Antibody response to booster dose of diphtheria and tetanus toxoids and pertussis vaccine: Thirteen years after inoculation of institutionalized subjects

IN 1943 several groups of mentally ill adult patients in the Pontiac State Hospital, Pontiac, Mich., were inoculated with different combina,tions of diphtheria and t,etanus toxoids, pertussis and typhoid vaccines, and scarlet fever toxin, according to defined dosage schedules. The subjects' reactions were studied, and their specific immune responses were measured in terms of circulating antibodies. The results forme,d the basis for a series of reports, which demonstrated that responses to each antigen were excellent in all combinations studied (14). In 1956 many of the subjects from this investigation were still in residence at the hospital and available for a study of their responses to a booster dose oif antigen. These institutionalized subjects represented a different population from the noninstitutionalized subjects reported earlier (5). Not only did they differ with respect to their age ancd environment, but owing to an institutional policy, they had received subsequent boosters of diphtheria and tetanus toxoids. Even before we gave them tlhe injections in 1943, the institutionalized subjects had received numerous Schick tests and booster injections of diphtheria toxoid at intervals throughout their hospitalization, exteniding back as far as 1932. The study reported here was designed primarily to measure the responses of 290 institutionalized subjects to a small dose of diphtheria and tetanus toxoids to determine whether their responses differed from those of the noninstitutionalized subjects, reportecl previously, who had not been given intervening booster injections (5). Secondarily, the investigation was concerned with the effect of a small dose of pertussis vaccine on production of agglutinins. Because pertussis may occur in older children and adults, even t,hough injected with pertiissis vacc.ine in infancy (personal communication fromI Dr. Harold J. Lambert, July 1963), thlere is a growing interest in the extension of pertussis boosters beyond preschool age. It seemed Dr. Volk is commissioner, Saginaw County Health Department, Saginaw, Mich. Dr. Gottshall is chief, antigens and antisera unit, biologic products section, and Dr. Anderson is chief, biologic products section, division of laboratories, Michigan Department of Health, Lansing. Dr. Top is head, department of hygiene and preventive medicine, State University of Iowa, Iowa City. Dr. Bunney is vice president and director of manufacturing operations, E. R. Squibb & Sons, New York City. Dr. Serfling is chief, Statistics Section, Epidemiological Branch, Communicable Disease Center, Public Health Service, Atlanta, Ga. Maud G. Gilbert, Saginaw County Health Department, and Frances Angela, Michigan Department of Health laboratories, gave technical assistance in this study. This study was made in cooperation with the technical committee on immunization, epidemiology section, American Public Health Association, and was supported in part by research grant E-1115 from the National Institute of Allergy and Infectious Diseases, Public Health Service.