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Biomedical subjects

W B Fletcher

Publications and source records attributed to W B Fletcher.

11 recordsLinked to original sources

Severity of notified whooping cough.

An analysis was made of the severity of over 8000 cases of whooping cough notified from October 1974 to March 1975. Ten per cent of these patients were admitted to hospital and there were 10 deaths. Severity was directly related to age, the disease being most severe in children under 1 year, especially those under 6 months. There was some evidence that previous vaccination reduced the severity of the disease, but the vaccination programme does not cover very young children, and for them whooping cough is a dangerous disease.

Age Factors↗

The response to oral poliovaccine in persons aged 16-18 years.

Serum neutralizing antibodies to polioviruses were titrated in serum samples from 182 police cadets aged 16-18 years before and, in 168 of the cadets, 6 weeks after vaccination with a single dose of oral polio vaccine (OPV). Faecal excretion of poliovirus was also followed. Vaccination histories were obtained and confirmed whenever possible. Pre-vaccination antibody could not be detected against type 1 in 9-3% cadets, against type 2 in 2-7% and against type 3 in 7-7%. Absence of antibody to at least one virus type was found in 14-3% of the cadets. In 93 cadets in whom vaccination histories could be confirmed 40 had received only inactivated polio vaccine (IPV) previously; of these 23% lacked antibody to at least one virus type, and they had less intestinal immunity to a challenge dose of OPV than those previously given OPV. Only two of the cadets known to have had OPV were non-immune - both had received a single dose following full courses of IPV. However, cadets who had received OPV had their last dose of vaccine more recently (average 4-6 years) than those who had received only IPV (all 12 years or more). The serum antibody response to a single booster dose of OPV, and the faecal excretion of each type of virus after vaccination, showed an inverse relation to the corresponding pre-vaccination antibody concentration. A single dose of OPV did not reliably boost the immunity of those who possessed adequate immunity, and a failure to respond was also observed in a proportion of the cadets with no detectable antibody, mostly in the case of type 3 antibody and particularly if antibody to types 1 or 2 virus was also absent. No evidence was obtained that intestinal immunity could be expected in the absence of detectable circulating antibody. The reasons for the absence of a serological response to OPV in some subjects are discussed and consideration is given to the practical significance of the findings. It is suggested that reinforcement of polio immunity at school-leaving is important, particularly at the present time when many of those aged 16-18 years will have been vaccinated only with IPV. A single dose of OPV is not ideal for this purpose, not only because a small proportion of persons are liable to be left unprotected, but also because failure to produce a reliable boost in persons with adequate immunity at the time of vaccination gives rise to the possibility that they may become susceptible later in adult life.

Adolescent↗

EB virus antibody and infectious mononucleosis in a boarding school for boys.

A study of EB virus antibody was undertaken in a boarding school for boys between 11 and 18 years of age; 35% of boys had EBV antibody when first sampled and a small number acquired antibody each year. Some of these boys had had no recorded illness during the period before the first positive sample and some developed classic infectious mononucleosis which was accompainied by a positive heterophil antibody test and detection of EB virus specific IgM. In a school of 800 boys there were 13 cases of infectious mononucleosis in four years.

Adolescent↗

Response to influenza vaccine in adjuvant 65-4.

A comparison was made of the antibody response and subjective reactions to zonally-purified influenza vaccine in aqueous suspension and in peanut oil adjuvant 65-4. Both preparations contained 700 CCA units of A/Aichi/2/68, and 300 CCA units of B/Mass/1/71. Subjective reactions were recorded by asking the volunteers to complete a record daily for 5 days. Pain at the injection site was recorded by 64 per cent of the recipients of the oil adjuvant vaccine compared with 35 per cent of the aqueous recipients, but local redness was more frequent after aqueous vaccine. Systemic symptoms was recorded a little more frequently after aqueous than oil adjuvant vaccine. When measured 71/2 weeks after a single dose of vaccine, the HAI geometric mean antibody titre (G.M.T) to the A/Hong Kong/1/68 antigen (antigenically similar to the A/Aichi/2/68 antigen in the vaccine) increased 2-7 fold after aqueous and 16-4 fold after adjuvant vaccine. Sixty-two weeks after vaccination the antibody titres remained higher in those given adjuvant vaccine. The G.M.T. to B/Mass/1/71 increased 1-9 fold 71/2 weeks after aqueous vaccine and 3-7 fold after adjuvant vaccine. The antibody response to both influenza A and B antigens was broader in the recipients of adjuvant vaccine. The G.M.T. to A/England/42/72 increased 2-8-fold after aqueous and 13-fold after adjuvant vaccine; and to B/England/847/73 it increased 1-3-fold after aqueous and 1-9-fold after adjuvant vaccine.

Adjuvants, Immunologic↗

Reactions to injected influenza vaccine.

Almost 6,000 healthy adults inoculated with influenza vaccine were asked to record daily for 5 days the presence or absence of defined local and general symptoms; 70 percent completed and returned the record. The overall incidence of subjective reactions derived in this way was high; approximately 50 percent complained of local pain and 40 percent of general symptoms. Only about one-third of vaccinees recorded no symptoms. The incidence of subjective local reactions was about 8 percent higher in women than men. Among 5,600 vaccinees a total of 63 days sickness absence was attributed to reaction in the week of immunization (1.1 days per 100 employees). Almost all the absences were of less than 3 days duration, unsupported by a doctor's certificate. In the week of vaccination sickness absence among vaccinees was not higher than that of non-vaccinees. Although the incidence of subjective reaction was found to be high and vaccination might itself cause some sickness absence, most of the reactions appear to be trivial. Among 700 employees who were interviewed 1 or 2 days after vaccination in 1973, the incidence of what was judged to be significant local pain and erythema was about 5 percent. Nevertheless,the reactions appear to have an important effect on acceptance of influenza vaccination. From the answers given to a questionnaire 30 percent of employees who refused vaccination did so either because they previously had symptoms after vaccination, or because others had told them of their occurrence. In approximately 16,500 injections, only 2 patients had an acute reaction resembling anaphylaxis.

Adult↗