LIVE POLIO IRUS VACCINES

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Further Observations on First Field Trial in Czechoslovakia 517 > u rr Ix I d3one 2- '- C *ne coo. o! one ttrain isolated lrom vaccinated persons o one stroin otisoted from non-vo.cinated persons 1,2,3 tJpe ef poliovirus an mp¡J q /nuryarl 1959- 1959 month alter start ol co*n (eca 2 .eekRs a/ter Ieeding type 3) '' 2_,700000 f )oA I.geamplEin . April 19gS- 4months alter start oa "ccin on (cc 2 montehs alter leeding 1t;pe 2) \ toon go/ter start rl vocc¡ataion FIC. 5. Spread of polioviruses in orally vaccinated Czech regions and number of paralytic polio cases, 1959. Date of sampling - A- JUNE 1959 fB-SEPTEIBER 1950 L I. P-1,ini a porsn- fram Jua- o Deremeer 1959 / Rgieone her-e 1ie Pbolovirus raccin . .. used(X 58-1 t 195 ') vere the t 4 dose ol Sol's rvacin.e as used FIG. 6. Paralytic poliocases and spread of polioviruses in some Czechoslovak regions, 1959 (Cases virologically and clinically confirmed). These results, particularly in conjunction with investigations of the spread of polioviruses in the population, influenced our final decision in a significant manner. 3. Results of Investigations of the Poliovirus Spread in the Population: In 1959 great attention was paid to these investigations in Czechoslovakia. The fate of attenuated polioviruses
518 Efficacy-Field Evidence in the population of the four experimental and neighboring regions was investigated and repeated investigations on the spread of wild polioviruses (and other enteroviruses) were conducted in several Czech and Slovak regions. The main attention was paid to relations between the amount of detected strains and the poliomyelitis morbidity*. The results, obtained before the usual onset and at the peak of the usual polio season (June-September), are of particular importance. From the results, discussed in greater detail elsewhere (Burian, Vojtová and others), I should like to demonstrate the following main facts shown on two maps (Figures 5 and 6): (a) Repeated investigations in four regions, where in the winter of 1958-1959 the live vaccine was administered (Fig. 5), revealed that attenuated viruses disappear relatively rapidly from the population. Isolated viruses, if detected later in non-vaccinated individuals (white circles on the map), were most probably wild viruses imported to these regions from elsewhere, or wild viruses occurring in the non-vaccinated part of the population. (It must be emphasized that the first field trial with the live vaccine was conducted in a relatively small part of the population-in less than 50 per cent of children aged two to eight years). The polio-morbidity in these four regions (black squares on the map; one square stands for one case of poliomyelitis) does not have any peculiar features. (b) Very important results are shown on the map summarizing the results of two investigations of the poliovirus spread in Czechoslovakia in 1959 during June (A) and September (B), and which gives also the number of cases of poliomyelitis in the second half of 1959 (Fig. 6). The results indicate that in regions neighboring upon those where the live vaccine was administered, the incidence of polioviruses was low and that thus, most probably, these viruses did not penetrate into neighboring regions. (It must also be taken into account that the vaccination was carried out in winter). If later there was a higher incidence of viruses in some localities (such as in the Gottwaldov region), this * Specimens of feces, proportional to the population densitv, were collected by random sampling, predominantly from children. In child communities, never more than two specimens were taken from one community. was more probably due to the penetration of wild viruses from neighboring Slovak regions, particularly the Zilina region, which is very close to the Gottwaldov region. (It is interesting to note that in 1959 there was an extensive poliomyelitis epidemic in neighboring Hungary, which borders on Slovakia along the entire frontier.) The most important conclusion from these investigations is that, when there was a higher incidence of polioviruses in the population, which had been practically evenly vaccinated with the inactivated vaccine, there was also a higher incidence of poliomyelitis. In other words, we may say that not even the previous high vaccination rate with inactivated vaccine was able to prevent the spread of polioviruses and that to a certain degree, we have to rely on chance whether an unexpected spread of viruses will occur or not. If we add to this the defects of seroimmunity, it is evident why in 1959 there was a substantially higher morbidity in Slovakia, as shown in Fig. 2 and why we considered the future epidemiological prognosis of poliomyelitis in our country uncertain.* The main purpose of my report was to give an idea of the trend of our deliberations and to demonstrate at least some fundamental facts on which we based our decision to use the live vaccine for mass vaccination. I think that our results indicated clearly the necessity to improve the state of immunity of our most susceptible population. A comparison of the results of the first field trial with the live vaccine with those after the administration of a fourth dose of inactivated vaccine on a mass scale, however, revealed also the method of how to achieve this improvement most expediently. I have tried to summarize the balance of our deliberations on the advantages of either method in Table 6. The objection could certainly be raised that our decision was premature. I dare not, however, answer the second aspect of this objection, and I doubt that anybody will be able to do so. It is my opinion that it would be much more difficult to explain to our people in the case of an epidemic, why we did not undertake every- * The results assembled during the first few months of 1960 confirmed to a certain extent that these fears were justified. The number of patients between 1 January 1960 and 28 March 1960 was, as comPared with the same period in 1959, three times greater (66:22), and several small local epidemics occurred.
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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 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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13. USE OF ATTENUATED LIVE POLIOVIR
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Use of Attenuated Live Poliovirus V
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Use of Attenuated Live Poliovirus V
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DISCUSSION CHAIRMAN LÉPINE: The tw
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Discussion 373 -~~~~~~ics o 7 domin
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Discussion 375 -~ ~~~~isuso 7 DR. C
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i 14. EFFECTS OF RAPID MASS IMMUNIZ
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Live Poliovirus Immunization-Condit
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Use of Sabin's Live Poliovirus Vacc
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- Use of Sabin's Live Poliovirus Va
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TABLE 14. Use of Sabin's Live Polio
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Discussion 411 DR. ANDERSON: My que
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Course of Mass Immunization in USSR
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, _ _ Course of Mass Immunization i
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DISCUSSION CHAIRMAN LÉPINE: Thank
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Discussion 431 DR. STUART-HARRIS: I
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436 Efficacy-Field Evidence TABLE 1
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438 Efficacy-Field Evidence Adminis
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444 Effcaey-Field Evidence 44 Efiay
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446 Efficacy-Field Evidence 446 Eff
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448 Efficacy-Field Evidence 448 lEf
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450 Efficacy-Field Evidence m Co 0
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452 Efficacy-Field Evidence ] ~~ ~
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454 Efficacy-Field Evidence It is n
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456 Efficacy-Field Evidence M.G. C
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460 460 Discussion Discussion~~~~~~
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462 Discussion one was sponsored by
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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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