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By the date of coming into operation of the National Health Service the incidence
of diphtheria in London had already fallen from 1,305 notifications in 1941 to 335 in
1948 (notifications corrected from changes in diagnoses). Further rapid diminution was
maintained after 1948. Only four cases were notified in 1957, and the annual figure
has been less than 20 each year since 1952. The small number of cases occurring has
made it possible to investigate the circumstances of each individual case very thoroughly
with a view to limiting spread. The present attack on diphtheria, therefore, consists of
energetic suppression of infection when it occurs combined with maintenance of the
highest possible level of immunisation.
The number of primary immunisations carried out since 1949 are given in Table (i).
The actual number of immunisations carried out each year varies with the number of
births in the previous year and is also affected by any restrictions that may be imposed
by a poliomyelitis epidemic. From the figures for the percentage immunised at age
5 years it will be seen that the fall which took place after 1950 and which was due to
uncertainty about the effect of poliomyelitis has now been made good in recent years.
Nevertheless, the figure of about two-thirds of the children immunised at 5 years of
age is far from satisfactory.
Diphtheria
immunisation

(a) Not available for these years.
(b) Estimated.
An interesting fact emerges from a comparison of the figures in columns (1) and (3),
the steady increase through the years of the percentage of the under five immunisations
which take place before the first birthday ; this is most probably the result of an increasing
use of the combined diphtheria/whooping cough prophylactic.
The main factors working against the attainment of high levels of immunisation
have been apathy, organised hostility, exaggerated fear on the part of parents of the
possibility of poliomyelitis following inoculation and measures taken by divisional
medical officers to reduce the amount of immunisation during local prevalence of
poliomyelitis.
Apathy and complacency are dangers which result directly from the success of the
campaign. Diphtheria seems so remote nowadays that it is necessary to be continually
reminding parents of the possible results of neglecting immunisation both for the
individual and the community. The potential danger in the present situation has recently
been vividly shown in the city of Detroit where as a result of public neglect of immunisation
an epidemic of 141 cases of diphtheria with four deaths occurred in a population
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