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17
Of the five clinical cases only one had been immunised (0.5.
c.c. B.W. A.P. T. x 2) 7½ years previously. The other four,
including the fatal case, had never been immunised. Of 59
carriers of school age 49 (84%) had been immunised, while of the
school population at risk approximately 70% had been immunised.
The first case R.C. a boy of 13, attending Sidney Chaplin
Secondary Modern School, was reported by St. Ann's General
Hospital on 16.1.60 as a case of faucial diphtheria.
Case 2 (19.1.60), his sister, Y.C. aged 8, was found to have
nasal diphtheria as a result of follow up of home contacts. She
attended the Roger Ascham Junior School.
Case 3 P.S. aged 8, was a boy in Y.C.'s class who developed
the disease on 29.1.60 after having given negative nose and
throat swabs a week before.
Case 4 L.E. aged 3, was the sister of a boy in Y.C's class
who was a carrier. She was diagnosed as acute diphtheria on
30.1.60 and was at once admitted to hospital. Unfortunately she
died the next day.
Case_5, the last confirmed case, occurred on February 8th
when D.B. a boy of 6½ attending the Infants' Department,
developed symptoms later confirmed as diphtheria.
CONTROL OF THE OUTBREAK
On the first notification, 16.1.60 (a Saturday morning) R.C's
family were visited and nose and throat swabs taken by a health
visitor. All these proved negative. All local doctors were
informed, and this contributed to the early recognition of cases
3 and 5.
On Monday, January 18th, R.C's school was alerted and his
class and other school contacts were swabbed and Schick tested.
All swabs were negative. Of the 44 children (aged 14) involved,
15 had never been immunised, 13 had received the primary course
only, and 16 had received a booster dose in addition. Schick
tests (4, absentees) showed 25 positives and 15 negative. No
spread occurred at this school.
On the same day R.C's family and their co-tenants were
swabbed and Schick tested. Y.C. had a sanious nasal discharge
and gave a positive swab while an aunt, M.G. aged 35, was
found to be a carrier and excluded from work. Immunisation
(1 c.c. P.T.) was offered to all contacts.
Attention was now directed to Y.C's school Roger Ascham
Junior, and 66 contacts were swabbed and Schick tested. Six
positive swabs were obtained and Case 3, a class contact, was
negative at that time but subsequently developed the disease
(29.1.60). Of these children 74% had been immunised.