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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