Republics

On p. 57 and p. 65, add:
Smallpox vaccination certificate required for all travellers
from the United Kingdom on arrival in the USSR.


CHOLERA VACCINATION


Because of the possibility of the spread of cholera
westward from Asia and the Middle East to countries in
Eastern Europe, all travellers to these areas are advised
to be vaccinated against cholera and have in their posses-
sion a valid international certificate of vaccination or
revaccination against cholera.
The standard primary course of cholera vaccine rec-
ommended is two injections given at least 7 days apart.
For persons vaccinated previously one booster dose of
'accine is recommended for revaccination.
The cholera vaccination certificate is valid for 6
months beginning 6 days after the first injection in the
primary series. If revaccination is within the 6-month
period the certificate then issued is valid immediately.
If the revaccination is done after the 6-month period of
the previous certificate has expired, the subsequent
certificate does not become valid until 6 days after re-
vaccination.
Cholera vaccination may be carried out by private
physicians who can issue certificates on the international
form. These certificates are not valid, however, until they
bear the approved stamp of the local, County or State
Health Authority. Failure to observe this requirement
will cause the traveller inconvenience.
The USSR requires valid cholera vaccination certifi-
cates from all arrivals from Turkey.
Lebanon requires all travellers from Asia to be in
possession of valid cholera vaccination certificates.


reality Weekly Report


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION OF 15.600. IS PUBLISHED AT THE COMMUNICABLE DISEASE
CENTER, ATLANTA, GEORGIA.
CHIEF. COMMUNICABLE DISEASE CENTER DAVID J. SENCER, M.D.
CHIEF. EPIDEMIOLOGY BRANCH A.D. LANGMUIR, M.D.
ACTING CHIEF, STATISTICS SECTION IDA L. SHERMAN, M.S.
EDITOR: MMWR D.J.M. MACKENZIE, M.B.,
F. R. C. P. E.
IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY, THE COMMUNICABLE DISEASE CENTER
WELCOMES ACCOUNTS OF INTERESTING OUTBREAKS OR CASE INVES.
TIGATIONS WHICH ARE OF CURRENT INTEREST TO HEALTH OFFICIALS
AND WHICH ARE DIRECTLY RELATED TO THE CONTROL OF
COMMUNICABLE DISEASES. SUCH COMMUNICATIONS SHOULD BE
ADDRESSED TO:
THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT
COMMUNICABLE DISEASE CENTER
ATLANTA. GEORGIA 30333
NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO THE CDC BY THE INDIVIDUAL
STATE HEALTH DEPARTMENTS. THE REPORTING WEEK CONCLUDES
ON SATURDAY: COMPILED DATA ON A NATIONAL BASIS ARE RELEASED
ON THE SUCCEEDING FRIDAY.


UNIV. OF FL L':.


I- I ,
DOCUMENT DESIPT.


rS. OR



U.S. DEPOSITORY


May 14, 1966


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