THE U. S. NAVY'S WAR RECORD WITH TETANUS TOXOID

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Abstract
Serol. studies previously reported from work on Navy volunteer groups between 1934 and 1940 had indicated that antitoxin response was reliable and adequate, using either plain (fluid) or alum-ppd. toxoid at proper intervals. Before war began, both Army and Navy adopted universal tetanus toxoid prophylaxis, the Army choosing plain toxoid; the Navy alum-ppd. toxoid. The Navy''s schedufe of injns.: Initial Immunization[long dash]Two doses of 0.5 ml. each, intramusc, not less than 4 or > 8 weeks apart; Booster Immunization[long dash] 0.5 ml. one year after initial, also 0.5 ml. before going into combat zone; Emergency Booster[long dash]0.5 ml. when wounded or burned. Navy personnel wounded in World War II totaled 89,988. No combat casualty developed tetanus. Accidental injuries: 1 non-fatal case of tetanus in a fully toxoid immunized man; 1 non-fatal case, incompletely immunized; 1 fatal case, immunization record incomplete, doubtful if any given; 1 fatal case, died shortly after entering service, had received no toxoid. Untoward reactions were infrequent and not severe. Alum-ppd. tetanus toxoid proved to be a safe and reliable antigen In German and Japanese casualties wounded in the same terrain but not toxoid immunized, tetanus was frequent and mortality high. U. S. Army records are quoted which report 12 cases of tetanus, 4 of whom, 2 fatal and 2 non-fatal, had received complete immunization with plain toxoid; 6 cases had received no toxoid and 2 cases, 1 fatal, had been incompletely immunized. The British report 22 cases of tetanus with 11 deaths in men who had been actively immunized. Some of these had also received antitetanic serum (ATS). Hall believes that A.T.S. given to toxoid immunized casuali-ties is not of value and concludes that complete dependence upon active immunization alone for protection against tetanus is fully justified, and both plain and alum ppd. toxoids are excellent antigens. Alum-ppd. toxoid is preferred because a higher level of antitoxin response results, and 2 injns. are ample for satisfactory immunization, while 3 of the plain or fluid toxoid are required.

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