New Observed in Children With Respiratory Diseases

ROBERT M. CHANOCK, M.D., ROBERT H. PARROTT, M.D., JOSEPH A. BELL, M.D., WALLACE P. ROWE, M.D., and ROBERT J. HUEBNER, M.D.

EVENTUAL control of the common respir- children, 8 of whom were studied in Washing- atory diseases depends on the determina- ton, D. C., hospitals and 27 of whom were in- tion of their etiology. Despite recent notable volved in an outbreak of febrile respiratory ill- advances in delineating the viral etiology of ness in a nursery group of a District of Co- such illnesses-at least 70 newly recognized lumbia welfare institution (Junior Village). viral agents have been described since 1948- When throat swabs were collected on one day the causes of most remain to be found. The from all infants in the affected nursery and preliminary report outlined here presents data tested for HA viruses, epidemiological analysis on two new respiratory viruses which have been indicated that there was a significant association found in children with respiratory illnesses and of type 1 HA isolations with febrile ill- which, while biologically related to nesses (chi-square test indicated P== 0.03), thus and , are also quite distinct. strongly suggesting but not proving an etio- Previously unrecognized myxoviruses classi- logical relationship. The illnesses were charac- fied in two serologic groups were isolated from terized by of 2 to 3 days' duration and children with respiratory illnesses during Oc- . Nearly half of the cases had moist tober and November 1957 (1). These two new medium to fine rales; several had coarse breath groups of agents, provisionally called hemad- sounds and rhonchi. sorption (HA) viruses types 1 and 2, were iso- Type 2 HA virus was isolated from three in- lated in monkey kidney cultures with the use fants with acute laryngotracheobronchitis of the hemadsorption technique recently intro- (), and more experience will be required duced by Vogel and Shelokov (2,3). Prelimi- with this agent before its etiological import- nary clinical and epidemiological observations ance in disease can be determined. indicated that these agents might be responsible Acute and convalescent serum specimens for a proportion of the common acute respira- from patients yielding either type 1 or type 2 tory illnesses in children which remain largely virus showed substantial antibody rises in unexplained despite recent advances exempli- complement fixation and hemagglutination fied by the discovery of adenoviruses (4, 5) and inhibition tests. Specimens from 82 hospital- other new agents (6-9). ized patients without respiratory illnesses did The type 1 HA virus was isolated from 35 not yield the two viruses. The contribution of the HA viruses to the Dr. Chanock, Dr. Bell, Dr. Rowe, and Dr. Huebner total respiratory disease picture cannot be as- are all with the Laboratory of Infectious Diseases, sessed at this time. However, serologic data National Institute of Allergy and Infectious Diseases, suggest that the contribution of these agents to Public Health Service. Dr. Parrott is physician-in- childhood respiratory illnesses may be substan- chief of Children's Hospital, Washington, D. C., with tial. Preliminary surveys for antibodies which Dr. Chanock is also associated. against HA viruses in the serums of 55 adults,

Vol. 73, No. 3, March 1958 193 nearly all young males, showed that all had receptors sensitive to RDE (receptor destroy- neutralizing antibodies to type 1 virus, and 39 ing enzyme of Vibrio cholerae filtrate), and had neutralizing antibodies to type 2. they were sensitive to ether. The following properties indicated that the Studies of the serologic relationships of HA HA viruses are members of the myxovirus viruses to other myxoviruses, as determined by family. Both types 1 and 2 HA viruses agglu- the use of specific animal serum, are reported tinated guinea and chicken red cells: They elsewhere (1). The table shows distinct im- propagated in the amniotic cavity of the em- munological differences from influenza A, B, bryonated hen's egg, they possessed erythrocyte and C, mumps, and croup associated (CA)

Relationship of types 1 and 2 hemadsorption (HA) virus to certain myxoviruses, as shown by rep- resentative complement fixation tests with human serums

Reciprocal of CF antibody titer with 4 units of indicated

Infection, patient, Influenza Sendai Mumps and serum HA HA Influenza Influenza C chick CA type 1 type 2 A Asian B CAM embryo MK MK MK CAM antigen 2 extract CAM Allantoic CAM Allantoic antigen 1 antigen I antigen 1 antigen 2 antigen3 antigen fluid antigen fluid antigen antigen _-- ... Type 1 HA Patient Ha: Acute ---- <8 <8 <8 <8 <8 <8 <8 <8 <8 <8 Convalescent 64 <8 <8 <8 <8 <8 <8 <8 <8 <8 Patient Mo: Acute -- <8 <8 <8 <8 <8 <8 <8 <8 <8 <8 Convalescent 64 <8 <8 <8 <8 <8 <8 <8 <8 <8 Type 2 HA Patient Sc: Acute- <8 <8 <8 <8 <8 <8 <8 <8 <8 <8 Convalescent 64 64 <8 <8 <8 <8 32 <8 <8 <8 Patient Se: Acute 16 <8 <8 <8 <8 <8 <8 <8 <8 <8 Convalescent -- 64 64 <8 <8 <8 <8 32 <8 <8 <8 Influenza A Asian Patient Su: Acute 16 <8 <8 Convalescent -- 16 <8 32 Patient Bu: Acute 16 <8 <8 Convalescent- 16 <8 <32 Influenza B Patient Ba: Acute 8 8 <8 Convalescent -- <8 <8 64 Patient St: Acute 32 16 <8 Convalescent - 32' 8 64 Influenza C Patient Tr: Acute 8 <8 <8 Convalescent -- 8 <8 64

1 Monkey kidney tissue culture antigen. 2 Chorio-allantoic membrane extract antigen centrifuged for 1 hour at 20,000 r.p.m.-group specific antigen. 3 Chick embryo extract antigen centrifuged for 1 hour at 30,000 r.p.m.

194 Public Health Reports viruses, as shown through use of paired acute (2) V'ogel, J., and Shelokov, A.: Adsorption-hemag- and convalescent serums from patieints witl glutinatioin test for influenza virus in monkey kidney tissue culture. Scieince 126: 358-359, HA. and influenza virus . Aug. 23, 1957. In representative complement fixation tests, (3) Shelokov, A., V'ogel, J., and Clii, L.: Hemiadsorp- persons infected with both type 1 and type 2 tion (adsorption-hemiiagglutination) test for slhowed no rises to influenza, A, B, or C whlen viral agents in tissue culture. In press. tested against the grouLp-specific CF antig,ens (4) Rowe, W. P., Huebner, R. J., Hartley, J. W., Ward, T. G., and Parrott, R. H.: Studies of of these agents. Type 1 HA virus was showni to the adenoidal-pharyngeal-conjunctiv.lI (APlC) be different from Sendai, mumps, and CA group of viruises. Am. J. Hyg. 61: 197-218 viruses by these same serums. Type 2 IIA (19-55). virus was not related to mumps or CAi virus, (5) Huebner, R. J., Bell, J. A., and Rowe, W. P.: but slhowed a relationship to Sendai virus, The importance of adenoviruses as agents of proto- respiratory and ocular disease. In Cellular which has recently been proposed as the biology, nucleic acids, and viruises. Speciall pub- type (10). Childreniwho lication of the New York Ac,ademy of Sciences. were infected witlh type 2 HA virus, ancd who New York, N. Y., 1957, vol. 5, Pp. 393-402. developed complement fixing antibody for the (6) Chanock, R. MI.: Association of a new type of homologouis virus, also developed antibody for cytopathogenic myxovirus with infantile croup. J. Exper. Med. 104: 555-576 (1956). Sendai viral antigen but not for the Sendai (7) Chanock, R. M., Roizmiian, B., and Myers, R.: Re- chorio-all antoic membrane extract (soluble) covery from infants with respiratory illiness of anitigen. Guiniea immunized with Sendai a virus irelated to clhimpanzee coryz.a agent. virus also developed CF an-tibody to type 2 I-IA 1. Isolations, properties, anid characterization. Amll. J. Hyg. 66: 281-290 (1957). virus, but in the hemiiagglutination inihibition (8) Price, W. H.: The isolation of a new virus asso- anid neutralizationi tests these ag,enits were ciated with respiratory clinical disease in shown to be distinct (1). hummains. Piroc. Nat. Acad. Sc. 42: 892'-896 (1956). (9) Pelon, W., Mogabgab, W. J., Phillips, I. A., aind REFERENCES Pierce, W. E.: A cytopathogenic agent isolated froiam Naval recruits waith niild respiratory ill- (1) Chanock, R. AI., Parrott, R. H., Cook, AM. K., An- miess. Proc. Soc. Exper. Biol. & Med. 94: 262- drews, B. E., Bell, J. A., Reichelderfer, T., 267 (1957). Kapikian, A. Z., an(d Huebner, R. J.: Newly (JO))Jensen, K. E., M1inuse, E., and Ackerinainn, recognized myxoviruses from childreii with re- W. W.: Serologic evideimce of Amiiericani experi- spiratory disease. New England J. Med. 25S: ence with inewborn pineuna)intiitis v-irulis (type 207-213, Jan. 31, 1958. Sendali). J. Iliimiuimol. 7.5: 71-77 (1955).

International Classification of Diseases Revised Tlhe sevenithi revision of the Anaiiuial of the International Statistical Classification of Diseases, Inijiuries, anid Causes of D)eath, effective January 1958, to be used by the IUni.ted States and othier memilbers of the WVorld Ilealthi Organization for thle niext 10 years, is niow available in two voluimes, at $3.5() for thie set. Tlle first voluime conitainis the classification: the sec- on(l, the alphabetical inidex. The Ptiblic Health Conference oni lVecords and Statistics is agrain couisoli(lating) orders in the I7nite(l States. Orders and(I chiecks payable to that orgalaiza- tioni i-ay be addiesse(d c/o T)epartinent of Health, Eduicationi, and Welfare, National Office of Vital Statistics, Washilnlg- toll 25, 1)..C.

Vol. 73, No. 3, March 1958 195 New Members of the PHR Board of Editors

Dr. Chope Mr. Hunter Dr. Kidd Dr. Langmuir Dr. Sowder

Five net me?nberws will atterld the April qmteet- of the University of Pittsburgh, where he taught from ing of the Board of Editors of Public Health 1930 to 1942, except during 1937-38, when he served Reports. Retired fromb the Boar-d are Har old as associate and managing editor of the Pittsburgh A. Erickson, Lloyd Florio, Victor H. Haas, Bulletin Index. and Seward E. Miller. Charles V. Kidd, Ph.D., has been chief of the Office of Research Planning of the National Institutes of Health, Public Health Service, since 1949. He is also Harold D. Chope, M.D., Dr.1P.II., has been director executive secretary of the consultants on medical re- of the San Mlateo County (Calif.) Department of search and education to the Secretary of Health, Edu- Public Health and Welfare since 1948. After taking cation, and Welfare. In 1947 he was executive secre- his doctorate in public health from Harvard Uni- tary of the President's Scientific Research Board, and versity (1940) where he had also been a Rockefeller later was a staff member of the President's Council Foundation fellow during work on his master's de- of Economic Advisers. He received a Rockefeller pub- gree, he was, from 1940 to 1948, successively, as- lic service award in 1955. He took an A.B. from sociate in public health administration at Harvard; Princeton in 1935, a diploma in history from Munich Rockefeller Foundation staff member in Sao Paulo, in 1936, and a Harvard doctorate in 1957. Brazil; and assistant district health officer, San Joa- Alexander D. Langmuir, M.D., M.P.H., has been quin Local Health District, Stockton, Calif. Prior to 1940 he served as chief of the bureau of epidemiology, chief of the Epidemiology Branch, Communicable St. Louis City Health Department, assistant director Disease Center, Public Health Service, since 1949. of the California State Health Department, and From August 1942 to July 1946, he was the epidemi- ologist of the on Dis- health officer, Newton, Mass. From 1936 to 1941 he Commission Acute Respiratory lectured at the Simmons School of Public Health eases of the Army Epidemiological Board, Fort Bragg, N. C. He served in the New York State Nursing and directed a field training unit at Harvard Departnment of to in vari- from 1935 to 1940. He was clinical professor of pre- Health from February 1937 August 1942 that commissioner ventive medicine at Stanford University in 1955, and, ous capacities, including of deputy of health of Westchester County. Before coining to from 1947 to the present, has been lecturer at the University of California School of Public Health. the Comimunicable Disease Center, he was associate professor of epidemiology at Johns Hopkins School of J. Stewart Hunter, M.A., assistant to the Surgeon Hygiene and Public Health for 3 years. In 1953 he General of the Public Health Service since 1950, serves served as a member of the WHO Committee on - as staff adviser on public information and supervises Vaccine. Since 1947 he has been consultant the inforim-ation and publications programs of the on biological warfare to the Secretary of Defense. Service. From AMarch 1953 until October 1955, at the request of the Department, he served as acting di- Wilson T. Sowder, M.D., M.P.H., Florida State rector of publications and reports for the Secretary health officer for the last 13 years, entered the Public of Health, Education, and Welfare. He camie to the Health Service as a commissioned officer in 1934. He Service in June 1949 from a position as associate di- served in hospitals, quarantine stations, and the Coast rector of the public relations department of the Guard, and in venereal disease control work in Ten- Chicago office of J. Walter Thompson Co. After serv- nessee and Florida. He was also a consultant on ing on the information staff of the Office of Price communicable diseases in the War Shipping Adminis- Administration during the early part of 1942, he saw tration and consultant in the Service's regional office active duty as lieutenant commander in the U. S. in Dallas, Tex., until his resignation in 19-36 from the Naval Reserve from October 1942 to January 1946, the Regular Corps to remain in Florida. He took his majority of the time as an officer on an aircraft medical degree in 1932 from the University of Virginia, carrier in the Pacific. Subsequently, he lectured in and his master's degree in public health from the English at Northwestern University. He is a graduate Johns Ilopkins University in 1939.

196 Public Health Reports