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The United States recorded 206,000 cases of diphtheria in 1921, resulting in 15,520 deaths (a case-fatality ratio of 7.5%). This was worst year for diphtheria in the United States in the 20th century.

William H. Park launched a massive program in New York City to Schick-test schoolchildren and immunize the unexposed children with diphtheria toxin-antitoxin mixture (TAT).

Park’s work was a public-health milestone: he needed not only the cooperation of scores of school administrators and school nurses, but he also had to seek the permission of parents to immunize their children with TAT. Park enlisted a total of 180,000 children in the campaign. Half were not tested for diphtheria immunity, and they were not given TAT. The other half were Schick-tested. If positive (meaning they had not been exposed to diphtheria), they were given two or three injections of TAT to immunize them.

In a period of five months, the 90,000 untested children developed four times as many cases of diphtheria as the tested-and-immunized children.

Park wanted to extend the benefits of Schick testing and TAT immunization to the younger siblings of schoolchildren, who were most at risk of contracting and dying from diphtheria. He used the school campaign to notify parents of immunization opportunities for babies. Mailing cards such as the one pictured were sent to 45,000 homes in New York City. Italian and Yiddish versions were produced as well.

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