Morbidity and mortality

F 5 1.i6 /':P'/U,


COMMUNICABLE DISEASE CENTER -






U sA










U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBL
-10


Vol. 14, No. 33




r


Week Ending

August 21, 1965


PLAGUE New Mexico


.4 fourth case of human plague ha- been confirmed in
New Mexico. The patient I; a .i-1 '2-.ear-old Indian girl
who became ill on August 14, the main complaint hbeinp
small blisters on the chest. The child'. condition rapidly.
got worse, so she was taken to the Puhlic Health Se.'r li-
Indian Hospital at Crownpoint.New Mexico, on \ugust 16.
On admission she had a temperature of 10.5 F with multiple
small blisters on the chest wall. The blisters coalesced
and ulcerated: later a right axillary bubo developed. Pas-
teurella pestis has been isolated from material from the
ulcerated area and the bubo. The patient has responded
well to streptomycin therapy.


-,, ,,,..

Pl..'uo N. t,., .. /r
:ur II .' umm r M, ,Iri' .n SEP I )
[h< r l .1 .1.l,.-.- t 1 1 rs
1: i.,. rri.,I,) ., 1n, ain l i .-'.on / ,
'1 di r \i,iLr. ni l Inlruidu -- ,i j / /t,
[h< Ini > ,, .i \ ," \ / -"'
.,,a!ri,'I -'!a' alia- i ""
nl[, rnl, nn il \olo Qu.,L tr ln> .1- .


This child comes from a family of nomadic sheep
herders who have been camping northeast of Crownpoint.
The present site of the family camp is on the eldgc of a
prairie dog "town" where there has recently been heavy
rodent mortality. Specimens of dead prairie dogs and of
fleas have been collected from the area and are under
examination in the CDC Special Projects Laboratory.


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
33nd 'EEK ENDED CUMULATIVE, FIRST 33 WEEKS
MEDIAN
DISEASE MEDIAN
DISEASE AUGUST 21, AUGUST 15, 1960- 1964 MEDIAN
1965 1964 19 1960- 1964


Aseptic meningitis .
Brucellosis ...............
Diphtheria ........ ....
Encephalitis, primary infectious *
Encephalitis, post-infectious .

Hepatitis, infectious including
serum hepatitis ...........
Measles .................
Meningococcal infections ......
Poliomyelitis, Total .........
Paralytir . .
Nonparatic ..............
Unspecified ......... .* *

Streptococcal Sore Throat and
Scarlet fever .............
Tetanus ................. *
Tularemia ............... *
T',phoid fever .......... .

Rabies in Animals ..........


605
665
24
1
1




3,200
7
5
8

60


541
919
26
1
1




4,079
7
10
6

81


93
10
5




746
1,407
30
25
23




3,003


20

63


1,048
155
96
1,014
504


21,913
237,865
2.217
35
28
7



272. /39
167
160
,"19

2, 134


1,114
271
165
1,211
658


25,367
459 248
1,858
65
54
8
3


?7..341
166
218
250

2,970


NOTIFIABLE DISEASES OF LOW i-RLQU-lt ..Y


1,167
271
244


28,354
391,982
1,487
389
297




228,148


354

2,509


Anthrax: ...............
Botulism: . ....
Leptospirosis: N.C.-1, Ore.-1.
Malaria: Pa.-2 ......
Plague: N.M.-1....... ...
Psittacosis: . .
Cholera: .........


Cum.
7
11
25
50
4
30
2


Rabies in Man: .. ........................
Smallpox: .. ...........................
Trichinosis: ** ..............................
Typhus -
Murine: . .
Rky. Mt. Spotted: N.Y. L'U.- 1, N.C.-3, La.-1, Pa.-2,
Va.-5, Tenn.-l ..


Cum.
1

72

21

188


2







Morbidity and Mortality Weekly Report


August 21, 1965


PLAGUE New Mexico
(Continued from front page)


Field investigations carried out in the areas from
which the first three cases of human plague were notified
(MMWR, Vol. 14, No. 30) have revealed extensive prairie
dog mortality in the area of Prewett, New Mexico. A car-
cass picked up in this area on August 7 has yielded
material positive for plague using the fluorescent antibody
technique. There has also been widespread prairie dog
mortality reported from the Navajo Indian Reserve in the
Dilkon area of Arizona, due west of Gallup, New Mexico.
A carcass of a prairie dog picked up at Dilkon on August
5 has also proved positive for plague.


Epidemiological investigations are continuing through-
out the areas in New Mexico and Arizona which are af-
fected by rodent mortality.
(Reported by Dr. Edwin O. Wicks, Director of Public
Health, New Mexico Department of Public Health; Dr.
H. Gordon Doran, State Epidemiologist, New Mexico
Department of Public Health; Dr. Walker, Attending Phy-
sician, Public Health Service Indian Hospital, Crown-
point, New Mexico; Dr. Philip M. Hotchkiss, State Epi-
demiologist, Arizona State Department of Health; CDC
Special Projects Laboratory and a team of EIS officers.)


SURVEILLANCE SUMMARY
MALARIA IN THE UNITED STATES 1964


The Malaria Surveillance Report is prepared annually
at the Communicable Disease Center and is based on
information received on individual case forms submitted
by State Health Departments. The terminology used to
describe categories of cases of malaria is that recom-
mendedin the 10th Report of the World Health Organization
Expert Committee on Malaria.
During 1964 there was a total of 171 cases of malaria
reported, all but 3 of which were imported cases. Of the
total, 152 cases were confirmed parasitologically. There
were three deaths attributable to malaria, two being due
to Plasmodium falciparum and one to Plasmodium malariae.
Figure 1 shows the numbers of cases of malaria reported
in the U.S. from 1933 to 1964.


This 1964 total of cases represents an 80 percent
increase over the previous 8-year average. The numbers
increased in the civilian population but decreased slightly
in the military population (Figure 2). The majority of
patients, in both civilian and military groups, were young
adult males, reflecting the greater exposure of this age
group to areas endemic for malaria. Merchant seamen were
a notably high risk group, contributing 35 cases or 20
percent of the annual total. Five confirmed malaria in-
fections were reported in Peace Corpsmen after their
return to the United States. Plasmodium rivaz was
identified in 66.4 percent of the patients, an indication
of the large number of infections from southeast Asia
where this is the predominant parasite.


FIGURE 1


REPORTED MALARIA IN THE UNITED STATES, 1933-1964


FIGURE 2


200,000-

100,000-
50,000-


U,
0 10,000-
LL
0
XE 5,000-

z

1,000-

500-



100-

50-


1935 1940 1945 1950 1955 1960 96 1970
YEARS


120-



100-
to-



80-

U) -
0n
*/)

~ 60-



z40-



20-


MILITARY AND CIVILIAN
CASES OF MALARIA
UNITED STATES, 1956-1964
I
I
I
I
I
I
CIVILIAN

I
I
I
I
A I


MILITARY


0 1956' '57 '58 59 60 ''61 '62 '63 64 ''65
YEAR


286


Malario Control Program


Moloria Control Program
- War Areas Control Program
- Relapses Overseas CoseP

SMalaria Eradication Program

Relapses From Korean Veterans

rPRIMAQUINE Treatment of Servicemen
Returning From Molorious Areas







SImported Coses











Three cases of malaria were reported diiring 1964
which appear to have oricinatted in the United States.
One -eemed clearly to be an "introduced" case, the
second an "induced" case through blood transfusion,
and the third a "crp lit case.
During 1964 there was clear documentation* in the
U.S. of four chloroquine resistant Pl',r.noli,im falciparum
malaria infections, each of which exhibited at least
partial resistance to chloroquine. This phenomenon of


287


Plasmodium falciparum resistance to conventional anti-
malarials has been previously detected in ir.i / i. Colombia,
Malaysia, Thailand, South Vietnam, and i, -t Africa.

(Reported by the Parasitic Disease I',,: Surveillance
Section, CDC.)

*Legters, i. J., l )l.I I., Powell, I. I). and Pollack, S.:
Apparent refractoriness to chloroquine, pyrimethamnine and
quinine in strains of Plasmodium falciparum from Vietnam.
Milit Med 130, No. 2: 168-176, February 1965.


EPIDEMIOLOGIC NOTES AND REPORTS
MALARIA APPARENTLY INTRODUCED INTO
THE UNITED STATES


An Account of Two Cases

The first documented introduction of malaria into the
United States since 1957 occurred at Fort Benning, Georgia,
in 1964. On July 10, 1964, an army wife developed an ill-
ness which was parasitologically confirmed as a Plas-
modium vivax infection.
The epidemiological investigations that followed re-
%ealed that a 25-year-old soldier, who had served in South
Korea, was in Fort Benning and suffering from chills and
fever during the period June 3 to June 23, 1964. He had
not reported sick during this time and he had frequented
the area of the base in which the woman patient lived who
de% eloped the vivax infection about one month later. The
soldier did not know the woman and it was only when he
reported sick after leaving Fort Benning that his vivax
infection was confirmed. At about the same time he was
in Fort Benning, routine entomological activities had re-
covered both larval and adult forms of Anopheles quad-
rimaculatus in the same residential area.
The following year on May 22, 1965, another army
wife developed an illness which was confirmed as being
due to a Plasmodium vivax infection. At that time she
was living about 15 miles away from Fort Benning. It
transpired that in July 1964 she had been living in the


same residential area in the Fort as the first documented
case. Further, on July 8, 1964, she had developed an un-
diagnosed febrile illness which lasted for about 10 da\-.
As far as could be ascertained, neither of these
women, aged 23 and 18 respectively, had travelled or
lived in an endemic malaria area. The possibilities of in-
fection through blood transfusion or self-inoculation were
both ruled out. Both lived in adequately screened houses
with air-conditioning while in Fort Benning.
(Reported by Major Nowosiwsky, Chief of Preventive
Medicine, Fort Benning, Georgia; Dr. J. E. McCroan,
Epidemiology Branch, Georgia Department of Public
Health; and a Field Epidemiologist from the Parasitic
Disease Unit, CDC.)

[Editorial note: The Korean strain of Plasmodium vivax
is known to exhibit incubation periods of 6 to 10 months
in a certain percentage of cases (Brunetti, 1954)*. It is not
improbable that the second case of vivax malaria reported
in May 1965 was the subject of a prolonged incubation
period, but it may have been due to a relapse.

*Brunetti, Rosemary, Fritz, Roy F., and Hollister, Arthur C.,
Jr.: An outbreak of malaria in California, 1952-1953. Amer J
Trop Med, Vol. 3, No. 5, September, 1954.


SALMONELLA ALLANDALE Florida


On June 23 an isolate of Salmonella allandale was
obtained from a 7-month-old female living in Orlando,
Florida, who had been ill for 5 days with a high fever of
up to 10)4 F, general malaise, and bloody diarrhea.
There was no history of travel by the child or of close
contact with persons outside the family before the illness
started. The child's diet immediately prior to the illness
consisted solely of canned baby foods, cereals, and evap-
orated milk.
Specimens were obtained from all members of the
child's family and from a pet dog in the house. However,


all were negative on culture and no source of the infec-
tion could be determined. Nevertheless, it is of interest
in that this is only the second recorded isolation of this
Salmonella serotype. The first, isolated during 1948, was
from an asymptomatic food handler in Allandale, Florida,
which is only 52 miles from Orlando.

(Reported by Dr. Wilfred N. Sisk, Director, Orange County
Health Drp,'ir!.n rt Dr. E. Charlton Prather, Director,
Division of Epidemiology, Florida State Board of Health;
and a team from the CDC.)


August i1, 1965


Morbidity and Mortality Weekly Report









288 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
AUGUST 21, 1965 AND AUGUST 15, 1964 (33rd WEEK)


Asetic Encephalitis Poliomyelitis Diphtheria
Aseptic
Meningitis Primary Post-Inf. Total Cases Paralytic
Area
Cumulative Cumulative Cum.
1965 1964 1965 1965 1965 1965 1964 1965 1965 1964 1965 1965
UNITED STATES... 53 88 44 7 1 35 65 1 28 54 6 96

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

MIDDLE ATLANTIC...... 6 13 15 2 10 1 10 5
New York City...... 3 1 8 1 1 1 3
New York, Up-State. 1 7 4 7 7 -
New Jersey.......... 1 2 2 1 2 1 2 -
Pennsylvania....... 1 3 1 2

EAST NORTH CENTRAL... 9 9 10 1 10 9 3
Ohio................ 3 1 8 2 -- 2 1
Indiana............ 1 1 2
Illinois........... 3 3 1 1 5 5 -
Michigan............ 3 5 1 1 -
Wisconsin........... 1 1 -

WEST NORTH CENTRAL... 5 2 4 1 1 8 4 1 7 3 18
Minnesota.......... 3 2 1 1 1 1 1 7
Iowa............... 2 2 2 1
Missouri........... 1 2 1 1
North Dakota....... 2 -
South Dakota....... 7
Nebraska........... 3 3 I
Kansas............. 2 1 1 1 1 1 1 1

SOUTH ATLANTIC....... 4 1 1 2 1 19 1 14 6 29
Delaware........... -
Maryland........... 1 1 1 1 1 -
Dist. of Columbia.. 3
Virginia........... 2 1 -
West Virginia..... -- 1- -
North Carolina..... 1 5 2
South Carolina..... I
Georgia............ -I 1 3 14
Florida............ 2 7 6 3 9

EAST SOUTH CENTRAL... 10 31 3 1 1 5 1 4 16
Kentucky............ 6 30 -
Tennessee........... 1 3 1 1 3 1 2 -
Alabama............ 3 1 2 2 15
Mississippi........ 1

WEST SOUTH CENTRAL... 4 7 14 6 12 6 19
Arkansas........... 2
Louisiana.......... 1 1 2
Oklahoma........... 1 2 -
Texas............... 4 6 13 4 11 4 15

MOUNTAIN............. 1 4 5 6 3 3 -
Montana............ -
Idaho.............. -
Wyoming............. 2 2- -
Colorado........... 3 1 1 -
New Mexico......... 1 1 3 -
Arizona............ 4 2 -
Utah............... 1 -
Nevada............ -

PACIFIC.............. 11 25 4 3 3 3 3 3 5
Washington......... 1 1 1 2 2 -
Oregon............. 1 I 1 1
California......... 9 23 3 3 1 2 1 2 4
Alaska............. -
Hawaii............. 1 -

Puerto Rico 2 7









Morbidily and Moriality WPeekly Report 289


CASES OF SPECIFIED NOIII IAIilI DIM A, [ I NIII1) STA 1

FOR \ IfKK ENI) I)
AUGlIST 21, 1965 AND Al (.I ST 15, 1964 (iSrd I I k) Continued


Brucel- Infectious Hepatitis Meningococcal
loss including Serum Hepatitis Infections Tetanus
Area Total Under 20 years Cumulative
incl. unk. 20 years and over Totals Cumulative Cum.
1965 1965 1965 1965 1965 1964 1965 1965 1964 1965 1965

UNITED STATES... 3 605 255 317 21,913 25,367 24 2,217 1,858 7 167

NEW ENGLAND ......... 29 13 15 1,290 2,415 1 112 50 5
Maine.............. 5 5 244 787 16 5 -
New Hampshire...... 2 2 123 177 7 1 1
Vermont............ 2 2 71 306 6 1 -
Massachusetts ..... 13 6 6 506 507 1 36 20 3
Rhode Island....... 1 1 152 125 14 8 -
Connecticut ........ 6 1 5 194 513 33 15 1

MIDDLE ATLANTIC...... 122 39 83 3,901 5,692 4 293 242 10
New York City...... 33 9 24 769 864 51 33 -
New York, Up-State. 34 13 21 1,502 2,532 1 81 69 4
New Jersey......... 32 6 26 738 1,003 1 77 84 -
P-nnFyl ant ....... 23 11 12 892 1,293 2 84 56 6

EAST NORTH CENTRAL... 1 100 43 45 4,168 3,931 6 303 256 1 21
Ohio ............... 30 11 16 1,158 1,039 2 81 68 1 2
Indiana............ 5 2 2 371 345 39 39 6
Illinois........... 1 16 8 7 788 703 2 81 65 8
Michigan............ 42 21 18 1,592 1,547 1 66 57 2
Wisconsin.......... 7 1 2 259 297 1 36 27 3

WEST NORTH CENTRAL.. 18 9 8 1,308 1,370 1 111 116 1 16
Minnesota.......... 5 2 2 134 143 22 26 7
Iowa............... 6 5 1 475 198 7 6 3
Missouri........... 2 2 280 342 1 51 55 1 2
North Dakota ....... 18 52 8 15
South Dakota ....... 17 112 2- -
Nebraska........... 1 I 47 35 10 6 2
Kansas............. 4 1 3 337 488 11 8 2

SOUTH ATLANTIC....... 1 58 20 36 2,248 2,390 3 427 383 1 39
Delaware........... 59 46 6 6 -
Maryland............ 7 3 4 405 448 2 42 25 1
Dist. of Columbia.. 2 1 1 30 40 8 12 -
Virginia........... 14 5 9 506 374 1 50 46 7
West Vir -inia..... 9 6 3 344 368 24 27 1
North C. -tina..... 1 5 5 209 417 82 67 5
South Carolina..... 4 1 2 93 90 57 49 1 4
Georgia.. ......... 84 60 53 53 4
Florida............ 17 4 12 518 547 105 98 17

EAST SOUTH CENTRAL... 1 59 36 18 1,565 1,770 4 176 157 1 23
Kentucky............ 18 10 3 541 687 1 69 53 6
Tennessee........... 19 13 6 538 601 3 54 52 7
Alabama............. 1 7 5 2 280 319 33 34 8
Miss-1i1pp ........ 15 8 7 206 163 20 18 1 2

WEST SOUTH CENTRAL... 53 21 30 1,924 1,908 301 221 33
Arkansas........... 10 8 2 258 190 14 19 8
Louisiana.......... 8 1 7 325 439 168 109 5
Oklahoma........... 2 1 1 47 99 18 7 1
Texas.............. 33 11 20 1,294 1,180 101 86 19

MOUNTAIN............. 29 8 11 1,267 1,557 68 65 3
Montana............ 1 1 91 140 2 -
Idaho............... 5 170 189 8 3 -
Wyoming............. 35 48 5 5 -
Colorado........... 14 7 7 269 425 13 11 2
New Mexico........ 2 1 267 221 10 26 -
Arizona............ 4 260 355 16 5 1
Utah............... 3 3 168 129 12 7 -
Nevada............. 7 50 2 8

PACIFIC.............. 137 66 71 4,242 4,334 5 426 368 3 17
Washington.......... 6 3 3 330 473 33 29 -
Oregon............. 7 4 3 355 479 30 21 3
California......... 123 58 65 3,354 3,163 5 340 299 3 14
Alaska............. 170 131 16 7 -
Hawaii............... 1 1 33 88 7 12

Puerto Rico 25 24 1 889 658 5 30 3 30









290 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 21, 1965 AND AUGUST 15, 1964 (33rd WEEK) Continued


Street.
Measles Sore Th. & Tularemia Typhoid Fever Rabies in
Scarlet Fev. Animals
Area
Cumulative Cum. Cum. Cum.
1965 1965 1964 1965 1965 1965 1965 1965 1965 1965
UNITED STATES... 665 237,865 459,248 3,200 5 160 8 249 60 2,975

NEW ENGLAND.......... 41 36,722 16,663 292 4 36
Maine............... 5 2,786 2,927 39 3
New Hampshire...... 381 248 2 -
Vermont............. 1,246 2,302 17 29
Massachusetts...... 31 19,269 5,203 24 3 2
Rhode Island....... 1 3,897 1,919 5 1 -
Connecticut........ 4 9,143 4,064 205 1

MIDDLE ATLANTIC...... 93 14,532 51,963 115 42 2 118
New York City...... 34 2,282 15,261 5 20 -
New York, up-State. 40 4,084 12,638 71 11 2 106
New Jersey......... 9 2,512 12,158 34 4 -
Pennsylvania ....... 10 5,654 11,906 5 7 12

EAST NORTH CENTRAL... 196 55,046 102,347 251 11 33 4 453
Ohio............... 21 8,843 19,555 39 8 234
Indiana............. 10 1,801 22,654 69 4 8 1 48
Illinois........... 13 2,602 16,580 17 5 8 1 76
Michigan........... 50 26,240 28,769 72 1 4 45
Wisconsin.......... 102 15,560 14,789 54 1 5 2 50

WEST NORTH CENTRAL... 8 16,391 30,178 129 17 1 8 14 615
Minnesota........... 625 331 1 5 128
Iowa............... 2 8,971 23,287 22 1 5 175
Missouri........... 2 2,580 1,012 3 12 1 6 84
North Dakota....... 4 3,654 4,711 55 38
South Dakota....... 112 25 6 2 44
Nebraska........... 449 812 -- 1 33
Kansas............. NN NN NN 43 2 4 113

SOUTH ATLANTIC ...... 83 24,394 38,020 357 29 1 51 1 406
Delaware............ 1 502 404 2 4 -
Maryland............ 12 1,146 3,395 28 15 15
Dist. of Columbia.. 73 353 -
Virginia........... 20 3,820 12,679 74 6 3 268
West Virginia ..... 38 13,511 8,523 121 3 20
North Carolina..... 378 1,152 11 6 14 2
South Carolina..... 2 1,009 4,226 36 3 1 6 2
Georgia............ 1 613 181 14 2 45
Florida............ 9 3,342 7,107 85 4 1 54

EAST SOUTH CENTRAL... 24 13,596 67,354 579 18 1 24 17 658
Kentucky ........... 2 2,409 18,416 50 3 6 64
Tennessee.......... 14 7,785 23,929 475 14 8 9 566
Alabama.............. 1 2,294 18,327 31 1 1 6 14
Mississippi........ 7 1,108 6,682 23 4 8 14

WEST SOUTH CENTRAL... 97 30,529 71,634 480 4 63 2 36 6 462
Arkansas........... 1,081 1,105 1 2 41 12 2 67
Louisiana.......... 1 104 100 1 3 5 66
Oklahoma ........... 202 1,011 12 1 9 2 3 85
Texas.............. 96 29,142 69,418 467 10 2 17 1 244

MOUNTAIN............. 67 19,548 18,304 656 15 2 23 5 63
Montana............ 6 3,696 2,998 23 4 1 2 5
Idaho.............. 22 2,761 1,896 86 -
Wyoming............ 841 245 16 3 1 -
Colorado............ 12 5,600 3,155 242 8
New Mexico.......... 674 438 152 9 11
Arizona............ 18 1,277 6,582 55 2 10 3 38
Utah............... 9 4,496 2,002 82 8 1
Nevada.............. 203 988 2 -

PACIFIC .............. 56 27,107 62,785 341 1 7 1 28 11 164
Washington......... 6 7,213 19,963 51 2 1 7
Oregon............. 10 3,176 8,550 4 1 3 3 1 5
California......... 33 12,820 32,705 262 4 1 22 9 150
Alaska............. 170 1,081 8 -- 2
Hawaii............. 7 3,728 486 16 A

Puerto Rico 29 2,298 5,717 4 I- 6 12









Morbidity and 'Mortality Weekly Report


WEEK ENDING 33


DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED AUGUST 21, 1965


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

All Causes Pneumonia Under All Causes Pneumonia Under
Syear Iand 1 year
Area All 65 years and 1 yea Area All 65 years and f 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.---------


679
205
52
31
25
36
21
21
30
58
52
8
44
35
61

3,178
50
30
146
30
64
31
70
67
1,631
34
502
164
48
107
24
32
55
46
28
19

2,430
49
39
746
141
176
123
64
324
35
53
38
47
47
141
35
108
35
37
34
97
61

845
60
31
35
126
31
144
65
235
68
50


*Estimate based on average percent of divisional total.


397
99
32
26
19
19
13
15
20
36
31
4
25
22
36

1,855
31
24
96
20
36
23
38
29
903
23
305
93
32
80
17
20
34
21
20
10

1,340
21
26
396
89
96
68
41
174
25
28
26
25
31
70
14
51
17
21
23
56
42

488
37
23
18
79
21
84
36
131
38
21


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.----------


1,070
118
241
41
49
84
49
89
32
69
80
177
41

626
96
42
32
144
141
43
28
100

998
37
28
20
151
25
62
178
55
157
82
121
49
33

383
42
22
110
18
84
14
49
44

1,454
24
49
34
37
71
505
70
44
83
72
83
162
21
118
49
32


Total| 11,663 6,524 447 684

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 412,443
All Causes, Age 65 and over------------------- 233,172
Pneumonia and Influenza, All Ages------------ 17,344
All Causes, Under 1 Year of Age--------------. 24,489


291


52
3
8
2
5
1
5
1
4
4
11
6
2

33
3
3

17
4
1
4
1

24
5


2
1
2
3

2
1
4
3
1

11
3

3
3
2




36

3

1

21
1
1
1
2

3
1
2


* "









292


Morbidity and Mortality Weekly Report


INTERNATIONAL NOTES QUARANTINE MEASURES

Cholera Vaccination

The Di'ision of Foreign Quarantine advises that as
of August 23, cholera is reported official3 in Afghanistan,
Bahrein, Burma, India, Pakistan, Philippines, Thailand
and Vietnam. It is important that all persons who plan to
travel or transit in these countries should hate been %ac-
cinated against cholera in the past six months and be in
possession of a talid International Certificate of Vaccina-
tion or Revaccination Against Cholera. Other% Ise the\ ma:
encounter delays in quarantine at ports of entry to those
cour.tries where there are declared cholera-infected local
areas. This also applies especially at ports of entry to
countries contiguous to those declared infected.
In the United States the standard course for immuni-
zation against cholera is two injections with at least a
seven-day interval between the two. Following on a stan-
dard course a booster dose should be obtained every six
months to maintain the validity of an International Certif-
icate. If more than six months has elapsed since vaccina-
tion, only one booster injection is required but the Certif-
icate is not immediately valid.
The International Certificate of Vaccination or Retac-
cination Against Cholera is talid for a period of six months
beginning six days after the first injection of a standard
course. If revaccination is within six months of a pret-
ious vaccination, the Certificate is retalidated on the date
of the booster injection. If more than six months has
elapsed before revaccination, only one injection is re-
quired but the Certificate is not valid until six da s have
elapsed. It is wise to keep old Certificates to assist
quarantine authorities to assess the vaccination status
of the train eller.
It is important that the information on a Certificate
should be complete and follow the wording of the Interna-
tional form. The written signature of the physician giving
the immunization should be clearly shown on the Certifi-
cate which must also be stamped by the Local or State
Health Officer of the area in which the physician who
has given the immunization practices.
Failure to comply with these International require-
ments may result in the traveller from a cholera-infected
area being either refused admission to another country by
the quarantine authorities or being placed in quarantine
for six days at his or her own expense.


August 21..


Mg'


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A RC0ULA-
TION OF 14,000. IS PUBLISHED AT THE COMMUNICABLE DISEASE
CENTER ATLANTA GEORGIA.
CHIEF COMMUNICABLE DISEASE CENTER JAMES L. GODDAROD M.D.
CHIEF EPIDEMIOLOGY BRANCH A. D. LANGMUIRr mI.D.
ACTING CHIEF STATISTICS SECTION IDA L. SHERMAN. M.S.
CHIEF SURVEILLANCE SECTION D. A. HENDERSON. M.D.
EDITOR MMIR 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 IN-
IES TiGA TIONS WHICH ARE OF CURRENT INTEREST TO HEALTH
OF FIC IALS AND WHICH ARE DIRECTLY RELATED TO THE CONTROL OF
COMMUNICABLE DISEASES. SUCH COMMUNICATIONS SHOULD BE AD-
DRESSED 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 SAT-
URDAY COMPILED DATA ON A NATIONAL BASIS ARE RELEASED ON
THE SUCCEEDING FRIDAY.


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