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INFECTIOUS DISEASES
The control of infectious disease is a matter of continual concern to the Health Department and
is given priority at all times. Although many of them can now be prevented, we prefer to describe them
as being checked, not conquered. We are engaged in an unremitting conflict, fully realizing.that only
the utmost vigilance on our part and the co-operation of the general public can ensure that the health
of the community is maintained and improved. An increasing proportion of our work is concerned with
infection from abroad, and it is therefore not surprising that we view with apprehension the impending
appearance in the world's air lines of the jumbo jet. Able to carry nearly 500 passengers at reduced
fares, it is likely to give an enormous boost to travel; so that we shall then be encountering a wide
range of diseases, from dhobie itch to Rocky Mountain spotted fever. However, there is likely to be at
least one good result from this cause; an increase in the smallpox vaccination rate, as many of the
countries which will be covered by the spreading tide of tourism, Asia, Africa and the Americas, will
be in endemic areas, as a few arealready. A valid international certificate will then become a necessity
fora large proportion of travellers. This is another reason why parents should ensure that their children
receive their first vaccination in their second year of life.
The weekly bulletin to general practitioners has continued to thrive, and has become so much a
part of medical life inHaringey that we are often asked to make announcements in it. The exchange of
information involved adds a zest to the work of the department, when we sit down on Friday mornings
to work out what the Haringey doctor receives on his breakfast table the following day.
It is a curious fact that the commonest infectious diseases are the ones we know least about.
Conditions like measles, rubella, mumps, chickenpox and influenza do not often cause serious illness,
but they certainly result in a large amount of discomfort and absence. 1968 will probably see a great
fall in the first of these, when the measles vaccination programme has been completed. A mention
should perhaps be made of the problems of publicity in cases of infectious disease. A health department
is always on a knife edge where this is concerned. To put the dilemma in a nutshell; while serious
infection is of public concern, illness is a private affair. This is complicated by the fact that our idea
of the communicability of a disease is often different from that held by the press or the public. For
example, there might be a good deal of general alarm about, say, a case of typhoid. But from our point
of view, it is rarely dangerous except if transmitted by food or close contact. In other words, you are
unlikely to come to harm ifyousitoppositesomebodysufferingfrom typhoid in a tube train. But instances
have been recorded elsewhere in which patients or their families have been shunned by others and
perhaps suffered financially because it became known that typhoid had occurred, even after all risk of
spread had ceased. Similarly, we have to keep information about cases of leprosy at a very confidential
level as, though it has a very low grade of infectivity, people have not yet realised this fact and have
been frightened of it for centuries. On the other hand, we were surprised to find this year that there
was one disease which had evidently lost its terrors for many people. When we made an announcement
aboutwhatwas thought at the time to be a case of diphtheria, it was reported only briefly in two newspapers
and there seemed to be no public reaction at all. Yet, since this is a disease which is
transmissible by air borne spread, it would be a very different thing from typhoid if encountered on a
tube train. One wonders, of course, if people have the impression that diphtheria has been conquered
by immunisation — a dangerous assumption, since the evidence is that it has only been checked, and
may recur if immunisation is not maintained at at least its present level. Our advice is; make sure
your children have been immunised against diphtheria, and have yourself protected against typhoid if
you mean to go abroad; you will then have little occasion for worry where these are concerned.
Infective Hepatitis
73 cases were reported, an increase of 22 on 1966. It is difficult to tell how real this increase
might be. The disease was made officially notifiable on 17th June 1968. A difficulty is that many
cases do not reach the stage of jaundice and may go unrecognised. We are grateful to doctors for
information that has been given to us about this disease.
Eighteen of the number occurred at a school over a period of four months. The long duration of
the epidemic is typical of the disease which has a lengthy incubation period of between two and six
weeks. 76pupils were given injections of gamma globulin to limit the spread, and there were ten more
cases extending over two months before the infection died out. There was another outbreak involving
five members of a family living in poor circumstances. Other cases later on in the same district may
have originated from this source, possibly from contact in school or at play.
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