Chorea and Bacterial Endocarditis

vaccinated with this batch of vaccine had shown no fever or rash.Owing to vaccination or exposure to the natural virus infection, her neutralizing antibody titre rose from positive at 1: 11 to 1: 128, and the titre of complement-fixing antibody from negative at 1:4 to positive at 1:6.Both the girls M. and C. were free of measles antibodies before vaccination and both showed adequate rises in complement-fixing and neutralizing antibody titres one month after vaccination. TAoL IIAntibody Titres Pre-vaccination Post-vaccination Complement-Neutralizng Complement-Neutralizin fixing Netaiig fixing Nurlzn Mrs. G. <4 11 6 128 M. .. <4 <4 56 45 C. .<4 <4 56 90DiscussIoN This appears to be the first report about the protection of home contacts after exposure to measles by vaccina- tion alone without gamma-globulin.Krugman and his colleagues thought that the rapid protective effect which they obtained with live vaccine and gamma-globulin could best be explained by an interference phenomenon.The results now reported suggest that in the two girls a normal immune reaction was stimulated by attenuated live measles-virus vaccine, even when given on the third day of exposure, quickly enough to abort the natural disease.This quick immunity was achieved without gamma-globulin, which must have influenced Krugman's results to an unknown extent, and without the development of any catarrhal symptoms or signs-presumably, therefore, without infectiousness.If these results are confirmed on other occasions, vaccination in this way, up to and including the third day of exposure at home, will offer a useful alternative to gamma-globulin for the protection of contacts during an epidemic in hospital wards or schools as well as in families.The lack of infectiousness during the vaccine reaction would be particularly useful in a community such as a school.Though many doctors and parents may still be reluctant to accept live measles-virus vaccination as a routine procedure, after contact with the disease at home the mild febrile reaction caused by the present vaccine (MV.16), even if not further modified, should be a wholly acceptable alternative to even an ordinary attack of uncomplicated measles.For example, neither of the girls who were protected by vaccination missed any time off school, whereas both the boys were in bed for nearly a week with their measles.This method of contact protection is an immediate possibility during the present epidemic and would be particularly useful in children over the age of 10, in whom measles may more often be severe (Study Group, 1957) and for whom the dose of gamma-globulin needs to be relatively larger.A family outbreak of measles is reported in which two out of four children in contact at home were protected by an injection of attenuated live measles-virus vaccine, given on the third day of exposure; while two others, left unvaccinated as controls, caught the disease.Vaccination was performed the day after the rash appeared in the primary case.Susceptibility and protection of contacts were confirmed serologically.