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unprotected, including certain groups particularly at risk. Such
groups employed by local authorities include parks, building, roads,
sewer and refuse collection and disposal staff An effort has been
made in Wood Green this year to put matters right in this respect,
and all such staff have been offered tetanus immunisation. There
has been a very good initial response and it is hoped that it may
be possible to continue this measure as a local authority service.
The changing pattern of infectious disease over the last few
years leaves no room for doubt as to the efficacy of immunisation
as a means of control. It is interesting to consider the age
range of our present population who are so protected from various
infectious diseases.
Smallpox. The population at all ages have had the opportunity
of smallpox vaccination. The response of the adult population
is directly related to any occurrence of smallpox in the vicinity.
As regards the child populztion, however, fortunately the response
is consistent and high. Every month, each Health Visitor records
the vaccination state of all children currently reaching the age
of 2. In the majority of cases a vaccination record card is
available and, if not, a home visit is paid so that records are
accurate. In Wood Green the percentage of children at 2 years
who have been successfully vaccinated has risen from 53% in 1955,
when this method of follow-up was commenced, to 87. 1% for 1963.
Diphtheria. A very high percentage of the population'from
infancy to adults aged 38 to 40 years have received diphtheria
immunisation. Diphtheria immunisation was carried out to some
extent in the late 1930s, but it was in 1940 that a campaign was
launched in Middlesex offering immunisation to all children up
to school-leaving age There was an immediate, massive response
with soon afterwards a spectacular drop in the cases of diphtheria
The response over the years has continued at a high level and
the primary protection is continued with "boost" injections to
maintain continuing immunity. It follows that in our present
population adults up to the age of 38 or 40 come within the range
of the protected group.
In Wood Green during 1963, 93, 2% of children reaching the
age of 2years had been immunised. This compares with a percentage
of 83% in 1955. The system of follow-up used is the same as that
in smallpox vaccination.
Whooping Cough. Our main concern in this disease is to protect
the very young children in whom the condition can still be fatal.
Immunisation, therefore, commences at 2 to 3 months. Protection
is thus given over the first few years of life, but since in older
children the disease tends to be mild, the regular immunisation
of older groups is not considered necessary
Poliomyelitis. Polio vaccine was introduced in 1956 and led to
a wide initial public response which later fluctuated Probably