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In all, 2,864 cases were notified during the epidemic, of which, 1,713 were in children
under the age of five, 1,100 in children between 5 and 15, and 51 in people over 15. A summary
of the figures of the outbreak is appended.
It will be noticed from this summary that the attack rate in children under five is more
than three times as high as that of children over five Eleven deaths occurred in children
under five, as compared with three in children over five, none of these affecting children of 3 and 4
attending school. Considering the extent of the epidemic, these numbers are remarkably low,
as will be evident from the 31 deaths which occurred in the 1934 outbreak. In the 1,508 children
under five attending school, 400 cases occurred, giving an attack rate of 305 per thousand. In the
2..344 children aged 3 and 4, not attending school, 489 cases occurred, giving an attack rate of
208 per thousand.
It is a little difficult to assess the significance of this difference in the attack rates in
two groups of children of similar environment, one group of which attend school, the ather
remaining at home. There is no doubt that some of the children remaining at home will be the
eldest in the family and, therefore, will not come into contact with school children either at
home or in the school. No estimate of the number of children to whom this applies has been
formulated, but, on the whole, it seems reasonable to assume that a difference of one hundred
per thousand in the attack rate is partly accounted for by the increased risk of school contact
with the disease.
Although no deaths from measles occurred amongst children aged 3 to 4 attending school,
the seriousness of the disease in children under five warrants further investigations of the effect of
school attendance on the incidence of the disease in this group. 1 have no doubt of the wisdom,
from the personal and from the public health point of view, of postponing measles wherever
possible, until after the age of five years.
Confirmatory evidence on the lines of the Fulham figures would to my mind, justify a
revision of the London County Council scheme of control in so far as children under five are
affected. Definite proof of increased risk of infection would warrant the exclusion of all children
under five during epidemic periods.
All population figures quoted in the various age groups, with the exception of the figures
of children under five attending school, which were supplied direct by the London County Council's
Education Officer, are taken on the 1931 Census. They are not, therefore, literally accurate
for 1930, but completely accurate figures are not available, and the effect on the rates quoted,
which adjustment would produce, would not, in any case, be significant.