LIVE POLIO IRUS VACCINES

Discussion
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In the case of Table 2, instead of gamma globulin
we injected intramuscularly into the gluteus
a commercial preparation of Tri-immunol, a vaccine
containing pertussis, diphtheria and tetanus
toxoids, and 8.6 logs of the Type 1 virus
intravenously. Neither paralysis nor lesions occurred.
In another experiment, Type 1 was injected
intravenously and saline intracerebrally: the
lesions were few and paralysis did not occur.
One batch of Type 3 shown in the table gave essentially
the same results.
Perhaps the major point to be made is, as
Dr. Kirschstein has already said, that this is
not a case of a virus growing and spreading by
the blood, since a vast dose intravenously and
trauma intracerebrally or intramuscularly did
not cause any paralysis.
DR. MELNICK: Dr. Kirschstein mentioned the
higher titers of virus found in 1960. I would
like to know whether this represents new material,
or 1959 material which was retitrated?
DR. KIRSCHSTEIN:
DR. MELNICK:
1960?
New material.
Prepared between 1959 and
DR. KIRSCHSTEIN: The material that Drs. Cox
and Koprowski sent us were new lots from the
same seed pools.
DR. MELNICK: Could we have it for the record
from those who submitted the new vaccines?
DR. Cox: I would like to point out that
some years ago we did inoculate monkeys in
the deltoid and also with 5 cc. and 10 cc.'s intravenously,
and we found nothing. I think
that this discovery of the behavior of Type 1,
by the intramuscular route in the buttocks, was
made somewhat by accident. We had never
inoculated monkeys by this route. Actually we
did not know about this until last December
after we had fed nearly one million people.
We did not know that our Type 1 had this
property.
Of course, the question was then asked: What
do you do in a case like this? Which are the
more significant, 20 monkeys or one million
people? Naturally we had to make a decision.
Since the intramuscular activity was found we
have confirmed it. We still have not been able
to produce clinical reactions in monkeys by
the intravenous route as Dr. Moyer has shown
you, even when we inoculated monkeys intravenously
with 10 cc.'s, and then tried to break
their resistance by intracerebral injections with
saline or other agents.
This is a peculiar propertv. It has been
found to exist at present in all Type 1 strains,
to a greater extent in some than in others.
You should keep in mind that we are not injecting
man intramuscularly, but are feeding
man orally. You should also keep in mind that
these vaccines are intended to be used in a certain
dosage and by a certain route. I should
like to remind you that you never vaccinate
people on the eyeball with smallpox. We know
that they would be blinded under those conditions.
Like everything else, further studies reveal
new or unknown properties. This is not limited
to polio research. This has been found
with every virus that we have ever worked with.
DR. KOPROWSKI: I would like to make a
statement concerning gamma globulin. I strongly
suspect that two factors are involved: One is
the very high concentration of virus used and
the other is the titer of antibodies in gamma
globulin. Perhaps before Dr. Kirschstein can
make a definite statement that gamma globulin
administration has no protective effect, a titration
of the virus in monkeys injected with high
concentration of gamma globulin should be undertaken
and compared with the results in controls.
Now a short comment on viremia. 1 believe
the problem of spillover versus multiplication
can be settled if titration of the virus in blood
can be performed at frequent intervals. If the
concentration of circulating virus should drop
in 24 hours or 48 hours after infection and later
on rise again, we should consider that the virus
multiplied in an organ communicating directly
with the blood.
Da. KIRSCHSTEIN: The dosage of gamma globulin
given to these monkeys is that which Dr.
Nathanson had used to prevent monkeys from
becoming paralyzed and developing lesions, using
Mahoney virus present in some partially inactivated
poliovirus vaccine. It had been effective