[Poliomyelitis in the Spanish press (1960-1975)]

OBJECTIVE

Vaccination has been one of the most effective preventive measures to reduce the number of diseases that affect humans. The primary objective of this study is to describe the informative treatment of polio in the written press at a time when it was of great importance.

METHODS

From the digital newspaper archive of the ABC and La Vanguardia newspapers, all the information in which the concept "polio", published during the period between 1960 and 1975 was selected.

RESULTS

In total there have been 961 units of analysis, 557 for the ABC newspaper and 404, for La Vanguardia. The year of greatest publication was the year 1963, coinciding with the authorization for the use of the Sabin vaccine. The need to intensify vaccination campaigns is highlighted as the number of annual cases continued to increase.

CONCLUSIONS

There are no significant differences in the coverage of the newspaper ABC and La Vanguardia, following a pattern of publication very similar between them, where the Sabin vaccine appears as one of the most important scientific advances, thanks to which they allowed to protect children against to this dreaded disease, thus avoiding a major epidemic.

Human Experimentation in Public Schools: How Schools Served as Sites of Vaccine Trials in the 20th Century

Schools have long been critical partners for public health authorities in achieving widespread vaccination. In the mid-20th century, however, public schools also served as sites of large-scale experiments on novel vaccines. Through examining the experimental diphtheria, polio, and measles vaccine trials, I explored the implications of using schools in this manner, as well as the continuities and discontinuities among the three cases. Common to all of them was that the use of schools brought decision-making into the public sphere, subjecting parents to social pressures and the influences of school officials and community members. However, the effects of using schools varied as well, as their social and institutional significance interacted differently with the narratives surrounding each disease, the public's changing perception of medicine and science, and society's changing values. These insights show not only the power of public institutions to influence opinions and perceptions, but also the subtle forces that one's authority figures, peers, and community members may bring to a seemingly private decision-making process. These considerations are relevant to health interventions today, such as the complex debate over community consent in global health research. (Am J Public Health. 2018;108:1015-1022. doi: 10.2105/AJPH.2018.304423).

A Brief History of Vaccines Against Polio

Poliomyelitis, a dreaded disease of the last century that had already crippled millions of people across the globe, is now on the verge of eradication thanks mainly to two polio vaccines, inactivated polio vaccine (IPV) and oral polio vaccine (OPV). Ever since their development in late 1950s and early 1960s, the journey of their early development process, clinical trials, licensure and ultimately widespread clinical use in different countries provide a fascinating tale of events. Oral polio vaccine has been the mainstay of global polio eradication initiative (GPEI) in most of the countries. With the advent of 'polio endgame', the focus has now shifted back to IPV. However, there are certain issues associated with global cessation of OPV use and universal implementation of IPV in routine immunization schedules across the globe that need to be dealt with some urgency, before proclaiming the global victory over polio.

Basil O'Connor, the National Foundation for Infantile Paralysis and the Reorganization of Polio Research in the United States, 1935-41

The costs associated with polio research in the late 1920s were high, while sources for research funding remained scarce. This began to change in the early 1930s with the creation of three private philanthropies that would form the basis of a system to fund polio research adequately: the International Committee for the Study of Infantile Paralysis (1928), The President's Birthday Ball Commission (1934), and the National Foundation for Infantile Paralysis (1938). This article explores how these three organizations shaped the process for directing funds to polio research. Beginning with the International Committee, all three philanthropies used medical advisory committees as vehicles for the review of proposals for research. The National Foundation adopted many of the policies and procedures of the earlier organizations, drawing on the experiences, misfortunes, and successes of its predecessors. The National Foundation also relied on some of the same personnel, although the microbiologist and writer Paul de Kruif, who was an influential figure in the early years, was gradually pushed out. This essay explores the establishment of the medical advisory committees of the National Foundation and reveals how by 1941 under leadership of Basil O'Connor and Dr. Thomas Rivers they developed a systematic and readily legitimated process for directing funding. By 1941, the NFIP had in place the fund-raising capacity to underwrite the scientific research that would ultimately produce two successful polio vaccines in the next twenty years.

What you don't know about vaccines can hurt you

As physicians, we've all learned in detail about the science behind vaccinations, but I suspect few of us have been taught about the history of vaccinations. Sure, we all know that Dr. Jonas Salk developed the poliovirus vaccine, but I wasn't aware that he inoculated himself, his wife, and his three children with his then experimental vaccine. When our editorial committee decided to focus on vaccinations as our theme for this month's Greene County Medical Society's Journal, I perused the internet for interesting topics. I came across a fascinating website, historyofvaccines.org; this website is a project of the College of Physicians of Philadelphia, touted as being the oldest professional medical organization in the United States. I credit the majority of the information in this article to the above website and the rest to the National Institutes of Health (nih.gov) website; I trust that the information is valid and true, based on the agencies behind these websites. Below are some interesting tidbits about vaccine preventable diseases that I found noteworthy to pass on to our readers.

[History of development of the live poliomyelitis vaccine from Sabin attenuated strains in 1959 and idea of poliomyelitis eradication]

In 1958 Poliomyelitis Institute in Moscow and Institute of Experimental Medicine in St. Petersburg received from A. Sabin the attenuated strains of poliomyelitis virus. The characteristics of the strains were thoroughly studied by A. A. Smorodintsev and coworkers. They found that the virulence of the strains fluctuated slightly in 10 consecutive passages through the intestine of the non-immune children. A part of the Sabin material was used by A. A. Smorodintsev and M. P. Chumakov in the beginning of 1959 for immunizing approximately 40000 children in Estonia, Lithuania, and Latvia. Epidemic poliomyelitis rate in these republics decreased from approximately 1000 cases yearly before vaccination to less than 20 in the third quarter of 1959. This was a convincing proof of the efficacy and safety of the vaccine from the attenuated Sabin strains. In 1959, according to A. Sabin's recommendation, a technology of live vaccine production was developed at the Poliomyelitis Institute, and several experimental lots of vaccine were prepared. In the second part of 1959, 13.5 million children in USSR were immunized. The epidemic poliomyelitis rate decreased 3-5 times in different regions without paralytic cases, which could be attributed to the vaccination. These results were the final proof of high efficiency and safety of live poliomyelitis vaccine from the attenuated Sabin strains. Based on these results, A. Sabin and M. P. Chumakov suggested in 1960 the idea of poliomyelitis eradication using mass immunization of children with live vaccine. 72 million persons up to 20 years old were vaccinated in USSR in 1960 with a 5 times drop in the paralytic rate. 50-year-long use of live vaccine results in poliomyelitis eradication in almost all countries worldwide. More than 10 million children were rescued from the death and palsy. Poliomyelitis eradication in a few countries where it still exists depends not on medical services but is defined by the attitude of their leaders to fight against poliomyelitis. In some developing countries the vaccination data are falsified, thereby threatening the polio epidemics reappearance and the virus spreading to other countries. Methods must be developed for detection and dealing with extremely rare persistent virus carriers. Because of all these constraints the outcome of poliomyelitis eradication at present is uncertain and vaccination must be continued. The world has become poliovaccine dependent.

[Piet de Somer, the University of Leuven and the Belgium poliovaccine in 1956-57]

In the years following WW II, all 'Western' countries were struck by recurrent epidemics of infantile paralysis (poliomyelitis). In the early 1950s, a vaccine developed by Jonas Salk in Pittsburgh, became available in the U.S. and Canada. In 1953-54 central virology laboratories in Sweden, Denmark and France were already well advanced in setting up local production lines of the vaccine. At that point in time, the Catholic University of Leuven, on the initiative of the young microbiology professor, Piet De Somer, and in collaboration with the pharmaceutical concern R.I.T. (Recherches et Industries Thérapeutiques, Genval, Belgium), erected a new, multidisciplinary medical research institute, the Rega Institute. One of the research units to be headed by De Somer was destined to introduce the relatively new discipline of virology. As a test case, De Somer decided to venture on developing a production line of the Salk vaccine. In less than one year's time, the project was successful, such that Belgium became one of the first European countries to be self-supporting for its vaccine supply and to be able to initiate a large-scale vaccination campaign. The planning, preparation and execution of the project was accompanied by an extensive correspondence of De Somer with experts and other concerned parties in Belgium and abroad. This correspondence has been preserved and allows for a detailed reconstruction of the remarkable achievement.

From emergence to eradication: the epidemiology of poliomyelitis deconstructed

Poliomyelitis has appeared in epidemic form, become endemic on a global scale, and been reduced to near-elimination, all within the span of documented medical history. Epidemics of the disease appeared in the late 19th century in many European countries and North America, following which polio became a global disease with annual epidemics. During the period of its epidemicity, 1900–1950, the age distribution of poliomyelitis cases increased gradually. Beginning in 1955, the creation of poliovirus vaccines led to a stepwise reduction in poliomyelitis, culminating in the unpredicted elimination of wild polioviruses in the United States by 1972. Global expansion of polio immunization resulted in a reduction of paralytic disease from an estimated annual prevaccine level of at least 600,000 cases to fewer than 1,000 cases in 2000. Indigenous wild type 2 poliovirus was eradicated in 1999, but unbroken localized circulation of poliovirus types 1 and 3 continues in 4 countries in Asia and Africa. Current challenges to the final eradication of paralytic poliomyelitis include the continued transmission of wild polioviruses in endemic reservoirs, reinfection of polio-free areas, outbreaks due to circulating vaccine-derived polioviruses, and persistent excretion of vaccine-derived poliovirus by a few vaccinees with B-cell immunodeficiencies. Beyond the current efforts to eradicate the last remaining wild polioviruses, global eradication efforts must safely navigate through an unprecedented series of endgame challenges to assure the permanent cessation of all human poliovirus infections.

And they shall walk: ideal versus reality in polio rehabilitation in the United States

This essay explores the significance that rehabilitation physicians and polio patients in the United States put on recovering the ability to walk. Polio often paralyzed or severely weakened the legs of those who contracted the disease. Regaining the ability to walk was thus a significant measure of recovery from the disease. However, walking meant more than the physical act itself. Regaining the ability to walk meant, in a symbolic sense, that one was no longer disabled, that one had again become normal. This attitude was shared by rehabilitation specialists and patients alike. This essay examines this attitude and the cultural values it embodied through a study of the efforts of selected polio survivors to learn to walk again and of the rehabilitation literature that held walking as an ideal. It also explores what happened when polio patients were unable to walk again because of the severity of their paralysis.

[Consolidating the medical model of disability: on poliomyelitis and constitution of orthopedic surgery and orthopaedics as a speciality in Spain (1930-1950)]

At the beginning of the 1930s, various factors made it necessary to transform one of the institutions which was renowned for its work regarding the social reinsertion of the disabled, that is, the Instituto de Reeducación Profesional de Inválidos del Trabajo (Institute for Occupational Retraining of Invalids of Work). The economic crisis of 1929 and the legislative reform aimed at regulating occupational accidents highlighted the failings of this institution to fulfill its objectives. After a time of uncertainty, the centre was renamed the Instituto Nacional de Reeducación de Inválidos (National Institute for Retraining of Invalids). This was done to take advantage of its work in championing the recovery of all people with disabilities.This work aims to study the role played in this process by the poliomyelitis epidemics in Spain at this time. It aims to highlight how this disease justified the need to continue the work of a group of professionals and how it helped to reorient the previous programme to re-educate the "invalids." Thus we shall see the way in which, from 1930 to 1950, a specific medical technology helped to consolidate an "individual model" of disability and how a certain cultural stereotype of those affected developed as a result. Lastly, this work discusses the way in which all this took place in the midst of a process of professional development of orthopaedic surgeons.

[The historical meaning of serological surveys as a laboratory technology applied to the immunization campaigns. The case of poliomyelitis in Spain]

The aim of the paper is to analyse the introduction, use and diffusion of the serological surveys, a public health technology on the borderline between epidemiology and laboratory, in connection with poliomyelitis in Spain during the Francoism period. Within the framework of the "new history" of medical technologies and innovations, the serological surveys played an important role both in the improvement of knowledge on socio-demographic distribution and the health politics arena.

[Epidemiological and virological studies into the poliomyelitis in Valencia (1959-1969)]

Studies into the polio virus began in Valencia in 1959 with the work undertaken by the microbiologist Vicente Sanchis-Bayarri Vaillant. After his education at the Rochester University and at the Pasteur Institute, Sanchis-Bayarri Vaillant established a laboratory of cell cultures at the Faculty of Medicine in Valencia, where he developed a new diagnostic technique for the poliomyelitis virus. In addition, epidemiological studies were carried out both prior to and post the 1963 vaccination campaign, which proved that Sabin's oral vaccine was both effective and safe for use.

Polio and nobel prizes: Looking back 50 years

In 1954, John Enders, Thomas Weller, and Frederick Robbins were awarded the Nobel Prize in Physiology or Medicine "for their discovery of the ability of poliomyelitis viruses to grow in cultures of various types of tissue."5370 This discovery provided for the first time opportunities to produce both inactivated and live polio vaccines. By searching previously sealed Nobel Committee archives, we were able to review the deliberations that led to the award. It appears that Sven Gard, who was Professor of Virus Research at the Karolinska Institute and an adjunct member of the Nobel Committee at the time, played a major role in the events leading to the awarding of the Prize. It appears that Gard persuaded the College of Teachers at the Institute to decide not to follow the recommendation by their Nobel Committee to give the Prize to Vincent du Vigneaud. Another peculiar feature of the 1954 Prize is that Weller and Robbins were included based on only two nominations submitted for the first time that year. In his speech at the Nobel Prize ceremony, Gard mentioned the importance of the discovery for the future production of vaccines, but emphasized the implications of this work for growing many different, medically important viruses. We can only speculate on why later nominations highlighting the contributions of scientists such as Jonas Salk, Hilary Koprowski, and Albert Sabin in the development of poliovirus vaccines have not been recognized by a Nobel Prize.

[French specificities in the history of vaccination. The end of an exception?]

Five years after the National Health minister launched the vaccination program against hepatitis B in 1994, French public health experts are not satisfied by the coverage rate among young people. Is this stagnation related to the controversial way the program was initially managed and to the debate that has raged on the link between the vaccine and multiple sclerosis? Is the popular reaction of distrust specific to the vaccine or does it reveal a growing concern towards the whole vaccinal enterprise? More generally, is it the end of the almost unconditional French acceptance of vaccines? A historical retrospective on the history of vaccination in the country of Louis Pasteur.

Polio vaccine: The first 50 years and beyond

A conference on "Polio vaccine: the first 50 years and beyond" was held in Toronto, Canada, June 2005. The purpose of the conference was to bring together regulators, manufacturers, academics and public health authorities to celebrate the accomplishments of the past 50 years, to consider the challenges of achieving and sustaining polio eradication and to review standardization and regulatory issues around existing and new polio vaccines. In the final session of the conference the following summary of the meeting was presented.

Passive immunization against poliomyelitis: the Hammon gamma globulin field trials, 1951-1953

Poliomyelitis has gone from being one of the worst scourges of the 20th century to nearing eradication in the 21st. This success is well known to be attributable to the Salk inactivated and Sabin attenuated poliovirus vaccines.However, before introduction of these vaccines, William McDowall Hammon of the University of Pittsburgh Graduate School of Public Health led the first major breakthrough in prevention of the disease by using passive immunization in one of the earliest double-blind, placebo-controlled clinical trials. This study provided the first evidence that antibodies to poliovirus could prevent the disease in humans.

[The history of polio in Sweden - from infantile paralysis to polio vaccine]

Although other epidemics declined due to improved hygiene and sanitation, legislation, and vaccination, polio epidemics appeared in Sweden in 1881 and at the turn of the 20th century the disease became and annual feature in the Swedish epidemiological pattern. Due to the vaccination starting in 1957 epidemics ceased to exist in Sweden around 1965. This article deals with the history polio epidemics in Sweden, 1880-1965 and gives a brief description of: the demographical influence of polio, how did the medical authorities investigate and try to combat it, and the different comprehensions of how polio affected its victims.A study of polio incidence in Sweden at the national level during 1905-1962 reveals that the disease caused major epidemics in 1911-1913 and 1953. At the beginning of the 20th century polio primarily attacked children up to 10 years of age, and at the end of the period victims were represented in all age groups, but mainly in the ages 20-39. Due to its enigmatic appearance, polio was not considered as an epidemic infectious disease during the 19th century. Sweden's early epidemics enabled Swedish medical science to act and together with American research institutes it acquired a leading role in international medical research on the disease. In the 1955 Jonas Salk produced the first successful vaccine against polio but also Sweden developed its own vaccine, different in choice of methods and materials from the widely used Salk-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.

[The history of poliomyelitis in Norway--disease, society and patients]

The first epidemic of poliomyelitis in Norway was reported in 1868. Over the course of the 20th century, a total of 23,000 cases of acute poliomyelitis were registered, and the disease caused much suffering and fear before vaccination was introduced in 1956. After 1960, treatment and rehabilitation facilities for polio patients were gradually converted to other uses. Today there are 5,000-10,000 persons with sequelae poliomyelitis in Norway, many of them suffering from late effects of poliomyelitis, so-called postpolio syndrome. Thus there is still a need for multidisciplinary services for these patients, even though the poliovirus could be eradicated in a few years' time.

Poliomyelitis: the role of the military in the final campaign

Poliomyelitis remains a disease of significance to military medicine. The medical branches of the military of many nations have much to contribute in the final 4 years of the campaign to eradicate poliomyelitis from the world. The service requirements of immunization remain a logistic charge on the defense health services of all nations. Risks to unimmunized troops remain current in the poliomyelitis endemic regions of Europe, Asia, and Africa; and recent epidemics in India, West Africa, and Albania have involved military personnel in containment programs. The 20th century has seen global attempts to eradicate seven diseases--hookworm, yellow fever, yaws, malaria, smallpox, dracunculiasis, and poliomyelitis. The first four of these were total failures, in spite of huge military logistic resources, especially in the case of yellow fever and malaria. But the global eradication of smallpox, achieved in 1979, led to the World Health Organization's Declaration of a Smallpox-Free World in 1980. Its success ranks as one of the greatest achievements in the history of medicine. Lessons learned and encouragement derived from that program led to the institution of the Poliomyelitis Global Eradication Program in 1988. Following the Declaration of a Polio-Free America, the target date for the Declaration of a Poliomyelitis-Free World has been set for 2004. Regional surveillance programs use the quality-control portal of acute flaccid paralysis to monitor every potential clinical case of acute poliomyelitis. In the Western Pacific region, a region of 22 countries with a recent history of significant operational deployments, 15 countries had experienced endemic poliomyelitis before 1990. In this region, the last case of poliomyelitis (in Cambodia) was reported in March 1997. Such audit, together with massive point vaccination programs, many using massive military support, conducted since 1997 hold realistic promise that the world may be declared poliomyelitis-free by 2004. Poliomyelitis will be more difficult to eradicate than smallpox; and the current world campaign will succeed only with the logistic and professional input of the military of many nations.