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Influenza surveillance report no. 77, June 14, 1963
  • Published Date:
    June 14, 1963
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Influenza surveillance report no. 77, June 14, 1963
  • Corporate Authors:
    Communicable Disease Center (U.S.), Influenza Surveillance Unit. ; United States, Public Health Service., Office of the Surgeon General., Advisory Committee on Influenza. ;
  • Series:
    Influenza surveillance report ; no. 77
  • Document Type:
  • Description:
    I. Summary -- II. Epidemic reports -- III. International summary -- IV. Special reports -- V. Laboratory report -- VI. Pneumonia influenza mortality -- VII. Surgeon General's Advisory Committee on Influenza: Recommendations for influenza immunization and control in the civilian population

    "Epidemics of influenza-like disease became widespread in several areas of the Eastern United States during January. The first confirmed outbreak of the season began early in the month in Robeson County in southern North Carolina. Adjacent counties in North Carolina and contiguous areas of South Carolina became progressively involved. By February 15, outbreaks of inf1uenza-like il1ness had been reported from the District of Columbia and 15 States, including North Carolina, Maryland, Virginia, Delaware, Kansas, Illinois, Georgia, Maine, Vermont, South Carolina, New York, Massachusetts, Ohio, Kentucky, and West Virginia. Influenza A2 virus had been confirmed by isolation or by serologic titer rise as the causative agent in outbreaks in the District of Columbia, North Carolina, Maryland, Kansas, New York, and at the Great Lakes Naval Training Station in Illinois. During the month of January, the pattern of spread of disease confined itself to a northerly and southerly direction along the Atlantic Seaboard. The early confirmed outbreaks in Kansas City and Chicago areas occurred in rather specialized population groups, and it was not until February that: community-wide outbreaks were seen in these areas. Figure 1 shows the distribution of outbreaks through February 15. In early February, outbreaks in West Virginia, Kentucky, and Ohio suggested the beginning of a westerly spread, which was confirmed when, by late February J large segments of Middle 'Western and South Central States became involved. By the first week of March, outbreaks of influenza-like disease had been reported from the District of Columbia and 35 States, all east of the Rocky Mountains with the exception of focal outbreaks in Montana and Arizona. Influenza A2 virus was implicated as the etiologic agent in one or more outbreaks in twelve more States including Connecticut, Delaware, Georgia, Iowa, Massachusetts, Michigan, Minnesota, New Jersey, Ohio, South Carolina, Virginia, and Wisconsin. By early March, outbreaks were subsiding in most affected areas of the East and Middle West. The pattern of epidemic spread, however, continued a westerly course, although the extensive, often state-wide, involvement which characterized earlier outbreaks on the Eastern Seaboard was not frequently observed as the epidemic moved westward. Among the Mountain States, Colorado, Idaho, and Utah reported outbreaks for the first time, and the West Coast States of Alaska and California began to experience outbreaks. In mid-March, the State of Washington reported two focal outbreaks. A small focal outbreak also occurred in Wyoming about this time. By late April, one or more outbreaks of influenza-like disease had been reported from the District of Columbia and45 States. Only the States of Florida, Hawaii, Nebraska, Nevada, and New Mexico failed to report increased incidences of this syndrome. InfluenzaA2 virus was implicated as the causative agent of one or more outbreaks in the District of Columbia and a total of 34 States, with the States of Arizona, Arkansas I California, Colorado, Indiana, Kentucky, Louisiana, Missouri, Montana, North Dakota, Pennsylvania, Rhode Island, Tennessee, I Utah, Vermont, Washington, and West Virginia, now added to the list. With the exception of the State of Alaska, where widespread community epidemics occurred during the months of March and April, the West Coast States were notable for the lack of demonstrated community involvement. The State of California represents an interesting example of this phenomenon in which the presence of influenza A2 virus was demonstrated over large areas of the State through serologic confirmation in sporadic cases, but in which outbreaks could be demonstrated largely only in institutional environments. In general, the force of the epidemic, in its capacity for large scale community involvement tended to dissipate as the epidemic moved west. Figure 2 shows the distribution of outbreaks for the epidemic as a whole. Conspicuous by its absence during this epidemic was the widespread excess secondary school absenteeism so markedly associated with the 1957 influenza A2 epidemic. This observation was, in part, confirmed by surveys of age specific attack rate in selected areas of epidemic prevalence, where a marked flattening of the attack rate curves was demonstrated in the age groups 10-19. (See Influenza Surveillance Report No. 76, page 14). For the epidemic as a whole, the only influenza agents implicated by isolation have been strains of influenza A. No isolations of influenza B strains were reported to the Influenza Surveillance Unit during the entire season. The contemporary A strains showed relation, through hemagglutination inhibition to the A2/Jap 305/57 prototype, and are clearly members of the A2 subtype. That a certain amount of .antigenic drift away from the 1957 prototype has occurred is also clearly demonstrated in reciprocal cross hemagglutination inhibition tests using both ferret and rooster immune antisera. Studies at the Respirovirus Unit, Communicable Disease Center would also indicate that this is a continuance of a drift noticed with the appearance of the A2lJap 170/62 prototype strain, in that certain contemporary U. S. isolates would appear to vary antigenical1y as much from A2lJap 170/62 as A2/ Jap 170/62 varies from A2lJap305/57. On May 27 the Surgeon General's Advisory Committee on Influenza met to consider recommendations for the coming year (See Part VII of this Influenza Surveillance Report). Of particular note was the agreement on the prediction that widespread outbreaks of influenza are not likely to occur during the coming winter season. Of further note was the decision to change the current civilian polyvalent vaccine from a four-strain to a six-strain material-with the addition of one more contemporary strain each of A2 and B. The total CCA unitage of the new vaccine will be 600 instead of the current 500, the total CCA unitage of the combined A2components remaining, as before, at 200, and the total unitage of the B components being increased by 100. Also of interest was the increased disparity between the composition of the military vaccine (continuing the old four-strain 1000 CCA unit/ml composition for the coming season) and the new civilian vaccine. The decision to incorporate a new A2 strain into the civilian vaccine, though the new AZ/Jap 170/62 prototype reflects only variation within the subtype and not a major antigenic shift, would seem to reflect an underlying assumption that variations within a subtype may affect vaccine efficacy. During the season there were few adequate studies of vaccine efficacy. However, studies, to be described later in this report, would tend to question the efficacy of the current vaccine in the specific populations considered. One of the studies, in particular, poses the question of whether influenza vaccine induced H. I. antibody is related to vaccine protection. Pneumonia-influenza deaths in the 108 cities first exceeded the epidemic threshold in early January and reached a peak during the week ending March 16. Deaths fell to below threshold levels during the week ending April 13 and have remained so to the present." - p. [1]-5

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