THE SMALLPOX PROBLEM

New Zealand Herald, Volume LXIX, Issue 21136, 19 March 1932, Page 12

THE SMALLPOX PROBLEM

AN UNVACCINATED PEOPLE.

RELIANCE ON HEALTH SERVICE. PRECAUTIONS AT PORTS. The smallpox outbreak at Vancouver, a port in direct steamer communication with Auckland, draws attention to a rather disquieting fact —that New Zealand has for all practical purposes a non-vaccinated population. The Dominion is not unique- in this. Most advanced countries to-day rely primarily for defence against disease upon the " thin red line" of health officers and inspectors at ports and on frontiers. There is a second line, namely, the internal health services, which track down casej that have gained an entry, vaccinate contacts and take other measures to surround" outbreaks and prevent them from spreading. Vaccination is becoming less and less a routine measure, and more and more an emergency - one. Health officials in nearly all countries would feel much moie comfortable if they knew that the populations under their care had been immunised as far as possible, but few, if any, are in that happy state, llie future, too, is not unclouded. Aeroplane travel and fast steamships make it increasingly easy for persons with the disease to travel from one country to another during the incubation period, and so pass undetected. Examination ol Ships. On the other hand, telegraphs and wireless make it easy to spread news of an outbreak on land or on ship, and there is a fairly general system for exchanging information between health authorities in different countries. That the Vancouver outbreak was not notified officially to New Zealand is a matter for surprise, and one that has probably been taken up already with the Canadian Government. Health officers at seaports fully realise their responsibility in searching for possible cases upon steamers arriving from ports where smallpox has broken out. The usual procedure is to examine everyone on board for spots upon the skin of the arms, face, neck and sometimes chest, and to note any other signs of illhealth. Temperatures' may also be taken. The master and surgeon of any vessel arriving from oversea are liable in most countries to heavy penalties for failing to disclose cases of illness within their knowledge, and in an emergency the port health officer is entitled to expect every assistance from the ship s surgeon. Passengers on Parole. A vessel which reaches a terminal port and is found to have actual or suspected cases of smajlpox on board is not dealt with in the same way to-day as it would have been 20 years or more ago. Then the ship and all on board were put into quarantine until all danger was considered to be past. Now the patients and immediate contacts are isolated, and the other passengers, after being vaccinated, are allowed to land and go to their destinations, under orders to report to specified doctors daily until the incubation period of a fortnight or so is over. This system involves an enormous amount of work, but its effectiveness has been proved on many occasions. New Zealand is fortunately placed in being remote from countries where smallpox is endemic, such as Asia and Eastern Europe. Advice of cases in Australia is readily obtained, but North America offers a certain amount of risk. The epidemic among Maoris in North Auckland and elsewhere in 1913 and 1914 was traced beyond doubt to a native Mormon missionary who had arrived from Vancouver. This man had contracted it from a fellow-passenger who had an attack so mild that it escaped notice. Otago Outbreak in 1920.

In this epidemic, it. was estimated, there were 1777 cases among Maoris and 111 among Europeans. The large majority were mild, but a few were acute. The disease was recognised as of a type found in North America. The epidemic was fought bv isolating contacts and carrying on a campaign of wholesale vaccination of natives and others in the affected districts. A check was also kept upon travelling, and over 12,000 passes for this purpose were issued. Onlv one outbreak has occurred since. In 1920 a case was detected at Gore, and inquiry disclosed that there, had been cases at Dunedin for' two months previously, the medical attendants believing them to be chicken-pox. Altogether, 90 cases were reported in Otago and Southland, and a small group of five cases at Ash burton. Only 18 out of 60 Otago cases had ever been vaccinated, and most of those inoculations dated back so far as to give little or no protection. The effect of' prompt vaccination was shown by the fact that only two contacts so treated developed the disease, and they probably were in the incubation stage when vaccinated. Aorangi in Quarantine. The Aorangi, on a voyage from Vancouver, was held up at Auckland in February, 1930, when a case of mild smallpox, or possibly chicken-pox, was discovered on board. The patient was a young woman passenger who had joined the vessel at Vancouver, and the symptoms were observed a day after leaving Suva. The ship was quarantined and fumigated, all board were vaccinated, and the patient and all the passengers for Auckland were landed on Motuihi Island. The. Aorangi was then allowed to sail for Sydney, where a rather similar process was gone through. Most of the passengers were allowed to leave the island in five days, but were required to report for a fortnight after. The patient, a " walking case," made a good recovery. Ample Supply cf Lymph. Vaccination under normal conditions has not been compulsory in New Zealand since 1921. Previously all infants were required to be vaccinated unless the parent or guardian had conscientious objections. The law was virtually a dead letter when repealed. A medical officer of health may still require a person who has been recently exposed to infection to be vaccinated or re-vaccinated, and the Minister of Health may require all persons in a given area, to be vaccinated if an outbreak has occurred, or threatens to occur there. The Health Department's laboratory in Wellington makes sufficient lymph for over 20,000 tubes annually, and maintains a large stock. Regular supplies of fresh lymph are sent to all parts of the Dominion and are available to doctors free of charge.