CENTERS FOR DISEASE CONTROL July 10, 1981 / Vol. 3 0 /N o . 26

International Notes317 Dengue — Cuba

Surveillance Summary318 Rocky Mountain Spotted Fever —

United States, 1980325 Tuberculosis — United States, 1980

MORBIDITY AND MORTALITY WEEKLY REPORT

International Notes

Dengue — Cuba

On June 28, 1981, the Ministry of Health of Cuba reported to the Pan American Health Organization that an epidemic of dengue was occurring in 4 provinces including Havana. The Ministry stated that between May 29 and June 28, 79,000 cases of dengue­like illness were reported, 61,000 from the city of Havana and Havana province. There have been 31 deaths (26 children and 5 adults) as a result of hemorrhage and shock. The virus was identified in Cuba as dengue type 2 by fluorescent antibody and neutralization testing. This type of dengue has not been reported from Caribbean countries other than Cuba in 1981. No hemorrhagic manifestations of dengue have been reported from other islands in the Caribbean.

Dengue type 4 has recently been detected in Dominica, St. Martin, St. Barthelemy, and Guadeloupe. Outbreaks on these islands have occurred in the period March-June 1981 (/).Reported by M in istry o f Health. Cuba; Pan American Health Organization, Washington, DC; Carib­bean Epidem iology Centre, Trinidad, W l; Vector-Borne Diseases Div, Center fo r Infectious Diseases, Quarantine Div, Center fo r Prevention Services, CDC.Editorial Note: Dengue has been endemic in the Caribbean for several years. However, at no time has dengue type 2 been associated with dengue hemorrhagic fever (DH F) or dengue shock syndrome (DSS) in this area. The diagnosis of these infrequent complica­tions of dengue is based on the following criteria: 1) a positive tourniquet test (20 or more petechiae/in2 of skin); 2) hemoconcentration (an increase above normal hema­tocrit of 20% or more); 3) thrombocytopenia (platelets less than 100,000/mm3 ); 4) in the case of DSS, frank hypotension or narrowing of pulse pressure to < 2 0 mm Hg. Hepa­tomegaly has frequently been associated with D SS cases in Southeast Asia.

Prompt treatment of patients with DSS, the most severe manifestation of DH F, with rapid volume replacement through intravenous electrolyte solutions, plasma, or plasma expanders can reduce the case-fatality ratio from 10%-20% to 3 % or less. Attention should also be directed to correcting acid-base abnormalities.

Travelers to the Caribbean can reduce their risk of acquiring dengue by remaining in well-screened areas when possible. Outdoors, exposure to mosquitoes can be reduced by wearing clothing that adequately covers the arms and legs and by applying mosquito repellent.

Reference1. CDC. Dengue type 4 infections in U.S. travelers to the Caribbean. M M W R 1981;30:249.

U.S. D E P A R T M E N T OF H EA LT H A N D H U M A N S E R V IC E S / P U B L IC H E A L T H S E R V IC E

318 M M W R July 10, 1981

Surveillance Summary

Rocky Mountain Spotted Fever — United States, 1980

For the fourth year in a row, the incidence and numbers of cases of Rocky Mountain spotted fever (R M SF ) in the United States have remained relatively constant. A pro­visional total of 1,156 cases of R M SF were reported to C D C for 1980. This number slightly exceeds the 1977 record total of 1,153, although the overall incidence based on 1980 census data was lower (0.51/100,000 population vs. 0.53/100,000) (Figure 1).

The South Atlantic states accounted for 709 (61.3%) of all reported cases. The inci­dence of R M S F was highest in North Carolina, which had 5.46/100,000 population (321 cases), followed by South Carolina (4.52/100,000; 141 cases), Oklahoma (2.55/ 100,000, 77 cases), Maryland (1.83/100,000; 77 cases), Virginia (1.80/100,000; 96 cases), Tennessee (1.33/100,000; 61 cases), and Georgia (1.10/100,000; 60 cases).

States submitted case-report forms on 924 (79.9%) of all the reported cases. Of these, 567 (61.4%) were confirmed by Weil-Felix agglutination, complement-fixation (CF), or micro-immunofluorescence (M IF) techniques. The age distribution (52.8% less than 20 years old), male/female ratio (1.75:1), and race (86.1% white) changed little from 1979. The case-fatality rate rose in 1980 from 3.1% to 4.7% (Figure 2), with the rate for blacks rising from 7.0% in 1979 to 10.7% in 1980.

The incidence of R M SF was highest in May and June; 94.7% of the patients became ill between April 1 and September 30.Reported by Viral Diseases Div, Center fo r Infectious Diseases, CDC.Editorial Note: Reported cases and incidence of R M SF have remained about the same since 1977, after a sustained climb from a low of 0.11/100,000 population in 1959 (7). Age, sex, race, and the locale of R M S F have changed little in the last several years. The case-fatality rate has fluctuated between 3 % and 8% since 1970. The 1980 case-fatality rates for blacks and persons > 4 0 years old are similar to the rates for the period 1975-78, suggesting that the low rates in 1979 were unusual. Persons at highest risk of death were

F IG U R E 1. Rocky Mountain spotted fever, reported cases per 100,000, by year. United States, 1955-1980*

*1980 total is provisional.

Vol. 30/No. 26 M M W R 319

Rocky M ountain Spotted Fever — Continuedin the age group 30-39 years old (11.7%), again showing that while young people get R M SF , relatively more older adults die from it.

Reducing the mortality associated with R M SF requires early diagnosis of the pre­senting symptoms of fever, headache, rash, and myalgias in persons who have a history of possible tick exposure. Lack of known tick exposure, late onset of rash, and gastro­intestinal complaints are more frequently associated with fatal cases (2). Serologic con­firmation of the clinical diagnosis is not possible until day 10-14 of illness.

C D C has changed its case definition for R M SF in 1981 because new serologic methods have been developed and made available (3). A clinically compatible case with "d iag­nostic" titers obtained by Weil-Felix (Proteus O X-19 or OX-2) will only be considered a "probable" case. A clinically compatible case with diagnostic titers obtained by the more specific and sensitive complement fixation (CF), indirect fluorescent antibody (IFA ), indirect hemagglutination (IHA), latex agglutination (LA), or microagglutination (M A) tests will be considered a "confirm ed" case (4,5). Patients from whom the causa­tive agent is isolated or who have positive fluorescent antibody staining of biopsy or au­topsy specimens (which should be done only in laboratories experienced in these tech-

F IG U R E 2. Rocky Mountain spotted fever, death-to-case ratio. United States, 1970-1980*

* Based on case-report form data; 1980 figure is preliminary.

320 M M W R July 10, 1981

Rocky Mountain Spotted Fever — Continuedniques) will still be considered to have "confirm ed " cases.

Since ticks must be attached for several hours before they cause infection, the only preventive measure available for persons who are likely to be exposed to ticks is to check for them frequently. Ticks can be removed by pulling slowly and steadily with tweezers or fingers protected with facial tissue; by covering the tick for several minutes with petroleum jelly, finger-nail polish, or isopropyl alcohol to ease removal (6 ). An ti­septic should be applied to the bite site to prevent infection. If the tick was touched with bare hands while being removed, the hands should be washed thoroughly with soap and water, because tick secretions can be infective. Although a vaccine is currently being developed, it is not expected to become available in the near future.References1. CDC. Rickettsial disease surveillance. Report no. 1, 1975-1978. Atlanta: CDC, 1979. (DH EW

publication no. |CDC]79-8379).2. Hattwick MA, Retailliau H, O 'Brian RJ, Slutzker M, Fontaine RE, Hanson B. Fatal Rocky M oun­

tain spotted fever. J A M A 1978;240:1499-503.3. CDC. Rickettsial disease surveillance. Report no. 2, 1979. Atlanta: CDC, 1981 (In press).4. Hechemy KE. Laboratory diagnosis of Rocky Mountain spotted fever. N Engl J Med 1979;300:

859-60.5. Philip RN , Casper EA, MacCormack JN, et al. A comparison of serologic methods for diagnosis

of Rocky Mountain spotted fever. Am J Epidemiol 1977;105:56-67.6. CDC. Ticks of public health importance and their control. Atlanta: CDC, 1978. (D H EW publica­

tion no. (CDC]78-8142).

T A B LE I. Summary — cases of specified notifiable diseases. United States[Cumulative totals include revised and delayed reports through previous weeks. 1

26th W EEK EN D INGM ED IA N

1976-1980

CU M U LAT IVE, F IR ST 26 W EEKS

D ISEASE July 4 1981

June 28 1980

July 4 1981

Junt 28 1980

M ED IA N1976-1980

Aseptic m eningitis 135 150 112 2 .0 0 3 1 ,7 6 9 1 ,238Brucellosis 6 2 3 79 84 84Chicken pox 2 ,2 2 5 3, 302 2 , 593 1 59 ,9 4 2 147 ,7 6 7 1 47 ,7 6 7Diphtheria _ _ 2 3 2 44Encephalitis: Prim ary (arthropod-borne & unspec.) 15 17 17 377 299 302

Post-infectious 2 2 4 45 100 107Hepatitis, V iral: Type B 399 388 294 9 ,9 4 8 8 ,3 6 5 7 ,556

Type A *78 510 558 1 2 ,6 1 3 1 3 ,4 5 5 14 ,581Type unspecified 231 205 174 5 ,6 5 4 5 ,501 4 , 4 2 7

Malaria 25 66 14 659 919 279Measles (rubeola) 55 410 553 2 , 3 4 7 1 1 ,6 3 4 2 1 ,2 3 2Meningococcal infections: Total 57 42 37 2 ,0 8 1 1 ,575 1 ,3 9 4

C ivilian 57 42 37 2 , 0 6 9 1 ,5 6 4 1 ,338M ilita ry - 12 11 13

M um ps 50 116 319 2 , 7 1 4 6 , 4 9 8 12 ,0 1 9Pertussis 15 33 28 498 557 557Rubella (Germ an measles) 33 108 183 1 ,461 2 ,8 6 4 9 , 8 9 3Tetanus 1 1 27 30 30Tuberculosis 506 632 633 13 ,361 1 3 ,3 0 4 1 4 ,3 0 2Tularem ia 9 6 3 96 76 63T y p h o id fever 12 10 10 234 181 181T y p h u s fever, tick-borne (R ky. Mt. spotted) 74 87 46 510 405 357Venereal diseases:

Gonorrhea: Civ ilian 18 .565 19, 502 19*150 4 8 4 ,7 0 4 4 7 1 ,7 4 7 471 ,747M ilita ry 603 564 443 14 ,3 3 4 1 3 ,3 2 0 13 ,4 9 3

Syph ilis, p rim ary & secondary: C iv ilian 515 520 416 14 ,8 2 3 1 2 ,9 0 7 11 ,9 9 2M ilita ry 2 9 5 180 160 153

Rabies in animals 103 142 63 3 ,5 9 1 3 ,3 9 2 1 ,5 7 2

T A B LE II. Notifiable diseases of lot» frequency. United StatesCUM. 1981 CUM. 1981

A n th rax - Poliom yelitis: Total _

B otu lism (Id a ho 1, Calif. 1) 31 Paralytic _

Cholera 1 Psittacosis (M iss. 1) 58Congenital rubella syndrom e (Va. 1) 5 Rabies in manLep rosy (N .Y . C ity 1. III. 1, Haw aii 4) 109 Trich inosis 91Lepto sp irosis (M inn. 1) 20 T y p h u s fever, flea-borne (endemic, m urine) (Tex. 4) 20Plague 5

A ll delayed reports and corrections will be included in the fo llow ing w eek 's cum ulative totals.

Vol. 30/No. 26 M M W R 321

T A B L E III. Cases of specified notifiable diseases, United States, weeks ending

July 4, 1981 and June 28, 1980 (26th week)

REPORTING AREA

ASEPTICMENIN­GITIS

BRU­CEL­LOSIS

CHICKENPOX

DIPHTHERIA

ENCEPHALITIS HEPATITIS (VIRAL), BY TYPEM ALAR IA

Primary Post-in-fectious

B A Unspecified

1981 1981 1981 1981 11

____

____

____

___

1981 1980 1981 1981 1981 1981 1981CUM.1981

U N IT E D S T A T E S 135 6 2 , 2 2 5 - 3 15 17 2 3 9 9 4 7 8 2 3 1 2 5 6 5 9

NEW E N G L A N D 7 I 3 9 3 - - - 1 1 8 3 8 2 3 6

Maine 2 - 16 - - - - “ “ 1 “ 1

N.H. - - 8 - - - - - “ ~ 3

Vt. - - 3 2 - - - - - - 1 “ - 2

Mass. - 1 1 6 1 - - - 1 - 2 - 8 2 19

R.I. 5 - 3 3 - - - - 1 1 1 “ 2

Conn. - - 1 4 3 - - - r 5 — “ ~ 9

M ID . A T L A N T IC 8 _ 3 2 6 _ _ 4 7 - 76 6 8 2 0 4 7 4

Upstate N.Y. - - 1 3 9 - - - - - 15 10 4 1 21

N.Y. City 2 _ 1 8 5 - - 2 1 - 2 3 20 3 3 2 6

N.J. 3 _ NN _ - 1 1 - 2 0 18 11 “ 19

Pa. 3 - 2 - - 1 5 ; t 18 20 2 “ 8

E.N. C E N T R A L 10 _ 7 8 2 _ _ _ 3 - 4 4 35 16 2 30

Ohio 6 - 1 0 5 - - - I - 27 18 9 - 6

Ind. 2 - 7 0 - - - 2 - * 2 3 “ 6

III. - - 9 2 - - - - — 6 8 2 2 9

Mich. 2 - 2 2 8 - - - - ” 8 7 1 9

Wis. - - 2 8 7 - - í r - — 3 1 "

W.N. C E N T R A L 7 1 2 4 8 _ _ - - - 31 2 0 15 - 1 9

Minn. - - - - - - - - - “ “ “ 8

Iowa 1 _ 5 2 - - - - - 1 1 2 “ 2

Mo. 3 - 2 - - - - - 2 7 18 9 2

N. Dak. - - 4 - - - - . ~ “ “ “ 1

S. Dak. - - 6 - - - — “ — — “ 1

Nebr. - - 1 - - - - - ~ 4 “

Kans. 3 1 * 1 8 3 - - - - “ 3 1 " “ 5

S. A T L A N T IC 31 1 2 3 0 _ 1 3 3 1 73 7 0 35 3 7 5

Del. _ _ 9 _ — — - - ~ 2 ~ 1

Md. 5 - 8 7 - - 1 1 - 16 10 11 1 16

D.C. _ _ 1 - _ - — — - 1 ~ ~ I

Va. 2 1 3 7 - - 1 1 - 9 7 7 - 11

W. Va. _ - 5 7 - - - - — 1 1 1 ~ 3

N.C. 3 - NN - - 1 1 - 6 6 1 1 7

S.C. _ _ 5 - - — - - 2 1 1 “ 1

Ga. I _ 3 _ - - - - 7 7 - ~ 8

Fla. 20 - 31 " 1 - “ 1 3 2 37 12 1 2 7

E.S. C E N T R A L 8 _ 8 _ _ 3 - - 13 20 4 - 4

Ky. - - 6 - - 1 - - 1 8 2 ~ -

Tenn. 5 - NN - - 1 - 7 2 1 “ ~

Ala. 3 - 1 - - 1 - — 2 6 1 — 3

Miss. - - 1 - “ - “ “ 3 4 ~ I

W.S. C E N T R A L 2 4 1 1 3 0 - - 3 - - 4 0 5 1 5 6 3 4 6

Ark. — — 1 - — - - — I 2 1 ~ 3

La. 6 _ NN - - - - - 13 10 17 - 2

Okla. 1 _ - - - 1 - - 8 4 I ” 4

Tex. 17 1 1 2 9 - - 2 “ “ 18 35 3 7 3 37

M O U N T A IN 4 1 31 - 1 1 - - 19 40 2 3 - 22

Mont. — - - - 1 - ” ~ 3 1 — -

Idaho - - - - - - “ — - 5 “ “

Wyo.Colo. 1 2 7 _ _ _ - - 2 5 3 - 11

N. Mex. - - - - - - - ~ 2 8 2 - 1

Ariz. - - NN - - 1 - - I 9 11 4

Utah _ _ 2 - - - - - 2 2 3 - 3

Nev. - 2 - - _ “ ~ 9 10 4 “ 3

P A C IF IC 36 1 7 7 _ 1 1 3 - 9 5 171 54 11 3 5 3

Wash. 3 - 4 9 - - - ~ “ 5 - I 19

Oreg. 2 - 1 - - - 1 ~ 4 8 - - 9

Calif. 26 1 21 - - 1 2 - 9 0 1 5 4 5 4 10 3 2 1

Alaska - - 1 - 1 - ” 1 4 ~ ' ?. 1

Hawaii 5 ” 5 -"

3

Guam NA NA NA NA _ NA _ _ NA NA NA NA 1P.R. - - 36 - - - - - 9 11 6 1 9

V.l. NA NA NA NA - NA - - NA NA NA N A 2Pac. Trust Terr. NA NA NA NA - NA - - NA NA NA NA -

N N : N o t notifiab le. N A : N o t available.A l l de layed repo rts a n d c o rre c t ion s w ill be in c lud e d in the fo llo w in g w e e k 's cum u la t ive totals.

322 M M W R July 10, 1981

T A B L E III (Cont.'d). Cases of specified notifiable diseases, United States, weeks ending

July 4, 1981 and June 28, 1980 (26th week)

REPORTING AREA

MEASLES(RUBEOLA) MENINGOCOCCAL INFECTIONS TOTAL

MUMPS PERTUSSIS RUBELLA TETANUS

1981 CUM.1981

CUM.1980

1981CUM.1981

CUM.1980

1981 CUM.1981

1981 1981 CUM.1981

CUM.1981

U N IT E D S T A T E S 5 5 2t 3 4 7 1 1 * 6 3 4 5 7 2 * 0 8 1 1 * 5 7 5 5 0 2 * 7 1 4 15 3 3 1* 4 6 1 2 7

N E W E N G L A N D - 7 2 6 5 8 4 1 3 5 1 0 0 5 1 3 0 2 3 10 0 1Maine - 5 3 3 - 2 0 3 3 27 - - 33 -N.H. - 4 3 2 6 - 12 5 1 15 1 2 35 -

Vt. - 1 2 2 6 - 6 13 - 4 - - - -Mass. - 5 4 4 9 1 3 3 3 5 - 39 - - 20 -R.I. - - 2 I 12 7 - 17 1 - - -

Conn. - 8 22 2 52 37 1 28 “ 1 12 1

M ID . A T L A N T IC 1 7 1 8 3 . 4 6 3 8 2 7 4 2 7 2 4 4 8 2 - _ 1 7 5 1Upstate N.Y. - 1 9 6 6 1 6 3 92 9 0 I 77 - - 7 3 -N.Y. City 1 5 3 1 * 0 4 6 - 4 5 71 3 5 6 - - 46 1N.J. - 51 7 7 2 - 6 4 5 8 - 81 - - 4 6 -Pa. - 4 1 8 1 * 0 2 9 5 73 5 3 - 2 6 8 - - 10 -

E.N. C E N T R A L _ 7 2 1 . 9 7 9 10 2 4 4 1 7 5 8 7 7 7 2 15 3 1 7 4Ohio - 15 2 5 0 4 88 6 5 3 1 1 6 - 1 I -Ind. - 8 86 - 36 31 - 89 2 8 1 1 3 -III. - 2 1 2 9 8 5 62 2 7 1 1 5 2 - 4 75 -Mich. - 2 7 2 2 5 1 54 4 0 1 2 8 9 - — 31 3Wis. - 1 1 , 1 2 0 - 4 12 3 13 1 - 2 9 7 1

W.N. C E N T R A L 2 10 1 * 2 7 0 1 96 6 7 _ 171 _ 2 75 3Minn. 2 6 1 * 0 3 9 - 33 18 - 6 - - 6 2Iowa - 1 2 0 - 18 7 - 4 0 - - 4 -Mo. - 1 6 3 - 2 8 3 0 - 27 - - 3 1N. Dak. - - - - 1 1 - - - - - -S. Dak. - - - - 4 4 - 1 - - - -Nebr. — 1 81 - - - - 3 - - 1 -Kans. - 1 6 7 1 12 7 - 9 4 - 2 6 1 -

S. A T L A N T IC 1 3 1 9 1 * 7 5 6 16 4 8 3 3 6 4 2 6 3 7 2 6 2 121 6Del. - - 3 - 4 2 - 9 - - 1 -Md. 1 2 7 0 5 34 3 4 1 71 - - 1 -D.C. — 1 - - I 1 - 1 - - - -Va. - 6 2 9 4 3 61 32 25 1 0 6 1 1 6 -W. Va. - 8 7 - 19 13 - 59 - — 20 -N.C. - 4 11 5 1 7 0 73 - 12 1 - 4 2S.C. - - 13 9 1 6 4 4 7 - 9 - - 8 1Ga. - 1 0 1 7 8 4 2 81 6 5 - 33 3 1 32 1Fla. - 1 9 7 3 4 4 4 1 4 9 9 7 “ 72 1 - 49 2

E.S. C E N T R A L _ 2 3 0 5 1 15 1 1 4 7 _ 6 4 _ _ 25 1Ky. - — 51 - 4 3 4 7 - 31 — - 14 -Tenn. - - 1 4 8 - 4 3 4 2 - 20 - - 10 -Ala. - 2 2 2 1 4 9 3 7 - 12 - — 1 1Miss. - - 84 - 16 21 - 1 - - -

W.S. C E N T R A L 33 8 2 8 9 0 3 8 3 5 6 1 7 9 1 1 5 8 1 3 1 2 5 5Ark. - 1 14 - 23 1 4 - 1 - — I ILa. - - 11 1 87 6 6 - 3 - - 9 2Okla. - 6 7 5 9 - 2 7 16 - - - — - 1Tex. 3 3 8 2 1 1 1 9 7 2 1 9 83 1 1 5 4 1 3 1 1 5 1

M O U N T A IN _ 32 3 6 1 - 71 5 8 3 98 2 2 6 5 1Mont. - - 1 - 6 2 - 5 I — 4 -Idaho - 1 - - 3 4 - 4 - - 3 -Wyo. - - - - - 2 - 1 - - 1 -Colo. - 8 17 - 31 14 1 4 0 - 1 27 -N. Mex. - 9 11 - 6 7 - - 1 - 2 -

Ariz. - 4 2 7 9 - 16 1 0 1 22 - 1 18 1Utah - - 4 6 - 5 2 1 15 - - 3 -Nev. - 10 7 - 4 1 7 - 11 - - 7 -

P A C IF IC 18 2 9 4 9 3 9 9 2 7 1 2 1 3 3 4 6 2 2 6 4 5 8 5Wash. - 1 16 6 I 52 38 - 1 2 9 I - 6 0 -Oreg. - 3 - 4 42 3 9 - 55 - - 30 -Calif. 18 2 8 8 7 6 3 3 1 6 8 1 3 4 3 2 5 8 1 5 3 6 2 5Alaska _ - 5 1 5 2 - 5 - - _ _Hawaii “ 2 5 - 4 “ - 15 - i 6 -

Guam NA 4 5 _ _1 NA 6 NA NA 1

P.R. 17 2 1 2 9 3 1 10 7 5 9 8 - - 3 3V.l. NA 5 6 - - 1 NA 4 NA NA 1 -Pac. Trust Terr. NA - 6 - - - NA 4 NA NA 1 -

N A : N o t available.A l l de layed repo rts a n d c o rrec t ion s w ill be in c lud e d in the fo llo w in g w e e k 's cum u la t ive totals.

Vol. 30/No. 26 MM W R 323

T A B L E III (Cont.'d). Cases of specified notifiable diseases. United States, weeks ending

July 4, 1981 and June 28, 1980 (26th week)

REPORTING a r e a

TUBERCULOSIS TU LA­REMIA

TYPHOIDFEVER

TYPHUS FEVER (Tick-borne)

(RMSF)

VEN EREAL DISEASES (Civilian) RABIES(in

Animals)GONORRHEA SYPH ILIS (Pri. Sec.)

1981CUM.1981

CUM.1981 1981 CUM.

1981 1981CUM.1981 1981

CUM.1981

CUM.1980 1981

CUM.1981

CUM.1980

CUM.1981

U N IT E D S T A T E S 5 0 6 1 3 , 3 6 1 9 6 12 2 3 4 7 4 5 1 0 1 8 . 5 6 5 4 8 4 , 7 0 4 4 7 1 , 7 4 7 5 1 5 1 4 , 8 2 3 1 2 , 9 0 7 3, 5 9 1

N E W E N G L A N D 2 4 3 8 4 1 _ 12 _ 5 4 3 0 1 1 . 9 3 5 1 2 . 0 3 8 11 3 2 4 2 7 7 13

Maine _ 23 - - 1 - - 2 2 5 9 0 6 9 5 - 2 4 7

N.H. 1 10 _ - - - - 17 4 1 3 3 9 7 - 10 1 IVt. 1 12 _ - - _ - 6 2 0 6 2 8 3 - 13 3 -

Mass. 17 2 2 0 _ _ 7 - 3 2 2 1 4 . 8 9 1 4 , 9 5 1 9 2 1 6 15 6 1R.I. 21 _ _ - - - 2 0 6 2 2 7 2 7 1 1 9 15 -

Conn. 5 9 8 1 - 4 - 2 1 4 4 5 . 2 1 3 4 , 9 8 5 1 6 4 9 8 4

M ID . A T L A N T IC 9 1 2 , 1 8 1 10 2 41 _ 9 2 . 5 2 8 5 6 ,9 9 9 5 0 , 8 0 9 7 3 2 , 2 3 8 1, 8 6 8 3 5

Upstate N.Y. 12 3 6 4 10 6 _ 2 3 9 3 9 , 5 8 2 9 * 3 1 2 - 2 0 7 1 5 3 2 6

N.Y. City 3 9 8 2 8 2 2 4 - 2 1 , 3 3 4 2 3 , 4 8 8 1 9 , 7 9 3 4 6 1 , 3 5 3 1, 2 3 3 -N.J. 3 3 5 0 1 _ 7 - 3 3 5 7 1 0 . 9 1 9 9 , 2 8 8 7 2 9 0 2 3 5 5Pa. 7 4 8 8 - - 4 - 2 4 4 4 1 3 , 0 1 0 1 2 . 4 1 6 2 0 3 8 8 2 4 7 4

E.N. C E N T R A L 5 4 1 . 7 6 0 1 _ 1 4 _ 1 7 1 , 5 4 3 7 2 , 8 1 2 7 2 . 5 7 6 14 9 6 3 1 , 2 2 3 4 6 1

Ohio 5 3 2 9 _ 1 - 1 5 4 8 7 2 5 , 6 2 2 1 9 . 3 7 1 6 1 3 4 1 9 9 3 7

Ind. 1 4 8 _ _ _ _ 2 1 5 0 6 , 6 6 3 6 . 8 8 4 2 10 5 9 5 39

III. 2 5 7 1 5 _ _ 6 _ _ 21 1 8 . 3 9 3 2 2 , 7 7 4 — 5 0 3 6 9 7 3 5 6

Mich. 2 4 4 7 9 1 _ 5 - - 6 4 5 1 5 . 6 4 1 1 6 . 4 5 3 6 1 7 4 18 3 4

Wis. NA 8 9 - 2 - - 2 4 0 6 . 4 9 3 7 , 0 9 4 4 7 4 9 2 5

W.N. C E N T R A L 1 4 4 8 6 7 _ 8 3 1 6 8 2 9 2 3 . 2 0 9 2 0 . 9 9 9 4 2 7 9 1 5 9 1 , 5 3 1

Minn. 2 8 6 _ _ 2 _ _ 1 5 8 3 . 6 5 3 3 , 5 1 0 - 1 0 1 5 6 2 7 5

Iowa 4 9 _ _ 2 - - 95 2 , 5 0 0 2 . 3 5 8 - 1 3 8 4 8 9

Mo. 11 2 0 9 6 _ 1 2 1 0 4 7 3 1 0 . 7 5 8 8 . 9 4 0 4 1 4 2 7 7 1 2 4

N. Dak. 20 _ _ - - - 5 3 1 9 3 1 5 - 4 2 2 52

S. Dak. _ 3 6 _ _ 1 _ _ 1 0 6 4 5 6 6 7 — 2 2 1 6 8

Nebr. 1 1 6 1 - 1 1 2 2 3 1 . 7 6 0 1 . 7 1 8 - 3 6 1 1 2

Kans. 7 0 - 1 " 4 6 5 3 . 5 7 4 3 . 4 9 1 ” 14 8 111

S. A T L A N T IC 7 7 2 , 9 5 8 8 1 3 5 5 9 3 1 4 4 . 5 2 8 1 1 8 . 8 3 6 1 1 6 . 7 3 3 1 6 2 3 , 9 0 5 3 , 0 7 6 2 0 6Del. 3 4 4 I - _ - 2 1 1 4 1 . 8 0 0 1 ,6 0 8 - 7 8 “

Md. 7 3 0 0 _ 11 4 3 6 8 7 3 1 2 . 5 9 1 1 2 , 0 5 7 9 2 9 4 2 1 2 8

D.C. 9 1 8 1 _ _ 1 _ _ 3 2 5 7 , 4 7 5 8 , 2 0 0 19 3 3 0 2 0 9 -

Va. 8 3 0 1 _ _ 1 12 4 4 2 8 1 1 0 , 8 0 3 1 0 , 2 4 5 - 3 4 7 2 8 2 3 4

W. Va. 3 9 9 _ _ 4 - 4 57 1 . 7 8 0 1 , 4 9 4 - 9 12 9

N.C. 14 5 0 0 1 _ 1 3 4 1 2 8 6 2 6 1 8 . 4 2 2 1 7 , 0 6 8 12 3 1 0 2 2 5 2

S.C. 2 7 5 2 _ _ 3 6 3 5 8 5 1 1 . 3 1 2 1 1 , 3 4 2 9 2 6 1 1 6 9 14

Ga. 1 8 4 7 1 4 _ 2 6 31 8 4 9 2 4 . 6 2 8 2 1 , 9 5 4 2 3 9 9 0 8 9 3 98

Fla. 15 7 8 7 - 1 15 - 6 8 1 8 3 0 . 0 2 5 3 2 , 7 6 5 9 0 1 , 3 5 7 1 , 0 6 6 41

E.S. C E N T R A L 3 0 1, 1 6 0 2_ 5 1 4 6 1 , 8 2 4 4 0 , 2 4 7 3 8 , 7 1 3 2 5 9 4 7 1 , 0 5 1 2 3 5

Ky. 3 0 9 2 _ _ _ 2 1 4 8 5 , 0 9 6 5 . 7 1 8 - 4 4 7 5 6 7

Tenn. 9 3 7 2 _ 1 1 3 3 5 6 0 1 5 , 1 4 1 1 3 . 6 8 7 10 3 7 4 4 2 3 131

Ala. 9 3 2 0 _ _ 2 2 9 1 9 1 2 , 5 8 3 1 1 . 4 3 3 10 2 6 1 2 1 7 3 7

Miss. 12 1 5 9 - - 2 - 9 1 9 7 7 , 4 2 7 7 , 8 7 5 5 2 6 8 3 3 6 “

W.S. C E N T R A L 5 8 1 , 4 6 9 4 9 3 2 4 10 92 2 , 4 6 9 6 4 . 0 9 2 6 1 , 3 5 0 1 2 4 3 , 5 9 7 2 , 4 9 0 6 6 6

Ark. 8 1 4 9 2 4 1 1 1 16 2 6 4 4 . 5 3 3 4 , 5 8 0 - 6 7 8 0 9 2

La. 3 2 7 2 2 _ _ _ - 2 4 7 1 0 . 0 0 3 1 0 , 8 9 7 2 4 8 2 0 6 0 4 2 0

Okla. 6 1 6 7 13 _ 3 4 5 9 1 9 4 6 . 8 2 5 6 , 0 9 1 - 8 4 5 2 1 2 6

Tex. 4 1 8 8 1 10 2 2 0 5 17 1 , 7 6 4 4 2 . 7 3 1 3 9 , 7 8 2 1 0 0 2 , 6 2 6 1 , 7 5 4 4 2 8

M O U N T A IN 25 3 8 3 15 1 18 1 1 0 7 4 1 1 9 . 2 1 3 1 8 , 1 2 0 1 3 3 8 4 3 0 4 1 0 6

Mont. 2 3 4 - 4 1 5 3 5 6 7 7 6 6 4 - 9 I 6 4

Idaho _ 6 2 - - - 2 2 7 8 0 7 8 5 7 - 15 9 -

Wyo. _ 6 1 - - - 2 9 4 2 2 5 3 2 1 8 7 5

Colo. 2 4 4 4 1 5 - - 2 2 5 5 . 1 3 4 4 , 8 5 2 11 1 1 7 8 2 12

N. Mex. 1 6 9 1 _ _ _ - 6 7 2 . 0 9 0 2 , 2 7 7 1 7 2 5 1 16

Ariz. 13 1 7 0 - 9 - - 2 4 6 5 . 9 8 5 4 , 8 6 4 - 8 0 1 0 7 7

Utah 8 2 7 2 - - - - 41 9 0 5 8 3 7 - 1 4 7 -

Nev. 1 38 1 - - - 1 91 3 , 1 9 3 3 , 2 3 7 6 9 4 0 2

P A C IF IC 1 3 3 2, 5 8 0 3 5 77 _ 1 3 , 6 7 3 7 7 , 3 6 1 8 0 , 4 0 9 89 2 , 18 6 2 , 4 5 9 3 3 8

Wash. 1 8 9 I 3 - - 2 2 2 6 , 1 1 7 6 , 7 6 7 - 6 6 1 2 3 3

Oreg. 10 10 4 _ 3 - - 1 7 4 4 , 8 2 1 5 , 6 0 1 1 4 6 56 3

Calif. 12 0 2, 1 8 4 2 5 71 - 1 3 , 1 6 9 6 3 ,0 5 2 6 4 , 4 3 6 88 2 , 0 3 1 2 , 1 8 0 3 1 9

Alaska 34 - - - - 6 0 1 , 9 0 9 I , 9 5 0 - 5 5 13

Hawaii 3 6 9 - - “ “ 4 8 1 , 4 6 2 1 , 6 5 5 38 9 5

Guam NA 7 NA . NA _ NA 4 7 72 NA - 4 -

P.R. 2 7 17 8 . _ 3 - - 5 6 1 , 6 5 5 1 , 3 5 3 10 3 3 7 2 7 7 4 1

V.l. NA 1 _ NA 2 NA - NA 32 1 0 8 NA 9 10 -

Pac. Trust Terr. NA 3 2 - NA - NA - NA 1 6 5 2 0 5 NA — “

N A : N o t available.A l l delayed re po rts and co rre c t ion s w ill be in c lud e d in the fo llo w in g w e e k 's cum ula tive totals.

324 M M W R July 10, 1981

T A B L E IV. Deaths in 121 U.S. cities,* week endingJuly 4, 1981 (26th week)

REPORTING AREA

ALL CAUSES. BY AGE (YEARS)P & l**TOTAL

REPORTING AREA

ALL CAUSES, BY AGE (YEARS)

P& 1** TOTALALL

AGES 5*65 45-64 25-44 1-24 < 1ALL

AGES > 6 5 45 64 25-44 1-24 < 1

NEW E N G L A N D 6 0 8 3 9 4 1 3 2 4 4 2 0 18 18 S. A T L A N T IC 9 9 8 5 6 1 2 5 6 8 6 3 7 5 6 2 9Boston, Mass. 168 96 3 8 17 8 9 - Atlanta, Ga. 15 1 91 3 7 16 5 2 2Bridgeport, Conn. 4 9 34 9 2 4 - 1 Baltimore, Md. 1 4 5 88 37 3 2 5 3Cambridge, Mass. 22 18 4 - - - 1 Charlotte, N.C. 6 4 30 18 9 4 1 4Fall River, Mass. 38 25 11 - 2 - - Jacksonville, Fla. 88 50 21 6 4 7 1Hartford, Conn. 53 36 10 4 1 2 2 Miami, Fla. 9 4 4 8 2 2 12 1 11 2Lowell, Mass. 17 13 3 - - I 2 Norfolk, Va. 4 7 2 3 16 3 2 3 4Lynn, Mass. 10 5 2 3 - - - Richmond, Va. 6 3 2 8 2 0 6 4 5 1New Bedford, Mass 14 11 2 I - - - Savannah, Ga. 3 3 15 12 4 I 1 1New Haven, Conn. 3 9 2 7 6 2 2 2 2 St. Petersburg, Fla. 8 2 65 13 1 2 1 4Providence, R.l. 6 5 41 1 6 4 1 3 6 Tampa, Fla. 5 8 3 4 12 5 1 6 4Somerville, Mass. 11 7 4 - - - - Washington, D.C. 1 0 0 5 0 2 6 8 8 8 3Springfield, Mass. 3 4 22 8 4 - - 1 Wilmington, Del. 73 39 2 2 3 3 6 -Waterbury, Conn. 2 4 14 4 5 1 - -Worcester, Mass. 6 4 45 15 2 I 1 3

E.S. C E N T R A L 5 5 3 3 4 1 1 3 5 2 9 2 7 21 2 8Birmingham, Ala. 81 4 4 2 2 4 6 5 -

M ID . A T L A N T IC 2 , 6 3 6 1, 7 1 3 5 8 1 1 8 4 73 85 86 Chattanooga, Tenn. 4 4 29 9 4 2 - 2Albany, N.Y. 4 5 2 6 1 3 1 1 4 2 Knoxville, Tenn. 39 29 8 - 2 - 2Allentown, Pa. 2 2 16 6 - - - - Louisville, Ky. 35 2 3 9 1 - 2 4Buffalo, N.Y. 10 0 68 19 5 4 4 12 Memphis, Tenn. 1 4 3 85 3 9 8 5 6 6Camden, N.J. 31 1 9 5 2 5 - - Mobile, Ala. 6 8 4 9 10 2 5 2 5Elizabeth, N.J. 2 6 15 7 3 1 - - Montgomery, Ala. 4 6 31 9 2 3 1 4Erie, Pa.t 3 2 18 10 2 1 1 1 Nashville, Tenn. 9 7 51 2 9 8 4 5 5Jersey City, N.J. 4 6 31 12 2 1 - -N.Y. City, N.Y. I , 4 7 0 9 6 2 3 0 2 1 2 4 39 4 3 35Newark, N.J. 4 7 25 15 3 1 3 1 W.S. C E N T R A L 1 , 1 3 4 6 5 1 2 8 1 1 0 4 61 3 7 3 0Paterson, N.J. 18 12 4 2 - - 1 Austin, Tex. 2 9 18 11 - - - 1Philadelphia, Pa. 4 1 8 2 4 8 1 1 4 2 8 10 18 22 Baton Rouge, La. 50 27 11 7 2 3 1Pittsburgh, Pa. t 4 5 28 13 1 1 2 1 Corpus Christi, Tex. 29 2 0 3 1 4 1 -Reading, Pa. 3 6 30 4 1 1 - 2 Dallas, Tex. 2 0 3 1 0 8 4 9 18 19 9 1Rochester, N.Y. 8 5 58 14 4 5 4 5 El Paso, Tex. 3 3 2 3 8 1 - 1 2Schenectady, N.Y. 30 2 2 7 1 - - 1 Fort Worth, Tex. 8 4 53 19 6 5 1 4Scranton, Pa.t 37 27 8 - - 2 1 Houston, Tex. 2 6 8 1 4 7 71 27 6 7 -Syracuse, N.Y. 76 53 14 3 3 3 I Little Rock, Ark. 6 7 3 7 18 5 4 3 6Trenton, N.J. 2 5 18 6 - - 1 I New Orleans, La. 1 4 7 80 3 5 21 5 6 IUtica, N.Y. 20 15 4 1 - - - San Antonio, Tex. 1 2 5 89 2 5 6 5 - 8Yonkers, N.Y. 2 7 22 4 1 - - - Shreveport, La. 3 3 17 11 3 - 2 2

Tulsa, Okla. 6 6 32 2 0 9 1 4 4

E.N. C E N T R A L 1 , 9 2 1 1 , 1 2 6 5 0 0 1 4 2 77 76 3 4Akron, Ohio 4 2 27 10 1 3 1 I M O U N T A IN 5 5 4 3 5 0 1 2 8 * 0 17 1 9 2 4Canton, Ohio 32 21 6 3 2 - - Albuquerque, N. Mex 8 3 52 2 3 5 2 1 8Chicago, III. 4 8 9 2 7 3 1 3 2 4 0 2 4 2 0 6 Colo. Springs, Colo. 3 0 19 7 2 2 - 5Cincinnati, Ohio 1 2 9 75 33 8 5 8 - Denver, Colo. 81 58 11 4 2 6 4Cleveland, Ohio 1 2 3 62 3 6 11 6 8 3 Las Vegas, Nev. 7 0 37 19 8 3 3 1Columbus, Ohio 1 3 3 73 4 3 11 2 4 3 Ogden, Utah 21 14 6 - 1 - -

Dayton, Ohio 8 6 5 3 22 6 2 3 - Phoenix, Ariz. 1 1 6 7 6 2 6 10 1 3 -

Detroit, Mich. 2 2 4 1 3 0 50 2 6 6 12 4 Pueblo, Colo. 3 2 2 0 7 3 1 1 2Evansville, Ind. 3 5 22 8 2 2 I 2 Salt Lake City, Utah 5 3 32 1 5 2 3 1 1Fort Wayne, Ind. 38 1 9 11 2 3 3 1 Tucson, Ariz. 6 8 4 2 14 6 2 4 3Gary, Ind. 1 7 7 5 3 2 - -Grand Rapids, Mich 4 3 27 11 3 - 2 1Indianapolis, Ind. 1 2 5 7 8 3 4 6 4 3 2 P A C IF IC 1 , 4 7 3 9 3 5 3 3 1 10 1 56 4 9 6 0Madison, Wis. 4 8 34 11 1 1 1 5 Berkeley, Calif. 1 6 12 3 1 - - 1Milwaukee, Wis. 1 0 4 6 3 2 9 5 2 5 - Fresno, Calif. 5 5 3 5 1 5 4 - 1 3Peoria, III. 2 3 12 8 - 3 - - Glendale, Calif. 19 12 4 3 - - IRockford, III. 36 22 10 2 - 2 2 Honolulu, Hawaii 3 5 19 11 2 2 1 1South Bend, Ind. 2 9 2 0 8 - 1 - 1 Long Beach, Calif. 7 9 4 7 2 7 2 1 2 3Toledo, Ohio 1 1 2 77 21 9 4 1 2 Los Angeles, Calif. 4 2 6 2 7 2 87 32 24 L0 8Youngstown, Ohio 5 3 31 12 3 5 2 1 Oakland, Calif. § 8 5 55 18 6 3 3 3

Pasadena, Calif. 17 13 1 1 I 1 2

Portland, Oreg. 1 2 7 85 2 6 6 5 5 1W.N. C E N T R A L 6 5 2 4 2 2 1 4 7 36 17 3 0 2 8 Sacramento, Calif. 58 35 11 6 3 3 5Des Moines, Iowa 41 27 7 5 1 1 - San Diego, Calif. 1 0 1 58 2 6 9 7 I 4Duluth, Minn. 3 1 2 0 7 - - 4 1 San Francisco, Calif 1 2 2 80 2 7 6 3 6 2Kansas City, Kans. 26 12 8 4 2 - I San Jose, Calif. 1 2 2 76 2 7 10 6 3 L0Kansas City, Mo. 1 1 2 72 2 3 6 3 8 3 Seattle, Wash. 1 2 4 80 2 9 6 - 9 4Lincoln, Nebr. 2 7 18 7 I 1 - 4 Spokane, Wash. 5 2 37 10 I - 4 1Minneapolis, Minn. 8 6 5 7 16 6 4 3 3 Tacoma, Wash. 3 5 19 9 6 1 - 1Omaha, Nebr. 7 6 53 18 3 - 2 4St. Louis, Mo. 1 5 6 92 4 3 9 2 10 9St. Paul, Minn. 51 3 8 9 - 3 I - T O T A L 1 0 , 5 2 9 6 , 4 9 3 2 , 4 9 1 7 6 6 3 8 5 3 9 1 3 3 7Wichita, Kans. 4 6 3 3 9 2 1 1 3

'M o rta lity 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.

"P n e u m o n ia and influenza

tBecause 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.

ttT ota l includes unknown ages.

§Data not available this week. Figures are estimates based on average percent of regional totals.

Vol. 30/No. 26 M M W R 325

Tuberculosis — United States, 1980

In 1980, 27,749 cases of tuberculosis were reported to CDC. This represents an increase from 1979 of 80 cases (0.3%). It is only the second time since 1953, the year in which all states began using standardized formats to report tuberculosis morbidity data to the U.S. Public Health Service, that the number of reported cases rose.* The case rate in 1980 was 12.3/100,000 population, 2.4% lower than in 1979 (Table 1).

Case rates for the 50 states ranged from 19.0/100,000 in Alaska to 2.4/100,000 in New Hampshire. The case rate rose in 20 states and the District of Columbia. A s in recent years, case rates were higher in the southern than in the northern half of the country (Table 1); however, states with increased case rates were more common in the northern half of the country (Figure 3).Reported by Tuberculosis Control Div, Center fo r Prevention Services, CDC.Editorial Note: Over the past 26 years, the number of reported cases and case rates have continued to decrease about 4 % and 5%, respectively, each year. In view of this steady pattern of progress in controlling tuberculosis, the 0.3% increase in cases and 2.4% decline in case rate in 1980 stand in contrast. The leveling off of the downward trend has now continued for 3 years. The decline in cases and case rate in 1979 was also smaller than usual (3.0% and 3.8%, respectively), and the provisional number of reported cases so far in 1981 exceeds the number reported during the equivalent period in 1980. One factor slowing the downward trend is the number of Indochinese refugees in the United States who have tuberculosis. A survey of tuberculosis among Indochinese refu­gees in 1980 has recently been conducted to determine the epidemiologic features of this factor; the results are pending.

'E xc lud ing 1975 when changes occurred in the criteria for counting cases.

F IG U R E 3. States with an increase in tuberculosis case rates. United States, 1980

326 M M W R July 10, 1981

Tuberculosis — Continued

T A B L E 1. Tuberculosis cases and case rates, by state, 1980 and 1979

State Tuberculosis casesCase rate per

1 0 0 ,0 0 0 populationRank according

to ratePopulation

1 98 0 census

1980 1979 1980 1979 1980 1979

United States 27,749 27,669 12.3 12.6 _ _ 226,504,825

Alabama 663 644 17.0 17.1 6 9 3,890,061Alaska 76 90 19.0 22.2 1 3 400,481Arizona 342 417 12.6 17.0 19 11 2,717,866Arkansas 369 382 16.1 17.5 9 8 2,285,513California 4,279 3,642 18.1 16.0 4 14 23,668,562Colorado 135 170 4.7 6.1 43 36 2,888,834Connecticut 173 169 5.6 5.4 38 38 3,107,576Delaware 76 63 12.8 10.8 17 25 595,225District of Colum bia* 341 324 53.5 49.4 — — 637,651Florida 1,647 1,628 16.9 18.4 7 4 9,739,992Georgia 849 929 15.5 18.2 11 5 5,464,265Hawaii 127 311 13.2 34.0 15 1 965,000Idaho 33 21 3.5 2.3 46 49 943,935Illinois 1,352 1,540 11.8 13.7 22 18 11,418,461Indiana 429 509 7.8 9.4 32 27 5,490,179Iowa 91 74 3.1 2.5 48 48 2,913,387Kansas 108 104 4.6 4.4 44 43 2,363,208Kentucky 570 635 15.6 18.0 10 6 3,661,433Louisiana 577 647 13.7 16.1 14 13 4,203,972Maine 58 56 5.2 5.1 41 39 1,124,660Maryland 610 648 14.5 15.6 13 15 4,216,446Massachusetts 452 476 7.9 8.3 31 30 5,737,037Michigan 1,168 1,052 12.6 11.4 18 24 9,258,344Minnesota 237 190 5.8 4.7 36 41 4,077,148Mississippi 458 553 18.2 22.8 2 2 2,520,638Missouri 466 500 9.5 10.3 27 26 4,917,444Montana 27 39 3.4 5.0 47 40 786,690Nebraska 44 30 2.8 1.9 49 50 1,570,006Nevada 44 54 5.5 7.7 39 33 799,184New Hampshire 22 25 2.4 2.8 50 47 920,610New Jersey 906 933 12.3 12.7 20 19 7,364,158New Mexico 146 153 11.2 12.3 23 21 1,299,968New York 2,294 2,229 13.1 12.6 16 20 17,557,288North Carolina 1,066 990 18.1 17.7 3 7 5,874,429North Dakota 54 22 8.3 3.3 30 46 652,695Ohio 747 764 6.9 7.1 35 34 10,797,419Oklahoma 333 352 11.0 12.2 24 22 3,025,266Oregon 218 179 8.3 7.1 29 35 2,632,663Pennsylvania 1,015 1,076 8.6 9.2 28 28 11,866,728Rhode Island 66 80 7.0 8.6 34 29 947,154South Carolina 520 483 16.7 16.5 8 12 3,119,208South Dakota 49 55 7.1 8.0 33 32 690,178Tennessee 791 748 17.2 17.1 5 10 4,590,750Texas 2,075 2,090 14.6 15.6 12 16 14,228,383Utah 61 46 4.2 3.4 45 45 1,461,037Vermont 25 29 4.9 5.9 42 37 511,456Virginia 654 747 12.2 14.4 21 17 5,346,279Washington 424 321 10.3 8.2 26 31 4,130,163West Virginia 203 221 10.4 11.8 25 23 1,949,644Wisconsin 252 210 5.4 4.4 40 42 4,705,335Wyoming 27 19 5.7 4.2 37 44 470,816

American Sam oa** 2 2 6.2 6.4 _ _ 32,395G uam ** 55 62 52.0 54.5 _ _ 105,816Puerto R ico ** 820 464 25.7 13.5 _ _ 3,187,570Trust Terr. Pacific Is.** N A 31 N A 26.6 _ _ 120,510tU.S. Virgin Is.** 8 8 8.4 8.3 - - 95,214

‘ District of Columbia is not ranked with the states but is included in totals. * *N o t included in totals.tPopulation estimate provided by the territory.(— ) = Not ranked.N A = Not available.

Vol. 30/No. 26 M M W R 327

Clarification, Vol. 30, No. 16

p194. The article "Guinea Worm (Dracunculiasis) and the International Water Supply and Sanitation Decade" stated that 3 W HO regions have a rural population of 786 million people who are still unserved by safe drinking water. An estimated ID - 48 million cases of dracunculiasis occur each year in this population, which rep­resents between 1.3% and 6.2% of the total rural population in these regions. The true population at risk of this disease is not known exactly but probably repre­sents a small subset of the 786 million. Dracunculiasis is not spread from person to person but tends to localize and recur in areas where the infected crustacean contaminates water supplies.

Since those at highest risk of acquiring infection one year are presumably the same persons who were infected the previous year (as a result of drinking con­taminated surface water) and since the usual duration of each infection is slightly more than 1 year, the most efficient action to interrupt transmission of the disease would be to provide safe drinking water to currently affected villages as rapidly as possible.

Addendum, Vol. 30, No. 25

p305. In the article "Kapo si's Sarcoma and Pneumocystis Pneumonia Am ong Hom o­sexual Men — New York City and California," in line 7 of the credits, A Brown, M D, Sloan-Kettering Memorial Institute, should be added.

Erratum, Vol. 30, No. 25

p305. In the article "K apo si's Sarcoma and Pneumocystis Pneumonia Am ong Hom o­sexual Men — New York City and California," in line 7 of the credits, one name was misspelled. It should read D Mildvan, MD.

The Morbidity and Mortality Weekly Report, circulation 118,223, is published by the Centers for Disease Control, Atlanta, Georgia. The data in this report are provisional, based on weekly telegraphs to C D C by state health departments. The reporting week concludes at close of business on Friday; compiled data on a national basis are officially released to the public on the succeeding Friday.

The editor welcomes accounts of interesting cases, outbreaks, environmental hazards, or other public health problems of current interest to health officials. Send reports to: Attn: Editor, Morbidity and Mortality Weekly Report, Centers for Disease Control, Atlanta, Georgia 30333.

Send mailing list additions, deletions and address changes to: Attn: Distribution Services, Manage­ment Analysis and Services Office, 1-SB-419, Centers for Disease Control, Atlanta, Georgia 30333. When requesting changes be sure to give your former address, including zip code and mailing list code number, or send an old address label.

328 M M W R July 10, 1981

*U .S . Governm ent P rin ting O ffice: 1981 -7 40 -185/9 02 Region IV

U.S. D E P A R T M E N T OF H EA LT H A N D H U M A N S E R V IC E SP U B L IC H E A L T H S E R V IC E / C E N T E R S FO R D IS E A S E C O N T R O L A T L A N T A , G E O R G IA 30333 O F F IC IA L B U S IN E SS

Postage and Fees Paid U.S. Departm ent of H H S

Director, Centers for Disease Control H H S 396W illiam H. Foege, M.D.

Director, Ep idem io logy Program Office Philip S. Brachman, M.D.

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Managing EditorA nne D. Mather, M .A.

Mathematical Statistician Keewhan Choi, Ph.D.

H H S Publication No. (CDC) 81-8017 Redistribution using indicia is illegal.