Editorials

Whooping cough—a continuing problem

BMJ 2002; 324 doi: http://dx.doi.org/10.1136/bmj.324.7353.1537 (Published 29 June 2002) Cite this as: BMJ 2002;324:1537

Pertussis has re-emerged in countries with high vaccination coverage and low mortality

  1. N S Crowcroft (ncrowcro@phls.org.uk), consultant epidemiologist,
  2. Joseph Britto, honorary senior lecturer in paediatric intensive care
  1. Immunisation Division, Public Health Laboratory Service Communicable Disease Surveillance Centre, London NW9 5EQ
  2. Department of Paediatrics, Imperial College School of Medicine at St Mary's Hospital, London W2 1NY

    News media announced a global resurgence of whooping cough in April this year following a session on pertussis at the 12th European Congress of Clinical Microbiology and Infectious Diseases in Milan, Italy. Subsequently the European Union sent an alert to member states. Pertussis is one of the top causes of vaccine preventable deaths, with nearly 300 000 deaths in children worldwide in 2000.1 However, reports of a global resurgence originated in countries with low mortality and high vaccination coverage. For such countries the issue is how to fine tune effective immunisation programmes. In the rest of the world, priorities are to decrease infant mortality by improving coverage and timeliness of vaccination and implementing pertussis surveillance.2

    Pertussis has re-emerged in low mortality countries in the past because of low coverage after a vaccine scare in the 1980s (in the United Kingdom) or the use of vaccines with poor efficacy (Canada, Sweden).3 Sweden and Germany stopped their vaccination programmes completely and only reinstituted vaccination for pertussis after years of recurrent epidemics of whooping cough. More recently …

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