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'The incompleted information beyond five years shows that similar
high levels of protection have continued up to at least six and a half
years'.
'There is now a suggestion that the lesions in the vaccinated cases
were less extensive and less severe than in the negative unvaccinated
cases'.
This particular age group was selected in the hope of reducing the
susceptibility of adolescents who are vulnerable and who are leaving their
more sheltered life for one of greater exposure. If the continuation of
this trial shows that the protection afforded lasts for an even longer time,
it might be possible, while giving the required protection to adolescents,
to lower the age at which vaccination is carried out, and so reduce the
number of cases occurring amongst those in the years just before thirteen
years of age. It is probably unwise to make the change until the trial
continued for even a longer time yet, can demonstrate that there is no
appreciable falling-off in the effect of the vaccination for a longer time
than the five years now being reported.
While the efficacy of the preparation has been demonstrated, there
is the quite independent question of whether it is needed. This depends
on the extent of the infection which the use of this preparation can be
expected to reduce. In those countries where there is much tuberculosis
any measures such as this will be helpful in any general campaign against
this disease. On the other hand, there might be the country or part of
the country in which so few adolescents succumb to tuberculosis that the
question of the worthwhileness of the scheme has to be gone into. In
such a district as this, in which the incidence among tuberculin negative
adolescents is already so low, the time might not be too far distant when
this problematical saving of infection in a child has to be weighed against
the disturbance to the school routine entailed in testing and inoculating
some thousands of children each year, and against the lesions suffered
by those who have unusual reactions.
The County Council's arrangements for B.C.G. inoculation of children
of 13 years of age were modified during the year so that vaccination
could be offered to those approaching 13 years and could conveniently
be treated along with those of that age, children of 14 and students
attending establishments of further education.
Fifteen persons of ages between 14 and 24 were notified during the
year as suffering from pulmonary tuberculosis which presumably they
contracted while living in this district. There were no non-pulmonary
cases. Of these, 3 (males of 16 and 18 and a female of 15) gave a family
history of infection. The ages of the remainder who did not give such a
history were: males 18, 21, 23, 24 and 24; females 19, 21, 23, 24 and -4.
Of the factors about which the District Council can help, the most
important is housing. The Council has all along been very generous in
its allocation of houses for those families in which there is a member
suffering from pulmonary tuberculosis. In selecting who should be helped,