Fifty-eight children with Reye's syndrome (RS) confirmed by liver biopsy were treated at the University of Cincinnati between 1963 and 1974. Cases were clustered in the winter and spring with the peak in February and March. These coincided with the occurrence of influenza and, numerically, were associated more closely with influenza B than with influenza A. Six of the 58 cases were associated with chickenpox. Twenty-six children with RS were seen from 1963 to 1971, before the beginning of a systematic epidemiologic and virologic study. Viral infection was documented in either the patient or a contact in only 19% of those studied. Between 1971 and 1973, after the study was initiated, 16 cases of RS were diagnosed and viral infection was confirmed in 56% of these. In 1974, an epidemic of RS occurred during an influenza B epidemic and viral infection was found in either the patient or a contact in 81% of 16 cases. This study demonstrates that an association with viral infection can be proven in the majority of cases of RS when an intensive investigation is undertaken. During this study no significant environmental toxic exposures could be idenified. Most children had taken aspirin and other medications, and seven children had a history of excessive aspirin ingestion.

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A live, attenuated, recombinant influenza vaccine (Alice strain) administered intranasally was evaluated in high school students and compared with intranasal placebo and subcutaneous, inactivated, bivalent influenza vaccine. The Alice strain was antigenic, increasing the geometric mean titer (GMT) from a prestudy level of 30.2 to a postvaccine level of 189.6. The inactivated vaccine increased the GMT from 32.9 to 361.8. There was no increase in the GMT among the placebo recipients. The Alice strain produced little reaction. With an antigenic, safe, acceptable, live, attenuated influenza vaccine available, immunization on a widespread basis should be considered.

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