070 - Immunization with Bacillus pertussis vaccine

As today's article states near its beginning:

"Most whooping cough patients need no physician, but those who do, need him badly." -Pospischill

Louis Sauer was one of the first to develop a whooping cough vaccine that actually seemed to work, at least sometimes. This was another article giving some data of efficacy.¹

As usual, the bacteria to make it were from fresh isolates of the disease, grown on human blood and suspended/killed in saline plus a little phenol.

Sauer first determined that the vaccine didn't work for vaccine therapy (i.e. using a vaccine to treat a disease, rather than prevent it). Not surprising; that concept didn't work too well in general.

So the next test would be for prophylaxis, preventing the disease by giving the vaccine to people before they were exposed to the disease. So he injected it into 394 children, most of whom had an older sibling known to be likely susceptible to pertussis (i.e. they hadn't been vaccinated or caught the disease before); these siblings were the controls. He used 3 injections total; he tried a single larger dose for some, but it seemed more prone to side effects.

Sauer reported that he did warn parents of the children about potential side effects, such as temporary fever and reactions at the site of injection, but all of them were eager for the treatment except for two, who refused it.

So within these children, over the course of 5 years, there were about 191 exposures to whooping cough, but not a single vaccinated subject got the disease. Of the controls, 31 got it, including many who were siblings of the vaccinated. There was definitely a lot of exposure of the vaccinated from their siblings, including as intimate as kissing (platonic, of course).

So Sauer concluded that his vaccine produced immunity after four months, at most, which lasted at least a few years. He recommended vaccination at ages 6-12 months, because immunity could definitely be produced at that age, and pertussis is most dangerous within the first two years.

This study had problems, of course, and isn't up to modern standards at all, but the results are fairly striking.

There was some discussion between physicians published after the main article, some of which was related and interesting:

"Dr. Sauer seems to have found a method of preparation and a method of administration of pertussis vaccine that will protect a child from whooping cough just as certainly as toxoid protects against diphtheria. His success in immunizing against pertussis is probably due to two factors. The first factor is the preparation of the vaccine. He uses only fresh cultures obtained every few months from active proved cases of pertussis. The second contributing factor is the tremendous dosage." -Dr. Raymond Schowalter

"Three or four months should elapse or intervene between completion of the vaccine administration and exposure to the disease. During the five years that this work has been going on, people wanted their children injected while whooping cough was in their neighborhoods. This was done and in a number of cases, within one or two months after the injections were begun, these children contracted pertussis. But in no case in which the time interval was more than three months has any child contracted pertussis, although, as the charts show, eighteen were intimately exposed to control cases in the family." -Louis Sauer 

 Also a later publication made an interesting remark on the quality of this study:

"Sauer's reports since 1933 as to the prophylactic value of [his vaccine] seem convincing, except for the fact that he does not fully discuss his results in an adequate number of control children."²

References:
1. Sauer, L. Immunization with Bacillus pertussis vaccine. JAMA 101, 1449–1453 (1933).
2. Siegel, M. & Goldberger, E. W. Active immunization of tuberculous children against whooping cough with Sauer’s vaccine. JAMA 109, 1088–1092 (1937).