Morbidity and mortality

Morbidity and Mortality



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

PUBLIC HEALTH SERVICE


Prepared by the


COMMUNICABLE DISEASE '


Ear rp..ln.. Apr 2-, 19i64 ATLANTA, GEORGIA 30333 Vol. 13. No. 16
PROVISIONAL INFORMATION ON SELECTED NOTIFIABLE DISEASES IN TFATES AND ON
DEATHS IN SELECTED CITIES FOR WEEK ENDED APRIL

BRUCELLOSIS

Fifteen cases of brucellosis were reported for the compare with re 2(6 ,1A t1giport rr comparable
week ended April 18, thus bringing to 120 the cumulative periods of 196 2, and 1961, res ly. Iowa ac-
total for 1964. Iowa reported 12 cases this week; single counted for 40 pe ent f the Nation's 9 roal.
cases were reported from Illinois, Kentucky, and North For rhe c omp' ble d le jago, 106 cases
Dakota. were reported through e Uni rates. The annual
Of Iowa's 12 cases, 7 were delayed reports from the total for the country has ec tied from the 6,321 cases
one county which annually reports the greatest number of reported in 194' to the 381 cases reported last year.
that State's cases. Thus far in 1964, this county has Nationally, packing house workers comprise 50 per-
accounted for 20 of Iowa's 39 cases of brucellosis. All of cent of the patients with brucellosis, contrasted with 25
this county's cases were industrially acquired, from swine percent in 1958. Whereas swine were the source for about
at a single packing house. 10 percent of brucellosis 6 years ago, they accounted for
This year's 120 cases represent reports from 31 about -10 percent in 1963. Most of the industrially acquired
States. Iowa's 39 cases are the highest for any State and brucellosis is of swine origin.


Table I. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
16th Week Ended Cumulative. First 16 Weeks
Disease April 18, April 20, Median Median
1964 1963 1959 1963 1964 1963 1959 1963
Aseptic meningitis ................ 29 18 --- 439 351
Brucellosis ....................... 15 13 11 120 106 167
Diphtheria ........................ 10 1 8 65 100 230
Encephalitis, primary infectious.. 38 -28 -- 514 ~ 412
Encephalitis, post-infectious ..... 27 --- 221 J1-
Hepatitis, infectious including
serum hepatitis ............... 825 845 845 14,566 16,334 16,334
Measles............................ 29,671 17,460 17,630 196,961 195,705 201,668
Meningococcal infections .......... 69 46 46 970 944 900
Poliomyelitis, Total ........... 3 1 6 22 44 127
Paralytic ...................... 3 1 6 16 39 82
Nonparalytic ................... --- 5 2 ---
Unspecified .................... --- 1 3
Streptococcal Sore Throat and
Scarlet fever .................. 10,452 7,408 --- 172,981 154,383 ---
Tetanus .......................... 5 5 --- 60 55
Tularemia ........................ 2 3 --- 78 61
Typhoid fever .................. 8 7 10 103 113 152
Rabies In Animals ................. 111 94 81 1,361 1,150 1,289

Table 2. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: 2 Psittacosis: 13
Botulism: 6 Rabies in Man:
Leptospirosis: Pa.-l 7 Smallpox:
Malaria: N.J.-1, Ga.-1 29 Typhus-
Plague: Marine: Mo.-1 3
SRky Mt. Spotted: Va.-I 7


634-S131


F7 2.60/4:13/1l








Morlidity and Mortality ~ ikly Rrport


EPIDEMIOLOGICAL REPORTS


PLAGUE Arizona
A detailed clinical account is presented of the fatal
case of plague reported on page 121, of Vol. 12 of the
M MTWR.
The victim was a 28-\ear-old, unmarried, Navajo
sheep herder who lircd 5 miles north of louck, Arizona,
which is located on U. lligh ay 66. On December 1, he
drove his sheep to a pasture where thev grazed through
IDccumber 5.
On December 5, he experienced the abrupt onset of
chills, headache, abdominal pains, green, waerry diarrhea,
and frequent expulsion of blood-tinged vomitus. He also
complained of pain under his left arm. His symptoms per-
sisted and he was driven to the Gallup, New Mexico,
Indian Hospital. December 7.
At 11 a.m., he was seen in the out-patient department.
His vital signs were: temperature %.8"F., blood pressure
1L2 88, and pulse 130. Positive physical findings in-
cluded subjective abdominal tenderness, moderate guard-
ing without rebound, and decreased bowel sounds. The
initial clinical impression was gastroenteritis, with the
possibility of surgical abdomen.
On the surgical ward at 2:30 p.m., his vital signs
were: temperature 98.80F., blood pressure 80 "60, pulse
14if. and respirations 36. He was described as alert,
restless, and dvspneic. He stated he had difficulty breath-
ing. oxygen was administered. A large, painful, solitary
node in the left axilla was noted on repeat physical ex-
amination. The overlying tissues were indurated without
pitting or eryrhema. Repeat abdominal examination re-
vealed increased guarding on the right.
His initial laboratory tests were: hemoglobin 16.6,
hematocrit 50, white count 105,000, differential poly-
morphs 64, bands 22, lymphs 13, and monocytes 1. Nu-
merous bacteria (5 per white blood cell) were noted on the
peripheral blood smear. Gram stain of the peripheral
blood revealed numerous pleomorphic gram negative rods.
His chest X-ray was interpreted as normal, his abdominal
film showed less than normal gas, an electrocardiogram
showed sinus rachvcardia, and his electrolytes were:
CO- 28.6, Na 134, C1 87, and K 5.2.
At 1:45 p.m., his temperature rose to 104.6"F. It was
learned at this time that he frequently killed rabbits for
food; he reported having killed and torn apart cottontail
rabbits for his dog 3 days prior to onset. Diagnosis of
gram negative septicemia,probably Pasteurella tularensis,
was made.
At 6 p.m., his temperature rose to 106.2"; his vital
signs were: blood pressure "6 '0, pulse 120, and respira-
tions 40. Despite treatment with streptomycin and chloro-
mvcetin. he expired 8 hours after he was first seen in
the out-patient department.
At post-mortem examination, the only skin lesions
present were a scratch on the lateral aspect of the left


arm and an abrasion of the right thumb. Positive autopsy
finding. included bilateral pleural effusions, heavily
congested lungs, gra Irothy fluid within the trachea and
bronchi, which had iniccied mucosa, submucosal gastric
pLrechiae. and black, liquid stool in the rectum. Lymph
nodes from the left axilla measured 2x2 centimeters and
were hemorrhagic and necrotic.
Pre-morrem blood cultures and bone marrow revealed
Pasteurtila prstrs and pn, imooccus type VI. Post-
mortem cultures of 1 mph node, liver, and spleen also
demonstrated both organisms. A bone marrow smear was
interpreted as demonstrating a leukemoid response.
Hospital and family contacts were treated prophylac-
tically with streptomycin and sulfonamide.
No further cases have been suspect or diagnosed.
(Reported b\ Robert L. HRrrschr. 11.D.. Medical Officer in
Charge. Indian ilcalrl Hospital. Gallup. \'eu Mexico. Dr. Lloyd
M. Farner. (.ummissionc, of I'ublic Health. Art:ona State De-
partment o Health, and a tearm tirom the Communicable Disease
Center).

Editor's .ote. The co-existence of another organism with
P. pestus, in thts case pneumococci Type VI, is an in-
teresting phenomena which has been observed in at least
one previous case of plague and which may mask the
diagnosis of plague. In 1961, when 3 cases of plague
were reported, post-mortem bacteriologic studies in one
of the 2 fatal cases revealed the presence of hemolyric
streptococcus Group A in addition to P. pests.



MUSHROOM POISONING Colifomin
Two San Joaquin County children experienced mus-
carine poisoning within I hours after ingesting dried mush-
rooms. Between 2 and I hours after eating the dried mush-
rooms, which had been added to freshly opened tomato
soup, a 16-year-old boy and his 3-year-old sister became
acutely ill. They experienced vomiting, diarrhea, hema-
temesis, melena, abdominal cramps, fever, vasomotor flush,
bradycardia, and hyporension. They were hospitalized and
treated with atropine; both children recovered within
48 hours.
The suspect mushrooms were part of a larger non-
commercial stock picked locally and used by the family
during the past year without known ill effects.
A sample of remaining mushroom was described as a
member of the Roletus genus; further identification was not
possible because of the condition of rhe sample. Certain
species of the Boulrts genus have been incriminated in
previous mushroom poisonings.
'Reported b\ ]ack J ili arr.s. M.D.. District Health Officer.
and Philip fBearg. s I.D.. assistantt District Health Officer.
San Joaquin Local Health District. Stockton. Caliornia; Philip
K rCondit .1.. Chriet. Bureau of Communicable Diseases.
California rate Department of Publir HealrbL.




____________A


13










Morbidity and Mortality Weekly Report





SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS

MARCH 1964 MARCH 1963


135


CASES OF PRIMARY AID SECONDARY SYPHILIS: By Reporting Area March 1964 and March 1963 Provisional

Cumulative Cumulative
Reporting Area March, Jan Mar Reporting Area March, Jan Mar
1964 1963 196' 1963 1964 16 196964 1963
NEW ENGLAND............... 43 28 125 97 EAST SOUTH CENTRAL.......... 139 134 376 353
Maine................... I I 1 2 Kentucky................. 11 3 30 24
New Hampshire ............ 1 4 2 Tennessee................ 36 46 108 116
Vermont ................. I I I 1 Alabama.................. 74 53 194 153
Massachusetts............ 25 12 78 49 MississippLi.............. 18 32 44 60
Rhode Island.............. 1 2 5 5
Connecticut............. 14 12 36 38 WEST SOUTH CENTRAL........ 202 227 612 687
Arkansas.................. 1. 18 46 48
MIDDLE ATLANTIC.......... 517 526 1,398 1,501 Louisiana ................ 46 43 145 146
Upstate New York......... 69 52 181 136 Oklahoma..... ............. 18 13 35 50
New York City............ 320 297 824 874 Texas.................... 124 153 386 443
Pa. (Excl. Phila.)....... 12 13 35 36
Philadelphia ............. 31 76 87 202 MOUNTAIN .................. 40 31 136 116
New Jersey............... 85 88 271 253 Montana.................. 2 3 -
Idaho .................... -
EAST NORTH CENTRAL ........ 177 181 561 492 Wyoming .................. 1 6 2
Ohio..................... 30 33 137 97 Colorado................. 3 3 4 15
Indiana............. .... ...... 3 3 18 12 Nei Mexico............... 20 8 70 22
Downstate Illinois....... 7 12 33 31 Arizona.................. 12 14 37 54
Chicago.................. 78 77 215 231 Utah ..................... 4 4 8
Michigan................. 53 49 144 105 Nevada ................... 2 2 8 15
Wisconsin................ 6 7 14 16
PACIFIC.................... 181 172 630 524
WEST NORTH CENTRAL......... 47 44 162 108 Washington............... 1 12 12 42
Minnesota ................ 10 9 34 21 Oregon ................... 8 3 25 10
Iowa ................... .. 2 4 8 7 California .......... ..... 171 156 585 465
Missouri .... ............. 25 19 77 42 Alaska ................... 3 2
North Dakota ..... ....... Hawaii..................... I 5 5
South Dakota.............. 2 15 5
Nebraska................. 4 6 19 16 U. S. TOTAL................ 1,870 1,962 5,637 5,.30
Kansas................... .. 6 9 17
TERRITORIES............... 63 70 196 178
SOUTH ATLANTIC............ 52' 619 1,637 1,552 Puerto Rico.............. 62 69 191 174
Delaware ................. 6 2 27 15 Virgin Islands........... 1 5 4
Maryland............. .. 62 40 142 129
District of Columbia..... 36 72 131 187
Virginia .................. 18 28 69 79
West Virginia............ 6 9 10 15
North Carolina........... 78 92 239 228 Note: Cumulative Totals include revised and delayed reports
South Carolina........... 80 68 226 181 through previous months.
Georgia................... 94 108 279 263
Florida................... 144 200 514 55


SUMMARY OF DEATHS AMONG PERSONS 65 YEARS
AND OVER IN 108 U.S. CITIES

The weekly average number of deaths among persons

65 years and over in 108 cities for the four-week period
ending April 18 was 6,"06 as compared with an expected
weekly average of 6,914.


Week Ending 4 Week Weekly
3 28 4'4 411 4. 18 Total Average

Observed 6,476 6,952 6,836 6,560 26,824 6,706
Expected 6,991 6,943 6,890 6,831 27,655 6,914

Excess -515 9 54 -271 -831 -208


NUMBER
or arwo
EATHS
8000


DEATHS or AGE 65 and OVER in 108 U.S CITIES
4.ero-- Nubwe Dc ee* 0. Our Hi eeh P-..os-


I 4
--- t


i-..oo No -. .. ? *.
i. .- .." '.- .* r. .- "-c


(Sce tab!c, page 119)











136 1lorbiditi and Mortality Weekl Report



1 ahlc (:ASES OF SPECIFIC) NOTIFIABLE DISEASES UNITED STATES

FOR WEEKS ENDED

APRIL IN. 196( AND APRIL 20. 1965 ( 16ih WEEK)


Encephalitis
Aseptic
Meningitis Primary Post-lnf. Puliomyelitis, Total Cases Poliomyelltai, Paralytic
Area Cumulative Cumulative

1964 1963 1964 1964 1964 1963 1964 1963 1964 1963 1964 1963

UNITED STATES... 29 18 38 27 3 1 22 44 3 1 16 39

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

MIDDLE ATLANTIC...... 10 9 5 4 5 4 5
New York City...... I 1 1 -
New York, Up-State. 2 1 1 2 4 2 4
New Jersey ......... 6 5 1 1 -
Pennsylvania....... 2 2 4 1 1

EAST NORTH CENTRAL... 5 1 7 12 1 2 12 1 2 10
Ohio ............... 1 2 1 1 1 4 1 1 3
Indiana............ 2 -
Illinois........... 3 9 1 6 1 5
Michigan........... 2 3 2 2 2
Wiscons n......... -

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

SOUTH ATLANTIC....... I 5 2 1 11 4 1 8 3
Delaware.......... -
Maryland........... -
Dist. of Columbia.. -
Virginia ........... --
West Virginia...... I I I 1
North Carolina..... I 5 2 I 2 2
South Carolina.... 1 1
Georgia............ 1 1 1 -
Florida............ 1 4 3 1

EAST SOUTH CENTRAL... 1 3 1 3 2
Kentucky........... 2 -
Tennessee .......... 1 1 1 1
Alabama............ I 2 1 -
Mississipp ........ ... -

WEST SOUTH CENTRAL... 1 2 3 2 9 1 9
Arkansas........... I -
Louisiana.......... 1 8- 8
Oklahoma............ .
Texas.............. 2 2 2 1 1 1

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

PACIFIC ............. 7 8 4 9 9 8
Washington.......... 1 2 3 1 1
Oregon............ I l 1
California......... 5 5 1 9 7 6
Alaska. ............ .
Hawaii............. -

Puerto Rico 2 2










Morbidity and Mortality Weekly Report 137


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

APRIL 18, 1964 AND APRIL 20. 1963 ( 16Ih WEEK) Coniinued


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... 15 120 10 65 825 386 371 68 14,566 16,334 8 103

NEW ENGLAND............ 1 4 74 30 40 4 1,563 1,942 7
Maine.............. 1 27 12 13 2 553 900
New Hampshire...... 2 1 123 134
Vermont ............ 10 9 1 193 27 -
Massachusetts....... 1 3 20 4 15 I 310 570 4
Rhode Island....... 1 1 69 48 3
Connecticut........ .- 14 3 10 1 315 263 -

MIDDLE ATLANTIC...... 2 4 223 92 131 3,315 3,170 1 18
New York City..... 1 33 11 22 472 400 1 6
New York, Up-State. I 82 46 36 1,466 1,422 4
New Jersey........ 2 40 9 31 600 491 -
Pennsylvania........ 1 68 26 42 777 857 8

EAST NORTH CENTRAL... I 16 6 124 70 44 10 2,176 2,582 1 22
Ohio............... 43 26 14 3 589 766 1 15
Indiana............1 15 9 5 1 184 229 3
Illinois........... 1 11 6 14 5 9 336 558 3
Michigan.......... 2 35 21 14 928 894 1
Wisconsin.......... 2 17 9 2 6 139 135 -

WEST NORTH CENTRAL... 13 68 1 10 39 18 10 11 855 720 1 10
Minnesota.......... 2 2 3 3 68 118 -
Iowa................ 12 39 5 1 4 124 121 3
Missouri........... 4 8 4 3 1 208 298 1 3
North Dakota....... 1 2 1 36 19 -
South Dakota....... 10 1 86 26 -
Nebraska........... 10 18 56
Kansas ............. .- 1 7 22 12 10 315 82 3

SOUTH ATLANTIC....... 6 6 17 90 44 44 2 1,444 1,746 4 24
Delaware............ 1 31 25 -
Maryland........... 12 5 7 272 193 1 1
Dist. of Columbia.. 26 57
Virginia........... 2 11 8 2 216 389 1 5
West Virginia...... 19 12 7 256 254 -
North Carolina..... I 25 16 9 274 471 9
South Carolina..... 3 7 4 3 49 76 2
Georgia............. 2 6 12 2 1 1 33 70 1 I
Florida ....... .... I 2 13 5 8 287 211 1 6

EAST SOUTH CENTRAL... 1 6 4 45 36 9 1,012 1,674 1 11
Kentucky............ 1 2 15 14 1 444 504 1 6
Tennessee.......... 1 18 14 4 348 656 4
Alabama............ 3 2 8 4 4 141 250 1
Mississippi........ 1 1 4 4 79 264 -

WEST SOUTH CENTRAL.. 5 3 13 54 32 17 5 1,046 1,110 6
Arkansas........... I 6 5 1 121 133 3
Louisiana........... 1 1 3 13 8 5 216 206 -
Oklahoma............ I 5 5 67 61 3
Texas.............. 2 2 10 30 14 11 5 642 710

MOUNTAIN............. 10 1 51 13 5 33 971 1,145
Montana............. 6 1 1 4 91 172 -
Idaho.............. 5 5 73 164 -
Wyoming............. 1 1 33 19 -
Colorado........... 21 5 16 303 242 -
New Mexico......... I 1 8 5 3 154 139 -
Arizona............. I 8 8 205 255 -
Utah............... 7 2 2 84 145
Nevada............... 1 28 9

PACIFIC............... 6 6 125 51 71 3 2,184 2,245 5
Washington......... 6 17 8 7 2 229 378 1
Oregon............. 1 20 14 5 1 235 321
California........ 5 85 27 58 1,605 1,484 4
Alaska............. -2 2 67 49 -
Hawaii............. 1 48 11 -

Puerto Rico 3 18 12 6 212 219 1 6










138 1Morbidity and MorIality 'eekly Report


Tjhlr 3 CASES OF SPECIFIED NOTIFIABLE DISEASES UNITED STATES

FOR WEEKS ENDED

APRIL IS. 1964 AND APRIL 20. 1964 ( 16rh WEEK) Conrinued


Streptococcal
Meningococcal Sore Throat and Rabies in
HMailesIf Meningitis Scarlet Fever Tetanus Tularemia Animala
Cumulative Cum. Cum. Cum.
_1961 9l6 1964 1963 1964 1963 1964 1 196 1964 1964 1964 1964

UNITED STATES... 29,671 69 970 944 10,452 7,408 5 60 2 78 111 1,361

NEW ENGLAND........... 801 3 29 67 1,185 969 3 7
Malne.............. 13* 2 10 46 10 3 5
Ntw Hampshirr...... 7 2 3 10 1
Vermont .............. 88 I 2 3 I I
MassachuseEtts ...... 254 13 31 242 119 -
Rh.odr Island ....... 139 2 6 127 70 -
C.nnecticut ........ 179 3 11 16 764 759 -

MIDDLE ATLANTIC...... 2,980 3 93 120 542 443 2 3 4 29
New Y'rk City...... 819 17 15 27 51 -
Neu Nork, Up-State. 464 I 34 39 250 200 4 28
New Jersey......... 871 14 21 104 126 2 2 -
Pennsylvania....... 826 2 28 45 161 66 1 1

EAST NORTH CENTRAL... 6,671 11 154 155 1,650 1,118 5 8 12 142
Ohio............... 1,637 3 48 45 384 113 1 1 68
Indiana ............ 1,785 3 28 18 318 144 1 8
Illinois........... 853 2 31 25 192 256 2 5 9 33
Michigan........... 1,441 2 34 48 472 379 I 1 12
Wisconsin.......... 955 1 13 19 284 226 1 3 21

WEST NORTH CENTRAL... 4,274 5 55 58 488 300 3 21 36 438
Minnesota.......... 24 10 10 25 23 1 11 131
lowa................. 3,740 1 3 2 221 50 I 1 13 152
Missouri........... 194 4 30 25 15 15 2 13 3 79
North Dakota....... 234 3 1 156 151 20
South Dakota....... 3 4 2 39
Nebraska........... 82 4 14 2 1 9
Kansas............. NN 5 3 65 59 6 3 8

SOLTH ATLANTIC....... 2,828 23 220 192 1,218 584 2 24 1 14 18 214
Delaware ........... 34 2 1 11 10 -
Maryland........... 144 2 17 27 184 41 1 2 -
Dist. of Columbia.. 15 7 3 8 -
Virginia........... 970 22 49 308 178 2 3 9 149
West Virginia...... 515 1 17 10 392 145 3 11
North Carolina ..... 193 37 30 77 63 7 1 4 2
South Carolina..... 302 5 34 12 42 13 3 -
Georgia ............ 5 1 18 11 13 1 1 7 5 26
Florida ............ 650 b 66 .9 183 133 1 9 1 26

EAST SOUTH CENTRAL... 2,780 4 99 79 1,657 1,156 1 9 16 23 214
Kentucky............ 869 31 20 161 147 1 1 3 28
Tennessee.......... 1,394 2 36 34 1,383 978 1 4 II 18 178
Alabama............ 373 17 12 13 13 3 3 2 8
Mississippi........ 144 2 15 13 100 18 1 1 -

WEST SOUTH CENTRAL... 5,264 10 87 105 758 684 8 1 15 11 214
Arkansas............ 63 1 8 5 11 1 2 3 7 53
Louisiana.......... 3 6 71 46 1 3 3 2 22
Oklahoma............ 94 3 19 50 86 1 11 2 24
Texas.............. 5,104 3 5 35 696 594 3 I 115

MOUNTAIN ............. 901 1 37 32 1,576 1,130 2 4 50
Montana............ 92 1 130 92 1
Idaho.............. 66 1 1 159 161 -
Wyoming............. 24 I 1 5 14 1 1 -
Colorado............ 163 1 8 7 622 390 -
New Mexico......... 39 18 2 235 238 1 25
Arizona............. 372 2 6 171 147 25
Utah............... 102 1 11 254 87 2 -
Nevada............. 43 6 3 I -

PACIFIC ......... ...3,172 9 196 136 1,378 1,024 6 4 53
Washington......... 1,263 16 12 428 371 -
Oregon ............. 365 1 12 6 45 28 -
California.......... 1,507 7 157 112 798 536 6 4 53
Alaska............. 1 I 6 4 7 54 -
Hawaii.............. 36 5 2 100 35 -

Puerto Rico 238 1 12 4 7 34 1 20 6










Morbidity and Mortalily U iklv Iy Rporl


139


1.ihk l (D) TOTAL DI A1Hs AM()N( PE H()NS 65 I AR. AN) ()\VI IN RI P()TIN(, I I



(Tables 4(A), 4(B), 4(Ci, and '(D) will be published in sequence covering a fuur-wit l period.)"



Art For weeks ending Fo r Weeks ending

3/28 1 /4 4/11 4/18 3/28 .-/II 11 4/18


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, l.J ..........
Newark, N.J ...............
New York Cit/, N.Y........
Paterson, N.J.............
Philadelphia, Pa..........
Pittsburgh, Pa............
Reading, Pa...............
Rochester, N. ............
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 Watne, Ind..........
Cary, Ind.................
Grand Rapids, Mich.......
Indianapolis, Ind.........
Madison, W ;s..............
Milwaukee, WL ............
Peoria, Ill............ ...
Rockford, Ill ............
South Bend, Ind............
Toledo, Ohi .o..............
Youngstown, Ohio..........

WEST NORTH CENTRAL:
Des Moines, iowa .........
Duluth, Minn.............
Kansas City, Kans........
Kansas City, M ...........
Lincoln, Nebr............
Minneapolis, Mann........
Omaha, Nebr..............
St. Louis, Mo............
St. Paul, Minn...........
Wichita, Kan ............


103
21
13
24
29
25
12
25
20
46
7
26
14
33


27
20
80
19
15
32
37
52
923
14
234
109
38
57
15
22
25
23
19
25


24
21
349
100
106
60
57
207
18
24
18
12
31
89
13
56
18
22
12
66
32


28
12
28
72
16
82
54
159
45
23


172
210
27
26
33
9
14
18
30
39
8
43
22
33


25
25
95
26
17
37
42
47
928
26
354
88
47
68
36
21
35
32
9
25


33
25
473
122
116
65
52
202
21
19
27
23
19
82
18
77
14
21
30
67
34


40
10
14
74
31
113
47
140
62
26


155
25
20
21
31
22
22
15
26
.2
9
22
16
41


27
24
90
21
23
22
48
50
1097
25
325
84
30
54
21
18
40
27
18
29


34
20
400
92
132
80
53
197
32
22
30
10
40
93
12
67
24
25
27
69
40


37
18
15
87
17
84
34
127
68
39


156
28
17
16
35
14
19
25
39
38
10
23
19
35


27
13
92
34
24
25
42
.8
950
3'
287
100
38
64
12
26
44
25
29
16


25
22
344
92
132
59
36
181
31
25
28
19
29
77
30
73
16
16
24
55
42


38
29
19
53
17
92
44
135
46
31


SOUTH ATLAWNIC:
Atlanta, Ga...............
Balt im:or ld ............
Charlorce, N.i ...........
Ja ck onv.'llE, Fla ........
Il m i, Fla ...............
Norfolk, Va..............
Rics c.nd, Va.............
Savannah, Ca.............
St. Petersburg, Fla......
Tampa, Fla...............
Washington, D.C..........
Wilminbir n, Del..........

EAST SOUTH CEirTPAL:
Bir li ngham, Ala..........
Chat tanooga, Tenn.......
Knoxville, T nn..........
Lco'uiville, Ky ...........
Memphis, Tinn............
Mobile, Ala ..............
Muntgaiery, Ala..........
Nashville, nnr ..........

WEST SOUTH CENTRAL:
Austin, Tex..............
Bacon Ro.Vue, La .........
Corpus Christi, Tex......
Dallas, lex..............
El Paso, 7Te .............
Fort Worth, Tex..........
Houscon, Te .............
Little Rock, Ark.........
New Or leans, La..........
Oklahoma Cit', Okla......
Ean AiC,'n.- Tex. ........
ShrE~po.rt, L. ...........
Tulsa, Okla ..............

MOUIflAIN:
Albuquerqu-,, l. lex ......
Cul radio Rpring; Colo...
Denver, C. 1 .............
Ogden, Utah..............
Phcenix, ArLZ ............
Pueblo, Coi .............
Salt LAsb Ct .., Uiah.....
Tu >ce n, Ariz.............

PACIFIC:
BerKr l Calif ..........
Fresno, Calif ............
Glendale, Calif..........
Honolulu, Hawar .........
Long BeEch, Calif........
Lo; Angele Cal if.......
Oakland, Calif...........
PasadErn C lif ...........
P-rcland, Ore ...........
Sacramenro, Calif........
San DicE'- L3 if .........
San Fran xc i o, Callf .....
San Jo,.; Cal f ..........
Seattl Wash............
Spukane, Wash ............
Tacoma, Wash .............


59
143
17
-2
45
23
49
17
69
33
101
25


48
19
24
54
56
20
6
40)


15
20
10
76
2'2
35
89
30
100
64
59
32
22


22
13
66
7
57
6
35
28


62
135
14
37
47
34
47
22
66
38
95
17


50 *
23
28
75 *
61
11
14
75


23
24
10
78
14
53
81
33
75
44
56
28
22


13
16
72
8
60
7
34
40


6
30
25
19 *
41
261
64
22
67
32
65
121
34
82
49
28


San Juar., P.R .............. .. 3 12 10


0Current Wek 1h rtality for 108 Select.J Citis

4(A) Total Mortality, all ags..................... 11,661
4(B) Pneumonia-Influenza Deaths, all ages........ 501
.(C) Total Deaths under 1 Year of Age ............ 670
4(D) Total Deaths, Persons 65 years and over..... 6,560


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


NOTE: 411 death by place o1 ccr..uace.


I








Morbidity and Morlality Weekly Report


INTERNATIONAL NOTES QUARANTINE MEASURES


Immuniration Informatirn for International Travel
19i6-64 edition I'bJ'i. Hl,,lilh r ,I rfr-r Publication No. 384

SECTION S EUROPE
Netherlands, page 60
Insert:
Smallpox And from all countries in Africa, Asia, and
America except Canada and the Unired Stares of
America I.
All other information remains the same.


Poland, page 60

Insert the information under REQUIRED:
Smallpox-Except: (a) children under 3 months who
have nor been in an infected local area during the 14
days preceding arrival; (b) travellers arriving directly
from the following countries, provided they have been
resident there for a period of 14 days, and these
countries are free from smallpox: USSR (thewhole
territory), all European countries, Canada and the
United States of America.


In addition to the established procedures for reporting morbidity
and mortality, the Commun.cable 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



Notes Theie provisionol data ore based on weekly rolegramu o the Communl-
cable Dsoease Center by the individual State heaolh depromenfs.
Symbols- Data not available
guanrtl) zero
Procedures for construction of various mortally curves may be abtalned from
Slatisics Section, Communicable Disease Center. Public Hedrh service,
U. S. Departnnt of Health, Educatlon, ad Welfare. Atlanta. Gorglo 3033..


i9
*
ml1
a Ir

W N
S~


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


Chief, Communicable Disease Center
Chref. Epidemiology Branch
Chief, Statstrics Section
Asst. Chief, Statistics Section
Chief. Surveillance Section
Ed tor, MMWR


James L. Goddard. M.D.
A D. Langmuir, M.D.
R. E. Serfling, Ph.D.
I. L. Sherman, M.S.
D. A. Henderson, M.D.
L. K. Airman, M.D.


1 40


UNIVERbITY OF FLORIDA

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