Morbidity and mortality

COMMUNICABLE DISEASE CENTER


Vol. 14, No. 43


Week Ending
October 30, 1965


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


AN OUTBREAK OF GASTROENTERITIS
Clearwater, Washington

A logging camp on the Olympic peninsula was the site
of an outbreak of gastroenteritis in August, September,
and early October of this year due to heavy contamination
of the water supply by sewage effluent. The illness
was mild in most cases and was characterized by abrupt
onset, watery non-bloody diarrhea, low grade fever, nausea
and abdominal cramps. Its duration ranged from 1 to 4
days; repeated attacks were frequent although the first
illness tended to be the most severe. New employees
became ill with regularity, usually within 48 hours of
arrival.


CON


An Outbreak of G(. trofenter"i i G NOV ;
I(learnitdli r, Wa hint on \ .
Influenza Current Trends .


4n average of 130 loggers ae bher camp.
Se\enty-fi\e of these men live in the camp hunk house
and take their meals in the camp mess hall. The remaining
loggers live at home and have little contact with the
bunk house residents. They seldom eat in the mess hall,
but regularly drink the camp water which is hauled to the
work sites in the forest.
(Continued on page 370)


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
43 rd WEEK ENDED CUMULATIVE, FIRST 43 WEEKS
MEDIAN
DISEASE MEDIAN
DISEASE OCTOBER 30, OCTOBER 24, 1960- 1964 MEDIAN
1965 1964 1964 1960- 1964
Aseptic meningitis .......... 42 67 67 1,751 1,760 2,161
Brucellosis ......****.... 4 5 6 206 341 343
Diphtheria .*.... .......... 2 10 18 123 223 366
Encephalitis, primary infectious.* 59 104 1,584 2,789 -
Encephalitis, post-infectious 7 8 --- 581 720 ---
Hepatitis. infectious including
serum hepatitis ........... 573 682 863 27,992 31,765 35,912
Measles ... .......... 1,041 1,061 1,504 244,813 466,472 402,004
Meningococcal infections ...... 40 46 46 2,541 2,297 1,828
Poliomyelitis, Total ......... 2 4 22 48 98 724
Paralytic ........ ....... 1 20 35 78 574
Nonparalytic *.........* 2 --- 9 10 ---
Unspecified ..........* 3 4 10
Streptococcal Sore Throat and
Scarlet fever ............. 5,613 6,041 5,019 322,547 326,640 263,660
Tetanus *........... 7 7 --- 221 237 --
Tularemia *................ 9 7 --- 217 282 ---
Typhoid fever ....... 14 5 10 366 356 520
Rabies in Animals 64 57 45 3,629 3,771 3,121

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ......... ............... ......... 7 Rabies in Man: ............................ 1
Botulism: ................................ 13 Smallpox: ................................
Leptospirosis: Tenn.- 1 .. ..... .... .... .. ...... 43 Trichinosis: Calif.-1 .. ...................... 97
Malaria: ................................. 68 Typhus-
Plague: ................................. 6 Murine: .......... .... .............. 22
Psittacosis: Va.-1 ......................... 37 Rky. Mt. Spotted: Ga.-1, Calif.-I ............... 246
Cholera: .... ............................. 2


caae








Morbidity and Mortality Weekly Report


OCTOBER 30, 1965


AN OUTBREAK OF GASTROENTERITIS
Clearwater, Washington
(Continued from front page)


In a survey of the incidence of gastroenteritis,
interviews were held with bunk house residents, loggers
who lived at home, family members of loggers who lived
at home, and people living in the Clearwater area who
had no relation to the logging camp. Eighty-eight percent
of the loggers were interviewed and the following data
obtained:


Number
Number Percent
Inter- Il
Ill Ill
viewed

Bunk house employees 68 61 89.7
Employees living at home 48 40 83.3
Family members of employees 120 33 27.5
Unrelated persons 129 18 13.9


An extremely dry summer in the Pacific Northwest,
where the total rainfall during June, July and August was
4.29 inches, depleted the stream which is the camp's
usual source of water. On several occasions during the
summer, water from a nearby river was pumped into the
camp water tank, chlorinated and used. The epidemio-
logical investigations revealed that the employees had
been complaining of poor tasting water on these occasions.
Further, it was found that septic tank effluent from the
camp was discharged into this river at three sites, one of
which was above the intake pipe through which the
supplemental water supply was obtained. The chlorination


process used was also found to be inadequate, as coliform
counts of samples of tap water collected in camp yielded
values as high as 43 MPN.
Examination of stool specimens from patients who
were ill resulted in positive cultures of a specific
serotype of enteropathogenic Escherichia coli 0126:B16.
This organism is documented as a cause of infantile
diarrheal, but has never been implicated as a pathogen
in adults.
The etiology of gastroenteritis associated with
ingestion of water heavily contaminated with sewage or
"sewage poisoning" is obscure. As certain serot\pes of
enteropathogenic E. coli have produced gastrointestinal
illness in adult volunteers2 the hypothesis that this
outbreak might have been caused by this organism was
tested ina rectal swab survey. In all, 233 specimens were
collected from loggers, their families, and unrelated
persons in the area. Complete laboratory data are not
available as yet, but preliminary results do not support
this hypothesis, as enteropathogenic E. coli serotype
0126:B16 is being recovered from all groups with about
the same frequency. No other pathogens hase been
found, but attempts to isolate virus are in progress.

(Reported by Dr. Ernest A. Ager, Chief, Division of
Epidemiology, Washington State Department of Health;
Dr. Phillip H. Jones, Medical Epidemiologist, Washington
State Department of Health; and two EIS Officers.)
1
Boris, M., et al: Pediat 33:18-19, 1964
2une, .C., et al: AmerJ yg 57:22-2. 1953
June, R.C., et al: Amer J Hyg 57:222-23d. 1953


INFLUENZA CURRENT TRENDS


Since publication of the influenza statement prepared
by the Public Health Service Advisory Committee on Im-
munization Practices in June 1965 (MMWR, Vol. 14, No.
24), there have been no outbreaks of influenza documented
in the continental United States, and only two reports have
been noted from other parts of the world. A moderate out-
break of type B influenza began in Australia in April 1965,
and type A2 disease appeared in early May in portions of
the Republic of the Philippines.
In Australia, mild epidemics of influenza type B were
reported in the States of Queensland, Victoria, and New
South Wales during the Australian winter of 1965. The
first case, which was reported in Geelong, Victoria, in
April 1965, yielded an isolate of type B influenza virus.
The same type was recovered from cases in Queensland,
Victoria, and New South Wales. Clinlcall3, the illness
was characterized by acute onset, fever ranging from 1000
to 1040F, headache, myalgia, and sore throat. Nausea and


vomiting were reported] common during the first 2 days
of illness and general weakness was prominent. An out-
standing feature was a severe inflammation of the pharynx
giving a red velvety appearance. Unlike the A2 influenza
epidemic in 1964, the development of cough was unusual.
Influenza B viruses were isolated from respiratory tract
specimens taken post-mortem from cases of sudden deaths
in older groups, both in Victoria and Queensland. Se eral
fatal pneumonias in older children and younger adults
also yielded type B influenza virus. Although mortality
figures for the various states were incomplete, the avail-
able data do not indicate a marked excess mortality.
The epidemic in the Philippines was initially noted
in the Manila area, beginning in mid May, and was brought
to light primarily through an increased number of admis-
sions to the San Lazaro Infectious Disease Hospital.
Subsequent reports from other parts of the Philippines
(Continued on back page)


370











OCTOBI-K 30, 1965


I ~ I


Illr.,, -
Louislnsa ...... ....

Minnesota ... .
New York, II'ptate .
Pennsylvania .... ....
Rhode Island ..... I .
Teannessa ...... .... I
Texas ......... S
St l-h.rlil,'n .. I ..



i.S. Cumulative
Totals (weeks 1-40):
1965"........... 363
1964** ........ 416i

*Includae revised and del.yed rep orl
*'Cort".ponding period in 19t4


Morbidity and Mortality Weekly Report




Table I
REPORTED () SE OF POST-INFlCTIOUS AND POST-IMMI NIZA TION EN(EPIIALITIS
EIGHT HEEK PERIOD ENDING OCTOBER 9, 10tl

I .i. i. .. I1. | l. ... I. -r... ..t...
1 l I I1 ,,,, I Il'* ll r Il i I ].- rh f,.. l


I I,., 111111 11 r


1 1 4


(SltatE not reporting a Cnas not l nstld


SUMMARY OF REPORTED CASES OF INFECTIOUS SYPHILIS

SEPTEMBER 1965 AND SEPTEMBER 1964


CASES OF PRIMARY AND SECONDARY SYPHILIS: By Reporting Areas September 1964 and September 1965 Provisional Data

Cumulative Cumulative
Reporting Area September Jan. Sept. Reporting Area September Jan. Sept.
1965 1964 1965 1964 1965 1964 1965 1964
NEW ENGLAND.............. 41 45 354 366 EAST SOUTH CENTRAL....... 232 166 2,131 1,349
Maine.................... 1 5 Kentucky................ 16 11 109 116
New Hampshire............ 1 23 8 Tennessee................. 31 41 412 334
Vermont.................. 2 3 Alabama.................. 116 77 1,136 670
Massachusetts............ 24 27 209 214 Mississippi.............. 69 37 474 229
Rhode Island............. 4 1 18 13
Connecticut............... 13 16 101 123 WEST SOUTH CENTRAL........ 197 214 1,796 1,955
Arkansas................. 10 10 173 147
MIDDLE ATLANTIC........... 407 432 3,589 4,101 Louisiana................ 59 67 526 539
Upstate New York.......... 46 53 408 498 Oklahoma ................. 4 11 89 113
New York City............ 220 233 2,088 2,356 Texas.................... 124 126 1,008 1,156
Pa. (Excl. Phila.)....... 36 20 144 130
Philadelphia............. 37 22 224 246 MOUNTAIN.................. 53 42 431 409
New Jersey............... 68 104 725 871 Montana.................. 2 2 11 28
Idaho.................... 2 1 7 4
EAST NORTH CENTRAL......... 253 225 2,258 1,719 Wyoming ................. 5 1 7 8
Ohio..................... 54 43 472 397 Colorado................. 13 4 38 24
Indiana.................. 5 6 41 47 New Mexico............... 11 8 86 149
Downstate Illinois....... 16 20 170 114 Arizona.................. 13 22 221 163
Chicago .................. 103 82 916 668 Utah..................... 2 2 12 10
Michigan................. 70 59 598 446 Nevada................... 5 2 49 23
Wisconsin................ 5 15 61 47
PACIFIC................... 163 190 1,527 1,671
WEST NORTH CENTRAL........ 51 48 396 395 Washington .............. 2 11 52 61
Minnesota ................ 7 14 69 98 Oregon................... 1 9 27 55
Iowa..................... 8 5 28 24 California............... 150 168 1,418 1,533
Missouri................. 19 18 174 175 Alaska..... ............ 1 6 8
North Dakota............. 1 2 Hawaii................... 9 2 24 14
South Dakota.............. 2 4 34 37
Nebraska.................... 9 3 70 39 U. S. TOTAL............... 1,194 1,900 17,516 17,212
Kansas ................... 5 4 19 22
TERRITORIES............... 86 78 636 651
SOUTH ATLANTIC............. 517 538 5,034 5,247 Puerto Rico............... 84 78 621 631
Delaware................. 9 44 69 Virgin Islands........... 2 15 20
Maryland....... .......... 37 45 331 396
District of Columbia..... 38 60 369 574
Virginia................. 28 16 259 214
West Virginia............ 9 12 57 37
North Carolina............ 79 92 777 857 Note: Cumulative Totals include revised and delayed reports
South Carolina........... 64 72 632 671 through previous months.
Georgia................ 109 83 828 879
Florida .................. 153 149 1,737 1,550


.1 .... 1~


( i F .. Ir.,

F lo ,-l..


371


1\111111111











372 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 30, 1965 AND OCTOBER 24, 1964 (43rd WEEK)


Encephalitis Poliomyelitis Diphtheria
Aseptic
Meningitis Primary Post-Inf. Total Cases Paralytic
Area
Cumulative Cumulative Cum.
1965 1964 1965 1965 1965 1965 1964 1965 1965 1964 1965 1965
UNITED STATES... 42 67 59 7 2 48 98 35 78 2 123

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

MIDDLE ATLANTIC...... 11 9 15 4 15 3 13 5
New York City...... 2 1 4 1 2 2 3
New York, Up-State. 7 3 3 10 9 -
New Jersey......... 1 4 8 3 3 3 2 -
Pennsylvania....... 1 1 -- --- 2

EAST NORTH CENTRAL... 12 11 7 1 2 21 2 15 6
Ohio............... 3 4 4 2 2 1
Indiana............ I 8 5 2
Illinoi............. 4 5 2 1 1 6 1 5 2
Michigan............. l 1 3 1 2 -
Wisconsin........... I 2 I 1

WEST NORTH CENTRAL... 5 3 14 11 9 7 7 19
Minnesota............. 5 2 2 1 3 1 2 7
Iowa............... 1 2 5 2 1
Missouri........... 3 1 4 3 1
North Dakota....... -
South Dakota....... l -- 7
Nebraska........... 5 3 2
Kansas............. 1 I I 1 1

SOUTH ATLANTIC....... 6 3 5 1 1 26 1 21 32
Delaware............ 5 -
Maryland ........... 1 -
Dist. of Columbia.. 3
Virginia........... 2 1 4 4 -
West Virginia...... I -
North Carolina..... 10 6 4
South Carolina..... 1 1 I
Georgia............. 3 1 1 15
Florida............ I I I 8 7 9

EAST SOUTH CENTRAL... 2 1 2 1 1 2 6 1 5 1 19
Kentucky ........... 2 2 1 1 -
Tennessee.......... 1 1 3 1 2 1 2
Alabama............ 2 2 15
Mississippi........ I 2

WEST SOUTH CENTRAL... 2 3 1 1 17 9 14 8 1 31
Arkansas........... -- 2
Louisiana........... 1 2 1 7
Oklahoma........... 1 1 3 1 2 1 1
Texas.............. 2 2 1 14 6 12 6 21

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

PACIFIC............... 4 34 6 2 6 3 4 3 9
Washington......... --- 1 -- -- --- 2 --- 2 --- 3
Oregon ........... 1 1 1 I
California......... 4 32 6 2 3 2 1 2 5
Alaska............. -
Hawaii ............. --

Puerto Rico 12










Morbidity and Mortality Weekly Report 373


CASES OF SPE(.ItlD No0llABLE DISFASIS UNITED STATES

FOR W lKbS FNI)II)
OCTOBIR 30, 1965 AND O I OBHI 24, 1964 (43rd X Ilk) Continued


Brucel- Infectious Hepatitis Meningococcal
loss 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... 4 573 280 268 27,992 31,765 40 2,541 2,297 7 221

NEW ENGLAND.......... 19 6 13 1,617 2,895 2 130 72 5
Maine.............. 2 1 1 282 909 1 17 6 -
New Hampshire...... 1 1 159 226 7 1 1
Vermont............. 1 1 88 353 1 8 4 -
Massachusetts ..... 7 1 6 634 645 46 30 3
Rhode Island ....... 1 1 175 174 14 10 -
Connecticut........ 7 1 6 279 588 38 21 1

MIDDLE ATLANTIC...... 96 45 51 4,947 6,990 6 327 291 13
New York City...... 12 5 7 1,001 1,079 1 55 38 -
New York, Up-State. 38 22 16 1,845 3,039 2 94 84 5
New Jersey......... 14 3 11 936 1,178 1 83 96 1
Pennsylvania....... 32 15 17 1,165 1,694 2 95 73 7

EAST NORTH CENTRAL... 2 103 57 43 5,404 4,992 9 373 306 1 33
Ohio................ 28 13 14 1,503 1,302 3 100 77 1 3
Indiana............. 8 5 3 460 430 1 48 48 9
Illinois........... 2 24 13 10 1,022 928 100 80 15
Michigan........... 36 21 15 2,076 1,979 4 82 70 3
Wisconsin.......... 7 5 1 343 353 1 43 31 3

WEST NORTH CENTRAL.. 27 15 10 1,582 1,722 1 129 133 19
Minnesota.......... 3 2 1 178 202 1 30 29 8
Iowa............... 6 4 2 537 278 12 8 4
Missouri........... 6 5 1 338 431 52 60 2
North Dakota....... 29 62 11 19 1
South Dakota....... 20 129 3 3 -
Nebraska........... 4 2 82 47 10 6 2
Kansas ............. 8 4 4 398 573 11 8 2

SOUTH ATLANTIC....... 51 17 31 2,898 3,001 9 480 451 3 50
Delaware........... 2 2 76 66 1 10 6
Maryland........... 9 5 4 507 547 1 46 32 1
Dist. of Columbia.. 41 61 9 15
Virginia........... 6 2 2 685 472 2 59 54 7
West Virginia ...... 6 4 2 401 427 25 33 1
North Carolina..... 13 3 10 288 499 4 100 76 7
South Carolina.. 128 117 62 55 6
Georgia............ 4 1 3 102 94 58 67 3 8
Florida............ 11 10 670 718 1 111 113 20

EAST SOUTH CENTRAL... 40 23 11 1,998 2,186 2 196 178 1 29
Kentucky.............. 19 9 4 717 781 76 58 6
Tennessee.......... 12 10 2 672 772 2 63 56 10
Alabama........... 5 3 2 356 415 35 40 1 11
Mississippi ....... 4 1 3 253 218 22 24 2

WEST SOUTH CENTRAL... 42 20 20 2,406 2,472 3 327 267 2 48
Arkansas ........... 3 2 1 304 235 16 24 11
Louisiana.......... 10 5 5 404 607 1 181 126 1 6
Oklahoma........... 2 2 52 120 20 11 1
Texas.............. 27 13 12 1,646 1,510 2 110 106 1 30

MOUNTAIN............. 34 15 12 1,549 1,920 3 90 77 3
Montana............ 8 3 4 135 170 2 1 -
Idaho.............. 1 186 273 2 11 3 -
Wyoming............. 40 72 5 5 --
Colorado............ 12 8 4 333 501 24 14 2
New Mexico......... 4 3 1 326 266 11 30
Arizona ........... 5 329 426 1 17 7 1
Utah............... 4 1 3 191 161 17 7 -
Nevada............. 9 51 3 10 -

PACIFIC.............. 2 161 82 77 5,591 5,587 5 489 522 21
Washington......... --- --- --- 418 563 --- 37 40 ---
Oregon............. 24 13 10 484 582 33 21 4
California.......... 1 133 66 66 4,424 4,092 5 393 442 17
Alaska............. 3 3 199 240 18 7 -
Haai................ 1 1 1 66 110 8 12


Puerto Rico 26 16 10 1,203 874 1 11 33 3 51


~


~










374 Morbidity and Mortality Weekly Report


CASES 01 SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 30, 1965 AND OCTOBER 24, 1964 (43rd 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... 1,041 244,813 466,472 5,613 9 217 14 366 64 3,629

NEW ENGLAND.......... 37 36,969 17,509 444 1 7 44
Maine.............. 7 2,835 3,095 53 4
New Hampshire...... 382 293 6 3
Vermont............ 18 1,319 2,349 41 31
Massachusetts...... 12 19,327 5,512 96 1 3 2
Rhode Island....... 3,943 2,010 28 1 --
Connecticut........ 9,163 4,250 220 3 4

MIDDLE ATLANTIC...... 165 15,327 52,469 254 1 64 8 172
New York City...... 45 2,533 15,401 3 29 -
New York, up-State. 32 4,227 12,811 163 15 8 159
New Jersey......... 57 2,771 12,243 69 7
Pennsylvania....... 31 5,796 12,014 19 1 13 13

EAST NORTH CENTRAL... 301 56,882 103,492 470 1 14 41 4 542
Ohio............... 9 8,930 19,677 34 10 277
Indiana............ 19 2,017 22,904 107 5 9 65
Illinois........... 53 2,880 16,666 75 1 6 10 1 84
Michigan........... 50 26,745 29,090 154 2 7 2 55
Wisconsin.......... 170 16,310 15,155 100 1 5 1 61

WEST NORTH CENTRAL... 88 16,802 30,379 262 2 28 2 13 12 740
Minnesota........... 8 713 336 10 1 1 2 151
Iowa............... 21 9,089 23,352 66 2 3 209
Missouri........... 1 2,601 1,033 43 1 20 1 8 '1 105
North Dakota....... 58 3,831 4,809 122 45
South Dakota....... 115 35 10 1 3 56
Nebraska........... 453 814 4 1 2 36
Kansas............. NN NN NN 7 4 6 138

SOUTH ATLANTIC....... 131 25,361 38,758 691 33 4 72 8 482
Delaware............... 1 507 414 18 4 -
Maryland........... 4 1,174 3,415 101 20 2 23
Dist. of Columbia.. 2 80 355 3 -
Virginia........... 6 3,919 12,737 153 8 8 2 291
West Virginia...... 73 14,093 8,896 199 3 21
North Carolina..... 3 399 1,179 14 8 15 3
South Carolina..... 28 1,086 4,270 33 3 8 1 3
Georgia............ 1 618 199 3 14 3 9 2 65
Florida............. 13 3,485 7,293 167 1 5 1 74

EAST SOUTH CENTRAL... 50 14,255 68,166 1,085 21 38 10 763
Kentucky........... 14 2,728 18,588 77 3 10 2 83
Tennessee.......... 27 8,053 24,470 851 17 12 8 623
Alabama............ 2,339 18,412 71 1 9 16
Mississippi........ 9 1,135 6,696 86 7 41

WEST SOUTH CENTRAL... 75 31,239 72,438 636 3 91 1 51 8 576
Arkansas........... 1,085 1,134 4 2 63 13 1 83
Louisiana.......... I 111 117 2 1 6 9 2 74
Oklahoma............ 1 211 1,023 29 11 1 7 126
Texas.............. 73 29,832 70,164 601 11 22 5 293

MOUNTAIN............. 105 20,087 19,190 953 16 3 31 4 84
Montana............ 30 3,794 3,289 30 4 1 5
Idaho............... 14 2,846 1,970 124 -
Wyoming............ 852 266 38 4 1 -
Colorado........... 50 5,765 3,280 379 1 9
New Mexico......... 679 539 197 1 12 14
Arizona............ 5 1,362 6,710 67 1 13 4 53
Utah .............. 6 4,583 2,144 '118 8 I 2
Nevada............. 206 992 2 1

PACIFIC.............. 89 27,891 64,071 818 3 13 3 49 10 226
Washington......... --- 7,295 20,223 --- --- -- 4 --- 7
Oregon............. 10 3,325 8,739 18 5 8 9
California......... 47 13,153 33,352 685 3 8 3 36 10 208
Alaska............. 190 1,127 17 2
Hauail............. 32 3,928 630 98 1 -

Puerto Rico 42 2,573 6,730 10 1 14 13










11orbiditN and Morialit) Weckl RHeport


DEATHS IN 122 UNITED STATES (I'I I. FOR U'l I-K ENDED OC1l Iltl Do, 1965


(By place of occurrence and week of filing certificate. Ex ludes


Area


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

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

EAST NORTH CENTRAL:
Akron, Ohio-----------
Canton, Ohio----------
Chicago, Ill.---------
Cincinnati, Ohio------
Cleveland, Ohio-------
Columbus, Ohio--------
Dayton, Ohio----------
Detroit, Mich.--------
Evansville, Ind.------
Flint, Mich.----------
Fort Wayne, Ind.------
Gary, Ind.-------------
Grand Rapids, Mich.---
Indianapolis, Ind.----
Madison, Wis.---------
Milwaukee, Wis.-------
Peoria, Ill.----------
Rockford, Ill---------
South Bend, Ind.------
Toledo, Ohio----------
Youngstown, Ohio------

WEST NORTH CENTRAL:
Des Moines, Iowa------.
Duluth, Minn.---------
Kansas City, Kans.----
Kansas City, Mo.------
Lincoln, Nebr.--------
Minneapolis, Minn.----
Omaha, Nebr.----------
St. Louis, Mo.--------
St. Paul, Minn.-------
Wichita, Kans.--------


All t I, -_,

All 65 years
Ages and over


I'i, -n L n
and
Influenza
All Ages


U'Id. r
1 year
All
Causes


All
Ages


65 years
and over


and
Influenza
All Ages


1 year
All
Causes


4 4 4 4 4+ 4 + I-


749
262
53
27
34
52
19
29
25
47
69
9
49
24
50

3,204
43
34
142
34
22
43
79
110
1,637
21
490
188
42
100
21
36
60
39
26
37

2,573
56
35
738
146
225
139
80
360
36
49
35
42
44
137
34
137
28
28
41
119
64

839
54
30
35
136
32
120
68
241
81
42


454
139
26
20
22
28
11
21
21
27
48
6
36
15
34

1,884
24
22
89
20
13
21
46
57
968
12
287
93
24
60
15
22
39
26
18
28

1,444
33
18
391
84
127
79
46
206
21
24
20
18
28
71
24
89
14
17
28
67
39

517
32
18
16
94
18
82
37
143
57
20


38
17
3

1
5
1
1

2
5

2

1

145
3

3
2
1
1
2
4
73
2
25
13
2
6


4
3
1


130
3
2
39
5
8
7
6
23
1
2
2
1
2
9
2
4
2
2
- 6
6
4

59
2
4
5
9
3
3
8
20
3
2


*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, Calif2*--------
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.----------


1,092
125
257
49
62
81
54
84
29
58
69
171
53

562
93
44
55
111
98
56
22
83

1,019
26
31
28
133
36
62
195
68
166
78
97
45
54

399
46
26
122
24
68
17
51
45


1,653
18
49
45
45
61
625
65
35
103
50
100
191
36
149
48
33


Total 12,090 6,864 469 663

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 528,298
All Causes, Age 65 and over------------------- 298,055
Pneumonia and Influenza, All Ages------------- 21,298
All Causes, Under 1 Year of Age--------------- 31,322


Week No.


3:75


_ _~__ ___ __


fetal deaths)









376


INFLUENZA CURRENT TRENDS
(Continued from page 370)


showed slight increases in the weekly incidence of
influenza-like illness. The epidemic continued at moder-
ately low levels through the subsequent weeks and spread
gradually to other areas. Type A2 influenza virus was
isolated, from typical cases, by the Bureau of Research
Laboratories. Symptoms were generally mild with deaths
occurring only rarely. By early summer, cases had begun
to decrease in number and the epidemic in general was on
the wane. The reported number of cases appears to be
considerably less than that recorded during the 1957 epi-
demic of Asian influenza.
The influenza prospectus for the United States during
1965-66 is unchanged from that in the statement in June.
The last major epidemic of type A influenza occurred
generally throughout the United States in 1962-63 and on
the west coast during the following year. Although A2
infections appeared at times in widely scattered areas in
1964-65, they reached epidemic levels, as measured by
excess mortality, only in certain parts of the Northeast
and in Texas and Oklahoma. In view of the 2- to 3-year
periodicity of type A influenza, an increased incidence
may be expected in the coming season.
The last major outbreak of type B influenza in the
United States was in 1961-62. In view of the 4- to 6-year
periodicity of influenza B epidemics, type B influenza
may also be anticipated during the coming year. This
expectation is strengthened by the substantial number of
type B strains isolated during the winter 1964-65 in the
U. S. and Europe.
The Public Health Service Advisory Committee on
Immunization Practices has outlined the influenza immuni-
zation schedule recommended for all persons in the "high
risk groups" detailed in the statement issued by the Com-
mittee on June 11, 1965 (MMWR, Vol. 14, No. 24).
(Reported by the Respiratory Diseases Unit of the Sur-
veillance Section, Epidemiology Branch, CDC.)


OCTOBER 30, 1965


THE MORBIDITY AND MORTALITY WEEKLY REPORT. WITH A CIRCULA-
TION OF 14 000. 15 PUBLISHED AT THE COMMUNICABLE DISEASE
CENTER. ATLANTA GEORGIA.
CHIEF. COMMUNICABLE DISEASE CENTER JAMES L. GODDARD. M.D.
CHIEF EPIDEMIOLOGY BRANCH A. D. LANGMUIR. M.D.
ACTING CHIEF. STATISTICS SECTION IDA L. SHERMAN. M.S.
CHIEF. SURVEILLANCE SECTION D. A. HENDERSON. M.D.
EDITOR MMAR D.J.M. MACKENZIE. M.B..
F.R.C.P.E.

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY. THE COMMUNICABLE DISEASE CENTER
WELCOMES ACCOUNTS OF INTERESTING OUTBREAKS OR CASE IN-
VESTIGA TIONS WHICH ARE OF CURRENT INTEREST TO HEALTH
OFFICIALS AND WHICH ARE DIRECTLY RELATED TO THE CONTROL OF
COMMUNICABLE DISEASES. SUCH COMMUNICATIONS SHOULD BE AD-
DRESSED TO:
THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT
COMMUNICABLE DISEASE CENTER
ATLANTA. GEORGIA 3033
NOTE' THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE BASED
ON WEEKLY TELEGRAMS TO THE CDC BY THE INDIVIDUAL STATE
HEALTH DEPARTMENTS. THE REPORTING WEEK CONCLUDES ON SAT-
URDAY. COMPILED DATA ON A NATIONAL BASIS APE RELEASED ON
THE SUCCEEDING FRIDAY.

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