- Email: [email protected]
Nicole Wolf
In Context
Focal point Preventing polio Vaccination has been essential in the fight to eradicate polio; because the virus can only be transmitted from person to person, vaccination breaks the cycle of infection.1 The first polio vaccination was licensed in the USA in 1955. This was the Salk vaccine (Jonas Salk 1914–95), comprising an injection of dead inactivated polio virus, which had been successfully trialled in about 440 000 elementary school children. Just a few months earlier, the development of another vaccine had been announced, the Sabin vaccine (Albert Bruce Sabin 1906–93), an oral vaccine with a live but attenuated strain of the virus. By 1959, at which time almost half the US population had received the Salk vaccine and the occurrence of polio had fallen by 80%, the Sabin vaccine had been shipped outside the USA for field trials in some 10 million people. On the basis of these trials, the American Medical Association House of Delegates declared that the Sabin vaccine had better persistence of immunity that was more akin to naturally developed immunity than the Salk vaccine, much to the chagrin of Salk. The type I Sabin vaccine was licensed in 1961, and the type III vaccine in 1963.2 It would, however, be an understatement to say that the story from then on was unproblematic. Notwithstanding the acrimony between Salk and Sabin, which lasted for the remainder of their lives,3 soon after licensing, reports started to come in of sporadic cases of iatrogenic poliomyelitis in people who had received either vaccine, leading to a drop in vaccine uptake and adding fuel to the ongoing spat about live versus dead vaccines.2,4 In the long run, rather than being fatal, these rare incidents actually helped to better inform on the benefits and limitations of each vaccine. As a result of the innovations of Salk, Sabin, and others, and the efforts of the Global Polio Eradication Initiative, through vaccination global polio occurrence has now been reduced by 99%, and polio remains endemic in only three countries (Afghanistan, Nigeria, and Pakistan).1
Steven Goodrick 1 2
3
4
WHO. Poliomyelitis factsheet. http://www.who.int/mediacentre/ factsheets/fs114/en/ (accessed May 31, 2014). Cummings P. Salk and Sabin. Brass Tacks. March, 1963. http://www. thecrimson.com/article/1963/3/2/salk-and-sabin-pin-january-1955/ (accessed May 30, 2014). CBC Digital Archives. Sabin vs Salk: oral vs injected polio vaccine. July 6, 1977. http://www.cbc.ca/player/Digital+Archives/Health/ Public+Health/Polio/ID/1824800224 (accessed May 30, 2014). Byrne A. The Salk vaccine fiasco. The Spectator. July 21, 1958: 8.
www.thelancet.com/neurology Vol 13 July 2014
Lifeline Nicole Wolf studied medicine in Germany, the UK, and Canada. She completed her thesis in the Department of Anatomy and Cell Biology in Heidelberg and its counterpart at Hadassah Medical School, Jerusalem, Israel. She then trained as a paediatrician and child neurologist in Heidelberg, Germany, and Zürich, Switzerland. In 2008, she moved to Amsterdam where she works on hypomyelinating disorders. What do you think is the most neglected field of science or medicine at the moment? In western countries: adults with intellectual impairment. Globally: resistance to antibiotics.
See Review page 727
What inspires you? My little patients’ resilience and their families’ courage. If you had not entered your current profession, what would you have liked to do? To be a historian, in order to find out what one can learn from the past. Who was your most influential teacher, and why? Dietz Rating, who taught me child neurology, because of his enthusiasm and honesty. And because of his sometimes unconventional approach. What was the most memorable comment you ever received from a referee? “My general impression is that it surely needs to be published in a decent journal, but probably not in this one.” What would be your advice to a newly qualified doctor? To carefully listen and observe. In child neurology, parents are mostly right. How do you relax? Reading; running in Amsterdam’s Vondelpark; listening to Schubert. What is your greatest regret? Having almost given up making music. What are you currently reading? The Sleepwalkers, by Christopher Clark. What is your worst habit? An addiction to chocolate and Diet Coke. And my impatience. In which other country would you like to live and why? France, because of the language and the food. What one discovery or invention would most improve your life? Automated grant-writing software. If you could have dinner tonight with a famous person of your choice (dead or alive), who would it be? Maria Sybilla Merian, to hear about her life as a female scientist in Amsterdam at the end of the Golden Age.
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Focal point Preventing polio Vaccination has been essential in the fight to eradicate polio; because the virus can only be transmitted from person to person, vaccination breaks the cycle of infection.1 The first polio vaccination was licensed in the USA in 1955. This was the Salk vaccine (Jonas Salk 1914–95), comprising an injection of dead inactivated polio virus, which had been successfully trialled in about 440 000 elementary school children. Just a few months earlier, the development of another vaccine had been announced, the Sabin vaccine (Albert Bruce Sabin 1906–93), an oral vaccine with a live but attenuated strain of the virus. By 1959, at which time almost half the US population had received the Salk vaccine and the occurrence of polio had fallen by 80%, the Sabin vaccine had been shipped outside the USA for field trials in some 10 million people. On the basis of these trials, the American Medical Association House of Delegates declared that the Sabin vaccine had better persistence of immunity that was more akin to naturally developed immunity than the Salk vaccine, much to the chagrin of Salk. The type I Sabin vaccine was licensed in 1961, and the type III vaccine in 1963.2 It would, however, be an understatement to say that the story from then on was unproblematic. Notwithstanding the acrimony between Salk and Sabin, which lasted for the remainder of their lives,3 soon after licensing, reports started to come in of sporadic cases of iatrogenic poliomyelitis in people who had received either vaccine, leading to a drop in vaccine uptake and adding fuel to the ongoing spat about live versus dead vaccines.2,4 In the long run, rather than being fatal, these rare incidents actually helped to better inform on the benefits and limitations of each vaccine. As a result of the innovations of Salk, Sabin, and others, and the efforts of the Global Polio Eradication Initiative, through vaccination global polio occurrence has now been reduced by 99%, and polio remains endemic in only three countries (Afghanistan, Nigeria, and Pakistan).1
Steven Goodrick 1 2
3
4
WHO. Poliomyelitis factsheet. http://www.who.int/mediacentre/ factsheets/fs114/en/ (accessed May 31, 2014). Cummings P. Salk and Sabin. Brass Tacks. March, 1963. http://www. thecrimson.com/article/1963/3/2/salk-and-sabin-pin-january-1955/ (accessed May 30, 2014). CBC Digital Archives. Sabin vs Salk: oral vs injected polio vaccine. July 6, 1977. http://www.cbc.ca/player/Digital+Archives/Health/ Public+Health/Polio/ID/1824800224 (accessed May 30, 2014). Byrne A. The Salk vaccine fiasco. The Spectator. July 21, 1958: 8.
www.thelancet.com/neurology Vol 13 July 2014
Lifeline Nicole Wolf studied medicine in Germany, the UK, and Canada. She completed her thesis in the Department of Anatomy and Cell Biology in Heidelberg and its counterpart at Hadassah Medical School, Jerusalem, Israel. She then trained as a paediatrician and child neurologist in Heidelberg, Germany, and Zürich, Switzerland. In 2008, she moved to Amsterdam where she works on hypomyelinating disorders. What do you think is the most neglected field of science or medicine at the moment? In western countries: adults with intellectual impairment. Globally: resistance to antibiotics.
See Review page 727
What inspires you? My little patients’ resilience and their families’ courage. If you had not entered your current profession, what would you have liked to do? To be a historian, in order to find out what one can learn from the past. Who was your most influential teacher, and why? Dietz Rating, who taught me child neurology, because of his enthusiasm and honesty. And because of his sometimes unconventional approach. What was the most memorable comment you ever received from a referee? “My general impression is that it surely needs to be published in a decent journal, but probably not in this one.” What would be your advice to a newly qualified doctor? To carefully listen and observe. In child neurology, parents are mostly right. How do you relax? Reading; running in Amsterdam’s Vondelpark; listening to Schubert. What is your greatest regret? Having almost given up making music. What are you currently reading? The Sleepwalkers, by Christopher Clark. What is your worst habit? An addiction to chocolate and Diet Coke. And my impatience. In which other country would you like to live and why? France, because of the language and the food. What one discovery or invention would most improve your life? Automated grant-writing software. If you could have dinner tonight with a famous person of your choice (dead or alive), who would it be? Maria Sybilla Merian, to hear about her life as a female scientist in Amsterdam at the end of the Golden Age.
653