Annual report of the Bureau of Vital Statistics of the North Carolina State Board of Health

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ANNUAL REPORT
OF
PUBLIC HEALTH
STATISTICS SECTION
PART I
COMMUNICABLE DISEASE
MORBIDITY STATISTICS
1958
NORTH CAROLINA STATE BOARD OF HEALTH
EPIDEMIOLOGY DIVISION
J.W. R. NORTON, M. D.
Secretory
and State Health Director
TABLE OF CONTENTS
Page
Introduction 1
TABLES
1. Estimated Population by Color: North Carolina and Each County, July 1, 1958 3
2. Estimated Population by Color and Sex: North Carolina, 1936-1958 4
3. Cases of Reportable Commimicable Diseases by Disease and Year of Report: North
Carolina, 1918-1958 5
4. Morbidity Rates Per 100,000 Population for Selected Reportable Communicable Diseases
by Disease and Year of Report: North Carolina, 1943-1958 9
5. Cases of Reportable Communicable Diseases by Disease and County of Residence: North
Carolina, 1958 10
6. Cases of Reportable Communicable Diseases by Disease and Month of Onset: North
Carolina, 1958 24
7. Cases of Reportable Communicable Diseases by Disease and Age: North Carolina, 1958.. 25
8. Cases of Reportable Communicable Diseases by Disease, Color, and Sex with Rates Per
100, 000 Population: North Carolina, 1958 26
9. Cases of Gastro-enteritis by County of Residence, Type, and Color: North Carolina,
1958 28
10. Cases of Pre'/iously Untreated Gonorrhea by County of Report, Type, Color, and Sex:
North Carolina, 1958 31
11. Cases of Infectious Jaundice by County of Residence, Type, and Color: North
Carolina, 1958 7 35
12. Cases of Poliomyelitis by County of Residence, Color, Paralytic Status, and Month of
Onset: North Carolina, 1958 36
13. Cases of Previously Untreated Syphilis by County of Report, Stage, Color, and Sex:
North Carolina, 1958 38
14. Cases of Previously Untreated Syphilis by Stage, Color, and Sex with Rates Per
100,000 Population: North Carolina, 1940, 1950, and 1958 * 41
15. Cases of Previously Untreated Congenital Syphilis by Year of Birth, Year of Report,
and Color: North Carolina, 1951-1958 42
16. Cases of Tuberculosis, All Forms, by County of Residence, Type, Stage, Activity, and
Color: North Carolina, 1958 44
"\
INTRODUCTION
Communicable disease morbidity statistics for North Carolina for 1958 are given in this
bulletin as Part I of the Annual Report of the Public Health Statistics Section. This is the
twenty-seventh year for which such a bulletin has been published. Natality and mortality data will
be published as Part II later in the year.
A discussion summary of the reportable communicable disease situation in the state is given
on the next page. Following this are population estimates and general summary tables showing the
reported incidence of reportable communicable diseases in 1958 by county, age, month of onset, sex,
and color. More detailed summaries are also given for certain selected diseases.
SOURCE OF DATA
These data were derived from report cards received from military baseSj local physicians,
health departments^ and hospitals in North Carolina, and through interstate reciprocal notification
of disease. Routinely all death certificates which list a reportable communicable disease as a
cause of death are checked against the case report files. Case reports are then obtained for all
previously unreported cases. Information on trends may be obtained by reference to the 1953 report.
More detailed data than that published in this report have been tabulated and will be made available
upon request.
REPORT PERIOD
The data included in this report are for cases of communicable disease which had their onset
in 1958 with the exception of amebiasis, tuberculosis, and the venereal diseases which are according
to date of report. Reports of all cases having their onset in 1958 and received during the period
January 1, 1958 to January 31, 1959 and those with unknown date of onset received in 1958 are in-cluded.
For those diseases tabulated by date of report, all reports received during 1958 are in-cluded,
regardless of onset date.
RESIDENCE
The cases included in this report, with the exception of the venereal diseases, are for resi-dents
of North Carolina and are allocated to county of residence of the patient. Venereal disease
cases are allocated to county of report unless reported by a hospital or institution; in which
case they are assigned to the county of residence. Only those counties for which cases were re-ported
are shown in the residence tables.
All rates shown are per 100,000 population. A 16-year trend in morbidity rates for selected
reportable communicable diseases is shown in table 4. Rates for 1958 by sex and color for all re-portable
diseases are given in table 8.
North Carolina population estimates by coimty and color, 1958 and by color and sex, 1936-1958
are given in tables 1 and 2, respectively.
Population estimates for 1936-1950 are those prepared by the U.S. Bureau of the Census. For
the years 1951-1958, estimates were made by the Public Health Statistics Section. The arithmetic
method, which assumes the same average annual increase or decrease for the decade 1950-1960 as
occurred between 1940 and 1950, was used for estimating the total population. Sex and color esti-mates
were obtained by this same method.
DISCUSSION
As in the recent past, the 1958 communicable disease experience in North Carolina shows favor-able
trends in case control. No epidemic, such as the epidemic of Asian influenza recorded in 1957^
was noted. However, Asian influenza did occur in Okracoke Island in March 1958, several months
after the peak incidence in the state as a whole.
For the second successive year anthrax was not reported. Cases of anthrax recorded in 1953,
1955 and 1956 were industrial in type and related to processing of imported goat hair used in manu-facture
of coat linings.
Cases of diphtheria reported numbered 32. Control of diphtheria has been among the more effec-tive
of the public health programs. A steady decline in cases from 550 reported in 1949 is reflec-ted
in the fall in case rate from 14.2 per 100,000 popiilation in that year to 0.7 per 100,000 popu-lation
in 1958. Wilson Coimty reported 4, Franklin and Lenoir Counties reported 3 cases each.
Gastro-enteritis, a category containing salmonellosis, shigellosis and transmissible gastro-enteritis
of undetermined etiology, showed an increase in cases from 327 in 1957 to 427 in 1958.
While reported cases may indicate a true rise in incidence it is possible that current interest and
intensive investigation of outbreaks has resulted in better reporting by medical personnel. Control
of gastro-enteritis remains an important part of commtmicable disease activities.
Infectious hepatitis cases fell from 110 in 1957 to 75 in 1958. The disease was first made
reportable in 1952 when 675 cases were recorded. In the following year 1953, there were 1,142 cases.
Since then, a steady fall in incidence from 27.1 (1953) to 1.7 (1958) per 100,000 population has in-dicated
promise of control of this disease. Much, however, remains to be learned before control can
be assured.
Six cases of malaria were reported. All were extraterritorial in origin, five of the six
persons were male military personnel. The sixth individual was a young woman who acquired infection m Pakistan. The service men contracted infection in Thailand (1) and Okinawa and Philippine Islands
area (4). Pour patients showed true initial attacks, one a recurrence and the civilian case repre-sented
an attack following a new exposure (two previous attacks followed a similar stay in Pakistan,
1952).
Evaluation of poliomyelitis by individual case study revealed a striking reduction in incidence
of this disease when comparison is made with the preceding year. Total cases declined from 233 to
74 and paralytic cases declined from 52 to 37. Of the 37 paralyzed individuals, 29 were white; 8
nonwhite; 22 were under 5 years of age; 25 had received no poliomyelitis vaccine; 4 had received the
complete series. Exactly 50 per cent of the cases reported were of the paralytic type; in 1957
paralytic cases constituted 22.3% of the total reported and in 1956 paralytic cases made up 56.8^ of
the cases. In each of the past 2 years Coxsackie and ECHO virus infections have made interpretation
of poliomyelitis data, especially in the nonparalytic category, difficult.
Only 2 cases of psittacosis were noted in 1958. A striking decline from the 75 cases noted in
1956 was also seen in 1957 when 4 cases were recorded. It is hoped that ca-se levels will remain low
under the impact of educational programs sponsored by health agencies and the bird industry itself.
Cases of Rocky Mountain Spotted Fever fell from 37in the preceding year to 25 in 1958. Twenty-four
cases occurred from May through August; 21 of the 25 were less than 15 years of age, 13 were
under age 8, and 10 under age 6. While many factors establish age pattern, unawareness of tick
attachment and failure to remove the attached ticks from young children undoubtedly plays a role.
A case of trichinosis was not reported in the year. Only 3 were reported in the previous year.
Whether absence of recorded disease means true absence cannot be stated with certainty since trichi-nosis
may be so mild as to escape medical attentions. Methods of pork preparation in North Carolina
minimize possibility of disease transmission.
Twelve cases of tularemia were reported in each of the past 2 years. Eight cases occurred during
the rabbit hunting season; 4 related to tick bites occurred in summer. Age distribution studies
show that 9 of 12 were seen in individuals 20 years of age or older. Males accoimted for 10 of the
cases. Of particular interest were 2 cases occurring in a husband and wife. Rabbits had been
dressed by the husband and put to soak in salt water overnight in a sink. On the following morning
the wife removed the carcasses from the sink and placed them in a deep freeze box. A hand lesion
was seen in each case. Response to streptomycin therapy was prompt.
Typhoid fever cases were 17 in number. Three counties contributed 2 cases each. No connected
case outbreak occurred. Cases were evenly distributed through the year, with the exception of Feb-ruary
and March during which no case occurred. With the present pat-Cern of individual case and
carrier relationship, cases are seen at all seasons of the year. Eight cases occurred in persons
under 10 years of age; two cases were seen in persons over age 65.
Undulant fever experience was a favorable one with 7 cases notified in 1958 in comparison with
12 in the like period, 1957. All cases could be traced to cattle or swine contact. All cases were
adults; 5 were males and 2 were females. No county accounted for more than a single case.
Cases of tuberculosis were essentially unchanged from the previous year. Case rate per 100,000
population, however, because of estimated changes in population fell from 37.4 (1957) to 36.6 (1958).
While this change is too small to carry great weight, it is of interest that the present rate is the
lowest yet recorded in North Carolina.
Cases of venereal diseases generally declined from the 19,439 reported in 1957 to 16,586 report-ed
in 1958. A decrease of cases was seeninboth gonorrhea and syphilis. In the latter disease cases
fell from 5.219 (1957) to 4,298 (1958). While the general reduction of cases of syphilis is encour-aging,
it should be noted that cases of previously imtreated syphilis in a communicable stage actually
increased from 192 (1957) to 251 (1958). Cases of previously untreated congenital syphilis fell from
300 in 1957 to 197 in 1958. Many of these cases are of several years standing. In 1957 a total of
14 cases of congenital syphilis was reported as having birth in 1957; in 1958 only 5 cases were reported
as having birth in 1957; in 1958 only 5 cases were reported as having birth during the year, indicating
effective progress in control of this important manifestation of syphilis. Ophthalmia neonatorum was
diagnosed in 10 individuals in 1957 and in 16 in 1958. Over the past 40 years cases have varied from
a low of 3 in 1948 to a high of 33 in 1919. Data were not available for the years of 1944-1945. The
mean n\amber of cases from 1918-1958 (excluding 1944-5) is 13.6. Other forms of venereal diseases
were _ essentially unchanged in number with 165 and 163 cases recorded in 1957 and 1958, respectively;
within the categories, however, chancroid declined from 125 to 109 cases and lymphogranuloma venerun:
increased from 10 to 21 cases.
Symbols Used in Tables
- Number or rate is zero
/ Disease was not reportable
N.A. Data was not available
0.0 Rate is more than but less than 0.05
ANNUAL REPORT OF MORBIDITY STATISTICS
TABLE
NORTH CAROLINA STATE BOARD OF HEALTH
ANNUAL REPORT OF MORBIDITY STATISTICS
-- CASES OF REPORTABLE COMMUNICABLE DISEASES BY
NORTH CAROLINA, 1918- 1958
ISEASE AND YEAR OF REPORT'
Disease
NORTH CAROLINA STATE BOARD OF HEALTH
ANNUAL REPORT OF MORBIDITY STATISTICS
TABLE 3. -- COMMUNICABLE DISEASES --
NORTH CAROLINA STATE BOARD OF HEALTH
ANNUAL REPORT OF MORBIDITY STATISTICS
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 5. — CASES OF REPORTABLE COMMUNICABLE DISEASES BY
DISEASE AND COUNTY OF RESIDENCE*: NORTH CAROLINA, 1958
Disease
ANNUAL REPORT OF MORBIDITY STATISTICS
TABLE 5. -- COMMUNICABLE DISEASES ~ Continued
Disease
NORTH CAROLINA STATE BOARD OF HEALTH
T4BLE 5. ~ COMMUNICABLE DISEASES — Continued
Disease
ANNUAL REPORT OF MORBIDITY STATISTICS
TABLE 5. -- COMMUNICABLE DISEASES -- Continued
Disease
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 5. -- COMMUNICABLE DISEASES -- Continued
Disease
ANNUAL REPORT OF MORBIDITY STATISTICS
TABLE 5. -- COMMUNICABLE DISEASES — Continued
Disease
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 5. -- COMMUNICABLE DISEASES -- Continued
Disease
ANNUAL REPORT OF MORBIDITY STATISTICS
TABLE 5. — COMMUNICABLE DISEASES — Continued
Disease
NORTH CAROLINA STATE
TABLE 5. — COMMU.NICABLE DISEASES ~ Continued
Disease
ANNUAL REPORT OF MORBIDITY STATISTICS
TABLE 5. -- COMMUNICABLE DISEASES - Continued
Disease
NORTH CAROLINA STATE BOARD OF HEALTH
COMMUNICABLE DISEASES
Disease
ANNUAL REPORT OF MORBIDITY STATISTICS
COMMUNICABLE DISE^SES -- Continued
Disease
KORTH CAROLINA STATE BOARD OF HEALTH
COMMUNICABLE DISEASES -- Continued
Disease
ANNUAL REPORT OF MORBIDITY STATISTICS
TABLE 5- — COMMUNICABLE DISEASES — Continued
Disease
NORTH CAROLINA STATE BOARD OF HEALTH
Si
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ANNUAL REPORT OF MORBIDITY STATISTICS
CM ir> ro 1 h-
ANNUAL REPORT OF MORBIDITY STATISTICS
TABLE II. -- CASES OF INFECTIOUS JAUNDICE* BY COUNTY OF RESIDENCE,
TYPE AND COLOR: NORTH CAROLINA, 1958
1
Area
NORTH CAROLINA STATE BOARD OF HEALTH
NORTH CAROLINA STATE BOARD OF HEALTH
Q-
1 1 1 Locrj
II
II a.
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 15. — CASES OF PREVIOUSLY UNTREATED CONGENITAL
NORTH, CAROLINA,
Year of
1951-1958
White
Non-
White white
1956
Total 2, 33
226 2, 105 197 261
ANNUAL REPORT OF MORBIDITY STATISTICS
YEAR OF BIRTH, YEAR OF REPORT, 4ND COLOR:
Report
1955
NORTH CAROLINA STATE BOARD OF HEALTH
TABLE 16. — CASES OF TUBERCULOSIS, ALL FORMS, BY COUNTY OF
ANNUAL REPORT OF MORBIDITY STATISTICS
RESIDENCE, TYPE, STAGE, ACTIVITY, AND COLOR: NORTH CAROLINA, 1958
Pulmonary
Primary
Act i ve
NORTH CAROLINA STATE BOARD OF HEALTH
ANNUAL REPORT OF MORBIDITY STATISTICS
TUBERCULOSIS — Continued
Pulmonary
Primary
Active