widespread campaign using oral vaccine early in 1963. Approximately half of all children born receive the vaccine at Maternal & Child Health Centres and general campaigns are held in January and March each year in an attempt to fully immunize the remainder.
29. It will be seen from Figure 6 that there was a recrudescence of the disease in the latter part of 1964 which, although low by comparison to notifications in the years prior to 1963. gave rise to some concern. An intensive educational drive was undertaken in conjunction with the immunization campaign staged in the first quarter of 1965 with a reasonably satisfactory response and it is hoped that this response will be reflected in future epidemiological statistics.
30. Virological investigation of the disease is maintained on routine and year-round basis. Of the 37 cases reported during 1964, 18 were due to Type I virus, 17 due to Type III virus and the remaining two to Type II; only two of the cases notified had received two doses of triple vaccine. These findings, coupled with the results of previous surveys which had revealed that only two-thirds of those receiving vaccine showed a response to Type I vaccine, suggested two methods by which the incidence of the disease might be reduced even further. One of these methods was a variation in the composition of the vaccine between the relative proportions of the three types; the other, prompted by the very high rate of institutional births in Hong Kong, was the possibility of feeding Type I vaccine soon after birth. Both these possibilities were under investigation at the time of compiling this report.
Influenza
31. The notification of influenza is entirely voluntary and hence too great a significance cannot be placed upon the recorded incidence. Virological investigations of throat swabbings and throat washings are continued on a year-round basis and, although there was little change in notifications received for clinical disease, there was a marked rise in isolations of virus during the first quarter of 1965; para-influenza strains predominated in January but were superceded during February and March by strains which were antigenically similar to the A2/57 (A/Asian/57) strain.
Tetanus
32. This disease, although not notifiable, is recorded with reasonable accuracy owing to the severity of the symptoms in clinical cases. In
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past years, approximately half the cases reported were newborns whose birth had not been attended by trained personnel and who had been exposed to various hazards from unsterile materials, particularly the use of a powder containing raw ground ginger root as an umbilical styplic. It is encouraging to record that, in 1964, tetanus neonatorum was responsible for only one-third of the recorded cases of the disease and that the infantile mortality from such infection was 0.25 deaths per 1,000 live-births as compared with 0.42 deaths per 1,000 in 1963 and 1.4 deaths per 1,000 in 1950.
33. Developments in certain other communicable diseases are review- ed later in this report while the remainder showed little variation during 1964 and hence require na comment.
III. WORK OF THE HEALTH DIVISION
AREA HEALTH WORK
34. Much of the work of the area Health Officers, apart from their duties with the Urban Services Department in the maintenance of satis- Factory standards in environmental sanitation and food hygiene, has been recounted in the preceding paragraphs on Epidemiology. Such work included not only the field investigations into the major communicable diseases but also the co-ordination of the activities of teams of in- oculators participating in prophylactic immunization drives. Four such campaigns were staged during the year and reference has already been made to three, namely cholera, poliomyelitis and diphtheria. The fourth, promoting smallpox vaccination, was held soon after Chinese New Year in February. 1965, traditionally an auspicious time for receiving this immunization. The increasing importance of Hong Kong in international travel by sea and air and the prevalence of smallpox in nearby countries underline the need to maintain a high level of community protection against the disease.
TUBERCULOSIS
35. As stated previously, tuberculosis is the major health problem of Hong Kong, the estimated incidence of two per cent of adults with active disease being probably the highest in the world. The magnitude of the problem makes it impossible both physically and financially to
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