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The difficulty facing a doctor with an injured patient will be to decide
whether or not to administer anti-toxin. He can decide against it only if
he knows the patient has recently been inoculated against tetanus or has
had a recent booster dose. Without some simple form of recording these
facts, a record which will be available to the doctor, the patient even
though he has been immunised, must still be given his dose of anti-toxic
serum.
Influenza
Incidence. Influenza appeared in America in the early part of the
year and towards the end of January it became prevalent in many parts
of the Continent, from some of which cases virus A2 was isolated.
Although in late February there had been a slight rise in the number of
deaths in this country from influenza and also in the numbers of notifications
of pneumonia and deaths from pneumonia and bronchitis, there was no
laboratory or other evidence that influenza was prevalent. These indices
of winter respiratory disease soon declined, and although virus was being
recovered from patients, influenza was not a public health problem in
this country in 1960. It was responsible for the deaths of only two local
residents.
Immunisation. Virologists believe that when pandemics of influenza
occur, the strain of virus responsible is so different from its predecessors
in antigenic constituents that the immunity built-up against them is
ineffective against the new strains.
Outbreaks of influenza in Great Britain are caused by viruses of type
A or type B. These two viruses are antigenically distinct and there is no
cross protection between them. Type A viruses are usually responsible
for the large and rapidly spreading epidemics or pandemics, while those
of type B are more commonly associated with local outbreaks and
sporadic cases, although they have on occasion caused widespread
disease. Variations do occur amongst these groups. "Classical" A viruses
were prevalent from the isolation of the influenza virus in 1933 until
1946/47. A—(A. prime) viruses first appeared in 1947 and persisted until
their replacement in 1956 by the Asian group to which the current type
A viruses belong. There is no protection between these groups. Out of
each group minor degrees of variation are noted from year to year.
These changes are probably not of importance from the immunological
point of view. For there to be real hope of benefit from a vaccine, it must
be prepared from the current strain. For there to be any hope of sufficient
vaccine being prepared in time to be used for the protection of key
workers e.g. in hospitals, transport and the postal services, the organism
must be identified well before it has been introduced into the country. In
the case of the outbreak of Asian influenza in 1957/58, more could have
been hoped for had the virus been available for the manufacture of
vaccine in February when it was first isolated in South-West China rather
than by the time it had reached Singapore in April.