Læknablaðið - 01.06.1973, Page 40

12Ó
LÆKNABLAÐiÐ
diseases like typhoid and paratyphoid by
sanitary measures and the vaccines are
not major factors in protection against
them. We should be able to develop a
safer and more effective vaccine against
whooping cough since the present vaccines
are far less satisfactory than most others
in use. The most important addition to our
armament would be an effective vaccine
against influenza, especially if it were
possible to develop a vaccine effective
against the various strains of virus A as
well as against virus B. In spite of all
the effort that has been put into develop-
ing vaccines over 30 or more years, none
yet available gives reasonable assurance
of protection, and such benefit as can be
gained rcquires repeated, probably year-
ly, re-vaccination. Certainly effective vac-
cines such as those against diphtheria,
tetanus and poliomyelitis are still unused
for nearly a fifth of Britain’s children be-
cause of failure of health education to
convince parents of the need. Especially
we have failed to carry conviction about
measles vaccine and perhaps an antigen
which is less disturbing may be needed
before we can do so. We could eradicata
measles, but through most of this year
3.000 cases a week have been notified in
Britain, none of them necessary. Measles
like smallpox is a disease spread only by
humans suffering from the disease. We
could in theory eliminate these diseases
from the world and perhaps if we can
show it can be done with smallpox,
measles can follow. We have not attempt-
ed anything like this with rubella, mainly
because it is rubella in pregnancy we are
trying to prevent rather than to secure
elimination of the disease. Where there
are carrier states as in diphtheria or
poliomyelitis and the possibility of sub-
clinical or animal infection as in tuber-
culosis or the presence of the offending
bacteria in the environment as in tetanus
immunisation is likelv to have to continue.
But in tuberculosis there is a special case.
The control of tuberculosis, which we are
approaching, is being brought about not
by a vaceine but by improved control of
the infective state. Active antituberculous
drugs prevent patients with the disease
from infecting others if they are propérly
used. But in Britain there are still some
12,000 new cases a year, only a fifth cf
the numbers 20 years ago but still too
many. Even here you have still enough
to give you concern. Tubarculcus infection
still kills each year more than the rest
cf the acute specific infections put together
with the single exception of influenza. In
some years it kills more than influenza.
There will be a case for continuing to u.se
BCG so long as resistance is needed
against infection which can be contracted
and brought back from other countries,
but our problems are not exactly parallel
— we have for instance our immigrants —
and cur solutions may differ.
We should be asking ourselves whether
the immunising agents we now use are
as effective and as safe as they can be
and whether the combinations could be
improved so that fewer separate pro-
cedures are needed in their use. There is
certainly room for more active research
and there are problems about the immuno-
logical effects of repeated use of large
numbers of antigens about which we know
too little. Are there prospects of more
antigens for routine use? The obvious one
of the common cold is, to say the least of
it, unpromising. There are more than a
hundred viruses capable of producing that
particular syndrome and the prospect of
general immunisation against the respira-
tory viruses is not very encouraging. Some
of them are seriously damaging, as for
instance the respiratory syncitial viruses
in infancy. We might find some oppor-
tunity there or with some of the echo
viruses, but there is nothing to suggest it
yet. We may yet succeed with vaccines,
an antiviral drug or interferon against
some of them. There seems no earlv
prospect of this. It seems more likely that
preventive medicine will be increasingly
concerned with other fields than that of
the communicable bacterial and viral in-
fections, both in the management of the
human environment and in checking the
evoluticn of other and more chronic dis-
eases.
Primary prevention can also be the out-
come of early treatment of the infectious