CENTERS FOR DISEASE CONTROL

August 28, 1981 / Vol. 30 / No. 33

Epidemiologic Notes and Reports
409 Follow-Up on Kaposi's Sarcoma and
Pneumocystis Pneumonia
ACIP Recommendation
410 Pneumococcal Polysaccharide Vaccine

MORBIDITY AND MORTALITY WEEKLY REPORT

Epidemiologic Notes and Reports
Follow-Up on Kaposi's Sarcoma and Pneumocystis Pneumonia
Twenty-six cases of Kaposi's sarcoma (K S) and 15 cases of Pneumocystis ca rin ii pneu
monia (PCP) among previously healthy homosexual men were recently reported [1,2).
Since Ju ly 3, 1981, CDC has received reports of an additional 70 cases of these 2 condi
tions in persons without known underlying disease. The sex, race, sexual preference, and
mortality data known for 108 persons with either or both conditions are summarized
n Table 1.
The majority of the reported cases of KS and/or PCP have occurred in white men.
Patients ranged in age from 15-52 years; over 95% were men 25-49 years of age. Ninetyfour percent (95/101) of the men for whom sexual preference was known were homo
sexual or bisexual. Forty percent of the reported cases were fatal. Of the 82 cases for
which the month of diagnosis is known, 75 (91%) have occurred since January 1980, with
55 (67%) diagnosed from January through Ju ly 1981. Although physicians from several
states have reported cases of KS and PCP among previously healthy homosexual men,
the majority of cases have been reported from New York and California.
R eported b y SM Friedman, M D, YM Felman, M D, N ew York C ity D ept o f H ealth; R Rothenberg,
MO, State Epidem iologist, N ew York State D ept o f H ealth; S D ritz, M D, E B ra ff, M D. C ity/C o u n ty
Health Dept, San Francisco; S Fannin, M D, Los Angeles C ounty D ept o f Health Svcs; / H eindl, M D,
C alifornia D e p t o f Health Svcs; R K Sikes, D V M , State Epidem iologist, Georgia D e p t o f Human Re
sources; RA Gunn, M D, State Epidem iologist, F lorid a State D e p t o f Health a nd R ehabilitative Svcs;
MA Roberts, PhD, State Epidem iologist, Oklahoma State D e p t o f H ealth; Task Force on Kaposi's
Sarcoma and O pportunistic Infections, Center fo r Prevention Svcs, Center fo r Infectious Diseases,
Center fo r Environm ental Health, F ield Svcs Div, Consolidated Surveillance and Com munications
A ctivities, Epidem iology Program O ffice, CDC.

Editorial Note: KS is a rare, malignant neoplasm seen predominantly in elderly men

in this country. In elderly men the disease is manifested by skin lesions and a chronic
clinical course; it is rarely fatal (3). In contrast, the persons currently reported to have
KS are young to middle-aged men, and 20% of the cases have been fatal. Although some
of the patients have presented with the violaceous skin or mucous membrane lesions
TABLE 1. Cases of Kaposi's sarcoma (KS) and Pneumocystis c a rin ii pneumonia (PCP)
reported to CDC with dates of onset between January 1976 and July 1981
Diagnosis
(number of patients)
KS and PCP (N7)
KS only (N -4 7 )
PCP only (N -5 4 )
Total (N -1 0 8 )

Sexual preference of men

Sax

Race of men

Male Female White

Black Hispanic Unknown

or bisexual

Heterosexual Unknown

Fatality
(percentage)

7
47
53

0
0
1

5
41
33

0
3
9

1
3
7

1
0
4

7
44
44

0
1
5

0
2
4

3 /7
8 /4 7
3 2 /5 4

(43%)
(17%)
(59%)

107

79

12

11

96

4 3 /1 0 8 (40%)

U.S. D EP A R TM E N T OF H E A LT H A N D H U M A N SERVICES / PUBLIC H EA LTH SERVICE

410

MMWR

August 28, 1981

Kaposi's Sarcoma C ontinued

typical of KS, many such lesions have been initially overlooked. Other patients have
been diagnosed by lymph-node biopsy after a prodrome consisting of fever, weight loss,
and lymphadenopathy. Seven (13%) of fifty-four KS patients also had PCP. In many
cases the histopathologic diagnosis from skin, lymph node, or visceral-lesion tissue has
been difficult even in specialized hands.
The occurrence of Pneumocystis c a rin ii pneumonia in patients who are not immunosuppressed due to known underlying disease or therapy is also highly unusual (4). A l
though 7 (11%) of the 61 patients with PCP also had KS, in many instances pneumonia
preceded the tumor. Although most of the patients with PCP reported recent respiratory
symptoms, some gave a history of weeks to months of systemic symptoms including
weight loss and general malaise, similar to the prodrome described by patients who devel
oped lymphadenopathic KS. Several of the patients with PCP had other serious infec
tions, including gastrointestinal candidiasis, cryptococcal meningitis, and disseminated
infections with Mycobacteriaceae and herpes simplex. Many of the PCP and KS patients
have had positive cultures or serologic evidence of infection with cytomegalovirus.
The apparent clustering of both Pneumocystis c a rin ii pneumonia and KS among homo
sexual men suggests a common underlying factor. Both diseases have been associated with
host immunosuppression (4-6), and studies in progress are showing immunosuppression in
some of these cases. The extent or cause of immune suppression is not known. Physicians
should be aware of the possible occurrence of these diseases and other opportunistic
infections, particularly among men with symptoms suggestive of these disorders or their
prodromes, since therapy is specific and verification of the diagnosis requires biopsy.
Several state and local health departments and CDC are conducting active surveil
lance for KS, PCP, and opportunistic infections in persons without known predisposing
underlying disease. A national case-control study will be implemented shortly.
References
1. CDC. Pneumocystis pneumonia Los Angeles. M M W R 1981;30:250-2.
2. CDC. Kaposi's sarcoma and Pneumocystis pneumonia among homosexual men New York City
and California. M MW R 1981;30:305-8.
3. Safai B, Good RA . Kaposi's sarcoma: a review and recent developments. CA 1981 ;31:1-12.
4. Walzer PD, Perl DP, Krogstad D J, Rawson PG, Schultz MG. Pneumocystis c a rin ii pneumonia in
the United States. Epidemiologic, diagnostic, and clinical features. Ann Intern Med 1974;80:
83-93.
5. Penn I. Kaposi's sarcoma in organ transplant recipients: report of 20 cases. Transplantation 1979;
27:8-11.
6. Gange RW , Jones EW. Kaposi's sarcoma and immunosuppressive therapy: an appraisal. Clin Exp
Dermatol 1978;3:135-46.

Recommendation o f the Im m unization

Practices A dvisory Committee (ACIP)

Pneumococcal Polysaccharide Vaccine

IN TR O D U C TIO N
Polyvalent polysaccharide vaccine against disease caused by Streptococcus pneumoniae
(pneumococcus) was licensed in the United States in 1977. This statement includes a
summary of current knowledge about the vaccine and a guide to its use in selected per
sons and groups.

Vol. 30/No. 33

411

MMWR

A C IP Recommendation fo r Pneumococcal Vaccine C ontinued

VAC CINE-PR EVENTA BLE PNEUMOCOCCAL DISEASE
Data on the precise occurrence of serious pneumococcal diseases in the United States
are not available. Estimates come from limited surveys, research reports, and several
community-based studies (Table 2).
Community studies indicate that pneumococcal pneumonia usually represents less
than 25% of all cases of pneumonia. Yet, it remains an important problem, even in the
antibiotic era, because of the substantial annual numbers of cases and deaths that occur.
Pneumococcal pneumonia occurs in all age groups, although incidence increases with
age over 40 years. Pneumococcal meningitis is seen primarily in young children, particu
larly those <2 years old. Mortality from pneumococcal disease is highest in patients who
have bacteremia or meningitis, in patients with underlying medical conditions, and in
older persons.
Patients with certain chronic conditions are clearly at increased risk of developing
pneumococcal infection as well as experiencing more severe pneumococcal illness. These
conditions include sickle cell anemia, multiple myeloma, cirrhosis, renal failure, splenic
dysfunction, and having had a splenectomy or organ transplant. Other patients may be
at greater risk of developing pneumococcal infection or having more severe illness as a
result of being alcoholic or having diabetes mellitus, congestive heart failure, chronic
pulmonary disease, or conditions associated with immunosuppression. Patients with
cerebrospinal fluid leakage complicating skull fracture or neurosurgical procedure can
have recurrent pneumococcal meningitis.
Surveillance of the antibiotic susceptibilities of recent S. pneumoniae isolates has
not indicated any trend toward increased resistance to penicillin. From 1978 to 1980,
less than 2% of clinically significant isolates of S. pneumoniae were relatively penicillinresistant (M IC* 0.1-0.9 /g/ml). Penicillin remains the antimicrobial agent of choice for
treatment of invasive pneumococcal disease.
PNEUMOCOCCAL POLYSACCHARIDE VACCINES
The pneumococcal vaccine licensed in 1977 for use in the United States contains
purified capsular material of 14 types of 5. pneum oniae (Danish types 1,2,3,4,6A,7F,8,
9N,12F,14,18C,19F,23F, and 25). When the vaccine is being prepared, polysaccharides
are extracted separately and combined in a final product. Each dose of vaccine contains
50 /ig of each polysaccharide. The 14 bacterial types represented in the vaccine are
responsible for 68% of bacteremic pneumococcal disease in the United States (3). An
additional 17% of bacteremic pneumococcal disease is due to serotypes immunologically
related to types in the vaccine. Studies of the cross-reactivity of human antibodies against
related types suggest that cross-protection may occur among some of these types (for
example, 6A and 6B) (4).
Minimal inhibitory concentration.

TABLE 2. Estimated occurrence of serious pneumococcal disease. United States

Pneumococcal
disease

Estimated cases
(thousands/yr)

Estimated
incidence*

Case-fatality
ratio (%)

Pneumonia
Meningitis (/)
Bacteremia (2)

150-570
2.6-6.2
16-55

68-260
1.2-2.8
7-25

5-7
32
20

'Pe r 100,000 population/yr.

412

MMWR

August 28. 1981

ACIP Recommendation for Pneumococcal Vaccine Continued

Most healthy adults respond to the vaccine and in 2-3 weeks show a 2-fold rise in
type-specific antibody, as measured by radioimmunoassay. The titer of antibody which
is protective against each serotype has not been determined.
EFFECTIVENESS OF PNEUMOCOCCAL POLYSACCHARIDE VACCINES
Several pneumococcal vaccines were developed and tested in the 1920s, 1930s, and
1940s. An unblinded trial of a trivalent vaccine was performed from 1937 to 1943 in
an elderly institutionalized population (5). Protection was demonstrated against pneu
monia and bacteremia due both to pneumococcal types in the vaccine and to ones that
were not in the vaccine. A tetravalent polysaccharide vaccine tested in 1944 in a young
male military population with a high endemic rate of disease prevented pneumonia caused
by types in the vaccine (6 ). Disease due to other types was not prevented. A combined
pneumococcal polysaccharide vaccine was distributed in the United States from 1945
to 1947. However, when effective antibiotics became available, the vaccine was infre
quently used, and the manufacturer voluntarily discontinued production.
In the 1970s, a 12-valent pneumococcal vaccine was field tested in South Africa in
healthy, young, adult gold-miner recruits among whom there was a high annual inci
dence of pneumococcal pneumonia200 cases/1,000 persons/year (7). This vaccine
(C ontinued on page 417)
T A B L E I. Summary cases of specified notifiable diseases. United States
[Cumulative totals include revised and delayed reports through previous weeksJ
CU M ULATIVE, FIR ST 33 W EEKS

33rd W EEK ENDING

DISEASE

August 22
1981

Aseptic meningitis
Brucellosis
Chicken pox
Diphtheria
Encephalitis: Prim ary (arthropod-borne & unspec.)
Post-infectious
Hepatitis, V ira l: T yp e B
Typ e A
Type unspecified
Malaria
Measles (rubeola)
Meningococcal infections: Total
Civilian
M ilitary
Mumps
Pertussis
R ubella (Germ an measles)
Tetanus
Tuberculosis
Tularemia
T yp ho id fever
Typhus fever, tick-borne (R k y . Mt. spotted)
Venereal diseases:
Gonorrhea: Civilian
M ilitary
Syphilis, prim ary & secondary: Civilian
M ilitary
Rabies in animals

August 16
1980

399
1
319
-

311

412
-

63
-

36
41
22
1
436
7
17
52

40
7
381
569
24 0
55
54
32
31
1
(6
76
33
3
54 3
6
14
49

2 0 ,2 6 6
46 4
621
5
151

2 1 * 88 5
446
559
6
133

359
<*15
193
40
27
47
47
-

MEDIAN
19761980

August 22
1981

August 16
1980

MEDIAN
1976 1980

e
44
64
2
566
3
11
49

4 ,0 8 1
92
1 6 5 ,8 8 6
3
647
52
1 2 ,8 2 5
1 5 ,8 8 7
7 ,1 1 2
908
2 ,6 0 8
2 ,4 1 0
2 ,3 9 8
12
3 ,0 1 4
720
1 ,6 8 0
37
1 7 ,0 1 1
14 2
317
894

3 ,2 0 7
125
1 5 6 ,5 6 4
2
51?
144
1 0 ,8 9 0
1 7 ,4 4 1
7 ,1 3 8
1 ,2 9 7
1 2 ,7 2 2
I ,8 6 9
I ,8 5 5
14
6 ,9 2 5
974
3 ,1 5 1
53
1 7 ,0 7 9
128
287
808

2 ,5 6 7
12 5
1 5 6 ,5 6 4
56
512
145
9 , 5 22
1 8 ,5 8 7
5 ,5 9 4
419
2 3 ,3 7 1
1 ,6 9 9
1 ,6 7 7
16
1 3 ,1 0 3
874
1 0 ,5 2 6
42
1 8 ,5 3 7
98
287
730

2 1 .2 7 7
49 1
5C2
4
88

6 2 9 ,2 8 5
18 ,4 0 1
1 8 ,9 9 3
236
4 ,6 5 3

6 1 5 ,9 2 7
1 7 ,1 3 5
16 ,4 8 1
202
4 ,3 2 2

6 1 6 ,9 5 1
1 7 ,1 3 5
1 5 ,2 5 4
19 0
2 ,0 1 8

301
8
3C8
I
5C
5
3 46
60C
ie c
ie
148
29
2S
-

T A B L E II. Notifiable diseases of low frequency. United States

CUM. 1981

CUM. 1981
Anthrax
Botulism (Calif. 3)
Cholera
Congenital rubella syndrome
Leprosy (C alif. 5)
Leptospirosis (T ex . 1)
Plague

37
3
7
163
26
5

Poliom yelitis:

Total
Paralytic
Psittacosis (C alif. 1)
Rabies in man
Trichinosis
Typhus fever, flea-borne (endemic, m urine) (C alif. 2)

A ll d e la y e d re p o rts a n d c o r r e c tio n s w ill be in c lu d e d in th e fo llo w in g w e e k 's c u m u la tiv e to tals.

3
3
76
I
10 4
33

Vol. 30/No.33

413

MMWR

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

August 22, 1981 and August 16, 1980 (33rd week)

R e p o r t in g a r e a

U N IT E D S T A T E S

BRU
CEL
LOSIS

CHICKENPOX

1981

1981

1981

1981

319

299

N EW E N G L A N D
Maine
N.H.
V I.
Mass.
R.I.
Conn.

24
5

MID. A T L A N T IC
Upstate N.Y.
N.Y. City
N.J.
Pa.

45
0
11
12
14

e .n .

87
38
22
2
25
-

CEN TRAL

Ohio
Ind.
III.
Mich.
Wis.

31
2
_

_
-

17

_
_

W.N. C E N T R A L
Minn.
Iowa
Mo.
N. Dak.
S. Dak.
Nebr.
Kans.

18
-

S. A T L A N T IC
Del.
Md.
D.C.
Va.
W. Va.
N.C.
S.C.
Ga.
Fla.

69
1
3

E.S. C E N T R A L
Ky.
Tenn.
Ala.
Miss.

59
4
52
3

W.S. C E N T R A L
Ark.
La.
Okla.
Tex.

38
2
3
9
24

14
4
11
1
2
33

20
1
1
3
7
e

_
_
_

_
-

22
8
14
NN
97
12
20
14
14
37
9
5
2
2

DIPHTHERIA

1981

1980

Unspecified

1981

1981

1981

1981

1981

40

359

41 5

193

11
2

11

3
2
4

3
1
2

10

45
11
5
29
-

23
6
6
11

19
1
18

39
11
2
14
11
1

64
8
13
12
29
2

28
10
6
11
.
_

18
4
3
9
-

63

40

_
-

_
-

_
-

_
-

_
_

9
I

_
_
_
-

6
2
1
2
I

_
-

29
12
12
-

22
11
5
1
3
2

6
-

2
-

1
4

1
7

1
-

"

28
1

2
3
NN

22

106
101
NN
5

3
5

_
-

I
-

_
-

6
2

2
_

_
_

NN
-

22

22

_
-

3
-

NN

P A C IF IC
Wash.
Oreg.
Calif.
Alaska
Hawaii

49
4
2
41
1
1

Guam
P.R.
V .l.
Pac. Trust Terr.

NA

NA

NA

NA

1981

MAL ARIA

Post-in
fectious

Mont.
Idaho
Wyo.
Colo.
N. Max.
Ariz.
Utah
Nev.

CUM.

Primary

m o u n t a in

HEPATITIS (VIRAL), BY TYPE

ENCEPHALITIS

ASEPTIC
MENIN
GITIS

1
94
5
11
1
7
4
7
8
29
22
15
8
3
4

12
4
5
3

44
7
6
14
17
-

3
1

25
9
3
3
1
1
1
7

I
54
4
1
6
1
3
9
30
15
4
9
_
2

25
1
2

1
1

_
-

10

10
4
-

55
3
5
1
46

25
1

23

"

43
2
2
3
10
5
7

13

14

15
8
-

5
2

1
_

_
_

73
4
1
67
_

123
3
5
114

NA
4
1
NA

1
2
_

3
1
13
1
5

44
1

22
_
-

42

22

9
1
65
5
3
6
51
29
1
2
13
4

NA

NA

NA
2

NA
6

NA
3

NA
_

NA

NA

NA

NA

NA

NA

NN: Not notifiable.

N A : Not available.
A ll delayed rep orts and c o rre c tio n s w ill be in clu d ed in the fo llo w in g w eek's cu m u lativ e totals.

110
1
25

1
1

4
3

4
-

20
3
7
1
8
37

69
3
13
6
47

7
_

45
1
3
3
26
2
10
108
30
33
34
11

29
I
10
3
15

_
-

1981

90 8

7
1
6

1
1

CUM.

47 2
26
12
426
1
7

1
9
4

414

August 28, 1981

MMWR

T A B L E III (Cont.'d). Cases of specified notifiable diseases. United States, weeks ending
August 22, 1981 and August 16, 1980 (33rd week)
MENINGOCOCCAL INFECTIONS
TOTAL

M EASLES(RUBEOLA)
REPORTING AREA
1981

U N IT E D S T A T E S

CUM.

CUM.

1981

1980

1981

CUM.

CUM.

1981

1980

MUMPS

1981

CUM.
1981

1981

1981

27

2 , 60 8

1 2 .7 2 2

47

2 .4 1 0

.8 6 9

36

3 .0 1 4

NEW EN G LAN D
Maine
N.H.
Vt.
Mass.
R.I.
Conn.

75
5
4
1
57
8

66 9
33
331
226
55
2
22

4
-

110
5
6
13
38
7
41

2
1

146
28
17
6
40
20
35

1
3

150
19
17
6
34
14
60

M ID. A T L A N T IC
Upstate N.Y.
N.Y. City
N.J.
Pa.

6
1
1
4

7 52
20 9
70
55
458

3 . 740
677
1 . 165
825
1 .0 7 3

10
5
3
1
1

336
108
59
77
92

321
106
78
70
67

8
5
-

540
102
70
83
28 5

12
3
1

E.N. C E N T R A L
Ohio
Ind.
III.
Mich.
Wis.

78
15
8
22
30
2

2 . 388
373
90
332
234
1 .3 5 9

4
3
1
-

291
108
40
72
67
4

23 8
72
36
64
53
13

838
133
94
168
297
146

9
2
3
3

W.N. C E N T R A L
Minn.
Iowa
Mo.
N. Dak.
S. Dak.
Nebr.
Kans.

6
2
1
1

1 ,3 2 7
1 .0 9 3
20
64

1
-

109
37
18
36
1
4
_

73
18
9
32
1
4
_

_
_

13

35 2
4
1
6
8
4
109
221

1 .8 5 8
3
71
-

14
-

441
2
44
1
42
14
82
53
72
131

298
9
128
157
799
393

546
4
40
2
65
23
80
70
92
17 0

328
53
169
22
84

2
-

178
48
50
57
23

169
53
44
45
27

932
16
11
770
135

405
22
99
33
251

197
16
72
17
92

4
2
2

W.S. C E N T R A L
Ark.
La.
Okla.
Tex.

8
8

922
1
2
6
912

M O U N T A IN
Mont.
Idaho
Wyo.
Colo.
N. Mex.
Ariz.
Utah
Nev.

P A C IF IC
Wash.
Oreg.
Calif.
Alaska
Hawaii

1
4

Guam
P.R.
V .l.
Pac. Trust Terr.

4
2
2

83
67

1
1

E.S. C E N T R A L
Ky.
Tenn.
Ala.
Miss.

7
7

S. A T L A N T IC
Del.
Md.
D.C.
Va.
W. Va.
N.C.
S.C.
Ga.
Fla.

33
1
9
8
5
10
345
2
4
336

455
2
23
11
364
47
8

3
1
4
4

6
4
-

3
1
-

1 .C 2 5
174
-

840
5
6

NA
4

NA

4
262
24
1

5
117
6
6

2
2

_
-

81
6
3
1
35
6
19
5
6

69
3
4
2
17
8
12
2
21

314
59
47
197
7
4

251
47
43
154
7

_
10
1
-

_
-

2
3
3
-

22

2
1
1

1
_
-

75
6
4
2

3
2

_
2
_
_
_
_
-

2
1
1
_
_

2
-

172
1
4

3
_

167

13
13
_

NA
2
NA

107
9
4
1
42
-

24
16
11
546
137
61
321
7
20

6
109
4
8

1
4

_
1
62
133
1
1
7
22
5
8
35
54

7
_

_
_
_
2
2
1
2

148
2
9
_

6
1
2
1
2

137

_
-

80
4
3
7
27
5
19
5
10

1
-

1
1

5
-

1
_
_

3
1

30
19
10
1
-

7
1
2
.

348
3
123
83
34
105

2
-

42 7
9
81
2
116
72
14
10
33
90

3
-

3
2

37

12

105
33
35
-

202
96
49
46
11

1 *6 8 0

4
4

_
_

_
_
_

1981

1
3
96

CUM.

1981

_
_
-

CUM.

25

N A: Not available.
A ll delayed reports an d co rre c tio n s w ill be in clu d ed in the fo llo w in g w ee k's cu m u lativ e totals.

74
36
20
15
3

1
9
1

16 4
8
41
15

41

TETANUS

RUBELLA

PERTUSSIS

8
1
7

5
_

NA
_
_

NA
_
_

NA

NA

559
94
32
422
1
10

1
3
1
1

2
_
_
_

1
1
6

_6
-

3
-

MMWR

Vol. 30/No. 33

415

T A B L E III (Cont.'d). Cases of specified notifiable diseases. United States, weeks ending
August 22, 1981 and August 16, 1980 (33rd week)
TUBERCULOSIS
REPORTING a r e a
1981
U N IT ED S T A T E S 48 6

CUM.
1981

TULA
REMIA
CUM.
1981

TYPHOID
FEVER
CUM.
1981

1981

TYPHUS FEVER
(Tick-borne)
(RMSF)
1981

CUM.
1981

V ENEREAL DISEASES (Civilian)

GONORRHEA
1981

SYPHILIS (Pri. & Sec.)

RABIES
(in
Animals)

CUM.
1981

CUM.
1980

1981

CUM.
1981

CUM.
1980

CUM.
1981

621

1 8 .9 9 3

1 6 .4 8 1

4 *6 5 3

385
2
11
13
256
21
82

330
4
1
5
191
19
110

26
12
2
-

2 .8 3 4
24 9
1 .7 1 2
391
48 2

2 ,3 5 3
200
1 .5 4 2
287
32 4

60
44
-

1 .2 8 9
193
131
67 3
229
63

1 .5 2 7
2 36
119
871
2 42
59

632
50
64
43 9
8
71

1 7 ,0 1 1

142

17

317

52

894

2 0 ,2 6 6

6 2 9 ,2 8 5

6 1 5 ,9 2 7

NEW E N G L A N D
Maine
N.H.
Vt.
Mass.
R.I.
Conn.

12
1
8
1
2

481
29
13
15
283
29
112

_
-

12
1
7
4

5
1
2

503
19
KA
5
232
29
218

1 5 .5 3 9
79 5
547
264
6 ,3 6 0
84 8
6 ,7 2 5

1 5 .3 4 0
88 2
54 6
33 3
6 ,3 6 7
9 91
6 ,2 2 1

MID. A T L A N T IC
Upstate N.Y.
N.Y. City
N.J.
B
,
a.

61
14
31
16

52
11
27
10
4

2
-

34
12
3
9
10

3 ,1 2 5
556
1 *1 0 0
709
760

7 5 ,1 2 5
1 2 .6 6 5
3 1 .6 1 0
1 4 ,3 4 0
1 6 .5 1 0

6 6 ,1 2 6
1 2 ,1 3 8
2 5 ,1 6 1
1 2 ,2 5 7
1 6 ,5 7 0

110
-

E-N. C E N T R A L
Ohio
Ind.
III.
Mich.
Wis.

31
24
2
-

22
3
11
6
2

9
8
1
-

44
36
2
5
I
-

2 ,3 3 1
95 0
151
58 6
4 42
202

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

9 4 ,5 8 3
2 5 ,0 0 8
9 ,2 7 2
2 9 ,8 3 2
2 1 .4 7 5
8 *9 9 6

49
26
9
-

W-N. C E N T R A L
Minn.
owa
Mo
N. Dak.
S. Dak.
Nebr.
*ans.

12
2
3
2
1
2
2

2
1
1
-

38
1
5
20

75 7
71
86
361
9
31
84
115

2 9 ,9 2 7
4 ,6 2 8
3 ,2 5 3
1 3 ,9 3 7
402
817
2 .3 2 2
4 .5 6 8

2 8 .2 0 5
4 .6 6 7
3 .0 9 8
1 2 .1 8 4
40 8
863
2 .2 5 7
4 .7 2 8

19
-

39 2
134
16
209
8
2
5
18

44
13
I
1
4
1

30
2

8
I
9
3
7

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

1 5 4 .1 7 3
2 . 151
1 6 .2 6 5
1 0 .7 6 2
1 3 .8 0 5
2 .0 5 4
2 1 .8 7 9
1 4 .6 9 5
2 9 .6 5 8
4 2 .9 0 4

175
1
4
19
15
1
16
11
43
65

5 .0 3 1
8
372
408
4 46
16
385
330
1 ,2 9 5
1 ,7 7 1

3 .8 8 6
10
273
289
358
15
269
21 7
1 .1 0 7
1 .3 4 8

298
I
14

86
5
217
84
59
8

5 ,8 1 3
131
777
276
7 74
1 10
966
747
1 ,0 6 8
964

94
2
60
13
19

1 ,5 0 4
146
812
260
28 6

5 2 .3 2 0
6 ,5 3 5
1 9 ,8 5 9
1 5 ,7 8 7
1 0 ,1 3 9

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

64
2
29
16
17

1 ,2 6 5
60
47 8
356
371

1 .3 6 0
91
576
282
411

29 9
93
155
51

137
31
77
29

8 3 ,3 4 9
6 .1 5 8
1 4 .2 1 8
8 ,9 5 0
5 4 ,0 2 3

7 9 ,3 4 4
6 ,0 5 9
1 4 ,3 9 6
7 ,8 8 4
5 1 ,0 0 5

114
6

2 ,7 0 3
28 8
67 2
37 0
1 ,3 7 3

4 ,5 7 7
89
1 ,0 6 2
106
3 ,3 2 0

3 .2 5 8
101
79 4
59
2 .3 0 4

801
110
26
156
509

25
12
5
5
1
2

775
21
26
11
273
53
20 7
32
152

2 4 ,5 9 5
893
1 ,0 9 8
56 4
6 ,6 7 1
2 ,6 4 1
7 ,4 4 8
1 ,1 5 2
4 ,1 2 8

2 3 .9 0 2
903
1 *0 5 6
702
6 *4 0 6
2 *9 5 4
6 *5 2 0
1*1 3 3
4 *2 2 8

10
-

488
11
17
7
149
92
105
17
90

385
1
14
8
103
64
129
11
55

151
82
1
12
19
21
12
1
3

5
I

2 .7 5 5
338
212
2 .0 9 3
58
54

9 8 ,7 6 9
7 ,9 9 2
5 ,8 6 6
8 0 ,4 6 3
2 ,4 7 6
1 ,9 7 2

1 0 4 *1 8 4
8 *7 1 0
7 *0 1 6
8 3 *8 8 8
2 *4 9 6
2 .0 7 4

73

2 ,7 3 2
94
63
2 ,5 2 0
9
46

3 . 177
162
67
2 .8 3 3
7
108

41 1
10
7
380
14

NA
63
2
NA

47
2 .0 5 5
131
2 11

86
1 ,6 2 4
108
26 4

4 30
15

4
358
10

53

S. A T L A N T IC
Del.
Md.
D.C.
/.
va.
W. Va.
N.C.
S.C.
ja.
Crla.
l.
E.S. C E N T R A L
Ky.

c
c

0)

ia.
Miss.

W.s. C E N T R A L
Ark.
La.
Okla.
Tex.

m o u n t a in

Mont.
Idaho
Wyo.
Colo.
N. Mex.
Ariz.
Utah
Nev.
p a c if ic

Wash.
Oreg.
Calif.
Alaska
Hawaii

Guam
PR.

W
V .l.I

Pac. Trust Terr.

2 , 665
491
1 ,0 3 5
545
594

10
10
-

1
-

2 ,2 0 1
44 5
214
851
571
120

1
1

2
I
1
-

14
2
4
6
1

611
108
66
271
23

17
15

1
1
-

10 5
4
e
5
1C
2

10
1

2
3

1
-

11
22
18

3 ,7 5 3
54
378
23 7
387
120
671
348
608
950

59
11
26
5
17

1 ,4 9 7
387
4 98
4 00
212

69
9
22
6
32

1 ,9 3 3
2 04
342
228
1 , 159

6e
39
2
15
12

20
5
2
9
1
2

48 6
27
6
7
50
92
23 0
35
39

25
5

115
2
I l l

3 ,3 8 4
249
121
2 , 879

5
1

2<t

Nt

NA

44
19
80

44
91

7
187
1
38

5
2
3

4
1
5
1
8
1

44
4

2
3
35

10
-

NA

NA

'

21

4
6
10
1
103
3
4
95
1

4
6
-

3
9

10
-

3
2
2

1
1
-

20

_
-

509
2
48

. -

NA
-

NA

A ll delayed rep orts and co rre ctio n s w ill be in clu d ed in the fo llo w in g w ee k's cu m u lativ e totals.

74
16
20

10

2
15

3
105

3
4
_
3

2
70
-

NA
16

NA

7
5

12
4

2 05 1 *9 7 5
74
34 3
12
62 5
170
100
3
309
236
2
6
149
8
143

50
15
6
19
137
56

_
-

MMWR

416

August 28, 198'

T A B L E IV. Deaths in 121 U.S. cities,* week ending

August 22, 1981 (33rd week)
ALL CAUSES, BY AGE (YEARS)

ALL CAUSES, BY AGE (YEARS)

REPORTING AREA

N EW E N G L A N D
Boston, Mass.
Bridgeport, Conn.
Cambridge, Mass.
Fall River, Mass.
Hartford, Conn.
Lowell, Mass.
Lynn, Mass.
New Bedford, Mass.
New Haven, Conn.
Providence, R.l.
Somerville, Mass.
Springfield, Mass.
Waterbury, Conn.
Worcester, Mass.

M ID. A T L A N T IC
Albany, N.Y.
Allentown, Pa.
Buffalo, N.Y.
Camden, N.J.
Elizabeth, N.J.
Erie. Pa.t
Jersey City, N.J.
N.Y. City, N.Y.
Newark, N.J.
Paterson, N.J.
Philadelphia, Pa.t
Pittsburgh, Pa.t
Reading, Pa.
Rochester, N.Y.
Schenectady, N.Y.
Scranton, Pa.t
Syracuse, N.Y.
Trenton, N.J.
Utica, N.Y.
Yonkers, N.Y.

ALL
AGES

>65

63 7
175
47
19
36
65
30
27
24
37
61
2
32
25
57

414
97
31
15
28
45
23
24
17
15
41
1
24
16
37

152
53
9
4
7
13
4
3
5
13
15
1
7
6
12

36
13
3

2 .2 7 6
59
18
100
33
23
29
46
1 .2 7 7
62
30
160
62
33
129
37
30
76

L. 46 3
41
15
76
17
14
19
27
79 7
30
20
99
38
27
95
26
23
50

525
9
3
13
8
6
8
15
301
15
5
43
16
5
21
9
6
22

141
2
-

73
3

75
4
-

3
3
2
2
87
13

8
5
1
6
1
1
3

2
4
1
1
49
2

4
4
1

5
I
2
1
43
2
5
6
3
3

513

153

77

70

32
24

16
21

18

10

2 .0 4 1
E.N. C E N T R A L
50
Akron, Ohio
Canton, Ohio
502
Chicago, III.
119
Cincinnati, Ohio
Cleveland, Ohio
89
Columbus, Ohio
95
Dayton, Ohio
Detroit, Mich.
Evansville, Ind.
Fort Wayne, Ind.
Gary, Ind.
Grand Rapids, Mich
Indianapolis, Ind.
Madison, Wis.
Milwaukee, Wis.
Peoria, III.
Rockford, III.
South Bend, Ind.
Toledo, Ohio
Youngstown, Ohio
53

L* 2 2 8
30

729
54
40
37
97
34
73
95
162
76
61

437
33
22
21
61
21
36
52
93
59

33

161

243
51
61
20
61
127
38
120
47
32
42
97

W.N. C E N T R A L
Des Moines, Iowa
Duluth, Minn.
Kansas City, Kans.
Kansas City, Mo.
Lincoln, Nebr.
Minneapolis, Minn.
Omaha, Nebr.
S t Louis, Mo.
S t Paul, Minn.
Wichita, Kans.

21

293
74
94
53
58

129
34
40
12
43
74
26
77
31
26
33
53
27

39

45-64

11
3

13
6
131
23
43
27
24
67
12
12
5
12
29
10
31
7
2
6
32
17

168
15
9
6
22
6
19
21
46
9
13

25-44

3
1
2
4
3

2
5

2
3
40
10
14
3

7
29
I
4
2
2
9
7
6
3
7
4
40
2
3
3
7
3
2
8
7
2
3

1-24

13
5
1

2
2

1
-

4
1
19
6
6
4
2
9
2
2
1
1
11
1
2
1

<1

22
7
3
1
2

3
2

1
19
6
4
2
4
9
2
3
3
4
1
3
2
1
1
3
2

39
1
2
1
3
2
4
10
10
4
2

45
3
4
6
4
12
4
6
2
4

p & r*
TOTAL

48
26
1
1

2
4
2
2
9

72

9
2
1

34
3

7
2
1
7
I
1
1

62
-

4
15
6
2
4

4
1
5
2
1
2
1
1
3
1
4
4
-

16

1
2
2
1
1
3
3
1
2

REPORTING AREA

P& l
ALL
AGES

>65

45-64

25-44

1 24

1 . 112
138
156
43
105
101
57
84
36
99
63
181
49

627
72
87
25
70
53
28
42
28
84
34
74
30

296
47
47
14
22
24
13
26
6
12
19
53
13

99
13
14
1
6
13
4
6

36
2
5
1
2
7
2
3
1

E.S. C E N T R A L
Birmingham, Ala.
Chattanooga, Tenn.
Knoxville, Tenn.
Louisville, Ky.
Memphis, Tenn.
Mobile, Ala.
Montgomery, Ala.
Nashville, Tenn.

629
75
56
44
84
159
75
36
100

34 9
34
37
30
49
67
34
26
52

W .S C E N T R A L
Austin, Tex.
Baton Rouge, La.
Corpus Christi, Tex.
Dallas, Tex.
El Paso, Tex.
Fort Worth, Tex.
Houston, Tex.
Little Rock, Ark.
New Orleans, La.
San Antonio, Tex.
Shreveport, La.
Tulsa, Okla.

1 .4 1 1
54
36
62
206
51
95
40 0
63

75 2
37
17
33
111
35
52
193
33

S. A T L A N T IC
Atlanta, Ga.
Baltimore, Md.
Charlotte, N.C.
Jacksonville, Fla.
Miami, Fla.
Norfolk, Va.
Richmond, Va.
Savannah, Ga.
St. Petersburg, Fla.
Tampa, Fla.
Washington, D.C.
Wilmington, Del.

M O U N T A IN
Albuquerque, N.Mex.
Colo. Springs, Colo.
Denver, Colo.
Las Vegas, Nev.
Ogden, Utah
Phoenix, Ariz.
Pueblo, Colo.
Salt Lake City, Utah
Tucson, Ariz.

P A C IF IC
Berkeley, Calif.
Fresno, Calif.
Glendale, Calif.
Honolulu, Hawaii
Long Beach, Calif.
Los Angeles, Calif.
Oakland, Calif.
Pasadena, Calif.
Portland, Oreg.
Sacramento, Calif.
San Diego, Calif.
San Francisco, Calif.
San Jose, Calif.
Seattle, Wash.
Spokane, Wash.
Tacoma, Wash.

TOTAL

132
164
40
106

571
74
32
112
53
13
151

16
50
70

1 .5 0 9
18
47
23
42
97
412
72
30
108
53
72
147
132
147
54
55

69

93
20
59

<1

4
35
3

3
9
1

1 70
25
13
10
19
45
21
5
32

53
7
2
1
7
15
9

27
5
2
1
3
5
6
2
3

30
4
2
2
6
7
5
3
1

21

3
1
4
9
1
2
1

364
11
10
10
51
12
25
113
15

140
2
2
7
22
2
4
49
10

87
2
3
8
13
1
3
29

68
2
6
4
9
1
11
16

41
3
2
1
1
3
T
6
7
4

37
42

12

11

2
7

3
6

13
6
12

13
2
4

3
1
4

313
27
15
70
26

155
15
12
31
17

45
9
2
9
7

20
3
-

6
90

1
39

1
8

36
20
3
2
1
2

970

14
31
20
24
50
262
46
23
74
30
41
91
86
101
36
39

4
13
23

1
3
5

336 112
2
2
7
2
2
1
12
3
29 16
95
26
14
7
4
2
21
5
9
3
20
4
37 14
8
30
32 11
13
2
9
4

10 91 7 6 .5 5 3 2 679

1
4
46
_
4
2
1
12
3
1
3
4
3
3
6
2
1
1

3
9
_

1
2

44

_
3

1
1
14
2
5
7
4
2
2
1
2

tBecause of changes in reporting methods in these 4 Pennsylvania cities, these numbers are partial counts for the current week. Complete counts will
be available in 4 to 6 weeks.
Data not available this week. Figures are estimates based on average percent of regional totals.

8
1
1
2

1
-

2
1

52

3
2
3
10
5
4
1
3

5
6
2
3

819 436 427 355

'M orta 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.
* 'Pneumonia and influenza

ttT o ta l includes unknown ages.

35
3
1
1
3
1
4
7
2
5
3
5
-

53
4
3
2
5
4
10
6
1
3
3
10
2

11
27

11
32
36

tota

V o l. 30/N o . 33

MMWR

417

ACIP Recommendation fo r Pneumococcal Vaccine C ontinued

conferred type-specific protection, significantly reducing the frequency of pneumo
coccal pneumonia and general respiratory morbidity. When 14-valent vaccine was tested
in a native population in New Guinea, where there was a large amount of acute and
chronic respiratory disease, much of it caused by the pneumococcus, pneumonia morbidi
ty and mortality was significantly reduced (8).
Two randomized, controlled trials of pneumococcal vaccine in older-age adults have
been conducted in the United States (9). One was in outpatients over 45 years old and
the other was in inpatients of a chronic-care psychiatric facility. In neither study was
there any difference in the occurrence of respiratory morbidity and mortality between
those vaccinated with a polyvalent pneumococcal vaccine and those given a placebo. In
the first study, data suggested some vaccine protection against bacteremic pneumococcal
disease, but the incidence of pneumococcal disease was low (less than 2.5/1,000 popu
lation/year) and may not have enabled a valid assessment of vaccine efficacy. In the other
study, there were no fewer cases of radiologically diagnosed pneumonia among vaccinees
than among controls.
The data from these 2 trials were analyzed using a case definition based on serocon
version to a vaccine serotype and radiographic documentation of pneumonia. With this
case definition, vaccine efficacy of 80%-100% was calculated. However, because persons
who have been vaccinated do not show an increase in antibody titer on revaccination,
vaccinees may have been unable to seroconvert to a natural infection, making it difficult
to document cases in vaccinees. The vaccine efficacy based on this case definition could
therefore be overestimated.
There have been only a few studies of pneumococcal vaccine efficacy in children.
The vaccine was generally found to be less antigenic for children <2 years old than for
other vaccinees. However, in a small, nonrandomized study of children and young adults
2-25 years old who had sickle cell anemia or had had splenectomy, occurrence of bac
teremic pneumococcal disease was found to be significantly reduced by immunization
with an 8-valent vaccine (10).
A recently proposed method to evaluate protection with pneumococcal vaccine
compares the distribution of serotypes of pneumococci isolated from the blood or
cerebrospinal fluid of vaccinated and unvaccinated patients (11). When this method
was used to compare 36 vaccinated patients >10 years oldunclassified with respect
to underlying medical conditionswith about 10 times that many comparable unvacci
nated controls, a vaccine efficacy rate of 49% was found (66%, if only patients with
blood isolates were considered.) As more patients become available for evaluation, esti
mates for specific diagnostic categories can be made, and the broad confidence intervals
now associated with the analysis, reduced.
The duration of protection induced by vaccination is unknown. Studies of persistence
of elevated antibody titers are ongoing; currently available data show elevation of titers
3-5 years after immunization.
SIDE EFFECTS A N D A DVERSE REACTIONS
About half of those given pneumococcal vaccine develop side effects such as erythema
and mild pain at the site of injection. Severe adverse effects such as anaphylactoid reac
tions have been quite rareabout 5/million doses administered.
Severe local and systemic reactions have been common among adults given second
doses (12). They are thought to result from localized antigen-antibody reactions involving
antibody induced by previous vaccination. Whether prior infection with the S. pneumo-

418

MMWR

August 28, 1981

A C IP Recommendation fo r Pneumococcal Vaccine C ontinued

niae types represented in the vaccine will result in comparable local reactions after vacci
nation is unknown. Several studies indicate that pneumococcal vaccine and influenza
vaccine can be given at different sites at the same time without an increase in side effects
(13), but it should be emphasized that pneumococcal vaccine should be given o n ly once
to adults. Data on revaccination of children are not yet sufficient to provide a basis for
comment.
VAC CINE USAGE
The currently available 14-valent pneumococcal vaccine (as well as the earlier pneumo
coccal vaccines) has been shown in selected populations to reduce by approximately 80%
the incidence of pneumonia with bacteremia caused by S. pneumoniae types represented
in the vaccines. In extrapolating this information for recommendations on vaccine use,
it is important to recognize that data on effectiveness have come predominantly from
studies in groups of adults who were at increased risk of disease but who were not chroni
cally ill. Because age and some chronic illnesses apparently predispose individuals to more
severe pneumococcal disease, it would be ideal if recommendations on immunization
could be based on definitive clinical trials in groups of elderly patients and patients with
chronic illnesses. While data on pneumococcal vaccine effectiveness in chronically ill
persons and in others continue to accumulate, they are not yet sufficient for conclusive
interpretations. Therefore, the Committee's recommendations that follow are derived
from admittedly limited data.
1. On the basis of preliminary evidence, persons>2 years old who have splenic dysfunc
tion or anatomic asplenia should benefit from immunization. Vaccine failures have
been reported, perhaps due to impairment of antibody responsiveness, but vaccination
is recommended for such patients because they are known to be at high risk of devel
oping fatal bacteremia.
2. Adults and children >2 years old with chronic illnesses which are or appear to be asso
ciated with an increased risk of pneumococcal disease or its complications (see above)
should be considered candidates for vaccination. Vaccine may be increasingly benefi
cial as these patients grow older because the elderly are at increased risk of dying from
pneumococcal infections. Vaccine efficacy in these groups needs further evaluation
and is currently under study.
3. There can be acute outbreaks or a high rate of endemic pneumococcal disease in some
populations, such as in nursing homes and other institutions where there is increased
risk that the disease will be severe. Under these conditions, vaccination of the entire
closed population should be considered.
4. Localized outbreaks of pneumocpccal disease caused by types represented in the
vaccine can occur in the general population, albeit rarely. In such instances, selective
immunization of those at high risk should be considered.
5. There are not yet sufficient data with which to formulate a recommendation on
routine use of pneumococcal vaccine in immunization programs for the general popu
lation, including the elderly. This should not preclude health-care providers from
giving vaccine to unimmunized healthy persons who, in their judgment, might benefit.
PRECAUTIONS
The safety of pneumococcal vaccine in pregnant women has not been evaluated. It
should not be given during pregnancy unless the risk of infection is substantially increased.
Because of a marked increase in adverse reactions with reinjection of pneumococcal

V ol. 3 0/N o. 33

MMWR

419

A C IP Recommendation fo r Pneumococcal Vaccine C ontinued

vaccine, second or "booster" doses should n o t be given, at least at this time.
Complete records on vaccination can help to avoid repeat doses.
References
1. Fraser DW, Darby CP, Koehler R E , Jacobs CF, Feldman R A . Risk factors in bacterial meningitis:
Charleston County, South Carolina. J Infect Dis 1973;127:271-7.
2. Filice GA, Darby CP, Fraser DW. Pneumococcal bacteremia in Charleston County, South Caro
lina. Am J Epidemiol 1980;112:828-35.
3. Broome CV, Facklam R R . Epidemiology of clinically significant isolates of Streptococcus pneu
m oniae in the United States. Review of Infectious Diseases 1981 ;3:277-80.
4. Robbins JB , Lee C J, Rastogi SC, Schiffman G, Henrichsen J. Comparative immunogenicity of
group 6 pneumococcal type 6A(6) and type 6B(26) capsular polysaccharides. Infect Immun
1979,26:1116-22.
5. Kaufman P. Pneumonia in old age. Active immunization against pneumonia with pneumonococ
cus polysaccharide; results of 6-year study. Arch Intern Med 1947;79:518-31.
6. MacLeod CM, Hodges RG , Heidelberger M, Bernhard WG. Prevention of pneumococcal pneu
monia by immunization with specific capsular polysaccharides. J Exp Med 1945;82:445-65.
7. Austrian R, Douglas RM , Schiffman G, et al. Prevention of pneumococcal pneumonia by vacci
nation. Trans Assoc Am Physicians 1976;89:184-94.
8. Riley ID, Andrews M, Howard R , et al. Immunisation with a polyvalent pneumococcal vaccine:
reduction of adult respiratory mortality in a New Guinea Highlands community. Lancet 1977;
1:1338-41.
9. Austrian R. Surveillance of pneumococcal infection for field trials of polyvalent pneumococcal
vaccines. Report DAB-VDP-12-84, National Institutes of Health, 1980.
10. Ammann A J, Addiego J, Wara DW, Lubin B, Smith W B, Mentzer WC. Polyvalent pneumococcalpolysaccharide immunization of patients with sickle-cell anemia and patients with splenectomy.
N Engl J Med 1977;297:897-900.
11. Broome CV, Facklam R R , Fraser DW. Pneumococcal disease after pneumococcal vaccination:
an alternative method to estimate the efficacy of pneumococcal vaccine. N Engl J Med 1980;
303:549-52.
12. Borgono JM , McLean AA, Vella PP, et al. Vaccination and revaccination with polyvalent pneu
mococcal polysaccharide vaccines in adults and infants (40010). Proc Soc Exp Biol Med 1978;
157:148-54.
13. Mufson MA, Krause HE, Tarrant C J, Schiffman G, Cano F R . Polyvalent pneumococcal vaccine
given alone and in combination with bivalent influenza virus vaccine (40804). Proc Soc Exp Biol
Med 1980; 163:498-503.

The Morbidity and Mortality Weekly Report, circulation 91,000, is published by the Centers for
Disease Control, Atlanta, Georgia. The data in this report are provisional, based on weekly telegraphs
to CDC 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, Manage
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When requesting changes be sure to give your former address, including zip code and mailing list code
number, or send an old address label.

420

August 28, 1981

MMWR

Erratum, Vol. 30, No. 32

p392.

In the article, "Multistate Outbreak of Salmonellosis Caused by Precooked Roast

Beef, 3 names from the New Jersey State Dept of Health were incorrectly
spelled. They should read: E Feuer, MD, I Guerrero, MD, and D Moulton.
Erratum, Vol. 30, No. 32

p404. The Recommendation of the Immunization Practices Advisory Committee on

Diphtheria, Tetanus, and Pertussis: "Guidelines for Vaccine Prophylaxis and
Other Preventive Measures," Table 3, contained an error in the third footnote.
The footnote should read: "Yes, if wound more than 24 hours old." The fol
lowing corrected table should be substituted:
CORRECTED
TABLE 3. Summary guide to tetanus prophylaxis in routine wound management, 1981*
Clean, minor
wounds

History of
tetanus
immunization
(doses)
Tdt

TIG

Tdt

TIG

Yes
Yes
Yes

No
No
No
No

Yes
Yes
Yes
No1-

Yes
Yes
No#
No

COO
o

Uncertain
0-1
2
3 or more

All other
wounds

"Important details are in the text.

tF o r children less than 7 years old DTP (DT, if pertussis vaccine is contraindicated) is preferred to
tetanus toxoid alone. For persons 7 years old and older, Td is preferred to tetanus toxoid alone.
+Yes, if wound more than 24 hours old.
Yes, if more than 10 years since last dose.
1' Yes, if more than 5 years since last dose. (More frequent boosters are not needed and can accentuate
side effects.)
<rU.S. G o v e rn m e n t P rin tin g O ffic e 1 981 7 4 0 - 1 8 5 /9 0 9

U.S. D EPA RTM EN T OF H E A LT H A N D H UM AN SERVICES

P U B L IC H E A L T H S E R V IC E / C E N T E R S F O B 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 3 0 3 3 3

O F F IC IA L BUSINESS

D ire c to r, C enters fo r Disease C o n tro l

W illia m H. Foege, M .D .
D ire c to r, E p id e m io lo g y Program O ffic e
P h ilip S. B ra c h m a n , M .D .
E d ito r
M ichael B. Gregg, M .D .
M a th e m a tic a l S ta tis tic ia n
K ee w h a n C hoi, P h .D .

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