During the past decade, the simultaneous immunization against diphtheria, tetanus, and pertussis has become quite well established on laboratory and clinical evidence. To retard the elimination of antigen (DTP) from the body and to enhance antitoxin and antibody development, various forms of aluminum have been used as adjuvant. Most private patients are now adequately protected by the customary primary series of three or four monthly doses, and subsequent recall (stimulating or booster) doses. Needless deaths due to pertussis are still occurring, however, in infants and children from families with low incomes and orphanages in congested cities and in rural areas. To reach these children, mass immunization clinics should function at well baby clinics, primary schools, and mobile units. The diverse difficulties encountered in the execution of these immunization procedures are problems due to earlier immunization, febrile reactions, alum cyst, postinoculation encephalopathy, paralytic poliomyelitis of the injected limb, and unfavorable results
Sauer LW. PRECAUTIONS IN PEDIATRIC IMMUNIZATION PROCEDURES. JAMA. 1953;152(14):1314–1317. doi:10.1001/jama.1953.03690140022005
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