Studies on Epidemic Influenza: Comprising Clinical and Laboratory InvestigationsUniversity of Pittsburgh. School of Medicine
History
Studies on Epidemic Influenza: Comprising Clinical and Laboratory Investigations
University of Pittsburgh. School of Medicine
Influenza; Influenza Epidemic, 1918-1919
How much Pittsburgh will learn from the experience with vaccines will
depend on the numerous analyses of data which were acquired during the
epidemic.
_Data on the Prophylactic Value of Mixed Vaccines_
Proof of the prophylactic value of mixed vaccines for epidemic influenza
depends entirely upon the results of its practical application to human
subjects in times when the disease is prevalent. Animal determinations
are out of the question, because it has not been possible to produce the
epidemic form of influenza experimentally. If all people were equally
susceptible and were equally exposed, it would be a simple matter to
compare the number of vaccinated persons who developed the disease with
the number of unvaccinated persons who contracted it; but since many
thousands were vaccinated and some of them contracted the disease in
spite of it, and a greater number of persons who were not vaccinated
entirely escaped, the analysis is extremely difficult.
The time element is a big factor. In instances where vaccination was
completed in a community before the epidemic appeared there, the figures
are worth more than those in which vaccination was undertaken after the
epidemic had become established. This is true, because the most
susceptible persons in a community developed the disease as soon as they
were exposed, the less susceptible ones were not attacked until later,
and the insusceptible ones escaped altogether. Whenever vaccination is
begun during an epidemic, the persons vaccinated for prophylactic
purposes are necessarily chosen from those who have not yet developed an
attack. The later in the epidemic that vaccination is begun, the greater
will be the number of persons selected for vaccination from among those
more or less naturally immune. Then, if the total number of cases among
the vaccinated is compared with the total number of cases among the
unvaccinated, the apparent value of the vaccine is increased; but the
estimation is not a fair one, because the vaccinated group is
unavoidably selected from among relatively immune persons, while the
controls include all of the very susceptible people who were suffering
from the disease at the time vaccination was begun. Where vaccination is
begun after the epidemic is advanced, the only figures worth while are
those obtained by a day-by-day or a week-by-week comparison between the
number of cases developing among controls and the number of cases
appearing among those vaccinated, and by beginning that comparison at a
time subsequent to the day on which the prophylactic inoculations were
completed.
Aside from the interpretation of the results there is possibly a more
serious reason for objecting to the beginning of vaccination during an
epidemic. This lies in the danger of producing a temporary negative
phase in the patient, which makes him somewhat more susceptible to
natural infection for a few hours immediately following each
administration.
Public-domain text, read in full here on John Shaqi.
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