LIVE POLIO IRUS VACCINES

Vaccination with Attenuated Polioviruses in Costa Rica
569
DR. QUIRCE (presenting Section II of the
paper, through an interpreter): When the decision
was made to undertake the mass vaccination
campaign with oral poliovirus vaccine, plans
were developed for the two major aspects of
the project. The organization for the administration
of the vaccine has been discussed in the
preceding section; this discussion deals with the
organization and findings of the surveillance
program.
Information regarding the technical details of
the vaccination campaign were distributed by
various means to medical societies and practicing
physicians and discussed with the medical
staffs of the hospitals and health centers throughout
the country. The purpose of the program
and the manner of its operation were explained
to the lay public by means of the press, radio,
and local announcements over mobile loudspeaker
units. At suitable times, further details
were supplied to the churches and schools. In
these ways a systematic effort was made to create
a maximum of interest and understanding at
all levels of the public.
As a result of the severe 1954 epidemic, the
medical profession specifically and the public in
general had been made painfully aware of poliomyelitis
and this had served to increase the
efficiency of the reporting of poliomyelitis and
similar clinical diseases. We believe that the
reporting of paralytic poliomyelitis after 1954
accurately reflects the incidence of the disease
in Costa Rica, and that as a result of this and
the preparatory measures taken early in 1959
we were in a position to carry out an effective
surveillance program. Other factors operated as
a part of the national health service to supply
us with information about the occurrence of
paralytic disease. These were the activities of
the Crippled Children's Program of the Ministry
of Health which organized visits of the director
of the Rehabilitation Center, physiotherapists
and appliance experts to local health centers in
various parts of the nation. This staff, as well
as the nurses, physicians and welfare workers
throughout the country were the principal
sources of information regarding cases or suspected
cases of poliomyelitis during the vaccination
campaign.
A central office was set up in San José to receive
and investigate reports from local sources
Section II. Surveillance Program
as well as those from the seven provinces. The
chief physician of the office and his assistant
were aided during part of the program by a
representative from the Pan American Health
Organization and two representatives from the
Communicable Disease Center of the U.S. Public
Health Service. Cases for investigation were
usually screened by the physicians of the local
health centers and hospitals, but periodic visits
were made by the staff of the Surveillance Service
to the Rehabilitation Center and general
hospital in San José and elsewhere in search of
unreported cases. When the clinical characteristics
of the case warranted, blood and stool
specimens were collected and dispatched to the
Middle America Research Unit Laboratory in
Panama and to the Pan American Sanitary
Bureau tissue-culture laboratory in Cali, Colombia
for diagnostic service. Many of the specimens
were also examined at the Viral and
Rickettsial Research Section of Lederle Laboratories
in Pearl River. Periodically, a panel of
personnel from the diagnostic laboratories and
the Surveillance Service met and reviewed the
clinical, epidemiological and laboratory evidence
assembled, and decided the status of each of
the reported cases of suspected poliomyelitis.
Conferences for this purpose were held twice in
San José and once in Panama. Except for those
cases which have accumulated since the last
panel meeting in mid-May, the judgment of this
conference group has been accepted in classifying
the cases now to be reviewed.
From the initiation of the oral vaccination
program in Costa Rica in March of 1959 to
mid-May 1960, 326 suspected cases of poliomyelitis
were reported to or uncovered by the
Surveillance Service. The first 51 of these were
reviewed by the conference group in January
1960 and 25 were rejected as being without
neurologic manifestations. Twenty of the remaining
cases were segregated as non-poliomyelitis
cases with nervous manifestations due
to various causes. Six confirmed polio cases
were accepted and all of them were without a
history of oral vaccination. A report reviewing
these cases was issued and circulated among
the various cooperating agencies involved in the
Costa Rican program.