FOR OFXi'XCUL USE ONLY NOT FOR PUBLICATION

V. 3. Department of Health, Education, and Welfare h b U o Health Service Burertu of State Semicets

Cornmicable Disease Center Robert 4 , W e r s s n , Chief

XeitA E. Sensen, Ph, D Robert N, Drachmm, PT. D. CDC Virus and Ricket ts ia Ssctia* Fsgderiek Le Dunn, N, B, i2, O1 Box 61 Xnfluenaa h ~ v e i l l m c e Unit b!o.n.tgomery 1, Alabama C~mnaztnjlceblis Disease Center telephone No. Mherst 3-&68 50 Seventh Straef, MI El

Atlanta 23, Gsargla *Serving as WNO International Tgf sphanle No, TEEldLy 6-3311 Influenza Center f o r t h e h a r f c a a mension 5455

InformerSion contained i n this report 98 a amaxly of data, sepofisd t a CDC by Sta te Health DepartmsnLs, Epidedc In%eU$gence S e r d c e O f ff cers, National O f f i c e of V i t el Statistics, collabora%ing influenss diagnost io labosatariss, and other pertinent Bourses, Much of it 3.8 prsL%min&ry 2x1 na2;ure and i s primwily intended f a r those involved i n influe~nae control &ctS~.tiesa It 2s understood t h a t t he eontents odf these reports wi,11 not be released t o the preas, except by t h e OfPiae o f the Surgeon General, h b U c Health Service, U, S. Department of Health, Education, and Welfara, Steke Wealth Officers, of course, w i l l Judge the &dviaability of releasing any hformation from their o m statss,

I, ry of Information

XI, E;apidmic and Case Reposts 1x1, Progress Reports

I V . Reporta of InflusneicAssoc1~ted Deaths V, 8 m a r y Tables - Cases and Outbreakis

Further evidence of infeetion with Asian s t r a i n influenza has been ob- tained i n Seat t le , Washin@on, and &aha, Nebraska. Bath acute episodes occurred i n l a t e June,

An increasing incidence of f eb r i l e respiratargf disease has been re- ported Prclre Mexico City, Asian stxla3.n o i m e has been Idientifled i n t h r m t mshing~l obtained a t a gir1s"~~hool near the c i t y . This i a the f i r s t instance of'a positive isolat ion of the s t r a i n in a North American country outsiasj the W. 8,

b$ditionaL outbreaks of influen=-like i l lnees have been reported from aevexal chi ldrents c m p ~ , a s t a t e nenlal hospital , and, another j a i l popula- %ion i n California, A fas ther InsLance of lnfZuenza=llke i l l n e s s among Air Force: reservists i n a s es t ra in ing camp Is a l s o noted,

It i s of part icular in te res t t o note t h a t several c i v i l i a n areas hn CaZlfomPa are reported t o be lexperierr:hg m a b a o m l l y increased r e s p i r a t o q i l lness sa%e f a r t h i s aeaaon, An e s t a l e of 5000 has been proposed f o r iru61nnenzalliks illnlessss i n San Diego. An Oakland laospiLaZ reports 200 cases 0% InfJ-uenaa-like i l lness seen i n the OPD during the we% two weeks, Qba University of California a t Berkeley has a l s o repos%ed an increased nwber sf: ~ l i n k v I s f % ~ for fobei le respirwtow dAsease i n the pas% two week@, Paired rsera i rm this l a t t e r group ksas shown a diagnostic t i t e r rise by C-F t e s t fo r type A inPluenza,

With the present Report a regis t ry of influenza-associated deaths i e hewn, Wese nocas~aaiby reprct;asn;t; m&y Lhaac &ea%h8 xep~a;.t;ed t o the Xn- fluenza UnlG, An effor t w i l l be mde Lo present confirmatory evidence of influenza when avai lable, Clinical h i s to r i e s and post-morbem reports with 2&boreh"txy d a b w i l l also be included i n sane d e t a i l when avai lable , S;\xm- mary chart$ w i l l appear once weekly,

I f ,

9 4 . CaX-, F"reswo

(~aported by Dr, P, R. Csndit, California Department of PubJlic Beal th* )

About July 14 an inflluenza-like i l l n e s s outbreak s t a r t e a among imaLes of the Fresno County J a i l . A t l e a s t 3.7 eases have occurred among the J a i l populat%on. Throat wshings and p i r e d sera a r e being exmined a t %he CallfornSa $Sate D ~ e p r b e n t of Public Health laboraa tory.

9-B, CALIFOmLB, San Diego County

( ~ e p o r t e d by Dr. P. K. Cordit, California Depsrtment o f Public 8ealth. )

An outbreak of f e b r i l e respi ra low i l l n e s s affecLing about SO of 250 boys laL a Pacific Beach mi l i ta ry a c a d w s t a r t e d about SFu3.y 1 4 , &$red aera a re t o Be obtained,

Qther reports indicate tha t there have been an est-ted 5000 e iv i l i an cases of influenza-l&e i l h e s a i n the San Diego area. Numn~r- . .

Qua Saa Diego mi l i t a ry caws orted greviouely (see C X Infltlenza Report 1-6)

OHTO, Cleveland 9-4, ( ~ e p o d e d by D r . Willim J o r b n , tqestern Reserw University, College of' Medicins.)

l lhe 217yeas-old s i s t e r of a p r s v i o u ~ l y reported confimed case of influenza (CDC Influenza Report, 4-F) was hospitalized with an in- fluenza-like illness on June 12, Her "co children were 113, with w similar but milder i l l n e s s on June 9 , The previoutirly regofied eister became ill on June 16, Evidence of' infection with Asian s t r a i n in - fluenza i n the present patierz-t WE~S demonstrated by a fourfold rise In antibody t i t e r ,

9-D, NEWSKJPI, Omaha

( ~ e p o r t e d by D r , E , A, Rogerts , Nebraska DegarLnent of Neal tb, and Ivlrs , Belen Reihart, University of Nebraska, College of Medicine, ) I

Cortvaleacent blood specimens from a University facul ty amber iread his wife ~koved FI-I: t i t e r s of 1:5P20 against Asian strtkin 1331Plu- enza virus. Both had wgerienced a mild i&kuenza-like i l lnees l a t e fn June, Bloods were tlralm Lhree and four weeks a f t e r onset, Addim Lional sporadic chsaee of nlPd i e luenza - l ike i l lneaa have been noted i n the sme b e p r h e n t of the University,

9 - E , ElaE?IICO, - Mexico D, F,

(.Reported by Dr , Guillemo E. S a m e , Pan American h n i t a r y Bureau, )

About Ju ly 15 an increase in f eb r i l e respiratory infection was notea i n Mexico City. In the week ended July 22, there w a ~ & very high a t tack r a t e outbreak i n a girlst sehool near Mexico City, Throat wshings were ob-tained and forwarded .blo CDC, Asian str~in influenza virus has been obtained Prom these specbens,

9nF. CALIFOmIA, SanLa Cllara and Calavesas Counties

( ~ e p a r t e d by Dr. 8. M, Moldenhauer, California Depar-2;aent of Public Health. )

In a Santa Clara C.ounvtiy ch i la ren ' s camp, there have been 70 cases of isnfluenza-like illness a o n g 100 children between 13-15 years of age. Blood spec&ens are being obtained, In anather children's cmp i n Galaveras County a t leeat 60 of 400 childsen isrtmilarly have became ill, Paired s e m are being obtained here, a lao .

( ~ e p o r t ed by Dr. R Fi, M, MoSdenhauer , California Ilepartnenl of Pw'alic Health. )

A t leas% 120 case$ of' febrile r e ~ p i r a t o r y i l l n e s s have o c e u s ~ d

won@: 500 A i r Force Beaervists from Oregon and Washln@an, i n %rain- ing i n h t t e County, Paired sera are being collected.

9 -He CALTFORNXA, Sonma County

(~epof i ed by D r . R . M. Moldenhauer, ~ a l i f o r n l a DeparWent of PUblic Meal%h * )

Ab0u.t; 100 cases df influenza-Like ilEness h ~ v e appeared era, four w r d s o f the Son- County State Mental Ilosgital within the *st Pew b y s , Throait; waehiags have been obtained and p i r e d esra w i l l be collected,

1x1.

9 4 , FlAGHINGTON, Seattle (8ee CDC Influenza Repart 5 4 , 6-C) -- (~epa~2;ed by X3r* R , T, Ravenholt, Seattle-Kin& County Dewhenit; of Wblic Ifeal%h. )

Convalescent bbaod speclmons o b t a i a ~ 8 'rrm four semen abmrd Ghc U,S,S, b n n have shorn a d i a ~ o s t i c titer r i se t o Asian a t r a i n influenza virus The U ,S ,El. &hnn arrived in Seattle an July 18. Of Lhe 2000 abwsd, 320 had deveLope8 an influenza-l&a i l h e s s ,

Aboard the M,9* Patrick, a merchant sawan arrived i n SaatiSle on July 1 with an scute influenza-like i l l n e s s , His shtp had l e f t Korea about June 15, A convalescent blood specimen drawn QM duly 19 showed a diamlostic t i t e r r i s e t o Asian sGrain influenza v i m s .

I( f n f o m t i o n reported by Drs . B. K. Condit and R. M, Moldenhauer , California Department o f Health, )

Listed below are deaths reported do the CDC XriP1uenza 51Llmreillance Unit as being associated wl%h influenza. Aaditional i n f o m t i o n rela&Sni[?: .to cases l i s t e d here as well as fbr ther reports o f deaths w i l l be included as they are received, Selected case h i s lo r i e s ineluding autopsy, virological and bacteriological P i~d ings tdEl be included as appropriate,

Cal ___I 1 On JuLy 7 a 56-yeas-old m3.e developed an f&Luenza-llke i l l n e s s , &n July 16 he died st Mercy Hospital, 9an Diego, Cnlifornis, of' bronchopneu- monia, codimned at atuopsy, One blood specben has shown a t i t e r o f I:64 by complement-fixation tas"t;for fnfluemlza A, Date of blaod specwen is not known, Further laboratory rest.&ts a re natr yet swilabl le ,

Ca1 2 A 44-year-old mole, with a known hiatory of cardiac disease, devel- - operan influenza-like i l lness on July 17 and died in San Diego four b y e laLer. The d i a ~ o s i s of' influenza was mde sole ly on o l i n i w l grcnnnds. A post-mortem examination was not perfomed,

A 12-year-old m l e was a t a r c a p , ap~rraren*ly In the Sa-n Diego area , when he develgped a mild f e b r i l e respiratory i l lness . One day a f t e r onsek, while on a h-e, he oollbpsed anti died. Diagnosis of ifl luenza was again c2in ica l and postaortcem report is not yet available.

Cab 4 On July 25 a- 25-year-old f em2e developed influenza--a, olinicail .111).-...-.3.

diagnosis--and dded three days l a t e r with a diagnosis of' "congeetion of" the le f t lung," She was pregnant aC the Line. No autopsy was perf"omed.

A 57-year-ald female served as a leader at n teen-age g i r l n 7 confer- ence a t Davis, California, from June 20-29, 3he l i v e d in close contact with t h e other pam*tlcipnts* During the conference influenza-like i l lness aggeared i n approx-tely 57% of .the group (see CDC Znfluenza Reports l-G and 3-5). On June 29 the pat ient beeme 113; by July 3 her condition had deter iora ted cons3derably. She was hospitalized, developed auricular fib- rll latxion and cardiac fa i lu re , and died on July 4, A feukeaoid reaction was noted on adnissioa t o the hospital and, pr ior t o death, a count showed 127,008 white ce l la with $o$ lylrsphooytes, A t poet lmortem exwinstion find- in69 were "eonsister& with an acute toxic mr;yocarditis o f the type wssocAaeed with v i r a l infectfone;," The leaemoid reaction ha$ not been explained, There was nothing i n the pa t i en t ' s p a t his tory o r previous blood c a m l s %a suggesS, chronic leukemia., Further bone marrow exminations are unaerway. Asian s t r a i n influenza has been conflmed frm the &via outbreak, but gera and throat washings 'were no% t;ob%ained from the p&%i@n%.

Cal 6 A 20-yesr-old seaman a t the Mare Island Naml StaGion, Vallejo, Gala- - fornla , developed, on June 10, 3,957, s f e b r i l e respiratory i l lneaa which was diagnose8 eZixllcrzlZy as influenza* Me was hospitalized tha t day and died three b y s l a t e r with b i l a t e r a l lobar pneumonia confirmed &L m t ~ p s y . M, pyogenes var , aureus, resia.t;ant Lo nost ant ibiot ics , m a responsible for t h e gnewnonia ,

Cal 7 A 34-year-old f w l e died on July 15 a t Mercy Eorapital, Sara Diego, I__

w i t h a d i s g n ~ a i s of " f i b l m t i n p influenza1 pxllemonia." Further details &re not avai lable at t h i s t h e ,

Several other deaths i n San Diego, apparently related t o influenza, &re presently under investigation, &n addilioh,ono crew member of' 'bhe U,S,S, Presiden'c Cleveland i s known t o have died after developing influenza during -%he outbreak on tha t ship i n June.