RADIAL NERVE CONDUCTION STUDIES.
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Biomedical subjects
Publications and source records attributed to A W DOWNIE.
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In view of the endemicity of smallpox in Madras and the poor take rate on revaccination with the lymph in current use, it was felt that the immunity of the general adult population might be relatively low. In an attempt to obtain some measure of this, sera were obtained from over 300 adults in Madras for the estimation of serum antibody. The results of neutralization tests against variola virus made on these sera showed that about 10% of those who had good scars from infant vaccination showed little or no antibody. A comparison of the antibody titres of adult sera showing good antibody levels when used undiluted was made with that of sera from smallpox convalescents. The antibody level in the latter sera was 20-100 times that of the sera of adult persons who showed good vaccination scars.
Epidemiological observations suggest that smallpox is not highly infectious in the febrile pre-eruptive period of illness. As virus is first discharged by most patients from lesions in the mouth or upper respiratory passages, mouth washings or garglings from smallpox patients in the acute stage of the disease were examined for virus. Only five specimens were obtained in the first two days of illness but no virus was recovered from them. Virus was most frequently found in specimens collected from the sixth to the ninth day of illness inclusive-a period when lesions in the mouth were breaking down and discharging virus. The results are in conformity with the view that the smallpox patient is most infective in the first few days of the eruptive phase of his illness.
It was known that the liquid glycerinated buffalo-calf lymph issued for routine use in smallpox vaccination in Madras gave a high take rate in primary vaccination but that successful takes on revaccination amounted to less than 10%. In the course of studies on smallpox carried out in Madras, it was therefore decided to compare a potent freeze-dried English vaccine with the current Madras lymph by revaccinations carried out on persons admitted to the Madras Infectious Diseases Hospital for ailments other than smallpox. The take rate of the freeze-dried preparation in these tests was 63% as against 27% for the liquid preparation. It would seem that, in the conditions prevailing in Madras at the time of the tests, the local lymph is not sufficiently potent for successful revaccination or for maintaining the immunity of the population at a satisfactory level. The authors suggest that freeze-dried vaccine produced in embryonated eggs might be more effective and economical.
This paper records an attempt to assess the prophylactic value of immune gamma-globulin, prepared from the serum of recently vaccinated adults, in the protection of close contacts of smallpox in Madras. The results serve to confirm findings of a previous study made in Madras in 1953, and show that the incidence of smallpox in close contacts given immune gamma-globulin prophylactically was about a quarter of that in the control contacts who received no such passive immunization-a statistically significant difference. Because of the limited supply of immune gamma-globulin, it is likely that its prophylactic use will be restricted to those especially at risk, for example, close unvaccinated family contacts, newborn infants and pregnant women.
The view is widely held that variola is highly infectious, and it was therefore thought of interest to obtain precise information on the amount of virus disseminated in the air by smallpox patients at various stages of their illness. To this end, measured samples of air in and around the smallpox wards of the Infectious Diseases Hospital, Madras, were tested for the presence of variola virus. Surprisingly, virus was recovered on one occasion only by the air sampling device used. All other tests were negative although large volumes of air were sampled in close proximity to patients at various stages of the disease. The authors consider that further observations should be made with more sensitive air sampling methods.
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In a vaccination and laboratory study, two dried smallpox vaccines (designated P and Q) were tested at intervals of 4, 8, 16, and 32 weeks after storage at both 37 degrees C and 45 degrees C. Vaccine P was also tested after 64 weeks at these temperatures and gave 100% successful vaccination rates after all periods of storage at both temperatures. Vaccine Q deteriorated within four weeks, rapidly at 45 degrees C and less rapidly, but very substantially, at 37 degrees C. There was no clear evidence of the cause of this deterioration, but there was a suggestion of denaturation of some of the samples stored at the higher temperature. So far as could be ascertained, the laboratory results-rabbit skin scarification tests and chorio-allantoic membrane pock counts-ran parallel with the vaccination success rates. The pock count was found to be the more accurate method of laboratory titration. Vaccine P as used in the trial was not an exceptional batch.Vaccines which give a pock count of 10(8) infective units per ml will give the highest possible rate of successful primary vaccinations.A statistical note on the trials is given in an annex.