Jaundice following Administration of Human Serum

Abstract

The literature (20 references) on the subject is briefly reviewed. Approx. 500 cases of hepatitis occurred among 11,358 individuals on the islands of St. Thomas and St. John, Virgin Islands, inoculated in 1942 with a certain lot (331) of yellow fever vaccine containing pooled human serum. In a survey carried out in the city of Charlotte Amalie, St. Thomas, 1198 persons (roughly 10% of the population involved) were studied. 153 (14.7%) of 1039 vaccinated and 3 (1.9%) of 159 who were said not to have been vaccinated developed symptoms of hepatitis. The incidence was greatest in the age groups between 20 and 59 yrs. The average incubation period in 75 patients for whom reliable data was obtained was 103 days with a range of 75 to 130 days. Cases varied from very mild to extremely severe. Onset usually began with headache, pains in the shoulders and back, a sensation of fullness in the epigastrium, anorexia, nausea, and weakness. Within a day or so the urine became dark and within 2-3 days icterus of the sclerae appeared. Vomiting also occurred. Some presented no frank jaundice; others were jaundiced for at least a month. The average individual was jaundiced for 6-10 days. In an exptl. study, 189 volunteers (11 groups) were inoculated with different materials[long dash]50 with yellow fever vaccine, 10 with heated vaccine, 10 with irradiated vaccine, and the others with different lots of filtered serum. 30 cases of jaundice occurred. For these the average incubation period was 12.3 weeks, the ay. serum bilirubin mg.% was 5.3, and the av. duration of jaundice was 2.1 weeks. Blood studies failed to show any cell variation in jaundiced patients. So far as known, no contact cases occurred. Jaundice was produced experimentally from yellow fever vaccine containing pooled human serum, and from the filtered serum of individuals previously inoculated with yellow fever vaccine containing human serum. The causative agent survives drying in vacuum, storage for long periods in serum at 4[degree] C, and heating to 56[degree] C for 1/2 hr. in the dried state, but is apparently inactivated by u.-v. irradiation. Both sexes appear equally susceptible. The agent is apparently present in the blood before jaundice appears, but not 21/2 months after disappearance of jaundice. Attempts to produce jaundice in exptl. animals and to develop a complement-fixation test were unsuccessful.