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which had previously been content to feel that 'it can't happen here'.* Organised
hostility has come from the sources that have been familiar in the past, and was
particularly evident from 1950 onwards when reports of poliomyelitis following
inoculations appeared. The subject of poliomyelitis following injections is discussed
later.
There can be little doubt that a factor which has assisted in maintaining higher
levels of diphtheria immunisation has been the possibility of combining this process
with vaccination against whooping cough. Whereas parents have to be persuaded to
accept diphtheria immunisation, whooping cough vaccination supports itself largely by
popular demand, this being a disease with which parents are familiar. When parents
present their children for whooping cough vaccination it is comparatively easy to
persuade them to have their children immunised against diphtheria at the same time
when this can be done in the form of a combined injection. In 1957 about 75 per cent.
of the diphtheria immunisation in London was carried out using combined prophylactics
containing whooping cough vaccine and diphtheria toxoid with or without tetanus
toxoid.
Whooping
cough
immunisation
Before 1948 certain of the metropolitan boroughs provided facilities for immunisation
against whooping cough, and in the Council's proposals under Section 26 of the
National Health Service Act, 1946, it was stated that these arrangements would be
extended and developed in the light of further knowledge. Since that time a considerable
amount of field research has taken place, and it is clear that vaccines currently manufactured
in this country can be relied upon to give a substantial degree of protection
against whooping cough. Although whooping cough occurs most frequently between
the ages of one and five years it is most serious when contracted by babies less than a
year old. In the effort to reduce mortality from whooping cough therefore it is advisable
to commence giving the vaccine earlier than the time at which diphtheria immunisation
has been usual in the past. Diphtheria immunisation was usually undertaken between
the ages of eight months and one year. Many workers give the whooping cough vaccine
in a course beginning about the age of three or four months. The fact that this course
is often given in the form of a combined whooping cough/diphtheria prophylactic is
responsible for the observation, already commented upon, that an increasing proportion
of diphtheria immunisations is being completed before the first birthday. During 1957
nearly 90 per cent. of the whooping cough immunisation carried out was in the form
of combined diphtheria/whooping cough prophylactic with or without tetanus toxoid.
The actual numbers of completed primary courses carried out being :
Plain whooping cough vaccine 3,779
Combined diphtheria/whooping cough 19,464
Diphtheria/whooping cough/tetanus (triple prophylactic) 12,405
While there is abundant evidence of the value of the vaccine to the individual
child in reducing the likelihood of infection and in reducing the severity of the attack
when complete protection is not conferred, the precise part played by vaccination in
the recent favourable community experience cannot be clearly shown. In view of the
demonstrable benefit to the individual it is reasonable to believe that the use of the
vaccine has assisted in the production of the comparatively low figures of mortality in
recent years. It is doubtful if a substantial reduction in incidence can be expected unless
further attention is given to the problem of maintaining immunity by reinforcing
doses. In so far as this could be done by combined diphtheria/whooping cough prophylactics,
in those whose primary course was of this nature, no problem would be presented.
However, as whooping cough, unlike diphtheria, is a comparatively mild disease in
older children many people feel that it would not be justifiable to embark on organising
repeated booster doses of whooping cough vaccine.
* Amer.J. Public Health—June, 1957.
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