GLEMNFN

INSTRUCTIONS REGARDING THE ADMINISTRATION OF
. ANTITYPHOID VACCINE

® O °
- é ‘ —

TREASURY DEPARTMENT
Bureau of the Public Heaith Service
Washington

May 29, 1915.

Bureau Circular
Letter No. 4],

To Medical Officers of the Publio Health Service:

vo The following directions should be observéd in
immunizing persons against typhoid fever:

The first dose is 1/2 o.c. (7-1/2 m.); the
second and third are each loc.c. (15 m.). An inter-
val of at least seven days should elapse between
doses, This interval may be extended to the four~
teenth day in case of necessity, but after that date
previous inocculation should not be counted,

The site of the inoculation is the arm at the
insertion of the deltoid muscle, If for any reason
this site cannot be used, the needle may be intro~
duced in the back, over the. lower portion of the
scapula, or in the chest below the clavicle. The
dose is to be given subcutaneously, and not into the
muscle nor into the skin, The arm should be cleansed
as for any other operation. Tincture of iodine
painted ovér the dry skin, before and after the in-
‘jection, has proved satisfactory. |

The ampule should be washed off in an antiseptic
solution and opened after making one or more cuts ,
near the top with a file. The vaccine can be drawn
ov of the container with a syringe, or it-may be
emptied into a shallow glass dish such as a salt
cellar which has been sterilized by boiling.

The syringe and needle should be sterilized by
boiling in two per cent goda solution. To insure
perfect sterilization, draw the piston out to its
full length, or remove it entirely, so that the
barrel is full of water during the boiling. A fresh
needle should be used for each person, or,,if one
needle must be used on two or more persons, it
should be re-sterilized before each injection.
No person should be immunized who is not per-
fectly healthy and free from fever. The tempera-
ture should be taken before immunization is begun,
and, in doubtful cases, the urine should be ex-
amined; if fever or any other symptoms of illness
are present, the procedure should be postponed.
Neither beer nor alcohol in any form should be drunk
on the day of treatment. The prophylactic is borne
well by children, and by women, and doses propor-
tionate to the body weight should be used. Women
should not be given the first dose during or near
the time of the menstrual period.

The most suitable time for the admiristration
is about 4 o'clock in the afternoon, as the great-
est part of the reaction is then over before morn-
ing. There is usually some headache and malaise,
and a local reaction consisting of a red and tender
area about the size of the palm of the hand and
sometimes tenderness in the axillary glands.

Rarely marked general reactions occur ~- headache,
backache, nausea, vomiting, herpes labialis,
occasionally albuminuria and some loss of body
weight. The number of such reactions is exceeding-
ly small, and, regardless of their severity, they
as a rule disappear inside of 48 hours,

Antityphoid waccine may be obtained by send-
ing a requisition for the desired amount to the
Director of the Hygienic Laboratory, P.H.S.,
Washington, D.C. Glass syringes and needles may
be obtained from the Purveying Depot, P.H.S., 1414
Pennsylvania Avenue, N.W., Washington, D.C.

A, H. GLENNAN

Acting Surgeon General.