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Active Immunization Against Diphtheria: Its Effect on the Distribution of Antitoxic Immunity and Case and Carrier Infection

JAMA. 1934;103(24):1879. doi:10.1001/jama.1934.02750500061027.
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An unusual opportunity presented itself at the Greenwich Hospital School in London to study the degree of immunity acquired under natural conditions by a group of about 1,000 boys over a period of seven years in comparison with the immunity obtained under artificial conditions of immunization at the same institution. From 1921 to 1928 the authorities at this school would not permit the administration of an immunizing agent but did sanction the Schick testing of the children. During the following five years, artificial immunization with toxoid was employed. The authors concluded that three doses of diphtheria toxoid can produce in three months as high an immunity as three years' residence in a community where diphtheria is endemic. The community in this instance was the boys' school, where the children live rather intimately, associated with one another and subjected to the dangers of direct contact infection. The authors further state that


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