FOR rnplrnISrnZrn USE

CBC mFLmZA REPORT

U. S. D D U W m I T OF m L T H J , EDUCATION, AWI Ta"EWA3EE PublZc Health Service Bureau of S t a t e ServrZces

Gommicable Disease Center Robert J. Anderson, Chief

KeSth E. Jensen, Ph. DI Robert I3, Dratnehm, M ,a3 CDC Virus a d Ricket ts ia Section"J; Frederick L+ D m , NuDm F. 6, Box 61 Influenza 5 urvsillancs Unit Montgomery 1, Alabma Cammicable Disease Center Tef ephone No a mherst 3-Lb68 50 Seventh St ree t , N , E;,

Atlanta 23, Georgia %'5emhg as WI-fO In te rna t ional Telephone Na TRfnIty 6-3311

1 Idluenea Center f o r %he Americas Extension 5b55

S1IECIU NOTE

Information c o n t a e d i n t h i s r v o r t f s a 3-ary of data reported t o CDC by S t a t e He@.%h Dey?asJ;ments, Epfd&c I n t s l l f g m c e hervice Officers, collaborat- i n g influenza Idiagnoa-tic laborator&es, md other p e r t i n a t sources, Much sf it i s pre &ry in nature and is ktanded f o r those Bnvolved in b f l u w a a control cnetivities. Anyone desiring t o quote this inflormation i s urged t o contact the person o r persons primarily responsible f o r the items reported i n ordies tha t the exact b t e q r e t a t i o n of the report md %he curreal s t a t u s of the h v e s t l ~ ; a t i o n be obtained. S t a t e lieal-th. Officers, of coursep Will judge %he advisability of releasing any Wormation from tk&r m slates*

11. Epidtm2~ and Case Reports

911, Progress Re2orts

IB, Reports of Influenza-As s ociated r) eatbs

V. S u r m n q Tables - Cases and Outbreas

V Appendix - Resolutions Adopted by Asaoeiatiolrl of' S t a t e and T e r r i t o r i a l Wealth Officers a t a Special ReeSing on Influenza, August 27-2B9 1957

Ag3peaded do G11is Report are several resa5ta.t;ilans adopeed by t h e Associa- %ion sf State and 'S!erri.t;ari.hzI Bealtzh Officers at a meeting i t a Washin@on, D. C ., be2d on Auggust 27, 28, Reccrnen&tians concerning survelflance and

vaccine use and gsamo%ion, c m u n l t y organizatZon an& research planning were offered.

A4diakionpbl data for influenza-1;Urie ilhecsses seen at C Z a a r i t ; ~ Eospitab fn Haw Orleans are ~vailable t h r o u a aaid-aCIa~s't;. A slight 5raerease i n viaits for tnf luenaa-LQcs lklneaa i s naked.

fa *%her influenza-asaocfa,ted &e&tls I o s reported from CetLifornla, Eo laboratory eo~fimation o2 inPluenzs infecLrioa rts av&&la231a a% prccent. Death m s &ue to meas~%ve elaphylococcal pnewnotltia xi%h a o s * c ~ p l e t ~ ib%fateral consoXidatiora,

bissse ccmg1ete clinical, &%a are preseneed Prcm the previously r*epsfie& M1aaias;%ppi cotzunty-au%bre& of l&Xueaza-15ke illness. Is notAee~ble %hat more khan s third oP the gsx.tients cmphined sf gaskroirt.testiw5 smp%ms. M8.t of aeae were in t h e ycunger age group.

An *pre~&)ion 02 bcreased fnfluenza-lflre illness is repofied frm marZ.doa and. Texas. In the fanner, aporadi~ ~ a a e s h v e been aofl2med as Asian @%rain influenza. EnPlttenza-ljhke i lhess has occurred 9n a Reserve Unit frm I l l ino i s , training a% San Diego, and aboard a Coast Guard Gutter in the Gulf ~f liul?;~ic~~ The proiblen of qm~ti'caLing ;t;hese, hpressions here and elsewhere continues to be a very e a p l w pne,

IX. m2demie and Case Reporha

(Reported by D r . B. Gundelf inger, Medical Research Unit No. 4, 'W. S. Naval Training Center, Great Lakes;, S11Saois. )

Cb July 10 %harou& 12, 39 of 112 ambers in a U. S, Marine Corps Reserve Unit, in *mining a t San Bfego, developed an illnese charac- terized by &ills5 fever, a l i @ t musea and same stomach c Fevers ranged f r a 99' t o 103 e 8 ° ~ , On July 13 mast of the group rec h,lrned to the i r hones in northeas6 I l l i n o i s bgr air. Because of lllness 26 Isen remained at San Dlego. %Q more men b e w e ill en rouke t o I11Bnois.

Asian s'krafn influenza had been repor\-eed Pram a large amber of recruits in the neA&boring Naval T'JainZng Center at, San Diego (see CDC IdEuenza Report No. 1-C) +

Con~&le~cr tn t blood specaens obtained two meks after° onset were t e ~ t e d by c~mplemen.t Ofwtlian wikh d/~apn/305/57 vira l antigen. ;Antie body t i t e r s of 1: 32 or @eater were ebit;alned In 14 of %he 19 spec-ens tested.

14-B. FLORIDA, Dade, Bramrd, ~h Eeach, Clay, Seminole, and Pour Counties

(~eported by Dr, J. 0. Bond, Florida State Board o f Health. )

Serologic c o e i m t i o n crf infeceion with Asian train iXZiF1ue~~a virus has been ob.talned from 16 cases which occurred In the counlies noted above. These represent sporadic cases but it apgears lately that a sllgh.t increase i n f e b r i l e respir&Lory diseafie has crccurred i n these areas.

14-C. FLOR196, b d i s a n

( ~ e p o r t e d by D r . J . 0. Bond, Florids Sta te Board of Mealth. )

A children" ssanp 8% b d i ~ o n mperienced an PuZIbreak o f dinf2uenza- l i k e i l l n e s s i n mid-Auest. Twelve children were hospltaZized for frcm 1-2 Idaytir, InSectfon wf%h Asian s t r a i n f&laenza virus has no% yet been conf imed.

A% JackaonvPlle Beach, 16 of 125 hotel employeecs Becme ill ~Ji"t_hin two ldags of each other In mid-Au~;ust. Investl@tIon reveded an ill- ness wiW1 chsmc%eris%ie i e l u e n z a smptoms, m r s a t mshing;e;: and bloat3 specimens are presently under hbora tory study.

( ~ e p w b e d by Dr. J, E, Peavy, Texas Depa&aent of He+%h. )

Seventeen pakients with Idluezaza-lilre Illnese have been a&iL%ed t o the gu'blic Neabth Service Hospita4 i~ GlaS;ves"tnn, irom a CoasL Guard Cuther. Symlptcrtls were genersclly mild but a few bad high Sever. Apgro- pr i~ate spechens are under labomdo;r~~ study.

16-E+ NEW YOm, Ii.Jyodng County

A small $am labor c a p located in tJe.t;hersPfel& Town~hip, Wcming Counky, exgerienced an outbreak, of Ieluenazej-like AUess on Au.ugua% 19 ;and 19, h o n g %he 33. adults and k children, k ca8es occurred. TIais group ha& arr ived i n New Yoxk St;ate om August 14. Ap2ropris;te spec%- men$ are under labomLosy etu&y.

Fatieats Seen In the Admitting Room and Xmter w3th Ingluensa-l&e Illness (&%a provided by Charity Bospftal AclministraLion through Dr, 3, D. Wrtin, ta. 'Dept. sf ~ e a ~ t h )

fo, seen No, aaen fdo, $ 2eJluenza-lae illness

. The above %akuJatfon, when intemreted %&.thin %he necessary 1aitw%ions, may over Lhs course o f weeks give an e s t m t i o n of ZYr;eluenza aorbfdity I n Hew OrIeans. rFfbi9ar i i w r a s fram omher city hospitals night be eqw13y valuab2.e. Ibtients visiting the Charity E.sspiLa1 Adaajltting Row are usually o f a low socioeccacMc group, a popu3.atian sewen% Pou.nd particularly. auscep.t;ible t o epidemic i&Iueazs, Consequently, they provide a seaei-bivc index of ie1uenza in iaa area. What rela- Llonahip these f l m e s m y hawe to over-afl camun;tty rnoxbldity is noif; easily datemined. A s &bsentee reports Prm achools an& industry are avallatrJ-e far com- parison, t h i s problem may be p r b i d l y iU~~(1lm%ed,

It i s apparent that p ~ ~ t i s n t s visgting the Clzecrity Hoepi%al b v e experienced a gra&al increase in Lhe nunber o f inf luenza- lue illnesses, both in number seen azld 19 percentage o f total cases seen during the first three m&s 02 August.

(8epar$eed by Dr. A. L. Gray, Mississigpf State Bcard of Health, &a, Dorothy Ca.2afiore, midemie IntellSgence Service GPflcer, and SLsiff of Wwshin&on Cown%y Keal%h Dep8rben.t;. )

The WashScn@on County outbreak, noted briefly fn CDC! hf'luenza Report No, 3.343, b s been etudAed In aone deLail, A s prelalrelmry regart I s presented below, Throat wtibshjlngs anid, blood sgec~ens are being a%udied at CPC,

The epi-ic o f Influenza-l&e il2ness occurred In t h e Glen, r\%lan area of the southern part of the county, The e i t y aF- fected consisted of about 2000 p@ople, 200 ef whoa l ived i n the vilbge of Glen Ulan, the remainder on et hrgie co%ton plan.t;ation.

- 5 - AppraxW*eQ 200 persons aP 1074 o f the c o w n i t y were ill during the xgiddUe tm weeks of Auwst, Because of t h e cotton economy', the one negro school i n Lhe region was open durlng the perfod of %he epidemic. The chiZdrea leave school during @he co-kton harvest season 18-trer fn the year, The school ea romen* is 300. Sharp absenkeeism was Pirst naked i n the schaoL on August 15, and many children, were still abserrt; on August 20.

A house-tamhouse survey was canducte& as part of the investiga- t ion. Fifty-seven patients with IMluienza-lac illslesa were inter- viewed in deh i l . meaty-nine were mle, 28 f a ~ l e ; 53 were negro, 4 wh;Ste (refflec~ing the local pawat ion 8istribut;ian by race), EfaU af those Intemiewed lived in %he vi1hgs and half out on t he planbt ian,

mn$y-five failles were Ineesvlewed. m i ~ e e n of these had multiple cases; 3.2 had aaly single case$. A131 members of one f a t l y of' 12 rfere al8feo"ced; several families wi$h 6 or 7 glernBers b d 81% but one person affected.

Tabulations ~resen%ed below a re beled on %he analysis sf 57 cases found during tho house-to-house sumey, The rlatc of onset sf the f i r s t of these ms hlyst 1, An upswin& in: onsetis occwred Auwst 12. The peak for the w o w occurred Auwst l h . 5 an& the l a s t caae becme f l l an August; 20.

mration 09 ilfiess ( f r a onset o f i d t i a l s;wm,ptonts to dieappearance of l a a t smpt;cm)

-,

nore Ghan 7 days .... 12

No. cases $ of cases

Meadrzche 49 86 cough 46 81

Psoduct ive 39 33 bjsn -productive; 27 47

b l e i s e 33 58 Haus ea 26 46 Dizziness 2 5 44 Abdcminab p i n 22 39 Generalized aching 22 39 Coryza 22 39 Vemiting 20 35 Diarrhea 20 35 ESctremiLy -pain and wleaknesa 28 32 Chest pain 3.6 28 Sore throat 13 23 Chills W. 19 Conjunctivitis (noted only In one chi1d3

Age Dl8tribution:

NO* of case^; Less than 1 2

1-4 4 5-9 10

10-14 12 15-33 6 20-2& 3 ZS-zP 5 33-34 2 35-39 3 40-41) 1 45-49 3 S015k 1

"J 5o older 5

1 - NA13%5I (see also CDC i&luszzza Report Ho, 1-33)

(1~epo~pt;ed by Dr. J, A a Enri&t, Chief, Bukeau of widaiology, Hamii Bcpn&men% of BealLh , )

ry 02 khs epidemic In8luenza sbtu8.tisn in %mi% is now amiletblcs. Solon after -the first appearance of influenza i n %he Islandc i n mid-June, an ouebreakr ~ZFarLed on Kauai. Asian sk ra ln iafluienaa, was serolog1cdly COB^ %m@d. &rangentents were made? for dai ly case regorting from %his i s b n d ,

First week of repo~gng - week end3ng June 29 649 cases Peak week - week ending July 13 1274 cases h a t week 02 ~sepor"eing week enan8 IAUgub~t 10 39 cases Total. b u a i eaees %lissau& August 20 4203

&e gopXat;$sn of Karsai is 28,60?--%he a"1;bck rate ;"far %he i s l a n d was over lb$,

IMlueaz~l has been re-prt.l;ea $ram aZa, Islands except EJlZhau (pop- ulation of 2283, With less compJeLe reporLfng than was psseible oms mualb, the &%Lack sates elsewhere mry f r ~ m $76 121 rural WU 60 2% for the city of Honolulu, me peak we& f o r the 'Irerri-bory (wf%h 3213 cases) ms t h e e n a n g July 21,

W a u @ August 17, abou-t; 17,500 cases bad been repoPtea fron the Territory ss s *ole, with four deaths at l r ibuted $0 influenza. The hisease has been mild with recovery in aibouL t h e e day$, but weakness has often persisted for another week*

IV. I_ DUTfJIS. Reports of X&2uenzs-Associa%ed Deaths

Ca1, 9 (f(egarf;ed by Dr, R. Moldenhauer, C~lifornia Pepm31rtxsent QP EUblSc Health, and Dr , (J , I, LeftMdh, San Jose. $

This 16-year-old male was attenttSng a, children s amp,, wbf ch

- 7 - was exgeriencing a greet deal of rcssplratory tUseaae, 4% &&st 14 he cmplained of fever, t i retheas, aching, &nil he had coryza. He me a h l t t e d t o the amp izlrimary and apparently was doing weal un%ll the afternoon of Augus.t; 16, when he ciomplained of substernal pain. A chest X-ray obtained at %his t i a e revealed no pathalogic changes. The patfent anakened a;bout 5:06 a,m, an August 17 wlth cheat, pi in and eoughfng, a"chich time be had mobrate hmogty~iis. Mter belng checked by the camp physician, be ms awltted - 5 ; ~ a nsa2- by hospital at; 5:Ja a*ns,, acuLely w i l l cyrznosis, dyspnea, s~rmptoms of shock and a temgera%ure of 1060,

Reexmimtion a% 9:30 a,a, revealed moist mlea thrau& the r ight lung an& a mocllem"t; ember of salex3i i n the left lurq. Resplra- %Pons = 60, heart rake - 160r Bload l?m~isure - 70/?. NO c&~~dPa& mumure. On a b l a s i o n , a chest X-ray showed complete conso.;lirlation of the r igh t lung and patchy i n f i l t r a t e s through the lef-l; 3yng. An electroeardiogrm ~howeS31 an acute c o r - p m a m l e pattern, The patient was given peniclllrln In%rauacularly and intmvenicsuely; strepLloraycin int;r&auscularly an& chlaromyaetin intrravens~sl~r . He was given levrophed and hydzloco~isone and ACTW i n pl;n ef fo r t to re- verb the shock. Ne became cornlose &bout; 22:30 p,m. and a txache- otmy was perfomed. %tien$ was given oxygen con.t;fmouslty. by interni t ten% positive pressure, Despite %hest? measures, %he blood presmre s20w3y f e l l t o zero and respirations becme s2omr an& f inal ly ceased a% approx-teby 3:38 p.m.

Cczr~EeLe cansol2dation of the en5ire lung, excep-b gsr thh apical posterior semen% a% the Left upper lobe, was aeen at autopsy por- formed about 7 hours a f t e r death, The rewinder o f the gross pas%= m 0 r . t ; ~ findings was negative. Coa@ase positive aureue was gram Bram sputum cul.t;ure~ and, from specwens taken E ~ L autopsy fron both ri@t and leg% lobes. These C M L ~ U ~ ~ E a r e presently being pkge tgrped.

Appendix to CDC Influenza Report No. 16

RESOLfrmIOaS ADOFTED 533! MSOGIbmON OF STAm ANL") I TORIdL OFFICmS AT G P E C W mETfNC ON' ENFLWIS[ZA, VMHDIGTON, D.C., AUGUST 27128, 2957

1. The &portant labomtory work lies i n the aubstantfation sf an epfdeagic and is BP litkle value Lo t he individual *tien%. In the SdentiPPcaLion o f a n outbreajk, "troat washings and paired sera should be submitted firm at least twelve clinical cases. Accwpanying the speeaens should be a c l in ica l ab~tract and dsta an how specimens were %&en. The specbens should be @thered In the face of am a p S s s - ive outbreak of ulpper r e s p i m t a m i152ess within the first three &ys crft i l l n e s s and submitted %hPIiau@ the state heal th au%harity,

Tciclisnical i & o m t i o n on setrur$ag and pmpasing spacrl;mene to~ethsr with re* s t r i c t ions should "b easemimted %boa@ s-t;itte channels. Lawl hieaLth authosfdjie* should prticiprzte in the eva3,wtfon of an e p i d a i c sl%wtian in a~cesrtatlce with exie6ing policy.

2. IT IS EBC DED that the several stakes plan t o wther l n t e l l i ~ e n e e r a p i a y C

regaralng the occurrence o f pneumonia, Since bacterial iden"cif"ication by sputum specaea i a as bgortant as virus diaefnosis, i.t i a A\s't;her r e c m e a d e d t h a t sputurn specaleas for bscterial s t u w , as welX a s an t ib io t i c isien;gitivity, be %&en as fioon, a a pnewnania. is suspected. The pnetuaonia xa2;e i n %he extremes a2 age should 'be used a s a sens i t ive index tia assess the severity of an epl$emPc, I

3. I T JS EtEG ED tht each state subnil a weekly si.t;ugtion regor% to %he Wzb- lic Health Service for opemlfone2 puqosers. This j.;nfomtion can be added. t o %he usual wekly telegrwm Lo NOVS. It is furGher recomen&ed tkt %he st&+et9 adog.1; a ~ r o g m o_P (1) epidern%c repo&lng by counties t o the stabes an4 then t o %he a b l i c I-lealth Service ; (2 ) adaption a$ a standEl.rd memod of @thering and repor2;irag in- famation om outbreaks; and (3) smpling a0 absenkee mSes in selec%ed schx403.s; and Industries.

;Sn order 5.0 Pae l l i t a t e amlysl~ 0.t' b t a &thered and t o aid local , state and national znamgmelzf; ok' the epidemic, s t a t e s a r e urged t o mrtiefpa.t;e in %he pro- posed Fublio Health Service suz*veillsznce and reporting progms .

4, 1%' IS FtEC BED %ba"cas much us;eNL i d o m t i o n shou2d be @thered in an epi4mic investigation as poasib2.e and should include, but not be limited. to, ~mp%oms and etlolow as delemined by laboratory confirnation on a representative smpling, co~flpLicatjloas and mortality, and, age groups Invojlved. Suggesked f o m s fo r @%hering useful % & o m t i o n i n organized fashion are bedng rlleveloped by the subcomi%tee an epidemic intelligence and the mblic HeaXth Service* 'Ffierefosre, these fsms a r e cmendeB t o the States for organizing and repo~ing such injeoma- t ion as they a r e able to ol$.tairr.

5* Z'b JS REC 13 that the Public EsaL"c hervkce prepare (E a o s s a r y 09 terns cormnoay used in rebation t o tihe l~fltzel-lza pro

6 . IT ZS WCOWNDEB that aolsishnce f r a %he Eublia Realtb Semice in auppos'b of virus Iaboratsriea In Seats heal"l; depamente t o include dia,gnastgc materiels a n a t m i n a g of hbomtosy pereonnel be grovided, Pbther, the providing of afd by the gubbic Heal%b Ssrvlee t a %he S-tatc~s me l a t t e r ,% request i n e p i d m i - ologllcel persomel is recornendeb. The a3c3"bI.i~ Bestl.t;.B Service should assis% the States by glanning for. future conferences concerning epidemic progress a8 aem t o be rreeded.

The px-ry objec'l;ive in prmoting vaccine pro s i s $0 preyen% ill- ness and &a* from epiba3c ;Znf"lu@nza w%thl~ %he 37ta3lts 03& ~ml3.Eable wcoiae ,

Should there be a sys tm of Sn%ers%te cmllaca-t;lon of influenza vaccine?

en8 thaG there be a sy~ten o f interstate al&acation of vaccine b a e d on s volwtary cm~eaelat with me mnujeachrers.

What priori"%ies, if any, al"lould be ersl~t.b~ished for influenza vaceinatlsn aad how and by whom tthrauld these be a temine&?

a. mat mcormnaenbtSLsns be eatsbllahsa for the use of fnfluenza, vacoine.

b, mereas a conaplets study. of the m%urei an& history of influenza fkldi- mth UU. 5. may be faced with epidemic of major proportions, and

%ereas fn;Bluenza Yaccfne is "being =nufacturered and w a l l 1 become PR- creas;ln@y avaihb1e bu6 i s last yet m i l a b l e for everyone

Now, therefore, be it resolved %b% trhe Surgeon General of %he Public Wealth S e W c s reisomend t o civilian p3roysIcfans that they give priority to:

(1) those individuals whose services are necessary t a maintain the heal-th B;P %he c

(2) theee lndlviduals necessary to msintain other basic community services

(3) persons with tuberculosis and others who i n the opinion of the physiclass constitute a special a e d i a l risk;

and be it fur.liher r e s o l ~ e d tha"hhe C ee on mf2uenga of the W e such ttct;ion aa necessary to assist in aplementaZ;$on o f -these recomendatiouls.

Whereas other basic cornunity rjervices vary frdm place to place, be tld resolved "chat each Ievel o f gmerment be encourezgea t o es tabl ish ad-

%tee@ braes- rspresen;t;aZ;Ive in mI;ure t o conaiaer which groupe are deemed eseeratial 50 reaintain necessary aerilricea.

$&at rea~runencliation should be made r ee rd ing nccinatlan of chil&en?

Adnrinistration of infjltrenza v ims mccfne containing the arsisn s t ra in is approved f o r use in children and that th i s may be inltiEE.eea at abcfut ehree months a f age* Frcrn experience with ear l i e r vaccines evidence has been obtained that a. somewrhzct be t te r 8nt2body response can be obtained In c3ail- dren i f the vwcc%nation is given i n two Injeations instead of one. Tbe doses recmendeid axe as follows :

- 0.1 ee, intraculameously of one t o two we&s.

- 6.5 cc, subeutaneaualy, repeated eks ,

For chLl&en of 13 years of age and older, -the dose f o r adul%s (%,O c.e, aubcutaneous;ly An a single injection) m y be used.

Eow can ac t iv i t i e s of national agencies, news media, m@zfnes, etc . , be success- M l y coordlnsled w l t b S*twLe can6 local. .mtcciaza.tfon prmotion glans?

We comnterad the EHS and a l l the other interested m t i o m l or@nizadions for the excellent mmer i n which they hwe transmf"cted pubZfcfLy and urge them to cant;inue this flne effort.

Special aspects to be consirkred i n prmoting the idlraenza mcedne i n mAat3t.o~ t o $he Salk vaccine,

That the polio vaecinatfon pro and the id luenza vaccinalian pragr6nt be continued a s independent and pamuel progsrurxs,

This res01~bion wi21 be ineluded i n the next CDC mluenza Rezort.

Recamen&t;ion No, 1

That the Swrgeoa OenemL appoint a national c m l s a i o n on inf~uenzcz *to iaentify research and other needs relat ing Lo %he effect of influenza on %he civi l ian popu- ~ a t i o n of the nation, and t o encourage, supportt and cooranate th233~gh exist ing channels, the planning ant% execution of research and other ac t i v i t i e s de s i aed t o nee% these needs. This ecmission should consider not only the urger& problas i n connection with the current epidemic but also the long range problems asso- ciated with the behavior 037 the A ~ i a n and other strainis of id luenza v lms in the population during the next deeaae i n anl;bcipe.tiorr of the emergence of new s t ra ins sctzletbe i n the fi%ure. X t i a suggested thaL t h i s group be similar i n function to the bmed Forces Epidaiolaglca2 Eoard but directed more spee5fically Lo the Consideration of problems of Sdlluenm affecting the c ivi l ian popdation.

ndaticon No. 2

That %he Surgeon CFenelvll (1) establish procedures to study syatemtlcally serime conplimtions of influenz~, p r t i c u l a r l y deafhs and the me%hods of t he i r prevea- Llon, and (2) report theee f indjengs to all interested pmps,