The diphtheria immunization clinic

Abstract

The Schick Test, given an accurate and constant technique with some degree of practice in interpretation of results, gives a reliable indication of the state of immunity or susceptibility of persons in relation to diphtheria.It is possible, moreover, to create in the susceptible that state of immunity which is found to exist naturally in others.The reliability of the Test is proved by the results obtained in lowering the incidence of diphtheria in institutions, fever hospitals, and various closed and semi-closed communities in this country and in America.An immunization clinic may be held in special clinic premises or in a school classroom or welfare centre. Where schools are c oncerned, little upset of the daily routine need occur. Shrewd staffing of such a clinic is advisable and records must be accurately made and filed, and general clerical work reduced to a minimum. The more clerical work the doctor and nurse have to do, the less time will be available for treatment and the greater will be the cost of this treatment in consequence. Efficient co- operation between the staff of the clinic and the district health visitors goes a long way towards completion of the injection course.The Schick Test should be dispensed with in children under the age of five years.Toxoid anti-toxin mixture is a reliable product and rarely gives rise to untoward reactions. These may be either general, local, or general and local, but seldom lead to discomfort, and are transient. They are less frequent than with Toxin anti-toxin, and less severe. While, moreover, it may be a weaker antigen than Formol toxoid, and necessitates the giving of three injections as compared with one or two of Alum-precipitated toxoid, time taken in acquiring immunity is of no particular importance, the chief consideration being certainty of protection with a minimum of upset. In my series 0.6 per cent of injections gave rise to reactions, the majority occurring after the first injection and in older children.The first step to be taken towards the success of any immunization scheme is the gaining of the support of Head Teachers. Once this is obtained, lectures, film demonstrations, posters and even broadcasting may be employed. General practitioners and nurses, thereafter, can do more perhaps than they realise in encouraging those who may rely upon their advice from day to day in regard to medical matters.Statistics show that immunization leads to a marked reduction in incidence among inoculated as compared with unprotected children, and while it is possible through immunization to decrease the incidence-rate very considerably, and even to reduce the death-rate, it is the inclusion of the pre-school child in any scheme which is the really important factor in this reduction.The cost of immunization is about one- ninetieth of the cost of treatment in hospital.While there is a theoretical risk of increase in the virulent carrier-rate following upon immunization within a community, this, in practice, is not of necessity true.