Biomedical subjects
Publications and source records attributed to W C Cockburn.
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In 1963 the World Health Organization established a system for the collection and distribution of information on viruses. By 1973 laboratories in 45 countries were participating in this scheme. The present study is an analysis of the reports on adenovirus, influenza viruses A, B, and C, parainfluenza virus, respiratory syncytial (RS) virus, rhinovirus, and Mycoplasma pneumoniae during 1967-73. In the northern hemisphere, from which over 95% of the reports were received, a clear pattern of the seasonal incidence of different respiratory tract infections emerged. Over 70% of the total number of reported adenovirus infections, over 80% of the parainfluenza virus infections, and over 90% of the RS virus infections were in children. M. pneumoniae infections were most frequently reported in adults. Influenza A virus infection was predominant in the adult population, with a high proportion in those aged 60 years and over. Influenza B infections were reported equally in adults and children, but over one third were in children of school age. The proportion of lower respiratory infections to total respiratory infections varied from one virus to another, and ranged from less than half for adenovirus to over four fifths for mycoplasma infections. Nonlocalizing fever was usually the second principal clinical condition reported in association with respiratory viruses.
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Notwithstanding the deficiencies in reporting, an attempt is made in the present study to provide some useful information on the importance of the communicable diseases in the world over the decade 1957-58 to 1967-68. In this period health authorities in the developing countries almost invariably reported communicable diseases as their main public health problems, whereas, in the developed countries, the only communicable diseases still considered as public health problems were tuberculosis, venereal diseases, and hepatitis. In the developing countries nearly half of the principal causes of death were communicable diseases, and in both the developing and developed countries respiratory infections ranked high on the list. Deaths from tuberculosis have come down markedly in the developed countries and to a lesser degree in the developing countries. Infectious diseases of childhood are no longer a problem in the developed countries but are still important in the developing countries. The communicable diseases of importance to the developing countries may be divided into two groups-those requiring long-term development for their solution (e.g., dysentery, typhoid fever, parasitic diseases, and respiratory infections) and those that would respond rapidly to control by such methods as immunization.
Since 1970, WHO has conducted a collaborative study on the use of "excess mortality" from respiratory diseases (that is, the number of deaths actually recorded in excess of the number expected on the basis of past seasonal experience) in order to assess in 13 different countries the severity of influenza epidemics. The use of computer-produced seasonal expected and actual curves permits quick visual assessment of influenza activity in any one country, as well as comparisons between different countries. The study demonstrates that an excess in the observed over the expected number of total deaths does not necessarily indicate an excess in deaths from influenza, and it is therefore limited, at least for the present time, to deaths from respiratory disease. It provides a week-to-week record of deaths from acute respiratory disease in countries where weekly returns are available and a retrospective analysis of the disease pattern in the collaborating countries. This study will be continued for a number of years and, apart from its value to the individual countries, should provide useful comparisons between countries with different climates.
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Poliomyelitis is an important problem of public health in warm-climate countries. Studies of serological responses to vaccination in these countries have given conflicting results but in many investigations the rates have been considerably less than in countries with temperate climates. In this study three possible factors influencing sero-conversion were investigated - the season of the year when vaccine was given, the social status of the mother (as indicated by the number of years of schooling) and the presence of non-poliomyelitis viruses (NPV) in the gut when vaccine was given.Over 200 children about 2 months of age were included in the study. Each was given three doses of trivalent vaccine at 6-week intervals.The sero-conversion rates of the groups fed in winter were excellent but were slightly less good in summer. The differences were greatest in children in the lower socio-economic groups and in children excreting other enteroviruses.The conclusions are that, provided a potent vaccine is used, the factors which diminish the effectiveness of immunization in warm-climate countries can be overcome: (1) by giving three doses of trivalent vaccine; (2) by beginning vaccination at the earliest possible age (when enteroviruses are fewest); (3) by concentrating special attention on the lower socio-economic groups and if necessary by giving a reinforcing dose several months after the third dose has been given - preferably in the colder months.
In 1968 in Poland an extensive outbreak of poliomyelitis, caused by type 3 poliovirus, began about four months after small vaccine trials with the Leon 12a(1)b (Sabin) and USOL-D bac vaccine strains had been carried out. Because of the temporal association, and because the first cases appeared in the province in which the USOL-D vaccine trial was carried out, a detailed investigation of the strains isolated from cases in the epidemic was made in four laboratories in an attempt to determine whether they were related to the two vaccine strains or to a "wild" strain. All the studies were made under code. The rct marker was of no help in determining the relationship of the epidemic strains to the vaccine strains. The McBride test and the elution marker test clearly separated the Leon 12a(1)b strains from those from the cases, but were incapable of detecting whether the epidemic strains were related to the USOL-D bac strain or to wild type 3 strains. Thus the studies did not provide valid information on the origin of the epidemic.
The tissue damage caused by virus infection has been traditionally explained by the ability of viruses to multiply in cells and thereby injure or destroy them. Recent evidence suggests, however, that lesions may also be caused by the host's immune response to viral antigens and that the immune system itself may be perturbed by some viruses. This memorandum reviews recent developments in viral immunopathology, with special reference to animal model systems, and indicates the possible relevance of the new concepts and techniques for certain diseases of man. Certain viruses, notably the leukaemia viruses and some of those causing persistent infections, depress the host's ability to mount an antibody response to antigens, while other viruses may enhance the antibody response. Cell-mediated immunity may also be depressed. Another immunopathological manifestation of virus infection is immune-complex disease. When viruses or their antigens persist in the circulation they combine with specific antibody, and the resulting complexes lodge in various sites, especially the kidney. Further combination with complement leads to the release of tissue-damaging substances. A third condition associated with virus infection is antibody-mediated immunologic injury. Both oncogenic and non-oncogenic viruses frequently induce new antigens on the surface of the cells they invade. When antibody attaches to these antigens in the presence of complement, the cells are destroyed.