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Table 2. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES, EACH DIVISION AND STATE, ALASKA, HAWAII, AND PUERTO RICO, FOR WEEKS ENDED AUGUST 20, 1955 AND AUGUST 18, 1956-Continued (By place of occurrence. Numbers under diseases are category numbers of the Sixth Revision of the International Lists, 1948)

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The chart shows the number of deaths reported for 108 major cities of the United States by week for the current year, and, for comparison, the median of the number of deaths reported for the corresponding weeks of the 3 previous calendar years. (The median is the central one of the three values arranged in order of magnitude.) If a report is not received from a city in time to be included in the total for the current week, an estimate is made to maintain comparability for graphic presentation.

The figures reported represent the number of death certificates received in the vital statistics offices during the week indicated for deaths occurring in that city. Figures compiled in this way, by week of receipt, usually approximate closely the number of deaths occurring during the week. However, differences are to be expected because of variations in the

interval between death and receipt of the certificate.

While week-to-week changes in the total number of deaths reported for all major cities generally represent a change in mortality conditions, this may not be true for variations in weekly figures for each city. For example, in a city with a weekly average of 50 deaths, the number of deaths occurring in a week may be expected to vary by chance alone from 36 to 64 (d± 2Vd, where d represents the average number of deaths per week).

The number of deaths in cities of the same size may also differ because of variations in the age, race, and sex composition of their populations, and because some cities are hospital centers serving the surrounding areas. Changes from year to year in the number of deaths may be due in part to population increases or decreases.

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Table 4. DEATHS IN SELECTED CITIES FOR WEEK ENDED AUGUST 18, 1956
(By place of occurrence, and week of filing certificate.

Exclusive of fetal deaths)

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August 31, 1956

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Provisional Information on Selected Notifiable Diseases in the United States and on Deaths in Selected Cities for Week Ended August 25, 1956

The number of cases of poliomyelitis reported for the current week is 943 as compared with 900 for the previous week. This number is less than the figure for the same week in all prior years since 1947. The number reported in Chicago for the current week (ended August 25) is 100 as compared with 133 for the previous week. This is the second successive week in which reported cases have been fewer in number. Fiftyeight of the 100 cases were paralytic, and there were 4 deaths. Information has been received that a larger proportion of the cases in Chicago are now occurring outside the high epidemic area. Incidence in the State of Illinois exclusive of Chicago is still rising.

The numbers of reported cases of poliomyelitis by type for the United States for the current week, disease year, and calendar year are:

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Information has been received regarding the occurrence of typhoid fever in persons who attended a church convention in Monarch Springs, Missouri, July 20-29. A total of 170 families is reported to have attended the convention. Two confirmed and 3 suspect cases with 1 death have been discovered in Louisiana among persons who have returned. There is a fatal suspect case and a reported case in Oklahoma, 2 reported cases in California, and 1 in Missouri. Preliminary investigation revealed that a well used by those attending the convention was contaminated. A phage type C2 organism has been isolated from one case.

EPIDEMIOLOGICAL REPORTS

Equine encephalitis

Dr. R. F. Feemster, Massachusetts Department of Public Health, has supplied additional information on the disease which is occurring in the eastern part of the State. The total number of cases in horses is now 15, 9 in Plymouth County, 2 in Bristol County, and 1 each in Norfolk, Middlesex, Essex, and Worcester Counties. The case in Essex County is the first in that area. There are now 6 suspect human cases, 3 of them fatal. Three of the human cases occurred in residents of Norfolk County, and 1 each in Plymouth, Suffolk, and Middlesex Counties. It is also reported that pheasants have died of the disease on 3 pheasant farms in Plymouth County and 1 in Bristol County. Spraying of large marshes in affected areas and in cities and towns is in progress.

Information also has been received of similar infections in New Jersey where cases in horses, pheasants, and humans are under investigation. Cases in horses have been reported along the Eastern Shore area of Maryland and in Delaware. Confirmation by virus isolation has been obtained in the latter State. Other States in regions where eastern equine encephalitis is generally found have reported cases in horses to the U. S. Department of Agriculture. These include Florida, Georgia, South Carolina, North Carolina, and Virginia.

Bubonic plague

Dr. A. C. Hollister, California State Department of Public Health, has furnished additional information on the fatal case of bubonic plague which was reported for the week ended June 23, 1956. The investigation revealed no evidence of infection in the environment of the patient's home or place of employment. Evidence of an epizootic among ground squirrels was found in the area visited by the patient and his son on a hunting trip. At the time of the investigation there was no evidence of freshly dead, sick, or dying animals. No specimens of other animals or of fleas collected were found to be plague infected. The patient's history indicated that illness started 2 days after visiting the above area. Physicial findings were typical for bubonic plague, and specimens from inguinal nodes and blood culture were positive for Pasteurella pestis. The patient died 1 week following onset of illness and 3 days following institution of treatment. The autopsy findings suggested that the patient died of toxemia rather than bacteremia. It was postulated that the treatment schedule of 3 antibiotics and sulfonamides administered simultaneously led to a rapid destruction of Past. pestis and consequently to the liberation of the highly potent protein known as plague toxin.

Leptospirosis

Dr. P. H. Cochran, Kentucky State Department of Health, has reported that a case of Leptospira pomona infection has been found in a herd of beef cattle which is said to be the first recognition of this infection in Kentucky. Abortion and a high fatality rate among calves were observed in the herd. Tests for brucellosis and tuberculosis were reported to be negative. Epidemic pleurodynia

Dr. R. B. Gordon, California State Department of Public Health, has reported the occurrence of an unusual number of cases of epidemic pleurodynia in northern California during the past 6 weeks. In some areas the estimated morbidity has been as high as 10 percent. Incidence has been relatively high in young adults but illness in children and elderly persons has also been reported. The illness has been characterized by intermittent fever up to 104 degrees, severe paroxysmal chest pain usually at the level of the diaphragm, upper abdominal pain, myalgia, arthralgia, and general malaise. Coxsackie virus, Group B, type 5, has been isolated from 7 stool specimens to date.

Dr. A. A. Jenkins, Utah State Department of Health, reported that laboratory tests on a suspect case of pleurodynia showed a positive complement fixation test in a titer of 1:16 for Coxsackie virTHE LIBRARY OFOTHES was recovered from stool specimens.

SEP 7 1950

UNIVERSITY OF ILLINOIS

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