Mortality and Morbidity Among Military Personnel and Civilians During the 1930s and World War II From Transmission of Hepatitis During Yellow Fever Vaccination: Systematic Review

摘要

During World War II, nearly all US and Allied troops received yellow fever vaccine. Until May 1942, it was both grown and suspended in human serum. In April 1942, major epidemics of hepatitis occurred in US and Allied troops who had received yellow fever vaccine. A rapid and thorough investigation by the US surgeon general followed, and a directive was issued discontinuing the use of human serum in vaccine production. The large number of cases of hepatitis caused by the administration of this vaccine could have been avoided. Had authorities undertaken a thorough review of the literature, they would have discovered published reports, as early as 1885, of postvaccination epidemics of hepatitis in both men and horses. It would take 4 additional decades of experiments and epidemiological research before viruses of hepatitis A, B, C, D, and E were identified, their modes of transmission understood, and their genomes sequenced. DURING WORLD WAR I, SIG nificant infectious hepatitis epidemics (caused by microbes later identified as hepatitis A and E viruses, predominantly hepatitis A virus) occurred among British, French, German, and Romanian troops deployed in the Middle East and Balkan theaters of war. US troops were not deployed in these areas, and the US Army had far less experience with infectious hepatitis. 1 Yellow fever vaccine development began in 1928. 2 The 17D strain of yellow fever vaccine was developed in 1937. On January 30, 1941, the US adjutant general ordered that all military persons stationed in tropical regions of the Western Hemisphere be vaccinated against yellow fever. 3 In March 1942, large outbreaks of hepatitis and jaundice occurred in Allied Army personnel previously vaccinated against yellow fever. 1 Until May 1942, yellow fever virus was propagated in cell cultures with human serum, and vaccine was stabilized with serum to maintain viability. On April 15, 1942, the US surgeon general, upon determining that human serum could transmit hepatitis from donors to vaccine recipients, ordered the omission of human serum from yellow fever vaccine production. 4 No further cases of hepatitis were henceforth attributable to yellow fever vaccine. 3.