http://bmj.com/cgi/content/full/323/7324/1308
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Letters
Second diphtheria booster in adults raises immunity to 92%
After
assessing the antibody response to one diphtheria booster vaccination in adults1 we
conducted a second part of the trial to determine the effect of
giving a second booster dose. Of the 176 volunteers whom we
originally recruited, 141 cooperated (mean age 41.0 (SD
4.0) years). After a blood sample was taken at month 6, a
second booster was given. An additional blood sample was taken a
month later. The methods and results of the first part of the trial
have been described.1
Six months after being given the first booster 27 of the subjects had
diphtheria antitoxin titres of <0.01 IU/ml (class 1), one had
protection of limited duration (titres between 
0.01 IU/ml and <0.1 IU/ml;
class 2), and 113 had protective titres (0.1 IU/ml; class 3). After being
given the second booster 130 of the subjects obtained
protection against diphtheria (class 3). Six subjects remained
susceptible, and five obtained protection of limited duration
(table).
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The proportion of subjects not fully protected fell from 19% after the first
booster to 8% after the second (table). Nicolay et al found figures
of 5% and 3%, respectively,2 and in the
study of Hasselhorn et al 6% of the subjects did not obtain protection
after one booster vaccination.3 Björkholm
et al studied various doses of diphtheria toxoid and found that 29%
to 14% of the subjects were not fully protected after one booster
dose.4
When these results are borne in mind the feeling of security that one
booster vaccination can give is misleading. For a substantial number
of people travelling to central and eastern European countries, the
Commonwealth of Independent States, and other high risk countries for
diphtheria, the World Health Organisation's recommendation of one
booster dose might be insufficient.
As no booster vaccinations are given after the age of 15 in Belgium and
an important factor influencing immunity is the time since the last
vaccination,5
giving booster vaccinations for diphtheria as is done for tetanus
(and possibly giving them together) should be considered. Also,
because antibody response is related to dose, the dose might need
further investigation.
Non-response and missed vaccinations have to be taken into consideration in
public health guidelines; the benefit of a second booster dose or
regular administration of diphtheria booster vaccination (for
example, every 10 years) therefore has to be considered.
Akke Vellinga
Pierre Van Damme
Els Joosens
Marie van der Wielen
Centre for the Evaluation of Vaccination, Department of Epidemiology and
Community Medicine, University of Antwerp, 2610 Antwerp, Belgium akkevel@uia.ua.ac.be
Herman Goossens
Laboratory of Microbiology, University of Antwerp
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1. |
Vellinga A, Van Damme P, Joosens E, Goossens H. Response
to diphtheria booster vaccination in healthy adults: vaccine trial. BMJ
2000; 320: 217 |
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2. |
Nicolay U, Girgsdies OE, Banzhoff A, Hundt E, Jilg W.
Diphtheria booster vaccination: one or two injections? Vaccine 1999;
17: 2223-2228 |
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3. |
Hasselhorn HM, Hofmann F, Tiller FW. Boostering antitoxin
diphtheria immunity in adults. Infection 1996; 24: 168-169 |
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4. |
Björkholm B, Granström M, Hagberg L. Diphtheria antitoxin
titres six years after basic immunization of adults. Vaccine 1996; 14:
1633-1636 |
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5. |
Hasselhorn HM, Nubling M, Tiller FW, Hofmann F. Factors influencing
immunity against diphtheria in adults. Vaccine 1998; 16: 70-75 |
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Other related articles in
BMJ:
PAPERS
Response to diphtheria booster vaccination in healthy adults: vaccine
trial.
Akke Vellinga, Pierre Van Damme,
Els Joossens, and Herman Goossens
BMJ 2000 320: 217.
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