Morbidity and mortality

COMMUNICABLE DISEASE CENTER


Vol. 15, No. 9


V.

P T


Week Ending

March 5, 1966


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


MEASLES ISABELLA COUNTY, MICHIGAN

Beginning December 2, 1965, an increased incidence
of measles was reported from Isabella County, Michigan
(population 35,348). A total of 22 cases was reported in
December and 52 additional cases by mid-January. These
included two patients hospitalized with measles enceph-
alitiz, and one patient with brochopneumonia. A plan was
developed to contain the epidemic as a community effort
of the physicians of the Central Michigan Community
Hospital, the Central Michigan Health District, the
United Fund of Isabella County, and numerous civic and
student groups.
A survey of absenteeism due to measles in kinder-
garten through the second grades of the eight schools in


PUBi HEAL"TS RVICE


I 2 1 7 s
Measles Isabella Count M. .
Current Trends
Measles .. .....
inf.jI n -' -


*1


C..
/ 7'
~ ~ ^


Mt. Pleasant (population 14,875) and the 12 county
schools revealed an additional 224 cases known to the
schools to have occurred from December 1, 1965. to
January 14, 1966. Six of the eight city schools had from
16 to 40 cases each, while the other two schools had 1
and 2 cases respectively. Six of the 12 county schools
reported measles absences: 3 county schools had 12
cases or more. (Continued on page 74)


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
9th WEEK ENDED CUMULATIVE, FIRST 9 WEEKS
MEDIAN
DISEASE MARCH 5, MARCH 6, 1961-1965 MEDIAN
1966 1965 1966 1965 1961-1965
Aseptic meningitis ............... .. .29 29 23 256 249 210
Brucellosis ............................ 3 4 10 31 32 55
Diphtheria .............. ........ ..... 4 3 5 24 31 55
Encephalitis, primary:
Arthropod-borne & unspecified .......... 19 38 203 262
Encephalitis, post-infectious ......... .. 20 17 -- 138 115 -
Hepatitis, serum ................. ..... 21 186
720 1,215 7.044 10.117
Hepatitis, infectious ................... 782 6,452
Measles rubeolaa) ....... .......... ... 8.664 9.396 13,980 56.969 70,911 86,933
Poliomyelitis, Total (including unspecified) 1 2 2 29
Paralytic .................. .. ..... 1 1 2 25
Nonparalytic ...... ..... -
Meningococcal infections, Total .......... 126 118 57 815 702 504
Civilian ...... .... ....... ........ 111 101 --- 689 652
Military ............................... 15 17 126 50 -
Rubella (German measles) ................ 1,485 -- 9,742 -- ---
Streptococcal sore throat & Scarlet fever .. 13,089 12,202 12,024 97,301 98,291 86.847
Tetanus................................ 1 5 19 35 --
Tularemia ................... ...... ... 2 2 38 40 -
Typhoid fever ...... ...................... 8 8 8 45 61 61
Typhus, tick-borne (Rky. Mt. Spotted fever) 7 6 -

Rabies in Animals. .............. 73 100 81 640 873 589

NOTIFIABLE DISEASES OF LOW FREQUENCY


Cum.
Anthrax: .......... .. ....... 1
Leptospirosis: ..................... .......... ... 8
Malaria: Utah- 1, Va. -1. Minn. -1, Calif. 1 ............. 46
Psittacosis: Ariz. -3 .. .... ........... 11
Typhus murnne ..


Botulism: ....
Trichinosis: ........ ......
Rabies in Man ..
Rubella. Congenital Syndrome: Pa.-4


I .-\ .~ \


4#a

















Figure 1 shows the monthly incidence of reported
measles from January 1961 through February 1966. The
last major measles epidemic began in November 1962, and
reached a peak over the 3-month period of January through
March 1963, with increased measles incidence persisting
through June. A total of 349 cases was reported during
this 8-month period.


FIGURE 1
REPORTED CASES OF MEASLES BY MONTH
ISABELLA COUNTY, MICHIGAN
JANUARY 1961 FEBRUARY 1966

120
loo
so
so




6 a0 # A a'Aso# 40aEM A aa 0So a a4. '#4 0
100
so






1964 1965 1966

Five measles immunization centers were established.
The clinics were staffed by volunteer physicians, public
health nurses from the local and State health departments,
volunteer registered and practical nurses, and volunteer
clerical personnel. The vaccine was offered free of charge
to all children who had not had vaccine or prior measles.
A request was made for a contribution of at least $1.00.
A total of 2,074 children from 1 to 8 years of age received
Schwarz strain measles vaccine in the 2-day campaign.
Table 1 presents the number of children immunized
and the population estimates by age group based on the
1960 school census. Nearly 40 percent of the children
from 1 to 8 years of age were immunized.
Gamma globulin furnished by the Michigan Department
of Public Health was made available to practicing phy-
sicians for children known to have had a close exposure


M4RCH 5, 1966


to a case of measles (for example, a household or intimate
playmate contact, excluding casual school contacts).
A summary of the distribution of gamma globulin by month
is as follows: November 54 cc; December 378 cc;
January 442 cc; February 114 cc. During the period
January 20 to February 15, a total of 54 cases of measles
was reported through routine channels. However, all but
one of these children became ill in January.
On February 15, 1966, a second school survey for
absenteeism due to measles revealed that 89 cases had
occurred between January 19 and February 15. Twenty-
seven of these children had not had vaccine in the cam-
paign; 62 school children developed measles from 2 to
12 days following vaccination, as shown in Table 2. No
school cases occurred among those vaccinated after
January 31, 1966. From February 15 to March 1, only
three cases of measles have been reported. No gamma
globulin for measles exposure has been requisitioned
from the Health Department since mid-February.

(Reported by Dr. George Agate, State Epidemiologist,
Michigan Department of Public Health; Dr. E.J. Brenner,
Director, Mrs. Louise Eppel, R.N., Mr. Kent L. Gray,
Health Educator, Central Michigan District Health
Department; Dr. Andrew V. Bedo, Central Michigan
Community Hospital, Mt. Pleasant; and an EIS Officer.)


Table 1
Measles in Isabella County, Michigan

S Pop io Number Percent
Age Population Immunized Immunized

1-4 2,659 1,094 41
5 668 251 38
6 715 294 41
7 718 263 37
8 681 172 25
Total 5,441 2,074 38



Table 2
Days from Measles Vaccine to Number of Cases
Absence due to Measles

0- 3 34
4- 7 19
8-12 9
13+ 0


CURRENT TRENDS MEASLES


During the 4-week period ending February 26, 1966, a
total of 28,234 cases of measles were reported, an in-


crease of 8,170 cases over the total notified during the
preceding 4-week period. The comparable total for the


Morbidity and Mortality Weekly Report



MEASLES ISABELLA COUNTY, MICHIGAN
(Continued from front page)












second 4-week period in 1965 was 35,117, which was
6,883 more than were reported in 1966 (Figure 2). Nine
States reported more than 1,000 cases during the last 4
weeks: Wisconsin (5,640), Illinois (2,838), Texas (2,392),
New York (2,269), Michigan (1,655), Tennessee (1,644),
California (1,467), Kentucky (1,446), and Pennsylvania
(1,138).
A total of 32 cases of post-measles encephalitis has
been reported to date in 1966, 10 of which occurred during


the first 4 weeks and '22 cases during the second 4 weeks.
Illinois has had 10 cases, Kentucky 6, California 5,
Michigan 3, Minnesota and Pennsylvania 2 each, and New
York, Tennessee, Louisiana and Texas, 1 each. In the
comparable periods in 1965 and 1964, there were 14 and 7
cases respectively.



(Reported by the Childhood Virus Disease Init, ('DC.)


FIGURE 2
MEASLES REPORTED BY FOUR-WEEK PERIODS UNITED STATES
EPIDEMIOLOGIC YEARS, 1964-65 AND 1965-66
COMPARED WITH 10-YEAR PERIOD, 1954-1963


.............. 1964-65 Epidemiologic Year
1965-66 Epidemiologic Year


44 48 52 4 8 12 16 20
WEEK NUMBER


24 28 32 36 40


CURRENT TRENDS INFLUENZA


At the present time, there have been reports of
confirmed i.,p:' B influenza outbreaks in 15 States,
primarily in the eastern part of the country, of type A
outbreaks in two States; and of influenza-like illnesses
in an additional five States.
Since publication of the summary table of States
reporting laboratory confirmed outbreaks of influenza
(\1M\R., Vol. 15, No. i. five States (New York, Penn-
sylvania, \ilrAin-,. Michigan, and Oregon) have reported
laboratory confirmed type B influenza as the cause of
primarily scattered outbreaks. Idaho has reported sero-
logical confirmation of type A influenza infection in one
part of the -tait. and Nevada recognizes evidence of
influenza-like illness although laboratory confirmation


is not yet available.
Although no associated outbreaks have been reported,
influenza viruses have been recovered from individual
cases in three States; Illinois type B, Iowa type A2,
Michigan type A2.
Pneumonia-influenza mortality reported from 122
United States cities has increased slightly in the last
week, influenced primarily by the substantial increase
in the number of deaths notified from the Pacific Division.


(Compiled by the Influenza-Respiratory Disease Unit,
CDC, from reports provided by State Health Departments
and reports received from the HHO International Influenza
Center for the Americas, CDC.)


MARCH 5, 1966


Morbidity and Mortality Weekly Report


170,000-


150,000.


130,000-


90,000-


70,000.


50,000-


30,000-


0
o


w



ILl
U)
a



0
cr
I.


w
zU
m



CD









Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MARCH 5, 1966 AND MARCH 6, 1965 (9th 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... 29 29 3 19 38 20 4 3 21 782 720

NEW ENGLAND.......... 1 1 1 25 38
Maine.............. -- 9 9
New Hampshire...... 3
Vermont............. -- 2 1
Massachusetts..... 1 1 8 13
Rhode Island....... 1 2 4
Connecticut........ 1 11

MIDDLE ATLANTIC...... 1 1 6 8 3 13 119 126
New York City...... 1 3 3 8 19 23
New York, Up-State. 1 1 1 31 63
New Jersey.......... 3 4 2 19 15
Pennsylvania....... 1 2 2 50 25

EAST NORTH CENTRAL... 5 4 3 4 5 2 213 127
Ohio............... 2 3 1 36 55
Indiana............ 2 7 13
Illinois........... 1 1 1 3 47 14
Michigan............ 2 3 1 2 1 115 41
Wisconsin........... 8 4

WEST NORTH CENTRAL... 1 3 2 2 4 1 1 37 45
Minnesota........... 1 3 1 1 5 4
Iowa................ 1 1 15 13
Missouri............. 1 16 8
North Dakota....... 2
South Dakota....... 2 1
Nebraska........... -
Kansas............. 1 1 18

SOUTH ATLANTIC....... 4 5 1 8 1 84 85
Delaware............ 1 1 4
Maryland............. 1 18 17
Dist. of Columbia.. 1 1
Virginia............ 1 1 22 30
West Virginia...... 6 12
North Carolina..... 11 5
South Carolina..... 1 2 1
Georgia............ 3 2
Florida............. 1 3 7 1 22 13

EAST SOUTH CENTRAL... 3 5 1 84 58
Kentucky .......... 1 5 47 18
Tennessee.......... 1 28 26
Alabama............. 1 1 5 9
Mississippi........ 4 5

WEST SOUTH CENTRAL... 7 5 3 4 1 1 70 53
Arkansas........... 1 8 4
Louisiana.......... 2 1 11 11
Oklahoma............ 2 -- 3
Texas............... 5 3 2 2 1 1 51 35

MOUNTAIN............. 1 1 2 5 32 50
Montana............. 1 4 8
Idaho.............. 1 3
Wyoming ........... 4 1
Colorado........... 1 4 8 14
New Mexico.......... 1 7 8
Arizona............ 1 -- 6 7
Utah............... 2 8
Nevada............. 1

PACIFIC.............. 7 6 2 8 7 1 2 3 118 138
Washington.......... 1 5 5
Oregon.............. 1 10 12
California......... 5 6 2 4 7 1 2 3 101 110
Alaska............. 2 11
Hawaii.............. 2 -


Puerto Rico..........


S- 12 28


- _









Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MARCH 5, 1966 AND MARCH 6, 1965 (9th WEEK) ( Continucd


MEASLES (Rubeola)
AREA
Cumulative
1966 1966 1965

UNITED STATES... 8,664 56,969 70,911

NEW ENGLAND........... 153 720 15,775
Maine............... 34 94 1,540
New Hampshire...... 1 9 246
Vermont............ 9 153 150
Massachusetts...... 93 292 9,068
Rhode Island....... 2 36 2,003
Connecticut........ 14 136 2,768

MIDDLE ATLANTIC...... 1,017 8,040 2,647
New York City...... 524 4,018 275
New York, Up-State. 70 790 938
New Jersey.......... 107 793 451
Pennsylvania....... 316 2,439 983

EAST NORTH CENTRAL... 3,610 23,424 11,955
Ohio............... 450 1,480 2,475
Indiana............. 523 1,612 607
Illinois........... 417 5,021 359
Michigan ........... 501 3,461 6,154
Wisconsin.......... 1,719 11,850 2,360

WEST NORTH CENTRAL... 353 2,360 5,643
Minnesota.......... 80 801 140
Iowa ................ 247 940 3,064
Missouri........... 3 139 717
North Dakota ...... 5 443 1,547
South Dakota....... 2 47
Nebraska........... 18 35 128
Kansas............. I NN NN NN


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

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

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

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

PACIFIC..............
Washington .........
Oregon.............
California.........
Alaska.............
Hawaii.............
Puerto Rico.........


517 4,418 9,836
9 57 191
100 799 334
38 235 12
33 355 1,255
161 1,871 6,881
6 51 127
52 212 178
2 93 270
116 745 588

972 6,838 3,756
307 2,583 273
523 3,689 2,359
130 423 829
12 143 295

957 4,538 8,958
65 102 629
2 40 21
11 58 58
879 4,338 8,250

443 2,583 5,905
29 408 1,746
38 344 918
24 45 176
10 233 910
22 64 125
316 1,393 174
4 92 1,808
4 48

642 4,048 6,436
125 1,074 2,042
34 320 1,034
480 2,614 2,666
2 10 65
1 08 629
91 589 297


MENINGOCOCCAL INFECTIONS,
TOTAL

Cumulative
1966 1966 1965


126 815 702

5 45 36
3 6
7 1
1 -
3 19 15
2 5
2 13 9

10 97 111
S 16 17
2 19 28
6 34 37
2 28 29

16 124 77
1 33 22
5 16 8
5 28 18
4 35 17
1 12 12

8 46 34
1 9 9
5 9 1
1 16 15
1 3 3
1 2
26
6 4


POLIOMYELITIS
Total P.

1966 1965 1966


-- RUBELLA
aralytic
Cumulative
1966 1966

1 1,485

157
3
7
5
43

S 99

68
38
30


- 533
- 44
-71
-81
S161
S176

59
6
- 6
52


1




I 103
1
- 17

13
- 11

- 18

- 43

S 81
17
- 61
3










140
6


-15

114
5


S 344
186
S 26
124
2


4










78 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MARCH 5, 1966 AND MARCH .6, 1965 (9th 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... 13,089 1 19 2 38 8 45 7 73 640

NEW ENGLAND........... 1,886 2 1 2 5
Maine............... 180 -
New Hampshire...... 69 1
Vermont............. 80 4
Massachusetts...... 417 2 1 -
Rhode Island....... 56 -
Connecticut........ 1,084 2 -

MIDDLE ATLANTIC...... 469 3 3 12 1 4 55
New York City...... 34 3 5 -
New York, Up-State. 314 1 3 4 53
New Jersey......... NN 1 3
Pennsylvania....... 121 1 1 1 2

EAST NORTH CENTRAL... 1,904 11 2 8 12 73
Ohio............... 200 3 2 5 9 40
Indiana............. 516 2 1 1 10
Illinois ........... 313 5 2 6
Michigan........... 572 1 8
Wisconsin.......... 303 1 1 9

WEST NORTH CENTRAL... 501 1 1 3 1 3 1 12 164
Minnesota........... 106 1 30
Iowa.............. 187 5 35
Missouri........... 9 1 1 1 1 2 6 72
North Dakota....... 39 3
South Dakota ..... 20 17
Nebraska........... 7 2
Kansas.............. 133 2 1 1 5

SOUTH ATLANTIC....... 1,236 1 5 5 8 5 11 86
Delaware .......... 22 -
Maryland ........... 207 -
Dist. of Columbia..- -
Virginia........... 338 2 5 1 8 67
West Virginia...... 360 1 1 1 7
North Carolina..... 15 2 1 3 -
South Carolina..... 89 -
Georgia............ 5 2 1 2 9
Florida............. 200 1 2 1 3

EAST SOUTH CENTRAL... 1,825 1 11 3 15 107
Kentucky........... 293 2 2 15
Tennessee.......... 1,342 6 3 13 90
Alabama............. 129 1 3 2
Mississippi........ 61 -

WEST SOUTH CENTRAL... 1,317 5 5 1 14 112
Arkansas........... 4 3 11
Louisiana.......... 2 4 7
Oklahoma........... 60 1 1 8
Texas............... 1,255 1 1 10 86

MOUNTAIN............. 1,786 1 1 4 2 7
Montana............ 1
Idaho............. 163 -
Wyoming ........... 138 -
Colorado........... 881 1 2 1 1
New Mexico......... 259 -
Arizona............. 143 1 1 5
Utah............... 200 I 1
Nevada............. 2 -

PACIFIC.............. 2,165 3 1 1 4 3 31
Washington......... 768 -
Oregon............. 40 1 1
California.......... 1,240 3 1 3 3 31
Alaska ............. 55
Hawaii ........... 6 -
Puerto Rico .......... 9 1 2 1 1









Morbidity and Mortality WVeekly Report






DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED MARCH 5, 1966


9 (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 Influenza All Ages and over Influenza All
All Ages Causes All Ages Causes


NEW ENGLAND:
Boston, Mass.---------
Bridgeport, Conn.-----
Cambridge, Mass.------
Fall River, Mass.-----
Hartford, Conn.-------
Lowell, Mass. -------
Lynn, Mass.-----------
New Bedford, Mass.----
New Haven, Conn.-----
Providence, R. I.---
Somerville, Mass.-----
Springfield, Mass.---
Waterbury, Conn.------
Worcester, Mass.------

MIDDLE ATLANTIC:
Albany, N. Y.---------
Allentown, Pa.--------
Buffalo, N. Y.--------
Camden, N. J.---------
Elizabeth, N. J.------
Erie, Pa.-------------
Jersey City, N. J.----
Newark, N. J.---------
New York City, N. Y.--
Paterson, N. J.-------
Philadelphia, Pa.-----
Pittsburgh, Pa.-------
Reading, Pa.----------
Rochester, N. Y.------
Schenectady, N. Y.----
Scranton, Pa.---------
Syracuse, N. Y.-------
Trenton, N. J.--------
Utica, N. Y.----------
Yonkers, N. Y.--------

EAST NORTH CENTRAL:
Akron, Ohio----------
Canton, Ohio----------
Chicago, Ill.---------
Cincinnati, Ohio------
Cleveland, Ohio-------
Columbus, Ohio--------
Dayton, Ohio----------
Detroit, Mich.--------
Evansville, Ind.------
Flint, Mich.----------
Fort Wayne, Ind.------
Gary, Ind.------------
Grand Rapids, Mich.---
Indianapolis, Ind.----
Madison, Wis.---------
Milwaukee, Wis.-------
Peoria, Ill.----------
Rockford, Ill.--------
South Bend, Ind.------
Toledo, Ohio----------
Youngstown, Ohio------

WEST NORTH CENTRAL:
Des Moines, Iowa------
Duluth, Minn.* -------
Kansas City, Kans.----
Kansas City, Mo.-----
Lincoln, Nebr.-------
Minneapolis, Minn.----
Omaha, Nebr.----------
St. Louis, Mo.--------
St. Paul, Minn.-------
Wichita, Kans.--------


792
273
44
45
30
50
28
19
28
51
59
14
57
36
58

3,536
74
23
186
41
37
44
59
134
1,704
35
598
194
58
110
27
28
55
55
32
42

2,696
59
36
764
153
238
155
92
392
39
38
47
26
52
150
40
138
27
25
57
116
52

920
72
30
41
140
33
112
101
277
68
46


SOUTH ATLANTIC:
Atlanta, Ga.-----------
Baltimore, Md.---------
Charlotte, N. C.-------
Jacksonville, Fla.-----
Miami, Fla.-------------
Norfolk, Va.-----------
Richmond, Va.-----------
Savannah, Ga.-----------
St. Petersburg, Fla.---
Tampa, Fla.------------
Washington, D. C.-----
Wilmington, Del.------

EAST SOUTH CENTRAL:
Birmingham, Ala.-------
Chattanooga, Tenn.-----
Knoxville, Tenn.--------
Louisville, Ky.---------
Memphis, Tenn.---------
Mobile, Ala.-----------
Montgomery, Ala.-------
Nashville, Tenn.-------

WEST SOUTH CENTRAL:
Austin, Tex.-----------
Baton Rouge, La.-------
Corpus Christi, Tex.---
Dallas, Tex.-----------
El Paso, Tex.----------
Fort Worth, Tex.-------
Houston, Tex.----------
Little Rock, Ark.------
New Orleans, La.-------
Oklahoma City, Okla.---
San Antonio, Tex.------
Shreveport, La.--------
Tulsa, Okla.-----------

MOUNTAIN:
Albuquerque, N. Mex.---
Colorado Springs, Colo.
Denver, Colo.----------
Ogden, Utah------------
Phoenix, Ariz.---------
Pueblo, Colo.----------
Salt Lake City, Utah---
Tucson, Ariz.----------

PACIFIC:
Berkeley, Calif.-------
Fresno, Calif.---------
Glendale, Calif.-------
Honolulu, Hawaii-------
Long Beach, Calif.-----
Los Angeles, Calif.----
Oakland, Calif.--------
Pasadena, Calif.-------
Portland, Oreg.--------
Sacramento, Calif.-----
San Diego, Calif.------
San Francisco, Calif.--
San Jose, Calif.-----
Seattle, Wash.---------
Spokane, Wash*--------
Tacoma, Wash.----------


Total


1,196
136
247
52
79
94
53
92
39
91
75
191
47

670
102
49
39
163
114
59
43
101

1,256
36
57
31
177
50
85
223
71
186
93
110
61
76

483
56
14
126
30
136
14
52
55

2,091
36
71
35
57
126
501
153
56
122
98
147
311
63
198
67
50


605
64
112
27
40
52
24
46
19
74
39
87
21

360
56
29
20
91
62
30
24
48

633
26
26
16
88
21
44
122
34
75
46
64
30
41

265
25
11
63
19
70
6
35
36

1,330
30
44
21
35
91
297
98
43
79
62
89
206
42
114
49
30


4 -t t


13.640


7.915


Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 119,875
All Causes, Age 65 and over------------------- 69,441
Pneumonia and Influenza, All Ages------------- 5,776
All Causes, Under 1 Year of Age--------------- 6,225


Week No.


*Estimate based on average


percent of divisional total.














INTERNATIONAL NOTES
SMALLPOX SURVEILLANCE Canada



On November 29, 1965, a mother and her son arrived
in Winnipeg, Canada, from London, on an international
flight which originated in East Pakistan. As these
passengers had come from a declared smallpox "local
infected area" in East Pakistan, a surveillance certif-
icate was issued by the Winnipeg International Airport
quarantine officer. A copy of this certificate was sent
to the Winnipeg City Health Department which, in turn,
sent a letter to the new arrivals requesting them to report
any illness occurring within 14 days of entry to Canada.
Both travellers had been vaccinated on November
20 and had presented valid international certificates of
vaccination against smallpox on arrival. Each of them
also had two well defined scars which were shown in
evidence of successful vaccinations prior to those
performed on November 20.
On December 3, the day after receiving the letter
from the City Health Department, the husband telephoned
the Department, from a lodging house in which the family
was living, to report that both his wife and son were
suffering from an itchy rash. The rash had been present
before leaving Pakistan but had suddenly become worse
the day after arriving in Canada.
Medical examination revealed little constitutional
disturbance although each patient had a generalized but
discrete pustular rash with some localization on one of
the boy's knees and on the palm of the mother's left
hand. Other lesions on the anterior surface of the child's
wrists and on the mother's toes and hands were suggestive
scabies. However, a provisional diagnosis of eczema
vaccinatum was made and, in view of the history and
nature of the rash, it was clearly necessary to regard the
condition as modified smallpox until proved otherwise.
Accordingly the two patients and the father were quar-
antined in special hospital accommodation and all primary
contacts in the lodging house were identified, vaccinated,
and put under surveillance. The isolation hospital staff
and two ambulance drivers were also vaccinated and
placed under surveillance.

Preliminary laboratory reports on December 4 indi-
cated that the skin eruption in both patients was due
to a pox virus. Examination at the Manitoba Virus
Laboratory and the National Laboratory of Hygiene in
Ottawa of material obtained from the patients later
confirmed that this virus was vaccinia virus.


(Reported by Dr. E. Snell, L.R.C.P., D.P.H., Director,
Preventive Medical Services, Department of Health, Pro-
vince of Manitoba, Winnipeg, Canada; Dr. E. W. R. Best,
Chief, Epidemiology di, -*s.n. Department of National
Health and Welfare, Oit ..i. Canada and Dr. Peter Con-
stantinidis, Deputy Medical Officer of Health, City of
Winnipeg.)


MARCH 5, 1966


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULAR.
TION OF 15.300, 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.


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