Mortality and Morbidity Among Military Personnel and Civilians During the 1930s and World War II From Transmission of Hepatitis During Yellow Fever Vaccination: Systematic Review

Steinmann²,

Front. Cell. Infect. Microbiol.

2020

During the World War II jaundice and hepatitis in the US army were observed after vaccination with the yellow fever vaccine containing human plasma for stabilization. This led to first heat experiments with volunteers without knowledge of the causative agents. Finally, experiments of human serum with volunteers and chimpanzees led to the conclusion that the hepatitis B virus (HBV) which had been identified as the responsible agent of the contamination of the vaccine, could not be inactivated at 98 • C after 1 min, whereas 2 min in two chimpanzees were enough. Meanwhile, a cell culture system became available showing that 2 min exposure time is not enough depending on the virus strain used whereas 5 min means complete inactivation of HBV. The great stability of the blood-borne HBV was also of interest in hospital hygiene due to the use of moist heat for disinfection of heat-stable medical devices in washer-disinfectants. The requirements for washer-disinfectors and the parameters describing disinfection with moist heat are defined in the EN ISO 15883. In this standard, the efficacy of this thermal disinfection is described by the A 0 value. For heat-resistant viruses a higher A 0 = 3,000 is often recommended including semi-critical instruments that undergo thermal disinfection and no final sterilization. All experiments including volunteers, chimpanzees and now cell culture were performed with greater A 0 values than 3,000. Therefore, an A 0 value of 3,000 e.g., being reached by 90 • C and 5 min in washer-disinfectants, can easily elevated to 6,000 by prolongation of the exposure time to 10 min. In contrast to the different laboratory experiments with high virus titers it should be considered that in practice the necessary cleaning step upfront will help to reduce virus load and then protect the personnel in the medical area. HBV AND THERMAL DISINFECTIONDespite the availability of vaccination, infections with hepatitis B virus (HBV) are still a severe global health burden, with ∼2 billion infected individuals and more than 250 million carriers worldwide. HBV, a small, enveloped, hepatotropic DNA virus is the major cause of chronic liver diseases, the primary causative agent of hepatocellular carcinoma (HCC) and responsible

Section: A Historical Overview Of the Thermostability Of Hbvmentioning

confidence: 99%

The Heat Stability of Hepatitis B Virus: A Chronological Review From Human Volunteers and Chimpanzees to Cell Culture Model Systems

Steinmann²,

Front. Cell. Infect. Microbiol.

2020

“…Thus, the iatrogenic transmission of HBV by YFV vaccination could have been avoided bundling all the available information in 1942 [7]. …”

Section: Hepatitis B Virus (Hbv) Transmission Linked To Yellow Fever mentioning

confidence: 99%

Aspects on the history of transmission and favor of distribution of viruses by iatrogenic action: perhaps an example of a paradigm of the worldwide spread of HIV

Gürtler

Eberle

2017

Med Microbiol Immunol

Transmission of infectious agents might be associated with iatrogenic actions of charitable help in health care. An example is the vaccination against yellow fever in USA that transmitted hepatitis B virus. Another example is injections of praziquantel for treatment and cure of schistosomiasis in Central and Northern Africa, with a focus in Egypt that has spread hepatitis C virus. There is no indication that human T-lymphotropic virus type 1 was spread by injection treatment for African trypanosomiasis, syphilis and treponematosis, but these treatments might have contributed to the early spread of human immunodeficiency virus type 1 (HIV-1) in Central Africa. Slave trade contributed as well to the spread of viruses from Africa to the Americas; it was stopped in 1850. Until that date HIV-1 was not transported to the Americas. By analysis of nucleic acid sequence data it can be concluded that the continental spread of HCV and HIV-1 might have started around 1920 with an exponential phase from 1940 to 1970. Further iatrogenic actions that promoted the spread of HCV and HIV-1 might be vaccinations to prevent deadly diseases. The successful vaccination was followed by diminution of the infectious agent in the population such as small pox, yellow fever and measles. Measurements to reduce the spread of plague and cholera were further benefits increasing survival of diseased subjects in a population. Thus, the reduction of exposure to deadly infectious agents might have given a chance to HIV-1 infected subjects to survive and for HIV-1 to be distributed around the world starting from Central Africa in the 1950s.

“…In the traditional paradigm, disease caused by vaccination has been a serious problem [ 27 ]. Rappuoli [ 28 ] has stressed the methodological approaches used to overcome the risks of vaccination in the 21st century ( Table 3 ).…”

Section: Current Issues and Conclusionmentioning

confidence: 99%

Clinical vaccine development

Han

2015

Clin Exp Vaccine Res

Vaccination is regarded as one of the biggest triumphs in the history of medicine. We are living in the most successful period of vaccine development. The accumulation of multidisciplinary knowledge and the investment of massive funding have enabled the development of vaccines against many infectious diseases as well as other diseases including malignant tumors. The paradigm of clinical vaccine evaluation and licensure has also been modernized based on scientific improvements and historical experience. However, there remain a number of hurdles to overcome. Continuous efforts are focused on increasing the efficacy and reducing the risks related to vaccine use. Cutting-edge knowledge about immunology and microbiology is being rapidly translated to vaccine development. Thus, physicians and others involved in the clinical development of vaccines should have sufficient understanding of the recent developmental trends in vaccination and the diseases of interest.