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Whilst many of the 'carriers' had received primary
immunisation, in only two of the clinical cases was there
any record of this, but a reinforcing injection had not
been given. It is estimated that over 70 per cent of children
in this part of London have been immunised in infancy, but
the proportion protected by a 'boosting dose' at school
age must have been very much less before these two episodes.
It is significant that nearly all the children affected
in both outbreaks were of primary school age.
Investigation and swabbing of the school contacts
were complicated by the closure of the school during the
Christmas holiday, but by close co-operation between the
Public Health Department and the Divisional Health Office
of the L.C.C. the investigation of both school and home
contacts was accomplished quickly. Active and passive
immunisation was begun with a minimum of delay. A special
clinic was set up by the L.C.C. at the affected school for
the benefit of families living in the area and was attended
by some hundreds of children. The attendances at other
immunisation clinics in the Borough also showed a gratifying
increase. The publicity given in the local and national
press, on radio and television no doubt played a large part
in stimulating the public to co-operate in this matter.
It is extremely fortunate that the disease did not
spread outside the area, particularly in view of the excessive
activity of visiting among friends and relations which
normally takes place during the festive season. As it was,
a number of contacts were traced outside theBorough, even
as far as the West Country and the Midlands where the
appropriate Medical Officers of Health were notified by
telephone. All the contacts, however, were reported to be
negative.
It is some compensation for evils that they enforce
lessons, and outbreaks such as this serve as a stern reminder
that failure to maintain a high rate of immunisation or
re-immunisation may have disastrous consequences. In addition,
they serve as a valuable exercise in that co-operation
between the general medical, public health, hospital and
laboratory services which has now become an essential
factor in progressive preventive medicine.