Morbidity and mortality

Fs ;2. 0/


COMMUNICABLE DISEASE CENTER


Vol. 14, No. 1







Week Ending
January 9, 1965


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


INFLUENZA
Only limited, sporadic outbreaks of influenza have
occurred in the United States thus far this season (MMWR
Vol. 13, No. 49). None have been recorded in recent
weeks. The four areas where influenza activity has been
documented include: (1) Puerto Rico a low level but
widespread outbreak occurring from late summer through-
out the fall fror' which A2 viruses were isolated; (2)
Oregon focal outbreaks in the fall identified serologi-
cally as Ak influenza; (3) Hawaii relatively widespread
outbreaks primarily on Oahu Island beginning in late
September from which influenza B viruses were isolated;
and, (4) Maine limited numbers ofcases among students
at the University of Maine in mid-fall confirmed serologi-
cally as influenza B.

Table 1. CASES OF SPECIFIED N(
(Cumulative totals include revised


EPIDEMIOLOGIC NOTES






CON\TE TS


Tuberculosis Summary. . . .

Encephalitis November-December . .


Salmonella Report ....... .. 7

Summary of Reported Cases ci'yp~php i A 8

The Current Mortality Cha '. . .. -9

3TIFIABLE DISEASES: UNITE STATIfEt; e ; .'
and delayed reports through previous weeks)


. -6

. 7


Ist Week Ended Cumula Xirst Week
Disease January 9, January -, Median Median
1965 1964 1960 1964 1965 \ 964 '--- 1960 196w

Aseptic meningitis .......,......... 38 19 19 38 19 19
Brucellosis ....................... 8 3 4 8 3
Diphtheria ...................... 3 8 15 3 8 15
Encephalitis, primary infectious.. 31 18 --- 31 18 ---
Encephalitis, post-infectious ..... 5 8 --- 5 8 ---

Hepatitis, infectious including
serum hepatitis ................ 6.'5 625 691 685 625 691
Measles ............................ 5,203 3,191 5,895 5,203 3,191 5,895
Meningococcal infections ........ 50 37 37 50 37 37
Poliomyelitis, Total ......... .. 7 7
Paralytic .......-.... .... .... 3 3
Nonparalytc ................... --- ----
Unspecified ................ ..- --- ---
Streptococcal Sore Throat and
Scarlet fever .................. 8,667 6,810 6,810 8,667 6,810 6,810
Tetanus ............... .......... .. 3 3 --- 3 3 ---
Tularemia ......................... 4 9 --- 9 ---
Typhoid fever ...... ....... ......... 1 2 5 1 2 5

Rabies in Animals ................ 92 49 49 92 49 49


Table 2. NOTIFIABLE DISEASES OF LOW FREQUENCY

Cum. Cum.
Anthrax: Rabies in Man:
Botulism: Smallpox:
Leptospirosis: Trichinosis: Maine-I1
Malaria: Typhus-
Plague: Marine:
Psittacosis: Ariz.-1 1 Rky Mr. Spotted:






Morbidity and Mortality Weekly Report


TUBERCULOSIS SURVEILLANCE SUMMARY


During the last 10 years there has been a steady
decline in the reported number of new "active cases" of
tuberculosis and tuberculosis deaths.
Statistics for the nation as a whole show that the
number of new active cases reported annually declined
from 83,304 in 1953 to 54,042 in 1963, a decrease of 35
percent (see fig. 1). The new actne case rate, which was
53.0 per 100,000 population in 1953, declined 46 percent
to a rate of 28.7 in 1963. Tuberculosis death rates have
fallen somewhat more rapidly from 12.4 per 100,000 popu-
lation in 1953 to 5.1 in 1963.
TREND IN NEW ACTIVE TUBERCULOSIS CASES AND
DEATHS, UNITED STATES, 1953-1963

Tuberculosis
New Active Cases Te ss
deaths
Year Rate Rate
Number per Number per
100,000 100,000
1953.. ... 84,304 53.0 19,707 12.4
1954 . .... 79,775 49.3 16,527 10.2
1955. .. ... 77,368 46.9 15,016 9.1
1956 . .. 69,895 41.6 14,137 8.4
1957 .. .. 67,149 39.2 13,390 7.8
1958 . .. 63,534 36.5 12,417 7.1
1959 . .... 57,535 32.5 11,474 6.5
1960............ 55,494 30.8 10,866 6.0
1961 . ... 53,726 29.4 9,938 5.4
1962 . ... 53,315 28.7 9,506 5.1
1963 ............ 54,042 28.7 9,311 5.1


Except for the group 15 years of age and under, there
has been a continuing decline in new cases in recent
years. In the past 2 years, however, there has been an
increase in cases in the under-age-15 group. In 1960,
4,388 new cases were reported in this age group; in 1963
the number had risen to 6,485. The increased number of
new cases in children under 15 years of age was observed
for both white and nonwhite males and females (see fig.
2). This increase undoubtedly reflects in part the less
restrictive definition of an "active case," a change which
was introduced in 1961 and increasingly widely applied.
Where pre% iously the only primary cases "to be reported"
were those with demonstrated tubercle bacilli, the term
now includes primary tuberculosis if there is either labo-
ratory or X-ray evidence of active disease, but excludes
tuberculin converters and infant reactors without laboratory
or X-ray e% idence.


Tuberculosis incidence rates among nonwhite persons
of every age are much higher than for white persons. The
rates among males are substantially higher than among
females. In 1963, the new case rate for nonwhite males
was over 3 times as high as for white males, and the rate
for nonwhite females was 4 times as high as for white
females. Although all race-sex groups have shown a
marked decline in both new cases and rates since 1953,
the rates for new active cases have declined faster in
the white than in the nonwhite population. The greatest
change occurred among white females. The rise in non-
white female rates in 1961 and 1962 was due almost en-
tirely to an increase in new cases reported among chil-
dren (see fig. 3).


FIGURE 1


REPORTED TUBERCULOSIS-NEW ACTIVE CASES
UNITED STATES, 1953-1963


1 I 1 T -


CASES


80,000




60,000




40,000.




20,000.




0


'62 "63 64


1953 '54 '55


'56


'58 '59 '60 '61


'57






Morbidity and Mortality Weekly Report


FIGURE 3


NEW ACTIVE TUBERCULOSIS CASE RATES BY AGE
UNITED STATES, 1953- 1963


l's


65+

45-65


UNDER 5




5-14


1953'


'55' "57' "59' '61' .3' 1


YEAR


(Reported by the Tuberculosis Branch, CDC, and ab-
stracted from Reported Tuberculosis Data, 1964 Edition,
Public Health Service Publication No. 638. Additional
1963 data is included.)


NEW ACTIVE TUBERCULOSIS CASE RATES BY RACE AND SEX
UNITED STATES, 1953-1963

200-


NONWHITE MALE


NONWHITE FEMALE



WHITE MALE




WHITE FEMALE


1953 '55 '57 '59 '61 63
YEAR

Geographic Distribution of Tuberculosis
The geographic distribution of tuberculosis varies
greatly within the United States. In 1963, new case rates
ranged from a high of 113.4 per 100,000 population in
Alaska to a low of 6.8 in Iowa; the number of reported
new active cases in the States varied from 6,756 in New
York to 30 in Wyoming. In general, most tuberculosis is
found in areas where there are large concentrations of
population and where low economic circumstances prevail.
In addition, since the new case rates are much higher in
nonwhites, much of the tuberculosis can be further local-
ized to certain urban communities where large numbers
of nonwhites reside (see fig. 4 and 5).

Mortality
Tuberculosis deaths and death rates follow a pattern
similar to cases and case rates in age-sex and geographic
distribution. In 1962, 7.5 percent of all tuberculosis
deaths were ascribed to nonpulmonary forms of the disease.
The 1963 death rate of 5.1 per 100,000 population is
identical with that of 1962.


NEW ACTIVE TUBERCULOSIS CASE RATES*, BY AGE, RACE, AND SEX
United States, 1963

WHITE NONWHITE
Age Groups Total
Total Male Female Total Male Female
All Ages...................... ......... ........ 28.7 21.7 29.4 14.1 81.5 103.4 60.8
0-4 ..... .. .......... ...... ............ 14.9 9.4 9.4 9.4 45.1 44.8 45.4
5-14 ................. ...................... 9.0 5.2 5.1 5.4 31.8 31.4 32.1
15.24 ................. ............ .......... 17.1 11.1 11.4 10.8 59.9 56.6 63.1
25.44 ............... ........... ............. 32.4 21.9 27.0 16.9 114.6 146.2 87.0
45-64 ............ ..... ..................... 46.2 36.7 58.4 16.2 137.0 212.3 66.6
65 & Over ..................................... 58.2 51.4 81.8 27.4 140.4 213.6 77.3

Rote per 100,000 population.


FIGURE 2






Morbidity and Mortality Weekly Report

FIGURE 4

TUBERCULOSIS BY SIZE OF COMMUNITY, 19E

PERCENT OF CASES SIZE OF COMMUNITY


NEW
ACTIVE
CASES


SCITIES WITH 500,000 16,326
OR MORE POPULATION


30.6% CITIES WITH 250,000 4,
TO 500,000 POPULATION
53.5%

CITIES WITH 100,000 4040
\ TO 250,000 POPULATION


\7.6% ALL OTHER AREAS 28,519
EXCLUSIVE OF LARGE CITIES

UNITED STATES 53,315

NOTE: Large cities have high case rates but more than half of the new cases
are in areas outside of these metropolitan centers.


CASE
RATE


56.0


36.9



30.6


21.7


28.7


I I I


PERCENT
OF
CASES


30.6



8.3



7.6


53.5


100.0


FIGURE 5

TUBERCULOSIS CASE RATES BY STATE, AVERAGE 1960-1963


62






Morbidity and Mortality Weekly Report 5



NEW ACTIVE TUBERCULOSIS CASES AND CASE RATES BY STATE, 1962 AND 1963

New Active Cases Case Rate Per 100,000 Population Rank According to Rate
STATE Population July 1, 1963
1962 1963 1962 1963 1962 1963
UNITED STATES .... 53,315 54,042 28.7 28.7 .. .. 188,616,000
CONTINENTAL U.S... 52,698 53,526 28.5 28.5 .. .. 187,686,000
Alabama .......... 1,164 1,326 35.1 39.3 12 7 3,376,000
Alaska ........... 323 279 133.4 113.4 1 1 246,000
Arizona ........... 703 631 47.3 41.6 3 3 1,516,000
Arkansas ......... 660 672 35.8 35.3 11 11 1,902,000
California ......... 5,032 5,034(a) 29.5 28.7 18 22 17,539,000
Colorado .......... 294 289 15.5 15.1 39 38 1,918,000
Connecticut ........ 337 301 12.8 11.1 42 45 2,715,000
Delaware ......... 179 143 38.3 29.8 9 19 480,000
District of Columbia 599 474 75.9 59.4 .. .. 798,000
Florida ........... 1,439 1,563 26.4 28.3 25 25 5,531,000
Georgia .......... 1,189 1,261 29.1 29.9 20 18 4,217,000
Hawaii ........... 294 237 42.4 34.6 6 13 684,000
Idaho ............ 82 71 11.7 10.3 45 46 687,000
Illinois ........... 3,895 3,739 38.6 36.0 8 10 10,382,000
Indiana ........... 1,231 1,351 26.4 28.3 26 24 4,779,000
Iowa ............. 186 186 6.7 6.8 49 50 2,755,000
Kansas ........... 273 283 12.3 12.8 43 43 2,217,000
Kentucky ......... 1,316 1,190 42.7 38.1 5 9 3,126,000
Louisiana ......... 1,060 1,068 31.4 31.3 17 14 3,415,000
Maine ............ 164 156 16.8 15.8 36 37 986,000
Maryland .......... 1,350 1,361 41.8 40.6 7 5 3,352,000
Massachusetts ...... 1,182 1,097 22.8 20.7 31 33 5,296,000
Michigan ........... 2,288 2,433 28.4 30.3 24 16 8,031,000
Minnesota ......... 501 456 14.4 13.1 41 42 3,492,000
Mississippi ........ 654 687 28.9 30.1 22 17 2,286,000
Missouri .......... 1,252 1,245 29.0 28.4 21 23 4,384,000
Montana .......... 116 127 16.6 18.1 38 34 701,000
Nebraska ......... 168 146 11.6 9.9 46 47 1,468,000
Nevada ........... 176 135 50.3 34.7 2 12 389,000
New Hampshire ...... 70 73 11.3 11.3 47 44 644,000
New Jersey ........ 1,533 1,634 24.1 24.9 29 28 6,554,000
New Mexico ........ 330 395 33.1 40.1 13 6 986,000
New York ......... 6,442 6,756 36.8 38.2 10 8 17,696,000
North Carolina ...... 1,344 1,386 28.6 29.0 23 21 4,787,000
North Dakota ....... 77 88 12.2 13.6 44 39 645,000
Ohio ............ 2,447 2,439 24.4 24.4 27 29 10,000,000
Oklahoma .......... 513 584 21.0 23.9 33 30 2,441,000
Oregon ........... 417 395 23.1 21.3 30 32 1,852,000
Pennsylvania ....... 3,340 3,113 29.3 27.2 19 27 11,425,000
Rhode Island ....... 173 154 19.7 17.3 35 35 892,000
South Carolina ...... 799 740 32.6 29.6 16 20 2,504,000
South Dakota ....... 120 96 16.6 13.6 37 40 708,000
Tennessee ......... 1,585 1,541 43.4 41.1 4 4 3,747,000
Texas (b) ......... 2,444 2,858 24.1 27.9 28 26 10,228,000
Utah ........... 47 80 4.9 8.2 50 49 971,000
Vermont .......... 58 54 15.0 13.3 40 41 405,000
Virginia (c) ......... 1,391 1,806 32.7 42.2 15 2 4,282,000
Washington ........ 655 640 21.8 21.6 32 31 2,961,000
West Virginia ....... 593 563 33.0 31.1 14 15 1,813,000
Wisconsin ......... 801 676 19.9 16.6 34 36 4,066,000
Wyoming ......... 29 30 8.7 8.8 48 48 339,000
Puerto Rico (d) ...... 1,816 1,852 73.8 73.4 .. .. 2,520,000

(a) Original PHS Report 1393 corrected August 1964.
(b) Increase in 1963 due to change in reporting procedures; now included are primary cases (424), and cases (256) from 86 counties
without organized health units.
(c) Increase in 1963 due primarily to more complete reporting of primary cases (437).
(d) Not included in totals.


The District of Columbia is classed as a city, and is not ranked with the states.







6 Morbidity and Mortality Weekly Report




TUBERCULOSIS DEATHS AND DEATH RATES BY STATE, 1962 AND 1963

Tuberculosis Deaths Death Rate Per 100,000 Population Rank According to Rate
STATE Population July 1, 1963
1962 1963 1962 1963 1962 1963
UNITED STATES .. 9,506 9,311 5.1 4.9 .. .. 188,616,000
CONTINENTAL U.S. 9,464 9,271 5.1 4.9 .. .. 187,686,000


Alabama ........
Alaska .........
Arizona .........
Arkansas .
California ..
Colorado .
Connecticut ......
Delaware ........
District of Columbia .
Florida . .
Georgia .........
Hawaii .........
Idaho ..........
Illinois . .
Indiana .........
Iowa ........ ...
Kansas . .
Kentucky .
Louisiana .
Maine . .
Maryland .
Massachusetts. .. ..
Michigan .
Minnesota .......
Mississippi .
Missouri .
Montana .
Nebraska .
Nevada ..
New Hampshire ....
New Jersey.... .
New Mexico ......
New York .......
North Carolina.....
North Dakota ......
Ohio . .
Oklahoma ........
Oregon ..........
Pennsylvania .....
Rhode Island......
South Carolina ....
South Dakota .....
Tennessee .......
Texas ..........
Utah ...........
Vermont .........
Virginia .........
Washington .......
West Virginia .....
Wisconsin .......
Wyoming ........


281
19
146
177
646
70
103
23
93
224
178
23
13
535
229
62
53
302
243
43
232
263
334
89
125
272
32
26
20
17
347
70
1,094
173
10
409
153
44
784
30
113
21
305
506
16
22
197
87
145
103
4


282
21
152
141
599
63
86
28
98
249
152
19
18
528
223
51
41
269
222
36
245
251
312
94
113
266
27
15
20
14
363
70
1,049
185
12
441
152
59
744
34
122
27
297
506
25
19
219
84
153
111
4


8.4
7.9
9.8
9.6
3.8
3.7
3.9
4.9
11.8
4.1
4.4
3.3
1.9
5.3
4.9
2.2
2.4
9.8
7.2
4.4
7.2
5.1
4.2
2.6
5.5
6.3
4.6
1.8
5.7
2.7
5.4
7.0
6.3
3.7
1.6
4.1
6.3
2.4
6.9
3.4
4.6
2.9
8.4
5.0
1.7
5.7
4.6
2.9
8.1
2.6
1.2


8.4
8.5
10.0
7.4
3.4
3.3
3.2
5.8
12.3
4.5
3.6
2.8
2.6
5.1
4.7
1.9
1.8
8.6
6.5
3.7
7.3
4.7
3.9
2.7
4.9
6.1
3.9
1.0
5.1
2.2
5.5
7.1
5.9
3.9
1.9
4.4
6.2
3.2
6.5
3.8
4.9
3.8
7.9
4.9
2.6
4.7
5.1
2.8
8.4
2.7
1.2


4
7
1
3
33
34
32
22

30
28
37
46
19
23
45
44
2
8
27
9
20
29
41
17
12
26
47
15
40
18
10
13
35
49
31
14
43
11
36
25
38
5
21
48
16
24
39
6
42
50


3,376,000
246,000
1,516,000
1,902,000
17,539,000
1,918,000
2,715,000
480,000
798,000
5,531,000
4,217,000
684,000
687,000
10,382,000
4,779,000
2,755,000
2,217,000
3,126,000
3,415,000
986,000
3,352,000
5,296,000
8,031,000
3,492,000
2,286,000
4,384,000
701,000
1,468,000
389,000
644,000
6,554,000
986,000
17,696,000
4,787,000
645,000
10,000,000
2,441,000
1,852,000
11,425,000
892,000
2,504,000
708,000
3,747,000
10,228,000
971,000
405,000
4,282,000
2,961,000
1,813,000
4,066,000
339,000


Columbia is classed as a city, hence is not ranked with the states.


I ______ __________ ______


NOTE: The District of







Morbidity and Mortality Weekly Report




REPORTED CASES OF POST.INFECTIOUS AND POST-IMMUNIZATION
ENCEPHALITIS FOR NOVEMBER AND DECEMBER
NINE WEEKS FROM 11.7.64-1.2.65


Post-Immunization
State Mumps Chickenpox Measles Rubella Influenza Herpes Respiratory t-mmuniz
Simplex Syncitial Post-Vaccinial Post-Pertussis
Arkansas ........ .... .. ...... 1 ..... 1 ..... ....... ......... .......
California ........ 26 ........ 2 .. .. ..... .. ........ .........
Georgia .......... .... ........ 2 ... ...... .... ....... ......... .........
Illinois .......... 3 1 1 ..... .. .. ...... ........ ........
Iowa ............ 1 ........ ...... ..... .... ..... ........ .. ...... .. .......
Nebraska ......... 1 ........ ...... ..... ...... .... ........ .......... ..........
New York, Upstate ... 1 2 ...... ..... ...... ..... ........ 1 ....
Pennsylvania ...... 4 1 ...... ..... 1 ....... ...... .. ....
Rhode Island ...... 5 ........ 1 .. ...... ........ .......... ..........
Virginia......... 1 .. ..... ... ...... ..... ..... .. ........ ........
Washington ........ 2 .. ... ... ..... .. ........ ........
U.S. Total ........ 44 4 7 ..... 2 ..... ........ 2 ..........

U.S. Cumulative Total*
Through 1/2/65 480 64 182 34 12 10 1 3 1


* Includes revised and delayed reports.


(States not reporting a case not listed)


SALMONELLA REPORT


During November 1964, 1,595 human isolations of
salmonella were reported to the Salmonella Surveillance
Unit for an average number of isolations per week of 339.
This represents a decrease of 63 from the figure for
October 1964 but an increase of 144 isolations over the
figure for November 1963. The decrease from October to
November in 1964, parallels that seen during the same
period in 1963 and is felt to be related to seasonal varia-
tions.
The 7 most frequently reported serotypes accounted
for 62 percent of all isolations although representing only
10 percent of the 70 different serotypes reported during
the month. The 7 commonest serotypes isolated and their
respective frequency calculated as a percentage of total
isolates is shown below.
Salmonella typhi-murium and
S. typhi-murium
var. copenhagen 27.0 percent
S. infants 7.7 percent
S. heidelberg 7.3 percent
S. newport 6.7 percent
S. enteritidis 4.9 percent
S. derby 4.3 percent
S. oranienburg 3.8 percent
There were 479 nonhuman isolates reported in
November, representing a decrease of 73 from the previ-
ous month. The commonest nonhuman isolate was S.
typhi-murium and S. typhi-murium var. copenhagen which
accounted for 19.6 percent of all nonhuman isolates.


REPORTED HUMAN ISOLATIONS OF SALMONELLAE
IN THE UNITED STATES
1963-1964


1964






Morbidity and Mortality Weekly Report


SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS


CASES OF PRIMARY AND SECONDARY SYPHILIS:


BY REPORTING AREA DECEMBER 1964 AND DECEMBER 1963 PROVISIONAL DATA


Cumulative Cumulative
Reporting Area DECEMBER JAN. DEC. Reporting Area DECEMBER JAN. DEC.
1964 1963 1964 1963 1964 1963 1964 1963
NEW ENGLAND. ............. 42 39 48.. 65 EAST SOUTH CENTRAL......... 171 109 1,921 1,537
Maine ................... 2 1 8 12 Kentucky ................. 20 10 178 149
New Hampshire............. 10 5 Tennessee ................ 38 34 479 400
Vermont ................. 3 7 Alabama .................. 78 56 902 695
Massachusetts........... 21 27 284 300 Mississippi.............. 35 9 362 293
Rhode Island............. 1 1 18 14
Connecticut.............. 17 10 161 127 WEST SOUTH CENTRAL........ 182 195 2,596 2,694
Arkansas................. 22 17 227 201
MIDDLE ATLANTIC........... 470 518 5,454 6,171 i Louisiana ................ 55 44 737 560
Upstate New York......... 42 70 635 711 Oklahoma .............. 16 23 151 198
New York City............ 299 288 3,180 3,489 Texas .................... 89 111 1,481 1,735
Pa. (Excl. Phila.)....... 16 13 182 173
Philadelphia.............. 22 30 309 611 MOUNTAIN................ 35 43 532 491
New Jersey............... 91 117 1,148 1,187 Montana.................. 1 I 32 14
Idaho..................... I 1 8 8
EAST NORTH CENTRAL......... 249 157 2,487 1,964 Wyoming.................. 1 8 16
Ohio...................... 58 52 584 433 Colorado................. 2 4 35 37
Indiana ................. 5 5 70 56 New Mexico............... 10 21 180 148
Downstate Illinois....... 22 7 160 119 Arizona.................. 14 10 219 194
Chicago .................. 103 47 979 849 Utah..................... 1 10 17
Michigan.................. 58 41 622 453 Nevada................... 6 5 40 57
Wisconsin................ 3 5 72 54
PACIFIC................... 178 223 2,308 2,251
WEST NORTH CENTRAL........ 44 41 552 490 Washington............... 2 6 73 124
Minnesota ................ 9 4 124 75 Oregon................... 5 15 76 71
Iowa ,..................... 4 3 37 29 California............... 167 200 2,131 2,028
Missouri................. 19 15 253 224 Alaska................... 1 9 8
North Dakota............. 4 Hawaii................... 4 1 19 20
South Dakota.............. 5 9 53 39
Nebraska................. 4 6 56 60 U. S. TOTAL............... 1,875 1,724 23,171 22,251
Kansas................... 3 4 29 59
TERRITORIES............... 73 39 874 841
SOUTH ATLANTIC............ 504 399 6,837 6,188 Puerto Rico.............. 71 31 88*5 825
Delaware................. 3 4 84 53 Virgin Islands.......... 2 8 29 16
Maryland................. 38 29 513 542
District of Columbia..... 36 40 698 676
Virginia................. 20 24 307 329
West Virginia............ 8 8 59 47
North Carolina........... 138 49 1,176 874 Note: Cumulative Totals include revised and delayed reports
South Carolina........... 58 46 860 721 through previous months.
Georgia.................. 83 64 1,137 1,063
Florida.................. 120 135 2,003 1,883


THE CURRENT MORTALITY CHART


Weekly deaths in 122 United States cities are pre-
sented in the accompanying figure. The reported numbers
are shown as dots joined by line segments. The solid
line for each mortality category is the expected number of
deaths. The dashed line, 1.65 standard deviations above
the expected number is the "epidemic threshold," a cri-
terion for recognition of significant deviations in excess
of the expected number. The vertical bars joining the
curve of expected numbers with the epidemic threshold
are in alignment with the divisions of the scale at the
bottom of the chart which mark 4-week time periods. The
vertical scale of each mortality curve is the same when
measured in standard deviation units.
Previous charts were based on data for 108 cities
but since the autumn of 1957 reports have been received
from 14 additional cities. The present charts, constructed
from data for the period 1959-63, include these cities. All
of the 122 reporting cities are listed in Table 4, the for-
mat of which has been altered to provide a weekly record
of deaths by each of the four categories. The table will
be published each week, the chart periodically.

The Data
The deaths reported are those recorded each week in
the Vital Statistics Offices of the 122 cities. They are by
place of occurrence of death, thus including deaths of
persons whose residence may be elsewhere and not in-
cluding deaths of residents which occur in other vital


statistics jurisdictions. The report is a count of deaths
certificates filed; so that each week the deaths recorded
include some which happened during the preceding week.
The number of delayed certificates usually increases
during holiday periods, causing a negative deviation
during the holiday week, followed by a positive deviation
when the delayed certificates are included in the report
for the succeeding week.
The population of the central cities of the 122 re-
porting cities was 49,566,346 in 1960 but inclusion of the
urban fringe population increases this total to 82,304,118.
Since the central cities frequently include hospital facili-
ties and nursing homes which provide services to sur-
rounding areas, the principal population in which the re-
ported deaths occur is in the range of 50-80 million per-
sons. Because of this great range the charts show the
number of deaths rather than the death rate. In order to
compensate for secular change in number of deaths as a
result of changes in population, hospital facilities and
death rates, a linear secular trend component, described
in the table (p. 9), is included in the estimation of the
expected number of deaths.


Excess Mortality
During influenza epidemics marked excess pneumonia-
influenza mortality extending over a period of several
weeks is characteristic. This is evident on the chart for






Morbidity and Mortality Weekly Report


the period early in 1963. For a full account see Collins
(1957) and Langmuir et al., (1964). Associated increases
in deaths from all causes also may be observed. These
are primarily deaths assigned to heart diseases and other
chronic conditions. The relationship to influenza epi-
demics has been discussed by Eickhoff et al., (1961) and
by Collins and Lehman (1953).
Excess mortality in the 122 cities during influenza
epidemics since the pandemic of 1957-58 is given in
Table 1. Influenza A2 first appeared in the United States
in the summer of 1957. Excess mortality became noti-
ceable in October, rose to a maximum during the week
ending November 2nd and then decreased to near the ex-
pected numbers in late December. This was the first
early autumn episode of this kind since the 1918 pan-
demic. In early 1958 excess mortality rose again, reaching
a peak during the week ending March 1. This "second
wave" appeared at the usual time of excess epidemic mor-
tality. Outbreaks of Influenza A2 accompanied by marked
excess mortality occurred again in early 1960 and in early
1963. During these epidemics excess mortality was of the
same order of magnitude as during the second wave of
1957-58.
Minor influenza Type B epidemics were observed in
1952 and 1955 but the first major recurrence since 1944
took place in 1962. In this epidemic excess mortality re-
corded for both pneumonia-influenza and deaths from all
causes was lower than in the Type A2 epidemics of the
1958-63 period. Excess mortality among persons under
65 years of age was negligible.
Brief periods of excess mortality may be observed in
summer months during severe heat waves. An account of
two recent episodes in the East North Central States has
been given by Schuman et al., (1964). One of these oc-
curring in the 7th period of 1963, is reflected in the data
for the 122 cities.
Martin and Bradley (1960) report increased mortality
in London immediately following days of heavy fog and
atmospheric pollution but it seems unlikely in this coun-
try that such occurrences would happen simultaneously in


a sufficiently large number of cities to cause marked up-
ward deviations in the combined reports of the 122 cities.


Construction of the Mortality Curves
The curves of expected mortality are of the form


Expected Deaths U + rt + Z A. cos (0t + i).
i-1


In this equation r is a linear trend coefficient, posi-
tive except in the curve for deaths under one year of age;
the cosine function describes the seasonal variation. The
procedures employed, using data for the period September
1959 through August 1963 differ from those previously
described, (Serfling, 1964) by inclusion of a second co-
sine term. In the earlierstudies, using data for the period
1954-1960, only a single cosine term was required. Least
squares estimates of the parameters of equation (1) were
obtained by an analytical inversion of the coefficient
matrix of the normal equations, a modification of the
method given in the paper cited.
As described in that paper the epidemic threshold
(dashed line in the figure) was calculated from the differences
between observed and expected values after exclusion of
epidemic periods and other weeks with extreme deviations.
It is placed at a distance (1.65 standard deviations above
the expected level) such that the random occurrence of
two successive deviations which exceed the epidemic
threshold is unlikely. If the deviations were successive
independent events the odds would be 9 to 1 against the
occurrence of one or more runs of two such events in a
series of 26 trials. The "epidemic threshold" thus serves
as a device for screening random fluctuations which may
occur because of temporary variations in mortality, arti-
facts such as delayed reporting and other variations of
a random character. In practice the stated odds are
approximate since successive deviations are not indepen-
dent but exhibit a small negative serial correlation. Use
of this criterion for several years has indicated that the
discrepancy between theory and practice is not serious.


EXCESS MORTALITY IN THE 122 CITIES DURING RECENT INFLUENZA EPIDEMICS

Excess Mortality

Duration Number of Excess Deaths Percent of Expected Deaths
Epidemic Period Influenza
in All Causes Pneumonia. All Causes Pneumonia.
(Weeks Ended) Weeks Type All 65 & ll 65 Pneun All 65 -& Under Pneuna
Ages Over 1 -64 1 Influenza Ages Over 1-64 1 Influenza
1957, Oct. 5-Dec. 28 13 A2 12,426 7,469 5,030 -73 3,753 8.6 9.8 8.9 -0.6 77.7
1958, Jan. 4-May 3 18 A2 14,330 10,911 3,486 -67 3,416 6.8 9.7 4.2 -0.4 41.5
1960, Jan. 2-Apr. 30 18 A2 12,237 9,333 2,903 1 4,400 5.6 7.8 3.5 0.0 49.1
1962, Dec. 30-May 5 19 B 5,855 6,216 -312 -49 1,446 2.5 4.7 -0.3 -0.3 14.4
1963, Jan. 5-May 4 18 A2 16,550 12,505 3,922 123 3,816 7.3 9.8 4.6 0.8 38.7


REFERENCES
Collins, S. D.: Long Term Trends in Illness and Medical Care.
Public Health Monograph No. 48, U.S. Government Printing
Office, Washington, D.C., 1957.
Collins, S. D., and Lehman, J.: Excess Deaths From Influenza
and Pneumonia and From Important Chronic Diseases During
Epidemic Periods, 1918-51. Public Health Monograph No. 10,
U.S. Government Printing Office, Washington, D.C., 1953.
Eickhoff, T. C., Sherman, I. L., and Serfling, R. E.: Observa-
tions on excess mortality associated with epidemic influenza.
J.A.M.A. 176:776-782 (1961).


Langmuir, A. D., Henderson, D. A., and Serfling, R. E.: The
epidemiological basis for the control of influenza. Amer. J.
Public Health 54:563-571 (1964).
Martin, A. E., and Bradley, V. H.: Mortality, fog and atmos-
pheric pollution. Monthly Bull. Minist. of Health (Lond.) 19:
56-72 (1960).
Schuman, S. H., Anderson, C. P., and Oliver. J. T.: Epidem-
iology of successive heat waves in Michigan in 1962 and
1963. Public Health Rep. 189:131-136 (1964).
Serfling. R. E.: Methods for the current statistical analysis of
excess pneumonia-influenza deaths. Public Health Rep. 78:
494-506 (1963).







Morbidity and Mortality Weekly Report


DEATHS IN 122 UNITED STATES CITIES THROUGH THE WEEK ENDING JANUARY 9, 1965




140o- ALL CAUSES
ALL AGES





14,000-













9,000-

ALL CAUSES
AGE 65 AND OVER

noo-
I.



























,4000]

1200-

1100-
PNEUMONIA-INFLUENZA



900-





100-
11400-







ooo ALL CAUSES, AGE UNDER
-AGE 65 AND OVER.
U8

















00-
U-

uj






















WEEK NO 4 8 12 16 20 t 25 32 36 40 44 48 5. 4 8 12 16 20 24 28 32 36 40 44 A48 53 4 12 16 20 24 28 32 36 40 44 48 52
WK ENDED 26 23 23 20 18 15 13 10 7 5 2 30 28 25 22 21 18 16 13 11 8 5 3 31 28 2 30 27 27 2d 22 19 17 14 11 9 6 4 1
MONTH J F M A M J J A S N J F M A M J J A S NDJ M A M J J A S 0 N D
1963 1964 1965
1963 1964 1965








Morbidity and Mortality Weekly Report







PNEUMONIA-INFLUENZA DEATHS IN 122 UNITED STATES CITIES


ALL
CITIES


















*. .I ,.' '. '.i .**''l I' '. .l '


. 40 44 48 52 4 8 12 16 20 24 28 3236 4044 48 52 4 8 12 16 20 24 28 32 3
6 3 1 29 26 23 23 20 18 15 13 10 7 5 2 30 28 25 22 21 18 16 13 11 8
ON D N J FM M M J J A S N J F M A M J J A
1962 11963 196311964


a 40 44 48 53 4 8 12 16 20 24 28 32 36
3 31 28 2 30 27 27 24 22 19 17 14 11
0 ND J F M A M J A S
1964 1965


200


W.N.
CENTRAL
10 CITIES


l IUU



...I ..,| .... I ...l,. I ^.I..^ ..I...I...o.


40 44 48 53 4 8 12 16 20 24 28 32
1964'1965
15(
MOUNTAIN
8 CITIES


PACIFIC
16 CITIES


100-



---r50-


125-
E.N.
CENTRAL 1oo0
21 CITIES


50

25-


40 44 48531 4 8 12 16 2
1964' 1965

E.S.
CENTRAL
8 CITIES


W.S.
CENTRAL
13 CITIES


100.



-f^so


NEW
ENGLAND
14 CITIES







..I, ..I .. ,. ,I,.,I.,,I...I.,, I I,. I I .. I


24 28 32 40 44 4853 46 8 12 16 20 24 28 32 36
1964 1965


FtL_ ............ nmn1.


MIDDLE
ATLANTIC
20 CITIES


SOUTH
ATLANTIC
12 CITIES


300-
1

WEEK NC
WK ENDEI
MONTI


WK. NO.


WK.NO
200-


WK NQ


4044 4853 4 12 16 20 24 28 32 4044 4 31 4 8 12 16 20 24 28 32 40 44 4 53 4 6 12 16 20 24 283236
1964 196 1964 1965 1964 196


liba~


i I ( III II I I I t I II I I ( II I I I I ) I I I I I I t I ) I I II It 1 ( I I I ) I I I I I I I ( I I I I It t t I I )t I I I II


i
.'
'




t ...,... I ... I ... I ... I... I ... I ... I ... I ... I...,... I ... I ... I ... I ... I ... t


IIIEIIEIU


. .. .. iI


''''''''''


Xl


.", "A ... ... ... .I III I ,IItI III III 1I r


.I









12 Morbidity and Mortality Weekly Report



Table 3 CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JANUARY 9, 1965 AND JANUARY 4. 1964 (Isr WEEK)



SEncephalitis Poliomyelitis Diphtheria
Aseptic
Meningitis Primary Post-Inf. Total Cases Paralytic
Area
Cumulative Cumulative Cum.
1965 1964 1965 1965 1965 1965 1964 1965 1965 196. 1965 1965

UNITED STATES... 38 19 31 5 3 3

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

MIDDLE ATLANTIC...... 6 1 13 -
New York City...... -
New York, Up-State. I -
New Jersey......... 3 10 -
Pennsylvania....... 2 1 2 -

EAST NORTH CENTRAL... 2 -
Ohio................- .
Indiana............ -
Illinois........... -
Michigan............ -
Wisconsin........... -

WEST NORTH CENTRAL... 2 2
Minnesota........... -
Iowa.... ............- -
Missouri........... I 1
North Dakota...... -- -
South Dakota....... 1 1
Nebraska ...........- -
Kansas............. 1 I

SOUTH ATLANTIC....... 2 1 6 1 1
Delaware............. -
Maryland............. -
Dist. of Columbia.. -
Virginia ........... -
West Virginia...... -
North Carolina..... -
South Carolina..... -
Georgia ............ -
Florida ............ I 1 5 1 1

EAST SOUTH CENTRAL... 8 2 2 -
Kentucky........... 8 1 1 -
Tennessee........... 1 1 -
Alabama............ .
Mississippi ........ -

WEST SOUTH CENTRAL... -
Arkansas............ -
Louisiana .......... -
Oklahoma............ 2 -
Texas.............. 2 -

MOUNTAIN............. 2 1 1 -
Montana............ -
Idaho............... -
Wyoming ............ -
Colorado............. -
New Mexico......... -
Arizona............. I I -
Utah................ -
Nevada............. -

PACIFIC.............. 15 12 4 4 -
Washington......... -. -
Oregon.............
California.......... 14 8 4 4 -
Alaska............. ..- .
Hawaii............. l 4

Puerto Rico -








Morbidity and Mortality Weekly Report 13


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

JANUARY 9, 1965 AND JANUARY 4, 1964 (1st 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... 8 685 343 283 685 625 50 50 37 3 3

NEW ENGLAND .......... 46 20 19 46 91 1 1 2 1 1
Maine............... 15 9 4 15 40 -
New Hampshire....... 5 4 5 13 1 1
Vermont............. 3 1 1 3 8 -
Massachusetts...... 11 6 5 11 17 1 1 1 -
Rhode Island....... 3 1 2 3 3 -
Connecticut........ 9 3 3 9 10 -

MIDDLE ATLANTIC...... 114 56 58 114 183 7 7 4 -
New York City...... 28 11 17 28 27 2 2 1 -
New York, Up-State. 31 23 8 31 109 3 3 2 -
New Jersey......... 21 6 15 21 13 1 1 -
Pennsylvania....... 34 16 18 34 34 1 1 1 -

EAST NORTH CENTRAL... 137 83 37 137 34 4 4 1 -
Ohio................ 55 30 10 55 20 2 2 -
Indiana............. 5 2 3 5 -
Illinois........... 23 19 4 23 2 2 2 1 -
Michigan........... 41 25 16 41 3 -
Wisconsin.......... 13 7 4 13 9 -

WEST NORTH CENTRAL... 7 46 27 18 46 36 4 4 2 2
Minnesota.......... 2 1 1 2 1 1
Iowa................ 7 30 18 11 30 9 -
Missouri........... 3 2 1 3 4 1 1 1 1
North Dakota....... 3 3 -
South Dakota........ 1 1 1 7 -
Nebraska........... -- 6 -
Kansas.............. 10 5 5 10 10 -

SOUTH ATLANTIC....... 65 24 36 65 43 11 11 7 -
Delaware........... -
Maryland........... 13 7 5 13 13 1 -
Dist. of Columbia.. -
Virginia........... 12 5 3 12 4 1 1- -
West Virginia...... 3 3 3 1 1- -
North Carolina..... 7 2 5 7 5 1 -
South Carolina..... 3 2 1 3 2 -
Georgia............. 9 2 7 9 4 4 -
Florida............. 18 3 15 18 20 5 5 3 -

EAST SOUTH CENTRAL... 1 31 18 13 31 43 3 3 3 -
Kentucky........... 10 9 1 10 21 1 1 2 -
Tennessee........... 1 9 5 4 9 14 2 2 1 -
Alabama........... 10 4 6 10 7 -
Mississippi ........ 2 2 2 1 -

WEST SOUTH CENTRAL... 89 52 36 89 32 9 9 7 -
Arkansas........... 14 8 6 14 5 2 2 1 -
Louisiana.......... 10 8 2 10 3 1 1 1 -
Oklahoma............ 3 3 3 2 3 3 2 -
Texas............... 62 36 25 62 22 3 3 3 -

MOUNTAIN............. 42 9 5 42 37 5 -
Montana............ 4 3 1 4 1 -
Idaho.............. 9 9 2 1
Wyoming........... 2 2 2 -
Colorado............ 1 8 2
New Mexico......... 6 3 2 6 3 2 -
Arizona ............ 17 17 15 -
Utah............... 3 1 2 3 7 -
Nevada............ 1 -

PACIFIC .............. 115 54 61 115 126 11 11 8 -
Washington......... 3 1 2 3 27 I
Oregon............. 17 13 4 17 8 -
California ........ 79 26 53 79 78 10 10 7
Alaska.............. 16 14 2 16 9 1 1 -
Hawaii................. 4

Puerto Rico 2 -









14 Morbidity and Mortality Weekly Report


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES UNITED STATES

FOR WEEKS ENDED

JANUARY 9, 1965 AND JANUARY 4, 1964 (1st WEEK) 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... 5,203 5,203 3,191 8,667 4 4 1 1 92 92

NEW ENGLAND.......... 1,876 1,876 149 1,044 1 1
Maine............... 257 257 6 162 -
New Hampshire...... 58 58 3 6 -
Vermont............. 5 5 22 7 -
Massachusetts...... 896 896 57 82 -
Rhode Island....... 84 84 6 47 -
Connecticut........ 576 576 55 740 I I

MIDDLE ATLANTIC...... 115 115 815 396 4 4
New York City...... 28 28 316 22 -
New York, up-State. 32 32 169 300 2 2
New Jersey......... 181 35 -
Pennsylvania....... 55 55 149 39 2 2

EAST NORTH CENTRAL... 502 502 322 886 3 3
Ohio ............... 69 69 94 94 -
Indiana............. 32 32 120 148 2 2
Illinois........... 25 25 23 89 -
Michigan............ 248 248 21 366 -
Wisconsin.......... 128 128 6- 189 1 1

WEST NORTH CENTRAL... 350 350 59 392 12 12
Minnesota.......... 3 3 8 3 3
Iowa................ 158 158 17 79 4 4
Missouri........... 49 49 12 1 1
North Dakota....... 124 124 41 226 3 3
South Dakota....... 12 12 1 44 -
Nebraska........... 4 4 3 -
Kansas............. NN NN NN 20 1 1

SOUTH ATLANTIC....... 783 783 436 1,134 2 2 12 12
Delaware............ 12 12 15 -
Maryland............ 10 10 71 53 -
Dist. of Columbia.. 17 1 -
Virginia........... 40 40 100 212 12 12
West Virginia...... 653 653 174 500 -
North Carolina..... 27 27 12 27 -
South Carolina..... 13 13 53 111 1 1 -
Georgia............. 5 5 34 1 1 -
Florida............ 23 23 9 181 -

EAST SOUTH CENTRAL... 233 233 592 1,303 41 41
Kentucky............ 6 6 426 87 2 2
Tennessee........... 165 165 146 1,114 37 37
Alabama............ 26 26 13 71 2 2
Mississippi........ 36 36 7 31 -

WEST SOUTH CENTRAL... 491 491 207 794 I 1 1 1 15 15
Arkansas........... 25 1 1 -
Louisiana.......... I I 2 2
Oklahoma........... 5 5 1 15 1 1 -4 4
Texas............... 485 485 181 778 9 9

MOUNTAIN............. 521 521 191 1,414 1 1 1 1
Montana............. 232 232 55 37 -
Idaho............... 76 76 52 122 -
Wyoming............ 15 15 38 -
Colorado........... 76 76 16 598 -
New Mexico......... 14 14 5 324 -
Arizona............ 22 22 45 179 1 1
Utah................ 86 86 7 116 1 1 -
Nevada............. 11 -

PACIFIC............... 332 332 420 1,304 3 3
Washington ........ 5 1 99 109 -
Oregon.............. 132 132 33 21 -
California......... 152 152 167 1,064 3 3
Alaska............. 2 2 119 32 -
Hawaii............. 41 41 2 78 -

Puerto Rico 40 40 11 -







Morbidity and Mortality Weekly Report


Week No. Table 4. DEATHS IN 122 UNITED STATES CITIES FOR WEEK ENDED JANUARY 9, 1965
1
(By place of occurrence and week of filing certificate. Excludes fetal deaths)

All Causes Pneumonia Under All Causes Pneumonia Under
Area All 65 years and 1 year Area All 65 years and 1 year
Ages and over Influenza AllAges and over Influenza All
All Ages Causes All Ages Causes


NEW ENGLAND:
Boston, Mass.---------
Bridgeport, Conn.-----
Cambridge, Mass.------
Fall River, Mass.-----
Hartford, Conn.-------
Lowell, Mass.---------
Lynn, Mass.-----------
New Bedford, Mass.----
New Haven, Conn.------
Providence, R. I.-----
Somerville, Mass.-----
Springfield, Mass.----
Waterbury, Conn.------
Worcester, Mass.------

MIDDLE ATLANTIC:
Albany, N. Y.--------
Allentown, Pa.-------
Buffalo, N. Y.--------
Camden, N. J.---------
Elizabeth, N. J.------
Erie, Pa.------------
Jersey City, N. J.----
Newark, N. J.--------
New York City, N. Y.--
Paterson, N. J.-------
Philadelphia, Pa.-----
Pittsburgh, Pa.-------
Reading, Pa.---------
Rochester, N. Y.------
Schenectady, N. Y.----
Scranton, Pa.---------
Syracuse, N. Y.-------
Trenton, N. J.--------
Utica, N. Y.---------
Yonkers, N. Y.--------

EAST NORTH CENTRAL:
Akron, Ohio-----------
Canton, Ohio----------
Chicago, Ill.---------
Cincinnati, Ohio------
Cleveland, Ohio-------
Columbus, Ohio--------
Dayton, Ohio----------
Detroit, Mich.--------
Evansville, Ind.------
Flint, Mich.----------
Port 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.--------


859
260
49
35
58
53
31
25
31
64
60
16
66
45
66

4,087
46
44
188
62
39
57
103
149
2,129
48
497
267
59
130
31
55
69
26
36
52

2,910
95
51
904
189
266
125
82
327
35
56
48
27
42
141
34
172
35
42
47
130
62

1,056
82
44
41
182
43
146
84
310
74
50


511
147
24
22
40
31
24
19
20
22
36
12
41
33
40

2,416
28
26
119
33
19
34
61
70
1,254
31
289
152
37
84
22
39
43
14
27
34

1,586
56
31
472
118
139
57
51
176
23
24
30
8
32
67
20
95
21
22
30
78
36

598
48
28
14
102
26
86
45
178
42
29


*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.------
Wilmington, Del.-------

EAST SOUTH CENTRAL:
Birmingham, Ala.-------
Chattanooga, Tenn.----
Knoxville, Tenn.-------
Louisville, Ky.--------
Memphis, Tenn.---------
Mobile, Ala.-----------
Montgomery, Ala.-------
Nashville, Tenn.-------

WEST SOUTH CENTRAL:
Austin, Tex.----------
Baton Rouge, La.-------
Corpus Christi, Tex.---
Dallas, Tex.-----------
El Paso, Tex.---------
Fort Worth, Tex.-------
Houston, Tex.---------
Little Rock, Ark.------
New Orleans, La.-------
Oklahoma City, Okla.---
San Antonio, Tex.-----
Shreveport, La.--------
Tulsa, Okla.-----------

MOUNTAIN:
Albuquerque, N. Mex.---
Colorado Springs, Colo.
Denver, Colo.----------
Ogden, Utah------------
Phoenix, Ariz.---------
Pueblo, Colo.----------
Salt Lake City, Utah---
Tucson, Ariz.----------

PACIFIC:*
Berkeley, Calif.-------
Fresno, Calif.---------
Glendale, Calif.-------
Honolulu, Hawaii-------
Long Beach, Calif.-----
Los Angeles, Calif.----
Oakland, Calif.--------
Pasadena, Calif.*------
Portland, Oreg.--------
Sacramento, Calif.----
San Diego, Calif.------
San Francisco, Calif.--
San Jose, Calif.*------
Seattle, Wash.--------
Spokane, Wash.--------
Tacoma, Wash.*---------


1,347
154
275
56
93
102
78
113
42
89
82
205
58

733
94
46
60
107
186
56
58
126

1,243
39
52
25
144
44
102
256
70
153
129
119
59
51

485
43
25
118
25
128
20
59
67

1,706
27
49
27
57
76
475
102
36
182
76
114
201
41
140
61
42


1,049
18
30
20
21
47
277
66
27
108
48
65
126
26
97
43
30


Total 14,426 8,172 666 893

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------- 14,426
All Causes, Age 65 and over------------------- 8,172
Pneumonia and Influenza, All Ages------------- 666
All Causes, Under 1 Year of Age--------------- 893




UnII VE-NbiY OF FLORIDA

3 11111 111111111111262 11 11108864 2532111111111111
3 1262 08864 2532


Morbidity and Mortality Weekly Report


INTERNATIONAL NOTES QUARANTINE MEASURES

Immunization Information for International Travel
1963-64 edition Public Health Service Publication No. 384

The following change should be made in the list of
Yellow Fever Vaccination Centers in Section 6:

Page 77 Delete

City: Nashville, Tennessee

Center: Davidson County Department of
Public Health


Clinic Hours:

Fee:

Page 77 Add

City:

Center:



Clinic Hours:

Fee:


Wednesday, by appointment only


Nashville, Tennessee

Metropolitan Health Department
311 23rd Avenue, North
Tele: 291-5100

Wednesday 2 p.m.

Yes


THE MORBIDITY AND MORTALITY WEEKLY REPORT WITH A CIRCULA-
TION OF 13.000 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. SERFLING PH.D.
ASST. CHIEF STATISTICS SECTION I. L. SHERMAN. M 5.
CHIEF SURVEILLANCE SECTION D. A. HENDERSON. M.D.
ASSISTANT EDITOR. MMWR PAUL D. STOLLEr. M.D.
IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTAL TV. 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
NOTE: THESE PROVISIONAL DATA ARE BASED ON WEEKLY TELE-
GRAMS TO THE CDC BY THE INDIVIDUAL STATE HEALTH. DEPART.
MENTS. THE REPORTING WEEK CONCLUDES ON SATURDAY. COMPILED
DATA ON A NATIONAL BASIS ARE RELEASED ON THE SUCCEEDING
FRIDAY.
SYMBOLS:---DATA NOT AVAILABLE
QUANTITY ZERO
THE CONSTRUCTION OF THE MORTALITY. CURVES IS DESCRIBED IN
VOL. I1 NO. 1 JANUARY 15, 1965.


.-a


3*

0 W

a<
nan
1M
.3.
6r


t41


I 0




z
M
-I


m


m
S*
0 M
S"
X
B

r,*

xml version 1.0 encoding UTF-8
REPORT xmlns http:www.fcla.edudlsmddaitss xmlns:xsi http:www.w3.org2001XMLSchema-instance xsi:schemaLocation http:www.fcla.edudlsmddaitssdaitssReport.xsd
INGEST IEID EZQ8BO2YK_M2ZT8A INGEST_TIME 2013-02-07T18:13:11Z PACKAGE AA00010654_00427
AGREEMENT_INFO ACCOUNT UF PROJECT UFDC
FILES