LIVE POLIO IRUS VACCINES

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TOPIC III. EFFICACY. (B) FIELD EVIDENCE
(continuation)
17. A PRELIMINARY REPORT ON A LARGE-SCALE FIELD TRIAL
WITH THE ORAL COX-LEDERLE ATTENUATED
POLIOMYELITIS VACCINE IN DADE COUNTY
(MIAMI), FLORIDA
M. E. FLIPSE, G. M. ERICKSON, W. R. HOFFERT, M. M. SIGEL, N. J. SCHNEIDER,
L. B. CLAYTON, A. W. MENZIN, R. E. MARKUSH, F. HOWELL, JR., M. I. CROSSLEY,
T. E. CATO, A. V. HARDY, AND F. J. EVANS
Section of Preventive Medicine and Public Health, University of Miami School of
Medicine; Dade County Department of Public Health; Dade County Medical
Association; and Florida State Board of Health
DR. FLIPSE (presenting the paper): During the
late fall and early winter of 1959 the individuals
and groups responsible for the control and prevention
of poliomyelitis in Dade County, Florida,
were forced to critically evaluate the past and
possible future programs against this disease
in this community. The factors which forced
this evaluation and which influenced the decisions
which were subsequently made, included:
1. The Salk-type polio vaccine did not provide
a satisfactory degree of protection against paralytic
and fatal poliomyelitis. In 1959 in Dade
County 15 of 38, or 40 per cent and in Massachusetts
64 of 137, or 47 per cent, of the reported
cases of paralytic poliomyelitis had previously
received three or more of the Salktype
polio injections (Table 1). In Dade County
the failure of the Salk vaccine occurred with
nearly equal frequency to both Types 1 and 3.
Likewise, the mortality data were disturbing
(Table 2). In 1959 in Dade County, two of
three, and in New Jersey four of seven deaths
from poliomyelitis occurred in individuals who
* Supported in part by a grant from the Lederle
Laboratories Division of the American Cyanamid
Company, Pearl River, New York.
435
had previously received three Salk-type injections.
One death from poliomyelitis in Florida
was a school-age child who had received five
Salk injections, the last only a few months
before the onset of his fatal illness.
2. There was evidence of increasing apathy and
decreasing participation in the serial and booster
injections required by the killed vaccine programs.
These trends were obvious in spite of
repeated intensive health education and promotional
campaigns by official and voluntary health
agencies and professional groups, and in spite of
the fact that polio vaccination was available
without charge in Health Department clinics to
all requesting it.
3. The presentations at the First International
Conference on Live Poliovirus Vaccines and at
the American Public Health Association Meeting
gave evidence of the practicability of large-scale
programs with apparently safe and antigenically
potent oral polio vaccines.
4. All segments of the community seemed willing,
even eager, to cooperate in a trial of a new
method for the prevention of poliomyelitis, which
appeared to have both theoretical and practical
advantages over killed polio vaccine.
After extending invitations to interested in-