Report on the outbreak of poliomyelitis during 1961 in Kingston-upon-Hull and the East Riding of Yorkshire.

  • Great Britain. Ministry of Health.
Date:
1963
Catalogue details

Licence: Public Domain Mark

Credit: Report on the outbreak of poliomyelitis during 1961 in Kingston-upon-Hull and the East Riding of Yorkshire. Source: Wellcome Collection.

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    IV DETAILS OF THE CASES All cases of suspected poliomyelitis occurring in Hull and the East Riding of Yorkshire were admitted to Castle Hill Hospital, Cottingham, East York- shire. The patients were sent first to a cubicle ward and remained there until the diagnosis was confirmed, when they were transferred to one of the three large wards set aside exclusively for cases of poliomyelitis. Cases showing evidence of bulbar and respiratory paralysis were admitted direct to the respiratory centre which is a 20-bedded single cell cubicle block containing operating theatre, anaesthetic room, X-ray development room, along with a battery of positive pressure respirators, where a 24-hour resident medical anaesthetic service was maintained by the consultant anaes- thetists and their staff. All patients were kept in hospital for a minimum period of three weeks before being sent home, or transferred to an orthopaedic hospital. When a patient could not be transferred to an orthopaedic ward set aside solely for poliomyelitis, then the patient was kept in Castle Hill Hospital for six weeks. Paralysed cases were seen by a consultant orthopaedic surgeon who advised on orthopaedic treatment and disposal of the patient. All patients received neurological supervision by a consultant neurologist. Diagnostic Criteria The diagnosis in each of the cases which were regarded as forming the outbreak was established after consideration of ‘all the available details of medical history, clinical examination and virological findings. The clinical criteria adopted were as follows: a suggestive prodromal ill- ness, signs of meningeal irritation, cerebrospinal fluid changes consistent with poliomyelitis with or without evidence of anterior horn cell, cranial nerve or medullary involvement. Virological investigations were made in all cases. Specimens of faeces were obtained from each case within 24 hours of admission. Where a speci- men could not be obtained naturally, a saline enema was given. Rectal swabs were only accepted when it was impossible to obtain faeces. Viro- logy reports were obtained in three days and this was very important when the turnover of patients was at its height and the demand on cubicles was high. Acute and convalescent (paired) sera were also obtained from all suspected cases in the first and third week of the disease and in some instances a third specimen of serum was obtained for further testing. The virological techniques used are described in detail in the Appendix to this Report. Patients were considered to have a poliovirus infection either when a poliovirus was isolated from their faeces or when they had positive complement-fixation or neutralizing antibody tests. The comple- ment-fixation test was considered to be positive when acute and convalescent- phase sera showed a four-fold or greater rise in antibody against any of the three poliovirus antigens or when there was an unchanging antibody titre of 1/64 or more against poliovirus type I antigen alone, the titres against types 2 and 3 being <1/4. The neutralizing antibody test was considered to be positive when acute and convalescent-phase sera showed a four-fold