Morbidity and mortality

COMMUNICABLE DISEASE CENTER .
















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


BOTULISM Fullerton, California


Vol. 14, No. 40







Week Ending
October 9, 1965


SERVICE


Two cases of suspected botulism were reported by
the Orange County Health Department on October 1, 1965.
The patients were a 4:3-year-old woman and her daughter
of 18 years. Both had eaten some home-canned albacore.
This tuna fish had been brought home from a fishing
trip by the father of the family on September 10. On
September 13 parts of the fish were cooked in a pressure
cooker for 1'" hours at 220 F and then placed in Mason
jars which were stored at room temperature. The rest
of the fish was frozen or given away as fillets.
On September 19 the daughter ate two small pieces
of albacore from one of the Mason jars. Three days later
she developed symptoms of blurred vision and diplopia


Botulism Full,.rrlJ
Epidemiology Notes
WMasivh ( urrvn.
,ea. I.'' in Orn *ag-


which continued until So onl mild di--
ability resulting. On that day the mother and daughter
prepared a salad containing some of the canned fi;h,
pickles, mayonnaise and olives. The father was away
from home when the salad was served for lunch on the
same day it was prepared. The two sons of the family
tasted the salad, complained of the taste and did not
eat any of it. The mother and the daughter ate quantities
which have not been determined.


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
40th WEEK ENDED CUMULATIVE, FIRST 40 WEEKS
MEDIAN
DISEASE OCTOBER 9, OCTOBER 3, 1960- 1964 MEDIAN
1965 1964
1965 1964 1960-1964
Aseptic meningitis 76 52 89 1,572 1,564 1,945
Brucellosis ............... 4 8 8 197 326 326
Diphtheria ....... .......*. 3 7 10 116 192 323
Encephalitis, primary infectious- 39 86 --- 1,388 2,460
Encephalitis, post-infectious 9 4 --- 567 703
Hepatitis, infectious including
serum hepatitis .......... 561 735 884 26,090 29,773 33,519
Measles .. ....... .. ..... 830 718 888 242,096 463,650 398,286
Meningococcal infections *..... 48 37 37 2,424 2,149 1,688
Poliomyelitis, Total ......... 2 3 37 45 87 645
Paralytic **............. 2 34 35 71 507
Nonparalytic *......* ...... --- 6 10 ---
Unspecified .............. 2 1 --- 4 6 ---

Streptococcal Sore Throat and
Scarlet fever ....... 5487 5,565 4,406 304.085 310,111 249,989
Tetanus *.......******* 6 4 --- 205 214 ---
Tularemia ........... 5 8 --- 197 262 ---
Typhoid fever .....* ...... 18 12 15 332 328 489

Rabies in Animals ..... 52 104 60 3,428 3.591 1 2.955

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ....... ........ ... ..... ........ 7 Rabies in Man: ............................. 1
Botulism: Calif:-2 ................ ......... 13 Smallpox: ...................... ......... -
Leptospirosis: La.-2, Hawaii-2 .................. 39 Trichinosis: ............................... 78
Malaria: Conn.-1 ............................ 63 Typhus -
Plague: ................................. 6 Murine: ...................... ........ 22
Psittacosis: ................. ............... 36 Rky. Mt. Spotted: NJ-1, Ill.-l, Ga.-4, Va.-1 ........ 240
Cholera: ................................. 2 ___


F:,


. .. 345
:)1
.4'.3








Morbidity and Mortality Weekly Report


BOTULISM Fullerton, California
(Continued from front page)


The same night, September 26, the daughter's symptoms
became worse and over the next few days she developed
dysphagia, dysphonia and postural hypotension. The
mother also became ill that same night with weakness-,
difficulty in talking and parasthesias, later developing
dysphagia and nausea without vomiting. Her symptoms
continued to increase in se% erity, she became progressively
weaker and by September 30 had developed frank dysphonia
and inability to swallow. She was admitted to the hospital
that day. Meantime the daughter had begun to have dif-
ficulty in respiration and she in turn was taken to the
hospital on October 1.
On October 1, the State Bureau of Communicable
Diseases was notified that these were two suspected
cases of botulism; antitoxin, polyvalent for types
A, B, E and F was obtained from the CDC San Francisco
Field Station. The mother and daughter were each given
one dose of antitoxin on the night of October 1 and one
dose on the morning of October 2. The daughter has since
made an uninterrupted recovery. The mother, however,


required four additional doses of antitoxin. One was
given on the night of October 2 but after some improvement
the next morning, she developed respiratory difficulty
which required tracheostomy to maintain breathing. Two
further doses were given on October 3 and one on October
4. The mother is recovering slowly and it will be some
time before she is well enough to leave the hospital.
Serum was obtained from both patients before anti-
toxin was given. Aliquots of the serum, the remainder of
the salad, the unopened jars of albacore and the frozen
fillet are being examined concurrently at each of the
California Department of Public Health Laboratory, the
Hooper Foundation, and the CDC Laboratory.

(Reported by Dr. Henry A. Renteln, Head, Special Sur-
veillance Section, Bureau of Communicable Diseases,
California Department of Public Health; Dr. Russell
Watson, Orange County Community Disease Control
Officer; Dr. William Cohen, the Attending Physician,
and an EIS Officer.)


EPIDEMIOLOGIC NOTES AND REPORTS

MEASLES Current Trends


A total of 242,096 cases of measles has been reported
from January 1 through October 9, 1965. The relationship
of this total to the years of highest and lowest incidence
during the past decade is shown in Figure 1. The seasonal
occurrence of measles by 4-week periods during the past
10 years and its distribution through the geographic
divisions of the United States are shown in Figure 2 and
Table 1 respectively.




Figure /
REPORTED MEASLES
BY FOUR-WEEK PERIODS, UNITED STATES
1965 COMPARED WITH II YEAR PERIOD, 1954-1964


----HIGHEST NUMBER, 1954-64
---- LOWEST NUMBER, 1954-64
-1965


Week Number


For 10 years past, the lowest incidence of measles
has occurred during the 37th to 40th weeks. This year
scattered outbreaks in various parts of the United States,
particularly in ruralareas, have given rise to a higher
total for this 4-week period than for the one immediately
preceding. Five counties in Colorado, Kentucky and
Tennessee, with a combined population of 54,000, have
reported more than 250 cases in the past 4 weeks.
According to mortality data for measles for the past
10 years, an average of 434 deaths occur each year.
Preliminary data, based on a 10 percent sampling of


T4BLE I
REPORTED CASES OF MEASLES BY GEOGRAPHIC DIVISION,
WEEKS 1-10. 1960-65

Geographic Dission 1960 1961 196' 1961 1964 1965"
Neu England ....... 40.097 37.362 56.6 7 14.202 17.062 36,876
Middle 4tlantir .... .6,127 9.343 %5.795 41.2%6 5*,263 14,945
East North Central 123.08 106,9.3s 64,111 ,l.l330 10..101 56,104
Hves Norlh Central .. 6.334 13.6b0 15,955 20,026 30,301 16,646
South Allantr ..... 20,246 40.36 *28,;327 32.551 3b.499 25,026
East South Central 3.026 2s.It 3 35.070 1i.12b 67,877 13.978
Host South Crntral .51.. 5 16.257 69.632 21.,031 72.194 31,026
Mounlann ........ ..21.903 17.570 27,025 2b,603 18,;b4 19.i85
Pacif . 50.5 1 19.569 62.402 36,730 63.569 27.641

Total ... 403.95 389,283 445.691 360.667 463.650 242,096
*PrOs i.-onsi drt(;


346


OCTOBER 9. 1965







OCTOB:R 9, 1965


Morbidity and Mortality Weekly Report


Figure 2

REPORTED MEASLES BY FOUR-WEEK PERIODS
UNITED STATES, 1956-1965


death certificates, indicate that there were 440 measles
deaths in 1964 (Monthly Vital Statistics Report, National
Center for Health Statistics.)
Since the live attenuated measles virus vaccine was
licensed for general use in 1962, seven million doses had
been distributed by January 1965; an additional four million
doses have been distributed since. This is enough vaccine
to immunize nearly all children born in the United States
in 3 years, although the proportion of the 11 million
doses used to immunize children actually susceptible
to measles is unknown.


Major epidemics of measles are to be expected during
the next 6 months in areas of the United States where
vaccine is not being used extensively to immunize sus-
ceptible age groups, particularly among pre-school
children. Accordingly, the experience of measles during
the coming winter among both well vaccinated and in-
adequately vaccinated groups of children is confidently
expected to demonstrate the preventive impact of the
currently used measles vaccine both on reported incidence
and on mortality.
(Reported by the Childhood Virus Disease Unit of CDC.)


Figure 3
CASES OF MEASLES -- BY MONTHS AND YEARS
ORANGE COUNTY, CALIFORNIA


347


700


19 1959 1960 1961


1965


(See back page for text)










348 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 9, 1965 AND OCTOBER 3, 1964 (40th 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 1964 1965 1965
UNITED STATES... 76 52 39 9 2 45 87 35 71 3 116

NEW ENGLAND.......... 4 1 2 2 2 2
Maine....... ....... 1 1 -
New Hampshire...... --- --- --- --- -
Vermont............ -
Massachusetts...... 2 2 2
Rhode Island....... 2 1 -
Connecticut........ 1 1 -

MIDDLE ATLANTIC...... 6 6 12 1 4 13 3 12 5
New York City...... 1 8 1 1 1 3
New York, Up-State. 1 3 10 9 -
New Jersey......... 3 5 1 3 2 3 2 -
Pennsylvania....... 2 1 2

EAST NORTH CENTRAL... 16 7 6 2 2 19 2 15 1 5
Ohio............... 3 2 3 2 2 1
Indiana............. 2 6 5 2
Illinois........... 8 3 1 2 1 6 1 5 1 1
Michigan............ 4 2 1 3 1 2 -
Wisconsin.......... 1 2 1 1

WEST NORTH CENTRAL... 9 1 5 10 9 7 7 18
Minnesota.......... 9 1 1 3 1 2 7
Iowa............... 4 2 1
Missouri............ 1 4 3 1
North Dakota....... 1 -- 1 -
South Dakota....... 7
Nebraska........... 1 3 3 I
Kansas............. 3 1 1 1 1 1

SOUTH ATLANTIC....... 2 5 4 3 1 21 1 16 1 30
Delaware........... -
Maryland............ 1 1 1 -1 1 -
Dist. of Columbia.. 3
Virginia........... 4 3 -
West Virginia...... 1 -
North Carolina..... 10 16 2
South Carolina...... 1 1
Georgia.......... ....... 1 1 1 15
Florida............ 1 1 3 8 7 9

EAST SOUTH CENTRAL... 1 3 1 6 1 5 1 18
Kentucky ........... .
Tennessee........... 1 3 1 3 1 2 1 1
Alabama............. 2 2 15
Mississippi........ 1 1 2

WEST SOUTH CENTRAL... 12 3 16 8 14 8 29
Arkansas........... -- 2
Louisiana.......... 1 1 1 6
Oklahoma........... 1 2 1 2 -
Texas............... 12 2 14 6 12 6 21

MOUNTAIN............. 3 6 5 6 3 3 -
Montana............ 1 -
Idaho.............. -
Wyoming............. 2 2 -
Colorado........... 3 1 1 -
New Mexico............. 5 1 3 1 -
Arizona............ 4 2 -
Utah................. -- -
Nevada.............. -. -

PACIFIC.............. 26 23 4 3 2 6 3 4 3 9
Washington........ --- --- --- --- 2 2 --- 3
Oregon ............. -- 1 1 1 1 1
California......... 25 23 3 3 2 3 2 1 2 5
Alaska.............. -
Hawaii.............. -

Puerto Rico 12
*Reports for 40th week not received.










Morbidity and Mortality Weekly Report 3 t1


CASES OF PlI( IIlI) NOTIFIABLE DISEASES: UNITED STATES

t)R WEEKS 1NIDI D

OCTOII K 9, 1965 AND OCTOHB R 3. 1964 (40th II Kl ) Continucd


Brucel- Infectious Hepatitis Mi u. I
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... 4 561 275 261 26,090 29,773 48 2,424 2,149 6 205

EW ENGLAND.......... 29 13 15 1,522 2,734 3 123 61 5
Maine.............. 4 3 1 269 868 16 5 -
New Hampshire .... --- --- --- --- 153 212 --- 7 1 --- 1
Vermont............ 3 1 2 83 342 7 4 -
Massachusetts...... 12 6 6 601 599 3 43 24 3
Rhode Island....... 3 1 2 171 153 14 10 -
Connecticut........ 7 2 4 245 560 36 17 1

MIDDLE ATLANTIC...... 107 46 61 4,648 6,605 3 314 272 13
New York City...... 30 11 19 925 1,011 54 36 -
New York, Up-State. 28 12 16 1,774 2,884 1 91 75 5
New Jersey......... 19 7 12 877 1,128 1 81 93 1
Pennsylvania....... 30 16 14 1,072 1,582 1 88 68 7

EAST NORTH CENTRAL... 116 67 45 5,021 4,665 7 347 293 1 29
Ohio............... 28 12 14 1,379 1,234 1 93 75 2
Indiana............ 15 10 4 440 407 2 45 46 7
Illinois........... 25 14 11 956 859 1 94 75 1 14
Michigan........... 39 24 15 1,923 1,833 2 76 67 3
Wisconsin.......... 9 7 1 323 332 1 39 30 3

WEST NORTH CENTRAL... 4 27 12 13 1,497 1,598 123 128 18
Minnesota.......... 2 1 1 155 183 27 29 8
Iowa............... 3 6 4 1 525 246 9 7 4
Missouri........... 9 3 5 318 394 52 57 2
North Dakota....... 27 58 11 18 -
South Dakota....... 20 126 3 3
Nebraska........... 5 3 2 69 42 10 6 2
Kansas.............. 1 5 1 4 383 549 11 8 2

SOUTH ATLANTIC...... 49 22 19 2,698 2,803 6 462 421 1 47
Delaware........... 1 1 65 55 1 8 6 -
Maryland............ 9 3 4 473 524 44 31 1
Dist. of Columbia.. 1 39 51 9 13 -
Virginia........... 20 8 7 642 439 2 56 49 7
West Virginia...... 3 1 2 376 407 1 25 33 1
North Carolina..... 2 1 1 256 469 1 94 72 1 7
South Carolina..... 122 104 1 60 50 6
Georgia............ 93 85 57 62 5
Florida............ 13 9 4 632 669 109 105 20

EAST SOUTH CENTRAL... 16 6 10 1,849 2,068 5 190 173 3 27
Kentucky........... 4 3 1 659 755 2 73 57 6
Tennessee.......... 5 2 3 621 719 60 55 2 9
Alabama............ 5 5 336 388 1 35 37 1 10
Mississippi ....... 2 1 1 233 206 2 22 24 2

WEST SOUTH CENTRAL... 45 18 24 2,275 2,332 4 315 246 1 45
Arkansas........... 3 1 2 293 220 15 23 1 11
Louisiana.......... 5 2 3 368 573 3 174 119 5
Oklahoma........... 49 110 20 10 1
Texas.............. 37 15 19 1,565 1,429 1 106 94 28

MOUNTAIN.............. 22 11 4 1,457 1,785 12 86 73 i- 3
Montana............ 9 4 2 118 158 2 -
Idaho.............. 183 252 1 9 3
Wyoming............ 40 57 5 5 -
Colorado............. 6 6 311 476 9 24 12 2
New Mexico......... 2 2 309 250 11 29 -
Arizona............ 4 307 395 16 7 1
Utah............... 1 1 180 146 2 16 7 -
Nevada............. 9 51 3 10 -

PACIFIC.............. 150 80 70 5,123 5,183 8 464 482 18
Washington*....... -- --- -- -- 387 538 --- 34 33 ---
Oregon............. 13 8 5 436 553 33 21 4
California.......... 125 69 56 4,061 3,807 7 371 409 14
Alaska............. 4 2 2 192 181 18 7 -
Hawaii............. 8 1 7 47 104 1 8 12

Puerto Rico 5 5 1,117 805 2 9 31 2 44

*Reports for 40th week not received.










350 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

OCTOBER 9, 1965 AND OCTOBER 3, 1964 (40th 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... 830 242,096 463,650 5,487 5 197 18 332 52 3,428

NEW ENGLAND.......... 37 36,876 17,062 506 1 2 6 39
Maine.............. 14 2,816 3,028 37 4
New Hampshire ..... --- 381 255 --- -- --- -- 1
Vermont............ 15 1,283 2,332 36 31
Massachusetts...... 5 19,303 5,375 103 1 3 2
Rhode Island....... 3,938 1,938 16 1
Connecticut........ 3 9,155 4,134 314 2 2 1

MIDDLE ATLANTIC...... 102 14,945 52,263 230 5 60 4 143
New York City...... 23 2,439 15,360 4 2 29 --
New York, Up-State. 14 4,157 12,727 180 2 15 4 130
New Jersey......... 45 2,622 12,223 34 7 --
Pennsylvania....... 20 5,727 11,953 12 1 9 13

EAST NORTH CENTRAL... 213 56,104 103,101 367 13 39 14 529
Ohio............... 7 8,902 19,643 24 9 10 272
Indiana............. 41 1,888 22,817 88 5 8 64
Illinois........... 13 2,777 16,644 63 5 10 1 82
Michigan........... 106 26,579 28,969 146 2 7 2 53
Wisconsin.......... 46 15,958 15,028 46 1 5 1 58

WEST NORTH CENTRAL... 68 16,646 30,301 192 2 25 11 8 695
Minnesota.......... 2 690 334 9 1 1 1 140
Iowa................ 49 9,050 23,332 47 2 3 198
Missouri........... 3 2,594 1,019 23 18 7 1 97
North Dakota....... 14 3,745 4,772 101 1 44
South Dakota....... 115 32 10 2 52
Nebraska........... 452 812 1 1 36
Kansas............. NN NN NN 2 2 4 1 128

SOUTH ATLANTIC....... 145 25,028 38,499 953 31 2 66 4 464
Delaware........... 505 411 18 4 -
Maryland............. 3 1,166 3,408 83 1 20 22
Dist. of Columbia.. 1 78 354 21 -
Virginia........... 23 3,895 12,717 197 8 8 1 285
West Virginia...... 58 13,897 8,730 230 3 21
North Carolina..... 390 1,161 19 6 15 3
South Carolina .... 34 1,052 4,261 171 3 8 2
Georgia............ 617 198 1 14 1 4 1 59
Florida............. 26 3,428 7,259 213 4 2 72

EAST SOUTH CENTRAL... 30 13,978 67,877 947 1 21 1 33 6 734
Kentucky........... 2,586 18,476 28 3 9 2 78
Tennessee.......... 27 7,937 24,340 839 1 17 1 12 4 603
Alabama............ 2,335 18,372 56 1 7 16
Mississippi........ 3 1,120 6,689 24 5 37

WEST SOUTH CENTRAL... 68 31,026 72,194 551 2 82 5 48 7 549
Arkansas........... 1,084 1,124 2 2 56 13 1 80
Louisiana.......... 1 108 115 2 5 1 7 70
Oklahoma........... 3 206 1,019 20 10 6 3 120
Texas.............. 64 29,628 69,936 527 11 4 22 3 279

MOUNTAIN ............. 35 19,852 18,784 746 15 1 28 1 75
Montana............ 8 3,739 3,122 22 4 1 5
Idaho.........l.... 4 2,798 1,943 78 -
Wyoming............ 1 849 262 12 3 1 -
Colorado........... 12 5,690 3,239 345 9
New Mexico......... 677 457 197 11 14
Arizona............ 7 1,339 6,684 69 12 1 45
Utah............... 3 4,556 2,085 23 8 1 1 I
Nevada................. 204 992 2 I

PACIFIC.............. 132 27,641 63,569 995 9 2 41 8 200
Washington ........ -- 7,245 20,068 --- -- --- 4 --- 7
Oregon............. 16 3,277 8,681 25 5 1 8 7
California......... 52 13,055 33,123 727 4 1 28 8 184
Alaska............. 186 1,112 16 2
Hawaii............. 64 3,878 585 227 -

Puerto Rico 28 2,463 6,454 16 9 13

*Reports for 40th week not received.










11orlbidity and MortaliNt W'eklI Relport


l)tATH' IN 122 I'NITI' ) STATI-E (l ItS Fi)R WEEK I NI) I) OCTOBER 9. 1965

(By place of occurrence and week of filing certificate. Excludes fetal deaths)


All I u c

Area All 65 years
Ages and over


NEW ENGLAND:
Boston, Mass.---------
Bridgfport, Conn.---
CambhridK. 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, Il1.---------
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.--------


P in 1 .1,. r.1 I.
and
Influenza
All Ages


rn~l, r
1 year
All
Causes


A I ,-,,, ,1


All
Ages


and I


65 years Infl
an r AInfluenza
and over
All Ages


I II It- I_ I -t_


691
231
39
20
26
57
25
24
38
45
60
14
34
28
50

3,191
45
35
148
41
26
36
59
83
1,628
37
495
201
42
101
27
40
60
40
23
24

2,416
78
40
729
162
168
114
73
290
39
45
35
25
48
164
50
110
30
27
40
92
57

762
64
21
38
125
33
101
55
201
85
39


436
135
26
14
16
27
19
20
28
25
37
8
23
20
38

1,856
24
21
89
23
18
19
36
37
941
28
279
107
20
73
18
30
37
20
18
18

1,344
32
26
377
102
97
56
47
171
25
21
20
12
29
82
26
66
16
16
24
63
36

477
42
16
19
87
22
66
31
118
51
25


*Estimate based on average percent of divisional total.


SOUTH ATLANTIC:
Atlanta, Ca.-----------
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.----------


125
266
53
67
84
47
78
28
62
67
174
46

538
89
47
23
114
94
50
26
95

1,076
36
28
17
149
24
78
211
54
186
74
98
62
59

343
38
12
107
17
64
16
45
44

1,601
18
43
34
48
69
491
124
43
88
71
108
222
27
145
28
42


1 year
All
Causes


Total 11,715 6,638 383 653

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 492,210
All Causes, Age 65 and over------------------- 277,616
Pneumonia and Influenza, All Ages------------- 19,938
All Causes, Under 1 Year of Age--------------- 29,251


Week No.


351


I










Morbidity and Mortality Weekly Report


OCTOBER 9, 1965


o--

o or
a -- -- e

O-
S-
S=.
40



z --
o, C4Y


THE MORBIDITY AND MORTALITY WEEKLY REPORT. WITH A CIRCULA-
TION OF 14 000 IS 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. ST ATISTC S SECTION IDA L. SHERMAN. M.S.
CHIEF. SURVEILLANCE SECTION D. A. HENDERSON. M.D.
EDITOR MMWR D.J.M. MACKENZIE. M.B..
F.R.C.P.E.

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORB.DITr AND MORTALITY THE COMMUNICABLE DISEASE CENTER
WELCOMES ACCOUNTS OF INTERESTING OUTBREAKS OR CASE IN-
'E.TIGATIONS WHIC*m- 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 30333
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.
URDA. COMPILED DATA ON A NATIONAL BASIS ARE RELEASED ON
THE SUCCEEDING FRIDAY.


MEASLES Orange County, California


Records of measles morbidity in Orange County,
California, from 1958 through September 1965 are depicted
in Figure 3. Between January 1 and the end of the 40th
week of 1963, the County had experienced an epidemic
of 2,737 reported cases. In the State of California as a
whole, however, it was not until the comparable period
of 1964 that an epidemic was recorded. During this time
a total of 33,065 cases was reported in the State compared
to the total of 20,904 cases during 1963.
In Orange County a total of 221 cases was recorded
at the end of the 40th week of this year, compared to 168
cases in 1964. The next epidemic peak in the County
would normally be predicted for the coming winter,
following the cyclic pattern of the past. However, the
increasing level in the County of immunization with
measles vaccine may be expected to modify the pattern,
assuming that the active immunization measures already
undertaken among pre-school children can be intensified.


(Reported by Dr. Edward Lee Russell, Health Officer,
Orange County Health Department, California; and Dr.
Henry A. Renteln, Head Special Surveillance Section,
Bureau of Communicable Disease, California Department
of Public Health.)







Editorial Note: The recommendations of the Public
Health Service Advisory Committee on Immunization
Practice regarding the dosage schedule for measles
vaccine are in the MMWR, Vol. 14, No. 7. A statement
prepared by the same Committee on the importance of
measles and methods for achieving high levels of measles
immunization in the community is in the MMWR, Vol. 14,
No. 36.


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