Survey of 2144 cases of red-back spider bites: Australia and New Zealand, 1963--1976.

An analysis has been made of 2144 consecutive cases of latrodectism (envenomation by the red-back spider, Latrodectus mactans hasselti) reported to the Commonwealth Serum Laboratories. In the last eight years, notifications have averaged 240 cases per annum. Bites, usually on the extremities (74%), occurred most frequently in the summer months, and in the afternoon or evening. Most victims (79%) were aged between 18 and 50 years and 64.4% of them were males. Males are still often bitten on the genitals or buttocks (9.7% of cases). Local pain, redness and swelling were the most common symptoms, although significant pain was felt at other sites in 39% of the cases. The regional lymph nodes often became swollen and tender within 30 minutes. General effects included nausea, vomiting and sweating, but coma and respiratory failure were very uncommon, probably because of use of specific antivenom. This was administered within 24 hours of the bite in 92% of cases, and within two hours in 70%. Although 11 anaphylactic reactions (0.54%) were reported, no deaths resulted either from the venom or from reactions to the antivenom. Few delayed serum reactions (1.7%) were recorded. The action of the venom is described and the management of red-back spider bite is outlined.

Over-immunization-an ever present problem.

The development of purified vaccines for the control of common infectious diseases may lead to a sense of false security and a tendency to over-immunize. Repeated antigenic challenge may cause hypersensitivity reactions which could harm the individual. For each vaccine there is an opitmum time and age for dosing; for those vaccines requiring a course of doses, there is a minimum but no maximum time interval between the doses. In Australia, active immunization is conducted on a regular basis against seven preventable infectious diseases. In this article, the vaccine control of each disease is discussed briefly and suggestions made to avoid hyperimmunization. The need to appreciate the dangers inherent in all immunization procedures in general, and in certain vaccines in particular, is emphasized. Indescriminate immunization cannot be condoned.

Combined diphtheria-tetanus immunization of adults.

The administration of a combined adult-type diphtheria-tetanus vaccine to a group of 35 adults seeking booster tetanus immunization produced a secondary immune response to the diphtheria antigen in 26. A satisfactory response to the tetanus antigen was noted in all those who gave a reliable history of active tetanus immunization, including eight individuals who had not received a dose of toxoid for 25 to 28 years. No systemic reactions were observed, but significant correlation was found between local reactivity and a high post-booster titre of tetanus antitoxin. Selective use of the combined vaccine instead of tetanus toxoid alone offers a means of raising the diphtheria immunity in the adult population.

Antibody response to successive booster doses of tetanus toxoid in adults.

A study of the rise and fall in circulating tetanus antitoxin in a group of 15 adults after basic and booster immunization indicates that although individuals vary greatly in their responsiveness to toxoid, the falloff in antitoxin appears to be fractionally constant for each individual, and over periods of 5 to 6 years appears to be the same after successive doses. The low level of antitoxin noted in some individuals after basic immunization with a plain toxoid preparation cannot always be rectified by the use of an adsorbed toxoid as a booster. Results indicate that routine boosters need not be administered more frequently than every 10 to 20 years, provided an adsorbed toxoid has been used to initiate active immunization.