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should be kept under continuous review and members of the Department are co-operating with
the local Public Health Laboratory to ensure that cases of whooping cough occurring in Hillingdon
are appropriately investigated. The Committee on the development of vaccine and immunological
procedures set up by the Medical Research Council has recommended this continuing monitoring
procedure, and in certain London Boroughs each case is visited by a Health Visitor who collects
a pernasal swab and a full immunisation history. During 1970 forty-nine cases of whooping cough
were notified and 74 pernasal swabs were taken. In seven of these cases Bordetella pertussis
organisms were isolated.
Immunisation is a safe and effective method of protecting against dangerous and potentially
lethal diseases. Under appropriate medical supervision it is virtually without risk, and when unexpected
local reactions occur, immediate investigations should be undertaken. A small number
of local reactions were brought to light concerning one vaccine during the year, and prompt action
to replace the vaccine speedily terminated the incident.
During the year the Department of Health and Social Security introduced a programme of
vaccination against rubella (German measles). This disease, which to the public represents the
epitome of trivial childhood infectious disease, can be extremely hazardous to the unborn child
if contracted by an expectant mother. When such a combination of circumstances has occurred
it has been usual to give an injection of immunoglobulin to mitigate the possible effects upon
the unborn child. Follow up studies have failed to confirm the efficacy of this treatment, so that
the only alternative is to ensure that before the age of child bearing each girl either contracts the
disease or is actively immunised against it. The former method which has been tried at "German
measles parties" is of dubious validity since the disease is not entirely without risk, and its spread
amongst the child-bearing population could not be avoided by such a policy. Thus a programme
of active immunisation has been commenced in the latter years of school life. The vaccine, a freeze
dried preparation of live attenuated rubella virus (Cendehill strain) has been offered to 13-year-old
schoolgirls by means of a single injection. In 1970 the parents of 336 girls accepted the offer of
vaccination representing approximately 66% of those eligible. This rate is clearly far too low if
the primary objective of eliminating rubella syndrome in babies is to be achieved.
An improvement in the present levels of immunisation is considered to be both possible
and desirable. A number of alternatives have been considered, and by far the most practicable
would be the introduction of computer processing of the appropriate records. By ensuring that
parent, doctor and health visitor are each reminded when the next immunisation procedure falls
due, the computer can lead to dramatic improvements in immunisation rates. Preliminary work
prior to the transfer of such records to the computer was commenced during the year.
Immunisation statistics are recorded on pages 161 & 162.
DENTAL SERVICE (MATERNITY AND CHILD HEALTH)
Mrs. B. Fox, B.D.S.—Chief Dental Officer
The full range of dental treatment is available for the pre-school child at the Borough dental
clinics. An increasing number is taking advantage of the services offered, but is a small percentage
of those children who could benefit. The aim of the service is to familiarise the young patients with
the dental surgery and equipment before they require more complex dental treatment. In many
cases this may be the first contact the child has had with a dentist, and it is important that a child
should not be introduced to dentistry for the relief of pain. Such emergency visits demand much
from the child as immediate treatment does not allow for adjustment to strange surroundings
and procedures.
Unfortunately many children still arrive at the dental clinic with teeth too badly decayed to
fill satisfactorily, and they are either extracted or otherwise conserved to prevent further decay.
The priority dental service relies to a great extent on the co-operation of health visitors and
school medical officers to refer children to the dental clinic. Members of the dental staff are always
available to advise parents on dental health education, including feeding difficulties, thumb
sucking, etc., and other problems which may subsequently affect the teeth and cause parents
much concern.
Dental statistics are recorded on page 163.
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