TABLE III. Cases of specified notifiable diseases, United States, weeks ending
May 14, 1988 and May 16, 1987 (19th Week)

TABLE III. (Cont'd.) Cases of specified notifiable diseases, United States, weeks ending May 14, 1988 and May 16, 1987 (19th Week)

*For measles only, imported cases includes both out-of-state and international importations. N: Not notifiable U: Unavailable *International $Out-of-state

TABLE III. (Cont'd.) Cases of specified notifiable diseases, United States, weeks ending May 14, 1988 and May 16, 1987 (19th Week)

Mich.

Wis.

W.N. CENTRAL

Minn.

lowa

Mo.

N. Dak.

S. Dak.

Nebr.

88

1323.

3

14

1

5

2

85

93

11

23

2,160

Kans.

S. ATLANTIC

4,817

.៩, ៩៩ ៩៩, ៩៨, ននគ៩ ១៩៩, ។៩៩៩៖ ៩១៧៩២៨៖១ ៨.

148

30

7

6

4

13

13

5

29

5

10

495

124

4

165

24

86

37

119

55

32

212

158

100

*Mortality data in this table are voluntarily reported from 121 cities in the United states, most of which have populations of 100,000 or more. A death is reported by the place of its occurrence and by the week that the death certificate was filed. Fetal deaths are not included. **Pneumonia and influenza.

†Because of changes in reporting methods in these 3 Pennsylvania cities, these numbers are partial counts for the current week. Complete counts will be available in 4 to 6 weeks.

ttTotal includes unknown ages.

§ Data not available. Figures are estimates based on average of past available 4 weeks.

Consequently, drug abusers may be candidates for the vaccines against HAV that are currently being developed (5,6).

References

1. Widell A, Hansson BG, Moestrup T, Serléus Z, Mathiesen LR, Johnsson T. Acute hepatitis A, B and non-A, non-B in a Swedish community studied over a ten-year period. Scand J Infect Dis 1982;14:253-9.

2. Widell A, Hansson BG, Moestrup T, Nordenfelt E. Increased occurrence of hepatitis A with cyclic outbreaks among drug addicts in a Swedish community. Infection 1983;11:198–200. 3. Scheutz F, Skinhøj P, Mark I. Viral hepatitis among parenteral drug addicts attending a Danish addiction clinic. Scand J Infect Dis 1983;15:139-43.

4. Sundkvist T, Johansson B, Widell A. Rectum carried drugs may spread hepatitis A among drug addicts. Scand J Infect Dis 1985;17:1-4.

5. Binn LN, Bancroft WH, Lemon SM, et al. Preparation of a prototype inactivated hepatitis A virus vaccine from infected cell cultures. J Infect Dis 1986;153:749-56.

6. Provost PJ, Bishop RP, Gerety RJ, et al. New findings in live, attenuated hepatitis A vaccine development. J Med Virol 1986;20:165–75.

In December 1987, the first case of human rabies in the United States since May 1985 was diagnosed in San Francisco, California. The patient was a 13-year-old male immigrant; the diagnosis was made post-mortem.

The patient had no history of exposure to a rabid animal and had not traveled outside the United States since arriving from the Philippines in 1981. He had traveled outside San Francisco county (a county with no reported rabies in terrestrial animals) only twice in the previous year, once for a picnic on a San Mateo County beach in August 1987 and once for a 3-day camping trip to Sonoma County in northern California with 82 classmates and teachers in October 1987. The purpose of the camping trip was to identify wild animals, but, aside from a deer, a dead rabbit, and bats that were seen by two students, no animals were reported by the other students or listed in the patient's camping journal. Interviews with relatives, classmates, friends, and teachers did not identify any likely animal contact.

The patient was well until November 26, when he began experiencing painful lower back spasms. These symptoms progressed, and he was taken to an emergency room on November 28. He complained of shaking chills and pain in the penis, buttocks, and lower back. His neurological examination was normal, and he was afebrile, but his white blood cell (WBC) count was 20,200 (74% segmented neutrophils, 4% band neutrophils, 21% lymphocytes, and 1% monocytes). He was sent home with medication for the pain and spasms but returned the next day reporting priapism, abdominal pain, and pruritus that caused him to scratch his lower right abdomen. Opisthotonic posturing was precipitated by touching his penis or his back. He was admitted to the hospital, with a differential diagnosis of pyelonephritis or appendicitis. On admission, his temperature was 38.3 °C (100.9 °F) rectally and his blood pressure was 150/90 mm Hg. Laboratory evaluation revealed a WBC count of 17,000/mm3 and a creatine phosphokinase (CPK) of 1,300 IU/mL (normal, 5–202). A urine toxic screen that was falsely positive for cocaine metabolites caused initial concern about drug ingestion. An exploratory laparotomy and appendectomy were performed; no abnormalities were found. Over the next 2 days, he became increasingly agitated. He complained of blurred vision and inability to move his legs, but