Morbidity and mortality

MISSING IMAGE

Material Information

Title:
Morbidity and mortality
Uniform Title:
Morbidity and mortality (Washington, D.C. : 1952)
Running title:
Weekly mortality report
Weekly morbidity report
Morbidity and mortality weekly report
Abbreviated Title:
Morb. mortal.
Physical Description:
25 v. : ; 27 cm.
Language:
English
Creator:
United States -- National Office of Vital Statistics
Communicable Disease Center (U.S.)
National Communicable Disease Center (U.S.)
Center for Disease Control
Publisher:
The Office
Place of Publication:
Washington, D.C
Publication Date:
Frequency:
weekly
regular

Subjects

Subjects / Keywords:
Communicable diseases -- Statistics -- Periodicals -- United States   ( lcsh )
Mortality -- Periodicals -- United States   ( lcsh )
Morbidity -- Periodicals -- United States   ( mesh )
Mortality -- Periodicals -- United States   ( mesh )
Statistics, Medical -- Periodicals -- United States   ( lcsh )
Statistics, Vital -- Periodicals -- United States   ( lcsh )
Genre:
federal government publication   ( marcgt )
statistics   ( marcgt )
periodical   ( marcgt )

Notes

Additional Physical Form:
Also issued online.
Statement of Responsibility:
Federal Security Agency, Public Health Service, National Office of Vital Statistics.
Dates or Sequential Designation:
Vol. 1, no. 1 (Jan. 11, 1952)-v. 25, no. 9 (Mar. 6, 1976).
Issuing Body:
Issued by: U.S. National Office of Vital Statistics, 1952-Jan. 6, 1961; Communicable Disease Center, 1961- ; National Communicable Disease Center, ; Center for Disease Control, -Mar. 6, 1976.
General Note:
Title from caption.

Record Information

Source Institution:
University of Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
oclc - 02246644
lccn - 74648956
issn - 0091-0031
ocm02246644
Classification:
lcc - RA407.3 .A37
ddc - 312/.3/0973
nlm - W2 A N25M
System ID:
AA00010654:00070

Related Items

Preceded by:
Weekly mortality index
Preceded by:
Weekly morbidity report
Succeeded by:
Morbidity and mortality weekly report

Full Text

=s.2 6o,/1


Morbidity and Mortality



U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE


Prepared by the


I I DIE S CE T


MElrose 4-5131


AILANrA 22. GEORGIA


--~~ ------- -ra~s1J-~-


,rA ""46 ,. 3


PROVISIONAL INFORMATION ON SFLF ICED NOTIFIABLE DIIA, ES IN THEL ~T T T L-\ N
DEATH HS IN SELECTED (. 1IEs FOR tEI: EK NDED SEPTEMBER 2


OLIOMYELITIS A total of 29 cases of poliomyelitis Thus far in 1962, vi ,c studies have b n m-
1 paralytic) were reported for the week which ended pleted on 119 cases repo d poliomyelitis tese
september 22, 1962. The comparable week in 1961 ac- 100 have yielded Type I po f se ates
mounted for 69 cases (40 paralytic). were from Texas cases), and ave 1 ype III
Thirteen States reported cases this week. Georgia and .virus.


Louisiana each recorded 4 cases, Alabama 3, and Texas
only 2. No epidemiologic concentrations have been noted
in these States.
Reported cases of paralytic poliomyelitis in 1962 are
over 20 percent below the comparable total for the previous
record low year (1961).


POLIOMYELITIS, 1ST THROUGH THE 38TH WEEK (1958.1962)

1962 1961 1960 1959 1958
Paralytic 436 557 1,446 3,771 1,680
Total 559 849 2,111 5,950 3,433


Table 1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES
(Cumulative totals include revised and delayed reports through previous week)
38th Week Cumulative
Ended Ended First 38 weeks
-. -' --=," Median
September 22, September 23, 1957 1961 Median
1962 1961 1962 1961 1957 1961
Aseptic meningitis ............... 106 144 -- 1,734 2,154
Brucellosis ................... 9 15 15 307 454 577
Diphtheria. ..................... 16 12 19 291 400 471
Encephalitis, infectious.......... 54 38 58 1,246 1,173 1,313
Hepatitis, infectious and serum... 929 1,213 401 41,024 56,042 16,170
Measles............ .......... 788 627 857 443,511 387,689 396,521
Meningococcal infections......... 31 29 34 1,596 1,590 1,710
Poliomyelitis, total.............. 29 69 213 559 849 3,368
Paral-,tic ................. 21 40 82 436 557 1,616
N'urnpral I, ............... 6 22 94 88 201 1,239
Unspecified. .................. 2 7 37 35 91 513
Streptococcal sore throat
Sand Scarlet fever ............ 4,132 3,209 -237,075 242,932
Teranu4 ....................... 12 --- 194
Tularei-i ...................... 3 --- --- 217
Typhoid fever ................... 14 21 26 447 580 591
Typhus fever, tick-borne,
(Rocky Mountain spotted) ..... 5 --- --- 190 -.
Rabies in Animals............... 45 61 68 2,873 2,572 2,850


Table 2. NOTIFIABLE DISEASES OF LOW FREQUENCY

Anthrax: Psittacosis:
Botulism: Rabies in Man:
Malaria: N.Y. 1, N. C. 2. Smallpox:
Plague: Typhus, murine: Ala. 1, Tex. 1.


P
(2
SI
ci


For rel ise ipcu.-t r ir ,196?


4 ,J









298 Morbidity and Morl




SPECIAL REPORT

Reported Paralytic Poliomyelitis Following Oral Vaccine:

On September 15, 1962, the Surgeon General's Oral
Pollomrciris Vaccine Advisory Committee met in Wash-
ington, D. C., and reviewed the data concerning the oc-
currence of reported cases of poliomyelitis after the ad-
ministration of oral poliomyelitis vaccines during the
current calendar year. After a full discussion of the prob-
lem the Committee unanimously recommended that the use
of Type II vaccine be limited to pre-school and school
age children and to adults at high risk, i.e., those travel-
ling to hyperendemic areas an.d those living in areas where
Type III epidemics were present or impending. They ad-
vised that mass programs using Types I and II oral vac-
cines be continued for all age groups. A complete report
of the information reviewed is being made available to the
health and medical professions. The salient features of
this report are abstracted below.*

Use of Poliomyelitis Vaccines:
The Type I oral vaccine was licensed for distribution
in interstate commerce on August 17, 1961; Type II vac-
cine on October 19, 1961; and Type III on March 27, 1962.
Most of the vaccine has been used in community-wide
vaccination programs; some has been used by private
practitioners and in health department clinics. In most
areas, the vaccine was offered to persons of all ages.
The estimated use of oral vaccines in the United
States is summarized in the accompanying graph. Since it
was recommended that Type I vaccine be fed first and
because many programs did not start until late spring, the
estimates show a much greater use of this type of vaccine
than Types 11 and III.

Incidence of Poliomyelitis:
Reported to date have been 559 cases (436 paralytic)
of poliomyelitis, a record low incidence in the United
States.
Present data indicate that for 1962, the paralytic
poliomyelitis rate for those under 20 will be approximately
7.6 per million; for those over 20, about 0.9 per iIllion.

The Occurrence of Cases Following Oral Vaccine:
With the licensing of Type 1 oral vaccine in August
1961, the CDC poliomyelitis surveillance program placed
particular emphasis on the evaluation of reported cases of
,,ollo~'.. ihrs developing after vaccine use. It was recog-
nized that when millions of persons participate in an im-


*Abstracied from a technical report by Luthpr L. Terry, M.D.,
Sorgron General, Public tIealth Srvi1e, entitled "The Associ-
.atoo of Catse of Poliomyelilti with th.e se of Type III Oral
Polio m ye.ist Vaccianes". This was officially rrlasRed on
September 21. 1962. A copy of the complete report may be
obtained c request.


lality Weekly Report


Estimaot of the Number of Persons Fed
During Known Mass Community Oral Polio Vaccination Programs
by Month from Date of Liconsure, United S5ates


2,ooo TYPE I


0

0
0
0
4
0
-
0


LICENSED



? J^T11


-i, A E.= T : TYPE II UCENSED
..ooo


o

,ooor 000 I


4,000
S.OOO

1,000


20oo0


SOOn


TYPE III


LICENSED-
y


AU. S.U O. NO. orCC I., MAR AP m N au
o -


munization program, any of a variety of subsequent events
might occur coincidentally but be attributed erroneously to
the vaccine. This could be particularly true of an inter-
current disease such as aseptic meningitis that might
simulate poliomyelitis and even poliomyelirs due to in-
fection with wild polioviruses that had been acquired prior
to the vaccination. The problem is compounded during the
summer and early fall when many enteroviruses are
actively circulating.
In epidemic control a number of cases of disease
among vaccinees can be expected in the days immediately
following an immunization program before there has been
opportunity for immunity to develop. In non-epidemic areas,
the frequency of coincidental cases should be lower, al-
'h.ut'li not nc t.*-.arll zero. If vaccine is related in a
causal way to the cases, the intervals between immuniza-
tion and onset of disease should group within the expected
7 to 30 day incubation period of the disease.


o








Morbidity and Mortality Weekly Report


Since August 17, 1961, when Type I oral vaccine be-
came commercially available, there have been 62 cases
of poliomyelitis officially reported to the Public Health
Service in which oral polio vaccine had been administered
within 30 days prior to the onset of symptoms.
During the epidemic in New York State in 1961, 32
"under 30-day vaccinated cases" were reported. Most of
these developed soon after administration of the vaccine,
in fact, 15 within 6 days. Similarly during epidemic con-
trol programs in South Carolina, Georgia, and Texas, 17
"under 30-day vaccinated cases", 11 within 6 days, were
reported. The early appearance of these cases indicates
a coincidental rather than a causal relationship to
vaccination.
In the non-epidemic areas, 16 "under 30-day vacci-
nated cases" have been reported. Two followed Type I
vaccine, one followed Type II vaccine, and 13 followed
Type III vaccine. Eleven of the 16 occurred between the
15th and 29th day.
The Advisory Committee directed special attention to
these 16 under 30-day cases reported from non-epidemic
areas. All available clinical, epidemiological, and labora-
tory information was reviewed. Each case was considered


individually, and excluded or not excluded by group deci-
sion from further consideration as to the possibility of its
being vaccine induced. No case was excluded except by
unanimous agreement of the committee members. Included
for consideration were those cases clinically compatible
with poliomyelitis which demonstrated any significant
paralysis and in which laboratory findings to date were
not inconsistent with a vaccine relationship. Descriptive
data regarding these cases are summarized in the accom-
panying table, page 303.
Of the two cases of poliomyelitis reported following
Type I vaccine administration, only one (case 2) was
thought by the Committee to be entirely compatible clini-
cally with poliomyelitis. Of recent onset, the virologic
studies on this patient are still in process. The clinical
history of the other case (case 1) indicated it to be ex-
ceedingly mild and atypical. The patient experienced no
known febrile illness, he was not hospitalized, and no
cerebrospinal fluid studies were performed. He recovered
with no residual paralysis.
The single case reported following immunization with
Type II vaccine was found to have a Type III virus in his

(Continued on page 303)


SUMMARY OF PNEUMONIA AND INFLUENZA DEATHS
The weekly average number of pneumonia-influenza
deaths for the four-week period ending September 22 was
324 as compared with an expected 365 weekly average.


WEEK ENDING 4 Week Weekly
9/1 9/8 9/15 9/22 Total Average
Observed 314 307 338 339 1,298 324
Expected 358 362 367 373 1,460 365
Excess -44 -55 .29 .34 -162 -41


PNEUMONIA-INFLUENZA DEATHS IN 108 U.S. CITIES
Average number per week by four-week periods


I90 NFLUENZ A
90C -T-r -------------------


800



00
RECORDED
_/DEATHS"



EXPECTED"
\ NUMBER





MBER 76 IS 9 6 13 1962 1 7 13
|eR 1960 I 1961 F 1962 L 1963
P~aCE OF OCCOSENWO 'CALCLOATEOFfM l 9O O SO OXPORIENCE


299


NUMBER
OF
DEATHS


(See Editor's Note. page 304)


PERIOD NU










Morbiditl and lMorlalit% W eekly Reporl



Tabilc CASES OF SPECIFIED NOTIFIABLE DISEASES: U UNITED STATES

FOR WEEKS ENDED

SEPTEMBER 23, 1961 AND SEPTEMBER 22, 1962


Area




IUITED STATES......

NEW. EN 1A\ND..............
L. onl. .............. .
ew i.am.pshire.........
V. rmi. n[..............
h-ssachs-etlt s ......
Rh.d. Islaond..........
Conneerticu ........

IDDLE AA.NTI.............
New Yrk..............
New Jersey............
Penn sylvania

EAST NORTI CENTRAL.......
Ohi. ..................
Ind inas ..............
Illin. s ...........
Nichiian .............
isneiin ... i .........

WEST NORTH CENTRAL.......
li nnes l .............
I.. ...................

S, rlh Dak0l.i.........

rb raI k ..............
5. hr i .........


OUTH A ANTIC .........
I.'la .. .. ......
Disltr: i t Clu nb..... a.
Virt Vir i.. ...........
i .i ii .........
I.rth Carol i n .......
Sitir C......i. .... ....
c ria........ ....... ..
Fl rid ..............

EAST STH CENTiIRAL.......
K. t ui................

A lbma ............
i sissippi........ .

WEST .OTliTf CENTRIA......

i i i i i.. .........
)Ai :ra. a ..............


M i(}NTAI ........... ..
IyA o ... ................






IFIA...................


................
l ri...............


i\a i l~~ ..ri.. .. .. .. .. .


Poliomyelitis,


38th week
I ': I I.AI


Iiciil I -


Total Cases
Cumulative
First 38 weeks
P 2 t**.,t


559 849

6 21
2
1

4 10

2 4

58 212
44 156
6 31
8 25

59 94
16 25
9 10
23 21
7 19
4 19

27 52
6 6
5 18
7 12
3 2
1 1
5 6
7

41 140
2
22
2 1
8 9
5 21
5 14
5 15
10 27
6 29

48 67
18 21
10 18
17 9
3 19

250 114
9 16
18 35
11 3
212 60

12 41
3 3
2 14
2
1 6
3
3 7
1 8


58 108
2 19
5 13
50 73



10 6


Poliomyelitis, Paraly
Cumul
38th week First 3
I -. I It. j t I.


21










1

1


3


2

1

1





1


5







1
4


4
1

3


7
1
4

2


- i -


436

6



4

2

41
29
6
6

41
14
5
14
6
2

17
6
2
2
1
1
5


36


1
8
5
3
5
9
5

38
15
3
17
3

195
7
16
9
163

8
2
1
1


3
I


54
2
5
46



10


tic
Lative
18 weeks



557

17
2

4
8

3

146
101
26
19

56
12
5
9
16
14

24
6
9
3


3
3

103
1
22
1
9
13
7
10
20
20

40
5
8
9
18

59
6
26

27

23
2
6

6

5
4


89
19
6
61



6


P. II ..No alyIti A.hpt l
Nonparalytic MHeningitis


38th week
~I 'I


38t~h w.ci-k
I.t I 77


300










Morbidity and Mortality Weekly Report 301


Table 3. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

SEPTEMBER 23, 1961 AND SEPTEMBER 22, 1962 (Continued)


Brucellosis Diphtheria Encephalitis, Hepatitis, Measles
Infectious Infectious and serum
Area
Cumu- Cumu- 38th week
lative lative Under 20 &
38th week 38 weeks 38th week 38 weeks 38th week 20 yr. over Total Total 38th week
1962 1962 1962 1962 1962 1961 1962 1962 1962 1961 1962 1961

UNITED STATES...... 9 307 16 291 54 38 482 386 929 1,213 788 627

NEW ENGLAND.............. 2 1 2 4 47 32 80 78 56 27
Maine................. 9 10 19 5 5 13
New Hampshire........... 4 1 5 12 5
Vermont................ 1 1 8 8 -
Massachusetts......... 1 1 1 31 20 51 32 27 -
Rhode Island.......... -- 2 1 4 1 -
Connecticut........... 1 2 3 4 17 15 9

MIDDLE ATLANTIC.......... 7 5 14 4 82 87 169 156 95 75
New York............... 3 3 9 49 50 99 71 47 44
New Jersey............. 1 11 15 26 27 34 13
Pennsylvania.......... 3 1 5 4 22 22 44 58 14 18

EAST NORTH CENTRAL....... 68 8 8 5 93 69 174 201 229 162
Ohio.................. 1 3 5 24 20 48 76 34 20
Indiana................ 5 3 4 2 6 15 26 26
Illinois.............. 49 2 4 27 20 47 43 19 35
Michigan..... ........ 4 3 1 34 23 57 64 90 43
Wisconsin............ 9 4 4 16 3 60 38

WEST NORTH CENTRAL ....... 6 120 4 60 5 11 21 23 51 86 14 12
Minnesota ............. 1 10 1 18 2 1 4 19 1 -
Iowa.................. 2 73 2 3 6 10 16 32 3 3
Missouri.............. 3 5 1 1 3 7 13 23 7
North Dakota.......... I 2 7 -- 7 1
South Dakota.......... 2 8 1 13 2 2 6 3 1
Nebraska................. 11 13 2 2 7 1 9 6 -
Kansas................ 13 1 8 4 3 7 NN NN

SOUTH ATLANTIC............ 1 24 8 74 5 5 71 52 125 155 67 69
Delaware................ 8 3 -
Maryland.............. 2 1 7 4 11 15 7 29
District of Columbia.. 2 2 1 3 6 1 -
Virginia .............. 12 12 6 8 14 16 5 10
West Virginia......... .- -1 12 4 16 32 19 19
North Carolina ....... 2 2 8 1 28 13 41 43 1 1
South Carolina........ 2 7 2 4 1 5 7 9 1
Georgia............... 3 3 19 2 1 3 6 -
Florida............... 1 7 1 25 3 10 20 32 22 22 9

EAST SOUTH CENTRAL....... 15 16 2 2 59 20 79 214 28 18
Kentucky .............. 1 16 3 19 55 4 2
Tennessee............. 7 7 2 29 9 38 85 22 14
Alabama............... 6 3 8 3 11 29 2 1
Mississippi ........... 1 6 2 6 5 11 45 1

WEST SOUTH CENTRAL....... 1 28 4 108 5 6 51 31 84 90 60 79
Arkansas .............. 1 6 3 18 1 1 5 6 23 2 -
Louisiana.......... ... 6 8 25 7 32 -
Oklahoma .............. 5 6 6 -
Texas ............... 11 1 76 5 5 25 19 46 61 58 79

MOUNTAIN.................. 13 9 4 10 47 56 45 64
Montana............... 1 6 2 3 6 13 24
Idaho................. 1 11 8 8 -
Wyoming ............... 1 1 2 3 1 -
Colorado.............. 2 9 18 4 7
New Mexico.................... 2 2 5 8 6 NN NN
Arizona............... 4 11 3 15 19
Utah................. 4 1 1 2 5 5 14
Nevada................. 9 -

PACIFIC.................. 1 30 10 13 1 54 62 120 177 194 121
Washington............ 12 10 24 22 35 13
Oregon................ 3 2 10 12 26 42 26
California............. 1 25 5 13 1 38 39 79 117 58 70
Alaska.................. 1 5 2 3 5 12 13 12
Hawaii ................ 1 46

Puerto Rico............. 34 20 5 25 11 66 76










Morbidity and Mortality Weekly Report


IIhlc (CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES

FOR WEEKS ENDED

SEPTEMBER 23, 1961 AND SEPTEMBER 22, 1962 (Continued)


[n l l, l i.,


L3t .
38th wk. 38 weeks
I ,'. *.


T



....... .......
New Hiampshire......
Ve ornt..............
aLssachus.etts...... 1
Rhode Island........
ConnecCtieut........ 1I

'llDDLE ATLANTIC..... 9
New York............ 6
New Jersey .........
Pennsy vania....... 3

EAST :NORTit CENTRAL.. 3
Ohio............... 3
Indiana .... .......
Illinois...........
Miichigan............
Wisconsin.........

IJFT MnORTIH CNTRAT


Miosnesota..........
Iowa..................
Fissouri............
North Dakta .......
South Dakota.......
Nebrraska........ ...
ansas............

SOU0 ATIALTIC...... 3
Delaware........... 1
Maryland............
Dist. of Columbia..
Virginia.........
West V;I ii .. .... .
North i ,. .. 2
South Carolina.....
CGorgia............
Florida............


93
13
3
3
39
9
26

287
130
74
83

315
94
26
72
102
21

87
16
11
21
7
5
14
13

251
33
17
7
53
12
60
15
10
44


EA7T SO iT CENTRAL.. 2 98
Ktucky ............ 23
Tc ni ssrc........ 1 42
Alabam. ........... 1 19
Mississippi........ 14

SEST SOUTI CERNTIAi.. 4 131
rkanss........... 15
Liu is ii..1..... 59
Oklah a ........... 6
...... .. .. 3 51

51
10U TAIS............ 51
M nlan1l............ 3
idaho.............. 3



r 1........ ... 8
Ar.z n............. 138
.. ...... 7 8
83


P" T"T. .. ..... 8 283
S 19
........ 16
7 236
Al......... ...... I 8


Sore Throat &
Scarlet Fever


38th week


.,I '

270
82
1
1
64
13
109

94
53
20
21

167
29

53
49
36

160

36
2
54
6

62

534
1
4

78
135
14
37

265

906
60
786
42
18

601
4
1

596

869
41
83
10
310
236
108
81


531
117
14
356
26
I h


Tetanus



38th wk.
I 6:


Thikborne
Typhus
(Rcky Mt.
Spotted)

38th wk.


Tularemia


Typhoid Fever Rabies in Animals


38th wk.138th wk.


Cumu-
lative
38 weeks


latI .e
38th week 38 .wr.ks
1962 1 1961 I 1962


103



36
5
61

90
53
16
21

184
21
80
14
36
33

110
1
17
35
18


39

353
1
8
2
120
116
10
25
2
69

795
36
746
5
8

506

3
8
495

772
25
47

329
157
107
104
3

296
105
21
144
19


302


__ '' __ t___ t __ ~ r


-1 I~ -T


1 I


10
2


7
1


48
24
11
13

74
38
10
15
7
4

19

2
13
2
1
1


80
2
3
7
16
5
4
4
18
21

42
10
17
10
5

104
25
28
6
45

34
10

3
3
11
6
1


36
1
1
I
34


-5 bl










2 4
1 4

1 -

2 4
- 3
2
1



10 14
1 4
3 2
4 5
- I1
2 2



7 4



3 1
2


1
1 3

2 3
1 1
- 2
2








1 5
1 10


9 14

3




-

2



12 5

2 -
10 5


I







101
68
1
32

658
329
179
84
35
31

754
170
294
129
46
89
19
7

281

2

115
102


9
53

301
107
173
21


534
59
18
22
435

22



I
11
10



221

16
205



I-









Morbidity and Mortality Weekly Report





CASES OF REPORTED PARALYTIC POLIOMYELITIS OCCURRING WITHIN 30 DAYS OF THE
ADMINISTRATION OF ORAL POLIOMYELITIS VACCINE IN NON-EPIDEMIC AREAS
JANUARY 1 TO SEPTEMBER 15, 1962


Case # Age Race Sex


1 3 W M
2 25 W M


3 2 W F


Onset
Doses First
IPV Symotom


Clinical
Severity


Interval From OPV (days)


Type I


Tyve II Tvye III


Virus Isolates
e Character


- -I.- l-* I I 4 4


2 5/29 1
1 8/30 3


2 2/23 3


15 52 W M 0 6/26 4
16 6 W M 4 6/12 2


23 -
10 -


Over 90 8


76

34
51
43
Over 90
43

34
50
54

52
37


- 17
22
7
22
- 15
26
- 15
21
7
23
27

19
5


Key for Severity: 1 Complete Recovery, no residual paralysis 2 Minor Involvement
4 Severely Disabled (bed, wheelchair, extensive bracing)
Key for Virus and Antibody Studies: 0 Negative Test
Test not Done
** Test in Progress
Virus character-was determined by the modified Wecker and McBride tests.


Wild Like
**





Wild Like
Vaccine Like






Vaccine Like
Vaccine Like
Wild Like
Vaccine Like
Vaccine Like


Ill
III



II & III

I & III
III



III
I


1 Considered compatible with vaccine-induced disease were those cases clinically indistinguishable from poliomyelitis with some significant
residual paralysis and laboratory studies not inconsistent with the possibility of vaccine relationship.


stool. Since Type III vaccine had not been fed, it can be
concluded that the infection was due to a wild virus.
Eleven of the thirteen cases following Type III oral
polio vaccine were considered by the Committee as possi-
bly vaccine related. Of the two cases excluded, one (case
14) had an illness atypical for poliomyelitis with no func-
tional impairment after 30 days.Both Types I and III polio-
viruses were recovered from the stool, 55 and 27 days re-
spectively after Types I and III vaccines had been fed to
the child. The Type I virus which was recovered was
characterized as "wild-like" according to the results ob-
tained by the modified Wecker and McBride tests. These
tests are used to demonstrate slight antigenic differences
between poliovirus strains of the same type. Since the
vaccine strains may, after a period of intestinal multipli-
cation, show such a shift in the antigenic characteristics
of the viruses, no definitive interpretation of this finding
was possible. The second case (case 16) which was ex-
cluded from further consideration had an insignificant
paralytic residual and no detectable Type III antibody in
either acute or convalescent serum specimens.
From 6 of the 11 cases, Type III poliovirus was re-
covered from stool specimens. Four of the six vere char-
acterized as "vaccine-like" by the modified Wecker and
McBride tests. Although this finding was of interest, it
unfortunately provided little help in determining whether


the vaccine played a casual role. Each of these con-
sidered had been fed oral vaccine and, hence might be
expected to be excreting the Type III vaccine virus which
might appear by the modified Wecker and McBride tests to
be, as noted above, either "wild-like" oi "vaccine-like."
Further, it is possible that the oral vaccine strain may
have displaced a "wild" enterovirus which was, in fact,
the etiological agent responsible for the paralytic illness.
In summary, isolation of a Type III virus from the stool
and demonstration of Type III antibodies in the patient's
sera served to indicate only that the paralytic disease
would not be incompatible with Type III vaccine-induced
disease.

The eleven cases considered as possibly related to
Type III vaccine feeding are between 16 and 52 years of
age, with all but three of the cases over 30. The vaccine
administered to this group of cases was from several lots
and was not produced by any single manufacturer. Of the
11 cases, 3 occurred in Oregon, 3 in Nebraska, 2 in Michi-
gan, 2 in Ohio, and 1 in New York State. The clinical ill-
nesses in these patients range from significant to severe.
No deaths occurred.

Discussion Summary:
Of the reported cases to date, one following Type I
vaccine and eleven following Type III vaccine were con-

(Continued on page 304)


303


Antibody
Response


Committee
Appraisal


Excluded
Compatible


Excluded


Compatible
Compatible
Compatible
Compatible
Compatible
Compatible
Compatible
Compatible
Compatible
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Excluded

Compatible
Excluded


3 Significant Disability




UNIVERSITY OF FLORIDA


3 1262 08864 1583


Morbidity and Mortality Weekly Report


sidered by the Committee to be clinically consistent with
paralytic poliomyelitis and with laboratory findings which
could not exclude a possible relationship to the admini-
stration of oral vaccine.
As noted, a single case occurred within 30 days of
Type I vaccinee administration during a period of almost
9 months when approximately 20,000,000 persons were
fed Type I vaccine. This is wholly compatible with coin-
cidental origin.
The 11 cases following Type Ill vaccine cannot all
be assumed to be coincidental. The adult age distribution
ranging from 16 to 52 years with 8 of the cases over 30
years of age, and the clustering of the intervals from
vaccine feeding to onset in the 2-3 week period suggest
a vaccine relationship. For these reasons the Committee
concluded that "there is sufficient epidemiological evi-
dence to indicate that at least some of these cases have
been caused by Type 111 vaccine."
The incidence, assuming all cases to have been vac-
cine induced, is but 11 cases among more than 13 million
fed. This is less than one case per million doses given.
When the risk is related to age it is apparent that adults
are exposed to a greater hazard than are children. Inade-
quate information on the age specific vaccine acceptance
rate, however, makes it impossible to calculate a more
precise estimate of the risk at this time.
With the incidence of poliomyelitis at a low level in
this country, the Committee therefore recommended that
the Type III vaccine be restricted to pre-school and school
age children and to those adults in high risk groups, such
as those travelling to hyperendemic areas or in areas
where a Type III epidemic is present or impending.
Since the vast majority of poliomyelitis cases occur
among young children and since children are the principal
disseminators of the virus, continued intensive immuniza-
tion programs among this group are clearly indicated. If
this group can be adequately immunized, the spread of the
poliomyelitis viruses will be sharply restricted, if not
essentially eradicated.


Editor's Note:
Table 4 (B) Reported Pneumonia Influenza Deaths in
Reporting Cities, which was scheduled to appear on page
303, has been omitted because of the special oral polio-
vaccine r.eper.. Copies of this table are available upon
request.





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