Increase in pertussis may be due to increased recognition and diagnosisBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e5463 (Published 21 August 2012) Cite this as: BMJ 2012;345:e5463
- Douglas Jenkinson, retired general practitioner1
I have meticulously studied all cases of whooping cough in my practice since 1977 and I have published many papers on the subject, mainly in the BMJ.
The increase in reported cases coincides with similar increases in the US and Australia.1 A large proportion of this increase is probably the result of better recognition and diagnosis. My data provide good evidence that it never went away. What went away was the ability of doctors to recognise it, and in the absence of a practicable diagnostic test, official figures fell.
Email feedback from people who have had whooping cough indicates that, in the past five years, doctors in the UK, US, and Australia have become more willing to consider the diagnosis in adults. This coincides with the wider availability of a practicable blood test.
I have noted a high incidence, including in teenagers and adults, for 20 years. For example, in 2002 my practice (11 000 patients) diagnosed 44 cases, 5% of all cases notified in England and Wales that year; 14 were confirmed by culture. A further eight were tested serologically and all were positive. Nineteen were aged 12 years or more.
The figure⇓ compares cases in my practice (Keyworth) with England and Wales. It shows a steady fall in notifications in England and Wales after 1982, which contrasts with the continued high rate in Keyworth.
Incidence may really be increasing, and I fully support any new immunisation strategies that will reduce the risks to infants, but I think the Health Protection Agency should be cautious when using its own possibly flawed data to support well intentioned policy changes.
Cite this as: BMJ 2012;345:e5463
Competing interests: DJ has a website that provides whooping cough information. He offers a fee paying advice service. The fees from this do not cover the expense of maintaining the site.