Mass smallpox vaccination and cardiac deaths, New York City, 1947

In April 1947, during a smallpox outbreak in New York City (NYC), >6,000,000 people were vaccinated. To determine whether vaccination increased cardiac death, we reviewed NYC death certificates for comparable periods in 1946 and 1948 (N = 81,529) and calculated adjusted relative death rates for the postvaccination period. No increases in cardiac deaths were observed.

Legend of hepatitis B vaccination: the Taiwan experience

Hepatitis B, a disease entity currently affecting more than 350 million persons worldwide, is also a serious health problem in Taiwan. Liver cirrhosis and hepatoma, which are both closely correlated with hepatitis B, are among the 10 leading causes of death in Taiwan. A mass hepatitis B vaccination program, conducted by the government of Taiwan, was started in 1984. Prior to this vaccination program, a series of viral epidemiological surveys, transmission pattern studies, and pilot immunization trials proved the clinical, economic, and strategic benefits of mass immunization, thus providing the impetus for the implementation of this mass vaccination program. The success of this program has led to a decline in hepatitis B carrier rates among children in Taiwan from 10% to <1%. Furthermore, the mortality rate of fulminant hepatitis in infants and the annual incidence of childhood hepatoma have also decreased significantly in recent years. This is one of the most remarkable success stories in the field of public health.

Cardiac deaths after a mass smallpox vaccination campaign--New York City, 1947

During the first wave of the 2003 smallpox vaccination campaign, two ischemic cardiac deaths occurred in civilian vaccinees aged 55 and 57 years, and one occurred in a military vaccinee aged 55 years, 4-17 days after vaccination with the New York City Board of Health (NYCBOH) vaccinia strain. Whether these and 13 other recognized military and civilian nonfatal ischemic events among vaccinees were associated with smallpox vaccination is unclear. The same NYCBOH strain was used in 1947 to vaccinate approximately six million New York City (NYC) residents (80% of the population) during a 4-week period (April 4-May 2) after a smallpox outbreak. To determine whether smallpox vaccination increased the risk for cardiac death in 1947, the NYC Department of Health and Mental Hygiene (DOHMH) analyzed data from NYC death certificates during that period. This report summarizes the results of that analysis, which found no increases in cardiac, atherosclerotic, or all-cause deaths. The findings are consistent with a growing body of evidence suggesting that ischemic cardiac deaths observed after the 2003 campaign might have been unrelated to vaccine.

[History of poliomyelitis infection in the world and in Poland ]

The history of poliomyelitis infection in the world with special regards to Poland has been described. The main clinical and epidemiological features of disease have been outlined, especially these that helped to start global polio eradication initiative. Study and search for safe and effective vaccine have been presented. An impact of vaccination on epidemiological situation of poliomyelitis in the world and in Poland has been illustrated. The general principles and results of global poliomyelitis eradication program have been reported.

[Centenary of the Health Council of the Netherlands. IV. Infectious diseases]

Many advisory reports of the Health Council of the Netherlands in the past century have dealt, directly or indirectly, with infectious diseases. One example is vaccination against smallpox. At the start of the last century, advice on this subject was important: initially, vaccination was compulsory by law, but people became increasingly aware of the associated side effects. A second example is immunisation against acute anterior poliomyelitis, which became a reality during the fifties. The advice also contained a discussion of which vaccine should be chosen: the inactivated 'dead' (Salk) form or the attenuated 'live' form (Sabin). Due to sound national organisation and associated logistics, a high level of vaccination was (and still is) achieved and the clinical disease known as polio disappeared from the Netherlands. Food-borne infections form the third example. The effect of the advice published by the Council on this subject (from 1960 onwards) has been limited, for a large part due to the significant economic consequences of the proposals for beef farming. The developments in the field of infectious diseases, immunology and vaccinology, together with social developments make it likely that in the coming years the Council will also frequently be asked for advice in the field of infectious diseases and the fight against them.

History and prospects for viral disease eradication

Edward Jenner first articulated the concept of eradication when he first inoculated the vaccinia. Before considering a disease for eradication some factors should be considered, such as the biological characteristics of the infectious agent: does the infectious agent infects only humans? Does it have a non-human reservoir and induce long-life immunity after infection? Is there a tool or intervention that effectively interrupts the chain of transmission from one individual to another? The first disease to be eradicated was smallpox. This extraordinary initiative set the example for any future disease eradication program. The eradication of polio from the Americas was launched in May 1985 and the Region of the Americas was certified polio-free in September 1994. At this same year, the Pan American Health Organization (PAHO) launched an initiative to eradicate measles from the Americas. Only 1,500 cases have been reported during the year 2000, and transmission was interrupted in most countries of the Region. Tremendous progress has been achieved in disease eradication efforts, which resulted in the global eradication of smallpox, the eradication of poliomyelitis from the Americas and its nearly global eradication, and the nearly complete eradication of measles from the Americas. The biotechnology revolution is providing us with many new vaccines and we have to continue the search for those diseases that could eventually be eradicated. Eradication of a disease brings the greatest health benefit, which is the absence of the health threat. It is also the quintessential example of health equity, as all mankind reaps the benefits, bringing eternal cost savings. As Louis Pasteur pointed out, "it is within the power of man to eradicate infection from the earth".

The precautionary principle and emerging biological risks: lessons from swine flu and HIV in blood products

Two examples-the "swine flu affair" in 1976 and the emergence of HIV in the blood supply in the early 1980s-illustrate the difficulties of decision-making in public health. Both cases illustrate trade-offs between product risks and public health benefits, especially with regard to uncertainty in estimates of product risks, public health risks, and the benefits of prevention. The cases also illustrate the tendency of public health policy makers to go all the way or do nothing at all, rather than consider intermediate options that can be adapted as new information emerges. This review suggests three lessons for public health policy makers: (1) be open and honest about scientific uncertainty; (2) communicate with the public, even when the facts are not clear; and (3) consider intermediate, adaptable policy options, such as obtaining more information, thus reducing uncertainty, and building in decision points to reconsider initial policies. Underlying all of these lessons is the need to commission studies to resolve important uncertainties and increase the information base for public communication, and to review regulations and other policy options in the light of the new data that emerge.

Federal immunization policy and funding: a history of responding to crises

This article outlines the history of federal immunization policy and funding, with a focus on discretionary federal funding under Section 317 of the Public Health Service Act, paying particular attention to the role of Congress in shaping the program in the past 2 decades. This review of funding trends and initiatives indicates that when both a presidential administration and key congressional actors viewed immunization as a priority and made sufficient funds available to support the public health delivery system and its infrastructure, coverage levels would continue to rise and disease levels continue to decline. From the beginning, immunization financing was explicitly structured as a federal-state-private-sector partnership. Section 317 program's statute has not changed much in 35 years, despite significant changes to the health care delivery system, other federal immunization activities, and rates of immunization coverage. Although the creation and implementation of the Vaccines for Children (VFC) program in the mid-1990s resulted in some congressional deliberations over immunization policies, no explicit restructuring of the 317 program occurred as a result. The Section 317 program retains its traditional authority and mission to address urgent needs, sustain public delivery systems, and provide funds for purchase of vaccines. The question remains whether the resources to sustain progress in immunization can be secured during times with no crisis, to ensure constant "readiness" in immunization (as in defense), or whether another epidemic must occur before the federal government is willing to commit optimal resources.

Immunization and the American way: 4 childhood vaccines

Childhood immunization constitutes one of the great success stories of American public health in the 20th century. This essay provides a historical examination of this topic through 4 particularly important examples: diphtheria, pertussis, polio, and measles. Each case study illustrates how new vaccines have posed unique challenges related to basic science, clinical trial methodology, medical ethics, and public acceptance. A brief comparison of each story to the experience of Great Britain, however, suggests an underlying unity connecting all 4 examples. Whereas the British led the way in introducing formal clinical trial methodology in the field of immunization development, the Americans excelled in the rapid translation of laboratory knowledge into strategies suitable for mass application. Although this distinction appears to have diminished in recent years, it offers insight into the sources of creativity underlying American vaccine development and the corresponding difficulties sometimes created for utilizing vaccines fruits rationally.

Protecting the world's children: the story of WHO's immunization programme

Systematic immunization on a worldwide scale was not officially recognized as a practical possibility until 1974, when WHO launched its Expanded Programme on Immunization. Today, 80% of the world's children receive this form of protection against childhood diseases during their first year of life. Coverage can reach 90% by the year 2000, the effectiveness of the vaccines used is improving, and vaccines against additional diseases are being added to the programme.

Inoculating the urban poor in the late eighteenth century

Historical accounts of the practice of smallpox inoculation in the late eighteenth century invariably made a distinction between the widespread general inoculations carried out within small rural parishes and the partial inoculations in urban centres such as London, Manchester, Newcastle and Leeds. This distinction, moreover, is generally reinforced by concluding that the rural inoculation programmes were 'highly effective' or 'successful' in contrast with the urban inoculation schemes, which are often seen as 'marginally effective' or indeed 'failing'. Success or failure tends to be judged by the impact which inoculation had upon reducing mortality from smallpox, but as a result of this demographic focus the motives behind the implementation of urban inoculation have been overlooked. My paper readjusts this balance by looking more closely at motives and by judging success in relation to aims. To achieve this I have taken a new approach towards the history of smallpox inoculation as a whole, and portray the basic idea of giving a person smallpox in order to confer subsequent immunity as being modified in the hands of different people throughout the course of the century. Hence it is possible to trace the development of inoculation from a folk practice carried out within the home with the aim of protecting individuals, to large-scale general inoculation of an entire community, which aimed to eradicate the disease altogether.

Incidence of infectious disease and the licensure of immunobiologics in the United States

INTRODUCTION

Our objective was to investigate the relationship of vaccine or toxoid licensure with the incidence of the target disease in the United States.

METHODS

We used a historical correlational study design with outcome measures of the national incidence and elimination rate of polio, pertussis, diphtheria, and measles as well as the New York City incidence and elimination rate of mumps, rubella, and tetanus.

RESULTS

The licensure of pertussis, measles, polio, mumps, and rubella vaccine was followed by an increase in the elimination rate of disease. The elimination rates of diphtheria and tetanus apparently worsened following the licensure of the respective toxoids.

CONCLUSIONS

Historical data provide evidence of proof of efficacy of mass immunization for measles, polio, rubella, mumps, and pertussis, but not for diphtheria or tetanus.

Edward Jenner's vaccine

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Origins of the Children's Vaccine Initiative: the intellectual foundations

The Children's Vaccine Initiative (CVI) was created as an attempt to revolutionize the way vaccines are developed for the developing world. It was formed, in part, out of optimism that the scientific advances of the biotechnology revolution could be harnessed to create new and improved vaccines, and in part out of fear that the health needs, of the developing world would be ignored by the increasingly profit-oriented vaccine industry that gave low priority to countries lacking a hard currency market. The CVI was founded in 1990 1991 but its intellectual roots came out of ten years of discussion and agitation about the opportunities and dangers that faced the international health community. The article looks at the indispensable role played by pivotal individuals (William Foege of the Task Force for Child Survival. Kenneth Warren and Scott Halstead of the Rockefeller Foundation. James Grant and James Sherry of UNICEF and D.A. Henderson of Johns Hopkins University) without whom the CVI would not have come into existence. While these individuals worked within the confines created by the large social economic political changes that shaped the 1980s, their personal goals, often targeted at fairly limited objectives, were crucial in determining the final, rather unlikely, outcome. The role of both individual choice and serendipity in determining major policy decisions are often under-estimated in the social science literature.

Origins of the Children's Vaccine Initiative: the political foundations

The Children's Vaccine Initiative (CVI) was founded in 1990-91 as a means to revolutionize the way that vaccines were developed for the South. The system for the creation of vaccines was a dis-articulated one in which basic research, product development and delivery were handled by different, often insufficiently linked groups. The public sector was deeply involved in research and delivery but not the vital product development area. That area was left to the private sector which was increasingly driven by the needs to maximize profits. Potential vaccines for diseases found in the South, where a hard currency market was limited, were often left undeveloped. The CVI was designed to change that situation. The CVI hoped to exploit the discoveries of biotechnology and produce not only new and improved vaccines, but ultimately to work towards a single multi-antigen vaccine given near birth that would immunize children for life. This article deals with the events that directly led to the creation of the CVI, and to the political problems caused by organizational and national rivalries that the new venture faced from its inception.

[Pasteurian science through the antirabies vaccine: the case of Mexico]

The history of the rabies in Mexico is a versatile topic because it provides a chance to study different aspects of the history of Mexican science and medicine. This article reconstructs the sequence of events related to rabies vaccination in Mexico. History is also used as a model to study scientific transfer and scientific imperialism, the use of science by politicians in order to validate their governments, and the impact of French medicine on Mexican medicine. In 1888 the physician Eduardo Liceaga, an important political figure, brought the rabies vaccine to Mexico. President Porfirío Diaz supported Liceaga because he assumed that the vaccine was synonymous with modernity, and hence a sign of good government. We also analyze the reasons why there was no Pasteur Institute in Mexico, even though the conditions that allowed its creation in other countries also existed. Two points are of particular interest: 1) Despite its importance, this topic has not formally been studied in the context of the history of Mexican medicine, and 2) A considerable part of the present research is based on original, unpublished manuscripts in French and Mexican archives.

Intimidation, coercion and resistance in the final stages of the South Asian Smallpox Eradication Campaign, 1973-1975

This paper reviews episodes during 1973-1975 when American physician-epidemiologists in South Asia, working under the auspices of the World Health Organization, intimidated local health officials and resorted to coercive methods in the final stages of the Smallpox Eradication Programme. While intimidation and coercion were successful in the short-run in ensuring disease containment, they evoked health-professional and popular resentments, and the long-term effect may have been to foster negative attitudes toward subsequent vaccination campaigns. At the very least these episodes suggest a need for paying attention to actual and perceived abuses when global health measures are introduced from 'above' into regional settings.

History of poliomyelitis in the Czech Republic--Part III

The "repression phase" of paralytic poliomyelitis in the Czech Republic (and in the Slovak Republic as well) between 1957 and 1960 was characterized by controlled, short term, mass vaccination campaigns. In spring 1957, at the very beginning of a polio epidemic, about 87% of all children aged 1 to 7 years and about 40% of those aged 8 to 15 years were intradermally vaccinated with IPV. The protective effect in population given two IPV doses was 66% (in Slovakia 74%). The starting epidemic of 1957 was stopped. Morbidity and mortality from poliomyelitis markedly decreased in 1958. Nevertheless, about 39%, 13% and 41% of children aged under 8 years (given three IPV doses) had not specific virus-neutralizing antibodies against polioviruses types 1, 2 and 3 respectively. A field trial with OPV started in winter 1958-59. Over 110,000 children aged 2 to 6 years were vaccinated with Sabin OPV, which proved to be safe, highly immunogenic and protective. In spring 1960 about 93% of children were vaccinated in the former Czechoslovakia with OPV in a mass, countrywide campaign. No case of paralytic poliomyelitis was reported during the second half of 1960. The same was true for all year 1961, the first year of the historical period of poliomyelitis elimination in our country.

Bucking the health establishment: Alexander Milne and the fight for a New Zealand hepatitis B immunization program

In order to successfully combat a disease it is necessary that their exists an individual or a group willing to 'champion' that ailment by arguing that it is serious enough to warrant the expenditure of scarce resources. In the case of hepatitis B such champions have often arisen outside of the public health establishments that are mandated to play that role. In New Zealand it was left up to one unusual and determined man to not only discover the seriousness of the hepatitis B epidemic but to practically single-handedly force a reluctant government to acknowledge the threat and act to contain it. He accomplished this by combining high quality scientific research with unrelenting political pressure generated by appeals to the public by means of the mass media. Alexander Milne demonstrates the vital role that the concerned citizen can make even in an age of timid bureaucracies.

[The childhood vaccination program. Background, status and future]

Surveillance of the Danish childhood immunization programme has taken place at Statens Seruminstitut since 1980. A description of the prevalence of the diseases, which are included in the programme, is presented. The Danish childhood immunization programme has for many years been one of the best in the world although it differs markedly from other countries. The polio immunization programme with inactivated polio vaccine given first and then later live attennuated vaccine is probably the optimal polio immunization programme. The childhood immunization programme began in 1943 with free diphtheria vaccination, and tetanus immunization was added in 1949. There was a big polio epidemic in 1952/53 and the polio vaccine was introduced in 1955. All three vaccines have markedly reduced the prevalence of these diseases. Pertussis vaccine was introduced in 1961 and measles, mumps and rubella vaccination in 1987. Vaccination against Haemophilus Influenzae type b was introduced with success in 1993. In the future several changes will probably be made in the programme because of the possibility using new combined vaccines.

The WHO-EPI initiative for the global eradication of poliomyelitis

Since the development of attenuated oral polio vaccine, Dr Albert Sabin consistently maintained that the global eradication of wild poliovirus was possible, but that to achieve polio eradication in developing countries would require the mass administration of the oral vaccine. Experience in Cuba and Czechoslovakia proved the effectiveness of this technique, but it was only with its deployment in Brazil in 1980 that its role in eradicating the virus from a broad geographical area started to be realized. With the declaration in 1985 of a target of regional polio eradication, extension of this policy, allied with the development of effective surveillance of acute flaccid paralysis in children, with laboratory confirmation of diagnosis rapidly led to apparent interruption of wild poliovirus transmission throughout the Americas. The World Health Assembly in 1988 committed WHO to the global eradication of poliomyelitis. Based on experience in the Americas and building on the solid foundation established by the Expanded Programme on Immunization, WHO has defined the strategies through which the global target could be achieved. Progress is encouraging and where the advocated strategies have been fully implemented, the incidence of poliomyelitis has declined dramatically. Significant geographical areas in Western Europe, the Maghreb, the Arabian peninsula, the Pacific basin and Southern Africa, each incorporating several countries, are now thought to be free of the disease caused by wild poliovirus. The target of a world free of polio by the year 2000 can be achieved.

Russian contribution to OPV

Field trials and the first mass immunization campaign using Oral Poliomyelitis Vaccine (OPV) from the strains derived by Albert Sabin were carried out in the former U.S.S.R. in 1959 under the guidance of Mikhail Chumakov. The results obtained during these trials contributed greatly to the general acceptance of OPV as a safe and efficient preparation. Mechanisms responsible for the attenuated phenotype of the Sabin strains have long been studied in Russia. For the first time, recombination analysis was used for mapping genetic determinants of attenuation, which were found to reside largely in the 5' half of the Sabin strains RNA. It has been established that the phenotype effect of a subset of the major attenuating mutations is due to the impairment of the translation initiation.