Immunization of man with typhoid and cholera vaccine. Agglutinating antibodies after intracutaneous and subcutaneous injection.

Tuft, the originator of intracutaneous typhoid immunization (Tuft, Yagle dZ; Rogers, 1932), found that, in man, intracutaneous immunization with one-fifth of the normal dose resulted in as much antibody as suboutaneous immunization with the normal dose, and that the reaction to the vaccination was lower after intracutaneous immunization. These observations were confirmed for both revaccinations (Siler &; Dunham, 1939; Longfellow dr; Luippold, 1940) and primary vaccinations (Valentine, Park, Falk dZ; McGuire, 1935; Perry, 1937; C:hiang dr; Ch'en, 1958). On the other hand, Morgan, Favorite dr; Horneff (1943) and Luippold (1944) found less antibody after intracutaneous immunization. The reduction of vaccination reactions obtained with intracutaneous immunization, even with a ten times concentrated vaccine (Shi, 1958), has been generally recognized, but Bardhan, Dutta &; Krishnaswami (1963), using only twice the suboutaneous dose for intracutaneous vaccination, observed more severe reactions in the intracutaneous group. These more severe reactions were accompanied by higher antibody titres. The intracutaneous method also proved satisfactory for vaccination with cholera vaccine (Singer, Weis &; Hoa, 1948; Noble, 1964) and a combination of cholera and typhoid vaccine (Noble dZ; Fielding, 1965). After preliminary investigations (Barr, Sayers & Stamm, 1959), the intracutaneous vaccination method was adopted by the British Army for routine immunization with a combined vaccine containing enteric and tetanus antigens (Noble, 1963). In an attempt to improve the standard immunization schedule used for recruits of the Dutch Army, it was decided to investigate not only the possibilities for a simpler time schedule but also the question of intracutaneous vaccination.