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EDITORIALS: N S Crowcroft and Joseph Britto Whooping cougha continuing problem BMJ 2002; 324: 1537-1538 [Full text]

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Act now to prevent pertussis in young infants

David S Sloan   (1 July 2002)

Act now to prevent pertussis in young infants 1 July 2002
David S Sloan, Epidemiologist Central Public Health Unit Rockhampton, PO Box 946, Rockhampton, Queensland, 4700, Australia Send response to journal: Re: Act now to prevent pertussis in young infants	Sir, 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 trusts. David S G Sloan Epidemiologist Central Public Health Unit Rockhampton, PO Box 946, Rochampton, Queensland 4700, Australia 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. Lancet 1995; 346:1326-9. (ps- the "o" of Konig has an umlaut.)