Intended for healthcare professionals


Despite high rates of vaccination, pertussis cases are on the rise. Is a new vaccination strategy needed?

BMJ 2019; 366 doi: (Published 09 July 2019) Cite this as: BMJ 2019;366:l4460

The Benefits of DPT

Mara Kardas-Nelson [1] should also note that as result of DPT controversy and the UK Vaccine Damage Payment Act of 1979 there were 600 payments in the period 1978-81 (1978/9: 36, 1979/80: 317, 1980/1: 256) [2,3]. The rhetoric behind the legislation was that injuries were rare but this was not borne out by the record [2,3]. The act enabled the government to retrieve the reputation of the programme amid adverse publicity by acknowledging the principle of harm but no one knew how many awards there had actually been - and initially there were a lot. This would also not take account of any deaths.

According to Mogensen et al, the introduction of DPT to Guinea-Bissau in 1981 was associated with a 5 fold increase in the rate of death [4]:

"Among 3–5-month-old children, having received DTP (±OPV) was associated with a mortality hazard ratio (HR) of 5.00 (95% CI 1.53–16.3) compared with not-yet-DTP-vaccinated children. Differences in background factors did not explain the effect. The negative effect was particularly strong for children who had received DTP-only and no OPV (HR = 10.0 (2.61–38.6)). All-cause infant mortality after 3 months of age increased after the introduction of these vaccines (HR = 2.12 (1.07–4.19))."

[1] Kardas- Nelson, 'Despite high rates of vaccination, pertussis cases are on the rise. Is a new vaccination strategy needed?'
BMJ 2019; 366 doi: (Published 09 July 2019)

[2] Gareth Millward, 'A Disability Act? The Vaccine Damage Payments Act 1979 and the British Government’s Response to the Pertussis Vaccine Scare', Social History of Medicine, Volume 30, Issue 2, May 2017, Pages 429–447,

[3] 'Annex A - Vaccine Damage Payments claims received and award statistics',

[4] Mogensen et al, 'The Introduction of Diphtheria-Tetanus-Pertussis and Oral Polio Vaccine Among Young Infants in an Urban African Community: A Natural Experiment', Ebiomedicine March 2017,

Competing interests: No competing interests

10 July 2019
John Stone
UK Editor
London N22