and extensive laboratory tests. Sera of 64 individuals were also examined for γ-globulin level and were screened for rheumatoid factor. Seven of the subjects also underwent a gingival biopsy. Three men who had persistent proteinuria underwent a percutaneous renal punch biopsy for detection of amyloid; the results were normal. Sera were drawn from 102 healthy blood donors in the same age group to serve as a control group for the electrophoretic and hexosamine studies.

Again, none of the nonoccupational illnesses occurred at a higher rate than in the general population, and there were no clinical illnesses that could be attributed to intense vaccination. Clinical and laboratory findings that are unexplained by previous illnesses included leukocytosis (n = 11), lymphocytosis (n = 24, with 6 subjects having lymphocytosis at both examination times), and some abnormalities in tests of renal or liver function.

Serum electrophoresis results showed poor separation of α2- and β-globulin factors (n = 19). The mean serum hexosamine level was significantly elevated in the intensively vaccinated group compared to the control group in both 1958 and 1962. Of the 64 sera exhibiting abnormalities on laboratory tests, 10 had γ-globulin levels above normal, 12 showed agglutination of anti-D coated cells, and 22 had positive latex tests for rheumatoid factors (3 subjects were positive on all tests). The amount of antigens received did not explain these positive results. In the seven individuals who did not receive vaccinations in the 2 years preceding this study, anti-γ-globulin factors could not be detected. The causes of the four deaths since 1956 (three acute coronary occlusions and one colon carcinoma) were deemed unrelated to the vaccination program. In the three postmortem examinations performed, there was no evidence of amyloid deposition or other abnormalities in sections of liver, spleen, and kidney.

1971 examination (White et al., 1974). In 1971, 77 members of the original study group were re-examined, ranging at that time from 43 to 79 years of age with a mean age of 55 years. In addition to the basic occupational vaccinations, at least 60 were vaccinated against Rift Valley fever, influenza, vaccinia, yellow fever, brucellosis, and anthrax; 41 against poliomyelitis; and 37 against diphtheria. The individuals had received an average of 55 skin tests (range = 6–93). The vaccination program was discontinued 10 months before this study.

As in the previous studies, each subject underwent a complete medical history, physical examination, electrocardiogram, and extensive laboratory tests. The control group consisted of 26 age-matched, long-term, civilian male employees of Fort Detrick who had never received special vaccinations and were not exposed to laboratory infections. The authors concluded that there were no clinical sequelae attributable to intense long-term immunization. Only one laboratory abnormality, elevated serum hexosamine, occurred that had also been described in the previous studies on the intensively immunized group. During the 1971 exam, there were slight but statistically significant differences in serum albumin, α2-globulin, and β-globulin levels compared to the control group. By 1971, 11 of the original group had died; this mortality rate agrees with the rate



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