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B
Pertussis and Rubella Vaccines: A Brief Chronology
PERTUSSIS VACCINES
1906
Jules Bordet and Octave Gengou of the Pasteur Institute of
Brussels are able to grow the pertussis bacterium in artificial
media. The bacterium, originally called Haemophilus
pertussis, is found to be sufficiently different from
Haemophilus to be classified as a new genus. It becomes known
as Bordetella pertussis in honor of Bordet. When the
description of the Bordet-Gengou technique is published, numerous
researchers begin to experiment with vaccines made from killed
whole-cell B. pertussis. In ensuing years, such vaccines are
developed, and used in children, by Bordet and Gengou in 1912,
Charles Nicolle of the Pasteur Institute in Tunis in 1913, and
Thorvald Madsen of the Danish State Serum Institute in Copenhagen
in 1914, among others (Chase, 1982).
1914
Pertussis vaccine is listed in the American Medical Association
publication New and Nonofficial Remedies (Council on
Pharmacy and Chemistry, 1914, 1931).
1925
Madsen is the first to describe the use of whole-cell pertussis
vaccine on a large scale (Madsen, 1925, 1933). Although his vaccine
successfully controls two outbreaks in the Faroe Islands,
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his 1933 account reports two deaths within 48 hours of
immunization, the first published report of serious adverse effects
after pertussis vaccination. In the same year, Louis Sauer of
Northwestern University Medical School, Chicago, describes minor
reactions to a whole-cell pertussis vaccine being used in the
United States (Sauer, 1933a,b).
1930s-1940s
Pearl Kendrick of the State of Michigan Health Department
further refines and uses whole-cell pertussis vaccines in children
(Kendrick, 1942, 1943; Kendrick and Eldering, 1936, 1939). In 1942,
she and colleagues combine her improved killed vaccine with
diphtheria and tetanus toxoids to produce the
diphtheria-tetanus-pertussis (DTP, also known as DPT) combination
vaccine. In 1944, the Committee on Infectious Diseases of the
American Academy of Pediatrics suggests routine use of pertussis
vaccine and, in 1947, recommends its use in the form of the DPT
combination (American Academy of Pediatrics, 1944; Cherry, 1984).
In the United States, vaccination of children against pertussis
becomes a routine procedure and is made compulsory in some
states.
1947-1948
The first published reports appear of irreversible brain damage
after whole-cell pertussis vaccine (Brody and Sorley, 1947; Byers
and Moll, 1948). Although the Brody and Sorley report describes one
case only, it leads to the first warnings that pertussis vaccine
should not be administered to those with a known neurologic
disorder.
1948
Approximately a dozen companies are manufacturing DPT vaccine
(Coulter and Fisher, 1985).
1959
The Parke-Davis Quadrigen vaccine (DPT combined with the Salk
polio vaccine) is licensed. The vaccine is alleged to be
particularly reactive because of the effect of the preservative on
the pertussis component. Several lawsuits ensue. The vaccine is
withdrawn from the market in 1968 (Coulter and Fisher, 1985).
1965
By the mid-1960s, many states have passed laws requiring that
all children be immunized with DPT vaccine prior to entering school
(Coulter and Fisher, 1985).
1974
In Great Britain, questions about the safety of whole-cell
pertussis vaccines are widely publicized in the popular press after
news-
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paper accounts of a study (Kulenkampff et al., 1974) suggesting
adverse reactions. The Association of Parents of Vaccine Damaged
Children is formed (Alderslade et al., 1981). Between 1974 and
1978, the proportion of children vaccinated against pertussis falls
from 80 to 30 percent (and as low as 9 percent in some areas)
(British Medical Journal, 1981).
1975
Japan temporarily stops using pertussis vaccine after publicity
about deaths following vaccination. Later in the year, pertussis
vaccination is reinstituted in children age 2 years and above. The
proportion of immunized children drops from 70 percent in 1974 to
20 to 40 percent in the following years. Reported cases of
pertussis increase from 393 with no deaths in 1974 to more than
13,000 with 41 deaths in 1979 (Coulter and Fisher, 1985).
1976
The government-funded National Childhood Encephalopathy Study
(NCES) begins in Great Britain, largely as a result of rising
public concern about the safety of pertussis vaccine. The study is
case-control in design and runs for 3 years (Alderslade et al.,
1981).
1977-1979
An epidemic of pertussis occurs in Great Britain. More
than 100,000 cases and 36 deaths are reported (Koplan and Hinman,
1987).
1978
In the United States, public health clinics using federally
purchased vaccines are required to have parents sign an ''important
information statement" before their child can be vaccinated
(Coulter and Fisher, 1985).
The Monitoring System for Illness Following Immunization (MSIFI)
is established by the Centers for Disease Control (CDC). The system
is an outgrowth of the monitoring of adverse events following the
swine flu vaccine incident.
1978-
Two lawsuits are filed in U.S. courts alleging that children
were harmed by pertussis vaccine (Koplan and Hinman, 1987).
1979
1979
Meetings are held at the Food and Drug Administration (FDA)
Bureau of Biologics and at the CDC to discuss reports of sudden
infant death syndrome (SIDS) in Tennessee following pertussis
vaccination. No evidence of a causal relationship is found. Wyeth
Laboratories, the manufacturer, withdraws the questioned vaccine
lot nonetheless (Coulter and Fisher, 1985).
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FDA funds a study to evaluate adverse reactions to DPT vaccines.
The study is to be carried out at the University of California, Los
Angeles (UCLA).
The Vaccine Damage Payment Act is passed in Great Britain. The
act provides a mechanism for government compensation to those with
vaccine-associated injuries (Griffith, 1989).
Sweden stops using whole-cell pertussis vaccine because of
reported reactions and a lack of vaccine efficacy. The number of
pertussis cases increases (Coulter and Fisher, 1985).
1981
The findings of the FDA-sponsored UCLA study are published (Cody
et al., 1981). The rate of minor reactions and serious short-term
reactions following DPT is found to be higher than that following
DT.
The British "Blue Book" (Department of Health and Social
Security, 1981) is published. It includes the findings of the
NCES (Alderslade et al., 1981) and reports from several panels. The
NCES concludes that both DPT and measles vaccines can cause acute
neurologic reactions and permanent brain damage but that the latter
is a very rare complication. The attributable risk (see Glossary of
Terms) of serious neurologic illness in the 7 days following
pertussis vaccination is estimated to be 1 in 110,000
immunizations, and that of persistent neurologic damage after 1
year is estimated to be 1 in 310,000 immunizations (with wide
confidence limits in both cases).
1982
The television program "DPT: Vaccine Roulette," first broadcast
by NBC affiliate WRC-TV in Washington, D.C., is widely publicized.
The program depicts children with severe injuries reported to be
associated with pertussis vaccine (Griffith, 1989; Koplan and
Hinman, 1987).
An advocacy group, Dissatisfied Parents Together, is formed in
the United States. Its members call for research toward a safer
pertussis vaccine and mandatory reporting of adverse reactions.
Some in the group call for a cessation of use of the whole-cell
vaccine (Coulter and Fisher, 1985; Koplan and Hinman, 1987).
The Senate Subcommittee on Investigations and General Oversight,
chaired by Senator Paula Hawkins, holds hearings "to examine
adverse drug reactions from immunization, federal efforts in
preventive medicine, and characteristics of certain diseases"
(Coulter and Fisher, 1985; Gonzalez, 1982).
The British Child Health and Education Study is published
(Butler et al., 1982). The study compares immunization rates,
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hospitalization rates, neurologic illness, and school
performance among a cohort of more than 13,000 children followed up
at age 5. Long-term neurologic problems are not found to be related
to pertussis immunizations.
1983
The Task Force Report on Pertussis is submitted to the U.S.
Senate Labor and Human Resources Committee by the U.S. Department
of Health and Human Services (DHHS). The committee holds hearings
on the report.
The American Academy of Pediatrics and Dissatisfied Parents
Together conduct more than 8 months of discussions to develop
recommendations for a federal compensation program for children
with vaccine-related illnesses and injuries (Coulter and Fisher,
1985). The National Childhood Vaccine Injury Compensation Act
(S-2117) is introduced in the U.S. Senate by Senators Paula Hawkins
and Orrin Hatch.
The Communicable Diseases Surveillance Centre Study, or North
West Thames Study, is published by Pollock and Morris (1983). The
study, which followed a large group of children after pertussis
vaccination, finds no convincing evidence relating DPT vaccine to
neurologic damage.
1984
Senate hearings are held by Senator Paula Hawkins on the
National Childhood Vaccine Injury Compensation Act.
Wyeth Laboratories discontinues its marketing of whole-cell
pertussis vaccine. Only two pharmaceutical companies in the United
States continue to sell pertussis vaccines.
The National Childhood Vaccine Injury Compensation Act is
introduced in the U.S. House of Representatives by Representative
Henry Waxman.
1985
A total of 219 lawsuits are filed in U.S. courts alleging harm
to a child from pertussis vaccine. The average amount of
compensation sought (when specified) is $26 million (Koplan and
Hinman, 1987).
The book DPT: A Shot in the Dark is published. Authors
Harris L. Coulter and Barbara Loe Fisher (a founder of Dissatisfied
Parents Together) describe numerous case histories of children
reportedly injured or killed by the DPT vaccine. The book
criticizes laws requiring vaccination, calls for further research
on and testing of acellular pertussis vaccines, and urges
additional research to identify children at particular risk of
reacting to vaccines.
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The Oversight and Investigations Subcommittee of the House
Committee on Energy and Commerce conducts hearings on vaccine
development as part of a series of hearings on biotechnology. Some
witnesses call for better coordination of vaccine activity at the
federal level.
1986
Public Law 99-660, the National Childhood Vaccine Injury Act, is
passed by the U.S. Congress. The law calls for the establishment of
the National Vaccine Program (NVP) ("to achieve optimal prevention
of human infectious diseases through immunization and to achieve
optimal prevention against adverse reactions to vaccines"); the
National Vaccine Advisory Committee (NVAC) to advise the director
of the NVP; the National Vaccine Injury Compensation Program (VICP)
to evaluate claims of injury from vaccines and provide compensation
where justified; and the Advisory Commission on Childhood Vaccines
(ACCV) to advise the Secretary of DHHS and the VICP on vaccine
policy. It also mandates a scientific review of possible adverse
effects of whole-cell pertussis vaccine by the Institute of
Medicine (IOM) of the National Academy of Sciences.
1987
The NVP, established under Public Law 99-660, begins operation.
The NVP Director is the Assistant Secretary for Health of DHHS.
The Study of Neurologic Illness in Children (SONIC) begins at
the University of Washington in Seattle. The CDC-sponsored study
includes the states of Washington and Oregon and consists of two
population-based case-control pilot studies to determine the risk
and frequency of serious acute neurologic illness and a sample
survey to estimate the number of doses of vaccine given during the
surveillance period.
1988
The NVAC, established under Public Law 99-660, is appointed in
April and meets for the first time in June. As specified in the
law, the IOM is consulted during the appointment process. The
committee reports to the Assistant Secretary for Health of DHHS and
is administered by staff of the NVP.
Two important legal cases are decided: the Loveday judgment in
Great Britain's High Court of Justice, Queen's Bench Division
(Stuart-Smith, 1988), and the Rothwell judgment in the Supreme
Court of Ontario, Canada (Osler, 1988). In both cases, the justices
rule that there is insufficient evidence to demonstrate that
pertussis vaccine can cause permanent brain damage
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in children. Both are considered as "test cases" in their
respective jurisdictions, meaning that other lawsuits claiming
permanent neurologic effects from pertussis vaccine are effectively
excluded.
1989
The ACCV, established under Public Law 99-660, is appointed
early in the year and meets for the first time in March. The
commission reports to the Secretary of DHHS and is administered by
staff of the Health Resources and Services Administration,
DHHS.
The VICP begins operation. It is administered by the Secretary
of DHHS through the staff of the Health Resources and Services
Administration. By the end of the year, it has received 201
petitions for compensation, of which 165 are related to DPT
vaccine.
The National Vaccine Information Center sponsors a workshop on
the neurologic complications of pertussis and pertussis vaccination
(Menkes and Kinsbourne, 1990).
The IOM holds a CDC-sponsored workshop on the National Childhood
Encephalopathy Study (Marcuse and Wentz, 1990).
1990
The IOM Committee to Review the Adverse Consequences of
Pertussis and Rubella Vaccines is appointed in December 1989 and
meets for the first time in January 1990. In the same month, the
committee sponsors a public meeting in Washington, D.C., to solicit
medical and other scientific data and comments on the nature,
frequency, and circumstances of adverse events following pertussis
and rubella vaccines. In May, it sponsors a workshop, Possible
Adverse Consequences of Pertussis and Rubella Vaccines. The IOM
study, mandated by Public Law 99-660, is sponsored by a consortium
of federal agencies through the National Institute of Allergy and
Infectious Diseases.
The Sixth International Symposium on Pertussis is held in
Bethesda, Maryland (Manclark, 1990a,b).
RUBELLA VACCINES
1914
A. F. Hess suggests that rubella is caused by a filtrable virus
(Chase, 1982).
1938
Y. Hiro and S. Tasaka succeed in transmitting rubella by
inoculating healthy nonimmune children with filtrates taken from
children
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with active cases of rubella. The causative agent remains
unidentified (Chase, 1982).
1941
Norman McAlister Gregg, an Australian ophthalmologist, notes
after a rubella epidemic that women who have had rubella during
pregnancy seem unusually likely to give birth to children with
cataracts and other birth defects (Gregg, 1941). He finds
confirmation of his observations in a survey of other physicians in
Australia. The defects described include cataracts, deafness,
congenital heart disease, microcephaly, cerebral palsy, and mental
retardation. Similar reports from other countries ensue. World War
II interferes with research to follow up on these observations
(Chase, 1982). Studies of Australian census and disease records
later suggest that congenital damage from rubella during pregnancy
had occurred for at least 40 years before being recognized (Burnet
and White, 1972).
1948
Macfarlane Burnet and colleagues use gamma globulin from
patients with rubella to confer short-term passive immunity on
pregnant women recently exposed to rubella (Chase, 1982). The
practice becomes common in a number of industrialized
countries.
1960-1961
The rubella virus is isolated by Thomas Weller at the Harvard
School of Public Health and, independently, byPaul Parkman and
colleagues at the Walter Reed Army Institute of Research (Chase,
1982).
1963-1964
One of the worst rubella outbreaks in U.S. history occurs.
Rubella is not, at that time, a notifiable disease, so it is not
known with certainty how many people contract the disease or how
many children suffer congenital or developmental damage caused by
prenatal infection. It is estimated that 20,000 children suffer
prenatal damage caused by rubella infections during the epidemic
and that the cost of their rehabilitation 5 years after the
epidemic ends is $1.5 billion to $2 billion in 1969 U.S. dollars.
The epidemic and its aftermath lend impetus to the search for a
rubella vaccine and are instrumental in the initial approval of
Title XIX (the Medicaid provisions) of the Social Security Act of
1965 and in subsequent amendments to Title XIX, the Early and
Periodic Screening, Diagnosis, and Treatment program. The latter
make comprehensive pediatric care, including necessary
vaccinations, the "mandated birthright" of every child regardless
of ability to pay (Chase, 1982).
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1965-1967
Several vaccines made from attenuated rubella strains are
developed and tested in clinical trials (Plotkin, 1988).
1969-1970
Three rubella vaccines are licensed in the United States: HPV-77
(grown in dog kidney), HPV-77 (grown in duck embryo), and Cendehill
(grown in rabbit kidney). Many states add rubella vaccines to the
list of immunizations required for school entry. RA 27/3, a human
diploid fibroblast vaccine developed in the United States, is
licensed in several European countries (Plotkin, 1988).
1969-1976
Reports of possible serious adverse events following rubella
vaccination begin to be published. Two types of events are
reported: neuropathies (Gilmartin et al., 1972; Grand et al., 1972;
Kilroy et al., 1970; Schaffner et al., 1974) and acute and chronic
arthralgia and arthritis (American Journal of Diseases of Children,
1969; Barnes et al., 1972; Fox et al., 1976; Freestone et al.,
1971; Horstmann et al., 1970; Lerman et al., 1971; Rowlands and
Freestone, 1971; Spruance and Smith, 1971; Spruance et al., 1972;
Swartz et al., 1971; Weibel et al., 1972). Because the HPV-77 dog
kidney vaccine appears to be associated with a higher proportion of
such adverse events, that vaccine is withdrawn from the market in
the United States and other countries.
1979
The human diploid cell culture, RA 27/3, is licensed in the
United States. The last U.S. manufacturer of the HPV-77 duck embryo
vaccine replaces it with RA 27/3, which becomes the only rubella
vaccine available in the United States (Plotkin, 1988).
1979-1980s
Systematic investigations are undertaken of the possible
association between rubella vaccines and chronic arthritis or
arthropathies, leading to an increased level of concern on the part
of some investigators and others (Cunningham and Fraser, 1985;
Tingle et al., 1979, 1983, 1985, 1986, 1989).
1986
Public Law 99-660, the National Childhood Vaccine Injury Act, is
passed by the U.S. Congress (see description above in the section
on pertussis vaccines). The law mandates a scientific review of
possible adverse effects of rubella vaccines by the IOM of the
National Academy of Sciences.
1987
The NVP begins operation. The NVP Director is the Assistant
Secretary for Health for DHHS.
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1988
The NVAC meets for the first time in June. The committee
reports to the Assistant Secretary for Health of DHHS and is
administered by staff of the NVP.
1989
The Advisory Commission on Childhood Vaccines meets for the
first time in March. The commission reports to the Secretary of
DHHS and is administered by staff of the Health Resources and
Services Administration, DHHS.
The National Vaccine Injury Compensation Program begins
operation. It is administered by the Secretary of DHHS through the
staff of the Health Resources and Services Administration, DHHS. By
the end of the year, it has received 201 petitions for
compensation, of which 11 are related to measles-mumps-rubella
vaccine.
1990
The IOM Committee to Review the Adverse Consequences of
Pertussis and Rubella Vaccines meets for the first time in January.
In the same month, the committee sponsors a public meeting in
Washington, D.C., to solicit medical and other scientific data and
comments on the nature, frequency, and circumstances of adverse
events following pertussis and rubella vaccines. In May, it
sponsors a workshop on Possible Adverse Consequences of Pertussis
and Rubella Vaccines.
The ABC News program "20/20" presents a report entitled "Why Am
I So Sick?," detailing the chronic and disabling symptoms reported
by some women after rubella immunization.
A randomized, double-blind, placebo-controlled trial of rubella
vaccine and chronic arthritis begins in Vancouver, British
Columbia, Canada.
1991
As of April, the CDC is considering issuing a request for
proposals for a study of chronic arthritis following rubella
vaccination that would include laboratory studies of
participants.
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Representative terms from entire chapter:
rubella vaccine