The Relation of Prophylactic Inoculations to the Onset of Poliomyelitis Lancet 1950 pp 659 63

The Relation of Prophylactic Inoculations to the Onset of Poliomyelitis.

Author(s) : MCCLOSKEY, B. P.

Journal article : Lancet 1950 pp.659-63

Abstract : Of 375 cases of poliomyelitis notified in Victoria, Australia from January to August 1949, 340 were investigated. Thirty-one patients had received an injection of diphtheria toxoid, pertussis vaccine, or both in combination, within three months of the onset of symptoms. The more recent the injection of any agent, the more likely was its association with the onset of poliomyelitis. 
Of the 340 cases, 69 were children under three years of age. Seventeen had received pertussis vaccine either alone or in combination within 35 days of the onset; in 15 the paralysis was in the limb last inoculated. 
Doctors were advised to defer using pertussis vaccine during the epidemic, in the same way as tonsillectomy is postponed since it may determine an attack of poliomyelitis in rare instances. The diphtheria immunization campaign was allowed to continue, because the connexion between inoculation and paralysis was less certain; moreover temporary cessation of the campaign was feasible if the need arose. There was no adverse comment in the Press, and the future of immunization in Victoria should not be prejudiced. 
Contamination of the prophylactic agents with poliomyelitis virus was excluded. Secondly, the chances of syringe transmission were so slight that this possibility too was rejected. The third hypothesis was that there were viraemia at the time of inoculation, arrest and concentration of the virus in injured tissue, and finally, travel of the virus to the cord. Lastly, local trauma (produced by exercise, tonsillectomy, or in this instance an injection) might be reflected by central changes in the cord, favouring activation of a virus already present in the central nervous system. So far none of these explanations of the observations is convincing, and further research is necessary, possibly in the monkey. 
Local damage to tissue seems to be a determining factor, and is much more severe after the injection of pertussis vaccine, or diphtheria-pertussis prophylactic than after diphtheria toxoid alone; more striking and frequent effects followed pertussis vaccination. 
The age of the children at the time of injection may be of some importance. Localization of the paralysis in an inoculated limb may be more likely to occur in younger children; the average age of the children given pertussis immunization in McCloskey's series was 2-4 years. 
The point to be emphasized is that all the cases of paralysis in association with inoculations occurred during a severe epidemic of poliomyelitis. [With regard to general policy, the risks of contracting diphtheria and whooping cough on the one hand and poliomyelitis after preventive inoculations on the other must be balanced against each other. Clearly the diphtheria campaign has been worth while, and whooping cough vaccination is also achieving useful results. Let us hope that, at the worst, brief closed seasons for certain inoculations may be all that is ever necessary, as was the case at Melbourne.] 
H. J. Parish.

Record Number : 19502702369

Language of text : English

Language of summary : English

Indexing terms for this abstract:

Organism descriptor(s) : man, monkeys, viruses

Descriptor(s) : bacterial diseases, central nervous system, children, diphtheria, epidemics, experimental infection, human diseases, immunization, infections, nervous system, paralysis, pertussis, poliomyelitis, prophylaxis, seasons, symptoms, toxoids, vaccination, vaccines, viraemia, viral diseases

Identifier(s) : bacterial infections, bacterioses, bacterium, CNS, experimental transmission, immune sensitization, polio, viral infections, viremia, whooping cough

Geographical Location(s) : Australia, Victoria

Broader term(s) : Homo, Hominidae, primates, mammals, vertebrates, Chordata, animals, eukaryotes, APEC countries, Australasia, Oceania, Commonwealth of Nations, Developed Countries, OECD Countries, Australia



https://www.cabdirect.org/cabdirect/abstract/19502702369


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