CTIVE immunization against tetanus A is regarded by many as a safe and effxcacious procedure.‘-lo It requires the injection of a primary course of two doses of aIum precipitated tetanus toxoid or three doses of pIain toxoid, which confers a basic immunity, to be followed by the injection of a “repeat” dose of toxoid whenever an injury occurs. The repeated injection of toxoid immediateIy raises the question of sensitization. Another question of importance is the rate of antitoxin production foIIowing the injection of the repeat doses of toxoid. FinaIIy, aIthough IocaI reactions at the site of injection are sIight to moderate in severity, any procedure that requires the repeated use of “ the needIe” with subsequent sore arms is IikeIy to meet with objections on the part of the patient. The intranasa1 route has been successfuIIy used for th e administration of drugs, glandular extracts and various bioIogica1 products. 11-18 Lesne et aI., SaIvioIo,24 .Jensen2j Bousheld and KingBrown,26 and more recently Wenger, HampiI and Masucci,“7 have reported on the use of diphtheria toxoid intranasaIIy. Ramon and ZoeIIer1g-“2 have also reported on intranasal immunization against diphtheria, tetanus, scarIet fever, and bacihary dysentery through the use of singIe or combined antigens. In 1927, these authors called attention to the chief benefits to be derived from the intranasa1 method of immunization, particuIarIy with reference to diphtheria. These are simplicity of administration and absence of reactions. Thus, individuals that were strongIy sensitive to diphtheria toxoid were immunized intranasalIy by Ramon with only a transient sweIIing of the nasa1 mucosa. The chiI1, fever, maIaise and IocaI inflammatory sweIIing that usualIy foIIow the injection of diphtheria toxoid into sensitive adults were conspicuously absent. Ramon’s objection to intranasa1 immunization was its expense, due to the need of three courses of treatment, each consisting of two daiIy instiIIations repeated for eight days. Each nasa1 treatment was equivalent to 0.3 cc. of Ramon’s toxoid. AIthough systemic reactions are rarely encountered after the injection of tetanus toxoid we can definitely state from our experience with subjects that have been immunized against tetanus bythe combined subcutaneous and intranasal routes that the instiIIation of toxoid into the nose rather than its injection under the skin is preferred by both aduIts and children. We are interested particularly in the use of a product for the “repeat dose ” that wiI1 not require subcutaneous injection and which wiI1 resuIt in the deveropment of a tetanus antitoxin titer generally relied upon to protect an individual against tetanus. A purified and concentrated tetanus toxoid (tetanus toxoid topagen) for topical appIication intranasaIIy was supplied to us by the MuIford BiologrcaI Laboratories of Sharp and Dohme. * We ha\-e overcome Ramon’s objection by the manner in which tetanus toxoid topagen is prepared and used as outIined in this report. * Tetanus toxoid topagen was prepared from highI antigenic plain tetanus toxoid. The toxoid WAS then purified and concentrated to contain 25 U’s per CL. Animal tests performed on guinea pigs that had IXXII previo”sIy injected with alum toxoid, showed that tetanus toxoid topagen administered intrannsall\, served as an excellent secondary stimulus.
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