Diphtheria in S. PAULO (BRASIL)

Abstract

Diphtheria in S. Paulo after decreasing since 1898, remained about stationary these last years, its death rate oscillating hetween 6-9 for 100.000 inhabitants. In 1938 however it reached 4,49 for 100.000. The number of registered cases went from 40,04 for lOO.000 inhahitats in 1927 to 54,15 in 1934 and 75,52 in 1936; in 1937 and 1938 it fell from 57,42 to 41,29 which seems to show a slight improvement of the conditions. The death rate in 1923 was of 18,79 and of 10,87 in 1938. The number of carriers of virulent bacilli in the city is calculated at 1% or between 2.000 to 2. =500 individuais o =f school age. which play an important part in the preservation of the endemicity. The greatest incidence is in April, while the cleath rate is higher in May; the minimum of the curve is reached in Decemher for the incidence rate and in January for the mortality rate; thus the greatest incidence is not observed in the coldest months but rather in the autumn when the temperature goes down. The correlation coefficients calculated between cases and deaths with average monthly temperature and rains gave no significant results, while, perhaps, the relation between cases and rainfall which is equal to - 0,26 ± 0,08 may be said to show a very discreet negative correlation to which however, no great importance can be attached. In general the disease is a little more frequent in men than in women. The greatest incidence for both sexes was always in children less than 5 years old and especially frequent in children hetween 1 and 2 years old. Up to 5 years the incidence is greater for males, after that the contrary obtains. The same fact is noted in reference to the mortality rate, only the curve is inverted from 3 years on, when females are more affected. The fatality rate is greatest in the first year of life when it reached 35%, male infants being more affected than female babies; the proportion of deaths to the number of cases decreases progressively in suhsequent years. During the period observed there was registered contact with eliphtheria patients or suspected cases only in 12,52%. The greater number of patients was taken to the Isolation Hospital (90%) and among these the fatality rate was greater than among those treated at home, probably because of late entrance in the hospital or of including severer cases. Conditions, however, have now improved and from 1927 to 1937 the fatality rate in patients under hospital treatment fell from 20,3 % to 11,4 %. Only 2,1 % had suffered a previous attack of the disease, and the fatality rate was very low among them. After discussing some other characteristic features of this disease in S. Paulo the A. advises the intensification and better organization of prophylactic immunization by the use of diphtheria anatoxina, preferably toxoid-alumen, whích shoud be made compulsory for children.