NCDC immunization against infectious disease 1968 U.S. DEPARTMENT OF HEALTH. EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE ' HealtLServices and Mental Health Administration YJ, >S i National Communicable Disease Center - Atlanta, Georgia 30333 National Communicable Disease Center Library Atlanta, Georgia 30333 Contents Page FOREWORD .................................................................................... 1 INTRODUCTION ........................................................................... 2 CURRENT REVIEWS-SELECTED INFECTIOUS DISEASES 3 Diphtheria................................................................. 5 Tetanus.................................................................... 8 Pertussis (Whooping Cough) .................................. 10 Measles (Rubeola)................................................. 12 Mumps ...................................................................... 17 'Poliomyelitis ............................................................ 20 Rubella (German M easles).................................... 26 C holera ................................................................... 29 Viral Hepatitis......................................................... 30 Influenza................................................................. 32 Plague.............................................................. .. 34 R abies.................................................................... 36 Smallpox............................................ , .................... 40 Tuberculosis............................................................ 44 BCG Vaccination................................................. 49 Preventive Treatment for Tuberculous Infection 51 Typhoid F ever......................................................... 52 Epidemic Typhus F ever......................................... 54 Yellow Fever .............■.......................................... 55 UNITED STATES IMMUNIZATION SURVEY, 1967-1968 SUMMARY 61 BIOLOGICS SURVEILLANCE, 1965-1968 SUMMARY ....................... 93 RECOMMENDATIONS-PHS ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES............................................................. 97 Cholera Vaccine.............................................................................. 101 Diphtheria and Tetanus Toxoids and Pertussis Vaccines.......... 103 Immune Serum Globulin for Prevention of Viral Hepatitis.......... 106 Influenza Vaccine—1969-70............................................................ 109 Measles V accine............................................................................ 111 Mumps V accine.............................................................................. 114 Plague Vaccine.............................................................................. 116 _ Poliomyelitis Vaccines ................................................................. 118 Rabies Prophylaxis ...................................................................... 120 Rubella Virus Prelicensing Statement.......................................... 124 Smallpox Vaccine............................................................................ 126 Typhoid V accine........................................................................... 131 Typhus Vaccine.............................................................................. 133 Yellow Fever Vaccine.................................................................... 135 435*0 Acknowledgments and Sources of Data \ Immunization Against Infectious Disease represents a NCDC as part of the established National Morbidity Re­ collaborative effort of various investigators in several porting System and are tabulated in the Morbidity and Programs and Branches of the National Communicable Mortality Weekly Report (MMWR), published regularly Disease Center, selected by the editor because of their by the Center. Official mortality data are provided by familiarity with specific diseases. It was originally devel­ the National Center for Health Statistics (NCHS). Wash­ oped in the Office of the Center Director, based on data ington, D.C. collected by the Epidemiology, Smallpox Eradication, Collecting information on individual cases of selected Foreign Quarantine, and Ecological Investigations Pro­ diseases, such as poliomyelitis and diphtheria, is a sur­ grams, the Laboratory Division, and the Immunization veillance activity of various Programs at the NCDC. This and Tuberculosis Branches of the State and Community information comes through epidemiologic and labora­ Services Division. Credit is due the staff of Statistical tory reporting channels from State and other health jur­ Services Activity of Epidemiology Program for efforts to isdictions. Surveillance data on cases of specific com­ ensure completeness and accuracy of data. Special credit municable diseases form a very useful resource for is due Miss Frances Porcher, chief of Epidemiology Pro­ careful analysis of disease trends. Case counts from sur­ gram’s editorial-graphics staff, who acted as the man­ veillance activities may not always match the official aging editor. The diligence of all participants is gratefully totals because of the inherently different mechanisms of acknowledged. collection. It should be noted that the official data Data in Immunization Against Infectious Disease are (MMWR, NCHS) are the authoritative and archival derived from official reports submitted by States and counts of cases and deaths, but surveillance records pro­ other reporting health jurisdictions. Weekly tallies of the vide additional insights on trends and patterns of com­ numbers of cases of reportable diseases are sent to the municable diseases and therefore merit attention. Foreword The Public Health Service Advisory Committee on Immunization Practices encouraged the National Communicable Disease Center to undertake the preparation and development o f a handbook Immunizationon Against Infec­ tious Disease. In their deliberations on communicable disease trends and the optimal role of immunizations, members of the committee agreed that a meaningful analysis o f achievements and current objectives should be made generally available to the country’s public health workers, students o f medi­ cine, and physicians in private practice and in academic medicine. And per­ haps more importantly, they recommended placing under one cover perti­ nent material bearing on this subject from several sources. This summary covers the basic communicable diseases in which effective vaccines play an important role. In future editions, additional subjects may be covered to provide a more comprehensive background for sound pre­ ventive medical practice. Readers are encouraged to submit comments and suggestions to the editor for improving this handbook, to make it as useful as possible to the profes­ sions that find this information helpful. J. Lyle Conrad, M.D. Editor INTRODUCTION In recent decades, effective vaccines have become ma­ all elements necessary for the development of a meaning­ jor resources of preventive medicine. Except for antigens ful immunization pattern. , of vaccinia and rabies, there were no effective vaccines This edition of Immunization Against Infectious Dis- ' for common infectious diseases until relatively recently. ease is a review of the status of infectious diseases impor- Use of the variety of inactivated vaccines and live a tte n ­ tant to the United States and for which there are effec­ uated antigens has resulted in dramatic control of several tive immunizing agents. The depth of analysis, scope of diseases in the United States. coverage, and general level of detail will undoubtedly There has not been one confirmed case of smallpox in change with added insights and new sources of informa­ this country in 20 years, poliomyelitis is under control, tion. This edition, primarily covering data summarized measles incidence is at its lowest point in history, and through the 1968 calendar year, is addressed to the stu­ diphtheria and tetanus are on the wane. In the future, we dents of public health and medicine; it assesses for them can expect mumps, rubella, and other common infec­ not only achievements in control but also their obliga­ tious diseases to be controlled or eliminated as public tions toward maintaining alertness to present and future health problems, through the use of vaccines currently needs. available or under development. The contents of this summary are divided into three This immunological basis of preventive medicine im­ major sections: The first deals with the status of major plies, however, a major responsibility for the public communicable diseases and the effects of vaccines on health and medical professions. Along with the luxury them. The second section contains summaries of the and ease of health provided by artificial antigens must go United States Immunization Survey, which is sponsored the commitment for maintaining careful, intensive by the National Communicable Disease Center and car­ watch — “surveillance” — on their performance. The ried out annually by the Bureau of the Census, and the scope of surveillance ranges from determining the popu­ 1968 Biologies Surveillance Summary, a collaborative ef­ lation’s level of protection to assessing the relative ef­ fort of the major producers of biologies in the United fectiveness of alternative antigens. States and the NCDC. The third section contains the Vaccines with short durations of protection could Recommendations of the Public Health Service Advisory merely postpone