Morbidity and mortality

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Vol. 15, No. 10


WE r IV',

REPOki

Week Ending
March 12, 1966


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


STAPHYLOCOCCAL FOOD POISONING CHICAGO


On January 1, 1966, an outbreak of food poisoning
occurred at a bowling alley in Chicago following a New
Year's Eve party. The buffet menu planned consisted of
ham, turkey, deviled eggs, salami, bread and the macaroni
and potato salads. Two to 4 hours after eating food at
this party, 37 persons developed nausea, vomiting and
diarrhea of a severity requiring medical attention. They
were taken to nearby southside hospitals where seven
persons were admitted for treatment; the other 30 were
treated as outpatients and allowed to go home. Various
foods served at the party were cultured and yielded
coagulase positive staphylococci.


C. Ni
Staphylococcal Food PoiscrrL'
Current Trends
Influenza United States ..
Influenza International .
Meningococcal Infection I r
Hepatitis United States .


Epidemiological investigation revealed that the
management of the bowling alley had contracted with the
operator of a small lunch counter to prepare the food for
a New Year's Eve party. Since the premises of the lunch
counter were inadequate for the preparation of the amount
of food required, the operator requested that the two
(Continued on page 82)


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
10th WEEK ENDED CUMULATIVE, FIRST 10 WEEKS
MEDIAN
DISEASE MARCH 12, MARCH 13, 1961-1965 MEDIAN
1966 1965 1966 1965 1961-1965
Aseptic meningitis ...................... .25 25 19 281 274 229
Brucellosis ........................... 4 1 5 35 33 59
Diphtheria. .............. ......... .. 2 11 8 27 42 63
Encephalitis, primary:
Arthropod-borne & unspecified ........... 18 37 221 299 -
Encephalitis, post-infectious ......... 20 12 158 127 -
Hepatitis, serum ............. .. ..... 36 222
Hepatitis, infectious ................709 822 1,026 716 7866 11104
Measles rubeolaa) ....................... 8,897 12,148 14,223 65.866 83.059 100,813
Poliomyelitis, Total (including unspecified) 2 2 2 32
Paralytic ............ ........... ... 2 1 2 28
Nonparalytic ..................... -
Meningococcal infections. Total .......... 118 10f 49 943 808 563
Civilian ............................... 106 96 801 748 -
Military.............................. 12 10 142 60 -
Rubella (German measles) ................ 1.727 -- -- 11,469 ---
Streptococcal sore throat & Scarlet fever .. 14,662 12.830 10,935 111.969 111,121 97,782
Tetanus........... ...... .. ...... .... 1 1 20 36 -
Tularemia ............... .... .. ... .. .2 7 --- 40 47 -
Typhoid fever ...................... 8 14 14 53 75 75
Typhus, tick-borne (Rky. Mt. Spotted fever). 1 8 6 -
Rabies in Animals ....................... 84 112 83 728 985 668

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: .... ...... .............................. 1 Botulism: ...... .. .... ........ ........ 1
Leptospirosis: ... .............................. 8 Trichinosis: N.Y. Up-State-1 ...................... 19
Malaria:lI1.-1, Va.-I, Ga.-2. ......................... 51 Rabies in Man:.............................. -
Psittacosis: Pa.-I, Tex.-l ........................... 13 Rubella, Congenital Syndrome: ........................ 7
Typhus, murine:Calif.-l ................... ........... 2 ....................


Vs X















relatives who live in his home help with the preparation.
He ordered the macaroni and potato salads from a licensed
caterer and purchased the salami from a commercial
wholesale dealer. A thorough epidemiological investigation
of all places in which the food was prepared was con-
ducted by the Chicago Board of Health.
Most of the food was prepared by the two relatives in
the home where they live with the lunch counter operator.
Four small turkeys and a 10-pound ham were purchased
on December 29 and refrigerated in the home. On the
following evening one relative took the turkeys and the
ham to another establishment for cooking only. The
turkeys were baked for 2% hours at 3500F and the ham for
1% hours at 3000F; they were then taken back to the
home while still warm. Boiled eggs were prepared in the
home on December 30 and placed in a refrigerator after
cooling; the salads and the salami were delivered that
evening and also placed in a refrigerator. The following
day the deviled eggs were prepared in the home between
2 p.m. and 5:30 p.m. and then refrigerated. Investigation
revealed that the refrigeration in the operator's home was
inadequate for the amount of food stored for the party.
At 10 p.m. on December 31, all the food was taken in


FEBRUARY 12, 1966


a private automobile to the bowling alley. The meat was
sliced at the lunch counter and the food was arranged in
buffet style some 2 hours before serving at 12:30 a.m. on
New Year's Day. The buffet meal lasted until 2:30 a.m.;
the common foods eaten were turkey, ham and deviled
eggs. In general, the major part of the food had been
unrefrigerated for 4 to 5 hours prior to being served.
Coagulase positive staphylococci of the phage type
47, 53, 83 and UC-18 were isolated in the Municipal
Contagious Disease Laboratory from specimens of ham,
turkey, macaroni salad, deviled eggs and bread. In addi-
tion, laboratory examinations of the specimens from the
three food handlers who lived together all yielded coag-
ulase positive staphylococci phage type 47, 53, 83 and
UC-18. Swabs taken from knives, forks, a hand-chopper
and a metal food container, which were used both in the
home of the lunch counter operator and at the lunch
counter in the bowling alley, likewise yielded coagulase
positive staphylococci of the same phage type.
Reported by Dr. Samuel Andelman, Commissioner of
Health, Dr. Morgan J. O'Connell, Assistant Commissioner
of Health, Mr. Edward F. King, Chief Sanitary Officer,
City of Chicago Board of Health, Illinois.)


CURRENT TRENDS
INFLUENZA UNITED STATES


Type B influenza virus activity is widely recognized,
particularly in the eastern part of the country, while type
A virus has been predominantly identified in the far west
(Table 1). Of interest are recent reports of serological
evidence of both types A and B influenza in Washington
and Oregon, attesting to wide distribution of the two
virus types in the present season. (Similar observations
have been made in other parts of the world, as sum-
marized in Table 2, International Influenza Summary on
page 92).
Eighteen States and the District of Columbia have
now identified the presence of type B influenza outbreaks
either by virus isolation or serological procedures, and
four States have demonstrated type A influenza (two of
them, Washington and Oregon, are also included in the
former tally). Three type A2 influenza strains and two
type B viruses have been recovered in five States from
sporadic cases not associated with outbreaks. Influenza-
like illnesses are under investigation in six additional
States.




(Reported by the Influenza-Respiratory Disease Unit,
CDC.)


Arizona
Increasing evidence of influenza-like illness was
first noted in the greater Phoenix area during the second
week of February. In the subsequent 3 weeks, involvement
of all surrounding counties was apparent. Practicing
physicians have generally reported that a considerable
number of adults as well as children have been affected.
However, this observation has not been reflected in
industrial absenteeism, which has remained normal. On the
other hand, school absenteeism in 6 of Arizona's 14
counties has significantly increased in recent weeks,
with many high schools in the affected areas reporting
absenteeism of up to 20 percent. Laboratory investigations
are underway.
(Reported by Dr. Philip M. Hotchkiss, Acting Director,
Preventive Disease Control, Arizona State Department
of Health.)

Idaho
Serological evidence of type A influenza has been
demonstrated in a representative case occurring as part
of the outbreak in Twin Falls County (MMWR, Vol. 15,
No. 8).
(Reported by Dr. A.W. Klots, Director, Division of Lab-
oratories, Idaho Department of Health.)


Morbidity and Mortality Weekly Report



STAPHYLOCOCCAL FOOD POISONING CHICAGO
(Continued from front page)












Table 1
UNITED STATES INFLUENZA SUMMARY
1965-66 (Winter)


State lFirst
State
Recognized
Lab. Confirmed Outbreaks
Florida Nov. 1965
Georgia Dec. 1965
Alabama Jan. 1966
California Jan. 1966
Connecticut Jan. 1966
Massachusetts Jan. 1966
Rhode Island Jan. 1966
Vermont Jan. 1966
Alaska Feb. 1966
Dist. of Col. Feb. 1966
Idaho Feb. 1966
Maine Feb. 1966
Michigan Feb. 1966
New Jersey Feb. 1966
New York Feb. 1966
N. Carolina Feb. 1966
Ohio Feb. 1966
Oregon Feb. 1966
Texas Feb. 1966
Virginia Feb. 1966
Washington Feb. 1966
Influenza Virus Identifications
(non-outbreak)
Illinois Jan. 1966
Iowa Feb. 1966
Kansas Feb. 1966
Maryland Feb. 1966
Michigan Feb. 1966
Iril ,l.nrz i-lik,' lip .- -e
Arizona Feb. 1966
Nevada Feb. 1966
New Hampshire Feb. 1966
West Virginia Feb. 1966
Montana Mar. 1966
Nebraska Mar. 1966


Laboratory Confirmation
Isolation Serology


B
B
B
A
B
B
B
B



A





B
B
A, B
B

A, B




A


. Information not available.
(Compiled from reports submitted by State Health Depart-
ments and collaborative laboratories to the Influenza-
Respiratory Disease Unit, CDC and the WHO International
Influenza Center for the Americas, CDC.)


Illinois
Since late January, four strains of type B influenza
virus have been recovered from isolated cases in northern
Illinois at the University of Chicago (two strains), North-
western University (one strain), and the Great Lakes
Naval Training Slration (on,- strain). None of tht patients
in whom influenza was identified is reported to have
been part of a confirmed outbreak. The Great Lakes Naval
Training Station isolate was made in a naval recruit who


recently returned from Florida where type B influenza had
previously been identified.
(Reported by Dr. Norman J. Rose, Chief, Bureau of
Epidemiology, Illinois Department of Public Health.)

Iowa
Type A2 influenza virus was recovered from a student
at the University of Iowa who was ill during late February.
Additional cases of type A influenza among other students
who were ill at the same time were identified by sero-
logical tests. However, there has not been evidence of
outbreaks of similar disease occurring in other parts of
the State.
(Reported by Dr. Albert P. McKee, Professor of Micro-
biology, University of Iowa College of Medicine, Iowa
City; and Dr. Ralph H. Heeren, Deputy Commissioner of
Public Health and Director, Preventable Diseases, Iowa
State Department of Health.)

Michigan
Beginning in late February a localized outbreak of
influenza, confirmed as type B by virus isolation, was
observed in rural Alto (Kent County). The illness was
clinically mild, occurring primarily in children.
In Ann Arbor, influenza-like illness resulted in
increased absenteeism in a high school during late
February and early March. Laboratory investigations are
pending. Involvement of the adult population in Ann Arbor
has not been observed.
An isolated case of influenza with recovery of type
A2 influenza virus was observed in a University of
Michigan graduate student. This student had no history
of recent exposure outside the city of Ann Arbor.
(Reported by Dr. George H. Agate, Director, Division of
Epidemiology, Department of Health; and Dr. Fred M.
Davenport, Professor of Epidemiology, University of
Michigan.)

Nevada
Increasing school absenteeism associated with
influenza-like illness was noted in the Reno area during
the third week in February. Although there have been
subsequent reports from scattered counties elsewhere in
the State, particularly from the Las Vegas area, the
prevalence of the disease now appears to be declining.
(Reported by Dr. B.A. Winne, Chief Preventive Medical
Services, Nevada Department of Health and Welfare.)

New York
Outbreaks of primarily school-centered febrile res-
piratory disease have been recognized in the greater
Albany area since the end of January.
Two strains of type B influenza have been isolated
from cases in the three counties of central upstate New
York. By the second week in March, three additional
rural counties in the southwestern part of the State had
(Continued on page 85)


FEBRUARY 12, 1966


Morbidity and Mortality Weekly Report








Morbidity and Mortality Weekly Report





Figure 1
PNEUMONIA-INFLUENZA DEATHS IN 122 UNITED STATES CITIES


FEBRUARY 12, 1966


ALL
CITIES


EPIDEMIC THRESHOLD-------
EXPECTED NUMBER -


1200-

1100-

1000-

900-

800-
TO-
700-

600-

500-

400-

300-


WEEK N(
WK ENOEI
MONTI


W N.
CENTRAL
10 CITIES


50- -- 100-

25- 50-


WK NO 40 44 48 52 4 8 12 16 20 24 28 32
196511966


25.



WK NO 40 44 48 52 4 8 12 16 20 24 28 32
196511966
z00
PACIFIC
16 CITIES 150
ISO-
1501


100
100



50, .50


EN. 125.
CENTRAL
21 CITIES 100-






25

40 44 48 524 8 12 16 20 24 28 32
1965 1966


E.S
CENTRAL
8 CITIES


200-

150-


i S0-



40 44 48 52 4 8 12 16 20 24 28 32
196511966


W.S.
CENTRAL
13 CITIES


100-



. 40 0lll


NEW
ENGLAND
14 CITIES









40 44 48 52 4 8 12 16 20 24 28 32 36
196511966


MIDDLE
ATLANTIC
20 CITIES










.... ... .I..nie1 ei d.Il. nind..al1ninal1ni
40 44 48 52 4 8 12 16 20 24 28 32 36
1965 1966

SOUTH
ATLANTIC
12 CITIES










is i sth l lll ll l l al i slllll ll l llsl h h I


WK NO 40 44 48 52 4 8 12 16 20 24 28 32 40 44 48 52 4 12 16 20 24 28 32 40 44 48 52 4 8 12 16 20 24 28 32 36
196511966 1965 1966 1965 1966


40 44 48 52 4 8 12 6 20 24 28 32 36 40 44 48 53 4 8 12 16 20 24 28 32 36 40 44 48 52 4 8 12 16 20 24 28 32 36
5 2 30 28 25 22 21 18 16 13 II 8 5 3 31 28 2 30 27 27 24 22 19 17 14 II 9 6 4 1 29 26 26 23 21 18 16 13 10
0 N D J F M A M J J A S 0 ND J F M A M J J A S O N 0 J FM A M J J A S
1963 1964 196411965 196511966


MOUNTAIN
8 CITIES


...an esse us ..






FEBRUARY 12, 1966


Morbidity and Mortality Weekly Report


CURRENT TRENDS
INFLUENZA UNITED STATES
(Continued from page 83)


reported school absenteeism of 10-15 percent attributed
to similar respiratory illness.
(Reported by Dr. Julia Freitag, Epidemiologist, New York
State Department of Health.)

Oregon
Beginning in late February, increasing school absen-
teeism attributed to influenza-like disease was recognized
in Jackson and Klamath Counties in the southern part of
the State. Similar illnesses have since appeared in other
areas, recently in counties surrounding Portland where
school absentee rates up to 20 percent were reported
during the second week in March. Junior and senior high
schools have generally been affected more than the ele-
mentary grades, and in some schools, many teachers as
well as students have been involved. Survey of selected
industries in the State has not demonstrated comparably
elevated absenteeism.
Serological identifications of type A influenza infec-
tion have been reported in Curry, Jackson and Benton
Counties. Type B influenza virus was recovered from a
representative case in an outbreak in Marion County dur-
ing late February and type B infection was serologically
demonstrated in Benton County. The recent serological
demonstrations of type A and of type B influenza infec-
tions in Benton County are of interest in that they occurred


respectively in two students currently attending the Oregon
State University in Corvallis.
(Reported by Dr. Gordon C. Edwards, Director, Division
of Preventive Medical Services, Oregon State Board of
Health.)

Pennsylvania
Influenza-like illness was first recognized in the
State during the last week in February when six school
districts in southern Allegheny County experienced
abrupt increases of daily absenteeism up to 30 percent.
The responsible illness was characterized by fever, sore
throat, cough and a considerable degree ofoccular myalgia.
Approximately 10 percent of affected individuals had
protracted illnesses of more than one week.
By the second week in March, school absenteeism
had returned to normal and no new cases were being
reported. The outbreaks had affected only one third of
the County.
Industrial absences in nearby greater Pittsburg have
not shown an increase over the expected seasonal norm,
and pneumonia-influenza mortality rates for the area
remain below the epidemic threshold. A statewide survey
indicates no evidence of an influenza-like disease else-
where in the State.
(Continued on page 92)


CURRENT TRENDS
MENINGOCOCCAL INFECTION United States


The weekly total of reported cases of meningococcal
infection in the United States for the first 10 weeks of
1966 is shown in Figure 2. The weekly incidence of
cases is expected to remain at these seasonal high levels
for several more weeks before declining during the spring
months.
The cumulative numbers of cases of meningococcal
infection reported in the U.S. during the first 10 weeks
of 1965 and 1966 are presented by geographic region in
Table 3. There has been an overall increase of 16.7
percent in the total number of cases reported to date this
year as compared to the same period in 1965. The increase
has been most marked in the East North Central and East
South Central regions. Military cases have been only a
minor factor in the East North Central region, but account
for almost one-third of all reported cases in the East
South Central region.
(Reportedby Inr:, -:,ga.',oq Section, Epidemiology Branch,
CDC.)


Table 3
Meningococcal Infection, U.S.
First 10 Weeks of 1965 and 1966

1966 1965
Total Military Total Military
United States: 943 142 808 60
New England 52 1 37 3
Middle Atlantic 104 15 123 6
East North Central 141 3 86 1
West North Central 50 10 43 12
South Atlantic 160 24 167 11
East South Central 84 27 47 5
West South Central 146 46 123 11
Mountain 32 2 35 3
Pacific 174 14 147 8


(Figure 2 on page 86)





Morbidity and Mortality Weekly Report



Figure 2
MENINGOCOCCAL INFECTIONS BY WEEK OF REPORT
1965, 1966 AND MEDIAN, 1961-65
UNITED STATES


CURRENT TRENDS HEPATITIS


A total of 22,883 cases of viral hepatitis was reported
during the first 36 weeks of Epidemiological Year 1965-
66*. This is 5.0 percent fewer cases than reported during
the corresponding period of the previous year. The present
downward trend appears to be continuing and it is likely
that the incidence in 1965-66 will be the lowest recorded
since the 1960-61 peak year of the present epidemic
cycle (Figure 4).
The seasonal distribution of cases in the United
States between July 1953 and June 1965 is shown in
Figure 3. It has been characterized by a gradual rise
extending from July through December, followed by a
relatively abrupt increase to the peak incidence in January.
The seasonal decline from March through the end of the
epidemiological year has been more rapid than was the
earlier increase. As represented in the bar graph for the
U.S., each 4-week period includes at least 5.9 percent of
all reported cases of hepatitis; the seasonal fluctuation
accounts for less than 23 percent of the total hepatitis
morbidity.
The seasonal pattern in the nine geographic regions
of the United States is presented in Figure 5. A seasonal


*Hepatitis morbidity data are summarized in terms of "Epide-
miological Year" which runs from the twenty-seventh week
of the current year to the twenty-sixth week of the succeeding
year.


variation has been most marked in the New England and
Mountain Regions. The Pacific Region, in contrast, has
showed relatively little fluctuation.

Figure 3
REPORTED CASES OF VIRAL HEPATITIS IN THE
UNITED STATES
AVERAGE DISTRIBUTION BY 4-WEEK PERIODS
JULY 1953 JUNE 1965




















W..k No 30 34 38 42 46 50 2 6 10 14 18 22 26
My Aug Ispt 0cI No- Doc -. I Fb Mr A *pr M, I Ju.-


FEBRUARY 12, 1966


JAN FEB MAR


i 6 '' l'' 6 SiP i''' 6' 66C
APR MAY JUN JUL AUG SEPT OCT NOV DEC
MONTH





FEBRUARY 12, 1966


Morbidity and Mortality Weekly Report


Figure 5
REPORTED CASES OF VIRAL HEPATITIS BY GEOGRAPHIC REGION OF THE UNITED STATES
AVERAGE DISTRIBUTION BY 4-WEEK PERIODS
JULY 1953 JUNE 1965


0
O0
z5
0




0
0

0
I-
0


EAST
SOUTH
CENTRAL


--r


s J A S o J F A J A M NSO N J FM A IJ 1 1 iI AS 0 N FM AM)


1







88 Morbidity and Mortality Weekly Report



CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MARCH 12, 1966 AND MARCH 13, 1965 (10th WEEK)


ENCEPHALITIS HEPATITIS
ASEPTIC Primary Post- Both
AREA MENINGITIS BRUCELLOSIS including Infectious DIPHTHERIA Serum Infectious Types
unsp. cases
1966 I 1965 1966 1966 1965 1966 1966 1965 1966 1966 1965


UNITED STATES... 25 25 4 18 37 20 2 11 36 709 822

NEW ENGIAND.......... 1 1 1 23 53
Maine............... 1 3 14
New Hampshire...... 4 3
Vermont............. 3 2
Massachusetts...... 1 10 20
Rhode Island....... -- 2
Connecticut........ 1 3 12

MIDDLE ATLANTIC...... 6 3 5 13 2 20 83 145
New York City...... 2 3 2 11 24 33
New York, Up-State. 50
New Jersey.......... 2 2 2 11 9 24 19
Pennsylvania....... 2 1 2 35 43

EAST NORTH CENTRAL... 2 3 2 2 6 4 1 166 177
Ohio................ 2 1 45 39
Indiana............ 3 12 16
Illinois........... 1 3 2 1 3 22 44
Michigan............ 1 1 1 1 80 67
Wisconsin.......... 7 11

WEST NORTH CENTRAL... 2 1 1 1 37 61
Minnesota.......... 2 1 1 9 5
Iowa............... 10 16
Missouri........... 1 13 19
North Dakota....... 4
South Dakota....... -
Nebraska............. 1 1
Kansas............. 15

SOUTH ATLANTIC....... 3 3 1 2 5 1 2 93 76
Delaware............ I 5
Maryland............ 1 1 23 9
Dist. of Columbia.. 1 -
Virginia............ 1 1 23 28
West Virginia...... 11 10
North Carolina..... 1 1 8 4
South Carolina..... 1 4 2
Georgia............ 3 3
Florida............ 2 2 1 3 1 20 15

EAST SOUTH CENTRAL... 1 2 4 1 79 71
Kentucky............ 2 32 31
Tennessee......... 1 28 24
Alabama............ 1 14 4
Mississippi........ 4 5 12

WEST SOUTH CENTRAL... 6 3 1 1 3 4 2 10 3 58 59
Arkansas........... 1 9 6
Louisiana.......... 1 1 7 16
Oklahoma............ 1 -
Texas............... 5 3 1 3 4 1 9 2 42 37

MOUNTAIN............. 1 2 1 37 62
Montana............. -
Idaho.............. 4 5
Wyoming............. 1
Colorado........... 1 14 11
New Mexico......... 1 9 14
Arizona............ 1 7 15
Utah............... 2 17
Nevada.............. 1 -

PACIFIC.............. 4 9 5 4 8 9 133 118
Washington......... 3 1 10 7
Oregon.............. 2 I 5 14
California......... 4 7 5 3 5 8 106 83
Alaska............. 11 13
Hawaii............. 1 1


Puerto Rico .......... 1 2 26 18


I









Morbidity and Mortality Weekly Report 89


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MARCH 12, 1966 AND MARCH 13, 1965 (10th WEEK) Continued


MENINGOCOCCAL INFECTIONS, POLIOMYELITIS
MEASLES (Rubeola) TOTAL Totl P c RUBELLA
Total Paralytic
Cumulative Cumulative Cumulative
1966 1966 1966 1965 1966 1966
1966 966 1965 1966 966 1965 961966 19651966 1966

UNITED STATES... 8,897 65,866 83,059 118 943 808 1 1,727

NEW ENGLAND........... 102 822 18,345 7 52 37 143
Maine............... 12 106 1,683 2 5 6 12
New Hampshire...... 2 11 274 7 1 14
Vermont.......... 8 161 181 1 3
Massachusetts...... 16 308 10,445 2 21 16 26
Rhode Island....... 11 47 2,150 1 3 5 4
Connecticut........ 53 189 3,612 2 15 9 84

MIDDLE ATLANTIC...... 1,138 9,178 3,076 7 104 123 88
New York City...... 537 4,555 309 2 18 18 48
New York, Up-State. 165 955 1,082 3 22 30 37
New Jersey.......... 178 971 549 1 35 42 -
Pennsylvania....... 258 2,697 1,136 1 29 33 3

EAST NORTH CENTRAL... 3,236 26,660 14,335 17 141 86 584
Ohio............... 211 1,691 3,012 3 36 24 41
Indiana............ 164 1,776 653 2 18 9 87
Illinois........... 786 5,807 466 4 32 18 141
Michigan............ 485 3,946 7,540 7 42 19 128
Wisconsin .......... 1,590 13,440 2,664 1 13 16 187

WEST NORTH CENTRAL... 432 2,792 6,541 4 50 43 43
Minnesota.......... 48 849 174 1 10 10 3
Iowa................ 220 1,160 3,626 1 10 1 39
Missouri .......... 41 180 844 2 18 23 -
North Dakota........ 123 566 1,717 3 3 1
South Dakota...... 2 51 1 2
Nebraska........... 35 129 2 -
Kansas............. NN NN NN 6 4

SOUTH ATLANTIC....... 587 5,005 11,156 16 160 167 225
Delaware........... 11 68 208 3 2
Maryland............ 102 901 379 17 12 5
Dist. of Columbia.. 20 255 12 2 2 3 -
Virginia.......... 26 381 1,589 1 17 20 62
West Virginia...... 220 2,091 7,551 2 7 12 96
North Carolina..... 5 56 140 6 36 28 -
South Carolina..... 40 252 208 25 22 18
Georgia............ 32 125 309 3 24 27 -
Florida ............ 131 876 760 2 32 40 42

EAST SOUTH CENTRAL... 977 7,815 4,473 8 84 47 143
Kentucky........... 141 2,724 377 3 46 19 71
Tennessee.......... 578 4,267 2,798 3 21 15 65
Alabama............ 143 566 973 1 13 9 7
Mississippi......... 115 258 325 1 4 4 -

WEST SOUTH CENTRAL... 1,060 5,598 10,613 19 146 123 1 2
Arkansas........... 102 648 2 9 8 -
Louisiana.......... 7 47 23 4 50 56 -
Oklahoma............ 44 102 65 1 5 13 1
Texas............... 1,009 5,347 9,877 12 82 46 2

MOUNTAIN............. 621 3,204 6,693 32 35 207
Montana............. 107 515 1,962 2 9
Idaho............... 88 432 1,026 1 4 12
Wyoming............ 1 46 178 1 2 -
Colorado............ 90 323 1,083 19 8 19
New Mexico......... 13 77 185 4 4 -
Arizona............ 312 1,705 217 4 11 161
Utah............... 7 99 1,990 4 6
Nevada............. 3 7 52 1 2

PACIFIC............... 744 4,792 7,827 40 174 147 292
Washington......... 124 1,198 2,429 1 10 7 112
Oregon.............. 85 405 1,233 1 6 12 42
California......... 523 3,137 3,372 38 148 126 133
Alaska.............. 8 18 69 8 1 3
Hawaii............. 4 34 724 1 -
Puerto Rico.......... 168 757 397 1 1 3 2









90 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MARCH 12, 1966 AND MARCH 13, 1965 (10th 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... 14,662 1 20 2 40 8 53 1 8 84 728

NEW ENGLAND.......... 1,704 2 1 2 1 6
Maine.............. 94
New Hampshire...... 18 1 2
Vermont............ 56 4
Massachusetts...... 401 2 1
Rhode Island....... 121 -
Connecticut........ 1,014 -

MIDDLE ATLANTIC...... 776 1 4 12 1 4 59
New York City...... 32 3 5
New York, Up-State. 620 3 3 56
New Jersey......... NN 3 3-
Pennsylvania....... 124 1 1 1 1 1 3

EAST NORTH CENTRAL... 2,293 11 1 9 8 81
Ohio................ 163 3 5 4 44
Indiana............. 561 2 1 3 13
Illinois........... 499 5 1 7
Michigan........... 725 1 8
Wisconsin.......... 345 1 1 2 9

WEST NORTH CENTRAL... 639 1 3 2 5 1 13 179
Minnesota.......... 19 3 33
Iowa................ 244 2 2 5 40
Missouri........... 5 1 1 2 2 74
North Dakota....... 268 3
South Dakota....... 14 2 19
Nebraska........... 6 1 5
Kansas............. 83 2 1 1 5

SOUTH ATLANTIC....... 1,364 5 5 2 10 1 6 18 104
Delaware............ 89 -
Maryland........... 173 2 2 -
Dist. of Columbia.. 20 -
Virginia............ 326 2 5 1 2 10 7.
West Virginia...... 372 1 1 4 11
North Carolina..... 35 2 1 3 -
South Carolina..... 106 1 -
Georgia............. 5 2 1 3 12
Florida............. 238 2 1 1 4

EAST SOUTH CENTRAL... 2,304 11 2 5 12 119
Kentucky............ 136 2 1 1 1 16
Tennessee........... 1,844 6 3 11 101
Alabama............ 145 3 1 1 2
Mississippi........ 179 -

WEST SOUTH CENTRAL... 1,195 5 2 7 I 18 132
Arkansas........... 7 2 6 5 18
Louisiana.......... 4 1 8
Oklahoma........... 70 1 8
Texas............... 1,117 1 1 12 98

MOUNTAIN............. 2,097 1 1 5 1 8
Montana............. 92 1
Idaho............... 346 -
Wyoming.............. 78 -
Colorado............ 1,040 2 1
New Mexico......... 196 1 1
Arizona............ 134 1 5
Utah................ 211 1 1 2 -
Nevada...............

PACIFIC.............. 2,290 3 1 4 9 40
Washington......... 716 -
Oregon.............. 91 1
California......... 1,351 3 1 3 9 40
Alaska............. 92 -
Hawaii............. 40 -
Puerto Rico........... 11 1 2 2 3 1









Morbidity and Mortality Weekly Report






DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED MARCH 12, 1966


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

All Causes Pneumonia Under All Causes Pneumonia Under

Area 65 nd year Area All 65 years and year
Area All 65 year Influenza All Influenza All
Ages and over Influenza All Ages and over Influenza Aue
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.--------

a~AT 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.----
Omha, Nebr.------
St. Louis, Mo.--------
St. Paul, Minn.------
Wichita, Kans.--------


790
261
35
31
36
62
25
20
22
40
69
14
76
35
64

3,523
57
28
143
45
31
37
90
71
1,754
29
662
184
46
100
30
42
63
50
30
31

2,660
67
42
781
161
214
97
66
354
57
36
46
25
56
171
46
140
53
28
46
108
66

875
52
15
46
117
34
153
84
261
64
49


507
153
19
21
29
35
21
17
13
24
48
10
49
22
46

2,095
34
16
76
26
19
24
49
33
1,067
19
389
94
37
66
19
24
35
27
22
19

1,523
37
27
427
94
120
62
32
192
32
19
23
12
41
108
29
85
31
21
30
60
41

550
33
9
26
75
23
92
58
157
40
37


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.-----------


1,283
125
259
47
88
107
66
80
38
119
83
230
41

657
99
47
50
116
160
52
45
88

1,259
48
46
25
168
63
91
240
65
187
96
106
51
73

494
47
22
121
13
150
15
49
77

2,109
25
52
47
43
113
733
139
58
129
83
123
270
38
163
64
29


659
58
117
24
47
67
26
42
19
93
55
95
16

355
41
28
30
74
79
30
25
48

662
26
23
10
89
35
50
121
33
91
60
58
27
39

290
27
16
69
8
90
7
30
43

1,420
17
30
36
25
76
514
92
43
92
53
78
180
26
100
43
15


Total 1 13,650 8,061 765 675

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 133,483
All Causes, Age 65 and over------------------- 77,474
Pneumonia and Influenza, All Ages------------- 6,558
All Causes, Under 1 Year of Age--------------- 6,899


Week No.


________I______ J I








Morbidity and Mortality Weekly Report


FEBRUARY 12, 1966


CURRENT TRENDS
INFLUENZA UNITED STATES
(Continued from page 85)



In early March, eight isolates of type B influenza
virus were recovered from specimens collected from
representative school cases.
(Reported by Dr. Edwin Brown, Epidemiologist, Allegheny
County Department of Health; Dr. Herbert Domke, Director,
Allegheny County Department of Health; Dr. Wm. D.
Schrack, Director of Communicable Diseases, Penn-
sylvania Department of Health; and an EIS O't t
assigned to the Allegheny Department of Health.)


Virginia
Influenza-like illnesses were first recognized during
late February in parts of central Virginia where elevated
school absenteeism up to 25 percent was recorded. Many
strains of type B influenza virus have been recovered
from the Richmond (Henrico and Chesterfield Counties)
and the Charlottesville (Albermarle County) areas. Pre-
liminary reports from additional parts of the State,
including the coastal area, suggest that increasing
numbers of influenza-like illnesses are being recognized
in widely scattered areas.
(Reported by Dr. James B. Kenley, Director, Bureau of
Epidemiology, Virginia State Department of Health.)


INFLUENZA INTERNATIONAL

Table 2
International Influenza Summary 1965-66 (Winter)

SFirst Laboratory Confirmation
Country Recognized Isolation Serology


Europe:
Czechoslovakia
Thailand
Hungary
Romania
Great Britain
Netherlands
Sweden
Eastern Germany
France
Asia:
Japan
Hong Kong
America:
Canada


B
B
B
B
A2, B
A2, B



A2, B


Dec 1965 A2, B
Jan 1966 A2

Feb 1966 A2


S Inform;.ion not ivailablc.

(Compiled by the Influenza-Respiratory Disease Unit.
CDC, from data published in the WHO W'ekly Epidem-
iological Report and from information sent to the WHO
International Influenza Center for the Americas, CDC.)


THE MORBIDITY AND MORTALITY WEEKLY REPORT. WITH A CIRCULAR.
TION OF 15.800 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 NATIONALBASIS ARE RELEASED
ON THESUCCEEDING FRIDAY.


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