Undernutrition and Immunity: Smallpox Vaccination in Chronically Starved, Undernourished Subjects and Its Immunologic Evaluation

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Abstract
This study illustrates the specific immune response of chronically starved, undernourished [human] adults after inoculation of live smallpox vaccine. It produced no adverse effect, and a major vaccinial reaction was observed in all. Of the undernourished individuals, 63% showed a 4-fold or greater rise of the neutralizing antibody titer. Only 9% of normal healthy subjects could show a similar response. The prevaccination titer was much lower in the undernourished group than in the control group, and the postvaccination titer also remained persistently lower in the former than in the latter group. Whereas the specific humoral antibody response in the undernourished subjects was partially adequate, the development of specific cellular immunity against vaccinia was remarkably poor, indicating that smallpox vaccination in these subjects might be less effective against variola infection. This observed profound effect of chronic stravation and severe undernutrition on the immune apparatus was possibly multifactorial, protein depletion being the most important factor, as proved by the significantly low serum albumin level. The significantly low peripheral blood lymphocyte count and spectacular unresponsiveness to many antigens in these individuals suggested profound depression of the thymo-lymphatic system. The significantly low level of neutralizing antibody in the malnourished subjects suggested that the formation of this protective antibody might necessitate the cooperation of T [thymus-derived] lymphocytes.