24 hours, except in two cases where the strains of vibrio proved to be resistant to streptomycin. In these two cases oral chloramphenicol in full therapeutic doses given over five days rendered the bowel free of vibrio cholerae.
101. Unfortunately, owing to pressure of work in the laboratory during the early stages, rectal swabs were taken from the chloram. phenicol group at only 48 hours interval. Therefore, the time factor for clearing the bowel was not comparable in the two groups and the only provisional conclusion is that streptomycin in the way given may be more rapidly effective provided that there is no true resistance factor arising.
102. Although antibiotics do not seem to have a place in the treat- ment of the clinical condition they do appear to have, under appro- priate control, a very definite place in the management of the contact carrier state. This aspect requires intensive investigation as it offers a method of control of the contacts of clinical cases under conditions where isolation is not possible or practicable and short term therapy with an oral antibiotic could be used on a community basis.
Inoculation Campaign
103. The response to the call for inoculation with cholera vaccine was unexpected and almost overwhelming. There was a stock of 840,000 c.c.'s of cholera vaccine, prepared locally in the Government Institute of Pathology, in hand during the first week of August. This was suffi- cient to inoculate some 1,200,000 persons giving one dose of 1 c.c. of 8,000 million organisms to adults with appropriate reductions for children between the ages of one and twelve years. This was expected to meet all demands until such time as fresh supplies were coming forward from the Institute at an expected rate of over 100,000 c.c.'s each day from the 18th August onwards. In the event, over one million inoculations were given between the 14th and the 19th of August and there had to be a temporary conservation of the remaining supplies over the week-end of 19th and 20th August. Due to the generous and quick response from many countries to an appeal for additional cholera vaccine, full scale inoculation was resumed on the 21st: by the 28th of August some 75% of the total population of the Colony had been inoculated. This was achieved by closing down many of the routine clinic and health activities and turning over the staff and premises to inoculation duties. The hospital services were not curtailed in any way during the outbreak.
Environmental Measures
104. On the environmental side, the whole of the Health Inspectorate and other supporting staff of the Urban Services Department was con- centrated on food inspections, markets and food hawkers control, the chlorination of wells, the control of fly breeding and the disinfection of premises.
Assessment
105. In retrospect, the sporadic occurrence of cases and their dis- tribution throughout the Colony indicated a very wide spread of cholera vibrios throughout the community. There is accordingly a number of factors to be taken into account in assessing the epidemiology of this outbreak. The first is that the people of Hong Kong have many close family links with Kwangtung Province and they were disturbed by the accounts reaching them of an epidemic of cholera in Kwangtung Province. Next, the older people had seen cholera in the past and know what could happen. The development, since the War, of health educa- tion in general and immunization techniques in particular has engen- dered a community sense of the benefits of inoculation, of early treat- ment of disease and of the environmental measures necessary during an epidemic emergency. Accordingly, when Hong Kong became infected. there was no concealment of cases and patients with symptoms of cholera were brought immediately for treatment to the nearest clinic or hospital. There was no opposition to the isolation of contacts or to the other environmental measures applied. Possibly the most sur- prising feature, judging by the past, was the demand for inoculation and a special tribute is due to the patience and good humour of the people in the long queues at the inoculation centres as they waited in the rain and the humid heal for their turn to come,
106. It was accordingly possible to apply fully the basic principles of the early isolation and treatment of clinical cases, the strict quarantine of contacts, the treatment of carriers, the immunization of the com- munity at risk and the necessary environmental measures to deal with potential sources and vehicles of infection.
107. The behaviour of the El Tor cholera vibrios in other countries affected during the past two years has demonstrated all the hall marks of cholera as a formidable epidemic disease. Undoubtedly, the problem in a predominantly urban area with all facilities available is an entirely different one to that presented by cholera in scattered rural communities, Nevertheless. the infecting agent was community wide in Hong Kong
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