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82
German Measles
Seventy-nine intimations were received of the absence of children
from school because of this condition. Of these, thirty-three occurred in
one department of a school in the closing week of the school year. Apart
from this, there seemed to be no spread of the infection in school, there
being in most instances only the one case in any department at the one
time.
It has been known for some twenty years that there is a connection
between rubella in pregnant women and congenital defects in their babies.
The degree of risk has not been known. Towards the end of the year, the
Ministry published a report of an enquiry which gives an indication of
this risk. The earlier in pregnancy that the mother has rubella, the greater
the risk ; an attack after the sixteenth week of pregnancy does not affect
the foetus. When the mother is under twelve weeks pregnant at the time of
the infection, there is a greater risk of abortion, of stillbirth and of the
death of the infant under two years of age. Of those who survive two
years, many suffer from congenital defects, especially cardiac abnormalities,
cataract and deafness.
Tetanus
The Registrar-General records about 200 deaths of tetanus each year
with a case mortality of twenty-seven per cent. The true figure is something
more than this because some deaths are certified as due to accident.
Children of school age, more particularly those in rural areas, are the
most affected.
Passive immunity by an injection of anti-toxic serum confers protection
for two or three weeks. Particularly those who have had a previous
horse serum injection might react severely. Nearly a million doses of antitoxin
are given in this country each year. In some thousands this is followed
by serum sickness, and by death in a number. While today's practice
favours the administration of anti-toxin to those who have been injured,
many of the fatal cases of tetanus were the rusult of infections of wounds
not considered sufficiently serious for the administration of prophylactic
anti-toxin.
Active immunisation with tetanus anti-toxoid was introduced some
twenty years ago. It was used extensively in the 1939/45 war. The incidence
of tetanus in the American Army was six cases per million injured. The
corresponding figure at the end of the 1914/18 war when only anti-tetanus
serum was available was one thousand cases per million injured.
With the small number of cases which develop it, it is questionable if
anything would have been done on a big scale if active immunisation
against tetanus involved another series of inoculations of a child.
Fortunately however, the prophylactic against tetanus can be incorporated
with that against other infections without appreciably lowering their
potency. The use of such a combined vaccine is growing in popularity.
To obtain active immunity three injections are needed, the second sonic
weeks after the first, the third six to eight months later. An injection a
five-yearly intervals after will provide protection.