Figure 6-2 annual poliomyelitis rates, united states, 1935-1965. (From Morris, L., Witte J. J.

, el al: surveillance of
poliomyelitis in the united states, 1962-65. Public Health., 82:417, 1967)

Fluoridation of water, and even immunization, remains to be achieved in the future.

There have been numerous trials to test the efficacy and safety of vaccines. Generally, vaccines,
once tested and licenced, have found ready acceptance in practice. For example, virtual elimination of
poliomyelitis in the United State was achieved within a decade of the introduction of vaccine against the
disease (Figure 6-2).

The WHO trial of typhoid vaccine in Yugoslavia in the mid-1950’s (Yugoslav Thyphoid
Commission, 1962) is interesting because it demonstrates that effectiveness of a vaccine in the field
cannot always be predicted from laboratory studies. In the trial, some persons received a heat-killed,
phenol-preserved vaccine, others an alcohol-killed and preserved vaccine. Better protection was
expected from the latter because a substance know as Vi antigen is better preserved vaccine gave
substantial protection. The mechanism for the difference in effectiveness of the two vaccines is not
clear.

Experimental trials have also been applied to prophylactic modalities other than vaccines.
Hammon’s controlled trial of the efficacy

*Study question 6-2 contrasts the two study plans that were used in the 1954 field tests of the Salk vaccine against
poliomyelitis.