Morbidity and mortality

fSZ2.(o/q cP/099





Morbidity and Morl



U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WEI


PUBLIC HEALTH SERVICE


Prepared by the


I COMMUNICA BLEDIA


For release May 15. 1964 ATLANTA, GEORGIA 30333 Vol. 13, No. 19

PROVISIONAL INFORMATION ON SELE(TFI) NOTIFIABLE DISI'ASE IN THI UNITED STATis AND ON
DEATH. IN SELECTED (ITIIS FOR %'WFl ENDED) MAY 9. 1964

DIPHTHERIA


A total of 14 cases of diphtheria was reported for the
week ended May 9. This brings to 88 the national cumula-
tive total thus far in 1964. For the comparable period of
1963, 109 cases were reported. The 1964 total is the
lowest ever recorded in this country for this period.
Four cases were reported from each of 3 States,
Maine, Minnesota, and Washington, while single cases
were reported from Georgia and Louisiana.
Maine's 4 cases bring to 7 its cumulative total for
theyear. All 7 cases occurred in aStare mental institution
in Augusta, and involved female patients aged 40 to '4.
Two of the cases were fatal. The first case occurred
March 25, the most recent one May 5. Two rounds of
immunization have been held for patients and staff;
cultures have been taken to detect carriers. Surveillance
of additional cases is being conducted.


Minnesota's 4 cases occurred in the vicinity of
Canby in Yellow Medicine County, which has reported 9
of the State's 10 cases this year. Six of the 9 cases have
occurred in one family, which refused immunization and
medical care, until late in the course of the disease. The
cases involved children, aged 4 to 1", and occurred from
March 31 through May 6. Two cases were fatal; a 4 year
old died of respiratory failure despite a tracheotomy and
administration of antitoxin late in the course of his
illness, and an 11 year old died of myocardial failure.
Three additional cases occurred in members of 3 other
families which had school or community contact with
this family of objectors.
Washington's cases were reported from Yakima
County, which has been the site of all 10 cases reported
in the State for 1964 (see page 158).


Table I. CASES OF SPECIFIED NOTIFIABLE DISEASES UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
19th Week Ended Cumulative, First 19 Weeks
Disease May 9, May 11, Median Median
1964 1963 1959 1963 1964 1963 1959 1963
Aseptic meningitis ................ 22 17 --- 511 409 .
Brucellosis ....................... 5 4 10 138 122 200
Diphtheria ........................ 14 2 9 88 109 264
Encephalitis, primary infectious .. 43 42 --- 624 540
Encephalitis, post-infectious ..... 31--- 312
Hepatitis, infectious including
serum hepatitis ................ 763 890 890 16,897 18,852 18,852
Measles ........................... 28,621 17,937 19,855 281,905 247,275 262,114
Meningococcal infections .......... 52 55 46 1,144 1,136 1,046
Poliomyelitis, Total .............. 1 3 10 25 51 146
Paralytic ...................... 1 2 8 19 45 96
Nonparalytic ................... ---- 5 2 ---
Unspecified .................... 1 --- 1 4 ---
Streptococcal Sore Throat and
Scarlet fever .................. 9,510 6,984 --- 202,742 176,856 ---
Tetanus ........................... 7 4 --- 72 72
Tularemia ......................... 5 1 --- 88 71 -
Typhoid fever ..................... 8 7 7 125 131 189
Rabies in Animals ................. 97 105 85 1,716 1,485 1,511


Table 2. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cuim.
Anthrax: 2 Psittacosis: 13
Botulism: 6 Rabies in Man:
Leptospirosis: 7 Smallpox:
Malaria: N. Y. Upstate-1, Vt.-l, Okla.-1 33 Typhus-
Plague: Murine 4
SRky Mr. Spotted: Wyo.-I, Va.-lI N.C.-l, Okla-1. PR-2 11


634-5131







.1,rbiility and Mlortalily ,,AI-klvy Reporl


DIPHTHERIA EPIDEMIC CASES BV wtE 01 ONST
YAKIMA COUNTY, WASHINCGON


of Ca-1
4
3

KR 11


MASS
IMMUNIZA' uN
CAMPAIGN
Round *I


MA 3,
IMuPNIZ AT .I
CAMP. 1-


14 2' 2B 4 11 I 1 B IS 2 29 14 21 29 4 11 I8 25 2 2
DEC JAN FEB MAR APR MA,
WELr ENOCD


DIPHTHERIA
Yakima Counrt', auihinicon has experienced a smol-
.I rine epidemic of liphihiria. trolling 10 cases, over a
4 month period from December through April (see epidemic
curve above). All cases occurred in the vicinity of the
Yakima Indian Reservation in lower Yakima alley e all
but one case involved Indians.
The epidemic was discovered in early Januarn when
the li anois of diphtheria was made in a l0-)ear-old
unemployed Indian male (case *2I who had become ill
December 17 with a sore throar, d sphagia and hoarseness.
Two days later he went to the U. S. Public Health
Service Indian Clinic with a temperature of 1000F. A
".Jirr% cra ish membrane" covered his large red tonsils.
lie had cellulitis of his soft palate and oropharynx, as
well as mild palatal paralysis. The clinical diagnosis
%as diphtheria or streptococcal pharngitis: the patient
rtnceC~ je penicillin after culture. ThL following morning
he appearedd much improved. ptnicillin therap. as,
continued ilor 10 Jays. The parent dls.ippearid from
folluo -up until Na v Year's E\c %hen hte nas ;s.en at a
hospital because of knee trauma. sulLered secondar,n to
alcoholic intoxicarion. At that time. rhi. positive results
of his throat culture became known and the patlcnt aas
gi\en 10.000 units of diphtheria .ntitoxin.
Investigation disclosedJ other cases, as %cll as -
diphtheria carriers among the household and classroom
contacts of the I cases 'see table below.
Rccause the cases and carriers were concentrated
amone the Indians. who had low lc\cls of immunization,
and who lil d in croadld households, the health officials


- Washington
conducted a mass imnunization campaign using let
iniectors between February I and 22.
While the immunization campaign was in progress, 2
unimmunized Indian children experienced exudative
pharyngiris and were later proved to be diphtheria (cases
5 and 6). By late April. -4 other cases were reported.
Three additional carriers were detected from among the
contacts of these 6 cases. None of the additional cases
or carriers received vaccinee in the first round.
Of the coral 10 cases, %ere mild and 3 moderately
severe with evidence of nasopharvngeal paralysis but
not of cardiac involvement, bull neck, pneumonia, or
nephritis. No racheostomies were performed. All survived;
only case one received diphtheria antitoxin. Laboratory
studies identified ,prnis strains in 9 cases, "ints in one.
Analysis of the carriers revealed that household
contacts were more at risk than school contacts, as seen
in the following table.
Type of Contact No. Cultured No. Positive % Positive


Household 154 9 5.8
School 60 1 1.6

Total 214 10 4.6
Health officials held the second round of the mass
immunization campaign April 28 through May 2. Approx-
imatclh one-half ol the county's Lower V\alle population
has responded to the 2 round-..
i* r l ,r, .Il / I. I.. r 11J. ., ( l. /,. i .,.II ,t. .f p,, P l i.rrI, .' ,.
H .; o' ) r, i \ ,i ti I' ,/,, t ill *ii..r ] ii h. I ,..i. ',i IHI, ri s, MI. ..
I'l ,'In, I !II till. I1. 1 1 t. ., ,-- I I, It l ,t ,. t .... ( (.. I


Immunization Status Symptoms Signs
Case Ethnic Date Fever Sore
No. Age & Sex Group Onset 10 Total Lost (max) Throat Paralysis Membrane Exudote


1.
2.'
3."
4.*
5.'"
6."
7.
8."
9.
10.


Indian
Indian
Indian
Indian
Indian
Indian
Indian
Mexican
Ind. Mex
Indian


12 8
12 17
17
18
2 12
2 12
4 1
43
4 12
4 18


0
0
3
1
0
0
0
Unknown
0
3


9 58
3 62





1 60


x
(103')
(101')
x


(99.6 )
(104.6')

(99.4')


**Contoct Case No. 2; *''Contact Case No. 7. t Blateral Olilis Med.a; x Yes; a No


158


*Contact Case No. 1;







Morbidity and Mortality Weekly Report


TETANUS New Jersey


Two cases of tetanus, both fatal and diagnosed
clhnicall',, were reported from New Jersey for the week
ended April 18. In neither case is the history of previous
retanus immunization known.
Case 1, a 29-year-old Negro female, consulted a
physician April 2, because of a -da', hisrorv of nuchal
rigidi(t and incrt sing trismus to the point where she
could not open her mouth. The patient a',e no history
of cuts, infections, or lacerations during the 3 months
prior to onset; no evidence of such could be found on
physical examination. She was admitted to a hospital,
where laboratory studies, including spinal tap and blood
cultures, were unre\ealing. A throat culture grew strepto-
cocci. A diagnosis of tetanus was made on the basis of
clinical evidence.
The patient was treated with 100,000 units of tetanus
antitoxin intravenously daily, l0,i000,u0ti units of Peni-
cillin daily, sedatives and muscle relaxants. On April 3,
a tracheostomy was performed because of respiratory
difficult; breathing was assisted with a respirator.
On April 6, the patient developed bronchopneumonia.
A broad spectrum antibiotic was added to the above
regimen. The patient became opisthotonic on April 7,
and died later that day.
At autopsy there were no abnormal findings on gross
examination. The results of the microscopic examination
are not yet available. The uterus showed no evidence of
a pregnancy; the diagnosis of a septic abortion appears
doubtful. A post-mortem vaginal culture was negative for
Clostridia.
Cose 2, a 58-%ear-old Negro female, sustained a 6-
inch cut on her left knee, after falling on outdoor stairs
April 2. She was taken to a hospital where the cut was
cleaned and repaired with cat gut and wire suture. She


was gi,. i-n tetanus toxoid and Penicillin. Four days later,
the patient saw a private doctor who described the wound
as red and inflamed. He treated her with a broad spectrum
antibiotic and Varidase, hot soaks and elevation of the
extremity. On April 7, the patient complained of trismus
and nuchal rigidity she was hospitalized with a Jiagno-
sis of tetanus.
On admission, the wound was opened and bathed
with a hydrogen peroxide solution. She received 20,000
units of tetanus antitoxin intramuscularly and an equal
amount intravenously, administered over a 12 hour period.
She also received 1,200,000 units of Penicillin. In the
evening the patient was sedated. She died the following
morning, April 8. The patient had no respiratory difficulty
or seizures during her hospitalization.
Gross examination at autopsy showed minimal cere-
bral edema and basilar congestion in both lungs. A smear
of the wound taken at autopsy showed gram positive rods;
a culture grew Clostridium welchii. Cl. tetani could not
be identified.

(Reported by William J. Dougherty, M.D., M.P.H., Director,
Division of Preventable Disease Control, New Jersey
State Health Department.)



Editor's Note: Fifty percent of wounds contaminated by
Clostridial organisms yielded more than one type of
Clostridial; the average number of species cultured per
contaminated wound was 2.62. C. tetani is more difficult
to isolate in the laboratory than C. welchii.


1MacLennan, J. D., Anaerobic Infections of War Wounds,
Lancet 2:')--'9, 1943.


INFANT DEATHS IN 108 CITIES


The weekly average number of infant deaths in 108
cities for the four-week period ending May 9 was 717 as
compared with an expected 716 weekly average.




Total Deaths Under One Year of Age Recorded in 108 Cities

Week Ending
Week Ending 4 Week Weekly
4/18 4/25 5/2 5/9 Total Average
Observed 665 737 747 720 2,869 717
Expected 720 717 715 713 2,865 716
Excess -55 20 32 7 4 1


DEATHS LUER ONE YEAR OFAGE IN 108 U.S CITIES
Avero" Num.br pr W.ek by Four-W-k P-rlodf


> 96 '9.65
* p.vCE or0, OCCUMft **cai.nTtO FM--A WCt


(See Table, page 16 )


159









160 Miirlidily and Morlalil reckly Report


Tablc 3. (.ASES OF SPECIFIED NOTIFIABLE DISEASES UNITED STATES

FOR WEEKS ENDED

MAY 9, 1964 AND MAY 11 1963 ( 19th WEEK)


Encephallt1i
Aseptic
Meningliis Primary Post-Inf. Pollomyel1tis, Total Cases Poliomyelitis, Paralytic
Area Cumulative Cumulative

1964 1963 196t. 196'. 1964 1963 1964 1963 196'. 1963 1964 1963
UNITED STAEc... 22 17 43 31 1 3 25 51 1 2 19 45

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

MIDDLE ATLANTIC...... 3 1 1 3 4 5 4 5
New York City ..... I I
New York, Up-State. 2 1 2 4 2 4
New Jersey.......... 1 1 1 -
Pennsylvania....... 1 3 1 I

EAST NORTH CENTRAL... 4 4 8 6 1 3 14 3 11
Ohio............... 1 1 2 2 4 2 3
Indiana............ 1 1 -
Illinois.......... 2 2 5 1 6 1 5
Michigan........... 1 3 3 1 3 3
Wisconsin........... -

WEST NORTH CENTRAL,.. 2 4 1 1
Minnesota.......... 2 2 1 1
Iowa............... 2 -- -
Missourl........... -- -
North Dakota....... -
South Dakota....... -
Nebraska.......... -
Kansas............. -

SOUTH ATANTIC....... 1 14 2 1 1 12 6 1 1 9 5
Delaware........... -
Maryland........... -
Dist. of Columbia.. 1 -
Virginia........... 1 2 1 1 1 1
West Virginia...... 1 1
North Carolina..... I 5 2 2 2
South Carolina..... 1 1 -
Georgia............ 1 1 1 -
Florida............ 12 1 4 2 1 4 2

EAST SOUTH CENTRA... 2 2 2 3 1 2
Kentucky........... -- -
Tennessee.......... 1 1 1
Alabama............. 2 1 2 1 1
Mississippi ........ 1 -

WEST SOUTH CENTRAL... 4 3 1 3 2 10 1 10
Arkansas........... -
Lou i sana........... 2 8 8
Oklahoma........... 1 1 -
Texas.............. 1 3 2 2 2 1 2

MOUNTAIN............... 3 1 2 1 1 1
Montana............. -
Idaho ............... 1 1
Wyomi np......... .. -
Cnl] rad ........... 1 1 1 -
New Mexico......... -
Arizona............ 1 -
t'rah ............... 1 -
Nevada............. 1 -

PACIFIC............... 8 6 7 16 10 -9
Washington......... 1 1
Oregon............ 1 1
California ......... 8 6 7 16 8 7
Alaska.............. .- -
Haa i ......... -

Puerto Rico 2 -- 2








Morbidity and Mortality Weekly Report 161


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

MAY 9, 1964 AND MAY II 1963 ( 19thWEEK) Con[inued


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 196'.

UNITED STATES... 5 138 14 88 763 403 296 64 16,897 18,852 8 125

NEW ENGLAND.......... 2 4 10 68 26 38 4 1,778 2,177 7
Maine... ...... 4 7 18 10 7 1 615 1,012 -
New Hampshire...... 3 2 1 134 151 -
Vermont............. 10 6 2 2 222 29 -
Massachusetts...... 2 3 6 1 5 345 640 4
Rhode Island....... 5 5 86 50 3
Connecticut........ 26 9 17 376 295 -

MIDDLE ATLANTIC...... 2 4 151 79 72 3,844 3,628 20
New York City...... 1 15 4 11 552 473 6
New York, Up-State. 1 74 48 26 1,703 1,620 4
New Jersey......... 2 35 9 26 709 570 1
Pennsylvania ....... 1 1 27 18 9 880 965 9

EAST NORTH CENTRAL... 17 6 143 83 52 8 2,579 3,003 3 28
Ohio............... 39 20 15 4 679 881 17
Indiana............ 1 5 4 1 220 275 1 4
1llinois........... 12 6 46 25 18 3 418 660 1 4
Michigan........... 2 48 31 17 1,082 1,037 1 3
Wisconsin......... 2 5 3 1 1 180 150 -

WEST NORTH CENTRAL... 4 74 4 18 35 20 7 8 973 856 10
Minnesota......... 2 4 10 6 4 1 1 85 147 -
Iowa............... 2 42 4 1 3 143 156 3
Missouri........... 4 12 9 2 1 247 334 3
North Dakota...... 2 1 1 38 21 -
South Dakota....... 1 12 1 97 36 1
Nebraska............ 10 20 64 -
Kansas.............. 1 2 7 12 6 6 343 98 3

SOUTH ATLANTIC....... 8 1 20 56 37 16 3 1,618 2,018 3 29
Delaware........... 1 1 35 27 -
Maryland........... 17 13 4 317 216 1
Dist. of Columbia.. 27 62 -
Virginia........... 2 7 2 4 1 236 451 1 7
West Virginia...... 3 3 275 307 -
North Carolina..... 1 11 7 4 311 530 1 10
South Carolina..... 3 56 79 2
Georgia............ 3 1 15 3 2 1 39 84 1
Florida............ 2 2 14 9 3 2 322 262 1 8

EAST SOUTH CENTRAL... 8 4 54 38 14 2 1,165 1,949 1 16
Kentucky........... 3 12 8 2 2 501 574 8
Tennessee.......... I 1 20 18 2 404 790 1 5
Alabama............. 3 2 14 6 8 163 278 2
Mississippi........ 1 1 8 6 2 97 307 1

WEST SOUTH CENTRAL... 1 10 1 14 71 46 23 2 1,232 1,266 1 8
Arkansas............ 1 2 2 2 131 149 1 4
Louisiana.......... 1 1 4 25 15 10 261 233 -
Oklahoma............ I 1 72 70 3
Texas.............. 6 10 43 31 10 2 768 814 1

MOUNTAIN............. 10 1 52 9 7 36 1,101 1,282 1
Montana............ 3 3 105 191 -
Idaho............... 14 14 97 197 -
Wyoming............ 3 1 2 37 20 -
Colorado........... 5 1 4 327 258 -
New Mexico ........ 1 1 6 3 2 1 168 158 -
Arizona............. 10 10 233 293 1
Utah............... 7 4 2 2 98 155 -
Nevada............. 1 7 7 36 10 -

PACIFIC............. 7 4 11 133 65 67 1 2,607 2,673 6
Washington........ 4 10 7 4 3 274 447 -
Oregon............. I 15 6 8 1 297 367 -
California........ 6 1 109 55 54 1,908 1,784 5
Alaska............. 1 1 78 59 -
Hawaii.............. 1 1 50 16 -

Puerto Rico 3 9 9 280 266 6









162 Mohrhidily and mortality <1eeklh Report


Tabcl 3. ( A.Fs OF SPH('IFI1) NOTIFIABLF DISEASES I NITID STATES

FOR WEEKs ENDLD

MAY 9, 19,(1 AN) MAY II, 1,)4 ( 19th W I K)- Continued


Sltr ipe. Ct 11
Meningococcal Sore Throat and Rabies in
M. i-l M. nin it ( Scarl' F'-v(-r T,.tanus Tularrmia Animals
Cumulative Cum. um. Cum.

1964 1964 1964 1963 1964 1963 196'. 196- 196- 1964 1964 1964.
I .ITFI' -TATF-... 28,621 52 1.14- 1,136 9,510 6,984 7 72 5 88 97 1,716

NE ENGLAND.......... 721 1 32 74 933 820 2 12
Mtine.............. 90 3 12 23 133 2 10
New Ii.rr.p-.Lr ...... 6 2 10 4 I
Vermont............ 37 1 2 12 17 I
Massachusetts........ 157 13 36 153 136 -
Rhode Island....... 80 2 6 57 61 -
Connecticut......... 351 1 13 16 678 469 -

MIDDLE ATLANTIC....... 2,849 6 108 161 566 523 3 4 36
New York City...... 652 19 22 37 31 -
New York, Ip-.tar. 617 4 42 53 370 303 4 35
New Jersey......... 827 14 23 71 85 2 -- -
Pennsylvania....... 753 2 33 63 88 104 1 I

EAST NORTH CENTRAL... 7,368 9 181 186 1,484 921 1 5 8 7 203
Ohio............... 1,053 3 51 52 257 123 I 1 4 105
Indiana............ 2,130 1 31 23 155 174 1 1 9
Illinois.......... 1,228 3 40 29 149 160 2 5 48
'l.hi,.in.......... 1,933 1 43 60 549 278 I 1 2 17
Wisconsin.......... 1,024 1 16 22 374 186 1 1 24

WEST NORTH CENTRAL... 2,082 4 70 70 392 229 3 1 22 46 564
Minnesota.......... 25 1 14 12 34 17 1 12 168
Iowa............... 1,596 3 3 125 89 1 1 11 190
Missouri........... 23 3 39 26 24 4 2 13 8 101
North Dakota....... 377 5 3 144 63 7 30
South Dakota....... 4 23 3 3 48
Nebraska........... 61 4 17 4 3 14
Kansas.............. hN 5 5 38 53 1 7 2 13

OUTH ATLANTIC....... 2,035 6 248 215 745 814 6 35 1 16 13 254
Delaware........... 11 3 1 2 8 -
Maryland........... 101 18 30 95 39 2 -
Dist. of Columbia.. 4 7 4 8 1 .
Virginia........... 830 2 29 52 234 418 4 3 6 163
West ViriniI ...... 299 1 19 12 217 152 1 1 2 15
North Carolina..... 20 42 33 14 15 2 10 4 2
South Carolina..... 230 1 40 13 29 76 3 -
Georgia............ 2 18 11 3 2 1 1 9 5 44
Florida............ 538 2 72 59 143 103 3 14 30

EAST SOUTH CENTRAL... 4,331 3 115 90 1,539 892 9 16 8 254
k, nt u-k............. 448 2 41 20 110 87 1 1 1 36
Tennessee.......... 1,532 38 41 1,316 779 4 11 7 208
Alabama............ 1,723 1 19 13 14 11 3 3 10
Mis-ilppl........ 628 17 16 99 15 1 1 -

WEST SOUTH CENTRAL... 4,142 4 105 117 626 623 8 3 20 10 255
Arkansas .......... 63 10 7 1 2 3 8 4 68
Louisiana.......... 4 1 80 49 2 3 3 28
Oklahoma........... 53 1 4 22 33 24 11 3 35
Texas.............. 4,022 2 11 39 590 599 3 1 124

MOUNTAIN..... .... 1,028 1 43 40 1,460 1,053 2 6 55
Montana............. 146 3 69 34 1 -
Idaho.............. 97 1 3 123 92 -
W "- 1*............ 23 3 1 14 50 I 2
Colorado........... 183 9 11 591 412 -
New Mexico......... 6 1 19 2 308 210 I 25
Arizona............ 451 3 6 174 145 30
Utah............... 122 2 11 180 100 3 -
Nevada ............. 6 3 1 10 -

PACTFTr .............. 4,065 18 242 183 1,765 1,109 7 7 83
Wl-hinv.,n.......... 1,506 I 19 15 7<7 -18 -
Or- e n ............. -50 16 10 17 26 I
Ca li rni. ......... 2,059 17 194 148 813 612 7 7 82
Alaska............. 32 6 5 103 39 -
Hawa.i .... ........ 18 7 5 85 14 -

Pucrt., Ri 28 1 15 1 1 26 9








Morbidity and Mortality Weekly Report





T.hlk (() TOTAL DEATHS L UNDER I YEAR OF A. E IN REPORTING (ITIFs



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


163


For weeks ending For weeks endLng
Area 4/25 5 5 Area 4/18 2
4/18 4/25 5/2 5/9 4/18 4/25 5/2 5/9


NEW ENGLAND:
Boston, Mass............... 16 23 7 10
Bridgeport, Conn.......... 2 1 4 3
Cambridge, Mass........... 1
Fall River, Mass.......... 3 I 1
Hartford, Conn........... 4 11 9 4
Lowell, Mass.............. 2 -
Lynn, Mass................. 1 -
New Bedford, Mass......... I 1
New Haven, Conn............ 3 2 4
Providence, R.I........... 4 5 5
Somerville, Mass .......... 1 2
Springfield, Mass......... 2 3 4 -
Waterbury, Conn........... 1 3
Worcester, Mass........... 4 2 1

MIDDLE ATLANTIC-
Albany, N.Y............... I 4 3 2
Allentown, Pa............. 1 2 1 1
Buffalo, N.Y.............. 7 8 16 6
Camden, N.J ... .......... 1 2 5 5
Elizabeth, N.J............ 3 1 9 2
Erie, Pa.................. 2 2 4 2
Jersey City, N.J........... 5 8 12 6
Newark, N.J................ 3 4 6 3
New York City, N.Y........ 75 113 86 81
Paterson, N.J........ ..... 2 2 1 3
Philadelphia, Pa.......... 23 32 21 25
Pittsburgh, Pa............ 11 5 4 11
Reading, Pa............... 1 1 3
Rochester, N.Y............ 12 7 10 5
Schenectady, N.Y. ......... 1 2 4 1
Scranton, Pa.............. 1 3 I
Syracuse, N.Y.............. 3 5 4 2
Trenton, N.J .............. 1 1 2
Utica, N.Y ................ 2 I1
Yonkers, N.Y.............. 3 1

EAST NORTH CENTRAL:
Akron, Ohio............... 5 5 6
Canton, Ohio............... 2 5 -
Chicago, Il .............. 41 34 48 36
Cincinnati, Ohio .......... 13 10 8 14
Cleveland, Ohio........... 25 3 12 26
Columbus, Ohio............ 7 5 8 7
Dayton, Ohio............... 4 8 5 9
Detroit, Mich............. 18 23 25 40
Evansville, Ind............ I I I
Flint, Mich..... ......... 4 1 5 5
Fort Wayne, Ind........... 5 6 2 1
Gary, Ind................. 2 3 7 1
Grand Rapids, Mich........ 2 3 3
Indianapolis, Ind......... 11 12 12 9
Madison, Wis............. 5 1 3 3
Milwaukee, Wis............ 11 11 7 11
Peoria, Ill............... 1 3 2 1
Rockford, Ill............. 2 -
South Bend, Ind........... 1 2 4
Toledo, Ohio............... 4 6 4 4
Youngstown, OhiL.......... 1 1 2

WEST NORTH CENTRAL:
Des Moines, Iowa........... 2 4 2 5
Duluth, Minn. .............. 3 1
Kansas City, Kans......... 3 4 3 5
Kansas City, Mo............ 6 14 4 14
Lincoln, NEbr............. 1 2 4
Minneapolis, Minn......... 9 7 4 2
Omaha, Nebr............... 10 15 4 4
St. Louis, Mo............. 17 7 17 11
St. Paul, Minn............ 2 4 4 4
Wichita, Kans.............. 6 2 5 4

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

NOTE: All dealbj bb placeof occurrence.


SOUTH ATL4ATIC:
Atlanta, Ca............... 6 14 2 10
Baltimore, Md............ 17 11 21 21
Charlotte, N.C ............ 2 2 5 5
Jacksonville, Fla........ 6 5 2 7
Miami, Fla ............... 4 6 4 3
Norfolk, Va.............. 7 1 3 9
Richmond, Va............. 3 7 5 3
Savannah, Ga.............. 1 6 2 2
St. Petersburg, la...... 3 3 2
Tampa, Fla ............... 2 5 2 3
Washington, D.C.......... 8 21 26 25
Wilmington, Del........... 3 2 3 2

EAST SOUTH CENTRAL:
Birmingham, Ala.......... 4 8 4 4
Chattanooga, Tenn........ 2 5 4
KnoX~,llc, Tenn.......... 2 4 3
Louisville, Ky............ 5 10 13 9
MEmphis, Tenn............ 14 10 6 12
Mobile, Ala............... 1 5 2
Montgomery, Ala........... 2 3 1
Nashville, Tenn........... 6 6 5 6

WEST SOUTH CENTRAl:
Austin, Tex............... 1 3 5 2
Bacon Rouge, La.......... 2 4 4
Corpus Chrisci, rex...... 3 I
Dallas, Tex.............. 9 14 12 13
El Paso, Tex.............. 3 4 3 7
Fort Worth, Tex.......... 6 4 5 7
Houston, Tex.............. 14 21 15 11
Little Rock, Ark......... 9 2 2 3
New Orleans, La.......... 16 14 26 17
Oklahoma City, Okla...... 9 6 7 3
San Antonio, Tex ......... 11 14 9 7
Shreveport, La........... 4 3 3
Tulsa, Okla.............. 2 2 1 4

MOUNTAIN:
Albuquerque, N. Mex...... 6 2 2 2
Colorado Springs, Colo... 4 1 2 2
Denver, Colo............. 12 10 10 15
Ogden, Utah.............. 2 1 3
Phoenix, Ariz............. 5 6 3 2
Pueblo, Colo ............. 1 1 -
Salt Lake City, Utah..... 5 2 3 1
Tucson, Ariz............. I1 6 2

PACIFIC:
Berkeley, Calif.......... 1
Fresno, Calif............ 5 6 3 3
Glendale, Calif.......... 1 1 1
Honolulu, Hawaii......... 3 8 3 7
Long Beach, Calif........ 3 5 5 7
Los Angeles, Calif....... 28 37 55 33
Oakland, Calif........... 4 1 6 6
Pasadena, Calif.......... 1 1 2
Portland, Oreg........... 2 3 7 5
Sacramento, Calif........ 1 2 4 4
San Diego, Calif......... 7 7 4 3
San Francisco, Calif..... 6 3 9 8
San Jose, Calif.......... 2 4 1 8
Seattle, Wash............ 4 6 4 10
Spokane, Wash............ 1 4 1
Tacoma, Wash......... ...... 3 4 1

San Juan, P.R.............. 3 1 (--' (---.


OCurrent Week Mortality for 108 Selected Cities

4(A) Total Mortality, all ages ...................11.180
4(B) Pneumonia-Influenza Deaths, all ages........ 437
4(C) Total Deaths under 1 Year of Age............. 720
4(D) Total Deaths, Persons 65 years and over..... 6,260









161


Morbidity and Mortality Weekly Report


INTERNATIONAL NOTES QUARANTINE MEASURES

CHOLERA Viet Nam


As of April 25, a total of 10,981 cases of cholera
11 Tor, including 607 deaths, has been reported through-
out the Republic of Vier Nam. Laboratory confirmation
was obtained in 2.094 cases, including 120 fatal cases.
The epidemic began in January and the disease has
since spread successively to most of the local areas of
the country. The ports of Saigon. Nhatrang, and Danang
(Tourane) are infected.


CHOLERA EL TOR
REPORTED CASES BY WEEK
SAIGON -196 4


UNIVERSITY OF FLORIDA


3 1262 08864 26-


In addition to the established procedures for reporting morbidity
and mortality, rhe Communicable Disease Center welcomes
accounts of interesting outbreaks or cases. Such accounts should
be addressed to.

Lawrence K. Altman. M.D.. Editor
Morbidity and Mortality Weekly Report
Communicable Disease Center
Atlanta, Georgia 30333



Note. There provl.ional date or*e Lamd on w.eeaIy telr***er M I e Ceimmu
cable Disease Caner by rbe individual Siere health department.
Symbols: Dara otr available
SQuanity nare
Procedures for consiruciaon of vaoriau mortality curve ay er e obrlned from
Statioillc Seclion. Communicable Disee Center, Public Health Service,
U. S. DDaort-nent> of Hoalth. Education, rnd Wlfare, Aflef.e, Georgsl 30YJ.


U N'v O r PL L
%4MPST DSOPT





US DEPOSITORY


25 1 8 i5 22 29 7
.IN FEB


'4 21 28 4 1 58 25 Wa.s
MAR APR


An epidemic curve of the cases of cholera reported
in Saigon since January is shown above. During the first
2 weeks of January, 197 cases were reported, the graph
depicts weekly reports after january 19.

(Retporrrd in (Lc'l, EpidemnoloRiral Record No. 18.
World Healtb Organization Mals I, l)9I,


The Mbrbidity and Mortality Weekly Report, with a circulation
of 11,000 is published by the Communicable Disease Center.
Atlanta. Georgio.

Chief. Communicable Disese Center James L. Goddard. M.D.
Chief. Epidemiology Branch A. D. Langmurr. M.D.
Chief, Sroatstics Section R. E. Serfling, Ph.D.
Asst. Chief, Statistics Section I. L. Shermon, M.S.
Chief, Surveillance Section D. A. Henderson. M.D.
Editor. MMWR L. K. Allman, M.D


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