Immunization Against Tetanus and Diphtheria With Special Combined Toxoid

Childhood immunization against diphtheria and tetanus has been established as a desirable and effective procedure. Ipsen¹has recently clearly reemphasized the need for the continuance of this important immunization program into the older children and adult groups. Unfortunately, the frequency of severe local and systemic reactions to diphtheria toxoid injection in older children and adults has prevented widespread usage of this proved procedure. Many physicians have observed such reactions even after using the Schick test to determine the susceptibles in the group. Moreover, such screening procedures are inconvenient and cumbersome when one is dealing with large numbers of persons. Extensive studies by Edsall and his colleagues²have indicated that a satisfactory combined tetanus and diphtheria toxoid for adults could be produced and used, provided that the diphtheria toxoid was highly purified and used with an adjuvant. With such a toxoid a satisfactory primary immunization was obtained by giving