Diphtheria vaccine

History

In 1890, Kitasato Shibasaburō and Emil von Behring at the University of Berlin reported the development of 'antitoxins' against diphtheria and tetanus. Their method involved injecting the respective toxins into animals and then purifying antibodies from their blood. Behring called this method 'serum therapy'. While effective against the pathogen, initial tests on humans were unsuccessful. By 1894, the production of antibodies had been optimised with help from Paul Ehrlich, and the treatment started to show success in humans. The serum therapy reduced mortality to 1–5%, although there were also reports of severe adverse reactions, including at least one death. Behring won the very first Nobel Prize in Physiology or Medicine for this discovery. Kitasato, however, was not awarded.

By 1913, Behring had created Antitoxin-Toxin (antibody-antigen) complexes to produce the diphtheria AT vaccine. In the 1920s, Gaston Ramon developed a cheaper version by using formaldehyde-inactivated toxins. As the use of these vaccines spread across the world, the number of diphtheria cases was greatly reduced. In the United States alone, the number of cases fell from 100,000 to 200,000 per year in the 1920s to 19,000 in 1945 and 14 in the period 1996–2018.

Effectiveness

About 95% of people vaccinated develop immunity, and vaccination against diphtheria has resulted in a more than 90% decrease in number of cases globally between 1980 and 2000. About 86% of the world population was vaccinated as of 2016.

Side effects

Severe side effects from diphtheria toxoid are rare. Pain may occur at the injection site. A bump may form at the site of injection that lasts a few weeks. Side effects of DTaP vaccines are similar but less frequent. Tetanus toxoid containing vaccines (Td, DT, DTP and DTaP) may cause brachial neuritis at a rate of 0.5 to 1 case per 100,000 toxoid recipients.

Recommendations

The World Health Organization has recommended vaccination against diphtheria since 1974. The first dose is recommended at six weeks of age with two additional doses four weeks apart, after receiving these three doses about 95% of people are immune. Three further doses are recommended during childhood. Booster doses every ten years are no longer recommended if this vaccination scheme of 3 doses + 3 booster doses is followed. Injection of 3 doses + 1 booster dose, provides immunity for 25 years after the last dose. If only three initial doses are given, booster doses are needed to ensure continuing protection.

References

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