AGENDA 1. Charge to the Committee Dr._ Luther Terry 2. Type III Oral Vaccine Associated Dr. Donald Henderson Cases and Type III Isolates Dr. James Bryan 3. Type III Vaccine Distribution and Use in the United States Dr. David Sencer 4. Analysis of Poliomyelitis Incidence in the United States - 1962 Dr. Donald Henderson 5. Laboratory Studies Pertaining to Suspect Cases Dr. Henry Gelfand 6. Discussion and Recommendations August 9, 1962 I. Cases l) Clinical Poliomyelitis following Type III feeding a) Vaccinees Oregon (4) Hichigan (l) Ohio (l) New York (l) Washington (1) b) Contact of Vaccinees Ohio (l) Massachusetts (1) 2) Aseptic Meningitis Associated with Oral Vaccine Feeding Arizona (1) Oklahoma (2) II. Type III vaccine distribution in the u.s.A. l) Hap - 1962 2) List - 1962 3) List - 1961 4) List - Pfizer Lot. 1148 III. Analysis of Poliomyelitis Incidence in the U.S.A. - 1962 August 8, 1962 Communicable Disease Center Atlanta 22, Georgia ( I. Clinical Paralytic Poliomyelitis Following Type III Vaccine A. Vaccinees case · Date Fed Virus Mfr. & III Interval Isolated Lot No. No. State County ----Age Race Sex IPV Onset Type - - I Oregon F 0 /62 7 ~ III Pf. 1148 Ore gon · t4 0 /62 23 I III Pf. 1148 H 0 · /62 .,_ III pf. 1148 ~ 1 3 Oregon ~ l 1 "~ ~ 4 ·Oregon l1 0 · /62 9 1 . III . Pf. 1148 lj. /62 ·_- t'rtt ~~ Pf. 1151 M ~t,~ -l:u.iJ..· ? ~ 5 Michigan ·I 6 New York M 0 , /62 f 26 J C - Pf. 1152 :> ~, lj. /62 1.o/'C ' S' 1 - Pf. 1152? - r.re- !1/f-'6 7 Washington . 1151? ..v~. ? -+h ~I.e 8 Ohio \ !1 0 /62 21 - Pf. 1151? 1153? fl 'f.rJ-t.- .-:1.~ ~·- q- ~ .5€-t~ B. Contacts of Vaccinees Contact Case Fed Vl.rus Hfr. & No. State County Age Race Sex ~ Onset Type III Interval Isolaterj Lot No. 9 Ohio · M 0 /62 33 III Pf. 111!.8 23 Lederle ~ Mass. F 1!. /62 Ne () (to-Y- ~-....rt£ --..; ~- ~- -- II. Aseptic Meningitis Associated with Type III Oral Vaccine Feeding Case Date Fed Virus Hfr. & III Interval Isolated Lot No. No. State County Age Race Sex --IPV Onset Type 11 Arizona M 0 /62 G) III Pf. 1148 /62 18 Pf. 1149 12 Oklahoma ~~ 4 - 13 Oklahoma F 4 /62 17 - Pf. 1149 III. Poliovirus Type III Isolat es Since April 1, 1962 A. Par alytic Poliomyelitis - No Evident Associatjon •·Tith Vaccination Case Date Fed Virus Mfr. & Diagnosis or al Isolated Lot No. Comment No. State County A ge~ Sex I PV Onset TyJe III Interv F 0 /62 0 ( III) 14 .Qhio - III 15 Virginia F 0 /62 0 - !1 0 III 16 Illinois 62 - - Type III Fed in 17 New York M 0 2 III Wyeth 62 Neighborhood. 18 California M 5 /62 0 - III B. Other Conditions 19 Oregon F 4 /62 7 III Pf. ll48 Foot Drop - Traumatic 20 Pa. M 4 /62 8 III Pf. 1153 Right Leg Pain - No Para. 21 Pa. · M /62 28 III Pf. 1153 r1umps Encephalitis - - Concussion 22 Ohio M 2 /62 9 III Pf. 1153 Transient Heakness 23 N.H. M 4 /62 9 III Wyeth ?Trauma to Brachial 03103 Plexus III Pf. Lassitude secondary 24 Minn. F - - -- to anemia. KNOWN TYPE Ill ORAL VACCINE PROGRAMS - 1962 Thousands of doses of Type Ill oral vaccine administered @ in community programs throughout State. ESTIMATED DOSES OF TYPE III ORAL VACCINE FED IN 1962 BY STATE AND GEOGRAPHIC REGION (Community Programs Only) State Counties Doses Estimated Proportion and with Fed by Manufacturer* Region Counties Program (Estimated) Lederle Pfizer Wyeth ~J B,rt•, rto UNITED STATES 3075 126 8!891,576 14% 76% 10% NEW ENGLAND 67 15 1,218,640 Maine 16 1 25,000 100 New Hampshire 10 0 Vermont 14 0 Hassachusetts 14 14 1,188,640 88 12 Rhode Island 5 0 Connecticut 8 0 s,ooo 100 MIDDLE ATLANTIC 150 11 711,100 New York 62 9 698,100 19 81 New Jersey 21 0 Pennsylvania 67 2 13,000 100 EAST NORTH CENTRAL 436 22 2,916,164 Ohio 88 12 Indiana 92 0 Illinois 102 5 70,450 100 Michigan 83 3 23,700 41 59 Wisconsin 71 2 4,000 100 WEST NORTH CENTRAL 619 22 728,400 Minnesota 87 14 229,900 100 Iowa 99 2 42,500 100 Missouri 115 0 North Dakota 53 0 South Dakota 67 3 10,000 100 Nebraska 93 2 423,000 100 Kansas 105 1 23,000 100 * Leder1e- 1,237,880 doses Pfizer - 6,783,519 doses Wyeth 870,177 doses ESTIMATED DOSES OF TYPE III ORAL VACCINE FED IN 1962 (continued) BY STATE AND GEOGRAPHIC REGION (Community Programs Only) State Counties Doses tstimated Proportion and with Fed by Manufacturer Region Counties Progr am (Estimated) Lederle Pfizer Wyeth SOUTH ATLANTIC 555 4 54,500 Delaware 3 0 Maryland 24 0 District of Columbia 1 0 Virginia 100 0 West Virginia 55 0 North Carolina 100 0 South Carolina 46 1 4,500 100 Georgia 159 0 Florida 67 3 50,000 100 EAST SOUTH CENTRAL 364 8 195,552 Kentucky 120 8 195,552 5 95 Tennessee 95 0 Alabama 57 0 Mississippi 82 0 WEST SOUTH CENTRAL 470 2 44,000 Arkansas 75 0 Louisiana 54 0 Oklahoma 77 2 44,000 68 32 Texas 254 0 MOUNTAIN 281 26 1,736,259 Montana 57 0 Idaho 45 1 2,300 100 Wyoming 24 1 39,500 100 Colorado 63 15 698,217 2 98 New Mexico 32 0 Arizona 14 8 862,237 100 Utah 29 0 Nevada 17 1 134,000 100 PACIFIC 133 16 1,286,966 Washington 39 2 67,000 100 Oregon 36 11 657,966 100 California 58 3 562,000 100 Alaska Hawaii ESTIHATED TYPE III ORAL POLIO VACCINE* ADMINISTERED IN THE UNITED STATES, 1960-61 Estimated Number ·· Area of Doses Middletown, Connecticut 10,000 Metropolitan Atlanta, Georgia 300,000 Monroe County, New York Cincinnati, 09io ~~ -2-8"Lp-o Harrisburg, Pennsylvania 105,000 Newberry County, South Carolina 22,000 Total 723,000 ESTIMATED TRIVALENT ORAL POLIO VACCINE* ADrUNISTERED IN THE UNITED STATES, 1962 Estimated Number Area of Doses Dade County, Florida 1,036 Hillsborough County, Florida 180,000 (1st feeding) 196,000 (2nd feeding) 1; Sabin strains. Type II I Oral Polio Vaccine ·- Pfizer Lot 203-1148 Distribution and Best Estimate of Vaccinees (August 6, 1962) Doses Vaccine Best Est. State Received\'; No. Fed In Stock Alabama 1,000 1,000 Arizona 387,500 413,777 20,000 California* ~'; 42,800 2,800 Connecticut 500 500 Delaware 100,500 1,500 99,000 Florida 5,700 5,700 Georgia 4,200 4,200 Illinois 12,100 12,100 Indiana 2,000 2,000 Iowa 28,000 27,500 Louisiana 400 400 t-1aine 25,000 25,000 Massachusetts 2,600 2,600 Michigan 200 200 Minnesota 36,000 36,000 Missouri 2,600 2,600 Montana 200 200 Nebraska 14,400 14,400 Nevada 134,000 134,000 New York 6,100 6,100 North Carolina 200 200 North Dakota 500 500 Ohio 541,000 469,700 15,400 Oregon 650 5 000 640 5 867 300 Pennsylvania 400 400 Tennessee 800 BOO Texas 200 200 Washington 1,000 1,000 West Virginia 4,500 4 5 500 Wisconsin 2,000 2,000 Totals 2,006,400 1,812,744 134,700 * The number fed plus vaccine in stock may not equal doses received due to wastage. ** 29,000 doses shipped to Yuma, Arizona. 11,000 doses shipped to San Luis, r-lexico. Paralytic Poliomyelitis With Onset Since April 1, 1962 by lileek of Onset (Cases reported through Week ending July 28, 1962) United States Vaccinee and Week United Type I (excluding Texas Vaccinee End in~ States Texas Cases and Type I) Contacts*** April 7 5 2 0 3 0 14 3 1 0 2 0 21 4 2 0 2 0 28 7 4 0 3 0 May 5 8 7 0 1 1 12 5 3 0 2 0 19 9 5 0 4 0 26 11 8 1 2 2 June 2 11 9 1 1 0 9 12 10 1 1 1 16 14 6 4 4 1* 23 11 8 1 2 1 30 15 8 0 7 2 July 7 9 4 0 5 0 14 4 2 0 2 0 21 3 2 0 1 2~':,': Unk. Onset 25 18 1 6 0 Total 156 99 9 48 10*** * Denotes case not yet officially reported by telegram. Current Paralytic Cases* by Age Group Cases Associated Non-associated Age with Type III Feeding Cases 0-4 1 18 5-9 2 5 10-19 0 5 20-29 1 5 30-39 2 2 40+ 4 1 Unk. 5 41 Current Paralytic Cases* by State State Hassachusetts () 0 Connecticut 0 1 New York 1 4 Ohio (i)(l 2 Indiana o- 1 Illinois 0 1 Michigan 1 0 Missouri 0 2 Virginia 0 2 Hest Virginia 0 3 South Carolina 0 1 Georgia 0 1 Kentucky 0 1 Tennessee 0 1 Alabama 0 2 Mississippi 0 1 Louisiana 0 3 Washington 0 Oregon 0' 1 California 0 14 lo*:'; 41 * Paralytic cases with onset since April l, excluding Type I cases and those from Texas. ** Includes 3 cases not yet officially reported by telegram. l ~ . ~ _,_1 J rP~A fj~~Y7 CASE 10 - !'1AS~ACHUSETTS Contact Fed Virus Manufacturer and Age Race Sex IPV Onset Type III Interval Isolated Lot Number F 4 23 Lederle This mother of two, wife of an engineer, became ill on with a fever of 101° F.