Morbidity and mortality

COMMUNICABLE DISEASE CENTER


Vol. 14, No. 49




T

Week Ending
December 11, 1965


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


HEALTH SERVICE


MEASLES CURRENT TRENDS


A total of 5-3,3.7:3 cases of measles has been re-
ported during the first 48 weeks of 1965. It is apparent
that the total number of cases for 1965 will be the
lowest recorded in recent years (Table I). A comparison
of the incidence of measles reported through the 4-Ith
week of 1965 with the highe'- and lowest incidence during
the pre% ious 11 years is depicted in Figure 1.
During the 4-week interval ended 4th December,
6,981 cases were reported, 2,915 more than for the pre-
ceding 4 weeks. This follows the pattern of seasonal
increase noted during comparable periods of past years,
with epidemic peaks in the following April and May. If


1. urr.
NM rn IrL. .. ... I
International No
Smallpox h


. 419


pai-t o\perien I t- rep eatp( ei- dor epi)deCn( ar t o he
expected in many sections of the country during the next
6 months.
Nine States reported more than 300 cases each
during the 4 weeks ended 4th December and together
they have reported approximately two-thirds of the nation's
total for this period. While the epidemiological picture
(Continued on page 418)


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous weeks)
49th WEEK ENDED CUMULATIVE, FIRST 49 WEEKS
MEDIAN
DISEASE DECEMBER 11, DECEMBER 5, 1960- 1964 MEDIAN
1965 1964 1960-1964
Aseptic meningitis .......... 34 38 42 2,013 2,041 2,441
Brucellosis ... ... ..... ...... *8 8 11 235 380 380
Diphtheria ... .............. 2 26 26 151 275 432
Encephalitis, primary infectious' 26 30 --- 1,790 3,070 ---
Encephalitis, post-infectious 7 11 --- 625 760 ---
Hepatitis, infectious including
serum hepatitis .......... 646 695 911 31,813 35,668 40,528
Measles ................. .. 3,070 2,712 3,693 256,443 478,518 417,027
Meningococcal infections ..... 48 60 52 2,854 2,619 2,083
Poliomyelitis, Total ......... 1 1 8 55 114 856
Paralytic *............... 1 5 39 89 678
Nonparalytic ......... 1 --- 10 14 --
Unspecified *........* ...... --- 6 11
Streptococcal Sore Throat and
Scarlet fever ............ 8,732 7,744 7,454 367,161 368.505 298,310
Tetanus .........***** ..7 7 --- 265 261 ---
Tularemia .*.. ........... 3 6 --- 233 310
Typhoid fever ..... * 10 6 9 431 428 605
Rabies in Animals .......... 72 73 64 4,048 4,236 3,425

NOTIFIABLE DISEASES OF LOW FREQUENCY
Cum. Cum.
Anthrax: ........ ... ........................ 7 Rabies in Man: .............................. 1
Botulism: Ky. -5 ................... .......... 18 Smallpox: .............................. -
Leptospirosis: Mass. -1, Ohio- 1, Calif. 1 .......... 54 Trichinosis: .............................. 105
Malana. N.C.-3, Ga.-1 ......................... 79 Typhus-
Plague: ............................. .... 6 Murine: ............................... 26
Psittacosis: Tenn. -1 ......................... 48 Rky. Mt. Spotted: ......... .. ............. 260
Cholera: ................................. 2


ac4d








Morbidity and Mortality Weekly Report


DECEMBER 11. 1965


MEASLES CURRENT TRENDS
(Continued from front page)


may be modified by recording totals of cases without
relation to the size of population at risk or to the efficacy
of reporting, the numbers of cases reported by each of'
these States, except New York, Texas and Pennsylvania,
exceed the average totals for the comparable periods of
the preceding 4 years. (Table II)

(Reported by the Childhood Virus Disease Unit, Epi-
demiology Branch, CDC.)


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


180,000-

140,000 -

100,000-

60,000-


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


4 8 12 16 20 24 28 32 36 40 44 48 52
Week Number


Table 1
REPORTED CASES OF MEASLES BY
GEOGRAPHIC DI\ VISION
Weeks 45-48, 1960-1965


Area 1960 1961 1962 1963 1964 1965

New England... 1,031 1,846 528 633 1,762 156
Middle Atlantic. 2,490 1,195 1,091 1,622 426 1,196
E. N. Central.. .2,404 1,718 3,606 1,603 1,229 2,617
W. N. Central... 435 475 564 284 551 363
South Atlantic.. 1,149 704 577 914 704 621
E. S. Central... 532 983 419 803 45S 649
W. S. Central ... 509 857 318 232 665 390
Mountain....... 594 787 1,221 619 1,190 399
Pacific........ 1,031 2,172 1,519 1,550 1,045 590

Total ........ 10,175 10,737 9,843 8h.20 8,030 6,981


Table 2
STATES REPORTING MORE THAN 300 CASES
OF MEASLES
Weeks 45-48, 1960-1965

State 1960 19il 1962 1963 1964 1965

\Wicon-in 906 -'67 1.,91 201 359 1.316
ichihan 40.3 4.32 960 :314 458 606
Ne\% Nork (incl.
N1 CI \) 1,044 696 378 6b4 189 551
Illinol 136 25 '229 495 64 395
West Virginin.. 171 227 338 231 406 374
Kentucky...... :300 103 97 626 102 364
Texa\ 442 767 23.5 227 651 359
Ne% Jervey :3.4 235 177 415 44 344
Penn.-yl ania 1.092 264 336 520 19: 301


MENINGOCOCCAL INFECTIONS


There have been 2,806 cases of nmningoeci'cl in-
fections reported in the United Stale- from January 1
through December 4, 1965. This is an increase of 9.7
percent over the 2,559 cases reported through the 48th
week of 1964 (Table 1). Figure 1 compares the incidence
of reported cases by week in 1965 with the median num-
ber of cases reported during the preceding 5-year period
of 1960-64. It is evident in Figure 1 that most of the in-
crease in cases reported in 1965 occurred during the
months of February, March, and April. Since that time the
weekly incidence has deviated little from the median
values of the preceding 5 years. A seasonal upward trend


in the weekly cases is apparent in recent weeks and
further increases may be anticipated in the next several
months.


Table 1
MENING(OCOCC 1. INFECTIONS (Cumulated Weekly)

1965 1964 1963 1962 1961

Through 4Sth Week 2S06* 2559 2165 1958 1971
annuall 'rotal 226 2470 2150 2232

'Prclhminnr\


418













Table 2
\M1.\ I\m IIC('' lL INFECTIONS
IN MILIT HR IPl It-i\1NEL*
Tir.ouh 48th Week, 1965


S1 ati Tot al Military Percent

.-ui h Carolina 65 33 50. S
Missouri 54 23 *12.6
Kentucky b3 27 32.5
Louisiana 192 27 14.1
( i rir i, 61 8 I: 1
New Jersey 1SO 11 11.0
( alifirni., 421 33 7

United -.i i- -'_ it) 201 7.2


*For those States with at least 7
in military personnel.


S per er nt of total castx -


\h-nini' ....cal infections at military installations
have remained at a relatively low level iluriri;, the year.
Through the 46th week of 1965, 201 cases were reported
Ib\ State Health Departments at military installations,
which is 7.2 percent of the total of :'.'iit cases. In con-
trast, 14.3 percent of the total cases in 1964 were among
military p,.r-inrn-l or their dependents.
Of '29. -t,,niieL.,, s, ,- strains submitted to the Lab-
oratory Branch of CDC from January 1 through October


419


Figure I

MENINGOCI:OL.CL rJFE TONS BY A FEKOF FFPuwT
1965 AND MEDiAN, 1960-64
UrjiTED STATE'


JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV OEC
MONTH

15, 1965, for sulfadiazine sensitivity studies, 102 strains
(35 percent) were not inhibited by 1.0 nrm. percent of
sulfadiazine. In 1964, 37 percent of the total submitted
were not inhibited by 1.0 mg. percent of sulfadiazine
(\1M\\l, Vol. 13, No. .'0).

(Reported by the Investigations Section, E'l,:' ..'i. :,.,:
Branch, CDC.)


INTERNATIONAL NOTES

SMALLPOX KULMBACH, WEST GERMANY


An imported case of smallpox in Kulmbach, a town
in West Germany of 23,700 inhabitants, was reported to
the world Health Organization by the German Federal
\lni-iry of Health on October :2'", 19t' The infection
occurred in a 49-year-old man who is a master machinist
nplri:.,.od by a firm -p iili, ine in .turri uli ral vehicles.
He had eorn to Tanzania at the end of September to dem-
onstrate farm trailers and in the course of his work had
visited Ifakara southwest of Dar es Salaam. Here no
hotel accommodation was available and between October
1 and 13 the machinist stayed in a guest room in a mis-
sion hospital which had a ward on the same floor con-
taining smallpox cases. He had been vaccinated at .I,.- 1,
12 and 41 as well as in July 1., just before his visit
to Africa. The July revaccination resulted in formation of
a red papule without vesiculation.
After loav.ine Ifakara, the machinist visited other
areas of Tanzania, ri turning to Dar es Salaam on October
16 en route to Europe. He left Dar es Salaam on Octo-
ber 17 for Rome where he arrived the following day and
spent 2'/ hours in the airport transit area before going on
to Munich by air. At Munich his wife met him and they


traveled by private car to Kulmbach, Lrritinlg there late
October 18.
The next d.n,, the machinist reported for duty at the
factory, working all dl. on October 19 Ihr.iuLh '2. he
also spent the imrrnii.u, of October :2'.2 at the factory.
During the morning of October 24 he h.ltp lr.1l a fever
of -'. C accompanied by headache, lumbar pain and a
i oueh. He consulted a doctor but apparently presented
no specific signs and I[i ,m"- and, as his temperature
fell to normal that i -.ning, he returned to work the next
day and was well enough to continue at work on October
-'.' and -'1. On the It-anin_ of October 27 he developed a
red macular rash over the forehead and face with a few
scattered lesions over the shoulders and upper trunk. On
the following nourniiu, he drove alone in his car to see
his family physician. In view of the travel history, small-
pox was suspected by the doctor and a consultation
.irrancill with the chief public health physician. The
patient a :..i drove alone to the Kulmbach Public Health
Clinic where the physician on duty concurred with the
clinical .li rgno-i- of suspect smallpox. The patient was
(Continued on pare .'-,


DECEMBER 11, 1965


Morbidity and Mortality Weekly Report











420 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

DECEMBER 11, 1965 AND DECEMBER 5, 1964 (49th 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... 34 38 26 7 1 55 114 1 39 89 2 151

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

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

EAST NORTH CENTRAL... 2 4 3 2 24 2 17 8
Ohio................ 3 2 2
Indiana............ 1 9 6 3
Illinois........... 2 1 1 6 1 5 2
Michigan........... 1 1 1 1 3 1 2 -
Wisconsin ........... 1 3 2 1

WEST NORTH CENTRAL... 6 3 1 3 11 10 7 8 21
Minnesota.......... 5 3 3 1 3 1 2 7
Iowa............... 5 1 2 1 1
Missouri........... 1 1 4 3 1
North Dakota....... 1 1 -
South Dakota....... 9
Nebraska........... 3 3 2
Kansas............. 1 1 I 1 1

SOUTH ATLANTIC....... 1 1 1 32 1 25 38
Delaware........... -
Maryland........... 1 1 1 1 -
Dist. of Columbia.. 3
Virginia........... -- 4 4 -
West Virginia...... 1 1 -
North Carolina..... I 1 12 7 4
South Carolina..... 1 1 2
Georgia............ 3 3 20
Florida............ 10 8 9

EAST SOUTH CENTRAL... 1 5 1 1 4 6 1 2 5 2 30
Kentucky............ 1 1 -
Tennessee.......... 2 3 1 2 2
Alabama............ 3 2 2 2 26
Mississippi........ 1 1 1 1 1 1 1 2

WEST SOUTH CENTRAL... 6 4 2 19 11 16 10 37
Arkansas............ 1 2
Louisiana.......... 2 1 10
Oklahoma........... 2 3 2 2 1
Texas.............. 6 4 1 15 8 13 8 24

MOUNTAIN............. 2 5 11 3 6 -
Montana............ -
Idaho.............. 1 -
Wyoming............. 2 2 -
Colorado............ 2 2 -
New Mexico......... 1 5 1 -
Arizona............ 1 4 1 2 1 -
Utah............... -
Nevada.............. .- -

PACIFIC.............. 13 19 7 2 8 3 4 3 9
Washington......... 1 2 2 2 3
Oregon............. I 1 1 1 1 1 I
California......... 11 16 6 2 5 2 1 2 5
Alaska............. -
Hawaii............. -

Puerto Rico 16











Morbidity and M11rtalil Weekly Report 121


CASES OF SPECIFIED NOTIFIAHII DII ~-IS UNITED) STATES

Ft)R WEEKS INI)II)

DECEMBER 11, 1965 AMI) DE( I MHI 5R 1964 (.9th WI k) Continued


Brucel- Infectious Hepatitis MeningococcaI
losis 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... 8 646 273 342 31,813 35,668 48 2,854 2,619 7 265

NEW ENGLAND.......... 28 10 18 1,799 3,182 3 147 89 7
Maine.............. 8 2 6 316 984 18 7
New Hampshire...... 166 252 9 2 2
Vermont............. 1 1 91 370 8 4
Massachusetts...... 10 3 7 717 732 1 55 37 4
Rhode Island....... 3 2 1 198 210 1 18 11
Connecticut........ 6 3 3 311 634 1 39 28 1

MIDDLE ATLANTIC...... 124 43 81 5,663 7,800 6 381 337 2 21
New York City...... 39 9 30 1,176 1,236 2 63 46 1 4
New York, Up-State. 43 16 27 2,122 3,391 2 109 102 6
New Jersey.......... 19 6 13 1,038 1,279 1 101 106 2
Pennsylvania....... 23 12 11 1,327 1,894 1 108 83 1 9

EAST NORTH CENTRAL... 124 50 70 6,202 5,726 9 434 346 35
Ohio................ 30 13 17 1,670 1,508 1 118 91 3
Indiana........... 5 1 4 516 476 50 54 9
Illinois........... 23 7 15 1,173 1,089 5 118 92 16
Michigan........... 53 19 34 2,451 2,257 3 100 77 3
Wisconsin.......... 13 10 392 396 48 32 4

WEST NORTH CENTRAL... 5 35 18 15 1,771 1,953 137 145 22
Minnesota.......... 17 12 3 216 221 32 32 9
Iowa............... 1 7 2 5 575 345 12 9 4
Missouri........... 2 2 1 1 394 487 54 65 4
North Dakota....... 34 63 13 20 1
South Dakota....... 2 22 134 3 3
Nebraska........... 89 69 10 7 2
Kansas............... 9 3 6 441 634 13 9 2

SOUTH ATLANTIC....... 1 94 38 48 3,280 3,294 8 538 509 1 63
Delaware........... 8 3 86 74 11 7
Maryland........... 18 11 7 587 600 53 41 3
Dist. of Columbia.. 1 1 50 69 11 17
Virginia............ 12 6 5 755 525 1 72 63 6
West Virginia...... 4 4 440 467 2 29 35 1
North Carolina..... 1 33 4 28 356 533 2 112 87 11
South Carolina..... 3 1 2 140 151 65 57 7
Georgia............ 4 4 116 106 61 82 10
Florida............ 11 5 5 750 769 3 124 120 1 25

EAST SOUTH CENTRAL... 38 20 17 2,263 2,427 6 221 197 2 34
Kentucky............ 12 10 1 820 856 3 86 68 8
Tennessee.......... 12 6 6 765 860 68 60 2 12
Alabama............. 9 3 6 394 474 1 40 43 12
Mississippi........ 5 1 4 284 237 2 27 26 2

WEST SOUTH CENTRAL... 1 45 25 17 2,662 2,803 8 359 295 2 57
Arkansas........... 1 5 3 2 339 285 18 33 13
Louisiana.......... 6 4 2 451 667 2 194 129 1 10
Oklahoma........... 54 132 21 15 I
Texas............... 34 18 13 1,818 1,719 6 126 118 1 33

MOUNTAIN ............. 25 10 7 1,727 2,179 2 102 96 3
Montana............. 5 4 153 185 2 1
Idaho............... 1 196 307 13 4
Wyoming ............ 1 1 51 91 1 6 5
Colorado............ 8 3 5 368 573 1 28 22 2
New Mexico......... 3 3 374 312 11 39
Arizona............. 6 365 475 20 8 1
Utah............... 1 1 205 185 17 7
Nevada............. 15 51 5 10

PACIFIC.............. 1 133 59 69 6,446 6,304 6 535 605 23
Washington......... 10 5 5 498 640 2 47 48
Oregon.............. 16 8 5 556 640 1 38 25 4
California.......... 1 103 46 57 5,074 4,629 3 424 512 19
Alaska.............. 2 233 278 18 7
Hawaii............... 2 2 85 117 8 13

Puerto Rico 15 9 6 1,338 962 11 36 1 57











122 Morbidity and Mortality Weekly Report


CASES OF SPECIFIED NOTIFIABLE DISEASES UNITED STATES

FOR WEEKS ENDED

DECEMBER 11, 1965 AND DECEMBER 5, 1964 (49th 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... 3,070 256,443 478,518 8,732 3 233 10 431 72 4,048

NEW ENGLAND........... 39 37,231 20,360 989 2 7 48
Maine............. 5 2,919 3,503 152 4
New Hampshire...... 383 760 30 5
Vermont............ 20 1,407 2,383 20 32
Massachusetts...... 2 19,374 6,530 179 2 3 2
Rhode Island....... 5 3,957 2,340 35 1 I
Connecticut........ 7 9,191 4,844 573 -- 3 4

MIDDLE ATLANTIC...... 646 17,356 53,093 385 1 68 17 245
New York City...... 209 3,261 15,483 15 -- 30 -
New York, Up-State. 63 4,407 13,032 261 1 16 17 229
New Jersey......... 238 3,425 12,319 60 7
Pennsylvania....... 136 6,263 12,259 49 15 16

EAST NORTH CENTRAL... 1,183 61,066 105,258 809 14 1 50 9 621
Ohio............... 97 9,130 19,970 44 10 3 333
Indiana............. 58 2,313 23,138 205 5 16 4 73
Illinois........... 236 3,631 16,758 118 6 11 2 90
Michigan........... 164 27,613 29,755 314 2 7 60
Wisconsin........... 628 18,379 15,637 128 1 1 6 65

WEST NORTH CENTRAL... 92 17,303 31,130 364 30 17 12 804
Minnesota........... 48 808 344 5 I 1 4 175
Iowa................ 26 9,261 23,561 100 2 3 225
Missouri............ 4 2,661 1,074 42 20 11 2 122
North Dakota....... 13 3,995 5,255 89 1 48
South Dakota....... 1 116 66 3 3 58
Nebraska.......... 462 830 6 2 3 36
Kansas............ NN NN NN 119 4 2 140

SOUTH ATLANTIC....... 195 26,514 39,879 897 1 35 1 79 9 525
Delaware........... 6 516 416 12 4
Maryland............ 24 1,240 3,442 116 21 27
Dist. of Columbia.. 17 127 357 9 -
Virginia........... 4 4,194 12,925 172 1 9 9 9 320
West Virginia...... 98 14,659 9,596 307 3 25
North Carolina..... 1 412 1,259 17 8 1 16 3
South Carolina..... 19 1,167 4,295 42 3 9 3
Georgia............. 1 628 213 11 15 12 70
Florida............. 25 3,571 7,376 211 5 77

EAST SOUTH CENTRAL... 378 15,521 68,908 1,239 1 24 1 46 7 811
Kentucky............ 278 3,473 18,770 109 3 10 1 93
Tennessee........... 97 8,547 24,898 1,000 1 20 1 18 6 661
Alabama............. 2 2,353 18,490 91 I 10 16
Mississippi........ 1 1,148 6,750 39 8 41

WEST SOUTH CENTRAL... 227 31,933 73,424 868 1 97 60 17 659
Arkansas........... 100 1,188 1,150 66 15 2 97
Louisiana.......... 1 121 121 3 1 8 11 83
Oklahoma............ 233 1,049 21 11 10 3 136
Texas............. 126 30,391 71,104 844 12 24 12 343

MOUNTAIN............ 123 20,707 20,864 1,748 16 32 95
Montana............ 20 3,894 3,949 68 4 1 5
Idaho.............. 8 2,985 2,125 139 -
W'..- Ve............ 12 871 284 58 4 1
Colorado............ 22 5,957 3,377 690 1 9
New Mexico......... 688 969 411 12 21
Arizona............ 38 1,-51 6,751 163 14 57
Utah................ 20 4,636 2,400 218 8 -
Nevada............. 3 225 1,009 1 2 1

PACIFIC.............. 187 28,812 65,602 1,433 14 7 72 1 240
'~- htrlu ............ 33 7,494 20,792 346 7 8
Oregon.............. 25 3,447 8,918 20 5 8 9
California......... 124 13,614 33,911 936 9 7 56 1 221
Alaska......... ..... 2 205 1,146 35 2
Hawaii............. 3 4,052 835 96 1

Puerto Rico 46 2,826 7,219 18 15 14









1lorbildit anid Mortality % rekl Hli eporti


Week No. Tablc 4. I)M THS IN 122 I NITED STATES ( 1111% liHK Ilk IND)II) 1)1 ( I Mll H 11, 1965

(By place if occurrence and week of tiling crtiicaite. Excludes total d aths)


I _________ I.. :.II--T


All
Ages


65 years
and over


Pneumonia
and
Influenza
All Ages


Under
1 year
All
Causes


All Causes

All 65 years
Ages c and over


Pneunionl
and
Influenza
All Ages


1I 1 + I I 1


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

MIDDLE ATLANTIC:
Albany, N. Y.---------
Allentown, Pa.--------
Buffalo, N. Y.--------
Camden, N. J.---------
Elizabeth, N. J.------
Erie, Pa.-------------
Jersey City, 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.---------
yvr. u r, 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.--------


790
293
25
29
24
49
36
18
30
41
61
19
47
27
91

3,405
48
47
134
34
28
37
86
92
1,718
35
545
175
63
111
19
40
76
43
37
37

2,780
72
34
778
175
186
146
68
389
53
57
38
50
64
203
58
133
49
29
26
106
66

936
62
24
54
128
29
123
108
246
98
64


464
159
14
19
19
24
22
11
19
25
34
14
30
15
59

1,991
26
27
87
17
14
25
53
43
1,011
23
310
89
43
64
14
26
44
24
27
24

1,560
36
23
402
110
101
82
36
206
38
30
22
18
46
123
31
75
34
16
17
68
46

576
43
21
20
75
17
72
72
156
65
35


27
10


I

2
2
1
1


2

6

137
1
3
3
5

2
8
3
70
2
6
1
6
9

1

6
8
3

97

6
35
4
1
4
1
14
3
2
1
2
8
5


3
3
3
2


33
1

3
3


1
14
5
6


SOUTH ATLANTIC:
Atlanta, a.------------
Baltimore, Md.---------
Charlotte, N. C.-------
Jacksonville, Fla.-----
Miami, Fla.------------
Norfolk, Va.------------
Richmond, Va.----------
Savannah, Ga.----------
St. Petersburg, Fla.---
Tampa, Fla.------------
.'.h f,, ,, D. C.------
I I....n1 on, 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 W rth, 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:
Berktely, 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.----------


1,291
164
252
53
82
100
61
107
29
99
87
221
36

761
128
47
43
143
194
57
51
98

1,211
42
30
24
164
22
90
210
61
188
85
125
70
100

419
31
22
124
20
106
19
51
46

1,763
19
48
48
48
73
676
54
37
105
74
97
220
34
137
59
34


12-3


UId 1 r
I ydar
All
(auscs


Total 13,356 7,539 554 776


Cumulative Totals
including reported corrections for


previous weeks


All Causes, All Ages ------------------------ 602,947
All Causes, Age 65 and over------------------- 340,485
Pneumonia and Influenza, All Ages------------- 24,317
All Causes, Under 1 Year of Age--------------- 35,507


Area


All Causes


1,018
13
25
31
21
43
381
38
S27
68
53
47
111
19
81
35
25


*Estimate based on average percent of divisional total.









424


INTERNATIONAL NOTES
SMALLPOX KULMBACH, WEST GERMANY
(Continued from page 419)


isolated in the examination room and the local hospital
was alerted to prepare smallpox isolation facilities. Skin
lesion specimens for virus identification were obtained
and forwarded by police car to the regional Smallpox
Diagnostic Laboratory in Munich, Germany.
Late that night, 2% hours after the specimens were
received at the laboratory, pox virus particles from the
skin lesions were demonstrated by electron microscopy
and a presumptive diagnosis of smallpox was made. This
was later confirmed within 48 hours by the culture of
variola virus on chick embryo chorio-allantoic membrane.
On the morning of October 29, WHO was notified of
an imported case of smallpox. Ninety-one of the 102
persons classified as face-to-face contacts of the patient
were quarantined. The primary contacts, who were vac-
cinated at the time of the identification visit to the home
by a public health physician and nurse, were trans-
ferred the next day to a quarantine hospital set up in a
local school. Eleven other primary contacts who had
left Kulmbach were located in various German cities in-
cluding one in the East Zone. Public health workers in
these cities were notified and the contacts were identi-
fied, vaccinated, and quarantined for 16 days after their
last contact with the patient.
A comprehensive vaccination campaign was started
in Kulmbach on October 29 and 27,309 persons had been
vaccinated by November 12; of these some 4,000 lived in
areas lying around Kulmbach. Each person vaccinated was
requested to return for a check of the vaccination 4 days
later and 18,300 of them returned of whom 2,800 were
revaccinated.
There were three other suspect cases of smallpox,
none of which have been confirmed. These were the wife
and son of the patient and a male employee at the factory
working in the same room as the patient.
The patient's illness was mild with only a few more
popular and vesicular lesions appearing on the back,
chest, and lower arms. He experienced no constitutional
symptoms after the prodromal period and the skin lesions
matured and crusted rapidly with only slight pustulation.
The clinical manifestations of the illness were said to
be in character with an abortive vaccine-modified
smallpox. *
No further cases had occurred by November 17 and
all primary contacts quarantined were released on this
day. On November 26 Kulmbach was removed from the
WHO list of infected local areas. In fact, as one im-
ported case only had been confirmed, Kulmbach was not
a smallpox "infected local area" in terms of the Inter-
national Sanitary Regulations.
(Reported by an observer from the Communicable Disease
Center invited by the Bavarian Public Health Authorities
and the Federal German Republic Health Ministry.)


THE MORBIDITI AND MORTALITY WEEKLf REPORT. WITH A CIRCULA-
TION OF 14.000 li PUBLISHED AT THE COMMUNICABLE DISEASE
CENTER. ATLANTA GEORGIA.
CHIEF COMMUNICABLE DISEASE CENTER JAMES L. GODDARD. M.D.
C .IE F EPIDEMIOLOG BRANCH A.D. LANGMUIR, M.D.
ACTING CHIEF. STATISTICS SECTION IDA L. SHERMAN. M.S.
CHIEF. SURVEILLANCE SEC TION D.A. HENDERSON. M.D.
EDITOR- MMWR D.J.M. MACKENZIE. M.B..
F.R.C.P.E.

IN ADDITION TO TME ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY &ND MORTALITY THE COMMUNICABLE DISEASE CENTER
WELCOMES ACCOUNTS OF INTERESTING OUTBREAKS OR CASE IN-
VESTICA TIONS I HICH ARE OF CURRENT INTEREST TO HEALTH
OFFICIALS AND WHICi- 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 AEEKLY TELEGRAMS TO THE CDC BY THE INDIVIDUAL STATE
HEALTH DEPARTMENTS. THE REPORTING WEEK CONCLUDES ON SAT-
URDAY. COMPILED DATA ON A NATIONAL BASIS ARE RELEASED ON
THE SUCCEEDING FRIDAY.


S USDPT
' U-- REPOSITORY


Morbidity and Mortality Weekly Report


DECEMBER 11. 1965


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