European Journal of Epidemiology

, Volume 10, Issue 3, pp 267–270

Long-term persistence of anti-diphtheria toxin antibodies among adults in Israel

Implications for vaccine policy
  • Dani Cohen
  • Manfred S. Green
  • Eli Katzenelson
  • Raphael Slepon
  • Hillel Bercovier
  • Michael Wiener
Article

Abstract

Vaccination against diphtheria has essentially led to the disappearance of the disease in Israel. However, in other countries with high immunization coverage, isolated cases and small outbreaks have occurred in adults. Immunity following vaccination or natural exposure to toxigenic strains ofC. diphtheriae is conferred by serum antibodies to diphtheria toxin. Since booster doses of diphtheria toxoid are recommended every ten years in adults, this raises the question of persistence of protective levels Of anti-diphtheria toxin antibodies. In this study we assessed a possible age-related decline in anti-diphtheria toxin antibodies among adults in Israel. The study population comprised random samples in three age groups: 263 male recruits aged 18–19 years, 116 male reserve soldiers aged 25–35 years and 153 aged 41–51 years. Anti-diphtheria toxin antibody levels were measured by means of ELISA. Results indicate that 64.3% (95% CI=58.5–70.1%) of those aged 18–19 had anti-diphtheria toxin levels in excess of 0.1 IU ml−1, whereas the corresponding figures for ages 25–35 and 41–51 were 32.8% (95% CI=24.2–41.3%) and 15% (95% CI=9.4–20.7%). However, even in the oldest age group, 95.4% (95% CI=90.8–98.1%) had antibodies above the presumed protective level of 0.01 IU ml−1. Although these results indicate a significant age-related decline in anti-diphtheria toxin antibodies in vaccinated subjects, most had apparently protective levels. The absence of cases suggests that vaccine-induced immunity is long-lasting. However the immune status of the population should be carefully monitored.

Key words

Antibodies Anti-diphtheria toxin Diphtheria Vaccination 

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References

  1. 1.
    Yekutiel P. Infective diseases in Israel: Changing patterns over 30 years. Isr J Med Sci 1979; 12: 976–980.Google Scholar
  2. 2.
    Central Bureau of Statistics, Israel Ministry of Health, Division of Epidemiology. Statistical tables on selective infectious diseases in Israel, 1971–1990.Google Scholar
  3. 3.
    Karzon DT, Edwards KM. Diphtheria outbreaks in immunized populations. N Engl J Med 1988; 318: 41–43.Google Scholar
  4. 4.
    Simonsen O, Kjeldsen K, Bentzon MW, Heron I. Susceptibility to diphtheria in populations vaccinated before and after elimination of indigenous diphtheria in Denmark. Acta Path Microbiol Immunol Scand Sect C 1987; 95: 225–231.Google Scholar
  5. 5.
    Rappuoli R, Perugini M, Falsen E. Molecular epidemiology of the 1984–1986 outbreak of diphtheria in Sweden. N Engl J Med 1988; 318: 12–14.Google Scholar
  6. 6.
    Ipsen J. Circulating antitoxin at the onset of diphtheria in 425 patients. J Immunol 1946; 54: 325–447.Google Scholar
  7. 7.
    Griffith AH. The role of immunization in the control of diphtheria. Dev Biol Stand 1979; 43: 3–13.Google Scholar
  8. 8.
    Masterton RG, Tettmar RE, Pile RLC, Jones J, Croft KF. Immunity to diphtheria in young British adults. J Infection 1987; 15: 27–32.Google Scholar
  9. 9.
    Christenson B, Hellstrom L, Aust-Kettis A. Diphtheria in Stockholm, with a theory concerning transmission. J Infection 1989; 19: 177–183.Google Scholar
  10. 10.
    Kjeldsen K, Simonsen O, Heron I. Immunity against diphtheria 25–30 years after primary vaccination in childhood. Lancet 1985 (i): 900–902.Google Scholar
  11. 11.
    Bjorkholm B, Wahl M, Granstrom M, Hagberg L. Immune status and booster effects of low doses of diphtheria toxoid in Swedish medical personnel. Scand J Infect Dis 1989; 21: 429–434.Google Scholar
  12. 12.
    Centers for Disease Control. Diphtheria, Tetanus, and Pertussis: Guidelines for Vaccine Prophylaxis and other Preventive Measures. Ann Int Med 1985; 103: 896–905.Google Scholar
  13. 13.
    Mortimer J, Melville-Smith M, Sheffield F. Diphtheria vaccine for adults. Lancet 1986 (ii): 1182–1183.Google Scholar
  14. 14.
    Mathias RG, Schechter MT. Booster immunisation for diphtheria and tetanus: No evidence of need in adults. Lancet 1985 (i): 1089–1090.Google Scholar
  15. 15.
    Cohen D, Katzenelson E, Green M, Slepon R, Bercovier H, Danon Y. Prevalence and correlates of diphtheria toxin antibodies among young adults in Israel. J Infect 1991; 23: 117–121.Google Scholar
  16. 16.
    Grushka T. Health services in Israel. Jerusalem: Ministry of Health, 1968, 52 pp.Google Scholar
  17. 17.
    Craig JP. Immune response toCorynebacterium diphtheriae andClostridium tetani. In: Rose NR, Friedman H,Fahey JL, eds. Manual of clinical laboratory immunology, 3rd ed. Washington, DC: American Society of Microbiology, 1986: 408–414.Google Scholar
  18. 18.
    Melville-Smith M, Balfour A. Estimation ofCorynebacterium diphtheriae antitoxin in human sera: A comparison of an enzyme-linked immunosorbent assay with the toxin neutralisation test. J Med Microbiol 1988; 25: 279–283.Google Scholar

Copyright information

© Kluwer Academic Publishers 1994

Authors and Affiliations

  • Dani Cohen
    • 1
  • Manfred S. Green
    • 1
  • Eli Katzenelson
    • 2
  • Raphael Slepon
    • 1
  • Hillel Bercovier
    • 1
    • 3
  • Michael Wiener
    • 1
  1. 1.Medical CorpsIsrael Defense ForceJerusalem
  2. 2.Central LaboratoriesIsrael Ministry of HealthJerusalem
  3. 3.Department of Clinical Microbiology, Hadassah Medical SchoolHebrew UniversityJerusalem

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