Enterovirus infections of the central nervous system. The present and future of poliomyelitis.
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Biomedical subjects
Publications and source records attributed to D M Horstmann.
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Serologic responses and patterns of antibody persistence in children given HPV-77 DE-5 or RA27/3 vaccine were compared with those in children who had experienced natural infection. The results indicated that both vaccines induce long-lasting immunity in most individuals. RA27/3 vaccine proved more immunogenic and resulted in higher antibody titers; after 11 years 95% of those who seroconverted who were tested had hemagglutination-inhibiting (HAI) antibodies and 100% had neutralizing (NT) antibodies. Titers in HPV-77 DE-5 vaccinees were lower, and in 16% of those whose immune responses were feeble, HAI titers decreased to less than 1:8 after nine to 12 years; however, when their sera were examined by the more sensitive latex-agglutination test, all but two were found to have specific rubella antibody at levels of 1:1 to 1:16. Natural infection with wild virus was shown to induce more vigorous immune responses than did either vaccine: antibody titers were higher, decreases were smaller, and none fell to less than 1:8 (HAI) or less than 1:4 (NT).
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Widespread use of the Sabin live attenuated poliovirus vaccine has had tremendous impact on the disease worldwide, virtually eliminating it from a number of countries, including the United States. Early proof of its safety and effectiveness was presented in 1959 by Russian investigators, who had staged massive trials in the USSR, involving millions of children. Their positive results were at first viewed in the United States and elsewhere with some skepticism, but the World Health Organization favored proceeding with large-scale trials, and responded to the claims made by Russian scientists by sending a representative to the USSR to review in detail the design and execution of the vaccine programs and the reliability of their results. The report that followed was a positive endorsement of the findings and contributed to the acceptance of the Sabin vaccine in the United States, where it has been the polio vaccine of choice since the mid-1960s.
There is evidence that paralytic poliomyelitis occurred in ancient times, but it was not recognized as a distinct disease until the eighteenth century and did not come into prominence until the late nineteenth century when epidemics began to appear. Outbreaks of increasing size were reported first in the Scandinavian countries, then in the United States and elsewhere, to the surprise and consternation of the medical profession. Poliovirus was first isolated in 1908, but many years of intensive research were required before the epidemiology and pathogenesis of the disease were sufficiently understood to allow preventive measures to be devised. The road to eventual success was complicated by controversies, setbacks, and tragedies, played out and influenced by many powerful personalities. Today there are two effective vaccines. The disease has been virtually eliminated in countries where they have been used extensively, yet in the developing areas of the world recent "lameness surveys" indicate that the incidence of paralytic poliomyelitis is as high as it was during the peak years in the United States in the early 1950s. The challenge now is to use the available vaccines to extend control to the developing countries and eventually to achieve elimination of the disease worldwide.