S.I. No. 127/1942 - The Vaccination Regulations, 1942.

STATUTORY RULES AND ORDERS. 1942. No. 127.

THE VACCINATION REGULATIONS, 1942.

DEPARTMENT OF LOCAL GOVERNMENT AND PUBLIC HEALTH.

The Minister for Local Government and Public Health in exercise of the powers vested in him by the Vaccination (Ireland) Acts, as defined in and as applied and adapted by section 87 of the Local Government Act, 1941 , and of all other powers in this behalf enabling him, does hereby make the following regulations, that is to say :—

1. These Regulations may be cited as the Vaccination Regulations, 1942.

2. These Regulations shall come into operation on the commencement of section 87 of the Local Government Act, 1941 .

3. In these Regulations—

the expression " the Minister " means the Minister for Local Government and Public Health ; and the expression " the vaccination authority " means an urban sanitary authority or rural sanitary authority, as the case may require.

4. The duties in relation to vaccination of a medical officer of health of a dispensary district shall be as follows, that is to say :—

(1) To attend at such convenient place within each vaccination district in his dispensary district as may be approved of by the vaccination authority at such times as may be fixed or approved of by such authority for the purpose of vaccinating all persons who may come to him, or whom he may be requested to vaccinate, being fit subjects for vaccination ; and to do and perform all such other acts and things as may be necessary for the purpose of causing such vaccination to be successfully terminated.

(2) To observe in the performance of vaccination the instructions as to vaccination set forth in the Second Schedule to these Regulations.

(3) To keep and duly enter up a register, in the Form No. 1 in the First Schedule to these Regulations, of all cases of successful vaccination performed by him ; and to submit the same to the vaccination authority as and when required ; provided however, that in any case where the medical officer of health of the dispensary district is also the registrar of births and deaths for the district, it shall not be necessary for him to insert in the said vaccination register any cases which he may have duly entered in the register of vaccination which he is required to keep in pursuance of section 7 of the Vaccination (Ireland) Act, 1863.

(4) To make the report, which he is required by section 3 of the Vaccination Act of 1858 to make to the vaccination authority of all persons successfully vaccinated by him, not less frequently than once in each half-year, in the Form No. 2 in the First Schedule to these Regulations.

(5) To keep the vaccination register open at all reasonable times to inspection by any member or authorised officer of the vaccination authority.

(6) To give to any person making application therefor a copy certified under his hand of any entry or entries in the vaccination register, which is not, or are not, required to be made in the register of vaccination which he is required to keep in pursuance of section 7 of the Vaccination (Ireland) Act, 1863, on payment of the fee of two shillings for each certificate, which shall include a fee for any search made by him.

(7) To forward to the vaccination authority on the 31st day of March, 30th day of June, 30th day of September, and 31st day of December, in each year, a report in the Form No. 3 in the First Schedule to these Regulations, of the names of all children, not previously reported by him to the vaccination authority, registered as born in the district, who are over three months of age and who do not appear to have been vaccinated and of any such children who have been so reported and are subsequently successfully vaccinated by him.

(8) To furnish a report to the Minister in such form and at such times as the Minister may prescribe on the performance of vaccination in his district.

5. A medical officer of health shall not re-vaccinate a person applying for the purpose save where :—

(1) the marks of the primary vaccination are not, in the opinion of the medical officer, sufficiently numerous, distinct, and typical to afford the necessary protection against small-pox ; or

(2) the person, although well vaccinated primarily, has attained the age of ten years, or, if there be an immediate danger of small-pox, the age of seven years ; or

(3) the person has not before been successfully re-vaccinated ; or

(4) there are no circumstances present which would render the operation undesirable.

Given under the Official Seal of the Minister for Local Government and Public Health this Twenty Second day of May, One Thousand Nine Hundred and Forty-two.

(Signed) SEAN MacENTEE.

Minister for Local Government

and Public Health.

FIRST SCHEDULE.

FORM NO. 1

VACCINATION REGISTER

............................................................ (1)

............................................................ Dispensary District

REGISTER OF CASES OF SUCCESSFUL VACCINATION AND RE-VACCINATION.

(1)Insert name of sanitary district.

FORM NO. 2.

REPORT OF THE MEDICAL OFFICER OF HEALTH IN PURSUANCE OF SECTION 3 OF THE VACCINATION (IRELAND) ACT, 1858, OF THE NUMBER OF PERSONS SUCCESSFULLY VACCINATED BY HIM.

To the........................................(1)

................................................Dispensary District

I hereby certify that as medical officer of health of the above-mentioned Dispensary District I have, between the dates........................................ and........................................duly and successfully vaccinated..............................persons.

(Signature) ........................................

Medical Officer of Health.

Date...................., 19......

FORM NO. 3.

To the........................................(1)

........................................Dispensary District

VACCINATION OF CHILDREN.

Report of medical officer of health for quarter ended......................... day of........................................19......

PART I.

Report of all children, not previously reported to the vaccination authority born in the above Dispensary District, who are over three months of age, and who do not appear to have been vaccinated.

Number of children reported in return for preceding quarter..............................

NOTE.—In any case in which the medical officer of health may be aware of the reason why the child has not been vaccinated, he should state it in the column for observations ; and in any case in which a certificate has been given that the child is not in a fit state for vaccination, or is insusceptible of the vaccine disease, the fact should be stated.

(1) Insert name of vaccination authority

PART II.

Report of all children born in the above Dispensary District and entered in previous returns as not having been vaccinated, who have been successfully vaccinated during the quarter.

(Signed........................................

Medical Officer of Health.

Date..............................

(1) Insert name of vaccination authority.

SECOND SCHEDULE.

INSTRUCTIONS AS TO VACCINATION.

(1) In all ordinary cases of primary vaccination the vaccinator must aim at producing not less than two and not more than four separate vesicles, not less than three-quarters of an inch from one another. The area of each vesicle should not be less than a quarter of an inch square.

(2) Except so far as any immediate danger of smallpox may require, the vaccinator should vaccinate only subjects who are in good health. As regards infants, he should ascertain that there is not any febrile state ; nor any irritation of the bowels ; nor any unhealthy state of skin ; especially no chafing or eczema behind the ears, or in the groin ; or elsewhere in folds of skin. He should not, except of necessity, vaccinate in cases where there has been recent exposure to the infection of measles, chickenpox or scarlatina, nor when erysipelas or any other streptococcal infection is prevailing in or about the place of residence.

(3) The vaccinator must keep in good condition the lancets or other instruments which he uses for vaccinating, and he must not use them for any other purposes whatever. When he vaccinates he must cleanse and sterilize the instruments after one operation before proceeding to another.

(4) All vaccinations should be performed with vaccine lymph supplied by the Vaccine Branch of the Department of Local Government and Public Health

(5) Each requisition to the Vaccine Branch for vaccine lymph should be limited to the quantity estimated as being required by the vaccinator within a period of seven days.

A requisition for the supply of vaccine lymph, as a standing order, at regular intervals will not be accepted by the Vaccine Branch.

(6) On receiving the supply of vaccine lymph the tubes should, until required for actual use, be stored by the vaccinator in a cool, dark place, such as the iron safe provided for the registration records, or the tubes should be placed in a room or apartment without a fire and protected from any appreciable changes of temperature. The supply should be used within seven days of its receipt, and any tubes remaining over for a longer period than a week should not be used for vaccinations, but instead should be returned to the Vaccine Branch.

(7) The vaccine lymph should never carried about by the vaccinator in his pocket, as even the heat of the body is injurious to the active properties of lymph.

(8) When once the vaccinator has unsealed a tube of vaccine lymph he must never attempt to keep any part of its contents for the purpose of vaccination on a future occasion. The contents of one tube of lymph should not be used on more than one child.

(9) Under no circumstances should the mouth be applied directly to the tube in which the vaccine lymph is contained for the purpose of expelling the lymph. An artificial blower (to be had from the contractor for medical supplies) should be used for this purpose. The lymph may be blown out of the capillary tube on to a clean lancet or directly on to the infant's arm.

(10) Vaccination should at every stage be carried out with aseptic precautions. These should include :—1st—the washing of operator's hands ; 2nd—the cleansing of the surface of the skin before vaccination, by washing it well with plain soap and sterilized water, afterwards rubbing the part with absorbent cotton steeped in rectified or methylated spirit, and then drying it with a piece of clean absorbent cotton or sterilized towel—a germicide should not be used ; and care should be taken in making the incision or scratches not to draw blood ; 3rd—carefully washing the tubes with sterilized water before opening them to obtain vaccine ; 4th—the use of sterilized instruments ; 5th—the protection of the vaccinated surface against extraneous infection by applying an aseptic pad after the performance of the operation, which pad should be kept in position until the eight ; and 6th—by washing the vesicles with sterilized water, on inspection of the results, and then dusting them with boric powder and applying an aseptic vaccination pad, which should be removed in four days, and the part dusted with boric powder until the crusts fall off.

Advice as to the precautions to be taken in this respect until the crusts have fallen off and the arm has healed should always be given to the person having the custody of the child.

(11) The vaccinator should scrupulously observe in his inspection every sign which may test the efficiency and purity of the vaccine lymph. He should note any case wherein the vaccine vesicle is unduly hastened or otherwise irregular in its developments, or wherein any undue local irritation arises ; and if similar results ensue in other cases vaccinated with the same lymph he should desist at once fom employing it.

(12) If vaccination with vaccine lymph fails, the infant should be vaccinated with vaccine lymph taken from a fresh supply. In the event of a second failure, the facts should be reported to the Department of Local Government and Public Health.

(13) Should a few tubes from any individual supply of lymph prove inert or otherwise defective the vaccinator should forthwith discontinue the use of that supply and report the facts to the Director of the Vaccine Branch, sending him back the unused tubes.

(14) The vaccinator should keep a careful record of his vaccination, and the source of the vaccine lymph used. The results form respecting each supply of lymph should be filled up and returned by the vaccinator within three weeks to the Director of the Vaccine Branch. Results forms should not be used for ordering supplies of lymph.

(15) Application for supplies of the vaccine lymph should be made direct to the Director of the Vaccine Branch and should state the number of infants and adults to be vaccinated, and the name of the dispensary district ; supplies will be furnished whenever required, and a medical officer should, therefore, keep as small a quantity as possible in stock.

Note.—Letters to the Vaccine Branch should be addresses as follows :—

THE DIRECTOR,

Vaccine Branch,

Department of Local Government and Public Health,

University of College,

Earlsfort Terrace,

Dublin.

MEMORANDUM IN RELATION TO THE VACCINATION ACTS.

VACCINATION AUTHORITY.

(i) By virtue of section 87 of the Local Government Act, 1941 , which applies and adapts the enactments therein refered to as the Vaccination Acts, the vaccination authority is the sanitary authority of each sanitary district, that is, as respects each county or other borough, the corporation of the borough ; as repects each county health district, the county council of the county in which the county health district is situate ; and as respects an urban county district, the urban district council. The vaccination officer is the medical officer of health of a dispensary district.

ENACTMENTS RELATING TO VACCINATION.

Vaccination Acts.

The enactments relating to vaccination comprise the following :—

Vaccination (Ireland) Act, 1858,

Vaccination (Ireland) Act, 1863,

Vaccination (Amendment) (Ireland) Act, 1868,

Vaccination (Amendment) (Ireland) Act, 1879,

Section 147 of the Public Health (Ireland) Act, 1878, and

Section 87 of the Local Government Act, 1941 .

The principal provisions of these enactments are as follows :—

Vaccination districts and attendance of medical officers of health.

(ii) Division of dispensary districts into districts, and duty of medical officers of health.

( a ) The vaccination authority shall divide each dispensary district into vaccination districts, and shall require the medical officer of health of the district to attend at some convenient place within each vaccination district at certain specified times to vaccinate all persons who may come to him for that purpose, and who are fit subjects for vaccination. (Section 1 of Act of 1858).

NOTE.—With regard to the particular periods of the year for attendance at the vaccination stations it is important that they should be fixed by the vaccination authority (after consultation with the medical officer of health if necessary), that they should be at intervals of not more than three months, and that they should be duly notified to the public.

Medical Officers of health to report number of persons successfully vaccinated or re-vaccinated.

( b ) The medical officer of health is to make a report to the vaccination authority from time to time of the numbers of persons successfully vaccinated or re-vaccinated by him in each year, to be made in such form and contain such particulars as the Minister for Local Government and Public Health shall direct, and to be recorded by the vaccination authority of their minutes (Section 3 of Act of 1858 and section 6 of Act 1879).

Children to be vaccinated within three months after birth.

(iii) Compulsory Vaccination.

( a ) The parent or guardian of every child born after the 15th August, 1879, or the person having the care and nurture of such child is bound within three months or as soon afterwards as may be practicable, to take the child to the dispensary for vaccination, unless it shall have been previously vaccinated by some duly qualified medical practitioner, and the vaccination duly certified. (Section 3 of Act of 1879).

Inspection after vaccination

( b ) On the same day of the week following the day on which the child has been vaccinated, the child shall be again taken to the medical officer of health by whom the operation has been performed, in order that he may ascertain by inspection the result of the operation. (Section 4 of Act of 1879).

Penalty for neglect.

( c ) A penalty not exceeding 20s. for neglecting to take a child to be vaccinated or to be inspected after vaccination is imposed by section 7 of the Act of 1879.

(iv) Certificates.

Certificate of successful vaccination to be given to parents or guardians and duplicate to be transmitted to registrar.

( a ) A certificate of successful vaccination in a prescribed form is to be delivered by the medical officer of health (or practitioner), who shall have performed the operation, to the father or the mother of the child, or to the person having the care or custody of the child. A duplicate of this certificate is to be transmitted by the medical officer of health (or practitioner) :—

(1) to the registrar of births and deaths of the district within which the birth was registered;

(2) but if after due inquiry such district is not known to the medical officer of health (or practitioner), or if the birth of the child has not been registered, the duplicate is to be transmitted to the registrar of the district in which the operation was performed. (Section 5 of Act of 1879).

Penalty

A penalty of 20s. is imposed by section 8 of the Act of 1879 on the medical officer of health or practitioner who fails to the perform this duty.

NOTE 1.—If the medical officer of health of any dispensary district is also the registrar of births and deaths of that district, it shall be sufficient for him to sign one certificate to be delivered to the father or mother or other person as aforesaid and to register the fact of such vaccination in the manner provided by section 7 of the Act of 1863.

Same cases not to be entered in register prescribed by Vaccination Acts and that prescribed by Vaccination Regulations 1942.

Note 2.—When a medical officer of health of a district is also the registrar of births and deaths of such district, it is his duty when he vaccinates a person whose birth has been registered in another district to forward a certificate of successful vaccination to the registrar of the district in which the birth was registered, and it will be necessary for him to enter the case in the vaccination register, Form No. 1 which he is required to keep by Article 4(3) Vaccination Regulations, 1942, instead of entering it in the vaccination register which is prescribed by section 7 of the Act of 1863.

Certificate of unfitness for vaccination.

( b ) If a medical officer of health or practitioner is of opinion that any child is not in a fit and proper state to be successfully vaccinated he may deliver a certificate to that effect, in a form prescribed, to the father or mother or the person having the care or custody of such child. This certificate is to remain in force for two months, andfresh certificates to the same effect may be given if necessary (Section 4 of Act of 1863).

Certificate of insusceptibility of vaccine disease.

( c ) If any medical practitioner is of opinion that any child who has been vaccinated by him is insusceptible of the vaccine disease, he shall deliver to the father or mother or person having the care of such child a certificate to that effect in a prescribed form. (Section 6 of Act of 1863).

Register of successful vaccination to be kept.

(v) Duties of Registrar of Births and Deaths.

( a ) He is to keep a register of cases of successful vaccination (Section 7 of Act of 1863), the certificates of which have been transmitted to him by any medical practitioner. (Section 5 of act of 1879).

The penalty for omitting to registrar vaccination is 20s. (Section 10 of Act of 1863).

Notice to parent and others of the requirements of vaccination.

( b ) He is to give notice of the requirements of vaccination in a prescribed form to the father or mother or person having the care of a child who has not been certified to him as been vaccinated within three months after the birth thereof.

(Section 8 of Act of 1863 ; Section 3 of Act of 1879).

NOTE.—In prosecution of defaulters it will not be necessary to prove that the notice was received by the defendant. (Section 9 of Act of 1879).

Transmission to medical officers of health of list of births and deaths.

( c ) Every registrar for any place who is not the medical officer of health of the district is to transmit once at least in every month to each medical officer of health whose district is wholly or partially comprised in such place a return of all births and of all deaths of infants under 12 months of age, which have since the date of the last return been registered by such registrar as having occured in the district of the medical officer of health to whom the return is sent. (Section 11 of Act of 1879).

NOTE.—Medical officers of health who are not registrars of births and deaths will thus be enabled to make out the quarter return of vaccination defaulters (Form No. 3) to the vaccination authority.

Rate of payment for successful cases of vaccination.

(vi) Miscellaneous provisions.

( a ) The medical officer of health is entitled to be paid two shillings for every person successfully vaccinated or re-vaccinated by him within his dispensary district, provided he has made the required report to the vaccination authority. (Section of Act of 1879).

Direction of proceedings by vaccination authority ; and remuneration of medical officers of health for attendance thereat.

( b ) The vaccination authority shall direct proceedings to be instituted for the purpose of enforcing obedience to the provisions of the Vaccination Acts of 1858 to 1879. The medical officer of health of any dispensary district who may be required by the vaccination authority to attend such proceedings, shall be entitled to receive, in addition to his actual expenses, such sum, not exceeding one guinea for each day's attendance required and given, as the Court shall certify ; these expenses, and all other expenses incurred in the prosecution, which the court is of opinion should be allowed, are to be ascertained and certified by the District Justice. (Section 10 of Act of 1879).

( c ) A registrar or person appointed by the vaccination authority to enforce the enactments relating to vaccination may on summons to the father, mother or person having charge of the child apply to the District Court for an order directing the vaccination of any unvaccinated child under the age of fourteen years.

The penalty for failure to comply with the order is 20s. (Section 147 of the Public Health (Ireland) Act, 1878).)

( d ) The practice of inoculation with small-pox virus (or the attempt to incoulate with such virus) is made punishable by six months' imprisonment. (Section 4 of Act of 1868).

TEACHERS OF VACCINATION.

The authorised teachers of vaccination in Eire whose certificates of proficiency will be accepted by the MInister for Local Government and Public Health are :—

(1) Dr. Colman Mansfield Saunders, 17 Fitzwilliam Square, Dublin.

(2) Professor J. M. O'Donovan, 26 Wellington Road, Cork.

(3) Dr. Joseph MacHale, 11, The Crescent, Galway.

The requirement in regard to proficiency in vaccination applies to temporary as well as permanent medical officers of health, and when nominating a temporary substitute, if such substitute has taken out his diplomas subsequent to 1st May, 1906, a medical officer of health should be careful to ascertain that he is fully qualified, as otherwise difficulty might arise upon the temporary appointment being reported to the Department of Local Government and Public Health.

COURSE OF INSTRUCTION IN VACCINATION.

The course of instruction in vaccination given by the authorised teachers extends over a period of at least six weeks. Six attendances are required from each student, and four of the attendances must be given in consecutive weeks. Before a certificate of proficiency is granted the student must pass an examination in the subject of the lectures delivered by the teacher during the course of instruction, and must also show practical knowledge and skill in the performance of the operation of vaccination.

The programme of instructions is carried out under the following headings :—

1. The history of Jenner's discovery of vaccination with all particulars on the subject.

2. The enactments relating to vaccination.

3. Small-pox with special reference to the value of vaccination and re-vaccination in preventing or modifying the disease.

4. Statistics showing the importance of the vesication areas in vaccination.

5. Practical demonstration of the various stages of the vaccine vesicle.

6. Instructions on the methods of vaccinating and dressing the patients' arms after vaccination and on the eighth and subsequent days.

7. The methods of sterilizing the patients' arms. Instructions to pupils how to vaccinate and permitting them to perform operations under personal supervision.

8. Explanations of the different vaccination instruments and vaccine blowers, and methods of sterilizing them.

A fee of £1 1s. 0d. may be charged by an authorised teacher to each student for the course of instruction, examination, and certificate.