A Report on Antimeningitis Vaccination and Observations on Agglutinins in the Blood of Chronic Meningococcus Carriers

Abstract

1. A meningococcus vaccine suspended in salt solution has been given subcutaneously as a prophylactic to about 3,700 volunteers in three injections of 2,000 million, 4,000 million, and 4,000 or 8,000 million cocci at weekly intervals. 2. These doses rarely caused more than the mildest local and general reactions. Exceptionally a more severe reaction emphasized the presence of an unusual individual susceptibility to the vaccine. In such instances the symptoms were in part those of meningeal irritation and sometimes simulated the onset of meningitis. 3. Specific meningococcus agglutinins have been demonstrated in the blood serum of vaccinated men as compared with normal controls. 4. Moreover, agglutinins have been demonstrated in the blood serum of chronic carriers of the meningococcus. Evidence is thus brought forward that the relative immunity of chronic carriers to epidemic meningitis may be due to the presence of specific antibodies in the blood stream.

Whole cell vaccination for meningococcus: Lessons from an idea whose time has gone

“…However, just five days later, there was little willingness to receive a second injection until they were threatened with cancellation of upcoming leave. 33 In four studies in which the investigators actively solicited adverse events, 15,17,19,33 both local and systemic reactions were more severe than described in other reports.…”

“…8 Over the next twenty years, up until the availability of sulfa chemoprophylaxis, similar vaccines were employed in the context of meningococcal outbreaks, being 45 types I and III under the Gordon-murray scheme correspond to what is now termed group A; type II refers to groups B and C, a distinction not being made until the 1940s, after which type II corresponds to group B and type IIa to group C. 45,46 As for duration of protection, Black observed that six out of seven vaccinees still had measurable complement fixation titers at two years post-vaccination. 28 Cases that developed after the full threedose regimen were observed at two 15 and six months 29 after the final dose with few studies maintaining follow-up for longer periods. Brutsaert believed that immunity from vaccination was short-lived, requiring at least two vaccinations to be given annually.…”

“…Except for small pilot studies, adverse events were not specifically solicited and acceptable safety was presumed if individuals did not report to sick call or miss work. 15,16 Compliance with the vaccination regime was also taken as evidence of acceptable safety, though in the context of an epidemic, or among soldiers or laborers who were financially or otherwise dependent on those conducting the study, it is reasonable to assume that adverse events were underreported. Aaser, for example, reports that in his infantry regiment, acceptance of the first inoculation was motivated by the recent deaths of several comrades and that none of the vaccine recipients were "seriously incommoded" by adverse events.…”

“…20 Clinical cases occurred in some instances immediately after, or between, vaccinations. 15,16,27 As these vaccinations were often given in the context of epidemics, it is not surprising that occasionally individuals were vaccinated who were already incubating their disease. Riding observed similar numbers of meningococcal cases and deaths within 24 hours of receiving either the meningococcal or the control (typhoid) vaccine, which would argue against viable meningococci in the vaccine or a transient phase of increased susceptibly being the cause.…”

“…8 In 1918 Gates compared several dosing regimens and concluded that a three dose regimen consisting of 2 billion, 4 billion and 4 billion organisms at intervals of seven or eight days, offered the best tradeoff between safety and immunogenicity. 15 This regimen was used by many subsequent authors. [16][17][18][19] The route of administration was usually subcutaneous, though at least two investigators administered the vaccine intramuscularly.…”