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responsibility according to age groups cannot but prejudice the success
of the scheme as a whole. Moreover, it should not be forgotten that
diphtheria immunisation is primarily a means of controlling infectious
disease, a function which is essentially one of the Sanitary Authority
and the Medical Officer of Health. He more than anyone is concerned
with the incidence of diphtheria in his district and should not be denied
the opportunity of wielding this powerful weapon.
For the last sixteen years the Medical Officer of Health has directed
diphtheria immunisation in this district with very gratifying results.
In addition to the staff of his Maternity and Child Welfare Service he
has had the willing co-operation of the School Medical Service and of the
head teachers, but he has provided the unremitting incentive which has
resulted in an immunisation rate of 76% for all children under the age
of 15 with the majority having had their immunity reinforced after an
interval of three to four years. As from July 5th next the County
Council, in conformity with the National Health Service Act, will
become solely responsible for diphtheria immunisation. It is encourage
ing to note that in their proposals for this scheme that Authority propose
to continue substantially the main principles on which this work has
been conducted so successfully up to the present and to use the services
of district medical officers of health for local control with the consent of
the local Sanitary Authorities.
The administrative arrangements in this district have been developed
in the light of lengthy experience. In respect of children under 5 years
of age they are substantially the methods advocated in Circular 145, but
more comprehensive. The greatest contribution to success lies in making
treatment readily accessible to mothers. To this end, special clinic
sessions necessitating a special journey for treatment have been discontinued
and treatment has been made available at all the infant
welfare and toddler clinics which are held on nine half days per week.
Under these arrangements 64% of children are immunised before entering
school at 5 years of age, and in 11(46 the number treated between the
age of 1 and 2 years was 67% of the children in that age group.
Twice a year a programme of immunisation sessions is carried out
in the infant and junior schools at which children not previously
immunised are treated, and those done more than three years previously
given a reinforcing dose. A complete card index register of all children
up to 15 years is available from the Maternity and Child Welfare and the
School Medical Service records, and the school lists are continually
revised at monthly intervals. By this procedure children up to the age
of 11 are covered and by that age they not only have received initial
treatment, but have mostly had two reinforcing doses. It is doubtful
whether any additional appreciable anti-genic response is obtainable
by further injection in the last years of school life though experience
may yet show this to be desirable.
The technique used is the two injection procedure of 0.5 cc. A.P.T.
for the primary course at one month's interval, with a dose of 0.2 cc.
A.P.T. for the reinforcing injections.
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