Kenneth L. Herrmann

The ToRCH complex-perinatal infections associated with toxoplasma and rubella, cytomegol- and herpes simplex viruses

It is difficult in most cases to differentiate clinically among perinatal infections associated with Toxoplasma (To), Rubella (R), Cytomegalovirus (C) and Herpes simplex virus, type 1 or 2 (H). To evaluate this problem, sera submitted to CDC from infants (<2 yrs.) with various abnormalities were tested for all agents in the ToRCH complex, besides those requested by the physician. Antibodies to To, R and C were measured by conventional technics, and antibodies to H type 1 and 2 by microneutralization and IgM fluorescent antibody tests. Interpretation of results were complicated by such factors as prior immunization, blood transfusions and the possible acquisition of antibodies either transplacentally or from a postnatal infection. Nevertheless, serological findings suggested perinatal infection with the ToRCH agents in 61 of 192 cases (37%). The type of involvement associated with individual agents is presented in the table:

Immune Status of Children One to Four Years of Age as Determined by History and Antibody Measurement

Abstract Measurement of serum antibody levels in children one to four years old, living in three city and one suburban census tract, revealed that 63 per cent of the total study population were susceptible to rubella and approximately 33 per cent had inadequate titers of measles antibody. Antitoxin levels to diphtheria and tetanus were low in 24 and 7 per cent respectively of the entire study group. A large proportion (57 per cent) of these children had serum antibody levels of less than 10 to one or more types of poliovirus. Many had low antibody levels after the recommended number of immunizations; others had not received adequate poliomyelitis vaccine. Although those with low levels may not contract paralytic disease, if reinfected with wild poliovirus, they may spread the infectious agent to susceptible persons in the environment. Increased effort should be made to immunize all preschool children. Advisory committees should consider the need for periodic reimmunization. (N Engl J Med 289:231–235, 1973)

Congenital rubella surveillance following epidemic rubella in a partially vaccinated community.

Epidemic rubella occurred in Casper, Wyo., nine months after completion of a community-wide rubella vaccination program for children under 12 years of age; 84 per cent of the 1,039 reported cases were in unvaccinated teenagers. Surveillance of all 830 pregnant women and their newborn infants in Casper was conducted during the nine months following the epidemic to document the impact of that epidemic of these pregnant women and to determine whether the previous rubella vaccination effort had altered the risk of congenital infection and malformation of the unborn fetus. Twenty per cent of the pregnant women in Casper were susceptible to rubella at the time of the epidemic. Twenty-four women had serologically documented prenatal rubella infections—seven clinical and 17 inapparent. Two infants had rubella IgM positive umbilical cord serum specimens consistent with congenital rubella infection but no infant was born with congenital defects. There was no increase in stillbirths or abortions. Rubella vaccine-induced immunity, althouhg not adequate to prevent this epidemic, probably reduced the occurrence of fetal infection and congenital malformations.

Rubella in pregnancy: Review of current problems.

Since rubella infection in pregnancy is cause for considering therapeutic abortion, it is important that diagnosis be rapid and accurate. Laboratory assistance is mandatory in distinguishing rubella from similar-appearing exanthems due to agents innocuous to the fetus and in recognizing subclinical rubella, which can damage the fetus.

An Evaluation of the United States Rubella Immunization Program

While the U.S. rubella immunization program has controlled epidemic rubella, endemic rubella activity still occurs and affects primarily adolescents and young adults. Further declines in congenital rubella can be expected only if there is a concerted effort to vaccinate older, susceptible individuals, especially women of childbearing age, as well as all children 12 months of age or older.

Clinical evaluation of a new live measles vaccine derived in chick chorioallantoic membranes

A new measles vaccine (CAM) prepared in chick chorioallantoic membranes was compared with the routinely used measles vaccine (Attenuvax, Merck, Sharpe and Dohme) prepared in chick embryo tissue culture for immunogenicity and adverse reactions in 77 children. Recipients of the CAM vaccine developed significantly ( P = 0·001) higher hemagglutination-inhibition (HI) geometric mean antibody titers (83·3 v. 42·8) than did recipients of Attenuvax. CAM vaccine recipients also experienced significantly ( P