Immunity and immunization of children against diphtheria in Sweden.

The level of immunity to diphtheria and the effect of vaccination with different doses of diphtheria toxoid was investigated. The 457 study children, 6, 10 and 16 years of age, had as infants received routine primary vaccination with three doses of diphtheria-tetanus-toxoid or diphtheria-tetanus-pertussis vaccine, and the 16 year-olds also had received a booster dose of tetanus with a small dose of diphtheria at the age of ten. Prior to the study booster, 15% of the 6-year-olds had antitoxin levels against diphtheria less than 0.01 IU/ml, the given minimum level for protection. Of the 10-year-olds, 48% had titres less than 0.01 IU/ml, while the corresponding figure for the 16-year-olds was 24%. After a booster injection of 0.1, 0.25 or 0.5 ml of diphtheria-tetanus vaccine, more than 97% of the children showed titre levels greater than or equal to 0.1 IU/ml, while levels of greater than or equal to 1 IU/ml, indicating titres sufficient for long-term protection, were attained by 23-96%. Systemic reactions were few and moderate. Local reactions were of little clinical significance. In a group of 5-years-olds given diphtheria-tetanus primary vaccinations over wider intervals, only 1.4% had antitoxin titres less than 0.01 IU/ml. The results show a need for serologic monitoring of vaccination programmes.