ORAL HISTORY PROJECT

Martha Lipson Lepow, MD

Interviewed by Danielle Wales, MD, MPH

January 11, 30 and March 6, 2017

Albany, New York

This interview was supported by donations from Albany Medical College and Capital District

Pediatric Society

This project made possible by donations through the Friends of Children Fund, a philanthropic fund of the American Academy of Pediatrics.

2017 American Academy of Pediatrics Elk Grove Village, IL

Martha Lipson Lepow, MD Interviewed by Danielle Wales, MD

Preface i About the Interviewer ii Interview of Martha Lepow, MD 1 Index of Interview 44 Curriculum Vita, Martha Lepow, MD 47

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PREFACE Oral history has its roots in the sharing of stories which has occurred throughout the centuries. It is a primary source of historical data, gathering information from living individuals via recorded interviews. Outstanding pediatricians and other leaders in child health care are being interviewed as part of the Oral History Project at the Pediatric History Center of the American Academy of Pediatrics. Under the direction of the Historical Archives Advisory Committee, its purpose is to record and preserve the recollections of those who have made important contributions to the advancement of the health care of children through the collection of spoken memories and personal narrations. This volume is the written record of one oral history interview. The reader is reminded that this is a verbatim transcript of spoken rather than written prose. It is intended to supplement other available sources of information about the individuals, organizations, institutions, and events that are discussed. The use of face-to-face interviews provides a unique opportunity to capture a firsthand, eyewitness account of events in an interactive session. Its importance lies less in the recitation of facts, names, and dates than in the interpretation of these by the speaker. Historical Archives Advisory Committee, 2016/2017 Jeffrey P. Baker, MD, FAAP, Chair Lawrence M. Gartner, MD, FAAP Jacqueline A. Noonan, MD, FAAP Howard A. Pearson, MD, FAAP Tonse N. K. Raju, MD, FAAP Stanford T. Shulman, MD, FAAP James E. Strain, MD, FAAP

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ABOUT THE INTERVIEWER

Danielle Wales, MD, MPH Dr. Danielle Wales is an Assistant Professor of Internal Medicine and Pediatrics at Albany Medical Center in Albany, NY. She graduated with her BS in biology from Boston College in 2005, and a combined MD/MPH degree from Albany Medical College and the University at Albany in 2010. After completing medical school, she completed her Internal Medicine/Pediatrics residency at Albany Medical College, including her chief resident year. After her residency, she served as a Pediatric Hospitalist at Augusta Health in Fishersville, VA, and was on the Pediatrics faculty at Edward Via College of Osteopathic Medicine from 2014-2015. She returned to Albany Medical Center in 2015 and currently practices primary care in Latham, NY. She has a particular interest in immunizations of both adults and children, and quality improvement.

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Interview of Martha Lipson Lepow, MD DR. WALES: Today is January 11th, 2017. I’m sitting in Albany, New York with Dr. Martha Lepow. And today, we’re going to go through Dr. Lepow’s career and many accomplishments. But first, we’re going to start at the beginning. So, the first question that we had to ask you today was: when did you first decide that you wanted to pursue medicine as a career? DR. LEPOW: Okay. Well, I was, I think, about 16 years old at the time. And I was having a conversation with my father, who was a practicing family physician. And I can’t remember exactly what stimulated this conversation, but I remember telling him that I was thinking about what I might do when I “grow up” or when I was going to go to college. I was struggling somewhat with a skill that I already had; I was a fairly accomplished pianist by that point. And the question was whether I was going to go on and pursue a career in music. I knew I couldn’t be a performer, and I was thinking that I really didn’t want to be relegating myself to teaching children how to play the piano. And so, I mentioned to my father that I was really considering nursing. He looked up at me and he said, “Why don’t you think about going into medicine so that you can be in charge.” I’ll never forget that particular conversation. That was an awakening to me. DR. WALES: And that’s around the time where not a lot of women were in medicine, too. DR. LEPOW: Yes, that’s very true. My father was, as I say, in the profession, and never thought too much about who were the doctors. To me, in my mind, they were male. And women were nurses. And I thought I’m a woman, and therefore there’s where I’m going to be. I had taken on what the prevailing thoughts were, that nice girls don’t do real well in math. Whether they could do well in math or not doesn’t matter, but -- that just seemed to be where society was at that time. This was, I think, already during the Second World War. I was born in 1927, and so if I were 15 at that point, this would have been 1942, when I was thinking about that. I actually entered college in 1944. DR. WALES: It sounds like your father was a role model for you, and inspired you to pursue medicine. Would you say that’s accurate? DR. LEPOW: Yes, I think so. Very much so. The other thing that was very interesting in retrospect is that he kind of had a hobby of looking at how people walked. We would be out in the car, and he would point out somebody, say, “That person has had a stroke.” Or, “that

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person has tabes [dorsalis],” which is a form of tertiary syphilis, or, “that person has polio.” The person would have a limp and kind of a withered leg or a leg with a brace, or might walk with a crutch or with a cane. That kind of thing. DR. WALES: Did he offer any other encouragement along the way? DR. LEPOW: Oh, not at that particular point. I know that when I finally did enter college, several years later, I entered with the idea of being a pre-med career. But I went to Oberlin College which was giving me some opportunities to enhance music and perhaps piano, and even possibly some other instrument. DR. WALES: So, when you were at Oberlin, what was your major? DR. LEPOW: Chemistry and pre-med. DR. WALES: And did you pursue piano while you were at Oberlin, as well? DR. LEPOW: I didn’t. I did take organ lessons. I was trying to diversify with the keyboard. Later on, I took up the harpsichord, too. DR. WALES: At Oberlin, were there any role models for you or people who encouraged you to go into medicine there? DR. LEPOW: I think the pre-med advisor was probably the best person. He was a chemistry professor, and he was also the pre-med advisor. Oberlin was one of the first colleges that actually took in women in 1833. The pre-med advisor was encouraging in terms of medicine, but I don’t know that it ever came up in the conversation. DR. WALES: That you were a woman? DR. LEPOW: That I was a woman and wanting to do this. I mean, it didn’t seem extraordinary. And he thought, you know, with my personality that I would deal well with patients. I would be a good practitioner, and he encouraged me to pursue questions, scientific questions, if that were my bent. And I know I got a good recommendation from him for application to medical school. There were 5 other members of my Oberlin class who eventually joined me as freshmen at Case Western Reserve [University], the class of 1952. DR. WALES: Out of your pre-med class, how many women were there?

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DR. LEPOW: I don’t really remember. There weren’t many. [Laughter] If any. DR. WALES: And when you went to Case Western, what was the size of your class? DR. LEPOW: Yes, well, the total class size was 87, of which I was one of 7 women. DR. WALES: What was it like, applying to medical school? DR. LEPOW: Oh, I sent in the applications. I was interviewed. I applied, actually, to Case Western, Ohio State, and Northwestern. I can’t imagine why I did Northwestern at this point. [Laughter] But I sent in the applications. There wasn’t any matching or anything like this at the time. We sent them in in our senior year. There was already MCATs [Medical College Admission Test], which I took. I did well. I was not the top in that, but I did well enough to make the cut, certainly. And then, I think I applied for an interview. I can’t remember exactly that process. But it occurred sometime in the spring of my senior year, which would have been the spring of 1948. DR. WALES: And it seems like you applied to a lot of medical schools in the Midwestern area. Is that where you were living at the time? DR. LEPOW: I was born and raised in Cleveland. I grew up in Cleveland Heights and I had not traveled very widely. I was active at that point in the war effort as civilians were. My father was 41 on December 7th of 1941. The cutoff for being recruited into the medical corps of the US Army was 40. But, later on, he was a volunteer in the recruitment office in Cleveland, for several years during World War II. DR. WALES: Did you volunteer for any efforts during the war? DR. LEPOW: I was part of Junior Red Cross and some things through our high school. DR. WALES: During medical school, did you pursue any other interests, as well? Did you start any research projects? DR. LEPOW: Not particularly. I came in with a good background from Cleveland Heights High [School]. I was, you know, National Honor Society. I’d been an honor student. We had pretty rudimentary biochemistry at that time. My years at Oberlin extended my foundation in science. I found medical school was a challenge, particularly in the basic

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sciences. The clinical was also challenging, because this was the time when there was a great amount of discovery. And maybe we can go into that a little bit later on. DR. WALES: So, after Case Western, where did you then apply for internship? DR. LEPOW: Well, being a local person, not having much experience outside, our advisor was actually the dean of the medical school. He was a pretty remarkable man. He had come from Columbia, originally, and was sort of a specialist in growth and development; not particularly in pediatrics but just in the whole spectrum of human growth. I think he was probably ahead of his time. There was a committee, but really he was the one that got me accepted into medical school. I was a good student. I was AOA [Alpha Omega Alpha] at that time. He suggested that I go to Boston. But you had to take an exam there to even to be an applicant for internship or residency. The other place he suggested was Columbia [University] in New York. I felt Boston was probably out of my realm. I mean, just the idea of going to a strange place, taking an exam, all these things. I wasn’t terribly excited about that. But I did apply for an interview at Columbia. I sent in my application. And you applied for an interview, pretty much like they do now, but they will review your credentials and see if you should come. So, I drove myself from Cleveland to New York. And I stayed overnight, and I went over to Columbia-Presbyterian [Medical Center]. I can’t really remember much about the interview except it was something that just seemed so far away from me that I really decided at that point I was going to go for pediatrics, which was pretty new at that particular point. This is 1952, when I graduated from medical school. And so, I ended up applying to the university hospitals. I was a little bit undecided between medicine and pediatrics. Had there been Med-Peds [combined internal medicine and pediatrics] at the time, I’d have been there in a second. [Laughter] I loved internal medicine, and it was exciting, and that’s where advances were coming. The thing about pediatrics was the challenges, particularly of the infants and cystic fibrosis and leukemia and all these things that affected children. So, that’s where I went, and I stayed in Cleveland for the residency. DR. WALES: Did you face any challenges as a woman in medical school or residency? DR. LEPOW: Not really specifically. I think it was more innuendos. Some bad jokes, and some locker room humor, maybe. Certainly not from my classmates at all. I think I was well accepted. Most of my classmates had been in service. Many of them were already married. There wasn’t a lot of

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social contact, other than the fact that we were together a lot of the time. Everybody sat in the classroom. Nobody skipped classes. This was quite different from the way [Laughter] it is now, 60-some years later. We didn’t have computers. Everything was handwritten and etc. We did have projectors, and things would come up on that. The only thing was some of the attitudes of some of my teachers. And particularly on of the clinical specialties, but not the medical specialties. More in the surgical specialties; there I felt denigrated. DR. WALES: And what were your plans at that point, after completing a pediatric residency? DR. LEPOW: At that particular juncture, I was thinking probably pediatric practice. I hadn’t really thought about specialties yet. Specialties were much more advanced in internal medicine than they were in pediatrics. So, I had an open mind at that point. And I have to say, in my clerkships, I really liked every rotation; I even liked the surgical rotations. Even though I was on at the end of a retractor. [Laughs]. But I had found out that one of my own skills was being able to talk to people. And I think my experiences with my father contributed to that. I mean, I learned a lot of medicine, because I used to hear the phone calls. I sometimes went with him on making house calls. So, you know, I knew the scope. This was the time when everything was going to change, or was in the process of changing. We had penicillin. In 1945, my second year in college, penicillin was licensed. Suddenly, the whole scope of medicine changed. As I say, I really struggled between medicine and pediatrics. But it was the challenges of pediatrics and the knowledge that there was going to be things that we could learn to do, learn about kids. Even in the next year or 2, during the course of my residency, we had, suddenly, in 1953, the description of DNA. So, 60 years later, here we are, and still playing that part of the scenario out. DR. WALES: At some point, I understand you got involved in research during your residency. How did you get involved in research? DR. LEPOW: [Laughter] Well, sometimes things happen. I’d say the big turning point of my life occurred during that residency. And it occurred on the second year of it, which would have been in 1953. Pediatric residency was 2 years at that point. The first year, I did at university hospitals. It was just called Babies & Children’s Hospital. That’s where I had been an acting intern. I knew the place. I knew lot of the people. So, that was exciting. In 1952, we had the greatest incidence of polio in the United States since 1916. And that was a major epidemic. We already knew that there was going to be a vaccine that was in the process of being developed. That much I knew. Didn’t know very much about it. So, the first half of my second year, I was

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assigned to the then City Hospital, which is now MetroHealth. It is on the west side of Cleveland. It was a major teaching hospital at my medical school. On July 1st of 1953, when we checked out at midnight, I turned into a pumpkin [Laughter], leaving one place and going to the next. When we went to make rounds at 8 o’clock in the morning, that residency was half in the infectious disease unit and half in pediatrics. There were 3 months of going to the infectious disease unit first. There was a whole ward full of patients, mostly young adults. And one part of the general hospital, they were not isolated. But in an area which was sort of the contagious disease area, because there were still children coming in there with measles who couldn’t be taken care of at home. Whooping cough, meningococcal disease. But this ward full of polio patients, they were almost all young adults, and in ventilators, these iron lungs. They looked like coffins, but their heads would stick out. And this was almost something surreal; I’m looking for a word for it. It didn’t really seem real that morning. DR. WALES: Almost surreal. DR. LEPOW: Yes, surreal. They had a wonderful attending there. His name was Dr. Robert Eiben. He just recently passed away. He is one of my heroes, you know? He was the most kind, compassionate physician. He trained in pediatrics, but he was a doctor for all of these patients. I probably not only learned so much from him about the care of these patients, but also what work needed to be done to prevent this disease. So, that was what we were assigned to, and there was me and a rotating intern on this polio floor. Now, this was also in the summer, so there were already new cases coming in. They were in a little separate area, but still in that same building. Each of these floors had at least an intern. I remember that we had to take care of all the polio patients. There were other people doing other things there. My other great mentor there, which I’ll come back to, was Dr. Fred [Frederick Chapman] Robbins. So, your question -- I’ve gone a little bit before the research. DR. WALES: Yes, my understanding is that you actually played a significant role in Dr. Robbins’s lab later. So, I’m curious about how Dr. Robbins involved you in his research. DR. LEPOW: Right. So, I was on this unit. I learned a lot about teamwork, in the first place, before I come to this prevention stuff. I learned a lot about teamwork. There still isn’t any cure for polio or for any of these other viral diseases. So, the major hope would be a vaccine, which I hadn’t heard too much about as a medical student. The first year, we had seen polio over at the Rainbow Hospital [now Rainbow Babies and Children’s

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Hospital]. But they did not have ventilators there. So, I had seen most of these before they were admitted. They’d come to the emergency room in various stages of muscle involvement, and some at home. Some looked like they were going to progress and were sent over to City Hospital. Some were admitted, but I did not take care of enough polio patients in the year to really know what to do. So, Dr. Robbins, I do have to digress on that and who he was. He was a pediatrician who as a fellow had worked with 2 other colleagues at Boston Children’s [Children’s Hospital Boston], Dr. [John F.] Enders and another fellow, Dr. [Thomas H.] Weller. And they were trying to isolate viruses in tissue culture, which had been developed. This is the living cells growing in vitro that could support viral growth. As you know, you have to have living cells. Even until this day, you cannot make an artificial media that’s going to support the virus. The virus has to grow in living cells and has to incorporate itself into the cell and kill it. So, they had, as a team, been able to grow polio virus in tissue culture. When he finished the fellowship, he was recruited to Cleveland, to City Hospital, to become head of pediatrics there in 1952. So, he’d been there a year before I came over, in 1953 and he had an active virus lab going. We were starting to collect specimens from the new patients who were coming in to identify the type of virus it was. Also, we were drawing some blood samples to look for their ability to make protecting substances, antibodies. A lot of this work was done in several different laboratories. In fact, 8 different laboratories across the country. It was part of the precursor of the Salk vaccine field trials, which occurred during 1954, in the spring of the next year. See, I was there in July of 1953, and this trial was going to go on. I got more interested at that point in the collecting of samples. I’d been interested in epidemiology. There was very good epidemiology taught in my medical school. And so, I’m always thinking about incidence of and control of infectious disease, etc. So, there were things incubating in my mind and I thought, ‘Gee, you know, it’d be very interesting to work in these things.’ And during those 3 months, Dr. Robbins had wanted to know whether I would have any interest in helping to start an adolescent program when I finished the residency. He was way ahead of his time, clinically. I mean, adolescents were kind of lost as far as the medical profession was concerned. [Laughter] I had worked in summer camp for a number of years as a counselor. I dealt with teenage youths, and had been a teenager not too long before. [Laughter] I thought that would be great. There was a program at Boston Children’s [Children’s Hospital Boston] and I was going to think about doing that. We didn’t go much further than that at that particular point. So, I finished my couple of months there in the contagious unit. Then I went up to pediatrics, and that was an interesting place, too. That is where

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we were taking care of, largely, children who were poor. The place was full of infants with diarrhea. DR. WALES: That was at City Hospital? DR. LEPOW: Yes, City Hospital. And this was 10 years before Medicaid. In Cleveland, there was marked segregation for medical care. This was a whole ethical thing that had always bothered me, even earlier on. It was all the separation. It was not to the point of getting up and screaming about it or doing anything, but things that just sort of percolate with you. DR. WALES: So you were planning to do adolescent care, and then your plans got derailed by a medical issue? DR. LEPOW: That’s right. I finished in December of 1953. I was destined to go back to what’s now Rainbow Babies and Children’s to finish the other 6 months. Dr. Robbins had also asked I would be interested in being a chief resident for a year. I said I thought that might be good. He really started the department. The residency was sort of evolving. And it was geared to sending people out in the practice. DR. WALES: I’m sure you would have been the first female chief resident, too. DR. LEPOW: I’d have to say that, over there, it didn’t matter. It wouldn’t have mattered what the color of my skin was or whether I dyed my hair or not. [Laughter] I was a doctor. I was contributing to the care of patients. They weren’t differentiating who we were. Along the way, there were a few nurses who were a little bit snooty about even seeing me as a resident. You know, this is along the way. Not at Rainbow, but Dr. Robbins and Dr. Eiben, those 2 people -- and there was a third person, is -- Ted [Edward] Mortimer [Jr.], who became well-known in general pediatrics, and also worked with streptococcus and rheumatic fever. He was a wonderful teacher. These people were -- all 3 of them, great mentors. One of the requirements of going back to Rainbow Babies was to get a chest x-ray, and mine had an abnormality in it. There was some right upper lobe infiltrate, and so they made a clinical diagnosis of tuberculosis. And so, I got suddenly derailed and all plans changed. I was actually admitted to the local TB hospital. The timing turned out to be fortuitous, because streptomycin had come into being and was licensed as an effective treatment for pulmonary tuberculosis in 1948. And so, the hospital where I went was not as full as it had been a few years earlier. There was also isoniazid out there.

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I had to stay in there for 6 months. And then, they gave me streptomycin, and I took 24 pills a day of something that’s called para-aminosalicylic acid, PAS. That was the second drug. And I gave myself streptomycin twice a year, injected in various sites that I could reach with my 2 hands. DR. WALES: Right. [Laughter] DR. LEPOW: Anyway, the various extremities and parts of extremities. We’ll leave it at that. And so, that was one turning point. And then, the next turning point was what was I going to do when I finished being in the TB [tuberculosis] hospital, which was right on the same campus? DR. WALES: Same campus as Rainbow Babies or City? DR. LEPOW: It’s all part of the City Hospital. The psych hospital is there and a TB hospital. I was feeling good, and was on modified rest. In May of that year, Dr. Robbins came over one day to visit me. And he asked me, “So, what are you going to do now?” They wouldn’t let me go back to work for another 6 months, to finish my residency. And then we’d already decided I would just stay at City Hospital, rather than go back to Rainbow Babies. So, he said, “Well, we could use you in the virus lab.” I’d never even seen the virus lab, which was down in the basement near the autopsy area. By the way, the pathologist was also the pathologist for the zoo. And so, sometimes we would have animals from the Cleveland Zoo brought in there, too. [Laughter] And it did not have air conditioning. It did have hoods. The work was basically making tissue culture and processing specimens. He was emphasizing the polio, but he was also looking ahead and thinking about trying to work on rubella, to see if he could isolate German measles virus. DR. WALES: And what was he using for tissue culture? DR. LEPOW: We were using cynomolgus monkey kidney. And the Salk vaccine was also produced in baboon kidney -- primate kidneys. The way we got our kidneys was from the neurosurgeons. They were working on ventriculo-ureteric shunts, studying that in primates, as a forerunner for treatment of hydrocephalus in kids. This was all supported by the National Foundation for Infantile Paralysis, which maybe we’ll have some time in the future to talk about that. But they would get them from the Philippines. They were just out of the jungle. But they had been exposed to tuberculosis themselves, through, I think, their captors and in the time they spent in captivity before they were sent for research. They used to come in on Saturdays. So, one of my jobs was to feed the monkeys in the cage on Saturdays. The people that took care of the animals would come in on

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Monday mornings. So, I used Wonder Bread and oranges. And there was a little place where you could throw the food into the animals so that you wouldn’t get your fingers bitten. And I would stand there and watch these monkeys carefully peeling the oranges. [Laughter] So, that was my first experience. Anyway, he took me up to see the lab and all that, and I said, “Sure.” And so, I started a couple of weeks after I got out of the hospital. My father was still alive and was still in Cleveland. He was not in good health at that particular point, so he was only minimally practicing. So, I went back to my home for a few weeks and reorganized my life. And then, I went back and stayed in the nurses’ dorm where I had stayed as the resident. That was one of the things. We got room and board over there, and I think we got paid $100 a month or something like that. But wasn’t very much. And so, I just stayed in a room there. DR. WALES: How long were you hospitalized for? DR. LEPOW: Five and a half months. I got out at the end of May. DR. WALES: Okay. DR. LEPOW: I was admitted the first or second week in January. The room became available again for me to stay when I decided I’d go in the virus lab. That was at the end of May. The vaccine trial was in full force, and there were 8 labs in the country that were regionally placed to work up sera from vaccinees. There was a massive field trial that was going on that was supported by the March of Dimes, the National Foundation for Infantile Paralysis. DR. WALES: And that was in 1954? DR. LEPOW: Late winter into the spring of 1954. It was in all 48 states at that time. And there was one rural county and one urban county. The age group were second graders, and it was a placebo control trial of about 600,000 children, in each arm of the trial. So, it was over a million kids. Then, there were uninoculated children in the first and third grades who were controls. And this was done through the schools. There was about an 80% compliance with the parents for this trial, which is the 3 doses and a certain percentage then got blood samples. Our lab was a reference lab for Ohio and Indiana, and all these specimens were already coming in. DR. WALES: And what type of specimens?

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DR. LEPOW: Well, we got blood samples, mainly, without knowing who they were from. They were just numbers. DR. WALES: Did you deal with cerebrospinal fluid? DR. LEPOW: We got some of that. Any child who was registered as in the vaccine trial who developed a polio-like disease or similar disease to polio -- not all of them were polio. We got into other enteroviruses, which is another part of the story on this, much later. But anyway, we had both, so in the summer months, we got spinal fluid, we got some rectal samples. All of the blood just came in these big tubes. They were vacuum containers. Hadn’t been spun down, even. I’m surprised that we were able to do as much as we could. We used some micropipettes and set up antigen antibody. We were looking for antibodies. We had to have a virus source, and then we would pipette in fresh new cells, which we made from these kidneys. I had to go to Dr. [Jonas] Salk’s lab in Pittsburgh, and I met his head technician, Dr. Julius Youngner, to learn this technique. I never met Dr. Salk. They were growing the virus in many gallon roller tubes of baboon kidney. I learned the technique of working up microneutralization tests. It was me and a technician, and Dr. Robbins would come in every morning and ask for results. He was kind of funny. He and Dr. Eiben were out there working up new patients. So, obviously, I got hooked on this. When I could go back to the residency, they decided I should be chief resident then. So, for a year and a half, I was the chief resident there. But I divided it with another person, so I had 6 months in the lab and 6 months on the clinical service. By the end of that, I decided I was going to commit myself to further fellowship in infectious disease. DR. WALES: So, how long did you spend in the lab? Six months? DR. LEPOW: The 6 months until January 1st of 1955. I went back and I just stayed at Metro. I learned a lot. I learned how to be a good teacher, for all the people who were coming along and working in the lab, suddenly. You know, I was involved in the forefront of eradication of a terrible disease. DR. WALES: I believe that means while you were there, Dr. Robbins actually won his Nobel Prize. Is that right? DR. LEPOW: That’s right. They won the Nobel Prize in 1954. It was during my time in the lab. DR. WALES: And what was the reaction like back then?

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DR. LEPOW: He had a great deal of humility about it. I mean, he had gotten wind that they were under consideration. And there were competing people who could have gotten the prize. One would have been Jonas Salk, and the other one would have been Dr. [Albert] Sabin, who ultimately developed the oral polio vaccine, the one to be given by mouth. We were in the lab, and this announcement, of course, had come over the television at that point, in the morning. You know, on the morning news, in the papers and all that. And he had a great deal of humility about it. He said, “Today is a regular workday, okay?” You know? [Laughter] We weren’t going to go out or do anything. There were the ceremonies and all that. Dr. Enders didn’t really like to fly. The other 2 flew to Stockholm; I can’t remember exactly when. I think it was shortly after the announcement. The announcement was October or November, and I think they went before the New Year. I think it was in December that they went. Dr. Enders would not fly, so he had to go by boat, which is about 2 weeks ahead of time. But he did get there. And their respective spouses came too. DR. WALES: It seems like Dr. Robbins played a significant role in your career path. DR. LEPOW: Yes, the trajectory all changed. DR. WALES: How was he as a mentor for you? DR. LEPOW: He was an excellent mentor. He was an excellent doctor. Dr. Eiben was probably the more experienced clinician, but Dr. Robbins, by virtue of this prize, opened doors for getting this vaccine, when the vaccine was licensed the following April. But there were already plans, how it would be disseminated in the States, and then worldwide eradication. He had a lot to do with that, first of all with the Pan American Health Organization [PAHO], which was already in existence. That’s for both North and South America. And then, ultimately, worldwide. He had a lot to do with maximizing the notoriety, as he called it. He retained a great deal of humility. Eventually, he became dean of the medical school, then on to the Institute of Medicine. DR. WALES: Did he or any of your other mentors teach you any important lessons during your training? DR. LEPOW: I learned that once you take on something, you do it. Do all the steps and do it all right. Whatever you’re going to do, be excellent. And I do think I had that instilled in me much earlier, as well. Compassion was part of my being. Drs. Robbins and Eiben both inspired me, but mostly

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Dr. Robbins, because he helped me to move on academically. I would not have gotten where I ultimately landed without having had this kind of experience. I also learned how to write papers, and then we got into very interesting work. We had all these specimens from the vaccine trials that we started to work up, spinal fluids and others. There were 8 labs doing similar work, and after a few years, there was a conference through the New York Academy of Medicine, titled, “Viruses in Search of Disease.” Some of them had turned out to be Coxsackieviruses that didn’t grow in tissue culture. DR. WALES: Do you think any of your mentors during your residency or fellowship influenced how you approach patient care? DR. LEPOW: Yes, I think there were 2 of them. One was Dr. Robert Eiben, who was at the City Hospital. He was one of the kindest human beings I think you’d ever have met. He was an excellent doctor. Eventually, when polio was essentially eradicated and these iron lungs became obsolete, he became one of the early pediatric neurologists. He just recently passed away. He was well into his 90s. He remained as a teacher and consultant in neurology at the City Hospital for the rest of his life after that. And he was certainly a great mentor. He dealt with the patients and their families with this horrible disease. I learned a great deal from him, and also from Ted Mortimer, Edward A. Mortimer. Ted was a pediatrician and diagnostician, with a great sense of humor. He was an excellent doctor. And, again, went beyond just the patient. He worked with Dr. [Charles] Rammelkamp, who was at the same institution. Dr. Rammelkamp was the one that showed that penicillin given prophylactically to Air Force recruits eradicated group A strep and therefore prevented rheumatic fever. He carried on with that in South America and Chile, doing studies there for some years. He certainly had a very inquiring mind, as well. So, those are the people who really influenced me the most clinically. Dr. Robbins was a very good doctor, too, but his goals were more to extend the vaccine, help to make it available elsewhere. He had a lot to do with Pan American Health Organization, getting North and South America polio-free. DR. WALES: I understand that you met your husband in the process of working in the lab. DR. LEPOW: Yes, it’s a good story. It reads like a novel, but it was absolutely real. I was in an infectious disease fellowship, supported by the National Foundation for Infantile Paralysis, starting in the summer of 1955. I was now on a trajectory, possibly, for an academic research career, maybe going toward a PhD. But I already knew that wouldn’t happen, sort of like

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with the piano, which has always been there, too, you know? I still play the piano and enjoy it and make good use of it. It’s great medicine for me. DR. WALES: Right. DR. LEPOW: Beats paying a psychiatrist. Anyway, this was in the second year of the fellowship, and there was a medical student by the name of Irwin “Lee” Lepow. I had known him when he was a PhD student at our university at the same time as I was in the medical class. So, he took some classes with us, but I didn’t know very much about him, and certainly didn’t know anything about him socially. He was studying complement, and with some successes. He was in a trajectory of his own. After the PhD he went into medical school, because he wanted to deal with people who had autoimmune disease and so on. So, he wanted to learn some tissue culture to use as an indicator system for certain things that he was manipulating. And I was the queen of tissue culture in the area at that point. He came over and talked to Dr. Robbins, who then introduced him to me. He said, “You know, Irv is a medical student.” I said I knew who he was, and I said, “Hi.” Dr. Robbins said, “He wants to learn tissue culture. He’s going to be here for 2 months. He wants to see some patients. He wants to do it as an elective, as well. So, I want you to take care of him.” And Dr. Robbins put this whole plan on my shoulder. This is December 1st of 1957 so and he said, “You take care of him.” DR. WALES: And this is while you were a fellow? DR. LEPOW: This is in the second year of my fellowship. And so, I smiled and we got married 2 months later, on February 7th of 1958. DR. WALES: That’s some story. [Laughter] Did you ever discuss research over the kitchen table? DR. LEPOW: Sometimes. I ended up, actually, being helpful to him and his colleagues by providing them with infant and early child sera, which we had been collecting for some of our studies, and which offered them the opportunity to look at the natural development of host responses to infection. DR. WALES: Now, after completing fellowship, where did you go next? DR. LEPOW: Well, I didn’t complete the fellowship because I got married. I married a man that had a child, who was 7 years old, from a previous marriage. And he was a widower. And I decided that I was not interested in really doing that third year. The following summer, I would

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have gone to Boston. There was no way I was going to do that. So, at that point, I had a teaching appointment in Pediatrics in Cleveland. I came in as an assistant professor. Lee was already there. He was moving toward becoming a professor and doing his research in experimental pathology. This was 6 years out of medical school for me, and he was in his fourth year. He had been teaching medical students in his field along the way. He was earning something as a teacher, and didn’t have to pay too much tuition. He was also in AOA [Alpha Omega Alpha]. So, he was a very bright man, and would have been an excellent doctor. But he never intended to practice. My life was going to be academic with continuing research in Dr. Robbins’ lab, but I would then get salaried as an attending. DR. WALES: Did you work on the wards? DR. LEPOW: Oh, yes, I worked on the wards. I was doing that during the fellowship, anyway. I was a teaching fellow on the ward, so I never gave up the clinical at all. And the kind of clinical material there was just incredible, you know? It was very interesting. And then, Dr. [Charles H.] Rammelkamp, who did the streptococcal work that showed that you could prevent rheumatic fever, worked right down the hall from us. There was a lot of excitement going on around that, as well. It was very interesting. DR. WALES: After you worked on polio, did you move on to research on other viruses or pathogens? DR. LEPOW: We moved onto Coxsackie, and then these so-called echoviruses, which were viruses that were not identified as polio or Coxsackie, but were enteroviruses that produced similar symptoms, but did not cause paralysis. And we got grant support for that, but it never would have happened without Dr. Robbins. He had the clout to be able to get money. We also set ourselves up to be a diagnostic lab for Cuyahoga County for polio-like diseases. DR. WALES: I would like to finish up today’s session with one more question. What do you consider your greatest accomplishment during your career? DR. LEPOW: Ah, boy. People have asked me that before, and I think probably the Salk vaccine. Because that was the turning point in my life. And if we want to look at what’s gone on now, I look back between 1960 and the present time, and just looking at infectious disease, social changes and cultural changes, political evolution. TV, and the goods and the bads of TV. You’re getting, now, all these wonderful things. You run out of money. We cannot afford our lifestyle, with all the wonderful things that we have. And

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the equal opportunity [Equal Employment Opportunity Act of 1972] is what’s made the difference in terms of women in medicine. That was 1972, and prior to that, there hadn’t been too much change in numbers of women in medicine, particularly in the basic sciences. There was kind of a prejudice there in terms of grants, a belief that people who were in the child-bearing period didn’t compete very well. Women didn’t compete very well. But what’s happened in infectious disease and in my life have been unparalleled. END OF AUDIO FILE 1 DR. WALES: Today is January 30th, 2017. My name is Danielle Wales, and I’m interviewing Dr. Martha Lepow today, who is Professor of Pediatrics at Albany Medical Center. We’re in her office today, and we’re doing this as part of the American Academy of Pediatrics Oral History Program. Tell me about when you started medical school. DR. LEPOW: 1948, the year I started medical school, was the year the Cleveland Indians won the only World Series that they ever had in the whole 100 years of their history. DR. WALES: And you were there, right? DR. LEPOW: And I went. My father had tickets for the first game of the World Series. DR. WALES: And did they win that game? DR. LEPOW: They won that game. DR. WALES: Very good. DR. LEPOW: They won the World Series, too. DR. WALES: Very good. DR. LEPOW: Unfortunately, they lost it this year. DR. WALES: Yes. It’s so funny how that comes full circle again. I recall that you talked about a patient named Kathy, during your residency.

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DR. LEPOW: Yes. Kathy was a 5-year-old that came in 1953. She had a brother, Michael. The father was a policeman and I’d known him from my internship, from the emergency room at Babies and Children’s. Kathy’s brother had polio, and Kathy became ill, and then she had an ascending paralysis. She was not able to breathe. She did not have bulbar symptoms, so she could still swallow but she could not breathe on her own. She learned how to do frog breathing. I’ll never forget her, because if they had to open up the tank for any time, to help her wash and things like that, she would do frog breathing. She would lap air, and force it down. I don’t know how she did it, but she just did it naturally. She went home, and they lived pretty close to a police and fire station, in case of electrical outage. They were pretty close to university hospitals, too. The iron lung went home with her. Unfortunately, she came back with pneumonia 2 years later and then she passed away at that point. Brother Michael had a weak leg but, with physical therapy, he did quite well. An older brother was not affected.

Dr. Martha Lepow reads to Kathy. Photo first appeared in Dr. Martha Lipson Lepow, “Love in the Virus Lab,” in Polio, ed. Frederick C. Robbins and Thomas M. Daniel, University of Rochester Press, 1997. END OF AUDIO FILE 2 DR. WALES: Today is Monday, February 27th. We’re in Dr. Martha Lepow’s office at Albany Medical Center in Albany, New York. We’re going to continue our interview today. And today, I was going to start with this question: after completing fellowship, what did you do next? DR. LEPOW: Well, I did not actually complete the fellowship. I finished 2 years of it. The fellowship was supposed to continue for 3 years. I was supposed to go to Dr. Enders’ lab to spend the third year of it. This was in preparation, possibly, for my going to get a grant for further work in

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virology, which required a certain amount of experience in that lab. However, I met my late husband during the second year of the fellowship. He was a medical student in his final year of medical school, but had gotten a PhD before that in immunology. And he was interested in learning tissue culture to apply to some of his own work. We married shortly after we met, and at that point, I gave up the fellowship at the end of the second year and was appointed immediately as assistant professor at Western Reserve Medical School. I continued as a faculty member for several years. My appointment was at the City Hospital, which is a teaching hospital of the medical school. And it was defined as research, teaching, patient care, and administration of the division. DR. WALES: And speaking about your husband, you said you met him during your second year of your fellowship? DR. LEPOW: That’s correct. DR. WALES: They say that everybody who meets the right person always learns an important life lesson from their partner. Do you think you learned any important life lessons from your husband? DR. LEPOW: I think so. I think I matured as a parent, because he had a child by a previous marriage, who was 7 years old when I met her. I learned how to balance my career and family, sometimes with difficulty. And certainly, I think both of us learned from each other in terms of the basic work that we were doing -- independently, but ultimately more together. DR. WALES: While you stayed on as faculty, what sort of research projects did you work on? DR. LEPOW: Well, the Sabin oral vaccine, which became licensed in 1962. And although we assisted in the utilization of it, because it was laid out initially in mass vaccine clinics, we assisted with that outside of our lab and moved into the community to be helpful on those things. And then, we moved on to measles as a collaborative study with Dr. Enders’ group again. And then, rubella over the next 3 to 4 years. Meanwhile, following the epidemiology of acute central nervous system disease, “polio lite,” without paralysis, which turned out to be Coxsackie or echoviruses. DR. WALES: Now, can you elaborate with the Sabin oral vaccine? I understand that the studies were initially in Russia before it came to the US. DR. LEPOW: That’s right, yes.

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DR. WALES: Did your group determine the efficacy after its release? DR. LEPOW: Actually, we tested it in younger infants to see how early we could administer it. And we tracked the use of it, but not in any official capacity. DR. WALES: And tell us about your role in the development of the measles vaccine. DR. LEPOW: Well, we collaborated in a multi-center study with Dr. Enders’ group for the inactivated measles vaccine, which is the first one. That was not a mass immunization, but relatively select. And that was done in children of members of our faculty who agreed to allow us to administer the inactivated vaccine to their children and get blood. So, we had a relatively small group of about 30 children that we followed, starting around the age of a year. DR. WALES: And which strain of measles vaccine was used? DR. LEPOW: Well, it’s the Edmonston strain. But the first one was an inactivated vaccine that had a lot of side effects to it, unfortunately, with fever and local pain after injection. So, it was actually administered with gamma globulin to modify that response. And then later, we participated in several of the mass trials with the attenuated vaccine, which we still use today, with some modifications. DR. WALES: Did you have a personal experience with measles that influenced you during the development of the vaccine? DR. LEPOW: Well, one of the subjects in this was my young son, who was actually less than a year old at the time. And we found out later that a maternal antibody lasted up to age 1 year. So, he failed, but he didn’t suffer any ill effects from it, and he was then immunized as soon as it was made available. DR. WALES: You said you also worked on studies with regards to rubella vaccine, too. DR. LEPOW: Right. Well, there was a group from NIH [National Institutes of Health] that actually was able to isolate that virus. That was the first or the second live attenuated virus. We participated in some of the trials on that, as well. Clinical trials. DR. WALES: Was it exciting to participate in those trials for measles and rubella, which are diseases that we really hardly see anymore?

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DR. LEPOW: Oh, that was very exciting, particularly measles because of the severity and infectivity of the virus. That was nice, to be able to see that disappear. With rubella, it was largely related to the congenital rubella syndrome, in 1964. And finally, 50 years later, fairly recently, the entire United States and its few international sites were declared free of congenital rubella. So, it takes many, many years, just like with the polio, to try to see if we can conquer it. But that has been much easier to do than the polio has been. The congenital rubella is still out there, but all Europe is almost free now, and Asia, also. They’re working; there are certainly products that are being delivered -- I don’t know of anything that is as widespread, in terms of eradication, as that one was. Mr. [Bill] Gates is now involved in a number of these other vaccines, as well. DR. WALES: When was the last time you saw a case of congenital rubella syndrome? DR. LEPOW: Oh, I’d say probably 50 years ago. DR. WALES: It certainly sounds like that’s something that we never want to see again. DR. LEPOW: Absolutely. I mean, those poor babies. They had eye problems with cataracts and congenital heart disease, most of which was already correctable. And the hearing and eyes were the major disabilities. The deafness was pervasive. It was a nerve deafness and there was nothing left for hearing aids or anything else. So, they contributed significantly to the population of deaf children and then, later on, deaf adults. But it was not infectious early on in the same way as the polio was. DR. WALES: Did you continue to keep the same mentors when you were junior faculty in Cleveland as you had during your residency and fellowship? DR. LEPOW: I did. Also the department grew and we had somebody that was working in metabolic disease. We started a neonatal program without ventilators; those came later. It was not easy to keep premature infants alive if they needed respiratory support. But there were studies underway for them for metabolic processes, although the technology was not very great and newborn screening hadn’t come in yet for activity. But we were concerned about neonatal sepsis and serious viral disease. And, in fact, we did have the opportunity to see congenital Coxsackie viral disease, which mimicked severe infection in newborns. DR. WALES: Any other projects that you remember working in Cleveland?

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DR. LEPOW: When we left Cleveland in 1967 for Connecticut, which is the next part of my history, we were embarking on looking for efficacy with the newly licensed measles vaccine. When we went to Connecticut, I sort of planned to do that. I would be working at an inner-city hospital, which the state of Connecticut had taken over until their final building was built. It was 6 miles from downtown Hartford. And one of the first serious illnesses that I saw wasn’t measles. It was lead poisoning. DR. WALES: So, tell us about your work on lead. What inspired you to look at the problem of lead poisoning in children? DR. LEPOW: My residency was very rich in problems. Not only infectious disease, although that was a major thing. One of the first babies that we saw with lead poisoning was a child where the family used discarded lead storage battery coverings, which they bought from peddlers, for heat in pot-belly stoves. These stoves are usually in the center of a kitchen, and this was very old housing. It’s very cold in the winter in Cleveland. So, the younger children slept near the source of heat. There weren’t any basements, and people couldn’t afford oil even if there were some. Coal was expensive. So, what happened was they burned these lead storage battery coverings plus wood for heat, and then created airborne lead, which the baby was breathing. And then there was also the element of carbon monoxide. But I only saw one child with serious lead poisoning, although occasionally we would get children who had suffocated from carbon monoxide poisoning. But that wasn’t what this baby had. The child was brought in with seizures. She was about 6 to 7 months old. This was during my second year of the residency in Cleveland. And unfortunately, that baby passed away before we were able to do anything for her. She had lead poisoning with central nervous system involvement. So, that was something that seemed to be very important to the residents like me who saw this. And we decided to try to do something about it to prevent it. So, that was our first small effort out into the community. And we did design the study to collect urine samples from the children in the neighborhood where this baby had been, and then set up a wider study to collect urine samples and test them for delta-aminolevulinic acid, which is one of the intermediate steps in the development of heme for hemoglobin. And so, that was the beginning. And then, in 1967, we moved off to Connecticut. I practiced in the last remaining city hospital in Connecticut, McCook Hospital in Hartford, serving a largely indigent population there. Again, one of the first children we saw came in with seizures that turned out to be due to lead in old paint. Similar picture. We had a routine picture of the chest at that time to see if

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there was some evidence of infection. And again, we saw pieces of the peeled paint, because they lit up in the plain film. Later, an epidemiologic study was designed to sample for lead intoxication in the census tract where this child lived in Hartford. We first went to the patient’s house. We climbed up to a third floor there in this old, old house. Walked in the door. There was a 2-year-old sibling in there, gnawing on a windowsill. We took a picture of this, with the parents’ permission, without identifying the child, to show the type of public health problem that existed. This led to a whole series of community epidemiologic studies, and then an effort to be a little bit political. Connecticut is a small state, and environmental toxicology was all housed in the state health department. We started to work with the state health department. We also looked at airborne lead, we looked at lead in soil, etc. There is a whole volume of Connecticut Medicine that has about 12 papers, out of which 4 or 5 are ours. DR. WALES: Now, finding all this data regarding lead contamination in homes and the air and soil, where did that take you? DR. LEPOW: Well, first of all, we went to the city, to talk to the mayor and I think we had some effect there. But going to the state, particularly with the airborne lead, that was during the time when there was a lot of debate about whether to take lead out of the gasoline because there’s a fallout from gas. Eventually, we went to Senator Philip Hart’s office, the US Senator from Michigan, who was the chairman of the subcommittee on energy, natural resources and the environment. And we went and testified, bringing our data from Hartford, Connecticut. Whether it helped or not, this was in support of the Clean Air Act of 1970, which was finally passed that year. DR. WALES: So, you and your colleagues went down to Washington, DC? DR. LEPOW: Actually it was a social worker and I who went together. DR. WALES: So, a lot of what you studied now is why we can breathe clean air today? DR. LEPOW: Well, that’s part of it, certainly. I’m sure there was a lot of other data, but this was something fairly unique, and the paint is still the major problem. Lead and old paint. I have not been particularly involved in that in Albany, but I know there are others who have been very important in reaching the powers-that-be to try to make sure that housing is safe. But it’s very difficult to get rid of the old leaded paint, because, you

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know, lead doesn’t go anywhere. It goes into the dust or it recycles in our water. Interestingly, there was a study done in Connecticut where one of the generators for electricity was housed in Middletown, Connecticut. And there were studies done there that showed that there was a half of ton of lead that went out in a year with coal-burning. And I think that data like that had been shown in support of the Clean Air Act as another reason for getting rid of coal. But I understand that that particular building is still there, whether it’s still in use now or whether they have gone on to some other form of generating electricity. That’s up for grabs again now. DR. WALES: Sure. DR. LEPOW: We don’t want to go back to coal, because there are so many other things. Nonetheless, lead is an important contaminant. DR. WALES: Sure. Now, let’s go back. You were in Cleveland. You and your husband were a power couple and both had reasons to move to Connecticut. What brought you to Connecticut? DR. LEPOW: The University of Connecticut was the first state medical school in Connecticut, established in 1962. And in 1967, they were starting to recruit faculty. They wanted to take in our first class by 1968. My late husband was recruited as head of pathology and I started the department of pediatrics in a downtown hospital, which served, largely, migrant workers, mostly from Puerto Rico, who worked in the tobacco fields where they grew shade tobacco. That set us off in another trail, although, again, I have to admit I thought we would be doing measles eradication. But we became involved in making sure that there was good medical care for the children of migrant workers. It was my first experience with international health, if you will. I’d never been to Puerto Rico, but I knew that even though they were part of the US, there were still a number of very primitive areas. In fact, there are still significant problems of parasites and other tropical diseases there. DR. WALES: And a lot of those were immigrated along with patients to Hartford? DR. LEPOW: That’s right, oh, yes. The tobacco fields were just outside of Hartford, and the families lived in ghetto areas of Hartford. They were originally started by the Cuban tobacco company for shade tobacco. They cut one leaf off at a time, at a certain point, for the cigar wrapper. Apparently, the climate is right there to grow tobacco, although it’s hard to believe, in the middle of the winter. Many of these workers came from the hill country, from the mountains, and they knew a lot about pineapples and bananas. They didn’t know about things coming out of the soil. Outdoor

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plumbing was the modus operandi in Puerto Rico, although not when they came to Hartford. However, they brought their parasites with them, and walking barefoot provided them with hookworm. DR. WALES: Any other parasites that you’d see? DR. LEPOW: Well, we had Ascaris, we had Trichuriasis. They did not have schistosomiasis. But the children tended to be anemic, and I think a lot of that might have been dietary. They did get vaccinated and they did get enrolled in healthcare. These families settled in the Hartford area. It’s now 40 years later, and you have a second generation already, and those children have done well because they all went to school and many to colleges. As they get more affluent, they move into the south end of Hartford, which is where the Italians are. And then, the African American population has moved north, sort of in the neighborhood of the Catholic hospital, St. Francis [Hospital and Medical Center]. So, the 2 populations have dispersed in different areas. Hartford Hospital has the children’s hospital there to this day. And all the signs are bilingual. There is a McDonald’s about a block away, and it’s all serviced by Hispanic people. You can walk in there and get your papas fritas and hamburguesas and café solo or café con leche very easily. DR. WALES: And I understand when you were there that there was only one other female academic faculty member there, Dr. Naomi Rothfield. DR. LEPOW: Rothfield, yeah. DR. WALES: I believe she was an internist, you told me. DR. LEPOW: She was an internist and a rheumatologist and one of the early experts in lupus. Internal medicine was started in an outpatient facility before the recruitment of specialties. Several years after we came, we moved the outpatient portion of the McCook Hospital, the city hospital, over to the department of health. We ran a combined clinic with community medicine, and part of the department of medicine. There was one Vietnam veteran who was a very fine doctor, Dr. Richard Gaintner. Eventually he moved on to higher goals. He and I tried to run a family clinic, particularly to serve the Hispanics and the Black population. But these were pretty much separate entities, separate populations. DR. WALES: And so, in the clinic, you’d serve both adults and children? DR. LEPOW: We saw both adults and children.

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DR. WALES: Now, I understand that, while you were in Connecticut, too, there was some burgeoning interest in meningococcal polysaccharide vaccine and you were involved in some of those -- DR. LEPOW: I got recruited into that, too. DR. WALES: Tell me about that. DR. LEPOW: Well, the meningococcal vaccine was developed in the early 1960s as we were starting to mobilize for the Vietnam War. And there were outbreaks of meningococcal disease in recruits in Camp Pendleton in California and Fort Dix, New Jersey. And at the Department of the Army epidemiology, meningococcal carriage seemed to be a very large problem, that some percentage of recruits were carrying one of the types of meningococcal disease. Not epidemic meningococcal disease, which was mostly type-A, but this was type-C, particularly. Later on, we have B and we also have Y. But at that time, there was pioneering work being done by an immunologist. His name is Irving Goldschneider, who was recruited by my late husband to the department of pathology. And he had known him as a pathology resident who had gone with the military. He worked in medical epidemiology rather than joining the Armed Forces. This was all part of public health. He teamed up with a biochemist from the Rockefeller [University], Emil Gotschlich, to identify the antigen, which was in the capsule, and it’s a polysaccharide to which antibodies would be made that could be protective. And most of the meningococcal disease occurred in the basic camps during the 8 weeks when recruits came from all over the country into very close quarters. And so, they inactivated this vaccine, and then they found recruits to get the vaccine. They used type-A and type-C. Type-A is the epidemic strain, still is prevalent in Africa and in Nepal. C has caused epidemics in this country as well as in Great Britain -- in other words, in the more temperate areas. Not particularly in Vietnam, but elsewhere in the Pacific arena. The idea was to immunize these recruits before they left boot camp if they didn’t get the disease. That vaccine was licensed, I think, in about 1965. When I came to Connecticut, the vaccine was still under the Army, but it seemed to be appropriate to try to look at infants and young children, who also had a high incidence of disease, particularly type-C. This was an inactivated vaccine, so it did not have any particular predilection to cause disease.

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DR. WALES: So, with this polysaccharide vaccine, did children under the age of 2 years show an immune response? DR. LEPOW: No, they didn’t do very well, and that led, ultimately, to the need for a conjugate carrier protein, which was later formulated. These observations led to the better understanding of T-cell independent polysaccharides as antigens. Up until the age of 2, polysaccharide antigens are poor immunogens, and this led to adding protein carriers. Most commonly used carrier was non-pathogenic inactivated diphtheria toxoid. We moved on to school-age children, to see if the polysaccharide vaccine would offer protection to this age group. My team was composed of Dr. Martin Randolph, a practicing community pediatrician in Danbury, Connecticut and adjunct faculty Yale School of Medicine in New Haven, Connecticut, Dr. Ronald Gold, a pediatrician from UConn [University of Connecticut], and Dr. Dorothy Horstmann, an infectious disease physician. Dr. Randolph previously worked with Dr. Horstmann on rubella vaccine in Dr. Randolph’s office. We recruited children age 5 to pre-puberty, and followed them after a single dose of vaccine. Later, we found that antibody levels fell off significantly. We gave a booster dose after 2 years, and got an antibody response that was comparable to the primary dose in same age children. DR. WALES: I understand they were able to get infants in the original study because the mayor’s wife was a volunteer in the nursery at Danbury Hospital? DR. LEPOW: There was some relationship. We were trying to start early, at 2 months, with the type-A and type-C vaccine. We had to recruit the babies in the nursery. And then, we kept track of them. Of course, we had to do it separate from DTP vaccine, but at least we tried to do it and coordinate it in a way that we were not quite in sync but close. We only set it up with 2 doses and then a booster. That was based on some animal studies. Meningococcus grows well in mice, so that was a lot easier than polio, where you had to use primates. A lot cheaper. END OF AUDIO FILE 3 DR. WALES: Today is March 6, 2017. We’re continuing our interview with Dr. Martha Lepow for the AAP [American Academy of Pediatrics] Oral History Project.

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In the 1960s, in Cleveland, you were part of several studies that examined causative agents of otitis media and anti-microbial therapy, which are still cited today as part of the AAP guidelines. What did you learn from these studies? DR. LEPOW: We found that oral ampicillin was superior, certainly, for strep pneumococci and Haemophilus influenzae. We also had chloramphenicol still out there, too. But ampicillin, and now amoxicillin -- that has really held up until today. DR. WALES: Besides chloramphenicol, what was ampicillin superior to? DR. LEPOW: To tetracycline and, actually, to TMP/SMX, too. DR. WALES: You also worked on the Hib vaccine against Haemophilus influenzae type b which is pertinent to otitis media. What were the lessons learned from the Hib vaccine trials? DR. LEPOW: That conjugate vaccine certainly was far superior. Could be any of several protein carriers. We happened to do it with diphtheria toxoid first. However, other carriers were used later. DR. WALES: Did they ever try using a polysaccharide vaccine for Haemophilus influenzae? DR. LEPOW: It had been tried, and, like the meningococcal polysaccharide vaccine, it was only effective from 18 months to 24 months. DR. WALES: What was the age group that your trials looked at for this vaccine? DR. LEPOW: They were from 1 to 3 or so. DR. WALES: Okay. Now, switching gears, what brought you and your husband to Albany, New York? DR. LEPOW: Well, we were both faculty at the University of Connecticut Medical School. And my husband was both a PhD and an MD. His PhD was not in pharmacology, but a headhunter came and found him to become the president of the Sterling-Winthrop Research Institute, which is the research arm of, at that time, Sterling Drug [Inc.]. He accepted this job and I was able to make a lateral move to Albany Medical [College] faculty. I came about 6 months after he started to work here. At that point, Dr. Bernard Pollara had just become the head of pediatrics. I came and interviewed and was appointed as a faculty member, and vice chair of pediatrics, as well as director of the clinical research center. Interestingly,

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my husband and I both only had Ohio licenses, and had used reciprocity. We never had national boards. Connecticut took us and New Hampshire took me so I could be a camp doctor up there, but New York State wouldn’t grant reciprocity. My husband just needed an MD after his name for the requirements of his job. And although I was already a full professor, I had to take the FLEX. And that was 3 half days of questions, including the basic sciences. And I took them and I passed, but I was there for 3 or 4 months before I got the results and could see patients on my own. DR. WALES: That was in 1978, correct? DR. LEPOW: That’s correct. March of 1978, I got the license so I can actually see patients. Prior to that, I was able to countersign resident notes, who were already licensed. I actually saw the patients with residents, but they wrote the notes and I countersigned them. DR. WALES: How big was the infectious disease department then? DR. LEPOW: Nothing. DR. WALES: It was just you, right? DR. LEPOW: Actually, pediatrics was mostly specialties. There was practically no primary care. We had cardiology. We had just gotten a NICU [neonatal intensive care unit]. Dr. Herman Risemberg had come just ahead of me and had started the first NICU here. We had endocrinology, we had some neurology, but practically no primary care. And the adult infectious disease was well-ensconced in with the children. They reluctantly gave up their priority in taking care of the children. DR. WALES: In the 1980s, HIV [human immunodeficiency virus] emerged and caught the attention of the public. While you were in Albany, HIV was emerging. DR. LEPOW: Right. DR. WALES: What was it like caring for children affected by the virus during those early days? DR. LEPOW: It was awful. They were very sick and frequently died. We didn’t have good diagnostic tools, and these are children who have either failure to thrive or acute lung disease. Mostly PCP [pneumocystis carinii pneumonia]. They were 4 to 5 months. But the failure to thrive was right from the beginning, and I think now I can go back with where we know the antibodies are made and where the virus lives, which is in the lymphocytes in

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the lower GI tract. And these children frequently had diarrhea. We had nothing to offer them, initially. DR. WALES: Were many of the children actually from this area? Did some come up from New York City? DR. LEPOW: The first child that we had was local, and probably the first 10. Then, in 1988, we got about 15 from New York City brought up by Catholic Charities, who had bought a house around Main Street, sort of adjacent to St. Anne’s. It was an order of nuns who served adolescents. Many of our children had late adolescent, early adult parents. The babies diagnosed the moms, and that’s still frequently been the case. It’s been very recent that we’ve been able to diagnose the moms and treat them in utero. We have been able to essentially eliminate perinatal infection in New York State. We have a lot of exposed babies, maybe 30 or so a year. Mothers are HIV-positive but are on treatment and we’ve been able to protect their offspring. So, I think that’s been a huge advance in the management of AIDS [acquired immunodeficiency syndrome]. DR. WALES: What was the biggest breakthrough in HIV treatment? DR. LEPOW: Well, I think in the actual treatment, of course, AZT [azidothymidine]. But subsequently, the protease inhibitors, because they could get to the enzymes inside the lymphocytes. We would follow the moms, also, if they were within our age group, which at that time was 21. DR. WALES: And how big was the development of AZT for pregnant women? DR. LEPOW: Oh, I think it was quite huge. But single drug treatment is still not adequate to eradicate the organism. And combination drugs have increased and have improved with different mechanisms. There’s entry-level drugs that can prevent the virus from actually going into the cell. And there are some of those that actually involve the RNA, and then ultimately the actual genetics. One of the problems with treatment of HIV for young adults or adolescents is compliance. With the little ones, many of them were in foster placement. Some of them were adopted. Most of those children that we got from New York did not have family, were essentially abandoned in the hospitals in New York City. DR. WALES: While in Albany, you also worked on varicella vaccine research. Tell me about those trials. DR. LEPOW: Well, we were part of the multi-center trial for varicella vaccine in adults. The principal investigator was Dr. Anne Gershon at

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Columbia University. She is a pediatric infectious disease physician, also. And she did the multi-center study, first for safety and immunogenicity in adults. We participated in that. Our major recruits were nursing staff here, at Albany Med. At that time, there were already regulations not to use any students in vaccine trials. That’s sort of been a code of ethics that really started with the varicella vaccine, because adults need to be immunized also. So, it was fair to start it in adults. If they never had chickenpox earlier, then they need to be immunized, because there’s more severe disease in adults. DR. WALES: I recall that you looked at whether or not the varicella vaccine virus was transmitted from healthy siblings to their leukopenic patients, right? DR. LEPOW: Yes. It did not, because the vaccine-associated virus did not transmit via respiratory secretions. The only time there was transmission was when there was a rash. But usually, the rash was on the trunk. There was rarely transmission. DR. WALES: Now, you also served as an assistant editor for the Red Book [Report of the Committee on Infectious Diseases] in the 1980s. What hot topics did you address as the assistant editor? DR. LEPOW: I was assigned to certain sections. They divided us up alphabetically by disease. And it seems to me that I had I or J through P. Something along that line, that I was responsible for. DR. WALES: And did you ever put your personal mark on the Red Book? DR. LEPOW: Yes. Well, I was listed there as an associate editor, which I was for 6 years. DR. WALES: Did they ever use any of your pictures? DR. LEPOW: Yes, in the Red Book Almanac. DR. WALES: I also believe you served on the advisory committee to the chief of NIAID [National Institute of Allergy and Infectious Diseases] on vaccines. DR. LEPOW: Yes. DR. WALES: When was that? DR. LEPOW: That was after the Red Book.

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DR. WALES: During your time here in the northeast, Lyme [disease] also emerged as an important pathogen, which strikes fear into the hearts of many patients and doctors alike. What important lessons have you learned from Lyme? DR. LEPOW: Well, I’ve learned that there are certain symptoms defining Lyme disease that occur in 3 stages, just like other spirochetal diseases like syphilis, and they’re well-documented. There’s a rash that goes with it and there are antibodies that develop. We realized there are latent periods in Lyme in untreated patients. There are diagnostic tests as well as treatment for Lyme disease at any stage. And unfortunately, there are a group of doctors that promote treatment for Lyme disease for much broader symptomatology, on multiple antibiotics for a long duration, which have complications, without evidence of efficacy. They have to be squelched, which is very hard to do. DR. WALES: Do any infectious diseases keep you up at night? DR. LEPOW: I think I used to be concerned about meningococcus, even in my own kids, as it would present initially with a high fever. DR. WALES: How about in the 1980s? Did HIV ever keep you up at night? DR. LEPOW: Well, no, not really, because it was a slow disease process that affected growth and development, and predisposed to treatable opportunistic infections. I mean, in some sense, the children were better off, because once we had some tools, we had a couple of drugs for the kids, at least by mid 1980s. And that was good. DR. WALES: So, you’ve told me in the past that HIV was frightening to you during the initial outbreak because we didn’t understand the disease and there was no treatment. DR. LEPOW: Right. DR. WALES: But fortunately, you were able to participate in a multi-center trial later on regarding AZT and pregnant women who are HIV-positive. Can you tell me a little bit about that? DR. LEPOW: Well, this was a multi-center trial. We recruited 13 pregnant women in it. This was done by Drs. Renee Samelson and Nancy Wade and myself. Nancy Wade had done an immunology fellowship. She was working largely in allergy. And when she finished getting her board qualifications in that, I was doing infectious disease here. We had a part of a grant that the adult AIDS program already had going in 1986. The first patient at our site

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enrolled in 1987. We received our first independent research grant around 1988. Since then, we have been continuously funded under one or another. Nancy did this, and later, [Dr.] Patricia Hughes, to help keep us continuously funded. DR. WALES: And what was found, ultimately, in this trial? DR. LEPOW: Well, it was shown, about halfway through, that the AZT was effective in preventing disease, because some of these women were pretty far along in the pregnancy. We didn’t just take first trimester pregnant women. So, that was a benefit in a sense, because we could start AZT treatment immediately and prevent transmission instead of waiting for CD4 counts to drop later in the pregnancy and then start AZT. But these people were essentially well, we didn’t have a lot to offer them, but we had AZT and at least DDI [didanosine]. The proteases came in after that trial. They came in in 1994 or 1995. DR. WALES: Did they have to have a certain CD4 count? DR. LEPOW: The CD4 count had to be above 200, because if it was below 200, they would be treated anyway. Because of the amount of drug that was being made available, we had to use women who didn’t qualify for the AZT to be given as routine. So, this was a placebo control trial. There was a monitoring committee and it became evident after about 18 months that this is safe and efficacious. DR. WALES: Did it become the standard of care? DR. LEPOW: It became the standard of care, then, at that point. DR. WALES: In recent years, vaccine hesitancy and mistrust has caught the attention of many in the public. What words of advice do you have for parents who may doubt the safety and/or the efficacy of vaccines? DR. LEPOW: Well, there are a lot of myths about vaccines. And I do criticize the media for presenting a rather one-sided view of vaccines, and some very prominent politicians have come along with this, to try to get legislation that’s going to limit the use of vaccines. And I think the message I’d like to see is that this is a good example of the effectiveness of vaccines. There were thousands of children who died with whooping cough or measles. And I have to blame the media for this, for disseminating things on Facebook and Twitter that are inappropriate, because they represent writings or speeches of prominent people. None of this is supported by data. There’s no evidence of any association of whooping cough or measles vaccine -- just as giving 2 examples of this – with autism. So, that’s what I have to say, is to

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tell parents we are protecting your children against diseases which can alter their development, and sometimes can affect their immune system so that they don’t cope well with either those or other viral infections or some bacterial infections. And there are stories and testimonials from people that are not backed up by any type of organized statistical data. DR. WALES: While in Albany, you’ve been involved in numerous extracurricular activities, including serving on the board at Whitney [M.] Young [Jr.] Health Center, which is our locally federally qualified health center in downtown Albany and Troy, NY. You also served on the medical advisory board for the Center for Disability Services, Ronald McDonald House, and also Double H Ranch, which is a popular camp for children with complex medical illnesses here, founded by Paul Newman and Charlie Woods, former owner of the Great Escape. Rumor has it that you’ve even met Paul Newman. What was that encounter like? DR. LEPOW: Well, you know, I spend 1 week every year as a volunteer. And now, there’s more than 1 of us that goes with each session. Because of the complexity of some of the children that come up there, it’s good to have more physicians. Although we don’t claim to be a hospital or do anything routine, except to ensure that they get whatever medications they have, and if there’s certain dietary needs, etc. But anyway, it was one of my sessions, and Newman came up sometime in August to do a gala fundraiser near Lake George. And so, he would come around noontime and have lunch in our dining hall, with the kids. He’d sit down with the 9- or 10-year-old kids and talk to them and eat whatever they were eating, you know? Before he left, he’d come up to our little infirmary, which is called Paul’s Body Shop. This was right after lunch, about the middle of the week. Somebody called me and said that Mr. Newman was on his way, because he wanted to see what was going on in the infirmary. We had no children in at that point. It was fine, you know? It wasn’t bustling. The best evidence of our effectiveness is when we have an empty infirmary, and can join in activities with children and staff. DR. WALES: It’s a good sign. DR. LEPOW: That’s the best sign. Not that we don’t take care of things [Laughter]. So, he [Paul Newman] came in and he was a rather short man, and he has the blue eyes. I guess he was very light in complexion. He was grey at this point. Maybe 5’-3” of 5’-4”, something like that. He walks in, he looks around, and he said, “Now, what do you need here?” I said, “Oh, we have our wish list.” I said, “We’ll be happy to provide it to you.” And he said, “Well, that’s good. I will look forward to it.” And then, he turned to one of the nurses.

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We always have a nurse in there, at least one per shift. They have 2 or 3 who work 12-hour shifts, and some work 8-hour shifts. Some live around the area and some of them are from Glens Falls Hospital. He went and talked to the nurses and, again, asks, “What can we -- what can I do?” Or, “What do you need?” And the nurse said sort of the same thing that I did and said, “We’ll be glad, you know, to sit down and make sure that you know what we do need.” He stayed for maybe all of 5 minutes. He was an interesting man, though. DR. WALES: Did your family get involved at Double H Ranch? DR. LEPOW: I had a great granddaughter who came as a camper with me from New Jersey. The others, our children and grandchildren and probably the great-grandchildren, of which there are now 4, had never grown up in Albany. So, they did not have school friends and, fortunately, none of them had any infectious problems of great note. But Nicole was 14, I think, when she first came and she returned the next year. And then, her 16th and 17th years had been spent back in New Jersey, in Princeton, where they have day camp. At 15, she was a volunteer at the day camp all summer. And then, last summer, when she was 16, she qualified for regular camp counselor. DR. WALES: Recently, you went to Costa Rica with a group from the University at Albany School of Public Health. What did you learn from this experience? DR. LEPOW: Well, this was a part of an exchange program where more advanced students from the University of Costa Rica School of Public Health come to the US, to Albany. And then, there are groups of between 10 and 15 people that go for 10 days in the winter. So, we can get where it’s a little bit warm to look at healthcare and vice-versa for the Costa Ricans. There are almost 6 million people that are covered under universal coverage [CCSS: Caja Costarricense de Seguro Social]. Everybody who is born in Costa Rica gets enrolled, at the expense of the state, for the child, until they reach an age where they’re working, and then they participate in the social security system where they pick up about 2 to 3 percent of the cost. Everybody, whatever their take-home pay is, about 3 percent of that goes strictly to healthcare. There’s also private sector there, but they’re very expensive. Some employers offer private health insurance. But they have to get their medication through CCSS. You can’t go out to a pharmacy and buy medication; you have to use their prescriptions for it. And the prices are negotiated with these pharmacy companies there. This system developed in the late 1940s, after World War II, when they gave up their army and they put their money into education and health care.

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DR. WALES: When people at Albany Med think of you, they think about your dedication to 2 things outside of medicine: exercise and music. What role has music played in your life? DR. LEPOW: It’s been a significant role. I made a decision fairly early in my life that I wasn’t going to be a concert pianist. I started to play piano when I was 4 years old and my mother put me in front of it and I started to pick out things. I enjoy it and enjoy playing with people and so on. I got involved in some group activities with a recorder group outside, and here in the hospital we have a chorus and orchestra. I try to promote that and participate in both. So, exercise -- I was a good swimmer. I now have some numb feet and I can’t get my feet up; I’m a sinker otherwise. I used to be a lap swimmer, and I would swim early in the morning. We had a pool in Connecticut and Albany, and in the summer I would swim in the morning and in the night. Kept that pool in the house for 26 years. My 2 sons, in fact, became competitive swimmers in high school. My husband passed away 7 years after we came to Albany, of lung cancer. He was a 50-year smoker. DR. WALES: Did your kids growing up ever help you with any of your research projects? DR. LEPOW: Yes, my stepdaughter did, Laurie. And the projects that she worked with were -- well, there were 2. One was lead levels in Hartford children. I think we’ve talked about that earlier. DR. WALES: What did Laurie do in those projects? DR. LEPOW: Laurie helped me keep records. She also helped hold children for blood sampling in Connecticut. In Cleveland, she helped in some of the later polio follow-ups, where we were collecting blood. There, she helped to lyophilize a lot of the sera to save for some of the future things. These were fairly young children. The follow-ups were school age. One of my sons, David, participated in one of the measles vaccine studies, plus other faculty children. DR. WALES: He was an actual participant? DR. LEPOW: He was an actual participant.

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DR. WALES: Does he hold that against you? DR. LEPOW: No, I don’t think so. DR. WALES: So, you had a stepdaughter and two sons -- DR. LEPOW: Yes. My sons were 10 and 11 years younger than Laurie, and I met her when she was 7, in 1958, when I married her dad. He was a widower. She was born in 1950, so she’s going to be 67 this year. And the boys are late 50s now. DR. WALES: Having a family of 3 children brings up the question that a lot of women struggle with in medicine, about balancing a family and also their clinical duties. But you also had research interest, as well. How did you, as a family, balance all 3? DR. LEPOW: Well, we all worked together on this. I mean, Laurie was a big help in the sense that she could help me with some babysitting. When she got to be about 12, she could help around the house, and we used to do that. As she got a little bit older, I was in competition with my neighbors for her -- for nights or weekends. My husband did not practice. And I was reasonably protected in Cleveland. And Connecticut, we took over the City Hospital when I was the head of pediatrics there, where I took care of all of these children and migrant workers. In addition to Laurie, we had hired household help, in both places. DR. WALES: Going back to the music question, I forgot to ask you: what instruments do you play? DR. LEPOW: I play piano. DR. WALES: Piano. What else? DR. LEPOW: And a little harpsichord. I took organ lessons for a while in college. But I was not good enough to excel. DR. WALES: You said you are part of a recorder group, too? DR. LEPOW: I don’t play recorder. I accompany the recorder group. DR. WALES: -- on piano? DR. LEPOW: On a keyboard. In my apartment, I have a small grand piano and a harpsichord, and we rehearse in my apartment.

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DR. WALES: And you’re part of an organization called the Pediatric Travel Club. When did it start and what is its mission? DR. LEPOW: I was nominated as a member in 1988 by Dr. Ian Porter, former chair of pediatrics, who was a long-time member. It started around the 1950s, and its mission was to gather faculty and community pediatricians who had interest in academics, whether it be office research or some allied activities. This was started by senior pediatricians. There were a fair number of infectious disease people, and it involves now 13 cities, most of them in the northeast. There were a couple of more before that had dropped out, not so much for lack of interest as lack of organization. It has to have some bodies to maintain continuity. And it works very well. We meet once a year, in different communities. Most of them are in the northeast. We go as far south as DC, and we go as far west as Cleveland. And, let’s see, where else? Upstate New York. Rochester and Buffalo are in it, along with Albany. And Cleveland has been in it right from the beginning, and one of my mentors was one of the original founders of this. DR. WALES: Which mentor was that? DR. LEPOW: It was Dr. Robbins. Then, eventually, Dr. Mortimer, too. Did you see this picture here? This photo? This was during my residency training at City Hospital in 1953.

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Front row (left to right): Eli Gold, Ted Mortimer, Fred Robbins, Bob Eiben, Bryant Galusha. Back row (left to right): Martha Lipson (Lepow), Mark Hildebrant, Phil Dew, Sel Strassman, Felino Barnes, George Richardson, Reich Watterson, Anna Mitus. Photo courtesy of Dr. Martha Lepow. That’s City Hospital, my resident group and the faculty. DR. WALES: So these are your colleagues? DR. LEPOW: The young ones in the back are my colleagues that were there. Half rotated from the City Hospital pediatric residency, and the others rotated from Babies and Children’s [Hospital]. And this was Eli Gold, who was the first chief resident early on. And then, he became faculty. And he went to Sacramento and became head of pediatrics there at the University of California Davis. And Ted went to Albuquerque, as the chair of pediatrics at the University of New Mexico. Ultimately he came back to Cleveland as an emeritus. And this is Dr. Robbins, who went on to become dean, then active in the Institute of Medicine. And then, there was Dr. Eiben. And he’s the one that became a pediatric neurologist Bryant Galusha was a classmate of mine at Case Western, and we shared the chief residency. There were 2 of us. So, we cross-covered the nights. I got 6 months of research in the virus lab and so did Bryant. And he went on to Charlotte, North Carolina, but is now retired. This is Anna Mitus, and she was a visiting PhD student that was spending time in our lab. And there’s me, over in the corner. DR. WALES: Okay, so, having lived in Albany for so long, do you come across patients that you’ve previously treated in the community? DR. LEPOW: Oh, yes, very much so, or parents. Mostly the parents of children who I saw as infants, who are in their 20s. DR. WALES: Many of your students and colleagues also know you for your clinical acumen and your reliance on a good history and physical exam. Do you recall any interesting diagnoses where the history and exam pointed to a diagnosis that had not previously been considered? DR. LEPOW: Yes, there was one a few years ago here. In the past, in Cleveland, I’d seen one adult with mercury poisoning. And he had red palms and red soles, and had some central nervous system manifestations, but not seizures. He was just a little bit encephalopathic, but not out of commission, I had never seen mercury poisoning, other than reading about the Mad Hatter.

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DR. WALES: Right. DR. LEPOW: And then, when we were doing studies -- in Danbury, Connecticut, there was a Stetson hat factory there, where they stiffen tall black hats. And that’s what the Mad Hatter had, mercury poisoning. DR. WALES: Interesting. DR. LEPOW: And I pulled out my old Alice in Wonderland. At the time, I kept a copy of that from my childhood. And I read the part of the Mad Hatter at the tea party in Alice in Wonderland. He had a tall hat. And so, I remembered him. About 8 to 10 years ago, in January or February, there was a child who was sent we saw in the clinic. He was about 12, and he and his mother both had what was being called Coxsackie hand and foot disease. He was seen at an outside hospital twice, and his pediatrician decided that maybe he needed an infectious disease consult, because they didn’t really blister; they were just red. What struck me, when I saw this kid in the clinic, was that that patient that we’d seen years back that just had these bright red hands. I don’t know if he had anything on his face, but I remember the hands. And this boy had a rash, too. It was kind of a non-specific maculopapular rash. And the hands were sore. I said, “Well, you know, I know it’s not Coxsackie.” He never had any fever. Been going on 3, 4 weeks already. The mother had had it longer, not quite as bad. Father was fine. And I don’t think there were other siblings in the home. His parents were somewhat older. And occupationally, nothing at all, initially. And I remember coming up and saying, “You know, I’m going to call toxicology and I’m going to have them get him in the emergency room. We’re going to draw mercury levels on him.” I think we also put in lead and a couple of other things, too. But it wasn’t that. In my mind, it was mercury poisoning, and that’s what it turned out to be. So, then we go back, looking for the source. They lived in a fairly old house that was owned by the patient’s grandfather. The grandfather cleaned clocks, the faces of old clocks. And they use mercury. He had mercury for something that he was doing with these old clocks, and it was a powder. The child played in the basement, and that’s where the mercury powder was kept. The grandfather had passed away fairly recently. So, they hadn’t really cleaned out the basement. They lived out near Glens Falls, somewhere between Saratoga and Glens Falls. The father worked outside the home; he was never down in the basement. So, once this was determined to be the diagnosis, we called toxicology, who then called the health department. And so, they got people out, and then they determined that there was mercury in the air. It was inhaled. The

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children ran around in the basement, it was their play area. But Mom was up and down there, too. And she was a little bit encephalopathic. They found a broken vial of mercury powder, so it was released into the environment. DR. WALES: Oh, interesting. DR. LEPOW: Dad was fine. I don’t think there were other children in that. And then they eventually got decontaminated. And so, I think that was the one that I can think of where, having seen something in the past, you know, that suddenly rang a bell. And, you know, it was no more Coxsackie than I have Coxsackie today. DR. WALES: Right. DR. LEPOW: You know? But, anything with hands and feet has got to be Coxsackie in the eyes of an emergency room. DR. WALES: Do you have any advice for new doctors? DR. LEPOW: You asked me that before, too. Strive for excellence in whatever you’re going to be doing. And listen to your patients. Particularly listen to the parents. The parents know their child better than you do, and most of the time, they know there is something wrong, something that isn’t quite right. Even if it’s a respiratory thing, there’s something else going on that’s making them sicker than the usual common cold. I think we all have to face some unknowns. There have been changes in the delivery of medical care. And hopefully, we all become advocates for prevention, to start with the babies in utero and throughout the life cycle for prevention of many diseases as we get more information. There’s more genetics coming. I think genetics are going to help us a lot in the future, for prevention, too. DR. WALES: How has the landscape changed for women in medicine during your career? DR. LEPOW: Well, I think women have stepped up to the plate. The Equal Employment Opportunity Act of 1972 has enabled opportunities for women who, I think, are proving to be equally competent in probably as many fields as there are. I think that the role of women in society has improved, and that there are a lot more opportunities for women. Not in all fields, but I think in medicine, women are not only accepted but sought after, particularly by teenagers and young adults. Not only women, but even some of the boys prefer women physician. In childcare now, I think there is more of a partnership in America now for couples in caring for children. I won’t say necessarily married couples, but for couples. There are shared

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opportunities. There are even some changes in the roles of women and then men, and some of them do deliver more child care, not necessarily in medicine, but in other fields, too. DR. WALES: What challenges lie ahead for the field of medicine as a whole? DR. LEPOW: Right now, the role of government is going to be ever-present in medicine. We don’t know how that will play out in the next few years. DR. WALES: What inspired you to teach medical students and residents? DR. LEPOW: I’ve always wanted to teach younger people. I’ve always liked to do that. And, you know, I did camp counseling for some years, and I taught swimming. I’ve always liked to teach and collaborate and try to get others to do things. I think that’s what it is. There’s a great deal of satisfaction to dealing with the younger generation, even when I was not very far away from my teenage years when I graduated from medical school. I’ve always had a lot of satisfaction mentoring students and residents. The feedback from mentees has helped keep me current in medicine DR. WALES: What do you consider your greatest accomplishment? DR. LEPOW: Oh, that’s hard to say. I think probably working on the polio vaccine trials. It changed my life. But then, it led to other vaccines, such as meningococcus. DR. WALES: Okay. DR. LEPOW: Because that was the next really major thrust for me in Connecticut. Measles was already underway, quite underway when we did the trial with that. Rubella was a good one, too. I think any of those. But certainly, the polio, because it changed the whole course of my life. And meningococcus, because we saw a difference, you know. DR. WALES: Sure. DR. LEPOW: Meningococcal, particularly the A and C, because we worked with people who had developed it for the military in the beginning of the recruitment in anticipation of the Vietnam War in the 1960s. I worked with Drs. Goldschneider and Emil Gotschlich and Ron Gold. These were all people who had been with the Army. Actually, Dr. Goldschneider was

42

recruited by my husband into pathology. He was a path resident in Cleveland, and he went in service and then joined us. I became the recruiter, the organizer of the trials in infants and children, and all that. So, I think that fits along with the polio. But the polio still is the biggest. DR. WALES: In your opinion, what will be the next big advancement in pediatric health? DR. LEPOW: I think primary prevention by identification of some of the genetic diseases that result in lifelong disability, you know? And learning more about the mitochondrial diseases. How to try to prevent neurologic disease, but also neuroscience, I think, is on a track to give us more information. I think it’s going to take a lot of time. And more toward prevention. And eradication of environmental toxins. There has to be some moderation of what’s going on in Washington right now. I don’t want to see coal come back. I think I may have mentioned it earlier, that in Middletown, Connecticut and the Connecticut River, there is a generator that’s fed by coal. It puts out a half a ton of lead every year. It’s not the only bad thing that comes out of it, you know? There’s the whole carbon and everything else. DR. WALES: The last question I have for the whole interview -- so, believe it or not, we came to the end. Compared to when you first started practicing medicine, do you think that children are better off now in regards to their health? DR. LEPOW: I do believe so. I think we’re going backwards a little bit, because I think a lot of it is media-driven. And now there’s so much misinformation out there to the public. I think this is where the issue is. I think we’re heading in the right direction, but it’s not only health that’s going to be important. There is serious inequality with regards to access to healthy food, healthcare and education. I don’t think the kids are better off educationally than even my generation was. I think we were a lot better off. Even in the suburban schools, there was better support from the community. Our taxes were high for whatever it was when our children were in school, but the school taxes were up there. But you had results. They had goals and class size and food and all that was there already. And so, I hope this isn’t too much of a setback right now. But, you know, we’ve always had ups and downs politically. I mean, ridiculous things are coming along. I’m very concerned about children of immigrants. I think there’s something in AAP News, which I didn’t really look at it yet, about the effects of current immigration policy, what’s the effect going to be on children? Uprooting families. Sending them back to places which aren’t good. I’m concerned, very concerned about what’s going on. We’ll see.

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DR. WALES: Do you think doctors can make a difference, and specifically pediatricians in this environment? DR. LEPOW: I hope we can. I think we have to be solid in what we want. We have good advocacy. DR. LEPOW: So, what are we doing? Children are not voting. Their parents are voting. So, I think it’s a changing world, and we have to see, but I think we have to stand by what we believe, and I think we do have to be advocates. I think we have to be out in the community, more visible in the community in some ways, asserting leadership on these issues. I think our students do well at some of this, and our residents do well. And maybe a lot of the practitioners, you know, are advocates of their kids, too. DR. WALES: Well, on that note, that actually concludes our whole interview, so thank you for spending your time with us. DR. LEPOW: Well, thank you for doing this. I’ve loved my career. I’ve loved everything that I’ve done and I hope to continue. I hope my enthusiasm for medicine will remain in all the young doctors I’ve taught. END OF AUDIO FILE 4

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Index

A Albany Med, 30, 35 Albany Medical College, 16, 17, 27 Albany, New York, 27 Alpha Omega Alpha, 4, 15 American Academy of Pediatrics, 27 azidothymidine, 29, 31, 32

B Babies & Children’s Hospital, 5 Babies & Children's Hospital, 6, 8, 9, 17, 38 Barnes, Felino, 38

C Case Western Reserve University, 2, 3, 4, 18,

38 City Hospital [Cleveland], 6, 7, 8, 9, 13, 18, 37 Clean Air Act of 1970, 22 Cleveland Heights, Ohio, 3 Cleveland Indians, 16 Cleveland, Ohio, 3, 8 Columbia University, 4 Columbia-Presbyterian Medical Center, 4 Connecticut Medicine, 22 Costa Rica, 34

D Dew, Phil, 38 Double H Ranch, 33, 34

E Eiben, Robert, 6, 8, 11, 12, 13, 38 Enders, John F., 7, 12, 17, 18, 19 Equal Employment Opportunity Act of 1972,

16, 40 exercise, 35

G Gaintner, Richard, 24 Galusha, Bryant, 38 Gates, Bill, 20 Gershon, Anne, 29 Gold, Eli, 38 Gold, Ronald, 26, 41 Goldschneider, Irving, 25, 41 Gotschlich, Emil, 25, 41

H Haemophilus influenzae type b, 27 Hart, Philip, 22 Hartford Hospital, 24 Hartford, Connecticut, 21, 22, 23, 24, 35 Hildebrant, Mark, 38 Horstmann, Dorothy, 26 Hughes, Patricia, 32 human immunodeficiency virus, 28, 29, 31

L lead poisoning, 21, 22, 35 Lepow, David, 35 Lepow, Irwin "Lee", 14, 15 Lepow, Laurie, 35, 36 Lyme disease, 31

M March of Dimes, 10 McCook Hospital, 21, 24 measles, 6, 9, 18, 19, 20, 21, 23, 32, 35 meningococcal vaccine, 25 migrant workers, 23 Mitus, Anna, 38 Mortimer, Edward, Jr., 8, 13, 37, 38

N National Foundation for Infantile Paralysis, 9,

10, 13 National Institute of Allergy and Infectious

Diseases, 30 New York Academy of Medicine, 13 Newman, Paul, 33 Nobel Prize, 11

O Oberlin College, 2, 3

P Pan American Health Organization, 12, 13 Pediatric Travel Club, 37 piano, 1, 2, 14, 35, 36 polio, 2, 5, 6, 7, 9, 11, 12, 13, 15, 17, 18, 20, 26,

35, 41, 42 Pollara, Bernard, 27 Porter, Ian, 37

45

R Rainbow Hospital, 6 Rammelkamp, Charles H., 13, 15 Randolph, Martin, 26 Red Book [Report of the Committee on

Infection Diseases], 30 Richardson, George, 38 Risemberg, Herman, 28 Robbins, Frederick Chapman, 6, 7, 8, 9, 11, 12,

13, 14, 15, 37, 38 Rothfield, Naomi, 24 rubella, 9, 18, 19, 20, 26

S Sabin oral vaccine, 18 Sabin, Albert, 12 Salk vaccine, 7, 9, 15 Salk, Jonas, 11, 12 Samelson, Renee, 31 Sterling-Winthrop Research Institute, 27 Strassman, Sel, 38

T tuberculosis, 8, 9

U University of Connecticut, 23, 27 US Army, 25, 41

V varicella, 29, 30

W Wade, Nancy, 31 Watterson, Reich, 38 Weller, Thomas H., 7

Y Youngner, Julius, 11

46

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CURRICULUM VITAE MARTHA LIPSON LEPOW, M.D.

D.O.B.: 3/28/27 BIRTHPLACE: Cleveland, Ohio

PERSONAL: Widow: Husband, Irwin H. Lepow, PhD (Deceased, 1984) Children: Lauren - D.O.B.: 1950 David - D.O.B.: 1959 Daniel - D.O.B.: 1960 Grandchildren: 5 Great Grandchildren: 4 EDUCATION: B.A.: Oberlin College, Ohio 1948, Premedical M.D.: Western Reserve University School of Medicine Cleveland, Ohio - 1952 INTERNSHIP AND RESIDENCY: 1952-1953 Internship, Pediatrics University Hospitals, Cleveland, Ohio 1953-1955 Assistant Resident, Pediatrics & Contagious Disease, Cleveland Metropolitan General Hospital, Ohio 1955-1956 Chief Resident, Pediatrics & Contagious Disease, Cleveland Metropolitan General Hospital, Ohio 1956 Teaching Resident Pediatrics, Cleveland Metropolitan General Hospital, Ohio HONORS AND AWARDS: Alpha Omega Alpha, Western Reserve University, 1951 Distinguished Alumnae Award, Case Western Reserve University, School of Medicine, 1987 The Golden Apple Award for Excellence in Clinical Teaching, Albany Medical College, 1992 and 2002 Best Doctors in America/Northeast Region

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Published by Woodward White Inc. of Aiken, NC, 1996 Elected as Honorary Alumna, Albany Medical College,1997, Honoree of Visiting Nurses Assn., 1999 Pediatric Resident Teaching Award, June, 1999 Selected Woman of Valor-SUNY Writers Institute, April 2000 One of 100 “Women of Excellence” Honoree of Albany-Colonie Regional Chamber of Commerce, June 2000 Resident “Excellence in Teaching Award”, June 2000 Named as Endowed Chair Recipient in Pediatrics, Albany Medical Center, 2001 Distinguished Humanitarian Award, presented by President of AMC, Mr. James Barba, Oct. 2001 Dr. James M. Bell Humanitarian Award, Parsons Child and Family Center, October 2002 Certificate of Recognition for 30 yrs. Pillars Award, Albany Medical Center, 2004

Service Award of the Cystic Fibrosis Foundation, 2004 Award from Whitney Young Health Center for 19 years of service on the Board, 2004

Elected Academy member CHP,2006 Honorary Dr. of Science Award

Oberlin College, 2009 Med/Ped Attending of the Year Award, 2008 American Academy of Pediatrics, Section of Infectious Disease, Award for Lifetime Contribution to Infectious Disease Education, 2011 Honored by Capital District Pediatric Society, 2014

SPECIALTY BOARD: American Board of Pediatrics, 1958 SUBSPECIATY BOARD Pediatric Infectious Diseases, 1997, 2003, 2010 (MOC) MEDICAL LICENSURE: Ohio, 1952; Connecticut, 1965; New Hampshire, 1969; Massachusetts (temp), 1977 New York, 1979 ACADEMIC AND PROFESSIONAL APPOINTMENTS

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Albany Medical College: 2007- Director of Excellence in Pediatric and Adolescent Care. Funded by NY State Health Department and Ryan White Fund. 1995-1997 Chair, Department of Pediatrics 1992-1994 Acting Chair, Department of Pediatrics 1982-1992 Vice Chair, Department of Pediatrics, Albany Medical College, Albany, NY 1981-1982 Director, Cystic Fibrosis Center, Albany Medical College, Albany, NY 1979-1991 Director, Pediatric Residency Program, Albany Medical College, Albany, NY 1978- Head, Division of Pediatric Infectious Diseases, Albany Medical College, Albany, NY 1978-1987 Program Director, Clinical Studies Center, Albany Medical College, Albany, NY 1977 Visiting Professor of Infectious Disease, Children's Hospital Medical Center, Boston, Massachusetts (October-December, 1977) University of Connecticut, School of Medicine: 1972-1978 Professor of Pediatrics, University of Connecticut School of Medicine 1968-1972 Lecturer, Department of Pediatrics, Yale University School of Medicine 1967-1972 Associate Professor of Pediatrics, University of Connecticut School of Medicine 1967-1969 Acting Head, Department of Pediatrics, University of Connecticut School of Medicine Case Western Reserve School of Medicine: 1961-1967 Assistant Professor, Department of Pediatrics, Western Reserve University at Cleveland Metropolitan General Hospital, Cleveland, Ohio 1961-1962 Special Fellowship, Oxford, England, U.S. Public Health 1958-1961 Senior Instructor, Department of Pediatrics, Western Reserve University, Ohio 1956-1958 Research Fellow, Department of Pediatrics, Western Reserve University, Ohio 1956-1958 Teaching Fellow, Department of Pediatrics, Western Reserve University, Ohio SCIENTIFIC SOCIETIES

Infectious Diseases Society of America 1966- American Academy of Pediatrics 1968- Society for Pediatric Research 1968 (Emeritus 1972) American Pediatric Society 1973- Connecticut Academy of Science and Engineering 1977 (External Mem.1978) Capital District Pediatric Society 1979- American Association of Immunology 1980 (Emeritus 1997) Member, Committee on Status of Women 1980-1985 SUNYA NY Chapter, Sigma XI 1981 (Emeritus 1996) American Society for Microbiology 1982- Pediatric Infectious Diseases Society 1994- NATIONAL & STATE COMMITTEES (COMMISSIONS)

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Member, National Institutes of Health, Epidemiology and Disease Control Study Section 1972-1976 American Academy of Pediatrics Member, Editorial Board, Pediatrics 1976-1981 Member, Committee on Infectious Disease 1985- Associate Editor, Report of Committee on Infectious Disease 1987-1991 Member, Secretary, HEW Task Force on Immunization Practices 1977-1978 Member, National Instituted of Health, NAIAD Advisory Committee to the Director 1978-1982 Member, Institute of Medicine, Committee on Vaccines 1983-1985 Member, March of Dimes Research Review Committee 1990-1994 Member, National Institute of Health NAIAD-Ad hoc Advisory Committees 1990-1991 Member, Health and Human Services Vaccine Injury Compensation Panel 1990- Member, New York Medicaid Committee on Otitis Media 1988- 1990 LOCAL VOLUNTARY ORGANIZATIONS Member, Professional Advisory Board Center for the Disabled 1980-1988 Member, Medical Advisory Committee Center for the Disabled 1980-1988 Member, Institutional Review Board, New York State Department of Health 1983-1988 Member Board of Directors Whitney Young Health Center 1984-1996,1997-2004 Chairperson, Patient Care Committee 1984-1996 Member, Whitney Young Health Center 1984-1998 Scholarship Committee 1984-1996 Member, Med. Advisory Board, Hole-in-the-Woods Camp, 1995- Member Board Albany College of Pharmacy 1987-1988 Associate Director for Cystic Fibrosis Center 1998-2000 Member, Ronald McDonald House Long Range 1998- Planning Committee Member, OptionCare Quality Care Committee 2000- Member, WMHT Edison Society 2001- Member, Medical Advisory Committee for 2004- Cystic Fibrosis Foundation NENY Chapter ALBANY MEDICAL CENTER COMMITTEES Chairperson, Infection Control Committee 1978-1995

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Member, Executive Committee of the Medical Staff 1979-1997 Member, Appointments, Promotions, & Tenure Committee 1982-1988 Member, Housestaff Education Committee 1987-1997 Member, Disciplinary Hearing Panel 1989- Member, Academic Governing Council 1995-1997 Member, Student Appeals Committee 1995- Member, Board of Director’s Committee on College Affairs 1997- Member, Special Committee for IRB 1997-1998 Member, APT Committee 2004- 2008 HOSPITAL APPOINTMENTS Albany Medical Center Hospital, Attending Physician 1979- Physician-in-Chief, Pediatrics 1995-1997 Division chief Pediatric Infectious Disease 1979- 2013

BIBLIOGRAPHY Original Articles

1. Davis DC, Lipson MJ, Carver DH, Melnick JL, Robbins FC. The degree and duration

of poliomyelitis virus excretion among vaccinated household contacts of clinical cases of poliomyelitis. Pediatrics. 1958;22(1, Part 1):33-40.

2. Lipson MJ, Carver DH, Eleff MG, Hingson RA, Robbins FC. Antibody response to

poliomyelitis vaccine administered by jet injection. American journal of public health and the nation's health. 1958;48(5):599-603.

3. Plank EN, Caughey PA, Lipson MJ. A general hospital child care program to

counteract hospitalism. The American journal of orthopsychiatry. 1959;29(1):94-101. 4. Katz SL, Kempe CH, Black FL, et al. Studies on an attenuated measles-virus vaccine.

VIII. General summary and evaluation of the results of vaccination. American journal of diseases of children (1960). 1960;100:942-946.

5. Katz SL, Kempe CH, Black FL, et al. Studies on an attenuated measles-virus vaccine.

VIII. General summary and evaluation of the results of vaccine. The New England journal of medicine. 1960;263:180-184.

6. Lepow ML, Carver DH, Robbins FC. Clinical and epidemiologic observation on

enterovirus infection in a circumscribed community during an epidemic of ECHO 9 infection. Pediatrics. 1960;26:12-26.

7. Lepow ML, Gray N, Robbins FC. Studies on an attenuated measles-virus vaccine. V.

Clinical, antigenic and prophylactic effects of vaccine in institutionalized and home-dwelling children. The New England journal of medicine. 1960;263:170-173.

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8. Lepow ML, Robbins FC, Woods WA. Influence of vaccination with formalin

inactivated vaccine upon gastrointestinal infection with polioviruses. American journal of public health and the nation's health. 1960;50:531-542.

9. Lepow ML, Warren RJ, Gray N, Ingram VG, Robbins FC. Effect of Sabin Type 1

poliomyelitis vaccine administered by mouth to newborn infants. The New England journal of medicine. 1961;264:1071-1078.

10. Lepow ML, Carver DH, Robbins FC. Serologic response of nonimmune subjects to

commercial Salk vaccine. Response and antibody persistence with four doses. American journal of diseases of children (1960). 1962;103:803-811.

11. Lepow ML, Carver DH, Wright HT, Jr., Woods WA, Robbins FC. A clinical,

epidemiologic and laboratory investigation of aseptic meningitis during the four-year period, 1955-1958. I. Observations concerning etiology and epidemiology. The New England journal of medicine. 1962;266:1181-1187.

12. Lepow ML, Coyne N, Thompson LB, Carver DH, Robbins FC. A clinical,

epidemiologic and laboratory investigation of aseptic meningitis during the four-year period, 1955-1958. II. The clinical disease and its sequelae. The New England journal of medicine. 1962;266:1188-1193.

13. Lepow ML, Warren RJ, Ingram VG, Daugherty SC, Robbins FC. Sabin type I

(LSc2ab) oral poliomyelitis vaccine. Effect of dose upon response of newborn infants. American journal of diseases of children (1960). 1962;104:67-71.

14. Mortimer EA, Jr., Lepow ML. Varicella with hypoglycemia possibly due to salicylates.

American journal of diseases of children (1960). 1962;103:583-590. 15. Watkins JF, Lepow ML. The role of neutralising antibody in immunity of the mouse to

herpes simplex virus inoculated intracerebrally. British journal of experimental pathology. 1963;44:244-250.

16. Lepow ML, Serfling RE, Sherman IL, Robbins FC. A survey of immunization levels

after an oral poliovaccine program in Cleveland. JAMA. 1964;187:749-757. 17. Warren RJ, Lepow ML, Bartsch GE, Robbins FC. The relationship of maternal

antibody, breast feeding, and age to the susceptibility of newborn infants to infection with attenuated polioviruses. Pediatrics. 1964;34:4-13.

18. Aronson SS, Lepow ML. The effect of repeated mumps skin tests on skin sensitivity to

mumps antigen. Pediatrics. 1965;36(3):422-425.

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19. Lepow ML, Spence DA. Effect of trivalent oral poliovirus vaccine in an institutionalized population with varying natural and acquired immunity to poliomyelitis. Pediatrics. 1965;35:236-246.

20. Lipson MJ, Silbert JE. Acid mucopolysaccharides of tadpole tail fin and back skin.

Biochimica et biophysica acta. 1965;101(3):279-284. 21. Woods WA, Johnson RT, Hostetler DD, Lepow ML, Robbins FC. Immunofluorescent

studies on rubella-infected tissue cultures and human tissues. Journal of immunology (Baltimore, Md. : 1950). 1966;96(2):253-260.

22. Cullum C, Lepow ML. Error in hematocrit determinations due to too high

concentration of anticoagulant. Pediatrics. 1967;40(6):1027-1028. 23. Halsted C, Lepow ML, Balassanian N, Emmerich J, Wolinsky E. Otitis media:

microbiology and evaluation of therapy. Annals of the New York Academy of Sciences. 1967;145(2):372-378.

24. Lepow ML, Nankervis GA, Robbins FC. Immunity of school children two years after

oral poliomyelitis vaccination. Jama. 1967;202(1):121-125. 25. Nogen AG, Lepow ML. Enteroviral meningitis in very young infants. Pediatrics.

1967;40(4):617-626. 26. Rosen FS, Lepow ML, Robbins FC. The gamma globulin content of meconium and

amniotic fluid and the intestinal immunity of the newborn to poliovirus. Archiv fur die gesamte Virusforschung. 1967;22(1):263-272.

27. Calafiore DC, Nader PR, Lepow ML, Nankervis GA, Casey H, Warren RJ. Attenuated

measles virus vaccine dosage study--Cleveland, Ohio, 1966. American journal of epidemiology. 1968;87(1):247-253.

28. Halsted C, Lepow ML, Balassanian N, Emmerich J, Wolinsky E. Otitis media. Clinical

observations, microbiology, and evaluation of therapy. American journal of diseases of children (1960). 1968;115(5):542-551.

29. Johnson KP, Lepow ML, Johnson RT. California encephalitis. I. Clinical and

epidemiological studies. Neurology. 1968;18(3):250-254. 30. Lepow ML, Balassanian N, Emmerich J, Roberts RB, Rosenthal MS, Wolinsky E.

Interrelationships of viral, mycoplasmal, and bacterial agents in uncomplicated pneumonia. The American review of respiratory disease. 1968;97(4):533-545.

31. Lepow ML, Veronelli JA, Hostetler DD, Robbins FC. A trial with live attenuated

rubella vaccine. American journal of diseases of children (1960). 1968;115(6):639-647.

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32. Lipson MJ, Silbert JE. Glycosaminoglycans of adult frog back skin. Biochimica et biophysica acta. 1968;158(3):344-350.

33. Lepow ML, Nankervis GA. Eight-year serologic evaluation of Edmonston live measles

vaccine. The Journal of pediatrics. 1969;75(3):407-411. 34. Fraumeni JF, Jr., Stark CR, Gold E, Lepow ML. Simian virus 40 in polio vaccine:

follow-up of newborn recipients. Science (New York, N.Y.). 1970;167(3914):59-60. 35. Lepow ML. Rubella vaccine--some perspectives. Connecticut medicine.

1970;34(5):340-342. 36. Lipson MJ, Naimi S. Multifocal atrial tachycardia (chaotic atrial tachycardia). Clinical

associations and significance. Circulation. 1970;42(3):397-407. 37. Cohen ML, Lipson MJ. Kidney biopsy in children. Arizona medicine. 1971;28(7):509-

512. 38. Hale M, Lepow ML. Epidemiology of increased lead exposure among 954 one to five-

year-old Hartford, Connecticut, Children--1970. Connecticut medicine. 1971;35(8):492-497.

39. Lipson MJ, Cerskus RA, Silbert JE. Glycosaminoglycans and glycosaminoglycan-

degrading enzyme of Rana catesbeiana back skin during late stages of metamorphosis. Developmental biology. 1971;25(2):198-208.

40. Lipson MJ, Naimi S. Effect of free fatty acid mobilization on the electrophoretic

mobility of alpha-lipoproteins in the dog. Journal of lipid research. 1971;12(3):294-305.

41. Lipson MJ, Naimi S, Proger S. Effect of a combination of propranolol and nicotinic

acid on the inhibition of norepinephrine-induced elevations of serum triglyceride, serum glycerol, and plasma free fatty acids in the dog. Metabolism: clinical and experimental. 1971;20(6):580-589.

42. Lipson MJ, Naimi S, Proger S. Synergistic effect of propranolol and nicotinic acid on

the inhibition of plasma free fatty acid release in the dog. Circulation research. 1971;28(2):270-276.

43. Murphy T, Lepow ML. Comparison of delta-aminolevulinic acid levels in urine and

blood lead levels for screening children for lead poisoning. Connecticut medicine. 1971;35(8):488-492.

44. Goldschneider I, Lepow ML, Gotschlich EC. Immunogenicity of the group A and

group C meningococcal polysaccharides in children. The Journal of infectious diseases. 1972;125(5):509-519.

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45. Cohen CJ, Bowers GN, Lepow ML. Epidemiology of lead poisoning. A comparison

between urban and rural children. Jama. 1973;226(12):1430-1433. 46. Goldschneider I, Lepow ML, Gotschlich EC, Mauck FT, Bachl F, Randolph M.

Immunogenicity of group A and group C meningococcal polysaccharides in human infants. The Journal of infectious diseases. 1973;128(6):769-776.

47. Pierz JJ, Lau T, Lepow ML. Prevalence of parasites in Puerto Rican and black children

of Hartford, Connecticut. Connecticut medicine. 1973;37(6):291-294. 48. Lepow ML, Bruckman L, Rubino RA, Markowtiz S, Gillette M, Kapish J. Role of

airborne lead in increased body burden of lead in Hartford children. Environmental health perspectives. 1974;7:99-102.

49. Lepow ML, Gold R. Current status of vaccines against the meningococcus. Preventive

medicine. 1974;3(4):449-455. 50. Gold R, Lepow ML, Goldschneider I, Draper TL, Gotschlich EC. Clinical evaluation of

group A and group C meningococcal polysaccharide vaccines in infants. The Journal of clinical investigation. 1975;56(6):1536-1547.

51. Lepow ML, Bruckman L, Gillette M, Markowitz S, Robino R, Kapish J. Investigations

into sources of lead in the environment of urban children. Environmental research. 1975;10(3):415-426.

52. Lepow ML, Steele FM, Ross MR, Randolph MF. Measles immunization status in 1972

among first- and second-grade school children in Danbury, Connecticut. Pediatrics. 1975;55(3):348-353.

53. Gold R, Lepow ML. Present status of polysaccharide vaccines in the prevention of

meningococcal disease. Advances in pediatrics. 1976;23:71-93. 54. Osborne RG, Raye JR, Bowers GN, Lepow ML. The influence of environmental

factors on maternal and neonatal blood lead levels. Connecticut medicine. 1976;40(7):452-455.

55. Gold R, Lepow ML, Goldschneider I, Gotschlich EC. Immune Response of human

infants of polysaccharide vaccines of group A and C Neisseria meningitidis. The Journal of infectious diseases. 1977;136 Suppl:S31-35.

56. Lepow ML, Gold R. Further conquest of the meningococcus. The New England journal

of medicine. 1977;297(13):721-722.

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57. Lepow ML, Gold R, Mauck FT. Evaluation of a two-dose regimen of influenza A/New Jersey/76 subunit virus vaccine in three- to 10-year-old children. The Journal of infectious diseases. 1977;136 Suppl:S601-603.

58. Lepow ML, Goldschneider I, Gold R, Randolph M, Gotschlich EC. Persistence of

antibody following immunization of children with groups A and C meningococcal polysaccharide vaccines. Pediatrics. 1977;60(5):673-680.

59. Lipson MJ. Medical legislation: its effect on rehabilitation programs. Archives of

physical medicine and rehabilitation. 1977;58(9):386-392. 60. Gold R, Goldschneider I, Lepow ML, Draper TF, Randolph M. Carriage of Neisseria

meningitidis and Neisseria lactamica in infants and children. The Journal of infectious diseases. 1978;137(2):112-121.

61. Gold R, Lepow ML, Goldschneider I, Draper TF, Gotschlich EC. Antibody responses

of human infants to three doses of group A Neisseria meningitidis polysaccharide vaccine administered at two, four, and six months of age. The Journal of infectious diseases. 1978;138(6):731-735.

62. Lepow ML. Enteroviral meningitis: A reappraisal. Pediatrics. 1978;62(2):267-269. 63. Lepow ML, Quintiliani R. "Should she or shouldn't she" receive the rubella

immunization before age 12. Connecticut medicine. 1978;42(6):403-404. 64. Gold R, Lepow ML, Goldschneider I, Draper TF, Gotshlich EC. Kinetics of antibody

production to group A and group C meningococcal polysaccharide vaccines administered during the first six years of life: prospects for routine immunization of infants and children. The Journal of infectious diseases. 1979;140(5):690-697.

65. Mortimer EA, Jr., Lepow ML, Gold E, Robbins FC, Burton GJ, Fraumeni JF, Jr. Long-

term follow-up of persons inadvertently inoculated with SV40 as neonates. The New England journal of medicine. 1981;305(25):1517-1518.

66. Zimmerman AW, Hambidge KM, Lepow ML, Greenberg RD, Stover ML, Casey CE.

Acrodermatitis in breast-fed premature infants: evidence for a defect of mammary zinc secretion. Pediatrics. 1982;69(2):176-183.

67. Fox AS, Lepow ML. Tuberculin skin testing in Vietnamese refugees with a history of

BCG vaccination. American journal of diseases of children (1960). 1983;137(11):1093-1094.

68. Lepow ML, Gold R. Editorial retrospective. Meningococcal A and other

polysaccharide vaccines. A five-year progress report. The New England journal of medicine. 1983;308(19):1158-1160.

57

69. Lepow ML, Peter G, Glode MP, et al. Response of infants to Haemophilus influenzae type b polysaccharide and diphtheria-tetanus-pertussis vaccines in combination. The Journal of infectious diseases. 1984;149(6):950-955.

70. Lepow ML, Samuelson JS, Gordon LK. Safety and immunogenicity of Haemophilus

influenzae type B polysaccharide-diphtheria toxoid conjugate vaccine in adults. The Journal of infectious diseases. 1984;150(3):402-406.

71. Lepow ML, Samuelson JS, Gordon LK. Safety and immunogenicity of Haemophilus

influenzae type b-polysaccharide diphtheria toxoid conjugate vaccine in infants 9 to 15 months of age. The Journal of pediatrics. 1985;106(2):185-189.

72. Messina JP, Hickox PG, Lepow ML, Pollara B, Venezia RA. Modification of a direct

enzyme-linked immunosorbent assay for the detection of immunoglobulin G and M antibodies to pneumococcal capsular polysaccharide. Journal of clinical microbiology. 1985;21(3):390-394.

73. Goldstein RL, Stanton BA, Lipson MJ. Clinical utility of serum digoxin level tests in

hospitalized elderly patients. Archives of physical medicine and rehabilitation. 1986;67(1):34-37.

74. Lepow ML, Beeler J, Randolph M, Samuelson JS, Hankins WA. Reactogenicity and

immunogenicity of a quadrivalent combined meningococcal polysaccharide vaccine in children. The Journal of infectious diseases. 1986;154(6):1033-1036.

75. Hetherington S, Lepow ML. Epidemiology and immunology of Hemophilus influenzae

type B infections in childhood: implications for chemoprophylaxis and immunization. Advances in pediatric infectious diseases. 1987;2:1-18.

76. Lepow ML, Barkin RM, Berkowitz CD, et al. Safety and immunogenicity of

Haemophilus influenzae type b polysaccharide-diphtheria toxoid conjugate vaccine (PRP-D) in infants. The Journal of infectious diseases. 1987;156(4):591-596.

77. Daum RS, Marcuse EK, Giebink GS, et al. Haemophilus influenzae type b vaccines:

lessons from the past. Pediatrics. 1988;81(6):893-897. 78. Lepow ML, Cimma R, Larsen D, et al. Persistence of antibody to Haemophilus

influenzae type b at 4 years of age in children previously immunized with polysaccharide antigen alone or conjugated with diphtheria toxoid. The Journal of pediatrics. 1988;112(5):741-742.

79. Musher DM, Watson DA, Lepow ML, McVerry P, Hamill R, Baughn RE. Vaccination

of 18-month-old children with conjugated polyribosyl ribitol phosphate stimulates production of functional antibody to Haemophilus influenzae type b. The Pediatric infectious disease journal. 1988;7(3):156-159.

58

80. Lepow ML. Measles vaccine and measles control. Pediatric annals. 1990;19(9):543-545, 548-550.

81. Lipson MJ, Minassian P. Differences in outcome: hospital rehabilitation vs skilled

nursing facility rehabilitation. Archives of internal medicine. 1990;150(7):1550-1551. 82. Hetherington SV, Lepow ML. Correlation between antibody affinity and serum

bactericidal activity in infants. The Journal of infectious diseases. 1992;165(4):753-756. 83. Kacica MA, Horgan MJ, Ochoa L, Sandler R, Lepow ML, Venezia RA. Prevention of

gram-positive sepsis in neonates weighing less than 1500 grams. The Journal of pediatrics. 1994;125(2):253-258.

84. Kacica MA, Lepow ML. Meningitis: clinical presentation and workup. Pediatric

annals. 1994;23(2):69-70, 73-65. 85. Kacica MA, Venezia RA, Miller J, Hughes PA, Lepow ML. Measles antibodies in

women and infants in the vaccine era. Journal of medical virology. 1995;45(2):227-229. 86. Swanson H, Cutts E, Lepow M. Penicillin-resistant Aerococcus viridans bacteremia in

a child receiving prophylaxis for sickle-cell disease. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 1996;22(2):387-388.

87. Rodriguez WJ, Gruber WC, Welliver RC, et al. Respiratory syncytial virus (RSV)

immune globulin intravenous therapy for RSV lower respiratory tract infection in infants and young children at high risk for severe RSV infections: Respiratory Syncytial Virus Immune Globulin Study Group. Pediatrics. 1997;99(3):454-461.

88. Gerber MA, Tanz RR, Kabat W, et al. Potential mechanisms for failure to eradicate

group A streptococci from the pharynx. Pediatrics. 1999;104(4 Pt 1):911-917. 89. Stellrecht KA, Harding I, Hussain FM, et al. A one-step RT-PCR assay using an

enzyme-linked detection system for the diagnosis of enterovirus meningitis. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology. 2000;17(3):143-149.

90. Stellrecht KA, Harding I, Woron AM, Lepow ML, Venezia RA. The impact of an

enteroviral RT-PCR assay on the diagnosis of aseptic meningitis and patient management. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology. 2002;25 Suppl 1:S19-26.

91. Lepow ML, Hughes PA. Meningococcal immunology. Immunology and allergy clinics

of North America. 2003;23(4):769-786. 92. Lepow ML. Advances in virology--Weller and Robbins. The New England journal of

medicine. 2004;351(15):1483-1485.

59

BOOK REVIEWS 1. DeAngelis C: An Introduction to Clinical Research. Oxford University Press, J Ped.,

1990. Reviewed in Journal of Pediatrics, 1990, vol. 117(5): 764. 2. Pizzo PA, Wilfert CM: Pediatric Aids: The Challenge of HIV Infection in Infants,

Children and Adolescents. Baltimore, Maryland, J Ped., 1990. Reviewed in Journal of Pediatrics, 1991, vol. 118(6): 974.

3. Donowitz LG: Infection Control in the Child Care Center and Preschool. Williams and

Wilkins, Baltimore, Maryland, 1991. Reviewed in Journal of Pediatrics, 1991, vol. 119(6): 932.

4. Ho, Monto: Cytomegalovirus: Biology and Infection. Plenum Medical Book Co.,

1991. Reviewed in Journal of Pediatrics, 1992, vol. 120(4): 644. 5. Greenough A, Osborne J, Sutherland S., eds: Congenital, Perinatal and Neonatal

Infections. Churchill Livingston, New York, 1992. Reviewed in Journal of Pediatrics, 1992, vol. 121(4): 626.

6. Gilbert GL: Infectious Disease in Pregnancy and the Newborn Infant; Vol. 2.

Monographs in Clinical Pediatrics. Harwood Academic Publishers, Philadelphia, PA, 1991. Reviewed in Journal of Pediatrics, 1992, vol. 121(5): 826.

7. Weller TH: Growing Pathogens in Tissue Culture, 2004, Science History Publication

USA, Canton, MA 02021-0493. Reviewed in New England Journal of Medicine, 2004, vol. 351(15): 1481-1487.

BOOK CHAPTERS 1. Gold, R., and Lepow, M.L.: vaccines in the prevention Present status of polysaccharide

of meningococcal disease. Adv. Pediatr. 23: 71-93, 1976. 2. Gotschlich, E.C., Goldschneider, J., Lepow, M.L., and Gold, R.: Immune response to

bacterial polysaccharide in man. IN: Antibodies in Human Diagnosis and Therapy. Eds. E. Haber and R.M. Krause. Raven Press, New York, pp. 391-402, 1977.

60

3. Lepow, M.L.: Bacterial polysaccharide vaccines: Present status and future propects.IN: Pediatrics Update: Reviews for Physicians, 1980. A.J. Moss, Ed., Elsevier, New York, pp. 345-357, 1980.

4. Lepow, M.L. and Gold, R.: Immunology of Neisseria Meningitis. IN: comprehensive

Immunology. A.J. Nahmias and R.J. O'Reilly, Eds. Plenum Medical Book Co., New York, pp. 139-155, 1981.

5. Lepow, M.L.: Meningococcal disease. IN: Current Pediatric Therapy 10, s.s. Davis and

B.M. Kagen, Eds. WB Saunders Co., Philadelphia, PA, pp. 518-520, 1982. 6. Lepow, M.L.: Infections of the lower respiratory tract. IN: Pediatric Otolaryngology,

Vol. II, Chapter 67, C.D. Bluestone, S.E. stone, and S.K. Arjona, Eds., WB Saunders Co., Philadelphia, PA, pp. 1249-1259, 1983.

7, Lepow, M. L. and Hetherington, S.: Lower Respiratory Infections. IN: Pediatric

otolaryngology (Revised). WB Saunders Company, Philadelphia, PA, Chapter 75, pp. 1152-1160, 1990.

8, Lepow, M.L.: Poliomyelitis. In: Infections in Children. R.J. Wedgev/Ood, S.D. Davis,

E.G. Roy, and V.C. Kelly, Eds., Harper and Row Publishers, Philadelphia, PA. Chapter 85, pp. 1240-1258 1972-1983.

9. Lepow, M.L.: Haemophilus influenzae infections. IN: Current Pediatric Therapy, S.S.

Davis and B.M. Kagen, Eds. WB Saunders Co., Philadelphia, PA. 11th Edition, p. 535-539, 1984.

10. Lepow, M.L., and Hetherington, S. Neonatal Infections. IN: current Therapy in

Infectious Diseases. E. Kass, Ed., 1986. 11. Hetherington, S. and Lepow, M: Epidemiology and immunology of Haemophilus

influenzae type b infections in childhood: Implications for chemoprophylaxis and immunization. IN: Advances in Pediatric Infectious Diseases, Vol.2, 1-13, 1986.

12. Lepow, M.L.: Meningococcal Vaccines- current Vaccines. E.A. Mortimer and S.A.

Plotkin, Eds. Co., Philadelphia, PA., Chapter 12, 1988. 2nd 1992-1993. 13. Lepow, M.L.: Poliomyelitis (Revised). IN: Practice of Pediatrics. V. Kelly, Ed., J.P.

Lippincott Company, Philadelphia, PA. 1987. 14. Lepow, M.L. and Kreth, W. Immunizations. IN: Current Therapy in Pediatrics. Eichenwald, Stroder, Ed. B.C. Decker, Inc., Philadelphia, PA, 1990 and 1992. 15. Lepow, M.L. and Hetherington, S. Respiratory infections in ambulatory pediatrics.IN:

Ambulatory Pediatrics, 4th Edition. Green, M. and Haggerty, W.A Eds.. Saunders Co., Philadelphia, PA. Chapter 75. pp. 1152-1160, 1990.

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16. Hughes PA, Lepow ML, Hill HR: Neonatal candidiasis. IN: Candidiasis Pathogenesis,

Diagnosis and Treatment, Second Edition. ED. G. Bodey., Raven Press, 1993. 17. Lepow ML: Pseudomonas of the gastrointestinal tract. IN: Pseudomonas Aeruginosa

Infections and Treatment. Baltch, AL and Smith, RP, Taylor & Francis, 1994. 18. Hughes P, and Lepow ML: Lower Respiratory Infections. In: Pediatric Otolaryngology - 3rd Edition, C.D. Bluestone, S.E. Stool Eds., WB Saunders Co., 3rd Edition, Chapter 83, pg.1329-1340, 1995. 19. Hughes P, and Lepow, ML: Measles (Rubeola) in Conn’s Current Therapy, 1997, Pg.

146-171, Philadelphia, PA. 20. Lepow, ML, Craig, JP: Clostridium tetani: Immune response and diagnostic methods.

Manual of Clinical Immunology, 5th edition, Chapter 54, Pg. 470-477, 1997 ASM Press, Washington, DC, Ed. Rose, NR, deMarcario,EC, Folds JF, Lane HC, Nakamura RM. 6th Edition, Chapter 47, 432-434, 2002

21. Lepow, ML: Love in the Virus Lab. In: Polio. Eds. Daniel, TM, Robbins, FC. University of Rochester Press, 1997. 22. Hughes PA and Lepow ML: Meningococcal disease. Burg FD, Polin RA, Ingelfinger JR and Wald ER: Ed. Current Pediatric Therapy, 16, Pg. 72-74, 1997, W.B. Saunders Co. Philadelphia. 23. Hughes PA and Lepow ML: Guidelines for prophylaxis and vaccination of health care workers exposed to meningococcal disease. Poland G, Schaffner W, Pugliese G. Immunization of Health Care Workers: A Practical Approach. Slack Inc. 2000. 24. Kacica M and Lepow ML: Meningitis and Encephalitis in Neuroscience for the Primary Care Physician, Popp J. Ed. AANS publications, pg. 365- 376, 1998. 25. Lepow ML, Perkins BA, Hughes, PA, Poolman, JT: Meningococcal Vaccines.

In: Vaccines. 3rd Edition, S. Plotkin and E.A. Mortimer, Eds., W.B. Saunders Co. Philadelphia, PA, pp.711-727, 1999.

26. Fernandez AD, Hughes PA, Lepow ML: Escherichia coli 0157:H7 Infections in

Current Pediatric Therapy 17th Edition, Berg, Ingelfinger, Polin, Gershon eds. W.B. Saunders Co., Philadelphia, PA, pg. 62-63, 2002.

27. Hughes P, Comber P, and Lepow ML: Lower Respiratory Infections. In: Pediatric Otolaryngology 4th Edition, Bluestone C, Stool S, Alper C, Arjmand E, Casselbrant M,

Dohar J and Yellon R.,WB Saunders, Chapter 85, pg 1484-1495, 2002

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28. Lepow ML, Hughes PA, Meningococcal Immunology. Clinics of North America. 23,

769-786, 2003.

ABSTRACTS

1. Gilette, M.B., McGrade, B.J., and Lepow, M.L.: The roles of behavior environment in childhood lead accumulations. Pediatric Res. 10:303, 1976.

2. Gold, R., Lepow, M.L., Randolph, M.F., and Goldschneider, I.: Natural immunity to

pyogenic bacteria. Pediat. Res. 12: 492, 1978.

3. Gold, R., Lepow, M.L., Goldschneider, I., DeSanctis, A., Hankins, W.A. and Metzger, D.: Immunogenicity of large molecular weight Group A meningococcal polysaccharide vaccine in infants. Pediatr. Res. 13(4) 1 Part 2: 460: 1979.

4. Cates, K.L., Williams, C.L., Caparas, L., Randolph, M.F., and Lepow, M.L.: Serus

opsonic response to H. influenzae type b (Hib) vaccine in 15-18 month old children. Pediatr. Res. 16(4), Part 2: 237A, 1982.

5. Lepow, M.L., Randolph, M.F., Mayer, D.L., Duo, J.S.c., and Williams, C.L.: Safety

and immunogenicity of a single dose of an H. influenzae b (Hib) vaccine, combined with diphtheria-pertussis-tetanus (DPT) in 15-18 month old children. Pediatr. Res. 16(4), Part 2: 275, 1983.

6. Perlman, M.B., Lepow, M.L., Bartoletti, A., Beeler, J., and Venezia, R.: Incidence of

cytomegalovirus (CMV) seroconversion following random donor transfusions in neonates. Pediatr. Res. 17(4), Part 2, 330A, 1983.

7. Mayer, D., Lepow, M.L., Randolph, M.F., Lui, N.S.T., Kuo, J.s.c., and stout, M.:

Persistence of antibody to haemophilus influenzae b polysaccharide combined with diptheria-pertussis-tetanus (PRP-DPT) or with pertussis (PRP-d) in infants immunized at 12-18 months of age. Abs. of the Twenty-third Interscience conference on Antimicrobial Agents and Chemotherapy. p. 230, 1983.

8. Peter, G., Calnen, C., Lepow, M.L., Lui, N.S.T., and Kuo, J.S.C.: Serological responses

of 18 month old children, previously immunized with Haemophilus influenzae b polysaccharide(PRP) vaccine, to combined DPT-PRP vaccine. Abs. of the Twenty third Interscience conference on Antibicrobial Agents and Chemotherapy, p. 259, 1983.

9. Gordon, L.K., Lepow, M.L., Zahradnik, J., Hendley, J.O., and Samuelson, J.:

Comparison of the age of immunocompetence to H. influenzae type b (Hib) capsular polysaccharide alone and as a covalent conjugate vaccine with diphtheria toxoid. Abst. #2147 for the Sixty-ninth Annual Meeting of the FASEB, Fed. Proc. P. 779, March 1, 1985.

63

10. Bartoletti, A., Lepow, M., St. Martin, S., Venezia, R., and Hipp, S.: Ureaplasma

urealyticum and newborn respiratory distress. Abst. #1332. Ped. Res., 19(2), 333A, 1985.

11. Lepow, M., Gordon, L., and Samuelson, J.: Persistence of antibody and response to

booster dose of Haemophilus influenzae type b polysaccharide- diptheria toxoid conjugate vaccine in children immunized at 7-14 months. Abst. #275 of the Twenty-fifth Interscience Conference on Antimicrobial Agents and Chemotherapy, p. 140, 1985.

12. Gordon, L.K., Ward, J.I., and Lepow, M.L.: The role of molecular size and

protein/polysaccharide composition in determining the immunogenicity of an H. influenzae type b polysaccharide-diptheria toxoid conjugate vaccine (PRP-D) in 7-14 month old children. Fed. Proceeding, March, 1986.

13. Cherry, J.D., Mortimer, E.A. Jr., Townsend, T.R., Plotkin, S.A., Sullivan, B.J., Gooch,

W.M., Nelson, D.B., Daum, R.S., Prober, C.G., Lepow, M.L., Grossman, L.K., Gershon, A.A., Dekker, C.L., Stout, M.G., Scott, J.V., and Study Group. Open and double blind clinical trials with the Takeda-Lederle acellular pertussis-diptheria-tetanus (APDT) vaccine in 2, 4 and 6 month old infants. Society for Pediatric Res., Abst#1033:175A, May, 1989.

14. Hughes PA, Yocum DM, Kacica MA, Venezia RA, Lepow ML. Candida Parapsiolosis

{CP} Fungemia in a Neonatal Intensive care unit. Society for Pediatric Res., Abst#543:993A, May, 1992.

15. Kacica MA, Horgan MJ, Venezia RA, Yocum D, Ochoa L, Lepow ML. Prevention of

gram positive (G+} bacteremia {BA} with low dose vancomycin (VA} infusion. Society for Pediatric Res., Abst#1651, 278A, Baltimore, Maryland, 1992.

16. Sanchez JL, Kacica MA, Walsh RF, Lepow ML. Treatment of NICU surviviros

requiring mechanical ventilation due to respiratory synctial virus. Society for Pediatric Res., Abst#196, 35A, 1992.

17. Kacica MA, Venezia RA, Miller J, Hughes PA, Lepow ML. Measles antibody titers in

mothers from the pre and post accine era and their infants. Society for Pediatric Res., Abst#547, 94A, Baltimore, Maryland, 1992.

18. Aschner JL, Kendall PA, McCarthy EA, Peloquin CA, Lepow ML. Isoniazid (INH}

serum levels in a neonatal intenisve care unit (NICU} population. Society for Pediatric Res., Abst#1625, 273A, May, 1992.

19. Kacica MA, Horgan MJ, Yocum D, Ochoa L, Lepow ML, Venezia RA. Continuous

infusion of low dose vancomycine {VA} in neonates prevents gram positive bacteremia

64

(G+BA) without altering VA susceptibilities. Presented at 32nd ICAAC, 1992, Anaheim, California.

20. Valentine L, Currie E, Lepow ML, Venezia RA: Pertussis Exposure in a Neonatal Intensive Care Unit (NICU) By An Undiagnosed Health Care Worker (HCW). Association for Professionals in Infection Control and Epidemiology. Presented January 1997.

21. Venezia RA, Valentine L, Veeder A, Kacica MA, Hughes P, Sanden G and Lepow

ML: Serological evaluation of Health Care Workers (HCWs) after exposure to pertussis in neonatal intensive care unit, (NICU). Presented October 1997.

22. Gerber MA, Tanz R, Lepow M, Kaplan EL, Shulman ST: Potential Mechanisms for

Treatment Failures in Group A Streptococcal Pharyngitis. Submitted to APS and SPR for May, 1998 meeting.

23. Stellrecht KA, Mishrik NG, Czap R, Tiedeman L, Hussain FM and Lepow ML. A

One-Step RT-PCR Assay Using an Enzyme-Linked Detection System for the Diagnosis of Enterovirus Infection. Presented to 98th General Meeting May 1998 American Society of Microbiology.

24. Weatherwax D, Hanley E, Evans A, Mitchell A, Lepow M, Mahoney L, Walsh R,

Clark D, and Venezia RA. Control of a Vancomycin-Resistant Enterococci (VRE) Outbreak on a Pediatric Unit. Annual Meeting of the Society for Healthcare Epidemiology of America. Presented April 1999.

25. Azuero R. Horgan MJ, Venezia RA, Lepow ML. Use of Vancomycin for the Prevention of Gram Positive Sepsis in Very Low Birth Weight (VLBW) Premature Infants: Update on Development of Vancomycin Resistance. Pediatr Res 2002; 51(4): 306A. Poster at SPR, May 2002.

26. Kerr HA, Stratton J, Lepow ML, Schulman J. Predictive Value for Admission with Bronchiolitis of Demographic and clinical Variable Collected During ER Evaluation. To be presented at 40th Annual Meeting of IDSA, Chicago, Ill, Oct. 24-26, 2002, (Poster).

Case Reports

1. Ruben FL, Papageorgiou SN, Lepow ML, Wolinsky E. Perianal vaccinia with associated streptococcal and staphylococcal infection. Archives of dermatology. 1969; 99(2):170-175.

65

2. Puri S, Lepow M, Spencer RP, Westcott JL. Abdominal hemangioma: diagnostic use of radiocolloid scans during steroid therapy. International journal of nuclear medicine and biology. 1978; 5(2-3):117, 119-120.

3. Hersh JH, Gold R, Lepow ML. Meningococcal group Y pneumonia in an adolescent

female. Pediatrics. 1979; 64(2):222-224. 4. White JJ, Goldman ML, Lepow M. Correction of hypersplenism without splenectomy.

Journal of pediatric surgery. 1981; 16(6):967. 5. Yanofsky CS, Hanson PA, Lepow M. Parainfectious acute obstructive hydrocephalus.

Annals of neurology. 1981; 10(1):62-63. 6. Wade NA, Lepow ML, Veazey J, Meuwissen HJ. Progressive varicella in three patients

with Wiskott-Aldrich syndrome: treatment with adenine arabinoside. Pediatrics. 1985; 75(4):672-675.

7. Lepow ML. Aplastic anemia following chloramphenicol therapy still happens!

Pediatrics. 1986; 77(6):932-933. 8. Nightingale LM, Eaton CB, Fruehan AE, Waldman JB, Clark WB, Lepow ML.

Cephalhematoma complicated by osteomyelitis presumed due to Gardnerella vaginalis. Jama. 1986; 256(14):1936-1937.

9. Urizar RE, Lepow M, Neumann M, Pietrocola D, Sarrafizadeh M. Fungal peritonitis

with splenic-pelvic abscess in a patient on continuous ambulatory peritoneal dialysis. Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis. 1993; 13(2):162-163.

10. Hughes P, LaRussa P, Pearce JM, Lepow M, Steinberg S, Gershon A. Transmission of

varicella-zoster virus from a vaccinee with leukemia, demonstrated by polymerase chain reaction. The Journal of pediatrics. 1994; 124(6):932-935.

11. Dangman BC, Albanese BA, Kacica MA, Lepow ML, Wallach MT. Cat scratch

disease in two children presenting with fever of unknown origin: imaging features and association with a new causative agent, Rochalimaea henselae. Pediatrics. 1995; 95(5):767-771.

12. Swanson H, Cutts E, Lepow M. Penicillin-resistant Aerococcus viridans bacteremia in

a child receiving prophylaxis for sickle-cell disease. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 1996; 22(2):387-388.

13. Swanson H, Hughes PA, Messer SA, Lepow ML, Pfaller MA. Candida albicans

arthritis one year after successful treatment of fungemia in a healthy infant. The Journal of pediatrics. 1996; 129(5):688-694.

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14. Ghedin E, Laplante J, DePasse J, et al. Deep sequencing reveals mixed infection with 2009 pandemic influenza A (H1N1) virus strains and the emergence of oseltamivir resistance. The Journal of infectious diseases. 2011; 203(2):168-174.

15. Santos RP, Chao J, Nepo AG, et al. The use of intravenous palivizumab for treatment of

persistent RSV infection in children with leukemia. Pediatrics. 2012; 130(6):e1695-1699.

16. Catts D, Santos RP, Lepow ML. Congenital CMV: a call for improved patient

education & screening protocols - a representative case. Family Doctor - A Journal of the New York State Academy of Family Physicians. 2016; 4(4): 23-4.

17. Santos RP, Chela K, Allmendinger N, Boulos MT, Whyte C, Lepow ML. A rare

complication of Hepatitis A infection. Consultant for Pediatricians. 2016; 15(5): 254-255.

18. Santos RP, Adams ME, Lepow ML. Pneumocystis pneumonia in a boy with AIDS.

Consultant for Pediatricians. 2016; 15(8):430-32. 19. Santos RP, Lepow ML. Cytomegalovirus Infection: A treatable cause of progressive

hearing loss in newborn infants. Family Doctor – A Journal of the New York State Academy of Family Physicians. Fall 2016; 5(2):19-20.