THE SPEED OF THE SECONDARY IMMUNE RESPONSE TO TETANUS TOXOID WITH A REVIEW OF WAR REPORTS AND OBSERVATIONS ON SIMULTANEOUS INJECTION OF TOXOID AND ANTITOXIN

Abstract

A review of the 30 reported cases of tetanus occurring in actively immunized personnel of the British and American armies permits the following conclusions. The only type of tetanus that need be feared in recently immunized individuals is that which may occur following extensive trauma or massive contamination. It is characterized by short incubation periods, sometimes even less than one week. and a high case fatality rate. The reinjection of toxoid on wounding in two such instances failed to prevent death. The speed of the antitoxin response during the week subsequent to a reinjection of tetanus toxoid was observed in a group of more than 150 actively immunized children. Marked individual differences were observed. Factors which influenced the speed of response were: 1. The type of toxoid employed in the basic immunization; alum-precipitated or aluminum hydroxide-adsorbed toxoid inducing a superior capacity to react promptly when compared to fluid toxoid. 2. The type of toxoid used for the reinjection (for the secondary stimulus); fluid toxoid inducing a more rapid rise in antitoxin than alum-precipitated toxoid. 3. The interval elapsing since the last injection of toxoid. When this interval was greater than four years the speed of response was occasionally slowed. Experimental evidence is advanced indicating that the simultaneous injection of prophylactic antitoxin and tetanus toxoid in different extremities does not prevent the secondary immune response to the toxoid. It is therefore suggested that the maximal prophylactic effect against tetanus in severely wounded immunized individuals (and/or when immunization occurred more than four years previously) may be obtained by simultaneous injection of toxoid and antitoxin in different extremities.