View report page

REPORT ON A FIVE YEARS' INVESTIGATION INTO THE SAFETY AND
EFFICIENCY OF ACTIVE IMMUNISATION AGAINST DIPHTHERIA
This investigation formed part of a campaign to protect the child population of the
Borough of Heston and Isleworth, following a severe outbreak of Diphtheria with a high mortality
in 1929. The main underlying idea was to demonstrate, as clearly as possible, that immunisation
with a suitable substance is a safe, almost painless, and practically completely efficient method of
safeguarding the child population against Diphtheria.
It was also considered essential to create public confidence by publishing the facts and figures
resulting from the investigation, and to show that immunisation, when carried out efficiently, by
competent physicians, is virtually 100% free from any risks of untoward happenings.
The antigen selected for this work was Messrs. Burroughs Wellcome's Toxoid-antitoxin
Mixture (T.A.M.). Despite pressure from various sources to use later preparations, and the
one shot variety in particular, no deviation from the original preparation was made, except in
the case of 12 children who showed more reaction to T.A.M. than is usually the case. These
subjects were given Toxoid-antitoxin Floccules (T.A.F.), for their final immunising injections.
It was felt that parents attending the Diphtheria Prevention Clinic came with the purpose
that their children should not have Diphtheria at all if it could be avoided. Their idea was not
merely that the child should be treated to the extent of ensurng that if an attack occurred, it
should be a milder one than if immunising injections had not been given.
They are not asking for the employment of methods which may leave as many as one child
in five unprotected.
At the present time the general practitioner, as well as the public health officer, is being
pressed on all sides by representatives of firms that manufacture ' single injection ' immunising
preparations, in an endeavour to procure their wide utilisation.
It must be borne in mind that many of the new preparations are liable to produce severe
reactions in a proportion of the children, and if employed at all generally, the method should be
reserved for the smallest children, unless a Moloney test is first performed. Even so, the data as
regards the percentage of persons immunised by 'one-shot' methods, and the durability of that
immunity, are insufficient for this type of immunisation to be generally recommended.
Working on the lines that we have been doing with T.A.M., we consider that we have
produced results which compare very favourably indeed with those obtained with any other antigen
in existence. It is possibly true that as long as Antitoxin is used, there is a very slight risk of
sensitising a very small percentage of cases, but so far, in the five years' work, we have had no
untoward symptoms arising from this cause. It does appear that when children have been
immunised with T.A.M., that there may be some degree of serum sensitisation, but this does not
seem to be of any serious extent.
The closest contact has been kept with Dr. Gammie, the Medical Superintendent of the
Joint Isolation Hospital. Since his appointment four years ago, Dr. Gammie, to whom we are
deeply grateful, has kept careful notes of the condition of immunised children from this district
entering the hospital.
It should be realised that in alluding to the children having serum injections, this does not
only refer to the Diphtheria patients, but to all kinds of injections for Scarlet Fever, Cerebrospinal
Fever, etc., containing horse serum. His report is as follows :—
" The following are the completed figures with regard to the susceptibility to serum rashes
of children immunised with T.A.M.
During just over four years commencing April 1931, 1101 patients had injections of antitoxin
of various kinds containing horse serum, in Mogden Hospital. Four of these were children
undergoing immunisation at the time. Two had rashes and two did not, but as they might only
have been desensitized by the T.A.M., I propose to omit them from the total.
There are thus 1,097 cases to investigate, and of these 293 had serum rashes. None of
them had serious symptoms, either in the immunised or the non-immunised group, but I have
divided the rashes into severe and not severe. By a severe rash I mean either a rash of very unusal
intensity and extent, or one accompanied by a sharp rise of temperature, considerable localized
oedema of any part of the body, or well marked joint pains.
1,015 non-immunised patients received serum treatment, and 239 (21.7%) of these developed
rashes, of which 24 (10%) were severe. 82 immunised children had serum, and rashes occurred
in 54 (65.8%), of which 13 (24%) were severe.
I think it only fair to point out that the proportion of cases receiving scarlatinal antitoxin
was somewhat higher amongst the immunised than amongst the non-immunised children, and this
form of antitoxin seems to be more liable to produce reactions than the diphtheria antitoxin; but
I think the figures show clearly that T.A.M. does sensitize a child to future injections of horse
serum. It is equally clear, however, that one need only expect discomfort, as in no case has actual
danger arisen."
37