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Despite the fairly close contact with the pupils in the affected
class swabbing of the pupils in the three unaffected classes did not
bring to light any further carriers. The Schick testing revealed that
28 pupils in the remaining classes were susceptible and it was decided
to protect these children by the simultaneous administration of antitoxin
and antigen, a procedure suggested by Downie et al (1948
Journal of Hygiene, 46, 34). A.P.T. was chosen despite the slight
risk of provoking poliomyelitis (Lancet, 1956, 11, 1223), becauseat
the time the district was free of this disease, and it was considered
that a potent antigen such as A.P.T. is more likely to lead to a
satisfactory level of immunity in the presence of small amounts of
antitoxin.
The outbreak stimulated a marked increase in demand for
diphtheria immunisation, and approximately 1,800 children were
immunised or received a booster dose of antigen within the few
weeks of the epidemic. T.A.F. or F.T. was used in all cases except
for the close contacts, who received prophylactic serum and A.P.T
Cases VI and VII. On 10th October two older siblings of one
of the carriers in the class were found also to have positive throat
swabs. Both had slight sore throats with scanty exudate when seen
at home. They were admitted to hospital and later notified as cases
of diphtheria although the clinical diagnosis was considered by the
Physician-in-Charge to be rather doubtful. Both had been immunised
in the past (one of them not for 8 years) and they had mild attacks.
Case VIII. Also on 10th October a sister of case V, aged 8
years, developed a sore throat and was sent to hospital as a suspected
case of diphtheria. Bacteriological confirmation was later obtained
She was under observation and was detected at an early stage. She
had not been immunised, but was not severely affected.
Case IX. The only patient not of school age was now detected
A boy of two years was admitted to hospital on 9th October with
inflamed tonsils sparsely covered with exudate. The diagnosis was
confirmed bateriologically later. He was bright and active all along
and was never very ill. His sister attended the affected school. but
was in a different class. He lived in the area from which most of
the cases and carriers were found. This boy's father, a labourer,
and the sister referred to above, were subsequently found to be carriers,
and treated at home.
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