Diphtheria and Poliomyelitis

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Specific Treatment

Antitoxin. Once a case of diphtheria is suspected and a throat swab sent for bacterio-logical examination, diphtheria antitoxin serum should be injected intramuscularly immediately without even awaiting the bacteriologist's report because delay increases the spread of the toxin. Only the tissues unaffected by the toxin are able to utilise the serum to counteract the poison. Modern antitoxic serum is much purer than the earlier forms and it is now very rare to find patients showing allergic reactions to the serum.

The essential features of serum treatment consist in the injection into some convenient part of the body, such as the back, arm, thigh, or abdominal wall, of doses of anti-toxin proportionate to the age of the patient, the severity of the disease, and the time elapsed since the onset of the symptoms. The dosage varies with all these conditions. The repetition of the dose depends on the amount of improvement in the membrane.

Immunisation. For preventive treatment or immunisation, diphtheria antitoxin and diphtheria vaccine are both used. When a case of diphtheria has been confirmed in a community such as a school or hospital ward it is advisable to give all contacts passive immunisation which has short-term effective-ness and also active immunisation which is long-lasting. Antitoxin gives immediate aid to tissues threatened by the diphtheritic toxin but it gradually passes out of the body. Diphtheria vaccine on the other hand stimulates the tissues to produce their own antitoxin and it remains effective for about five years, repelling any invasions of the Corynebacteriurn diphtheria. Three injections are necessary to secure an adequate production of antitoxin.

In children, booster doses are given five years later, and often repeated after another five years. A small number of children and adults may show an allergic reaction to the horse serum in the vaccine at the first injection and further injections are not given.

To test whether or not a person is immune to diphtheria a Schick Test is made before vaccination. The Test Toxin is injected into the skin of the forearm: if a red flush appears at the injection site the person is susceptible to the disease and should be vaccinated. Schick Tests are made on children over the age of eight; younger children should all be immunised.

To prevent an unnecessary number of injections in young children, mixed vaccines are sometimes preferred for immunising. Diphtheria and Pertussis Vaccine; Diphtheria and Tetanus Vaccine; and Diphtheria, Tetanus and Pertussis Vaccine are all avail-able through the National Health Service.

Antibiotics. Benzylpenicillin assists anti-toxin treatment because it helps to kill the diphtheria micro-organisms and will also eliminate other organisms lurking in the nose and throat which might give rise to secondary diseases such as tonsillitis. Erythromycin has been used when the patient cannot be given penicillin.

Carriers of diphtheria infection must be isolated and any septic focus of the mouth or throat treated. Sulphonamides and penicillin are used for this purpose.

Poliomyelitis

Prevention. Children in contact with a case must be kept away from school and other crowded gatherings for three weeks, and should be under medical supervision, the temperature being taken morning and evening. It is not advisable to close boarding schools when an outbreak has occurred, but all contacts of a case should have their temperatures taken, and be carefully watched for the three weeks. Discharges from the nose and throat must be carefully collected on paper handkerchiefs and promptly burnt, and the urine and stools should be disinfected.

Adult contacts may continue their occupation provided it does not entail mixing with children. They should, however, avoid social activities for three weeks from the date of the last contact, and should carefully avoid playing with children, or kissing them. A person who has recovered from the disease should as far as possible avoid contact with children for three months after the date of apparent recovery.

Vaccomes. The advent of vaccines in the 1950's and their widespread use to prevent the spread of the crippling effects of poliomyelitis has vastly reduced the number of cases in most parts of the world.

The common vaccine in use today is one which is simple to use. Three drops are put on a piece of sugar and swallowed. This makes it an easy procedure for children. The first dose of the vaccine is given between the ages of three and six months, the second six months later, and a third six months after that. These three doses make up the immunisation programme but further booster doses come later. The first booster comes at school entry age of five years, and a further one about the time of leaving school, age fifteen to nineteen.

The vaccine is made from living polio-myelitis viruses which have been so attenuated or weakened that in the blood of the person taking the vaccine an antibody reaction to repel the viruses is set up instead of their succumbing to the full disease. n

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Diphtheria

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