[Further improvements in schedules for immunizing children against diphtheria and tetanus]

The study of the rational schedule of revaccinations made at different ages for the prevention of diphtheria and tetanus was carried out on 800 children belonging to the age groups of 6-9 years and 11-14 years. The content of diphtheria antitoxin was determined by Jensen's method, and the content of tetanus antitoxin in the passive hemagglutination test. In the first age group immunity to the above-mentioned infections was determined after the primary immunization, and in the second age group after the first revaccination made at an age indicated in the schedule. The high level of immunity to both diphtheria and tetanus was shown to preserve for 6-7 years. For this reason intervals between revaccinations scheduled for children achieving a definite age in accordance with the existing scheme of immunization against diphtheria and tetanus may be increased. the most rational time for such revaccinations is the age of 9 (instead of 6) years and 16 (instead of 11) years.

Analysis of human anti-diphtheria antibodies by isoelectric focusing: evidence for restricted clonal heterogeneity of anti-fragment A antibodies

The in vivo human humoral response to diphtheria toxoid-tetanus toxoid booster immunization was studied by isoelectric focusing analysis of sera obtained after immunization. The anti-diphtheria toxoid (immunoglobulin G [IgG]-Dip), anti-fragment A (IgG-Frag A), and anti-tetanus toxoid antibodies from 20 donors post-booster immunization were focused by using agarose isoelectric focusing and visualized by development with radiolabeled antigens. The quantities of the IgG-Dip and IgG-Frag A antibodies correlated with the number of bands seen on the isoelectric focusing pattern in that more bands were found in the spectrotypes of donors with high serum levels of antibody. No difference was apparent in the antibody spectrotypes obtained from sera of donors at successive times post-booster immunization. Individual heterogeneity of the different donors' spectrotypes was often found for IgG-Frag A antibodies, but a close comparison of several different donors revealed antibodies with the same spectrotype patterns. Thus, individual clones of antibody were revealed in humans after in vivo immunization, particularly when antibodies against antigens of restricted epitope size were analyzed. Additionally, the sharing of certain antibody spectrotypes among several individuals raised the possibility that certain antibody clones may be preferentially expressed in the human population.

Diphtheria immunization in adolescents and adults with reduced doses of adsorbed diphtheria toxoid

A study was undertaken in Schick-positive university students and schoolchildren to determine the diphtheria antitoxin response to vaccines containing a reduced dose of adsorbed diphtheria toxoid. It was found that the majority of participants, apparently previously sensitized, responded with an increase in antitoxin titre to protective levels after performance of the Schick test, or after the first dose of vaccine. A group of non-immune students required three doses of vaccine to reach adequate antitoxin levels to ensure durable immunity. Only one local reaction was observed in the group of 51 students, and this was attributed to an Arthus-type reaction involving the tetanus toxoid component of a combined adsorbed diphtheria and tetanus vaccine.

Immunochemical studies of diphtherial toxin and related nontoxic mutant proteins

Competitive binding radioimmunoassays were used to analyze the immunochemistry of diphtherial toxin. Rabbit antisera obtained by immunization with formolized toxoid or fragment A were used to characterize purified toxin, toxoid, fragment A, and related nontoxic mutant proteins. Antitoxoid serum had a high titer of neutralizing activity. Most of the antibodies in antitoxoid bound to toxin but not to fragment A. The anti-fragment A antibodies that were present in antitoxoid recognized determinants of fragment A that were exposed on unnicked toxin. Formaldehyde treatment partially destroyed antibody-binding sites associated with the A and B domains of toxin. Anti-fragment A serum had a low titer of neutralizing activity. The specificities of the anti-fragment A antibodies in antitoxoid and anti-fragment A sera were different. Approximately half of the anti-fragment A antibodies in anti-fragment A serum recognized determinants of fragment A that were masked in toxin. Per unit of fragment A-binding activity, anti-fragment A serum was significantly more potent than antitoxoid serum as an inhibitor of the enzymatic activity of fragment A. By analyzing the antigenic structure of several nontoxic mutant proteins (cross-reacting materials) that cross-react with toxin, we distinguished three different subgroups of antigenic determinants associated with the B domain of toxin. Furthermore, the exposed antigenic determinants of the A domain of toxin were separated into two subgroups, both of which were distinct from the masked determinants of the A domain. The radioimmunoassays described here provide rapid, sensitive, quantitative, and versatile methods for immunochemical characterization of toxin or related cross-reacting proteins encoded by corynebacteriophages.

[Diphtheria. Immune status of an urban infant population of São Paulo, SP, Brazil]

A verificação do teor de anticorpos antidiftéricos provenientes de 130 crianças de 7 a 10 anos de idade, do município de São Paulo, Brasil, revelou 31, 14 e 5% de indivíduos susceptíveis nas idades de 7, 8 e 9 anos, respectivamente. Todas as crianças de 10 anos de idade apresentaram proteção contra a difteria, revelando teor de antitoxina circulante em níveis superiores a 0,01 UI/ml. O teor médio de antitoxina diftérica encontrada variou de 0,0385 a 0,1315 UI/ml de soro, na população examinada.

Influence of anti-fragment A of diphtheria toxin on passive hemagglutination with antitoxin

Hemagglutination (HA) and toxin neutralization (TN) tests were used to titrate human and guinea-pig serum specimens taken at various stages of immunization for diphtheria antitoxin. The ratio of HA to TN titers varied significantly depending on the immune status. The ratios and the range of their variations became larger and high values exceeding five were often obtained after repeated booster immunization. Such a high value was proved to be related to the antibody against fragment A (FrA) of diphtheria toxin, since the ratio reduced significantly when anti-FrA was absorbed. Anti-FrA was not produced in children after the basic immunization with diphtheria toxoid and was detected in only one-third of vaccines after the booster injection given after 1 year. It was produced abundantly, however, when booster immunization was repeated. The pattern of production of anti-FrA in guinea pigs was similar to that in humans, when immunized with diphtheria toxoid with adjuvant. No anti-FrA was produced even when the animals were immunized repeatedly with plain diphtheria toxoid.

Immunity to diphtheria in Helsinki in 1975

To determine the status of the population's immunity to diphtheria, the Schick test was performed on 489 and the diphtheria antitoxin level determined in 404 hospital patients, all residents of Helsinki. A low ("unprotective", less than 0.01 IU/ml) antitoxin level was found in not more than 5% among persons under 20. The highest percentage, 48%, was found in the 50--59 years age group. A low antitoxin level was more common among women than men in those over 40 years of age. Taking into consideration the age structure of the population of Helsinki in 1975, 23% of the population had an antitoxin level less than 0.01 IU/ml. The percentage of Schick-positives among different age groups was almost the same as the percentage of low antitoxin levels. Of 100 serum samples from military recruits coming from different regions of the country, 15% had an antitoxin level below 0.01 IU/ml.

Tetanus and diphtheria immunity in urban Minnesota adults

Tetanus and diphtheria antitoxin levels were measured in 183 urban adults, using a hemagglutination technique. Protective levels (greater than 0.01 unit/mL) of tetanus antitoxin were present in more than 85% of sera from all subjects under 40 years of age and from men between 40 and 59 years old. A minority of women (36%) between 40 and 59 years of age, and of men (41%) and women (29%) over 60 years of age, were protected. Less than one quarter of the study group had protective levels (greater than 0.01 unit/mL) of diphtheria antitoxin. The results of the study suggest that a minority of middle-aged women and older adults have been appropriately immunized against diphtheria and tetanus.

[Antidiphtheria and antitetanus antitoxic immunity indices in the population of the Estonian SSR (an assessment of the effectiveness of a planned vaccine prophylaxis)]

In 1972-1974 and 1977 in the Estonian SSR children and adults were surveyed for the presence of antibodies against tetanus and diphtheria toxins (toxoids) by means of the passive hemagglutination test. The level of protection against tetanus was revealed to correspond to the proportion of child population covered by vaccination: in 1977, with 98.8% covered by vaccination, the level of protection among children aged 7 to 14 years and adolescents of 15-19 years exceeded 98%; with the increase of age (every 10-15 years) the level of protection against tetanus regularly decreased. This dynamics correlated with the existing terms of postvaccinal immunity and the epidemiological independence of tetanus as infectiion. The level of protection in child population against diphtheria in 1972-1974 and 1977 lagged behind the level of protection against tetanus and the coverage by vaccination. The diphtheria component of adsorbed DPT vaccine seemed to be unable to ensure the sufficient level and intensity of immunity under conditions of a sharply decreased risk of encounter with the infective agent. In persons aged 40 years and over the indices of immunity against diphtheria were higher than against tetanus. These indices resulted from diphtheria infection at the prevaccination period and could serve as an objective sign in following up the decrease of the process of diphtheria epidemics.

Immunity of children to diphtheria, tetanus, and poliomyelitis

A survey of titres of diphtheria and tetanus antitoxins and of antibodies to polioviruses in the sera of 291 schoolchildren aged 15, 11, and 7 years showed that high immunisation rates can evoke protective concentrations of tetanus antitoxin in 98% of children and protective levels of the antibodies to diphtheria and all three types of poliomyelitis in 85% of children. Reinforcing immunisation at school entry appeared to be necessary to maintain adequate titres of diphtheria antitoxin in children up to 15 years of age, not essential to maintain adequate titres of tetanus antitoxin, and to have little effect on the titres of antibodies to poliomyelitis.

Immunisation of adults against diphtheria

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