Extent of Immunization and Case Histories for Diphtheria, Smallpox, Scarlet Fever, and Typhoid Fever in 200,000 Surveyed Families in 28 Large Cities

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Abstract
Diphtheria, smallpox, scarlet and typhoid fevers were selected for this study with respect to the extent of immunization and case history because active immunization against these infections has been available for a considerable period. The program of the armed forces of the U. S. required smallpox, typhoid, paratyphoid, and tetanus inoculations. A combination of anti-typhoid-paratyphoid vaccine and tetanus toxoid (T.A.B.T.) was being used in large quantities for the immunization of factory workers. The findings of the present survey are here recorded by geographic section, family income, and nativity and color of the family head. The survey covered by house-to-house canvass a total of 213,931 families in 28 cities of 100,000 population or more, located in 19 States. A comparison of certain characteristics of the surveyed population with census data indicates that it is fairly representative of the population. Immunizations against scarlet and typhoid fever are negligible in frequency as compared with those against diphtheria and smallpox. There is considerable geographic variation in the extent of immunization against these diseases. These 28 large cities were divided into 5 geographic groups, Northeast, North Central, Intermediate, South, and West. In diphtheria immunizations the West is lowest from birth through 7 years but beyond that age the South is lowest. In smallpox vaccinations the Northeast, Intermediate, and South all get above 90% by about 8 yrs. of age, but the North Central and particularly the West are low. In history of smallpox cases the West is above any other section. In scarlet fever immunizations the West and North Central are far above the other sections. In scarlet fever cases the North Central and Intermediate are at the top. In typhoid immunizations the South is far above any other section, with the West second. The percentages of native, foreign, and colored children of specific ages who have been immunized against diphtheria are approximately the same and have the same geographic variation. The only index of economic status available was the income of the family during the year preceding the canvass. In the preschool ages the percentages of children who had been immunized against diphtheria and smallpox increase definitely with income. Scarlet and typhoid fever immunizations increase with income in each of the 3 age groups under 15 years, indicating that these immunizations are largely the result of individual initiative rather than public programs.