IX 



MODIFICATION OF THE COURSE OF 



INFECTIOUS DISEASE AS A RESULT OF 



ANOMALIES OF THE IMMUNE RESPONSE 



The rather unexpected finding that most children with 

 agammaglobuUnaemia can deal with most virus infections as 

 effectively as normal individuals and show post-infection 

 immunity has already been discussed. It is of equal interest 

 that clinical observations suggest that there are other 

 anomalies of the immune response which do interfere 

 seriously with the normal course of common infections. 



In this chapter an attempt is made to discuss aspects of 

 immunological process which are or may be concerned in 

 determining the course and some of the complications of 

 certain infections. No attempt is made at completeness and, 

 in general, only examples are discussed which present aspects 

 relevant to the concepts of immunity with which we are 

 concerned. 



I. Jennerian vaccination 



In many ways Jennerian vaccination provides the most com- 

 prehensive information. This is a standardized infection in 

 which both the virus strain and the initial lesion are virtually 

 identical in all subjects. The great majority of infections are 

 uncomplicated but amongst the millions of children vac- 

 cinated annually there are always some severe illnesses and 

 some deaths. 



Kempe (1958) has classified these into several groups. 

 There are first the eczematous children who develop severe 

 infection of the affected skin by vaccinia virus and staphylo- 

 cocci (Kaposi's eruption). 



The other groups comprise cases of progressive vaccinia 



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