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