The Health bulletin [serial] - University of North Carolina at Chapel Hill

^^ T^>TTiBl IPUBLI5MED BYTAE N^A CAROLINA STATE B'^ARD-zAEALTAl BVoL 66 MAY, 1951 No. 5J. W. R. NORTON, M.D., M.P.H., Sute Health Officer JOHN H. HAMILTON, M.D., EditorIMMUNIZATION POLICYBy a. H. Elliott, M.D., John H. Hamilton, M.D.,C. P. Stevick, M.D., AND Robert J. Murphy, M.D.State Board of Health, Raleigh, North CarolinaRecommendations first made severalyears ago for the immunization of infantsbefore the age of six monthsagainst pertussis have now been followedwith general agreement In thellteratvire on this subject. At the sametime there has also been widespreadacceptance of the principle of simultaneousadministration of diphtheriaand tetanus toxoids combined with pertussisvaccine. Earlier hesitancy to theuse of diphtheria toxoid before the ageof six months no longer appears toexist, to an important extent. The injectionof diphtheria and tetanus toxoidsearly in Infancy is necessary ifthey are to be used in combinationwith pertussis vaccine and the latteris to be administered at the age whenprotection against pertussis is mostneeded.The use of these combined antigensIs discussed in two articles appearingin the June 1950 issue of the Journalof the American Public Health Association.In a group of 189 Infants receivingthree injections of alum precipitateddiphtheria and tetanus toxoidscombined with pertussis vaccine atone, five, and nine weeks of age, respectively,di Sant'Agnese found thata rise In antibodies occurred in themajority. The dosage of the antigenused was O.Sc.c, Ic.c, and Ic.c, containinga total of 50 billion pertussisbacilli. The rise in antibodies was notas satisfactory in .these young infantsas in older children, however, and therecommendation was made that Immimizationnot be attempted before theage of three months.Sauer and Tucker found that fourdoses of the alvun precipitated tripleantigen administered at three, four,five, and six months, respectively, conferredprotection against diphtheria to86 per cent of the infants studied,against tetanus in 100 per cent, and topertussis in 98 per cent.Sauer used a product containing twicethe necessary amount of diphtheria andtetanus toxoids and 30 billion pertussisbacilli per c.c. Doses of 0.5c.c. were injected,giving a total dose of 60 millionpertvissis bacilli.In a round-table on Immimology InPediatric Practice, published in theJanuary 1951 Issue of the Journal ofPediatrics, Miller recommends the administrationof O.Sc.c. of alimi precipitateddiphtheria and tetanus toxoidswith pertussis vaccine (30 billionorganisms per c.c.) at four to eightweeks followed in one month by asecond Injection of 0.5c.c. and afterthree more months, by a third Injectionof 0.5C.C.All authors agree that recall or boosterdoses are essential at approximatelyone year and again before startingschool. It is important to note that thelevel of immimity after booster doses