title: How many doses of diphtheria toxoid are required for protection in adults? Results of a case-control study among 40- to 49-year-old adults in the Russian Federation.
abstract: During the Russian diphtheria epidemic of the 1990s, adults had an unexpectedly high rate of disease. A retrospective, matched case-control study was done to measure the effectiveness of one, two, or three or more doses of diphtheria toxoid against diphtheria among 40- to 49-year-old Russians. Thirty-nine diphtheria case-patients and 117 controls were studied. Previous vaccinations were included if one dose was received within the previous 10 years. Five cases (13%) and 33 controls (28%) had received three or more doses of vaccine. The matched odds ratio was 0.3 (95% confidence interval, 0.1-0.9) for three or more doses compared with no doses, which was a vaccine effectiveness of 70% (95% confidence interval, 10-90). A trend existed toward milder disease with increasing doses (chi2 test for trend, P=.02). The results suggest that Russian adults, who were unlikely to have acquired immunity to diphtheria through immunization or natural infection, required at least three doses of diphtheria toxoid for reliable protection against disease.
authors.affiliation: National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. mvb5@cdc.gov
authors.forename: M
authors.initials: M
authors.lastname: Brennan
authors.forename: C
authors.initials: C
authors.lastname: Vitek
authors.forename: P
authors.initials: P
authors.lastname: Strebel
authors.forename: W
authors.initials: W
authors.lastname: Wattigney
authors.forename: K
authors.initials: K
authors.lastname: Bisgard
authors.forename: S
authors.initials: S
authors.lastname: Brisgalov
authors.forename: V
authors.initials: V
authors.lastname: Bragina
authors.forename: V
authors.initials: V
authors.lastname: Pyanikh
authors.forename: M
authors.initials: M
authors.lastname: Wharton
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D004165:Diphtheria / Q000453:epidemiology / Q000517:prevention & control*; D004168:Diphtheria Toxoid / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012426:Russia / Q000453:epidemiology; D014611:Vaccination
chemical_list: D004168:Diphtheria Toxoid