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

.'The Health Bulletin May, 1951reaches approximately the same pointIn childi-en immunized early in infancyas in those immunized later.Reactions have not been found to beserious if care is taken to inject thematerial intramuscularly and to changethe needle after the syringe has beenfilled. Should a serious febrile reactionoccur, it is recormnended that the subsequentdose be reduced to O.lc.c. andthe patient's response again observed.At a meeting of State Epidemiologistsin Atlanta in April 1951, Dr. MyronWegman of the Louisiana State UniversityMedical School recommended aschedule of three doses of the alumprecipitated triple antigen at two, three,and four months with booster doses atone and six years.The use of tetanus toxoid routinely inInfant immunization is of special significancein relation to Civil Defense.A proposal has been made that tetanusImmunization of adults be included inthe nation-wide plans now being formulated.Some have felt that this procedureshould be delayed vmtil productionof the material to be usedcould be increased adequately to meetthe huge demand and imtil certainother more urgent civil defense needscould be met. In view of this situation,it appears to be a practical procedureto begin immediately the use of combinedalum precipitated diphtheria andtetanus toxoids with pertussis vaccinewhere this is not already the case, inorder that the infant popiilation nowundergoing immunization would notneed to be reinjected except for boosterdoses. This recommendation includesthe use of an alum precipitated tripleantigen containing not less than 30billion pertussis bacilli per c.c. and atotal minimum dose of at least 45bUlion.There is a considerable weight ofopinion that administration of tetanvistoxoid is important as a routine peacetimeprocedure because of the fact thatthe prophylactic use of antitoxin inhorse serum can be eliminated in mostcases that have been so inununized.In a child who has previously receivedtetanus toxoid and who has received aslight to moderately severe injury requiringtetanus prophylaxis. Miller recormnendsa booster dose of Ic.c. offluid toxoid. This preparation is advisedin lieu of alum precipitated toxoidsince it acts as a more promptstimulus of the patient's immunity. Insevere injuries such as compoimd fracturesor gross contamination of wounds,tetanus antitoxin is recommended byMiller at the same time as the toxoid.When early combined immunizationagainst diphtheria, tetanus and pertussisis carried out, there is adequatetime in the immunization schedule inwhich to administer smallpox vaccinebefore the age of one year. This resultsin fewer reactions and the child is lessapt to scratch the site of the vaccination.Six or seven months is a satisfactoryage.Early immimization has one otherpractical advantage from the publichealth standpoint, namely, that a higherpercentage of yoimg infants reach wellbabyclinics and physicians' offices thando children of an older age.Typhoid immunization is no longerrecommended by public health authoritiesfor routine vise on a mass scale.In rural areas where typhoid fever stillocciirs, selected groups of the populationshould be immunized. It is alsoessential that all persons in contactwith a known carrier or persons whoanticipate exposure to vmsanitary conditionsreceive typhoid immimization.Rocky Mountain spotted fever vaccineis recommended for immunizingpersons who are routinely exposed towooded areas. Present incidence of thisdisease does not justify the administrationof the vaccine to the entire population.An outline summary of the aboverecommendations is as follows:Recommended ImmimizationSchedule1 month—Examination and conferencewith mother.2 months—Conference. First injectionof alum precipitated diphtheria andtetanus toxoids with pertussis vac-