Protective study with a group A streptococcal M protein vaccine. Infectivity challenge of human volunteers.

Healthy adult male volunteers were immunized with purified M protein from Group A streptococci. Type 1. The vaccine was administered subcutaneously as an aluminum hydroxide-precipitated antigen in three montly doses. Control subjects received a placebo of the aluminum hydroxide adjuvant. To test the efficacy of the immunization, vaccinees and controls were challenged with a virulent strain of Type 1 streptococci applied to the pharynx. The immunization and challenge of the vaccinated and control subjects (19 men in each group) were carried out as a double blind experiment. All subjects were carefully screened by physical and laboratory examinations before and after the immunization and infectivity schedules. 30-50 days after the last injection, the vaccinees and control subjects were infected with the streptococci. Careful surveillance was maintained to evaluate the extent of acquired streptococcal infection. Throat cultures, leukocytes counts, temperatures, and physical signs and symptoms were monitored daily. All subjects received 1.2 million U of penicillin intramuscularly no later than 6 days after inoculation with the culture. Illness was judged by the appearance of exudative pharyngitis and cervical adenopathy accompanied by a positive throat culture. By these criteria, 9 of the 19 placebo controls, and 1 of 19 vaccinees were ill. No residual illness or clinical complications was observed after the penicillin treatment. It is concluded that the alum-precipitated M protein vaccine afforded protection against an upper respiratory Type 1 streptococcal infection.