The Health bulletin [serial] - University of North Carolina at Chapel Hill

December, 1951The Health Bulletinformerly, and to the use of the triplecombined antigen containing diphtheriaand tetanus toxoids and pertussis vaccine.The Immunization policy publishedin the May 1951 issue of the HealthBulletin is based on this trend.A recently observed and unexpected,practical advantage of an immunizationschedule early in the first year oflife is that it probably minimizes therisk of local paralysis from concurrentpoliomyelitis. The incidence of this diseasein the age group under six monthsis extremely low.Adult immunization should be limitedto revaccination against smallpox atintervals of five to ten years, the typhoidfever only in endemic areas andamong persons exposed to known carriers,and to Rocky Mountain spottedfever for individuals working in thewoods or hunting frequently.For the present time, it is much betterpublic health practice to decreasethe time spent on ts^ihoid immunizationand increase the time spent ondiphtheria, pertussis, and tetanus immunizationsof children, and smallpoxvaccination of children and adults. Ifand when conditions deteriorate to acritical level, tsTJhoid immunization canbe begun on a mass scale and continuedas long as necessary.Renewed emphasis at this time ondiphtheria immunization would be a"mvist" in this state imder normal conditionsand is even more urgent as partof civil defense preparation. The suddenincrease of 123 per cent that wehad in 1945 as compared to 1944 wasaccompanied by only a 21 per cent increasefor the nation. The North Carolinadiphtheria rate in 1949 was 13.7cases per 100,000 population as comparedto the national rate of 5.4, orabout 2^/^ cases for us to 1 for theUnited States as a whole. In 1950 theNorth Carolina rate dropped onlyslightly to 12.3 while the national ratedropped to 3.9, or slightly over 3 casesfor us to 1 for the coiuitry. This stateranked tenth in size in the nation in1950, but our total of 503 diphtheriacases was exceeded only by Texas with900 cases. Alabama was third with 319cases. If we do nothing else in thepublic health civil defense program, wemust get busy on this diphtheria problem!Tuberculosis and the venereal diseasesare two of the most important reservoirsof infection in the populationwhich must be reduced as rapidly aspossible during the remaining period ofgrace before a possible disaster opensthe gates for a return of these diseasesto their former levels.The most important possibility remainingfor strengthening our venerealdisease control program is the developmentof cooperation with private practitionersso as to make possible contactinterviews of their patients. A NorthCarolina physician reported last yearthan an interview of one of his privates3T)hilis patients led to a series of infectedcontacts who, in turn, were interviewedwith the result that therewere located the following previouslyuntreated infections: 2 primary sj^Dhilis,5 secondary s3T)hilis, 4 chancroid, 4lymphogranuloma venereum, and 3gonorrhea. Every health departmentshould also continue to give high priorityto contact interviews of all clinicpatients. Every person infected with avenereal disease is a source of valuableepidemiological information. We shouldact upon this information with thesame urgency as we woiild evidence regardinga saboteur in our midst.As one additional method of takingevery advantage of all sources of informationregarding infected persons,it is recommended that all health departmentsreview all their existingvenereal disease clinic records as soonas possible and recall all persons needingfurther follow-up before final discharge.The tuberculosis control program canbe greatly improved in efficiency by ourtaking advantage of the informationobtained in Halifax County by Dr.Yoimg relative to the pin-pointing ofpopulation groups for x-ray surveys andthrough the experience gained from theDuke Hospital mass x-ray survey.By careful use of epidemiologicaldata, Dr. Young increased the discovery