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should be given booster doses to stimulate their waning immunity,
especially just before they go to school. Without this stimulus, even though
they have been treated in infancy, they might become susceptible to
attack.
Diphtheria in less than two decades was reduced from a dread
disease, causing much illness and many deaths, to one of low incidence,
though in those attacked still one of high case-mortality. To maintain
this favourable state in the population as a whole, a high proportion of
the population must be inoculated, and the immunity produced kept at a
high level by booster doses. To protect every child it is necessary that
every one of them shall be inoculated and in later years be given booster
doses.
In recent years localised outbreaks occurring in and about London
have emphasised the need for this infection still to be treated seriously. In
the Autumn of 1958, twelve cases associated with infection in an infants'
class occurred in a district near London. Four of the children were
severely ill and there was one death. Soon after that there were cases in
some schools in two districts in London. Two other districts were affected
towards the end of the year, and early in 1960, associated with a school
in a district just outside London there were five cases, one being fatal.
None of the severe cases had been immunised. These occurrences underline
the importance of securing that children are immunised, and are
maintained in a state of immunity during school life. This state can be
achieved by inoculating the infant, giving a reinforcing dose at about
15-18 months, and a booster dose just on entry to school.
During the year, 3,055 were treated for the first time ; 1,541 by
general practitioners and 1,514 at the infant welfare clinics. The corresponding
figures for 1959 were 2,307, 1,415 and 892 ; for 1958, 1,934,
1,128 and 806 ; for 1957, 2,135, 1,174 and 962 and for 1956, 2,336, 1,109
and 1,227. This increase in the numbers treated at the clinics is probably
the result of the removal of the ban on the use there of the combined
vaccine, a measure which had been taken because of apprehension about
provocation poliomyelitis. The ban meant that children, in order to
Protect them against the risk of contracting diphtheria and whooping
cough, had to receive five inoculations against the three necessary to
afford the same protection when the combined vaccine was used. Because
of this there was a falling-off in the protection against diphtheria.
It was estimated that at the end of the year, sixty-six per cent. of
children under five years of age were protected and ninety-eight per cent.
of those aged five to fifteen years. These proportions are probably sufficient
to ensure freedom from the risk of any serious outbreak of this
infection in the district. The large numbers protected reduce the risk of
the unprotected being attacked, but gives no assurance. For parents to
ensure that their children are not likely to contract this infection, they
rnust see that these children themselves are protected.
Booster doses were given to 1,234 children, 795 by general pracers
and 439 at the clinic.