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The Ministry of Health in September, issued a memorandum based
on advice received from the Standing Medical Advisory Committee.
Unfortunately, alternative programmes are offered. In the one, three
doses of triple vaccine are given within the first six months, followed by
three doses of vaccine against poliomyelitis, then a fourth dose of triple
vaccine. This programme entails seven inoculations apart from vaccination
against smallpox. In addition, in later years booster doses are
advised. In the alternative schedule, designed to reduce the risk of
provocation poliomyelitis two doses of poliomyelitis vaccine are given
between six and eight months, then two doses of triple vaccine, followed
by the last dose of poliomyelitis and then the last dose of triple vaccine;
in all six inoculations. In addition, in this schedule there is the vaccination
against smallpox and booster doses have to be given later. It is unfortunate
that the Standing Committee could not have reached a decision to
recommend one schedule which would then have been adopted throughout
the country.
Further changes will soon be introduced if only because work is being
done of the manufacture of a vaccine which will protect against four
infections—diphtheria, pertussis, tetanus and poliomyelitis. On the other
hand, inoculation against poliomyelitis might soon be replaced by the
giving of the vaccine by mouth.
DIPHTHERIA
In none of the patients admitted to the isolation hospital suspected
to be suffering from diphtheria was the diagnosis confirmed. The district
has been free from this infection since 1950, a period of eleven years. The
last fatal case here was in 1946.
This freedom from diphtheria is today accepted as common-place.
In this last year, a number of towns had limited outbreaks but all totalled
to only a small number of cases. This satisfactory position is almost
certainly the result of the production of immunity in the susceptible
population by inoculation. Where the general level of immunity is low,
either because many of the people have not been immunised or having
been treated, with a passage of time their immunity has waned, diphtheria
is liable to strike, and where it does the case mortality is just as
high as ever. Over a long stretch of years in the country as a whole there
would be as many as 50,000 cases of diphtheria each year of which 3,000
might prove fatal. Although the means to bring about immunity were
available in the late 1920's, they were not used to any great extent. It took
with the war, with the risk of transmission of infection in communal air
raid shelters, to get the practice adopted. When a high proportion of the
population were protected, then the fall in incidence started, a fall which
was to continue each year so that the position was reached when throughout
the country in one year less than 100 cases were notified. This district
was never attacked on the same scale as the rest of the country, the