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CSU 38/2009: HORSTMANN ON POLIO/ NATHANSON ET AL ON US POLIO SURVEILLANCE, 1956 / THE CUTTER INCIDENT

Sunday, 31st of May 2009 Print

CSU 38/2009: HORSTMANN ON POLIO/ NATHANSON ET AL ON US POLIO SURVEILLANCE, 1956 / THE CUTTER INCIDENT
 
 HORSTMANN ON POLIO
 
 Writing three years before the WHA eradication resolution of 1988, Dorothy
 Horstmann of Yale looked at the
 R and D work culminating in the FDA licensing of the first polio vaccine in
 1955.
 
 The residual lameness surveys to which she refers were a mainstay of polio
 advocacy in the early ‘80s, before  surveillance was good enough to
 establish polio disease burden in many developing countries.
 http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=2994307
 
 
 NATHANSON ET AL ON US POLIO SURVEILLANCE, 1956
 
 The US government licensed the Salk vaccine in 1955, so that 1956 was the
 first year with 12 months of data on vaccine impact.
 
 Rising living standards in the decade after World War II had led to later
 and more frequently symptomatic infection with polio, so that by 1954 the
 polio epidemics were regular front page news. The decade before 1955 saw
 polio in the US ranging from 2000 to 3500 cases per year.
 
 Nathanson and colleagues review the evidence on decline in incidence and
 shift in age distribution seen in 1956. The dramatic decline in polio cases
 did not alter the view that transmission continued. The authors comment:
 
 ¨the primary effect of vaccine appears to be the prevention of invasion of
 the central nervous system and thereby the prevention of paralysis. This
 limitation on the effectiveness of the vaccine may be associated with the
 evidence that poliovirus did spread rather extensively in various
 populations during 1956, not only in Chicago, but in Louisiana, Utah,
 Idaho, California, and elsewhere. In spite of relatively widespread, but
 incomplete, vaccination, these populations experienced high incidence of
 disease, particularly among preschool children in all socioeconomic groups.
 
 ¨The immediate public health implication of the experience in 1956 is that
 substantially higher levels of immunity must be achieved among all elements
 of the population.¨
 
 Full text at
 www.pubmedcentral.nih.gov/picrender.fcgi?artid=2031288&blobtype=pdf
 
 
 THE CUTTER INCIDENT
 
 Though the 1956 authors do not say so, the publicity surrounding the Cutter
 incident of 1955 may have slowed acceptance of IPV. For a retrospective
 look at the Cutter incident and its impact on product liability law,
 see ¨The Cutter Incident, 50 Years Later,¨ New England Journal of Medicine,
 http://content.nejm.org/cgi/content/full/352/14/1411
 
 Good reading.
 
 BD

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