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Diphtheria mortality in England and Wales has declined only 60 per cent compared with 80 per cent in the United States. The significant decline in mortality under 5 years in ratio to that above 5 years among persons of the lower social grades in London is attributed to reduction in number of overcrowded areas and in size of families. There has occurred an age shift in the diphtheria mortality from preschool to school ages among the child population in London. This is due largely to the influence of the trend of the death rates in the lowest social group. Prior to 1940 little was done with active immunization. Since 1940 the government has distributed the immunizing agent to all local authorities, and good progress has been made. By the end of 1942, 46.5 per cent of the child population under 15 in England and Wales had been immunized. Statistical evidence
The Epidemiology of Diphtheria During the Last Forty Years. JAMA. 1944;124(8):541-542. doi:10.1001/jama.1944.02850080069035