Did a then unknown virus, HHV-6/7, give rise to the whooping cough vaccine controversy of the 1970s?

During the 1970s there was a gross loss of public confidence in infant diphtheria-tetanus-pertussis (DTP) vaccination in the UK. As well as febrile reactions and convulsions, permanent neurological damage was ascribed to the pertussis component of the vaccine, and those concerns resonated worldwide. The subsequent recognition of human herpes virus 6 (HHV-6) and 7 (HHV-7) as common sources of fever in infancy suggests that they were the main underlying cause of what was reported as DTP constitutional side-effects. With more precise data on the incidence of HHV-6/7 and other virus infections in early life it would be possible to model the concurrence of viral illnesses with routine immunizations. Adventitious viral infections may be the cause of side-effects ascribed to the numerous childhood immunizations now being given.

Prospects for the development of pre-mortem laboratory diagnostic tests for Creutzfeldt-Jakob disease.

At present the diagnosis of Creutzfeldt-Jakob disease (CJD) and related transmissible spongiform encephalopathies in humans is based on clinical criteria and (at post-mortem) the histopathological and immunological examination of brain tissue. The misfolded prion protein, PrPSc, is the single most significant marker, but its recognition by standard serological methods is complicated by its antigenic similarity to the normal prion protein, PrPC. Although there are commercial diagnostic assays available for bovine spongiform encephalopathy using brain specimens taken at slaughter, there are no suitable pre-mortem assays for cattle and none either for pre-mortem human disease. Especially in view of the recent report of variant CJD transmission by blood transfusion, it is important that tests for pre-symptomatic infections are developed. This will safeguard the blood supply and, for example, prevent the transmission of CJD in neurosurgery. This paper reviews the current and prospective approaches to the pre-mortem diagnosis of CJD, in particular its variant form.

Anticipating smallpox as a bioterrorist weapon.

The treat of bioterrorism means it is important to be able to diagnose smallpox. The responsibility for the initial recognition of cases lies with clinicians, and early diagnosis is the key to the successful control of an outbreak. Unless rapidly contained, a bioterrorist release of smallpox would constitute not just a national but a global threat to health. This brief review sets smallpox in its modern context as an infection potentially spread by bioterrorists and recommends sources of information from the twentieth century that will assist clinicians in diagnosing the disease.

Five postulates for resolving outbreaks of infectious disease.

Outbreaks of infection challenge the surveillance of infectious disease, but they also offer opportunities to improve and refine it. An outbreak may be the first sign of an emerging pathogen or it may draw attention to a new risk group or route of infection. Postulates analogous to those used a century ago by Robert Koch to prove the microbial aetiology of infectious diseases can be employed to verify the existence of an outbreak, demonstrate its cause and pinpoint its origins. In doing this, high-resolution molecular finger printing of micro-organisms has now assumed a crucial role. Without formal analysis based on postulates, the existence, extent and source of outbreaks may be overlooked and public health interventions misapplied or lost.