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15
group of hospitals, a circumstance which it was felt must afford
some explanation of her infection (This matter is referred to
later in the account of the outbreak)
Action taken at St Ann's Hospital
It was agreed that immediate responsibility for vaccination'
and other control measures at St Ann's Hospital should be undertaken
by one of us (G D McK ) who had arranged for the supply of
sufficient lymph to vaccinate the whole complement of the hospital
and the preparation of a list of all primary contacts on the staff
with their vaccinal history and that of the other patients on the
two wards in which MB had been nursed
There were 42 primary contacts among the staff and 31 patients
on the two wards, only six of the latter having previously been
vaccinated Permission to vaccinate these children was sought by
telegram and all but two were vaccinated within twelve hours - the
remaining two being vaccinated the following day when permission
was received
On discovering the inadequate vaccinal state of the children
nursed in the cubicles adjacent to M B, it was decided to give
them hyperimmune anti-variola gamma globulin, and accordingly
these 15 children each received 5 ml of this prophylactic All
42 primary contacts among the staff had been vaccinated at some
previous time, but in 9 there was no satisfactory proof of recent
successful vaccination, and each was therefore given 10 ml hyperimmune
gamma globulin, Our findings agree with the observation
of Kempe and his fellow-workers (Kempe, cH Berge, T 0 England,
B 1956 Ped XVIII 2,177) that the administration of hyperimmune
gamma globulin 24 hours after vaccination does not interfere with
the course of vaccination, for all 24 vaccinations were successful
Vaccination of the remaining hospital patients and staff (approx
1,000 persons) was started on the 29th June, and continued through
out the early part of the following week,, re vaccinations being
done where necessary
The hospital was closed for admissions and discharges on
Friday morning (28th June) and visiting was restricted to those
seriously ill During the week-end a zone of isolation was set
UP (on the "hospital within a hospital" principle) using one
previously empty ward which was made into living quarters and the
two wards where the patient MB had been nursed This area was
roped off and all 26 primary contacts among the resident staff of
the hospital were isolated within it Entrance was restricted to