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61
unprotected, and judged by the absence of deaths, the incidence in the protected
population was restricted to mild cases. Comment on the role of immunisation in
accelerating the fall in the incidence of diphtheria in London is given in the Vital
Statistics Section of this report (p. 16). In London the notification rate 0-4
has fallen from 5.88 per thousand in 1938 to 0.17 per thousand in 1949. The rate
at age 5.14 has fallen from 4.43 to 0.32. In 1938 there were 205 deaths of all ages,
and in 1949 only 9.
Whooping Cough Immunisation
A limited amount of immunisation against whooping cough has been undertaken,
the antigen used being Glaxo pertussis or Glaxo A.P.T. combined. In the
majority of cases, the children attending immunisation sessions at infant welfare
centres were injected with the combined antigen.
Welfare
centres
In seven of the Council's residential nurseries and at one of the Council's
residential homes for children in London, whooping cough immunisation has been
undertaken and at the end of the year 48 per cent. of children then in residence at
these establishments had been so immunised or were in process of being immunised.
Residential
establishments
for children
in London
In 1947 and 1948 advantage was taken of the opportunity afforded by the
facilities for observation at the London residential nurseries to carry out a controlled
investigation of whooping cough immunisation using the Glaxo combined
diphtheria and pertussis antigen. The results which were reported in detail in the
medical press (Beck, A., Breen, G. E. and Benjamin, B.—Lancet 1950-i-198)
showed a significant difference in the incidence of whooping cough as between the
vaccinated and the controls. It was concluded that the antigen conferred a useful
degree of protection against whooping cough. The antigenic potency of the
pertussis vaccine was confirmed by complement-fixation tests though no conclusions
could be drawn from these on the presence of protective anti-bodies.
The arrangements at these establishments, as in the case of diphtheria
immunisation, are made by the local health authority in whose area the establishment
is located. Not all the local health authorities concerned include immunisation
against whooping cough in their scheme under Section 26 of the National Health
Service Act, 1946, but if the medical officer of the establishment wishes to undertake
this work, the Council itself supplies the antigen, as mentioned above. In 12
establishments immunisation against whooping cough was performed during the
year and at the end of the year 58 per cent. of children then in residence at these
establishments had been so immunised or were in the process of being immunised.
Table 18, p. 131, shows the number of children in London who, at the end of
1949, had received a course of whooping cough immunisation injections.
Residential
establishments
for children
outside
London
During the poliomyelitis epidemic of 1949 attention was drawn to the fact
that a small number of children developing the disease had been given combined
diphtheria and whooping cough prophylactic during the previous month. It was
not possible to decide if this observation was anything but a coincidence. The
matter was reported to the Ministry of Health who decided to carry out a general
statistical investigation throughout the country. Pending the result of this investigation
the use of combined diphtheria and whooping cough prophylactic was
discontinued until the poliomyelitis epidemic was over.
Possible
connection
with
Poliomyelitis
Vaccination
Special sessions for vaccination are held at welfare centres and general
practitioners who wish to do so carry out vaccination on the Council's behalf. The
lymph is supplied free of charge to the Council by the Ministry of Health through
their Public Health Laboratory Service and general practitioners are also able to
obtain supplies from the same source,
Welfare
Centres and
General
Practitioners