Morbidity and mortality

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Morbidity and Mortalit,



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

PUBLIC HEALTH SERVICE


Prepared by the


For release October 16, 1964


COMMUNICABL DISEASE C R


ATLANTA, GEORGIA 30333


PROVISIONAL INFORMATION ON SELECTED NOTIFIABLE DISEASES IN THE UNI
DEATHS IN SELECTED CITIES FOR WEEK ENDED OCTOBER 10, 1964

EPIDEMIOLOGIC NOTES


Meningococcol Infections
There were 43 meningococcal infections reported
during the 41st week, ending October 10, as compared to
29 for the 41st week in 1963. The cumulative number of
reported infections during the first 41 weeks of 1964 is
2092, whereas 1871 were reported for the same period
last year.
Certain bases of the Armed Forces have been
experiencing outbreaks of meningococcal meningitis
among new recruits. One of these, Fort Ord, California,
has reported 82 cases with 11 deaths among service
personnel, and 7 cases with 1 death among dependents
since January 1, 1964.
The State of California reports 409 cases of


meningococcal infections, including the Fort Ord cases,
between January 1 and September 30, 1964. These cases
have been scattered throughout the State. This is a
slight increase over the number of cases reported for the
same period last year.
There has been some small increase noted in the
percentage of sulfonamide-resistant strains in California.
The majority of strains have been identified as group B,
and the remaining strains were found to be group C.

(Reported by Dr. Henry A. Renteln, Bureau of Com-
municable Diseases, California State Department of
Public Health.)


Table 1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
41st Week Ended Cumulative. First 41 Weeks
Disease October 10, October 12, Median Median
1964 1963 1959 1963 1964 1963 1959 1963
Aseptic meningitis ................ 68 59 --- 1,630 1,445 ---
Brucellosis ...................... 8 9 9 335 295 481
Diphtheria ........................ 9 9 17 202 203 437
Encephalitis, primary infectious.. 134 23 --- 2,561 1,263
Encephalitis, post-infectious .... 4 --- 705
Hepatitis, infectious including
serum hepatitis ................ 650 798 798 30,414 34,317 34,317
Measles ........................... 800 857 913 436,944 361,744 390,194
Meningococcal infections .......... 43 29 38 2,135 1,900 1,730
Poliomyelitis, Total ............ 2 24 35 93 347 1,027
Paralytic ...................... 2 20 26 75 296 661
Nonparalytic ................... 3 --- 11 35 --
Unspecified .................... 1 --- 7 16 ---
Streptococcal Sore Throat and
SCarlet fever .................. 5,153 4,610 --- 315,224 268,524 ---
Tetanus ........................... 6 15 --- 220 219 ---
Tularemia ......................... 2 4 --- 263 226 ---
Typhoid fever ..................... 17 20 20 345 431 638
Rabies in Animals ................. 63 69 69 3,647 3,024 3,024

Table 2. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: 3 Psittacosis: Calif 1 36
Botulism: 11 Rabies in Man: 1
Leptospirosis: 36 Smallpox:
Malaria: Penn 1 76 Typhus-
Plague: Murine: Tex 1 22
R ky Mt. Spotted: d-1, Penn-1, Ala-1, Ga-2 211







Morbidity and Mortality Weekly Report


ENCEPHALITIS SURVEILLANCE SUMMARY


A total of 938 human cases of suspected arthropod-
borne encephalitis have been reported to the Encephalitis
Surveillance Unit thus far in 1964. Since final reporting
of arthropod-borne encephalitis is on an annual basis,
this represents a preliminary total based primarily on
epidemic investigations. and several special reports.
Since the establishment of the Encephalitis Surveillance
Unit in 1955, the previous high total of arthropod-borne
encephalitis for any one year was 625 cases, reported
in 1956. Six discrete outbreaks of St. Louis Encephalitis
and two mixed epidemics of Western Equine and St.


Louis Encephalitis have occurred in the United States
during 1964. The locations of the 1964 SLE epidemics
as well as all States where SLE virus activity has been
noted previously are shown on the map below. The
current outbreak in New Jersey is of particular interest
in that it represents the first time SLE activity has been
noted in that State.

Reports from States where outbreaks of encephalitis
or arthropod-borne virus activity of unusual interest have
been noted are summarized in this issue.


362


GEOGRAPHIC DISTRIBUTION OF SAINT LOUIS ENCEPHALITIS
(TOTAL VIRUS ACTIVITY IN MAN AND ANIMALS REPORTED TO CDC SINCE 1955)


History Of Virus Activity Within The
Outbreaks 1964








363


Morbidity and Mortality Weekly Report




STATE REPORTS


New Jersey
The New Jersey State Department of Health has
reported the occurrence of 80 cases, including 6 deaths,
of suspected encephalitis, which have occurred since
early August. As shown in the epidemic curve below, a
sharp increase in incidence occurred during early
September reaching a peak during the weeks ended
September 20 and 27 when 20 and 21 cases respectively
occurred. All cases reside in either Camden or Burlington
Counties, most in close proximity to the Delaware River.


Of these, 51 have thus far shown serologic evidence of
St. Louis Encephalitis infection. The age and sex
distribution of the cases, presented in the following
table, shows that the. majority of cases have occurred
among females over the age of 40.

(Reported by W. J. Dol.wr1.,, M. D., Director, Division
of Preventive Diseases, New Jersey State Department
of Health.)


REPORTED ENCEPHALITIS CASES BY AGE AND SEX
NEW JERSEY, 1964

AGE MALE FEMALE TOTAL
0-9 1 0 1
10.19 3 0 3
20-29 2 4 6
30-39 5 4 9
40-49 2 16 18
50-59 4 10 14
60-69 3 13 16
70.79 5 5 10
80-89 0 3 3
TOTAL 25 55 80


REPORTED CASES OF ENCEPHALITIS
BURLINGTON AND CAMDEN COUNTIES, NEW JERSEY

1964


r-


8 15 22 29 5 12 19 26 3
8 15 22 29 5 12 19 26 3 10


WEEK OF ONSET OF ILLNESS


I I








Morbidity and Mortality Weekly Report


Texas


Hale County: Sixty-eight cases of suspected enceph-
alitis have been reported thus far from Hale County, mid-
June 1964. An additional 8 cases have occurred in
immediately surrounding counties. More than 75 percent
of the cases had onsets of illness between August 8 and
September 5. In Hale County, the overall attack rate was
185 per 100,000, with higher attack rates noted in the
younger age groups. Five deaths, all serologically con-
firmed as WEE have occurred, all in children 2 years of
age or less. WEE virus has been recovered from both
brain and cerebrospinal fluid from one fatal case. There







Harris County (Houston): Through October 10, 1964
a total of 711 suspected cases of encephalitis, including
33 deaths, have been reported from the Houston metropol-
itan area. The epidemic appears to be essentially termi-
nated with only 10 cases reported with onsets of illness
since September 19. The age specific attack rates for the
227 cases with serologic evidence of recent SLE infection
is shown in the table below. The lowest rate, 8.5, is
found in the 0-9 year age group. There is a relatively
uniform rate between the ages of 10 and 49 followed by a
progressive rise with advancing age over 50. Thirty-one
of the 33 deaths have occurred in individuals over 50 years


have been 20 cases serologically confirmed as WEE and
4 confirmed SLE cases. Sera from 14 of the cases were
negative for both SLE and WEE.
Both the State Laboratory and the CDC Disease
Ecology Section, Technology Branch, Greeley, Colorado
have recovered WEE virus from mosquito pools of Cltez
tarsalis collected in Hale County.

(Reported by Dr. Van C. Tipton, Director, Communicable
Disease Division, Texas State Department of Health and
a team from the Communicable Disease Center.)







of age. Serologic study has been performed on 547 cases
thus far. Of these, 225 are classified as presumptive or
confirmed SLE, 49 are negative and 273 are inconclusive,
thus far.
SLE virus has been recovered from 10 mosquito pools
of Culex quinquefasciatus and from the blood of 2 wild
birds (1 bluejay; 1 mockingbird).

(Reported by Dr. Charles A. Pigford. Houston City-County
Health Officer, and Dr. Van C. Tipton, Director, Com-
municable Disease Division, Texas State Department of
Health and a team from the Communicable Disease Center.)


AGE SPECIFIC ATTACK RATES FOR CONFIRMED AND
PRESUMPTIVE CASES OF ST. LOUIS ENCEPHALITIS

Harris County, Texas, 1964

AGE CASES POPULATION (1000 s) RATE / 100,000

0-9 26 305 8.5
10-19 24 201 11.9
20-29 26 168 15.5
30-39 29 198 14.6
40-49 23 157 14.6
50-59 25 113 22.1
60-69 36 66 54.5
70-79 24 30 80.0
80+ 14 9 155.6


TOTAL 227 1244 18.2


364








Morbidity and Mortality Weekly Report


Pennsylvania

Two reported cases of encephalitis, one ser-
ologically confirmed to be SLE have recently occurred in
Bucks County. Both cases reside directly across the
Delaware River from the epidemic area in New Jersey.

(Reported by W. D. Schrack, Jr., M. D., Director, Division
of Communicable Disease Control, Pennsylvania De-
partment of Health.)




Illinois

Two outbreaks of St. Louis Encephalitis have been
reported from southern Illinois. In addition, a single case
of serologically confirmed Western Equine Encephalitis
has occurred in central Illinois.

1) Eleven cases of confirmed SLE, including 2
deaths have been reported from McLeansboro. The dates
of onset ranged from July 18 to September 3. Nine of the
11 cases occurred in persons over age 60. Dr. Robert
Kokernot, Director of the Zoonoses Research Center of
the University of Illinois reports that 31 of the first 50
pools of Culex pipiens studied to date have yielded SLE
virus. SLE virus has also been recovered from the blood
of 3 wild birds (2 sparrows; 1 catbird).

2) A total of 11 serologically confirmed cases of
SLE including one death, have been reported from the
Edwardsville-Alton area (northeast of St. Louis). The
onset dates ranged between August 22 to September 24.

3) An isolated case of serologically confirmed WEE
occurred in a 9 year old male from Urbana, Illinois who
became ill on September 3.

(Reported by Dr. Norman J. Rose, Chief, Bureau of Epi-
demiology, Illinois Department of Public Health.)




Florida

Four serologically confirmed cases of Eastern
Equine Encephalitis have been reported with onsets
since June 1, 1964. The cases occurred in 4 widely
scattered counties in the central and northern areas of
the State. The ages of the cases were 5, 6, 17, and 38
years; 2 deaths occurred. The most recent case became
ill on July 22.
More than 80 cases of EEE in horses have been re-
ported. The peak incidence occurred during June and


July. Serologic or virologic confirmation has thus far
been made in 15 cases. EEE virus has been recovered
from pools of mosquitoes collected in 2 areas of the
State where human cases occurred.

(Reported by Dr. Charlton Prather, State Epidemiologist,
Florida State Board of Health.)




Colorado

A total of 40 cases of suspected encephalitis
including 2 deaths has been reported from Colorado. The
onset dates range from July 20 through September 18.
Though scattered cases have occurred in several areas
of the State, small discrete outbreaks have occurred in
Adams County (Suburban Denver), Lajunta and the Fort
Collins area. Available data suggests no predilection for
any age group. Confirmatory or presumptive serologic
evidence of Western Equine Encephalitis has been
obtained in 12 cases. Five cases show confirmatory or
presumptive serologic evidence of St. Louis Encephalitis.
Western Equine virus was isolated from 7 of 21
pools of Culex tarsalis mosquitoes collected in Weld
County, Colorado between August 3 and September 2.
A number of suspected cases among horses have occurred
during 1964. Of fourteen paired horse sera studied thus
far, 9 showed diagnostic titer rises to WEE.

(Reported by Dr., C. S. Mollohan, Chief, Division of
Epidemiology, Colorado State Department of Public
Health and a team from the Communicable Disease Center
Disease Ecology Section, Technology Branch, Greeley,
Colorado.)





Tennessee
Four cases of suspected encephalitis, including one
death, have been reported from Memphis. The dates of
onset were between August 20 to September 21. All
occurred among elderly Negroes living in one sector of
the city. Thus far, one case has been serologically con-
firmed as SLE.
SLE virus has been recovered from 2 mosquito pools
of Culex quiquefasriatus-pipiens collected in Memphis
during the period September 8 through 11.

(Reported by Dr. Cecil B. Tucker, Director, Division of
Preventable Diseases, Tennessee Department of Public
Health.)


365







Morbidity and Mortality Weekly Report


Indiana
A total of 19 cases of suspected encephalitis in-
cluding 2 deaths have been reported from southern In-
diana. Fourteen of the cases occurred in Vanderburgh
County (Evansville) and 5 cases were from adjacent
counties (Warrick, Gibson, and Posey). The onset dates
of the cases ranged from August 21 through September 30.
A peak occurred during the first half of September. Most
of the cases (including both deaths) have occurred in
persons above the age of 40. Thus far, 8 cases have
been serologically confirmed as SLE. Further laboratory
studies are in progress.

(Reported by Dr. A. L. Marshall, Jr., Director, Division
of Communicable Disease Control, Indiana State Board
of Health.)


Kentucky
Thirty-two cases of suspected encephalitis, in-
cluding one death, were reported in Boyle County (Dan-
ville) during August and September. A peak incidence
occurred in early September. The most recent case be-
came ill on September 22. To date, sera from 13 cases
show presumptive evidence of recent SLE infection. SLE
virus has been recovered from one mosquito pool of
Culex pipiens. An additional 10 cases of suspected
encephalitis, including one with presumptive serologic
evidence of SLE, have been reported from adjacent
counties.

(Reported by Dr. William McBeath, Director, Preventive
Medicine and Epidemiology and Mr. Clifford Todd,
Epidemiologist, Kentucky State Department of Health.)


MEASLES Bonin Islands


An epidemic of measles afflicted 117 of the 203
residents of one of the Bonin (Ogasawara) Islands in the
Northern Pacific during June and July 1963. The index
case was a 16-year-old girl who had returned from Guam,
where she attended school, and where she had been ex-
posed to measles. Within 14 days following the appearance
of her rash, secondary cases occurred. No deaths were
reported in the epidemic. The only complication occurred
in a 16-year-old girl who exhibited bizarre behavior for
the 2 weeks after her illness with measles.


The distribution of cases according to age groups is
shown in the following table.

This was the first measles epidemic in at least 18
in this community.

(Abstracted from report in U.S. Navy Medical News Letter,
Vol. 43, No. 7, April 3, 1964 by Dr. D. A. Passick; and
Captain Jack W. Millar, Director, Preventive Medicine
Provision, Department of the Navy, Bureau of Medical &
Surgery, Washington, D.C.)


Total
Age Pop. in No. Attack % Total Cumulative
Group Age Group Cases Rate Cases %


0-4
5-9
10-14
15-19
20-24
25-29
30-49
50>


22
29
36
26
10
6
47
27


30
25
35
25
6
2
3
1


91
86
97
96
60
33
6
4


17
21
30
21
5
2
3
1


203 117 58% 100%


366


TOTAL








Morbidity and Mortality Weekly Report


TOTAL DEATHS REPORTED IN 108 CITIES


The weekly average number of total deaths in 108
cities for the four-week period ending October 10 was
11,038 as compared with an expected weekly average of
11,020.


TOTAL DEATHS RECORDED IN 10 U.S. CITIES
A'.ror Num.b p. W..k by Fur-W, k Pfrtodf


NUMSER ----- r


OF

DEATHS


,NFLLJCNLA Ag


I ,JatENUCZA B l
i2X. I CC
Oh Jfk


,,a 0!,-.!..


Week Ending 4 Week Weekly
9/19 9/26 10/3 10/10 Total Average
Observed 11,164 11,051 10,835 11,102 44,152 11,038
Expected 10,875 10,964 11,065 11,177 44,081 11,020
Excess 289 87 -230 -75 71 18


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1111nI


(See Table Page 371)


INTERNATIONAL NOTES QUARANTINE MEASURES
Immunization Information for International Travel
1963-64 Edition
Public Health Service Publication No. 384

SECTION 5


Senegal, page 31, Insert:
Under smallpox add "Six months of age and over."

Spanish Guinea, page 34
Delete all information related to yellow fever.

Tunisia, page 35

Under smallpox delete "and from Italy."





ASIA
Sabah, page 53, Insert the country and add the following:
Smallpox vaccination is required for all arrivals from in-
fected areas.
Cholera vaccination is required for all arrivals from in-
fected areas, 1 year of age and over.
Yellow fever vaccination is required for all arrivals from
infected areas by air, 1 year of age and over.

Syria, page 54
Delete all information related to yellow fever.


Union of Soviet Socialist Republics, page 55 and 62
Delete previous information under smallpox and insert:
Smallpox vaccination is required for all arrivals except
China (mainland), North Korea, Mongolian People's Repub-
lic and countries in North America, Europe and Oceania.

Under cholera delete previous information and insert:
A certificate is required from arrivals from infected areas,
1 year of age and over.






EUROPE
Albania, page 56
Delete previous information under smallpox and insert:
Smallpox vaccination is required for all arrivals except
China (mainland), North Korea, Mongolian People's Re-
public, North Vietnam, countries in Europe, North America
and Oceania. This exemption is extended to travelers
who have been resident for more than 14-days in these
countries immediately before arrival in Albania.


(Continued on page 372)


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368 Morbidity and Mortality Weekly Report


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 10, 1964 AND OCTOBER 12, 1963 (41ST WEEK)


Encephalitis
Aseptic
Meningitis Primary Post-Inf. Poliomyelitis, Total Cases Poliomyelitis, Paralytic
Area
Cumulative Cumulative
1964 1963 1964 1964 1964 1963 1964 1963 1964 1963 1964 1963
UNITED STATES... 68 59 134 4 2 24 93 347 2 20 75 296

NEW ENGLAND........... 3 2 1 2 6 1 2 6
Maine.............. 2 2
New Hampshire...... .
Vermont............. 1 1
Massachusetts...... 1 2 1 3 1 3
Rhode Island....... 2 -
Connecticut........ 2 2

MIDDLE ATLANTIC...... 11 4 86 1 8 13 110 7 12 88
New York City...... 2 3 1 1 -
New York, Up-State. 4 4 10 8 9 5
New Jersey......... 3 78 2 1 2 1
Pennsylvania....... 2 5 1 8 101 7 82

EAST NORTH CENTRAL... 11 8 13 1 1 18 53 1 13 43
Ohio................ 4 1 3 2 8 2 4
Indiana............. 1 4 6 4 3 3
Illinois........... 4 3 5 1 1 5 16 1 5 15
Michigan........... 1 4 3 19 2 19
Wisconsin.......... 1 2 6 1 2

WEST NORTH CENTRAL... 9 3 9 9 6 7 5
Minnesota.......... 1 3 3 4 2 4
Iowa .............- 3 -
Missouri......... 2 4 3
North Dakota..... 1 1 1
South Dakota....... -
Nebraska............ 1 1 -
Kansas ............. 8 3 1

SOUTH ATLANTIC....... 3 1 7 1 13 25 59 1 10 20 51
Delaware.............- 1 -
Maryland............ 1 1 1 1 1
Dist. of Columbia.. 1 1 1 -
Virginia........... 1 7 15 5 10
West Virginia...... 1 2 1 3 1 3
North Carolina..... 10 3 -6 3
South Carolina..... 3 6 1 -3 5
Georgia............. 2 1 19 2 1 18
Florida............ 1 4 2 9 10 2 8 10

EAST SOUTH CENTRAL... 3 8 1 6 65 1 5 60
Kentucky .......... 6 -
Tennessee.......... 3 10 2 9
Alabama............ 2 1 1 2 48 1 2 44
Mississippi........ 1 1 7 -1 7

WEST SOUTH CENTRAL... 6 3 1 -- 9 23 8 22
Arkansas........... 1 4 3
Louisiana.......... 1 13 13
Oklahoma............ 2 2 2
Texas.............. 3 3 7 6 6 6

MOUNTAIN............. 8 11 1 8 5 1 5 4
Montana............. 1 1
Idaho.............. 1 1 1 1 1 1
Wyoming............ 1 2 2
Colorado............ 6 9 1 1 1 1
New Mexico......... 3 1 -
Arizona............... 1 2 2
Utah................ 2 -
Nevada............. -.

PACIFIC.............. 22 22 7 2 3 20 3 17
Washington......... 1 2 2 2
Oregon................. 1 2 1 1
California.......... 21 20 7 2 2 16 2 14
Alaska............... .
Hawaii............... .

Puerto Rico 5 4










Morbidity and Mortality Weekly Report 369


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 10, 1964 AND OCTOBER 12, 1963 (41ST WEEK) CONTINUED


Infectious Hepatitis
Brucellosis Diphtheria including Serum Hepatitis Typhoid Fever
Area Under 20 years Age
Cum. Cum. Total 20 years and over Unknown Cumulative Cum.
1964 1964 1964 1964 1964 1964 1964 1964 1964 1963 1964 1964

UNITED STATES... 8 335 9 202 650 348 256 46 30,414 34,317 17 345

NEW ENGLAND.......... 2 44 55 27 24 4 2,789 3,774 14
Maine.............. 39 13 10 3 881 1,698 -
New Hampshire...... 5 2 3 217 416 -
Vermont ........... 4 1 3 346 82 -
Massachusetts...... 2 5 23 9 13 1 622 1,016 6
Rhode Island.........- 153 89 6
Connecticut........ 10 5 5 570 473 2

MIDDLE ATLANTIC..... 5 1 8 139 71 68 6,741 6,819 2 57
New York City..... 1 4 18 6 12 1,029 1,060 2 29
New York, Up-State. 2 64 38 26 2,936 2,940 10
New Jersey......... 2 23 9 14 1,151 1,014 1
Pennsylvania...... 3 2 34 18 16 1,625 1,805 17

EAST NORTH CENTRAL... 3 48 8 119 69 46 4 4,785 5,517 4 77
Ohio............... 2 5 25 11 11 3 1,259 1,529 19
Indiana............ .- 1 1 4 1 3 412 501 2 23
Illinois................ 1 27 6 41 29 11 1 900 1,167 1 22
Michigan.......... 6 1 37 22 15 1,870 2,075 1 10
Wisconsin.......... 9 12 6 6 344 245 3

WEST NORTH CENTRAL... 3 140 27 30 14 15 1 1,628 1,519 27
Minnesota.......... .- 9 11 5 3 2 188 233 3
Iowa............... 2 87 3 1 2 249 271 4
Missouri........... 10 1 7 3 4 401 534 10
North Dakota....... 2 2 1 1 59 67 2
South Dakota....... 16 2 3 3 129 108 1
Nebraska............ 13 4 3 1 1 1 45 101 3
Kansas............. 1 3 7 8 5 3 557 205 4

SOUTH ATLANTIC ....... 33 4 49 65 35 30 2,869 3,492 2 68
Delaware........... 7 2 5 62 67 -
Maryland............ .- 9 4 5 533 432 6
Dist. of Columbia.. 6 5 1 57 98 -
Virginia........... 15 13 7 6 452 716 11
West Virginia....... 6 6 413 525
North Carolina..... 3 8 4 4 478 866 1 19
South Carolina..... 7 5 2 3 109 145 11
Georgia............ 12 4 25 1 1 86 151 5
Florida............ 3 17 10 4 6 679 492 1 16

EAST SOUTH CENTRAL.. 17 4 19 24 17 7 2,084 3,227 31
Kentucky........... 6 2 2 749 919 8
Tennessee.......... 5 2 16 9 7 735 1,253 15
Alabama............. 4 4 12 2 2 390 514 6
Mississippi....... 2 5 4 4 210 541 2

WEST SOUTH CENTRAL.. 2 39 30 46 25 19 2 2,378 2,420 4 29
Arkansas........... 6 5 3 2 225 273 13
Louisiana........... 4 8 8 2 6 581 488 1 5
Oklahoma........... 7 7 7 117 111 3 7
Texas.............. 2 22 22 26 13 11 2 1,455 1,548 4

MOUNTAIN ............ 30 3 48 13 3 32 1,833 2,201 1 10
Montana............ 5 2 2 1 163 287 -
Idaho.............. 7 7 259 359 -
Wyoming............ 1 1 58 27 1
Colorado............ 14 3 1 10 490 457 -
New Mexico......... 1 1 6 6 256 259 2
Arizona............ 2 2 14 14 409 507 1 7
Utah............... 26 1 1 147 288 -
Nevada............. 1 51 17 -

PACIFIC.............. 21 14 124 77 44 3 5,307 5,348 4 32
Washington ........ 13 7 1 6 545 928 2
Oregon............. 2 7 4 3 560 654 -
California......... 19 1 93 61 32 3,900 3,586 4 30
Alaska............. 17 11 3 3 198 142 -
Hawaii............. 104 38 -

Puerto Rico 1 11 16 11 5 787 693 1 12









370 Morbidity and Mortality Weekly Report


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
OCTOBER 10, 1964 AND OCTOBER 12, 1963 (41ST WEEK) CONTINUED


Streptococcal
Meningococcal Sore Throat and Rabies in
Measles Meningitis Scarlet Fever Tetanus Tularemia Animals
Area --- ----
Cumulative Cum. Cum. Cum.
1964 1964 1964 1963 1964 1963 1964 1964 1964 1964 1964 1964
UNITED STATES... 800 43 2,135 1,900 5,153 4,610 6 220 2 263 63 3,647

NEW ENGLAND........... 105 3 64 117 338 248 9 1 1 33
Maine.............. 7 1 6 17 22 13 1 28
New Hampshire...... 1 1 4 2
Vermont............ 3 4 4 12 1 2
Massachusetts...... 28 24 54 42 44 9 1 1
Rhode Island....... 28 10 11 19 14 -
Connecticut........ 38 2 19 27 243 176 -

MIDDLE ATLANTIC...... 59 7 279 255 204 153 19 2 108
New York City...... 14 1 37 39 7 8 -
New York, Up-State. 25 4 79 82 155 85 7 2 102
New Jersey......... 9 93 36 20 30 6 -
Pennsylvania....... 11 2 70 98 22 30 6 6

EAST NORTH CENTRAL... 169 5 299 294 431 341 3 42 20 5 520
Ohio............... 18 75 79 43 42 1 12 1 2 267
Indiana............. 35 2 49 41 71 69 1 10 2 22
Illinois........... 8 2 77 58 63 49 12 13 97
Michigan............. 68 1 68 87 153 136 1 7 1 52
Wisconsin.......... 40 30 29 101 45 1 3 3 82

WEST NORTH CENTRAL... 15 1 129 119 183 163 1 12 52 13 1,118
Minnesota.......... 1 29 23 4 16 1 2 3 341
Iowa............... 5 7 7 71 35 5 1 7 404
Missouri........... 3 57 34 32 12 1 4 26 171
North Dakota....... 3 1 19 13 43 25 55
South Dakota....... 3 3 6 17 12 1 15 1 81
Nebraska........... 6 25 34
Kansas............. NN 8 11 16 63 1 8 2 32

SOUTH ATLANTIC........ 85 7 429 351 528 567 54 1 26 9 502
Delaware........... 6 4 10 4 -
Maryland........... 2 1 32 50 84 12 3 1
Dist. of Columbia.. 13 6 5 1 1 1 -
Virginia........... 2 1 51 78 69 143 7 6 4 262
West Virginia...... 71 33 19 196 247 1 2 32
North Carolina..... 3 1 73 63 8 15 13 1 7 5
South Carolina..... 5 2 52 18 35 35 4 2
Georgia........... 1 63 28 21 3 4 11 1 109
Florida............. 2 1 106 85 100 107 21 1 2 91

EAST SOUTH CENTRAL.. 71 3 175 137 954 954 29 30 17 477
Kentucky........... 4 56 30 17 117 8 2 55
Tennessee.......... 63 1 56 62 932 785 11 20 8 348
Alabama............ 4 2 39 23 1 19 6 3 17
Mississippi........ 24 22 4 33 4 5 9 57

WEST SOUTH CENTRAL... 43 7 195 172 476 516 25 1 88 10 506
Arkansas........... 23 11 1 6 7 1 52 4 126
Louisiana.......... 2 3 122 70 1 2 4 5 2 48
Oklahoma........... 10 31 31 10 19 1 84
Texas.............. 41 4 40 60 443 498 14 12 3 248

MOUNTAIN............. 104 73 63 1,131 811 1 6 43 1 125
Montana............ 38 3 59 57 18 1
Idaho.............. 5 3 6 106 84 1 1 -
Wyoming............ 5 4 25 32 2 8 -
Colorado........... 20 12 19 574 266 8
New Mexico......... 15 29 4 61 159 1 48
Arizona............ 11 7 10 119 85 1 1 55
Utah............... 15 7 14 187 128 1 17 2
Nevada............. 10 3 11

PACIFIC.............. 149 10 492 392 908 857 1 24 3 5 258
Washington.......... 48 2 35 31 179 247 2 -
Oregon............. 18 21 28 8 11 1 10
California......... 61 8 417 312 536 369 1 21 2 5 248
Alaska ............ 5 7 12 21 58 -
Hawaii............. 17 12 9 164 172 1 -

Puerto Rico 90 30 7 10 6 59 24









Morbidity and Mortality Weekly Report




Table 4 (A). TOTAL DEATHS IN REPORTING ( ITIEs


(Tables 4(A), 4(B), 4(C), and 4(D) will be published in sequence covering a four-week period.)o


371


Area For weeks ending Area For weeks ending
Area 9 /26 10/3 10/10 Area 10/3 10/10

9/19 9/26 10/3 10/10 __9/19 9/26 10/3 10/0


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. ...........


241
31
24
15
57
16
18
26
49
64
13
29
27
59


44
24
141
47
24
37
57
96
1,502
35
403
217
32
96
25
28
71
44
23
38


66
30
682
178
197
106
62
366
35
33
33
20
47
172
26
121
27
39
40
108
70


75
13
34
126
30
114
70
196
60
62


195
40
30
24
52
17
17
24
42
64
9
44
30
56


35
28
140
34
32
26
61
96
1,587
34
497
191
44
111
22
25
53
35
19
22


58
40
700
176
204
114
94
332
45
43
41
40
39
135
36
110
32
20
41
97
56


51
34
38
148
28
118
60
222
72
57


258
33
23
18
34
22
18
20
52
67
16
61
23
58


54
30
132
37
22
42
75
69
1,471
39
435
175
50
89
20
28
52
51
36
29


52
25
688
152
206
99
78
359
43
48
39
14
48
144
13
123
20
22
31
96
47


70
13
41
108
39
113
54
221
87
36


274
44
27
27
66
24
21
26
49
59
8
43
21
57*


30
34
143*
48
37
35
59
115
1,723
41
487
185
50
109
28
38
66
34
33
33


78
30
718
149
190
116
81
353
38
50
31
31
54
145
37
116
26
24
22
97
48


53
22
43
151
21
108
69
235
57
39


SOUTH ATLANTIC:
Atlanta, Ga. .............. 164 108 126 103
Baltimore, M. ............ 238 249 243 218
Charlotte, N.C. ........... 26 33 52 38
Jacksonville, Fla. ........ 50 66 58 67
Miami, Fla. ............... 100 73 54 64
Norfolk, Va. .............. 59 37 53 49
Richmond, Va. ............. 78 78 71 88
Savannah, Ga. ............. 41 38 26 26
St. Petersburg, Fla. ...... 70 65 59 70
Tampa, Fla. ............... 65 45 79 58
Washington, D.C. .......... 233 197 155 180
Wilmington, Del. .......... 41 50 38 48

EAST SOUTH CENTRAL:
Birmingham, Ala. .......... 116 93 74 94
Chattanooga, Tenn. ........ 61 30 36 30
Knoxville, Tenn. .......... 46 28 32 19
Louisville, Ky. ........... 133 137 112 80
Memphis, Tenn. ............. 161 133 128 113
Mobile, Ala. .............. 38 39 56 43
Montgomery, Ala. ........... 38 20 39 29
Nashville, Tenn. .......... 115 95 104 104

WEST SOUTH CENTRAL:
Austin, Tex. .............. 36 43 25 23
Baton Rouge, La. .......... 34 15 30 28
Corpus Christi, Tex. ...... 22 43 22 24
Dallas, Tex. .............. 138 118 128 121
El Paso, Tex .............. 34 39 25 31
Fort Worth, Tex. .......... 53 74 75 77
Houston, Tex. ............. 199 196 192 202
Little Rock, Ark. ......... 59 74 59 60
New Orleans, La. .......... 183 157 170 188
Oklahoma City, Okla. ...... 81 85 63 84
San Antonio, Tex. ......... 107 102 111 89
Shreveport, La. ............ 33 51 46 51
Tulsa, Okla. ............... 50 44 66 30

MOUNTAIN:
Albuquerque, N. Mex. ...... 29 28 32 33
Colorado Springs, Colo. ... 28 19 30 19
Denver, Colo. ............. 115 114 115 111
Ogden, Utah........... ...... 15 20 9 12
Phoenix, Ariz. ............ 76 84 78 86
Pueblo, Colo. .............. 7 15 13 14
Salt Lake City, Utah....... 51 58 45 50
Tucson, Ariz. ............. 43 57 44 46

PACIFIC:
Berkeley, Calif. .......... 24 18 22 15
Fresno, Calif. ............ 56 47 47 53
Glendale, Calif. .......... 48 33 32 37
Honolulu, Hawaii............ 30 31 30 34
Long Beach, Calif. ........ 48 57 56 61
Los Angeles, Calif. ....... 559 484 521 463
Oakland, Calif. ........... 37 108 129 32
Pasadena, Calif. .......... 34 23 29 37
Portland, Oreg. ........... 99 116 100 90
Sacramento, Calif. ........ 67 70 63 69
San Diego, Calif. ......... 74 97 91 98
San Francisco, Calif. ..... 225 196 190 181
San Jose, Calif. .......... 40 40 45 41
Seattle, Wash. ............ 118 104 145 | 153
Spokane, Wash. ............. 45 62 44 i 53
Tacoma, Wash. ............. 37 39 43 42




OCurrent Week Mortality for 108 Selected Cities


4(A) Total Mortality, all ages...................
4(B) Pneumonia-Influenza Deaths, all ages........
4(C) Total Deaths under 1 Year of Age.............
4(D) Total Deaths, Persons 65 years and over.....


11,102
419
708
6,123


NOTF: All deaths by place of occurrence.


*Estimate based on average percent of divisional total.
Totals for previous weeks include reported corrections.




UNIVERSITY OF FLORIDA

1111111111 08864ill IU I2 81111111111111 II i111111
3 1262 08864 2888


Morbidity and Mortality Weekly Report


INTERNATIONAL NOTES QUARANTINE MEASURES
(Continued from page 367)


Guernsey, Alderney, and Sark, page 58

Delete previous information under smallpox and cholera
and insert: No certificate normally required.


Liechtenstein, page 60


Smallpox vaccination is required for arrivals from in-
fected areas and from all countries in Africa (except
Algeria, Libya, Morocco, Tunisia, United Arab Republic,)
in America (except Canada, the United States of America)
and Asia (except Israel, Jordan, Lebanon, Syria, Turkey.)


Luxembourg, page 60


Under smallpox add: "And from all countries in Africa,
Asia and America (except Canada and the UnitedStates
of America.)


Netherlands, page 60


Under smallpox add: "And from all countries in Africa,
Asia and America (except Canada and the United States
of America.)



Switzerland, page 62


Smallpox vaccination is required for arrivals from infected
areas and from all countries in Africa (except Algeria,
Libya, Morocco, Tunisia, United Arab Republic,) in
America (except Canada, the United States of America)
and Asia (except Israel, Jordan, Lebanon, Syria, Turkey.)


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L_^l^E^ o~r~-


THE MORBIDITY AND MORTALITY WEEKLY REPORT, WITH A CIRCULA-
TION OF 12.000 IS PUBLISHED BY THE COMMUNICABLE DISEASE
CENTER, ATLANTA. GEORGIA 30333.
CHIEF, COMMUNICABLE DISEASE CENTER JAMES L. GODDARD, M.D.
CHIEF, EPIDEMIOLOGY BRANCH A. D. LANGMUIR, M.D.
CHIEF, STATISTICS SECTION R. E. SERE LING. PH.D.
ASST. CHIEF, STATISTICS SECTION I. L. SHERMAN. M.S.
CHIEF. SURVEILLANCE SECTION 0. A. HENDERSON, M.D.
ASSISTANT EDITOR, MMWR PAUL D. STOLE M.D.
IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY, THE COMMUNICABLE DISEASE CENTER
WELCOMES ACCOUNTS OF INTERESTING OUTBREAKS OR CASES, SUCH
ACCOUNTS SHOULD BE ADDRESSED TO:
THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT
COMMUNICABLE DISEASE CENTER
ATLANTA, GEORGIA 30333
NOTES: THESE PROVISIONAL DATA ARE BASED ON WEEKLY TELE-
GRAMS TO THE COMMUNICABLE DISEASE CENTER BY THE INDIVIDUAL
STATE HEALTH DEPARTMENTS.
SYMBOLS:---DATA NOT AVAILABLE
QUANTITY ZERO
PROCEDURES FOR CONSTRUCTION OF VARIOUS MORTALITY CURVES
MAY BE OBTAINED FROM STATISTICS SECTION. COMMUNICABLE
DISEASE CENTER, PUBLIC HEALTH SERVICE, U.S. DEPARTMENT OF
HEALTH. EDUCATION, AND WELFARE, ATLANTA, GEORGIA 30333.


372


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