The Municipal Maternal and Child Health Clinics at Kuala Lumpur were faced with a declining but continuing problem of diphtheria. The arrangements for immunization were such that a low coverage was obtained for triple vaccination, but a high one for smallpox, a disease they had not experienced for many years. By reversing the schedule, so that triple vaccine injections were administered first, and ensuring that fewer children were not immunized because of concurrent minor ailments, the diphtheria immunization coverage was greatly improved. There was some loss of smallpox cover.
The revision commenced in 1970 and the diphtheria incidence rate, which had been falling since 1965, continued to fall but at a lower rate. The author does not discuss possible explanations for this. The article illustrates a dramatic improvement in immunization cover by a simple re-arrangement better suited to the needs of the town
1. Observations made on groups of light and dark skinned individuals indicate that the percentage of dark skinned people who can be recognized as immune by their reaction to vaccination is considerably lower than in the case of people with a lesser skin pigmentation.
2. It is suggested that the reading of "immune reaction" is influenced considerably by the intensity of skin pigment found in the individual.
3. It would appear that while the usefulness of immune reaction readings in light-skinned peope is very great, its value is limited when applied to those with dark skins.