title: Active Immunization-Some Present-Day Problems: (Section of Therapeutics and Pharmacology).
abstract: Diphtheria.-Immunization is safe and effective. Compulsory measures are indicated, especially for the younger age-groups. The Schick test may be reserved for selected groups and to control modified methods. Proper spacing of doses of prophylactics and periodic reinoculation will ensure a high level of immunity. It is important to beware of "one-shot" methods. Indiscriminate swabbing is to be discouraged; high carrier rates are an indication for widespread diphtheria prophylaxis.Enteric fever.-Mass immunization is desirable in many areas, although there is no justification for compulsion except for people exposed to special risks. In deciding upon dosage of vaccine, more attention should be paid to physical state and body-weight. After the primary course, very small periodic doses (for example o.i.c.c) are worthy of trial. Vaccine can be given during an epidemic without increasing the chances of infection.Tetanus.-Two doses of toxoid spaced by six weeks give useful immunity. Women give significantly higher titres than men. A third dose of i.o.c.c. after a long interval-seven to nine months-often produces a dramatic rise in circulating antitoxin, and counteracts any tendency to waning immunity.Smallpox.-As vaccination has not been made compulsory in this country, infection by virulent strains from the continent may tax the resources of the public health services.Whooping-cough.-The large number of injections of vaccine usually recommended is a deterrent to mass immunization. Research into the possibility of fewer doses and wider spacing is indicated.Other diseases are considered briefly.Combined immunization.-It may be useful to combine diphtheria T.A.F. and tetanus toxoid, also tetanus toxoid and T.A.B. vaccine. T.A.F. plus T.A.B. is probably contra-indicated for adults on account of severe reactions. Diphtheria A.P.T. should not be mixed with tetanus toxoid as it may go into solution and become ineffective.Sterilization of syringes and needles.-An intensive inoculation campaign is no excuse for slip-shod methods.