LIVE POLIO IRUS VACCINES

448
Efficacy-Field Evidence
448 lEfficacy-Field Evidence
operative relationship among the health department,
the practicing physicians, and the medical to provide surveillance of any Dade County re-
Disease Center, U.S. Public Health Service, were
school, as exemplified by the joint sponsorship lated poliomyelitis cases occurring elsewhere.
and participation in the present studies. In Dade Despite all these precautions, a non-hospitalized
fatal case occurred this year in Dade County
County, therefore, there is a particularly favorable
environment for exacting epidemiological and was reported as polio only after post-mortem
surveillance.
study by the medical examiner.
The usually adequate epidemiological procedures
were reinforced for this study. Discussion
at the monthly meeting of the medical society
and correspondence directed to all physicians,
urged the necessity of reporting all known or
suspect infections of central nervous system
diseases or of alleged vaccine reactions. A large
proportion of the physicians were voluntary participants
in this program. They shared our
scientific interest in assaying the merit of this
new vaccine, still further assuring complete
reporting. The Department of Public Health
was the recognized focus for receiving reports
of reactions to the vaccine. A specially trained
interviewer received incoming calls and recorded
all pertinent inquiries and observations.
The nature of the epidemiological field investigation
depended on the characteristics of the
case. The first level of surveillance comprised
spontaneous reports from the public, usually attained
by telephone. There were similar reports
from physicians' offices. Few home visits were
required to investigate these minor problems.
Cases with any possible significance were scheduled
for more detailed investigation. If a case
were reported in which the physician had not
done a lumbar puncture, an initial field visit was
made by a public health nurse. When preliminary
findings were significant, an investigation
was made by an epidemiologist. Medical consultants
were frequently called upon.
Whenever a lumbar puncture had been done,
and in all cases of paralytic disease, the level of
surveillance was maximum and carried out by the
epidemiologists. Appropriate consultants were
designated to review all cases where the diagnosis
of poliomyelitis was under consideration.
Plans were effected to assure that appropriate
specimens for desired laboratory tests would be
collected and delivered properly to the virus
laboratory.
Through special arrangements, the Florida
State Board of Health and the Communicable
OBSERVATIONS
There were relatively few telephone calls reporting
possible minor reactions to the vaccine
and in most instances persons were satisfied with
appropriate information. All inquiries were reviewed
by the epidemiologist. Nineteen reports
of early reactions were of interest. Urticaria followed
the taking of the vaccine in 18 individuals
and there was one case of acute arthralgia. The
various ingredients in the vaccine are to be
offered separately to these persons to determine
whether there is any sensitivity to some particular
ingredient. Apart from these cases there was no
reason to suspect that the disorders reported as
following ingestion of vaccine were other than a
sample of the general ailments occurring in the
community.
During the first five months of this year, 29
cases of non-paralytic non-bacterial infections of
the central nervous system were reported. Data
on these are given in Table 2. Four occurred
prior to the beginning of the vaccination program
and in three recently reported cases the definitive
diagnosis is pending. Among the remaining
22 cases, there were 12 cases of encephalitis,
six due to mumps, two to varicella, one each to
measles and herpes zoster, and two with etiology
undetermined. There were 10 cases of aseptic
meningitis, two with onset in February, five in
March, one in April, and two in May. Twenty-one
fecal specimens from seven patients have been
examined for polio with the isolation of polio
Type 3 virus from one, a case of aseptic meningitis.
Of the 12 cases of encephalitis, seven took
oral polio vaccine, one on the day of onset, the
others with intervals of 14, 41, 41, 51, 72, and
96 days between administration of vaccine and
onset of symptoms. Only four of the ten cases
with aseptic meningitis had taken oral vaccine
15, 35, 53, and 75 days, respectively, prior to
onset. In all, there were two cases only in which