LIVE POLIO IRUS VACCINES

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25. VACCINATION AND CHALLENGE-POLIOMYELITIS IN NICARAGUA, 1959-1960 JUAN JosÉ ALCOCER, M.D., ROBERTO ARMIJO, M.D., AND MAURICIO MARTINS DA SILVA, M.D.* Dr. ALCOCER (presenting the paper): In a report presented at the First International Conference on Live Poliovirus Vaccines in Washington, D. C., 22-26 June 1959,1 we gave an account of the history of poliomyelitis in Nicaragua, and described in detail the oral vaccination program in the City of Managua, carried out during an epidemic of poliomyelitis in 1958. The epidemic started in Managua in May and extended to 14 of the 16 departments of the country. It lasted five months, during which time 237 cases were reported, 98 of which were from Managua. The attack rate in Nicaragua in 1958 was 18.4 per 100,000 population with a case fatality rate of 7.1 per cent. It was established that the epidemic was due to poliovirus Type 2. The vaccination program started in September 1958 and included children between two months and 10 years of age in the City and the Department of Managua. Mass vaccination was followed by a maintenance program, which was intended to immunize newborn infants in maternity hospitals and health centers in the City of Managua with a liquid trivalent vaccine. Up to 15 May 1959, a total of 59,855 children had received the Type 2 virus, 54,732 the Type 3 virus, and 49,585 all three types. On the basis of information available at the time of the vaccination campaign it was estimated that 98, 91, and 82 per cent of the eligible population under 10 years of age, in Managua, had received vaccine for Types 2, 3, and 1 respectively. However, using the revised population and age distribution data for the Department of Managua in 1959,2 the actual coverage was 67, 61, and 56 per cent for Types 2, 3, and 1, respectively. * Dr. Alcocer and Dr. Martins da Silva (Pan American Health Organization/World Health Organization); and Dr. Armijo (Ministry of Public Health, Managua, Nicaragua). 547 The serologic studies showed that of those children who were seronegative at the time of vaccination, 74 per cent responded to Type 1, 58 per cent to Type 2, and 80 per cent to Type 3 polioviruses. No illness attributable to the vaccine was observed and it was gratifying that during the eight months following the vaccination program, no cases of paralytic poliomyelitis were reported in Managua. POLIOMYELITIS OUTBREAK IN 1960 The maintenance program continued throughout 1959 and 1960 using the trivalent vaccine which contained approximately 106.1 TCD,,o of each of the three types of poliovirus in a 2 ml. dose. By 15 April 1960 a total of 73,533 children under 10 years of age, including 5,344 newborns, had received the oral vaccine (Table 1) on page 48. In mid-1959, in anticaption of the seasonal epidemic exacerbation of the disease, which has been experienced in Managua since 1938, the health authorities of Nicaragua expanded their surveillance activities, in the course of which three unreported paralytic cases of poliomyelitis in 1959 were uncovered in Managua; one had onset in January, one in May, and one in June (Fig. 1) on page 47. This finding requires correction of the previous statement that no cases occurred in Managua between 15 October 1958 and 15 June 1959. From 23 August to 10 October 1959, seven additional cases were notified in the City of Managua. After a quiet period of 10 weeks a new upsurge in notified cases prompted the health authorities to request the cooperation of the Pan American Sanitary Bureau for diagnostic assistance and additional supplies of vaccine. Reports of cases continued to increase in Managua and epidemic outbreaks appeared successively in the departments of Granada, Masaya, Chinandega, León, and Rivas,
548 Efficacy-Field Evidence TABLE 1. AGE DISTRIBUTION OF CHILDREN FED VACCINE CONTAINING THREE TYPES OF LIVE POLIOVIRUS, SEPARATELY OR COMBINED, IN NICARAGUA AND IN THE DEPARTMENT OF MANAGUA, 1958-1960 POPULATION RECEIVING VACCINE AGE IN TOTAL FIRST STAGE: 7 SEPTEMBER 1958- 15 MAY 1959 SECOND STAGE: 16 MAY 1959- 15 APRIL 1960 YEARS NICARAGUA MANAGUA NICARAGUA MANAGUA NICARAGUA MANAGUA Total 73,533 58,884 56,160 49,585 17,373 9,299
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SECOND INTERNATIONAL CONFERENCE ON
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Preface The accumulation of informa
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Dr. Ghislain COURTOIS Director, Pri
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Dr. Edith PETTE Institute for the R
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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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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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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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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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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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Use of Attenuated Live Poliovirus V
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Use of Attenuated Live Poliovirus V
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Live Poliovirus Immunization-Condit
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Use of Sabin's Live Poliovirus Vacc
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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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436 Efficacy-Field Evidence TABLE 1
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Vaccination with CHAT Strain Type 1
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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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