Morbidity and mortality

Morbidity and Mortality


I1


PUBLIC HEALTH SERVICE

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

Priapurd oby ae (s MElrose 4-5131

For release February 3, 1961 Atlanta 22. Georgia Vol. 10, No. 4

Provisional Information on Selected Notifiable Diseases in the United States and on


Deaths in Selected Cities for Week Ended January 28, 1961


Influenza No reports of epidemic influenza or re-
cent influenza virus isolations have been received during
the current season from any part of the United States.
During the past six weeks, influenza and pneumonia
deaths in this country have remained slightly above nor-
mal levels, but no significant excess mortality has
occurred.

Hepatitis A total of 1,856 cases was reported for
the week ending january 28, 1061, a figure almost identi-
cal with last week's total of 1,820 cases. Hepatitis cases
for 1961 remain high above comparative totals of the past
9 years. Localized outbreaks are occurring in most States


and CDC has been notified this week of specific out-
breaks in Clark County, Kentucky; Franklin County,
Illinois; and Duchesne County, Utah.


AMffIO AGICAL REPORTS


cal Officer in Charge,
Winnebago, Nebraska,
*tious hepatitis among
*s have occurred since


Table I. Cases of Specified Notifiable D ii Id States
(Cumulative totals include revised and delayed reports through previous week)

Disease 4th Week Cumulative
(Seventh Revision of International Approxi-
Lists, 1955) First 4 weeks Since seasonal low week mate
Ended Ended seasonal
Jan. Jan. Median Median low
Weekly incidence low or sporadic 28, 30, 1956-6. Median 96-6 195_-56 point
-- Data not available 1961 ., 1961 196( 195i-6, 6-616 19 -9 to
Quantity zero I 1959-E0
Anthrax ----------062 *
Botulism----------.----------049.1 3 *
Brucellosis undulantt fever) ----0 7 14 10 30 58 47 *
Diphtheria----------------------055 22 24 22 94 91 94 674 621 834 July 1
Encephalitis, infectiou---- --082 22 32 27 85 107 83 85 107 83 Jan. 1
Hepatitis, infectious, and
serunn---------------092,1N98.5 pt. 1,856 711 544 6,154 2,837 1,925 21,329 10,833 6,704 Sept. 1
Malaria--------------------110-117 *1 5 *
Measles--------------------------065 9,403 8,823 9,432 32,511 31,562 30,927 68,558 69,114 69,114 Sept. 1
Meningitis, aseptic----------340 pt. 26 36 --- 90 132 --- 90 132 --- Jan. 1
Meningococcal infections---------057 52 51 53 211 214 230 865 869 1,040 Sept. 1
Polioayelitis-------------------080 8 36 36 47 108 108 3,111 8,382 8,382 Apr. 1
Paralytic-------------080.0,080.1 5 23 23 27 78 78 2,136 5,579 5,579 Apr. 1
Ionparslytic------------- 00.2 2 10 10 8 17 17 629 2,134 2,134 Apr. 1
Unspecified-----------------080.3 1 3 3 12 13 13 346 669 669 Apr. 1
Pttacosis-----------------096.2 1 1 3 4 *
babies In man---------------------094 2 *
Streptococcal sore throat,
including scarlet fever----050,051 9,699 9,346 -- 34,405 32,759 --- 132,057 --- -- Aug. 1
TFphoid fever-------------------040 11 9 13 30 31 50 716 757 1,062 Apr. 1
Tphus fever, endemic-----------101 1 1 3 3 *
Iabies in animals--------------- 55 73 93 197 294 345 767 1,274 1,274 Oct. 1









Morbidity and Mortality Weekly Report


August in and around Macy, a town of 732 population. Only
2 cases were reported among these Indians between 1957
and August 1960. All of the cases were jaundiced, and
all were mild with the exception of two white women -
a nurse who treated cases at the Indian hospital and a
minister's wife who taught Sunday school; their courses
necessitated longer convalescent periods. The figure
below shows cases by week of onset:


HEPATITIS, OMAHA INDIAN
RESERVATION


No. of


Q Over 20
years of age


6 20
AUG


IMMUNE GLOBULIN
PROPHYLAXIS BEGUN


.


.- I.


3 17 I 15 29 12 26 b 24 '7 21
SEP OCT NOV DEC JAN


Fifteen had onset in December and 7 in January. Two
peaks separated by about :30 days are discernible in
December and January. The ages of the cases s.~oved a
distinct pattern. Six were. preschool age, 17 were, 9
years old, 1 was in the 10'- 14..age group, and 5,were 20
or above. The paucity of cass .over 10 years'of age is
noteworthy. Fourteen of the children attended a single
elementary school. All were Indians with the exception of
the two white women. A careful study of the cases points
to the person-to-person route as the predominant means of
spread. All household contacts of cases occurring after
November 15 have been given immune serum globulin and
subsequent cases have not occurred in these family
members.

Typhoid Colorado

One week ago Colorado reported three typhoid cases;
during the entire year 1961, a total of one case was re-
ported. Dr. Cecil Mollohan, Chief, Division of Epidemi-
ology, Colorado State Department of Public Health, has
informed us that the current cases were apparently unre-
lated. Two cases were adults the first, a 33-year old
man developed symptoms in mid-December. He had been
traveling in South America and was hospitalized with
compatible symptoms and elevated H and O agglutinin
titers. No culture was taken before treatment with chlo-
ramphenicol was initiated. The second, a 29-vyar old man
recently returned from Mexico, developed symptoms on
January 10 and was found to have positive stools for
S. typhosa. The third case, a three year old girl, had on-
set of symptoms on January 12 and stool cultures were


positive. A most interesting background to this case is
being investigated. The girl's grandmother, who has a
history of having typhoid fever at age 11, came to live
in the home of the patient in November. Late in the same
month the grandmother was hospitalized with gallstone
ileus and in mid-January (before cultures could be taken)
she had a cholecystectomy. The girl's mother was hos-
pitalized December 27, 1960, with fever, chills, and diar-
rhea and a gram-negative bacillus was isolated from her
blood. She was started on chloramphenicol prior to further
cultures. It appears that the grandmother may have un-
knowingly affected both her daughter and granddaughter.

Poliomyelitis Puerto Rico

A preliminary total of 497 paralytic poliomyelitis
cases occurred in Puerto Rico during 1960. Of these, 433
or 89 percent had spinal paralysis with the remaining 11
percent having bulbar or bulbo-spinal involvement. The
epidemic began late in January and reached a peak during
the week ending June 11. The first case resided in the
Ponce area and later cases occurred throughout the island
with 68 of 76 municipalities having at least one case.
The cases are shown in the following table by age and
vaccination status.



Paralytic Poliomyelitis by Age and Vaccination Status
Puerto Rico, 1960 Preliminary Data


Age
<1
1
2
3
4
5-9
10-14
15+
Total
%*


Vaccination Status
0 1 2 3 4+ Unk Total


85
110
71
56
39
38
3
4
406
83.2


7
4
2
10
1
4
0
0
28
5.7


25 28
5.1 5.7


0
0
1
0
0
0
0
0
1
.0.2


%*

20.3
24.3
16.5
15.5
9.5
11.6
0.8
1.4


9 497 100.0
100.0


* Specified cases



It is evident that the epidemic involved predominantly
unvaccinated preschool children; 86 percent of the cases
were under 5 years of age. Only 6 percent of the cases
received three or more doses of vaccine while 83 percent
had not had one dose.
(Submitted by Dr. Manuel Feliberri, Epidemiologist,
Puerto Rico Department of Health)
(Continued on page 8)








Morbidity and Mortality Weekly Report 3

Table 2. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES, EACH DIVISION AND STATE, AND
PUERTO RICO, FOR WEEKS ENDED JANUARY 30, 1960 AND JANUARY 28, 1961

(By place of occurrence. Numbers under diseases are category numbers of the Seventh Revision of the International Lists, 1955)

Follomyelitls 080 Brucel-
Menin- loss
Total Paralytic 080.0,080.1 gitis, (undu-
(Includes cases not specified by type) Nonparalytic aseptic lant

ea Cumulative, Cumulative, fever)
4th Week first 4 weeks 4th Week first 4 weeks 080.2 340 pt. 044


1961 1960 1961 1960 1961 1960 1961 1960 1961 1960 1961 1961

TD STATES---------- 8 36 47 108 5 23 27 78 2 10 26 7

NEW ENGLD--------------- 5 5 1 -
Maine ---------------------- 1 1 1 -
New Baspshire----------- -
Vermont------------------- -- -
Massachusetts------------ 4 4 -
Rhode Island------------- -
Connecticut-------------- -
MIDDIE ATANTIC---------- 1 4 5 18 3 4 12 1 2 -
New York------------------- 1 4 1 17 3 11 1 1 -
New Jersey---------------- 1 -
Pennsylvania-------------- 4 4 1 -
EAST NORTH ENTRA----------- 1 2 8 11 1 6 2 3 1
Ohio----------------------- 1 2 4 10 1 3 2 1 -
Indlana-------------------- -
Illinois------------------ 2 2 2 -
Michigan--------------- -
Wisconsin----------------- 2 1 1 1
WEST NORT CENTRAL -------- 2 2 3 2 1 3 6
Minnesota---------------- 2 1 3 2 1 3 -
Iowa ---------------------- 6
Missouri------------------ -
North Dakota--------------- -
South Dakota--------------- 1 -
Nebraska------------------- -
Kansas------------------- -- -
SOUTH ATIANTIC---------- 1 14 4 29 1 8 3 23 6 1 -
Delaware------------------ I 1 -
Maryland------------------- -
District of Columbia----- -
Virginia-- ---------------- 1 -
West Virginia-------------- 2 2 -
North Carolina------------- 1 1 11 1 1 11 -
South Carolina------------ 1 1 -
Georgia------------------ 1 1 -
Florida-------------------- 1 12 2 14 1 6 1 8 6 -
EAST SOUT CENTRAL-- ----- 1 5 2 1 .- 1 3 -
Kentucky------------------ -1 5 2 1 1 -
Tennessee----------------- ..
Alabanma------------------- .
Mississippi------.-------- 3
WEST SOUTH CENTRAL-------- --- 4 5 5 3 2 4 1 2 -
Arkansas------------------- 2 -
Louisiana----------------- 1 3 2 1 2 2 -
Oklahoma------------------- -
Texas--------------------- -3 3 2 2 1 2 -
MOUNTAIN------------------- 3 10 4 2 5 3 5 -
Montana------------------ 1 4 1 3 1 -
Idaho----------------- --- 1 2 -
Wyoming--------------------- -
Colorado------------------ 1 1 1 3 -
New Mexico----------------- 1 -
Arizona-------------------- 1 2 1 1 -
Utah---------------------- 4 2 -
Nevada-------------------- -
PACIFIC---------------------- 2 9 8 31 1 7 6 25 1 2 9 -
Washington-------------- 1 1 -
Oregon-------------------- 1 7 3 1 1 -
California------------- 2 8 8 22 1 7 6 20 1 1 8 -
Alaska--- ---------- ------ .
Hawaii-------------------- 1 1 -

Puerto Rico----------------- 2 -- -









4 Morbidity and Mortality Weekly Report

Table 2. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES, EACH DIVISION AND STATE, AND
PUERTO RICO, FOR WEEKS ENDED JANUARY 30, 1960 AND JANUARY 28, 1961 Continued

(iy place of occurrence. Numbers under diseases are category numbers of the Seventh Revision of the International Lists, 1955)


Diphtheria 055 Hepatitis, infectious, and
Encephalitis, erum 092,N998.5 pt.
infectious Measl
Area Cumulative, Cumulative,
4th Week first 4 weeks 082 4th Week first 4 weeks 085

1961 1960 1961 1960 1961 1960 1961 1960 1961 1960 1961 1960


UNITED STATES------ 22 24 94 91 22 32 1,856 711 6,154 2,837 9,403 8,825

NEW ENGLAND--------------. 1 1 1 61 37 206 110 476 635
Maine----------------- 1 8 12 11 18 106
New Hampshire------------ -- 2 6 15 2
Vermont----------------- 19 1 64 4 1
Massachusetts------------- 1 1 21 21 59 63 241 368
Rhode Island-------------- 1 5 2 15 16 140 4
Connecticut---------------- 13 5 50 16 62 154
MIDDIE ATIAMIC---------- 1 1 2 4 5 3 270 76 795 261 2,365 1,040
New York------------- 1 1 3 1 151 33 365 117 1,394* 868
New Jersey----------- 31 4 106 17 209 112
Pennsylvania-------------- 1 1 1 3 2 2 88 39 324 127 762 60
EAST NORTH CENTRAL------ 6 10 1 2 348 118 1,169 468 2,628 2,234
Ohio--------------------- 5 7 142 19 514 103 596 308
Indiana---------------- 1 42 12 123 58 149 219
Illinois----..-----.--.--.- 1 1 1 55 40 172 119 425 653
Michigan--------------- 1 1 1 99 36 335 147 346 612
Wisconsin------------------ 10 11 25 41 1,112 442
WEST NORTH CENTRAL-------- 1 3 5 8 1 2 156 70 574 243 344 236
Minnesota----------------- 2 2 37 14 114 30 2 112
Iowa--------------------- 1 1 1 22 12 94 53 84 46
Missouri------------------- 1 1 38 27 162 71 138 4
North Dakota--------------- 1 1 6 8 16 31 91 72
South Dakota------------ 2 2 2 17 4 37 22 1
Nebraska-------------- 1 16 2 54 17 29 1
Knsas------- 1 1 20 3 97 19 NN NN
SOTH ATLANTIC-------- 1 3 9 24 2 7 202 59 696 295 1,082 483
Delaware---------------- 3 4 21 13 76 8
Maryland------.----------- 14 6 80 34 40 79
District of Columbia---- 3 2 7 2 2 58
Virginia----------------- 1 2 5 1 34 10 91 76 315 155
West Virginia------------- 1 1 1 33 12 147 75 127 46
North Carolina------------- 1 1 1 5 55 5 139 15 351 69
South Carolina----- -- 10 14 2 93 6 56 4
Georgia----------------- 2 1 27 7 52 22 3
Florida----------------- 1 3 6 2 1 19 11 66 52 112 64
EAST SOUTH CXhRL------ 1 3 8 2 8 368 159 1,161 583 608 918
Kentucky--------------- 1 2 5 121 72 422 272 354 378
Tennessee-------- -- 1 1 2 170 47 500 186 207 500
Alabama---------------- 6 2 49 30 181 98 45 32
Mississippi------------- 1 1 28 10 58 27 2 8
WEST SOUTH CETRAL------- 16 8 72 20 2 1 104 42 351 209 295 1,604
Arkansas----------------- 22 4 69 12 16 11
Louisiana--------------- 1 4 5 5 4 3 13 10 2
Oklahoma---------------- 1 2 3 10 5 37 30 1 51
Texas---------------- 15 3 65 12 2 1 68 30 232 157 278 1,540
MO ------------ 2 2 3 15 1 1 135 58 420 304 448 618
Montana---------------- 1 2 6 1 54 9 49 62
Idaho------------------- 2 11 8 18 35 45 166 240
Wyoming-- ----------- 3 5 2 12 5
Colorado------------------ 1 1 47 18 162 87 35 86
New Mexico------------- 16 5 31 63 -
Arizona-------------------- 10 7 41 59 141 54
Utah---------------------- 1 1 1 46 8 78 33 44 171
Nevada------------------- 2 1 14 6 1 -
PACIFIC------.------------- 1 1 7 7 212 92 782 364 1,157 1,057
Washington--------------- 18 9 76 33 184 367
Oregon------------------- 61 22 159 75 197 218
California--------------- 7 7 123 57 518 235 755 280
Alaska --------------- 1 1 9 2 18 14 16 6
Haaii---------------- 1 2 11 7 5 186

Puerto Rico--- -------- 11 4 2 10 42 32 38
*Shul hav rea 94 1o 1ee enin 1aur 21 1NO NOLt


NH-Nat Norlflable


*Should have read 942 for week ending January 21.









Morbidity and Mortality Weekly Report 5


Table 2. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES, EACH DIVISION AND STATE, AND
PUERTO RICO, FOR WEEKS ENDED JANUARY 30, 1960 AND JANUARY 28, 1961 Continued

(By place of occurrence. Numbers under diseases are category numbers of the Seventh Revision of the International Lists, 1955)

Strepto-
ccningoccocal cal Typhoid fever 040 Typhus
Meningoccocal Psitta-
Malaria infections cos8s sore fever, Rabies in
throat, endemic i
Area etc. Cumulative,
110-117 057 096.2 050,051 4th Week first 4 weeks 101

1961 1961 1960 1961 1961 1961 1960 19 1 i9?'. 19ci 19Ei 19e6

u ED STATES---------- 52 51 1 9,699 11 9 30 31 1 55 73

HEW ENGLAND---------------- I 1 6 476 1 1 -
Maine---------------------- 3 14 -
New Hampshire------------- 5 -
Vermont------------- -- 30 -
Massachusetts-------------- 2 159 1 1 -
ode Island--------------- 22 -
Connecticut---------- ---- I 1 246 -
MIDDIE ATLATIC------------ 7 6 714 1 3 2 1 4
New York------------------- 2 2 414 1 1 3
New Jersey--------------- 1 105 -
Pennsylvania--------------- 5 3 195 1 2 2 1
EAST N0R I CNRAL ----------- 12 5 1,199 1 4 2 9 3
Ohio----------------------- -- 1 2 352 2 2 -
Indiana--------------- 2 182 1 4 1
Illinois------------------- 1 3 143 3 1
Michigan------------------ 7 338 1 1 1 1
Wisconsin------------------ 1 184 1 -
WEST ORTH CETRAL----------- 5 357 3 2 5 8 16
Minnesota----------------- 13 1 5
Iowa------------------- -- 63 3 4
Missouri------------------- 2 24 3 2 5 2 5
North Dakota------ ---- 103 2 1
South Dakota-------------- 1 1 -
Nebraka---------------- 1
Kansas-------------------- 2 153 -
SOUTH ATLANTIC--------------- 9 8 636 2 2 5 4 1 12 12
Delaware-------------------- 4 -
Maryland------------------ 1 21 -
District of Columbia------- -- 1 1 5 -
Virginia----------------- 162 1 1 6 7
West Virginia------------- 1 237 1 1 1 2
North Carolina------------- 5 4 31 1 1 3 1 3
South Carolina------------ 13 1 1 -
Georgia------------------- 10 1 -- -
Florida-------------------- 3 153 1 5 -
EAS OUTH CTRAL--------- 1 10 1,805 2 3 4 9 5 7
Kentuck------------- 4 484 2 1 3 2 1
Tennessee ----------------- 1 1 1,260 1 1 4 3 5
Alabama---------------- 2 32 1 1 2 2 -
Mississippi---------------- 3 29 1
WBST S1TH CENTRAL ----- -- 9 3 1,240 2 3 17 27
Arkansas----------------- 9 1 3 3
Louisiana--------------- 3 7 1
Oklahoma---------------- 15 1 -
exas---------------------- 6 3 1,209 1 2 13 24
MOUTAIN----------------- .- 2 1 2,101 2 6 3 -
Montana-------------------- 180 1 3 -
Idaho---------------------- 1 1 148 -
Wyoming------------------ 81 -
Colorado----------------. 1 524 3 -
Ne Mexico----------------- 475 1 1 -
Arizona ------------------ 217 -
Utah----------------------- -. 463 1 1 -
Nevada--------------------- 13 -
PACIFIC-------------------- -- 6 12 1 1,171 3 4 2 3 4
Washington----------------- 1 1 586 1 1 -
Oegon---------------------- 76 -
California---------------- -- 4 7 1 452 2 3 2 3 4
Alaska- 1 4 51 -- -
aii--------------- 6 -

Puerto Rico--------------- 2 5 2







Morbidity and Mortality Weekly Report


NUMBER OF DEATHS IN SELECTED CITIES


r i I T I i i I T I I I T I T I I I I T I I I T I T I I I T I I T I I I T I I I T I I I I 1


JUL AUG


SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
1960 1961


The chart shows the number of deaths reported for
117 major cities of the United States by week for the cur-
rent year, a 5-week moving average of these figures
plotted at the central week, and an adjusted average for
comparison. For each region the adjusted average was
computed as follows: From the total deaths reported each
week for the years 1956-1960, 3 central figures were
selected by eliminating the highest and lowest figure
reported for that week. A 5-week moving average of the
arithmetic mean of the 3 central figures was then com-
puted with adjustment to allow for population growth in
each region. The average value of the regional increases
was 2 percent which was incorporated in the adjusted
average shown in the chart.
Table 4 shows the number of death certificates re-


ceived during the week indicated for deaths that occurred
in selected cities. Figures compiled in this way, by week
of receipt, usually approximate closely the number of
deaths occurring during the week. However, differences
are to be expected because of variations in the interval
between death and receipt of the certificate and because
of incomplete reporting due to holidays or vacations. If a
report is not received from a city in time to be included
in the total for the current week, an estimate is used.
The number of deaths in cities of the same size may
also differ because of variations in the age, race, and sex
composition of the populations and because some cities
are hospitalcenters serving the surrounding areas. Changes
from year to year in the number of deaths may be due in
part to population increases or decreases.


Table 3. DEATHS IN SELECTED CITIES BY GEOQAPHIC DIVISIONS


(By place of occurrence and veekof filing certificate. Excludes fetal deaths. Data exclude figures shownin ijarenthesee in table 4)

4th 3rd Percent Cumulative, first 4 weeks
week week Adjusted change,
ended ended averages adjusted
Area Jan. Jan. 4th average
28, 21, to 1961 1960
1961 1961 1956-60 current change
1961 1961eic __________
veek

TOTAL, 117 REPORING CITIES--------------------- 12,304 12,009 12,403 -0.8 49,933 52,870 -5.6

New England------------------------------(1 cities) 806 717 743 +8.5 3,083 3,269 -5.7
Middle Atlantic---------------------------(20 cities) 3,403 3,400 3,392 +0.3 14,025 14,203 -1.3
East North Central-------------------------(21 cities) 2,532 2,556 2,653 -4.6 10,487 11,819 -11.3
West North Central--------------------------(9 cities) 784 755 881 -11.0 3,267 3,527 -7.4
South Atlantic-----------------------------(11 cities) 1,126 1,058 1,071 +5.1 4,543 4,442 +2.3
Baet South Central---------------------------(8 cities) 575 480 571 +0.7 2,314 2,396 -3.4
West South Central.------------------------(13 cities) 1,180 1,039 1,134 +4.1 4,393 4,664 -5.8
Mountain------------------------..-------(8 cities) 368 423 382 -3.7 1,510 1,552 -2.7
Pacific-------- ---. ----------- ------- (13 cities) 1,530 1,581 1,576 -2.9 6,311 6,998 -9.8









Morbidity and Mortality Weekly Report


Table 4. DEATHS IN SELECTED CITIES

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


Area


NEW ENGLAND:
Boston, Mass.-----------
Bridgeport, Conn.--------
Cambridge, Mass.------
Pall 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, ll1.------------
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, Ws.------------
Milwaukee, Wis.----------
Peoria, Ill.-------------
Rockford, Il.------------
South Bend, nd.--------
Toledo, Ohio-------------
Youngstown, Ohio--------

WEST NORTB CEiTRAL:
Des Moines, Iowa---------
Duluth, Mnn.-------------
Kansas City, Kans.-------
Kansas City, Mo.---------
Lincoln, Nebr.-----------
Minneapolis, Minn.-------
Omaha, Nebr.-------------


4th
week
ended
Jan.
28,
1961


3rd
3rd Cumulative,
"ede first 4 weeks
ended


Jan.
21,
1961


1961


4. 4 4


284
45
31
21
61
27
17
32
62
67
12
49
30
68


54
37
152
42
33
39
60
113
1,829
41
523
135
27
107
20
32
58
33
33
35

74
28
740
162
235
126
75
329
49
35
40
39
51
150
25
119
32
34
29
111
49


60
25
41
106
(25)
137
82


256
50
23
26
55
19
17
25
44
54
9
59
30
50


38
33
144
38
31
32
80
92
1,666
36
595
222
27
116
25
52
56
36
33
48

61
40
776
155
214
101
85
347
32
44
42
35
46
140
39
114
25
33
37
117
73


54
30
37
134
(21)
130
59


1,077
184
122
100
203
97
91
126
198
264
48
214
118
241


226
148
616
163
119
165
316
440
7,107
164
2,181
828
96
460
101
160
252
186
145
152

256
125
3,139
700
914
492
358
1,412
141
176
172
131
186
619
124
527
127
112
122
423
231


203
117
170
553
(134)
518
274


196'


1,078
175
153
126
200
104
1ll
146
217
290
70
229
118
252


175
138
691
198
96
166
354
463
6,938
186
2,145
1,044
112
518
103
174
276
157
131
138

230
182
3,762
736
999
596
320
1,650
157
174
173
136
195
611
148
600
120
133
143
511
243


220
123
163
516
(119)
528
319


() Figures shown in parenthesis are from cities which have
been reporting less than five years and hence are not in-
cluded in Table 3.


Area


4th
week
ended
Jan.
28,
1961


3rd
week
ended
Jan.
21,
1961


Cumulative,
first 4 weeks


1961 1960


I I


WEST NORH CENTAL--Con.:
St. Louis, Mo.-------
St. Paul, Minn.---------
Wichita, Kans.----------

SOUTH ATLANTIC:
Atlanta, Ga.------------
Baltimore, Ma.----------
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:
pirmingham, Ala.---------
Chattanooga, Tenn.----
Knoxvlle, enn.--------
Louisville, IK.------
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.---------
Oklahoa City, Okla.----
San Antonio, Tex.--------
Shreveport, La.----------
Tulsa, Okla.------------

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


224
68
41


135
256
30
71
91
56
87
37
(63)
84
223
56


75
68
21
156
117
51
41
46


43
37
31
155
42
72
179
60
206
103
118
81
53


29
15
126
16
77
17
48
40


15
(48)
(33)
45
67
510
124
30
113
50
113
230
(23)
148
41
44


San Juan, P. R.----------- (29)


233
46
32


138
270
41
63
53
52
83
36
(80)
70
208
44


84
32
30
120
88
29
31
66


43
34
20
117
45
66
206
67
159
98
122
22
40


39
12
135
17
93
16
62
49


22
(38)
(37)
49
75
640
97
29
63
65
86
240
(37)
133
39
43

(31)


970
269
193


532
1,084
155
314
306
204
384
168
(329)
328
881
187


397
227
124
495
492
181
155
243


154
156
113
536
170
252
779
242
726
362
447
222
234


131
72
476
59
352
61
196
163


71
(171)
(146)
186
264
2,306
455
121
414
267
374
923
(135)
561
187
182

(134)


1,131
327
200


508
1,115
171
267
348
222
351
168
(348)
271
827
194


384
227
138
503
473
198
165
308


172
137
128
529
201
271
763
285
778
348
560
213
279


145
77
529
69
328
55
228
121


82
(230)
(215)
172
263
2,705
451
188
452
301
493
935
(126)
574
193
189

(---)





31262Il0lllI 4ll l
3 1262 08864 0445


Morbidity and Mortality Weekly Report


Botulism Minnesota (Follow-up Report)

In September lo60 (Volume 9, Number 38) the Minnesota
Department of Health supplied preliminary information on
two fatal cases of botulism. Death followed within two
days after consumption of smoked fresh water fish mar-
keted in vacuum packed plastic bags. In a follow-up letter,
Dr. Karl R. Lundeberg, Commissioner of Health, Minne-
apolis, reports that the early impression, that the botuli-
nus toxin responsible for the two deaths was either type
A or B was erroneous. "Subsequent studies by Dr. C. E.
Dolman, University of Vancouver, Dr. G. M. Dack, Uni-
versity of Chicago, and the Pure Food and Drugs Labora-
tory, Washington, demonstrated that this outbreak was due
to botulinus toxin type E. Cl. botulinum, type E organ-
isms were isolated from the smoked fish by Dr. Dolman.
It is interesting to note that type E is reported to grow
and elaborate toxin at considerably lower temperatures
than the more common types, A and B. In these deaths,
the question of refrigeration assumed special importance
because it was claimed that refrigeration was contin-
uously maintained up to the time of consumption of the
fish even though the accident happened during a spell of
unusually hot weather." These two cases are thought
to represent the first report in the United States of botu-
lism due to :ype E toxin ascribed to fresh water fish.



INTERNATIONAL NOTES

Influenza Dr. Edward J. O'Rourke, Epidemiologic
Consultant, Europe.U.S. Public Health Service, American
Embassy, London, reports that influenza continues in
Great Britain where cases are widespread in the Midland
and Northwestern Regions and beginning to occur in
London. Many isolations of the A2 influenza virus strain
have been made. England and Wales report 358 influenza
deaths for the week ending January 21, 1961, which com-
pares with 32 deaths for the corresponding week in 1960.
Pneumonia and bronchitis deaths have remained above the
1960 levels for the past six weeks. Professor Patrick N.
Meenan, University College, Dublin, has reported that
influenza is widespread in Dublin and appears also, from
preliminary information, to be occurring in all parts that
country. Viruses isolated from patients in the Dadblin area
are of the A2 strain. There is no reported influenza :o
the European Continent.

The WHO Weekly Epidemiological Record, Number 4,
January 27, 1961 mentions a small outbreak of virus B
influenza which occurred in December 1960, in a class of
a primary school in Tokyo, Japan. An associated press
release dated January 27, Tokyo, indicates that influenza
outbreaks in that city have resulted in widespread closing
of schools.


QUARANTINE MEASURES

Immunization Information for International Travel

No Changes Reported


SOURCE AND NATURE OF MORBIDITY DATA

These provisional data are based on reports to the
Public Health Service from the health departments of
each State and Puerto Rico. They give the total number
of cases of certain communicable diseases reported
during the week usually ended the preceding Saturday.
Total figures for the United States and the Pacific Divi-
sion include data for the States of Alaska and Hawaii.
Cases of anthrax, botulism, and rabies in man are not
shown in table 2, but a footnote to table 1 shows the
States reporting these diseases. When diseases of rare
occurrence are reported by a State (cholera, dengue,
plague, louse-borne relapsing fever, smallpox, louse-
borne epidemic typhus, and yellow fever) this is noted
below table 1.


ID OF F


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U S DEPOSITORY


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