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59
In another family, one male aged 2 years when tested and one female aged
5 years when tested were both Schick positive.
In one family of four, all Schick positive to the first test, two members were
found to be Schick positive to the second test. The first of these (F. 4) was
immunised some months previously to the second one (M. 1), and was further
inoculated, being negative to the second test; the second child is not yet
retested.
In another family of four (Fs.), all Schick positive to the first test, the eldest
only was Schick posit ive to the retest; this child was still Schick positive after a
second course of 3 c.cm.; she became Schick negative after a total of 8 c.cm.
had been given.
Routine Procedure.
The routine of the procedure carried out is as follows. The child is Schick
tested at the Council's Maternity and Child Welfare Centre, and if susceptible to
diphtheria is brought up by the parent at weekly intervals for the next three weeks
for immunisation, and then at the end of another three months (formerly we tried
for the period six to eight weeks) for re-Schick testing, when, if it happens to be
still positive, it receives further inoculation. A modification of the routine occurs
if from the Schick test it is seen that the child is particularly susceptible to
protein reactions; in this case the 3 c.cm. of toxoid antitoxin mixture are given in
four or five doses at weekly intervals
Some difficulty has been experienced in securing the necessary number of immunising
injections owing to the children belonging to families who remove from the district; some
of these however attend to finish the course. A few adolescents at times fail to complete
the course by reason of being employed and it no longer being convenient for them to
attend.
Although Park and Zingher recommend that Schick testing should only be
applied to children over 5 years, it would seem inadvisable to dispense with the
test as a routine at the present time in Holborn. It is a great satisfaction to
nervous parents to think that there will be no inoculation unless susceptibilityis
proved.
Retesting is unpopular with parents, and the need for it does not help to
increase their confidence in immunisation. Of 482 that have been retested 64
were found to be still Schick positive after three inoculations. The facts relating
to these are given in Table V.