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4. If the child has had clinical Whooping Cough before Triple immunisation has started DiphtheriaTetanus
Vaccine (PTAH) should be substituted for Triple Vaccine, but the timing of the visits
should be the same.
5. Measles Vaccination is given by one dose of live attenuated vaccine. For routine immunisation
it should be given in the second year (about fifteen months) AFTER completion of the basic course
of immunisation with Triple and Oral Polio, and preferably BEFORE routine vaccination against
SmalIpox.
6. The Booster Dose of Triple Vaccine and Oral Polio previously recommended to be given during the
second year is considered to be UNNECESSARY if the basic course is spaced as stated.
7. Routine PRIMARY Smallpox Vaccination should be given during the second year at least one month
AFTER Measles vaccination. In special circumstances, smallpox vaccination may be carried out
during the first year. Primary vaccination against smallpox in infancy should be regarded as the
first of a series of vaccinations to be given through childhood to adult life, and RE-VACCINATIONS
are therefore to be offered at School Entry and School Leaving ages.
PRIMARY VACCINATION is NOT advised as a routine after early childhood.
8. If a child at School Entry age has had NO immunisation (e.g. an Immigrant Child) a combined
course of Dip-Tet (PTAH) and Oral Polio should be given. (As in Note 4).
9. If a child at School Entry age has had Diphtheria and Polio immunisation but not Tetanus, the
parents should be advised that the child should be actively immunised against Tetanus and the
following vaccines should be given at the usual intervals:-
Visit 1 - T(PTAH) 0.5 ml - Oral Polio
Visit 2 - Dip/T (PTAH) 0.5 ml
Visit 3 - T(PTAH) 0.5 ml
10. It is only in exceptional circumstances that PRIMARY immunisation against Diphtheria, or a
reinforcing dose should be given to a child over 10 years of age. If it is considered necessary a
Schick Test should be done. If the result is positive after 2-4 days the child should be
immunised. It is recommended that in these circumstances plain FORMAL TOXOID should be used,
rather than the alum-containing vaccine which may cause more severe reactions in older children
and adults. If Tetanus immunisation is also required it can be given as a combined DiphtheriaTetanus/Formal
Toxoid.
11. Booster doses of Tetanus and Oral Polio are now recommendea at School Leaving age(15-19 years)
with Smallpox Re-Vaccination for those children vaccinated in infancy and re-vaccinated at School
Entry.
The new Schedule delays the start of the first Triple injection until the age of six months, and
the primary courses of Triple and Poliomyelitis immunisation are not completeduntiI at least fourteen
months. This is the reason for the great reduction from the 1967 numbers in the completion of primary
Triple and Poliomyelitis courses in the 0 — 1 year age group.
The gap in the immunisation programme, produced by the extra three months delay in starting
primary courses, was more than filled by the introduction of Measles Vaccination. During the year
Measles Vaccination was offered to all susceptible children between the ages of fourteen months and
fifteen years. It was not until February that it was known that intensive Measles Vaccination was to
be started in 1968 and that the Ministry of Health wanted the campaign to start in May. The first
sessions were held in May but the programme got off to rather a slow start because of the national
shortage of measles vaccine. This was disappointing after the tremendous efforts made by the staff
of the Infectious Diseases Section to get the necessary clerical work completed in the short time
available. However, the bulk of the special sessions had been completed by October and almost
4,500 doses were given. Measles vaccination is now included in the schedule as a routine at the age
of fifteen to sixteen months.
There has been an encouraging decrease in the incidence of measles at the beginning of the
1968-9 season, which would normally have been expected to be an epidemic year.
By the end of 1968 it has not been possible to do more than begin to plan for the introduction of
the recommended Booster injections for school leavers. This was because there were no previous
facts available to give a guide to the likely response from the children and their parents and therefore
to the amount of work which will be involved.
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