Diphtheria Among Immunized Children

Abstract

NEW YORKMy object in reporting these cases is to have on record the fact that diphtheria can occur among children who possess either natural immunity or who have been immunized by the toxin-antitoxin procedure. If we are to utilize our knowledge of diphtheria immunity intelligently, without prejudice to the community or to the child who has suspicious sore throat, and raise the bars of precautions against a disease of so many possibilities, we must be sure that our interpretative value of a negative Schick reaction will stand the test of time and experience, and particularly that immunity, as obtained by the toxin\x=req-\ antitoxin instillation, is sufficiently universal in its application that not even an occasional exception will alter its value. An immunity recorded by a negative Schick reaction should not be sufficient, and only when a sufficient number of Schick negative immunized children have been exposed to diphtheria contagion and have escaped the disease can a proper value be placed on it. An experience which I and my co-workers have had in a carefully supervised orphan asylum,1 has taught us that diphtheria in epidemic form can occur among immunized children, at least to say now that the value of a negative Schick reaction is not universal, and as a result further studies and clinical observations must be made before its exact value can be computed. I am aware that these cases of diphtheria among immunized children are probably the first on record, at least where virulency test was taken, and, therefore, exception may be taken that our experience can be due to either faulty technic, imperfect toxin or antitoxin, or we are even dealing with an epidemic of septic sore throat in diphtheria carriers. All these possibilities have been considered and excluded and with the clinical picture and behavior of the cases there can be no other conclusion but that they were true cases of clinical diphtheria.The children at the orphan asylum had all been given the Schick test, and our figures correspond so closely with the results of other investi¬ gators (40 per cent, positive and 60 per cent, negative) that no fault should be found with either technic or our material. The Schick posi¬ tive children were all immunized by three doses of toxin-antitoxin.