The dramatic story of the development of vaccination and its blessing to humanity is quite generally known. Through a consistent program of health education, the confidence of the public in this procedure is becoming better established. The wide acceptance and use of immunization has reduced the incidence of infectious and contagious diseases so markedly that they appear more and more infrequently each year. This accomplishment in the reduction of the incidence of the disease has caused some of the present generation to question the necessity of continuing and extending the immunization program.
Why is a widespread program of immunization necessary for the health of the public? The answer in part is that each year science brings forth inventions which make possible more rapid and better transportation facilities. Although modern sanitation has done much to check the spread of sickness, diseases which are not controlled can be spread to larger numbers more rapidly than in the eighteenth century when Jenner did the first work on producing immunity in man.
Dr. William A. Howard, instructor of Pediatrics, Georgetown University, Washington, D. C., classifies immunization practices in three groups, as follows:
1. The "must be done" group.
a. Smallpox.
b. Diphtheria.
2. The "may be done" group.
a. Whooping cough.
b. Typhoid fever.
3. The "no" group.
a. Scarlet fever.
1. The "Must Be Done" Group—Smallpox
Vaccination against smallpox is considered one of the triumphs of modern medicine. It is the only known method of control for this disease, and a systematic application of this procedure would soon eliminate it from the list of human diseases. A program of routine vaccination requires persistence and continued vigilance in the execution of the plan, as sporadic cases will always appear among non-immunized persons.
Smallpox is readily transmitted. Individuals may be infected from secretions from the nose and the throat of persons who have the disease, and from particles which are thrown off by the skin.' Consequently, it is not necessary to come in contact with a person who has the disease in order to acquire it. These facts indicate why it is necessary to use the strictest precautions in isolating the patient, and disinfecting everything which comes in contact with the sickroom.
The incubation period of smallpox is eight to sixteen days. In some cases a person who has been exposed to smallpox can still be protected from the disease by immediate vaccination, but in all likelihood, vaccination at so late a date may serve only to abate the severity of the disease. The time necessary to acquire immunity is dependent on how rapid the individual reaction may be. Consequently, it is not wise to wait until exposed to the disease to be vaccinated.
Some communities have been successful in their attempt to reduce the incidence of smallpox by compulsory vaccination. Records show that during the period 1919 to 1928: ten States had compulsory vaccination, with an incidence of 6.6 cases per too,000 population; twenty-nine States had no vaccination laws, with an incidence of 66.7 cases per ioo,000 population; four States had laws prohibiting compulsory vaccination, with an incidence of 115.2 cases per 100,000 population.
Through the combined efforts of public-health workers and others interested in health, much is being accomplished in eradicating the disease. This is shown in the tabulations of reported cases in 47 States which give the following information concerning smallpox: (See PDF for Table)2
For the complete protection of the community against smallpox, all should avail themselves of the protection afforded through vaccination. There are still many who are nonimmunized, however. The committee on the costs of medical care and the United States Public Health Service conducted a study of illness in families in 130 localities in 18 States during 1928-1931. They pointed out:
"Considering the whole group, about 70 per cent gave a history of vaccination or case (an attack) at some time ; 65 per cent gave a history of vaccination, and 5 per cent gave a history of an attack. Only 10 to 20 percent of the children had been vaccinated before the age of school entrance : most of the vaccinations were done between 5 and to years of age, and 85 to 90 percent of adults had not been vaccinated within 7 vears.""
Great care is given to the preparation of vaccine used to produce immunization. It is prepared by passing the virus (the contagious matter of the disease) through healthy animals, which are certified to be free from disease and are maintained on a controlled diet and in a hygienic situation. The material is removed from the animals under sterile conditions, and is mixed with four times its weight of glycerin and water (glycerin, 50 percent, water, 49 percent, carbolic acid, 1 percent)!
After being passed through a fine sieve, this material is cultured to determine that it is free from all foreign organisms. Experimental vaccinations then occur under controlled conditions. These must show certain typical reactions in too per cent of the cases. After the vaccine has been released for professional use, it is tested every two weeks under controlled conditions during the period for which it is guaranteed. If the reaction is not typical, the entire supply is recalled at once.
No dressing whatever should be applied to the vaccination place. It is a cause of sore arms. If some moisture is produced after a few days, a piece of sterile gauze may be pinned to the inside of the sleeve, but nothing should be attached to the arm.'
A. M. Stimson, medical director, United States Public Health Service,' says, "It must be clearly recognized that a single vaccination in infancy does not guarantee full protection for life. In fact, statistics indicate that in about half of such persons, protection has become entirely lost at the age of twenty-one. Proper vaccination, therefore, means repeated vaccination, in infancy, on entering school, and at intervals during later life."
There is no such thing as a negative vaccination. A "negative" vaccination means that poor technique has been used or the serum was old. "When a person who is still immune is revaccinated, there will be no regular 'take'—only a small red spot which soon fades out, the 'immune reaction.' If the person is not still immune, a regular or modified 'take' will occur.'"
If good technique is used, complications resulting from vaccination are now comparatively rare. Suppuration is usually due to uncleanliness on the part of the operator during or after treatment. No dressing should be applied to the site of vaccination.
"A proper vaccination is defined as one in which the insertion is not over one-eighth inch in its greatest diameter, made by some method which does not remove or destroy the epidermis. Such insertions treated openly, i. e., without the use of shields or dressing strapped to the site, have never, in so far as we are aware, been followed by postvaccination tetanus. It seems probable that the adoption of these simple procedures of technique on the part of vaccinators, coupled with a proper warning to the vaccinated individual, or his parents or guardian, concerning the dangers of home-applied shields and dressings, would eliminate tetanus as a complication of vaccination."
In view of these facts, it would seem that the entire public would be eager to secure protection against smallpox. However, Doctors Ellis and Boynton, following an extensive study of vaccination, state :
"It cannot be denied that an attitude of resistance to vaccination against smallpox embraces a considerable portion of the population. This attitude does not appear to obtain to the same extent in regard to active immunization against diphtheria. In addition, organized effort, widespread in occurrence, is continually attempting to marshal active resistance against all immunization procedures. This appears to be more successful in arousing sentiment against smallpox vaccination than is the case with other immunizations."'
These observations should serve as a challenge to all who are interested in health to inform others of the safety of the procedure of vaccination, and to encourage them to avail themselves of its protection for the safeguarding of their own health as well as the health of other members of their family and those of the community.
______ To be continued.
References
1. Stimson, A. M., "The Communicable Diseases, P. 95. United States Government Printing Office, Miscellaneous Publication No. 30, Washington, D. C., 1939.
2. Public Health Reports, "The Notifiable Diseases —Prevalence in States," Supplement Number 105 (1931) and Number 163 (1939) United States Government Printing Office, Washington, D. C.
3. Collins, Selwyn D., "History and Frequency of Smallpox Vaccination and Cases in 9,000 Families," P. 34. United States Government Printing Office, Washington, D. C., 1936.
4. Smeeton, M. A, "Practical Microbiology," p. 244. Macmillan, New York City, 1939.
5. Stimson, A. M., "The Communicable Diseases," p. 96.
6. Id., p. 94.
7. Ibid.
8. Armstrong, Charles, "Tetanus Following Vaccination Against Smallpox and Its Prevention," p. 12, Reprint No. 1195, Public Health Reports, 1927.
8. Ellis, Ralph V., M. D., and Boynton. Ruth E., M. D., "Smallpox Vaccination : A Comparison of Vaccines and Techniques," p. 3, Reprint No. 2078, Public Health Reports, June 9, 1939.
