Whooping cough—a continuing problemBMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7353.1537 (Published 29 June 2002) Cite this as: BMJ 2002;324:1537
All rapid responses
Although the subtitle of the recent editorial on Whooping cough 1
referred to “countries with high vaccination rates and low mortality”, the
authors offered little practical advice to doctors in such countries, eg
the UK and Australia, as how to currently tackle this re-emerging
condition. It is precisely because these are developed countries that
affected parents or the community, as a whole does not readily accept even
a “low” mortality from infection.
England and Wales had achieved a vaccination uptake of over 80% in
1972, only to see this fall to about 30% in 1975 because of public anxiety
about the vaccine’s safety 2, (sparked by a member of our own profession,
as with the current scare about the safety of MMR vaccine).
It did not need a genius to have anticipated that in the UK one would
see a cohort of children many of whom were neither vaccinated nor
naturally infected with pertussis. This cohort is now of the age to become
/ have become young mothers and fathers.
There are now pertussis vaccines that are suitable for use in adults
3. Is it not unreasonable to consider including pertussis serology as
part of antenatal screening, and offer vaccination to susceptible
mothers,(and fathers)? They after all, will in the main be the chief
caregivers to their infants during their vulnerable “window period”,
between birth and protection after their vaccination course—with infection
at this age carrying the greatest risk of death or critical illness.
Of course other people might infect them, but at present one can only
re-emphasise the old message-“coughs and sneezes spread diseases”.
Medical interventions today require cost benefit analysis, and be
evidence based. It should be possible to conduct a randomised controlled
trial of this strategy between different hospital and primary health care
David S G Sloan
Central Public Health Unit Rockhampton,
PO Box 946, Rochampton,
1 Crowcroft N S, Britto J. Whooping cough-a continuing problem. BMJ
2002; 324: 1537-8.(29 June.)
2 Department of Health. Immunisation against Infectious Disease.
London. Her Majesty’s Stationary Office,1996.
3 Wirsing von Konig CH, Postels-Multani S, Block H L, Schimitt H J.
Pertussis in adults: frequency of transmission after household exposure.
(ps- the "o" of Konig has an umlaut.)
Competing interests: No competing interests