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COMMUNICABLE DISEASE CENTER / ~Jti^T *- I {'*** 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 ~- ' ' ''' ' '' ". '' ."' '''' .~ "'' '" .... .:. . .. ... . . 10 - 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. o o - W-- >w i-^s mmm m n 0 9 5 - C a-< o* o e rn Ed f SNIV. OF FL i DOCUMENTS DEP. I. D I-- O U.S DEPOSITORY c -43 cm "to I'0 -"n Om mo 324. |
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