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Immunity in Scarlet Fever

The Dick Reaction, the Circulating Antitoxin and the Immunizing Dose

From the Bureau of Laboratories of the Department of Health of the City of New York, and Willard Parker Hospital

Abstract

1. Antitoxic titers were determined in 30 Dick-positive nurses prior to immunization: 19 had less than one unit, ten—from one to two, and one nurse had 7.5 units per 1 ml of serum.

2. The nurses reacting positively received a series of toxin-injections with doses selected on the basis of local and systemic reactions caused by the preceding injections. Although all became Dick-negative, only one–third of them responded with a progressive rise of antitoxic titer, while in the remainder the antitoxin-rise was found only in the early stage of immunization or not at all.

3. Antitoxin-formation following injections with toxin occurred more readily in persons who had, previous to these injections, at least about one unit of circulating antitoxin per 1 ml of serum.

4. Persons not responding to toxin-injections by antitoxin-formation, remained refractory in spite of very large additional doses.

5. In a group of 43 nurses a wide variation was observed in the amount of toxin required for their immunization.

6. Antitoxin-formation was usually scant in persons who responded with severe local and systemic reactions.

7. None of the 43 persons, who became Dick-negative after immunization, contracted scarlet fever during exposure in the wards. Likewise—none of the yearly 400 student-nurses became ill with scarlet fever during the first 3 years of obligatory immunization of the Dick-positive subjects.

8. Of the 4 members of the medical and nursing staff who subsequently became ill with scarlet fever, 3 were positive to 2 S.T.D., while negative to 1 S.T.D. The fourth entered the ward service before the Dick test was performed and on the first day of illness was found to be positive.