1949-53 Adelaide outbreak: Difference between revisions

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From 1949 to 1953 in '''Adelaide, Australia,''' there was an [[Epidemic myalgic encephalomyelitis|outbreak]] of a disease resembling [[poliomyelitis]], during and after a poliomyelitis epidemic. In August of 1949, cases of [[myalgic encephalomyelitis]] began to appear and continued to be seen until 1951, by which time 800 patients had been admitted to Northfield Infectious Diseases Hospital.  |title= |title=Patients has slight, diffuse muscle weakness mainly affecting the legs, In some, weakness appeared for the first time up to three months after the onset of the initial symptoms.<ref name=":0">{{Cite journal|last=Parish|first=JG| |date=1978| |title=Early outbreaks of 'epidemic neuromyasthenia'|url=https://www.ncbi.nlm.nih.gov/pubmed/370810|journal=Postgraduate Medical Journal|volume=54|pages=711-7|via=}}</ref> Dr. R.A. Pellew, of Adelaide, believed that most of the 3,130 polio cases during this period suffered from a mild form of polio (i.e., [[abortive poliomyelitis]], [[atypical poliomyelitis]]).<ref>[http://trove.nla.gov.au/newspaper/article/47377426? "Conference on Polio"] "The Advertiser'', Adelaide Australia, 01 February 1952''</ref> |title= |title=== Onset == |title=Onset was either gradual or sudden, often in the form of an upper respiratory tract infection and/or gastrointestinal distress with low-grade fever. Sudden onset was often accompanied by severe headache.<ref name=":12">Dr R.A. Pellew, [http://www.cabdirect.org/abstracts/19522700678.html;jsessionid=AA4534CA199AC800732B3877608F5CE0 "A Clinical Description of a Disease resembling Poliomyelitis, seen in Adelaide, 1949-1951"] ''Medical Journal of Australia'', Medical Journal of Australia 1951, June 30 Vol. 1 No. 26 pp. 944-6</ref> Pellew describes the initial symptoms as indistinguishable from poliomyelitis: "bursting [[headache]], stiff back, stiff neck, aching limbs, pain behind the eyes, [[upper respiratory tract infection]], mild [[muscle weakness]], and a fever followed by [[lysis]] over a period of three days."<ref name=":2">{{Cite journal|last=Pellew|first=R.A.A.| |date=September 24, 1955| |title=Further Investigations on a Disease Resembling Poliomyelitis Seen in Adelaide|url=https://www.ncbi.nlm.nih.gov/pubmed/13272481|journal=The Medical Journal of Australia|volume=2|pages=480-2|via=}}</ref> |title= |title=Also noted was a rise in temperature between the seventh and tenth days, with a recurrence of symptoms.<ref name=":2" /> |title= |title=== Symptoms == |title= |title=* [[headache]] |title=* muscle weakness |title=* cognitive dysfunction (lack of concentration, depression, irritability, emotional instability)<ref name=":2" /> |title=* sound sensitivity |title=* pain behind the eyes<ref name=":12" /> |title=* hyperaesthesia |title= |title="Muscle weakness - generally slight and diffuse in distribution - occurred more commonly in the legs than in the arms. Where paralysis was severe, rapid recovery generally ensued. Two noteworthy features of the muscle involvement in this disease were as follows: the pain frequently persisted in various muscles for periods up to six months after the acute illness; in some cases the onset of muscle weakness was delayed for several months.<ref name=":1">Dr R.A. Pellew, [http://www.cabdirect.org/abstracts/19522700678.html;jsessionid=AA4534CA199AC800732B3877608F5CE0 "A Clinical Description of a Disease resembling Poliomyelitis, seen in Adelaide, 1949-1951"] ''Medical Journal of Australia'', Medical Journal of Australia 1951, June 30 Vol. 1 No. 26 pp. 944-6</ref>  |title= |title=== Findings == |title=As with other epidemics, no virus was isolated and there was an absence of abnormal findings in [[cerebrospinal fluid]]<ref name=":12" /> However, there were some interesting finding in animal studies.  |title= |title=Pellew collected throat washings, feces, and cerebrospinal fluid from a subset of patients and inoculated rhesus monkeys, mice, and hen eggs. Several monkeys displayed sluggishness and subnormal body temperature. One died. On autopsy, two monkeys showed red spots along the sciatic nerves and microscopic damage:<blockquote>"There were lesions in the nerve roots and in the sciatic nerves. In the nerve roots close to their point of exit from the spinal canal there was pronounced infiltration with lymphocytes and mononuclear cells, and in a percentage of the nerve fibres were found vacuoles in the myelin sheaths and axon swellings. In the sciatic nerves there were small localized infiltrations with inflammatory cells associated with exudation of a few red blood corpuscles. The only abnormality in the skeletal muscle was the presence of sarcoporidiosis in all sections from one animal; but examination of the heart muscle of the monkey which had died showed severe myocarditis with widepread infiltration mainly with lymphocytes and mononuclear cells."<ref name=":2" /></blockquote> |title= |title=== Epidemiology == |title= |title=The male : female ratio was 1: 1.<ref name=":0" />  |title={| class="wikitable" |title=|+'''Age distribution in the Adelaide outbreak'''<ref name=":12" /> |title=!Age set |title=!Percentage |title=|- |title=|< 5 |title=|15% |title=|- |title=|5-9 |title=|20% |title=|- |title=|10-15 |title=|10% |title=|- |title=|15-20 |title=|10% |title=|- |title=|20-25 |title=|10% |title=|- |title=|25-30 |title=|10% |title=|- |title=|30-65 |title=|25% |title=|- |title=|> 65 |title=|none |title=|} |title=During the Adelaide outbreak of atypical polio, while the number of reported polio cases increased in New South Wales and Queensland, and remained constant in the rest of Australia, there was a 43% reduction in typical polio cases in South Australia (where Adelaide is located).<ref>[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2542300/ "Poliomyelitis in 1953"] ''Bulletin of the World Health Organization.'' 1955;12(4):595-649.</ref> This may have be indirect evidence of [[Poliovirus#Cross-immunity|cross-immunity]], that is, partial immunity to poliovirus acquired via exposure to a related [[enterovirus]].  |title= |title=A similar phenomenon was observed in Iceland, when children from an area that had recently had an outbreak of [[epidemic myalgic encephalomyelitis]] had a stronger response to [[poliovirus]] vaccination, with higher antibody titers.<ref name=":0" /><ref>{{Cite journal|url=https://www.ncbi.nlm.nih.gov/pubmed/13515219| |title=Response to poliomyelitis vaccination|last=Sigurdsson|first=B|author-link=Björn Sigurdsson| |date=February 15, 1958|journal=The Lancet|volume=1|pages=370-1|via=}}</ref> Conversely, in a study of children exposed to live and inactive poliovirus vaccines in Estonia and Finland,<ref>{{Cite journal|last=Juhela|first=S| |date=July 1999| |title=Comparison of enterovirus-specific cellular immunity in two populations of young children vaccinated with inactivated or live poliovirus vaccines|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1905481/|journal=Clinical & Experimental Immunology|volume=117|pages=100–105|via=}}</ref> where those who has been exposed to the live polio vaccine had a stronger antibody response to [[Coxsackievirus B4]]. |title= |title=== Prognosis == |title= |title=Pellew followed up with five cases, three years after onset.  |title= |title=== See also == |title= |title=*[[Epidemic myalgic encephalomyelitis]] |title=*[[List of myalgic encephalomyelitis and chronic fatigue syndrome outbreaks]] |title= |title=== References == |title={{Reflist}} |title=[[Category:History]] |title=[[Category:Outbreaks]] |title=[[Category:Outbreaks in the 1940s]] |title=[[Category:Outbreaks in the 1950s]] |title=[[Category:Outbreaks in Australia]]
From 1949 to 1953 in '''Adelaide, Australia,''' there was an [[Epidemic myalgic encephalomyelitis|outbreak]] of a disease resembling [[poliomyelitis]], during and after a poliomyelitis epidemic. In August of 1949, cases of [[myalgic encephalomyelitis]] began to appear and continued to be seen until 1951, by which time 800 patients had been admitted to Northfield Infectious Diseases Hospital.  |title= |title=Patients has slight, diffuse muscle weakness mainly affecting the legs, In some, weakness appeared for the first time up to three months after the onset of the initial symptoms.<ref name=":0">{{Cite journal|last=Parish|first=JG|date=1978| |title=Early outbreaks of 'epidemic neuromyasthenia'|url=https://www.ncbi.nlm.nih.gov/pubmed/370810|journal=Postgraduate Medical Journal|volume=54|pages=711-7|via=}}</ref> Dr. R.A. Pellew, of Adelaide, believed that most of the 3,130 polio cases during this period suffered from a mild form of polio (i.e., [[abortive poliomyelitis]], [[atypical poliomyelitis]]).<ref>[http://trove.nla.gov.au/newspaper/article/47377426? "Conference on Polio"] "The Advertiser'', Adelaide Australia, 01 February 1952''</ref> |title= |title=== Onset == |title=Onset was either gradual or sudden, often in the form of an upper respiratory tract infection and/or gastrointestinal distress with low-grade fever. Sudden onset was often accompanied by severe headache.<ref name=":12">Dr R.A. Pellew, [http://www.cabdirect.org/abstracts/19522700678.html;jsessionid=AA4534CA199AC800732B3877608F5CE0 "A Clinical Description of a Disease resembling Poliomyelitis, seen in Adelaide, 1949-1951"] ''Medical Journal of Australia'', Medical Journal of Australia 1951, June 30 Vol. 1 No. 26 pp. 944-6</ref> Pellew describes the initial symptoms as indistinguishable from poliomyelitis: "bursting [[headache]], stiff back, stiff neck, aching limbs, pain behind the eyes, [[upper respiratory tract infection]], mild [[muscle weakness]], and a fever followed by [[lysis]] over a period of three days."<ref name=":2">{{Cite journal|last=Pellew|first=R.A.A.|date=September 24, 1955| |title=Further Investigations on a Disease Resembling Poliomyelitis Seen in Adelaide|url=https://www.ncbi.nlm.nih.gov/pubmed/13272481|journal=The Medical Journal of Australia|volume=2|pages=480-2|via=}}</ref> |title= |title=Also noted was a rise in temperature between the seventh and tenth days, with a recurrence of symptoms.<ref name=":2" /> |title= |title=== Symptoms == |title= |title=* [[headache]] |title=* muscle weakness |title=* cognitive dysfunction (lack of concentration, depression, irritability, emotional instability)<ref name=":2" /> |title=* sound sensitivity |title=* pain behind the eyes<ref name=":12" /> |title=* hyperaesthesia |title= |title="Muscle weakness - generally slight and diffuse in distribution - occurred more commonly in the legs than in the arms. Where paralysis was severe, rapid recovery generally ensued. Two noteworthy features of the muscle involvement in this disease were as follows: the pain frequently persisted in various muscles for periods up to six months after the acute illness; in some cases the onset of muscle weakness was delayed for several months.<ref name=":1">Dr R.A. Pellew, [http://www.cabdirect.org/abstracts/19522700678.html;jsessionid=AA4534CA199AC800732B3877608F5CE0 "A Clinical Description of a Disease resembling Poliomyelitis, seen in Adelaide, 1949-1951"] ''Medical Journal of Australia'', Medical Journal of Australia 1951, June 30 Vol. 1 No. 26 pp. 944-6</ref>  |title= |title=== Findings == |title=As with other epidemics, no virus was isolated and there was an absence of abnormal findings in [[cerebrospinal fluid]]<ref name=":12" /> However, there were some interesting finding in animal studies.  |title= |title=Pellew collected throat washings, feces, and cerebrospinal fluid from a subset of patients and inoculated rhesus monkeys, mice, and hen eggs. Several monkeys displayed sluggishness and subnormal body temperature. One died. On autopsy, two monkeys showed red spots along the sciatic nerves and microscopic damage:<blockquote>"There were lesions in the nerve roots and in the sciatic nerves. In the nerve roots close to their point of exit from the spinal canal there was pronounced infiltration with lymphocytes and mononuclear cells, and in a percentage of the nerve fibres were found vacuoles in the myelin sheaths and axon swellings. In the sciatic nerves there were small localized infiltrations with inflammatory cells associated with exudation of a few red blood corpuscles. The only abnormality in the skeletal muscle was the presence of sarcoporidiosis in all sections from one animal; but examination of the heart muscle of the monkey which had died showed severe myocarditis with widepread infiltration mainly with lymphocytes and mononuclear cells."<ref name=":2" /></blockquote> |title= |title=== Epidemiology == |title= |title=The male : female ratio was 1: 1.<ref name=":0" />  |title={| class="wikitable" |title=|+'''Age distribution in the Adelaide outbreak'''<ref name=":12" /> |title=!Age set |title=!Percentage |title=|- |title=|< 5 |title=|15% |title=|- |title=|5-9 |title=|20% |title=|- |title=|10-15 |title=|10% |title=|- |title=|15-20 |title=|10% |title=|- |title=|20-25 |title=|10% |title=|- |title=|25-30 |title=|10% |title=|- |title=|30-65 |title=|25% |title=|- |title=|> 65 |title=|none |title=|} |title=During the Adelaide outbreak of atypical polio, while the number of reported polio cases increased in New South Wales and Queensland, and remained constant in the rest of Australia, there was a 43% reduction in typical polio cases in South Australia (where Adelaide is located).<ref>[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2542300/ "Poliomyelitis in 1953"] ''Bulletin of the World Health Organization.'' 1955;12(4):595-649.</ref> This may have be indirect evidence of [[Poliovirus#Cross-immunity|cross-immunity]], that is, partial immunity to poliovirus acquired via exposure to a related [[enterovirus]].  |title= |title=A similar phenomenon was observed in Iceland, when children from an area that had recently had an outbreak of [[epidemic myalgic encephalomyelitis]] had a stronger response to [[poliovirus]] vaccination, with higher antibody titers.<ref name=":0" /><ref>{{Cite journal|url=https://www.ncbi.nlm.nih.gov/pubmed/13515219| |title=Response to poliomyelitis vaccination|last=Sigurdsson|first=B|author-link=Björn Sigurdsson|date=February 15, 1958|journal=The Lancet|volume=1|pages=370-1|via=}}</ref> Conversely, in a study of children exposed to live and inactive poliovirus vaccines in Estonia and Finland,<ref>{{Cite journal|last=Juhela|first=S|date=July 1999| |title=Comparison of enterovirus-specific cellular immunity in two populations of young children vaccinated with inactivated or live poliovirus vaccines|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1905481/|journal=Clinical & Experimental Immunology|volume=117|pages=100–105|via=}}</ref> where those who has been exposed to the live polio vaccine had a stronger antibody response to [[Coxsackievirus B4]]. |title= |title=== Prognosis == |title= |title=Pellew followed up with five cases, three years after onset.  |title= |title=== See also == |title= |title=*[[Epidemic myalgic encephalomyelitis]] |title=*[[List of myalgic encephalomyelitis and chronic fatigue syndrome outbreaks]] |title= |title=== References == |title={{Reflist}} |title=[[Category:History]] |title=[[Category:Outbreaks]] |title=[[Category:Outbreaks in the 1940s]] |title=[[Category:Outbreaks in the 1950s]] |title=[[Category:Outbreaks in Australia]]

Revision as of 11:40, May 11, 2022

From 1949 to 1953 in Adelaide, Australia, there was an outbreak of a disease resembling poliomyelitis, during and after a poliomyelitis epidemic. In August of 1949, cases of myalgic encephalomyelitis began to appear and continued to be seen until 1951, by which time 800 patients had been admitted to Northfield Infectious Diseases Hospital. |title= |title=Patients has slight, diffuse muscle weakness mainly affecting the legs, In some, weakness appeared for the first time up to three months after the onset of the initial symptoms.[1] Dr. R.A. Pellew, of Adelaide, believed that most of the 3,130 polio cases during this period suffered from a mild form of polio (i.e., abortive poliomyelitis, atypical poliomyelitis).[2] |title= |title=== Onset == |title=Onset was either gradual or sudden, often in the form of an upper respiratory tract infection and/or gastrointestinal distress with low-grade fever. Sudden onset was often accompanied by severe headache.[3] Pellew describes the initial symptoms as indistinguishable from poliomyelitis: "bursting headache, stiff back, stiff neck, aching limbs, pain behind the eyes, upper respiratory tract infection, mild muscle weakness, and a fever followed by lysis over a period of three days."[4] |title= |title=Also noted was a rise in temperature between the seventh and tenth days, with a recurrence of symptoms.[4] |title= |title=== Symptoms == |title= |title=* headache |title=* muscle weakness |title=* cognitive dysfunction (lack of concentration, depression, irritability, emotional instability)[4] |title=* sound sensitivity |title=* pain behind the eyes[3] |title=* hyperaesthesia |title= |title="Muscle weakness - generally slight and diffuse in distribution - occurred more commonly in the legs than in the arms. Where paralysis was severe, rapid recovery generally ensued. Two noteworthy features of the muscle involvement in this disease were as follows: the pain frequently persisted in various muscles for periods up to six months after the acute illness; in some cases the onset of muscle weakness was delayed for several months.[5] |title= |title=== Findings == |title=As with other epidemics, no virus was isolated and there was an absence of abnormal findings in cerebrospinal fluid[3] However, there were some interesting finding in animal studies. |title= |title=Pellew collected throat washings, feces, and cerebrospinal fluid from a subset of patients and inoculated rhesus monkeys, mice, and hen eggs. Several monkeys displayed sluggishness and subnormal body temperature. One died. On autopsy, two monkeys showed red spots along the sciatic nerves and microscopic damage:

"There were lesions in the nerve roots and in the sciatic nerves. In the nerve roots close to their point of exit from the spinal canal there was pronounced infiltration with lymphocytes and mononuclear cells, and in a percentage of the nerve fibres were found vacuoles in the myelin sheaths and axon swellings. In the sciatic nerves there were small localized infiltrations with inflammatory cells associated with exudation of a few red blood corpuscles. The only abnormality in the skeletal muscle was the presence of sarcoporidiosis in all sections from one animal; but examination of the heart muscle of the monkey which had died showed severe myocarditis with widepread infiltration mainly with lymphocytes and mononuclear cells."[4]

|title= |title=== Epidemiology == |title= |title=The male : female ratio was 1: 1.[1] |title={| class="wikitable" |title=|+Age distribution in the Adelaide outbreak[3] |title=!Age set |title=!Percentage |title=|- |title=|< 5 |title=|15% |title=|- |title=|5-9 |title=|20% |title=|- |title=|10-15 |title=|10% |title=|- |title=|15-20 |title=|10% |title=|- |title=|20-25 |title=|10% |title=|- |title=|25-30 |title=|10% |title=|- |title=|30-65 |title=|25% |title=|- |title=|> 65 |title=|none |title=|} |title=During the Adelaide outbreak of atypical polio, while the number of reported polio cases increased in New South Wales and Queensland, and remained constant in the rest of Australia, there was a 43% reduction in typical polio cases in South Australia (where Adelaide is located).[6] This may have be indirect evidence of cross-immunity, that is, partial immunity to poliovirus acquired via exposure to a related enterovirus. |title= |title=A similar phenomenon was observed in Iceland, when children from an area that had recently had an outbreak of epidemic myalgic encephalomyelitis had a stronger response to poliovirus vaccination, with higher antibody titers.[1][7] Conversely, in a study of children exposed to live and inactive poliovirus vaccines in Estonia and Finland,[8] where those who has been exposed to the live polio vaccine had a stronger antibody response to Coxsackievirus B4. |title= |title=== Prognosis == |title= |title=Pellew followed up with five cases, three years after onset. |title= |title=== See also == |title= |title=*Epidemic myalgic encephalomyelitis |title=*List of myalgic encephalomyelitis and chronic fatigue syndrome outbreaks |title= |title=== References == |title=

  1. 1.0 1.1 1.2 Parish, JG (1978). "Early outbreaks of 'epidemic neuromyasthenia'". Postgraduate Medical Journal. 54: 711–7. Cite has empty unknown parameter: |1= (help)
  2. "Conference on Polio" "The Advertiser, Adelaide Australia, 01 February 1952
  3. 3.0 3.1 3.2 3.3 Dr R.A. Pellew, "A Clinical Description of a Disease resembling Poliomyelitis, seen in Adelaide, 1949-1951" Medical Journal of Australia, Medical Journal of Australia 1951, June 30 Vol. 1 No. 26 pp. 944-6
  4. 4.0 4.1 4.2 4.3 Pellew, R.A.A. (September 24, 1955). "Further Investigations on a Disease Resembling Poliomyelitis Seen in Adelaide". The Medical Journal of Australia. 2: 480–2. Cite has empty unknown parameter: |1= (help)
  5. Dr R.A. Pellew, "A Clinical Description of a Disease resembling Poliomyelitis, seen in Adelaide, 1949-1951" Medical Journal of Australia, Medical Journal of Australia 1951, June 30 Vol. 1 No. 26 pp. 944-6
  6. "Poliomyelitis in 1953" Bulletin of the World Health Organization. 1955;12(4):595-649.
  7. Sigurdsson, B (February 15, 1958). "Response to poliomyelitis vaccination". The Lancet. 1: 370–1. Cite has empty unknown parameter: |1= (help)
  8. Juhela, S (July 1999). "Comparison of enterovirus-specific cellular immunity in two populations of young children vaccinated with inactivated or live poliovirus vaccines". Clinical & Experimental Immunology. 117: 100–105. Cite has empty unknown parameter: |1= (help)

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