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TABLE III. (Cont'd.) Cases of specified notifiable diseases, United States, weeks ending

February 6, 1988 and February 7, 1987 (5th Week)

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*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

February 7, 1988 and February 6, 1987 (5th Week)

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NEW ENGLAND 632 Boston, Mass.

196 Bridgeport, Conn. 51 Cambridge, Mass. 18 Fall River, Mass.

35 Hartford, Conn.

45 Lowell, Mass.

23 Lynn, Mass.

31 New Bedford, Mass. 27 New Haven, Conn. 27 Providence, R.I.

33 Somerville, Mass. 7 Springfield, Mass. 47 Waterbury, Conn. 34 Worcester, Mass. 58 MID, ATLANTIC 2,916 Albany, N.Y.

53 Allentown, Pa.

19 Buffalo, N.Y.S

108 Camden, N.J.

28 Elizabeth, N.J.

26 Erie, Pat

45 Jersey City, N.J. 54 N.Y. City, N.Y. 1,525 Newark, N.J.

41 Paterson, N.J.

27 Philadelphia, Pa. 486 Pittsburgh, Pat

78 Reading, Pa.

41 Rochester, N.Y.

115 Schenectady, N.Y. 29 Scranton, Pat

40 Syracuse, N.Y.

89 Trenton, N.J.

49 Utica, N.Y.

20 Yonkers, N.Y.

43 E.N. CENTRAL 2,377 Akron, Ohio

80 Canton, Ohio

43 Chicago, III.S

564 Cincinnati, Ohio 134 Cleveland, Ohio

156 Columbus, Ohio 129 Dayton, Ohio

115 Detroit, Mich.

223 Evansville, Ind.

46 Fort Wayne, Ind. 85 Gary, Ind.

21 Grand Rapids, Mich. 58 Indianapolis, Ind. 173 Madison, Wis.

45 Milwaukee, Wis. 148 Peoria, III.

60 Rockford, III.

47 South Bend, Ind.

16 Toledo, Ohio

133 Youngstown, Ohio 101 W.N. CENTRAL

965 Des Moines, lowa 50 Duluth, Minn,

20 Kansas City, Kans. 40 Kansas City, Mo. 113 Lincoln, Nebr.

43 Minneapolis, Minn. 322 Omaha, Nebr.

65 St. Louis, Mo.

151 St. Paul, Minn.

83 Wichita, Kans.

78

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56 S. ATLANTIC

1,555 948

356 19 Atlanta, Ga.

214 122 42 3 Baltimore, Md.

298 172 83 6 Charlotte, N.C.

83 47 24 1

Jacksonville, Fla. 114 70 30 1 Miami, Fla.

239 138 55 2 Norfolk, Va.

57 37 13 2 Richmond, Va.

86 56 20 3 Savannah, Ga.

59 39 13 2 St. Petersburg, Fla. 104 87 7 1 Tampa, Fla.

71 47 13 Washington, D.C. 201 113 50 4 Wilmington, Del. 29 20 6 7 5 E.S. CENTRAL

935 631 192 Birmingham, Ala. 113 62 28 149 Chattanooga, Tenn. 77 60 15 1

Knoxville, Tenn. 126 92 16
Louisville, Ky.

132

89 30 7 Memphis, Tenn. 255 176 47 Mobile, Ala.

72 46 16 1 Montgomery, Ala.

34 8 7 Nashville, Tenn. 117 72 32 2 73 W.S. CENTRAL 1,421

318 5 Austin, Tex.

74 57 9 3

Baton Rouge, La. 55 33 17 18 Corpus Christi, Tex. 32 29 2 Dallas, Tex.

210 118 54 1 El Paso, Tex.

57 32 18 14 Fort Worth, Tex 110 76 19 i Houston, Tex.

308 176 74 Little Rock, Ark.

108 63 22 8

New Orleans, La. 108 65 25 3

San Antonio, Tex. 215 137 55 3 Shreveport, La.

23 18 4 2 Tulsa, Okla.

121 86 19 120 MOUNTAIN

649 447 135 3 Albuquerque, N. Mex. 81 63 9 12 Colo. Springs, Colo. 43 31 7 16 Denver, Colo.

66 45 13 10 Las Vegas, Nev. 108 76 24 3 Ogden, Utah

20 13 3 2 Phoenix, Ariz.

137 90 29 4 Pueblo, Colo.

30 21 5 6

Salt Lake City, Utah 40 21 14 4 Tucson, Ariz.

124 87 31 6 PACIFIC

2,295 1,581 395 Berkeley, Calif.

17 15 2 6 Fresno, Calif.

123 84 22 4 Glendale, Calif.

49 37 6 4 Honolulu, Hawaii 81 56 18 10 Long Beach, Calif. 53 41 6 9 Los Angeles Calif. 646 431 115 7 Oakland, Calif.

80 63 11 1 Pasadena, Calif.

56 40 10 11 Portland, Oreg.

149 108 24 1 Sacramento, Calif. 184 133 23 71

San Diego, Calif. 198 131 37 2

San Francisco, Calif. 185 112 38 2 San Jose, Calif. 192

132 31 Seattle, Wash.

165 115 31 4 Spokane, Wash.

54 40 11 Tacoma, Wash.

63 43 10 35 TOTAL

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*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. It Total includes unknown ages,

& Data not available figures are perimetehased on average nae+ A weeke

Exposure Continued

Exposure to or contact with H by any route - respiratory, skin, or oral – should be limited to the extent practicable. This can be accomplished by use of appropriate engineering controls, personal protective equipment, and work practices. Concentrations in the workplace and surrounding air should be measured and verified by instruments that can reliably detect concentrations at or below the control limits. At this time, the most sensitive monitors can reliably measure 0.003 mg/m3 of H and L in the workplace air. Because of dispersion and dilution, this level would be adequate protection for the general population.

The members of the working group also considered DOD's proposal for agent stack emission levels during incineration. These limits should be 1) attainable by a well-designed, constructed, and operated incineration facility, 2) capable of offering an early indication of disturbed operating conditions, and 3) able to be accurately measured in a timely manner. The allowable stack concentrations proposed by DOD meet these criteria and appear to restrict emissions to concentrations well below those that would endanger health. They must be evaluated by air dispersion modeling of credible worst-case events and conditions specific to each site to ensure that they will not result in emissions exceeding the permissible level for the general population and the workplace.

On the basis of the evidence reviewed, members of the working group concluded that human health will be adequately protected from exposure to the chemical agents at the recommended concentrations in this report. Even long-term exposure to these concentrations would not create adverse health effects. The relatively short duration of the disposal program provides an additional margin of safety.

Epidemiologic Notes and Reports

La Crosse Encephalitis in West Virginia

Between July 6 and September 1, 1987, in central West Virginia, 19 cases of La Crosse encephalitis were serologically confirmed (Figure 1). After a cluster of meningo-encephalitis cases was reported from a referral pediatric service in Charleston, active hospital-based surveillance was undertaken in 15 counties in central and southern West Virginia, where La Crosse encephalitis had previously occurred. Cases were identified in five of these counties.

Eleven (58%) of the 19 patients were diagnosed as having viral encephalitis. Four (21%) had symptoms of meningitis alone, and four (21%) had meningo-encephalitis. The patients ranged in age from 1 to 14 years (mean = 7 years). Fifteen (79%) patients were male; the male-to-female ratio was 3.8:1. Eighteen (95%) children were hospitalized, and one child was treated as an outpatient. One patient, a 9-year-old boy with cerebral edema, died despite intensive supportive care.

All patients lived in rural areas of central West Virginia, a region with thick hardwood forests conducive to mosquito breeding. Attack rates varied by the patients' sex and place of residence (Table 1). Males were at much greater risk of becoming ill than females. The attack rate among children under 15 years of age in Nicholas County was over four times the rate in any other county. A case-control study is under way to test hypotheses regarding possible behavioral and environmental risk factors.

Encephalitis Continued

For six (32%) of the patients, diagnosis was based on compatible clinical findings and a single immunofluorescent antibody (IFA) titer >128 during the convalescent stage of illness. For the other 13 (68%), a fourfold rise in antibody titer was demonstrated between the acute and convalescent stages of illness.

In the past, few cases of La Crosse encephalitis have been reported in West Virginia. Of 223 cases of encephalitis reported to the West Virginia Department of Health from 1980 through 1986, only eight (4%) – six in 1984 and two in 1985 – were attributed to a California serogroup virus. Much of the increase in reported incidence in 1987 may be the result of intensive case-finding efforts. A change in the state laboratory's serologic procedure for La Crosse virus diagnosis may also have contributed to the increase in the number of identified cases. Previously, serologic diagnoses were made by measuring complement-fixing antibodies. The more sensitive IFA was adopted in 1987.

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FIGURE 1. Reported cases of LaCrosse encephalitis, by week of onset
Virginia, 1987

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TABLE 1. Attack rates of La Crosse encephalitis, by sex and county of residence West Virginia, July 6-September 1, 1987

23

County
Nicholas
Greenbrier
Fayette
Kanawha
Logan
Total

Males
Females

Total
No.
Rate*

No.
Rate*

No.

Rate*
5
129

3
84

8

107 2 45

0

2
3
41

3

21 4 16 1 4 5

10
1
14

0
1

7
15
31
4
9
19

20 number of patients <15 years of age per 100,000 population of the same age.

* Attack rate =

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