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PART 1
ENVIRONMENTAL HEALTH AND INFECTIOUS DISEASE
INFECTIOUS DISEASES
IV. T. Orton, Deputy Medical Officer of Health
1969 proved to be a quieter year than usual for infectious diseases, though it began with a tragic
outbreak of typhoid fever. There is certainly no reason to assume that vigilance should be relaxed.
The increase in foreign travel in large aircraft can bring dangerous infectious disease to our doorstep
in a few hours. One can only regard with growing concern the cynical endeavours of travel agents to
increase their business without giving their customers any inkling of the health hazards they face
when visiting many countries overseas.
It is especially alarming to notice that in the year of the jumbo jet the government's second green
paper should propose a reorganisation of the health services in which infectious disease control is
divided between area health boards and local authority public health inspectorates. It is strange to
think that ideas like this can result from an intention to unify! Perhaps it is thought that it does
not matter because infectious disease is not as important as it used to be. There may be a rude
awakening from this, for there is every likelihood that the jumbo jet is well able to convey every
infection we have had to face in the past, plus quite a few more than will be new to us.
Measles
In spite of the frustrations over delays in obtaining vaccine, the Health Department was able to
complete its programme of measles vaccination, though the public response was rather disappointing.
The results were awaited with interest.
Measles is normally a biennial affair, that is, there are large epidemics every two years. So we have
to compare 1969 with 1967. The figures of notifications were 1212 and 1627 respectively, meaning
that the 1969 figures were 74 per cent of those for the last "measles year" during which there had
been no vaccination. These are not as good as we had hoped, but it seems likely that the vaccination
had an effect on the incidence. The 1967 epidemic reached a peak of 221 in the weekly notifications
in January of that year: but the peak for 1969 was only 73 and took place in April. The results
therefore suggest that vaccination may also have had a delaying effect.
If measles is to be wiped out in this country there will have to be a greater response from the public.
This has not been helped by the withdrawal of one of the vaccines from use; and as supplies return
to normal the department will be hard-pressed to complete the programme of vaccination before the
autumn of 1970 - and the next measles year.
Enteric
There were seven cases of typhoid altogether. Three occurred in Haringey residents on holiday in
Wales, and unfortunately one of them was fatal. The same type of organism was discovered in a
woman who had been caring for a baby of two of the victims, and the evidence suggested that the
infection had been passed through the child to the parents, though without causing any serious
illness in the infant. The woman turned out to be a chronic typhoid carrier, the result of an attack
many years before. She agreed to an operation which removed the source of the infection.
In another incident a woman developed the disease, and her husband was found to be excreting the
organism, although he was in good health. Both were admitted to hospital and treated successfully.
Here it seems likely that the man was infected at about the same time as his wife. The source
appears to have been in another borough,
There was also the case of a boy born in this country of Cypriot parents who caught the infection
while visiting the ancestral island.
The Department co-operated with the staff of a hospital in Haringey in investigating contacts of a
child from another borough who was suffering from typhoid while a patient in a ward. Fortunately none
of the other children had caught the disease, and similarly investigations of other Haringey residents
who had been contacts of cases of typhoid in this country or abroad during the year showed them
to be free of infection.
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