Morbidity and mortality

COMMUNICABLE DISEASE CENTER


Vol. 14, No. 46






Week Ending
November 20, 1965


PUBLIC HEALTH SERVICE


U.S. DEPARTMENT OF HEALTH, EDU, A


SALMONELLA SURVEILLANCE /

ANNUAL SUMMARY 1964 DE

A total of 21.113 isolations of -almon a Kom
human sources was reported to the Salmonella Sur\ P nce
Unit during 1964. This represents an increase ofi
percent over the previous year; the seasonal pattern in
1964 was generally similar to 1963 although the peak of
incidenceoccurred one month earlier in 1964. The average
number of isolations each week during 1963 and 1964
and the seasonal pattern are portrayed in Figure 1. The
"expected" seasonal pattern is based on a seasonal
index computed from data reported monthly. There were
57 deaths recorded as due to salmonella infections


.- \ CO\TE\TS
C lInt.'kll44r illin,> Annual Summary 1964........ 393
S ( rreni r r I ut.erculosis in the United States .. ..395
Epidemo a co Notes and Reports
TuercuAbsis Chemoproph laxis Program -
lenotinee Count\, \isconsin. . 400


during the year resulting in a death to case ratio of
0.27 percent as compared to 0.34 percent in 1963.
Non-human isolations accounted for 5.461 recoveries
of salmonella which is an increase of one percent over
the previous year. A close correlation was noted between
the ten most frequently reported serotypes isolated from
human and non-human sources. (Table 1)
(Continued on page 394)


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
46th WEEK ENDED CUMULATIVE, FIRST 46 WEEKS
MEDIAN
DISEASE NOVEMBER 20, NOVEMBER 14. 1960 1964 MEDIAN
1965 1964 1965 1964 1960-1964
Aseptic meningitis .... 45 52 49 1,882 1,914 2,312
Brucellosis ...* -..-........... 4 6 8 221 357 357
Diphtheria ................ -4 8 12 145 244 398
Encephalitis, primary infectious 39 63 --- 1,713 2,965 -
Encephalitis, post-infectious 7 6 --- 600 736 ---
Hepatitis, infectious including
serum hepatitis ....-... .. 667 621 817 29,862 33,726 38,292
Measles ..... ... ......... 1,702 1.539 2,483 249,121 471,218 407,506
Meningococcal infections ...... 69 46 41 2,702 2,454 1,952
Poliomyelitis, Total -....*... 2 21 52 106 798
Paralytic ... *.....- *.. 1 17 38 84 632
Nonparalytic ........... .. --- 10 11 -
Unspecified ..........- 1 --- 4 11 ---
Streptococcal Sore Throat and
Scarlet fever .* ............ 7.333 6,436 5.767 343,434 346,917 279,603
Tetanus ....... ..........11 5 --- 245 249 -
Tularemia ...'............. *4 2 228 293 -
Typhoid fever **...... **- .11 6 12 392 406 568
Rabies in Animals .......... 79 72 63 3.847 3.989 3,285

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: .. ................................ 7 Rabies in Man: ............................ 1
Botulism: .................... ............ 13 Smallpox: ............................... -
Leptospirosis: N.J. 1................ ........ 49 Trichinosis: Calif. -1 ......................... 101
Malaria: ....... ...... ................. ..... 73 Typhus-
Plague: ................. ... .............. 6 Murine: .............................. 24
Psittacosis: Pa. 1. Texas 1 ................... 39 Rky. Mt. Spotted: N.C. 1, N.Y. Up-State- 1, Ga. 2 .. .. 256
Cholera: .......2.......................... 2 __


a~a








Morbidity and Mortality Weekly Report


NOVEMBER 20, 1965


SALMONELLA SURVEILLANCE

ANNUAL SUMMARY 1964
(Continued from front page)


There were 139 serotypes identified in humans of
which ten accounted for just under 75 percent of the
total isolations. Salmonella typhi-murium and Salmonella
typhi-murium var copenhagen were again the commonest
isolates from both human and non-human sources.
Salmonella derby, however, accounted for one third of
the human deaths associated with salmonellosis.
(Table 1)
Despite better and more comprehensive reporting of
salmonellosis in the United States it is believed that
there is, in fact, an increased incidence in humans.
Figure 2 depicts the reported incidence between 1942
and 1964 and compares the relative prevalence of typhoid
fever which has been decreasing since 1942.
During 1964, of the total human isolations reported,
21 percent represented two or more infections within a
family. This rate was higher than in 1963 when it was
18 percent. There were 174 persons reported as being
infected simultaneously with more than one serotype;


Figure I.
REPORTED HUMAN ISOLATIONS OF SALMONELLAE
IN THE UNITED STATES


1963 1964
.' a .. ,,, .,., ... ., .. .. .
.. .. ..' ,. .. '.. -. _. : : ;, : ...


Table 1. The ten most common salmonella serotypes isolated from human and non-human specimens in the United States, 1964



Human Non-human Associated with deaths (human)
Rank
Serotype Number Percent Serotype Number Percent Serotype Number Percent


1 typhi-murium & typhi- 5,862 27.8 typhi-murium & typhi- 1,095 20.1 derby ................ 19 33.3
murium var. copenhagen murium var. copenhagen

2 derby ................. 2,360 11.2 heidelberg ............ 483 8.8 typhi-murium .......... 16 28.1

3 heidelberg ............ 1,717 8.1 infants .............. 362 6.6 enteritidis ............ 7 12.3

4 infants .............. 1,523 7.2 anatum ............... 250 4.6 infants, muenchen & (2ea.)6
paratyphi B 1

5 newport .............. 1,036 4.9 montevideo ........... 215 3.9 bredeney, cholerae-suis'
var. kunzendorf, grump-
6 enteritidis ............ 801 3.8 derby ................ 213 3.9 ensis, heidelberg, mont- (lea) 9
video, newport, typhi,
7 typhi ................ 703 3.3 pullorum.............. 203 3.7 untypable (group C1)
untypable (group H)
8 saint-paul ........... 645 3.1 saint-paul ............ 194 3.6

9 oranienburg ........... 550 2.6 chester .............. 181 3.3

10 montevideo ........... 524 2.5 newport ............. 161 2.9


Total 15,721 4.5 Total .. 3,357 61.5 Total 57 100.0


Total (all scrotvpcsl 21.113 Total (all serotspes) 5.461 Total (all serotvpes) 57


394


ACTUAL -
EXPECTEDo--














1; 4 harbored two srco, I'" and 10 harbored three. No
particular combination of serl\|l was noteworthy.


V)
W
l4.000
U
0


Ftigue 2
REPORTED INCIDENCE OF HUMAN SALMONELLOSIS
UNITED STATES, 1942-1964


Or -. So F... O ,*
_ Ti|S1Dhi Fw^~rOf ii
*~* Otnrr thtii* Titni~id ?'**


942 4 '46 0e


0 52 54 "56 "58 '60o '6 4 66
YEAR


S-orce MItorditb y oad MorMthy wty Report. Annao, Supplement, 1951, 1954, and 1964

There were 52 outbreaks of human salmonellosis
reportedly <.iii-i i an estimated minimum of 2.150
illnesses. Of "'i, human epidemics IIl..-ii..lld eleven
were either presumed or proved to be due to salmonella
inift'.-ed eg' Salmonella typhi-murium was the commonest
sr-rot\pe. it was incriminated in outbreaks on eleven


395


figure J

NUMBER OF HUMAN ISOLATIONS OF SALMONELLA
PER 100,000 POPULATION, 1964


I _r r r 1
S* *. 0 80 90 100
AGE IN YEARS


occasions. No sex predilection was noted ronrr.ill.,
although there was a preponderance of infections in males
under 20 years and in females over 211 years. Highest
attack rates were among infants and in children less
than 10 \(. ir, of .ago'. (Figure 3)

More than half of the isolations from non-human
sources were from chickens and turkeys. Recoveries
from t(-g and egg products showed an increase of *2 r
percent over the 1963 filur>. There was also a sharp
increase of j-' percent in recoveries from cold blooded
vertebrates, primarily turtles.
(r'r,,':'. ,. from the Annual Summary for 1964 of the
Salmonella Surveillance Unit, CDC, issued on October
13, 1965. Copies are available on request to the Editor.)


CURRENT TRENDS


TUBERCULOSIS IN THE UNITED STATES


Tuberculosis is a nationally reportable disease and
individual case reports are made to the relevant tuber-
culosis authority at the State level. Data are compiled
by the States for an annual statistical report to the
Tuberculosis Branch of CDC.
The Tuberculosis Branch publishes an annual
statistical review entitled "Reported Tuberculosis Data."
Thi review gives the totals of new cases of active
tuberculosis, of tuberculosis deaths, and estimates of
the number of tuberculosis cases under medical care or
public health supervision in the United States.
Each State is responsible for its own tuberculosis
control program and all States maintain such programs.
Federal assistance is given through formula grants to
all States on a pro rata allocation of annually appro-
priated funds and through T7r. I.','. Project Grants.
The Project Grants are made to States which request
such aid and are administered by the Tuberculosis
Branch of CDC.


During 1964, the Health Departments in the United
i, 1.io reported 50,874 new active cases of tuberculosis,
establishing the "new case" rate as ti.t; per 100,000
population. The 'orrri.la-poidir, case rate for 1963 was
28.7 per 100, 1 l population.
On January 1, 1965, the available data indicated
that an estimated .1'-.t000 persons were enrolled on
Departments of Health tuberculosis registers in the
United States. Of this total, 105,000 individuals were
ro,.-ei ine, treatment for active tuberculosis, of whom some
42.000were in hospitals and sanatoria, and approximately
6.1.11" were under the medical care of clinics and private
ph, inii,-. The remrriininL 215,000 cases included
persons under supervision for inactive disease, and
cases for which disease activity had not yet been deter-
mined. At the b'eLinnine of 1'l65, the selected areas that
were receiving special Tuberi ulo-i- Project Grants
from the Public Health Service included 94,603 of the
(Continued on page .,f11i


N011 I IllI It 20(. 1965


Morllidity and Mortality Weekly Report


"









396 Mlorbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

NOVEMBER 20, 1965 AND NOVEMBER 14, 1964 (46th 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... 45 52 39 7 52 106 38 84 4 145

NEW ENGLAND.......... 1 3 2 2 2
Maine............... 1 1
New Hampshire...... -
Vermont..............
Massachusetts ...... -
Rhode Island....... 1 2-
Connecticut ......... 1 1

MIDDLE ATLANTIC...... 6 1 11 5 15 4 13 6
New York City...... 1 4 1 2 2 3
New York, Up-State. 2 1 1 10 1 9 1
New Jersey......... 3 4 3 3 3 2 -
Pennsylvania....... 3 -- -_ 2

EAST NORTH CENTRAL... 11 5 5 5 2 23 2 16 6
Ohio............... 1 1 3 3 2 1
Indiana ............. 8 5 2
Illinois........... 3 1 1 2 1 6 1 5 2
Michigan........... 7 2 1 3 1 3 1 2 -
Wisconsin.......... 1 3 2 1

WEST NORTH CENTRAL... 1 8 2 11 10 7 8 20
Minnesota.......... 1 1 1 3 1 2 7
Iowa............... 5 1 2 1 1
Missouri ........... 7 1 4 3 1
North Dakota ....... 1 -
South Dakota ....... 1 8
Nebraska ........... 1 3 3 2
Kansas............... 1 1 1 1 1

SOUTH ATLANTIC....... 6 7 3 1 30 1 24 2 37
Delaware ........... 2
Maryland ........... .. 1 1 1 1
Dist. of Columbia.. 3
Virginia........... 1 1 4 4 -
West Virginia..... 1 -
North Carolina..... 12 7 4
South Carolina..... 2 1 1 -
Georgia............ .- 2 2 2 20
Florida............ 1 5 2 9 8 9

EAST SOUTH CENTRAL... 1 1 3 6 1 5 1 28
Kentucky........... 1 1
Tennessee.......... 1 2 3 1 2 2
Alabama............ 2 2 1 24
Mississippi........ 1 2

WEST SOUTH CENTRAL... 3 5 19 9 16 8 1 37
Arkansas........... 2
Louisiana.......... 2 1 1 10
Oklahoma............ .- 1 2 3 2 2 1
Texas............. 3 4 15 6 13 6 24

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

PACIFIC.............. 15 20 11 1 6 3 4 3 9
Washington......... 1 1 2 2 2 3
Oregon ............. 1 1 1 1 1 1
California......... 14 19 8 1 3 2 1 2 5
Alaska............... -
Hawaii............. -

Puerto Rico 1 12









Mlorbidity and Mortality Weekly I l-,prt 397


CASES OF SPCIF IEt) \)(IIIABLE DISUEASFS: UNITEDD STAIIN

tH) WEEKS I \NI 1)

NO)VEMBEIR 20, 196s ANI) 1)VEIMBER 1., 1964 (16th \\IIK) (o)Itinueti


Brucel- Infectious Hepattits M, nii I cl
loss including Secum Hepatitis InfeItrnns Trtanus
Area Total Under 20 years Cumulative
ncl. unk. 20 years and over Totals Cumulit iv. Cum.
1965 1965 1965 1965 1965 1964 1965 1965 1964 1965 1965

UNITED STATES... 4 667 309 321 29,862 33,726 69 2,702 2,454 11 245

NEW ENGLAND ......... 1 40 21 18 1.704 3,036 5 138 78 5
Maine.............. 6 2 3 298 948 17 6
New Hjmp hirt ..... 3 1 2 163 236 2 9 2 1
Vermont............ 1 1 89 364 8 4 -
Massachusetts...... 24 15 9 674 690 2 51 31 3
Rhode Island....... 2 2 187 188 1 15 10
Connecticut ....... 4 2 2 293 610 38 25 1

MIDDLE ATLANTIC...... 126 44 82 5,250 7,415 14 358 316 15
New York City...... 33 9 24 1,090 1,153 1 59 44 -
New York, Up-State. 38 16 22 1,941 3,223 3 101 93 6
New Jersey......... 25 9 16 988 1,239 7 95 103 2
Pennsylvania ....... 30 10 20 1,231 1,800 3 103 76 7

EAST NORTH CENTRAL... 150 77 66 5,828 5,359 7 405 332 2 34
Ohio............... 30 17 13 1,582 1,399 2 109 88 3
Indiana............. 15 3 12 493 455 49 52 1 9
Illinois........... 30 17 9 1,107 1,013 4 107 89 15
Michigan............ 68 36 32 2,282 2,124 1 93 72 3
Wisconsin........... 7 4 364 368 47 31 1 4

WEST NORTH CENTRAL... 38 21 15 1,686 1,844 2 134 137 22
Minnesota.......... 4 3 191 213 32 29 9
Iowa................ 14 10 4 562 324 12 8 4
Missouri........... 9 4 4 375 455 53 62 4
North Dakota....... 29 63 1 12 20 1
South Dakota....... 22 133 3 3 -
Nebraska........... 1 1 88 53 10 6 2
Kansas.............. 10 7 3 419 603 1 12 9 2

SOUTH ATLANTIC....... 77 31 40 3,082 3,142 10 504 482 6 61
Delaware........... 78 70 10 6 -
Maryland ........... 16 7 9 550 564 3 50 36 1 3
Dist. of Columbia.. 2 1 1 46 65 1 11 16 -
Virginia........... 15 7 6 715 501 2 65 57 7
West Virginia...... 7 6 1 422 445 26 35 I
North Carolina..... 10 4 6 307 516 2 105 78 2 11
South Carolina..... 3 2 1 133 129 1 63 56 1 7
Georgia............. 4 4 110 105 1 60 81 2 10
Florida............. 20 4 12 721 747 114 117 22

EAST SOUTH CENTRAL... 32 22 10 2,144 2,313 4 206 189 32
Kentucky........... 11 8 3 781 821 78 66 8
Tennessee.......... 12 6 6 716 816 1 65 56 10
Alabama............ 6 5 1 377 446 3 38 43 12
Mississippi........ 3 3 270 230 25 24 2

WEST SOUTH CENTRAL... 56 30 24 2,542 2,626 16 349 279 2 51
Arkansas........... 9 3 6 317 263 1 18 30 1 12
Louisiana.......... 16 11 5 433 637 14 196 127 1 8
Oklahoma........... 1 1 54 126 21 13 1
Texas............... 30 16 12 1,738 1,600 1 114 109 30

MOUNTAIN............. 38 19 5 1,634 2,030 2 96 82 3
Montana............ 4 2 141 171 2 1 -
Idaho.............. 2 193 286 11 3 -
Wyoming............. 3 48 82 5 5 -
Colorado........... 10 8 2 347 530 1 27 15 2
New Mexico......... 9 6 2 342 286 11 33 -
Arizona............. 6 348 447 1 20 8 1
Utah............... 4 3 1 200 177 17 7 -
Nevada............. 15 51 3 10 -

PACIFIC.............. 3 110 44 61 5,992 5,961 9 512 559 1 22
Washington......... 7 3 4 448 604 39 45 -
Oregon.............. 14 4 5 518 605 1 36 21 4
California......... 3 87 37 50 4,743 4,370 8 411 473 1 18
Alaska.............. 207 266 18 7 -
Hawaii.............. 2 2 76 116 8 13

Puerto Rico 14 11 3 1,275 929 11 34 54










398 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED
NOVEMBER 20, 1965 AND NOVEMBER 14, 1964 (46th 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... 1,702 249,121 471,218 7,333 4 228 11 392 79 3,847

NEW ENGLAND.......... 48 37,114 18,646 686 2 7 2 47
Maine.............. 11 2,884 3,275 59 4
New Hampshire...... 382 521 8 1 4
Vermont............. 25 1,369 2,370 4 32
Massachusetts...... 6 19,352 5,847 222 2 3 2
Rhode Island....... 1 3,951 2,180 12 1 1 1
Connecticut........ 5 9,176 4,453 381 3 4

MIDDLE ATLANTIC..... 319 15,988 52,841 373 1 1 64 13 201
New York City...... 120 2,767 15,435 9 29 -
New York, up-State. 26 4,278 12,929 249 1 1 15 13 186
New Jersey......... 73 2,989 12,279 71 7 -
Pennsylvania....... 100 5,954 12,198 44 13 15

EAST NORTH CENTRAL... 569 58,249 104,168 531 14 2 44 11 593
Ohio............... 16 8,974 19,801 39 9 8 321
Indiana............. 59 2,132 23,011 70 5 2 12 2 68
Illinois........... 81 3,118 16,709 90 6 11 84
Michigan............ 119 27,081 29,306 231 2 7 58
Wisconsin.......... 294 16,944 15,341 101 1 5 1 62

WEST NORTH CENTRAL... 89 17,031 30,620 344 2 30 14 13 773
Minnesota.......... 25 748 341 5 1 1 7 163
Iowa............... 41 9,186 23,432 111 2 3 217
Missouri........... 13 2,635 1,050 3 20 9 2 115
North Dakota....... 9 3,890 4,927 120 46
South Dakota....... 115 47 14 3 1 58
Nebraska........... 1 457 823 1 2 2 2 36
Kansas............. NN NN NN 90 4 138

SOUTH ATLANTIC....... 160 25,831 39,109 637 1 34 2 77 9 499
Delaware........... 508 415 38 4 -
Maryland............ 15 1,203 3,428 79 20 25
Dist. of Columbia.. 5 88 355 5 -
Virginia........... 33 3,971 12,785 160 8 1 9 6 301
West Virginia...... 82 14,383 9,097 196 3 1 23
North Carolina..... 2 405 1,194 35 8 15 3
South Carolina..... 20 1,119 4,285 118 3 9 3
Georgia............ 3 626 209 6 1 15 1 12 1 68
Florida............ 3,528 7,341 5 1 76

EAST SOUTH CENTRAL... 175 14,752 68,501 1,417 22 42 10 789
Kentucky........... 124 2,983 18,655 125 3 10 3 88
Tennessee.......... 48 8,280 24,668 1,119 18 14 7 644
Alabama ............ 2 2,347 18,434 153 1 10 16
Mississippi........ 1 1,142 6,744 20 8 41

WEST SOUTH CENTRAL... 89 31,482 72,853 772 95 3 55 18 619
Arkansas............ 1,088 1,149 65 2 15 2 89
Louisiana.......... 1 114 121 7 9 4 80
Oklahoma........... 4 219 1,025 40 11 1 9 130
Texas.............. 84 30,061 70,558 732 12 22 12 320

MOUNTAIN............. 103 20,368 19,731 1,380 16 1 32 92
Montana............ 3 3,828 3,575 57 4 1 5
Idaho.............. 31 2,918 2,026 113 -
Wyoming............ 1 855 275 23 4 1-
Colorado........... 47 5,883 3,322 443 1 9
New Mexico......... 6 685 602 521 12 21
Arizona............ 9 1,390 6,720 88 1 14 54
Utah............... 6 4,595 2,218 135 8 1 -
Nevada............. .- 214 993 2 I

PACIFIC.............. 150 28,306 64.749 1,193 14 3 57 3 234
Washington......... 30 7,382 20,475 356 7 8
Oregon............. 39 3,395 8,797 12 5 8 9
California ......... 77 13,333 33,613 768 9 3 41 3 215
Alaska............. 197 1,137 9 2
Hawaii............. 4 3,999 727 48 1

Puerto Rico 82 2,727 6,996 2 15 13










Morbiditl and 11orlality W',' kl Report


Week No. Table 4. DEA HII IN 122 IUNIIFI) STATES CITIES FOR WEEK INDI I) DNM\ I NMII R 20, 1965

46
(By place of occurrence and week of filing certificate. Excludes fetal deaths)


Area


NEW ENGLAND:
Boston, Mass.----------
BriJgpuorr, Conn.-----
Cambridpt, Mass.------
Fall River, Mass.-----
Hart rrd, 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.--------


A l I I i%

All 65 years
Ages and over


P111i UII, U Il
and
Influenza
All Ages


I'll.I .
1 year
All
Causes


Area


A ll I .n .., IP,,.. ,,,, ,,


65 years
and over


I 4 4 4 4 4 4


786
278
49
20
27
47
28
32
31
58
52
26
46
35
57

3,518
48
39
164
34
42
50
92
131
1,748
34
497
213
54
125
38
47
53
46
33
30

2,719
50
42
788
172
206
125
81
356
46
69
43
33
50
207
43
134
21
26
30
121
76

912
63
34
49
117
31
136
74
293
73
42


493
164
27
15
20
29
16
22
23
36
34
17
30
21
39

2,083
31
28
111
18
26
29
56
72
1,017
14
294
107
32
92
21
32
27
35
22
19

1,513
24
24
439
104
103
67
45
182
35
40
24
13
38
113
16
75
8
17
21
80
45

581
40
26
29
71
22
97
44
179
46
27


38
14
3


5
1
3
1
I
4
1
2
2
1

180
2
1
6
4
1
1
6
8
104
2
18
10
2
1

1
5
2
4
2

158
3
3
49
8
10
8
4
17
1
3
3
7
3
15
1
3
5
1
1
8
5

42
3

4
8
3
6
5
12

1


*Estimate based on average percent of divisional total.


SOUTH ATLANTIC:
Atlanta, Ga.-----------
Baltimore, Md.----------
Charlotte, N. C.-------
Jacksonville, Fla.-----
Miami, Fla.-------------
Norfolk, Va.------------
Richmond, Va.-----------
Savannah, Ga.----------
St. Petersburg, Fla.---
Tampa, Fla.------------
Washington, D. C.------
Wilmington, Del.-------

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

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

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

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


1,185
120
274
48
76
85
62
76
31
79
77
207
50

629
113
57
37
123
117
52
32
98

1,086
33
35
44
145
32
70
223
59
138
91
109
51
56

484
68
30
108
16
105
23
85
49

1,707
26
51
41
58
90
524
65
40
116
64
102
199
53
149
90
39


and
Influenza
All Ages


II y r
All
Causes


80
16
21
2
7
5
6
7
I
2
5
5
3

42
8
3
2
11
9
4
2
3

92
2
5
2
6
2
12
22
7
12
5
11
4
2


Total 13,026 7,340 559 760

Cumulative Totals
including reported corrections for previous weeks

All Causes, All Ages ------------------------ 565,055
All Causes, Age 65 and over------------------- 318,957
Pneumonia and Influenza, All Ages------------- 22,748
All Causes, Under 1 Year of Age--------------- 33,402


394)









400 Morbidity and Mo






TUBERCULOSIS IN THE UNITED STATES
(Continued from page 395)


total cases on their registers. In this group there were
23.007 active cases, of which 11,394 were in hospitals.
By June 30, 1965, reports showed that the expansion of
existing Projects and the initiation of new ones had
resulted in a provisional total of 114,142 cases reported
of which 27,811 had active disease; of the latter, 13,226
were under hospital care.
(Reported by the Tuberculosis Branch of CDC.)



EPIDEMIOLOGIC NOTES AND REPORTS
TUBERCULOSIS CHEMOPROPHYLAXIS PROGRAM
Menominee County, Wisconsin


The Wisconsin State Board of Health was awarded
a Public Health Service Tuberculosis Project Grant on
April 1, 1965, to establish a tuberculosis chemo-
prophylaxis program in the newly created Menominee
County in south-central Wisconsin.
The Project is being conducted in two phases.
The aim of phase I is to tuberculin test a population of
some 2,700 persons, to X-ray all positive reactors, and
to establish a definitive diagnosis, followed by the
treatment of confirmed cases of active tuberculosis.
In phase II a course of INH chemoprophylaxis over a
period of 12 months will be given to all positive reactors,
their associates, and to contacts of known cases who
do not require a full regimen of chemotherapy.
The first phase began on May 17, 1965. By November
5, .2,400 persons had been tuberculin tested of whom
500 had positive reactions of 10mm or more of induration.
Of those with positive reactions, 414 have been X-rayed
and 106 showed changes indicative of latent or arrested
tuberculosis because of calcification, fibrosis or pleural
abnormalities. No case of active tuberculosis was found
in this group, but one patient had lung cancer. Phase I
will continue until all individuals in the study group
have been located, skin tested and, where necessary,
X-rayed.
Phase II began on August 31, 1965, when 22 indi-
viduals were started on a regimen of INH prophylaxis.
By November 5, this number had increased to 428. This
second phase will continue for each individual throughout
a full year, with County Health personnel giving all the
support and encouragement necessary to maintain the
prophylaxis.
(Reported by Dr. Josef Preizler, Director, Division of
Preventable Diseases, Wisconsin State Board of Health;
and the Tuberculosis Branch of CDC.)


ERRATUM, Vol. 14, No. 45, P. 386, Table 1:


The figure for the Total Attack Rate/100 in line 3
of the Table should read 45 and not 61.


realityy Weekly Report


NOVEMBER 20. 1965


THE MORBIDIT AND MORTALITY WEErKLY REPORT. WITH A CIRCULA-
TION OF 14 00. PUBLIS.H-ED 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 SURVEILL ANCE SECTION D A. HENDERSON. M.D.
EDITOR MMAR D.J.M. MACKENZIE. M.B..
F R.C.P.E.

IN ADDITION TO TnE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY. TH-E COMMUNICABLE DISEASE CENTER
WELCOME. ACCOUNTS OF INTERESTING OUTBREAKS OR CASE IN-
VESTIGA TIONE WHICH ARE OF CURRENT INTEREST TO HEALTH
OFFICIALS AND WHICH ARE DIRECTLY RELATED TO THE CONTROL OF
COMMUNICABLE DISEASE S.UC, COMMUNICATIONS SHOULD BE AD-
DREiiED TO
THE EDITOR
MORBIDITY AND MORTALITY IfEEKLY REPORT
COMMUNICABLE DISEASE CENTER
ATLANTA. GEORGIA 30333
NOTE THE DATA IN T-HI3 REPORT ARE PROVISIONAL AND ARE BASED
ON WEEKLY TELEGRAMS TO THE CDC BY THE INDIVIDUAL STATE
HEALTH DEPARTMENTS THE REPORTING *EEK CONCLUDES ON SAT.
URDA. COMPILED DATA ON A NATIONAL BASIS APE RELEASED ON
THE SUCCEEDING FRIDAV.

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