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The administrative
approach to
parents
Without prejudice to the primary importance of the personal approach it has been
shown that the proportion of children immunised can be raised when the personal
approach is supplemented by an approach to parents through the post. However
industrious a health visitor may be she cannot guarantee always to see parents at the
time at which the various prophylactic processes become due. If arrangements can be
made for a letter to be sent to the parents of each child as soon as it reaches the appropriate
age suggesting immunisation, the health visitor may be saved a great deal of special
visiting. A letter of this kind may be followed by a reminder when there is no record
of immunisation following the first letter, and a special visit if the reminder fails. This
postal approach involves the use of clerical staff in the divisional health office, and trials
are being carried out in certain districts to see how the benefits resulting from it can
be achieved with the greatest economy of staff. Preliminary figures are encouraging.
Immunisation
sessions
The Council s scheme tor immunisation and vaccination gives parents the choice or
having the inoculation carried out either by the family doctor or at the Council's centres.
The Council makes available to family doctors free of charge any prophylactic used in
the service, and pays a fee of 5s. to the doctor on receipt of a record of a completed
course of immunisation. During 1957 general practitioners performed about 20 per cent.
of the primary immunisation against diphtheria and whooping cough and about 30 per
cent. of the primary vaccinations against smallpox. Immunisation and vaccination not
carried out by the general practitioner is performed by the Council's full-time or parttime
medical staff in the welfare centres either at special immunisation or vaccination
sessions, or (in certain areas) at combined immunisation and maternity and child welfare
sessions.
In the immunisation of children of school age a different approach is used, the
parents being approached through the school health organisation and the immunisations
carried out in special sessions held from time to time in the schools. Immunisation
against diphtheria carried out in the schools consists principally of reinforcing doses at
the ages of five years and 10 years for children who received primary immunisation in
infancy. In some areas the first boosting dose at 5 years of age is given before school
entry as part of the child welfare routine, but in most districts this is left until just after
school entry. Reinforcing doses of diphtheria prophylactic given in 1957 totalled
39,268.
Vaccination
under the
National
Health
Service
The improvement in the level of mfant vaccmation m London since 1948 has already
been commented upon. At least two factors have contributed to this, the first being
that compulsion has been replaced by the persuasive zeal of the health visitor, the
second the fact that a number of local epidemics of smallpox have focused the attention
of the public on smallpox and vaccination. The effect of an epidemic is often to stimulate
a wide public demand for vaccination. In so far as this serves to increase the amount of
infant vaccination it is welcome, but it can be somewhat embarrassing in other respects.
None would deny that a person who is in contact with smallpox should be vaccinated
as a matter of urgency. However, mass vaccination of members of the public who
have not been in contact with the disease is a measure that should not be encouraged
unless smallpox is occurring outside the known contacts—an event which has only
rarely occurred in recent epidemics. Children of school age and adults if they have
never been vaccinated before are liable to have more serious reactions to vaccination
than infants; it is therefore usual not to encourage the primary vaccination of such
persons unless they have actually been in contact with smallpox.
It sometimes occurs that a case of smallpox is admitted to a general hospital or a
fever hospital before the true nature of the disease is apparent. The Ministry of Health
has, therefore, taken steps to encourage the highest possible degree of vaccination of the
staff of hospitals.
The Ministry of Health memorandum 312 MED was issued in a revised form in
1956. It recommends the multiple pressure method with one insertion for routine use
as being almost free from discomfort. In the face of exposure to smallpox two insertions
are recommended and the scratch method is preferred.
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