Epidemiological Observations in the Halifax Epidemic

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Abstract
The epidemiological observations made during the epidemic which occurred in Halifax in the winter of 1940-1941 when a simultaneous outbreak of gravis diphtheria, scarlet fever, and meningo-coccus meningitis occurred are reported. The common factors underlying this general increase in the prevalence of respiratory diseases were in large part the result of the impact of war on civilian life. Crowding and the rapid overturn of susceptibles in a population are the inevitable results of mobilization and increased industrial activity. Sharp epidemics of other respiratory diseases, notably influenza and measles occurred in the late fall and early winter. The influenza was mild and not followed to any extent by post-influenzal pneumonias and deaths. The diphtheria was the most interesting in that it is the first recorded extensive outbreak due to the gravis strains in America. Studies of the diphtheria outbreak are given in detail. The epidemic started in the Norwegian merchant marine and spread rapidly among the civilians in the water-front area. Cases in the services appeared first chiefly in the Royal Canadian Navy personnel, whose contacts would be greatest along the waterfront. As with the civilians, there was a decline over the period of the Christmas holidays, followed by an increased incidence in Jan. It appeared that in the later stages the epidemic was maintained by the soldiers, sailors, and aviators and their wives or sweethearts. The control measures included Schick surveys, isolation of carriers and establishment of clinics for active immunization against diphtheria. This was carried out with fluid toxoid, 3 doses at 3-week intervals, followed by a repeat Schick test in 3 months. The necessity for decent housing in defense areas and the need for applying to civilian populations and to troops all the effective methods in our knowledge for the specific prevention of disease are emphasized and a recommendation is made that every soldier and sailor be Schick tested and immunized if found to be susceptible.