H—3l

their children at home and the school during the early weeks of the outbreak recorded a very considerably reduced attendance. The nominal school roll is 289, of whom some 80 come in daily from country areas outside the town. These country children normally bring their own lunches to school ; no single case of typhoid occurred among them. Prophylactic Inoculation The question of mass inoculation inevitably came up for consideration. In view of the fact that there could be little doubt as to the origin of the epidemic even at an early stage and that satisfactory measures had already been taken to obviate any further possibility of an infection from this source, it was decided that no real case existed for such a measure. The pros and cons of the case for mass immunization is well set out in the following extract from " Control of Common Fevers " (1942), p. 233 : The question remains whether prophylactic vaccination has any part to play in the control of an actual outbreak of the disease (enteric). If the vehicle of infection—water, milk, or food —has been found and stopped, it seems clear that vaccination would be too late to protect those in the incubation stage and unnecessary for those who have escaped infection. Household contacts of known cases will be in the same position, with a few exceptions. Contacts of people who are still in the incubation stage obviously cannot be known beforehand and will ordinarily form so small a proportion of the total population in the affected district that mass immunization of that population, so as to include them, would rarely be justified. An outbreak continuing without discoverable source is not likely to arise in this country ; it would, however, be equivalent to a state of high endemic incidence of enteric fever and might similarly require mass immunization as a protection pending the removal of the sanitary defects responsible. If the foregoing propositions be accepted, the only justification for immunization is continued exposure to infection. The only persons coming into this category were the nursing and domestic staff' of the hospital. It was therefore recommended that those already on duty and liable to infection be immunized in batches as quickly as possible and that the emergency voluntary staff be given prophylactic inoculations before taking up duty. Value of T.A.B. Inoculations Only two persons developed typhoid who had been inoculated. One was a member of the R.N.Z.A.F., the other a nurse at the hospital. Case 74 was inoculated on the sth and 12th September and became ill on the 10th November. This case was one of only three that ended fatally. He was admitted to hospital on the day of onset and on this score should have had an excellent chance of recovery. The other two fatal cases were admitted later in the disease, case 5 on the twenty-sixth day after onset and case 13 on the fourteenth day. Both were much older men than case 74 and only succumbed after a long struggle, death taking place on the fifty-first and fifty-fifth day of sickness respectively, whereas case 74 died on the twenty-third day of illness. Case 77 was inoculated on 4th and 11th November and became sick on 21st November. It is probable that she became infected prior to the second immunizing dose and therefore before the fullest immunity that the vaccine was capable of conferring had been developed. Conditions fob Discharge from Hospital The hospital authorities were requested to adhere to the period of isolation and criteria for discharge set out in the Health (Infectious and Notifiable Diseases) Regulations 1948 (4), which, though at the time not in force, were available in draft form. All but one —that is, 77 of the 78 cases —-have been discharged as non-infectious. The remaining case has so far failed to obtain the necessary clearance and is still in hospital. He states that this is the second time he has had typhoid, the first occasion being while he was on active service during the Boer War.

106