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Diphtheria Immunisation
Although one can feel satisfaction at the continued freedom from this
infection, the fact that it is becoming increasingly difficult to maintain the
original high level of immunisation in the child population, gives grounds
for some uneasiness as to how long we can expect this immunity to continue.
Outbreaks, limited in extent it is true, do occur from time to time in different
parts of the country and only by keeping a satisfactorily high proportion
of the population effectively immunised, can we hope to escape any return
of this dangerous infection.
By arrangement with the District Councils, the scheme is directed
locally on behalf of the County Council who are the responsible authority
by the District Medical Officers of Health. The aim of the scheme is to
secure primary immunisation before the age of one year and to reinforce
the protection by further booster injections at not more than five year
intervals since the Ministry of Health's "immunity index" is calculated on
the percentage immunised within the previous five years. The actual
practice in Carshalton has for many years been to secure reinforcement at
intervals of not more than three years which increases the margin of safety.
There is an increasing tendency to give primary immunisation in the
first six months of life. This arises from the desirability of combining it
with whooping cough immunisation which the advocates of early treatment
believe should be done before six months to prevent the mortality from
whooping cough, which is high in the first year of life. It is, however,
doubtful whether a public programme of diphtheria immunisation based
on this practice is likely to be as effective as the long established one of
giving the primary treatment towards the end of the frrst year of life. There is
reason to believe that the immunity against diphtheria conferred by immunisation
before six months of age, needs reinforcement in a matter of eighteen
months to two years and experience shows that it is exceedingly difficult
to secure reinforcement on any adequate scale at this age, since it involves
an effort on the part of parents in bringing children to a clinic for the
purpose. The practice in operation for a long time past secured the first
reinforcement in effect when the child was five years old after it had entered
school, when most parents were quite willing for it to be done. This established
timing of the primary treatment and spacing of booster doses has
shown itself to give adequate protection and should not be discarded unless
it can be replaced by another which can be as readily applied on the scale
necessary for a public scheme and sure of equal success. There is moreover,
no reason why the incidence of whooping cough under one year of age should
not fall if the main reservoir of infection in the children over that age is
eliminated by immunisation, just as it did in the case of diphtheria when
immunisation was given at about the age of one year.
During 1955, 624 resident children received a primary course of
treatment as follows :
46