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All occupants of the house were informed of the situation and were offered and
accepted oral poliomyelitis vaccine which was given after faecal specimens had
been collected from every occupant and sent for laboratory investigation to the
Public Health Laboratory Service, Colindale.
Preliminary results on two faecal specimens from the patient identified Polio
virus type II supporting the provisional diagnoses of a Sabin-associated case of
poliomyelitis.
Marker tests, although not wholly reliable, were being proceeded with and were
later notified as confirming vaccine strain of virus. At this stage a specimen of
stool from one of the infants on the ground floor was also reported as positive for
poliomyelitis virus type II. This child had not previously been immunised, was
said to have no contact with the patient or her family or with any other children
who had been recently immunised by oral poliomyelitis vaccine.
Further investigation showed that this child was, in fact, being cared for
regularly by an unregistered child minder (who subsequently became registered).
With some difficulty the name and address was obtained and, again with difficulty,
the names and addresses of other children being "minded" were obtained. Some
of these children had recently been given oral poliomyelitis vaccine and could have
been the source of this positive stool. All were observed and vaccine courses
completed. Shortly afterwards the patient's husband and his two children left their
lodgings and it was only possible through the hospital medical social worker to
find his new address, which happened to be in another borough, to arrange
follow up.
No further cases occurred, and the child with the positive stool remained well.
The patient was eventually discharged from hospital wearing calipers, with aids
provided in the home, and home help.
Various other social factors of interest arose during the investigation of this case.
Both the patient and her husband were illiterate. They were not on the housing
list because they were unable to complete the appropriate forms and did not
reveal their difficulties and so obtain the assistance that was available. Once forms
were completed housing was made available on overriding medical grounds but
the accommodation provided by a housing aid society was preferred.
The landlord and his family had spent some time in Germany, prior to arrival
in this country, after leaving their country of origin. The other tenant of the ground
floor (related to the landlord) had one child who had arrived from his former home
(where polio is not uncommon) within the previous three months. Records of
immunisation for this group of twelve people were not complete. However, records
of immunisation against poliomyelitis-in this country were available for four of
the children and a further two were said to have been immunised in Germany.
During the period of observation a further young couple was found to be
occupying one of the formerly empty rooms on the first floor. In spite of difficulties
this couple were interviewed. After the situation had been explained, they were
offered, and accepted, oral vaccine, but they left the area with no forwarding address
shortly afterwards. Neither thought they had been previously immunised. At the
time this case occurred legal steps were being taken to gain entry as the house was
known to be in "multiple occupation" and entry had been refused.
In conclusion (D. L. Miller et al Public Health London (1970) 84, 265-285):
"Type 2 virus appears to spread to contacts of patients given trivalent vaccine more
readily than types 1 and 3, and type 2 virus was isolated from the contact vaccine—
associated cases more often than either of the other two types It is noteworthy
that—type 1 virus has resumed its former position as the predominant infecting
type in poliomyelitis, mainly owing to outbreaks caused by this type—type 3 virus
which shows a greater tendency to revert to laboratory markers of virulence than
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