LIVE POLIO IRUS VACCINES

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Discussion 411 DR. ANDERSON: My question is along the same line as Dr. Melnick's. Dr. Sabin has referred to a comparison with measles, pointing out that there is a high incidence one year and a low incidence the next. We know that, in a given year, the period of spread of measles is concentrated in a relatively short portion of that year. It may be that Dr. Sabin explained this and I missed it, but I did not understand on what basis he assumed that this reduction from 11 per cent of shedding of poliovirus down to .7 per cent is something that was achieved by the immunization. Has he any control data to show that there may not have been seasonal variations and that a decline of this sort could have occurred independent of the immunization? DR. SABIN: The only control data are that the factors conducive to the dissemination of enteric viruses continued, as is indicated by the fact that the other enteric viruses were spreading to the same extent. The only thing that changed was the ratio of polio to non-polio. The ratio of change is due to the large number of resistant intestinal tracts that are created by massive spread of polioviruses, whether it be by nature or even more extensively by man, as was done in Toluca. Nature can do the same thing-if it spreads Type 1 poliovirus extensively over a period of six months in one year, the result is a natural drop in Type 1 relative to other viruses the next year. We were merely trying to do what nature did, except in a much heavier and more extensive manner. DR. BODIAN: I think this is a very interesting point and I wonder whether dissemination of polioviruses in Querétaro is somewhat indicative, although it can hardly serve as a completely adequate control in this regard. Is there any evidence that the wild polioviruses in the second city were diminishing seasonally? DR. SABIN: We had our hands full with Toluca. Carrying out the serologic studies in Querétaro is about as much as we were able to do. DR. BODIAN: I should like to ask a question of Dr. Ramos Alvarez, whose study I found most interesting, and that is whether he has some measure of the comparability of the two groups with respect to the incidence of poliomyelitis, that is, the unvaccinated and the vaccinated. I do not believe I heard him mention any measure of comparability or any factors which were used to select those who received immunization. DR. RAMOS ALVAREZ: The administration of the vaccine, as I mentioned, was made on a voluntary basis, and that was our method of selection. I think that both groups are comparable, since they belong to the same socioeconomic level. Does this answer your question? DR. BODIAN: What I really was getting at was an independent measure of whether these two groups are comparable with respect to their probability of acquiring paralytic poliomyelitis. For example, age and antibody status are factors which would help in a comparison. DR. RAMOS ALVAREZ: I think they are. I do not have with me the information you requested on the number of children in the different age groups. However, I shall be glad to make the data available later. DR. MELNICK: Looking at Table 16*, of Dr. Ramos Alvarez's paper, which indicates the maximum effectiveness of the vaccine (from the number of expected cases and the number of observed cases), am I to understand that an effectiveness of 80 per cent is what he feels he achieved in this study? DR. RAMOS ALVAREZ: I did not say it was an effectiveness of 80 per cent, merely that there was a striking difference between the groups. DR. MELNICK: I should like an interpretation of Dr. Ramos Alvarez's data, where he shows 187 expected cases and 35 observed. At face value this comes out to about 80 per cent effectiveness. Do I interpret the table correctly? DR. RAMOS ALVAREZ: Yes, but we must take one thing into consideration, that is, in Mexico City the numbers are not comparable. We vaccinated only 17 per cent of the estimated popula- *see p. 398.
412 Discussion tion. I do not see how effectiveness can be measured on that basis. DR. MELNICK: From your data, Dr. Ramos Alvarez, you indicated that in Mexico City you expected 75 cases in the 17 per cent vaccinated. Instead of findings 75 did you observe 18? DR. RAMOS ALVAREZ: This is right. DR. MELNICK: Calculated on this basis, do we not arrive at an effectiveness rate of about 80 per cent? DR. RAMOS ALVAREZ: If you wish to take it that way. CHAIRMAN LÉPINE: We have the figures. Are there any other remarks? If not, we shall now change continents, leaving America and going to Russia. The next paper is by Professor Chumakov and his associates entitled "On the Course of Mass Immunization of the Population in the Soviet Union with the Live Poliovirus Vaccine from Albert B. Sabin's Strains." The presentation of this paper will be made by Dr. Voroshilova.
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LIVE POLIO IRUS VACCINES Papers Pre
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SECOND INTERNATIONAL CONFERENCE ON
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Preface The accumulation of informa
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Page Discussion .......... .......
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Page 6. Vaccination of Full-Term In
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Page 23. Vaccination against Poliom
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Dr. Ghislain COURTOIS Director, Pri
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Dr. Edith PETTE Institute for the R
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4 Introductory Remarks 4 Introducto
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6 General Considerations immunity a
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8 General Considerations from accep
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10 General Considerations 10 Genera
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14 Safety-Laboratory Evidence of At
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- 26 Safety-Laboratory Evidence of
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DISCUSSION CHAIRMAN ANDERSON: There
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30 Discussion CHAIRMAN ANDERSON: Th
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32 TABLE 1. Safety-Laboratory Evide
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40 Discussion Of the 22 monkeys inf
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DISCUSSION CHAIRMAN ANDERSON: Thank
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46 Discussion a paralytic case. Thi
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48 Discussion + - + + I + - I + + 1
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50 Discussion sages of neurovirulen
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Application of Genetic Markers to D
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Discussion 67 TABLE 1. INCIDENCE OF
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Experimental Studies on Animals wit
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6. DETECTION OF A "NON-DETECTABLE"
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Detection of a "Non-Detectable" Sim
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Discussion 87 Dr. Koprowski's state
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Discussion 89 recognize its effects
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Laboratory Investigations of Attenu
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Discussion 99 In the case of Table
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8. BEHAVIOR OF COLD MUTANTS OF POLI
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Behavior of Cold Mutants of Poliovi
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DISCUSSION CHAIRMAN BURNET: Thank y
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114 Safety-Field Evidence of Safety
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118 S afety-Field Evidence of S af
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122 Discussion 122 Discussion~~~~~~
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10. LABORATORY INVESTIGATIONS OF TH
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126 VIRUS 1 MAhONEY Safety-Field Ev
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128 Safety-Field Evidence óf Safet
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DISCUSSION CHAIRMAN ZHDANOV: This p
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11. EPIDEMIOLOGICAL AND VIROLOGICAL
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12. SPREAD OF A VACCINE STRAIN OF P
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148 Saf ety-Field Evidence of Saf e
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152 Saf ety-Field Evidence of Safet
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DISCUSSION CHAIRMAN ZHDANOV: The pa
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158 Discussion 158 Díscussion~~~~~
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160 Discussion specimens. We were u
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. . . 168 Safety-Field Evidence of
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14. THE CAPACITY OF LIVE ATTENUATED
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176 Saf ety-Field Evidence of Saf e
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Field, Laboratory Experiences With
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16. STUDIES ON LIVE POLIOVIRUS VACC
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Studies on Live Poliovirus Vaccine
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Da. HORSTMANN: If I may answer for
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Discussion 205 Discussion 205 tried
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NOTE: The Spanish translation of th
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Vaccination of Pregnant Women and Y
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Development and Persistence of Poli
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Virologic, Serologic Investigations
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_ _ _ _ _ _ _ _ Virologic, Serologi
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cARE NUC:4I Discussion 267 CUAw # J
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Discussion 269 in the investigation
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Virological Findings, Antibody Resp
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4. ROUTINE IMMUNIZATION WITH ATTENU
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Routine Immunization With Attenuate
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Experimental Infectionwith CHATAtte
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Experimental Infection with CHATAtt
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Experimental Infection with CHATAtt
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Vaccination of Full-Term Infants wi
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Response of Newborn Infants to Vacc
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Susceptibility of Newborn Infants t
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9. IMMUNIZATION OF NEWBORN INFANTS
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Immunization of Newborn Infants wit
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Discussion 323 vaccinated siblings
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Discussion 325 Discussion 325 ance
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transplacental antibodies, or antib
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Discussion 329 Discussion 329 born
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Recent Experience with Lederle Triv
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11. FURTHER EXPERIENCES WITH ORAL P
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Further Experiences with Oral Polio
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Minnesota Studies with Oral Poliomy
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Page 446 and 447: DISCUSSION CHAIRMAN LÉPINE: Thank
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462 Discussion one was sponsored by
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Vaccination with CHAT Strain Type 1
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Live Virus Vaccine Studies in South
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Discussion 481 the ages of the five
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Immunological and Epidemiological E
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DISCUSSION CHAIRMAN STUART-HARRIS:
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Further Observations on First Field
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Further Observations Qn First Field
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Further Observations on First FielJ
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Poliomyelitis Vaccination in Poland
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24. A SMALL-SCALE TRIAL WITH LIVE P
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Live Poliomyelitis Vaccine-Small-Sc
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25. VACCINATION AND CHALLENGE-POLIO
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Vaccination and Challenge-Poliomyel
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26. VACCINATION WITH ATTENUATED POL
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Vaccination with Attenuated Poliovi
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Discussion 575 ence last year. The
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Large-Scale Practical Trials, Use o
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594 Discussion 594 Disenísion ~ ~
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596 Discussion 596 Díscussion~~~~~
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598 Discussion 598 Discussion high
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602 Summary of the Conference 602 S
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Appendix The following letter was r
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608 Index Antibodies-continued half
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610 Index Bulychev, N. P., paper, 4
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612 Index Coxsackie--continued B-3
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614 Index Epidemics-continued intro
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616 Index Genetic stability-continu
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618 Index Infants-continued source
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620 Index Laboratory surveillance d
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622 Index Monkey neurovirulence, 95
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624 Index pH neutralization test, 6
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626 Index Poliomyelitis virus-conti
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628 Index Serological response-cont
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630 Index T marker-continued T- str
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632 Index Vaccine, Attenuated-conti
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634 Index Virus isolations and anti
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LIVE POLIO IRUS VACCINES

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