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DIPHTHERIA:- Twenty-two cases were notified, an increase of
five cases. One, was an institutional case. The twenty-one
district cases occurred in separate groups. During January and
February, six sporadic cases occurred in the Sutton area. The
cases were not interconnected, and were due to carrier infection.
Two carriers were detected and freed from infection. During
March and April there was an outbreak of Diphtheria in the
Worcester Park and North Cheam areas among older children
attending a school outside the Borough. Eight girls aged 10
to 15 years were infected, and six secondary cases occurred.
One sporadic case occurred in September, but no local source of
infection was found. Of the total cases, eight had been
immunised. The organism was of the gravis type, and was
extremely virulent. In some cases serious symptoms developed
within 24 hours from onset. Where more than four years had
elapsed, from th6 date of primary immunisation there was no
modification of illness. Four of the patients were adults,
twelve were between 10 and 16 years of age, five were aged 5 to
10 years, and one was under 5 years. The concentration of
attention on primary immunisation in infancy has led to a shift
of the incidence of infection to older age groups. Therefore
it is highly/important that immunity should be sustained by
reinforcing injections at regular intervals of not more than
four years throughout school life.
The case rate was 0.28 per 1000 of population, compared
with 0.28 per 1000 of population for England and Wales. There
was no death from Diphtheria.
DIPHTHERIA ANTITOXIN:- Early diagnosis and the early
administration of Diphtheria Antitoxin remain the greatest
safeguards against mortality. Diphtheria antitoxin should be
administered in large doses by medical practitioners on suspicion
of infection and while awaiting bacteriological confirmation of
the diagnosis. Otherwise, suspected cases should be admitted
to hospital for observation. Any delay in the administration of
antitoxin gives time for the fixation of the powerful toxin in
the heart and nervous system leading to protracted illness and
subsequent disability. Diphtheria antitoxin is available free
of cost for necessitous cases.
DIPHTHERIA IMMUNISATION:- Experience of artificial immunisation
has shown that primary immunisation is protective for a period of
from three to four years. Immediately following injection, a
high level of immunity is obtained, but this gradually declines,
and after four years may have reached such a low level as to be
insecure against infection. Reinforcing injections restore
immunity to a safe level. Primary immunisation should be
completed at the age of 1 year. Reinforcing injections must
always be given before entry to nursery schools at the age of
3 years, or to day schools at the age of 5 years. School
children should be reinforced by injection every four years.
Parents have responded well to the campaign for immunisation,
but there must be no relaxation. Each year over 1300 babies are
born within the Borough. The complete success of the campaign
depends on the primary immunisation of all these babies at or
before the age of 1 year, and their subsequent reinforcement
at regular.intervals. Carriers of infection are not increased
in number by immunisation, but they are not diminished in number.
The danger lurks in our midst, and immunisation is a barrier
protecting the individual and the community against epidemic
spread of the disease.
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