Recent Reverses in Immunisation

DIPHTHERIA immunisation has been criticised recently on two counts. First, as one type of trauma to muscle which may influence the site of paralysis in persons incubating poliomyelitis; and second, on its failure to restrict epidemic spread of the gravis strain of diphtheria bacillus. Evidence of an association between the site of a previous inoculation and the site of paralysis in poliomyelitis is contained in reports from Melbourne (McCloskey), and London (Geffen), and in the statistical survey of certain areas in England by Hill and Knowelden. These reports state that children inoculated within four weeks prior to the onset of poliomyelitis have developed paralysis of the arms more often than non-inoculated children. This finding has not been confirmed in Cardiff or in Belfast. A report of the 1950 epidemic in Belfast, in which the nein-inoculated children show an unusually high proportion of arm paralysis, has been publishe(d in the British Medicat Joutrnal. Geffen, in London, calculates the risk of association, site of paralysis with site of inoculation, using the combined diphtheria-pertussis antigen to be 1 in 1,800 inoculations, while, in Belfast, using a pure diphtheria toxoid (P.T.A.P.), we failed to find any such association in 6,250 inoculations. This difference may be due to the use of different antigens. The responsibility of advising the cessation of immunisation during an epidemic of poliomyelitis is a heavy one, and should rest on the Medical Officer of Health of the affected area. Ihis was pointed out by the Ministry of Health in England during the 1950 epidemic. Certainly the Medical Officer of Health should be in a position to assess the relative risk of diphtheria in the non-immunised and arm paralysis in the recently immunised. There is no shadow of doubt that the former is by far the greater risk in Belfast. A recent M.R.C. report describes outbreaks of diphtheria, mainly of the gravis type, in Dundee and on Tyneside, in which immunisation failed to prevent epidemic spread. It is emphasised that deaths did not occur in immunised children. A similar report comes from Amsterdam (Ruys and Noordam). The M.R.C. report states neither the number or percentage of children immunised nor the relative incidence of diphtheria in immunised and non-immunised children, but the point is made that large numbers of immunised children contracted diphtheria. Most people will not be surprised at this result, when they note that in many of the cases in which …