RESULTS OF PROPHYLACTIC INOCULATION AGAINST PNEUMOCOCCUS IN 12,519 MEN
Authors: Russell L. Cecil, J. Harold Austin
Journal: The Journal of Experimental Medicine (1918)

1. From a study of the agglutinins and protective power of the serum of 42 persons vaccinated against the pneumococcus, Types I, II, and III, it is demonstrated that a definite immune response has been secured to Types I and II by the dose of vaccine employed. Little evidence of response to Type III can be demonstrated by these methods, but this is of less significance in that in animals it is relatively difficult to secure antibodies against this strain in the serum, even though a considerable degree of active immunity may have been produced in the vaccinated animal. 2. The degree of response to the vaccination appears to be dependent upon the total dosage of each type of pneumococcus administered. While some response may be elicited by 2(1/2) billion cocci of each type, a much more constant and greater response follows 13 billion. 3. In subcutaneous administration the manner in which the total dosage is divided, whether given in a single large dose, in seven small daily doses, or in three to five moderate doses at 3 to 7 day intervals, seems to have little influence upon the degree of immune response, provided the total dosage is the same. 4. The local and general toxic reaction varies greatly in different individuals. The smaller the individual doses, the fewer are the severe reactions. This makes it desirable to divide the total dosage into as many inoculations as circumstances make practicable. 5. At Camp Upton 12,519 men have been vaccinated against Pneumococcus Types I, II, and III. Three or four doses were given at intervals of 5 to 7 days with a total dosage of 6 to 9 billion of Types I and II and 4(1/2) to 6 billion of Type III. 6. During the 10 weeks that have elapsed since the vaccination, no cases of pneumonia of these three types have occurred among the men who had received two or more injections of vaccine. 7. In a control of approximately 20,000 men there were twenty-six cases of Pneumococcus Types I, II, and III pneumonias during the same period. 8. The incidence of Pneumococcus Type IV pneumonia and streptococcus pneumonia was much less among the vaccinated troops than among the unvaccinated. No explanation has been advanced for this difference. 9. Small sterile infiltrations disappearing spontaneously occasionally follow the injection of large doses of pneumococcus vaccine and appear to be an expression of cutaneous hypersusceptibility. 10. The persons who develop these lesions exhibit local reactions to each dose of vaccine. They also give abnormally marked reactions to intradermal injections of pneumotoxin. They do not, however, exhibit anything notable in the agglutinative or protective powers of their sera after vaccination. Whereas the immune response is characteristically specific for the type of pneumococcus, this reaction is not specific for any type. We have found no evidence that Type III is more prone to elicit these severe local reactions than are Types I and II. 11. Prophylactic vaccination against pneumococcus of Types I, II, and III is practical and apparently gives protection against pneumonia produced by these types. It remains to be determined how long this immunity persists.