Morbidity and mortality

Morbidity and Mortality



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

PUBLIC HEALTH SERVICE SEP 1'; 1

Prepared by the CB L : DA 634-5131


For release August 28, 1964 ATLANTA, GEORGIA 30333 lNo. 3
PROVISIONAL INFORMATION ON SELECTED NOTIFIABLE DISEASES IN THE UNITED STATES AND ON
DEATHS IN SELECTED CITIES FOR WEEK ENDED AUGUST 22, 1964


ENCEPHALITIS


A total of 248 cases of primary encephalitis was re-
ported for the week ended August 22. This brings to 1,458
the cumulative total thus far in 1964. A comparison of
this year's sum with that of comparable periods for pre-
vious years is not possible because reporting of primary
encephalitis, as a separate category, did not begin until
January 1, 1964.
Of the cases reported during the past week, 212 were
from Texas; the remainder were scattered throughout the
country. In Texas, 2 outbreaks are occurring; one is in
Houston, the other in the South Plains area of Hale, Lub-


bock, and Castro Counties (See Epidemiologic Reports,
page 290 ). In Houston, St. Louis Encephalitis virus in-
fection has been identified serologically in 8 cases.
Small, discrete, apparently unrelated outbreaks have
occurred in Florida, Illinois, and Arizona during recent
weeks (see page 292). Since it is not uncommon for viral
encephalitis to be reported at this season in these regions
it is too early to determine the significance of these cases
as reflecting a more widespread problem.
A summary of post-infectious encephalitis for July is
presented on page 293.


Table 1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
34th Week Ended Cumulative. First 34 Weeks
Disease August 22, August 24, Median Median
1964 1963 1959 1963 1964 1963 1959 1963
Aseptic meningitis ................ 63 57 --- 1,176 1,018 ---
Brucellosis ....................... 14 10 10 285 243 402
Diphtheria ........................ 9 3 9 174 156 366
Encephalitis, primary infectious.. 248 --- 1,458 1,027 ---
Encephalitis, post-infectious ..... 8 --- 664 ---
Hepatitis, infectious including
serum hepatitis ................. 641 685 685 26,009 29,039 29,041
Measles ............................ 828 996 1,055 432,587 356,342 384,757
Meningococcal infections .......... 27 23 24 1,825 1,688 1,578
Poliomyelitis, Total .............. 4 22 77 70 204 559
Paralytic ...................... 3 19 60 58 174 382
Nonparalytic .................. 1 3 --- 9 19 ---
Unspecified .................... --- 3 11
Streptococcal Sore Throat and
Scarlet fever ................ 4,147 2,831 --- 283,486 241,819 ---
Tetanus ........................... 12 4 --- 177 157 ---
Tularemia ......................... 6 1 --- 223 186 ---
Typhoid fever ..................... 8 13 23 263 301 480
Rabies in Animals .................. 98 59 58 3,062 2,568 2,563

Table 2. NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: Mass-1 3 Psittacosis: Mass-1, Calif-2 28
Botulism: 11 Rabies in Man:
Leptospirosis: Ark-1, Iowa-1, Tenn-1 29 Smallpox:
Malaria: NJ-1, NC-1 57 Typhus-
Plague: Murine: Texas-2 19
Rky Mt. Spotted:NJ-1, Md-l, Ohio-1, Ky-1, SC-1, Ga-3, 156
Tenn-2, Texas-1


p5 S a, tO f7 V4 /S/ J3







290


**


20 27 4 II 18 25 1 8 15 22 29
JUNE JULY AUGUST


* 202 Cases with known date of onset
** Through August 25, 1964


EPIDEMIOLOGIC REPORTS

ENCEPHALITIS


TEXAS
Houston
As of August 25, a total of 215 cases, including 22
deaths, was reported in Houston. The vast majority (207)
of these are suspect cases; serologic identification of
St. Louis encephalitis virus infection was made in 8 cases.
A histogram of 202 cases with known dates of onset is
shown above; fatal cases with known dates of onset are so
identified. The earliest case had onset during the week
ended June 20. Six cases occurred the weeks ended July 4
and 11, and 12 cases occurred the following week; since
August 8, there has been a rise in the number of cases
each week, with an abrupt increase to 38 cases the week
ended August 15 and 72 cases the week ended August 22.


The 22 deaths constitute a 10 percent case fatality
rate. With one exception, the deaths for which ages are
known have occurred in persons over 50 years. The cases
with earlier onsets were chiefly from a single lower socio-
economic area of the city. The more recent cases repre-
sent a more diffuse pattern. Cases have been reported in
all sections of Houston.
Of the 215 cases, 96 are in males, 78 in females; for
41, the sex is not yet reported.

In the 162 cases where the race has been reported, 98
were in whites and 64 in non-whites.

Approximately two-thirds of the cases are among per-
sons over 20 years of age. The age distribution of the


Morbidity and Mortality Weekly Report


80 REPORTED CASES OF ENCEPHALITIS*
BY WEEK OF ONSET
HOUSTON, TEXAS-1964

70-



60


M DEATHS







Morbidity and Mortality Weekly Report


REPORTED
BY
HALE


CASES OF ENCEPHALITIS
WEEK OF ONSET
COUNTY, TEXAS-1964


I-I-

- I- I


0 I I II I


JULY


I I
I 8


15 22


AUGUST


*23 Cases with known dc

cases and deaths are presented in the following table:


AGE SPECIFIC ATTACK RATES FOR ENCEPHALITIS
HOUSTON, TEXAS, 1964

Serologically Attack Rate/
Age Group No. Cases No. Deaths Confirmed 100,000*
0.4 20 1 1 16.5
5-9 20 0 1 18.7
10.14 15 0 2 17.8
15-19 14 0 0 23.0
20.29 24 0 0 18.3
30.39 21 0 0 14.0
40.49 17 0 0 14.5
50.59 25 5 0 29.2
60.69 23 4 1 46.4
70+ 28 9 2 89.9
Unk. 8 3 1 -
215 22 8 23.0
*1960 Census

In a survey of the mosquito population in Houston, 97
percent of the 2,000 mosquitoes trapped have been identi-
fied as Culex quiriqurfa.icatu s, one of the known vectors
of St. Louis Encephalitis. Vector Control operations, pri-
marily larvaciding, are in progress. Fogging operations are
also being conducted.

(Reported by Charles A. Pigford, M.D., Director of Public
Health, Houston, Van C. Tipton, M.D., Director, Communi-
cable Disease Division, Texas State Department of Health,
and a team from the Communicable Disease Center.)


ite of onset.

South Plains Area

A total of 33 cases of suspect encephalitis in humans
has been reported through August 25 in 3 counties in the
South Plains area of Texas. Hale County reported 29,
Lubbock County 3, and Castro County one. Both St. Louis
and Western Encephalitis viruses have been isolated from
human cases in previous years in this region; thus far,
no isolations or serologic confirmations have been made
in 1964.
As shown in the histogram ( above ), one case oc-
curred each week in July and early August. During the
week ended August 8, there were 5 cases. The total rose
to 10 cases during the week ended August 15. Four
cases became ill during the week ended August 22; most of
the suspect cases, which do not appear in the table,
became ill during this period.

AGE SPECIFIC ATTACK RATES FOR ENCEPHALITIS
HALE COUNTY, TEXAS, 1964

Attack Rate/
Age Group No. Cases 100,000'
0.4 12 253
5.9 4 89
10.19 1 14
20.29 3 63
30.39 4 88
40.59 3 40
60+ 0 0
Total 24 60


291







Morbidity and Mortality Weekly Report


The overall attack rate thus far is 60 per 100,000.
The age distribution, presented before, shows the highest
attack rate to be in pre-school age children, among whom
one-half of the cases have occurred. There is a rather
uniform spread through the older age groups.
Approximately one-half of the recorded cases are
among Mexican migrant workers (Braceros). There has
been one fatality, a 2-month-old infant.
Western Encephalitis virus has been recovered in the
State laboratory at Austin from pools of mosquitoes in
Hale County.
(Reported by Dr. Van C. Tipton, Director, Division of
Communicable Disease Control, Texas State Department
of Health, and a team from CDC.)

SOUTH CAROLINA

Eastern Encephalitis virus was isolated from the
brain of one horse and tentatively identified from the
brain of another horse, both of which died within the last
3 weeks in the eastern half of South Carolina. Clinical
cases in horses have occurred elsewhere in the State.
No human cases of suspected arboviral encephalitis
have been reported.
(Reported by Dr. G. E. McDaniel, Director, Division of
Disease Control, South Carolina State Board of Health.)


ARIZONA
Two Indians died of encephalitis-like illness on
August 14 and 16 at the Division of Indian Health Hospital,
Gallup, New Mexico. The patients, a 29-year-old female (5
months pregnant) and a 5.year-old male, resided at 2 sepa-
rate areas of the Navajo Indian Reservation in northeastern
Arizona. Onset dates were August 6 and 15.

(Reported by Division of Indian Health, Bureau of Medical
Services, Public Health Service, and a team from the
Communicable Disease Center.)


FLORIDA

Between early June and July 22, 4 serologically con-
firmed cases of Eastern Encephalitis occurred in 4 widely
scattered counties in the central, northern and Panhandle
sections of Florida. The patients were 5- and 6-year-old
children, and 17- and 38-year-old males. Two of the
patients died.
Eastern encephalitis virus was recovered from pools
of mosquitoes collected in 2 of the areas in which these
human cases occurred.
In addition, at least 80 cases of clinical Eastern
Encephalitis in horses have been reported; the majority
occurred in June and July. (An earlier report appeared in
MMWR, Vol. 13, page 242). Confirmation by serology or
viral isolation was made in 15 of the horse cases.
(Reported by Charlton Prather, M.D., Epidemiologist,
Florida State Board of Health.)


ILLINOIS

Four cases of encephalitis-like illness were re-
ported this month in children residing in 2 central Illinois
communities; 3 occurred in Pekin, the fourth in Springfield.
Onset dates for the Pekin cases were August 4 for
the first case and August 13 for the 2 others. One patient
experienced abrupt onset of fever, convulsions and local-
ized neurologic signs. The other 2 patients also had
abrupt onsets of fever and transient convulsions; neuro-
logic sequelae were not noted.
The patient in Springfield experienced fever, menin-
gismus, convulsions, and localized neurologic findings in-
cluding dysarthria, commencing August 16.
No cases have been reported elsewhere in the State
as of August 26. Virological studies are in progress.
(Reported by Norman Rose, M.D., Chief, Buresu of Epi-
demiology, Illinois State Department of Public Health,
Fred Long, M.D., Director of Health, Peoria County, and
a team from the Communicable Disease Center.)


STAPHYLOCOCCAL FOOD POISONING Georgia


From 2-6 hours after eating ham, 7 residents of
Haralson County, Georgia, experienced vomiting and
diarrhea in an outbreak of staphylococcal enterotoxin
food-borne disease. All but one of the victims was a
member of one family. The ham was consumed over a
period of 5 days, from June 13 to 17. The mother ate the
ham on 2 occasions; each time she became symptomatic.
The ham was commercially packaged. After purchase
at a local grocery, it was brought to a bakery shop, where
it was cooked. After cooking, the bakery owner's wife
sampled a slice; she did not become ill. Then she wrapped
the ham in a fresh piece of aluminum foil. The warm ham


remained at the bakery for 12 hours until the family called
for it.
A portion of sliced ham yielded 4,900,000,000 coagu-
lase-positive staphylococci per gram. These organisms
were not typable with the International set of bacteri-
ophages. Physical examinations of the bakery workers
failed to demonstrate skin lesions; nasal cultures were
negative for staphylococci.
(Reported by Thomas W. McKinley, Associate Epidemi-
ologist, and Dr. John E. McCroan, Chief Epidemiologist,
Epidemiologic Investigations Branch, Georgia Department
of Public Health.)


292







293


Morbidity and Mortality Weekly Report


REPORTED CASES OF POST-INFECTIOUS ENCEPHALITIS FOR JULY
5 WEEKS ENDING 7/4, 7/11, 7/18, 7/25, 8/1
REPORTED PRIMARY INFECTION
Herpes Respiratory
REPORTING AREA Mumps Chickenpox Measles Rubella Influenza Simplex Syncitial Vaccinia Pertussis
NEW ENGLAND
Rhode Island 1 1
MIDDLE ATLANTIC
New York Up.State 1 1 2 1 1
Pennsylvania 1 2 2 2 1
EAST NORTH CENTRAL
Illinois 9 2
WEST NORTH CENTRAL
Iowa 1
SOUTH ATLANTIC
Virginia 5
EAST SOUTH CENTRAL
Tennessee 3 1
WEST SOUTH CENTRAL
Arkansas 3 1 1
PACIFIC
Washington 7
Oregon 4 1 1
California 29 4 9 2
U.S. TOTAL 63 9 15 6 2 4
U.S. CUMULATIVE TOTAL*
through 8/1 359 51 166 31 9 8 1 1 1
*Includes revised and delayed reports. (States not reporting a case not listed)


POST-INFECTIOUS ENCEPHALITIS JULY


A total of 99 cases of post-infectious encephalitis was
reported for the 5-week period ended August 1 (see table
above). This brings to 627 the cumulative total of post-
infectious encephalitis cases reported for the first 7
months of 1964. (For earlier reports, see MMWR, Vol. 13,
pp. 46, 102, 143, 177, 219, and 266).
Post-mumps encephalitis cases numbered 63 (64 per-
cent of all cases for this period). This sum is approxi-
mately the same as for the preceding 3 months, but the
percent of the monthly total is greater. Post-measles
encephalitis cases and percent total decreased compared


to each of the 4 preceding months. A comparison of the
cases attributed to mumps, measles, and other causes is
presented by month in the table below.
There were 9 cases of post-chickenpox encephalitis
reported; 4 were from California, the remainder from 4
States. The cumulative number of chickenpox cases is 51;
thus, its percentage of the national total remains at 8.
Six cases of post-rubella encephalitis were reported,
bringing the cumulative count to 31. This figure represents
5 percent of the national total. The case reported from
Oregon represents the first in the Pacific region in 1964.


PERCENT DISTRIBUTION OF POST-INFECTIOUS ENCEPHALITIS DUE TO MUMPS, MEASLES, AND OTHER
OTHER CAUSES IN 1964, BY MONTHS*

Mumps Measles Other

Month Percent Percent Percent Total Cases
Cases Total Cases Total Cases Total

January 26 84 3 10 2 6 31
February 40 77 6 11 6 11 52

March 39 57 19 27 11 16 69

April 68 49 51 36 21 15 140
May 60 50 46 39 13 11 119
June 63 54 26 22 28 24 117
July 63 64 15 15 21 21 99

CUMULATIVE TOTAL 359 57 166 26 102 16 627
*Includes revised and delayed reports.







Morbidity and Mortality Weekly Report


CONGENITAL SYPHILIS


During fiscal year 1963, 4,140 cases of congenital
syphilis were reported in the United States. In fiscal year
1962, the total number of cases reported was 4,085.
These 1963 cases represent a 74 percent reduction
from the 16,164 cases reported 2 decades ago (fiscal year
1943) and a 48 percent reduction from the 8,021 cases


reported one decade ago. In fiscal year 1963, the number
of cases among non-whites (2,202) slightly exceeded
the number of cases among whites (1,938).

(Reported by the Venereal Dis.ase Branch of the Com-
municable Disease Center)


REPORTED CASES OF CONGENITAL SYPHILIS, UNITED STATES
EXCLUSIVE OF KNOWN MILITARY CASES


18,000.


16,000.


14,000.


12,000.


10,000.


8,000.


6,000.


4,000.


2,000.


0.


1941 '43 '45 47 '49


I I
'53


'55 '57 '59 '61 '63 '65


FISCAL YEAR



INFECTIOUS SYPHILIS JULY


A total of 1,999 cases of infectious syphilis was re-
ported for July (see table opposite page). This figure
represents an increase of 6 percent over the 1,890 cases
reported for July 1963. The cumulative total of 13,220
cases in 1964 is 4 percent above that for the comparable
period one year ago.
During the first 7 months, the cumulative totals for all


but 2 of the regions have shown an increase over the
comparable period of 1963. The largest increase, 15%,
occurred in the East North Central region; the south At-
lantic States showed a 14 percent rise.

The West South Central and Middle Atlantic regions
declined 11 and 7 percent, respectively.


294






SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS JULY 1964 JULY 1963
CASES OF PRIMARY AND SECONDARY SYPHILIS: BY REPORTING AREA JULY 1964 AND JULY 1963 PROVISIONAL DATA
Cumulative Cumulative
Reporting Area Jan-July Reporting Area Jan-July
1964 1963 1963 1963 1964 1963 1964 1963


NEW ENGLAND...............
Maine....................
New Hampshire...........
Vermont..................
Massachusetts...........
Rhode Island.............
Connecticut..............

MIDDLE ATLANTIC...........
Upstate New York.........
New York City............
Pa. (Excl. Phila.).......
Philadelphia.............
New Jersey...............

EAST NORTH CENTRAL........
Ohio....................
Indiana..................
Downstate Illinois......
Chicago.................
Michigan................
Wisconsin................

WEST NORTH CENTRAL........
Minnesota................
Iowa.. .......... ....
Missouri..................
North Dakota..............
South Dakota.............
Nebraska................
Kansas..................

SOUTH ATLANTIC............
Delaware.................
Maryland.................
District of Columbia.....
Virginia.................
West Virginia............
North Carolina............
South Carolina..........
Georgia..................
Florida..................


447
57
244
18
27
101

184
46
7
11
73
43
4

40
5
5
22

4
1
3

650
2
54
48
29
1
128
83
91
214


3,166
394
1,859
81
194
638

1,286
312
37
89
508
312
28

296
72
19
134

28
24
19

4,021
45
308
332
165
25
653
525
722
1,246


3,410
364
1,896
87
425
638

1,118
218
36
66
528
235
35

274
46
18
126
4
18
28
34

3,533
27
326
406
176
26
531
419
600
1,022


EAST SOUTH CENTRAL........
Kentucky.................
Tennessee...............
Alabama............o.....
Mississippi................

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

MOUNTAIN ...............
Montana................
Idaho...................
Wyoming..................
Colorado................
New Mexico...............
Arizona..................
Utah.....................
Nevada...................

PACIFIC..................
Washington..............
Oregon.................
California .............
Alaska...................
Hawaii........ ... ......

U. S. TOTAL..............


1,999


1,890


1,009
81
258
509
161

1,485
118
393
94
880

313
23
3
7
16
128
111
8
17

1,358
43
39
1,259
6
11

13,220


903
85
234
406
178


1,663
131
348
104
1,080

284
5
4
6
23
70
126
12
38

1,286
74
32
1,163
3
14

12,731


TERRITORIES............... 71 44 486 452
Puerto Rico.............. 63 44 466 441
Virgin Islands........... 8 20 11


Note:


Cumulative Totals include revised and delayed reports
through previous months.


I A.










296 Morbidity and Mortality Weekly Report


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 22, 1964 AND AUGUST 24, (34TH WEEK)


Aseptic Encephalitis
Aseptic
Meningitis Primary Post-Inf. Poliomyelitis, Total Cases Poliomyelitis, Paralytic
Area
Cumulative Cumulative
1964 1963 1964 1964 1964 1963 1964 1963 1964 1963 1964 1963
UNITED STATES... 63 57 248 8 4 22 70 204 3 19 58 174

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

MIDDLE ATLANTIC...... 14 8 11 2 2 14 12 54 1 11 11 41
New York City...... 3 3 1 1 -
New York, Up-State. 6 7 5 1 2 9 7 1 8 5
New Jersey......... 1 2 2 1 -2 1
Pennsylvania....... 4 1 1 1 14 46 11 35

EAST NORTH CENTRAL... 4 5 7 1 1 1 10 30 1 1 9 22
Ohio................ 2 2 5 2 8 2 4
Indiana............ 2 1 2 2 1 2 1
Illinois............ 1 2 1 4 11 4 10
Michigan........... 1 1 1 1 5 1 5
Wisconsin........... 1 4 1 2

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

SOUTH ATLANTIC....... 7 7 4 1 2 23 28 1 2 18 25
Delaware........... 2 1 1
Maryland............ 1 1 -
Dist. of Columbia.. 1 -
Virginia........... 1 1 2 1
West Virginia...... 3 1 1 2 1 2
North Carolina..... 1 9 3 5 3
South Carolina..... 2 5 2 4
Georgia............. 2 1 8 2 1 7
Florida............ 3 3 2 1 9 7 1 8 7

EAST SOUTH CENTRAL... 1 5 5 43 5 4 41
Kentucky........... -
Tennessee.......... 1 3 5 2 5
Alabama............ 5 2 35 5 2 33
Mississippi........ 3 3

WEST SOUTH CENTRAL... 3 4 215 6 21 6 21
Arkansas........... 2 3 3
Louisiana.......... 2 1 13 13
Oklahoma............ 2 2 2 -
Texas............... 1 2 212 4 5 4 5

MOUNTAIN............. 1 2 7 2 4 1
Montana............. 1 I -
Idaho............... 1 1
Wyoming.............. 2 2 -
Colorado............ 1 2 1 1 -
New Mexico......... 3 -
Arizona........... -
Utah................ -
Nevada............. -

PACIFIC.............. 29 24 7 4 3 19 3 17
Washington......... 1 I 2 2
Oregon............... 1 2 1 1
California......... 28 24 6 4 2 15 2 14
Alaska............. -
Hawaii.............. -

Puerto Rico 4









Morbidity and Mortality Weekly Report 297


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

AUGUST 22, 1964 AND AUGUST 24, 1963 (34TH WEEK) CONTINUED


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

UNITED STATES... 14 285 9 174 641 309 297 35 26,009 29,039 8 263

NEW ENGLAND........... 2 1 44 54 28 25 1 2,469 3,107 13
Maine............... 39 10 5 5 797 1,413 -
New Hampshire...... 7 2 5 184 273 -
Vermont............. 8 6 1 1 314 51 -
Massachusetts...... 2 1 5 20 13 7 527 887 6
Rhode Island....... 2 1 1 127 72 6
Connecticut........ 7 1 6 520 411 1

MIDDLE ATLANTIC...... 5 7 122 54 68 5,819 5,699 40
New York City...... 3 23 7 16 887 844 15
New York, Up-State. 2 57 32 25 2,589 2,528 9
New Jersey......... 2 15 5 10 1,018 852 1
Pennsylvania....... 3 2 27 10 17 1,325 1,475 15

EAST NORTH CENTRAL... 3 38 8 120 63 51 6 4,043 4,742 1 61
Ohio............... 2 26 12 13 1 1,065 1,306 23
Indiana............ 1 1 8 3 5 354 430 1 12
Illinois........... 2 24 6 29 12 17 723 1,021 14
Michigan........... 5 1 51 35 16 1,598 1,773 9
Wisconsin.......... 1 6 6 1 5 303 212 3

WEST NORTH CENTRAL... 5 127 2 26 33 17 14 2 1,403 1,318 2 26
Minnesota.......... 7 11 4 4 147 200 1 3
Iowa............... 3 82 7 2 3 2 205 241 1 4
Missouri........... 1 9 1 8 4 4 350 491 9
North Dakota....... 2 2 1 1 53 43 2
South Dakota ...... 1 14 1 4 3 1 116 82 1
Nebraska........... 11 2 4 35 94 3
Kansas............. 2 7 9 7 2 497 167 4

SOUTH ATLANTIC....... 27 6 40 59 25 31 3 2,451 2,960 2 56
Delaware............ 2 1 1 48 41 -
Maryland........... 12 8 4 460 362 3
Dist. of Columbia.. 1 1 141 83 -
Virginia............. 13 7 1 5 1 381 615 10
West Virginia...... 2 1 1 370 456 -
North Carolina..... 3 8 5 3 427 756 1 16
South Carolina..... 7 2 1 1 92 127 10
Georgia............ 8 20 2 1 1 62 121 1 3
Florida............ 3 6 13 23 8 14 1 570 399 14

EAST SOUTH CENTRAL .. 14 6 32 18 12 2 1,800 2,804 25
Kentucky........... 4 10 5 3 2 695 803 7
Tennessee.......... 4 1 12 7 5 613 1,084 11
Alabama ............ 4 3 3 3 322 443 5
Mississippi........ 2 2 7 6 1 170 474 2

WEST SOUTH CENTRAL.. 3 30 27 71 42 27 2 1,981 2,053 3 20
Arkansas........... 1 5 4 3 1 196 230 2 10
Louisiana.......... 1 4 5 22 12 10 461 411 3
Oklahoma........... 4 1 1 100 96 4
Texas.............. 1 17 22 44 26 16 2 1,224 1,316 1 3

MOUNTAIN............. 1 25 2 31 8 4 19 1,590 1,864 7
Montana............... 140 240 -
Idaho.............. 12 12 201 289 -
Wyoming............. 2 1 1 50 25 1
Colorado........... 6 1 1 4 433 380 -
New Mexico......... 1 1 6 5 1 227 219 2
Arizona............. 2 1 3 3 358 439 4
Utah............... 1 21 2 1 1 131 256 -
Nevada............. 1 50 16 -

PACIFIC.............. 2 17 14 119 54 65 4,453 4,492 15
Washington......... 13 6 1 5 479 770 2
Oregon.............. 2 8 3 5 487 555 -
California......... 2 15 1 97 43 54 3,260 3,024 13
Alaska............. 7 6 1 138 111 -
Hawaii................ 1 1 89 32 -

Puerto Rico 9 13 10 3 587 539 9









298 Morbidity and Mortality Weekly Report


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
AUGUST 22, 1964 AND AUGUST 24, 1963 (34TH WEEK) CONTINUED


Streptococcal
Meningococcal Sore Throat and Rabies in
Measles Meningitis Scarlet Fever Tetanus Tularemia Animals
Area ---
Cumulative Cum. Cum. Cum.
1964 1964 1964 1963 1964 1963 1964 1964 1964 1964 1964 1964
UNITED STATES... 828 27 1,825 1,688 4,147 2,831 12 177 6 223 98 3,062

NEW ENGLAND.......... 74 50 106 255 163 8 1 28
Maine.............. 16 5 17 16 5 24
New Hampshire...... 1 4 3 1
Vermont............ 11 1 4 27 3 2
Massachusetts..... 22 20 50 1 14 8 1 1
Rhode Island....... 2 8 9 19 16 -
Connecticut........ 23 15 22 189 125 -

MIDDLE ATLANTIC...... 54 8 250 234 204 78 1 17 86
New York City...... 20 2 35 35 7 2 -
New York, Up-State. 22 2 71 74 174 66 1 6 82
New Jersey......... 10 84 32 14 7 5 -
Pennsylvania....... 2 4 60 93 9 3 6 4

EAST NORTH CENTRAL... 160 2 258 263 260 160 2 32 1 17 6 423
Ohio............... 40 68 73 15 18 1 9 1 220
Indiana............. 22 40 31 80 24 5 2 1 21
Illinois........... 11 1 65 51 36 23 1 11 10 1 83
Michigan........... 53 1 58 81 63 85 6 1 2 43
Wisconsin.......... 34 27 27 66 10 1 1 3 2 56

WEST NORTH CENTRAL... 17 1 117 106 139 44 9 47 27 984
Minnesota.......... 1 1 27 21 2 3 1 2 5 299
Iowa............... 11 6 6 22 13 3 1 11 357
Missouri........... 2 55 33 23 3 3 24 6 151
North Dakota....... 3 15 8 76 23 1 50
South Dakota....... 5 7 2 1 12 1 74
Nebraska............ 6 22 3 31
Kansas.............. NN 8 11 9 1 8 22

SOUTH ATLANTIC....... 89 8 391 314 412 262 1 51 1 21 16 421
Delaware........... 6 2 1 13 -
Maryland........... 1 25 49 2 13 3 -
Dist. of Columbia.. 1 12 6 2 1 1 1 1 -
Virginia........... 9 46 72 114 110 5 4 6 222
West Virginia...... 26 2 29 16 128 54 1 25
North Carolina..... 3 1 68 53 14 8 13 1 5 5
South Carolina..... 21 1 50 15 22 31 4 2
Georgia............ 11 2 55 24 35 3 11 4 93
Florida............ 17 2 100 77 94 32 21 6 74

EAST SOUTH CENTRAL... 59 1 156 124 797 621 3 19 25 13 369
Kentucky............... 7 51 27 67 68 2 5 1 2 50
Tennessee.......... 45 1 53 54 668 515 1 9 17 10 303
Alabama............. 5 34 21 40 10 4 3 1 16
Mississippi........ 2 18 22 22 28 1 4 -

WEST SOUTH CENTRAL... 129 4 167 161 466 435 1 18 74 23 441
Arkansas........... 1 1 20 11 1 6 41 10 112
Louisiana.......... 2 1 110 66 1 1 3 3 2 35
Oklahoma............ 4 7 29 14 35 19 4 75
Texas.............. 122 2 30 55 451 399 9 11 7 219

MOUNTAIN............. 101 65 58 956 697 5 4 35 1 105
Montana............ 10 3 16 26 18 -
Idaho............... 7 3 5 55 42 -
Wyoming............ 6 5 4 19 2 2 1 5 -
Colorado........... 31 11 16 397 308 8
New Mexico......... 3 26 4 333 194 1 47
Arizona............ 24 5 9 64 49 1 46
Utah............... 19 7 14 72 76 1 3 12 1
Nevada.............. 1 8 3 1 3

PACIFIC .............. 145 3 371 322 658 371 4 18 3 12 205
Washington......... 2 29 25 36 45 1 -
Oregon............. 33 21 24 4 8 1 1 8
California......... 97 3 302 253 535 273 4 16 2 11 197
Alaska.............. 4 7 12 31 25 -
Hawaii............. 9 12 8 52 20 1 -

Puerto Rico 48 29 7 11 9 50 1 17










299


Morbidity and Mortality Weekly Report





Table 4 (B). REPORTED PNEUMONIA-INFLUENZA DEATHS IN RIPOR1ING CITIES



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


For weeks ending For weeks ending
Area 8/____ IArea 8/ 8/8 8/1
8/1 8/8 8/15 8/22 8/1 8/8 8/15 8/22


NEW ENGLAND:
Boston, Mass.............. 9 6 10 11
Bridgeport, Conn........... 5 1 4 4
Cambridge, Mass........... -
Fall River, Mass.......... 1 1 1 1
Hartford, Conn............
Lowell, Mass.............. 1 2 -
Lynn, Mass................. 1 1 -
New Bedford, Mass.......... 2 2
New Haven, Conn............ 1 1 1 1*
Providence, R.I............ 2 2 2
Somerville, Mass.......... 1I 2 1
Springfield, Mass.......... 4 1 5
Waterbury, Conn............ -
Worcester, Mass........... 1 3 3 6

MIDDLE ATLANTIC:
Albany, N.Y............... 1 1
Allentown, Pa............. 1 3 2 2
Buffalo, N.Y............... 7 6 6 7
Camden, N.J............... 1 1 1 1
Elizabeth, N.J............ 1 -
Erie, Pa.................. 1 1 4
Jersey City, N.J .......... 4 10 1 3
Newark, N.J............... 2 4 4 3
New York City, N.Y......... 40 42 48 63
Paterson, N.J............. 1 1 3 3
Philadelphia, Pa.......... 19 5 6 11
Pittsburgh, Pa............ 7 6 2 4
Reading, Pa............... 6 1 3 1
Rochester, N.Y............. 10 11 8 9
Schenectady, N.Y........... 1 1 1
Scranton, Pa.............. 1 1 -
Syracuse, N.Y............. 1 3 1 2
Trenton, N.J.............. 3 4 2 1
Utica, N.Y............... 1 2 3 4
Yonkers, N.Y............... 3 2 1 2

EAST NORTH CENTRAL:
Akron, Ohio.............. 2 -
Canton, Ohio............... 10 2 4 1
Chicago, Ill.............. 31 29 30 31
Cincinnati, Ohio........... 3 5 7 3
Cleveland, Ohio........... 5 3 2 3*
Columbus, Ohio............ 4 5 -
Dayton, Ohio............... 1 2 3 1
Detroit, Mich............ 22 18 9 17
Evansville, Ind........... 3 4 4 1
Flint, Mich............... 6 2 1
Fort Wayne, Ind............ 5 4 2
Gary, Ind................. 2 2 3 1
Grand Rapids, Mich........ 6 4 2 2
Indianapolis, Ind......... 4 5 1 1
Madison, Wis............... -
Milwaukee, Wis............. 3 4 3 1
Peoria, Ill............... 2 1 -
Rockford, Ill............ 1 4 2 4
South Bend, Ind........... 1 6 2 1
Toledo, Ohio............... 8 6 3 2
Youngstown, Ohio........... 1 2 1

WEST NORTH CENTRAL:
Des Moines, Iowa........... 1 2 5 1
Duluth, Minn............... -
Kansas City, Kans......... 4 4 2 1
Kansas City, Mo............ 1 2 3
Lincoln, Nebr............. 3 4 2
Minneapolis, Minn........... 1 1 2 1
Omaha, Nebr................ 2 3 1 1
St. Louis, Mo.............. 4 8 13 2
St. Paul, Minn.............. 3 3 3 2
Wichita, Kans............. 3 3 5 8

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

NOTE: All deaths by place of occnrence.


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


"Current Week Mortality for 108 Selected Cities

4(A) Total Mortality, all ages.................... 10,504
4(B) Pneumonia-Influenza Deaths, all ages........ 365
4(C) Total Deaths under I Year of Age............. 684
4(D) Total Deaths, Persons 65 years and over..... 5,705




UNIVERSITY OF FLORIDA


3 1111 111111 8 I I III7III I IIIll11111
3 1262 08864 2979


Morbidity and Mortality Weekly Report


SUMMARY OF PNEUMONIA AND INFLUENZA DEATHS

The weekly average number of pneumonia-influenza
deaths for the four-week period ending August 22 was 385
as compared with an expected weekly average of 396.


ifw
NUMBER
OFr 90
DEA FT5
80O


Summary of Pneumonia and Influenza Deaths


Week Ending
Week Ending -4 Week Weekly
8 1 8 8 8 15 8 22 Total Average

Observed 398 398 380 365 1,541 385
Expected 397 395 395 396 1,583 396

Excess 1 3 -15 -31 -42 -11


Ml


PNEUMONIA INFLUENZA DEA THS in 1OB U S CITIES
Average flneD per WeeM by Four -Week PerIod.

|I '.ELuEtaZA A, I
4-- I--i-


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PCC Sd No -- .* r 9 I ,* iB
L_ 19.1 _'I 9 | 96J J 1964
*vw t*ce v wxuI cr CYL>r fo ',*04 pa gero e9I9')C



(See table, page E99)


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THE MORBIDITt AND MORTALITY WEEKLY REPORT, FAITH A CIRCULA-
TION OF 12.0'0 15 PUBLISHED BY THE COMMUNICABLE DISEASE
CENTER, ATLANTA, GEORGIA.
C-IIEF, COMMUNICABLE DISEASE CENTER JAMES L. GOODDARDM.O.
CHIEF, EPIDEMIOLOGY BRANCH A. D. LANGMUIR, M.D.
CHIEF, STATISTICS SECTION R. E. SERFLING. P-.D.
ASST. CmIEF, STATISTICS SECTION 1. L. SHERMAN, M.S.
CHIEF. SURVEILLANCE SECTION D. A. IENDEqSON. M.D.
DEPuTE CHIEP. SURV. SECTION J. D. MILL.AR. M.D.
EDITOR. MMAr L.. ALTMAN, M.D.
ASSISTANT EDITOR. MMAR P. D. STOLLEY. M.D.

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDIT' AND MORTALITY, THE COMMUNICABLE DISEASE CENTER
CELCOC*ES ACCOUNTS OF INTERESTING OUJTBREAKS OR CASES, SUCH
ACCOUNTS SHOULD BE ADDRESSED TO:
LAWRENCE K. ALTMAN.M.D., EDITOR
MCRBIDITY AND MORTALITY *EERLV REPORT
COMMUNICABLE DISEASE CENTER
ATLANTA. GEOCGIA 30333
NOTES: THESE PROVISIONAL DATA ARE BASED ON IEEKL L TELE-
GRAMS TO THE COMMUNICABLE DISEASE CENTER BY TME INDIVIDUAL
STATE HEEALTH DEPARTMENTS.
SY MBOL.S. DATA NOT AVAILABLE
QUANTITY ZERO
PROCEDURES FOR CONSTRUCTION OF VARIOUS MORTALITY CURVES
MAY BE OBTAINED FROM STATISTICS SECTION. COMMUNICABLE
DISEASE CENTER, PUBLIC HEALTH SERVICE, U.S. DEPARTMENT OF
HEALTH, EDUCATION. AND WELFARE, ATLANTA, GEORGIA 30333.


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