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all have not been referred to in this Report, and also that a number
have only recently been introduced as suitable for general use.
Obviously the time has already come when the more they can
be given in combination, the fewer the injections and the less the
inconvenience to all concerned, with consequent greater popularity
and wider acceptance. Unfortunately, there are a number of resultant
problems which necessitate and are receiving considerable
time absorbing research, in particular the question as to what
extent combining various vaccines affects the efficiency of each.
Rapid progress along these lines cannot be expected.
Meanwhile the advice to parents has to be very carefully considered,
not only in the interests of the individual child but bearing
in mind the degree to which the advice will be acceptable as being
convenient to the parent.
At present the general use of anti- tuberculosis vaccination is not
anticipated, while vaccination against poliomyelitis has been limited
by the quantity of vaccine becoming available. (At present this
form of vaccination is only given providing a minimum interval of
two or three weeks follows or precedes any other form of immunisation,
and that the child is otherwise fit and not likely to be incubating
any infectious disease).
Vaccination against smallpox can be given as early as two
months after birth in a healthy baby and, owing to the child's
comparative immobility, there are advantages in carrying out this
treatment as early as possible. During the Spring months and
possibly when poliomyelitis is not occurring in a district, this can
be followed by a course of combined diphtheria, whooping cough
and tetanus prophylactics, commencing at the third month, particularly
in view of the relatively high number of deaths from
whooping cough in early infancy. There is evidence, however,
against such an early start in diphtheria immunisation, while the
use of the triple vaccine may increase the risks of paralysis if and
when poliomyelitis is occurring in the neighbourhood.
Ideally, therefore, the whooping cough vaccine is best given
on its own, starting in the third month, and reserving the prophylatic
treatment against diphtheria and tetanus until the following
Spring, but this would involve many injections in the first year,
including 2 injections against poliomyelitis after the child is 6
months old.
The practice followed and advice being given now varies from
District to District, and further variations can be expected. Meanwhile
the local practice has been to continue the use of the triple
antigen in children of 3 months upwards unless a case of poliomyelitis
occurs in any given part of the District, and then to suspend
treatment locally for as short a time as possible; this appears
to be justified in view of the almost negligible number of cases of
paralytic poliomyelitis which have occurred in Surrey during the
last 10 years following injections of the triple vaccine.
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