Morbidity and mortality

COMMUNICABLE DISEASE CENTER





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W W ^ T :''*:-: ****** **^ ^*.-"B, r~f*:,r


Vol. 14, No. 37


WEf



Week Ending
September 18, 1965


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


AN EPIDEMIC OF WATERBORNE GASTROENTERITIS
Modera, California
During the middle of August an estimated total of
2,500 cases of acute gastroenteritis of apparently multiple
causation occurred in Madera, a city of 15,000 population
lying in the center of the San Joaquin Valley of California.
The cases were widely distributed throughout the city
and surrounding area,but with a higher incidence localized
in the southwestern area of the town. The source was
traced to sewage contamination of one of 14 deep wells
of the municipal water system.
On Friday, August 13, an area physician reported to
the County Health Authority that on the preceding day he
had seen an unusually large number of patients with


(ro.V rE,' S
Epidemic of Waterborne Gastroenteritis . 318
Epidemiologic Notes and Reports
Death Associated with Tick Paralysis ... 319
International Notes
Poliomyelitis Blackburn, England ... .... 324


diarrhea, the majority of whom lived in the southwest
section of town. Because of this apparent localization, the
County Sanitarian took samples of water from the two
wells serving this section. That evening, as a result of
a steadily increasing number of cases of diarrhea, both
in the southwest area and elsewhere in the city, the two
wells were closed and the townspeople advised to-boil
(Continued on page 318)


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
37th WEEK ENDED CUMULATIVE, FIRST 37 WEEKS
MEDIAN
DISEASE SEPTEMBER 18, SEPTEMBER 12, 1960--1964 MEDIAN
1965 1964 1965 11960- 1964
Aseptic meningitis ......... 102 51 129 1,337 1,331 1,634
Brucellosis .,. .. .......... *6 5 7 183 305 305
Diphtherena .. ................. 1 2 9 106 181 274
Encephalitis, primary infectious 49 117 --- 1,220 2,170 ---
Encephalitis, post-infectious 8 1 --- 539 683 -
Hepatitis, infectious including
serum hepautis .......... 624 L ( 738 24,127 27,679 31.134
Measles ...................** 623 i4(, 800 240,003 461,750 395.788
Meningococcal infections .. ** 26 / 26 -27 2,316 2,044 1,596
Poliomyelitis. Total ......... -* / 3 32 41 76 536
Paralytic ............... 3 23 32 63 416
Nonparalytic .............** --- 7 9 ---
Unspecified .........* *: i --- 2 4
Streptococcal Sore Throat and
Scarlet fever .......... 4,245 \ -4.010 3,513 288,818 295,333 239,723
Tetanus ......... 5 --- 192 200 ---
Tularemia 9 ."" --- 187 240 ---
Typhoid fever 16 21 297 291 432
Rabies in Animals *'....' 81 109 53 3,240 3,359 2,753

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ... .............................. 7 Rabies in Man: ............................. 1
Botulism: ................................ 11 Smallpox: ............................... -
Leptospirosis: Hawaii-1, S.C.-l, Tenn.- l............ 31 Trichinosis: N.Y. Upstate-1 .................... 77
Malaria: N.Y. Upstate-1, Calif.-1 ................. 59 Typhus-
Plague: ........... .................. ... 5 Murine: ............................... 22
Psittacosis: ............................. 34 Rky. Mt. Spotted: N.C.-3, Ala.-l, Colo.-1, W. Va.-1 .. 223
Cholera: ................................. 1 2 Ky.-I, Tenn.-I


'p S /9 ..' ^/s 7










Morbidity and Mortality Weekly Report


AN EPIDEMIC OF WATERBORNE GASTROENTERITIS Madero, California


(Continued from front page)


their water for domestic use until further notice. The
State Department of Public Health was notified of the
situation.
Investigation activities involved systematic sampling
of the water supply with subsequent laboratory examina-
tions, and a household sample survey of 10 percent of the
urban population. The municipal water system, which is
not routinely chlorinated, consists of 14 wells located
throughout the town, all contributing to the distribution
system and balancing reservoir. Through Tuesday, August
10, the laboratory reports from weekly bacteriological
examinations of water samples from the entire distribution
system were satisfactory. On Saturday, August 14, labora-
tory reports resealed that of the sample water taken from
two closed wells on the preceding day, only that of well
Number 14 was contaminated. Laboratory findings from
the extensive sampling of water from the other 12 wells,
the distribution system, and the reservoir indicated that
although none of the other wells were contaminated, the
entire distribution system and reservoir had been affected.
It was presumed that the one contaminated well was the
agent responsible for the extensive contamination.

Subsequent focus of investigation on well Number 14
led to the discovery of two relevant factors, a field 22
feet from the edge of the well which had been irrigated
with sewage effluent on either August 10 or 11 and a
sounding tube leading into the well water which was
uncapped and had evidently been that way for some time.
It was then experimentally demonstrated that sewage-
contaminated water could seep from a gopher hole at the


50




40




30


edge of the field into a valle pit next to the well and then
either leak through a wooden barrieror through the uncapped
sounding tube into the well shaft, thereby contaminating
the water. Remedial action necessitated progressive
chlorination of all city water and this was completed
between Saturday, August 14, and early Monday, August
16.
The household sample survey, conducted by a team
from the State Department of Health, was begun on August
18. Data collected indicated that the epidemic started
Wednesday, August 11, reached a peak on Saturday, and
was almost o\er by Wednesday, August 18 (Figure 1).
The clinical picture was characterized by an abrupt onset.
of diarrhea; cramps and vomiting were present in 70 to 80
percent of the cases and fever in 65 percent. Blood
and mucus rarel) accompanied the diarrhea. There were
no deaths and only two persons required hospitalization.
Laboratory investigations of approximately 50 stool
cultures or rectal swabs yielded isolates of five Shigella
flexreri type 3 and two Salmonella heidleberg. The low
frequency of isolation of pathogens and the mild clinical
characteristics of the illness suggest a multiple and
diverse etiology consistent with the contamination by
sewage.

The geographical distribution revealed by the survey
indicated that the highest diarrhea attack rates occurred
in the southwest portion of town, where in one area the
attack rate reached 53.6 percent. The average attack rate
for the entire town was 16.5 percent. Another survey
conducted among residents in areas just outside the town


Figure 1. OUTBREAK OF GASTROENTERITIS
MADERA, CALIFORNIA, CASES BY DATE OF ONSET*


10 cases prior to August


9f
: .. -..:


9 10


q s-


. .
,
*
5 5


13 114
AUGUST


16


17


7-i


18


*Determined by sample survey of 10% of urban population conducted on August 18, 1965.


. _


.


.


. .. .


318


SEPTEMBER 18, 1965


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Morbidity and Morta


which were not connected to the town water -uipl.%
revealed that the attack rate ao1111ng the group as a whole
was 7.5 percent. Of those who did not drink any town
water, the attack rate was 4.2 percent; of those who did
have occasion to drink it, the rate was 16.5 percent.
No significant variation in age specific attack rate was
apparent.
Epidtemiolovical and clinical data indicate that this
was a common source epidemic of gastroenteritis, pre-


lity Weekly Report 319




sumably due to a mixture of fecal Iiplthog~'(,. and ri-idllngr
from the contamination of a deep well by -~wII."- .I flluinit.
The outbreak was terminated by chlorination of the public
water supply.


(Reported by Dr.
Renteln, Bureau
State Department


PIhilip Condit, Chief, and Dr. Henry
of Communicable Disease, California
of Public Health; and an EIS Offie rr.)


EPIDEMIOLOGIC NOTES AND REPORTS

DEATH ASSOCIATED WITH TICK PARALYSIS

La Grande, Oregon


On May 4, a five-year-old boy was present at a family
picnic at La Grande, Oregon; four days later his parents
noticed that the boy, who was normally unsteady on his
feet due to congenital cranial abnormalities, was falling
more often than usual. By the evening of that day, he was
unable to stand. The next morning, May 9, the boy was
taken to the family physician who immediately arranged
for admission to the hospital on account of marked
weakness of the arms and legs and difficulty in breathing.
On admission, the boy, who weighed only 32 pounds,
was placed in a respirator and a tracheostomy was
performed. Once breathing was properly established, an
examination revealed a tick on the nuchal hairline which
was promptly removed. For the next 18 hours the boy's
breathing was easier, but after that time progressive
respiratory and circulatory embarrassment developed.
Despite all resuscitatory measures, including cardiac
massage, he died on May 11.
Autopsy reports showed that the boy had several
congenital abnormalities: choanal stenosis, shallow
orbital cavities, craniosynostosis, and markedly diminished
muscle masses. Otherwise there was only a relatively
minor degree of cerebral endema.
May is the month of peak tick activity in the La Grande
area and veterinarians have reported 10 cases of tick
paralysis in dogs during the past few months. The tick
that had been removed was later classified as Dermacentor
andersoni. As far as is known the family picnic was the


only occasion on which the boy had been exposed to tick
infestation.

(Reported by Dr. Monroe A. Holmes, Acting Director,
Epidemiology Section, Preventive Medical Services,
Oregon State Department of Public Health; and Dr.
R.A. Gingrich, Attending Physician, La Grande, Oregon).



Editorial note: Cases of tick paralysis in humans are
reported annually in North America and recently a non-
fatal case was reported at Montrose in British Columbia,
Canada.* In the U.S. some 100 cases have been recorded,
of which 10 percent have proved fatal; of 250 cases
recorded in Canada, 28 have died. The paralysis is a
motor one believed to be caused by a toxin originating
in the salivary glands of certain ticks. There is usually
a 4-day attachment of a feeding tick, commonly a female,
before the paralysis appears. Amelioration of the symptoms
normally begins as soon as the tick is removed or it
stops feeding. If the host's cardiac and respiratory centers
are unaffected when the tick is removed, recovery takes
place within a few hours to several days.**]


*Canadian Epidemiological Bulletin, Vol. 9, No. 7, (July,
1965), p. 59.
**Arthur, Don R. Ticks and Disease. Pergamon Press, London,
England, 1962, pp. 309-313.


SE:PTEIMBI K 18, 1965










320 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

SEPTEMBER 18, 1965 AND SEPTEMBER 12, 1964 (37th WEEK)


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 '965
UNITED STATES... 102 51 49 8 41 76 32 63 1 106

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

MIDDLE ATLANTIC...... 2 6 15 3 12 2 11 5
New York City ...... '3 5 1 1 1 3
New York, Up-State 1 9 -
New Jersey......... 1 7 2 2 2 2 -
Pennsylvania....... 2 2 2 2

EAST NORTH CENTRAL... 33 8 12 2 1 16 14 4
Ohio............... 3 4 6 2 2 1
Indiana...........*... 2 1 1 4 4 2
Illinois........... 5 1 4 2 1 5 5 -
Michigan........... 20 2 -- 3 2 -
Wisconsin.......... 3 1 2 1 1

WEST NORTH CENTRAL... 14 2 8 10 6 7 5 18
Minnesota.......... 10 2 1 2 1 2 7
Iowa............... 3 2 4 2 1
Missouri........... 1 1 3 2 1
North Dakota....... 1 -- -
South Dakota....... 7
Nebraska........... 1 3 3 1
Kansas............. 4 1 1 1 1 1

SOUTH ATLANTIC....... 6 1 3 5 1 20 1 15 29
Delaware ........... 1 -
Maryland........... 1 1 1 1 1 -
Dist. of Columbia .. 3
Virginia........... 1 1 -
West Virginia...... 1 1 -1
North Carolina..... 1 9 5 2
South Carolina..... 1
Georgia............ 1 1 14
Florida............ 2 2 5 8 7 9

EAST SOUTH CENTRAL... 5 4 2 1 5 1 4 17
Kentucky........... -
Tennessee.......... 1 2 1 3 1 2 -
Alabama............ 4 4 2 2 15
Mississippi ........ 2

WEST SOUTH CENTRAL... 7 3 1 16 6 14 6 23
Arkansas............ 2
Louisiana.......... 2 2 1 1 5
Oklahoma............ 1 1 2 1 2 -
Texas.............. 5 1 14 4 12 4 16

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

PACIFIC.............. 29 21 5 1 4 3 4 3 8
Washington......... 1 2 2 2 2
Oregon............. 1 1 1 1 1-
California......... 26 19 4 1 1 2 1 2 5
Alaska.............. -
Hawaii.............. -

Puerto Rico 10










Morbidily and tlorlalitl Weekly Report 321


(CASES 01 ( SPH Ill) NM ll I-AHi [) II ASI IUNITI) STATES

()R WEEKS NI)I I)

%IPIIMNHIR IS, 1965 ANI) MPIINIIIR 12, 1964 (-'ih II K) Continued


Strept.
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.. 623 240,003 461,750 4,245 9 187 16 297 81 3,240

NEW ENGLAND.......... 44 36,798 16,903 245 1 4 1 38
Maine.............. 2 2,792 2,999 53 1 4
New Hampshire...... 381 250 1
Vermont............ 1,257 2,319 30
Massachusetts...... 1 19,281 5,295 37 1 -3 2
Rhode Island....... 39 3,938 1,928 11 1 -
Connecticut........ 2 9,149 4,112 144 1

MIDDLE ATLANTIC...... 52 14,747 52,148 132 51 2 129
New York City...... 19 2,378 15,329 4 25 -
New York, up-State. 6 4,125 12,698 72 13 2 117
New Jersey......... 18 2,565 12,201 49 6
Pennsylvania....... 9 5,679 11,920 7 7 12

EAST NORTH CENTRAL... 153 55,655 102,765 322 1 13 1 38 11 496
Ohio............... 6 8,867 19,620 16 9 5 257
Indiana............. 8 1,828 22,724 102 5 8 3 56
Illinois........... 24 2,701 16,616 46 5 10 1 79
Michigan........... 64 26,441 28,888 118 1 2 1 6 1 50
Wisconsin.......... 51 15,818 14,917 40 1 5 1 54

WEST NORTH CENTRAL... 12 16,457 30,238 130 23 10 15 665
Minnesota.......... 1 636 333 1 1 1 135
Iowa................ 5 8,983 23,312 39 2 4 191
Missouri............ 1 2,588 1,019 2 18 7 5 91
North Dakota....... 5 3,685 4,734 80 3 42
South Dakota....... 115 28 5 2 48
Nebraska........... 450 812 1 35
Kansas............. NN N NNN 3 2 2 123

SOUTH ATLANTIC....... 126 24,693 38,268 540 1 30 7 63 11 445
Delaware........... 1 503 409 6 4
Maryland............ 3 1,160 3,402 26 3 18 1 22
Dist. of Columbia.. 77 354 11 -
Virginia........... 4 3,851 12,698 122 1 7 4 8 4 278
West Virginia...... 92 13,698 8,612 222 3 21
North Carolina..... 5 389 1,160 2 6 15 1 3
South Carolina..... 6 1,016 4,253 34 3 8 2
Georgia............. 617 194 2 14 3 4 54
Florida............. 15 3,382 7,186 115 4 1 65

EAST SOUTH CENTRAL... 59 13,770 67,628 1,029 20 3 29 8 694
Kentucky........... 22 2,480 18,451 29 3 2 8 1 72
Tennessee.......... 25 7,853 24,134 832 16 1 10 7 593
Alabama............ 11 2,322 18,356 62 1 6 15
Mississippi........ 1 1,115 6,687 106 5 14

WEST SOUTH CENTRAL... 72 30,818 72,006 656 6 76 3 42 22 515
Arkansas........... 1,084 1,124 5 51 13 3 77
Louisiana.......... 1 105 105 1 1 4 1 6 69
Oklahoma........... 203 1,018 24 10 2 6 13 106
Texas.............. 71 29,426 69,759 631 11 17 6 263

MOUNTAIN............. 39 19,688 18,570 719 15 24 3 72
Montana............ 3 3,714 3,038 56 4 1 5
Idaho............... 10 2,783 1,928 18 -
Wyoming............ 2 845 260 3 3 1 -
Colorado........... 7 5,627 3,226 349 9
New Mexico......... 677 450 177 9 14
Arizona............ 13 1,309 6,627 49 11 2 42
Utah................ 3 4,529 2,051 64 8 1
Nevada............. 1 204 990 3 2 1 1

PACIFIC.............. 66 27,377 63,224 472 1 9 2 36 8 186
Washington......... 4 7,222 19,998 59 4 7
Oregon............. 18 3,231 8,631 6 1 5 5 6
California ......... 23 12,942 32,964 321 4 2 26 8 171
Alaska............. 4 182 1,095 7 2
Hawaii ............. 17 3,800 536 79 1- -

Puerto Rico 32 2,388 6,013 6 1 7 13










322 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
SEPTEMBER 18, 1965 AND SEPTEMBER 12, 1964 (37th WEEK) Continued


Brucel- Infectious Hepatitis Meningococcal
losis 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... 6 624 288 300 24,127 27,679 26 2,316 2,044 5 192

NEW ENGLAND.......... 52 20 31 1,428 2,578 3 117 55 5
Maine.............. 5 3 2 260 825 16 5 --
New Hampshire...... 5 4 143 202 7 1 1
Vermont............ 2 2 76 323 6 1 -
Massachusetts...... 20 6 14 563 554 1 39 22 3
Rhode Island....... 7 2 5 164 137 14 9 -
Connecticut........ 13 7 6 222 537 2 35 17 1

MIDDLE ATLANTIC...... 87 37 50 4,268 6,141 3 303 256 1 12
New York City...... 32 11 21 853 943 51 35 -
New York, Up-State. 13 3 10 1,621 2,697 1 87 71 4
New Jersey.......... 16 10 6 808 1,067 79 88 1
Pennsylvania....... 26 13 13 986 1,434 2 86 62 1 7

EAST NORTH CENTRAL... 3 134 65 63 4,606 4,346 5 327 278 2 27
Ohio............... 34 13 17 1,264 1,144 2 88 71 2
Indiana............ 12 10 1 409 378 1 42 42 1 7
Illinois........... 1 21 11 10 878 788 1 90 72 1 12
Michigan........... 1 65 29 35 1,779 1,723 1 70 64 3
Wisconsin.......... 1 2 2 276 313 37 29 3

WEST NORTH CENTRAL... 1 30 17 11 1,425 1,496 1 119 122 17
Minnesota.......... 2 1 143 166 1 24 29 7
Iowa................ 6 4 1 510 222 8 6 4
Missouri........... 1 5 2 3 305 367 52 56 2
North Dakota....... 4 2 2 27 57 11 16 -
South Dakota....... 17 116 3 1 -
Nebraska........... 3 1 2 60 42 10 6 2
Kansas............. 10 8 2 363 526 11 8 2

SOUTH ATLANTIC....... 74 34 34 2,515 2,594 5 448 404 2 43
Delaware........... 1 1 60 49 7 6 -
Maryland........... 4 2 2 442 493 1 43 26 1
Dist. of Columbia.. 2 1 1 38 44 9 13 -
Virginia........... 16 6 7 582 407 2 54 46 7
West Virginia...... 12 8 4 370 385 24 31 I
North Carolina..... 6 3 3 240 443 1 90 69 1 6
South Carolina..... 9 5 4 114 95 58 50 6
Georgia............ 2 1 1 93 72 57 61 4
Florida............ 22 7 12 576 606 1 106 102 1 18

EAST SOUTH CENTRAL... 1 51 29 22 1,731 1,922 1 181 169 24
Kentucky............ 21 14 7 605 726 69 55 6
Tennessee.......... 16 8 8 588 656 1 58 55 7
Alabama........... 7 2 5 313 350 34 35 9
Mississippi....... 1 7 5 2 225 190 20 24 2

WEST SOUTH CENTRAL... 51 26 23 2,096 2,138 2 307 231 43
Arkansas............ 7 4 3 280 210 1 15 20 10
Louisiana.......... 2 1 1 345 503 1 170 114 5
Oklahoma............. 48 101 19 8 I
Texas............... 42 21 19 1,423 1,324 103 89 27

MOUNTAIN............. 36 16 10 1,358 1,675 72 69 3
Montana............ 1 1 103 147 2 -
Idaho.............. 4 177 224 8 3 -
Wyoming............ 38 52 5 5 -
Colorado........... 16 10 6 295 444 14 12 2
New Mexico......... 8 6 2 279 245 11 28 -
Arizona ........... 5 283 373 16 6 I
Utah................ 1 1 175 140 14 7 -
Nevada............. 1 8 50 2 8 -

PACIFIC.............. 1 109 44 56 4,700 4,789 6 442 460 18
Washington......... 14 3 11 374 506 33 30 -
Oregon............. 9 397 524 32 21 4
California....... 1 85 40 45 3,710 3,494 6 352 390 14
Alaska............. 181 167 18 7 -
Hawaii............. 1 1 38 98 7 12 -


Puerto Rico 34 29 5 1,030 733 5 31 4 39











Nlorhidiity and Morlality A eekly Report


Week No. Table 4. DEATHS IN 122 I'NITFD STATES CITIES FOR W'lIK .NI)iD)D s II I IB MII 1, 19i5

37 (By place of occurrence and week of filing certificate. Excludes fetal deaths)
__ __ __ __ __ __ ___ ii I


Area


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.------
Eric, 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.--------


All Causes

All 65 years
Ages and over


Pneumonia
and
Influenza
All Ages


Under
I year
All
Causes


Area


All
Ages


65 years
and ov er


Pneumon ia
and
Infl enza
All Ages


I 1 4 F II I 1 1 -


709
233
38
31
27
53
25
17
23
46
69
12
45
34
56

3,097
52
35
141
44
29
33
58
74
1,574
24
512
189
39
97
29
27
45
41
18
36

2,429
64
42
672
153
199
112
77
335
30
66
40
29
36
161
48
119
30
23
35
112
46

853
58
29
31
150
40
123
70
231
67
54


428
132
21
19
13
28
15
11
13
26
47
10
31
24
38

1,767
30
23
93
28
14
20
34
33
902
11
292
89
25
51
19
15
22
26
14
26

1,308
34
23
348
91
98
62
38
168
20
36
27
13
20
92
21
68
20
12
22
69
26

512
41
24
18
83
29
75
41
128
45
28


*Estimate based on average percent of divisional total.


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.------
i I nington, 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.----------


1,103
134
256
44
66
87
57
88
38
65
62
174
32

581
112
47
37
116
118
42
29
80

1,185
42
19
30
138
36
70
228
58
247
94
94
83
46

352
40
20
103
17
61
18
42
51

1,610
25
70
32
51
70
482
66
53
140
72
94
208
40
130
46
31


Under
Year
All
Causes


Total 1 11,919 6,571 368 753

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ----------------------- 457,319
All Causes, Age 65 and over------------------- 258,072
Pneumonia and Influenza, All Ages------------- 18,807
All Causes, Under 1 Year of Age--------------- 27,222


:12:3


Al l Causes










Morbidity and Mortality Weekly Report


SEPTEMBER 18. 1965


INTERNATIONAL NOTES
POLIOMYELITIS Blackburn, England


An epidemic of poliomyelitis in Blackburn, Lancashire,
England and certain smaller contiguous communities has
given rise to 50 cases. Of these, 24 have been classified
as paralytic. The date of onset of the first case was June
28; the onset date of the last case reported in this series
is not known but laboratory confirmation was given on
September 1. Type I polio virus has been recovered from
each of the 50 patients, all of whom were either unvac-
cinatqd or inadequately vaccinated.

The first seven patients were under 20 years of age
and have a persistent paralysis; the remaining 43 patients
were all adults, 17 of whom were reported to have varying
degrees of paralysis.
The earliest cases occurred in a small community
within Blackburn itself. Four days after laboratory con-
firmation of a Type I polio virus infection had been
received, a mass immunization program using trivalent
oral poliomyelitis vaccine was undertaken in this com-
munity. Later, as cases were being confirmed elsewhere
in Blackburn, a mass program for the whole city was
carried out over 4 days.
In two communities contiguous to Blackburn where
single cases of polio had occurred, vaccination programs
were also undertaken.


(Reported by Dr. Lawrence K. Altman, Chief, Epidemiology
and Immunization Section, Division of Foreign Quarantine,
U.S. Public Health Service, Washington, D.C.)


T.-E MORBIDITY AND MORTALITY WEEKLY REPORT. WITH A CIRCULA-
TION OF 14000. IS PUBLISHED AT THE COMMUNICABLE DISEASE
CENTER. ATLANTA. GEORGIA.
CHIEF. COMMUNICABLE DISEASE CENTER JAMES L. GODDARD. M.D.
CHIEF, EPIDEMIOLOGY BRANCH A.D. LANGMUIR. M.D.
ACTING CHIEF. STATISTICS SECTION IDA L. SHERMAN. M.S.
CHIEF. SURVEILLANCE SECTION D. A. HENDERSON. M.D.
EDITOR' MMWR D.J.M. MACKENZIE. M.B..
F.R.C.P.E.

N ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY. THE COMMUNICABLE DISEASE CENTER
WELCOMES ACCOUNTS OF INTERESTING OUTBREAKS OR CASE IN-
IESTIGATIONS AHIC1 ARE OF CURRENT INTEREST TO HEALTH
OFFICIALS 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
JOTE THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE BASED
ON &EEKL TELEGRAMS TO THE CDC BY THE INDIVIDUAL STATE
HEALTH DEPARTMENTS. THE REPORTING WEEK CONCLUDES ON SAT.
JRDAY COMPILED DATA ON A NATIONAL BASIS ARE RELEASED ON
THE SUCCEEDING FRIDAY.


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