asked the Minister for Health if he will state, in respect of each of the years ended 30th September, 1940 to 1947, inclusive: (a) the number of cases of infantile paralysis; and (b) the number of deaths attributable to the disease.
Ceisteanna—Questions. Oral Answers. - Infantile Paralysis.
The statistics in regard to mortality are not available in respect of the periods mentioned by the Deputy but are compiled in respect of calendar years. The incidence and mortality figures in respect of the calendar years 1940 to 1946 are accordingly shown in a tabular statement which, subject to the concurrence of the Ceann Comhairle, will be circulated with the Official Report. The number of cases notified this year up to the 30th September last is also shown. Mortality statistics for that period are not yet complete.
TABLE
|
Year |
Number of Cases |
Number of Deaths Attributable |
|
1940 |
10 |
12* |
|
1941 |
86 |
20 |
|
1942 |
361 |
75 |
|
1943 |
126 |
58 |
|
1944 |
43 |
12 |
|
1945 |
81 |
16 |
|
1946 |
189 |
30 |
|
1947 |
216 |
|
|
(Up to 30th September) |
*The discrepancy as between the number of notifications and the number of deaths in the year 1940 may be attributed to the fact that the figures for deaths includes cases notified in the previous year.
asked the Minister for Health if he will state what steps his Department are taking to prevent the spread of infantile paralysis, and if he will make a statement on the matter.
As the reply to this question is somewhat lengthy, I propose, subject to your concurrence, a Chinn Comhairle, to circulate it with the Official Report.
The following is the reply:—
Acute Anterior Poliomyelitis.
Before outlining the steps taken by my Department to prevent the spread of acute anterior poliomyelitis, I would like to review briefly the incidence of the disease in this country. Acute anterior poliomyelitis or infantile paralysis has been endemic here in a mild way probably since the turn of the century. Our worst experience was in 1942, when we had 361 cases. The yearly incidence fluctuates widely. In 1944, only 43 cases occurred. In 1946, the total number of cases was 189 and this year the number of cases notified up to the 30th September last is 216. The incidence of the disease has so far this year been relatively lighter here than in neighbouring countries. It is not, however, possible to predict with epidemiological certainty how many cases we are likely to have within the next few months, since in Ireland small outbreaks of the disease have occurred at unexpected periods and the disease is not so much related to the seasons as elsewhere.
Acute anterior poliomyelitis, which is caused by a virus, spreads with great rapidity. The virus is found in the nose and throat and in the intestine, and while it is probably transmitted from such original sources, it may be said that despite 40 years of active research, it is still uncertain how the virus is spread from patient to patient. Further, it is held by many, that the virus, at any rate during an epidemic period, is ubiquitous and there is little possibility of controlling or limiting the spread of the disease. Therefore, until recently, little has been possible in the way of practical measures of control.
In poliomyelitis, as in the prevention of infectious diseases generally, the practical steps to be taken in individual cases are primarily matters for the professional judgement of the medical officers concerned, but responsibility for general policy, in controlling the spread of infectious disease, rests with the central health authority.
In pursuance of this responsibility and as a result of the 1942 outbreak, a memorandum was prepared in the Department of Local Government and Public Health on acute anterior poliomyelitis, setting out clinical particulars of the disease, particularly with reference to early diagnosis. This was circulated to chief medical officers of local authorities, who were urged in the event of a case or a suspected case of the disease occurring in their area:—
(a) to arrange for the immediate isolation of the patient;
(b) to adopt all reasonable sanitary or other precautions appropriate to prevent an extension of the infection, having regard to the possibility of transmission of the disease by persons who are apparently healthy or only mildly affected;
(c) to make full investigation of the associated circumstances, including a search for any "missed" cases and to report fully thereon to the Department;
(d) medical officers were also advised to adopt suitable publicity measures should it become necessary to acquaint the public of possible precautions;
(e) arrangements were made for the follow-up and treatment of patients by orthopædic specialists and physiotherapists (some patients are still receiving continuous specialist treatment since 1942 for after-effects of the disease, under this arrangement).
In September, 1945, as a result of investigations carried out by my Department, additional measures necessary to constitute a scheme to prevent the spread of the disease were recommended to the chief medical officers of local authorities. These were based on the possibility of limiting the transmission of the virus from infected persons and contacts and were framed particularly to prevent the possibility of spread from intestinal sources.
The scheme of control now adopted by my Department and which has been outlined to local authorities from time to time in official circulars consists of:—
(1) immediate isolation of cases in hospital with thorough disinfection of their homes, etc;
(2) quarantine of family contacts for a week and partial quarantine for two weeks thereafter;
(3) information to doctors and the public in the area affected so that all cases of pyrexial illness might be seen at once;
(4) exclusion from schools and other public places of the children of the area;
(5) propaganda by local Press and leaflets, with follow-up by public health personnel, advising (a) care in the handling of food especially in its protection from fly contamination, (b) the boiling of milk and (c) frequent careful washing of the hands in running water especially after visiting the lavatory and particularly by those handling and preparing foods;
(6) in districts where a piped supply is not available, water used for all domestic purpose to be boiled;
(7) treatment of fæces with disinfectants (in rural districts fæces to be covered with fresh earth to prevent access by flies);
(8) destruction as far as possible of flies in the area with D.D.T.;
(9) notification of all cases by wire or telephone and submission of a special report of each case to my Department.
In August, 1946, attention was further directed to the receipt of worn clothing in parcels from abroad and the precautions to be adopted before use. In December, 1946, the attention of chief medical officers of local authorities was drawn to the necessity for strict compliance with the quarantine regulations and the observance of the precautionary measures generally. Particular stress was laid on the necessity of deferring operations for the removal of tonsils and adenoids in such areas where the disease appeared.
Again in August, 1947, local authorities were advised by circular to make arrangements for the employment of physiotherapists in local hospitals so that patients might have continuous treatment from the onset of the disease. Further, they were empowered to employ orthopædic specialists to advise on such treatment so that any shortage of beds in orthopædic hospitals need not prejudice the recovery of sufferers from the disease. For this purpose orthopædic specialists are visiting centres all over the country consulting and advising the local medical officers on the care of cases. The officers and the resources of the central health department are always available to assist local authorities in the event of any outbreak which would be beyond their powers to deal with. An analytical study of the recent epidemiological features of the condition is at present being carried out in the Department.
I have outlined generally the control measures which we have organised against this disease and would assert that the scheme recommended by the Department compares very favourably in its comprehensive nature with the control measures which are in force in other countries. I would, however, point out that in the present state of knowledge of the nature and spread of the disease there is no guarantee that the scheme has prevented the disease or will protect the community against it. Nevertheless, I feel that the recent low incidence of acute anterior poliomyelitis in this country has been related to the active application of these precautions which have now been energetically pursued for nearly two years by our public health officers.