THE MASS BCG VACCINATION CAMPAIGN IN JAMAICA*? (October 1951-June 1953) 1. THE CAMPAIGN WHO scholarship to Ecuador for training with the “International Tuberculosis Cam- 1. The Joinf Agreement between WHO, paign” BCG vaccination teams in that UNICEF and the Govemment of Jamaica country. In September 1951 they, in turn, for a Mas-s BCG Caynpaign trained four junior medical officers and eight Early in 1951 it mas agreed between repre- nurses in Jamaica. At the onset of the sentatives of the Jamaican Government, programme, Dr. Knut Osvik, WHO Regional the World Health Organization and the BCG adviser, was present during one month United Nations Children’s Fund (UNICEF) to instruct and advise the local personnel. that a tuberculin testing and BCG vaccina- The chief of the campaign was Dr. J. 1. tion campa@ should be started in Jamaica Rerrie, Chief of Tuberculosis Division, during 1951. An agreement was reached Island Medical Department, Jamaica. Cam- concerning details about the objectives of paign organizer was Dr. R. G. Lampart, the project, the organization, method and Jamaica. extent, the training of personnel and the Four teams, each consisting of one as- proposed commitments of WHO, UNICEF sistant medical officer and two nurses plus and the Government of Jamaica. a chauffeur, were working during the whole The campaign was expected to cover the campaign. During June 1952 two of the whole island and to last for at least two doctors working as team leaders were re- years. The population LO be examined was placed by the two senior nurses who were hmited to persons O-20 years of age in the trained in Ecuador and two new nurses were urban areas and O-30 years of age in the appointed. The personnel in the central rural areas. The field work was planned to BCG Office in Kingston were one supply be done by four teams, each consisting of officer, one statistician, two clerks, a chauf- one doctor, two nurses and one driver. feur and a messenger. The Office consisted It was estimated that about 600,000 of three rooms plus a store room. persons would thus be examined in the A team consisting of one doctor and two campaign. Name-lists of the positive tuber- nurses arrived in November 1951 from culin reactors should be made for the local Trinidad for two months’ training in BCG health authorities’ use in their case-finding work. A similar team from Paraguay arrived programmes. one month later for a short visit. 2. Training, Personnel and O$îce 3. Equipment In February 1951, Dr. R. G. Lampart All the equipment: 6 Willys station wag- and two nurses, Miss P. Manahan and Miss ons, vaccination kits, propaganda material, V. Skeffery, mere sent on a three months etc., was supplied by UNICEF and arrived in July 1951 in good condition. The tuber- * Campa@ carried out under the joint auspices of the Government of Jamaica, World Health culin and vaccine were paid for by UKICEF Organization and the United Nations Children’s and sent weekly by air-freight from Mexico Fund. This report-mas prepared under the direc- City to Kingston. Yc tion of Dr. J. 1. Rerrie, Tuberculosis Officer, ’ Jamaica, with the assistance of Mr. Truls Zeiner- 4. Propaganda and Planning Hendriksen, Statistician, World Health Organisa- tion. During September and October 1951 t Manuscript received in July, 1956. extensive propaganda was carried out 61 62 BOLETIN DE LA OFICINA SANITARIA PANAMERICANA through press and radio and public meetings. tested even though they were over 30 years Before the campaign teams were scheduled of age. Refusal to test such persons was diffi- to arrive in a district, meetings were held cult and perhaps unnecessary. Accordingly, with local doctors, health workers, sc&hool- almost everyone up t’o about 50 years of age teachers and other authorities, pamphlets who carne to the vaccination centres was distributed and propaganda films with accept’ed. It was derided not to test or popular lectures shown for the public. The vaccinate babies under one year of age in schools were visited, and sites were selected the campaign, because of t,he often difficult as vaccination centres. Before and during working ronditions for at,tending new-borns the examinations, loud-speaker propaganda in the field. was made from the team cars. This proved Name-lists of positive reactors were pre- to be very effective, and good contact was pared for the lora1 health authorities. obtained with the public. Table 1 shows the progress of the cam- paign in terms of the number of persons 5. Progress of Worlc tested and the number vaccinated each The vaccination teams generally worked month from October 1951 through June together in the same district and covered 1953. one entire parish before proceeding to another. 6. Tuberculin Testing and BCG Vaccination The campaign started in Kingston on 22 B single 5 T‘C’ intradermal tuberculin test October 1951, with vaccination in schools was used throughout the rampaign. This and later in some offices and factories. The meant that people only had to be seen twice: four teams continued to work in Kingston once to be given the test and a second time and St. Andrew parish through November, three days later to have the reaction read December and January. The next parishes and to be vaccinated, if considered “nega- to be covered were St. Thomas and Portland tive”. With few except’ions the tuberculin in the eastern part of the island. In April tests were given on Mondays, Tuesdays and 1952 the campaign proceeded to the parish Wednesdays; the reactions were read and of St. Mary. During May, June and July the “negatives” were vaccinated on Thurs- the parishes of St. Mary, St. Ann and days, Fridays and Saturdays. Trelawny, al1 on the north coast, were Tuberculin for the campaign was the covered. St. James and Hanover in the purified protein derivative (PPD) identified north-western part of the island were cov- as RT XX11 from the State Serum Institute, ered in September; Westmoreland and St. Copenhagen. Stock solutions sent from Elizabeth in the south-western part of the Copenhagen were diluted at the Laboratorio island in November and December. In del BCG in Mexico City, and the ready-to- January 1953, the campaign had reached use dilutions were forwarded weekly (as a Manchester and proceeded to Clarendon, rule), by air, in 100 CC. bottles packed in where vaccination was done until May. The specially const,ructed ice-containers. The parish of St. Catherine was also finished tuberculin test’ mas given by intradermal during May. In June some additional injection of approximately 0.1 CC. of the 5 vaccination was done in Kingston, and one TU dilution into t,he dorsal aspect of the team was sent to the island of Grand Cay- left forearm. man where vaccination was done until the Reactions with indurations measuring 6 end of June 1953. mm. or more in transverse diameter were The age-range considered in the campaign considered “positive”, those with indura- was changed from what had been set out in tions of 5 mm. or less were considered the agreement. It was found difficult to hold “negative”. Only persons with “negative” the oldest age limit, as adults coming to reactions were offered BCG vaccination. the centres with their children wanted to be The time interval between injecting the July 195?] BCG VACCINATION IN JAMAICA 63 TABLE I.-Number of. .persons tuberculin-tested and vaccinated with BCG during October 1951-June 1953, by month. - - - Number with test read Month and year Number I l Number given test - vaccinated Total Positive Negative -- -- _- October 1951 15,971 15,279 6,007 9,272 9,190 November 1951.. 54,237 50,138 25,427 24,711 24,681 December 1951 : : 39,242 37,817 22,462 15,355 15,330 January 1952.. 28,767 26 >852 14,163 12,689 12,655 February 1952.. <l 31,688 29,570 12,625 16,945 16,937 March 1952.. 26 >388 23,663 8,900 14,763 14,710 April 1952.. : : 21,187 19 >570 6,344 13,226 13,213 May 1952, 27,246 24,989 9,347 15,642 15,618 June 1952. 30,426 27,344 8,062 19,282 19,262 July 1952.. : : : : 39,798 36,184 11,232 24,952 24,925 August 1952.. 28,041 26,614 11,645 14,969 14,940 September 1952 30,257 28,190 8,951 19,239 19,211 October1952.. -1” . 39,431 36,308 13,548 22,760 22,737 November 1952.. 26,898 24,635 7,747 16,888 16,788 December 1952 20,050 18,404 5,268 13,136 12,545 January 1953.. : : : 33,177 30,757 11,262 19,495 19,482 February 1953.. 39,788 36,000 12,116 23,884 23,867 March 1953. 50,264 46,061 19,956 26,105 25,728 April 1953.. 24 >038 21,639 10,707 10,932 10,928 May 1953. 22,273 20,384 8,611 11,773 11,740 June 1953. 6,254 5,616 2,560 3,056 3,056 -- _- _- Total 635,421 586,014 236,940 349,074 347,543* - * In addition to this 117 persons were vaccinated without previous testing. tuberculin and reading the reaction was tuberculin testing programmes were carried usually three days, in a few cases two or out: the first from 2 June to ll July 1952, four days. The vaccination was made by the second from 8 September to 15 October injecting approximately 0.1 CC. of BCG 1953. Under the supervision of WHO per- vaccine intradermally into the deltoid region sonnel, both programmes were done in of the left shoulder.