SHIGELLOSIS IN CUSTODIAL INSTITUTIONS1

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Abstract
Levine M. M. (Univ. of Maryland School of Medicine, Baltimore, Md. 21201), H. L. DuPont, E. J. Gangarosa, R. B. Hornick, M. J. Snyder, J. P. Libonati, K. Glaser and S. B. Formal. Shigellosis in custodial institutions. II. Clinical, immunologic and bacteriologic response of institutionalized children to oral attenuated shigella vaccines. Am J Epidemiol 96: 40–49, 1972.—Isolation techniques and the extensive use of antibiotics have failed to control shigellosis in custodial institutions. As a necessary prerequisite to field-testing, multiple doses of attenuated shigella vaccines were given orally to adult volunteers and institutionalized children to evaluate their safety and bacteriologic and immunologic properties. Two vaccines were studied, a streptomycin-dependent (SmD) and a mutanthybrid (MH) S. flexneri 2a. SmD vaccine was given to 95 children, MH to 102, and placebo to 95. Vomiting was the predominant adverse reaction occurring in 6 of the SmD-vaccinated children (6.3%) and in 8 of those receiving the MH vaccine (7.8%) as compared to 5 placebo fed children (5.3%). Reactions were seen almost exclusively among the most retarded, debilitated children of whom even 8.3% of those ingesting placebo vomited. Vomiting was most frequently encountered after the first dose, never occurring following the fourth dose. Vaccine organisms were recovered by rectal swab culture from 92 of 95 SmD (97%) and 54 of 102 MH vaccinees (53%). Fourfold rise in hemagglutination titer was exhibited by 12 of 49 SmD vaccinees (25%) and 20 of 64 MH vaccinees (31%). Propensity toward seroconversion was found to be related to the preimmunization antibody level. The geometric mean preimmunizaton titer of vaccinees who seroconverted was 30. The respective titer of the vaccinees who did not seroconvert was 166. An efficacious yet palatable means of administering vaccine was developed which utilized 0.8 grams of NaHCO3 in 8 ounces of milk. These vaccines (at doses as high as 4 × 1010 organisms) were considered sufficiently safe for field trials to begin.

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