404
spinal
in
onset
with
subsequent bulbar involvement, the
illness lasted 6-2 years on average. The cause of this protracted course of the various forms of M.N.D. in Israel is not known. Beilinson Hospital, Tel-Aviv University, Israel.
MARTA ELIAN MICHAL ARTAL.
SMALLPOX VACCINATION IN INFANCY SIR,—The problems of trying to vaccinate all children at risk of smallpox in most of the less developed countries have been studied intensively over the past two decades. Attempts have been made to demonstrate the efficacy of smallpox vaccination in neonates as a method of achieving a better coverage of the vulnerable populations.1-3 None of these studies demonstrated any serological evidence that smallpox vaccination within the first three weeks of life afforded any protection. However, Wurapa et al. found vaccinia antibodies in sera from neonates vaccinated 4 weeks previously.4 Only 36% demonstrated a fourfold increase in titre, however, on the basis of the half-life of passively transferred antibodies, we suggest that the vaccination of Since maternal antibodies may neonates was effective. interfere with the results obtained, the effectiveness of neonatal vaccination can only be established when vaccinia antibodies are demonstrated 3-4 years after vaccination. VARICELLA ANTIBODY TITRES IN VACCINEES AND CONTROLS
Fifteen of the vaccinated children had vaccinia-virus antibodies (see accompanying table). 4 years after vaccination antibody titres had dropped considerably in vaccinees who had had high 4-week post-vaccination titres. After a certain period, immunity is probably demonstrated by low titres (1/4) regardless of the peak reached after vaccination. Since fifteen of the nineteen vaccinees and only one of the controls had vaccinia antibody, we believe that the vaccination of neonates against smallpox can be recommended in countries in which adequate coverage of children later in life is difficult. Department of Community Health, University of Ghana Medical School, P.O. Box 4236, Accra, Ghana. Institute of Microbiology, University Medical School,
Pecs, Hungary. Department of Microbiology, University of Ghana Medical School, Accra, Ghana.
F. K. WURAPA.
S. PACSA. P. A. K. ADDY.
Ministry of Health, P.O. Box M.44,
S. AMOAH.
Accra, Ghana.
THE FUTURE OF NATIONAL DRIED MILK SiR,—The conclusions of Dr Baum and Dr Harker (Jan. 18, p. 159) call for comment. It has recently become obvious that the present composition of full-cream dried milks, including National Dried Milk (N.D.M.) (see accompanying table), does not allow for minor aberrations in the technique of making up feeds. The result is that babies are commonly receiving milk of high osmolality compared to breast milk, and over-rich in sodium 1-3 and calories.2 SODIUM CONTENT OF MILKS
Values expressed per 100 ml. milk made up instructions.5
*
Twins in whom additional vaccination could
not
be excluded.
0 =less than 1/4.
In June, 1974, 4 years after initial vaccination, nineteen of the original vaccinees and nineteen age-matched control children had a test for vaccinia antibodies. Care was taken to exclude any child who had had additional vaccination since the start of the study. The control group was made up of new entrants to a day care centre in Accra who have never been vaccinated. Five dilutions of sera (1/4, 1/16, 1/64, 1/128, and 1/256) were tested. Serum samples, stored at -20°C, were inactivated at 56° C for 30 minutes just before the test. A modified neutralisation test based on 60% plague reduction was used to detect vaccinia antibodies.5 1. 2. 3.
Kemp, C. H., Benenson, A. S. J. Pediat. 1953, 42, 525. Lin, H. T., Hyg, S. M. Bull. Wld Hlth Org. 1965, 749. Ray, S., Indra, S., Roy, A., Roy, I. B. Indian J. med. Res. 1970, 58, 382.
Wurapa, F. K., Amoah, S., Pobee, L. M., Pacsa, S. Ghana med. J. 1972, 2, 25. 5. Millar, J. D., Roberto, R. R., Wulff, H., Wenner, H. A., Henderson, D. A. Bull. Wld Hlth Org. 1969, 41, 749. 4.
according
to
manufacturers’
This certainly does contribute to hypematrxrniaand possibly, therefrom, to cot deathand may influence the later development of hypertension. Dr Dunn and Dr Pollnitz (Feb. 1, p. 269) draw attention to the contribution that the cycle of satiety makes to infant obesity. Is it also not possible that a thirsty crying baby may become a battered baby ? It is now time for the D.H.S.S. to implement the recommendations of its recent working-party5 and alter the composition of N.D.M. to make its solute content similar to
humanised milk. This new N.D.M. should not need the addition of sugar and, in health, the dilution should be the same from birth onwards. Only then should the milk receive extra publicity, being promoted as " modem " and new formula " and widely advertised in the Press and on "
television. Why cannot N.D.M. be supplied to maternity units for use as a second-best to breast-feeding ? St. James’s Hospital, TIMOTHY L. CHAMBERS. Leeds LS9 7TF. 1. 2. 3. 4. 5.
Chambers, T. L., Steel, A. E. Archs Dis. Childh. (in the press). Taitz, L. S., Byers, H. D. ibid. 1972, 47, 257. Smith, B. A. M. Br. med. J. 1974, iv, 741. Emery, J. L., Swift, P. G. F., Worthy, E. Archs Dis. Childh. 1974, 49, 686. Present-day Practice in Infant Feeding. Report of D.H.S.S. Working Party. H.M. Stationery Office, 1974.
spinal
in
onset
with
subsequent bulbar involvement, the
illness lasted 6-2 years on average. The cause of this protracted course of the various forms of M.N.D. in Israel is not known. Beilinson Hospital, Tel-Aviv University, Israel.
MARTA ELIAN MICHAL ARTAL.
SMALLPOX VACCINATION IN INFANCY SIR,—The problems of trying to vaccinate all children at risk of smallpox in most of the less developed countries have been studied intensively over the past two decades. Attempts have been made to demonstrate the efficacy of smallpox vaccination in neonates as a method of achieving a better coverage of the vulnerable populations.1-3 None of these studies demonstrated any serological evidence that smallpox vaccination within the first three weeks of life afforded any protection. However, Wurapa et al. found vaccinia antibodies in sera from neonates vaccinated 4 weeks previously.4 Only 36% demonstrated a fourfold increase in titre, however, on the basis of the half-life of passively transferred antibodies, we suggest that the vaccination of Since maternal antibodies may neonates was effective. interfere with the results obtained, the effectiveness of neonatal vaccination can only be established when vaccinia antibodies are demonstrated 3-4 years after vaccination. VARICELLA ANTIBODY TITRES IN VACCINEES AND CONTROLS
Fifteen of the vaccinated children had vaccinia-virus antibodies (see accompanying table). 4 years after vaccination antibody titres had dropped considerably in vaccinees who had had high 4-week post-vaccination titres. After a certain period, immunity is probably demonstrated by low titres (1/4) regardless of the peak reached after vaccination. Since fifteen of the nineteen vaccinees and only one of the controls had vaccinia antibody, we believe that the vaccination of neonates against smallpox can be recommended in countries in which adequate coverage of children later in life is difficult. Department of Community Health, University of Ghana Medical School, P.O. Box 4236, Accra, Ghana. Institute of Microbiology, University Medical School,
Pecs, Hungary. Department of Microbiology, University of Ghana Medical School, Accra, Ghana.
F. K. WURAPA.
S. PACSA. P. A. K. ADDY.
Ministry of Health, P.O. Box M.44,
S. AMOAH.
Accra, Ghana.
THE FUTURE OF NATIONAL DRIED MILK SiR,—The conclusions of Dr Baum and Dr Harker (Jan. 18, p. 159) call for comment. It has recently become obvious that the present composition of full-cream dried milks, including National Dried Milk (N.D.M.) (see accompanying table), does not allow for minor aberrations in the technique of making up feeds. The result is that babies are commonly receiving milk of high osmolality compared to breast milk, and over-rich in sodium 1-3 and calories.2 SODIUM CONTENT OF MILKS
Values expressed per 100 ml. milk made up instructions.5
*
Twins in whom additional vaccination could
not
be excluded.
0 =less than 1/4.
In June, 1974, 4 years after initial vaccination, nineteen of the original vaccinees and nineteen age-matched control children had a test for vaccinia antibodies. Care was taken to exclude any child who had had additional vaccination since the start of the study. The control group was made up of new entrants to a day care centre in Accra who have never been vaccinated. Five dilutions of sera (1/4, 1/16, 1/64, 1/128, and 1/256) were tested. Serum samples, stored at -20°C, were inactivated at 56° C for 30 minutes just before the test. A modified neutralisation test based on 60% plague reduction was used to detect vaccinia antibodies.5 1. 2. 3.
Kemp, C. H., Benenson, A. S. J. Pediat. 1953, 42, 525. Lin, H. T., Hyg, S. M. Bull. Wld Hlth Org. 1965, 749. Ray, S., Indra, S., Roy, A., Roy, I. B. Indian J. med. Res. 1970, 58, 382.
Wurapa, F. K., Amoah, S., Pobee, L. M., Pacsa, S. Ghana med. J. 1972, 2, 25. 5. Millar, J. D., Roberto, R. R., Wulff, H., Wenner, H. A., Henderson, D. A. Bull. Wld Hlth Org. 1969, 41, 749. 4.
according
to
manufacturers’
This certainly does contribute to hypematrxrniaand possibly, therefrom, to cot deathand may influence the later development of hypertension. Dr Dunn and Dr Pollnitz (Feb. 1, p. 269) draw attention to the contribution that the cycle of satiety makes to infant obesity. Is it also not possible that a thirsty crying baby may become a battered baby ? It is now time for the D.H.S.S. to implement the recommendations of its recent working-party5 and alter the composition of N.D.M. to make its solute content similar to
humanised milk. This new N.D.M. should not need the addition of sugar and, in health, the dilution should be the same from birth onwards. Only then should the milk receive extra publicity, being promoted as " modem " and new formula " and widely advertised in the Press and on "
television. Why cannot N.D.M. be supplied to maternity units for use as a second-best to breast-feeding ? St. James’s Hospital, TIMOTHY L. CHAMBERS. Leeds LS9 7TF. 1. 2. 3. 4. 5.
Chambers, T. L., Steel, A. E. Archs Dis. Childh. (in the press). Taitz, L. S., Byers, H. D. ibid. 1972, 47, 257. Smith, B. A. M. Br. med. J. 1974, iv, 741. Emery, J. L., Swift, P. G. F., Worthy, E. Archs Dis. Childh. 1974, 49, 686. Present-day Practice in Infant Feeding. Report of D.H.S.S. Working Party. H.M. Stationery Office, 1974.
