Epidemiology in Military and Veteran Populations Proceedings of the Second Biennial Conference, March 7, 1990 (1991) / Chapter Skim
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Yellow Fever Vaccine-Associated Hepatitis Epidemic During World War II: Follow-up More than 40 Years Later
Yellow Fever Vaccine-Associated Hepatitis Epidemic During World War II: Follow-up More than 40 Years Later
Pages 9-18
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From page 9... ...
In contrast, in areas of the world nonendemic for HBV, such as the United States, HBV infection occurs predominantly in late adolescence or early adulthood, the carrier state is low, and HCC is an uncommon form of cancer (1~. Limited data from such areas have suggested that advancement from acute to chronic hepatitis occurs in 5-10% of acutely infected persons (5, 6~.
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From page 10... ...
The first consideration was to define the responsible virus by serologic means; the second was to establish a link between receipt of the contaminated vaccine and the occurrence of cirrhosis and HCC by means of a cohort mortality study, comparing the rates of these endpoints among the selected cohorts; and the third was to conduct a case-control study, comparing the frequency of receipt of the implicated vaccines among World War II veterans who had died from HCC with the frequency of their receipt among those who had
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From page 11... ...
The following three cohorts were chosen for serologic and mortality study: Group I were patients who had received the plasma-containing yellow fever vaccine and had been hospitalized with jaundice in 1942; this ~symptomatic" group were derived from the microfilmed file of 31,500 military personnel who had been questioned during 1942-1943 in regard to their hospitalization for jaundice. Group II individuals had been vaccinated with one of the seven most Infectious lots, but had not developed jaundice or been hospitalized, thus being acceptably referred to as the Symptomatic" group; their names came from the payroll rosters of enlisted men in units who had received the contaminated vaccine matched against the file of patients from those units hospitalized for jaundice.
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From page 12... ...
levels as a marker of incipient HCC. For the cohort mortality segment of the study, mortality status was established by examining the Veterans Administration Beneficiary Identification and Records Locator System, which has recorded over 90% of deaths of World War II veterans.
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From page 13... ...
Deaths from liver diseases of other types, in particular viral hepatitis and nonalcoholic chronic liver disease, showed no significant differences.
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From page 14... ...
First is the evidence that this dramatic hepatitis B epidemic did not appear to be associated with the expected HBV carrier rate. It had been anticipated that approximately 10% of acutely infected persons would become carriers, especially if they had had subclinical infection (5, 6~.
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From page 15... ...
Data from highly endemic areas where perinatal transmission is the predominant mode of virus propagation indicate that there is a strong inverse relationship between the age of the primary infection and the likelihood of becoming a carrier, the rate declining dramatically with advancing age (17-19~. The outbreak under discussion involved young, generally healthy white males, permitting the conclusion that this population group uncommonly become carriers following acute HBV infection.
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From page 16... ...
10. Alward WLM, McMahon BJ, Hall DB, e al: The long-term serologic course of asymptomatic hepatitis B virus carriers and the development of prima~y hepatocellular carcinoma.
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From page 17... ...
20. Davis GL, Hoofnagle JH: Reactivation of chronic type B hepatitis presenting as acute viral hepatitis.
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