Nightingale E O
N Engl J Med. 1977 Aug 4;297(5):249-53. doi: 10.1056/NEJM197708042970505.
Declining numbers of adequately vaccinated persons, new data about the comparative safety and effectiveness of live, attenuated and killed poliomyelitis-virus vaccines, increased consumer awareness of adverse reactions and pressure from manufacturers seeking protection from liability were factors leading the Institute of Medicine to re-examine poliomyelitis vaccination programs. The relative merits of live and killed virus vaccines as immunizing agents were reviewed within the context of the 60 to 70 per cent level of poliomyelitis vaccination now reached in the United States. Until about 90 per cent of persons are adequately immunized, the continued use of live-virus vaccines for infants is recommended, with provision that certain categories of persons receive killed-virus vaccine. Vaccination with attenuated live virus of children 11 to 12 years old is suggested to reduce vaccine-associated disease when they become parents of vaccinated infants. Recommendations are made on education, research, liability and informed consent as they pertain to prevention of polyomyelitis.
充分接种疫苗的人数减少、减毒活疫苗和灭活脊髓灰质炎病毒疫苗相对安全性和有效性的新数据、消费者对不良反应的认识提高以及制造商寻求责任保护的压力，这些因素促使医学研究所重新审视脊髓灰质炎疫苗接种计划。在美国目前脊髓灰质炎疫苗接种率达到60%至70%的背景下，对活病毒疫苗和灭活病毒疫苗作为免疫剂的相对优点进行了审查。在约90%的人得到充分免疫之前，建议继续为婴儿使用活病毒疫苗，但某些类别的人应接种灭活病毒疫苗。建议对11至12岁的儿童接种减毒活病毒疫苗，以减少他们成为接种疫苗婴儿的父母时与疫苗相关的疾病。针对与预防脊髓灰质炎相关的教育、研究、责任和知情同意提出了建议。
