H. D. Anderson

Antibody response to booster dose of diphtheria and tetanus toxoids: Reactions in institutionalized adults and non-institutionalized children and young adults.

FROM 1943 to 1950, large groups of institutionalized mentally ill or retarded patients and noninstitutionalized young adults and children were inoculated with different combinations of diphtheria and tetanus toxoids, pertussis and typhoid vaccines, and scarlet fever toxin. Studies, reported by Volk and associates (14), were made to determine the antibody responses and the reactions elicited by different dosages and combinations of these antigens. When a reinoculation study of certain of these groups was initiated in 1956, the first problem to be resolved was the efficacy of booster doses consistent with freedom from reactions. This report deals with the studies which led to the selection of a 0.2-ml. booster dose, and therefore is a report of the reactions elicited by different doses of DT, diphtheria and tetanus toxoids, aluminum phosphate adsorbed, and DTP, diphtheria and tetanus toxoids, aluminum phosphate adsorbed, combined with pertussis vaccine.

Response to two small doses of tetanus toxoid singly or combined as DT or DTP.

DURING the past 20 years we have studied the response to single and multiple antigen preparations in both institutionalized and noninstitutionalized subjects (1-4). In 1943-44, individuals in several of the study institutions were inoculated with different antigrens: diphtheria and tetanus toxoids, typhoid and pertussis vaccines, and scarlet fever toxin, singly or in various combinations. Many of the subjects were still available in 1958 for a followup study to determine their response to a booster injection of some of the antigens. Among the individuals were 19 from an institution for the mentally retarded with a record of no previous injections of tetanus toxoid. These were studied for their response to small doses of tetanus toxoid or an antigen containing tetanus toxoid. They were given two 0.2-ml. intramuscular injections of adsorbed tetanus toxoid, either singly or combined with another antigen, 2 years apart. In 17 of the 19 subjects, the injections were followed by high serum antitoxin titers. Because the results were so favorable, they were made the subject of this report. The material injected and the test methods used were described in an earlier report (5), and pertinent information is given in table 1. The subjects, of both sexes, were residents of the same institution; their ages ranged between 21 and 27 years. The first injection in 7 of the 19 subijects was diphtheria and tetanus toxoids and pertussis vaccine combined (DTP), aluminum phosphate adsorbed; in 7 it was diphtheria and tetanus toxoids (DT), aluminum phosphate adsorbed, and in 5 it was tetanus toxoid, aluminum phosphate adsorbed. In all 19 the second injection, 2 years later, was DT (table 2). The serum antitoxin titers before and after administrationI of the two doses are also shown in table 2, with material injected, sex of the subjects, and age at time of first injection. After the first injection three of the seven subjects who received DTP had tetanus anti-