FOR ADKINISmATITJrE USE

CDC INFLUENZA SURVEILLdPJCE REPOW NO, 25

U. S. DEPmTMENT OF FlUU"H, EDUCATXON, W W m Pu'blic Health Serdce Bureau of State Services

Cammudcable Disease Center - Robes* J, Anderson, H, Do, Chief Surveillance Seetion - Maris Pi~ef, W, D., Chfef

Keith E. Jenrsan, fh, D, Yates Trodter, Jr., Me D* CBC Virus and Rickettsia Section* Frederick L, hm , MI D, P, 0, Box 61 Infhnanza Surveillance U n i t Montgsmtsry 1, Alabama $0 Saventh Strest , N, E. Telephone Ma, Mhsrst 3-4.468 Atlanta 23, Georgia

Telephone No. TRfdty 6-33U *Serving as WHO International Eaetenslw 5455 Pnf luenza Center for the h e r f cas

Tnformatfon contained i n t h i s report i s & sumasy o f data reported to CDC by State Health Departments, Epidedc EP1Celligence Service Officers, col- laborating influenza diagnostic laboratories, and other par thef i t saurees. Nuch of it i s p r e l i m b a q i n nature and i s intended for those inwbvsd rin influsnaa control act1vitfes, Anyone dssirfng t o quote t h i s information is urged t o contact the person o r parsons primarily responsible for the item re~cW%e?d i n order that t h e exact h te rpre ta t ion of the report and the curran6 k i t u s of t h e investigat;ian be obtained* St&%* HsalLh Officers, of course,

9

Table of Contents

I, S m q of Information

11, Infbuensa Map and Table

III, Current Analysis of Influenza and heumorxka Mortality

IV, Natfonal Health Survey Data

V, Indust r ia l Absentee Data

VE. Influenza Vaccine Prodvetion and Distr5butisn

VSI , Studies an J.flluenza Vaccine Ef fectiiveness

Appendh - Supplementary Report; International Spread of A s i a Strain Influenza

A t Jeas t 414'0 of %he nation" 3068 counties have now reported inf lu- enza. During the past week, most of the new reports have come fn'an She Soubh Atlant ic and West Nortb Centm2 Sta tes . Excess mortal i ty frm influenza and pnemonia and indus t r ia l absenteeism rex~ain elevated i n ci2;ies of these two areas, !lke epidemic, a s measurod by mo&ality and induetrial absentaeism, i s now i n i t 8 f i f t h week. Uthough n o r t a l i t y and new o u t b r e a s a re on the increase i n cer ta in areas, Wlere i s evidence that, m.t;fon-wide a o r t a l i l y may be reaching i t s peak. Sf excess mortal i ty baa ac tual ly r e a b e d i t s peak and if It f o 2 J . o ~ ~ the pat tern of" decreaeie sec;n i n previous agfdesn3cs, mor-bality should be back t o normal by l a t e December,

Msi&ioa&l EIeal*h Survey data show that a marked increase i n respim- tory illneasers 'tse@;an %a mid-Septmber. 'Phis agresa with the above mor- t a l i t y ddbta beoauee i t haa been found that deaths do not increase appre- ciably until abaut ona t o Lwo weeks afi&er a camunily has experienced a Mdespread outbreak, The Sumey data represent a careful sampling and shsu2.d pa ra l l e l the excesa m o r h l l t y curves when sufficient t3ms has elapsed t o allow cornprison,

b "ctta 2of 40,382,719 mJ of Asian jlnflucnea vaccine ksas been re- leased tfir6ugk3. November 6, This includes 6,190,679 m1 released aince 0s.tobes. Xn t h i s l a s t releetse were 525,400 m2. 09 400 aca, vaccine and 371,925 ml of polyvalent vaccine,

Resub"e sf aeveral vaccine effectiveness studies are now avai lable. These studies agree f a i r l y we21 . b b t one mZ of the 200 cca vaccine will prevent iMluenza i n about 45 t o 60$ of persona otherwise expected to develop the Itisease, The new 400 cca vaccine should prove even more ef fec t ive , Tnvestigators have noted that there i s a l s o a decrease i n sever i ty i n vaccinated cases, the disease being showct;er i n duration, Available i n f o m t l o n suggests that f a t a l cmplicat ions m y be decreased by vaccimtion,

ry of the internat ional spread of influenza shows that the crliseasrse i s n m afnz~aL wosrl&-t\etde, There i a some evidence of a second minor wave of Asian stra3.n influenza i n Japan, It b s a l s o been learned thwb Chitaw exgerienced a ddeopread o u t b r e a of Asian s t r a i n influenza during F a b m r y and Maarch of 1957,

- 3 .-

313, Influenza Map a d Table

Dur ing %he week Movember 5-12, new reports of' county influenza occur- rences came t o GDC from 23 of the L8 states. At l e a s t 1255 count%es, o r kl$ of the 3068 United States counties, have not$ experienced outbreaks of influenza or, a t b a s t , confimed cases of Asian s t ra in influenza. Large increases week have come from North a d South Dakota, Wisconsin, Ohio, Iowa, Washington, Nebraska, Tudssowi, Kentucky, South Casof ina , .and Virginia. ?be South A t h n t i c and TJest Norm Central states have thus reported most heavily lclusine the past week. This is in accord t s i - t k the weekly inf"Jut3nsa and pneumonia m o r t d i t y data published elsewlaere i n ithis report which also show l a rge rises in maortality in these two div i s ions* With the ad&tion of North Dakota this week, all. states have now been xffec'ted by the epidemic. Haine azld Rhode Island remain the only states repvting all counties involved. Fourteen sla-kes, however, representing a U major gleograpwcijl diTnsions ex- cep% the West Horth Central, have repar-bed well over 5% a f th&r counties affected,

Tabulation of Influenza Outbsedks o r Confirmed Sporadic Asian S t ra in Gases i n the Continental United States

June throuph Rovember 12, 1957

blab 67 19 Arizona 14 8 Arkansas '7 5 33 C a l i 2 ornia 58 44 Colorado 2 1 Comecticut 8 LT s l a ~ ~ ~ a r e 3 Dm C* ---. F l o r i d a 67

xxparadic: confirmed cases -- Cos* not h

Nebraska 9 3 33 Hevada 37 - ,*t. New Nmpsure 10 2 New Jersey 2 2 19

North Dakota

Rhode Island

Virginia Washington West VirginLa Wisconsin

61% r Current A

Table L

Curren'c Influenza and Pnemoda Deaths in 108 U&..ted S taLss Ci%i.ea

Nwbsr of Cities DSdabon

46.4. The number of deaths given includes estimates f o r cities not reporting in a given weekr The tab le I s corrected far preceding weeks as l a t e figures are received. The chart will be corrected only Tor gross diserepanciesr

For the ne%ion as a whole, the number of pneumorda and influenaa deaths showed an increase over las t week of ten percent* Last week the number or" deaths had increased by twenty-four percent over the preceding week* This may be an indicat ion that the ep idedc peak i s a t hand*

The northern t i e s of s ta tes , [\Sets England, P41ddle Atlant ic alad East North Central, which l a s t week emeriencsd a steep increase, now shows a def in i te down- ward t m r The: tJesS North Central. Btates, however, continue to r i s e r The SOU%&- ern t i e r o f s ta tes , South Atlantic, East South Central and Vest South Central, a l so shew a mmlced increase, The PIountain and Pacific s ta tes are relatively stable: the Mountain s t a t e s have decli.ned t o normal levels, while the Pac i f i c showed a slSghL increase,

*prepared by %he S ta t i s t i c s SecWon, CPC.

WEEKLY PNEUMONIA AND INFLUENZA DEATHS

t -c----

# # *EPFMMIC THRESHOLD*

/ - 'NORMAL INCIDENCE'

f5FF fX&dNdTl# O& BACK 5F SHEErl

a EPIDEMK

UNITED STATES, 108 Clt16s 1.

w . I . . . *,, 1 . . . . .

-i . *.. .*..... I

NEW ENGLAND, 14 CHIm -ST SOVTH CENTAIIL, B Cltlm

MlDOLE ATUKSIC, t? Cltlm WEST m CENTRAL, 43 CHrm

4 EAST NORTH CENTRAL, 18 CEfFss

WEST NORTH GENTRAL, 9 Gltlw. , ,j PAC!FIG, I2 C t t h

I n t e r p r e t a t i o n o f "Epidemic Threshold"

I f two succes s ive weeks i nc idence i n exces s o f the "epidemic

t h r e s h o l d H Is de f ined as a "run of two", t h e n wi th "normal inc idence"

a "run o f two" will be uncommon, When inc idence exceeds normal l e v e l s

a "sun of two" w i l l be more l i k e l y t o occur , S p e c i f i c a l l y , wi th normal

i nc idenceF t h e odds a g a i n s t one o r more "suns o f two" d o s i n g a pe r iod o f

52 weeks a r e f o u r t o one, If i nc idence i n c r e a s e s above normal by tw

s tandard d e v i a t i o n s t h e odds a r e even t h a t a "run of two" w i l l f o l l o w

immediate1 y,

A d e s c r i p t i o n o f t h e method used i n c o n s t r u c t i n g t h e charts i s

given i n Influenza Survei l lance Report No, 16,

Ci.tSes s i ther coult;indn,g to report excess i n f l u e n ~ a and pneumonia morta i ty , or showing a marked increase are as follows:

Week Ending Oc~tobs3s 26 November 2 Movenber 9

West North Central Xowa ( ~ e s ~ o i n e s ) Kansas (2 c i t i e s ) Nimesota (2 Cities) Missouri (2 Cities) Nebraska maha ha)

S outh Atlantic Atlanta, Gas Baa timore, Md, Norfolk, V a r

East South Central Lo~3.sviLls~ Kg, Telvness ee

Memphf s Chattanooga

West South Central. Slareveport, Texas

Aus=bin Hous ton S a n Antonio

In las t week's report It was s ta t sd Lhat CDC d33. change its neth hod o f reporting serology t i ters for influenza, Titers w%II be reported i n terms of h n i t i a l dilution* D r . Kalter of CDC Diagnostic and Mathodology Unit aL Chambaeel Georgia, inform; us %ha% h i s lab has been reporting in terms of' i n i t i a l d i lu t ion for the past f ew yews, and no change w i l l be necosswyr

V Inda~s t r i a l Absent9 tes fop 36 Cities of the United St&*

(compiled from a number of sources)

a = normal absentee ra te UP =5 increased absenteeism NR = no rate available

"ata not available

V * I n d u s t r i a l Absentee Data

Industdd absentee data a r e now essen t i a l ly complete f o r t he 36 raporL9 i n g c i t i e s Wzrsu~h November 2, Additional f igures f o r some previous dates have enabled us t o revise the columns f a r t h e last two weeks of October, It w i l l be noted that 1 2 c i t i e s showed increases i n absenteeism f o r the f i rs t time during the period October 13139* These c i t i e s included S e a t t l e J Zoa hge les , Oklahoma City, Kansas Cityr S t . Louis, Cmalna, a d liinneapolis i n addition t o those on the unrevised t ab le in CDC ~nf ' luenza Report 23, Betiween October 20-26, Riehond, JaeksonvilSe, Hew Orleans, and Sm Francisco reported first increases, and onlyhmpMs noted a Sirs% increase between October 21- November 2 , It i s i n t e r e ~ t i n g that h1m Orleans has increased i n d u s t r i a l a b m senteeism after a long period of nomalcy, The c i t y experienced an e p i d d c aC Asian sLrarin f d l u s n g a I n l a t e strmnler. X f the increase i s due t o influ- enza i t ; may represent a se~ond minor wave in tha-b areal It should a l s o be noted that Denver has returned to a noma3, r a t e after a month 05 increased absenteeism* Through November 2 every reportxing e i % y had emerienced i n - creased industrial absenteeism except Wichmi *

Influenza Vaccine Prpducti.on and Distribution Influenza Vaccine Released

( ~ s t ; a l s through Povsmber 6, 1957) LOO cca 290 cea K onovalent, PI onovalen% Po lpa len% w i t h

PharmaceutPeal Concern Asian strain Asian s t r a i n uI-.c

A ~ i a n s t r a i n

Llederle Bjo31,830 m5 537,950 fi Lillry 2,1L6,717 286,000 herck, Sharpe & Dohme S ~ S J ~ O O nil. 13,473,220 National Drug 6,8983370 2 054;435 Parke, Davis 5'f37373.0 Pi tman-PIosre 5,015,242 829,835

Total released t o date: h0,382,719 Amount released since October 31: 6,190,679 m l

Estimated Vaccine Production:

November December

VII, Summaries of Vaccine Effectiveness Stu-

Patuxant, Naryland --(By D r , Joseph Bell, MIH, e t a l e ) Fifty-five volunteers, aged 21-57, a t the Maryland Sta te Board of Correc- t i o n ' s Patuxent I n s t i t u t i o n were given a nssaJ spray a2 inf4uenea virus mater ial . The v i rus had been obtained from three Boy Scouts a t the 1957 Jamboree, Laboratory s tudies indicated t h a t no disease producing ~rgents a t h e r than influenza virus m r e present i n these specfmens, Past of the group of volunteers had prew=Eousby been inoculated with co~yzercially pre- pared inPluenxa vaccine, 200 cca units given intramuscuParJly approximately 2 weeks before challenge, The r e s u l t s i n the tab le below indicate s 4h.98 ef fec t iveness i n t h i s study.

Number Nmber C hallsnged With Influenza

Placebo 23 18

Vaccine 32 I4 -- (Dr, Fred kl, Davenport, Director

The C o d s s i o n on Influenza of the Armed Farces E p i d e ~ o f o g i c a l Board has .obta%ned the following spec i f ic information regarding the effectiveness 04 vaccines against t h e current epidemic of Asian f l u ,

The vaccines were prepared by commercial firms aceordiw t o formulae requested by t h e Commission f o r these s tudias which were begun on mi l i t a ry pos ts at the end of July when only l imited amounts o f vaccine could be obtained and t h e i r potency was i r regular . Dr. Fred M I Davenport, Director of t he Commission on Influenxa, bore the major respons ib i l i ty i n procurement of these preparations f o r coordination of the f i e l d studies, and f o r the extended s tudies of t he antigenic e f f ec t of d i f fe rent concentratiana of v i rus , Except aa noted, 1 m l of' vaccine was given subcutaneously.

For t Ord, Cal i fornia - Influenza was already prevalent a t the t h e vaccination with 250 cca un i t s began. Based upon the number of tnen who ~ e p o r t e d t o the Dispensary with aeutis respiratory flllness ten d&ye o r more a f t e r vaccination, Doators Culver and Lennette have estimated &ri effective- ness of about 42 percent during the month of Augusta

For t Bfx, New Jeraeg - Dr, Harry Rose and h i s associates began. vacci- na t ion on August 1 w i t h two d i f fe rent preparations of vaccine, Beginning t h e second week a f t e r hocu la t ion , the r a t e of admissions f o r all respira- t o r y disease f o r t h e next f ive weeks averaged 12.4 per 1,000 among those receiving 200 eca uni t s , 10,9 among those receiving 750 cca uni ts , and 26.6 among the controls, an estimated effectiveness of 53 - 53 percent*

-#hen vaccination was 5.nitfa;llg carr ied out a t the end of July, there was no evidence of the prest3nce 02' influenza but it appeared i n the t h i r d week of September, Dr* Gordon N m Meiklejohn and h i s assoc ia tes h s ~ e a n a l y ~ e d the szbissians t o hospi tal f o r acute res- p i r a t o r y dieease from September 14 to the present ( ~ c t o b e r 13) fo r those

:.-vrrocfina%rd with"oaccbe of 200 cca u n i t s axla from the control group* There is samewhat less than B one t o three r a t i o i n favor of the vaccfnatad, or an e a t h a t e d effectiveness of 60 percenit, On Ssptsmber 24, when influenza had alrsadg become prevalent* several groups were vaccinated d t h vaccine preparations con%ahing e i the r 400 cca u n i t s of A s i a n virus or no Asian d r * u S . I n t k s first Len days a f t e r vaccination no sigrdficant d2ffesences were observed betwen the groups but fn the subsequent per3.06 the r a t e o f adds- sions t o hospi ta l has been fm Sines as high isl those receiving Type B o r cr%her control vaccine as %n those racer2v%ng Ct0O cca units of Asian virus, e i the r alone or in polyvalent preparations. This suggeats an effect ivaness of about 75 percent.

Great Lakas Naval Training Center, I l l i n o i s - Ths Surqeon General, Uni t@d Sta tes Baw. has provided information concern- the r e s u l t s sf s tudies carried ~&*under - the direct ion of Lt. ~omander 0. F, G u n d e f f i ~ a r , Jr.

Three-foufihs of the m;en recaiving Asim virus vaccine wrs vaccinated subcutaneously wAth a 1 cc dose o f 2W cca d t s on August 10 and t h e semsinder raceived the vaccine intracutaneouau i n a O,l m l dose, Their exwrfence has not been analyaed separately as ye t , St i l l . other groups seceivsd e i the r a polyvsaben% vaEcfne of 750 cca unfts of 3956 fa5mla without A s i m virus, or a control material, Dr. Gundelfinger repor ts t h a t influenza appsassd in epidemic proportions during the week ending October 5 md has continued through the week ending October 12, The average admission rate f o r the two weeks was 70,2/L000 i n a placebo vaecfna?ted group, 28.4 h a group n'eceiurling monov&sn"t~"isian virus, and 3Bs7 i n a group seceiv9ng t h e 1956 polpa len t f ornula vaecLne. The estimated effectiveness of t h e mono- valent vsceine was about 59.2% a3ld of the old formula polvaepl2, vaccine about, &,$, according Lo the data obtained d u r l ~ this ahor% h t e s v a l .

&though the studies are incomplete, t h e trends are surfPci lsntu dis- tinct t o %nd%cate the f"jlna2 effects which may even be increased when labora- to ry studies identify and remove cases caused by other respiratory disease agents which are so common in recrui t s , They emphasize, too, t h a t vaccfm of 286 cca units provides somewhat less than sptlrnal resul t s .

Amen* A: CW: Influearn Sumeillaace Beport No. 25

8upplmentsry ReparZ;: International Spread of Asian Stmini ~nslukree Tbraa@ bctober 31, 1957

By F. 2. &m, M. D*

(9ee CM: Influenza Report Mo. 8, &Le ry; Reporb No, 15, Append5.x C, First Supplaenkry Regart; and Report No. 21, Appenajx A, Second h m l a e a a r y Rego*, )

IEpidemAc Asian atmrn InPluena;a is now abost world-wide 2a distribution. O n l y a few f aobted lslands and areas have been untouched by the ~ a a n d a f c . I n c a - plste re-gorting I s u-sldoub%eUy resppmaible for scame of the, rked areas on the Influenza 3nag appeahd t o t h i s repox%,

Xnffomlion awihb3,e gb Dc%ober 31, 1957, on W3e world-wide sp-rea izad in the outline below, Much CPP the la9

GZon reviewed refers t o the Late Aulgust-Septabes perfad ralher than t o the three- week period since the secona supple~entary repark appeared. It m a t be recognized %ha% much of the infomtlon -In tbia report is incomplete sna gre1higbp.m in na-bure?. A emplete picture of the intermtiom1 spread of %he dgsease w i l l not be a ~ i h b l e until. wel l a f t e r the! pandembc bas ended.

A listing of sources of the i n f a m ~ t i o n repmduced in this s ~ a r y i a - a g ~ e d c d ~ These sources have been used nat only for the present rerport but also for the pre- ceding supplementary reporles .

OPE

During October epidernlc influenza conklnued d Belgium, Switzerland, -8 Wales - Greece ,

t;s were reported about t of October i n Sweden, and Norway reported only scattered local outbreaks, Inowever, b r i n g the ea r ly part of the montb.

Same data from the Weekly lnPluenzsa 8tatenen.t for England and Wales, grewred by Dr. FJ, H. Bradley, lvlinfstry of Hedth, Londoa, are presented below:

Dea;ths f r a I&luenaa and Prmemonia in 160 Ore8.t Toms of &@and and Wales

Week Endlfng No. mluenw Deaths

Age Itis-tribnztian of' Influenza Dea't;Bs Report;ed for the Week mang October 19, l957 far =the 160 Great Tarns

&E less than Jb 5

1-4 7 5 -14 3-5 152.25 22 25-34 22 +a e;.#45 33 g5-54 66 55-64 123 65-71, 176

'j'$ an& aver - 130 Total : 608

A g ~ e m t e Totals A.w the ileek Ending August 24 though the Week &bin&. October 26 for %be 460 Great Ile"1.m~ for 1957 and %he Four Fsrevievurs %ears:

Year ---ICL-

No, Pnemonirjl Deaths No. $n%luenza Deaths ~ 9 5 3 1362 53 1954 ~ 4 2 5 42 1955 1517 kt3 19% 1638 43 3.957 3507 2495

8a, October 7 the firs$ iasbtieas of Asian istaraia virus were reposlced from GreLand end Fls73andl. 312 early October the influen- epfdmic i n Frrkey' was *par- ----- -- /__- If . -- ..,*."""-- eutly de,-.2ir,ir,[;. ___. Bulgaria _I_ reported the onset of egi&aic infhenza in "ce cauntry about, -the third week of Septenber .

In R r s ~ i a , . -, .. .-- according Ice a reparb of October 18, Asian strarLn inflx~enza teas epi6emic r:. 7 ~ ~ l ~ > c s ~ : ~ > ~ i dl~r ing %he ~ a 6 U e of October. Many schsals e.nd e~%cr:taiment places wcrs ricnod. W vaccine was ~zwilaZi,je huL in sllorf; si~;?pIy, Xn uzher parts of tiae ccuntry, e.t a%f>'t.bt the same t i m e , in2Xuenza broke o\;."i;yrWriJiy in urban a:f,cd.s and alonb the psincipa? liazes of comunl,cs"r,ian, As-ial;ic Russia, including S i b c i a , was reported 4x3 be affecte4 at; the end 02 %he month,

By the f i n a l week of October a l l sections o f -.= Cam+da *- were more or less involved by Asia2 s+rak -tcfl-~~~;.lrsn. Confirzosttiona have Seen rt::,orter2" fim many locali t ies . In genezcl, eo: i u C'a!i~,& hes thus far been m::e hewi ly affected than the ~t%tern provinces. W.'-c:3s$read epidem;lc inPluenza has been reported from Prince Edward Island, Eova Scotia, New Bmnswick, Quebec, and Ontarfa, while only local and sca t tered outbreaks have so Tar been reported Sasbt&ew~m, Alberta, ~lanitoba, British Colclmbia, and North 1JesL Territories,

Quatanah, and Mexico were rela"t;i.creLy free of e p i d a i c Asian s-train ind"1uenzsa by the end of September, Costa Rfea and Sac Salvador were s t i l l irtuohed. in early October. British Hondums and N i c a m w Wve apparently not; been heavily Involved by the disease t o date,

The mador epidemic i n N e d o Rico passed its peak a-na subsided slowly during October. A large prspo~Aion of the S s h n d 1 s populallon ma affected. Xn the Virgin Islands the? first l o c a l catbreaks of inf1uenzs were noted in the bast we& oP September, Asian s t m i n virus has not yet been reported as identSfIed from the Is lands , Cuba also, experlenced only local outbre&s 09 b ~ l u e n z a durlng October. -'

Qnly %std.nime and Janaica have 13xperlenced fsbnd-wi8e epidemics i n scidd-t;lon Euerto RZco, The *rtInique e g i d a c shr?ced i n the last week of' Septaber;

that i n Jamaica about October 8, i n the Kingstan area, when e, amber of school ouL- breaks aelcurred. The fslrst Jamlean outbreak ~sas reported i n the la& neelr of Sep- t enber i n ia boarding school in a rum1 area* C2hiZdren a% the school had came Prom ~03,lamd via France and Maikf, frore Veulemela, from. !.&inidrta, and Amh.

Spread o f epidmic influenza continued 331 South h e r l a &sing September and October, although the countries heavily affecked during o w s r mantbs @hiae, Argentina, Urnmay, and ~ol~vis) were? essenkially free of' the ilisesse,

Ecuador, which also bad aheady experlenced an epidemfc, reported new an%- breaks o f influenza--strain undeteMned--in .m.ld-5eptaber, The s itmation resea- bles t h a t i n Japan, where a minor "second wave" of Asian sdrain irUe1uenm has Been detected %his fall..

Brazil reported the onset of ;an epldmie at %he end 0%' September In %he RTa de Janeiro area, with spread %bou&ou,tp the country by early October, By Od=%ober 2, RZo Janeiso hala estimated that s m e 5Q0,OOa cases bad occurred i n the cfLy,

Venezuela experienced widespread ep lda ic iMlzrenza during most of Septmber, French Guiam reporked only' Pew cases of 3nfluenza-lac illness by %Be end o f -her and Suri noted %he onset of an ep ida ie in latie Sep.Z;der.

B m w y note& the f irst i sutbrea3;rs of Z&Zuenze;t only fn la te Septabes and early October. To date no widespread epidenrie has appeared in t h i s count;ry.. The first epidemics in Peru were reported fran Cuzco and Rmo, i n the southern high- lands near Eolivfa, in late August. Spread nodh t o L%aa bad occwred by early September, and the whole country was involved during the month. A number of schoof~ w e r e closed Sn Lima beeauae 02' hi& absenteeisgl, and 20% @zxmnteeism was recs>rde.tl in sme industries during -$ark of %he epidemic perlo&.

Most of the counLTies of %he r\%ldaS.e E&s% were free of e p i d a i c Asian s t r a i n influenza by the middle of September. O n l y Israel (which has l i t t l e contact with tiha rest of' the Mdd3.e ~ a s t ) i.n@d f ~ e e of asease duping ~~~ The first isoht;ions of Asian strzzin v%ms Sn Xsmel were r@~oT"e;ed an;X.y on Sap%ern-

ber 30 ana an epidmlc was not i n progress until October 8.

Eh;hrein replorTted the end, of i t s epldemic in the farst week of Septwber, after an over-al l at%&& ra te of 25% a o n g the popflation of 30,QOY). - 3or&n, Traq, - *

S w a and Saudi Ambla were free af the disease by Late A u p s t or early 6eptaber, ".&--J II-

Many of the areas of Mrics , ineluding E m t , East Africa, and Soukh Africa, were f ree o f c;lpidenic idluenzs, By the firs% week of October, Sersreral countriest however, reported %heir first au%breaIcs or isoh%lons a% about this sme t a e ,

Ghana) which first emerfeneed egrderxlie influeam in mid-September, repor-tea v

L b L the egidemic was st i l l i n progress ea r ly i n October. N3geria reported de- cl ine I n sme areas by early Sep%ember, a f t e r a country-wide spread. -- Sierra Leone no.t;e& the firat bdluenza awt;breQ3?ca In the first week o f September. - Sudan sego3;rteCt deslabne I n early September and the country was free of epiaemic influeslza by the fJlr8-b week of October. ReunZon agerienced a n epidemic of influenza i n the th i rd treek of September, French CJes% Mxics has apgarently been only l i gh t ly affected --- excep-t; i n the , where there was a 30% &tea& rate and a considerabLe ex- cess marta i ly , reported the f l ra"esian s t r a i n virus %soht ians only on Oc%ober 3,

By early September every- s ta te of Aus"ta1ia had been af"fec.ted s i ~ i f i c a n t l y by Aaian s t ra in I&%uensa and the aSscaae ms everywhere on the decline. In -- New Zea- land, also, *he epidemic was dxopping o f f sharply during September. - ANTbBCTXCA

Cn October 22 a report was received of au%bre&a of i&1.uenzat-llke iL3ness among persome% a t M&rdo Sound, Asian s t ra in vims has not been identif ied as responsible Pos the sutbredcs, which occurred soon a f t e r the arrival of the spring supp3y ships and new personnel,

By the f i rs t week of October epidemic influenza hati aisappeare& Prcm most of A s h . A few areas were still i n %he period of epidemic decline an& i n J a p n a, rnfnor secona wave of the disease was appren%ly I r a progress. Asian countries no% mentioned below can be considered %a be easentlally f ree of epidemfc &$an strain influenza.

In - India the epidesslic had endea or sharply declined frr all s%a,tes excep;t; m a - chaL Bsrdesh by the Paurth week of September. In '6Jest ESa3.zist.an %he eprdemic was

---.-.I-

over By the f i rs t week of October; however, i n East - Palsistan aaay cases were s t i l l occurring a% " c h e end aP Septaber. Thailand, which experie<ced a slow epidemic decline, was f ree of influenza say on September.20,

l lhe following notes are frm the FsEO Influenza Epidemic? Mema of 24 S q - tmnber. In a paper given a5 the Third 1nd;ernsntional Meeting of Biological Stan- dardrizallora, Opait;iJa, 2-6 September 2957 , by Tang Per-Fan and Usng Yuw-Ken ( "An.t;igenic Studies of' Influenza Virus f salated frem %he 1957 Epiderpic Zn ~hlm.'", it a s noted that a widespread e p i d a i c of SnPSuenza occurred In -8 China involving

p r a c t i c a l l y the whole country, Influenza viruses (~sian st ra la) were isolated in Peking, Cbang-Chia-K~w~ 50-Yang, anC3 Chngehun. A s-1;rain of virus obtained frm D r . Tang was exmined at the World XnfLuenza Centre and i&entif ied a s a ty-picial h i a n a t ra in .

X t i s evident t h a t the disease probably began a t the ens af Febsauary i n a SL2mited ares i n Kweichov Province between Kweiyang and Kutsing (in Yunaai Prcvinee), 1% spreadt, " in early b r c h , into 'dunan Province and, by the xni&&Le of March, was all aver China.

I n Korea %be epidemic was over by the end o f August, after an e s t m t e d P

2,700,000 cases had occurred. Jn fiorbb Easneo the end sf: the epi&ernic was repor%ed __I- duriag Lhe first week of Segterdber; and, on the Islana of E4auri.tlusp t;he end of tihe

epiEfezn2.c w s placed at abou6,the fireti o f October.

Irr - Japan, which experienced a mjsr Asian a tmin epldemlc between my and mLd-Ji.kly, a minor seeonid. wave of tihe dlsease appearea a t the end of September. During OcLober a number of local and scattered ou'tbreaks of' InSXuenzia occurred i n various parts of the country, Asian s t ra in virus has been Identtfled from at least a few aP -these ~u.tbre&s, though try no means f r m all, Aslan s t ra in influ- eraza had apprentfy disappeared frcm Japan i n l a t e July or early A u s a t .

Sources of inf orm~tion Include :

3.. World EXea3th Or@nization FJeekly Qidemiologlwl Records.

2, Norbid-lty an6 rJlo*lity Reports, Natioml. Wfice of V f h l S-t;atisLics,

3. Xnfluenza Epidemic Memos, Dr, A. M.-M, hynt3, Chief, Sectfan af Endem- epidemic D%sease, WHO.

4, Dispatches from the major w5re s e w 2 ces,

5, Personal ccmmunicallans.

6 . Foreign Qide9llolagicsl S Ebxi of the U* I3Aa.c IIealth b%?mce *

7 , International Cooperation Administration Influenzs Reports.

8. weekly ~ e p o r t , Influenza in Canada, ~ r . E. H. bss ing , Chief, Epidemiology Division, Deprtment of Natlanal Health and hfelf%re.

9. Weekly Influenza Statement for hg l andand Wales, Dr. W. H. Bradley, finistry of Eealth, London.