Practice Easily Missed?

Whooping cough

BMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.b1772 (Published 21 May 2009) Cite this as: BMJ 2009;338:b1772
  1. Anthony Harnden, university lecturer in general practice1
  1. 1Department of Primary Health Care, University of Oxford, Oxford OX3 7LF
  1. anthony.harnden{at}dphpc.ox.ac.uk

    Whooping cough is a common respiratory infection caused by the bacterium Bordetella pertussis. It should be considered as a possible diagnosis in any adolescent or adult with an acute cough of more than two weeks’ duration, even if they have been fully immunised.

    Case scenario

    A 17 year old girl presents with a three week history of cough. The cough keeps her awake at night and she has bouts of coughing that disturb her classmates. She is fully immunised. Her general practitioner requests serology for anti-pertussis toxin IgG antibodies, which are found to be raised, indicating a recent infection with Bordetella pertussis.

    Why is it missed?

    In the post-vaccination era, whooping cough is under-recognised in primary care as the incidence is incorrectly thought to be low. The classic clinical features of whooping cough, such as an inspiratory “whoop” (listen on bmj.com), may be attenuated in older children and adults who have been immunised.1 Moreover, many doctors may not be aware that there is a simple diagnostic serological test.

    How common is it?

    Whooping cough is a statutory notifiable disease in the United Kingdom, but notifications …

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